SF 2574

as introduced - 88th Legislature (2013 - 2014) Posted on 03/13/2014 09:07am

A bill for an act
relating to human services; exempting services provided by providers licensed
under Minnesota Statutes, chapter 245D, from the family deductible under
medical assistance; amending Minnesota Statutes 2012, section 256B.0631,
subdivision 2; Minnesota Statutes 2013 Supplement, section 256B.0631,
subdivision 1.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 256B.0631, subdivision 1,
is amended to read:

Subdivision 1.

Cost-sharing.

(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:

(1) $3 per nonpreventive visit deleted text begin , except as provided in paragraph (b) deleted text end . 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;

(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
this co-payment shall be increased to $20 upon federal approval;

(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;

(4) effective January 1, 2012, a family deductible equal to the maximum amount
allowed under Code of Federal Regulations, title 42, part 447.54; and

(5) for individuals identified by the commissioner with income at or below 100
percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
percent of family income. For purposes of this paragraph, family income is the total
earned and unearned income of the individual and the individual's spouse, if the spouse is
enrolled in medical assistance and also subject to the five percent limit on cost-sharing.

(b) Recipients of medical assistance are responsible for all co-payments and
deductibles in this subdivision.

(c) Notwithstanding paragraph (b), the commissioner, through the contracting
process under sections 256B.69 and 256B.692, may allow managed care plans and
county-based purchasing plans to waive the family deductible under paragraph (a),
clause (4). The value of the family deductible shall not be included in the capitation
payment to managed care plans and county-based purchasing plans. Managed care plans
and county-based purchasing plans shall certify annually to the commissioner the dollar
value of the family deductible.

(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
the family deductible described under paragraph (a), clause (4), from individuals and
allow long-term care deleted text begin and waivered service deleted text end providers to assume responsibility for payment.

(e) Notwithstanding paragraph (b), the commissioner, through the contracting
process under section 256B.0756 shall allow the pilot program in Hennepin County to
waive co-payments. The value of the co-payments shall not be included in the capitation
payment amount to the integrated health care delivery networks under the pilot program.

Sec. 2.

Minnesota Statutes 2012, section 256B.0631, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

Co-payments and deductibles shall be subject to the following
exceptions:

(1) children under the age of 21;

(2) pregnant women for services that relate to the pregnancy or any other medical
condition that may complicate the pregnancy;

(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
intermediate care facility for the developmentally disabled;

(4) recipients receiving hospice care;

(5) 100 percent federally funded services provided by an Indian health service;

(6) emergency services;

(7) family planning services;

(8) services that are paid by Medicare, resulting in the medical assistance program
paying for the coinsurance and deductible;

(9) co-payments that exceed one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room; deleted text begin and
deleted text end

(10) services, fee-for-service payments subject to volume purchase through
competitive bidding new text begin ; and
new text end

new text begin (11) services provided by providers licensed under chapter 245D new text end .