HF 1602

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; making health care 
  1.3             changes; clarifying prescription drug coverage for the 
  1.4             senior drug program; allowing reconsideration of 
  1.5             commissioner's decision that services are not 
  1.6             medically necessary under medical assistance program; 
  1.7             changing medical assistance payments for hospital 
  1.8             providers; establishing performance measurement for 
  1.9             health care; changing a provision for medical 
  1.10            assistance eligibility; establishing medical 
  1.11            assistance income standard for supplemental security 
  1.12            income recipients; adopting income deductions for 
  1.13            medical assistance for institutionalized persons; 
  1.14            changing rehabilitation services review; establishing 
  1.15            telemedicine consultation; improving pharmacy medicine 
  1.16            management; refinancing medical assistance school 
  1.17            reimbursement; providing community-based services for 
  1.18            severely emotionally disturbed children; increasing 
  1.19            professional provider payment; improving dental 
  1.20            access; clarifying MinnesotaCare premium payment 
  1.21            provisions; clarifying earned income disregard in the 
  1.22            waiver request to health care financing 
  1.23            administration; amending Minnesota Statutes 1998, 
  1.24            sections 256.955, subdivisions 3, 4, 7, 8, and 9; 
  1.25            256.9685, subdivision 1a; 256.969, subdivision 1; 
  1.26            256B.04, by adding a subdivision; 256B.055, 
  1.27            subdivision 3a; 256B.056, subdivision 4; 256B.057, by 
  1.28            adding a subdivision; 256B.0575; 256B.0625, 
  1.29            subdivisions 8, 8a, 13, 26, 32, 35, and by adding 
  1.30            subdivisions; 256B.0635, subdivision 3; 256B.75; 
  1.31            256B.76; 256L.03, subdivision 5; 256L.04, subdivisions 
  1.32            2, 8, and 13; 256L.05, subdivision 4; 256L.06, 
  1.33            subdivision 3; 256L.07; and 256L.15, subdivisions 1, 
  1.34            1b, and 2; Laws 1995, chapter 178, article 2, section 
  1.35            46, subdivision 10. 
  1.36  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.37     Section 1.  Minnesota Statutes 1998, section 256.955, 
  1.38  subdivision 3, is amended to read: 
  1.39     Subd. 3.  [PRESCRIPTION DRUG COVERAGE.] Coverage under the 
  1.40  program is limited to prescription drugs covered under the 
  2.1   medical assistance program as described in section 256B.0625, 
  2.2   subdivision 13, subject to a maximum deductible of $300 
  2.3   annually, except drugs cleared by the FDA shall be available to 
  2.4   qualified senior citizens enrolled in the program without 
  2.5   restriction when prescribed for medically accepted indication as 
  2.6   defined in the federal rebate program under section 1927 of 
  2.7   title XIX of the federal Social Security Act.  Coverage under 
  2.8   the program shall be limited to those prescription drugs that: 
  2.9      (1) are covered under the medical assistance program as 
  2.10  described in section 256B.0625, subdivision 13; and 
  2.11     (2) are provided by manufacturers that have fully executed 
  2.12  senior drug rebate agreements with the commissioner and comply 
  2.13  with such agreements. 
  2.14     Sec. 2.  Minnesota Statutes 1998, section 256.955, 
  2.15  subdivision 4, is amended to read: 
  2.16     Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
  2.17  MEDICAL ASSISTANCE.] Applications and information on the program 
  2.18  must be made available at county social service agencies, health 
  2.19  care provider offices, and agencies and organizations serving 
  2.20  senior citizens.  Senior citizens shall submit applications and 
  2.21  any information specified by the commissioner as being necessary 
  2.22  to verify eligibility directly to the county social service 
  2.23  agencies:  
  2.24     (1) beginning January 1, 1999, the county social service 
  2.25  agency shall determine medical assistance spenddown eligibility 
  2.26  of individuals who qualify for the senior citizen drug program 
  2.27  of individuals; and 
  2.28     (2) program payments will be used to reduce the spenddown 
  2.29  obligations of individuals who are determined to be eligible for 
  2.30  medical assistance with a spenddown as defined in section 
  2.31  256B.056, subdivision 5. 
  2.32  Seniors who are eligible for medical assistance with a spenddown 
  2.33  shall be financially responsible for the deductible amount up to 
  2.34  the satisfaction of the spenddown.  No deductible applies once 
  2.35  the spenddown has been met.  Payments to providers for 
  2.36  prescription drugs for persons eligible under this subdivision 
  3.1   shall be reduced by the deductible.  
  3.2      County social service agencies shall determine an 
  3.3   applicant's eligibility for the program within 30 days from the 
  3.4   date the application is received.  Eligibility begins the month 
  3.5   after approval. 
  3.6      Sec. 3.  Minnesota Statutes 1998, section 256.955, 
  3.7   subdivision 7, is amended to read: 
  3.8      Subd. 7.  [COST SHARING.] (a) Enrollees At the time of 
  3.9   application, applicants shall pay an annual premium enrollment 
  3.10  fee of $120 that is nonrefundable except if an applicant is 
  3.11  found ineligible.  
  3.12     (b) Program enrollees must satisfy a $300 annual 
  3.13  deductible, based upon expenditures for prescription drugs, to 
  3.14  be paid as follows: in $25 monthly increments. 
  3.15     (1) $25 monthly deductible for persons with a monthly 
  3.16  spenddown; or 
  3.17     (2) $150 biannual deductible for persons with a six-month 
  3.18  spenddown.  
  3.19     Sec. 4.  Minnesota Statutes 1998, section 256.955, 
  3.20  subdivision 8, is amended to read: 
  3.21     Subd. 8.  [REPORT.] The commissioner shall annually report 
  3.22  to the legislature on the senior citizen drug program.  The 
  3.23  report must include demographic information on enrollees, 
  3.24  per-prescription expenditures, total program expenditures, 
  3.25  hospital and nursing home costs avoided by enrollees, any 
  3.26  savings to medical assistance and Medicare resulting from the 
  3.27  provision of prescription drug coverage under Medicare by health 
  3.28  maintenance organizations, other public and private options for 
  3.29  drug assistance to the senior population, any hardships caused 
  3.30  by the annual premium enrollment fee and deductible, and any 
  3.31  recommendations for changes in the senior drug program. 
  3.32     Sec. 5.  Minnesota Statutes 1998, section 256.955, 
  3.33  subdivision 9, is amended to read: 
  3.34     Subd. 9.  [PROGRAM LIMITATION.] The commissioner shall 
  3.35  administer the senior drug program so that the costs total no 
  3.36  more than funds appropriated plus the drug rebate proceeds.  
  4.1   Senior drug program rebate revenues are appropriated to the 
  4.2   commissioner and shall be expended to augment funding of the 
  4.3   senior drug program.  New enrollment shall cease if the 
  4.4   commissioner determines that, given current enrollment, costs of 
  4.5   the program will exceed appropriated funds and rebate proceeds.  
  4.6   This section shall be repealed upon federal approval of the 
  4.7   waiver to allow the commissioner to provide prescription drug 
  4.8   coverage for qualified Medicare beneficiaries whose income is 
  4.9   less than 150 percent of the federal poverty guidelines. 
  4.10     Sec. 6.  Minnesota Statutes 1998, section 256.9685, 
  4.11  subdivision 1a, is amended to read: 
  4.12     Subd. 1a.  [ADMINISTRATIVE RECONSIDERATION.] 
  4.13  Notwithstanding sections 256B.04, subdivision 15, and 256D.03, 
  4.14  subdivision 7, the commissioner shall establish an 
  4.15  administrative reconsideration process for appeals of inpatient 
  4.16  hospital services determined to be medically unnecessary.  A 
  4.17  physician or hospital may request a reconsideration of the 
  4.18  decision that inpatient hospital services are not medically 
  4.19  necessary by submitting a written request for review to the 
  4.20  commissioner within 30 days after receiving notice of the 
  4.21  decision.  The reconsideration process shall take place prior to 
  4.22  the procedures of subdivision 1b and shall be conducted by 
  4.23  physicians that are independent of the case under 
  4.24  reconsideration.  A majority decision by the physicians is 
  4.25  necessary to make a determination that the services were not 
  4.26  medically necessary.  
  4.27     Sec. 7.  Minnesota Statutes 1998, section 256.969, 
  4.28  subdivision 1, is amended to read: 
  4.29     Subdivision 1.  [HOSPITAL COST INDEX.] (a) The hospital 
  4.30  cost index shall be the change in the Consumer Price Index-All 
  4.31  Items (United States city average) (CPI-U) forecasted by Data 
  4.32  Resources, Inc.  The commissioner shall use the indices as 
  4.33  forecasted in the third quarter of the calendar year prior to 
  4.34  the rate year.  The hospital cost index may be used to adjust 
  4.35  the base year operating payment rate through the rate year on an 
  4.36  annually compounded basis.  
  5.1      (b) For fiscal years beginning on or after July 1, 1993, 
  5.2   the commissioner of human services shall not provide automatic 
  5.3   annual inflation adjustments for hospital payment rates under 
  5.4   medical assistance, nor under general assistance medical care, 
  5.5   except that the inflation adjustments under paragraph (a) for 
  5.6   medical assistance, excluding general assistance medical care, 
  5.7   shall apply through calendar year 1999 2001.  The index for 
  5.8   calendar year 2000 shall be reduced 2.5 percentage points to 
  5.9   recover overprojections of the index from 1994 to 1996.  The 
  5.10  commissioner of finance shall include as a budget change request 
  5.11  in each biennial detailed expenditure budget submitted to the 
  5.12  legislature under section 16A.11 annual adjustments in hospital 
  5.13  payment rates under medical assistance and general assistance 
  5.14  medical care, based upon the hospital cost index. 
  5.15     Sec. 8.  Minnesota Statutes 1998, section 256B.04, is 
  5.16  amended by adding a subdivision to read: 
  5.17     Subd. 19.  [PERFORMANCE DATA REPORTING UNIT.] The 
  5.18  commissioner of human services shall establish a performance 
  5.19  data reporting unit that serves counties and the state.  The 
  5.20  department shall support this unit and provide counties 
  5.21  technical assistance and access to the data warehouse.  The 
  5.22  performance data reporting unit, which will operate within the 
  5.23  department's central office and consist of both county and 
  5.24  department staff, shall provide performance data reports to 
  5.25  individual counties, share expertise from counties and the 
  5.26  department perspective, and participate in joint planning to 
  5.27  link with county databases and other county data sources in 
  5.28  order to provide information on services provided to public 
  5.29  clients from state, federal, and county funding sources. 
  5.30     Sec. 9.  Minnesota Statutes 1998, section 256B.055, 
  5.31  subdivision 3a, is amended to read: 
  5.32     Subd. 3a.  [MFIP-S FAMILIES; FAMILIES ELIGIBLE UNDER PRIOR 
  5.33  AFDC RULES.] (a) Beginning January 1, 1998, or on the date that 
  5.34  MFIP-S is implemented in counties, medical assistance may be 
  5.35  paid for a person receiving public assistance under the MFIP-S 
  5.36  program. 
  6.1      (b) Beginning January 1, 1998, medical assistance may be 
  6.2   paid for a person who would have been eligible for public 
  6.3   assistance under the income and resource standards and 
  6.4   deprivation requirements, or who would have been eligible but 
  6.5   for excess income or assets, under the state's AFDC plan in 
  6.6   effect as of July 16, 1996, as required by the Personal 
  6.7   Responsibility and Work Opportunity Reconciliation Act of 1996 
  6.8   (PRWORA), Public Law Number 104-193. 
  6.9      Sec. 10.  Minnesota Statutes 1998, section 256B.056, 
  6.10  subdivision 4, is amended to read: 
  6.11     Subd. 4.  [INCOME.] To be eligible for medical assistance, 
  6.12  a person eligible under section 256B.055, subdivision 7, not 
  6.13  receiving supplemental security income program payments, and 
  6.14  families and children may have an income up to 133-1/3 percent 
  6.15  of the AFDC income standard in effect under the July 16, 1996, 
  6.16  AFDC state plan.  For rate years beginning on or after July 1, 
  6.17  1999, the commissioner shall consider increasing the base AFDC 
  6.18  standard in effect on July 16, 1996, by an amount equal to the 
  6.19  percent change in the Consumer Price Index for All Urban 
  6.20  Consumers for the previous October compared to one year 
  6.21  earlier.  Effective January 1, 2000, and each successive 
  6.22  January, recipients of supplemental security income may have an 
  6.23  income up to the supplemental security income standard in effect 
  6.24  on that date.  In computing income to determine eligibility of 
  6.25  persons who are not residents of long-term care facilities, the 
  6.26  commissioner shall disregard increases in income as required by 
  6.27  Public Law Numbers 94-566, section 503; 99-272; and 99-509.  
  6.28  Veterans aid and attendance benefits and Veterans Administration 
  6.29  unusual medical expense payments are considered income to the 
  6.30  recipient. 
  6.31     Sec. 11.  Minnesota Statutes 1998, section 256B.057, is 
  6.32  amended by adding a subdivision to read: 
  6.33     Subd. 9.  [EMPLOYED INDIVIDUALS WITH DISABILITIES.] (a) 
  6.34  Medical assistance may be paid for an employed individual:  (1) 
  6.35  who meets the definition of disabled under the supplemental 
  6.36  security income program; (2) whose countable family income, 
  7.1   excluding the unearned income of the individual, is below 250 
  7.2   percent of the federal poverty guidelines for the applicable 
  7.3   family size; and (3) who pays a premium as provided in paragraph 
  7.4   (c). 
  7.5      (b) For purposes of determining eligibility under this 
  7.6   subdivision, the asset limitations under section 256B.056, 
  7.7   subdivision 3, are increased by $20,000, and any retirement 
  7.8   account of the individual is excluded.  Retirement accounts 
  7.9   include individual retirement accounts, 401(k) plans, 403(b) 
  7.10  plans, Keogh plans, pension plans, and other retirement funds 
  7.11  held by the individual. 
  7.12     (c) The premium shall be equal to ten percent of the amount 
  7.13  of the family's annual gross earned income above 250 percent of 
  7.14  the federal poverty guidelines for the applicable family size, 
  7.15  but shall not exceed the maximum MinnesotaCare premium for one 
  7.16  person under section 256L.15, subdivision 2. 
  7.17     (d) An individual's eligibility and premium amount shall be 
  7.18  determined by the county agency.  Premiums are paid to the 
  7.19  commissioner and dedicated to the commissioner. 
  7.20     (e) The required premium amount is determined at 
  7.21  application and redetermined at annual recertification or when a 
  7.22  change in gross earned income occurs.  Premium payment is due 
  7.23  upon notification and may be accepted in installments at the 
  7.24  commissioner's discretion. 
  7.25     (f) Nonpayment of the premium will result in denial or 
  7.26  termination of medical assistance.  Nonpayment of the premium 
  7.27  includes payment with a returned, refused, or dishonored 
  7.28  instrument.  The commissioner may require a guaranteed form of 
  7.29  payment as the only means to replace a returned, refused, or 
  7.30  dishonored instrument. 
  7.31     Sec. 12.  Minnesota Statutes 1998, section 256B.0575, is 
  7.32  amended to read: 
  7.33     256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 
  7.34  PERSONS.] 
  7.35     When an institutionalized person is determined eligible for 
  7.36  medical assistance, the income that exceeds the deductions in 
  8.1   paragraphs (a) and (b) must be applied to the cost of 
  8.2   institutional care.  
  8.3      (a) The following amounts must be deducted from the 
  8.4   institutionalized person's income in the following order: 
  8.5      (1) the personal needs allowance under section 256B.35 or, 
  8.6   for a veteran who does not have a spouse or child, or a 
  8.7   surviving spouse of a veteran having no child, the amount of an 
  8.8   improved pension received from the veteran's administration not 
  8.9   exceeding $90 per month; 
  8.10     (2) the personal allowance for disabled individuals under 
  8.11  section 256B.36; 
  8.12     (3) if the institutionalized person has a legally appointed 
  8.13  guardian or conservator, five percent of the recipient's gross 
  8.14  monthly income up to $100 as reimbursement for guardianship or 
  8.15  conservatorship services; 
  8.16     (4) a monthly income allowance determined under section 
  8.17  256B.058, subdivision 2, but only to the extent income of the 
  8.18  institutionalized spouse is made available to the community 
  8.19  spouse; 
  8.20     (5) a monthly allowance for children under age 18 which, 
  8.21  together with the net income of the children, would provide 
  8.22  income equal to the medical assistance standard for families and 
  8.23  children according to section 256B.056, subdivision 4, for a 
  8.24  family size that includes only the minor children.  This 
  8.25  deduction applies only if the children do not live with the 
  8.26  community spouse and only to the extent that the deduction is 
  8.27  not included in the personal needs allowance under section 
  8.28  256B.35, subdivision 1, as child support garnished under a court 
  8.29  order; 
  8.30     (6) a monthly family allowance for other family members, 
  8.31  equal to one-third of the difference between 122 percent of the 
  8.32  federal poverty guidelines and the monthly income for that 
  8.33  family member; 
  8.34     (7) reparations payments made by the Federal Republic of 
  8.35  Germany and reparations payments made by the Netherlands for 
  8.36  victims of Nazi persecution between 1940 and 1945; and 
  9.1      (8) all other exclusions from income for institutionalized 
  9.2   persons as mandated by federal law; and 
  9.3      (8) (9) amounts for reasonable expenses incurred for 
  9.4   necessary medical or remedial care for the institutionalized 
  9.5   spouse that are not medical assistance covered expenses and that 
  9.6   are not subject to payment by a third party.  
  9.7      For purposes of clause (6), "other family member" means a 
  9.8   person who resides with the community spouse and who is a minor 
  9.9   or dependent child, dependent parent, or dependent sibling of 
  9.10  either spouse.  "Dependent" means a person who could be claimed 
  9.11  as a dependent for federal income tax purposes under the 
  9.12  Internal Revenue Code. 
  9.13     (b) Income shall be allocated to an institutionalized 
  9.14  person for a period of up to three calendar months, in an amount 
  9.15  equal to the medical assistance standard for a family size of 
  9.16  one if:  
  9.17     (1) a physician certifies that the person is expected to 
  9.18  reside in the long-term care facility for three calendar months 
  9.19  or less; 
  9.20     (2) if the person has expenses of maintaining a residence 
  9.21  in the community; and 
  9.22     (3) if one of the following circumstances apply:  
  9.23     (i) the person was not living together with a spouse or a 
  9.24  family member as defined in paragraph (a) when the person 
  9.25  entered a long-term care facility; or 
  9.26     (ii) the person and the person's spouse become 
  9.27  institutionalized on the same date, in which case the allocation 
  9.28  shall be applied to the income of one of the spouses.  
  9.29  For purposes of this paragraph, a person is determined to be 
  9.30  residing in a licensed nursing home, regional treatment center, 
  9.31  or medical institution if the person is expected to remain for a 
  9.32  period of one full calendar month or more. 
  9.33     Sec. 13.  Minnesota Statutes 1998, section 256B.0625, 
  9.34  subdivision 8, is amended to read: 
  9.35     Subd. 8.  [PHYSICAL THERAPY.] Medical assistance covers 
  9.36  physical therapy and related services, including specialized 
 10.1   maintenance therapy.  Services provided by a physical therapy 
 10.2   assistant shall be reimbursed at the same rate as services 
 10.3   performed by a physical therapist when the services of the 
 10.4   physical therapy assistant are provided under the direction of a 
 10.5   physical therapist who is on the premises.  Services provided by 
 10.6   a physical therapy assistant that are provided under the 
 10.7   direction of a physical therapist who is not on the premises 
 10.8   shall be reimbursed at 65 percent of the physical therapist rate.
 10.9      Sec. 14.  Minnesota Statutes 1998, section 256B.0625, 
 10.10  subdivision 8a, is amended to read: 
 10.11     Subd. 8a.  [OCCUPATIONAL THERAPY.] Medical assistance 
 10.12  covers occupational therapy and related services, including 
 10.13  specialized maintenance therapy.  Services provided by an 
 10.14  occupational therapy assistant shall be reimbursed at the same 
 10.15  rate as services performed by an occupational therapist when the 
 10.16  services of the occupational therapy assistant are provided 
 10.17  under the direction of the occupational therapist who is on the 
 10.18  premises.  Services provided by an occupational therapy 
 10.19  assistant that are provided under the direction of an 
 10.20  occupational therapist who is not on the premises shall be 
 10.21  reimbursed at 65 percent of the occupational therapist rate. 
 10.22     Sec. 15.  Minnesota Statutes 1998, section 256B.0625, is 
 10.23  amended by adding a subdivision to read: 
 10.24     Subd. 8b.  [SPEECH LANGUAGE PATHOLOGY.] Medical assistance 
 10.25  covers speech language pathology and related services, including 
 10.26  specialized maintenance therapy. 
 10.27     Sec. 16.  Minnesota Statutes 1998, section 256B.0625, is 
 10.28  amended by adding a subdivision to read: 
 10.29     Subd. 8c.  [CARE MANAGEMENT; REHABILITATION SERVICES.] (a) 
 10.30  Effective July 1, 1999, one-time thresholds shall replace annual 
 10.31  thresholds for provision of rehabilitation services described in 
 10.32  subdivisions 8, 8a, and 8b.  The one-time thresholds will be the 
 10.33  same in amount and description as the thresholds prescribed by 
 10.34  the department of human services health care programs provider 
 10.35  manual for calendar year 1997, except they will not be renewed 
 10.36  annually, and they will include sensory skills and cognitive 
 11.1   training skills. 
 11.2      (b) A care management approach for authorization of 
 11.3   services beyond the threshold shall be instituted in conjunction 
 11.4   with the one-time thresholds.  The care management approach 
 11.5   shall require the provider and the department rehabilitation 
 11.6   reviewer to work together directly through written 
 11.7   communication, or telephone communication when appropriate, to 
 11.8   establish a medically necessary care management plan. 
 11.9      (c) The department shall implement an expedited five-day 
 11.10  turnaround time to review authorization requests for recipients 
 11.11  who need emergency rehabilitation services and who have 
 11.12  exhausted their one-time threshold limit for those services. 
 11.13     Sec. 17.  Minnesota Statutes 1998, section 256B.0625, is 
 11.14  amended by adding a subdivision to read: 
 11.15     Subd. 8d.  [TELEMEDICINE CONSULTATIONS.] Medical assistance 
 11.16  covers telemedicine consultations.  Telemedicine consultations 
 11.17  must be made via two-way, interactive video.  Payments will be 
 11.18  made to both the referring provider and the consulting physician 
 11.19  specialist.  Physician specialist includes any physician 
 11.20  consulting with an emergency department provider. 
 11.21     Sec. 18.  Minnesota Statutes 1998, section 256B.0625, is 
 11.22  amended by adding a subdivision to read: 
 11.23     Subd. 8e.  [CONSULTATION SERVICES BY PHYSICIANS 
 11.24  SPECIALIZING IN CHILD ABUSE AND NEGLECT.] Medical assistance 
 11.25  covers consultation services by physicians specializing in child 
 11.26  abuse and neglect.  Alternative media formats may be used when 
 11.27  the patient is a child being examined for potential abuse or 
 11.28  neglect, the consulting physician is a specialist in child abuse 
 11.29  and neglect, and the use of two-way, interactive video or the 
 11.30  occurrence of a second exam would be medically counter indicated 
 11.31  for the child. 
 11.32     Sec. 19.  Minnesota Statutes 1998, section 256B.0625, is 
 11.33  amended by adding a subdivision to read: 
 11.34     Subd. 9a.  [DENTAL HYGIENIST SERVICES.] Medical assistance 
 11.35  covers preventive dental services provided by dental hygienists 
 11.36  if the services are otherwise covered under this chapter as 
 12.1   dental services, and if the services are within the scope of 
 12.2   practice of a licensed dental hygienist, as defined in section 
 12.3   150A.05. 
 12.4      Sec. 20.  Minnesota Statutes 1998, section 256B.0625, 
 12.5   subdivision 13, is amended to read: 
 12.6      Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
 12.7   except for fertility drugs when specifically used to enhance 
 12.8   fertility, if prescribed by a licensed practitioner and 
 12.9   dispensed by a licensed pharmacist, by a physician enrolled in 
 12.10  the medical assistance program as a dispensing physician, or by 
 12.11  a physician or a nurse practitioner employed by or under 
 12.12  contract with a community health board as defined in section 
 12.13  145A.02, subdivision 5, for the purposes of communicable disease 
 12.14  control.  The commissioner, after receiving recommendations from 
 12.15  professional medical associations and professional pharmacist 
 12.16  associations, shall designate a formulary committee to advise 
 12.17  the commissioner on the names of drugs for which payment is 
 12.18  made, recommend a system for reimbursing providers on a set fee 
 12.19  or charge basis rather than the present system, and develop 
 12.20  methods encouraging use of generic drugs when they are less 
 12.21  expensive and equally effective as trademark drugs.  The 
 12.22  formulary committee shall consist of nine members, four of whom 
 12.23  shall be physicians who are not employed by the department of 
 12.24  human services, and a majority of whose practice is for persons 
 12.25  paying privately or through health insurance, three of whom 
 12.26  shall be pharmacists who are not employed by the department of 
 12.27  human services, and a majority of whose practice is for persons 
 12.28  paying privately or through health insurance, a consumer 
 12.29  representative, and a nursing home representative.  Committee 
 12.30  members shall serve three-year terms and shall serve without 
 12.31  compensation.  Members may be reappointed once.  
 12.32     (b) The commissioner shall establish a drug formulary.  Its 
 12.33  establishment and publication shall not be subject to the 
 12.34  requirements of the Administrative Procedure Act, but the 
 12.35  formulary committee shall review and comment on the formulary 
 12.36  contents.  The formulary committee shall review and recommend 
 13.1   drugs which require prior authorization.  The formulary 
 13.2   committee may recommend drugs for prior authorization directly 
 13.3   to the commissioner, as long as opportunity for public input is 
 13.4   provided.  Prior authorization may be requested by the 
 13.5   commissioner based on medical and clinical criteria before 
 13.6   certain drugs are eligible for payment.  Before a drug may be 
 13.7   considered for prior authorization at the request of the 
 13.8   commissioner:  
 13.9      (1) the drug formulary committee must develop criteria to 
 13.10  be used for identifying drugs; the development of these criteria 
 13.11  is not subject to the requirements of chapter 14, but the 
 13.12  formulary committee shall provide opportunity for public input 
 13.13  in developing criteria; 
 13.14     (2) the drug formulary committee must hold a public forum 
 13.15  and receive public comment for an additional 15 days; and 
 13.16     (3) the commissioner must provide information to the 
 13.17  formulary committee on the impact that placing the drug on prior 
 13.18  authorization will have on the quality of patient care and 
 13.19  information regarding whether the drug is subject to clinical 
 13.20  abuse or misuse.  Prior authorization may be required by the 
 13.21  commissioner before certain formulary drugs are eligible for 
 13.22  payment.  The formulary shall not include:  
 13.23     (i) drugs or products for which there is no federal 
 13.24  funding; 
 13.25     (ii) over-the-counter drugs, except for antacids, 
 13.26  acetaminophen, family planning products, aspirin, insulin, 
 13.27  products for the treatment of lice, vitamins for adults with 
 13.28  documented vitamin deficiencies, vitamins for children under the 
 13.29  age of seven and pregnant or nursing women, and any other 
 13.30  over-the-counter drug identified by the commissioner, in 
 13.31  consultation with the drug formulary committee, as necessary, 
 13.32  appropriate, and cost-effective for the treatment of certain 
 13.33  specified chronic diseases, conditions or disorders, and this 
 13.34  determination shall not be subject to the requirements of 
 13.35  chapter 14; 
 13.36     (iii) anorectics; 
 14.1      (iv) drugs for which medical value has not been 
 14.2   established; and 
 14.3      (v) drugs from manufacturers who have not signed a rebate 
 14.4   agreement with the Department of Health and Human Services 
 14.5   pursuant to section 1927 of title XIX of the Social Security Act 
 14.6   and who have not signed an agreement with the state for drugs 
 14.7   purchased pursuant to the senior citizen drug program 
 14.8   established under section 256.955. 
 14.9      The commissioner shall publish conditions for prohibiting 
 14.10  payment for specific drugs after considering the formulary 
 14.11  committee's recommendations.  
 14.12     (c) The basis for determining the amount of payment shall 
 14.13  be the lower of the actual acquisition costs of the drugs plus a 
 14.14  fixed dispensing fee; the maximum allowable cost set by the 
 14.15  federal government or by the commissioner plus the fixed 
 14.16  dispensing fee; or the usual and customary price charged to the 
 14.17  public.  The pharmacy dispensing fee shall be $3.65.  Actual 
 14.18  acquisition cost includes quantity and other special discounts 
 14.19  except time and cash discounts.  The actual acquisition cost of 
 14.20  a drug shall be estimated by the commissioner, at average 
 14.21  wholesale price minus nine percent.  The maximum allowable cost 
 14.22  of a multisource drug may be set by the commissioner and it 
 14.23  shall be comparable to, but no higher than, the maximum amount 
 14.24  paid by other third-party payors in this state who have maximum 
 14.25  allowable cost programs.  The commissioner shall set maximum 
 14.26  allowable costs for multisource drugs that are not on the 
 14.27  federal upper limit list as described in United States Code, 
 14.28  title 42, chapter 7, section 1396r-8(e), the Social Security 
 14.29  Act, and Code of Federal Regulations, title 42, part 447, 
 14.30  section 447.332.  Establishment of the amount of payment for 
 14.31  drugs shall not be subject to the requirements of the 
 14.32  Administrative Procedure Act.  An additional dispensing fee of 
 14.33  $.30 may be added to the dispensing fee paid to pharmacists for 
 14.34  legend drug prescriptions dispensed to residents of long-term 
 14.35  care facilities when a unit dose blister card system, approved 
 14.36  by the department, is used.  Under this type of dispensing 
 15.1   system, the pharmacist must dispense a 30-day supply of drug.  
 15.2   The National Drug Code (NDC) from the drug container used to 
 15.3   fill the blister card must be identified on the claim to the 
 15.4   department.  The unit dose blister card containing the drug must 
 15.5   meet the packaging standards set forth in Minnesota Rules, part 
 15.6   6800.2700, that govern the return of unused drugs to the 
 15.7   pharmacy for reuse.  The pharmacy provider will be required to 
 15.8   credit the department for the actual acquisition cost of all 
 15.9   unused drugs that are eligible for reuse.  Over-the-counter 
 15.10  medications must be dispensed in the manufacturer's unopened 
 15.11  package.  The commissioner may permit the drug clozapine to be 
 15.12  dispensed in a quantity that is less than a 30-day supply.  
 15.13  Whenever a generically equivalent product is available, payment 
 15.14  shall be on the basis of the actual acquisition cost of the 
 15.15  generic drug, unless the prescriber specifically indicates 
 15.16  "dispense as written - brand necessary" on the prescription as 
 15.17  required by section 151.21, subdivision 2. 
 15.18     Sec. 21.  Minnesota Statutes 1998, section 256B.0625, 
 15.19  subdivision 26, is amended to read: 
 15.20     Subd. 26.  [SPECIAL EDUCATION SERVICES.] (a) Medical 
 15.21  assistance covers medical services identified in a recipient's 
 15.22  individualized education plan and covered under the medical 
 15.23  assistance state plan.  The services may be provided by a 
 15.24  Minnesota school district that is enrolled as a medical 
 15.25  assistance provider or its subcontractor, and only if the 
 15.26  services meet all the requirements otherwise applicable if the 
 15.27  service had been provided by a provider other than a school 
 15.28  district, in the following areas:  medical necessity, 
 15.29  physician's orders, documentation, personnel qualifications, and 
 15.30  prior authorization requirements.  Services of a speech-language 
 15.31  pathologist provided under this section are covered 
 15.32  notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item 
 15.33  L, if the person: 
 15.34     (1) holds a masters degree in speech-language pathology; 
 15.35     (2) is licensed by the Minnesota board of teaching as an 
 15.36  educational speech-language pathologist; and 
 16.1      (3) either has a certificate of clinical competence from 
 16.2   the American Speech and Hearing Association, has completed the 
 16.3   equivalent educational requirements and work experience 
 16.4   necessary for the certificate or has completed the academic 
 16.5   program and is acquiring supervised work experience to qualify 
 16.6   for the certificate.  Medical assistance coverage for medically 
 16.7   necessary services provided under other subdivisions in this 
 16.8   section may not be denied solely on the basis that the same or 
 16.9   similar services are covered under this subdivision. 
 16.10     (b) Effective July 1, 2000, medical assistance coverage of 
 16.11  eligible local educational agency services shall be paid at the 
 16.12  rate of 95 percent of the federal share of reimbursement.  The 
 16.13  department of human services shall amend its federal waiver 
 16.14  allowing the state to carve out individual education plan and 
 16.15  individualized family service plan services for children 
 16.16  enrolled in the prepaid medical assistance program and 
 16.17  MinnesotaCare program.  Effective July 1, 2000, or upon federal 
 16.18  approval, medical assistance coverage of eligible individual 
 16.19  education plan and individualized family service plan services 
 16.20  shall not be included in the capitated services for children 
 16.21  enrolled in health plans through the prepaid medical assistance 
 16.22  program and the MinnesotaCare program.  Upon federal approval, 
 16.23  local educational agencies shall bill the department of human 
 16.24  services for these services and claims will be paid on a 
 16.25  fee-for-service basis.  The department of human service shall 
 16.26  develop a methodology for payment of individual education plan 
 16.27  and individualized family service plan services that is packaged 
 16.28  based on the child's needs, for ease of billing, and seek 
 16.29  approval of this rate methodology from the health care finance 
 16.30  agency.  The department of human services shall develop a 
 16.31  cost-based payment structure for payment of these services.  
 16.32  Effective July 1, 2000, medical assistance services provided by 
 16.33  the local educational agencies shall not count against medical 
 16.34  assistance threshholds for that child. 
 16.35     (c) The local educational agency receiving medical 
 16.36  assistant payment for individual educational plan and 
 17.1   individualized family service plan services shall comply with 
 17.2   all health care finance agency requirements for receiving 
 17.3   federal financial participation.  The nonfederal share of 
 17.4   medical assistance coverage shall be paid by the local 
 17.5   educational agency providing individual educational plan and 
 17.6   individualized family service plan services.  Expenditures for 
 17.7   local educational agency services eligible for federal 
 17.8   reimbursement under this section must not be made from federal 
 17.9   funds or funds used to match other federal funds.  The 
 17.10  department of children, families, and learning and the 
 17.11  department of human services shall enter into an interagency 
 17.12  agreement by July 1, 2000, outlining data sharing, and family 
 17.13  consent arrangements whereby local educational agencies may 
 17.14  receive payment for medical assistance eligible individual 
 17.15  educational plan and individualized family service plan services 
 17.16  for children receiving special education services as authorized 
 17.17  by section 1903 of the Social Security Act, as amended. 
 17.18     Sec. 22.  Minnesota Statutes 1998, section 256B.0625, 
 17.19  subdivision 32, is amended to read: 
 17.20     Subd. 32.  [NUTRITIONAL PRODUCTS.] (a) Medical assistance 
 17.21  covers nutritional products needed for nutritional 
 17.22  supplementation because solid food or nutrients thereof cannot 
 17.23  be properly absorbed by the body or needed for treatment of 
 17.24  phenylketonuria, hyperlysinemia, maple syrup urine disease, a 
 17.25  combined allergy to human milk, cow's milk, and soy formula, or 
 17.26  any other childhood or adult diseases, conditions, or disorders 
 17.27  identified by the commissioner as requiring a similarly 
 17.28  necessary nutritional product.  Nutritional products needed for 
 17.29  the treatment of a combined allergy to human milk, cow's milk, 
 17.30  and soy formula require prior authorization.  Separate payment 
 17.31  shall not be made for nutritional products for residents of 
 17.32  long-term care facilities.  Payment for dietary requirements is 
 17.33  a component of the per diem rate paid to these facilities. 
 17.34     (b) The commissioner shall designate a nutritional 
 17.35  supplementation products advisory committee to advise the 
 17.36  commissioner on nutritional supplementation products for which 
 18.1   payment is made.  The committee shall consist of nine members, 
 18.2   one of whom shall be a physician, one of whom shall be a 
 18.3   pharmacist, two of whom shall be registered dietitians, one of 
 18.4   whom shall be a public health nurse, one of whom shall be a 
 18.5   representative of a home health care agency, one of whom shall 
 18.6   be a provider of long-term care services, and two of whom shall 
 18.7   be consumers of nutritional supplementation products.  Committee 
 18.8   members shall serve two-year terms and shall serve without 
 18.9   compensation. 
 18.10     (c) The advisory committee shall review and recommend 
 18.11  nutritional supplementation products which require prior 
 18.12  authorization.  The commissioner shall develop procedures for 
 18.13  the operation of the advisory committee so that the advisory 
 18.14  committee operates in a manner parallel to the drug formulary 
 18.15  committee. 
 18.16     Sec. 23.  Minnesota Statutes 1998, section 256B.0625, 
 18.17  subdivision 35, is amended to read: 
 18.18     Subd. 35.  [FAMILY COMMUNITY SUPPORT SERVICES.] Medical 
 18.19  assistance covers family community support services as defined 
 18.20  in section 245.4871, subdivision 17.  In addition to the 
 18.21  provisions of section 245.4871, and to the extent authorized by 
 18.22  rules promulgated by the state agency, medical assistance covers 
 18.23  the following services as family community support services: 
 18.24     (1) services identified in an individual treatment plan 
 18.25  when provided by a trained behavioral aide under the direction 
 18.26  of a mental health practitioner or mental health professional; 
 18.27     (2) mental health crisis intervention and crisis 
 18.28  stabilization services provided outside of hospital inpatient 
 18.29  settings; and 
 18.30     (3) the therapeutic components of preschool and therapeutic 
 18.31  camp programs. 
 18.32     Sec. 24.  Minnesota Statutes 1998, section 256B.0635, 
 18.33  subdivision 3, is amended to read: 
 18.34     Subd. 3.  [MEDICAL ASSISTANCE FOR MFIP-S PARTICIPANTS WHO 
 18.35  OPT TO DISCONTINUE MONTHLY CASH ASSISTANCE.] Upon federal 
 18.36  approval, Medical assistance is available to persons who 
 19.1   received MFIP-S in at least three of the six months preceding 
 19.2   the month in which the person opted opt to discontinue receiving 
 19.3   MFIP-S cash assistance under section 256J.31, subdivision 12.  A 
 19.4   person who is eligible for medical assistance under this section 
 19.5   may receive medical assistance without reapplication as long as 
 19.6   the person meets MFIP-S eligibility requirements, unless the 
 19.7   assistance unit does not include a dependent child.  Medical 
 19.8   assistance may be paid pursuant to subdivisions 1 and 2 for 
 19.9   persons who are no longer eligible for MFIP-S due to increased 
 19.10  employment or child support.  A person may be eligible for 
 19.11  MinnesotaCare due to increased employment or child support, and 
 19.12  as such must be informed of the option to transition onto 
 19.13  MinnesotaCare. 
 19.14     Sec. 25.  Minnesota Statutes 1998, section 256B.75, is 
 19.15  amended to read: 
 19.16     256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 
 19.17     For outpatient hospital facility fee payments for services 
 19.18  rendered on or after October 1, 1992, the commissioner of human 
 19.19  services shall pay the lower of (1) submitted charge, or (2) 32 
 19.20  percent above the rate in effect on June 30, 1992, except for 
 19.21  those services for which there is a federal maximum allowable 
 19.22  payment.  Effective for services rendered on or after January 1, 
 19.23  2000, payment rates for nonsurgical outpatient hospital facility 
 19.24  fees and emergency room facility fees shall be increased by ten 
 19.25  percent over the rates in effect on December 31, 1999, except 
 19.26  for those services for which there is a federal maximum 
 19.27  allowable payment.  Services for which there is a federal 
 19.28  maximum allowable payment shall be paid at the lower of (1) 
 19.29  submitted charge, or (2) the federal maximum allowable payment.  
 19.30  Total aggregate payment for outpatient hospital facility fee 
 19.31  services shall not exceed the Medicare upper limit.  If it is 
 19.32  determined that a provision of this section conflicts with 
 19.33  existing or future requirements of the United States government 
 19.34  with respect to federal financial participation in medical 
 19.35  assistance, the federal requirements prevail.  The commissioner 
 19.36  may, in the aggregate, prospectively reduce payment rates to 
 20.1   avoid reduced federal financial participation resulting from 
 20.2   rates that are in excess of the Medicare upper limitations. 
 20.3      Sec. 26.  Minnesota Statutes 1998, section 256B.76, is 
 20.4   amended to read: 
 20.5      256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
 20.6      (a) The physician reimbursement increase provided in 
 20.7   section 256B.74, subdivision 2, shall not be implemented.  
 20.8   Effective for services rendered on or after October 1, 1992, the 
 20.9   commissioner shall make payments for physician services as 
 20.10  follows: 
 20.11     (1) payment for level one Health Care Finance 
 20.12  Administration's common procedural coding system (HCPCS) codes 
 20.13  titled "office and other outpatient services," "preventive 
 20.14  medicine new and established patient," "delivery, antepartum, 
 20.15  and postpartum care," "critical care," Caesarean delivery and 
 20.16  pharmacologic management provided to psychiatric patients, and 
 20.17  HCPCS level three codes for enhanced services for prenatal high 
 20.18  risk, shall be paid at the lower of (i) submitted charges, or 
 20.19  (ii) 25 percent above the rate in effect on June 30, 1992.  If 
 20.20  the rate on any procedure code within these categories is 
 20.21  different than the rate that would have been paid under the 
 20.22  methodology in section 256B.74, subdivision 2, then the larger 
 20.23  rate shall be paid; 
 20.24     (2) payments for all other services shall be paid at the 
 20.25  lower of (i) submitted charges, or (ii) 15.4 percent above the 
 20.26  rate in effect on June 30, 1992; and 
 20.27     (3) all physician rates shall be converted from the 50th 
 20.28  percentile of 1982 to the 50th percentile of 1989, less the 
 20.29  percent in aggregate necessary to equal the above increases 
 20.30  except that payment rates for home health agency services shall 
 20.31  be the rates in effect on September 30, 1992.; 
 20.32     (4) effective for services rendered on or after October 1, 
 20.33  1999, payment rates for physician and professional services 
 20.34  shall be increased by four percent over the rates in effect on 
 20.35  September 30, 1999, except for home health agency services; 
 20.36     (5) the department shall present a proposal during the year 
 21.1   2000 legislative session detailing physician and professional 
 21.2   services payment methodology conversion to Resource Based 
 21.3   Relative Value Scale; and 
 21.4      (6) the increases in clause (4) shall be implemented 
 21.5   January 1, 2000, for managed care. 
 21.6      (b) The dental reimbursement increase provided in section 
 21.7   256B.74, subdivision 5, shall not be implemented.  Effective for 
 21.8   services rendered on or after October 1, 1992, the commissioner 
 21.9   shall make payments for dental services as follows: 
 21.10     (1) dental services shall be paid at the lower of (i) 
 21.11  submitted charges, or (ii) 25 percent above the rate in effect 
 21.12  on June 30, 1992; and 
 21.13     (2) dental rates shall be converted from the 50th 
 21.14  percentile of 1982 to the 50th percentile of 1989, less the 
 21.15  percent in aggregate necessary to equal the above increases.; 
 21.16     (3) effective for services rendered on or after October 1, 
 21.17  1999, payment rates for dental services shall be increased by 
 21.18  five percent over the rates in effect on September 30, 1999; 
 21.19     (4) the department shall increase payments by 20 percent 
 21.20  over the October 1, 1999, fee-for-service rates, for those 
 21.21  fee-for-service providers for whom public programs under MA, 
 21.22  GAMC, and MinnesotaCare account for 20 percent or more of their 
 21.23  practice; 
 21.24     (5) the commissioner shall award grants to community 
 21.25  clinics or other nonprofit community organizations which will 
 21.26  increase the availability of dental services to public program 
 21.27  recipients.  These grants may be used to fund the costs related 
 21.28  to coordinating access for recipients, developing and 
 21.29  implementing patient care criteria, establishing new or 
 21.30  upgrading existing facilities, acquiring furnishings or 
 21.31  equipment, recruiting new providers, or other development costs 
 21.32  that will improve access to dental care in that region.  The 
 21.33  commissioner shall consider the following in awarding the 
 21.34  grants:  (i) potential to successfully increase access to an 
 21.35  underserved population; (ii) the ability to raise matching 
 21.36  funds; (iii) the long-term viability of the project to improve 
 22.1   access beyond the period of initial funding; (iv) the efficiency 
 22.2   in the use of the funding; and (v) the experience of the 
 22.3   proposers in providing services to the target population.  The 
 22.4   commissioner shall monitor the grants and may terminate a grant 
 22.5   if the grantee does not increase dental access for public 
 22.6   program recipients; 
 22.7      (6) the department shall fund two initiatives to improve 
 22.8   dental access that will allow the commissioner to increase rates 
 22.9   if the percentage of public program recipients with at least one 
 22.10  dental visit per year increases; 
 22.11     (7) beginning October 1, 1999, the payment for tooth 
 22.12  sealants and fluoride treatments shall be the lower of (i) 
 22.13  submitted charge, or (ii) 80 percent of median 1997 charges; and 
 22.14     (8) the increases listed in clauses (3, (4), and (7) shall 
 22.15  be implemented January 1, 2000, for managed care. 
 22.16     (c) An entity that operates both a Medicare certified 
 22.17  comprehensive outpatient rehabilitation facility and a facility 
 22.18  which was certified prior to January 1, 1993, that is licensed 
 22.19  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 22.20  whom at least 33 percent of the clients receiving rehabilitation 
 22.21  services in the most recent calendar year are medical assistance 
 22.22  recipients, shall be reimbursed by the commissioner for 
 22.23  rehabilitation services at rates that are 38 percent greater 
 22.24  than the maximum reimbursement rate allowed under paragraph (a), 
 22.25  clause (2), when those services are (1) provided within the 
 22.26  comprehensive outpatient rehabilitation facility and (2) 
 22.27  provided to residents of nursing facilities owned by the entity. 
 22.28     Sec. 27.  Minnesota Statutes 1998, section 256L.03, 
 22.29  subdivision 5, is amended to read: 
 22.30     Subd. 5.  [COPAYMENTS AND COINSURANCE.] The MinnesotaCare 
 22.31  benefit plan shall include the following copayments and 
 22.32  coinsurance requirements for all enrollees except parents and 
 22.33  relative caretakers of children under 21 in households with 
 22.34  income at or below 175 percent of the federal poverty guidelines 
 22.35  and pregnant women and children under 21:  
 22.36     (1) ten percent of the paid charges for inpatient hospital 
 23.1   services for adult enrollees, subject to an annual inpatient 
 23.2   out-of-pocket maximum of $1,000 per individual and $3,000 per 
 23.3   family; 
 23.4      (2) $3 per prescription for adult enrollees; 
 23.5      (3) $25 for eyeglasses for adult enrollees; and 
 23.6      (4) effective July 1, 1998, 50 percent of the 
 23.7   fee-for-service rate for adult dental care services other than 
 23.8   preventive care services for persons eligible under section 
 23.9   256L.04, subdivisions 1 to 7, with income equal to or less than 
 23.10  175 percent of the federal poverty guidelines. 
 23.11     Effective July 1, 1997, adult enrollees with family gross 
 23.12  income that exceeds 175 percent of the federal poverty 
 23.13  guidelines and who are not pregnant shall be financially 
 23.14  responsible for the coinsurance amount and amounts which exceed 
 23.15  the $10,000 inpatient hospital benefit limit. 
 23.16     When a MinnesotaCare enrollee becomes a member of a prepaid 
 23.17  health plan, or changes from one prepaid health plan to another 
 23.18  during a calendar year, any charges submitted towards the 
 23.19  $10,000 annual inpatient benefit limit, and any out-of-pocket 
 23.20  expenses incurred by the enrollee for inpatient services, that 
 23.21  were submitted or incurred prior to enrollment, or prior to the 
 23.22  change in health plans, shall be disregarded. 
 23.23     Sec. 28.  Minnesota Statutes 1998, section 256L.04, 
 23.24  subdivision 2, is amended to read: 
 23.25     Subd. 2.  [COOPERATION IN ESTABLISHING THIRD-PARTY 
 23.26  LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
 23.27  eligible for MinnesotaCare, individuals and families must 
 23.28  cooperate with the state agency to identify potentially liable 
 23.29  third-party payers and assist the state in obtaining third-party 
 23.30  payments.  "Cooperation" includes, but is not limited to, 
 23.31  identifying any third party who may be liable for care and 
 23.32  services provided under MinnesotaCare to the enrollee, providing 
 23.33  relevant information to assist the state in pursuing a 
 23.34  potentially liable third party, and completing forms necessary 
 23.35  to recover third-party payments. 
 23.36     (b) A parent, guardian, relative caretaker, or child 
 24.1   enrolled in the MinnesotaCare program must cooperate with the 
 24.2   department of human services and the local agency in 
 24.3   establishing the paternity of an enrolled child and in obtaining 
 24.4   medical care support and payments for the child and any other 
 24.5   person for whom the person can legally assign rights, in 
 24.6   accordance with applicable laws and rules governing the medical 
 24.7   assistance program.  A child shall not be ineligible for or 
 24.8   disenrolled from the MinnesotaCare program solely because the 
 24.9   child's parent, relative caretaker, or guardian fails to 
 24.10  cooperate in establishing paternity or obtaining medical support.
 24.11     Sec. 29.  Minnesota Statutes 1998, section 256L.04, 
 24.12  subdivision 8, is amended to read: 
 24.13     Subd. 8.  [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL 
 24.14  ASSISTANCE.] (a) Individuals who receive supplemental security 
 24.15  income or retirement, survivors, or disability benefits due to a 
 24.16  disability, or other disability-based pension, who qualify under 
 24.17  subdivision 7, but who are potentially eligible for medical 
 24.18  assistance without a spenddown shall be allowed to enroll in 
 24.19  MinnesotaCare for a period of 60 days, so long as the applicant 
 24.20  meets all other conditions of eligibility.  The commissioner 
 24.21  shall identify and refer the applications of such individuals to 
 24.22  their county social service agency.  The county and the 
 24.23  commissioner shall cooperate to ensure that the individuals 
 24.24  obtain medical assistance coverage for any months for which they 
 24.25  are eligible. 
 24.26     (b) The enrollee must cooperate with the county social 
 24.27  service agency in determining medical assistance eligibility 
 24.28  within the 60-day enrollment period.  Enrollees who do not 
 24.29  cooperate with medical assistance within the 60-day enrollment 
 24.30  period shall be disenrolled from the plan within one calendar 
 24.31  month.  Persons disenrolled for nonapplication for medical 
 24.32  assistance may not reenroll until they have obtained a medical 
 24.33  assistance eligibility determination.  Persons disenrolled for 
 24.34  noncooperation with medical assistance may not reenroll until 
 24.35  they have cooperated with the county agency and have obtained a 
 24.36  medical assistance eligibility determination. 
 25.1      (c) Beginning January 1, 2000, counties that choose to 
 25.2   become MinnesotaCare enrollment sites shall consider 
 25.3   MinnesotaCare applications of individuals described in paragraph 
 25.4   (a) to also be applications for medical assistance and shall 
 25.5   first determine whether medical assistance eligibility exists.  
 25.6   Adults with children with family income under 175 percent of the 
 25.7   federal poverty guidelines for the applicable family size, 
 25.8   pregnant women, and children who qualify under subdivision 1.  
 25.9   Applicants who are potentially eligible for medical assistance 
 25.10  without a spenddown may choose to enroll in either MinnesotaCare 
 25.11  or medical assistance. 
 25.12     (d) The commissioner shall redetermine provider payments 
 25.13  made under MinnesotaCare to the appropriate medical assistance 
 25.14  payments for those enrollees who subsequently become eligible 
 25.15  for medical assistance. 
 25.16     Sec. 30.  Minnesota Statutes 1998, section 256L.04, 
 25.17  subdivision 13, is amended to read: 
 25.18     Subd. 13.  [FAMILIES WITH GRANDPARENTS, RELATIVE 
 25.19  CARETAKERS, FOSTER PARENTS, OR LEGAL GUARDIANS.] Beginning 
 25.20  January 1, 1999, in families that include a grandparent, 
 25.21  relative caretaker as defined in the medical assistance program, 
 25.22  foster parent, or legal guardian, the grandparent, relative 
 25.23  caretaker, foster parent, or legal guardian may apply as a 
 25.24  family or may apply separately for the children.  If the 
 25.25  caretaker applies separately for the children, only the 
 25.26  children's income is counted and the provisions of subdivision 
 25.27  1, paragraph (b), do not apply.  If the grandparent, relative 
 25.28  caretaker, foster parent, or legal guardian applies with the 
 25.29  children, their income is included in the gross family income 
 25.30  for determining eligibility and premium amount. 
 25.31     Sec. 31.  Minnesota Statutes 1998, section 256L.05, 
 25.32  subdivision 4, is amended to read: 
 25.33     Subd. 4.  [APPLICATION PROCESSING.] The commissioner of 
 25.34  human services shall determine an applicant's eligibility for 
 25.35  MinnesotaCare no more than 30 days from the date that the 
 25.36  application is received by the department of human services.  
 26.1   Beginning January 1, 2000, this requirement also applies to 
 26.2   local county human services agencies that determine eligibility 
 26.3   for MinnesotaCare.  Once annually for initial applications, to 
 26.4   prevent processing delays, applicants who, from the information 
 26.5   provided on the application, appear to meet eligibility 
 26.6   requirements shall be enrolled upon timely payment of premiums. 
 26.7   The enrollee must provide all required verifications within 30 
 26.8   days of enrollment notification of the eligibility determination 
 26.9   or coverage from the program shall be terminated.  Enrollees who 
 26.10  are determined to be ineligible when verifications are provided 
 26.11  shall be disenrolled from the program. 
 26.12     Sec. 32.  Minnesota Statutes 1998, section 256L.06, 
 26.13  subdivision 3, is amended to read: 
 26.14     Subd. 3.  [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 
 26.15  Premiums are dedicated to the commissioner for MinnesotaCare. 
 26.16     (b) The commissioner shall develop and implement procedures 
 26.17  to:  (1) require enrollees to report changes in income; (2) 
 26.18  adjust sliding scale premium payments, based upon changes in 
 26.19  enrollee income; and (3) disenroll enrollees from MinnesotaCare 
 26.20  for failure to pay required premiums.  Beginning July 1, 1998, 
 26.21  Failure to pay includes payment with a dishonored check and, a 
 26.22  returned automatic bank withdrawal, or a refused credit card or 
 26.23  debit card payment.  The commissioner may demand a guaranteed 
 26.24  form of payment, including a cashier's check or a money order, 
 26.25  as the only means to replace a dishonored check, returned, or 
 26.26  refused payment. 
 26.27     (c) Premiums are calculated on a calendar month basis and 
 26.28  may be paid on a monthly, quarterly, or annual basis, with the 
 26.29  first payment due upon notice from the commissioner of the 
 26.30  premium amount required.  The commissioner shall inform 
 26.31  applicants and enrollees of these premium payment options. 
 26.32  Premium payment is required before enrollment is complete and to 
 26.33  maintain eligibility in MinnesotaCare.  
 26.34     (d) Nonpayment of the premium will result in disenrollment 
 26.35  from the plan within one calendar month after the due date.  
 26.36  Persons disenrolled for nonpayment or who voluntarily terminate 
 27.1   coverage from the program may not reenroll until four calendar 
 27.2   months have elapsed.  Persons disenrolled for nonpayment who pay 
 27.3   all past due premiums as well as current premiums due, within 20 
 27.4   days of disenrollment, shall be reenrolled for the next month.  
 27.5   Persons disenrolled for nonpayment or who voluntarily terminate 
 27.6   coverage from the program may not reenroll for four calendar 
 27.7   months unless the person demonstrates good cause for 
 27.8   nonpayment.  Good cause does not exist if a person chooses to 
 27.9   pay other family expenses instead of the premium.  The 
 27.10  commissioner shall define good cause in rule. 
 27.11     Sec. 33.  Minnesota Statutes 1998, section 256L.07, is 
 27.12  amended to read: 
 27.13     256L.07 [ELIGIBILITY FOR SUBSIDIZED PREMIUMS BASED ON 
 27.14  SLIDING SCALE MINNESOTACARE.] 
 27.15     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
 27.16  enrolled in the original children's health plan as of September 
 27.17  30, 1992, children who enrolled in the MinnesotaCare program 
 27.18  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 27.19  article 4, section 17, and children who have family gross 
 27.20  incomes that are equal to or less than 150 percent of the 
 27.21  federal poverty guidelines are eligible for subsidized premium 
 27.22  payments without meeting the requirements of subdivision 2, as 
 27.23  long as they maintain continuous coverage in the MinnesotaCare 
 27.24  program or medical assistance.  Children who apply for 
 27.25  MinnesotaCare on or after the implementation date of the 
 27.26  employer-subsidized health coverage program as described in Laws 
 27.27  1998, chapter 407, article 5, section 45, who have family gross 
 27.28  incomes that are equal to or less than 150 percent of the 
 27.29  federal poverty guidelines, must meet the requirements of 
 27.30  subdivision 2 to be eligible for MinnesotaCare. 
 27.31     (b) Families enrolled in MinnesotaCare under section 
 27.32  256L.04, subdivision 1, whose income increases above 275 percent 
 27.33  of the federal poverty guidelines, are no longer eligible for 
 27.34  the program and shall be disenrolled by the commissioner.  
 27.35  Individuals enrolled in MinnesotaCare under section 256L.04, 
 27.36  subdivision 7, whose income increases above 175 percent of the 
 28.1   federal poverty guidelines are no longer eligible for the 
 28.2   program and shall be disenrolled by the commissioner.  For 
 28.3   persons disenrolled under this subdivision, MinnesotaCare 
 28.4   coverage terminates the last day of the calendar month following 
 28.5   the month in which the commissioner determines that the income 
 28.6   of a family or individual, determined over a four-month period 
 28.7   as required by section 256L.15, subdivision 2, exceeds program 
 28.8   income limits.  
 28.9      (c) Notwithstanding paragraph (b), individuals and families 
 28.10  may remain enrolled in MinnesotaCare if ten percent of their 
 28.11  annual income is less than the annual premium for a policy with 
 28.12  a $500 deductible available through the Minnesota comprehensive 
 28.13  health association.  Individuals and families who are no longer 
 28.14  eligible for MinnesotaCare under this subdivision shall be given 
 28.15  an 18-month notice period from the date that ineligibility is 
 28.16  determined before disenrollment.  
 28.17     Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
 28.18  COVERAGE.] (a) To be eligible for subsidized premium payments 
 28.19  based on a sliding scale, a family or individual must not have 
 28.20  access to subsidized health coverage through an employer.  A 
 28.21  family or individual whose employer-subsidized coverage is lost 
 28.22  due to an employer terminating health care coverage as an 
 28.23  employee benefit during the previous 18 months is not eligible.  
 28.24     (b) For purposes of this requirement, subsidized health 
 28.25  coverage means health coverage for which the employer pays at 
 28.26  least 50 percent of the cost of coverage for the employee or 
 28.27  dependent, or a higher percentage as specified by the 
 28.28  commissioner.  Children are eligible for employer-subsidized 
 28.29  coverage through either parent, including the noncustodial 
 28.30  parent.  The commissioner must treat employer contributions to 
 28.31  Internal Revenue Code Section 125 plans and any other employer 
 28.32  benefits intended to pay health care costs as qualified employer 
 28.33  subsidies toward the cost of health coverage for employees for 
 28.34  purposes of this subdivision. 
 28.35     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
 28.36  individuals enrolled in the MinnesotaCare program must have no 
 29.1   health coverage while enrolled or for at least four months prior 
 29.2   to application and renewal.  Children enrolled in the original 
 29.3   children's health plan and children in families with income 
 29.4   equal to or less than 150 percent of the federal poverty 
 29.5   guidelines, who have other health insurance, are eligible if the 
 29.6   other health coverage meets the requirements of Minnesota Rules, 
 29.7   part 9506.0020, subpart 3, item B. coverage: 
 29.8      (1) lacks two or more of the following: 
 29.9      (i) basic hospital insurance; 
 29.10     (ii) medical-surgical insurance; 
 29.11     (iii) prescription drug coverage; 
 29.12     (iv) dental coverage; or 
 29.13     (v) vision coverage; 
 29.14     (2) requires a deductible of $100 or more per person per 
 29.15  year; or 
 29.16     (3) lacks coverage because the child has exceeded the 
 29.17  maximum coverage for a particular diagnosis or the policy 
 29.18  excludes a particular diagnosis. 
 29.19     The commissioner may change this eligibility criterion for 
 29.20  sliding scale premiums in order to remain within the limits of 
 29.21  available appropriations.  The requirement of no health coverage 
 29.22  does not apply to newborns. 
 29.23     (b) For purposes of this section, medical assistance, 
 29.24  general assistance medical care, and civilian health and medical 
 29.25  program of the uniformed service, CHAMPUS, are not considered 
 29.26  insurance or health coverage. 
 29.27     (c) For purposes of this section, Medicare Part A or B 
 29.28  coverage under title XVIII of the Social Security Act, United 
 29.29  States Code, title 42, sections 1395c to 1395w-4, is considered 
 29.30  health coverage.  An applicant or enrollee may not refuse 
 29.31  Medicare coverage to establish eligibility for MinnesotaCare. 
 29.32     (d) Applicants who were recipients of medical assistance or 
 29.33  general assistance medical care within one month of application 
 29.34  must meet the provisions of this subdivision and subdivision 2. 
 29.35     Sec. 34.  Minnesota Statutes 1998, section 256L.15, 
 29.36  subdivision 1, is amended to read: 
 30.1      Subdivision 1.  [PREMIUM DETERMINATION.] Families with 
 30.2   children and individuals shall pay a premium determined 
 30.3   according to a sliding fee based on the cost of coverage as a 
 30.4   percentage of the family's gross family income.  Pregnant women 
 30.5   and children under age two are exempt from the provisions of 
 30.6   section 256L.06, subdivision 3, paragraph (b), clause (3), 
 30.7   requiring disenrollment for failure to pay premiums.  For 
 30.8   pregnant women, this exemption continues until the first day of 
 30.9   the month following the 60th day postpartum.  Women who remain 
 30.10  enrolled during pregnancy or the postpartum period, despite 
 30.11  nonpayment of premiums, shall be disenrolled on the first of the 
 30.12  month following the 60th day postpartum for the penalty period 
 30.13  that otherwise applies under section 256L.06, unless they begin 
 30.14  paying premiums. 
 30.15     Sec. 35.  Minnesota Statutes 1998, section 256L.15, 
 30.16  subdivision 1b, is amended to read: 
 30.17     Subd. 1b.  [PAYMENTS NONREFUNDABLE.] Only MinnesotaCare 
 30.18  premiums are not refundable paid for future months of coverage 
 30.19  for which a health plan capitation fee has not been paid may be 
 30.20  refunded. 
 30.21     Sec. 36.  Minnesota Statutes 1998, section 256L.15, 
 30.22  subdivision 2, is amended to read: 
 30.23     Subd. 2.  [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 
 30.24  GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner shall 
 30.25  establish a sliding fee scale to determine the percentage of 
 30.26  gross individual or family income that households at different 
 30.27  income levels must pay to obtain coverage through the 
 30.28  MinnesotaCare program.  The sliding fee scale must be based on 
 30.29  the enrollee's gross individual or family income during the 
 30.30  previous four months.  The sliding fee scale must contain 
 30.31  separate tables based on enrollment of one, two, or three or 
 30.32  more persons.  The sliding fee scale begins with a premium of 
 30.33  1.5 percent of gross individual or family income for individuals 
 30.34  or families with incomes below the limits for the medical 
 30.35  assistance program for families and children in effect on 
 30.36  January 1, 1999, and proceeds through the following evenly 
 31.1   spaced steps:  1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 
 31.2   percent.  These percentages are matched to evenly spaced income 
 31.3   steps ranging from the medical assistance income limit for 
 31.4   families and children in effect on January 1, 1999, to 275 
 31.5   percent of the federal poverty guidelines for the applicable 
 31.6   family size, up to a family size of five.  The sliding fee scale 
 31.7   for a family of five must be used for families of more than 
 31.8   five.  The sliding fee scale and percentages are not subject to 
 31.9   the provisions of chapter 14.  If a family or individual reports 
 31.10  increased income after enrollment, premiums shall not be 
 31.11  adjusted until eligibility renewal. 
 31.12     (b) Enrolled individuals whose gross annual income 
 31.13  increases above 275 percent of the federal poverty guideline 
 31.14  shall pay the maximum premium.  The maximum premium is defined 
 31.15  as a base charge for one, two, or three or more enrollees so 
 31.16  that if all MinnesotaCare cases paid the maximum premium, the 
 31.17  total revenue would equal the total cost of MinnesotaCare 
 31.18  medical coverage and administration.  In this calculation, 
 31.19  administrative costs shall be assumed to equal ten percent of 
 31.20  the total.  The costs of medical coverage for pregnant women and 
 31.21  children under age two and the enrollees in these groups shall 
 31.22  be excluded from the total.  The maximum premium for two 
 31.23  enrollees shall be twice the maximum premium for one, and the 
 31.24  maximum premium for three or more enrollees shall be three times 
 31.25  the maximum premium for one. 
 31.26     Sec. 37.  Laws 1995, chapter 178, article 2, section 46, 
 31.27  subdivision 10, is amended to read: 
 31.28     Subd. 10.  [ADDITIONAL WAIVER REQUEST FOR EMPLOYED DISABLED 
 31.29  PERSONS.] The commissioner shall seek a federal waiver in order 
 31.30  to implement a work incentive for disabled persons eligible for 
 31.31  medical assistance who are not residents of long-term care 
 31.32  facilities, when determining their eligibility for medical 
 31.33  assistance.  The waiver shall request authorization to establish 
 31.34  a medical assistance earned income disregard for employed 
 31.35  disabled persons who, but for earned income, are eligible for 
 31.36  SSDI and who receive require personal care assistance under the 
 32.1   Medical Assistance Program.  The disregard shall be equivalent 
 32.2   to the threshold amount applied to persons who qualify under 
 32.3   section 1619(b) of the Social Security Act, except that when a 
 32.4   disabled person's earned income reaches the maximum income 
 32.5   permitted at the threshold under section 1619(b), the person 
 32.6   shall retain medical assistance eligibility and must contribute 
 32.7   to the costs of medical care on a sliding fee basis. 
 32.8      Sec. 38.  [HOME-BASED MENTAL HEALTH SERVICES.] 
 32.9      By January 1, 2000, the commissioner shall amend Minnesota 
 32.10  Rules under the expedited process of Minnesota Statutes, section 
 32.11  14.389, to effect the following changes: 
 32.12     (1) amend Minnesota Rules, part 9505.0324, subpart 2, to 
 32.13  permit a county board to contract with any agency qualified 
 32.14  under Minnesota Rules, part 9505.0324, subparts 4 and 5, as an 
 32.15  eligible provider of home-based mental health services; 
 32.16     (2) amend Minnesota Rules, part 9505.0324, subpart 2, to 
 32.17  permit children's mental health collaboratives approved by the 
 32.18  children's cabinet under Minnesota Statutes, section 245.493, to 
 32.19  provide or to contract with any agency qualified under Minnesota 
 32.20  Rules, part 9505.0324, subparts 4 and 5, as an eligible provider 
 32.21  of home-based mental health services. 
 32.22     Sec. 39.  [AMENDING MEDICAL ASSISTANCE RULES.] 
 32.23     By January 1, 2001, the commissioner shall amend Minnesota 
 32.24  Rules, parts 9505.0323, 9505.0324, 9505.0326, and 9505.0327, as 
 32.25  necessary to implement the changes outlined in Minnesota 
 32.26  Statutes, section 256B.0625, subdivision 35.