SF 2234

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 03/21/2014 08:58am

A bill for an act
relating to health; establishing a state-only health care program to cover
uninsured children who are ineligible for medical assistance and MinnesotaCare;
amending Minnesota Statutes 2012, section 256B.06, by adding a subdivision;
proposing coding for new law in Minnesota Statutes, chapter 256L.

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

ARTICLE 1

COVERAGE FOR LOW-INCOME UNINSURED CHILDREN

Section 1.

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

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin (a) The commissioner shall establish a program that
provides coverage to low-income uninsured children who are not eligible for medical
assistance or MinnesotaCare.
new text end

new text begin (b) A child is eligible for the program under this section if the child is under the age
of 21, and meets all other MinnesotaCare eligibility requirements under this chapter,
except as otherwise specified in this section, and:
new text end

new text begin (1) has been determined eligible for the emergency medical assistance program
under section 256B.06, subdivision 4, paragraph (e) or (f); or
new text end

new text begin (2) the child's treating health care provider certifies that the child has an emergency
medical condition as defined in United States Code, title 42, section 1396b(v), that is
likely to lead to the child being admitted to a hospital or emergency department unless
intervening outpatient health care treatment is provided.
new text end

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

new text begin (d) Children eligible for the program under this subdivision are exempt from the
income eligibility limits under section 256L.04 and section 256L.07, and remain eligible
for the program so long as their family income is equal to or less than 275 percent of federal
poverty guidelines, and the citizenship requirements under section 256L.04, subdivision 10.
new text end

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

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

new text begin Subd. 2. new text end

new text begin Covered services. new text end

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

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

new text begin (c) For children who are eligible under subdivision 1, the program covers nursing
facility services described under section 144.0724, subdivision 11, and home and
community-based services described in paragraph (d), if the child's family income is equal
to or less than the medical assistance income eligibility standards described in section
256B.056, subdivision 4, or meets the excess income standards described in section
256B.056, subdivisions 5 and 5c. All requirements of the medical assistance program
under chapter 256B relating to these services apply to the program under this section.
new text end

new text begin (d) For purposes of this section, home and community-based services include:
new text end

new text begin (1) home and community-based waivered services for persons with developmental
disabilities, including consumer-directed community supports under section 256B.092;
new text end

new text begin (2) waivered services under community alternatives for disabled individuals,
including consumer-directed community supports under section 256B.49;
new text end

new text begin (3) community alternative care waivered services, including consumer-directed
community supports under section 256B.49;
new text end

new text begin (4) brain injury waivered services, including consumer-directed community supports
under section 256B.49;
new text end

new text begin (5) home and community-based waivered services for the elderly under section
256B.0915;
new text end

new text begin (6) nursing services and home health services under section 256B.0625, subdivision
6a;
new text end

new text begin (7) personal care services and qualified professional supervision of personal care
services under section 256B.0625, subdivisions 6a and 19a;
new text end

new text begin (8) private duty nursing services under section 256B.0625, subdivision 7; and
new text end

new text begin (9) community first services and supports under section 256B.85.
new text end

new text begin Subd. 3. new text end

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

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

new text begin Subd. 4. new text end

new text begin Service delivery. new text end

new text begin (a) The commissioner may contract with managed care
plans, county-based purchasing plans, provider networks, nonprofit coverage programs,
counties, or health care delivery systems established under section 256B.0755 or
256B.0756 to administer the program authorized under this section in order to control the
costs of the program through care coordination, limited provider networks, fee discounts,
and other methods. The commissioner may delegate to a contractor the responsibility
to perform case reviews and authorize payment. The commissioner may contract on
a capitated or fixed budget basis under which the contractor shall be responsible for
providing the covered services to eligible children within the limits of the capitation
or budgeted amount. The commissioner may also contract using gain-sharing and
risk-sharing methods authorized for demonstration projects established under sections
256B.0755 and 256B.0756. If the commissioner contracts with a contractor under
this subdivision, the commissioner may separate nursing facility services, home and
community-based services, and pharmacy services from other covered services and may
provide payment for these services under the commissioner's fee-for-service payment
system instead of payment to the contracted entity.
new text end

new text begin (b) If no qualified contractors are available and willing to contract on alternative
payment terms in a geographic area of the state, the commissioner shall administer the
program as a fee-for-service program in that area, but may establish additional utilization
review and care management programs and requirements in order to control the costs
of the program.
new text end

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

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2014.
new text end

ARTICLE 2

MEDICAL ASSISTANCE

Section 1.

Minnesota Statutes 2012, section 256B.06, is amended by adding a
subdivision to read:

new text begin Subd. 6. new text end

new text begin Federal authority. new text end

new text begin The commissioner shall seek federal authority to make
changes to the emergency medical assistance program established under section 256B.06,
subdivision 4, paragraphs (e) to (h), to allow coverage and payment for cost-effective
community-based and outpatient services as an alternative to hospital inpatient and
emergency department services in order to reduce the total cost of care.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end