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HF 1665

as introduced - 89th Legislature (2015 - 2016) Posted on 03/23/2015 04:01pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 03/10/2015

Current Version - as introduced

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A bill for an act
relating to human services; repealing the MinnesotaCare program; requiring
health carriers to offer MinnesotaCare II plans; providing cost-sharing reductions
and premium subsidies for MinnesotaCare II enrollees; making conforming
changes; appropriating money; amending Minnesota Statutes 2014, sections
62V.05, by adding a subdivision; 256.98, subdivision 1; 256B.021, subdivision
4; 270A.03, subdivision 5; 270B.14, subdivision 1; repealing Minnesota Statutes
2014, sections 13.461, subdivision 26; 16A.724, subdivision 3; 62A.046,
subdivision 5; 256L.01, subdivisions 1, 1a, 1b, 2, 3, 3a, 5, 6, 7; 256L.02,
subdivisions 1, 2, 3, 5, 6; 256L.03, subdivisions 1, 1a, 1b, 2, 3, 3a, 3b, 4, 4a, 5,
6; 256L.04, subdivisions 1, 1a, 1c, 2, 2a, 7, 7a, 7b, 8, 10, 12, 13, 14; 256L.05,
subdivisions 1, 1a, 1b, 1c, 2, 3, 3a, 3c, 4, 5, 6; 256L.06, subdivision 3; 256L.07,
subdivisions 1, 2, 3, 4; 256L.09, subdivisions 1, 2, 4, 5, 6, 7; 256L.10; 256L.11,
subdivisions 1, 2, 2a, 3, 4, 7; 256L.12; 256L.121; 256L.15, subdivisions 1, 1a,
1b, 2; 256L.18; 256L.22; 256L.24; 256L.26; 256L.28.

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

ARTICLE 1

MINNESOTACARE REPEAL

Section 1.

Minnesota Statutes 2014, section 256.98, subdivision 1, is amended to read:


Subdivision 1.

Wrongfully obtaining assistance.

A person who commits any of
the following acts or omissions with intent to defeat the purposes of sections 145.891
to 145.897, the MFIP program formerly codified in sections 256.031 to 256.0361, the
AFDC program formerly codified in sections 256.72 to 256.871, chapters 256B, 256D,
256J, 256K, or 256L, and child care assistance programs, is guilty of theft and shall be
sentenced under section 609.52, subdivision 3, clauses (1) to (5):

(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of
a willfully false statement or representation, by intentional concealment of any material
fact, or by impersonation or other fraudulent device, assistance or the continued receipt of
assistance, to include child care assistance or vouchers produced according to sections
145.891 to 145.897 and deleted text beginMinnesotaCare services according to sectionsdeleted text endnew text begin premium assistance
under section
new text end 256.9365deleted text begin, 256.94, and 256L.01 to 256L.15deleted text end, to which the person is not
entitled or assistance greater than that to which the person is entitled;

(2) knowingly aids or abets in buying or in any way disposing of the property of a
recipient or applicant of assistance without the consent of the county agency; or

(3) obtains or attempts to obtain, alone or in collusion with others, the receipt of
payments to which the individual is not entitled as a provider of subsidized child care, or
by furnishing or concurring in a willfully false claim for child care assistance.

The continued receipt of assistance to which the person is not entitled or greater
than that to which the person is entitled as a result of any of the acts, failure to act, or
concealment described in this subdivision shall be deemed to be continuing offenses from
the date that the first act or failure to act occurred.

Sec. 2.

Minnesota Statutes 2014, section 256B.021, subdivision 4, is amended to read:


Subd. 4.

Projects.

The commissioner shall request permission and funding to
further the following initiatives.

(a) Health care delivery demonstration projects. This project involves testing
alternative payment and service delivery models in accordance with sections 256B.0755
and 256B.0756. These demonstrations will allow the Minnesota Department of Human
Services to engage in alternative payment arrangements with provider organizations that
provide services to a specified patient population for an agreed upon total cost of care or
risk/gain sharing payment arrangement, but are not limited to these models of care delivery
or payment. Quality of care and patient experience will be measured and incorporated into
payment models alongside the cost of care. Demonstration sites should include Minnesota
health care programs fee-for-services recipients and managed care enrollees and support a
robust primary care model and improved care coordination for recipients.

(b) Promote personal responsibility and encourage and reward healthy outcomes.
This project provides Medicaid funding to provide individual and group incentives to
encourage healthy behavior, prevent the onset of chronic disease, and reward healthy
outcomes. Focus areas may include diabetes prevention and management, tobacco
cessation, reducing weight, lowering cholesterol, and lowering blood pressure.

(c) Encourage utilization of high quality, cost-effective care. This project creates
incentives through Medicaid and MinnesotaCare enrollee cost-sharing and other means to
encourage the utilization of high-quality, low-cost, high-value providers, as determined by
the state's provider peer grouping initiative under section 62U.04.

(d) Adults without children. This proposal includes requesting federal authority to
impose a limit on assets for adults without children in medical assistance, as defined in
section 256B.055, subdivision 15, who have a household income equal to or less than
75 percent of the federal poverty limitdeleted text begin, and to impose a 180-day durational residency
deleted text enddeleted text beginrequirement in MinnesotaCare, consistent with section 256L.09, subdivision 4, for adults
without children, regardless of income
deleted text end.

(e) Empower and encourage work, housing, and independence. This project provides
services and supports for individuals who have an identified health or disabling condition
but are not yet certified as disabled, in order to delay or prevent permanent disability,
reduce the need for intensive health care and long-term care services and supports, and to
help maintain or obtain employment or assist in return to work. Benefits may include:

(1) coordination with health care homes or health care coordinators;

(2) assessment for wellness, housing needs, employment, planning, and goal setting;

(3) training services;

(4) job placement services;

(5) career counseling;

(6) benefit counseling;

(7) worker supports and coaching;

(8) assessment of workplace accommodations;

(9) transitional housing services; and

(10) assistance in maintaining housing.

(f) Redesign home and community-based services. This project realigns existing
funding, services, and supports for people with disabilities and older Minnesotans to
ensure community integration and a more sustainable service system. This may involve
changes that promote a range of services to flexibly respond to the following needs:

(1) provide people less expensive alternatives to medical assistance services;

(2) offer more flexible and updated community support services under the Medicaid
state plan;

(3) provide an individual budget and increased opportunity for self-direction;

(4) strengthen family and caregiver support services;

(5) allow persons to pool resources or save funds beyond a fiscal year to cover
unexpected needs or foster development of needed services;

(6) use of home and community-based waiver programs for people whose needs
cannot be met with the expanded Medicaid state plan community support service options;

(7) target access to residential care for those with higher needs;

(8) develop capacity within the community for crisis intervention and prevention;

(9) redesign case management;

(10) offer life planning services for families to plan for the future of their child
with a disability;

(11) enhance self-advocacy and life planning for people with disabilities;

(12) improve information and assistance to inform long-term care decisions; and

(13) increase quality assurance, performance measurement, and outcome-based
reimbursement.

This project may include different levels of long-term supports that allow seniors to
remain in their homes and communities, and expand care transitions from acute care to
community care to prevent hospitalizations and nursing home placement. The levels
of support for seniors may range from basic community services for those with lower
needs, access to residential services if a person has higher needs, and targets access to
nursing home care to those with rehabilitation or high medical needs. This may involve
the establishment of medical need thresholds to accommodate the level of support
needed; provision of a long-term care consultation to persons seeking residential services,
regardless of payer source; adjustment of incentives to providers and care coordination
organizations to achieve desired outcomes; and a required coordination with medical
assistance basic care benefit and Medicare/Medigap benefit. This proposal will improve
access to housing and improve capacity to maintain individuals in their existing home;
adjust screening and assessment tools, as needed; improve transition and relocation
efforts; seek federal financial participation for alternative care and essential community
supports; and provide Medigap coverage for people having lower needs.

(g) Coordinate and streamline services for people with complex needs, including
those with multiple diagnoses of physical, mental, and developmental conditions. This
project will coordinate and streamline medical assistance benefits for people with complex
needs and multiple diagnoses. It would include changes that:

(1) develop community-based service provider capacity to serve the needs of this
group;

(2) build assessment and care coordination expertise specific to people with multiple
diagnoses;

(3) adopt service delivery models that allow coordinated access to a range of services
for people with complex needs;

(4) reduce administrative complexity;

(5) measure the improvements in the state's ability to respond to the needs of this
population; and

(6) increase the cost-effectiveness for the state budget.

(h) Implement nursing home level of care criteria. This project involves obtaining
any necessary federal approval in order to implement the changes to the level of care
criteria in section 144.0724, subdivision 11, and implement further changes necessary to
achieve reform of the home and community-based service system.

(i) Improve integration of Medicare and Medicaid. This project involves reducing
fragmentation in the health care delivery system to improve care for people eligible for
both Medicare and Medicaid, and to align fiscal incentives between primary, acute, and
long-term care. The proposal may include:

(1) requesting an exception to the new Medicare methodology for payment
adjustment for fully integrated special needs plans for dual eligible individuals;

(2) testing risk adjustment models that may be more favorable to capturing the
needs of frail dually eligible individuals;

(3) requesting an exemption from the Medicare bidding process for fully integrated
special needs plans for the dually eligible;

(4) modifying the Medicare bid process to recognize additional costs of health
home services; and

(5) requesting permission for risk-sharing and gain-sharing.

(j) Intensive residential treatment services. This project would involve providing
intensive residential treatment services for individuals who have serious mental illness
and who have other complex needs. This proposal would allow such individuals to remain
in these settings after mental health symptoms have stabilized, in order to maintain their
mental health and avoid more costly or unnecessary hospital or other residential care due
to their other complex conditions. The commissioner may pursue a specialized rate for
projects created under this section.

(k) Seek federal Medicaid matching funds for Anoka Metro Regional Treatment
Center (AMRTC). This project involves seeking Medicaid reimbursement for medical
services provided to patients to AMRTC, including requesting a waiver of United States
Code, title 42, section 1396d, which prohibits Medicaid reimbursement for expenditures
for services provided by hospitals with more than 16 beds that are primarily focused on
the treatment of mental illness. This waiver would allow AMRTC to serve as a statewide
resource to provide diagnostics and treatment for people with the most complex conditions.

(l) Waivers to allow Medicaid eligibility for children under age 21 receiving care
in residential facilities. This proposal would seek Medicaid reimbursement for any
Medicaid-covered service for children who are placed in residential settings that are
determined to be "institutions for mental diseases," under United States Code, title 42,
section 1396d.

Sec. 3.

Minnesota Statutes 2014, section 270A.03, subdivision 5, is amended to read:


Subd. 5.

Debt.

(a) "Debt" means a legal obligation of a natural person to pay a fixed
and certain amount of money, which equals or exceeds $25 and which is due and payable
to a claimant agency. The term includes criminal fines imposed under section 609.10 or
609.125, fines imposed for petty misdemeanors as defined in section 609.02, subdivision
4a
, and restitution. A debt may arise under a contractual or statutory obligation, a court
order, or other legal obligation, but need not have been reduced to judgment.

A debt includes any legal obligation of a current recipient of assistance which is
based on overpayment of an assistance grant where that payment is based on a client
waiver or an administrative or judicial finding of an intentional program violation;
or where the debt is owed to a program wherein the debtor is not a client at the time
notification is provided to initiate recovery under this chapter and the debtor is not a
current recipient of food support, transitional child care, or transitional medical assistance.

(b) A debt does not include any legal obligation to pay a claimant agency for medical
care, including hospitalization if the income of the debtor at the time when the medical
care was rendered does not exceed the following amount:

(1) for an unmarried debtor, an income of $8,800 or less;

(2) for a debtor with one dependent, an income of $11,270 or less;

(3) for a debtor with two dependents, an income of $13,330 or less;

(4) for a debtor with three dependents, an income of $15,120 or less;

(5) for a debtor with four dependents, an income of $15,950 or less; and

(6) for a debtor with five or more dependents, an income of $16,630 or less.

(c) The commissioner shall adjust the income amounts in paragraph (b) by the
percentage determined pursuant to the provisions of section 1(f) of the Internal Revenue
Code, except that in section 1(f)(3)(B) the word "1999" shall be substituted for the word
"1992." For 2001, the commissioner shall then determine the percent change from the 12
months ending on August 31, 1999, to the 12 months ending on August 31, 2000, and in
each subsequent year, from the 12 months ending on August 31, 1999, to the 12 months
ending on August 31 of the year preceding the taxable year. The determination of the
commissioner pursuant to this subdivision shall not be considered a "rule" and shall not
be subject to the Administrative Procedure Act contained in chapter 14. The income
amount as adjusted must be rounded to the nearest $10 amount. If the amount ends in
$5, the amount is rounded up to the nearest $10 amount.

(d) Debt also includes an agreement to pay a MinnesotaCare premium, regardless
of the dollar amount of the premium authorized undernew text begin Minnesota Statutes 2014,new text end section
256L.15, subdivision 1a.

Sec. 4.

Minnesota Statutes 2014, section 270B.14, subdivision 1, is amended to read:


Subdivision 1.

Disclosure to commissioner of human services.

(a) On the request
of the commissioner of human services, the commissioner shall disclose return information
regarding taxes imposed by chapter 290, and claims for refunds under chapter 290A, to
the extent provided in paragraph (b) and for the purposes set forth in paragraph (c).

(b) Data that may be disclosed are limited to data relating to the identity,
whereabouts, employment, income, and property of a person owing or alleged to be owing
an obligation of child support.

(c) The commissioner of human services may request data only for the purposes of
carrying out the child support enforcement program and to assist in the location of parents
who have, or appear to have, deserted their children. Data received may be used only
as set forth in section 256.978.

(d) The commissioner shall provide the records and information necessary to
administer the supplemental housing allowance to the commissioner of human services.

(e) At the request of the commissioner of human services, the commissioner of
revenue shall electronically match the Social Security numbers and names of participants
in the telephone assistance plan operated under sections 237.69 to 237.71, with those of
property tax refund filers, and determine whether each participant's household income is
within the eligibility standards for the telephone assistance plan.

(f) The commissioner may provide records and information collected under sections
295.50 to 295.59 to the commissioner of human services for purposes of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991, Public Law
102-234. Upon the written agreement by the United States Department of Health and
Human Services to maintain the confidentiality of the data, the commissioner may provide
records and information collected under sections 295.50 to 295.59 to the Centers for
Medicare and Medicaid Services section of the United States Department of Health and
Human Services for purposes of meeting federal reporting requirements.

(g) The commissioner may provide records and information to the commissioner of
human services as necessary to administer the early refund of refundable tax credits.

deleted text begin (h) The commissioner may disclose information to the commissioner of human
services necessary to verify income for eligibility and premium payment under the
MinnesotaCare program, under section 256L.05, subdivision 2.
deleted text end

deleted text begin (i)deleted text endnew text begin (h)new text end The commissioner may disclose information to the commissioner of human
services necessary to verify whether applicants or recipients for the Minnesota family
investment program, general assistance, food support, Minnesota supplemental aid
program, and child care assistance have claimed refundable tax credits under chapter 290
and the property tax refund under chapter 290A, and the amounts of the credits.

deleted text begin (j)deleted text endnew text begin (i)new text end The commissioner may disclose information to the commissioner of human
services necessary to verify income for purposes of calculating parental contribution
amounts under section 252.27, subdivision 2a.

Sec. 5. new text beginREVISOR INSTRUCTION.
new text end

new text begin In Minnesota Statutes and Minnesota Rules, the revisor of statutes shall strike
references to Minnesota Statutes, chapter 256L, and to statutory sections within that
chapter, and shall make all necessary grammatical and conforming changes.
new text end

Sec. 6. new text begin REPEALER.
new text end

new text begin Subdivision 1. new text end

new text begin MinnesotaCare program. new text end

new text begin Minnesota Statutes 2014, sections
256L.01, subdivisions 1, 1a, 1b, 2, 3, 3a, 5, 6, and 7; 256L.02, subdivisions 1, 2, 3, 5, and
6; 256L.03, subdivisions 1, 1a, 1b, 2, 3, 3a, 3b, 4, 4a, 5, and 6; 256L.04, subdivisions 1,
1a, 1c, 2, 2a, 7, 7a, 7b, 8, 10, 12, 13, and 14; 256L.05, subdivisions 1, 1a, 1b, 1c, 2, 3, 3a,
3c, 4, 5, and 6; 256L.06, subdivision 3; 256L.07, subdivisions 1, 2, 3, and 4; 256L.09,
subdivisions 1, 2, 4, 5, 6, and 7; 256L.10; 256L.11, subdivisions 1, 2, 2a, 3, 4, and 7;
256L.12; 256L.121; 256L.15, subdivisions 1, 1a, 1b, and 2; 256L.18; 256L.22; 256L.24;
256L.26; and 256L.28,
new text end new text begin are repealed.
new text end

new text begin Subd. 2. new text end

new text begin Conforming repealers. new text end

new text begin Minnesota Statutes 2014, sections 13.461,
subdivision 26; 16A.724, subdivision 3; and 62A.046, subdivision 5,
new text end new text begin are repealed.
new text end

Sec. 7. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 to 6 are effective January 1, 2016.
new text end

ARTICLE 2

MINNESOTACARE II PLANS AND SUBSIDIES

Section 1.

Minnesota Statutes 2014, section 62V.05, is amended by adding a
subdivision to read:


new text begin Subd. 11. new text end

new text begin MinnesotaCare II plans. new text end

new text begin (a) The MNsure board shall require each health
carrier offering a silver plan through MNsure to offer a corresponding MinnesotaCare II
plan. In order to be eligible for a MinnesotaCare II plan, an applicant or enrollee must:
new text end

new text begin (1) have an income greater than 133 percent but not exceeding 200 percent of the
federal poverty guidelines; or
new text end

new text begin (2) have an income equal to or less than 133 percent of the federal poverty
guidelines, if the applicant or enrollee would have been eligible for MinnesotaCare
coverage under the eligibility criteria in effect on December 31, 2015.
new text end

new text begin The MinnesotaCare II plan must be identical to the base silver plan, except that a
MinnesotaCare II plan must provide an actuarial value equal to 94 percent for enrollees
with incomes not exceeding 150 percent of the federal poverty guidelines, and an actuarial
value of 87 percent for enrollees with incomes equal to or greater than 150 percent but not
exceeding 200 percent of the federal poverty guidelines. Subject to federal approval, the
board shall require a health plan to achieve this actuarial value first by reducing the annual
deductible, and then, if necessary, by reducing other cost-sharing.
new text end

new text begin (b) The board shall subsidize premium costs for persons eligible for a MinnesotaCare
II plan by reducing monthly premiums by ... percent, subject to a maximum monthly
premium reduction of $....... The MNsure board shall pay premium subsidies directly to
health carriers.
new text end

new text begin (c) The board shall ensure that the MNsure Web site automatically applies the
cost-sharing reductions and premium subsidies to persons eligible under this subdivision.
new text end

new text begin (d) Each health carrier may seek federal reimbursement as provided under section
1402 of the Affordable Care Act for the cost of providing a cost-sharing reduction under
this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016, and sunsets January
1, 2020.
new text end

Sec. 2. new text beginMINNESOTACARE II STUDY.
new text end

new text begin The commissioner of human services shall study and make recommendations to the
legislature on whether the continuation of MinnesotaCare II plans and related premium
subsidies under Minnesota Statutes, section 62V.05, subdivision 11, beyond December
31, 2019, is necessary to ensure the availability of affordable health coverage to persons
purchasing coverage through MNsure. If continuation is recommended, the commissioner
shall also evaluate and recommend state funding options for MinnesotaCare II premium
subsidies. The commissioner shall present evaluation results and recommendations to the
legislature by December 15, 2018.
new text end

Sec. 3. new text beginAPPROPRIATION.
new text end

new text begin $....... is appropriated for the biennium ending June 30, 2017, from the health care
access fund to the MNsure board to provide premium subsidies under Minnesota Statutes,
section 62V.05, subdivision 11.
new text end