HF 153

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health care; modifying premium rate
restrictions; establishing expenditure limits;
modifying cost containment provisions; providing for
an electronic medical record system; modifying certain
loan forgiveness programs; modifying medical
assistance, general assistance medical care, and
MinnesotaCare programs; authorizing the sale of bonds;
requiring reports; appropriating money; amending
Minnesota Statutes 2004, sections 62A.65, subdivision
3; 62J.04, subdivision 3, by adding a subdivision;
62J.041; 62J.301, subdivision 3; 62J.38; 62J.43;
62J.692, subdivision 3; 62L.08, subdivision 8;
144.1501, subdivisions 2, 4; 256.955, subdivisions 2a,
2b, 3, 4, 6; 256.9693; 256B.03, subdivision 3;
256B.061; 256B.0625, subdivisions 3b, 9, 13e, by
adding a subdivision; 256B.0631, by adding a
subdivision; 256B.075, subdivisions 1, 2, 3; 256D.03,
subdivisions 3, 4; 256L.03, subdivision 1; 256L.05,
subdivision 4; 256L.07, subdivision 1; 256L.12,
subdivision 6; Laws 2003, First Special Session
chapter 14, article 6, section 65; proposing coding
for new law in Minnesota Statutes, chapters 62J; 62Q;
256; 256B; 256L; repealing Minnesota Statutes 2004,
sections 256.955, subdivision 4a; 256B.075,
subdivision 5; 256L.035.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2004, section 62A.65,
subdivision 3, is amended to read:

Subd. 3.

Premium rate restrictions.

No individual health
plan may be offered, sold, issued, or renewed to a Minnesota
resident unless the premium rate charged is determined in
accordance with the following requirements:

(a) Premium rates must be no more than 25 percent above and
no more than 25 percent below the index rate charged to
individuals for the same or similar coverage, adjusted pro rata
for rating periods of less than one year. The premium
variations permitted by this paragraph must be based only upon
health status, claims experience, and occupation. For purposes
of this paragraph, health status includes refraining from
tobacco use or other actuarially valid lifestyle factors
associated with good health, provided that the lifestyle factor
and its effect upon premium rates have been determined by the
commissioner to be actuarially valid and have been approved by
the commissioner. Variations permitted under this paragraph
must not be based upon age or applied differently at different
ages. This paragraph does not prohibit use of a constant
percentage adjustment for factors permitted to be used under
this paragraph.

(b) Premium rates may vary based upon the ages of covered
persons only as provided in this paragraph. In addition to the
variation permitted under paragraph (a), each health carrier may
use an additional premium variation based upon age of up to plus
or minus 50 percent of the index rate.

(c) A health carrier may request approval by the
commissioner to establish no more than three geographic regions
and to establish separate index rates for each region, provided
that the index rates do not vary between any two regions by more
than 20 percent. Health carriers that do not do business in the
Minneapolis/St. Paul metropolitan area may request approval for
no more than two geographic regions, and clauses (2) and (3) do
not apply to approval of requests made by those health
carriers. The commissioner may grant approval if the following
conditions are met:

(1) the geographic regions must be applied uniformly by the
health carrier;

(2) one geographic region must be based on the
Minneapolis/St. Paul metropolitan area;

(3) for each geographic region that is rural, the index
rate for that region must not exceed the index rate for the
Minneapolis/St. Paul metropolitan area; and

(4) the health carrier provides actuarial justification
acceptable to the commissioner for the proposed geographic
variations in index rates, establishing that the variations are
based upon differences in the cost to the health carrier of
providing coverage.

(d) Health carriers may use rate cells and must file with
the commissioner the rate cells they use. Rate cells must be
based upon the number of adults or children covered under the
policy and may reflect the availability of Medicare coverage.
The rates for different rate cells must not in any way reflect
generalized differences in expected costs between principal
insureds and their spouses.

(e) In developing its index rates and premiums for a health
plan, a health carrier shall take into account only the
following factors:

(1) actuarially valid differences in rating factors
permitted under paragraphs (a) and (b); and

(2) actuarially valid geographic variations if approved by
the commissioner as provided in paragraph (c).

(f) All premium variations must be justified in initial
rate filings and upon request of the commissioner in rate
revision filings. All rate variations are subject to approval
by the commissioner.

(g) The loss ratio must comply with the section 62A.021
requirements for individual health plans.

(h) new text begin Notwithstanding paragraphs (a) to (g), new text end the rates must
not be approved deleted text begin , deleted text end unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the
commissioner shall deleted text begin consider the growth rates applied under
section 62J.04, subdivision 1, paragraph (b) deleted text end new text begin apply the premium
growth limits established under section 62J.04, subdivision 1b new text end ,
to the calendar year or years that the proposed premium rate
would be in effect, new text begin and shall consider new text end actuarially valid changes
in risks associated with the enrollee populations deleted text begin , deleted text end and
actuarially valid changes as a result of statutory changes in
Laws 1992, chapter 549.

Sec. 2.

Minnesota Statutes 2004, section 62J.04, is
amended by adding a subdivision to read:

new text begin Subd. 1b. new text end

new text begin Premium growth limits. new text end

new text begin (a) For calendar year
2005 and each year thereafter, the commissioner shall set annual
premium growth limits for health plan companies. The premium
limits set by the commissioner for calendar years 2005 to 2010
shall not exceed the regional Consumer Price Index for urban
consumers for the preceding calendar year plus two percentage
points and an additional one percentage point to be used to
finance the implementation of the electronic medical record
system described under section 62J.565. The commissioner shall
ensure that the additional percentage point is being used to
provide financial assistance to health care providers to
implement electronic medical record systems either directly or
through an increase in reimbursement.
new text end

new text begin (b) For the calendar years beyond 2010, the rate of premium
growth shall be limited to the change in the Consumer Price
Index for urban consumers for the previous calendar year plus
two percentage points. The commissioners of health and commerce
shall make a recommendation to the legislature by January 15,
2009, regarding the continuation of the additional percentage
point to the growth limit described in paragraph (a). The
recommendation shall be based on the progress made by health
care providers in instituting an electronic medical record
system and in creating a statewide interactive electronic health
record system.
new text end

new text begin (c) The commissioner may add additional percentage points
as needed to the premium limit for a calendar year if a major
disaster, bioterrorism, or a public health emergency occurs that
results in higher health care costs. Any additional percentage
points must reflect the additional cost to the health care
system directly attributed to the disaster or emergency.
new text end

new text begin (d) The commissioner shall publish the annual premium
growth limits in the State Register by January 31 of the year
that the limits are to be in effect.
new text end

new text begin (e) For the purpose of this subdivision, premium growth is
measured as the percentage change in per member, per month
premium revenue from the current year to the previous year.
Premium growth rates shall be calculated for the following lines
of business: individual, small group, and large group. Data
used for premium growth rate calculations shall be submitted as
part of the cost containment filing under section 62J.38.
new text end

new text begin (f) For purposes of this subdivision, "health plan
company," has the meaning given in section 62J.041.
new text end

new text begin (g) For coverage that is provided by a health plan company
under the terms of a contract with the Department of Employee
Relations, the commissioner of employee relations shall direct
the contracting health plan companies to reduce reimbursement to
providers in order to meet the premium growth limitations
required by this section.
new text end

Sec. 3.

Minnesota Statutes 2004, section 62J.04,
subdivision 3, is amended to read:

Subd. 3.

Cost containment duties.

The commissioner shall:

(1) establish statewide and regional cost containment goals
for total health care spending under this section and collect
data as described in sections 62J.38 to 62J.41 to monitor
statewide achievement of the cost containment goals new text begin and premium
growth limits new text end ;

(2) divide the state into no fewer than four regions, with
one of those regions being the Minneapolis/St. Paul metropolitan
statistical area but excluding Chisago, Isanti, Wright, and
Sherburne Counties, for purposes of fostering the development of
regional health planning and coordination of health care
delivery among regional health care systems and working to
achieve the cost containment goals;

(3) monitor the quality of health care throughout the state
and take action as necessary to ensure an appropriate level of
quality;

(4) issue recommendations regarding uniform billing forms,
uniform electronic billing procedures and data interchanges,
patient identification cards, and other uniform claims and
administrative procedures for health care providers and private
and public sector payers. In developing the recommendations,
the commissioner shall review the work of the work group on
electronic data interchange (WEDI) and the American National
Standards Institute (ANSI) at the national level, and the work
being done at the state and local level. The commissioner may
adopt rules requiring the use of the Uniform Bill 82/92 form,
the National Council of Prescription Drug Providers (NCPDP) 3.2
electronic version, the Centers for Medicare and Medicaid
Services 1500 form, or other standardized forms or procedures;

(5) undertake health planning responsibilities;

(6) authorize, fund, or promote research and
experimentation on new technologies and health care procedures;

(7) within the limits of appropriations for these purposes,
administer or contract for statewide consumer education and
wellness programs that will improve the health of Minnesotans
and increase individual responsibility relating to personal
health and the delivery of health care services, undertake
prevention programs including initiatives to improve birth
outcomes, expand childhood immunization efforts, and provide
start-up grants for worksite wellness programs;

(8) undertake other activities to monitor and oversee the
delivery of health care services in Minnesota with the goal of
improving affordability, quality, and accessibility of health
care for all Minnesotans; and

(9) make the cost containment goal new text begin and premium growth limit
new text end data available to the public in a consumer-oriented manner.

Sec. 4.

Minnesota Statutes 2004, section 62J.041, is
amended to read:

62J.041 deleted text begin INTERIM deleted text end HEALTH PLAN COMPANY deleted text begin COST CONTAINMENT GOALS
deleted text end new text begin HEALTH CARE EXPENDITURE LIMITS new text end .

Subdivision 1.

Definitions.

(a) For purposes of this
section, the following definitions apply.

(b) "Health plan company" has the definition provided in
section 62Q.01 new text begin and also includes employee health plans offered
by self-insured employers new text end .

(c) " deleted text begin Total deleted text end new text begin Health care new text end expenditures" means incurred claims
or expenditures on health care services deleted text begin , administrative
expenses, charitable contributions, and all other payments deleted text end made
by health plan companies deleted text begin out of premium revenues deleted text end .

(d) deleted text begin "Net expenditures" means total expenditures minus
exempted taxes and assessments and payments or allocations made
to establish or maintain reserves.
deleted text end

deleted text begin (e) "Exempted taxes and assessments" means direct payments
for taxes to government agencies, contributions to the Minnesota
Comprehensive Health Association, the medical assistance
provider's surcharge under section 256.9657, the MinnesotaCare
provider tax under section 295.52, assessments by the Health
Coverage Reinsurance Association, assessments by the Minnesota
Life and Health Insurance Guaranty Association, assessments by
the Minnesota Risk Adjustment Association, and any new
assessments imposed by federal or state law.
deleted text end

deleted text begin (f) deleted text end "Consumer cost-sharing or subscriber liability" means
enrollee coinsurance, co-payment, deductible payments, and
amounts in excess of benefit plan maximums.

Subd. 2.

Establishment.

The commissioner of health shall
establish deleted text begin cost containment goals deleted text end new text begin health care expenditure limits
new text end for deleted text begin the increase in net deleted text end new text begin calendar year 2006, and each year
thereafter, for health care new text end expenditures by each health plan
company deleted text begin for calendar years 1994, 1995, 1996, and 1997. The cost
containment goals must be the same as the annual cost
containment goals for health care spending established under
section 62J.04, subdivision 1, paragraph (b) deleted text end . Health plan
companies that are affiliates may elect to meet one
combined deleted text begin cost containment goal deleted text end new text begin health care expenditure limit.
The limits set by the commissioner shall not exceed the premium
limits established in section 62J.04, subdivision 1b new text end .

Subd. 3.

Determination of expenditures.

Health plan
companies shall submit to the commissioner of health, by April
deleted text begin 1, 1994, for calendar year 1993; April 1, 1995, for calendar
year 1994; April 1, 1996, for calendar year 1995; April 1, 1997,
for calendar year 1996; and April 1, 1998, for calendar year
1997 deleted text end new text begin of each year beginning 2006, new text end all information the
commissioner determines to be necessary to implement this
section. The information must be submitted in the form
specified by the commissioner. The information must include,
but is not limited to, new text begin health care new text end expenditures per member per
month or cost per employee per month, and detailed information
on revenues and reserves. The commissioner, to the extent
possible, shall coordinate the submittal of the information
required under this section with the submittal of the financial
data required under chapter 62J, to minimize the administrative
burden on health plan companies. The commissioner may adjust
final expenditure figures for demographic changes, risk
selection, changes in basic benefits, and legislative
initiatives that materially change health care costs, as long as
these adjustments are consistent with the methodology submitted
by the health plan company to the commissioner, and approved by
the commissioner as actuarially justified. deleted text begin The methodology to
be used for adjustments and the election to meet one cost
containment goal for affiliated health plan companies must be
submitted to the commissioner by September 1, 1994. Community
integrated service networks may submit the information with
their application for licensure. The commissioner shall also
accept changes to methodologies already submitted. The
adjustment methodology submitted and approved by the
commissioner must apply to the data submitted for calendar years
1994 and 1995. The commissioner may allow changes to accepted
adjustment methodologies for data submitted for calendar years
1996 and 1997. Changes to the adjustment methodology must be
received by September 1, 1996, and must be approved by the
commissioner.
deleted text end

Subd. 4.

Monitoring of reserves.

(a) The commissioners
of health and commerce shall monitor health plan company
reserves and net worth as established under chapters 60A, 62C,
62D, 62H, and 64B, with respect to the health plan companies
that each commissioner respectively regulates to assess the
degree to which savings resulting from the establishment of cost
containment goals are passed on to consumers in the form of
lower premium rates.

(b) Health plan companies shall fully reflect in the
premium rates the savings generated by the cost containment
goals. No premium rate, currently reviewed by the Department of
Health or Commerce, may be approved for those health plan
companies unless the health plan company establishes to the
satisfaction of the commissioner of commerce or the commissioner
of health, as appropriate, that the proposed new rate would
comply with this paragraph.

(c) Health plan companies, except those licensed under
chapter 60A to sell accident and sickness insurance under
chapter 62A, shall annually before the end of the fourth fiscal
quarter provide to the commissioner of health or commerce, as
applicable, a projection of the level of reserves the company
expects to attain during each quarter of the following fiscal
year. These health plan companies shall submit with required
quarterly financial statements a calculation of the actual
reserve level attained by the company at the end of each quarter
including identification of the sources of any significant
changes in the reserve level and an updated projection of the
level of reserves the health plan company expects to attain by
the end of the fiscal year. In cases where the health plan
company has been given a certificate to operate a new health
maintenance organization under chapter 62D, or been licensed as
a community integrated service network under chapter 62N, or
formed an affiliation with one of these organizations, the
health plan company shall also submit with its quarterly
financial statement, total enrollment at the beginning and end
of the quarter and enrollment changes within each service area
of the new organization. The reserve calculations shall be
maintained by the commissioners as trade secret information,
except to the extent that such information is also required to
be filed by another provision of state law and is not treated as
trade secret information under such other provisions.

(d) Health plan companies in paragraph (c) whose reserves
are less than the required minimum or more than the required
maximum at the end of the fiscal year shall submit a plan of
corrective action to the commissioner of health or commerce
under subdivision 7.

(e) The commissioner of commerce, in consultation with the
commissioner of health, shall report to the legislature no later
than January 15, 1995, as to whether the concept of a reserve
corridor or other mechanism for purposes of monitoring reserves
is adaptable for use with indemnity health insurers that do
business in multiple states and that must comply with their
domiciliary state's reserves requirements.

Subd. 5.

Notice.

The commissioner of health shall
publish in the State Register and make available to the public
by July 1, deleted text begin 1995 deleted text end new text begin 2007 new text end , new text begin and each year thereafter, new text end a list of all
health plan companies that exceeded their deleted text begin cost containment goal
deleted text end new text begin health care expenditure limit new text end for the deleted text begin 1994 deleted text end new text begin previous new text end calendar
year. deleted text begin The commissioner shall publish in the State Register and
make available to the public by July 1, 1996, a list of all
health plan companies that exceeded their combined cost
containment goal for calendar years 1994 and 1995. deleted text end The
commissioner shall notify each health plan company that the
commissioner has determined that the health plan company
exceeded its deleted text begin cost containment goal, deleted text end new text begin health care expenditure
limit new text end at least 30 days before publishing the list, and shall
provide each health plan company deleted text begin with deleted text end ten days to provide an
explanation for exceeding the deleted text begin cost containment goal deleted text end new text begin health care
expenditure limit new text end . The commissioner shall review the
explanation and may change a determination if the commissioner
determines the explanation to be valid.

Subd. 6.

Assistance by the commissioner of commerce.

The
commissioner of commerce shall provide assistance to the
commissioner of health in monitoring health plan companies
regulated by the commissioner of commerce.

Sec. 5.

new text begin [62J.255] HEALTH RISK INFORMATION SHEET.
new text end

new text begin (a) A health plan company shall provide to each enrollee on
an annual basis information on the increased personal health
risks and the additional costs to the health care system due to
obesity and to the use of tobacco.
new text end

new text begin (b) The commissioner, in consultation with the Minnesota
Medical Association, shall develop an information sheet on the
personal health risks of obesity and smoking and on the
additional costs to the health care system due to obesity and
due to smoking. The information sheet shall be posted on the
Minnesota Department of Health's Web site.
new text end

new text begin (c) When providing the information required in paragraph
(a), the health plan company must also provide each enrollee
with information on the best practices care guidelines and
quality of care measurement criteria identified in section
62J.43 as well as the availability of this information on the
department's Web site.
new text end

Sec. 6.

Minnesota Statutes 2004, section 62J.301,
subdivision 3, is amended to read:

Subd. 3.

General duties.

The commissioner shall:

(1) collect and maintain data which enable population-based
monitoring and trending of the access, utilization, quality, and
cost of health care services within Minnesota;

(2) collect and maintain data for the purpose of estimating
total Minnesota health care expenditures and trends;

(3) collect and maintain data for the purposes of setting
cost containment goals new text begin and premium growth limits new text end under section
62J.04, and measuring cost containment goal new text begin and premium growth
limit new text end compliance;

(4) conduct applied research using existing and new data
and promote applications based on existing research;

(5) develop and implement data collection procedures to
ensure a high level of cooperation from health care providers
and health plan companies, as defined in section 62Q.01,
subdivision 4;

(6) work closely with health plan companies and health care
providers to promote improvements in health care efficiency and
effectiveness; and

(7) participate as a partner or sponsor of private sector
initiatives that promote publicly disseminated applied research
on health care delivery, outcomes, costs, quality, and
management.

Sec. 7.

Minnesota Statutes 2004, section 62J.38, is
amended to read:

62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.

(a) The commissioner shall require group purchasers to
submit detailed data on total health care spending for each
calendar year. Group purchasers shall submit data for the 1993
calendar year by April 1, 1994, and each April 1 thereafter
shall submit data for the preceding calendar year.

(b) The commissioner shall require each group purchaser to
submit data on revenue, expenses, and member months, as
applicable. Revenue data must distinguish between premium
revenue and revenue from other sources and must also include
information on the amount of revenue in reserves and changes in
reserves. new text begin Premium revenue data, information on aggregate
enrollment, and data on member months must be broken down to
distinguish between individual market, small group market, and
large group market. Filings under this section for calendar
year 2005 must also include information broken down by
individual market, small group market, and large group market
for calendar year 2004. new text end Expenditure data must distinguish
between costs incurred for patient care and administrative
costs. Patient care and administrative costs must include only
expenses incurred on behalf of health plan members and must not
include the cost of providing health care services for
nonmembers at facilities owned by the group purchaser or
affiliate. Expenditure data must be provided separately for the
following categories and for other categories required by the
commissioner: physician services, dental services, other
professional services, inpatient hospital services, outpatient
hospital services, emergency, pharmacy services and other
nondurable medical goods, mental health, and chemical dependency
services, other expenditures, subscriber liability, and
administrative costs. Administrative costs must include costs
for marketing; advertising; overhead; salaries and benefits of
central office staff who do not provide direct patient care;
underwriting; lobbying; claims processing; provider contracting
and credentialing; detection and prevention of payment for
fraudulent or unjustified requests for reimbursement or
services; clinical quality assurance and other types of medical
care quality improvement efforts; concurrent or prospective
utilization review as defined in section 62M.02; costs incurred
to acquire a hospital, clinic, or health care facility, or the
assets thereof; capital costs incurred on behalf of a hospital
or clinic; lease payments; or any other costs incurred pursuant
to a partnership, joint venture, integration, or affiliation
agreement with a hospital, clinic, or other health care
provider. Capital costs and costs incurred must be recorded
according to standard accounting principles. The reports of
this data must also separately identify expenses for local,
state, and federal taxes, fees, and assessments. The
commissioner may require each group purchaser to submit any
other data, including data in unaggregated form, for the
purposes of developing spending estimates, setting spending
limits, and monitoring actual spending and costs. In addition
to reporting administrative costs incurred to acquire a
hospital, clinic, or health care facility, or the assets
thereof; or any other costs incurred pursuant to a partnership,
joint venture, integration, or affiliation agreement with a
hospital, clinic, or other health care provider; reports
submitted under this section also must include the payments made
during the calendar year for these purposes. The commissioner
shall make public, by group purchaser data collected under this
paragraph in accordance with section 62J.321, subdivision 5.
Workers' compensation insurance plans and automobile insurance
plans are exempt from complying with this paragraph as it
relates to the submission of administrative costs.

(c) The commissioner may collect information on:

(1) premiums, benefit levels, managed care procedures, and
other features of health plan companies;

(2) prices, provider experience, and other information for
services less commonly covered by insurance or for which
patients commonly face significant out-of-pocket expenses; and

(3) information on health care services not provided
through health plan companies, including information on prices,
costs, expenditures, and utilization.

(d) All group purchasers shall provide the required data
using a uniform format and uniform definitions, as prescribed by
the commissioner.

Sec. 8.

Minnesota Statutes 2004, section 62J.43, is
amended to read:

62J.43 BEST PRACTICES AND QUALITY IMPROVEMENT.

(a) To improve quality and reduce health care costs, state
agencies shall encourage the adoption of best practice
guidelines and participation in best practices measurement
activities by physicians, other health care providers, and
health plan companies. The commissioner of health shall
facilitate access to best practice guidelines and quality of
care measurement information to providers, purchasers, and
consumers by:

(1) identifying and promoting local community-based,
physician-designed best practices care across the Minnesota
health care system;

(2) disseminating information available to the commissioner
on adherence to best practices care by physicians and other
health care providers in Minnesota;

(3) educating consumers and purchasers on how to
effectively use this information in choosing their providers and
in making purchasing decisions; and

(4) making best practices and quality care measurement
information available to enrollees and program participants
through the Department of Health's Web site. The commissioner
may convene an advisory committee to ensure that the Web site is
designed to provide user friendly and easy accessibility.

(b) The commissioner of health shall collaborate with a
nonprofit Minnesota quality improvement organization
specializing in best practices and quality of care measurements
to provide best practices criteria and assist in the collection
of the data.

(c) The initial best practices and quality of care
measurement criteria developed shall include asthma, diabetes,
and at least two other preventive health measures. Hypertension
and coronary artery disease shall be included within one year
following availability.

(d) The commissioners of human services and employee
relations deleted text begin may deleted text end new text begin shall new text end use the data to make decisions about
contracts they enter into with health plan companies new text begin and shall
establish payment withholds based on best practices and quality
of care measurements as part of the contracts in effect January
1, 2007. The health plan companies may pass the withholds
through to physicians and other health care providers if the
physician or health care provider fails to follow the best
practices and quality of care measurement criteria identified in
this section. The withholds established by the commissioner of
human services shall be included with the withholds described in
sections 256B.69, subdivision 5a, and 256L.12, subdivision 9.
If a payment withhold is passed through, a provider may not
terminate an existing contract with a health plan company based
solely on this withhold new text end .

(e) This section does not apply if the best practices
guidelines authorize or recommend denial of treatment, food, or
fluids necessary to sustain life on the basis of the patient's
age or expected length of life or the patient's present or
predicted disability, degree of medical dependency, or quality
of life.

(f) The commissioner of health, human services, and
employee relations shall report to the legislature by January
15, 2005, on the status of best practices and quality of care
initiatives, and shall present recommendations to the
legislature on any statutory changes needed to increase the
effectiveness of these initiatives.

deleted text begin (g) This section expires June 30, 2006.
deleted text end

Sec. 9.

new text begin [62J.565] IMPLEMENTATION OF ELECTRONIC MEDICAL
RECORD SYSTEM.
new text end

new text begin (a) By January 1, 2010, all hospitals and health care
providers must have in place an electronic medical record system
within their hospital system or clinical practice setting. The
commissioner may grant exemptions from this requirement if the
commissioner determines that the cost of compliance would place
the provider in financial distress or if the commissioner
determines that appropriate technology is not available or
advantageous to that type of practice. Before an exemption is
granted for financial reasons, the commissioner must ensure that
the provider has explored all possible alliances or partnerships
with other provider groups in the provider's geographical area
to become part of the larger provider group's system.
new text end

new text begin (b) The commissioner shall provide assistance to hospitals
and provider groups in establishing an electronic medical record
system, including, but not limited to, provider education,
facilitation of possible alliances or partnerships among
provider groups for purposes of implementing a system,
identification or establishment of low-interest financing
options for hardware and software, and systems implementation
support.
new text end

new text begin (c) The commissioner of human services shall convene an
advisory committee with representatives of safety-net hospitals,
community health clinics, and other providers who serve
low-income patients to address their specific needs and concerns
regarding the establishment of an electronic medical record
system within their hospital or practice setting. As part of
addressing the specific needs of these providers, the
commissioner shall explore the implementation of an accessible
interactive system created collaboratively by publicly owned
hospitals and clinics. The commissioner shall also explore
financial assistance options, including bonding and federal
grants.
new text end

Sec. 10.

Minnesota Statutes 2004, section 62J.692,
subdivision 3, is amended to read:

Subd. 3.

Application process.

(a) A clinical medical
education program conducted in Minnesota by a teaching
institution to train physicians, doctor of pharmacy
practitioners, dentists, chiropractors, or physician assistants
is eligible for funds under subdivision 4 if the program:

(1) is funded, in part, by patient care revenues;

(2) occurs in patient care settings that face increased
financial pressure as a result of competition with nonteaching
patient care entities; and

(3) emphasizes primary care or specialties that are in
undersupply in Minnesota.

new text begin A clinical medical education program that trains
pediatricians is requested to include in its program curriculum
training in case management and medication management for
children suffering from mental illness to be eligible for funds
under subdivision 4.
new text end

(b) A clinical medical education program for advanced
practice nursing is eligible for funds under subdivision 4 if
the program meets the eligibility requirements in paragraph (a),
clauses (1) to (3), and is sponsored by the University of
Minnesota Academic Health Center, the Mayo Foundation, or
institutions that are part of the Minnesota State Colleges and
Universities system or members of the Minnesota Private College
Council.

(c) Applications must be submitted to the commissioner by a
sponsoring institution on behalf of an eligible clinical medical
education program and must be received by October 31 of each
year for distribution in the following year. An application for
funds must contain the following information:

(1) the official name and address of the sponsoring
institution and the official name and site address of the
clinical medical education programs on whose behalf the
sponsoring institution is applying;

(2) the name, title, and business address of those persons
responsible for administering the funds;

(3) for each clinical medical education program for which
funds are being sought; the type and specialty orientation of
trainees in the program; the name, site address, and medical
assistance provider number of each training site used in the
program; the total number of trainees at each training site; and
the total number of eligible trainee FTEs at each site. Only
those training sites that host 0.5 FTE or more eligible trainees
for a program may be included in the program's application; and

(4) other supporting information the commissioner deems
necessary to determine program eligibility based on the criteria
in paragraphs (a) and (b) and to ensure the equitable
distribution of funds.

(d) An application must include the information specified
in clauses (1) to (3) for each clinical medical education
program on an annual basis for three consecutive years. After
that time, an application must include the information specified
in clauses (1) to (3) in the first year of each biennium:

(1) audited clinical training costs per trainee for each
clinical medical education program when available or estimates
of clinical training costs based on audited financial data;

(2) a description of current sources of funding for
clinical medical education costs, including a description and
dollar amount of all state and federal financial support,
including Medicare direct and indirect payments; and

(3) other revenue received for the purposes of clinical
training.

(e) An applicant that does not provide information
requested by the commissioner shall not be eligible for funds
for the current funding cycle.

Sec. 11.

new text begin [62J.82] ELECTRONIC MEDICAL RECORD SYSTEM LOAN
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner shall
establish and implement a loan program to help physicians or
physician group practices obtain the necessary finances to
install an electronic medical record system.
new text end

new text begin Subd. 2. new text end

new text begin Rules. new text end

new text begin The commissioner may adopt rules to
administer the loan program.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin To be eligible for a loan under
this section, the borrower must:
new text end

new text begin (1) have a signed contract with a vendor;
new text end

new text begin (2) be a physician licensed in this state or a physician
group practice located in this state;
new text end

new text begin (3) provide evidence of financial stability;
new text end

new text begin (4) demonstrate an ability to repay the loan;
new text end

new text begin (5) demonstrate that the borrower has explored possible
alliances or contractual opportunities with other provider
groups located in the same geographical area to become part of
the larger provider group's system; and
new text end

new text begin (6) meet any other requirement the commissioner imposes by
administrative procedure or by rule.
new text end

new text begin Subd. 4. new text end

new text begin Loans. new text end

new text begin (a) The commissioner may make a direct
loan to a provider or provider group who is eligible under
subdivision 3. The total accumulative loan principal must not
exceed $65,000 per loan.
new text end

new text begin (b) The commissioner may prescribe forms and establish an
application process and, notwithstanding section 16A.1283, may
impose a reasonable nonrefundable application fee to cover the
cost of administering the loan program.
new text end

new text begin (c) Loan principal balance outstanding plus all assessed
interest must be repaid no later than 15 years from the date of
the loan.
new text end

Sec. 12.

new text begin [62J.83] ELECTRONIC MEDICAL RECORD SYSTEM LOAN
FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The electronic medical record
system loan fund is established as a special account in the
state treasury. All application fees, loan repayments, and
other revenue received under section 62J.82 must be credited to
the fund.
new text end

new text begin Subd. 2. new text end

new text begin Bond proceeds account. new text end

new text begin An electronic medical
record system revenue bond proceeds account is established in
the electronic medical record system loan fund. The proceeds of
any bonds issued under section 62J.84 must be credited to the
account. Money in the account is appropriated to the
commissioner to make loans under section 62J.82.
new text end

new text begin Subd. 3. new text end

new text begin Debt service account. new text end

new text begin An electronic medical
record system revenue bond debt service account is established
in the electronic medical record system loan fund. There must
be credited to this debt service account in each fiscal year
from the income to the electronic medical record system loan
fund an amount sufficient to increase the balance on hand in the
debt service account on each December 1 to an amount equal to
the full amount of principal and interest to come due on all
outstanding bonds issued under section 62J.84 to and including
the second following July 1. The assets of the account are
pledged to and may only be used to pay principal and interest on
bonds issued under section 62J.84. Money in the debt service
account is appropriated to the commissioner of finance to pay
principal and interest on bonds issued under section 62J.84.
new text end

new text begin Subd. 4. new text end

new text begin Appropriation. new text end

new text begin Money in the electronic medical
record system loan fund not otherwise appropriated is
appropriated to the commissioner to administer the loan program.
new text end

Sec. 13.

new text begin [62J.84] ELECTRONIC MEDICAL RECORD SYSTEM
REVENUE BONDS.
new text end

new text begin Subdivision 1. new text end

new text begin Bonding authority. new text end

new text begin Upon request of the
commissioner, the commissioner of finance may sell and issue
state revenue bonds to make loans under section 62J.82, to
establish a reserve fund or funds, and to pay the cost of
issuance of the bonds.
new text end

new text begin Subd. 2. new text end

new text begin Amount. new text end

new text begin The principal amount of the bonds
issued for the purposes specified in subdivision 1 must not
exceed $5,000,000.
new text end

new text begin Subd. 3. new text end

new text begin Procedure. new text end

new text begin The commissioner may sell and issue
the bonds on the terms and conditions the commissioner
determines to be in the best interests of the state. The bonds
may be sold at public or private sale. The commissioner may
enter any agreements or pledges the commissioner determines
necessary or useful to sell the bonds that are not inconsistent
with sections 62J.82 to 62J.84. Sections 16A.672 to 16A.675
apply to the bonds.
new text end

new text begin Subd. 4. new text end

new text begin Revenue sources. new text end

new text begin The bonds are payable only
from the following sources:
new text end

new text begin (1) loan repayments credited to the electronic medical
record system loan fund;
new text end

new text begin (2) the principal and any investment earnings on the assets
of the debt service account; and
new text end

new text begin (3) other revenues pledged to the payment of the bonds.
new text end

new text begin Subd. 5. new text end

new text begin Refunding bonds. new text end

new text begin The commissioner may issue
bonds to refund outstanding bonds issued under subdivision 1,
including the payment of any redemption premiums on the bonds
and any interest accrued or to accrue to the first redemption
date after delivery of the refunding bonds. The proceeds of the
refunding bonds may, in the discretion of the commissioner, be
applied to the purchases or payment at maturity of the bonds to
be refunded, or the redemption of the outstanding bonds on the
first redemption date after delivery of the refunding bonds and
may, until so used, be placed in escrow to be applied to the
purchase, retirement, or redemption. Refunding bonds issued
under this subdivision must be issued and secured in the manner
provided by the commissioner.
new text end

new text begin Subd. 6. new text end

new text begin Not a general or moral obligation. new text end

new text begin Bonds issued
under this section are not public debt, and the full faith,
credit, and taxing powers of the state are not pledged for their
payment. The bonds may not be paid directly in whole or part
from a tax of statewide application on any class of property,
income, transaction, or privilege. Payment of the bonds is
limited to the revenues explicitly authorized to be pledged
under this section. The state neither makes nor has a moral
obligation to pay the bonds if the pledged revenues and other
legal security for them is insufficient.
new text end

new text begin Subd. 7. new text end

new text begin Trustee. new text end

new text begin The commissioner may contract with and
appoint a trustee for bondholders. The trustee has the powers
and authority vested in it by the commissioner under the bond
and trust indentures.
new text end

new text begin Subd. 8. new text end

new text begin Pledges. new text end

new text begin Any pledge made by the commissioner is
valid and binding from the time the pledge is made. The money
or property pledged and later received by the commissioner is
immediately subject to the lien of the pledge without any
physical delivery of the property or money or further act, and
the lien of any pledge is valid and binding as against all
parties having claims of any kind in tort, contract, or
otherwise against the commissioner, whether or not those parties
have notice of the lien or pledge. Neither the order nor any
other instrument by which a pledge is created need be recorded.
new text end

new text begin Subd. 9. new text end

new text begin Bonds; purchase and cancellation. new text end

new text begin The
commissioner, subject to agreements with bondholders that may
then exist, may, out of any money available for the purpose,
purchase bonds of the commissioner at a price not exceeding:
new text end

new text begin (1) if the bonds are then redeemable, the redemption price
then applicable plus accrued interest to the next interest
payment date thereon; or
new text end

new text begin (2) if the bonds are not redeemable, the redemption price
applicable on the first date after the purchase upon which the
bonds become subject to redemption plus accrued interest to that
date.
new text end

new text begin Subd. 10. new text end

new text begin State pledge against impairment of contracts.
new text end

new text begin The state pledges and agrees with the holders of any bonds that
the state will not limit or alter the rights vested in the
commissioner to fulfill the terms of any agreements made with
the bondholders, or in any way impair the rights and remedies of
the holders until the bonds, together with interest on them,
with interest on any unpaid installments of interest, and all
costs and expenses in connection with any action or proceeding
by or on behalf of the bondholders, are fully met and
discharged. The commissioner may include this pledge and
agreement of the state in any agreement with the holders of
bonds issued under this section.
new text end

Sec. 14.

Minnesota Statutes 2004, section 62L.08,
subdivision 8, is amended to read:

Subd. 8.

Filing requirement.

new text begin (a) new text end No later than July 1,
1993, and each year thereafter, a health carrier that offers,
sells, issues, or renews a health benefit plan for small
employers shall file with the commissioner the index rates and
must demonstrate that all rates shall be within the rating
restrictions defined in this chapter. Such demonstration must
include the allowable range of rates from the index rates and a
description of how the health carrier intends to use demographic
factors including case characteristics in calculating the
premium rates.

new text begin (b) Notwithstanding paragraph (a), new text end the rates shall not be
approved deleted text begin , deleted text end unless the commissioner has determined that the rates
are reasonable. In determining reasonableness, the commissioner
shall deleted text begin consider the growth rates applied under section 62J.04,
subdivision 1, paragraph (b) deleted text end new text begin apply the premium growth limits
established under section 62J.04, subdivision 1b new text end , to the
calendar year or years that the proposed premium rate would be
in effect, new text begin and shall consider new text end actuarially valid changes in risk
associated with the enrollee population, and actuarially valid
changes as a result of statutory changes in Laws 1992, chapter
549. deleted text begin For premium rates proposed to go into effect between July
1, 1993 and December 31, 1993, the pertinent growth rate is the
growth rate applied under section 62J.04, subdivision 1,
paragraph (b), to calendar year 1994.
deleted text end

Sec. 15.

new text begin [62Q.175] COVERAGE EXEMPTIONS.
new text end

new text begin Notwithstanding any law to the contrary, no health plan
company is required to provide coverage for any health care
service included on the list established under section
256B.0625, subdivision 46.
new text end

Sec. 16.

Minnesota Statutes 2004, section 144.1501,
subdivision 2, is amended to read:

Subd. 2.

Creation of account.

new text begin (a) new text end A health professional
education loan forgiveness program account is established. The
commissioner of health shall use money from the account to
establish a loan forgiveness program new text begin :
new text end

new text begin (1) new text end for medical residents agreeing to practice in
designated rural areas or underserved urban communities deleted text begin , deleted text end new text begin or
specializing in the area of pediatric psychiatry;
new text end

new text begin (2) new text end for midlevel practitioners agreeing to practice in
designated rural areas deleted text begin , deleted text end new text begin or to teach for at least 20 hours per
week in the nursing field in a postsecondary program; new text end and

new text begin (3) new text end for nurses who agree to practice in a Minnesota nursing
home or intermediate care facility for persons with mental
retardation or related conditions new text begin or to teach for at least 20
hours per week in the nursing field in a postsecondary program;
and
new text end

new text begin (4) for other health care technicians agreeing to teach for
at least 20 hours per week in their designated field in a
postsecondary program. The commissioner, in consultation with
the Healthcare Education-Industry Partnership, shall determine
the health care fields where the need is the greatest,
including, but not limited to, respiratory therapy, clinical
laboratory technology, radiologic technology, and surgical
technology new text end .

new text begin (b) new text end Appropriations made to the account do not cancel and
are available until expended, except that at the end of each
biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing
commitments shall cancel to the fund.

Sec. 17.

Minnesota Statutes 2004, section 144.1501,
subdivision 4, is amended to read:

Subd. 4.

Loan forgiveness.

The commissioner of health
may select applicants each year for participation in the loan
forgiveness program, within the limits of available funding. The
commissioner shall distribute available funds for loan
forgiveness proportionally among the eligible professions
according to the vacancy rate for each profession in the
required geographic area deleted text begin or deleted text end new text begin , new text end facility type new text begin , or teaching area
new text end specified in subdivision 2. The commissioner shall allocate
funds for physician loan forgiveness so that deleted text begin 75 deleted text end new text begin 50 new text end percent of
the funds available are used for rural physician loan
forgiveness deleted text begin and deleted text end new text begin , new text end 25 percent of the funds available are used for
underserved urban communities loan forgiveness new text begin , and 25 percent
of the funds available are used for pediatric psychiatry loan
forgiveness new text end . If the commissioner does not receive enough
qualified applicants each year to use the entire allocation of
funds for urban underserved communities, the remaining funds may
be allocated for rural physician loan forgiveness. Applicants
are responsible for securing their own qualified educational
loans. The commissioner shall select participants based on
their suitability for practice serving the required geographic
area deleted text begin or deleted text end new text begin , new text end facility type new text begin , or specialty area new text end specified in
subdivision 2, as indicated by experience or training. The
commissioner shall give preference to applicants closest to
completing their training. For each year that a participant
meets the service obligation required under subdivision 3, up to
a maximum of four years, the commissioner shall make annual
disbursements directly to the participant equivalent to 15
percent of the average educational debt for indebted graduates
in their profession in the year closest to the applicant's
selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
Before receiving loan repayment disbursements and as requested,
the participant must complete and return to the commissioner an
affidavit of practice form provided by the commissioner
verifying that the participant is practicing as required under
subdivisions 2 and 3. The participant must provide the
commissioner with verification that the full amount of loan
repayment disbursement received by the participant has been
applied toward the designated loans. After each disbursement,
verification must be received by the commissioner and approved
before the next loan repayment disbursement is made.
Participants who move their practice remain eligible for loan
repayment as long as they practice as required under subdivision
2.

Sec. 18.

new text begin [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; administration. new text end

new text begin The
commissioner shall establish and administer the prescription
drug discount program, effective July 1, 2005.
new text end

new text begin Subd. 2. new text end [COMMISSIONER'S AUTHORITY.] new text begin The commissioner
shall administer a drug rebate program for drugs purchased
according to the prescription drug discount program. The
commissioner shall require a rebate agreement from all
manufacturers of covered drugs as defined in section 256B.0625,
subdivision 13. For each drug, the amount of the rebate shall
be equal to the rebate as defined for purposes of the federal
rebate program in United States Code, title 42, section
1396r-8. The rebate program shall utilize the terms and
conditions used for the federal rebate program established
according to section 1927 of title XIX of the federal Social
Security Act.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For the purpose of this section,
the following terms have the meanings given them.
new text end

new text begin (a) "Commissioner" means the commissioner of human services.
new text end

new text begin (b) "Manufacturer" means a manufacturer as defined in
section 151.44, paragraph (c).
new text end

new text begin (c) "Covered prescription drug" means a prescription drug
as defined in section 151.44, paragraph (d), that is covered
under medical assistance as described in section 256B.0625,
subdivision 13, and that is provided by a manufacturer that has
a fully executed rebate agreement with the commissioner under
this section and complies with that agreement.
new text end

new text begin (d) "Health carrier" means an insurance company licensed
under chapter 60A to offer, sell, or issue an individual or
group policy of accident and sickness insurance as defined in
section 62A.01; a nonprofit health service plan corporation
operating under chapter 62C; a health maintenance organization
operating under chapter 62D; a joint self-insurance employee
health plan operating under chapter 62H; a community integrated
systems network licensed under chapter 62N; a fraternal benefit
society operating under chapter 64B; a city, county, school
district, or other political subdivision providing self-insured
health coverage under section 471.617 or sections 471.98 to
471.982; and a self-funded health plan under the Employee
Retirement Income Security Act of 1974, as amended.
new text end

new text begin (e) "Participating pharmacy" means a pharmacy as defined in
section 151.01, subdivision 2, that agrees to participate in the
prescription drug discount program.
new text end

new text begin (f) "Enrolled individual" means a person who is eligible
for the program under subdivision 4 and has enrolled in the
program according to subdivision 5.
new text end

new text begin Subd. 4. new text end

new text begin Eligible persons. new text end

new text begin To be eligible for the
program, an applicant must:
new text end

new text begin (1) be a permanent resident of Minnesota as defined in
section 256L.09, subdivision 4;
new text end

new text begin (2) not be enrolled in Medicare, medical assistance,
general assistance medical care, MinnesotaCare, or the
prescription drug program under section 256.955;
new text end

new text begin (3) not be enrolled in and have currently available
prescription drug coverage under a health plan offered by a
health carrier or employer or under a pharmacy benefit program
offered by a pharmaceutical manufacturer; and
new text end

new text begin (4) not be enrolled in and have currently available
prescription drug coverage under a Medicare supplement plan, as
defined in sections 62A.31 to 62A.44, or policies, contracts, or
certificates that supplement Medicare issued by health
maintenance organizations or those policies, contracts, or
certificates governed by section 1833 or 1876 of the federal
Social Security Act, United States Code, title 42, section 1395,
et seq., as amended.
new text end

new text begin Subd. 5. new text end

new text begin Application procedure. new text end

new text begin (a) Applications and
information on the program must be made available at county
social services agencies, health care provider offices, and
agencies and organizations serving senior citizens. Individuals
shall submit applications and any information specified by the
commissioner as being necessary to verify eligibility directly
to the commissioner. The commissioner shall determine an
applicant's eligibility for the program within 30 days from the
date the application is received. Upon notice of approval, the
applicant must submit to the commissioner the enrollment fee
specified in subdivision 10. Eligibility begins the month after
the enrollment fee is received by the commissioner.
new text end

new text begin (b) An enrollee's eligibility must be renewed every 12
months with the 12-month period beginning in the month after the
application is approved.
new text end

new text begin (c) The commissioner shall develop an application form that
does not exceed one page in length and requires information
necessary to determine eligibility for the program.
new text end

new text begin Subd. 6. new text end

new text begin Participating pharmacy. new text end

new text begin According to a valid
prescription, a participating pharmacy must sell a covered
prescription drug to an enrolled individual at the pharmacy's
usual and customary retail price, minus an amount that is equal
to the rebate amount described in subdivision 8, plus the amount
of any switch fee established by the commissioner under
subdivision 10. Each participating pharmacy shall provide the
commissioner with all information necessary to administer the
program, including, but not limited to, information on
prescription drug sales to enrolled individuals and usual and
customary retail prices.
new text end

new text begin Subd. 7. new text end

new text begin Notification of rebate amount. new text end

new text begin The commissioner
shall notify each drug manufacturer, each calendar quarter or
according to a schedule to be established by the commissioner,
of the amount of the rebate owed on the prescription drugs sold
by participating pharmacies to enrolled individuals.
new text end

new text begin Subd. 8. new text end

new text begin Provision of rebate. new text end

new text begin To the extent that a
manufacturer's prescription drugs are prescribed to a resident
of this state, the manufacturer must provide a rebate equal to
the rebate provided under the medical assistance program for any
prescription drug distributed by the manufacturer that is
purchased by an enrolled individual at a participating
pharmacy. The manufacturer must provide full payment within 30
days of receipt of the state invoice for the rebate, or
according to a schedule to be established by the commissioner.
The commissioner shall deposit all rebates received into the
Minnesota prescription drug dedicated fund established under
subdivision 11. The manufacturer must provide the commissioner
with any information necessary to verify the rebate determined
per drug.
new text end

new text begin Subd. 9. new text end

new text begin Payment to pharmacies. new text end

new text begin The commissioner shall
distribute on a biweekly basis an amount that is equal to an
amount collected under subdivision 8 to each participating
pharmacy based on the prescription drugs sold by that pharmacy
to enrolled individuals.
new text end

new text begin Subd. 10. new text end

new text begin Enrollment fee; switch fee. new text end

new text begin (a) The
commissioner shall establish an annual enrollment fee that
covers the commissioner's expenses for enrollment, processing
claims, and distributing rebates under this program.
new text end

new text begin (b) The commissioner shall establish a reasonable switch
fee that covers expenses incurred by pharmacies in formatting
for electronic submission claims for prescription drugs sold to
enrolled individuals.
new text end

new text begin Subd. 11. new text end

new text begin Dedicated fund; creation; use of fund. new text end

new text begin (a) The
Minnesota prescription drug dedicated fund is established as an
account in the state treasury. The commissioner of finance
shall credit to the dedicated fund all rebates paid under
subdivision 8, any federal funds received for the program, all
enrollment fees paid by the enrollees, and any appropriations or
allocations designated for the fund. The commissioner of
finance shall ensure that fund money is invested under section
11A.25. All money earned by the fund must be credited to the
fund. The fund shall earn a proportionate share of the total
state annual investment income.
new text end

new text begin (b) Money in the fund is appropriated to the commissioner
to reimburse participating pharmacies for prescription drug
discounts provided to enrolled individuals under this section;
to reimburse the commissioner for costs related to enrollment,
processing claims, and distributing rebates and for other
reasonable administrative costs related to administration of the
prescription drug discount program; and to repay the
appropriation provided for this section. The commissioner must
administer the program so that the costs total no more than
funds appropriated plus the drug rebate proceeds.
new text end

Sec. 19.

Minnesota Statutes 2004, section 256.955,
subdivision 2a, is amended to read:

Subd. 2a.

Eligibility.

An individual satisfying the
following requirements and the requirements described in
subdivision 2, paragraph (d), is eligible for the prescription
drug program:

(1) is at least 65 years of age or older; deleted text begin and
deleted text end

(2) is eligible as a qualified Medicare beneficiary
according to section 256B.057, subdivision 3 or 3a, or is
eligible under section 256B.057, subdivision 3 or 3a, and is
also eligible for medical assistance with a spenddown as defined
in section 256B.056, subdivision 5 new text begin ; and
new text end

new text begin (3) applies for the Medicare-endorsed drug discount card
and for transitional assistance, if eligible new text end .

Sec. 20.

Minnesota Statutes 2004, section 256.955,
subdivision 2b, is amended to read:

Subd. 2b.

Eligibility.

Effective July 1, 2002, an
individual satisfying the following requirements and the
requirements described in subdivision 2, paragraph (d), is
eligible for the prescription drug program:

(1) is under 65 years of age; deleted text begin and
deleted text end

(2) is eligible as a qualified Medicare beneficiary
according to section 256B.057, subdivision 3 or 3a or is
eligible under section 256B.057, subdivision 3 or 3a and is also
eligible for medical assistance with a spenddown as defined in
section 256B.056, subdivision 5 new text begin ; and
new text end

new text begin (3) applies for the Medicare-endorsed drug discount card
and for transitional assistance, if eligible new text end .

Sec. 21.

Minnesota Statutes 2004, section 256.955,
subdivision 3, is amended to read:

Subd. 3.

Prescription drug coverage.

Coverage under the
program shall be limited to those prescription drugs that:

(1) are covered under the medical assistance program as
described in section 256B.0625, subdivision 13;

(2) are provided by manufacturers that have fully executed
deleted text begin senior deleted text end new text begin prescription new text end drug new text begin program new text end rebate agreements with the
commissioner and comply with such agreements; and

(3) for a specific enrollee, are not covered under deleted text begin an
assistance program offered by a pharmaceutical manufacturer, as
determined by the board on aging under section 256.975,
subdivision 9, except that this shall not apply to qualified
individuals under this section who are also eligible for medical
assistance with a spenddown as described in subdivisions 2a,
clause (2), and 2b, clause (2). deleted text end new text begin a Medicare-endorsed drug
discount card transitional assistance unless:
new text end

new text begin (i) the prescription drug is not included in the
Medicare-endorsed discount card plan formulary but is covered
under the prescription drug program;
new text end

new text begin (ii) the cost of a prescription drug is more than the
remaining Medicare-endorsed drug discount card transitional
assistance; or
new text end

new text begin (iii) a prescribed over-the-counter medication is not
included in the Medicare-endorsed drug discount card plan
formulary but is covered under the prescription drug program.
new text end

Sec. 22.

Minnesota Statutes 2004, section 256.955,
subdivision 4, is amended to read:

Subd. 4.

Application procedures and coordination with
medical assistance new text begin and medicare-endorsed drug discount card new text end .

new text begin (a) new text end Applications and information on the program must be
made available at county social service agencies, health care
provider offices, and agencies and organizations serving senior
citizens and persons with disabilities. Individuals shall
submit applications and any information specified by the
commissioner as being necessary to verify eligibility directly
to the county social service agencies:

(1) beginning January 1, 1999, the county social service
agency shall determine medical assistance spenddown eligibility
of individuals who qualify for the prescription drug program;
and

(2) program payments will be used to reduce the spenddown
obligations of individuals who are determined to be eligible for
medical assistance with a spenddown as defined in section
256B.056, subdivision 5.

new text begin (b) new text end Qualified individuals who are eligible for medical
assistance with a spenddown shall be financially responsible for
the deductible amount up to the satisfaction of the spenddown.
No deductible applies once the spenddown has been met. Payments
to providers for prescription drugs for persons eligible under
this subdivision shall be reduced by the deductible.

new text begin (c) new text end County social service agencies shall determine an
applicant's eligibility for the program within 30 days from the
date the application is received. Eligibility begins the month
after approval.

new text begin (d) Enrollees who are also enrolled in the
Medicare-endorsed drug discount card plan and for transitional
assistance must obtain prescription drugs at a pharmacy enrolled
as a provider for both the Medicare-endorsed drug discount plan
and the prescription drug program.
new text end

Sec. 23.

Minnesota Statutes 2004, section 256.955,
subdivision 6, is amended to read:

Subd. 6.

Pharmacy reimbursement.

The commissioner shall
reimburse participating pharmacies for drug and dispensing costs
at the medical assistance reimbursement level, minus the
deductible required under subdivision 7. new text begin The commissioner shall
not reimburse enrolled pharmacies until the Medicare-endorsed
drug discount card transitional assistance has been exhausted,
unless the exceptions in subdivision 3, clause (3), are met.
new text end

Sec. 24.

Minnesota Statutes 2004, section 256.9693, is
amended to read:

256.9693 CONTINUING CARE PROGRAM FOR PERSONS WITH MENTAL
ILLNESS.

The commissioner shall establish a continuing care benefit
program for persons with mental illness in which persons with
mental illness may obtain acute care hospital inpatient
treatment for mental illness for up to 45 days beyond that
allowed by section 256.969. Persons with mental illness who are
eligible for medical assistance new text begin or general assistance medical
care new text end may obtain inpatient treatment under this program in
hospital beds for which the commissioner contracts under this
section. The commissioner may selectively contract with
hospitals to provide this benefit through competitive bidding
when reasonable geographic access by recipients can be assured.
Payments under this section shall not affect payments under
section 256.969. The commissioner may contract externally with
a utilization review organization to authorize persons with
mental illness to access the continuing care benefit program.
The commissioner, as part of the contracts with hospitals, shall
establish admission criteria to allow persons with mental
illness to access the continuing care benefit program. If a
court orders acute care hospital inpatient treatment for mental
illness for a person, the person may obtain the treatment under
the continuing care benefit program. The commissioner shall not
require, as part of the admission criteria, any commitment or
petition under chapter 253B as a condition of accessing the
program. This benefit is not available for people who are also
eligible for Medicare and who have not exhausted their annual or
lifetime inpatient psychiatric benefit under Medicare. If a
recipient is enrolled in a prepaid plan, this program is
included in the plan's coverage.

Sec. 25.

Minnesota Statutes 2004, section 256B.03,
subdivision 3, is amended to read:

Subd. 3.

Tribal purchasing model.

(a) Notwithstanding
subdivision 1 and sections 256B.0625 and 256D.03, subdivision 4,
paragraph deleted text begin (i) deleted text end new text begin (h) new text end , the commissioner may make payments to
federally recognized Indian tribes with a reservation in the
state to provide medical assistance and general assistance
medical care to Indians, as defined under federal law, who
reside on or near the reservation. The payments may be made in
the form of a block grant or other payment mechanism determined
in consultation with the tribe. Any alternative payment
mechanism agreed upon by the tribes and the commissioner under
this subdivision is not dependent upon county or health plan
agreement but is intended to create a direct payment mechanism
between the state and the tribe for the administration of the
medical assistance and general assistance medical care programs,
and for covered services.

(b) A tribe that implements a purchasing model under this
subdivision shall report to the commissioner at least annually
on the operation of the model. The commissioner and the tribe
shall cooperatively determine the data elements, format, and
timetable for the report.

(c) For purposes of this subdivision, "Indian tribe" means
a tribe, band, or nation, or other organized group or community
of Indians that is recognized as eligible for the special
programs and services provided by the United States to Indians
because of their status as Indians and for which a reservation
exists as is consistent with Public Law 100-485, as amended.

(d) Payments under this subdivision may not result in an
increase in expenditures that would not otherwise occur in the
medical assistance program under this chapter or the general
assistance medical care program under chapter 256D.

Sec. 26.

Minnesota Statutes 2004, section 256B.061, is
amended to read:

256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.

new text begin (a) new text end If any individual has been determined to be eligible
for medical assistance, it will be made available for care and
services included under the plan and furnished in or after the
third month before the month in which the individual made
application for such assistance, if such individual was, or upon
application would have been, eligible for medical assistance at
the time the care and services were furnished. The commissioner
may limit, restrict, or suspend the eligibility of an individual
for up to one year upon that individual's conviction of a
criminal offense related to application for or receipt of
medical assistance benefits.

new text begin (b) On the basis of information provided on the completed
application, an applicant who meets the following criteria shall
be determined eligible beginning in the month of application:
new text end

new text begin (1) has gross income less than 90 percent of the applicable
income standard;
new text end

new text begin (2) has total liquid assets less than 90 percent of the
asset limit;
new text end

new text begin (3) does not reside in a long-term care facility; and
new text end

new text begin (4) meets all other eligibility requirements.
new text end

new text begin The applicant must provide all required verifications within 30
days' notice of the eligibility determination or eligibility
shall be terminated.
new text end

Sec. 27.

Minnesota Statutes 2004, section 256B.0625,
subdivision 3b, is amended to read:

Subd. 3b.

Telemedicine consultations.

Medical assistance
covers telemedicine consultations. Telemedicine consultations
must be made via two-way, interactive video or store-and-forward
technology. Store-and-forward technology includes telemedicine
consultations that do not occur in real time via synchronous
transmissions, and that do not require a face-to-face encounter
with the patient for all or any part of any such telemedicine
consultation. The patient record must include a written opinion
from the consulting physician providing the telemedicine
consultation. A communication between two physicians that
consists solely of a telephone conversation is not a
telemedicine consultation new text begin , unless the communication is between a
pediatrician and psychiatrist for the purpose of managing the
medications of a child with mental health needs new text end . Coverage is
limited to three telemedicine consultations per recipient per
calendar week. Telemedicine consultations shall be paid at the
full allowable rate.

Sec. 28.

Minnesota Statutes 2004, section 256B.0625,
subdivision 9, is amended to read:

Subd. 9.

Dental services.

deleted text begin (a) deleted text end Medical assistance covers
dental services. Dental services include, with prior
authorization, fixed bridges that are cost-effective for persons
who cannot use removable dentures because of their medical
condition.

deleted text begin (b) Coverage of dental services for adults age 21 and over
who are not pregnant is subject to a $500 annual benefit limit
and covered services are limited to:
deleted text end

deleted text begin (1) diagnostic and preventative services;
deleted text end

deleted text begin (2) restorative services; and
deleted text end

deleted text begin (3) emergency services.
deleted text end

deleted text begin Emergency services, dentures, and extractions related to
dentures are not included in the $500 annual benefit limit.
deleted text end

Sec. 29.

Minnesota Statutes 2004, section 256B.0625,
subdivision 13e, is amended to read:

Subd. 13e.

Payment rates.

(a) The basis for determining
the amount of payment shall be the lower of the actual
acquisition costs of the drugs plus a fixed dispensing fee; the
maximum allowable cost set by the federal government or by the
commissioner plus the fixed dispensing fee; or the usual and
customary price charged to the public. The amount of payment
basis must be reduced to reflect all discount amounts applied to
the charge by any provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net
submitted charge may not be greater than the patient liability
for the service. The pharmacy dispensing fee shall be $3.65,
except that the dispensing fee for intravenous solutions which
must be compounded by the pharmacist shall be $8 per bag, $14
per bag for cancer chemotherapy products, and $30 per bag for
total parenteral nutritional products dispensed in one liter
quantities, or $44 per bag for total parenteral nutritional
products dispensed in quantities greater than one liter. Actual
acquisition cost includes quantity and other special discounts
except time and cash discounts. The actual acquisition cost of
a drug shall be estimated by the commissioner, at average
wholesale price minus 11.5 percent, except that where a drug has
had its wholesale price reduced as a result of the actions of
the National Association of Medicaid Fraud Control Units, the
estimated actual acquisition cost shall be the reduced average
wholesale price, without the 11.5 percent deduction. new text begin The actual
acquisition cost of antihemophilic factor drugs shall be
estimated at the average wholesale price minus 30 percent. new text end The
maximum allowable cost of a multisource drug may be set by the
commissioner and it shall be comparable to, but no higher than,
the maximum amount paid by other third-party payors in this
state who have maximum allowable cost programs. Establishment
of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.

(b) An additional dispensing fee of $.30 may be added to
the dispensing fee paid to pharmacists for legend drug
prescriptions dispensed to residents of long-term care
facilities when a unit dose blister card system, approved by the
department, is used. Under this type of dispensing system, the
pharmacist must dispense a 30-day supply of drug. The National
Drug Code (NDC) from the drug container used to fill the blister
card must be identified on the claim to the department. The
unit dose blister card containing the drug must meet the
packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the
pharmacy for reuse. The pharmacy provider will be required to
credit the department for the actual acquisition cost of all
unused drugs that are eligible for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened
package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a generically equivalent product is available,
payment shall be on the basis of the actual acquisition cost of
the generic drug, or on the maximum allowable cost established
by the commissioner.

(d) The basis for determining the amount of payment for
drugs administered in an outpatient setting shall be the lower
of the usual and customary cost submitted by the provider, the
average wholesale price minus five percent, or the maximum
allowable cost set by the federal government under United States
Code, title 42, chapter 7, section 1396r-8(e), and Code of
Federal Regulations, title 42, section 447.332, or by the
commissioner under paragraphs (a) to (c).

Sec. 30.

Minnesota Statutes 2004, section 256B.0625, is
amended by adding a subdivision to read:

new text begin Subd. 46. new text end

new text begin List of health care services not eligible for
coverage. new text end

new text begin (a) The commissioner of human services, in
consultation with the commissioner of health, shall biennially
establish a list of diagnosis/treatment pairings that are not
eligible for reimbursement under this chapter and chapters 256D
and 256L, effective for services provided on or after July 1,
2007. The commissioner shall review the list in effect for the
prior biennium and shall make any additions or deletions from
the list as appropriate, taking into consideration the following:
new text end

new text begin (1) scientific and medical information;
new text end

new text begin (2) clinical assessment;
new text end

new text begin (3) cost-effectiveness of treatment;
new text end

new text begin (4) prevention of future costs; and
new text end

new text begin (5) medical ineffectiveness.
new text end

new text begin (b) The commissioner may appoint an ad hoc advisory panel
made up of physicians, consumers, nurses, dentists,
chiropractors, and other experts to assist the commissioner in
reviewing and establishing the list. The commissioner shall
solicit comments and recommendations from any interested persons
and organizations and shall schedule at least one public hearing.
new text end

new text begin (c) The list must be established by January 15, 2007, for
the list effective July 1, 2007, and by October 1 of the
even-numbered years beginning October 1, 2008, for the lists
effective the following July 1. The commissioner shall publish
the list in the State Register by November 1 of the
even-numbered years beginning November 1, 2008. The list shall
be submitted to the legislature by January 15 of the
odd-numbered years beginning January 15, 2007.
new text end

Sec. 31.

Minnesota Statutes 2004, section 256B.0631, is
amended by adding a subdivision to read:

new text begin Subd. 5. new text end

new text begin Healthy lifestyle waiver. new text end

new text begin The co-payments
described in subdivision 1 shall be waived by the provider if
the recipient is practicing a healthy lifestyle by refraining
from tobacco use or is participating in a smoking cessation
program. To obtain the waiver, the recipient must sign a
statement stating that the recipient does not use tobacco
products or is currently participating in a smoking cessation
program. The provider shall keep the signed statement on file.
new text end

Sec. 32.

Minnesota Statutes 2004, section 256B.075,
subdivision 1, is amended to read:

Subdivision 1.

General.

The commissioner shall implement
disease management new text begin and care coordination new text end initiatives that seek
to improve patient care and health outcomes and reduce health
care costs by managing the care provided to recipients with
chronic conditions.

Sec. 33.

Minnesota Statutes 2004, section 256B.075,
subdivision 2, is amended to read:

Subd. 2.

Fee-for-service.

(a) The commissioner shall
develop and implement a disease management program for medical
assistance and general assistance medical care recipients who
are not enrolled in the prepaid medical assistance or prepaid
general assistance medical care programs and who are receiving
services on a fee-for-service basis. The commissioner may
contract with an outside organization to provide these services.

(b) new text begin The commissioner shall identify recipients with special
health care diagnosis through the use of data analysis software
designed to identify persons most likely to need extended or
costly health care in the immediate future. Based on this
identification system, the commissioner shall establish a list
of care coordinators and primary care providers who are
qualified to act as a care manager to coordinate the care of the
patient.
new text end

new text begin (c) The commissioner shall request the identified
recipients to choose a care coordinator or primary care provider
from the list established in paragraph (b). The care
coordinator or primary care provider shall be responsible for:
new text end

new text begin (1) establishing a care team that must include a pharmacist
and any health care provider necessary to treat the specific
conditions of the identified recipient;
new text end

new text begin (2) performing an initial assessment and developing an
individualized care plan with input from the patient;
new text end

new text begin (3) educating the patient in self-management and the
importance of adhering to the care plan;
new text end

new text begin (4) providing problem follow-up and new assessments, as
needed; and
new text end

new text begin (5) adhering to evidence-based best practices care
strategies.
new text end

new text begin (d) The care coordinator or primary care provider may
create incentives for a recipient to ensure cooperation and
patient engagement in the care plan and management.
new text end

new text begin (e) The recipient shall be required to seek health care
services related to a specific diagnosis identified in paragraph
(b) from the care coordinator or primary care provider or from
the providers on the recipient's care team.
new text end

new text begin (f) The commissioner shall set a cost-savings target of ten
percent reduction in inpatient hospitalization and emergency
room costs for fiscal year 2006. Based on the achievement of
this goal, one-half of the savings shall be used as a bonus to
the participating primary care providers for the following
fiscal year. The bonus shall be paid on a quarterly basis and
shall be based on the percentage of patients treated by the
provider who have been identified by the commissioner in
accordance with this subdivision.
new text end

new text begin (g) new text end The commissioner shall seek any federal approval
necessary to implement this section and to obtain federal
matching funds.

Sec. 34.

Minnesota Statutes 2004, section 256B.075,
subdivision 3, is amended to read:

Subd. 3.

Prepaid managed care programs.

new text begin (a) new text end For the
prepaid medical assistance, prepaid general assistance medical
care, and MinnesotaCare programs, the commissioner shall ensure
that contracting health plans implement disease management
programs that are appropriate for Minnesota health care program
recipients and have been designed by the health plan to improve
patient care and health outcomes and reduce health care costs by
managing the care provided to recipients with chronic conditions.

new text begin (b) The commissioner shall require all managed care plans
entering into contracts under section 256B.69 to develop and
implement at least three disease management programs that will
improve patient care and health outcomes for those enrollees who
are at risk of or diagnosed with a chronic condition.
new text end

new text begin (c) The commissioner shall require the managed care plans
to measure and report outcomes according to measurements
approved by the commissioner. In determining outcome
measurements, the commissioner shall establish a baseline
indicating the prevalence of each disease identified in
paragraph (b) in the general population and within identified
racial or ethnic groups. The managed care plan must report the
number of enrollees who are at risk based on the baseline
measurement; the number of enrollees who have been diagnosed
with the disease; and the number of enrollees participating in
the managed care plan's disease management program.
new text end

new text begin (d) The commissioner shall establish targets based on the
number of enrollees who should be receiving disease management
services as determined by the prevalence of the disease within
the general population and the number of enrollees who are
receiving disease management services. The targets must also
include a specified reduction in inpatient hospitalization costs
and in the progression of the chronic diseases for the enrollees
identified as being at risk of or diagnosed with a chronic
condition.
new text end

Sec. 35.

new text begin [256B.0918] EMPLOYEE SCHOLARSHIP COSTS AND
TRAINING IN ENGLISH AS A SECOND LANGUAGE.
new text end

new text begin (a) For the fiscal year beginning July 1, 2005, the
commissioner shall provide to each provider listed in paragraph
(c) a scholarship reimbursement increase of two-tenths percent
of the reimbursement rate for that provider to be used:
new text end

new text begin (1) for employee scholarships that satisfy the following
requirements:
new text end

new text begin (i) scholarships are available to all employees who work an
average of at least 20 hours per week for the provider, except
administrators, department supervisors, and registered nurses;
and
new text end

new text begin (ii) the course of study is expected to lead to career
advancement with the provider or in long-term care, including
home care or care of persons with disabilities, including
medical care interpreter services and social work; and
new text end

new text begin (2) to provide job-related training in English as a second
language.
new text end

new text begin (b) A provider receiving a rate adjustment under this
subdivision with an annualized value of at least $1,000 shall
maintain documentation to be submitted to the commissioner on a
schedule determined by the commissioner and on a form supplied
by the commissioner of the scholarship rate increase received,
including:
new text end

new text begin (1) the amount received from this reimbursement increase;
new text end

new text begin (2) the amount used for training in English as a second
language;
new text end

new text begin (3) the number of persons receiving the training;
new text end

new text begin (4) the name of the person or entity providing the
training; and
new text end

new text begin (5) for each scholarship recipient, the name of the
recipient, the amount awarded, the educational institution
attended, the nature of the educational program, the program
completion date, and a determination of the amount spent as a
percentage of the provider's reimbursement.
new text end

new text begin The commissioner shall report to the legislature annually,
beginning January 15, 2006, with information on the use of these
funds.
new text end

new text begin (c) The rate increases described in this section shall be
provided to home and community-based waivered services for
persons with mental retardation or related conditions under
section 256B.501; home and community-based waivered services for
the elderly under section 256B.0915; waivered services under
community alternatives for disabled individuals under section
256B.49; community alternative care waivered services under
section 256B.49; traumatic brain injury waivered services under
section 256B.49; nursing services and home health services under
section 256B.0625, subdivision 6a; personal care services and
nursing supervision of personal care services under section
256B.0625, subdivision 19a; private duty nursing services under
section 256B.0625, subdivision 7; day training and habilitation
services for adults with mental retardation or related
conditions under sections 252.40 to 252.46; alternative care
services under section 256B.0913; adult residential program
grants under Minnesota Rules, parts 9535.2000 to 9535.3000;
semi-independent living services (SILS) under section 252.275,
including SILS funding under county social services grants
formerly funded under chapter 256I; community support services
for deaf and hard-of-hearing adults with mental illness who use
or wish to use sign language as their primary means of
communication; the group residential housing supplementary
service rate under section 256I.05, subdivision 1a; chemical
dependency residential and nonresidential service providers
under section 254B.03; and intermediate care facilities for
persons with mental retardation under section 256B.5012.
new text end

new text begin (d) These increases shall be included in the provider's
reimbursement rate for the purpose of determining future rates
for the provider.
new text end

Sec. 36.

Minnesota Statutes 2004, section 256D.03,
subdivision 3, is amended to read:

Subd. 3.

General assistance medical care; eligibility.

(a) General assistance medical care may be paid for any person
who is not eligible for medical assistance under chapter 256B,
including eligibility for medical assistance based on a
spenddown of excess income according to section 256B.056,
subdivision 5, or MinnesotaCare as defined in paragraph (b),
except as provided in paragraph (c), and:

(1) who is receiving assistance under section 256D.05,
except for families with children who are eligible under
Minnesota family investment program (MFIP), or who is having a
payment made on the person's behalf under sections 256I.01 to
256I.06; or

(2) who is a resident of Minnesota; and

(i) who has gross countable income not in excess of 75
percent of the federal poverty guidelines for the family size,
using a six-month budget period and whose equity in assets is
not in excess of $1,000 per assistance unit. Exempt assets, the
reduction of excess assets, and the waiver of excess assets must
conform to the medical assistance program in section 256B.056,
subdivision 3, with the following exception: the maximum amount
of undistributed funds in a trust that could be distributed to
or on behalf of the beneficiary by the trustee, assuming the
full exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum; or

(ii) who has gross countable income above 75 percent of the
federal poverty guidelines but not in excess of 175 percent of
the federal poverty guidelines for the family size, using a
six-month budget period, whose equity in assets is not in excess
of the limits in section 256B.056, subdivision 3c, and who
applies during an inpatient hospitalization.

(b) General assistance medical care may not be paid for
applicants or recipients who meet all eligibility requirements
of MinnesotaCare as defined in sections 256L.01 to 256L.16, and
are adults with dependent children under 21 whose gross family
income is equal to or less than 275 percent of the federal
poverty guidelines.

(c) For applications received on or after October 1, 2003,
eligibility may begin no earlier than the date of application.
For individuals eligible under paragraph (a), clause (2), item
(i), a redetermination of eligibility must occur every 12
months. Individuals are eligible under paragraph (a), clause
(2), item (ii), only during inpatient hospitalization but may
reapply if there is a subsequent period of inpatient
hospitalization. Beginning January 1, 2000, Minnesota health
care program applications completed by recipients and applicants
who are persons described in paragraph (b), may be returned to
the county agency to be forwarded to the Department of Human
Services or sent directly to the Department of Human Services
for enrollment in MinnesotaCare. If all other eligibility
requirements of this subdivision are met, eligibility for
general assistance medical care shall be available in any month
during which a MinnesotaCare eligibility determination and
enrollment are pending. Upon notification of eligibility for
MinnesotaCare, notice of termination for eligibility for general
assistance medical care shall be sent to an applicant or
recipient. If all other eligibility requirements of this
subdivision are met, eligibility for general assistance medical
care shall be available until enrollment in MinnesotaCare
subject to the provisions of paragraph (e).

(d) The date of an initial Minnesota health care program
application necessary to begin a determination of eligibility
shall be the date the applicant has provided a name, address,
and Social Security number, signed and dated, to the county
agency or the Department of Human Services. If the applicant is
unable to provide a name, address, Social Security number, and
signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an
applicant's behalf to establish the date of an initial Minnesota
health care program application by providing the county agency
or Department of Human Services with deleted text begin provider identification and
a temporary unique identifier for the applicant deleted text end new text begin the applicant's
name and address. If the name and address are not available,
the provider may submit provider identification and a temporary
unique identifier for the applicant by the end of the next
business day. The date of hospital admission shall be
considered to be the application date for such requests new text end . The
applicant must complete the remainder of the application and
provide necessary verification before eligibility can be
determined. The county agency must assist the applicant in
obtaining verification if necessary. new text begin On the basis of
information provided on the completed application, an applicant
who meets the following criteria shall be determined eligible
beginning in the month of application:
new text end

new text begin (1) has gross income less than 90 percent of the applicable
income standard;
new text end

new text begin (2) has liquid assets that total within $300 of the asset
standard;
new text end

new text begin (3) does not reside in a long-term care facility; and
new text end

new text begin (4) meets all other eligibility requirements.
new text end

new text begin The applicant must provide all required verifications within 30
days' notice of the eligibility determination or eligibility
shall be terminated.
new text end

(e) County agencies are authorized to use all automated
databases containing information regarding recipients' or
applicants' income in order to determine eligibility for general
assistance medical care or MinnesotaCare. Such use shall be
considered sufficient in order to determine eligibility and
premium payments by the county agency.

(f) General assistance medical care is not available for a
person in a correctional facility unless the person is detained
by law for less than one year in a county correctional or
detention facility as a person accused or convicted of a crime,
or admitted as an inpatient to a hospital on a criminal hold
order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or
admitted on a criminal hold order and as long as the person
continues to meet other eligibility requirements of this
subdivision.

(g) General assistance medical care is not available for
applicants or recipients who do not cooperate with the county
agency to meet the requirements of medical assistance.

(h) In determining the amount of assets of an individual
eligible under paragraph (a), clause (2), item (i), there shall
be included any asset or interest in an asset, including an
asset excluded under paragraph (a), that was given away, sold,
or disposed of for less than fair market value within the 60
months preceding application for general assistance medical care
or during the period of eligibility. Any transfer described in
this paragraph shall be presumed to have been for the purpose of
establishing eligibility for general assistance medical care,
unless the individual furnishes convincing evidence to establish
that the transaction was exclusively for another purpose. For
purposes of this paragraph, the value of the asset or interest
shall be the fair market value at the time it was given away,
sold, or disposed of, less the amount of compensation received.
For any uncompensated transfer, the number of months of
ineligibility, including partial months, shall be calculated by
dividing the uncompensated transfer amount by the average
monthly per person payment made by the medical assistance
program to skilled nursing facilities for the previous calendar
year. The individual shall remain ineligible until this fixed
period has expired. The period of ineligibility may exceed 30
months, and a reapplication for benefits after 30 months from
the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period
of ineligibility begins in the month the transfer was reported
to the county agency, or if the transfer was not reported, the
month in which the county agency discovered the transfer,
whichever comes first. For applicants, the period of
ineligibility begins on the date of the first approved
application.

(i) When determining eligibility for any state benefits
under this subdivision, the income and resources of all
noncitizens shall be deemed to include their sponsor's income
and resources as defined in the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, title IV, Public Law
104-193, sections 421 and 422, and subsequently set out in
federal rules.

(j) Undocumented noncitizens and nonimmigrants are
ineligible for general assistance medical care. For purposes of
this subdivision, a nonimmigrant is an individual in one or more
of the classes listed in United States Code, title 8, section
1101(a)(15), and an undocumented noncitizen is an individual who
resides in the United States without the approval or
acquiescence of the Immigration and Naturalization Service.

(k) Notwithstanding any other provision of law, a
noncitizen who is ineligible for medical assistance due to the
deeming of a sponsor's income and resources, is ineligible for
general assistance medical care.

(l) Effective July 1, 2003, general assistance medical care
emergency services end.

Sec. 37.

Minnesota Statutes 2004, section 256D.03,
subdivision 4, is amended to read:

Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation
agencies;

(4) prescription drugs and other products recommended
through the process established in section 256B.0625,
subdivision 13;

(5) equipment necessary to administer insulin and
diagnostic supplies and equipment for diabetics to monitor blood
sugar level;

(6) eyeglasses and eye examinations provided by a physician
or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical
assistance program;

(13) podiatric services;

(14) dental services and dentures, subject to the
limitations specified in section 256B.0625, subdivision 9;

(15) outpatient services provided by a mental health center
or clinic that is under contract with the county board and is
established under section 245.62;

(16) day treatment services for mental illness provided
under contract with the county board;

(17) prescribed medications for persons who have been
diagnosed as mentally ill as necessary to prevent more
restrictive institutionalization;

(18) psychological services, medical supplies and
equipment, and Medicare premiums, coinsurance and deductible
payments;

(19) medical equipment not specifically listed in this
paragraph when the use of the equipment will prevent the need
for costlier services that are reimbursable under this
subdivision;

(20) services performed by a certified pediatric nurse
practitioner, a certified family nurse practitioner, a certified
adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or
a certified geriatric nurse practitioner in independent
practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an
inpatient basis is not included as part of the cost for
inpatient services included in the operating payment rate, and
(3) the service is within the scope of practice of the nurse
practitioner's license as a registered nurse, as defined in
section 148.171;

(21) services of a certified public health nurse or a
registered nurse practicing in a public health nursing clinic
that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the
scope of practice of the public health nurse's license as a
registered nurse, as defined in section 148.171; and

(22) telemedicine consultations, to the extent they are
covered under section 256B.0625, subdivision 3b.

(ii) Effective October 1, 2003, for a person who is
eligible under subdivision 3, paragraph (a), clause (2), item
(ii), general assistance medical care coverage is limited to
inpatient hospital services, including physician services
provided during the inpatient hospital stay. A $1,000
deductible is required for each inpatient hospitalization.

(b) Gender reassignment surgery and related services are
not covered services under this subdivision unless the
individual began receiving gender reassignment services prior to
July 1, 1995.

(c) In order to contain costs, the commissioner of human
services shall select vendors of medical care who can provide
the most economical care consistent with high medical standards
and shall where possible contract with organizations on a
prepaid capitation basis to provide these services. The
commissioner shall consider proposals by counties and vendors
for prepaid health plans, competitive bidding programs, block
grants, or other vendor payment mechanisms designed to provide
services in an economical manner or to control utilization, with
safeguards to ensure that necessary services are provided.
Before implementing prepaid programs in counties with a county
operated or affiliated public teaching hospital or a hospital or
clinic operated by the University of Minnesota, the commissioner
shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to
participate in the program in a manner that reflects the risk of
adverse selection and the nature of the patients served by the
hospital, provided the terms of participation in the program are
competitive with the terms of other participants considering the
nature of the population served. Payment for services provided
pursuant to this subdivision shall be as provided to medical
assistance vendors of these services under sections 256B.02,
subdivision 8, and 256B.0625. For payments made during fiscal
year 1990 and later years, the commissioner shall consult with
an independent actuary in establishing prepayment rates, but
shall retain final control over the rate methodology.

(d) Recipients eligible under subdivision 3, paragraph (a),
clause (2), item (i), shall pay the following co-payments for
services provided on or after October 1, 2003:

(1) $3 per nonpreventive visit. For purposes of this
subdivision, a visit means an episode of service which is
required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory
setting by a physician or physician ancillary, chiropractor,
podiatrist, nurse midwife, advanced practice nurse, audiologist,
optician, or optometrist;

(2) $25 for eyeglasses;

(3) $25 for nonemergency visits to a hospital-based
emergency room;

(4) $3 per brand-name drug prescription and $1 per generic
drug prescription, subject to a $20 per month maximum for
prescription drug co-payments. No co-payments shall apply to
antipsychotic drugs when used for the treatment of mental
illness; and

(5) 50 percent coinsurance on restorative dental services.

(e) Co-payments shall be limited to one per day per
provider for nonpreventive visits, eyeglasses, and nonemergency
visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all
co-payments in this subdivision. The general assistance medical
care reimbursement to the provider shall be reduced by the
amount of the co-payment, except that reimbursement for
prescription drugs shall not be reduced once a recipient has
reached the $20 per month maximum for prescription drug
co-payments. The provider collects the co-payment from the
recipient. Providers may not deny services to recipients who
are unable to pay the co-payment, except as provided in
paragraph (f).

(f) If it is the routine business practice of a provider to
refuse service to an individual with uncollected debt, the
provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient
with uncollected debt before services can be denied.

new text begin (g) The co-payments described in paragraph (d) shall be
waived by the provider if the recipient practices a healthy
lifestyle by refraining from tobacco use or is participating in
a smoking cessation program. To obtain the waiver, the
recipient must sign a statement stating that the recipient does
not use tobacco products or is currently participating in a
smoking cessation program. The provider shall keep the signed
statement on file.
new text end

deleted text begin (g) deleted text end new text begin (h) new text end Any county may, from its own resources, provide
medical payments for which state payments are not made.

deleted text begin (h) deleted text end new text begin (i) new text end Chemical dependency services that are reimbursed
under chapter 254B must not be reimbursed under general
assistance medical care.

deleted text begin (i) deleted text end new text begin (j) new text end The maximum payment for new vendors enrolled in the
general assistance medical care program after the base year
shall be determined from the average usual and customary charge
of the same vendor type enrolled in the base year.

deleted text begin (j) deleted text end new text begin (k) new text end The conditions of payment for services under this
subdivision are the same as the conditions specified in rules
adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.

deleted text begin (k) deleted text end new text begin (l) new text end Inpatient and outpatient payments shall be reduced
by five percent, effective July 1, 2003. This reduction is in
addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (i).

deleted text begin (l) deleted text end new text begin (m) new text end Payments for all other health services except
inpatient, outpatient, and pharmacy services shall be reduced by
five percent, effective July 1, 2003.

deleted text begin (m) deleted text end new text begin (n) new text end Payments to managed care plans shall be reduced by
five percent for services provided on or after October 1, 2003.

deleted text begin (n) deleted text end new text begin (o) new text end A hospital receiving a reduced payment as a result
of this section may apply the unpaid balance toward satisfaction
of the hospital's bad debts.

Sec. 38.

Minnesota Statutes 2004, section 256L.03,
subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

deleted text begin For individuals
under section 256L.04, subdivision 7, with income no greater
than 75 percent of the federal poverty guidelines or for
families with children under section 256L.04, subdivision 1, all
subdivisions of this section apply. deleted text end "Covered health services"
means the health services reimbursed under chapter 256B, with
the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care
services other than new text begin preventive new text end services deleted text begin covered under section
256B.0625, subdivision 9, paragraph (b) deleted text end , orthodontic services,
nonemergency medical transportation services, personal care
assistant and case management services, nursing home or
intermediate care facilities services, inpatient mental health
services, and chemical dependency services. new text begin Adult dental care
for nonpreventive services, with the exception of orthodontic
services, is covered for persons who qualify under section
256L.04, subdivisions 1, 2, and 7, with family gross income
equal to or less than 175 percent of the federal poverty
guidelines. new text end Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments,
psychological testing, explanation of findings, medication
management by a physician, day treatment, partial
hospitalization, and individual, family, and group psychotherapy.

No public funds shall be used for coverage of abortion
under MinnesotaCare except where the life of the female would be
endangered or substantial and irreversible impairment of a major
bodily function would result if the fetus were carried to term;
or where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in
this section.

Sec. 39.

Minnesota Statutes 2004, section 256L.05,
subdivision 4, is amended to read:

Subd. 4.

Application processing.

The commissioner of
human services shall determine an applicant's eligibility for
MinnesotaCare no more than 30 days from the date that the
application is received by the Department of Human Services.
Beginning January 1, 2000, this requirement also applies to
local county human services agencies that determine eligibility
for MinnesotaCare. new text begin At application or reenrollment, to prevent
processing delays, applicants or enrollees who, from the
information provided on the application, appear to meet
eligibility requirements shall be enrolled upon timely payment
of premiums. The enrollee must provide all required
verifications within 30 days of notification of the eligibility
determination or coverage from the program shall be terminated.
Enrollees who are determined to be ineligible when verifications
are provided shall be disenrolled from the program.
new text end

Sec. 40.

Minnesota Statutes 2004, section 256L.07,
subdivision 1, is amended to read:

Subdivision 1.

General requirements.

(a) Children
enrolled in the original children's health plan as of September
30, 1992, children who enrolled in the MinnesotaCare program
after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross
incomes that are equal to or less than 150 percent of the
federal poverty guidelines are eligible without meeting the
requirements of subdivision 2 and the four-month requirement in
subdivision 3, as long as they maintain continuous coverage in
the MinnesotaCare program or medical assistance. Children who
apply for MinnesotaCare on or after the implementation date of
the employer-subsidized health coverage program as described in
Laws 1998, chapter 407, article 5, section 45, who have family
gross incomes that are equal to or less than 150 percent of the
federal poverty guidelines, must meet the requirements of
subdivision 2 to be eligible for MinnesotaCare.

(b) Families enrolled in MinnesotaCare under section
256L.04, subdivision 1, whose income increases above 275 percent
of the federal poverty guidelines, are no longer eligible for
the program and shall be disenrolled by the commissioner.
Individuals enrolled in MinnesotaCare under section 256L.04,
subdivision 7, whose income increases above 175 percent of the
federal poverty guidelines are no longer eligible for the
program and shall be disenrolled by the commissioner. For
persons disenrolled under this subdivision, MinnesotaCare
coverage terminates the last day of the calendar month following
the month in which the commissioner determines that the income
of a family or individual exceeds program income limits.

(c) deleted text begin (1) deleted text end Notwithstanding paragraph (b), new text begin individuals and
new text end families deleted text begin enrolled in MinnesotaCare under section 256L.04,
subdivision 1, deleted text end may remain enrolled in MinnesotaCare if ten
percent of their annual income is less than the annual premium
for a policy with a $500 deductible available through the
Minnesota Comprehensive Health Association. new text begin Individuals and
new text end families who are no longer eligible for MinnesotaCare under this
subdivision shall be given deleted text begin an 18-month deleted text end new text begin a 12-month new text end notice period
from the date that ineligibility is determined before
disenrollment. deleted text begin This clause expires February 1, 2004.
deleted text end

deleted text begin (2) Effective February 1, 2004, notwithstanding paragraph
(b), children may remain enrolled in MinnesotaCare if ten
percent of their annual family income is less than the annual
premium for a policy with a $500 deductible available through
the Minnesota Comprehensive Health Association. Children who
are no longer eligible for MinnesotaCare under this clause shall
be given a 12-month notice period from the date that
ineligibility is determined before disenrollment. deleted text end The premium
for deleted text begin children deleted text end new text begin individuals and families new text end remaining eligible under
this deleted text begin clause deleted text end new text begin paragraph new text end shall be the maximum premium determined
under section 256L.15, subdivision 2, paragraph (b).

(d) Effective July 1, 2003, notwithstanding paragraphs (b)
and (c), parents are no longer eligible for MinnesotaCare if
gross household income exceeds $50,000.

Sec. 41.

Minnesota Statutes 2004, section 256L.12,
subdivision 6, is amended to read:

Subd. 6.

Co-payments and benefit limits.

Enrollees are
responsible for all co-payments in deleted text begin sections deleted text end new text begin section new text end 256L.03,
subdivision 5, deleted text begin and 256L.035, deleted text end and shall pay co-payments to the
managed care plan or to its participating providers. The
enrollee is also responsible for payment of inpatient hospital
charges which exceed the MinnesotaCare benefit limit.

Sec. 42.

new text begin [256L.20] MINNESOTACARE OPTION FOR SMALL
EMPLOYERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purpose of this
section, the terms used have the meanings given them.
new text end

new text begin (b) "Dependent" means an unmarried child under 21 years of
age.
new text end

new text begin (c) "Eligible employer" means a business that employs at
least two, but not more than 50, eligible employees, the
majority of whom are employed in the state, and includes a
municipality that has 50 or fewer employees.
new text end

new text begin (d) "Eligible employee" means an employee who works at
least 20 hours per week for an eligible employer. Eligible
employee does not include an employee who works on a temporary
or substitute basis or who does not work more than 26 weeks
annually.
new text end

new text begin (e) "Maximum premium" has the meaning given under section
256L.15, subdivision 2, paragraph (b), clause (3).
new text end

new text begin (f) "Participating employer" means an eligible employer who
meets the requirements described in subdivision 3 and applies to
the commissioner to enroll its eligible employees and their
dependents in the MinnesotaCare program.
new text end

new text begin (g) "Program" means the MinnesotaCare program.
new text end

new text begin Subd. 2. new text end

new text begin Option. new text end

new text begin Eligible employees and their dependents
may enroll in MinnesotaCare if the eligible employer meets the
requirements of subdivision 3. The effective date of coverage
is according to section 256L.05, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Employer requirements. new text end

new text begin The commissioner shall
establish procedures for an eligible employer to apply for
coverage through the program. In order to participate, an
eligible employer must meet the following requirements:
new text end

new text begin (1) agrees to contribute toward the cost of the premium for
the employee and the employee's dependents according to
subdivision 4;
new text end

new text begin (2) certifies that at least 75 percent of its eligible
employees who do not have other creditable health coverage are
enrolled in the program;
new text end

new text begin (3) offers coverage to all eligible employees and the
dependents of eligible employees; and
new text end

new text begin (4) has not provided employer-subsidized health coverage as
an employee benefit during the previous 12 months, as defined in
section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 4. new text end

new text begin Premiums. new text end

new text begin (a) The premium for MinnesotaCare
coverage provided under this section is equal to the maximum
premium regardless of the income of the eligible employee.
new text end

new text begin (b) For eligible employees without dependents with income
equal to or less than 175 percent of the federal poverty
guidelines and for eligible employees with dependents with
income equal to or less than 275 percent of the federal poverty
guidelines, the participating employer shall pay 50 percent of
the maximum premium for the eligible employee and any
dependents, if applicable.
new text end

new text begin (c) For eligible employees without dependents with income
over 175 percent of the federal poverty guidelines and for
eligible employees with dependents with income over 275 percent
of the federal poverty guidelines, the participating employer
shall pay the full cost of the maximum premium for the eligible
employee and any dependents, if applicable. The participating
employer may require the employee to pay a portion of the cost
of the premium so long as the employer pays 50 percent of the
cost. If the employer requires the employee to pay a portion of
the premium, the employee shall pay the portion of the cost to
the employer.
new text end

new text begin (d) The commissioner shall collect premium payments from
participating employers for eligible employees and their
dependents who are covered by the program as provided under this
section. All premiums collected shall be deposited in the
health care access fund.
new text end

new text begin Subd. 5. new text end

new text begin Coverage. new text end

new text begin The coverage offered to those
enrolled in the program under this section must include all
health services described under section 256L.03 and all
co-payments and coinsurance requirements described under section
256L.03, subdivision 5, apply.
new text end

new text begin Subd. 6. new text end

new text begin Enrollment. new text end

new text begin Upon payment of the premium, in
accordance with this section and section 256L.06, eligible
employees and their dependents shall be enrolled in
MinnesotaCare. For purposes of enrollment under this section,
income eligibility limits established under sections 256L.04 and
256L.07, subdivision 1, and asset limits established under
section 256L.17 do not apply. The barriers established under
section 256L.07, subdivision 2 or 3, do not apply to enrollees
eligible under this section. The commissioner may require
eligible employees to provide income verification to determine
premiums.
new text end

Sec. 43.

Laws 2003, First Special Session chapter 14,
article 6, section 65, is amended to read:

Sec. 65 new text begin FEDERAL GRANTS TO MAINTAIN INDEPENDENCE AND
EMPLOYMENT.
new text end

(a) The commissioner of human services shall seek federal
funding to participate in grant activities authorized under
Public Law 106-170, the Ticket to Work and Work Incentives
Improvement Act of 1999. The purpose of the federal grant funds
are to establish:

(1) a demonstration project to improve the availability of
health care services and benefits to workers with potentially
severe physical or mental impairments that are likely to lead to
disability without access to Medicaid services; and

(2) a comprehensive initiative to remove employment
barriers that includes linkages with non-Medicaid programs,
including those administered by the Social Security
Administration and the Department of Labor.

(b) The state's proposal for a demonstration project in
paragraph (a), clause (1), shall focus on assisting workers with:

(1) a serious mental illness as defined by the federal
Center for Mental Health Services;

(2) concurrent mental health and chemical dependency
conditions; deleted text begin and
deleted text end

(3) young adults up to the age of 24 who have a physical or
mental impairment that is severe and will potentially lead to a
determination of disability by the Social Security
Administration or state medical review team new text begin ; and
new text end

new text begin (4) adults without children who are eligible for
MinnesotaCare and who suffer from one or more of the following
chronic health conditions: diabetes, hypertension, coronary
artery disease, asthma, thyroid disease, cancer, chronic
arthritis, HIV, or multiple sclerosis new text end .

(c) The commissioner is authorized to take the actions
necessary to design and implement the demonstration project in
paragraph (a), clause (1), that include:

(1) establishing work-related requirements for
participation in the demonstration project;

(2) working with stakeholders to establish methods that
identify the population that will be served in the demonstration
project;

(3) seeking funding for activities to design, implement,
and evaluate the demonstration project;

(4) taking necessary administrative actions to implement
the demonstration project by July 1, 2004, or within 180 days of
receiving formal notice from the Centers for Medicare and
Medicaid Services that a grant has been awarded;

(5) establishing limits on income and resources;

(6) establishing a method to coordinate health care
benefits and payments with other coverage that is available to
the participants;

(7) establishing premiums based on guidelines that are
consistent with those found in Minnesota Statutes, section
256B.057, subdivision 9, for employed persons with disabilities;

(8) notifying local agencies of potentially eligible
individuals in accordance with Minnesota Statutes, section
256B.19, subdivision 2c; and

(9) limiting the caseload of qualifying individuals
participating in the demonstration project.

(d) The state's proposal for the comprehensive employment
initiative in paragraph (a), clause (2), shall focus on:

(1) infrastructure development that creates incentives for
greater work effort and participation by people with
disabilities or workers with severe physical or mental
impairments;

(2) consumer access to information and benefit assistance
that enables the person to maximize employment and career
advancement potential;

(3) improved consumer access to essential assistance and
support;

(4) enhanced linkages between state and federal agencies to
decrease the barriers to employment experienced by persons with
disabilities or workers with severe physical or mental
impairments; and

(5) research efforts to provide useful information to guide
future policy development on both the state and federal levels.

(e) Funds awarded by the federal government for the
purposes of this section are appropriated to the commissioner of
human services.

(f) The commissioner shall report to the chairs of the
senate and house of representatives finance divisions having
jurisdiction over health care issues on the federal approval of
the waiver under this section and the projected savings in the
November and February forecasts. new text begin Any savings projected for the
individuals described in paragraph (b), clause (4), shall be
deposited in the health care access fund.
new text end

The commissioner must consider using the savings to
increase GAMC hospital rates to the July 1, deleted text begin 2003 deleted text end new text begin 2004 new text end , levels as
a deleted text begin supplemental deleted text end budget proposal in the deleted text begin 2004 deleted text end new text begin 2005 new text end legislative
session.

Sec. 44. new text begin DISEASE MANAGEMENT PROGRAM ACCOUNTABILITY.
new text end

new text begin Any savings generated from the disease management
initiatives under Minnesota Statutes, section 256B.075, shall be
retained by the commissioner of human services and used for
provider bonuses in the disease management program as described
in Minnesota Statutes, section 256B.075, and for increasing
other provider rates within the fee-for-service program.
new text end

Sec. 45. new text begin FEDERAL 340B DRUG PRICING PROGRAM INFORMATION.
new text end

new text begin The commissioner of human services, in consultation with
other state agencies and representatives of health care
providers and facilities in the state, shall provide the
following information:
new text end

new text begin (1) a description of all health care providers and
facilities in the state potentially eligible for designation as
a "covered entity" under section 340B of the federal Veterans
Health Care Act of 1992, Public Law 102-585, including, but not
limited to, all hospitals eligible as disproportionate share
hospitals; recipients of grants from the United States Public
Health Service; federally qualified health centers;
state-operated AIDS drug assistance programs; Ryan White Care
Act, title I, title II, and title III programs; family planning
and sexually transmitted disease clinics; hemophilia treatment
centers; public housing primary care clinics; and clinics for
homeless people. The commissioner may encourage those
facilities that are or may be eligible to participate in the
program and may provide any necessary technical assistance to
access the program; and
new text end

new text begin (2) a list of potential applications of section 340B and
the potential benefits to public, private, and third-party
payers, including, but not limited to:
new text end

new text begin (i) evaluating methods to allow community mental health
patients to obtain medications through 340B providers;
new text end

new text begin (ii) maximizing the use of 340B providers within
state-funded managed care plans;
new text end

new text begin (iii) including 340B providers in state bulk purchasing
initiatives; and
new text end

new text begin (iv) utilizing sole source contracts with 340B providers to
furnish high-cost chronic care drugs.
new text end

Sec. 46. new text begin LIMITING COVERAGE OF HEALTH CARE SERVICES FOR
MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE, AND
MINNESOTACARE PROGRAMS.
new text end

new text begin Subdivision 1. new text end

new text begin General assistance medical care and
minnesotacare. new text end

new text begin (a) Effective July 1, 2005, the
diagnosis/treatment pairings described in subdivision 3 shall
not be covered under the general assistance medical care program
or under the MinnesotaCare program for persons eligible under
Minnesota Statutes, section 256L.04, subdivision 7.
new text end

new text begin (b) This subdivision expires July 1, 2007, or when a list
is established according to Minnesota Statutes, section
256B.0625, subdivision 46, whichever is earlier.
new text end

new text begin Subd. 2. new text end

new text begin Prior authorization of services for medical
assistance. new text end

new text begin (a) Effective July 1, 2005, prior authorization is
required for the diagnosis/treatment pairings described in
subdivision 3 for reimbursement under Minnesota Statutes,
chapter 256B, and under the MinnesotaCare program for persons
eligible under Minnesota Statutes, section 256L.04, subdivision
1.
new text end

new text begin (b) This subdivision expires July 1, 2007, or when a list
is established according to Minnesota Statutes, section
256B.0625, subdivision 46, whichever is earlier.
new text end

new text begin Subd. 3. new text end

new text begin List of diagnosis/treatment pairings. new text end

new text begin (a)(1)
Diagnosis: TRIGEMINAL AND OTHER NERVE DISORDERS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 350,352
new text end

new text begin (2) Diagnosis: DISRUPTIONS OF THE LIGAMENTS AND TENDONS OF
THE ARMS AND LEGS, EXCLUDING THE KNEE, GRADE II AND III
new text end

new text begin Treatment: REPAIR
new text end

new text begin ICD-9: 726.5, 727.59, 727.62-727.65, 727.68-727.69, 728.83,
728.89, 840.0-840.3, 840.5-840.9, 841-843, 845.0
new text end

new text begin (3) Diagnosis: DISORDERS OF SHOULDER
new text end

new text begin Treatment: REPAIR/RECONSTRUCTION
new text end

new text begin ICD-9: 718.01, 718.11, 718.21, 718.31, 718.41, 718.51, 718.81,
726.0, 726.10-726.11, 726.19, 726.2, 727.61, 840.4, 840.7
new text end

new text begin (4) Diagnosis: INTERNAL DERANGEMENT OF KNEE AND
LIGAMENTOUS DISRUPTIONS OF THE KNEE, GRADE II AND III
new text end

new text begin Treatment: REPAIR, MEDICAL THERAPY
new text end

new text begin ICD-9: 717.0-717.4, 717.6-717.8, 718.26, 718.36, 718.46,
718.56, 727.66, 836.0-836.2, 844
new text end

new text begin (5) Diagnosis: MALUNION AND NONUNION OF FRACTURE
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 733.8
new text end

new text begin (6) Diagnosis: FOREIGN BODY IN UTERUS, VULVA AND VAGINA
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 939.1-939.2
new text end

new text begin (7) Diagnosis: UTERINE PROLAPSE; CYSTOCELE
new text end

new text begin Treatment: SURGICAL REPAIR
new text end

new text begin ICD-9: 618
new text end

new text begin (8) Diagnosis: OSTEOARTHRITIS AND ALLIED DISORDERS
new text end

new text begin Treatment: MEDICAL THERAPY, INJECTIONS
new text end

new text begin ICD-9: 713.5, 715, 716.0-716.1, 716.5-716.6
new text end

new text begin (9) Diagnosis: METABOLIC BONE DISEASE
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 731.0, 733.0
new text end

new text begin (10) Diagnosis: SYMPTOMATIC IMPACTED TEETH
new text end

new text begin Treatment: SURGERY
new text end

new text begin ICD-9: 520.6, 524.3-524.4
new text end

new text begin (11) Diagnosis: UNSPECIFIED DISEASE OF HARD TISSUES OF
TEETH (AVULSION)
new text end

new text begin Treatment: INTERDENTAL WIRING
new text end

new text begin ICD-9: 525.9
new text end

new text begin (12) Diagnosis: ABSCESSES AND CYSTS OF BARTHOLIN'S GLAND
AND VULVA
new text end

new text begin Treatment: INCISION AND DRAINAGE, MEDICAL THERAPY
new text end

new text begin ICD-9: 616.2-616.9
new text end

new text begin (13) Diagnosis: CERVICITIS, ENDOCERVICITIS, HEMATOMA OF
VULVA, AND NONINFLAMMATORY DISORDERS OF THE VAGINA
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 616.0, 623.6, 623.8-623.9, 624.5
new text end

new text begin (14) Diagnosis: DENTAL CONDITIONS (e.g., TOOTH LOSS)
new text end

new text begin Treatment: SPACE MAINTENANCE AND PERIODONTAL MAINTENANCE
new text end

new text begin ICD-9: V72.2
new text end

new text begin (15) Diagnosis: URINARY INCONTINENCE
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 599.81, 625.6, 788.31-788.33
new text end

new text begin (16) Diagnosis: HYPOSPADIAS AND EPISPADIAS
new text end

new text begin Treatment: REPAIR
new text end

new text begin ICD-9: 752.6
new text end

new text begin (17) Diagnosis: RESIDUAL FOREIGN BODY IN SOFT TISSUE
new text end

new text begin Treatment: REMOVAL
new text end

new text begin ICD-9: 374.86, 729.6, 883.1-883.2
new text end

new text begin (18) Diagnosis: BRANCHIAL CLEFT CYST
new text end

new text begin Treatment: EXCISION, MEDICAL THERAPY
new text end

new text begin ICD-9: 744.41-744.46, 744.49, 759.2
new text end

new text begin (19) Diagnosis: EXFOLIATION OF TEETH DUE TO SYSTEMIC
CAUSES; SPECIFIC DISORDERS OF THE TEETH AND SUPPORTING
STRUCTURES
new text end

new text begin Treatment: EXCISION OF DENTOALVEOLAR STRUCTURE
new text end

new text begin ICD-9: 525.0, 525.8, 525.11
new text end

new text begin (20) Diagnosis: PTOSIS (ACQUIRED) WITH VISION IMPAIRMENT
new text end

new text begin Treatment: PTOSIS REPAIR
new text end

new text begin ICD-9: 374.2-374.3, 374.41, 374.43, 374.46
new text end

new text begin (21) Diagnosis: SIMPLE AND SOCIAL PHOBIAS
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 300.23, 300.29
new text end

new text begin (22) Diagnosis: RETAINED DENTAL ROOT
new text end

new text begin Treatment: EXCISION OF DENTOALVEOLAR STRUCTURE
new text end

new text begin ICD-9: 525.3
new text end

new text begin (23) Diagnosis: PERIPHERAL NERVE ENTRAPMENT
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 354.0, 354.2, 355.5, 723.3, 728.6
new text end

new text begin (24) Diagnosis: INCONTINENCE OF FECES
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 787.6
new text end

new text begin (25) Diagnosis: RECTAL PROLAPSE
new text end

new text begin Treatment: PARTIAL COLECTOMY
new text end

new text begin ICD-9: 569.1-569.2
new text end

new text begin (26) Diagnosis: BENIGN NEOPLASM OF KIDNEY AND OTHER
URINARY ORGANS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 223
new text end

new text begin (27) Diagnosis: URETHRAL FISTULA
new text end

new text begin Treatment: EXCISION, MEDICAL THERAPY
new text end

new text begin ICD-9: 599.1-599.2, 599.4
new text end

new text begin (28) Diagnosis: THROMBOSED AND COMPLICATED HEMORRHOIDS
new text end

new text begin Treatment: HEMORRHOIDECTOMY, INCISION
new text end

new text begin ICD-9: 455.1-455.2, 455.4-455.5, 455.7-455.8
new text end

new text begin (29) Diagnosis: VAGINITIS, TRICHOMONIASIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 112.1, 131, 616.1, 623.5
new text end

new text begin (30) Diagnosis: BALANOPOSTHITIS AND OTHER DISORDERS OF
PENIS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 607.1, 607.81-607.83, 607.89
new text end

new text begin (31) Diagnosis: CHRONIC ANAL FISSURE; ANAL FISTULA
new text end

new text begin Treatment: SPHINCTEROTOMY, FISSURECTOMY, FISTULECTOMY, MEDICAL
THERAPY
new text end

new text begin ICD-9: 565.0-565.1
new text end

new text begin (32) Diagnosis: CHRONIC OTITIS MEDIA
new text end

new text begin Treatment: PE TUBES/ADENOIDECTOMY/TYMPANOPLASTY, MEDICAL
THERAPY
new text end

new text begin ICD-9: 380.5, 381.1-381.8, 382.1-382.3, 382.9, 383.1-383.2,
383.30-383.31, 383.9, 384.2, 384.8-384.9
new text end

new text begin (33) Diagnosis: ACUTE CONJUNCTIVITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 077, 372.00
new text end

new text begin (34) Diagnosis: CERUMEN IMPACTION, FOREIGN BODY IN EAR &
NOSE
new text end

new text begin Treatment: REMOVAL OF FOREIGN BODY
new text end

new text begin ICD-9: 380.4, 931-932
new text end

new text begin (35) Diagnosis: VERTIGINOUS SYNDROMES AND OTHER DISORDERS
OF VESTIBULAR SYSTEM
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 379.54, 386.1-386.2, 386.4-386.9, 438.6-438.7,
438.83-438.85
new text end

new text begin (36) Diagnosis: UNSPECIFIED URINARY OBSTRUCTION AND BENIGN
PROSTATIC HYPERPLASIA WITHOUT OBSTRUCTION
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 599.6, 600
new text end

new text begin (37) Diagnosis: PHIMOSIS
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 605
new text end

new text begin (38) Diagnosis: CONTACT DERMATITIS, ATOPIC DERMATITIS AND
OTHER ECZEMA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 691.8, 692.0-692.6, 692.70-692.74, 692.79, 692.8-692.9
new text end

new text begin (39) Diagnosis: PSORIASIS AND SIMILAR DISORDERS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 696.1-696.2, 696.8
new text end

new text begin (40) Diagnosis: CYSTIC ACNE
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 705.83, 706.0-706.1
new text end

new text begin (41) Diagnosis: CLOSED FRACTURE OF GREAT TOE
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 826.0
new text end

new text begin (42) Diagnosis: SYMPTOMATIC URTICARIA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 708.0-708.1, 708.5, 708.8, 995.7
new text end

new text begin (43) Diagnosis: PERIPHERAL NERVE DISORDERS
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 355.4,
355.7-355.8, 723.2
new text end

new text begin (44) Diagnosis: DYSFUNCTION OF NASOLACRIMAL SYSTEM;
LACRIMAL SYSTEM LACERATION
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT; CLOSURE
new text end

new text begin ICD-9: 370.33, 375, 870.2
new text end

new text begin (45) Diagnosis: NASAL POLYPS, OTHER DISORDERS OF NASAL
CAVITY AND SINUSES
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 471, 478.1, 993.1
new text end

new text begin (46) Diagnosis: SIALOLITHIASIS, MUCOCELE, DISTURBANCE OF
SALIVARY SECRETION, OTHER AND UNSPECIFIED DISEASES OF SALIVARY
GLANDS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 527.5-527.9
new text end

new text begin (47) Diagnosis: DENTAL CONDITIONS (e.g., BROKEN APPLIANCES)
new text end

new text begin Treatment: PERIODONTICS AND COMPLEX PROSTHETICS
new text end

new text begin ICD-9: 522.6, 522.8, V72.2
new text end

new text begin (48) Diagnosis: IMPULSE DISORDERS
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 312.31-312.39
new text end

new text begin (49) Diagnosis: BENIGN NEOPLASM BONE AND ARTICULAR
CARTILAGE, INCLUDING OSTEOID OSTEOMAS; BENIGN NEOPLASM OF
CONNECTIVE AND OTHER SOFT TISSUE
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 213, 215, 526.0-526.1, 526.81, 719.2, 733.2
new text end

new text begin (50) Diagnosis: SEXUAL DYSFUNCTION
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT, PSYCHOTHERAPY
new text end

new text begin ICD-9: 302.7, 607.84
new text end

new text begin (51) Diagnosis: STOMATITIS AND DISEASES OF LIPS
new text end

new text begin Treatment: INCISION AND DRAINAGE/MEDICAL THERAPY
new text end

new text begin ICD-9: 528.0, 528.5, 528.9, 529.0
new text end

new text begin (52) Diagnosis: BELL'S PALSY, EXPOSURE
KERATOCONJUNCTIVITIS
new text end

new text begin Treatment: TARSORRHAPHY
new text end

new text begin ICD-9: 351.0-351.1, 351.8-351.9, 370.34, 374.44, 374.45, 374.89
new text end

new text begin (53) Diagnosis: HORDEOLUM AND OTHER DEEP INFLAMMATION OF
EYELID; CHALAZION
new text end

new text begin Treatment: INCISION AND DRAINAGE/MEDICAL THERAPY
new text end

new text begin ICD-9: 373.11-373.12, 373.2, 374.50, 374.54, 374.56, 374.84
new text end

new text begin (54) Diagnosis: ECTROPION, TRICHIASIS OF EYELID, BENIGN
NEOPLASM OF EYELID
new text end

new text begin Treatment: ECTROPION REPAIR
new text end

new text begin ICD-9: 216.1, 224, 372.63, 374.1, 374.85
new text end

new text begin (55) Diagnosis: CHONDROMALACIA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 733.92
new text end

new text begin (56) Diagnosis: DYSMENORRHEA
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 625.3
new text end

new text begin (57) Diagnosis: SPASTIC DIPLEGIA
new text end

new text begin Treatment: RHIZOTOMY
new text end

new text begin ICD-9: 343.0
new text end

new text begin (58) Diagnosis: ATROPHY OF EDENTULOUS ALVEOLAR RIDGE
new text end

new text begin Treatment: VESTIBULOPLASTY, GRAFTS, IMPLANTS
new text end

new text begin ICD-9: 525.2
new text end

new text begin (59) Diagnosis: DEFORMITIES OF UPPER BODY AND ALL LIMBS
new text end

new text begin Treatment: REPAIR/REVISION/RECONSTRUCTION/RELOCATION/MEDICAL
THERAPY
new text end

new text begin ICD-9: 718.02-718.05, 718.13-718.15, 718.42-718.46,
718.52-718.56, 718.65, 718.82-718.86, 728.79, 732.3, 732.6,
732.8-732.9, 733.90-733.91, 736.00-736.04, 736.07, 736.09,
736.1, 736.20, 736.29, 736.30, 736.39, 736.4, 736.6, 736.76,
736.79, 736.89, 736.9, 738.6, 738.8, 754.42-754.44, 754.61,
754.8, 755.50-755.53, 755.56-755.57, 755.59, 755.60,
755.63-755.64, 755.69, 755.8, 756.82-756.83, 756.89
new text end

new text begin (60) Diagnosis: DEFORMITIES OF FOOT
new text end

new text begin Treatment: FASCIOTOMY/INCISION/REPAIR/ARTHRODESIS
new text end

new text begin ICD-9: 718.07, 718.47, 718.57, 718.87, 727.1, 732.5,
735.0-735.2, 735.3-735.9, 736.70-736.72, 754.50, 754.59, 754.60,
754.69, 754.70, 754.79, 755.65-755.67
new text end

new text begin (61) Diagnosis: PERITONEAL ADHESION
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 568.0, 568.82-568.89, 568.9
new text end

new text begin (62) Diagnosis: PELVIC PAIN SYNDROME, DYSPAREUNIA
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 300.81, 614.1, 614.6, 620.6, 625.0-625.2, 625.5,
625.8-625.9
new text end

new text begin (63) Diagnosis: TENSION HEADACHES
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 307.81, 784.0
new text end

new text begin (64) Diagnosis: CHRONIC BRONCHITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 490, 491.0, 491.8-491.9
new text end

new text begin (65) Diagnosis: DISORDERS OF FUNCTION OF STOMACH AND OTHER
FUNCTIONAL DIGESTIVE DISORDERS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 536.0-536.3, 536.8-536.9, 537.1-537.2, 537.5-537.6,
537.89, 537.9, 564.0-564.7, 564.9
new text end

new text begin (66) Diagnosis: TMJ DISORDER
new text end

new text begin Treatment: TMJ SPLINTS
new text end

new text begin ICD-9: 524.6, 848.1
new text end

new text begin (67) Diagnosis: URETHRITIS, NONSEXUALLY TRANSMITTED
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 597.8, 599.3-599.5, 599.9
new text end

new text begin (68) Diagnosis: LESION OF PLANTAR NERVE; PLANTAR FASCIAL
FIBROMATOSIS
new text end

new text begin Treatment: MEDICAL THERAPY, EXCISION
new text end

new text begin ICD-9: 355.6, 728.71
new text end

new text begin (69) Diagnosis: GRANULOMA OF MUSCLE, GRANULOMA OF SKIN AND
SUBCUTANEOUS TISSUE
new text end

new text begin Treatment: REMOVAL OF GRANULOMA
new text end

new text begin ICD-9: 709.4, 728.82
new text end

new text begin (70) Diagnosis: DERMATOPHYTOSIS OF NAIL, GROIN, AND FOOT
AND OTHER DERMATOMYCOSIS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 110.0-110.6, 110.8-110.9, 111
new text end

new text begin (71) Diagnosis: INTERNAL DERANGEMENT OF JOINT OTHER THAN
KNEE
new text end

new text begin Treatment: REPAIR, MEDICAL THERAPY
new text end

new text begin ICD-9: 718.09, 718.19, 718.29, 718.48, 718.59, 718.88-718.89,
719.81-719.85, 719.87-719.89
new text end

new text begin (72) Diagnosis: STENOSIS OF NASOLACRIMAL DUCT (ACQUIRED)
new text end

new text begin Treatment: DACRYOCYSTORHINOSTOMY
new text end

new text begin ICD-9: 375.02, 375.30, 375.32, 375.4, 375.56-375.57, 375.61,
771.6
new text end

new text begin (73) Diagnosis: PERIPHERAL NERVE DISORDERS
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 355.4,
355.7-355.8, 723.2
new text end

new text begin (74) Diagnosis: CAVUS DEFORMITY OF FOOT; FLAT FOOT;
POLYDACTYLY AND SYNDACTYLY OF TOES
new text end

new text begin Treatment: MEDICAL THERAPY, ORTHOTIC
new text end

new text begin ICD-9: 734, 736.73, 755.00, 755.02, 755.10, 755.13-755.14
new text end

new text begin (75) Diagnosis: PERIPHERAL ENTHESOPATHIES
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 726.12, 726.3-726.9, 728.81
new text end

new text begin (76) Diagnosis: PERIPHERAL ENTHESOPATHIES
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 726.12, 726.3-726.4, 726.6-726.9, 728.81
new text end

new text begin (77) Diagnosis: DISORDERS OF SOFT TISSUE
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 729.0-729.2, 729.31-729.39, 729.4-729.9
new text end

new text begin (78) Diagnosis: ENOPHTHALMOS
new text end

new text begin Treatment: ORBITAL IMPLANT
new text end

new text begin ICD-9: 372.64, 376.5
new text end

new text begin (79) Diagnosis: MACROMASTIA
new text end

new text begin Treatment: SUBCUTANEOUS TOTAL MASTECTOMY, BREAST REDUCTION
new text end

new text begin ICD-9: 611.1
new text end

new text begin (80) Diagnosis: GALACTORRHEA, MASTODYNIA, ATROPHY, BENIGN
NEOPLASMS AND UNSPECIFIED DISORDERS OF THE BREAST
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 217, 611.3, 611.4, 611.6, 611.71, 611.9, 757.6
new text end

new text begin (81) Diagnosis: ACUTE AND CHRONIC DISORDERS OF SPINE
WITHOUT NEUROLOGIC IMPAIRMENT
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 721.0, 721.2-721.3, 721.7-721.8, 721.90, 722.0-722.6,
722.8-722.9, 723.1, 723.5-723.9, 724.1-724.2, 724.5-724.9, 739,
839.2, 847
new text end

new text begin (82) Diagnosis: CYSTS OF ORAL SOFT TISSUES
new text end

new text begin Treatment: INCISION AND DRAINAGE
new text end

new text begin ICD-9: 527.1, 528.4, 528.8
new text end

new text begin (83) Diagnosis: FEMALE INFERTILITY, MALE INFERTILITY
new text end

new text begin Treatment: ARTIFICIAL INSEMINATION, MEDICAL THERAPY
new text end

new text begin ICD-9: 606, 628.4-628.9, 629.9, V26.1-V26.2, V26.8-V26.9
new text end

new text begin (84) Diagnosis: INFERTILITY DUE TO ANNOVULATION
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 626.0-626.1, 628.0, 628.1
new text end

new text begin (85) Diagnosis: POSTCONCUSSION SYNDROME
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 310.2
new text end

new text begin (86) Diagnosis: SIMPLE AND UNSPECIFIED GOITER, NONTOXIC
NODULAR GOITER
new text end

new text begin Treatment: MEDICAL THERAPY, THYROIDECTOMY
new text end

new text begin ICD-9: 240-241
new text end

new text begin (87) Diagnosis: CONDUCTIVE HEARING LOSS
new text end

new text begin Treatment: AUDIANT BONE CONDUCTORS
new text end

new text begin ICD-9: 389.0, 389.2
new text end

new text begin (88) Diagnosis: CANCER OF LIVER AND INTRAHEPATIC BILE
DUCTS
new text end

new text begin Treatment: LIVER TRANSPLANT
new text end

new text begin ICD-9: 155.0-155.1, 996.82
new text end

new text begin (89) Diagnosis: HYPOTENSION
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 458
new text end

new text begin (90) Diagnosis: VIRAL HEPATITIS, EXCLUDING CHRONIC VIRAL
HEPATITIS B AND VIRAL HEPATITIS C WITHOUT HEPATIC COMA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 070.0-070.2, 070.30-070.31, 070.33, 070.4,
070.52-070.53, 070.59, 070.6-070.9
new text end

new text begin (91) Diagnosis: BENIGN NEOPLASMS OF SKIN AND OTHER SOFT
TISSUES
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 210, 214, 216, 221, 222.1, 222.4, 228.00-228.01, 228.1,
229, 686.1, 686.9
new text end

new text begin (92) Diagnosis: REDUNDANT PREPUCE
new text end

new text begin Treatment: ELECTIVE CIRCUMCISION
new text end

new text begin ICD-9: 605, V50.2
new text end

new text begin (93) Diagnosis: BENIGN NEOPLASMS OF DIGESTIVE SYSTEM
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 211.0-211.2, 211.5-211.6, 211.8-211.9
new text end

new text begin (94) Diagnosis: OTHER NONINFECTIOUS GASTROENTERITIS AND
COLITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 558
new text end

new text begin (95) Diagnosis: FACTITIOUS DISORDERS
new text end

new text begin Treatment: CONSULTATION
new text end

new text begin ICD-9: 300.10, 300.16, 300.19, 301.51
new text end

new text begin (96) Diagnosis: HYPOCHONDRIASIS; SOMATOFORM DISORDER, NOS
AND UNDIFFERENTIATED
new text end

new text begin Treatment: CONSULTATION
new text end

new text begin ICD-9: 300.7, 300.9, 306
new text end

new text begin (97) Diagnosis: CONVERSION DISORDER, ADULT
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 300.11
new text end

new text begin (98) Diagnosis: SPINAL DEFORMITY, NOT CLINICALLY
SIGNIFICANT
new text end

new text begin Treatment: ARTHRODESIS/REPAIR/RECONSTRUCTION, MEDICAL THERAPY
new text end

new text begin ICD-9: 721.5-721.6, 723.0, 724.0, 731.0, 737.0-737.3,
737.8-737.9, 738.4-738.5, 754.1-754.2, 756.10-756.12,
756.13-756.17, 756.19, 756.3
new text end

new text begin (99) Diagnosis: ASYMPTOMATIC URTICARIA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 708.2-708.4, 708.9
new text end

new text begin (100) Diagnosis: CIRCUMSCRIBED SCLERODERMA; SENILE PURPURA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 287.2, 287.8-287.9, 701.0
new text end

new text begin (101) Diagnosis: DERMATITIS DUE TO SUBSTANCES TAKEN
INTERNALLY
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 693
new text end

new text begin (102) Diagnosis: ALLERGIC RHINITIS AND CONJUNCTIVITIS,
CHRONIC RHINITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 372.01-372.05, 372.14, 372.54, 372.56, 472, 477, 955.3,
V07.1
new text end

new text begin (103) Diagnosis: PLEURISY
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 511.0, 511.9
new text end

new text begin (104) Diagnosis: CONJUNCTIVAL CYST
new text end

new text begin Treatment: EXCISION OF CONJUNCTIVAL CYST
new text end

new text begin ICD-9: 372.61-372.62, 372.71-372.72, 372.74-372.75
new text end

new text begin (105) Diagnosis: HEMATOMA OF AURICLE OR PINNA AND HEMATOMA
OF EXTERNAL EAR
new text end

new text begin Treatment: DRAINAGE
new text end

new text begin ICD-9: 380.3, 380.8, 738.7
new text end

new text begin (106) Diagnosis: ACUTE NONSUPPURATIVE LABYRINTHITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 386.30-386.32, 386.34-386.35
new text end

new text begin (107) Diagnosis: INFECTIOUS MONONUCLEOSIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 075
new text end

new text begin (108) Diagnosis: ASEPTIC MENINGITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 047-049
new text end

new text begin (109) Diagnosis: CONGENITAL ANOMALIES OF FEMALE GENITAL
ORGANS, EXCLUDING VAGINA
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 752.0-752.3, 752.41
new text end

new text begin (110) Diagnosis: CONGENITAL DEFORMITIES OF KNEE
new text end

new text begin Treatment: ARTHROSCOPIC REPAIR
new text end

new text begin ICD-9: 755.64, 727.83
new text end

new text begin (111) Diagnosis: UNCOMPLICATED HERNIA IN ADULTS AGE 18 OR
OVER
new text end

new text begin Treatment: REPAIR
new text end

new text begin ICD-9: 550.9, 553.0-553.2, 553.8-553.9
new text end

new text begin (112) Diagnosis: ACUTE ANAL FISSURE
new text end

new text begin Treatment: FISSURECTOMY, MEDICAL THERAPY
new text end

new text begin ICD-9: 565.0
new text end

new text begin (113) Diagnosis: CYST OF KIDNEY, ACQUIRED
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 593.2
new text end

new text begin (114) Diagnosis: PICA
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 307.52
new text end

new text begin (115) Diagnosis: DISORDERS OF SLEEP WITHOUT SLEEP APNEA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 307.41-307.45, 307.47-307.49, 780.50, 780.52,
780.54-780.56, 780.59
new text end

new text begin (116) Diagnosis: CYST, HEMORRHAGE, AND INFARCTION OF
THYROID
new text end

new text begin Treatment: SURGERY - EXCISION
new text end

new text begin ICD-9: 246.2, 246.3, 246.9
new text end

new text begin (117) Diagnosis: DEVIATED NASAL SEPTUM, ACQUIRED DEFORMITY
OF NOSE, OTHER DISEASES OF UPPER RESPIRATORY TRACT
new text end

new text begin Treatment: EXCISION OF CYST/RHINECTOMY/PROSTHESIS
new text end

new text begin ICD-9: 470, 478.0, 738.0, 754.0
new text end

new text begin (118) Diagnosis: ERYTHEMA MULTIFORM
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 695.1
new text end

new text begin (119) Diagnosis: HERPES SIMPLEX WITHOUT COMPLICATIONS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 054.2, 054.6, 054.73, 054.9
new text end

new text begin (120) Diagnosis: CONGENITAL ANOMALIES OF THE EAR WITHOUT
IMPAIRMENT OF HEARING; UNILATERAL ANOMALIES OF THE EAR
new text end

new text begin Treatment: OTOPLASTY, REPAIR AND AMPUTATION
new text end

new text begin ICD-9: 744.00-744.04, 744.09, 744.1-744.3
new text end

new text begin (121) Diagnosis: BLEPHARITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 373.0, 373.8-373.9, 374.87
new text end

new text begin (122) Diagnosis: HYPERTELORISM OF ORBIT
new text end

new text begin Treatment: ORBITOTOMY
new text end

new text begin ICD-9: 376.41
new text end

new text begin (123) Diagnosis: INFERTILITY DUE TO TUBAL DISEASE
new text end

new text begin Treatment: MICROSURGERY
new text end

new text begin ICD-9: 608.85, 622.5, 628.2-628.3, 629.9, V26.0
new text end

new text begin (124) Diagnosis: KERATODERMA, ACANTHOSIS NIGRICANS, STRIAE
ATROPHICAE, AND OTHER HYPERTROPHIC OR ATROPHIC CONDITIONS OF
SKIN
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 373.3, 690, 698, 701.1-701.3, 701.8, 701.9
new text end

new text begin (125) Diagnosis: LICHEN PLANUS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 697
new text end

new text begin (126) Diagnosis: OBESITY
new text end

new text begin Treatment: NUTRITIONAL AND LIFESTYLE COUNSELING
new text end

new text begin ICD-9: 278.0
new text end

new text begin (127) Diagnosis: MORBID OBESITY
new text end

new text begin Treatment: GASTROPLASTY
new text end

new text begin ICD-9: 278.01
new text end

new text begin (128) Diagnosis: CHRONIC DISEASE OF TONSILS AND ADENOIDS
new text end

new text begin Treatment: TONSILLECTOMY AND ADENOIDECTOMY
new text end

new text begin ICD-9: 474.0, 474.1-474.2, 474.9
new text end

new text begin (129) Diagnosis: HYDROCELE
new text end

new text begin Treatment: MEDICAL THERAPY, EXCISION
new text end

new text begin ICD-9: 603, 608.84, 629.1, 778.6
new text end

new text begin (130) Diagnosis: KELOID SCAR; OTHER ABNORMAL GRANULATION
TISSUE
new text end

new text begin Treatment: INTRALESIONAL INJECTIONS/DESTRUCTION/EXCISION,
RADIATION THERAPY
new text end

new text begin ICD-9: 701.4-701.5
new text end

new text begin (131) Diagnosis: NONINFLAMMATORY DISORDERS OF CERVIX;
HYPERTROPHY OF LABIA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 622.4, 622.6-622.9, 623.4, 624.2-624.3, 624.6-624.9
new text end

new text begin (132) Diagnosis: SPRAINS OF JOINTS AND ADJACENT MUSCLES,
GRADE I
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 355.1-355.3, 355.9, 717, 718.26, 718.36, 718.46, 718.56,
836.0-836.2, 840-843, 844.0-844.3, 844.8-844.9, 845.00-845.03,
845.1, 846, 848.3, 848.40-848.42, 848.49, 848.5, 848.8-848.9,
905.7
new text end

new text begin (133) Diagnosis: SYNOVITIS AND TENOSYNOVITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 726.12, 727.00, 727.03-727.09
new text end

new text begin (134) Diagnosis: OTHER DISORDERS OF SYNOVIUM, TENDON AND
BURSA, COSTOCHONDRITIS, AND CHONDRODYSTROPHY
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 719.5-719.6, 719.80, 719.86, 727.2-727.3, 727.50,
727.60, 727.82, 727.9, 733.5-733.7, 756.4
new text end

new text begin (135) Diagnosis: DISEASE OF NAILS, HAIR, AND HAIR
FOLLICLES
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 703.8-703.9, 704.0, 704.1-704.9, 706.3, 706.9,
757.4-757.5, V50.0
new text end

new text begin (136) Diagnosis: CANDIDIASIS OF MOUTH, SKIN, AND NAILS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 112.0, 112.3, 112.9
new text end

new text begin (137) Diagnosis: BENIGN LESIONS OF TONGUE
new text end

new text begin Treatment: EXCISION
new text end

new text begin ICD-9: 529.1-529.6, 529.8-529.9
new text end

new text begin (138) Diagnosis: MINOR BURNS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 692.76, 941.0-941.2, 942.0-942.2, 943.0-943.2,
944.0-944.2, 945.0-945.2, 946.0-946.2, 949.0-949.1
new text end

new text begin (139) Diagnosis: MINOR HEAD INJURY: HEMATOMA/EDEMA WITH
NO LOSS OF CONSCIOUSNESS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 800.00-800.01, 801.00-801.01, 803.00-803.01, 850.0,
850.9, 851.00-851.01, 851.09, 851.20-851.21, 851.29,
851.40-851.41, 851.49, 851.60-851.61, 851.69, 851.80-851.81,
851.89
new text end

new text begin (140) Diagnosis: CONGENITAL DEFORMITY OF KNEE
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 755.64
new text end

new text begin (141) Diagnosis: PHLEBITIS AND THROMBOPHLEBITIS,
SUPERFICIAL
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 451.0, 451.2, 451.82, 451.84, 451.89, 451.9
new text end

new text begin (142) Diagnosis: PROLAPSED URETHRAL MUCOSA
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 599.3, 599.5
new text end

new text begin (143) Diagnosis: RUPTURE OF SYNOVIUM
new text end

new text begin Treatment: REMOVAL OF BAKER'S CYST
new text end

new text begin ICD-9: 727.51
new text end

new text begin (144) Diagnosis: PERSONALITY DISORDERS, EXCLUDING
BORDERLINE, SCHIZOTYPAL AND ANTISOCIAL
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 301.0, 301.10-301.12, 301.20-301.21, 301.3-301.4,
301.50, 301.59, 301.6, 301.81-301.82, 301.84, 301.89, 301.9
new text end

new text begin (145) Diagnosis: GENDER IDENTIFICATION DISORDER,
PARAPHILIAS AND OTHER PSYCHOSEXUAL DISORDERS
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 302.0-302.4, 302.50, 302.6, 302.85, 302.9
new text end

new text begin (146) Diagnosis: FINGERTIP AVULSION
new text end

new text begin Treatment: REPAIR WITHOUT PEDICLE GRAFT
new text end

new text begin ICD-9: 883.0
new text end

new text begin (147) Diagnosis: ANOMALIES OF RELATIONSHIP OF JAW TO
CRANIAL BASE, MAJOR ANOMALIES OF JAW SIZE, OTHER SPECIFIED AND
UNSPECIFIED DENTOFACIAL ANOMALIES
new text end

new text begin Treatment: OSTEOPLASTY, MAXILLA/MANDIBLE
new text end

new text begin ICD-9: 524.0-524.2, 524.5, 524.7-524.8, 524.9
new text end

new text begin (148) Diagnosis: CERVICAL RIB
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 756.2
new text end

new text begin (149) Diagnosis: GYNECOMASTIA
new text end

new text begin Treatment: MASTECTOMY
new text end

new text begin ICD-9: 611.1
new text end

new text begin (150) Diagnosis: VIRAL, SELF-LIMITING ENCEPHALITIS,
MYELITIS AND ENCEPHALOMYELITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 056.0, 056.71, 323.8-323.9
new text end

new text begin (151) Diagnosis: GALLSTONES WITHOUT CHOLECYSTITIS
new text end

new text begin Treatment: MEDICAL THERAPY, CHOLECYSTECTOMY
new text end

new text begin ICD-9: 574.2, 575.8
new text end

new text begin (152) Diagnosis: BENIGN NEOPLASM OF NASAL CAVITIES, MIDDLE
EAR AND ACCESSORY SINUSES
new text end

new text begin Treatment: EXCISION, RECONSTRUCTION
new text end

new text begin ICD-9: 212.0
new text end

new text begin (153) Diagnosis: ACUTE TONSILLITIS OTHER THAN
BETA-STREPTOCOCCAL
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 463
new text end

new text begin (154) Diagnosis: EDEMA AND OTHER CONDITIONS INVOLVING THE
INTEGUMENT OF THE FETUS AND NEWBORN
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 778.5, 778.7-778.9
new text end

new text begin (155) Diagnosis: ACUTE UPPER RESPIRATORY INFECTIONS AND
COMMON COLD
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 460, 465
new text end

new text begin (156) Diagnosis: DIAPER RASH
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 691.0
new text end

new text begin (157) Diagnosis: DISORDERS OF SWEAT GLANDS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 705.0-705.1, 705.81-705.83, 705.89, 705.9, 780.8
new text end

new text begin (158) Diagnosis: OTHER VIRAL INFECTIONS, EXCLUDING
PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER
AGE 3
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 052, 055, 056.79, 056.8-056.9, 057, 072, 074, 078.0,
078.2, 078.4-078.8, 079.0-079.6, 079.88-079.89, 079.9, 480, 487
new text end

new text begin (159) Diagnosis: PHARYNGITIS AND LARYNGITIS AND OTHER
DISEASES OF VOCAL CORDS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 462, 464.00, 464.50, 476, 478.5
new text end

new text begin (160) Diagnosis: CORNS AND CALLUSES
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 700
new text end

new text begin (161) Diagnosis: VIRAL WARTS, EXCLUDING VENEREAL WARTS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT, CRYOSURGERY
new text end

new text begin ICD-9: 078.0, 078.10, 078.19
new text end

new text begin (162) Diagnosis: OLD LACERATION OF CERVIX AND VAGINA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 621.5, 622.3, 624.4
new text end

new text begin (163) Diagnosis: TONGUE TIE AND OTHER ANOMALIES OF TONGUE
new text end

new text begin Treatment: FRENOTOMY, TONGUE TIE
new text end

new text begin ICD-9: 529.5, 750.0-750.1
new text end

new text begin (164) Diagnosis: OPEN WOUND OF INTERNAL STRUCTURES OF
MOUTH WITHOUT COMPLICATION
new text end

new text begin Treatment: REPAIR SOFT TISSUES
new text end

new text begin ICD-9: 525.10, 525.12, 525.13, 525.19, 873.6
new text end

new text begin (165) Diagnosis: CENTRAL SEROUS RETINOPATHY
new text end

new text begin Treatment: LASER SURGERY
new text end

new text begin ICD-9: 362.40-362.41, 362.6-362.7
new text end

new text begin (166) Diagnosis: SEBORRHEIC KERATOSIS, DYSCHROMIA, AND
VASCULAR DISORDERS, SCAR CONDITIONS, AND FIBROSIS OF SKIN
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 278.1, 702.1-702.8, 709.1-709.3, 709.8-709.9
new text end

new text begin (167) Diagnosis: UNCOMPLICATED HEMORRHOIDS
new text end

new text begin Treatment: HEMORRHOIDECTOMY, MEDICAL THERAPY
new text end

new text begin ICD-9: 455.0, 455.3, 455.6, 455.9
new text end

new text begin (168) Diagnosis: GANGLION
new text end

new text begin Treatment: EXCISION
new text end

new text begin ICD-9: 727.02, 727.4
new text end

new text begin (169) Diagnosis: CHRONIC CONJUNCTIVITIS,
BLEPHAROCONJUNCTIVITIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 372.10-372.13, 372.2-372.3, 372.53, 372.73, 374.55
new text end

new text begin (170) Diagnosis: TOXIC ERYTHEMA, ACNE ROSACEA, DISCOID
LUPUS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 695.0, 695.2-695.9
new text end

new text begin (171) Diagnosis: PERIPHERAL NERVE DISORDERS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3,
355.7-355.8, 357.5-357.9, 723.2
new text end

new text begin (172) Diagnosis: OTHER COMPLICATIONS OF A PROCEDURE
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 371.82, 457.0, 998.81, 998.9
new text end

new text begin (173) Diagnosis: RAYNAUD'S SYNDROME
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 443.0, 443.89, 443.9
new text end

new text begin (174) Diagnosis: TMJ DISORDERS
new text end

new text begin Treatment: TMJ SURGERY
new text end

new text begin ICD-9: 524.5, 524.6, 718.08, 718.18, 718.28, 718.38, 718.58
new text end

new text begin (175) Diagnosis: VARICOSE VEINS OF LOWER EXTREMITIES
WITHOUT ULCER OR INFLAMMATION
new text end

new text begin Treatment: STRIPPING/SCLEROTHERAPY
new text end

new text begin ICD-9: 454.9, 459, 607.82
new text end

new text begin (176) Diagnosis: VULVAL VARICES
new text end

new text begin Treatment: VASCULAR SURGERY
new text end

new text begin ICD-9: 456.6
new text end

new text begin (177) Diagnosis: CHRONIC PANCREATITIS
new text end

new text begin Treatment: SURGICAL TREATMENT
new text end

new text begin ICD-9: 577.1
new text end

new text begin (178) Diagnosis: CHRONIC PROSTATITIS, OTHER DISORDERS OF
PROSTATE
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 601.1, 601.3, 601.9, 602
new text end

new text begin (179) Diagnosis: MUSCULAR CALCIFICATION AND OSSIFICATION
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 728.1
new text end

new text begin (180) Diagnosis: CANCER OF VARIOUS SITES WHERE TREATMENT
WILL NOT RESULT IN A FIVE PERCENT FIVE-YEAR SURVIVAL
new text end

new text begin Treatment: CURATIVE MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 140-208
new text end

new text begin (181) Diagnosis: AGENESIS OF LUNG
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 748.5
new text end

new text begin (182) Diagnosis: DISEASE OF CAPILLARIES
new text end

new text begin Treatment: EXCISION
new text end

new text begin ICD-9: 448.1-448.9
new text end

new text begin (183) Diagnosis: BENIGN POLYPS OF VOCAL CORDS
new text end

new text begin Treatment: MEDICAL THERAPY, STRIPPING
new text end

new text begin ICD-9: 478.4
new text end

new text begin (184) Diagnosis: FRACTURES OF RIBS AND STERNUM, CLOSED
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 807.0, 807.2, 805.6, 839.41
new text end

new text begin (185) Diagnosis: CLOSED FRACTURE OF ONE OR MORE PHALANGES
OF THE FOOT, NOT INCLUDING THE GREAT TOE
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 826.0
new text end

new text begin (186) Diagnosis: DISEASES OF THYMUS GLAND
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 254
new text end

new text begin (187) Diagnosis: DENTAL CONDITIONS WHERE TREATMENT RESULTS
IN MARGINAL IMPROVEMENT
new text end

new text begin Treatment: ELECTIVE DENTAL SERVICES
new text end

new text begin ICD-9: 520.7, V72.2
new text end

new text begin (188) Diagnosis: ANTISOCIAL PERSONALITY DISORDER
new text end

new text begin Treatment: MEDICAL/PSYCHOTHERAPY
new text end

new text begin ICD-9: 301.7
new text end

new text begin (189) Diagnosis: SEBACEOUS CYST
new text end

new text begin Treatment: MEDICAL AND SURGICAL THERAPY
new text end

new text begin ICD-9: 685.1, 706.2, 744.47
new text end

new text begin (190) Diagnosis: CENTRAL RETINAL ARTERY OCCLUSION
new text end

new text begin Treatment: PARACENTESIS OF AQUEOUS
new text end

new text begin ICD-9: 362.31-362.33
new text end

new text begin (191) Diagnosis: ORAL APHTHAE
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 528.2
new text end

new text begin (192) Diagnosis: SUBLINGUAL, SCROTAL, AND PELVIC VARICES
new text end

new text begin Treatment: VENOUS INJECTION, VASCULAR SURGERY
new text end

new text begin ICD-9: 456.3-456.5
new text end

new text begin (193) Diagnosis: SUPERFICIAL WOUNDS WITHOUT INFECTION AND
CONTUSIONS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 910.0, 910.2, 910.4, 910.6, 910.8, 911.0, 911.2, 911.4,
911.6, 911.8, 912.0, 912.2, 912.4, 912.6, 912.8, 913.0, 913.2,
913.4, 913.6, 913.8, 914.0, 914.2, 914.4, 914.6, 914.8, 915.0,
915.2, 915.4, 915.6, 915.8, 916.0, 916.2, 916.4, 916.6, 916.8,
917.0, 917.2, 917.4, 917.6, 917.8, 919.0, 919.2, 919.4, 919.6,
919.8, 920-924, 959.0-959.8
new text end

new text begin (194) Diagnosis: UNSPECIFIED RETINAL VASCULAR OCCLUSION
new text end

new text begin Treatment: LASER SURGERY
new text end

new text begin ICD-9: 362.30
new text end

new text begin (195) Diagnosis: BENIGN NEOPLASM OF EXTERNAL FEMALE
GENITAL ORGANS
new text end

new text begin Treatment: EXCISION
new text end

new text begin ICD-9: 221.1-221.9
new text end

new text begin (196) Diagnosis: BENIGN NEOPLASM OF MALE GENITAL ORGANS:
TESTIS, PROSTATE, EPIDIDYMIS
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 222.0, 222.2, 222.3, 222.8, 222.9
new text end

new text begin (197) Diagnosis: XEROSIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 706.8
new text end

new text begin (198) Diagnosis: CONGENITAL CYSTIC LUNG - SEVERE
new text end

new text begin Treatment: LUNG RESECTION
new text end

new text begin ICD-9: 748.4
new text end

new text begin (199) Diagnosis: ICHTHYOSIS
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 757.1
new text end

new text begin (200) Diagnosis: LYMPHEDEMA
new text end

new text begin Treatment: MEDICAL THERAPY, OTHER OPERATION ON LYMPH CHANNEL
new text end

new text begin ICD-9: 457.1-457.9, 757.0
new text end

new text begin (201) Diagnosis: DERMATOLOGICAL CONDITIONS WITH NO
EFFECTIVE TREATMENT OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: MEDICAL AND SURGICAL TREATMENT
new text end

new text begin ICD-9: 696.3-696.5, 709.0, 757.2-757.3, 757.8-757.9
new text end

new text begin (202) Diagnosis: INFECTIOUS DISEASES WITH NO EFFECTIVE
TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 071, 136.0, 136.9
new text end

new text begin (203) Diagnosis: RESPIRATORY CONDITIONS WITH NO EFFECTIVE
TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 519.3, 519.9, 748.60, 748.69, 748.9
new text end

new text begin (204) Diagnosis: GENITOURINARY CONDITIONS WITH NO
EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 593.0-593.1, 593.6, 607.9, 608.3, 608.9, 621.6,
621.8-621.9, 626.9, 629.8, 752.9
new text end

new text begin (205) Diagnosis: CARDIOVASCULAR CONDITIONS WITH NO
EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 429.3, 429.81-429.82, 429.89, 429.9, 747.9
new text end

new text begin (206) Diagnosis: MUSCULOSKELETAL CONDITIONS WITH NO
EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 716.9, 718.00, 718.10, 718.20, 718.40, 718.50, 718.60,
718.80, 718.9, 719.7, 719.9, 728.5, 728.84, 728.9, 731.2,
738.2-738.3, 738.9, 744.5-744.9, 748.1, 755.9, 756.9
new text end

new text begin (207) Diagnosis: INTRACRANIAL CONDITIONS WITH NO EFFECTIVE
TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 348.2, 377.01, 377.02, 377.2, 377.3, 377.5, 377.7,
437.7-437.8
new text end

new text begin (208) Diagnosis: SENSORY ORGAN CONDITIONS WITH NO
EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 360.30-360.31, 360.33, 362.37, 362.42-362.43,
362.8-362.9, 363.21, 364.5, 364.60, 364.9, 371.20, 371.22,
371.24, 371.3, 371.81, 371.89, 371.9, 372.40-372.42,
372.44-372.45, 372.50-372.52, 372.55, 372.8-372.9,
374.52-374.53, 374.81-374.83, 374.9, 376.82, 376.89, 376.9,
377.03, 377.1, 377.4, 377.6, 379.24, 379.29, 379.4-379.8, 380.9,
747.47
new text end

new text begin (209) Diagnosis: ENDOCRINE AND METABOLIC CONDITIONS WITH
NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 251.1-251.2, 259.4, 259.8-259.9, 277.3, 759.1
new text end

new text begin (210) Diagnosis: GASTROINTESTINAL CONDITIONS WITH NO
EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 527.0, 569.9, 573.9
new text end

new text begin (211) Diagnosis: MENTAL DISORDERS WITH NO EFFECTIVE
TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 313.1, 313.3, 313.83
new text end

new text begin (212) Diagnosis: NEUROLOGIC CONDITIONS WITH NO EFFECTIVE
TREATMENTS OR NO TREATMENT NECESSARY
new text end

new text begin Treatment: EVALUATION
new text end

new text begin ICD-9: 333.82, 333.84, 333.91, 333.93
new text end

new text begin (213) Diagnosis: DENTAL CONDITIONS (e.g., ORTHODONTICS)
new text end

new text begin Treatment: COSMETIC DENTAL SERVICES
new text end

new text begin ICD-9: 520.0-520.5, 520.8-520.9, 521.1-521.9, 522.3, V72.2
new text end

new text begin (214) Diagnosis: TUBAL DYSFUNCTION AND OTHER CAUSES OF
INFERTILITY
new text end

new text begin Treatment: IN-VITRO FERTILIZATION, GIFT
new text end

new text begin ICD-9: 256
new text end

new text begin (215) Diagnosis: HEPATORENAL SYNDROME
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 572.4
new text end

new text begin (216) Diagnosis: SPASTIC DYSPHONIA
new text end

new text begin Treatment: MEDICAL THERAPY
new text end

new text begin ICD-9: 478.79
new text end

new text begin (217) Diagnosis: DISORDERS OF REFRACTION AND ACCOMMODATION
new text end

new text begin Treatment: RADIAL KERATOTOMY
new text end

new text begin ICD-9: 367, 368.1-368.9
new text end

new text begin (b) The commissioner of human services shall identify the
related CPT codes that correspond with the diagnosis/treatment
pairings described in this section. The identification of the
related CPT codes is not subject to the requirements of
Minnesota Statutes, chapter 14, and Minnesota Statutes, section
14.386 does not apply.
new text end

new text begin Subd. 4. new text end

new text begin Federal approval. new text end

new text begin The commissioner of human
services shall seek federal approval to eliminate medical
assistance coverage for the diagnosis/treatment pairings
described in subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Nonexpansion of covered services. new text end

new text begin Nothing in
this section shall be construed to expand medical assistance
coverage to services that are not currently covered under the
medical assistance program as of June 30, 2005.
new text end

Sec. 47. new text begin MINNESOTACARE OPTION FOR SMALL EMPLOYERS.
new text end

new text begin The commissioner of human services, in consultation with
the Minnesota Hospital Association, Minnesota Medical
Association, Minnesota Chamber of Commerce, and the Minnesota
Business Partnership shall evaluate the effect of the limited
hospital benefit under the MinnesotaCare program for single
adults without children as it applies to the MinnesotaCare
enrollment option for small employers described under Minnesota
Statutes, section 256L.20. In the evaluation, the commissioner
shall determine whether this limitation discourages
participation in the program by small employers, whether it has
added to the amount of uncompensated care provided by hospitals,
and the cost to the MinnesotaCare program if the hospital
benefit limitation was eliminated for enrollees enrolled under
Minnesota Statutes, section 256L.20. The commissioner shall
submit the results of the evaluation to the legislature by
January 15, 2006.
new text end

Sec. 48. new text begin QUALITY IMPROVEMENT.
new text end

new text begin The commissioners of human services and employee relations
shall jointly develop a written plan for a provider payment
system to be implemented by January 1, 2007. Under the provider
payment system, a minimum of five percent of a provider's
payment shall be withheld. Return of the withhold to a provider
will be conditioned on the provider achieving certain quality
improvement performance standards. The commissioners shall
consult with local and national quality improvement groups to
identify appropriate standards and measures related to
performance. The plan must be submitted to the legislature by
March 1, 2006. This provision does not prohibit the
commissioners from negotiating the implementation of
performance-based payment terms with particular providers prior
to January 1, 2006.
new text end

Sec. 49. new text begin TASK FORCE ON IMPROVING HEALTH STATUS OF STATE'S
CHILDREN.
new text end

new text begin (a) The commissioners of education, health, and human
services shall convene a task force to study and make
recommendations on the role of public schools in improving the
health status of children. In order to assess the health status
of children, the task force shall determine the number of
children who are currently obese and set a goal, including
measurable outcomes for the state in terms of reducing the rate
of childhood obesity. The task force shall make recommendations
on how to achieve this goal, including, but not limited to,
increasing physical education activities within the public
schools; exploring opportunities to promote physical education
and healthy eating programs; improving the nutritional offerings
through breakfast and lunch menus; and evaluating the
availability and choice of nutritional products offered in
public schools. The members of the task force shall include
representatives of the Minnesota Medical Association; the
Minnesota Nurses Association; the Local Public Health
Association of Minnesota; the Minnesota Dietetic Association;
the Minnesota School Food Service Association; the Minnesota
Association of Health, Physical Education, Recreation, and
Dance; the Minnesota School Boards Association; the Minnesota
School Administrators Association; the Minnesota Secondary
Principals Association; the vending industry; and consumers.
The terms and compensation of the members of the task force
shall be in accordance with Minnesota Statutes, section 15.059,
subdivision 6.
new text end

new text begin (b) The commissioner must submit the recommendations of the
task force to the legislature by January 15, 2006.
new text end

Sec. 50. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated for the biennium beginning
July 1, 2005, from the general fund to the Board of Trustees of
the Minnesota State Colleges and Universities for the nursing
and health care education plan designed to:
new text end

new text begin (1) expand the system's enrollment in registered nursing
education programs;
new text end

new text begin (2) support practical nursing programs in regions of high
need;
new text end

new text begin (3) address the shortage of nursing faculty; and
new text end

new text begin (4) provide accessible learning opportunities to students
through distance education and simulation experiences.
new text end

new text begin (b) $....... is appropriated from the general fund to the
commissioner of finance for transfer to the electronic medical
record system loan fund to capitalize the fund. The
appropriation is available until expended.
new text end

new text begin (c) $....... is appropriated for the biennium beginning
July 1, 2005, from the general fund to the commissioner of
health for the loan forgiveness program in Minnesota Statutes,
section 144.1501.
new text end

new text begin (d) $500,000 is appropriated for fiscal year 2006 from the
health care access fund to the Board of Regents of the
University of Minnesota for the University of Minnesota's dental
clinic to address dental care access for low-income patients.
new text end

Sec. 51. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, sections 256.955, subdivision 4a;
256B.075, subdivision 5; and 256L.035, are repealed.
new text end