SF 695

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; increasing the medical assistance asset limit
and excess income standard for aged, blind, or disabled persons; modifying
a Minnesota disabilities health options program provision; modifying the
medical assistance employed persons with disabilities program; directing the
commissioner of human services to seek federal approval; amending Minnesota
Statutes 2006, sections 256B.056, subdivisions 1a, 3, 5c; 256B.69, subdivision
23.

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

Section 1.

Minnesota Statutes 2006, section 256B.056, subdivision 1a, is amended to
read:

Subd. 1a.

Income and assets generally.

Unless specifically required by state law or
rule or federal law or regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons whose eligibility category is
based on blindness, disability, or age of 65 or more years, the methodologies for the
supplemental security income program shall be used new text begin , except as provided under subdivision
3, paragraph (f) new text end . Increases in benefits under title II of the Social Security Act shall not be
counted as income for purposes of this subdivision until July 1 of each year. Effective
upon federal approval, for children eligible under section 256B.055, subdivision 12, or
for home and community-based waiver services whose eligibility for medical assistance
is determined without regard to parental income, child support payments, including any
payments made by an obligor in satisfaction of or in addition to a temporary or permanent
order for child support, and Social Security payments are not counted as income. For
families and children, which includes all other eligibility categories, the methodologies
under the state's AFDC plan in effect as of July 16, 1996, as required by the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public
Law 104-193, shall be used, except that effective October 1, 2003, the earned income
disregards and deductions are limited to those in subdivision 1c. For these purposes, a
"methodology" does not include an asset or income standard, or accounting method,
or method of determining effective dates.

Sec. 2.

Minnesota Statutes 2006, section 256B.056, subdivision 3, is amended to read:

Subd. 3.

Asset limitations for new text begin aged, blind, or disabled new text end individuals deleted text begin and families deleted text end .

To be eligible for medical assistance, a person new text begin whose eligibility is based on blindness,
disability, or age of 65 or more years new text end must not individually own more than deleted text begin $3,000 deleted text end new text begin $6,000
new text end in assets, or if a member of a household with two family members, husband and wife, or
parent and child, the household must not own more than deleted text begin $6,000 deleted text end new text begin $12,000 new text end in assets, plus
deleted text begin $200 deleted text end new text begin $400 new text end for each additional legal dependent. In addition to these maximum amounts,
an eligible individual or family may accrue interest on these amounts, but they must be
reduced to the maximum at the time of an eligibility redetermination. The accumulation
of the clothing and personal needs allowance according to section 256B.35 must also be
reduced to the maximum at the time of the eligibility redetermination. The value of assets
that are not considered in determining eligibility for medical assistance is the value of
those assets excluded under the supplemental security income program for aged, blind,
and disabled persons, with the following exceptions:

(a) Household goods and personal effects are not considered.

(b) Capital and operating assets of a trade or business that the local agency
determines are necessary to the person's ability to earn an income are not considered.

(c) Motor vehicles are excluded to the same extent excluded by the supplemental
security income program.

(d) Assets designated as burial expenses are excluded to the same extent excluded by
the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses.

(e) Effective upon federal approval, for a person who no longer qualifies as an
employed person with a disability due to loss of earnings, assets allowed while eligible
for medical assistance under section 256B.057, subdivision 9, are not considered for 12
months, beginning with the first month of ineligibility as an employed person with a
disability, to the extent that the person's total assets remain within the allowed limits of
section 256B.057, subdivision 9, paragraph (b).

new text begin (f) When a person enrolled in medical assistance under section 256B.057,
subdivision 9, reaches age 65 and has been enrolled during each of the 24 consecutive
months before the person's 65th birthday, the assets owned by the person and the person's
spouse must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph
(b), when determining eligibility for medical assistance under section 256B.055,
subdivision 7. The income of a spouse of a person enrolled in medical assistance under
section 256B.057, subdivision 9, during each of the 24 consecutive months before the
person's 65th birthday must be disregarded when determining eligibility for medical
assistance under section 256B.055, subdivision 7, when the person reaches age 65. This
paragraph does not apply at the time the person or the person's spouse requests medical
assistance payment for long-term care services.
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. 3.

Minnesota Statutes 2006, section 256B.056, subdivision 5c, is amended to read:

Subd. 5c.

Excess income standard.

(a) The excess income standard for families
with children is the standard specified in subdivision 4.

(b) The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
family size. Effective July 1, 2002, the excess income standard for this paragraph shall
equal 75 percent of the federal poverty guidelines. new text begin Effective July 1, 2007, the excess
income standard for this paragraph shall equal 85 percent of the federal poverty guidelines.
The excess income standard for this paragraph shall be increased by five percentage points
on July 1 of each of the next three years, so that the excess income standard shall equal
100 percent of the federal poverty guidelines effective July 1, 2010.
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. 4.

Minnesota Statutes 2006, section 256B.69, subdivision 23, is amended to read:

Subd. 23.

Alternative services; elderly and disabled persons.

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

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

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

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

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

(f) The commissioner shall seek federal approval to expand the Minnesota disability
health options (MnDHO) program established under this subdivision in stages, first to
regional population centers outside the seven-county metro area and then to all areas
of the state. Until deleted text begin January 1, 2008 deleted text end new text begin July 1, 2009 new text end , expansion for MnDHO projects that
include home and community-based services is limited to the two projects and service
areas in effect on March 1, 2006. Enrollment in integrated MnDHO programs that
include home and community-based services shall remain voluntary. Costs for home
and community-based services included under MnDHO must not exceed costs that
would have been incurred under the fee-for-service program. In developing program
specifications for expansion of integrated programs, the commissioner shall involve and
consult the state-level stakeholder group established in subdivision 28, paragraph (d),
including consultation on whether and how to include home and community-based waiver
programs. Plans for further expansion of MnDHO projects shall be presented to the chairs
of the house and senate committees with jurisdiction over health and human services
policy and finance by February 1, 2007.

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

Sec. 5. new text begin COMMISSIONER REQUIRED TO SEEK FEDERAL APPROVAL.
new text end

new text begin By October 1, 2007, the commissioner shall seek federal approval to allow persons
who have been eligible for medical assistance for employed persons with disabilities
(MA-EPD) under Minnesota Statutes, section 256B.057, subdivision 9, for each of the 24
consecutive months prior to becoming age 65 to continue using the MA-EPD eligibility
rules as long as they qualify.
new text end