SF 1760

2nd Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health care; modifying premium rate 
  1.3             restrictions; modifying cost containment provisions; 
  1.4             providing for an electronic medical record system; 
  1.5             modifying certain loan forgiveness programs; modifying 
  1.6             medical assistance, general assistance medical care 
  1.7             and MinnesotaCare programs; authorizing the sale of 
  1.8             bonds; requiring reports; appropriating money; 
  1.9             amending Minnesota Statutes 2002, sections 62A.65, 
  1.10            subdivision 3; 62J.04, by adding a subdivision; 
  1.11            62J.301, subdivision 3; 62J.38; 62L.08, subdivision 8; 
  1.12            256.9693; 256B.03, subdivision 3; 256B.0625, 
  1.13            subdivision 3b, by adding a subdivision; Minnesota 
  1.14            Statutes 2003 Supplement, sections 62J.04, subdivision 
  1.15            3; 62J.692, subdivision 3; 144.1501, subdivisions 2, 
  1.16            4; 256.954, subdivisions 4, 6, 10; 256B.061; 
  1.17            256B.0625, subdivision 9; 256B.69, subdivision 2; 
  1.18            256D.03, subdivisions 3, 4; 256L.03, subdivision 1; 
  1.19            256L.05, subdivision 4; 256L.07, subdivision 1; 
  1.20            256L.12, subdivision 6; Laws 2003, First Special 
  1.21            Session chapter 14, article 6, section 65; proposing 
  1.22            coding for new law in Minnesota Statutes, chapters 
  1.23            62J; 62Q; 256B; 256L; repealing Minnesota Statutes 
  1.24            2003 Supplement, sections 256.954, subdivision 12; 
  1.25            256B.0631; 256L.035. 
  1.26  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.27     Section 1.  Minnesota Statutes 2002, section 62A.65, 
  1.28  subdivision 3, is amended to read: 
  1.29     Subd. 3.  [PREMIUM RATE RESTRICTIONS.] No individual health 
  1.30  plan may be offered, sold, issued, or renewed to a Minnesota 
  1.31  resident unless the premium rate charged is determined in 
  1.32  accordance with the following requirements:  
  1.33     (a) Premium rates must be no more than 25 percent above and 
  1.34  no more than 25 percent below the index rate charged to 
  1.35  individuals for the same or similar coverage, adjusted pro rata 
  2.1   for rating periods of less than one year.  The premium 
  2.2   variations permitted by this paragraph must be based only upon 
  2.3   health status, claims experience, and occupation.  For purposes 
  2.4   of this paragraph, health status includes refraining from 
  2.5   tobacco use or other actuarially valid lifestyle factors 
  2.6   associated with good health, provided that the lifestyle factor 
  2.7   and its effect upon premium rates have been determined by the 
  2.8   commissioner to be actuarially valid and have been approved by 
  2.9   the commissioner.  Variations permitted under this paragraph 
  2.10  must not be based upon age or applied differently at different 
  2.11  ages.  This paragraph does not prohibit use of a constant 
  2.12  percentage adjustment for factors permitted to be used under 
  2.13  this paragraph. 
  2.14     (b) Premium rates may vary based upon the ages of covered 
  2.15  persons only as provided in this paragraph.  In addition to the 
  2.16  variation permitted under paragraph (a), each health carrier may 
  2.17  use an additional premium variation based upon age of up to plus 
  2.18  or minus 50 percent of the index rate. 
  2.19     (c) A health carrier may request approval by the 
  2.20  commissioner to establish no more than three geographic regions 
  2.21  and to establish separate index rates for each region, provided 
  2.22  that the index rates do not vary between any two regions by more 
  2.23  than 20 percent.  Health carriers that do not do business in the 
  2.24  Minneapolis/St. Paul metropolitan area may request approval for 
  2.25  no more than two geographic regions, and clauses (2) and (3) do 
  2.26  not apply to approval of requests made by those health 
  2.27  carriers.  The commissioner may grant approval if the following 
  2.28  conditions are met: 
  2.29     (1) the geographic regions must be applied uniformly by the 
  2.30  health carrier; 
  2.31     (2) one geographic region must be based on the 
  2.32  Minneapolis/St. Paul metropolitan area; 
  2.33     (3) for each geographic region that is rural, the index 
  2.34  rate for that region must not exceed the index rate for the 
  2.35  Minneapolis/St. Paul metropolitan area; and 
  2.36     (4) the health carrier provides actuarial justification 
  3.1   acceptable to the commissioner for the proposed geographic 
  3.2   variations in index rates, establishing that the variations are 
  3.3   based upon differences in the cost to the health carrier of 
  3.4   providing coverage. 
  3.5      (d) Health carriers may use rate cells and must file with 
  3.6   the commissioner the rate cells they use.  Rate cells must be 
  3.7   based upon the number of adults or children covered under the 
  3.8   policy and may reflect the availability of Medicare coverage.  
  3.9   The rates for different rate cells must not in any way reflect 
  3.10  generalized differences in expected costs between principal 
  3.11  insureds and their spouses. 
  3.12     (e) In developing its index rates and premiums for a health 
  3.13  plan, a health carrier shall take into account only the 
  3.14  following factors: 
  3.15     (1) actuarially valid differences in rating factors 
  3.16  permitted under paragraphs (a) and (b); and 
  3.17     (2) actuarially valid geographic variations if approved by 
  3.18  the commissioner as provided in paragraph (c). 
  3.19     (f) All premium variations must be justified in initial 
  3.20  rate filings and upon request of the commissioner in rate 
  3.21  revision filings.  All rate variations are subject to approval 
  3.22  by the commissioner. 
  3.23     (g) The loss ratio must comply with the section 62A.021 
  3.24  requirements for individual health plans. 
  3.25     (h) Notwithstanding paragraphs (a) to (g), the rates must 
  3.26  not be approved, unless the commissioner has determined that the 
  3.27  rates are reasonable.  In determining reasonableness, the 
  3.28  commissioner shall consider the growth rates applied under 
  3.29  section 62J.04, subdivision 1, paragraph (b) apply the premium 
  3.30  growth limits established under section 62J.04, subdivision 1b, 
  3.31  to the calendar year or years that the proposed premium rate 
  3.32  would be in effect, and shall consider actuarially valid changes 
  3.33  in risks associated with the enrollee populations, and 
  3.34  actuarially valid changes as a result of statutory changes in 
  3.35  Laws 1992, chapter 549. 
  3.36     Sec. 2.  Minnesota Statutes 2002, section 62J.04, is 
  4.1   amended by adding a subdivision to read: 
  4.2      Subd. 1b.  [PREMIUM GROWTH LIMITS.] (a) For calendar year 
  4.3   2005 and each year thereafter, the commissioner shall set annual 
  4.4   premium growth limits for health plan companies.  The premium 
  4.5   limits set by the commissioner for calendar years 2005 to 2010 
  4.6   shall not exceed the regional Consumer Price Index for urban 
  4.7   consumers for the preceding calendar year plus one percentage 
  4.8   point and an additional two percentage points to be used to 
  4.9   finance the implementation of the electronic medical record 
  4.10  system described under section 62J.565.  The commissioner shall 
  4.11  ensure that the additional percentage points are being used to 
  4.12  provide financial assistance to health care providers to 
  4.13  implement electronic medical record systems either directly or 
  4.14  through an increase in reimbursement.  
  4.15     (b) For the calendar years beyond 2010, the rate of premium 
  4.16  growth shall be limited to the change in the Consumer Price 
  4.17  Index for urban consumers for the previous calendar year plus 
  4.18  one percentage point.  The commissioners of health and commerce 
  4.19  shall make a recommendation to the legislature by January 15, 
  4.20  2009, regarding the continuation of the additional percentage 
  4.21  points to the growth limit described in paragraph (a).  The 
  4.22  recommendation shall be based on the progress made by health 
  4.23  care providers in instituting an electronic medical record 
  4.24  system and in creating a statewide interactive electronic health 
  4.25  record system.  
  4.26     (c) The commissioner may add additional percentage points 
  4.27  as needed to the premium limit for a calendar year if a major 
  4.28  disaster, bioterrorism, or a public health emergency occurs that 
  4.29  results in higher health care costs.  Any additional percentage 
  4.30  points must reflect the additional cost to the health care 
  4.31  system directly attributed to the disaster or emergency.  
  4.32     (d) The commissioner shall publish the annual premium 
  4.33  growth limits in the State Register by January 31 of the year 
  4.34  that the limits are to be in effect.  
  4.35     (e) For the purpose of this subdivision, premium growth is 
  4.36  measured as the percentage change in per member, per month 
  5.1   premium revenue from the current year to the previous year.  
  5.2   Premium growth rates shall be calculated for the following lines 
  5.3   of business:  individual, small group, and large group.  Data 
  5.4   used for premium growth rate calculations shall be submitted as 
  5.5   part of the cost containment filing under section 62J.38.  
  5.6      Sec. 3.  Minnesota Statutes 2003 Supplement, section 
  5.7   62J.04, subdivision 3, is amended to read: 
  5.8      Subd. 3.  [COST CONTAINMENT DUTIES.] The commissioner shall:
  5.9      (1) establish statewide and regional cost containment goals 
  5.10  for total health care spending under this section and collect 
  5.11  data as described in sections 62J.38 to 62J.41 to monitor 
  5.12  statewide achievement of the cost containment goals and premium 
  5.13  growth limits; 
  5.14     (2) divide the state into no fewer than four regions, with 
  5.15  one of those regions being the Minneapolis/St. Paul metropolitan 
  5.16  statistical area but excluding Chisago, Isanti, Wright, and 
  5.17  Sherburne Counties, for purposes of fostering the development of 
  5.18  regional health planning and coordination of health care 
  5.19  delivery among regional health care systems and working to 
  5.20  achieve the cost containment goals; 
  5.21     (3) monitor the quality of health care throughout the state 
  5.22  and take action as necessary to ensure an appropriate level of 
  5.23  quality; 
  5.24     (4) issue recommendations regarding uniform billing forms, 
  5.25  uniform electronic billing procedures and data interchanges, 
  5.26  patient identification cards, and other uniform claims and 
  5.27  administrative procedures for health care providers and private 
  5.28  and public sector payers.  In developing the recommendations, 
  5.29  the commissioner shall review the work of the work group on 
  5.30  electronic data interchange (WEDI) and the American National 
  5.31  Standards Institute (ANSI) at the national level, and the work 
  5.32  being done at the state and local level.  The commissioner may 
  5.33  adopt rules requiring the use of the Uniform Bill 82/92 form, 
  5.34  the National Council of Prescription Drug Providers (NCPDP) 3.2 
  5.35  electronic version, the Centers for Medicare and Medicaid 
  5.36  Services 1500 form, or other standardized forms or procedures; 
  6.1      (5) undertake health planning responsibilities; 
  6.2      (6) authorize, fund, or promote research and 
  6.3   experimentation on new technologies and health care procedures; 
  6.4      (7) within the limits of appropriations for these purposes, 
  6.5   administer or contract for statewide consumer education and 
  6.6   wellness programs that will improve the health of Minnesotans 
  6.7   and increase individual responsibility relating to personal 
  6.8   health and the delivery of health care services, undertake 
  6.9   prevention programs including initiatives to improve birth 
  6.10  outcomes, expand childhood immunization efforts, and provide 
  6.11  start-up grants for worksite wellness programs; 
  6.12     (8) undertake other activities to monitor and oversee the 
  6.13  delivery of health care services in Minnesota with the goal of 
  6.14  improving affordability, quality, and accessibility of health 
  6.15  care for all Minnesotans; and 
  6.16     (9) make the cost containment goal and premium growth limit 
  6.17  data available to the public in a consumer-oriented manner. 
  6.18     Sec. 4.  [62J.255] [HEALTH RISK INFORMATION SHEET.] 
  6.19     (a) A health plan company shall provide to each enrollee on 
  6.20  an annual basis information on the increased personal health 
  6.21  risks and the additional costs to the health care system due to 
  6.22  obesity and to the use of tobacco.  
  6.23     (b) The commissioner, in consultation with the Minnesota 
  6.24  Medical Association, shall develop an information sheet on the 
  6.25  personal health risks of obesity and smoking and on the 
  6.26  additional costs to the health care system due to obesity and 
  6.27  due to smoking.  The information sheet shall be posted on the 
  6.28  Minnesota Department of Health's Web site.  
  6.29     Sec. 5.  Minnesota Statutes 2002, section 62J.301, 
  6.30  subdivision 3, is amended to read: 
  6.31     Subd. 3.  [GENERAL DUTIES.] The commissioner shall: 
  6.32     (1) collect and maintain data which enable population-based 
  6.33  monitoring and trending of the access, utilization, quality, and 
  6.34  cost of health care services within Minnesota; 
  6.35     (2) collect and maintain data for the purpose of estimating 
  6.36  total Minnesota health care expenditures and trends; 
  7.1      (3) collect and maintain data for the purposes of setting 
  7.2   cost containment goals and premium growth limits under section 
  7.3   62J.04, and measuring cost containment goal and premium growth 
  7.4   limit compliance; 
  7.5      (4) conduct applied research using existing and new data 
  7.6   and promote applications based on existing research; 
  7.7      (5) develop and implement data collection procedures to 
  7.8   ensure a high level of cooperation from health care providers 
  7.9   and health plan companies, as defined in section 62Q.01, 
  7.10  subdivision 4; 
  7.11     (6) work closely with health plan companies and health care 
  7.12  providers to promote improvements in health care efficiency and 
  7.13  effectiveness; and 
  7.14     (7) participate as a partner or sponsor of private sector 
  7.15  initiatives that promote publicly disseminated applied research 
  7.16  on health care delivery, outcomes, costs, quality, and 
  7.17  management. 
  7.18     Sec. 6.  Minnesota Statutes 2002, section 62J.38, is 
  7.19  amended to read: 
  7.20     62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 
  7.21     (a) The commissioner shall require group purchasers to 
  7.22  submit detailed data on total health care spending for each 
  7.23  calendar year.  Group purchasers shall submit data for the 1993 
  7.24  calendar year by April 1, 1994, and each April 1 thereafter 
  7.25  shall submit data for the preceding calendar year. 
  7.26     (b) The commissioner shall require each group purchaser to 
  7.27  submit data on revenue, expenses, and member months, as 
  7.28  applicable.  Revenue data must distinguish between premium 
  7.29  revenue and revenue from other sources and must also include 
  7.30  information on the amount of revenue in reserves and changes in 
  7.31  reserves.  Premium revenue data, information on aggregate 
  7.32  enrollment, and data on member months must be broken down to 
  7.33  distinguish between individual market, small group market, and 
  7.34  large group market.  Filings under this section for calendar 
  7.35  year 2005 must also include information broken down by 
  7.36  individual market, small group market, and large group market 
  8.1   for calendar year 2004.  Expenditure data must distinguish 
  8.2   between costs incurred for patient care and administrative 
  8.3   costs.  Patient care and administrative costs must include only 
  8.4   expenses incurred on behalf of health plan members and must not 
  8.5   include the cost of providing health care services for 
  8.6   nonmembers at facilities owned by the group purchaser or 
  8.7   affiliate.  Expenditure data must be provided separately for the 
  8.8   following categories and for other categories required by the 
  8.9   commissioner:  physician services, dental services, other 
  8.10  professional services, inpatient hospital services, outpatient 
  8.11  hospital services, emergency, pharmacy services and other 
  8.12  nondurable medical goods, mental health, and chemical dependency 
  8.13  services, other expenditures, subscriber liability, and 
  8.14  administrative costs.  Administrative costs must include costs 
  8.15  for marketing; advertising; overhead; salaries and benefits of 
  8.16  central office staff who do not provide direct patient care; 
  8.17  underwriting; lobbying; claims processing; provider contracting 
  8.18  and credentialing; detection and prevention of payment for 
  8.19  fraudulent or unjustified requests for reimbursement or 
  8.20  services; clinical quality assurance and other types of medical 
  8.21  care quality improvement efforts; concurrent or prospective 
  8.22  utilization review as defined in section 62M.02; costs incurred 
  8.23  to acquire a hospital, clinic, or health care facility, or the 
  8.24  assets thereof; capital costs incurred on behalf of a hospital 
  8.25  or clinic; lease payments; or any other costs incurred pursuant 
  8.26  to a partnership, joint venture, integration, or affiliation 
  8.27  agreement with a hospital, clinic, or other health care 
  8.28  provider.  Capital costs and costs incurred must be recorded 
  8.29  according to standard accounting principles.  The reports of 
  8.30  this data must also separately identify expenses for local, 
  8.31  state, and federal taxes, fees, and assessments.  The 
  8.32  commissioner may require each group purchaser to submit any 
  8.33  other data, including data in unaggregated form, for the 
  8.34  purposes of developing spending estimates, setting spending 
  8.35  limits, and monitoring actual spending and costs.  In addition 
  8.36  to reporting administrative costs incurred to acquire a 
  9.1   hospital, clinic, or health care facility, or the assets 
  9.2   thereof; or any other costs incurred pursuant to a partnership, 
  9.3   joint venture, integration, or affiliation agreement with a 
  9.4   hospital, clinic, or other health care provider; reports 
  9.5   submitted under this section also must include the payments made 
  9.6   during the calendar year for these purposes.  The commissioner 
  9.7   shall make public, by group purchaser data collected under this 
  9.8   paragraph in accordance with section 62J.321, subdivision 5.  
  9.9   Workers' compensation insurance plans and automobile insurance 
  9.10  plans are exempt from complying with this paragraph as it 
  9.11  relates to the submission of administrative costs. 
  9.12     (c) The commissioner may collect information on: 
  9.13     (1) premiums, benefit levels, managed care procedures, and 
  9.14  other features of health plan companies; 
  9.15     (2) prices, provider experience, and other information for 
  9.16  services less commonly covered by insurance or for which 
  9.17  patients commonly face significant out-of-pocket expenses; and 
  9.18     (3) information on health care services not provided 
  9.19  through health plan companies, including information on prices, 
  9.20  costs, expenditures, and utilization. 
  9.21     (d) All group purchasers shall provide the required data 
  9.22  using a uniform format and uniform definitions, as prescribed by 
  9.23  the commissioner. 
  9.24     Sec. 7.  [62J.385] [TARGETED HEALTH IMPROVEMENT.] 
  9.25     The commissioner of health shall gather information on the 
  9.26  prevalence of high-risk, chronic conditions in Minnesota and on 
  9.27  the health status of patients with these conditions.  The 
  9.28  commissioner shall establish targets for improving the health 
  9.29  status of those with these high-risk, chronic conditions and 
  9.30  develop a strategy for targeted health promotion and health 
  9.31  interventions.  The interventions should be designed in 
  9.32  collaboration with health care providers, health plan companies, 
  9.33  and local public health professionals. 
  9.34     Sec. 8.  [62J.411] [BEST PRACTICES DATA.] 
  9.35     (a) The commissioner shall collect from primary care 
  9.36  providers information on patients who have been diagnosed with 
 10.1   one of the following conditions: 
 10.2      (1) diabetes; 
 10.3      (2) hypertension; 
 10.4      (3) stroke; or 
 10.5      (4) asthma.  
 10.6      (b) The information collected shall include for each of the 
 10.7   conditions identified in paragraph (a): 
 10.8      (1) the number of patients who have been diagnosed with or 
 10.9   suffer from the condition; and 
 10.10     (2) the health care services provided to the patient within 
 10.11  the reporting period that are related to the specific condition 
 10.12  in terms of the percentage of patients identified in clause (1) 
 10.13  who received the service. 
 10.14     (c) The commissioner may not collect information in 
 10.15  individually identifiable form in which the patient is or can be 
 10.16  identified. 
 10.17     (d) The information collected may be used to: 
 10.18     (1) track and target best practices in the delivery of 
 10.19  health care for these conditions; 
 10.20     (2) assess the health care system and physician's quality 
 10.21  of care; 
 10.22     (3) identify utilization trends; and 
 10.23     (4) provide early identification and targeting of 
 10.24  populations at risk. 
 10.25     (e) Health care providers shall submit the required 
 10.26  information for the period of July 1, 2004, to December 31, 
 10.27  2004, by April 1, 2005.  For calendar year 2005, the health care 
 10.28  providers shall submit the required information by April 1, 
 10.29  2006, and each April 1 thereafter shall submit the required 
 10.30  information for the preceding calendar year. 
 10.31     Sec. 9.  [62J.565] [IMPLEMENTATION OF ELECTRONIC MEDICAL 
 10.32  RECORD SYSTEM.] 
 10.33     Subdivision 1.  [GENERAL PROVISIONS.] (a) The legislature 
 10.34  finds that there is a need to advance the use of electronic 
 10.35  medical record systems by health care providers in the state in 
 10.36  order to achieve significant administrative cost savings and to 
 11.1   improve the safety, quality, and efficiency of health care 
 11.2   delivery in the state.  The legislature also finds that in order 
 11.3   to advance the use of an electronic medical record system in a 
 11.4   cost-effective manner and to ensure an electronic medical record 
 11.5   system's interoperability and compatibility with other systems, 
 11.6   the state needs to develop a standard, definitional model of an 
 11.7   electronic medical record system that includes uniform formats, 
 11.8   data standards, and technology standards for the collection, 
 11.9   storage, and exchange of electronic health records.  These 
 11.10  standards must be nationally accepted, widely recognized, and 
 11.11  available for immediate use. 
 11.12     (b) By January 1, 2010, all hospitals and health care 
 11.13  providers must have in place an electronic medical record system 
 11.14  within their hospital system or clinical practice setting.  The 
 11.15  commissioner may grant exemptions from this requirement if the 
 11.16  commissioner determines that the cost of compliance would place 
 11.17  the provider in financial distress or if the commissioner 
 11.18  determines that appropriate technology is not available or 
 11.19  advantageous to that type of practice.  Before an exemption is 
 11.20  granted for financial reasons, the commissioner must ensure that 
 11.21  the provider has explored all possible alliances or partnerships 
 11.22  with other provider groups in the provider's geographical area 
 11.23  to become part of the larger provider group's system. 
 11.24     (c) The commissioner shall provide assistance to hospitals 
 11.25  and provider groups in establishing an electronic medical record 
 11.26  system, including, but not limited to, provider education, 
 11.27  facilitation of possible alliances or partnerships among 
 11.28  provider groups for purposes of implementing a system, 
 11.29  identification or establishment of low-interest financing 
 11.30  options for hardware and software, and systems implementation 
 11.31  support. 
 11.32     Subd. 2.  [MODEL ELECTRONIC MEDICAL RECORD SYSTEM.] (a) The 
 11.33  commissioner of health, in consultation with the Minnesota 
 11.34  Administrative Uniformity Committee, shall develop a functional 
 11.35  model for an electronic medical record system according to the 
 11.36  following schedule: 
 12.1      (1) by October 1, 2005, the commissioner shall develop a 
 12.2   model system that provides immediate, electronic on-site access 
 12.3   to complete patient information, including information necessary 
 12.4   for quality assurance at the point of care delivery; 
 12.5      (2) by October 1, 2005, the commissioner shall develop 
 12.6   standards for secure Internet or other viewing-only access to 
 12.7   patient medical records that require the patient to provide 
 12.8   access information to an off-site provider and do not allow 
 12.9   interaction with the records; and 
 12.10     (3) by January 15, 2006, the commissioner shall develop 
 12.11  standards for interoperable systems for sharing and 
 12.12  synchronizing patient data across systems.  The standards must 
 12.13  include a requirement for a secure, biometric patient 
 12.14  identification system to ensure access security and identity 
 12.15  authentication.  In creating the infrastructure of the system, 
 12.16  the model must include the development of uniform data standards 
 12.17  in terms of clinical terminology, the exchange of data among 
 12.18  systems, and the representation of medical information and must 
 12.19  include the development of a common set of requirements for 
 12.20  functional capabilities for the system software components.  The 
 12.21  uniform standards developed must be functional for use by 
 12.22  providers of all disciplines and care settings.  The standards 
 12.23  must also be compatible with federal and private sector efforts 
 12.24  to develop a national electronic medical record and must 
 12.25  incorporate existing standards and state and federal regulatory 
 12.26  requirements.  In developing a model, the commissioner shall 
 12.27  consider data privacy and security concerns and must ensure 
 12.28  compliance with federal law.  
 12.29     (b) The commissioner of human services shall convene an 
 12.30  advisory committee with representatives of safety-net hospitals, 
 12.31  community health clinics, and other providers who serve 
 12.32  low-income patients to address their specific needs and concerns 
 12.33  regarding the establishment of an electronic medical record 
 12.34  system within their hospital or practice setting.  As part of 
 12.35  addressing the specific needs of these providers, the 
 12.36  commissioner shall explore the implementation of an accessible 
 13.1   interactive system created collaboratively by publicly owned 
 13.2   hospitals and clinics.  The commissioner shall also explore 
 13.3   financial assistance options, including bonding and federal 
 13.4   grants.  
 13.5      (c) The commissioner shall report to the legislature by 
 13.6   January 15, 2005, on the progress in the development of uniform 
 13.7   standards and on a functional model for an electronic medical 
 13.8   record system. 
 13.9      Sec. 10.  Minnesota Statutes 2003 Supplement, section 
 13.10  62J.692, subdivision 3, is amended to read: 
 13.11     Subd. 3.  [APPLICATION PROCESS.] (a) A clinical medical 
 13.12  education program conducted in Minnesota by a teaching 
 13.13  institution to train physicians, doctor of pharmacy 
 13.14  practitioners, dentists, chiropractors, or physician assistants 
 13.15  is eligible for funds under subdivision 4 if the program: 
 13.16     (1) is funded, in part, by patient care revenues; 
 13.17     (2) occurs in patient care settings that face increased 
 13.18  financial pressure as a result of competition with nonteaching 
 13.19  patient care entities; and 
 13.20     (3) emphasizes primary care or specialties that are in 
 13.21  undersupply in Minnesota. 
 13.22     A clinical medical education program that trains 
 13.23  pediatricians is requested to include in its program curriculum 
 13.24  training in case management and medication management for 
 13.25  children suffering from mental illness to be eligible for funds 
 13.26  under subdivision 4. 
 13.27     (b) A clinical medical education program for advanced 
 13.28  practice nursing is eligible for funds under subdivision 4 if 
 13.29  the program meets the eligibility requirements in paragraph (a), 
 13.30  clauses (1) to (3), and is sponsored by the University of 
 13.31  Minnesota Academic Health Center, the Mayo Foundation, or 
 13.32  institutions that are part of the Minnesota State Colleges and 
 13.33  Universities system or members of the Minnesota Private College 
 13.34  Council.  
 13.35     (c) Applications must be submitted to the commissioner by a 
 13.36  sponsoring institution on behalf of an eligible clinical medical 
 14.1   education program and must be received by October 31 of each 
 14.2   year for distribution in the following year.  An application for 
 14.3   funds must contain the following information: 
 14.4      (1) the official name and address of the sponsoring 
 14.5   institution and the official name and site address of the 
 14.6   clinical medical education programs on whose behalf the 
 14.7   sponsoring institution is applying; 
 14.8      (2) the name, title, and business address of those persons 
 14.9   responsible for administering the funds; 
 14.10     (3) for each clinical medical education program for which 
 14.11  funds are being sought; the type and specialty orientation of 
 14.12  trainees in the program; the name, site address, and medical 
 14.13  assistance provider number of each training site used in the 
 14.14  program; the total number of trainees at each training site; and 
 14.15  the total number of eligible trainee FTEs at each site.  Only 
 14.16  those training sites that host 0.5 FTE or more eligible trainees 
 14.17  for a program may be included in the program's application; and 
 14.18     (4) other supporting information the commissioner deems 
 14.19  necessary to determine program eligibility based on the criteria 
 14.20  in paragraphs (a) and (b) and to ensure the equitable 
 14.21  distribution of funds.  
 14.22     (d) An application must include the information specified 
 14.23  in clauses (1) to (3) for each clinical medical education 
 14.24  program on an annual basis for three consecutive years.  After 
 14.25  that time, an application must include the information specified 
 14.26  in clauses (1) to (3) in the first year of each biennium:  
 14.27     (1) audited clinical training costs per trainee for each 
 14.28  clinical medical education program when available or estimates 
 14.29  of clinical training costs based on audited financial data; 
 14.30     (2) a description of current sources of funding for 
 14.31  clinical medical education costs, including a description and 
 14.32  dollar amount of all state and federal financial support, 
 14.33  including Medicare direct and indirect payments; and 
 14.34     (3) other revenue received for the purposes of clinical 
 14.35  training.  
 14.36     (e) An applicant that does not provide information 
 15.1   requested by the commissioner shall not be eligible for funds 
 15.2   for the current funding cycle. 
 15.3      Sec. 11.  [62J.82] [ELECTRONIC MEDICAL RECORD SYSTEM LOAN 
 15.4   PROGRAM.] 
 15.5      Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
 15.6   establish and implement a loan program to help physicians or 
 15.7   physician group practices obtain the necessary finances to 
 15.8   install an electronic medical record system.  
 15.9      Subd. 2.  [RULES.] The commissioner may adopt rules to 
 15.10  administer the loan program.  
 15.11     Subd. 3.  [ELIGIBILITY.] To be eligible for a loan under 
 15.12  this section, the borrower must: 
 15.13     (1) have a signed contract with a vendor; 
 15.14     (2) be a physician licensed in this state or a physician 
 15.15  group practice located in this state; 
 15.16     (3) provide evidence of financial stability; 
 15.17     (4) demonstrate an ability to repay the loan; 
 15.18     (5) demonstrate that the borrower has explored possible 
 15.19  alliances or contractual opportunities with other provider 
 15.20  groups located in the same geographical area to become part of 
 15.21  the larger provider group's system; and 
 15.22     (6) meet any other requirement the commissioner imposes by 
 15.23  administrative procedure or by rule.  
 15.24     Subd. 4.  [LOANS.] (a) The commissioner may make a direct 
 15.25  loan to a provider or provider group who is eligible under 
 15.26  subdivision 3.  The total accumulative loan principal must not 
 15.27  exceed $....... per loan.  
 15.28     (b) The commissioner may prescribe forms and establish an 
 15.29  application process and, notwithstanding section 16A.1283, may 
 15.30  impose a reasonable nonrefundable application fee to cover the 
 15.31  cost of administering the loan program.  
 15.32     (c) Loan principal balance outstanding plus all assessed 
 15.33  interest must be repaid no later than 15 years from the date of 
 15.34  the loan.  
 15.35     Sec. 12.  [62J.83] [ELECTRONIC MEDICAL RECORD SYSTEM LOAN 
 15.36  FUND.] 
 16.1      Subdivision 1.  [CREATION.] The electronic medical record 
 16.2   system loan fund is established as a special account in the 
 16.3   state treasury.  All application fees, loan repayments, and 
 16.4   other revenue received under section 62J.82 must be credited to 
 16.5   the fund.  
 16.6      Subd. 2.  [BOND PROCEEDS ACCOUNT.] An electronic medical 
 16.7   record system revenue bond proceeds account is established in 
 16.8   the electronic medical record system loan fund.  The proceeds of 
 16.9   any bonds issued under section 62J.84 must be credited to the 
 16.10  account.  Money in the account is appropriated to the 
 16.11  commissioner to make loans under section 62J.82. 
 16.12     Subd. 3.  [DEBT SERVICE ACCOUNT.] An electronic medical 
 16.13  record system revenue bond debt service account is established 
 16.14  in the electronic medical record system loan fund.  There must 
 16.15  be credited to this debt service account in each fiscal year 
 16.16  from the income to the electronic medical record system loan 
 16.17  fund an amount sufficient to increase the balance on hand in the 
 16.18  debt service account on each December 1 to an amount equal to 
 16.19  the full amount of principal and interest to come due on all 
 16.20  outstanding bonds issued under section 62J.84 to and including 
 16.21  the second following July 1.  The assets of the account are 
 16.22  pledged to and may only be used to pay principal and interest on 
 16.23  bonds issued under section 62J.84.  Money in the debt service 
 16.24  account is appropriated to the commissioner of finance to pay 
 16.25  principal and interest on bonds issued under section 62J.84. 
 16.26     Subd. 4.  [APPROPRIATION.] Money in the electronic medical 
 16.27  record system loan fund not otherwise appropriated is 
 16.28  appropriated to the commissioner to administer the loan program. 
 16.29     Sec. 13.  [62J.84] [ELECTRONIC MEDICAL RECORD SYSTEM 
 16.30  REVENUE BONDS.] 
 16.31     Subdivision 1.  [BONDING AUTHORITY.] Upon request of the 
 16.32  commissioner, the commissioner of finance may sell and issue 
 16.33  state revenue bonds to make loans under section 62J.82, to 
 16.34  establish a reserve fund or funds, and to pay the cost of 
 16.35  issuance of the bonds. 
 16.36     Subd. 2.  [AMOUNT.] The principal amount of the bonds 
 17.1   issued for the purposes specified in subdivision 1 must not 
 17.2   exceed $........ 
 17.3      Subd. 3.  [PROCEDURE.] The commissioner may sell and issue 
 17.4   the bonds on the terms and conditions the commissioner 
 17.5   determines to be in the best interests of the state.  The bonds 
 17.6   may be sold at public or private sale.  The commissioner may 
 17.7   enter any agreements or pledges the commissioner determines 
 17.8   necessary or useful to sell the bonds that are not inconsistent 
 17.9   with sections 62J.82 to 62J.84.  Sections 16A.672 to 16A.675 
 17.10  apply to the bonds.  
 17.11     Subd. 4.  [REVENUE SOURCES.] The bonds are payable only 
 17.12  from the following sources: 
 17.13     (1) loan repayments credited to the electronic medical 
 17.14  record system loan fund; 
 17.15     (2) the principal and any investment earnings on the assets 
 17.16  of the debt service account; and 
 17.17     (3) other revenues pledged to the payment of the bonds. 
 17.18     Subd. 5.  [REFUNDING BONDS.] The commissioner may issue 
 17.19  bonds to refund outstanding bonds issued under subdivision 1, 
 17.20  including the payment of any redemption premiums on the bonds 
 17.21  and any interest accrued or to accrue to the first redemption 
 17.22  date after delivery of the refunding bonds.  The proceeds of the 
 17.23  refunding bonds may, in the discretion of the commissioner, be 
 17.24  applied to the purchases or payment at maturity of the bonds to 
 17.25  be refunded, or the redemption of the outstanding bonds on the 
 17.26  first redemption date after delivery of the refunding bonds and 
 17.27  may, until so used, be placed in escrow to be applied to the 
 17.28  purchase, retirement, or redemption.  Refunding bonds issued 
 17.29  under this subdivision must be issued and secured in the manner 
 17.30  provided by the commissioner. 
 17.31     Subd. 6.  [NOT A GENERAL OR MORAL OBLIGATION.] Bonds issued 
 17.32  under this section are not public debt, and the full faith, 
 17.33  credit, and taxing powers of the state are not pledged for their 
 17.34  payment.  The bonds may not be paid, directly in whole or part 
 17.35  from a tax of statewide application on any class of property, 
 17.36  income, transaction, or privilege.  Payment of the bonds is 
 18.1   limited to the revenues explicitly authorized to be pledged 
 18.2   under this section.  The state neither makes nor has a moral 
 18.3   obligation to pay the bonds if the pledged revenues and other 
 18.4   legal security for them is insufficient. 
 18.5      Subd. 7.  [TRUSTEE.] The commissioner may contract with and 
 18.6   appoint a trustee for bondholders.  The trustee has the powers 
 18.7   and authority vested in it by the commissioner under the bond 
 18.8   and trust indentures.  
 18.9      Subd. 8.  [PLEDGES.] Any pledge made by the commissioner is 
 18.10  valid and binding from the time the pledge is made.  The money 
 18.11  or property pledged and later received by the commissioner is 
 18.12  immediately subject to the lien of the pledge without any 
 18.13  physical delivery of the property or money or further act, and 
 18.14  the lien of any pledge is valid and binding as against all 
 18.15  parties having claims of any kind in tort, contract, or 
 18.16  otherwise against the commissioner, whether or not those parties 
 18.17  have notice of the lien or pledge.  Neither the order nor any 
 18.18  other instrument by which a pledge is created need be recorded. 
 18.19     Subd. 9.  [BONDS; PURCHASE AND CANCELLATION.] The 
 18.20  commissioner, subject to agreements with bondholders that may 
 18.21  then exist, may, out of any money available for the purpose, 
 18.22  purchase bonds of the commissioner at a price not exceeding: 
 18.23     (1) if the bonds are then redeemable, the redemption price 
 18.24  then applicable plus accrued interest to the next interest 
 18.25  payment date thereon; or 
 18.26     (2) if the bonds are not redeemable, the redemption price 
 18.27  applicable on the first date after the purchase upon which the 
 18.28  bonds become subject to redemption plus accrued interest to that 
 18.29  date. 
 18.30     Subd. 10.  [STATE PLEDGE AGAINST IMPAIRMENT OF CONTRACTS.] 
 18.31  The state pledges and agrees with the holders of any bonds that 
 18.32  the state will not limit or alter the rights vested in the 
 18.33  commissioner to fulfill the terms of any agreements made with 
 18.34  the bondholders, or in any way impair the rights and remedies of 
 18.35  the holders until the bonds, together with interest on them, 
 18.36  with interest on any unpaid installments of interest, and all 
 19.1   costs and expenses in connection with any action or proceeding 
 19.2   by or on behalf of the bondholders, are fully met and 
 19.3   discharged.  The commissioner may include this pledge and 
 19.4   agreement of the state in any agreement with the holders of 
 19.5   bonds issued under this section. 
 19.6      Sec. 14.  Minnesota Statutes 2002, section 62L.08, 
 19.7   subdivision 8, is amended to read: 
 19.8      Subd. 8.  [FILING REQUIREMENT.] (a) No later than July 1, 
 19.9   1993, and each year thereafter, a health carrier that offers, 
 19.10  sells, issues, or renews a health benefit plan for small 
 19.11  employers shall file with the commissioner the index rates and 
 19.12  must demonstrate that all rates shall be within the rating 
 19.13  restrictions defined in this chapter.  Such demonstration must 
 19.14  include the allowable range of rates from the index rates and a 
 19.15  description of how the health carrier intends to use demographic 
 19.16  factors including case characteristics in calculating the 
 19.17  premium rates.  
 19.18     (b) Notwithstanding paragraph (a), the rates shall not be 
 19.19  approved, unless the commissioner has determined that the rates 
 19.20  are reasonable.  In determining reasonableness, the commissioner 
 19.21  shall consider the growth rates applied under section 62J.04, 
 19.22  subdivision 1, paragraph (b) apply the premium growth limits 
 19.23  established under section 62J.04, subdivision 1b, to the 
 19.24  calendar year or years that the proposed premium rate would be 
 19.25  in effect, and shall consider actuarially valid changes in risk 
 19.26  associated with the enrollee population, and actuarially valid 
 19.27  changes as a result of statutory changes in Laws 1992, chapter 
 19.28  549.  For premium rates proposed to go into effect between July 
 19.29  1, 1993 and December 31, 1993, the pertinent growth rate is the 
 19.30  growth rate applied under section 62J.04, subdivision 1, 
 19.31  paragraph (b), to calendar year 1994. 
 19.32     Sec. 15.  [62Q.175] [COVERAGE EXEMPTIONS.] 
 19.33     Notwithstanding any law to the contrary, no health plan 
 19.34  company is required to provide coverage for any health care 
 19.35  service included on the list established under section 
 19.36  256B.0625, subdivision 46. 
 20.1      Sec. 16.  Minnesota Statutes 2003 Supplement, section 
 20.2   144.1501, subdivision 2, is amended to read: 
 20.3      Subd. 2.  [CREATION OF ACCOUNT.] A health professional 
 20.4   education loan forgiveness program account is established.  The 
 20.5   commissioner of health shall use money from the account to 
 20.6   establish a loan forgiveness program for medical residents 
 20.7   agreeing to practice in designated rural areas or underserved 
 20.8   urban communities, for midlevel practitioners agreeing to 
 20.9   practice in designated rural areas or to teach for at least 20 
 20.10  hours per week in the nursing field in a postsecondary program, 
 20.11  and for nurses who agree to practice in a Minnesota nursing home 
 20.12  or intermediate care facility for persons with mental 
 20.13  retardation or related conditions or to teach for at least 20 
 20.14  hours per week in the nursing field in a postsecondary program, 
 20.15  and for other health care technicians agreeing to teach for at 
 20.16  least 20 hours per week in their designated field in a 
 20.17  postsecondary program.  The commissioner, in consultation with 
 20.18  the Healthcare Education-Industry Partnership, shall determine 
 20.19  the health care fields where the need is the greatest, 
 20.20  including, but not limited to, respiratory therapy, clinical 
 20.21  laboratory technology, radiologic technology, and surgical 
 20.22  technology.  Appropriations made to the account do not cancel 
 20.23  and are available until expended, except that at the end of each 
 20.24  biennium, any remaining balance in the account that is not 
 20.25  committed by contract and not needed to fulfill existing 
 20.26  commitments shall cancel to the fund. 
 20.27     Sec. 17.  Minnesota Statutes 2003 Supplement, section 
 20.28  144.1501, subdivision 4, is amended to read: 
 20.29     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
 20.30  may select applicants each year for participation in the loan 
 20.31  forgiveness program, within the limits of available funding. The 
 20.32  commissioner shall distribute available funds for loan 
 20.33  forgiveness proportionally among the eligible professions 
 20.34  according to the vacancy rate for each profession in the 
 20.35  required geographic area or, facility type, or teaching area 
 20.36  specified in subdivision 2.  The commissioner shall allocate 
 21.1   funds for physician loan forgiveness so that 75 percent of the 
 21.2   funds available are used for rural physician loan forgiveness 
 21.3   and 25 percent of the funds available are used for underserved 
 21.4   urban communities loan forgiveness.  If the commissioner does 
 21.5   not receive enough qualified applicants each year to use the 
 21.6   entire allocation of funds for urban underserved communities, 
 21.7   the remaining funds may be allocated for rural physician loan 
 21.8   forgiveness.  Applicants are responsible for securing their own 
 21.9   qualified educational loans.  The commissioner shall select 
 21.10  participants based on their suitability for practice serving the 
 21.11  required geographic area or facility type specified in 
 21.12  subdivision 2, as indicated by experience or training.  The 
 21.13  commissioner shall give preference to applicants closest to 
 21.14  completing their training.  For each year that a participant 
 21.15  meets the service obligation required under subdivision 3, up to 
 21.16  a maximum of four years, the commissioner shall make annual 
 21.17  disbursements directly to the participant equivalent to 15 
 21.18  percent of the average educational debt for indebted graduates 
 21.19  in their profession in the year closest to the applicant's 
 21.20  selection for which information is available, not to exceed the 
 21.21  balance of the participant's qualifying educational loans.  
 21.22  Before receiving loan repayment disbursements and as requested, 
 21.23  the participant must complete and return to the commissioner an 
 21.24  affidavit of practice form provided by the commissioner 
 21.25  verifying that the participant is practicing as required under 
 21.26  subdivisions 2 and 3.  The participant must provide the 
 21.27  commissioner with verification that the full amount of loan 
 21.28  repayment disbursement received by the participant has been 
 21.29  applied toward the designated loans.  After each disbursement, 
 21.30  verification must be received by the commissioner and approved 
 21.31  before the next loan repayment disbursement is made.  
 21.32  Participants who move their practice remain eligible for loan 
 21.33  repayment as long as they practice as required under subdivision 
 21.34  2. 
 21.35     Sec. 18.  Minnesota Statutes 2003 Supplement, section 
 21.36  256.954, subdivision 4, is amended to read: 
 22.1      Subd. 4.  [ELIGIBLE PERSONS.] To be eligible for the 
 22.2   program, an applicant must: 
 22.3      (1) be a permanent resident of Minnesota as defined in 
 22.4   section 256L.09, subdivision 4; 
 22.5      (2) not be enrolled in Medicare, medical assistance, 
 22.6   general assistance medical care, MinnesotaCare, or the 
 22.7   prescription drug program under section 256.955; 
 22.8      (3) not be enrolled in and have currently available 
 22.9   prescription drug coverage under a health plan offered by a 
 22.10  health carrier or employer or under a pharmacy benefit program 
 22.11  offered by a pharmaceutical manufacturer; and 
 22.12     (4) not be enrolled in and have currently available 
 22.13  prescription drug coverage under a Medicare supplement plan, as 
 22.14  defined in sections 62A.31 to 62A.44, or policies, contracts, or 
 22.15  certificates that supplement Medicare issued by health 
 22.16  maintenance organizations or those policies, contracts, or 
 22.17  certificates governed by section 1833 or 1876 of the federal 
 22.18  Social Security Act, United States Code, title 42, section 1395, 
 22.19  et seq., as amended; and 
 22.20     (5) have a gross household income that does not exceed 250 
 22.21  percent of the federal poverty guidelines. 
 22.22     Sec. 19.  Minnesota Statutes 2003 Supplement, section 
 22.23  256.954, subdivision 6, is amended to read: 
 22.24     Subd. 6.  [PARTICIPATING PHARMACY.] According to a valid 
 22.25  prescription, a participating pharmacy must sell a covered 
 22.26  prescription drug to an enrolled individual at the pharmacy's 
 22.27  usual and customary retail price, minus an amount that is equal 
 22.28  to the rebate amount described in subdivision 8, plus the amount 
 22.29  of any administrative fee and switch fee established by the 
 22.30  commissioner under subdivision 10.  Each participating pharmacy 
 22.31  shall provide the commissioner with all information necessary to 
 22.32  administer the program, including, but not limited to, 
 22.33  information on prescription drug sales to enrolled individuals 
 22.34  and usual and customary retail prices. 
 22.35     Sec. 20.  Minnesota Statutes 2003 Supplement, section 
 22.36  256.954, subdivision 10, is amended to read: 
 23.1      Subd. 10.  [ADMINISTRATIVE ENROLLMENT FEE; SWITCH FEE.] (a) 
 23.2   The commissioner shall establish a reasonable administrative 
 23.3   enrollment fee that covers the commissioner's expenses for 
 23.4   enrollment, processing claims, and distributing rebates under 
 23.5   this program. 
 23.6      (b) The commissioner shall establish a reasonable switch 
 23.7   fee that covers expenses incurred by pharmacies in formatting 
 23.8   for electronic submission claims for prescription drugs sold to 
 23.9   enrolled individuals. 
 23.10     Sec. 21.  Minnesota Statutes 2002, section 256.9693, is 
 23.11  amended to read: 
 23.12     256.9693 [CONTINUING CARE PROGRAM FOR PERSONS WITH MENTAL 
 23.13  ILLNESS.] 
 23.14     The commissioner shall establish a continuing care benefit 
 23.15  program for persons with mental illness in which persons with 
 23.16  mental illness may obtain acute care hospital inpatient 
 23.17  treatment for mental illness for up to 45 days beyond that 
 23.18  allowed by section 256.969.  Persons with mental illness who are 
 23.19  eligible for medical assistance or general assistance medical 
 23.20  care may obtain inpatient treatment under this program in 
 23.21  hospital beds for which the commissioner contracts under this 
 23.22  section.  The commissioner may selectively contract with 
 23.23  hospitals to provide this benefit through competitive bidding 
 23.24  when reasonable geographic access by recipients can be assured.  
 23.25  Payments under this section shall not affect payments under 
 23.26  section 256.969.  The commissioner may contract externally with 
 23.27  a utilization review organization to authorize persons with 
 23.28  mental illness to access the continuing care benefit program.  
 23.29  The commissioner, as part of the contracts with hospitals, shall 
 23.30  establish admission criteria to allow persons with mental 
 23.31  illness to access the continuing care benefit program.  If a 
 23.32  court orders acute care hospital inpatient treatment for mental 
 23.33  illness for a person, the person may obtain the treatment under 
 23.34  the continuing care benefit program.  The commissioner shall not 
 23.35  require, as part of the admission criteria, any commitment or 
 23.36  petition under chapter 253B as a condition of accessing the 
 24.1   program.  This benefit is not available for people who are also 
 24.2   eligible for Medicare and who have not exhausted their annual or 
 24.3   lifetime inpatient psychiatric benefit under Medicare.  If a 
 24.4   recipient is enrolled in a prepaid plan, this program is 
 24.5   included in the plan's coverage. 
 24.6      Sec. 22.  Minnesota Statutes 2002, section 256B.03, 
 24.7   subdivision 3, is amended to read: 
 24.8      Subd. 3.  [TRIBAL PURCHASING MODEL.] (a) Notwithstanding 
 24.9   subdivision 1 and sections 256B.0625 and 256D.03, subdivision 4, 
 24.10  paragraph (i) (h), the commissioner may make payments to 
 24.11  federally recognized Indian tribes with a reservation in the 
 24.12  state to provide medical assistance and general assistance 
 24.13  medical care to Indians, as defined under federal law, who 
 24.14  reside on or near the reservation.  The payments may be made in 
 24.15  the form of a block grant or other payment mechanism determined 
 24.16  in consultation with the tribe.  Any alternative payment 
 24.17  mechanism agreed upon by the tribes and the commissioner under 
 24.18  this subdivision is not dependent upon county or health plan 
 24.19  agreement but is intended to create a direct payment mechanism 
 24.20  between the state and the tribe for the administration of the 
 24.21  medical assistance and general assistance medical care programs, 
 24.22  and for covered services.  
 24.23     (b) A tribe that implements a purchasing model under this 
 24.24  subdivision shall report to the commissioner at least annually 
 24.25  on the operation of the model.  The commissioner and the tribe 
 24.26  shall cooperatively determine the data elements, format, and 
 24.27  timetable for the report. 
 24.28     (c) For purposes of this subdivision, "Indian tribe" means 
 24.29  a tribe, band, or nation, or other organized group or community 
 24.30  of Indians that is recognized as eligible for the special 
 24.31  programs and services provided by the United States to Indians 
 24.32  because of their status as Indians and for which a reservation 
 24.33  exists as is consistent with Public Law 100-485, as amended. 
 24.34     (d) Payments under this subdivision may not result in an 
 24.35  increase in expenditures that would not otherwise occur in the 
 24.36  medical assistance program under this chapter or the general 
 25.1   assistance medical care program under chapter 256D. 
 25.2      Sec. 23.  Minnesota Statutes 2003 Supplement, section 
 25.3   256B.061, is amended to read: 
 25.4      256B.061 [ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.] 
 25.5      (a) If any individual has been determined to be eligible 
 25.6   for medical assistance, it will be made available for care and 
 25.7   services included under the plan and furnished in or after the 
 25.8   third month before the month in which the individual made 
 25.9   application for such assistance, if such individual was, or upon 
 25.10  application would have been, eligible for medical assistance at 
 25.11  the time the care and services were furnished.  The commissioner 
 25.12  may limit, restrict, or suspend the eligibility of an individual 
 25.13  for up to one year upon that individual's conviction of a 
 25.14  criminal offense related to application for or receipt of 
 25.15  medical assistance benefits. 
 25.16     (b) On the basis of information provided on the completed 
 25.17  application, an applicant who meets the following criteria shall 
 25.18  be determined eligible beginning in the month of application: 
 25.19     (1) has gross income less than 90 percent of the applicable 
 25.20  income standard; 
 25.21     (2) has total liquid assets less than 90 percent of the 
 25.22  asset limit; 
 25.23     (3) does not reside in a long-term care facility; and 
 25.24     (4) meets all other eligibility requirements. 
 25.25  The applicant must provide all required verifications within 30 
 25.26  days' notice of the eligibility determination or eligibility 
 25.27  shall be terminated. 
 25.28     Sec. 24.  Minnesota Statutes 2002, section 256B.0625, 
 25.29  subdivision 3b, is amended to read: 
 25.30     Subd. 3b.  [TELEMEDICINE CONSULTATIONS.] Medical assistance 
 25.31  covers telemedicine consultations.  Telemedicine consultations 
 25.32  must be made via two-way, interactive video or store-and-forward 
 25.33  technology.  Store-and-forward technology includes telemedicine 
 25.34  consultations that do not occur in real time via synchronous 
 25.35  transmissions, and that do not require a face-to-face encounter 
 25.36  with the patient for all or any part of any such telemedicine 
 26.1   consultation.  The patient record must include a written opinion 
 26.2   from the consulting physician providing the telemedicine 
 26.3   consultation.  A communication between two physicians that 
 26.4   consists solely of a telephone conversation is not a 
 26.5   telemedicine consultation, unless the communication is between a 
 26.6   pediatrician and psychiatrist for the purpose of managing the 
 26.7   medications of a child with mental health needs.  Coverage is 
 26.8   limited to three telemedicine consultations per recipient per 
 26.9   calendar week.  Telemedicine consultations shall be paid at the 
 26.10  full allowable rate. 
 26.11     Sec. 25.  Minnesota Statutes 2003 Supplement, section 
 26.12  256B.0625, subdivision 9, is amended to read: 
 26.13     Subd. 9.  [DENTAL SERVICES.] (a) Medical assistance covers 
 26.14  dental services.  Dental services include, with prior 
 26.15  authorization, fixed bridges that are cost-effective for persons 
 26.16  who cannot use removable dentures because of their medical 
 26.17  condition.  
 26.18     (b) Coverage of dental services for adults age 21 and over 
 26.19  who are not pregnant is subject to a $500 annual benefit limit 
 26.20  and covered services are limited to:  
 26.21     (1) diagnostic and preventative services; 
 26.22     (2) basic restorative services; and 
 26.23     (3) emergency services. 
 26.24     Emergency services, dentures, and extractions related to 
 26.25  dentures are not included in the $500 annual benefit limit. 
 26.26     Sec. 26.  Minnesota Statutes 2002, section 256B.0625, is 
 26.27  amended by adding a subdivision to read: 
 26.28     Subd. 46.  [LIST OF HEALTH CARE SERVICES NOT ELIGIBLE FOR 
 26.29  COVERAGE.] (a) The commissioner of human services, in 
 26.30  consultation with the commissioner of health, shall biennially 
 26.31  establish a list of diagnosis/treatment pairings that are not 
 26.32  eligible for reimbursement under this chapter and chapters 256D 
 26.33  and 256L, effective for services provided on or after July 1, 
 26.34  2005.  The commissioner shall review the list in effect for the 
 26.35  prior biennium and shall make any additions or deletions from 
 26.36  the list as appropriate, taking into consideration the following:
 27.1      (1) scientific and medical information; 
 27.2      (2) clinical assessment; 
 27.3      (3) cost-effectiveness of treatment; 
 27.4      (4) prevention of future costs; and 
 27.5      (5) medical ineffectiveness.  
 27.6      (b) The commissioner may appoint an ad hoc advisory panel 
 27.7   made up of physicians, consumers, nurses, dentists, 
 27.8   chiropractors, and other experts to assist the commissioner in 
 27.9   reviewing and establishing the list.  The commissioner shall 
 27.10  solicit comments and recommendations from any interested persons 
 27.11  and organizations and shall schedule at least one public hearing.
 27.12     (c) The list must be established by January 15, 2005, for 
 27.13  the list effective July 1, 2005, and by October 1 of the 
 27.14  even-numbered years beginning October 1, 2006.  The commissioner 
 27.15  shall publish the list in the State Register by November 1 of 
 27.16  the even-numbered years beginning November 1, 2006.  The list 
 27.17  shall be submitted to the legislature by January 15 of the 
 27.18  odd-numbered years beginning January 15, 2005. 
 27.19     Sec. 27.  [256B.075] [DISEASE MANAGEMENT PROGRAMS.] 
 27.20     Subdivision 1.  [GENERAL.] The commissioner shall design 
 27.21  and implement a disease management initiative for the medical 
 27.22  assistance, general assistance medical care, and MinnesotaCare 
 27.23  programs.  The initiative shall provide an integrated and 
 27.24  systematic approach to manage the health care needs of 
 27.25  recipients who are at risk of, or diagnosed with, specified 
 27.26  conditions or diseases that require frequent medical attention.  
 27.27  The initiative shall seek to improve patient care and health 
 27.28  outcomes and reduce health care costs by managing the care 
 27.29  provided to recipients with chronic conditions.  
 27.30     Subd. 2.  [FEE-FOR-SERVICE.] (a) The commissioner shall 
 27.31  develop and implement a disease management program for medical 
 27.32  assistance and general assistance medical care recipients who 
 27.33  are not enrolled in the prepaid medical assistance or general 
 27.34  assistance medical care program and who are receiving services 
 27.35  on a fee-for-service basis.  
 27.36     (b) The commissioner shall identify the recipients with 
 28.1   special health care needs either by the use of a self-reported 
 28.2   condition-based checklist or by diagnosis.  If a recipient has 
 28.3   several chronic conditions, the commissioner shall determine the 
 28.4   most prevalent and most serious condition.  Based on this 
 28.5   identification system, the commissioner shall identify the three 
 28.6   most serious conditions that are prevalent among the identified 
 28.7   recipients and shall establish for each of these conditions a 
 28.8   list of primary care providers who are qualified to act as a 
 28.9   case manager to coordinate the care of the patient.  
 28.10     (c) The commissioner shall request the identified 
 28.11  recipients to choose a primary care provider from the list 
 28.12  established in paragraph (b).  The provider shall be responsible 
 28.13  for: 
 28.14     (1) establishing a care team that must include a licensed 
 28.15  physician and a pharmacist and any specialist necessary to treat 
 28.16  the specific conditions of the targeted diagnosis; 
 28.17     (2) performing an initial assessment and developing an 
 28.18  individualized care plan with input from the patient; 
 28.19     (3) educating the patient in self-management and the 
 28.20  importance of adhering to the care plan; 
 28.21     (4) providing problem follow-up and new assessments, as 
 28.22  needed; and 
 28.23     (5) adhering to evidence-based best practices care 
 28.24  strategies. 
 28.25     (d) The provider may create incentives for a recipient to 
 28.26  ensure cooperation and patient engagement in the care plan and 
 28.27  management.  
 28.28     (e) The recipient shall be required to seek health care 
 28.29  services related to the specific diagnosis from the primary care 
 28.30  provider or from the providers on the recipient's care team.  
 28.31     (f) The commissioner shall set a cost-savings target of ten 
 28.32  percent reduction in inpatient hospitalization and emergency 
 28.33  room costs for fiscal year 2005.  Based on the achievement of 
 28.34  this goal, one-half the savings shall be used as a bonus to the 
 28.35  participating primary care providers for the following fiscal 
 28.36  year.  
 29.1      (g) The commissioner shall seek any federal waivers 
 29.2   necessary to implement this section and to obtain federal 
 29.3   matching funds.  
 29.4      Subd. 3.  [MANAGED CARE CONTRACTS.] The commissioner shall 
 29.5   require all managed care plans entering into contracts under 
 29.6   section 256B.69 to develop and implement at least two disease 
 29.7   management programs that will improve patient care and health 
 29.8   outcomes for those enrollees who are at risk of or diagnosed 
 29.9   with a chronic condition.  The commissioner shall require the 
 29.10  managed care plans to measure and report outcomes in accordance 
 29.11  with measurements approved by the commissioner.  
 29.12     Subd. 4.  [HEMOPHILIA.] Notwithstanding subdivisions 2 and 
 29.13  3, the commissioner shall develop a disease management 
 29.14  initiative for public health care program recipients who have 
 29.15  been diagnosed with hemophilia.  In developing the program, the 
 29.16  commissioner shall explore the feasibility of contracting with a 
 29.17  section 340B provider to provide disease management services or 
 29.18  coordination of care in order to maximize the discounted 
 29.19  prescription drug prices of the federal 340B program offered 
 29.20  through section 340B of the federal Public Health Services Act, 
 29.21  United States Code, title 42, section 256b (1999).  
 29.22     Sec. 28.  [256B.0918] [EMPLOYEE SCHOLARSHIP COSTS AND 
 29.23  TRAINING IN ENGLISH AS A SECOND LANGUAGE.] 
 29.24     (a) For the fiscal year beginning July 1, 2004, the 
 29.25  commissioner shall provide to each provider listed in paragraph 
 29.26  (c) a scholarship reimbursement increase of two-tenths percent 
 29.27  of the reimbursement rate for that provider to be used: 
 29.28     (1) for employee scholarships that satisfy the following 
 29.29  requirements: 
 29.30     (i) scholarships are available to all employees who work an 
 29.31  average of at least 20 hours per week for the provider, except 
 29.32  administrators, department supervisors, and registered nurses; 
 29.33  and 
 29.34     (ii) the course of study is expected to lead to career 
 29.35  advancement with the provider or in long-term care, including 
 29.36  home care or care of persons with disabilities, including 
 30.1   medical care interpreter services and social work; and 
 30.2      (2) to provide job-related training in English as a second 
 30.3   language. 
 30.4      (b) A provider receiving a rate adjustment under this 
 30.5   subdivision with an annualized value of at least $1,000 shall 
 30.6   maintain documentation to be submitted to the commissioner on a 
 30.7   schedule determined by the commissioner and on a form supplied 
 30.8   by the commissioner of the scholarship rate increase received, 
 30.9   including:  
 30.10     (1) the amount received from this reimbursement increase; 
 30.11     (2) the amount used for training in English as a second 
 30.12  language; 
 30.13     (3) the number of persons receiving the training; 
 30.14     (4) the name of the person or entity providing the 
 30.15  training; and 
 30.16     (5) for each scholarship recipient, the name of the 
 30.17  recipient, the amount awarded, the educational institution 
 30.18  attended, the nature of the educational program, the program 
 30.19  completion date, and a determination of the amount spent as a 
 30.20  percentage of the provider's reimbursement.  
 30.21  The commissioner shall report to the legislature annually, 
 30.22  beginning January 15, 2006, with information on the use of these 
 30.23  funds. 
 30.24     (c) The rate increases described in this section shall be 
 30.25  provided to home and community-based waivered services for 
 30.26  persons with mental retardation or related conditions under 
 30.27  section 256B.501; home and community-based waivered services for 
 30.28  the elderly under section 256B.0915; waivered services under 
 30.29  community alternatives for disabled individuals under section 
 30.30  256B.49; community alternative care waivered services under 
 30.31  section 256B.49; traumatic brain injury waivered services under 
 30.32  section 256B.49; nursing services and home health services under 
 30.33  section 256B.0625, subdivision 6a; personal care services and 
 30.34  nursing supervision of personal care services under section 
 30.35  256B.0625, subdivision 19a; private-duty nursing services under 
 30.36  section 256B.0625, subdivision 7; day training and habilitation 
 31.1   services for adults with mental retardation or related 
 31.2   conditions under sections 252.40 to 252.46; alternative care 
 31.3   services under section 256B.0913; adult residential program 
 31.4   grants under Minnesota Rules, parts 9535.2000 to 9535.3000; 
 31.5   semi-independent living services (SILS) under section 252.275, 
 31.6   including SILS funding under county social services grants 
 31.7   formerly funded under chapter 256I; community support services 
 31.8   for deaf and hard-of-hearing adults with mental illness who use 
 31.9   or wish to use sign language as their primary means of 
 31.10  communication; the group residential housing supplementary 
 31.11  service rate under section 256I.05, subdivision 1a; chemical 
 31.12  dependency residential and nonresidential service providers 
 31.13  under section 245B.03; and intermediate care facilities for 
 31.14  persons with mental retardation under section 256B.5012. 
 31.15     (d) These increases shall be included in the provider's 
 31.16  reimbursement rate for the purpose of determining future rates 
 31.17  for the provider. 
 31.18     Sec. 29.  Minnesota Statutes 2003 Supplement, section 
 31.19  256B.69, subdivision 2, is amended to read: 
 31.20     Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
 31.21  the following terms have the meanings given.  
 31.22     (a) "Commissioner" means the commissioner of human services.
 31.23  For the remainder of this section, the commissioner's 
 31.24  responsibilities for methods and policies for implementing the 
 31.25  project will be proposed by the project advisory committees and 
 31.26  approved by the commissioner.  
 31.27     (b) "Demonstration provider" means a health maintenance 
 31.28  organization, community integrated service network, or 
 31.29  accountable provider network authorized and operating under 
 31.30  chapter 62D, 62N, or 62T that participates in the demonstration 
 31.31  project according to criteria, standards, methods, and other 
 31.32  requirements established for the project and approved by the 
 31.33  commissioner.  For purposes of this section, a county board, or 
 31.34  group of county boards operating under a joint powers agreement, 
 31.35  is considered a demonstration provider if the county or group of 
 31.36  county boards meets the requirements of section 256B.692.  
 32.1   Notwithstanding the above, Itasca County may continue to 
 32.2   participate as a demonstration provider until July 1, 2004. 
 32.3      (c) "Eligible individuals" means those persons eligible for 
 32.4   medical assistance benefits as defined in sections 256B.055, 
 32.5   256B.056, and 256B.06, except as provided under paragraph (e). 
 32.6      (d) "Limitation of choice" means suspending freedom of 
 32.7   choice while allowing eligible individuals to choose among the 
 32.8   demonstration providers.  
 32.9      (e) This paragraph supersedes paragraph (c) as long as the 
 32.10  Minnesota health care reform waiver remains in effect.  When the 
 32.11  waiver expires, this paragraph expires and the commissioner of 
 32.12  human services shall publish a notice in the State Register and 
 32.13  notify the revisor of statutes.  "Eligible individuals" means 
 32.14  those persons eligible for medical assistance benefits as 
 32.15  defined in sections 256B.055, 256B.056, and 256B.06.  
 32.16  Notwithstanding sections 256B.055, 256B.056, and 256B.06, an 
 32.17  individual who becomes ineligible for the program because of 
 32.18  failure to submit income reports or recertification forms in a 
 32.19  timely manner shall remain enrolled in the prepaid health plan 
 32.20  and shall remain eligible to receive medical assistance coverage 
 32.21  through the last day of the month following the month in which 
 32.22  the enrollee became ineligible for the medical assistance 
 32.23  program. 
 32.24     Sec. 30.  Minnesota Statutes 2003 Supplement, section 
 32.25  256D.03, subdivision 3, is amended to read: 
 32.26     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
 32.27  (a) General assistance medical care may be paid for any person 
 32.28  who is not eligible for medical assistance under chapter 256B, 
 32.29  including eligibility for medical assistance based on a 
 32.30  spenddown of excess income according to section 256B.056, 
 32.31  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
 32.32  except as provided in paragraph (c), and: 
 32.33     (1) who is receiving assistance under section 256D.05, 
 32.34  except for families with children who are eligible under 
 32.35  Minnesota family investment program (MFIP), or who is having a 
 32.36  payment made on the person's behalf under sections 256I.01 to 
 33.1   256I.06; or 
 33.2      (2) who is a resident of Minnesota; and 
 33.3      (i) who has gross countable income not in excess of 75 
 33.4   percent of the federal poverty guidelines for the family size, 
 33.5   using a six-month budget period and whose equity in assets is 
 33.6   not in excess of $1,000 per assistance unit.  Exempt assets, the 
 33.7   reduction of excess assets, and the waiver of excess assets must 
 33.8   conform to the medical assistance program in section 256B.056, 
 33.9   subdivision 3, with the following exception:  the maximum amount 
 33.10  of undistributed funds in a trust that could be distributed to 
 33.11  or on behalf of the beneficiary by the trustee, assuming the 
 33.12  full exercise of the trustee's discretion under the terms of the 
 33.13  trust, must be applied toward the asset maximum; or 
 33.14     (ii) who has gross countable income above 75 percent of the 
 33.15  federal poverty guidelines but not in excess of 175 percent of 
 33.16  the federal poverty guidelines for the family size, using a 
 33.17  six-month budget period, whose equity in assets is not in excess 
 33.18  of the limits in section 256B.056, subdivision 3c, and who 
 33.19  applies during an inpatient hospitalization.  
 33.20     (b) General assistance medical care may not be paid for 
 33.21  applicants or recipients who meet all eligibility requirements 
 33.22  of MinnesotaCare as defined in sections 256L.01 to 256L.16, and 
 33.23  are adults with dependent children under 21 whose gross family 
 33.24  income is equal to or less than 275 percent of the federal 
 33.25  poverty guidelines. 
 33.26     (c) For applications received on or after October 1, 2003, 
 33.27  eligibility may begin no earlier than the date of application.  
 33.28  For individuals eligible under paragraph (a), clause (2), item 
 33.29  (i), a redetermination of eligibility must occur every 12 
 33.30  months.  Individuals are eligible under paragraph (a), clause 
 33.31  (2), item (ii), only during inpatient hospitalization but may 
 33.32  reapply if there is a subsequent period of inpatient 
 33.33  hospitalization.  Beginning January 1, 2000, Minnesota health 
 33.34  care program applications completed by recipients and applicants 
 33.35  who are persons described in paragraph (b), may be returned to 
 33.36  the county agency to be forwarded to the Department of Human 
 34.1   Services or sent directly to the Department of Human Services 
 34.2   for enrollment in MinnesotaCare.  If all other eligibility 
 34.3   requirements of this subdivision are met, eligibility for 
 34.4   general assistance medical care shall be available in any month 
 34.5   during which a MinnesotaCare eligibility determination and 
 34.6   enrollment are pending.  Upon notification of eligibility for 
 34.7   MinnesotaCare, notice of termination for eligibility for general 
 34.8   assistance medical care shall be sent to an applicant or 
 34.9   recipient.  If all other eligibility requirements of this 
 34.10  subdivision are met, eligibility for general assistance medical 
 34.11  care shall be available until enrollment in MinnesotaCare 
 34.12  subject to the provisions of paragraph (e). 
 34.13     (d) The date of an initial Minnesota health care program 
 34.14  application necessary to begin a determination of eligibility 
 34.15  shall be the date the applicant has provided a name, address, 
 34.16  and Social Security number, signed and dated, to the county 
 34.17  agency or the Department of Human Services.  If the applicant is 
 34.18  unable to provide a name, address, Social Security number, and 
 34.19  signature when health care is delivered due to a medical 
 34.20  condition or disability, a health care provider may act on an 
 34.21  applicant's behalf to establish the date of an initial Minnesota 
 34.22  health care program application by providing the county agency 
 34.23  or Department of Human Services with provider identification and 
 34.24  a temporary unique identifier for the applicant by the end of 
 34.25  the next business day.  The applicant must complete the 
 34.26  remainder of the application and provide necessary verification 
 34.27  before eligibility can be determined.  The county agency must 
 34.28  assist the applicant in obtaining verification if necessary.  On 
 34.29  the basis of information provided on the completed application, 
 34.30  an applicant who meets the following criteria shall be 
 34.31  determined eligible beginning in the month of application: 
 34.32     (1) has gross income less than 90 percent of the applicable 
 34.33  income standard; 
 34.34     (2) has liquid assets that total within $300 of the asset 
 34.35  standard; 
 34.36     (3) does not reside in a long-term care facility; and 
 35.1      (4) meets all other eligibility requirements. 
 35.2   The applicant must provide all required verifications within 30 
 35.3   days' notice of the eligibility determination or eligibility 
 35.4   shall be terminated.  
 35.5      (e) County agencies are authorized to use all automated 
 35.6   databases containing information regarding recipients' or 
 35.7   applicants' income in order to determine eligibility for general 
 35.8   assistance medical care or MinnesotaCare.  Such use shall be 
 35.9   considered sufficient in order to determine eligibility and 
 35.10  premium payments by the county agency. 
 35.11     (f) General assistance medical care is not available for a 
 35.12  person in a correctional facility unless the person is detained 
 35.13  by law for less than one year in a county correctional or 
 35.14  detention facility as a person accused or convicted of a crime, 
 35.15  or admitted as an inpatient to a hospital on a criminal hold 
 35.16  order, and the person is a recipient of general assistance 
 35.17  medical care at the time the person is detained by law or 
 35.18  admitted on a criminal hold order and as long as the person 
 35.19  continues to meet other eligibility requirements of this 
 35.20  subdivision.  
 35.21     (g) General assistance medical care is not available for 
 35.22  applicants or recipients who do not cooperate with the county 
 35.23  agency to meet the requirements of medical assistance.  
 35.24     (h) In determining the amount of assets of an individual 
 35.25  eligible under paragraph (a), clause (2), item (i), there shall 
 35.26  be included any asset or interest in an asset, including an 
 35.27  asset excluded under paragraph (a), that was given away, sold, 
 35.28  or disposed of for less than fair market value within the 60 
 35.29  months preceding application for general assistance medical care 
 35.30  or during the period of eligibility.  Any transfer described in 
 35.31  this paragraph shall be presumed to have been for the purpose of 
 35.32  establishing eligibility for general assistance medical care, 
 35.33  unless the individual furnishes convincing evidence to establish 
 35.34  that the transaction was exclusively for another purpose.  For 
 35.35  purposes of this paragraph, the value of the asset or interest 
 35.36  shall be the fair market value at the time it was given away, 
 36.1   sold, or disposed of, less the amount of compensation received.  
 36.2   For any uncompensated transfer, the number of months of 
 36.3   ineligibility, including partial months, shall be calculated by 
 36.4   dividing the uncompensated transfer amount by the average 
 36.5   monthly per person payment made by the medical assistance 
 36.6   program to skilled nursing facilities for the previous calendar 
 36.7   year.  The individual shall remain ineligible until this fixed 
 36.8   period has expired.  The period of ineligibility may exceed 30 
 36.9   months, and a reapplication for benefits after 30 months from 
 36.10  the date of the transfer shall not result in eligibility unless 
 36.11  and until the period of ineligibility has expired.  The period 
 36.12  of ineligibility begins in the month the transfer was reported 
 36.13  to the county agency, or if the transfer was not reported, the 
 36.14  month in which the county agency discovered the transfer, 
 36.15  whichever comes first.  For applicants, the period of 
 36.16  ineligibility begins on the date of the first approved 
 36.17  application. 
 36.18     (i) When determining eligibility for any state benefits 
 36.19  under this subdivision, the income and resources of all 
 36.20  noncitizens shall be deemed to include their sponsor's income 
 36.21  and resources as defined in the Personal Responsibility and Work 
 36.22  Opportunity Reconciliation Act of 1996, title IV, Public Law 
 36.23  104-193, sections 421 and 422, and subsequently set out in 
 36.24  federal rules. 
 36.25     (j) Undocumented noncitizens and nonimmigrants are 
 36.26  ineligible for general assistance medical care, except an 
 36.27  individual eligible under paragraph (a), clause (4), remains 
 36.28  eligible through September 30, 2003.  For purposes of this 
 36.29  subdivision, a nonimmigrant is an individual in one or more of 
 36.30  the classes listed in United States Code, title 8, section 
 36.31  1101(a)(15), and an undocumented noncitizen is an individual who 
 36.32  resides in the United States without the approval or 
 36.33  acquiescence of the Immigration and Naturalization Service. 
 36.34     (k) Notwithstanding any other provision of law, a 
 36.35  noncitizen who is ineligible for medical assistance due to the 
 36.36  deeming of a sponsor's income and resources, is ineligible for 
 37.1   general assistance medical care. 
 37.2      (l) Effective July 1, 2003, general assistance medical care 
 37.3   emergency services end.  
 37.4      Sec. 31.  Minnesota Statutes 2003 Supplement, section 
 37.5   256D.03, subdivision 4, is amended to read: 
 37.6      Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
 37.7   (a)(i) For a person who is eligible under subdivision 3, 
 37.8   paragraph (a), clause (2), item (i), general assistance medical 
 37.9   care covers, except as provided in paragraph (c): 
 37.10     (1) inpatient hospital services; 
 37.11     (2) outpatient hospital services; 
 37.12     (3) services provided by Medicare certified rehabilitation 
 37.13  agencies; 
 37.14     (4) prescription drugs and other products recommended 
 37.15  through the process established in section 256B.0625, 
 37.16  subdivision 13; 
 37.17     (5) equipment necessary to administer insulin and 
 37.18  diagnostic supplies and equipment for diabetics to monitor blood 
 37.19  sugar level; 
 37.20     (6) eyeglasses and eye examinations provided by a physician 
 37.21  or optometrist; 
 37.22     (7) hearing aids; 
 37.23     (8) prosthetic devices; 
 37.24     (9) laboratory and X-ray services; 
 37.25     (10) physician's services; 
 37.26     (11) medical transportation except special transportation; 
 37.27     (12) chiropractic services as covered under the medical 
 37.28  assistance program; 
 37.29     (13) podiatric services; 
 37.30     (14) dental services and dentures, subject to the 
 37.31  limitations specified in section 256B.0625, subdivision 9; 
 37.32     (15) outpatient services provided by a mental health center 
 37.33  or clinic that is under contract with the county board and is 
 37.34  established under section 245.62; 
 37.35     (16) day treatment services for mental illness provided 
 37.36  under contract with the county board; 
 38.1      (17) prescribed medications for persons who have been 
 38.2   diagnosed as mentally ill as necessary to prevent more 
 38.3   restrictive institutionalization; 
 38.4      (18) psychological services, medical supplies and 
 38.5   equipment, and Medicare premiums, coinsurance and deductible 
 38.6   payments; 
 38.7      (19) medical equipment not specifically listed in this 
 38.8   paragraph when the use of the equipment will prevent the need 
 38.9   for costlier services that are reimbursable under this 
 38.10  subdivision; 
 38.11     (20) services performed by a certified pediatric nurse 
 38.12  practitioner, a certified family nurse practitioner, a certified 
 38.13  adult nurse practitioner, a certified obstetric/gynecological 
 38.14  nurse practitioner, a certified neonatal nurse practitioner, or 
 38.15  a certified geriatric nurse practitioner in independent 
 38.16  practice, if (1) the service is otherwise covered under this 
 38.17  chapter as a physician service, (2) the service provided on an 
 38.18  inpatient basis is not included as part of the cost for 
 38.19  inpatient services included in the operating payment rate, and 
 38.20  (3) the service is within the scope of practice of the nurse 
 38.21  practitioner's license as a registered nurse, as defined in 
 38.22  section 148.171; 
 38.23     (21) services of a certified public health nurse or a 
 38.24  registered nurse practicing in a public health nursing clinic 
 38.25  that is a department of, or that operates under the direct 
 38.26  authority of, a unit of government, if the service is within the 
 38.27  scope of practice of the public health nurse's license as a 
 38.28  registered nurse, as defined in section 148.171; and 
 38.29     (22) telemedicine consultations, to the extent they are 
 38.30  covered under section 256B.0625, subdivision 3b.  
 38.31     (ii) Effective October 1, 2003, for a person who is 
 38.32  eligible under subdivision 3, paragraph (a), clause (2), item 
 38.33  (ii), general assistance medical care coverage is limited to 
 38.34  inpatient hospital services, including physician services 
 38.35  provided during the inpatient hospital stay.  A $1,000 
 38.36  deductible is required for each inpatient hospitalization.  
 39.1      (b) Gender reassignment surgery and related services are 
 39.2   not covered services under this subdivision unless the 
 39.3   individual began receiving gender reassignment services prior to 
 39.4   July 1, 1995.  
 39.5      (c) In order to contain costs, the commissioner of human 
 39.6   services shall select vendors of medical care who can provide 
 39.7   the most economical care consistent with high medical standards 
 39.8   and shall where possible contract with organizations on a 
 39.9   prepaid capitation basis to provide these services.  The 
 39.10  commissioner shall consider proposals by counties and vendors 
 39.11  for prepaid health plans, competitive bidding programs, block 
 39.12  grants, or other vendor payment mechanisms designed to provide 
 39.13  services in an economical manner or to control utilization, with 
 39.14  safeguards to ensure that necessary services are provided.  
 39.15  Before implementing prepaid programs in counties with a county 
 39.16  operated or affiliated public teaching hospital or a hospital or 
 39.17  clinic operated by the University of Minnesota, the commissioner 
 39.18  shall consider the risks the prepaid program creates for the 
 39.19  hospital and allow the county or hospital the opportunity to 
 39.20  participate in the program in a manner that reflects the risk of 
 39.21  adverse selection and the nature of the patients served by the 
 39.22  hospital, provided the terms of participation in the program are 
 39.23  competitive with the terms of other participants considering the 
 39.24  nature of the population served.  Payment for services provided 
 39.25  pursuant to this subdivision shall be as provided to medical 
 39.26  assistance vendors of these services under sections 256B.02, 
 39.27  subdivision 8, and 256B.0625.  For payments made during fiscal 
 39.28  year 1990 and later years, the commissioner shall consult with 
 39.29  an independent actuary in establishing prepayment rates, but 
 39.30  shall retain final control over the rate methodology.  
 39.31     (d) Recipients eligible under subdivision 3, paragraph (a), 
 39.32  clause (2), item (i), shall pay the following co-payments for 
 39.33  services provided on or after October 1, 2003: 
 39.34     (1) $3 per nonpreventive visit.  For purposes of this 
 39.35  subdivision, a visit means an episode of service which is 
 39.36  required because of a recipient's symptoms, diagnosis, or 
 40.1   established illness, and which is delivered in an ambulatory 
 40.2   setting by a physician or physician ancillary, chiropractor, 
 40.3   podiatrist, nurse midwife, advanced practice nurse, audiologist, 
 40.4   optician, or optometrist; 
 40.5      (2) $25 for eyeglasses; 
 40.6      (3) $25 for nonemergency visits to a hospital-based 
 40.7   emergency room; 
 40.8      (4) $3 per brand-name drug prescription and $1 per generic 
 40.9   drug prescription, subject to a $20 per month maximum for 
 40.10  prescription drug co-payments.  No co-payments shall apply to 
 40.11  antipsychotic drugs when used for the treatment of mental 
 40.12  illness; and 
 40.13     (5) 50 percent coinsurance on basic restorative dental 
 40.14  services. 
 40.15     (e) Recipients of general assistance medical care are 
 40.16  responsible for all co-payments in this subdivision.  The 
 40.17  general assistance medical care reimbursement to the provider 
 40.18  shall be reduced by the amount of the co-payment, except that 
 40.19  reimbursement for prescription drugs shall not be reduced once a 
 40.20  recipient has reached the $20 per month maximum for prescription 
 40.21  drug co-payments.  The provider collects the co-payment from the 
 40.22  recipient.  Providers may not deny services to recipients who 
 40.23  are unable to pay the co-payment, except as provided in 
 40.24  paragraph (f). 
 40.25     (f) If it is the routine business practice of a provider to 
 40.26  refuse service to an individual with uncollected debt, the 
 40.27  provider may include uncollected co-payments under this 
 40.28  section.  A provider must give advance notice to a recipient 
 40.29  with uncollected debt before services can be denied There shall 
 40.30  be no co-payment required of any recipient of benefits for any 
 40.31  services provided under this subdivision. 
 40.32     (g) (e) Any county may, from its own resources, provide 
 40.33  medical payments for which state payments are not made. 
 40.34     (h) (f) Chemical dependency services that are reimbursed 
 40.35  under chapter 254B must not be reimbursed under general 
 40.36  assistance medical care. 
 41.1      (i) (g) The maximum payment for new vendors enrolled in the 
 41.2   general assistance medical care program after the base year 
 41.3   shall be determined from the average usual and customary charge 
 41.4   of the same vendor type enrolled in the base year. 
 41.5      (j) (h) The conditions of payment for services under this 
 41.6   subdivision are the same as the conditions specified in rules 
 41.7   adopted under chapter 256B governing the medical assistance 
 41.8   program, unless otherwise provided by statute or rule. 
 41.9      (k) (i) Inpatient and outpatient payments shall be reduced 
 41.10  by five percent, effective July 1, 2003.  This reduction is in 
 41.11  addition to the five percent reduction effective July 1, 2003, 
 41.12  and incorporated by reference in paragraph (i) (g).  
 41.13     (l) (j) Payments for all other health services except 
 41.14  inpatient, outpatient, and pharmacy services shall be reduced by 
 41.15  five percent, effective July 1, 2003.  
 41.16     (m) (k) Payments to managed care plans shall be reduced by 
 41.17  five percent for services provided on or after October 1, 2003. 
 41.18     (n) (l) A hospital receiving a reduced payment as a result 
 41.19  of this section may apply the unpaid balance toward satisfaction 
 41.20  of the hospital's bad debts. 
 41.21     Sec. 32.  Minnesota Statutes 2003 Supplement, section 
 41.22  256L.03, subdivision 1, is amended to read: 
 41.23     Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
 41.24  under section 256L.04, subdivision 7, with income no greater 
 41.25  than 75 percent of the federal poverty guidelines or for 
 41.26  families with children under section 256L.04, subdivision 1, all 
 41.27  subdivisions of this section apply.  "Covered health services" 
 41.28  means the health services reimbursed under chapter 256B, with 
 41.29  the exception of inpatient hospital services, special education 
 41.30  services, private duty nursing services, adult dental care 
 41.31  services other than preventive services covered under section 
 41.32  256B.0625, subdivision 9, paragraph (b), orthodontic services, 
 41.33  nonemergency medical transportation services, personal care 
 41.34  assistant and case management services, nursing home or 
 41.35  intermediate care facilities services, inpatient mental health 
 41.36  services, and chemical dependency services.  Adult dental care 
 42.1   for nonpreventive services, with the exception of orthodontic 
 42.2   services, is covered for persons who qualify under section 
 42.3   256L.04, subdivisions 1, 2, and 7, with family gross income 
 42.4   equal to or less than 175 percent of the federal poverty 
 42.5   guidelines.  Outpatient mental health services covered under the 
 42.6   MinnesotaCare program are limited to diagnostic assessments, 
 42.7   psychological testing, explanation of findings, medication 
 42.8   management by a physician, day treatment, partial 
 42.9   hospitalization, and individual, family, and group psychotherapy.
 42.10     No public funds shall be used for coverage of abortion 
 42.11  under MinnesotaCare except where the life of the female would be 
 42.12  endangered or substantial and irreversible impairment of a major 
 42.13  bodily function would result if the fetus were carried to term; 
 42.14  or where the pregnancy is the result of rape or incest. 
 42.15     Covered health services shall be expanded as provided in 
 42.16  this section. 
 42.17     Sec. 33.  Minnesota Statutes 2003 Supplement, section 
 42.18  256L.05, subdivision 4, is amended to read: 
 42.19     Subd. 4.  [APPLICATION PROCESSING.] The commissioner of 
 42.20  human services shall determine an applicant's eligibility for 
 42.21  MinnesotaCare no more than 30 days from the date that the 
 42.22  application is received by the Department of Human Services.  
 42.23  Beginning January 1, 2000, this requirement also applies to 
 42.24  local county human services agencies that determine eligibility 
 42.25  for MinnesotaCare.  At application or reenrollment, to prevent 
 42.26  processing delays, applicants or enrollees who, from the 
 42.27  information provided on the application, appear to meet 
 42.28  eligibility requirements shall be enrolled upon timely payment 
 42.29  of premiums.  The enrollee must provide all required 
 42.30  verifications within 30 days of notification of the eligibility 
 42.31  determination or coverage from the program shall be terminated.  
 42.32  Enrollees who are determined to be ineligible when verifications 
 42.33  are provided shall be disenrolled from the program.  
 42.34     Sec. 34.  Minnesota Statutes 2003 Supplement, section 
 42.35  256L.07, subdivision 1, is amended to read: 
 42.36     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
 43.1   enrolled in the original children's health plan as of September 
 43.2   30, 1992, children who enrolled in the MinnesotaCare program 
 43.3   after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 43.4   article 4, section 17, and children who have family gross 
 43.5   incomes that are equal to or less than 150 percent of the 
 43.6   federal poverty guidelines are eligible without meeting the 
 43.7   requirements of subdivision 2 and the four-month requirement in 
 43.8   subdivision 3, as long as they maintain continuous coverage in 
 43.9   the MinnesotaCare program or medical assistance.  Children who 
 43.10  apply for MinnesotaCare on or after the implementation date of 
 43.11  the employer-subsidized health coverage program as described in 
 43.12  Laws 1998, chapter 407, article 5, section 45, who have family 
 43.13  gross incomes that are equal to or less than 150 percent of the 
 43.14  federal poverty guidelines, must meet the requirements of 
 43.15  subdivision 2 to be eligible for MinnesotaCare. 
 43.16     (b) Families enrolled in MinnesotaCare under section 
 43.17  256L.04, subdivision 1, whose income increases above 275 percent 
 43.18  of the federal poverty guidelines, are no longer eligible for 
 43.19  the program and shall be disenrolled by the commissioner.  
 43.20  Individuals enrolled in MinnesotaCare under section 256L.04, 
 43.21  subdivision 7, whose income increases above 175 percent of the 
 43.22  federal poverty guidelines are no longer eligible for the 
 43.23  program and shall be disenrolled by the commissioner.  For 
 43.24  persons disenrolled under this subdivision, MinnesotaCare 
 43.25  coverage terminates the last day of the calendar month following 
 43.26  the month in which the commissioner determines that the income 
 43.27  of a family or individual exceeds program income limits.  
 43.28     (c)(1) Notwithstanding paragraph (b), individuals and 
 43.29  families enrolled in MinnesotaCare under section 256L.04, 
 43.30  subdivision 1, may remain enrolled in MinnesotaCare if ten 
 43.31  percent of their annual income is less than the annual premium 
 43.32  for a policy with a $500 deductible available through the 
 43.33  Minnesota Comprehensive Health Association.  Individuals and 
 43.34  families who are no longer eligible for MinnesotaCare under this 
 43.35  subdivision shall be given an 18-month a 12-month notice period 
 43.36  from the date that ineligibility is determined before 
 44.1   disenrollment.  This clause expires February 1, 2004. 
 44.2      (2) Effective February 1, 2004, notwithstanding paragraph 
 44.3   (b), children may remain enrolled in MinnesotaCare if ten 
 44.4   percent of their annual family income is less than the annual 
 44.5   premium for a policy with a $500 deductible available through 
 44.6   the Minnesota Comprehensive Health Association.  Children who 
 44.7   are no longer eligible for MinnesotaCare under this clause shall 
 44.8   be given a 12-month notice period from the date that 
 44.9   ineligibility is determined before disenrollment.  The premium 
 44.10  for children individuals and families remaining eligible under 
 44.11  this clause paragraph shall be the maximum premium determined 
 44.12  under section 256L.15, subdivision 2, paragraph (b). 
 44.13     (d) Effective July 1, 2003, notwithstanding paragraphs (b) 
 44.14  and (c), parents are no longer eligible for MinnesotaCare if 
 44.15  gross household income exceeds $50,000. 
 44.16     Sec. 35.  Minnesota Statutes 2003 Supplement, section 
 44.17  256L.12, subdivision 6, is amended to read: 
 44.18     Subd. 6.  [CO-PAYMENTS AND BENEFIT LIMITS.] Enrollees are 
 44.19  responsible for all co-payments in sections section 256L.03, 
 44.20  subdivision 5, and 256L.035, and shall pay co-payments to the 
 44.21  managed care plan or to its participating providers.  The 
 44.22  enrollee is also responsible for payment of inpatient hospital 
 44.23  charges which exceed the MinnesotaCare benefit limit. 
 44.24     Sec. 36.  [256L.20] [MINNESOTACARE OPTION FOR SMALL 
 44.25  EMPLOYERS.] 
 44.26     Subdivision 1.  [DEFINITIONS.] (a) For the purpose of this 
 44.27  section, the definitions have the meanings given them.  
 44.28     (b) "Dependent" means an unmarried child under 21 years of 
 44.29  age.  
 44.30     (c) "Eligible employer" means a business that employs at 
 44.31  least two, but not more than 50, eligible employees, the 
 44.32  majority of whom are employed in the state, and includes a 
 44.33  municipality that has 50 or fewer employees.  
 44.34     (d) "Eligible employee" means an employee who works at 
 44.35  least 20 hours per week for an eligible employer.  Eligible 
 44.36  employee does not include an employee who works on a temporary 
 45.1   or substitute basis or who does not work more than 26 weeks 
 45.2   annually.  
 45.3      (e) "Maximum premium" has the meaning given under section 
 45.4   256L.15, subdivision 2, paragraph (b), clause (3). 
 45.5      (f) "Participating employer" means an eligible employer who 
 45.6   meets the requirements described in subdivision 3 and applies to 
 45.7   the commissioner to enroll its eligible employees and their 
 45.8   dependents in the MinnesotaCare program.  
 45.9      (g) "Program" means the MinnesotaCare program.  
 45.10     Subd. 2.  [OPTION.] Eligible employees and their dependents 
 45.11  may enroll in MinnesotaCare if the eligible employer meets the 
 45.12  requirements of subdivision 3.  The effective date of coverage 
 45.13  is according to section 265L.05, subdivision 3. 
 45.14     Subd. 3.  [EMPLOYER REQUIREMENTS.] The commissioner shall 
 45.15  establish procedures for an eligible employer to apply for 
 45.16  coverage through the program.  In order to participate, an 
 45.17  eligible employer must meet the following requirements:  
 45.18     (1) agrees to contribute toward the cost of the premium for 
 45.19  the employee and the employee's dependents according to 
 45.20  subdivision 4; 
 45.21     (2) certifies that at least 75 percent of its eligible 
 45.22  employees who do not have other creditable health coverage are 
 45.23  enrolled in the program; 
 45.24     (3) offers coverage to all eligible employees and the 
 45.25  dependents of eligible employees; and 
 45.26     (4) has not provided employer-subsidized health coverage as 
 45.27  an employee benefit during the previous 12 months, as defined in 
 45.28  section 256L.07, subdivision 2, paragraph (c).  
 45.29     Subd. 4.  [PREMIUMS.] (a) The premium for MinnesotaCare 
 45.30  coverage provided under this section is equal to the maximum 
 45.31  premium regardless of the income of the eligible employee.  
 45.32     (b) For eligible employees without dependents with income 
 45.33  equal to or less than 175 percent of the federal poverty 
 45.34  guidelines and for eligible employees with dependents with 
 45.35  income equal to or less than 275 percent of the federal poverty 
 45.36  guidelines, the participating employer shall pay 50 percent of 
 46.1   the maximum premium for the eligible employee and any 
 46.2   dependents, if applicable.  
 46.3      (c) For eligible employees without dependents with income 
 46.4   over 175 percent of the federal poverty guidelines and for 
 46.5   eligible employees with dependents with income over 275 percent 
 46.6   of the federal poverty guidelines, the participating employer 
 46.7   shall pay the full cost of the maximum premium for the eligible 
 46.8   employee and any dependents, if applicable.  The participating 
 46.9   employer may require the employee to pay a portion of the cost 
 46.10  of the premium so long as the employer pays 50 percent of the 
 46.11  cost.  If the employer requires the employee to pay a portion of 
 46.12  the premium, the employee shall pay the portion of the cost to 
 46.13  the employer.  
 46.14     (d) The commissioner shall collect premium payments from 
 46.15  participating employers for eligible employees and their 
 46.16  dependents who are covered by the program as provided under this 
 46.17  section.  All premiums collected shall be deposited in the 
 46.18  health care access fund.  
 46.19     Subd. 5.  [COVERAGE.] The coverage offered to those 
 46.20  enrolled in the program under this section must include all 
 46.21  health services described under section 256L.03 and all 
 46.22  co-payments and coinsurance requirements described under section 
 46.23  256L.03, subdivision 5, shall apply.  
 46.24     Subd. 6.  [ENROLLMENT.] Upon payment of the premium, in 
 46.25  accordance with this section and section 256L.06, eligible 
 46.26  employees and their dependents shall be enrolled in 
 46.27  MinnesotaCare.  For purposes of enrollment under this section, 
 46.28  income eligibility limits established under sections 256L.04 and 
 46.29  256L.07, subdivision 1, and asset limits established under 
 46.30  section 256L.17 do not apply.  The barriers established under 
 46.31  section 256L.07, subdivision 2 or 3, do not apply to enrollees 
 46.32  eligible under this section.  The commissioner may require 
 46.33  eligible employees to provide income verification to determine 
 46.34  premiums. 
 46.35     Sec. 37.  Laws 2003, First Special Session chapter 14, 
 46.36  article 6, section 65, is amended to read: 
 47.1      Sec. 65.  [FEDERAL GRANTS TO MAINTAIN INDEPENDENCE AND 
 47.2   EMPLOYMENT.] 
 47.3      (a) The commissioner of human services shall seek federal 
 47.4   funding to participate in grant activities authorized under 
 47.5   Public Law 106-170, the Ticket to Work and Work Incentives 
 47.6   Improvement Act of 1999.  The purpose of the federal grant funds 
 47.7   are to establish: 
 47.8      (1) a demonstration project to improve the availability of 
 47.9   health care services and benefits to workers with potentially 
 47.10  severe physical or mental impairments that are likely to lead to 
 47.11  disability without access to Medicaid services; and 
 47.12     (2) a comprehensive initiative to remove employment 
 47.13  barriers that includes linkages with non-Medicaid programs, 
 47.14  including those administered by the Social Security 
 47.15  Administration and the Department of Labor. 
 47.16     (b) The state's proposal for a demonstration project in 
 47.17  paragraph (a), clause (1), shall focus on assisting workers with:
 47.18     (1) a serious mental illness as defined by the federal 
 47.19  Center for Mental Health Services; 
 47.20     (2) concurrent mental health and chemical dependency 
 47.21  conditions; and 
 47.22     (3) young adults up to the age of 24 who have a physical or 
 47.23  mental impairment that is severe and will potentially lead to a 
 47.24  determination of disability by the Social Security 
 47.25  Administration or state medical review team; and 
 47.26     (4) adults without children who are eligible for 
 47.27  MinnesotaCare and who suffer from one or more of the following 
 47.28  chronic health conditions:  diabetes, hypertension, coronary 
 47.29  artery disease, asthma, thyroid disease, cancer, chronic 
 47.30  arthritis, HIV, or multiple sclerosis. 
 47.31     (c) The commissioner is authorized to take the actions 
 47.32  necessary to design and implement the demonstration project in 
 47.33  paragraph (a), clause (1), that include: 
 47.34     (1) establishing work-related requirements for 
 47.35  participation in the demonstration project; 
 47.36     (2) working with stakeholders to establish methods that 
 48.1   identify the population that will be served in the demonstration 
 48.2   project; 
 48.3      (3) seeking funding for activities to design, implement, 
 48.4   and evaluate the demonstration project; 
 48.5      (4) taking necessary administrative actions to implement 
 48.6   the demonstration project by July 1, 2004, or within 180 days of 
 48.7   receiving formal notice from the Centers for Medicare and 
 48.8   Medicaid Services that a grant has been awarded; 
 48.9      (5) establishing limits on income and resources; 
 48.10     (6) establishing a method to coordinate health care 
 48.11  benefits and payments with other coverage that is available to 
 48.12  the participants; 
 48.13     (7) establishing premiums based on guidelines that are 
 48.14  consistent with those found in Minnesota Statutes, section 
 48.15  256B.057, subdivision 9, for employed persons with disabilities; 
 48.16     (8) notifying local agencies of potentially eligible 
 48.17  individuals in accordance with Minnesota Statutes, section 
 48.18  256B.19, subdivision 2c; and 
 48.19     (9) limiting the caseload of qualifying individuals 
 48.20  participating in the demonstration project. 
 48.21     (d) The state's proposal for the comprehensive employment 
 48.22  initiative in paragraph (a), clause (2), shall focus on: 
 48.23     (1) infrastructure development that creates incentives for 
 48.24  greater work effort and participation by people with 
 48.25  disabilities or workers with severe physical or mental 
 48.26  impairments; 
 48.27     (2) consumer access to information and benefit assistance 
 48.28  that enables the person to maximize employment and career 
 48.29  advancement potential; 
 48.30     (3) improved consumer access to essential assistance and 
 48.31  support; 
 48.32     (4) enhanced linkages between state and federal agencies to 
 48.33  decrease the barriers to employment experienced by persons with 
 48.34  disabilities or workers with severe physical or mental 
 48.35  impairments; and 
 48.36     (5) research efforts to provide useful information to guide 
 49.1   future policy development on both the state and federal levels. 
 49.2      (e) Funds awarded by the federal government for the 
 49.3   purposes of this section are appropriated to the commissioner of 
 49.4   human services. 
 49.5      (f) The commissioner shall report to the chairs of the 
 49.6   senate and house of representatives finance divisions having 
 49.7   jurisdiction over health care issues on the federal approval of 
 49.8   the waiver under this section and the projected savings in the 
 49.9   November and February forecasts.  Any savings projected for the 
 49.10  individuals described in paragraph (a), clause (4), shall be 
 49.11  deposited in the health care access fund.  
 49.12     The commissioner must consider using the savings to 
 49.13  increase GAMC hospital rates to the July 1, 2003 2004, levels as 
 49.14  a supplemental budget proposal in the 2004 2005 legislative 
 49.15  session. 
 49.16     Sec. 38.  [FEDERAL 340B DRUG PRICING PROGRAM INFORMATION.] 
 49.17     The commissioner of human services, in consultation with 
 49.18  the commissioner of corrections, shall examine the feasibility 
 49.19  of providing discounted prescription drugs to targeted patient 
 49.20  populations through the use of section 340B of the federal 
 49.21  Public Health Services Act, United States Code, title 42, 
 49.22  section 256b (1999).  The commissioner of human services shall 
 49.23  also consult with other state agencies and representatives of 
 49.24  health care providers and facilities in the state to provide the 
 49.25  following information:  
 49.26     (1) a description of all health care providers and 
 49.27  facilities in the state potentially eligible for designation as 
 49.28  a "covered entity" under section 340B, including, but not 
 49.29  limited to, all hospitals eligible as disproportionate share 
 49.30  hospitals; recipients of grants from the United States Public 
 49.31  Health Service; federally qualified health centers; 
 49.32  state-operated AIDS drug assistance programs; Ryan White Care 
 49.33  Act, title I, title II, and title III programs; family planning 
 49.34  and sexually transmitted disease clinics; hemophilia treatment 
 49.35  centers; public housing primary care clinics; and clinics for 
 49.36  homeless people.  The commissioner shall encourage those 
 50.1   facilities that are or may be eligible to participate in the 
 50.2   program and shall provide any necessary technical assistance to 
 50.3   access the program; and 
 50.4      (2) a list of potential applications of section 340B and 
 50.5   the potential benefits to public, private, and third-party 
 50.6   payers, including, but not limited to: 
 50.7      (i) application to inmates and employees in youth 
 50.8   correctional facilities, county jails, and state prisons; 
 50.9      (ii) maximizing the use of section 340B within state-funded 
 50.10  managed care plans; 
 50.11     (iii) including section 340B providers in state bulk 
 50.12  purchasing initiatives; and 
 50.13     (iv) utilizing sole source contracts with section 340B 
 50.14  providers to furnish high-cost chronic care drugs. 
 50.15     Sec. 39.  [DISEASE MANAGEMENT PROGRAM ACCOUNTABILITY.] 
 50.16     (a) The commissioner of human services shall establish an 
 50.17  estimated cost savings to medical assistance, general assistance 
 50.18  medical care, and the MinnesotaCare program due to the 
 50.19  implementation of the disease management initiatives required 
 50.20  under Minnesota Statutes, section 256B.075. 
 50.21     (b) The commissioner shall submit a recommendation to the 
 50.22  legislature by January 15, 2006, on whether to reduce the 
 50.23  managed care plan payments under Minnesota Statutes, section 
 50.24  256B.69, to reflect the estimated cost savings, and if so, the 
 50.25  amount of the reduction. 
 50.26     Sec. 40.  [HEALTH CARE REPORTING CONSOLIDATION STUDY.] 
 50.27     The commissioners of human services, health, and commerce 
 50.28  shall meet with representatives of health plans, insurance 
 50.29  companies, nonprofit health service plan corporations, and 
 50.30  hospitals, to discuss all of the reports and reporting 
 50.31  requirements that are required of these entities with the 
 50.32  intention of consolidating, and where appropriate, reducing the 
 50.33  number of reports and reporting requirements.  These discussions 
 50.34  shall be conducted prior to November 30, 2004.  The 
 50.35  commissioners of human services, health, and commerce shall 
 50.36  submit a report to the legislature by January 15, 2005.  The 
 51.1   report shall identify the name and scope of each required report 
 51.2   with justification as to the need and use of each report, 
 51.3   including the value to consumers and to what extent the report 
 51.4   is used to help decrease costs or increase the quality of care 
 51.5   or services provided.  
 51.6      Sec. 41.  [MINNESOTACARE OPTION FOR SMALL EMPLOYERS.] 
 51.7      The commissioner of human services, in consultation with 
 51.8   the Minnesota Hospital Association, Minnesota Medical 
 51.9   Association, Minnesota Chamber of Commerce, and the Minnesota 
 51.10  Business Partnership shall evaluate the effect of the limited 
 51.11  hospital benefit under the MinnesotaCare program for single 
 51.12  adults without children as it applies to the MinnesotaCare 
 51.13  enrollment option for small employers described under Minnesota 
 51.14  Statutes, section 256L.20.  In the evaluation, the commissioner 
 51.15  shall determine whether this limitation discourages 
 51.16  participation in the program by small employers, whether it has 
 51.17  added to the amount of uncompensated care provided by hospitals, 
 51.18  and the cost to the MinnesotaCare program if the hospital 
 51.19  benefit limitation was eliminated for enrollees enrolled under 
 51.20  Minnesota Statutes, section 256L.20.  The commissioner shall 
 51.21  submit the results of the evaluation to the legislature by 
 51.22  January 15, 2006. 
 51.23     Sec. 42.  [TASK FORCE ON IMPROVING THE HEALTH STATUS OF THE 
 51.24  STATE'S CHILDREN.] 
 51.25     (a) The commissioners of education, health, and human 
 51.26  services shall convene a task force to study and make 
 51.27  recommendations on the role of public schools in improving the 
 51.28  health status of children.  In order to assess the health status 
 51.29  of children, the task force shall determine the number of 
 51.30  children who are currently obese and set a goal, including 
 51.31  measurable outcomes for the state in terms of reducing the rate 
 51.32  of childhood obesity.  The task force shall make recommendations 
 51.33  on how to achieve this goal, including, but not limited to, 
 51.34  increasing physical education activities within the public 
 51.35  schools; exploring opportunities to promote physical education 
 51.36  and healthy eating programs; improving the nutritional offerings 
 52.1   through breakfast and lunch menus; and evaluating the 
 52.2   availability and choice of nutritional products offered in 
 52.3   public schools.  The members of the task force shall include 
 52.4   representatives of the Minnesota Medical Association; Minnesota 
 52.5   Nurses Association; Local Public Health Association of 
 52.6   Minnesota; the Minnesota Dietetic Association; Minnesota School 
 52.7   Food Service Association; the Minnesota Association of Health, 
 52.8   Physical Education, Recreation, and Dance; the Minnesota School 
 52.9   Boards Association; the Minnesota School Administrators 
 52.10  Association; the Minnesota Secondary Principals Association; the 
 52.11  vending industry; and consumers.  The terms and compensation of 
 52.12  the members of the task force shall be in accordance with 
 52.13  Minnesota Statutes, section 15.059, subdivision 6.  
 52.14     (b) The commissioner must submit the recommendations of the 
 52.15  task force to the legislature by January 15, 2005. 
 52.16     Sec. 43.  [QUALITY IMPROVEMENT.] 
 52.17     The commissioners of human services and employee relations 
 52.18  shall jointly develop a written plan for a provider payment 
 52.19  system to be implemented by January 1, 2006.  Under the provider 
 52.20  payment system, a minimum of five percent of a provider's 
 52.21  payment shall be withheld.  Return of the withhold to a provider 
 52.22  will be conditioned on the provider achieving certain quality 
 52.23  improvement performance standards.  The commissioners shall 
 52.24  consult with local and national quality improvement groups to 
 52.25  identify appropriate standards and measures related to 
 52.26  performance.  The plan must be submitted to the legislature by 
 52.27  March 1, 2005.  This provision does not prohibit the 
 52.28  commissioners from negotiating the implementation of 
 52.29  performance-based payment terms with particular providers prior 
 52.30  to January 1, 2006. 
 52.31     Sec. 44.  [APPROPRIATION.] 
 52.32     (a) $.......  is appropriated for fiscal year 2005 from the 
 52.33  general fund to the Board of Trustees of the Minnesota State 
 52.34  Colleges and Universities for the nursing and health care 
 52.35  education plan designed to: 
 52.36     (1) expand the system's enrollment in registered nursing 
 53.1   education programs; 
 53.2      (2) support practical nursing programs in regions of high 
 53.3   need; 
 53.4      (3) address the shortage of nursing faculty; and 
 53.5      (4) provide accessible learning opportunities to students 
 53.6   through distance education and simulation experiences.  
 53.7      (b) $....... is appropriated from the general fund to the 
 53.8   commissioner of finance for transfer to the electronic medical 
 53.9   record system loan fund to capitalize the fund.  The 
 53.10  appropriation is available until expended. 
 53.11     (c) $....... is appropriated for fiscal year 2005 from the 
 53.12  general fund to the commissioner of health for the loan 
 53.13  forgiveness program in Minnesota Statutes, section 144.1501.  
 53.14     (d) $500,000 is appropriated in fiscal year 2005 to the 
 53.15  Board of Regents of the University of Minnesota for the 
 53.16  University of Minnesota's dental clinic to address dental care 
 53.17  access for low-income patients. 
 53.18     Sec. 45.  [REPEALER.] 
 53.19     Minnesota Statutes 2003 Supplement, sections 256.954, 
 53.20  subdivision 12; 256B.0631; and 256L.035, are repealed.