1.1 	A bill for an act
1.2 	relating to health care; establishing mental health urgent care and consultation 
1.3 	services; modifying the general assistance medical care program; requiring 
1.4 	a report; appropriating money;amending Minnesota Statutes 2008, sections 
1.5 	256.969, subdivision 27, by adding a subdivision; 256B.0625, subdivision 13f, 
1.6 	by adding a subdivision; 256D.03, subdivisions 3a, 3b; 256D.06, subdivision 7; 
1.7 	256L.05, subdivisions 1b, 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4; 
1.8 	256L.17, subdivision 7; Minnesota Statutes 2009 Supplement, sections 256.969, 
1.9 	subdivisions 2b, 3a; 256B.196, subdivision 2; 256B.199; 256D.03, subdivision 
1.10 	3; proposing coding for new law in Minnesota Statutes, chapters 245; 256D.
1.11 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

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

3.15 	Sec. 2. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 2b, is 
3.16 	amended to read:
3.17 		Subd. 2b.Operating payment rates. In determining operating payment rates for 
3.18 	admissions occurring on or after the rate year beginning January 1, 1991, and every two 
3.19 	years after, or more frequently as determined by the commissioner, the commissioner shall 
3.20 	obtain operating data from an updated base year and establish operating payment rates 
3.21 	per admission for each hospital based on the cost-finding methods and allowable costs of 
3.22 	the Medicare program in effect during the base year. Rates under the general assistance 
3.23 	medical care, medical assistance, and MinnesotaCare programs shall not be rebased to 
3.24 	more current data on January 1, 1997, January 1, 2005, for the first 24 months of the 
3.25 	rebased period beginning January 1, 2009. For the first three six months of the rebased 
3.26 	period beginning January 1, 2011, rates shall not be rebased at 74.25 percent of the full 
3.27 	value of the rebasing percentage change. From April July 1, 2011, to March 31, 2012, 
3.28 	rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change. 
3.29 	Effective April 1, 2012, rates shall be rebased at full value. The base year operating 
3.30 	payment rate per admission is standardized by the case mix index and adjusted by the 
3.31 	hospital cost index, relative values, and disproportionate population adjustment. The 
3.32 	cost and charge data used to establish operating rates shall only reflect inpatient services 
3.33 	covered by medical assistance and shall not include property cost information and costs 
3.34 	recognized in outlier payments.

4.1 	Sec. 3. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is 
4.2 	amended to read:
4.3 		Subd. 3a.Payments. (a) Acute care hospital billings under the medical 
4.4 	assistance program must not be submitted until the recipient is discharged. However, 
4.5 	the commissioner shall establish monthly interim payments for inpatient hospitals that 
4.6 	have individual patient lengths of stay over 30 days regardless of diagnostic category. 
4.7 	Except as provided in section 256.9693, medical assistance reimbursement for treatment 
4.8 	of mental illness shall be reimbursed based on diagnostic classifications. Individual 
4.9 	hospital payments established under this section and sections 256.9685, 256.9686, and 
4.10 	256.9695, in addition to third party and recipient liability, for discharges occurring during 
4.11 	the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 
4.12 	inpatient services paid for the same period of time to the hospital. This payment limitation 
4.13 	shall be calculated separately for medical assistance and general assistance medical 
4.14 	care services. The limitation on general assistance medical care shall be effective for 
4.15 	admissions occurring on or after July 1, 1991. Services that have rates established under 
4.16 	subdivision 11 or 12, must be limited separately from other services. After consulting with 
4.17 	the affected hospitals, the commissioner may consider related hospitals one entity and 
4.18 	may merge the payment rates while maintaining separate provider numbers. The operating 
4.19 	and property base rates per admission or per day shall be derived from the best Medicare 
4.20 	and claims data available when rates are established. The commissioner shall determine 
4.21 	the best Medicare and claims data, taking into consideration variables of recency of the 
4.22 	data, audit disposition, settlement status, and the ability to set rates in a timely manner. 
4.23 	The commissioner shall notify hospitals of payment rates by December 1 of the year 
4.24 	preceding the rate year. The rate setting data must reflect the admissions data used to 
4.25 	establish relative values. Base year changes from 1981 to the base year established for the 
4.26 	rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 
4.27 	to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 
4.28 	1. The commissioner may adjust base year cost, relative value, and case mix index data 
4.29 	to exclude the costs of services that have been discontinued by the October 1 of the year 
4.30 	preceding the rate year or that are paid separately from inpatient services. Inpatient stays 
4.31 	that encompass portions of two or more rate years shall have payments established based 
4.32 	on payment rates in effect at the time of admission unless the date of admission preceded 
4.33 	the rate year in effect by six months or more. In this case, operating payment rates for 
4.34 	services rendered during the rate year in effect and established based on the date of 
4.35 	admission shall be adjusted to the rate year in effect by the hospital cost index.
5.1 	(b) For fee-for-service admissions occurring on or after July 1, 2002, the total 
5.2 	payment, before third-party liability and spenddown, made to hospitals for inpatient 
5.3 	services is reduced by .5 percent from the current statutory rates.
5.4 	(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 
5.5 	admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 
5.6 	before third-party liability and spenddown, is reduced five percent from the current 
5.7 	statutory rates. Mental health services within diagnosis related groups 424 to 432, and 
5.8 	facilities defined under subdivision 16 are excluded from this paragraph.
5.9 	(d) In addition to the reduction in paragraphs (b) and (c), the total payment for 
5.10 	fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 
5.11 	inpatient services before third-party liability and spenddown, is reduced 6.0 percent 
5.12 	from the current statutory rates. Mental health services within diagnosis related groups 
5.13 	424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 
5.14 	Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical 
5.15 	assistance does not include general assistance medical care. Payments made to managed 
5.16 	care plans shall be reduced for services provided on or after January 1, 2006, to reflect 
5.17 	this reduction.
5.18 	(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 
5.19 	fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 
5.20 	to hospitals for inpatient services before third-party liability and spenddown, is reduced 
5.21 	3.46 percent from the current statutory rates. Mental health services with diagnosis related 
5.22 	groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 
5.23 	paragraph. Payments made to managed care plans shall be reduced for services provided 
5.24 	on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
5.25 	(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 
5.26 	fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011, 
5.27 	made to hospitals for inpatient services before third-party liability and spenddown, is 
5.28 	reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis 
5.29 	related groups 424 to 432 and facilities defined under subdivision 16 are excluded from 
5.30 	this paragraph. Payments made to managed care plans shall be reduced for services 
5.31 	provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.
5.32 	(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 
5.33 	for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals 
5.34 	for inpatient services before third-party liability and spenddown, is reduced 1.79 percent 
5.35 	from the current statutory rates. Mental health services with diagnosis related groups 
5.36 	424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 
6.1 	Payments made to managed care plans shall be reduced for services provided on or after 
6.2 	July 1, 2010 2011, to reflect this reduction.
6.3 	(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 
6.4 	payment for fee-for-service admissions occurring on or after July 1, 2009, made to 
6.5 	hospitals for inpatient services before third-party liability and spenddown, is reduced 
6.6 	one percent from the current statutory rates. Facilities defined under subdivision 16 are 
6.7 	excluded from this paragraph. Payments made to managed care plans shall be reduced for 
6.8 	services provided on or after October 1, 2009, to reflect this reduction.

6.9 	EFFECTIVE DATE. This section is effective March 1, 2010.

6.10 	Sec. 4. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 
6.11 	to read:
6.12 		Subd. 26a.Psychiatric and burn services payment adjustment on or after July 
6.13 	1, 2010. (a) For admissions occurring on or after July 1, 2010, the commissioner shall 
6.14 	increase the total payment for medical assistance fee-for-service inpatient admissions for 
6.15 	the diagnosis-related groups specified in paragraph (b) at any hospital that is a nonstate 
6.16 	public Minnesota hospital and a Level I trauma center. The rate increases shall be 
6.17 	established for each hospital by the commissioner at a level that uses each hospital's 
6.18 	voluntary payments under paragraph (c) as the nonfederal share. For purposes of this 
6.19 	subdivision, medical assistance does not include general assistance medical care.
6.20 	(b) The rate increases provided in paragraph (a) apply to the following 
6.21 	diagnosis-related groups or subgroups, or any subsequent designations of such groups 
6.22 	or subgroups: 424 to 431, 433, 504 to 511, 521, and 523. These increases are only 
6.23 	available to the extent that revenue is available from the counties under paragraph (c) 
6.24 	for the nonfederal share.
6.25 	(c) Effective July 15, 2010, in addition to any payment otherwise required under 
6.26 	sections 256B.19, 256B.195, 256B.196, and 256B.199, the following government entities 
6.27 	may make the following voluntary payments to the commissioner on an annual basis:
6.28 	(1) Hennepin County, $7,000,000; and
6.29 	(2) Ramsey County, $3,500,000.
6.30 	The amounts in this paragraph shall be part of the designated governmental unit's portion 
6.31 	of the nonfederal share of medical assistance costs.
6.32 	(d) The commissioner may adjust the intergovernmental transfers under paragraph 
6.33 	(c) and the payments under paragraph (a) based on the commissioner's determination of 
6.34 	Medicare upper payment limits, hospital-specific charge limits, and any limits imposed 
7.1 	by the federal government regarding the rate increase or the restriction in the American 
7.2 	Resource and Recovery Act, Public Law 111-5, regarding increased local share.
7.3 	(e) This section shall be implemented upon federal approval, retroactive to July 1, 
7.4 	2010, for services provided on or after that date.

7.5 	Sec. 5. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:
7.6 		Subd. 27.Quarterly payment adjustment. (a) In addition to any other payment 
7.7 	under this section, the commissioner shall make the following payments effective July 
7.8 	1, 2007:
7.9 	(1) for a hospital located in Minnesota and not eligible for payments under 
7.10 	subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8 
7.11 	percent of total patient days as of the base year in effect on July 1, 2005, a payment 
7.12 	equal to 13 percent of the total of the operating and property payment rates, except that 
7.13 	Hennepin County Medical Center and Regions Hospital shall not receive a payment 
7.14 	under this subdivision;
7.15 	(2) for a hospital located in Minnesota in a specified urban area outside of the 
7.16 	seven-county metropolitan area and not eligible for payments under subdivision 20, with 
7.17 	a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total 
7.18 	patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent 
7.19 	of the total of the operating and property payment rates. For purposes of this clause, the 
7.20 	following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria, 
7.21 	Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, 
7.22 	Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena; 
7.23 	(3) for a hospital located in Minnesota but not located in a specified urban area 
7.24 	under clause (2), with a medical assistance inpatient utilization rate less than or equal to 
7.25 	17.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment 
7.26 	equal to four percent of the total of the operating and property payment rates. A hospital 
7.27 	located in Woodbury and not in existence during the base year shall be reimbursed under 
7.28 	this clause; and
7.29 	(4) in addition to any payments under clauses (1) to (3), for a hospital located in 
7.30 	Minnesota and not eligible for payments under subdivision 20 with a medical assistance 
7.31 	inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect 
7.32 	on July 1, 2005, a payment equal to eight percent of the total of the operating and property 
7.33 	payment rates, and for a hospital located in Minnesota and not eligible for payments 
7.34 	under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent 
7.35 	of total patient days as of the base year in effect on July 1, 2005, a payment equal to 
8.1 	nine percent of the total of the operating and property payment rates. After making any 
8.2 	ratable adjustments required under paragraph (b), the commissioner shall proportionately 
8.3 	reduce payments under clauses (2) and (3) by an amount needed to make payments under 
8.4 	this clause.
8.5 	(b) The state share of payments under paragraph (a) shall be equal to federal 
8.6 	reimbursements to the commissioner to reimburse expenditures reported under section 
8.7 	256B.199, paragraphs (a) to (d). The commissioner shall ratably reduce or increase 
8.8 	payments under this subdivision in order to ensure that these payments equal the amount 
8.9 	of reimbursement received by the commissioner under section 256B.199, paragraphs (a) 
8.10 	to (d), except that payments shall be ratably reduced by an amount equivalent to the state 
8.11 	share of a four percent reduction in MinnesotaCare and medical assistance payments for 
8.12 	inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be equivalent 
8.13 	to the state share of a three percent reduction in these payments. Effective for federal 
8.14 	disproportionate share hospital funds earned on general assistance medical care payments 
8.15 	for services rendered on or after March 1, 2010, to June 30, 2011, the amount of the three 
8.16 	percent ratable reduction required under this paragraph shall be deposited in the account 
8.17 	established in section 256D.032.
8.18 	(c) The payments under paragraph (a) shall be paid quarterly based on each hospital's 
8.19 	operating and property payments from the second previous quarter, beginning on July 
8.20 	15, 2007, or upon federal approval of federal reimbursements under section 256B.199, 
8.21 	paragraphs (a) to (d), whichever occurs later.
8.22 	(d) The commissioner shall not adjust rates paid to a prepaid health plan under 
8.23 	contract with the commissioner to reflect payments provided in paragraph (a).
8.24 	(e) The commissioner shall maximize the use of available federal money for 
8.25 	disproportionate share hospital payments and shall maximize payments to qualifying 
8.26 	hospitals. In order to accomplish these purposes, the commissioner may, in consultation 
8.27 	with the nonstate entities identified in section 256B.199, paragraphs (a) to (d), adjust, 
8.28 	on a pro rata basis if feasible, the amounts reported by nonstate entities under section 
8.29 	256B.199, paragraphs (a) to (d), when application for reimbursement is made to the federal 
8.30 	government, and otherwise adjust the provisions of this subdivision. The commissioner 
8.31 	shall utilize a settlement process based on finalized data to maximize revenue under 
8.32 	section 256B.199, paragraphs (a) to (d), and payments under this section.
8.33 	(f) For purposes of this subdivision, medical assistance does not include general 
8.34 	assistance medical care.

8.35 	EFFECTIVE DATE. This section is effective for services rendered on or after 
8.36 	March 1, 2010.

9.1 	Sec. 6. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to 
9.2 	read:
9.3 		Subd. 13f.Prior authorization. (a) The Formulary Committee shall review and 
9.4 	recommend drugs which require prior authorization. The Formulary Committee shall 
9.5 	establish general criteria to be used for the prior authorization of brand-name drugs for 
9.6 	which generically equivalent drugs are available, but the committee is not required to 
9.7 	review each brand-name drug for which a generically equivalent drug is available.
9.8 	(b) Prior authorization may be required by the commissioner before certain 
9.9 	formulary drugs are eligible for payment. The Formulary Committee may recommend 
9.10 	drugs for prior authorization directly to the commissioner. The commissioner may also 
9.11 	request that the Formulary Committee review a drug for prior authorization. Before the 
9.12 	commissioner may require prior authorization for a drug:
9.13 	(1) the commissioner must provide information to the Formulary Committee on the 
9.14 	impact that placing the drug on prior authorization may have on the quality of patient care 
9.15 	and on program costs, information regarding whether the drug is subject to clinical abuse 
9.16 	or misuse, and relevant data from the state Medicaid program if such data is available;
9.17 	(2) the Formulary Committee must review the drug, taking into account medical and 
9.18 	clinical data and the information provided by the commissioner; and
9.19 	(3) the Formulary Committee must hold a public forum and receive public comment 
9.20 	for an additional 15 days.
9.21 	The commissioner must provide a 15-day notice period before implementing the prior 
9.22 	authorization.
9.23 	(c) Except as provided in subdivision 13j, prior authorization shall not be required or 
9.24 	utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:
9.25 	(1) there is no generically equivalent drug available; and
9.26 	(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
9.27 	(3) the drug is part of the recipient's current course of treatment.
9.28 	This paragraph applies to any multistate preferred drug list or supplemental drug rebate 
9.29 	program established or administered by the commissioner. Prior authorization shall 
9.30 	automatically be granted for 60 days for brand name drugs prescribed for treatment of 
9.31 	mental illness within 60 days of when a generically equivalent drug becomes available, 
9.32 	provided that the brand name drug was part of the recipient's course of treatment at the 
9.33 	time the generically equivalent drug became available.
9.34 	(d) Prior authorization shall not be required or utilized for any antihemophilic factor 
9.35 	drug prescribed for the treatment of hemophilia and blood disorders where there is no 
9.36 	generically equivalent drug available if the prior authorization is used in conjunction with 
10.1 	any supplemental drug rebate program or multistate preferred drug list established or 
10.2 	administered by the commissioner.
10.3 	(e) The commissioner may require prior authorization for brand name drugs 
10.4 	whenever a generically equivalent product is available, even if the prescriber specifically 
10.5 	indicates "dispense as written-brand necessary" on the prescription as required by section 
10.6 	151.21, subdivision 2.
10.7 	(f) Notwithstanding this subdivision, the commissioner may automatically require 
10.8 	prior authorization, for a period not to exceed 180 days, for any drug that is approved by 
10.9 	the United States Food and Drug Administration on or after July 1, 2005. The 180-day 
10.10 	period begins no later than the first day that a drug is available for shipment to pharmacies 
10.11 	within the state. The Formulary Committee shall recommend to the commissioner general 
10.12 	criteria to be used for the prior authorization of the drugs, but the committee is not 
10.13 	required to review each individual drug. In order to continue prior authorizations for a 
10.14 	drug after the 180-day period has expired, the commissioner must follow the provisions 
10.15 	of this subdivision.

10.16 	EFFECTIVE DATE. This section is effective March 1, 2010.

10.17 	Sec. 7. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
10.18 	subdivision to read:
10.19 		Subd. 13j.Antipsychotic and attention deficit disorder and attention deficit 
10.20 	hyperactivity disorder medications. (a) The commissioner, in consultation with the 
10.21 	Drug Utilization Review Board established in subdivision 13i and actively practicing 
10.22 	pediatric mental health professionals, must:
10.23 	(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs 
10.24 	and drugs used for attention deficit disorder or attention deficit hyperactivity disorder 
10.25 	based on available medical, clinical, and safety data and research. The commissioner 
10.26 	shall periodically review the list of medications and pediatric dose ranges and update 
10.27 	the medications and doses listed as needed after consultation with the Drug Utilization 
10.28 	Review Board;
10.29 	(2) identify situations where a collaborative psychiatric consultation and prior 
10.30 	authorization should be required before the initiation or continuation of drug therapy 
10.31 	in pediatric patients including, but not limited to, high-dose regimens, off-label use of 
10.32 	prescription medication, a patient's young age, and lack of coordination among multiple 
10.33 	prescribing providers; and
10.34 	(3) track prescriptive practices and the use of psychotropic medications in children 
10.35 	with the goal of reducing the use of medication, where appropriate.
11.1 	(b) Effective July 1, 2011, the commissioner shall require prior authorization and 
11.2 	a collaborative psychiatric consultation before an atypical antipsychotic and attention 
11.3 	deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria 
11.4 	identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric 
11.5 	consultation must be completed before the identified medications are eligible for payment 
11.6 	unless:
11.7 	(1) the patient has already been stabilized on the medication regimen; or
11.8 	(2) the prescriber indicates that the child is in crisis.
11.9 	If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed 
11.10 	within 90 days for payment to continue.
11.11 	(c) For purposes of this subdivision, a collaborative psychiatric consultation must 
11.12 	meet the criteria described in section 245.4862, subdivision 5.

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

13.3 	EFFECTIVE DATE. This section is effective the day following final enactment.

13.4 	Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.199, is amended to read:
13.5 	256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
13.6 	(a) Effective July 1, 2007, the commissioner shall apply for federal matching funds 
13.7 	for the expenditures in paragraphs (b) and (c).
13.8 	(b) The commissioner shall apply for federal matching funds for certified public 
13.9 	expenditures as follows:
13.10 	(1) Hennepin County, Hennepin County Medical Center, Ramsey County, and 
13.11 	Regions Hospital, the University of Minnesota, and Fairview-University Medical Center
13.12 	shall report quarterly to the commissioner beginning June 1, 2007, payments made during 
13.13 	the second previous quarter that may qualify for reimbursement under federal law;
13.14 	 (2) based on these reports, the commissioner shall apply for federal matching 
13.15 	funds. These funds are appropriated to the commissioner for the payments under section 
13.16 	256.969, subdivision 27; and
13.17 	 (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform 
13.18 	the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share 
13.19 	hospital payment money expected to be available in the current federal fiscal year.
13.20 	(c) The commissioner shall apply for federal matching funds for general assistance 
13.21 	medical care expenditures as follows:
13.22 	(1) for hospital services occurring on or after July 1, 2007, general assistance medical 
13.23 	care expenditures for fee-for-service inpatient and outpatient hospital payments made by 
13.24 	the department shall be used to apply for federal matching funds, except as limited below:
13.25 	(i) only those general assistance medical care expenditures made to an individual 
13.26 	hospital that would not cause the hospital to exceed its individual hospital limits under 
13.27 	section 1923 of the Social Security Act may be considered; and
13.28 	(ii) general assistance medical care expenditures may be considered only to the extent 
13.29 	of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
13.30 	(2) all hospitals must provide any necessary expenditure, cost, and revenue 
13.31 	information required by the commissioner as necessary for purposes of obtaining federal 
13.32 	Medicaid matching funds for general assistance medical care expenditures.
13.33 	(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall 
13.34 	apply for additional federal matching funds available as disproportionate share hospital 
14.1 	payments under the American Recovery and Reinvestment Act of 2009. These funds shall 
14.2 	be made available as the state share of payments under section 256.969, subdivision 28. 
14.3 	The entities required to report certified public expenditures under paragraph (b), clause 
14.4 	(1), shall report additional certified public expenditures as necessary under this paragraph.
14.5 	(e) Effective July 15, 2010, in addition to any payment otherwise required under 
14.6 	sections 256B.19, 256B.195, and 256B.196, the following government entities may make 
14.7 	the following voluntary payments to the commissioner on an annual basis:
14.8 	(1) Hennepin County, $6,200,000; and
14.9 	(2) Ramsey County, $4,000,000.
14.10 	(f) The sums in paragraph (e) shall be part of the designated governmental unit's 
14.11 	portion of the nonfederal share of medical assistance costs.
14.12 	(g) Effective July 15, 2010, the commissioner shall make the following Medicaid 
14.13 	disproportionate share hospital payments to the hospitals on a monthly basis:
14.14 	(1) to Hennepin County Medical Center, the amount of the transfer under paragraph 
14.15 	(e), clause (1), plus any federal matching funds available to recognize higher medical 
14.16 	assistance costs in institutions that provide high levels of charity care; and
14.17 	(2) to Regions Hospital, the amount of the transfer under paragraph (e), clause (2), 
14.18 	plus any federal matching funds available to recognize higher medical assistance costs in 
14.19 	institutions that provide high levels of charity care.
14.20 	(h) Effective July 15, 2010, after making the payments provided in paragraph 
14.21 	(g), the commissioner shall make the increased payments provided in section 256.969, 
14.22 	subdivision 26a.
14.23 	(i) The commissioner shall make the payments under paragraphs (g) and (h) prior 
14.24 	to making any other payments under this section, section 256.969, subdivision 27, or 
14.25 	256B.195.
14.26 	(j) The commissioner may adjust the intergovernmental transfers under paragraph 
14.27 	(e) and the payments under paragraph (g) based on the commissioner's determination 
14.28 	of Medicare upper payment limits, hospital-specific charge limits, and any limitations 
14.29 	imposed by the federal government regarding the rate increase or the restriction in the 
14.30 	American Resource and Recovery Act, Public Law 111-5, regarding increased local share.
14.31 	(k) This section shall be implemented upon federal approval of the rate increase 
14.32 	and a federal determination that the increased transfers do not violate the restriction in 
14.33 	the American Resource and Recovery Act, Public Law 111-5, regarding the local share, 
14.34 	retroactive to admissions occurring on or after July 15, 2010.

15.1 	Sec. 10. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is 
15.2 	amended to read:
15.3 		Subd. 3.General assistance medical care; eligibility. (a) General assistance 
15.4 	medical care may be paid for any person who is not eligible for medical assistance under 
15.5 	chapter 256B, including eligibility for medical assistance based on a spenddown of excess 
15.6 	income according to section 256B.056, subdivision 5, or MinnesotaCare for applicants 
15.7 	and recipients defined in paragraph (c), except as provided in paragraph (d), and:
15.8 	(1) who is receiving assistance under section 256D.05, except for families with 
15.9 	children who are eligible under Minnesota family investment program (MFIP), or who is 
15.10 	having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
15.11 	(2) who is a resident of Minnesota; and
15.12 	(i) who has gross countable income not in excess of 75 percent of the federal poverty 
15.13 	guidelines for the family size, using a six-month budget period and whose equity in assets 
15.14 	is not in excess of $1,000 per assistance unit. General assistance medical care is not 
15.15 	available for applicants or enrollees who are otherwise eligible for medical assistance but 
15.16 	fail to verify their assets. Enrollees who become eligible for medical assistance shall be 
15.17 	terminated and transferred to medical assistance. Exempt assets, the reduction of excess 
15.18 	assets, and the waiver of excess assets must conform to the medical assistance program in 
15.19 	section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum 
15.20 	amount of undistributed funds in a trust that could be distributed to or on behalf of the 
15.21 	beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the 
15.22 	terms of the trust, must be applied toward the asset maximum; or
15.23 	(ii) who has gross countable income above 75 percent of the federal poverty 
15.24 	guidelines but not in excess of 175 percent of the federal poverty guidelines for the family 
15.25 	size, using a six-month budget period, whose equity in assets is not in excess of the limits 
15.26 	in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization.
15.27 	(b) The commissioner shall adjust the income standards under this section each July 
15.28 	1 by the annual update of the federal poverty guidelines following publication by the 
15.29 	United States Department of Health and Human Services.
15.30 	(c) Effective for applications and renewals processed on or after September 1, 2006, 
15.31 	general assistance medical care may not be paid for applicants or recipients who are adults 
15.32 	with dependent children under 21 whose gross family income is equal to or less than 275 
15.33 	percent of the federal poverty guidelines who are not described in paragraph (f).
15.34 	(d) Effective for applications and renewals processed on or after September 1, 2006, 
15.35 	general assistance medical care may be paid for applicants and recipients who meet all 
15.36 	eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period 
16.1 	beginning the date of application. Immediately following approval of general assistance 
16.2 	medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04, 
16.3 	subdivision 7, with covered services as provided in section 256L.03 for the rest of the 
16.4 	six-month general assistance medical care eligibility period, until their six-month renewal.
16.5 	(e) To be eligible for general assistance medical care following enrollment in 
16.6 	MinnesotaCare as required by paragraph (d), an individual must complete a new 
16.7 	application.
16.8 	(f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are 
16.9 	exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
16.10 	(1) have applied for and are awaiting a determination of blindness or disability by 
16.11 	the state medical review team or a determination of eligibility for Supplemental Security 
16.12 	Income or Social Security Disability Insurance by the Social Security Administration;
16.13 	(2) fail to meet the requirements of section 256L.09, subdivision 2;
16.14 	(3) are homeless as defined by United States Code, title 42, section 11301, et seq.;
16.15 	(4) are classified as end-stage renal disease beneficiaries in the Medicare program;
16.16 	(5) are enrolled in private health care coverage as defined in section 256B.02, 
16.17 	subdivision 9;
16.18 	(6) are eligible under paragraph (k);
16.19 	(7) receive treatment funded pursuant to section 254B.02; or
16.20 	(8) reside in the Minnesota sex offender program defined in chapter 246B.
16.21 	(g) For applications received on or after October 1, 2003, eligibility may begin no 
16.22 	earlier than the date of application. For individuals eligible under paragraph (a), clause 
16.23 	(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are 
16.24 	eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but 
16.25 	may reapply if there is a subsequent period of inpatient hospitalization.
16.26 	(h) Beginning September 1, 2006, Minnesota health care program applications and 
16.27 	renewals completed by recipients and applicants who are persons described in paragraph 
16.28 	(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility 
16.29 	by the county agency. If all other eligibility requirements of this subdivision are met, 
16.30 	eligibility for general assistance medical care shall be available in any month during which 
16.31 	MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare, 
16.32 	notice of termination for eligibility for general assistance medical care shall be sent to 
16.33 	an applicant or recipient. If all other eligibility requirements of this subdivision are 
16.34 	met, eligibility for general assistance medical care shall be available until enrollment in 
16.35 	MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).
17.1 	(i) The date of an initial Minnesota health care program application necessary to 
17.2 	begin a determination of eligibility shall be the date the applicant has provided a name, 
17.3 	address, and Social Security number, signed and dated, to the county agency or the 
17.4 	Department of Human Services. If the applicant is unable to provide a name, address, 
17.5 	Social Security number, and signature when health care is delivered due to a medical 
17.6 	condition or disability, a health care provider may act on an applicant's behalf to establish 
17.7 	the date of an initial Minnesota health care program application by providing the county 
17.8 	agency or Department of Human Services with provider identification and a temporary 
17.9 	unique identifier for the applicant. The applicant must complete the remainder of the 
17.10 	application and provide necessary verification before eligibility can be determined. The 
17.11 	applicant must complete the application within the time periods required under the 
17.12 	medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart 
17.13 	5, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining 
17.14 	verification if necessary.
17.15 	(j) County agencies are authorized to use all automated databases containing 
17.16 	information regarding recipients' or applicants' income in order to determine eligibility for 
17.17 	general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 
17.18 	in order to determine eligibility and premium payments by the county agency.
17.19 	(k) General assistance medical care is not available for a person in a correctional 
17.20 	facility unless the person is detained by law for less than one year in a county correctional 
17.21 	or detention facility as a person accused or convicted of a crime, or admitted as an 
17.22 	inpatient to a hospital on a criminal hold order, and the person is a recipient of general 
17.23 	assistance medical care at the time the person is detained by law or admitted on a criminal 
17.24 	hold order and as long as the person continues to meet other eligibility requirements 
17.25 	of this subdivision.
17.26 	(l) General assistance medical care is not available for applicants or recipients who 
17.27 	do not cooperate with the county agency to meet the requirements of medical assistance.
17.28 	(m) In determining the amount of assets of an individual eligible under paragraph 
17.29 	(a), clause (2), item (i), there shall be included any asset or interest in an asset, including 
17.30 	an asset excluded under paragraph (a), that was given away, sold, or disposed of for 
17.31 	less than fair market value within the 60 months preceding application for general 
17.32 	assistance medical care or during the period of eligibility. Any transfer described in this 
17.33 	paragraph shall be presumed to have been for the purpose of establishing eligibility for 
17.34 	general assistance medical care, unless the individual furnishes convincing evidence to 
17.35 	establish that the transaction was exclusively for another purpose. For purposes of this 
17.36 	paragraph, the value of the asset or interest shall be the fair market value at the time it 
18.1 	was given away, sold, or disposed of, less the amount of compensation received. For any 
18.2 	uncompensated transfer, the number of months of ineligibility, including partial months, 
18.3 	shall be calculated by dividing the uncompensated transfer amount by the average monthly 
18.4 	per person payment made by the medical assistance program to skilled nursing facilities 
18.5 	for the previous calendar year. The individual shall remain ineligible until this fixed period 
18.6 	has expired. The period of ineligibility may exceed 30 months, and a reapplication for 
18.7 	benefits after 30 months from the date of the transfer shall not result in eligibility unless 
18.8 	and until the period of ineligibility has expired. The period of ineligibility begins in the 
18.9 	month the transfer was reported to the county agency, or if the transfer was not reported, 
18.10 	the month in which the county agency discovered the transfer, whichever comes first. For 
18.11 	applicants, the period of ineligibility begins on the date of the first approved application.
18.12 	(n) When determining eligibility for any state benefits under this subdivision, 
18.13 	the income and resources of all noncitizens shall be deemed to include their sponsor's 
18.14 	income and resources as defined in the Personal Responsibility and Work Opportunity 
18.15 	Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 
18.16 	subsequently set out in federal rules.
18.17 	(o) Undocumented noncitizens and nonimmigrants are ineligible for general 
18.18 	assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 
18.19 	in one or more of the classes listed in United States Code, title 8, section 1101, subsection 
18.20 	(a), paragraph (15), and an undocumented noncitizen is an individual who resides in 
18.21 	the United States without the approval or acquiescence of the United States Citizenship 
18.22 	and Immigration Services.
18.23 	(p) Notwithstanding any other provision of law, a noncitizen who is ineligible for 
18.24 	medical assistance due to the deeming of a sponsor's income and resources, is ineligible 
18.25 	for general assistance medical care.
18.26 	(q) Effective July 1, 2003, general assistance medical care emergency services end.
18.27 	(r) For the period beginning March 1, 2010, and ending July 1, 2011, the general 
18.28 	assistance medical care program shall be administered according to section 256D.031, 
18.29 	unless otherwise stated.

18.30 	EFFECTIVE DATE. This section is effective March 1, 2010.

18.31 	Sec. 11. Minnesota Statutes 2008, section 256D.03, subdivision 3a, is amended to read:
18.32 		Subd. 3a.Claims; assignment of benefits. (a) Claims must be filed pursuant to 
18.33 	section 256D.16. General assistance medical care applicants and recipients must apply or 
18.34 	agree to apply third party health and accident benefits to the costs of medical care. They 
18.35 	must cooperate with the state in establishing paternity and obtaining third party payments. 
19.1 	By accepting general assistance, a person assigns to the Department of Human Services 
19.2 	all rights to medical support or payments for medical expenses from another person or 
19.3 	entity on their own or their dependent's behalf and agrees to cooperate with the state in 
19.4 	establishing paternity and obtaining third party payments. The application shall contain 
19.5 	a statement explaining the assignment. Any rights or amounts assigned shall be applied 
19.6 	against the cost of medical care paid for under this chapter. An assignment is effective on 
19.7 	the date general assistance medical care eligibility takes effect. 
19.8 	(b) Effective for general assistance medical care services rendered on or after 
19.9 	March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 
19.10 	this subdivision shall be deposited in or credited to the account established in section 
19.11 	256D.032.

19.12 	EFFECTIVE DATE. This section is effective March 1, 2010.

19.13 	Sec. 12. Minnesota Statutes 2008, section 256D.03, subdivision 3b, is amended to read:
19.14 		Subd. 3b.Cooperation. (a) General assistance or general assistance medical care 
19.15 	applicants and recipients must cooperate with the state and local agency to identify 
19.16 	potentially liable third-party payors and assist the state in obtaining third-party payments. 
19.17 	Cooperation includes identifying any third party who may be liable for care and services 
19.18 	provided under this chapter to the applicant, recipient, or any other family member for 
19.19 	whom application is made and providing relevant information to assist the state in pursuing 
19.20 	a potentially liable third party. General assistance medical care applicants and recipients 
19.21 	must cooperate by providing information about any group health plan in which they may 
19.22 	be eligible to enroll. They must cooperate with the state and local agency in determining 
19.23 	if the plan is cost-effective. For purposes of this subdivision, coverage provided by the 
19.24 	Minnesota Comprehensive Health Association under chapter 62E shall not be considered 
19.25 	group health plan coverage or cost-effective by the state and local agency. If the plan is 
19.26 	determined cost-effective and the premium will be paid by the state or local agency or is 
19.27 	available at no cost to the person, they must enroll or remain enrolled in the group health 
19.28 	plan. Cost-effective insurance premiums approved for payment by the state agency and 
19.29 	paid by the local agency are eligible for reimbursement according to subdivision 6.
19.30 	(b) Effective for all premiums due on or after June 30, 1997, general assistance 
19.31 	medical care does not cover premiums that a recipient is required to pay under a qualified 
19.32 	or Medicare supplement plan issued by the Minnesota Comprehensive Health Association. 
19.33 	General assistance medical care shall continue to cover premiums for recipients who are 
19.34 	covered under a plan issued by the Minnesota Comprehensive Health Association on June 
20.1 	30, 1997, for a period of six months following receipt of the notice of termination or 
20.2 	until December 31, 1997, whichever is later.
20.3 	(c) Effective for general assistance medical care services rendered on or after 
20.4 	March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 
20.5 	this subdivision shall be deposited in or credited to the account established in section 
20.6 	256D.032.

20.7 	EFFECTIVE DATE. This section is effective March 1, 2010.

20.8 	Sec. 13. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.
20.9 		Subdivision 1.Eligibility. (a) Except as provided under subdivision 2, general 
20.10 	assistance medical care may be paid for any individual who is not eligible for medical 
20.11 	assistance under chapter 256B, including eligibility for medical assistance based on a 
20.12 	spenddown of excess income according to section 256B.056, subdivision 5, and who:
20.13 	(1) is receiving assistance under section 256D.05, except for families with children 
20.14 	who are eligible under the Minnesota family investment program (MFIP), or who is 
20.15 	having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
20.16 	(2) is a resident of Minnesota and has gross countable income not in excess of 75 
20.17 	percent of federal poverty guidelines for the family size, using a six-month budget period, 
20.18 	and whose equity in assets is not in excess of $1,000 per assistance unit.
20.19 	Exempt assets, the reduction of excess assets, and the waiver of excess assets must 
20.20 	conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d, 
20.21 	except that the maximum amount of undistributed funds in a trust that could be distributed 
20.22 	to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's 
20.23 	discretion under the terms of the trust, must be applied toward the asset maximum.
20.24 	(b) The commissioner shall adjust the income standards under this section each July 
20.25 	1 by the annual update of the federal poverty guidelines following publication by the 
20.26 	United States Department of Health and Human Services.
20.27 		Subd. 2.Ineligible groups. (a) General assistance medical care may not be paid for 
20.28 	an applicant or a recipient who:
20.29 	(1) is otherwise eligible for medical assistance but fails to verify their assets;
20.30 	(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;
20.31 	(3) is enrolled in private health coverage as defined in section 256B.02, subdivision 
20.32 	9;
21.1 	(4) is in a correctional facility, including an individual in a county correctional or 
21.2 	detention facility as an individual accused or convicted of a crime, or admitted as an 
21.3 	inpatient to a hospital on a criminal hold order;
21.4 	(5) resides in the Minnesota sex offender program defined in chapter 246B;
21.5 	(6) does not cooperate with the county agency to meet the requirements of medical 
21.6 	assistance; or
21.7 	(7) does not cooperate with a county or state agency or the state medical review team 
21.8 	in determining a disability or for determining eligibility for Supplemental Security Income 
21.9 	or Social Security Disability Insurance by the Social Security Administration.
21.10 	(b) Undocumented noncitizens and nonimmigrants are ineligible for general 
21.11 	assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 
21.12 	in one or more of the classes listed in United States Code, title 8, section 1101, subsection 
21.13 	(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the 
21.14 	United States without approval or acquiescence of the United States Citizenship and 
21.15 	Immigration Services.
21.16 	(c) Notwithstanding any other provision of law, a noncitizen who is ineligible for 
21.17 	medical assistance due to the deeming of a sponsor's income and resources is ineligible for 
21.18 	general assistance medical care.
21.19 	(d) General assistance medical care recipients who become eligible for medical 
21.20 	assistance shall be terminated from general assistance medical care and transferred to 
21.21 	medical assistance.
21.22 		Subd. 3.Transitional MinnesotaCare. (a) Except as provided in paragraph (c), 
21.23 	effective March 1, 2010, all applicants and recipients who meet the eligibility requirements 
21.24 	in subdivision 1, paragraph (a), clause (2), and who are not described in subdivision 2 
21.25 	shall be enrolled in MinnesotaCare under section 256L.04, subdivision 7, immediately 
21.26 	following approval of general assistance medical care. 
21.27 	(b) If all other eligibility requirements of this subdivision are met, general assistance 
21.28 	medical care may be paid for individuals identified in paragraph (a) for a temporary 
21.29 	period beginning the date of application. Eligibility for general assistance medical care 
21.30 	shall continue until enrollment in MinnesotaCare is completed. Upon notification of 
21.31 	eligibility for MinnesotaCare, notice of termination for eligibility for general assistance 
21.32 	medical care shall be sent to the applicant or recipient. Once enrolled in MinnesotaCare, 
21.33 	the MinnesotaCare-covered services as described in section 256L.03 shall apply for the 
21.34 	remainder of the six-month general assistance medical care eligibility period until their 
21.35 	six-month renewal.
21.36 	(c) This subdivision does not apply if the applicant or recipient:
22.1 	(1) has applied for and is awaiting a determination of blindness or disability by the 
22.2 	state medical review team or a determination of eligibility for Supplemental Security 
22.3 	Income or Social Security Disability Insurance by the Social Security Administration;
22.4 	(2) is homeless as defined by United States Code, title 42, section 11301, et seq.;
22.5 	(3) is classified as an end-stage renal disease beneficiary in the Medicare program; 
22.6 	(4) receives treatment funded in section 254B.02; or
22.7 	(5) fails to meet the requirements of section 256L.09, subdivision 2.
22.8 	Applicants and recipients who meet any one of these criteria shall remain eligible for 
22.9 	general assistance medical care and shall not be required to enroll in MinnesotaCare.
22.10 	(d) To be eligible for general assistance medical care following enrollment 
22.11 	in MinnesotaCare as required in paragraph (a), an individual must complete a new 
22.12 	application.
22.13 		Subd. 4.Eligibility and enrollment procedures. (a) Eligibility for general 
22.14 	assistance medical care shall begin no earlier than the date of application. The date of 
22.15 	application shall be the date the applicant has provided a name, address, and Social 
22.16 	Security number, signed and dated, to the county agency or the Department of Human 
22.17 	Services. If the applicant is unable to provide a name, address, Social Security number, 
22.18 	and signature when health care is delivered due to a medical condition or disability, a 
22.19 	health care provider may act on an applicant's behalf to establish the date of an application 
22.20 	by providing the county agency or Department of Human Services with provider 
22.21 	identification and a temporary unique identifier for the applicant. The applicant must 
22.22 	complete the remainder of the application and provide necessary verification before 
22.23 	eligibility can be determined. The applicant must complete the application within the time 
22.24 	periods required under the medical assistance program as specified in Minnesota Rules, 
22.25 	parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the 
22.26 	applicant in obtaining verification if necessary. 
22.27 	(b) County agencies are authorized to use all automated databases containing 
22.28 	information regarding recipients' or applicants' income in order to determine eligibility for 
22.29 	general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 
22.30 	in order to determine eligibility and premium payments by the county agency.
22.31 	(c) In determining the amount of assets of an individual eligible under subdivision 1, 
22.32 	paragraph (a), clause (2), there shall be included any asset or interest in an asset, including 
22.33 	an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or 
22.34 	disposed of for less than fair market value within the 60 months preceding application for 
22.35 	general assistance medical care or during the period of eligibility. Any transfer described 
22.36 	in this paragraph shall be presumed to have been for the purpose of establishing eligibility 
23.1 	for general assistance medical care, unless the individual furnishes convincing evidence to 
23.2 	establish that the transaction was exclusively for another purpose. For purposes of this 
23.3 	paragraph, the value of the asset or interest shall be the fair market value at the time it 
23.4 	was given away, sold, or disposed of, less the amount of compensation received. For any 
23.5 	uncompensated transfer, the number of months of ineligibility, including partial months, 
23.6 	shall be calculated by dividing the uncompensated transfer amount by the average monthly 
23.7 	per person payment made by the medical assistance program to skilled nursing facilities 
23.8 	for the previous calendar year. The individual shall remain ineligible until this fixed period 
23.9 	has expired. The period of ineligibility may exceed 30 months, and a reapplication for 
23.10 	benefits after 30 months from the date of the transfer shall not result in eligibility unless 
23.11 	and until the period of ineligibility has expired. The period of ineligibility begins in the 
23.12 	month the transfer was reported to the county agency, or if the transfer was not reported, 
23.13 	the month in which the county agency discovered the transfer, whichever comes first. For 
23.14 	applicants, the period of ineligibility begins on the date of the first approved application.
23.15 	(d) When determining eligibility for any state benefits under this subdivision, 
23.16 	the income and resources of all noncitizens shall be deemed to include their sponsor's 
23.17 	income and resources as defined in the Personal Responsibility and Work Opportunity 
23.18 	Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 
23.19 	subsequently set out in federal rules.
23.20 		Subd. 5.General assistance medical care; services. (a) General assistance 
23.21 	medical care covers:
23.22 	(1) inpatient hospital services within the limitations described in subdivision 10;
23.23 	(2) outpatient hospital services;
23.24 	(3) services provided by Medicare-certified rehabilitation agencies;
23.25 	(4) prescription drugs and other products recommended through the process 
23.26 	established in section 256B.0625, subdivision 13;
23.27 	(5) equipment necessary to administer insulin and diagnostic supplies and equipment 
23.28 	for diabetics to monitor blood sugar level;
23.29 	(6) eyeglasses and eye examinations provided by a physician or optometrist;
23.30 	(7) hearing aids;
23.31 	(8) prosthetic devices;
23.32 	(9) laboratory and x-ray services;
23.33 	(10) physicians' services;
23.34 	(11) medical transportation except special transportation;
23.35 	(12) chiropractic services as covered under the medical assistance program;
23.36 	(13) podiatric services;
24.1 	(14) dental services as covered under the medical assistance program;
24.2 	(15) mental health services covered under chapter 256B;
24.3 	(16) prescribed medications for persons who have been diagnosed as mentally ill as 
24.4 	necessary to prevent more restrictive institutionalization;
24.5 	(17) medical supplies and equipment, and Medicare premiums, coinsurance, and 
24.6 	deductible payments;
24.7 	(18) medical equipment not specifically listed in this paragraph when the use of 
24.8 	the equipment will prevent the need for costlier services that are reimbursable under 
24.9 	this subdivision;
24.10 	(19) services performed by a certified pediatric nurse practitioner, a certified family 
24.11 	nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 
24.12 	nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 
24.13 	practitioner in independent practice, if (1) the service is otherwise covered under this 
24.14 	chapter as a physician service, (2) the service provided on an inpatient basis is not included 
24.15 	as part of the cost for inpatient services included in the operating payment rate, and (3) the 
24.16 	service is within the scope of practice of the nurse practitioner's license as a registered 
24.17 	nurse, as defined in section 148.171;
24.18 	(20) services of a certified public health nurse or a registered nurse practicing in 
24.19 	a public health nursing clinic that is a department of, or that operates under the direct 
24.20 	authority of, a unit of government, if the service is within the scope of practice of the 
24.21 	public health nurse's license as a registered nurse, as defined in section 148.171;
24.22 	(21) telemedicine consultations, to the extent they are covered under section 
24.23 	256B.0625, subdivision 3b;
24.24 	(22) care coordination and patient education services provided by a community 
24.25 	health worker according to section 256B.0625, subdivision 49; and
24.26 	(23) regardless of the number of employees that an enrolled health care provider 
24.27 	may have, sign language interpreter services when provided by an enrolled health care 
24.28 	provider during the course of providing a direct, person-to-person-covered health care 
24.29 	service to an enrolled recipient who has a hearing loss and uses interpreting services.
24.30 	(b) Sex reassignment surgery is not covered under this section.
24.31 	(c) Drug coverage is covered in accordance with section 256D.03, subdivision 4, 
24.32 	paragraph (d).
24.33 	(d) The following co-payments shall apply for services provided:
24.34 	(1) $25 for nonemergency visits to a hospital-based emergency room; and
25.1 	(2) $3 per brand-name drug prescription, subject to a $7 per month maximum for 
25.2 	prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when 
25.3 	used for the treatment of mental illness.
25.4 	(e) Co-payments shall be limited to one per day per provider for nonemergency 
25.5 	visits to a hospital-based emergency room. Recipients of general assistance medical care 
25.6 	are responsible for all co-payments in this subdivision. Reimbursement for prescription 
25.7 	drugs shall be reduced by the amount of the co-payment until the recipient has reached the 
25.8 	$7 per month maximum for prescription drug co-payments. The provider shall collect 
25.9 	the co-payment from the recipient. Providers may not deny services to recipients who 
25.10 	are unable to pay the co-payment.
25.11 	(f) Chemical dependency services that are reimbursed under chapter 254B shall not 
25.12 	be reimbursed under general assistance medical care.
25.13 	(g) Inpatient hospital services that are provided in community behavioral health 
25.14 	hospitals operated by state-operated services shall not be reimbursed under general 
25.15 	assistance medical care.
25.16 		Subd. 6.Coordinated care delivery option. (a) A county or group of counties may 
25.17 	elect to provide health care and supportive services to individuals who are eligible for 
25.18 	general assistance medical care under this section and who reside within the county or 
25.19 	counties through a coordinated care delivery option. The health care services provided 
25.20 	by the county must include the services described in subdivision 5 with the exception of 
25.21 	outpatient prescription drug coverage but including drugs administered in an outpatient 
25.22 	setting. Support services may include, but are not limited to, social services, outreach, 
25.23 	health care navigation, housing, and transportation. Counties that elect to provide health 
25.24 	care services through this option must ensure that the requirements of this subdivision 
25.25 	are met. Upon electing to provide services through this option, the county accepts the 
25.26 	financial risk of the delivery of the health care services described in this subdivision to 
25.27 	general assistance medical care recipients residing in the county for the period beginning 
25.28 	July 1, 2010, and ending July 1, 2011, for the fixed payments described in subdivision 10.
25.29 	(b) A county that elects to provide services through this option must provide to 
25.30 	the commissioner the following:
25.31 	(1) the names of the county or counties that are electing to provide services through 
25.32 	the county care delivery option; and
25.33 	(2) the geographic area to be served.
25.34 	(c) The county may contract with a managed care plan, an integrated delivery 
25.35 	system, a physician-hospital organization, or an academic health center to administer 
25.36 	the delivery of services through this option. Any county providing general assistance 
26.1 	medical care services through a county-based purchasing plan in accordance with section 
26.2 	256B.692 may continue to provide services through the county-based purchasing plan. 
26.3 	Payments to the county-based purchasing plan for the period beginning July 1, 2010, and 
26.4 	ending July 1, 2011, shall be paid according to subdivision 10.
26.5 	(d) A county must demonstrate the ability to:
26.6 	(1) provide the covered services required under this subdivision to recipients 
26.7 	residing within the county;
26.8 	(2) provide a system for advocacy, consumer protection, and complaints and appeals 
26.9 	that is independent of care providers or other risk bearers and complies with section 
26.10 	256B.69;
26.11 	(3) establish a process to monitor enrollment and ensure the quality of care provided; 
26.12 	and
26.13 	(4) coordinate the delivery of health care services with existing homeless prevention, 
26.14 	supportive housing, and rent subsidy programs and funding administered by the Minnesota 
26.15 	Housing Finance Agency under chapter 462A.
26.16 	(e) The commissioner may require the county to provide the commissioner with data 
26.17 	necessary for assessing enrollment, quality of care, cost, and utilization of services.
26.18 	(f) A county that elects to provide services through this option shall be considered to 
26.19 	be a prepaid health plan for purposes of section 256.045.
26.20 	(g) The state shall not be liable for the payment of any cost or obligation incurred 
26.21 	by the county or a participating provider.
26.22 		Subd. 7.Health care home designation. The commissioner or a county may 
26.23 	require a recipient to designate a primary care provider or a primary care clinic that is 
26.24 	certified as a health care home under section 256B.0751.
26.25 		Subd. 8.Payments; fee-for-service rate for the period between March 1, 
26.26 	2010, and July 1, 2010. (a) Effective for services provided on or after March 1, 2010, 
26.27 	and before July 1, 2010, the payment rates for all covered services provided to general 
26.28 	assistance medical care recipients, with the exception of outpatient prescription drug 
26.29 	coverage, shall be 50 percent of the general assistance medical care payment rate in effect 
26.30 	on February 28, 2010.
26.31 	(b) Outpatient prescription drug coverage provided on or after March 1, 2010, and 
26.32 	before July 1, 2010, shall be paid on a fee-for-service basis in accordance with section 
26.33 	256B.0625, subdivision 13e.
26.34 		Subd. 9.Payments; fee-for-service rates for the period between July 1, 2010, 
26.35 	and July 1, 2011. (a) Effective for services provided on or after July 1, 2010, and before 
26.36 	July 1, 2011, to general assistance medical care recipients residing in counties that are 
27.1 	not served through the coordinated care delivery option, payments shall be made by the 
27.2 	commissioner to providers at rates described in this subdivision.
27.3 	(b) For inpatient hospital admissions provided on or after July 1, 2010, and before 
27.4 	July 1, 2011, the payment rate shall be:
27.5 	(1) 65.6 percent of the general assistance medical care rate in effect on February 
27.6 	28, 2010, if the inpatient hospital services were provided in a hospital where the 
27.7 	fee-for-service inpatient and outpatient hospital general assistance medical care payments 
27.8 	to the hospital for admissions provided in calendar year 2007 totaled $1,000,000 or more 
27.9 	or the hospital's fee-for-service inpatient and outpatient hospital general assistance medical 
27.10 	care payments received for calendar year 2007 admissions was one percent or more of the 
27.11 	hospital's net patient revenue received for services provided in calendar year 2007; or
27.12 	(2) 60 percent of the general assistance medical care rate in effect on February 28, 
27.13 	2010, if the inpatient hospital services were provided by a hospital that does not meet the 
27.14 	criteria described in clause (1).
27.15 	(c) Effective for services other than inpatient hospital services and outpatient 
27.16 	prescription drug coverage provided on or after July 1, 2010, and before July 1, 2011, 
27.17 	the payment rate shall begin at 50 percent of the general assistance medical care rate 
27.18 	in effect on February 28, 2010.
27.19 	(d) Outpatient prescription drug coverage provided on or after July 1, 2010, and 
27.20 	before July 1, 2011, shall be paid on a fee-for-service basis in accordance with section 
27.21 	256B.0625, subdivision 13e.
27.22 	(e) The commissioner may adjust the rates paid under paragraphs (b) and (c) on a 
27.23 	quarterly basis to ensure that the total aggregate amount paid out for services provided 
27.24 	on a fee-for-service basis beginning March 1, 2010, and ending June 30, 2011, does not 
27.25 	exceed the appropriation from the general assistance medical care account established in 
27.26 	section 256D.032 for the general assistance medical care program.
27.27 		Subd. 10.Payments; rate setting for the coordinated care delivery option. (a) 
27.28 	Effective for general assistance medical care services, with the exception of outpatient 
27.29 	prescription drug coverage, provided on or after July 1, 2010, and before July 1, 2011, 
27.30 	to recipients residing in counties that have elected to provide services through the 
27.31 	coordinated delivery care option, the commissioner shall establish quarterly prospective 
27.32 	fixed payments to the county. The payments must not exceed 60 percent of the county's 
27.33 	general assistance medical care county allocation amount as determined in paragraph (b). 
27.34 	These payments must not be used by the county to pay MinnesotaCare premiums for 
27.35 	general assistance medical care recipients or MinnesotaCare enrollees.
28.1 	(b) For each county that elects to provide services in accordance with subdivision 
28.2 	7, the commissioner shall determine a general assistance medical care county allocation 
28.3 	amount that equals the total general assistance medical care payments made for recipients 
28.4 	residing within the county in fiscal year 2009 for all covered general assistance medical 
28.5 	care services with the exception of outpatient prescription drug coverage.
28.6 	(c) Outpatient prescription drug coverage provided on or after July 1, 2010, 
28.7 	and before July 1, 2011, shall be paid on a fee-for-service basis according to section 
28.8 	256B.0625, subdivision 13e.
28.9 		Subd. 11.Veterans medical review team. (a) To ensure the timely processing of 
28.10 	determinations of service-connected disabilities among veterans enrolled in the temporary 
28.11 	general assistance medical care program, the commissioner shall review all medical 
28.12 	evidence submitted by enrollees with a referral and seek additional information from 
28.13 	providers, applicants, and enrollees to support the determination of a service-connected 
28.14 	disability when necessary. Service-connected disability shall be determined according to 
28.15 	the regulations and policies of the United States Department of Veterans Affairs.
28.16 	(b) Prior to a denial or withdrawal of a requested determination of service-connected 
28.17 	disability due to insufficient evidence, the commissioner shall:
28.18 	(1) ensure that the missing evidence is necessary and appropriate to a determination 
28.19 	of service-connected disability; and
28.20 	(2) assist applicants and enrollees to obtain the evidence, including, but not limited 
28.21 	to, medical examinations and electronic medical records.
28.22 	(c) The commissioner shall provide the chairs of the legislative committees with 
28.23 	jurisdiction over health and human services finance and veterans affairs finance and 
28.24 	budget the following information on the activities of the veterans medical review team by 
28.25 	August 1, 2010, and provide an update by January 1, 2011:
28.26 	(1) the number of applications to the veterans medical review team that were denied, 
28.27 	approved, or withdrawn;
28.28 	(2) the average length of time from receipt of the application to a decision;
28.29 	(3) the number of appeals and appeal results;
28.30 	(4) for applicants, their age, health coverage at the time of application, 
28.31 	hospitalization  history within three months of application, and whether an application for 
28.32 	service-connected veterans benefits is pending; and
28.33 	(5) specific information on the medical certification, licensure, or other credentials 
28.34 	of the person or persons performing the medical review determinations and length of 
28.35 	time in that position.

29.1 	EFFECTIVE DATE. This section is effective for services rendered on or after 
29.2 	March 1, 2010, and before July 1, 2011.

29.3 	Sec. 14. [256D.032] GENERAL ASSISTANCE MEDICAL CARE ACCOUNT.
29.4 	The general assistance medical care account is created in the special revenue fund. 
29.5 	Money deposited into the account is subject to appropriation by the legislature, and shall 
29.6 	be used only for expenditures related to the general assistance medical care program 
29.7 	or as provided in this act.

29.8 	EFFECTIVE DATE. This section is effective March 1, 2010.

29.9 	Sec. 15. Minnesota Statutes 2008, section 256D.06, subdivision 7, is amended to read:
29.10 		Subd. 7.SSI conversions and back claims. (a) The commissioner of human 
29.11 	services shall contract with agencies or organizations capable of ensuring that clients who 
29.12 	are presently receiving assistance under sections 256D.01 to 256D.21, and who may be 
29.13 	eligible for benefits under the federal Supplemental Security Income program, apply and, 
29.14 	when eligible, are converted to the federal income assistance program and made eligible 
29.15 	for health care benefits under the medical assistance program. The commissioner shall 
29.16 	ensure that money owing to the state under interim assistance agreements is collected.
29.17 	(b) The commissioner shall also directly or through contract implement procedures 
29.18 	for collecting federal Medicare and medical assistance funds for which clients converted 
29.19 	to SSI are retroactively eligible.
29.20 	(c) The commissioner shall contract with agencies to ensure implementation of 
29.21 	this section. County contracts with providers for residential services shall include the 
29.22 	requirement that providers screen residents who may be eligible for federal benefits and 
29.23 	provide that information to the local agency. The commissioner shall modify the MAXIS 
29.24 	computer system to provide information on clients who have been on general assistance 
29.25 	for two years or longer. The list of clients shall be provided to local services for screening 
29.26 	under this section.
29.27 	(d) Effective for general assistance medical care services rendered on or after 
29.28 	March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 
29.29 	this subdivision shall be deposited in or credited to the account established in section 
29.30 	256D.032.

29.31 	EFFECTIVE DATE. This section is effective March 1, 2010.

29.32 	Sec. 16. Minnesota Statutes 2008, section 256L.05, subdivision 1b, is amended to read:
30.1 		Subd. 1b.MinnesotaCare enrollment by county agencies. Beginning September 
30.2 	1, 2006, county agencies shall enroll single adults and households with no children 
30.3 	formerly enrolled in general assistance medical care in MinnesotaCare according to 
30.4 	section 256D.03, subdivision 3, or 256D.031. County agencies shall perform all duties 
30.5 	necessary to administer the MinnesotaCare program ongoing for these enrollees, including 
30.6 	the redetermination of MinnesotaCare eligibility at renewal.

30.7 	EFFECTIVE DATE. This section is effective March 1, 2010.

30.8 	Sec. 17. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
30.9 		Subd. 3.Effective date of coverage. (a) The effective date of coverage is the 
30.10 	first day of the month following the month in which eligibility is approved and the first 
30.11 	premium payment has been received. As provided in section 256B.057, coverage for 
30.12 	newborns is automatic from the date of birth and must be coordinated with other health 
30.13 	coverage. The effective date of coverage for eligible newly adoptive children added to a 
30.14 	family receiving covered health services is the month of placement. The effective date 
30.15 	of coverage for other new members added to the family is the first day of the month 
30.16 	following the month in which the change is reported. All eligibility criteria must be met 
30.17 	by the family at the time the new family member is added. The income of the new family 
30.18 	member is included with the family's gross income and the adjusted premium begins in 
30.19 	the month the new family member is added.
30.20 	(b) The initial premium must be received by the last working day of the month for 
30.21 	coverage to begin the first day of the following month.
30.22 	(c) Benefits are not available until the day following discharge if an enrollee is 
30.23 	hospitalized on the first day of coverage.
30.24 	(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to 
30.25 	256L.18 are secondary to a plan of insurance or benefit program under which an eligible 
30.26 	person may have coverage and the commissioner shall use cost avoidance techniques to 
30.27 	ensure coordination of any other health coverage for eligible persons. The commissioner 
30.28 	shall identify eligible persons who may have coverage or benefits under other plans of 
30.29 	insurance or who become eligible for medical assistance.
30.30 	(e) The effective date of coverage for single adults and households with no children 
30.31 	formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 
30.32 	according to section 256D.03, subdivision 3, or 256D.031, is the first day of the month 
30.33 	following the last day of general assistance medical care coverage.

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

31.1 	Sec. 18. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
31.2 		Subd. 3a.Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 
31.3 	must be renewed every 12 months. The 12-month period begins in the month after the 
31.4 	month the application is approved.
31.5 	(b) Each new period of eligibility must take into account any changes in 
31.6 	circumstances that impact eligibility and premium amount. An enrollee must provide all 
31.7 	the information needed to redetermine eligibility by the first day of the month that ends 
31.8 	the eligibility period. If there is no change in circumstances, the enrollee may renew 
31.9 	eligibility at designated locations that include community clinics and health care providers' 
31.10 	offices. The designated sites shall forward the renewal forms to the commissioner. The 
31.11 	commissioner may establish criteria and timelines for sites to forward applications to the 
31.12 	commissioner or county agencies. The premium for the new period of eligibility must be 
31.13 	received as provided in section 256L.06 in order for eligibility to continue.
31.14 	(c) For single adults and households with no children formerly enrolled in general 
31.15 	assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 
31.16 	subdivision 3, or 256D.031, the first period of eligibility begins the month the enrollee 
31.17 	submitted the application or renewal for general assistance medical care.
31.18 	(d) An enrollee who fails to submit renewal forms and related documentation 
31.19 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
31.20 	for one additional month beyond the end of the current eligibility period before being 
31.21 	disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 
31.22 	additional month.

31.23 	Sec. 19. Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read:
31.24 		Subd. 6.Exception for certain adults. Single adults and households with 
31.25 	no children formerly enrolled in general assistance medical care and enrolled in 
31.26 	MinnesotaCare according to section 256D.03, subdivision 3, or 256D.031, are eligible 
31.27 	without meeting the requirements of this section until renewal.

31.28 	EFFECTIVE DATE. This section is effective March 1, 2010.

31.29 	Sec. 20. Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read:
31.30 		Subd. 4.Exception for transitioned adults. County agencies shall pay premiums 
31.31 	for single adults and households with no children formerly enrolled in general assistance 
31.32 	medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3, 
31.33 	or 256D.031, until six-month renewal. The county agency has the option of continuing to 
31.34 	pay premiums for these enrollees.

32.1 	EFFECTIVE DATE. This section is effective March 1, 2010.

32.2 	Sec. 21. Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read:
32.3 		Subd. 7.Exception for certain adults. Single adults and households with 
32.4 	no children formerly enrolled in general assistance medical care and enrolled in 
32.5 	MinnesotaCare according to section 256D.03, subdivision 3, or 256D.031, are exempt 
32.6 	from the requirements of this section until renewal.

32.7 	EFFECTIVE DATE. This section is effective March 1, 2010.

32.8 	Sec. 22. DRUG REBATE PROGRAM.
 32.9 	The commissioner of human services shall continue to administer a drug rebate 
32.10 	program for drugs purchased for persons eligible for the general assistance medical care 
32.11 	program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph 
32.12 	(cc), and 256D.03. The rebate revenues collected under the drug rebate program for 
32.13 	persons eligible for the general assistance medical care program shall be deposited in the 
32.14 	general assistance medical care account in the special revenue fund established under 
32.15 	Minnesota Statutes, section 256D.032. 

32.16 	EFFECTIVE DATE. This section is effective March 1, 2010, and expires June 
32.17 	30, 2011.

32.18 	Sec. 23. PROVIDER PARTICIPATION.
 32.19 	For purposes of Minnesota Statutes, section 256B.0644, the reference to the general 
32.20 	assistance medical care program shall include the temporary general assistance medical 
32.21 	care program established under Minnesota Statutes, section 256D.031. In meeting the 
32.22 	requirements of Minnesota Statutes, section 256B.0644, a provider must accept new 
32.23 	patients regardless of the Minnesota health care program the patient is enrolled in and may 
32.24 	not refuse to accept patients enrolled in one Minnesota health care program and continue 
32.25 	to accept patients enrolled in other Minnesota health care programs.

32.26 	EFFECTIVE DATE. This section is effective March 1, 2010.

32.27 	Sec. 24. TEMPORARY SUSPENSION.
 32.28 	(a) For the period beginning March 1, 2010, to June 30, 2011, the commissioner 
32.29 	of human services shall not implement or administer Minnesota Statutes 2008, section 
32.30 	256D.03, subdivisions 6 and 9; Minnesota Statutes 2009 Supplement, section 256D.03, 
32.31 	subdivision 4; or Minnesota Statutes 2008, section 256B.692; and Minnesota Statutes 
33.1 	2009 Supplement, section 256B.69, as they apply to the general assistance medical care 
33.2 	program unless specifically continued in Minnesota Statutes, section 256D.031.
33.3 	(b) Notwithstanding paragraph (a), outpatient prescription drug coverage shall 
33.4 	continue to be provided under Minnesota Statutes, section 256D.03.

33.5 	EFFECTIVE DATE. This section is effective March 1, 2010, and expires July 1, 
33.6 	2011.

33.7 	Sec. 25. COORDINATED CARE DELIVERY ORGANIZATION 
33.8 	DEMONSTRATION PROJECT.
 33.9 	The commissioner of human services shall develop, and present to the legislature 
33.10 	by December 15, 2010, a plan to establish a demonstration project to deliver inpatient 
33.11 	hospital, primary care, and specialist services to general assistance medical care enrollees 
33.12 	through coordinated care delivery organizations, beginning January 1, 2012. Each 
33.13 	coordinated care delivery organization must deliver coordinated care through at least one 
33.14 	hospital and one physician group practice, and may include counties and other health 
33.15 	care providers. The coordinated care delivery organization must provide inpatient 
33.16 	hospital services to general assistance medical care enrollees eligible for the program 
33.17 	under Minnesota Statutes, section 256D.03 or 256D.031. The coordinated care delivery 
33.18 	organization must accept responsibility for the quality of care and must assume financial 
33.19 	risk for the services provided. The plan must include:
33.20 	(1) financial incentives for coordinated care delivery organizations to reduce the 
33.21 	growth in the volume and cost of services provided, while maintaining or improving 
33.22 	the quality of care;
33.23 	(2) recommendations for the delivery of services not provided through a coordinated 
33.24 	care delivery organization and coordination of outpatient and inpatient health care services;
33.25 	(3) recommendations as to the size and scope of the demonstration project and 
33.26 	whether participation would be mandatory or voluntary for general assistance medical 
33.27 	care enrollees; and
33.28 	(4) recommendations for managing financial risk within a coordinated care delivery 
33.29 	organization.

33.30 	Sec. 26. APPROPRIATION TRANSFERS.
 33.31 	(a) Of the general fund appropriation to the commissioner of human services for 
33.32 	health care management in Laws 2009, chapter 79, article 13, section 3, subdivision 
33.33 	7, as amended by Laws 2009, chapter 173, article 2, section 1, $3,300,000 for health 
33.34 	care administration and $4,100,000 for health care operations shall be transferred on 
34.1 	March 1, 2010, to the fund established in Minnesota Statutes, section 256D.032. These 
34.2 	amounts are appropriated to the commissioner for the administration and operation of the 
34.3 	general assistance medical care program under Minnesota Statutes, section 256D.031. For 
34.4 	purposes of consistent cost allocation and accounting, the commissioner may transfer the 
34.5 	amounts appropriated for program administration and operation to the general fund.
34.6 	(b) Of the general fund appropriation to the commissioner of human services for 
34.7 	general assistance medical care grants in fiscal year 2010 in Laws 2009, chapter 79, article 
34.8 	13, section 3, subdivision 6, paragraph (d), as amended by Laws 2009, chapter 173, article 
34.9 	2, section 1, $44,000,000 shall be transferred on March 1, 2010, to the fund established 
34.10 	in Minnesota Statutes, section 256D.032, and any unexpended amount not used for 
34.11 	general assistance medical care expenditures incurred prior to March 1, 2010, does not 
34.12 	cancel and shall be transferred to the fund established in Minnesota Statutes, section 
34.13 	256D.032, by January 1, 2011.
34.14 	(c) The commissioner of finance shall transfer $169,733,000 in fiscal year 2011 
34.15 	and $12,979,000 in fiscal year 2012, from the general fund to the fund established in 
34.16 	Minnesota Statutes, section 256D.032.

34.17 	EFFECTIVE DATE. This section is effective March 1, 2010.

34.18 	Sec. 27. APPROPRIATION REDUCTION; TRANSFER.
 34.19 	(a) The general fund appropriation to the commissioner of human services for 
34.20 	children and community services grants in Laws 2009, chapter 79, article 13, section 3, 
34.21 	subdivision 4, as amended by Laws 2009, chapter 173, article 2, section 1, subdivision 4, 
34.22 	is reduced by $11,560,000 in fiscal year 2011 and is reduced by $1,062,000 in fiscal year 
34.23 	2012. The general fund base for children and community service grants is increased by 
34.24 	$11,560,000 per year for fiscal years 2012 and 2013. The general fund base for children 
34.25 	and community service grants is further increased by $1,062,000 for fiscal year 2013. This 
34.26 	$1,062,000 increase is onetime.
34.27 	(b) The general fund appropriation to the commissioner of human services for adult 
34.28 	mental health grants in Laws 2009, chapter 79, article 13, section 3, subdivision 8, as 
34.29 	amended by Laws 2009, chapter 173, article 2, section 1, subdivision 8, is reduced by 
34.30 	$11,560,000 in fiscal year 2011 and is reduced by $1,062,000 in fiscal year 2012. The 
34.31 	general fund base for adult mental health grants is increased by $11,560,000 per year in 
34.32 	fiscal years 2012 and 2013. The general fund base for adult mental health grants is further 
34.33 	increased by $1,062,000 for fiscal year 2013. This $1,062,000 increase is onetime.
35.1 	(c) $23,120,000 shall be transferred in fiscal year 2011 from the general fund to 
35.2 	the general assistance medical care account established in Minnesota Statutes, section 
35.3 	256D.032.
35.4 	(d) $2,124,000 shall be transferred in fiscal year 2012 from the general fund to 
35.5 	the general assistance medical care account established in Minnesota Statutes, section 
35.6 	256D.032.  $2,124,000 shall be transferred in fiscal year 2013 from the general assistance 
35.7 	medical care account established in Minnesota Statutes, section 256D.032, to the general 
35.8 	fund.

35.9 	Sec. 28. APPROPRIATIONS.
 35.10 	$....... for the period from March 1, 2010, to June 30, 2010, and $....... for fiscal 
35.11 	year 2011 is appropriated from the account established in Minnesota Statutes, section 
35.12 	256D.032, to the commissioner of human services for the general assistance medical care 
35.13 	program established in Minnesota Statutes, section 256D.031.

35.14 	EFFECTIVE DATE. This section is effective March 1, 2010.