HF 2271

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; making changes to health care services; amending
data management; Medicaid reimbursement; providing lead risk assessment
services; changing the prepayment demonstration project; general assistance
medical care; medical assistance provisions; eligibility requirements; the
long-term care partnership program; treatment of assets; covered services;
amending Minnesota Statutes 2006, sections 144.9507, by adding a subdivision;
256B.055, subdivision 14; 256B.056, subdivisions 2, 11, by adding a subdivision;
256B.057, subdivision 1; 256B.0571, subdivisions 6, 9; 256B.058; 256B.059,
subdivisions 1, 1a; 256B.0594; 256B.0595, subdivisions 1, 2, 3, 4; 256B.0625,
subdivisions 5a, 5j, by adding a subdivision; 256B.69, subdivisions 6, 23, 27;
256D.03, subdivision 3; 256L.035; repealing Minnesota Statutes 2006, section
256B.0571, subdivision 8a.

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

Section 1.

Minnesota Statutes 2006, section 144.9507, is amended by adding a
subdivision to read:

new text begin Subd. 6. new text end

new text begin Medicaid reimbursement. new text end

new text begin Medicaid reimbursement for lead risk
assessment services may not be used to replace or decrease existing state or local funding
for lead services and lead-related activities.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.055, subdivision 14, is amended to read:

Subd. 14.

Persons detained by law.

(a) Medical assistance may be paid for an
inmate of a correctional facility who is conditionally released as authorized under section
241.26, 244.065, or 631.425, if the individual does not require the security of a public
detention facility and is housed in a halfway house or community correction center, or
under house arrest and monitored by electronic surveillance in a residence approved
by the commissioner of corrections, and if the individual meets the other eligibility
requirements of this chapter.

(b) An individual, regardless of age, who is considered an inmate of a public
institution as defined in Code of Federal Regulations, title 42, section ,
is not eligible for medical assistance.

Sec. 3.

Minnesota Statutes 2006, section 256B.056, subdivision 2, is amended to read:

Subd. 2.

Homestead exclusion deleted text begin and homestead equity limit deleted text end for deleted text begin institutionalized
persons deleted text end new text begin individuals residing in a long-term care facility new text end .

deleted text begin (a) deleted text end The homestead shall
be excluded for the first six calendar months of deleted text begin a person's deleted text end new text begin an individual's new text end stay in a
long-term care facility and shall continue to be excluded for as long as the recipient can
be reasonably expected to return to the homestead. For purposes of this subdivision,
"reasonably expected to return to the homestead" means the recipient's attending physician
has certified that the expectation is reasonable, and the recipient can show that the cost of
care upon returning home will be met through medical assistance or other sources. The
homestead shall continue to be excluded for deleted text begin persons deleted text end new text begin individuals new text end residing in a long-term
care facility if it is used as a primary residence by one of the following individuals:

(1) the spouse;

(2) a child under age 21;

(3) a child of any age who is blind or permanently and totally disabled as defined in
the supplemental security income program;

(4) a sibling who has equity interest in the home and who resided in the home for
at least one year immediately before the date of the deleted text begin person's deleted text end new text begin individual's new text end admission to
the facility; or

(5) a child of any age, or deleted text begin , subject to federal approval, deleted text end a grandchild of any age, who
resided in the home for at least two years immediately before the date of the deleted text begin person's deleted text end new text begin
individual's new text end admission to the facility, and who provided care to the deleted text begin person deleted text end new text begin individual new text end that
permitted the deleted text begin person deleted text end new text begin individual new text end to reside at home rather than in an institution.

deleted text begin (b) Effective for applications filed on or after July 1, 2006, and for renewals after
July 1, 2006, for persons who first applied for payment of long-term care services on
or after January 2, 2006, the equity interest in the homestead of an individual whose
eligibility for long-term care services is determined on or after January 1, 2006, shall not
exceed $500,000, unless it is the lawful residence of the individual's spouse or child
who is under age 21, blind, or disabled. The amount specified in this paragraph shall be
increased beginning in year 2011, from year to year based on the percentage increase in
the Consumer Price Index for all urban consumers (all items; United States city average),
rounded to the nearest $1,000. This provision may be waived in the case of demonstrated
hardship by a process to be determined by the secretary of health and human services
pursuant to section 6014 of the Deficit Reduction Act of 2005, Public Law 109-171.
deleted text end

Sec. 4.

Minnesota Statutes 2006, section 256B.056, is amended by adding a
subdivision to read:

new text begin Subd. 2a. new text end

new text begin Home equity limit for medical assistance payment of long-term care
services. new text end

new text begin (a) Effective for requests of medical assistance payment of long-term care
services filed on or after July 1, 2006, and for renewals on or after July 1, 2006, for
individuals who received payment of long-term care services under a request filed on or
after January 1, 2006, the equity interest in the home of an individual whose eligibility
for long-term care services is determined on or after January 1, 2006, shall not exceed
$500,000, unless it is the lawful residence of the individual's spouse or child who is under
age 21, or a child of any age who is blind or permanently and totally disabled as defined
in the Supplemental Security Income program. The amount specified in this paragraph
shall be increased beginning in year 2011, from year to year based on the percentage
increase in the Consumer Price Index for all urban consumers (all items; United States city
average), rounded to the nearest $1,000.
new text end

new text begin (b) For purposes of this subdivision, a "home" means any real or personal property
interest, including an agricultural homestead as defined under section 273.124, subdivision
1, owned by the individual requesting medical assistance payment of long-term care
services that is the primary dwelling of the individual or was the primary dwelling of the
individual before receipt of long-term care services began outside of the home.
new text end

new text begin (c) An individual denied or terminated from medical assistance payment of
long-term care services because the individual's home equity exceeds the home equity
limit may seek a waiver based upon a hardship by filing a written request with the county
agency. Hardship is an imminent threat to the individual's health and well-being that is
demonstrated by documentation of no alternatives for payment of long-term care services.
The county agency shall make a decision regarding the written request to waive the home
equity limit within 30 days if all necessary information has been provided. The county
agency shall send the individual and the individual's representative a written notice of
decision on the request for a demonstrated hardship waiver that also advises the client of
appeal rights under the fair hearing process of section 256.045.
new text end

Sec. 5.

Minnesota Statutes 2006, section 256B.056, subdivision 11, is amended to read:

Subd. 11.

Treatment of annuities.

(a) Any deleted text begin individual applying for or seeking
recertification of eligibility for deleted text end new text begin person requesting new text end medical assistance payment of long-term
care services shall provide a complete description of any interest either the deleted text begin individual deleted text end
new text begin person new text end or the deleted text begin individual's deleted text end new text begin person's new text end spouse has in annuities new text begin on a form designated by the
department. The form shall include a statement that the state becomes a preferred
remainder beneficiary of annuities or similar financial instruments by virtue of the receipt
of medical assistance payment of long-term care services new text end . The deleted text begin individual deleted text end new text begin person new text end and the
deleted text begin individual's deleted text end new text begin person's new text end spouse shall furnish the agency responsible for determining eligibility
with complete current copies of their annuities and related documents deleted text begin for review as part
of the application process on disclosure forms provided by the department as part of
their application deleted text end new text begin and complete the form designating the state as the preferred remainder
beneficiary for each annuity in which the person or the person's spouse has an interest new text end .

(b) deleted text begin The disclosure form shall include a statement that the department becomes the
remainder beneficiary under the annuity or similar financial instrument by virtue of the
receipt of medical assistance. deleted text end The deleted text begin disclosure form deleted text end new text begin department new text end shall deleted text begin include a deleted text end new text begin provide new text end
notice to the issuer of the department's right under this section as a preferred remainder
beneficiary under the annuity or similar financial instrument for medical assistance
furnished to the deleted text begin individual deleted text end new text begin person new text end or the deleted text begin individual's deleted text end new text begin person's new text end spouse, and deleted text begin require the
issuer to provide confirmation that a remainder beneficiary designation has been made
and to notify the county agency when there is a change in the amount of the income or
principal being withdrawn from the annuity or other similar financial instrument at the
time of the most recent disclosure required under this section. The individual and the
individual's spouse shall execute separate disclosure forms for each annuity or similar
financial instrument that they are required to disclose under this section and in which they
have an interest. deleted text end new text begin provide notice of the issuer's responsibilities as provided in paragraph (c).
new text end

(c) An issuer of an annuity or similar financial instrument who receives notice
deleted text begin on a disclosure form deleted text end new text begin of the state's right to be named a preferred remainder beneficiary new text end
as described in paragraph (b) shall provide confirmation to the requesting agency that
deleted text begin a remainder beneficiary designating deleted text end the state has been made deleted text begin and deleted text end new text begin a preferred remainder
beneficiary. The issuer new text end shall new text begin also new text end notify the county agency when deleted text begin there is deleted text end a change in the
amount of income or principal being withdrawn from the annuity or other similar financial
instrument new text begin or a change in the state's preferred remainder beneficiary designation under
the annuity or other similar financial instrument occurs new text end . The county agency shall provide
the issuer with the name, address, and telephone number of a unit within the department
that the issuer can contact to comply with this paragraph.

new text begin (d) "Preferred remainder beneficiary" for this subdivision and sections 256B.0594
and 256B.0595 means the state is a remainder beneficiary in the first position in an amount
equal to the amount of medical assistance paid on behalf of the institutionalized person, or
is a remainder beneficiary in the second position if the institutionalized person designates
and is survived by (1) a remainder beneficiary not receiving medical assistance payment
of long-term care services, (2) a minor child, or (3) a child of any age who is blind or
permanently and totally disabled as defined in the Supplemental Security Income program.
Notwithstanding this paragraph, the state is the remainder beneficiary in the first position
if the spouse or child disposes of the remainder for less than fair market value.
new text end

new text begin (e) For purposes of this subdivision, "institutionalized person" and "long-term care
services" have the meanings given in section 256B.0595, subdivision 1, paragraph (h).
new text end

new text begin (f) For purposes of this subdivision, "medical institution" has the meaning given in
section 256B.15, subdivision 1a, paragraph (b).
new text end

Sec. 6.

Minnesota Statutes 2006, section 256B.057, subdivision 1, is amended to read:

Subdivision 1.

Infants and pregnant women.

(a)(1) An infant less than one year of
age new text begin or a pregnant woman who has written verification of a positive pregnancy test from a
physician or licensed registered nurse new text end is eligible for medical assistance if countable family
income is equal to or less than 275 percent of the federal poverty guideline for the same
family size. deleted text begin A pregnant woman who has written verification of a positive pregnancy test
from a physician or licensed registered nurse is eligible for medical assistance if countable
family income is equal to or less than 200 percent of the federal poverty guideline for the
same family size. deleted text end For purposes of this subdivision, "countable family income" means the
amount of income considered available using the methodology of the AFDC program
under the state's AFDC plan as of July 16, 1996, as required by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193,
except for the earned income disregard and employment deductions.

(2) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to the effective date for any months in the six-month budget period before
that date and the income standards and methodologies in effect on the effective date for
any months in the six-month budget period on or after that date. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
2003, and the income standards and methodologies in effect on the expiration date for any
months in the six-month budget period on or after July 1, 2003. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

new text begin (3) An amount equal to the amount of earned income exceeding 275 percent of
the federal poverty guideline, up to a maximum of the amount by which the combined
total of 185 percent of the federal poverty guideline plus the earned income disregards
and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
pregnant women and infants less than one year of age.
new text end

(c) Dependent care and child support paid under court order shall be deducted from
the countable income of pregnant women.

(d) An infant born on or after January 1, 1991, to a woman who was eligible for and
receiving medical assistance on the date of the child's birth shall continue to be eligible for
medical assistance without redetermination until the child's first birthday, as long as the
child remains in the woman's household.

Sec. 7.

Minnesota Statutes 2006, section 256B.0571, subdivision 6, is amended to read:

Subd. 6.

Partnership policy.

"Partnership policy" means a long-term care insurance
policy that meets the requirements under subdivision 10 and was issued on or after the
effective date of the state plan amendment implementing the partnership program in
Minnesota. new text begin Policies that are exchanged or that have riders or endorsements added on or
after the effective date of the state plan amendment as authorized by the commissioner of
commerce qualify as a partnership policy.
new text end

Sec. 8.

Minnesota Statutes 2006, section 256B.0571, subdivision 9, is amended to read:

Subd. 9.

Medical assistance eligibility.

(a) Upon deleted text begin application deleted text end new text begin request new text end for medical
assistance program payment of long-term care services by an individual who meets the
requirements described in subdivision 8, the commissioner shall determine the individual's
eligibility for medical assistance according to paragraphs (b) to (i).

(b) After determining assets subject to the asset limit under section 256B.056,
subdivision 3 or 3c, or 256B.057, subdivision 9 or 10, the commissioner shall allow
the individual to designate assets to be protected from recovery under subdivisions 13
and 15 up to the dollar amount of the benefits utilized under the partnership policy.
Designated assets shall be disregarded for purposes of determining eligibility for payment
of long-term care services.

(c) The individual shall identify the designated assets and the full fair market value
of those assets and designate them as assets to be protected at the time of initial application
for medical assistance. The full fair market value of real property or interests in real
property shall be based on the most recent full assessed value for property tax purposes
for the real property, unless the individual provides a complete professional appraisal by
a licensed appraiser to establish the full fair market value. The extent of a life estate in
real property shall be determined using the life estate table in the health care program's
manual. Ownership of any asset in joint tenancy shall be treated as ownership as tenants
in common for purposes of its designation as a disregarded asset. The unprotected value
of any protected asset is subject to estate recovery according to subdivisions 13 and 15.

(d) The right to designate assets to be protected is personal to the individual and
ends when the individual dies, except as otherwise provided in subdivisions 13 and
15. It does not include the increase in the value of the protected asset and the income,
dividends, or profits from the asset. It may be exercised by the individual or by anyone
with the legal authority to do so on the individual's behalf. It shall not be sold, assigned,
transferred, or given away.

(e) If the dollar amount of the benefits utilized under a partnership policy is greater
than the full fair market value of all assets protected at the time of the application for
medical assistance long-term care services, the individual may designate additional assets
that become available during the individual's lifetime for protection under this section.
The individual must make the designation in writing deleted text begin to the county agency deleted text end no later than
deleted text begin the last date on which the individual must report a change in circumstances to the county
agency, as provided for under the medical assistance program deleted text end new text begin ten days from the date the
designation is requested by the county agency new text end . Any excess used for this purpose shall not
be available to the individual's estate to protect assets in the estate from recovery under
section 256B.15 or 524.3-1202, or otherwise.

(f) This section applies only to estate recovery under United States Code, title 42,
section 1396p, subsections (a) and (b), and does not apply to recovery authorized by other
provisions of federal law, including, but not limited to, recovery from trusts under United
States Code, title 42, section 1396p, subsection (d)(4)(A) and (C), or to recovery from
annuities, or similar legal instruments, subject to section 6012, subsections (a) and (b), of
the Deficit Reduction Act of 2005, Public Law 109-171.

(g) An individual's protected assets owned by the individual's spouse who applies
for payment of medical assistance long-term care services shall not be protected assets or
disregarded for purposes of eligibility of the individual's spouse solely because they were
protected assets of the individual.

(h) Assets designated under this subdivision shall not be subject to penalty under
section 256B.0595.

(i) The commissioner shall otherwise determine the individual's eligibility
for payment of long-term care services according to medical assistance eligibility
requirements.

Sec. 9.

Minnesota Statutes 2006, section 256B.058, is amended to read:

256B.058 TREATMENT OF INCOME OF INSTITUTIONALIZED SPOUSE.

Subdivision 1.

Income not available.

The income described in subdivisions 2 and 3
shall be deducted from an institutionalized spouse's monthly income and is not considered
available for payment of the monthly costs of an institutionalized deleted text begin person deleted text end new text begin spouse new text end in the
institution after deleted text begin the person has been deleted text end determined eligible for medical assistance.

Subd. 2.

Monthly income allowance for community spouse.

(a) For an
institutionalized spouse deleted text begin with a spouse residing in the community deleted text end , monthly income may be
allocated to the community spouse as a monthly income allowance for the community
spouse. Beginning with the first full calendar month the institutionalized spouse is
in the institution, the monthly income allowance is not considered available to the
institutionalized spouse for monthly payment of costs of care in the institution as long as
the income is made available to the community spouse.

(b) The monthly income allowance is the amount by which the community spouse's
monthly maintenance needs allowance under paragraphs (c) and (d) exceeds the amount
of monthly income otherwise available to the community spouse.

(c) The community spouse's monthly maintenance needs allowance is the lesser of
$1,500 or 122 percent of the monthly federal poverty guideline for a family of two plus
an excess shelter allowance. The excess shelter allowance is for the amount of shelter
expenses that exceed 30 percent of 122 percent of the federal poverty guideline line for a
family of two. Shelter expenses are the community spouse's expenses for rent, mortgage
payments including principal and interest, taxes, insurance, required maintenance charges
for a cooperative or condominium that is the community spouse's principal residence,
and the standard utility allowance under section 5(e) of the federal Food Stamp Act of
1977. If the community spouse has a required maintenance charge for a cooperative or
condominium, the standard utility allowance must be reduced by the amount of utility
expenses included in the required maintenance charge.

If the community or institutionalized spouse establishes that the community spouse
needs income greater than the monthly maintenance needs allowance determined in this
paragraph due to exceptional circumstances resulting in significant financial duress, the
monthly maintenance needs allowance may be increased to an amount that provides
needed additional income.

(d) The percentage of the federal poverty guideline used to determine the monthly
maintenance needs allowance in paragraph (c) is increased to 133 percent on July 1,
1991, and to 150 percent on July 1, 1992. Adjustments in the income limits due to annual
changes in the federal poverty guidelines shall be implemented the first day of July
following publication of the annual changes. The $1,500 maximum must be adjusted
January 1, 1990, and every January 1 after that by the same percentage increase in the
Consumer Price Index for all urban consumers (all items; United States city average)
between the two previous Septembers.

(e) If a court has entered an order against an institutionalized spouse for monthly
income for support of the community spouse, the community spouse's monthly income
allowance under this subdivision shall not be less than the amount of the monthly income
ordered.

Subd. 3.

Family allowance.

(a) A family allowance determined under paragraph
(b) is not considered available to the institutionalized spouse for monthly payment of costs
of care in the institution.

(b) The family allowance is equal to one-third of the amount by which 122 percent
of the monthly federal poverty guideline for a family of two exceeds the monthly income
for that family member.

(c) For purposes of this subdivision, the term family member only includes a
minor or dependent child new text begin as defined in the Internal Revenue Code new text end , dependent parent, or
dependent sibling of the institutionalized or community spouse if the sibling resides with
the community spouse.

(d) The percentage of the federal poverty guideline used to determine the family
allowance in paragraph (b) is increased to 133 percent on July 1, 1991, and to 150 percent
on July 1, 1992. Adjustments in the income limits due to annual changes in the federal
poverty guidelines shall be implemented the first day of July following publication of
the annual changes.

Subd. 4.

Treatment of income.

(a) No income of the community spouse will
be considered available to an eligible institutionalized spouse, beginning the first full
calendar month of institutionalization, except as provided in this subdivision.

(b) In determining the income of an institutionalized spouse or community spouse,
after the institutionalized spouse has been determined eligible for medical assistance,
the following rules apply.

(1) For income that is not from a trust, availability is determined according to items
(i) to (v), unless the instrument providing the income otherwise specifically provides:

(i) if payment is made solely in the name of one spouse, the income is considered
available only to that spouse;

(ii) if payment is made in the names of both spouses, one-half of the income is
considered available to each;

(iii) if payment is made in the names of one or both spouses together with one or
more other persons, the income is considered available to each spouse according to the
spouse's interest, or one-half of the joint interest is considered available to each spouse
if each spouse's interest is not specified;

(iv) if there is no instrument that establishes ownership, one-half of the income is
considered available to each spouse; and

(v) either spouse may rebut the determination of availability of income by showing
by a preponderance of the evidence that ownership interests are different than provided
above.

(2) For income from a trust, income is considered available to each spouse as
provided in the trust. If the trust does not specify an amount available to either or both
spouses, availability will be determined according to items (i) to (iii):

(i) if payment of income is made only to one spouse, the income is considered
available only to that spouse;

(ii) if payment of income is made to both spouses, one-half is considered available to
each; and

(iii) if payment is made to either or both spouses and one or more other persons,
the income is considered available to each spouse in proportion to each spouse's interest,
or if no such interest is specified, one-half of the joint interest is considered available
to each spouse.

Sec. 10.

Minnesota Statutes 2006, section 256B.059, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section and deleted text begin section deleted text end new text begin sections
256B.058 and new text end 256B.0595, the terms defined in this subdivision have the meanings given
them.

(b) "Community spouse" means the spouse of an institutionalized spouse.

(c) "Spousal share" means one-half of the total value of all assets, to the extent that
either the institutionalized spouse or the community spouse had an ownership interest at
the time of new text begin the first continuous period of new text end institutionalization.

(d) "Assets otherwise available to the community spouse" means assets individually
or jointly owned by the community spouse, other than assets excluded by subdivision 5,
paragraph (c).

(e) "Community spouse asset allowance" is the value of assets that can be transferred
under subdivision 3.

(f) "Institutionalized spouse" means a person who is:

(1) in a hospital, nursing facility, or intermediate care facility for persons with
developmental disabilities, or receiving home and community-based services under
section 256B.0915 deleted text begin or 256B.49 deleted text end , and is expected to remain in the facility or institution or
receive the home and community-based services for at least 30 consecutive days; and

(2) married to a person who is not in a hospital, nursing facility, or intermediate
care facility for persons with developmental disabilities, and is not receiving home and
community-based services under section 256B.0915 or 256B.49.

(g) "For the sole benefit of" means no other individual or entity can benefit in any
way from the assets or income at the time of a transfer or at any time in the future.

new text begin (h) "Continuous period of institutionalization" means a 30-consecutive-day period
of time in which a person is expected to stay in a medical or long-term care facility,
or receive home and community-based services that would qualify for coverage under
the elderly waiver (EW) or alternative care (AC) programs. For a stay in a facility, the
30-consecutive-day period begins on the date of entry into a medical or long-term care
facility. For receipt of home and community-based services, the 30-consecutive-day
period begins on the date that the following conditions are met:
new text end

new text begin (1) the person is receiving services that meet the nursing facility level of care
determined by a long-term care consultation;
new text end

new text begin (2) the person has received the long-term care consultation within the past 60 days;
new text end

new text begin (3) the services are paid by the EW program under section 256B.0915 or the AC
program under section 256B.0913 or would qualify for payment under the EW or AC
programs if the person were otherwise eligible for either program, and but for the receipt
of such services the person would have resided in a nursing facility; and
new text end

new text begin (4) the services are provided by a licensed provider qualified to provide home and
community-based services.
new text end

Sec. 11.

Minnesota Statutes 2006, section 256B.059, subdivision 1a, is amended to
read:

Subd. 1a.

Institutionalized spouse.

The provisions of this section apply only
when a spouse deleted text begin is institutionalized for a deleted text end new text begin begins the first new text end continuous period deleted text begin beginning deleted text end new text begin of
institutionalization new text end on or after October 1, 1989.

Sec. 12.

Minnesota Statutes 2006, section 256B.0594, is amended to read:

256B.0594 PAYMENT OF BENEFITS FROM AN ANNUITY.

When payment becomes due under an annuity that names the department a
remainder beneficiary deleted text begin as described in section 256B.056, subdivision 11 deleted text end , the issuer shall
request and the department shall, within 45 days after receipt of the request, provide
a written statement of the total amount of the medical assistance paid new text begin or confirmation
that any family member designated as a remainder beneficiary meets requirements for
qualification as a beneficiary in the first position new text end . Upon timely receipt of the written
statement of the amount of medical assistance paid, the issuer shall pay the department an
amount equal to the lesser of the amount due the department under the annuity or the total
amount of medical assistance paid on behalf of the individual or the individual's spouse.
Any amounts remaining after the issuer's payment to the department shall be payable
according to the terms of the annuity or similar financial instrument. The county agency
or the department shall provide the issuer with the name, address, and telephone number
of a unit within the department the issuer can contact to comply with this section. The
requirements of section 72A.201, subdivision 4, clause (3), shall not apply to payments
made under this section until the issuer has received final payment information from the
department, if the issuer has notified the beneficiary of the requirements of this section at
the time it initially requests payment information from the department.

Sec. 13.

Minnesota Statutes 2006, section 256B.0595, subdivision 1, is amended to
read:

Subdivision 1.

Prohibited transfers.

(a) For transfers of assets made on or before
August 10, 1993, if deleted text begin a deleted text end new text begin an institutionalized new text end person or the new text begin institutionalized new text end person's spouse
has given away, sold, or disposed of, for less than fair market value, any asset or interest
therein, except assets other than the homestead that are excluded under the supplemental
security program, within 30 months before or any time after the date of institutionalization
if the person has been determined eligible for medical assistance, or within 30 months
before or any time after the date of the first approved application for medical assistance
if the person has not yet been determined eligible for medical assistance, the person is
ineligible for long-term care services for the period of time determined under subdivision
2.

(b) Effective for transfers made after August 10, 1993, deleted text begin a deleted text end new text begin an institutionalized new text end person,
deleted text begin a deleted text end new text begin an institutionalized new text end person's spouse, or any person, court, or administrative body with
legal authority to act in place of, on behalf of, at the direction of, or upon the request of the
new text begin institutionalized new text end person or new text begin institutionalized new text end person's spouse, may not give away, sell, or
dispose of, for less than fair market value, any asset or interest therein, except assets other
than the homestead that are excluded under the supplemental security income program,
for the purpose of establishing or maintaining medical assistance eligibility. This applies
to all transfers, including those made by a community spouse after the month in which
the institutionalized spouse is determined eligible for medical assistance. For purposes of
determining eligibility for long-term care services, any transfer of such assets within 36
months before or any time after an institutionalized person deleted text begin applies for deleted text end new text begin requests new text end medical
assistance new text begin payment of long-term care services new text end , or 36 months before or any time after a
medical assistance recipient becomes institutionalized, for less than fair market value
may be considered. Any such transfer is presumed to have been made for the purpose
of establishing or maintaining medical assistance eligibility and the new text begin institutionalized new text end
person is ineligible for long-term care services for the period of time determined under
subdivision 2, unless the new text begin institutionalized new text end person furnishes convincing evidence to
establish that the transaction was exclusively for another purpose, or unless the transfer
is permitted under subdivision 3 or 4. In the case of payments from a trust or portions
of a trust that are considered transfers of assets under federal law, or in the case of any
other disposal of assets made on or after February 8, 2006, any transfers made within 60
months before or any time after an institutionalized person deleted text begin applies for deleted text end new text begin requests new text end medical
assistance new text begin payment of long-term care services new text end and within 60 months before or any time
after a medical assistance recipient becomes institutionalized, may be considered.

(c) This section applies to transfers, for less than fair market value, of income
or assets, including assets that are considered income in the month received, such as
inheritances, court settlements, and retroactive benefit payments or income to which the new text begin
institutionalized new text end person or the new text begin institutionalized new text end person's spouse is entitled but does not
receive due to action by the new text begin institutionalized new text end person, the new text begin institutionalized new text end person's spouse,
or any person, court, or administrative body with legal authority to act in place of, on
behalf of, at the direction of, or upon the request of the new text begin institutionalized new text end person or the new text begin
institutionalized new text end person's spouse.

(d) This section applies to payments for care or personal services provided by a
relative, unless the compensation was stipulated in a notarized, written agreement which
was in existence when the service was performed, the care or services directly benefited
the person, and the payments made represented reasonable compensation for the care
or services provided. A notarized written agreement is not required if payment for the
services was made within 60 days after the service was provided.

(e) This section applies to the portion of any asset or interest that deleted text begin a deleted text end new text begin an institutionalized new text end
person, deleted text begin a deleted text end new text begin an institutionalized new text end person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the direction of, or upon the request
of the new text begin institutionalized new text end person or the new text begin institutionalized new text end person's spouse, transfers to any
annuity that exceeds the value of the benefit likely to be returned to the new text begin institutionalized
new text end person or new text begin institutionalized person's new text end spouse while alive, based on estimated life expectancy
using the life expectancy tables employed by the supplemental security income program
to determine the value of an agreement for services for life. The commissioner may adopt
rules reducing life expectancies based on the need for long-term care. This section applies
to an annuity described in this paragraph purchased on or after March 1, 2002, that:

(1) is not purchased from an insurance company or financial institution that is
subject to licensing or regulation by the Minnesota Department of Commerce or a similar
regulatory agency of another state;

(2) does not pay out principal and interest in equal monthly installments; or

(3) does not begin payment at the earliest possible date after annuitization.

(f) Effective for transactions, including the purchase of an annuity, occurring on
or after February 8, 2006, deleted text begin the purchase of an annuity deleted text end by or on behalf of an deleted text begin individual deleted text end new text begin
institutionalized person new text end who has applied for or is receiving long-term care services or the
deleted text begin individual's deleted text end new text begin institutionalized person's new text end spouse shall be treated as the disposal of an asset for
less than fair market value unless the department is named deleted text begin as the deleted text end new text begin a preferred new text end remainder
beneficiary deleted text begin in first position for an amount equal to at least the total amount of medical
assistance paid on behalf of the individual or the individual's spouse; or the department
is named as the remainder beneficiary in second position for an amount equal to at least
the total amount of medical assistance paid on behalf of the individual or the individual's
spouse after the individual's community spouse or minor or disabled child and is named as
the remainder beneficiary in the first position if the community spouse or a representative
of the minor or disabled child disposes of the remainder for less than fair market value deleted text end new text begin as
described in section 256B.056, subdivision 11 new text end . Any subsequent change to the designation
of the department as a new text begin preferred new text end remainder beneficiary shall result in the annuity being
treated as a disposal of assets for less than fair market value. The amount of such transfer
shall be the maximum amount the deleted text begin individual deleted text end new text begin institutionalized person new text end or the deleted text begin individual's deleted text end new text begin
institutionalized person's new text end spouse could receive from the annuity or similar financial
instrument. Any change in the amount of the income or principal being withdrawn
from the annuity or other similar financial instrument at the time of the most recent
disclosure shall be deemed to be a transfer of assets for less than fair market value unless
the deleted text begin individual deleted text end new text begin institutionalized person new text end or the deleted text begin individual's deleted text end new text begin institutionalized person's new text end spouse
demonstrates that the transaction was for fair market value. new text begin In the event a distribution
of income or principal has been improperly distributed or disbursed from an annuity or
other retirement planning instrument of an institutionalized person or the institutionalized
person's spouse, a cause of action exists against the individual receiving the improper
distribution for the cost of medical assistance services provided or the amount of the
improper distribution, whichever is less. The action may be brought by the state or the
local agency responsible for providing medical assistance under chapter 256B.
new text end

(g) Effective for transactions, including the purchase of an annuity, occurring on
or after February 8, 2006, deleted text begin the purchase of an annuity deleted text end by or on behalf of an deleted text begin individual deleted text end new text begin
institutionalized person new text end applying for or receiving long-term care services shall be treated
as a disposal of assets for less than fair market value unless it is:

(i) an annuity described in subsection (b) or (q) of section 408 of the Internal
Revenue Code of 1986; or

(ii) purchased with proceeds from:

(A) an account or trust described in subsection (a), (c), or (p) of section 408 of the
Internal Revenue Code;

(B) a simplified employee pension within the meaning of section 408(k) of the
Internal Revenue Code; or

(C) a Roth IRA described in section 408A of the Internal Revenue Code; or

(iii) an annuity that is irrevocable and nonassignable; is actuarially sound as
determined in accordance with actuarial publications of the Office of the Chief Actuary of
the Social Security Administration; and provides for payments in equal amounts during
the term of the annuity, with no deferral and no balloon payments made.

(h) For purposes of this section, long-term care services include services in a nursing
facility, services that are eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care facility for persons with
developmental disabilities, and home and community-based services provided pursuant
to sections 256B.0915, 256B.092, and 256B.49. For purposes of this subdivision and
subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient
in a nursing facility or in a swing bed, or intermediate care facility for persons with
developmental disabilities or who is receiving home and community-based services under
sections 256B.0915, 256B.092, and 256B.49.

(i) This section applies to funds used to purchase a promissory note, loan, or
mortgage unless the note, loan, or mortgage:

(1) has a repayment term that is actuarially sound;

(2) provides for payments to be made in equal amounts during the term of the loan,
with no deferral and no balloon payments made; and

(3) prohibits the cancellation of the balance upon the death of the lender.

In the case of a promissory note, loan, or mortgage that does not meet an exception
in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding
balance due as of the date of the deleted text begin individual's application deleted text end new text begin institutionalized person's request
new text end for new text begin medical assistance payment of new text end long-term care services.

(j) This section applies to the purchase of a life estate interest in another deleted text begin individual's deleted text end
new text begin person's new text end home unless the purchaser resides in the home for a period of at least one year
after the date of purchase.

Sec. 14.

Minnesota Statutes 2006, section 256B.0595, subdivision 2, is amended to
read:

Subd. 2.

Period of ineligibility.

(a) For any uncompensated transfer occurring on or
before August 10, 1993, the number of months of ineligibility for long-term care services
shall be the lesser of 30 months, or the uncompensated transfer amount divided by the
average medical assistance rate for nursing facility services in the state in effect on the
date of application. The amount used to calculate the average medical assistance payment
rate shall be adjusted each July 1 to reflect payment rates for the previous calendar year.
The period of ineligibility begins with the month in which the assets were transferred.
If the transfer was not reported to the local agency at the time of application, and the
applicant received long-term care services during what would have been the period of
ineligibility if the transfer had been reported, a cause of action exists against the transferee
for the cost of long-term care services provided during the period of ineligibility, or for the
uncompensated amount of the transfer, whichever is less. The action may be brought by
the state or the local agency responsible for providing medical assistance under chapter
256G. The uncompensated transfer amount is the fair market value of the asset at the time
it was given away, sold, or disposed of, less the amount of compensation received.

(b) For uncompensated transfers made after August 10, 1993, the number of months
of ineligibility for long-term care services shall be the total uncompensated value of the
resources transferred divided by the average medical assistance rate for nursing facility
services in the state in effect on the date of application. The amount used to calculate the
average medical assistance payment rate shall be adjusted each July 1 to reflect payment
rates for the previous calendar year. The period of ineligibility begins with the first day
of the month after the month in which the assets were transferred except that if one or
more uncompensated transfers are made during a period of ineligibility, the total assets
transferred during the ineligibility period shall be combined and a penalty period calculated
to begin on the first day of the month after the month in which the first uncompensated
transfer was made. If the transfer was reported to the local agency after the date that
advance notice of a period of ineligibility that affects the next month could be provided to
the recipient and the recipient received medical assistance services or the transfer was not
reported to the local agency, and the applicant or recipient received medical assistance
services during what would have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for the cost of medical assistance
services provided during the period of ineligibility, or for the uncompensated amount of
the transfer, whichever is less. The action may be brought by the state or the local agency
responsible for providing medical assistance under chapter 256G. The uncompensated
transfer amount is the fair market value of the asset at the time it was given away, sold, or
disposed of, less the amount of compensation received. Effective for transfers made on or
after March 1, 1996, involving persons who apply for medical assistance on or after April
13, 1996, no cause of action exists for a transfer unless:

(1) the transferee knew or should have known that the transfer was being made by a
person who was a resident of a long-term care facility or was receiving that level of care in
the community at the time of the transfer;

(2) the transferee knew or should have known that the transfer was being made to
assist the person to qualify for or retain medical assistance eligibility; or

(3) the transferee actively solicited the transfer with intent to assist the person to
qualify for or retain eligibility for medical assistance.

(c) For uncompensated transfers made on or after February 8, 2006, the period
of ineligibility new text begin :
new text end

new text begin (1) for uncompensated transfers by or on behalf of individuals receiving medical
assistance payment of long-term care services, new text end begins deleted text begin on deleted text end the first day of the month
deleted text begin in which deleted text end new text begin following new text end advance notice deleted text begin can be given following deleted text end new text begin of the penalty period, but no
later than the first day of new text end the month deleted text begin in which assets have been transferred for less than
fair market value, deleted text end new text begin that follows three full calendar months from the date of the report
or discovery of the transfer; new text end or

new text begin (2) for uncompensated transfers by individuals requesting medical assistance
payment of long-term care services, begins new text end the date on which the individual is eligible
for medical assistance under the Medicaid state plan and would otherwise be receiving
long-term care services based on an approved application for such care but for the
application of the penalty period, deleted text begin whichever is later, deleted text end new text begin ; new text end and deleted text begin which does not occur deleted text end

new text begin (3) cannot begin new text end during any other period of ineligibility.

(d) If a calculation of a penalty period results in a partial month, payments for
long-term care services shall be reduced in an amount equal to the fraction.

(e) In the case of multiple fractional transfers of assets in more than one month for
less than fair market value on or after February 8, 2006, the period of ineligibility is
calculated by treating the total, cumulative, uncompensated value of all assets transferred
during all months on or after February 8, 2006, as one transfer.

Sec. 15.

Minnesota Statutes 2006, section 256B.0595, subdivision 3, is amended to
read:

Subd. 3.

Homestead exception to transfer prohibition.

(a) An institutionalized
person is not ineligible for long-term care services due to a transfer of assets for less than
fair market value if the asset transferred was a homestead and:

(1) title to the homestead was transferred to the individual's:

(i) spouse;

(ii) child who is under age 21;

(iii) blind or permanently and totally disabled child as defined in the supplemental
security income program;

(iv) sibling who has equity interest in the home and who was residing in the home
for a period of at least one year immediately before the date of the individual's admission
to the facility; or

(v) son or daughter who was residing in the individual's home for a period of at least
two years immediately before the date deleted text begin of the individual's admission to the facility deleted text end new text begin the
individual became an institutionalized person new text end , and who provided care to the individual
that, as certified by the individual's attending physician, permitted the individual to
reside at home rather than new text begin receive care new text end in an institution or facility new text begin , or from home and
community-based services under sections 256B.0915, 256B.092, and 256B.49 new text end ;

(2) a satisfactory showing is made that the individual intended to dispose of the
homestead at fair market value or for other valuable consideration; or

(3) the local agency grants a waiver of a penalty resulting from a transfer for less
than fair market value because denial of eligibility would cause undue hardship for the
individual, based on imminent threat to the individual's health and well-being. Whenever
an applicant or recipient is denied eligibility because of a transfer for less than fair market
value, the local agency shall notify the applicant or recipient that the applicant or recipient
may request a waiver of the penalty if the denial of eligibility will cause undue hardship.
With the written consent of the individual or the personal representative of the individual,
a long-term care facility in which an individual is residing may file an undue hardship
waiver request, on behalf of the individual who is denied eligibility for long-term care
services on or after July 1, 2006, due to a period of ineligibility resulting from a transfer on
or after February 8, 2006. In evaluating a waiver, the local agency shall take into account
whether the individual was the victim of financial exploitation, whether the individual has
made reasonable efforts to recover the transferred property or resource, and other factors
relevant to a determination of hardship. If the local agency does not approve a hardship
waiver, the local agency shall issue a written notice to the individual stating the reasons
for the denial and the process for appealing the local agency's decision.

(b) When a waiver is granted under paragraph (a), clause (3), a cause of action exists
against the person to whom the homestead was transferred for that portion of long-term
care services granted within:

(1) 30 months of a transfer made on or before August 10, 1993;

(2) 60 months if the homestead was transferred after August 10, 1993, to a trust or
portion of a trust that is considered a transfer of assets under federal law;

(3) 36 months if transferred in any other manner after August 10, 1993, but prior
to February 8, 2006; or

(4) 60 months if the homestead was transferred on or after February 8, 2006,

or the amount of the uncompensated transfer, whichever is less, together with the
costs incurred due to the action. The action shall be brought by the state unless the
state delegates this responsibility to the local agency responsible for providing medical
assistance under chapter 256G.

Sec. 16.

Minnesota Statutes 2006, section 256B.0595, subdivision 4, is amended to
read:

Subd. 4.

Other exceptions to transfer prohibition.

An institutionalized person
who has made, or whose spouse has made a transfer prohibited by subdivision 1, is not
ineligible for long-term care services if one of the following conditions applies:

(1) the assets were transferred to the individual's spouse or to another for the sole
benefit of the spouse; or

(2) the institutionalized spouse, prior to being institutionalized, transferred assets
to a spouse, provided that the spouse to whom the assets were transferred does not then
transfer those assets to another person for less than fair market value. (At the time when
one spouse is institutionalized, assets must be allocated between the spouses as provided
under section 256B.059); or

(3) the assets were transferred to the individual's child who is blind or permanently
and totally disabled as determined in the supplemental security income program; or

(4) a satisfactory showing is made that the individual intended to dispose of the
assets either at fair market value or for other valuable consideration; or

(5) the local agency determines that denial of eligibility for long-term care services
would work an undue hardship and grants a waiver of a penalty resulting from a transfer
for less than fair market value based on an imminent threat to the individual's health
and well-being. Whenever an applicant or recipient is denied eligibility because of a
transfer for less than fair market value, the local agency shall notify the applicant or
recipient that the applicant or recipient may request a waiver of the penalty if the denial of
eligibility will cause undue hardship. With the written consent of the individual or the
personal representative of the individual, a long-term care facility in which an individual
is residing may file an undue hardship waiver request, on behalf of the individual who
is denied eligibility for long-term care services on or after July 1, 2006, due to a period
of ineligibility resulting from a transfer on or after February 8, 2006. In evaluating a
waiver, the local agency shall take into account whether the individual was the victim of
financial exploitation, whether the individual has made reasonable efforts to recover the
transferred property or resource, whether the individual has taken any action to prevent
the designation of the department as a remainder beneficiary on an annuity as described
in section 256B.056, subdivision 11, and other factors relevant to a determination of
hardship. new text begin The local agency shall make a determination within 30 days of the receipt of all
necessary information needed to make such a determination. new text end If the local agency does not
approve a hardship waiver, the local agency shall issue a written notice to the individual
stating the reasons for the denial and the process for appealing the local agency's decision.
When a waiver is granted, a cause of action exists against the person to whom the assets
were transferred for that portion of long-term care services granted within:

(i) 30 months of a transfer made on or before August 10, 1993;

(ii) 60 months of a transfer if the assets were transferred after August 30, 1993, to a
trust or portion of a trust that is considered a transfer of assets under federal law;

(iii) 36 months of a transfer if transferred in any other manner after August 10, 1993,
but prior to February 8, 2006; or

(iv) 60 months of any transfer made on or after February 8, 2006,

or the amount of the uncompensated transfer, whichever is less, together with the
costs incurred due to the action. The action shall be brought by the state unless the
state delegates this responsibility to the local agency responsible for providing medical
assistance under this chapter; or

(6) for transfers occurring after August 10, 1993, the assets were transferred by
the person or person's spouse: (i) into a trust established for the sole benefit of a son or
daughter of any age who is blind or disabled as defined by the Supplemental Security
Income program; or (ii) into a trust established for the sole benefit of an individual who is
under 65 years of age who is disabled as defined by the Supplemental Security Income
program.

"For the sole benefit of" has the meaning found in section 256B.059, subdivision 1.

Sec. 17.

Minnesota Statutes 2006, section 256B.0625, subdivision 5a, is amended to
read:

Subd. 5a.

Services for children with autism spectrum disorders.

(a) new text begin Subject
to federal approval, new text end medical assistance covers home-based intensive early intervention
behavior therapy for children with autism spectrum disorders, effective July 1, 2007.
Children with autism spectrum disorder, and their custodial parents or foster parents, may
access other covered services to treat autism spectrum disorder, and are not required to
receive intensive early intervention behavior therapy services under this subdivision.

(b) Intensive early intervention behavior therapy does not include coverage for
services to treat developmental disorders of language, early onset psychosis, Rett's
disorder, selective mutism, social anxiety disorder, stereotypic movement disorder,
dementia, obsessive compulsive disorder, schizoid personality disorder, avoidant
personality disorder, or reactive attachment disorder.

(c) If a child with autism spectrum disorder is diagnosed to have one or more of
these conditions, intensive early intervention behavior therapy includes coverage only for
services necessary to treat the autism spectrum disorder.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 18.

Minnesota Statutes 2006, section 256B.0625, subdivision 5j, is amended to
read:

Subd. 5j.

Payment rates.

The following payment rates apply:

(1) for an IEIBTS clinical supervisor practitioner under supervision of a mental
health professional, the lower of the submitted charge or $67 per hour unit;

(2) for an IEIBTS senior behavior therapist practitioner under supervision of a
mental health professional, the lower of the submitted charge or $37 per hour unit; or

(3) for an IEIBTS behavior therapist practitioner under supervision of a mental
health professional, the lower of the submitted charge or $27 per hour unit.

An IEIBTS practitioner may receive payment for travel time which exceeds 50 minutes
one-way. The maximum payment allowed will be $0.51 per minute for up to a maximum
of 300 hours per year.

For any week during which the above charges are made to medical assistance,
payments for the following services are excluded: supervising mental health professional
hours deleted text begin and deleted text end new text begin , new text end personal care attendant, deleted text begin home-based mental health, family-community support deleted text end new text begin
children's therapeutic services and supports new text end , or mental health behavioral aide hours.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 19.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 49. new text end

new text begin Lead risk assessment services. new text end

new text begin (a) Effective July 1, 2007, or six months
after federal approval, whichever is later, medical assistance covers lead risk assessment
provided by a lead risk assessor, who is licensed by the commissioner of health as defined
in section 144.9505 and employed by an assessing agency as defined in section 144.9501.
Medical assistance covers one lead risk assessment per case to enrolled individuals under
age 21 who have a venous blood lead level of 15 micrograms per deciliter or higher.
Medical assistance coverage of lead risk assessments is not included in the capitated
services for children enrolled in health plans through the prepaid medical assistance
program and the MinnesotaCare program.
new text end

new text begin (b) A medical assistance covered lead risk assessment is defined as a onetime,
on-site investigation of the child's home or primary residence to determine the existence of
lead. Medical assistance reimbursement covers the lead risk assessor's time to complete
the following activities: gathering samples, interviewing family members, gathering data
including meter readings, and providing a report with the results of the investigation and
options for reducing lead-based paint hazards. Medical assistance coverage of lead risk
assessment does not include testing of environmental substances such as water, paint,
soil, or any laboratory services.
new text end

new text begin (c) Payment for lead risk assessment must be cost-based and must meet the criteria
for federal financial participation under the Medicaid program. The rate must be based on
allowable expenditures from cost information gathered. Pursuant to section 144.9507,
subdivision 5, federal medical assistance funds may not replace existing funding for
lead-related activities. The nonfederal share of costs for services provided under this
subdivision must be from state or local funds and is the responsibility of the agency
providing the risk assessment. Eligible expenditures for the nonfederal share of costs may
not be made from federal funds or funds used to match other federal funds. Any federal
disallowances are the responsibility of the agency providing risk assessment services.
new text end

Sec. 20.

Minnesota Statutes 2006, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) Each demonstration provider shall be responsible for
the health care coordination for eligible individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered
to enrollees; new text begin notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section will provide relocation
service coordination to enrolled persons age 65 and over;
new text end

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated health care services for eligible
individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide
services to enrollees; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

Sec. 21.

Minnesota Statutes 2006, section 256B.69, subdivision 23, is amended to read:

Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations and may contract with
Medicare-approved special needs plans to provide Medicaid services. Medicare funds and
services shall be administered according to the terms and conditions of the federal contract
and demonstration provisions. For the purpose of administering medical assistance funds,
demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations,
with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1,
items B and C, which do not apply to persons enrolling in demonstrations under this
section. An initial open enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
the health plan's participation is subsequently terminated for any reason, the person shall
be provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons
required to participate in health plans under this section who fail to make a choice of
health plan shall not be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
the commissioner may contract with managed care organizations, including counties, to
serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
disabled persons only. For persons with a primary diagnosis of developmental disability,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with a primary diagnosis of developmental disabilities, serious and persistent
mental illness, or serious emotional disturbance, without approval of the county board of
the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for developmental
disabilities, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by
the federal government. Case management and active treatment must be individualized
and developed in accordance with a person-centered plan. Costs under these projects may
not exceed costs that would have been incurred under fee-for-service. Beginning July 1,
2003, and until deleted text begin two deleted text end new text begin four new text end years after the pilot project implementation date, subcontractor
participation in the long-term care developmental disability pilot is limited to a nonprofit
long-term care system providing ICF/MR services, home and community-based waiver
services, and in-home services to no more than 120 consumers with developmental
disabilities in Carver, Hennepin, and Scott Counties. The commissioner shall report to the
legislature prior to expansion of the developmental disability pilot project. This paragraph
expires deleted text begin two deleted text end new text begin four new text end years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas
of the state. Until January 1, 2008, expansion for MnDHO projects that include home
and community-based services is limited to the two projects and service areas in effect
on March 1, 2006. Enrollment in integrated MnDHO programs that include home and
community-based services shall remain voluntary. Costs for home and community-based
services included under MnDHO must not exceed costs that would have been incurred
under the fee-for-service program. In developing program specifications for expansion of
integrated programs, the commissioner shall involve and consult the state-level stakeholder
group established in subdivision 28, paragraph (d), including consultation on whether and
how to include home and community-based waiver programs. Plans for further expansion
of MnDHO projects shall be presented to the chairs of the house and senate committees
with jurisdiction over health and human services policy and finance by February 1, 2007.

(g) Notwithstanding section , health plans providing services
under this section are responsible for home care targeted case management and relocation
targeted case management. Services must be provided according to the terms of the
waivers and contracts approved by the federal government.

Sec. 22.

Minnesota Statutes 2006, section 256B.69, subdivision 27, is amended to read:

Subd. 27.

Information for persons with limited English-language proficiency.

Managed care contracts entered into under this section and sections 256D.03, subdivision
4, paragraph (c), and 256L.12 must require demonstration providers to deleted text begin inform enrollees
that upon request the enrollee can obtain a certificate of coverage in the following
languages: Spanish, Hmong, Laotian, Russian, Somali, Vietnamese, or Cambodian.
Upon request, the demonstration provider must provide the enrollee with a certificate of
coverage in the specified language of preference deleted text end new text begin provide language assistance to enrollees
that ensures meaningful access to its programs and services according to Title VI of the
Civil Rights Act and federal regulations adopted under that law or any guidance from the
United States Department of Health and Human Services new text end .

Sec. 23.

Minnesota Statutes 2006, section 256D.03, subdivision 3, is amended to read:

Subd. 3.

General assistance medical care; eligibility.

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

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

(2) who is a resident of Minnesota; and

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

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

(iii) the commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.

(b) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (e).

(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
subdivision 7, with covered services as provided in section 256L.03 for the rest of the
six-month eligibility period, until their six-month renewal.

(d) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (c), an individual must complete a new
application.

(e) new text begin The following new text end applicants and recipients eligible under paragraph (a), clause (1) deleted text begin ; deleted text end new text begin ,
are exempt from the MinnesotaCare enrollment requirements in this subdivision new text end who new text begin :
new text end

new text begin (1) new text end have applied for and are awaiting a determination of blindness or disability by
the state medical review team or a determination of eligibility for Supplemental Security
Income or Social Security Disability Insurance by the Social Security Administration; deleted text begin who
deleted text end

new text begin (2) new text end fail to meet the requirements of section 256L.09, subdivision 2; deleted text begin who
deleted text end

new text begin (3) new text end are classified as end-stage renal disease beneficiaries in the Medicare program;
deleted text begin who
deleted text end

new text begin (4) new text end are enrolled in private health care coverage as defined in section 256B.02,
subdivision 9; deleted text begin who
deleted text end

new text begin (5) new text end are eligible under paragraph (j); deleted text begin or who
deleted text end

new text begin (6) new text end receive treatment funded pursuant to section 254B.02 new text begin ; or new text end

deleted text begin are exempt from the MinnesotaCare enrollment requirements of this subdivision deleted text end new text begin (7)
reside in the Minnesota sex offender program defined in chapter 246B new text end .

(f) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.

(g) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).

(h) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
county agency must assist the applicant in obtaining verification if necessary.

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

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

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

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

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

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

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

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 24.

Minnesota Statutes 2006, section 256L.035, is amended to read:

256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE
ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.

(a) "Covered health services" for individuals under section 256L.04, subdivision
7, with income above 75 percent, but not exceeding 175 percent, of the federal poverty
guideline means:

(1) inpatient hospitalization benefits with a ten percent co-payment up to $1,000 and
subject to an annual limitation of $10,000;

(2) physician services provided during an inpatient stay; and

(3) physician services not provided during an inpatient stay; outpatient hospital
services; freestanding ambulatory surgical center services; chiropractic services; lab and
diagnostic services; diabetic supplies and equipment; and prescription drugs; subject to
the following co-payments:

(i) $50 co-pay per emergency room visit;

(ii) $3 co-pay per prescription drug; and

(iii) $5 co-pay per nonpreventive visit.

The services covered under this section may be provided by a physician, physician
ancillary, chiropractor, psychologist, or licensed independent clinical social worker if the
services are within the scope of practice of that health care professional.

For purposes of this section, "a visit" means an episode of service which is required
because of a recipient's symptoms, diagnosis, or established illness, and which is delivered
in an ambulatory setting by any health care provider identified in this paragraph.

Enrollees are responsible for all co-payments in this section.

(b) Reimbursement to the providers shall be reduced by the amount of the
co-payment, except that reimbursement for prescription drugs shall not be reduced once a
recipient has reached the $20 per month maximum for prescription drug co-payments.
The provider collects the co-payment from the recipient. Providers may not deny services
to recipients who are unable to pay the co-payment, except as provided in paragraph (c).

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

new text begin (d) MinnesotaCare does not cover drugs that are coverable under Medicare Part D as
defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003,
Public Law 108-173, section 1860D-2(e), for individuals eligible for drug coverage as
defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003,
Public Law 108-173, section 1860D-1(a)(3)(A). For these individuals, MinnesotaCare
may cover drugs from the drug classes listed in United States Code, title 42, section
1396r-8(d)(2), subject to this subdivision and subdivisions 13a to 13g, except that drugs
listed in United States Code, title 42, section 1396r-8(d)(2)(E), are not covered.
new text end

Sec. 25. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256B.0571, subdivision 8a, new text end new text begin is repealed.
new text end