SF 1566

1st Unofficial Engrossment - 86th Legislature (2009 - 2010) Posted on 12/26/2012 11:17pm

1.1A bill for an act

1.2relating to human services; changing health care eligibility and application
1.3provisions for medical assistance, MinnesotaCare, and general assistance
1.4medical care; requiring certain data; authorizing centers of excellence criteria;
1.5establishing a Drug Utilization Review Board; making technical changes;
1.6changing coinsurance provisions for MinnesotaCare; authorizing rulemaking;
1.7requiring a report; amending Minnesota Statutes 2008, sections 62J.2930,
1.8subdivision 3; 245.494, subdivision 3; 256.015, subdivision 7; 256.969,
1.9subdivision 3a; 256B.037, subdivision 5; 256B.056, subdivisions 1c, 3c,
1.106; 256B.0625, by adding subdivisions; 256B.094, subdivision 3; 256B.195,
1.11subdivisions 1, 2, 3; 256B.199; 256B.69, subdivision 5a; 256B.77, subdivision
1.1213; 256D.03, subdivision 3; 256L.03, subdivision 5; 256L.15, subdivision 2;
1.13Laws 2005, First Special Session chapter 4, article 8, sections 54; 61; 63; 66; 74;
1.14repealing Minnesota Statutes 2008, sections 256B.031; 256L.01, subdivision 4;
1.15Laws 2005, First Special Session chapter 4, article 8, sections 21; 22; 23; 24.
1.16BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.17    Section 1. Minnesota Statutes 2008, section 62J.2930, subdivision 3, is amended to
1.18read:
1.19    Subd. 3. Consumer information. (a) The information clearinghouse or another
1.20entity designated by the commissioner shall provide consumer information to health
1.21plan company enrollees to:
1.22(1) assist enrollees in understanding their rights;
1.23(2) explain and assist in the use of all available complaint systems, including internal
1.24complaint systems within health carriers, community integrated service networks, and
1.25the Departments of Health and Commerce;
1.26(3) provide information on coverage options in each region of the state;
1.27(4) provide information on the availability of purchasing pools and enrollee
1.28subsidies; and
2.1(5) help consumers use the health care system to obtain coverage.
2.2(b) The information clearinghouse or other entity designated by the commissioner
2.3for the purposes of this subdivision shall not:
2.4(1) provide legal services to consumers;
2.5(2) represent a consumer or enrollee; or
2.6(3) serve as an advocate for consumers in disputes with health plan companies.
2.7(c) Nothing in this subdivision shall interfere with the ombudsman program
2.8established under section 256B.031, subdivision 6 256B.69, subdivision 20, or other
2.9existing ombudsman programs.

2.10    Sec. 2. Minnesota Statutes 2008, section 245.494, subdivision 3, is amended to read:
2.11    Subd. 3. Duties of the commissioner of human services. The commissioner of
2.12human services, in consultation with the Integrated Fund Task Force, shall:
2.13(1) in the first quarter of 1994, in areas where a local children's mental health
2.14collaborative has been established, based on an independent actuarial analysis, identify all
2.15medical assistance and MinnesotaCare resources devoted to mental health services for
2.16children in the target population including inpatient, outpatient, medication management,
2.17services under the rehabilitation option, and related physician services in the total health
2.18capitation of prepaid plans under contract with the commissioner to provide medical
2.19assistance services under section 256B.69;
2.20(2) assist each children's mental health collaborative to determine an actuarially
2.21feasible operational target population;
2.22(3) ensure that a prepaid health plan that contracts with the commissioner to provide
2.23medical assistance or MinnesotaCare services shall pass through the identified resources
2.24to a collaborative or collaboratives upon the collaboratives meeting the requirements
2.25of section 245.4933 to serve the collaborative's operational target population. The
2.26commissioner shall, through an independent actuarial analysis, specify differential rates
2.27the prepaid health plan must pay the collaborative based upon severity, functioning, and
2.28other risk factors, taking into consideration the fee-for-service experience of children
2.29excluded from prepaid medical assistance participation;
2.30(4) ensure that a children's mental health collaborative that enters into an agreement
2.31with a prepaid health plan under contract with the commissioner shall accept medical
2.32assistance recipients in the operational target population on a first-come, first-served basis
2.33up to the collaborative's operating capacity or as determined in the agreement between
2.34the collaborative and the commissioner;
3.1(5) ensure that a children's mental health collaborative that receives resources passed
3.2through a prepaid health plan under contract with the commissioner shall be subject to
3.3the quality assurance standards, reporting of utilization information, standards set out in
3.4sections 245.487 to 245.4889, and other requirements established in Minnesota Rules,
3.5part 9500.1460;
3.6(6) ensure that any prepaid health plan that contracts with the commissioner,
3.7including a plan that contracts under section 256B.69, must enter into an agreement with
3.8any collaborative operating in the same service delivery area that:
3.9(i) meets the requirements of section 245.4933;
3.10(ii) is willing to accept the rate determined by the commissioner to provide medical
3.11assistance services; and
3.12(iii) requests to contract with the prepaid health plan;
3.13(7) ensure that no agreement between a health plan and a collaborative shall
3.14terminate the legal responsibility of the health plan to assure that all activities under the
3.15contract are carried out. The agreement may require the collaborative to indemnify the
3.16health plan for activities that are not carried out;
3.17(8) ensure that where a collaborative enters into an agreement with the commissioner
3.18to provide medical assistance and MinnesotaCare services a separate capitation rate will
3.19be determined through an independent actuarial analysis which is based upon the factors
3.20set forth in clause (3) to be paid to a collaborative for children in the operational target
3.21population who are eligible for medical assistance but not included in the prepaid health
3.22plan contract with the commissioner;
3.23(9) ensure that in counties where no prepaid health plan contract to provide medical
3.24assistance or MinnesotaCare services exists, a children's mental health collaborative that
3.25meets the requirements of section 245.4933 shall:
3.26(i) be paid a capitated rate, actuarially determined, that is based upon the
3.27collaborative's operational target population;
3.28(ii) accept medical assistance or MinnesotaCare recipients in the operational target
3.29population on a first-come, first-served basis up to the collaborative's operating capacity or
3.30as determined in the contract between the collaborative and the commissioner; and
3.31(iii) comply with quality assurance standards, reporting of utilization information,
3.32standards set out in sections 245.487 to 245.4889, and other requirements established in
3.33Minnesota Rules, part 9500.1460;
3.34(10) subject to federal approval, in the development of rates for local children's
3.35mental health collaboratives, the commissioner shall consider, and may adjust, trend and
3.36utilization factors, to reflect changes in mental health service utilization and access;
4.1(11) consider changes in mental health service utilization, access, and price, and
4.2determine the actuarial value of the services in the maintenance of rates for local children's
4.3mental health collaborative provided services, subject to federal approval;
4.4(12) provide written notice to any prepaid health plan operating within the service
4.5delivery area of a children's mental health collaborative of the collaborative's existence
4.6within 30 days of the commissioner's receipt of notice of the collaborative's formation;
4.7(13) ensure that in a geographic area where both a prepaid health plan including
4.8those established under either section 256B.69 or 256L.12 and a local children's mental
4.9health collaborative exist, medical assistance and MinnesotaCare recipients in the
4.10operational target population who are enrolled in prepaid health plans will have the choice
4.11to receive mental health services through either the prepaid health plan or the collaborative
4.12that has a contract with the prepaid health plan, according to the terms of the contract;
4.13(14) develop a mechanism for integrating medical assistance resources for mental
4.14health service with MinnesotaCare and any other state and local resources available for
4.15services for children in the operational target population, and develop a procedure for
4.16making these resources available for use by a local children's mental health collaborative;
4.17(15) gather data needed to manage mental health care including evaluation data and
4.18data necessary to establish a separate capitation rate for children's mental health services
4.19if that option is selected;
4.20(16) by January 1, 1994, develop a model contract for providers of mental health
4.21managed care that meets the requirements set out in sections 245.491 to 245.495 and
4.22256B.69 , and utilize this contract for all subsequent awards, and before January 1, 1995,
4.23the commissioner of human services shall not enter into or extend any contract for any
4.24prepaid plan that would impede the implementation of sections 245.491 to 245.495;
4.25(17) develop revenue enhancement or rebate mechanisms and procedures to
4.26certify expenditures made through local children's mental health collaboratives for
4.27services including administration and outreach that may be eligible for federal financial
4.28participation under medical assistance and other federal programs;
4.29(18) ensure that new contracts and extensions or modifications to existing contracts
4.30under section 256B.69 do not impede implementation of sections 245.491 to 245.495;
4.31(19) provide technical assistance to help local children's mental health collaboratives
4.32certify local expenditures for federal financial participation, using due diligence in order to
4.33meet implementation timelines for sections 245.491 to 245.495 and recommend necessary
4.34legislation to enhance federal revenue, provide clinical and management flexibility, and
4.35otherwise meet the goals of local children's mental health collaboratives and request
5.1necessary state plan amendments to maximize the availability of medical assistance for
5.2activities undertaken by the local children's mental health collaborative;
5.3(20) take all steps necessary to secure medical assistance reimbursement under the
5.4rehabilitation option for family community support services and therapeutic support of
5.5foster care and for individualized rehabilitation services;
5.6(21) provide a mechanism to identify separately the reimbursement to a county
5.7for child welfare targeted case management provided to children served by the local
5.8collaborative for purposes of subsequent transfer by the county to the integrated fund;
5.9(22) ensure that family members who are enrolled in a prepaid health plan and
5.10whose children are receiving mental health services through a local children's mental
5.11health collaborative file complaints about mental health services needed by the family
5.12members, the commissioner shall comply with section 256B.031, subdivision 6 256B.69,
5.13subdivision 20. A collaborative may assist a family to make a complaint; and
5.14(23) facilitate a smooth transition for children receiving prepaid medical assistance
5.15or MinnesotaCare services through a children's mental health collaborative who become
5.16enrolled in a prepaid health plan.

5.17    Sec. 3. Minnesota Statutes 2008, section 256.015, subdivision 7, is amended to read:
5.18    Subd. 7. Cooperation with information requests required. (a) Upon the request
5.19of the Department commissioner of human services,:
5.20(1) any state agency or third party payer shall cooperate with the department in by
5.21furnishing information to help establish a third party liability. Upon the request of the
5.22Department of Human Services or county child support or human service agencies, as
5.23required by the federal Deficit Reduction Act of 2005, Public Law 109-171;
5.24(2) any employer or third party payer shall cooperate in by furnishing a data file
5.25containing information about group health insurance plans plan or medical benefit plans
5.26available to plan coverage of its employees or insureds within 60 days of the request.
5.27(b) For purposes of section 176.191, subdivision 4, the Department commissioner
5.28of labor and industry may allow the Department commissioner of human services and
5.29county agencies direct access and data matching on information relating to workers'
5.30compensation claims in order to determine whether the claimant has reported the fact of
5.31a pending claim and the amount paid to or on behalf of the claimant to the Department
5.32commissioner of human services.
5.33(c) For the purpose of compliance with section 169.09, subdivision 13, and
5.34federal requirements under Code of Federal Regulations, title 42, section 433.138(d)(4),
5.35the commissioner of public safety shall provide accident data as requested by the
6.1commissioner of human services. The disclosure shall not violate section 169.09,
6.2subdivision 13, paragraph (d).
6.3(d) The Department commissioner of human services and county agencies shall
6.4limit its use of information gained from agencies, third party payers, and employers to
6.5purposes directly connected with the administration of its public assistance and child
6.6support programs. The provision of information by agencies, third party payers, and
6.7employers to the department under this subdivision is not a violation of any right of
6.8confidentiality or data privacy.

6.9    Sec. 4. Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:
6.10    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
6.11assistance program must not be submitted until the recipient is discharged. However,
6.12the commissioner shall establish monthly interim payments for inpatient hospitals that
6.13have individual patient lengths of stay over 30 days regardless of diagnostic category.
6.14Except as provided in section 256.9693, medical assistance reimbursement for treatment
6.15of mental illness shall be reimbursed based on diagnostic classifications. Individual
6.16hospital payments established under this section and sections 256.9685, 256.9686, and
6.17256.9695 , in addition to third party and recipient liability, for discharges occurring during
6.18the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
6.19inpatient services paid for the same period of time to the hospital. This payment limitation
6.20shall be calculated separately for medical assistance and general assistance medical
6.21care services. The limitation on general assistance medical care shall be effective for
6.22admissions occurring on or after July 1, 1991. Services that have rates established under
6.23subdivision 11 or 12, must be limited separately from other services. After consulting with
6.24the affected hospitals, the commissioner may consider related hospitals one entity and
6.25may merge the payment rates while maintaining separate provider numbers. The operating
6.26and property base rates per admission or per day shall be derived from the best Medicare
6.27and claims data available when rates are established. The commissioner shall determine
6.28the best Medicare and claims data, taking into consideration variables of recency of the
6.29data, audit disposition, settlement status, and the ability to set rates in a timely manner.
6.30The commissioner shall notify hospitals of payment rates by December 1 of the year
6.31preceding the rate year. The rate setting data must reflect the admissions data used to
6.32establish relative values. Base year changes from 1981 to the base year established for the
6.33rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
6.34to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
6.351. The commissioner may adjust base year cost, relative value, and case mix index data
7.1to exclude the costs of services that have been discontinued by the October 1 of the year
7.2preceding the rate year or that are paid separately from inpatient services. Inpatient stays
7.3that encompass portions of two or more rate years shall have payments established based
7.4on payment rates in effect at the time of admission unless the date of admission preceded
7.5the rate year in effect by six months or more. In this case, operating payment rates for
7.6services rendered during the rate year in effect and established based on the date of
7.7admission shall be adjusted to the rate year in effect by the hospital cost index.
7.8    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
7.9payment, before third-party liability and spenddown, made to hospitals for inpatient
7.10services is reduced by .5 percent from the current statutory rates.
7.11    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
7.12admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
7.13before third-party liability and spenddown, is reduced five percent from the current
7.14statutory rates. Mental health services within diagnosis related groups 424 to 432, and
7.15facilities defined under subdivision 16 are excluded from this paragraph.
7.16    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
7.17fee-for-service admissions occurring on or after July August 1, 2005, made to hospitals
7.18for inpatient services before third-party liability and spenddown, is reduced 6.0 percent
7.19from the current statutory rates. Mental health services within diagnosis related groups
7.20424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
7.21Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
7.22assistance does not include general assistance medical care. Payments made to managed
7.23care plans shall be reduced for services provided on or after January 1, 2006, to reflect
7.24this reduction.
7.25    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
7.26fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
7.27to hospitals for inpatient services before third-party liability and spenddown, is reduced
7.283.46 percent from the current statutory rates. Mental health services with diagnosis related
7.29groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
7.30paragraph. Payments made to managed care plans shall be reduced for services provided
7.31on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
7.32    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
7.33fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made
7.34to hospitals for inpatient services before third-party liability and spenddown, is reduced
7.351.9 percent from the current statutory rates. Mental health services with diagnosis related
7.36groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
8.1paragraph. Payments made to managed care plans shall be reduced for services provided
8.2on or after July 1, 2009, through June 30, 2010, to reflect this reduction.
8.3    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
8.4for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for
8.5inpatient services before third-party liability and spenddown, is reduced 1.79 percent
8.6from the current statutory rates. Mental health services with diagnosis related groups
8.7424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
8.8Payments made to managed care plans shall be reduced for services provided on or after
8.9July 1, 2010, to reflect this reduction.

8.10    Sec. 5. Minnesota Statutes 2008, section 256B.037, subdivision 5, is amended to read:
8.11    Subd. 5. Other contracts permitted. Nothing in this section prohibits the
8.12commissioner from contracting with an organization for comprehensive health services,
8.13including dental services, under section 256B.031, sections 256B.035, 256B.69, or
8.14256D.03, subdivision 4 , paragraph (c).

8.15    Sec. 6. Minnesota Statutes 2008, section 256B.056, subdivision 1c, is amended to read:
8.16    Subd. 1c. Families with children income methodology. (a)(1) [Expired, 1Sp2003
8.17c 14 art 12 s 17]
8.18(2) For applications processed within one calendar month prior to July 1, 2003,
8.19eligibility shall be determined by applying the income standards and methodologies in
8.20effect prior to July 1, 2003, for any months in the six-month budget period before July
8.211, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
8.22months in the six-month budget period on or after that date. The income standards for
8.23each month shall be added together and compared to the applicant's total countable income
8.24for the six-month budget period to determine eligibility.
8.25(3) For children ages one through 18 whose eligibility is determined under section
8.26256B.057, subdivision 2 , the following deductions shall be applied to income counted
8.27toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
8.2816, 1996: $90 work expense, dependent care, and child support paid under court order.
8.29This clause is effective October 1, 2003.
8.30(b) For families with children whose eligibility is determined using the standard
8.31specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
8.32earned income shall be disregarded for up to four months and the following deductions
8.33shall be applied to each individual's income counted toward eligibility as allowed under
9.1the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
9.2under court order.
9.3(c) If the four-month disregard in paragraph (b) has been applied to the wage
9.4earner's income for four months, the disregard shall not be applied again until the wage
9.5earner's income has not been considered in determining medical assistance eligibility for
9.612 consecutive months.
9.7(d) The commissioner shall adjust the income standards under this section each July
9.81 by the annual update of the federal poverty guidelines following publication by the
9.9United States Department of Health and Human Services.
9.10(e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
9.11organization to or for the benefit of the child with a life-threatening illness must be
9.12disregarded from income.

9.13    Sec. 7. Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to read:
9.14    Subd. 3c. Asset limitations for families and children. A household of two or more
9.15persons must not own more than $20,000 in total net assets, and a household of one
9.16person must not own more than $10,000 in total net assets. In addition to these maximum
9.17amounts, an eligible individual or family may accrue interest on these amounts, but they
9.18must be reduced to the maximum at the time of an eligibility redetermination. The value of
9.19assets that are not considered in determining eligibility for medical assistance for families
9.20and children is the value of those assets excluded under the AFDC state plan as of July 16,
9.211996, as required by the Personal Responsibility and Work Opportunity Reconciliation
9.22Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:
9.23(1) household goods and personal effects are not considered;
9.24(2) capital and operating assets of a trade or business up to $200,000 are not
9.25considered;
9.26(3) one motor vehicle is excluded for each person of legal driving age who is
9.27employed or seeking employment;
9.28(4) one burial plot and all other burial expenses equal to the supplemental security
9.29income program asset limit are not considered for each individual assets designated as
9.30burial expenses are excluded to the same extent they are excluded by the Supplemental
9.31Security Income program;
9.32(5) court-ordered settlements up to $10,000 are not considered;
9.33(6) individual retirement accounts and funds are not considered; and
9.34(7) assets owned by children are not considered.

10.1    Sec. 8. Minnesota Statutes 2008, section 256B.056, subdivision 6, is amended to read:
10.2    Subd. 6. Assignment of benefits. To be eligible for medical assistance a person
10.3must have applied or must agree to apply all proceeds received or receivable by the person
10.4or the person's legal representative from any third party liable for the costs of medical
10.5care. By accepting or receiving assistance, the person is deemed to have assigned the
10.6person's rights to medical support and third party payments as required by title 19 of
10.7the Social Security Act. Persons must cooperate with the state in establishing paternity
10.8and obtaining third party payments. By accepting medical assistance, a person assigns
10.9to the Department of Human Services all rights the person may have to medical support
10.10or payments for medical expenses from any other person or entity on their own or their
10.11dependent's behalf and agrees to cooperate with the state in establishing paternity and
10.12obtaining third party payments. Any rights or amounts so assigned shall be applied against
10.13the cost of medical care paid for under this chapter. Any assignment takes effect upon
10.14the determination that the applicant is eligible for medical assistance and up to three
10.15months prior to the date of application if the applicant is determined eligible for and
10.16receives medical assistance benefits. The application must contain a statement explaining
10.17this assignment. For the purposes of this section, "the Department of Human Services or
10.18the state" includes prepaid health plans under contract with the commissioner according
10.19to sections 256B.031, 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12;
10.20children's mental health collaboratives under section 245.493; demonstration projects for
10.21persons with disabilities under section 256B.77; nursing facilities under the alternative
10.22payment demonstration project under section 256B.434; and the county-based purchasing
10.23entities under section 256B.692.

10.24    Sec. 9. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
10.25subdivision to read:
10.26    Subd. 13i. Drug Utilization Review Board; report. (a) A nine-member Drug
10.27Utilization Review Board is established. The board must be comprised of at least three
10.28but no more than four licensed physicians actively engaged in the practice of medicine
10.29in Minnesota; at least three licensed pharmacists actively engaged in the practice of
10.30pharmacy in Minnesota; and one consumer representative. The remainder must be made
10.31up of health care professionals who are licensed in their field and have recognized
10.32knowledge in the clinically appropriate prescribing, dispensing, and monitoring of covered
10.33outpatient drugs. Members of the board must be appointed by the commissioner, shall
10.34serve three-year terms, and may be reappointed by the commissioner. The board shall
10.35annually elect a chair from among its members.
11.1(b) The board must be staffed by an employee of the department who shall serve as
11.2an ex officio nonvoting member of the board.
11.3(c) The commissioner shall, with the advice of the board:
11.4(1) implement a medical assistance retrospective and prospective drug utilization
11.5review program as required by United States Code, title 42, section 1396r-8(g)(3);
11.6(2) develop and implement the predetermined criteria and practice parameters for
11.7appropriate prescribing to be used in retrospective and prospective drug utilization review;
11.8(3) develop, select, implement, and assess interventions for physicians, pharmacists,
11.9and patients that are educational and not punitive in nature;
11.10(4) establish a grievance and appeals process for physicians and pharmacists under
11.11this section;
11.12(5) publish and disseminate educational information to physicians and pharmacists
11.13regarding the board and the review program;
11.14(6) adopt and implement procedures designed to ensure the confidentiality of any
11.15information collected, stored, retrieved, assessed, or analyzed by the board, staff to
11.16the board, or contractors to the review program that identifies individual physicians,
11.17pharmacists, or recipients;
11.18(7) establish and implement an ongoing process to:
11.19(i) receive public comment regarding drug utilization review criteria and standards;
11.20and
11.21(ii) consider the comments along with other scientific and clinical information in
11.22order to revise criteria and standards on a timely basis; and
11.23(8) adopt any rules necessary to carry out this section.
11.24(d) The board may establish advisory committees. The commissioner may contract
11.25with appropriate organizations to assist the board in carrying out the board's duties.
11.26The commissioner may enter into contracts for services to develop and implement a
11.27retrospective and prospective review program.
11.28(e) The board shall report to the commissioner annually on the date the drug
11.29utilization review annual report is due to the Centers for Medicare and Medicaid Services.
11.30This report must cover the preceding federal fiscal year. The commissioner shall make the
11.31report available to the public upon request. The report must include information on the
11.32activities of the board and the program; the effectiveness of implemented interventions;
11.33administrative costs; and any fiscal impact resulting from the program. An honorarium
11.34of $100 per meeting and reimbursement for mileage must be paid to each board member
11.35in attendance.
11.36(f) This subdivision is exempt from the provisions of section 15.059.

12.1    Sec. 10. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
12.2subdivision to read:
12.3    Subd. 53. Centers of excellence. For complex medical procedures with a high
12.4degree of variation in outcomes, for which the Medicare program requires facilities
12.5providing the services to meet certain criteria as a condition of coverage, the commissioner
12.6may develop centers of excellence facility criteria in consultation with the Health Services
12.7Policy Committee, section 256B.0625, subdivision 3c. The criteria must reflect facility
12.8traits that have been linked to superior patient safety and outcomes for the procedures
12.9in question, and must be based on the best available empirical evidence. For medical
12.10assistance recipients enrolled on a fee-for-service basis, the commissioner may make
12.11coverage for these procedures conditional upon the facility providing the services meeting
12.12the specified criteria. Only facilities meeting the criteria may be reimbursed for the
12.13procedures in question.
12.14EFFECTIVE DATE.This section is effective August 1, 2009, or upon federal
12.15approval, whichever is later.

12.16    Sec. 11. Minnesota Statutes 2008, section 256B.094, subdivision 3, is amended to read:
12.17    Subd. 3. Coordination and provision of services. (a) In a county or reservation
12.18where a prepaid medical assistance provider has contracted under section 256B.031 or
12.19256B.69 to provide mental health services, the case management provider shall coordinate
12.20with the prepaid provider to ensure that all necessary mental health services required
12.21under the contract are provided to recipients of case management services.
12.22(b) When the case management provider determines that a prepaid provider is not
12.23providing mental health services as required under the contract, the case management
12.24provider shall assist the recipient to appeal the prepaid provider's denial pursuant to
12.25section 256.045, and may make other arrangements for provision of the covered services.
12.26(c) The case management provider may bill the provider of prepaid health care
12.27services for any mental health services provided to a recipient of case management
12.28services which the county or tribal social services arranges for or provides and which are
12.29included in the prepaid provider's contract, and which were determined to be medically
12.30necessary as a result of an appeal pursuant to section 256.045. The prepaid provider
12.31must reimburse the mental health provider, at the prepaid provider's standard rate for that
12.32service, for any services delivered under this subdivision.
12.33(d) If the county or tribal social services has not obtained prior authorization for
12.34this service, or an appeal results in a determination that the services were not medically
13.1necessary, the county or tribal social services may not seek reimbursement from the
13.2prepaid provider.

13.3    Sec. 12. Minnesota Statutes 2008, section 256B.195, subdivision 1, is amended to read:
13.4    Subdivision 1. Federal approval required. Sections Section 145.9268, 256.969,
13.5subdivision 26 , and this section are contingent on federal approval of the intergovernmental
13.6transfers and payments to safety net hospitals and community clinics authorized under
13.7this section. These sections are also contingent on current payment, by the government
13.8entities, of intergovernmental transfers under section 256B.19 and this section.

13.9    Sec. 13. Minnesota Statutes 2008, section 256B.195, subdivision 2, is amended to read:
13.10    Subd. 2. Payments from governmental entities. (a) In addition to any payment
13.11required under section 256B.19, effective July 15, 2001, the following government entities
13.12shall make the payments indicated before noon on the 15th of each month annually:
13.13(1) Hennepin County, $2,000,000 $24,000,000; and
13.14(2) Ramsey County, $1,000,000 $12,000,000.
13.15(b) These sums shall be part of the designated governmental unit's portion of the
13.16nonfederal share of medical assistance costs. Of these payments, Hennepin County shall
13.17pay 71 percent directly to Hennepin County Medical Center, and Ramsey County shall
13.18pay 71 percent directly to Regions Hospital. The counties must provide certification to the
13.19commissioner of payments to hospitals under this subdivision.

13.20    Sec. 14. Minnesota Statutes 2008, section 256B.195, subdivision 3, is amended to read:
13.21    Subd. 3. Payments to certain safety net providers. (a) Effective July 15, 2001,
13.22the commissioner shall make the following payments to the hospitals indicated after
13.23noon on the 15th of each month annually:
13.24(1) to Hennepin County Medical Center, any federal matching funds available to
13.25match the payments received by the medical center under subdivision 2, to increase
13.26payments for medical assistance admissions and to recognize higher medical assistance
13.27costs in institutions that provide high levels of charity care; and
13.28(2) to Regions Hospital, any federal matching funds available to match the payments
13.29received by the hospital under subdivision 2, to increase payments for medical assistance
13.30admissions and to recognize higher medical assistance costs in institutions that provide
13.31high levels of charity care.
14.1(b) Effective July 15, 2001, the following percentages of the transfers under
14.2subdivision 2 shall be retained by the commissioner for deposit each month into the
14.3general fund:
14.4(1) 18 percent, plus any federal matching funds, shall be allocated for the following
14.5purposes:
14.6(i) during the fiscal year beginning July 1, 2001, of the amount available under
14.7this clause, 39.7 percent shall be allocated to make increased hospital payments under
14.8section 256.969, subdivision 26; 34.2 percent shall be allocated to fund the amounts
14.9due from small rural hospitals, as defined in section 144.148, for overpayments under
14.10section 256.969, subdivision 5a, resulting from a determination that medical assistance
14.11and general assistance payments exceeded the charge limit during the period from 1994 to
14.121997; and 26.1 percent shall be allocated to the commissioner of health for rural hospital
14.13capital improvement grants under section 144.148; and
14.14(ii) during fiscal years beginning on or after July 1, 2002, of the amount available
14.15under this clause, 55 percent shall be allocated to make increased hospital payments under
14.16section 256.969, subdivision 26, and 45 percent shall be allocated to the commissioner of
14.17health for rural hospital capital improvement grants under section 144.148; and
14.18(2) 11 percent shall be allocated to the commissioner of health to fund community
14.19clinic grants under section 145.9268.
14.20(c) This subdivision shall apply to fee-for-service payments only and shall not
14.21increase capitation payments or payments made based on average rates. The allocation in
14.22paragraph (b), clause (1), item (ii), to increase hospital payments under section 256.969,
14.23subdivision 26 , shall not limit payments under that section.
14.24(d) Medical assistance rate or payment changes, including those required to obtain
14.25federal financial participation under section 62J.692, subdivision 8, shall precede the
14.26determination of intergovernmental transfer amounts determined in this subdivision.
14.27Participation in the intergovernmental transfer program shall not result in the offset of
14.28any health care provider's receipt of medical assistance payment increases other than
14.29limits resulting from hospital-specific charge limits and limits on disproportionate share
14.30hospital payments.
14.31(e) Effective July 1, 2003, if the amount available for allocation under paragraph
14.32(b) is greater than the amounts available during March 2003, after any increase in
14.33intergovernmental transfers and payments that result from section 256.969, subdivision
14.343a , paragraph (c), are paid to the general fund, any additional amounts available under this
14.35subdivision after reimbursement of the transfers under subdivision 2 shall be allocated to
15.1increase medical assistance payments, subject to hospital-specific charge limits and limits
15.2on disproportionate share hospital payments, as follows:
15.3(1) if the payments under subdivision 5 are approved, the amount shall be paid to
15.4the largest ten percent of hospitals as measured by 2001 payments for medical assistance,
15.5general assistance medical care, and MinnesotaCare in the nonstate government hospital
15.6category. Payments shall be allocated according to each hospital's proportionate share
15.7of the 2001 payments; or
15.8(2) if the payments under subdivision 5 are not approved, the amount shall be paid to
15.9the largest ten percent of hospitals as measured by 2001 payments for medical assistance,
15.10general assistance medical care, and MinnesotaCare in the nonstate government category
15.11and to the largest ten percent of hospitals as measured by payments for medical assistance,
15.12general assistance medical care, and MinnesotaCare in the nongovernment hospital
15.13category. Payments shall be allocated according to each hospital's proportionate
15.14share of the 2001 payments in their respective category of nonstate government and
15.15nongovernment. The commissioner shall determine which hospitals are in the nonstate
15.16government and nongovernment hospital categories.

15.17    Sec. 15. Minnesota Statutes 2008, section 256B.199, is amended to read:
15.18256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
15.19    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
15.20for the expenditures in paragraphs (b) and (c).
15.21    (b) The commissioner shall apply for federal matching funds for certified public
15.22expenditures as follows:
15.23    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions
15.24Hospital, the University of Minnesota, and Fairview-University Medical Center shall
15.25report quarterly annually to the commissioner beginning June 1, 2007, payments made
15.26during the second previous quarter calendar year that may qualify for reimbursement
15.27under federal law;
15.28     (2) based on these reports, the commissioner shall apply for federal matching
15.29funds. These funds are appropriated to the commissioner for the payments under section
15.30256.969, subdivision 27 ; and
15.31     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
15.32the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
15.33hospital payment money expected to be available in the current federal fiscal year.
15.34    (c) The commissioner shall apply for federal matching funds for general assistance
15.35medical care expenditures as follows:
16.1    (1) for hospital services occurring on or after July 1, 2007, general assistance medical
16.2care expenditures for fee-for-service inpatient and outpatient hospital payments made by
16.3the department shall be used to apply for federal matching funds, except as limited below:
16.4    (i) only those general assistance medical care expenditures made to an individual
16.5hospital that would not cause the hospital to exceed its individual hospital limits under
16.6section 1923 of the Social Security Act may be considered; and
16.7    (ii) general assistance medical care expenditures may be considered only to the extent
16.8of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
16.9    (2) all hospitals must provide any necessary expenditure, cost, and revenue
16.10information required by the commissioner as necessary for purposes of obtaining federal
16.11Medicaid matching funds for general assistance medical care expenditures.

16.12    Sec. 16. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:
16.13    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
16.14and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
16.15basis beginning January 1, 1996. Managed care contracts which were in effect on June
16.1630, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
16.17through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
16.18commissioner may issue separate contracts with requirements specific to services to
16.19medical assistance recipients age 65 and older.
16.20    (b) A prepaid health plan providing covered health services for eligible persons
16.21pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
16.22of its contract with the commissioner. Requirements applicable to managed care programs
16.23under chapters 256B, 256D, and 256L, established after the effective date of a contract
16.24with the commissioner take effect when the contract is next issued or renewed.
16.25    (c) Effective for services rendered on or after January 1, 2003, the commissioner
16.26shall withhold five percent of managed care plan payments under this section for the
16.27prepaid medical assistance and general assistance medical care programs pending
16.28completion of performance targets. Each performance target must be quantifiable,
16.29objective, measurable, and reasonably attainable, except in the case of a performance
16.30target based on a federal or state law or rule. Criteria for assessment of each performance
16.31target must be outlined in writing prior to the contract effective date. The managed
16.32care plan must demonstrate, to the commissioner's satisfaction, that the data submitted
16.33regarding attainment of the performance target is accurate. The commissioner shall
16.34periodically change the administrative measures used as performance targets in order
16.35to improve plan performance across a broader range of administrative services. The
17.1performance targets must include measurement of plan efforts to contain spending
17.2on health care services and administrative activities. The commissioner may adopt
17.3plan-specific performance targets that take into account factors affecting only one plan,
17.4including characteristics of the plan's enrollee population. The withheld funds must be
17.5returned no sooner than July of the following year if performance targets in the contract
17.6are achieved. The commissioner may exclude special demonstration projects under
17.7subdivision 23. A managed care plan or a county-based purchasing plan under section
17.8256B.692 may include as admitted assets under section 62D.044 any amount withheld
17.9under this paragraph that is reasonably expected to be returned.
17.10    (d)(1) Effective for services rendered on or after January 1, 2009, the commissioner
17.11shall withhold three percent of managed care plan payments under this section for the
17.12prepaid medical assistance and general assistance medical care programs. The withheld
17.13funds must be returned no sooner than July 1 and no later than July 31 of the following
17.14year. The commissioner may exclude special demonstration projects under subdivision 23.
17.15    (2) A managed care plan or a county-based purchasing plan under section 256B.692
17.16may include as admitted assets under section 62D.044 any amount withheld under
17.17this paragraph. The return of the withhold under this paragraph is not subject to the
17.18requirements of paragraph (c).
17.19(e) Contracts between the commissioner and a prepaid health plan are exempt from
17.20the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
17.21(a), and 7.

17.22    Sec. 17. Minnesota Statutes 2008, section 256B.77, subdivision 13, is amended to read:
17.23    Subd. 13. Ombudsman. Enrollees shall have access to ombudsman services
17.24established in section 256B.031, subdivision 6 256B.69, subdivision 20, and advocacy
17.25services provided by the ombudsman for mental health and developmental disabilities
17.26established in sections 245.91 to 245.97. The managed care ombudsman and the
17.27ombudsman for mental health and developmental disabilities shall coordinate services
17.28provided to avoid duplication of services. For purposes of the demonstration project,
17.29the powers and responsibilities of the Office of Ombudsman for Mental Health and
17.30Developmental Disabilities, as provided in sections 245.91 to 245.97 are expanded
17.31to include all eligible individuals, health plan companies, agencies, and providers
17.32participating in the demonstration project.

17.33    Sec. 18. Minnesota Statutes 2008, section 256D.03, subdivision 3, is amended to read:
18.1    Subd. 3. General assistance medical care; eligibility. (a) General assistance
18.2medical care may be paid for any person who is not eligible for medical assistance under
18.3chapter 256B, including eligibility for medical assistance based on a spenddown of excess
18.4income according to section 256B.056, subdivision 5, or MinnesotaCare as for applicants
18.5and recipients defined in paragraph (b) (c), except as provided in paragraph (c) (d), and:
18.6    (1) who is receiving assistance under section 256D.05, except for families with
18.7children who are eligible under Minnesota family investment program (MFIP), or who is
18.8having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
18.9    (2) who is a resident of Minnesota; and
18.10    (i) who has gross countable income not in excess of 75 percent of the federal poverty
18.11guidelines for the family size, using a six-month budget period and whose equity in assets
18.12is not in excess of $1,000 per assistance unit. General assistance medical care is not
18.13available for applicants or enrollees who are otherwise eligible for medical assistance but
18.14fail to verify their assets. Enrollees who become eligible for medical assistance shall be
18.15terminated and transferred to medical assistance. Exempt assets, the reduction of excess
18.16assets, and the waiver of excess assets must conform to the medical assistance program in
18.17section 256B.056, subdivisions 3 and 3d, with the following exception: the maximum
18.18amount of undistributed funds in a trust that could be distributed to or on behalf of the
18.19beneficiary by the trustee, assuming the full exercise of the trustee's discretion under the
18.20terms of the trust, must be applied toward the asset maximum; or
18.21    (ii) who has gross countable income above 75 percent of the federal poverty
18.22guidelines but not in excess of 175 percent of the federal poverty guidelines for the
18.23family size, using a six-month budget period, whose equity in assets is not in excess
18.24of the limits in section 256B.056, subdivision 3c, and who applies during an inpatient
18.25hospitalization; or.
18.26    (iii) (b) the commissioner shall adjust the income standards under this section each
18.27July 1 by the annual update of the federal poverty guidelines following publication by the
18.28United States Department of Health and Human Services.
18.29    (b) (c) Effective for applications and renewals processed on or after September 1,
18.302006, general assistance medical care may not be paid for applicants or recipients who are
18.31adults with dependent children under 21 whose gross family income is equal to or less than
18.32275 percent of the federal poverty guidelines who are not described in paragraph (e) (f).
18.33    (c) (d) Effective for applications and renewals processed on or after September 1,
18.342006, general assistance medical care may be paid for applicants and recipients who meet
18.35all eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
18.36beginning the date of application. Immediately following approval of general assistance
19.1medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
19.2subdivision 7 , with covered services as provided in section 256L.03 for the rest of the
19.3six-month general assistance medical care eligibility period, until their six-month renewal.
19.4    (d) (e) To be eligible for general assistance medical care following enrollment in
19.5MinnesotaCare as required by paragraph (c) (d), an individual must complete a new
19.6application.
19.7    (e) (f) Applicants and recipients eligible under paragraph (a), clause (1) (2), item (i),
19.8are exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
19.9    (1) have applied for and are awaiting a determination of blindness or disability by
19.10the state medical review team or a determination of eligibility for Supplemental Security
19.11Income or Social Security Disability Insurance by the Social Security Administration;
19.12    (2) fail to meet the requirements of section 256L.09, subdivision 2;
19.13    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.;
19.14    (4) are classified as end-stage renal disease beneficiaries in the Medicare program;
19.15    (5) are enrolled in private health care coverage as defined in section 256B.02,
19.16subdivision 9;
19.17    (6) are eligible under paragraph (j) (k);
19.18    (7) receive treatment funded pursuant to section 254B.02; or
19.19    (8) reside in the Minnesota sex offender program defined in chapter 246B.
19.20    (f) (g) For applications received on or after October 1, 2003, eligibility may begin no
19.21earlier than the date of application. For individuals eligible under paragraph (a), clause
19.22(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
19.23eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
19.24may reapply if there is a subsequent period of inpatient hospitalization.
19.25    (g) (h) Beginning September 1, 2006, Minnesota health care program applications
19.26and renewals completed by recipients and applicants who are persons described
19.27in paragraph (c) (d) and submitted to the county agency shall be determined for
19.28MinnesotaCare eligibility by the county agency. If all other eligibility requirements of
19.29this subdivision are met, eligibility for general assistance medical care shall be available
19.30in any month during which MinnesotaCare enrollment is pending. Upon notification of
19.31eligibility for MinnesotaCare, notice of termination for eligibility for general assistance
19.32medical care shall be sent to an applicant or recipient. If all other eligibility requirements
19.33of this subdivision are met, eligibility for general assistance medical care shall be available
19.34until enrollment in MinnesotaCare subject to the provisions of paragraphs (c) (d), (e) (f),
19.35and (f) (g).
20.1    (h) (i) The date of an initial Minnesota health care program application necessary
20.2to begin a determination of eligibility shall be the date the applicant has provided a
20.3name, address, and Social Security number, signed and dated, to the county agency
20.4or the Department of Human Services. If the applicant is unable to provide a name,
20.5address, Social Security number, and signature when health care is delivered due to a
20.6medical condition or disability, a health care provider may act on an applicant's behalf to
20.7establish the date of an initial Minnesota health care program application by providing
20.8the county agency or Department of Human Services with provider identification and a
20.9temporary unique identifier for the applicant. The applicant must complete the remainder
20.10of the application and provide necessary verification before eligibility can be determined.
20.11The applicant must complete the application within the time periods required under the
20.12medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart
20.135, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining
20.14verification if necessary.
20.15    (i) (j) County agencies are authorized to use all automated databases containing
20.16information regarding recipients' or applicants' income in order to determine eligibility for
20.17general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
20.18in order to determine eligibility and premium payments by the county agency.
20.19    (j) (k) General assistance medical care is not available for a person in a correctional
20.20facility unless the person is detained by law for less than one year in a county correctional
20.21or detention facility as a person accused or convicted of a crime, or admitted as an
20.22inpatient to a hospital on a criminal hold order, and the person is a recipient of general
20.23assistance medical care at the time the person is detained by law or admitted on a criminal
20.24hold order and as long as the person continues to meet other eligibility requirements
20.25of this subdivision.
20.26    (k) (l) General assistance medical care is not available for applicants or recipients
20.27who do not cooperate with the county agency to meet the requirements of medical
20.28assistance.
20.29    (l) (m) In determining the amount of assets of an individual eligible under paragraph
20.30(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
20.31an asset excluded under paragraph (a), that was given away, sold, or disposed of for
20.32less than fair market value within the 60 months preceding application for general
20.33assistance medical care or during the period of eligibility. Any transfer described in this
20.34paragraph shall be presumed to have been for the purpose of establishing eligibility for
20.35general assistance medical care, unless the individual furnishes convincing evidence to
20.36establish that the transaction was exclusively for another purpose. For purposes of this
21.1paragraph, the value of the asset or interest shall be the fair market value at the time it
21.2was given away, sold, or disposed of, less the amount of compensation received. For any
21.3uncompensated transfer, the number of months of ineligibility, including partial months,
21.4shall be calculated by dividing the uncompensated transfer amount by the average monthly
21.5per person payment made by the medical assistance program to skilled nursing facilities
21.6for the previous calendar year. The individual shall remain ineligible until this fixed period
21.7has expired. The period of ineligibility may exceed 30 months, and a reapplication for
21.8benefits after 30 months from the date of the transfer shall not result in eligibility unless
21.9and until the period of ineligibility has expired. The period of ineligibility begins in the
21.10month the transfer was reported to the county agency, or if the transfer was not reported,
21.11the month in which the county agency discovered the transfer, whichever comes first. For
21.12applicants, the period of ineligibility begins on the date of the first approved application.
21.13    (m) (n) When determining eligibility for any state benefits under this subdivision,
21.14the income and resources of all noncitizens shall be deemed to include their sponsor's
21.15income and resources as defined in the Personal Responsibility and Work Opportunity
21.16Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
21.17subsequently set out in federal rules.
21.18    (n) (o) Undocumented noncitizens and nonimmigrants are ineligible for general
21.19assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
21.20in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
21.21an undocumented noncitizen is an individual who resides in the United States without the
21.22approval or acquiescence of the United States Citizenship and Immigration Services.
21.23    (o) (p) Notwithstanding any other provision of law, a noncitizen who is ineligible for
21.24medical assistance due to the deeming of a sponsor's income and resources, is ineligible
21.25for general assistance medical care.
21.26    (p) (q) Effective July 1, 2003, general assistance medical care emergency services
21.27end.

21.28    Sec. 19. Minnesota Statutes 2008, section 256L.03, subdivision 5, is amended to read:
21.29    Subd. 5. Co-payments and coinsurance. (a) Except as provided in paragraphs (b)
21.30and (c), the MinnesotaCare benefit plan shall include the following co-payments and
21.31coinsurance requirements for all enrollees:
21.32    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
21.33subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
21.34$3,000 per family;
21.35    (2) $3 per prescription for adult enrollees;
22.1    (3) $25 for eyeglasses for adult enrollees;
22.2    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
22.3episode of service which is required because of a recipient's symptoms, diagnosis, or
22.4established illness, and which is delivered in an ambulatory setting by a physician or
22.5physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
22.6audiologist, optician, or optometrist; and
22.7    (5) $6 for nonemergency visits to a hospital-based emergency room.
22.8    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
22.9children under the age of 21.
22.10    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
22.11    (d) Paragraph (a), clause (4), does not apply to mental health services.
22.12    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
22.13poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
22.14and who are not pregnant shall be financially responsible for the coinsurance amount, if
22.15applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
22.16    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
22.17or changes from one prepaid health plan to another during a calendar year, any charges
22.18submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
22.19expenses incurred by the enrollee for inpatient services, that were submitted or incurred
22.20prior to enrollment, or prior to the change in health plans, shall be disregarded.

22.21    Sec. 20. Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:
22.22    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
22.23commissioner shall establish a sliding fee scale to determine the percentage of monthly
22.24gross individual or family income that households at different income levels must pay to
22.25obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
22.26on the enrollee's monthly gross individual or family income. The sliding fee scale must
22.27contain separate tables based on enrollment of one, two, or three or more persons. Until
22.28June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
22.29individual or family income for individuals or families with incomes below the limits for
22.30the medical assistance program for families and children in effect on January 1, 1999, and
22.31proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
22.328.8 percent. These percentages are matched to evenly spaced income steps ranging from
22.33the medical assistance income limit for families and children in effect on January 1, 1999,
22.34to 275 percent of the federal poverty guidelines for the applicable family size, up to a
22.35family size of five. The sliding fee scale for a family of five must be used for families of
23.1more than five. The sliding fee scale and percentages are not subject to the provisions of
23.2chapter 14. If a family or individual reports increased income after enrollment, premiums
23.3shall be adjusted at the time the change in income is reported.
23.4    (b) Children in families whose gross income is above 275 percent of the federal
23.5poverty guidelines shall pay the maximum premium. The maximum premium is defined
23.6as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
23.7cases paid the maximum premium, the total revenue would equal the total cost of
23.8MinnesotaCare medical coverage and administration. In this calculation, administrative
23.9costs shall be assumed to equal ten percent of the total. The costs of medical coverage
23.10for pregnant women and children under age two and the enrollees in these groups shall
23.11be excluded from the total. The maximum premium for two enrollees shall be twice the
23.12maximum premium for one, and the maximum premium for three or more enrollees shall
23.13be three times the maximum premium for one.
23.14    (c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
23.15to the premium scale specified in paragraph (d) with the exception that children in families
23.16with income at or below 150 percent of the federal poverty guidelines shall pay a monthly
23.17premium of $4. For purposes of paragraph (d), "minimum" means a monthly premium
23.18of $4.
23.19    (d) The following premium scale is established for individuals and families with
23.20gross family incomes of 300 275 percent of the federal poverty guidelines or less:

23.21 23.22	Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
23.23	0-45%	minimum
23.24 23.25	46-54%	$4 or 1.1% of family income, whichever is greater
23.26	55-81%	1.6%
23.27	82-109%	2.2%
23.28	110-136%	2.9%
23.29	137-164%	3.6%
23.30	165-191%	4.6%
23.31	192-219%	5.6%
23.32	220-248%	6.5%
23.33	249-274%249-275%	7.2%
23.34	275-300%	8.0%

23.35EFFECTIVE DATE.This section is effective January 1, 2009, or upon federal
23.36approval, whichever is later. The commissioner of human services shall notify the revisor
23.37of statutes when federal approval is obtained.

24.1    Sec. 21. Laws 2005, First Special Session chapter 4, article 8, section 54, the effective
24.2date, is amended to read:
24.3EFFECTIVE DATE.This section is effective August 1, 2007, or upon HealthMatch
24.4implementation, whichever is later 2009.

24.5    Sec. 22. Laws 2005, First Special Session chapter 4, article 8, section 61, the effective
24.6date, is amended to read:
24.7EFFECTIVE DATE.This section is effective August 1, 2007, or upon HealthMatch
24.8implementation, whichever is later 2009.

24.9    Sec. 23. Laws 2005, First Special Session chapter 4, article 8, section 63, the effective
24.10date, is amended to read:
24.11EFFECTIVE DATE.This section is effective August 1, 2007, or upon HealthMatch
24.12implementation, whichever is later 2009.

24.13    Sec. 24. Laws 2005, First Special Session chapter 4, article 8, section 66, the effective
24.14date, is amended to read:
24.15EFFECTIVE DATE.Paragraph (a) is effective August 1, 2007, or upon
24.16HealthMatch implementation, whichever is later 2009, and paragraph (e) is effective
24.17September 1, 2006.

24.18    Sec. 25. Laws 2005, First Special Session chapter 4, article 8, section 74, the effective
24.19date, is amended to read:
24.20EFFECTIVE DATE.The amendment to paragraph (a) changing gross family or
24.21individual income to monthly gross family or individual income is effective August 1,
24.222007, or upon implementation of HealthMatch, whichever is later 2009. The amendment
24.23to paragraph (a) related to premium adjustments and changes of income and the
24.24amendment to paragraph (c) are effective September 1, 2005, or upon federal approval,
24.25whichever is later. Prior to the implementation of HealthMatch, The commissioner
24.26shall implement this section to the fullest extent possible, including the use of manual
24.27processing. Upon implementation of HealthMatch, the commissioner shall implement this
24.28section in a manner consistent with the procedures and requirements of HealthMatch.

24.29    Sec. 26. REPEALER.
25.1(a) Minnesota Statutes 2008, sections 256B.031; and 256L.01, subdivision 4, are
25.2repealed.
25.3(b) Laws 2005, First Special Session chapter 4, article 8, sections 21; 22; 23; and
25.424, are repealed.
25.5EFFECTIVE DATE.This section is effective August 1, 2009.