HF 3780

as introduced - 89th Legislature (2015 - 2016) Posted on 04/04/2016 04:23pm

A bill for an act
relating to human services; establishing a health care program for low-income
uninsured adults and children who are ineligible for medical assistance or
MinnesotaCare; amending Minnesota Statutes 2014, section 256B.06, by adding
a subdivision; proposing coding for new law in Minnesota Statutes, chapter 256L.

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

Section 1.

Minnesota Statutes 2014, section 256B.06, is amended by adding a
subdivision to read:

new text begin Subd. 7. new text end

new text begin Low-income uninsured health program. new text end

new text begin (a) The commissioner shall
establish a program that provides coverage to low-income uninsured individuals who are
21 years of age or older and who meet the requirements of this subdivision.
new text end

new text begin (b) An individual must: (1) not be eligible for medical assistance or MinnesotaCare;
(2) have a family income equal to or less than 133 percent of the federal poverty guidelines
adjusted for family size; and (3) have been determined eligible for emergency medical
assistance under subdivision 4, paragraph (e) or (f), or the individual's treating health care
provider certified that the individual has an emergency medical condition as defined in
United States Code, title 42, section 1396b(v), that is likely to lead to the individual
being admitted to a hospital or emergency department, unless intervening health care
treatment is provided.
new text end

new text begin (c) Eligibility under this subdivision shall continue for as long as the individual
continues to have the underlying medical condition that gave rise to the initial emergency
medical condition.
new text end

new text begin (d) The program shall cover the services described under section 256B.0625, except
as otherwise specified in this subdivision. Services that are covered under emergency
medical assistance under subdivision 4, paragraphs (e) to (h), shall continue to be covered
under emergency medical assistance. The commissioner shall coordinate the program
with the federally subsidized emergency medical assistance program with the goal of
making transitions between the programs seamless and invisible to the enrollee to the
extent possible.
new text end

new text begin (e) All cost-sharing provisions under section 256B.0631 shall apply.
new text end

new text begin (f) The commissioner may contract with a health plan, provider network, nonprofit
coverage program, county or group of counties, or health care delivery system established
under sections 256B.0755 and 256B.0756 to administer the coverage program authorized
under this subdivision, and may delegate to the contractor the responsibility to perform
case reviews and authorize payment. The commissioner may contract under this
paragraph on a capitated or fixed-budget basis under which the contractor is responsible
for providing the covered services to eligible persons within the limits of the capitation or
payment amount. The commissioner may also contract using gain-sharing and risk-sharing
methods authorized for demonstration projects established under sections 256B.0755
and 256B.0756. If the commissioner contracts on a capitated, fixed-fee payment, or
gain-sharing or risk-sharing method, the commissioner may withhold up to five percent
of the payment amount, to be paid only if the contractor achieves standards for quality
and cost that are comparable to those required of health care delivery system projects
under sections 256B.0755 and 256B.0756. The commissioner may separate nursing
facility services and pharmacy services from other covered services to provide payment
for these services under the commissioner's fee-for-service payment system instead of
payment to the contracted entity. The commissioner may administer the program through
a fee-for-service payment system without a health plan, provider network, coverage
program, county or group of counties, or health care delivery system in rural areas and
other regions where these options are not feasible or appropriate.
new text end

new text begin (g) The commissioner may authorize coverage and payment for additional services
determined by the commissioner to be cost-effective because the services are likely to
produce offsetting reductions in costs for inpatient hospital services, emergency services,
or other covered services.
new text end

new text begin (h) The commissioner shall ensure that an eligible individual is provided the
opportunity to receive covered services through any essential community provider, as
defined in section 62Q.19, and that the terms of participation of an essential community
provider conform with the requirements of section 62Q.19.
new text end

Sec. 2.

new text begin [256L.30] LOW-INCOME UNINSURED CHILDREN'S HEALTH
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin (a) The commissioner shall establish a program that
provides coverage to low-income uninsured children who are under 21 years of age.
new text end

new text begin (b) A child is eligible for the program under this section if the child's family income
is equal to or less than 200 percent of the federal poverty guidelines, adjusted for family
size, and if the child meets all other eligibility requirements under this chapter, with the
exception of the citizenship requirements under section 256L.04, subdivision 10.
new text end

new text begin (c) Children who are eligible for medical assistance under chapter 256B or
MinnesotaCare under this chapter are not eligible for the program under this section.
new text end

new text begin (d) All application, navigation services, eligibility determination, enrollment,
disenrollment, and premium requirements and procedures of the MinnesotaCare program
apply to this program, except as otherwise specified in this section.
new text end

new text begin Subd. 2. new text end

new text begin Covered services. new text end

new text begin (a) The program covers the services described under
section 256L.03, except as otherwise specified in this subdivision.
new text end

new text begin (b) The program does not cover services for an emergency medical condition that
are covered by emergency medical assistance under section 256B.06, subdivision 4,
paragraphs (e) to (h). The commissioner shall coordinate the program with the federally
subsidized emergency medical assistance program with the goal of making transitions
between the programs seamless and invisible to the enrollee to the extent possible.
new text end

new text begin Subd. 3. new text end

new text begin Premiums and cost-sharing. new text end

new text begin For children who are eligible under
subdivision 1, the premium and cost-sharing provisions of the MinnesotaCare program
shall apply.
new text end

new text begin Subd. 4. new text end

new text begin Service delivery. new text end

new text begin (a) The commissioner may contract with managed
care plans, county-based purchasing plans, provider networks, nonprofit coverage
programs, counties, or health care delivery systems established under section 256B.0755
or 256B.0756 to administer the program authorized under this section to control the costs
of the program through care coordination, limited provider networks, fee discounts, and
other methods.
new text end

new text begin (b) The commissioner shall ensure that an eligible child is provided the opportunity
to receive covered services from any essential community provider, as defined in section
62Q.19, and that the terms of participation of the essential community provider conform
with the requirements of section 62Q.19.
new text end

Sec. 3. new text begin FEDERAL APPROVAL.
new text end

new text begin The commissioner of human services shall seek federal approval for changes to the
emergency medical assistance program to allow coverage and payment for cost-effective
community-based and outpatient services as an alternative to hospital inpatient and
emergency department services to reduce the total cost of care.
new text end