HF 1865

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:56am

A bill for an act
relating to human services; modifying the provision of MinnesotaCare services;
establishing requirements for healthy Minnesota plans; establishing healthy
Minnesota accounts for certain MinnesotaCare enrollees; amending Minnesota
Statutes 2008, sections 256L.01, by adding a subdivision; 256L.03, subdivisions
1, 1a, 3; 256L.15, by adding a subdivision; proposing coding for new law in
Minnesota Statutes, chapter 256L; repealing Minnesota Statutes 2008, sections
256L.03, subdivisions 1b, 5; 256L.12, subdivision 6.

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

Section 1. new text begin HEALTHY MINNESOTA PLAN; PRIVATE SECTOR COVERAGE.
new text end

new text begin It is the intent of the State of Minnesota to enact a coverage program that utilizes
market-based solutions within the health care sector that provides access to high quality
health care, reduces costs for coverage, and utilizes commercial reimbursement rates to
providers.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256L.01, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Qualified adult. new text end

new text begin "Qualified adult" means a parent, grandparent, foster
parent, relative caretaker as defined in the medical assistance program, and legal guardian
enrolled under section 256L.04, subdivision 1, and an individual residing in a household
with no children enrolled under section 256L.04, subdivision 7.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256L.03, subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

new text begin For children, new text end "covered health services"
means the health services reimbursed under chapter 256B, with the exception of inpatient
hospital services, special education services, private duty nursing services, adult dental
care services other than services covered under section 256B.0625, subdivision 9,
orthodontic services, nonemergency medical transportation services, personal care
assistant and case management services, nursing home or intermediate care facilities
services, inpatient mental health services, and chemical dependency services.

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

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

Sec. 4.

Minnesota Statutes 2008, section 256L.03, subdivision 1a, is amended to read:

Subd. 1a.

deleted text begin Pregnant women and deleted text end Children; MinnesotaCare health care reform
waiver.

Beginning January 1, 1999, children deleted text begin and pregnant women deleted text end are eligible for
coverage of all services that are eligible for reimbursement under the medical assistance
program according to chapter 256B, except that abortion services under MinnesotaCare
shall be limited as provided under subdivision 1. deleted text begin Pregnant women and deleted text end Children are
exempt from the provisions of subdivision 5, regarding co-payments. deleted text begin Pregnant women
and deleted text end Children who are lawfully residing in the United States but who are not "qualified
noncitizens" under title IV of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, Public Law 104-193, Statutes at Large, volume 110, page
2105, are eligible for coverage of all services provided under the medical assistance
program according to chapter 256B.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 5.

Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:

Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. deleted text begin The inpatient hospital benefit for adult enrollees who qualify under
section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
2, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of $10,000. deleted text end

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 6.

new text begin [256L.031] COVERED HEALTH SERVICES; QUALIFIED ADULTS.
new text end

new text begin Subdivision 1. new text end

new text begin Covered health care services. new text end

new text begin For qualified adults, "covered health
services" means all services covered under the health plan benefit design established by
the commissioner under section 256L.033.
new text end

new text begin Subd. 2. new text end

new text begin Contracts with health plan companies; enrollment of qualified adults.
new text end

new text begin The commissioner shall contract with health plan companies, as defined in section
62Q.01, subdivision 4, to provide to qualified adults the coverage established under
section 256L.033. The commissioner shall contract with and pay premiums to health plan
companies that can provide or arrange for high-quality, cost-effective care, and shall set
state premium payment rates for plan contracts. State premium payment rates must be
sufficient to allow health plan companies to reimburse providers under contract at payment
rates comparable to private sector provider payment rates.
new text end

new text begin Subd. 3. new text end

new text begin Enrollment of qualified adults. new text end

new text begin The commissioner shall develop and
implement procedures to enroll qualified adults with health plan companies that provide
the coverage established under section 256L.033. Qualified adults are exempt from
enrollment with managed care plans under section 256L.12, but may enroll with managed
care plans to obtain the coverage established under section 256L.033.
new text end

new text begin Subd. 4. new text end

new text begin MCHA. new text end

new text begin MinnesotaCare enrollees who are denied coverage under an
individual health plan by a health plan company are eligible for coverage through a health
plan offered by the Minnesota Comprehensive Health Association, as provided under
section 256L.033.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 7.

new text begin [256L.032] MINNESOTACARE; HEALTHY MINNESOTA ACCOUNTS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner shall establish and administer
a healthy Minnesota plan account for each recipient, or may contract with the health
plan company providing individual health plan coverage to a recipient to establish and
administer a healthy Minnesota plan account for that recipient.
new text end

new text begin Subd. 2. new text end

new text begin Deposits into healthy Minnesota account. new text end

new text begin The commissioner shall
initially deposit $....... into each enrollee's healthy Minnesota plan account, and thereafter
shall annually deposit an amount equal to the difference between $....... and the account
balance.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 8.

new text begin [256L.033] HEALTHY MINNESOTA PLAN; PRIVATE SECTOR
COVERAGE.
new text end

new text begin (a) Qualified adults enrolled in MinnesotaCare shall enroll in their choice of the
individual health plans under contract with the commissioner. The health plans must meet
the benefit design and cost-sharing requirements established by the commissioner. The
health plan benefit design and cost-sharing must be actuarially equivalent to that provided
under section 256L.03 to nonpregnant adults with family gross income that does not exceed
200 percent of the federal poverty guidelines, and in addition to coverage of physician,
inpatient and outpatient hospital, and other acute care services, must also include:
new text end

new text begin (1) eyewear coverage;
new text end

new text begin (2) coverage of maternity labor, delivery, or postpartum care on the same basis
as other care;
new text end

new text begin (3) dental coverage;
new text end

new text begin (4) prescription drug coverage;
new text end

new text begin (5) preventive care; and
new text end

new text begin (6) a lifetime maximum benefit of $5,000,000.
new text end

new text begin (b) The commissioner shall sponsor the healthy Minnesota plan, which must be
designed to the extent possible to function in the same manner as a voluntary employee
beneficiary association qualified under Internal Revenue Code, section 501(c)(9) or a
government plan qualified under Internal Revenue Code, section 1115, to the extent
practicable for a plan not providing benefits to employees.
new text end

new text begin (c) All payments out of the HMP must be adjudicated by a third-party administrator
contracted for by the commissioner in the same manner used for Health Reimbursement
Accounts under federal law, except as otherwise provided in section 256L.032, subdivision
1.
new text end

new text begin (d) Providers of individual health plans available for enrollment under paragraph
(a) may decline to cover a prospective enrollee on the basis of medical underwriting
permitted under section 62A.65 in the private market. A person rejected for coverage on
that basis shall apply for and enroll in a plan which must be provided by the Minnesota
Comprehensive Health Association (MCHA) governed under chapter 62E, without a
preexisting condition limitation, even if use of a preexisting condition is otherwise
permitted under chapter 62E. The plan benefit design must be identical to that established
under paragraph (a). The commissioner shall pay the premium for the person's coverage.
Notwithstanding any other law to the contrary, an individual health plan may decline
to enroll a person who is pregnant, and that person may enroll in MCHA without a
preexisting condition limitation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 9.

Minnesota Statutes 2008, section 256L.15, is amended by adding a subdivision
to read:

new text begin Subd. 1c. new text end

new text begin Premium payment; qualified adults. new text end

new text begin Qualified adults shall pay sliding
scale premiums, as determined under subdivision 2, directly to the health plan company
from whom they receive coverage. Health plan companies shall adopt and implement all
premium payment, collection, and disenrollment procedures that would otherwise be the
responsibility of the commissioner under this section and section 256L.06.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 10. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 256L.03, subdivisions 1b and 5; and 256L.12,
subdivision 6, new text end new text begin are repealed effective January 1, 2010, or upon federal approval, whichever
is later.
new text end