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Minnesota Legislature

Office of the Revisor of Statutes

SF 2

2nd Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

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

Current Version - 2nd Engrossment

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44.1 44.2

A bill for an act
relating to health care; requiring an interoperable electronic health records
system; requiring a plan to achieve universal health care; expanding the
definition of dependent coverage; establishing an electronic health record
system revolving account and loan program; modifying hospital information
reporting disclosures; regulating federally qualified health centers; establishing
health care programs outreach; establishing a primary care access initiative;
requiring a medical assistance co-payment for certain emergency room visits;
changing eligibility requirements for medical assistance; modifying general
assistance medical care eligibility requirements for the homeless; modifying
application assistance; allowing MinnesotaCare applicants to use a place of
public accommodation as a verified address; exempting workers' compensation
settlements from income eligibility; eliminating the modification to the
MinnesotaCare application form; increasing reimbursement for critical access
dental providers; extending medical assistance coverage to Medicare Part
D co-payments; creating grants for nonprofit dental providers with a high
proportion of uninsured patients; eliminating co-payments for medical assistance
and general assistance medical care; modifying the period of renewal for
MinnesotaCare; modifying the definition of employer-subsidized insurance;
creating a prescription drug discount program; expanding the benefit set for
single adults; increasing the eligibility income limit for single adults; increasing
the cap for inpatient hospitalization benefits for adults; modifying the definition
of income for self-employed farmers; removing insurance barriers for children
in MinnesotaCare; eliminating MinnesotaCare premiums for members of the
military and their families; reducing premiums for MinnesotaCare; restoring
family planning grants; creating a patient incentive health program; requiring
uniform billing forms; establishing a small employer option; affirming that every
resident of Minnesota has the right to affordable health care; requiring reports;
appropriating money; amending Minnesota Statutes 2006, sections 62E.02,
subdivision 7; 62J.07, subdivisions 1, 3; 62J.495; 62J.82; 62L.02, subdivision
11; 62Q.165, subdivisions 1, 2; 256.01, subdivision 2b; 256B.056, subdivision
10; 256B.0625, subdivision 30, by adding a subdivision; 256B.69, subdivision
2; 256B.76; 256D.03, subdivisions 3, 4; 256L.01, subdivisions 1, 4; 256L.03,
subdivisions 1, 3, 5; 256L.04, subdivisions 1a, 7, 10; 256L.05, subdivisions 1,
1b, 2, 3a, 3c; 256L.07, subdivisions 1, 2, 3, 6; 256L.09, subdivision 4; 256L.15,
subdivisions 1, 2, 4; 256L.17, subdivisions 2, 3, 7; Laws 2005, First Special
Session chapter 4, article 9, section 3, subdivision 2; proposing coding for new
law in Minnesota Statutes, chapters 62J; 145; 256; 256B; 256L; repealing
Minnesota Statutes 2006, sections 62A.301; 256B.0631; 256L.035.

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

Section 1.

Minnesota Statutes 2006, section 62E.02, subdivision 7, is amended to read:


Subd. 7.

Dependent.

"Dependent" means a spouse or unmarried child deleted text beginunder the
age of 19 years, a dependent child
deleted text end who is deleted text begina studentdeleted text end under the age of 25new text begin regardless of
whether the dependent child is enrolled in an educational institution
new text end, or a dependent
child of any age who is disabled.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2008.
new text end

Sec. 2.

Minnesota Statutes 2006, section 62J.07, subdivision 1, is amended to read:


Subdivision 1.

Legislative oversight.

The Legislative Commission on Health
Care Access deleted text beginreviews the activities of the commissioner of health, the Health Technology
Advisory Committee, and all other state agencies involved in the implementation and
administration of this chapter, including efforts to obtain federal approval through waivers
and other means
deleted text endnew text begin shall make recommendations to the legislature on how to achieve the
goal of universal health coverage as described in section 62Q.165. The recommendations
shall include a timetable in which measurable progress must be achieved toward this goal.
The commission shall submit to the legislature by January 15, 2008, the recommendations
and corresponding timetable
new text end.

Sec. 3.

Minnesota Statutes 2006, section 62J.07, subdivision 3, is amended to read:


Subd. 3.

Reports to the commission.

The deleted text begincommissionerdeleted text end new text begincommissioners new text endof
healthnew text begin, human services, commerce,new text end and deleted text beginthe Health Technology Advisory Committee shall
report on their activities annually and at other times at the request of the Legislative
Commission on Health Care Access. The commissioners of health, commerce, and human
services shall provide periodic reports to the legislative commission on the progress of
rulemaking that is authorized or required under this chapter and shall notify members
of the commission when a draft of a proposed rule has been completed and scheduled
for publication in the State Register. At the request of a member of the commission,
a commissioner shall provide a description and a copy of a proposed rule
deleted text endnew text begin other state
agencies shall provide assistance and technical support to the commission at the request
of the commission. The commission may convene subcommittees to provide additional
assistance and advice to the commission
new text end.

Sec. 4.

Minnesota Statutes 2006, section 62J.495, is amended to read:


62J.495 HEALTH INFORMATION TECHNOLOGY AND
INFRASTRUCTURE deleted text beginADVISORY COMMITTEEdeleted text end.

Subdivision 1.

deleted text beginEstablishment; members; dutiesdeleted text endnew text begin Implementationnew text end.

new text begin By January
1, 2015, all hospitals and health care providers must have in place an interoperable
electronic health records system within their hospital system or clinical practice setting.
The commissioner of health, in consultation with the Health Information Technology and
Infrastructure Advisory Committee, shall develop a statewide plan to meet this goal,
including uniform standards to be used for the interoperable system for sharing and
synchronizing patient data across systems. The standards must be compatible with federal
efforts. The uniform standards must be developed by January 1, 2009, with a status report
on the development of these standards submitted to the legislature by January 15, 2008.
new text end

new text begin Subd. 2. new text end

new text begin Health Information Technology and Infrastructure Advisory
Committee.
new text end

(a) The commissioner shall establish a Health Information Technology
and Infrastructure Advisory Committee governed by section 15.059 to advise the
commissioner on the following matters:

(1) assessment of the use of health information technology by the state, licensed
health care providers and facilities, and local public health agencies;

(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for administrative data exchange, clinical support programs, patient privacy requirements,
and maintenance of the security and confidentiality of individual patient data; and

(3) other related issues as requested by the commissioner.

(b) The members of the Health Information Technology and Infrastructure Advisory
Committee shall include the commissioners, or commissioners' designees, of health,
human services, administration, and commerce and additional members to be appointed
by the commissioner to include persons representing Minnesota's local public health
agencies, licensed hospitals and other licensed facilities and providers, private purchasers,
the medical and nursing professions, health insurers and health plans, the state quality
improvement organization, academic and research institutions, consumer advisory
organizations with an interest and expertise in health information technology, and other
stakeholders as identified by the Health Information Technology and Infrastructure
Advisory Committee.

deleted text begin Subd. 2. deleted text end

deleted text begin Annual report. deleted text end

new text begin(c) new text endThe commissioner shall prepare and issue an annual
report not later than January 30 of each year outlining progress to date in implementing a
statewide health information infrastructure and recommending future projects.

deleted text begin Subd. 3. deleted text end

deleted text begin Expiration. deleted text end

new text begin(d) new text endNotwithstanding section 15.059, this deleted text beginsectiondeleted text end new text beginsubdivision
new text endexpires June 30, deleted text begin2009deleted text endnew text begin 2015new text end.

Sec. 5.

new text begin [62J.496] ELECTRONIC HEALTH RECORD SYSTEM REVOLVING
ACCOUNT AND LOAN PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Account establishment. new text end

new text begin The commissioner of finance shall
establish and implement a revolving account in the state government special revenue
fund to provide loans to physicians or physician group practices to assist in financing the
installation or support of an interoperable health record system. The system must provide
for the interoperable exchange of health care information between the applicant and, at a
minimum, a hospital system, pharmacy, and a health care clinic or other physician group.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility. new text end

new text begin To be eligible for a loan under this section, the applicant
must submit a loan application to the commissioner of health on forms prescribed by the
commissioner. The application must include, at a minimum:
new text end

new text begin (1) the amount of the loan requested and a description of the purpose or project
for which the loan proceeds will be used;
new text end

new text begin (2) a signed contract with a vendor;
new text end

new text begin (3) a description of the health care entities and other groups participating in the
project;
new text end

new text begin (4) evidence of financial stability and a demonstrated ability to repay the loan; and
new text end

new text begin (5) a description of how the system to be financed interconnects or plans in the
future to interconnect with other health care entities and provider groups located in the
same geographical area.
new text end

new text begin Subd. 3. new text end

new text begin Loans. new text end

new text begin (a) The commissioner of health may make a no interest loan
to a provider or provider group who is eligible under subdivision 2 on a first-come,
first-served basis provided that the applicant is able to comply with this section. The total
accumulative loan principal must not exceed $....... per loan. The commissioner of health
has discretion over the size and number of loans made.
new text end

new text begin (b) The commissioner of health may prescribe forms and establish an application
process and, notwithstanding section 16A.1283, may impose a reasonable nonrefundable
application fee to cover the cost of administering the loan program.
new text end

new text begin (c) The borrower must begin repaying the principal no later than two years from the
date of the loan. Loans must be amortized no later than 15 years from the date of the loan.
new text end

new text begin (d) Repayments must be credited to the account.
new text end

Sec. 6.

Minnesota Statutes 2006, section 62J.82, is amended to read:


62J.82 HOSPITAL deleted text beginCHARGEdeleted text end new text beginINFORMATION REPORTING new text endDISCLOSURE.

new text begin Subdivision 1. new text end

new text begin Required information. new text end

The Minnesota Hospital Association shall
develop a Web-based system, available to the public free of charge, for reporting deleted text begincharge
information
deleted text endnew text begin the followingnew text end, for Minnesota residentsdeleted text begin,deleted text endnew text begin:
new text end

new text begin (1) hospital-specific performance on the measures of care developed under section
256B.072 for acute myocardial infarction, heart failure, and pneumonia;
new text end

new text begin (2) by January 1, 2009, hospital-specific performance on the public reporting
measures for hospital-acquired infections as published by the National Quality Forum
and collected by the Minnesota Hospital Association and Stratis Health in collaboration
with infection control practitioners; and
new text end

new text begin (3) charge information, new text endincluding, but not limited to, number of discharges, average
length of stay, average charge, average charge per day, and median charge, for each of the
50 most common inpatient diagnosis-related groups and the 25 most common outpatient
surgical procedures as specified by the Minnesota Hospital Association.

new text begin Subd. 2. new text end

new text begin Web site. new text end

The Web site must provide information that compares
hospital-specific data to hospital statewide data. The Web site must be deleted text beginestablished by
October 1, 2006, and must be
deleted text end updated annually. new text beginThe commissioner shall provide a link to
this reporting information on the department's Web site.
new text end

new text begin Subd. 3. new text end

new text begin Enforcement. new text end

new text beginThe commissioner shall provide a link to this information
on the department's Web site.
new text endIf a hospital does not provide this information to the
Minnesota Hospital Association, the commissioner new text beginof health new text endmay require the hospital to
do sonew text begin in accordance with section 144.55, subdivision 6new text end. deleted text beginThe commissioner shall provide a
link to this information on the department's Web site.
deleted text end

Sec. 7.

Minnesota Statutes 2006, section 62L.02, subdivision 11, is amended to read:


Subd. 11.

Dependent.

"Dependent" means an eligible employee's spouse,
unmarried child who is deleted text beginunder the age of 19 years, unmarried childdeleted text end under the age of 25
years deleted text beginwho is a full-time student as defined in section 62A.301deleted text endnew text begin regardless of whether
the dependent child is enrolled in an educational institution
new text end, dependent child of any age
who is disabled and who meets the eligibility criteria in section 62A.14, subdivision 2,
or any other person whom state or federal law requires to be treated as a dependent for
purposes of health plans. For the purpose of this definition, a child includes a child for
whom the employee or the employee's spouse has been appointed legal guardian and an
adoptive child as provided in section 62A.27.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2008.
new text end

Sec. 8.

Minnesota Statutes 2006, section 62Q.165, subdivision 1, is amended to read:


Subdivision 1.

Definition.

It is the commitment of the state to achieve universal
health coverage for all Minnesotansnew text begin by the year 2010new text end. Universal coverage is achieved
when:

(1) every Minnesotan has access to a full range of quality health care services;

(2) every Minnesotan is able to obtain affordable health coverage which pays for the
full range of services, including preventive and primary care; and

(3) every Minnesotan pays into the health care system according to that person's
ability.

Sec. 9.

Minnesota Statutes 2006, section 62Q.165, subdivision 2, is amended to read:


Subd. 2.

Goal.

It is the goal of the state to make continuous progress toward
reducing the number of Minnesotans who do not have health coverage so that by January
1, deleted text begin2000deleted text endnew text begin 2010new text end, deleted text beginfewer than four percent of the state's population will be without health
coverage
deleted text endnew text begin all Minnesota residents have access to affordable health carenew text end. deleted text beginThe goal will bedeleted text end
deleted text begin achieved bydeleted text end new text beginIn achieving this goal, a number of options shall be considered, including
new text endimproving access to private health coverage through insurance reforms and market
reforms, deleted text beginbydeleted text end making health coverage more affordable for low-income Minnesotans through
purchasing pools and state subsidies, and deleted text beginbydeleted text end reducing the cost of health coverage through
cost containment programs and methods of ensuring that all Minnesotans are paying
into the system according to their ability.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 10.

new text begin [145.9269] FEDERALLY QUALIFIED HEALTH CENTERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, "federally qualified health
center" means an entity that is receiving a grant under United States Code, title 42,
section 254b, or, based on the recommendation of the Health Resources and Services
Administration within the Public Health Service, is determined by the secretary to meet
the requirements for receiving such a grant.
new text end

new text begin Subd. 2. new text end

new text begin Allocation of subsidies. new text end

new text begin The commissioner of health shall distribute
subsidies to federally qualified health centers operating in Minnesota to continue, expand,
and improve federally qualified health center services to low-income populations. The
commissioner shall distribute the funds appropriated under this section to federally
qualified health centers operating in Minnesota as of January 1, 2007. The amount of
each subsidy shall be in proportion to each federally qualified health center's amount of
discounts granted to patients during calendar year 2006 as reported on the federal Uniform
Data System report in conformance with the Bureau of Primary Health Care Program
Expectations Policy Information Notice 98-23, except that each eligible federally qualified
health center shall receive at least two percent but no more than 30 percent of the total
amount of money available under this section.
new text end

Sec. 11.

Minnesota Statutes 2006, section 256.01, subdivision 2b, is amended to read:


Subd. 2b.

Performance payments.

new text begin(a) new text endThe commissioner shall develop and
implement a pay-for-performance system to provide performance payments to medical
groups that demonstrate optimum care in serving individuals with chronic diseases who
are enrolled in health care programs administered by the commissioner under chapters
256B, 256D, and 256L.

new text begin (b) The commissioner shall also develop and implement a patient incentive health
program to provide incentives and rewards to patients who are enrolled in health care
programs administered by the commissioner under chapters 256B, 256D, and 256L, and
who have agreed to and met personal health goals established with their primary care
provider to manage a chronic disease or condition, including, but not limited to, diabetes,
high blood pressure, and coronary artery disease.
new text end

Sec. 12.

new text begin [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; administration. new text end

new text begin The commissioner shall establish
and administer the prescription drug discount program.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner's authority. new text end

new text begin The commissioner shall administer a drug
rebate program for drugs purchased according to the prescription drug discount program.
The commissioner shall execute a rebate agreement from all manufacturers that choose to
participate in the program for those drugs covered under the medical assistance program.
For each drug, the amount of the rebate shall be equal to the rebate as defined for purposes
of the federal rebate program in United States Code, title 42, section 1396r-8. The
rebate program shall utilize the terms and conditions used for the federal rebate program
established according to section 1927 of title XIX of the federal Social Security Act.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have the
meanings given them.
new text end

new text begin (a) "Commissioner" means the commissioner of human services.
new text end

new text begin (b) "Covered prescription drug" means a prescription drug as defined in section
151.44, paragraph (d), that is covered under medical assistance as described in section
256B.0625, subdivision 13, and that is provided by a participating manufacturer that has a
fully executed rebate agreement with the commissioner under this section and complies
with that agreement.
new text end

new text begin (c) "Enrolled individual" means a person who is eligible for the program under
subdivision 4 and has enrolled in the program according to subdivision 5.
new text end

new text begin (d) "Health carrier" means an insurance company licensed under chapter 60A to
offer, sell, or issue an individual or group policy of accident and sickness insurance as
defined in section 62A.01; a nonprofit health service plan corporation operating under
chapter 62C; a health maintenance organization operating under chapter 62D; a joint
self-insurance employee health plan operating under chapter 62H; a community integrated
service network licensed under chapter 62N; a fraternal benefit society operating under
chapter 64B; a city, county, school district, or other political subdivision providing
self-insured health coverage under section 471.617 or sections 471.98 to 471.982; and a
self-funded health plan under the Employee Retirement Income Security Act of 1974, as
amended.
new text end

new text begin (e) "Participating manufacturer" means a manufacturer as defined in section 151.44,
paragraph (c), that agrees to participate in the prescription drug discount program.
new text end

new text begin (f) "Participating pharmacy" means a pharmacy as defined in section 151.01,
subdivision 2, that agrees to participate in the prescription drug discount program.
new text end

new text begin Subd. 4. new text end

new text begin Eligibility. new text end

new text begin (a) To be eligible for the program, an applicant must:
new text end

new text begin (1) be a permanent resident of Minnesota as defined in section 256L.09, subdivision
4;
new text end

new text begin (2) not be enrolled in medical assistance, general assistance medical care, or
MinnesotaCare;
new text end

new text begin (3) not be enrolled in and have currently available prescription drug coverage under
a health plan offered by a health carrier or employer or under a pharmacy benefit program
offered by a pharmaceutical manufacturer; and
new text end

new text begin (4) not be enrolled in and have currently available prescription drug coverage
under a Medicare supplement policy, as defined in sections 62A.31 to 62A.44, or
policies, contracts, or certificates that supplement Medicare issued by health maintenance
organizations or those policies, contracts, or certificates governed by section 1833 or 1876
of the federal Social Security Act, United States Code, title 42, section 1395, et seq., as
amended.
new text end

new text begin (b) Notwithstanding paragraph (a), clause (3), an individual who is enrolled in a
Medicare Part D prescription drug plan or Medicare Advantage plan is eligible for the
program but only for drugs that are not covered under the Medicare Part D plan or for
drugs that are covered under the plan, but according to the conditions of the plan, the
individual is responsible for 100 percent of the cost of the prescription drug.
new text end

new text begin Subd. 5. new text end

new text begin Application procedure. new text end

new text begin (a) Applications and information on the program
must be made available at county social services agencies, health care provider offices, and
agencies and organizations serving senior citizens. Individuals shall submit applications
and any information specified by the commissioner as being necessary to verify eligibility
directly to the commissioner. The commissioner shall determine an applicant's eligibility
for the program within 30 days from the date the application is received. Upon notice of
approval, the applicant must submit to the commissioner the enrollment fee specified in
subdivision 10. Eligibility begins the month after the enrollment fee is received by the
commissioner.
new text end

new text begin (b) An enrollee's eligibility must be renewed every 12 months with the 12-month
period beginning in the month after the application is approved.
new text end

new text begin (c) The commissioner shall develop an application form that does not exceed one
page in length and requires information necessary to determine eligibility for the program.
new text end

new text begin Subd. 6. new text end

new text begin Participating pharmacy. new text end

new text begin (a) Upon implementation of the prescription
drug discount program, and until January 1, 2009, a participating pharmacy, with a
valid prescription, must sell a covered prescription drug to an enrolled individual at the
medical assistance rate.
new text end

new text begin (b) After January 1, 2009, a participating pharmacy, with a valid prescription, must
sell a covered prescription drug to an enrolled individual at the medical assistance rate,
minus an amount that is equal to the rebate amount described in subdivision 8, plus
the amount of any switch fee established by the commissioner under subdivision 10,
paragraph (b).
new text end

new text begin (c) Each participating pharmacy shall provide the commissioner with all information
necessary to administer the program, including, but not limited to, information on
prescription drug sales to enrolled individuals and usual and customary retail prices.
new text end

new text begin Subd. 7. new text end

new text begin Notification of rebate amount. new text end

new text begin The commissioner shall notify each
participating manufacturer, each calendar quarter or according to a schedule established
by the commissioner, of the amount of the rebate owed on the prescription drugs sold by
participating pharmacies to enrolled individuals.
new text end

new text begin Subd. 8. new text end

new text begin Provision of rebate. new text end

new text begin To the extent that a participating manufacturer's
prescription drugs are prescribed to a resident of this state, the manufacturer must provide
a rebate equal to the rebate provided under the medical assistance program for any
prescription drug distributed by the manufacturer that is purchased at a participating
pharmacy by an enrolled individual. The participating manufacturer must provide full
payment within 38 days of receipt of the state invoice for the rebate, or according to
a schedule to be established by the commissioner. The commissioner shall deposit all
rebates received into the Minnesota prescription drug dedicated fund established under
subdivision 11. The manufacturer must provide the commissioner with any information
necessary to verify the rebate determined per drug.
new text end

new text begin Subd. 9. new text end

new text begin Payment to pharmacies. new text end

new text begin Beginning January 1, 2009, the commissioner
shall distribute on a biweekly basis an amount that is equal to an amount collected under
subdivision 8 to each participating pharmacy based on the prescription drugs sold by that
pharmacy to enrolled individuals on or after January 1, 2009.
new text end

new text begin Subd. 10. new text end

new text begin Enrollment fee; switch fee. new text end

new text begin (a) The commissioner shall establish an
annual enrollment fee that covers the commissioner's expenses for enrollment, processing
claims, and distributing rebates under this program.
new text end

new text begin (b) The commissioner shall establish a reasonable switch fee that covers expenses
incurred by participating pharmacies in formatting for electronic submission claims for
prescription drugs sold to enrolled individuals.
new text end

new text begin Subd. 11. new text end

new text begin Dedicated fund; creation; use of fund. new text end

new text begin (a) The Minnesota prescription
drug dedicated fund is established as an account in the state treasury. The commissioner
of finance shall credit to the dedicated fund all rebates paid under subdivision 8, any
federal funds received for the program, all enrollment fees paid by the enrollees, and
any appropriations or allocations designated for the fund. The commissioner of finance
shall ensure that fund money is invested under section 11A.25. All money earned by the
fund must be credited to the fund. The fund shall earn a proportionate share of the total
state annual investment income.
new text end

new text begin (b) Money in the fund is appropriated to the commissioner to reimburse participating
pharmacies for prescription drugs provided to enrolled individuals under subdivision 6,
paragraph (b); to reimburse the commissioner for costs related to enrollment, processing
claims, distributing rebates, and for other reasonable administrative costs related to
administration of the prescription drug discount program; and to repay the appropriation
provided by law for this section. The commissioner must administer the program so that
the costs total no more than funds appropriated plus the drug rebate proceeds.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 13.

new text begin [256.962] MINNESOTA HEALTH CARE PROGRAMS OUTREACH.
new text end

new text begin Subdivision 1. new text end

new text begin Public awareness and education. new text end

new text begin (a) The commissioner shall
design and implement a statewide campaign to raise public awareness on the availability
of health coverage through medical assistance, general assistance medical care, and
MinnesotaCare and to educate the public on the importance of obtaining and maintaining
health care coverage. The campaign shall include multimedia messages directed to the
general population and messages that are culturally specific and community-based,
directed to high-uninsured population areas.
new text end

new text begin (b) The commissioner shall collaborate with public and private entities, including,
but not limited to, hospitals, providers, health plans, legal aid offices, pharmacies,
insurance agencies, and faith-based organizations to develop outreach activities and
partnerships to ensure the distribution of information and applications.
new text end

new text begin (c) The commissioner shall ensure that all outreach materials are available in
languages other than English.
new text end

new text begin Subd. 2. new text end

new text begin Outreach grants. new text end

new text begin The commissioner shall award grants to public and
private organizations to provide information, applications, and assistance in obtaining
coverage through Minnesota public health care programs. In awarding these grants, the
commissioner shall give priority to community organizations with a proven ability to
provide multilingual and cultural outreach efforts in areas of high-uninsured populations.
new text end

new text begin Subd. 3. new text end

new text begin Application and assistance. new text end

new text begin (a) The Minnesota health care programs
application must be made available at provider offices, local human services agencies,
school districts, public and private elementary schools in which 25 percent or more of
the students receive free or reduced price lunches, community health offices, Women,
Infants and Children (WIC) program sites, Head Start program sites, public housing
councils, child care centers, early childhood education and preschool program sites, legal
aid offices, and libraries. The commissioner shall ensure that applications are available in
languages other than English and that individuals and families who need assistance due to
language or cultural barriers receive the necessary services.
new text end

new text begin (b) Local human service agencies, hospitals, and health care community clinics
receiving state funds must provide direct assistance in completing the application form,
including the free use of a copy machine and a drop box for applications. Other locations
where applications are required to be available shall either provide direct assistance in
completing the application form or provide information on where an applicant can receive
application assistance.
new text end

new text begin (c) Counties must offer applications and application assistance when providing
child support collection services.
new text end

new text begin (d) Local public health agencies and counties that provide immunization clinics must
offer applications and application assistance during these clinics.
new text end

new text begin Subd. 4. new text end

new text begin Statewide toll-free telephone number. new text end

new text begin The commissioner shall provide
funds to establish a statewide toll-free telephone number to provide information on public
and private health coverage options and sources of free and low-cost health care.
new text end

new text begin Subd. 5. new text end

new text begin Incentive program. new text end

new text begin The commissioner shall establish an incentive
program for organizations that directly identify and assist potential enrollees in filling
out and submitting an application. For each applicant who is successfully enrolled in
MinnesotaCare, medical assistance, or general assistance medical care, the commissioner
shall pay the organization a $25 application assistance fee. The organization may provide
an applicant a gift certificate or other incentive upon enrollment.
new text end

new text begin Subd. 6. new text end

new text begin School districts. new text end

new text begin (a) At the beginning of each school year, a school district
shall provide information to each student on the availability of health care coverage
through the Minnesota health care programs.
new text end

new text begin (b) For each child who is determined to be eligible for a free or reduced priced lunch,
the district shall provide the child's family with an application for the Minnesota health
care programs and information on how to obtain application assistance.
new text end

new text begin (c) A district shall also ensure that applications and information on application
assistance are available at early childhood education sites and public schools located
within the district's jurisdiction.
new text end

new text begin (d) Each district shall designate an enrollment specialist to provide application
assistance and follow-up services with families who are eligible for the reduced or free
lunch program or who have indicated an interest in receiving information or an application
for the Minnesota health care program.
new text end

new text begin (e) Each school district shall provide on their Web site a link to information on how
to obtain an application and application assistance.
new text end

new text begin Subd. 7. new text end

new text begin Renewal notice. new text end

new text begin (a) The commissioner shall mail a renewal notice to
enrollees notifying the enrollee that their eligibility must be renewed. A notice shall be
sent at 90 days prior to the renewal date and at 60 days prior to the renewal date.
new text end

new text begin (b) For enrollees who are receiving services through managed care plans, the
managed care plan must provide a follow-up renewal call at least 60 days prior to the
enrollee's renewal date.
new text end

new text begin (c) The commissioner shall include the end of coverage dates on the monthly rosters
of enrollees provided to managed care organizations.
new text end

new text begin Subd. 8. new text end

new text begin MinnesotaCare small employer buy-in option. new text end

new text begin The commissioner shall
provide information on the small employer buy-in option for MinnesotaCare to insurance
agents and local chambers of commerce.
new text end

Sec. 14.

new text begin [256.963] PRIMARY CARE ACCESS INITIATIVE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin (a) The commissioner shall award a grant to
implement in Hennepin and Ramsey Counties a Web-based primary care access pilot
project designed as a collaboration between private and public sectors to connect, where
appropriate, a patient with a primary care medical home and schedule patients into
available community-based appointments as an alternative to nonemergency use of the
hospital emergency room. The grantee must establish a program that diverts patients
presenting at an emergency room for nonemergency care to more appropriate outpatient
settings. The program must refer the patient to an appropriate health care professional
based on the patient's health care needs and situation. The program must provide the
patient with a scheduled appointment that is timely, with an appropriate provider who is
conveniently located. If the patient is uninsured and potentially eligible for a Minnesota
health care program, the program must connect the patient to a primary care provider,
community clinic, or agency that can assist the patient with the application process. The
program must also ensure that discharged patients are connected with a community-based
primary care provider and assist in scheduling any necessary follow-up visits before
the patient is discharged.
new text end

new text begin (b) The program must not require a provider to pay a fee for accepting charity care
patients or patients enrolled in a Minnesota public health care program.
new text end

new text begin Subd. 2. new text end

new text begin Evaluation. new text end

new text begin (a) The grantee must report to the commissioner on a quarterly
basis the following information:
new text end

new text begin (1) total number of appointments available for scheduling by specialty;
new text end

new text begin (2) average length of time between scheduling and actual appointment; and
new text end

new text begin (3) total number of patients referred and whether the patient was insured or
uninsured.
new text end

new text begin (b) The commissioner, in consultation with the Minnesota Hospital Association,
shall conduct an evaluation of the emergency room diversion pilot project and submit the
results to the legislature by January 15, 2009. The evaluation shall compare the number of
nonemergency visits and repeat visits to hospital emergency rooms for the period before
the commencement of the project and one year after the commencement, and an estimate
of the costs saved from any documented reductions.
new text end

Sec. 15.

Minnesota Statutes 2006, section 256B.056, subdivision 10, is amended to
read:


Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10
, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.

deleted text begin (c) The commissioner shall modify the application for Minnesota health care
programs to require more detailed information related to verification of assets and income,
and shall verify assets and income for all applicants, and for all recipients upon renewal.
deleted text end

deleted text begin (d) The commissioner shall require Minnesota health care program recipients to
report new or an increase in earned income within ten days of the change, and to verify new
or an increase in earned income that affects eligibility within ten days of notification by
the agency that the new or increased earned income affects eligibility. Recipients who fail
to verify new or an increase in earned income that affects eligibility shall be disenrolled.
deleted text end

Sec. 16.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:


new text begin Subd. 13i. new text end

new text begin Medicare Part D co-payments. new text end

new text begin For recipients who are enrolled in a
Medicare Part D prescription drug plan or Medicare Advantage plan, medical assistance
covers the co-payments which the recipient is responsible for under the Medicare Part D
prescription drug plan or Medicare Advantage plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 17.

Minnesota Statutes 2006, 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 services, and the services of a clinic meeting the criteria
established in rule by the commissioner. 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) deleted text beginIn 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.
deleted text end

deleted text begin (d)deleted text end deleted text beginEffective 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.
deleted text end

deleted text begin (e)deleted text end 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.

deleted text begin (f)deleted text endnew text begin (d)new text end 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 deleted text begincostdeleted text end new text begincosts new text endas determined
deleted text begin according todeleted text endnew text begin by generally accepted accounting principles and annualnew text end Medicare cost
deleted text begin principlesdeleted text endnew text begin reports, including Medicaid-eligible cost add-onsnew text end.

Sec. 18.

new text begin [256B.0632] MEDICAL ASSISTANCE CO-PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Co-payment. new text end

new text begin The medical assistance benefit plan shall include a
$6 co-payment for nonemergency visits to a hospital-based emergency room, except as
provided in subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Exceptions. new text end

new text begin A co-payment shall not be charged to:
new text end

new text begin (1) children under the age of 21;
new text end

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

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

new text begin (4) recipients receiving hospice care.
new text end

Sec. 19.

Minnesota Statutes 2006, section 256B.69, subdivision 2, is amended to read:


Subd. 2.

Definitions.

For the purposes of this section, the following terms have
the meanings given.

(a) "Commissioner" means the commissioner of human services. For the
remainder of this section, the commissioner's responsibilities for methods and policies
for implementing the project will be proposed by the project advisory committees and
approved by the commissioner.

(b) "Demonstration provider" means a health maintenance organization, community
integrated service network, or accountable provider network authorized and operating
under chapter 62D, 62N, or 62T that participates in the demonstration project according
to criteria, standards, methods, and other requirements established for the project and
approved by the commissioner. For purposes of this section, a county board, or group of
county boards operating under a joint powers agreement, is considered a demonstration
provider if the county or group of county boards meets the requirements of section
256B.692. Notwithstanding the above, Itasca County may continue to participate as a
demonstration provider until July 1, 2004.

(c) "Eligible individuals" means those persons eligible for medical assistance
benefits as defined in sections 256B.055, 256B.056, and 256B.06. new text beginNotwithstanding
sections 256B.055, 256B.056, and 256B.06, an individual who becomes ineligible for
the program because of failure to submit income reports or recertification forms in a
timely manner, shall remain enrolled in the prepaid health plan and shall remain eligible
to receive medical assistance coverage through the last day of the month following the
month in which the enrollee became ineligible for the medical assistance program.
new text end

(d) "Limitation of choice" means suspending freedom of choice while allowing
eligible individuals to choose among the demonstration providers.

Sec. 20.

Minnesota Statutes 2006, section 256B.76, is amended to read:


256B.76 PHYSICIAN AND DENTAL REIMBURSEMENT.

(a) Effective for services rendered on or after October 1, 1992, the commissioner
shall make payments for physician services as follows:

(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care,"
"critical care," cesarean delivery and pharmacologic management provided to psychiatric
patients, and level three codes for enhanced services for prenatal high risk, shall be paid
at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
30, 1992. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;

(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992;

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992;

(4) effective for services rendered on or after January 1, 2000, payment rates for
physician and professional services shall be increased by three percent over the rates in
effect on December 31, 1999, except for home health agency and family planning agency
services; and

(5) the increases in clause (4) shall be implemented January 1, 2000, for managed
care.

(b) Effective for services rendered on or after October 1, 1992, the commissioner
shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
percent above the rate in effect on June 30, 1992;

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases;

(3) effective for services rendered on or after January 1, 2000, payment rates for
dental services shall be increased by three percent over the rates in effect on December
31, 1999;

(4) the commissioner shall award grants to community clinics or other nonprofit
community organizations, political subdivisions, professional associations, or other
organizations that demonstrate the ability to provide dental services effectively to public
program recipients. Grants may be used to fund the costs related to coordinating access for
recipients, developing and implementing patient care criteria, upgrading or establishing
new facilities, acquiring furnishings or equipment, recruiting new providers, or other
development costs that will improve access to dental care in a region. In awarding grants,
the commissioner shall give priority to applicants that plan to serve areas of the state in
which the number of dental providers is not currently sufficient to meet the needs of
recipients of public programs or uninsured individuals. The commissioner shall consider
the following in awarding the grants:

(i) potential to successfully increase access to an underserved population;

(ii) the ability to raise matching funds;

(iii) the long-term viability of the project to improve access beyond the period
of initial funding;

(iv) the efficiency in the use of the funding; and

(v) the experience of the proposers in providing services to the target population.

The commissioner shall monitor the grants and may terminate a grant if the grantee
does not increase dental access for public program recipients. The commissioner shall
consider grants for the following:

(i) implementation of new programs or continued expansion of current access
programs that have demonstrated success in providing dental services in underserved
areas;

(ii) a pilot program for utilizing hygienists outside of a traditional dental office to
provide dental hygiene services; and

(iii) a program that organizes a network of volunteer dentists, establishes a system to
refer eligible individuals to volunteer dentists, and through that network provides donated
dental care services to public program recipients or uninsured individuals;

(5) beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (i) submitted charge, or (ii) 80 percent of median 1997 charges;

(6) the increases listed in clauses (3) and (5) shall be implemented January 1, 2000,
for managed care; and

(7) effective for services provided on or after January 1, 2002, payment for
diagnostic examinations and dental x-rays provided to children under age 21 shall be the
lower of (i) the submitted charge, or (ii) 85 percent of median 1999 charges.

(c) Effective for dental services rendered on or after January 1, 2002, the
commissioner deleted text beginmay, within the limits of available appropriation,deleted text end new text beginshall new text endincrease
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. Reimbursement to a critical access dental provider may be
increased by not more than 50 percent above the reimbursement rate that would
otherwise be paid to the provider. Payments to health plan companies shall be adjusted to
reflect increased reimbursements to critical access dental providers as approved by the
commissioner. In determining which dentists and dental clinics shall be deemed critical
access dental providers, the commissioner shall review:

(1) the utilization rate in the service area in which the dentist or dental clinic operates
for dental services to patients covered by medical assistance, general assistance medical
care, or MinnesotaCare as their primary source of coverage;

(2) the level of services provided by the dentist or dental clinic to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare as their primary
source of coverage; and

(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within the service area.

In the absence of a critical access dental provider in a service area, the commissioner may
designate a dentist or dental clinic as a critical access dental provider if the dentist or
dental clinic is willing to provide care to patients covered by medical assistance, general
assistance medical care, or MinnesotaCare at a level which significantly increases access
to dental care in the service area.

The commissioner shall annually establish a reimbursement schedule for critical
access dental providers and provider-specific limits on total reimbursement received
under the reimbursement schedule, and shall notify each critical access dental provider
of the schedule and limit.

(d) new text beginThe commissioner shall award special hardship grants to nonprofit dental
providers with a high proportion of uninsured patients that equals or exceeds 15 percent
of the total number of patients served by that provider and the provider does not receive
a financial benefit comparable to other critical access dental providers under the critical
access dental provider formula described in paragraph (c). The commissioner shall award
a grant to these providers allocated in proportion to each critical access dental provider's
ratio of uninsured patients to the total number of patients served by all providers who
qualify for a grant under this paragraph.
new text end

new text begin (e) new text endAn entity that operates both a Medicare certified comprehensive outpatient
rehabilitation facility and a facility which was certified prior to January 1, 1993, that is
licensed under Minnesota Rules, parts 9570.2000 to 9570.3600, and for whom at least 33
percent of the clients receiving rehabilitation services in the most recent calendar year are
medical assistance recipients, shall be reimbursed by the commissioner for rehabilitation
services at rates that are 38 percent greater than the maximum reimbursement rate
allowed under paragraph (a), clause (2), when those services are (1) provided within the
comprehensive outpatient rehabilitation facility and (2) provided to residents of nursing
facilities owned by the entity.

deleted text begin (e)deleted text end new text begin(f) new text endEffective for services rendered on or after January 1, 2007, the commissioner
shall make payments for physician and professional services based on the Medicare
relative value units (RVU's). This change shall be budget neutral and the cost of
implementing RVU's will be incorporated in the established conversion factor.

Sec. 21.

Minnesota Statutes 2006, 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 as defined in
paragraph (b), except as provided in paragraph (c), 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, subdivision 3, 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;

(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; or

(iii) 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 Services.

(b) 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 (e).

(c) 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
deleted text begin six-monthdeleted text end new text begininitial new text endeligibility period, until their deleted text beginsix-monthdeleted text end new text beginannual new text endrenewal.

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

(e) Applicants and recipients eligible under paragraph (a), clause (1); who 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; who fail to meet the
requirements of section 256L.09, subdivision 2; new text beginwho are homeless as defined by United
States Code, title 42, section 11301, et seq.;
new text end who are classified as end-stage renal disease
beneficiaries in the Medicare program; who are enrolled in private health care coverage as
defined in section 256B.02, subdivision 9; who are eligible under paragraph (j); or who
receive treatment funded pursuant to section 254B.02 are exempt from the MinnesotaCare
enrollment requirements of this subdivision.

(f) 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.

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

(h) 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
county agency must assist the applicant in obtaining verification if necessary.

(i) 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.

(j) 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.

(k) 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.

(l) 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.

(m) 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.

(n) 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(a)(15), and
an undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service.

(o) 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.

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

Sec. 22.

Minnesota Statutes 2006, section 256D.03, subdivision 4, is amended to read:


Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation agencies;

(4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;

(5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;

(6) eyeglasses and eye examinations provided by a physician or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical assistance program;

(13) podiatric services;

(14) dental services as covered under the medical assistance program;

(15) outpatient services provided by a mental health center or clinic that is under
contract with the county board and is established under section 245.62;

(16) day treatment services for mental illness provided under contract with the
county board;

(17) prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;

(18) psychological services, medical supplies and equipment, and Medicare
premiums, coinsurance and deductible payments;

(19) medical equipment not specifically listed in this paragraph when the use of
the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;

(20) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an inpatient basis is not included
as part of the cost for inpatient services included in the operating payment rate, and (3) the
service is within the scope of practice of the nurse practitioner's license as a registered
nurse, as defined in section 148.171;

(21) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;

(22) telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b; and

(23) mental health telemedicine and psychiatric consultation as covered under
section 256B.0625, subdivisions 46 and 48.

(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.

(b) Effective August 1, 2005, sex reassignment surgery is not covered under this
subdivision.

(c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.

deleted text begin (d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003:
deleted text end

deleted text begin (1) $25 for eyeglasses;
deleted text end

deleted text begin (2) $25 for nonemergency visits to a hospital-based emergency room;
deleted text end

deleted text begin (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness; and
deleted text end

deleted text begin (4) 50 percent coinsurance on restorative dental services.
deleted text end

deleted text begin (e) Co-payments shall be limited to one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by
the amount of the co-payment, except that reimbursement for prescription drugs shall not
be reduced once a recipient has reached the $12 per month maximum for prescription
drug co-payments. The provider collects the co-payment from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment, except as
provided in paragraph (f).
deleted text end

deleted text begin (f) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.
deleted text end

deleted text begin (g)deleted text end new text begin(d) new text endAny county may, from its own resources, provide medical payments for
which state payments are not made.

deleted text begin (h)deleted text end new text begin(e) new text endChemical dependency services that are reimbursed under chapter 254B must
not be reimbursed under general assistance medical care.

deleted text begin (i)deleted text end new text begin(f) new text endThe maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.

deleted text begin (j)deleted text end new text begin(g) new text endThe conditions of payment for services under this subdivision are the same
as the conditions specified in rules adopted under chapter 256B governing the medical
assistance program, unless otherwise provided by statute or rule.

deleted text begin (k)deleted text endnew text begin (h)new text end Inpatient and outpatient payments shall be reduced by five percent, effective
July 1, 2003. This reduction is in addition to the five percent reduction effective July 1,
2003, and incorporated by reference in paragraph deleted text begin(i)deleted text endnew text begin (f)new text end.

deleted text begin (l)deleted text end new text begin(i) new text endPayments for all other health services except inpatient, outpatient, and
pharmacy services shall be reduced by five percent, effective July 1, 2003.

deleted text begin (m)deleted text end new text begin(j) new text endPayments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.

deleted text begin (n)deleted text end new text begin(k) new text endA hospital receiving a reduced payment as a result of this section may apply
the unpaid balance toward satisfaction of the hospital's bad debts.

deleted text begin (o) Fee-for-service payments for nonpreventive visits shall be reduced by $3
for services provided on or after January 1, 2006. For purposes of this subdivision, a
visit means an episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory setting by
a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
audiologist, optician, or optometrist.
deleted text end

deleted text begin (p) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.
deleted text end

new text begin (l) Recipients eligible under subdivision 3, paragraph (a), shall pay a $25 co-payment
for nonemergency visits to a hospital-based emergency room.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 23.

Minnesota Statutes 2006, section 256L.01, subdivision 1, is amended to read:


Subdivision 1.

Scope.

For purposes of deleted text beginsections 256L.01 to 256L.18deleted text endnew text begin this chapternew text end,
the following terms shall have the meanings given them.

Sec. 24.

Minnesota Statutes 2006, section 256L.01, subdivision 4, is amended to read:


Subd. 4.

Gross individual or gross family income.

(a) "Gross individual or gross
family income" for nonfarm self-employed means income calculated for the deleted text beginsix-monthdeleted text end
new text begin 12-month new text endperiod of eligibility using the net profit or loss reported on the applicant's
federal income tax form for the previous year and using the medical assistance families
with children methodology for determining allowable and nonallowable self-employment
expenses and countable income.

(b) "Gross individual or gross family income" for farm self-employed means income
calculated for the deleted text beginsix-monthdeleted text end new text begin12-month new text endperiod of eligibility using as the baseline the
adjusted gross income reported on the applicant's federal income tax form for the previous
year deleted text beginand adding back in reported depreciation amounts that apply to the business in which
the family is currently engaged
deleted text end.

(c) "Gross individual or gross family income" means the total income for all family
members, calculated for the deleted text beginsix-monthdeleted text end new text begin12-month new text endperiod of eligibility.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 25.

Minnesota Statutes 2006, section 256L.03, subdivision 1, is amended to read:


Subdivision 1.

Covered health services.

deleted text beginFor individuals under section 256L.04,
subdivision 7
, with income no greater than 75 percent of the federal poverty guidelines
or for families with children under section 256L.04, subdivision 1, all subdivisions of
this section apply.
deleted text end "Covered health services" means the health services reimbursed
under chapter 256B, with the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care services other than services
covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency
medical transportation services, personal care assistant and case management services,
nursing home or intermediate care facilities services, inpatient mental health services,
and chemical dependency services. Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments, psychological testing,
explanation of findings, mental health telemedicine, psychiatric consultation, medication
management by a physician, day treatment, partial hospitalization, and individual, family,
and group psychotherapy.

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in this section.

Sec. 26.

Minnesota Statutes 2006, section 256L.03, subdivision 3, is amended to read:


Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. deleted text beginPrior to July 1, 1997, the inpatient hospital benefit for adult
enrollees is subject to an annual benefit limit of $10,000.
deleted text end The inpatient hospital benefit
for adult enrollees who qualify under section 256L.04, subdivision 7, or who qualify
under section 256L.04, subdivisions 1 and 2, with family gross income that exceeds
deleted text begin 175deleted text endnew text begin 200new text end percent of the federal poverty guidelines new text beginor 215 percent of the federal poverty
guidelines on or after July 1, 2009,
new text endand who are not pregnant, is subject to an annual
limit of deleted text begin$10,000deleted text endnew text begin $20,000new text end.

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3
, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

Sec. 27.

Minnesota Statutes 2006, section 256L.03, subdivision 5, is amended to read:


Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21 deleted text beginin households with family income equal to or less than 175
percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
parents and relative caretakers of children under the age of 21 in households with family
income greater than 175 percent of the federal poverty guidelines for inpatient hospital
admissions occurring on or after January 1, 2001
deleted text end.

(c) Paragraph (a), clauses (1) to (4), do not apply to pregnant women and children
under the age of 21.

(d) Adult enrollees with family gross income that exceeds deleted text begin175deleted text endnew text begin 200new text end percent of the
federal poverty guidelines new text beginor 215 percent of the federal poverty guidelines on or after July
1, 2009,
new text endand who are not pregnant shall be financially responsible for the coinsurance
amount, if applicable, and amounts which exceed the deleted text begin$10,000deleted text endnew text begin $20,000new text end inpatient hospital
benefit limit.

(e) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the deleted text begin$10,000deleted text endnew text begin $20,000new text end annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

Sec. 28.

Minnesota Statutes 2006, section 256L.04, subdivision 1a, is amended to read:


Subd. 1a.

Social Security number required.

(a) Individuals and families applying
for MinnesotaCare coverage must provide a Social Security number.new text begin This requirement
does not apply to an undocumented noncitizen or nonimmigrant who is eligible for
MinnesotaCare.
new text end

(b) The commissioner shall not deny eligibility to an otherwise eligible applicant
who has applied for a Social Security number and is awaiting issuance of that Social
Security number.

(c) Newborns enrolled under section 256L.05, subdivision 3, are exempt from the
requirements of this subdivision.

(d) Individuals who refuse to provide a Social Security number because of
well-established religious objections are exempt from the requirements of this subdivision.
The term "well-established religious objections" has the meaning given in Code of Federal
Regulations, title 42, section 435.910.

Sec. 29.

Minnesota Statutes 2006, section 256L.04, subdivision 7, is amended to read:


Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and households with no children who have gross family
incomes that are equal to or less than deleted text begin175deleted text endnew text begin 200new text end percent of the federal poverty guidelines.new text begin
Effective July 1, 2009, the definition of eligible persons includes all individuals and
households with no children who have gross family incomes that are equal to or less than
215 percent of the federal poverty guidelines.
new text end

Sec. 30.

Minnesota Statutes 2006, section 256L.04, subdivision 10, is amended to read:


Subd. 10.

Citizenship requirements.

new text begin(a) new text endEligibility for MinnesotaCare is limited
to citizens or nationals of the United States, qualified noncitizens, and other persons
residing lawfully in the United States as described in section 256B.06, subdivision 4,
paragraphs (a) to (e) and (j). Undocumented noncitizens and nonimmigrants are ineligible
for MinnesotaCare. new text beginThis paragraph does not apply to children.new text end

new text begin (b) new text endFor 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(a)(15), and an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service.

new text begin (c) new text endFamilies with children who are citizens or nationals of the United States must
cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.new text begin State and county workers must assist applicants in obtaining satisfactory
documentary evidence of citizenship or nationality.
new text end

Sec. 31.

Minnesota Statutes 2006, section 256L.05, subdivision 1, is amended to read:


Subdivision 1.

Application and information availability.

Applications and deleted text beginother
information
deleted text endnew text begin application assistancenew text end must be made available deleted text begintodeleted text endnew text begin atnew text end provider offices, local
human services agencies, school districts, public and private elementary schools in which
25 percent or more of the students receive free or reduced price lunches, community health
offices, deleted text beginanddeleted text end Women, Infants and Children (WIC) program sitesnew text begin, Head Start program sites,
public housing councils, crisis nurseries, child care centers, early childhood education
and preschool program sites, legal aid offices, and libraries
new text end. These sites may accept
applications and forward the forms to the commissionernew text begin or local county human services
agencies that choose to participate as an enrollment site
new text end. Otherwise, applicants may apply
directly to the commissionernew text begin or to participating local county human services agenciesnew text end.
deleted text begin Beginning January 1, 2000, MinnesotaCare enrollment sites will be expanded to include
local county human services agencies which choose to participate.
deleted text end

Sec. 32.

Minnesota Statutes 2006, section 256L.05, subdivision 1b, is amended to read:


Subd. 1b.

MinnesotaCare enrollment by county agencies.

Beginning September
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
section 256D.03, subdivision 3. County agencies shall perform all duties necessary
to administer the MinnesotaCare program ongoing for these enrollees, including the
redetermination of MinnesotaCare eligibility at deleted text beginsix-monthdeleted text end renewal.

Sec. 33.

Minnesota Statutes 2006, section 256L.05, subdivision 2, is amended to read:


Subd. 2.

Commissioner's duties.

deleted text begin(a)deleted text end The commissioner or county agency shall
use electronic verification as the primary method of income verification. If there is a
discrepancy between reported income and electronically verified income, an individual
may be required to submit additional verification. In addition, the commissioner shall
perform random audits to verify reported income and eligibility. The commissioner
may execute data sharing arrangements with the Department of Revenue and any other
governmental agency in order to perform income verification related to eligibility and
premium payment under the MinnesotaCare program.

deleted text begin (b) In determining eligibility for MinnesotaCare, the commissioner shall require
applicants and enrollees seeking renewal of eligibility to verify both earned and unearned
income. The commissioner shall also require applicants and enrollees to submit the names
of their employers and a contact name with a telephone number for each employer for
purposes of verifying whether the applicant or enrollee, and any dependents, are eligible
for employer-subsidized coverage. Data collected is nonpublic data as defined in section
deleted text begin13.02, subdivision 9deleted text end.
deleted text end

Sec. 34.

Minnesota Statutes 2006, section 256L.05, subdivision 3a, is amended to read:


Subd. 3a.

Renewal of eligibility.

(a) Beginning deleted text beginJanuary 1, 1999deleted text endnew text begin July 1, 2007new text end, an
enrollee's eligibility must be renewed every 12 months. The 12-month period begins in
the month after the month the application is approved.

(b) deleted text beginBeginning October 1, 2004, an enrollee's eligibility must be renewed every
six months. The first six-month period of eligibility begins the month the application is
received by the commissioner. The effective date of coverage within the first six-month
period of eligibility is as provided in subdivision 3.
deleted text end Each new period of eligibility must
take into account any changes in circumstances that impact eligibility and premium
amount. An enrollee must provide all the information needed to redetermine eligibility by
the first day of the month that ends the eligibility period. The premium for the new period
of eligibility must be received as provided in section 256L.06 in order for eligibility to
continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3
, the first deleted text beginsix-monthdeleted text end period of eligibility begins the month the enrollee
submitted the application or renewal for general assistance medical care.

Sec. 35.

Minnesota Statutes 2006, section 256L.05, subdivision 3c, is amended to read:


Subd. 3c.

Retroactive coverage.

Notwithstanding subdivision 3, the effective
date of coverage shall be the deleted text beginfirstdeleted text end day deleted text beginof the monthdeleted text end following termination from medical
assistance or general assistance medical care for families and individuals who are eligible
for MinnesotaCare and who submitted a written request for retroactive MinnesotaCare
coverage with a completed application within 30 days of the mailing of notification of
termination from medical assistance or general assistance medical care. The applicant
must provide all required verifications within 30 days of the written request for
verification. For retroactive coverage, premiums must be paid in full for any retroactive
month, current month, and next month within 30 days of the premium billing.

Sec. 36.

Minnesota Statutes 2006, section 256L.07, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

(a) deleted text beginChildren enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.
deleted text end

deleted text begin (b)deleted text end Families enrolled in MinnesotaCare under section 256L.04, subdivision 1,
whose income increases above 275 percent of the federal poverty guidelines, are no
longer eligible for the program and shall be disenrolled by the commissioner. Individuals
enrolled in MinnesotaCare under section 256L.04, subdivision 7, whose income increases
above deleted text begin175deleted text endnew text begin 200new text end percent of the federal poverty guidelines new text beginor 215 percent of the federal
poverty guidelines on or after July 1, 2009,
new text endare no longer eligible for the program and
shall be disenrolled by the commissioner. For persons disenrolled under this subdivision,
MinnesotaCare coverage terminates the last day of the calendar month following the
month in which the commissioner determines that the income of a family or individual
exceeds program income limits.

deleted text begin (c)deleted text endnew text begin (b) new text end Notwithstanding paragraph deleted text begin(b)deleted text endnew text begin (a)new text end, children may remain enrolled in
MinnesotaCare if ten percent of their gross individual or gross family income as defined
in section 256L.01, subdivision 4, is less than the new text beginannual new text endpremium for a deleted text beginsix-monthdeleted text end
policy with a $500 deductible available through the Minnesota Comprehensive Health
Association. Children who are no longer eligible for MinnesotaCare under this clause shall
be given a 12-month notice period from the date that ineligibility is determined before
disenrollment. The premium for children remaining eligible under this clause shall be the
maximum premium determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (d) Notwithstanding paragraphs (b) and (c), parents are not eligible for
MinnesotaCare if gross household income exceeds $25,000 for the six-month period
of eligibility.
deleted text end

Sec. 37.

Minnesota Statutes 2006, section 256L.07, subdivision 2, is amended to read:


Subd. 2.

Must not have access to employer-subsidized coverage.

(a) To be
eligible, deleted text begina family or individualdeleted text endnew text begin an adultnew text end must not have access to subsidized health coverage
through an employer and must not have had access to employer-subsidized coverage
through a current employer for 18 months prior to application or reapplication. deleted text beginA family
or individual
deleted text endnew text begin An adultnew text end whose employer-subsidized coverage is lost due to an employer
terminating health care coverage as an employee benefit during the previous 18 months
is not eligible.

(b) This subdivision does not apply to deleted text begina family or individualdeleted text endnew text begin an adultnew text end who was
enrolled in MinnesotaCare within six months or less of reapplication and who no longer
has employer-subsidized coverage due to the employer terminating health care coverage
as an employee benefit.

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
deleted text begin Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent.
deleted text end The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

new text begin (d) Notwithstanding paragraph (c), if an employer-subsidized health plan requires
the employee to pay more than eight percent of the employee's family gross income in
co-payments, deductibles, or coinsurance, the health coverage offered shall not constitute
employer-subsidized coverage for purposes of determining eligibility for MinnesotaCare.
new text end

new text begin (e) This subdivision does not apply to children.
new text end

Sec. 38.

Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:


Subd. 3.

Other health coverage.

(a) deleted text beginFamilies and individualsdeleted text end new text beginAdults new text endenrolled in the
MinnesotaCare program must have no health coverage while enrolled or for at least four
months prior to application and renewal. deleted text beginChildren enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:
deleted text end

deleted text begin (1) lacks two or more of the following:
deleted text end

deleted text begin (i) basic hospital insurance;
deleted text end

deleted text begin (ii) medical-surgical insurance;
deleted text end

deleted text begin (iii) prescription drug coverage;
deleted text end

deleted text begin (iv) dental coverage; or
deleted text end

deleted text begin (v) vision coverage;
deleted text end

deleted text begin (2) requires a deductible of $100 or more per person per year; or
deleted text end

deleted text begin (3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.
deleted text end

The commissioner may change this eligibility criterion for sliding scale premiums in
order to remain within the limits of available appropriations. deleted text beginThe requirement of no health
coverage
deleted text endnew text begin This paragraphnew text end does not apply to deleted text beginnewbornsdeleted text endnew text begin childrennew text end.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.

(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

Sec. 39.

Minnesota Statutes 2006, section 256L.07, subdivision 6, is amended to read:


Subd. 6.

Exception for certain adults.

Single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, are eligible without meeting
the requirements of this section until deleted text beginsix-monthdeleted text end renewal.

Sec. 40.

Minnesota Statutes 2006, section 256L.09, subdivision 4, is amended to read:


Subd. 4.

Eligibility as Minnesota resident.

(a) For purposes of this section, a
permanent Minnesota resident is a person who has demonstrated, through persuasive and
objective evidence, that the person is domiciled in the state and intends to live in the
state permanently.

(b) To be eligible as a permanent resident, an applicant must demonstrate the
requisite intent to live in the state permanently by:

(1) showing that the applicant maintains a residence at a verified address deleted text beginother than a
place of public accommodation
deleted text end, through the use of evidence of residence described in
section 256D.02, subdivision 12a, new text beginparagraph (b), new text endclause deleted text begin(1)deleted text endnew text begin (2)new text end;

(2) demonstrating that the applicant has been continuously domiciled in the state for
no less than 180 days immediately before the application; and

(3) signing an affidavit declaring that (A) the applicant currently resides in the state
and intends to reside in the state permanently; and (B) the applicant did not come to the
state for the primary purpose of obtaining medical coverage or treatment.

(c) A person who is temporarily absent from the state does not lose eligibility for
MinnesotaCare. "Temporarily absent from the state" means the person is out of the state
for a temporary purpose and intends to return when the purpose of the absence has been
accomplished. A person is not temporarily absent from the state if another state has
determined that the person is a resident for any purpose. If temporarily absent from the
state, the person must follow the requirements of the health plan in which the person is
enrolled to receive services.

Sec. 41.

Minnesota Statutes 2006, section 256L.15, subdivision 1, is amended to read:


Subdivision 1.

Premium determination.

(a) Families with children and individuals
shall pay a premium determined according to subdivision 2.

(b) Pregnant women and children under age two are exempt from the provisions
of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
for failure to pay premiums. For pregnant women, this exemption continues until the
first day of the month following the 60th day postpartum. Women who remain enrolled
during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
disenrolled on the first of the month following the 60th day postpartum for the penalty
period that otherwise applies under section 256L.06, unless they begin paying premiums.

new text begin (c) Members of the military and their families who meet the eligibility criteria
for MinnesotaCare upon eligibility approval made within 24 months following the end
of the member's tour of active duty shall have their premiums paid by the commissioner.
The effective date of coverage for an individual or family who meets the criteria of this
paragraph shall be the first day of the month following the month in which eligibility is
approved. This exemption shall apply for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007, or upon federal
approval, whichever is later.
new text end

Sec. 42.

Minnesota Statutes 2006, section 256L.15, subdivision 2, is amended to read:


Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay
to obtain coverage through the MinnesotaCare program. The sliding fee scale must be
based on the enrollee's monthly gross individual or family income. The sliding fee scale
must contain separate tables based on enrollment of one, two, or three or more persons.
The sliding fee scale begins with a premium of 1.5 percent of monthly gross individual or
family income for individuals or families with incomes below the limits for the medical
assistance program for families and children in effect on January 1, 1999, and proceeds
through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 percent.
These percentages are matched to evenly spaced income steps ranging from the medical
assistance income limit for families and children in effect on January 1, 1999, to 275
percent of the federal poverty guidelines for the applicable family size, up to a family size
of five. The sliding fee scale for a family of five must be used for families of more than
five. deleted text beginEffective October 1, 2003, the commissioner shall increase each percentage by 0.5
percentage points for enrollees with income greater than 100 percent but not exceeding
200 percent of the federal poverty guidelines and shall increase each percentage by 1.0
percentage points for families and children with incomes greater than 200 percent of
the federal poverty guidelines.
deleted text end The sliding fee scale and percentages are not subject to
the provisions of chapter 14. If a family or individual reports increased income after
enrollment, premiums shall be adjusted at the time the change in income is reported.

(b) deleted text beginChildren indeleted text end Families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

deleted text begin (c) After calculating the percentage of premium each enrollee shall pay under
paragraph (a), eight percent shall be added to the premium.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 43.

Minnesota Statutes 2006, section 256L.15, subdivision 4, is amended to read:


Subd. 4.

Exception for transitioned adults.

County agencies shall pay premiums
for single adults and households with no children formerly enrolled in general assistance
medical care and enrolled in MinnesotaCare according to section 256D.03, subdivision 3,
deleted text begin until six-month renewaldeleted text endnew text begin for six monthsnew text end. The county agency has the option of continuing to
pay premiums for these enrollees past the first deleted text beginsix-monthdeleted text end new text beginsix months until the 12-month
new text endrenewal period.

Sec. 44.

Minnesota Statutes 2006, section 256L.17, subdivision 2, is amended to read:


Subd. 2.

Limit on total assets.

(a) Effective July 1, 2002, or upon federal approval,
whichever is later, in order to be eligible for the MinnesotaCare program, a household of
two or more persons must not own more than $20,000 in total net assets, and a household
of one person must not own more than $10,000 in total net assets.

(b) For purposes of this subdivision, assets are determined according to section
256B.056, subdivision 3cnew text begin, except that workers' compensation settlements received due to
a work-related injury shall not be considered
new text end.

(c) State-funded MinnesotaCare is not available for applicants or enrollees who are
otherwise eligible for medical assistance but fail to verify assets. Enrollees who become
eligible for federally funded medical assistance shall be terminated from state-funded
MinnesotaCare and transferred to medical assistance.

Sec. 45.

Minnesota Statutes 2006, section 256L.17, subdivision 3, is amended to read:


Subd. 3.

Documentation.

(a) The commissioner of human services shall require
individuals and families, at the time of application or renewal, to indicate on a checkoff
form developed by the commissioner whether they satisfy the MinnesotaCare asset
requirement. deleted text beginThis form must include the following or similar language: "To be eligible for
MinnesotaCare, individuals and families must not own net assets in excess of $30,000
for a household of two or more persons or $15,000 for a household of one person, not
including a homestead, household goods and personal effects, assets owned by children,
vehicles used for employment, court-ordered settlements up to $10,000, individual
retirement accounts, and capital and operating assets of a trade or business up to $200,000.
Do you and your household own net assets in excess of these limits?"
deleted text end

(b) The commissioner may require individuals and families to provide any
information the commissioner determines necessary to verify compliance with the asset
requirement, if the commissioner determines that there is reason to believe that an
individual or family has assets that exceed the program limit.

Sec. 46.

Minnesota Statutes 2006, section 256L.17, subdivision 7, is amended to read:


Subd. 7.

Exception for certain adults.

Single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, are exempt from the
requirements of this section until deleted text beginsix-monthdeleted text end renewal.

Sec. 47.

new text begin [256L.20] MINNESOTACARE OPTION FOR SMALL EMPLOYERS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms
have the meanings given them.
new text end

new text begin (b) "Dependent" means an unmarried child who is under the age of 21 and who is
not eligible for employer-subsidized health coverage.
new text end

new text begin (c) "Eligible employee" means an employee who works at least 20 hours per week
for an eligible employer. Eligible employee does not include an employee who works
on a temporary or substitute basis or who does not work more than 26 weeks annually.
Coverage of an eligible employee includes the employee's spouse if the spouse does not
have access to employer-subsidized health coverage.
new text end

new text begin (d) "Eligible employer" means a business that employs at least two, but not more
than 50, eligible employees, the majority of whom are employed in the state, and includes
a municipality that has 50 or fewer employees.
new text end

new text begin (e) "Employer-subsidized health coverage" has the meaning given under section
256L.07, subdivision 2, paragraph (c).
new text end

new text begin (f) "Maximum premium" has the meaning given under section 256L.15, subdivision
2, paragraph (b), except that the cost of medical coverage for single adults and households
without children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare in accordance with section 256D.03, subdivision 3, paragraph (c), are
excluded from the total cost when determining the maximum premium.
new text end

new text begin (g) "Participating employer" means an eligible employer who meets the requirements
in subdivision 3 and applies to the commissioner to enroll its eligible employees and their
dependents in the MinnesotaCare program.
new text end

new text begin (h) "Program" means the MinnesotaCare program.
new text end

new text begin Subd. 2. new text end

new text begin Application and renewal procedures. new text end

new text begin (a) Eligible employees and their
dependents may enroll in MinnesotaCare through their employer if their employer meets
the requirements of subdivision 3. The commissioner shall establish procedures for an
eligible employer to participate in the program. The commissioner shall provide an
employer with applications for each eligible employee. The employee must fill out the
application and submit it to the employer. The employer must submit the completed
applications to the commissioner. The commissioner shall determine eligibility for the
program and determine the premiums owed by the employer for each eligible employee.
The commissioner may require eligible employees to provide income verification to
determine premiums.
new text end

new text begin (b) The effective date of coverage is in accordance with section 256L.05, subdivision
3.
new text end

new text begin (c) An employer's eligibility must be renewed every 12 months. At that time, all
eligible employees enrolled in the program regardless of their enrollment date must
reapply.
new text end

new text begin (d) A participating employer must inform the commissioner of any changes in its
employees and premiums must be adjusted accordingly beginning the first day of the
month following the month in which the change is reported. An employer's premiums
shall not be adjusted due to a change in an employee's income until the next renewal
period. Eligible employees hired after enrollment must fill out an application and submit
the application to the commissioner. Employees who terminate their employment with
the participating employer shall remain enrolled in the program until the last day of the
month in which employment is terminated. A terminating employee may remain in the
MinnesotaCare program if the employee meets the eligibility requirements of enrollment
described in sections 256L.01 to 256L.18.
new text end

new text begin Subd. 3. new text end

new text begin Employer requirements. new text end

new text begin In order to participate, an eligible employer
must meet the following requirements:
new text end

new text begin (1) agree to contribute toward the cost of the premium for the employee, the
employee's spouse, and the employee's dependents according to subdivision 4;
new text end

new text begin (2) certify that each eligible employee was informed of the availability of coverage
through the program and that at least 75 percent of its eligible employees are planning to
or are enrolled in the program; and
new text end

new text begin (3) have not provided employer-subsidized health coverage as an employee benefit
during the previous 12 months, as defined in section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 4. new text end

new text begin Premiums. new text end

new text begin (a) The premium for coverage provided under this section is
equal to the maximum premium as defined in subdivision 1 regardless of the income
of the eligible employee.
new text end

new text begin (b) For eligible employees without dependents with a gross family income equal to
or less than 200 percent of the federal poverty guidelines or 215 percent of the federal
poverty guidelines on or after July 1, 2009, and for eligible employees with dependents
whose gross family income is equal to or less than 275 percent of the federal poverty
guidelines, the participating employer shall pay 50 percent of the premium established
under paragraph (a) for the eligible employee, the employee's spouse, and any dependents,
if applicable.
new text end

new text begin (c) For eligible employees without dependents with a gross family income over 200
percent of the federal poverty guidelines or 215 percent of the federal poverty guidelines
on or after July 1, 2009, and for eligible employees with dependents with a gross family
income over 275 percent of the federal poverty guidelines, the participating employer shall
pay the full cost of the premium established under paragraph (a) for the eligible employee,
the employee's spouse, and any dependents, if applicable. The participating employer may
require the employee to pay a portion of the cost of the premium so long as the employer
pays at least 50 percent. If the employer requires the employee to pay a portion of the
premium, the employee shall pay the portion of the cost to the employer.
new text end

new text begin (d) The commissioner shall collect premium payments from participating employers
for eligible employees, spouses, and dependents who are covered by the program as
provided under this section. All premiums collected shall be deposited in the health care
access fund.
new text end

new text begin (e) Nonpayment of premiums by a participating employer will result in the
disenrollment of all eligible employees, spouses, and dependents from the program
effective the end of the month in which the premium was due.
new text end

new text begin Subd. 5. new text end

new text begin Coverage. new text end

new text begin The coverage offered to those enrolled in the program under
this section shall include all health services described under section 256L.03 and all
co-payments and coinsurance requirements under section 256L.03 shall apply.
new text end

new text begin Subd. 6. new text end

new text begin Enrollment. new text end

new text begin For purposes of enrollment under this section, income
eligibility limits established under sections 256L.04 and 256L.07, asset limits established
under section 256L.17, and the barriers established under section 256L.07, subdivision 2
or 3, do not apply to applicants eligible for this program unless specified in this section.
The residency requirement under section 256L.09 shall apply.
new text end

new text begin Subd. 7. new text end

new text begin Outreach. new text end

new text begin The commissioner shall provide information on the availability
of this buy-in option for small employers and application forms to entities that provide
insurance information to small employers, including, but not limited to, insurance agents
and chambers of commerce. The commissioner shall establish an assistance fee of $25 per
enrolled employee for such entities that assist eligible employers and their employees in
applying to the program.
new text end

Sec. 48.

Laws 2005, First Special Session chapter 4, article 9, section 3, subdivision 2,
is amended to read:


Subd. 2.

Community and Family Health
Improvement

Summary by Fund
General
40,413,000
40,382,000
State Government
Special Revenue
141,000
128,000
Health Care Access
3,510,000
3,516,000
Federal TANF
6,000,000
6,000,000

deleted text begin FAMILY PLANNING BASE
REDUCTION.
Base level funding for
the family planning special projects grant
program is reduced by $1,877,000 each
year of the biennium beginning July 1,
2007, provided that this reduction shall
only take place upon full implementation of
the family planning project section of the
1115 waiver. Notwithstanding Minnesota
Statutes, section deleted text begin145.925deleted text end, the commissioner
shall give priority to community health care
clinics providing family planning services
that either serve a high number of women
who do not qualify for medical assistance
or are unable to participate in the medical
assistance program as a medical assistance
provider when allocating the remaining
appropriations. Notwithstanding section 15,
this paragraph shall not expire.
deleted text end

SHAKEN BABY VIDEO. Of the
state government special revenue fund
appropriation, $13,000 in 2006 is
appropriated to the commissioner of health
to provide a video to hospitals on shaken
baby syndrome. The commissioner of health
shall assess a fee to hospitals to cover the
cost of the approved shaken baby video and
the revenue received is to be deposited in the
state government special revenue fund.

Sec. 49. new text beginADMINISTRATIVE SIMPLIFICATION.
new text end

new text begin All health care providers and health plans that contract with the state of Minnesota
to provide health care services either through the health care programs administered
under Minnesota Statutes, chapters 256B, 256D, and 256L, or through the state employee
group insurance program administered under Minnesota Statutes, chapter 43A, must
use and accept the uniform billing forms and coding requirements established by the
Administrative Uniformity Committee by January 1, 2009.
new text end

Sec. 50. new text beginAPPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the health care access fund to the commissioner of
human services for the biennium beginning July 1, 2007, for the purpose of Minnesota
health care programs outreach grants and the enrollment incentive programs under
Minnesota Statutes, section 256.962.
new text end

new text begin (b) $1,156,000 is appropriated each fiscal year beginning July 1, 2007, from the
general fund to the commissioner of health for family planning grants under Minnesota
Statutes, section 145.925.
new text end

new text begin (c) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of human services for the critical access dental providers
reimbursement rates under Minnesota Statutes, section 256B.76, paragraph (c).
new text end

new text begin (d) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of health for the subsidies for federally qualified health centers
under Minnesota Statutes, section 145.9269.
new text end

new text begin (e) $....... is appropriated for the biennium beginning July 1, 2007, from the general
fund to the commissioner of human services for the patient incentive health program
established in Minnesota Statutes, section 256.01, subdivision 2b, paragraph (b).
new text end

Sec. 51. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, sections 62A.301; 256B.0631; and 256L.035, new text end new text begin are repealed.
new text end