as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to human services; modifying provisions in 1.3 health care programs; amending Minnesota Statutes 1999 1.4 Supplement, sections 256B.0945, subdivisions 1, 2, 4, 1.5 5, 6, 7, 8, and 9; 256D.03, subdivision 3; and 1.6 256L.03, subdivision 5; Laws 1999, chapter 245, 1.7 article 8, section 84; repealing Laws 1998, chapter 1.8 407, article 5, section 44. 1.9 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.10 Section 1. Minnesota Statutes 1999 Supplement, section 1.11 256B.0945, subdivision 1, is amended to read: 1.12 Subdivision 1. [PROVIDER QUALIFICATIONS.] Counties must 1.13 arrange to provide residential services for children with severe 1.14 emotional disturbance according to
sectionsections 245.4882, 1.15 245.4885, and this section. Services must be provided by a 1.16 facility that is licensed according to section 245.4882 and 1.17 administrative rules promulgated thereunder, and under contract 1.18 with the county. Facilities providing services under subdivision 1.19 2, paragraph (a), must be accredited as a psychiatric facility 1.20 by the Joint Commission on Accreditation of Healthcare 1.21 Organizations, the Commission on Accreditation of Rehabilitation 1.22 Facilities, or the Council on Accreditation. Accreditation is 1.23 not required for facilities providing services under subdivision 1.24 2, paragraph (b). 1.25 Sec. 2. Minnesota Statutes 1999 Supplement, section 1.26 256B.0945, subdivision 2, is amended to read: 1.27 Subd. 2. [COVERED SERVICES.] All services must be included 2.1 in a child's individualized treatment or collaborative family2.2 servicemultiagency plan of care as defined in chapter 245. 2.3 (a) For facilities that are institutions for mental 2.4 diseases according to statute and regulation or are not 2.5 institutions for mental diseases but chooseare approved by the 2.6 commissioner to provide services under this paragraph, medical 2.7 assistance covers the full contract rate, including room and 2.8 board if the services meet the requirements of Code of Federal 2.9 Regulations, title 42, section 440.160. 2.10 (b) For facilities that are not institutions for mental 2.11 diseases according to federal statute and regulation and are not 2.12 providing services under paragraph (a), medical assistance 2.13 covers mental health related services that are required to be 2.14 provided by a residential facility under section 245.4882 and 2.15 administrative rules promulgated thereunder, except for room and 2.16 board. 2.17 Sec. 3. Minnesota Statutes 1999 Supplement, section 2.18 256B.0945, subdivision 4, is amended to read: 2.19 Subd. 4. [PAYMENT RATES.] (a) Notwithstanding sections 2.20 256.025, subdivision 2; 256B.19; and 256B.041, payments to 2.21 counties for residential services provided by a residential 2.22 facility shall only be made of federal earnings for services 2.23 provided under this section, and the nonfederal share of costs 2.24 for services provided under this section shall be paid by the 2.25 county from sources other than federal funds or funds used to 2.26 match other federal funds. Total annual payments for federal2.27 earnings shall not exceed the federal medical assistance2.28 percentage matching rate multiplied by the total county2.29 expenditures for services provided under section 245.4882 for2.30 either (1) the calendar year 1999 or (2) the average annual2.31 expenditures for the calendar years 1995 to 1999, whichever is2.32 greater.Payment to counties for services provided according to 2.33 subdivision 2, paragraph (a), shall be the federal share of the 2.34 contract rate. Payment to counties for services provided 2.35 according to subdivision 2, paragraph (b), shall be a proportion 2.36 of the per day contract rate that relates to rehabilitative 3.1 mental health services and shall not include payment for costs 3.2 or services that are billed to the IV-E program as room and 3.3 board. 3.4 (b) Annual earnings that exceed a county's limit as3.5 established under paragraph (a) shall be retained by the3.6 commissioner and managed as grants for community-based3.7 children's mental health services under section 245.4886. The3.8 commissioner may target these grant funds as necessary to reduce3.9 reliance on residential treatment of children with severe3.10 emotional disturbance.3.11 (c)(b) The commissioner shall set aside a portion not to 3.12 exceed five percent of the federal funds earned under this 3.13 section to cover the state costs of two staff positions and3.14 support costs necessary inadministering this section. Any 3.15 unexpended funds from the set-aside shall be distributed to the 3.16 counties in proportion to their earnings under this section. 3.17 Sec. 4. Minnesota Statutes 1999 Supplement, section 3.18 256B.0945, subdivision 5, is amended to read: 3.19 Subd. 5. [QUALITY MEASURES.] Counties must collect and 3.20 report to the commissioner information on outcomes for services 3.21 provided under this section using standardized tools that 3.22 measure the impact of residential treatment programs on child 3.23 functioning and/or behavior, living stability, and parent and 3.24 child satisfaction consistent with the goals of sections 3.25 245.4876, subdivision 1, and 256F.01. The commissioner shall 3.26 designate standardized tools to be used and shall collect and 3.27 analyze individualized outcome data on a statewide basis and 3.28 report to the legislature by December 1, 2003. The commissioner 3.29 shall provide standardized tools that measure child and 3.30 adolescent functional assessment for intake and discharge, child3.31 behavior, residential living environment andfunctionality, 3.32 placement stability, and satisfaction for youth and family 3.33 members. 3.34 Sec. 5. Minnesota Statutes 1999 Supplement, section 3.35 256B.0945, subdivision 6, is amended to read: 3.36 Subd. 6. [FEDERAL EARNINGS.] Use of new federal funding 4.1 earned from services provided under this section is limited to: 4.2 (1) increasing prevention and early intervention and 4.3 supportive services to meet the mental health and child welfare 4.4 needs of the children and families in the system of care; 4.5 (2) replacing reductions in federal IV-E reimbursement 4.6 resulting from new medical assistance coverage; and4.7 (3) paying the nonfederal share of additional provider 4.8 costs due to accreditation and new program standards necessary 4.9 for Medicaid reimbursement; and 4.10 (4) paying for the costs of complying with the data 4.11 collection and reporting requirements contained in subdivision 5. 4.12 For purposes of this section, prevention, early intervention, 4.13 and supportive services for children and families include 4.14 alternative responses to child maltreatment reports under 4.15 chapter 626 and nonresidential children's mental health services 4.16 outlined in sectionssection 245.4875, subdivision 2, children's4.17 mental health,and family preservation services outlined in 4.18 section 256F.05, subdivision 8 , family preservation services. 4.19 Sec. 6. Minnesota Statutes 1999 Supplement, section 4.20 256B.0945, subdivision 7, is amended to read: 4.21 Subd. 7. [MAINTENANCE OF EFFORT.] (a) Counties that 4.22 receive payment under this section must maintain a level of 4.23 expenditures such that each year's county expenditures 4.24 for prevention, early intervention, and supportive services for 4.25 children and families is at least equal to that county's average 4.26 expenditures for those services for calendar years 1998 and 4.27 1999. For purposes of this section, "county expenditures" are4.28 the total expenditures for those services minus the state and4.29 federal revenues specifically designated for these services.4.30 (b) The commissioner may waive the requirements in 4.31 paragraph (a) if any of the conditions specified in section 4.32 256F.13, subdivision 1, paragraph (a), clause (4), items (i) to 4.33 (iv), are met. 4.34 Sec. 7. Minnesota Statutes 1999 Supplement, section 4.35 256B.0945, subdivision 8, is amended to read: 4.36 Subd. 8. [REPORTS.] The commissioner shall review county 5.1 expenditures annually using reports required under sections 5.2 245.482; 256.01, subdivision 2, clause (17); and 256E.08, 5.3 subdivision 8, to ensure that counties meet their obligation 5.4 under subdivision 7, and that the base level of expenditures for 5.5 mental health and child welfareprevention, early intervention, 5.6 and family supportsupportive services for children and families 5.7 and children's mental health residential treatment is continued 5.8 from sources other than federal funds earned under this section. 5.9 Sec. 8. Minnesota Statutes 1999 Supplement, section 5.10 256B.0945, subdivision 9, is amended to read: 5.11 Subd. 9. [SANCTIONS.] The commissioner may suspend, 5.12 reduce, or terminate the federal reimbursementfunds for 5.13 prevention, early intervention, and supportive services for 5.14 children and families up to the limit of federal revenue earned 5.15 under this section to a county that does not meet one or all of 5.16 the requirements of this section. If the commissioner finds 5.17 evidence of children placed in residential treatment who do not 5.18 meet the criteria outlined in section 245.4885, subdivision 1, 5.19 the commissioner may take action to limit inappropriate 5.20 placements in residential treatment. 5.21 Sec. 9. Minnesota Statutes 1999 Supplement, section 5.22 256D.03, subdivision 3, is amended to read: 5.23 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 5.24 (a) General assistance medical care may be paid for any person 5.25 who is not eligible for medical assistance under chapter 256B, 5.26 including eligibility for medical assistance based on a 5.27 spenddown of excess income according to section 256B.056, 5.28 subdivision 5, or MinnesotaCare as defined in paragraph (b), 5.29 except as provided in paragraph (c); and: 5.30 (1) who is receiving assistance under section 256D.05, 5.31 except for families with children who are eligible under 5.32 Minnesota family investment program-statewide (MFIP-S), who is 5.33 having a payment made on the person's behalf under sections 5.34 256I.01 to 256I.06, or who resides in group residential housing 5.35 as defined in chapter 256I and can meet a spenddown using the 5.36 cost of remedial services received through group residential 6.1 housing; or 6.2 (2)(i) who is a resident of Minnesota; and whose equity in 6.3 assets is not in excess of $1,000 per assistance unit. Exempt 6.4 assets, the reduction of excess assets, and the waiver of excess 6.5 assets must conform to the medical assistance program in chapter 6.6 256B, with the following exception: the maximum amount of 6.7 undistributed funds in a trust that could be distributed to or 6.8 on behalf of the beneficiary by the trustee, assuming the full 6.9 exercise of the trustee's discretion under the terms of the 6.10 trust, must be applied toward the asset maximum; and 6.11 (ii) who has countable income not in excess of the 6.12 assistance standards established in section 256B.056, 6.13 subdivision 4, or whose excess income is spent down according to 6.14 section 256B.056, subdivision 5, using a six-month budget 6.15 period. The method for calculating earned income disregards and 6.16 deductions for a person who resides with a dependent child under 6.17 age 21 shall follow section 256B.056, subdivision 1a. However, 6.18 if a disregard of $30 and one-third of the remainder has been 6.19 applied to the wage earner's income, the disregard shall not be 6.20 applied again until the wage earner's income has not been 6.21 considered in an eligibility determination for general 6.22 assistance, general assistance medical care, medical assistance, 6.23 or MFIP-S for 12 consecutive months. The earned income and work 6.24 expense deductions for a person who does not reside with a 6.25 dependent child under age 21 shall be the same as the method 6.26 used to determine eligibility for a person under section 6.27 256D.06, subdivision 1, except the disregard of the first $50 of 6.28 earned income is not allowed; 6.29 (3) who would be eligible for medical assistance except 6.30 that the person resides in a facility that is determined by the 6.31 commissioner or the federal Health Care Financing Administration 6.32 to be an institution for mental diseases; or 6.33 (4) who is ineligible for medical assistance under chapter 6.34 256B or general assistance medical care under any other 6.35 provision of this section, and is receiving care and 6.36 rehabilitation services from a nonprofit center established to 7.1 serve victims of torture. These individuals are eligible for 7.2 general assistance medical care only for the period during which 7.3 they are receiving services from the center. During this period 7.4 of eligibility, individuals eligible under this clause shall not 7.5 be required to participate in prepaid general assistance medical 7.6 care. 7.7 (b) Beginning January 1, 2000, applicants or recipients who 7.8 meet all eligibility requirements of MinnesotaCare as defined in 7.9 sections 256L.01 to 256L.16, and are: 7.10 (i) adults with dependent children under 21 whose gross 7.11 family income is equal to or less than 275 percent of the 7.12 federal poverty guidelines; or 7.13 (ii) adults without children with earned income and whose 7.14 family gross income is between 75 percent of the federal poverty 7.15 guidelines and the amount set by section 256L.04, subdivision 7, 7.16 shall be terminated from general assistance medical care upon 7.17 enrollment in MinnesotaCare. 7.18 (c) For services rendered on or after July 1, 1997, 7.19 eligibility is limited to one month prior to application if the 7.20 person is determined eligible in the prior month. A 7.21 redetermination of eligibility must occur every 12 months. 7.22 Beginning January 1, 2000, Minnesota health care program 7.23 applications completed by recipients and applicants who are 7.24 persons described in paragraph (b), may be returned to the 7.25 county agency to be forwarded to the department of human 7.26 services or sent directly to the department of human services 7.27 for enrollment in MinnesotaCare. If all other eligibility 7.28 requirements of this subdivision are met, eligibility for 7.29 general assistance medical care shall be available in any month 7.30 during which a MinnesotaCare eligibility determination and 7.31 enrollment are pending. Upon notification of eligibility for 7.32 MinnesotaCare, notice of termination for eligibility for general 7.33 assistance medical care shall be sent to an applicant or 7.34 recipient. If all other eligibility requirements of this 7.35 subdivision are met, eligibility for general assistance medical 7.36 care shall be available until enrollment in MinnesotaCare 8.1 subject to the provisions of paragraph (e). 8.2 (d) The date of an initial Minnesota health care program 8.3 application necessary to begin a determination of eligibility 8.4 shall be the date the applicant has provided a name, address, 8.5 and social security number, signed and dated, to the county 8.6 agency or the department of human services. If the applicant is 8.7 unable to provide an initial application when health care is 8.8 delivered due to a medical condition or disability, a health 8.9 care provider may act on the person's behalf to complete the 8.10 initial application. The applicant must complete the remainder 8.11 of the application and provide necessary verification before 8.12 eligibility can be determined. The county agency must assist 8.13 the applicant in obtaining verification if necessary. On the 8.14 basis of information provided on the completed application, an 8.15 applicant who meets the following criteria shall be determined 8.16 eligible beginning in the month of application: 8.17 (1) has gross income less than 90 percent of the applicable 8.18 income standard; 8.19 (2) has liquid assets that total within $300 of the asset 8.20 standard; 8.21 (3) does not reside in a long-term care facility; and 8.22 (4) meets all other eligibility requirements. 8.23 The applicant must provide all required verifications within 30 8.24 days' notice of the eligibility determination or eligibility 8.25 shall be terminated. 8.26 (e) County agencies are authorized to use all automated 8.27 databases containing information regarding recipients' or 8.28 applicants' income in order to determine eligibility for general 8.29 assistance medical care or MinnesotaCare. Such use shall be 8.30 considered sufficient in order to determine eligibility and 8.31 premium payments by the county agency. 8.32 (f) General assistance medical care is not available for a 8.33 person in a correctional facility unless the person is detained 8.34 by law for less than one year in a county correctional or 8.35 detention facility as a person accused or convicted of a crime, 8.36 or admitted as an inpatient to a hospital on a criminal hold 9.1 order, and the person is a recipient of general assistance 9.2 medical care at the time the person is detained by law or 9.3 admitted on a criminal hold order and as long as the person 9.4 continues to meet other eligibility requirements of this 9.5 subdivision. 9.6 (g) General assistance medical care is not available for 9.7 applicants or recipients who do not cooperate with the county 9.8 agency to meet the requirements of medical assistance. General 9.9 assistance medical care is limited to payment of emergency 9.10 services only for applicants or recipients as described in 9.11 paragraph (b), whose MinnesotaCare coverage is denied or 9.12 terminated for nonpayment of premiums as required by sections 9.13 256L.06 and 256L.07. 9.14 (h) In determining the amount of assets of an individual, 9.15 there shall be included any asset or interest in an asset, 9.16 including an asset excluded under paragraph (a), that was given 9.17 away, sold, or disposed of for less than fair market value 9.18 within the 60 months preceding application for general 9.19 assistance medical care or during the period of eligibility. 9.20 Any transfer described in this paragraph shall be presumed to 9.21 have been for the purpose of establishing eligibility for 9.22 general assistance medical care, unless the individual furnishes 9.23 convincing evidence to establish that the transaction was 9.24 exclusively for another purpose. For purposes of this 9.25 paragraph, the value of the asset or interest shall be the fair 9.26 market value at the time it was given away, sold, or disposed 9.27 of, less the amount of compensation received. For any 9.28 uncompensated transfer, the number of months of ineligibility, 9.29 including partial months, shall be calculated by dividing the 9.30 uncompensated transfer amount by the average monthly per person 9.31 payment made by the medical assistance program to skilled 9.32 nursing facilities for the previous calendar year. The 9.33 individual shall remain ineligible until this fixed period has 9.34 expired. The period of ineligibility may exceed 30 months, and 9.35 a reapplication for benefits after 30 months from the date of 9.36 the transfer shall not result in eligibility unless and until 10.1 the period of ineligibility has expired. The period of 10.2 ineligibility begins in the month the transfer was reported to 10.3 the county agency, or if the transfer was not reported, the 10.4 month in which the county agency discovered the transfer, 10.5 whichever comes first. For applicants, the period of 10.6 ineligibility begins on the date of the first approved 10.7 application. 10.8 (i) When determining eligibility for any state benefits 10.9 under this subdivision, the income and resources of all 10.10 noncitizens shall be deemed to include their sponsor's income 10.11 and resources as defined in the Personal Responsibility and Work 10.12 Opportunity Reconciliation Act of 1996, title IV, Public Law 10.13 Number 104-193, sections 421 and 422, and subsequently set out 10.14 in federal rules. 10.15 (j)(1) An undocumented noncitizen or a nonimmigrant is 10.16 ineligible for general assistance medical care other than 10.17 emergency services. For purposes of this subdivision, a 10.18 nonimmigrant is an individual in one or more of the classes 10.19 listed in United States Code, title 8, section 1101(a)(15), and 10.20 an undocumented noncitizen is an individual who resides in the 10.21 United States without the approval or acquiescence of the 10.22 Immigration and Naturalization Service. 10.23 (2) This paragraph does not apply to a child under age 18, 10.24 to a Cuban or Haitian entrant as defined in Public Law Number 10.25 96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 10.26 aged, blind, or disabled as defined in Code of Federal 10.27 Regulations, title 42, sections 435.520, 435.530, 435.531, 10.28 435.540, and 435.541, or effective October 1, 1998, to an 10.29 individual eligible for general assistance medical care under 10.30 paragraph (a), clause (4), who cooperates with the Immigration 10.31 and Naturalization Service to pursue any applicable immigration 10.32 status, including citizenship, that would qualify the individual 10.33 for medical assistance with federal financial participation. 10.34 (3)(k) For purposes of this paragraphparagraphs (g) and 10.35 (j), "emergency services" has the meaning given in Code of 10.36 Federal Regulations, title 42, section 440.255(b)(1), except 11.1 that it also means services rendered because of suspected or 11.2 actual pesticide poisoning. 11.3 (k)(l) Notwithstanding any other provision of law, a 11.4 noncitizen who is ineligible for medical assistance due to the 11.5 deeming of a sponsor's income and resources, is ineligible for 11.6 general assistance medical care. 11.7 Sec. 10. Minnesota Statutes 1999 Supplement, section 11.8 256L.03, subdivision 5, is amended to read: 11.9 Subd. 5. [COPAYMENTS AND COINSURANCE.] (a) The 11.10 MinnesotaCare benefit plan shall include the following 11.11 copayments and coinsurance requirements for all enrollees except 11.12 clause (1) shall not apply to parents and relative caretakers of 11.13 children under the age of 21 in households with income at or11.14 below 175 percent of the federal poverty guidelinesand clauses 11.15 (1) to (4) shall not apply to pregnant women and children under 11.16 the age of 21: 11.17 (1) ten percent of the paid charges for inpatient hospital 11.18 services for adult enrollees, subject to an annual inpatient 11.19 out-of-pocket maximum of $1,000 per individual and $3,000 per 11.20 family; 11.21 (2) $3 per prescription for adult enrollees; 11.22 (3) $25 for eyeglasses for adult enrollees; and 11.23 (4) effective July 1, 1998, 50 percent of the 11.24 fee-for-service rate for adult dental care services other than 11.25 preventive care services for persons eligible under section 11.26 256L.04, subdivisions 1 to 7, with income equal to or less than 11.27 175 percent of the federal poverty guidelines. 11.28 The exceptions described in this paragraph shall only be11.29 implemented if required to obtain federal Medicaid funding for11.30 these individuals and shall expire July 1, 2000.The exception 11.31 for parents and relative caretakers in households with income 11.32 greater than 175 percent of the federal poverty guidelines shall 11.33 not be implemented for inpatient hospital admissions occurring 11.34 before January 1, 2001. 11.35 (b) Effective July 1, 1997, adult enrollees with family 11.36 gross income that exceeds 175 percent of the federal poverty 12.1 guidelines and who are not pregnant shall be financially 12.2 responsible for the coinsurance amount and amounts which exceed 12.3 the $10,000 inpatient hospital benefit limit. 12.4 (c) When a MinnesotaCare enrollee becomes a member of a 12.5 prepaid health plan, or changes from one prepaid health plan to 12.6 another during a calendar year, any charges submitted towards 12.7 the $10,000 annual inpatient benefit limit, and any 12.8 out-of-pocket expenses incurred by the enrollee for inpatient 12.9 services, that were submitted or incurred prior to enrollment, 12.10 or prior to the change in health plans, shall be disregarded. 12.11 Sec. 11. Laws 1999, chapter 245, article 8, section 84, is 12.12 amended to read: 12.13 Sec. 84. [RECOMMENDATIONS TO THE LEGISLATURE.] 12.14 The commissioner of human services shall submit to the 12.15 legislature design and implementation recommendations for the 12.16 proposals required in sections 82 and 83, including draft 12.17 legislation, by January 15, 20002001, for implementation 12.18 by July 1, 2000January 1, 2002, with respect to the proposal in 12.19 section 82 only. The proposals shall not include requirements 12.20 for maintenance of effort and expanded expenditures concerning 12.21 federal reimbursements earned in these programs. 12.22 Sec. 12. [OBSOLETE RULES.] 12.23 The commissioner shall amend or repeal obsolete provisions 12.24 of Minnesota Rules, parts 9505.0010 to 9505.0150, governing 12.25 eligibility for the medical assistance program, under the 12.26 expedited process of Minnesota Statutes, section 14.389, to 12.27 bring them into conformance with state and federal law. 12.28 Sec. 13. [REPEALER.] 12.29 Laws 1998, chapter 407, article 5, section 44, is repealed. 12.30 Sec. 14. [EFFECTIVE DATE.] 12.31 Section 10 is effective July 1, 2000.