HF 2290

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; modifying limited benefits
coverage for MinnesotaCare; amending Minnesota
Statutes 2004, section 256L.035.

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

Section 1.

Minnesota Statutes 2004, section 256L.035, is
amended to read:

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

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

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

(2) physician services provided during an inpatient stay;
deleted text begin and
deleted text end

(3) physician services not provided during an inpatient
stay deleted text begin , deleted text end new text begin ; new text end outpatient hospital services deleted text begin , deleted text end new text begin ; new text end freestanding ambulatory
surgical center services deleted text begin , deleted text end new text begin ; new text end chiropractic services deleted text begin , deleted text end new text begin ; new text end lab and
diagnostic services deleted text begin , deleted text end new text begin ; vision services, excluding the dispensing,
fitting, and adjustment of eyeglasses or contacts and eye
examinations to determine refractive state; new text end and prescription
drugs, subject to an aggregate cap of $2,000 per calendar year
and the following co-payments:

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

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

(iii) $5 co-pay per nonpreventive physician visit new text begin ; and
new text end

new text begin (4) dental services, limited to diagnostic and preventive
services, restorative services, and emergency services and
subject to a $500 annual benefit limit. Emergency services,
dentures, and extractions related to dentures are not included
in the $500 annual benefit limit new text end .

For purposes of this subdivision, "a visit" means an
episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is
delivered in an ambulatory setting by a physician deleted text begin or deleted text end new text begin , new text end physician
ancillary new text begin , or optometrist new text end .

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

(b) The November 2006 MinnesotaCare forecast for the
biennium beginning July 1, 2007, shall assume an adjustment in
the aggregate cap on the services identified in paragraph (a),
clause (3), in $1,000 increments up to a maximum of $10,000, but
not less than $2,000, to the extent that the balance in the
health care access fund is sufficient in each year of the
biennium to pay for this benefit level. The aggregate cap shall
be adjusted according to the forecast.

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

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