1.1A bill for an act1.2relating to relating to health care; establishing mental health urgent care and 1.3consultation services; modifying the general assistance medical care program; 1.4appropriating money;amending Minnesota Statutes 2008, sections 256.9657, 1.5subdivisions 2, 3; 256.969, subdivisions 21, 26, 27, by adding subdivisions; 1.6256B.0625, subdivision 13f, by adding a subdivision; 256B.69, by adding a 1.7subdivision; 256D.03, subdivisions 3a, 3b; 256D.06, subdivision 7; 256L.05, 1.8subdivisions 1b, 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4; 1.9256L.17, subdivision 7; Minnesota Statutes 2009 Supplement, sections 256.969, 1.10subdivisions 2b, 3a, 30; 256B.195, subdivision 3; 256B.196, subdivision 2; 1.11256B.199; 256D.03, subdivision 3; proposing coding for new law in Minnesota 1.12Statutes, chapters 245; 256D.1.13BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:1.14    Section 1. [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC 1.15CONSULTATION.1.16    Subdivision 1.Mental health urgent care and psychiatric consultation.The 1.17commissioner shall include mental health urgent care and psychiatric consultation 1.18services as part of, but not limited to, the redesign of six community-based behavioral 1.19health hospitals and the Anoka-Metro Regional Treatment Center. These services must 1.20not duplicate existing services in the region, and must be implemented as specified in 1.21subdivisions 3 to 7.1.22    Subd. 2.Definitions.For purposes of this section:1.23(a) Mental health urgent care includes:1.24(1) initial mental health screening;1.25(2) mobile crisis assessment and intervention;1.26(3) rapid access to psychiatry, including psychiatric evaluation, initial treatment, 1.27and short-term psychiatry;2.1(4) nonhospital crisis stabilization residential beds; and2.2(5) health care navigator services which include, but are not limited to, assisting 2.3uninsured individuals in obtaining health care coverage.2.4(b) Psychiatric consultation services includes psychiatric consultation to primary 2.5care practitioners.2.6    Subd. 3.Rapid access to psychiatry.The commissioner shall develop rapid access 2.7to psychiatric services based on the following criteria:2.8(1) the individuals who receive the psychiatric services must be at risk of 2.9hospitalization and otherwise unable to receive timely services;2.10(2) where clinically appropriate, the service may be provided via interactive video 2.11where the service is provided in conjunction with an emergency room, a local crisis 2.12service, or a primary care or behavioral care practitioner; and2.13(3) the commissioner may integrate rapid access to psychiatry with the psychiatric 2.14consultation services in subdivision 4.2.15    Subd. 4.Collaborative psychiatric consultation.(a) The commissioner shall 2.16establish a collaborative psychiatric consultation service based on the following criteria:2.17(1) the service may be available via telephone, interactive video, e-mail, or other 2.18means of communication to emergency rooms, local crisis services, mental health 2.19professionals, and primary care practitioners, including pediatricians;2.20(2) the service shall be provided by a multidisciplinary team including, at a 2.21minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical 2.22social worker;2.23(3) the service shall include a triage-level assessment to determine the most 2.24appropriate response to each request, including appropriate referrals to other mental health 2.25professionals, as well as provision of rapid psychiatric access when other appropriate 2.26services are not available;  2.27(4) the first priority for this service is to provide the consultations required under 2.28section 256B.0625, subdivision 13j; and2.29(5) the service must encourage use of cognitive and behavioral therapies and other 2.30evidence-based treatments in addition to or in place of medication, where appropriate.2.31(b) The commissioner shall appoint an interdisciplinary work group to establish 2.32appropriate medication and psychotherapy protocols to guide the consultative process, 2.33including consultation with the Drug Utilization Review Board, as provided in section 2.34256B.0625, subdivision 13j. 3.1    Subd. 5.Phased availability.(a) The commissioner may phase in the availability 3.2of mental health urgent care services based on the limits of appropriations and the 3.3commissioner's determination of level of need and cost-effectiveness.3.4(b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin 3.5and Ramsey Counties and children statewide who are affected by section 256B.0625, 3.6subdivision 13j, and must include tracking of costs for the services provided and 3.7associated impacts on utilization of inpatient, emergency room, and other services.3.8    Subd. 6.Limited appropriations.The commissioner shall maximize use 3.9of available health care coverage for the services provided under this section. The 3.10commissioner's responsibility to provide these services for individuals without health care 3.11coverage must not exceed the appropriations for this section.3.12    Subd. 7.Flexible implementation.To implement this section, the commissioner 3.13shall select the structure and funding method that is the most cost-effective for each county 3.14or group of counties. This may include grants, contracts, direct provision by state-operated 3.15services, and public-private partnerships. Where feasible, the commissioner shall make 3.16any grants under this section a part of the integrated adult mental health initiative grants 3.17under section 245.4661.3.18    Sec. 2. Minnesota Statutes 2008, section 256.9657, subdivision 2, is amended to read:3.19    Subd. 2. Hospital surcharge. (a) Effective October 1, 1992, each Minnesota 3.20hospital except facilities of the federal Indian Health Service and regional treatment 3.21centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net 3.22patient revenues excluding net Medicare revenues reported by that provider to the health 3.23care cost information system according to the schedule in subdivision 4.3.24(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 
         1.563.25percent. 3.26(c) Effective March 1, 2010, to September 30, 2010, the surcharge under paragraph 3.27(b) is increased to 3.95 percent. Effective October 1, 2010, to June 30, 2011, the surcharge 3.28under paragraph (b) is increased to 3.06 percent. Notwithstanding section 256.9656, 3.29money collected under this paragraph in excess of the amount collected under paragraph 3.30(b) shall be deposited in the account established in section 256D.032.3.31(d) Notwithstanding the Medicare cost finding and allowable cost principles, the 3.32hospital surcharge is not an allowable cost for purposes of rate setting under sections 3.33256.9685
          to 
         256.9695. 3.34EFFECTIVE DATE.This section is effective March 1, 2010.4.1    Sec. 3. Minnesota Statutes 2008, section 256.9657, subdivision 3, is amended to read:4.2    Subd. 3. Surcharge on HMOs and community integrated service networks. (a) 4.3Effective October 1, 1992, each health maintenance organization with a certificate of 4.4authority issued by the commissioner of health under chapter 62D and each community 4.5integrated service network licensed by the commissioner under chapter 62N shall pay to 4.6the commissioner of human services a surcharge equal to six-tenths of one percent of the 4.7total premium revenues of the health maintenance organization or community integrated 4.8service network as reported to the commissioner of health according to the schedule in 4.9subdivision 4.4.10(b) Effective March 1, 2010, to June 30, 2011: (1) the surcharge under paragraph (a) 4.11is increased to 4.0 percent; and (2) each county-based purchasing plan authorized under 4.12section 256B.692 shall pay to the commissioner a surcharge equal to 4.0 percent of the 4.13total premium revenues of the plan, as reported to the commissioner of health, according 4.14to the payment schedule in subdivision 4. Notwithstanding section 256.9656, money 4.15collected under this paragraph in excess of the amount collected under paragraph (a) shall 4.16be deposited in the account established in section 256D.032.4.17(c) For purposes of this subdivision, total premium revenue means:4.18(1) premium revenue recognized on a prepaid basis from individuals and groups 4.19for provision of a specified range of health services over a defined period of time which 4.20is normally one month, excluding premiums paid to a health maintenance organization 4.21or community integrated service network from the Federal Employees Health Benefit 4.22Program;4.23(2) premiums from Medicare wrap-around subscribers for health benefits which 4.24supplement Medicare coverage;4.25(3) Medicare revenue, as a result of an arrangement between a health maintenance 4.26organization or a community integrated service network and the Centers for Medicare 4.27and Medicaid Services of the federal Department of Health and Human Services, for 4.28services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited 4.29from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social 4.30Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and 4.311395w-24, respectively, as they may be amended from time to time; and4.32(4) medical assistance revenue, as a result of an arrangement between a health 4.33maintenance organization or community integrated service network and a Medicaid state 4.34agency, for services to a medical assistance beneficiary.5.1If advance payments are made under clause (1) or (2) to the health maintenance 5.2organization or community integrated service network for more than one reporting period, 5.3the portion of the payment that has not yet been earned must be treated as a liability.5.4(c) (d) When a health maintenance organization or community integrated service 5.5network merges or consolidates with or is acquired by another health maintenance 5.6organization or community integrated service network, the surviving corporation or the 5.7new corporation shall be responsible for the annual surcharge originally imposed on 5.8each of the entities or corporations subject to the merger, consolidation, or acquisition, 5.9regardless of whether one of the entities or corporations does not retain a certificate of 5.10authority under chapter 62D or a license under chapter 62N.5.11(d) (e) Effective July 1 of each year, the surviving corporation's or the new 5.12corporation's surcharge shall be based on the revenues earned in the second previous 5.13calendar year by all of the entities or corporations subject to the merger, consolidation, 5.14or acquisition regardless of whether one of the entities or corporations does not retain a 5.15certificate of authority under chapter 62D or a license under chapter 62N until the total 5.16premium revenues of the surviving corporation include the total premium revenues of all 5.17the merged entities as reported to the commissioner of health.5.18(e) (f) When a health maintenance organization or community integrated service 5.19network, which is subject to liability for the surcharge under this chapter, transfers, 5.20assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability 5.21for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer 5.22of the health maintenance organization or community integrated service network.5.23(f) (g) In the event a health maintenance organization or community integrated 5.24service network converts its licensure to a different type of entity subject to liability 5.25for the surcharge under this chapter, but survives in the same or substantially similar 5.26form, the surviving entity remains liable for the surcharge regardless of whether one of 5.27the entities or corporations does not retain a certificate of authority under chapter 62D 5.28or a license under chapter 62N.5.29(g) (h) The surcharge assessed to a health maintenance organization or community 5.30integrated service network ends when the entity ceases providing services for premiums 5.31and the cessation is not connected with a merger, consolidation, acquisition, or conversion.5.32EFFECTIVE DATE.This section is effective March 1, 2010.5.33    Sec. 4. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 2b, is 5.34amended to read:6.1    Subd. 2b. Operating payment rates. In determining operating payment rates for 6.2admissions occurring on or after the rate year beginning January 1, 1991, and every two 6.3years after, or more frequently as determined by the commissioner, the commissioner shall 6.4obtain operating data from an updated base year and establish operating payment rates 6.5per admission for each hospital based on the cost-finding methods and allowable costs of 6.6the Medicare program in effect during the base year. Rates under the general assistance 6.7medical care, medical assistance, and MinnesotaCare programs shall not be rebased to 6.8more current data on January 1, 1997, January 1, 2005, for the first 24 months of the 6.9rebased period beginning January 1, 2009. For the first three six months of the rebased 6.10period beginning January 1, 2011, rates shall not be rebased at 74.25 percent of the full 6.11value of the rebasing percentage change. From April July 1, 2011, to March 31, 2012, 6.12rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change. 6.13Effective April 1, 2012, rates shall be rebased at full value. The base year operating 6.14payment rate per admission is standardized by the case mix index and adjusted by the 6.15hospital cost index, relative values, and disproportionate population adjustment. The 6.16cost and charge data used to establish operating rates shall only reflect inpatient services 6.17covered by medical assistance and shall not include property cost information and costs 6.18recognized in outlier payments.6.19    Sec. 5. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is 6.20amended to read:6.21    Subd. 3a. Payments. (a) Acute care hospital billings under the medical 6.22assistance program must not be submitted until the recipient is discharged. However, 6.23the commissioner shall establish monthly interim payments for inpatient hospitals that 6.24have individual patient lengths of stay over 30 days regardless of diagnostic category. 6.25Except as provided in section 
         256.9693, medical assistance reimbursement for treatment 6.26of mental illness shall be reimbursed based on diagnostic classifications. Individual 6.27hospital payments established under this section and sections 
         256.9685, 
         256.9686, and 6.28256.9695
         , in addition to third party and recipient liability, for discharges occurring during 6.29the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 6.30inpatient services paid for the same period of time to the hospital. This payment limitation 6.31shall be calculated separately for medical assistance and general assistance medical 6.32care services. The limitation on general assistance medical care shall be effective for 6.33admissions occurring on or after July 1, 1991. Services that have rates established under 6.34subdivision 11 or 12, must be limited separately from other services. After consulting with 6.35the affected hospitals, the commissioner may consider related hospitals one entity and 7.1may merge the payment rates while maintaining separate provider numbers. The operating 7.2and property base rates per admission or per day shall be derived from the best Medicare 7.3and claims data available when rates are established. The commissioner shall determine 7.4the best Medicare and claims data, taking into consideration variables of recency of the 7.5data, audit disposition, settlement status, and the ability to set rates in a timely manner. 7.6The commissioner shall notify hospitals of payment rates by December 1 of the year 7.7preceding the rate year. The rate setting data must reflect the admissions data used to 7.8establish relative values. Base year changes from 1981 to the base year established for the 7.9rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 7.10to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 7.111. The commissioner may adjust base year cost, relative value, and case mix index data 7.12to exclude the costs of services that have been discontinued by the October 1 of the year 7.13preceding the rate year or that are paid separately from inpatient services. Inpatient stays 7.14that encompass portions of two or more rate years shall have payments established based 7.15on payment rates in effect at the time of admission unless the date of admission preceded 7.16the rate year in effect by six months or more. In this case, operating payment rates for 7.17services rendered during the rate year in effect and established based on the date of 7.18admission shall be adjusted to the rate year in effect by the hospital cost index.7.19    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total 7.20payment, before third-party liability and spenddown, made to hospitals for inpatient 7.21services is reduced by .5 percent from the current statutory rates.7.22    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 7.23admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 7.24before third-party liability and spenddown, is reduced five percent from the current 7.25statutory rates. Mental health services within diagnosis related groups 424 to 432, and 7.26facilities defined under subdivision 16 are excluded from this paragraph.7.27    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for 7.28fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 7.29inpatient services before third-party liability and spenddown, is reduced 6.0 percent 7.30from the current statutory rates. Mental health services within diagnosis related groups 7.31424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 7.32Notwithstanding section 
         256.9686, subdivision 7, for purposes of this paragraph, medical 7.33assistance does not include general assistance medical care. Payments made to managed 7.34care plans shall be reduced for services provided on or after January 1, 2006, to reflect 7.35this reduction.8.1    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 8.2fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 8.3to hospitals for inpatient services before third-party liability and spenddown, is reduced 8.43.46 percent from the current statutory rates. Mental health services with diagnosis related 8.5groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 8.6paragraph. Payments made to managed care plans shall be reduced for services provided 8.7on or after January 1, 2009, through June 30, 2009, to reflect this reduction.8.8    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 8.9fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011, 8.10made to hospitals for inpatient services before third-party liability and spenddown, is 8.11reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis 8.12related groups 424 to 432 and facilities defined under subdivision 16 are excluded from 8.13this paragraph. Payments made to managed care plans shall be reduced for services 8.14provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.8.15    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 8.16for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals 8.17for inpatient services before third-party liability and spenddown, is reduced 1.79 percent 8.18from the current statutory rates. Mental health services with diagnosis related groups 8.19424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 8.20Payments made to managed care plans shall be reduced for services provided on or after 8.21July 1, 2010 2011, to reflect this reduction.8.22(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 8.23payment for fee-for-service admissions occurring on or after July 1, 2009, made to 8.24hospitals for inpatient services before third-party liability and spenddown, is reduced 8.25one percent from the current statutory rates. Facilities defined under subdivision 16 are 8.26excluded from this paragraph. Payments made to managed care plans shall be reduced for 8.27services provided on or after October 1, 2009, to reflect this reduction.8.28(i) In order to offset the ratable reductions provided for in this subdivision, the total 8.29payment rate for medical assistance fee-for-service admissions occurring on or after 8.30March 1, 2010, to June 30, 2011, made to Minnesota hospitals for inpatient services before 8.31third-party liability and spenddown, shall be increased by 14 percent from the current 8.32statutory rates if the hospital is located in Hennepin or Ramsey County and 18 percent from 8.33the current statutory rates for all other Minnesota hospitals. For purposes of this paragraph, 8.34medical assistance does not include general assistance medical care. This increase shall 8.35be paid from the account established in section 256D.032. The commissioner shall not 8.36adjust rates paid to a prepaid health plan under contract with the commissioner to reflect 9.1payments provided in this paragraph, and prepaid health plans are not required to increase 9.2rates to providers under contract to reflect payments provided in this paragraph. The 9.3commissioner may utilize a settlement process to adjust rates in excess of the Medicare 9.4upper limits on payments. The commissioner may ratably reduce payments under this 9.5paragraph in order to comply with section 256B.195, subdivision 3, paragraph (f).9.6EFFECTIVE DATE.This section is effective March 1, 2010.9.7    Sec. 6. Minnesota Statutes 2008, section 256.969, subdivision 21, is amended to read:9.8    Subd. 21. Mental health or chemical dependency admissions; rates.(a) 9.9Admissions under the general assistance medical care program occurring on or after 9.10July 1, 1990, and admissions under medical assistance, excluding general assistance 9.11medical care, occurring on or after July 1, 1990, and on or before September 30, 1992, 9.12that are classified to a diagnostic category of mental health or chemical dependency 9.13shall have rates established according to the methods of subdivision 14, except the per 9.14day rate shall be multiplied by a factor of 2, provided that the total of the per day rates 9.15shall not exceed the per admission rate. This methodology shall also apply when a hold 9.16or commitment is ordered by the court for the days that inpatient hospital services are 9.17medically necessary. Stays which are medically necessary for inpatient hospital services 9.18and covered by medical assistance shall not be billable to any other governmental entity. 9.19Medical necessity shall be determined under criteria established to meet the requirements 9.20of section 
         256B.04, subdivision 15, or 
         256D.03, subdivision 7, paragraph (b). 9.21(b) In order to ensure adequate access for the provision of mental health services 9.22and to encourage broader delivery of these services outside the nonstate governmental 9.23hospital setting, payment rates for medical assistance admissions occurring on or after 9.24March 1, 2010, to June 30, 2011, at a Minnesota private, not-for-profit hospital above the 9.2575th percentile of all Minnesota private, nonprofit hospitals for diagnosis-related groups 9.26424 to 432 and 521 to 523 admissions paid by medical assistance for admissions occurring 9.27in calendar year 2007, shall be increased for these diagnosis-related groups at a percentage 9.28calculated to cost not more than a total of $40,000,000, including state and federal shares. 9.29This increase shall be paid from the account established in section 256D.032. For purposes 9.30of this paragraph, medical assistance does not include general assistance medical care. 9.31The commissioner shall not adjust rates paid to a prepaid health plan under contract with 9.32the commissioner to reflect payments provided in this paragraph, and prepaid health plans 9.33are not required to increase rates to providers under contract to reflect payments provided 9.34in this paragraph. The commissioner may utilize a settlement process to adjust rates in 9.35excess of the Medicare upper limits on payments. The commissioner may ratably reduce 10.1payments under this paragraph in order to comply with section 256B.195, subdivision 3, 10.2paragraph (f).10.3EFFECTIVE DATE.This section is effective March 1, 2010.10.4    Sec. 7. Minnesota Statutes 2008, section 256.969, subdivision 26, is amended to read:10.5    Subd. 26. Greater Minnesota payment adjustment after June 30, 2001. (a) For 10.6admissions occurring after June 30, 2001, the commissioner shall pay fee-for-service 10.7inpatient admissions for the diagnosis-related groups specified in paragraph (b) at hospitals 10.8located outside of the seven-county metropolitan area at the higher of:10.9(1) the hospital's current payment rate for the diagnostic category to which the 10.10diagnosis-related group belongs, exclusive of disproportionate population adjustments 10.11received under subdivision 9 and hospital payment adjustments received under subdivision 10.1223; or10.13(2) 90 percent of the average payment rate for that diagnostic category for hospitals 10.14located within the seven-county metropolitan area, exclusive of disproportionate 10.15population adjustments received under subdivision 9 and hospital payment adjustments 10.16received under subdivisions 20 and 23.10.17(b) The payment increases provided in paragraph (a) apply to the following 10.18diagnosis-related groups, as they fall within the diagnostic categories:10.19(1) 370 cesarean section with complicating diagnosis;10.20(2) 371 cesarean section without complicating diagnosis;10.21(3) 372 vaginal delivery with complicating diagnosis;10.22(4) 373 vaginal delivery without complicating diagnosis;10.23(5) 386 extreme immaturity and respiratory distress syndrome, neonate;10.24(6) 388 full-term neonates with other problems;10.25(7) 390 prematurity without major problems;10.26(8) 391 normal newborn;10.27(9) 385 neonate, died or transferred to another acute care facility;10.28(10) 425 acute adjustment reaction and psychosocial dysfunction;10.29(11) 430 psychoses;10.30(12) 431 childhood mental disorders; and10.31(13) 164-167 appendectomy.10.32(c) For medical assistance admissions occurring on or after March 1, 2010, to June 10.3330, 2011, the payment rate under paragraph (a), clause (2), shall be increased to 100 10.34percent from 90 percent, after application of the rate increase in subdivision 3a, paragraph 10.35(i). This increase shall be paid from the account established in section 256D.032. For 11.1purposes of this paragraph, medical assistance does not include general assistance medical 11.2care. The commissioner shall not adjust rates paid to a prepaid health plan under contract 11.3with the commissioner to reflect payments provided in this paragraph, and prepaid health 11.4plans are not required to increase rates to providers under contract to reflect payments 11.5provided in this paragraph. The commissioner may utilize a settlement process to adjust 11.6rates in excess of the Medicare upper limits on payments. The commissioner may 11.7ratably reduce payments under this paragraph in order to comply with section 256B.195, 11.8subdivision 3, paragraph (f).11.9EFFECTIVE DATE.This section is effective March 1, 2010.11.10    Sec. 8. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 11.11to read:11.12    Subd. 26a.Psychiatric and burn services payment adjustment on or after July 11.131, 2010.(a) For admissions occurring on or after July 1, 2010, the commissioner shall 11.14increase the total payment for medical assistance fee-for-service inpatient admissions 11.15for the diagnosis-related groups specified in paragraph (b) at any hospital that is a 11.16nonstate public Minnesota hospital and a Level I trauma center. The rate increases 11.17shall be established for each hospital by the commissioner at a level that uses each 11.18hospital's voluntary payments under paragraph (c) as the state share. For purposes of this 11.19subdivision, medical assistance does not include general assistance medical care.11.20    (b) The rate increases provided in paragraph (a) apply to the following 11.21diagnosis-related groups or subgroups, or any subsequent designations of such groups 11.22or subgroups: 424 to 431, 433, 504 to 511, 521, and 523. These increases are only 11.23available to the extent that revenue is available from the counties under paragraph (c) 11.24for the nonfederal share.11.25    (c) Effective July 15, 2010, in addition to any payment otherwise required under 11.26sections 256B.19, 256B.195, 256B.196, and 256B.199, the following government entities 11.27may make the following voluntary payments to the commissioner on an annual basis:11.28    (1) Hennepin County, $7,000,000; and11.29    (2) Ramsey County, $3,500,000.11.30The amounts in this paragraph shall be part of the designated governmental unit's portion 11.31of the nonfederal share of medical assistance costs.11.32    (d) The commissioner may adjust the intergovernmental transfers under paragraph 11.33(c) and the payments under paragraph (a) based on the commissioner's determination of 11.34Medicare upper payment limits and hospital-specific charge limits.12.1    Sec. 9. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:12.2    Subd. 27. Quarterly payment adjustment. (a) In addition to any other payment 12.3under this section, the commissioner shall make the following payments effective July 12.41, 2007:12.5    (1) for a hospital located in Minnesota and not eligible for payments under 12.6subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8 12.7percent of total patient days as of the base year in effect on July 1, 2005, a payment 12.8equal to 13 percent of the total of the operating and property payment rates, except that 12.9Hennepin County Medical Center and Regions Hospital shall not receive a payment 12.10under this subdivision;12.11    (2) for a hospital located in Minnesota in a specified urban area outside of the 12.12seven-county metropolitan area and not eligible for payments under subdivision 20, with 12.13a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total 12.14patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent 12.15of the total of the operating and property payment rates. For purposes of this clause, the 12.16following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria, 12.17Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, 12.18Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena; 12.19    (3) for a hospital located in Minnesota but not located in a specified urban area 12.20under clause (2), with a medical assistance inpatient utilization rate less than or equal to 12.2117.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment 12.22equal to four percent of the total of the operating and property payment rates. A hospital 12.23located in Woodbury and not in existence during the base year shall be reimbursed under 12.24this clause; and12.25    (4) in addition to any payments under clauses (1) to (3), for a hospital located in 12.26Minnesota and not eligible for payments under subdivision 20 with a medical assistance 12.27inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect 12.28on July 1, 2005, a payment equal to eight percent of the total of the operating and property 12.29payment rates, and for a hospital located in Minnesota and not eligible for payments 12.30under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent 12.31of total patient days as of the base year in effect on July 1, 2005, a payment equal to 12.32nine percent of the total of the operating and property payment rates. After making any 12.33ratable adjustments required under paragraph (b), the commissioner shall proportionately 12.34reduce payments under clauses (2) and (3) by an amount needed to make payments under 12.35this clause.13.1    (b) The state share of payments under paragraph (a) shall be equal to federal 13.2reimbursements to the commissioner to reimburse expenditures reported under section 13.3256B.199
         . The commissioner shall ratably reduce or increase payments under this 13.4subdivision in order to ensure that these payments equal the amount of reimbursement 13.5received by the commissioner under section 
         256B.199, except that payments shall be 13.6ratably reduced by an amount equivalent to the state share of a four percent reduction in 13.7MinnesotaCare and medical assistance payments for inpatient hospital services. Effective 13.8July 1, 2009, the ratable reduction shall be equivalent to the state share of a three percent 13.9reduction in these payments. Effective for federal disproportionate share hospital funds 13.10earned on general assistance medical care payments for services rendered on or after 13.11March 1, 2010, to June 30, 2011, the amount of the three percent ratable reduction required 13.12under this paragraph shall be deposited in the account established in section 256D.032.13.13    (c) The payments under paragraph (a) shall be paid quarterly based on each hospital's 13.14operating and property payments from the second previous quarter, beginning on July 13.1515, 2007, or upon federal approval of federal reimbursements under section 
         256B.199, 13.16whichever occurs later.13.17    (d) The commissioner shall not adjust rates paid to a prepaid health plan under 13.18contract with the commissioner to reflect payments provided in paragraph (a).13.19    (e) The commissioner shall maximize the use of available federal money for 13.20disproportionate share hospital payments and shall maximize payments to qualifying 13.21hospitals. In order to accomplish these purposes, the commissioner may, in consultation 13.22with the nonstate entities identified in section 
         256B.199, adjust, on a pro rata basis 13.23if feasible, the amounts reported by nonstate entities under section 
         256B.199 when 13.24application for reimbursement is made to the federal government, and otherwise adjust 13.25the provisions of this subdivision. The commissioner shall utilize a settlement process 13.26based on finalized data to maximize revenue under section 
         256B.199 and payments 13.27under this section.13.28    (f) For purposes of this subdivision, medical assistance does not include general 13.29assistance medical care.13.30EFFECTIVE DATE.This section is effective for services rendered on or after 13.31March 1, 2010.13.32    Sec. 10. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 30, 13.33is amended to read:13.34    Subd. 30. Payment rates for births. (a) For admissions occurring on or after 13.35October 1, 2009, the total operating and property payment rate, excluding disproportionate 14.1population adjustment, for the following diagnosis-related groups, as they fall within 14.2the diagnostic categories: (1) 371 cesarean section without complicating diagnosis; (2) 14.3372 vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without 14.4complicating diagnosis, shall be no greater than $3,528.14.5(b) The rates described in this subdivision do not include newborn care.14.6(c) Payments to managed care and county-based purchasing plans under section 14.7256B.69
         , 
         256B.692, or 
         256L.12 shall be reduced for services provided on or after October 14.81, 2009, to reflect the adjustments in paragraph (a).14.9(d) Prior authorization shall not be required before reimbursement is paid for a 14.10cesarean section delivery.14.11(e) In order to ensure adequate access for the provision of maternity services and 14.12to encourage broader delivery of these services outside the nonstate governmental 14.13hospital setting, and notwithstanding paragraph (a), payment rates for medical assistance 14.14admissions, excluding general assistance medical care admissions, occurring from March 14.151, 2010, to June 30, 2011, at a private, not-for-profit hospital above the 65th percentile of 14.16all Minnesota private, nonprofit hospitals for diagnosis-related groups 370 to 373 and 391 14.17admissions paid by medical assistance for admissions provided in calendar year 2007, shall 14.18be increased for these diagnosis-related groups at a percentage calculated to cost not more 14.19than a total of $35,000,000, including state and federal shares. This increase shall be paid 14.20from the account established in section 256D.032. For purposes of this paragraph, medical 14.21assistance does not include general assistance medical care. The commissioner shall not 14.22adjust rates paid to a prepaid health plan under contract with the commissioner to reflect 14.23payments provided in this paragraph, and prepaid health plans are not required to increase 14.24rates to providers under contract to reflect payments provided in this paragraph. The 14.25commissioner may utilize a settlement process to adjust rates in excess of the Medicare 14.26upper limits on payments. The commissioner may ratably reduce payments under this 14.27paragraph in order to comply with section 256B.195, subdivision 3, paragraph (f).14.28EFFECTIVE DATE.This section is effective March 1, 2010.14.29    Sec. 11. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 14.30to read:14.31    Subd. 31.Rate increase for hospitals in cities of the third class and fourth class.14.32    Effective for services rendered on or after March 1, 2010, to June 30, 2011, payment rates 14.33for medical assistance admissions, excluding general assistance medical care admissions, 14.34at Minnesota hospitals with fewer than 500 medical assistance admissions during fiscal 14.35year 2008 and located in cities of the third class or of the fourth class, as defined in 15.1section 410.01, shall be increased by 27 percent. This increase shall be paid from the 15.2account established in section 256D.032. The commissioner shall not adjust rates paid to a 15.3prepaid health plan under contract with the commissioner to reflect payments provided 15.4in this paragraph. The commissioner may utilize a settlement process to adjust rates in 15.5excess of the Medicare upper limits on payments. The commissioner may ratably reduce 15.6payments under this paragraph in order to comply with section 256B.195, subdivision 3, 15.7paragraph (f).15.8EFFECTIVE DATE.This section is effective March 1, 2010.15.9    Sec. 12. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to 15.10read:15.11    Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and 15.12recommend drugs which require prior authorization. The Formulary Committee shall 15.13establish general criteria to be used for the prior authorization of brand-name drugs for 15.14which generically equivalent drugs are available, but the committee is not required to 15.15review each brand-name drug for which a generically equivalent drug is available.15.16(b) Prior authorization may be required by the commissioner before certain 15.17formulary drugs are eligible for payment. The Formulary Committee may recommend 15.18drugs for prior authorization directly to the commissioner. The commissioner may also 15.19request that the Formulary Committee review a drug for prior authorization. Before the 15.20commissioner may require prior authorization for a drug:15.21(1) the commissioner must provide information to the Formulary Committee on the 15.22impact that placing the drug on prior authorization may have on the quality of patient care 15.23and on program costs, information regarding whether the drug is subject to clinical abuse 15.24or misuse, and relevant data from the state Medicaid program if such data is available;15.25(2) the Formulary Committee must review the drug, taking into account medical and 15.26clinical data and the information provided by the commissioner; and15.27(3) the Formulary Committee must hold a public forum and receive public comment 15.28for an additional 15 days.15.29The commissioner must provide a 15-day notice period before implementing the prior 15.30authorization.15.31(c) Except as provided in subdivision 13j, prior authorization shall not be required or 15.32utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:15.33(1) there is no generically equivalent drug available; and15.34(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or16.1(3) the drug is part of the recipient's current course of treatment.16.2This paragraph applies to any multistate preferred drug list or supplemental drug rebate 16.3program established or administered by the commissioner. Prior authorization shall 16.4automatically be granted for 60 days for brand name drugs prescribed for treatment of 16.5mental illness within 60 days of when a generically equivalent drug becomes available, 16.6provided that the brand name drug was part of the recipient's course of treatment at the 16.7time the generically equivalent drug became available.16.8(d) Prior authorization shall not be required or utilized for any antihemophilic factor 16.9drug prescribed for the treatment of hemophilia and blood disorders where there is no 16.10generically equivalent drug available if the prior authorization is used in conjunction with 16.11any supplemental drug rebate program or multistate preferred drug list established or 16.12administered by the commissioner.16.13(e) The commissioner may require prior authorization for brand name drugs 16.14whenever a generically equivalent product is available, even if the prescriber specifically 16.15indicates "dispense as written-brand necessary" on the prescription as required by section 16.16151.21, subdivision 2
         .16.17(f) Notwithstanding this subdivision, the commissioner may automatically require 16.18prior authorization, for a period not to exceed 180 days, for any drug that is approved by 16.19the United States Food and Drug Administration on or after July 1, 2005. The 180-day 16.20period begins no later than the first day that a drug is available for shipment to pharmacies 16.21within the state. The Formulary Committee shall recommend to the commissioner general 16.22criteria to be used for the prior authorization of the drugs, but the committee is not 16.23required to review each individual drug. In order to continue prior authorizations for a 16.24drug after the 180-day period has expired, the commissioner must follow the provisions 16.25of this subdivision.16.26EFFECTIVE DATE.This section is effective March 1, 2010.16.27    Sec. 13. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 16.28subdivision to read:16.29    Subd. 13j.Antipsychotic and attention deficit disorder and attention deficit 16.30hyperactivity disorder medications.(a) The commissioner, in consultation with the 16.31Drug Utilization Review Board established in subdivision 13i and actively practicing 16.32pediatric mental health professionals, must:16.33(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs 16.34and drugs used for attention deficit disorder or attention deficit hyperactivity disorder 17.1based on available medical, clinical, and safety data and research. The commissioner 17.2shall periodically review the list of medications and pediatric dose ranges and update 17.3the medications and doses listed as needed after consultation with the Drug Utilization 17.4Review Board;17.5(2) identify situations where a collaborative psychiatric consultation and prior 17.6authorization should be required before the initiation or continuation of drug therapy 17.7in pediatric patients including, but not limited to, high-dose regimens, off-label use of 17.8prescription medication, a patient's young age, and lack of coordination among multiple 17.9prescribing providers; and17.10(3) track prescriptive practices and the use of psychotropic medications in children 17.11with the goal of reducing the use of medication, where appropriate.17.12(b) Effective July 1, 2011, the commissioner shall require prior authorization and 17.13a collaborative psychiatric consultation before an atypical antipsychotic and attention 17.14deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria 17.15identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric 17.16consultation must be completed before the identified medications are eligible for payment 17.17unless:17.18(1) the patient has already been stabilized on the medication regimen; or17.19(2) the prescriber indicates that the child is in crisis.17.20If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed 17.21within 90 days for payment to continue.17.22(c) For purposes of this subdivision, a collaborative psychiatric consultation must 17.23meet the criteria described in section 245.4862, subdivision 5.17.24    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.195, subdivision 3, 17.25is amended to read:17.26    Subd. 3. Payments to certain safety net providers. (a) Effective July 15, 2001, the 17.27commissioner shall make the following payments to the hospitals indicated annually:17.28(1) to Hennepin County Medical Center, any federal matching funds available to 17.29match the payments received by the medical center under subdivision 2, to increase 17.30payments for medical assistance admissions and to recognize higher medical assistance 17.31costs in institutions that provide high levels of charity care; and17.32(2) to Regions Hospital, any federal matching funds available to match the payments 17.33received by the hospital under subdivision 2, to increase payments for medical assistance 17.34admissions and to recognize higher medical assistance costs in institutions that provide 17.35high levels of charity care.18.1(b) Effective July 15, 2001, the following percentages of the transfers under 18.2subdivision 2 shall be retained by the commissioner for deposit each month into the 18.3general fund:18.4(1) 18 percent, plus any federal matching funds, shall be allocated for the following 18.5purposes:18.6(i) during the fiscal year beginning July 1, 2001, of the amount available under 18.7this clause, 39.7 percent shall be allocated to make increased hospital payments under 18.8section 
         256.969, subdivision 26; 34.2 percent shall be allocated to fund the amounts 18.9due from small rural hospitals, as defined in section 
         144.148, for overpayments under 18.10section 
         256.969, subdivision 5a, resulting from a determination that medical assistance 18.11and general assistance payments exceeded the charge limit during the period from 1994 to 18.121997; and 26.1 percent shall be allocated to the commissioner of health for rural hospital 18.13capital improvement grants under section 
         144.148; and18.14(ii) during fiscal years beginning on or after July 1, 2002, of the amount available 18.15under this clause, 55 percent shall be allocated to make increased hospital payments under 18.16section 
         256.969, subdivision 26, and 45 percent shall be allocated to the commissioner of 18.17health for rural hospital capital improvement grants under section 
         144.148; and18.18(2) 11 percent shall be allocated to the commissioner of health to fund community 18.19clinic grants under section 
         145.9268.18.20(c) This subdivision shall apply to fee-for-service payments only and shall not 18.21increase capitation payments or payments made based on average rates. The allocation in 18.22paragraph (b), clause (1), item (ii), to increase hospital payments under section 
         256.969, 18.23subdivision 26
         , shall not limit payments under that section.18.24(d) Medical assistance rate or payment changes, including those required to obtain 18.25federal financial participation under section 
         62J.692, subdivision 8, shall precede the 18.26determination of intergovernmental transfer amounts determined in this subdivision. 18.27Participation in the intergovernmental transfer program shall not result in the offset of 18.28any health care provider's receipt of medical assistance payment increases other than 18.29limits resulting from hospital-specific charge limits and limits on disproportionate share 18.30hospital payments.18.31(e) Effective July 1, 2003, if the amount available for allocation under paragraph 18.32(b) is greater than the amounts available during March 2003, after any increase in 18.33intergovernmental transfers and payments that result from section 
         256.969, subdivision 18.343a
         , paragraph (c), are paid to the general fund, any additional amounts available under this 18.35subdivision after reimbursement of the transfers under subdivision 2 shall be allocated to 19.1increase medical assistance payments, subject to hospital-specific charge limits and limits 19.2on disproportionate share hospital payments, as follows:19.3(1) if the payments under subdivision 5 are approved, the amount shall be paid to 19.4the largest ten percent of hospitals as measured by 2001 payments for medical assistance, 19.5general assistance medical care, and MinnesotaCare in the nonstate government hospital 19.6category. Payments shall be allocated according to each hospital's proportionate share 19.7of the 2001 payments; or19.8(2) if the payments under subdivision 5 are not approved, the amount shall be paid to 19.9the largest ten percent of hospitals as measured by 2001 payments for medical assistance, 19.10general assistance medical care, and MinnesotaCare in the nonstate government category 19.11and to the largest ten percent of hospitals as measured by payments for medical assistance, 19.12general assistance medical care, and MinnesotaCare in the nongovernment hospital 19.13category. Payments shall be allocated according to each hospital's proportionate 19.14share of the 2001 payments in their respective category of nonstate government and 19.15nongovernment. The commissioner shall determine which hospitals are in the nonstate 19.16government and nongovernment hospital categories.19.17(f) For federal fiscal years 2010 and 2011, payments under this subdivision shall 19.18be made at no less than the federal fiscal year 2009 level.19.19EFFECTIVE DATE.This section is effective March 1, 2010.19.20    Sec. 15. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, 19.21is amended to read:19.22    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and 19.23subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 19.24services upper payment limit for nonstate government hospitals. The commissioner shall 19.25then determine the amount of a supplemental payment to Hennepin County Medical 19.26Center and Regions Hospital for these services that would increase medical assistance 19.27spending in this category to the aggregate upper payment limit for all nonstate government 19.28hospitals in Minnesota. In making this determination, the commissioner shall allot the 19.29available increases between Hennepin County Medical Center and Regions Hospital 19.30based on the ratio of medical assistance fee-for-service outpatient hospital payments to 19.31the two facilities. The commissioner shall adjust this allotment as necessary based on 19.32federal approvals, the amount of intergovernmental transfers received from Hennepin and 19.33Ramsey Counties, and other factors, in order to maximize the additional total payments. 19.34The commissioner shall inform Hennepin County and Ramsey County of the periodic 19.35intergovernmental transfers necessary to match federal Medicaid payments available 20.1under this subdivision in order to make supplementary medical assistance payments to 20.2Hennepin County Medical Center and Regions Hospital equal to an amount that when 20.3combined with existing medical assistance payments to nonstate governmental hospitals 20.4would increase total payments to hospitals in this category for outpatient services to 20.5the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 20.6receipt of these periodic transfers, the commissioner shall make supplementary payments 20.7to Hennepin County Medical Center and Regions Hospital.20.8    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall 20.9determine an upper payment limit for physicians affiliated with Hennepin County Medical 20.10Center and with Regions Hospital. The upper payment limit shall be based on the average 20.11commercial rate or be determined using another method acceptable to the Centers for 20.12Medicare and Medicaid Services. The commissioner shall inform Hennepin County and 20.13Ramsey County of the periodic intergovernmental transfers necessary to match the federal 20.14Medicaid payments available under this subdivision in order to make supplementary 20.15payments to physicians affiliated with Hennepin County Medical Center and Regions 20.16Hospital equal to the difference between the established medical assistance payment for 20.17physician services and the upper payment limit. Upon receipt of these periodic transfers, 20.18the commissioner shall make supplementary payments to physicians of Hennepin Faculty 20.19Associates and HealthPartners.20.20    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shallmay 20.21make monthly intergovernmental transfers to the commissioner in the following amounts: 20.22$133,333 by Hennepin County and $100,000 by Ramsey County order to increase 20.23medical assistance capitation payments to licensed health care plans in Minnesota that 20.24pay enhanced amounts to Hennepin County Medical Center and Regions Hospital for the 20.25provision of services to Minnesota health care program enrollees. The commissioner 20.26shall increase the medical assistance capitation payments to Metropolitan Health Plan 20.27and HealthPartnerseach licensed health plan that agrees to provide enhanced payments 20.28to Hennepin County Medical Center or Regions Hospital for the provision of services 20.29to Minnesota health care program enrollees by an amount in total equal to the annual 20.30value of the monthly transfers plus federal financial participation. health plan's increase 20.31in capitation payments as a result of the monthly intergovernmental transfers. The 20.32commissioner shall annually set the amount of the capitation rate increase for each plan, 20.33and the corresponding intergovernmental transfer amount, based on information submitted 20.34by Hennepin County Medical Center and Regions Hospital and actuarial soundness data 20.35for the licensed health plans. Upon the request of the commissioner, health plans shall 20.36submit individual-level cost data for verification purposes. The commissioner may ratably 21.1reduce these payments on a pro rata basis in order to satisfy federal requirements for 21.2actuarial soundness. If payments are reduced, transfers shall be reduced accordingly.21.3    (d) The commissioner shall inform Hennepin County and Ramsey County on an 21.4ongoing basis of the need for any changes needed in the intergovernmental transfers 21.5in order to continue the payments under paragraphs (a) to (c), at their maximum level, 21.6including increases in upper payment limits, changes in the federal Medicaid match, and 21.7other factors.21.8    (e) The payments in paragraphs (a) to (c) shall be implemented independently of 21.9each other, subject to federal approval and to the receipt of transfers under subdivision 3.21.10EFFECTIVE DATE.This section is effective the day following final enactment.21.11    Sec. 16. Minnesota Statutes 2009 Supplement, section 256B.199, is amended to read:21.12256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.21.13    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds 21.14for the expenditures in paragraphs (b) and (c).21.15    (b) The commissioner shall apply for federal matching funds for certified public 21.16expenditures as follows:21.17    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, and 21.18Regions Hospital, the University of Minnesota, and Fairview-University Medical Center21.19shall report quarterly to the commissioner beginning June 1, 2007, payments made during 21.20the second previous quarter that may qualify for reimbursement under federal law;21.21     (2) based on these reports, the commissioner shall apply for federal matching 21.22funds. These funds are appropriated to the commissioner for the payments under section 21.23256.969, subdivision 27
         ; and21.24     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform 21.25the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share 21.26hospital payment money expected to be available in the current federal fiscal year.21.27    (c) The commissioner shall apply for federal matching funds for general assistance 21.28medical care expenditures as follows:21.29    (1) for hospital services occurring on or after July 1, 2007, general assistance medical 21.30care expenditures for fee-for-service inpatient and outpatient hospital payments made by 21.31the department shall be used to apply for federal matching funds, except as limited below:21.32    (i) only those general assistance medical care expenditures made to an individual 21.33hospital that would not cause the hospital to exceed its individual hospital limits under 21.34section 1923 of the Social Security Act may be considered; and22.1    (ii) general assistance medical care expenditures may be considered only to the extent 22.2of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and22.3    (2) all hospitals must provide any necessary expenditure, cost, and revenue 22.4information required by the commissioner as necessary for purposes of obtaining federal 22.5Medicaid matching funds for general assistance medical care expenditures.22.6    (d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall 22.7apply for additional federal matching funds available as disproportionate share hospital 22.8payments under the American Recovery and Reinvestment Act of 2009. These funds shall 22.9be made available as the state share of payments under section 
         256.969, subdivision 28. 22.10The entities required to report certified public expenditures under paragraph (b), clause 22.11(1), shall report additional certified public expenditures as necessary under this paragraph.22.12    (e) Effective July 15, 2010, in addition to any payment otherwise required under 22.13sections 256B.19, 256B.195, and 256B.196, the following government entities may make 22.14the following voluntary payments on an annual basis:22.15    (1) Hennepin County, $6,200,000; and22.16    (2) Ramsey County, $4,000,000.22.17    (f) The sums in paragraph (e) shall be part of the designated governmental unit's 22.18portion of the nonfederal share of medical assistance costs.22.19    (g) Effective July 15, 2010, the commissioner shall make the following Medicaid 22.20disproportionate share hospital payments to the hospitals on a monthly basis:22.21    (1) to Hennepin County Medical Center, any federal matching funds available to 22.22match the payments received by the medical center for contributions under paragraph (e), 22.23to increase payments for medical assistance admissions and to recognize higher medical 22.24assistance costs in institutions that provide high levels of charity care; and22.25    (2) to Regions Hospital, any federal matching funds available to match the payments 22.26received by the hospital for contributions under paragraph (e), to increase payments 22.27for medical assistance admissions and to recognize higher medical assistance costs in 22.28institutions that provide high levels of charity care.22.29    (h) Effective July 15, 2010, after making the payments provided in paragraph 22.30(g), the commissioner shall make the increased payments provided in section 256.969, 22.31subdivision 26a.22.32    (i) The commissioner shall make the payments under paragraphs (g) and (h) prior 22.33to making any other payments under this section, section 256.969, subdivision 27, or 22.34256B.195.23.1    Sec. 17. Minnesota Statutes 2008, section 256B.69, is amended by adding a 23.2subdivision to read:23.3    Subd. 5k.Temporary rate modifications.For services rendered effective May 23.41, 2010, to June 30, 2011, the total payment made to managed care plans under the 23.5medical assistance program and under MinnesotaCare for families with children shall be 23.6increased by 4.61 percent. This increase shall be paid from the account established in 23.7section 256D.032.23.8EFFECTIVE DATE.This section is effective March 1, 2010.23.9    Sec. 18. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is 23.10amended to read:23.11    Subd. 3. General assistance medical care; eligibility. (a) General assistance 23.12medical care may be paid for any person who is not eligible for medical assistance under 23.13chapter 256B, including eligibility for medical assistance based on a spenddown of excess 23.14income according to section 
         256B.056, subdivision 5, or MinnesotaCare for applicants 23.15and recipients defined in paragraph (c), except as provided in paragraph (d), and:23.16    (1) who is receiving assistance under section 
         256D.05, except for families with 23.17children who are eligible under Minnesota family investment program (MFIP), or who is 23.18having a payment made on the person's behalf under sections 
         256I.01 to 
         256I.06; or23.19    (2) who is a resident of Minnesota; and23.20    (i) who has gross countable income not in excess of 75 percent of the federal poverty 23.21guidelines for the family size, using a six-month budget period and whose equity in assets 23.22is not in excess of $1,000 per assistance unit. General assistance medical care is not 23.23available for applicants or enrollees who are otherwise eligible for medical assistance but 23.24fail to verify their assets. Enrollees who become eligible for medical assistance shall be 23.25terminated and transferred to medical assistance. Exempt assets, the reduction of excess 23.26assets, and the waiver of excess assets must conform to the medical assistance program in 23.27section 
         256B.056, subdivisions 3 and 3d, with the following exception: the maximum 23.28amount of undistributed funds in a trust that could be distributed to or on behalf of the 23.29beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the 23.30terms of the trust, must be applied toward the asset maximum; or23.31    (ii) who has gross countable income above 75 percent of the federal poverty 23.32guidelines but not in excess of 175 percent of the federal poverty guidelines for the family 23.33size, using a six-month budget period, whose equity in assets is not in excess of the limits 23.34in section 
         256B.056, subdivision 3c, and who applies during an inpatient hospitalization.24.1    (b) The commissioner shall adjust the income standards under this section each July 24.21 by the annual update of the federal poverty guidelines following publication by the 24.3United States Department of Health and Human Services.24.4    (c) Effective for applications and renewals processed on or after September 1, 2006, 24.5general assistance medical care may not be paid for applicants or recipients who are adults 24.6with dependent children under 21 whose gross family income is equal to or less than 275 24.7percent of the federal poverty guidelines who are not described in paragraph (f).24.8    (d) Effective for applications and renewals processed on or after September 1, 2006, 24.9general assistance medical care may be paid for applicants and recipients who meet all 24.10eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period 24.11beginning the date of application. Immediately following approval of general assistance 24.12medical care, enrollees shall be enrolled in MinnesotaCare under section 
         256L.04, 24.13subdivision 7
         , with covered services as provided in section 
         256L.03 for the rest of the 24.14six-month general assistance medical care eligibility period, until their six-month renewal.24.15    (e) To be eligible for general assistance medical care following enrollment in 24.16MinnesotaCare as required by paragraph (d), an individual must complete a new 24.17application.24.18    (f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are 24.19exempt from the MinnesotaCare enrollment requirements in this subdivision if they:24.20    (1) have applied for and are awaiting a determination of blindness or disability by 24.21the state medical review team or a determination of eligibility for Supplemental Security 24.22Income or Social Security Disability Insurance by the Social Security Administration;24.23    (2) fail to meet the requirements of section 
         256L.09, subdivision 2;24.24    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.;24.25    (4) are classified as end-stage renal disease beneficiaries in the Medicare program;24.26    (5) are enrolled in private health care coverage as defined in section 
         256B.02, 24.27subdivision 9;24.28    (6) are eligible under paragraph (k);24.29    (7) receive treatment funded pursuant to section 
         254B.02; or24.30    (8) reside in the Minnesota sex offender program defined in chapter 246B.24.31    (g) For applications received on or after October 1, 2003, eligibility may begin no 24.32earlier than the date of application. For individuals eligible under paragraph (a), clause 24.33(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are 24.34eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but 24.35may reapply if there is a subsequent period of inpatient hospitalization.25.1    (h) Beginning September 1, 2006, Minnesota health care program applications and 25.2renewals completed by recipients and applicants who are persons described in paragraph 25.3(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility 25.4by the county agency. If all other eligibility requirements of this subdivision are met, 25.5eligibility for general assistance medical care shall be available in any month during which 25.6MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare, 25.7notice of termination for eligibility for general assistance medical care shall be sent to 25.8an applicant or recipient. If all other eligibility requirements of this subdivision are 25.9met, eligibility for general assistance medical care shall be available until enrollment in 25.10MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).25.11    (i) The date of an initial Minnesota health care program application necessary to 25.12begin a determination of eligibility shall be the date the applicant has provided a name, 25.13address, and Social Security number, signed and dated, to the county agency or the 25.14Department of Human Services. If the applicant is unable to provide a name, address, 25.15Social Security number, and signature when health care is delivered due to a medical 25.16condition or disability, a health care provider may act on an applicant's behalf to establish 25.17the date of an initial Minnesota health care program application by providing the county 25.18agency or Department of Human Services with provider identification and a temporary 25.19unique identifier for the applicant. The applicant must complete the remainder of the 25.20application and provide necessary verification before eligibility can be determined. The 25.21applicant must complete the application within the time periods required under the 25.22medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart 25.235, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining 25.24verification if necessary.25.25    (j) County agencies are authorized to use all automated databases containing 25.26information regarding recipients' or applicants' income in order to determine eligibility for 25.27general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 25.28in order to determine eligibility and premium payments by the county agency.25.29    (k) General assistance medical care is not available for a person in a correctional 25.30facility unless the person is detained by law for less than one year in a county correctional 25.31or detention facility as a person accused or convicted of a crime, or admitted as an 25.32inpatient to a hospital on a criminal hold order, and the person is a recipient of general 25.33assistance medical care at the time the person is detained by law or admitted on a criminal 25.34hold order and as long as the person continues to meet other eligibility requirements 25.35of this subdivision.26.1    (l) General assistance medical care is not available for applicants or recipients who 26.2do not cooperate with the county agency to meet the requirements of medical assistance.26.3    (m) In determining the amount of assets of an individual eligible under paragraph 26.4(a), clause (2), item (i), there shall be included any asset or interest in an asset, including 26.5an asset excluded under paragraph (a), that was given away, sold, or disposed of for 26.6less than fair market value within the 60 months preceding application for general 26.7assistance medical care or during the period of eligibility. Any transfer described in this 26.8paragraph shall be presumed to have been for the purpose of establishing eligibility for 26.9general assistance medical care, unless the individual furnishes convincing evidence to 26.10establish that the transaction was exclusively for another purpose. For purposes of this 26.11paragraph, the value of the asset or interest shall be the fair market value at the time it 26.12was given away, sold, or disposed of, less the amount of compensation received. For any 26.13uncompensated transfer, the number of months of ineligibility, including partial months, 26.14shall be calculated by dividing the uncompensated transfer amount by the average monthly 26.15per person payment made by the medical assistance program to skilled nursing facilities 26.16for the previous calendar year. The individual shall remain ineligible until this fixed period 26.17has expired. The period of ineligibility may exceed 30 months, and a reapplication for 26.18benefits after 30 months from the date of the transfer shall not result in eligibility unless 26.19and until the period of ineligibility has expired. The period of ineligibility begins in the 26.20month the transfer was reported to the county agency, or if the transfer was not reported, 26.21the month in which the county agency discovered the transfer, whichever comes first. For 26.22applicants, the period of ineligibility begins on the date of the first approved application.26.23    (n) When determining eligibility for any state benefits under this subdivision, 26.24the income and resources of all noncitizens shall be deemed to include their sponsor's 26.25income and resources as defined in the Personal Responsibility and Work Opportunity 26.26Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 26.27subsequently set out in federal rules.26.28    (o) Undocumented noncitizens and nonimmigrants are ineligible for general 26.29assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 26.30in one or more of the classes listed in United States Code, title 8, section 1101, subsection 26.31(a), paragraph (15), and an undocumented noncitizen is an individual who resides in 26.32the United States without the approval or acquiescence of the United States Citizenship 26.33and Immigration Services.26.34    (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for 26.35medical assistance due to the deeming of a sponsor's income and resources, is ineligible 26.36for general assistance medical care.27.1    (q) Effective July 1, 2003, general assistance medical care emergency services end.27.2(r) For the period beginning March 1, 2010, and ending July 1, 2011, the general 27.3assistance medical care program shall be administered according to section 256D.031, 27.4unless otherwise stated.27.5EFFECTIVE DATE.This section is effective March 1, 2010.27.6    Sec. 19. Minnesota Statutes 2008, section 256D.03, subdivision 3a, is amended to read:27.7    Subd. 3a. Claims; assignment of benefits.(a) Claims must be filed pursuant to 27.8section 
         256D.16. General assistance medical care applicants and recipients must apply or 27.9agree to apply third party health and accident benefits to the costs of medical care. They 27.10must cooperate with the state in establishing paternity and obtaining third party payments. 27.11By accepting general assistance, a person assigns to the Department of Human Services 27.12all rights to medical support or payments for medical expenses from another person or 27.13entity on their own or their dependent's behalf and agrees to cooperate with the state in 27.14establishing paternity and obtaining third party payments. The application shall contain 27.15a statement explaining the assignment. Any rights or amounts assigned shall be applied 27.16against the cost of medical care paid for under this chapter. An assignment is effective on 27.17the date general assistance medical care eligibility takes effect. 27.18(b) Effective for general assistance medical care services rendered on or after 27.19March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 27.20this subdivision shall be deposited in or credited to the account established in section 27.21256D.032.27.22EFFECTIVE DATE.This section is effective March 1, 2010.27.23    Sec. 20. Minnesota Statutes 2008, section 256D.03, subdivision 3b, is amended to read:27.24    Subd. 3b. Cooperation. (a) General assistance or general assistance medical care 27.25applicants and recipients must cooperate with the state and local agency to identify 27.26potentially liable third-party payors and assist the state in obtaining third-party payments. 27.27Cooperation includes identifying any third party who may be liable for care and services 27.28provided under this chapter to the applicant, recipient, or any other family member for 27.29whom application is made and providing relevant information to assist the state in pursuing 27.30a potentially liable third party. General assistance medical care applicants and recipients 27.31must cooperate by providing information about any group health plan in which they may 27.32be eligible to enroll. They must cooperate with the state and local agency in determining 27.33if the plan is cost-effective. For purposes of this subdivision, coverage provided by the 28.1Minnesota Comprehensive Health Association under chapter 62E shall not be considered 28.2group health plan coverage or cost-effective by the state and local agency. If the plan is 28.3determined cost-effective and the premium will be paid by the state or local agency or is 28.4available at no cost to the person, they must enroll or remain enrolled in the group health 28.5plan. Cost-effective insurance premiums approved for payment by the state agency and 28.6paid by the local agency are eligible for reimbursement according to subdivision 6.28.7(b) Effective for all premiums due on or after June 30, 1997, general assistance 28.8medical care does not cover premiums that a recipient is required to pay under a qualified 28.9or Medicare supplement plan issued by the Minnesota Comprehensive Health Association. 28.10General assistance medical care shall continue to cover premiums for recipients who are 28.11covered under a plan issued by the Minnesota Comprehensive Health Association on June 28.1230, 1997, for a period of six months following receipt of the notice of termination or 28.13until December 31, 1997, whichever is later.28.14(c) Effective for general assistance medical care services rendered on or after 28.15March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 28.16this subdivision shall be deposited in or credited to the account established in section 28.17256D.032.28.18EFFECTIVE DATE.This section is effective March 1, 2010.28.19    Sec. 21. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.28.20    Subdivision 1.Eligibility.(a) Except as provided under subdivision 2, general 28.21assistance medical care may be paid for any individual who is not eligible for medical 28.22assistance under chapter 256B, including eligibility for medical assistance based on a 28.23spenddown of excess income according to section 256B.056, subdivision 5, and who:28.24(1) is receiving assistance under section 256D.05, except for families with children 28.25who are eligible under the Minnesota family investment program (MFIP), or who is 28.26having a payment made on the person's behalf under sections 256I.01 to 256I.06; or28.27(2) is a resident of Minnesota and has gross countable income not in excess of 75 28.28percent of federal poverty guidelines for the family size, using a six-month budget period, 28.29and whose equity in assets is not in excess of $1,000 per assistance unit.28.30Exempt assets, the reduction of excess assets, and the waiver of excess assets must 28.31conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d, 28.32except that the maximum amount of undistributed funds in a trust that could be distributed 28.33to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's 28.34discretion under the terms of the trust, must be applied toward the asset maximum.29.1(b) The commissioner shall adjust the income standards under this section each July 29.21 by the annual update of the federal poverty guidelines following publication by the 29.3United States Department of Health and Human Services.29.4    Subd. 2.Ineligible groups.(a) General assistance medical care may not be paid for 29.5an applicant or a recipient who:29.6(1) is otherwise eligible for medical assistance but fails to verify their assets;29.7(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;29.8(3) is enrolled in private health coverage as defined in section 256B.02, subdivision 29.99;29.10(4) is in a correctional facility, including an individual in a county correctional or 29.11detention facility as an individual accused or convicted of a crime, or admitted as an 29.12inpatient to a hospital on a criminal hold order;29.13(5) resides in the Minnesota sex offender program defined in chapter 246B;29.14(6) does not cooperate with the county agency to meet the requirements of medical 29.15assistance; or29.16(7) does not cooperate with a county or state agency or the state medical review team 29.17in determining a disability or for determining eligibility for Supplemental Security Income 29.18or Social Security Disability Insurance by the Social Security Administration.29.19(b) Undocumented noncitizens and nonimmigrants are ineligible for general 29.20assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 29.21in one or more of the classes listed in United States Code, title 8, section 1101, subsection 29.22(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the 29.23United States without approval or acquiescence of the United States Citizenship and 29.24Immigration Services.29.25(c) Notwithstanding any other provision of law, a noncitizen who is ineligible for 29.26medical assistance due to the deeming of a sponsor's income and resources is ineligible for 29.27general assistance medical care.29.28(d) General assistance medical care recipients who become eligible for medical 29.29assistance shall be terminated from general assistance medical care and transferred to 29.30medical assistance.29.31    Subd. 3.Transitional MinnesotaCare.(a) Except as provided in paragraph (c), 29.32effective March 1, 2010, all applicants and recipients who meet the eligibility requirements 29.33in subdivision 1, paragraph (a), clause (2), and who are not described in subdivision 2 29.34shall be enrolled in MinnesotaCare under section 256L.04, subdivision 7, immediately 29.35following approval of general assistance medical care. 30.1(b) If all other eligibility requirements of this subdivision are met, general assistance 30.2medical care may be paid for individuals identified in paragraph (a) for a temporary 30.3period beginning the date of application. Eligibility for general assistance medical care 30.4shall continue until enrollment in MinnesotaCare is completed. Upon notification of 30.5eligibility for MinnesotaCare, notice of termination for eligibility for general assistance 30.6medical care shall be sent to the applicant or recipient. Once enrolled in MinnesotaCare, 30.7the MinnesotaCare-covered services as described in section 256L.03 shall apply for the 30.8remainder of the six-month general assistance medical care eligibility period until their 30.9six-month renewal.30.10(c) This subdivision does not apply if the applicant or recipient:30.11(1) has applied for and is awaiting a determination of blindness or disability by the 30.12state medical review team or a determination of eligibility for Supplemental Security 30.13Income or Social Security Disability Insurance by the Social Security Administration;30.14(2) is homeless as defined by United States Code, title 42, section 11301, et seq.;30.15(3) is classified as an end-stage renal disease beneficiary in the Medicare program; 30.16(4) receives treatment funded in section 254B.02; or30.17(5) fails to meet the requirements of section 256L.09, subdivision 2.30.18Applicants and recipients who meet any one of these criteria shall remain eligible for 30.19general assistance medical care and shall not be required to enroll in MinnesotaCare.30.20(d) To be eligible for general assistance medical care following enrollment 30.21in MinnesotaCare as required in paragraph (a), an individual must complete a new 30.22application.30.23    Subd. 4.Eligibility and enrollment procedures.(a) Eligibility for general 30.24assistance medical care shall begin no earlier than the date of application. The date of 30.25application shall be the date the applicant has provided a name, address, and Social 30.26Security number, signed and dated, to the county agency or the Department of Human 30.27Services. If the applicant is unable to provide a name, address, Social Security number, 30.28and signature when health care is delivered due to a medical condition or disability, a 30.29health care provider may act on an applicant's behalf to establish the date of an application 30.30by providing the county agency or Department of Human Services with provider 30.31identification and a temporary unique identifier for the applicant. The applicant must 30.32complete the remainder of the application and provide necessary verification before 30.33eligibility can be determined. The applicant must complete the application within the time 30.34periods required under the medical assistance program as specified in Minnesota Rules, 30.35parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the 30.36applicant in obtaining verification if necessary. 31.1    (b) County agencies are authorized to use all automated databases containing 31.2information regarding recipients' or applicants' income in order to determine eligibility for 31.3general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 31.4in order to determine eligibility and premium payments by the county agency.31.5    (c) In determining the amount of assets of an individual eligible under subdivision 1, 31.6paragraph (a), clause (2), there shall be included any asset or interest in an asset, including 31.7an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or 31.8disposed of for less than fair market value within the 60 months preceding application for 31.9general assistance medical care or during the period of eligibility. Any transfer described 31.10in this paragraph shall be presumed to have been for the purpose of establishing eligibility 31.11for general assistance medical care, unless the individual furnishes convincing evidence to 31.12establish that the transaction was exclusively for another purpose. For purposes of this 31.13paragraph, the value of the asset or interest shall be the fair market value at the time it 31.14was given away, sold, or disposed of, less the amount of compensation received. For any 31.15uncompensated transfer, the number of months of ineligibility, including partial months, 31.16shall be calculated by dividing the uncompensated transfer amount by the average monthly 31.17per person payment made by the medical assistance program to skilled nursing facilities 31.18for the previous calendar year. The individual shall remain ineligible until this fixed period 31.19has expired. The period of ineligibility may exceed 30 months, and a reapplication for 31.20benefits after 30 months from the date of the transfer shall not result in eligibility unless 31.21and until the period of ineligibility has expired. The period of ineligibility begins in the 31.22month the transfer was reported to the county agency, or if the transfer was not reported, 31.23the month in which the county agency discovered the transfer, whichever comes first. For 31.24applicants, the period of ineligibility begins on the date of the first approved application.31.25    (d) When determining eligibility for any state benefits under this subdivision, 31.26the income and resources of all noncitizens shall be deemed to include their sponsor's 31.27income and resources as defined in the Personal Responsibility and Work Opportunity 31.28Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 31.29subsequently set out in federal rules.31.30    Subd. 5.General assistance medical care; services.(a) General assistance 31.31medical care covers:31.32    (1) inpatient hospital services within the limitations described in subdivision 10;31.33    (2) outpatient hospital services;31.34    (3) services provided by Medicare-certified rehabilitation agencies;31.35    (4) prescription drugs and other products recommended through the process 31.36established in section 256B.0625, subdivision 13;32.1    (5) equipment necessary to administer insulin and diagnostic supplies and equipment 32.2for diabetics to monitor blood sugar level;32.3    (6) eyeglasses and eye examinations provided by a physician or optometrist;32.4    (7) hearing aids;32.5    (8) prosthetic devices;32.6    (9) laboratory and x-ray services;32.7    (10) physicians' services;32.8    (11) medical transportation except special transportation;32.9    (12) chiropractic services as covered under the medical assistance program;32.10    (13) podiatric services;32.11    (14) dental services as covered under the medical assistance program;32.12    (15) mental health services covered under chapter 256B;32.13    (16) prescribed medications for persons who have been diagnosed as mentally ill as 32.14necessary to prevent more restrictive institutionalization;32.15    (17) medical supplies and equipment, and Medicare premiums, coinsurance, and 32.16deductible payments;32.17    (18) medical equipment not specifically listed in this paragraph when the use of 32.18the equipment will prevent the need for costlier services that are reimbursable under 32.19this subdivision;32.20    (19) services performed by a certified pediatric nurse practitioner, a certified family 32.21nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 32.22nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 32.23practitioner in independent practice, if (1) the service is otherwise covered under this 32.24chapter as a physician service, (2) the service provided on an inpatient basis is not included 32.25as part of the cost for inpatient services included in the operating payment rate, and (3) the 32.26service is within the scope of practice of the nurse practitioner's license as a registered 32.27nurse, as defined in section 148.171;32.28    (20) services of a certified public health nurse or a registered nurse practicing in 32.29a public health nursing clinic that is a department of, or that operates under the direct 32.30authority of, a unit of government, if the service is within the scope of practice of the 32.31public health nurse's license as a registered nurse, as defined in section 148.171;32.32    (21) telemedicine consultations, to the extent they are covered under section 32.33256B.0625, subdivision 3b;32.34    (22) care coordination and patient education services provided by a community 32.35health worker according to section 256B.0625, subdivision 49; and33.1    (23) regardless of the number of employees that an enrolled health care provider 33.2may have, sign language interpreter services when provided by an enrolled health care 33.3provider during the course of providing a direct, person-to-person-covered health care 33.4service to an enrolled recipient who has a hearing loss and uses interpreting services.33.5(b) Sex reassignment surgery is not covered under this section.33.6(c) Drug coverage is covered in accordance with section 256D.03, subdivision 4, 33.7paragraph (d).33.8(d) The following co-payments shall apply for services provided:33.9(1) $25 for nonemergency visits to a hospital-based emergency room; and33.10(2) $3 per brand-name drug prescription, subject to a $7 per month maximum for 33.11prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when 33.12used for the treatment of mental illness.33.13(e) Co-payments shall be limited to one per day per provider for nonemergency 33.14visits to a hospital-based emergency room. Recipients of general assistance medical care 33.15are responsible for all co-payments in this subdivision. Reimbursement for prescription 33.16drugs shall be reduced by the amount of the co-payment until the recipient has reached the 33.17$7 per month maximum for prescription drug co-payments. The provider shall collect 33.18the co-payment from the recipient. Providers may not deny services to recipients who 33.19are unable to pay the co-payment.33.20(f) Chemical dependency services that are reimbursed under chapter 254B shall not 33.21be reimbursed under general assistance medical care.33.22(g) Inpatient hospital services that are provided in community behavioral health 33.23hospitals operated by state-operated services shall not be reimbursed under general 33.24assistance medical care.33.25    Subd. 6.Coordinated care delivery option.(a) A county or group of counties may 33.26elect to provide health care and supportive services to individuals who are eligible for 33.27general assistance medical care under this section and who reside within the county or 33.28counties through a coordinated care delivery option. The health care services provided 33.29by the county must include the services described in subdivision 5 with the exception of 33.30outpatient prescription drug coverage but including drugs administered in an outpatient 33.31setting. Support services may include, but are not limited to, social services, outreach, 33.32health care navigation, housing, and transportation. Counties that elect to provide health 33.33care services through this option must ensure that the requirements of this subdivision 33.34are met. Upon electing to provide services through this option, the county accepts the 33.35financial risk of the delivery of the health care services described in this subdivision to 34.1general assistance medical care recipients residing in the county for the period beginning 34.2July 1, 2010, and ending July 1, 2011, for the fixed payments described in subdivision 10.34.3(b) A county that elects to provide services through this option must provide to 34.4the commissioner the following:34.5(1) the names of the county or counties that are electing to provide services through 34.6the county care delivery option; and34.7(2) the geographic area to be served.34.8(c) The county may contract with a managed care plan, an integrated delivery 34.9system, a physician-hospital organization, or an academic health center to administer 34.10the delivery of services through this option. Any county providing general assistance 34.11medical care services through a county-based purchasing plan in accordance with section 34.12256B.692 may continue to provide services through the county-based purchasing plan. 34.13Payments to the county-based purchasing plan for the period beginning July 1, 2010, and 34.14ending July 1, 2011, shall be paid according to subdivision 10.34.15(d) A county must demonstrate the ability to:34.16(1) provide the covered services required under this subdivision to recipients 34.17residing within the county;34.18(2) provide a system for advocacy, consumer protection, and complaints and appeals 34.19that is independent of care providers or other risk bearers and complies with section 34.20256B.69;34.21(3) establish a process to monitor enrollment and ensure the quality of care provided; 34.22and34.23(4) coordinate the delivery of health care services with existing homeless prevention, 34.24supportive housing, and rent subsidy programs and funding administered by the Minnesota 34.25Housing Finance Agency under chapter 462A.34.26(e) The commissioner may require the county to provide the commissioner with data 34.27necessary for assessing enrollment, quality of care, cost, and utilization of services.34.28(f) A county that elects to provide services through this option shall be considered to 34.29be a prepaid health plan for purposes of section 256.045.34.30(g) The state shall not be liable for the payment of any cost or obligation incurred 34.31by the county or a participating provider.34.32    Subd. 7.Health care home designation.The commissioner or a county may 34.33require a recipient to designate a primary care provider or a primary care clinic that is 34.34certified as a health care home under section 256B.0751.34.35    Subd. 8.Payments; fee-for-service rate for the period between March 1, 34.362010, and July 1, 2010.(a) Effective for services provided on or after March 1, 2010, 35.1and before July 1, 2010, the payment rates for all covered services provided to general 35.2assistance medical care recipients, with the exception of outpatient prescription drug 35.3coverage, shall be 50 percent of the general assistance medical care payment rate in effect 35.4on February 28, 2010.35.5(b) Outpatient prescription drug coverage provided on or after March 1, 2010, and 35.6before July 1, 2010, shall be paid on a fee-for-service basis in accordance with section 35.7256B.0625, subdivision 13e.35.8    Subd. 9.Payments; fee-for-service rates for the period between July 1, 2010, 35.9and July 1, 2011.(a) Effective for services provided on or after July 1, 2010, and before 35.10July 1, 2011, to general assistance medical care recipients residing in counties that are 35.11not served through the coordinated care delivery option, payments shall be made by the 35.12commissioner to providers at rates described in this subdivision.35.13(b) For inpatient hospital admissions provided on or after July 1, 2010, and before 35.14July 1, 2011, the payment rate shall be:35.15(1) 69 percent of the general assistance medical care rate in effect on February 35.1628, 2010, if the inpatient hospital services were provided in a hospital where the 35.17fee-for-service inpatient and outpatient hospital general assistance medical care payments 35.18to the hospital for admissions provided in calendar year 2007 totaled $1,000,000 or more 35.19or the hospital's fee-for-service inpatient and outpatient hospital general assistance medical 35.20care payments received for calendar year 2007 admissions was one percent or more of the 35.21hospital's net patient revenue received for services provided in calendar year 2007; or35.22(2) 60 percent of the general assistance medical care rate in effect on February 28, 35.232010, if the inpatient hospital services were provided by a hospital that does not meet the 35.24criteria described in clause (1).35.25(c) Effective for services other than inpatient hospital services and outpatient 35.26prescription drug coverage provided on or after July 1, 2010, and before July 1, 2011, 35.27the payment rate shall begin at 50 percent of the general assistance medical care rate 35.28in effect on February 28, 2010.35.29(d) Outpatient prescription drug coverage provided on or after July 1, 2010, and 35.30before July 1, 2011, shall be paid on a fee-for-service basis in accordance with section 35.31256B.0625, subdivision 13e.35.32(e) The commissioner may adjust the rates paid under paragraphs (b) and (c) on a 35.33quarterly basis to ensure that the total aggregate amount paid out for services provided 35.34on a fee-for-service basis beginning March 1, 2010, and ending June 30, 2011, does not 35.35exceed the appropriation from the general assistance medical care account established in 35.36section 256D.032 for the general assistance medical care program.36.1    Subd. 10.Payments; rate setting for the coordinated care delivery option.(a) 36.2Effective for general assistance medical care services, with the exception of outpatient 36.3prescription drug coverage, provided on or after July 1, 2010, and before July 1, 2011, 36.4to recipients residing in counties that have elected to provide services through the 36.5coordinated delivery care option, the commissioner shall establish quarterly prospective 36.6fixed payments to the county. The payments must not exceed 60 percent of the county's 36.7general assistance medical care county allocation amount as determined in paragraph (b). 36.8These payments must not be used by the county to pay MinnesotaCare premiums for 36.9general assistance medical care recipients or MinnesotaCare enrollees.36.10(b) For each county that elects to provide services in accordance with subdivision 36.117, the commissioner shall determine a general assistance medical care county allocation 36.12amount that equals the total general assistance medical care payments made for recipients 36.13residing within the county in fiscal year 2009 for all covered general assistance medical 36.14care services with the exception of outpatient prescription drug coverage.36.15(c) Outpatient prescription drug coverage provided on or after July 1, 2010, 36.16and before July 1, 2011, shall be paid on a fee-for-service basis according to section 36.17256B.0625, subdivision 13e.36.18EFFECTIVE DATE.This section is effective for services rendered on or after 36.19March 1, 2010, and before July 1, 2011.36.20    Sec. 22. [256D.032] GENERAL ASSISTANCE MEDICAL CARE ACCOUNT.36.21The general assistance medical care account is created in the special revenue fund. 36.22Money deposited into the account is subject to appropriation by the legislature, and shall 36.23be used only for expenditures related to the general assistance medical care program 36.24or as provided in this act.36.25EFFECTIVE DATE.This section is effective March 1, 2010.36.26    Sec. 23. Minnesota Statutes 2008, section 256D.06, subdivision 7, is amended to read:36.27    Subd. 7. SSI conversions and back claims. (a) The commissioner of human 36.28services shall contract with agencies or organizations capable of ensuring that clients who 36.29are presently receiving assistance under sections 
         256D.01 to 
         256D.21, and who may be 36.30eligible for benefits under the federal Supplemental Security Income program, apply and, 36.31when eligible, are converted to the federal income assistance program and made eligible 36.32for health care benefits under the medical assistance program. The commissioner shall 36.33ensure that money owing to the state under interim assistance agreements is collected.37.1(b) The commissioner shall also directly or through contract implement procedures 37.2for collecting federal Medicare and medical assistance funds for which clients converted 37.3to SSI are retroactively eligible.37.4(c) The commissioner shall contract with agencies to ensure implementation of 37.5this section. County contracts with providers for residential services shall include the 37.6requirement that providers screen residents who may be eligible for federal benefits and 37.7provide that information to the local agency. The commissioner shall modify the MAXIS 37.8computer system to provide information on clients who have been on general assistance 37.9for two years or longer. The list of clients shall be provided to local services for screening 37.10under this section.37.11(d) Effective for general assistance medical care services rendered on or after 37.12March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 37.13this subdivision shall be deposited in or credited to the account established in section 37.14256D.032.37.15EFFECTIVE DATE.This section is effective March 1, 2010.37.16    Sec. 24. Minnesota Statutes 2008, section 256L.05, subdivision 1b, is amended to read:37.17    Subd. 1b. MinnesotaCare enrollment by county agencies. Beginning September 37.181, 2006, county agencies shall enroll single adults and households with no children 37.19formerly enrolled in general assistance medical care in MinnesotaCare according to 37.20section 
         256D.03, subdivision 3, or 256D.031. County agencies shall perform all duties 37.21necessary to administer the MinnesotaCare program ongoing for these enrollees, including 37.22the redetermination of MinnesotaCare eligibility at renewal.37.23EFFECTIVE DATE.This section is effective March 1, 2010.37.24    Sec. 25. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:37.25    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the 37.26first day of the month following the month in which eligibility is approved and the first 37.27premium payment has been received. As provided in section 
         256B.057, coverage for 37.28newborns is automatic from the date of birth and must be coordinated with other health 37.29coverage. The effective date of coverage for eligible newly adoptive children added to a 37.30family receiving covered health services is the month of placement. The effective date 37.31of coverage for other new members added to the family is the first day of the month 37.32following the month in which the change is reported. All eligibility criteria must be met 37.33by the family at the time the new family member is added. The income of the new family 38.1member is included with the family's gross income and the adjusted premium begins in 38.2the month the new family member is added.38.3(b) The initial premium must be received by the last working day of the month for 38.4coverage to begin the first day of the following month.38.5(c) Benefits are not available until the day following discharge if an enrollee is 38.6hospitalized on the first day of coverage.38.7(d) Notwithstanding any other law to the contrary, benefits under sections 
         256L.01 to 38.8256L.18
          are secondary to a plan of insurance or benefit program under which an eligible 38.9person may have coverage and the commissioner shall use cost avoidance techniques to 38.10ensure coordination of any other health coverage for eligible persons. The commissioner 38.11shall identify eligible persons who may have coverage or benefits under other plans of 38.12insurance or who become eligible for medical assistance.38.13(e) The effective date of coverage for single adults and households with no children 38.14formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 38.15according to section 
         256D.03, subdivision 3, or 256D.031, is the first day of the month 38.16following the last day of general assistance medical care coverage.38.17EFFECTIVE DATE.This section is effective March 1, 2010.38.18    Sec. 26. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:38.19    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 38.20must be renewed every 12 months. The 12-month period begins in the month after the 38.21month the application is approved.38.22    (b) Each new period of eligibility must take into account any changes in 38.23circumstances that impact eligibility and premium amount. An enrollee must provide all 38.24the information needed to redetermine eligibility by the first day of the month that ends 38.25the eligibility period. If there is no change in circumstances, the enrollee may renew 38.26eligibility at designated locations that include community clinics and health care providers' 38.27offices. The designated sites shall forward the renewal forms to the commissioner. The 38.28commissioner may establish criteria and timelines for sites to forward applications to the 38.29commissioner or county agencies. The premium for the new period of eligibility must be 38.30received as provided in section 
         256L.06 in order for eligibility to continue.38.31    (c) For single adults and households with no children formerly enrolled in general 38.32assistance medical care and enrolled in MinnesotaCare according to section 
         256D.03, 38.33subdivision 3
         , or 256D.031, the first period of eligibility begins the month the enrollee 38.34submitted the application or renewal for general assistance medical care.39.1    (d) An enrollee who fails to submit renewal forms and related documentation 39.2necessary for verification of continued eligibility in a timely manner shall remain eligible 39.3for one additional month beyond the end of the current eligibility period before being 39.4disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 39.5additional month.39.6    Sec. 27. Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read:39.7    Subd. 6. Exception for certain adults. Single adults and households with 39.8no children formerly enrolled in general assistance medical care and enrolled in 39.9MinnesotaCare according to section 
         256D.03, subdivision 3, or 256D.031, are eligible 39.10without meeting the requirements of this section until renewal.39.11EFFECTIVE DATE.This section is effective March 1, 2010.39.12    Sec. 28. Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read:39.13    Subd. 4. Exception for transitioned adults. County agencies shall pay premiums 39.14for single adults and households with no children formerly enrolled in general assistance 39.15medical care and enrolled in MinnesotaCare according to section 
         256D.03, subdivision 3, 39.16or 256D.031, until six-month renewal. The county agency has the option of continuing to 39.17pay premiums for these enrollees.39.18EFFECTIVE DATE.This section is effective March 1, 2010.39.19    Sec. 29. Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read:39.20    Subd. 7. Exception for certain adults. Single adults and households with 39.21no children formerly enrolled in general assistance medical care and enrolled in 39.22MinnesotaCare according to section 
         256D.03, subdivision 3, or 256D.031, are exempt 39.23from the requirements of this section until renewal.39.24EFFECTIVE DATE.This section is effective March 1, 2010.39.25    Sec. 30. DRUG REBATE PROGRAM.39.26The commissioner of human services shall continue to administer a drug rebate 39.27program for drugs purchased for persons eligible for the general assistance medical care 39.28program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph 39.29(cc), and 256D.03. The rebate revenues collected under the drug rebate program for 39.30persons eligible for the general assistance medical care program shall be deposited in the 40.1general assistance medical care account in the special revenue fund established under 40.2Minnesota Statutes, section 256D.032. 40.3EFFECTIVE DATE.This section is effective March 1, 2010, and expires June 40.430, 2011.40.5    Sec. 31. PROVIDER PARTICIPATION.40.6For purposes of Minnesota Statutes, section 256B.0644, the reference to the general 40.7assistance medical care program shall include the temporary general assistance medical 40.8care program established under Minnesota Statutes, section 256D.031. In meeting the 40.9requirements of Minnesota Statutes, section 256B.0644, a provider must accept new 40.10patients regardless of the Minnesota health care program the patient is enrolled in and may 40.11not refuse to accept patients enrolled in one Minnesota health care program and continue 40.12to accept patients enrolled in other Minnesota health care programs.40.13EFFECTIVE DATE.This section is effective March 1, 2010.40.14    Sec. 32. TEMPORARY SUSPENSION.40.15(a) For the period beginning March 1, 2010, to June 30, 2011, the commissioner 40.16of human services shall not implement or administer Minnesota Statutes 2008, section 40.17256D.03, subdivisions 6 and 9; Minnesota Statutes 2009 Supplement, section 256D.03, 40.18subdivision 4; or Minnesota Statutes 2008, section 256B.692; and Minnesota Statutes 40.192009 Supplement, section 256B.69, as they apply to the general assistance medical care 40.20program unless specifically continued in Minnesota Statutes, section 256D.031.40.21(b) Notwithstanding paragraph (a), outpatient prescription drug coverage shall 40.22continue to be provided under Minnesota Statutes, section 256D.03.40.23EFFECTIVE DATE.This section is effective March 1, 2010, and expires July 1, 40.242011.40.25    Sec. 33. COORDINATED CARE DELIVERY ORGANIZATION 40.26DEMONSTRATION PROJECT.40.27The commissioner of human services shall develop, and present to the legislature 40.28by December 15, 2010, a plan to establish a demonstration project to deliver inpatient 40.29hospital, primary care, and specialist services to general assistance medical care enrollees 40.30through coordinated care delivery organizations, beginning January 1, 2012. Each 40.31coordinated care delivery organization must deliver coordinated care through at least one 40.32hospital and one physician group practice, and may include counties and other health 41.1care providers. The coordinated care delivery organization must provide inpatient 41.2hospital services to general assistance medical care enrollees eligible for the program 41.3under Minnesota Statutes, section 256D.03 or 256D.031. The coordinated care delivery 41.4organization must accept responsibility for the quality of care and must assume financial 41.5risk for the services provided. The plan must include:41.6(1) financial incentives for coordinated care delivery organizations to reduce the 41.7growth in the volume and cost of services provided, while maintaining or improving 41.8the quality of care;41.9(2) recommendations for the delivery of services not provided through a coordinated 41.10care delivery organization and coordination of outpatient and inpatient health care services;41.11(3) recommendations as to the size and scope of the demonstration project and 41.12whether participation would be mandatory or voluntary for general assistance medical 41.13care enrollees; and41.14(4) recommendations for managing financial risk within a coordinated care delivery 41.15organization.41.16    Sec. 34. MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION 41.17ASSESSMENT MODIFICATION; TRANSFER.41.18    Subdivision 1.Minnesota Comprehensive Health Association assessment 41.19modification.For the purpose of the annual assessment allocation required in Minnesota 41.20Statutes, section 62E.11, the Minnesota Comprehensive Health Association shall credit 41.21$21,875,000 to HealthPartners' assessment for calendar year 2010 and $13,125,000 to 41.22HealthPartners' assessment for calendar year 2011, upon receipt by the association of the 41.23transfers specified in subdivision 2.41.24    Subd. 2.Transfer.$21,875,000 shall be transferred in fiscal year 2011 and 41.25$13,125,000 in fiscal year 2012 from the general assistance medical care account 41.26established in Minnesota Statutes, section 256D.032, to the commissioner of commerce 41.27for disbursement upon receipt to the Minnesota Comprehensive Health Association, to 41.28compensate for the loss in the association's assessments created by the credits specified in 41.29subdivision 1.41.30    Sec. 35. APPROPRIATION TRANSFERS.41.31(a) Of the general fund appropriation to the commissioner of human services for 41.32health care management in Laws 2009, chapter 79, article 13, section 3, subdivision 41.337, as amended by Laws 2009, chapter 173, article 2, section 1, $3,300,000 for health 41.34care administration and $4,100,000 for health care operations shall be transferred on 42.1March 1, 2010, to the fund established in Minnesota Statutes, section 256D.032. These 42.2amounts are appropriated to the commissioner for the administration and operation of the 42.3general assistance medical care program under Minnesota Statutes, section 256D.031. For 42.4purposes of consistent cost allocation and accounting, the commissioner may transfer the 42.5amounts appropriated for program administration and operation to the general fund.42.6(b) Of the general fund appropriation to the commissioner of human services for 42.7general assistance medical care grants in fiscal year 2010 in Laws 2009, chapter 79, article 42.813, section 3, subdivision 6, paragraph (d), as amended by Laws 2009, chapter 173, article 42.92, section 1, $44,000,000 shall be transferred on March 1, 2010, to the fund established 42.10in Minnesota Statutes, section 256D.032, and any unexpended amount not used for 42.11general assistance medical care expenditures incurred prior to March 1, 2010, does not 42.12cancel and shall be transferred to the fund established in Minnesota Statutes, section 42.13256D.032, by January 1, 2011.42.14EFFECTIVE DATE.This section is effective March 1, 2010.42.15    Sec. 36. APPROPRIATIONS; HOSPITAL GRANTS.42.16$8,000,000 is appropriated from the general fund to the commissioner for grants 42.17to hospitals. In order to receive a grant, a hospital must apply for funds from the 42.18commissioner prior to July 1, 2011. The commissioner after consultation with the 42.19Minnesota Hospital Association shall develop the criteria for awarding grants. The criteria 42.20must reflect the difference in 2009 GAMC revenue, or actual GAMC revenue in 2010 42.21whichever is greater, plus additional medical assistance revenue.42.22    Sec. 37. APPROPRIATION REDUCTION; TRANSFER.42.23    (a) The general fund appropriation to the commissioner of human services for 42.24children and community services grants in Laws 2009, chapter 79, article 13, section 3, 42.25subdivision 4, as amended by Laws 2009, chapter 173, article 2, section 1, subdivision 42.264, is reduced by $9,560,500 in fiscal year 2011. The general fund base for children and 42.27community service grants is increased by $9,560,500 per year for fiscal years 2012 and 42.28201342.29    (b) The general fund appropriation to the commissioner of human services for adult 42.30mental health grants in Laws 2009, chapter 79, article 13, section 3, subdivision 8, as 42.31amended by Laws 2009, chapter 173, article 2, section 1, subdivision 8, is reduced by 42.32$9,560,500 in fiscal year 2011. The general fund base for adult mental health grants is 42.33increased by $9,560,500 per year in fiscal years 2012 and 2013.43.1    (c) $19,121,000 shall be transferred in fiscal year 2011 from the general fund to 43.2the general assistance medical care account established in Minnesota Statutes, section 43.3256D.032.43.4    Sec. 38. APPROPRIATIONS.43.5The following appropriations are from the account established in Minnesota 43.6Statutes, section 256D.032, to the commissioner of human services for the time periods 43.7and purposes indicated:43.8(1) $....... for the period from March 1, 2010, to June 30, 2010, and $....... for fiscal 43.9year 2011 for the hospital rate increases under Minnesota Statutes, section 256.969. The 43.10commissioner may transfer these appropriations to the medical assistance account in the 43.11general fund and pay the rate increases from the medical assistance account;43.12(2) $....... for the period from May 1, 2010, to June 30, 2010, and $....... for fiscal 43.13year 2011 for the managed care plan rate increase in Minnesota Statutes, section 256B.69, 43.14subdivision 5k. The commissioner may transfer these appropriations to the medical 43.15assistance account in the general fund and pay the medical assistance rate increases 43.16from the medical assistance account, and to the health care access fund and pay the 43.17MinnesotaCare rate increases from the health care access fund; and43.18(3) $....... for the period from March 1, 2010, to June 30, 2010, and $....... for fiscal 43.19year 2011 for the general assistance medical care program established in Minnesota 43.20Statutes, section 256D.031.43.21EFFECTIVE DATE.This section is effective March 1, 2010.