Minnesota Legislature
SF 954
as introduced - 92nd Legislature (2021 - 2022) Posted on 03/26/2021 10:12am
Current Version - as introduced
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A bill for an act
relating to health care; waiving cost-sharing for medical assistance enrollees who
do not use tobacco products; creating a tobacco use premium surcharge in the
MinnesotaCare program; amending Minnesota Statutes 2020, sections 256B.0631,
subdivision 1, by adding a subdivision; 256L.15, by adding a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2020, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:
(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service deleted text begin whichdeleted text end new text begin thatnew text end is required because of a recipient's
symptoms, diagnosis, or established illness, and deleted text begin whichdeleted text end new text begin thatnew text end is delivered in an ambulatory
setting by a physician or physician assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometristnew text begin . Co-payments must not apply to visits
that involve tobacco cessation treatments or servicesnew text end ;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription and $1 per generic drug prescription, subject
to a $12 per month maximum for prescription drug co-payments. deleted text begin Nodeleted text end Co-payments deleted text begin shalldeleted text end new text begin
must notnew text end apply to antipsychotic drugs when used for the treatment of mental illnessnew text begin or to
drugs used for tobacco cessationnew text end ;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
Sec. 2.
Minnesota Statutes 2020, section 256B.0631, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Tobacco abstinence cost-sharing exception. new text end
new text begin
The cost-sharing and deductibles
described in subdivision 1 must be waived for non-tobacco users, and must only apply to
tobacco users. For purposes of this subdivision, a tobacco user is defined as an individual
who uses, four or more times per week within the past six months, any tobacco product.
Tobacco products include cigarettes, cigars, pipe tobacco, chewing tobacco, or snuff. Tobacco
products do not include the use of tobacco by an American Indian who meets the
requirements in Code of Federal Regulations, title 42, sections 447.51 and 447.56, as part
of a traditional Native American spiritual or cultural ceremony.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 3.
Minnesota Statutes 2020, section 256L.15, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Tobacco use premium surcharge. new text end
new text begin
(a) An enrollee who uses tobacco products
as defined in paragraph (e) and is not actively participating in a tobacco cessation program
must pay a tobacco premium surcharge in an amount that is equal to ten percent of the
enrollee's monthly premium. The tobacco use premium surcharge must be calculated on a
monthly basis and paid in accordance with section 256L.06. Nonpayment of the surcharge
may result in disenrollment.
new text end
new text begin
(b) Enrollees who initially apply or renew enrollment in the MinnesotaCare program on
or after July 1, 2021, must attest as part of the application or renewal process whether the
enrollee is using tobacco products and if so, whether the enrollee is actively participating
in a tobacco cessation program. Upon request of the commissioner, the enrollee must provide
documentation verifying that the enrollee is actively participating in tobacco cessation.
new text end
new text begin
(c) If an enrollee indicates on the initial application or at renewal that the enrollee does
not use tobacco or is using tobacco products but is actively participating in a tobacco
cessation program, and it is determined that the enrollee was using tobacco products and
was not actively participating in a tobacco cessation program during the period of enrollment,
the enrollee must pay the total amount of the tobacco use premium surcharge that the enrollee
would have been required to pay as a tobacco user during that enrollment period. If the
enrollee fails to pay the surcharge amount due, the enrollee may be disenrolled and the
unpaid amount may be subject to recovery by the commissioner.
new text end
new text begin
(d) Nonpayment of the surcharge amount owed by the enrollee under paragraph (a) or
(c) shall result in disenrollment effective for the calendar month following the month for
which the surcharge was due. Disenrollment for nonpayment of the surcharge must meet
the requirements in section 256L.06, subdivision 3, paragraphs (d) and (e).
new text end
new text begin
(e) For purposes of this subdivision, the use of tobacco products means the use of a
tobacco product four or more times per week within the past six months. Tobacco products
include the use of cigarettes, cigars, pipe tobacco, chewing tobacco, or snuff.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 4. new text begin WAIVER REQUEST.
new text end
new text begin
The commissioner of human services must submit any federal waivers and approvals
necessary to implement this act. The commissioner must inform the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance when the waiver request is submitted with a copy of the submitted
waiver. The commissioner must also inform the chairs and ranking minority members of
any federal action regarding this request.
new text end