HF 802

1st Committee Engrossment - 86th Legislature (2009 - 2010)

Posted on 03/19/2013 07:28 p.m.

1.1A bill for an act 1.2relating to human services; requiring mental health urgent care and psychiatric 1.3consultation; reducing certain hospital payment rates; changing medical 1.4assistance covered services; allowing intergovernmental transfers; creating a new 1.5general assistance medical care program; providing transitional MinnesotaCare 1.6coverage; requiring coordinated care delivery systems; creating a temporary 1.7uncompensated care pool and prescription drug pool; appropriating money; 1.8amending Minnesota Statutes 2008, sections 256.969, subdivision 27; 1.9256B.0625, subdivision 13f, by adding a subdivision; 256B.0644; 256L.05, 1.10subdivisions 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4; 256L.17, 1.11subdivision 7; 517.08, subdivision 1c; Minnesota Statutes 2009 Supplement, 1.12sections 256.969, subdivision 3a; 256B.0947, subdivision 1; 256B.196, 1.13subdivision 2; 256D.03, subdivision 3; proposing coding for new law in 1.14Minnesota Statutes, chapters 245; 256B; 256D; repealing Minnesota Statutes 1.152008, sections 256.742; 256.979, subdivision 8; 256B.195, subdivisions 4, 1.165; 256D.03, subdivision 9; 256L.05, subdivision 1b; 256L.07, subdivision 6; 1.17256L.15, subdivision 4; 256L.17, subdivision 7; Minnesota Statutes 2009 1.18Supplement, sections 256B.195, subdivisions 1, 2, 3; 256D.03, subdivision 4. 1.19BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.20ARTICLE 1 1.21GENERAL ASSISTANCE MEDICAL CARE 1.22    Section 1. new text begin [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC new text end 1.23 new text begin CONSULTATION. new text end 1.24     new text begin Subdivision 1. new text end new text begin Mental health urgent care and psychiatric consultation. new text end new text begin The new text end 1.25 new text begin commissioner shall include mental health urgent care and psychiatric consultation new text end 1.26 new text begin services as part of, but not limited to, the redesign of six community-based behavioral new text end 1.27 new text begin health hospitals and the Anoka-Metro Regional Treatment Center. These services must new text end 1.28 new text begin not duplicate existing services in the region, and must be implemented as specified in new text end 1.29 new text begin subdivisions 3 to 7. new text end 2.1     new text begin Subd. 2. new text end new text begin Definitions. new text end new text begin For purposes of this section: new text end 2.2 new text begin (1) mental health urgent care includes: new text end 2.3 new text begin (i) initial mental health screening; new text end 2.4 new text begin (ii) mobile crisis assessment and intervention; new text end 2.5 new text begin (iii) rapid access to psychiatry, including psychiatric evaluation, initial treatment, new text end 2.6 new text begin and short-term psychiatry; new text end 2.7 new text begin (iv) nonhospital crisis stabilization residential beds; and new text end 2.8 new text begin (v) health care navigator services which include, but are not limited to, assisting new text end 2.9 new text begin uninsured individuals in obtaining health care coverage; and new text end 2.10 new text begin (2) psychiatric consultation services includes psychiatric consultation to primary new text end 2.11 new text begin care practitioners. new text end 2.12     new text begin Subd. 3. new text end new text begin Rapid access to psychiatry. new text end new text begin The commissioner shall develop rapid access new text end 2.13 new text begin to psychiatric services based on the following criteria: new text end 2.14 new text begin (1) the individuals who receive the psychiatric services must be at risk of new text end 2.15 new text begin hospitalization and otherwise unable to receive timely services; new text end 2.16 new text begin (2) where clinically appropriate, the service may be provided via interactive video new text end 2.17 new text begin where the service is provided in conjunction with an emergency room, a local crisis new text end 2.18 new text begin service, or a primary care or behavioral care practitioner; and new text end 2.19 new text begin (3) the commissioner may integrate rapid access to psychiatry with the psychiatric new text end 2.20 new text begin consultation services in subdivision 4. new text end 2.21     new text begin Subd. 4. new text end new text begin Collaborative psychiatric consultation. new text end new text begin (a) The commissioner shall new text end 2.22 new text begin establish a collaborative psychiatric consultation service based on the following criteria: new text end 2.23 new text begin (1) the service may be available via telephone, interactive video, e-mail, or other new text end 2.24 new text begin means of communication to emergency rooms, local crisis services, mental health new text end 2.25 new text begin professionals, and primary care practitioners, including pediatricians; new text end 2.26 new text begin (2) the service shall be provided by a multidisciplinary team including, at a new text end 2.27 new text begin minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical new text end 2.28 new text begin social worker; new text end 2.29 new text begin (3) the service shall include a triage-level assessment to determine the most new text end 2.30 new text begin appropriate response to each request, including appropriate referrals to other mental health new text end 2.31 new text begin professionals, as well as provision of rapid psychiatric access when other appropriate new text end 2.32 new text begin services are not available; new text end 2.33 new text begin (4) the first priority for this service is to provide the consultations required under new text end 2.34 new text begin section 256B.0625, subdivision 13j; and new text end 2.35 new text begin (5) the service must encourage use of cognitive and behavioral therapies and other new text end 2.36 new text begin evidence-based treatments in addition to or in place of medication, where appropriate. new text end 3.1 new text begin (b) The commissioner shall appoint an interdisciplinary work group to establish new text end 3.2 new text begin appropriate medication and psychotherapy protocols to guide the consultative process, new text end 3.3 new text begin including consultation with the Drug Utilization Review Board, as provided in section new text end 3.4 new text begin 256B.0625, subdivision 13j. new text end 3.5     new text begin Subd. 5. new text end new text begin Phased availability. new text end new text begin (a) The commissioner may phase in the availability new text end 3.6 new text begin of mental health urgent care services based on the limits of appropriations and the new text end 3.7 new text begin commissioner's determination of level of need and cost-effectiveness. new text end 3.8 new text begin (b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin new text end 3.9 new text begin and Ramsey Counties and children statewide who are affected by section 256B.0625, new text end 3.10 new text begin subdivision 13j, and must include tracking of costs for the services provided and new text end 3.11 new text begin associated impacts on utilization of inpatient, emergency room, and other services. new text end 3.12     new text begin Subd. 6. new text end new text begin Limited appropriations. new text end new text begin The commissioner shall maximize use new text end 3.13 new text begin of available health care coverage for the services provided under this section. The new text end 3.14 new text begin commissioner's responsibility to provide these services for individuals without health care new text end 3.15 new text begin coverage must not exceed the appropriations for this section. new text end 3.16     new text begin Subd. 7. new text end new text begin Flexible implementation. new text end new text begin To implement this section, the commissioner new text end 3.17 new text begin shall select the structure and funding method that is the most cost-effective for each county new text end 3.18 new text begin or group of counties. This may include grants, contracts, direct provision by state-operated new text end 3.19 new text begin services, and public-private partnerships. Where feasible, the commissioner shall make new text end 3.20 new text begin any grants under this section a part of the integrated adult mental health initiative grants new text end 3.21 new text begin under section 245.4661. new text end 3.22    Sec. 2. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is 3.23amended to read: 3.24    Subd. 3a. Payments. (a) Acute care hospital billings under the medical 3.25assistance program must not be submitted until the recipient is discharged. However, 3.26the commissioner shall establish monthly interim payments for inpatient hospitals that 3.27have individual patient lengths of stay over 30 days regardless of diagnostic category. 3.28Except as provided in section 256.9693, medical assistance reimbursement for treatment 3.29of mental illness shall be reimbursed based on diagnostic classifications. Individual 3.30hospital payments established under this section and sections 256.9685, 256.9686, and 3.31256.9695 , in addition to third party and recipient liability, for discharges occurring during 3.32the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 3.33inpatient services paid for the same period of time to the hospital. This payment limitation 3.34shall be calculated separately for medical assistance and general assistance medical 3.35care services. The limitation on general assistance medical care shall be effective for 4.1admissions occurring on or after July 1, 1991. Services that have rates established under 4.2subdivision 11 or 12, must be limited separately from other services. After consulting with 4.3the affected hospitals, the commissioner may consider related hospitals one entity and 4.4may merge the payment rates while maintaining separate provider numbers. The operating 4.5and property base rates per admission or per day shall be derived from the best Medicare 4.6and claims data available when rates are established. The commissioner shall determine 4.7the best Medicare and claims data, taking into consideration variables of recency of the 4.8data, audit disposition, settlement status, and the ability to set rates in a timely manner. 4.9The commissioner shall notify hospitals of payment rates by December 1 of the year 4.10preceding the rate year. The rate setting data must reflect the admissions data used to 4.11establish relative values. Base year changes from 1981 to the base year established for the 4.12rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 4.13to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 4.141. The commissioner may adjust base year cost, relative value, and case mix index data 4.15to exclude the costs of services that have been discontinued by the October 1 of the year 4.16preceding the rate year or that are paid separately from inpatient services. Inpatient stays 4.17that encompass portions of two or more rate years shall have payments established based 4.18on payment rates in effect at the time of admission unless the date of admission preceded 4.19the rate year in effect by six months or more. In this case, operating payment rates for 4.20services rendered during the rate year in effect and established based on the date of 4.21admission 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 4.23payment, before third-party liability and spenddown, made to hospitals for inpatient 4.24services 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 4.26admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 4.27before third-party liability and spenddown, is reduced five percent from the current 4.28statutory rates. Mental health services within diagnosis related groups 424 to 432, and 4.29facilities 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 4.31fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 4.32inpatient services before third-party liability and spenddown, is reduced 6.0 percent 4.33from the current statutory rates. Mental health services within diagnosis related groups 4.34424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 4.35Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical 4.36assistance does not include general assistance medical care. Payments made to managed 5.1care plans shall be reduced for services provided on or after January 1, 2006, to reflect 5.2this reduction. 5.3    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 5.4fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 5.5to hospitals for inpatient services before third-party liability and spenddown, is reduced 5.63.46 percent from the current statutory rates. Mental health services with diagnosis related 5.7groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 5.8paragraph. Payments made to managed care plans shall be reduced for services provided 5.9on 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 5.11fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 new text begin 2011 new text end , 5.12made to hospitals for inpatient services before third-party liability and spenddown, is 5.13reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis 5.14related groups 424 to 432 and facilities defined under subdivision 16 are excluded from 5.15this paragraph. Payments made to managed care plans shall be reduced for services 5.16provided on or after July 1, 2009, through June 30, 2010 new text begin 2011 new text end , to reflect this reduction. 5.17    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 5.18for fee-for-service admissions occurring on or after July 1, 2010 new text begin 2011 new text end , made to hospitals 5.19for inpatient services before third-party liability and spenddown, is reduced 1.79 percent 5.20from the current statutory rates. Mental health services with diagnosis related groups 5.21424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 5.22Payments made to managed care plans shall be reduced for services provided on or after 5.23July 1, 2010 new text begin 2011 new text end , to reflect this reduction. 5.24(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 5.25payment for fee-for-service admissions occurring on or after July 1, 2009, made to 5.26hospitals for inpatient services before third-party liability and spenddown, is reduced 5.27one percent from the current statutory rates. Facilities defined under subdivision 16 are 5.28excluded from this paragraph. Payments made to managed care plans shall be reduced for 5.29services provided on or after October 1, 2009, to reflect this reduction. 5.30 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 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 5.33under this section, the commissioner shall make the following payments effective July 5.341, 2007: 6.1    (1) for a hospital located in Minnesota and not eligible for payments under 6.2subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8 6.3percent of total patient days as of the base year in effect on July 1, 2005, a payment 6.4equal to 13 percent of the total of the operating and property payment rates new text begin , except that new text end 6.5 new text begin Hennepin County Medical Center and Regions Hospital shall not receive a payment new text end 6.6 new text begin under this subdivision new text end ; 6.7    (2) for a hospital located in Minnesota in a specified urban area outside of the 6.8seven-county metropolitan area and not eligible for payments under subdivision 20, with 6.9a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total 6.10patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent 6.11of the total of the operating and property payment rates. For purposes of this clause, the 6.12following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria, 6.13Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, 6.14Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena; 6.15    (3) for a hospital located in Minnesota but not located in a specified urban area 6.16under clause (2), with a medical assistance inpatient utilization rate less than or equal to 6.1717.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment 6.18equal to four percent of the total of the operating and property payment rates. A hospital 6.19located in Woodbury and not in existence during the base year shall be reimbursed under 6.20this clause; and 6.21    (4) in addition to any payments under clauses (1) to (3), for a hospital located in 6.22Minnesota and not eligible for payments under subdivision 20 with a medical assistance 6.23inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect 6.24on July 1, 2005, a payment equal to eight percent of the total of the operating and property 6.25payment rates, and for a hospital located in Minnesota and not eligible for payments 6.26under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent 6.27of total patient days as of the base year in effect on July 1, 2005, a payment equal to 6.28nine percent of the total of the operating and property payment rates. After making any 6.29ratable adjustments required under paragraph (b), the commissioner shall proportionately 6.30reduce payments under clauses (2) and (3) by an amount needed to make payments under 6.31this clause. 6.32    (b) The state share of payments under paragraph (a) shall be equal to federal 6.33reimbursements to the commissioner to reimburse expenditures reported under section 6.34256B.199 new text begin , paragraphs (a) to (d) new text end . The commissioner shall ratably reduce or increase 6.35payments under this subdivision in order to ensure that these payments equal the amount 6.36of reimbursement received by the commissioner under section 256B.199 new text begin , paragraphs (a) new text end 7.1 new text begin to (d) new text end , except that payments shall be ratably reduced by an amount equivalent to the state 7.2share of a four percent reduction in MinnesotaCare and medical assistance payments 7.3for inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be 7.4equivalent to the state share of a three percent reduction in these payments. new text begin Effective for new text end 7.5 new text begin federal disproportionate share hospital funds earned on payments reported under section new text end 7.6 new text begin 256B.199, paragraphs (a) to (d), for services rendered on or after April 1, 2010, payments new text end 7.7 new text begin shall not be made under this subdivision. new text end 7.8    (c) The payments under paragraph (a) shall be paid quarterly based on each hospital's 7.9operating and property payments from the second previous quarter, beginning on July 7.1015, 2007, or upon federal approval of federal reimbursements under section 256B.199 new text begin , new text end 7.11 new text begin paragraphs (a) to (d) new text end , whichever occurs later. 7.12    (d) The commissioner shall not adjust rates paid to a prepaid health plan under 7.13contract with the commissioner to reflect payments provided in paragraph (a). 7.14    (e) The commissioner shall maximize the use of available federal money for 7.15disproportionate share hospital payments and shall maximize payments to qualifying 7.16hospitals. In order to accomplish these purposes, the commissioner may, in consultation 7.17with the nonstate entities identified in section 256B.199 new text begin , paragraphs (a) to (d) new text end , adjust, 7.18on a pro rata basis if feasible, the amounts reported by nonstate entities under section 7.19256B.199 new text begin , paragraphs (a) to (d), new text end when application for reimbursement is made to the federal 7.20government, and otherwise adjust the provisions of this subdivision. The commissioner 7.21shall utilize a settlement process based on finalized data to maximize revenue under 7.22section 256B.199 new text begin , paragraphs (a) to (d), new text end and payments under this section. 7.23    (f) For purposes of this subdivision, medical assistance does not include general 7.24assistance medical care. 7.25 new text begin EFFECTIVE DATE. new text end new text begin This section is effective for services rendered on or after new text end 7.26 new text begin April 1, 2010. new text end 7.27    Sec. 4. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to 7.28read: 7.29    Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and 7.30recommend drugs which require prior authorization. The Formulary Committee shall 7.31establish general criteria to be used for the prior authorization of brand-name drugs for 7.32which generically equivalent drugs are available, but the committee is not required to 7.33review each brand-name drug for which a generically equivalent drug is available. 7.34(b) Prior authorization may be required by the commissioner before certain 7.35formulary drugs are eligible for payment. The Formulary Committee may recommend 8.1drugs for prior authorization directly to the commissioner. The commissioner may also 8.2request that the Formulary Committee review a drug for prior authorization. Before the 8.3commissioner may require prior authorization for a drug: 8.4(1) the commissioner must provide information to the Formulary Committee on the 8.5impact that placing the drug on prior authorization may have on the quality of patient care 8.6and on program costs, information regarding whether the drug is subject to clinical abuse 8.7or misuse, and relevant data from the state Medicaid program if such data is available; 8.8(2) the Formulary Committee must review the drug, taking into account medical and 8.9clinical data and the information provided by the commissioner; and 8.10(3) the Formulary Committee must hold a public forum and receive public comment 8.11for an additional 15 days. 8.12The commissioner must provide a 15-day notice period before implementing the prior 8.13authorization. 8.14(c) new text begin Except as provided in subdivision 13j, new text end prior authorization shall not be required or 8.15utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if: 8.16(1) there is no generically equivalent drug available; and 8.17(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or 8.18(3) the drug is part of the recipient's current course of treatment. 8.19This paragraph applies to any multistate preferred drug list or supplemental drug rebate 8.20program established or administered by the commissioner. Prior authorization shall 8.21automatically be granted for 60 days for brand name drugs prescribed for treatment of 8.22mental illness within 60 days of when a generically equivalent drug becomes available, 8.23provided that the brand name drug was part of the recipient's course of treatment at the 8.24time the generically equivalent drug became available. 8.25(d) Prior authorization shall not be required or utilized for any antihemophilic factor 8.26drug prescribed for the treatment of hemophilia and blood disorders where there is no 8.27generically equivalent drug available if the prior authorization is used in conjunction with 8.28any supplemental drug rebate program or multistate preferred drug list established or 8.29administered by the commissioner. 8.30(e) The commissioner may require prior authorization for brand name drugs 8.31whenever a generically equivalent product is available, even if the prescriber specifically 8.32indicates "dispense as written-brand necessary" on the prescription as required by section 8.33151.21, subdivision 2 . 8.34(f) Notwithstanding this subdivision, the commissioner may automatically require 8.35prior authorization, for a period not to exceed 180 days, for any drug that is approved by 8.36the United States Food and Drug Administration on or after July 1, 2005. The 180-day 9.1period begins no later than the first day that a drug is available for shipment to pharmacies 9.2within the state. The Formulary Committee shall recommend to the commissioner general 9.3criteria to be used for the prior authorization of the drugs, but the committee is not 9.4required to review each individual drug. In order to continue prior authorizations for a 9.5drug after the 180-day period has expired, the commissioner must follow the provisions 9.6of this subdivision. 9.7 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 9.8    Sec. 5. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 9.9subdivision to read: 9.10     new text begin Subd. 13j. new text end new text begin Antipsychotic and attention deficit disorder and attention deficit new text end 9.11 new text begin hyperactivity disorder medications. new text end new text begin (a) The commissioner, in consultation with the new text end 9.12 new text begin Drug Utilization Review Board established in subdivision 13i and actively practicing new text end 9.13 new text begin pediatric mental health professionals, must: new text end 9.14 new text begin (1) identify recommended pediatric dose ranges for atypical antipsychotic drugs new text end 9.15 new text begin and drugs used for attention deficit disorder or attention deficit hyperactivity disorder new text end 9.16 new text begin based on available medical, clinical, and safety data and research. The commissioner new text end 9.17 new text begin shall periodically review the list of medications and pediatric dose ranges and update new text end 9.18 new text begin the medications and doses listed as needed after consultation with the Drug Utilization new text end 9.19 new text begin Review Board; new text end 9.20 new text begin (2) identify situations where a collaborative psychiatric consultation and prior new text end 9.21 new text begin authorization should be required before the initiation or continuation of drug therapy new text end 9.22 new text begin in pediatric patients including, but not limited to, high-dose regimens, off-label use of new text end 9.23 new text begin prescription medication, a patient's young age, and lack of coordination among multiple new text end 9.24 new text begin prescribing providers; and new text end 9.25 new text begin (3) track prescriptive practices and the use of psychotropic medications in children new text end 9.26 new text begin with the goal of reducing the use of medication, where appropriate. new text end 9.27 new text begin (b) Effective July 1, 2011, the commissioner shall require prior authorization and new text end 9.28 new text begin a collaborative psychiatric consultation before an atypical antipsychotic and attention new text end 9.29 new text begin deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria new text end 9.30 new text begin identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric new text end 9.31 new text begin consultation must be completed before the identified medications are eligible for payment new text end 9.32 new text begin unless: new text end 9.33 new text begin (1) the patient has already been stabilized on the medication regimen; or new text end 9.34 new text begin (2) the prescriber indicates that the child is in crisis. new text end 10.1 new text begin If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed new text end 10.2 new text begin within 90 days for payment to continue. new text end 10.3 new text begin (c) For purposes of this subdivision, a collaborative psychiatric consultation must new text end 10.4 new text begin meet the criteria described in section 245.4862, subdivision 4. new text end 10.5    Sec. 6. Minnesota Statutes 2008, section 256B.0644, is amended to read: 10.6256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE 10.7PROGRAMS. 10.8    (a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a 10.9health maintenance organization, as defined in chapter 62D, must participate as a provider 10.10or contractor in the medical assistance program, general assistance medical care program, 10.11and MinnesotaCare as a condition of participating as a provider in health insurance plans 10.12and programs or contractor for state employees established under section 43A.18, the 10.13public employees insurance program under section 43A.316, for health insurance plans 10.14offered to local statutory or home rule charter city, county, and school district employees, 10.15the workers' compensation system under section 176.135, and insurance plans provided 10.16through the Minnesota Comprehensive Health Association under sections 62E.01 to 10.1762E.19 . The limitations on insurance plans offered to local government employees shall 10.18not be applicable in geographic areas where provider participation is limited by managed 10.19care contracts with the Department of Human Services. 10.20    (b) For providers other than health maintenance organizations, participation in the 10.21medical assistance program means that: 10.22     (1) the provider accepts new medical assistance, general assistance medical care, 10.23and MinnesotaCare patients; 10.24    (2) for providers other than dental service providers, at least 20 percent of the 10.25provider's patients are covered by medical assistance, general assistance medical care, 10.26and 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 10.28covered by medical assistance, general assistance medical care, and MinnesotaCare as 10.29their primary source of coverage, or the provider accepts new medical assistance and 10.30MinnesotaCare patients who are children with special health care needs. For purposes 10.31of this section, "children with special health care needs" means children up to age 18 10.32who: (i) require health and related services beyond that required by children generally; 10.33and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional 10.34condition, including: bleeding and coagulation disorders; immunodeficiency disorders; 10.35cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other 11.1neurological diseases; visual impairment or deafness; Down syndrome and other genetic 11.2disorders; autism; fetal alcohol syndrome; and other conditions designated by the 11.3commissioner after consultation with representatives of pediatric dental providers and 11.4consumers. 11.5    (c) Patients seen on a volunteer basis by the provider at a location other than 11.6the provider's usual place of practice may be considered in meeting the participation 11.7requirement in this section. The commissioner shall establish participation requirements 11.8for health maintenance organizations. The commissioner shall provide lists of participating 11.9medical assistance providers on a quarterly basis to the commissioner of management and 11.10budget, the commissioner of labor and industry, and the commissioner of commerce. Each 11.11of the commissioners shall develop and implement procedures to exclude as participating 11.12providers in the program or programs under their jurisdiction those providers who do 11.13not participate in the medical assistance program. The commissioner of management 11.14and budget shall implement this section through contracts with participating health and 11.15dental carriers. 11.16 new text begin (d) Any hospital or other provider that is participating in a coordinated care new text end 11.17 new text begin delivery system under section 256D.031, subdivision 6, or receives payments from the new text end 11.18 new text begin uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to new text end 11.19 new text begin provide services to any patient enrolled in general assistance medical care regardless of new text end 11.20 new text begin the availability or the amount of payment. new text end 11.21    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0947, subdivision 1, 11.22is amended to read: 11.23    Subdivision 1. Scope. Effective November 1, 2010 new text begin 2011 new text end , and subject to federal 11.24approval, medical assistance covers medically necessary, intensive nonresidential 11.25rehabilitative mental health services as defined in subdivision 2, for recipients as defined 11.26in subdivision 3, when the services are provided by an entity meeting the standards 11.27in this section. 11.28    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, is 11.29amended to read: 11.30    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and 11.31subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 11.32services upper payment limit for nonstate government hospitals. The commissioner shall 11.33then determine the amount of a supplemental payment to Hennepin County Medical 11.34Center and Regions Hospital for these services that would increase medical assistance 12.1spending in this category to the aggregate upper payment limit for all nonstate government 12.2hospitals in Minnesota. In making this determination, the commissioner shall allot the 12.3available increases between Hennepin County Medical Center and Regions Hospital 12.4based on the ratio of medical assistance fee-for-service outpatient hospital payments to 12.5the two facilities. The commissioner shall adjust this allotment as necessary based on 12.6federal approvals, the amount of intergovernmental transfers received from Hennepin and 12.7Ramsey Counties, and other factors, in order to maximize the additional total payments. 12.8The commissioner shall inform Hennepin County and Ramsey County of the periodic 12.9intergovernmental transfers necessary to match federal Medicaid payments available 12.10under this subdivision in order to make supplementary medical assistance payments to 12.11Hennepin County Medical Center and Regions Hospital equal to an amount that when 12.12combined with existing medical assistance payments to nonstate governmental hospitals 12.13would increase total payments to hospitals in this category for outpatient services to 12.14the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 12.15receipt of these periodic transfers, the commissioner shall make supplementary payments 12.16to Hennepin County Medical Center and Regions Hospital. 12.17    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall 12.18determine an upper payment limit for physicians affiliated with Hennepin County Medical 12.19Center and with Regions Hospital. The upper payment limit shall be based on the average 12.20commercial rate or be determined using another method acceptable to the Centers for 12.21Medicare and Medicaid Services. The commissioner shall inform Hennepin County and 12.22Ramsey County of the periodic intergovernmental transfers necessary to match the federal 12.23Medicaid payments available under this subdivision in order to make supplementary 12.24payments to physicians affiliated with Hennepin County Medical Center and Regions 12.25Hospital equal to the difference between the established medical assistance payment for 12.26physician services and the upper payment limit. Upon receipt of these periodic transfers, 12.27the commissioner shall make supplementary payments to physicians of Hennepin Faculty 12.28Associates and HealthPartners. 12.29    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shall new text begin may new text end 12.30make monthly new text begin voluntary new text end intergovernmental transfers to the commissioner in the following 12.31amounts: $133,333 by new text begin not to exceed $12,000,000 per year from new text end Hennepin County 12.32and $100,000 by new text begin $6,000,000 per year from new text end Ramsey County. The commissioner shall 12.33increase the medical assistance capitation payments to Metropolitan Health Plan and 12.34HealthPartners by new text begin any licensed health plan under contract with the medical assistance new text end 12.35 new text begin program that agrees to make enhanced payments to Hennepin County Medical Center or new text end 12.36 new text begin Regions Hospital. The increase shall be in new text end an amount equal to the annual value of the 13.1monthly transfers plus federal financial participation. new text begin , with each health plan receiving its new text end 13.2 new text begin pro rata share of the increase based on the pro rata share of medical assistance admissions new text end 13.3 new text begin to Hennepin County Medical Center and Regions Hospital by those plans. Upon the new text end 13.4 new text begin request of the commissioner, health plans shall submit individual-level cost data for new text end 13.5 new text begin verification purposes. The commissioner may ratably reduce these payments on a pro rata new text end 13.6 new text begin basis in order to satisfy federal requirements for actuarial soundness. If payments are new text end 13.7 new text begin reduced, transfers shall be reduced accordingly. Any licensed health plan that receives new text end 13.8 new text begin increased medical assistance capitation payments under the intergovernmental transfer new text end 13.9 new text begin described in this paragraph shall increase its medical assistance payments to Hennepin new text end 13.10 new text begin County Medical Center and Regions Hospital by the same amount as the increased new text end 13.11 new text begin payments received in the capitation payment described in this paragraph. new text end 13.12    (d) The commissioner shall inform Hennepin County and Ramsey County on an 13.13ongoing basis of the need for any changes needed in the intergovernmental transfers 13.14in order to continue the payments under paragraphs (a) to (c), at their maximum level, 13.15including increases in upper payment limits, changes in the federal Medicaid match, and 13.16other factors. 13.17    (e) The payments in paragraphs (a) to (c) shall be implemented independently of 13.18each other, subject to federal approval and to the receipt of transfers under subdivision 3. 13.19 new text begin EFFECTIVE DATE. new text end new text begin This section is effective the day following final enactment. new text end 13.20    Sec. 9. new text begin [256B.197] INTERGOVERNMENTAL TRANSFERS; INPATIENT new text end 13.21 new text begin HOSPITAL PAYMENTS. new text end 13.22     new text begin Subdivision 1. new text end new text begin Federal approval required. new text end new text begin This section is effective for federal new text end 13.23 new text begin fiscal year 2010 and future years contingent on federal approval of the intergovernmental new text end 13.24 new text begin transfers and payments authorized under this section and contingent on payment of the new text end 13.25 new text begin intergovernmental transfers under this section. new text end 13.26     new text begin Subd. 2. new text end new text begin Eligible nonstate government hospitals. new text end new text begin (a) Hennepin County Medical new text end 13.27 new text begin Center and Regions Hospital are eligible nonstate government hospitals. new text end 13.28 new text begin (b) If the commissioner obtains federal approval to include other hospitals, including new text end 13.29 new text begin Fairview University Medical Center, the commissioner may expand the definition of new text end 13.30 new text begin eligible nonstate government hospitals to include other hospitals. new text end 13.31     new text begin Subd. 3. new text end new text begin Commissioner's duties. new text end new text begin (a) For the purposes of this subdivision, the new text end 13.32 new text begin commissioner shall determine the fee-for-service inpatient hospital services upper new text end 13.33 new text begin payment limit for nonstate government hospitals. The commissioner shall determine, new text end 13.34 new text begin for each eligible nonstate government hospital, the amount of a supplemental payment new text end 13.35 new text begin for inpatient hospital services that would increase medical assistance spending for each new text end 14.1 new text begin eligible nonstate government hospital up to the amount that Medicare would pay for new text end 14.2 new text begin the Medicaid fee-for-service inpatient hospital services provided by that hospital. If new text end 14.3 new text begin the combined amount of such supplemental payment amounts and existing medical new text end 14.4 new text begin assistance payments for inpatient hospital services to all nonstate government hospitals new text end 14.5 new text begin is less than the upper payment limit, the commissioner shall increase the supplemental new text end 14.6 new text begin payment amount for each eligible nonstate government hospital in proportion to the initial new text end 14.7 new text begin supplemental payments in order to maximize the additional total payments. new text end 14.8 new text begin (b) The commissioner shall inform each eligible nonstate government hospital and new text end 14.9 new text begin associated governmental entities of intergovernmental transfers necessary to provide new text end 14.10 new text begin the nonfederal share for the supplemental payment amount attributable to each eligible new text end 14.11 new text begin nonstate government hospital, as calculated under paragraph (a). new text end 14.12 new text begin (c) Upon receipt of an intergovernmental transfer from a governmental entity new text end 14.13 new text begin associated with an eligible nonstate government hospital or from the eligible nonstate new text end 14.14 new text begin government hospital, the commissioner shall make a supplemental payment, using the new text end 14.15 new text begin amounts calculated under paragraph (a), to the associated eligible nonstate government new text end 14.16 new text begin hospital. new text end 14.17 new text begin (d) The commissioner may implement the payments in this section through use of new text end 14.18 new text begin periodic payments and intergovernmental transfers. new text end 14.19 new text begin (e) The commissioner shall inform eligible nonstate government hospitals and new text end 14.20 new text begin associated governmental entities on an ongoing basis of the need for any changes needed new text end 14.21 new text begin in the payment amounts or intergovernmental transfers in order to continue the payments new text end 14.22 new text begin under paragraph (c) at their maximum level, including increases in upper payment limits, new text end 14.23 new text begin changes in the federal Medicaid match, and other factors. new text end 14.24 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 14.25    Sec. 10. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is 14.26amended to read: 14.27    Subd. 3. General assistance medical care; eligibility. (a) General assistance 14.28medical care may be paid for any person who is not eligible for medical assistance 14.29under chapter 256B, including eligibility for medical assistance based on a spenddown 14.30of excess income according to section 256B.056, subdivision 5, or MinnesotaCare for 14.31applicants and recipients defined in paragraph (c), except as provided in paragraph (d), 14.32and: new text begin Beginning April 1, 2010, the general assistance medical care program shall be new text end 14.33 new text begin administered according to section 256D.031, unless otherwise stated, except for outpatient new text end 14.34 new text begin prescription drug coverage which will continue to be administered under this section. new text end 15.1 new text begin (b) Drug coverage under general assistance medical care is limited to prescription new text end 15.2 new text begin drugs that: new text end 15.3 new text begin (1) are covered under the medical assistance program as described in section new text end 15.4 new text begin 256B.0625, subdivisions 13 and 13d; and new text end 15.5 new text begin (2) are provided by manufacturers that have fully executed general assistance new text end 15.6 new text begin medical care rebate agreements with the commissioner and comply with the agreements. new text end 15.7 new text begin Prescription drug coverage under general assistance medical care must conform to new text end 15.8 new text begin coverage under the medical assistance program according to section 256B.0625, new text end 15.9 new text begin subdivisions 13 to 13g. new text end 15.10    (1) who is receiving assistance under section , except for families with 15.11children who are eligible under Minnesota family investment program (MFIP), or who is 15.12having a payment made on the person's behalf under sections to ; or 15.13    (2) who is a resident of Minnesota; and 15.14    (i) who has gross countable income not in excess of 75 percent of the federal poverty 15.15guidelines for the family size, using a six-month budget period and whose equity in assets 15.16is not in excess of $1,000 per assistance unit. General assistance medical care is not 15.17available for applicants or enrollees who are otherwise eligible for medical assistance but 15.18fail to verify their assets. Enrollees who become eligible for medical assistance shall be 15.19terminated and transferred to medical assistance. Exempt assets, the reduction of excess 15.20assets, and the waiver of excess assets must conform to the medical assistance program in 15.21section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum 15.22amount of undistributed funds in a trust that could be distributed to or on behalf of the 15.23beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the 15.24terms of the trust, must be applied toward the asset maximum; or 15.25    (ii) who has gross countable income above 75 percent of the federal poverty 15.26guidelines but not in excess of 175 percent of the federal poverty guidelines for the family 15.27size, using a six-month budget period, whose equity in assets is not in excess of the limits 15.28in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization. 15.29    (b) The commissioner shall adjust the income standards under this section each July 15.301 by the annual update of the federal poverty guidelines following publication by the 15.31United States Department of Health and Human Services. 15.32    (c) Effective for applications and renewals processed on or after September 1, 2006, 15.33general assistance medical care may not be paid for applicants or recipients who are adults 15.34with dependent children under 21 whose gross family income is equal to or less than 275 15.35percent of the federal poverty guidelines who are not described in paragraph (f). 16.1    (d) Effective for applications and renewals processed on or after September 1, 2006, 16.2general assistance medical care may be paid for applicants and recipients who meet all 16.3eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period 16.4beginning the date of application. Immediately following approval of general assistance 16.5medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04, 16.6subdivision 7 , with covered services as provided in section for the rest of the 16.7six-month general assistance medical care eligibility period, until their six-month renewal. 16.8    (e) To be eligible for general assistance medical care following enrollment in 16.9MinnesotaCare as required by paragraph (d), an individual must complete a new 16.10application. 16.11    (f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are 16.12exempt from the MinnesotaCare enrollment requirements in this subdivision if they: 16.13    (1) have applied for and are awaiting a determination of blindness or disability by 16.14the state medical review team or a determination of eligibility for Supplemental Security 16.15Income or Social Security Disability Insurance by the Social Security Administration; 16.16    (2) fail to meet the requirements of section 256L.09, subdivision 2; 16.17    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.; 16.18    (4) are classified as end-stage renal disease beneficiaries in the Medicare program; 16.19    (5) are enrolled in private health care coverage as defined in section , 16.20subdivision 9; 16.21    (6) are eligible under paragraph (k); 16.22    (7) receive treatment funded pursuant to section ; or 16.23    (8) reside in the Minnesota sex offender program defined in chapter 246B. 16.24    (g) For applications received on or after October 1, 2003, eligibility may begin no 16.25earlier than the date of application. For individuals eligible under paragraph (a), clause 16.26(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are 16.27eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but 16.28may reapply if there is a subsequent period of inpatient hospitalization. 16.29    (h) Beginning September 1, 2006, Minnesota health care program applications and 16.30renewals completed by recipients and applicants who are persons described in paragraph 16.31(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility 16.32by the county agency. If all other eligibility requirements of this subdivision are met, 16.33eligibility for general assistance medical care shall be available in any month during which 16.34MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare, 16.35notice of termination for eligibility for general assistance medical care shall be sent to 16.36an applicant or recipient. If all other eligibility requirements of this subdivision are 17.1met, eligibility for general assistance medical care shall be available until enrollment in 17.2MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g). 17.3    (i) The date of an initial Minnesota health care program application necessary to 17.4begin a determination of eligibility shall be the date the applicant has provided a name, 17.5address, and Social Security number, signed and dated, to the county agency or the 17.6Department of Human Services. If the applicant is unable to provide a name, address, 17.7Social Security number, and signature when health care is delivered due to a medical 17.8condition or disability, a health care provider may act on an applicant's behalf to establish 17.9the date of an initial Minnesota health care program application by providing the county 17.10agency or Department of Human Services with provider identification and a temporary 17.11unique identifier for the applicant. The applicant must complete the remainder of the 17.12application and provide necessary verification before eligibility can be determined. The 17.13applicant must complete the application within the time periods required under the 17.14medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart 17.155, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining 17.16verification if necessary. 17.17    (j) County agencies are authorized to use all automated databases containing 17.18information regarding recipients' or applicants' income in order to determine eligibility for 17.19general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 17.20in order to determine eligibility and premium payments by the county agency. 17.21    (k) General assistance medical care is not available for a person in a correctional 17.22facility unless the person is detained by law for less than one year in a county correctional 17.23or detention facility as a person accused or convicted of a crime, or admitted as an 17.24inpatient to a hospital on a criminal hold order, and the person is a recipient of general 17.25assistance medical care at the time the person is detained by law or admitted on a criminal 17.26hold order and as long as the person continues to meet other eligibility requirements 17.27of this subdivision. 17.28    (l) General assistance medical care is not available for applicants or recipients who 17.29do not cooperate with the county agency to meet the requirements of medical assistance. 17.30    (m) In determining the amount of assets of an individual eligible under paragraph 17.31(a), clause (2), item (i), there shall be included any asset or interest in an asset, including 17.32an asset excluded under paragraph (a), that was given away, sold, or disposed of for 17.33less than fair market value within the 60 months preceding application for general 17.34assistance medical care or during the period of eligibility. Any transfer described in this 17.35paragraph shall be presumed to have been for the purpose of establishing eligibility for 17.36general assistance medical care, unless the individual furnishes convincing evidence to 18.1establish that the transaction was exclusively for another purpose. For purposes of this 18.2paragraph, the value of the asset or interest shall be the fair market value at the time it 18.3was given away, sold, or disposed of, less the amount of compensation received. For any 18.4uncompensated transfer, the number of months of ineligibility, including partial months, 18.5shall be calculated by dividing the uncompensated transfer amount by the average monthly 18.6per person payment made by the medical assistance program to skilled nursing facilities 18.7for the previous calendar year. The individual shall remain ineligible until this fixed period 18.8has expired. The period of ineligibility may exceed 30 months, and a reapplication for 18.9benefits after 30 months from the date of the transfer shall not result in eligibility unless 18.10and until the period of ineligibility has expired. The period of ineligibility begins in the 18.11month the transfer was reported to the county agency, or if the transfer was not reported, 18.12the month in which the county agency discovered the transfer, whichever comes first. For 18.13applicants, the period of ineligibility begins on the date of the first approved application. 18.14    (n) When determining eligibility for any state benefits under this subdivision, 18.15the income and resources of all noncitizens shall be deemed to include their sponsor's 18.16income and resources as defined in the Personal Responsibility and Work Opportunity 18.17Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 18.18subsequently set out in federal rules. 18.19    (o) Undocumented noncitizens and nonimmigrants are ineligible for general 18.20assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 18.21in one or more of the classes listed in United States Code, title 8, section 1101, subsection 18.22(a), paragraph (15), and an undocumented noncitizen is an individual who resides in 18.23the United States without the approval or acquiescence of the United States Citizenship 18.24and Immigration Services. 18.25    (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for 18.26medical assistance due to the deeming of a sponsor's income and resources, is ineligible 18.27for general assistance medical care. 18.28    (q) Effective July 1, 2003, general assistance medical care emergency services end. 18.29 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 18.30    Sec. 11. new text begin [256D.031] GENERAL ASSISTANCE MEDICAL CARE. new text end 18.31     new text begin Subdivision 1. new text end new text begin Eligibility. new text end new text begin (a) Except as provided under subdivision 2, general new text end 18.32 new text begin assistance medical care may be paid for any individual who is not eligible for medical new text end 18.33 new text begin assistance under chapter 256B, including eligibility for medical assistance based on a new text end 18.34 new text begin spenddown of excess income according to section 256B.056, subdivision 5, and who: new text end 19.1 new text begin (1) is receiving assistance under section 256D.05, except for families with children new text end 19.2 new text begin who are eligible under the Minnesota family investment program (MFIP), or who is new text end 19.3 new text begin having a payment made on the person's behalf under sections 256I.01 to 256I.06; or new text end 19.4 new text begin (2) is a resident of Minnesota and has gross countable income not in excess of 75 new text end 19.5 new text begin percent of federal poverty guidelines for the family size, using a six-month budget period, new text end 19.6 new text begin and whose equity in assets is not in excess of $1,000 per assistance unit. new text end 19.7 new text begin Exempt assets, the reduction of excess assets, and the waiver of excess assets must new text end 19.8 new text begin conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d, new text end 19.9 new text begin except that the maximum amount of undistributed funds in a trust that could be distributed new text end 19.10 new text begin to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's new text end 19.11 new text begin discretion under the terms of the trust, must be applied toward the asset maximum. new text end 19.12 new text begin (b) The commissioner shall adjust the income standards under this section each July new text end 19.13 new text begin 1 by the annual update of the federal poverty guidelines following publication by the new text end 19.14 new text begin United States Department of Health and Human Services. new text end 19.15     new text begin Subd. 2. new text end new text begin Ineligible groups. new text end new text begin (a) General assistance medical care may not be paid for new text end 19.16 new text begin an applicant or a recipient who: new text end 19.17 new text begin (1) is otherwise eligible for medical assistance but fails to verify their assets; new text end 19.18 new text begin (2) is an adult in a family with children as defined in section 256L.01, subdivision 3a; new text end 19.19 new text begin (3) is enrolled in private health coverage as defined in section 256B.02, subdivision new text end 19.20 new text begin 9; new text end 19.21 new text begin (4) is in a correctional facility, including an individual in a county correctional or new text end 19.22 new text begin detention facility as an individual accused or convicted of a crime, or admitted as an new text end 19.23 new text begin inpatient to a hospital on a criminal hold order; new text end 19.24 new text begin (5) resides in the Minnesota sex offender program defined in chapter 246B; new text end 19.25 new text begin (6) does not cooperate with the county agency to meet the requirements of medical new text end 19.26 new text begin assistance; or new text end 19.27 new text begin (7) does not cooperate with a county or state agency or the state medical review team new text end 19.28 new text begin in determining a disability or for determining eligibility for Supplemental Security Income new text end 19.29 new text begin or Social Security Disability Insurance by the Social Security Administration. new text end 19.30 new text begin (b) Undocumented noncitizens and nonimmigrants are ineligible for general new text end 19.31 new text begin assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual new text end 19.32 new text begin in one or more of the classes listed in United States Code, title 8, section 1101, subsection new text end 19.33 new text begin (a), paragraph (15), and an undocumented noncitizen is an individual who resides in the new text end 19.34 new text begin United States without approval or acquiescence of the United States Citizenship and new text end 19.35 new text begin Immigration Services. new text end 20.1 new text begin (c) Notwithstanding any other provision of law, a noncitizen who is ineligible for new text end 20.2 new text begin medical assistance due to the deeming of a sponsor's income and resources is ineligible for new text end 20.3 new text begin general assistance medical care. new text end 20.4 new text begin (d) General assistance medical care recipients who become eligible for medical new text end 20.5 new text begin assistance shall be terminated from general assistance medical care and transferred to new text end 20.6 new text begin medical assistance. new text end 20.7     new text begin Subd. 2a. new text end new text begin Transitional MinnesotaCare. new text end new text begin (a) Except as provided in paragraph (c), new text end 20.8 new text begin effective for applications received on or after April 1, 2010, and before June 1, 2010, all new text end 20.9 new text begin applicants who meet the eligibility requirements in subdivision 1, paragraph (a), clause new text end 20.10 new text begin (2), and who are not described in subdivision 2 shall be enrolled in MinnesotaCare under new text end 20.11 new text begin section 256L.04, subdivision 7, immediately following approval for general assistance new text end 20.12 new text begin medical care. new text end 20.13 new text begin (b) If all other eligibility requirements of this subdivision are met, general assistance new text end 20.14 new text begin medical care may be paid for individuals identified in paragraph (a) for a temporary period new text end 20.15 new text begin beginning the date of application in accordance with subdivision 4. Notwithstanding new text end 20.16 new text begin subdivision 7, paragraph (c), eligibility for general assistance medical care shall continue new text end 20.17 new text begin until enrollment in MinnesotaCare is completed. Upon notification of eligibility for new text end 20.18 new text begin MinnesotaCare, notice of termination for eligibility for general assistance medical care new text end 20.19 new text begin shall be sent to the applicant. Once enrolled in MinnesotaCare, the MinnesotaCare-covered new text end 20.20 new text begin services as described in section 256L.03 shall apply for the remainder of the six-month new text end 20.21 new text begin general assistance medical care eligibility period until their six-month renewal. new text end 20.22 new text begin (c) This subdivision does not apply if the applicant: new text end 20.23 new text begin (1) has applied for and is awaiting a determination of blindness or disability by the new text end 20.24 new text begin state medical review team or a determination of eligibility for Supplemental Security new text end 20.25 new text begin Income or Social Security Disability Insurance by the Social Security Administration; new text end 20.26 new text begin (2) is homeless as defined by United States Code, title 42, section 11301, et seq.; new text end 20.27 new text begin (3) is classified as an end-stage renal disease beneficiary in the Medicare program; new text end 20.28 new text begin (4) receives treatment funded in section 254B.02; or new text end 20.29 new text begin (5) fails to meet the requirements of section 256L.09, subdivision 2. new text end 20.30 new text begin Applicants and recipients who meet any one of these criteria shall remain eligible for new text end 20.31 new text begin general assistance medical care and are not eligible to enroll in MinnesotaCare until new text end 20.32 new text begin the next renewal period. new text end 20.33 new text begin (d) To be eligible for general assistance medical care following enrollment new text end 20.34 new text begin in MinnesotaCare as required in paragraph (a), an individual must complete a new new text end 20.35 new text begin application. new text end 21.1 new text begin (e) This subdivision expires June 1, 2010. For any applicant or recipient who meets new text end 21.2 new text begin the requirements of this subdivision before June 1, 2010, the commissioner shall continue new text end 21.3 new text begin the process of enrolling the individual in MinnesotaCare and, upon the completion of new text end 21.4 new text begin enrollment, the individual shall receive services under MinnesotaCare in accordance new text end 21.5 new text begin with paragraph (b). new text end 21.6     new text begin Subd. 3. new text end new text begin Eligibility and enrollment procedures. new text end new text begin (a) Eligibility for general new text end 21.7 new text begin assistance medical care shall begin no earlier than the date of application. The date of new text end 21.8 new text begin application shall be the date the applicant has provided a name, address, and Social new text end 21.9 new text begin Security number, signed and dated, to the county agency or the Department of Human new text end 21.10 new text begin Services. If the applicant is unable to provide a name, address, Social Security number, new text end 21.11 new text begin and signature when health care is delivered due to a medical condition or disability, a new text end 21.12 new text begin health care provider may act on an applicant's behalf to establish the date of an application new text end 21.13 new text begin by providing the county agency or Department of Human Services with provider new text end 21.14 new text begin identification and a temporary unique identifier for the applicant. The applicant must new text end 21.15 new text begin complete the remainder of the application and provide necessary verification before new text end 21.16 new text begin eligibility can be determined. The applicant must complete the application within the time new text end 21.17 new text begin periods required under the medical assistance program as specified in Minnesota Rules, new text end 21.18 new text begin parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the new text end 21.19 new text begin applicant in obtaining verification if necessary. new text end 21.20     new text begin (b) County agencies are authorized to use all automated databases containing new text end 21.21 new text begin information regarding recipients' or applicants' income in order to determine eligibility for new text end 21.22 new text begin general assistance medical care or MinnesotaCare. Such use shall be considered sufficient new text end 21.23 new text begin in order to determine eligibility and premium payments by the county agency. new text end 21.24     new text begin (c) In determining the amount of assets of an individual eligible under subdivision 1, new text end 21.25 new text begin paragraph (a), clause (2), there shall be included any asset or interest in an asset, including new text end 21.26 new text begin an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or new text end 21.27 new text begin disposed of for less than fair market value within the 60 months preceding application for new text end 21.28 new text begin general assistance medical care or during the period of eligibility. Any transfer described new text end 21.29 new text begin in this paragraph shall be presumed to have been for the purpose of establishing eligibility new text end 21.30 new text begin for general assistance medical care, unless the individual furnishes convincing evidence to new text end 21.31 new text begin establish that the transaction was exclusively for another purpose. For purposes of this new text end 21.32 new text begin paragraph, the value of the asset or interest shall be the fair market value at the time it new text end 21.33 new text begin was given away, sold, or disposed of, less the amount of compensation received. For any new text end 21.34 new text begin uncompensated transfer, the number of months of ineligibility, including partial months, new text end 21.35 new text begin shall be calculated by dividing the uncompensated transfer amount by the average monthly new text end 21.36 new text begin per person payment made by the medical assistance program to skilled nursing facilities new text end 22.1 new text begin for the previous calendar year. The individual shall remain ineligible until this fixed period new text end 22.2 new text begin has expired. The period of ineligibility may exceed 30 months, and a reapplication for new text end 22.3 new text begin benefits after 30 months from the date of the transfer shall not result in eligibility unless new text end 22.4 new text begin and until the period of ineligibility has expired. The period of ineligibility begins in the new text end 22.5 new text begin month the transfer was reported to the county agency, or if the transfer was not reported, new text end 22.6 new text begin the month in which the county agency discovered the transfer, whichever comes first. For new text end 22.7 new text begin applicants, the period of ineligibility begins on the date of the first approved application. new text end 22.8     new text begin (d) When determining eligibility for any state benefits under this subdivision, new text end 22.9 new text begin the income and resources of all noncitizens shall be deemed to include their sponsor's new text end 22.10 new text begin income and resources as defined in the Personal Responsibility and Work Opportunity new text end 22.11 new text begin Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and new text end 22.12 new text begin subsequently set out in federal rules. new text end 22.13 new text begin (e) Applicants and recipients are eligible for general assistance medical care for a new text end 22.14 new text begin six-month eligibility period. Eligibility may be renewed for additional six-month periods. new text end 22.15 new text begin During each six-month eligibility period, individuals are not eligible for MinnesotaCare. new text end 22.16     new text begin Subd. 4. new text end new text begin General assistance medical care; services. new text end new text begin (a) Within the limitations new text end 22.17 new text begin described in this section, general assistance medical care covers medically necessary new text end 22.18 new text begin services that include: new text end 22.19 new text begin (1) inpatient hospital services; new text end 22.20     new text begin (2) outpatient hospital services; new text end 22.21     new text begin (3) services provided by Medicare-certified rehabilitation agencies; new text end 22.22     new text begin (4) prescription drugs; new text end 22.23     new text begin (5) equipment necessary to administer insulin and diagnostic supplies and equipment new text end 22.24 new text begin for diabetics to monitor blood sugar level; new text end 22.25     new text begin (6) eyeglasses and eye examinations; new text end 22.26     new text begin (7) hearing aids; new text end 22.27     new text begin (8) prosthetic devices, if not covered by veteran's benefits; new text end 22.28     new text begin (9) laboratory and x-ray services; new text end 22.29     new text begin (10) physicians' services; new text end 22.30     new text begin (11) medical transportation except special transportation; new text end 22.31     new text begin (12) chiropractic services as covered under the medical assistance program; new text end 22.32     new text begin (13) podiatric services; new text end 22.33     new text begin (14) dental services; new text end 22.34     new text begin (15) mental health services covered under chapter 256B; new text end 22.35     new text begin (16) services performed by a certified pediatric nurse practitioner, a certified family new text end 22.36 new text begin nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological new text end 23.1 new text begin nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse new text end 23.2 new text begin practitioner in independent practice, if (1) the service is otherwise covered under this new text end 23.3 new text begin chapter as a physician service, (2) the service provided on an inpatient basis is not included new text end 23.4 new text begin as part of the cost for inpatient services included in the operating payment rate, and (3) the new text end 23.5 new text begin service is within the scope of practice of the nurse practitioner's license as a registered new text end 23.6 new text begin nurse, as defined in section new text end new text begin ; new text end 23.7     new text begin (17) services of a certified public health nurse or a registered nurse practicing in new text end 23.8 new text begin a public health nursing clinic that is a department of, or that operates under the direct new text end 23.9 new text begin authority of, a unit of government, if the service is within the scope of practice of the new text end 23.10 new text begin public health nurse's license as a registered nurse, as defined in section new text end new text begin ; new text end 23.11     new text begin (18) telemedicine consultations, to the extent they are covered under section new text end 23.12 new text begin 256B.0625, subdivision 3b new text end new text begin ; new text end 23.13     new text begin (19) care coordination and patient education services provided by a community new text end 23.14 new text begin health worker according to section new text end new text begin 256B.0625, subdivision 49 new text end new text begin ; and new text end 23.15 new text begin (20) regardless of the number of employees that an enrolled health care provider new text end 23.16 new text begin may have, sign language interpreter services when provided by an enrolled health care new text end 23.17 new text begin provider during the course of providing a direct, person-to-person-covered health care new text end 23.18 new text begin service to an enrolled recipient who has a hearing loss and uses interpreting services. new text end 23.19 new text begin (b) Sex reassignment surgery is not covered under this section. new text end 23.20 new text begin (c) Drug coverage is covered in accordance with section 256D.03, subdivision 3, new text end 23.21 new text begin paragraph (b). new text end 23.22 new text begin (d) The following co-payments shall apply for services provided: new text end 23.23 new text begin (1) $25 for nonemergency visits to a hospital-based emergency room; and new text end 23.24 new text begin (2) $3 per brand-name drug prescription, subject to a $7 per month maximum for new text end 23.25 new text begin prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when new text end 23.26 new text begin used for the treatment of mental illness. new text end 23.27 new text begin (e) Co-payments shall be limited to one per day per provider for nonemergency new text end 23.28 new text begin visits to a hospital-based emergency room. Recipients of general assistance medical care new text end 23.29 new text begin are responsible for all co-payments in this subdivision. Reimbursement for prescription new text end 23.30 new text begin drugs shall be reduced by the amount of the co-payment until the recipient has reached the new text end 23.31 new text begin $7 per month maximum for prescription drug co-payments. The provider shall collect new text end 23.32 new text begin the co-payment from the recipient. Providers may not deny services to recipients who new text end 23.33 new text begin are unable to pay the co-payment. new text end 23.34 new text begin (f) Chemical dependency services that are reimbursed under chapter 254B shall not new text end 23.35 new text begin be reimbursed under general assistance medical care. new text end 24.1 new text begin (g) Inpatient hospital services that are provided in community behavioral health new text end 24.2 new text begin hospitals operated by state-operated services shall not be reimbursed under general new text end 24.3 new text begin assistance medical care. new text end 24.4     new text begin Subd. 5. new text end new text begin Payment rates and contract modification; April 1, 2010, to May 31, new text end 24.5 new text begin 2010. new text end new text begin (a) For the period April 1, 2010, to May 31, 2010, general assistance medical new text end 24.6 new text begin care shall be paid on a fee-for-service basis. Fee-for-service payment rates for services new text end 24.7 new text begin other than outpatient prescription drugs shall be set at 37 percent of the payment rate in new text end 24.8 new text begin effect on March 31, 2010. new text end 24.9 new text begin (b) Outpatient prescription drug coverage provided during the period April 1, 2010, new text end 24.10 new text begin to May 31, 2010, shall be paid on a fee-for-service basis according to section 256B.0625, new text end 24.11 new text begin subdivision 13e. new text end 24.12     new text begin Subd. 6. new text end new text begin Coordinated care delivery systems. new text end new text begin (a) Effective June 1, 2010, the new text end 24.13 new text begin commissioner shall contract with hospitals or groups of hospitals that qualify under new text end 24.14 new text begin paragraph (b) and agree to deliver services according to this subdivision. Contracting new text end 24.15 new text begin hospitals shall develop and implement a coordinated care delivery system to provide new text end 24.16 new text begin health care services to individuals who are eligible for general assistance medical care new text end 24.17 new text begin under this section and who either choose to receive services through the coordinated new text end 24.18 new text begin care delivery system or who are enrolled by the commissioner under paragraph (c). The new text end 24.19 new text begin health care services provided by the system must include: (1) the services described in new text end 24.20 new text begin subdivision 4 with the exception of outpatient prescription drug coverage but shall include new text end 24.21 new text begin drugs administered in an outpatient setting; or (2) a set of comprehensive and medically new text end 24.22 new text begin necessary health services that the recipients might reasonably require to be maintained in new text end 24.23 new text begin good health and that has been approved by the commissioner, including as a minimum, new text end 24.24 new text begin but not limited to, emergency care, emergency ground ambulance transportation services, new text end 24.25 new text begin inpatient hospital and physician care, outpatient health services, preventive health services, new text end 24.26 new text begin mental health services, and drugs administered in an outpatient setting. Outpatient new text end 24.27 new text begin prescription drug coverage is covered on a fee-for-service basis in accordance with new text end 24.28 new text begin subdivisions 7 and 9. A hospital establishing a coordinated care delivery system under this new text end 24.29 new text begin subdivision must ensure that the requirements of this subdivision are met. new text end 24.30 new text begin (b) A hospital or group of hospitals may contract with the commissioner to develop new text end 24.31 new text begin and implement a coordinated care delivery system as follows: new text end 24.32 new text begin (1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during new text end 24.33 new text begin calendar year 2007, it received fee-for-service payments for services to general assistance new text end 24.34 new text begin medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater new text end 24.35 new text begin than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to new text end 25.1 new text begin provide geographic access or to ensure that at least 80 percent of enrollees have access to new text end 25.2 new text begin a coordinated care delivery system; and new text end 25.3 new text begin (2) effective December 1, 2010, a Minnesota hospital not qualified under clause new text end 25.4 new text begin (1) may contract with the commissioner under this subdivision if it agrees to satisfy the new text end 25.5 new text begin requirements of this subdivision. new text end 25.6 new text begin Participation by hospitals shall become effective quarterly on June 1, September 1, new text end 25.7 new text begin December 1, or March 1. Hospital participation is effective for a period of 12 months and new text end 25.8 new text begin may be renewed for successive 12-month periods. new text end 25.9 new text begin (c) Applicants and recipients may enroll in any available coordinated care delivery new text end 25.10 new text begin system. If more than one coordinated care delivery system is available, the applicant or new text end 25.11 new text begin recipient shall be allowed to choose among the systems. The commissioner may assign new text end 25.12 new text begin an applicant or recipient to a coordinated care delivery system if no choice is made by new text end 25.13 new text begin the applicant or recipient. Upon enrollment into a coordinated care delivery system, the new text end 25.14 new text begin enrollee must agree to receive all nonemergency services through the coordinated care new text end 25.15 new text begin delivery system. Enrollment in a coordinated care delivery system is for six months new text end 25.16 new text begin and may be renewed for additional six-month periods, except that initial enrollment is new text end 25.17 new text begin for six months or until the end of a recipient's period of general assistance medical care new text end 25.18 new text begin eligibility, whichever occurs first. An individual is not eligible to enroll in MinnesotaCare new text end 25.19 new text begin during a period of enrollment in a coordinated care delivery system. From June 1, 2010, to new text end 25.20 new text begin November 30, 2010, applicants and enrollees not enrolled in a coordinated care delivery new text end 25.21 new text begin system may seek services from a hospital eligible for reimbursement under the temporary new text end 25.22 new text begin uncompensated care pool established under subdivision 8. After November 30, 2010, new text end 25.23 new text begin services are available only through a coordinated care delivery system. new text end 25.24 new text begin (d) The hospital may contract and coordinate with providers and clinics for the new text end 25.25 new text begin delivery of services and shall contract with essential community providers as defined new text end 25.26 new text begin under section 62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the extent new text end 25.27 new text begin practicable. If a provider or clinic contracts with a hospital to provide services through the new text end 25.28 new text begin coordinated care delivery system, the provider may not refuse to provide services to any new text end 25.29 new text begin of the system's enrollees, and payment for services shall be negotiated with the hospital new text end 25.30 new text begin and paid by the hospital from the system's allocation under subdivision 7. new text end 25.31 new text begin (e) A coordinated care delivery system must: new text end 25.32 new text begin (1) provide the covered services required under paragraph (a) to recipients enrolled new text end 25.33 new text begin in the coordinated care delivery system, and comply with the requirements of subdivision new text end 25.34 new text begin 4, paragraphs (b) to (g); new text end 25.35 new text begin (2) establish a process to monitor enrollment and ensure the quality of care provided; new text end 26.1 new text begin (3) in cooperation with counties, coordinate the delivery of health care services with new text end 26.2 new text begin existing homeless prevention, supportive housing, and rent subsidy programs and funding new text end 26.3 new text begin administered by the Minnesota Housing Finance Agency under chapter 462A; and new text end 26.4 new text begin (4) adopt innovative and cost-effective methods of care delivery and coordination, new text end 26.5 new text begin which may include the use of allied health professionals, telemedicine, patient educators, new text end 26.6 new text begin care coordinators, and community health workers. new text end 26.7 new text begin (f) The hospital may require an enrollee to designate a primary care provider or a new text end 26.8 new text begin primary care clinic that is certified as a health care home under section 256B.0751. The new text end 26.9 new text begin hospital may limit the delivery of services to a network of providers who have contracted new text end 26.10 new text begin with the hospital to deliver services in accordance with this subdivision, and require new text end 26.11 new text begin an enrollee to seek services only within this network. The hospital may also require new text end 26.12 new text begin a referral to a provider before the service is eligible for payment. A coordinated care new text end 26.13 new text begin delivery system is not required to provide payment to a provider who is not employed new text end 26.14 new text begin by or under contract with the system for services provided to an enrollee of the system, new text end 26.15 new text begin except in cases of an emergency. new text end 26.16 new text begin (g) An enrollee of a coordinated care delivery system has the right to appeal to the new text end 26.17 new text begin commissioner according to section 256.045. new text end 26.18 new text begin (h) The state shall not be liable for the payment of any cost or obligation incurred new text end 26.19 new text begin by the coordinated care delivery system. new text end 26.20 new text begin (i) The hospital must provide the commissioner with data necessary for assessing new text end 26.21 new text begin enrollment, quality of care, cost, and utilization of services. Each hospital must provide, new text end 26.22 new text begin on a quarterly basis on a form prescribed by the commissioner for each enrollee served new text end 26.23 new text begin through the coordinated care delivery system, the services provided, the cost of services new text end 26.24 new text begin provided, the actual payment amount for the services provided, and any other information new text end 26.25 new text begin the commissioner deems necessary to claim federal Medicaid match. new text end 26.26     new text begin Subd. 7. new text end new text begin Payments; rate setting for the hospital coordinated care delivery new text end 26.27 new text begin system. new text end new text begin (a) Effective for general assistance medical care services, with the exception new text end 26.28 new text begin of outpatient prescription drug coverage, provided on or after June 1, 2010, through a new text end 26.29 new text begin coordinated care delivery system, the commissioner shall allocate the annual appropriation new text end 26.30 new text begin for the coordinated care delivery system to hospitals participating under subdivision 6 new text end 26.31 new text begin twice every three months, starting June 1, 2010. The payment shall be allocated among all new text end 26.32 new text begin hospitals qualified to participate on the allocation date. Each hospital or group of hospitals new text end 26.33 new text begin shall receive a pro rata share of the allocation based on the hospital's or group of hospitals' new text end 26.34 new text begin calendar year 2007 payments for general assistance medical care services, provided that, new text end 26.35 new text begin for the purposes of this allocation, payments to Hennepin County Medical Center, Regions new text end 26.36 new text begin Hospital, and Fairview University Medical Center shall be weighted at 110 percent of the new text end 27.1 new text begin actual amount. The commissioner shall conduct a settle-up after the conclusion of each new text end 27.2 new text begin quarter to ensure that final allocations reflect actual hospital utilization and shall reallocate new text end 27.3 new text begin funds as necessary among participating hospitals. The 2007 base year shall be updated by new text end 27.4 new text begin one calendar year each June 1, beginning June 1, 2011. new text end 27.5 new text begin (b) In order to be reimbursed under this section, nonhospital providers of health new text end 27.6 new text begin care services shall contract with one or more hospitals described in paragraph (a) to new text end 27.7 new text begin provide services to general assistance medical care recipients through the coordinated care new text end 27.8 new text begin delivery system established by the hospital. The hospital shall reimburse bills submitted new text end 27.9 new text begin by nonhospital providers participating under this paragraph at a rate negotiated between new text end 27.10 new text begin the hospital and the nonhospital provider. new text end 27.11 new text begin (c) The commissioner shall apply for federal matching funds under section new text end 27.12 new text begin 256B.199, paragraphs (a) to (d), for expenditures under this subdivision. new text end 27.13 new text begin (d) Outpatient prescription drug coverage provided on or after June 1, 2010, shall new text end 27.14 new text begin be paid on a fee-for-service basis according to subdivision 9 and section 256B.0625, new text end 27.15 new text begin subdivision 13e. new text end 27.16     new text begin Subd. 8. new text end new text begin Temporary uncompensated care pool. new text end new text begin (a) The commissioner shall new text end 27.17 new text begin establish a temporary uncompensated care pool, effective June 1, 2010. Payments from new text end 27.18 new text begin the pool must be distributed, within the limits of the available appropriation, to hospitals new text end 27.19 new text begin that are not part of a coordinated care delivery system established under subdivision 6. new text end 27.20 new text begin (b) Hospitals seeking reimbursement from this pool must submit an invoice to new text end 27.21 new text begin the commissioner in a form prescribed by the commissioner for payment for services new text end 27.22 new text begin provided to an applicant or enrollee not enrolled in a coordinated care delivery system. A new text end 27.23 new text begin payment amount, as calculated under current law, must be determined, but not paid, for new text end 27.24 new text begin each admission of or service provided to a general assistance medical care recipient on or new text end 27.25 new text begin after June 1, 2010, to November 30, 2010. new text end 27.26 new text begin (c) The aggregated payment amounts for each hospital must be calculated as a new text end 27.27 new text begin percentage of the total calculated amount for all hospitals. new text end 27.28 new text begin (d) Distributions from the uncompensated care pool for each hospital must be new text end 27.29 new text begin determined by multiplying the factor in paragraph (c) by the amount of money in the new text end 27.30 new text begin uncompensated care pool that is available for the six-month period. new text end 27.31 new text begin (e) The commissioner shall apply for federal matching funds under section new text end 27.32 new text begin 256B.199, paragraphs (a) to (d), for expenditures under this subdivision. new text end 27.33 new text begin (f) Outpatient prescription drugs are not eligible for payment under this subdivision. new text end 27.34     new text begin Subd. 9. new text end new text begin Prescription drug pool. new text end new text begin (a) The commissioner shall establish a new text end 27.35 new text begin prescription drug pool, effective June 1, 2010. Money in the pool must be used to new text end 27.36 new text begin reimburse pharmacies and other providers for prescription drugs dispensed to enrollees, new text end 28.1 new text begin on a fee-for-service basis according to section 256B.0625, subdivision 13e. Prescription new text end 28.2 new text begin drug coverage is subject to the availability of funds in the pool. If the commissioner new text end 28.3 new text begin forecasts that expenditures under this subdivision will exceed the appropriation for this new text end 28.4 new text begin purpose, the commissioner may bring recommendations to the Legislative Advisory new text end 28.5 new text begin Commission on methods to resolve the shortfall. new text end 28.6 new text begin (b) Effective June 1, 2010, coordinated care delivery systems established under new text end 28.7 new text begin subdivision 6 shall pay to the commissioner, on a quarterly basis, an assessment that in the new text end 28.8 new text begin aggregate equals 20 percent of the state appropriation for the prescription drug pool. Each new text end 28.9 new text begin coordinated care delivery system's assessment must be in proportion to the system's share new text end 28.10 new text begin of total funding provided by the state for coordinated care delivery systems, as calculated new text end 28.11 new text begin by the commissioner based on the most recent available data. new text end 28.12     new text begin Subd. 10. new text end new text begin Assistance for veterans. new text end new text begin Hospitals participating in the coordinated care new text end 28.13 new text begin delivery system under subdivision 6 shall consult with counties, county veterans service new text end 28.14 new text begin officers, and the Veterans Administration to identify other programs for which general new text end 28.15 new text begin assistance medical care recipients enrolled in their system are qualified. new text end 28.16 new text begin EFFECTIVE DATE. new text end new text begin This section is effective for services rendered on or after new text end 28.17 new text begin April 1, 2010. new text end 28.18    Sec. 12. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read: 28.19    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the 28.20first day of the month following the month in which eligibility is approved and the first 28.21premium payment has been received. As provided in section 256B.057, coverage for 28.22newborns is automatic from the date of birth and must be coordinated with other health 28.23coverage. The effective date of coverage for eligible newly adoptive children added to a 28.24family receiving covered health services is the month of placement. The effective date 28.25of coverage for other new members added to the family is the first day of the month 28.26following the month in which the change is reported. All eligibility criteria must be met 28.27by the family at the time the new family member is added. The income of the new family 28.28member is included with the family's gross income and the adjusted premium begins in 28.29the month the new family member is added. 28.30(b) The initial premium must be received by the last working day of the month for 28.31coverage to begin the first day of the following month. 28.32(c) Benefits are not available until the day following discharge if an enrollee is 28.33hospitalized on the first day of coverage. 28.34(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to 28.35256L.18 are secondary to a plan of insurance or benefit program under which an eligible 29.1person may have coverage and the commissioner shall use cost avoidance techniques to 29.2ensure coordination of any other health coverage for eligible persons. The commissioner 29.3shall identify eligible persons who may have coverage or benefits under other plans of 29.4insurance or who become eligible for medical assistance. 29.5(e) The effective date of coverage for single adults and households with no children 29.6formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 29.7according to section 256D.03, subdivision 3 new text begin 256D.031, subdivision 2a new text end , is the first day of 29.8the month following the last day of general assistance medical care coverage. 29.9 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 29.10    Sec. 13. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read: 29.11    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 29.12must be renewed every 12 months. The 12-month period begins in the month after the 29.13month the application is approved. 29.14    (b) Each new period of eligibility must take into account any changes in 29.15circumstances that impact eligibility and premium amount. An enrollee must provide all 29.16the information needed to redetermine eligibility by the first day of the month that ends 29.17the eligibility period. If there is no change in circumstances, the enrollee may renew 29.18eligibility at designated locations that include community clinics and health care providers' 29.19offices. The designated sites shall forward the renewal forms to the commissioner. The 29.20commissioner may establish criteria and timelines for sites to forward applications to the 29.21commissioner or county agencies. The premium for the new period of eligibility must be 29.22received as provided in section 256L.06 in order for eligibility to continue. 29.23    (c) For single adults and households with no children formerly enrolled in general 29.24assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 29.25subdivision 3 new text begin 256D.031, subdivision 2a new text end , the first period of eligibility begins the month the 29.26enrollee submitted the application or renewal for general assistance medical care. 29.27    (d) An enrollee who fails to submit renewal forms and related documentation 29.28necessary for verification of continued eligibility in a timely manner shall remain eligible 29.29for one additional month beyond the end of the current eligibility period before being 29.30disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 29.31additional month. 29.32 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 29.33    Sec. 14. Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read: 30.1    Subd. 6. Exception for certain adults. Single adults and households with 30.2no children formerly enrolled in general assistance medical care and enrolled in 30.3MinnesotaCare according to section 256D.03, subdivision 3 new text begin 256D.031, subdivision 2a new text end , are 30.4eligible without meeting the requirements of this section until renewal. 30.5 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 30.6    Sec. 15. Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read: 30.7    Subd. 4. Exception for transitioned adults. County agencies shall pay premiums 30.8for single adults and households with no children formerly enrolled in general assistance 30.9medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3 new text begin new text end 30.10 new text begin 256D.031, subdivision 2a new text end , until six-month renewal. The county agency has the option of 30.11continuing to pay premiums for these enrollees. 30.12 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 30.13    Sec. 16. Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read: 30.14    Subd. 7. Exception for certain adults. Single adults and households with 30.15no children formerly enrolled in general assistance medical care and enrolled in 30.16MinnesotaCare according to section 256D.03, subdivision 3 new text begin 256D.031, subdivision 2a new text end , are 30.17exempt from the requirements of this section until renewal. 30.18 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 30.19    Sec. 17. Minnesota Statutes 2008, section 517.08, subdivision 1c, is amended to read: 30.20    Subd. 1c. Disposition of license fee. (a) Of the marriage license fee collected 30.21pursuant to subdivision 1b, paragraph (a), $25 must be retained by the county. The local 30.22registrar must pay $85 to the commissioner of management and budget to be deposited 30.23as follows: 30.24    (1) $50 new text begin $55 new text end in the general fund; 30.25    (2) $3 in the state government special revenue fund to be appropriated to the 30.26commissioner of public safety for parenting time centers under section 119A.37; 30.27    (3) $2 in the special revenue fund to be appropriated to the commissioner of health 30.28for developing and implementing the MN ENABL program under section 145.9255; new text begin and new text end 30.29    (4) $25 in the special revenue fund is appropriated to the commissioner of 30.30employment and economic development for the displaced homemaker program under 30.31section 116L.96; and 31.1    (5) $5 in the special revenue fund is appropriated to the commissioner of human 31.2services for the Minnesota Healthy Marriage and Responsible Fatherhood Initiative under 31.3section . 31.4    (b) Of the $40 fee under subdivision 1b, paragraph (b), $25 must be retained by the 31.5county. The local registrar must pay $15 to the commissioner of management and budget 31.6to be deposited as follows: 31.7    (1) $5 as provided in paragraph (a), clauses (2) and (3); and 31.8    (2) $10 in the special revenue fund is appropriated to the commissioner of 31.9employment and economic development for the displaced homemaker program under 31.10section 116L.96. 31.11    (c) The increase in the marriage license fee under paragraph (a) provided for in Laws 31.122004, chapter 273, and disbursement of the increase in that fee to the special fund for the 31.13Minnesota Healthy Marriage and Responsible Fatherhood Initiative under paragraph (a), 31.14clause (5), is contingent upon the receipt of federal funding under United States Code, title 31.1542, section 1315, for purposes of the initiative. 31.16 new text begin EFFECTIVE DATE. new text end new text begin This section is effective July 1, 2010. new text end 31.17    Sec. 18. new text begin DRUG REBATE PROGRAM. new text end 31.18 new text begin The commissioner of human services shall continue to administer a drug rebate new text end 31.19 new text begin program for drugs purchased for persons eligible for the general assistance medical care new text end 31.20 new text begin program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph new text end 31.21 new text begin (cc), and 256D.03. new text end 31.22 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 31.23    Sec. 19. new text begin REVISOR'S INSTRUCTION. new text end 31.24 new text begin The revisor of statutes shall edit Minnesota Statutes, sections 256B.69 and 256B.692, new text end 31.25 new text begin to remove references to the general assistance medical care program. new text end 31.26 new text begin EFFECTIVE DATE. new text end new text begin This section is effective June 1, 2010. new text end 31.27    Sec. 20. new text begin REPEALER. new text end 31.28 new text begin (a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; 256B.195, new text end 31.29 new text begin subdivisions 4 and 5; and 256D.03, subdivision 9, new text end new text begin are repealed. new text end 31.30 new text begin (b) Minnesota Statutes 2009 Supplement, sections 256B.195, subdivisions 1, 2, and new text end 31.31 new text begin 3; and 256D.03, subdivision 4, new text end new text begin are repealed. new text end 32.1 new text begin (c) Minnesota Statutes 2008, sections 256L.05, subdivision 1b; 256L.07, subdivision new text end 32.2 new text begin 6; 256L.15, subdivision 4; and 256L.17, subdivision 7, new text end new text begin are repealed effective January 1, new text end 32.3 new text begin 2011. new text end 32.4 new text begin EFFECTIVE DATE. new text end new text begin This section is effective April 1, 2010. new text end 32.5ARTICLE 2 32.6APPROPRIATIONS 32.7 Section 1. new text begin HUMAN SERVICES APPROPRIATION. new text end 32.8 new text begin The sums shown in the columns marked "Appropriations" are added to or, if shown new text end 32.9 new text begin in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, as amended new text end 32.10 new text begin by Laws 2009, chapter 173, or other law, to the agencies and for the purposes specified in new text end 32.11 new text begin this article. The appropriations are from the general fund, or another named fund, and are new text end 32.12 new text begin available for the fiscal years indicated for each purpose. The figures "2010" and "2011" new text end 32.13 new text begin used in this article mean that the addition to or subtraction from appropriations listed under new text end 32.14 new text begin them are available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively. new text end 32.15 new text begin "The first year" is fiscal year 2010. "The second year" is fiscal year 2011. "The biennium" new text end 32.16 new text begin is fiscal years 2010 and 2011. Supplemental appropriations and reductions for the fiscal new text end 32.17 new text begin year ending June 30, 2010, are effective the day following final enactment. new text end 32.18 new text begin APPROPRIATIONS new text end 32.19 new text begin Available for the Year new text end 32.20 new text begin Ending June 30 new text end 32.21 new text begin 2010 new text end new text begin 2011 new text end 32.22 Sec. 2. new text begin HUMAN SERVICES new text end 32.23 new text begin Subdivision 1. new text end new text begin Total Appropriation new text end new text begin $ new text end new text begin (7,517,000) new text end new text begin $ new text end new text begin (69,393,000) new text end 32.24 new text begin Appropriations by Fund new text end 32.25 new text begin 2010 new text end new text begin 2011 new text end 32.26 new text begin General new text end new text begin 34,807,000 new text end new text begin 118,493,000 new text end 32.27 new text begin Health Care Access new text end new text begin (42,324,000) new text end new text begin (187,886,000) new text end 32.28 new text begin The amounts that may be spent for each new text end 32.29 new text begin purpose are specified in the following new text end 32.30 new text begin subdivisions. new text end 32.31 32.32 new text begin Subd. 2. new text end new text begin Children Support Enforcement new text end new text begin Grants new text end new text begin -0- new text end new text begin (300,000) new text end 32.33 new text begin Minnesota Healthy Marriage and new text end 32.34 new text begin Responsible Fatherhood Initiative Fee. new text end 33.1 new text begin Notwithstanding Minnesota Statutes, section new text end 33.2 new text begin 517.08, the balance and the fee revenue new text end 33.3 new text begin available to the commissioner of human new text end 33.4 new text begin services for the healthy marriage and new text end 33.5 new text begin responsible fatherhood initiative in the state new text end 33.6 new text begin government special revenue fund must be new text end 33.7 new text begin transferred to and deposited into the general new text end 33.8 new text begin fund by June 30, 2011. new text end 33.9 33.10 new text begin Subd. 3. new text end new text begin Children and Economic Assistance new text end new text begin Operations new text end new text begin (1,408,000) new text end new text begin (1,560,000) new text end 33.11 new text begin Subd. 4. new text end new text begin Basic Health Care Grants new text end 33.12 new text begin The amounts that may be spent from this new text end 33.13 new text begin appropriation for each purpose are as follows: new text end 33.14 new text begin (a) new text end new text begin MinnesotaCare Grants new text end 33.15 new text begin Appropriations by Fund new text end 33.16 new text begin Health Care Access new text end new text begin (42,324,000) new text end new text begin (187,886,000) new text end 33.17 33.18 new text begin (b) new text end new text begin Medical Assistance Basic Health Care new text end new text begin Grants - Families and Children new text end new text begin -0- new text end new text begin (49,000) new text end 33.19 33.20 new text begin (c) new text end new text begin Medical Assistance Basic Health Care new text end new text begin Grants - Elderly and Disabled new text end new text begin -0- new text end new text begin (1,275,000) new text end 33.21 new text begin (d) new text end new text begin General Assistance Medical Care new text end new text begin 39,413,000 new text end new text begin 135,837,000 new text end 33.22 new text begin For general assistance medical care payments new text end 33.23 new text begin under Minnesota Statutes, section 256D.031. new text end 33.24 new text begin $5,500,000 in fiscal year 2010 and new text end 33.25 new text begin $65,500,000 in fiscal year 2011 is for new text end 33.26 new text begin payments to coordinated care delivery new text end 33.27 new text begin systems under Minnesota Statutes, section new text end 33.28 new text begin 256D.031, subdivision 7. new text end 33.29 new text begin $4,375,000 in fiscal year 2010 and new text end 33.30 new text begin $51,875,000 in fiscal year 2011 is for new text end 33.31 new text begin payments for prescription drugs under new text end 33.32 new text begin Minnesota Statutes, section 256D.031, new text end 33.33 new text begin subdivision 9. new text end 34.1 new text begin $28,000,000 in fiscal year 2010 is for new text end 34.2 new text begin provider and prescription drug payments new text end 34.3 new text begin under Minnesota Statutes, section 256D.031, new text end 34.4 new text begin subdivision 5. new text end 34.5 new text begin $1,538,000 in fiscal year 2010 and new text end 34.6 new text begin $18,462,000 in fiscal year 2011 is for new text end 34.7 new text begin payments from the temporary uncompensated new text end 34.8 new text begin care pool under Minnesota Statutes, section new text end 34.9 new text begin 256D.031, subdivision 8. new text end 34.10 new text begin Any amount under paragraph (d) that is not new text end 34.11 new text begin spent in the first year does not cancel and is new text end 34.12 new text begin available for payments in the second year. new text end 34.13 new text begin The commissioner may transfer any new text end 34.14 new text begin unexpended amount under Minnesota new text end 34.15 new text begin Statutes, section 256D.031, subdivision 9, new text end 34.16 new text begin after the final allocation in fiscal year 2011 to new text end 34.17 new text begin make payments under Minnesota Statutes, new text end 34.18 new text begin section 256D.031, subdivision 7. new text end 34.19 new text begin Any unexpended amount not used for new text end 34.20 new text begin general assistance medical care expenditures new text end 34.21 new text begin incurred before April 1, 2010, under new text end 34.22 new text begin Minnesota Statutes, section 256D.03, shall be new text end 34.23 new text begin used to make payments under paragraph (d). new text end 34.24 new text begin Subd. 5. new text end new text begin Health Care Management new text end 34.25 new text begin The amounts that may be spent from the new text end 34.26 new text begin appropriation for each purpose are as follows: new text end 34.27 new text begin Health Care Administration new text end new text begin (2,998,000) new text end new text begin (5,270,000) new text end 34.28 new text begin Base Adjustment. new text end new text begin The general fund base new text end 34.29 new text begin for health care administration is reduced by new text end 34.30 new text begin $182,000 in fiscal year 2012 and $182,000 in new text end 34.31 new text begin fiscal year 2013. new text end 34.32 new text begin Subd. 6. new text end new text begin Continuing Care Grants new text end 34.33 new text begin (a) Mental Health Grants new text end new text begin (200,000) new text end new text begin (7,904,000) new text end 35.1 new text begin The general fund appropriation to the new text end 35.2 new text begin commissioner of human services for adult new text end 35.3 new text begin mental health grants in Laws 2009, chapter new text end 35.4 new text begin 79, article 13, section 3, subdivision 8, as new text end 35.5 new text begin amended by Laws 2009, chapter 173, article new text end 35.6 new text begin 2, section 1, subdivision 8, is reduced by new text end 35.7 new text begin $7,704,000 in fiscal year 2011. This is a new text end 35.8 new text begin onetime reduction. new text end 35.9 new text begin $200,000 of the reduction in each year is new text end 35.10 new text begin to eliminate specialty care grants for the new text end 35.11 new text begin 2007 mental health initiative infrastructure new text end 35.12 new text begin investments. new text end 35.13 new text begin (b) Other Continuing Care Grants new text end new text begin -0- new text end new text begin (2,037,000) new text end 35.14 new text begin HIV Grants. new text end new text begin The general fund appropriation new text end 35.15 new text begin for the HIV drug and insurance grant new text end 35.16 new text begin program shall be reduced by $2,037,000 in new text end 35.17 new text begin fiscal year 2011 and increased by $2,037,000 new text end 35.18 new text begin in fiscal year 2013. These adjustments are new text end 35.19 new text begin onetime and must not be applied to the base. new text end 35.20 new text begin Notwithstanding any contrary provision, this new text end 35.21 new text begin provision expires June 30, 2013. new text end 35.22 new text begin Subd. 7. new text end new text begin Continuing Care Management new text end new text begin -0- new text end new text begin 1,051,000 new text end 35.23 new text begin Subd. 8. new text end new text begin Transfers new text end 35.24 new text begin The commissioner must transfer $29,538,000 new text end 35.25 new text begin in fiscal year 2010 and $18,462,000 in fiscal new text end 35.26 new text begin year 2011 from the health care access fund to new text end 35.27 new text begin the general fund. This is a onetime transfer. new text end 35.28 new text begin The commissioner must transfer $4,800,000 new text end 35.29 new text begin from the consolidated chemical dependency new text end 35.30 new text begin treatment fund to the general fund by June new text end 35.31 new text begin 30, 2010. new text end 35.32 new text begin EFFECTIVE DATE. new text end new text begin This article is effective April 1, 2010. new text end