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Minnesota Legislature

Office of the Revisor of Statutes

SF 3027

2nd Engrossment - 86th Legislature (2009 - 2010) Posted on 05/06/2010 10:46am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 2nd Engrossment

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A bill for an act
relating to human services; changing health care eligibility provisions;
making changes to individualized education plan requirements; state health
access program; children's health insurance reauthorization act; long-term
care partnership; asset transfers; community clinics; dental benefits; prior
authorization for health services; drug formulary committee; preferred drug list;
multisource drugs; administrative uniformity committee; health plans; claims
against the state; income standards for eligibility; prepaid health plans; amending
Minnesota Statutes 2008, sections 62A.045; 62Q.80; 62S.24, subdivision 8;
256B.055, subdivision 10; 256B.057, subdivision 1; 256B.0571, subdivision 6;
256B.0625, subdivisions 13c, 13g, 25, 30, by adding a subdivision; 256L.04,
subdivision 7b; Minnesota Statutes 2009 Supplement, sections 15C.13;
256B.032; 256B.056, subdivision 1c; 256B.0571, subdivision 8; 256B.0625,
subdivisions 9, 13e, 26; 256B.69, subdivisions 5a, 23; 256D.03, subdivision 3;
proposing coding for new law in Minnesota Statutes, chapter 62S; repealing
Minnesota Statutes 2008, sections 256B.0571, subdivision 10; 256B.0595,
subdivisions 1b, 2b, 3b, 4b, 5.

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

ARTICLE 1

INDIVIDUALIZED EDUCATION PLAN SERVICES

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 26,
is amended to read:


Subd. 26.

Special education services.

(a) Medical assistance covers medical
services identified in a recipient's individualized education plan and covered under the
medical assistance state plan. Covered services include occupational therapy, physical
therapy, speech-language therapy, clinical psychological services, nursing services,
school psychological services, school social work services, personal care assistants
serving as management aides, assistive technology devices, transportation services,
health assessments, and other services covered under the medical assistance state plan.
Mental health services eligible for medical assistance reimbursement must be provided or
coordinated through a children's mental health collaborative where a collaborative exists if
the child is included in the collaborative operational target population. The provision or
coordination of services does not require that the individual education plan be developed
by the collaborative.

The services may be provided by a Minnesota school district that is enrolled as a
medical assistance provider or its subcontractor, and only if the services meet all the
requirements otherwise applicable if the service had been provided by a provider other
than a school district, in the following areas: medical necessity, physician's orders,
documentation, personnel qualifications, and prior authorization requirements. The
nonfederal share of costs for services provided under this subdivision is the responsibility
of the local school district as provided in section 125A.74. Services listed in a child's
individual education plan are eligible for medical assistance reimbursement only if those
services meet criteria for federal financial participation under the Medicaid program.

(b) Approval of health-related services for inclusion in the individual education plan
does not require prior authorization for purposes of reimbursement under this chapter.
The commissioner may require physician review and approval of the plan not more than
once annually or upon any modification of the individual education plan that reflects a
change in health-related services.

(c) Services of a speech-language pathologist provided under this section are covered
notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:

(1) holds a masters degree in speech-language pathology;

(2) is licensed by the Minnesota Board of Teaching as an educational
speech-language pathologist; and

(3) either has a certificate of clinical competence from the American Speech and
Hearing Association, has completed the equivalent educational requirements and work
experience necessary for the certificate or has completed the academic program and is
acquiring supervised work experience to qualify for the certificate.

(d) Medical assistance coverage for medically necessary services provided under
other subdivisions in this section may not be denied solely on the basis that the same or
similar services are covered under this subdivision.

(e) The commissioner shall develop and implement package rates, bundled rates, or
per diem rates for special education services under which separately covered services are
grouped together and billed as a unit in order to reduce administrative complexity.

(f) The commissioner shall develop a cost-based payment structure for payment of
these services. new text beginOnly costs reported through the designated Minnesota Department of
Education data systems in distinct service categories qualify for inclusion in the cost-based
payment structure.
new text endThe commissioner shall reimburse claims submitted based on an
interim rate, and shall settle at a final rate once the department has determined it. The
commissioner shall notify the school district of the final rate. The school district has 60
days to appeal the final rate. To appeal the final rate, the school district shall file a written
appeal request to the commissioner within 60 days of the date the final rate determination
was mailed. The appeal request shall specify (1) the disputed items and (2) the name and
address of the person to contact regarding the appeal.

(g) Effective July 1, 2000, medical assistance services provided under an individual
education plan or an individual family service plan by local school districts shall not count
against medical assistance authorization thresholds for that child.

(h) Nursing services as defined in section 148.171, subdivision 15, and provided
as an individual education plan health-related service, are eligible for medical assistance
payment if they are otherwise a covered service under the medical assistance program.
Medical assistance covers the administration of prescription medications by a licensed
nurse who is employed by or under contract with a school district when the administration
of medications is identified in the child's individualized education plan. The simple
administration of medications alone is not covered under medical assistance when
administered by a provider other than a school district or when it is not identified in the
child's individualized education plan.

ARTICLE 2

STATE HEALTH ACCESS PROGRAM

Section 1.

Minnesota Statutes 2008, section 62Q.80, is amended to read:


62Q.80 COMMUNITY-BASED HEALTH CARE COVERAGE PROGRAM.

Subdivision 1.

Scope.

(a) deleted text beginAdeleted text endnew text begin Anynew text end community-based health care initiative may
develop and operate deleted text beginadeleted text end community-based health care coverage deleted text beginprogramdeleted text endnew text begin programsnew text end that
deleted text begin offersdeleted text endnew text begin offernew text end to eligible individuals and their dependents the option of purchasing through
their employer health care coverage on a fixed prepaid basis without meeting the
requirements of chapter 60A, 62A, 62C, 62D, new text begin62M, 62N, new text end62Q, deleted text beginordeleted text end 62T, new text beginor 62U, new text endor any
other law or rule that applies to entities licensed under these chapters.

(b) deleted text beginThedeleted text end new text beginEach new text endinitiative shall establish health outcomes to be achieved through the
deleted text begin programdeleted text endnew text begin programsnew text end and performance measurements in order to determine whether these
outcomes have been met. The outcomes must include, but are not limited to:

(1) a reduction in uncompensated care provided by providers participating in the
community-based health network;

(2) an increase in the delivery of preventive health care services; and

(3) health improvement for enrollees with chronic health conditions through the
management of these conditions.

In establishing performance measurements, the initiative shall use measures that are
consistent with measures published by nonprofit Minnesota or national organizations that
produce and disseminate health care quality measures.

(c) Any program established under this section shall not constitute a financial
liability for the state, in that any financial risk involved in the operation or termination
of the program shall be borne by the community-based initiative and the participating
health care providers.

Subd. 1a.

Demonstration project.

The commissioner of health new text beginand the
commissioner of human services
new text endshall award deleted text beginadeleted text end demonstration project deleted text begingrantdeleted text endnew text begin grantsnew text end
to deleted text beginadeleted text end community-based health care deleted text begininitiativedeleted text endnew text begin initiativesnew text end to develop and operate deleted text beginadeleted text end
community-based health care coverage deleted text beginprogram to operate within Carlton, Cook, Lake,
and St. Louis Counties
deleted text endnew text begin programs in Minnesotanew text end. The demonstration deleted text beginprojectdeleted text endnew text begin projectsnew text end shall
extend for five years and must comply with the requirements of this section.

Subd. 2.

Definitions.

For purposes of this section, the following definitions apply:

(a) "Community-based" means located in or primarily relating to the community
deleted text begin of geographically contiguous political subdivisionsdeleted text end, as determined by the board of a
community-based health initiative that is served by the community-based health care
coverage program.

(b) "Community-based health care coverage program" or "program" means a
program administered by a community-based health initiative that provides health care
services through provider members of a community-based health network or combination
of networks to eligible individuals and their dependents who are enrolled in the program.

(c) "Community-based health initiative" new text beginor "initiative" new text endmeans a nonprofit corporation
that is governed by a board that has at least 80 percent of its members residing in the
community and includes representatives of the participating network providers and
employersnew text begin, or a county-based purchasing organization as defined in section 256B.692new text end.

(d) "Community-based health network" means a contract-based network of health
care providers organized by the community-based health initiative to provide or support
the delivery of health care services to enrollees of the community-based health care
coverage program on a risk-sharing or nonrisk-sharing basis.

(e) "Dependent" means an eligible employee's spouse or unmarried child who is
under the age of 19 years.

Subd. 3.

Approval.

(a) Prior to the operation of a community-based health
care coverage program, a community-based health initiativenew text begin, defined in subdivision
2, paragraph (c), and receiving funds from the Department of Health,
new text end shall submit to
the commissioner of health for approval the community-based health care coverage
program developed by the initiative. new text beginEach community-based health initiative as defined
in subdivision 2, paragraph (c), and receiving State Health Access Program (SHAP)
grant funding shall submit to the commissioner of human services for approval prior
to its operation the community-based health care coverage programs developed by the
initiatives.
new text endThe deleted text begincommissionerdeleted text endnew text begin commissionersnew text end shall ensure that deleted text beginthedeleted text endnew text begin eachnew text end program meets
the federal grant requirements and any requirements described in this section and is
actuarially sound based on a review of appropriate records and methods utilized by the
community-based health initiative in establishing premium rates for the community-based
health care coverage deleted text beginprogramdeleted text endnew text begin programsnew text end.

(b) Prior to approval, the commissioner shall also ensure that:

(1) the benefits offered comply with subdivision 8 and that there are adequate
numbers of health care providers participating in the community-based health network to
deliver the benefits offered under the program;

(2) the activities of the program are limited to activities that are exempt under this
section or otherwise from regulation by the commissioner of commerce;

(3) the complaint resolution process meets the requirements of subdivision 10; and

(4) the data privacy policies and procedures comply with state and federal law.

Subd. 4.

Establishment.

The initiative shall establish and operate upon approval
by the deleted text begincommissionerdeleted text end new text begincommissioners new text endof health deleted text beginadeleted text end new text beginand human services new text endcommunity-based
health care coverage deleted text beginprogramdeleted text endnew text begin programsnew text end. The operational structure established by the
initiative shall include, but is not limited to:

(1) establishing a process for enrolling eligible individuals and their dependents;

(2) collecting and coordinating premiums from enrollees and employers of enrollees;

(3) providing payment to participating providers;

(4) establishing a benefit set according to subdivision 8 and establishing premium
rates and cost-sharing requirements;

(5) creating incentives to encourage primary care and wellness services; and

(6) initiating disease management services, as appropriate.

Subd. 5.

Qualifying employees.

To be eligible for the community-based health
care coverage program, an individual must:

(1) reside in or work within the designated community-based geographic area
served by the program;

(2) be employed by a qualifying employer deleted text beginordeleted text endnew text begin,new text end be an employee's dependentnew text begin, or be
self-employed on a full-time basis
new text end;

(3) not be enrolled in or have currently available health coveragenew text begin, except for
catastrophic health care coverage
new text end; and

(4) not be new text begineligible for or new text endenrolled in medical assistancedeleted text begin,deleted text end new text beginor new text endgeneral assistance medical
care, new text beginand not be enrolled in new text endMinnesotaCaredeleted text begin,deleted text end or Medicare.

Subd. 6.

Qualifying employers.

(a) To qualify for participation in the
community-based health care coverage program, an employer must:

(1) employ at least one but no more than 50 employees at the time of initial
enrollment in the program;

(2) pay its employees a median wage deleted text beginof $12.50 per hourdeleted text end new text begin that equals 350 percent of
the federal poverty guidelines
new text endor lessnew text begin for an individualnew text end; and

(3) not have offered employer-subsidized health coverage to its employees for
at least 12 months prior to the initial enrollment in the program. For purposes of this
section, "employer-subsidized health coverage" means health care coverage for which the
employer pays at least 50 percent of the cost of coverage for the employee.

(b) To participate in the program, a qualifying employer agrees to:

(1) offer health care coverage through the program to all eligible employees and
their dependents regardless of health status;

(2) participate in the program for an initial term of at least one year;

(3) pay a percentage of the premium established by the initiative for the employee;
and

(4) provide the initiative with any employee information deemed necessary by the
initiative to determine eligibility and premium payments.

Subd. 7.

Participating providers.

Any health care provider participating in the
community-based health network must accept as payment in full the payment rate
established by the deleted text begininitiativedeleted text end new text begininitiatives new text endand may not charge to or collect from an enrollee
any amount in access of this amount for any service covered under the program.

Subd. 8.

Coverage.

(a) The deleted text begininitiativedeleted text endnew text begin initiativesnew text end shall establish the health care
benefits offered through the community-based health care coverage deleted text beginprogramdeleted text endnew text begin programsnew text end.
The benefits established shall include, at a minimum:

(1) child health supervision services up to age 18, as defined under section 62A.047;
and

(2) preventive services, including:

(i) health education and wellness services;

(ii) health supervision, evaluation, and follow-up;

(iii) immunizations; and

(iv) early disease detection.

(b) Coverage of health care services offered by the program may be limited to
participating health care providers or health networks. All services covered under the
deleted text begin programdeleted text end new text beginprograms new text endmust be services that are offered within the scope of practice of the
participating health care providers.

(c) The deleted text begininitiativedeleted text end new text begininitiatives new text endmay establish cost-sharing requirements. Any
co-payment or deductible provisions established may not discriminate on the basis of age,
sex, race, disability, economic status, or length of enrollment in the deleted text beginprogramdeleted text endnew text begin programsnew text end.

(d) If new text beginany of new text endthe deleted text begininitiativedeleted text endnew text begin initiativesnew text end amends or alters the benefits offered through
the program from the initial offering, deleted text beginthedeleted text endnew text begin thatnew text end initiative must notify the deleted text begincommissionerdeleted text endnew text begin
commissioners
new text end of health and new text beginhuman services and new text endall enrollees of the benefit change.

Subd. 9.

Enrollee information.

(a) The deleted text begininitiativedeleted text endnew text begin initiativesnew text end must provide an
individual or family who enrolls in the program a clear and concise written statement
that includes the following information:

(1) health care services that are deleted text beginprovideddeleted text endnew text begin coverednew text end under the program;

(2) any exclusions or limitations on the health care services deleted text beginoffereddeleted text endnew text begin coverednew text end,
including any cost-sharing arrangements or prior authorization requirements;

(3) a list of where the health care services can be obtained and that all health
care services must be provided by or through a participating health care provider or
community-based health network;

(4) a description of the program's complaint resolution process, including how to
submit a complaint; how to file a complaint with the commissioner of health; and how to
obtain an external review of any adverse decisions as provided under subdivision 10;

(5) the conditions under which the program or coverage under the program may
be canceled or terminated; and

(6) a precise statement specifying that this program is not an insurance product and,
as such, is exempt from state regulation of insurance products.

(b) The deleted text begincommissionerdeleted text endnew text begin commissionersnew text end of health new text beginand human services new text endmust approve a
copy of the written statement prior to the operation of the program.

Subd. 10.

Complaint resolution process.

(a) The deleted text begininitiativedeleted text endnew text begin initiativesnew text end must
establish a complaint resolution process. The process must make reasonable efforts to
resolve complaints and to inform complainants in writing of the initiative's decision within
60 days of receiving the complaint. Any decision that is adverse to the enrollee shall
include a description of the right to an external review as provided in paragraph (c) and
how to exercise this right.

(b) The deleted text begininitiativedeleted text endnew text begin initiatives new text end must report any complaint that is not resolved within 60
days to the commissioner of health.

(c) The deleted text begininitiativedeleted text endnew text begin initiatives new text end must include in the complaint resolution process the
ability of an enrollee to pursue the external review process provided under section 62Q.73
with any decision rendered under this external review process binding on the deleted text begininitiativedeleted text endnew text begin
initiatives
new text end.

Subd. 11.

Data privacy.

The deleted text begininitiativedeleted text endnew text begin initiativesnew text end shall establish data privacy policies
and procedures for the program that comply with state and federal data privacy laws.

Subd. 12.

Limitations on enrollment.

(a) The deleted text begininitiativedeleted text endnew text begin initiativesnew text end may limit
enrollment in the program. If enrollment is limited, a waiting list must be established.

(b) The deleted text begininitiativedeleted text endnew text begin initiativesnew text end shall not restrict or deny enrollment in the program
except for nonpayment of premiums, fraud or misrepresentation, or as otherwise permitted
under this section.

(c) The deleted text begininitiativedeleted text endnew text begin initiativesnew text end may require a certain percentage of participation from
eligible employees of a qualifying employer before coverage can be offered through the
program.

Subd. 13.

Report.

deleted text begin(a) Thedeleted text endnew text begin Eachnew text end initiative shall submit quarterly status reports to the
commissioner of health on January 15, April 15, July 15, and October 15 of each year,
with the first report due January 15, 2008. deleted text beginThedeleted text endnew text begin Each initiative receiving funding from the
Department of Human Services shall submit status reports to the commissioner of human
services as defined in the terms of contract with the Department of Human Services. Each
new text end
status report shall include:

(1) the financial status of the program, including the premium rates, cost per member
per month, claims paid out, premiums received, and administrative expenses;

(2) a description of the health care benefits offered and the services utilized;

(3) the number of employers participating, the number of employees and dependents
covered under the program, and the number of health care providers participating;

(4) a description of the health outcomes to be achieved by the program and a status
report on the performance measurements to be used and collected; and

(5) any other information requested by the deleted text begincommissionerdeleted text endnew text begin commissionersnew text end of healthnew text begin,new text end
new text begin human services, new text endor commerce or the legislature.

deleted text begin (b) The initiative shall contract with an independent entity to conduct an evaluation
of the program to be submitted to the commissioners of health and commerce and the
legislature by January 15, 2010. The evaluation shall include:
deleted text end

deleted text begin (1) an analysis of the health outcomes established by the initiative and the
performance measurements to determine whether the outcomes are being achieved;
deleted text end

deleted text begin (2) an analysis of the financial status of the program, including the claims to
premiums loss ratio and utilization and cost experience;
deleted text end

deleted text begin (3) the demographics of the enrollees, including their age, gender, family income,
and the number of dependents;
deleted text end

deleted text begin (4) the number of employers and employees who have been denied access to the
program and the basis for the denial;
deleted text end

deleted text begin (5) specific analysis on enrollees who have aggregate medical claims totaling over
$5,000 per year, including data on the enrollee's main diagnosis and whether all the
medical claims were covered by the program;
deleted text end

deleted text begin (6) number of enrollees referred to state public assistance programs;
deleted text end

deleted text begin (7) a comparison of employer-subsidized health coverage provided in a comparable
geographic area to the designated community-based geographic area served by the
program, including, to the extent available:
deleted text end

deleted text begin (i) the difference in the number of employers with 50 or fewer employees offering
employer-subsidized health coverage;
deleted text end

deleted text begin (ii) the difference in uncompensated care being provided in each area; and
deleted text end

deleted text begin (iii) a comparison of health care outcomes and measurements established by the
initiative; and
deleted text end

deleted text begin (8) any other information requested by the commissioner of health or commerce.
deleted text end

Subd. 14.

Sunset.

This section expires deleted text beginDecember 31, 2012deleted text endnew text begin August 31, 2014new text end.

ARTICLE 3

CHILDREN'S HEALTH INSURANCE REAUTHORIZATION ACT (CHIPRA)

Section 1.

Minnesota Statutes 2008, section 256B.055, subdivision 10, is amended to
read:


Subd. 10.

Infants.

Medical assistance may be paid for an infant less than one year
of age, whose mother was eligible for and receiving medical assistance at the time of birth
deleted text begin and who remains in the mother's householddeleted text end or who is in a family with countable income
that is equal to or less than the income standard established under section 256B.057,
subdivision 1
.

Sec. 2.

Minnesota Statutes 2008, section 256B.057, subdivision 1, is amended to read:


Subdivision 1.

Infants and pregnant women.

(a)(1) An infant less than one year of
age or a pregnant woman who has written verification of a positive pregnancy test from
a physician or licensed registered nurse is eligible for medical assistance if countable
family income is equal to or less than 275 percent of the federal poverty guideline for the
same family size. For purposes of this subdivision, "countable family income" means the
amount of income considered available using the methodology of the AFDC program
under the state's AFDC plan as of July 16, 1996, as required by the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193,
except for the earned income disregard and employment deductions.

(2) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to the effective date for any months in the six-month budget period before
that date and the income standards and methodologies in effect on the effective date for
any months in the six-month budget period on or after that date. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
2003, and the income standards and methodologies in effect on the expiration date for any
months in the six-month budget period on or after July 1, 2003. The income standards
for each month shall be added together and compared to the applicant's total countable
income for the six-month budget period to determine eligibility.

(3) An amount equal to the amount of earned income exceeding 275 percent of
the federal poverty guideline, up to a maximum of the amount by which the combined
total of 185 percent of the federal poverty guideline plus the earned income disregards
and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
pregnant women and infants less than one year of age.

(c) Dependent care and child support paid under court order shall be deducted from
the countable income of pregnant women.

(d) An infant born deleted text beginon or after January 1, 1991,deleted text end to a woman who was eligible for and
receiving medical assistance on the date of the child's birth shall continue to be eligible for
medical assistance without redetermination until the child's first birthdaydeleted text begin, as long as the
child remains in the woman's household
deleted text end.

ARTICLE 4

LONG-TERM CARE PARTNERSHIP

Section 1.

Minnesota Statutes 2008, section 62S.24, subdivision 8, is amended to read:


Subd. 8.

Exchange for long-term care partnership policy; addition of policy
rider.

(a) deleted text beginIf authorized by federal law or a federal waiver is granteddeleted text end With respect to the
long-term care partnership program referenced in section 256B.0571, issuers of long-term
care policies may voluntarily exchange a current long-term care insurance policy for a
long-term care partnership policy that meets the requirements of Public Law 109-171,
section 6021, after the effective date of the state plan amendment implementing the
partnership program in this state.new text begin The exchange may be in the form of: (1) an amendment
or rider; or (2) a disclosure statement indicating that the coverage is now partnership
qualified.
new text end

(b) deleted text beginIf authorized by federal law or a federal waiver is granteddeleted text end With respect to the
long-term care partnership program referenced in section 256B.0571, deleted text beginallowingdeleted text endnew text begin to allownew text end
an existing long-term care insurance policy to qualify as a partnership policy by addition
ofnew text begin: (1)new text end a policy ridernew text begin, or amendment; or (2) a disclosure statementnew text end, the issuer of the policy
is authorized to add the ridernew text begin, amendment, or disclosure statementnew text end to the policy after the
effective date of the state plan amendment implementing the partnership program in
this state.

(c) The commissioner, in cooperation with the commissioner of human services,
shall pursue any federal law changes or waivers necessary to allow the implementation
of paragraphs (a) and (b).

Sec. 2.

new text begin [62S.312] CONSUMER PROTECTION STANDARDS FOR
LONG-TERM CARE PARTNERSHIP POLICIES.
new text end

new text begin To qualify as a long-term care partnership policy under this chapter, long-term
care insurance policies must meet the requirements for being tax qualified as defined in
section 7702B(b) of the Internal Revenue Code and meet certain consumer protection
requirements in Section 6021(a)(1)(B)(5)(A) of the Deficit Reduction Act of 2005, Public
Law 109-171, which are taken from the National Association of Insurance Commissioners
(NAIC) Model Act and Regulation of 2000. Insurance carriers must certify for each policy
form to be included in the long-term care partnership that the form complies with the
requirements of the NAIC Model Act and Regulation of 2000 as implemented in sections
62S.05 to 62S.11; 62S.13 to 62S.18; 62S.19; 62S.20, subdivisions 1 to 5; 62S.21; 62S.22;
62S.24; 62S.25; 62S.266; 62S.28; 62S.29; 62S.30; and 62S.31.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.0571, subdivision 6, is amended to read:


Subd. 6.

Partnership policy.

"Partnership policy" means a long-term care insurance
policy that meets the deleted text beginrequirements under subdivision 10 anddeleted text end new text begincriteria in sections 62S.23,
subdivision 1, paragraph (b), and 62S.312 and
new text endwas issued on or after deleted text beginthe effective date of
the state plan amendment implementing the partnership program in Minnesota. Policies
that are exchanged or that have riders or endorsements added on or after the effective date
of the state plan amendment as authorized by the commissioner of commerce qualify
as a partnership policy
deleted text endnew text begin July 1, 2006, or exchanged on or after July 1, 2006, under the
provisions of section 62S.24, subdivision 8
new text end.

Sec. 4.

Minnesota Statutes 2009 Supplement, section 256B.0571, subdivision 8,
is amended to read:


Subd. 8.

Program established.

(a) The commissioner, in cooperation with the
commissioner of commerce, shall establish the Minnesota partnership for long-term care
program to provide for the financing of long-term care through a combination of private
insurance and medical assistance.

(b) An individual becomes eligible to participate in the partnership program by
meeting the requirements of either clause (1) or (2):

(1) the individual may qualify as a beneficiary of a partnership policy that deleted text begineither
(i) is issued on or after the effective date of the state plan amendment implementing the
partnership plan in Minnesota, or (ii) qualifies as a partnership policy as authorized by the
commissioner of commerce
deleted text endnew text begin meets the criterianew text end under subdivision 6. To be eligible under
this clause, the individual must be a Minnesota resident at the time coverage first became
effective under the partnership policy; or

(2) the individual may qualify as a beneficiary of a policy recognized under
subdivision 17.

Sec. 5. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256B.0571, subdivision 10, new text end new text begin is repealed.
new text end

ARTICLE 5

MODIFICATION TO PROHIBITIONS ON ASSET TRANSFERS

Section 1. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 256B.0595, subdivisions 1b, 2b, 3b, 4b, and 5, new text end new text begin are
repealed.
new text end

ARTICLE 6

COMMUNITY CLINICS

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.032, is amended to read:


256B.032 ELIGIBLE VENDORS OF MEDICAL CARE.

(a) Effective January 1, 2011, the commissioner shall establish performance
thresholds for health care providers included in the provider peer grouping system
developed by the commissioner of health under section 62U.04. The thresholds shall be
set at the 10th percentile of the combined cost and quality measure used for provider peer
grouping, and separate thresholds shall be set for hospital and physician services.

(b) Beginning January 1, 2012, any health care provider with a combined cost and
quality score below the threshold set in paragraph (a) shall be prohibited from enrolling
as a vendor of medical care in the medical assistance, general assistance medical care,
or MinnesotaCare programs, and shall not be eligible for direct payments under those
programs or for payments made by managed care plans under their contracts with the
commissioner under section 256B.69 or 256L.12. A health care provider that is prohibited
from enrolling as a vendor or receiving payments under this paragraph may reenroll
effective January 1 of any subsequent year if the provider's most recent combined cost and
quality score exceeds the threshold established in paragraph (a).

(c) Notwithstanding paragraph (b), a provider may continue to participate as a vendor
or as part of a managed care plan provider network if the commissioner determines that a
contract with the provider is necessary to ensure adequate access to health care services.

(d) By January 15, 2013, the commissioner shall report to the legislature on the
impact of this section. The commissioner's report shall include information on:

(1) the providers falling below the thresholds as of January 1, 2012;

(2) the volume of services and cost of care provided to enrollees in the medical
assistance, general assistance medical care, or MinnesotaCare programs in the 12 months
prior to January 1, 2012, by providers falling below the thresholds;

(3) providers who fell below the thresholds but continued to be eligible vendors
under deleted text beginparagraphdeleted text endnew text begin paragraphsnew text end (c)new text begin and (e)new text end;

(4) the estimated cost savings achieved by not contracting with providers who do
not meet the performance thresholds; and

(5) recommendations for increasing the threshold levels of performance over time.

new text begin (e) Federally qualified health centers and rural health clinics are exempt from the
requirements of paragraph (b).
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0625, subdivision 30, is amended to
read:


Subd. 30.

Other clinic services.

(a) Medical assistance covers rural health clinic
services, federally qualified health center services, nonprofit community health clinic
services, public health clinic servicesdeleted text begin, and the services of a clinic meeting the criteria
established in rule by the commissioner
deleted text end. Rural health clinic services and federally
qualified health center services mean services defined in United States Code, title 42,
section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified
health center services shall be made according to applicable federal law and regulation.

(b) A federally qualified health center that is beginning initial operation shall submit
an estimate of budgeted costs and visits for the initial reporting period in the form and
detail required by the commissioner. A federally qualified health center that is already in
operation shall submit an initial report using actual costs and visits for the initial reporting
period. Within 90 days of the end of its reporting period, a federally qualified health
center shall submit, in the form and detail required by the commissioner, a report of
its operations, including allowable costs actually incurred for the period and the actual
number of visits for services furnished during the period, and other information required
by the commissioner. Federally qualified health centers that file Medicare cost reports
shall provide the commissioner with a copy of the most recent Medicare cost report filed
with the Medicare program intermediary for the reporting year which support the costs
claimed on their cost report to the state.

(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
must apply for designation as an essential community provider within six months of final
adoption of rules by the Department of Health according to section 62Q.19, subdivision
7
. For those federally qualified health centers and rural health clinics that have applied
for essential community provider status within the six-month time prescribed, medical
assistance payments will continue to be made according to paragraphs (a) and (b) for the
first three years after application. For federally qualified health centers and rural health
clinics that either do not apply within the time specified above or who have had essential
community provider status for three years, medical assistance payments for health services
provided by these entities shall be according to the same rates and conditions applicable
to the same service provided by health care providers that are not federally qualified
health centers or rural health clinics.

(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally
qualified health center or a rural health clinic to make application for an essential
community provider designation in order to have cost-based payments made according
to paragraphs (a) and (b) no longer apply.

(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b)
shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.

(f) Effective January 1, 2001, each federally qualified health center and rural health
clinic may elect to be paid either under the prospective payment system established
in United States Code, title 42, section 1396a(aa), or under an alternative payment
methodology consistent with the requirements of United States Code, title 42, section
1396a(aa), and approved by the Centers for Medicare and Medicaid Services. The
alternative payment methodology shall be 100 percent of cost as determined according to
Medicare cost principles.

new text begin (g) For purposes of this section, "nonprofit community clinic" is a clinic that:
new text end

new text begin (1) has nonprofit status as specified in chapter 317A;
new text end

new text begin (2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
new text end

new text begin (3) is established to provide health services to low-income population groups,
uninsured, high-risk and special needs populations, underserved and other special needs
populations;
new text end

new text begin (4) employs professional staff at least one-half of which are familiar with the
cultural background of their clients;
new text end

new text begin (5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
new text end

new text begin (6) does not restrict access or services because of a client's financial limitations or
public assistance status and provides no-cost care as needed.
new text end

ARTICLE 7

DENTAL BENEFIT SET

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9,
is amended to read:


Subd. 9.

Dental services.

(a) Medical assistance covers dental services.

(b) Medical assistance dental coverage for nonpregnant adults is limited to the
following services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one per year;

(5) periapical x-rays;

(6) panoramic x-rays, limited to one every five yearsdeleted text begin, and only if provided in
conjunction with a posterior extraction or scheduled outpatient facility procedure, or
as
deleted text endnew text begin except (1) whennew text end medically necessary for the diagnosis and follow-up of oral and
maxillofacial pathology and traumadeleted text begin. Panoramic x-rays may be takendeleted text endnew text begin or (2)new text end once every two
years for patients who cannot cooperate for intraoral film due to a developmental disability
or medical condition that does not allow for intraoral film placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars only;

(12) removable prostheses, each dental arch limited to one every six years;

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;

(14) palliative treatment and sedative fillings for relief of pain; and

(15) full-mouth debridement, limited to one every five years.

(c) In addition to the services specified in paragraph (b), medical assistance
covers the following services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two
years;

(2) general anesthesia; and

(3) full-mouth survey once every five years.

(d) Medical assistance covers new text beginmedically necessary new text enddental services for children deleted text beginthat
are medically necessary
deleted text endnew text begin and pregnant womennew text end. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants new text beginare covered new text endonce every five years per permanent molarnew text begin for
children only
new text end; deleted text beginand
deleted text end

(3) application of fluoride varnish new text beginis covered new text endonce every six monthsdeleted text begin.deleted text endnew text begin; and
new text end

new text begin (4) orthodontia is eligible for coverage for children only.
new text end

ARTICLE 8

PRIOR AUTHORIZATION FOR HEALTH SERVICES

Section 1.

Minnesota Statutes 2008, section 256B.0625, subdivision 25, is amended to
read:


Subd. 25.

Prior authorization required.

The commissioner shall publish in the
deleted text begin State Registerdeleted text endnew text begin Minnesota health care programs provider manual and on the department's
Web site
new text end a list of health services that require prior authorization, as well as the criteria and
standards used to select health services on the list. The list and the criteria and standards
used to formulate it are not subject to the requirements of sections 14.001 to 14.69. The
commissioner's decision whether prior authorization is required for a health service is not
subject to administrative appeal.

ARTICLE 9

DRUG FORMULARY COMMITTEE

Section 1.

Minnesota Statutes 2008, section 256B.0625, subdivision 13c, is amended to
read:


Subd. 13c.

Formulary committee.

The commissioner, after receiving
recommendations from professional medical associations and professional pharmacy
associations, and consumer groups shall designate a Formulary Committee to carry
out duties as described in subdivisions 13 to 13g. The Formulary Committee shall be
comprised of four licensed physicians actively engaged in the practice of medicine in
Minnesota one of whom must be actively engaged in the treatment of persons with
mental illness; at least three licensed pharmacists actively engaged in the practice of
pharmacy in Minnesota; and one consumer representative; the remainder to be made
up of health care professionals who are licensed in their field and have recognized
knowledge in the clinically appropriate prescribing, dispensing, and monitoring of covered
outpatient drugs. Members of the Formulary Committee shall not be employed by the
Department of Human Services, but the committee shall be staffed by an employee of the
department who shall serve as an ex officio, nonvoting member of the committee. The
department's medical director shall also serve as an ex officio, nonvoting member for the
committee. Committee members shall serve three-year terms and may be reappointed by
the commissioner. The Formulary Committee shall meet at least deleted text beginquarterlydeleted text endnew text begin twice per yearnew text end.
The commissioner may require more frequent Formulary Committee meetings as needed.
An honorarium of $100 per meeting and reimbursement for mileage shall be paid to each
committee member in attendance.

ARTICLE 10

PREFERRED DRUG LIST

Section 1.

Minnesota Statutes 2008, section 256B.0625, subdivision 13g, is amended
to read:


Subd. 13g.

Preferred drug list.

(a) The commissioner shall adopt and implement
a preferred drug list by January 1, 2004. The commissioner may enter into a contract
with a vendor for the purpose of participating in a preferred drug list and supplemental
rebate program. The commissioner shall ensure that any contract meets all federal
requirements and maximizes federal financial participation. The commissioner shall
publish the preferred drug list annually in the State Register and shall maintain an accurate
and up-to-date list on the agency Web site.

(b) The commissioner may add to, delete from, and otherwise modify the preferred
drug list, after consulting with the Formulary Committee and appropriate medical
specialists and providing public notice and the opportunity for public comment.

(c) The commissioner shall adopt and administer the preferred drug list as part of the
administration of the supplemental drug rebate program. Reimbursement for prescription
drugs not on the preferred drug list may be subject to prior authorizationdeleted text begin, unless the drug
manufacturer signs a supplemental rebate contract
deleted text end.

(d) For purposes of this subdivision, "preferred drug list" means a list of prescription
drugs within designated therapeutic classes selected by the commissioner, for which prior
authorization based on the identity of the drug or class is not required.

(e) The commissioner shall seek any federal waivers or approvals necessary to
implement this subdivision.

ARTICLE 11

MULTISOURCE DRUGS

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 13e,
is amended to read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment
shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee;
the maximum allowable cost set by the federal government or by the commissioner plus
the fixed dispensing fee; or the usual and customary price charged to the public. The
amount of payment basis must be reduced to reflect all discount amounts applied to the
charge by any provider/insurer agreement or contract for submitted charges to medical
assistance programs. The net submitted charge may not be greater than the patient liability
for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee
for intravenous solutions which must be compounded by the pharmacist shall be $8 per
bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral
nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral
nutritional products dispensed in quantities greater than one liter. Actual acquisition cost
includes quantity and other special discounts except time and cash discounts. Effective
July 1, 2009, the actual acquisition cost of a drug shall be estimated by the commissioner,
at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic
factor drugs shall be estimated at the average wholesale price minus 30 percent. The
maximum allowable cost of a multisource drug may be set by the commissioner and it
shall be comparable to, but no higher than, the maximum amount paid by other third-party
payors in this state who have maximum allowable cost programs. Establishment of the
amount of payment for drugs shall not be subject to the requirements of the Administrative
Procedure Act.

(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
to pharmacists for legend drug prescriptions dispensed to residents of long-term care
facilities when a unit dose blister card system, approved by the department, is used. Under
this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to fill the blister card must
be identified on the claim to the department. The unit dose blister card containing the
drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
will be required to credit the department for the actual acquisition cost of all unused
drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
manufacturer's unopened package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a deleted text begingenerically equivalent product is availabledeleted text endnew text begin maximum allowable
cost has been set for a multisource drug
new text end, payment shall be on the basis of deleted text beginthe actual
acquisition cost of the generic drug, or on
deleted text end the maximum allowable cost established by
the commissionernew text begin unless prior authorization for the brand name product has been granted
according to the criteria established by the Drug Formulary Committee as required by
subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on
the prescription in a manner consistent with section 151.21, subdivision 2
new text end.

(d) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider or the amount established for Medicare by the United States Department of
Health and Human Services pursuant to title XVIII, section 1847a of the federal Social
Security Act.

(e) The commissioner may negotiate lower reimbursement rates for specialty
pharmacy products than the rates specified in paragraph (a). The commissioner may
require individuals enrolled in the health care programs administered by the department
to obtain specialty pharmacy products from providers with whom the commissioner has
negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
used by a small number of recipients or recipients with complex and chronic diseases
that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, high-cost therapies, and therapies that require complex care. The
commissioner shall consult with the formulary committee to develop a list of specialty
pharmacy products subject to this paragraph. In consulting with the formulary committee
in developing this list, the commissioner shall take into consideration the population
served by specialty pharmacy products, the current delivery system and standard of care in
the state, and access to care issues. The commissioner shall have the discretion to adjust
the reimbursement rate to prevent access to care issues.

ARTICLE 12

ADMINISTRATIVE UNIFORMITY COMMITTEE

Section 1.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 8d. new text end

new text begin Home infusion therapy services. new text end

new text begin Home infusion therapy services
provided by home infusion therapy pharmacies must be paid the lower of the submitted
charge or the combined payment rates for component services typically provided.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
new text end

Sec. 2.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 13e,
is amended to read:


Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment
shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee;
the maximum allowable cost set by the federal government or by the commissioner plus
the fixed dispensing fee; or the usual and customary price charged to the public. The
amount of payment basis must be reduced to reflect all discount amounts applied to the
charge by any provider/insurer agreement or contract for submitted charges to medical
assistance programs. The net submitted charge may not be greater than the patient liability
for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee
for intravenous solutions which must be compounded by the pharmacist shall be $8 per
bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral
nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral
nutritional products dispensed in quantities greater than one liter. Actual acquisition cost
includes quantity and other special discounts except time and cash discounts. Effective
July 1, 2009, the actual acquisition cost of a drug shall be estimated by the commissioner,
at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic
factor drugs shall be estimated at the average wholesale price minus 30 percent. The
maximum allowable cost of a multisource drug may be set by the commissioner and it
shall be comparable to, but no higher than, the maximum amount paid by other third-party
payors in this state who have maximum allowable cost programs. Establishment of the
amount of payment for drugs shall not be subject to the requirements of the Administrative
Procedure Act.

(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
to pharmacists for legend drug prescriptions dispensed to residents of long-term care
facilities when a unit dose blister card system, approved by the department, is used. Under
this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to fill the blister card must
be identified on the claim to the department. The unit dose blister card containing the
drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
will be required to credit the department for the actual acquisition cost of all unused
drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
manufacturer's unopened package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.

(c) Whenever a generically equivalent product is available, payment shall be on the
basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost
established by the commissioner.

(d) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider or the amount established for Medicare by the United States Department of
Health and Human Services pursuant to title XVIII, section 1847a of the federal Social
Security Act.

(e) The commissioner may negotiate lower reimbursement rates for specialty
pharmacy products than the rates specified in paragraph (a). The commissioner may
require individuals enrolled in the health care programs administered by the department
to obtain specialty pharmacy products from providers with whom the commissioner has
negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
used by a small number of recipients or recipients with complex and chronic diseases
that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, high-cost therapies, and therapies that require complex care. The
commissioner shall consult with the formulary committee to develop a list of specialty
pharmacy products subject to this paragraph. In consulting with the formulary committee
in developing this list, the commissioner shall take into consideration the population
served by specialty pharmacy products, the current delivery system and standard of care in
the state, and access to care issues. The commissioner shall have the discretion to adjust
the reimbursement rate to prevent access to care issues.

new text begin (f) Home infusion therapy services provided by home infusion therapy pharmacies
must be paid at rates according to subdivision 8d.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval.
new text end

ARTICLE 13

HEALTH PLANS

Section 1.

Minnesota Statutes 2008, section 62A.045, is amended to read:


62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT
HEALTH PROGRAMS.

(a) As a condition of doing business in Minnesotanew text begin or providing coverage to
residents of Minnesota covered by this section
new text end, each health insurer shall comply with the
requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171, including
any federal regulations adopted under that act, to the extent that it imposes a requirement
that applies in this state and that is not also required by the laws of this state. This section
does not require compliance with any provision of the federal act prior to the effective date
provided for that provision in the federal act. The commissioner shall enforce this section.

For the purpose of this section, "health insurer" includes self-insured plans, group
health plans (as defined in section 607(1) of the Employee Retirement Income Security
Act of 1974), service benefit plans, managed care organizations, pharmacy benefit
managers, or other parties that are by contract legally responsible to pay a claim for a
healthcare item or service for an individual receiving benefits under paragraph (b).

(b) No deleted text beginhealthdeleted text end plannew text begin offered by a health insurernew text end issued or renewed to provide coverage
to a Minnesota resident shall contain any provision denying or reducing benefits because
services are rendered to a person who is eligible for or receiving medical benefits pursuant
to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256;
256B; or 256D or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331,
subdivision 2
; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health
deleted text begin carrierdeleted text endnew text begin insurernew text end providing benefits under plans covered by this section shall use eligibility
for medical programs named in this section as an underwriting guideline or reason for
nonacceptance of the risk.

(c) If payment for covered expenses has been made under state medical programs
for health care items or services provided to an individual, and a third party has a legal
liability to make payments, the rights of payment and appeal of an adverse coverage
decision for the individual, or in the case of a child their responsible relative or caretaker,
will be subrogated to the state agency. The state agency may assert its rights under this
section within three years of the date the service was rendered. For purposes of this
section, "state agency" includes prepaid health plans under contract with the commissioner
according to sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12;
children's mental health collaboratives under section 245.493; demonstration projects for
persons with disabilities under section 256B.77; nursing homes under the alternative
payment demonstration project under section 256B.434; and county-based purchasing
entities under section 256B.692.

(d) Notwithstanding any law to the contrary, when a person covered by a deleted text beginhealthdeleted text end plannew text begin
offered by a health insurer
new text end receives medical benefits according to any statute listed in this
section, payment for covered services or notice of denial for services billed by the provider
must be issued directly to the provider. If a person was receiving medical benefits through
the Department of Human Services at the time a service was provided, the provider must
indicate this benefit coverage on any claim forms submitted by the provider to the health
deleted text begin carrierdeleted text endnew text begin insurernew text end for those services. If the commissioner of human services notifies the health
deleted text begin carrierdeleted text endnew text begin insurernew text end that the commissioner has made payments to the provider, payment for
benefits or notices of denials issued by the health deleted text begincarrierdeleted text endnew text begin insurernew text end must be issued directly to
the commissioner. Submission by the department to the health deleted text begincarrierdeleted text endnew text begin insurernew text end of the claim
on a Department of Human Services claim form is proper notice and shall be considered
proof of payment of the claim to the provider and supersedes any contract requirements of
the health deleted text begincarrierdeleted text endnew text begin insurernew text end relating to the form of submission. Liability to the insured for
coverage is satisfied to the extent that payments for those benefits are made by the health
deleted text begin carrierdeleted text endnew text begin insurernew text end to the provider or the commissioner as required by this section.

(e) When a state agency has acquired the rights of an individual eligible for medical
programs named in this section and has health benefits coverage through a health deleted text begincarrierdeleted text endnew text begin
insurer
new text end, the health deleted text begincarrierdeleted text endnew text begin insurernew text end shall not impose requirements that are different from
requirements applicable to an agent or assignee of any other individual covered.

deleted text begin (f) For the purpose of this section, health plan includes coverage offered by
community integrated service networks, any plan governed under the federal Employee
Retirement Income Security Act of 1974 (ERISA), United States Code, title 29, sections
1001 to 1461, and coverage offered under the exclusions listed in section 62A.011,
subdivision 3
, clauses (2), (6), (9), (10), and (12).
deleted text end

Sec. 2.

Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23, is
amended to read:


Subd. 23.

Alternative services; elderly and disabled persons.

(a) The
commissioner may implement demonstration projects to create alternative integrated
delivery systems for acute and long-term care services to elderly persons and persons
with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
coordination, improve access to quality services, and mitigate future cost increases.
The commissioner may seek federal authority to combine Medicare and Medicaid
capitation payments for the purpose of such demonstrations and may contract with
Medicare-approved special needs plans new text beginthat are offered by a demonstration provider or
by an entity that is directly or indirectly wholly owned or controlled by a demonstration
provider
new text endto provide Medicaid services. Medicare funds and services shall be administered
according to the terms and conditions of the federal contract and demonstration provisions.
For the purpose of administering medical assistance funds, demonstrations under this
subdivision are subject to subdivisions 1 to 22. The provisions of Minnesota Rules, parts
9500.1450 to 9500.1464, apply to these demonstrations, with the exceptions of parts
9500.1452, subpart 2, item B; and 9500.1457, subpart 1, items B and C, which do not
apply to persons enrolling in demonstrations under this section. new text beginAll enforcement and
rulemaking powers available under chapters 62D, 62M, and 62Q are hereby granted to the
commissioner of health with respect to Medicare-approved special needs plans with which
the commissioner contracts to provide Medicaid services under this section.
new text endAn initial
open enrollment period may be provided. Persons who disenroll from demonstrations
under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464.
When a person is enrolled in a health plan under these demonstrations and the health
plan's participation is subsequently terminated for any reason, the person shall be
provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons
required to participate in health plans under this section who fail to make a choice of
health plan shall not be randomly assigned to health plans under these demonstrations.
Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
the commissioner may contract with managed care organizations, including counties, to
serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
disabled persons only. For persons with a primary diagnosis of developmental disability,
serious and persistent mental illness, or serious emotional disturbance, the commissioner
must ensure that the county authority has approved the demonstration and contracting
design. Enrollment in these projects for persons with disabilities shall be voluntary. The
commissioner shall not implement any demonstration project under this subdivision for
persons with a primary diagnosis of developmental disabilities, serious and persistent
mental illness, or serious emotional disturbance, without approval of the county board of
the county in which the demonstration is being implemented.

(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
under this section projects for persons with developmental disabilities. The commissioner
may capitate payments for ICF/MR services, waivered services for developmental
disabilities, including case management services, day training and habilitation and
alternative active treatment services, and other services as approved by the state and by the
federal government. Case management and active treatment must be individualized and
developed in accordance with a person-centered plan. Costs under these projects may not
exceed costs that would have been incurred under fee-for-service. Beginning July 1, 2003,
and until four years after the pilot project implementation date, subcontractor participation
in the long-term care developmental disability pilot is limited to a nonprofit long-term
care system providing ICF/MR services, home and community-based waiver services,
and in-home services to no more than 120 consumers with developmental disabilities in
Carver, Hennepin, and Scott Counties. The commissioner shall report to the legislature
prior to expansion of the developmental disability pilot project. This paragraph expires
four years after the implementation date of the pilot project.

(c) Before implementation of a demonstration project for disabled persons, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups
in the design of the demonstration projects.

(d) A nursing facility reimbursed under the alternative reimbursement methodology
in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
provide services under paragraph (a). The commissioner shall amend the state plan and
seek any federal waivers necessary to implement this paragraph.

(e) The commissioner, in consultation with the commissioners of commerce and
health, may approve and implement programs for all-inclusive care for the elderly (PACE)
according to federal laws and regulations governing that program and state laws or rules
applicable to participating providers. The process for approval of these programs shall
begin only after the commissioner receives grant money in an amount sufficient to cover
the state share of the administrative and actuarial costs to implement the programs during
state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
account in the special revenue fund and are appropriated to the commissioner to be used
solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
not required to be licensed or certified as a health plan company as defined in section
62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county
and found to be eligible for services under the elderly waiver or community alternatives
for disabled individuals or who are already eligible for Medicaid but meet level of
care criteria for receipt of waiver services may choose to enroll in the PACE program.
Medicare and Medicaid services will be provided according to this subdivision and
federal Medicare and Medicaid requirements governing PACE providers and programs.
PACE enrollees will receive Medicaid home and community-based services through the
PACE provider as an alternative to services for which they would otherwise be eligible
through home and community-based waiver programs and Medicaid State Plan Services.
The commissioner shall establish Medicaid rates for PACE providers that do not exceed
costs that would have been incurred under fee-for-service or other relevant managed care
programs operated by the state.

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas of
the state. Until July 1, 2009, expansion for MnDHO projects that include home and
community-based services is limited to the two projects and service areas in effect on
March 1, 2006. Enrollment in integrated MnDHO programs that include home and
community-based services shall remain voluntary. Costs for home and community-based
services included under MnDHO must not exceed costs that would have been incurred
under the fee-for-service program. Notwithstanding whether expansion occurs under
this paragraph, in determining MnDHO payment rates and risk adjustment methods for
contract years starting in 2012, the commissioner must consider the methods used to
determine county allocations for home and community-based program participants. If
necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs
for home and community-based services, the commissioner shall achieve the reduction by
maintaining the base rate for contract years 2010 and 2011 for services provided under the
community alternatives for disabled individuals waiver at the same level as for contract
year 2009. The commissioner may apply other reductions to MnDHO rates to implement
decreases in provider payment rates required by state law. In developing program
specifications for expansion of integrated programs, the commissioner shall involve and
consult the state-level stakeholder group established in subdivision 28, paragraph (d),
including consultation on whether and how to include home and community-based waiver
programs. Plans for further expansion of MnDHO projects shall be presented to the chairs
of the house of representatives and senate committees with jurisdiction over health and
human services policy and finance by February 1, 2007.

(g) Notwithstanding section 256B.0261, health plans providing services under this
section are responsible for home care targeted case management and relocation targeted
case management. Services must be provided according to the terms of the waivers and
contracts approved by the federal government.

ARTICLE 14

CLAIMS AGAINST THE STATE

Section 1.

Minnesota Statutes 2009 Supplement, section 15C.13, is amended to read:


15C.13 DISTRIBUTION TO PRIVATE PLAINTIFF IN CERTAIN ACTIONS.

If the prosecuting attorney intervenes at the outset in an action brought by a person
under section 15C.05, the person is entitled to receive not less than 15 percent or more
than 25 percent of any recovery in proportion to the person's contribution to the conduct
of the action. If the prosecuting attorney does not intervene in the action at any time,
the person is entitled to receive not less than 25 percent or more than 30 percent of any
recovery of the civil penalty and damages, or settlement, as the court determines is
reasonable. If the prosecuting attorney does not intervene in the action at the outset but
subsequently intervenes, the person is entitled to receive not less than 15 percent or more
than 30 percent of any recovery, as the court determines is reasonable based on the person's
participation in the action before the prosecuting attorney intervened.new text begin For recoveries
whose distribution is governed by federal code or rule, the basis for calculating the portion
of the recovery the person is entitled to receive shall not include amounts reserved for
distribution to the federal government or designated in their use by federal code or rule.
new text end

ARTICLE 15

PREPAID HEALTH PLANS

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 5a,
is amended to read:


Subd. 5a.

Managed care contracts.

(a) Managed care contracts under this section
and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
basis beginning January 1, 1996. Managed care contracts which were in effect on June
30, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to services to
medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
of its contract with the commissioner. Requirements applicable to managed care programs
under chapters 256B, 256D, and 256L, established after the effective date of a contract
with the commissioner take effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section and
county-based purchasing plan's payment rate under section 256B.692 for the prepaid
medical assistance and general assistance medical care programs pending completion of
performance targets. Each performance target must be quantifiable, objective, measurable,
and reasonably attainable, except in the case of a performance target based on a federal
or state law or rule. Criteria for assessment of each performance target must be outlined
in writing prior to the contract effective date. The managed care plan must demonstrate,
to the commissioner's satisfaction, that the data submitted regarding attainment of
the performance target is accurate. The commissioner shall periodically change the
administrative measures used as performance targets in order to improve plan performance
across a broader range of administrative services. The performance targets must include
measurement of plan efforts to contain spending on health care services and administrative
activities. The commissioner may adopt plan-specific performance targets that take into
account factors affecting only one plan, including characteristics of the plan's enrollee
population. The withheld funds must be returned no sooner than July of the following
year if performance targets in the contract are achieved. The commissioner may exclude
special demonstration projects under subdivision 23.

(d) Effective for services rendered on or after January 1, 2009, through December 31,
2009, the commissioner shall withhold three percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance and general assistance medical care programs. The withheld
funds must be returned no sooner than July 1 and no later than July 31 of the following
year. The commissioner may exclude special demonstration projects under subdivision 23.

deleted text begin The return of the withhold under this paragraph is not subject to the requirements of
paragraph (c).
deleted text end

(e) Effective for services provided on or after January 1, 2010, the commissioner
shall require that managed care plans use the assessment and authorization processes,
forms, timelines, standards, documentation, and data reporting requirements, protocols,
billing processes, and policies consistent with medical assistance fee-for-service or the
Department of Human Services contract requirements consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all
personal care assistance services under section 256B.0659.

(f) Effective for services rendered on or after January 1, 2010, through December
31, 2010, the commissioner shall withhold 3.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(g) Effective for services rendered on or after January 1, 2011, through December
31, 2011, the commissioner shall withhold four percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(h) Effective for services rendered on or after January 1, 2012, through December
31, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
under this section and county-based purchasing plan payments under section 256B.692
for the prepaid medical assistance program. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year. The commissioner may
exclude special demonstration projects under subdivision 23.

(i) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.

(j) Effective for services rendered on or after January 1, 2014, the commissioner
shall withhold three percent of managed care plan payments under this section and
county-based purchasing plan payments under section 256B.692 for the prepaid medical
assistance and prepaid general assistance medical care programs. The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following year. The
commissioner may exclude special demonstration projects under subdivision 23.

(k) A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.

(l) Contracts between the commissioner and a prepaid health plan are exempt from
the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
(a), and 7.

new text begin (m) The return of the withhold under paragraph (d) and paragraphs (f) to (j) is not
subject to the requirements of paragraph (c).
new text end

ARTICLE 16

INCOME STANDARDS FOR ELIGIBILITY

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.056, subdivision 1c,
is amended to read:


Subd. 1c.

Families with children income methodology.

(a)(1) [Expired, 1Sp2003
c 14 art 12 s 17]

(2) For applications processed within one calendar month prior to July 1, 2003,
eligibility shall be determined by applying the income standards and methodologies in
effect prior to July 1, 2003, for any months in the six-month budget period before July
1, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
months in the six-month budget period on or after that date. The income standards for
each month shall be added together and compared to the applicant's total countable income
for the six-month budget period to determine eligibility.

(3) For children ages one through 18 whose eligibility is determined under section
256B.057, subdivision 2, the following deductions shall be applied to income counted
toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
16, 1996: $90 work expense, dependent care, and child support paid under court order.
This clause is effective October 1, 2003.

(b) For families with children whose eligibility is determined using the standard
specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
earned income shall be disregarded for up to four months and the following deductions
shall be applied to each individual's income counted toward eligibility as allowed under
the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
under court order.

(c) If the four-month disregard in paragraph (b) has been applied to the wage
earner's income for four months, the disregard shall not be applied again until the wage
earner's income has not been considered in determining medical assistance eligibility for
12 consecutive months.

(d) 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 Servicesnew text begin except that the income standards
shall not go below those in effect on July 1, 2009
new text end.

(e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
organization to or for the benefit of the child with a life-threatening illness must be
disregarded from income.

Sec. 2.

Minnesota Statutes 2009 Supplement, 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 for applicants
and recipients defined in paragraph (c), except as provided in paragraph (d), 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, subdivisions 3 and 3d, 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; or

(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.

(b) 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 Servicesnew text begin except that the income standards
shall not go below those in effect on July 1, 2009
new text end.

(c) 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 (f).

(d) 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
six-month general assistance medical care eligibility period, until their six-month renewal.

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

(f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are
exempt from the MinnesotaCare enrollment requirements in this subdivision if they:

(1) 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;

(2) fail to meet the requirements of section 256L.09, subdivision 2;

(3) are homeless as defined by United States Code, title 42, section 11301, et seq.;

(4) are classified as end-stage renal disease beneficiaries in the Medicare program;

(5) are enrolled in private health care coverage as defined in section 256B.02,
subdivision 9;

(6) are eligible under paragraph (k);

(7) receive treatment funded pursuant to section 254B.02; or

(8) reside in the Minnesota sex offender program defined in chapter 246B.

(g) 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.

(h) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(d) 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 (d), (f), and (g).

(i) 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
applicant must complete the application within the time periods required under the
medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart
5, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining
verification if necessary.

(j) 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.

(k) 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.

(l) 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.

(m) 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.

(n) 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.

(o) 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, subsection
(a), paragraph (15), and an undocumented noncitizen is an individual who resides in
the United States without the approval or acquiescence of the United States Citizenship
and Immigration Services.

(p) 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.

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

Sec. 3.

Minnesota Statutes 2008, section 256L.04, subdivision 7b, is amended to read:


Subd. 7b.

Annual income limits adjustment.

The commissioner shall adjust the
income limits 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
Servicesnew text begin except that the income standards shall not go below those in effect on July 1,
2009
new text end.