<a id="pl.1.3"></a><var>1.3</var>provisions for medical assistance, MinnesotaCare, and general assistance <br/>
<a id="pl.1.4"></a><var>1.4</var>medical care; requiring certain data; authorizing centers of excellence criteria; <br/>
<a id="pl.1.5"></a><var>1.5</var>establishing a Drug Utilization Review Board; making technical changes; <br/>
<a id="pl.1.6"></a><var>1.6</var>changing coinsurance provisions for MinnesotaCare; authorizing rulemaking; <br/>
<a id="pl.1.7"></a><var>1.7</var>requiring a report; amending Minnesota Statutes 2008, sections 62J.2930, <br/>
<a id="pl.1.8"></a><var>1.8</var>subdivision 3; 245.494, subdivision 3; 256.015, subdivision 7; 256.969, <br/>
<a id="pl.1.9"></a><var>1.9</var>subdivision 3a; 256B.037, subdivision 5; 256B.056, subdivisions 1c, 3c, <br/>
<a id="pl.1.10"></a><var>1.10</var>6; 256B.0625, by adding subdivisions; 256B.094, subdivision 3; 256B.195, <br/>
<a id="pl.1.11"></a><var>1.11</var>subdivisions 1, 2, 3; 256B.199; 256B.69, subdivision 5a; 256B.77, subdivision <br/>
<a id="pl.1.12"></a><var>1.12</var>13; 256D.03, subdivision 3; 256L.03, subdivision 5; 256L.15, subdivision 2; <br/>
<a id="pl.1.13"></a><var>1.13</var>Laws 2005, First Special Session chapter 4, article 8, sections 54; 61; 63; 66; 74; <br/>
<a id="pl.1.14"></a><var>1.14</var>repealing Minnesota Statutes 2008, sections 256B.031; 256L.01, subdivision 4; <br/>
<a id="pl.1.15"></a><var>1.15</var>Laws 2005, First Special Session chapter 4, article 8, sections 21; 22; 23; 24.<br/>
<a id="pl.1.16"></a><var>1.16</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.0.1.0"></a><a id="pl.1.17"></a><var>1.17</var>    Section 1. Minnesota Statutes 2008, section 62J.2930, subdivision 3, is amended to <br/>
<a id="pl.1.18"></a><var>1.18</var>read:<br/>
<a id="pl.1.19"></a><var>1.19</var>    Subd. 3. <b>Consumer information.</b> (a) The information clearinghouse or another <br/>
<a id="pl.1.20"></a><var>1.20</var>entity designated by the commissioner shall provide consumer information to health <br/>
<a id="pl.1.21"></a><var>1.21</var>plan company enrollees to:<br/>
<a id="pl.1.22"></a><var>1.22</var>(1) assist enrollees in understanding their rights;<br/>
<a id="pl.1.23"></a><var>1.23</var>(2) explain and assist in the use of all available complaint systems, including internal <br/>
<a id="pl.1.24"></a><var>1.24</var>complaint systems within health carriers, community integrated service networks, and <br/>
<a id="pl.1.25"></a><var>1.25</var>the Departments of Health and Commerce;<br/>
<a id="pl.1.26"></a><var>1.26</var>(3) provide information on coverage options in each region of the state;<br/>
<a id="pl.1.27"></a><var>1.27</var>(4) provide information on the availability of purchasing pools and enrollee <br/>
<a id="pl.1.28"></a><var>1.28</var>subsidies; and<br/>
<a id="pl.2.1"></a><var>2.1</var>(5) help consumers use the health care system to obtain coverage.<br/>
<a id="pl.2.2"></a><var>2.2</var>(b) The information clearinghouse or other entity designated by the commissioner <br/>
<a id="pl.2.3"></a><var>2.3</var>for the purposes of this subdivision shall not:<br/>
<a id="pl.2.4"></a><var>2.4</var>(1) provide legal services to consumers;<br/>
<a id="pl.2.5"></a><var>2.5</var>(2) represent a consumer or enrollee; or<br/>
<a id="pl.2.6"></a><var>2.6</var>(3) serve as an advocate for consumers in disputes with health plan companies.<br/>
<a id="pl.2.7"></a><var>2.7</var>(c) Nothing in this subdivision shall interfere with the ombudsman program <br/>
<a id="pl.2.8"></a><var>2.8</var>established under section 
         <statute_ref>256B.031, subdivision 6</statute_ref> 256B.69, subdivision 20, or other <br/>
<a id="pl.2.9"></a><var>2.9</var>existing ombudsman programs.  <br/>
<br/>
<a id="bill.0.2.0"></a><a id="pl.2.10"></a><var>2.10</var>    Sec. 2. Minnesota Statutes 2008, section 245.494, subdivision 3, is amended to read:<br/>
<a id="pl.2.11"></a><var>2.11</var>    Subd. 3. <b>Duties of the commissioner of human services.</b> The commissioner of <br/>
<a id="pl.2.12"></a><var>2.12</var>human services, in consultation with the Integrated Fund Task Force, shall:<br/>
<a id="pl.2.13"></a><var>2.13</var>(1) in the first quarter of 1994, in areas where a local children's mental health <br/>
<a id="pl.2.14"></a><var>2.14</var>collaborative has been established, based on an independent actuarial analysis, identify all <br/>
<a id="pl.2.15"></a><var>2.15</var>medical assistance and MinnesotaCare resources devoted to mental health services for <br/>
<a id="pl.2.16"></a><var>2.16</var>children in the target population including inpatient, outpatient, medication management, <br/>
<a id="pl.2.17"></a><var>2.17</var>services under the rehabilitation option, and related physician services in the total health <br/>
<a id="pl.2.18"></a><var>2.18</var>capitation of prepaid plans under contract with the commissioner to provide medical <br/>
<a id="pl.2.19"></a><var>2.19</var>assistance services under section 
         <statute_ref>256B.69</statute_ref>; <br/>
<a id="pl.2.20"></a><var>2.20</var>(2) assist each children's mental health collaborative to determine an actuarially <br/>
<a id="pl.2.21"></a><var>2.21</var>feasible operational target population;<br/>
<a id="pl.2.22"></a><var>2.22</var>(3) ensure that a prepaid health plan that contracts with the commissioner to provide <br/>
<a id="pl.2.23"></a><var>2.23</var>medical assistance or MinnesotaCare services shall pass through the identified resources <br/>
<a id="pl.2.24"></a><var>2.24</var>to a collaborative or collaboratives upon the collaboratives meeting the requirements <br/>
<a id="pl.2.25"></a><var>2.25</var>of section 
         <statute_ref>245.4933</statute_ref> to serve the collaborative's operational target population. The <br/>
<a id="pl.2.26"></a><var>2.26</var>commissioner shall, through an independent actuarial analysis, specify differential rates <br/>
<a id="pl.2.27"></a><var>2.27</var>the prepaid health plan must pay the collaborative based upon severity, functioning, and <br/>
<a id="pl.2.28"></a><var>2.28</var>other risk factors, taking into consideration the fee-for-service experience of children <br/>
<a id="pl.2.29"></a><var>2.29</var>excluded from prepaid medical assistance participation; <br/>
<a id="pl.2.30"></a><var>2.30</var>(4) ensure that a children's mental health collaborative that enters into an agreement <br/>
<a id="pl.2.31"></a><var>2.31</var>with a prepaid health plan under contract with the commissioner shall accept medical <br/>
<a id="pl.2.32"></a><var>2.32</var>assistance recipients in the operational target population on a first-come, first-served basis <br/>
<a id="pl.2.33"></a><var>2.33</var>up to the collaborative's operating capacity or as determined in the agreement between <br/>
<a id="pl.2.34"></a><var>2.34</var>the collaborative and the commissioner;<br/>
<a id="pl.3.1"></a><var>3.1</var>(5) ensure that a children's mental health collaborative that receives resources passed <br/>
<a id="pl.3.2"></a><var>3.2</var>through a prepaid health plan under contract with the commissioner shall be subject to <br/>
<a id="pl.3.3"></a><var>3.3</var>the quality assurance standards, reporting of utilization information, standards set out in <br/>
<a id="pl.3.4"></a><var>3.4</var>sections 
         <statute_ref>245.487</statute_ref> to 
         <statute_ref>245.4889</statute_ref>, and other requirements established in Minnesota Rules, <br/>
<a id="pl.3.5"></a><var>3.5</var>part 9500.1460; <br/>
<a id="pl.3.6"></a><var>3.6</var>(6) ensure that any prepaid health plan that contracts with the commissioner, <br/>
<a id="pl.3.7"></a><var>3.7</var>including a plan that contracts under section 
         <statute_ref>256B.69</statute_ref>, must enter into an agreement with <br/>
<a id="pl.3.8"></a><var>3.8</var>any collaborative operating in the same service delivery area that: <br/>
<a id="pl.3.9"></a><var>3.9</var>(i) meets the requirements of section 
         <statute_ref>245.4933</statute_ref>; <br/>
<a id="pl.3.10"></a><var>3.10</var>(ii) is willing to accept the rate determined by the commissioner to provide medical <br/>
<a id="pl.3.11"></a><var>3.11</var>assistance services; and<br/>
<a id="pl.3.12"></a><var>3.12</var>(iii) requests to contract with the prepaid health plan;<br/>
<a id="pl.3.13"></a><var>3.13</var>(7) ensure that no agreement between a health plan and a collaborative shall <br/>
<a id="pl.3.14"></a><var>3.14</var>terminate the legal responsibility of the health plan to assure that all activities under the <br/>
<a id="pl.3.15"></a><var>3.15</var>contract are carried out. The agreement may require the collaborative to indemnify the <br/>
<a id="pl.3.16"></a><var>3.16</var>health plan for activities that are not carried out;<br/>
<a id="pl.3.17"></a><var>3.17</var>(8) ensure that where a collaborative enters into an agreement with the commissioner <br/>
<a id="pl.3.18"></a><var>3.18</var>to provide medical assistance and MinnesotaCare services a separate capitation rate will <br/>
<a id="pl.3.19"></a><var>3.19</var>be determined through an independent actuarial analysis which is based upon the factors <br/>
<a id="pl.3.20"></a><var>3.20</var>set forth in clause (3) to be paid to a collaborative for children in the operational target <br/>
<a id="pl.3.21"></a><var>3.21</var>population who are eligible for medical assistance but not included in the prepaid health <br/>
<a id="pl.3.22"></a><var>3.22</var>plan contract with the commissioner;<br/>
<a id="pl.3.23"></a><var>3.23</var>(9) ensure that in counties where no prepaid health plan contract to provide medical <br/>
<a id="pl.3.24"></a><var>3.24</var>assistance or MinnesotaCare services exists, a children's mental health collaborative that <br/>
<a id="pl.3.25"></a><var>3.25</var>meets the requirements of section 
         <statute_ref>245.4933</statute_ref> shall: <br/>
<a id="pl.3.26"></a><var>3.26</var>(i) be paid a capitated rate, actuarially determined, that is based upon the <br/>
<a id="pl.3.27"></a><var>3.27</var>collaborative's operational target population;<br/>
<a id="pl.3.28"></a><var>3.28</var>(ii) accept medical assistance or MinnesotaCare recipients in the operational target <br/>
<a id="pl.3.29"></a><var>3.29</var>population on a first-come, first-served basis up to the collaborative's operating capacity or <br/>
<a id="pl.3.30"></a><var>3.30</var>as determined in the contract between the collaborative and the commissioner; and<br/>
<a id="pl.3.31"></a><var>3.31</var>(iii) comply with quality assurance standards, reporting of utilization information, <br/>
<a id="pl.3.32"></a><var>3.32</var>standards set out in sections 
         <statute_ref>245.487</statute_ref> to 
         <statute_ref>245.4889</statute_ref>, and other requirements established in <br/>
<a id="pl.3.33"></a><var>3.33</var>Minnesota Rules, part 9500.1460; <br/>
<a id="pl.3.34"></a><var>3.34</var>(10) subject to federal approval, in the development of rates for local children's <br/>
<a id="pl.3.35"></a><var>3.35</var>mental health collaboratives, the commissioner shall consider, and may adjust, trend and <br/>
<a id="pl.3.36"></a><var>3.36</var>utilization factors, to reflect changes in mental health service utilization and access;<br/>
<a id="pl.4.1"></a><var>4.1</var>(11) consider changes in mental health service utilization, access, and price, and <br/>
<a id="pl.4.2"></a><var>4.2</var>determine the actuarial value of the services in the maintenance of rates for local children's <br/>
<a id="pl.4.3"></a><var>4.3</var>mental health collaborative provided services, subject to federal approval;<br/>
<a id="pl.4.4"></a><var>4.4</var>(12) provide written notice to any prepaid health plan operating within the service <br/>
<a id="pl.4.5"></a><var>4.5</var>delivery area of a children's mental health collaborative of the collaborative's existence <br/>
<a id="pl.4.6"></a><var>4.6</var>within 30 days of the commissioner's receipt of notice of the collaborative's formation;<br/>
<a id="pl.4.7"></a><var>4.7</var>(13) ensure that in a geographic area where both a prepaid health plan including <br/>
<a id="pl.4.8"></a><var>4.8</var>those established under either section 
         <statute_ref>256B.69</statute_ref> or 
         <statute_ref>256L.12</statute_ref> and a local children's mental <br/>
<a id="pl.4.9"></a><var>4.9</var>health collaborative exist, medical assistance and MinnesotaCare recipients in the <br/>
<a id="pl.4.10"></a><var>4.10</var>operational target population who are enrolled in prepaid health plans will have the choice <br/>
<a id="pl.4.11"></a><var>4.11</var>to receive mental health services through either the prepaid health plan or the collaborative <br/>
<a id="pl.4.12"></a><var>4.12</var>that has a contract with the prepaid health plan, according to the terms of the contract; <br/>
<a id="pl.4.13"></a><var>4.13</var>(14) develop a mechanism for integrating medical assistance resources for mental <br/>
<a id="pl.4.14"></a><var>4.14</var>health service with MinnesotaCare and any other state and local resources available for <br/>
<a id="pl.4.15"></a><var>4.15</var>services for children in the operational target population, and develop a procedure for <br/>
<a id="pl.4.16"></a><var>4.16</var>making these resources available for use by a local children's mental health collaborative;<br/>
<a id="pl.4.17"></a><var>4.17</var>(15) gather data needed to manage mental health care including evaluation data and <br/>
<a id="pl.4.18"></a><var>4.18</var>data necessary to establish a separate capitation rate for children's mental health services <br/>
<a id="pl.4.19"></a><var>4.19</var>if that option is selected;<br/>
<a id="pl.4.20"></a><var>4.20</var>(16) by January 1, 1994, develop a model contract for providers of mental health <br/>
<a id="pl.4.21"></a><var>4.21</var>managed care that meets the requirements set out in sections 
         <statute_ref>245.491</statute_ref> to 
         <statute_ref>245.495</statute_ref> and <br/>
<statute_ref><a id="pl.4.22"></a><var>4.22</var>256B.69
         </statute_ref>, and utilize this contract for all subsequent awards, and before January 1, 1995, <br/>
<a id="pl.4.23"></a><var>4.23</var>the commissioner of human services shall not enter into or extend any contract for any <br/>
<a id="pl.4.24"></a><var>4.24</var>prepaid plan that would impede the implementation of sections 
         <statute_ref>245.491</statute_ref> to 
         <statute_ref>245.495</statute_ref>; <br/>
<a id="pl.4.25"></a><var>4.25</var>(17) develop revenue enhancement or rebate mechanisms and procedures to <br/>
<a id="pl.4.26"></a><var>4.26</var>certify expenditures made through local children's mental health collaboratives for <br/>
<a id="pl.4.27"></a><var>4.27</var>services including administration and outreach that may be eligible for federal financial <br/>
<a id="pl.4.28"></a><var>4.28</var>participation under medical assistance and other federal programs;<br/>
<a id="pl.4.29"></a><var>4.29</var>(18) ensure that new contracts and extensions or modifications to existing contracts <br/>
<a id="pl.4.30"></a><var>4.30</var>under section 
         <statute_ref>256B.69</statute_ref> do not impede implementation of sections 
         <statute_ref>245.491</statute_ref> to 
         <statute_ref>245.495</statute_ref>; <br/>
<a id="pl.4.31"></a><var>4.31</var>(19) provide technical assistance to help local children's mental health collaboratives <br/>
<a id="pl.4.32"></a><var>4.32</var>certify local expenditures for federal financial participation, using due diligence in order to <br/>
<a id="pl.4.33"></a><var>4.33</var>meet implementation timelines for sections 
         <statute_ref>245.491</statute_ref> to 
         <statute_ref>245.495</statute_ref> and recommend necessary <br/>
<a id="pl.4.34"></a><var>4.34</var>legislation to enhance federal revenue, provide clinical and management flexibility, and <br/>
<a id="pl.4.35"></a><var>4.35</var>otherwise meet the goals of local children's mental health collaboratives and request <br/>
<a id="pl.5.1"></a><var>5.1</var>necessary state plan amendments to maximize the availability of medical assistance for <br/>
<a id="pl.5.2"></a><var>5.2</var>activities undertaken by the local children's mental health collaborative; <br/>
<a id="pl.5.3"></a><var>5.3</var>(20) take all steps necessary to secure medical assistance reimbursement under the <br/>
<a id="pl.5.4"></a><var>5.4</var>rehabilitation option for family community support services and therapeutic support of <br/>
<a id="pl.5.5"></a><var>5.5</var>foster care and for individualized rehabilitation services;<br/>
<a id="pl.5.6"></a><var>5.6</var>(21) provide a mechanism to identify separately the reimbursement to a county <br/>
<a id="pl.5.7"></a><var>5.7</var>for child welfare targeted case management provided to children served by the local <br/>
<a id="pl.5.8"></a><var>5.8</var>collaborative for purposes of subsequent transfer by the county to the integrated fund;<br/>
<a id="pl.5.9"></a><var>5.9</var>(22) ensure that family members who are enrolled in a prepaid health plan and <br/>
<a id="pl.5.10"></a><var>5.10</var>whose children are receiving mental health services through a local children's mental <br/>
<a id="pl.5.11"></a><var>5.11</var>health collaborative file complaints about mental health services needed by the family <br/>
<a id="pl.5.12"></a><var>5.12</var>members, the commissioner shall comply with section 
         <statute_ref>256B.031, subdivision 6</statute_ref> 256B.69, <br/>
<a id="pl.5.13"></a><var>5.13</var>subdivision 20. A collaborative may assist a family to make a complaint; and <br/>
<a id="pl.5.14"></a><var>5.14</var>(23) facilitate a smooth transition for children receiving prepaid medical assistance <br/>
<a id="pl.5.15"></a><var>5.15</var>or MinnesotaCare services through a children's mental health collaborative who become <br/>
<a id="pl.5.16"></a><var>5.16</var>enrolled in a prepaid health plan.<br/>
<br/>
<a id="bill.0.3.0"></a><a id="pl.5.17"></a><var>5.17</var>    Sec. 3. Minnesota Statutes 2008, section 256.015, subdivision 7, is amended to read:<br/>
<a id="pl.5.18"></a><var>5.18</var>    Subd. 7. <b>Cooperation</b><b> with information requests</b><b> required.</b> (a) Upon the request <br/>
<a id="pl.5.19"></a><var>5.19</var>of the Department commissioner of human services,:<br/>
<a id="pl.5.20"></a><var>5.20</var>(1) any state agency or third party payer shall cooperate with the department in by <br/>
<a id="pl.5.21"></a><var>5.21</var>furnishing information to help establish a third party liability. Upon the request of the <br/>
<a id="pl.5.22"></a><var>5.22</var>Department of Human Services or county child support or human service agencies, as <br/>
<a id="pl.5.23"></a><var>5.23</var>required by the federal Deficit Reduction Act of 2005, Public Law 109-171;<br/>
<a id="pl.5.24"></a><var>5.24</var>(2) any employer or third party payer shall cooperate in by furnishing a data file <br/>
<a id="pl.5.25"></a><var>5.25</var>containing information about group health insurance plans plan or medical benefit plans <br/>
<a id="pl.5.26"></a><var>5.26</var>available to plan coverage of its employees or insureds within 60 days of the request.<br/>
<a id="pl.5.27"></a><var>5.27</var>(b) For purposes of section 
         <statute_ref>176.191, subdivision 4</statute_ref>, the Department commissioner <br/>
<a id="pl.5.28"></a><var>5.28</var>of labor and industry may allow the Department commissioner of human services and <br/>
<a id="pl.5.29"></a><var>5.29</var>county agencies direct access and data matching on information relating to workers' <br/>
<a id="pl.5.30"></a><var>5.30</var>compensation claims in order to determine whether the claimant has reported the fact of <br/>
<a id="pl.5.31"></a><var>5.31</var>a pending claim and the amount paid to or on behalf of the claimant to the Department <br/>
<a id="pl.5.32"></a><var>5.32</var>commissioner of human services.<br/>
<a id="pl.5.33"></a><var>5.33</var>(c) For the purpose of compliance with section 169.09, subdivision 13, and <br/>
<a id="pl.5.34"></a><var>5.34</var>federal requirements under Code of Federal Regulations, title 42, section 433.138(d)(4), <br/>
<a id="pl.5.35"></a><var>5.35</var>the commissioner of public safety shall provide accident data as requested by the <br/>
<a id="pl.6.1"></a><var>6.1</var>commissioner of human services. The disclosure shall not violate section 169.09, <br/>
<a id="pl.6.2"></a><var>6.2</var>subdivision 13, paragraph (d).<br/>
<a id="pl.6.3"></a><var>6.3</var>(d) The Department commissioner of human services and county agencies shall <br/>
<a id="pl.6.4"></a><var>6.4</var>limit its use of information gained from agencies, third party payers, and employers to <br/>
<a id="pl.6.5"></a><var>6.5</var>purposes directly connected with the administration of its public assistance and child <br/>
<a id="pl.6.6"></a><var>6.6</var>support programs. The provision of information by agencies, third party payers, and <br/>
<a id="pl.6.7"></a><var>6.7</var>employers to the department under this subdivision is not a violation of any right of <br/>
<a id="pl.6.8"></a><var>6.8</var>confidentiality or data privacy.<br/>
<br/>
<a id="bill.0.4.0"></a><a id="pl.6.9"></a><var>6.9</var>    Sec. 4. Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:<br/>
<a id="pl.6.10"></a><var>6.10</var>    Subd. 3a. <b>Payments.</b> (a) Acute care hospital billings under the medical <br/>
<a id="pl.6.11"></a><var>6.11</var>assistance program must not be submitted until the recipient is discharged. However, <br/>
<a id="pl.6.12"></a><var>6.12</var>the commissioner shall establish monthly interim payments for inpatient hospitals that <br/>
<a id="pl.6.13"></a><var>6.13</var>have individual patient lengths of stay over 30 days regardless of diagnostic category. <br/>
<a id="pl.6.14"></a><var>6.14</var>Except as provided in section 
         <statute_ref>256.9693</statute_ref>, medical assistance reimbursement for treatment <br/>
<a id="pl.6.15"></a><var>6.15</var>of mental illness shall be reimbursed based on diagnostic classifications. Individual <br/>
<a id="pl.6.16"></a><var>6.16</var>hospital payments established under this section and sections 
         <statute_ref>256.9685</statute_ref>, 
         <statute_ref>256.9686</statute_ref>, and <br/>
<statute_ref><a id="pl.6.17"></a><var>6.17</var>256.9695
         </statute_ref>, in addition to third party and recipient liability, for discharges occurring during <br/>
<a id="pl.6.18"></a><var>6.18</var>the rate year shall not exceed, in aggregate, the charges for the medical assistance covered <br/>
<a id="pl.6.19"></a><var>6.19</var>inpatient services paid for the same period of time to the hospital. This payment limitation <br/>
<a id="pl.6.20"></a><var>6.20</var>shall be calculated separately for medical assistance and general assistance medical <br/>
<a id="pl.6.21"></a><var>6.21</var>care services. The limitation on general assistance medical care shall be effective for <br/>
<a id="pl.6.22"></a><var>6.22</var>admissions occurring on or after July 1, 1991. Services that have rates established under <br/>
<a id="pl.6.23"></a><var>6.23</var>subdivision 11 or 12, must be limited separately from other services. After consulting with <br/>
<a id="pl.6.24"></a><var>6.24</var>the affected hospitals, the commissioner may consider related hospitals one entity and <br/>
<a id="pl.6.25"></a><var>6.25</var>may merge the payment rates while maintaining separate provider numbers. The operating <br/>
<a id="pl.6.26"></a><var>6.26</var>and property base rates per admission or per day shall be derived from the best Medicare <br/>
<a id="pl.6.27"></a><var>6.27</var>and claims data available when rates are established. The commissioner shall determine <br/>
<a id="pl.6.28"></a><var>6.28</var>the best Medicare and claims data, taking into consideration variables of recency of the <br/>
<a id="pl.6.29"></a><var>6.29</var>data, audit disposition, settlement status, and the ability to set rates in a timely manner. <br/>
<a id="pl.6.30"></a><var>6.30</var>The commissioner shall notify hospitals of payment rates by December 1 of the year <br/>
<a id="pl.6.31"></a><var>6.31</var>preceding the rate year. The rate setting data must reflect the admissions data used to <br/>
<a id="pl.6.32"></a><var>6.32</var>establish relative values. Base year changes from 1981 to the base year established for the <br/>
<a id="pl.6.33"></a><var>6.33</var>rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited <br/>
<a id="pl.6.34"></a><var>6.34</var>to the limits ending June 30, 1987, on the maximum rate of increase under subdivision <br/>
<a id="pl.6.35"></a><var>6.35</var>1. The commissioner may adjust base year cost, relative value, and case mix index data <br/>
<a id="pl.7.1"></a><var>7.1</var>to exclude the costs of services that have been discontinued by the October 1 of the year <br/>
<a id="pl.7.2"></a><var>7.2</var>preceding the rate year or that are paid separately from inpatient services. Inpatient stays <br/>
<a id="pl.7.3"></a><var>7.3</var>that encompass portions of two or more rate years shall have payments established based <br/>
<a id="pl.7.4"></a><var>7.4</var>on payment rates in effect at the time of admission unless the date of admission preceded <br/>
<a id="pl.7.5"></a><var>7.5</var>the rate year in effect by six months or more. In this case, operating payment rates for <br/>
<a id="pl.7.6"></a><var>7.6</var>services rendered during the rate year in effect and established based on the date of <br/>
<a id="pl.7.7"></a><var>7.7</var>admission shall be adjusted to the rate year in effect by the hospital cost index.<br/>
<a id="pl.7.8"></a><var>7.8</var>    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total <br/>
<a id="pl.7.9"></a><var>7.9</var>payment, before third-party liability and spenddown, made to hospitals for inpatient <br/>
<a id="pl.7.10"></a><var>7.10</var>services is reduced by .5 percent from the current statutory rates.<br/>
<a id="pl.7.11"></a><var>7.11</var>    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service <br/>
<a id="pl.7.12"></a><var>7.12</var>admissions occurring on or after July 1, 2003, made to hospitals for inpatient services <br/>
<a id="pl.7.13"></a><var>7.13</var>before third-party liability and spenddown, is reduced five percent from the current <br/>
<a id="pl.7.14"></a><var>7.14</var>statutory rates. Mental health services within diagnosis related groups 424 to 432, and <br/>
<a id="pl.7.15"></a><var>7.15</var>facilities defined under subdivision 16 are excluded from this paragraph.<br/>
<a id="pl.7.16"></a><var>7.16</var>    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for <br/>
<a id="pl.7.17"></a><var>7.17</var>fee-for-service admissions occurring on or after July August 1, 2005, made to hospitals <br/>
<a id="pl.7.18"></a><var>7.18</var>for inpatient services before third-party liability and spenddown, is reduced 6.0 percent <br/>
<a id="pl.7.19"></a><var>7.19</var>from the current statutory rates. Mental health services within diagnosis related groups <br/>
<a id="pl.7.20"></a><var>7.20</var>424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. <br/>
<a id="pl.7.21"></a><var>7.21</var>Notwithstanding section 
         <statute_ref>256.9686, subdivision 7</statute_ref>, for purposes of this paragraph, medical <br/>
<a id="pl.7.22"></a><var>7.22</var>assistance does not include general assistance medical care. Payments made to managed <br/>
<a id="pl.7.23"></a><var>7.23</var>care plans shall be reduced for services provided on or after January 1, 2006, to reflect <br/>
<a id="pl.7.24"></a><var>7.24</var>this reduction.<br/>
<a id="pl.7.25"></a><var>7.25</var>    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for <br/>
<a id="pl.7.26"></a><var>7.26</var>fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made <br/>
<a id="pl.7.27"></a><var>7.27</var>to hospitals for inpatient services before third-party liability and spenddown, is reduced <br/>
<a id="pl.7.28"></a><var>7.28</var>3.46 percent from the current statutory rates. Mental health services with diagnosis related <br/>
<a id="pl.7.29"></a><var>7.29</var>groups 424 to 432 and facilities defined under subdivision 16 are excluded from this <br/>
<a id="pl.7.30"></a><var>7.30</var>paragraph. Payments made to managed care plans shall be reduced for services provided <br/>
<a id="pl.7.31"></a><var>7.31</var>on or after January 1, 2009, through June 30, 2009, to reflect this reduction.<br/>
<a id="pl.7.32"></a><var>7.32</var>    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for <br/>
<a id="pl.7.33"></a><var>7.33</var>fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made <br/>
<a id="pl.7.34"></a><var>7.34</var>to hospitals for inpatient services before third-party liability and spenddown, is reduced <br/>
<a id="pl.7.35"></a><var>7.35</var>1.9 percent from the current statutory rates. Mental health services with diagnosis related <br/>
<a id="pl.7.36"></a><var>7.36</var>groups 424 to 432 and facilities defined under subdivision 16 are excluded from this <br/>
<a id="pl.8.1"></a><var>8.1</var>paragraph. Payments made to managed care plans shall be reduced for services provided <br/>
<a id="pl.8.2"></a><var>8.2</var>on or after July 1, 2009, through June 30, 2010, to reflect this reduction.<br/>
<a id="pl.8.3"></a><var>8.3</var>    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment <br/>
<a id="pl.8.4"></a><var>8.4</var>for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for <br/>
<a id="pl.8.5"></a><var>8.5</var>inpatient services before third-party liability and spenddown, is reduced 1.79 percent <br/>
<a id="pl.8.6"></a><var>8.6</var>from the current statutory rates. Mental health services with diagnosis related groups <br/>
<a id="pl.8.7"></a><var>8.7</var>424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. <br/>
<a id="pl.8.8"></a><var>8.8</var>Payments made to managed care plans shall be reduced for services provided on or after <br/>
<a id="pl.8.9"></a><var>8.9</var>July 1, 2010, to reflect this reduction.<br/>
<br/>
<a id="bill.0.5.0"></a><a id="pl.8.10"></a><var>8.10</var>    Sec. 5. Minnesota Statutes 2008, section 256B.037, subdivision 5, is amended to read:<br/>
<a id="pl.8.11"></a><var>8.11</var>    Subd. 5. <b>Other contracts permitted.</b> Nothing in this section prohibits the <br/>
<a id="pl.8.12"></a><var>8.12</var>commissioner from contracting with an organization for comprehensive health services, <br/>
<a id="pl.8.13"></a><var>8.13</var>including dental services, under section 
<statute_ref>256B.031</statute_ref>, sections
<statute_ref>256B.035</statute_ref>, 
         <statute_ref>256B.69</statute_ref>, or <br/>
<statute_ref><a id="pl.8.14"></a><var>8.14</var>256D.03, subdivision 4
         </statute_ref>, paragraph (c).  <br/>
<br/>
<a id="bill.0.6.0"></a><a id="pl.8.15"></a><var>8.15</var>    Sec. 6. Minnesota Statutes 2008, section 256B.056, subdivision 1c, is amended to read:<br/>
<a id="pl.8.16"></a><var>8.16</var>    Subd. 1c. <b>Families with children income methodology.</b> (a)(1) [Expired, 1Sp2003 <br/>
<a id="pl.8.17"></a><var>8.17</var>c 14 art 12 s 17]<br/>
<a id="pl.8.18"></a><var>8.18</var>(2) For applications processed within one calendar month prior to July 1, 2003, <br/>
<a id="pl.8.19"></a><var>8.19</var>eligibility shall be determined by applying the income standards and methodologies in <br/>
<a id="pl.8.20"></a><var>8.20</var>effect prior to July 1, 2003, for any months in the six-month budget period before July <br/>
<a id="pl.8.21"></a><var>8.21</var>1, 2003, and the income standards and methodologies in effect on July 1, 2003, for any <br/>
<a id="pl.8.22"></a><var>8.22</var>months in the six-month budget period on or after that date. The income standards for <br/>
<a id="pl.8.23"></a><var>8.23</var>each month shall be added together and compared to the applicant's total countable income <br/>
<a id="pl.8.24"></a><var>8.24</var>for the six-month budget period to determine eligibility.<br/>
<a id="pl.8.25"></a><var>8.25</var>(3) For children ages one through 18 whose eligibility is determined under section <br/>
<statute_ref><a id="pl.8.26"></a><var>8.26</var>256B.057, subdivision 2
         </statute_ref>, the following deductions shall be applied to income counted <br/>
<a id="pl.8.27"></a><var>8.27</var>toward the child's eligibility as allowed under the state's AFDC plan in effect as of July <br/>
<a id="pl.8.28"></a><var>8.28</var>16, 1996: $90 work expense, dependent care, and child support paid under court order. <br/>
<a id="pl.8.29"></a><var>8.29</var>This clause is effective October 1, 2003.<br/>
<a id="pl.8.30"></a><var>8.30</var>(b) For families with children whose eligibility is determined using the standard <br/>
<a id="pl.8.31"></a><var>8.31</var>specified in section 
         <statute_ref>256B.056, subdivision 4</statute_ref>, paragraph (c), 17 percent of countable <br/>
<a id="pl.8.32"></a><var>8.32</var>earned income shall be disregarded for up to four months and the following deductions <br/>
<a id="pl.8.33"></a><var>8.33</var>shall be applied to each individual's income counted toward eligibility as allowed under <br/>
<a id="pl.9.1"></a><var>9.1</var>the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid <br/>
<a id="pl.9.2"></a><var>9.2</var>under court order.<br/>
<a id="pl.9.3"></a><var>9.3</var>(c) If the four-month disregard in paragraph (b) has been applied to the wage <br/>
<a id="pl.9.4"></a><var>9.4</var>earner's income for four months, the disregard shall not be applied again until the wage <br/>
<a id="pl.9.5"></a><var>9.5</var>earner's income has not been considered in determining medical assistance eligibility for <br/>
<a id="pl.9.6"></a><var>9.6</var>12 consecutive months.<br/>
<a id="pl.9.7"></a><var>9.7</var>(d) The commissioner shall adjust the income standards under this section each July <br/>
<a id="pl.9.8"></a><var>9.8</var>1 by the annual update of the federal poverty guidelines following publication by the <br/>
<a id="pl.9.9"></a><var>9.9</var>United States Department of Health and Human Services.<br/>
<a id="pl.9.10"></a><var>9.10</var>(e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt <br/>
<a id="pl.9.11"></a><var>9.11</var>organization to or for the benefit of the child with a life-threatening illness must be <br/>
<a id="pl.9.12"></a><var>9.12</var>disregarded from income.<br/>
<br/>
<a id="bill.0.7.0"></a><a id="pl.9.13"></a><var>9.13</var>    Sec. 7. Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to read:<br/>
<a id="pl.9.14"></a><var>9.14</var>    Subd. 3c. <b>Asset limitations for families and children.</b> A household of two or more <br/>
<a id="pl.9.15"></a><var>9.15</var>persons must not own more than $20,000 in total net assets, and a household of one <br/>
<a id="pl.9.16"></a><var>9.16</var>person must not own more than $10,000 in total net assets. In addition to these maximum <br/>
<a id="pl.9.17"></a><var>9.17</var>amounts, an eligible individual or family may accrue interest on these amounts, but they <br/>
<a id="pl.9.18"></a><var>9.18</var>must be reduced to the maximum at the time of an eligibility redetermination. The value of <br/>
<a id="pl.9.19"></a><var>9.19</var>assets that are not considered in determining eligibility for medical assistance for families <br/>
<a id="pl.9.20"></a><var>9.20</var>and children is the value of those assets excluded under the AFDC state plan as of July 16, <br/>
<a id="pl.9.21"></a><var>9.21</var>1996, as required by the Personal Responsibility and Work Opportunity Reconciliation <br/>
<a id="pl.9.22"></a><var>9.22</var>Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:<br/>
<a id="pl.9.23"></a><var>9.23</var>(1) household goods and personal effects are not considered;<br/>
<a id="pl.9.24"></a><var>9.24</var>(2) capital and operating assets of a trade or business up to $200,000 are not <br/>
<a id="pl.9.25"></a><var>9.25</var>considered;<br/>
<a id="pl.9.26"></a><var>9.26</var>(3) one motor vehicle is excluded for each person of legal driving age who is <br/>
<a id="pl.9.27"></a><var>9.27</var>employed or seeking employment;<br/>
<a id="pl.9.28"></a><var>9.28</var>(4) one burial plot and all other burial expenses equal to the supplemental security <br/>
<a id="pl.9.29"></a><var>9.29</var>income program asset limit are not considered for each individual assets designated as <br/>
<a id="pl.9.30"></a><var>9.30</var>burial expenses are excluded to the same extent they are excluded by the Supplemental <br/>
<a id="pl.9.31"></a><var>9.31</var>Security Income program;<br/>
<a id="pl.9.32"></a><var>9.32</var>(5) court-ordered settlements up to $10,000 are not considered;<br/>
<a id="pl.9.33"></a><var>9.33</var>(6) individual retirement accounts and funds are not considered; and<br/>
<a id="pl.9.34"></a><var>9.34</var>(7) assets owned by children are not considered.<br/>
<br/>
<a id="bill.0.8.0"></a><a id="pl.10.1"></a><var>10.1</var>    Sec. 8. Minnesota Statutes 2008, section 256B.056, subdivision 6, is amended to read:<br/>
<a id="pl.10.2"></a><var>10.2</var>    Subd. 6. <b>Assignment of benefits.</b> To be eligible for medical assistance a person <br/>
<a id="pl.10.3"></a><var>10.3</var>must have applied or must agree to apply all proceeds received or receivable by the person <br/>
<a id="pl.10.4"></a><var>10.4</var>or the person's legal representative from any third party liable for the costs of medical <br/>
<a id="pl.10.5"></a><var>10.5</var>care. By accepting or receiving assistance, the person is deemed to have assigned the <br/>
<a id="pl.10.6"></a><var>10.6</var>person's rights to medical support and third party payments as required by title 19 of <br/>
<a id="pl.10.7"></a><var>10.7</var>the Social Security Act. Persons must cooperate with the state in establishing paternity <br/>
<a id="pl.10.8"></a><var>10.8</var>and obtaining third party payments. By accepting medical assistance, a person assigns <br/>
<a id="pl.10.9"></a><var>10.9</var>to the Department of Human Services all rights the person may have to medical support <br/>
<a id="pl.10.10"></a><var>10.10</var>or payments for medical expenses from any other person or entity on their own or their <br/>
<a id="pl.10.11"></a><var>10.11</var>dependent's behalf and agrees to cooperate with the state in establishing paternity and <br/>
<a id="pl.10.12"></a><var>10.12</var>obtaining third party payments. Any rights or amounts so assigned shall be applied against <br/>
<a id="pl.10.13"></a><var>10.13</var>the cost of medical care paid for under this chapter. Any assignment takes effect upon <br/>
<a id="pl.10.14"></a><var>10.14</var>the determination that the applicant is eligible for medical assistance and up to three <br/>
<a id="pl.10.15"></a><var>10.15</var>months prior to the date of application if the applicant is determined eligible for and <br/>
<a id="pl.10.16"></a><var>10.16</var>receives medical assistance benefits. The application must contain a statement explaining <br/>
<a id="pl.10.17"></a><var>10.17</var>this assignment. For the purposes of this section, "the Department of Human Services or <br/>
<a id="pl.10.18"></a><var>10.18</var>the state" includes prepaid health plans under contract with the commissioner according <br/>
<a id="pl.10.19"></a><var>10.19</var>to sections 
         <statute_ref>256B.031</statute_ref>,
<statute_ref>256B.69</statute_ref>, 
         <statute_ref>256D.03, subdivision 4</statute_ref>, paragraph (c), and 
         <statute_ref>256L.12</statute_ref>; <br/>
<a id="pl.10.20"></a><var>10.20</var>children's mental health collaboratives under section 
         <statute_ref>245.493</statute_ref>; demonstration projects for <br/>
<a id="pl.10.21"></a><var>10.21</var>persons with disabilities under section 
         <statute_ref>256B.77</statute_ref>; nursing facilities under the alternative <br/>
<a id="pl.10.22"></a><var>10.22</var>payment demonstration project under section 
         <statute_ref>256B.434</statute_ref>; and the county-based purchasing <br/>
<a id="pl.10.23"></a><var>10.23</var>entities under section 
         <statute_ref>256B.692</statute_ref>. <br/>
<br/>
<a id="bill.0.9.0"></a><a id="pl.10.24"></a><var>10.24</var>    Sec. 9. Minnesota Statutes 2008, section 256B.0625, is amended by adding a <br/>
<a id="pl.10.25"></a><var>10.25</var>subdivision to read:<br/>
<a id="pl.10.26"></a><var>10.26</var>    Subd. 13i. <b>Drug Utilization Review Board; report.</b> (a) A nine-member Drug <br/>
<a id="pl.10.27"></a><var>10.27</var>Utilization Review Board is established. The board must be comprised of at least three <br/>
<a id="pl.10.28"></a><var>10.28</var>but no more than four licensed physicians actively engaged in the practice of medicine <br/>
<a id="pl.10.29"></a><var>10.29</var>in Minnesota; at least three licensed pharmacists actively engaged in the practice of <br/>
<a id="pl.10.30"></a><var>10.30</var>pharmacy in Minnesota; and one consumer representative. The remainder must be made <br/>
<a id="pl.10.31"></a><var>10.31</var>up of health care professionals who are licensed in their field and have recognized <br/>
<a id="pl.10.32"></a><var>10.32</var>knowledge in the clinically appropriate prescribing, dispensing, and monitoring of covered <br/>
<a id="pl.10.33"></a><var>10.33</var>outpatient drugs. Members of the board must be appointed by the commissioner, shall <br/>
<a id="pl.10.34"></a><var>10.34</var>serve three-year terms, and may be reappointed by the commissioner. The board shall <br/>
<a id="pl.10.35"></a><var>10.35</var>annually elect a chair from among its members.<br/>
<a id="pl.11.1"></a><var>11.1</var>(b) The board must be staffed by an employee of the department who shall serve as <br/>
<a id="pl.11.2"></a><var>11.2</var>an ex officio nonvoting member of the board.<br/>
<a id="pl.11.3"></a><var>11.3</var>(c) The commissioner shall, with the advice of the board:<br/>
<a id="pl.11.4"></a><var>11.4</var>(1) implement a medical assistance retrospective and prospective drug utilization <br/>
<a id="pl.11.5"></a><var>11.5</var>review program as required by United States Code, title 42, section 1396r-8(g)(3);<br/>
<a id="pl.11.6"></a><var>11.6</var>(2) develop and implement the predetermined criteria and practice parameters for <br/>
<a id="pl.11.7"></a><var>11.7</var>appropriate prescribing to be used in retrospective and prospective drug utilization review;<br/>
<a id="pl.11.8"></a><var>11.8</var>(3) develop, select, implement, and assess interventions for physicians, pharmacists, <br/>
<a id="pl.11.9"></a><var>11.9</var>and patients that are educational and not punitive in nature;<br/>
<a id="pl.11.10"></a><var>11.10</var>(4) establish a grievance and appeals process for physicians and pharmacists under <br/>
<a id="pl.11.11"></a><var>11.11</var>this section;<br/>
<a id="pl.11.12"></a><var>11.12</var>(5) publish and disseminate educational information to physicians and pharmacists <br/>
<a id="pl.11.13"></a><var>11.13</var>regarding the board and the review program;<br/>
<a id="pl.11.14"></a><var>11.14</var>(6) adopt and implement procedures designed to ensure the confidentiality of any <br/>
<a id="pl.11.15"></a><var>11.15</var>information collected, stored, retrieved, assessed, or analyzed by the board, staff to <br/>
<a id="pl.11.16"></a><var>11.16</var>the board, or contractors to the review program that identifies individual physicians, <br/>
<a id="pl.11.17"></a><var>11.17</var>pharmacists, or recipients;<br/>
<a id="pl.11.18"></a><var>11.18</var>(7) establish and implement an ongoing process to:<br/>
<a id="pl.11.19"></a><var>11.19</var>(i) receive public comment regarding drug utilization review criteria and standards; <br/>
<a id="pl.11.20"></a><var>11.20</var>and<br/>
<a id="pl.11.21"></a><var>11.21</var>(ii) consider the comments along with other scientific and clinical information in <br/>
<a id="pl.11.22"></a><var>11.22</var>order to revise criteria and standards on a timely basis; and<br/>
<a id="pl.11.23"></a><var>11.23</var>(8) adopt any rules necessary to carry out this section.<br/>
<a id="pl.11.24"></a><var>11.24</var>(d) The board may establish advisory committees. The commissioner may contract <br/>
<a id="pl.11.25"></a><var>11.25</var>with appropriate organizations to assist the board in carrying out the board's duties. <br/>
<a id="pl.11.26"></a><var>11.26</var>The commissioner may enter into contracts for services to develop and implement a <br/>
<a id="pl.11.27"></a><var>11.27</var>retrospective and prospective review program.<br/>
<a id="pl.11.28"></a><var>11.28</var>(e) The board shall report to the commissioner annually on the date the drug <br/>
<a id="pl.11.29"></a><var>11.29</var>utilization review annual report is due to the Centers for Medicare and Medicaid Services. <br/>
<a id="pl.11.30"></a><var>11.30</var>This report must cover the preceding federal fiscal year. The commissioner shall make the <br/>
<a id="pl.11.31"></a><var>11.31</var>report available to the public upon request. The report must include information on the <br/>
<a id="pl.11.32"></a><var>11.32</var>activities of the board and the program; the effectiveness of implemented interventions; <br/>
<a id="pl.11.33"></a><var>11.33</var>administrative costs; and any fiscal impact resulting from the program. An honorarium <br/>
<a id="pl.11.34"></a><var>11.34</var>of $100 per meeting and reimbursement for mileage must be paid to each board member <br/>
<a id="pl.11.35"></a><var>11.35</var>in attendance.<br/>
<a id="pl.11.36"></a><var>11.36</var>(f) This subdivision is exempt from the provisions of section 15.059.<br/>
<br/>
<a id="bill.0.10.0"></a><a id="pl.12.1"></a><var>12.1</var>    Sec. 10. Minnesota Statutes 2008, section 256B.0625, is amended by adding a <br/>
<a id="pl.12.2"></a><var>12.2</var>subdivision to read:<br/>
<a id="pl.12.3"></a><var>12.3</var>    Subd. 53. <b>Centers of excellence.</b> For complex medical procedures with a high <br/>
<a id="pl.12.4"></a><var>12.4</var>degree of variation in outcomes, for which the Medicare program requires facilities <br/>
<a id="pl.12.5"></a><var>12.5</var>providing the services to meet certain criteria as a condition of coverage, the commissioner <br/>
<a id="pl.12.6"></a><var>12.6</var>may develop centers of excellence facility criteria in consultation with the Health Services <br/>
<a id="pl.12.7"></a><var>12.7</var>Policy Committee, section 256B.0625, subdivision 3c. The criteria must reflect facility <br/>
<a id="pl.12.8"></a><var>12.8</var>traits that have been linked to superior patient safety and outcomes for the procedures <br/>
<a id="pl.12.9"></a><var>12.9</var>in question, and must be based on the best available empirical evidence. For medical <br/>
<a id="pl.12.10"></a><var>12.10</var>assistance recipients enrolled on a fee-for-service basis, the commissioner may make <br/>
<a id="pl.12.11"></a><var>12.11</var>coverage for these procedures conditional upon the facility providing the services meeting <br/>
<a id="pl.12.12"></a><var>12.12</var>the specified criteria. Only facilities meeting the criteria may be reimbursed for the <br/>
<a id="pl.12.13"></a><var>12.13</var>procedures in question.<br/>
<a id="pl.12.14"></a><var>12.14</var><b>EFFECTIVE DATE.</b>This section is effective August 1, 2009, or upon federal <br/>
<a id="pl.12.15"></a><var>12.15</var>approval, whichever is later.<br/>
<br/>
<a id="bill.0.11.0"></a><a id="pl.12.16"></a><var>12.16</var>    Sec. 11. Minnesota Statutes 2008, section 256B.094, subdivision 3, is amended to read:<br/>
<a id="pl.12.17"></a><var>12.17</var>    Subd. 3. <b>Coordination and provision of services.</b> (a) In a county or reservation <br/>
<a id="pl.12.18"></a><var>12.18</var>where a prepaid medical assistance provider has contracted under section 
         <statute_ref>256B.031</statute_ref> or <br/>
<statute_ref><a id="pl.12.19"></a><var>12.19</var>256B.69
         </statute_ref> to provide mental health services, the case management provider shall coordinate <br/>
<a id="pl.12.20"></a><var>12.20</var>with the prepaid provider to ensure that all necessary mental health services required <br/>
<a id="pl.12.21"></a><var>12.21</var>under the contract are provided to recipients of case management services. <br/>
<a id="pl.12.22"></a><var>12.22</var>(b) When the case management provider determines that a prepaid provider is not <br/>
<a id="pl.12.23"></a><var>12.23</var>providing mental health services as required under the contract, the case management <br/>
<a id="pl.12.24"></a><var>12.24</var>provider shall assist the recipient to appeal the prepaid provider's denial pursuant to <br/>
<a id="pl.12.25"></a><var>12.25</var>section 
         <statute_ref>256.045</statute_ref>, and may make other arrangements for provision of the covered services. <br/>
<a id="pl.12.26"></a><var>12.26</var>(c) The case management provider may bill the provider of prepaid health care <br/>
<a id="pl.12.27"></a><var>12.27</var>services for any mental health services provided to a recipient of case management <br/>
<a id="pl.12.28"></a><var>12.28</var>services which the county or tribal social services arranges for or provides and which are <br/>
<a id="pl.12.29"></a><var>12.29</var>included in the prepaid provider's contract, and which were determined to be medically <br/>
<a id="pl.12.30"></a><var>12.30</var>necessary as a result of an appeal pursuant to section 
         <statute_ref>256.045</statute_ref>. The prepaid provider <br/>
<a id="pl.12.31"></a><var>12.31</var>must reimburse the mental health provider, at the prepaid provider's standard rate for that <br/>
<a id="pl.12.32"></a><var>12.32</var>service, for any services delivered under this subdivision. <br/>
<a id="pl.12.33"></a><var>12.33</var>(d) If the county or tribal social services has not obtained prior authorization for <br/>
<a id="pl.12.34"></a><var>12.34</var>this service, or an appeal results in a determination that the services were not medically <br/>
<a id="pl.13.1"></a><var>13.1</var>necessary, the county or tribal social services may not seek reimbursement from the <br/>
<a id="pl.13.2"></a><var>13.2</var>prepaid provider.<br/>
<br/>
<a id="bill.0.12.0"></a><a id="pl.13.3"></a><var>13.3</var>    Sec. 12. Minnesota Statutes 2008, section 256B.195, subdivision 1, is amended to read:<br/>
<a id="pl.13.4"></a><var>13.4</var>    Subdivision 1. <b>Federal approval required.</b> Sections Section
<statute_ref>145.9268</statute_ref>, 
<statute_ref>256.969, <br/>
<a id="pl.13.5"></a><var>13.5</var>subdivision 26
</statute_ref>, and this section are contingent on federal approval of the intergovernmental <br/>
<a id="pl.13.6"></a><var>13.6</var>transfers and payments to safety net hospitals and community clinics authorized under <br/>
<a id="pl.13.7"></a><var>13.7</var>this section. These sections are also contingent on current payment, by the government <br/>
<a id="pl.13.8"></a><var>13.8</var>entities, of intergovernmental transfers under section 
         <statute_ref>256B.19</statute_ref> and this section.  <br/>
<br/>
<a id="bill.0.13.0"></a><a id="pl.13.9"></a><var>13.9</var>    Sec. 13. Minnesota Statutes 2008, section 256B.195, subdivision 2, is amended to read:<br/>
<a id="pl.13.10"></a><var>13.10</var>    Subd. 2. <b>Payments from governmental entities.</b> (a) In addition to any payment <br/>
<a id="pl.13.11"></a><var>13.11</var>required under section 
         <statute_ref>256B.19</statute_ref>, effective July 15, 2001, the following government entities <br/>
<a id="pl.13.12"></a><var>13.12</var>shall make the payments indicated before noon on the 15th of each month annually:  <br/>
<a id="pl.13.13"></a><var>13.13</var>(1) Hennepin County, $2,000,000 $24,000,000; and<br/>
<a id="pl.13.14"></a><var>13.14</var>(2) Ramsey County, $1,000,000 $12,000,000.<br/>
<a id="pl.13.15"></a><var>13.15</var>(b) These sums shall be part of the designated governmental unit's portion of the <br/>
<a id="pl.13.16"></a><var>13.16</var>nonfederal share of medical assistance costs. Of these payments, Hennepin County shall <br/>
<a id="pl.13.17"></a><var>13.17</var>pay 71 percent directly to Hennepin County Medical Center, and Ramsey County shall <br/>
<a id="pl.13.18"></a><var>13.18</var>pay 71 percent directly to Regions Hospital. The counties must provide certification to the <br/>
<a id="pl.13.19"></a><var>13.19</var>commissioner of payments to hospitals under this subdivision.<br/>
<br/>
<a id="bill.0.14.0"></a><a id="pl.13.20"></a><var>13.20</var>    Sec. 14. Minnesota Statutes 2008, section 256B.195, subdivision 3, is amended to read:<br/>
<a id="pl.13.21"></a><var>13.21</var>    Subd. 3. <b>Payments to certain safety net providers.</b> (a) Effective July 15, 2001, <br/>
<a id="pl.13.22"></a><var>13.22</var>the commissioner shall make the following payments to the hospitals indicated after <br/>
<a id="pl.13.23"></a><var>13.23</var>noon on the 15th of each month annually:<br/>
<a id="pl.13.24"></a><var>13.24</var>(1) to Hennepin County Medical Center, any federal matching funds available to <br/>
<a id="pl.13.25"></a><var>13.25</var>match the payments received by the medical center under subdivision 2, to increase <br/>
<a id="pl.13.26"></a><var>13.26</var>payments for medical assistance admissions and to recognize higher medical assistance <br/>
<a id="pl.13.27"></a><var>13.27</var>costs in institutions that provide high levels of charity care; and<br/>
<a id="pl.13.28"></a><var>13.28</var>(2) to Regions Hospital, any federal matching funds available to match the payments <br/>
<a id="pl.13.29"></a><var>13.29</var>received by the hospital under subdivision 2, to increase payments for medical assistance <br/>
<a id="pl.13.30"></a><var>13.30</var>admissions and to recognize higher medical assistance costs in institutions that provide <br/>
<a id="pl.13.31"></a><var>13.31</var>high levels of charity care.<br/>
<a id="pl.14.1"></a><var>14.1</var>(b) Effective July 15, 2001, the following percentages of the transfers under <br/>
<a id="pl.14.2"></a><var>14.2</var>subdivision 2 shall be retained by the commissioner for deposit each month into the <br/>
<a id="pl.14.3"></a><var>14.3</var>general fund:<br/>
<a id="pl.14.4"></a><var>14.4</var>(1) 18 percent, plus any federal matching funds, shall be allocated for the following <br/>
<a id="pl.14.5"></a><var>14.5</var>purposes:<br/>
<a id="pl.14.6"></a><var>14.6</var>(i) during the fiscal year beginning July 1, 2001, of the amount available under <br/>
<a id="pl.14.7"></a><var>14.7</var>this clause, 39.7 percent shall be allocated to make increased hospital payments under <br/>
<a id="pl.14.8"></a><var>14.8</var>section 
         <statute_ref>256.969, subdivision 26</statute_ref>; 34.2 percent shall be allocated to fund the amounts <br/>
<a id="pl.14.9"></a><var>14.9</var>due from small rural hospitals, as defined in section 
         <statute_ref>144.148</statute_ref>, for overpayments under <br/>
<a id="pl.14.10"></a><var>14.10</var>section 
         <statute_ref>256.969, subdivision 5a</statute_ref>, resulting from a determination that medical assistance <br/>
<a id="pl.14.11"></a><var>14.11</var>and general assistance payments exceeded the charge limit during the period from 1994 to <br/>
<a id="pl.14.12"></a><var>14.12</var>1997; and 26.1 percent shall be allocated to the commissioner of health for rural hospital <br/>
<a id="pl.14.13"></a><var>14.13</var>capital improvement grants under section 
         <statute_ref>144.148</statute_ref>; and<br/>
<a id="pl.14.14"></a><var>14.14</var>(ii) during fiscal years beginning on or after July 1, 2002, of the amount available <br/>
<a id="pl.14.15"></a><var>14.15</var>under this clause, 55 percent shall be allocated to make increased hospital payments under <br/>
<a id="pl.14.16"></a><var>14.16</var>section 
         <statute_ref>256.969, subdivision 26</statute_ref>, and 45 percent shall be allocated to the commissioner of <br/>
<a id="pl.14.17"></a><var>14.17</var>health for rural hospital capital improvement grants under section 
         <statute_ref>144.148</statute_ref>; and<br/>
<a id="pl.14.18"></a><var>14.18</var>(2) 11 percent shall be allocated to the commissioner of health to fund community <br/>
<a id="pl.14.19"></a><var>14.19</var>clinic grants under section 
         <statute_ref>145.9268</statute_ref>.<br/>
<a id="pl.14.20"></a><var>14.20</var>(c) This subdivision shall apply to fee-for-service payments only and shall not <br/>
<a id="pl.14.21"></a><var>14.21</var>increase capitation payments or payments made based on average rates. The allocation in <br/>
<a id="pl.14.22"></a><var>14.22</var>paragraph (b), clause (1), item (ii), to increase hospital payments under section 
         <statute_ref>256.969, <br/>
<a id="pl.14.23"></a><var>14.23</var>subdivision 26
         </statute_ref>, shall not limit payments under that section.<br/>
<a id="pl.14.24"></a><var>14.24</var>(d) Medical assistance rate or payment changes, including those required to obtain <br/>
<a id="pl.14.25"></a><var>14.25</var>federal financial participation under section 
         <statute_ref>62J.692, subdivision 8</statute_ref>, shall precede the <br/>
<a id="pl.14.26"></a><var>14.26</var>determination of intergovernmental transfer amounts determined in this subdivision. <br/>
<a id="pl.14.27"></a><var>14.27</var>Participation in the intergovernmental transfer program shall not result in the offset of <br/>
<a id="pl.14.28"></a><var>14.28</var>any health care provider's receipt of medical assistance payment increases other than <br/>
<a id="pl.14.29"></a><var>14.29</var>limits resulting from hospital-specific charge limits and limits on disproportionate share <br/>
<a id="pl.14.30"></a><var>14.30</var>hospital payments.<br/>
<a id="pl.14.31"></a><var>14.31</var>(e) Effective July 1, 2003, if the amount available for allocation under paragraph <br/>
<a id="pl.14.32"></a><var>14.32</var>(b) is greater than the amounts available during March 2003, after any increase in <br/>
<a id="pl.14.33"></a><var>14.33</var>intergovernmental transfers and payments that result from section 
         <statute_ref>256.969, subdivision <br/>
<a id="pl.14.34"></a><var>14.34</var>3a
         </statute_ref>, paragraph (c), are paid to the general fund, any additional amounts available under this <br/>
<a id="pl.14.35"></a><var>14.35</var>subdivision after reimbursement of the transfers under subdivision 2 shall be allocated to <br/>
<a id="pl.15.1"></a><var>15.1</var>increase medical assistance payments, subject to hospital-specific charge limits and limits <br/>
<a id="pl.15.2"></a><var>15.2</var>on disproportionate share hospital payments, as follows:<br/>
<a id="pl.15.3"></a><var>15.3</var>(1) if the payments under subdivision 5 are approved, the amount shall be paid to <br/>
<a id="pl.15.4"></a><var>15.4</var>the largest ten percent of hospitals as measured by 2001 payments for medical assistance, <br/>
<a id="pl.15.5"></a><var>15.5</var>general assistance medical care, and MinnesotaCare in the nonstate government hospital <br/>
<a id="pl.15.6"></a><var>15.6</var>category. Payments shall be allocated according to each hospital's proportionate share <br/>
<a id="pl.15.7"></a><var>15.7</var>of the 2001 payments; or<br/>
<a id="pl.15.8"></a><var>15.8</var>(2) if the payments under subdivision 5 are not approved, the amount shall be paid to <br/>
<a id="pl.15.9"></a><var>15.9</var>the largest ten percent of hospitals as measured by 2001 payments for medical assistance, <br/>
<a id="pl.15.10"></a><var>15.10</var>general assistance medical care, and MinnesotaCare in the nonstate government category <br/>
<a id="pl.15.11"></a><var>15.11</var>and to the largest ten percent of hospitals as measured by payments for medical assistance, <br/>
<a id="pl.15.12"></a><var>15.12</var>general assistance medical care, and MinnesotaCare in the nongovernment hospital <br/>
<a id="pl.15.13"></a><var>15.13</var>category. Payments shall be allocated according to each hospital's proportionate <br/>
<a id="pl.15.14"></a><var>15.14</var>share of the 2001 payments in their respective category of nonstate government and <br/>
<a id="pl.15.15"></a><var>15.15</var>nongovernment. The commissioner shall determine which hospitals are in the nonstate <br/>
<a id="pl.15.16"></a><var>15.16</var>government and nongovernment hospital categories.<br/>
<br/>
<a id="bill.0.15.0"></a><a id="pl.15.17"></a><var>15.17</var>    Sec. 15. Minnesota Statutes 2008, section 256B.199, is amended to read:<br/>
<a id="pl.15.18"></a><var>15.18</var><b>256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.</b><br/>
<a id="pl.15.19"></a><var>15.19</var>    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds <br/>
<a id="pl.15.20"></a><var>15.20</var>for the expenditures in paragraphs (b) and (c).<br/>
<a id="pl.15.21"></a><var>15.21</var>    (b) The commissioner shall apply for federal matching funds for certified public <br/>
<a id="pl.15.22"></a><var>15.22</var>expenditures as follows:<br/>
<a id="pl.15.23"></a><var>15.23</var>    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions <br/>
<a id="pl.15.24"></a><var>15.24</var>Hospital, the University of Minnesota, and Fairview-University Medical Center shall <br/>
<a id="pl.15.25"></a><var>15.25</var>report quarterly annually to the commissioner beginning June 1, 2007, payments made <br/>
<a id="pl.15.26"></a><var>15.26</var>during the second previous quarter calendar year that may qualify for reimbursement <br/>
<a id="pl.15.27"></a><var>15.27</var>under federal law;<br/>
<a id="pl.15.28"></a><var>15.28</var>     (2) based on these reports, the commissioner shall apply for federal matching <br/>
<a id="pl.15.29"></a><var>15.29</var>funds. These funds are appropriated to the commissioner for the payments under section <br/>
<statute_ref><a id="pl.15.30"></a><var>15.30</var>256.969, subdivision 27
         </statute_ref>; and<br/>
<a id="pl.15.31"></a><var>15.31</var>     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform <br/>
<a id="pl.15.32"></a><var>15.32</var>the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share <br/>
<a id="pl.15.33"></a><var>15.33</var>hospital payment money expected to be available in the current federal fiscal year.<br/>
<a id="pl.15.34"></a><var>15.34</var>    (c) The commissioner shall apply for federal matching funds for general assistance <br/>
<a id="pl.15.35"></a><var>15.35</var>medical care expenditures as follows:<br/>
<a id="pl.16.1"></a><var>16.1</var>    (1) for hospital services occurring on or after July 1, 2007, general assistance medical <br/>
<a id="pl.16.2"></a><var>16.2</var>care expenditures for fee-for-service inpatient and outpatient hospital payments made by <br/>
<a id="pl.16.3"></a><var>16.3</var>the department shall be used to apply for federal matching funds, except as limited below:<br/>
<a id="pl.16.4"></a><var>16.4</var>    (i) only those general assistance medical care expenditures made to an individual <br/>
<a id="pl.16.5"></a><var>16.5</var>hospital that would not cause the hospital to exceed its individual hospital limits under <br/>
<a id="pl.16.6"></a><var>16.6</var>section 1923 of the Social Security Act may be considered; and<br/>
<a id="pl.16.7"></a><var>16.7</var>    (ii) general assistance medical care expenditures may be considered only to the extent <br/>
<a id="pl.16.8"></a><var>16.8</var>of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and<br/>
<a id="pl.16.9"></a><var>16.9</var>    (2) all hospitals must provide any necessary expenditure, cost, and revenue <br/>
<a id="pl.16.10"></a><var>16.10</var>information required by the commissioner as necessary for purposes of obtaining federal <br/>
<a id="pl.16.11"></a><var>16.11</var>Medicaid matching funds for general assistance medical care expenditures.<br/>
<br/>
<a id="bill.0.16.0"></a><a id="pl.16.12"></a><var>16.12</var>    Sec. 16. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:<br/>
<a id="pl.16.13"></a><var>16.13</var>    Subd. 5a. <b>Managed care contracts.</b> (a) Managed care contracts under this section <br/>
<a id="pl.16.14"></a><var>16.14</var>and sections 
         <statute_ref>256L.12</statute_ref> and 
         <statute_ref>256D.03</statute_ref>, shall be entered into or renewed on a calendar year <br/>
<a id="pl.16.15"></a><var>16.15</var>basis beginning January 1, 1996. Managed care contracts which were in effect on June <br/>
<a id="pl.16.16"></a><var>16.16</var>30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995 <br/>
<a id="pl.16.17"></a><var>16.17</var>through December 31, 1995 at the same terms that were in effect on June 30, 1995. The <br/>
<a id="pl.16.18"></a><var>16.18</var>commissioner may issue separate contracts with requirements specific to services to <br/>
<a id="pl.16.19"></a><var>16.19</var>medical assistance recipients age 65 and older.<br/>
<a id="pl.16.20"></a><var>16.20</var>    (b) A prepaid health plan providing covered health services for eligible persons <br/>
<a id="pl.16.21"></a><var>16.21</var>pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms <br/>
<a id="pl.16.22"></a><var>16.22</var>of its contract with the commissioner. Requirements applicable to managed care programs <br/>
<a id="pl.16.23"></a><var>16.23</var>under chapters 256B, 256D, and 256L, established after the effective date of a contract <br/>
<a id="pl.16.24"></a><var>16.24</var>with the commissioner take effect when the contract is next issued or renewed.<br/>
<a id="pl.16.25"></a><var>16.25</var>    (c) Effective for services rendered on or after January 1, 2003, the commissioner <br/>
<a id="pl.16.26"></a><var>16.26</var>shall withhold five percent of managed care plan payments under this section for the <br/>
<a id="pl.16.27"></a><var>16.27</var>prepaid medical assistance and general assistance medical care programs pending <br/>
<a id="pl.16.28"></a><var>16.28</var>completion of performance targets. Each performance target must be quantifiable, <br/>
<a id="pl.16.29"></a><var>16.29</var>objective, measurable, and reasonably attainable, except in the case of a performance <br/>
<a id="pl.16.30"></a><var>16.30</var>target based on a federal or state law or rule. Criteria for assessment of each performance <br/>
<a id="pl.16.31"></a><var>16.31</var>target must be outlined in writing prior to the contract effective date. The managed <br/>
<a id="pl.16.32"></a><var>16.32</var>care plan must demonstrate, to the commissioner's satisfaction, that the data submitted <br/>
<a id="pl.16.33"></a><var>16.33</var>regarding attainment of the performance target is accurate. The commissioner shall <br/>
<a id="pl.16.34"></a><var>16.34</var>periodically change the administrative measures used as performance targets in order <br/>
<a id="pl.16.35"></a><var>16.35</var>to improve plan performance across a broader range of administrative services. The <br/>
<a id="pl.17.1"></a><var>17.1</var>performance targets must include measurement of plan efforts to contain spending <br/>
<a id="pl.17.2"></a><var>17.2</var>on health care services and administrative activities. The commissioner may adopt <br/>
<a id="pl.17.3"></a><var>17.3</var>plan-specific performance targets that take into account factors affecting only one plan, <br/>
<a id="pl.17.4"></a><var>17.4</var>including characteristics of the plan's enrollee population. The withheld funds must be <br/>
<a id="pl.17.5"></a><var>17.5</var>returned no sooner than July of the following year if performance targets in the contract <br/>
<a id="pl.17.6"></a><var>17.6</var>are achieved. The commissioner may exclude special demonstration projects under <br/>
<a id="pl.17.7"></a><var>17.7</var>subdivision 23. A managed care plan or a county-based purchasing plan under section <br/>
<statute_ref><a id="pl.17.8"></a><var>17.8</var>256B.692
         </statute_ref> may include as admitted assets under section 
         <statute_ref>62D.044</statute_ref> any amount withheld <br/>
<a id="pl.17.9"></a><var>17.9</var>under this paragraph that is reasonably expected to be returned.<br/>
<a id="pl.17.10"></a><var>17.10</var>    (d)(1) Effective for services rendered on or after January 1, 2009, the commissioner <br/>
<a id="pl.17.11"></a><var>17.11</var>shall withhold three percent of managed care plan payments under this section for the <br/>
<a id="pl.17.12"></a><var>17.12</var>prepaid medical assistance and general assistance medical care programs. The withheld <br/>
<a id="pl.17.13"></a><var>17.13</var>funds must be returned no sooner than July 1 and no later than July 31 of the following <br/>
<a id="pl.17.14"></a><var>17.14</var>year. The commissioner may exclude special demonstration projects under subdivision 23.<br/>
<a id="pl.17.15"></a><var>17.15</var>    (2) A managed care plan or a county-based purchasing plan under section 
         <statute_ref>256B.692 <br/>
</statute_ref><a id="pl.17.16"></a><var>17.16</var>may include as admitted assets under section 
         <statute_ref>62D.044</statute_ref> any amount withheld under <br/>
<a id="pl.17.17"></a><var>17.17</var>this paragraph. The return of the withhold under this paragraph is not subject to the <br/>
<a id="pl.17.18"></a><var>17.18</var>requirements of paragraph (c).<br/>
<a id="pl.17.19"></a><var>17.19</var>(e) Contracts between the commissioner and a prepaid health plan are exempt from <br/>
<a id="pl.17.20"></a><var>17.20</var>the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph <br/>
<a id="pl.17.21"></a><var>17.21</var>(a), and 7.<br/>
<br/>
<a id="bill.0.17.0"></a><a id="pl.17.22"></a><var>17.22</var>    Sec. 17. Minnesota Statutes 2008, section 256B.77, subdivision 13, is amended to read:<br/>
<a id="pl.17.23"></a><var>17.23</var>    Subd. 13. <b>Ombudsman.</b> Enrollees shall have access to ombudsman services <br/>
<a id="pl.17.24"></a><var>17.24</var>established in section 
         <statute_ref>256B.031, subdivision 6</statute_ref> 256B.69, subdivision 20, and advocacy <br/>
<a id="pl.17.25"></a><var>17.25</var>services provided by the ombudsman for mental health and developmental disabilities <br/>
<a id="pl.17.26"></a><var>17.26</var>established in sections 
         <statute_ref>245.91</statute_ref> to 
         <statute_ref>245.97</statute_ref>. The managed care ombudsman and the <br/>
<a id="pl.17.27"></a><var>17.27</var>ombudsman for mental health and developmental disabilities shall coordinate services <br/>
<a id="pl.17.28"></a><var>17.28</var>provided to avoid duplication of services. For purposes of the demonstration project, <br/>
<a id="pl.17.29"></a><var>17.29</var>the powers and responsibilities of the Office of Ombudsman for Mental Health and <br/>
<a id="pl.17.30"></a><var>17.30</var>Developmental Disabilities, as provided in sections 
         <statute_ref>245.91</statute_ref> to 
         <statute_ref>245.97</statute_ref> are expanded <br/>
<a id="pl.17.31"></a><var>17.31</var>to include all eligible individuals, health plan companies, agencies, and providers <br/>
<a id="pl.17.32"></a><var>17.32</var>participating in the demonstration project. <br/>
<br/>
<a id="bill.0.18.0"></a><a id="pl.17.33"></a><var>17.33</var>    Sec. 18. Minnesota Statutes 2008, section 256D.03, subdivision 3, is amended to read:<br/>
<a id="pl.18.1"></a><var>18.1</var>    Subd. 3.  <b>General assistance medical care; eligibility.</b> (a) General assistance <br/>
<a id="pl.18.2"></a><var>18.2</var>medical care may be paid for any person who is not eligible for medical assistance under <br/>
<a id="pl.18.3"></a><var>18.3</var>chapter 256B, including eligibility for medical assistance based on a spenddown of excess <br/>
<a id="pl.18.4"></a><var>18.4</var>income according to section 
         <statute_ref>256B.056, subdivision 5</statute_ref>, or MinnesotaCare as for applicants <br/>
<a id="pl.18.5"></a><var>18.5</var>and recipients defined in paragraph (b) (c), except as provided in paragraph (c) (d), and: <br/>
<a id="pl.18.6"></a><var>18.6</var>    (1) who is receiving assistance under section 
         <statute_ref>256D.05</statute_ref>, except for families with <br/>
<a id="pl.18.7"></a><var>18.7</var>children who are eligible under Minnesota family investment program (MFIP), or who is <br/>
<a id="pl.18.8"></a><var>18.8</var>having a payment made on the person's behalf under sections 
         <statute_ref>256I.01</statute_ref> to 
         <statute_ref>256I.06</statute_ref>; or <br/>
<a id="pl.18.9"></a><var>18.9</var>    (2) who is a resident of Minnesota; and <br/>
<a id="pl.18.10"></a><var>18.10</var>    (i) who has gross countable income not in excess of 75 percent of the federal poverty <br/>
<a id="pl.18.11"></a><var>18.11</var>guidelines for the family size, using a six-month budget period and whose equity in assets <br/>
<a id="pl.18.12"></a><var>18.12</var>is not in excess of $1,000 per assistance unit. General assistance medical care is not <br/>
<a id="pl.18.13"></a><var>18.13</var>available for applicants or enrollees who are otherwise eligible for medical assistance but <br/>
<a id="pl.18.14"></a><var>18.14</var>fail to verify their assets. Enrollees who become eligible for medical assistance shall be <br/>
<a id="pl.18.15"></a><var>18.15</var>terminated and transferred to medical assistance. Exempt assets, the reduction of excess <br/>
<a id="pl.18.16"></a><var>18.16</var>assets, and the waiver of excess assets must conform to the medical assistance program in <br/>
<a id="pl.18.17"></a><var>18.17</var>section 
         <statute_ref>256B.056, subdivisions 3</statute_ref> and 3d, with the following exception: the maximum <br/>
<a id="pl.18.18"></a><var>18.18</var>amount of undistributed funds in a trust that could be distributed to or on behalf of the <br/>
<a id="pl.18.19"></a><var>18.19</var>beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the <br/>
<a id="pl.18.20"></a><var>18.20</var>terms of the trust, must be applied toward the asset maximum; or <br/>
<a id="pl.18.21"></a><var>18.21</var>    (ii) who has gross countable income above 75 percent of the federal poverty <br/>
<a id="pl.18.22"></a><var>18.22</var>guidelines but not in excess of 175 percent of the federal poverty guidelines for the <br/>
<a id="pl.18.23"></a><var>18.23</var>family size, using a six-month budget period, whose equity in assets is not in excess <br/>
<a id="pl.18.24"></a><var>18.24</var>of the limits in section 
         <statute_ref>256B.056, subdivision 3c</statute_ref>, and who applies during an inpatient <br/>
<a id="pl.18.25"></a><var>18.25</var>hospitalization; or. <br/>
<a id="pl.18.26"></a><var>18.26</var>    (iii) (b) the commissioner shall adjust the income standards under this section each <br/>
<a id="pl.18.27"></a><var>18.27</var>July 1 by the annual update of the federal poverty guidelines following publication by the <br/>
<a id="pl.18.28"></a><var>18.28</var>United States Department of Health and Human Services. <br/>
<a id="pl.18.29"></a><var>18.29</var>    (b) (c) Effective for applications and renewals processed on or after September 1, <br/>
<a id="pl.18.30"></a><var>18.30</var>2006, general assistance medical care may not be paid for applicants or recipients who are <br/>
<a id="pl.18.31"></a><var>18.31</var>adults with dependent children under 21 whose gross family income is equal to or less than <br/>
<a id="pl.18.32"></a><var>18.32</var>275 percent of the federal poverty guidelines who are not described in paragraph (e) (f). <br/>
<a id="pl.18.33"></a><var>18.33</var>    (c) (d) Effective for applications and renewals processed on or after September 1, <br/>
<a id="pl.18.34"></a><var>18.34</var>2006, general assistance medical care may be paid for applicants and recipients who meet <br/>
<a id="pl.18.35"></a><var>18.35</var>all eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period <br/>
<a id="pl.18.36"></a><var>18.36</var>beginning the date of application. Immediately following approval of general assistance <br/>
<a id="pl.19.1"></a><var>19.1</var>medical care, enrollees shall be enrolled in MinnesotaCare under section 
         <statute_ref>256L.04, <br/>
<a id="pl.19.2"></a><var>19.2</var>subdivision 7
         </statute_ref>, with covered services as provided in section 
         <statute_ref>256L.03</statute_ref> for the rest of the <br/>
<a id="pl.19.3"></a><var>19.3</var>six-month general assistance medical care eligibility period, until their six-month renewal. <br/>
<a id="pl.19.4"></a><var>19.4</var>    (d) (e) To be eligible for general assistance medical care following enrollment in <br/>
<a id="pl.19.5"></a><var>19.5</var>MinnesotaCare as required by paragraph (c) (d), an individual must complete a new <br/>
<a id="pl.19.6"></a><var>19.6</var>application. <br/>
<a id="pl.19.7"></a><var>19.7</var>    (e) (f) Applicants and recipients eligible under paragraph (a), clause (1) (2), item (i), <br/>
<a id="pl.19.8"></a><var>19.8</var>are exempt from the MinnesotaCare enrollment requirements in this subdivision if they: <br/>
<a id="pl.19.9"></a><var>19.9</var>    (1) have applied for and are awaiting a determination of blindness or disability by <br/>
<a id="pl.19.10"></a><var>19.10</var>the state medical review team or a determination of eligibility for Supplemental Security <br/>
<a id="pl.19.11"></a><var>19.11</var>Income or Social Security Disability Insurance by the Social Security Administration; <br/>
<a id="pl.19.12"></a><var>19.12</var>    (2) fail to meet the requirements of section 
         <statute_ref>256L.09, subdivision 2</statute_ref>; <br/>
<a id="pl.19.13"></a><var>19.13</var>    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.; <br/>
<a id="pl.19.14"></a><var>19.14</var>    (4) are classified as end-stage renal disease beneficiaries in the Medicare program; <br/>
<a id="pl.19.15"></a><var>19.15</var>    (5) are enrolled in private health care coverage as defined in section 
         <statute_ref>256B.02</statute_ref>, <br/>
<a id="pl.19.16"></a><var>19.16</var>subdivision 9; <br/>
<a id="pl.19.17"></a><var>19.17</var>    (6) are eligible under paragraph (j) (k); <br/>
<a id="pl.19.18"></a><var>19.18</var>    (7) receive treatment funded pursuant to section 
         <statute_ref>254B.02</statute_ref>; or <br/>
<a id="pl.19.19"></a><var>19.19</var>    (8) reside in the Minnesota sex offender program defined in chapter 246B. <br/>
<a id="pl.19.20"></a><var>19.20</var>    (f) (g) For applications received on or after October 1, 2003, eligibility may begin no <br/>
<a id="pl.19.21"></a><var>19.21</var>earlier than the date of application. For individuals eligible under paragraph (a), clause <br/>
<a id="pl.19.22"></a><var>19.22</var>(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are <br/>
<a id="pl.19.23"></a><var>19.23</var>eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but <br/>
<a id="pl.19.24"></a><var>19.24</var>may reapply if there is a subsequent period of inpatient hospitalization. <br/>
<a id="pl.19.25"></a><var>19.25</var>    (g) (h) Beginning September 1, 2006, Minnesota health care program applications <br/>
<a id="pl.19.26"></a><var>19.26</var>and renewals completed by recipients and applicants who are persons described <br/>
<a id="pl.19.27"></a><var>19.27</var>in paragraph (c) (d) and submitted to the county agency shall be determined for <br/>
<a id="pl.19.28"></a><var>19.28</var>MinnesotaCare eligibility by the county agency. If all other eligibility requirements of <br/>
<a id="pl.19.29"></a><var>19.29</var>this subdivision are met, eligibility for general assistance medical care shall be available <br/>
<a id="pl.19.30"></a><var>19.30</var>in any month during which MinnesotaCare enrollment is pending. Upon notification of <br/>
<a id="pl.19.31"></a><var>19.31</var>eligibility for MinnesotaCare, notice of termination for eligibility for general assistance <br/>
<a id="pl.19.32"></a><var>19.32</var>medical care shall be sent to an applicant or recipient. If all other eligibility requirements <br/>
<a id="pl.19.33"></a><var>19.33</var>of this subdivision are met, eligibility for general assistance medical care shall be available <br/>
<a id="pl.19.34"></a><var>19.34</var>until enrollment in MinnesotaCare subject to the provisions of paragraphs (c) (d), (e) (f), <br/>
<a id="pl.19.35"></a><var>19.35</var>and (f) (g). <br/>
<a id="pl.20.1"></a><var>20.1</var>    (h) (i) The date of an initial Minnesota health care program application necessary <br/>
<a id="pl.20.2"></a><var>20.2</var>to begin a determination of eligibility shall be the date the applicant has provided a <br/>
<a id="pl.20.3"></a><var>20.3</var>name, address, and Social Security number, signed and dated, to the county agency <br/>
<a id="pl.20.4"></a><var>20.4</var>or the Department of Human Services. If the applicant is unable to provide a name, <br/>
<a id="pl.20.5"></a><var>20.5</var>address, Social Security number, and signature when health care is delivered due to a <br/>
<a id="pl.20.6"></a><var>20.6</var>medical condition or disability, a health care provider may act on an applicant's behalf to <br/>
<a id="pl.20.7"></a><var>20.7</var>establish the date of an initial Minnesota health care program application by providing <br/>
<a id="pl.20.8"></a><var>20.8</var>the county agency or Department of Human Services with provider identification and a <br/>
<a id="pl.20.9"></a><var>20.9</var>temporary unique identifier for the applicant. The applicant must complete the remainder <br/>
<a id="pl.20.10"></a><var>20.10</var>of the application and provide necessary verification before eligibility can be determined. <br/>
<a id="pl.20.11"></a><var>20.11</var>The applicant must complete the application within the time periods required under the <br/>
<a id="pl.20.12"></a><var>20.12</var>medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart <br/>
<a id="pl.20.13"></a><var>20.13</var>5, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining <br/>
<a id="pl.20.14"></a><var>20.14</var>verification if necessary. <br/>
<a id="pl.20.15"></a><var>20.15</var>    (i) (j) County agencies are authorized to use all automated databases containing <br/>
<a id="pl.20.16"></a><var>20.16</var>information regarding recipients' or applicants' income in order to determine eligibility for <br/>
<a id="pl.20.17"></a><var>20.17</var>general assistance medical care or MinnesotaCare. Such use shall be considered sufficient <br/>
<a id="pl.20.18"></a><var>20.18</var>in order to determine eligibility and premium payments by the county agency. <br/>
<a id="pl.20.19"></a><var>20.19</var>    (j) (k) General assistance medical care is not available for a person in a correctional <br/>
<a id="pl.20.20"></a><var>20.20</var>facility unless the person is detained by law for less than one year in a county correctional <br/>
<a id="pl.20.21"></a><var>20.21</var>or detention facility as a person accused or convicted of a crime, or admitted as an <br/>
<a id="pl.20.22"></a><var>20.22</var>inpatient to a hospital on a criminal hold order, and the person is a recipient of general <br/>
<a id="pl.20.23"></a><var>20.23</var>assistance medical care at the time the person is detained by law or admitted on a criminal <br/>
<a id="pl.20.24"></a><var>20.24</var>hold order and as long as the person continues to meet other eligibility requirements <br/>
<a id="pl.20.25"></a><var>20.25</var>of this subdivision. <br/>
<a id="pl.20.26"></a><var>20.26</var>    (k) (l) General assistance medical care is not available for applicants or recipients <br/>
<a id="pl.20.27"></a><var>20.27</var>who do not cooperate with the county agency to meet the requirements of medical <br/>
<a id="pl.20.28"></a><var>20.28</var>assistance. <br/>
<a id="pl.20.29"></a><var>20.29</var>    (l) (m) In determining the amount of assets of an individual eligible under paragraph <br/>
<a id="pl.20.30"></a><var>20.30</var>(a), clause (2), item (i), there shall be included any asset or interest in an asset, including <br/>
<a id="pl.20.31"></a><var>20.31</var>an asset excluded under paragraph (a), that was given away, sold, or disposed of for <br/>
<a id="pl.20.32"></a><var>20.32</var>less than fair market value within the 60 months preceding application for general <br/>
<a id="pl.20.33"></a><var>20.33</var>assistance medical care or during the period of eligibility. Any transfer described in this <br/>
<a id="pl.20.34"></a><var>20.34</var>paragraph shall be presumed to have been for the purpose of establishing eligibility for <br/>
<a id="pl.20.35"></a><var>20.35</var>general assistance medical care, unless the individual furnishes convincing evidence to <br/>
<a id="pl.20.36"></a><var>20.36</var>establish that the transaction was exclusively for another purpose. For purposes of this <br/>
<a id="pl.21.1"></a><var>21.1</var>paragraph, the value of the asset or interest shall be the fair market value at the time it <br/>
<a id="pl.21.2"></a><var>21.2</var>was given away, sold, or disposed of, less the amount of compensation received. For any <br/>
<a id="pl.21.3"></a><var>21.3</var>uncompensated transfer, the number of months of ineligibility, including partial months, <br/>
<a id="pl.21.4"></a><var>21.4</var>shall be calculated by dividing the uncompensated transfer amount by the average monthly <br/>
<a id="pl.21.5"></a><var>21.5</var>per person payment made by the medical assistance program to skilled nursing facilities <br/>
<a id="pl.21.6"></a><var>21.6</var>for the previous calendar year. The individual shall remain ineligible until this fixed period <br/>
<a id="pl.21.7"></a><var>21.7</var>has expired. The period of ineligibility may exceed 30 months, and a reapplication for <br/>
<a id="pl.21.8"></a><var>21.8</var>benefits after 30 months from the date of the transfer shall not result in eligibility unless <br/>
<a id="pl.21.9"></a><var>21.9</var>and until the period of ineligibility has expired. The period of ineligibility begins in the <br/>
<a id="pl.21.10"></a><var>21.10</var>month the transfer was reported to the county agency, or if the transfer was not reported, <br/>
<a id="pl.21.11"></a><var>21.11</var>the month in which the county agency discovered the transfer, whichever comes first. For <br/>
<a id="pl.21.12"></a><var>21.12</var>applicants, the period of ineligibility begins on the date of the first approved application. <br/>
<a id="pl.21.13"></a><var>21.13</var>    (m) (n) When determining eligibility for any state benefits under this subdivision, <br/>
<a id="pl.21.14"></a><var>21.14</var>the income and resources of all noncitizens shall be deemed to include their sponsor's <br/>
<a id="pl.21.15"></a><var>21.15</var>income and resources as defined in the Personal Responsibility and Work Opportunity <br/>
<a id="pl.21.16"></a><var>21.16</var>Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and <br/>
<a id="pl.21.17"></a><var>21.17</var>subsequently set out in federal rules. <br/>
<a id="pl.21.18"></a><var>21.18</var>    (n) (o) Undocumented noncitizens and nonimmigrants are ineligible for general <br/>
<a id="pl.21.19"></a><var>21.19</var>assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual <br/>
<a id="pl.21.20"></a><var>21.20</var>in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and <br/>
<a id="pl.21.21"></a><var>21.21</var>an undocumented noncitizen is an individual who resides in the United States without the <br/>
<a id="pl.21.22"></a><var>21.22</var>approval or acquiescence of the United States Citizenship and Immigration Services. <br/>
<a id="pl.21.23"></a><var>21.23</var>    (o) (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for <br/>
<a id="pl.21.24"></a><var>21.24</var>medical assistance due to the deeming of a sponsor's income and resources, is ineligible <br/>
<a id="pl.21.25"></a><var>21.25</var>for general assistance medical care. <br/>
<a id="pl.21.26"></a><var>21.26</var>    (p) (q) Effective July 1, 2003, general assistance medical care emergency services <br/>
<a id="pl.21.27"></a><var>21.27</var>end. <br/>
<br/>
<a id="bill.0.19.0"></a><a id="pl.21.28"></a><var>21.28</var>    Sec. 19. Minnesota Statutes 2008, section 256L.03, subdivision 5, is amended to read:<br/>
<a id="pl.21.29"></a><var>21.29</var>    Subd. 5. <b>Co-payments and coinsurance.</b> (a) Except as provided in paragraphs (b) <br/>
<a id="pl.21.30"></a><var>21.30</var>and (c), the MinnesotaCare benefit plan shall include the following co-payments and <br/>
<a id="pl.21.31"></a><var>21.31</var>coinsurance requirements for all enrollees:<br/>
<a id="pl.21.32"></a><var>21.32</var>    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees, <br/>
<a id="pl.21.33"></a><var>21.33</var>subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and <br/>
<a id="pl.21.34"></a><var>21.34</var>$3,000 per family;<br/>
<a id="pl.21.35"></a><var>21.35</var>    (2) $3 per prescription for adult enrollees;<br/>
<a id="pl.22.1"></a><var>22.1</var>    (3) $25 for eyeglasses for adult enrollees;<br/>
<a id="pl.22.2"></a><var>22.2</var>    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an <br/>
<a id="pl.22.3"></a><var>22.3</var>episode of service which is required because of a recipient's symptoms, diagnosis, or <br/>
<a id="pl.22.4"></a><var>22.4</var>established illness, and which is delivered in an ambulatory setting by a physician or <br/>
<a id="pl.22.5"></a><var>22.5</var>physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, <br/>
<a id="pl.22.6"></a><var>22.6</var>audiologist, optician, or optometrist; and<br/>
<a id="pl.22.7"></a><var>22.7</var>    (5) $6 for nonemergency visits to a hospital-based emergency room.<br/>
<a id="pl.22.8"></a><var>22.8</var>    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of <br/>
<a id="pl.22.9"></a><var>22.9</var>children under the age of 21.<br/>
<a id="pl.22.10"></a><var>22.10</var>    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.<br/>
<a id="pl.22.11"></a><var>22.11</var>    (d) Paragraph (a), clause (4), does not apply to mental health services.<br/>
<a id="pl.22.12"></a><var>22.12</var>    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal <br/>
<a id="pl.22.13"></a><var>22.13</var>poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, <br/>
<a id="pl.22.14"></a><var>22.14</var>and who are not pregnant shall be financially responsible for the coinsurance amount, if <br/>
<a id="pl.22.15"></a><var>22.15</var>applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.<br/>
<a id="pl.22.16"></a><var>22.16</var>    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan, <br/>
<a id="pl.22.17"></a><var>22.17</var>or changes from one prepaid health plan to another during a calendar year, any charges <br/>
<a id="pl.22.18"></a><var>22.18</var>submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket <br/>
<a id="pl.22.19"></a><var>22.19</var>expenses incurred by the enrollee for inpatient services, that were submitted or incurred <br/>
<a id="pl.22.20"></a><var>22.20</var>prior to enrollment, or prior to the change in health plans, shall be disregarded.<br/>
<br/>
<a id="bill.0.20.0"></a><a id="pl.22.21"></a><var>22.21</var>    Sec. 20. Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:<br/>
<a id="pl.22.22"></a><var>22.22</var>    Subd. 2. <b>Sliding fee scale; monthly gross individual or family income.</b> (a) The <br/>
<a id="pl.22.23"></a><var>22.23</var>commissioner shall establish a sliding fee scale to determine the percentage of monthly <br/>
<a id="pl.22.24"></a><var>22.24</var>gross individual or family income that households at different income levels must pay to <br/>
<a id="pl.22.25"></a><var>22.25</var>obtain coverage through the MinnesotaCare program. The sliding fee scale must be based <br/>
<a id="pl.22.26"></a><var>22.26</var>on the enrollee's monthly gross individual or family income. The sliding fee scale must <br/>
<a id="pl.22.27"></a><var>22.27</var>contain separate tables based on enrollment of one, two, or three or more persons. Until <br/>
<a id="pl.22.28"></a><var>22.28</var>June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross <br/>
<a id="pl.22.29"></a><var>22.29</var>individual or family income for individuals or families with incomes below the limits for <br/>
<a id="pl.22.30"></a><var>22.30</var>the medical assistance program for families and children in effect on January 1, 1999, and <br/>
<a id="pl.22.31"></a><var>22.31</var>proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and <br/>
<a id="pl.22.32"></a><var>22.32</var>8.8 percent. These percentages are matched to evenly spaced income steps ranging from <br/>
<a id="pl.22.33"></a><var>22.33</var>the medical assistance income limit for families and children in effect on January 1, 1999, <br/>
<a id="pl.22.34"></a><var>22.34</var>to 275 percent of the federal poverty guidelines for the applicable family size, up to a <br/>
<a id="pl.22.35"></a><var>22.35</var>family size of five. The sliding fee scale for a family of five must be used for families of <br/>
<a id="pl.23.1"></a><var>23.1</var>more than five. The sliding fee scale and percentages are not subject to the provisions of <br/>
<a id="pl.23.2"></a><var>23.2</var>chapter 14. If a family or individual reports increased income after enrollment, premiums <br/>
<a id="pl.23.3"></a><var>23.3</var>shall be adjusted at the time the change in income is reported.<br/>
<a id="pl.23.4"></a><var>23.4</var>    (b) Children in families whose gross income is above 275 percent of the federal <br/>
<a id="pl.23.5"></a><var>23.5</var>poverty guidelines shall pay the maximum premium. The maximum premium is defined <br/>
<a id="pl.23.6"></a><var>23.6</var>as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare <br/>
<a id="pl.23.7"></a><var>23.7</var>cases paid the maximum premium, the total revenue would equal the total cost of <br/>
<a id="pl.23.8"></a><var>23.8</var>MinnesotaCare medical coverage and administration. In this calculation, administrative <br/>
<a id="pl.23.9"></a><var>23.9</var>costs shall be assumed to equal ten percent of the total. The costs of medical coverage <br/>
<a id="pl.23.10"></a><var>23.10</var>for pregnant women and children under age two and the enrollees in these groups shall <br/>
<a id="pl.23.11"></a><var>23.11</var>be excluded from the total. The maximum premium for two enrollees shall be twice the <br/>
<a id="pl.23.12"></a><var>23.12</var>maximum premium for one, and the maximum premium for three or more enrollees shall <br/>
<a id="pl.23.13"></a><var>23.13</var>be three times the maximum premium for one.<br/>
<a id="pl.23.14"></a><var>23.14</var>    (c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according <br/>
<a id="pl.23.15"></a><var>23.15</var>to the premium scale specified in paragraph (d) with the exception that children in families <br/>
<a id="pl.23.16"></a><var>23.16</var>with income at or below 150 percent of the federal poverty guidelines shall pay a monthly <br/>
<a id="pl.23.17"></a><var>23.17</var>premium of $4. For purposes of paragraph (d), "minimum" means a monthly premium <br/>
<a id="pl.23.18"></a><var>23.18</var>of $4.<br/>
<a id="pl.23.19"></a><var>23.19</var>    (d) The following premium scale is established for individuals and families with <br/>
<a id="pl.23.20"></a><var>23.20</var>gross family incomes of 300 275 percent of the federal poverty guidelines or less:<br/>
<table>
<col width="50px"/>
<col width=""/>
<col width=""/>
<tr>
<td><a id="pl.23.21"></a><var>23.21</var><br/>
<a id="pl.23.22"></a><var>23.22</var><br/>
</td>
<td><b>Federal Poverty Guideline Range</b><br/>
</td>
<td><b>Percent of Average Gross Monthly </b><br/>
<b>Income</b><br/>
</td>
</tr>
<tr>
<td><a id="pl.23.23"></a><var>23.23</var><br/>
</td>
<td>0-45%<br/>
</td>
<td>minimum<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.24"></a><var>23.24</var><br/>
<a id="pl.23.25"></a><var>23.25</var><br/>
</td>
<td valign="top">46-54%<br/>
</td>
<td valign="top">$4 or 1.1% of family income, whichever is <br/>
greater<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.26"></a><var>23.26</var><br/>
</td>
<td>55-81%<br/>
</td>
<td>1.6%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.27"></a><var>23.27</var><br/>
</td>
<td>82-109%<br/>
</td>
<td>2.2%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.28"></a><var>23.28</var><br/>
</td>
<td>110-136%<br/>
</td>
<td>2.9%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.29"></a><var>23.29</var><br/>
</td>
<td>137-164%<br/>
</td>
<td>3.6%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.30"></a><var>23.30</var><br/>
</td>
<td>165-191%<br/>
</td>
<td>4.6%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.31"></a><var>23.31</var><br/>
</td>
<td>192-219%<br/>
</td>
<td>5.6%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.32"></a><var>23.32</var><br/>
</td>
<td>220-248%<br/>
</td>
<td>6.5%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.33"></a><var>23.33</var><br/>
</td>
<td>249-274%249-275%<br/>
</td>
<td>7.2%<br/>
</td>
</tr>
<tr>
<td><a id="pl.23.34"></a><var>23.34</var><br/>
</td>
<td>275-300%<br/>
</td>
<td>8.0%<br/>
</td>
</tr>
</table><a id="pl.23.35"></a><var>23.35</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2009, or upon federal <br/>
<a id="pl.23.36"></a><var>23.36</var>approval, whichever is later. The commissioner of human services shall notify the revisor <br/>
<a id="pl.23.37"></a><var>23.37</var>of statutes when federal approval is obtained.<br/>
<br/>
<a id="bill.0.21.0"></a><a id="pl.24.1"></a><var>24.1</var>    Sec. 21. Laws 2005, First Special Session chapter 4, article 8, section 54, the effective <br/>
<a id="pl.24.2"></a><var>24.2</var>date, is amended to read:<br/>
<a id="pl.24.3"></a><var>24.3</var><b>EFFECTIVE DATE.</b>This section is effective August 1, 2007, or upon HealthMatch <br/>
<a id="pl.24.4"></a><var>24.4</var>implementation, whichever is later 2009.<br/>
<br/>
<a id="bill.0.22.0"></a><a id="pl.24.5"></a><var>24.5</var>    Sec. 22. Laws 2005, First Special Session chapter 4, article 8, section 61, the effective <br/>
<a id="pl.24.6"></a><var>24.6</var>date, is amended to read:<br/>
<a id="pl.24.7"></a><var>24.7</var><b>EFFECTIVE DATE.</b>This section is effective August 1, 2007, or upon HealthMatch <br/>
<a id="pl.24.8"></a><var>24.8</var>implementation, whichever is later 2009.<br/>
<br/>
<a id="bill.0.23.0"></a><a id="pl.24.9"></a><var>24.9</var>    Sec. 23. Laws 2005, First Special Session chapter 4, article 8, section 63, the effective <br/>
<a id="pl.24.10"></a><var>24.10</var>date, is amended to read:<br/>
<a id="pl.24.11"></a><var>24.11</var><b>EFFECTIVE DATE.</b>This section is effective August 1, 2007, or upon HealthMatch <br/>
<a id="pl.24.12"></a><var>24.12</var>implementation, whichever is later 2009.<br/>
<br/>
<a id="bill.0.24.0"></a><a id="pl.24.13"></a><var>24.13</var>    Sec. 24. Laws 2005, First Special Session chapter 4, article 8, section 66, the effective <br/>
<a id="pl.24.14"></a><var>24.14</var>date, is amended to read:<br/>
<a id="pl.24.15"></a><var>24.15</var><b>EFFECTIVE DATE.</b>Paragraph (a) is effective August 1, 2007, or upon <br/>
<a id="pl.24.16"></a><var>24.16</var>HealthMatch implementation, whichever is later 2009, and paragraph (e) is effective <br/>
<a id="pl.24.17"></a><var>24.17</var>September 1, 2006.<br/>
<br/>
<a id="bill.0.25.0"></a><a id="pl.24.18"></a><var>24.18</var>    Sec. 25. Laws 2005, First Special Session chapter 4, article 8, section 74, the effective <br/>
<a id="pl.24.19"></a><var>24.19</var>date, is amended to read:<br/>
<a id="pl.24.20"></a><var>24.20</var><b>EFFECTIVE DATE.</b>The amendment to paragraph (a) changing gross family or <br/>
<a id="pl.24.21"></a><var>24.21</var>individual income to monthly gross family or individual income is effective August 1, <br/>
<a id="pl.24.22"></a><var>24.22</var>2007, or upon implementation of HealthMatch, whichever is later 2009. The amendment <br/>
<a id="pl.24.23"></a><var>24.23</var>to paragraph (a) related to premium adjustments and changes of income and the <br/>
<a id="pl.24.24"></a><var>24.24</var>amendment to paragraph (c) are effective September 1, 2005, or upon federal approval, <br/>
<a id="pl.24.25"></a><var>24.25</var>whichever is later. Prior to the implementation of HealthMatch, The commissioner <br/>
<a id="pl.24.26"></a><var>24.26</var>shall implement this section to the fullest extent possible, including the use of manual <br/>
<a id="pl.24.27"></a><var>24.27</var>processing. Upon implementation of HealthMatch, the commissioner shall implement this <br/>
<a id="pl.24.28"></a><var>24.28</var>section in a manner consistent with the procedures and requirements of HealthMatch.<br/>
<br/>
<a id="bill.0.26.0"></a><a id="pl.24.29"></a><var>24.29</var>    Sec. 26. <b> REPEALER.</b><br/>
<a id="pl.25.1"></a><var>25.1</var>(a) Minnesota Statutes 2008, sections 256B.031; and 256L.01, subdivision 4, are <br/>
<a id="pl.25.2"></a><var>25.2</var>repealed.<br/>
<a id="pl.25.3"></a><var>25.3</var>(b) Laws 2005, First Special Session chapter 4, article 8, sections 21; 22; 23; and <br/>
<a id="pl.25.4"></a><var>25.4</var>24, are repealed.<br/>
<a id="pl.25.5"></a><var>25.5</var><b>EFFECTIVE DATE.</b>This section is effective August 1, 2009.<br/>