1.1A bill for an act1.2relating to health care; establishing mental health urgent care and consultation 1.3services; modifying the general assistance medical care program; requiring 1.4a report; appropriating money;amending Minnesota Statutes 2008, sections 1.5256.969, subdivision 27, by adding a subdivision; 256B.0625, subdivision 13f, 1.6by adding a subdivision; 256D.03, subdivisions 3a, 3b; 256D.06, subdivision 7; 1.7256L.05, subdivisions 1b, 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4; 1.8256L.17, subdivision 7; Minnesota Statutes 2009 Supplement, sections 256.969, 1.9subdivisions 2b, 3a; 256B.196, subdivision 2; 256B.199; 256D.03, subdivision 1.103; proposing coding for new law in Minnesota Statutes, chapters 245; 256D.1.11BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:1.12ARTICLE 11.13HEALTH CARE PROGRAM MODIFICATION1.14    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;2.1(3) rapid access to psychiatry, including psychiatric evaluation, initial treatment, 2.2and short-term psychiatry;2.3(4) nonhospital crisis stabilization residential beds; and2.4(5) health care navigator services which include, but are not limited to, assisting 2.5uninsured individuals in obtaining health care coverage.2.6(b) Psychiatric consultation services includes psychiatric consultation to primary 2.7care practitioners.2.8    Subd. 3.Rapid access to psychiatry.The commissioner shall develop rapid access 2.9to psychiatric services based on the following criteria:2.10(1) the individuals who receive the psychiatric services must be at risk of 2.11hospitalization and otherwise unable to receive timely services;2.12(2) where clinically appropriate, the service may be provided via interactive video 2.13where the service is provided in conjunction with an emergency room, a local crisis 2.14service, or a primary care or behavioral care practitioner; and2.15(3) the commissioner may integrate rapid access to psychiatry with the psychiatric 2.16consultation services in subdivision 4.2.17    Subd. 4.Collaborative psychiatric consultation.(a) The commissioner shall 2.18establish a collaborative psychiatric consultation service based on the following criteria:2.19(1) the service may be available via telephone, interactive video, e-mail, or other 2.20means of communication to emergency rooms, local crisis services, mental health 2.21professionals, and primary care practitioners, including pediatricians;2.22(2) the service shall be provided by a multidisciplinary team including, at a 2.23minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical 2.24social worker;2.25(3) the service shall include a triage-level assessment to determine the most 2.26appropriate response to each request, including appropriate referrals to other mental health 2.27professionals, as well as provision of rapid psychiatric access when other appropriate 2.28services are not available;  2.29(4) the first priority for this service is to provide the consultations required under 2.30section 256B.0625, subdivision 13j; and2.31(5) the service must encourage use of cognitive and behavioral therapies and other 2.32evidence-based treatments in addition to or in place of medication, where appropriate.2.33(b) The commissioner shall appoint an interdisciplinary work group to establish 2.34appropriate medication and psychotherapy protocols to guide the consultative process, 2.35including consultation with the Drug Utilization Review Board, as provided in section 2.36256B.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 2009 Supplement, section 256.969, subdivision 2b, is 3.19amended to read:3.20    Subd. 2b. Operating payment rates. In determining operating payment rates for 3.21admissions occurring on or after the rate year beginning January 1, 1991, and every two 3.22years after, or more frequently as determined by the commissioner, the commissioner shall 3.23obtain operating data from an updated base year and establish operating payment rates 3.24per admission for each hospital based on the cost-finding methods and allowable costs of 3.25the Medicare program in effect during the base year. Rates under the general assistance 3.26medical care, medical assistance, and MinnesotaCare programs shall not be rebased to 3.27more current data on January 1, 1997, January 1, 2005, for the first 24 months of the 3.28rebased period beginning January 1, 2009. For the first three six months of the rebased 3.29period beginning January 1, 2011, rates shall not be rebased at 74.25 percent of the full 3.30value of the rebasing percentage change. From April July 1, 2011, to March 31, 2012, 3.31rates shall be rebased at 39.2 percent of the full value of the rebasing percentage change. 3.32Effective April 1, 2012, rates shall be rebased at full value. The base year operating 3.33payment rate per admission is standardized by the case mix index and adjusted by the 3.34hospital cost index, relative values, and disproportionate population adjustment. The 3.35cost and charge data used to establish operating rates shall only reflect inpatient services 4.1covered by medical assistance and shall not include property cost information and costs 4.2recognized in outlier payments.4.3    Sec. 3. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is 4.4amended to read:4.5    Subd. 3a. Payments. (a) Acute care hospital billings under the medical 4.6assistance program must not be submitted until the recipient is discharged. However, 4.7the commissioner shall establish monthly interim payments for inpatient hospitals that 4.8have individual patient lengths of stay over 30 days regardless of diagnostic category. 4.9Except as provided in section 
         256.9693, medical assistance reimbursement for treatment 4.10of mental illness shall be reimbursed based on diagnostic classifications. Individual 4.11hospital payments established under this section and sections 
         256.9685, 
         256.9686, and 4.12256.9695
         , in addition to third party and recipient liability, for discharges occurring during 4.13the rate year shall not exceed, in aggregate, the charges for the medical assistance covered 4.14inpatient services paid for the same period of time to the hospital. This payment limitation 4.15shall be calculated separately for medical assistance and general assistance medical 4.16care services. The limitation on general assistance medical care shall be effective for 4.17admissions occurring on or after July 1, 1991. Services that have rates established under 4.18subdivision 11 or 12, must be limited separately from other services. After consulting with 4.19the affected hospitals, the commissioner may consider related hospitals one entity and 4.20may merge the payment rates while maintaining separate provider numbers. The operating 4.21and property base rates per admission or per day shall be derived from the best Medicare 4.22and claims data available when rates are established. The commissioner shall determine 4.23the best Medicare and claims data, taking into consideration variables of recency of the 4.24data, audit disposition, settlement status, and the ability to set rates in a timely manner. 4.25The commissioner shall notify hospitals of payment rates by December 1 of the year 4.26preceding the rate year. The rate setting data must reflect the admissions data used to 4.27establish relative values. Base year changes from 1981 to the base year established for the 4.28rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited 4.29to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 4.301. The commissioner may adjust base year cost, relative value, and case mix index data 4.31to exclude the costs of services that have been discontinued by the October 1 of the year 4.32preceding the rate year or that are paid separately from inpatient services. Inpatient stays 4.33that encompass portions of two or more rate years shall have payments established based 4.34on payment rates in effect at the time of admission unless the date of admission preceded 4.35the rate year in effect by six months or more. In this case, operating payment rates for 5.1services rendered during the rate year in effect and established based on the date of 5.2admission shall be adjusted to the rate year in effect by the hospital cost index.5.3    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total 5.4payment, before third-party liability and spenddown, made to hospitals for inpatient 5.5services is reduced by .5 percent from the current statutory rates.5.6    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service 5.7admissions occurring on or after July 1, 2003, made to hospitals for inpatient services 5.8before third-party liability and spenddown, is reduced five percent from the current 5.9statutory rates. Mental health services within diagnosis related groups 424 to 432, and 5.10facilities defined under subdivision 16 are excluded from this paragraph.5.11    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for 5.12fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for 5.13inpatient services before third-party liability and spenddown, is reduced 6.0 percent 5.14from the current statutory rates. Mental health services within diagnosis related groups 5.15424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 5.16Notwithstanding section 
         256.9686, subdivision 7, for purposes of this paragraph, medical 5.17assistance does not include general assistance medical care. Payments made to managed 5.18care plans shall be reduced for services provided on or after January 1, 2006, to reflect 5.19this reduction.5.20    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 5.21fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made 5.22to hospitals for inpatient services before third-party liability and spenddown, is reduced 5.233.46 percent from the current statutory rates. Mental health services with diagnosis related 5.24groups 424 to 432 and facilities defined under subdivision 16 are excluded from this 5.25paragraph. Payments made to managed care plans shall be reduced for services provided 5.26on or after January 1, 2009, through June 30, 2009, to reflect this reduction.5.27    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for 5.28fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011, 5.29made to hospitals for inpatient services before third-party liability and spenddown, is 5.30reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis 5.31related groups 424 to 432 and facilities defined under subdivision 16 are excluded from 5.32this paragraph. Payments made to managed care plans shall be reduced for services 5.33provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.5.34    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment 5.35for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals 5.36for inpatient services before third-party liability and spenddown, is reduced 1.79 percent 6.1from the current statutory rates. Mental health services with diagnosis related groups 6.2424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph. 6.3Payments made to managed care plans shall be reduced for services provided on or after 6.4July 1, 2010 2011, to reflect this reduction.6.5(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total 6.6payment for fee-for-service admissions occurring on or after July 1, 2009, made to 6.7hospitals for inpatient services before third-party liability and spenddown, is reduced 6.8one percent from the current statutory rates. Facilities defined under subdivision 16 are 6.9excluded from this paragraph. Payments made to managed care plans shall be reduced for 6.10services provided on or after October 1, 2009, to reflect this reduction.6.11EFFECTIVE DATE.This section is effective March 1, 2010.6.12    Sec. 4. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision 6.13to read:6.14    Subd. 26a.Psychiatric and burn services payment adjustment on or after July 6.151, 2010.(a) For admissions occurring on or after July 1, 2010, the commissioner shall 6.16increase the total payment for medical assistance fee-for-service inpatient admissions for 6.17the diagnosis-related groups specified in paragraph (b) at any hospital that is a nonstate 6.18public Minnesota hospital and a Level I trauma center. The rate increases shall be 6.19established for each hospital by the commissioner at a level that uses each hospital's 6.20voluntary payments under paragraph (c) as the nonfederal share. For purposes of 6.21this subdivision, medical assistance does not include general assistance medical care. 6.22Payments to managed care health plans shall not be increased for payments under this 6.23subdivision.6.24    (b) The rate increases provided in paragraph (a) apply to the following 6.25diagnosis-related groups or subgroups, or any subsequent designations of such groups 6.26or subgroups: 424 to 431, 433, 504 to 511, 521, and 523. These increases are only 6.27available to the extent that revenue is available from the counties under paragraph (c) 6.28for the nonfederal share.6.29    (c) Effective July 15, 2010, in addition to any payment otherwise required under 6.30sections 256B.19, 256B.195, 256B.196, and 256B.199, the following government entities 6.31may make the following voluntary payments to the commissioner on an annual basis:6.32    (1) Hennepin County, $7,000,000; and6.33    (2) Ramsey County, $3,500,000.7.1The amounts in this paragraph shall be part of the designated governmental unit's portion of 7.2the nonfederal share of medical assistance costs, including payments under subdivision 9.7.3    (d) The commissioner may adjust the intergovernmental transfers under paragraph 7.4(c) and the payments under paragraph (a) based on the commissioner's determination of 7.5Medicare upper payment limits, hospital-specific charge limits, and any limits imposed 7.6by the federal government regarding the rate increase or the restriction in the American 7.7Resource and Recovery Act, Public Law 111-5, regarding increased local share.7.8    (e) This section shall be implemented upon federal approval, retroactive to July 1, 7.92010, for services provided on or after that date.7.10    Sec. 5. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:7.11    Subd. 27. Quarterly payment adjustment. (a) In addition to any other payment 7.12under this section, the commissioner shall make the following payments effective July 7.131, 2007:7.14    (1) for a hospital located in Minnesota and not eligible for payments under 7.15subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8 7.16percent of total patient days as of the base year in effect on July 1, 2005, a payment 7.17equal to 13 percent of the total of the operating and property payment rates, except that 7.18Hennepin County Medical Center and Regions Hospital shall not receive a payment 7.19under this subdivision;7.20    (2) for a hospital located in Minnesota in a specified urban area outside of the 7.21seven-county metropolitan area and not eligible for payments under subdivision 20, with 7.22a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total 7.23patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent 7.24of the total of the operating and property payment rates. For purposes of this clause, the 7.25following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria, 7.26Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids, 7.27Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena; 7.28    (3) for a hospital located in Minnesota but not located in a specified urban area 7.29under clause (2), with a medical assistance inpatient utilization rate less than or equal to 7.3017.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment 7.31equal to four percent of the total of the operating and property payment rates. A hospital 7.32located in Woodbury and not in existence during the base year shall be reimbursed under 7.33this clause; and7.34    (4) in addition to any payments under clauses (1) to (3), for a hospital located in 7.35Minnesota and not eligible for payments under subdivision 20 with a medical assistance 8.1inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect 8.2on July 1, 2005, a payment equal to eight percent of the total of the operating and property 8.3payment rates, and for a hospital located in Minnesota and not eligible for payments 8.4under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent 8.5of total patient days as of the base year in effect on July 1, 2005, a payment equal to 8.6nine percent of the total of the operating and property payment rates. After making any 8.7ratable adjustments required under paragraph (b), the commissioner shall proportionately 8.8reduce payments under clauses (2) and (3) by an amount needed to make payments under 8.9this clause.8.10    (b) The state share of payments under paragraph (a) shall be equal to federal 8.11reimbursements to the commissioner to reimburse expenditures reported under section 8.12256B.199, paragraphs (a) to (d). The commissioner shall ratably reduce or increase 8.13payments under this subdivision in order to ensure that these payments equal the amount 8.14of reimbursement received by the commissioner under section 
         256B.199, paragraphs (a) 8.15to (d), except that payments shall be ratably reduced by an amount equivalent to the state 8.16share of a four percent reduction in MinnesotaCare and medical assistance payments for 8.17inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be equivalent 8.18to the state share of a three percent reduction in these payments. Effective for federal 8.19disproportionate share hospital funds earned on general assistance medical care payments 8.20for services rendered on or after March 1, 2010, to June 30, 2011, the amount of the three 8.21percent ratable reduction required under this paragraph shall be deposited in the account 8.22established in section 256D.032. Payments under this subdivision shall be further ratably 8.23reduced as follows: by $3,243,000 in fiscal year 2011; and by $2,495,000 in fiscal year 8.242012. These amounts shall be deposited in the account established in section 256D.032.8.25    (c) The payments under paragraph (a) shall be paid quarterly based on each hospital's 8.26operating and property payments from the second previous quarter, beginning on July 8.2715, 2007, or upon federal approval of federal reimbursements under section 
         256B.199, 8.28paragraphs (a) to (d), whichever occurs later.8.29    (d) The commissioner shall not adjust rates paid to a prepaid health plan under 8.30contract with the commissioner to reflect payments provided in paragraph (a).8.31    (e) The commissioner shall maximize the use of available federal money for 8.32disproportionate share hospital payments and shall maximize payments to qualifying 8.33hospitals. In order to accomplish these purposes, the commissioner may, in consultation 8.34with the nonstate entities identified in section 
         256B.199, paragraphs (a) to (d), adjust, 8.35on a pro rata basis if feasible, the amounts reported by nonstate entities under section 8.36256B.199, paragraphs (a) to (d), when application for reimbursement is made to the federal 9.1government, and otherwise adjust the provisions of this subdivision. The commissioner 9.2shall utilize a settlement process based on finalized data to maximize revenue under 9.3section 
         256B.199, paragraphs (a) to (d), and payments under this section.9.4    (f) For purposes of this subdivision, medical assistance does not include general 9.5assistance medical care.9.6EFFECTIVE DATE.This section is effective for services rendered on or after 9.7March 1, 2010.9.8    Sec. 6. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to 9.9read:9.10    Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and 9.11recommend drugs which require prior authorization. The Formulary Committee shall 9.12establish general criteria to be used for the prior authorization of brand-name drugs for 9.13which generically equivalent drugs are available, but the committee is not required to 9.14review each brand-name drug for which a generically equivalent drug is available.9.15(b) Prior authorization may be required by the commissioner before certain 9.16formulary drugs are eligible for payment. The Formulary Committee may recommend 9.17drugs for prior authorization directly to the commissioner. The commissioner may also 9.18request that the Formulary Committee review a drug for prior authorization. Before the 9.19commissioner may require prior authorization for a drug:9.20(1) the commissioner must provide information to the Formulary Committee on the 9.21impact that placing the drug on prior authorization may have on the quality of patient care 9.22and on program costs, information regarding whether the drug is subject to clinical abuse 9.23or misuse, and relevant data from the state Medicaid program if such data is available;9.24(2) the Formulary Committee must review the drug, taking into account medical and 9.25clinical data and the information provided by the commissioner; and9.26(3) the Formulary Committee must hold a public forum and receive public comment 9.27for an additional 15 days.9.28The commissioner must provide a 15-day notice period before implementing the prior 9.29authorization.9.30(c) Except as provided in subdivision 13j, prior authorization shall not be required or 9.31utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:9.32(1) there is no generically equivalent drug available; and9.33(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or9.34(3) the drug is part of the recipient's current course of treatment.10.1This paragraph applies to any multistate preferred drug list or supplemental drug rebate 10.2program established or administered by the commissioner. Prior authorization shall 10.3automatically be granted for 60 days for brand name drugs prescribed for treatment of 10.4mental illness within 60 days of when a generically equivalent drug becomes available, 10.5provided that the brand name drug was part of the recipient's course of treatment at the 10.6time the generically equivalent drug became available.10.7(d) Prior authorization shall not be required or utilized for any antihemophilic factor 10.8drug prescribed for the treatment of hemophilia and blood disorders where there is no 10.9generically equivalent drug available if the prior authorization is used in conjunction with 10.10any supplemental drug rebate program or multistate preferred drug list established or 10.11administered by the commissioner.10.12(e) The commissioner may require prior authorization for brand name drugs 10.13whenever a generically equivalent product is available, even if the prescriber specifically 10.14indicates "dispense as written-brand necessary" on the prescription as required by section 10.15151.21, subdivision 2
         .10.16(f) Notwithstanding this subdivision, the commissioner may automatically require 10.17prior authorization, for a period not to exceed 180 days, for any drug that is approved by 10.18the United States Food and Drug Administration on or after July 1, 2005. The 180-day 10.19period begins no later than the first day that a drug is available for shipment to pharmacies 10.20within the state. The Formulary Committee shall recommend to the commissioner general 10.21criteria to be used for the prior authorization of the drugs, but the committee is not 10.22required to review each individual drug. In order to continue prior authorizations for a 10.23drug after the 180-day period has expired, the commissioner must follow the provisions 10.24of this subdivision.10.25EFFECTIVE DATE.This section is effective March 1, 2010.10.26    Sec. 7. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 10.27subdivision to read:10.28    Subd. 13j.Antipsychotic and attention deficit disorder and attention deficit 10.29hyperactivity disorder medications.(a) The commissioner, in consultation with the 10.30Drug Utilization Review Board established in subdivision 13i and actively practicing 10.31pediatric mental health professionals, must:10.32(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs 10.33and drugs used for attention deficit disorder or attention deficit hyperactivity disorder 10.34based on available medical, clinical, and safety data and research. The commissioner 10.35shall periodically review the list of medications and pediatric dose ranges and update 11.1the medications and doses listed as needed after consultation with the Drug Utilization 11.2Review Board;11.3(2) identify situations where a collaborative psychiatric consultation and prior 11.4authorization should be required before the initiation or continuation of drug therapy 11.5in pediatric patients including, but not limited to, high-dose regimens, off-label use of 11.6prescription medication, a patient's young age, and lack of coordination among multiple 11.7prescribing providers; and11.8(3) track prescriptive practices and the use of psychotropic medications in children 11.9with the goal of reducing the use of medication, where appropriate.11.10(b) Effective July 1, 2011, the commissioner shall require prior authorization and 11.11a collaborative psychiatric consultation before an atypical antipsychotic and attention 11.12deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria 11.13identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric 11.14consultation must be completed before the identified medications are eligible for payment 11.15unless:11.16(1) the patient has already been stabilized on the medication regimen; or11.17(2) the prescriber indicates that the child is in crisis.11.18If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed 11.19within 90 days for payment to continue.11.20(c) For purposes of this subdivision, a collaborative psychiatric consultation must 11.21meet the criteria described in section 245.4862, subdivision 5.11.22    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, is 11.23amended to read:11.24    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and 11.25subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital 11.26services upper payment limit for nonstate government hospitals. The commissioner shall 11.27then determine the amount of a supplemental payment to Hennepin County Medical 11.28Center and Regions Hospital for these services that would increase medical assistance 11.29spending in this category to the aggregate upper payment limit for all nonstate government 11.30hospitals in Minnesota. In making this determination, the commissioner shall allot the 11.31available increases between Hennepin County Medical Center and Regions Hospital 11.32based on the ratio of medical assistance fee-for-service outpatient hospital payments to 11.33the two facilities. The commissioner shall adjust this allotment as necessary based on 11.34federal approvals, the amount of intergovernmental transfers received from Hennepin and 11.35Ramsey Counties, and other factors, in order to maximize the additional total payments. 12.1The commissioner shall inform Hennepin County and Ramsey County of the periodic 12.2intergovernmental transfers necessary to match federal Medicaid payments available 12.3under this subdivision in order to make supplementary medical assistance payments to 12.4Hennepin County Medical Center and Regions Hospital equal to an amount that when 12.5combined with existing medical assistance payments to nonstate governmental hospitals 12.6would increase total payments to hospitals in this category for outpatient services to 12.7the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon 12.8receipt of these periodic transfers, the commissioner shall make supplementary payments 12.9to Hennepin County Medical Center and Regions Hospital.12.10    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall 12.11determine an upper payment limit for physicians affiliated with Hennepin County Medical 12.12Center and with Regions Hospital. The upper payment limit shall be based on the average 12.13commercial rate or be determined using another method acceptable to the Centers for 12.14Medicare and Medicaid Services. The commissioner shall inform Hennepin County and 12.15Ramsey County of the periodic intergovernmental transfers necessary to match the federal 12.16Medicaid payments available under this subdivision in order to make supplementary 12.17payments to physicians affiliated with Hennepin County Medical Center and Regions 12.18Hospital equal to the difference between the established medical assistance payment for 12.19physician services and the upper payment limit. Upon receipt of these periodic transfers, 12.20the commissioner shall make supplementary payments to physicians of Hennepin Faculty 12.21Associates and HealthPartners.12.22    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shallmay 12.23make monthly voluntary intergovernmental transfers to the commissioner in the following12.24amounts: $133,333 bynot to exceed $12,000,000 per year from Hennepin County 12.25and $100,000 by$6,000,000 per year from Ramsey County. The commissioner shall 12.26increase the medical assistance capitation payments to Metropolitan Health Plan and 12.27HealthPartners byany licensed health plan under contract with the medical assistance 12.28program that agrees to make enhanced payments to Hennepin County Medical Center or 12.29Regions Hospital. The increase shall be in an amount equal to the annual value of the 12.30monthly transfers plus federal financial participation., with each health plan receiving its 12.31pro rata share of the increase based on the pro rata share of medical assistance admissions 12.32to Hennepin County Medical Center and Regions Hospital by those plans. Upon the 12.33request of the commissioner, health plans shall submit individual-level cost data for 12.34verification purposes. The commissioner may ratably reduce these payments on a pro rata 12.35basis in order to satisfy federal requirements for actuarial soundness. If payments are 12.36reduced, transfers shall be reduced accordingly. Any licensed health plan that receives 13.1increased medical assistance capitation payments under the intergovernmental transfer 13.2described in this paragraph shall increase its medical assistance payments to Hennepin 13.3County Medical Center and Regions Hospital by the same amount as the increased 13.4payments received in the capitation payment described in this paragraph.13.5    (d) The commissioner shall inform Hennepin County and Ramsey County on an 13.6ongoing basis of the need for any changes needed in the intergovernmental transfers 13.7in order to continue the payments under paragraphs (a) to (c), at their maximum level, 13.8including increases in upper payment limits, changes in the federal Medicaid match, and 13.9other factors.13.10    (e) The payments in paragraphs (a) to (c) shall be implemented independently of 13.11each other, subject to federal approval and to the receipt of transfers under subdivision 3.13.12EFFECTIVE DATE.This section is effective the day following final enactment.13.13    Sec. 9. Minnesota Statutes 2009 Supplement, section 256B.199, is amended to read:13.14256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.13.15    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds 13.16for the expenditures in paragraphs (b) and (c).13.17    (b) The commissioner shall apply for federal matching funds for certified public 13.18expenditures as follows:13.19    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, and 13.20Regions Hospital, the University of Minnesota, and Fairview-University Medical Center13.21shall report quarterly to the commissioner beginning June 1, 2007, payments made during 13.22the second previous quarter that may qualify for reimbursement under federal law;13.23     (2) based on these reports, the commissioner shall apply for federal matching 13.24funds. These funds are appropriated to the commissioner for the payments under section 13.25256.969, subdivision 27
         ; and13.26     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform 13.27the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share 13.28hospital payment money expected to be available in the current federal fiscal year.13.29    (c) The commissioner shall apply for federal matching funds for general assistance 13.30medical care expenditures as follows:13.31    (1) for hospital services occurring on or after July 1, 2007, general assistance medical 13.32care expenditures for fee-for-service inpatient and outpatient hospital payments made by 13.33the department shall be used to apply for federal matching funds, except as limited below:14.1    (i) only those general assistance medical care expenditures made to an individual 14.2hospital that would not cause the hospital to exceed its individual hospital limits under 14.3section 1923 of the Social Security Act may be considered; and14.4    (ii) general assistance medical care expenditures may be considered only to the extent 14.5of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and14.6    (2) all hospitals must provide any necessary expenditure, cost, and revenue 14.7information required by the commissioner as necessary for purposes of obtaining federal 14.8Medicaid matching funds for general assistance medical care expenditures.14.9    (d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall 14.10apply for additional federal matching funds available as disproportionate share hospital 14.11payments under the American Recovery and Reinvestment Act of 2009. These funds shall 14.12be made available as the state share of payments under section 
         256.969, subdivision 28. 14.13The entities required to report certified public expenditures under paragraph (b), clause 14.14(1), shall report additional certified public expenditures as necessary under this paragraph.14.15    (e) Effective July 15, 2010, in addition to any payment otherwise required under 14.16sections 256B.19, 256B.195, and 256B.196, the following government entities may make 14.17the following voluntary payments to the commissioner on an annual basis:14.18    (1) Hennepin County, $6,200,000; and14.19    (2) Ramsey County, $4,000,000.14.20    (f) The sums in paragraph (e) shall be part of the designated governmental unit's 14.21portion of the nonfederal share of medical assistance costs.14.22    (g) Effective July 15, 2010, the commissioner shall make the following Medicaid 14.23disproportionate share hospital payments to the hospitals on a monthly basis:14.24    (1) to Hennepin County Medical Center, the amount of the transfer under paragraph 14.25(e), clause (1), plus any federal matching funds available to recognize higher medical 14.26assistance costs in institutions that provide high levels of charity care; and14.27    (2) to Regions Hospital, the amount of the transfer under paragraph (e), clause (2), 14.28plus any federal matching funds available to recognize higher medical assistance costs in 14.29institutions that provide high levels of charity care.14.30    (h) Effective July 15, 2010, after making the payments provided in paragraph 14.31(g), the commissioner shall make the increased payments provided in section 256.969, 14.32subdivision 26a.14.33    (i) The commissioner shall make the payments under paragraphs (g) and (h) prior 14.34to making any other payments under this section, section 256.969, subdivision 27, or 14.35256B.195.15.1    (j) The commissioner may adjust the intergovernmental transfers under paragraph 15.2(e) and the payments under paragraph (g) based on the commissioner's determination 15.3of Medicare upper payment limits, hospital-specific charge limits, and any limitations 15.4imposed by the federal government regarding the rate increase or the restriction in the 15.5American Resource and Recovery Act, Public Law 111-5, regarding increased local share.15.6    (k) This section shall be implemented upon federal approval of the rate increase 15.7and a federal determination that the increased transfers do not violate the restriction in 15.8the American Resource and Recovery Act, Public Law 111-5, regarding the local share, 15.9retroactive to admissions occurring on or after July 15, 2010.15.10    Sec. 10. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is 15.11amended to read:15.12    Subd. 3. General assistance medical care; eligibility. (a) General assistance 15.13medical care may be paid for any person who is not eligible for medical assistance under 15.14chapter 256B, including eligibility for medical assistance based on a spenddown of excess 15.15income according to section 
         256B.056, subdivision 5, or MinnesotaCare for applicants 15.16and recipients defined in paragraph (c), except as provided in paragraph (d), and:15.17    (1) who is receiving assistance under section 
         256D.05, except for families with 15.18children who are eligible under Minnesota family investment program (MFIP), or who is 15.19having a payment made on the person's behalf under sections 
         256I.01 to 
         256I.06; or15.20    (2) who is a resident of Minnesota; and15.21    (i) who has gross countable income not in excess of 75 percent of the federal poverty 15.22guidelines for the family size, using a six-month budget period and whose equity in assets 15.23is not in excess of $1,000 per assistance unit. General assistance medical care is not 15.24available for applicants or enrollees who are otherwise eligible for medical assistance but 15.25fail to verify their assets. Enrollees who become eligible for medical assistance shall be 15.26terminated and transferred to medical assistance. Exempt assets, the reduction of excess 15.27assets, and the waiver of excess assets must conform to the medical assistance program in 15.28section 
         256B.056, subdivisions 3 and 3d, with the following exception: the maximum 15.29amount of undistributed funds in a trust that could be distributed to or on behalf of the 15.30beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the 15.31terms of the trust, must be applied toward the asset maximum; or15.32    (ii) who has gross countable income above 75 percent of the federal poverty 15.33guidelines but not in excess of 175 percent of the federal poverty guidelines for the family 15.34size, using a six-month budget period, whose equity in assets is not in excess of the limits 15.35in section 
         256B.056, subdivision 3c, and who applies during an inpatient hospitalization.16.1    (b) The commissioner shall adjust the income standards under this section each July 16.21 by the annual update of the federal poverty guidelines following publication by the 16.3United States Department of Health and Human Services.16.4    (c) Effective for applications and renewals processed on or after September 1, 2006, 16.5general assistance medical care may not be paid for applicants or recipients who are adults 16.6with dependent children under 21 whose gross family income is equal to or less than 275 16.7percent of the federal poverty guidelines who are not described in paragraph (f).16.8    (d) Effective for applications and renewals processed on or after September 1, 16.92006, general assistance medical care may be paid for applicants and recipients who 16.10meet all eligibility requirements of paragraph (a), clause (2), item (i), for a temporary 16.11period beginning the date of application. Immediately following approval of general 16.12assistance medical care, enrollees shall be enrolled in MinnesotaCare under section 16.13256L.04, subdivision 7
         , with covered services as provided in section 
         256L.03 for the rest 16.14of the six-month general assistance medical care eligibility period, until their six-month 16.15renewal. This paragraph does not apply to applicants and recipients who are exempt 16.16under paragraph (f).16.17    (e) To be eligible for general assistance medical care following enrollment in 16.18MinnesotaCare as required by paragraph (d), an individual must complete a new 16.19application.16.20    (f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are 16.21exempt from the MinnesotaCare enrollment requirements in this subdivision if they:16.22    (1) have applied for and are awaiting a determination of blindness or disability by 16.23the state medical review team or a determination of eligibility for Supplemental Security 16.24Income or Social Security Disability Insurance by the Social Security Administration;16.25    (2) fail to meet the requirements of section 
         256L.09, subdivision 2;16.26    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.;16.27    (4) are classified as end-stage renal disease beneficiaries in the Medicare program;16.28    (5) are enrolled in private health care coverage as defined in section 
         256B.02, 16.29subdivision 9;16.30    (6) are eligible under paragraph (k);16.31    (7) receive treatment funded pursuant to section 
         254B.02; or16.32    (8) reside in the Minnesota sex offender program defined in chapter 246B. 16.33If an enrollee meets one of the categories described in this paragraph, the 16.34commissioner shall not require the enrollee to enroll in MinnesotaCare.16.35    (g) For applications received on or after October 1, 2003, eligibility may begin no 16.36earlier than the date of application. For individuals eligible under paragraph (a), clause 17.1(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are 17.2eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but 17.3may reapply if there is a subsequent period of inpatient hospitalization.17.4    (h) Beginning September 1, 2006, Minnesota health care program applications and 17.5renewals completed by recipients and applicants who are persons described in paragraph 17.6(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility 17.7by the county agency. If all other eligibility requirements of this subdivision are met, 17.8eligibility for general assistance medical care shall be available in any month during which 17.9MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare, 17.10notice of termination for eligibility for general assistance medical care shall be sent to 17.11an applicant or recipient. If all other eligibility requirements of this subdivision are 17.12met, eligibility for general assistance medical care shall be available until enrollment in 17.13MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).17.14    (i) The date of an initial Minnesota health care program application necessary to 17.15begin a determination of eligibility shall be the date the applicant has provided a name, 17.16address, and Social Security number, signed and dated, to the county agency or the 17.17Department of Human Services. If the applicant is unable to provide a name, address, 17.18Social Security number, and signature when health care is delivered due to a medical 17.19condition or disability, a health care provider may act on an applicant's behalf to establish 17.20the date of an initial Minnesota health care program application by providing the county 17.21agency or Department of Human Services with provider identification and a temporary 17.22unique identifier for the applicant. The applicant must complete the remainder of the 17.23application and provide necessary verification before eligibility can be determined. The 17.24applicant must complete the application within the time periods required under the 17.25medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart 17.265, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining 17.27verification if necessary.17.28    (j) County agencies are authorized to use all automated databases containing 17.29information regarding recipients' or applicants' income in order to determine eligibility for 17.30general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 17.31in order to determine eligibility and premium payments by the county agency.17.32    (k) General assistance medical care is not available for a person in a correctional 17.33facility unless the person is detained by law for less than one year in a county correctional 17.34or detention facility as a person accused or convicted of a crime, or admitted as an 17.35inpatient to a hospital on a criminal hold order, and the person is a recipient of general 17.36assistance medical care at the time the person is detained by law or admitted on a criminal 18.1hold order and as long as the person continues to meet other eligibility requirements 18.2of this subdivision.18.3    (l) General assistance medical care is not available for applicants or recipients who 18.4do not cooperate with the county agency to meet the requirements of medical assistance.18.5    (m) In determining the amount of assets of an individual eligible under paragraph 18.6(a), clause (2), item (i), there shall be included any asset or interest in an asset, including 18.7an asset excluded under paragraph (a), that was given away, sold, or disposed of for 18.8less than fair market value within the 60 months preceding application for general 18.9assistance medical care or during the period of eligibility. Any transfer described in this 18.10paragraph shall be presumed to have been for the purpose of establishing eligibility for 18.11general assistance medical care, unless the individual furnishes convincing evidence to 18.12establish that the transaction was exclusively for another purpose. For purposes of this 18.13paragraph, the value of the asset or interest shall be the fair market value at the time it 18.14was given away, sold, or disposed of, less the amount of compensation received. For any 18.15uncompensated transfer, the number of months of ineligibility, including partial months, 18.16shall be calculated by dividing the uncompensated transfer amount by the average monthly 18.17per person payment made by the medical assistance program to skilled nursing facilities 18.18for the previous calendar year. The individual shall remain ineligible until this fixed period 18.19has expired. The period of ineligibility may exceed 30 months, and a reapplication for 18.20benefits after 30 months from the date of the transfer shall not result in eligibility unless 18.21and until the period of ineligibility has expired. The period of ineligibility begins in the 18.22month the transfer was reported to the county agency, or if the transfer was not reported, 18.23the month in which the county agency discovered the transfer, whichever comes first. For 18.24applicants, the period of ineligibility begins on the date of the first approved application.18.25    (n) When determining eligibility for any state benefits under this subdivision, 18.26the income and resources of all noncitizens shall be deemed to include their sponsor's 18.27income and resources as defined in the Personal Responsibility and Work Opportunity 18.28Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 18.29subsequently set out in federal rules.18.30    (o) Undocumented noncitizens and nonimmigrants are ineligible for general 18.31assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 18.32in one or more of the classes listed in United States Code, title 8, section 1101, subsection 18.33(a), paragraph (15), and an undocumented noncitizen is an individual who resides in 18.34the United States without the approval or acquiescence of the United States Citizenship 18.35and Immigration Services.19.1    (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for 19.2medical assistance due to the deeming of a sponsor's income and resources, is ineligible 19.3for general assistance medical care.19.4    (q) Effective July 1, 2003, general assistance medical care emergency services end.19.5(r) For the period beginning March 1, 2010, and ending July 1, 2011, the general 19.6assistance medical care program shall be administered according to section 256D.031, 19.7unless otherwise stated.19.8EFFECTIVE DATE.This section is effective March 1, 2010.19.9    Sec. 11. Minnesota Statutes 2008, section 256D.03, subdivision 3a, is amended to read:19.10    Subd. 3a. Claims; assignment of benefits.(a) Claims must be filed pursuant to 19.11section 
         256D.16. General assistance medical care applicants and recipients must apply or 19.12agree to apply third party health and accident benefits to the costs of medical care. They 19.13must cooperate with the state in establishing paternity and obtaining third party payments. 19.14By accepting general assistance, a person assigns to the Department of Human Services 19.15all rights to medical support or payments for medical expenses from another person or 19.16entity on their own or their dependent's behalf and agrees to cooperate with the state in 19.17establishing paternity and obtaining third party payments. The application shall contain 19.18a statement explaining the assignment. Any rights or amounts assigned shall be applied 19.19against the cost of medical care paid for under this chapter. An assignment is effective on 19.20the date general assistance medical care eligibility takes effect. 19.21(b) Effective for general assistance medical care services rendered on or after 19.22March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 19.23this subdivision shall be deposited in or credited to the account established in section 19.24256D.032.19.25EFFECTIVE DATE.This section is effective March 1, 2010.19.26    Sec. 12. Minnesota Statutes 2008, section 256D.03, subdivision 3b, is amended to read:19.27    Subd. 3b. Cooperation. (a) General assistance or general assistance medical care 19.28applicants and recipients must cooperate with the state and local agency to identify 19.29potentially liable third-party payors and assist the state in obtaining third-party payments. 19.30Cooperation includes identifying any third party who may be liable for care and services 19.31provided under this chapter to the applicant, recipient, or any other family member for 19.32whom application is made and providing relevant information to assist the state in pursuing 19.33a potentially liable third party. General assistance medical care applicants and recipients 20.1must cooperate by providing information about any group health plan in which they may 20.2be eligible to enroll. They must cooperate with the state and local agency in determining 20.3if the plan is cost-effective. For purposes of this subdivision, coverage provided by the 20.4Minnesota Comprehensive Health Association under chapter 62E shall not be considered 20.5group health plan coverage or cost-effective by the state and local agency. If the plan is 20.6determined cost-effective and the premium will be paid by the state or local agency or is 20.7available at no cost to the person, they must enroll or remain enrolled in the group health 20.8plan. Cost-effective insurance premiums approved for payment by the state agency and 20.9paid by the local agency are eligible for reimbursement according to subdivision 6.20.10(b) Effective for all premiums due on or after June 30, 1997, general assistance 20.11medical care does not cover premiums that a recipient is required to pay under a qualified 20.12or Medicare supplement plan issued by the Minnesota Comprehensive Health Association. 20.13General assistance medical care shall continue to cover premiums for recipients who are 20.14covered under a plan issued by the Minnesota Comprehensive Health Association on June 20.1530, 1997, for a period of six months following receipt of the notice of termination or 20.16until December 31, 1997, whichever is later.20.17(c) Effective for general assistance medical care services rendered on or after 20.18March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 20.19this subdivision shall be deposited in or credited to the account established in section 20.20256D.032.20.21EFFECTIVE DATE.This section is effective March 1, 2010.20.22    Sec. 13. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.20.23    Subdivision 1.Eligibility.(a) Except as provided under subdivision 2, general 20.24assistance medical care may be paid for any individual who is not eligible for medical 20.25assistance under chapter 256B, including eligibility for medical assistance based on a 20.26spenddown of excess income according to section 256B.056, subdivision 5, and who:20.27(1) is receiving assistance under section 256D.05, except for families with children 20.28who are eligible under the Minnesota family investment program (MFIP), or who is 20.29having a payment made on the person's behalf under sections 256I.01 to 256I.06; or20.30(2) is a resident of Minnesota and has gross countable income not in excess of 75 20.31percent of federal poverty guidelines for the family size, using a six-month budget period, 20.32and whose equity in assets is not in excess of $1,000 per assistance unit.20.33Exempt assets, the reduction of excess assets, and the waiver of excess assets must 20.34conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d, 21.1except that the maximum amount of undistributed funds in a trust that could be distributed 21.2to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's 21.3discretion under the terms of the trust, must be applied toward the asset maximum.21.4(b) The commissioner shall adjust the income standards under this section each July 21.51 by the annual update of the federal poverty guidelines following publication by the 21.6United States Department of Health and Human Services.21.7    Subd. 2.Ineligible groups.(a) General assistance medical care may not be paid for 21.8an applicant or a recipient who:21.9(1) is otherwise eligible for medical assistance but fails to verify their assets;21.10(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;21.11(3) is enrolled in private health coverage as defined in section 256B.02, subdivision 21.129;21.13(4) is in a correctional facility, including an individual in a county correctional or 21.14detention facility as an individual accused or convicted of a crime, or admitted as an 21.15inpatient to a hospital on a criminal hold order;21.16(5) resides in the Minnesota sex offender program defined in chapter 246B;21.17(6) does not cooperate with the county agency to meet the requirements of medical 21.18assistance; or21.19(7) does not cooperate with a county or state agency or the state medical review team 21.20in determining a disability or for determining eligibility for Supplemental Security Income 21.21or Social Security Disability Insurance by the Social Security Administration.21.22(b) Undocumented noncitizens and nonimmigrants are ineligible for general 21.23assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual 21.24in one or more of the classes listed in United States Code, title 8, section 1101, subsection 21.25(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the 21.26United States without approval or acquiescence of the United States Citizenship and 21.27Immigration Services.21.28(c) Notwithstanding any other provision of law, a noncitizen who is ineligible for 21.29medical assistance due to the deeming of a sponsor's income and resources is ineligible for 21.30general assistance medical care.21.31(d) General assistance medical care recipients who become eligible for medical 21.32assistance shall be terminated from general assistance medical care and transferred to 21.33medical assistance.21.34    Subd. 3.Transitional MinnesotaCare.(a) Except as provided in paragraph (c), 21.35effective March 1, 2010, all applicants and recipients who meet the eligibility requirements 21.36in subdivision 1, paragraph (a), clause (2), and who are not described in subdivision 2 22.1shall be enrolled in MinnesotaCare under section 256L.04, subdivision 7, immediately 22.2following approval of general assistance medical care. 22.3(b) If all other eligibility requirements of this subdivision are met, general assistance 22.4medical care may be paid for individuals identified in paragraph (a) for a temporary 22.5period beginning the date of application. Eligibility for general assistance medical care 22.6shall continue until enrollment in MinnesotaCare is completed. Upon notification of 22.7eligibility for MinnesotaCare, notice of termination for eligibility for general assistance 22.8medical care shall be sent to the applicant or recipient. Once enrolled in MinnesotaCare, 22.9the MinnesotaCare-covered services as described in section 256L.03 shall apply for the 22.10remainder of the six-month general assistance medical care eligibility period until their 22.11six-month renewal.22.12(c) This subdivision does not apply if the applicant or recipient:22.13(1) has applied for and is awaiting a determination of blindness or disability by the 22.14state medical review team or a determination of eligibility for Supplemental Security 22.15Income or Social Security Disability Insurance by the Social Security Administration;22.16(2) is homeless as defined by United States Code, title 42, section 11301, et seq.;22.17(3) is classified as an end-stage renal disease beneficiary in the Medicare program; 22.18(4) receives treatment funded in section 254B.02; or22.19(5) fails to meet the requirements of section 256L.09, subdivision 2.22.20Applicants and recipients who meet any one of these criteria shall remain eligible for 22.21general assistance medical care and shall not be required to enroll in MinnesotaCare.22.22(d) To be eligible for general assistance medical care following enrollment 22.23in MinnesotaCare as required in paragraph (a), an individual must complete a new 22.24application.22.25    Subd. 4.Eligibility and enrollment procedures.(a) Eligibility for general 22.26assistance medical care shall begin no earlier than the date of application. The date of 22.27application shall be the date the applicant has provided a name, address, and Social 22.28Security number, signed and dated, to the county agency or the Department of Human 22.29Services. If the applicant is unable to provide a name, address, Social Security number, 22.30and signature when health care is delivered due to a medical condition or disability, a 22.31health care provider may act on an applicant's behalf to establish the date of an application 22.32by providing the county agency or Department of Human Services with provider 22.33identification and a temporary unique identifier for the applicant. The applicant must 22.34complete the remainder of the application and provide necessary verification before 22.35eligibility can be determined. The applicant must complete the application within the time 22.36periods required under the medical assistance program as specified in Minnesota Rules, 23.1parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the 23.2applicant in obtaining verification if necessary. 23.3    (b) County agencies are authorized to use all automated databases containing 23.4information regarding recipients' or applicants' income in order to determine eligibility for 23.5general assistance medical care or MinnesotaCare. Such use shall be considered sufficient 23.6in order to determine eligibility and premium payments by the county agency.23.7    (c) In determining the amount of assets of an individual eligible under subdivision 1, 23.8paragraph (a), clause (2), there shall be included any asset or interest in an asset, including 23.9an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or 23.10disposed of for less than fair market value within the 60 months preceding application for 23.11general assistance medical care or during the period of eligibility. Any transfer described 23.12in this paragraph shall be presumed to have been for the purpose of establishing eligibility 23.13for general assistance medical care, unless the individual furnishes convincing evidence to 23.14establish that the transaction was exclusively for another purpose. For purposes of this 23.15paragraph, the value of the asset or interest shall be the fair market value at the time it 23.16was given away, sold, or disposed of, less the amount of compensation received. For any 23.17uncompensated transfer, the number of months of ineligibility, including partial months, 23.18shall be calculated by dividing the uncompensated transfer amount by the average monthly 23.19per person payment made by the medical assistance program to skilled nursing facilities 23.20for the previous calendar year. The individual shall remain ineligible until this fixed period 23.21has expired. The period of ineligibility may exceed 30 months, and a reapplication for 23.22benefits after 30 months from the date of the transfer shall not result in eligibility unless 23.23and until the period of ineligibility has expired. The period of ineligibility begins in the 23.24month the transfer was reported to the county agency, or if the transfer was not reported, 23.25the month in which the county agency discovered the transfer, whichever comes first. For 23.26applicants, the period of ineligibility begins on the date of the first approved application.23.27    (d) When determining eligibility for any state benefits under this subdivision, 23.28the income and resources of all noncitizens shall be deemed to include their sponsor's 23.29income and resources as defined in the Personal Responsibility and Work Opportunity 23.30Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and 23.31subsequently set out in federal rules.23.32    Subd. 5.General assistance medical care; services.(a) General assistance 23.33medical care covers:23.34    (1) inpatient hospital services within the limitations described in subdivision 10;23.35    (2) outpatient hospital services;23.36    (3) services provided by Medicare-certified rehabilitation agencies;24.1    (4) prescription drugs and other products recommended through the process 24.2established in section 256B.0625, subdivision 13;24.3    (5) equipment necessary to administer insulin and diagnostic supplies and equipment 24.4for diabetics to monitor blood sugar level;24.5    (6) eyeglasses and eye examinations provided by a physician or optometrist;24.6    (7) hearing aids;24.7    (8) prosthetic devices;24.8    (9) laboratory and x-ray services;24.9    (10) physicians' services;24.10    (11) medical transportation except special transportation;24.11    (12) chiropractic services as covered under the medical assistance program;24.12    (13) podiatric services;24.13    (14) dental services as covered under the medical assistance program;24.14    (15) mental health services covered under chapter 256B;24.15    (16) prescribed medications for persons who have been diagnosed as mentally ill as 24.16necessary to prevent more restrictive institutionalization;24.17    (17) medical supplies and equipment, and Medicare premiums, coinsurance, and 24.18deductible payments;24.19    (18) medical equipment not specifically listed in this paragraph when the use of 24.20the equipment will prevent the need for costlier services that are reimbursable under 24.21this subdivision;24.22    (19) services performed by a certified pediatric nurse practitioner, a certified family 24.23nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 24.24nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 24.25practitioner in independent practice, if (1) the service is otherwise covered under this 24.26chapter as a physician service, (2) the service provided on an inpatient basis is not included 24.27as part of the cost for inpatient services included in the operating payment rate, and (3) the 24.28service is within the scope of practice of the nurse practitioner's license as a registered 24.29nurse, as defined in section 148.171;24.30    (20) services of a certified public health nurse or a registered nurse practicing in 24.31a public health nursing clinic that is a department of, or that operates under the direct 24.32authority of, a unit of government, if the service is within the scope of practice of the 24.33public health nurse's license as a registered nurse, as defined in section 148.171;24.34    (21) telemedicine consultations, to the extent they are covered under section 24.35256B.0625, subdivision 3b;25.1    (22) care coordination and patient education services provided by a community 25.2health worker according to section 256B.0625, subdivision 49; and25.3    (23) regardless of the number of employees that an enrolled health care provider 25.4may have, sign language interpreter services when provided by an enrolled health care 25.5provider during the course of providing a direct, person-to-person-covered health care 25.6service to an enrolled recipient who has a hearing loss and uses interpreting services.25.7(b) Sex reassignment surgery is not covered under this section.25.8(c) Drug coverage is covered in accordance with section 256D.03, subdivision 4, 25.9paragraph (d).25.10(d) The following co-payments shall apply for services provided:25.11(1) $25 for nonemergency visits to a hospital-based emergency room; and25.12(2) $3 per brand-name drug prescription, subject to a $7 per month maximum for 25.13prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when 25.14used for the treatment of mental illness.25.15(e) Co-payments shall be limited to one per day per provider for nonemergency 25.16visits to a hospital-based emergency room. Recipients of general assistance medical care 25.17are responsible for all co-payments in this subdivision. Reimbursement for prescription 25.18drugs shall be reduced by the amount of the co-payment until the recipient has reached the 25.19$7 per month maximum for prescription drug co-payments. The provider shall collect 25.20the co-payment from the recipient. Providers may not deny services to recipients who 25.21are unable to pay the co-payment.25.22(f) Chemical dependency services that are reimbursed under chapter 254B shall not 25.23be reimbursed under general assistance medical care.25.24(g) Inpatient hospital services that are provided in community behavioral health 25.25hospitals operated by state-operated services shall not be reimbursed under general 25.26assistance medical care.25.27    Subd. 6.Coordinated care delivery option.(a) A county or group of counties may 25.28elect to provide health care services to individuals who are eligible for general assistance 25.29medical care under this section and who reside within the county or counties through 25.30a coordinated care delivery option. The health care services provided by the county 25.31must include the services described in subdivision 5 with the exception of outpatient 25.32prescription drug coverage but including drugs administered in an outpatient setting. 25.33Counties that elect to provide health care services through this option must ensure that 25.34the requirements of this subdivision are met. Upon electing to provide services through 25.35this option, the county accepts the financial risk of the delivery of the health care services 25.36described in this subdivision to general assistance medical care recipients residing in 26.1the county for the period beginning July 1, 2010, and ending July 1, 2011, for the fixed 26.2payments described in subdivision 10.26.3(b) A county that elects to provide services through this option must provide to 26.4the commissioner the following:26.5(1) the names of the county or counties that are electing to provide services through 26.6the county care delivery option; and26.7(2) the geographic area to be served.26.8(c) The county may contract with a managed care plan, an integrated delivery 26.9system, a physician-hospital organization, or an academic health center to administer 26.10the delivery of services through this option. Any county providing general assistance 26.11medical care services through a county-based purchasing plan in accordance with section 26.12256B.692 may continue to provide services through the county-based purchasing plan. 26.13Payments to the county-based purchasing plan for the period beginning July 1, 2010, and 26.14ending July 1, 2011, shall be paid according to subdivision 10.26.15(d) A county must demonstrate the ability to:26.16(1) provide the covered services required under this subdivision to recipients 26.17residing within the county;26.18(2) provide a system for advocacy, consumer protection, and complaints and appeals 26.19that is independent of care providers or other risk bearers and complies with section 26.20256B.69;26.21(3) establish a process to monitor enrollment and ensure the quality of care provided; 26.22and26.23(4) coordinate the delivery of health care services with existing homeless prevention, 26.24supportive housing, and rent subsidy programs and funding administered by the Minnesota 26.25Housing Finance Agency under chapter 462A.26.26(e) The commissioner may require the county to provide the commissioner with data 26.27necessary for assessing enrollment, quality of care, cost, and utilization of services.26.28(f) A county that elects to provide services through this option shall be considered to 26.29be a prepaid health plan for purposes of section 256.045.26.30(g) The state shall not be liable for the payment of any cost or obligation incurred 26.31by the county or a participating provider.26.32    Subd. 7.Health care home designation.The commissioner or a county may 26.33require a recipient to designate a primary care provider or a primary care clinic that is 26.34certified as a health care home under section 256B.0751.26.35    Subd. 8.Payments; fee-for-service rate for the period between March 1, 26.362010, and July 1, 2010.(a) Effective for services provided on or after March 1, 2010, 27.1and before July 1, 2010, the payment rates for all covered services provided to general 27.2assistance medical care recipients, with the exception of outpatient prescription drug 27.3coverage, shall be 50 percent of the general assistance medical care payment rate in effect 27.4on February 28, 2010.27.5(b) Outpatient prescription drug coverage provided on or after March 1, 2010, and 27.6before July 1, 2010, shall be paid on a fee-for-service basis in accordance with section 27.7256B.0625, subdivision 13e.27.8    Subd. 9.Payments; fee-for-service rates for the period between July 1, 2010, 27.9and July 1, 2011.(a) Effective for services provided on or after July 1, 2010, and before 27.10July 1, 2011, to general assistance medical care recipients residing in counties that are 27.11not served through the coordinated care delivery option, payments shall be made by the 27.12commissioner to providers at rates described in this subdivision.27.13(b) For inpatient hospital admissions provided on or after July 1, 2010, and before 27.14July 1, 2011, the payment rate shall be:27.15(1) 70 percent of the general assistance medical care rate in effect on February 27.1628, 2010, if the inpatient hospital services were provided in a hospital where the 27.17fee-for-service inpatient and outpatient hospital general assistance medical care payments 27.18to the hospital for admissions provided in calendar year 2007 totaled $1,000,000 or more 27.19or the hospital's fee-for-service inpatient and outpatient hospital general assistance medical 27.20care payments received for calendar year 2007 admissions was one percent or more of the 27.21hospital's net patient revenue received for services provided in calendar year 2007; or27.22(2) 40 percent of the general assistance medical care rate in effect on February 28, 27.232010, if the inpatient hospital services were provided by a hospital that does not meet the 27.24criteria described in clause (1).27.25(c) Effective for services other than inpatient hospital services and outpatient 27.26prescription drug coverage provided on or after July 1, 2010, and before July 1, 2011, 27.27the payment rate shall begin at 50 percent of the general assistance medical care rate 27.28in effect on February 28, 2010.27.29(d) Outpatient prescription drug coverage provided on or after July 1, 2010, and 27.30before July 1, 2011, shall be paid on a fee-for-service basis in accordance with section 27.31256B.0625, subdivision 13e.27.32(e) The commissioner may adjust the rates paid under paragraphs (b) and (c) on a 27.33quarterly basis to ensure that the total aggregate amount paid out for services provided 27.34on a fee-for-service basis beginning March 1, 2010, and ending June 30, 2011, does not 27.35exceed the appropriation from the general assistance medical care account established in 27.36section 256D.032 for the general assistance medical care program.28.1    Subd. 10.Payments; rate setting for the coordinated care delivery option.(a) 28.2Effective for general assistance medical care services, with the exception of outpatient 28.3prescription drug coverage, provided on or after July 1, 2010, and before July 1, 2011, 28.4to recipients residing in counties that have elected to provide services through the 28.5coordinated delivery care option, the commissioner shall establish quarterly prospective 28.6fixed payments to the county. The payments must not exceed 60 percent of the county's 28.7general assistance medical care county allocation amount as determined in paragraph (b). 28.8These payments must not be used by the county to pay MinnesotaCare premiums for 28.9general assistance medical care recipients or MinnesotaCare enrollees.28.10(b) For each county that elects to provide services in accordance with subdivision 28.117, the commissioner shall determine a general assistance medical care county allocation 28.12amount that equals the total general assistance medical care payments made for recipients 28.13residing within the county in fiscal year 2009 for all covered general assistance medical 28.14care services with the exception of outpatient prescription drug coverage.28.15(c) Outpatient prescription drug coverage provided on or after July 1, 2010, 28.16and before July 1, 2011, shall be paid on a fee-for-service basis according to section 28.17256B.0625, subdivision 13e.28.18    Subd. 11.Veterans medical review team.(a) To ensure the timely processing of 28.19determinations of service-connected disabilities among veterans enrolled in the temporary 28.20general assistance medical care program, the commissioner shall review all medical 28.21evidence submitted by enrollees with a referral and seek additional information from 28.22providers, applicants, and enrollees to support the determination of a service-connected 28.23disability when necessary. Service-connected disability shall be determined according to 28.24the regulations and policies of the United States Department of Veterans Affairs.28.25(b) Prior to a denial or withdrawal of a requested determination of service-connected 28.26disability due to insufficient evidence, the commissioner shall:28.27(1) ensure that the missing evidence is necessary and appropriate to a determination 28.28of service-connected disability; and28.29(2) assist applicants and enrollees to obtain the evidence, including, but not limited 28.30to, medical examinations and electronic medical records.28.31(c) The commissioner shall provide the chairs of the legislative committees with 28.32jurisdiction over health and human services finance and veterans affairs finance the 28.33following information on the activities of the veterans medical review team by August 1, 28.342010, and provide an update by January 1, 2011:28.35(1) the number of applications to the veterans medical review team that were denied, 28.36approved, or withdrawn;29.1(2) the average length of time from receipt of the application to a decision;29.2(3) the number of appeals and appeal results;29.3(4) for applicants, their age, health coverage at the time of application, 29.4hospitalization  history within three months of application, and whether an application for 29.5service-connected veterans benefits is pending; and29.6(5) specific information on the medical certification, licensure, or other credentials 29.7of the person or persons performing the medical review determinations and length of 29.8time in that position.29.9EFFECTIVE DATE.This section is effective for services rendered on or after 29.10March 1, 2010, and before July 1, 2011.29.11    Sec. 14. [256D.032] GENERAL ASSISTANCE MEDICAL CARE ACCOUNT.29.12The general assistance medical care account is created in the special revenue fund. 29.13Money deposited into the account is subject to appropriation by the legislature.29.14EFFECTIVE DATE.This section is effective March 1, 2010.29.15    Sec. 15. Minnesota Statutes 2008, section 256D.06, subdivision 7, is amended to read:29.16    Subd. 7. SSI conversions and back claims. (a) The commissioner of human 29.17services shall contract with agencies or organizations capable of ensuring that clients who 29.18are presently receiving assistance under sections 
         256D.01 to 
         256D.21, and who may be 29.19eligible for benefits under the federal Supplemental Security Income program, apply and, 29.20when eligible, are converted to the federal income assistance program and made eligible 29.21for health care benefits under the medical assistance program. The commissioner shall 29.22ensure that money owing to the state under interim assistance agreements is collected.29.23(b) The commissioner shall also directly or through contract implement procedures 29.24for collecting federal Medicare and medical assistance funds for which clients converted 29.25to SSI are retroactively eligible.29.26(c) The commissioner shall contract with agencies to ensure implementation of 29.27this section. County contracts with providers for residential services shall include the 29.28requirement that providers screen residents who may be eligible for federal benefits and 29.29provide that information to the local agency. The commissioner shall modify the MAXIS 29.30computer system to provide information on clients who have been on general assistance 29.31for two years or longer. The list of clients shall be provided to local services for screening 29.32under this section.30.1(d) Effective for general assistance medical care services rendered on or after 30.2March 1, 2010, to June 30, 2011, any medical collections, payments, or recoveries under 30.3this subdivision shall be deposited in or credited to the account established in section 30.4256D.032.30.5EFFECTIVE DATE.This section is effective March 1, 2010.30.6    Sec. 16. Minnesota Statutes 2008, section 256L.05, subdivision 1b, is amended to read:30.7    Subd. 1b. MinnesotaCare enrollment by county agencies. Beginning September 30.81, 2006, county agencies shall enroll single adults and households with no children 30.9formerly enrolled in general assistance medical care in MinnesotaCare according to 30.10section 
         256D.03, subdivision 3, or 256D.031. County agencies shall perform all duties 30.11necessary to administer the MinnesotaCare program ongoing for these enrollees, including 30.12the redetermination of MinnesotaCare eligibility at renewal.30.13EFFECTIVE DATE.This section is effective March 1, 2010.30.14    Sec. 17. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:30.15    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the 30.16first day of the month following the month in which eligibility is approved and the first 30.17premium payment has been received. As provided in section 
         256B.057, coverage for 30.18newborns is automatic from the date of birth and must be coordinated with other health 30.19coverage. The effective date of coverage for eligible newly adoptive children added to a 30.20family receiving covered health services is the month of placement. The effective date 30.21of coverage for other new members added to the family is the first day of the month 30.22following the month in which the change is reported. All eligibility criteria must be met 30.23by the family at the time the new family member is added. The income of the new family 30.24member is included with the family's gross income and the adjusted premium begins in 30.25the month the new family member is added.30.26(b) The initial premium must be received by the last working day of the month for 30.27coverage to begin the first day of the following month.30.28(c) Benefits are not available until the day following discharge if an enrollee is 30.29hospitalized on the first day of coverage.30.30(d) Notwithstanding any other law to the contrary, benefits under sections 
         256L.01 to 30.31256L.18
          are secondary to a plan of insurance or benefit program under which an eligible 30.32person may have coverage and the commissioner shall use cost avoidance techniques to 30.33ensure coordination of any other health coverage for eligible persons. The commissioner 31.1shall identify eligible persons who may have coverage or benefits under other plans of 31.2insurance or who become eligible for medical assistance.31.3(e) The effective date of coverage for single adults and households with no children 31.4formerly enrolled in general assistance medical care and enrolled in MinnesotaCare 31.5according to section 
         256D.03, subdivision 3, or 256D.031, is the first day of the month 31.6following the last day of general assistance medical care coverage.31.7EFFECTIVE DATE.This section is effective March 1, 2010.31.8    Sec. 18. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:31.9    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 31.10must be renewed every 12 months. The 12-month period begins in the month after the 31.11month the application is approved.31.12    (b) Each new period of eligibility must take into account any changes in 31.13circumstances that impact eligibility and premium amount. An enrollee must provide all 31.14the information needed to redetermine eligibility by the first day of the month that ends 31.15the eligibility period. If there is no change in circumstances, the enrollee may renew 31.16eligibility at designated locations that include community clinics and health care providers' 31.17offices. The designated sites shall forward the renewal forms to the commissioner. The 31.18commissioner may establish criteria and timelines for sites to forward applications to the 31.19commissioner or county agencies. The premium for the new period of eligibility must be 31.20received as provided in section 
         256L.06 in order for eligibility to continue.31.21    (c) For single adults and households with no children formerly enrolled in general 31.22assistance medical care and enrolled in MinnesotaCare according to section 
         256D.03, 31.23subdivision 3
         , or 256D.031, the first period of eligibility begins the month the enrollee 31.24submitted the application or renewal for general assistance medical care.31.25    (d) An enrollee who fails to submit renewal forms and related documentation 31.26necessary for verification of continued eligibility in a timely manner shall remain eligible 31.27for one additional month beyond the end of the current eligibility period before being 31.28disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 31.29additional month.31.30    Sec. 19. Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read:31.31    Subd. 6. Exception for certain adults. Single adults and households with 31.32no children formerly enrolled in general assistance medical care and enrolled in 31.33MinnesotaCare according to section 
         256D.03, subdivision 3, or 256D.031, are eligible 31.34without meeting the requirements of this section until renewal.32.1EFFECTIVE DATE.This section is effective March 1, 2010.32.2    Sec. 20. Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read:32.3    Subd. 4. Exception for transitioned adults. County agencies shall pay premiums 32.4for single adults and households with no children formerly enrolled in general assistance 32.5medical care and enrolled in MinnesotaCare according to section 
         256D.03, subdivision 3, 32.6or 256D.031, until six-month renewal. The county agency has the option of continuing to 32.7pay premiums for these enrollees.32.8EFFECTIVE DATE.This section is effective March 1, 2010.32.9    Sec. 21. Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read:32.10    Subd. 7. Exception for certain adults. Single adults and households with 32.11no children formerly enrolled in general assistance medical care and enrolled in 32.12MinnesotaCare according to section 
         256D.03, subdivision 3, or 256D.031, are exempt 32.13from the requirements of this section until renewal.32.14EFFECTIVE DATE.This section is effective March 1, 2010.32.15    Sec. 22. DRUG REBATE PROGRAM.32.16The commissioner of human services shall continue to administer a drug rebate 32.17program for drugs purchased for persons eligible for the general assistance medical care 32.18program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph 32.19(cc), and 256D.03. The rebate revenues collected under the drug rebate program for 32.20persons eligible for the general assistance medical care program shall be deposited in the 32.21general assistance medical care account in the special revenue fund established under 32.22Minnesota Statutes, section 256D.032. 32.23EFFECTIVE DATE.This section is effective March 1, 2010, and expires June 32.2430, 2011.32.25    Sec. 23. PROVIDER PARTICIPATION.32.26For purposes of Minnesota Statutes, section 256B.0644, the reference to the general 32.27assistance medical care program shall include the temporary general assistance medical 32.28care program established under Minnesota Statutes, section 256D.031. In meeting the 32.29requirements of Minnesota Statutes, section 256B.0644, a provider must accept new 32.30patients regardless of the Minnesota health care program the patient is enrolled in and may 33.1not refuse to accept patients enrolled in one Minnesota health care program and continue 33.2to accept patients enrolled in other Minnesota health care programs.33.3EFFECTIVE DATE.This section is effective March 1, 2010.33.4    Sec. 24. TEMPORARY SUSPENSION.33.5(a) For the period beginning March 1, 2010, to June 30, 2011, the commissioner 33.6of human services shall not implement or administer Minnesota Statutes 2008, section 33.7256D.03, subdivisions 6 and 9; Minnesota Statutes 2009 Supplement, section 256D.03, 33.8subdivision 4; or Minnesota Statutes 2008, section 256B.692; and Minnesota Statutes 33.92009 Supplement, section 256B.69, as they apply to the general assistance medical care 33.10program unless specifically continued in Minnesota Statutes, section 256D.031.33.11(b) Notwithstanding paragraph (a), outpatient prescription drug coverage shall 33.12continue to be provided under Minnesota Statutes, section 256D.03.33.13EFFECTIVE DATE.This section is effective March 1, 2010, and expires July 1, 33.142011.33.15    Sec. 25. COORDINATED CARE DELIVERY ORGANIZATION 33.16DEMONSTRATION PROJECT.33.17The commissioner of human services shall develop, and present to the legislature 33.18by December 15, 2010, a plan to establish a demonstration project to deliver inpatient 33.19hospital, primary care, and specialist services to general assistance medical care enrollees 33.20through coordinated care delivery organizations, beginning January 1, 2012. Each 33.21coordinated care delivery organization must deliver coordinated care through at least one 33.22hospital and one physician group practice, and may include counties and other health care 33.23providers. The coordinated care delivery organization must provide inpatient hospital, 33.24primary care, and specialist services to general assistance medical care enrollees eligible 33.25for the program under Minnesota Statutes, section 256D.03 or 256D.031. The coordinated 33.26care delivery organization must accept responsibility for the quality of care and must 33.27assume financial risk for the services provided. The plan must include:33.28(1) financial incentives for coordinated care delivery organizations to reduce the 33.29growth in the volume and cost of services provided, while maintaining or improving 33.30the quality of care;33.31(2) recommendations for the delivery of services not provided through a coordinated 33.32care delivery organization and coordination of outpatient and inpatient health care services;34.1(3) recommendations as to the size and scope of the demonstration project and 34.2whether participation would be mandatory or voluntary for general assistance medical 34.3care enrollees; and34.4(4) recommendations for managing financial risk within a coordinated care delivery 34.5organization.34.6ARTICLE 234.7APPROPRIATIONS

34.8Section 1. HEALTH AND HUMAN SERVICES APPROPRIATION.

34.9The sums shown in the columns marked "Appropriations" are added to or, if shown 34.10in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, as amended 34.11by Laws 2009, chapter 173, or other law to the agencies and for the purposes specified in 34.12this article. The appropriations are from the general fund, or another named fund, and are 34.13available for the fiscal years indicated for each purpose. The figures "2010" and "2011" 34.14used in this article mean that the addition to or subtraction from appropriations listed under 34.15them are available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively. 34.16"The first year" is fiscal year 2010. "The second year" is fiscal year 2011. "The biennium" 34.17is fiscal years 2010 and 2011. Supplemental appropriations and reductions for the fiscal 34.18year ending June 30, 2010, are effective the day following final enactment.

34.19APPROPRIATIONS34.20Available for the Year34.21Ending June 3034.2220102011

34.23Sec. 2. HUMAN SERVICES

34.24Subdivision 1.Total Appropriation$(88,580,000)$27,041,000

34.25Appropriations by Fund34.262010201134.27General(62,256,000)(34,866,000)34.28Health Care Access(68,568,000)(185,157,000)34.29Special Revenue 42,244,000247,064,000

34.30The amounts that may be spent for each 34.31purpose are specified in the following 34.32subdivisions.

34.3334.34Subd. 2.Children and Economic Assistance Grants-0-(9,939,000)

35.1The general fund appropriation to the 35.2commissioner of human services for children 35.3and community services grants in Laws 35.42009, chapter 79, article 13, section 3, 35.5subdivision 4, as amended by Laws 2009, 35.6chapter 173, article 2, section 1, subdivision 35.74, is reduced by $9,938,000 in fiscal year 35.82011. The general fund base for children 35.9and community service grants is increased 35.10by $9,938,000 per year for fiscal years 2012 35.11and 2013.

35.1235.13Subd. 3.Children and Economic Assistance Management

35.14Children and Economic Assistance Operations

35.15Appropriations by Fund35.16Special Revenue 29,000-0-

35.17Subd. 4.Basic Health Care Grants

35.18The amounts that may be spent from this 35.19appropriation for each purpose are as follows:

35.20(a) MinnesotaCare Grants(68,569,000)(185,157,000)

35.2135.22(b) Medical Assistance Basic Health Care Grants - Families and Children-0-(4,070,000)

35.2335.24(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled-0-(6,470,000)

35.25(d) General Assistance Medical Care Grants

35.26Appropriations by Fund35.27General(60,406,000)-0-35.28Special Revenue40,323,000241,308,000

35.29For general assistance medical care grants 35.30under Minnesota Statutes, section 256D.031. 35.31The commissioner shall transfer $60,406,000 35.32on March 1, 2010, from the general fund to 35.33the fund established in Minnesota Statutes, 35.34section 256D.032. Any unexpended amount 36.1not used for general assistance medical care 36.2expenditures incurred before March 1, 2010, 36.3does not cancel and shall be transferred to 36.4the fund established in Minnesota Statutes, 36.5section 256D.032, by January 1, 2011.

36.6Subd. 5.Health Care Management

36.7The amounts that may be spent from the 36.8appropriation for each purpose are as follows:

36.9(a) Health Care Administration

36.10Appropriations by Fund36.11General(825,000)(2,425,000)36.12Special Revenue825,0002,681,000

36.13$825,000 in fiscal year 2010 and $2,475,000 36.14in fiscal year 2011 from the special revenue 36.15fund are for administration of the general 36.16assistance medical care program under 36.17Minnesota Statutes, section 256D.031. For 36.18purposes of consistent cost allocation and 36.19accounting, the commissioner may transfer 36.20these amounts to the general fund. The 36.21commissioner shall transfer $825,000 in 36.22fiscal year 2010 and $2,475,000 in fiscal 36.23year 2011 from the general fund to the fund 36.24established in Minnesota Statutes, section 36.25256D.032.

36.26(b) Health Care Operations

36.27Appropriations by Fund36.28General(1,025,000)(3,075,000)36.29Special Revenue1,067,0003,075,000

36.30$1,025,000 in fiscal year 2010 and 36.31$3,075,000 in fiscal year 2011 from the 36.32special revenue fund are for operations of 36.33the general assistance medical care program 36.34under Minnesota Statutes, section 256D.031. 36.35For purposes of consistent cost allocation 37.1and accounting, the commissioner may 37.2transfer these amounts to the general fund. 37.3The commissioner shall transfer $1,025,000 37.4in fiscal year 2010 and $3,075,000 in fiscal 37.5year 2011 from the general fund to the fund 37.6established in Minnesota Statutes, section 37.7256D.032.

37.8Subd. 6.Continuing Care Grants

37.9Mental Health Grants-0-(9,938,000)

37.10The general fund appropriation to the 37.11commissioner of human services for adult 37.12mental health grants in Laws 2009, chapter 37.1379, article 13, section 3, subdivision 8, as 37.14amended by Laws 2009, chapter 173, article 37.152, section 1, subdivision 8, is reduced by 37.16$9,939,000 in fiscal year 2011. The general 37.17fund base for adult mental health grants is 37.18increased by $9,939,000 per year in fiscal 37.19years 2012 and 2013.

37.20Subd. 7.Continuing Care Management-0-1,051,000

37.21Subd. 8.Transfers

37.22(a) The commissioner of management and 37.23budget shall transfer $168,733,000 in fiscal 37.24year 2011 and $12,979,000 in fiscal year 37.252012, from the general fund to the fund 37.26established in Minnesota Statutes, section 37.27256D.032.37.28(b) $19,877,000 shall be transferred in 37.29fiscal year 2011 from the general fund to 37.30the general assistance medical care account 37.31established in Minnesota Statutes, section 37.32256D.032.37.33EFFECTIVE DATE.This article is effective March 1, 2010.