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SF 2

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health care; establishing premium rate restrictions and expenditure
limits; requiring an interoperable electronic health records system; requiring a
plan to achieve universal health care; expanding the definition of dependent
coverage; eliminating the modification to the MinnesotaCare application form;
implementing an intensive care management program; increasing reimbursement
for critical access dental providers; extending medical assistance coverage to
Medicare Part D co-payments; creating grants for nonprofit dental providers with
a high proportion of uninsured patients; eliminating co-payments for medical
assistance and general assistance medical care; modifying the period of renewal
for MinnesotaCare; modifying the definition of employer-subsidized insurance;
providing for MinnesotaCare outreach; creating a prescription drug discount
program; expanding the benefit set for single adults; increasing the eligibility
income limit for single adults; increasing the cap for inpatient hospitalization
benefits for adults; modifying the definition of income for self-employed
farmers; removing insurance barriers for children in MinnesotaCare; eliminating
MinnesotaCare premiums for members of the military and their families;
reducing premiums for MinnesotaCare; restoring family planning grants;
creating a patient incentive health program; requiring uniform billing forms;
establishing a small employer option; proposing an amendment to the Minnesota
Constitution, article XIII, by adding a section; affirming that every resident
of Minnesota has the right to affordable health care; appropriating money;
amending Minnesota Statutes 2006, sections 62A.65, subdivision 3; 62E.02,
subdivision 7; 62J.04, subdivision 3, by adding a subdivision; 62J.041; 62J.301,
subdivision 3; 62J.38; 62J.495; 62L.02, subdivision 11; 62L.08, subdivision
8; 62Q.165, subdivisions 1, 2, by adding a subdivision; 256.01, subdivision
2b; 256B.056, subdivision 10; 256B.0625, by adding a subdivision; 256B.075,
subdivision 2; 256B.76; 256D.03, subdivisions 3, 4; 256L.01, subdivision 4;
256L.03, subdivisions 1, 3, 5; 256L.04, subdivisions 1a, 7, 10, by adding a
subdivision; 256L.05, subdivisions 1b, 2, 3a; 256L.07, subdivisions 1, 2, 3, 6;
256L.15, subdivisions 1, 2, 4; 256L.17, subdivision 7; Laws 2005, First Special
Session chapter 4, article 9, section 3, subdivision 2; proposing coding for new
law in Minnesota Statutes, chapters 256; 256L; repealing Minnesota Statutes
2006, sections 62A.301; 256B.0631; 256L.035.

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

Section 1.

Minnesota Statutes 2006, section 62A.65, subdivision 3, is amended to read:


Subd. 3.

Premium rate restrictions.

No individual health plan may be offered,
sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
determined in accordance with the following requirements:

(a) Premium rates must be no more than 25 percent above and no more than 25
percent below the index rate charged to individuals for the same or similar coverage,
adjusted pro rata for rating periods of less than one year. The premium variations
permitted by this paragraph must be based only upon health status, claims experience,
and occupation. For purposes of this paragraph, health status includes refraining from
tobacco use or other actuarially valid lifestyle factors associated with good health,
provided that the lifestyle factor and its effect upon premium rates have been determined
by the commissioner to be actuarially valid and have been approved by the commissioner.
Variations permitted under this paragraph must not be based upon age or applied
differently at different ages. This paragraph does not prohibit use of a constant percentage
adjustment for factors permitted to be used under this paragraph.

(b) Premium rates may vary based upon the ages of covered persons only as
provided in this paragraph. In addition to the variation permitted under paragraph (a),
each health carrier may use an additional premium variation based upon age of up to
plus or minus 50 percent of the index rate.

(c) A health carrier may request approval by the commissioner to establish separate
geographic regions determined by the health carrier and to establish separate index rates
for each such region. The commissioner shall grant approval if the following conditions
are met:

(1) the geographic regions must be applied uniformly by the health carrier;

(2) each geographic region must be composed of no fewer than seven counties that
create a contiguous region; and

(3) the health carrier provides actuarial justification acceptable to the commissioner
for the proposed geographic variations in index rates, establishing that the variations are
based upon differences in the cost to the health carrier of providing coverage.

(d) Health carriers may use rate cells and must file with the commissioner the rate
cells they use. Rate cells must be based upon the number of adults or children covered
under the policy and may reflect the availability of Medicare coverage. The rates for
different rate cells must not in any way reflect generalized differences in expected costs
between principal insureds and their spouses.

(e) In developing its index rates and premiums for a health plan, a health carrier shall
take into account only the following factors:

(1) actuarially valid differences in rating factors permitted under paragraphs (a)
and (b); and

(2) actuarially valid geographic variations if approved by the commissioner as
provided in paragraph (c).

(f) All premium variations must be justified in initial rate filings and upon request of
the commissioner in rate revision filings. All rate variations are subject to approval by
the commissioner.

(g) The loss ratio must comply with the section 62A.021 requirements for individual
health plans.

(h) new text begin Notwithstanding paragraphs (a) to (g), new text end the rates must not be approved, unless the
commissioner has determined that the rates are reasonable. In determining reasonableness,
the commissioner shall deleted text begin consider the growth rates applied under section 62J.04, subdivision
1
, paragraph (b)
deleted text end new text begin apply the premium growth limits established under section 62J.04,
subdivision 1b
new text end , to the calendar year or years that the proposed premium rate would be in
effect, new text begin and shall consider new text end actuarially valid changes in risks associated with the enrollee
populations, and actuarially valid changes as a result of statutory changes in Laws 1992,
chapter 549.

(i) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under
section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
paragraph. The rating practices guarantee must be in writing and must guarantee that
the policy form will be offered, sold, issued, and renewed only with premium rates and
premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices
guarantee must be accompanied by an actuarial memorandum that demonstrates that the
premium rates and premium rating system used in connection with the policy form will
satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to
policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4,
or 5. An insurer that complies with this paragraph in connection with a policy form is
exempt from the requirement of prior approval by the commissioner under paragraphs
(c), (f), and (h).

Sec. 2.

Minnesota Statutes 2006, section 62E.02, subdivision 7, is amended to read:


Subd. 7.

Dependent.

"Dependent" means a spouse or unmarried child deleted text begin under the
age of 19 years, a dependent child
deleted text end who is deleted text begin a studentdeleted text end under the age of 25new text begin regardless of
whether the dependent child is enrolled in an educational institution
new text end , or a dependent
child of any age who is disabled.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2008.
new text end

Sec. 3.

Minnesota Statutes 2006, section 62J.04, is amended by adding a subdivision to
read:


new text begin Subd. 1b. new text end

new text begin Premium growth limits. new text end

new text begin (a) For calendar year 2008 and each year
thereafter, the commissioner shall set annual premium growth limits for health plan
companies. The premium limits set by the commissioner for calendar years 2008 to 2013
shall not exceed the regional Consumer Price Index for urban consumers for the preceding
calendar year plus two percentage points and an additional one percentage point to be used
to finance the implementation of the electronic medical record system described under
section 62J.495. The commissioner shall ensure that the additional percentage point is
being used to provide financial assistance to health care providers to implement electronic
medical record systems either directly or through an increase in reimbursement.
new text end

new text begin (b) For the calendar years beyond 2013, the rate of premium growth shall be
limited to the change in the Consumer Price Index for urban consumers for the previous
calendar year plus two percentage points. The commissioners of health and commerce
shall make a recommendation to the legislature by January 15, 2012, regarding the
continuation of the additional percentage point to the growth limit described in paragraph
(a). The recommendation shall be based on the progress made by health care providers
in instituting an electronic medical record system and in creating a statewide interactive
electronic health record system.
new text end

new text begin (c) The commissioner may add additional percentage points as needed to the
premium limit for a calendar year if a major disaster, bioterrorism, or a public health
emergency occurs that results in higher health care costs. Any additional percentage
points must reflect the additional cost to the health care system directly attributed to
the disaster or emergency.
new text end

new text begin (d) The commissioner shall publish the annual premium growth limits in the State
Register by January 31 of the year that the limits are to be in effect.
new text end

new text begin (e) For the purposes of this subdivision, premium growth is measured as the
percentage change in per member, per month premium revenue from the current year to
the previous year. Premium growth rates shall be calculated for the following lines of
business: individual, small group, and large group. Data used for premium growth rate
calculations shall be submitted as part of the cost containment filing under section 62J.38.
new text end

new text begin (f) For purposes of this subdivision, "health plan company" has the meaning given
in section 62J.041.
new text end

new text begin (g) A health plan company may reduce reimbursement to providers in order to meet
the premium growth limitations required by this section.
new text end

Sec. 4.

Minnesota Statutes 2006, section 62J.04, subdivision 3, is amended to read:


Subd. 3.

Cost containment duties.

The commissioner shall:

(1) establish statewide and regional cost containment goals for total health care
spending under this section and collect data as described in sections 62J.38 to 62J.41 to
monitor statewide achievement of the cost containment goalsnew text begin and premium growth limitsnew text end ;

(2) divide the state into no fewer than four regions, with one of those regions being
the Minneapolis/St. Paul metropolitan statistical area but excluding Chisago, Isanti,
Wright, and Sherburne Counties, for purposes of fostering the development of regional
health planning and coordination of health care delivery among regional health care
systems and working to achieve the cost containment goals;

(3) monitor the quality of health care throughout the state and take action as
necessary to ensure an appropriate level of quality;

(4) issue recommendations regarding uniform billing forms, uniform electronic
billing procedures and data interchanges, patient identification cards, and other uniform
claims and administrative procedures for health care providers and private and public
sector payers. In developing the recommendations, the commissioner shall review the
work of the work group on electronic data interchange (WEDI) and the American National
Standards Institute (ANSI) at the national level, and the work being done at the state and
local level. The commissioner may adopt rules requiring the use of the Uniform Bill
82/92 form, the National Council of Prescription Drug Providers (NCPDP) 3.2 electronic
version, the Centers for Medicare and Medicaid Services 1500 form, or other standardized
forms or procedures;

(5) undertake health planning responsibilities;

(6) authorize, fund, or promote research and experimentation on new technologies
and health care procedures;

(7) within the limits of appropriations for these purposes, administer or contract for
statewide consumer education and wellness programs that will improve the health of
Minnesotans and increase individual responsibility relating to personal health and the
delivery of health care services, undertake prevention programs including initiatives to
improve birth outcomes, expand childhood immunization efforts, and provide start-up
grants for worksite wellness programs;

(8) undertake other activities to monitor and oversee the delivery of health care
services in Minnesota with the goal of improving affordability, quality, and accessibility of
health care for all Minnesotans; and

(9) make the cost containment goal new text begin and premium growth limit new text end data available to
the public in a consumer-oriented manner.

Sec. 5.

Minnesota Statutes 2006, section 62J.041, is amended to read:


62J.041 deleted text begin INTERIMdeleted text end HEALTH PLAN COMPANY deleted text begin COST CONTAINMENT
GOALS
deleted text end new text begin HEALTH CARE EXPENDITURE LIMITSnew text end .

Subdivision 1.

Definitions.

(a) For purposes of this section, the following definitions
apply.

(b) "Health plan company" has the definition provided in section 62Q.01. new text begin This
definition does not include the state employee health plan offered under chapter 43A.
new text end

(c) "deleted text begin Totaldeleted text end new text begin Health carenew text end expenditures" means incurred claims or expenditures on health
care servicesdeleted text begin , administrative expenses, charitable contributions, and all other paymentsdeleted text end
made by health plan companies deleted text begin out of premium revenuesdeleted text end .

deleted text begin (d) "Net expenditures" means total expenditures minus exempted taxes and
assessments and payments or allocations made to establish or maintain reserves.
deleted text end

deleted text begin (e) "Exempted taxes and assessments" means direct payments for taxes to
government agencies, contributions to the Minnesota Comprehensive Health Association,
the medical assistance provider's surcharge under section , the MinnesotaCare
provider tax under section , assessments by the Health Coverage Reinsurance
Association, assessments by the Minnesota Life and Health Insurance Guaranty
Association, assessments by the Minnesota Risk Adjustment Association, and any new
assessments imposed by federal or state law.
deleted text end

deleted text begin (f)deleted text end new text begin (d)new text end "Consumer cost-sharing or subscriber liability" means enrollee coinsurance,
co-payment, deductible payments, and amounts in excess of benefit plan maximums.

Subd. 2.

Establishment.

The commissioner of health shall establish deleted text begin cost
containment goals
deleted text end new text begin health care expenditure limitsnew text end for deleted text begin the increase in netdeleted text end new text begin calendar year
2008, and each year thereafter, for health care
new text end expenditures by each health plan company
deleted text begin for calendar years 1994, 1995, 1996, and 1997. The cost containment goals must be the
same as the annual cost containment goals for health care spending established under
section 62J.04, subdivision 1, paragraph (b)
deleted text end . Health plan companies that are affiliates may
elect to meet one combined deleted text begin cost containment goaldeleted text end new text begin health care expenditure limit. The
limits set by the commissioner shall not exceed the premium limits established in section
62J.04, subdivision 1b
new text end .

Subd. 3.

Determination of expenditures.

Health plan companies shall submit to
the commissioner of health, by April 1deleted text begin , 1994, for calendar year 1993; April 1, 1995, for
calendar year 1994; April 1, 1996, for calendar year 1995; April 1, 1997, for calendar
year 1996; and April 1, 1998, for calendar year 1997
deleted text end new text begin of each year beginning 2008,new text end all
information the commissioner determines to be necessary to implement this section.
The information must be submitted in the form specified by the commissioner. The
information must include, but is not limited to, new text begin health care new text end expenditures per member per
month or cost per employee per month, and detailed information on revenues and reserves.
The commissioner, to the extent possible, shall coordinate the submittal of the information
required under this section with the submittal of the financial data required under chapter
62J, to minimize the administrative burden on health plan companies. The commissioner
may adjust final expenditure figures for demographic changes, risk selection, changes in
basic benefits, and legislative initiatives that materially change health care costs, as long
as these adjustments are consistent with the methodology submitted by the health plan
company to the commissioner, and approved by the commissioner as actuarially justified.
deleted text begin The methodology to be used for adjustments and the election to meet one cost containment
goal for affiliated health plan companies must be submitted to the commissioner by
September 1, 1994. Community integrated service networks may submit the information
with their application for licensure. The commissioner shall also accept changes to
methodologies already submitted. The adjustment methodology submitted and approved
by the commissioner must apply to the data submitted for calendar years 1994 and 1995.
The commissioner may allow changes to accepted adjustment methodologies for data
submitted for calendar years 1996 and 1997. Changes to the adjustment methodology
must be received by September 1, 1996, and must be approved by the commissioner.
deleted text end

Subd. 4.

Monitoring of reserves.

(a) The commissioners of health and commerce
shall monitor health plan company reserves and net worth as established under chapters
60A, 62C, 62D, 62H, and 64B, with respect to the health plan companies that each
commissioner respectively regulates to assess the degree to which savings resulting from
the establishment of cost containment goals are passed on to consumers in the form of
lower premium rates.

(b) Health plan companies shall fully reflect in the premium rates the savings
generated by the cost containment goals. No premium rate, currently reviewed by the
Department of Health or Commerce, may be approved for those health plan companies
unless the health plan company establishes to the satisfaction of the commissioner of
commerce or the commissioner of health, as appropriate, that the proposed new rate
would comply with this paragraph.

(c) Health plan companies, except those licensed under chapter 60A to sell accident
and sickness insurance under chapter 62A, shall annually before the end of the fourth fiscal
quarter provide to the commissioner of health or commerce, as applicable, a projection of
the level of reserves the company expects to attain during each quarter of the following
fiscal year. These health plan companies shall submit with required quarterly financial
statements a calculation of the actual reserve level attained by the company at the end
of each quarter including identification of the sources of any significant changes in the
reserve level and an updated projection of the level of reserves the health plan company
expects to attain by the end of the fiscal year. In cases where the health plan company has
been given a certificate to operate a new health maintenance organization under chapter
62D, or been licensed as a community integrated service network under chapter 62N, or
formed an affiliation with one of these organizations, the health plan company shall also
submit with its quarterly financial statement, total enrollment at the beginning and end of
the quarter and enrollment changes within each service area of the new organization. The
reserve calculations shall be maintained by the commissioners as trade secret information,
except to the extent that such information is also required to be filed by another provision
of state law and is not treated as trade secret information under such other provisions.

(d) Health plan companies in paragraph (c) whose reserves are less than the required
minimum or more than the required maximum at the end of the fiscal year shall submit a
plan of corrective action to the commissioner of health or commerce under subdivision 7.

(e) The commissioner of commerce, in consultation with the commissioner of health,
shall report to the legislature no later than January 15, 1995, as to whether the concept of
a reserve corridor or other mechanism for purposes of monitoring reserves is adaptable
for use with indemnity health insurers that do business in multiple states and that must
comply with their domiciliary state's reserves requirements.

Subd. 5.

Notice.

The commissioner of health shall publish in the State Register
and make available to the public by July 1, deleted text begin 1995deleted text end new text begin 2009new text end , new text begin and each year thereafter, new text end a list
of all health plan companies that exceeded their deleted text begin cost containment goaldeleted text end new text begin health care
expenditure limit
new text end for the deleted text begin 1994deleted text end new text begin previousnew text end calendar year. deleted text begin The commissioner shall publish
in the State Register and make available to the public by July 1, 1996, a list of all health
plan companies that exceeded their combined cost containment goal for calendar years
1994 and 1995.
deleted text end The commissioner shall notify each health plan company that the
commissioner has determined that the health plan company exceeded its deleted text begin cost containment
goal,
deleted text end new text begin health care expenditure limit new text end at least 30 days before publishing the list, and shall
provide each health plan company deleted text begin withdeleted text end ten days to provide an explanation for exceeding
the deleted text begin cost containment goaldeleted text end new text begin health care expenditure limitnew text end . The commissioner shall review
the explanation and may change a determination if the commissioner determines the
explanation to be valid.

Subd. 6.

Assistance by the commissioner of commerce.

The commissioner of
commerce shall provide assistance to the commissioner of health in monitoring health
plan companies regulated by the commissioner of commerce.

Sec. 6.

Minnesota Statutes 2006, section 62J.301, subdivision 3, is amended to read:


Subd. 3.

General duties.

The commissioner shall:

(1) collect and maintain data which enable population-based monitoring and trending
of the access, utilization, quality, and cost of health care services within Minnesota;

(2) collect and maintain data for the purpose of estimating total Minnesota health
care expenditures and trends;

(3) collect and maintain data for the purposes of setting cost containment goals new text begin and
premium growth limits
new text end under section 62J.04, and measuring cost containment goal new text begin and
premium growth limit
new text end compliance;

(4) conduct applied research using existing and new data and promote applications
based on existing research;

(5) develop and implement data collection procedures to ensure a high level of
cooperation from health care providers and health plan companies, as defined in section
62Q.01, subdivision 4;

(6) work closely with health plan companies and health care providers to promote
improvements in health care efficiency and effectiveness; and

(7) participate as a partner or sponsor of private sector initiatives that promote
publicly disseminated applied research on health care delivery, outcomes, costs, quality,
and management.

Sec. 7.

Minnesota Statutes 2006, section 62J.38, is amended to read:


62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.

(a) The commissioner shall require group purchasers to submit detailed data on total
health care spending for each calendar year. Group purchasers shall submit data for the
1993 calendar year by April 1, 1994, and each April 1 thereafter shall submit data for the
preceding calendar year.

(b) The commissioner shall require each group purchaser to submit data on revenue,
expenses, and member months, as applicable. Revenue data must distinguish between
premium revenue and revenue from other sources and must also include information
on the amount of revenue in reserves and changes in reserves. new text begin Premium revenue data,
information on aggregate enrollment, and data on member months must be broken down
to distinguish between individual market, small group market, and large group market.
Filings under this section for calendar year 2008 must also include information broken
down by individual market, small group market, and large group market for calendar year
2007.
new text end Expenditure data must distinguish between costs incurred for patient care and
administrative costs. Patient care and administrative costs must include only expenses
incurred on behalf of health plan members and must not include the cost of providing
health care services for nonmembers at facilities owned by the group purchaser or affiliate.
Expenditure data must be provided separately for the following categories and for other
categories required by the commissioner: physician services, dental services, other
professional services, inpatient hospital services, outpatient hospital services, emergency,
pharmacy services and other nondurable medical goods, mental health, and chemical
dependency services, other expenditures, subscriber liability, and administrative costs.
Administrative costs must include costs for marketing; advertising; overhead; salaries
and benefits of central office staff who do not provide direct patient care; underwriting;
lobbying; claims processing; provider contracting and credentialing; detection and
prevention of payment for fraudulent or unjustified requests for reimbursement or
services; clinical quality assurance and other types of medical care quality improvement
efforts; concurrent or prospective utilization review as defined in section 62M.02; costs
incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; capital
costs incurred on behalf of a hospital or clinic; lease payments; or any other costs incurred
pursuant to a partnership, joint venture, integration, or affiliation agreement with a
hospital, clinic, or other health care provider. Capital costs and costs incurred must be
recorded according to standard accounting principles. The reports of this data must also
separately identify expenses for local, state, and federal taxes, fees, and assessments. The
commissioner may require each group purchaser to submit any other data, including data
in unaggregated form, for the purposes of developing spending estimates, setting spending
limits, and monitoring actual spending and costs. In addition to reporting administrative
costs incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; or
any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation
agreement with a hospital, clinic, or other health care provider; reports submitted under
this section also must include the payments made during the calendar year for these
purposes. The commissioner shall make public, by group purchaser data collected under
this paragraph in accordance with section 62J.321, subdivision 5. Workers' compensation
insurance plans and automobile insurance plans are exempt from complying with this
paragraph as it relates to the submission of administrative costs.

(c) The commissioner may collect information on:

(1) premiums, benefit levels, managed care procedures, and other features of health
plan companies;

(2) prices, provider experience, and other information for services less commonly
covered by insurance or for which patients commonly face significant out-of-pocket
expenses; and

(3) information on health care services not provided through health plan companies,
including information on prices, costs, expenditures, and utilization.

(d) All group purchasers shall provide the required data using a uniform format and
uniform definitions, as prescribed by the commissioner.

Sec. 8.

Minnesota Statutes 2006, section 62J.495, is amended to read:


62J.495 HEALTH INFORMATION TECHNOLOGY AND
INFRASTRUCTURE deleted text begin ADVISORY COMMITTEEdeleted text end .

Subdivision 1.

new text begin Implementation. new text end

new text begin By January 1, 2015, all hospitals and health care
providers must have in place an interoperable electronic health records system within their
hospital system or clinical practice setting. The commissioner of health, in consultation
with the Health Information Technology and Infrastructure Advisory Committee, shall
develop a statewide plan to meet this goal, including uniform standards to be used for
the interoperable system for sharing and synchronizing patient data across systems.
The standards must be compatible with federal efforts. The uniform standards must be
developed by January 1, 2009, with a status report on the development of these standards
submitted to the legislature by January 15, 2008.
new text end

new text begin Subd. 2. new text end

deleted text begin Establishment; members; dutiesdeleted text end new text begin Health Information Technology and
Infrastructure Advisory Committee
new text end .

(a) The commissioner shall establish a Health
Information Technology and Infrastructure Advisory Committee governed by section
15.059 to advise the commissioner on the following matters:

(1) assessment of the use of health information technology by the state, licensed
health care providers and facilities, and local public health agencies;

(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for administrative data exchange, clinical support programs, patient privacy requirements,
and maintenance of the security and confidentiality of individual patient data; and

(3) other related issues as requested by the commissioner.

(b) The members of the Health Information Technology and Infrastructure Advisory
Committee shall include the commissioners, or commissioners' designees, of health,
human services, administration, and commerce and additional members to be appointed
by the commissioner to include persons representing Minnesota's local public health
agencies, licensed hospitals and other licensed facilities and providers, private purchasers,
the medical and nursing professions, health insurers and health plans, the state quality
improvement organization, academic and research institutions, consumer advisory
organizations with an interest and expertise in health information technology, and other
stakeholders as identified by the Health Information Technology and Infrastructure
Advisory Committee.

deleted text begin Subd. 2. deleted text end

deleted text begin Annual report. deleted text end

new text begin (c) new text end The commissioner shall prepare and issue an annual
report not later than January 30 of each year outlining progress to date in implementing a
statewide health information infrastructure and recommending future projects.

deleted text begin Subd. 3. deleted text end

deleted text begin Expiration. deleted text end

new text begin (d) new text end Notwithstanding section 15.059, this deleted text begin sectiondeleted text end new text begin subdivision
new text end expires June 30, deleted text begin 2009deleted text end new text begin 2015new text end .

Sec. 9.

Minnesota Statutes 2006, section 62L.02, subdivision 11, is amended to read:


Subd. 11.

Dependent.

"Dependent" means an eligible employee's spouse,
unmarried child who is deleted text begin under the age of 19 years, unmarried childdeleted text end under the age of 25
years deleted text begin who is a full-time student as defined in section 62A.301deleted text end new text begin regardless of whether
the dependent child is enrolled in an educational institution
new text end , dependent child of any age
who is disabled and who meets the eligibility criteria in section 62A.14, subdivision 2,
or any other person whom state or federal law requires to be treated as a dependent for
purposes of health plans. For the purpose of this definition, a child includes a child for
whom the employee or the employee's spouse has been appointed legal guardian and an
adoptive child as provided in section 62A.27.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2008.
new text end

Sec. 10.

Minnesota Statutes 2006, section 62L.08, subdivision 8, is amended to read:


Subd. 8.

Filing requirement.

new text begin (a) new text end A health carrier that offers, sells, issues, or renews
a health benefit plan for small employers shall file with the commissioner the index rates
and must demonstrate that all rates shall be within the rating restrictions defined in this
chapter. Such demonstration must include the allowable range of rates from the index rates
and a description of how the health carrier intends to use demographic factors including
case characteristics in calculating the premium rates.

new text begin (b) Notwithstanding paragraph (a), new text end the rates shall not be approveddeleted text begin ,deleted text end unless the
commissioner has determined that the rates are reasonable. In determining reasonableness,
the commissioner shall deleted text begin consider the growth rates applied under section 62J.04, subdivision
1
, paragraph (b)
deleted text end new text begin apply the premium growth limits established under section 62J.04,
subdivision 1b
new text end , to the calendar year or years that the proposed premium rate would be
in effect, new text begin and shall consider new text end actuarially valid changes in risk associated with the enrollee
population, and actuarially valid changes as a result of statutory changes in Laws 1992,
chapter 549.

Sec. 11.

Minnesota Statutes 2006, section 62Q.165, subdivision 1, is amended to read:


Subdivision 1.

Definition.

It is the commitment of the state to achieve universal
health coverage for all Minnesotansnew text begin by the year 2010new text end . Universal coverage is achieved
when:

(1) every Minnesotan has access to a full range of quality health care services;

(2) every Minnesotan is able to obtain affordable health coverage which pays for the
full range of services, including preventive and primary care; and

(3) every Minnesotan pays into the health care system according to that person's
ability.

Sec. 12.

Minnesota Statutes 2006, section 62Q.165, subdivision 2, is amended to read:


Subd. 2.

Goal.

It is the goal of the state to make continuous progress toward
reducing the number of Minnesotans who do not have health coverage so that by January
1, deleted text begin 2000deleted text end new text begin 2010new text end , deleted text begin fewer than four percent of the state's population will be without health
coverage
deleted text end new text begin all Minnesota residents have access to affordable health carenew text end . The goal will be
achieved by improving access to private health coverage through insurance reforms and
market reforms, by making health coverage more affordable for low-income Minnesotans
through purchasing pools and state subsidies, and by reducing the cost of health coverage
through cost containment programs and methods of ensuring that all Minnesotans are
paying into the system according to their ability.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 13.

Minnesota Statutes 2006, section 62Q.165, is amended by adding a
subdivision to read:


new text begin Subd. 4. new text end

new text begin Legislative Commission on Health Care Access. new text end

new text begin The Legislative
Commission on Health Care Access established under section 62J.07 shall make
recommendations on how to achieve the goal described in subdivision 2. The
recommendations shall include a timetable in which measurable progress must be
achieved toward this goal. The commission, with the assistance of the commissioners of
human services, health, and commerce, shall submit to the legislature by January 15,
2008, the recommendations and corresponding timetable.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 14.

Minnesota Statutes 2006, section 256.01, subdivision 2b, is amended to read:


Subd. 2b.

Performance payments.

new text begin (a) new text end The commissioner shall develop and
implement a pay-for-performance system to provide performance payments to medical
groups that demonstrate optimum care in serving individuals with chronic diseases who
are enrolled in health care programs administered by the commissioner under chapters
256B, 256D, and 256L.

new text begin (b) The commissioner shall also develop and implement a patient incentive health
program to provide incentives and rewards to patients who are enrolled in health care
programs administered by the commissioner under chapters 256B, 256D, and 256L and
who have agreed to and met personal health goals established with their primary care
provider to manage a chronic disease or condition, including, but not limited to, diabetes,
high blood pressure, and coronary artery disease.
new text end

Sec. 15.

new text begin [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; administration. new text end

new text begin The commissioner shall establish
and administer the prescription drug discount program.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner's authority. new text end

new text begin The commissioner shall administer a drug
rebate program for drugs purchased according to the prescription drug discount program.
The commissioner shall execute a rebate agreement from all manufacturers that choose to
participate in the program for those drugs covered under the medical assistance program.
For each drug, the amount of the rebate shall be equal to the rebate as defined for purposes
of the federal rebate program in United States Code, title 42, section 1396r-8. The
rebate program shall utilize the terms and conditions used for the federal rebate program
established according to section 1927 of title XIX of the federal Social Security Act.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have the
meanings given them.
new text end

new text begin (a) "Commissioner" means the commissioner of human services.
new text end

new text begin (b) "Covered prescription drug" means a prescription drug as defined in section
151.44, paragraph (d), that is covered under medical assistance as described in section
256B.0625, subdivision 13, and that is provided by a participating manufacturer that has a
fully executed rebate agreement with the commissioner under this section and complies
with that agreement.
new text end

new text begin (c) "Enrolled individual" means a person who is eligible for the program under
subdivision 4 and has enrolled in the program according to subdivision 5.
new text end

new text begin (d) "Health carrier" means an insurance company licensed under chapter 60A to
offer, sell, or issue an individual or group policy of accident and sickness insurance as
defined in section 62A.01; a nonprofit health service plan corporation operating under
chapter 62C; a health maintenance organization operating under chapter 62D; a joint
self-insurance employee health plan operating under chapter 62H; a community integrated
service network licensed under chapter 62N; a fraternal benefit society operating under
chapter 64B; a city, county, school district, or other political subdivision providing
self-insured health coverage under section 471.617 or sections 471.98 to 471.982; and a
self-funded health plan under the Employee Retirement Income Security Act of 1974, as
amended.
new text end

new text begin (e) "Participating manufacturer" means a manufacturer as defined in section 151.44,
paragraph (c), that agrees to participate in the prescription drug discount program.
new text end

new text begin (f) "Participating pharmacy" means a pharmacy as defined in section 151.01,
subdivision 2, that agrees to participate in the prescription drug discount program.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible for the program, an applicant must:
new text end

new text begin (1) be a permanent resident of Minnesota as defined in section 256L.09, subdivision
4;
new text end

new text begin (2) not be enrolled in medical assistance, general assistance medical care, or
MinnesotaCare;
new text end

new text begin (3) not be enrolled in and have currently available prescription drug coverage under
a health plan offered by a health carrier or employer or under a pharmacy benefit program
offered by a pharmaceutical manufacturer; and
new text end

new text begin (4) not be enrolled in and have currently available prescription drug coverage
under a Medicare supplement policy, as defined in sections 62A.31 to 62A.44, or
policies, contracts, or certificates that supplement Medicare issued by health maintenance
organizations or those policies, contracts, or certificates governed by section 1833 or 1876
of the federal Social Security Act, United States Code, title 42, section 1395, et seq., as
amended.
new text end

new text begin (b) Notwithstanding paragraph (a), clause (3), an individual who is enrolled in a
Medicare Part D prescription drug plan or Medicare Advantage plan is eligible for the
program but only for drugs that are not covered under the Medicare Part D plan or for
drugs that are covered under the plan, but according to the conditions of the plan, the
individual is responsible for 100 percent of the cost of the prescription drug.
new text end

new text begin Subd. 5. new text end

new text begin Application procedure. new text end

new text begin (a) Applications and information on the program
must be made available at county social services agencies, health care provider offices, and
agencies and organizations serving senior citizens. Individuals shall submit applications
and any information specified by the commissioner as being necessary to verify eligibility
directly to the commissioner. The commissioner shall determine an applicant's eligibility
for the program within 30 days from the date the application is received. Upon notice of
approval, the applicant must submit to the commissioner the enrollment fee specified in
subdivision 10. Eligibility begins the month after the enrollment fee is received by the
commissioner.
new text end

new text begin (b) An enrollee's eligibility must be renewed every 12 months with the 12-month
period beginning in the month after the application is approved.
new text end

new text begin (c) The commissioner shall develop an application form that does not exceed one
page in length and requires information necessary to determine eligibility for the program.
new text end

new text begin Subd. 6. new text end

new text begin Participating pharmacy. new text end

new text begin (a) Upon implementation of the prescription
drug discount program, and until January 1, 2009, a participating pharmacy, with a
valid prescription, must sell a covered prescription drug to an enrolled individual at the
medical assistance rate.
new text end

new text begin (b) After January 1, 2009, a participating pharmacy, with a valid prescription, must
sell a covered prescription drug to an enrolled individual at the medical assistance rate,
minus an amount that is equal to the rebate amount described in subdivision 8, plus
the amount of any switch fee established by the commissioner under subdivision 10,
paragraph (b).
new text end

new text begin (c) Each participating pharmacy shall provide the commissioner with all information
necessary to administer the program, including, but not limited to, information on
prescription drug sales to enrolled individuals and usual and customary retail prices.
new text end

new text begin Subd. 7. new text end

new text begin Notification of rebate amount. new text end

new text begin The commissioner shall notify each
participating manufacturer, each calendar quarter or according to a schedule established
by the commissioner, of the amount of the rebate owed on the prescription drugs sold by
participating pharmacies to enrolled individuals.
new text end

new text begin Subd. 8. new text end

new text begin Provision of rebate. new text end

new text begin To the extent that a participating manufacturer's
prescription drugs are prescribed to a resident of this state, the manufacturer must provide
a rebate equal to the rebate provided under the medical assistance program for any
prescription drug distributed by the manufacturer that is purchased at a participating
pharmacy by an enrolled individual. The participating manufacturer must provide full
payment within 38 days of receipt of the state invoice for the rebate, or according to
a schedule to be established by the commissioner. The commissioner shall deposit all
rebates received into the Minnesota prescription drug dedicated fund established under
subdivision 11. The manufacturer must provide the commissioner with any information
necessary to verify the rebate determined per drug.
new text end

new text begin Subd. 9. new text end

new text begin Payment to pharmacies. new text end

new text begin Beginning January 1, 2009, the commissioner
shall distribute on a biweekly basis an amount that is equal to an amount collected under
subdivision 8 to each participating pharmacy based on the prescription drugs sold by that
pharmacy to enrolled individuals on or after January 1, 2009.
new text end

new text begin Subd. 10. new text end

new text begin Enrollment fee; switch fee. new text end

new text begin (a) The commissioner shall establish an
annual enrollment fee that covers the commissioner's expenses for enrollment, processing
claims, and distributing rebates under this program.
new text end

new text begin (b) The commissioner shall establish a reasonable switch fee that covers expenses
incurred by participating pharmacies in formatting for electronic submission claims for
prescription drugs sold to enrolled individuals.
new text end

new text begin Subd. 11. new text end

new text begin Dedicated fund; creation; use of fund. new text end

new text begin (a) The Minnesota prescription
drug dedicated fund is established as an account in the state treasury. The commissioner
of finance shall credit to the dedicated fund all rebates paid under subdivision 8, any
federal funds received for the program, all enrollment fees paid by the enrollees, and
any appropriations or allocations designated for the fund. The commissioner of finance
shall ensure that fund money is invested under section 11A.25. All money earned by the
fund must be credited to the fund. The fund shall earn a proportionate share of the total
state annual investment income.
new text end

new text begin (b) Money in the fund is appropriated to the commissioner to reimburse participating
pharmacies for prescription drugs provided to enrolled individuals under subdivision 6,
paragraph (b); to reimburse the commissioner for costs related to enrollment, processing
claims, distributing rebates, and for other reasonable administrative costs related to
administration of the prescription drug discount program; and to repay the appropriation
provided by law for this section. The commissioner must administer the program so that
the costs total no more than funds appropriated plus the drug rebate proceeds.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 16.

Minnesota Statutes 2006, section 256B.056, subdivision 10, is amended to
read:


Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10
, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.

deleted text begin (c) The commissioner shall modify the application for Minnesota health care
programs to require more detailed information related to verification of assets and income,
and shall verify assets and income for all applicants, and for all recipients upon renewal.
deleted text end

deleted text begin (d) The commissioner shall require Minnesota health care program recipients to
report new or an increase in earned income within ten days of the change, and to verify new
or an increase in earned income that affects eligibility within ten days of notification by
the agency that the new or increased earned income affects eligibility. Recipients who fail
to verify new or an increase in earned income that affects eligibility shall be disenrolled.
deleted text end

Sec. 17.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 13i. new text end

new text begin Medicare Part D co-payments. new text end

new text begin For recipients who are enrolled in a
Medicare Part D prescription drug plan or Medicare Advantage plan, medical assistance
covers the co-payments which the recipient is responsible for under the Medicare Part D
prescription drug plan or Medicare Advantage plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 18.

Minnesota Statutes 2006, section 256B.075, subdivision 2, is amended to read:


Subd. 2.

Fee-for-service.

(a) The commissioner shall develop and implement
a disease management program for medical assistance and general assistance medical
care recipients who are not enrolled in the prepaid medical assistance or prepaid general
assistance medical care programs and who are receiving services on a fee-for-service
basis. The commissioner may contract with an outside organization to provide deleted text begin thesedeleted text end
servicesnew text begin under this subdivisionnew text end .

(b) The commissioner shall seek any federal approval necessary to implement this
section and to obtain federal matching funds.

(c) The commissioner shall develop and implement a pilot intensive care
management program for medical assistance children with complex and chronic medical
issues who are not able to participate in the metro-based U Special Kids program due
to geographic distance.

new text begin (d) The commissioner shall develop and implement an intensive care management
pilot program for children, adults, and families who have complex and chronic medical
conditions, or who are at high risk of developing them, and who receive their primary
care through a federally qualified health center or community clinic. For purposes of
this paragraph, "federally qualified health center" means an entity that is receiving a
grant under United States Code, title 42, section 254b, or, based on the recommendation
of the Health Resources and Services Administration within the Public Health Service,
is determined by the secretary to meet the requirements for receiving such a grant; and
"community clinic" means a clinic that is not a federally qualified health center, but is
certified by the Minnesota Department of Health as being eligible to receive a grant under
section 145.9268.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 19.

Minnesota Statutes 2006, section 256B.76, is amended to read:


256B.76 PHYSICIAN AND DENTAL REIMBURSEMENT.

(a) Effective for services rendered on or after October 1, 1992, the commissioner
shall make payments for physician services as follows:

(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care,"
"critical care," cesarean delivery and pharmacologic management provided to psychiatric
patients, and level three codes for enhanced services for prenatal high risk, shall be paid
at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
30, 1992. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;

(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992;

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992;

(4) effective for services rendered on or after January 1, 2000, payment rates for
physician and professional services shall be increased by three percent over the rates in
effect on December 31, 1999, except for home health agency and family planning agency
services; and

(5) the increases in clause (4) shall be implemented January 1, 2000, for managed
care.

(b) Effective for services rendered on or after October 1, 1992, the commissioner
shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
percent above the rate in effect on June 30, 1992;

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases;

(3) effective for services rendered on or after January 1, 2000, payment rates for
dental services shall be increased by three percent over the rates in effect on December
31, 1999;

(4) the commissioner shall award grants to community clinics or other nonprofit
community organizations, political subdivisions, professional associations, or other
organizations that demonstrate the ability to provide dental services effectively to public
program recipients. Grants may be used to fund the costs related to coordinating access for
recipients, developing and implementing patient care criteria, upgrading or establishing
new facilities, acquiring furnishings or equipment, recruiting new providers, or other
development costs that will improve access to dental care in a region. In awarding grants,
the commissioner shall give priority to applicants that plan to serve areas of the state in
which the number of dental providers is not currently sufficient to meet the needs of
recipients of public programs or uninsured individuals. The commissioner shall consider
the following in awarding the grants:

(i) potential to successfully increase access to an underserved population;

(ii) the ability to raise matching funds;

(iii) the long-term viability of the project to improve access beyond the period
of initial funding;

(iv) the efficiency in the use of the funding; and

(v) the experience of the proposers in providing services to the target population.

The commissioner shall monitor the grants and may terminate a grant if the grantee
does not increase dental access for public program recipients. The commissioner shall
consider grants for the following:

(i) implementation of new programs or continued expansion of current access
programs that have demonstrated success in providing dental services in underserved
areas;

(ii) a pilot program for utilizing hygienists outside of a traditional dental office to
provide dental hygiene services; and

(iii) a program that organizes a network of volunteer dentists, establishes a system to
refer eligible individuals to volunteer dentists, and through that network provides donated
dental care services to public program recipients or uninsured individuals;

(5) beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (i) submitted charge, or (ii) 80 percent of median 1997 charges;

(6) the increases listed in clauses (3) and (5) shall be implemented January 1, 2000,
for managed care; and

(7) effective for services provided on or after January 1, 2002, payment for
diagnostic examinations and dental x-rays provided to children under age 21 shall be the
lower of (i) the submitted charge, or (ii) 85 percent of median 1999 charges.

(c) Effective for dental services rendered on or after January 1, 2002, the
commissioner deleted text begin may, within the limits of available appropriation,deleted text end new text begin shall new text end increase
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. Reimbursement to a critical access dental provider may be
increased by not more than 50 percent above the reimbursement rate that would
otherwise be paid to the provider. Payments to health plan companies shall be adjusted to
reflect increased reimbursements to critical access dental providers as approved by the
commissioner. In determining which dentists and dental clinics shall be deemed critical
access dental providers, the commissioner shall review:

(1) the utilization rate in the service area in which the dentist or dental clinic operates
for dental services to patients covered by medical assistance, general assistance medical
care, or MinnesotaCare as their primary source of coverage;

(2) the level of services provided by the dentist or dental clinic to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare as their primary
source of coverage; and

(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within the service area.

In the absence of a critical access dental provider in a service area, the commissioner may
designate a dentist or dental clinic as a critical access dental provider if the dentist or
dental clinic is willing to provide care to patients covered by medical assistance, general
assistance medical care, or MinnesotaCare at a level which significantly increases access
to dental care in the service area.

The commissioner shall annually establish a reimbursement schedule for critical
access dental providers and provider-specific limits on total reimbursement received
under the reimbursement schedule, and shall notify each critical access dental provider
of the schedule and limit.

(d) new text begin The commissioner shall award special hardship grants to nonprofit dental
providers with a high proportion of uninsured patients that equals or exceeds 15 percent
of the total number of patients served by that provider and the provider does not receive
a financial benefit comparable to other critical access dental providers under the critical
access dental provider formula described in paragraph (c). The commissioner shall award
a grant to these providers allocated in proportion to each critical access dental provider's
ratio of uninsured patients to the total number of patients served by all providers who
qualify for a grant under this paragraph.
new text end

new text begin (e) new text end An entity that operates both a Medicare certified comprehensive outpatient
rehabilitation facility and a facility which was certified prior to January 1, 1993, that is
licensed under Minnesota Rules, parts 9570.2000 to 9570.3600, and for whom at least 33
percent of the clients receiving rehabilitation services in the most recent calendar year are
medical assistance recipients, shall be reimbursed by the commissioner for rehabilitation
services at rates that are 38 percent greater than the maximum reimbursement rate
allowed under paragraph (a), clause (2), when those services are (1) provided within the
comprehensive outpatient rehabilitation facility and (2) provided to residents of nursing
facilities owned by the entity.

deleted text begin (e)deleted text end new text begin (f) new text end Effective for services rendered on or after January 1, 2007, the commissioner
shall make payments for physician and professional services based on the Medicare
relative value units (RVU's). This change shall be budget neutral and the cost of
implementing RVU's will be incorporated in the established conversion factor.

Sec. 20.

Minnesota Statutes 2006, section 256D.03, subdivision 3, is amended to read:


Subd. 3.

General assistance medical care; eligibility.

(a) General assistance
medical care may be paid for any person who is not eligible for medical assistance under
chapter 256B, including eligibility for medical assistance based on a spenddown of excess
income according to section 256B.056, subdivision 5, or MinnesotaCare as defined in
paragraph (b), except as provided in paragraph (c), and:

(1) who is receiving assistance under section 256D.05, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or

(2) who is a resident of Minnesota; and

(i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
section 256B.056, subdivision 3, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or on behalf of the beneficiary by
the trustee, assuming the full exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum;

(ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the
family size, using a six-month budget period, whose equity in assets is not in excess
of the limits in section 256B.056, subdivision 3c, and who applies during an inpatient
hospitalization; or

(iii) the commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.

(b) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (e).

(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
subdivision 7
, with covered services as provided in section 256L.03 for the rest of the
deleted text begin six-monthdeleted text end new text begin initial new text end eligibility period, until their deleted text begin six-monthdeleted text end new text begin annual new text end renewal.

(d) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (c), an individual must complete a new
application.

(e) Applicants and recipients eligible under paragraph (a), clause (1); who have
applied for and are awaiting a determination of blindness or disability by the state medical
review team or a determination of eligibility for Supplemental Security Income or Social
Security Disability Insurance by the Social Security Administration; who fail to meet the
requirements of section 256L.09, subdivision 2; who are classified as end-stage renal
disease beneficiaries in the Medicare program; who are enrolled in private health care
coverage as defined in section 256B.02, subdivision 9; who are eligible under paragraph
(j); or who receive treatment funded pursuant to section 254B.02 are exempt from the
MinnesotaCare enrollment requirements of this subdivision.

(f) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.

(g) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).

(h) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
county agency must assist the applicant in obtaining verification if necessary.

(i) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.

(j) General assistance medical care is not available for a person in a correctional
facility unless the person is detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order, and the person is a recipient of general
assistance medical care at the time the person is detained by law or admitted on a criminal
hold order and as long as the person continues to meet other eligibility requirements
of this subdivision.

(k) General assistance medical care is not available for applicants or recipients who
do not cooperate with the county agency to meet the requirements of medical assistance.

(l) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.

(m) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.

(n) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
an undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service.

(o) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources, is ineligible
for general assistance medical care.

(p) Effective July 1, 2003, general assistance medical care emergency services end.

Sec. 21.

Minnesota Statutes 2006, section 256D.03, subdivision 4, is amended to read:


Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation agencies;

(4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;

(5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;

(6) eyeglasses and eye examinations provided by a physician or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical assistance program;

(13) podiatric services;

(14) dental services as covered under the medical assistance program;

(15) outpatient services provided by a mental health center or clinic that is under
contract with the county board and is established under section 245.62;

(16) day treatment services for mental illness provided under contract with the
county board;

(17) prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;

(18) psychological services, medical supplies and equipment, and Medicare
premiums, coinsurance and deductible payments;

(19) medical equipment not specifically listed in this paragraph when the use of
the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;

(20) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an inpatient basis is not included
as part of the cost for inpatient services included in the operating payment rate, and (3) the
service is within the scope of practice of the nurse practitioner's license as a registered
nurse, as defined in section 148.171;

(21) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;

(22) telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b; and

(23) mental health telemedicine and psychiatric consultation as covered under
section 256B.0625, subdivisions 46 and 48.

(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.

(b) Effective August 1, 2005, sex reassignment surgery is not covered under this
subdivision.

(c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.

deleted text begin (d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003:
deleted text end

deleted text begin (1) $25 for eyeglasses;
deleted text end

deleted text begin (2) $25 for nonemergency visits to a hospital-based emergency room;
deleted text end

deleted text begin (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness; and
deleted text end

deleted text begin (4) 50 percent coinsurance on restorative dental services.
deleted text end

deleted text begin (e) Co-payments shall be limited to one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by
the amount of the co-payment, except that reimbursement for prescription drugs shall not
be reduced once a recipient has reached the $12 per month maximum for prescription
drug co-payments. The provider collects the co-payment from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment, except as
provided in paragraph (f).
deleted text end

deleted text begin (f) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.
deleted text end

deleted text begin (g)deleted text end new text begin (d) new text end Any county may, from its own resources, provide medical payments for
which state payments are not made.

deleted text begin (h)deleted text end new text begin (e) new text end Chemical dependency services that are reimbursed under chapter 254B must
not be reimbursed under general assistance medical care.

deleted text begin (i)deleted text end new text begin (f) new text end The maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.

deleted text begin (j)deleted text end new text begin (g) new text end The conditions of payment for services under this subdivision are the same
as the conditions specified in rules adopted under chapter 256B governing the medical
assistance program, unless otherwise provided by statute or rule.

deleted text begin (k)deleted text end new text begin (h)new text end Inpatient and outpatient payments shall be reduced by five percent, effective
July 1, 2003. This reduction is in addition to the five percent reduction effective July 1,
2003, and incorporated by reference in paragraph deleted text begin (i)deleted text end new text begin (f)new text end .

deleted text begin (l)deleted text end new text begin (i) new text end Payments for all other health services except inpatient, outpatient, and
pharmacy services shall be reduced by five percent, effective July 1, 2003.

deleted text begin (m)deleted text end new text begin (j) new text end Payments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.

deleted text begin (n)deleted text end new text begin (k) new text end A hospital receiving a reduced payment as a result of this section may apply
the unpaid balance toward satisfaction of the hospital's bad debts.

deleted text begin (o) Fee-for-service payments for nonpreventive visits shall be reduced by $3
for services provided on or after January 1, 2006. For purposes of this subdivision, a
visit means an episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory setting by
a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
audiologist, optician, or optometrist.
deleted text end

deleted text begin (p) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 22.

Minnesota Statutes 2006, section 256L.01, subdivision 4, is amended to read:


Subd. 4.

Gross individual or gross family income.

(a) "Gross individual or gross
family income" for nonfarm self-employed means income calculated for the deleted text begin six-monthdeleted text end
new text begin 12-month new text end period of eligibility using the net profit or loss reported on the applicant's
federal income tax form for the previous year and using the medical assistance families
with children methodology for determining allowable and nonallowable self-employment
expenses and countable income.

(b) "Gross individual or gross family income" for farm self-employed means income
calculated for the deleted text begin six-monthdeleted text end new text begin 12-month new text end period of eligibility using as the baseline the
adjusted gross income reported on the applicant's federal income tax form for the previous
year deleted text begin and adding back in reported depreciation amounts that apply to the business in which
the family is currently engaged
deleted text end .

(c) "Gross individual or gross family income" means the total income for all family
members, calculated for the deleted text begin six-monthdeleted text end new text begin 12-month new text end period of eligibility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 23.

Minnesota Statutes 2006, section 256L.03, subdivision 1, is amended to read:


Subdivision 1.

Covered health services.

deleted text begin For individuals under section 256L.04,
subdivision 7
, with income no greater than 75 percent of the federal poverty guidelines
or for families with children under section 256L.04, subdivision 1, all subdivisions of
this section apply.
deleted text end "Covered health services" means the health services reimbursed
under chapter 256B, with the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care services other than services
covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency
medical transportation services, personal care assistant and case management services,
nursing home or intermediate care facilities services, inpatient mental health services,
and chemical dependency services. Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments, psychological testing,
explanation of findings, mental health telemedicine, psychiatric consultation, medication
management by a physician, day treatment, partial hospitalization, and individual, family,
and group psychotherapy.

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in this section.

Sec. 24.

Minnesota Statutes 2006, section 256L.03, subdivision 3, is amended to read:


Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. deleted text begin Prior to July 1, 1997, the inpatient hospital benefit for adult
enrollees is subject to an annual benefit limit of $10,000.
deleted text end The inpatient hospital benefit for
adult enrollees who qualify under section 256L.04, subdivision 7, or who qualify under
section 256L.04, subdivisions 1 and 2, with family gross income that exceeds deleted text begin 175deleted text end new text begin 200new text end
percent of the federal poverty guidelines and who are not pregnant, is subject to an annual
limit of deleted text begin $10,000deleted text end new text begin $20,000new text end .

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3
, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

Sec. 25.

Minnesota Statutes 2006, section 256L.03, subdivision 5, is amended to read:


Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21 deleted text begin in households with family income equal to or less than 175
percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
parents and relative caretakers of children under the age of 21 in households with family
income greater than 175 percent of the federal poverty guidelines for inpatient hospital
admissions occurring on or after January 1, 2001
deleted text end .

(c) Paragraph (a), clauses (1) to (4), do not apply to pregnant women and children
under the age of 21.

(d) Adult enrollees with family gross income that exceeds deleted text begin 175deleted text end new text begin 200new text end percent of the
federal poverty guidelines and who are not pregnant shall be financially responsible for
the coinsurance amount, if applicable, and amounts which exceed the deleted text begin $10,000deleted text end new text begin $20,000new text end
inpatient hospital benefit limit.

(e) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the deleted text begin $10,000deleted text end new text begin $20,000new text end annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

Sec. 26.

Minnesota Statutes 2006, section 256L.04, subdivision 1a, is amended to read:


Subd. 1a.

Social Security number required.

(a) Individuals and families applying
for MinnesotaCare coverage must provide a Social Security number.new text begin This requirement
does not apply to an undocumented noncitizen or nonimmigrant who is eligible for
MinnesotaCare.
new text end

(b) The commissioner shall not deny eligibility to an otherwise eligible applicant
who has applied for a Social Security number and is awaiting issuance of that Social
Security number.

(c) Newborns enrolled under section 256L.05, subdivision 3, are exempt from the
requirements of this subdivision.

(d) Individuals who refuse to provide a Social Security number because of
well-established religious objections are exempt from the requirements of this subdivision.
The term "well-established religious objections" has the meaning given in Code of Federal
Regulations, title 42, section 435.910.

Sec. 27.

Minnesota Statutes 2006, section 256L.04, subdivision 7, is amended to read:


Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and households with no children who have gross family
incomes that are equal to or less than deleted text begin 175deleted text end new text begin 200new text end percent of the federal poverty guidelines.

Sec. 28.

Minnesota Statutes 2006, section 256L.04, subdivision 10, is amended to read:


Subd. 10.

Citizenship requirements.

new text begin (a) new text end Eligibility for MinnesotaCare is limited
to citizens or nationals of the United States, qualified noncitizens, and other persons
residing lawfully in the United States as described in section 256B.06, subdivision 4,
paragraphs (a) to (e) and (j). Undocumented noncitizens and nonimmigrants are ineligible
for MinnesotaCare.

new text begin (b) new text end For purposes of this subdivision, a nonimmigrant is an individual in one or
more of the classes listed in United States Code, title 8, section 1101(a)(15), and an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service. new text begin This paragraph
does not apply to children.
new text end

new text begin (c) new text end Families with children who are citizens or nationals of the United States must
cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.new text begin State and county workers must assist applicants in obtaining satisfactory
documentary evidence of citizenship or nationality.
new text end

Sec. 29.

Minnesota Statutes 2006, section 256L.04, is amended by adding a subdivision
to read:


new text begin Subd. 14. new text end

new text begin MinnesotaCare outreach. new text end

new text begin (a) The commissioner shall award grants to
public or private organizations to provide information on the importance of maintaining
insurance coverage and on how to obtain coverage through the MinnesotaCare program in
areas of the state with high uninsured populations.
new text end

new text begin (b) In awarding the grants, the commissioner shall consider the following:
new text end

new text begin (1) geographic areas and populations with high uninsured rates;
new text end

new text begin (2) the ability to raise matching funds; and
new text end

new text begin (3) the ability to contact or serve eligible populations.
new text end

new text begin The commissioner shall monitor the grants and may terminate a grant if the outreach
effort does not increase enrollment in medical assistance, general assistance medical care,
or the MinnesotaCare program.
new text end

new text begin (c) The commissioner shall develop an incentive program for individuals and
families in geographic areas and high uninsured populations with high uninsured rates
who enroll in MinnesotaCare. The incentives may include gift certificates for groceries,
household items, or other sundries.
new text end

Sec. 30.

Minnesota Statutes 2006, section 256L.05, subdivision 1b, is amended to read:


Subd. 1b.

MinnesotaCare enrollment by county agencies.

Beginning September
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
section 256D.03, subdivision 3. County agencies shall perform all duties necessary
to administer the MinnesotaCare program ongoing for these enrollees, including the
redetermination of MinnesotaCare eligibility at deleted text begin six-monthdeleted text end renewal.

Sec. 31.

Minnesota Statutes 2006, section 256L.05, subdivision 2, is amended to read:


Subd. 2.

Commissioner's duties.

deleted text begin (a)deleted text end The commissioner or county agency shall
use electronic verification as the primary method of income verification. If there is a
discrepancy between reported income and electronically verified income, an individual
may be required to submit additional verification. In addition, the commissioner shall
perform random audits to verify reported income and eligibility. The commissioner
may execute data sharing arrangements with the Department of Revenue and any other
governmental agency in order to perform income verification related to eligibility and
premium payment under the MinnesotaCare program.

deleted text begin (b) In determining eligibility for MinnesotaCare, the commissioner shall require
applicants and enrollees seeking renewal of eligibility to verify both earned and unearned
income. The commissioner shall also require applicants and enrollees to submit the names
of their employers and a contact name with a telephone number for each employer for
purposes of verifying whether the applicant or enrollee, and any dependents, are eligible
for employer-subsidized coverage. Data collected is nonpublic data as defined in section
deleted text begin 13.02, subdivision 9deleted text end .
deleted text end

Sec. 32.

Minnesota Statutes 2006, section 256L.05, subdivision 3a, is amended to read:


Subd. 3a.

Renewal of eligibility.

(a) Beginning deleted text begin January 1, 1999deleted text end new text begin July 1, 2007new text end , an
enrollee's eligibility must be renewed every 12 months. The 12-month period begins in
the month after the month the application is approved.

(b) deleted text begin Beginning October 1, 2004, an enrollee's eligibility must be renewed every
six months. The first six-month period of eligibility begins the month the application is
received by the commissioner. The effective date of coverage within the first six-month
period of eligibility is as provided in subdivision 3.
deleted text end Each new period of eligibility must
take into account any changes in circumstances that impact eligibility and premium
amount. An enrollee must provide all the information needed to redetermine eligibility by
the first day of the month that ends the eligibility period. The premium for the new period
of eligibility must be received as provided in section 256L.06 in order for eligibility to
continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3
, the first deleted text begin six-monthdeleted text end period of eligibility begins the month the enrollee
submitted the application or renewal for general assistance medical care.

Sec. 33.

Minnesota Statutes 2006, section 256L.07, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

deleted text begin (a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.
deleted text end

deleted text begin (b)deleted text end new text begin (a)new text end Families enrolled in MinnesotaCare under section 256L.04, subdivision
1
, whose income increases above 275 percent of the federal poverty guidelines, are no
longer eligible for the program and shall be disenrolled by the commissioner. Individuals
enrolled in MinnesotaCare under section 256L.04, subdivision 7, whose income increases
above deleted text begin 175deleted text end new text begin 200new text end percent of the federal poverty guidelines are no longer eligible for the
program and shall be disenrolled by the commissioner. For persons disenrolled under
this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
following the month in which the commissioner determines that the income of a family or
individual exceeds program income limits.

deleted text begin (c)deleted text end new text begin (b) new text end Notwithstanding paragraph deleted text begin (b)deleted text end new text begin (a)new text end , children may remain enrolled in
MinnesotaCare if ten percent of their gross individual or gross family income as defined
in section 256L.01, subdivision 4, is less than the new text begin annual new text end premium for a deleted text begin six-monthdeleted text end
policy with a $500 deductible available through the Minnesota Comprehensive Health
Association. Children who are no longer eligible for MinnesotaCare under this clause shall
be given a 12-month notice period from the date that ineligibility is determined before
disenrollment. The premium for children remaining eligible under this clause shall be the
maximum premium determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (d) Notwithstanding paragraphs (b) and (c), parents are not eligible for
MinnesotaCare if gross household income exceeds $25,000 for the six-month period
of eligibility.
deleted text end

Sec. 34.

Minnesota Statutes 2006, section 256L.07, subdivision 2, is amended to read:


Subd. 2.

Must not have access to employer-subsidized coverage.

(a) To be
eligible, deleted text begin a family or individualdeleted text end new text begin an adultnew text end must not have access to subsidized health coverage
through an employer and must not have had access to employer-subsidized coverage
through a current employer for 18 months prior to application or reapplication. deleted text begin A family
or individual
deleted text end new text begin An adultnew text end whose employer-subsidized coverage is lost due to an employer
terminating health care coverage as an employee benefit during the previous 18 months
is not eligible.

(b) This subdivision does not apply to deleted text begin a family or individualdeleted text end new text begin an adultnew text end who was
enrolled in MinnesotaCare within six months or less of reapplication and who no longer
has employer-subsidized coverage due to the employer terminating health care coverage
as an employee benefit.

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
deleted text begin Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent.
deleted text end The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

new text begin (d) Notwithstanding paragraph (c), if an employer-subsidized health plan requires
the employee to pay more than eight percent of the employee's family gross income in
co-payments, deductibles, or coinsurance, the health coverage offered shall not constitute
employer-subsidized coverage for purposes of determining eligibility for MinnesotaCare.
new text end

new text begin (e) This subdivision does not apply to children.
new text end

Sec. 35.

Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:


Subd. 3.

Other health coverage.

(a) deleted text begin Families and individualsdeleted text end new text begin Adults new text end enrolled in the
MinnesotaCare program must have no health coverage while enrolled or for at least four
months prior to application and renewal. deleted text begin Children enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:
deleted text end

deleted text begin (1) lacks two or more of the following:
deleted text end

deleted text begin (i) basic hospital insurance;
deleted text end

deleted text begin (ii) medical-surgical insurance;
deleted text end

deleted text begin (iii) prescription drug coverage;
deleted text end

deleted text begin (iv) dental coverage; or
deleted text end

deleted text begin (v) vision coverage;
deleted text end

deleted text begin (2) requires a deductible of $100 or more per person per year; or
deleted text end

deleted text begin (3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.
deleted text end

The commissioner may change this eligibility criterion for sliding scale premiums in
order to remain within the limits of available appropriations. deleted text begin The requirement of no health
coverage
deleted text end new text begin This paragraphnew text end does not apply to deleted text begin newbornsdeleted text end new text begin childrennew text end .

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.

(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

Sec. 36.

Minnesota Statutes 2006, section 256L.07, subdivision 6, is amended to read:


Subd. 6.

Exception for certain adults.

Single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, are eligible without meeting
the requirements of this section until deleted text begin six-monthdeleted text end renewal.

Sec. 37.

Minnesota Statutes 2006, section 256L.15, subdivision 1, is amended to read:


Subdivision 1.

Premium determination.

(a) Families with children and individuals
shall pay a premium determined according to subdivision 2.

(b) Pregnant women and children under age two are exempt from the provisions
of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
for failure to pay premiums. For pregnant women, this exemption continues until the
first day of the month following the 60th day postpartum. Women who remain enrolled
during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
disenrolled on the first of the month following the 60th day postpartum for the penalty
period that otherwise applies under section 256L.06, unless they begin paying premiums.

new text begin (c) Members of the military and their families who meet the eligibility criteria
for MinnesotaCare upon eligibility approval made within 24 months following the end
of the member's tour of active duty shall have their premiums paid by the commissioner.
The effective date of coverage for an individual or family who meets the criteria of this
paragraph shall be the first day of the month following the month in which eligibility is
approved. This exemption shall apply for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007, or upon federal
approval, whichever is later.
new text end

Sec. 38.

Minnesota Statutes 2006, section 256L.15, subdivision 2, is amended to read:


Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay
to obtain coverage through the MinnesotaCare program. The sliding fee scale must be
based on the enrollee's monthly gross individual or family income. The sliding fee scale
must contain separate tables based on enrollment of one, two, or three or more persons.
The sliding fee scale begins with a premium of 1.5 percent of monthly gross individual or
family income for individuals or families with incomes below the limits for the medical
assistance program for families and children in effect on January 1, 1999, and proceeds
through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 percent.
These percentages are matched to evenly spaced income steps ranging from the medical
assistance income limit for families and children in effect on January 1, 1999, to 275
percent of the federal poverty guidelines for the applicable family size, up to a family size
of five. The sliding fee scale for a family of five must be used for families of more than
five. deleted text begin Effective October 1, 2003, the commissioner shall increase each percentage by 0.5
percentage points for enrollees with income greater than 100 percent but not exceeding
200 percent of the federal poverty guidelines and shall increase each percentage by 1.0
percentage points for families and children with incomes greater than 200 percent of
the federal poverty guidelines.
deleted text end The sliding fee scale and percentages are not subject to
the provisions of chapter 14. If a family or individual reports increased income after
enrollment, premiums shall be adjusted at the time the change in income is reported.

(b) deleted text begin Children indeleted text end Families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

deleted text begin (c) After calculating the percentage of premium each enrollee shall pay under
paragraph (a), eight percent shall be added to the premium.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 39.

Minnesota Statutes 2006, section 256L.15, subdivision 4, is amended to read:


Subd. 4.

Exception for transitioned adults.

County agencies shall pay premiums
for single adults and households with no children formerly enrolled in general assistance
medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3,
deleted text begin until six-month renewaldeleted text end new text begin for six monthsnew text end . The county agency has the option of continuing to
pay premiums for these enrollees past the first deleted text begin six-monthdeleted text end new text begin six months until the 12-month
new text end renewal period.

Sec. 40.

Minnesota Statutes 2006, section 256L.17, subdivision 7, is amended to read:


Subd. 7.

Exception for certain adults.

Single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, are exempt from the
requirements of this section until deleted text begin six-monthdeleted text end renewal.

Sec. 41.

new text begin [256L.20] MINNESOTACARE OPTION FOR SMALL EMPLOYERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms used
have the meanings given them.
new text end

new text begin (b) "Dependent" means an unmarried child under the age of 21.
new text end

new text begin (c) "Eligible employee" means an employee who works at least 20 hours per week
for an eligible employer. Eligible employee does not include an employee who works
on a temporary or substitute basis or who does not work more than 26 weeks annually.
Coverage of an eligible employee includes the employee's spouse.
new text end

new text begin (d) "Eligible employer" means a business that employs at least two, but not more
than 50, eligible employees, the majority of whom are employed in the state, and includes
a municipality that has 50 or fewer employees.
new text end

new text begin (e) "Maximum premium" has the meaning given under section 256L.15, subdivision
2, paragraph (b), clause (3).
new text end

new text begin (f) "Participating employer" means an eligible employer who meets the requirements
in subdivision 3 and applies to the commissioner to enroll its eligible employees and their
dependents in the MinnesotaCare program.
new text end

new text begin (g) "Program" means the MinnesotaCare program.
new text end

new text begin Subd. 2. new text end

new text begin Option. new text end

new text begin Eligible employees and their dependents may enroll in
MinnesotaCare if the eligible employer meets the requirements of subdivision 3. The
effective date of coverage is as defined in section 256L.05, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Employer requirements. new text end

new text begin The commissioner shall establish procedures for
an eligible employer to apply for coverage through the program. In order to participate, an
eligible employer must meet the following requirements:
new text end

new text begin (1) agree to contribute toward the cost of the premium for the employee, the
employee's spouse, and the employee's dependents according to subdivision 4;
new text end

new text begin (2) certify that at least 75 percent of its eligible employees who do not have other
creditable health coverage are enrolled in the program;
new text end

new text begin (3) offer coverage to all eligible employees, spouses, and dependents of eligible
employees; and
new text end

new text begin (4) have not provided employer-subsidized health coverage as an employee benefit
during the previous 12 months, as defined in section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 4. new text end

new text begin Premiums. new text end

new text begin (a) The premium for coverage provided under this section is
equal to the maximum premium regardless of the income of the eligible employee, as
defined in section 256L.15, subdivision 2, paragraph (b).
new text end

new text begin (b) For eligible employees without dependents with income equal to or less than 200
percent of the federal poverty guidelines and for eligible employees with dependents with
income equal to or less than 275 percent of the federal poverty guidelines, the participating
employer shall pay 50 percent of the premium established under paragraph (a) for the
eligible employee, the employee's spouse, and any dependents, if applicable.
new text end

new text begin (c) For eligible employees without dependents with income over 200 percent of the
federal poverty guidelines and for eligible employees with dependents with income over
275 percent of the federal poverty guidelines, the participating employer shall pay the
full cost of the premium established under paragraph (a) for the eligible employee, the
employee's spouse, and any dependents, if applicable. The participating employer may
require the employee to pay a portion of the cost of the premium so long as the employer
pays 50 percent. If the employer requires the employee to pay a portion of the premium,
the employee shall pay the portion of the cost to the employer.
new text end

new text begin (d) The commissioner shall collect premium payments from participating employers
for eligible employees, spouses, and dependents who are covered by the program as
provided under this section. All premiums collected shall be deposited in the health care
access fund.
new text end

new text begin Subd. 5. new text end

new text begin Coverage. new text end

new text begin The coverage offered to those enrolled in the program under
this section must include all health services described under section 256L.03 and all
co-payments and coinsurance requirements under section 256L.03, subdivision 5, apply.
new text end

new text begin Subd. 6. new text end

new text begin Enrollment. new text end

new text begin Upon payment of the premium, according to this section
and section 256L.06, eligible employees, spouses, and dependents shall be enrolled in
MinnesotaCare. For purposes of enrollment under this section, income eligibility limits
established under sections 256L.04 and 256L.07, subdivision 1, and asset limits established
under section 256L.17, do not apply. The barriers established under section 256L.07,
subdivision 2 or 3, do not apply to enrollees eligible under this section. The commissioner
may require eligible employees to provide income verification to determine premiums.
new text end

Sec. 42.

Laws 2005, First Special Session chapter 4, article 9, section 3, subdivision 2,
is amended to read:


Subd. 2.

Community and Family Health
Improvement

Summary by Fund
General
40,413,000
40,382,000
State Government
Special Revenue
141,000
128,000
Health Care Access
3,510,000
3,516,000
Federal TANF
6,000,000
6,000,000

deleted text begin FAMILY PLANNING BASE
REDUCTION.
Base level funding for
the family planning special projects grant
program is reduced by $1,877,000 each
year of the biennium beginning July 1,
2007, provided that this reduction shall
only take place upon full implementation of
the family planning project section of the
1115 waiver. Notwithstanding Minnesota
Statutes, section , the commissioner
shall give priority to community health care
clinics providing family planning services
that either serve a high number of women
who do not qualify for medical assistance
or are unable to participate in the medical
assistance program as a medical assistance
provider when allocating the remaining
appropriations. Notwithstanding section 15,
this paragraph shall not expire.
deleted text end

SHAKEN BABY VIDEO. Of the
state government special revenue fund
appropriation, $13,000 in 2006 is
appropriated to the commissioner of health
to provide a video to hospitals on shaken
baby syndrome. The commissioner of health
shall assess a fee to hospitals to cover the
cost of the approved shaken baby video and
the revenue received is to be deposited in the
state government special revenue fund.

Sec. 43. new text begin ADMINISTRATIVE SIMPLIFICATION.
new text end

new text begin All health care providers and health plans that contract with the state of Minnesota
to provide health care services either through the health care programs administered
under Minnesota Statutes, chapters 256B, 256D, and 256L, or through the state employee
group insurance program administered under Minnesota Statutes, chapter 43A, must
use and accept the uniform billing forms and coding requirements established by the
Administrative Uniformity Committee by January 1, 2009.
new text end

Sec. 44. new text begin CONSTITUTIONAL AMENDMENT PROPOSED.
new text end

new text begin An amendment to the Minnesota Constitution is proposed to the people. If the
amendment is adopted, a section will be added to article XIII, to read:
new text end

new text begin Sec. 13.new text end

new text begin Every Minnesota resident has the right to health care. It is the responsibility of
the governor and the legislature to implement all necessary legislation to ensure affordable
health care.
new text end

Sec. 45. new text begin SUBMISSION TO VOTERS.
new text end

new text begin The proposed amendment shall be submitted to the people at the 2008 general
election. The question submitted shall be:
new text end

new text begin "Shall the Minnesota Constitution be amended to state that every resident of
Minnesota has the right to health care and that it is the responsibility of the governor and
the legislature to implement all necessary legislation to ensure affordable health care?
new text end

new text begin Yes .......
new text end
new text begin No ......."
new text end

Sec. 46. new text begin ACTION BY LEGISLATURE AND GOVERNOR.
new text end

new text begin If the constitutional amendment proposed in section 44 is approved by the people at
the 2008 general election, the legislature and governor must enact legislation to implement
the constitutional amendment by July 1, 2011.
new text end

Sec. 47. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the health care access fund to the commissioner of
human services for the biennium beginning July 1, 2007, for the purpose of MinnesotaCare
outreach grants and the enrollment incentive programs under Minnesota Statutes, section
256L.04, subdivision 14.
new text end

new text begin (b) $1,156,000 is appropriated each fiscal year beginning July 1, 2007, from the
general fund to the commissioner of health for family planning grants under Minnesota
Statutes, section 145.925.
new text end

new text begin (c) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of human services for the intensive care management pilot
program described in Minnesota Statutes, section 256B.075, subdivision 2, paragraph (d).
new text end

new text begin (d) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of human services for the critical access dental providers
reimbursement rates under Minnesota Statutes, section 256B.76, paragraph (c).
new text end

new text begin (e) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of human services for the special hardship grants to nonprofit
dental providers described in Minnesota Statutes, section 256B.76, paragraph (d).
new text end

new text begin (f) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of human services for the patient incentive health program
established in Minnesota Statutes, section 256.01, subdivision 2a, paragraph (b).
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Sec. 48. new text begin REPEALER.
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new text begin Minnesota Statutes 2006, sections 62A.301; 256B.0631; and 256L.035, new text end new text begin are repealed.
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