as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am
|Introduction||Posted on 02/19/2004|
1.1 A bill for an act 1.2 relating to health care; modifying premium rate 1.3 restrictions; modifying cost containment provisions; 1.4 providing for an electronic medical record system; 1.5 modifying certain loan forgiveness programs; modifying 1.6 medical assistance, general assistance medical care 1.7 and MinnesotaCare programs; authorizing the sale of 1.8 bonds; requiring reports; appropriating money; 1.9 amending Minnesota Statutes 2002, sections 62A.65, 1.10 subdivision 3; 62J.04, by adding a subdivision; 1.11 62J.301, subdivision 3; 62J.38; 62L.08, subdivision 8; 1.12 256.9693; 256B.03, subdivision 3; 256B.0625, 1.13 subdivision 3b, by adding a subdivision; Minnesota 1.14 Statutes 2003 Supplement, sections 62J.04, subdivision 1.15 3; 62J.692, subdivision 3; 144.1501, subdivisions 2, 1.16 4; 256.954, subdivisions 4, 6, 10; 256B.061; 1.17 256B.0625, subdivision 9; 256B.69, subdivision 2; 1.18 256D.03, subdivisions 3, 4; 256L.03, subdivision 1; 1.19 256L.05, subdivision 4; 256L.07, subdivision 1; 1.20 256L.12, subdivision 6; proposing coding for new law 1.21 in Minnesota Statutes, chapters 62J; 62Q; 256B; 256L; 1.22 repealing Minnesota Statutes 2003 Supplement, sections 1.23 256.954, subdivision 12; 256B.0631; 256L.035. 1.24 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.25 Section 1. Minnesota Statutes 2002, section 62A.65, 1.26 subdivision 3, is amended to read: 1.27 Subd. 3. [PREMIUM RATE RESTRICTIONS.] No individual health 1.28 plan may be offered, sold, issued, or renewed to a Minnesota 1.29 resident unless the premium rate charged is determined in 1.30 accordance with the following requirements: 1.31 (a) Premium rates must be no more than 25 percent above and 1.32 no more than 25 percent below the index rate charged to 1.33 individuals for the same or similar coverage, adjusted pro rata 1.34 for rating periods of less than one year. The premium 2.1 variations permitted by this paragraph must be based only upon 2.2 health status, claims experience, and occupation. For purposes 2.3 of this paragraph, health status includes refraining from 2.4 tobacco use or other actuarially valid lifestyle factors 2.5 associated with good health, provided that the lifestyle factor 2.6 and its effect upon premium rates have been determined by the 2.7 commissioner to be actuarially valid and have been approved by 2.8 the commissioner. Variations permitted under this paragraph 2.9 must not be based upon age or applied differently at different 2.10 ages. This paragraph does not prohibit use of a constant 2.11 percentage adjustment for factors permitted to be used under 2.12 this paragraph. 2.13 (b) Premium rates may vary based upon the ages of covered 2.14 persons only as provided in this paragraph. In addition to the 2.15 variation permitted under paragraph (a), each health carrier may 2.16 use an additional premium variation based upon age of up to plus 2.17 or minus 50 percent of the index rate. 2.18 (c) A health carrier may request approval by the 2.19 commissioner to establish no more than three geographic regions 2.20 and to establish separate index rates for each region, provided 2.21 that the index rates do not vary between any two regions by more 2.22 than 20 percent. Health carriers that do not do business in the 2.23 Minneapolis/St. Paul metropolitan area may request approval for 2.24 no more than two geographic regions, and clauses (2) and (3) do 2.25 not apply to approval of requests made by those health 2.26 carriers. The commissioner may grant approval if the following 2.27 conditions are met: 2.28 (1) the geographic regions must be applied uniformly by the 2.29 health carrier; 2.30 (2) one geographic region must be based on the 2.31 Minneapolis/St. Paul metropolitan area; 2.32 (3) for each geographic region that is rural, the index 2.33 rate for that region must not exceed the index rate for the 2.34 Minneapolis/St. Paul metropolitan area; and 2.35 (4) the health carrier provides actuarial justification 2.36 acceptable to the commissioner for the proposed geographic 3.1 variations in index rates, establishing that the variations are 3.2 based upon differences in the cost to the health carrier of 3.3 providing coverage. 3.4 (d) Health carriers may use rate cells and must file with 3.5 the commissioner the rate cells they use. Rate cells must be 3.6 based upon the number of adults or children covered under the 3.7 policy and may reflect the availability of Medicare coverage. 3.8 The rates for different rate cells must not in any way reflect 3.9 generalized differences in expected costs between principal 3.10 insureds and their spouses. 3.11 (e) In developing its index rates and premiums for a health 3.12 plan, a health carrier shall take into account only the 3.13 following factors: 3.14 (1) actuarially valid differences in rating factors 3.15 permitted under paragraphs (a) and (b); and 3.16 (2) actuarially valid geographic variations if approved by 3.17 the commissioner as provided in paragraph (c). 3.18 (f) All premium variations must be justified in initial 3.19 rate filings and upon request of the commissioner in rate 3.20 revision filings. All rate variations are subject to approval 3.21 by the commissioner. 3.22 (g) The loss ratio must comply with the section 62A.021 3.23 requirements for individual health plans. 3.24 (h) Notwithstanding paragraphs (a) to (g), the rates must 3.25 not be approved
,unless the commissioner has determined that the 3.26 rates are reasonable. In determining reasonableness, the 3.27 commissioner shall consider the growth rates applied under3.28 section 62J.04, subdivision 1, paragraph (b)apply the premium 3.29 growth limits established under section 62J.04, subdivision 1b, 3.30 to the calendar year or years that the proposed premium rate 3.31 would be in effect, and shall consider actuarially valid changes 3.32 in risks associated with the enrollee populations ,and 3.33 actuarially valid changes as a result of statutory changes in 3.34 Laws 1992, chapter 549. 3.35 Sec. 2. Minnesota Statutes 2002, section 62J.04, is 3.36 amended by adding a subdivision to read: 4.1 Subd. 1b. [PREMIUM GROWTH LIMITS.] (a) For calendar year 4.2 2005 and each year thereafter, the commissioner shall set annual 4.3 premium growth limits for health plan companies. The premium 4.4 limits set by the commissioner for calendar years 2005 to 2010 4.5 shall not exceed the regional Consumer Price Index for urban 4.6 consumers for the preceding calendar year plus one percentage 4.7 point and an additional two percentage points to be used to 4.8 finance the implementation of the electronic medical record 4.9 system described under section 62J.565. The commissioner shall 4.10 ensure that the additional percentage points are being used to 4.11 provide financial assistance to health care providers to 4.12 implement electronic medical record systems either directly or 4.13 through an increase in reimbursement. 4.14 (b) For the calendar years beyond 2010, the rate of premium 4.15 growth shall be limited to the change in the Consumer Price 4.16 Index for urban consumers for the previous calendar year plus 4.17 one percentage point. The commissioners of health and commerce 4.18 shall make a recommendation to the legislature by January 15, 4.19 2009, regarding the continuation of the additional percentage 4.20 points to the growth limit described in paragraph (a). The 4.21 recommendation shall be based on the progress made by health 4.22 care providers in instituting an electronic medical record 4.23 system and in creating a statewide interactive electronic health 4.24 record system. 4.25 (c) The commissioner may add additional percentage points 4.26 as needed to the premium limit for a calendar year if a major 4.27 disaster, bioterrorism, or a public health emergency occurs that 4.28 results in higher health care costs. Any additional percentage 4.29 points must reflect the additional cost to the health care 4.30 system directly attributed to the disaster or emergency. 4.31 (d) The commissioner shall publish the annual premium 4.32 growth limits in the State Register by January 31 of the year 4.33 that the limits are to be in effect. 4.34 (e) For the purpose of this subdivision, premium growth is 4.35 measured as the percentage change in per member, per month 4.36 premium revenue from the current year to the previous year. 5.1 Premium growth rates shall be calculated for the following lines 5.2 of business: individual, small group, and large group. Data 5.3 used for premium growth rate calculations shall be submitted as 5.4 part of the cost containment filing under section 62J.38. 5.5 Sec. 3. Minnesota Statutes 2003 Supplement, section 5.6 62J.04, subdivision 3, is amended to read: 5.7 Subd. 3. [COST CONTAINMENT DUTIES.] The commissioner shall: 5.8 (1) establish statewide and regional cost containment goals 5.9 for total health care spending under this section and collect 5.10 data as described in sections 62J.38 to 62J.41 to monitor 5.11 statewide achievement of the cost containment goals and premium 5.12 growth limits; 5.13 (2) divide the state into no fewer than four regions, with 5.14 one of those regions being the Minneapolis/St. Paul metropolitan 5.15 statistical area but excluding Chisago, Isanti, Wright, and 5.16 Sherburne Counties, for purposes of fostering the development of 5.17 regional health planning and coordination of health care 5.18 delivery among regional health care systems and working to 5.19 achieve the cost containment goals; 5.20 (3) monitor the quality of health care throughout the state 5.21 and take action as necessary to ensure an appropriate level of 5.22 quality; 5.23 (4) issue recommendations regarding uniform billing forms, 5.24 uniform electronic billing procedures and data interchanges, 5.25 patient identification cards, and other uniform claims and 5.26 administrative procedures for health care providers and private 5.27 and public sector payers. In developing the recommendations, 5.28 the commissioner shall review the work of the work group on 5.29 electronic data interchange (WEDI) and the American National 5.30 Standards Institute (ANSI) at the national level, and the work 5.31 being done at the state and local level. The commissioner may 5.32 adopt rules requiring the use of the Uniform Bill 82/92 form, 5.33 the National Council of Prescription Drug Providers (NCPDP) 3.2 5.34 electronic version, the Centers for Medicare and Medicaid 5.35 Services 1500 form, or other standardized forms or procedures; 5.36 (5) undertake health planning responsibilities; 6.1 (6) authorize, fund, or promote research and 6.2 experimentation on new technologies and health care procedures; 6.3 (7) within the limits of appropriations for these purposes, 6.4 administer or contract for statewide consumer education and 6.5 wellness programs that will improve the health of Minnesotans 6.6 and increase individual responsibility relating to personal 6.7 health and the delivery of health care services, undertake 6.8 prevention programs including initiatives to improve birth 6.9 outcomes, expand childhood immunization efforts, and provide 6.10 start-up grants for worksite wellness programs; 6.11 (8) undertake other activities to monitor and oversee the 6.12 delivery of health care services in Minnesota with the goal of 6.13 improving affordability, quality, and accessibility of health 6.14 care for all Minnesotans; and 6.15 (9) make the cost containment goal and premium growth limit 6.16 data available to the public in a consumer-oriented manner. 6.17 Sec. 4. [62J.255] [HEALTH RISK INFORMATION SHEET.] 6.18 (a) A health plan company shall provide to each enrollee on 6.19 an annual basis information on the increased personal health 6.20 risks and the additional costs to the health care system due to 6.21 obesity and to the use of tobacco. 6.22 (b) The commissioner, in consultation with the Minnesota 6.23 Medical Association, shall develop an information sheet on the 6.24 personal health risks of obesity and smoking and on the 6.25 additional costs to the health care system due to obesity and 6.26 due to smoking. The information sheet shall be posted on the 6.27 Minnesota Department of Health's Web site. 6.28 Sec. 5. Minnesota Statutes 2002, section 62J.301, 6.29 subdivision 3, is amended to read: 6.30 Subd. 3. [GENERAL DUTIES.] The commissioner shall: 6.31 (1) collect and maintain data which enable population-based 6.32 monitoring and trending of the access, utilization, quality, and 6.33 cost of health care services within Minnesota; 6.34 (2) collect and maintain data for the purpose of estimating 6.35 total Minnesota health care expenditures and trends; 6.36 (3) collect and maintain data for the purposes of setting 7.1 cost containment goals and premium growth limits under section 7.2 62J.04, and measuring cost containment goal and premium growth 7.3 limit compliance; 7.4 (4) conduct applied research using existing and new data 7.5 and promote applications based on existing research; 7.6 (5) develop and implement data collection procedures to 7.7 ensure a high level of cooperation from health care providers 7.8 and health plan companies, as defined in section 62Q.01, 7.9 subdivision 4; 7.10 (6) work closely with health plan companies and health care 7.11 providers to promote improvements in health care efficiency and 7.12 effectiveness; and 7.13 (7) participate as a partner or sponsor of private sector 7.14 initiatives that promote publicly disseminated applied research 7.15 on health care delivery, outcomes, costs, quality, and 7.16 management. 7.17 Sec. 6. Minnesota Statutes 2002, section 62J.38, is 7.18 amended to read: 7.19 62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 7.20 (a) The commissioner shall require group purchasers to 7.21 submit detailed data on total health care spending for each 7.22 calendar year. Group purchasers shall submit data for the 1993 7.23 calendar year by April 1, 1994, and each April 1 thereafter 7.24 shall submit data for the preceding calendar year. 7.25 (b) The commissioner shall require each group purchaser to 7.26 submit data on revenue, expenses, and member months, as 7.27 applicable. Revenue data must distinguish between premium 7.28 revenue and revenue from other sources and must also include 7.29 information on the amount of revenue in reserves and changes in 7.30 reserves. Premium revenue data, information on aggregate 7.31 enrollment, and data on member months must be broken down to 7.32 distinguish between individual market, small group market, and 7.33 large group market. Filings under this section for calendar 7.34 year 2005 must also include information broken down by 7.35 individual market, small group market, and large group market 7.36 for calendar year 2004. Expenditure data must distinguish 8.1 between costs incurred for patient care and administrative 8.2 costs. Patient care and administrative costs must include only 8.3 expenses incurred on behalf of health plan members and must not 8.4 include the cost of providing health care services for 8.5 nonmembers at facilities owned by the group purchaser or 8.6 affiliate. Expenditure data must be provided separately for the 8.7 following categories and for other categories required by the 8.8 commissioner: physician services, dental services, other 8.9 professional services, inpatient hospital services, outpatient 8.10 hospital services, emergency, pharmacy services and other 8.11 nondurable medical goods, mental health, and chemical dependency 8.12 services, other expenditures, subscriber liability, and 8.13 administrative costs. Administrative costs must include costs 8.14 for marketing; advertising; overhead; salaries and benefits of 8.15 central office staff who do not provide direct patient care; 8.16 underwriting; lobbying; claims processing; provider contracting 8.17 and credentialing; detection and prevention of payment for 8.18 fraudulent or unjustified requests for reimbursement or 8.19 services; clinical quality assurance and other types of medical 8.20 care quality improvement efforts; concurrent or prospective 8.21 utilization review as defined in section 62M.02; costs incurred 8.22 to acquire a hospital, clinic, or health care facility, or the 8.23 assets thereof; capital costs incurred on behalf of a hospital 8.24 or clinic; lease payments; or any other costs incurred pursuant 8.25 to a partnership, joint venture, integration, or affiliation 8.26 agreement with a hospital, clinic, or other health care 8.27 provider. Capital costs and costs incurred must be recorded 8.28 according to standard accounting principles. The reports of 8.29 this data must also separately identify expenses for local, 8.30 state, and federal taxes, fees, and assessments. The 8.31 commissioner may require each group purchaser to submit any 8.32 other data, including data in unaggregated form, for the 8.33 purposes of developing spending estimates, setting spending 8.34 limits, and monitoring actual spending and costs. In addition 8.35 to reporting administrative costs incurred to acquire a 8.36 hospital, clinic, or health care facility, or the assets 9.1 thereof; or any other costs incurred pursuant to a partnership, 9.2 joint venture, integration, or affiliation agreement with a 9.3 hospital, clinic, or other health care provider; reports 9.4 submitted under this section also must include the payments made 9.5 during the calendar year for these purposes. The commissioner 9.6 shall make public, by group purchaser data collected under this 9.7 paragraph in accordance with section 62J.321, subdivision 5. 9.8 Workers' compensation insurance plans and automobile insurance 9.9 plans are exempt from complying with this paragraph as it 9.10 relates to the submission of administrative costs. 9.11 (c) The commissioner may collect information on: 9.12 (1) premiums, benefit levels, managed care procedures, and 9.13 other features of health plan companies; 9.14 (2) prices, provider experience, and other information for 9.15 services less commonly covered by insurance or for which 9.16 patients commonly face significant out-of-pocket expenses; and 9.17 (3) information on health care services not provided 9.18 through health plan companies, including information on prices, 9.19 costs, expenditures, and utilization. 9.20 (d) All group purchasers shall provide the required data 9.21 using a uniform format and uniform definitions, as prescribed by 9.22 the commissioner. 9.23 Sec. 7. [62J.411] [BEST PRACTICES DATA.] 9.24 (a) The commissioner shall collect from primary care 9.25 providers information on patients who have been diagnosed with 9.26 or who are at risk of one of the following conditions: 9.27 (1) diabetes; 9.28 (2) hypertension; 9.29 (3) stroke; or 9.30 (4) asthma. 9.31 (b) The information collected shall include for each of the 9.32 conditions identified in paragraph (a): 9.33 (1) the number of patients who have been diagnosed with or 9.34 suffer from the condition; and 9.35 (2) the health care services provided to the patient within 9.36 the reporting period that are related to the specific condition 10.1 in terms of the percentage of patients identified in clause (1) 10.2 who received the service. 10.3 (c) The commissioner may not collect information in 10.4 individually identifiable form in which the patient is or can be 10.5 identified. 10.6 (d) The information collected may be used to: 10.7 (1) track and target best practices in the delivery of 10.8 health care for these conditions; 10.9 (2) assess the health care system and physician's quality 10.10 of care; 10.11 (3) identify utilization trends; and 10.12 (4) provide early identification and targeting of 10.13 populations at risk. 10.14 (e) Health care providers shall submit the required 10.15 information for the period of July 1, 2004, to December 31, 10.16 2004, by April 1, 2005. For calendar year 2005, the health care 10.17 providers shall submit the required information by April 1, 10.18 2006, and each April 1 thereafter shall submit the required 10.19 information for the preceding calendar year. 10.20 Sec. 8. [62J.565] [IMPLEMENTATION OF ELECTRONIC MEDICAL 10.21 RECORD SYSTEM.] 10.22 Subdivision 1. [GENERAL PROVISIONS.] (a) The legislature 10.23 finds that there is a need to advance the use of electronic 10.24 medical record systems by health care providers in the state in 10.25 order to achieve significant administrative cost savings and to 10.26 improve the safety, quality, and efficiency of health care 10.27 delivery in the state. The legislature also finds that in order 10.28 to advance the use of an electronic medical record system in a 10.29 cost-effective manner and to ensure an electronic medical record 10.30 system's interoperability and compatibility with other systems, 10.31 the state needs to develop a standard, definitional model of an 10.32 electronic medical record system that includes uniform formats, 10.33 data standards, and technology standards for the collection, 10.34 storage, and exchange of electronic health records. These 10.35 standards must be nationally accepted, widely recognized, and 10.36 available for immediate use. 11.1 (b) By January 1, 2010, all hospitals and health care 11.2 providers must have in place an electronic medical record system 11.3 within their hospital system or clinical practice setting. The 11.4 commissioner may grant exemptions from this requirement if the 11.5 commissioner determines that the cost of compliance would place 11.6 the provider in financial distress or if the commissioner 11.7 determines that appropriate technology is not available or 11.8 advantageous to that type of practice. Before an exemption is 11.9 granted for financial reasons, the commissioner must ensure that 11.10 the provider has explored all possible alliances or partnerships 11.11 with other provider groups in the provider's geographical area 11.12 to become part of the larger provider group's system. 11.13 (c) The commissioner shall provide assistance to hospitals 11.14 and provider groups in establishing an electronic medical record 11.15 system, including, but not limited to, provider education, 11.16 facilitation of possible alliances or partnerships among 11.17 provider groups for purposes of implementing a system, 11.18 identification or establishment of low-interest financing 11.19 options for hardware and software, and systems implementation 11.20 support. 11.21 Subd. 2. [MODEL ELECTRONIC MEDICAL RECORD SYSTEM.] (a) By 11.22 October 1, 2005, the commissioners of health and human services, 11.23 in consultation with the Minnesota Administrative Uniformity 11.24 Committee, shall develop a functional model for an interactive 11.25 electronic medical record system. The system must be able to 11.26 provide immediate access to complete patient information, permit 11.27 a provider to record information about a patient's health at the 11.28 point of care delivery, and ensure the accessibility and 11.29 exchange of patient health information with other providers and 11.30 care systems. In creating the infrastructure of the system, the 11.31 model must include the development of uniform data standards in 11.32 terms of clinical terminology, the exchange of data among 11.33 systems, and the representation of medical information and must 11.34 include the development of a common set of requirements for 11.35 functional capabilities for the system software components. The 11.36 uniform standards developed must be functional for use by 12.1 providers of all disciplines and care settings. The standards 12.2 must also be compatible with federal and private sector efforts 12.3 to develop a national electronic medical record and must 12.4 incorporate existing standards and state and federal regulatory 12.5 requirements. In developing a model, the commissioners shall 12.6 consider data privacy and security concerns and must ensure 12.7 compliance with federal law. 12.8 (b) The commissioner of human services shall convene an 12.9 advisory committee with representatives of safety-net hospitals, 12.10 community health clinics, and other providers who serve 12.11 low-income patients to address their specific needs and concerns 12.12 regarding the establishment of an electronic medical record 12.13 system within their hospital or practice setting. As part of 12.14 addressing the specific needs of these providers, the 12.15 commissioner shall explore the implementation of an accessible 12.16 interactive system created collaboratively by publicly owned 12.17 hospitals and clinics. The commissioner shall also explore 12.18 financial assistance options, including bonding and federal 12.19 grants. 12.20 (c) The commissioners shall report to the legislature by 12.21 January 15, 2005, on the progress in the development of uniform 12.22 standards and on a functional model for an electronic medical 12.23 record system. 12.24 Sec. 9. Minnesota Statutes 2003 Supplement, section 12.25 62J.692, subdivision 3, is amended to read: 12.26 Subd. 3. [APPLICATION PROCESS.] (a) A clinical medical 12.27 education program conducted in Minnesota by a teaching 12.28 institution to train physicians, doctor of pharmacy 12.29 practitioners, dentists, chiropractors, or physician assistants 12.30 is eligible for funds under subdivision 4 if the program: 12.31 (1) is funded, in part, by patient care revenues; 12.32 (2) occurs in patient care settings that face increased 12.33 financial pressure as a result of competition with nonteaching 12.34 patient care entities; and 12.35 (3) emphasizes primary care or specialties that are in 12.36 undersupply in Minnesota. 13.1 In addition to clauses (1), (2), and (3), a clinical 13.2 medical education program that trains pediatricians must also 13.3 include in its program curriculum training in medication 13.4 management for children suffering from mental illness to be 13.5 eligible for funds under subdivision 4. 13.6 (b) A clinical medical education program for advanced 13.7 practice nursing is eligible for funds under subdivision 4 if 13.8 the program meets the eligibility requirements in paragraph (a), 13.9 clauses (1) to (3), and is sponsored by the University of 13.10 Minnesota Academic Health Center, the Mayo Foundation, or 13.11 institutions that are part of the Minnesota State Colleges and 13.12 Universities system or members of the Minnesota Private College 13.13 Council. 13.14 (c) Applications must be submitted to the commissioner by a 13.15 sponsoring institution on behalf of an eligible clinical medical 13.16 education program and must be received by October 31 of each 13.17 year for distribution in the following year. An application for 13.18 funds must contain the following information: 13.19 (1) the official name and address of the sponsoring 13.20 institution and the official name and site address of the 13.21 clinical medical education programs on whose behalf the 13.22 sponsoring institution is applying; 13.23 (2) the name, title, and business address of those persons 13.24 responsible for administering the funds; 13.25 (3) for each clinical medical education program for which 13.26 funds are being sought; the type and specialty orientation of 13.27 trainees in the program; the name, site address, and medical 13.28 assistance provider number of each training site used in the 13.29 program; the total number of trainees at each training site; and 13.30 the total number of eligible trainee FTEs at each site. Only 13.31 those training sites that host 0.5 FTE or more eligible trainees 13.32 for a program may be included in the program's application; and 13.33 (4) other supporting information the commissioner deems 13.34 necessary to determine program eligibility based on the criteria 13.35 in paragraphs (a) and (b) and to ensure the equitable 13.36 distribution of funds. 14.1 (d) An application must include the information specified 14.2 in clauses (1) to (3) for each clinical medical education 14.3 program on an annual basis for three consecutive years. After 14.4 that time, an application must include the information specified 14.5 in clauses (1) to (3) in the first year of each biennium: 14.6 (1) audited clinical training costs per trainee for each 14.7 clinical medical education program when available or estimates 14.8 of clinical training costs based on audited financial data; 14.9 (2) a description of current sources of funding for 14.10 clinical medical education costs, including a description and 14.11 dollar amount of all state and federal financial support, 14.12 including Medicare direct and indirect payments; and 14.13 (3) other revenue received for the purposes of clinical 14.14 training. 14.15 (e) An applicant that does not provide information 14.16 requested by the commissioner shall not be eligible for funds 14.17 for the current funding cycle. 14.18 Sec. 10. [62J.82] [ELECTRONIC MEDICAL RECORD SYSTEM LOAN 14.19 PROGRAM.] 14.20 Subdivision 1. [ESTABLISHMENT.] The commissioner shall 14.21 establish and implement a loan program to help physicians or 14.22 physician group practices obtain the necessary finances to 14.23 install an electronic medical record system. 14.24 Subd. 2. [RULES.] The commissioner may adopt rules to 14.25 administer the loan program. 14.26 Subd. 3. [ELIGIBILITY.] To be eligible for a loan under 14.27 this section, the borrower must: 14.28 (1) have a signed contract with a vendor; 14.29 (2) be a physician licensed in this state or a physician 14.30 group practice located in this state; 14.31 (3) provide evidence of financial stability; 14.32 (4) demonstrate an ability to repay the loan; 14.33 (5) demonstrate that the borrower has explored possible 14.34 alliances or contractual opportunities with other provider 14.35 groups located in the same geographical area to become part of 14.36 the larger provider group's system; and 15.1 (6) meet any other requirement the commissioner imposes by 15.2 administrative procedure or by rule. 15.3 Subd. 4. [LOANS.] (a) The commissioner may make a direct 15.4 loan to a provider or provider group who is eligible under 15.5 subdivision 3. The total accumulative loan principal must not 15.6 exceed $....... per loan. 15.7 (b) The commissioner may prescribe forms and establish an 15.8 application process and, notwithstanding section 16A.1283, may 15.9 impose a reasonable nonrefundable application fee to cover the 15.10 cost of administering the loan program. 15.11 (c) Loan principal balance outstanding plus all assessed 15.12 interest must be repaid no later than 15 years from the date of 15.13 the loan. 15.14 Sec. 11. [62J.83] [ELECTRONIC MEDICAL RECORD SYSTEM LOAN 15.15 FUND.] 15.16 Subdivision 1. [CREATION.] The electronic medical record 15.17 system loan fund is established as a special account in the 15.18 state treasury. All application fees, loan repayments, and 15.19 other revenue received under section 62J.82 must be credited to 15.20 the fund. 15.21 Subd. 2. [BOND PROCEEDS ACCOUNT.] An electronic medical 15.22 record system revenue bond proceeds account is established in 15.23 the electronic medical record system loan fund. The proceeds of 15.24 any bonds issued under section 62J.84 must be credited to the 15.25 account. Money in the account is appropriated to the 15.26 commissioner to make loans under section 62J.82. 15.27 Subd. 3. [DEBT SERVICE ACCOUNT.] An electronic medical 15.28 record system revenue bond debt service account is established 15.29 in the electronic medical record system loan fund. There must 15.30 be credited to this debt service account in each fiscal year 15.31 from the income to the electronic medical record system loan 15.32 fund an amount sufficient to increase the balance on hand in the 15.33 debt service account on each December 1 to an amount equal to 15.34 the full amount of principal and interest to come due on all 15.35 outstanding bonds issued under section 62J.84 to and including 15.36 the second following July 1. The assets of the account are 16.1 pledged to and may only be used to pay principal and interest on 16.2 bonds issued under section 62J.84. Money in the debt service 16.3 account is appropriated to the commissioner of finance to pay 16.4 principal and interest on bonds issued under section 62J.84. 16.5 Subd. 4. [APPROPRIATION.] Money in the electronic medical 16.6 record system loan fund not otherwise appropriated is 16.7 appropriated to the commissioner to administer the loan program. 16.8 Sec. 12. [62J.84] [ELECTRONIC MEDICAL RECORD SYSTEM 16.9 REVENUE BONDS.] 16.10 Subdivision 1. [BONDING AUTHORITY.] Upon request of the 16.11 commissioner, the commissioner of finance may sell and issue 16.12 state revenue bonds to make loans under section 62J.82, to 16.13 establish a reserve fund or funds, and to pay the cost of 16.14 issuance of the bonds. 16.15 Subd. 2. [AMOUNT.] The principal amount of the bonds 16.16 issued for the purposes specified in subdivision 1 must not 16.17 exceed $........ 16.18 Subd. 3. [PROCEDURE.] The commissioner may sell and issue 16.19 the bonds on the terms and conditions the commissioner 16.20 determines to be in the best interests of the state. The bonds 16.21 may be sold at public or private sale. The commissioner may 16.22 enter any agreements or pledges the commissioner determines 16.23 necessary or useful to sell the bonds that are not inconsistent 16.24 with sections 62J.82 to 62J.84. Sections 16A.672 to 16A.675 16.25 apply to the bonds. 16.26 Subd. 4. [REVENUE SOURCES.] The bonds are payable only 16.27 from the following sources: 16.28 (1) loan repayments credited to the electronic medical 16.29 record system loan fund; 16.30 (2) the principal and any investment earnings on the assets 16.31 of the debt service account; and 16.32 (3) other revenues pledged to the payment of the bonds. 16.33 Subd. 5. [REFUNDING BONDS.] The commissioner may issue 16.34 bonds to refund outstanding bonds issued under subdivision 1, 16.35 including the payment of any redemption premiums on the bonds 16.36 and any interest accrued or to accrue to the first redemption 17.1 date after delivery of the refunding bonds. The proceeds of the 17.2 refunding bonds may, in the discretion of the commissioner, be 17.3 applied to the purchases or payment at maturity of the bonds to 17.4 be refunded, or the redemption of the outstanding bonds on the 17.5 first redemption date after delivery of the refunding bonds and 17.6 may, until so used, be placed in escrow to be applied to the 17.7 purchase, retirement, or redemption. Refunding bonds issued 17.8 under this subdivision must be issued and secured in the manner 17.9 provided by the commissioner. 17.10 Subd. 6. [NOT A GENERAL OR MORAL OBLIGATION.] Bonds issued 17.11 under this section are not public debt, and the full faith, 17.12 credit, and taxing powers of the state are not pledged for their 17.13 payment. The bonds may not be paid, directly in whole or part 17.14 from a tax of statewide application on any class of property, 17.15 income, transaction, or privilege. Payment of the bonds is 17.16 limited to the revenues explicitly authorized to be pledged 17.17 under this section. The state neither makes nor has a moral 17.18 obligation to pay the bonds if the pledged revenues and other 17.19 legal security for them is insufficient. 17.20 Subd. 7. [TRUSTEE.] The commissioner may contract with and 17.21 appoint a trustee for bondholders. The trustee has the powers 17.22 and authority vested in it by the commissioner under the bond 17.23 and trust indentures. 17.24 Subd. 8. [PLEDGES.] Any pledge made by the commissioner is 17.25 valid and binding from the time the pledge is made. The money 17.26 or property pledged and later received by the commissioner is 17.27 immediately subject to the lien of the pledge without any 17.28 physical delivery of the property or money or further act, and 17.29 the lien of any pledge is valid and binding as against all 17.30 parties having claims of any kind in tort, contract, or 17.31 otherwise against the commissioner, whether or not those parties 17.32 have notice of the lien or pledge. Neither the order nor any 17.33 other instrument by which a pledge is created need be recorded. 17.34 Subd. 9. [BONDS; PURCHASE AND CANCELLATION.] The 17.35 commissioner, subject to agreements with bondholders that may 17.36 then exist, may, out of any money available for the purpose, 18.1 purchase bonds of the commissioner at a price not exceeding: 18.2 (1) if the bonds are then redeemable, the redemption price 18.3 then applicable plus accrued interest to the next interest 18.4 payment date thereon; or 18.5 (2) if the bonds are not redeemable, the redemption price 18.6 applicable on the first date after the purchase upon which the 18.7 bonds become subject to redemption plus accrued interest to that 18.8 date. 18.9 Subd. 10. [STATE PLEDGE AGAINST IMPAIRMENT OF CONTRACTS.] 18.10 The state pledges and agrees with the holders of any bonds that 18.11 the state will not limit or alter the rights vested in the 18.12 commissioner to fulfill the terms of any agreements made with 18.13 the bondholders, or in any way impair the rights and remedies of 18.14 the holders until the bonds, together with interest on them, 18.15 with interest on any unpaid installments of interest, and all 18.16 costs and expenses in connection with any action or proceeding 18.17 by or on behalf of the bondholders, are fully met and 18.18 discharged. The commissioner may include this pledge and 18.19 agreement of the state in any agreement with the holders of 18.20 bonds issued under this section. 18.21 Sec. 13. Minnesota Statutes 2002, section 62L.08, 18.22 subdivision 8, is amended to read: 18.23 Subd. 8. [FILING REQUIREMENT.] (a) No later than July 1, 18.24 1993, and each year thereafter, a health carrier that offers, 18.25 sells, issues, or renews a health benefit plan for small 18.26 employers shall file with the commissioner the index rates and 18.27 must demonstrate that all rates shall be within the rating 18.28 restrictions defined in this chapter. Such demonstration must 18.29 include the allowable range of rates from the index rates and a 18.30 description of how the health carrier intends to use demographic 18.31 factors including case characteristics in calculating the 18.32 premium rates. 18.33 (b) Notwithstanding paragraph (a), the rates shall not be 18.34 approved ,unless the commissioner has determined that the rates 18.35 are reasonable. In determining reasonableness, the commissioner 18.36 shall consider the growth rates applied under section 62J.04,19.1 subdivision 1, paragraph (b)apply the premium growth limits 19.2 established under section 62J.04, subdivision 1b, to the 19.3 calendar year or years that the proposed premium rate would be 19.4 in effect, and shall consider actuarially valid changes in risk 19.5 associated with the enrollee population, and actuarially valid 19.6 changes as a result of statutory changes in Laws 1992, chapter 19.7 549. For premium rates proposed to go into effect between July19.8 1, 1993 and December 31, 1993, the pertinent growth rate is the19.9 growth rate applied under section 62J.04, subdivision 1,19.10 paragraph (b), to calendar year 1994.19.11 Sec. 14. [62Q.175] [COVERAGE EXEMPTIONS.] 19.12 Notwithstanding any law to the contrary, no health plan 19.13 company is required to provide coverage for any health care 19.14 service included on the list established under section 19.15 256B.0625, subdivision 46. 19.16 Sec. 15. Minnesota Statutes 2003 Supplement, section 19.17 144.1501, subdivision 2, is amended to read: 19.18 Subd. 2. [CREATION OF ACCOUNT.] A health professional 19.19 education loan forgiveness program account is established. The 19.20 commissioner of health shall use money from the account to 19.21 establish a loan forgiveness program for medical residents 19.22 agreeing to practice in designated rural areas or underserved 19.23 urban communities, for midlevel practitioners agreeing to 19.24 practice in designated rural areas or to teach for at least 20 19.25 hours per week in the nursing field in a postsecondary program, 19.26 and for nurses who agree to practice in a Minnesota nursing home 19.27 or intermediate care facility for persons with mental 19.28 retardation or related conditions or to teach for at least 20 19.29 hours per week in the nursing field in a postsecondary program, 19.30 and for other health care technicians agreeing to teach for at 19.31 least 20 hours per week in their designated field in a 19.32 postsecondary program. The commissioner, in consultation with 19.33 the Healthcare Education-Industry Partnership, shall determine 19.34 the health care fields where the need is the greatest, 19.35 including, but not limited to, respiratory therapy, clinical 19.36 laboratory technology, radiologic technology, and surgical 20.1 technology. Appropriations made to the account do not cancel 20.2 and are available until expended, except that at the end of each 20.3 biennium, any remaining balance in the account that is not 20.4 committed by contract and not needed to fulfill existing 20.5 commitments shall cancel to the fund. 20.6 Sec. 16. Minnesota Statutes 2003 Supplement, section 20.7 144.1501, subdivision 4, is amended to read: 20.8 Subd. 4. [LOAN FORGIVENESS.] The commissioner of health 20.9 may select applicants each year for participation in the loan 20.10 forgiveness program, within the limits of available funding. The 20.11 commissioner shall distribute available funds for loan 20.12 forgiveness proportionally among the eligible professions 20.13 according to the vacancy rate for each profession in the 20.14 required geographic area or, facility type, or teaching area 20.15 specified in subdivision 2. The commissioner shall allocate 20.16 funds for physician loan forgiveness so that 75 percent of the 20.17 funds available are used for rural physician loan forgiveness 20.18 and 25 percent of the funds available are used for underserved 20.19 urban communities loan forgiveness. If the commissioner does 20.20 not receive enough qualified applicants each year to use the 20.21 entire allocation of funds for urban underserved communities, 20.22 the remaining funds may be allocated for rural physician loan 20.23 forgiveness. Applicants are responsible for securing their own 20.24 qualified educational loans. The commissioner shall select 20.25 participants based on their suitability for practice serving the 20.26 required geographic area or facility type specified in 20.27 subdivision 2, as indicated by experience or training. The 20.28 commissioner shall give preference to applicants closest to 20.29 completing their training. For each year that a participant 20.30 meets the service obligation required under subdivision 3, up to 20.31 a maximum of four years, the commissioner shall make annual 20.32 disbursements directly to the participant equivalent to 15 20.33 percent of the average educational debt for indebted graduates 20.34 in their profession in the year closest to the applicant's 20.35 selection for which information is available, not to exceed the 20.36 balance of the participant's qualifying educational loans. 21.1 Before receiving loan repayment disbursements and as requested, 21.2 the participant must complete and return to the commissioner an 21.3 affidavit of practice form provided by the commissioner 21.4 verifying that the participant is practicing as required under 21.5 subdivisions 2 and 3. The participant must provide the 21.6 commissioner with verification that the full amount of loan 21.7 repayment disbursement received by the participant has been 21.8 applied toward the designated loans. After each disbursement, 21.9 verification must be received by the commissioner and approved 21.10 before the next loan repayment disbursement is made. 21.11 Participants who move their practice remain eligible for loan 21.12 repayment as long as they practice as required under subdivision 21.13 2. 21.14 Sec. 17. Minnesota Statutes 2003 Supplement, section 21.15 256.954, subdivision 4, is amended to read: 21.16 Subd. 4. [ELIGIBLE PERSONS.] To be eligible for the 21.17 program, an applicant must: 21.18 (1) be a permanent resident of Minnesota as defined in 21.19 section 256L.09, subdivision 4; 21.20 (2) not be enrolled in Medicare, medical assistance, 21.21 general assistance medical care, MinnesotaCare, or the 21.22 prescription drug program under section 256.955; 21.23 (3) not be enrolled in and have currently available 21.24 prescription drug coverage under a health plan offered by a 21.25 health carrier or employer or under a pharmacy benefit program 21.26 offered by a pharmaceutical manufacturer; and 21.27 (4) not be enrolled in and have currently available 21.28 prescription drug coverage under a Medicare supplement plan, as 21.29 defined in sections 62A.31 to 62A.44, or policies, contracts, or 21.30 certificates that supplement Medicare issued by health 21.31 maintenance organizations or those policies, contracts, or 21.32 certificates governed by section 1833 or 1876 of the federal 21.33 Social Security Act, United States Code, title 42, section 1395, 21.34 et seq., as amended ; and21.35 (5) have a gross household income that does not exceed 25021.36 percent of the federal poverty guidelines. 22.1 Sec. 18. Minnesota Statutes 2003 Supplement, section 22.2 256.954, subdivision 6, is amended to read: 22.3 Subd. 6. [PARTICIPATING PHARMACY.] According to a valid 22.4 prescription, a participating pharmacy must sell a covered 22.5 prescription drug to an enrolled individual at the pharmacy's 22.6 usual and customary retail price, minus an amount that is equal 22.7 to the rebate amount described in subdivision 8, plus the amount 22.8 of any administrative fee andswitch fee established by the 22.9 commissioner under subdivision 10. Each participating pharmacy 22.10 shall provide the commissioner with all information necessary to 22.11 administer the program, including, but not limited to, 22.12 information on prescription drug sales to enrolled individuals 22.13 and usual and customary retail prices. 22.14 Sec. 19. Minnesota Statutes 2003 Supplement, section 22.15 256.954, subdivision 10, is amended to read: 22.16 Subd. 10. [ ADMINISTRATIVEENROLLMENT FEE; SWITCH FEE.] (a) 22.17 The commissioner shall establish a reasonable administrative22.18 enrollment fee that covers the commissioner's expenses for 22.19 enrollment, processing claims, and distributing rebates under 22.20 this program. 22.21 (b) The commissioner shall establish a reasonable switch 22.22 fee that covers expenses incurred by pharmacies in formatting 22.23 for electronic submission claims for prescription drugs sold to 22.24 enrolled individuals. 22.25 Sec. 20. Minnesota Statutes 2002, section 256.9693, is 22.26 amended to read: 22.27 256.9693 [CONTINUING CARE PROGRAM FOR PERSONS WITH MENTAL 22.28 ILLNESS.] 22.29 The commissioner shall establish a continuing care benefit 22.30 program for persons with mental illness in which persons with 22.31 mental illness may obtain acute care hospital inpatient 22.32 treatment for mental illness for up to 45 days beyond that 22.33 allowed by section 256.969. Persons with mental illness who are 22.34 eligible for medical assistance or general assistance medical 22.35 care may obtain inpatient treatment under this program in 22.36 hospital beds for which the commissioner contracts under this 23.1 section. The commissioner may selectively contract with 23.2 hospitals to provide this benefit through competitive bidding 23.3 when reasonable geographic access by recipients can be assured. 23.4 Payments under this section shall not affect payments under 23.5 section 256.969. The commissioner may contract externally with 23.6 a utilization review organization to authorize persons with 23.7 mental illness to access the continuing care benefit program. 23.8 The commissioner, as part of the contracts with hospitals, shall 23.9 establish admission criteria to allow persons with mental 23.10 illness to access the continuing care benefit program. If a 23.11 court orders acute care hospital inpatient treatment for mental 23.12 illness for a person, the person may obtain the treatment under 23.13 the continuing care benefit program. The commissioner shall not 23.14 require, as part of the admission criteria, any commitment or 23.15 petition under chapter 253B as a condition of accessing the 23.16 program. This benefit is not available for people who are also 23.17 eligible for Medicare and who have not exhausted their annual or 23.18 lifetime inpatient psychiatric benefit under Medicare. If a 23.19 recipient is enrolled in a prepaid plan, this program is 23.20 included in the plan's coverage. 23.21 Sec. 21. Minnesota Statutes 2002, section 256B.03, 23.22 subdivision 3, is amended to read: 23.23 Subd. 3. [TRIBAL PURCHASING MODEL.] (a) Notwithstanding 23.24 subdivision 1 and sections 256B.0625 and 256D.03, subdivision 4, 23.25 paragraph (i)(h), the commissioner may make payments to 23.26 federally recognized Indian tribes with a reservation in the 23.27 state to provide medical assistance and general assistance 23.28 medical care to Indians, as defined under federal law, who 23.29 reside on or near the reservation. The payments may be made in 23.30 the form of a block grant or other payment mechanism determined 23.31 in consultation with the tribe. Any alternative payment 23.32 mechanism agreed upon by the tribes and the commissioner under 23.33 this subdivision is not dependent upon county or health plan 23.34 agreement but is intended to create a direct payment mechanism 23.35 between the state and the tribe for the administration of the 23.36 medical assistance and general assistance medical care programs, 24.1 and for covered services. 24.2 (b) A tribe that implements a purchasing model under this 24.3 subdivision shall report to the commissioner at least annually 24.4 on the operation of the model. The commissioner and the tribe 24.5 shall cooperatively determine the data elements, format, and 24.6 timetable for the report. 24.7 (c) For purposes of this subdivision, "Indian tribe" means 24.8 a tribe, band, or nation, or other organized group or community 24.9 of Indians that is recognized as eligible for the special 24.10 programs and services provided by the United States to Indians 24.11 because of their status as Indians and for which a reservation 24.12 exists as is consistent with Public Law 100-485, as amended. 24.13 (d) Payments under this subdivision may not result in an 24.14 increase in expenditures that would not otherwise occur in the 24.15 medical assistance program under this chapter or the general 24.16 assistance medical care program under chapter 256D. 24.17 Sec. 22. Minnesota Statutes 2003 Supplement, section 24.18 256B.061, is amended to read: 24.19 256B.061 [ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.] 24.20 (a) If any individual has been determined to be eligible 24.21 for medical assistance, it will be made available for care and 24.22 services included under the plan and furnished in or after the 24.23 third month before the month in which the individual made 24.24 application for such assistance, if such individual was, or upon 24.25 application would have been, eligible for medical assistance at 24.26 the time the care and services were furnished. The commissioner 24.27 may limit, restrict, or suspend the eligibility of an individual 24.28 for up to one year upon that individual's conviction of a 24.29 criminal offense related to application for or receipt of 24.30 medical assistance benefits. 24.31 (b) On the basis of information provided on the completed 24.32 application, an applicant who meets the following criteria shall 24.33 be determined eligible beginning in the month of application: 24.34 (1) has gross income less than 90 percent of the applicable 24.35 income standard; 24.36 (2) has total liquid assets less than 90 percent of the 25.1 asset limit; 25.2 (3) does not reside in a long-term care facility; and 25.3 (4) meets all other eligibility requirements. 25.4 The applicant must provide all required verifications within 30 25.5 days' notice of the eligibility determination or eligibility 25.6 shall be terminated. 25.7 Sec. 23. Minnesota Statutes 2002, section 256B.0625, 25.8 subdivision 3b, is amended to read: 25.9 Subd. 3b. [TELEMEDICINE CONSULTATIONS.] Medical assistance 25.10 covers telemedicine consultations. Telemedicine consultations 25.11 must be made via two-way, interactive video or store-and-forward 25.12 technology. Store-and-forward technology includes telemedicine 25.13 consultations that do not occur in real time via synchronous 25.14 transmissions, and that do not require a face-to-face encounter 25.15 with the patient for all or any part of any such telemedicine 25.16 consultation. The patient record must include a written opinion 25.17 from the consulting physician providing the telemedicine 25.18 consultation. A communication between two physicians that 25.19 consists solely of a telephone conversation is not a 25.20 telemedicine consultation, unless the communication is between a 25.21 pediatrician and psychiatrist for the purpose of managing the 25.22 medications of a child with mental health needs who is either in 25.23 the hospital or at home, and is awaiting placement in a regional 25.24 treatment center. Coverage is limited to three telemedicine 25.25 consultations per recipient per calendar week. Telemedicine 25.26 consultations shall be paid at the full allowable rate. 25.27 Sec. 24. Minnesota Statutes 2003 Supplement, section 25.28 256B.0625, subdivision 9, is amended to read: 25.29 Subd. 9. [DENTAL SERVICES.] (a)Medical assistance covers 25.30 dental services. Dental services include, with prior 25.31 authorization, fixed bridges that are cost-effective for persons 25.32 who cannot use removable dentures because of their medical 25.33 condition. 25.34 (b) Coverage of dental services for adults age 21 and over25.35 who are not pregnant is subject to a $500 annual benefit limit25.36 and covered services are limited to:26.1 (1) diagnostic and preventative services;26.2 (2) basic restorative services; and26.3 (3) emergency services.26.4 Emergency services, dentures, and extractions related to26.5 dentures are not included in the $500 annual benefit limit.26.6 Sec. 25. Minnesota Statutes 2002, section 256B.0625, is 26.7 amended by adding a subdivision to read: 26.8 Subd. 46. [LIST OF HEALTH CARE SERVICES NOT ELIGIBLE FOR 26.9 COVERAGE.] (a) The commissioner of human services, in 26.10 consultation with the commissioner of health, shall biennially 26.11 establish a list of diagnosis/treatment pairings that are not 26.12 eligible for reimbursement under this chapter and chapters 256D 26.13 and 256L, effective for services provided on or after July 1, 26.14 2005. The commissioner shall review the list in effect for the 26.15 prior biennium and shall make any additions or deletions from 26.16 the list as appropriate, taking into consideration the following: 26.17 (1) scientific and medical information; 26.18 (2) clinical assessment; 26.19 (3) cost-effectiveness of treatment; 26.20 (4) prevention of future costs; and 26.21 (5) medical ineffectiveness. 26.22 (b) The commissioner may appoint an ad hoc advisory panel 26.23 made up of physicians, consumers, nurses, dentists, 26.24 chiropractors, and other experts to assist the commissioner in 26.25 reviewing and establishing the list. The commissioner shall 26.26 solicit comments and recommendations from any interested persons 26.27 and organizations and shall schedule at least one public hearing. 26.28 (c) The list must be established by January 15, 2005, for 26.29 the list effective July 1, 2005, and by October 1 of the 26.30 even-numbered years beginning October 1, 2006. The commissioner 26.31 shall publish the list in the State Register by November 1 of 26.32 the even-numbered years beginning November 1, 2006. The list 26.33 shall be submitted to the legislature by January 15 of the 26.34 odd-numbered years beginning January 15, 2005. 26.35 Sec. 26. [256B.075] [DISEASE MANAGEMENT PROGRAMS.] 26.36 Subdivision 1. [GENERAL.] The commissioner shall design 27.1 and implement a disease management initiative for the medical 27.2 assistance, general assistance medical care, and MinnesotaCare 27.3 programs. The initiative shall provide an integrated and 27.4 systematic approach to manage the health care needs of 27.5 recipients who are at risk of, or diagnosed with, specified 27.6 conditions or diseases that require frequent medical attention. 27.7 The initiative shall seek to improve patient care and health 27.8 outcomes and reduce health care costs by managing the care 27.9 provided to recipients with chronic conditions. 27.10 Subd. 2. [FEE-FOR-SERVICE.] (a) The commissioner shall 27.11 develop and implement a disease management program for medical 27.12 assistance and general assistance medical care recipients who 27.13 are not enrolled in the prepaid medical assistance or general 27.14 assistance medical care program and who are receiving services 27.15 on a fee-for-service basis. 27.16 (b) The commissioner shall identify the recipients with 27.17 special health care needs either by the use of a self-reported 27.18 condition-based checklist or by diagnosis. If a recipient has 27.19 several chronic conditions, the commissioner shall determine the 27.20 most prevalent and most serious condition. Based on this 27.21 identification system, the commissioner shall identify the three 27.22 most serious conditions that are prevalent among the identified 27.23 recipients and shall establish for each of these conditions a 27.24 list of primary care providers who are qualified to act as a 27.25 case manager to coordinate the care of the patient. 27.26 (c) The commissioner shall request the identified 27.27 recipients to choose a primary care provider from the list 27.28 established in paragraph (b). The provider shall be responsible 27.29 for: 27.30 (1) establishing a care team that must include a licensed 27.31 physician and a pharmacist and any specialist necessary to treat 27.32 the specific conditions of the targeted diagnosis; 27.33 (2) performing an initial assessment and developing an 27.34 individualized care plan with input from the patient; 27.35 (3) educating the patient in self-management and the 27.36 importance of adhering to the care plan; 28.1 (4) providing problem follow-up and new assessments, as 28.2 needed; and 28.3 (5) adhering to evidence-based best practices care 28.4 strategies. 28.5 (d) The provider may create incentives for a recipient to 28.6 ensure cooperation and patient engagement in the care plan and 28.7 management. 28.8 (e) The recipient shall be required to seek health care 28.9 services related to the specific diagnosis from the primary care 28.10 provider or from the providers on the recipient's care team. 28.11 (f) The commissioner shall set a cost-savings target of ten 28.12 percent reduction in inpatient hospitalization and emergency 28.13 room costs for fiscal year 2005. Based on the achievement of 28.14 this goal, one-half the savings shall be used as a bonus to the 28.15 participating primary care providers for the following fiscal 28.16 year. 28.17 (g) The commissioner shall seek any federal waivers 28.18 necessary to implement this section and to obtain federal 28.19 matching funds. 28.20 Subd. 3. [MANAGED CARE CONTRACTS.] The commissioner shall 28.21 require all managed care plans entering into contracts under 28.22 section 256B.69 to develop and implement at least two disease 28.23 management programs that will improve patient care and health 28.24 outcomes for those enrollees who are at risk of or diagnosed 28.25 with a chronic condition. The commissioner shall require the 28.26 managed care plans to measure and report outcomes in accordance 28.27 with measurements approved by the commissioner. 28.28 Subd. 4. [HEMOPHILIA.] Notwithstanding subdivisions 2 and 28.29 3, the commissioner shall develop a disease management 28.30 initiative for public health care program recipients who have 28.31 been diagnosed with hemophilia. In developing the program, the 28.32 commissioner shall explore the feasibility of contracting with a 28.33 section 340B provider to provide disease management services or 28.34 coordination of care in order to maximize the discounted 28.35 prescription drug prices of the federal 340B program offered 28.36 through section 340B of the federal Public Health Services Act, 29.1 United States Code, title 42, section 256b (1999). 29.2 Sec. 27. [256B.0918] [EMPLOYEE SCHOLARSHIP COSTS AND 29.3 TRAINING IN ENGLISH AS A SECOND LANGUAGE.] 29.4 (a) For the fiscal year beginning July 1, 2004, the 29.5 commissioner shall provide to each provider listed in paragraph 29.6 (c) a scholarship reimbursement increase of two-tenths percent 29.7 of the reimbursement rate for that provider to be used: 29.8 (1) for employee scholarships that satisfy the following 29.9 requirements: 29.10 (i) scholarships are available to all employees who work an 29.11 average of at least 20 hours per week for the provider, except 29.12 administrators, department supervisors, and registered nurses; 29.13 and 29.14 (ii) the course of study is expected to lead to career 29.15 advancement with the provider or in long-term care, including 29.16 home care or care of persons with disabilities, including 29.17 medical care interpreter services and social work; and 29.18 (2) to provide job-related training in English as a second 29.19 language. 29.20 (b) A provider receiving a rate adjustment under this 29.21 subdivision with an annualized value of at least $1,000 shall 29.22 maintain documentation to be submitted to the commissioner on a 29.23 schedule determined by the commissioner and on a form supplied 29.24 by the commissioner of the scholarship rate increase received, 29.25 including: 29.26 (1) the amount received from this reimbursement increase; 29.27 (2) the amount used for training in English as a second 29.28 language; 29.29 (3) the number of persons receiving the training; 29.30 (4) the name of the person or entity providing the 29.31 training; and 29.32 (5) for each scholarship recipient, the name of the 29.33 recipient, the amount awarded, the educational institution 29.34 attended, the nature of the educational program, the program 29.35 completion date, and a determination of the amount spent as a 29.36 percentage of the provider's reimbursement. 30.1 The commissioner shall report to the legislature annually, 30.2 beginning January 15, 2006, with information on the use of these 30.3 funds. 30.4 (c) The rate increases described in this section shall be 30.5 provided to home and community-based waivered services for 30.6 persons with mental retardation or related conditions under 30.7 section 256B.501; home and community-based waivered services for 30.8 the elderly under section 256B.0915; waivered services under 30.9 community alternatives for disabled individuals under section 30.10 256B.49; community alternative care waivered services under 30.11 section 256B.49; traumatic brain injury waivered services under 30.12 section 256B.49; nursing services and home health services under 30.13 section 256B.0625, subdivision 6a; personal care services and 30.14 nursing supervision of personal care services under section 30.15 256B.0625, subdivision 19a; private-duty nursing services under 30.16 section 256B.0625, subdivision 7; day training and habilitation 30.17 services for adults with mental retardation or related 30.18 conditions under sections 252.40 to 252.46; alternative care 30.19 services under section 256B.0913; adult residential program 30.20 grants under Minnesota Rules, parts 9535.2000 to 9535.3000; 30.21 semi-independent living services (SILS) under section 252.275, 30.22 including SILS funding under county social services grants 30.23 formerly funded under chapter 256I; community support services 30.24 for deaf and hard-of-hearing adults with mental illness who use 30.25 or wish to use sign language as their primary means of 30.26 communication; the group residential housing supplementary 30.27 service rate under section 256I.05, subdivision 1a; chemical 30.28 dependency residential and nonresidential service providers 30.29 under section 245B.03; and intermediate care facilities for 30.30 persons with mental retardation under section 256B.5012. 30.31 (d) These increases shall be included in the provider's 30.32 reimbursement rate for the purpose of determining future rates 30.33 for the provider. 30.34 Sec. 28. Minnesota Statutes 2003 Supplement, section 30.35 256B.69, subdivision 2, is amended to read: 30.36 Subd. 2. [DEFINITIONS.] For the purposes of this section, 31.1 the following terms have the meanings given. 31.2 (a) "Commissioner" means the commissioner of human services. 31.3 For the remainder of this section, the commissioner's 31.4 responsibilities for methods and policies for implementing the 31.5 project will be proposed by the project advisory committees and 31.6 approved by the commissioner. 31.7 (b) "Demonstration provider" means a health maintenance 31.8 organization, community integrated service network, or 31.9 accountable provider network authorized and operating under 31.10 chapter 62D, 62N, or 62T that participates in the demonstration 31.11 project according to criteria, standards, methods, and other 31.12 requirements established for the project and approved by the 31.13 commissioner. For purposes of this section, a county board, or 31.14 group of county boards operating under a joint powers agreement, 31.15 is considered a demonstration provider if the county or group of 31.16 county boards meets the requirements of section 256B.692. 31.17 Notwithstanding the above, Itasca County may continue to 31.18 participate as a demonstration provider until July 1, 2004. 31.19 (c) "Eligible individuals" means those persons eligible for 31.20 medical assistance benefits as defined in sections 256B.055, 31.21 256B.056, and 256B.06, except as provided under paragraph (e). 31.22 (d) "Limitation of choice" means suspending freedom of 31.23 choice while allowing eligible individuals to choose among the 31.24 demonstration providers. 31.25 (e) This paragraph supersedes paragraph (c) as long as the 31.26 Minnesota health care reform waiver remains in effect. When the 31.27 waiver expires, this paragraph expires and the commissioner of 31.28 human services shall publish a notice in the State Register and 31.29 notify the revisor of statutes. "Eligible individuals" means 31.30 those persons eligible for medical assistance benefits as 31.31 defined in sections 256B.055, 256B.056, and 256B.06. 31.32 Notwithstanding sections 256B.055, 256B.056, and 256B.06, an 31.33 individual who becomes ineligible for the program because of 31.34 failure to submit income reports or recertification forms in a 31.35 timely manner shall remain enrolled in the prepaid health plan 31.36 and shall remain eligible to receive medical assistance coverage 32.1 through the last day of the month following the month in which 32.2 the enrollee became ineligible for the medical assistance 32.3 program. 32.4 Sec. 29. Minnesota Statutes 2003 Supplement, section 32.5 256D.03, subdivision 3, is amended to read: 32.6 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 32.7 (a) General assistance medical care may be paid for any person 32.8 who is not eligible for medical assistance under chapter 256B, 32.9 including eligibility for medical assistance based on a 32.10 spenddown of excess income according to section 256B.056, 32.11 subdivision 5, or MinnesotaCare as defined in paragraph (b), 32.12 except as provided in paragraph (c), and: 32.13 (1) who is receiving assistance under section 256D.05, 32.14 except for families with children who are eligible under 32.15 Minnesota family investment program (MFIP), or who is having a 32.16 payment made on the person's behalf under sections 256I.01 to 32.17 256I.06; or 32.18 (2) who is a resident of Minnesota; and 32.19 (i) who has gross countable income not in excess of 75 32.20 percent of the federal poverty guidelines for the family size, 32.21 using a six-month budget period and whose equity in assets is 32.22 not in excess of $1,000 per assistance unit. Exempt assets, the 32.23 reduction of excess assets, and the waiver of excess assets must 32.24 conform to the medical assistance program in section 256B.056, 32.25 subdivision 3, with the following exception: the maximum amount 32.26 of undistributed funds in a trust that could be distributed to 32.27 or on behalf of the beneficiary by the trustee, assuming the 32.28 full exercise of the trustee's discretion under the terms of the 32.29 trust, must be applied toward the asset maximum; or 32.30 (ii) who has gross countable income above 75 percent of the 32.31 federal poverty guidelines but not in excess of 175 percent of 32.32 the federal poverty guidelines for the family size, using a 32.33 six-month budget period, whose equity in assets is not in excess 32.34 of the limits in section 256B.056, subdivision 3c, and who 32.35 applies during an inpatient hospitalization. 32.36 (b) General assistance medical care may not be paid for 33.1 applicants or recipients who meet all eligibility requirements 33.2 of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 33.3 are adults with dependent children under 21 whose gross family 33.4 income is equal to or less than 275 percent of the federal 33.5 poverty guidelines. 33.6 (c) For applications received on or after October 1, 2003, 33.7 eligibility may begin no earlier than the date of application. 33.8 For individuals eligible under paragraph (a), clause (2), item 33.9 (i), a redetermination of eligibility must occur every 12 33.10 months. Individuals are eligible under paragraph (a), clause 33.11 (2), item (ii), only during inpatient hospitalization but may 33.12 reapply if there is a subsequent period of inpatient 33.13 hospitalization. Beginning January 1, 2000, Minnesota health 33.14 care program applications completed by recipients and applicants 33.15 who are persons described in paragraph (b), may be returned to 33.16 the county agency to be forwarded to the Department of Human 33.17 Services or sent directly to the Department of Human Services 33.18 for enrollment in MinnesotaCare. If all other eligibility 33.19 requirements of this subdivision are met, eligibility for 33.20 general assistance medical care shall be available in any month 33.21 during which a MinnesotaCare eligibility determination and 33.22 enrollment are pending. Upon notification of eligibility for 33.23 MinnesotaCare, notice of termination for eligibility for general 33.24 assistance medical care shall be sent to an applicant or 33.25 recipient. If all other eligibility requirements of this 33.26 subdivision are met, eligibility for general assistance medical 33.27 care shall be available until enrollment in MinnesotaCare 33.28 subject to the provisions of paragraph (e). 33.29 (d) The date of an initial Minnesota health care program 33.30 application necessary to begin a determination of eligibility 33.31 shall be the date the applicant has provided a name, address, 33.32 and Social Security number, signed and dated, to the county 33.33 agency or the Department of Human Services. If the applicant is 33.34 unable to provide a name, address, Social Security number, and 33.35 signature when health care is delivered due to a medical 33.36 condition or disability, a health care provider may act on an 34.1 applicant's behalf to establish the date of an initial Minnesota 34.2 health care program application by providing the county agency 34.3 or Department of Human Services with provider identification and 34.4 a temporary unique identifier for the applicant by the end of 34.5 the next business day. The applicant must complete the 34.6 remainder of the application and provide necessary verification 34.7 before eligibility can be determined. The county agency must 34.8 assist the applicant in obtaining verification if necessary. On 34.9 the basis of information provided on the completed application, 34.10 an applicant who meets the following criteria shall be 34.11 determined eligible beginning in the month of application: 34.12 (1) has gross income less than 90 percent of the applicable 34.13 income standard; 34.14 (2) has liquid assets that total within $300 of the asset 34.15 standard; 34.16 (3) does not reside in a long-term care facility; and 34.17 (4) meets all other eligibility requirements. 34.18 The applicant must provide all required verifications within 30 34.19 days' notice of the eligibility determination or eligibility 34.20 shall be terminated. 34.21 (e) County agencies are authorized to use all automated 34.22 databases containing information regarding recipients' or 34.23 applicants' income in order to determine eligibility for general 34.24 assistance medical care or MinnesotaCare. Such use shall be 34.25 considered sufficient in order to determine eligibility and 34.26 premium payments by the county agency. 34.27 (f) General assistance medical care is not available for a 34.28 person in a correctional facility unless the person is detained 34.29 by law for less than one year in a county correctional or 34.30 detention facility as a person accused or convicted of a crime, 34.31 or admitted as an inpatient to a hospital on a criminal hold 34.32 order, and the person is a recipient of general assistance 34.33 medical care at the time the person is detained by law or 34.34 admitted on a criminal hold order and as long as the person 34.35 continues to meet other eligibility requirements of this 34.36 subdivision. 35.1 (g) General assistance medical care is not available for 35.2 applicants or recipients who do not cooperate with the county 35.3 agency to meet the requirements of medical assistance. 35.4 (h) In determining the amount of assets of an individual 35.5 eligible under paragraph (a), clause (2), item (i), there shall 35.6 be included any asset or interest in an asset, including an 35.7 asset excluded under paragraph (a), that was given away, sold, 35.8 or disposed of for less than fair market value within the 60 35.9 months preceding application for general assistance medical care 35.10 or during the period of eligibility. Any transfer described in 35.11 this paragraph shall be presumed to have been for the purpose of 35.12 establishing eligibility for general assistance medical care, 35.13 unless the individual furnishes convincing evidence to establish 35.14 that the transaction was exclusively for another purpose. For 35.15 purposes of this paragraph, the value of the asset or interest 35.16 shall be the fair market value at the time it was given away, 35.17 sold, or disposed of, less the amount of compensation received. 35.18 For any uncompensated transfer, the number of months of 35.19 ineligibility, including partial months, shall be calculated by 35.20 dividing the uncompensated transfer amount by the average 35.21 monthly per person payment made by the medical assistance 35.22 program to skilled nursing facilities for the previous calendar 35.23 year. The individual shall remain ineligible until this fixed 35.24 period has expired. The period of ineligibility may exceed 30 35.25 months, and a reapplication for benefits after 30 months from 35.26 the date of the transfer shall not result in eligibility unless 35.27 and until the period of ineligibility has expired. The period 35.28 of ineligibility begins in the month the transfer was reported 35.29 to the county agency, or if the transfer was not reported, the 35.30 month in which the county agency discovered the transfer, 35.31 whichever comes first. For applicants, the period of 35.32 ineligibility begins on the date of the first approved 35.33 application. 35.34 (i) When determining eligibility for any state benefits 35.35 under this subdivision, the income and resources of all 35.36 noncitizens shall be deemed to include their sponsor's income 36.1 and resources as defined in the Personal Responsibility and Work 36.2 Opportunity Reconciliation Act of 1996, title IV, Public Law 36.3 104-193, sections 421 and 422, and subsequently set out in 36.4 federal rules. 36.5 (j) Undocumented noncitizens and nonimmigrants are 36.6 ineligible for general assistance medical care, except an 36.7 individual eligible under paragraph (a), clause (4), remains 36.8 eligible through September 30, 2003. For purposes of this 36.9 subdivision, a nonimmigrant is an individual in one or more of 36.10 the classes listed in United States Code, title 8, section 36.11 1101(a)(15), and an undocumented noncitizen is an individual who 36.12 resides in the United States without the approval or 36.13 acquiescence of the Immigration and Naturalization Service. 36.14 (k) Notwithstanding any other provision of law, a 36.15 noncitizen who is ineligible for medical assistance due to the 36.16 deeming of a sponsor's income and resources, is ineligible for 36.17 general assistance medical care. 36.18 (l) Effective July 1, 2003, general assistance medical care 36.19 emergency services end. 36.20 Sec. 30. Minnesota Statutes 2003 Supplement, section 36.21 256D.03, subdivision 4, is amended to read: 36.22 Subd. 4. [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 36.23 (a)(i) For a person who is eligible under subdivision 3, 36.24 paragraph (a), clause (2), item (i), general assistance medical 36.25 care covers, except as provided in paragraph (c): 36.26 (1) inpatient hospital services; 36.27 (2) outpatient hospital services; 36.28 (3) services provided by Medicare certified rehabilitation 36.29 agencies; 36.30 (4) prescription drugs and other products recommended 36.31 through the process established in section 256B.0625, 36.32 subdivision 13; 36.33 (5) equipment necessary to administer insulin and 36.34 diagnostic supplies and equipment for diabetics to monitor blood 36.35 sugar level; 36.36 (6) eyeglasses and eye examinations provided by a physician 37.1 or optometrist; 37.2 (7) hearing aids; 37.3 (8) prosthetic devices; 37.4 (9) laboratory and X-ray services; 37.5 (10) physician's services; 37.6 (11) medical transportation except special transportation; 37.7 (12) chiropractic services as covered under the medical 37.8 assistance program; 37.9 (13) podiatric services; 37.10 (14) dental services and dentures, subject to the 37.11 limitations specified in section 256B.0625, subdivision 9; 37.12 (15) outpatient services provided by a mental health center 37.13 or clinic that is under contract with the county board and is 37.14 established under section 245.62; 37.15 (16) day treatment services for mental illness provided 37.16 under contract with the county board; 37.17 (17) prescribed medications for persons who have been 37.18 diagnosed as mentally ill as necessary to prevent more 37.19 restrictive institutionalization; 37.20 (18) psychological services, medical supplies and 37.21 equipment, and Medicare premiums, coinsurance and deductible 37.22 payments; 37.23 (19) medical equipment not specifically listed in this 37.24 paragraph when the use of the equipment will prevent the need 37.25 for costlier services that are reimbursable under this 37.26 subdivision; 37.27 (20) services performed by a certified pediatric nurse 37.28 practitioner, a certified family nurse practitioner, a certified 37.29 adult nurse practitioner, a certified obstetric/gynecological 37.30 nurse practitioner, a certified neonatal nurse practitioner, or 37.31 a certified geriatric nurse practitioner in independent 37.32 practice, if (1) the service is otherwise covered under this 37.33 chapter as a physician service, (2) the service provided on an 37.34 inpatient basis is not included as part of the cost for 37.35 inpatient services included in the operating payment rate, and 37.36 (3) the service is within the scope of practice of the nurse 38.1 practitioner's license as a registered nurse, as defined in 38.2 section 148.171; 38.3 (21) services of a certified public health nurse or a 38.4 registered nurse practicing in a public health nursing clinic 38.5 that is a department of, or that operates under the direct 38.6 authority of, a unit of government, if the service is within the 38.7 scope of practice of the public health nurse's license as a 38.8 registered nurse, as defined in section 148.171; and 38.9 (22) telemedicine consultations, to the extent they are 38.10 covered under section 256B.0625, subdivision 3b. 38.11 (ii) Effective October 1, 2003, for a person who is 38.12 eligible under subdivision 3, paragraph (a), clause (2), item 38.13 (ii), general assistance medical care coverage is limited to 38.14 inpatient hospital services, including physician services 38.15 provided during the inpatient hospital stay. A $1,000 38.16 deductible is required for each inpatient hospitalization. 38.17 (b) Gender reassignment surgery and related services are 38.18 not covered services under this subdivision unless the 38.19 individual began receiving gender reassignment services prior to 38.20 July 1, 1995. 38.21 (c) In order to contain costs, the commissioner of human 38.22 services shall select vendors of medical care who can provide 38.23 the most economical care consistent with high medical standards 38.24 and shall where possible contract with organizations on a 38.25 prepaid capitation basis to provide these services. The 38.26 commissioner shall consider proposals by counties and vendors 38.27 for prepaid health plans, competitive bidding programs, block 38.28 grants, or other vendor payment mechanisms designed to provide 38.29 services in an economical manner or to control utilization, with 38.30 safeguards to ensure that necessary services are provided. 38.31 Before implementing prepaid programs in counties with a county 38.32 operated or affiliated public teaching hospital or a hospital or 38.33 clinic operated by the University of Minnesota, the commissioner 38.34 shall consider the risks the prepaid program creates for the 38.35 hospital and allow the county or hospital the opportunity to 38.36 participate in the program in a manner that reflects the risk of 39.1 adverse selection and the nature of the patients served by the 39.2 hospital, provided the terms of participation in the program are 39.3 competitive with the terms of other participants considering the 39.4 nature of the population served. Payment for services provided 39.5 pursuant to this subdivision shall be as provided to medical 39.6 assistance vendors of these services under sections 256B.02, 39.7 subdivision 8, and 256B.0625. For payments made during fiscal 39.8 year 1990 and later years, the commissioner shall consult with 39.9 an independent actuary in establishing prepayment rates, but 39.10 shall retain final control over the rate methodology. 39.11 (d) Recipients eligible under subdivision 3, paragraph (a),39.12 clause (2), item (i), shall pay the following co-payments for39.13 services provided on or after October 1, 2003:39.14 (1) $3 per nonpreventive visit. For purposes of this39.15 subdivision, a visit means an episode of service which is39.16 required because of a recipient's symptoms, diagnosis, or39.17 established illness, and which is delivered in an ambulatory39.18 setting by a physician or physician ancillary, chiropractor,39.19 podiatrist, nurse midwife, advanced practice nurse, audiologist,39.20 optician, or optometrist;39.21 (2) $25 for eyeglasses;39.22 (3) $25 for nonemergency visits to a hospital-based39.23 emergency room;39.24 (4) $3 per brand-name drug prescription and $1 per generic39.25 drug prescription, subject to a $20 per month maximum for39.26 prescription drug co-payments. No co-payments shall apply to39.27 antipsychotic drugs when used for the treatment of mental39.28 illness; and39.29 (5) 50 percent coinsurance on basic restorative dental39.30 services.39.31 (e) Recipients of general assistance medical care are39.32 responsible for all co-payments in this subdivision. The39.33 general assistance medical care reimbursement to the provider39.34 shall be reduced by the amount of the co-payment, except that39.35 reimbursement for prescription drugs shall not be reduced once a39.36 recipient has reached the $20 per month maximum for prescription40.1 drug co-payments. The provider collects the co-payment from the40.2 recipient. Providers may not deny services to recipients who40.3 are unable to pay the co-payment, except as provided in40.4 paragraph (f).40.5 (f) If it is the routine business practice of a provider to40.6 refuse service to an individual with uncollected debt, the40.7 provider may include uncollected co-payments under this40.8 section. A provider must give advance notice to a recipient40.9 with uncollected debt before services can be deniedThere shall 40.10 be no co-payment required of any recipient of benefits for any 40.11 services provided under this subdivision. 40.12 (g)(e) Any county may, from its own resources, provide 40.13 medical payments for which state payments are not made. 40.14 (h)(f) Chemical dependency services that are reimbursed 40.15 under chapter 254B must not be reimbursed under general 40.16 assistance medical care. 40.17 (i)(g) The maximum payment for new vendors enrolled in the 40.18 general assistance medical care program after the base year 40.19 shall be determined from the average usual and customary charge 40.20 of the same vendor type enrolled in the base year. 40.21 (j)(h) The conditions of payment for services under this 40.22 subdivision are the same as the conditions specified in rules 40.23 adopted under chapter 256B governing the medical assistance 40.24 program, unless otherwise provided by statute or rule. 40.25 (k)(i) Inpatient and outpatient payments shall be reduced 40.26 by five percent, effective July 1, 2003. This reduction is in 40.27 addition to the five percent reduction effective July 1, 2003, 40.28 and incorporated by reference in paragraph (i)(g). 40.29 (l)(j) Payments for all other health services except 40.30 inpatient, outpatient, and pharmacy services shall be reduced by 40.31 five percent, effective July 1, 2003. 40.32 (m)(k) Payments to managed care plans shall be reduced by 40.33 five percent for services provided on or after October 1, 2003. 40.34 (n)(l) A hospital receiving a reduced payment as a result 40.35 of this section may apply the unpaid balance toward satisfaction 40.36 of the hospital's bad debts. 41.1 Sec. 31. Minnesota Statutes 2003 Supplement, section 41.2 256L.03, subdivision 1, is amended to read: 41.3 Subdivision 1. [COVERED HEALTH SERVICES.] For individuals41.4 under section 256L.04, subdivision 7, with income no greater41.5 than 75 percent of the federal poverty guidelines or for41.6 families with children under section 256L.04, subdivision 1, all41.7 subdivisions of this section apply."Covered health services" 41.8 means the health services reimbursed under chapter 256B, with 41.9 the exception of inpatient hospital services, special education 41.10 services, private duty nursing services, adult dental care 41.11 services other than preventive services covered under section41.12 256B.0625, subdivision 9, paragraph (b), orthodontic services, 41.13 nonemergency medical transportation services, personal care 41.14 assistant and case management services, nursing home or 41.15 intermediate care facilities services, inpatient mental health 41.16 services, and chemical dependency services. Adult dental care 41.17 for nonpreventive services, with the exception of orthodontic 41.18 services, is covered for persons who qualify under section 41.19 256L.04, subdivisions 1, 2, and 7, with family gross income 41.20 equal to or less than 175 percent of the federal poverty 41.21 guidelines. Outpatient mental health services covered under the 41.22 MinnesotaCare program are limited to diagnostic assessments, 41.23 psychological testing, explanation of findings, medication 41.24 management by a physician, day treatment, partial 41.25 hospitalization, and individual, family, and group psychotherapy. 41.26 No public funds shall be used for coverage of abortion 41.27 under MinnesotaCare except where the life of the female would be 41.28 endangered or substantial and irreversible impairment of a major 41.29 bodily function would result if the fetus were carried to term; 41.30 or where the pregnancy is the result of rape or incest. 41.31 Covered health services shall be expanded as provided in 41.32 this section. 41.33 Sec. 32. Minnesota Statutes 2003 Supplement, section 41.34 256L.05, subdivision 4, is amended to read: 41.35 Subd. 4. [APPLICATION PROCESSING.] The commissioner of 41.36 human services shall determine an applicant's eligibility for 42.1 MinnesotaCare no more than 30 days from the date that the 42.2 application is received by the Department of Human Services. 42.3 Beginning January 1, 2000, this requirement also applies to 42.4 local county human services agencies that determine eligibility 42.5 for MinnesotaCare. At application or reenrollment, to prevent 42.6 processing delays, applicants or enrollees who, from the 42.7 information provided on the application, appear to meet 42.8 eligibility requirements shall be enrolled upon timely payment 42.9 of premiums. The enrollee must provide all required 42.10 verifications within 30 days of notification of the eligibility 42.11 determination or coverage from the program shall be terminated. 42.12 Enrollees who are determined to be ineligible when verifications 42.13 are provided shall be disenrolled from the program. 42.14 Sec. 33. Minnesota Statutes 2003 Supplement, section 42.15 256L.07, subdivision 1, is amended to read: 42.16 Subdivision 1. [GENERAL REQUIREMENTS.] (a) Children 42.17 enrolled in the original children's health plan as of September 42.18 30, 1992, children who enrolled in the MinnesotaCare program 42.19 after September 30, 1992, pursuant to Laws 1992, chapter 549, 42.20 article 4, section 17, and children who have family gross 42.21 incomes that are equal to or less than 150 percent of the 42.22 federal poverty guidelines are eligible without meeting the 42.23 requirements of subdivision 2 and the four-month requirement in 42.24 subdivision 3, as long as they maintain continuous coverage in 42.25 the MinnesotaCare program or medical assistance. Children who 42.26 apply for MinnesotaCare on or after the implementation date of 42.27 the employer-subsidized health coverage program as described in 42.28 Laws 1998, chapter 407, article 5, section 45, who have family 42.29 gross incomes that are equal to or less than 150 percent of the 42.30 federal poverty guidelines, must meet the requirements of 42.31 subdivision 2 to be eligible for MinnesotaCare. 42.32 (b) Families enrolled in MinnesotaCare under section 42.33 256L.04, subdivision 1, whose income increases above 275 percent 42.34 of the federal poverty guidelines, are no longer eligible for 42.35 the program and shall be disenrolled by the commissioner. 42.36 Individuals enrolled in MinnesotaCare under section 256L.04, 43.1 subdivision 7, whose income increases above 175 percent of the 43.2 federal poverty guidelines are no longer eligible for the 43.3 program and shall be disenrolled by the commissioner. For 43.4 persons disenrolled under this subdivision, MinnesotaCare 43.5 coverage terminates the last day of the calendar month following 43.6 the month in which the commissioner determines that the income 43.7 of a family or individual exceeds program income limits. 43.8 (c) (1)Notwithstanding paragraph (b), individuals and 43.9 families enrolled in MinnesotaCare under section 256L.04,43.10 subdivision 1,may remain enrolled in MinnesotaCare if ten 43.11 percent of their annual income is less than the annual premium 43.12 for a policy with a $500 deductible available through the 43.13 Minnesota Comprehensive Health Association. Individuals and 43.14 families who are no longer eligible for MinnesotaCare under this 43.15 subdivision shall be given an 18-montha 12-month notice period 43.16 from the date that ineligibility is determined before 43.17 disenrollment. This clause expires February 1, 2004.43.18 (2) Effective February 1, 2004, notwithstanding paragraph43.19 (b), children may remain enrolled in MinnesotaCare if ten43.20 percent of their annual family income is less than the annual43.21 premium for a policy with a $500 deductible available through43.22 the Minnesota Comprehensive Health Association. Children who43.23 are no longer eligible for MinnesotaCare under this clause shall43.24 be given a 12-month notice period from the date that43.25 ineligibility is determined before disenrollment.The premium 43.26 for childrenindividuals and families remaining eligible under 43.27 this clauseparagraph shall be the maximum premium determined 43.28 under section 256L.15, subdivision 2, paragraph (b). 43.29 (d) Effective July 1, 2003, notwithstanding paragraphs (b) 43.30 and (c), parents are no longer eligible for MinnesotaCare if 43.31 gross household income exceeds $50,000. 43.32 Sec. 34. Minnesota Statutes 2003 Supplement, section 43.33 256L.12, subdivision 6, is amended to read: 43.34 Subd. 6. [CO-PAYMENTS AND BENEFIT LIMITS.] Enrollees are 43.35 responsible for all co-payments in sectionssection 256L.03, 43.36 subdivision 5, and 256L.035,and shall pay co-payments to the 44.1 managed care plan or to its participating providers. The 44.2 enrollee is also responsible for payment of inpatient hospital 44.3 charges which exceed the MinnesotaCare benefit limit. 44.4 Sec. 35. [256L.20] [MINNESOTACARE OPTION FOR SMALL 44.5 EMPLOYERS.] 44.6 Subdivision 1. [DEFINITIONS.] (a) For the purpose of this 44.7 section, the definitions have the meanings given them. 44.8 (b) "Dependent" means an unmarried child under 21 years of 44.9 age. 44.10 (c) "Eligible employer" means a business that employs at 44.11 least two, but not more than 50, eligible employees, the 44.12 majority of whom are employed in the state, and includes a 44.13 municipality that has 50 or fewer employees. 44.14 (d) "Eligible employee" means an employee who works at 44.15 least 20 hours per week for an eligible employer. Eligible 44.16 employee does not include an employee who works on a temporary 44.17 or substitute basis or who does not work more than 26 weeks 44.18 annually. 44.19 (e) "Maximum premium" has the meaning given under section 44.20 256L.15, subdivision 2, paragraph (b), clause (3). 44.21 (f) "Participating employer" means an eligible employer who 44.22 meets the requirements described in subdivision 3 and applies to 44.23 the commissioner to enroll its eligible employees and their 44.24 dependents in the MinnesotaCare program. 44.25 (g) "Program" means the MinnesotaCare program. 44.26 Subd. 2. [OPTION.] Eligible employees and their dependents 44.27 may enroll in MinnesotaCare if the eligible employer meets the 44.28 requirements of subdivision 3. The effective date of coverage 44.29 is according to section 265L.05, subdivision 3. 44.30 Subd. 3. [EMPLOYER REQUIREMENTS.] The commissioner shall 44.31 establish procedures for an eligible employer to apply for 44.32 coverage through the program. In order to participate, an 44.33 eligible employer must meet the following requirements: 44.34 (1) agrees to contribute toward the cost of the premium for 44.35 the employee and the employee's dependents according to 44.36 subdivision 4; 45.1 (2) certifies that at least 75 percent of its eligible 45.2 employees who do not have other creditable health coverage are 45.3 enrolled in the program; 45.4 (3) offers coverage to all eligible employees and the 45.5 dependents of eligible employees; and 45.6 (4) has not provided employer-subsidized health coverage as 45.7 an employee benefit during the previous 12 months, as defined in 45.8 section 256L.07, subdivision 2, paragraph (c). 45.9 Subd. 4. [PREMIUMS.] (a) The premium for MinnesotaCare 45.10 coverage provided under this section is equal to the maximum 45.11 premium regardless of the income of the eligible employee. 45.12 (b) For eligible employees without dependents with income 45.13 equal to or less than 175 percent of the federal poverty 45.14 guidelines and for eligible employees with dependents with 45.15 income equal to or less than 275 percent of the federal poverty 45.16 guidelines, the participating employer shall pay 50 percent of 45.17 the maximum premium for the eligible employee and any 45.18 dependents, if applicable. 45.19 (c) For eligible employees without dependents with income 45.20 over 175 percent of the federal poverty guidelines and for 45.21 eligible employees with dependents with income over 275 percent 45.22 of the federal poverty guidelines, the participating employer 45.23 shall pay the full cost of the maximum premium for the eligible 45.24 employee and any dependents, if applicable. The participating 45.25 employer may require the employee to pay a portion of the cost 45.26 of the premium so long as the employer pays 50 percent of the 45.27 cost. If the employer requires the employee to pay a portion of 45.28 the premium, the employee shall pay the portion of the cost to 45.29 the employer. 45.30 (d) The commissioner shall collect premium payments from 45.31 participating employers for eligible employees and their 45.32 dependents who are covered by the program as provided under this 45.33 section. All premiums collected shall be deposited in the 45.34 health care access fund. 45.35 Subd. 5. [COVERAGE.] The coverage offered to those 45.36 enrolled in the program under this section must include all 46.1 health services described under section 256L.03 and all 46.2 co-payments and coinsurance requirements described under section 46.3 256L.03, subdivision 5, shall apply. 46.4 Subd. 6. [ENROLLMENT.] Upon payment of the premium, in 46.5 accordance with this section and section 256L.06, eligible 46.6 employees and their dependents shall be enrolled in 46.7 MinnesotaCare. For purposes of enrollment under this section, 46.8 income eligibility limits established under sections 256L.04 and 46.9 256L.07, subdivision 1, and asset limits established under 46.10 section 256L.17 do not apply. The barriers established under 46.11 section 256L.07, subdivision 2 or 3, do not apply to enrollees 46.12 eligible under this section. The commissioner may require 46.13 eligible employees to provide income verification to determine 46.14 premiums. 46.15 Sec. 36. [FEDERAL 340B DRUG PRICING PROGRAM INFORMATION.] 46.16 The commissioner of human services, in consultation with 46.17 the commissioner of corrections, shall examine the feasibility 46.18 of providing discounted prescription drugs to targeted patient 46.19 populations through the use of section 340B of the federal 46.20 Public Health Services Act, United States Code, title 42, 46.21 section 256b (1999). The commissioner of human services shall 46.22 also consult with other state agencies and representatives of 46.23 health care providers and facilities in the state to provide the 46.24 following information: 46.25 (1) a description of all health care providers and 46.26 facilities in the state potentially eligible for designation as 46.27 a "covered entity" under section 340B, including, but not 46.28 limited to, all hospitals eligible as disproportionate share 46.29 hospitals; recipients of grants from the United States Public 46.30 Health Service; federally qualified health centers; 46.31 state-operated AIDS drug assistance programs; Ryan White Care 46.32 Act, title I, title II, and title III programs; family planning 46.33 and sexually transmitted disease clinics; hemophilia treatment 46.34 centers; public housing primary care clinics; and clinics for 46.35 homeless people. The commissioner shall encourage those 46.36 facilities that are or may be eligible to participate in the 47.1 program and shall provide any necessary technical assistance to 47.2 access the program; and 47.3 (2) a list of potential applications of section 340B and 47.4 the potential benefits to public, private, and third-party 47.5 payers, including, but not limited to: 47.6 (i) application to inmates and employees in youth 47.7 correctional facilities, county jails, and state prisons; 47.8 (ii) maximizing the use of section 340B within state-funded 47.9 managed care plans; 47.10 (iii) including section 340B providers in state bulk 47.11 purchasing initiatives; and 47.12 (iv) utilizing sole source contracts with section 340B 47.13 providers to furnish high-cost chronic care drugs. 47.14 Sec. 37. [DISEASE MANAGEMENT PROGRAM ACCOUNTABILITY.] 47.15 (a) The commissioner of human services shall establish an 47.16 estimated cost savings to medical assistance, general assistance 47.17 medical care, and the MinnesotaCare program due to the 47.18 implementation of the disease management initiatives required 47.19 under Minnesota Statutes, section 256B.075. 47.20 (b) The commissioner shall submit a recommendation to the 47.21 legislature by January 15, 2006, on whether to reduce the 47.22 managed care plan payments under Minnesota Statutes, section 47.23 256B.69, to reflect the estimated cost savings, and if so, the 47.24 amount of the reduction. 47.25 Sec. 38. [HEALTH CARE REPORTING CONSOLIDATION STUDY.] 47.26 The commissioners of human services, health, and commerce 47.27 shall meet with representatives of health plans, insurance 47.28 companies, nonprofit health service plan corporations, and 47.29 hospitals, to discuss all of the reports and reporting 47.30 requirements that are required of these entities with the 47.31 intention of consolidating, and where appropriate, reducing the 47.32 number of reports and reporting requirements. These discussions 47.33 shall be conducted prior to November 30, 2004. The 47.34 commissioners of human services, health, and commerce shall 47.35 submit a report to the legislature by January 15, 2005. The 47.36 report shall identify the name and scope of each required report 48.1 with justification as to the need and use of each report, 48.2 including the value to consumers and to what extent the report 48.3 is used to help decrease costs or increase the quality of care 48.4 or services provided. 48.5 Sec. 39. [MINNESOTACARE OPTION FOR SMALL EMPLOYERS.] 48.6 The commissioner of human services, in consultation with 48.7 the Minnesota Hospital Association, Minnesota Medical 48.8 Association, Minnesota Chamber of Commerce, and the Minnesota 48.9 Business Partnership shall evaluate the effect of the limited 48.10 hospital benefit under the MinnesotaCare program for single 48.11 adults without children as it applies to the MinnesotaCare 48.12 enrollment option for small employers described under Minnesota 48.13 Statutes, section 256L.20. In the evaluation, the commissioner 48.14 shall determine whether this limitation discourages 48.15 participation in the program by small employers, whether it has 48.16 added to the amount of uncompensated care provided by hospitals, 48.17 and the cost to the MinnesotaCare program if the hospital 48.18 benefit limitation was eliminated for enrollees enrolled under 48.19 Minnesota Statutes, section 256L.20. The commissioner shall 48.20 submit the results of the evaluation to the legislature by 48.21 January 15, 2006. 48.22 Sec. 40. [TASK FORCE ON IMPROVING THE HEALTH STATUS OF THE 48.23 STATE'S CHILDREN.] 48.24 (a) The commissioners of education, health, and human 48.25 services shall convene a task force to make recommendations on 48.26 the role of public schools in improving the health status of 48.27 children, including, but not limited to, increasing physical 48.28 education activities within the public schools; exploring 48.29 opportunities to promote physical education and healthy eating 48.30 programs; improving the nutritional offerings through breakfast 48.31 and lunch menus; and evaluating the availability and choice of 48.32 products offered in vending machines located within public 48.33 schools. The members of the task force shall include 48.34 representatives of the Minnesota Medical Association; Minnesota 48.35 Nurses Association; Local Public Health Association of 48.36 Minnesota; the Minnesota Dietetic Association; Minnesota School 49.1 Food Services Association; the Minnesota Association of Health, 49.2 Physical Education, Recreation, and Dance; and consumers. The 49.3 terms and compensation of the members of the task force shall be 49.4 in accordance with Minnesota Statutes, section 15.059, 49.5 subdivision 6. 49.6 (b) The commissioner must submit the recommendations of the 49.7 task force to the legislature by January 15, 2005. 49.8 Sec. 41. [APPROPRIATION.] 49.9 (a) $6,000,000 is appropriated for fiscal year 2005 from 49.10 the general fund to the Board of Trustees of the Minnesota State 49.11 Colleges and Universities for the nursing and health care 49.12 education plan designed to: 49.13 (1) expand the system's enrollment in registered nursing 49.14 education programs; 49.15 (2) support practical nursing programs in regions of high 49.16 need; 49.17 (3) address the shortage of nursing faculty; and 49.18 (4) provide accessible learning opportunities to students 49.19 through distance education and simulation experiences. 49.20 (b) $....... is appropriated from the general fund to the 49.21 commissioner of finance for transfer to the electronic medical 49.22 record system loan fund to capitalize the fund. The 49.23 appropriation is available until expended. 49.24 (c) $....... is appropriated for fiscal year 2005 from the 49.25 general fund to the commissioner of health for the loan 49.26 forgiveness program in Minnesota Statutes, section 144.1501. 49.27 Sec. 42. [REPEALER.] 49.28 Minnesota Statutes 2003 Supplement, sections 256.954, 49.29 subdivision 12; 256B.0631; and 256L.035, are repealed.