SF 2602

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health care; modifying medical assistance, 
  1.3             general assistance medical care, and MinnesotaCare 
  1.4             programs; providing for determination of health care 
  1.5             provider tax rates; increasing the tax on tobacco 
  1.6             products; appropriating money; amending Minnesota 
  1.7             Statutes 2002, sections 256B.055, by adding a 
  1.8             subdivision; 256B.057, by adding a subdivision; 
  1.9             295.52, subdivisions 1, 1a, 2, 3, by adding a 
  1.10            subdivision; 297F.05, subdivisions 3, 4; 297F.10, 
  1.11            subdivision 2; Minnesota Statutes 2003 Supplement, 
  1.12            sections 256B.057, subdivisions 1, 2; 256B.0625, 
  1.13            subdivisions 9, 13e; 256B.76; 256D.03, subdivision 4; 
  1.14            256L.03, subdivision 1; 256L.07, subdivisions 1, 3; 
  1.15            297F.05, subdivision 1; 297F.10, subdivision 1; 
  1.16            proposing coding for new law in Minnesota Statutes, 
  1.17            chapter 145; repealing Minnesota Statutes 2003 
  1.18            Supplement, section 256L.035.  
  1.19  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.20     Section 1.  [145.8895] [CHILDREN WITH SPECIAL HEALTH CARE 
  1.21  NEEDS.] 
  1.22     When cost-effective, the commissioner may use money 
  1.23  received for the services for children with special health care 
  1.24  needs program to purchase health care coverage for eligible 
  1.25  children.  
  1.26     Sec. 2.  Minnesota Statutes 2002, section 256B.055, is 
  1.27  amended by adding a subdivision to read: 
  1.28     Subd. 10b.  [CHILDREN.] This subdivision supersedes 
  1.29  subdivision 10, as long the Minnesota health care reform waiver 
  1.30  remains in effect.  When the waiver expires, this subdivision 
  1.31  expires and the commissioner of human services shall publish a 
  1.32  notice in the State Register and notify the revisor of 
  2.1   statutes.  Medical assistance may be paid for a child less than 
  2.2   two years of age, whose mother was eligible for and receiving 
  2.3   medical assistance at the time of birth and who remains in the 
  2.4   mother's household or who is in a family with countable income 
  2.5   that is equal to or less than the income standard established 
  2.6   under section 256B.057, subdivision 1. 
  2.7      Sec. 3.  Minnesota Statutes 2003 Supplement, section 
  2.8   256B.057, subdivision 1, is amended to read: 
  2.9      Subdivision 1.  [PREGNANT WOMEN AND INFANTS.] (a)(1) An 
  2.10  infant less than one year of age is eligible for medical 
  2.11  assistance if countable family income is equal to or less than 
  2.12  275 percent of the federal poverty guideline for the same family 
  2.13  size.  A pregnant woman who has written verification of a 
  2.14  positive pregnancy test from a physician or licensed registered 
  2.15  nurse is eligible for medical assistance if countable family 
  2.16  income is equal to or less than 200 275 percent of the federal 
  2.17  poverty guideline for the same family size.  For purposes of 
  2.18  this subdivision, "countable family income" means the amount of 
  2.19  income considered available using the methodology of the AFDC 
  2.20  program under the state's AFDC plan as of July 16, 1996, as 
  2.21  required by the Personal Responsibility and Work Opportunity 
  2.22  Reconciliation Act of 1996 (PRWORA), Public Law 104-193, except 
  2.23  for the earned income disregard and employment deductions. 
  2.24     (2) For applications processed within one calendar month 
  2.25  prior to the effective date, eligibility shall be determined by 
  2.26  applying the income standards and methodologies in effect prior 
  2.27  to the effective date for any months in the six-month budget 
  2.28  period before that date and the income standards and 
  2.29  methodologies in effect on the effective date for any months in 
  2.30  the six-month budget period on or after that date.  The income 
  2.31  standards for each month shall be added together and compared to 
  2.32  the applicant's total countable income for the six-month budget 
  2.33  period to determine eligibility. 
  2.34     (b)(1)  [EXPIRED.] 
  2.35     (2) For applications processed within one calendar month 
  2.36  prior to July 1, 2003, eligibility shall be determined by 
  3.1   applying the income standards and methodologies in effect prior 
  3.2   to July 1, 2003, for any months in the six-month budget period 
  3.3   before July 1, 2003, and the income standards and methodologies 
  3.4   in effect on the expiration date for any months in the six-month 
  3.5   budget period on or after July 1, 2003.  The income standards 
  3.6   for each month shall be added together and compared to the 
  3.7   applicant's total countable income for the six-month budget 
  3.8   period to determine eligibility. 
  3.9      (c) Dependent care and child support paid under court order 
  3.10  shall be deducted from the countable income of pregnant women. 
  3.11     (d) An infant born on or after January 1, 1991, to a woman 
  3.12  who was eligible for and receiving medical assistance on the 
  3.13  date of the child's birth shall continue to be eligible for 
  3.14  medical assistance without redetermination until the child's 
  3.15  first birthday, as long as the child remains in the woman's 
  3.16  household. 
  3.17     Sec. 4.  Minnesota Statutes 2002, section 256B.057, is 
  3.18  amended by adding a subdivision to read: 
  3.19     Subd. 1d.  [PREGNANT WOMEN AND INFANTS; EXPANSION.] (a) 
  3.20  This subdivision supersedes subdivision 1 as long as the 
  3.21  Minnesota health care reform waiver remains in effect.  When the 
  3.22  waiver expires, the commissioner of human services shall publish 
  3.23  a notice in the State Register and notify the revisor of 
  3.24  statutes.  An infant less than two years of age or a pregnant 
  3.25  woman who has written verification of a positive pregnancy test 
  3.26  from a physician or licensed registered nurse is eligible for 
  3.27  medical assistance if countable family income is equal to or 
  3.28  less than 275 percent of the federal poverty guideline for the 
  3.29  same family size.  For purposes of this subdivision, "countable 
  3.30  family income" means the amount of income considered available 
  3.31  using the methodology of the AFDC program under the state's AFDC 
  3.32  plan as of July 16, 1996, as required by the Personal 
  3.33  Responsibility and Work Opportunity Reconciliation Act of 1996 
  3.34  (PRWORA), Public Law 104-193, except for the earned income 
  3.35  disregard and employment deductions.  An amount equal to the 
  3.36  amount of earned income exceeding 275 percent of the federal 
  4.1   poverty guideline, up to a maximum of the amount by which the 
  4.2   combined total of 185 percent of the federal poverty guideline 
  4.3   plus the earned income disregards and deductions of the AFDC 
  4.4   program under the state's AFDC plan as of July 16, 1996, as 
  4.5   required by the Personal Responsibility and Work Opportunity 
  4.6   Reconciliation Act of 1996 (PRWORA), Public Law 104-193, 
  4.7   exceeding 275 percent of the federal poverty guideline will be 
  4.8   deducted for pregnant women and infants less than two years of 
  4.9   age. 
  4.10     (b) An infant born on or after January 1, 1991, to a woman 
  4.11  who was eligible for and receiving medical assistance on the 
  4.12  date of the child's birth shall continue to be eligible for 
  4.13  medical assistance without redetermination until the child's 
  4.14  second birthday, as long as the child remains in the woman's 
  4.15  household. 
  4.16     Sec. 5.  Minnesota Statutes 2003 Supplement, section 
  4.17  256B.057, subdivision 2, is amended to read: 
  4.18     Subd. 2.  [CHILDREN.] (a) Except as specified in 
  4.19  subdivision 1b, effective October 1, 2003 July 1, 2004, a child 
  4.20  one through 18 years of age in a family whose countable income 
  4.21  is no greater than 150 170 percent of the federal poverty 
  4.22  guidelines for the same family size, is eligible for medical 
  4.23  assistance.  
  4.24     (b) For applications processed within one calendar month 
  4.25  prior to the effective date, eligibility shall be determined by 
  4.26  applying the income standards and methodologies in effect prior 
  4.27  to the effective date for any months in the six-month budget 
  4.28  period before that date and the income standards and 
  4.29  methodologies in effect on the effective date for any months in 
  4.30  the six-month budget period on or after that date.  The income 
  4.31  standards for each month shall be added together and compared to 
  4.32  the applicant's total countable income for the six-month budget 
  4.33  period to determine eligibility. 
  4.34     Sec. 6.  Minnesota Statutes 2003 Supplement, section 
  4.35  256B.0625, subdivision 9, is amended to read: 
  4.36     Subd. 9.  [DENTAL SERVICES.] (a) Medical assistance covers 
  5.1   dental services.  Dental services include, with prior 
  5.2   authorization, fixed bridges that are cost-effective for persons 
  5.3   who cannot use removable dentures because of their medical 
  5.4   condition.  
  5.5      (b) Coverage of dental services for adults age 21 and over 
  5.6   who are not pregnant is subject to a $500 annual benefit limit 
  5.7   and covered services are limited to:  
  5.8      (1) diagnostic and preventative services; 
  5.9      (2) basic restorative services; and 
  5.10     (3) emergency services. 
  5.11     Emergency services, dentures, and extractions related to 
  5.12  dentures are not included in the $500 annual benefit limit. 
  5.13     Sec. 7.  Minnesota Statutes 2003 Supplement, section 
  5.14  256B.0625, subdivision 13e, is amended to read: 
  5.15     Subd. 13e.  [PAYMENT RATES.] (a) The basis for determining 
  5.16  the amount of payment shall be the lower of the actual 
  5.17  acquisition costs of the drugs plus a fixed dispensing fee; the 
  5.18  maximum allowable cost set by the federal government or by the 
  5.19  commissioner plus the fixed dispensing fee; or the usual and 
  5.20  customary price charged to the public.  The amount of payment 
  5.21  basis must be reduced to reflect all discount amounts applied to 
  5.22  the charge by any provider/insurer agreement or contract for 
  5.23  submitted charges to medical assistance programs.  The net 
  5.24  submitted charge may not be greater than the patient liability 
  5.25  for the service.  The pharmacy dispensing fee shall be $3.65, 
  5.26  except that the dispensing fee for intravenous solutions which 
  5.27  must be compounded by the pharmacist shall be $8 per bag, $14 
  5.28  per bag for cancer chemotherapy products, and $30 per bag for 
  5.29  total parenteral nutritional products dispensed in one liter 
  5.30  quantities, or $44 per bag for total parenteral nutritional 
  5.31  products dispensed in quantities greater than one liter.  Actual 
  5.32  acquisition cost includes quantity and other special discounts 
  5.33  except time and cash discounts.  The actual acquisition cost of 
  5.34  a drug shall be estimated by the commissioner, at average 
  5.35  wholesale price minus 11.5 nine percent, except that where a 
  5.36  drug has had its wholesale price reduced as a result of the 
  6.1   actions of the National Association of Medicaid Fraud Control 
  6.2   Units, the estimated actual acquisition cost shall be the 
  6.3   reduced average wholesale price, without the 11.5 nine percent 
  6.4   deduction.  The maximum allowable cost of a multisource drug may 
  6.5   be set by the commissioner and it shall be comparable to, but no 
  6.6   higher than, the maximum amount paid by other third-party payors 
  6.7   in this state who have maximum allowable cost programs.  
  6.8   Establishment of the amount of payment for drugs shall not be 
  6.9   subject to the requirements of the Administrative Procedure Act. 
  6.10     (b) An additional dispensing fee of $.30 may be added to 
  6.11  the dispensing fee paid to pharmacists for legend drug 
  6.12  prescriptions dispensed to residents of long-term care 
  6.13  facilities when a unit dose blister card system, approved by the 
  6.14  department, is used.  Under this type of dispensing system, the 
  6.15  pharmacist must dispense a 30-day supply of drug.  The National 
  6.16  Drug Code (NDC) from the drug container used to fill the blister 
  6.17  card must be identified on the claim to the department.  The 
  6.18  unit dose blister card containing the drug must meet the 
  6.19  packaging standards set forth in Minnesota Rules, part 
  6.20  6800.2700, that govern the return of unused drugs to the 
  6.21  pharmacy for reuse.  The pharmacy provider will be required to 
  6.22  credit the department for the actual acquisition cost of all 
  6.23  unused drugs that are eligible for reuse.  Over-the-counter 
  6.24  medications must be dispensed in the manufacturer's unopened 
  6.25  package.  The commissioner may permit the drug clozapine to be 
  6.26  dispensed in a quantity that is less than a 30-day supply.  
  6.27     (c) Whenever a generically equivalent product is available, 
  6.28  payment shall be on the basis of the actual acquisition cost of 
  6.29  the generic drug, or on the maximum allowable cost established 
  6.30  by the commissioner. 
  6.31     (d) The basis for determining the amount of payment for 
  6.32  drugs administered in an outpatient setting shall be the lower 
  6.33  of the usual and customary cost submitted by the provider, the 
  6.34  average wholesale price minus five percent, or the maximum 
  6.35  allowable cost set by the federal government under United States 
  6.36  Code, title 42, chapter 7, section 1396r-8(e), and Code of 
  7.1   Federal Regulations, title 42, section 447.332, or by the 
  7.2   commissioner under paragraphs (a) to (c). 
  7.3      Sec. 8.  Minnesota Statutes 2003 Supplement, section 
  7.4   256B.76, is amended to read: 
  7.5      256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  7.6      (a) Effective for services rendered on or after October 1, 
  7.7   1992, the commissioner shall make payments for physician 
  7.8   services as follows: 
  7.9      (1) payment for level one Centers for Medicare and Medicaid 
  7.10  Services' common procedural coding system codes titled "office 
  7.11  and other outpatient services," "preventive medicine new and 
  7.12  established patient," "delivery, antepartum, and postpartum 
  7.13  care," "critical care," cesarean delivery and pharmacologic 
  7.14  management provided to psychiatric patients, and level three 
  7.15  codes for enhanced services for prenatal high risk, shall be 
  7.16  paid at the lower of (i) submitted charges, or (ii) 25 percent 
  7.17  above the rate in effect on June 30, 1992.  If the rate on any 
  7.18  procedure code within these categories is different than the 
  7.19  rate that would have been paid under the methodology in section 
  7.20  256B.74, subdivision 2, then the larger rate shall be paid; 
  7.21     (2) payments for all other services shall be paid at the 
  7.22  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  7.23  rate in effect on June 30, 1992; 
  7.24     (3) all physician rates shall be converted from the 50th 
  7.25  percentile of 1982 to the 50th percentile of 1989, less the 
  7.26  percent in aggregate necessary to equal the above increases 
  7.27  except that payment rates for home health agency services shall 
  7.28  be the rates in effect on September 30, 1992; 
  7.29     (4) effective for services rendered on or after January 1, 
  7.30  2000, payment rates for physician and professional services 
  7.31  shall be increased by three percent over the rates in effect on 
  7.32  December 31, 1999, except for home health agency and family 
  7.33  planning agency services; and 
  7.34     (5) the increases in clause (4) shall be implemented 
  7.35  January 1, 2000, for managed care. 
  7.36     (b) Effective for services rendered on or after October 1, 
  8.1   1992, the commissioner shall make payments for dental services 
  8.2   as follows: 
  8.3      (1) dental services shall be paid at the lower of (i) 
  8.4   submitted charges, or (ii) 25 percent above the rate in effect 
  8.5   on June 30, 1992; 
  8.6      (2) dental rates shall be converted from the 50th 
  8.7   percentile of 1982 to the 50th percentile of 1989, less the 
  8.8   percent in aggregate necessary to equal the above increases; 
  8.9      (3) effective for services rendered on or after January 1, 
  8.10  2000, payment rates for dental services shall be increased by 
  8.11  three percent over the rates in effect on December 31, 1999; 
  8.12     (4) the commissioner shall award grants to community 
  8.13  clinics or other nonprofit community organizations, political 
  8.14  subdivisions, professional associations, or other organizations 
  8.15  that demonstrate the ability to provide dental services 
  8.16  effectively to public program recipients.  Grants may be used to 
  8.17  fund the costs related to coordinating access for recipients, 
  8.18  developing and implementing patient care criteria, upgrading or 
  8.19  establishing new facilities, acquiring furnishings or equipment, 
  8.20  recruiting new providers, or other development costs that will 
  8.21  improve access to dental care in a region.  In awarding grants, 
  8.22  the commissioner shall give priority to applicants that plan to 
  8.23  serve areas of the state in which the number of dental providers 
  8.24  is not currently sufficient to meet the needs of recipients of 
  8.25  public programs or uninsured individuals.  The commissioner 
  8.26  shall consider the following in awarding the grants: 
  8.27     (i) potential to successfully increase access to an 
  8.28  underserved population; 
  8.29     (ii) the ability to raise matching funds; 
  8.30     (iii) the long-term viability of the project to improve 
  8.31  access beyond the period of initial funding; 
  8.32     (iv) the efficiency in the use of the funding; and 
  8.33     (v) the experience of the proposers in providing services 
  8.34  to the target population. 
  8.35     The commissioner shall monitor the grants and may terminate 
  8.36  a grant if the grantee does not increase dental access for 
  9.1   public program recipients.  The commissioner shall consider 
  9.2   grants for the following: 
  9.3      (i) implementation of new programs or continued expansion 
  9.4   of current access programs that have demonstrated success in 
  9.5   providing dental services in underserved areas; 
  9.6      (ii) a pilot program for utilizing hygienists outside of a 
  9.7   traditional dental office to provide dental hygiene services; 
  9.8   and 
  9.9      (iii) a program that organizes a network of volunteer 
  9.10  dentists, establishes a system to refer eligible individuals to 
  9.11  volunteer dentists, and through that network provides donated 
  9.12  dental care services to public program recipients or uninsured 
  9.13  individuals; 
  9.14     (5) beginning October 1, 1999, the payment for tooth 
  9.15  sealants and fluoride treatments shall be the lower of (i) 
  9.16  submitted charge, or (ii) 80 percent of median 1997 charges; 
  9.17     (6) the increases listed in clauses (3) and (5) shall be 
  9.18  implemented January 1, 2000, for managed care; and 
  9.19     (7) effective for services provided on or after January 1, 
  9.20  2002, payment for diagnostic examinations and dental x-rays 
  9.21  provided to children under age 21 shall be the lower of (i) the 
  9.22  submitted charge, or (ii) 85 percent of median 1999 charges.  
  9.23     (c) Effective for dental services rendered on or after 
  9.24  January 1, 2002, the commissioner may, within the limits of 
  9.25  available appropriation, increase reimbursements to dentists and 
  9.26  dental clinics deemed by the commissioner to be critical access 
  9.27  dental providers.  Reimbursement to a critical access dental 
  9.28  provider may be increased by not more than 50 percent above the 
  9.29  reimbursement rate that would otherwise be paid to the 
  9.30  provider.  Payments to health plan companies shall be adjusted 
  9.31  to reflect increased reimbursements to critical access dental 
  9.32  providers as approved by the commissioner.  In determining which 
  9.33  dentists and dental clinics shall be deemed critical access 
  9.34  dental providers, the commissioner shall review: 
  9.35     (1) the utilization rate in the service area in which the 
  9.36  dentist or dental clinic operates for dental services to 
 10.1   patients covered by medical assistance, general assistance 
 10.2   medical care, or MinnesotaCare as their primary source of 
 10.3   coverage; 
 10.4      (2) the level of services provided by the dentist or dental 
 10.5   clinic to patients covered by medical assistance, general 
 10.6   assistance medical care, or MinnesotaCare as their primary 
 10.7   source of coverage; and 
 10.8      (3) whether the level of services provided by the dentist 
 10.9   or dental clinic is critical to maintaining adequate levels of 
 10.10  patient access within the service area. 
 10.11  In the absence of a critical access dental provider in a service 
 10.12  area, the commissioner may designate a dentist or dental clinic 
 10.13  as a critical access dental provider if the dentist or dental 
 10.14  clinic is willing to provide care to patients covered by medical 
 10.15  assistance, general assistance medical care, or MinnesotaCare at 
 10.16  a level which significantly increases access to dental care in 
 10.17  the service area. 
 10.18     (d) An entity that operates both a Medicare certified 
 10.19  comprehensive outpatient rehabilitation facility and a facility 
 10.20  which was certified prior to January 1, 1993, that is licensed 
 10.21  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 10.22  whom at least 33 percent of the clients receiving rehabilitation 
 10.23  services in the most recent calendar year are medical assistance 
 10.24  recipients, shall be reimbursed by the commissioner for 
 10.25  rehabilitation services at rates that are 38 percent greater 
 10.26  than the maximum reimbursement rate allowed under paragraph (a), 
 10.27  clause (2), when those services are (1) provided within the 
 10.28  comprehensive outpatient rehabilitation facility and (2) 
 10.29  provided to residents of nursing facilities owned by the entity. 
 10.30     (e) Effective for services rendered on or after January 1, 
 10.31  2007, the commissioner shall make payments for physician and 
 10.32  professional services based on the Medicare relative value units 
 10.33  (RVUs).  This change shall be budget neutral and the cost of 
 10.34  implementing RVUs will be incorporated in the established 
 10.35  conversion factor. 
 10.36     (f) Effective for services rendered on or after July 1, 
 11.1   2004, payment rates for dental services shall be increased by 
 11.2   ten percent over the rates in effect on June 30, 2004.  
 11.3      Sec. 9.  Minnesota Statutes 2003 Supplement, section 
 11.4   256D.03, subdivision 4, is amended to read: 
 11.5      Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
 11.6   (a)(i) For a person who is eligible under subdivision 3, 
 11.7   paragraph (a), clause (2), item (i), general assistance medical 
 11.8   care covers, except as provided in paragraph (c): 
 11.9      (1) inpatient hospital services; 
 11.10     (2) outpatient hospital services; 
 11.11     (3) services provided by Medicare certified rehabilitation 
 11.12  agencies; 
 11.13     (4) prescription drugs and other products recommended 
 11.14  through the process established in section 256B.0625, 
 11.15  subdivision 13; 
 11.16     (5) equipment necessary to administer insulin and 
 11.17  diagnostic supplies and equipment for diabetics to monitor blood 
 11.18  sugar level; 
 11.19     (6) eyeglasses and eye examinations provided by a physician 
 11.20  or optometrist; 
 11.21     (7) hearing aids; 
 11.22     (8) prosthetic devices; 
 11.23     (9) laboratory and X-ray services; 
 11.24     (10) physician's services; 
 11.25     (11) medical transportation except special transportation; 
 11.26     (12) chiropractic services as covered under the medical 
 11.27  assistance program; 
 11.28     (13) podiatric services; 
 11.29     (14) dental services and dentures, subject to the 
 11.30  limitations specified in section 256B.0625, subdivision 9; 
 11.31     (15) outpatient services provided by a mental health center 
 11.32  or clinic that is under contract with the county board and is 
 11.33  established under section 245.62; 
 11.34     (16) day treatment services for mental illness provided 
 11.35  under contract with the county board; 
 11.36     (17) prescribed medications for persons who have been 
 12.1   diagnosed as mentally ill as necessary to prevent more 
 12.2   restrictive institutionalization; 
 12.3      (18) psychological services, medical supplies and 
 12.4   equipment, and Medicare premiums, coinsurance and deductible 
 12.5   payments; 
 12.6      (19) medical equipment not specifically listed in this 
 12.7   paragraph when the use of the equipment will prevent the need 
 12.8   for costlier services that are reimbursable under this 
 12.9   subdivision; 
 12.10     (20) services performed by a certified pediatric nurse 
 12.11  practitioner, a certified family nurse practitioner, a certified 
 12.12  adult nurse practitioner, a certified obstetric/gynecological 
 12.13  nurse practitioner, a certified neonatal nurse practitioner, or 
 12.14  a certified geriatric nurse practitioner in independent 
 12.15  practice, if (1) the service is otherwise covered under this 
 12.16  chapter as a physician service, (2) the service provided on an 
 12.17  inpatient basis is not included as part of the cost for 
 12.18  inpatient services included in the operating payment rate, and 
 12.19  (3) the service is within the scope of practice of the nurse 
 12.20  practitioner's license as a registered nurse, as defined in 
 12.21  section 148.171; 
 12.22     (21) services of a certified public health nurse or a 
 12.23  registered nurse practicing in a public health nursing clinic 
 12.24  that is a department of, or that operates under the direct 
 12.25  authority of, a unit of government, if the service is within the 
 12.26  scope of practice of the public health nurse's license as a 
 12.27  registered nurse, as defined in section 148.171; and 
 12.28     (22) telemedicine consultations, to the extent they are 
 12.29  covered under section 256B.0625, subdivision 3b.  
 12.30     (ii) Effective October 1, 2003, for a person who is 
 12.31  eligible under subdivision 3, paragraph (a), clause (2), item 
 12.32  (ii), general assistance medical care coverage is limited to 
 12.33  inpatient hospital services, including physician services 
 12.34  provided during the inpatient hospital stay.  A $1,000 
 12.35  deductible is required for each inpatient hospitalization.  
 12.36     (b) Gender reassignment surgery and related services are 
 13.1   not covered services under this subdivision unless the 
 13.2   individual began receiving gender reassignment services prior to 
 13.3   July 1, 1995.  
 13.4      (c) In order to contain costs, the commissioner of human 
 13.5   services shall select vendors of medical care who can provide 
 13.6   the most economical care consistent with high medical standards 
 13.7   and shall where possible contract with organizations on a 
 13.8   prepaid capitation basis to provide these services.  The 
 13.9   commissioner shall consider proposals by counties and vendors 
 13.10  for prepaid health plans, competitive bidding programs, block 
 13.11  grants, or other vendor payment mechanisms designed to provide 
 13.12  services in an economical manner or to control utilization, with 
 13.13  safeguards to ensure that necessary services are provided.  
 13.14  Before implementing prepaid programs in counties with a county 
 13.15  operated or affiliated public teaching hospital or a hospital or 
 13.16  clinic operated by the University of Minnesota, the commissioner 
 13.17  shall consider the risks the prepaid program creates for the 
 13.18  hospital and allow the county or hospital the opportunity to 
 13.19  participate in the program in a manner that reflects the risk of 
 13.20  adverse selection and the nature of the patients served by the 
 13.21  hospital, provided the terms of participation in the program are 
 13.22  competitive with the terms of other participants considering the 
 13.23  nature of the population served.  Payment for services provided 
 13.24  pursuant to this subdivision shall be as provided to medical 
 13.25  assistance vendors of these services under sections 256B.02, 
 13.26  subdivision 8, and 256B.0625.  For payments made during fiscal 
 13.27  year 1990 and later years, the commissioner shall consult with 
 13.28  an independent actuary in establishing prepayment rates, but 
 13.29  shall retain final control over the rate methodology.  
 13.30     (d) Recipients eligible under subdivision 3, paragraph (a), 
 13.31  clause (2), item (i), shall pay the following co-payments for 
 13.32  services provided on or after October 1, 2003: 
 13.33     (1) $3 per nonpreventive visit.  For purposes of this 
 13.34  subdivision, a visit means an episode of service which is 
 13.35  required because of a recipient's symptoms, diagnosis, or 
 13.36  established illness, and which is delivered in an ambulatory 
 14.1   setting by a physician or physician ancillary, chiropractor, 
 14.2   podiatrist, nurse midwife, advanced practice nurse, audiologist, 
 14.3   optician, or optometrist; 
 14.4      (2) $25 for eyeglasses; 
 14.5      (3) $25 for nonemergency visits to a hospital-based 
 14.6   emergency room; and 
 14.7      (4) $3 per brand-name drug prescription and $1 per generic 
 14.8   drug prescription, subject to a $20 per month maximum for 
 14.9   prescription drug co-payments.  No co-payments shall apply to 
 14.10  antipsychotic drugs when used for the treatment of mental 
 14.11  illness; and 
 14.12     (5) 50 percent coinsurance on basic restorative dental 
 14.13  services. 
 14.14     (e) Recipients of general assistance medical care are 
 14.15  responsible for all co-payments in this subdivision.  The 
 14.16  general assistance medical care reimbursement to the provider 
 14.17  shall be reduced by the amount of the co-payment, except that 
 14.18  reimbursement for prescription drugs shall not be reduced once a 
 14.19  recipient has reached the $20 per month maximum for prescription 
 14.20  drug co-payments.  The provider collects the co-payment from the 
 14.21  recipient.  Providers may not deny services to recipients who 
 14.22  are unable to pay the co-payment, except as provided in 
 14.23  paragraph (f). 
 14.24     (f) If it is the routine business practice of a provider to 
 14.25  refuse service to an individual with uncollected debt, the 
 14.26  provider may include uncollected co-payments under this 
 14.27  section.  A provider must give advance notice to a recipient 
 14.28  with uncollected debt before services can be denied. 
 14.29     (g) Any county may, from its own resources, provide medical 
 14.30  payments for which state payments are not made. 
 14.31     (h) Chemical dependency services that are reimbursed under 
 14.32  chapter 254B must not be reimbursed under general assistance 
 14.33  medical care. 
 14.34     (i) The maximum payment for new vendors enrolled in the 
 14.35  general assistance medical care program after the base year 
 14.36  shall be determined from the average usual and customary charge 
 15.1   of the same vendor type enrolled in the base year. 
 15.2      (j) The conditions of payment for services under this 
 15.3   subdivision are the same as the conditions specified in rules 
 15.4   adopted under chapter 256B governing the medical assistance 
 15.5   program, unless otherwise provided by statute or rule. 
 15.6      (k) Inpatient and outpatient payments shall be reduced by 
 15.7   five percent, effective July 1, 2003.  This reduction is in 
 15.8   addition to the five percent reduction effective July 1, 2003, 
 15.9   and incorporated by reference in paragraph (i).  
 15.10     (l) Payments for all other health services except 
 15.11  inpatient, outpatient, and pharmacy services shall be reduced by 
 15.12  five percent, effective July 1, 2003.  
 15.13     (m) Payments to managed care plans shall be reduced by five 
 15.14  percent for services provided on or after October 1, 2003. 
 15.15     (n) A hospital receiving a reduced payment as a result of 
 15.16  this section may apply the unpaid balance toward satisfaction of 
 15.17  the hospital's bad debts. 
 15.18     Sec. 10.  Minnesota Statutes 2003 Supplement, section 
 15.19  256L.03, subdivision 1, is amended to read: 
 15.20     Subdivision 1.  [COVERED HEALTH SERVICES.] For individuals 
 15.21  under section 256L.04, subdivision 7, with income no greater 
 15.22  than 75 percent of the federal poverty guidelines or for 
 15.23  families with children under section 256L.04, subdivision 1, all 
 15.24  subdivisions of this section apply.  "Covered health services" 
 15.25  means the health services reimbursed under chapter 256B, with 
 15.26  the exception of inpatient hospital services, special education 
 15.27  services, private duty nursing services, adult dental care 
 15.28  services other than preventive services covered under section 
 15.29  256B.0625, subdivision 9, paragraph (b), orthodontic services, 
 15.30  nonemergency medical transportation services, personal care 
 15.31  assistant and case management services, nursing home or 
 15.32  intermediate care facilities services, inpatient mental health 
 15.33  services, and chemical dependency services.  Adult dental care 
 15.34  for nonpreventive services, with the exception of orthodontic 
 15.35  services, is covered for persons who qualify under section 
 15.36  256L.04, subdivisions 1, 2, and 7, with family gross income 
 16.1   equal to or less than 175 percent of the federal poverty 
 16.2   guidelines.  Outpatient mental health services covered under the 
 16.3   MinnesotaCare program are limited to diagnostic assessments, 
 16.4   psychological testing, explanation of findings, medication 
 16.5   management by a physician, day treatment, partial 
 16.6   hospitalization, and individual, family, and group psychotherapy.
 16.7      No public funds shall be used for coverage of abortion 
 16.8   under MinnesotaCare except where the life of the female would be 
 16.9   endangered or substantial and irreversible impairment of a major 
 16.10  bodily function would result if the fetus were carried to term; 
 16.11  or where the pregnancy is the result of rape or incest. 
 16.12     Covered health services shall be expanded as provided in 
 16.13  this section. 
 16.14     Sec. 11.  Minnesota Statutes 2003 Supplement, section 
 16.15  256L.07, subdivision 1, is amended to read: 
 16.16     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
 16.17  enrolled in the original children's health plan as of September 
 16.18  30, 1992, children who enrolled in the MinnesotaCare program 
 16.19  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 16.20  article 4, section 17, and children who have family gross 
 16.21  incomes that are equal to or less than 150 170 percent of the 
 16.22  federal poverty guidelines are eligible without meeting the 
 16.23  requirements of subdivision 2 and the four-month requirement in 
 16.24  subdivision 3, as long as they maintain continuous coverage in 
 16.25  the MinnesotaCare program or medical assistance.  Children who 
 16.26  apply for MinnesotaCare on or after the implementation date of 
 16.27  the employer-subsidized health coverage program as described in 
 16.28  Laws 1998, chapter 407, article 5, section 45, who have family 
 16.29  gross incomes that are equal to or less than 150 170 percent of 
 16.30  the federal poverty guidelines, must meet the requirements of 
 16.31  subdivision 2 to be eligible for MinnesotaCare. 
 16.32     (b) Families enrolled in MinnesotaCare under section 
 16.33  256L.04, subdivision 1, whose income increases above 275 percent 
 16.34  of the federal poverty guidelines, are no longer eligible for 
 16.35  the program and shall be disenrolled by the commissioner.  
 16.36  Individuals enrolled in MinnesotaCare under section 256L.04, 
 17.1   subdivision 7, whose income increases above 175 percent of the 
 17.2   federal poverty guidelines are no longer eligible for the 
 17.3   program and shall be disenrolled by the commissioner.  For 
 17.4   persons disenrolled under this subdivision, MinnesotaCare 
 17.5   coverage terminates the last day of the calendar month following 
 17.6   the month in which the commissioner determines that the income 
 17.7   of a family or individual exceeds program income limits.  
 17.8      (c)(1) Notwithstanding paragraph (b), families enrolled in 
 17.9   MinnesotaCare under section 256L.04, subdivision 1, may remain 
 17.10  enrolled in MinnesotaCare if ten percent of their annual income 
 17.11  is less than the annual premium for a policy with a $500 
 17.12  deductible available through the Minnesota Comprehensive Health 
 17.13  Association.  Families who are no longer eligible for 
 17.14  MinnesotaCare under this subdivision shall be given an 18-month 
 17.15  notice period from the date that ineligibility is determined 
 17.16  before disenrollment.  This clause expires February 1, 2004. 
 17.17     (2) Effective February 1, 2004, notwithstanding paragraph 
 17.18  (b), children may remain enrolled in MinnesotaCare if ten 
 17.19  percent of their annual family income is less than the annual 
 17.20  premium for a policy with a $500 deductible available through 
 17.21  the Minnesota Comprehensive Health Association.  Children who 
 17.22  are no longer eligible for MinnesotaCare under this clause shall 
 17.23  be given a 12-month notice period from the date that 
 17.24  ineligibility is determined before disenrollment.  The premium 
 17.25  for children remaining eligible under this clause shall be the 
 17.26  maximum premium determined under section 256L.15, subdivision 2, 
 17.27  paragraph (b). 
 17.28     (d) Effective July 1, 2003, notwithstanding paragraphs (b) 
 17.29  and (c), parents are no longer eligible for MinnesotaCare if 
 17.30  gross household income exceeds $50,000. 
 17.31     Sec. 12.  Minnesota Statutes 2003 Supplement, section 
 17.32  256L.07, subdivision 3, is amended to read: 
 17.33     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
 17.34  individuals enrolled in the MinnesotaCare program must have no 
 17.35  health coverage while enrolled or for at least four months prior 
 17.36  to application and renewal.  Children enrolled in the original 
 18.1   children's health plan and children in families with income 
 18.2   equal to or less than 150 170 percent of the federal poverty 
 18.3   guidelines, who have other health insurance, are eligible if the 
 18.4   coverage: 
 18.5      (1) lacks two or more of the following: 
 18.6      (i) basic hospital insurance; 
 18.7      (ii) medical-surgical insurance; 
 18.8      (iii) prescription drug coverage; 
 18.9      (iv) dental coverage; or 
 18.10     (v) vision coverage; 
 18.11     (2) requires a deductible of $100 or more per person per 
 18.12  year; or 
 18.13     (3) lacks coverage because the child has exceeded the 
 18.14  maximum coverage for a particular diagnosis or the policy 
 18.15  excludes a particular diagnosis. 
 18.16     The commissioner may change this eligibility criterion for 
 18.17  sliding scale premiums in order to remain within the limits of 
 18.18  available appropriations.  The requirement of no health coverage 
 18.19  does not apply to newborns.  
 18.20     (b) Medical assistance, general assistance medical care, 
 18.21  and the Civilian Health and Medical Program of the Uniformed 
 18.22  Service, CHAMPUS, or other coverage provided under United States 
 18.23  Code, title 10, subtitle A, part II, chapter 55, are not 
 18.24  considered insurance or health coverage for purposes of the 
 18.25  four-month requirement described in this subdivision. 
 18.26     (c) For purposes of this subdivision, Medicare Part A or B 
 18.27  coverage under title XVIII of the Social Security Act, United 
 18.28  States Code, title 42, sections 1395c to 1395w-4, is considered 
 18.29  health coverage.  An applicant or enrollee may not refuse 
 18.30  Medicare coverage to establish eligibility for MinnesotaCare. 
 18.31     (d) Applicants who were recipients of medical assistance or 
 18.32  general assistance medical care within one month of application 
 18.33  must meet the provisions of this subdivision and subdivision 2. 
 18.34     (e) Effective October 1, 2003, applicants who were 
 18.35  recipients of medical assistance and had cost-effective health 
 18.36  insurance which was paid for by medical assistance are exempt 
 19.1   from the four-month requirement under this section. 
 19.2      Sec. 13.  Minnesota Statutes 2002, section 295.52, 
 19.3   subdivision 1, is amended to read: 
 19.4      Subdivision 1.  [HOSPITAL TAX.] A tax is imposed on each 
 19.5   hospital equal to two 1.5 percent of its gross revenues. 
 19.6      Sec. 14.  Minnesota Statutes 2002, section 295.52, 
 19.7   subdivision 1a, is amended to read: 
 19.8      Subd. 1a.  [SURGICAL CENTER TAX.] A tax is imposed on each 
 19.9   surgical center equal to two 1.5 percent of its gross revenues. 
 19.10     Sec. 15.  Minnesota Statutes 2002, section 295.52, 
 19.11  subdivision 2, is amended to read: 
 19.12     Subd. 2.  [PROVIDER TAX.] A tax is imposed on each health 
 19.13  care provider equal to two 1.5 percent of its gross revenues. 
 19.14     Sec. 16.  Minnesota Statutes 2002, section 295.52, 
 19.15  subdivision 3, is amended to read: 
 19.16     Subd. 3.  [WHOLESALE DRUG DISTRIBUTOR TAX.] A tax is 
 19.17  imposed on each wholesale drug distributor equal to two 1.5 
 19.18  percent of its gross revenues.  
 19.19     Sec. 17.  Minnesota Statutes 2002, section 295.52, is 
 19.20  amended by adding a subdivision to read: 
 19.21     Subd. 8.  [CONTINGENT ADJUSTMENT OF TAX.] The commissioner 
 19.22  shall adjust the tax rates for calendar years beginning on or 
 19.23  after January 1, 2005, based upon determinations made by the 
 19.24  commissioner of finance regarding the structural balance of the 
 19.25  health care access fund.  The commissioner of finance shall, on 
 19.26  September 1 of each year, beginning September 1, 2004, determine 
 19.27  the structural balance of the health care access fund for the 
 19.28  fiscal year that begins the following July 1.  If the 
 19.29  commissioner of finance determines on September 1 that there is 
 19.30  no structural deficit for the following fiscal year, taxes shall 
 19.31  be imposed in accordance with subdivisions 1, 1a, 2, 3, and 4 
 19.32  for the calendar year that begins immediately following that 
 19.33  September 1.  If the commissioner of finance determines on 
 19.34  September 1 that there will be a structural deficit in the fund 
 19.35  for the following fiscal year, then the commissioner shall 
 19.36  increase the rate of the tax imposed under subdivisions 1, 1a, 
 20.1   2, 3, and 4 to two percent.  The commissioner shall publish in 
 20.2   the State Register by October 1 of each year, beginning October 
 20.3   1, 2004, the amount of the tax to be imposed for the following 
 20.4   calendar year.  
 20.5      Sec. 18.  Minnesota Statutes 2003 Supplement, section 
 20.6   297F.05, subdivision 1, is amended to read: 
 20.7      Subdivision 1.  [RATES; CIGARETTES.] A tax is imposed upon 
 20.8   the sale of cigarettes in this state, upon having cigarettes in 
 20.9   possession in this state with intent to sell, upon any person 
 20.10  engaged in business as a distributor, and upon the use or 
 20.11  storage by consumers, at the following rates: 
 20.12     (1) on cigarettes weighing not more than three pounds per 
 20.13  thousand, 24 74 mills on each such cigarette; and 
 20.14     (2) on cigarettes weighing more than three pounds per 
 20.15  thousand, 48 148 mills on each such cigarette. 
 20.16     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 20.17     Sec. 19.  Minnesota Statutes 2002, section 297F.05, 
 20.18  subdivision 3, is amended to read: 
 20.19     Subd. 3.  [RATES; TOBACCO PRODUCTS.] A tax is imposed upon 
 20.20  all tobacco products in this state and upon any person engaged 
 20.21  in business as a distributor, at the rate of 35 108 percent of 
 20.22  the wholesale sales price of the tobacco products.  The tax is 
 20.23  imposed at the time the distributor: 
 20.24     (1) brings, or causes to be brought, into this state from 
 20.25  outside the state tobacco products for sale; 
 20.26     (2) makes, manufactures, or fabricates tobacco products in 
 20.27  this state for sale in this state; or 
 20.28     (3) ships or transports tobacco products to retailers in 
 20.29  this state, to be sold by those retailers. 
 20.30     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 20.31     Sec. 20.  Minnesota Statutes 2002, section 297F.05, 
 20.32  subdivision 4, is amended to read: 
 20.33     Subd. 4.  [USE TAX; TOBACCO PRODUCTS.] A tax is imposed 
 20.34  upon the use or storage by consumers of tobacco products in this 
 20.35  state, and upon such consumers, at the rate of 35 108 percent of 
 20.36  the cost to the consumer of the tobacco products. 
 21.1      [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 21.2      Sec. 21.  Minnesota Statutes 2003 Supplement, section 
 21.3   297F.10, subdivision 1, is amended to read: 
 21.4      Subdivision 1.  [TAX AND USE TAX ON CIGARETTES.] Revenue 
 21.5   received from cigarette taxes, as well as related penalties, 
 21.6   interest, license fees, and miscellaneous sources of revenue 
 21.7   shall be deposited by the commissioner in the state treasury and 
 21.8   credited as follows: 
 21.9      (1) the revenue produced by 3.25 mills of the tax on 
 21.10  cigarettes weighing not more than three pounds a thousand and 
 21.11  6.5 mills of the tax on cigarettes weighing more than three 
 21.12  pounds a thousand must be credited to the Academic Health Center 
 21.13  special revenue fund hereby created and is annually appropriated 
 21.14  to the Board of Regents at the University of Minnesota for 
 21.15  Academic Health Center funding at the University of Minnesota; 
 21.16  and 
 21.17     (2) the revenue produced by 1.25 mills of the tax on 
 21.18  cigarettes weighing not more than three pounds a thousand and 
 21.19  2.5 mills of the tax on cigarettes weighing more than three 
 21.20  pounds a thousand must be credited to the medical education and 
 21.21  research costs account hereby created in the special revenue 
 21.22  fund and is annually appropriated to the commissioner of health 
 21.23  for distribution under section 62J.692, subdivision 4; and 
 21.24     (3) the balance of the revenues derived from taxes, 
 21.25  penalties, and interest (under this chapter) and from license 
 21.26  fees and miscellaneous sources of revenue shall be credited to 
 21.27  the general fund the revenue produced by 43.5 mills of the tax 
 21.28  on cigarettes weighing not more than three pounds a thousand and 
 21.29  87 mills of the tax on cigarettes weighing more than three 
 21.30  pounds a thousand must be credited to the general fund; and 
 21.31     (4) the balance of the revenues derived from taxes, 
 21.32  penalties, and interest, under this chapter, and from license 
 21.33  fees and miscellaneous sources of revenue shall be credited to 
 21.34  the health care access fund. 
 21.35     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 21.36     Sec. 22.  Minnesota Statutes 2002, section 297F.10, 
 22.1   subdivision 2, is amended to read: 
 22.2      Subd. 2.  [TAX AND USE TAX ON TOBACCO PRODUCTS.] 
 22.3   Twenty-seven percent of the revenue received from taxes on 
 22.4   tobacco products shall be deposited by the commissioner in the 
 22.5   state treasury and credited to the general fund.  The balance of 
 22.6   the revenues, as well as related penalties, interest, and 
 22.7   license fees, shall be deposited by the commissioner in the 
 22.8   state treasury and credited to the general health care access 
 22.9   fund. 
 22.10     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 22.11     Sec. 23.  [CIGARETTES; FLOOR STOCKS TAX.] 
 22.12     (a) A floor stocks tax is imposed on every person engaged 
 22.13  in business in this state as a distributor, retailer, subjobber, 
 22.14  vendor, manufacturer, or manufacturer's representative of 
 22.15  cigarettes on the stamped cigarettes in the person's possession 
 22.16  or under the person's control at 12:01 a.m. on July 1, 2004.  
 22.17  The tax is imposed at the following rates, subject to the 
 22.18  discounts in Minnesota Statutes, section 297F.08, subdivision 7: 
 22.19     (1) on cigarettes weighing not more than three pounds per 
 22.20  thousand, 50 mills on each cigarette; and 
 22.21     (2) on cigarettes weighing more than three pounds per 
 22.22  thousand, 100 mills on each cigarette. 
 22.23     By July 8, 2004, each distributor shall file a report with 
 22.24  the commissioner, in the form the commissioner prescribes, 
 22.25  showing the cigarettes on hand at 12:01 a.m. on July 1, 2004, 
 22.26  and the amount of tax due on the cigarettes.  The tax imposed by 
 22.27  this section is due and payable by August 1, 2004, and after 
 22.28  that date bears interest at the rate specified by Minnesota 
 22.29  Statutes, section 297F.18. 
 22.30     By July 15, 2004, each retailer, subjobber, vendor, 
 22.31  manufacturer, or manufacturer's representative of cigarettes 
 22.32  shall file a return with the commissioner, in the form the 
 22.33  commissioner prescribes, showing the cigarettes on hand at 12:01 
 22.34  a.m. on July 1, 2004, and the amount of tax due on the 
 22.35  cigarettes.  The tax imposed by this section is due and payable 
 22.36  by August 1, 2004, and after that date bears interest at the 
 23.1   rate specified by Minnesota Statutes, section 297F.18. 
 23.2      (b) The revenue from the tax imposed under this section, as 
 23.3   well as related penalties and interest, shall be deposited by 
 23.4   the commissioner in the state treasury and credited to the 
 23.5   health care access fund. 
 23.6      [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 23.7      Sec. 24.  [INCENTIVES TO ENCOURAGE A HEALTHY LIFESTYLE.] 
 23.8      The commissioner of health, in consultation with the 
 23.9   commissioners of human services, commerce, and employee 
 23.10  relations, shall convene a work group to study and make 
 23.11  recommendations on creating incentives within the health care 
 23.12  system to encourage individuals to participate in healthy 
 23.13  lifestyles in order to produce better health and outcomes.  The 
 23.14  work group shall explore rewarding individuals who maintain good 
 23.15  health with discounts on health care, lower premiums, or other 
 23.16  benefits.  The work group shall also explore ways to encourage 
 23.17  employers and communities to establish programs that encourage 
 23.18  individuals to adopt healthier behaviors.  The work group shall 
 23.19  include representatives from the Minnesota Medical Association, 
 23.20  Minnesota Chamber of Commerce, Minnesota Business Partnership, 
 23.21  and Minnesota Council of Health Plans.  The commissioner of 
 23.22  health shall submit the recommendations of the work group to the 
 23.23  legislature by January 15, 2005.  
 23.24     Sec. 25.  [APPROPRIATIONS.] 
 23.25     Subdivision 1.  [MCHA ASSESSMENT RELIEF.] $50,000,000 is 
 23.26  appropriated for fiscal year 2005 from the general fund for a 
 23.27  grant to the Minnesota Comprehensive Health Association and 
 23.28  shall be made available on January 1 of each fiscal year to be 
 23.29  used to offset the annual assessment beginning for calendar year 
 23.30  2005 that is required to be paid by each contributing member in 
 23.31  accordance with Minnesota Statutes, section 62E.11.  This 
 23.32  appropriation shall become part of the base for the 2006-2007 
 23.33  biennium.  
 23.34     Subd. 2.  [TOBACCO PREVENTION.] $5,000,000 is appropriated 
 23.35  for fiscal year 2005 from the general fund to the commissioner 
 23.36  of health to award as grants in accordance with Minnesota 
 24.1   Statutes, section 144.396, subdivisions 5, 6, and 7.  The 
 24.2   appropriation shall be distributed as described in Minnesota 
 24.3   Statutes, section 144.395, subdivision 2, paragraph (c), clauses 
 24.4   (1), (2), and (3).  A maximum of $150,000 of this annual 
 24.5   appropriation to the commissioner of health may be used by the 
 24.6   commissioner for administrative expenses associated with 
 24.7   distributing the grants.  
 24.8      Subd. 3.  [DISPROPORTIONATE SHARE.] $....... is 
 24.9   appropriated from the general fund to the commissioner of human 
 24.10  services for the fiscal year ending June 30, 2005, to be used as 
 24.11  the state match for increased disproportionate share hospital 
 24.12  payments authorized under the Medicare Prescription Drug and 
 24.13  Modernization Act of 2003, title X, subtitle A, section 1001. 
 24.14     Subd. 4.  [CRITICAL ACCESS DENTAL PROVIDERS.] $....... is 
 24.15  appropriated for fiscal year 2005 from the general fund to the 
 24.16  commissioner of human services for reimbursements to dentists 
 24.17  and dental clinics deemed by the commissioner to be a critical 
 24.18  access dental provider in accordance with Minnesota Statutes, 
 24.19  section 256B.76, paragraph (c).  This appropriation shall become 
 24.20  part of the base for the 2006-2007 biennium.  
 24.21     Subd. 5.  [CHILDREN WITH SPECIAL HEALTH CARE 
 24.22  NEEDS.] $1,500,000 is appropriated for fiscal year 2005 from the 
 24.23  general fund to the commissioner of health for the children with 
 24.24  special health care needs program.  This appropriation shall 
 24.25  become part of base level funding for the 2006-2007 biennium.  
 24.26     Subd. 6.  [OTHER GENERAL AND HEALTH CARE ACCESS FUND 
 24.27  APPROPRIATIONS.] $....... is appropriated for fiscal year 2005 
 24.28  from the general fund and $....... is appropriated for fiscal 
 24.29  year 2005 from the health care access fund to the commissioner 
 24.30  of human services for the purposes of this act.  
 24.31     Sec. 26.  [REPEALER.] 
 24.32     Minnesota Statutes 2003 Supplement, section 256L.035, is 
 24.33  repealed July 1, 2004. 
 24.34     Sec. 27.  [EFFECTIVE DATE.] 
 24.35     Sections 13 to 16 are effective for gross revenues received 
 24.36  on or after January 1, 2004.