HF 802

1st Committee Engrossment - 86th Legislature (2009 - 2010) Posted on 03/19/2013 07:28pm

1.1A bill for an act

1.2relating to human services; requiring mental health urgent care and psychiatric
1.3consultation; reducing certain hospital payment rates; changing medical
1.4assistance covered services; allowing intergovernmental transfers; creating a new
1.5general assistance medical care program; providing transitional MinnesotaCare
1.6coverage; requiring coordinated care delivery systems; creating a temporary
1.7uncompensated care pool and prescription drug pool; appropriating money;
1.8amending Minnesota Statutes 2008, sections 256.969, subdivision 27;
1.9256B.0625, subdivision 13f, by adding a subdivision; 256B.0644; 256L.05,
1.10subdivisions 3, 3a; 256L.07, subdivision 6; 256L.15, subdivision 4; 256L.17,
1.11subdivision 7; 517.08, subdivision 1c; Minnesota Statutes 2009 Supplement,
1.12sections 256.969, subdivision 3a; 256B.0947, subdivision 1; 256B.196,
1.13subdivision 2; 256D.03, subdivision 3; proposing coding for new law in
1.14Minnesota Statutes, chapters 245; 256B; 256D; repealing Minnesota Statutes
1.152008, sections 256.742; 256.979, subdivision 8; 256B.195, subdivisions 4,
1.165; 256D.03, subdivision 9; 256L.05, subdivision 1b; 256L.07, subdivision 6;
1.17256L.15, subdivision 4; 256L.17, subdivision 7; Minnesota Statutes 2009
1.18Supplement, sections 256B.195, subdivisions 1, 2, 3; 256D.03, subdivision 4.
1.19BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.20ARTICLE 1

1.21GENERAL ASSISTANCE MEDICAL CARE

1.22    Section 1. [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC
1.23CONSULTATION.
1.24    Subdivision 1. Mental health urgent care and psychiatric consultation. The
1.25commissioner shall include mental health urgent care and psychiatric consultation
1.26services as part of, but not limited to, the redesign of six community-based behavioral
1.27health hospitals and the Anoka-Metro Regional Treatment Center. These services must
1.28not duplicate existing services in the region, and must be implemented as specified in
1.29subdivisions 3 to 7.
2.1    Subd. 2. Definitions. For purposes of this section:
2.2(1) mental health urgent care includes:
2.3(i) initial mental health screening;
2.4(ii) mobile crisis assessment and intervention;
2.5(iii) rapid access to psychiatry, including psychiatric evaluation, initial treatment,
2.6and short-term psychiatry;
2.7(iv) nonhospital crisis stabilization residential beds; and
2.8(v) health care navigator services which include, but are not limited to, assisting
2.9uninsured individuals in obtaining health care coverage; and
2.10(2) psychiatric consultation services includes psychiatric consultation to primary
2.11care practitioners.
2.12    Subd. 3. Rapid access to psychiatry. The commissioner shall develop rapid access
2.13to psychiatric services based on the following criteria:
2.14(1) the individuals who receive the psychiatric services must be at risk of
2.15hospitalization and otherwise unable to receive timely services;
2.16(2) where clinically appropriate, the service may be provided via interactive video
2.17where the service is provided in conjunction with an emergency room, a local crisis
2.18service, or a primary care or behavioral care practitioner; and
2.19(3) the commissioner may integrate rapid access to psychiatry with the psychiatric
2.20consultation services in subdivision 4.
2.21    Subd. 4. Collaborative psychiatric consultation. (a) The commissioner shall
2.22establish a collaborative psychiatric consultation service based on the following criteria:
2.23(1) the service may be available via telephone, interactive video, e-mail, or other
2.24means of communication to emergency rooms, local crisis services, mental health
2.25professionals, and primary care practitioners, including pediatricians;
2.26(2) the service shall be provided by a multidisciplinary team including, at a
2.27minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical
2.28social worker;
2.29(3) the service shall include a triage-level assessment to determine the most
2.30appropriate response to each request, including appropriate referrals to other mental health
2.31professionals, as well as provision of rapid psychiatric access when other appropriate
2.32services are not available;
2.33(4) the first priority for this service is to provide the consultations required under
2.34section 256B.0625, subdivision 13j; and
2.35(5) the service must encourage use of cognitive and behavioral therapies and other
2.36evidence-based treatments in addition to or in place of medication, where appropriate.
3.1(b) The commissioner shall appoint an interdisciplinary work group to establish
3.2appropriate medication and psychotherapy protocols to guide the consultative process,
3.3including consultation with the Drug Utilization Review Board, as provided in section
3.4256B.0625, subdivision 13j.
3.5    Subd. 5. Phased availability. (a) The commissioner may phase in the availability
3.6of mental health urgent care services based on the limits of appropriations and the
3.7commissioner's determination of level of need and cost-effectiveness.
3.8(b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin
3.9and Ramsey Counties and children statewide who are affected by section 256B.0625,
3.10subdivision 13j, and must include tracking of costs for the services provided and
3.11associated impacts on utilization of inpatient, emergency room, and other services.
3.12    Subd. 6. Limited appropriations. The commissioner shall maximize use
3.13of available health care coverage for the services provided under this section. The
3.14commissioner's responsibility to provide these services for individuals without health care
3.15coverage must not exceed the appropriations for this section.
3.16    Subd. 7. Flexible implementation. To implement this section, the commissioner
3.17shall select the structure and funding method that is the most cost-effective for each county
3.18or group of counties. This may include grants, contracts, direct provision by state-operated
3.19services, and public-private partnerships. Where feasible, the commissioner shall make
3.20any grants under this section a part of the integrated adult mental health initiative grants
3.21under section 245.4661.

3.22    Sec. 2. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is
3.23amended to read:
3.24    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
3.25assistance program must not be submitted until the recipient is discharged. However,
3.26the commissioner shall establish monthly interim payments for inpatient hospitals that
3.27have individual patient lengths of stay over 30 days regardless of diagnostic category.
3.28Except as provided in section 256.9693, medical assistance reimbursement for treatment
3.29of mental illness shall be reimbursed based on diagnostic classifications. Individual
3.30hospital payments established under this section and sections 256.9685, 256.9686, and
3.31256.9695 , in addition to third party and recipient liability, for discharges occurring during
3.32the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
3.33inpatient services paid for the same period of time to the hospital. This payment limitation
3.34shall be calculated separately for medical assistance and general assistance medical
3.35care services. The limitation on general assistance medical care shall be effective for
4.1admissions occurring on or after July 1, 1991. Services that have rates established under
4.2subdivision 11 or 12, must be limited separately from other services. After consulting with
4.3the affected hospitals, the commissioner may consider related hospitals one entity and
4.4may merge the payment rates while maintaining separate provider numbers. The operating
4.5and property base rates per admission or per day shall be derived from the best Medicare
4.6and claims data available when rates are established. The commissioner shall determine
4.7the best Medicare and claims data, taking into consideration variables of recency of the
4.8data, audit disposition, settlement status, and the ability to set rates in a timely manner.
4.9The commissioner shall notify hospitals of payment rates by December 1 of the year
4.10preceding the rate year. The rate setting data must reflect the admissions data used to
4.11establish relative values. Base year changes from 1981 to the base year established for the
4.12rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
4.13to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
4.141. The commissioner may adjust base year cost, relative value, and case mix index data
4.15to exclude the costs of services that have been discontinued by the October 1 of the year
4.16preceding the rate year or that are paid separately from inpatient services. Inpatient stays
4.17that encompass portions of two or more rate years shall have payments established based
4.18on payment rates in effect at the time of admission unless the date of admission preceded
4.19the rate year in effect by six months or more. In this case, operating payment rates for
4.20services rendered during the rate year in effect and established based on the date of
4.21admission shall be adjusted to the rate year in effect by the hospital cost index.
4.22    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
4.23payment, before third-party liability and spenddown, made to hospitals for inpatient
4.24services is reduced by .5 percent from the current statutory rates.
4.25    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
4.26admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
4.27before third-party liability and spenddown, is reduced five percent from the current
4.28statutory rates. Mental health services within diagnosis related groups 424 to 432, and
4.29facilities defined under subdivision 16 are excluded from this paragraph.
4.30    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
4.31fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
4.32inpatient services before third-party liability and spenddown, is reduced 6.0 percent
4.33from the current statutory rates. Mental health services within diagnosis related groups
4.34424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
4.35Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
4.36assistance does not include general assistance medical care. Payments made to managed
5.1care plans shall be reduced for services provided on or after January 1, 2006, to reflect
5.2this reduction.
5.3    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
5.4fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
5.5to hospitals for inpatient services before third-party liability and spenddown, is reduced
5.63.46 percent from the current statutory rates. Mental health services with diagnosis related
5.7groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
5.8paragraph. Payments made to managed care plans shall be reduced for services provided
5.9on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
5.10    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
5.11fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011,
5.12made to hospitals for inpatient services before third-party liability and spenddown, is
5.13reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis
5.14related groups 424 to 432 and facilities defined under subdivision 16 are excluded from
5.15this paragraph. Payments made to managed care plans shall be reduced for services
5.16provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.
5.17    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
5.18for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals
5.19for inpatient services before third-party liability and spenddown, is reduced 1.79 percent
5.20from the current statutory rates. Mental health services with diagnosis related groups
5.21424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
5.22Payments made to managed care plans shall be reduced for services provided on or after
5.23July 1, 2010 2011, to reflect this reduction.
5.24(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
5.25payment for fee-for-service admissions occurring on or after July 1, 2009, made to
5.26hospitals for inpatient services before third-party liability and spenddown, is reduced
5.27one percent from the current statutory rates. Facilities defined under subdivision 16 are
5.28excluded from this paragraph. Payments made to managed care plans shall be reduced for
5.29services provided on or after October 1, 2009, to reflect this reduction.
5.30EFFECTIVE DATE.This section is effective April 1, 2010.

5.31    Sec. 3. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:
5.32    Subd. 27. Quarterly payment adjustment. (a) In addition to any other payment
5.33under this section, the commissioner shall make the following payments effective July
5.341, 2007:
6.1    (1) for a hospital located in Minnesota and not eligible for payments under
6.2subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8
6.3percent of total patient days as of the base year in effect on July 1, 2005, a payment
6.4equal to 13 percent of the total of the operating and property payment rates, except that
6.5Hennepin County Medical Center and Regions Hospital shall not receive a payment
6.6under this subdivision;
6.7    (2) for a hospital located in Minnesota in a specified urban area outside of the
6.8seven-county metropolitan area and not eligible for payments under subdivision 20, with
6.9a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total
6.10patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent
6.11of the total of the operating and property payment rates. For purposes of this clause, the
6.12following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria,
6.13Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids,
6.14Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena;
6.15    (3) for a hospital located in Minnesota but not located in a specified urban area
6.16under clause (2), with a medical assistance inpatient utilization rate less than or equal to
6.1717.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment
6.18equal to four percent of the total of the operating and property payment rates. A hospital
6.19located in Woodbury and not in existence during the base year shall be reimbursed under
6.20this clause; and
6.21    (4) in addition to any payments under clauses (1) to (3), for a hospital located in
6.22Minnesota and not eligible for payments under subdivision 20 with a medical assistance
6.23inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect
6.24on July 1, 2005, a payment equal to eight percent of the total of the operating and property
6.25payment rates, and for a hospital located in Minnesota and not eligible for payments
6.26under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent
6.27of total patient days as of the base year in effect on July 1, 2005, a payment equal to
6.28nine percent of the total of the operating and property payment rates. After making any
6.29ratable adjustments required under paragraph (b), the commissioner shall proportionately
6.30reduce payments under clauses (2) and (3) by an amount needed to make payments under
6.31this clause.
6.32    (b) The state share of payments under paragraph (a) shall be equal to federal
6.33reimbursements to the commissioner to reimburse expenditures reported under section
6.34256B.199, paragraphs (a) to (d) . The commissioner shall ratably reduce or increase
6.35payments under this subdivision in order to ensure that these payments equal the amount
6.36of reimbursement received by the commissioner under section 256B.199, paragraphs (a)
7.1to (d) , except that payments shall be ratably reduced by an amount equivalent to the state
7.2share of a four percent reduction in MinnesotaCare and medical assistance payments
7.3for inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be
7.4equivalent to the state share of a three percent reduction in these payments. Effective for
7.5federal disproportionate share hospital funds earned on payments reported under section
7.6256B.199, paragraphs (a) to (d), for services rendered on or after April 1, 2010, payments
7.7shall not be made under this subdivision.
7.8    (c) The payments under paragraph (a) shall be paid quarterly based on each hospital's
7.9operating and property payments from the second previous quarter, beginning on July
7.1015, 2007, or upon federal approval of federal reimbursements under section 256B.199,
7.11paragraphs (a) to (d) , whichever occurs later.
7.12    (d) The commissioner shall not adjust rates paid to a prepaid health plan under
7.13contract with the commissioner to reflect payments provided in paragraph (a).
7.14    (e) The commissioner shall maximize the use of available federal money for
7.15disproportionate share hospital payments and shall maximize payments to qualifying
7.16hospitals. In order to accomplish these purposes, the commissioner may, in consultation
7.17with the nonstate entities identified in section 256B.199, paragraphs (a) to (d), adjust,
7.18on a pro rata basis if feasible, the amounts reported by nonstate entities under section
7.19256B.199, paragraphs (a) to (d), when application for reimbursement is made to the federal
7.20government, and otherwise adjust the provisions of this subdivision. The commissioner
7.21shall utilize a settlement process based on finalized data to maximize revenue under
7.22section 256B.199, paragraphs (a) to (d), and payments under this section.
7.23    (f) For purposes of this subdivision, medical assistance does not include general
7.24assistance medical care.
7.25EFFECTIVE DATE.This section is effective for services rendered on or after
7.26April 1, 2010.

7.27    Sec. 4. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to
7.28read:
7.29    Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and
7.30recommend drugs which require prior authorization. The Formulary Committee shall
7.31establish general criteria to be used for the prior authorization of brand-name drugs for
7.32which generically equivalent drugs are available, but the committee is not required to
7.33review each brand-name drug for which a generically equivalent drug is available.
7.34(b) Prior authorization may be required by the commissioner before certain
7.35formulary drugs are eligible for payment. The Formulary Committee may recommend
8.1drugs for prior authorization directly to the commissioner. The commissioner may also
8.2request that the Formulary Committee review a drug for prior authorization. Before the
8.3commissioner may require prior authorization for a drug:
8.4(1) the commissioner must provide information to the Formulary Committee on the
8.5impact that placing the drug on prior authorization may have on the quality of patient care
8.6and on program costs, information regarding whether the drug is subject to clinical abuse
8.7or misuse, and relevant data from the state Medicaid program if such data is available;
8.8(2) the Formulary Committee must review the drug, taking into account medical and
8.9clinical data and the information provided by the commissioner; and
8.10(3) the Formulary Committee must hold a public forum and receive public comment
8.11for an additional 15 days.
8.12The commissioner must provide a 15-day notice period before implementing the prior
8.13authorization.
8.14(c) Except as provided in subdivision 13j, prior authorization shall not be required or
8.15utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:
8.16(1) there is no generically equivalent drug available; and
8.17(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
8.18(3) the drug is part of the recipient's current course of treatment.
8.19This paragraph applies to any multistate preferred drug list or supplemental drug rebate
8.20program established or administered by the commissioner. Prior authorization shall
8.21automatically be granted for 60 days for brand name drugs prescribed for treatment of
8.22mental illness within 60 days of when a generically equivalent drug becomes available,
8.23provided that the brand name drug was part of the recipient's course of treatment at the
8.24time the generically equivalent drug became available.
8.25(d) Prior authorization shall not be required or utilized for any antihemophilic factor
8.26drug prescribed for the treatment of hemophilia and blood disorders where there is no
8.27generically equivalent drug available if the prior authorization is used in conjunction with
8.28any supplemental drug rebate program or multistate preferred drug list established or
8.29administered by the commissioner.
8.30(e) The commissioner may require prior authorization for brand name drugs
8.31whenever a generically equivalent product is available, even if the prescriber specifically
8.32indicates "dispense as written-brand necessary" on the prescription as required by section
8.33151.21, subdivision 2 .
8.34(f) Notwithstanding this subdivision, the commissioner may automatically require
8.35prior authorization, for a period not to exceed 180 days, for any drug that is approved by
8.36the United States Food and Drug Administration on or after July 1, 2005. The 180-day
9.1period begins no later than the first day that a drug is available for shipment to pharmacies
9.2within the state. The Formulary Committee shall recommend to the commissioner general
9.3criteria to be used for the prior authorization of the drugs, but the committee is not
9.4required to review each individual drug. In order to continue prior authorizations for a
9.5drug after the 180-day period has expired, the commissioner must follow the provisions
9.6of this subdivision.
9.7EFFECTIVE DATE.This section is effective April 1, 2010.

9.8    Sec. 5. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
9.9subdivision to read:
9.10    Subd. 13j. Antipsychotic and attention deficit disorder and attention deficit
9.11hyperactivity disorder medications. (a) The commissioner, in consultation with the
9.12Drug Utilization Review Board established in subdivision 13i and actively practicing
9.13pediatric mental health professionals, must:
9.14(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs
9.15and drugs used for attention deficit disorder or attention deficit hyperactivity disorder
9.16based on available medical, clinical, and safety data and research. The commissioner
9.17shall periodically review the list of medications and pediatric dose ranges and update
9.18the medications and doses listed as needed after consultation with the Drug Utilization
9.19Review Board;
9.20(2) identify situations where a collaborative psychiatric consultation and prior
9.21authorization should be required before the initiation or continuation of drug therapy
9.22in pediatric patients including, but not limited to, high-dose regimens, off-label use of
9.23prescription medication, a patient's young age, and lack of coordination among multiple
9.24prescribing providers; and
9.25(3) track prescriptive practices and the use of psychotropic medications in children
9.26with the goal of reducing the use of medication, where appropriate.
9.27(b) Effective July 1, 2011, the commissioner shall require prior authorization and
9.28a collaborative psychiatric consultation before an atypical antipsychotic and attention
9.29deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria
9.30identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric
9.31consultation must be completed before the identified medications are eligible for payment
9.32unless:
9.33(1) the patient has already been stabilized on the medication regimen; or
9.34(2) the prescriber indicates that the child is in crisis.
10.1If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed
10.2within 90 days for payment to continue.
10.3(c) For purposes of this subdivision, a collaborative psychiatric consultation must
10.4meet the criteria described in section 245.4862, subdivision 4.

10.5    Sec. 6. Minnesota Statutes 2008, section 256B.0644, is amended to read:
10.6256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
10.7PROGRAMS.
10.8    (a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a
10.9health maintenance organization, as defined in chapter 62D, must participate as a provider
10.10or contractor in the medical assistance program, general assistance medical care program,
10.11and MinnesotaCare as a condition of participating as a provider in health insurance plans
10.12and programs or contractor for state employees established under section 43A.18, the
10.13public employees insurance program under section 43A.316, for health insurance plans
10.14offered to local statutory or home rule charter city, county, and school district employees,
10.15the workers' compensation system under section 176.135, and insurance plans provided
10.16through the Minnesota Comprehensive Health Association under sections 62E.01 to
10.1762E.19 . The limitations on insurance plans offered to local government employees shall
10.18not be applicable in geographic areas where provider participation is limited by managed
10.19care contracts with the Department of Human Services.
10.20    (b) For providers other than health maintenance organizations, participation in the
10.21medical assistance program means that:
10.22     (1) the provider accepts new medical assistance, general assistance medical care,
10.23and MinnesotaCare patients;
10.24    (2) for providers other than dental service providers, at least 20 percent of the
10.25provider's patients are covered by medical assistance, general assistance medical care,
10.26and MinnesotaCare as their primary source of coverage; or
10.27    (3) for dental service providers, at least ten percent of the provider's patients are
10.28covered by medical assistance, general assistance medical care, and MinnesotaCare as
10.29their primary source of coverage, or the provider accepts new medical assistance and
10.30MinnesotaCare patients who are children with special health care needs. For purposes
10.31of this section, "children with special health care needs" means children up to age 18
10.32who: (i) require health and related services beyond that required by children generally;
10.33and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
10.34condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
10.35cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
11.1neurological diseases; visual impairment or deafness; Down syndrome and other genetic
11.2disorders; autism; fetal alcohol syndrome; and other conditions designated by the
11.3commissioner after consultation with representatives of pediatric dental providers and
11.4consumers.
11.5    (c) Patients seen on a volunteer basis by the provider at a location other than
11.6the provider's usual place of practice may be considered in meeting the participation
11.7requirement in this section. The commissioner shall establish participation requirements
11.8for health maintenance organizations. The commissioner shall provide lists of participating
11.9medical assistance providers on a quarterly basis to the commissioner of management and
11.10budget, the commissioner of labor and industry, and the commissioner of commerce. Each
11.11of the commissioners shall develop and implement procedures to exclude as participating
11.12providers in the program or programs under their jurisdiction those providers who do
11.13not participate in the medical assistance program. The commissioner of management
11.14and budget shall implement this section through contracts with participating health and
11.15dental carriers.
11.16(d) Any hospital or other provider that is participating in a coordinated care
11.17delivery system under section 256D.031, subdivision 6, or receives payments from the
11.18uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to
11.19provide services to any patient enrolled in general assistance medical care regardless of
11.20the availability or the amount of payment.

11.21    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0947, subdivision 1,
11.22is amended to read:
11.23    Subdivision 1. Scope. Effective November 1, 2010 2011, and subject to federal
11.24approval, medical assistance covers medically necessary, intensive nonresidential
11.25rehabilitative mental health services as defined in subdivision 2, for recipients as defined
11.26in subdivision 3, when the services are provided by an entity meeting the standards
11.27in this section.

11.28    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, is
11.29amended to read:
11.30    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
11.31subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
11.32services upper payment limit for nonstate government hospitals. The commissioner shall
11.33then determine the amount of a supplemental payment to Hennepin County Medical
11.34Center and Regions Hospital for these services that would increase medical assistance
12.1spending in this category to the aggregate upper payment limit for all nonstate government
12.2hospitals in Minnesota. In making this determination, the commissioner shall allot the
12.3available increases between Hennepin County Medical Center and Regions Hospital
12.4based on the ratio of medical assistance fee-for-service outpatient hospital payments to
12.5the two facilities. The commissioner shall adjust this allotment as necessary based on
12.6federal approvals, the amount of intergovernmental transfers received from Hennepin and
12.7Ramsey Counties, and other factors, in order to maximize the additional total payments.
12.8The commissioner shall inform Hennepin County and Ramsey County of the periodic
12.9intergovernmental transfers necessary to match federal Medicaid payments available
12.10under this subdivision in order to make supplementary medical assistance payments to
12.11Hennepin County Medical Center and Regions Hospital equal to an amount that when
12.12combined with existing medical assistance payments to nonstate governmental hospitals
12.13would increase total payments to hospitals in this category for outpatient services to
12.14the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
12.15receipt of these periodic transfers, the commissioner shall make supplementary payments
12.16to Hennepin County Medical Center and Regions Hospital.
12.17    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
12.18determine an upper payment limit for physicians affiliated with Hennepin County Medical
12.19Center and with Regions Hospital. The upper payment limit shall be based on the average
12.20commercial rate or be determined using another method acceptable to the Centers for
12.21Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
12.22Ramsey County of the periodic intergovernmental transfers necessary to match the federal
12.23Medicaid payments available under this subdivision in order to make supplementary
12.24payments to physicians affiliated with Hennepin County Medical Center and Regions
12.25Hospital equal to the difference between the established medical assistance payment for
12.26physician services and the upper payment limit. Upon receipt of these periodic transfers,
12.27the commissioner shall make supplementary payments to physicians of Hennepin Faculty
12.28Associates and HealthPartners.
12.29    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shall may
12.30make monthly voluntary intergovernmental transfers to the commissioner in the following
12.31amounts: $133,333 by not to exceed $12,000,000 per year from Hennepin County
12.32and $100,000 by $6,000,000 per year from Ramsey County. The commissioner shall
12.33increase the medical assistance capitation payments to Metropolitan Health Plan and
12.34HealthPartners by any licensed health plan under contract with the medical assistance
12.35program that agrees to make enhanced payments to Hennepin County Medical Center or
12.36Regions Hospital. The increase shall be in an amount equal to the annual value of the
13.1monthly transfers plus federal financial participation., with each health plan receiving its
13.2pro rata share of the increase based on the pro rata share of medical assistance admissions
13.3to Hennepin County Medical Center and Regions Hospital by those plans. Upon the
13.4request of the commissioner, health plans shall submit individual-level cost data for
13.5verification purposes. The commissioner may ratably reduce these payments on a pro rata
13.6basis in order to satisfy federal requirements for actuarial soundness. If payments are
13.7reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
13.8increased medical assistance capitation payments under the intergovernmental transfer
13.9described in this paragraph shall increase its medical assistance payments to Hennepin
13.10County Medical Center and Regions Hospital by the same amount as the increased
13.11payments received in the capitation payment described in this paragraph.
13.12    (d) The commissioner shall inform Hennepin County and Ramsey County on an
13.13ongoing basis of the need for any changes needed in the intergovernmental transfers
13.14in order to continue the payments under paragraphs (a) to (c), at their maximum level,
13.15including increases in upper payment limits, changes in the federal Medicaid match, and
13.16other factors.
13.17    (e) The payments in paragraphs (a) to (c) shall be implemented independently of
13.18each other, subject to federal approval and to the receipt of transfers under subdivision 3.
13.19EFFECTIVE DATE.This section is effective the day following final enactment.

13.20    Sec. 9. [256B.197] INTERGOVERNMENTAL TRANSFERS; INPATIENT
13.21HOSPITAL PAYMENTS.
13.22    Subdivision 1. Federal approval required. This section is effective for federal
13.23fiscal year 2010 and future years contingent on federal approval of the intergovernmental
13.24transfers and payments authorized under this section and contingent on payment of the
13.25intergovernmental transfers under this section.
13.26    Subd. 2. Eligible nonstate government hospitals. (a) Hennepin County Medical
13.27Center and Regions Hospital are eligible nonstate government hospitals.
13.28(b) If the commissioner obtains federal approval to include other hospitals, including
13.29Fairview University Medical Center, the commissioner may expand the definition of
13.30eligible nonstate government hospitals to include other hospitals.
13.31    Subd. 3. Commissioner's duties. (a) For the purposes of this subdivision, the
13.32commissioner shall determine the fee-for-service inpatient hospital services upper
13.33payment limit for nonstate government hospitals. The commissioner shall determine,
13.34for each eligible nonstate government hospital, the amount of a supplemental payment
13.35for inpatient hospital services that would increase medical assistance spending for each
14.1eligible nonstate government hospital up to the amount that Medicare would pay for
14.2the Medicaid fee-for-service inpatient hospital services provided by that hospital. If
14.3the combined amount of such supplemental payment amounts and existing medical
14.4assistance payments for inpatient hospital services to all nonstate government hospitals
14.5is less than the upper payment limit, the commissioner shall increase the supplemental
14.6payment amount for each eligible nonstate government hospital in proportion to the initial
14.7supplemental payments in order to maximize the additional total payments.
14.8(b) The commissioner shall inform each eligible nonstate government hospital and
14.9associated governmental entities of intergovernmental transfers necessary to provide
14.10the nonfederal share for the supplemental payment amount attributable to each eligible
14.11nonstate government hospital, as calculated under paragraph (a).
14.12(c) Upon receipt of an intergovernmental transfer from a governmental entity
14.13associated with an eligible nonstate government hospital or from the eligible nonstate
14.14government hospital, the commissioner shall make a supplemental payment, using the
14.15amounts calculated under paragraph (a), to the associated eligible nonstate government
14.16hospital.
14.17(d) The commissioner may implement the payments in this section through use of
14.18periodic payments and intergovernmental transfers.
14.19(e) The commissioner shall inform eligible nonstate government hospitals and
14.20associated governmental entities on an ongoing basis of the need for any changes needed
14.21in the payment amounts or intergovernmental transfers in order to continue the payments
14.22under paragraph (c) at their maximum level, including increases in upper payment limits,
14.23changes in the federal Medicaid match, and other factors.
14.24EFFECTIVE DATE.This section is effective April 1, 2010.

14.25    Sec. 10. Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, is
14.26amended to read:
14.27    Subd. 3. General assistance medical care; eligibility. (a) General assistance
14.28medical care may be paid for any person who is not eligible for medical assistance
14.29under chapter 256B, including eligibility for medical assistance based on a spenddown
14.30of excess income according to section 256B.056, subdivision 5, or MinnesotaCare for
14.31applicants and recipients defined in paragraph (c), except as provided in paragraph (d),
14.32and: Beginning April 1, 2010, the general assistance medical care program shall be
14.33administered according to section 256D.031, unless otherwise stated, except for outpatient
14.34prescription drug coverage which will continue to be administered under this section.
15.1(b) Drug coverage under general assistance medical care is limited to prescription
15.2drugs that:
15.3(1) are covered under the medical assistance program as described in section
15.4256B.0625, subdivisions 13 and 13d; and
15.5(2) are provided by manufacturers that have fully executed general assistance
15.6medical care rebate agreements with the commissioner and comply with the agreements.
15.7Prescription drug coverage under general assistance medical care must conform to
15.8coverage under the medical assistance program according to section 256B.0625,
15.9subdivisions 13 to 13g.
15.10    (1) who is receiving assistance under section 256D.05, except for families with
15.11children who are eligible under Minnesota family investment program (MFIP), or who is
15.12having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
15.13    (2) who is a resident of Minnesota; and
15.14    (i) who has gross countable income not in excess of 75 percent of the federal poverty
15.15guidelines for the family size, using a six-month budget period and whose equity in assets
15.16is not in excess of $1,000 per assistance unit. General assistance medical care is not
15.17available for applicants or enrollees who are otherwise eligible for medical assistance but
15.18fail to verify their assets. Enrollees who become eligible for medical assistance shall be
15.19terminated and transferred to medical assistance. Exempt assets, the reduction of excess
15.20assets, and the waiver of excess assets must conform to the medical assistance program in
15.21section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum
15.22amount of undistributed funds in a trust that could be distributed to or on behalf of the
15.23beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the
15.24terms of the trust, must be applied toward the asset maximum; or
15.25    (ii) who has gross countable income above 75 percent of the federal poverty
15.26guidelines but not in excess of 175 percent of the federal poverty guidelines for the family
15.27size, using a six-month budget period, whose equity in assets is not in excess of the limits
15.28in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization.
15.29    (b) The commissioner shall adjust the income standards under this section each July
15.301 by the annual update of the federal poverty guidelines following publication by the
15.31United States Department of Health and Human Services.
15.32    (c) Effective for applications and renewals processed on or after September 1, 2006,
15.33general assistance medical care may not be paid for applicants or recipients who are adults
15.34with dependent children under 21 whose gross family income is equal to or less than 275
15.35percent of the federal poverty guidelines who are not described in paragraph (f).
16.1    (d) Effective for applications and renewals processed on or after September 1, 2006,
16.2general assistance medical care may be paid for applicants and recipients who meet all
16.3eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
16.4beginning the date of application. Immediately following approval of general assistance
16.5medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
16.6subdivision 7 , with covered services as provided in section 256L.03 for the rest of the
16.7six-month general assistance medical care eligibility period, until their six-month renewal.
16.8    (e) To be eligible for general assistance medical care following enrollment in
16.9MinnesotaCare as required by paragraph (d), an individual must complete a new
16.10application.
16.11    (f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are
16.12exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
16.13    (1) have applied for and are awaiting a determination of blindness or disability by
16.14the state medical review team or a determination of eligibility for Supplemental Security
16.15Income or Social Security Disability Insurance by the Social Security Administration;
16.16    (2) fail to meet the requirements of section 256L.09, subdivision 2;
16.17    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.;
16.18    (4) are classified as end-stage renal disease beneficiaries in the Medicare program;
16.19    (5) are enrolled in private health care coverage as defined in section 256B.02,
16.20subdivision 9;
16.21    (6) are eligible under paragraph (k);
16.22    (7) receive treatment funded pursuant to section 254B.02; or
16.23    (8) reside in the Minnesota sex offender program defined in chapter 246B.
16.24    (g) For applications received on or after October 1, 2003, eligibility may begin no
16.25earlier than the date of application. For individuals eligible under paragraph (a), clause
16.26(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
16.27eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
16.28may reapply if there is a subsequent period of inpatient hospitalization.
16.29    (h) Beginning September 1, 2006, Minnesota health care program applications and
16.30renewals completed by recipients and applicants who are persons described in paragraph
16.31(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility
16.32by the county agency. If all other eligibility requirements of this subdivision are met,
16.33eligibility for general assistance medical care shall be available in any month during which
16.34MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
16.35notice of termination for eligibility for general assistance medical care shall be sent to
16.36an applicant or recipient. If all other eligibility requirements of this subdivision are
17.1met, eligibility for general assistance medical care shall be available until enrollment in
17.2MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).
17.3    (i) The date of an initial Minnesota health care program application necessary to
17.4begin a determination of eligibility shall be the date the applicant has provided a name,
17.5address, and Social Security number, signed and dated, to the county agency or the
17.6Department of Human Services. If the applicant is unable to provide a name, address,
17.7Social Security number, and signature when health care is delivered due to a medical
17.8condition or disability, a health care provider may act on an applicant's behalf to establish
17.9the date of an initial Minnesota health care program application by providing the county
17.10agency or Department of Human Services with provider identification and a temporary
17.11unique identifier for the applicant. The applicant must complete the remainder of the
17.12application and provide necessary verification before eligibility can be determined. The
17.13applicant must complete the application within the time periods required under the
17.14medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart
17.155, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining
17.16verification if necessary.
17.17    (j) County agencies are authorized to use all automated databases containing
17.18information regarding recipients' or applicants' income in order to determine eligibility for
17.19general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
17.20in order to determine eligibility and premium payments by the county agency.
17.21    (k) General assistance medical care is not available for a person in a correctional
17.22facility unless the person is detained by law for less than one year in a county correctional
17.23or detention facility as a person accused or convicted of a crime, or admitted as an
17.24inpatient to a hospital on a criminal hold order, and the person is a recipient of general
17.25assistance medical care at the time the person is detained by law or admitted on a criminal
17.26hold order and as long as the person continues to meet other eligibility requirements
17.27of this subdivision.
17.28    (l) General assistance medical care is not available for applicants or recipients who
17.29do not cooperate with the county agency to meet the requirements of medical assistance.
17.30    (m) In determining the amount of assets of an individual eligible under paragraph
17.31(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
17.32an asset excluded under paragraph (a), that was given away, sold, or disposed of for
17.33less than fair market value within the 60 months preceding application for general
17.34assistance medical care or during the period of eligibility. Any transfer described in this
17.35paragraph shall be presumed to have been for the purpose of establishing eligibility for
17.36general assistance medical care, unless the individual furnishes convincing evidence to
18.1establish that the transaction was exclusively for another purpose. For purposes of this
18.2paragraph, the value of the asset or interest shall be the fair market value at the time it
18.3was given away, sold, or disposed of, less the amount of compensation received. For any
18.4uncompensated transfer, the number of months of ineligibility, including partial months,
18.5shall be calculated by dividing the uncompensated transfer amount by the average monthly
18.6per person payment made by the medical assistance program to skilled nursing facilities
18.7for the previous calendar year. The individual shall remain ineligible until this fixed period
18.8has expired. The period of ineligibility may exceed 30 months, and a reapplication for
18.9benefits after 30 months from the date of the transfer shall not result in eligibility unless
18.10and until the period of ineligibility has expired. The period of ineligibility begins in the
18.11month the transfer was reported to the county agency, or if the transfer was not reported,
18.12the month in which the county agency discovered the transfer, whichever comes first. For
18.13applicants, the period of ineligibility begins on the date of the first approved application.
18.14    (n) When determining eligibility for any state benefits under this subdivision,
18.15the income and resources of all noncitizens shall be deemed to include their sponsor's
18.16income and resources as defined in the Personal Responsibility and Work Opportunity
18.17Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
18.18subsequently set out in federal rules.
18.19    (o) Undocumented noncitizens and nonimmigrants are ineligible for general
18.20assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
18.21in one or more of the classes listed in United States Code, title 8, section 1101, subsection
18.22(a), paragraph (15), and an undocumented noncitizen is an individual who resides in
18.23the United States without the approval or acquiescence of the United States Citizenship
18.24and Immigration Services.
18.25    (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for
18.26medical assistance due to the deeming of a sponsor's income and resources, is ineligible
18.27for general assistance medical care.
18.28    (q) Effective July 1, 2003, general assistance medical care emergency services end.
18.29EFFECTIVE DATE.This section is effective April 1, 2010.

18.30    Sec. 11. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.
18.31    Subdivision 1. Eligibility. (a) Except as provided under subdivision 2, general
18.32assistance medical care may be paid for any individual who is not eligible for medical
18.33assistance under chapter 256B, including eligibility for medical assistance based on a
18.34spenddown of excess income according to section 256B.056, subdivision 5, and who:
19.1(1) is receiving assistance under section 256D.05, except for families with children
19.2who are eligible under the Minnesota family investment program (MFIP), or who is
19.3having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
19.4(2) is a resident of Minnesota and has gross countable income not in excess of 75
19.5percent of federal poverty guidelines for the family size, using a six-month budget period,
19.6and whose equity in assets is not in excess of $1,000 per assistance unit.
19.7Exempt assets, the reduction of excess assets, and the waiver of excess assets must
19.8conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d,
19.9except that the maximum amount of undistributed funds in a trust that could be distributed
19.10to or on behalf of the beneficiary by the trustee, assuming the full exercise of the trustee's
19.11discretion under the terms of the trust, must be applied toward the asset maximum.
19.12(b) The commissioner shall adjust the income standards under this section each July
19.131 by the annual update of the federal poverty guidelines following publication by the
19.14United States Department of Health and Human Services.
19.15    Subd. 2. Ineligible groups. (a) General assistance medical care may not be paid for
19.16an applicant or a recipient who:
19.17(1) is otherwise eligible for medical assistance but fails to verify their assets;
19.18(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;
19.19(3) is enrolled in private health coverage as defined in section 256B.02, subdivision
19.209;
19.21(4) is in a correctional facility, including an individual in a county correctional or
19.22detention facility as an individual accused or convicted of a crime, or admitted as an
19.23inpatient to a hospital on a criminal hold order;
19.24(5) resides in the Minnesota sex offender program defined in chapter 246B;
19.25(6) does not cooperate with the county agency to meet the requirements of medical
19.26assistance; or
19.27(7) does not cooperate with a county or state agency or the state medical review team
19.28in determining a disability or for determining eligibility for Supplemental Security Income
19.29or Social Security Disability Insurance by the Social Security Administration.
19.30(b) Undocumented noncitizens and nonimmigrants are ineligible for general
19.31assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
19.32in one or more of the classes listed in United States Code, title 8, section 1101, subsection
19.33(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the
19.34United States without approval or acquiescence of the United States Citizenship and
19.35Immigration Services.
20.1(c) Notwithstanding any other provision of law, a noncitizen who is ineligible for
20.2medical assistance due to the deeming of a sponsor's income and resources is ineligible for
20.3general assistance medical care.
20.4(d) General assistance medical care recipients who become eligible for medical
20.5assistance shall be terminated from general assistance medical care and transferred to
20.6medical assistance.
20.7    Subd. 2a. Transitional MinnesotaCare. (a) Except as provided in paragraph (c),
20.8effective for applications received on or after April 1, 2010, and before June 1, 2010, all
20.9applicants who meet the eligibility requirements in subdivision 1, paragraph (a), clause
20.10(2), and who are not described in subdivision 2 shall be enrolled in MinnesotaCare under
20.11section 256L.04, subdivision 7, immediately following approval for general assistance
20.12medical care.
20.13(b) If all other eligibility requirements of this subdivision are met, general assistance
20.14medical care may be paid for individuals identified in paragraph (a) for a temporary period
20.15beginning the date of application in accordance with subdivision 4. Notwithstanding
20.16subdivision 7, paragraph (c), eligibility for general assistance medical care shall continue
20.17until enrollment in MinnesotaCare is completed. Upon notification of eligibility for
20.18MinnesotaCare, notice of termination for eligibility for general assistance medical care
20.19shall be sent to the applicant. Once enrolled in MinnesotaCare, the MinnesotaCare-covered
20.20services as described in section 256L.03 shall apply for the remainder of the six-month
20.21general assistance medical care eligibility period until their six-month renewal.
20.22(c) This subdivision does not apply if the applicant:
20.23(1) has applied for and is awaiting a determination of blindness or disability by the
20.24state medical review team or a determination of eligibility for Supplemental Security
20.25Income or Social Security Disability Insurance by the Social Security Administration;
20.26(2) is homeless as defined by United States Code, title 42, section 11301, et seq.;
20.27(3) is classified as an end-stage renal disease beneficiary in the Medicare program;
20.28(4) receives treatment funded in section 254B.02; or
20.29(5) fails to meet the requirements of section 256L.09, subdivision 2.
20.30Applicants and recipients who meet any one of these criteria shall remain eligible for
20.31general assistance medical care and are not eligible to enroll in MinnesotaCare until
20.32the next renewal period.
20.33(d) To be eligible for general assistance medical care following enrollment
20.34in MinnesotaCare as required in paragraph (a), an individual must complete a new
20.35application.
21.1(e) This subdivision expires June 1, 2010. For any applicant or recipient who meets
21.2the requirements of this subdivision before June 1, 2010, the commissioner shall continue
21.3the process of enrolling the individual in MinnesotaCare and, upon the completion of
21.4enrollment, the individual shall receive services under MinnesotaCare in accordance
21.5with paragraph (b).
21.6    Subd. 3. Eligibility and enrollment procedures. (a) Eligibility for general
21.7assistance medical care shall begin no earlier than the date of application. The date of
21.8application shall be the date the applicant has provided a name, address, and Social
21.9Security number, signed and dated, to the county agency or the Department of Human
21.10Services. If the applicant is unable to provide a name, address, Social Security number,
21.11and signature when health care is delivered due to a medical condition or disability, a
21.12health care provider may act on an applicant's behalf to establish the date of an application
21.13by providing the county agency or Department of Human Services with provider
21.14identification and a temporary unique identifier for the applicant. The applicant must
21.15complete the remainder of the application and provide necessary verification before
21.16eligibility can be determined. The applicant must complete the application within the time
21.17periods required under the medical assistance program as specified in Minnesota Rules,
21.18parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the
21.19applicant in obtaining verification if necessary.
21.20    (b) County agencies are authorized to use all automated databases containing
21.21information regarding recipients' or applicants' income in order to determine eligibility for
21.22general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
21.23in order to determine eligibility and premium payments by the county agency.
21.24    (c) In determining the amount of assets of an individual eligible under subdivision 1,
21.25paragraph (a), clause (2), there shall be included any asset or interest in an asset, including
21.26an asset excluded under subdivision 1, paragraph (a), that was given away, sold, or
21.27disposed of for less than fair market value within the 60 months preceding application for
21.28general assistance medical care or during the period of eligibility. Any transfer described
21.29in this paragraph shall be presumed to have been for the purpose of establishing eligibility
21.30for general assistance medical care, unless the individual furnishes convincing evidence to
21.31establish that the transaction was exclusively for another purpose. For purposes of this
21.32paragraph, the value of the asset or interest shall be the fair market value at the time it
21.33was given away, sold, or disposed of, less the amount of compensation received. For any
21.34uncompensated transfer, the number of months of ineligibility, including partial months,
21.35shall be calculated by dividing the uncompensated transfer amount by the average monthly
21.36per person payment made by the medical assistance program to skilled nursing facilities
22.1for the previous calendar year. The individual shall remain ineligible until this fixed period
22.2has expired. The period of ineligibility may exceed 30 months, and a reapplication for
22.3benefits after 30 months from the date of the transfer shall not result in eligibility unless
22.4and until the period of ineligibility has expired. The period of ineligibility begins in the
22.5month the transfer was reported to the county agency, or if the transfer was not reported,
22.6the month in which the county agency discovered the transfer, whichever comes first. For
22.7applicants, the period of ineligibility begins on the date of the first approved application.
22.8    (d) When determining eligibility for any state benefits under this subdivision,
22.9the income and resources of all noncitizens shall be deemed to include their sponsor's
22.10income and resources as defined in the Personal Responsibility and Work Opportunity
22.11Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
22.12subsequently set out in federal rules.
22.13(e) Applicants and recipients are eligible for general assistance medical care for a
22.14six-month eligibility period. Eligibility may be renewed for additional six-month periods.
22.15During each six-month eligibility period, individuals are not eligible for MinnesotaCare.
22.16    Subd. 4. General assistance medical care; services. (a) Within the limitations
22.17described in this section, general assistance medical care covers medically necessary
22.18services that include:
22.19(1) inpatient hospital services;
22.20    (2) outpatient hospital services;
22.21    (3) services provided by Medicare-certified rehabilitation agencies;
22.22    (4) prescription drugs;
22.23    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
22.24for diabetics to monitor blood sugar level;
22.25    (6) eyeglasses and eye examinations;
22.26    (7) hearing aids;
22.27    (8) prosthetic devices, if not covered by veteran's benefits;
22.28    (9) laboratory and x-ray services;
22.29    (10) physicians' services;
22.30    (11) medical transportation except special transportation;
22.31    (12) chiropractic services as covered under the medical assistance program;
22.32    (13) podiatric services;
22.33    (14) dental services;
22.34    (15) mental health services covered under chapter 256B;
22.35    (16) services performed by a certified pediatric nurse practitioner, a certified family
22.36nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
23.1nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
23.2practitioner in independent practice, if (1) the service is otherwise covered under this
23.3chapter as a physician service, (2) the service provided on an inpatient basis is not included
23.4as part of the cost for inpatient services included in the operating payment rate, and (3) the
23.5service is within the scope of practice of the nurse practitioner's license as a registered
23.6nurse, as defined in section 148.171;
23.7    (17) services of a certified public health nurse or a registered nurse practicing in
23.8a public health nursing clinic that is a department of, or that operates under the direct
23.9authority of, a unit of government, if the service is within the scope of practice of the
23.10public health nurse's license as a registered nurse, as defined in section 148.171;
23.11    (18) telemedicine consultations, to the extent they are covered under section
23.12256B.0625, subdivision 3b;
23.13    (19) care coordination and patient education services provided by a community
23.14health worker according to section 256B.0625, subdivision 49; and
23.15(20) regardless of the number of employees that an enrolled health care provider
23.16may have, sign language interpreter services when provided by an enrolled health care
23.17provider during the course of providing a direct, person-to-person-covered health care
23.18service to an enrolled recipient who has a hearing loss and uses interpreting services.
23.19(b) Sex reassignment surgery is not covered under this section.
23.20(c) Drug coverage is covered in accordance with section 256D.03, subdivision 3,
23.21paragraph (b).
23.22(d) The following co-payments shall apply for services provided:
23.23(1) $25 for nonemergency visits to a hospital-based emergency room; and
23.24(2) $3 per brand-name drug prescription, subject to a $7 per month maximum for
23.25prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when
23.26used for the treatment of mental illness.
23.27(e) Co-payments shall be limited to one per day per provider for nonemergency
23.28visits to a hospital-based emergency room. Recipients of general assistance medical care
23.29are responsible for all co-payments in this subdivision. Reimbursement for prescription
23.30drugs shall be reduced by the amount of the co-payment until the recipient has reached the
23.31$7 per month maximum for prescription drug co-payments. The provider shall collect
23.32the co-payment from the recipient. Providers may not deny services to recipients who
23.33are unable to pay the co-payment.
23.34(f) Chemical dependency services that are reimbursed under chapter 254B shall not
23.35be reimbursed under general assistance medical care.
24.1(g) Inpatient hospital services that are provided in community behavioral health
24.2hospitals operated by state-operated services shall not be reimbursed under general
24.3assistance medical care.
24.4    Subd. 5. Payment rates and contract modification; April 1, 2010, to May 31,
24.52010. (a) For the period April 1, 2010, to May 31, 2010, general assistance medical
24.6care shall be paid on a fee-for-service basis. Fee-for-service payment rates for services
24.7other than outpatient prescription drugs shall be set at 37 percent of the payment rate in
24.8effect on March 31, 2010.
24.9(b) Outpatient prescription drug coverage provided during the period April 1, 2010,
24.10to May 31, 2010, shall be paid on a fee-for-service basis according to section 256B.0625,
24.11subdivision 13e.
24.12    Subd. 6. Coordinated care delivery systems. (a) Effective June 1, 2010, the
24.13commissioner shall contract with hospitals or groups of hospitals that qualify under
24.14paragraph (b) and agree to deliver services according to this subdivision. Contracting
24.15hospitals shall develop and implement a coordinated care delivery system to provide
24.16health care services to individuals who are eligible for general assistance medical care
24.17under this section and who either choose to receive services through the coordinated
24.18care delivery system or who are enrolled by the commissioner under paragraph (c). The
24.19health care services provided by the system must include: (1) the services described in
24.20subdivision 4 with the exception of outpatient prescription drug coverage but shall include
24.21drugs administered in an outpatient setting; or (2) a set of comprehensive and medically
24.22necessary health services that the recipients might reasonably require to be maintained in
24.23good health and that has been approved by the commissioner, including as a minimum,
24.24but not limited to, emergency care, emergency ground ambulance transportation services,
24.25inpatient hospital and physician care, outpatient health services, preventive health services,
24.26mental health services, and drugs administered in an outpatient setting. Outpatient
24.27prescription drug coverage is covered on a fee-for-service basis in accordance with
24.28subdivisions 7 and 9. A hospital establishing a coordinated care delivery system under this
24.29subdivision must ensure that the requirements of this subdivision are met.
24.30(b) A hospital or group of hospitals may contract with the commissioner to develop
24.31and implement a coordinated care delivery system as follows:
24.32(1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during
24.33calendar year 2007, it received fee-for-service payments for services to general assistance
24.34medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater
24.35than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to
25.1provide geographic access or to ensure that at least 80 percent of enrollees have access to
25.2a coordinated care delivery system; and
25.3(2) effective December 1, 2010, a Minnesota hospital not qualified under clause
25.4(1) may contract with the commissioner under this subdivision if it agrees to satisfy the
25.5requirements of this subdivision.
25.6Participation by hospitals shall become effective quarterly on June 1, September 1,
25.7December 1, or March 1. Hospital participation is effective for a period of 12 months and
25.8may be renewed for successive 12-month periods.
25.9(c) Applicants and recipients may enroll in any available coordinated care delivery
25.10system. If more than one coordinated care delivery system is available, the applicant or
25.11recipient shall be allowed to choose among the systems. The commissioner may assign
25.12an applicant or recipient to a coordinated care delivery system if no choice is made by
25.13the applicant or recipient. Upon enrollment into a coordinated care delivery system, the
25.14enrollee must agree to receive all nonemergency services through the coordinated care
25.15delivery system. Enrollment in a coordinated care delivery system is for six months
25.16and may be renewed for additional six-month periods, except that initial enrollment is
25.17for six months or until the end of a recipient's period of general assistance medical care
25.18eligibility, whichever occurs first. An individual is not eligible to enroll in MinnesotaCare
25.19during a period of enrollment in a coordinated care delivery system. From June 1, 2010, to
25.20November 30, 2010, applicants and enrollees not enrolled in a coordinated care delivery
25.21system may seek services from a hospital eligible for reimbursement under the temporary
25.22uncompensated care pool established under subdivision 8. After November 30, 2010,
25.23services are available only through a coordinated care delivery system.
25.24(d) The hospital may contract and coordinate with providers and clinics for the
25.25delivery of services and shall contract with essential community providers as defined
25.26under section 62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the extent
25.27practicable. If a provider or clinic contracts with a hospital to provide services through the
25.28coordinated care delivery system, the provider may not refuse to provide services to any
25.29of the system's enrollees, and payment for services shall be negotiated with the hospital
25.30and paid by the hospital from the system's allocation under subdivision 7.
25.31(e) A coordinated care delivery system must:
25.32(1) provide the covered services required under paragraph (a) to recipients enrolled
25.33in the coordinated care delivery system, and comply with the requirements of subdivision
25.344, paragraphs (b) to (g);
25.35(2) establish a process to monitor enrollment and ensure the quality of care provided;
26.1(3) in cooperation with counties, coordinate the delivery of health care services with
26.2existing homeless prevention, supportive housing, and rent subsidy programs and funding
26.3administered by the Minnesota Housing Finance Agency under chapter 462A; and
26.4(4) adopt innovative and cost-effective methods of care delivery and coordination,
26.5which may include the use of allied health professionals, telemedicine, patient educators,
26.6care coordinators, and community health workers.
26.7(f) The hospital may require an enrollee to designate a primary care provider or a
26.8primary care clinic that is certified as a health care home under section 256B.0751. The
26.9hospital may limit the delivery of services to a network of providers who have contracted
26.10with the hospital to deliver services in accordance with this subdivision, and require
26.11an enrollee to seek services only within this network. The hospital may also require
26.12a referral to a provider before the service is eligible for payment. A coordinated care
26.13delivery system is not required to provide payment to a provider who is not employed
26.14by or under contract with the system for services provided to an enrollee of the system,
26.15except in cases of an emergency.
26.16(g) An enrollee of a coordinated care delivery system has the right to appeal to the
26.17commissioner according to section 256.045.
26.18(h) The state shall not be liable for the payment of any cost or obligation incurred
26.19by the coordinated care delivery system.
26.20(i) The hospital must provide the commissioner with data necessary for assessing
26.21enrollment, quality of care, cost, and utilization of services. Each hospital must provide,
26.22on a quarterly basis on a form prescribed by the commissioner for each enrollee served
26.23through the coordinated care delivery system, the services provided, the cost of services
26.24provided, the actual payment amount for the services provided, and any other information
26.25the commissioner deems necessary to claim federal Medicaid match.
26.26    Subd. 7. Payments; rate setting for the hospital coordinated care delivery
26.27system. (a) Effective for general assistance medical care services, with the exception
26.28of outpatient prescription drug coverage, provided on or after June 1, 2010, through a
26.29coordinated care delivery system, the commissioner shall allocate the annual appropriation
26.30for the coordinated care delivery system to hospitals participating under subdivision 6
26.31twice every three months, starting June 1, 2010. The payment shall be allocated among all
26.32hospitals qualified to participate on the allocation date. Each hospital or group of hospitals
26.33shall receive a pro rata share of the allocation based on the hospital's or group of hospitals'
26.34calendar year 2007 payments for general assistance medical care services, provided that,
26.35for the purposes of this allocation, payments to Hennepin County Medical Center, Regions
26.36Hospital, and Fairview University Medical Center shall be weighted at 110 percent of the
27.1actual amount. The commissioner shall conduct a settle-up after the conclusion of each
27.2quarter to ensure that final allocations reflect actual hospital utilization and shall reallocate
27.3funds as necessary among participating hospitals. The 2007 base year shall be updated by
27.4one calendar year each June 1, beginning June 1, 2011.
27.5(b) In order to be reimbursed under this section, nonhospital providers of health
27.6care services shall contract with one or more hospitals described in paragraph (a) to
27.7provide services to general assistance medical care recipients through the coordinated care
27.8delivery system established by the hospital. The hospital shall reimburse bills submitted
27.9by nonhospital providers participating under this paragraph at a rate negotiated between
27.10the hospital and the nonhospital provider.
27.11(c) The commissioner shall apply for federal matching funds under section
27.12256B.199, paragraphs (a) to (d), for expenditures under this subdivision.
27.13(d) Outpatient prescription drug coverage provided on or after June 1, 2010, shall
27.14be paid on a fee-for-service basis according to subdivision 9 and section 256B.0625,
27.15subdivision 13e.
27.16    Subd. 8. Temporary uncompensated care pool. (a) The commissioner shall
27.17establish a temporary uncompensated care pool, effective June 1, 2010. Payments from
27.18the pool must be distributed, within the limits of the available appropriation, to hospitals
27.19that are not part of a coordinated care delivery system established under subdivision 6.
27.20(b) Hospitals seeking reimbursement from this pool must submit an invoice to
27.21the commissioner in a form prescribed by the commissioner for payment for services
27.22provided to an applicant or enrollee not enrolled in a coordinated care delivery system. A
27.23payment amount, as calculated under current law, must be determined, but not paid, for
27.24each admission of or service provided to a general assistance medical care recipient on or
27.25after June 1, 2010, to November 30, 2010.
27.26(c) The aggregated payment amounts for each hospital must be calculated as a
27.27percentage of the total calculated amount for all hospitals.
27.28(d) Distributions from the uncompensated care pool for each hospital must be
27.29determined by multiplying the factor in paragraph (c) by the amount of money in the
27.30uncompensated care pool that is available for the six-month period.
27.31(e) The commissioner shall apply for federal matching funds under section
27.32256B.199, paragraphs (a) to (d), for expenditures under this subdivision.
27.33(f) Outpatient prescription drugs are not eligible for payment under this subdivision.
27.34    Subd. 9. Prescription drug pool. (a) The commissioner shall establish a
27.35prescription drug pool, effective June 1, 2010. Money in the pool must be used to
27.36reimburse pharmacies and other providers for prescription drugs dispensed to enrollees,
28.1on a fee-for-service basis according to section 256B.0625, subdivision 13e. Prescription
28.2drug coverage is subject to the availability of funds in the pool. If the commissioner
28.3forecasts that expenditures under this subdivision will exceed the appropriation for this
28.4purpose, the commissioner may bring recommendations to the Legislative Advisory
28.5Commission on methods to resolve the shortfall.
28.6(b) Effective June 1, 2010, coordinated care delivery systems established under
28.7subdivision 6 shall pay to the commissioner, on a quarterly basis, an assessment that in the
28.8aggregate equals 20 percent of the state appropriation for the prescription drug pool. Each
28.9coordinated care delivery system's assessment must be in proportion to the system's share
28.10of total funding provided by the state for coordinated care delivery systems, as calculated
28.11by the commissioner based on the most recent available data.
28.12    Subd. 10. Assistance for veterans. Hospitals participating in the coordinated care
28.13delivery system under subdivision 6 shall consult with counties, county veterans service
28.14officers, and the Veterans Administration to identify other programs for which general
28.15assistance medical care recipients enrolled in their system are qualified.
28.16EFFECTIVE DATE.This section is effective for services rendered on or after
28.17April 1, 2010.

28.18    Sec. 12. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
28.19    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
28.20first day of the month following the month in which eligibility is approved and the first
28.21premium payment has been received. As provided in section 256B.057, coverage for
28.22newborns is automatic from the date of birth and must be coordinated with other health
28.23coverage. The effective date of coverage for eligible newly adoptive children added to a
28.24family receiving covered health services is the month of placement. The effective date
28.25of coverage for other new members added to the family is the first day of the month
28.26following the month in which the change is reported. All eligibility criteria must be met
28.27by the family at the time the new family member is added. The income of the new family
28.28member is included with the family's gross income and the adjusted premium begins in
28.29the month the new family member is added.
28.30(b) The initial premium must be received by the last working day of the month for
28.31coverage to begin the first day of the following month.
28.32(c) Benefits are not available until the day following discharge if an enrollee is
28.33hospitalized on the first day of coverage.
28.34(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
28.35256L.18 are secondary to a plan of insurance or benefit program under which an eligible
29.1person may have coverage and the commissioner shall use cost avoidance techniques to
29.2ensure coordination of any other health coverage for eligible persons. The commissioner
29.3shall identify eligible persons who may have coverage or benefits under other plans of
29.4insurance or who become eligible for medical assistance.
29.5(e) The effective date of coverage for single adults and households with no children
29.6formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
29.7according to section 256D.03, subdivision 3 256D.031, subdivision 2a, is the first day of
29.8the month following the last day of general assistance medical care coverage.
29.9EFFECTIVE DATE.This section is effective April 1, 2010.

29.10    Sec. 13. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
29.11    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility
29.12must be renewed every 12 months. The 12-month period begins in the month after the
29.13month the application is approved.
29.14    (b) Each new period of eligibility must take into account any changes in
29.15circumstances that impact eligibility and premium amount. An enrollee must provide all
29.16the information needed to redetermine eligibility by the first day of the month that ends
29.17the eligibility period. If there is no change in circumstances, the enrollee may renew
29.18eligibility at designated locations that include community clinics and health care providers'
29.19offices. The designated sites shall forward the renewal forms to the commissioner. The
29.20commissioner may establish criteria and timelines for sites to forward applications to the
29.21commissioner or county agencies. The premium for the new period of eligibility must be
29.22received as provided in section 256L.06 in order for eligibility to continue.
29.23    (c) For single adults and households with no children formerly enrolled in general
29.24assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
29.25subdivision 3 256D.031, subdivision 2a, the first period of eligibility begins the month the
29.26enrollee submitted the application or renewal for general assistance medical care.
29.27    (d) An enrollee who fails to submit renewal forms and related documentation
29.28necessary for verification of continued eligibility in a timely manner shall remain eligible
29.29for one additional month beyond the end of the current eligibility period before being
29.30disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
29.31additional month.
29.32EFFECTIVE DATE.This section is effective April 1, 2010.

29.33    Sec. 14. Minnesota Statutes 2008, section 256L.07, subdivision 6, is amended to read:
30.1    Subd. 6. Exception for certain adults. Single adults and households with
30.2no children formerly enrolled in general assistance medical care and enrolled in
30.3MinnesotaCare according to section 256D.03, subdivision 3 256D.031, subdivision 2a, are
30.4eligible without meeting the requirements of this section until renewal.
30.5EFFECTIVE DATE.This section is effective April 1, 2010.

30.6    Sec. 15. Minnesota Statutes 2008, section 256L.15, subdivision 4, is amended to read:
30.7    Subd. 4. Exception for transitioned adults. County agencies shall pay premiums
30.8for single adults and households with no children formerly enrolled in general assistance
30.9medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3
30.10256D.031, subdivision 2a, until six-month renewal. The county agency has the option of
30.11continuing to pay premiums for these enrollees.
30.12EFFECTIVE DATE.This section is effective April 1, 2010.

30.13    Sec. 16. Minnesota Statutes 2008, section 256L.17, subdivision 7, is amended to read:
30.14    Subd. 7. Exception for certain adults. Single adults and households with
30.15no children formerly enrolled in general assistance medical care and enrolled in
30.16MinnesotaCare according to section 256D.03, subdivision 3 256D.031, subdivision 2a, are
30.17exempt from the requirements of this section until renewal.
30.18EFFECTIVE DATE.This section is effective April 1, 2010.

30.19    Sec. 17. Minnesota Statutes 2008, section 517.08, subdivision 1c, is amended to read:
30.20    Subd. 1c. Disposition of license fee. (a) Of the marriage license fee collected
30.21pursuant to subdivision 1b, paragraph (a), $25 must be retained by the county. The local
30.22registrar must pay $85 to the commissioner of management and budget to be deposited
30.23as follows:
30.24    (1) $50 $55 in the general fund;
30.25    (2) $3 in the state government special revenue fund to be appropriated to the
30.26commissioner of public safety for parenting time centers under section 119A.37;
30.27    (3) $2 in the special revenue fund to be appropriated to the commissioner of health
30.28for developing and implementing the MN ENABL program under section 145.9255; and
30.29    (4) $25 in the special revenue fund is appropriated to the commissioner of
30.30employment and economic development for the displaced homemaker program under
30.31section 116L.96; and
31.1    (5) $5 in the special revenue fund is appropriated to the commissioner of human
31.2services for the Minnesota Healthy Marriage and Responsible Fatherhood Initiative under
31.3section 256.742.
31.4    (b) Of the $40 fee under subdivision 1b, paragraph (b), $25 must be retained by the
31.5county. The local registrar must pay $15 to the commissioner of management and budget
31.6to be deposited as follows:
31.7    (1) $5 as provided in paragraph (a), clauses (2) and (3); and
31.8    (2) $10 in the special revenue fund is appropriated to the commissioner of
31.9employment and economic development for the displaced homemaker program under
31.10section 116L.96.
31.11    (c) The increase in the marriage license fee under paragraph (a) provided for in Laws
31.122004, chapter 273, and disbursement of the increase in that fee to the special fund for the
31.13Minnesota Healthy Marriage and Responsible Fatherhood Initiative under paragraph (a),
31.14clause (5), is contingent upon the receipt of federal funding under United States Code, title
31.1542, section 1315, for purposes of the initiative.
31.16EFFECTIVE DATE.This section is effective July 1, 2010.

31.17    Sec. 18. DRUG REBATE PROGRAM.
31.18The commissioner of human services shall continue to administer a drug rebate
31.19program for drugs purchased for persons eligible for the general assistance medical care
31.20program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph
31.21(cc), and 256D.03.
31.22EFFECTIVE DATE.This section is effective April 1, 2010.

31.23    Sec. 19. REVISOR'S INSTRUCTION.
31.24The revisor of statutes shall edit Minnesota Statutes, sections 256B.69 and 256B.692,
31.25to remove references to the general assistance medical care program.
31.26EFFECTIVE DATE.This section is effective June 1, 2010.

31.27    Sec. 20. REPEALER.
31.28(a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; 256B.195,
31.29subdivisions 4 and 5; and 256D.03, subdivision 9, are repealed.
31.30(b) Minnesota Statutes 2009 Supplement, sections 256B.195, subdivisions 1, 2, and
31.313; and 256D.03, subdivision 4, are repealed.
32.1(c) Minnesota Statutes 2008, sections 256L.05, subdivision 1b; 256L.07, subdivision
32.26; 256L.15, subdivision 4; and 256L.17, subdivision 7, are repealed effective January 1,
32.32011.
32.4EFFECTIVE DATE.This section is effective April 1, 2010.

32.5ARTICLE 2

32.6APPROPRIATIONS

32.7	Section 1. HUMAN SERVICES APPROPRIATION.

32.8The sums shown in the columns marked "Appropriations" are added to or, if shown
32.9in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, as amended
32.10by Laws 2009, chapter 173, or other law, to the agencies and for the purposes specified in
32.11this article. The appropriations are from the general fund, or another named fund, and are
32.12available for the fiscal years indicated for each purpose. The figures "2010" and "2011"
32.13used in this article mean that the addition to or subtraction from appropriations listed under
32.14them are available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively.
32.15"The first year" is fiscal year 2010. "The second year" is fiscal year 2011. "The biennium"
32.16is fiscal years 2010 and 2011. Supplemental appropriations and reductions for the fiscal
32.17year ending June 30, 2010, are effective the day following final enactment.

32.18				APPROPRIATIONS
32.19				Available for the Year
32.20				Ending June 30
32.21					2010		2011

32.22

Sec. 2. HUMAN SERVICES

32.23

Subdivision 1.Total Appropriation

$

(7,517,000)

$

(69,393,000)

32.24	Appropriations by Fund
32.25		2010	2011
32.26	General	34,807,000	118,493,000
32.27	Health Care Access	(42,324,000)	(187,886,000)

32.28The amounts that may be spent for each
32.29purpose are specified in the following
32.30subdivisions.

32.31 32.32

Subd. 2.Children Support Enforcement Grants

-0-

(300,000)

32.33Minnesota Healthy Marriage and
32.34Responsible Fatherhood Initiative Fee.
33.1Notwithstanding Minnesota Statutes, section
33.2517.08, the balance and the fee revenue
33.3available to the commissioner of human
33.4services for the healthy marriage and
33.5responsible fatherhood initiative in the state
33.6government special revenue fund must be
33.7transferred to and deposited into the general
33.8fund by June 30, 2011.

33.9 33.10

Subd. 3.Children and Economic Assistance Operations

(1,408,000)

(1,560,000)

33.11

Subd. 4.Basic Health Care Grants

33.12The amounts that may be spent from this
33.13appropriation for each purpose are as follows:

33.14

(a) MinnesotaCare Grants

33.15	Appropriations by Fund
33.16	Health Care Access	(42,324,000)	(187,886,000)

33.17 33.18

(b) Medical Assistance Basic Health Care Grants - Families and Children

-0-

(49,000)

33.19 33.20

(c) Medical Assistance Basic Health Care Grants - Elderly and Disabled

-0-

(1,275,000)

33.21

(d) General Assistance Medical Care

39,413,000

135,837,000

33.22For general assistance medical care payments
33.23under Minnesota Statutes, section 256D.031.
33.24$5,500,000 in fiscal year 2010 and
33.25$65,500,000 in fiscal year 2011 is for
33.26payments to coordinated care delivery
33.27systems under Minnesota Statutes, section
33.28256D.031, subdivision 7.
33.29$4,375,000 in fiscal year 2010 and
33.30$51,875,000 in fiscal year 2011 is for
33.31payments for prescription drugs under
33.32Minnesota Statutes, section 256D.031,
33.33subdivision 9.
34.1$28,000,000 in fiscal year 2010 is for
34.2provider and prescription drug payments
34.3under Minnesota Statutes, section 256D.031,
34.4subdivision 5.
34.5$1,538,000 in fiscal year 2010 and
34.6$18,462,000 in fiscal year 2011 is for
34.7payments from the temporary uncompensated
34.8care pool under Minnesota Statutes, section
34.9256D.031, subdivision 8.
34.10Any amount under paragraph (d) that is not
34.11spent in the first year does not cancel and is
34.12available for payments in the second year.
34.13The commissioner may transfer any
34.14unexpended amount under Minnesota
34.15Statutes, section 256D.031, subdivision 9,
34.16after the final allocation in fiscal year 2011 to
34.17make payments under Minnesota Statutes,
34.18section 256D.031, subdivision 7.
34.19Any unexpended amount not used for
34.20general assistance medical care expenditures
34.21incurred before April 1, 2010, under
34.22Minnesota Statutes, section 256D.03, shall be
34.23used to make payments under paragraph (d).

34.24

Subd. 5.Health Care Management

34.25The amounts that may be spent from the
34.26appropriation for each purpose are as follows:

34.27

Health Care Administration

(2,998,000)

(5,270,000)

34.28Base Adjustment. The general fund base
34.29for health care administration is reduced by
34.30$182,000 in fiscal year 2012 and $182,000 in
34.31fiscal year 2013.

34.32

Subd. 6.Continuing Care Grants

34.33

(a) Mental Health Grants

(200,000)

(7,904,000)

35.1The general fund appropriation to the
35.2commissioner of human services for adult
35.3mental health grants in Laws 2009, chapter
35.479, article 13, section 3, subdivision 8, as
35.5amended by Laws 2009, chapter 173, article
35.62, section 1, subdivision 8, is reduced by
35.7$7,704,000 in fiscal year 2011. This is a
35.8onetime reduction.
35.9$200,000 of the reduction in each year is
35.10to eliminate specialty care grants for the
35.112007 mental health initiative infrastructure
35.12investments.

35.13

(b) Other Continuing Care Grants

-0-

(2,037,000)

35.14HIV Grants. The general fund appropriation
35.15for the HIV drug and insurance grant
35.16program shall be reduced by $2,037,000 in
35.17fiscal year 2011 and increased by $2,037,000
35.18in fiscal year 2013. These adjustments are
35.19onetime and must not be applied to the base.
35.20Notwithstanding any contrary provision, this
35.21provision expires June 30, 2013.

35.22

Subd. 7.Continuing Care Management

-0-

1,051,000

35.23

Subd. 8.Transfers

35.24The commissioner must transfer $29,538,000
35.25in fiscal year 2010 and $18,462,000 in fiscal
35.26year 2011 from the health care access fund to
35.27the general fund. This is a onetime transfer.
35.28The commissioner must transfer $4,800,000
35.29from the consolidated chemical dependency
35.30treatment fund to the general fund by June
35.3130, 2010.
35.32EFFECTIVE DATE.This article is effective April 1, 2010.