HF 2937

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

A bill for an act
relating to human services; providing coverage for vision services under
MinnesotaCare limited benefit set; amending Minnesota Statutes 2005
Supplement, section 256L.035.

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

Section 1.

Minnesota Statutes 2005 Supplement, section 256L.035, is amended to read:

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

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

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

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

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

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

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

(iii) $5 co-pay per nonpreventive visit new text begin , including optometrist visit new text end .

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

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

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

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

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