3rd Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to operation of state government; conforming 1.3 to federal tax changes to encourage consumer-driven 1.4 health plans; encouraging efficiency in providing 1.5 health care; requiring disease management initiatives; 1.6 implementing health care cost containment, 1.7 cost-shifting provisions, and reduction of government 1.8 mandates; implementing health plan competition and 1.9 reform provisions; changing health maintenance 1.10 organization regulatory authority; changing provisions 1.11 related to child care, economic supports, health care, 1.12 long-term care, continuing care, and program integrity 1.13 and administration; making health and human services 1.14 forecast adjustments and reductions; appropriating 1.15 money; amending Minnesota Statutes 2002, sections 1.16 16A.10, by adding a subdivision; 43A.23, by adding a 1.17 subdivision; 62A.02, subdivision 2; 62D.02, 1.18 subdivision 4, by adding a subdivision; 62D.03, 1.19 subdivision 1; 62D.04, subdivision 1; 62D.05, 1.20 subdivision 1; 62Q.65; 72A.20, by adding a 1.21 subdivision; 119B.13, by adding a subdivision; 1.22 144.148, by adding a subdivision; 144A.10, subdivision 1.23 1a, by adding a subdivision; 144D.025; 147.03, 1.24 subdivision 1; 256.01, by adding subdivisions; 1.25 256.9365, subdivision 1; 256.955, subdivisions 2b, 4, 1.26 6; 256B.02, subdivision 12; 256B.04, subdivision 14, 1.27 by adding a subdivision; 256B.056, subdivision 5, by 1.28 adding subdivisions; 256B.0916, subdivision 2; 1.29 256B.431, by adding subdivisions; 256B.49, by adding a 1.30 subdivision; 256D.045; 256D.051, subdivisions 1a, 3a, 1.31 6c; 256I.04, subdivision 2a; 256L.01, subdivision 5; 1.32 256L.03, subdivision 5, by adding a subdivision; 1.33 256L.04, subdivision 2, by adding subdivisions; 1.34 256L.05, subdivision 3; 549.02, by adding a 1.35 subdivision; 549.04; Minnesota Statutes 2003 1.36 Supplement, sections 62E.08, subdivision 1; 62E.091; 1.37 62J.26, by adding a subdivision; 119B.09, subdivision 1.38 9; 119B.13, subdivision 1; 144.7063, subdivision 3; 1.39 144A.071, subdivision 4c; 245A.10, subdivision 4; 1.40 246B.04, as amended; 252.27, subdivision 2a; 256.019, 1.41 subdivision 1; 256.046, subdivision 1; 256.955, 1.42 subdivisions 2a, 3; 256B.056, subdivision 3c; 1.43 256B.057, subdivision 9; 256B.0595, subdivision 2; 1.44 256B.06, subdivision 4; 256B.0625, subdivision 9; 1.45 256B.0631, subdivision 2; 256B.19, subdivision 1; 1.46 256B.434, subdivision 4; 256B.69, subdivision 2; 2.1 256D.03, subdivisions 3, 4; 256D.44, subdivision 5; 2.2 256J.24, subdivision 6; 256J.37, subdivision 3a; 2.3 256J.53, subdivision 1; 256L.03, subdivision 1; 2.4 256L.035; 256L.07, subdivisions 1, 3; 290.01, 2.5 subdivisions 19, 31; 295.50, subdivision 9b; 295.53, 2.6 subdivision 1; Laws 2003, First Special Session 2.7 chapter 14, article 9, section 34; Laws 2003, First 2.8 Special Session chapter 14, article 13C, section 1; 2.9 Laws 2003, First Special Session chapter 14, article 2.10 13C, section 2, subdivisions 1, 3, 6, 7, 9, 11; Laws 2.11 2003, First Special Session chapter 14, article 13C, 2.12 section 10, subdivision 1; proposing coding for new 2.13 law in Minnesota Statutes, chapters 62J; 62L; 62Q; 2.14 144A; 145; 151; 256B; repealing Minnesota Statutes 2.15 2002, sections 62A.309; 62J.17, subdivisions 1, 3, 4a, 2.16 5a, 6a, 7, 8; 256.955, subdivisions 1, 2, 2b, 4, 5, 6, 2.17 7, 9; 256L.04, subdivision 11; Minnesota Statutes 2003 2.18 Supplement, sections 62J.17, subdivision 2; 256.955, 2.19 subdivisions 2a, 3, 4a; 256B.431, subdivision 36. 2.20 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 2.21 ARTICLE 1 2.22 HEALTH CARE COST CONTAINMENT; CONSUMER EMPOWERMENT 2.23 Section 1. Minnesota Statutes 2002, section 43A.23, is 2.24 amended by adding a subdivision to read: 2.25 Subd. 4. [HEALTH SAVINGS ACCOUNTS.] During collective 2.26 bargaining negotiations with the exclusive representatives of 2.27 state employees, the commissioner must propose that state 2.28 employee health coverage include at least one plan of hospital 2.29 and medical benefits that combines a high deductible health plan 2.30 with a health savings account, so as to qualify the health 2.31 savings account under section 223 of the Internal Revenue Code, 2.32 as amended. 2.33 Sec. 2. [62J.81] [DISCLOSURE OF PAYMENTS FOR HEALTH CARE 2.34 SERVICES.] 2.35 Subdivision 1. [REQUIRED DISCLOSURE OF PAYMENT RANGE.] A 2.36 health care provider, as defined in section 62J.03, subdivision 2.37 8, shall, at the request of a consumer, provide that consumer 2.38 with the beginning and end of the range of payments received by 2.39 the provider from health plan companies for a specific service 2.40 or services that the consumer may reasonably expect to receive 2.41 from the provider, based upon the consumer's medical condition. 2.42 The beginning of the range of payments received by a provider is 2.43 the lowest amount the provider is paid by a health plan company 2.44 for a specific service and the end of the range is the highest 2.45 amount the provider is paid by a health plan company for the 3.1 service, based upon the provider agreements in force at the time 3.2 of the request. A provider is not required to identify the 3.3 names of health plan companies. 3.4 Subd. 2. [APPLICABILITY.] For purposes of this section, 3.5 "consumer" does not include a medical assistance, MinnesotaCare, 3.6 or general assistance medical care enrollee, for services 3.7 covered under those programs, and a health care provider shall 3.8 not include in the range, payments from the medical assistance, 3.9 MinnesotaCare, and general assistance medical care programs. 3.10 Sec. 3. Minnesota Statutes 2002, section 62Q.65, is 3.11 amended to read: 3.12 62Q.65 [ACCESS TO PROVIDER DISCOUNTS.] 3.13 Subdivision 1. [REQUIREMENT.] A high deductible health 3.14 plan must, when used in connection witha medical savings3.15accountan Archer MSA or with a health savings account, provide 3.16 the enrollee access to any discounted provider fees for services 3.17 covered by the high deductible health plan, regardless of 3.18 whether the enrollee has satisfied the deductible for the high 3.19 deductible health plan. 3.20 Subd. 2. [DEFINITIONS.] For purposes of this section, the 3.21 following terms have the meanings given: 3.22 (1) "high deductible health plan" has the meaning given 3.23 under the Internal Revenue Code of 1986, section 220(c)(2) or 3.24 223(c)(2); 3.25 (2) "medical savings accountArcher MSA" has the meaning 3.26 given under the Internal Revenue Code of 1986, section 3.27 220(d)(1);and3.28 (3) "discounted provider fees" means fees contained in a 3.29 provider agreement entered into by the issuer of the high 3.30 deductible health plan, or by an affiliate of the issuer, for 3.31 use in connection with the high deductible health plan; and 3.32 (4) "health savings account" has the meaning given under 3.33 the Internal Revenue Code of 1986, section 223(d). 3.34 Sec. 4. [151.214] [PAYMENT DISCLOSURE.] 3.35 Subdivision 1. [EXPLANATION OF PHARMACY BENEFITS.] A 3.36 pharmacist licensed under this chapter must provide to a 4.1 patient, for each prescription dispensed where part or all of 4.2 the cost of the prescription is being paid or reimbursed by an 4.3 employer-sponsored plan or health plan company, or its 4.4 contracted pharmacy benefit manager, the patient's co-payment 4.5 amount and the usual and customary price of the prescription or 4.6 the amount the pharmacy will be paid for the prescription drug 4.7 by the patient's employer-sponsored plan or health plan company, 4.8 or its contracted pharmacy benefit manager. 4.9 Subd. 2. [NO PROHIBITION ON DISCLOSURE.] No contracting 4.10 agreement between an employer-sponsored health plan or health 4.11 plan company, or its contracted pharmacy benefit manager, and a 4.12 resident or nonresident pharmacy registered under this chapter, 4.13 may prohibit the pharmacy from disclosing to patients 4.14 information a pharmacy is required or given the option to 4.15 provide under subdivision 1. 4.16 Sec. 5. Minnesota Statutes 2003 Supplement, section 4.17 290.01, subdivision 19, is amended to read: 4.18 Subd. 19. [NET INCOME.] The term "net income" means the 4.19 federal taxable income, as defined in section 63 of the Internal 4.20 Revenue Code of 1986, as amended through the date named in this 4.21 subdivision, incorporating any elections made by the taxpayer in 4.22 accordance with the Internal Revenue Code in determining federal 4.23 taxable income for federal income tax purposes, and with the 4.24 modifications provided in subdivisions 19a to 19f. 4.25 In the case of a regulated investment company or a fund 4.26 thereof, as defined in section 851(a) or 851(g) of the Internal 4.27 Revenue Code, federal taxable income means investment company 4.28 taxable income as defined in section 852(b)(2) of the Internal 4.29 Revenue Code, except that: 4.30 (1) the exclusion of net capital gain provided in section 4.31 852(b)(2)(A) of the Internal Revenue Code does not apply; 4.32 (2) the deduction for dividends paid under section 4.33 852(b)(2)(D) of the Internal Revenue Code must be applied by 4.34 allowing a deduction for capital gain dividends and 4.35 exempt-interest dividends as defined in sections 852(b)(3)(C) 4.36 and 852(b)(5) of the Internal Revenue Code; and 5.1 (3) the deduction for dividends paid must also be applied 5.2 in the amount of any undistributed capital gains which the 5.3 regulated investment company elects to have treated as provided 5.4 in section 852(b)(3)(D) of the Internal Revenue Code. 5.5 The net income of a real estate investment trust as defined 5.6 and limited by section 856(a), (b), and (c) of the Internal 5.7 Revenue Code means the real estate investment trust taxable 5.8 income as defined in section 857(b)(2) of the Internal Revenue 5.9 Code. 5.10 The net income of a designated settlement fund as defined 5.11 in section 468B(d) of the Internal Revenue Code means the gross 5.12 income as defined in section 468B(b) of the Internal Revenue 5.13 Code. 5.14 The provisions of sections 1113(a), 1117, 1206(a), 1313(a), 5.15 1402(a), 1403(a), 1443, 1450, 1501(a), 1605, 1611(a), 1612, 5.16 1616, 1617, 1704(l), and 1704(m) of the Small Business Job 5.17 Protection Act, Public Law 104-188, the provisions of Public Law 5.18 104-117, the provisions of sections 313(a) and (b)(1), 602(a), 5.19 913(b), 941, 961, 971, 1001(a) and (b), 1002, 1003, 1012, 1013, 5.20 1014, 1061, 1062, 1081, 1084(b), 1086, 1087, 1111(a), 1131(b) 5.21 and (c), 1211(b), 1213, 1530(c)(2), 1601(f)(5) and (h), and 5.22 1604(d)(1) of the Taxpayer Relief Act of 1997, Public Law 5.23 105-34, the provisions of section 6010 of the Internal Revenue 5.24 Service Restructuring and Reform Act of 1998, Public Law 5.25 105-206, the provisions of section 4003 of the Omnibus 5.26 Consolidated and Emergency Supplemental Appropriations Act, 5.27 1999, Public Law 105-277, and the provisions of section 318 of 5.28 the Consolidated Appropriation Act of 2001, Public Law 106-554, 5.29 shall become effective at the time they become effective for 5.30 federal purposes. 5.31 The Internal Revenue Code of 1986, as amended through 5.32 December 31, 1996, shall be in effect for taxable years 5.33 beginning after December 31, 1996. 5.34 The provisions of sections 202(a) and (b), 221(a), 225, 5.35 312, 313, 913(a), 934, 962, 1004, 1005, 1052, 1063, 1084(a) and 5.36 (c), 1089, 1112, 1171, 1204, 1271(a) and (b), 1305(a), 1306, 6.1 1307, 1308, 1309, 1501(b), 1502(b), 1504(a), 1505, 1527, 1528, 6.2 1530, 1601(d), (e), (f), and (i) and 1602(a), (b), (c), and (e) 6.3 of the Taxpayer Relief Act of 1997, Public Law 105-34, the 6.4 provisions of sections 6004, 6005, 6012, 6013, 6015, 6016, 7002, 6.5 and 7003 of the Internal Revenue Service Restructuring and 6.6 Reform Act of 1998, Public Law 105-206, the provisions of 6.7 section 3001 of the Omnibus Consolidated and Emergency 6.8 Supplemental Appropriations Act, 1999, Public Law 105-277, the 6.9 provisions of section 3001 of the Miscellaneous Trade and 6.10 Technical Corrections Act of 1999, Public Law 106-36, and the 6.11 provisions of section 316 of the Consolidated Appropriation Act 6.12 of 2001, Public Law 106-554, shall become effective at the time 6.13 they become effective for federal purposes. 6.14 The Internal Revenue Code of 1986, as amended through 6.15 December 31, 1997, shall be in effect for taxable years 6.16 beginning after December 31, 1997. 6.17 The provisions of sections 5002, 6009, 6011, and 7001 of 6.18 the Internal Revenue Service Restructuring and Reform Act of 6.19 1998, Public Law 105-206, the provisions of section 9010 of the 6.20 Transportation Equity Act for the 21st Century, Public Law 6.21 105-178, the provisions of sections 1004, 4002, and 5301 of the 6.22 Omnibus Consolidation and Emergency Supplemental Appropriations 6.23 Act, 1999, Public Law 105-277, the provision of section 303 of 6.24 the Ricky Ray Hemophilia Relief Fund Act of 1998, Public Law 6.25 105-369, the provisions of sections 532, 534, 536, 537, and 538 6.26 of the Ticket to Work and Work Incentives Improvement Act of 6.27 1999, Public Law 106-170, the provisions of the Installment Tax 6.28 Correction Act of 2000, Public Law 106-573, and the provisions 6.29 of section 309 of the Consolidated Appropriation Act of 2001, 6.30 Public Law 106-554, shall become effective at the time they 6.31 become effective for federal purposes. 6.32 The Internal Revenue Code of 1986, as amended through 6.33 December 31, 1998, shall be in effect for taxable years 6.34 beginning after December 31, 1998. 6.35 The provisions of the FSC Repeal and Extraterritorial 6.36 Income Exclusion Act of 2000, Public Law 106-519, and the 7.1 provision of section 412 of the Job Creation and Worker 7.2 Assistance Act of 2002, Public Law 107-147, shall become 7.3 effective at the time it became effective for federal purposes. 7.4 The Internal Revenue Code of 1986, as amended through 7.5 December 31, 1999, shall be in effect for taxable years 7.6 beginning after December 31, 1999. The provisions of sections 7.7 306 and 401 of the Consolidated Appropriation Act of 2001, 7.8 Public Law 106-554, and the provision of section 632(b)(2)(A) of 7.9 the Economic Growth and Tax Relief Reconciliation Act of 2001, 7.10 Public Law 107-16, and provisions of sections 101 and 402 of the 7.11 Job Creation and Worker Assistance Act of 2002, Public Law 7.12 107-147, shall become effective at the same time it became 7.13 effective for federal purposes. 7.14 The Internal Revenue Code of 1986, as amended through 7.15 December 31, 2000, shall be in effect for taxable years 7.16 beginning after December 31, 2000. The provisions of sections 7.17 659a and 671 of the Economic Growth and Tax Relief 7.18 Reconciliation Act of 2001, Public Law 107-16, the provisions of 7.19 sections 104, 105, and 111 of the Victims of Terrorism Tax 7.20 Relief Act of 2001, Public Law 107-134, and the provisions of 7.21 sections 201, 403, 413, and 606 of the Job Creation and Worker 7.22 Assistance Act of 2002, Public Law 107-147, shall become 7.23 effective at the same time it became effective for federal 7.24 purposes. 7.25 The Internal Revenue Code of 1986, as amended through March 7.26 15, 2002, shall be in effect for taxable years beginning after 7.27 December 31, 2001. 7.28 The provisions of sections 101 and 102 of the Victims of 7.29 Terrorism Tax Relief Act of 2001, Public Law 107-134, shall 7.30 become effective at the same time it becomes effective for 7.31 federal purposes. 7.32 The Internal Revenue Code of 1986, as amended through June 7.33 15, 2003, shall be in effect for taxable years beginning after 7.34 December 31, 2002. The provisions of section 201 of the Jobs 7.35 and Growth Tax Relief and Reconciliation Act of 2003, H.R. 2, if 7.36 it is enacted into law, are effective at the same time it became 8.1 effective for federal purposes. 8.2 Section 1201 of the Medicare Prescription Drug, 8.3 Improvement, and Modernization Act of 2003, codified as section 8.4 223 of the Internal Revenue Code, as amended, relating to health 8.5 savings accounts, is effective at the same time it became 8.6 effective for federal purposes. 8.7 Except as otherwise provided, references to the Internal 8.8 Revenue Code in subdivisions 19a to 19g mean the code in effect 8.9 for purposes of determining net income for the applicable year. 8.10 Sec. 6. Minnesota Statutes 2003 Supplement, section 8.11 290.01, subdivision 31, is amended to read: 8.12 Subd. 31. [INTERNAL REVENUE CODE.] Unless specifically 8.13 defined otherwise, "Internal Revenue Code" means the Internal 8.14 Revenue Code of 1986, as amended through June 15, 2003, and as 8.15 amended by section 1201 of the Medicare Prescription Drug, 8.16 Improvement, and Modernization Act of 2003, codified as section 8.17 223 of the Internal Revenue Code, as amended, relating to health 8.18 savings accounts. 8.19 ARTICLE 2 8.20 HEALTH CARE COST CONTAINMENT; BEST PRACTICES 8.21 Section 1. [62J.43] [BEST PRACTICES AND QUALITY 8.22 IMPROVEMENT.] 8.23 (a) To improve quality and reduce health care costs, state 8.24 agencies shall encourage the adoption of best practice 8.25 guidelines and participation in best practices measurement 8.26 activities by physicians, other health care providers, 8.27 universities and colleges, health care purchasers, and health 8.28 plan companies. The commissioner of health shall facilitate 8.29 access to best practice guidelines and quality of care 8.30 measurement information for providers, purchasers, and consumers 8.31 by: 8.32 (1) identifying and promoting local, community-based, 8.33 physician-designed best practices care across the Minnesota 8.34 health care system; 8.35 (2) disseminating information on adherence to best 8.36 practices care by physicians and other health care providers in 9.1 Minnesota; and 9.2 (3) educating consumers and purchasers on how to 9.3 effectively use this information in choosing their health care 9.4 providers and making purchasing decisions. 9.5 (b) The commissioner of health shall collaborate with a 9.6 nonprofit Minnesota quality improvement organization 9.7 specializing in best practices and quality of care measurements 9.8 to provide best practices criteria. 9.9 (c) The initial best practices and quality of care 9.10 measurement criteria developed shall address diabetes and 9.11 congestive heart failure. 9.12 (d) The commissioners of human services and employee 9.13 relations may use the best practices guidelines to assist them 9.14 in developing contracting strategies that are appropriate for 9.15 the populations they serve. The commissioners shall report to 9.16 the legislature by January 1, 2006, on agency use of best 9.17 practices guidelines. 9.18 (e) This section does not apply if the best practices 9.19 guidelines authorizes or recommends denial of treatment, food, 9.20 or fluids necessary to sustain life on the basis of the 9.21 patient's age or expected length of life or the patient's 9.22 present or predicted disability, degree of medical dependency, 9.23 or quality of life. 9.24 Sec. 2. Minnesota Statutes 2003 Supplement, section 9.25 144.7063, subdivision 3, is amended to read: 9.26 Subd. 3. [FACILITY.] "Facility" means a hospital licensed 9.27 under sections 144.50 to 144.58 or an outpatient surgical center 9.28 licensed under Minnesota Rules, chapter 4675. 9.29 Sec. 3. [256B.075] [DISEASE MANAGEMENT PROGRAMS.] 9.30 Subdivision 1. [GENERAL.] The commissioner shall implement 9.31 disease management initiatives that seek to improve patient care 9.32 and health outcomes and reduce health care costs by managing the 9.33 care provided to recipients with chronic conditions. 9.34 Subd. 2. [FEE-FOR-SERVICE.] (a) The commissioner shall 9.35 develop and implement a disease management program for medical 9.36 assistance and general assistance medical care recipients who 10.1 are not enrolled in the prepaid medical assistance or prepaid 10.2 general assistance medical care programs and who are receiving 10.3 services on a fee-for-service basis. The commissioner may 10.4 contract with an outside organization to provide these services. 10.5 (b) The commissioner shall seek any federal approval 10.6 necessary to implement this section and to obtain federal 10.7 matching funds. 10.8 Subd. 3. [PREPAID MANAGED CARE PROGRAMS.] For the prepaid 10.9 medical assistance, prepaid general assistance medical care, and 10.10 MinnesotaCare programs, the commissioner shall ensure that 10.11 contracting health plans implement disease management programs 10.12 that are appropriate for Minnesota health care program 10.13 recipients and have been designed by the health plan to improve 10.14 patient care and health outcomes and reduce health care costs by 10.15 managing the care provided to recipients with chronic conditions. 10.16 Subd. 4. [HEMOPHILIA.] The commissioner shall develop a 10.17 disease management initiative for Minnesota health care program 10.18 recipients who have been diagnosed with hemophilia. In 10.19 developing the program, the commissioner shall explore the 10.20 feasibility of contracting with a section 340B provider to 10.21 provide disease management services or coordination of care in 10.22 order to maximize the discounted prescription drug prices of the 10.23 federal 340B program offered through section 340B of the federal 10.24 Public Health Services Act, United States Code, title 42, 10.25 section 256b (1999). 10.26 ARTICLE 3 10.27 HEALTH CARE COST CONTAINMENT; COST-SHIFTING 10.28 Section 1. Minnesota Statutes 2002, section 16A.10, is 10.29 amended by adding a subdivision to read: 10.30 Subd. 4. [LIMIT ON STATE HEALTH CARE PROGRAM 10.31 EXPANSION.] No budget proposal shall include any provision that 10.32 requests new or increased funding for an expansion of 10.33 eligibility or covered services for a state health care program, 10.34 unless state health care program reimbursement rates for major 10.35 service categories, at the time the expansion is to take effect, 10.36 will be sufficient to cover estimated provider costs for each 11.1 major service category. For purposes of this section, "state 11.2 health care program" means the medical assistance, 11.3 MinnesotaCare, and general assistance medical care programs. 11.4 Sec. 2. [STUDY OF COST-SHIFTING.] 11.5 (a) The commissioner of health shall evaluate the extent to 11.6 which state health care program reimbursement rates result in 11.7 health care provider cost-shifting to private sector payers and 11.8 individuals paying for services out-of-pocket. In conducting 11.9 the evaluation, the commissioner shall: 11.10 (1) examine the extent to which average state health care 11.11 program reimbursement rates for major categories of services 11.12 vary from average private sector reimbursement rates; 11.13 (2) examine the extent to which average state health care 11.14 program reimbursement rates for major categories of services 11.15 cover average provider costs; 11.16 (3) estimate the amount by which average state health care 11.17 program reimbursement rates for major categories of services 11.18 would need to be increased to match average private sector 11.19 reimbursement rates and to cover average provider costs; and 11.20 (4) present recommendations to the legislature on methods 11.21 of increasing average state health care program reimbursement 11.22 rates for major categories of services, over a six-year period, 11.23 to the average private sector reimbursement rate and to a level 11.24 that covers average provider costs. 11.25 (b) The commissioner shall present results and 11.26 recommendations to the legislature by December 15, 2004. The 11.27 commissioner may contract with an actuarial consulting firm to 11.28 implement this section. Payment and reimbursement data 11.29 collected by the commissioner in the course of implementing this 11.30 section shall be classified as not public data under Minnesota 11.31 Statutes, chapter 13, except that data shall be classified as 11.32 public data not on individuals if the information collected was 11.33 already accessible to the public under the policies of the 11.34 private sector entity providing the data. For purposes of this 11.35 section, "state health care program" means the medical 11.36 assistance, MinnesotaCare, and general assistance medical care 12.1 programs. 12.2 ARTICLE 4 12.3 HEALTH CARE COST CONTAINMENT; REDUCING GOVERNMENT MANDATES 12.4 Section 1. Minnesota Statutes 2003 Supplement, section 12.5 62J.26, is amended by adding a subdivision to read: 12.6 Subd. 6. [MANDATED BENEFITS MORATORIUM.] (a) No new 12.7 mandated health benefit proposal, as defined in subdivision 1, 12.8 shall be enacted. 12.9 (b) This subdivision expires January 1, 2007. 12.10 Sec. 2. [62L.056] [SMALL EMPLOYER ALTERNATIVE BENEFIT 12.11 PLANS.] 12.12 (a) Notwithstanding any provision of this chapter, chapter 12.13 363A, or any other law to the contrary, the commissioner of 12.14 commerce shall by January 1, 2005, permit health carriers to 12.15 offer alternative health benefit plans to small employers if the 12.16 following requirements are satisfied: 12.17 (1) the health carrier is assessed less than ten percent of 12.18 the total amount assessed by the Minnesota Comprehensive Health 12.19 Association; 12.20 (2) the health plans must be offered in compliance with 12.21 this chapter, except as otherwise permitted in this section; 12.22 (3) the health plans to be offered must be designed to 12.23 enable employers and covered persons to better manage costs and 12.24 coverage options through the use of co-pays, deductibles, and 12.25 other cost-sharing arrangements; 12.26 (4) the health plans must be issued and administered in 12.27 compliance with sections 62E.141; 62L.03, subdivision 6; and 12.28 62L.12, subdivisions 3 and 4, relating to prohibitions against 12.29 enrolling in the Minnesota Comprehensive Health Association 12.30 persons eligible for employer group coverage; 12.31 (5) loss-ratio requirements do not apply to health plans 12.32 issued under this section; 12.33 (6) the health plans may alter or eliminate coverages that 12.34 would otherwise be required by law, except for maternity 12.35 coverage as required under federal law; 12.36 (7) each health plan must be approved by the commissioner 13.1 of commerce; and 13.2 (8) the commissioner may limit the types and numbers of 13.3 health plan forms permitted under this section, but must permit, 13.4 as one option, a health plan form in which a health carrier may 13.5 exclude or alter coverage of any or all benefits otherwise 13.6 mandated by state law, except for maternity coverage as required 13.7 under federal law. 13.8 (b) The definitions in section 62L.02 apply to this section 13.9 as modified by this section. 13.10 (c) An employer may provide health plans permitted under 13.11 this section to its employees, the employees' dependents, and 13.12 other persons eligible for coverage under the employer's plan, 13.13 notwithstanding chapter 363A or any other law to the contrary. 13.14 Sec. 3. [REPEALER; BONE MARROW TRANSPLANT MANDATE.] 13.15 Minnesota Statutes 2002, section 62A.309, is repealed. 13.16 ARTICLE 5 13.17 HEALTH CARE COST CONTAINMENT; 13.18 HEALTH PLAN COMPETITION AND REFORM 13.19 Section 1. Minnesota Statutes 2002, section 62A.02, 13.20 subdivision 2, is amended to read: 13.21 Subd. 2. [APPROVAL.] (a) The health plan form shall not be 13.22 issued, nor shall any application, rider, endorsement, or rate 13.23 be used in connection with it, until the expiration of 60 days 13.24 after it has been filed unless the commissioner approves it 13.25 before that time. 13.26 (b) Notwithstanding paragraph (a), a health plan form or a 13.27 rate, filed with respect to a policy of accident and sickness 13.28 insurance as defined in section 62A.01 by an insurer licensed 13.29 under chapter 60A, may be used on or after the date of filing 13.30 with the commissioner. Health plan forms and rates that are not 13.31 approved or disapproved within the 60-day time period are deemed 13.32 approved. This paragraph does not apply to Medicare-related 13.33 coverage as defined in section 62A.31, subdivision 3, paragraph 13.34 (q). 13.35 Sec. 2. Minnesota Statutes 2002, section 62D.02, 13.36 subdivision 4, is amended to read: 14.1 Subd. 4. [HEALTH MAINTENANCE ORGANIZATION.] (a) "Health 14.2 maintenance organization" means anonprofit corporation14.3organized under chapter 317A, orperson, including a local 14.4 governmental unit as defined in subdivision 11, controlled and 14.5 operated as provided in sections 62D.01 to 62D.30, which 14.6 provides, either directly or through arrangements with providers 14.7 or other persons, comprehensive health maintenance services, or 14.8 arranges for the provision of these services, to enrollees on 14.9 the basis of a fixed prepaid sum without regard to the frequency 14.10 or extent of services furnished to any particular enrollee. 14.11 Sec. 3. Minnesota Statutes 2002, section 62D.02, is 14.12 amended by adding a subdivision to read: 14.13 Subd. 17. [PERSON.] "Person" means a natural or artificial 14.14 person, including, but not limited to, individuals, 14.15 partnerships, limited liability companies, associations, trusts, 14.16 corporations, other business entities, or governmental entities. 14.17 Sec. 4. Minnesota Statutes 2002, section 62D.03, 14.18 subdivision 1, is amended to read: 14.19 Subdivision 1. [CERTIFICATE OF AUTHORITY REQUIRED.] 14.20 Notwithstanding any law of this state to the contrary, any 14.21nonprofit corporation organized to do so or a local governmental14.22unitperson may apply to the commissioner of health for a 14.23 certificate of authority to establish and operate a health 14.24 maintenance organization in compliance with sections 62D.01 to 14.25 62D.30. No person shall establish or operate a health 14.26 maintenance organization in this state, nor sell or offer to 14.27 sell, or solicit offers to purchase or receive advance or 14.28 periodic consideration in conjunction with a health maintenance 14.29 organization or health maintenance contract unless the 14.30 organization has a certificate of authority under sections 14.31 62D.01 to 62D.30. An out-of-state corporation may qualify under 14.32 this chapter, subject to obtaining a certificate of authority to 14.33 do business in this state, as an out-of-state corporation under 14.34 chapter 303 and compliance with this chapter and other 14.35 applicable state laws. 14.36 Sec. 5. Minnesota Statutes 2002, section 62D.04, 15.1 subdivision 1, is amended to read: 15.2 Subdivision 1. [APPLICATION REVIEW.] Upon receipt of an 15.3 application for a certificate of authority, the commissioner of 15.4 health shall determine whether the applicant for a certificate 15.5 of authority has: 15.6 (a) demonstrated the willingness and potential ability to 15.7 assure that health care services will be provided in such a 15.8 manner as to enhance and assure both the availability and 15.9 accessibility of adequate personnel and facilities; 15.10 (b) arrangements for an ongoing evaluation of the quality 15.11 of health care; 15.12 (c) a procedure to develop, compile, evaluate, and report 15.13 statistics relating to the cost of its operations, the pattern 15.14 of utilization of its services, the quality, availability and 15.15 accessibility of its services, and such other matters as may be 15.16 reasonably required by regulation of the commissioner of health; 15.17 (d) reasonable provisions for emergency and out of area 15.18 health care services; 15.19 (e) demonstrated that it is financially responsible and may 15.20 reasonably be expected to meet its obligations to enrollees and 15.21 prospective enrollees. In making this determination, the 15.22 commissioner of health shall require the amounts of net worth 15.23 and working capital required in section 62D.042, the deposit 15.24 required in section 62D.041, and in addition shall consider: 15.25 (1) the financial soundness of its arrangements for health 15.26 care services and the proposed schedule of charges used in 15.27 connection therewith; 15.28 (2) arrangements which will guarantee for a reasonable 15.29 period of time the continued availability or payment of the cost 15.30 of health care services in the event of discontinuance of the 15.31 health maintenance organization; and 15.32 (3) agreements with providers for the provision of health 15.33 care services; 15.34 (f) demonstrated that it will assume full financial risk on 15.35 a prospective basis for the provision of comprehensive health 15.36 maintenance services, including hospital care; provided, 16.1 however, that the requirement in this paragraph shall not 16.2 prohibit the following: 16.3 (1) a health maintenance organization from obtaining 16.4 insurance or making other arrangements (i) for the cost of 16.5 providing to any enrollee comprehensive health maintenance 16.6 services, the aggregate value of which exceeds $5,000 in any 16.7 year, (ii) for the cost of providing comprehensive health care 16.8 services to its members on a nonelective emergency basis, or 16.9 while they are outside the area served by the organization, or 16.10 (iii) for not more than 95 percent of the amount by which the 16.11 health maintenance organization's costs for any of its fiscal 16.12 years exceed 105 percent of its income for such fiscal years; 16.13 and 16.14 (2) a health maintenance organization from having a 16.15 provision in a group health maintenance contract allowing an 16.16 adjustment of premiums paid based upon the actual health 16.17 services utilization of the enrollees covered under the 16.18 contract, except that at no time during the life of the contract 16.19 shall the contract holder fully self-insure the financial risk 16.20 of health care services delivered under the contract. Risk 16.21 sharing arrangements shall be subject to the requirements of 16.22 sections 62D.01 to 62D.30; 16.23 (g) demonstrated that it has made provisions for and 16.24 adopted a conflict of interest policy applicable to all members 16.25 of the board of directors and the principal officers of the 16.26 health maintenance organization. The conflict of interest 16.27 policy shall include the procedures described in section 16.28 317A.255, subdivisions 1 and 2, or a substantially similar 16.29 provision contained in the laws under which the health 16.30 maintenance organization is incorporated or otherwise 16.31 organized. However, the commissioner is not precluded from 16.32 finding that a particular transaction is an unreasonable expense 16.33 as described in section 62D.19 even if the directors follow the 16.34 required procedures; and 16.35 (h) otherwise met the requirements of sections 62D.01 to 16.36 62D.30. 17.1 Sec. 6. Minnesota Statutes 2002, section 62D.05, 17.2 subdivision 1, is amended to read: 17.3 Subdivision 1. [AUTHORITY GRANTED.] Anynonprofit17.4corporation or local governmental unitperson may, upon 17.5 obtaining a certificate of authority as required in sections 17.6 62D.01 to 62D.30, operate as a health maintenance organization. 17.7 Sec. 7. Minnesota Statutes 2003 Supplement, section 17.8 62E.08, subdivision 1, is amended to read: 17.9 Subdivision 1. [ESTABLISHMENT.] The association shall 17.10 establish the following maximum premiums to be charged for 17.11 membership in the comprehensive health insurance plan: 17.12 (a) the premium for the number one qualified plan shall 17.13 range from a minimum of101115 percent to a maximum of125135 17.14 percent of the weighted average of rates charged by those 17.15 insurers and health maintenance organizations with individuals 17.16 enrolled in: 17.17 (1) $1,000 annual deductible individual plans of insurance 17.18 in force in Minnesota; 17.19 (2) individual health maintenance organization contracts of 17.20 coverage with a $1,000 annual deductible which are in force in 17.21 Minnesota; and 17.22 (3) other plans of coverage similar to plans offered by the 17.23 association based on generally accepted actuarial principles; 17.24 (b) the premium for the number two qualified plan shall 17.25 range from a minimum of101115 percent to a maximum of125135 17.26 percent of the weighted average of rates charged by those 17.27 insurers and health maintenance organizations with individuals 17.28 enrolled in: 17.29 (1) $500 annual deductible individual plans of insurance in 17.30 force in Minnesota; 17.31 (2) individual health maintenance organization contracts of 17.32 coverage with a $500 annual deductible which are in force in 17.33 Minnesota; and 17.34 (3) other plans of coverage similar to plans offered by the 17.35 association based on generally accepted actuarial principles; 17.36 (c) the premiums for the plans with a $2,000, $5,000, or 18.1 $10,000 annual deductible shall range from a minimum of101115 18.2 percent to a maximum of125135 percent of the weighted average 18.3 of rates charged by those insurers and health maintenance 18.4 organizations with individuals enrolled in: 18.5 (1) $2,000, $5,000, or $10,000 annual deductible individual 18.6 plans, respectively, in force in Minnesota; and 18.7 (2) individual health maintenance organization contracts of 18.8 coverage with a $2,000, $5,000, or $10,000 annual deductible, 18.9 respectively, which are in force in Minnesota; or 18.10 (3) other plans of coverage similar to plans offered by the 18.11 association based on generally accepted actuarial principles; 18.12 (d) the premium for each type of Medicare supplement plan 18.13 required to be offered by the association pursuant to section 18.14 62E.12 shall range from a minimum of101115 percent to a 18.15 maximum of125135 percent of the weighted average of rates 18.16 charged by those insurers and health maintenance organizations 18.17 with individuals enrolled in: 18.18 (1) Medicare supplement plans in force in Minnesota; 18.19 (2) health maintenance organization Medicare supplement 18.20 contracts of coverage which are in force in Minnesota; and 18.21 (3) other plans of coverage similar to plans offered by the 18.22 association based on generally accepted actuarial principles; 18.23 and 18.24 (e) the charge for health maintenance organization coverage 18.25 shall be based on generally accepted actuarial principles. 18.26 The list of insurers and health maintenance organizations 18.27 whose rates are used to establish the premium for coverage 18.28 offered by the association pursuant to paragraphs (a) to (d) 18.29 shall be established by the commissioner on the basis of 18.30 information which shall be provided to the association by all 18.31 insurers and health maintenance organizations annually at the 18.32 commissioner's request. This information shall include the 18.33 number of individuals covered by each type of plan or contract 18.34 specified in paragraphs (a) to (d) that is sold, issued, and 18.35 renewed by the insurers and health maintenance organizations, 18.36 including those plans or contracts available only on a renewal 19.1 basis. The information shall also include the rates charged for 19.2 each type of plan or contract. 19.3 In establishing premiums pursuant to this section, the 19.4 association shall utilize generally accepted actuarial 19.5 principles, provided that the association shall not discriminate 19.6 in charging premiums based upon sex. In order to compute a 19.7 weighted average for each type of plan or contract specified 19.8 under paragraphs (a) to (d), the association shall, using the 19.9 information collected pursuant to this subdivision, list 19.10 insurers and health maintenance organizations in rank order of 19.11 the total number of individuals covered by each insurer or 19.12 health maintenance organization. The association shall then 19.13 compute a weighted average of the rates charged for coverage by 19.14 all the insurers and health maintenance organizations by: 19.15 (1) multiplying the numbers of individuals covered by each 19.16 insurer or health maintenance organization by the rates charged 19.17 for coverage; 19.18 (2) separately summing both the number of individuals 19.19 covered by all the insurers and health maintenance organizations 19.20 and all the products computed under clause (1); and 19.21 (3) dividing the total of the products computed under 19.22 clause (1) by the total number of individuals covered. 19.23 The association may elect to use a sample of information 19.24 from the insurers and health maintenance organizations for 19.25 purposes of computing a weighted average. In no case, however, 19.26 may a sample used by the association to compute a weighted 19.27 average include information from fewer than the two insurers or 19.28 health maintenance organizations highest in rank order. 19.29 Sec. 8. Minnesota Statutes 2003 Supplement, section 19.30 62E.091, is amended to read: 19.31 62E.091 [APPROVAL OF STATE PLAN PREMIUMS.] 19.32 The association shall submit to the commissioner any 19.33 premiums it proposes to become effective for coverage under the 19.34 comprehensive health insurance plan, pursuant to section 62E.08, 19.35 subdivision 3. No later than 45 days before the effective date 19.36 for premiums specified in section 62E.08, subdivision 3, the 20.1 commissioner shall approve, modify, or reject the proposed 20.2 premiums on the basis of the following criteria: 20.3 (a) whether the association has complied with the 20.4 provisions of section 62E.11, subdivision 11; 20.5 (b) whether the association has submitted the proposed 20.6 premiums in a manner which provides sufficient time for 20.7 individuals covered under the comprehensive insurance plan to 20.8 receive notice of any premium increase no less than 30 days 20.9 prior to the effective date of the increase; 20.10 (c) the degree to which the association's computations and 20.11 conclusions are consistent with section 62E.08; 20.12 (d) the degree to which any sample used to compute a 20.13 weighted average by the association pursuant to section 62E.08 20.14 reasonably reflects circumstances existing in the private 20.15 marketplace for individual coverage; 20.16 (e) the degree to which a weighted average computed 20.17 pursuant to section 62E.08 that uses information pertaining to 20.18 individual coverage available only on a renewal basis reflects 20.19 the circumstances existing in the private marketplace for 20.20 individual coverage; 20.21 (f) a comparison of the proposed increases with increases 20.22 in the cost of medical care and increases experienced in the 20.23 private marketplace for individual coverage; 20.24 (g) the financial consequences to enrollees of the proposed 20.25 increase; 20.26 (h) the actuarially projected effect of the proposed 20.27 increase upon both total enrollment in, and the nature of the 20.28 risks assumed by, the comprehensive health insurance plan; 20.29 (i) the relative solvency of the contributing members; and 20.30 (j) other factors deemed relevant by the commissioner. 20.31 In no case, however, may the commissioner approve premiums 20.32 for those plans of coverage described in section 62E.08, 20.33 subdivision 1, paragraphs (a) to (d), that are lower than10120.34 115 percent or greater than125135 percent of the weighted 20.35 averages computed by the association pursuant to section 20.36 62E.08. The commissioner shall support a decision to approve, 21.1 modify, or reject any premium proposed by the association with 21.2 written findings and conclusions addressing each criterion 21.3 specified in this section. If the commissioner does not 21.4 approve, modify, or reject the premiums proposed by the 21.5 association sooner than 45 days before the effective date for 21.6 premiums specified in section 62E.08, subdivision 3, the 21.7 premiums proposed by the association under this section become 21.8 effective. 21.9 Sec. 9. [62Q.37] [AUDITS CONDUCTED BY NATIONALLY 21.10 RECOGNIZED INDEPENDENT ORGANIZATION.] 21.11 Subdivision 1. [APPLICABILITY.] This section applies only 21.12 to (i) a nonprofit health service plan corporation operating 21.13 under chapter 62C; (ii) a health maintenance organization 21.14 operating under chapter 62D; (iii) a community integrated 21.15 service network operating under chapter 62N; and (iv) managed 21.16 care organizations operating under chapter 256B, 256D, or 256L. 21.17 Subd. 2. [DEFINITIONS.] For purposes of this section, the 21.18 following terms have the meanings given them. 21.19 (a) "Commissioner" means the commissioner of health for 21.20 purposes of regulating health maintenance organizations and 21.21 community integrated service networks, the commissioner of 21.22 commerce for purposes of regulating nonprofit health service 21.23 plan corporations, or the commissioner of human services for the 21.24 purpose of contracting with managed care organizations serving 21.25 persons enrolled in programs under chapter 256B, 256D, or 256L. 21.26 (b) "Health plan company" means (i) a nonprofit health 21.27 service plan corporation operating under chapter 62C; (ii) a 21.28 health maintenance organization operating under chapter 62D; 21.29 (iii) a community integrated service network operating under 21.30 chapter 62N; or (iv) a managed care organization operating under 21.31 chapter 256B, 256D, or 256L. 21.32 (c) "Nationally recognized independent organization" means 21.33 (i) an organization that sets specific national standards 21.34 governing health care quality assurance processes, utilization 21.35 review, provider credentialing, marketing, and other topics 21.36 covered by this chapter and other chapters and audits and 22.1 provides accreditation to those health plan companies that meet 22.2 those standards. The American Accreditation Health Care 22.3 Commission (URAC), the National Committee for Quality Assurance 22.4 (NCQA), and the Joint Commission on Accreditation of Healthcare 22.5 Organizations (JCAHO) are, at a minimum, defined as nationally 22.6 recognized independent organizations; and (ii) the Centers for 22.7 Medicare and Medicaid Services for purposes of reviews or audits 22.8 conducted of health plan companies under Part C of Title XVIII 22.9 of the Social Security Act or under section 1876 of the Social 22.10 Security Act. 22.11 (d) "Performance standard" means those standards relating 22.12 to quality management and improvement, access and availability 22.13 of service, utilization review, provider selection, provider 22.14 credentialing, marketing, member rights and responsibilities, 22.15 complaints, appeals, grievance systems, enrollee information and 22.16 materials, enrollment and disenrollment, subcontractual 22.17 relationships and delegation, confidentiality, continuity and 22.18 coordination of care, assurance of adequate capacity and 22.19 services, coverage and authorization of services, practice 22.20 guidelines, health information systems, and financial solvency. 22.21 Subd. 3. [AUDITS.] (a) The commissioner may conduct 22.22 routine audits and investigations as prescribed under the 22.23 commissioner's respective state authorizing statutes. If a 22.24 nationally recognized independent organization has conducted an 22.25 audit of the health plan company using audit procedures that are 22.26 comparable to or more stringent than the commissioner's audit 22.27 procedures: 22.28 (1) the commissioner may accept the independent audit and 22.29 require no further audit if the results of the independent audit 22.30 show that the performance standard being audited meets or 22.31 exceeds state standards; 22.32 (2) the commissioner may accept the independent audit and 22.33 limit further auditing if the results of the independent audit 22.34 show that the performance standard being audited partially meets 22.35 state standards; 22.36 (3) the health plan company must demonstrate to the 23.1 commissioner that the nationally recognized independent 23.2 organization that conducted the audit is qualified and that the 23.3 results of the audit demonstrate that the particular performance 23.4 standard partially or fully meets state standards; and 23.5 (4) if the commissioner has partially or fully accepted an 23.6 independent audit of the performance standard, the commissioner 23.7 may use the finding of a deficiency with regard to statutes or 23.8 rules by an independent audit as the basis for a targeted audit 23.9 or enforcement action. 23.10 (b) If a health plan company has formally delegated 23.11 activities that are required under either state law or contract 23.12 to another organization that has undergone an audit by a 23.13 nationally recognized independent organization, that health plan 23.14 company may use the nationally recognized accrediting body's 23.15 determination on its own behalf under this section. 23.16 Subd. 4. [DISCLOSURE OF NATIONAL STANDARDS AND 23.17 REPORTS.] The health plan company shall: 23.18 (1) request that the nationally recognized independent 23.19 organization provide to the commissioner a copy of the current 23.20 nationally recognized independent organization's standards upon 23.21 which the acceptable accreditation status has been granted; and 23.22 (2) provide the commissioner a copy of the most current 23.23 final audit report issued by the nationally recognized 23.24 independent organization. 23.25 Subd. 5. [ACCREDITATION NOT REQUIRED.] Nothing in this 23.26 section requires a health plan company to seek an acceptable 23.27 accreditation status from a nationally recognized independent 23.28 organization. 23.29 Subd. 6. [CONTINUED AUTHORITY.] Nothing in this section 23.30 precludes the commissioner from conducting audits and 23.31 investigations or requesting data as granted under the 23.32 commissioner's respective state authorizing statutes. 23.33 Subd. 7. [HUMAN SERVICES.] The commissioner of human 23.34 services shall implement this section in a manner that is 23.35 consistent with applicable federal laws and regulations. 23.36 Subd. 8. [CONFIDENTIALITY.] Any documents provided to the 24.1 commissioner related to the audit report that may be accepted 24.2 under this section are private data on individuals pursuant to 24.3 chapter 13 and may only be released as permitted under section 24.4 60A.03, subdivision 9. 24.5 Sec. 10. Minnesota Statutes 2002, section 72A.20, is 24.6 amended by adding a subdivision to read: 24.7 Subd. 37. [ELECTRONIC TRANSMISSION OF REQUIRED 24.8 INFORMATION.] A health carrier, as defined in section 62A.011, 24.9 subdivision 2, is not in violation of this chapter for 24.10 electronically transmitting or electronically making available 24.11 information otherwise required to be delivered in writing under 24.12 chapters 62A to 62Q and 72A to an enrollee as defined in section 24.13 62Q.01, subdivision 2a, and with the requirements of those 24.14 chapters if the following conditions are met: 24.15 (1) the health carrier informs the enrollee that electronic 24.16 transmission or access is available and, at the discretion of 24.17 the health carrier, the enrollee is given one of the following 24.18 options: 24.19 (i) electronic transmission or access will occur only if 24.20 the enrollee affirmatively requests to the health carrier that 24.21 the required information be electronically transmitted or 24.22 available and a record of that request is retained by the health 24.23 carrier; or 24.24 (ii) electronic transmission or access will automatically 24.25 occur if the enrollee has not opted out of that manner of 24.26 transmission by request to the health carrier and requested that 24.27 the information be provided in writing. If the enrollee opts 24.28 out of electronic transmission, a record of that request must be 24.29 retained by the health carrier; 24.30 (2) the enrollee is allowed to withdraw the request at any 24.31 time; 24.32 (3) if the information transmitted electronically contains 24.33 individually identifiable data, it must be transmitted to a 24.34 secured mailbox. If the information made available 24.35 electronically contains individually identifiable data, it must 24.36 be made available at a password-protected secured Web site; 25.1 (4) the enrollee is provided a customer service number on 25.2 the enrollee's member card that may be called to request a 25.3 written copy of the document; and 25.4 (5) the electronic transmission or electronic availability 25.5 meets all other requirements of this chapter including, but not 25.6 limited to, size of the typeface and any required time frames 25.7 for distribution. 25.8 Sec. 11. [CHANGE OF HEALTH MAINTENANCE ORGANIZATION 25.9 REGULATORY AUTHORITY.] 25.10 (a) Effective July 1, 2005, regulatory authority for health 25.11 maintenance organizations under Minnesota Statutes, chapter 62D; 25.12 community health clinics with respect to health care services 25.13 prepaid option plans offered under Minnesota Statutes, section 25.14 62Q.22; community integrated service networks, as defined in 25.15 Minnesota Statutes, section 62N.02, subdivision 4a; health care 25.16 cooperatives operating under Minnesota Statutes, chapter 62R; 25.17 health care purchasing alliances and accountable provider 25.18 networks operating under Minnesota Statutes, chapter 62T; and 25.19 county-based purchasing programs operating under Minnesota 25.20 Statutes, section 256B.692, subdivision 2, is transferred from 25.21 the commissioner of health to the commissioner of commerce. 25.22 (b) Minnesota Statutes, section 15.039, applies to this 25.23 transfer of authority. 25.24 (c) The revisor of statutes shall make changes to conform 25.25 to paragraph (a) by changing references to the commissioner of 25.26 health, Department of Health, and similar references, to the 25.27 commissioner of commerce, Department of Commerce, or similar 25.28 references, and by changing references to both commissioners or 25.29 both departments or "the appropriate commissioner" or similar 25.30 term to the commissioner or Department of Commerce, as 25.31 appropriate in Minnesota Statutes, sections 62A.021, subdivision 25.32 1, paragraph (h); 62D.02, subdivision 3; 62D.12, subdivision 1; 25.33 62D.15, subdivision 1; 62D.24, by also changing the existing 25.34 reference to "commissioner of commerce" to read "commissioner of 25.35 health"; 62E.05, subdivision 2; 62E.11, subdivision 13; 62J.041, 25.36 subdivision 4; 62J.701; 62J.74, subdivisions 1 and 2; 62L.02, 26.1 subdivision 8; 62L.05, subdivision 12; 62L.08, subdivisions 10 26.2 and 11; 62L.09, subdivision 3; 62L.10, subdivision 4; 62L.11, 26.3 subdivision 2; 62M.11; 62M.16; 62N.02, subdivision 4; 62N.26; 26.4 62Q.01, subdivision 2; 62Q.106; 62Q.22, subdivisions 2, 6, and 26.5 7; 62Q.33, subdivision 2, by specifying that the commissioner 26.6 referenced in the last sentence is the commissioner of health; 26.7 62Q.49, subdivision 2; 62Q.51, subdivision 3; 62Q.525, 26.8 subdivision 3; 62Q.69, subdivisions 2 and 3; 62Q.71; 62Q.72; 26.9 62Q.73, subdivisions 3, 4, 5, and 6; 62R.04, subdivision 5; 26.10 62R.06, subdivision 1; 62T.01; 256B.692, subdivisions 2 and 7. 26.11 The revisor of statutes shall, in preparing Minnesota Statutes 26.12 2004, make all conforming changes in Minnesota Statutes, chapter 26.13 62D, and other chapters. 26.14 ARTICLE 6 26.15 HEALTH CARE COST CONTAINMENT; ADMINISTRATIVE SIMPLIFICATION 26.16 Section 1. Minnesota Statutes 2002, section 147.03, 26.17 subdivision 1, is amended to read: 26.18 Subdivision 1. [ENDORSEMENT; RECIPROCITY.] (a) The board 26.19 may issue a license to practice medicine to any person who 26.20 satisfies the requirements in paragraphs (b) to (f). 26.21 (b) The applicant shall satisfy all the requirements 26.22 established in section 147.02, subdivision 1, paragraphs (a), 26.23 (b), (d), (e), and (f). 26.24 (c) The applicant shall: 26.25 (1) have passed an examination prepared and graded by the 26.26 Federation of State Medical Boards, the National Board of 26.27 Medical Examiners, or the United States Medical Licensing 26.28 Examination program in accordance with section 147.02, 26.29 subdivision 1, paragraph (c), clause (2); the National Board of 26.30 Osteopathic Examiners; or the Medical Council of Canada; and 26.31 (2) have a current license from the equivalent licensing 26.32 agency in another state or Canada and, if the examination in 26.33 clause (1) was passed more than ten years ago, either: 26.34 (i) pass the Special Purpose Examination of the Federation 26.35 of State Medical Boards with a score of 75 or better within 26.36 three attempts; or 27.1 (ii) have a current certification by a specialty board of 27.2 the American Board of Medical Specialties, of the American 27.3 Osteopathic Association Bureau of Professional Education, or of 27.4 the Royal College of Physicians and Surgeons of Canada. 27.5 (d) The applicant shall pay a fee established by the board 27.6 by rule. The fee may not be refunded. 27.7 (e) The applicant must not be under license suspension or 27.8 revocation by the licensing board of the state or jurisdiction 27.9 in which the conduct that caused the suspension or revocation 27.10 occurred. 27.11 (f) The applicant must not have engaged in conduct 27.12 warranting disciplinary action against a licensee, or have been 27.13 subject to disciplinary action other than as specified in 27.14 paragraph (e). If an applicant does not satisfy the 27.15 requirements stated in this paragraph, the board may issue a 27.16 license only on the applicant's showing that the public will be 27.17 protected through issuance of a license with conditions or 27.18 limitations the board considers appropriate. 27.19 (g) Upon the request of an applicant, the board may conduct 27.20 the final interview of the applicant by teleconference. 27.21 Sec. 2. Minnesota Statutes 2002, section 256B.04, is 27.22 amended by adding a subdivision to read: 27.23 Subd. 20. [INFORMATION WEB SITE FOR INTERPRETER SERVICES.] 27.24 The commissioner shall establish an information Web site to 27.25 assist health care providers in obtaining oral language 27.26 interpreter services when these services are needed to enable a 27.27 patient to obtain a health care service from a provider. The 27.28 commissioner must collect and maintain contact and rate 27.29 information for providers of oral language interpreter services 27.30 and must make this information available to all health care 27.31 providers, whether or not the provider is enrolled in a state 27.32 health care program. The Web site list is not an endorsement by 27.33 the commissioner of any particular interpreter. 27.34 Sec. 3. [COST OF HEALTH CARE REPORTING.] 27.35 The commissioners of human services, health, and commerce 27.36 shall meet with representatives of health plan companies as 28.1 defined in Minnesota Statutes, section 62Q.01, subdivision 4, 28.2 and hospitals to evaluate reporting requirements for these 28.3 regulated entities and develop recommendations for reducing 28.4 required reports. The commissioner must meet with the specified 28.5 representatives prior to August 30, 2004, and must submit a 28.6 consolidated report to the legislature by January 15, 2005. The 28.7 report must: 28.8 (1) identify the name and scope of each required report; 28.9 (2) evaluate the need for and use of each report, including 28.10 the value of the report to consumers; 28.11 (3) evaluate the extent to which the report is used to 28.12 reduce costs and increase quality of care; 28.13 (4) identify reports that are no longer required; and 28.14 (5) specify any statutory changes necessary to eliminate 28.15 required reports. 28.16 Sec. 4. [REPEALER.] 28.17 Minnesota Statutes 2002, section 62J.17, subdivisions 1, 3, 28.18 4a, 5a, 6a, 7, and 8; and Minnesota Statutes 2003 Supplement, 28.19 section 62J.17, subdivision 2, are repealed effective the day 28.20 following final enactment. 28.21 ARTICLE 7 28.22 CHILD CARE 28.23 Section 1. Minnesota Statutes 2003 Supplement, section 28.24 119B.09, subdivision 9, is amended to read: 28.25 Subd. 9. [LICENSED AND LEGAL NONLICENSED FAMILY CHILD CARE 28.26 PROVIDERS; ASSISTANCE.] Licensed and legal nonlicensed family 28.27 child care providers are not eligible to receive child care 28.28 assistance subsidies under this chapter for their own children 28.29 or children in theircustodyfamily during the hours they are 28.30 providing child care or being paid to provide child care. Child 28.31 care providers are eligible to receive child care assistance 28.32 subsidies for their own children when they are engaged in other 28.33 work activities that meet the requirements of this chapter and 28.34 for which child care assistance can be paid. The hours for 28.35 which the child care provider receives a child care subsidy for 28.36 their own children must not overlap with the hours the provider 29.1 provides child care services. 29.2 Sec. 2. Minnesota Statutes 2003 Supplement, section 29.3 119B.13, subdivision 1, is amended to read: 29.4 Subdivision 1. [SUBSIDY RESTRICTIONS.] (a) The maximum 29.5 rate paid for child care assistance under the child care fund 29.6 may not exceed the 75th percentile rate for like-care 29.7 arrangements in the county as surveyed by the commissioner. 29.8 (b) A rate which includesa provider bonus paid under29.9subdivision 2 ora special needs rate paid under subdivision 3 29.10 may be in excess of the maximum rate allowed under this 29.11 subdivision. 29.12 (c) The department shall monitor the effect of this 29.13 paragraph on provider rates. The county shall pay the 29.14 provider's full charges for every child in care up to the 29.15 maximum established. The commissioner shall determine the 29.16 maximum rate for each type of care on an hourly, full-day, and 29.17 weekly basis, including special needs and handicapped care.Not29.18less than once every two years, the commissioner shall evaluate29.19market practices for payment of absences and shall establish29.20policies for payment of absent days that reflect current market29.21practice.29.22 (d) When the provider charge is greater than the maximum 29.23 provider rate allowed, the parent is responsible for payment of 29.24 the difference in the rates in addition to any family co-payment 29.25 fee. 29.26 Sec. 3. Minnesota Statutes 2002, section 119B.13, is 29.27 amended by adding a subdivision to read: 29.28 Subd. 7. [ABSENT DAYS.] Child care providers may not be 29.29 reimbursed for more than 25 absent days per child in a 12-month 29.30 period, or for more than ten consecutive absent days, unless the 29.31 child has a documented medical condition that causes more 29.32 frequent absences. Documentation of medical conditions must be 29.33 on the forms and submitted according to the timelines 29.34 established by the commissioner. 29.35 [EFFECTIVE DATE.] This section is effective July 1, 2004. 29.36 Sec. 4. Minnesota Statutes 2003 Supplement, section 30.1 245A.10, subdivision 4, is amended to read: 30.2 Subd. 4. [ANNUAL LICENSE OR CERTIFICATION FEE FOR PROGRAMS 30.3 WITH LICENSED CAPACITY.] (a) Child care centers and programs 30.4 with a licensed capacity shall pay an annual nonrefundable 30.5 license or certification fee based on the following schedule: 30.6 Licensed Capacity Child Care Other 30.7 Center Program 30.8 License Fee License Fee 30.9 1 to 24 persons$300$225 $400 30.10 25 to 49 persons$450$340 $600 30.11 50 to 74 persons$600$450 $800 30.12 75 to 99 persons$750$565 $1,000 30.13 100 to 124 persons$900$675 $1,200 30.14 125 to 149 persons$1,200$900 $1,400 30.15 150 to 174 persons$1,400$1,050 $1,600 30.16 175 to 199 persons$1,600$1,200 $1,800 30.17 200 to 224 persons$1,800$1,350 $2,000 30.18 225 or more persons$2,000$1,500 $2,500 30.19 (b) A day training and habilitation program serving persons 30.20 with developmental disabilities or related conditions shall be 30.21 assessed a license fee based on the schedule in paragraph (a) 30.22 unless the license holder serves more than 50 percent of the 30.23 same persons at two or more locations in the community. When a 30.24 day training and habilitation program serves more than 50 30.25 percent of the same persons in two or more locations in a 30.26 community, the day training and habilitation program shall pay a 30.27 license fee based on the licensed capacity of the largest 30.28 facility and the other facility or facilities shall be charged a 30.29 license fee based on a licensed capacity of a residential 30.30 program serving one to 24 persons. 30.31 Sec. 5. Laws 2003, First Special Session chapter 14, 30.32 article 9, section 34, is amended to read: 30.33 Sec. 34. [DIRECTION TO COMMISSIONER; PROVIDER RATES.] 30.34 The provider rates determined under Minnesota Statutes, 30.35 section 119B.13, for fiscal year 2003 and implemented on July 1, 30.36 2002, are to be continued in effect through June 30,20052007. 31.1 Counties shall not reduce any child care center's reimbursement 31.2 rate below the rate implemented on July 1, 2002. The 31.3 commissioner of human services is directed to evaluate the costs 31.4 of child care in Minnesota, to examine the differences in the 31.5 cost of child care in rural and metropolitan areas, and to make 31.6 recommendations to the legislature for containing future cost 31.7 increases in the child care program under Minnesota Statutes, 31.8 chapter 119B, in a manner that complies with federal child care 31.9 and development block grant requirements for promoting parental 31.10 choice and permits the department to track the effect of rate 31.11 changes on child care assistance program costs, the availability 31.12 of different types of care throughout the state, the length of 31.13 waiting lists, and the care options available to program 31.14 participants. The commissioner shall also examine the 31.15 allocation formula under Minnesota Statutes, section 119B.03, 31.16 and make recommendations to the legislature in order to create a 31.17 more equitable formula. The commissioner shall consider the 31.18 impact any recommendations might have on work incentives for low 31.19 and middle income families and possible changes to MFIP child 31.20 care, basic sliding fee child care, and the dependent care tax 31.21 credit. The commissioner shall make recommendations to the 31.22 legislature by January 15, 2005. 31.23 The commissioner shall also study the relationship between 31.24 child care assistance subsidies and tax credits or tax 31.25 incentives related to child care expenses, and include this 31.26 information in the January 15, 2005, report to the legislature 31.27 under this section. 31.28 Sec. 6. [TEMPORARY INELIGIBILITY OF MILITARY PERSONNEL.] 31.29 Counties must reserve a family's position under the child 31.30 care assistance fund if a family has been receiving child care 31.31 assistance but is temporarily ineligible for assistance due to 31.32 increased income from active military service. Activated 31.33 military personnel may be temporarily ineligible until 31.34 deactivated. A county must reserve a military family's position 31.35 on the basic sliding fee waiting list under the child care 31.36 assistance fund if a family is approved to receive child care 32.1 assistance and reaches the top of the waiting list but is 32.2 temporarily ineligible for assistance. 32.3 ARTICLE 8 32.4 ECONOMIC SUPPORTS 32.5 Section 1. Minnesota Statutes 2002, section 256D.051, 32.6 subdivision 1a, is amended to read: 32.7 Subd. 1a. [NOTICES AND SANCTIONS.] (a) At the time the 32.8 county agency notifies the household that it is eligible for 32.9 food stamps, the county agency must inform all mandatory 32.10 employment and training services participants as identified in 32.11 subdivision 1 in the household that they must comply with all 32.12 food stamp employment and training program requirements each 32.13 month, including the requirement to attend an initial 32.14 orientation to the food stamp employment and training program 32.15 and that food stamp eligibility will end unless the participants 32.16 comply with the requirements specified in the notice. 32.17 (b) A participant who fails without good cause to comply 32.18 with food stamp employment and training program requirements of 32.19 this section, including attendance at orientation, will lose 32.20 food stamp eligibility for the following periods: 32.21 (1) for the first occurrence, for one month or until the 32.22 person complies with the requirements not previously complied 32.23 with, whichever is longer; 32.24 (2) for the second occurrence, for three months or until 32.25 the person complies with the requirements not previously 32.26 complied with, whichever is longer; or 32.27 (3) for the third and any subsequent occurrence, for six 32.28 months or until the person complies with the requirements not 32.29 previously complied with, whichever is longer. 32.30 If the participant is not the food stamp head of household, 32.31 the person shall be considered an ineligible household member 32.32 for food stamp purposes. If the participant is the food stamp 32.33 head of household, the entire household is ineligible for food 32.34 stamps as provided in Code of Federal Regulations, title 7, 32.35 section 273.7(g). "Good cause" means circumstances beyond the 32.36 control of the participant, such as illness or injury, illness 33.1 or injury of another household member requiring the 33.2 participant's presence, a household emergency, or the inability 33.3 to obtain child care for children between the ages of six and 12 33.4 or to obtain transportation needed in order for the participant 33.5 to meet the food stamp employment and training program 33.6 participation requirements. 33.7 (c) The county agency shall mail or hand deliver a notice 33.8 to the participant not later than five days after determining 33.9 that the participant has failed without good cause to comply 33.10 with food stamp employment and training program requirements 33.11 which specifies the requirements that were not complied with, 33.12 the factual basis for the determination of noncompliance, and 33.13 the right to reinstate eligibility upon a showing of good cause 33.14 for failure to meet the requirements. The notice must ask the 33.15 reason for the noncompliance and identify the participant's 33.16 appeal rights. The notice must request that the participant 33.17 inform the county agency if the participant believes that good 33.18 cause existed for the failure to comply and must state that the 33.19 county agency intends to terminate eligibility for food stamp 33.20 benefits due to failure to comply with food stamp employment and 33.21 training program requirements. 33.22 (d) If the county agency determines that the participant 33.23 did not comply during the month with all food stamp employment 33.24 and training program requirements that were in effect, and if 33.25 the county agency determines that good cause was not present, 33.26 the county must provide a ten-day notice of termination of food 33.27 stamp benefits. The amount of food stamps that are withheld 33.28 from the household and determination of the impact of the 33.29 sanction on other household members is governed by Code of 33.30 Federal Regulations, title 7, section 273.7. 33.31 (e) A participant in the diversionary work program with 33.32 children under age six may be required to participate in 33.33 employment services under this section, but is not subject to 33.34 sanction. 33.35 (f) The participant may appeal the termination of food 33.36 stamp benefits under the provisions of section 256.045. 34.1 Sec. 2. Minnesota Statutes 2002, section 256D.051, 34.2 subdivision 3a, is amended to read: 34.3 Subd. 3a. [PERSONS REQUIRED TO REGISTER FOR AND 34.4 PARTICIPATE IN THE FOOD STAMP EMPLOYMENT AND TRAINING PROGRAM.] 34.5 (a) To the extent required under Code of Federal Regulations, 34.6 title 7, section 273.7(a), each applicant for and recipient of 34.7 food stamps is required to register for work as a condition of 34.8 eligibility for food stamp benefits. Applicants and recipients 34.9 are registered by signing an application or annual reapplication 34.10 for food stamps, and must be informed that they are registering 34.11 for work by signing the form. 34.12 (b) The commissioner shall determine, within federal 34.13 requirements, persons required to participate in the food stamp 34.14 employment and training (FSET) program. 34.15 (c) The following food stamp recipients are exempt from 34.16 mandatory participation in food stamp employment and training 34.17 services: 34.18 (1) recipients of benefits under the Minnesota family 34.19 investment program, Minnesota supplemental aid program, or the 34.20 general assistance program; 34.21 (2) a child; 34.22 (3) a recipient over age5549; 34.23 (4) a recipient who has a mental or physical illness, 34.24 injury, or incapacity which is expected to continue for at least 34.25 30 days and which impairs the recipient's ability to obtain or 34.26 retain employment as evidenced by professional certification or 34.27 the receipt of temporary or permanent disability benefits issued 34.28 by a private or government source; 34.29 (5) a parent or other household member responsible for the 34.30 care of either a dependent child in the household who is under 34.31 age six, unless the parent or other household member is a 34.32 participant in the diversionary work program, or a person in the 34.33 household who is professionally certified as having a physical 34.34 or mental illness, injury, or incapacity. Only one parent or 34.35 other household member may claim exemption under this provision; 34.36 (6) a recipient receiving unemployment compensation or who 35.1 has applied for unemployment compensation and has been required 35.2 to register for work with the Department of Economic Security as 35.3 part of the unemployment compensation application process; 35.4 (7) a recipient participating each week in a drug addiction 35.5 or alcohol abuse treatment and rehabilitation program, provided 35.6 the operators of the treatment and rehabilitation program, in 35.7 consultation with the county agency, recommend that the 35.8 recipient not participate in the food stamp employment and 35.9 training program; 35.10 (8) a recipient employed or self-employed for 30 or more 35.11 hours per week at employment paying at least minimum wage, or 35.12 who earns wages from employment equal to or exceeding 30 hours 35.13 multiplied by the federal minimum wage;or35.14 (9) a student enrolled at least half time in any school, 35.15 training program, or institution of higher education. When 35.16 determining if a student meets this criteria, the school's, 35.17 program's or institution's criteria for being enrolled half time 35.18 shall be used; and 35.19 (10) a participant in the diversionary work program who 35.20 meets the requirements in section 256J.95, subdivision 11, 35.21 paragraph (d). 35.22 Sec. 3. Minnesota Statutes 2002, section 256D.051, 35.23 subdivision 6c, is amended to read: 35.24 Subd. 6c. [PROGRAM FUNDING.] Within the limits of 35.25 available resources, the commissioner shall reimburse the actual 35.26 costs of county agencies and their employment and training 35.27 service providers for the provision of food stamp employment and 35.28 training services, including participant support services, 35.29 direct program services, and program administrative activities. 35.30 The cost of services for each county's food stamp employment and 35.31 training program shall not exceedan average of $400 per35.32participantthe annual allocated amount. No more than 15 35.33 percent of program funds may be used for administrative 35.34 activities. The county agency may expend county funds in excess 35.35 of the limits of this subdivision without state reimbursement. 35.36 Program funds shall be allocated based on the county's 36.1 average number of food stamp cases as compared to the statewide 36.2 total number of such cases. The average number of cases shall 36.3 be based on counts of cases as of March 31, June 30, September 36.4 30, and December 31 of the previous calendar year. The 36.5 commissioner may reallocate unexpended money appropriated under 36.6 this section to those county agencies that demonstrate a need 36.7 for additional funds. 36.8 Sec. 4. Minnesota Statutes 2003 Supplement, section 36.9 256J.24, subdivision 6, is amended to read: 36.10 Subd. 6. [FAMILY CAP.] (a) MFIP assistance units shall not 36.11 receive an increase in the cash portion of the transitional 36.12 standard as a result of the birth of a child, unless one of the 36.13 conditions under paragraph (b) is met. The child shall be 36.14 considered a member of the assistance unit according to 36.15 subdivisions 1 to 3, but shall be excluded in determining family 36.16 size for purposes of determining the amount of the cash portion 36.17 of the transitional standard under subdivision 5. The child 36.18 shall be included in determining family size for purposes of 36.19 determining the food portion of the transitional standard. The 36.20 transitional standard under this subdivision shall be the total 36.21 of the cash and food portions as specified in this paragraph. 36.22 The family wage level under this subdivision shall be based on 36.23 the family size used to determine the food portion of the 36.24 transitional standard. 36.25 (b) A child shall be included in determining family size 36.26 for purposes of determining the amount of the cash portion of 36.27 the MFIP transitional standard when at least one of the 36.28 following conditions is met: 36.29 (1) for families receiving MFIP assistance on July 1, 2003, 36.30 the child is born to the adult parent before May 1, 2004; 36.31 (2) for families who apply for the diversionary work 36.32 program under section 256J.95 or MFIP assistance on or after 36.33 July 1, 2003, the child is born to the adult parent within ten 36.34 months of the date the family is eligible for assistance; 36.35 (3) the child was conceived as a result of a sexual assault 36.36 or incest, provided that the incident has been reported to a law 37.1 enforcement agency; 37.2 (4) the child's mother is a minor caregiver as defined in 37.3 section 256J.08, subdivision 59, and the child, or multiple 37.4 children, are the mother's first birth; or 37.5 (5) any child previously excluded in determining family 37.6 size under paragraph (a) shall be included if the adult parent 37.7 or parents have not received benefits from the diversionary work 37.8 program under section 256J.95 or MFIP assistance in the previous 37.9 ten months. An adult parent or parents who reapply and have 37.10 received benefits from the diversionary work program or MFIP 37.11 assistance in the past ten months shall be under the ten-month 37.12 grace period of their previous application under clause (2). 37.13 (c) Income and resources of a child excluded under this 37.14 subdivision, except income of the childsupport received or37.15distributed on behalf of this childequal to the change in cash 37.16 standard due to the family cap, must be considered using the 37.17 same policies as for other children when determining the grant 37.18 amount of the assistance unit. 37.19 (d) The caregiver must assign support and cooperate with 37.20 the child support enforcement agency to establish paternity and 37.21 collect child support on behalf of the excluded child. Failure 37.22 to cooperate results in the sanction specified in section 37.23 256J.46, subdivisions 2 and 2a. Current support paid on behalf 37.24 of the excluded child shall be distributed according to section 37.25 256.741, subdivision 15. 37.26 (e) County agencies must inform applicants of the 37.27 provisions under this subdivision at the time of each 37.28 application and at recertification. 37.29 (f) Children excluded under this provision shall be deemed 37.30 MFIP recipients for purposes of child care under chapter 119B. 37.31 Sec. 5. Minnesota Statutes 2003 Supplement, section 37.32 256J.37, subdivision 3a, is amended to read: 37.33 Subd. 3a. [RENTAL SUBSIDIES; UNEARNED INCOME.] (a) 37.34Effective July 1, 2003,The county agency shall count$50$200 37.35 of the value of public and assisted rental subsidies provided 37.36 through the Department of Housing and Urban Development (HUD) as 38.1 unearned income to the cash portion of the MFIP grant. The full 38.2 amount of the subsidy must be counted as unearned income when 38.3 the subsidy is less than$50$200. The income from this subsidy 38.4 shall be budgeted according to section 256J.34. 38.5 (b) The provisions of this subdivision shall not apply to 38.6 an MFIP assistance unit which includes a participant who is: 38.7 (1) age 60 or older; 38.8 (2) a caregiver who is suffering from an illness, injury, 38.9 or incapacity that has been certified by a qualified 38.10 professional when the illness, injury, or incapacity is expected 38.11 to continue for more than 30 days and prevents the person from 38.12 obtaining or retaining employment; or 38.13 (3) a caregiver whose presence in the home is required due 38.14 to the illness or incapacity of another member in the assistance 38.15 unit, a relative in the household, or a foster child in the 38.16 household when the illness or incapacity and the need for the 38.17 participant's presence in the home has been certified by a 38.18 qualified professional and is expected to continue for more than 38.19 30 days. 38.20 (c) The provisions of this subdivision shall not apply to 38.21 an MFIP assistance unit where theparentalrelative caregiver is 38.22 an SSI recipient. 38.23 (d) Prior to implementing this provision, the commissioner 38.24 must identify the MFIP participants subject to this provision 38.25 and provide written notice to these participants at least 30 38.26 days before the first grant reduction. The notice must inform 38.27 the participant of the basis for the potential grant reduction, 38.28 the exceptions to the provision, if any, and inform the 38.29 participant of the steps necessary to claim an exception. A 38.30 person who is found not to meet one of the exceptions to the 38.31 provision must be notified and informed of the right to a fair 38.32 hearing under section 256J.40. The notice must also inform the 38.33 participant that the participant may be eligible for a rent 38.34 reduction resulting from a reduction in the MFIP grant and 38.35 encourage the participant to contact the local housing authority. 38.36 Sec. 6. Minnesota Statutes 2003 Supplement, section 39.1 256J.53, subdivision 1, is amended to read: 39.2 Subdivision 1. [LENGTH OF PROGRAM.] In order for a 39.3 postsecondary education or training program to be an approved 39.4 work activity as defined in section 256J.49, subdivision 13, 39.5 clause (6), it must be a program lasting2412 months or less, 39.6 and the participant must meet the requirements of subdivisions 39.7 2, 3, and 5. 39.8 ARTICLE 9 39.9 HEALTH CARE 39.10 Section 1. Minnesota Statutes 2003 Supplement, section 39.11 256.955, subdivision 2a, is amended to read: 39.12 Subd. 2a. [ELIGIBILITY.] An individual satisfying the 39.13 following requirements and the requirements described in 39.14 subdivision 2, paragraph (d), is eligible for the prescription 39.15 drug program who: 39.16 (1) is at least 65 years of age or older;and39.17 (2) is eligible as a qualified Medicare beneficiary 39.18 according to section 256B.057, subdivision 3 or 3a, or is 39.19 eligible under section 256B.057, subdivision 3 or 3a, and is 39.20 also eligible for medical assistance or general assistance 39.21 medical care with a spenddown as defined in section 256B.056, 39.22 subdivision 5; and 39.23 (3) applies for the Medicare drug discount card, if 39.24 eligible. 39.25 [EFFECTIVE DATE.] Clause (3) is effective July 1, 2004, or 39.26 when enrollment for the Medicare drug discount card is 39.27 available, whichever is later. 39.28 Sec. 2. Minnesota Statutes 2002, section 256.955, 39.29 subdivision 2b, is amended to read: 39.30 Subd. 2b. [ELIGIBILITY.] Effective July 1, 2002, an 39.31 individual satisfying the following requirements and the 39.32 requirements described in subdivision 2, paragraph (d), is 39.33 eligible for the prescription drug program: 39.34 (1) is under 65 years of age;and39.35 (2) is eligible as a qualified Medicare beneficiary 39.36 according to section 256B.057, subdivision 3 or 3a or is 40.1 eligible under section 256B.057, subdivision 3 or 3a and is also 40.2 eligible for medical assistance or general assistance medical 40.3 care with a spenddown as defined in section 256B.056, 40.4 subdivision 5; and 40.5 (3) applies for the Medicare drug discount card, if 40.6 eligible. 40.7 [EFFECTIVE DATE.] Clause (3) is effective July 1, 2004, or 40.8 when enrollment for the Medicare drug discount card is 40.9 available, whichever is later. 40.10 Sec. 3. Minnesota Statutes 2003 Supplement, section 40.11 256.955, subdivision 3, is amended to read: 40.12 Subd. 3. [PRESCRIPTION DRUG COVERAGE.] Coverage under the 40.13 program shall be limited to those prescription drugs that: 40.14 (1) are covered under the medical assistance program as 40.15 described in section 256B.0625, subdivision 13; 40.16 (2) are provided by manufacturers that have fully executed 40.17seniorprescription drug program rebate agreements with the 40.18 commissioner and comply with such agreements;and40.19 (3) for a specific enrollee, are not covered under an 40.20 assistance program offered by a pharmaceutical manufacturer, as 40.21 determined by the board on aging under section 256.975, 40.22 subdivision 9, except that this shall not apply to qualified 40.23 individuals under this section who are also eligible for medical 40.24 assistance with a spenddown as described in subdivisions 2a, 40.25 clause (2), and 2b, clause (2).; and 40.26 (4) for a specific enrollee, are not covered under a 40.27 Medicare drug discount card plan subsidy unless: 40.28 (i) the prescription drug is not included in the Medicare 40.29 discount card plan formulary, but is covered under the 40.30 prescription drug program; 40.31 (ii) the cost of a prescription drug is more than the 40.32 remaining Medicare drug discount card subsidy; or 40.33 (iii) a prescribed over-the-counter medication is not 40.34 included in the Medicare drug discount card plan formulary, but 40.35 is covered under the prescription drug program. 40.36 Sec. 4. Minnesota Statutes 2002, section 256.955, 41.1 subdivision 4, is amended to read: 41.2 Subd. 4. [APPLICATION PROCEDURES AND COORDINATION WITH 41.3 MEDICAL ASSISTANCE AND MEDICARE DRUG DISCOUNT CARD.] 41.4 Applications and information on the program must be made 41.5 available at county social service agencies, health care 41.6 provider offices, and agencies and organizations serving senior 41.7 citizens and persons with disabilities. Individuals shall 41.8 submit applications and any information specified by the 41.9 commissioner as being necessary to verify eligibility directly 41.10 to the county social service agencies: 41.11 (1) beginning January 1, 1999, the county social service 41.12 agency shall determine medical assistance spenddown eligibility 41.13 of individuals who qualify for the prescription drug program; 41.14 and 41.15 (2) program payments will be used to reduce the spenddown 41.16 obligations of individuals who are determined to be eligible for 41.17 medical assistance with a spenddown as defined in section 41.18 256B.056, subdivision 5. 41.19 Qualified individuals who are eligible for medical assistance 41.20 with a spenddown shall be financially responsible for the 41.21 deductible amount up to the satisfaction of the spenddown. No 41.22 deductible applies once the spenddown has been met. Payments to 41.23 providers for prescription drugs for persons eligible under this 41.24 subdivision shall be reduced by the deductible. 41.25 County social service agencies shall determine an 41.26 applicant's eligibility for the program within 30 days from the 41.27 date the application is received. Eligibility begins the month 41.28 after approval. 41.29 Enrollees who are also enrolled in the Medicare drug 41.30 discount card plan must obtain prescription drugs at a pharmacy 41.31 enrolled as a provider for both the Medicare drug discount plan 41.32 and the prescription drug program. 41.33 Sec. 5. Minnesota Statutes 2002, section 256.955, 41.34 subdivision 6, is amended to read: 41.35 Subd. 6. [PHARMACY REIMBURSEMENT.] The commissioner shall 41.36 reimburse participating pharmacies for drug and dispensing costs 42.1 at the medical assistance reimbursement level, minus the 42.2 deductible required under subdivision 7. The commissioner shall 42.3 not reimburse enrolled pharmacies until the Medicare drug 42.4 discount card subsidy has been exhausted, unless the exceptions 42.5 in subdivision 3, clause (3), are met. 42.6 Sec. 6. Minnesota Statutes 2003 Supplement, section 42.7 256B.056, subdivision 3c, is amended to read: 42.8 Subd. 3c. [ASSET LIMITATIONS FOR FAMILIES AND CHILDREN.] A 42.9 household of two or more persons must not own more than $20,000 42.10 in total net assets, and a household of one person must not own 42.11 more than $10,000 in total net assets. In addition to these 42.12 maximum amounts, an eligible individual or family may accrue 42.13 interest on these amounts, but they must be reduced to the 42.14 maximum at the time of an eligibility redetermination. The 42.15 value of assets that are not considered in determining 42.16 eligibility for medical assistance for families and children is 42.17 the value of those assets excluded under the AFDC state plan as 42.18 of July 16, 1996, as required by the Personal Responsibility and 42.19 Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 42.20 104-193, with the following exceptions: 42.21 (1) household goods and personal effects are not 42.22 considered; 42.23 (2) capital and operating assets of a trade or business up 42.24 to $200,000 are not considered; 42.25 (3) one motor vehicle is excluded for each person of legal 42.26 driving age who is employed or seeking employment; 42.27 (4)one burial plot and all other burial expenses equal to42.28the supplemental security income program asset limit are not42.29considered for each individualassets designated as burial 42.30 expenses are excluded to the same extent excluded by the 42.31 supplemental security income program. Burial expenses funded by 42.32 annuity contracts or life insurance policies must irrevocably 42.33 designate the individual's estate as the contingent beneficiary 42.34 to the extent proceeds are not used for payment of selected 42.35 burial expenses; 42.36 (5) court-ordered settlements up to $10,000 are not 43.1 considered; 43.2 (6) individual retirement accounts and funds are not 43.3 considered; and 43.4 (7) assets owned by children are not considered. 43.5 Sec. 7. Minnesota Statutes 2003 Supplement, section 43.6 256B.057, subdivision 9, is amended to read: 43.7 Subd. 9. [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 43.8 assistance may be paid for a person who is employed and who: 43.9 (1) meets the definition of disabled under the supplemental 43.10 security income program; 43.11 (2) is at least 16 but less than 65 years of age; 43.12 (3) meets the asset limits in paragraph (b); and 43.13 (4) effective November 1, 2003, pays a premium and other 43.14 obligations under paragraph (d). 43.15 Any spousal income or assets shall be disregarded for purposes 43.16 of eligibility and premium determinations. 43.17 After the month of enrollment, a person enrolled in medical 43.18 assistance under this subdivision who: 43.19 (1) is temporarily unable to work and without receipt of 43.20 earned income due to a medical condition, as verified by a 43.21 physician, may retain eligibility for up to four calendar 43.22 months; or 43.23 (2) effective January 1, 2004, loses employment for reasons 43.24 not attributable to the enrollee, may retain eligibility for up 43.25 to four consecutive months after the month of job loss. To 43.26 receive a four-month extension, enrollees must verify the 43.27 medical condition or provide notification of job loss. All 43.28 other eligibility requirements must be met and the enrollee must 43.29 pay all calculated premium costs for continued eligibility. 43.30 (b) For purposes of determining eligibility under this 43.31 subdivision, a person's assets must not exceed $20,000, 43.32 excluding: 43.33 (1) all assets excluded under section 256B.056; 43.34 (2) retirement accounts, including individual accounts, 43.35 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 43.36 (3) medical expense accounts set up through the person's 44.1 employer. 44.2 (c)(1) Effective January 1, 2004, for purposes of 44.3 eligibility, there will be a $65 earned income disregard. To be 44.4 eligible, a person applying for medical assistance under this 44.5 subdivision must have earned income above the disregard level. 44.6 (2) Effective January 1, 2004, to be considered earned 44.7 income, Medicare, Social Security, and applicable state and 44.8 federal income taxes must be withheld. To be eligible, a person 44.9 must document earned income tax withholding. 44.10 (d)(1) A person whose earned and unearned income is equal 44.11 to or greater than 100 percent of federal poverty guidelines for 44.12 the applicable family size must pay a premium to be eligible for 44.13 medical assistance under this subdivision. The premium shall be 44.14 based on the person's gross earned and unearned income and the 44.15 applicable family size using a sliding fee scale established by 44.16 the commissioner, which begins at one percent of income at 100 44.17 percent of the federal poverty guidelines and increases to 7.5 44.18 percent of income for those with incomes at or above 300 percent 44.19 of the federal poverty guidelines. Annual adjustments in the 44.20 premium schedule based upon changes in the federal poverty 44.21 guidelines shall be effective for premiums due in July of each 44.22 year. 44.23 (2) Effective January 1, 2004, all enrollees must pay a 44.24 premium to be eligible for medical assistance under this 44.25 subdivision. An enrollee shall pay the greater of a $35 premium 44.26 or the premium calculated in clause (1). 44.27 (3) Effective November 1, 2003, all enrollees who receive 44.28 unearned income must pay one-half of one percent of unearned 44.29 income in addition to the premium amount. 44.30 (4) Effective November 1, 2003, for enrollees whose income 44.31 does not exceed 200 percent of the federal poverty guidelines 44.32 and who are also enrolled in Medicare, the commissioner must 44.33 reimburse the enrollee for Medicare Part B premiums under 44.34 section 256B.0625, subdivision 15, paragraph (a). 44.35 (5) Increases in benefits under Title II of the Social 44.36 Security Act shall not be counted as income for purposes of this 45.1 subdivision until July 1 of each year. 45.2 (e) A person's eligibility and premium shall be determined 45.3 by the local county agency. Premiums must be paid to the 45.4 commissioner. All premiums are dedicated to the commissioner. 45.5 (f) Any required premium shall be determined at application 45.6 and redetermined at the enrollee's six-month income review or 45.7 when a change in income or household size is reported. 45.8 Enrollees must report any change in income or household size 45.9 within ten days of when the change occurs. A decreased premium 45.10 resulting from a reported change in income or household size 45.11 shall be effective the first day of the next available billing 45.12 month after the change is reported. Except for changes 45.13 occurring from annual cost-of-living increases, a change 45.14 resulting in an increased premium shall not affect the premium 45.15 amount until the next six-month review. 45.16 (g) Premium payment is due upon notification from the 45.17 commissioner of the premium amount required. Premiums may be 45.18 paid in installments at the discretion of the commissioner. 45.19 (h) Nonpayment of the premium shall result in denial or 45.20 termination of medical assistance unless the person demonstrates 45.21 good cause for nonpayment. Good cause exists if the 45.22 requirements specified in Minnesota Rules, part 9506.0040, 45.23 subpart 7, items B to D, are met. Except when an installment 45.24 agreement is accepted by the commissioner, all persons 45.25 disenrolled for nonpayment of a premium must pay any past due 45.26 premiums as well as current premiums due prior to being 45.27 reenrolled. Nonpayment shall include payment with a returned, 45.28 refused, or dishonored instrument. The commissioner may require 45.29 a guaranteed form of payment as the only means to replace a 45.30 returned, refused, or dishonored instrument. 45.31 [EFFECTIVE DATE.] This section is effective July 1, 2004. 45.32 Sec. 8. Minnesota Statutes 2003 Supplement, section 45.33 256B.06, subdivision 4, is amended to read: 45.34 Subd. 4. [CITIZENSHIP REQUIREMENTS.] (a) Eligibility for 45.35 medical assistance is limited to citizens of the United States, 45.36 qualified noncitizens as defined in this subdivision, and other 46.1 persons residing lawfully in the United States. 46.2 (b) "Qualified noncitizen" means a person who meets one of 46.3 the following immigration criteria: 46.4 (1) admitted for lawful permanent residence according to 46.5 United States Code, title 8; 46.6 (2) admitted to the United States as a refugee according to 46.7 United States Code, title 8, section 1157; 46.8 (3) granted asylum according to United States Code, title 46.9 8, section 1158; 46.10 (4) granted withholding of deportation according to United 46.11 States Code, title 8, section 1253(h); 46.12 (5) paroled for a period of at least one year according to 46.13 United States Code, title 8, section 1182(d)(5); 46.14 (6) granted conditional entrant status according to United 46.15 States Code, title 8, section 1153(a)(7); 46.16 (7) determined to be a battered noncitizen by the United 46.17 States Attorney General according to the Illegal Immigration 46.18 Reform and Immigrant Responsibility Act of 1996, title V of the 46.19 Omnibus Consolidated Appropriations Bill, Public Law 104-200; 46.20 (8) is a child of a noncitizen determined to be a battered 46.21 noncitizen by the United States Attorney General according to 46.22 the Illegal Immigration Reform and Immigrant Responsibility Act 46.23 of 1996, title V, of the Omnibus Consolidated Appropriations 46.24 Bill, Public Law 104-200; or 46.25 (9) determined to be a Cuban or Haitian entrant as defined 46.26 in section 501(e) of Public Law 96-422, the Refugee Education 46.27 Assistance Act of 1980. 46.28 (c) All qualified noncitizens who were residing in the 46.29 United States before August 22, 1996, who otherwise meet the 46.30 eligibility requirements of this chapter, are eligible for 46.31 medical assistance with federal financial participation. 46.32 (d) All qualified noncitizens who entered the United States 46.33 on or after August 22, 1996, and who otherwise meet the 46.34 eligibility requirements of this chapter, are eligible for 46.35 medical assistance with federal financial participation through 46.36 November 30, 1996. 47.1 Beginning December 1, 1996, qualified noncitizens who 47.2 entered the United States on or after August 22, 1996, and who 47.3 otherwise meet the eligibility requirements of this chapter are 47.4 eligible for medical assistance with federal participation for 47.5 five years if they meet one of the following criteria: 47.6 (i) refugees admitted to the United States according to 47.7 United States Code, title 8, section 1157; 47.8 (ii) persons granted asylum according to United States 47.9 Code, title 8, section 1158; 47.10 (iii) persons granted withholding of deportation according 47.11 to United States Code, title 8, section 1253(h); 47.12 (iv) veterans of the United States armed forces with an 47.13 honorable discharge for a reason other than noncitizen status, 47.14 their spouses and unmarried minor dependent children; or 47.15 (v) persons on active duty in the United States armed 47.16 forces, other than for training, their spouses and unmarried 47.17 minor dependent children. 47.18 Beginning December 1, 1996, qualified noncitizens who do 47.19 not meet one of the criteria in items (i) to (v) are eligible 47.20 for medical assistance without federal financial participation 47.21 as described in paragraph (j). 47.22 (e) Noncitizens who are not qualified noncitizens as 47.23 defined in paragraph (b), who are lawfully residing in the 47.24 United States and who otherwise meet the eligibility 47.25 requirements of this chapter, are eligible for medical 47.26 assistance under clauses (1) to (3). These individuals must 47.27 cooperate with the Immigration and Naturalization Service to 47.28 pursue any applicable immigration status, including citizenship, 47.29 that would qualify them for medical assistance with federal 47.30 financial participation. 47.31 (1) Persons who were medical assistance recipients on 47.32 August 22, 1996, are eligible for medical assistance with 47.33 federal financial participation through December 31, 1996. 47.34 (2) Beginning January 1, 1997, persons described in clause 47.35 (1) are eligible for medical assistance without federal 47.36 financial participation as described in paragraph (j). 48.1 (3) Beginning December 1, 1996, persons residing in the 48.2 United States prior to August 22, 1996, who were not receiving 48.3 medical assistance and persons who arrived on or after August 48.4 22, 1996, are eligible for medical assistance without federal 48.5 financial participation as described in paragraph (j). 48.6 (f) Nonimmigrants who otherwise meet the eligibility 48.7 requirements of this chapter are eligible for the benefits as 48.8 provided in paragraphs (g) to (i). For purposes of this 48.9 subdivision, a "nonimmigrant" is a person in one of the classes 48.10 listed in United States Code, title 8, section 1101(a)(15). 48.11 (g) Payment shall also be made for care and services that 48.12 are furnished to noncitizens, regardless of immigration status, 48.13 who otherwise meet the eligibility requirements of this chapter, 48.14 if such care and services are necessary for the treatment of an 48.15 emergency medical condition, except for organ transplants and 48.16 related care and services and routine prenatal care. 48.17 (h) For purposes of this subdivision, the term "emergency 48.18 medical condition" means a medical condition that meets the 48.19 requirements of United States Code, title 42, section 1396b(v). 48.20 (i) Pregnant noncitizens who are undocumentedor, 48.21 nonimmigrants, or eligible for medical assistance as described 48.22 in paragraph (j), and who are not covered by a group health plan 48.23 or health insurance coverage according to Code of Federal 48.24 Regulations, title 42, section 457.310, and who otherwise meet 48.25 the eligibility requirements of this chapter, are eligible for 48.26 medical assistancepayment without federal financial48.27participation for care and servicesthrough the period of 48.28 pregnancy,andincluding labor and delivery, to the extent 48.29 federal funds are available under Title XXI of the Social 48.30 Security Act, and the state children's health insurance program, 48.31 followed by 60 days postpartum, except for labor and48.32deliverywithout federal financial participation. 48.33 (j) Qualified noncitizens as described in paragraph (d), 48.34 and all other noncitizens lawfully residing in the United States 48.35 as described in paragraph (e), who are ineligible for medical 48.36 assistance with federal financial participation and who 49.1 otherwise meet the eligibility requirements of chapter 256B and 49.2 of this paragraph, are eligible for medical assistance without 49.3 federal financial participation. Qualified noncitizens as 49.4 described in paragraph (d) are only eligible for medical 49.5 assistance without federal financial participation for five 49.6 years from their date of entry into the United States. 49.7 (k) Beginning October 1, 2003, persons who are receiving 49.8 care and rehabilitation services from a nonprofit center 49.9 established to serve victims of torture and are otherwise 49.10 ineligible for medical assistance under this chapter or general 49.11 assistance medical care under section 256D.03 are eligible for 49.12 medical assistance without federal financial participation. 49.13 These individuals are eligible only for the period during which 49.14 they are receiving services from the center. Individuals 49.15 eligible under this paragraph shall not be required to 49.16 participate in prepaid medical assistance. 49.17 Sec. 9. Minnesota Statutes 2003 Supplement, section 49.18 256B.0625, subdivision 9, is amended to read: 49.19 Subd. 9. [DENTAL SERVICES.](a)Medical assistance covers 49.20 dental services. Dental services include, with prior 49.21 authorization, fixed bridges that are cost-effective for persons 49.22 who cannot use removable dentures because of their medical 49.23 condition. 49.24(b) Coverage of dental services for adults age 21 and over49.25who are not pregnant is subject to a $500 annual benefit limit49.26and covered services are limited to:49.27(1) diagnostic and preventative services;49.28(2) basic restorative services; and49.29(3) emergency services.49.30Emergency services, dentures, and extractions related to49.31dentures are not included in the $500 annual benefit limit.49.32 [EFFECTIVE DATE.] This section is effective January 1, 2005. 49.33 Sec. 10. Minnesota Statutes 2003 Supplement, section 49.34 256B.0631, subdivision 2, is amended to read: 49.35 Subd. 2. [EXCEPTIONS.] Co-payments shall be subject to the 49.36 following exceptions: 50.1 (1) children under the age of 21; 50.2 (2) pregnant women for services that relate to the 50.3 pregnancy or any other medical condition that may complicate the 50.4 pregnancy; 50.5 (3) recipientsexpected to reside for at least 30 days in a50.6hospital, nursing home, or intermediate care facility for the50.7mentally retardedwhose only available income is a personal 50.8 needs allowance under section 256B.35 or 256B.36 and whose 50.9 exemption from co-payments is approved by the centers for 50.10 Medicare and Medicaid services; 50.11 (4) recipients receiving hospice care; 50.12 (5) 100 percent federally funded services provided by an 50.13 Indian health service; 50.14 (6) emergency services; 50.15 (7) family planning services; 50.16 (8) services that are paid by Medicare, resulting in the 50.17 medical assistance program paying for the coinsurance and 50.18 deductible; and 50.19 (9) co-payments that exceed one per day per provider for 50.20 nonpreventive visits, eyeglasses, and nonemergency visits to a 50.21 hospital-based emergency room. 50.22 [EFFECTIVE DATE.] This section is effective July 1, 2004, 50.23 or upon federal approval, whichever is later. 50.24 Sec. 11. Minnesota Statutes 2003 Supplement, section 50.25 256B.69, subdivision 2, is amended to read: 50.26 Subd. 2. [DEFINITIONS.] For the purposes of this section, 50.27 the following terms have the meanings given. 50.28 (a) "Commissioner" means the commissioner of human services. 50.29 For the remainder of this section, the commissioner's 50.30 responsibilities for methods and policies for implementing the 50.31 project will be proposed by the project advisory committees and 50.32 approved by the commissioner. 50.33 (b) "Demonstration provider" means a health maintenance 50.34 organization, community integrated service network, or 50.35 accountable provider network authorized and operating under 50.36 chapter 62D, 62N, or 62T that participates in the demonstration 51.1 project according to criteria, standards, methods, and other 51.2 requirements established for the project and approved by the 51.3 commissioner. For purposes of this section, a county board, or 51.4 group of county boards operating under a joint powers agreement, 51.5 is considered a demonstration provider if the county or group of 51.6 county boards meets the requirements of section 256B.692. 51.7 Notwithstanding the above, Itasca County may continue to 51.8 participate as a demonstration provider until July 1, 2004. 51.9 (c) "Eligible individuals" means those persons eligible for 51.10 medical assistance benefits as defined in sections 256B.055, 51.11 256B.056, and 256B.06. 51.12 (d) "Limitation of choice" means suspending freedom of 51.13 choice while allowing eligible individuals to choose among the 51.14 demonstration providers. 51.15 (e) This paragraph supersedes paragraph (c) as long as the 51.16 Minnesota health care reform waiver remains in effect. When the 51.17 waiver expires, this paragraph expires and the commissioner of 51.18 human services shall publish a notice in the State Register and 51.19 notify the revisor of statutes. "Eligible individuals" means 51.20 those persons eligible for medical assistance benefits as 51.21 defined in sections 256B.055, 256B.056, and 256B.06. An 51.22 individual enrolled under section 256B.055, subdivision 7, who 51.23 becomes ineligible for the program because of failure to submit 51.24 income reports or recertification forms in a timely manner, 51.25 shall remain enrolled in the prepaid health plan and shall 51.26 remain eligible to receive medical assistance coverage through 51.27 the last day of the month following the month in which the 51.28 enrollee became ineligible for the medical assistance program. 51.29 [EFFECTIVE DATE.] This section is effective July 1, 2004, 51.30 or upon federal approval, whichever is later. 51.31 Sec. 12. Minnesota Statutes 2003 Supplement, section 51.32 256D.03, subdivision 3, is amended to read: 51.33 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 51.34 (a) General assistance medical care may be paid for any person 51.35 who is not eligible for emergency medical assistance, or medical 51.36 assistance under chapter 256B, including eligibility for medical 52.1 assistance based on a spenddown of excess income according to 52.2 section 256B.056, subdivision 5, or MinnesotaCare as defined in 52.3 paragraph (b), except as provided in paragraph (c), and: 52.4 (1) who is receiving assistance under section 256D.05, 52.5 except for families with children who are eligible under 52.6 Minnesota family investment program (MFIP), or who is having a 52.7 payment made on the person's behalf under sections 256I.01 to 52.8 256I.06; or 52.9 (2) who is a resident of Minnesota; and 52.10 (i) who has gross countable income not in excess of 75 52.11 percent of the federal poverty guidelines for the family size, 52.12 using a six-month budget period and whose equity in assets is 52.13 not in excess of $1,000 per assistance unit. Exempt assets, the 52.14 reduction of excess assets, and the waiver of excess assets must 52.15 conform to the medical assistance program in section 256B.056, 52.16 subdivision 3, with the following exception: the maximum amount 52.17 of undistributed funds in a trust that could be distributed to 52.18 or on behalf of the beneficiary by the trustee, assuming the 52.19 full exercise of the trustee's discretion under the terms of the 52.20 trust, must be applied toward the asset maximum; or 52.21 (ii) who has gross countable incomeabove 75 percent of the52.22federal poverty guidelines butor assets in excess of the limits 52.23 in item (i), but whose income is not in excess of175150 52.24 percent of the federal poverty guidelines for the family size, 52.25 using a six-month budget period, and whose equity in assets is 52.26 not in excess of the limits in section 256B.056, subdivision 3c, 52.27 and who applies during an inpatient hospitalization. 52.28 (b) General assistance medical care may not be paid for 52.29 applicants or recipients who meet all eligibility requirements 52.30 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 52.31 are adults with dependent children under 21 whose gross family 52.32 income is equal to or less than 275 percent of the federal 52.33 poverty guidelines. 52.34 (c) For applications received on or after October 1, 2003, 52.35 eligibility may begin no earlier than the date of application. 52.36 For individuals eligible under paragraph (a), clause (2), item 53.1 (i), a redetermination of eligibility must occur every 12 53.2 months. Individuals are eligible under paragraph (a), clause 53.3 (2), item (ii), only during inpatient hospitalization but may 53.4 reapply if there is a subsequent period of inpatient 53.5 hospitalization. Beginning January 1, 2000, Minnesota health 53.6 care program applications completed by recipients and applicants 53.7 who are persons described in paragraph (b), may be returned to 53.8 the county agency to be forwarded to the Department of Human 53.9 Services or sent directly to the Department of Human Services 53.10 for enrollment in MinnesotaCare. If all other eligibility 53.11 requirements of this subdivision are met, eligibility for 53.12 general assistance medical care shall be available in any month 53.13 during which a MinnesotaCare eligibility determination and 53.14 enrollment are pending. Upon notification of eligibility for 53.15 MinnesotaCare, notice of termination for eligibility for general 53.16 assistance medical care shall be sent to an applicant or 53.17 recipient. If all other eligibility requirements of this 53.18 subdivision are met, eligibility for general assistance medical 53.19 care shall be available until enrollment in MinnesotaCare 53.20 subject to the provisions of paragraph (e). 53.21 (d) The date of an initial Minnesota health care program 53.22 application necessary to begin a determination of eligibility 53.23 shall be the date the applicant has provided a name, address, 53.24 and Social Security number, signed and dated, to the county 53.25 agency or the Department of Human Services. If the applicant is 53.26 unable to provide a name, address, Social Security number, and 53.27 signature when health care is delivered due to a medical 53.28 condition or disability, a health care provider may act on an 53.29 applicant's behalf to establish the date of an initial Minnesota 53.30 health care program application by providing the county agency 53.31 or Department of Human Services with provider identification and 53.32 a temporary unique identifier for the applicant. The applicant 53.33 must complete the remainder of the application and provide 53.34 necessary verification before eligibility can be determined. 53.35 The county agency must assist the applicant in obtaining 53.36 verification if necessary. 54.1 (e) County agencies are authorized to use all automated 54.2 databases containing information regarding recipients' or 54.3 applicants' income in order to determine eligibility for general 54.4 assistance medical care or MinnesotaCare. Such use shall be 54.5 considered sufficient in order to determine eligibility and 54.6 premium payments by the county agency. 54.7 (f) General assistance medical care is not available for a 54.8 person in a correctional facility unless the person is detained 54.9 by law for less than one year in a county correctional or 54.10 detention facility as a person accused or convicted of a crime, 54.11 or admitted as an inpatient to a hospital on a criminal hold 54.12 order, and the person is a recipient of general assistance 54.13 medical care at the time the person is detained by law or 54.14 admitted on a criminal hold order and as long as the person 54.15 continues to meet other eligibility requirements of this 54.16 subdivision. 54.17 (g) General assistance medical care is not available for 54.18 applicants or recipients who do not cooperate with the county 54.19 agency to meet the requirements of medical assistance. 54.20 (h) In determining the amount of assets of an individual 54.21 eligible under paragraph (a), clause (2), item (i), there shall 54.22 be included any asset or interest in an asset, including an 54.23 asset excluded under paragraph (a), that was given away, sold, 54.24 or disposed of for less than fair market value within the 60 54.25 months preceding application for general assistance medical care 54.26 or during the period of eligibility. Any transfer described in 54.27 this paragraph shall be presumed to have been for the purpose of 54.28 establishing eligibility for general assistance medical care, 54.29 unless the individual furnishes convincing evidence to establish 54.30 that the transaction was exclusively for another purpose. For 54.31 purposes of this paragraph, the value of the asset or interest 54.32 shall be the fair market value at the time it was given away, 54.33 sold, or disposed of, less the amount of compensation received. 54.34 For any uncompensated transfer, the number of months of 54.35 ineligibility, including partial months, shall be calculated by 54.36 dividing the uncompensated transfer amount by the average 55.1 monthly per person payment made by the medical assistance 55.2 program to skilled nursing facilities for the previous calendar 55.3 year. The individual shall remain ineligible until this fixed 55.4 period has expired. The period of ineligibility may exceed 30 55.5 months, and a reapplication for benefits after 30 months from 55.6 the date of the transfer shall not result in eligibility unless 55.7 and until the period of ineligibility has expired. The period 55.8 of ineligibility begins in the month the transfer was reported 55.9 to the county agency, or if the transfer was not reported, the 55.10 month in which the county agency discovered the transfer, 55.11 whichever comes first. For applicants, the period of 55.12 ineligibility begins on the date of the first approved 55.13 application. 55.14 (i) When determining eligibility for any state benefits 55.15 under this subdivision, the income and resources of all 55.16 noncitizens shall be deemed to include their sponsor's income 55.17 and resources as defined in the Personal Responsibility and Work 55.18 Opportunity Reconciliation Act of 1996, title IV, Public Law 55.19 104-193, sections 421 and 422, and subsequently set out in 55.20 federal rules. 55.21 (j) Undocumented noncitizens and nonimmigrants are 55.22 ineligible for general assistance medical care, except that an 55.23 individual eligible under paragraph (a), clause (4), remains 55.24 eligible through September 30, 2003, and an undocumented 55.25 noncitizen or nonimmigrant who is diagnosed with active or 55.26 latent tuberculosis and meets all other eligibility requirements 55.27 of this section is eligible for the duration of the need for 55.28 tuberculosis treatment. For purposes of this subdivision, a 55.29 nonimmigrant is an individual in one or more of the classes 55.30 listed in United States Code, title 8, section 1101(a)(15), and 55.31 an undocumented noncitizen is an individual who resides in the 55.32 United States without the approval or acquiescence of the 55.33 Immigration and Naturalization Service. 55.34 (k) Notwithstanding any other provision of law, a 55.35 noncitizen who is ineligible for medical assistance due to the 55.36 deeming of a sponsor's income and resources, is ineligible for 56.1 general assistance medical care. 56.2 (l) Effective July 1, 2003, general assistance medical care 56.3 emergency services end. 56.4 [EFFECTIVE DATE.] This section is effective July 1, 2004, 56.5 except that the change in the income limit for hospital-only 56.6 coverage in paragraph (a), clause (2), item (ii) is effective 56.7 July 1, 2005. 56.8 Sec. 13. Minnesota Statutes 2003 Supplement, section 56.9 256D.03, subdivision 4, is amended to read: 56.10 Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 56.11 (a)(i) For a person who is eligible under subdivision 3, 56.12 paragraph (a), clause (2), item (i), general assistance medical 56.13 care covers, except as provided in paragraph (c): 56.14 (1) inpatient hospital services; 56.15 (2) outpatient hospital services; 56.16 (3) services provided by Medicare certified rehabilitation 56.17 agencies; 56.18 (4) prescription drugs and other products recommended 56.19 through the process established in section 256B.0625, 56.20 subdivision 13; 56.21 (5) equipment necessary to administer insulin and 56.22 diagnostic supplies and equipment for diabetics to monitor blood 56.23 sugar level; 56.24 (6) eyeglasses and eye examinations provided by a physician 56.25 or optometrist; 56.26 (7) hearing aids; 56.27 (8) prosthetic devices; 56.28 (9) laboratory and X-ray services; 56.29 (10) physician's services; 56.30 (11) medical transportation except special transportation; 56.31 (12) chiropractic services as covered under the medical 56.32 assistance program; 56.33 (13) podiatric services; 56.34 (14) dental servicesand dentures, subject to the56.35limitations specified in section 256B.0625, subdivision 9as 56.36 covered under the medical assistance program; 57.1 (15) outpatient services provided by a mental health center 57.2 or clinic that is under contract with the county board and is 57.3 established under section 245.62; 57.4 (16) day treatment services for mental illness provided 57.5 under contract with the county board; 57.6 (17) prescribed medications for persons who have been 57.7 diagnosed as mentally ill as necessary to prevent more 57.8 restrictive institutionalization; 57.9 (18) psychological services, medical supplies and 57.10 equipment, and Medicare premiums, coinsurance and deductible 57.11 payments; 57.12 (19) medical equipment not specifically listed in this 57.13 paragraph when the use of the equipment will prevent the need 57.14 for costlier services that are reimbursable under this 57.15 subdivision; 57.16 (20) services performed by a certified pediatric nurse 57.17 practitioner, a certified family nurse practitioner, a certified 57.18 adult nurse practitioner, a certified obstetric/gynecological 57.19 nurse practitioner, a certified neonatal nurse practitioner, or 57.20 a certified geriatric nurse practitioner in independent 57.21 practice, if (1) the service is otherwise covered under this 57.22 chapter as a physician service, (2) the service provided on an 57.23 inpatient basis is not included as part of the cost for 57.24 inpatient services included in the operating payment rate, and 57.25 (3) the service is within the scope of practice of the nurse 57.26 practitioner's license as a registered nurse, as defined in 57.27 section 148.171; 57.28 (21) services of a certified public health nurse or a 57.29 registered nurse practicing in a public health nursing clinic 57.30 that is a department of, or that operates under the direct 57.31 authority of, a unit of government, if the service is within the 57.32 scope of practice of the public health nurse's license as a 57.33 registered nurse, as defined in section 148.171; and 57.34 (22) telemedicine consultations, to the extent they are 57.35 covered under section 256B.0625, subdivision 3b. 57.36 (ii) Effective October 1, 2003, for a person who is 58.1 eligible under subdivision 3, paragraph (a), clause (2), item 58.2 (ii), general assistance medical care coverage is limited to 58.3 inpatient hospital services, including physician services 58.4 provided during the inpatient hospital stay. A $1,000 58.5 deductible is required for each inpatient hospitalization. 58.6 (b) Gender reassignment surgery and related services are 58.7 not covered services under this subdivision unless the 58.8 individual began receiving gender reassignment services prior to 58.9 July 1, 1995. 58.10 (c) In order to contain costs, the commissioner of human 58.11 services shall select vendors of medical care who can provide 58.12 the most economical care consistent with high medical standards 58.13 and shall where possible contract with organizations on a 58.14 prepaid capitation basis to provide these services. The 58.15 commissioner shall consider proposals by counties and vendors 58.16 for prepaid health plans, competitive bidding programs, block 58.17 grants, or other vendor payment mechanisms designed to provide 58.18 services in an economical manner or to control utilization, with 58.19 safeguards to ensure that necessary services are provided. 58.20 Before implementing prepaid programs in counties with a county 58.21 operated or affiliated public teaching hospital or a hospital or 58.22 clinic operated by the University of Minnesota, the commissioner 58.23 shall consider the risks the prepaid program creates for the 58.24 hospital and allow the county or hospital the opportunity to 58.25 participate in the program in a manner that reflects the risk of 58.26 adverse selection and the nature of the patients served by the 58.27 hospital, provided the terms of participation in the program are 58.28 competitive with the terms of other participants considering the 58.29 nature of the population served. Payment for services provided 58.30 pursuant to this subdivision shall be as provided to medical 58.31 assistance vendors of these services under sections 256B.02, 58.32 subdivision 8, and 256B.0625. For payments made during fiscal 58.33 year 1990 and later years, the commissioner shall consult with 58.34 an independent actuary in establishing prepayment rates, but 58.35 shall retain final control over the rate methodology. 58.36 (d) Recipients eligible under subdivision 3, paragraph (a), 59.1 clause (2), item (i), shall pay the following co-payments for 59.2 services provided on or after October 1, 2003: 59.3 (1) $3 per nonpreventive visit. For purposes of this 59.4 subdivision, a visit means an episode of service which is 59.5 required because of a recipient's symptoms, diagnosis, or 59.6 established illness, and which is delivered in an ambulatory 59.7 setting by a physician or physician ancillary, chiropractor, 59.8 podiatrist, nurse midwife, advanced practice nurse, audiologist, 59.9 optician, or optometrist; 59.10 (2) $25 for eyeglasses; 59.11 (3) $25 for nonemergency visits to a hospital-based 59.12 emergency room; and 59.13 (4) $3 per brand-name drug prescription and $1 per generic 59.14 drug prescription, subject to a $20 per month maximum for 59.15 prescription drug co-payments. No co-payments shall apply to 59.16 antipsychotic drugs when used for the treatment of mental 59.17 illness; and59.18(5) 50 percent coinsurance on basic restorative dental59.19services. 59.20 (e) Recipients of general assistance medical care are 59.21 responsible for all co-payments in this subdivision, except that 59.22 this requirement does not apply to recipients receiving group 59.23 residential housing payments under chapter 256I whose available 59.24 income is limited to a personal needs allowance under section 59.25 256B.35. The general assistance medical care reimbursement to 59.26 the provider shall be reduced by the amount of the co-payment, 59.27 except that reimbursement for prescription drugs shall not be 59.28 reduced once a recipient has reached the $20 per month maximum 59.29 for prescription drug co-payments. The provider collects the 59.30 co-payment from the recipient. Providers may not deny services 59.31 to recipients who are unable to pay the co-payment, except as 59.32 provided in paragraph (f). 59.33 (f) If it is the routine business practice of a provider to 59.34 refuse service to an individual with uncollected debt, the 59.35 provider may include uncollected co-payments under this 59.36 section. A provider must give advance notice to a recipient 60.1 with uncollected debt before services can be denied. 60.2 (g) Any county may, from its own resources, provide medical 60.3 payments for which state payments are not made. 60.4 (h) Chemical dependency services that are reimbursed under 60.5 chapter 254B must not be reimbursed under general assistance 60.6 medical care. 60.7 (i) The maximum payment for new vendors enrolled in the 60.8 general assistance medical care program after the base year 60.9 shall be determined from the average usual and customary charge 60.10 of the same vendor type enrolled in the base year. 60.11 (j) The conditions of payment for services under this 60.12 subdivision are the same as the conditions specified in rules 60.13 adopted under chapter 256B governing the medical assistance 60.14 program, unless otherwise provided by statute or rule. 60.15 (k) Inpatient and outpatient payments shall be reduced by 60.16 five percent, effective July 1, 2003. This reduction is in 60.17 addition to the five percent reduction effective July 1, 2003, 60.18 and incorporated by reference in paragraph (i). 60.19 (l) Payments for all other health services except 60.20 inpatient, outpatient, and pharmacy services shall be reduced by 60.21 five percent, effective July 1, 2003. 60.22 (m) Payments to managed care plans shall be reduced by five 60.23 percent for services provided on or after October 1, 2003. 60.24 (n) A hospital receiving a reduced payment as a result of 60.25 this section may apply the unpaid balance toward satisfaction of 60.26 the hospital's bad debts. 60.27 [EFFECTIVE DATE.] This section is effective January 1, 60.28 2005, except that the amendments to paragraph (e) are effective 60.29 July 1, 2004. 60.30 Sec. 14. Minnesota Statutes 2002, section 256L.01, 60.31 subdivision 5, is amended to read: 60.32 Subd. 5. [INCOME.] (a) "Income" has the meaning given for 60.33 earned and unearned income for families and children in the 60.34 medical assistance program, according to the state's aid to 60.35 families with dependent children plan in effect as of July 16, 60.36 1996. The definition does not include medical assistance income 61.1 methodologies and deeming requirements. The earned income of 61.2 full-time and part-time students under age 19 is not counted as 61.3 income. Public assistance payments and supplemental security 61.4 income are not excluded income. 61.5 (b) For purposes of this subdivision, and unless otherwise 61.6 specified in this section, the commissioner shall use reasonable 61.7 methods to calculate gross earned and unearned income including, 61.8 but not limited to, projecting income based on income received 61.9 within the last 30 days, the last 90 days, or the last 12 months. 61.10 [EFFECTIVE DATE.] This section is effective July 1, 2004. 61.11 Sec. 15. Minnesota Statutes 2003 Supplement, section 61.12 256L.03, subdivision 1, is amended to read: 61.13 Subdivision 1. [COVERED HEALTH SERVICES.] For individuals 61.14 under section 256L.04, subdivision 7, with income no greater 61.15 than 75 percent of the federal poverty guidelines or for 61.16 families with children under section 256L.04, subdivision 1, all 61.17 subdivisions of this section apply. "Covered health services" 61.18 means the health services reimbursed under chapter 256B, with 61.19 the exception of inpatient hospital services, special education 61.20 services, private duty nursing services, adult dental care 61.21 servicesother than servicesexcept as covered undersection61.22256B.0625,subdivision9, paragraph (b), orthodontic services61.23 3b, nonemergency medical transportation services, personal care 61.24 assistant and case management services, nursing home or 61.25 intermediate care facilities services, inpatient mental health 61.26 services, and chemical dependency services. Outpatient mental 61.27 health services covered under the MinnesotaCare program are 61.28 limited to diagnostic assessments, psychological testing, 61.29 explanation of findings, medication management by a physician, 61.30 day treatment, partial hospitalization, and individual, family, 61.31 and group psychotherapy. 61.32 No public funds shall be used for coverage of abortion 61.33 under MinnesotaCare except where the life of the female would be 61.34 endangered or substantial and irreversible impairment of a major 61.35 bodily function would result if the fetus were carried to term; 61.36 or where the pregnancy is the result of rape or incest. 62.1 Covered health services shall be expanded as provided in 62.2 this section. 62.3 [EFFECTIVE DATE.] This section is effective January 1, 2005. 62.4 Sec. 16. Minnesota Statutes 2002, section 256L.03, is 62.5 amended by adding a subdivision to read: 62.6 Subd. 3b. [DENTAL SERVICES EFFECTIVE JANUARY 1, 2005.] (a) 62.7 Effective January 1, 2005, the provisions in paragraphs (b) to 62.8 (c) apply. 62.9 (b) For parents, grandparents, foster parents, relative 62.10 caretakers, and legal guardians eligible under section 256L.04, 62.11 subdivision 1, with incomes not exceeding 75 percent of the 62.12 federal poverty guidelines, dental services are covered as 62.13 provided under section 256B.0625, subdivision 9, except that no 62.14 coverage is provided for orthodontic services. 62.15 (c) For pregnant women and children under age 21, dental 62.16 services are covered as provided under section 256B.0625, 62.17 subdivision 9. 62.18 Sec. 17. Minnesota Statutes 2002, section 256L.03, 62.19 subdivision 5, is amended to read: 62.20 Subd. 5. [CO-PAYMENTS AND COINSURANCE.] (a) Except as 62.21 provided in paragraphs (b) and (c), the MinnesotaCare benefit 62.22 plan shall include the following co-payments and coinsurance 62.23 requirements for all enrollees: 62.24 (1) ten percent of the paid charges for inpatient hospital 62.25 services for adult enrollees, subject to an annual inpatient 62.26 out-of-pocket maximum of $1,000 per individual and $3,000 per 62.27 family; 62.28 (2) $3 per prescription for adult enrollees; 62.29 (3) $25 for eyeglasses for adult enrollees;and62.30 (4) $3 per nonpreventive visit. For purposes of this 62.31 subdivision, a visit means an episode of service which is 62.32 required because of an enrollee's symptoms, diagnosis, or 62.33 established illness, and which is delivered in an ambulatory 62.34 setting by a physician or physician ancillary, chiropractor, 62.35 podiatrist, advanced practice nurse, audiologist, optician, or 62.36 optometrist; 63.1 (5) $6 for nonemergency visits to a hospital-based 63.2 emergency room; and 63.3 (6) 50 percent of the fee-for-service rate for adult dental 63.4 care services other than preventive care services for persons 63.5 eligible under section 256L.04, subdivisions 1 to 7, with income 63.6 equal to or less than 175 percent of the federal poverty 63.7 guidelines. 63.8 (b) Paragraph (a), clause (1), does not apply to parents 63.9 and relative caretakers of children under the age of 21 in 63.10 households with family income equal to or less than 175 percent 63.11 of the federal poverty guidelines. Paragraph (a), clause (1), 63.12 does not apply to parents and relative caretakers of children 63.13 under the age of 21 in households with family income greater 63.14 than 175 percent of the federal poverty guidelines for inpatient 63.15 hospital admissions occurring on or after January 1, 2001. 63.16 (c) Paragraph (a), clauses (1) to(4)(6), do not apply to 63.17 pregnant women and children under the age of 21. 63.18 (d) Adult enrollees with family gross income that exceeds 63.19 175 percent of the federal poverty guidelines and who are not 63.20 pregnant shall be financially responsible for the coinsurance 63.21 amount, if applicable, and amounts which exceed the $10,000 63.22 inpatient hospital benefit limit. 63.23 (e) When a MinnesotaCare enrollee becomes a member of a 63.24 prepaid health plan, or changes from one prepaid health plan to 63.25 another during a calendar year, any charges submitted towards 63.26 the $10,000 annual inpatient benefit limit, and any 63.27 out-of-pocket expenses incurred by the enrollee for inpatient 63.28 services, that were submitted or incurred prior to enrollment, 63.29 or prior to the change in health plans, shall be disregarded. 63.30 (f) Paragraph (a), clauses (4) and (5), are limited to one 63.31 co-payment per day per provider. 63.32 [EFFECTIVE DATE.] This section is effective January 1, 2005. 63.33 Sec. 18. Minnesota Statutes 2003 Supplement, section 63.34 256L.035, is amended to read: 63.35 256L.035 [LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE 63.36 ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.] 64.1 (a) "Covered health services" for individuals under section 64.2 256L.04, subdivision 7, with income above 75 percent, but not 64.3 exceeding 175 percent, of the federal poverty guideline means: 64.4 (1) inpatient hospitalization benefits with a ten percent 64.5 co-payment up to $1,000 and subject to an annual limitation of 64.6 $10,000; 64.7 (2) physician services provided during an inpatient stay; 64.8 and 64.9 (3) physician services not provided during an inpatient 64.10 stay,; outpatient hospital services,; chiropractic services 64.11,; lab and diagnostic services,; vision services excluding the 64.12 dispensing, fitting, and adjustment of eyeglasses or contacts 64.13 and eye examinations to determine refractive state; and 64.14 prescription drugs,; and supplies and equipment for diabetic 64.15 testing and insulin administration, subject to an aggregate cap 64.16 of $2,000 per calendar year and the following co-payments: 64.17 (i) $50 co-pay per emergency room visit; 64.18 (ii) $3 co-pay per prescription drug; and 64.19 (iii) $5 co-pay per nonpreventive physician and optometrist 64.20 visit. 64.21 For purposes of this subdivision, "a visit" means an 64.22 episode of service which is required because of a recipient's 64.23 symptoms, diagnosis, or established illness, and which is 64.24 delivered in an ambulatory setting by a physicianor, physician 64.25 ancillary, or optometrist. 64.26 Enrollees are responsible for all co-payments in this 64.27 subdivision, except that this requirement does not apply to 64.28 enrollees receiving group residential housing payments under 64.29 chapter 256I whose available income is limited to a personal 64.30 needs allowance under section 256B.35. 64.31 (b) The November 2006 MinnesotaCare forecast for the 64.32 biennium beginning July 1, 2007, shall assume an adjustment in 64.33 the aggregate cap on the services identified in paragraph (a), 64.34 clause (3), in $1,000 increments up to a maximum of $10,000, but 64.35 not less than $2,000, to the extent that the balance in the 64.36 health care access fund is sufficient in each year of the 65.1 biennium to pay for this benefit level. The aggregate cap shall 65.2 be adjusted according to the forecast. 65.3 (c) Reimbursement to the providers shall be reduced by the 65.4 amount of the co-payment, except that reimbursement for 65.5 prescription drugs shall not be reduced once a recipient has 65.6 reached the $20 per month maximum for prescription drug 65.7 co-payments. The provider collects the co-payment from the 65.8 recipient. Providers may not deny services to recipients who 65.9 are unable to pay the co-payment, except as provided in 65.10 paragraph (d). 65.11 (d) If it is the routine business practice of a provider to 65.12 refuse service to an individual with uncollected debt, the 65.13 provider may include uncollected co-payments under this 65.14 section. A provider must give advance notice to a recipient 65.15 with uncollected debt before services can be denied. 65.16 [EFFECTIVE DATE.] This section is effective January 1, 2005. 65.17 Sec. 19. Minnesota Statutes 2002, section 256L.05, 65.18 subdivision 3, is amended to read: 65.19 Subd. 3. [EFFECTIVE DATE OF COVERAGE.] (a) The effective 65.20 date of coverage is the first day of the month following the 65.21 month in which eligibility is approved and the first premium 65.22 payment has been received. As provided in section 256B.057, 65.23 coverage for newborns is automatic from the date of birth and 65.24 must be coordinated with other health coverage. The effective 65.25 date of coverage for eligible newly adoptive children added to a 65.26 family receiving covered health services is thedate of entry65.27into the family. Themonth of placement or the month placement 65.28 is reported, whichever is later. The effective date of coverage 65.29 for other newrecipientsmembers added to the familyreceiving65.30covered health servicesis the first day of the month following 65.31 the month in whicheligibility is approved or at renewal,65.32whichever the family receiving covered health services65.33prefersthe change is reported. All eligibility criteria must 65.34 be met by the family at the time the new family member is 65.35 added. The income of the new family member is included with the 65.36 family's gross income and the adjusted premium begins in the 66.1 month the new family member is added. 66.2 (b) The initial premium must be received by the last 66.3 working day of the month for coverage to begin the first day of 66.4 the following month. 66.5 (c) Benefits are not available until the day following 66.6 discharge if an enrollee is hospitalized on the first day of 66.7 coverage. 66.8 (d) Notwithstanding any other law to the contrary, benefits 66.9 under sections 256L.01 to 256L.18 are secondary to a plan of 66.10 insurance or benefit program under which an eligible person may 66.11 have coverage and the commissioner shall use cost avoidance 66.12 techniques to ensure coordination of any other health coverage 66.13 for eligible persons. The commissioner shall identify eligible 66.14 persons who may have coverage or benefits under other plans of 66.15 insurance or who become eligible for medical assistance. 66.16 Sec. 20. Minnesota Statutes 2003 Supplement, section 66.17 256L.07, subdivision 1, is amended to read: 66.18 Subdivision 1. [GENERAL REQUIREMENTS.] (a) Children 66.19 enrolled in the original children's health plan as of September 66.20 30, 1992, children who enrolled in the MinnesotaCare program 66.21 after September 30, 1992, pursuant to Laws 1992, chapter 549, 66.22 article 4, section 17, and children who have family gross 66.23 incomes that are equal to or less than 150 percent of the 66.24 federal poverty guidelines are eligible without meeting the 66.25 requirements of subdivision 2 and the four-month requirement in 66.26 subdivision 3, as long as they maintain continuous coverage in 66.27 the MinnesotaCare program or medical assistance. Children who 66.28 apply for MinnesotaCare on or after the implementation date of 66.29 the employer-subsidized health coverage program as described in 66.30 Laws 1998, chapter 407, article 5, section 45, who have family 66.31 gross incomes that are equal to or less than 150 percent of the 66.32 federal poverty guidelines, must meet the requirements of 66.33 subdivision 2 to be eligible for MinnesotaCare. 66.34 (b) Families enrolled in MinnesotaCare under section 66.35 256L.04, subdivision 1, whose income increases above 275 percent 66.36 of the federal poverty guidelines, are no longer eligible for 67.1 the program and shall be disenrolled by the commissioner. 67.2 Individuals enrolled in MinnesotaCare under section 256L.04, 67.3 subdivision 7, whose income increases above 175 percent of the 67.4 federal poverty guidelines are no longer eligible for the 67.5 program and shall be disenrolled by the commissioner.For67.6persons disenrolled under this subdivision, MinnesotaCare67.7coverage terminates the last day of the calendar month following67.8the month in which the commissioner determines that the income67.9of a family or individual exceeds program income limits.67.10 (c)(1) Notwithstanding paragraph (b), families enrolled in 67.11 MinnesotaCare under section 256L.04, subdivision 1, may remain 67.12 enrolled in MinnesotaCare if ten percent of their annual income 67.13 is less than the annual premium for a policy with a $500 67.14 deductible available through the Minnesota Comprehensive Health 67.15 Association. Families who are no longer eligible for 67.16 MinnesotaCare under this subdivision shall be given an 18-month 67.17 notice period from the date that ineligibility is determined 67.18 before disenrollment. This clause expires February 1, 2004. 67.19 (2) Effective February 1, 2004, notwithstanding paragraph 67.20 (b), children may remain enrolled in MinnesotaCare if ten 67.21 percent of their annual family income is less than the annual 67.22 premium for a policy with a $500 deductible available through 67.23 the Minnesota Comprehensive Health Association. Children who 67.24 are no longer eligible for MinnesotaCare under this clause shall 67.25 be given a 12-month notice period from the date that 67.26 ineligibility is determined before disenrollment. The premium 67.27 for children remaining eligible under this clause shall be the 67.28 maximum premium determined under section 256L.15, subdivision 2, 67.29 paragraph (b). 67.30 (d) Effective July 1, 2003, notwithstanding paragraphs (b) 67.31 and (c), parents are no longer eligible for MinnesotaCare if 67.32 gross household income exceeds $50,000. 67.33 Sec. 21. Minnesota Statutes 2003 Supplement, section 67.34 256L.07, subdivision 3, is amended to read: 67.35 Subd. 3. [OTHER HEALTH COVERAGE.] (a) Families and 67.36 individuals enrolled in the MinnesotaCare program must have no 68.1 health coverage while enrolled or for at least four months prior 68.2 to application and renewal. Children enrolled in the original 68.3 children's health plan and children in families with income 68.4 equal to or less than 150 percent of the federal poverty 68.5 guidelines, who have other health insurance, are eligible if the 68.6 coverage: 68.7 (1) lacks two or more of the following: 68.8 (i) basic hospital insurance; 68.9 (ii) medical-surgical insurance; 68.10 (iii) prescription drug coverage; 68.11 (iv) dental coverage; or 68.12 (v) vision coverage; 68.13 (2) requires a deductible of $100 or more per person per 68.14 year; or 68.15 (3) lacks coverage because the child has exceeded the 68.16 maximum coverage for a particular diagnosis or the policy 68.17 excludes a particular diagnosis. 68.18 The commissioner may change this eligibility criterion for 68.19 sliding scale premiums in order to remain within the limits of 68.20 available appropriations. The requirement of no health coverage 68.21 does not apply to newborns. 68.22 (b) Medical assistance, general assistance medical care, 68.23 and the Civilian Health and Medical Program of the Uniformed 68.24 Service, CHAMPUS, or other coverage provided under United States 68.25 Code, title 10, subtitle A, part II, chapter 55, are not 68.26 considered insurance or health coverage for purposes of the 68.27 four-month requirement described in this subdivision. 68.28 (c) For purposes of this subdivision, Medicare Part A or B 68.29 coverage under title XVIII of the Social Security Act, United 68.30 States Code, title 42, sections 1395c to 1395w-4, is considered 68.31 health coverage. An applicant or enrolleemay not refusewho is 68.32 entitled to Medicare but has failed to apply or refused Medicare 68.33 coverageto establish eligibilityis not eligible for 68.34 MinnesotaCare. 68.35 (d) Applicants who were recipients of medical assistance or 68.36 general assistance medical care within one month of application 69.1 must meet the provisions of this subdivision and subdivision 2. 69.2 (e)Effective October 1, 2003, applicants who were69.3recipients of medical assistance and hadCost-effective health 69.4 insurancewhichthat was paid for by medical assistanceare69.5exempt fromis not considered health coverage for purposes of 69.6 the four-month requirement under this section, except if the 69.7 insurance continued after medical assistance no longer 69.8 considered it cost-effective or after medical assistance closed. 69.9 Sec. 22. [FEDERAL APPROVAL.] 69.10 The commissioner of human services shall request federal 69.11 approval to exempt from co-payments medical assistance 69.12 recipients with personal needs allowances by July 1, 2004, and 69.13 provide copies of the request to the chairs of the house Health 69.14 and Human Services Finance Committee and senate Health, Human 69.15 Services and Corrections Budget Division. If federal approval 69.16 to exempt all recipients with a personal needs allowance is not 69.17 obtained, the commissioner shall seek federal approval to exempt 69.18 from co-payments all those who can qualify for an exemption 69.19 through a state plan amendment or a waiver request. 69.20 Sec. 23. [REPEALER.] 69.21 Subdivision 1. [PRESCRIPTION DRUG PROGRAM.] Minnesota 69.22 Statutes 2002, section 256.955, subdivisions 1, 2, 2b, 4, 5, 6, 69.23 7, and 9; and Minnesota Statutes 2003 Supplement, section 69.24 256.955, subdivisions 2a, 3, and 4a, are repealed effective 69.25 January 1, 2006. 69.26 Subd. 2. [MINNESOTACARE OUTREACH GRANTS.] Minnesota 69.27 Statutes 2002, section 256L.04, subdivision 11, is repealed 69.28 effective July 1, 2004. 69.29 ARTICLE 10 69.30 LONG-TERM CARE 69.31 Section 1. Minnesota Statutes 2003 Supplement, section 69.32 144A.071, subdivision 4c, is amended to read: 69.33 Subd. 4c. [EXCEPTIONS FOR REPLACEMENT BEDS AFTER JUNE 30, 69.34 2003.] (a) The commissioner of health, in coordination with the 69.35 commissioner of human services, may approve the renovation, 69.36 replacement, upgrading, or relocation of a nursing home or 70.1 boarding care home, under the following conditions: 70.2 (1) to license and certify an 80-bed city-owned facility in 70.3 Nicollet County to be constructed on the site of a new 70.4 city-owned hospital to replace an existing 85-bed facility 70.5 attached to a hospital that is also being replaced. The 70.6 threshold allowed for this project under section 144A.073 shall 70.7 be the maximum amount available to pay the additional medical 70.8 assistance costs of the new facility;and70.9 (2) to license and certify 29 beds to be added to an 70.10 existing 69-bed facility in St. Louis County, provided that the 70.11 29 beds must be transferred from active or layaway status at an 70.12 existing facility in St. Louis County that had 235 beds on April 70.13 1, 2003. 70.14 The licensed capacity at the 235-bed facility must be reduced to 70.15 206 beds, but the payment rate at that facility shall not be 70.16 adjusted as a result of this transfer. The operating payment 70.17 rate of the facility adding beds after completion of this 70.18 project shall be the same as it was on the day prior to the day 70.19 the beds are licensed and certified. This project shall not 70.20 proceed unless it is approved and financed under the provisions 70.21 of section 144A.073; and 70.22 (3) to license and certify a new 60-bed facility in Austin, 70.23 provided that: 70.24 (i) 45 of the new beds are transferred from a 45-bed 70.25 facility in Austin under common ownership that is closed, and 15 70.26 of the new beds are transferred from a 182-bed facility in 70.27 Albert Lea under common ownership; 70.28 (ii) the commissioner of human services is authorized by 70.29 the 2004 legislature to negotiate budget-neutral planned nursing 70.30 facility closures; and 70.31 (iii) money is available from planned closures of 70.32 facilities under common ownership to make implementation of this 70.33 clause budget-neutral to the state. 70.34 The bed capacity of the Albert Lea facility shall be 70.35 reduced to 167 beds following the transfer. Of the 60 beds at 70.36 the new facility, 20 beds shall be used for a special care unit 71.1 for persons with Alzheimer's disease or related dementias. 71.2 (b) Projects approved under this subdivision shall be 71.3 treated in a manner equivalent to projects approved under 71.4 subdivision 4a. 71.5 Sec. 2. Minnesota Statutes 2002, section 144A.10, 71.6 subdivision 1a, is amended to read: 71.7 Subd. 1a. [TRAINING AND EDUCATION FOR NURSING FACILITY 71.8 PROVIDERS.] The commissioner of health must establish and 71.9 implement a prescribed process and program for providing 71.10 training and education to providers licensed by the Department 71.11 of Health,either by itself orin conjunction with the industry 71.12 trade associations, before using any new regulatory guideline, 71.13 regulation, interpretation, program letter or memorandum, or any 71.14 other materials used in surveyor training to survey licensed 71.15 providers. The process should include, but is not limited to, 71.16 the following key components: 71.17 (1) facilitate the implementation of immediate revisions to 71.18 any course curriculum for nursing assistants which reflect any 71.19 new standard of care practice that has been adopted or 71.20 referenced by the Health Department concerning the issue in 71.21 question; 71.22 (2) conduct training of long-term care providers and health 71.23 department survey inspectorseitherjointlyor during the same71.24time frameon the department's new expectations; and 71.25 (3)within available resourcesthe commissioner shall 71.26cooperate in the development of clinical standards, work with71.27vendors of supplies and services regarding hazards, and identify71.28research of interest to the long-term care communityconsult 71.29 with experts in the field to develop or make available training 71.30 resources on current standards of practice and the use of 71.31 technology. 71.32 Sec. 3. Minnesota Statutes 2002, section 144A.10, is 71.33 amended by adding a subdivision to read: 71.34 Subd. 17. [AGENCY QUALITY IMPROVEMENT PROGRAM; ANNUAL 71.35 REPORT ON SURVEY PROCESS.] (a) The commissioner shall establish 71.36 a quality improvement program for the nursing facility survey 72.1 and complaint processes. The commissioner must regularly 72.2 consult with consumers, consumer advocates, and representatives 72.3 of the nursing home industry and representatives of nursing home 72.4 employees in implementing the program. The commissioner, 72.5 through the quality improvement program, shall submit to the 72.6 legislature an annual survey and certification quality 72.7 improvement report, beginning December 15, 2004, and each 72.8 December 15 thereafter. 72.9 (b) The report must include, but is not limited to, an 72.10 analysis of: 72.11 (1) the number, scope, and severity of citations by region 72.12 within the state; 72.13 (2) cross-referencing of citations by region within the 72.14 state and between states within the Centers for Medicare and 72.15 Medicaid Services region in which Minnesota is located; 72.16 (3) the number and outcomes of independent dispute 72.17 resolutions; 72.18 (4) the number and outcomes of appeals; 72.19 (5) compliance with timelines for survey revisits and 72.20 complaint investigations; 72.21 (6) techniques of surveyors in investigations, 72.22 communication, and documentation to identify and support 72.23 citations; 72.24 (7) compliance with timelines for providing facilities with 72.25 completed statements of deficiencies; and 72.26 (8) other survey statistics relevant to improving the 72.27 survey process. 72.28 (c) The report must also identify and explain 72.29 inconsistencies and patterns across regions of the state, 72.30 include analyses and recommendations for quality improvement 72.31 areas identified by the commissioner, consumers, consumer 72.32 advocates, and representatives of the nursing home industry and 72.33 nursing home employees, and provide action plans to address 72.34 problems that are identified. 72.35 Sec. 4. [144A.101] [PROCEDURES FOR FEDERALLY REQUIRED 72.36 SURVEY PROCESS.] 73.1 Subdivision 1. [APPLICABILITY.] This section applies to 73.2 survey certification and enforcement activities by the 73.3 commissioner related to regular, expanded, or extended surveys 73.4 under Code of Federal Regulations, title 42, part 488. 73.5 Subd. 2. [STATEMENT OF DEFICIENCIES.] The commissioner 73.6 shall provide nursing facilities with draft statements of 73.7 deficiencies at the time of the survey exit process and shall 73.8 provide facilities with completed statements of deficiencies 73.9 within 15 working days of the exit process. 73.10 Subd. 3. [SURVEYOR NOTES.] The commissioner, upon the 73.11 request of a nursing facility, shall provide the facility with 73.12 copies of formal surveyor notes taken during the survey, with 73.13 the exception of the resident, family, and staff interviews, at 73.14 the time the completed statement of deficiency is provided to 73.15 the facility. The survey notes shall be redacted to protect the 73.16 confidentiality of individuals providing information to the 73.17 surveyors. A facility requesting formal surveyor notes must 73.18 agree to pay the commissioner for the cost of copying and 73.19 redacting. 73.20 Subd. 4. [POSTING OF STATEMENTS OF DEFICIENCIES.] The 73.21 commissioner, when posting statements of a nursing facility's 73.22 deficiencies on the agency Web site, must include in the posting 73.23 the facility's response to the citations. The Web site must 73.24 also include the dates upon which deficiencies are corrected and 73.25 the date upon which a facility is considered to be in compliance 73.26 with survey requirements. If deficiencies are under dispute, 73.27 the commissioner must note this on the Web site using a method 73.28 that clearly identifies for consumers which citations are under 73.29 dispute. 73.30 Subd. 5. [SURVEY REVISITS.] The commissioner shall conduct 73.31 survey revisits within 15 calendar days of the date by which 73.32 corrections will be completed, as specified by the provider in 73.33 its plan of correction, in cases where category 2 or category 3 73.34 remedies are in place. The commissioner may conduct survey 73.35 revisits by telephone or written communications for facilities 73.36 at which the highest scope and severity score for a violation 74.1 was level E or lower. 74.2 Subd. 6. [FAMILY COUNCILS.] Nursing facility family 74.3 councils shall be interviewed as part of the survey process and 74.4 invited to participate in the exit conference. 74.5 Sec. 5. Minnesota Statutes 2002, section 256.01, is 74.6 amended by adding a subdivision to read: 74.7 Subd. 21. [INTERAGENCY AGREEMENT WITH DEPARTMENT OF 74.8 HEALTH.] The commissioner of human services shall amend the 74.9 interagency agreement with the commissioner of health to certify 74.10 nursing facilities for participation in the medical assistance 74.11 program, to require the commissioner of health, as a condition 74.12 of the agreement, to comply beginning July 1, 2005, with action 74.13 plans included in the annual survey and certification quality 74.14 improvement report required under section 144A.10, subdivision 74.15 17. 74.16 Sec. 6. Minnesota Statutes 2002, section 256B.431, is 74.17 amended by adding a subdivision to read: 74.18 Subd. 40. [DESIGNATION OF AREAS TO RECEIVE METROPOLITAN 74.19 RATES.] (a) For rate years beginning on or after July 1, 2004, 74.20 and subject to paragraph (b), nursing facilities located in 74.21 areas designated as metropolitan areas by the federal Office of 74.22 Management and Budget using census bureau data shall be 74.23 considered metro, in order to: 74.24 (1) determine rate increases under this section, section 74.25 256B.434, or any other section; and 74.26 (2) establish nursing facility reimbursement rates for the 74.27 new nursing facility reimbursement system developed under Laws 74.28 2001, First Special Session chapter 9, article 5, section 35, as 74.29 amended by Laws 2002, chapter 220, article 14, section 19. 74.30 (b) Paragraph (a) applies only if designation as a metro 74.31 facility results in a level of reimbursement that is higher than 74.32 the level the facility would have received without application 74.33 of that paragraph. 74.34 [EFFECTIVE DATE.] This section is effective July 1, 2004. 74.35 Sec. 7. Minnesota Statutes 2002, section 256B.431, is 74.36 amended by adding a subdivision to read: 75.1 Subd. 41. [PROFESSIONAL LIABILITY COSTS.] (a) After the 75.2 computations in subdivision 40, the commissioner shall make 75.3 available to eligible nursing facilities reimbursed under this 75.4 section whose rates are not determined under Minnesota Rules, 75.5 part 9549.0057, and to eligible nursing facilities reimbursed 75.6 under section 256B.434, an adjustment to the nursing facility's 75.7 operating cost per diems for the rate year beginning July 1, 75.8 2004, to assist facilities in paying increased professional 75.9 liability insurance premiums greater than five percent. The per 75.10 diem adjustment shall be computed by the commissioner using the 75.11 information described in paragraph (b) and the method described 75.12 in paragraph (c). This adjustment is onetime and must not be 75.13 included in a facility's base when calculating operating cost 75.14 per diems for rate years beginning on or after July 1, 2005. 75.15 (b) A facility is eligible for an adjustment if the 75.16 facility experienced a rate of increase in premiums for 75.17 professional liability insurance of more than five percent 75.18 between calendar years 2002 and 2003, and provides to the 75.19 commissioner, in the form and manner specified by the 75.20 commissioner, information on the amount of premiums paid for 75.21 professional liability insurance for calendar years 2002 and 75.22 2003. The information must be delivered to the commissioner by 75.23 October 1, 2004, or postmarked by September 30, 2004. 75.24 Facilities that do not meet this deadline are ineligible for the 75.25 rate adjustment. 75.26 (c) The commissioner shall review the information timely 75.27 submitted under paragraph (b) to determine each facility's 75.28 allowable increased costs. For purposes of this requirement, 75.29 "allowable increased costs" is the dollar amount of the portion 75.30 of the percentage increase in a facility's professional 75.31 liability insurance between calendar years 2002 and 2003 that 75.32 exceeds five percent. Subject to the limitation in paragraph 75.33 (d), the commissioner shall compute a facility's rate adjustment 75.34 by dividing the allowable increased costs for that facility by 75.35 actual resident days from the most recent reporting year. 75.36 (d) If the rate increases are projected to increase the 76.1 state share of medical assistance costs by $1,700,000 or less, 76.2 the rate adjustments shall be implemented. If the rate 76.3 increases are projected to increase the state share of medical 76.4 assistance costs by more than $1,700,000, the commissioner shall 76.5 proportionally decrease each facility's rate adjustment to 76.6 levels that project to spending no more than $1,700,000. 76.7 Sec. 8. Minnesota Statutes 2003 Supplement, section 76.8 256B.434, subdivision 4, is amended to read: 76.9 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 76.10 nursing facilities which have their payment rates determined 76.11 under this section rather than section 256B.431, the 76.12 commissioner shall establish a rate under this subdivision. The 76.13 nursing facility must enter into a written contract with the 76.14 commissioner. 76.15 (b) A nursing facility's case mix payment rate for the 76.16 first rate year of a facility's contract under this section is 76.17 the payment rate the facility would have received under section 76.18 256B.431. 76.19 (c) A nursing facility's case mix payment rates for the 76.20 second and subsequent years of a facility's contract under this 76.21 section are the previous rate year's contract payment rates plus 76.22 an inflation adjustment and, for facilities reimbursed under 76.23 this section or section 256B.431, an adjustment to include the 76.24 cost of any increase in Health Department licensing fees for the 76.25 facility taking effect on or after July 1, 2001. The index for 76.26 the inflation adjustment must be based on the change in the 76.27 Consumer Price Index-All Items (United States City average) 76.28 (CPI-U) forecasted by the commissioner of finance's national 76.29 economic consultant, as forecasted in the fourth quarter of the 76.30 calendar year preceding the rate year. The inflation adjustment 76.31 must be based on the 12-month period from the midpoint of the 76.32 previous rate year to the midpoint of the rate year for which 76.33 the rate is being determined. For the rate years beginning on 76.34 July 1, 1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 76.35 2003,andJuly 1, 2004, July 1, 2005, and July 1, 2006, this 76.36 paragraph shall apply only to the property-related payment rate, 77.1 except that adjustments to include the cost of any increase in 77.2 Health Department licensing fees taking effect on or after July 77.3 1, 2001, shall be provided. In determining the amount of the 77.4 property-related payment rate adjustment under this paragraph, 77.5 the commissioner shall determine the proportion of the 77.6 facility's rates that are property-related based on the 77.7 facility's most recent cost report. 77.8 (d) The commissioner shall develop additional 77.9 incentive-based payments of up to five percent above the 77.10 standard contract rate for achieving outcomes specified in each 77.11 contract. The specified facility-specific outcomes must be 77.12 measurable and approved by the commissioner. The commissioner 77.13 may establish, for each contract, various levels of achievement 77.14 within an outcome. After the outcomes have been specified the 77.15 commissioner shall assign various levels of payment associated 77.16 with achieving the outcome. Any incentive-based payment cancels 77.17 if there is a termination of the contract. In establishing the 77.18 specified outcomes and related criteria the commissioner shall 77.19 consider the following state policy objectives: 77.20 (1) improved cost effectiveness and quality of life as 77.21 measured by improved clinical outcomes; 77.22 (2) successful diversion or discharge to community 77.23 alternatives; 77.24 (3) decreased acute care costs; 77.25 (4) improved consumer satisfaction; 77.26 (5) the achievement of quality; or 77.27 (6) any additional outcomes proposed by a nursing facility 77.28 that the commissioner finds desirable. 77.29 Sec. 9. [NURSING FACILITY SCHOLARSHIP PROGRAM.] 77.30 For the rate year beginning July 1, 2004, the amount 77.31 determined under Minnesota Statutes, section 256B.431, 77.32 subdivision 36, shall be removed from each nursing facility's 77.33 rate. 77.34 Sec. 10. [PROGRESS REPORT.] 77.35 The commissioner of health shall include in the December 77.36 15, 2004, quality improvement report required under section 2 a 78.1 progress report and implementation plan for the following 78.2 legislatively directed activities: 78.3 (1) an analysis of the frequency of defensive documentation 78.4 and a plan, developed in consultation with the nursing home 78.5 industry, consumers, unions representing nursing home employees, 78.6 and advocates, to minimize defensive documentation; 78.7 (2) the nursing home providers workgroup established under 78.8 Laws 2003, First Special Session chapter 14, article 13C, 78.9 section 3; and 78.10 (3) progress in implementing the independent informal 78.11 dispute resolution process required under Minnesota Statutes, 78.12 section 144A.10, subdivision 16. 78.13 Sec. 11. [RESUBMITTAL OF REQUESTS FOR FEDERAL WAIVERS AND 78.14 APPROVALS.] 78.15 (a) The commissioner of health shall seek federal waivers, 78.16 approvals, and law changes necessary to implement the 78.17 alternative nursing home survey process established under 78.18 Minnesota Statutes, section 144A.37. 78.19 (b) The commissioner of health shall seek changes in the 78.20 federal policy that mandates the imposition of federal sanctions 78.21 without providing an opportunity for a nursing facility to 78.22 correct deficiencies, solely as the result of previous 78.23 deficiencies issued to the nursing facility. 78.24 Sec. 12. [REPEALER; NURSING FACILITY SCHOLARSHIPS.] 78.25 Minnesota Statutes 2003 Supplement, section 256B.431, 78.26 subdivision 36, is repealed effective July 1, 2004. 78.27 ARTICLE 11 78.28 CONTINUING CARE 78.29 Section 1. Minnesota Statutes 2003 Supplement, section 78.30 252.27, subdivision 2a, is amended to read: 78.31 Subd. 2a. [CONTRIBUTION AMOUNT.] (a) The natural or 78.32 adoptive parents of a minor child, including a child determined 78.33 eligible for medical assistance without consideration of 78.34 parental income, must contribute monthly to the cost of 78.35 services, unless the child is married or has been married, 78.36 parental rights have been terminated, or the child's adoption is 79.1 subsidized according to section 259.67 or through title IV-E of 79.2 the Social Security Act. 79.3 (b) For households with adjusted gross income equal to or 79.4 greater than 100 percent of federal poverty guidelines, the 79.5 parental contribution shall be computed by applying the 79.6 following schedule of rates to the adjusted gross income of the 79.7 natural or adoptive parents: 79.8 (1) if the adjusted gross income is equal to or greater 79.9 than 100 percent of federal poverty guidelines and less than 175 79.10 percent of federal poverty guidelines, the parental contribution 79.11 is $4 per month; 79.12 (2) if the adjusted gross income is equal to or greater 79.13 than 175 percent of federal poverty guidelines and less than or 79.14 equal to375540 percent of federal poverty guidelines, the 79.15 parental contribution shall be determined using a sliding fee 79.16 scale established by the commissioner of human services which 79.17 begins at one percent of adjusted gross income at 175 percent of 79.18 federal poverty guidelines and increases to 7.5 percent of 79.19 adjusted gross income for those with adjusted gross income up to 79.20375540 percent of federal poverty guidelines; 79.21 (3) if the adjusted gross income is greater than375540 79.22 percent of federal poverty guidelines and less than 675 percent 79.23 of federal poverty guidelines, the parental contribution shall 79.24 be 7.5 percent of adjusted gross income; 79.25 (4) if the adjusted gross income is equal to or greater 79.26 than 675 percent of federal poverty guidelines and less than 975 79.27 percent of federal poverty guidelines, the parental contribution 79.28 shall be determined using a sliding fee scale established by the 79.29 commissioner of human services which begins at 7.5 percent of 79.30 adjusted gross income at 675 percent of federal poverty 79.31 guidelines and increases to ten percent of adjusted gross income 79.32 for those with adjusted gross income up to 975 percent of 79.33 federal poverty guidelines; and 79.34 (5) if the adjusted gross income is equal to or greater 79.35 than 975 percent of federal poverty guidelines, the parental 79.36 contribution shall be 12.5 percent of adjusted gross income. 80.1 If the child lives with the parent, the annual adjusted 80.2 gross income is reduced by $2,400 prior to calculating the 80.3 parental contribution. If the child resides in an institution 80.4 specified in section 256B.35, the parent is responsible for the 80.5 personal needs allowance specified under that section in 80.6 addition to the parental contribution determined under this 80.7 section. The parental contribution is reduced by any amount 80.8 required to be paid directly to the child pursuant to a court 80.9 order, but only if actually paid. 80.10 (c) The household size to be used in determining the amount 80.11 of contribution under paragraph (b) includes natural and 80.12 adoptive parents and their dependents under age 21, including 80.13 the child receiving services. Adjustments in the contribution 80.14 amount due to annual changes in the federal poverty guidelines 80.15 shall be implemented on the first day of July following 80.16 publication of the changes. 80.17 (d) For purposes of paragraph (b), "income" means the 80.18 adjusted gross income of the natural or adoptive parents 80.19 determined according to the previous year's federal tax form, 80.20 except, effective retroactive to July 1, 2003, taxable capital 80.21 gains to the extent the funds have been used to purchase a home 80.22 shall not be counted as income. 80.23 (e) The contribution shall be explained in writing to the 80.24 parents at the time eligibility for services is being 80.25 determined. The contribution shall be made on a monthly basis 80.26 effective with the first month in which the child receives 80.27 services. Annually upon redetermination or at termination of 80.28 eligibility, if the contribution exceeded the cost of services 80.29 provided, the local agency or the state shall reimburse that 80.30 excess amount to the parents, either by direct reimbursement if 80.31 the parent is no longer required to pay a contribution, or by a 80.32 reduction in or waiver of parental fees until the excess amount 80.33 is exhausted. 80.34 (f) The monthly contribution amount must be reviewed at 80.35 least every 12 months; when there is a change in household size; 80.36 and when there is a loss of or gain in income from one month to 81.1 another in excess of ten percent. The local agency shall mail a 81.2 written notice 30 days in advance of the effective date of a 81.3 change in the contribution amount. A decrease in the 81.4 contribution amount is effective in the month that the parent 81.5 verifies a reduction in income or change in household size. 81.6 (g) Parents of a minor child who do not live with each 81.7 other shall each pay the contribution required under paragraph 81.8 (a). An amount equal to the annual court-ordered child support 81.9 payment actually paid on behalf of the child receiving services 81.10 shall be deducted from the adjusted gross income of the parent 81.11 making the payment prior to calculating the parental 81.12 contribution under paragraph (b). 81.13 (h) The contribution under paragraph (b) shall be increased 81.14 by an additional five percent if the local agency determines 81.15 that insurance coverage is available but not obtained for the 81.16 child. For purposes of this section, "available" means the 81.17 insurance is a benefit of employment for a family member at an 81.18 annual cost of no more than five percent of the family's annual 81.19 income. For purposes of this section, "insurance" means health 81.20 and accident insurance coverage, enrollment in a nonprofit 81.21 health service plan, health maintenance organization, 81.22 self-insured plan, or preferred provider organization. 81.23 Parents who have more than one child receiving services 81.24 shall not be required to pay more than the amount for the child 81.25 with the highest expenditures. There shall be no resource 81.26 contribution from the parents. The parent shall not be required 81.27 to pay a contribution in excess of the cost of the services 81.28 provided to the child, not counting payments made to school 81.29 districts for education-related services. Notice of an increase 81.30 in fee payment must be given at least 30 days before the 81.31 increased fee is due. 81.32 (i) The contribution under paragraph (b) shall be reduced 81.33 by $300 per fiscal year if, in the 12 months prior to July 1: 81.34 (1) the parent applied for insurance for the child; 81.35 (2) the insurer denied insurance; 81.36 (3) the parents submitted a complaint or appeal, in writing 82.1 to the insurer, submitted a complaint or appeal, in writing, to 82.2 the commissioner of health or the commissioner of commerce, or 82.3 litigated the complaint or appeal; and 82.4 (4) as a result of the dispute, the insurer reversed its 82.5 decision and granted insurance. 82.6 For purposes of this section, "insurance" has the meaning 82.7 given in paragraph (h). 82.8 A parent who has requested a reduction in the contribution 82.9 amount under this paragraph shall submit proof in the form and 82.10 manner prescribed by the commissioner or county agency, 82.11 including, but not limited to, the insurer's denial of 82.12 insurance, the written letter or complaint of the parents, court 82.13 documents, and the written response of the insurer approving 82.14 insurance. The determinations of the commissioner or county 82.15 agency under this paragraph are not rules subject to chapter 14. 82.16 Sec. 2. Minnesota Statutes 2003 Supplement, section 82.17 256.019, subdivision 1, is amended to read: 82.18 Subdivision 1. [RETENTION RATES.] When an assistance 82.19 recovery amount is collected and posted by a county agency under 82.20 the provisions governing public assistance programs including 82.21 general assistance medical care, general assistance, and 82.22 Minnesota supplemental aid, the county may keep one-half of the 82.23 recovery made by the county agency using any method other than 82.24 recoupment. For medical assistance, if the recovery is made by 82.25 a county agency using any method other than recoupment, the 82.26 county may keep one-half of the nonfederal share of the 82.27 recovery. County agencies may retain 25 percent of a 82.28 MinnesotaCare assistance recovery collection when the recovery 82.29 is collected and posted by the county. 82.30 This does not apply to recoveries from medical providers or 82.31 to recoveries begun by the Department of Human Services' 82.32 Surveillance and Utilization Review Division, State Hospital 82.33 Collections Unit, and the Benefit Recoveries Division or, by the 82.34 attorney general's office, or child support collections. In the 82.35 food stamp or food support program, the nonfederal share of 82.36 recoveries in the federal tax offset program only will be 83.1 divided equally between the state agency and the involved county 83.2 agency. 83.3 Sec. 3. Minnesota Statutes 2002, section 256.9365, 83.4 subdivision 1, is amended to read: 83.5 Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of 83.6 human services shall establish a program to pay private health 83.7 plan premiums for persons who have contracted human 83.8 immunodeficiency virus (HIV) to enable them to continue coverage 83.9 under a group or individual health plan. If a person is 83.10 determined to be eligible under subdivision 2, the commissioner 83.11 shall pay the portion of the group plan premium for which the 83.12 individual is responsible, if the individual is responsible for 83.13 at least 50 percent of the cost of the premium, or pay the 83.14 individual plan premium. The commissioner shall not pay for 83.15 that portion of a premium that is attributable to other family 83.16 members or dependents. The commissioner shall establish 83.17 cost-sharing provisions for individuals participating in this 83.18 program that are consistent with provisions in section 256B.057, 83.19 subdivision 9, for employed persons with disabilities. 83.20 [EFFECTIVE DATE.] This section is effective July 1, 2004. 83.21 Sec. 4. Minnesota Statutes 2002, section 256B.0916, 83.22 subdivision 2, is amended to read: 83.23 Subd. 2. [DISTRIBUTION OF FUNDS; PARTNERSHIPS.] (a) 83.24 Beginning with fiscal year 2000, the commissioner shall 83.25 distribute all funding available for home and community-based 83.26 waiver services for persons with mental retardation or related 83.27 conditions to individual counties or to groups of counties that 83.28 form partnerships to jointly plan, administer, and authorize 83.29 funding for eligible individuals. The commissioner shall 83.30 encourage counties to form partnerships that have a sufficient 83.31 number of recipients and funding to adequately manage the risk 83.32 and maximize use of available resources. 83.33 (b) Counties must submit a request for funds and a plan for 83.34 administering the program as required by the commissioner. The 83.35 plan must identify the number of clients to be served, their 83.36 ages, and their priority listing based on: 84.1 (1) requirements in Minnesota Rules, part 9525.1880; 84.2 (2) unstable living situations due to the age or incapacity 84.3 of the primary caregiver; 84.4 (3) the need for services to avoid out-of-home placement of 84.5 children;and84.6 (4) the need to serve persons affected by private sector 84.7 ICF/MR closures; and 84.8 (5) the need to serve persons whose consumer support grant 84.9 exception amount was eliminated in 2004. 84.10 The plan must also identify changes made to improve services to 84.11 eligible persons and to improve program management. 84.12 (c) In allocating resources to counties, priority must be 84.13 given to groups of counties that form partnerships to jointly 84.14 plan, administer, and authorize funding for eligible individuals 84.15 and to counties determined by the commissioner to have 84.16 sufficient waiver capacity to maximize resource use. 84.17 (d) Within 30 days after receiving the county request for 84.18 funds and plans, the commissioner shall provide a written 84.19 response to the plan that includes the level of resources 84.20 available to serve additional persons. 84.21 (e) Counties are eligible to receive medical assistance 84.22 administrative reimbursement for administrative costs under 84.23 criteria established by the commissioner. 84.24 Sec. 5. Minnesota Statutes 2003 Supplement, section 84.25 256B.19, subdivision 1, is amended to read: 84.26 Subdivision 1. [DIVISION OF COST.] The state and county 84.27 share of medical assistance costs not paid by federal funds 84.28 shall be as follows: 84.29 (1) beginning January 1, 1992, 50 percent state funds and 84.30 50 percent county funds for the cost of placement of severely 84.31 emotionally disturbed children in regional treatment centers; 84.32 (2) beginning January 1, 2003, 80 percent state funds and 84.33 20 percent county funds for the costs of nursing facility 84.34 placements of persons with disabilities under the age of 65 that 84.35 have exceeded 90 days. This clause shall be subject to chapter 84.36 256G and shall not apply to placements in facilities not 85.1 certified to participate in medical assistance; and 85.2 (3)beginning July 1, 2004, 80 percent state funds and 2085.3percent county funds for the costs of placements that have85.4exceeded 90 days in intermediate care facilities for persons85.5with mental retardation or a related condition that have seven85.6or more beds. This provision includes pass-through payments85.7made under section 256B.5015; and85.8(4)beginning July 1, 2004, when state funds are used to 85.9 pay for a nursing facility placement due to the facility's 85.10 status as an institution for mental diseases (IMD), the county 85.11 shall pay 20 percent of the nonfederal share of costs that have 85.12 exceeded 90 days. This clause is subject to chapter 256G. 85.13 For counties that participate in a Medicaid demonstration 85.14 project under sections 256B.69 and 256B.71, the division of the 85.15 nonfederal share of medical assistance expenses for payments 85.16 made to prepaid health plans or for payments made to health 85.17 maintenance organizations in the form of prepaid capitation 85.18 payments, this division of medical assistance expenses shall be 85.19 95 percent by the state and five percent by the county of 85.20 financial responsibility. 85.21 In counties where prepaid health plans are under contract 85.22 to the commissioner to provide services to medical assistance 85.23 recipients, the cost of court ordered treatment ordered without 85.24 consulting the prepaid health plan that does not include 85.25 diagnostic evaluation, recommendation, and referral for 85.26 treatment by the prepaid health plan is the responsibility of 85.27 the county of financial responsibility. 85.28 [EFFECTIVE DATE.] This section is effective the day 85.29 following final enactment. 85.30 Sec. 6. Minnesota Statutes 2002, section 256B.49, is 85.31 amended by adding a subdivision to read: 85.32 Subd. 21. [REPORT.] The commissioner shall expand on the 85.33 annual report required under section 256B.0916, subdivision 7, 85.34 to include information on the county of residence and financial 85.35 responsibility, age, and major diagnoses for persons eligible 85.36 for the home and community-based waivers authorized under 86.1 subdivision 11 who are: 86.2 (1) receiving those services; 86.3 (2) screened and waiting for waiver services; and 86.4 (3) residing in nursing facilities and are under age 65. 86.5 Sec. 7. [ICF/MR PLAN.] 86.6 The commissioner of human services shall consult with 86.7 ICF/MR providers, advocates, counties, and consumer families to 86.8 develop recommendations and legislation concerning the future 86.9 services provided to people now served in ICFs/MR. The 86.10 recommendations shall be reported to the house and senate 86.11 committees with jurisdiction over health and human services 86.12 policy and finance issues by December 15, 2004. In preparing 86.13 the recommendations, the commissioner shall consider: 86.14 (1) consumer choice of services; 86.15 (2) consumers' service needs, including, but not limited 86.16 to, active treatment; 86.17 (3) the total cost of providing services in ICFs/MR and 86.18 alternative delivery systems; 86.19 (4) whether it is the policy of the state to maintain an 86.20 ICF/MR system and, if so, the recommendations shall define the 86.21 ICF/MR payment system to ensure adequate resources to meet 86.22 changing consumer needs, provide crisis and respite services, 86.23 and ensure stability when occupancy changes; and 86.24 (5) if alternative services are recommended to support 86.25 people now receiving services in an ICF/MR, the recommendations 86.26 shall ensure adequate financial resources are available to meet 86.27 the needs of ICF/MR recipients. 86.28 [EFFECTIVE DATE.] This section is effective the day 86.29 following final enactment. 86.30 Sec. 8. [CONSUMER DIRECTED COMMUNITY SUPPORT; INDEPENDENT 86.31 EVALUATION AND STAKEHOLDER PARTICIPATION.] 86.32 The commissioner shall consult with a group of interested 86.33 stakeholders including representatives of persons affected, 86.34 families, guardians, advocacy groups, counties, and providers in 86.35 conducting an independent evaluation of the new consumer 86.36 directed community support option under the home and 87.1 community-based waiver programs required by the federal Center 87.2 for Medicare and Medicaid Services. The independent evaluation 87.3 shall include, but not be limited to, an examination of whether 87.4 any current consumer directed option participants will have 87.5 their funding reduced so significantly that their health, 87.6 safety, and welfare at home will be jeopardized and whether 87.7 replacement services will cost more or be of lower quality than 87.8 their current consumer directed services. The preliminary 87.9 findings of the independent evaluation shall be provided to the 87.10 house and senate committees with jurisdiction over human 87.11 services policy and finance by February 15, 2005. 87.12 ARTICLE 12 87.13 DHS PROGRAM INTEGRITY AND ADMINISTRATION 87.14 Section 1. Minnesota Statutes 2002, section 256.01, is 87.15 amended by adding a subdivision to read: 87.16 Subd. 2a. [AUTHORIZATION FOR TEST SITES FOR HEALTH CARE 87.17 PROGRAMS.] In coordination with the development and 87.18 implementation of HealthMatch, an automated eligibility system 87.19 for medical assistance, general assistance medical care, and 87.20 MinnesotaCare, the commissioner, in cooperation with county 87.21 agencies, is authorized to test and compare a variety of 87.22 administrative models to demonstrate and evaluate outcomes of 87.23 integrating health care program business processes and points of 87.24 access. The models will be evaluated for ease of enrollment for 87.25 health care program applicants and recipients and administrative 87.26 efficiencies. Test sites will combine the administration of all 87.27 three programs and will include both local county and 87.28 centralized statewide customer assistance. The duration of each 87.29 approved test site shall be no more than one year. Based on the 87.30 evaluation, the commissioner shall recommend the most efficient 87.31 and effective administrative model for statewide implementation. 87.32 Sec. 2. Minnesota Statutes 2003 Supplement, section 87.33 256.046, subdivision 1, is amended to read: 87.34 Subdivision 1. [HEARING AUTHORITY.] A local agency must 87.35 initiate an administrative fraud disqualification hearing for 87.36 individuals, including child care providers caring for children 88.1 receiving child care assistance, accused of wrongfully obtaining 88.2 assistance or intentional program violations, in lieu of a 88.3 criminal action when it has not been pursued, in the aid to 88.4 families with dependent children program formerly codified in 88.5 sections 256.72 to 256.87, MFIP, child care assistance programs, 88.6 general assistance, family general assistance program formerly 88.7 codified in section 256D.05, subdivision 1, clause (15), 88.8 Minnesota supplemental aid, food stamp programs, general 88.9 assistance medical care, MinnesotaCare for adults without 88.10 children, and upon federal approval, all categories of medical 88.11 assistance and remaining categories of MinnesotaCare except for 88.12 children through age 18. The Department of Human Services, in 88.13 lieu of a local agency, may initiate an administrative fraud 88.14 disqualification hearing for individuals accused of wrongfully 88.15 obtaining assistance or intentional program violations, in lieu 88.16 of a criminal action when a criminal action has not been pursued 88.17 in the MinnesotaCare program for adults without children, and 88.18 upon federal approval, all remaining categories of 88.19 MinnesotaCare, except for children through age 18. The hearing 88.20 is subject to the requirements of section 256.045 and the 88.21 requirements in Code of Federal Regulations, title 7, section 88.22 273.16, for the food stamp program and title 45, section 88.23 235.112, as of September 30, 1995, for the cash grant, medical 88.24 care programs, and child care assistance under chapter 119B. 88.25 Sec. 3. Minnesota Statutes 2002, section 256B.02, 88.26 subdivision 12, is amended to read: 88.27 Subd. 12. "Third-party payer" means a person, entity, or 88.28 agency or government program that has a probable obligation to 88.29 pay all or part of the costs of a medical assistance recipient's 88.30 health services. Third-party payer includes an entity under 88.31 contract with the recipient to cover all or part of the 88.32 recipient's medical costs. 88.33 Sec. 4. Minnesota Statutes 2002, section 256B.04, 88.34 subdivision 14, is amended to read: 88.35 Subd. 14. [COMPETITIVE BIDDING.] When determined to be 88.36 effective, economical, and feasible, the commissioner may 89.1 utilize volume purchase through competitive bidding and 89.2 negotiation under the provisions of chapter 16C, to provide 89.3 items under the medical assistance program including but not 89.4 limited to the following: 89.5 (1) eyeglasses; 89.6 (2) oxygen. The commissioner shall provide for oxygen 89.7 needed in an emergency situation on a short-term basis, until 89.8 the vendor can obtain the necessary supply from the contract 89.9 dealer; 89.10 (3) hearing aids and supplies; and 89.11 (4) durable medical equipment, including but not limited to: 89.12 (a) hospital beds; 89.13 (b) commodes; 89.14 (c) glide-about chairs; 89.15 (d) patient lift apparatus; 89.16 (e) wheelchairs and accessories; 89.17 (f) oxygen administration equipment; 89.18 (g) respiratory therapy equipment; 89.19 (h) electronic diagnostic, therapeutic and life support 89.20 systems; 89.21 (5) special transportation services; and 89.22 (6) drugs. 89.23 Rate changes under chapters 256B, 256D, and 256L, do not 89.24 effect contract payments under this subdivision unless 89.25 specifically identified. 89.26 Sec. 5. Minnesota Statutes 2002, section 256B.056, 89.27 subdivision 5, is amended to read: 89.28 Subd. 5. [EXCESS INCOME.] (a) A person who has excess 89.29 income is eligible for medical assistance if the person has 89.30 expenses for medical care that are more than the amount of the 89.31 person's excess income, computed by deducting incurred medical 89.32 expenses from the excess income to reduce the excess to the 89.33 income standard specified in subdivision 5c. If a person is 89.34 ineligible for payment of long-term care services due to an 89.35 uncompensated transfer under section 256B.0595, only the current 89.36 month's long-term care expenses that are greater than the 90.1 average medical assistance rate for nursing facility services in 90.2 the state, along with other incurred medical expenses, may be 90.3 deducted from excess income. The person shall elect to have the 90.4 medical expenses deducted at the beginning of a one-month budget 90.5 period or at the beginning of a six-month budget period. 90.6 (b) The commissioner shall allow persons eligible for 90.7 assistance on a one-month spenddown basis under this subdivision 90.8 to elect to pay the monthly spenddown amount in advance of the 90.9 month of eligibility to the state agency in order to maintain 90.10 eligibility on a continuous basis. If the recipient does not 90.11 pay the spenddown amount on or before the20thlast business day 90.12 of the month, the recipient is ineligible for this option for 90.13 the following month. The local agency shall code the Medicaid 90.14 Management Information System (MMIS) to indicate that the 90.15 recipient has elected this option. The state agency shall 90.16 convey recipient eligibility information relative to the 90.17 collection of the spenddown to providers through the Electronic 90.18 Verification System (EVS). A recipient electing advance payment 90.19 must pay the state agency the monthly spenddown amounton or90.20 before noon on the20thlast business day of the month in order 90.21 to be eligible for this option in the following month. 90.22 [EFFECTIVE DATE.] The amendment to paragraph (b) is 90.23 effective upon implementation of HealthMatch. 90.24 Sec. 6. Minnesota Statutes 2002, section 256B.056, is 90.25 amended by adding a subdivision to read: 90.26 Subd. 8a. [NOTICE.] The state agency must be given notice 90.27 of monetary claims against a person, entity, or corporation that 90.28 may be liable to pay all or part of all of the cost of medical 90.29 care when the state agency has paid or becomes liable for the 90.30 cost of that care. Notice must be given as follows: 90.31 (a) An applicant for medical assistance shall notify the 90.32 state or local agency of any possible claims when the applicant 90.33 submits the application. A recipient of medical assistance 90.34 shall notify the state or local agency of any possible claims 90.35 when those claims arise. 90.36 (b) A person providing medical care services to a recipient 91.1 of medical assistance shall notify the state agency when the 91.2 person has reason to believe that a third party may be liable 91.3 for payment of the cost of medical care. 91.4 (c) A party to a claim that may be assigned to the state 91.5 agency under this section shall notify the state agency of its 91.6 potential assignment claim in writing at each of the following 91.7 stages of a claim: 91.8 (1) when a claim is filed; 91.9 (2) when an action is commenced; and 91.10 (3) when a claim is concluded by payment, award, judgment, 91.11 settlement, or otherwise. 91.12 Every party involved in any stage of a claim under this 91.13 subdivision is required to provide notice to the state agency at 91.14 that stage of the claim. However, when one of the parties to 91.15 the claim provides notice at that stage, every other party to 91.16 the claim is deemed to have provided the required notice for 91.17 that stage of the claim. If the required notice under this 91.18 paragraph is not provided to the state agency, all parties to 91.19 the claim are deemed to have failed to provide the required 91.20 notice. A party to the claim includes the injured person or the 91.21 person's legal representative, the plaintiff, the defendants, or 91.22 persons alleged to be responsible for compensating the injured 91.23 person or plaintiff, and any other party to the cause of action 91.24 or claim, regardless of whether the party knows the state agency 91.25 has a potential or actual assignment claim. 91.26 Sec. 7. Minnesota Statutes 2002, section 256B.056, is 91.27 amended by adding a subdivision to read: 91.28 Subd. 8b. [JOINDER OF STATE IN ACTIONS AGAINST THIRD 91.29 PARTIES.] Any medical assistance recipient or the recipient's 91.30 legal representative asserting a claim against a third party 91.31 potentially liable for all or part of the recipient's medical 91.32 costs shall join the state agency as a party to the claim. 91.33 Sec. 8. Minnesota Statutes 2002, section 256B.056, is 91.34 amended by adding a subdivision to read: 91.35 Subd. 8c. [SETTLEMENT.] Pursuant to United States Code, 91.36 title 42, section 1396k(b), no judgment, award, or settlement of 92.1 any action or claim by or on behalf of a medical assistance 92.2 recipient to recover damages from a third party potentially 92.3 liable for all or part of the recipient's medical costs shall be 92.4 acceded to or satisfied by the recipient or the recipient's 92.5 legal representative or approved by the court without granting 92.6 the state agency first recovery from the liable third party to 92.7 the full extent of its medical expenditures, minus pro rata 92.8 costs and attorney fees, regardless of whether the recipient has 92.9 been fully compensated. 92.10 Sec. 9. Minnesota Statutes 2003 Supplement, section 92.11 256B.0595, subdivision 2, is amended to read: 92.12 Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any 92.13 uncompensated transfer occurring on or before August 10, 1993, 92.14 the number of months of ineligibility for long-term care 92.15 services shall be the lesser of 30 months, or the uncompensated 92.16 transfer amount divided by the average medical assistance rate 92.17 for nursing facility services in the state in effect on the date 92.18 of application. The amount used to calculate the average 92.19 medical assistance payment rate shall be adjusted each July 1 to 92.20 reflect payment rates for the previous calendar year. The 92.21 period of ineligibility begins with the month in which the 92.22 assets were transferred. If the transfer was not reported to 92.23 the local agency at the time of application, and the applicant 92.24 received long-term care services during what would have been the 92.25 period of ineligibility if the transfer had been reported, a 92.26 cause of action exists against the transferee for the cost of 92.27 long-term care services provided during the period of 92.28 ineligibility, or for the uncompensated amount of the transfer, 92.29 whichever is less. The action may be brought by the state or 92.30 the local agency responsible for providing medical assistance 92.31 under chapter 256G. The uncompensated transfer amount is the 92.32 fair market value of the asset at the time it was given away, 92.33 sold, or disposed of, less the amount of compensation received. 92.34 (b) For uncompensated transfers made after August 10, 1993, 92.35 the number of months of ineligibility for long-term care 92.36 services shall be the total uncompensated value of the resources 93.1 transferred divided by the average medical assistance rate for 93.2 nursing facility services in the state in effect on the date of 93.3 application. The amount used to calculate the average medical 93.4 assistance payment rate shall be adjusted each July 1 to reflect 93.5 payment rates for the previous calendar year. The period of 93.6 ineligibility begins with the first day of the month after the 93.7 month in which the assets were transferred except that if one or 93.8 more uncompensated transfers are made during a period of 93.9 ineligibility, the total assets transferred during the 93.10 ineligibility period shall be combined and a penalty period 93.11 calculated to begin on the first day of the month after the 93.12 month in which the first uncompensated transfer was made. If 93.13 the transfer was reported to the local agency after the date 93.14 advance notice of a period of ineligibility that affects the 93.15 next month could be provided to the recipient and the recipient 93.16 received medical assistance services, or the transfer was not 93.17 reported to the local agency,and the applicant or recipient 93.18 received medical assistance services during what would have been 93.19 the period of ineligibility if the transfer had been reported, a 93.20 cause of action exists against the transferee for the cost of 93.21 medical assistance services provided during the period of 93.22 ineligibility, or for the uncompensated amount of the transfer, 93.23 whichever is less. The action may be brought by the state or 93.24 the local agency responsible for providing medical assistance 93.25 under chapter 256G. The uncompensated transfer amount is the 93.26 fair market value of the asset at the time it was given away, 93.27 sold, or disposed of, less the amount of compensation received. 93.28 Effective for transfers made on or after March 1, 1996, 93.29 involving persons who apply for medical assistance on or after 93.30 April 13, 1996, no cause of action exists for a transfer unless: 93.31 (1) the transferee knew or should have known that the 93.32 transfer was being made by a person who was a resident of a 93.33 long-term care facility or was receiving that level of care in 93.34 the community at the time of the transfer; 93.35 (2) the transferee knew or should have known that the 93.36 transfer was being made to assist the person to qualify for or 94.1 retain medical assistance eligibility; or 94.2 (3) the transferee actively solicited the transfer with 94.3 intent to assist the person to qualify for or retain eligibility 94.4 for medical assistance. 94.5 (c) If a calculation of a penalty period results in a 94.6 partial month, payments for long-term care services shall be 94.7 reduced in an amount equal to the fraction, except that in 94.8 calculating the value of uncompensated transfers, if the total 94.9 value of all uncompensated transfers made in a month not 94.10 included in an existing penalty period does not exceed $200, 94.11 then such transfers shall be disregarded for each month prior to 94.12 the month of application for or during receipt of medical 94.13 assistance. 94.14 [EFFECTIVE DATE.] This section is effective for transfers 94.15 occurring on or after July 1, 2004. 94.16 Sec. 10. Minnesota Statutes 2003 Supplement, section 94.17 256D.03, subdivision 3, is amended to read: 94.18 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 94.19 (a) General assistance medical care may be paid for any person 94.20 who is not eligible for medical assistance under chapter 256B, 94.21 including eligibility for medical assistance based on a 94.22 spenddown of excess income according to section 256B.056, 94.23 subdivision 5, or MinnesotaCare as defined in paragraph (b), 94.24 except as provided in paragraph (c), and: 94.25 (1) who is receiving assistance under section 256D.05, 94.26 except for families with children who are eligible under 94.27 Minnesota family investment program (MFIP), or who is having a 94.28 payment made on the person's behalf under sections 256I.01 to 94.29 256I.06; or 94.30 (2) who is a resident of Minnesota; and 94.31 (i) who has gross countable income not in excess of 75 94.32 percent of the federal poverty guidelines for the family size, 94.33 using a six-month budget period and whose equity in assets is 94.34 not in excess of $1,000 per assistance unit. Exempt assets, the 94.35 reduction of excess assets, and the waiver of excess assets must 94.36 conform to the medical assistance program in section 256B.056, 95.1 subdivision 3, with the following exception: the maximum amount 95.2 of undistributed funds in a trust that could be distributed to 95.3 or on behalf of the beneficiary by the trustee, assuming the 95.4 full exercise of the trustee's discretion under the terms of the 95.5 trust, must be applied toward the asset maximum; or 95.6 (ii) who has gross countable income above 75 percent of the 95.7 federal poverty guidelines but not in excess of 175 percent of 95.8 the federal poverty guidelines for the family size, using a 95.9 six-month budget period, whose equity in assets is not in excess 95.10 of the limits in section 256B.056, subdivision 3c, and who 95.11 applies during an inpatient hospitalization. 95.12 (b) General assistance medical care may not be paid for 95.13 applicants or recipients who meet all eligibility requirements 95.14 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 95.15 are adults with dependent children under 21 whose gross family 95.16 income is equal to or less than 275 percent of the federal 95.17 poverty guidelines. 95.18 (c) For applications received on or after October 1, 2003, 95.19 eligibility may begin no earlier than the date of application. 95.20 For individuals eligible under paragraph (a), clause (2), item 95.21 (i), a redetermination of eligibility must occur every 12 95.22 months. Individuals are eligible under paragraph (a), clause 95.23 (2), item (ii), only during inpatient hospitalization but may 95.24 reapply if there is a subsequent period of inpatient 95.25 hospitalization. Beginning January 1, 2000, Minnesota health 95.26 care program applications completed by recipients and applicants 95.27 who are persons described in paragraph (b), may be returned to 95.28 the county agency to be forwarded to the Department of Human 95.29 Services or sent directly to the Department of Human Services 95.30 for enrollment in MinnesotaCare. If all other eligibility 95.31 requirements of this subdivision are met, eligibility for 95.32 general assistance medical care shall be available in any month 95.33 during which a MinnesotaCare eligibility determination and 95.34 enrollment are pending. Upon notification of eligibility for 95.35 MinnesotaCare, notice of termination for eligibility for general 95.36 assistance medical care shall be sent to an applicant or 96.1 recipient. If all other eligibility requirements of this 96.2 subdivision are met, eligibility for general assistance medical 96.3 care shall be available until enrollment in MinnesotaCare 96.4 subject to the provisions of paragraph (e). 96.5 (d) The date of an initial Minnesota health care program 96.6 application necessary to begin a determination of eligibility 96.7 shall be the date the applicant has provided a name, address, 96.8 and Social Security number, signed and dated, to the county 96.9 agency or the Department of Human Services. If the applicant is 96.10 unable to provide a name, address, Social Security number, and 96.11 signature when health care is delivered due to a medical 96.12 condition or disability, a health care provider may act on an 96.13 applicant's behalf to establish the date of an initial Minnesota 96.14 health care program application by providing the county agency 96.15 or Department of Human Services with provider identification and 96.16 a temporary unique identifier for the applicant. The applicant 96.17 must complete the remainder of the application and provide 96.18 necessary verification before eligibility can be determined. 96.19 The county agency must assist the applicant in obtaining 96.20 verification if necessary. 96.21 (e) County agencies are authorized to use all automated 96.22 databases containing information regarding recipients' or 96.23 applicants' income in order to determine eligibility for general 96.24 assistance medical care or MinnesotaCare. Such use shall be 96.25 considered sufficient in order to determine eligibility and 96.26 premium payments by the county agency. 96.27 (f) General assistance medical care is not available for a 96.28 person in a correctional facility unless the person is detained 96.29 by law for less than one year in a county correctional or 96.30 detention facility as a person accused or convicted of a crime, 96.31 or admitted as an inpatient to a hospital on a criminal hold 96.32 order, and the person is a recipient of general assistance 96.33 medical care at the time the person is detained by law or 96.34 admitted on a criminal hold order and as long as the person 96.35 continues to meet other eligibility requirements of this 96.36 subdivision. 97.1 (g) General assistance medical care is not available for 97.2 applicants or recipients who do not cooperate with the county 97.3 agency to meet the requirements of medical assistance. 97.4 (h) In determining the amount of assets of an individual 97.5eligible under paragraph (a), clause (2), item (i), there shall 97.6 be included any asset or interest in an asset, including an 97.7 asset excluded under paragraph (a), that was given away, sold, 97.8 or disposed of for less than fair market value within the 60 97.9 months preceding application for general assistance medical care 97.10 or during the period of eligibility. Any transfer described in 97.11 this paragraph shall be presumed to have been for the purpose of 97.12 establishing eligibility for general assistance medical care, 97.13 unless the individual furnishes convincing evidence to establish 97.14 that the transaction was exclusively for another purpose. For 97.15 purposes of this paragraph, the value of the asset or interest 97.16 shall be the fair market value at the time it was given away, 97.17 sold, or disposed of, less the amount of compensation received. 97.18 For any uncompensated transfer, the number of months of 97.19 ineligibility, including partial months, shall be calculated by 97.20 dividing the uncompensated transfer amount by the average 97.21 monthly per person payment made by the medical assistance 97.22 program to skilled nursing facilities for the previous calendar 97.23 year. The individual shall remain ineligible until this fixed 97.24 period has expired. The period of ineligibility may exceed 30 97.25 months, and a reapplication for benefits after 30 months from 97.26 the date of the transfer shall not result in eligibility unless 97.27 and until the period of ineligibility has expired. The period 97.28 of ineligibility begins in the month the transfer was reported 97.29 to the county agency, or if the transfer was not reported, the 97.30 month in which the county agency discovered the transfer, 97.31 whichever comes first. For applicants, the period of 97.32 ineligibility begins on the date of the first approved 97.33 application. 97.34 (i) When determining eligibility for any state benefits 97.35 under this subdivision, the income and resources of all 97.36 noncitizens shall be deemed to include their sponsor's income 98.1 and resources as defined in the Personal Responsibility and Work 98.2 Opportunity Reconciliation Act of 1996, title IV, Public Law 98.3 104-193, sections 421 and 422, and subsequently set out in 98.4 federal rules. 98.5 (j) Undocumented noncitizens and nonimmigrants are 98.6 ineligible for general assistance medical care, except an 98.7 individual eligible under paragraph (a), clause (4), remains 98.8 eligible through September 30, 2003. For purposes of this 98.9 subdivision, a nonimmigrant is an individual in one or more of 98.10 the classes listed in United States Code, title 8, section 98.11 1101(a)(15), and an undocumented noncitizen is an individual who 98.12 resides in the United States without the approval or 98.13 acquiescence of the Immigration and Naturalization Service. 98.14 (k) Notwithstanding any other provision of law, a 98.15 noncitizen who is ineligible for medical assistance due to the 98.16 deeming of a sponsor's income and resources, is ineligible for 98.17 general assistance medical care. 98.18 (l) Effective July 1, 2003, general assistance medical care 98.19 emergency services end. 98.20 Sec. 11. Minnesota Statutes 2002, section 256D.045, is 98.21 amended to read: 98.22 256D.045 [SOCIAL SECURITY NUMBER REQUIRED.] 98.23 To be eligible for general assistance under sections 98.24 256D.01 to 256D.21, an individual must provide the individual's 98.25 Social Security number to the county agency or submit proof that 98.26 an application has been made. An individual who refuses to 98.27 provide a Social Security number because of a well-established 98.28 religious objection as described in Code of Federal Regulations, 98.29 title 42, section 435.910, may be eligible for general 98.30 assistance medical care under section 256D.03. The provisions 98.31 of this section do not apply to the determination of eligibility 98.32 for emergency general assistance under section 256D.06, 98.33 subdivision 2. This provision applies to eligible children 98.34 under the age of 18 effective July 1, 1997. 98.35 Sec. 12. Minnesota Statutes 2002, section 256L.04, is 98.36 amended by adding a subdivision to read: 99.1 Subd. 1a. [SOCIAL SECURITY NUMBER REQUIRED.] (a) 99.2 Individuals and families applying for MinnesotaCare coverage 99.3 must provide a Social Security number. 99.4 (b) The commissioner shall not deny eligibility to an 99.5 otherwise eligible applicant who has applied for a Social 99.6 Security number and is awaiting issuance of that Social Security 99.7 number. 99.8 (c) Newborns enrolled under section 256L.05, subdivision 3, 99.9 are exempt from the requirements of this subdivision. 99.10 (d) Individuals who refuse to provide a Social Security 99.11 number because of well-established religious objections are 99.12 exempt from this subdivision. The term "well-established 99.13 religious objections" has the meaning given in Code of Federal 99.14 Regulations, title 42, section 435.910. 99.15 Sec. 13. Minnesota Statutes 2002, section 256L.04, 99.16 subdivision 2, is amended to read: 99.17 Subd. 2. [COOPERATION IN ESTABLISHING THIRD-PARTY 99.18 LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 99.19 eligible for MinnesotaCare, individuals and families must 99.20 cooperate with the state agency to identify potentially liable 99.21 third-party payers and assist the state in obtaining third-party 99.22 payments. "Cooperation" includes, but is not limited to, 99.23 complying with the notice and settlement requirements in section 99.24 256B.056, subdivisions 8a and 8c, identifying any third party 99.25 who may be liable for care and services provided under 99.26 MinnesotaCare to the enrollee, providing relevant information to 99.27 assist the state in pursuing a potentially liable third party, 99.28 and completing forms necessary to recover third-party payments. 99.29 (b) A parent, guardian, relative caretaker, or child 99.30 enrolled in the MinnesotaCare program must cooperate with the 99.31 Department of Human Services and the local agency in 99.32 establishing the paternity of an enrolled child and in obtaining 99.33 medical care support and payments for the child and any other 99.34 person for whom the person can legally assign rights, in 99.35 accordance with applicable laws and rules governing the medical 99.36 assistance program. A child shall not be ineligible for or 100.1 disenrolled from the MinnesotaCare program solely because the 100.2 child's parent, relative caretaker, or guardian fails to 100.3 cooperate in establishing paternity or obtaining medical support. 100.4 Sec. 14. Minnesota Statutes 2002, section 256L.04, is 100.5 amended by adding a subdivision to read: 100.6 Subd. 2a. [APPLICATIONS FOR OTHER BENEFITS.] To be 100.7 eligible for MinnesotaCare, individuals and families must take 100.8 all necessary steps to obtain other benefits as described in 100.9 Code of Federal Regulations, title 42, section 435.608. 100.10 Applicants and enrollees must apply for other benefits within 30 100.11 days. 100.12 Sec. 15. Minnesota Statutes 2002, section 549.02, is 100.13 amended by adding a subdivision to read: 100.14 Subd. 3. [LIMITATION.] Notwithstanding subdivisions 1 and 100.15 2, where the state agency is joined as a party according to 100.16 section 256B.056, subdivision 8b, or brings an independent 100.17 action to enforce the agency's rights under section 256B.056, 100.18 the state agency shall not be liable for costs to any prevailing 100.19 defendant. 100.20 Sec. 16. Minnesota Statutes 2002, section 549.04, is 100.21 amended to read: 100.22 549.04 [DISBURSEMENTS; TAXATION AND ALLOWANCE.] 100.23 Subdivision 1. [GENERALLY.] In every action in a district 100.24 court, the prevailing party, including any public employee who 100.25 prevails in an action for wrongfully denied or withheld 100.26 employment benefits or rights, shall be allowed reasonable 100.27 disbursements paid or incurred, including fees and mileage paid 100.28 for service of process by the sheriff or by a private person. 100.29 Subd. 2. [LIMITATION.] Notwithstanding subdivision 1, 100.30 where the state agency is joined as a party according to section 100.31 256B.056, subdivision 8b, or brings an independent action to 100.32 enforce its rights under section 256B.056, the state agency 100.33 shall not be liable for disbursements to any prevailing 100.34 defendant. 100.35 ARTICLE 13 100.36 MISCELLANEOUS 101.1 Section 1. Minnesota Statutes 2002, section 144.148, is 101.2 amended by adding a subdivision to read: 101.3 Subd. 9. [STATUS OF PREVIOUS AWARDS.] The commissioner 101.4 must regard grants or loans awarded to eligible rural hospitals 101.5 before August 1, 1999, as grants subject to the conditions of 101.6 this section and not subject to repayment as loans under 101.7 Minnesota Statutes 1998, section 144.148. 101.8 Sec. 2. Minnesota Statutes 2002, section 144D.025, is 101.9 amended to read: 101.10 144D.025 [OPTIONAL REGISTRATION.] 101.11 An establishment that meets all the requirements of this 101.12 chapter except that fewer than 80 percent of the adult residents 101.13 are age 55 or older, or a supportive housing establishment 101.14 developed and funded in whole or in part with funds provided 101.15 specifically as part of the plan to end long-term homelessness 101.16 required under Laws 2003, chapter 128, article 15, section 9, 101.17 may,at its option, register as a housing with services 101.18 establishment. 101.19 Sec. 3. [145.417] [FAMILY PLANNING GRANT FUNDS NOT USED TO 101.20 SUBSIDIZE ABORTION SERVICES.] 101.21 Subdivision 1. [DEFINITIONS.] (a) For purposes of this 101.22 section, the following definitions apply. 101.23 (b) "Abortion" means the use or prescription of any 101.24 instrument, medicine, drug, or any other substance or device to 101.25 intentionally terminate the pregnancy of a female known to be 101.26 pregnant, with an intention other than to prevent the death of 101.27 the female, increase the probability of a live birth, preserve 101.28 the life or health of the child after live birth, or remove a 101.29 dead fetus. 101.30 (c) "Family planning grant funds" means funds distributed 101.31 through the maternal and child health block grant program under 101.32 sections 145.881 to 145.889, the family planning special 101.33 projects grant program under section 145.925, the program to 101.34 eliminate health disparities under section 145.928, or any other 101.35 state grant program whose funds are or may be used to fund 101.36 family planning services. 102.1 (d) "Family planning services" means preconception services 102.2 that limit or enhance fertility, including methods of 102.3 contraception, the management of infertility, preconception 102.4 counseling, education, and general reproductive health care. 102.5 (e) "Nondirective counseling" means providing patients with: 102.6 (1) a list of health care providers and social service 102.7 providers that provide prenatal care, childbirth care, infant 102.8 care, foster care, adoption services, alternatives to abortion, 102.9 or abortion services; and 102.10 (2) nondirective, nonmarketing information regarding such 102.11 providers. 102.12 (f) "Public advocacy" means engaging in one or more of the 102.13 following: 102.14 (1) regularly engaging in efforts to encourage the passage 102.15 or defeat of legislation pertaining to the continued or expanded 102.16 availability of abortion; 102.17 (2) publicly endorsing or recommending the election or 102.18 defeat of a candidate for public office based on the candidate's 102.19 position on the legality of abortion; or 102.20 (3) engaging in civil litigation against a unit of 102.21 government as a plaintiff seeking to enjoin or otherwise 102.22 prohibit enforcement of a statute, ordinance, rule, or 102.23 regulation pertaining to abortion. 102.24 Subd. 2. [USES OF FAMILY PLANNING GRANT FUNDS.] No family 102.25 planning grant funds may be: 102.26 (1) expended to directly or indirectly subsidize abortion 102.27 services or administrative expenses; or 102.28 (2) paid or granted to an organization or an affiliate of 102.29 an organization that provides abortion services, unless the 102.30 affiliate is independent as provided in subdivision 4. 102.31 Subd. 3. [ORGANIZATIONS RECEIVING FAMILY PLANNING GRANT 102.32 FUNDS.] An organization that receives family planning grant 102.33 funds: 102.34 (1) may provide nondirective counseling relating to 102.35 pregnancy, but may not directly refer patients who seek abortion 102.36 services to any organization that provides abortion services, 103.1 including an independent affiliate of the organization receiving 103.2 family planning grant funds. For purposes of this clause, an 103.3 affiliate is independent if it satisfies the criteria in 103.4 subdivision 4, paragraph (a); 103.5 (2) may not display or distribute marketing materials about 103.6 abortion services to patients; 103.7 (3) may not engage in public advocacy promoting the 103.8 legality or accessibility of abortion; and 103.9 (4) must be separately incorporated from any affiliated 103.10 organization that provides abortion services. 103.11 Subd. 4. [INDEPENDENT AFFILIATES THAT PROVIDE ABORTION 103.12 SERVICES.] (a) To ensure that the state does not lend its 103.13 imprimatur to abortion services and to ensure that an 103.14 organization that provides abortion services does not receive a 103.15 direct or indirect economic or marketing benefit from family 103.16 planning grant funds, an organization that receives family 103.17 planning grant funds may not be affiliated with an organization 103.18 that provides abortion services unless the organizations are 103.19 independent from each other. To be independent, the 103.20 organizations may not share any of the following: 103.21 (1) the same or a similar name; 103.22 (2) medical facilities or nonmedical facilities, including, 103.23 but not limited to, business offices, treatment rooms, 103.24 consultation rooms, examination rooms, and waiting rooms; 103.25 (3) expenses; 103.26 (4) employee wages or salaries; or 103.27 (5) equipment or supplies, including, but not limited to, 103.28 computers, telephone systems, telecommunications equipment, and 103.29 office supplies. 103.30 (b) An organization that receives family planning grant 103.31 funds and that is affiliated with an organization that provides 103.32 abortion services must maintain financial records that 103.33 demonstrate strict compliance with this subdivision and that 103.34 demonstrate that its independent affiliate that provides 103.35 abortion services receives no direct or indirect economic or 103.36 marketing benefit from the family planning grant funds. 104.1 Subd. 5. [INDEPENDENT AUDIT.] When an organization applies 104.2 for family planning grant funds, the organization must submit 104.3 with the grant application a copy of the organization's most 104.4 recent independent audit to ensure the organization is in 104.5 compliance with this section. The independent audit must have 104.6 been conducted no more than two years before the organization 104.7 submits its grant application. 104.8 Subd. 6. [ORGANIZATIONS RECEIVING TITLE X FUNDS.] Nothing 104.9 in this section requires an organization that receives federal 104.10 funds under Title X of the Public Health Service Act to refrain 104.11 from performing any service that is required to be provided as a 104.12 condition of receiving Title X funds, as specified by the 104.13 provisions of Title X or the Title X program guidelines for 104.14 project grants for family planning services published by the 104.15 United States Department of Health and Human Services. 104.16 Subd. 7. [SEVERABILITY.] If any one or more provision, 104.17 word, phrase, clause, sentence, or subdivision of this section, 104.18 or the application to any person or circumstance, is found to be 104.19 unconstitutional, it is declared to be severable and the balance 104.20 of this section shall remain effective notwithstanding such 104.21 unconstitutionality. The legislature hereby declares that it 104.22 would have passed this section, and each provision, word, 104.23 phrase, clause, sentence, or subdivision of it, regardless of 104.24 the fact that any one or more provision, word, phrase, clause, 104.25 sentence, or subdivision be declared unconstitutional. 104.26 Sec. 4. Minnesota Statutes 2003 Supplement, section 104.27 246B.04, as amended by Laws 2004, chapter 134, section 2, is 104.28 amended to read: 104.29 246B.04 [RULES; EVALUATION.] 104.30 Subdivision 1. [PROGRAM RULES AND EVALUATION.] The 104.31 commissioner of human services shall adopt rules to govern the 104.32 operation, maintenance, and licensure of secure treatment 104.33 facilities operated by the Minnesota sex offender program or at 104.34 any other facility operated by the commissioner, for a person 104.35 committed as a sexual psychopathic personality or a sexually 104.36 dangerous person. The commissioner shall establish an 105.1 evaluation process to measure outcomes and behavioral changes as 105.2 a result of treatment compared with incarceration without 105.3 treatment, to determine the value, if any, of treatment in 105.4 protecting the public. 105.5 Subd. 2. [BAN ON OBSCENE MATERIAL OR PORNOGRAPHIC WORK.] 105.6 The commissioner shall prohibit persons civilly committed as 105.7 sexual psychopathic personalities or sexually dangerous persons 105.8 undersectionsMinnesota Statutes 1978, section 246.43 and 105.9 section 253B.185 from having or receiving material that is 105.10 obscene as defined under section 617.241, subdivision 1, 105.11 material that depicts sexual conduct as defined under section 105.12 617.241, subdivision 1, or pornographic work as defined under 105.13 section 617.246, subdivision 1, while receiving services in any 105.14 secure treatment facilities operated by the Minnesota sex 105.15 offender program or any other facilities operated by the 105.16 commissioner. 105.17 Sec. 5. Minnesota Statutes 2002, section 256.01, is 105.18 amended by adding a subdivision to read: 105.19 Subd. 14a. [SINGLE BENEFIT DEMONSTRATION.] The 105.20 commissioner may conduct a demonstration program under a federal 105.21 Title IV-E waiver to demonstrate the impact of a single benefit 105.22 level on the rate of permanency for children in long-term foster 105.23 care through transfer of permanent legal custody or adoption. 105.24 The commissioner of human services is authorized to waive 105.25 enforcement of related statutory program requirements, rules, 105.26 and standards in one or more counties for the purpose of this 105.27 demonstration. The demonstration must comply with the 105.28 requirements of the secretary of health and human services under 105.29 federal waiver and be cost neutral to the state. 105.30 The commissioner may measure cost neutrality to the state 105.31 by the same mechanism approved by the secretary of health and 105.32 human services to measure federal cost neutrality. The 105.33 commissioner is authorized to accept and administer county funds 105.34 and to transfer state and federal funds among the affected 105.35 programs as necessary for the conduct of the demonstration. 105.36 Sec. 6. Minnesota Statutes 2003 Supplement, section 106.1 256D.44, subdivision 5, is amended to read: 106.2 Subd. 5. [SPECIAL NEEDS.] In addition to the state 106.3 standards of assistance established in subdivisions 1 to 4, 106.4 payments are allowed for the following special needs of 106.5 recipients of Minnesota supplemental aid who are not residents 106.6 of a nursing home, a regional treatment center, or a group 106.7 residential housing facility. 106.8 (a) The county agency shall pay a monthly allowance for 106.9 medically prescribed diets if the cost of those additional 106.10 dietary needs cannot be met through some other maintenance 106.11 benefit. The need for special diets or dietary items must be 106.12 prescribed by a licensed physician. Costs for special diets 106.13 shall be determined as percentages of the allotment for a 106.14 one-person household under the thrifty food plan as defined by 106.15 the United States Department of Agriculture. The types of diets 106.16 and the percentages of the thrifty food plan that are covered 106.17 are as follows: 106.18 (1) high protein diet, at least 80 grams daily, 25 percent 106.19 of thrifty food plan; 106.20 (2) controlled protein diet, 40 to 60 grams and requires 106.21 special products, 100 percent of thrifty food plan; 106.22 (3) controlled protein diet, less than 40 grams and 106.23 requires special products, 125 percent of thrifty food plan; 106.24 (4) low cholesterol diet, 25 percent of thrifty food plan; 106.25 (5) high residue diet, 20 percent of thrifty food plan; 106.26 (6) pregnancy and lactation diet, 35 percent of thrifty 106.27 food plan; 106.28 (7) gluten-free diet, 25 percent of thrifty food plan; 106.29 (8) lactose-free diet, 25 percent of thrifty food plan; 106.30 (9) antidumping diet, 15 percent of thrifty food plan; 106.31 (10) hypoglycemic diet, 15 percent of thrifty food plan; or 106.32 (11) ketogenic diet, 25 percent of thrifty food plan. 106.33 (b) Payment for nonrecurring special needs must be allowed 106.34 for necessary home repairs or necessary repairs or replacement 106.35 of household furniture and appliances using the payment standard 106.36 of the AFDC program in effect on July 16, 1996, for these 107.1 expenses, as long as other funding sources are not available. 107.2 (c) A fee for guardian or conservator service is allowed at 107.3 a reasonable rate negotiated by the county or approved by the 107.4 court. This rate shall not exceed five percent of the 107.5 assistance unit's gross monthly income up to a maximum of $100 107.6 per month. If the guardian or conservator is a member of the 107.7 county agency staff, no fee is allowed. 107.8 (d) The county agency shall continue to pay a monthly 107.9 allowance of $68 for restaurant meals for a person who was 107.10 receiving a restaurant meal allowance on June 1, 1990, and who 107.11 eats two or more meals in a restaurant daily. The allowance 107.12 must continue until the person has not received Minnesota 107.13 supplemental aid for one full calendar month or until the 107.14 person's living arrangement changes and the person no longer 107.15 meets the criteria for the restaurant meal allowance, whichever 107.16 occurs first. 107.17 (e) A fee of ten percent of the recipient's gross income or 107.18 $25, whichever is less, is allowed for representative payee 107.19 services provided by an agency that meets the requirements under 107.20 SSI regulations to charge a fee for representative payee 107.21 services. This special need is available to all recipients of 107.22 Minnesota supplemental aid regardless of their living 107.23 arrangement. 107.24 (f) Notwithstanding the language in this subdivision, an 107.25 amount equal to the maximum allotment authorized by the federal 107.26 Food Stamp Program for a single individual which is in effect on 107.27 the first day of January of the previous year will be added to 107.28 the standards of assistance established in subdivisions 1 to 4 107.29 for individuals under the age of 65 who are relocating from an 107.30 institution or a Department of Human Services Rule 36 facility, 107.31 and who are shelter needy. An eligible individual who receives 107.32 this benefit prior to age 65 may continue to receive the benefit 107.33 after the age of 65. 107.34 "Shelter needy" means that the assistance unit incurs 107.35 monthly shelter costs that exceed 40 percent of the assistance 107.36 unit's gross income before the application of this special needs 108.1 standard. "Gross income" for the purposes of this section is 108.2 the applicant's or recipient's income as defined in section 108.3 256D.35, subdivision 10, or the standard specified in 108.4 subdivision 3, whichever is greater. A recipient of a federal 108.5 or state housing subsidy, that limits shelter costs to a 108.6 percentage of gross income, shall not be considered shelter 108.7 needy for purposes of this paragraph. 108.8 Sec. 7. Minnesota Statutes 2002, section 256I.04, 108.9 subdivision 2a, is amended to read: 108.10 Subd. 2a. [LICENSE REQUIRED.] A county agency may not 108.11 enter into an agreement with an establishment to provide group 108.12 residential housing unless: 108.13 (1) the establishment is licensed by the Department of 108.14 Health as a hotel and restaurant; a board and lodging 108.15 establishment; a residential care home; a boarding care home 108.16 before March 1, 1985; or a supervised living facility, and the 108.17 service provider for residents of the facility is licensed under 108.18 chapter 245A. However, an establishment licensed by the 108.19 Department of Health to provide lodging need not also be 108.20 licensed to provide board if meals are being supplied to 108.21 residents under a contract with a food vendor who is licensed by 108.22 the Department of Health; 108.23 (2) the residence is licensed by the commissioner of human 108.24 services under Minnesota Rules, parts 9555.5050 to 9555.6265, or 108.25 certified by a county human services agency prior to July 1, 108.26 1992, using the standards under Minnesota Rules, parts 9555.5050 108.27 to 9555.6265; or 108.28 (3) the establishment is registered under chapter 144D and 108.29 provides three meals a day,except thator is an establishment 108.30 voluntarily registered under section 144D.025 as a supportive 108.31 housing establishment. An establishment voluntarily registered 108.32 under section 144D.025, other than a supportive housing 108.33 establishment under this subdivision, is not eligiblefor an108.34agreementto provide group residential housing. 108.35 The requirements underclauses (1), (2), and (3)this 108.36 subdivision do not apply to establishments exempt from state 109.1 licensure because they are located on Indian reservations and 109.2 subject to tribal health and safety requirements. 109.3 Sec. 8. Minnesota Statutes 2003 Supplement, section 109.4 295.50, subdivision 9b, is amended to read: 109.5 Subd. 9b. [PATIENT SERVICES.] (a) "Patient services" means 109.6 inpatient and outpatient services and other goods and services 109.7 provided by hospitals, surgical centers, or health care 109.8 providers. They include the following health care goods and 109.9 services provided to a patient or consumer: 109.10 (1) bed and board; 109.11 (2) nursing services and other related services; 109.12 (3) use of hospitals, surgical centers, or health care 109.13 provider facilities; 109.14 (4) medical social services; 109.15 (5) drugs, biologicals, supplies, appliances, and 109.16 equipment; 109.17 (6) other diagnostic or therapeutic items or services; 109.18 (7) medical or surgical services; 109.19 (8) items and services furnished to ambulatory patients not 109.20 requiring emergency care; and 109.21 (9) emergency services; and109.22(10) covered services listed in section 256B.0625 and in109.23Minnesota Rules, parts 9505.0170 to 9505.0475. 109.24 (b) "Patient services" does not include: 109.25 (1) services provided to nursing homes licensed under 109.26 chapter 144A; 109.27 (2) examinations for purposes of utilization reviews, 109.28 insurance claims or eligibility, litigation, and employment, 109.29 including reviews of medical records for those purposes; 109.30 (3) services provided to and by community residential 109.31 mental health facilities licensed under Minnesota Rules, parts 109.32 9520.0500 to 9520.0690, and to and by children's residential 109.33 treatment programs licensed under Minnesota Rules, parts 109.34 9545.0905 to 9545.1125, or its successor; 109.35 (4) services provided to and by community support programs 109.36 and family community support programs approved under Minnesota 110.1 Rules, parts 9535.1700 to 9535.1760 or certified as mental 110.2 health rehabilitative services under chapter 256B; 110.3 (5) services provided to and by community mental health 110.4 centers as defined in section 245.62, subdivision 2; 110.5 (6) services provided to and by assisted living programs 110.6 and congregate housing programs;and110.7 (7) hospice care services.; 110.8 (8) home and community-based waivered services under 110.9 sections 256B.0915, 256B.49, 256B.491, and 256B.501; 110.10 (9) targeted case management services under sections 110.11 256B.0621; 256B.0625, subdivisions 20, 20a, 33, and 44; and 110.12 256B.094; and 110.13 (10) services provided to the following: supervised living 110.14 facilities for persons with mental retardation or related 110.15 conditions licensed under Minnesota Rules, parts 4665.0100 to 110.16 4665.9900; housing with services establishments required to be 110.17 registered under chapter 144D; board and lodging establishments 110.18 providing only custodial services that are licensed under 110.19 chapter 157 and registered under section 157.17 to provide 110.20 supportive services or health supervision services; adult foster 110.21 homes as defined in Minnesota Rules, part 9555.5105; day 110.22 training and habilitation services for adults with mental 110.23 retardation and related conditions as defined in section 252.41, 110.24 subdivision 3; boarding care homes as defined in Minnesota 110.25 Rules, part 4655.0100; adult day care centers as defined in 110.26 Minnesota Rules, part 9555.9600; and home health agencies as 110.27 defined in Minnesota Rules, part 9505.0175, subpart 15. 110.28 [EFFECTIVE DATE.] This section is effective retroactively 110.29 from January 1, 2004. 110.30 Sec. 9. Minnesota Statutes 2003 Supplement, section 110.31 295.53, subdivision 1, is amended to read: 110.32 Subdivision 1. [EXEMPTIONS.] (a) The following payments 110.33 are excluded from the gross revenues subject to the hospital, 110.34 surgical center, or health care provider taxes under sections 110.35 295.50 to 295.59: 110.36 (1) payments received for services provided under the 111.1 Medicare program, including payments received from the 111.2 government, and organizations governed by sections 1833 and 1876 111.3 of title XVIII of the federal Social Security Act, United States 111.4 Code, title 42, section 1395, and enrollee deductibles, 111.5 coinsurance, and co-payments, whether paid by the Medicare 111.6 enrollee or by a Medicare supplemental coverage as defined in 111.7 section 62A.011, subdivision 3, clause (10), or by Medicaid 111.8 payments under title XIX of the federal Social Security Act. 111.9 Payments for services not covered by Medicare are taxable; 111.10 (2) payments received for home health care services; 111.11 (3) payments received from hospitals or surgical centers 111.12 for goods and services on which liability for tax is imposed 111.13 under section 295.52 or the source of funds for the payment is 111.14 exempt under clause (1), (7), (10), or (14); 111.15 (4) payments received from health care providers for goods 111.16 and services on which liability for tax is imposed under this 111.17 chapter or the source of funds for the payment is exempt under 111.18 clause (1), (7), (10), or (14); 111.19 (5) amounts paid for legend drugs, other than nutritional 111.20 products, to a wholesale drug distributor who is subject to tax 111.21 under section 295.52, subdivision 3, reduced by reimbursements 111.22 received for legend drugs otherwise exempt under this chapter; 111.23 (6) payments received by a health care provider or the 111.24 wholly owned subsidiary of a health care provider for care 111.25 provided outside Minnesota; 111.26 (7) payments received from the chemical dependency fund 111.27 under chapter 254B; 111.28 (8) payments received in the nature of charitable donations 111.29 that are not designated for providing patient services to a 111.30 specific individual or group; 111.31 (9) payments received for providing patient services 111.32 incurred through a formal program of health care research 111.33 conducted in conformity with federal regulations governing 111.34 research on human subjects. Payments received from patients or 111.35 from other persons paying on behalf of the patients are subject 111.36 to tax; 112.1 (10) payments received from any governmental agency for 112.2 services benefiting the public, not including payments made by 112.3 the government in its capacity as an employer or insurer or 112.4 payments made by the government for services provided under 112.5medical assistance,general assistance medical care,orthe 112.6 MinnesotaCare program, or the medical assistance program 112.7 governed by title XIX of the federal Social Security Act, United 112.8 States Code, title 42, sections 1396 to 1396v; 112.9 (11) government payments received bya regional treatment112.10centerthe commissioner of human services for state-operated 112.11 services; 112.12 (12) payments received by a health care provider for 112.13 hearing aids and related equipment or prescription eyewear 112.14 delivered outside of Minnesota; 112.15 (13) payments received by an educational institution from 112.16 student tuition, student activity fees, health care service 112.17 fees, government appropriations, donations, or grants, and for 112.18 services identified in and provided under an individualized 112.19 education plan as defined in section 256B.0625 or Code of 112.20 Federal Regulations, chapter 34, section 300340(a). Fee for 112.21 service payments and payments for extended coverage are taxable; 112.22 and 112.23 (14) payments received under the federal Employees Health 112.24 Benefits Act, United States Code, title 5, section 8909(f), as 112.25 amended by the Omnibus Reconciliation Act of 1990. 112.26 (b) Payments received by wholesale drug distributors for 112.27 legend drugs sold directly to veterinarians or veterinary bulk 112.28 purchasing organizations are excluded from the gross revenues 112.29 subject to the wholesale drug distributor tax under sections 112.30 295.50 to 295.59. 112.31 [EFFECTIVE DATE.] This section is effective retroactively 112.32 from January 1, 2004. 112.33 ARTICLE 14 112.34 HEALTH AND HUMAN SERVICES FORECAST ADJUSTMENTS 112.35 Section 1. Laws 2003, First Special Session chapter 14, 112.36 article 13C, section 1, is amended to read: 113.1 Section 1. [HEALTH AND HUMAN SERVICESAPPROPRIATIONSFORECAST 113.2 ADJUSTMENTS.] 113.3 The sums shown in the columns marked "APPROPRIATIONS" are 113.4 appropriated from the general fund, or any other fund named, to 113.5 the agencies and for the purposes specified in the sections of 113.6 this article, to be available for the fiscal years indicated for 113.7 each purpose. The figures "2004" and "2005" where used in this 113.8 article, mean that the appropriation or appropriations listed 113.9 under them are available for the fiscal year ending June 30, 113.10 2004, or June 30, 2005, respectively. Where a dollar amount 113.11 appears in parentheses, it means a reduction of an appropriation. 113.12 SUMMARY BY FUND 113.13 BIENNIAL 113.14 2004 2005 TOTAL 113.15 General$3,765,212,000$3,727,319,000$7,492,531,000113.16 $3,500,860,000 $3,746,520,000 $7,247,380,000 113.17 State Government 113.18 Special Revenue 45,337,000 45,104,000 90,441,000 113.19 Health Care 113.20 Access294,090,000308,525,000602,615,000113.21 280,060,000 308,609,000 588,669,000 113.22 Federal TANF261,552,000270,364,000531,916,000113.23 276,425,000 276,363,000 552,788,000 113.24 Lottery Prize 113.25 Fund 1,556,000 1,556,000 3,112,000 113.26 Special Revenue 3,340,000 3,340,000 6,680,000 113.27 TOTAL$4,371,087,000$4,356,208,000$8,727,295,000113.28 $4,107,578,000 $4,381,492,000 $8,489,070,000 113.29 APPROPRIATIONS 113.30 Available for the Year 113.31 Ending June 30 113.32 2004 2005 113.33 Sec. 2. Laws 2003, First Special Session chapter 14, 113.34 article 13C, section 2, subdivision 1, is amended to read: 113.35 Subdivision 1. Total 113.36 Appropriation$4,111,558,000$4,110,496,000113.37 $3,848,049,000 $4,135,780,000 113.38 Summary by Fund 113.39 General3,566,163,0003,541,854,000113.40 3,301,811,000 3,561,055,000 114.1 State Government 114.2 Special Revenue 534,000 534,000 114.3 Health Care 114.4 Access287,753,000302,188,000114.5 273,723,000 302,272,000 114.6 Federal TANF255,552,000264,364,000114.7 270,425,000 270,363,000 114.8 Lottery Cash 114.9 Flow 1,556,000 1,556,000 114.10 [FEDERAL CONTINGENCY APPROPRIATION.] 114.11 (a)Any additionalFederal Medicaid 114.12 funds made available under title IV of 114.13 the federal Jobs and Growth Tax Relief 114.14 Reconciliation Act of 2003 are 114.15 appropriated to the commissioner of 114.16 human services for use in the state's 114.17 medical assistance and MinnesotaCare 114.18 programs. The commissioners of human 114.19 services and finance shall report to 114.20 the legislative advisory committee on 114.21 the additional federal Medicaid 114.22 matching funds that will be available 114.23 to the state. 114.24 (b)Contingent uponBecause of the 114.25 availability of these funds, the 114.26 following policies shall become 114.27 effectiveand necessary funds are114.28appropriated for those purposes: 114.29 (1) medical assistance and 114.30 MinnesotaCare eligibility and local 114.31 financial participation changes 114.32 provided for in this act may be 114.33 implemented prior to September 2, 2003, 114.34 or may be delayed as necessary to 114.35 maximize the use of federal funds 114.36 received under title IV of the Jobs and 114.37 Growth Tax Relief Reconciliation Act of 114.38 2003; 114.39 (2) the aggregate cap on the services 114.40 identified in Minnesota Statutes, 114.41 section 256L.035, paragraph (a), clause 114.42 (3), shall be increased from $2,000 to 114.43 $5,000. This increase shall expire at 114.44 the end of fiscal year 2007. Funds may 114.45 be transferred from the general fund to 114.46 the health care access fund as 114.47 necessary to implement this provision; 114.48 and 114.49 (3) the following payment shifts shall 114.50 not be implemented: 114.51 (i) MFIP payment shift found in 114.52 subdivision 11; 114.53 (ii) the county payment shift found in 114.54 subdivision 1; and 114.55 (iii) the delay in medical assistance 114.56 and general assistance medical care 114.57 fee-for-service payments found in 114.58 subdivision 6. 115.1 (c) Notwithstanding section 14, 115.2 paragraphs (a) and (b) shall expire 115.3 June 30, 2007. 115.4 [RECEIPTS FOR SYSTEMS PROJECTS.] 115.5 Appropriations and federal receipts for 115.6 information system projects for MAXIS, 115.7 PRISM, MMIS, and SSIS must be deposited 115.8 in the state system account authorized 115.9 in Minnesota Statutes, section 115.10 256.014. Money appropriated for 115.11 computer projects approved by the 115.12 Minnesota office of technology, funded 115.13 by the legislature, and approved by the 115.14 commissioner of finance may be 115.15 transferred from one project to another 115.16 and from development to operations as 115.17 the commissioner of human services 115.18 considers necessary. Any unexpended 115.19 balance in the appropriation for these 115.20 projects does not cancel but is 115.21 available for ongoing development and 115.22 operations. 115.23 [GIFTS.] Notwithstanding Minnesota 115.24 Statutes, chapter 7, the commissioner 115.25 may accept on behalf of the state 115.26 additional funding from sources other 115.27 than state funds for the purpose of 115.28 financing the cost of assistance 115.29 program grants or nongrant 115.30 administration. All additional funding 115.31 is appropriated to the commissioner for 115.32 use as designated by the grantor of 115.33 funding. 115.34 [SYSTEMS CONTINUITY.] In the event of 115.35 disruption of technical systems or 115.36 computer operations, the commissioner 115.37 may use available grant appropriations 115.38 to ensure continuity of payments for 115.39 maintaining the health, safety, and 115.40 well-being of clients served by 115.41 programs administered by the department 115.42 of human services. Grant funds must be 115.43 used in a manner consistent with the 115.44 original intent of the appropriation. 115.45 [NONFEDERAL SHARE TRANSFERS.] The 115.46 nonfederal share of activities for 115.47 which federal administrative 115.48 reimbursement is appropriated to the 115.49 commissioner may be transferred to the 115.50 special revenue fund. 115.51 [TANF FUNDS APPROPRIATED TO OTHER 115.52 ENTITIES.] Any expenditures from the 115.53 TANF block grant shall be expended in 115.54 accordance with the requirements and 115.55 limitations of part A of title IV of 115.56 the Social Security Act, as amended, 115.57 and any other applicable federal 115.58 requirement or limitation. Prior to 115.59 any expenditure of these funds, the 115.60 commissioner shall assure that funds 115.61 are expended in compliance with the 115.62 requirements and limitations of federal 115.63 law and that any reporting requirements 115.64 of federal law are met. It shall be 115.65 the responsibility of any entity to 115.66 which these funds are appropriated to 116.1 implement a memorandum of understanding 116.2 with the commissioner that provides the 116.3 necessary assurance of compliance prior 116.4 to any expenditure of funds. The 116.5 commissioner shall receipt TANF funds 116.6 appropriated to other state agencies 116.7 and coordinate all related interagency 116.8 accounting transactions necessary to 116.9 implement these appropriations. 116.10 Unexpended TANF funds appropriated to 116.11 any state, local, or nonprofit entity 116.12 cancel at the end of the state fiscal 116.13 year unless appropriating language 116.14 permits otherwise. 116.15 [TANF FUNDS TRANSFERRED TO OTHER 116.16 FEDERAL GRANTS.] The commissioner must 116.17 authorize transfers from TANF to other 116.18 federal block grants so that funds are 116.19 available to meet the annual 116.20 expenditure needs as appropriated. 116.21 Transfers may be authorized prior to 116.22 the expenditure year with the agreement 116.23 of the receiving entity. Transferred 116.24 funds must be expended in the year for 116.25 which the funds were appropriated 116.26 unless appropriation language permits 116.27 otherwise. In accelerating transfer 116.28 authorizations, the commissioner must 116.29 aim to preserve the future potential 116.30 transfer capacity from TANF to other 116.31 block grants. 116.32 [TANF MAINTENANCE OF EFFORT.] (a) In 116.33 order to meet the basic maintenance of 116.34 effort (MOE) requirements of the TANF 116.35 block grant specified under Code of 116.36 Federal Regulations, title 45, section 116.37 263.1, the commissioner may only report 116.38 nonfederal money expended for allowable 116.39 activities listed in the following 116.40 clauses as TANF/MOE expenditures: 116.41 (1) MFIP cash, diversionary work 116.42 program, and food assistance benefits 116.43 under Minnesota Statutes, chapter 256J; 116.44 (2) the child care assistance programs 116.45 under Minnesota Statutes, sections 116.46 119B.03 and 119B.05, and county child 116.47 care administrative costs under 116.48 Minnesota Statutes, section 119B.15; 116.49 (3) state and county MFIP 116.50 administrative costs under Minnesota 116.51 Statutes, chapters 256J and 256K; 116.52 (4) state, county, and tribal MFIP 116.53 employment services under Minnesota 116.54 Statutes, chapters 256J and 256K; 116.55 (5) expenditures made on behalf of 116.56 noncitizen MFIP recipients who qualify 116.57 for the medical assistance without 116.58 federal financial participation program 116.59 under Minnesota Statutes, section 116.60 256B.06, subdivision 4, paragraphs (d), 116.61 (e), and (j); and 116.62 (6) qualifying working family credit 116.63 expenditures under Minnesota Statutes, 117.1 section 290.0671. 117.2 (b) The commissioner shall ensure that 117.3 sufficient qualified nonfederal 117.4 expenditures are made each year to meet 117.5 the state's TANF/MOE requirements. For 117.6 the activities listed in paragraph (a), 117.7 clauses (2) to (6), the commissioner 117.8 may only report expenditures that are 117.9 excluded from the definition of 117.10 assistance under Code of Federal 117.11 Regulations, title 45, section 260.31. 117.12 (c) By August 31 of each year, the 117.13 commissioner shall make a preliminary 117.14 calculation to determine the likelihood 117.15 that the state will meet its annual 117.16 federal work participation requirement 117.17 under Code of Federal Regulations, 117.18 title 45, sections 261.21 and 261.23, 117.19 after adjustment for any caseload 117.20 reduction credit under Code of Federal 117.21 Regulations, title 45, section 261.41. 117.22 If the commissioner determines that the 117.23 state will meet its federal work 117.24 participation rate for the federal 117.25 fiscal year ending that September, the 117.26 commissioner may reduce the expenditure 117.27 under paragraph (a), clause (1), to the 117.28 extent allowed under Code of Federal 117.29 Regulations, title 45, section 117.30 263.1(a)(2). 117.31 (d) For fiscal years beginning with 117.32 state fiscal year 2003, the 117.33 commissioner shall assure that the 117.34 maintenance of effort used by the 117.35 commissioner of finance for the 117.36 February and November forecasts 117.37 required under Minnesota Statutes, 117.38 section 16A.103, contains expenditures 117.39 under paragraph (a), clause (1), equal 117.40 to at least 25 percent of the total 117.41 required under Code of Federal 117.42 Regulations, title 45, section 263.1. 117.43 (e) If nonfederal expenditures for the 117.44 programs and purposes listed in 117.45 paragraph (a) are insufficient to meet 117.46 the state's TANF/MOE requirements, the 117.47 commissioner shall recommend additional 117.48 allowable sources of nonfederal 117.49 expenditures to the legislature, if the 117.50 legislature is or will be in session to 117.51 take action to specify additional 117.52 sources of nonfederal expenditures for 117.53 TANF/MOE before a federal penalty is 117.54 imposed. The commissioner shall 117.55 otherwise provide notice to the 117.56 legislative commission on planning and 117.57 fiscal policy under paragraph (g). 117.58 (f) If the commissioner uses authority 117.59 granted under section 11, or similar 117.60 authority granted by a subsequent 117.61 legislature, to meet the state's 117.62 TANF/MOE requirement in a reporting 117.63 period, the commissioner shall inform 117.64 the chairs of the appropriate 117.65 legislative committees about all 117.66 transfers made under that authority for 118.1 this purpose. 118.2 (g) If the commissioner determines that 118.3 nonfederal expenditures under paragraph 118.4 (a) are insufficient to meet TANF/MOE 118.5 expenditure requirements, and if the 118.6 legislature is not or will not be in 118.7 session to take timely action to avoid 118.8 a federal penalty, the commissioner may 118.9 report nonfederal expenditures from 118.10 other allowable sources as TANF/MOE 118.11 expenditures after the requirements of 118.12 this paragraph are met. The 118.13 commissioner may report nonfederal 118.14 expenditures in addition to those 118.15 specified under paragraph (a) as 118.16 nonfederal TANF/MOE expenditures, but 118.17 only ten days after the commissioner of 118.18 finance has first submitted the 118.19 commissioner's recommendations for 118.20 additional allowable sources of 118.21 nonfederal TANF/MOE expenditures to the 118.22 members of the legislative commission 118.23 on planning and fiscal policy for their 118.24 review. 118.25 (h) The commissioner of finance shall 118.26 not incorporate any changes in federal 118.27 TANF expenditures or nonfederal 118.28 expenditures for TANF/MOE that may 118.29 result from reporting additional 118.30 allowable sources of nonfederal 118.31 TANF/MOE expenditures under the interim 118.32 procedures in paragraph (g) into the 118.33 February or November forecasts required 118.34 under Minnesota Statutes, section 118.35 16A.103, unless the commissioner of 118.36 finance has approved the additional 118.37 sources of expenditures under paragraph 118.38 (g). 118.39 (i) Minnesota Statutes, section 118.40 256.011, subdivision 3, which requires 118.41 that federal grants or aids secured or 118.42 obtained under that subdivision be used 118.43 to reduce any direct appropriations 118.44 provided by law, do not apply if the 118.45 grants or aids are federal TANF funds. 118.46 (j) Notwithstanding section 14, 118.47 paragraph (a), clauses (1) to (6), and 118.48 paragraphs (b) to (j) expire June 30, 118.49 2007. 118.50 [WORKING FAMILY CREDIT EXPENDITURES AS 118.51 TANF MOE.] The commissioner may claim 118.52 as TANF maintenance of effort up to the 118.53 following amounts of working family 118.54 credit expenditures for the following 118.55 fiscal years: 118.56 (1) fiscal year 2004, $7,013,000; 118.57 (2) fiscal year 2005, $25,133,000; 118.58 (3) fiscal year 2006, $6,942,000; and 118.59 (4) fiscal year 2007, $6,707,000. 118.60 [FISCAL YEAR 2003 APPROPRIATIONS 118.61 CARRYFORWARD.] Effective the day 119.1 following final enactment, 119.2 notwithstanding Minnesota Statutes, 119.3 section 16A.28, or any other law to the 119.4 contrary, state agencies and 119.5 constitutional offices may carry 119.6 forward unexpended and unencumbered 119.7 nongrant operating balances from fiscal 119.8 year 2003 general fund appropriations 119.9 into fiscal year 2004 to offset general 119.10 budget reductions. 119.11 [TRANSFER OF GRANT BALANCES.] Effective 119.12 the day following final enactment, the 119.13 commissioner of human services, with 119.14 the approval of the commissioner of 119.15 finance and after notification of the 119.16 chair of the senate health, human 119.17 services and corrections budget 119.18 division and the chair of the house of 119.19 representatives health and human 119.20 services finance committee, may 119.21 transfer unencumbered appropriation 119.22 balances for the biennium ending June 119.23 30, 2003, in fiscal year 2003 among the 119.24 MFIP, MFIP child care assistance under 119.25 Minnesota Statutes, section 119B.05, 119.26 general assistance, general assistance 119.27 medical care, medical assistance, 119.28 Minnesota supplemental aid, and group 119.29 residential housing programs, and the 119.30 entitlement portion of the chemical 119.31 dependency consolidated treatment fund, 119.32 and between fiscal years of the 119.33 biennium. 119.34 [TANF APPROPRIATION CANCELLATION.] 119.35 Notwithstanding the provisions of Laws 119.36 2000, chapter 488, article 1, section 119.37 16, any prior appropriations of TANF 119.38 funds to the department of trade and 119.39 economic development or to the job 119.40 skills partnership board or any 119.41 transfers of TANF funds from another 119.42 agency to the department of trade and 119.43 economic development or to the job 119.44 skills partnership board are not 119.45 available until expended, and if 119.46 unobligated as of June 30, 2003, these 119.47 appropriations or transfers shall 119.48 cancel to the TANF fund. 119.49 [SHIFT COUNTY PAYMENT.] The 119.50 commissioner shall make up to 100 119.51 percent of the calendar year 2005 119.52 payments to counties for developmental 119.53 disabilities semi-independent living 119.54 services grants, developmental 119.55 disabilities family support grants, and 119.56 adult mental health grants from fiscal 119.57 year 2006 appropriations. This is a 119.58 onetime payment shift. Calendar year 119.59 2006 and future payments for these 119.60 grants are not affected by this shift. 119.61 This provision expires June 30, 2006. 119.62 [CAPITATION RATE INCREASE.] Of the 119.63 health care access fund appropriations 119.64 to the University of Minnesota in the 119.65 higher education omnibus appropriation 119.66 bill, $2,157,000 in fiscal year 2004 119.67 and $2,157,000 in fiscal year 2005 are 120.1 to be used to increase the capitation 120.2 payments under Minnesota Statutes, 120.3 section 256B.69. Notwithstanding the 120.4 provisions of section 14, this 120.5 provision shall not expire. 120.6 Sec. 3. Laws 2003, First Special Session chapter 14, 120.7 article 13C, section 2, subdivision 3, is amended to read: 120.8 Subd. 3. Revenue and Pass-Through 120.9 Federal TANF55,855,00053,315,000120.10 56,643,000 57,275,000 120.11 [TANF TRANSFER TO SOCIAL SERVICES BLOCK 120.12 GRANT.] $3,137,000 in fiscal year 2005 120.13 is appropriated to the commissioner for 120.14 the purposes of providing services for 120.15 families with children whose incomes 120.16 are at or below 200 percent of the 120.17 federal poverty guidelines. The 120.18 commissioner shall authorize a 120.19 sufficient transfer of funds from the 120.20 state's federal TANF block grant to the 120.21 state's federal social services block 120.22 grant to meet this appropriation. The 120.23 funds shall be distributed to counties 120.24 for the children and community services 120.25 grant according to the formula for the 120.26 state appropriations in Minnesota 120.27 Statutes, chapter 256M. 120.28 [TANF FUNDS FOR FISCAL YEAR 2006 AND 120.29 FISCAL YEAR 2007 REFINANCING.] 120.30$12,692,000$6,692,000 in fiscal year 120.31 2006 and$9,192,000$3,192,000 in 120.32 fiscal year 2007 in TANF funds are 120.33 available to the commissioner to 120.34 replace general funds in the amount 120.35 of$12,692,000$6,692,000 in fiscal 120.36 year 2006 and$9,192,000$3,192,000 in 120.37 fiscal year 2007 in expenditures that 120.38 may be counted toward TANF maintenance 120.39 of effort requirements or as an 120.40 allowable TANF expenditure. 120.41 [ADJUSTMENTS IN TANF TRANSFER TO CHILD 120.42 CARE AND DEVELOPMENT FUND.] Transfers 120.43 of TANF to the child care development 120.44 fund for the purposes of MFIP child 120.45 care assistance shall be reduced by 120.46 $116,000 in fiscal year 2004 and shall 120.47 be increased by $1,976,000 in fiscal 120.48 year 2005. 120.49 Sec. 4. Laws 2003, First Special Session chapter 14, 120.50 article 13C, section 2, subdivision 6, is amended to read: 120.51 Subd. 6. Basic Health Care Grants 120.52 Summary by Fund 120.53 General1,499,941,0001,533,016,000120.54 1,290,454,000 1,475,996,000 120.55 Health Care Access268,151,000282,605,000121.1 254,121,000 282,689,000 121.2 [UPDATING FEDERAL POVERTY GUIDELINES.] 121.3 Annual updates to the federal poverty 121.4 guidelines are effective each July 1, 121.5 following publication by the United 121.6 States Department of Health and Human 121.7 Services for health care programs under 121.8 Minnesota Statutes, chapters 256, 256B, 121.9 256D, and 256L. 121.10 The amounts that may be spent from this 121.11 appropriation for each purpose are as 121.12 follows: 121.13 (a) MinnesotaCare Grants 121.14 Health Care Access267,401,000281,855,000121.15 253,371,000 281,939,000 121.16 [MINNESOTACARE FEDERAL RECEIPTS.] 121.17 Receipts received as a result of 121.18 federal participation pertaining to 121.19 administrative costs of the Minnesota 121.20 health care reform waiver shall be 121.21 deposited as nondedicated revenue in 121.22 the health care access fund. Receipts 121.23 received as a result of federal 121.24 participation pertaining to grants 121.25 shall be deposited in the federal fund 121.26 and shall offset health care access 121.27 funds for payments to providers. 121.28 [MINNESOTACARE FUNDING.] The 121.29 commissioner may expend money 121.30 appropriated from the health care 121.31 access fund for MinnesotaCare in either 121.32 fiscal year of the biennium. 121.33 (b) MA Basic Health Care Grants - 121.34 Families and Children 121.35 General568,254,000582,161,000121.36 427,769,000 489,545,000 121.37 [SERVICES TO PREGNANT WOMEN.] The 121.38 commissioner shall use available 121.39 federal money for the State-Children's 121.40 Health Insurance Program for medical 121.41 assistance services provided to 121.42 pregnant women who are not otherwise 121.43 eligible for federal financial 121.44 participation beginning in fiscal year 121.45 2003. This federal money shall be 121.46 deposited in the federal fund and shall 121.47 offset general funds for payments to 121.48 providers. Notwithstanding section 14, 121.49 this paragraph shall not expire. 121.50 [MANAGED CARE RATE INCREASE.] (a) 121.51 Effective January 1, 2004, the 121.52 commissioner of human services shall 121.53 increase the total payments to managed 121.54 care plans under Minnesota Statutes, 121.55 section 256B.69, by an amount equal to 121.56 the cost increases to the managed care 121.57 plans from by the elimination of: (1) 121.58 the exemption from the taxes imposed 121.59 under Minnesota Statutes, section 122.1 297I.05, subdivision 5, for premiums 122.2 paid by the state for medical 122.3 assistance, general assistance medical 122.4 care, and the MinnesotaCare program; 122.5 and (2) the exemption of gross revenues 122.6 subject to the taxes imposed under 122.7 Minnesota Statutes, sections 295.50 to 122.8 295.57, for payments paid by the state 122.9 for services provided under medical 122.10 assistance, general assistance medical 122.11 care, and the MinnesotaCare program. 122.12 Any increase based on clause (2) must 122.13 be reflected in provider rates paid by 122.14 the managed care plan unless the 122.15 managed care plan is a staff model 122.16 health plan company. 122.17 (b) The commissioner of human services 122.18 shall increase by two percent the 122.19 fee-for-service payments under medical 122.20 assistance, general assistance medical 122.21 care, and the MinnesotaCare program for 122.22 services subject to the hospital, 122.23 surgical center, or health care 122.24 provider taxes under Minnesota 122.25 Statutes, sections 295.50 to 295.57, 122.26 effective for services rendered on or 122.27 after January 1, 2004. 122.28 (c) The commissioner of finance shall 122.29 transfer from the health care access 122.30 fund to the general fund the following 122.31 amounts in the fiscal years indicated: 122.32 2004, $16,587,000; 2005, $46,322,000; 122.33 2006, $49,413,000; and 2007, 122.34 $52,659,000. 122.35 (d) For fiscal years after 2007, the 122.36 commissioner of finance shall transfer 122.37 from the health care access fund to the 122.38 general fund an amount equal to the 122.39 revenue collected by the commissioner 122.40 of revenue on the following: 122.41 (1) gross revenues received by 122.42 hospitals, surgical centers, and health 122.43 care providers as payments for services 122.44 provided under medical assistance, 122.45 general assistance medical care, and 122.46 the MinnesotaCare program, including 122.47 payments received directly from the 122.48 state or from a prepaid plan, under 122.49 Minnesota Statutes, sections 295.50 to 122.50 295.57; and 122.51 (2) premiums paid by the state under 122.52 medical assistance, general assistance 122.53 medical care, and the MinnesotaCare 122.54 program under Minnesota Statutes, 122.55 section 297I.05, subdivision 5. 122.56 The commissioner of finance shall 122.57 monitor and adjust if necessary the 122.58 amount transferred each fiscal year 122.59 from the health care access fund to the 122.60 general fund to ensure that the amount 122.61 transferred equals the tax revenue 122.62 collected for the items described in 122.63 clauses (1) and (2) for that fiscal 122.64 year. 123.1 (e) Notwithstanding section 14, these 123.2 provisions shall not expire. 123.3 (c) MA Basic Health Care Grants - Elderly 123.4 and Disabled 123.5 General695,421,000741,605,000123.6 610,518,000 743,858,000 123.7 [DELAY MEDICAL ASSISTANCE 123.8 FEE-FOR-SERVICE - ACUTE CARE.] The 123.9 following payments in fiscal year 2005 123.10 from the Medicaid Management 123.11 Information System that would otherwise 123.12 have been made to providers for medical 123.13 assistance and general assistance 123.14 medical care services shall be delayed 123.15 and included in the first payment in 123.16 fiscal year 2006: 123.17 (1) for hospitals, the last two 123.18 payments; and 123.19 (2) for nonhospital providers, the last 123.20 payment. 123.21 This payment delay shall not include 123.22 payments to skilled nursing facilities, 123.23 intermediate care facilities for mental 123.24 retardation, prepaid health plans, home 123.25 health agencies, personal care nursing 123.26 providers, and providers of only waiver 123.27 services. The provisions of Minnesota 123.28 Statutes, section 16A.124, shall not 123.29 apply to these delayed payments. 123.30 Notwithstanding section 14, this 123.31 provision shall not expire. 123.32 [DEAF AND HARD-OF-HEARING SERVICES.] 123.33 If, after making reasonable efforts, 123.34 the service provider for mental health 123.35 services to persons who are deaf or 123.36 hearing impaired is not able to earn 123.37 $227,000 through participation in 123.38 medical assistance intensive 123.39 rehabilitation services in fiscal year 123.40 2005, the commissioner shall transfer 123.41 $227,000 minus medical assistance 123.42 earnings achieved by the grantee to 123.43 deaf and hard-of-hearing grants to 123.44 enable the provider to continue 123.45 providing services to eligible persons. 123.46 (d) General Assistance Medical Care 123.47 Grants 123.48 General223,960,000196,617,000123.49 239,861,000 229,960,000 123.50 (e) Health Care Grants - Other 123.51 Assistance 123.52 General 3,067,000 3,407,000 123.53 Health Care Access 750,000 750,000 123.54 [MINNESOTA PRESCRIPTION DRUG DEDICATED 123.55 FUND.] Of the general fund 123.56 appropriation, $284,000 in fiscal year 124.1 2005 is appropriated to the 124.2 commissioner for the prescription drug 124.3 dedicated fund established under the 124.4 prescription drug discount program. 124.5 [DENTAL ACCESS GRANTS CARRYOVER 124.6 AUTHORITY.] Any unspent portion of the 124.7 appropriation from the health care 124.8 access fund in fiscal years 2002 and 124.9 2003 for dental access grants under 124.10 Minnesota Statutes, section 256B.53, 124.11 shall not cancel but shall be allowed 124.12 to carry forward to be spent in the 124.13 biennium beginning July 1, 2003, for 124.14 these purposes. 124.15 [STOP-LOSS FUND ACCOUNT.] The 124.16 appropriation to the purchasing 124.17 alliance stop-loss fund account 124.18 established under Minnesota Statutes, 124.19 section 256.956, subdivision 2, for 124.20 fiscal years 2004 and 2005 shall only 124.21 be available for claim reimbursements 124.22 for qualifying enrollees who are 124.23 members of purchasing alliances that 124.24 meet the requirements described under 124.25 Minnesota Statutes, section 256.956, 124.26 subdivision 1, paragraph (f), clauses 124.27 (1), (2), and (3). 124.28 (f) Prescription Drug Program 124.29 General 9,239,000 9,226,000 124.30 [PRESCRIPTION DRUG ASSISTANCE PROGRAM.] 124.31 Of the general fund appropriation, 124.32 $702,000 in fiscal year 2004 and 124.33 $887,000 in fiscal year 2005 are for 124.34 the commissioner to establish and 124.35 administer the prescription drug 124.36 assistance program through the 124.37 Minnesota board on aging. 124.38 [REBATE REVENUE RECAPTURE.] Any funds 124.39 received by the state from a drug 124.40 manufacturer due to errors in the 124.41 pharmaceutical pricing used by the 124.42 manufacturer in determining the 124.43 prescription drug rebate are 124.44 appropriated to the commissioner to 124.45 augment funding of the prescription 124.46 drug program established in Minnesota 124.47 Statutes, section 256.955. 124.48 Sec. 5. Laws 2003, First Special Session chapter 14, 124.49 article 13C, section 2, subdivision 7, is amended to read: 124.50 Subd. 7. Health Care Management 124.51 Summary by Fund 124.52 General24,845,00026,199,000 124.53 24,834,000 124.54 Health Care Access 14,522,000 14,533,000 124.55 The amounts that may be spent from this 124.56 appropriation for each purpose are as 124.57 follows: 125.1 (a) Health Care Policy Administration 125.2 General 5,523,000 7,223,000 125.3 Health Care Access 1,066,000 1,200,000 125.4 [PAYMENT CODE STUDY.] Of this 125.5 appropriation, $345,000 each year is 125.6 for a study to determine the 125.7 appropriateness of eliminating 125.8 reimbursement for certain payment codes 125.9 under medical assistance, general 125.10 assistance medical care, or 125.11 MinnesotaCare. As part of the study, 125.12 the commissioner shall also examine 125.13 covered services under the Minnesota 125.14 health care programs and make 125.15 recommendations on possible 125.16 modification of the services covered 125.17 under the program. The commissioner 125.18 shall report to the legislature by 125.19 January 15, 2005, with an analysis of 125.20 the feasibility of this approach, a 125.21 list of codes, if any, to be eliminated 125.22 from the payment system, and estimates 125.23 of savings to be obtained from this 125.24 approach. 125.25 [TRANSFERS FROM HEALTH CARE ACCESS 125.26 FUND.] (a) Notwithstanding Minnesota 125.27 Statutes, section 295.581, to the 125.28 extent available resources in the 125.29 health care access fund exceed 125.30 expenditures in that fund during fiscal 125.31 years 2005 to 2007, the excess annual 125.32 funds shall be transferred from the 125.33 health care access fund to the general 125.34 fund on June 30 of fiscal years 2005, 125.35 2006, and 2007. These transfers shall 125.36 not be reduced to accommodate 125.37 MinnesotaCare expansions. The 125.38 estimated amounts to be transferred are: 125.39 (1) in fiscal year 2005, $192,442,000; 125.40 (2) in fiscal year 2006, $52,943,000; 125.41 and 125.42 (3) in fiscal year 2007, $59,105,000. 125.43 These estimates shall be updated with 125.44 each forecast, but in no case shall the 125.45 transfers exceed the amounts listed in 125.46 clauses (1) to (3). 125.47 (b) The commissioner shall limit 125.48 transfers under paragraph (a) in order 125.49 to avoid implementation of Minnesota 125.50 Statutes, section 256L.02, subdivision 125.51 3, paragraph (b). 125.52 (c) For fiscal years 2004 to 2007, 125.53 MinnesotaCare shall be a forecasted 125.54 program and, if necessary, the 125.55 commissioner shall reduce transfers 125.56 under paragraph (a) to meet forecasted 125.57 expenditures. 125.58 (d) The department of human services in 125.59 recommending its 2007-2008 budget shall 125.60 consider the repayment of the amount 126.1 transferred in fiscal years 2006 and 126.2 2007 from the health care access fund 126.3 to the general fund to the health care 126.4 access fund. 126.5 (e) Notwithstanding section 14, this 126.6 section is in effect until June 30, 126.7 2007. 126.8 [MINNESOTACARE OUTREACH REIMBURSEMENT.] 126.9 Federal administrative reimbursement 126.10 resulting from MinnesotaCare outreach 126.11 is appropriated to the commissioner for 126.12 this activity. 126.13 [MINNESOTA SENIOR HEALTH OPTIONS 126.14 REIMBURSEMENT.] Federal administrative 126.15 reimbursement resulting from the 126.16 Minnesota senior health options project 126.17 is appropriated to the commissioner for 126.18 this activity. 126.19 [UTILIZATION REVIEW.] Federal 126.20 administrative reimbursement resulting 126.21 from prior authorization and inpatient 126.22 admission certification by a 126.23 professional review organization shall 126.24 be dedicated to the commissioner for 126.25 these purposes. A portion of these 126.26 funds must be used for activities to 126.27 decrease unnecessary pharmaceutical 126.28 costs in medical assistance. 126.29 (b) Health Care Operations 126.30 General19,322,00018,976,000 126.31 19,311,000 126.32 Health Care Access 13,456,000 13,333,000 126.33 [PREPAID MEDICAL PROGRAMS.] For all 126.34 counties in which the PMAP program has 126.35 been operating for 12 or more months, 126.36 state funding for the nonfederal share 126.37 of prepaid medical assistance program 126.38 administration costs for county managed 126.39 care advocacy and enrollment operations 126.40 is eliminated. State funding will 126.41 continue for these activities for 126.42 counties and tribes establishing new 126.43 PMAP programs for a maximum of 16 126.44 months (four months prior to beginning 126.45 PMAP enrollment and through the first 126.46 12 months of their PMAP program 126.47 operation). Those counties operating 126.48 PMAP programs for less than 12 months 126.49 can continue to receive state funding 126.50 for advocacy and enrollment activities 126.51 through their first year of operation. 126.52 Sec. 6. Laws 2003, First Special Session chapter 14, 126.53 article 13C, section 2, subdivision 9, is amended to read: 126.54 Subd. 9. Continuing Care Grants 126.55 Summary by Fund 126.56 General1,504,933,0001,490,958,000127.1 1,448,029,000 1,567,392,000 127.2 Lottery Prize Fund 1,408,000 1,408,000 127.3 The amounts that may be spent from this 127.4 appropriation for each purpose are as 127.5 follows: 127.6 (a) Community Social Services 127.7 General 496,000 371,000 127.8 (b) Aging and Adult Service Grant 127.9 General 12,998,000 13,951,000 127.10 [LONG-TERM CARE PROGRAM REDUCTIONS.] 127.11 For the biennium ending June 30, 2005, 127.12 state funding for the following state 127.13 long-term care programs is reduced by 127.14 15 percent from the level of state 127.15 funding provided on June 30, 2003: 127.16 SAIL project grants under Minnesota 127.17 Statutes, section 256B.0917; senior 127.18 nutrition programs under Minnesota 127.19 Statutes, section 256.9752; foster 127.20 grandparents program under Minnesota 127.21 Statutes, section 256.976; retired 127.22 senior volunteer program under 127.23 Minnesota Statutes, section 256.9753; 127.24 and the senior companion program under 127.25 Minnesota Statutes, section 256.977. 127.26 (c) Deaf and Hard-of-hearing 127.27 Service Grants 127.28 General 1,719,000 1,490,000 127.29 (d) Mental Health Grants 127.30 General 53,479,00034,690,000127.31 46,551,000 127.32 Lottery Prize Fund 1,408,000 1,408,000 127.33 [RESTRUCTURING OF ADULT MENTAL HEALTH 127.34 SERVICES.] The commissioner may make 127.35 transfers that do not increase the 127.36 state share of costs to effectively 127.37 implement the restructuring of adult 127.38 mental health services. 127.39 [COMPULSIVE GAMBLING.] Of the 127.40 appropriation from the lottery prize 127.41 fund, $250,000 each year is for the 127.42 following purposes: 127.43 (1) $100,000 each year is for a grant 127.44 to the Southeast Asian Problem Gambling 127.45 Consortium. The consortium must 127.46 provide statewide compulsive gambling 127.47 prevention and treatment services for 127.48 Lao, Hmong, Vietnamese, and Cambodian 127.49 families, adults, and adolescents. The 127.50 appropriation in this clause shall not 127.51 become part of base level funding for 127.52 the biennium beginning July 1, 2005. 127.53 Any unencumbered balance of the 127.54 appropriation in the first year does 127.55 not cancel but is available for the 128.1 second year; and 128.2 (2) $150,000 each year is for a grant 128.3 to a compulsive gambling council 128.4 located in St. Louis county. The 128.5 gambling council must provide a 128.6 statewide compulsive gambling 128.7 prevention and education project for 128.8 adolescents. Any unencumbered balance 128.9 of the appropriation in the first year 128.10 of the biennium does not cancel but is 128.11 available for the second year. 128.12 (e) Community Support Grants 128.13 12,523,0009,093,000128.14 12,024,000 128.15 [CENTERS FOR INDEPENDENT LIVING STUDY.] 128.16 The commissioner of human services, in 128.17 consultation with the commissioner of 128.18 economic security, the centers for 128.19 independent living, and consumer 128.20 representatives, shall study the 128.21 financing of the centers for 128.22 independent living authorized under 128.23 Minnesota Statutes, section 268A.11, 128.24 and make recommendations on options to 128.25 maximize federal financial 128.26 participation. Study components shall 128.27 include: 128.28 (1) the demographics of individuals 128.29 served by the centers for independent 128.30 living; 128.31 (2) the range of services the centers 128.32 for independent living provide to these 128.33 individuals; 128.34 (3) other publicly funded services 128.35 received by individuals supported by 128.36 the centers; and 128.37 (4) strategies for maximizing federal 128.38 financial participation for eligible 128.39 activities carried out by centers for 128.40 independent living. 128.41 The commissioner shall report with 128.42 fiscal and programmatic recommendations 128.43 to the chairs of the appropriate house 128.44 of representatives and senate finance 128.45 and policy committees by January 15, 128.46 2004. 128.47 (f) Medical Assistance Long-Term 128.48 Care Waivers and Home Care Grants 128.49 General659,211,000718,665,000128.50 624,631,000 748,189,000 128.51 [RATE AND ALLOCATION DECREASES FOR 128.52 CONTINUING CARE PROGRAMS.] 128.53 Notwithstanding any law or rule to the 128.54 contrary, the commissioner of human 128.55 services shall decrease reimbursement 128.56 rates or reduce allocations to assure 128.57 the necessary reductions in state 129.1 spending for the providers or programs 129.2 listed in paragraphs (a) to (d). The 129.3 decreases are effective for services 129.4 rendered on or after July 1, 2003. 129.5 (a) Effective July 1, 2003, the 129.6 commissioner shall reduce payment rates 129.7 for services and individual or service 129.8 limits by one percent. The rate 129.9 decreases described in this section 129.10 must be applied to: 129.11 (1) home and community-based waivered 129.12 services for the elderly under 129.13 Minnesota Statutes, section 256B.0915; 129.14 (2) day training and habilitation 129.15 services for adults with mental 129.16 retardation or related conditions under 129.17 Minnesota Statutes, sections 252.40 to 129.18 252.46; 129.19 (3) the group residential housing 129.20 supplementary service rate under 129.21 Minnesota Statutes, section 256I.05, 129.22 subdivision 1a; 129.23 (4) chemical dependency residential and 129.24 nonresidential service rates under 129.25 Minnesota Statutes, section 245B.03; 129.26 (5) consumer support grants under 129.27 Minnesota Statutes, section 256.476; 129.28 and 129.29 (6) home and community-based services 129.30 for alternative care services under 129.31 Minnesota Statutes, section 256B.0913. 129.32 (b) The commissioner shall reduce 129.33 allocations made available to county 129.34 agencies for home and community-based 129.35 waivered services to assure a 129.36 one-percent reduction in state spending 129.37 for services rendered on or after July 129.38 1, 2003. The commissioner shall apply 129.39 the allocation decreases described in 129.40 this section to: 129.41 (1) persons with mental retardation or 129.42 related conditions under Minnesota 129.43 Statutes, section 256B.501; 129.44 (2) waivered services under community 129.45 alternatives for disabled individuals 129.46 under Minnesota Statutes, section 129.47 256B.49; 129.48 (3) community alternative care waivered 129.49 services under Minnesota Statutes, 129.50 section 256B.49; and 129.51 (4) traumatic brain injury waivered 129.52 services under Minnesota Statutes, 129.53 section 256B.49. 129.54 County agencies will be responsible for 129.55 100 percent of any spending in excess 129.56 of the allocation made by the 129.57 commissioner. Nothing in this section 129.58 shall be construed as reducing the 130.1 county's responsibility to offer and 130.2 make available feasible home and 130.3 community-based options to eligible 130.4 waiver recipients within the resources 130.5 allocated to them for that purpose. 130.6 (c) The commissioner shall reduce deaf 130.7 and hard-of-hearing grants by one 130.8 percent on July 1, 2003. 130.9 (d) Effective July 1, 2003, the 130.10 commissioner shall reduce payment rates 130.11 for each facility reimbursed under 130.12 Minnesota Statutes, section 256B.5012, 130.13 by decreasing the total operating 130.14 payment rate for intermediate care 130.15 facilities for the mentally retarded by 130.16 one percent. For each facility, the 130.17 commissioner shall multiply the 130.18 adjustment by the total payment rate, 130.19 excluding the property-related payment 130.20 rate, in effect on June 30, 2003. A 130.21 facility whose payment rates are 130.22 governed by closure agreements, 130.23 receivership agreements, or Minnesota 130.24 Rules, part 9553.0075, is not subject 130.25 to an adjustment otherwise taken under 130.26 this subdivision. 130.27 Notwithstanding section 14, these 130.28 adjustments shall not expire. 130.29 [REDUCE GROWTH IN MR/RC WAIVER.] The 130.30 commissioner shall reduce the growth in 130.31 the MR/RC waiver by not allocating the 130.32 300 additional diversion allocations 130.33 that are included in the February 2003 130.34 forecast for the fiscal years that 130.35 begin on July 1, 2003, and July 1, 2004. 130.36 [MANAGE THE GROWTH IN THE TBI WAIVER.] 130.37 During the fiscal years beginning on 130.38 July 1, 2003, and July 1, 2004, the 130.39 commissioner shall allocate money for 130.40 home and community-based programs 130.41 covered under Minnesota Statutes, 130.42 section 256B.49, to assure a reduction 130.43 in state spending that is equivalent to 130.44 limiting the caseload growth of the TBI 130.45 waiver to 150 in each year of the 130.46 biennium. Priorities for the 130.47 allocation of funds shall be for 130.48 individuals anticipated to be 130.49 discharged from institutional settings 130.50 or who are at imminent risk of a 130.51 placement in an institutional setting. 130.52 [TARGETED CASE MANAGEMENT FOR HOME CARE 130.53 RECIPIENTS.] Implementation of the 130.54 targeted case management benefit for 130.55 home care recipients, according to 130.56 Minnesota Statutes, section 256B.0621, 130.57 subdivisions 2, 3, 5, 6, 7, 9, and 10, 130.58 will be delayed until July 1, 2005. 130.59 [COMMON SERVICE MENU.] Implementation 130.60 of the common service menu option 130.61 within the home and community-based 130.62 waivers, according to Minnesota 130.63 Statutes, section 256B.49, subdivision 130.64 16, will be delayed until July 1, 2005. 131.1 [LIMITATION ON COMMUNITY ALTERNATIVES 131.2 FOR DISABLED INDIVIDUALS CASELOAD 131.3 GROWTH.] For the biennium ending June 131.4 30, 2005, the commissioner shall limit 131.5 the allocations made available in the 131.6 community alternatives for disabled 131.7 individuals waiver program in order not 131.8 to exceed average caseload growth of 95 131.9 per month from June 2003 program 131.10 levels, plus any additional 131.11 legislatively authorized program 131.12 growth. The commissioner shall 131.13 allocate available resources to achieve 131.14 the following outcomes: 131.15 (1) the establishment of feasible and 131.16 viable alternatives for persons in 131.17 institutional or hospital settings to 131.18 relocate to home and community-based 131.19 settings; 131.20 (2) the availability of timely 131.21 assistance to persons at imminent risk 131.22 of institutional or hospital placement 131.23 or whose health and safety is at 131.24 immediate risk; and 131.25 (3) the maximum provision of essential 131.26 community supports to eligible persons 131.27 in need of and waiting for home and 131.28 community-based service alternatives. 131.29 The commissioner may reallocate 131.30 resources from one county or region to 131.31 another if available funding in that 131.32 county or region is not likely to be 131.33 spent and the reallocation is necessary 131.34 to achieve the outcomes specified in 131.35 this paragraph. 131.36 (g) Medical Assistance Long-term 131.37 Care Facilities Grants 131.38 General543,999,000514,483,000131.39 513,763,000 536,321,000 131.40 (h) Alternative Care Grants 131.41 General 75,206,000 66,351,000 131.42 [ALTERNATIVE CARE TRANSFER.] Any money 131.43 allocated to the alternative care 131.44 program that is not spent for the 131.45 purposes indicated does not cancel but 131.46 shall be transferred to the medical 131.47 assistance account. 131.48 [ALTERNATIVE CARE APPROPRIATION.] The 131.49 commissioner may expend the money 131.50 appropriated for the alternative care 131.51 program for that purpose in either year 131.52 of the biennium. 131.53 [ALTERNATIVE CARE IMPLEMENTATION OF 131.54 CHANGES TO FEES AND ELIGIBILITY.] 131.55 Changes to Minnesota Statutes, section 131.56 256B.0913, subdivision 4, paragraph 131.57 (d), and subdivision 12, are effective 131.58 July 1, 2003, for all persons found 131.59 eligible for the alternative care 131.60 program on or after July 1, 2003. All 132.1 recipients of alternative care funding 132.2 as of June 30, 2003, shall be subject 132.3 to Minnesota Statutes, section 132.4 256B.0913, subdivision 4, paragraph 132.5 (d), and subdivision 12, on the annual 132.6 reassessment and review of their 132.7 eligibility after July 1, 2003, but no 132.8 later than January 1, 2004. 132.9 (i) Group Residential Housing Grants 132.10 General94,996,00080,472,000132.11 94,547,000 81,055,000 132.12 [GROUP RESIDENTIAL HOUSING COSTS 132.13 REFINANCED.] (1) Effective July 1, 132.14 2004, the commissioner shall increase 132.15 the home and community-based service 132.16 rates and county allocations provided 132.17 to programs for persons with 132.18 disabilities established under section 132.19 1915(c) of the Social Security Act to 132.20 the extent that these programs will be 132.21 paying for the costs above the rate 132.22 established in Minnesota Statutes, 132.23 section 256I.05, subdivision 1. 132.24 (2) For persons in receipt of services 132.25 under Minnesota Statutes, section 132.26 256B.0915, who reside in licensed adult 132.27 foster care beds for which a 132.28 supplemental room and board payment was 132.29 being made under Minnesota Statutes, 132.30 section 256I.05, subdivision 1, 132.31 counties may request an exception to 132.32 the individual caps specified in 132.33 Minnesota Statutes, section 256B.0915, 132.34 subdivision 3, paragraph (b), not to 132.35 exceed the difference between the 132.36 individual cap and the client's monthly 132.37 service expenditures plus the amount of 132.38 the supplemental room and board rate. 132.39 The county must submit a request to 132.40 exceed the individual cap to the 132.41 commissioner for approval. 132.42 (j) Chemical Dependency 132.43 Entitlement Grants 132.44 General49,251,00050,337,000132.45 57,612,000 60,034,000 132.46 (k) Chemical Dependency Nonentitlement 132.47 Grants 132.48 General 1,055,000 1,055,000 132.49 Sec. 7. Laws 2003, First Special Session chapter 14, 132.50 article 13C, section 2, subdivision 11, is amended to read: 132.51 Subd. 11. Economic Support Grants 132.52 Summary by Fund 132.53 General122,647,000117,198,000132.54 124,697,000 116,985,000 133.1 Federal TANF199,009,000207,224,000133.2 212,844,000 209,264,000 133.3 The amounts that may be spent from this 133.4 appropriation for each purpose are as 133.5 follows: 133.6 (a) Minnesota Family Investment Program 133.7 General59,922,00039,375,000133.8 53,818,000 43,942,000 133.9 Federal TANF106,535,000110,543,000133.10 114,370,000 106,583,000 133.11 (b) Work Grants 133.12 General666,00014,678,000133.13 8,666,000 8,678,000 133.14 Federal TANF92,474,00096,681,000133.15 98,474,000 102,681,000 133.16 [MFIP SUPPORT SERVICES COUNTY AND 133.17 TRIBAL ALLOCATION.] When determining 133.18 the funds available for the 133.19 consolidated MFIP support services 133.20 grant in the 18-month period ending 133.21 December 31, 2004, the commissioner 133.22 shall apportion the funds appropriated 133.23 for fiscal year 2005 in such manner as 133.24 necessary to provide $14,000,000 more 133.25 to counties and tribes for the period 133.26 ending December 31, 2004, than would 133.27 have been available had the funds been 133.28 evenly divided within the fiscal year 133.29 between the period before December 31, 133.30 2004, and the period after December 31, 133.31 2004. 133.32 For allocations for the calendar years 133.33 starting January 1, 2005, the 133.34 commissioner shall apportion the funds 133.35 appropriated for each fiscal year in 133.36 such manner as necessary to provide 133.37 $14,000,000 more to counties and tribes 133.38 for the period ending December 31 of 133.39 that year than would have been 133.40 available had the funds been evenly 133.41 divided within the fiscal year between 133.42 the period before December 31 and the 133.43 period after December 31. 133.44 (c) Economic Support Grants - Other 133.45 Assistance 133.46 General 3,358,000 3,463,000 133.47 [SUPPORTIVE HOUSING.] Of the general 133.48 fund appropriation, $500,000 each year 133.49 is to provide services to families who 133.50 are participating in the supportive 133.51 housing and managed care pilot project 133.52 under Minnesota Statutes, section 133.53 256K.25. This appropriation shall not 133.54 become part of base level funding for 134.1 the biennium beginning July 1, 2007. 134.2 (d) Child Support Enforcement Grants 134.3 General 3,571,000 3,503,000 134.4 (e) General Assistance Grants 134.5 General24,901,00024,732,000134.6 26,329,000 26,909,000 134.7 [GENERAL ASSISTANCE STANDARD.] The 134.8 commissioner shall set the monthly 134.9 standard of assistance for general 134.10 assistance units consisting of an adult 134.11 recipient who is childless and 134.12 unmarried or living apart from parents 134.13 or a legal guardian at $203. The 134.14 commissioner may reduce this amount 134.15 according to Laws 1997, chapter 85, 134.16 article 3, section 54. 134.17 [EMERGENCY GENERAL ASSISTANCE.] The 134.18 amount appropriated for emergency 134.19 general assistance funds is limited to 134.20 no more than $7,889,812 in each fiscal 134.21 year of 2004 and 2005. Funds to 134.22 counties shall be allocated by the 134.23 commissioner using the allocation 134.24 method specified in Minnesota Statutes, 134.25 section 256D.06. 134.26 (f) Minnesota Supplemental Aid Grants 134.27 General30,229,00031,447,000134.28 28,955,000 30,490,000 134.29 [EMERGENCY MINNESOTA SUPPLEMENTAL AID 134.30 FUNDS.] The amount appropriated for 134.31 emergency Minnesota supplemental aid 134.32 funds is limited to no more than 134.33 $1,138,707 in fiscal year 2004 and 134.34 $1,017,000 in fiscal year 2005. Funds 134.35 to counties shall be allocated by the 134.36 commissioner using the allocation 134.37 method specified in Minnesota Statutes, 134.38 section 256D.46. 134.39 Sec. 8. Laws 2003, First Special Session chapter 14, 134.40 article 13C, section 10, subdivision 1, is amended to read: 134.41 Subdivision 1. Total 134.42 Appropriation$107,829,000$92,649,000134.43 $ 106,221,000 $ 97,564,000 134.44 Summary by Fund 134.45 General104,489,00089,309,000134.46 102,881,000 94,224,000 134.47 State Special 134.48 Revenue 3,340,000 3,340,000 134.49 Sec. 9. Laws 2003, First Special Session chapter 14, 134.50 article 13C, section 10, subdivision 2, is amended to read: 135.1 Subd. 2. Child Care 135.2 [BASIC SLIDING FEE CHILD CARE.] Of this 135.3 appropriation, $27,628,000 in fiscal 135.4 year 2004 and $18,771,000 in fiscal 135.5 year 2005 are for child care assistance 135.6 according to Minnesota Statutes, 135.7 section 119B.03. These appropriations 135.8 are available to be spent either year. 135.9 The fiscal years 2006 and 2007 general 135.10 fund base for basic sliding fee child 135.11 care is $30,312,000 each year. 135.12 [MFIP CHILD CARE.] Of this 135.13 appropriation,$69,543,000$67,935,000 135.14 in fiscal year 2004 135.15 and$63,720,000$68,635,000 in fiscal 135.16 year 2005 are for MFIP child care. 135.17 [CHILD CARE PROGRAM INTEGRITY.] Of this 135.18 appropriation, $425,000 in fiscal year 135.19 2004, and $376,000 in fiscal year 2005 135.20 are for the administrative costs of 135.21 program integrity and fraud prevention 135.22 for child care assistance under 135.23 Minnesota Statutes, chapter 119B. 135.24 [CHILD CARE DEVELOPMENT.] Of this 135.25 appropriation, $1,115,000 in fiscal 135.26 year 2004, and $1,164,000 in fiscal 135.27 year 2005 are for child care 135.28 development grants according to 135.29 Minnesota Statutes, section 119B.21. 135.30 Sec. 10. [EFFECTIVE DATE.] 135.31 Sections 1 to 9 are effective the day following final 135.32 enactment, unless a different effective date is specified. 135.33 ARTICLE 15 135.34 APPROPRIATIONS 135.35 Section 1. [HEALTH AND HUMAN SERVICES APPROPRIATIONS.] 135.36 The sums shown in the columns marked "APPROPRIATIONS" are 135.37 added to or, if shown in parentheses, are subtracted from the 135.38 appropriations in Laws 2003, First Special Session chapter 14, 135.39 article 13C, or other law, and are appropriated from the general 135.40 fund, or any other fund named, to the agencies and for the 135.41 purposes specified in the sections of this article, to be 135.42 available for the fiscal years indicated for each purpose. The 135.43 figures "2004" and "2005" where used in this article, mean that 135.44 the appropriation or appropriations listed under them are 135.45 available for the fiscal year ending June 30, 2004, or June 30, 135.46 2005, respectively. 135.47 SUMMARY BY FUND 135.48 2004 2005 TOTAL 136.1 General $137,376,000 $(118,240,000) $ 19,136,000 136.2 Health Care 136.3 Access 41,994,000 (46,286,000) (4,292,000) 136.4 Federal TANF -0- -0- -0- 136.5 Lottery Prize Fund -0- 75,000 75,000 136.6 TOTAL $179,370,000 $(164,301,000) $ 15,069,000 136.7 APPROPRIATIONS 136.8 Available for the Year 136.9 Ending June 30 136.10 2004 2005 136.11 Sec. 2. COMMISSIONER OF 136.12 HUMAN SERVICES 136.13 Subdivision 1. Total 136.14 Appropriation $ 179,370,000 $(163,613,000) 136.15 Summary by Fund 136.16 General 137,376,000 (117,558,000) 136.17 Health Care 136.18 Access 41,994,000 (46,280,000) 136.19 Federal TANF -0- -0- 136.20 Lottery Prize Fund -0- 75,000 136.21 Other Funds -0- 150,000 136.22 Subd. 2. Agency Management 136.23 Summary by Fund 136.24 General -0- (2,300,000) 136.25 The amounts that may be spent from the 136.26 appropriation for each purpose are as 136.27 follows: 136.28 (a) Financial Operations 136.29 General -0- (2,300,000) 136.30 (b) Legal and Regulatory Operations 136.31 (c) Management Operations 136.32 (d) Information Technology 136.33 Subd. 3. Revenue and Pass-Through 136.34 Federal TANF -0- 10,652,000 136.35 [TANF REFINANCING.] In addition to the 136.36 amount of TANF funds available for use 136.37 with the Minnesota working family tax 136.38 credit program under current law 136.39 appropriations, there is further 136.40 appropriated the following amounts: 136.41 FY 2005 ..... $10,652,000 136.42 FY 2006 ..... $15,113,000 136.43 FY 2007 ..... $15,339,000 137.1 [ADJUSTMENTS IN WORKING FAMILY CREDIT 137.2 EXPENDITURES COUNTED AS TANF MOE.] In 137.3 addition to the amounts identified in 137.4 Laws 2003, First Special Session 137.5 chapter 14, article 13C, section 2, the 137.6 commissioner may claim up to the 137.7 following amounts of Working Family 137.8 Credit expenditures for the following 137.9 fiscal years: 137.10 FY 2006 ..... $27,656,000 137.11 FY 2007 ..... $17,883,000 137.12 Subd. 4. Children's Services Grants 137.13 [PRIVATIZED ADOPTION GRANT.] For the 137.14 biennium ending June 30, 2005, federal 137.15 reimbursement for privatized adoption 137.16 grant and foster care recruitment grant 137.17 expenditures is appropriated to the 137.18 commissioner for adoption grants and 137.19 foster care and adoption administrative 137.20 purposes. 137.21 [ADJUSTMENTS IN TANF TRANSFERS TO CHILD 137.22 CARE DEVELOPMENT FUND.] Transfers of 137.23 TANF to the federal Child Care 137.24 Development Fund for child care 137.25 assistance shall be reduced by these 137.26 amounts in fiscal year 2005: 137.27 Basic sliding fee child care $370,000 137.28 MFIP child care $1,152,000 137.29 Subd. 5. Children's Services Management 137.30 Subd. 6. Basic Health Care Grants 137.31 Summary by Fund 137.32 General 133,114,000 (138,463,000) 137.33 Health Care Access 41,994,000 (46,580,000) 137.34 The amounts that may be spent from this 137.35 appropriation for each purpose are as 137.36 follows: 137.37 (a) MinnesotaCare Grants 137.38 Health Care Access 41,944,000 (45,830,000) 137.39 [HEALTH CARE ACCESS FUND TRANSFER.] 137.40 Notwithstanding Laws 2003, First 137.41 Special Session chapter 14, article 137.42 13C, section 2, subdivision 7, the 137.43 commissioner of finance shall transfer 137.44 $70,000,000 from the health care access 137.45 fund to the general fund on July 1, 137.46 2004. This transfer is in addition to 137.47 all other transfers from the health 137.48 care access fund to the general fund. 137.49 (b) MA Basic Health Care 137.50 Grants - Families and Children 137.51 General 76,265,000 (80,589,000) 137.52 [CAPITATION PAYMENTS.] Capitation 138.1 payments and performance withhold 138.2 payments under Minnesota Statutes, 138.3 chapters 256B, 256D, and 256L, for the 138.4 months of June 2004 and July 2004 shall 138.5 be made prior to June 30, 2004. This 138.6 rider is effective the day following 138.7 final enactment. 138.8 [HEALTH CARE GRANTS FORECAST.] The 138.9 commissioner of finance, as part of the 138.10 November 2004 forecast, shall determine 138.11 the extent to which projected state 138.12 spending for medical assistance, MFIP, 138.13 and basic health care grants for the 138.14 biennium ending June 30, 2007, exceeds 138.15 the level of spending projected for 138.16 that biennium in the February 2004 138.17 forecast. If the level of state 138.18 spending projected for the biennium 138.19 ending June 30, 2007, exceeds the level 138.20 of state spending projected for that 138.21 biennium in the February 2004 forecast 138.22 by more than $100,000,000, the 138.23 commissioner of human services shall 138.24 present to the legislature, by December 138.25 15, 2004, draft legislation to reduce 138.26 the projected increase above the 138.27 February 2004 estimate to an amount no 138.28 greater than $100,000,000. The draft 138.29 legislation must achieve this reduction 138.30 without reducing medical assistance 138.31 reimbursement rates to providers. 138.32 (c) MA Basic Health Care 138.33 Grants - Elderly and Disabled 138.34 General 28,821,000 (31,301,000) 138.35 (d) General Assistance 138.36 Medical Care Grants 138.37 General 28,028,000 (26,863,000) 138.38 (e) Health Care Grants - 138.39 Other Assistance 138.40 General -0- 290,000 138.41 Health Care Access -0- (750,000) 138.42 (f) Prescription Drug Program 138.43 General -0- -0- 138.44 [PRESCRIPTION DRUG PROGRAM.] The 138.45 commissioner may expend the money 138.46 appropriated for the prescription drug 138.47 program in either year of the 138.48 biennium. Unexpended funds do not 138.49 cancel and are available to the 138.50 commissioner for fiscal year 2006 138.51 prescription drug program expenditures. 138.52 Subd. 7. Health Care Management 138.53 Summary by Fund 138.54 General -0- 2,085,000 138.55 Health Care Access -0- 300,000 139.1 Other Funds -0- 150,000 139.2 The amounts that may be spent from this 139.3 appropriation for each purpose are as 139.4 follows: 139.5 (a) Health Care Policy 139.6 Administration 139.7 General -0- 1,965,000 139.8 Health Care Access -0- 300,000 139.9 Other Funds -0- 150,000 139.10 (b) Health Care 139.11 Operations 139.12 General -0- 120,000 139.13 Subd. 8. State-Operated Services 139.14 Summary by Fund 139.15 General 4,262,000 5,520,000 139.16 [TEMPORARY CONFINEMENT COST OF CARE.] 139.17 The cost of care shall be ten percent 139.18 as specified in Minnesota Statutes, 139.19 section 246.54, subdivision 2, for any 139.20 individual for whom a county obtained 139.21 an order from a court authorizing 139.22 temporary confinement, as defined in 139.23 Minnesota Statutes, section 253B.045, 139.24 between January 1, 2004, and June 30, 139.25 2004, to the Minnesota sex offender 139.26 program as defined in Minnesota 139.27 Statutes, section 253B.02, subdivision 139.28 18a, not 100 percent as required under 139.29 Minnesota Statutes, section 253B.045, 139.30 subdivision 3. 139.31 [MINNESOTA SEX OFFENDER PROGRAM.] The 139.32 commissioner of human services shall 139.33 implement cost efficiencies in the 139.34 Minnesota sex offender program under 139.35 Minnesota Statutes, chapter 246B, in 139.36 order to reduce base-level operating 139.37 costs by $5,400,000 over the fiscal 139.38 year 2006-2007 biennium. The 139.39 $5,400,000 reduction shall, at a 139.40 minimum, seek to lower current year per 139.41 diem operating costs. This reduction 139.42 shall not result in fewer patients 139.43 served under the Minnesota sex offender 139.44 program. 139.45 Subd. 9. Continuing Care Grants 139.46 Summary by Fund 139.47 General -0- 15,482,000 139.48 Lottery Prize Fund -0- 75,000 139.49 The amounts that may be spent from this 139.50 appropriation for each purpose are as 139.51 follows: 139.52 (a) Community Social Services 140.1 (b) Aging Adult Service Grant 140.2 General -0- 1,000 140.3 (c) Deaf and Hard-of-Hearing 140.4 Service Grants 140.5 General -0- 4,000 140.6 (d) Mental Health Grants 140.7 Lottery Prize Fund -0- 75,000 140.8 $75,000 in fiscal year 2005 is 140.9 appropriated from the lottery prize 140.10 fund to the commissioner of human 140.11 services for a grant to the Northstar 140.12 Problem Gambling Alliance, located in 140.13 Arlington, Minnesota. The Northstar 140.14 Problem Gambling Alliance must provide 140.15 services to increase public awareness 140.16 of problem gambling, education and 140.17 training for individuals and 140.18 organizations providing services to 140.19 problem gamblers and their families, 140.20 and research relating to problem 140.21 gambling. This appropriation is 140.22 contingent on the demonstration of an 140.23 equal amount in nonstate matching funds 140.24 to the commissioner of finance but may 140.25 be disbursed in two payments of $37,500 140.26 upon receipt of a commitment for an 140.27 equal amount of matching nonstate funds. 140.28 (e) Community Support Grants 140.29 General -0- 111,000 140.30 (f) Medical Assistance 140.31 Long-Term Waivers and Home 140.32 Care Grants 140.33 General -0- 2,295,000 140.34 [MANAGE THE GROWTH IN THE TBI WAIVER.] 140.35 The commissioner shall allocate funding 140.36 for home and community-based services 140.37 covered under Minnesota Statutes, 140.38 section 256B.49, so that new TBI waiver 140.39 caseload growth is limited to 300 each 140.40 year of the biennium ending June 30, 140.41 2007. State fiscal year 2005 caseload 140.42 levels, as determined in the February 140.43 2004 forecast, will serve as the base 140.44 against which these limits will be 140.45 established. Priority for new 140.46 allocations shall be given to 140.47 individuals seeking to be discharged 140.48 from institutional settings or who are 140.49 at imminent risk of placement in an 140.50 institutional setting. Notwithstanding 140.51 any provision to the contrary, this 140.52 paragraph remains in effect for the 140.53 biennium ending June 30, 2007. 140.54 [MANAGE THE GROWTH IN THE COMMUNITY 140.55 ALTERNATIVES FOR DISABLED INDIVIDUALS 140.56 WAIVER.] The commissioner shall 140.57 allocate funding for home and 140.58 community-based services covered under 140.59 Minnesota Statutes, section 256B.49, so 141.1 that new CADI caseload growth is 141.2 limited to an average of 160 per month 141.3 in each year of the biennium ending 141.4 June 30, 2007. State fiscal year 2005 141.5 caseload levels, as determined in the 141.6 February 2004 forecast, will serve as 141.7 the base against which these limits 141.8 will be established. Priority for new 141.9 allocations shall be given to 141.10 individuals seeking to be discharged 141.11 from institutional settings or who are 141.12 at imminent risk of a placement in an 141.13 institutional setting. Notwithstanding 141.14 any provision to the contrary, this 141.15 paragraph remains in effect for the 141.16 biennium ending June 30, 2007. 141.17 (g) Medical Assistance 141.18 Long-term Care Facilities Grants 141.19 General -0- 12,591,000 141.20 [NURSING FACILITY SCHOLARSHIP PROGRAM.] 141.21 For the rate year beginning July 1, 141.22 2004, the amount determined under 141.23 section 256B.431, subdivision 36, shall 141.24 be removed from each nursing facility's 141.25 rate. 141.26 [RATE AND ALLOCATION INCREASES FOR 141.27 CONTINUING CARE PROGRAMS.] 141.28 Notwithstanding any law or rule to the 141.29 contrary, including Laws 2003, First 141.30 Special Session chapter 14, article 141.31 13C, section 2, subdivision 9, the 141.32 commissioner of human services shall 141.33 increase reimbursement rates or 141.34 increase allocations to assure the 141.35 necessary increases in state spending 141.36 for the providers or programs listed in 141.37 clauses (1) to (4). The increases are 141.38 added to base-level funding and are 141.39 effective for services rendered on or 141.40 after July 1, 2004. 141.41 (1) Effective July 1, 2004, the 141.42 commissioner shall increase payment 141.43 rates for services and individual or 141.44 service limits by up to one-half 141.45 percent. The rate increases described 141.46 in this section must be applied to: 141.47 (i) home and community-based waivered 141.48 services for the elderly under 141.49 Minnesota Statutes, section 256B.0915; 141.50 (ii) day training and habilitation 141.51 services for adults with mental 141.52 retardation or related conditions under 141.53 Minnesota Statutes, sections 252.40 to 141.54 252.46; 141.55 (iii) the group residential housing 141.56 supplementary service rate under 141.57 Minnesota Statutes, section 256I.05, 141.58 subdivision 1a; 141.59 (iv) chemical dependency residential 141.60 and nonresidential service rates under 141.61 Minnesota Statutes, section 245B.03; 142.1 (v) consumer support grants under 142.2 Minnesota Statutes, section 256.476; 142.3 and 142.4 (vi) home and community-based services 142.5 for alternative care services under 142.6 Minnesota Statutes, section 256B.0913. 142.7 (2) The commissioner shall increase 142.8 allocations made available to county 142.9 agencies for home and community-based 142.10 waivered services to assure up to a 142.11 one-half percent increase in state 142.12 spending for services rendered on or 142.13 after July 1, 2004. The commissioner 142.14 shall apply the allocation increases 142.15 described in this section to: 142.16 (i) persons with mental retardation or 142.17 related conditions under Minnesota 142.18 Statutes, section 256B.501; 142.19 (ii) waivered services under community 142.20 alternatives for disabled individuals 142.21 under Minnesota Statutes, section 142.22 256B.49; 142.23 (iii) community alternative care 142.24 waivered services under Minnesota 142.25 Statutes, section 256B.49; and 142.26 (iv) traumatic brain injury waivered 142.27 services under Minnesota Statutes, 142.28 section 256B.49. 142.29 County agencies will be responsible for 142.30 100 percent of any spending in excess 142.31 of the allocation made by the 142.32 commissioner. Nothing in this section 142.33 shall be construed as changing the 142.34 county's responsibility to offer and 142.35 make available feasible home and 142.36 community-based options to eligible 142.37 waiver recipients within the resources 142.38 allocated to them for that purpose. 142.39 (3) The commissioner shall increase 142.40 deaf and hard-of-hearing grants by up 142.41 to one-half percent on July 1, 2004. 142.42 (4) Effective July 1, 2004, the 142.43 commissioner shall increase payment 142.44 rates for each facility reimbursed 142.45 under Minnesota Statutes, section 142.46 256B.5012, by increasing the total 142.47 operating payment rate for intermediate 142.48 care facilities for the mentally 142.49 retarded by up to one-half percent. 142.50 For each facility, the commissioner 142.51 shall multiply the adjustment by the 142.52 total payment rate, excluding the 142.53 property-related payment rate, in 142.54 effect on June 30, 2004. A facility 142.55 whose payment rates are governed by 142.56 closure agreements, receivership 142.57 agreements, or Minnesota Rules, part 142.58 9553.0075, is not subject to an 142.59 adjustment otherwise taken under this 142.60 subdivision. 142.61 Notwithstanding any contrary provision, 143.1 these adjustments shall not expire. 143.2 (h) Alternative Care Grants 143.3 General -0- 252,000 143.4 (i) Group Residential 143.5 Housing Grants 143.6 General -0- (25,000) 143.7 (j) Chemical Dependency 143.8 Entitlement Grants 143.9 General -0- 253,000 143.10 (k) Chemical Dependency 143.11 Nonentitlement Grants 143.12 Subd. 10. Continuing Care Management 143.13 Subd. 11. Economic Support Grants 143.14 Summary by Fund 143.15 General -0- 118,000 143.16 Federal TANF -0- (10,225,000) 143.17 The amounts that may be spent from this 143.18 appropriation for each purpose are as 143.19 follows: 143.20 (a) Minnesota Family 143.21 Investment Program 143.22 Federal TANF -0- (10,225,000) 143.23 (b) Work Grants 143.24 [FOOD STAMPS EMPLOYMENT AND TRAINING 143.25 FUNDS.] Notwithstanding Minnesota 143.26 Statutes, section 256D.051, subdivision 143.27 6d, for fiscal years 2005, 2006, and 143.28 2007 only, Federal food stamps 143.29 employment and training funds received 143.30 as reimbursement of Minnesota family 143.31 investment program consolidated fund 143.32 grant expenditures must be deposited in 143.33 the general fund. Consistent with the 143.34 receipt of these federal funds, the 143.35 commissioner may adjust the level of 143.36 working family credit expenditures 143.37 claimed as TANF maintenance of effort. 143.38 (c) Economic Support Grants - 143.39 Other Assistance 143.40 [MEC2
IMPLEMENTATION.] The commissioner 143.41 may make up to five percent of a 143.42 county's subsequent calendar year basic 143.43 sliding fee child care assistance 143.44 allocation available to the county in 143.45 the current calendar year to offset the 143.46 cash flow effect of MEC2
implementation. 143.47 This adjustment shall not be considered 143.48 when calculating future allocation 143.49 amounts under Minnesota Statutes, 143.50 section 119B.03. 143.51 [BASIC SLIDING FEE CHILD CARE.] The 143.52 fiscal year 2006 and 2007 general fund 144.1 base for basic sliding fee child care 144.2 is reduced by $11,045,000. 144.3 (d) Child Support Enforcement Grants 144.4 (e) General Assistance Grants 144.5 (f) Minnesota Supplemental Aid Grants 144.6 General -0- 118,000 144.7 Sec. 3. COMMISSIONER OF HEALTH 144.8 Subdivision 1. Total 144.9 Appropriation -0- 598,000 144.10 Summary by Fund 144.11 General Fund -0- (592,000) 144.12 Health Care Access Fund -0- (6,000) 144.13 Subd. 2. Health Quality and Access 144.14 Health Care Access Fund -0- 83,000 144.15 Of the Health Care Access Fund 144.16 appropriation, $48,000 is for the 144.17 evaluation of health care providers 144.18 cost-shifting. This is a onetime 144.19 appropriation. 144.20 Subd. 3. Management and 144.21 Support Services -0- (692,000) 144.22 Health Care Access Fund -0- (89,000) 144.23 Subd. 4. Health Protection 144.24 General Fund -0- 100,000 144.25 [TRANSFER OF LEAD ABATEMENT.] The lead 144.26 abatement program is transferred from 144.27 the Department of Education to the 144.28 Department of Health. The program 144.29 shall be administered according to 144.30 Minnesota Statutes, section 119A.46. 144.31 Sec. 4. BOARD OF CHIROPRACTIC EXAMINERS 144.32 In fiscal year 2004, $200,000 in state 144.33 government special revenue funds is 144.34 transferred from Laws 2003, First 144.35 Special Session chapter 1, article 1, 144.36 section 28, to the Board of 144.37 Chiropractic Examiners to pay for 144.38 contested case activity. These funds 144.39 are available until June 30, 2005. 144.40 Sec. 5. VETERANS HOMES BOARD 144.41 General Fund -0- (90,000)