Minnesota Legislature
SF 3486
as introduced - 91st Legislature (2019 - 2020) Posted on 06/02/2020 10:33am
Current Version - as introduced
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A bill for an act
relating to health care; waiving cost-sharing for medical assistance enrollees who
do not use tobacco products; creating a tobacco use premium surcharge in the
MinnesotaCare program; amending Minnesota Statutes 2018, sections 256B.0631,
subdivision 1, by adding a subdivision; 256L.15, subdivision 1, by adding a
subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided on or after September 1, 2011:
(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service 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 assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometristnew text begin . Co-payments must not apply to visits
that involve tobacco cessation treatments or servicesnew text end ;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription and $1 per generic drug prescription, subject
to a $12 per month maximum for prescription drug co-payments. deleted text begin Nodeleted text end Co-payments deleted text begin shalldeleted text end new text begin
must notnew text end apply to antipsychotic drugs when used for the treatment of mental illnessnew text begin or to
drugs used for tobacco cessationnew text end ;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
Sec. 2.
Minnesota Statutes 2018, section 256B.0631, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Tobacco abstinence cost-sharing exception. new text end
new text begin
The cost-sharing and deductibles
described in section 256B.0631, subdivision 1, must be waived for non-tobacco users, and
must only apply to tobacco users. For purposes of this subdivision, a tobacco user is defined
as an individual who uses, four or more times per week within the past six months, any
tobacco product. Tobacco products include cigarettes, cigars, pipe tobacco, chewing tobacco,
or snuff. Tobacco products do not include the use of tobacco by an American Indian who
meets the requirements in Code of Federal Regulations, title 42, sections 447.51 and 447.56,
as part of a traditional Native American spiritual or cultural ceremony.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2020, or upon federal approval,
whichever is later.
new text end
Sec. 3.
Minnesota Statutes 2018, section 256L.15, subdivision 1, is amended to read:
Subdivision 1.
Premium determination for MinnesotaCare.
(a) Families with children
and individuals shall pay a premium determined according to subdivision 2.
(b) 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 applies for 12 months.
(c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and their
families shall have their premiums waived by the commissioner in accordance with section
5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. An
individual must indicate status as an American Indian, as defined under Code of Federal
Regulations, title 42, section 447.50, to qualify for the waiver of premiums. The
commissioner shall accept attestation of an individual's status as an American Indian as
verification until the United States Department of Health and Human Services approves an
electronic data source for this purpose.
deleted text begin
(d) For premiums effective August 1, 2015, and after, the commissioner, after consulting
with the chairs and ranking minority members of the legislative committees with jurisdiction
over human services, shall increase premiums under subdivision 2 for recipients based on
June 2015 program enrollment. Premium increases shall be sufficient to increase projected
revenue to the fund described in section 16A.724 by at least $27,800,000 for the biennium
ending June 30, 2017. The commissioner shall publish the revised premium scale on the
Department of Human Services website and in the State Register no later than June 15,
2015. The revised premium scale applies to all premiums on or after August 1, 2015, in
place of the scale under subdivision 2.
deleted text end
deleted text begin
(e) By July 1, 2015, the commissioner shall provide the chairs and ranking minority
members of the legislative committees with jurisdiction over human services the revised
premium scale effective August 1, 2015, and statutory language to codify the revised
premium schedule.
deleted text end
deleted text begin
(f) Premium changes authorized under paragraph (d) must only apply to enrollees not
otherwise excluded from paying premiums under state or federal law. Premium changes
authorized under paragraph (d) must satisfy the requirements for premiums for the Basic
Health Program under title 42 of Code of Federal Regulations, section 600.505.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2018, section 256L.15, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Tobacco use premium surcharge. new text end
new text begin
(a) An enrollee who uses tobacco products
must pay a tobacco premium surcharge in an amount that is equal to ten percent of the
enrollee's monthly premium. The tobacco use premium surcharge must be calculated on a
monthly basis and paid in accordance with section 256L.06. Nonpayment of the surcharge
may result in disenrollment.
new text end
new text begin
(b) For enrollees who initially enroll in the MinnesotaCare program after July 1, 2020,
the tobacco use premium surcharge in paragraph (a) must be waived for the initial 12-month
period of enrollment and must go into effect upon renewal. For enrollees who are enrolled
in the MinnesotaCare program on July 1, 2020, the tobacco use premium surcharge must
be waived until July 1, 2021, and must go into effect at the enrollee's next renewal.
new text end
new text begin
(c) If an enrollee indicates on the initial application or at renewal that the enrollee does
not use tobacco and it is determined that the enrollee is or was a tobacco user during the
period of enrollment and did not pay the tobacco use premium surcharge, the enrollee must
pay the total amount of the tobacco use premium surcharge that the enrollee was required
to pay as a tobacco user during that enrollment period. If the enrollee fails to pay the
surcharge amount due, the enrollee may be disenrolled and the unpaid amount may be
subject to recovery by the commissioner.
new text end
new text begin
(d) Notwithstanding paragraph (b), nonpayment of the surcharge amount owed by the
enrollee under paragraph (a) or (c) must result in disenrollment effective for the calendar
month following the month for which the surcharge was due. Disenrollment for nonpayment
of the surcharge must meet the requirements in section 256L.06, subdivision 3, paragraphs
(d) and (e).
new text end
new text begin
(e) For purposes of this subdivision, the use of tobacco products means the use of a
tobacco product four or more times per week within the past six months. Tobacco products
include the use of cigarettes, cigars, pipe tobacco, chewing tobacco, or snuff.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2020, or upon federal approval,
whichever is later.
new text end
Sec. 5. new text begin WAIVER REQUEST.
new text end
new text begin
The commissioner of human services must submit any federal waivers and approvals
necessary to implement this act. The commissioner must inform the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance when the waiver request is submitted with a copy of the submitted
waiver. The commissioner must also inform the chairs and ranking minority members of
any federal action regarding this request.
new text end