2nd Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am
|Introduction||Posted on 02/12/2002|
|1st Engrossment||Posted on 03/04/2002|
|2nd Engrossment||Posted on 03/08/2002|
1.1 A bill for an act 1.2 relating to human services; making technical changes 1.3 in health care programs; amending Minnesota Statutes 1.4 2000, sections 13.05, subdivision 4; 245.4932, 1.5 subdivision 3; 253B.045, subdivision 2; 256.01, 1.6 subdivision 11; 256.023; 256.9685, subdivision 1; 1.7 256.9866; 256B.041, subdivision 5; 256B.0575; 1.8 256B.0625, subdivision 27; 256B.0629, subdivision 2; 1.9 256B.0915, subdivision 1c; 256B.0945, subdivision 4; 1.10 256B.19, subdivisions 1, 1d, 2b; 256B.37, subdivision 1.11 5a; 256B.692, subdivision 3; 256F.10, subdivision 9; 1.12 256F.13, subdivision 1; 256L.05, subdivision 3; 1.13 256L.07, subdivision 3; Minnesota Statutes 2001 1.14 Supplement, sections 245.474, subdivision 4; 1.15 256B.0623, subdivision 14; 256B.0625, subdivisions 13, 1.16 20; 256B.0915, subdivision 3; 256B.0924, subdivision 1.17 6; 256B.19, subdivision 1c; 256L.06, subdivision 3; 1.18 Laws 2001, First Special Session chapter 9, article 2, 1.19 section 76; repealing Minnesota Statutes 2000, 1.20 sections 256.025; 256B.0635, subdivision 3; 256B.19, 1.21 subdivision 1a; 256B.77, subdivision 24. 1.22 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.23 Section 1. Minnesota Statutes 2000, section 13.05, 1.24 subdivision 4, is amended to read: 1.25 Subd. 4. [LIMITATIONS ON COLLECTION AND USE OF DATA.] 1.26 Private or confidential data on an individual shall not be 1.27 collected, stored, used, or disseminated by political 1.28 subdivisions, statewide systems, or state agencies for any 1.29 purposes other than those stated to the individual at the time 1.30 of collection in accordance with section 13.04, except as 1.31 provided in this subdivision. 1.32 (a) Data collected prior to August 1, 1975, and which have 1.33 not been treated as public data, may be used, stored, and 2.1 disseminated for the purposes for which the data was originally 2.2 collected or for purposes which are specifically approved by the 2.3 commissioner as necessary to public health, safety, or welfare. 2.4 (b) Private or confidential data may be used and 2.5 disseminated to individuals or agencies specifically authorized 2.6 access to that data by state, local, or federal law enacted or 2.7 promulgated after the collection of the data. 2.8 (c) Private or confidential data may be used and 2.9 disseminated to individuals or agencies subsequent to the 2.10 collection of the data when the responsible authority 2.11 maintaining the data has requested approval for a new or 2.12 different use or dissemination of the data and that request has 2.13 been specifically approved by the commissioner as necessary to 2.14 carry out a function assigned by law. 2.15 (d) Private data may be used by and disseminated to any 2.16 person or agency if the individual subject or subjects of the 2.17 data have given their informed consent. Whether a data subject 2.18 has given informed consent shall be determined by rules of the 2.19 commissioner. The format for informed consent is as follows, 2.20 unless otherwise prescribed by the HIPAA, Standards for Privacy 2.21 of Individually Identifiable Health Information, 65 Fed. Reg. 2.22 82, 461 (2000) (to be codified as Code of Federal Regulations, 2.23 title 45, section 164): informed consent shall not be deemed to 2.24 have been given by an individual subject of the data by the 2.25 signing of any statement authorizing any person or agency to 2.26 disclose information about the individual to an insurer or its 2.27 authorized representative, unless the statement is: 2.28 (1) in plain language; 2.29 (2) dated; 2.30 (3) specific in designating the particular persons or 2.31 agencies the data subject is authorizing to disclose information 2.32 about the data subject; 2.33 (4) specific as to the nature of the information the 2.34 subject is authorizing to be disclosed; 2.35 (5) specific as to the persons or agencies to whom the 2.36 subject is authorizing information to be disclosed; 3.1 (6) specific as to the purpose or purposes for which the 3.2 information may be used by any of the parties named in clause 3.3 (5), both at the time of the disclosure and at any time in the 3.4 future; 3.5 (7) specific as to its expiration date which should be 3.6 within a reasonable period of time, not to exceed one year 3.7 except in the case of authorizations given in connection with 3.8 applications for life insurance or noncancelable or guaranteed 3.9 renewable health insurance and identified as such, two years 3.10 after the date of the policy. 3.11 The responsible authority may require a person requesting 3.12 copies of data under this paragraph to pay the actual costs of 3.13 making, certifying, and compiling the copies. 3.14 (e) Private or confidential data on an individual may be 3.15 discussed at a meeting open to the public to the extent provided 3.16 in section 13D.05. 3.17 Sec. 2. Minnesota Statutes 2001 Supplement, section 3.18 245.474, subdivision 4, is amended to read: 3.19 Subd. 4. [STAFF SAFETY TRAINING.] The commissioner 3.20 shall
by rulerequire all staff in mental health and support 3.21 units at regional treatment centers who have contact with 3.22 persons with mental illness or severe emotional disturbance to 3.23 be appropriately trained in violence reduction and violence 3.24 prevention and shall establish criteria for such training. 3.25 Training programs shall be developed with input from consumer 3.26 advocacy organizations and shall employ violence prevention 3.27 techniques as preferable to physical interaction. 3.28 Sec. 3. Minnesota Statutes 2000, section 245.4932, 3.29 subdivision 3, is amended to read: 3.30 Subd. 3. [PAYMENTS.] Notwithstanding section 256.025,3.31 subdivision 2,Payments under sections 245.493 to 245.496 to 3.32 providers for services for which the collaborative elects to pay 3.33 the nonfederal share of medical assistance shall only be made of 3.34 federal earnings from services provided under sections 245.493 3.35 to 245.496. 3.36 Sec. 4. Minnesota Statutes 2000, section 253B.045, 4.1 subdivision 2, is amended to read: 4.2 Subd. 2. [FACILITIES.] Each county or a group of counties 4.3 shall maintain or provide by contract a facility for confinement 4.4 of persons held temporarily for observation, evaluation, 4.5 diagnosis, treatment, and care. When the temporary confinement 4.6 is provided at a regional center, the commissioner shall charge 4.7 the county of financial responsibility for the costs of 4.8 confinement of persons hospitalized under section 253B.05, 4.9 subdivisions 1 and 2, and section 253B.07, subdivision 2b, 4.10 except that the commissioner shall bill the responsible prepaid4.11 plan for medically necessary hospitalizations for individuals4.12 enrolled in a prepaid plan under contract to provide medical4.13 assistance, general assistance medical care, or MinnesotaCare4.14 services. If the prepaid plan determines under the terms of the4.15 medical assistance, general assistance medical care, or4.16 MinnesotaCare contract that a hospitalization was not medically4.17 necessaryhealth plan first. If the person has health plan 4.18 coverage, but the hospitalization does not meet the criteria in 4.19 subdivision 6 or section 62M.07, 62Q.53, or 62Q.535, the county 4.20 is responsible. "County of financial responsibility" means the 4.21 county in which the person resides at the time of confinement 4.22 or, if the person has no residence in this state, the county 4.23 which initiated the confinement. The charge shall be based on 4.24 the commissioner's determination of the cost of care pursuant to 4.25 section 246.50, subdivision 5. When there is a dispute as to 4.26 which county is the county of financial responsibility, the 4.27 county charged for the costs of confinement shall pay for them 4.28 pending final determination of the dispute over financial 4.29 responsibility. Disputes about the county of financial 4.30 responsibility shall be submitted to the commissioner to be 4.31 settled in the manner prescribed in section 256G.09. 4.32 Sec. 5. Minnesota Statutes 2000, section 256.01, 4.33 subdivision 11, is amended to read: 4.34 Subd. 11. [CENTRALIZED DISBURSEMENT SYSTEM.] The state 4.35 agency may establish a system for the centralized disbursement 4.36 of food coupons, assistance payments, and related documents. 5.1 Benefits shall be issued by the state or county and funded under5.2 this section according to section 256.025, subdivision 3, and5.3 subject to section 256.017. 5.4 Sec. 6. Minnesota Statutes 2000, section 256.023, is 5.5 amended to read: 5.6 256.023 [ONE HUNDRED PERCENT COUNTY ASSISTANCE.] 5.7 The commissioner of human services may maintain client 5.8 records and issue public assistance benefits that are over state 5.9 and federal standards or that are not required by state or 5.10 federal law, providing the cost of benefits is paid by the 5.11 counties to the department of human services. Payment methods5.12 for this section shall be according to section 256.025,5.13 subdivision 3.5.14 Sec. 7. Minnesota Statutes 2000, section 256.9685, 5.15 subdivision 1, is amended to read: 5.16 Subdivision 1. [AUTHORITY.] (a) The commissioner shall 5.17 establish procedures for determining medical assistance and 5.18 general assistance medical care payment rates under a 5.19 prospective payment system for inpatient hospital services in 5.20 hospitals that qualify as vendors of medical assistance. The 5.21 commissioner shall establish, by rule, procedures for 5.22 implementing this section and sections 256.9686, 256.969, and 5.23 256.9695. Services must meet the requirements of section 5.24 256B.04, subdivision 15, or 256D.03, subdivision 7, paragraph 5.25 (b), to be eligible for payment. 5.26 (b) The commissioner may reduce the types of inpatient 5.27 hospital admissions that are required to be certified as 5.28 medically necessary after notice in the State Register and a 5.29 30-day comment period. 5.30 Sec. 8. Minnesota Statutes 2000, section 256.9866, is 5.31 amended to read: 5.32 256.9866 [COMMUNITY SERVICE AS A COUNTY OBLIGATION.] 5.33 Community service shall be an acceptable sentencing option 5.34 but shall not reduce the state or federal share of any amount to 5.35 be repaid or any subsequent recovery. Any reduction or offset 5.36 of any such amount ordered by a court shall be treated as 6.1 follows: 6.2 (1) any reduction in an overpayment amount, to include the 6.3 amount ordered as restitution, shall not reduce the underlying 6.4 amount established as an overpayment by the state or county 6.5 agency; 6.6 (2) total overpayments shall continue as a debt owed and 6.7 may be recovered by any civil or administrative means otherwise 6.8 available to the state or county agency; and 6.9 (3) any amount ordered to be offset against any overpayment 6.10 shall be deducted from the county share only of any recovery and 6.11 shall be based on the prevailing state minimum wage. To the6.12 extent that any deduction is in fact made against any state or6.13 county share, it shall be reimbursed from the county share of6.14 payments to be made under section 256.025.6.15 Sec. 9. Minnesota Statutes 2000, section 256B.041, 6.16 subdivision 5, is amended to read: 6.17 Subd. 5. [PAYMENT BY COUNTY TO STATE TREASURER.] If 6.18 required by federal law or rules promulgated thereunder, or by 6.19 authorized rule of the state agency, each county shall pay to 6.20 the state treasurer the portion of medical assistance paid by 6.21 the state for which it is responsible. The county's share of6.22 cost shall be ten percent of that portion not met by federal6.23 funds.6.24 The county shall advance ten percent of that portion of6.25 medical assistance costs not met by federal funds, based upon 6.26 estimates submitted by the state agency to the county agency, 6.27 stating the estimated expenditures for the succeeding month. 6.28 Upon the direction of the county agency, payment shall be made 6.29 monthly by the county to the state for the estimated 6.30 expenditures for each month. Adjustment of any overestimate or 6.31 underestimate based on actual expenditures shall be made by the 6.32 state agency by adjusting the estimate for any succeeding month. 6.33 Beginning July 1, 1991, the state will reimburse counties6.34 according to the payment schedule in section 256.025 for the6.35 county share of local agency expenditures under this subdivision6.36 from January 1, 1991, on.Payment to counties under this 7.1 subdivision is subject to the provisions of section 256.017. 7.2 Sec. 10. Minnesota Statutes 2000, section 256B.0575, is 7.3 amended to read: 7.4 256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 7.5 PERSONS.] 7.6 When an institutionalized person is determined eligible for 7.7 medical assistance, the income that exceeds the deductions in 7.8 paragraphs (a) and (b) must be applied to the cost of 7.9 institutional care. 7.10 (a) The following amounts must be deducted from the 7.11 institutionalized person's income in the following order: 7.12 (1) the personal needs allowance under section 256B.35 or, 7.13 for a veteran who does not have a spouse or child, or a 7.14 surviving spouse of a veteran having no child, the amount of an 7.15 improved pension received from the veteran's administration not 7.16 exceeding $90 per month; 7.17 (2) the personal allowance for disabled individuals under 7.18 section 256B.36; 7.19 (3) if the institutionalized person has a legally appointed 7.20 guardian or conservator, five percent of the recipient's gross 7.21 monthly income up to $100 as reimbursement for guardianship or 7.22 conservatorship services; 7.23 (4) a monthly income allowance determined under section 7.24 256B.058, subdivision 2, but only to the extent income of the 7.25 institutionalized spouse is made available to the community 7.26 spouse; 7.27 (5) a monthly allowance for children under age 18 which, 7.28 together with the net income of the children, would provide 7.29 income equal to the medical assistance standard for families and 7.30 children according to section 256B.056, subdivision 4, for a 7.31 family size that includes only the minor children. This 7.32 deduction applies only if the children do not live with the 7.33 community spouse and only to the extent that the deduction is 7.34 not included in the personal needs allowance under section 7.35 256B.35, subdivision 1, as child support garnished under a court 7.36 order; 8.1 (6) a monthly family allowance for other family members, 8.2 equal to one-third of the difference between 122 percent of the 8.3 federal poverty guidelines and the monthly income for that 8.4 family member; 8.5 (7) reparations payments made by the Federal Republic of 8.6 Germany and reparations payments made by the Netherlands for 8.7 victims of Nazi persecution between 1940 and 1945; 8.8 (8) all other exclusions from income for institutionalized 8.9 persons as mandated by federal law; and 8.10 (9) amounts for reasonable expenses incurred for necessary 8.11 medical or remedial care for the institutionalized spouseperson 8.12 that are not medical assistance covered expenses and that are 8.13 not subject to payment by a third party. 8.14 For purposes of clause (6), "other family member" means a 8.15 person who resides with the community spouse and who is a minor 8.16 or dependent child, dependent parent, or dependent sibling of 8.17 either spouse. "Dependent" means a person who could be claimed 8.18 as a dependent for federal income tax purposes under the 8.19 Internal Revenue Code. 8.20 (b) Income shall be allocated to an institutionalized 8.21 person for a period of up to three calendar months, in an amount 8.22 equal to the medical assistance standard for a family size of 8.23 one if: 8.24 (1) a physician certifies that the person is expected to 8.25 reside in the long-term care facility for three calendar months 8.26 or less; 8.27 (2) if the person has expenses of maintaining a residence 8.28 in the community; and 8.29 (3) if one of the following circumstances apply: 8.30 (i) the person was not living together with a spouse or a 8.31 family member as defined in paragraph (a) when the person 8.32 entered a long-term care facility; or 8.33 (ii) the person and the person's spouse become 8.34 institutionalized on the same date, in which case the allocation 8.35 shall be applied to the income of one of the spouses. 8.36 For purposes of this paragraph, a person is determined to be 9.1 residing in a licensed nursing home, regional treatment center, 9.2 or medical institution if the person is expected to remain for a 9.3 period of one full calendar month or more. 9.4 Sec. 11. Minnesota Statutes 2001 Supplement, section 9.5 256B.0623, subdivision 14, is amended to read: 9.6 Subd. 14. [BILLING WHEN SERVICES ARE PROVIDED BY QUALIFIED 9.7 STATE STAFF.] When rehabilitative services are provided by 9.8 qualified state staff who are assigned to pilot projects under 9.9 section 245.4661, the county or other local entity to which the 9.10 qualified state staff are assigned may consider these staff part 9.11 of the local provider entity for which certification is sought 9.12 under this section and may bill the medical assistance program 9.13 for qualifying services provided by the qualified state 9.14 staff. Notwithstanding section 256.025, subdivision 2,Payments 9.15 for services provided by state staff who are assigned to adult 9.16 mental health initiatives shall only be made from federal funds. 9.17 Sec. 12. Minnesota Statutes 2001 Supplement, section 9.18 256B.0625, subdivision 13, is amended to read: 9.19 Subd. 13. [DRUGS.] (a) Medical assistance covers drugs, 9.20 except for fertility drugs when specifically used to enhance 9.21 fertility, if prescribed by a licensed practitioner and 9.22 dispensed by a licensed pharmacist, by a physician enrolled in 9.23 the medical assistance program as a dispensing physician, or by 9.24 a physician or a nurse practitioner employed by or under 9.25 contract with a community health board as defined in section 9.26 145A.02, subdivision 5, for the purposes of communicable disease 9.27 control. The commissioner, after receiving recommendations from 9.28 professional medical associations and professional pharmacist 9.29 associations, shall designate a formulary committee to advise 9.30 the commissioner on the names of drugs for which payment is 9.31 made, recommend a system for reimbursing providers on a set fee 9.32 or charge basis rather than the present system, and develop 9.33 methods encouraging use of generic drugs when they are less 9.34 expensive and equally effective as trademark drugs. The 9.35 formulary committee shall consist of nine members, four of whom 9.36 shall be physicians who are not employed by the department of 10.1 human services, and a majority of whose practice is for persons 10.2 paying privately or through health insurance, three of whom 10.3 shall be pharmacists who are not employed by the department of 10.4 human services, and a majority of whose practice is for persons 10.5 paying privately or through health insurance, a consumer 10.6 representative, and a nursing home representative. Committee 10.7 members shall serve three-year terms and shall serve without 10.8 compensation. Members may be reappointed once. 10.9 (b) The commissioner shall establish a drug formulary. Its 10.10 establishment and publication shall not be subject to the 10.11 requirements of the Administrative Procedure Act, but the 10.12 formulary committee shall review and comment on the formulary 10.13 contents. The formulary committee shall review and recommend 10.14 drugs which require prior authorization. The formulary 10.15 committee may recommend drugs for prior authorization directly 10.16 to the commissioner, as long as opportunity for public input is 10.17 provided. Prior authorization may be requested by the 10.18 commissioner based on medical and clinical criteria before 10.19 certain drugs are eligible for payment. Before a drug may be 10.20 considered for prior authorization at the request of the 10.21 commissioner: 10.22 (1) the drug formulary committee must develop criteria to 10.23 be used for identifying drugs; the development of these criteria 10.24 is not subject to the requirements of chapter 14, but the 10.25 formulary committee shall provide opportunity for public input 10.26 in developing criteria; 10.27 (2) the drug formulary committee must hold a public forum 10.28 and receive public comment for an additional 15 days; and 10.29 (3) the commissioner must provide information to the 10.30 formulary committee on the impact that placing the drug on prior 10.31 authorization will have on the quality of patient care and 10.32 information regarding whether the drug is subject to clinical 10.33 abuse or misuse. Prior authorization may be required by the 10.34 commissioner before certain formulary drugs are eligible for 10.35 payment. The formulary shall not include: 10.36 (i) drugs or products for which there is no federal 11.1 funding; 11.2 (ii) over-the-counter drugs, except for antacids, 11.3 acetaminophen, family planning products, aspirin, insulin, 11.4 products for the treatment of lice, vitamins for adults with 11.5 documented vitamin deficiencies, vitamins for children under the 11.6 age of seven and pregnant or nursing women, and any other 11.7 over-the-counter drug identified by the commissioner, in 11.8 consultation with the drug formulary committee, as necessary, 11.9 appropriate, and cost-effective for the treatment of certain 11.10 specified chronic diseases, conditions or disorders, and this 11.11 determination shall not be subject to the requirements of 11.12 chapter 14; 11.13 (iii) anorectics, except that medically necessary 11.14 anorectics shall be covered for a recipient previously diagnosed 11.15 as having pickwickian syndrome and currently diagnosed as having 11.16 diabetes and being morbidly obese; 11.17 (iv) drugs for which medical value has not been 11.18 established; and 11.19 (v) drugs from manufacturers who have not signed a rebate 11.20 agreement with the Department of Health and Human Services 11.21 pursuant to section 1927 of title XIX of the Social Security Act. 11.22 The commissioner shall publish conditions for prohibiting 11.23 payment for specific drugs after considering the formulary 11.24 committee's recommendations. An honorarium of $100 per meeting 11.25 and reimbursement for mileage shall be paid to each committee 11.26 member in attendance. 11.27 (c) The basis for determining the amount of payment shall 11.28 be the lower of the actual acquisition costs of the drugs plus a 11.29 fixed dispensing fee; the maximum allowable cost set by the 11.30 federal government or by the commissioner plus the fixed 11.31 dispensing fee; or the usual and customary price charged to the 11.32 public. The amount of payment basis must be reduced to reflect 11.33 all discount amounts applied to the charge by any 11.34 provider/insurer agreement or contract for submitted charges to 11.35 medical assistance programs. The net submitted charge may not 11.36 be greater than the patient liability for the service. The 12.1 pharmacy dispensing fee shall be $3.65, except that the 12.2 dispensing fee for intravenous solutions which must be 12.3 compounded by the pharmacist shall be $8 per bag, $14 per bag 12.4 for cancer chemotherapy products, and $30 per bag for total 12.5 parenteral nutritional products dispensed in one liter 12.6 quantities, or $44 per bag for total parenteral nutritional 12.7 products dispensed in quantities greater than one liter. Actual 12.8 acquisition cost includes quantity and other special discounts 12.9 except time and cash discounts. The actual acquisition cost of 12.10 a drug shall be estimated by the commissioner, at average 12.11 wholesale price minus nine percent, except that where a drug has 12.12 had its wholesale price reduced as a result of the actions of 12.13 the National Association of Medicaid Fraud Control Units, the 12.14 estimated actual acquisition cost shall be the reduced average 12.15 wholesale price, without the nine percent deduction. The 12.16 maximum allowable cost of a multisource drug may be set by the 12.17 commissioner and it shall be comparable to, but no higher than, 12.18 the maximum amount paid by other third-party payors in this 12.19 state who have maximum allowable cost programs. The 12.20 commissioner shall set maximum allowable costs for multisource 12.21 drugs that are not on the federal upper limit list as described 12.22 in United States Code, title 42, chapter 7, section 1396r-8(e), 12.23 the Social Security Act, and Code of Federal Regulations, title 12.24 42, part 447, section 447.332. Establishment of the amount of 12.25 payment for drugs shall not be subject to the requirements of 12.26 the Administrative Procedure Act. An additional dispensing fee 12.27 of $.30 may be added to the dispensing fee paid to pharmacists 12.28 for legend drug prescriptions dispensed to residents of 12.29 long-term care facilities when a unit dose blister card system, 12.30 approved by the department, is used. Under this type of 12.31 dispensing system, the pharmacist must dispense a 30-day supply 12.32 of drug. The National Drug Code (NDC) from the drug container 12.33 used to fill the blister card must be identified on the claim to 12.34 the department. The unit dose blister card containing the drug 12.35 must meet the packaging standards set forth in Minnesota Rules, 12.36 part 6800.2700, that govern the return of unused drugs to the 13.1 pharmacy for reuse. The pharmacy provider will be required to 13.2 credit the department for the actual acquisition cost of all 13.3 unused drugs that are eligible for reuse. Over-the-counter 13.4 medications must be dispensed in the manufacturer's unopened 13.5 package. The commissioner may permit the drug clozapine to be 13.6 dispensed in a quantity that is less than a 30-day supply. 13.7 Whenever a generically equivalent product is available, payment 13.8 shall be on the basis of the actual acquisition cost of the 13.9 generic drug, unless the prescriber specifically indicates 13.10 "dispense as written - brand necessary" on the prescription as 13.11 required by section 151.21, subdivision 2. 13.12 (d) For purposes of this subdivision, "multisource drugs" 13.13 means covered outpatient drugs, excluding innovator multisource 13.14 drugs for which there are two or more drug products, which: 13.15 (1) are related as therapeutically equivalent under the 13.16 Food and Drug Administration's most recent publication of 13.17 "Approved Drug Products with Therapeutic Equivalence 13.18 Evaluations"; 13.19 (2) are pharmaceutically equivalent and bioequivalent as 13.20 determined by the Food and Drug Administration; and 13.21 (3) are sold or marketed in Minnesota. 13.22 "Innovator multisource drug" means a multisource drug that was 13.23 originally marketed under an original new drug application 13.24 approved by the Food and Drug Administration. 13.25 (e) The basis for determining the amount of payment for 13.26 drugs administered in an outpatient setting shall be the lower 13.27 of the usual and customary cost submitted by the provider; the 13.28 average wholesale price minus five percent; or the maximum 13.29 allowable cost set by the federal government under United States 13.30 Code, title 42, chapter 7, section 1396r-8(e), and Code of 13.31 Federal Regulations, title 42, section 447.332, or by the 13.32 commissioner under paragraph (c). 13.33 Sec. 13. Minnesota Statutes 2001 Supplement, section 13.34 256B.0625, subdivision 20, is amended to read: 13.35 Subd. 20. [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 13.36 extent authorized by rule of the state agency, medical 14.1 assistance covers case management services to persons with 14.2 serious and persistent mental illness and children with severe 14.3 emotional disturbance. Services provided under this section 14.4 must meet the relevant standards in sections 245.461 to 14.5 245.4888, the Comprehensive Adult and Children's Mental Health 14.6 Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 14.7 9505.0322, excluding subpart 10. 14.8 (b) Entities meeting program standards set out in rules 14.9 governing family community support services as defined in 14.10 section 245.4871, subdivision 17, are eligible for medical 14.11 assistance reimbursement for case management services for 14.12 children with severe emotional disturbance when these services 14.13 meet the program standards in Minnesota Rules, parts 9520.0900 14.14 to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 14.15 (c) Medical assistance and MinnesotaCare payment for mental 14.16 health case management shall be made on a monthly basis. In 14.17 order to receive payment for an eligible child, the provider 14.18 must document at least a face-to-face contact with the child, 14.19 the child's parents, or the child's legal representative. To 14.20 receive payment for an eligible adult, the provider must 14.21 document: 14.22 (1) at least a face-to-face contact with the adult or the 14.23 adult's legal representative; or 14.24 (2) at least a telephone contact with the adult or the 14.25 adult's legal representative and document a face-to-face contact 14.26 with the adult or the adult's legal representative within the 14.27 preceding two months. 14.28 (d) Payment for mental health case management provided by 14.29 county or state staff shall be based on the monthly rate 14.30 methodology under section 256B.094, subdivision 6, paragraph 14.31 (b), with separate rates calculated for child welfare and mental 14.32 health, and within mental health, separate rates for children 14.33 and adults. 14.34 (e) Payment for mental health case management provided by 14.35 Indian health services or by agencies operated by Indian tribes 14.36 may be made according to this section or other relevant 15.1 federally approved rate setting methodology. 15.2 (f) Payment for mental health case management provided by 15.3 vendors who contract with a county or Indian tribe shall be 15.4 based on a monthly rate negotiated by the host county or tribe. 15.5 The negotiated rate must not exceed the rate charged by the 15.6 vendor for the same service to other payers. If the service is 15.7 provided by a team of contracted vendors, the county or tribe 15.8 may negotiate a team rate with a vendor who is a member of the 15.9 team. The team shall determine how to distribute the rate among 15.10 its members. No reimbursement received by contracted vendors 15.11 shall be returned to the county or tribe, except to reimburse 15.12 the county or tribe for advance funding provided by the county 15.13 or tribe to the vendor. 15.14 (g) If the service is provided by a team which includes 15.15 contracted vendors, tribal staff, and county or state staff, the 15.16 costs for county or state staff participation in the team shall 15.17 be included in the rate for county-provided services. In this 15.18 case, the contracted vendor, the tribal agency, and the county 15.19 may each receive separate payment for services provided by each 15.20 entity in the same month. In order to prevent duplication of 15.21 services, each entity must document, in the recipient's file, 15.22 the need for team case management and a description of the roles 15.23 of the team members. 15.24 (h) The commissioner shall calculate the nonfederal share 15.25 of actual medical assistance and general assistance medical care 15.26 payments for each county, based on the higher of calendar year 15.27 1995 or 1996, by service date, project that amount forward to 15.28 1999, and transfer one-half of the result from medical 15.29 assistance and general assistance medical care to each county's 15.30 mental health grants under sections 245.4886 and 256E.12 for 15.31 calendar year 1999. The annualized minimum amount added to each 15.32 county's mental health grant shall be $3,000 per year for 15.33 children and $5,000 per year for adults. The commissioner may 15.34 reduce the statewide growth factor in order to fund these 15.35 minimums. The annualized total amount transferred shall become 15.36 part of the base for future mental health grants for each county. 16.1 (i) Any net increase in revenue to the county or tribe as a 16.2 result of the change in this section must be used to provide 16.3 expanded mental health services as defined in sections 245.461 16.4 to 245.4888, the Comprehensive Adult and Children's Mental 16.5 Health Acts, excluding inpatient and residential treatment. For 16.6 adults, increased revenue may also be used for services and 16.7 consumer supports which are part of adult mental health projects 16.8 approved under Laws 1997, chapter 203, article 7, section 25. 16.9 For children, increased revenue may also be used for respite 16.10 care and nonresidential individualized rehabilitation services 16.11 as defined in section 245.492, subdivisions 17 and 23. 16.12 "Increased revenue" has the meaning given in Minnesota Rules, 16.13 part 9520.0903, subpart 3. 16.14 (j) Notwithstanding section 256B.19, subdivision 1, the 16.15 nonfederal share of costs for mental health case management 16.16 shall be provided by the recipient's county of responsibility, 16.17 as defined in sections 256G.01 to 256G.12, from sources other 16.18 than federal funds or funds used to match other federal funds. 16.19 If the service is provided by a tribal agency, the nonfederal 16.20 share, if any, shall be provided by the recipient's tribe. 16.21 (k) The commissioner may suspend, reduce, or terminate the 16.22 reimbursement to a provider that does not meet the reporting or 16.23 other requirements of this section. The county of 16.24 responsibility, as defined in sections 256G.01 to 256G.12, or, 16.25 if applicable, the tribal agency, is responsible for any federal 16.26 disallowances. The county or tribe may share this 16.27 responsibility with its contracted vendors. 16.28 (l) The commissioner shall set aside a portion of the 16.29 federal funds earned under this section to repay the special 16.30 revenue maximization account under section 256.01, subdivision 16.31 2, clause (15). The repayment is limited to: 16.32 (1) the costs of developing and implementing this section; 16.33 and 16.34 (2) programming the information systems. 16.35 (m) Notwithstanding section 256.025, subdivision 2,16.36 Payments to counties and tribal agencies for case management 17.1 expenditures under this section shall only be made from federal 17.2 earnings from services provided under this section. Payments to 17.3 county-contracted vendors shall include both the federal 17.4 earnings and the county share. 17.5 (n) Notwithstanding section 256B.041, county payments for 17.6 the cost of mental health case management services provided by 17.7 county or state staff shall not be made to the state treasurer. 17.8 For the purposes of mental health case management services 17.9 provided by county or state staff under this section, the 17.10 centralized disbursement of payments to counties under section 17.11 256B.041 consists only of federal earnings from services 17.12 provided under this section. 17.13 (o) Case management services under this subdivision do not 17.14 include therapy, treatment, legal, or outreach services. 17.15 (p) If the recipient is a resident of a nursing facility, 17.16 intermediate care facility, or hospital, and the recipient's 17.17 institutional care is paid by medical assistance, payment for 17.18 case management services under this subdivision is limited to 17.19 the last 180 days of the recipient's residency in that facility 17.20 and may not exceed more than six months in a calendar year. 17.21 (q) Payment for case management services under this 17.22 subdivision shall not duplicate payments made under other 17.23 program authorities for the same purpose. 17.24 (r) By July 1, 2000, the commissioner shall evaluate the 17.25 effectiveness of the changes required by this section, including 17.26 changes in number of persons receiving mental health case 17.27 management, changes in hours of service per person, and changes 17.28 in caseload size. 17.29 (s) For each calendar year beginning with the calendar year 17.30 2001, the annualized amount of state funds for each county 17.31 determined under paragraph (h) shall be adjusted by the county's 17.32 percentage change in the average number of clients per month who 17.33 received case management under this section during the fiscal 17.34 year that ended six months prior to the calendar year in 17.35 question, in comparison to the prior fiscal year. 17.36 (t) For counties receiving the minimum allocation of $3,000 18.1 or $5,000 described in paragraph (h), the adjustment in 18.2 paragraph (s) shall be determined so that the county receives 18.3 the higher of the following amounts: 18.4 (1) a continuation of the minimum allocation in paragraph 18.5 (h); or 18.6 (2) an amount based on that county's average number of 18.7 clients per month who received case management under this 18.8 section during the fiscal year that ended six months prior to 18.9 the calendar year in question, times the average statewide grant 18.10 per person per month for counties not receiving the minimum 18.11 allocation. 18.12 (u) The adjustments in paragraphs (s) and (t) shall be 18.13 calculated separately for children and adults. 18.14 Sec. 14. Minnesota Statutes 2000, section 256B.0625, 18.15 subdivision 27, is amended to read: 18.16 Subd. 27. [ORGAN AND TISSUE TRANSPLANTS.] Medical 18.17 assistance coverage for organ and tissue transplant procedures 18.18 is limited to those procedures covered by the Medicare program ;18.19 heart-lung transplants for persons with primary pulmonary18.20 hypertension andor approved by the Advisory Committee on Organ 18.21 and Tissue Transplants. All organ transplants must be performed 18.22 at Minnesotatransplant centers meeting united network for organ 18.23 sharing criteria to perform heart-lung transplants; lung18.24 transplants using cadaveric donors and performed at Minnesota18.25 transplant centers meeting united network for organ sharing18.26 criteria to perform lung transplants; pancreas transplants for18.27 uremic diabetic recipients of kidney transplants and performed18.28 at Minnesota facilities meeting united network for organ sharing18.29 criteria to perform pancreas transplants; and allogenic bone18.30 marrow transplants for persons with stage III or IV Hodgkin's18.31 diseaseor at Medicare-approved organ transplant centers. Stem 18.32 cell or bone marrow transplant centers must meet the standards 18.33 established by the Foundation for the Accreditation of 18.34 Hematopoietic Cell Therapy or be approved by the Advisory 18.35 Committee on Organ and Tissue Transplants. Transplant 18.36 procedures must comply with all applicable laws, rules, and 19.1 regulations governing (1) coverage by the Medicare program, (2) 19.2 federal financial participation by the Medicaid program, and (3) 19.3 coverage by the Minnesota medical assistance 19.4 program. Transplant centers must meet american society of19.5 hematology and clinical oncology criteria for bone marrow19.6 transplants and be located in Minnesota to receive reimbursement19.7 for bone marrowTransplants performed out of Minnesota or the 19.8 local trade area must be prior authorized. 19.9 Sec. 15. Minnesota Statutes 2000, section 256B.0629, 19.10 subdivision 2, is amended to read: 19.11 Subd. 2. [FUNCTION AND OBJECTIVES.] The advisory committee19.12 shall meet at least twice a year.The committee's activities 19.13 include, but are not limited to: 19.14 (1) collection of information on the efficacy and 19.15 experience of various forms of transplantation not approved by 19.16 Medicare; 19.17 (2) collection of information from Minnesota transplant 19.18 providers on available services, success rates, and the current 19.19 status of transplant activity in the state; 19.20 (3) development of guidelines for determining when and 19.21 under what conditions organ and tissue transplants not approved 19.22 by Medicare should be eligible for reimbursement by medical 19.23 assistance and general assistance medical care; 19.24 (4) providing recommendations , at least annually,to the 19.25 commissioner on: (i) organ and tissue transplant procedures, 19.26 beyond those approved by Medicare, that should also be eligible 19.27 for reimbursement under medical assistance and general 19.28 assistance medical care; and (ii) which transplant centers 19.29 should be eligible for reimbursement from medical assistance and 19.30 general assistance medical care. 19.31 Sec. 16. Minnesota Statutes 2000, section 256B.0915, 19.32 subdivision 1c, is amended to read: 19.33 Subd. 1c. [CASE MANAGEMENT ACTIVITIES UNDER THE STATE 19.34 PLAN.] The commissioner shall seek an amendment to the home and 19.35 community-based services waiver for the elderly to implement the 19.36 provisions of subdivisions 1a and 1b. If the commissioner is 20.1 unable to secure the approval of the secretary of health and 20.2 human services for the requested waiver amendment by December 20.3 31, 1993, the commissioner shall amend the medical assistance 20.4 state plan to provide that case management provided under the 20.5 home and community-based services waiver for the elderly is 20.6 performed by counties as an administrative function for the 20.7 proper and effective administration of the state medical 20.8 assistance plan. Notwithstanding section 256.025, subdivision20.9 3,The state shall reimburse counties for the nonfederal share 20.10 of costs for case management performed as an administrative 20.11 function under the home and community-based services waiver for 20.12 the elderly. 20.13 Sec. 17. Minnesota Statutes 2001 Supplement, section 20.14 256B.0915, subdivision 3, is amended to read: 20.15 Subd. 3. [LIMITS OF CASES, RATES, PAYMENTS, AND 20.16 FORECASTING.] (a) The number of medical assistance waiver 20.17 recipients that a county may serve must be allocated according 20.18 to the number of medical assistance waiver cases open on July 1 20.19 of each fiscal year. Additional recipients may be served with 20.20 the approval of the commissioner. 20.21 (b) The monthly limit for the cost of waivered services to 20.22 an individual elderly waiver client shall be the weighted 20.23 average monthly nursing facility rate of the case mix resident 20.24 class to which the elderly waiver client would be assigned under 20.25 Minnesota Rules, parts 9549.0050 to 9549.0059, less the 20.26 recipient's maintenance needs allowance as described in 20.27 subdivision 1d, paragraph (a), until the first day of the state 20.28 fiscal year in which the resident assessment system as described 20.29 in section 256B.437 for nursing home rate determination is 20.30 implemented. Effective on the first day of the state fiscal 20.31 year in which the resident assessment system as described in 20.32 section 256B.437 for nursing home rate determination is 20.33 implemented and the first day of each subsequent state fiscal 20.34 year, the monthly limit for the cost of waivered services to an 20.35 individual elderly waiver client shall be the rate of the case 20.36 mix resident class to which the waiver client would be assigned 21.1 under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect 21.2 on the last day of the previous state fiscal year, adjusted by 21.3 the greater of any legislatively adopted home and 21.4 community-based services cost-of-living percentage increase or 21.5 any legislatively adopted statewide percent rate increase for 21.6 nursing facilities. 21.7 (c) If extended medical supplies and equipment or 21.8 environmental modifications are or will be purchased for an 21.9 elderly waiver client, the costs may be prorated for up to 12 21.10 consecutive months beginning with the month of purchase. If the 21.11 monthly cost of a recipient's waivered services exceeds the 21.12 monthly limit established in paragraph (b), the annual cost of 21.13 all waivered services shall be determined. In this event, the 21.14 annual cost of all waivered services shall not exceed 12 times 21.15 the monthly limit of waivered services as described in paragraph 21.16 (b). 21.17 (d) For a person who is a nursing facility resident at the 21.18 time of requesting a determination of eligibility for elderly 21.19 waivered services, a monthly conversion limit for the cost of 21.20 elderly waivered services may be requested. The monthly 21.21 conversion limit for the cost of elderly waiver services shall 21.22 be the resident class assigned under Minnesota Rules, parts 21.23 9549.0050 to 9549.0059, for that resident in the nursing 21.24 facility where the resident currently resides until July 1 of 21.25 the state fiscal year in which the resident assessment system as 21.26 described in section 256B.437 for nursing home rate 21.27 determination is implemented. Effective on July 1 of the state 21.28 fiscal year in which the resident assessment system as described 21.29 in section 256B.437 for nursing home rate determination is 21.30 implemented, the monthly conversion limit for the cost of 21.31 elderly waiver services shall be the per diem nursing facility 21.32 rate as determined by the resident assessment system as 21.33 described in section 256B.437 for that resident in the nursing 21.34 facility where the resident currently resides multiplied by 365 21.35 and divided by 12, less the recipient's maintenance needs 21.36 allowance as described in subdivision 1d. The limit under this 22.1 clause only applies to persons discharged from a nursing 22.2 facility after a minimum 30-day stay and found eligible for 22.3 waivered services on or after July 1, 1997. The following costs 22.4 must be included in determining the total monthly costs for the 22.5 waiver client: 22.6 (1) cost of all waivered services, including extended 22.7 medical supplies and equipment and environmental modifications; 22.8 and 22.9 (2) cost of skilled nursing, home health aide, and personal 22.10 care services reimbursable by medical assistance. 22.11 (e) Medical assistance funding for skilled nursing 22.12 services, private duty nursing, home health aide, and personal 22.13 care services for waiver recipients must be approved by the case 22.14 manager and included in the individual care plan. 22.15 (f) A county is not required to contract with a provider of 22.16 supplies and equipment if the monthly cost of the supplies and 22.17 equipment is less than $250. 22.18 (g) The adult foster care rate shall be considered a 22.19 difficulty of care payment and shall not include room and 22.20 board. The adult foster care service rate shall be negotiated 22.21 between the county agency and the foster care provider. The 22.22 elderly waiver payment for the foster care service in 22.23 combination with the payment for all other elderly waiver 22.24 services, including case management, must not exceed the limit 22.25 specified in paragraph (b). 22.26 (h) Payment for assisted living service shall be a monthly 22.27 rate negotiated and authorized by the county agency based on an 22.28 individualized service plan for each resident and may not cover 22.29 direct rent or food costs. 22.30 (1) The individualized monthly negotiated payment for 22.31 assisted living services as described in section 256B.0913, 22.32 subdivision 5, paragraph (g) or (h), and residential care 22.33 services as described in section 256B.0913, subdivision 5, 22.34 paragraph (f), shall not exceed the nonfederal share, in effect 22.35 on July 1 of the state fiscal year for which the rate limit is 22.36 being calculated, of the greater of either the statewide or any 23.1 of the geographic groups' weighted average monthly nursing 23.2 facility rate of the case mix resident class to which the 23.3 elderly waiver eligible client would be assigned under Minnesota 23.4 Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 23.5 allowance as described in subdivision 1d, paragraph (a), until 23.6 the July 1 of the state fiscal year in which the resident 23.7 assessment system as described in section 256B.437 for nursing 23.8 home rate determination is implemented. Effective on July 1 of 23.9 the state fiscal year in which the resident assessment system as 23.10 described in section 256B.437 for nursing home rate 23.11 determination is implemented and July 1 of each subsequent state 23.12 fiscal year, the individualized monthly negotiated payment for 23.13 the services described in this clause shall not exceed the limit 23.14 described in this clause which was in effect on June 30 of the 23.15 previous state fiscal year and which has been adjusted by the 23.16 greater of any legislatively adopted home and community-based 23.17 services cost-of-living percentage increase or any legislatively 23.18 adopted statewide percent rate increase for nursing facilities. 23.19 (2) The individualized monthly negotiated payment for 23.20 assisted living services described in section 144A.4605 and 23.21 delivered by a provider licensed by the department of health as 23.22 a class A home care provider or an assisted living home care 23.23 provider and provided in a building that is registered as a 23.24 housing with services establishment under chapter 144D and that 23.25 provides 24-hour supervision in combination with the payment for 23.26 other elderly waiver services, including case management, must 23.27 not exceed the limit specified in paragraph (b). 23.28 (i) The county shall negotiate individual service rates 23.29 with vendors and may authorize payment for actual costs up to 23.30 the county's current approved rate. Persons or agencies must be 23.31 employed by or under a contract with the county agency or the 23.32 public health nursing agency of the local board of health in 23.33 order to receive funding under the elderly waiver program, 23.34 except as a provider of supplies and equipment when the monthly 23.35 cost of the supplies and equipment is less than $250. 23.36 (j) Reimbursement for the medical assistance recipients 24.1 under the approved waiver shall be made from the medical 24.2 assistance account through the invoice processing procedures of 24.3 the department's Medicaid Management Information System (MMIS), 24.4 only with the approval of the client's case manager. The budget 24.5 for the state share of the Medicaid expenditures shall be 24.6 forecasted with the medical assistance budget, and shall be 24.7 consistent with the approved waiver. 24.8 (k) To improve access to community services and eliminate 24.9 payment disparities between the alternative care program and the 24.10 elderly waiver, the commissioner shall establish statewide 24.11 maximum service rate limits and eliminate county-specific 24.12 service rate limits. 24.13 (1) Effective July 1, 2001, for service rate limits, except 24.14 those described or defined in paragraphs (g) and (h), the rate 24.15 limit for each service shall be the greater of the alternative 24.16 care statewide maximum rate or the elderly waiver statewide 24.17 maximum rate. 24.18 (2) Counties may negotiate individual service rates with 24.19 vendors for actual costs up to the statewide maximum service 24.20 rate limit. 24.21 (l) Beginning July 1, 1991, the state shall reimburse24.22 counties according to the payment schedule in section 256.02524.23 for the county share of costs incurred under this subdivision on24.24 or after January 1, 1991, for individuals who are receiving24.25 medical assistance.24.26 Sec. 18. Minnesota Statutes 2001 Supplement, section 24.27 256B.0924, subdivision 6, is amended to read: 24.28 Subd. 6. [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a) 24.29 Medical assistance and MinnesotaCare payment for targeted case 24.30 management shall be made on a monthly basis. In order to 24.31 receive payment for an eligible adult, the provider must 24.32 document at least one contact per month and not more than two 24.33 consecutive months without a face-to-face contact with the adult 24.34 or the adult's legal representative. 24.35 (b) Payment for targeted case management provided by county 24.36 staff under this subdivision shall be based on the monthly rate 25.1 methodology under section 256B.094, subdivision 6, paragraph 25.2 (b), calculated as one combined average rate together with adult 25.3 mental health case management under section 256B.0625, 25.4 subdivision 20, except for calendar year 2002. In calendar year 25.5 2002, the rate for case management under this section shall be 25.6 the same as the rate for adult mental health case management in 25.7 effect as of December 31, 2001. Billing and payment must 25.8 identify the recipient's primary population group to allow 25.9 tracking of revenues. 25.10 (c) Payment for targeted case management provided by 25.11 county-contracted vendors shall be based on a monthly rate 25.12 negotiated by the host county. The negotiated rate must not 25.13 exceed the rate charged by the vendor for the same service to 25.14 other payers. If the service is provided by a team of 25.15 contracted vendors, the county may negotiate a team rate with a 25.16 vendor who is a member of the team. The team shall determine 25.17 how to distribute the rate among its members. No reimbursement 25.18 received by contracted vendors shall be returned to the county, 25.19 except to reimburse the county for advance funding provided by 25.20 the county to the vendor. 25.21 (d) If the service is provided by a team that includes 25.22 contracted vendors and county staff, the costs for county staff 25.23 participation on the team shall be included in the rate for 25.24 county-provided services. In this case, the contracted vendor 25.25 and the county may each receive separate payment for services 25.26 provided by each entity in the same month. In order to prevent 25.27 duplication of services, the county must document, in the 25.28 recipient's file, the need for team targeted case management and 25.29 a description of the different roles of the team members. 25.30 (e) Notwithstanding section 256B.19, subdivision 1, the 25.31 nonfederal share of costs for targeted case management shall be 25.32 provided by the recipient's county of responsibility, as defined 25.33 in sections 256G.01 to 256G.12, from sources other than federal 25.34 funds or funds used to match other federal funds. 25.35 (f) The commissioner may suspend, reduce, or terminate 25.36 reimbursement to a provider that does not meet the reporting or 26.1 other requirements of this section. The county of 26.2 responsibility, as defined in sections 256G.01 to 256G.12, is 26.3 responsible for any federal disallowances. The county may share 26.4 this responsibility with its contracted vendors. 26.5 (g) The commissioner shall set aside five percent of the 26.6 federal funds received under this section for use in reimbursing 26.7 the state for costs of developing and implementing this section. 26.8 (h) Notwithstanding section 256.025, subdivision 2,26.9 Payments to counties for targeted case management expenditures 26.10 under this section shall only be made from federal earnings from 26.11 services provided under this section. Payments to contracted 26.12 vendors shall include both the federal earnings and the county 26.13 share. 26.14 (i) Notwithstanding section 256B.041, county payments for 26.15 the cost of case management services provided by county staff 26.16 shall not be made to the state treasurer. For the purposes of 26.17 targeted case management services provided by county staff under 26.18 this section, the centralized disbursement of payments to 26.19 counties under section 256B.041 consists only of federal 26.20 earnings from services provided under this section. 26.21 (j) If the recipient is a resident of a nursing facility, 26.22 intermediate care facility, or hospital, and the recipient's 26.23 institutional care is paid by medical assistance, payment for 26.24 targeted case management services under this subdivision is 26.25 limited to the last 180 days of the recipient's residency in 26.26 that facility and may not exceed more than six months in a 26.27 calendar year. 26.28 (k) Payment for targeted case management services under 26.29 this subdivision shall not duplicate payments made under other 26.30 program authorities for the same purpose. 26.31 (l) Any growth in targeted case management services and 26.32 cost increases under this section shall be the responsibility of 26.33 the counties. 26.34 Sec. 19. Minnesota Statutes 2000, section 256B.0945, 26.35 subdivision 4, is amended to read: 26.36 Subd. 4. [PAYMENT RATES.] (a) Notwithstanding sections 27.1 256.025, subdivision 2;256B.19 ;and 256B.041, payments to 27.2 counties for residential services provided by a residential 27.3 facility shall only be made of federal earnings for services 27.4 provided under this section, and the nonfederal share of costs 27.5 for services provided under this section shall be paid by the 27.6 county from sources other than federal funds or funds used to 27.7 match other federal funds. Payment to counties for services 27.8 provided according to subdivision 2, paragraph (a), shall be the 27.9 federal share of the contract rate. Payment to counties for 27.10 services provided according to subdivision 2, paragraph (b), 27.11 shall be a proportion of the per day contract rate that relates 27.12 to rehabilitative mental health services and shall not include 27.13 payment for costs or services that are billed to the IV-E 27.14 program as room and board. 27.15 (b) The commissioner shall set aside a portion not to 27.16 exceed five percent of the federal funds earned under this 27.17 section to cover the state costs of administering this section. 27.18 Any unexpended funds from the set-aside shall be distributed to 27.19 the counties in proportion to their earnings under this section. 27.20 Sec. 20. Minnesota Statutes 2000, section 256B.19, 27.21 subdivision 1, is amended to read: 27.22 Subdivision 1. [DIVISION OF COST.] The state and county 27.23 share of medical assistance costs not paid by federal funds 27.24 shall be as follows: 27.25 (1) ninety percent state funds and ten percent county27.26 funds, unless otherwise provided below;27.27 (2)beginning January 1, 1992, 50 percent state funds and 27.28 50 percent county funds for the cost of placement of severely 27.29 emotionally disturbed children in regional treatment centers. 27.30 For counties that participate in a Medicaid demonstration 27.31 project under sections 256B.69 and 256B.71, the division of the 27.32 nonfederal share of medical assistance expenses for payments 27.33 made to prepaid health plans or for payments made to health 27.34 maintenance organizations in the form of prepaid capitation 27.35 payments, this division of medical assistance expenses shall be 27.36 95 percent by the state and five percent by the county of 28.1 financial responsibility. 28.2 In counties where prepaid health plans are under contract 28.3 to the commissioner to provide services to medical assistance 28.4 recipients, the cost of court ordered treatment ordered without 28.5 consulting the prepaid health plan that does not include 28.6 diagnostic evaluation, recommendation, and referral for 28.7 treatment by the prepaid health plan is the responsibility of 28.8 the county of financial responsibility. 28.9 Sec. 21. Minnesota Statutes 2001 Supplement, section 28.10 256B.19, subdivision 1c, is amended to read: 28.11 Subd. 1c. [ADDITIONAL PORTION OF NONFEDERAL SHARE.] (a) 28.12 Hennepin county shall be responsible for a monthly transfer 28.13 payment of $1,500,000, due before noon on the 15th of each month 28.14 and the University of Minnesota shall be responsible for a 28.15 monthly transfer payment of $500,000 due before noon on the 15th 28.16 of each month, beginning July 15, 1995. These sums shall be 28.17 part of the designated governmental unit's portion of the 28.18 nonfederal share of medical assistance costs , but shall not be28.19 subject to payback provisions of section 256.025. 28.20 (b) Beginning July 1, 2001, Hennepin county's payment under 28.21 paragraph (a) shall be $2,066,000 each month. 28.22 (c) Beginning July 1, 2001, the commissioner shall increase 28.23 annual capitation payments to the metropolitan health plan under 28.24 section 256B.69 for the prepaid medical assistance program by 28.25 approximately $3,400,000, plus any available federal matching 28.26 funds, to recognize higher than average medical education costs. 28.27 Sec. 22. Minnesota Statutes 2000, section 256B.19, 28.28 subdivision 1d, is amended to read: 28.29 Subd. 1d. [PORTION OF NONFEDERAL SHARE TO BE PAID BY 28.30 CERTAIN COUNTIES.] In addition to the percentage contribution 28.31 paid by a county under subdivision 1, the governmental units 28.32 designated in this subdivision shall be responsible for an 28.33 additional portion of the nonfederal share of medical assistance 28.34 cost. For purposes of this subdivision, "designated 28.35 governmental unit" means the counties of Becker, Beltrami, 28.36 Clearwater, Cook, Dodge, Hubbard, Itasca, Lake, Pennington, 29.1 Pipestone, Ramsey, St. Louis, Steele, Todd, Traverse, and Wadena. 29.2 Beginning in 1994, each of the governmental units 29.3 designated in this subdivision shall transfer before noon on May 29.4 31 to the state Medicaid agency an amount equal to the number of 29.5 licensed beds in any nursing home owned and operated by the 29.6 county, with the county named as licensee, multiplied by $5,723. 29.7 If two or more counties own and operate a nursing home, the 29.8 payment shall be prorated. These sums shall be part of the 29.9 designated governmental unit's portion of the nonfederal share 29.10 of medical assistance costs , but shall not be subject to payback29.11 provisions of section 256.025. 29.12 Sec. 23. Minnesota Statutes 2000, section 256B.19, 29.13 subdivision 2b, is amended to read: 29.14 Subd. 2b. [PILOT PROJECT REIMBURSEMENT.] In counties where 29.15 a pilot or demonstration project is operated under the medical 29.16 assistance program, the state may pay 100 percent of the 29.17 administrative costs for the pilot or demonstration project 29.18 after June 30, 1990. Reimbursement for these costs is subject29.19 to section 256.025.29.20 Sec. 24. Minnesota Statutes 2000, section 256B.37, 29.21 subdivision 5a, is amended to read: 29.22 Subd. 5a. [SUPPLEMENTAL PAYMENT BY MEDICAL ASSISTANCE.] 29.23 Medical assistance payment will not be made when either covered 29.24 charges are paid in full by a third party or the provider has an 29.25 agreement to accept payment for less than charges as payment in 29.26 full. Payment for patients that are simultaneously covered by 29.27 medical assistance and a liable third party other than Medicare 29.28 will be determined as the lesser of clauses (1) to (3): 29.29 (1) the patient liability according to the provider/insurer 29.30 agreement; 29.31 (2) covered charges minus the third party payment amount; 29.32 or 29.33 (3) the medical assistance rate minus the third party 29.34 payment amount. 29.35 A negative difference will not be implemented. 29.36 All providers must reduce their submitted charge to medical 30.1 assistance programs to reflect all discount amounts applied to 30.2 the charge by any provider/insurer agreement or contract. The 30.3 net submitted charge may not be greater than the patient 30.4 liability for the service. 30.5 Sec. 25. Minnesota Statutes 2000, section 256B.692, 30.6 subdivision 3, is amended to read: 30.7 Subd. 3. [REQUIREMENTS OF THE COUNTY BOARD.] A county 30.8 board that intends to purchase or provide health care under this 30.9 section, which may include purchasing all or part of these 30.10 services from health plans or individual providers on a 30.11 fee-for-service basis, or providing these services directly, 30.12 must demonstrate the ability to follow and agree to the 30.13 following requirements: 30.14 (1) purchase all covered services for a fixed payment from 30.15 the state that does not exceed the estimated state and federal 30.16 cost that would have occurred under the prepaid medical 30.17 assistance and general assistance medical care programs; 30.18 (2) ensure that covered services are accessible to all 30.19 enrollees and that enrollees have a reasonable choice of 30.20 providers, health plans, or networks when possible. If the 30.21 county is also a provider of service, the county board shall 30.22 develop a process to ensure that providers employed by the 30.23 county are not the sole referral source and are not the sole 30.24 provider of health care services if other providers, which meet 30.25 the same quality and cost requirements are available; 30.26 (3) issue payments to participating vendors or networks in 30.27 a timely manner; 30.28 (4) establish a process to ensure and improve the quality 30.29 of care provided; 30.30 (5) provide appropriate quality and other required data in 30.31 a format required by the state; 30.32 (6) provide a system for advocacy, enrollee protection, and 30.33 complaints and appeals that is independent of care providers or 30.34 other risk bearers and complies with section 256B.69; 30.35 (7) for counties within the seven-county metropolitan area,30.36 ensure that the implementation and operation of the Minnesota 31.1 senior health options demonstration project and the Minnesota 31.2 disability health options demonstration project, authorized 31.3 under section 256B.69, subdivision 23, will not be impeded; 31.4 (8) ensure that all recipients that are enrolled in the 31.5 prepaid medical assistance or general assistance medical care 31.6 program will be transferred to county-based purchasing without 31.7 utilizing the department's fee-for-service claims payment 31.8 system; 31.9 (9) ensure that all recipients who are required to 31.10 participate in county-based purchasing are given sufficient 31.11 information prior to enrollment in order to make informed 31.12 decisions; and 31.13 (10) ensure that the state and the medical assistance and 31.14 general assistance medical care recipients will be held harmless 31.15 for the payment of obligations incurred by the county if the 31.16 county, or a health plan providing services on behalf of the 31.17 county, or a provider participating in county-based purchasing 31.18 becomes insolvent, and the state has made the payments due to 31.19 the county under this section. 31.20 Sec. 26. Minnesota Statutes 2000, section 256F.10, 31.21 subdivision 9, is amended to read: 31.22 Subd. 9. [PAYMENTS.] Notwithstanding section 256.025,31.23 subdivision 2,Payments to certified providers for child welfare 31.24 targeted case management expenditures under section 256B.094 and 31.25 this section shall only be made of federal earnings from 31.26 services provided under section 256B.094 and this section. 31.27 Payments to contracted vendors shall include both the federal 31.28 earnings and the nonfederal share. 31.29 Sec. 27. Minnesota Statutes 2000, section 256F.13, 31.30 subdivision 1, is amended to read: 31.31 Subdivision 1. [FEDERAL REVENUE ENHANCEMENT.] (a) [DUTIES 31.32 OF THE COMMISSIONER OF HUMAN SERVICES.] The commissioner of 31.33 human services may enter into an agreement with one or more 31.34 family services collaboratives to enhance federal reimbursement 31.35 under Title IV-E of the Social Security Act and federal 31.36 administrative reimbursement under Title XIX of the Social 32.1 Security Act. The commissioner may contract with the department 32.2 of children, families, and learning for purposes of transferring 32.3 the federal reimbursement to the commissioner of children, 32.4 families, and learning to be distributed to the collaboratives 32.5 according to clause (2). The commissioner shall have the 32.6 following authority and responsibilities regarding family 32.7 services collaboratives: 32.8 (1) the commissioner shall submit amendments to state plans 32.9 and seek waivers as necessary to implement the provisions of 32.10 this section; 32.11 (2) the commissioner shall pay the federal reimbursement 32.12 earned under this subdivision to each collaborative based on 32.13 their earnings. Notwithstanding section 256.025, subdivision 2,32.14 Payments to collaboratives for expenditures under this 32.15 subdivision will only be made of federal earnings from services 32.16 provided by the collaborative; 32.17 (3) the commissioner shall review expenditures of family 32.18 services collaboratives using reports specified in the agreement 32.19 with the collaborative to ensure that the base level of 32.20 expenditures is continued and new federal reimbursement is used 32.21 to expand education, social, health, or health-related services 32.22 to young children and their families; 32.23 (4) the commissioner may reduce, suspend, or eliminate a 32.24 family services collaborative's obligations to continue the base 32.25 level of expenditures or expansion of services if the 32.26 commissioner determines that one or more of the following 32.27 conditions apply: 32.28 (i) imposition of levy limits that significantly reduce 32.29 available funds for social, health, or health-related services 32.30 to families and children; 32.31 (ii) reduction in the net tax capacity of the taxable 32.32 property eligible to be taxed by the lead county or 32.33 subcontractor that significantly reduces available funds for 32.34 education, social, health, or health-related services to 32.35 families and children; 32.36 (iii) reduction in the number of children under age 19 in 33.1 the county, collaborative service delivery area, subcontractor's 33.2 district, or catchment area when compared to the number in the 33.3 base year using the most recent data provided by the state 33.4 demographer's office; or 33.5 (iv) termination of the federal revenue earned under the 33.6 family services collaborative agreement; 33.7 (5) the commissioner shall not use the federal 33.8 reimbursement earned under this subdivision in determining the 33.9 allocation or distribution of other funds to counties or 33.10 collaboratives; 33.11 (6) the commissioner may suspend, reduce, or terminate the 33.12 federal reimbursement to a provider that does not meet the 33.13 reporting or other requirements of this subdivision; 33.14 (7) the commissioner shall recover from the family services 33.15 collaborative any federal fiscal disallowances or sanctions for 33.16 audit exceptions directly attributable to the family services 33.17 collaborative's actions in the integrated fund, or the 33.18 proportional share if federal fiscal disallowances or sanctions 33.19 are based on a statewide random sample; and 33.20 (8) the commissioner shall establish criteria for the 33.21 family services collaborative for the accounting and financial 33.22 management system that will support claims for federal 33.23 reimbursement. 33.24 (b) [FAMILY SERVICES COLLABORATIVE RESPONSIBILITIES.] The 33.25 family services collaborative shall have the following authority 33.26 and responsibilities regarding federal revenue enhancement: 33.27 (1) the family services collaborative shall be the party 33.28 with which the commissioner contracts. A lead county shall be 33.29 designated as the fiscal agency for reporting, claiming, and 33.30 receiving payments; 33.31 (2) the family services collaboratives may enter into 33.32 subcontracts with other counties, school districts, special 33.33 education cooperatives, municipalities, and other public and 33.34 nonprofit entities for purposes of identifying and claiming 33.35 eligible expenditures to enhance federal reimbursement, or to 33.36 expand education, social, health, or health-related services to 34.1 families and children; 34.2 (3) the family services collaborative must continue the 34.3 base level of expenditures for education, social, health, or 34.4 health-related services to families and children from any state, 34.5 county, federal, or other public or private funding source 34.6 which, in the absence of the new federal reimbursement earned 34.7 under this subdivision, would have been available for those 34.8 services, except as provided in subdivision 1, paragraph (a), 34.9 clause (4). The base year for purposes of this subdivision 34.10 shall be the four-quarter calendar year ending at least two 34.11 calendar quarters before the first calendar quarter in which the 34.12 new federal reimbursement is earned; 34.13 (4) the family services collaborative must use all new 34.14 federal reimbursement resulting from federal revenue enhancement 34.15 to expand expenditures for education, social, health, or 34.16 health-related services to families and children beyond the base 34.17 level, except as provided in subdivision 1, paragraph (a), 34.18 clause (4); 34.19 (5) the family services collaborative must ensure that 34.20 expenditures submitted for federal reimbursement are not made 34.21 from federal funds or funds used to match other federal funds. 34.22 Notwithstanding section 256B.19, subdivision 1, for the purposes 34.23 of family services collaborative expenditures under agreement 34.24 with the department, the nonfederal share of costs shall be 34.25 provided by the family services collaborative from sources other 34.26 than federal funds or funds used to match other federal funds; 34.27 (6) the family services collaborative must develop and 34.28 maintain an accounting and financial management system adequate 34.29 to support all claims for federal reimbursement, including a 34.30 clear audit trail and any provisions specified in the agreement; 34.31 and 34.32 (7) the family services collaborative shall submit an 34.33 annual report to the commissioner as specified in the agreement. 34.34 Sec. 28. Minnesota Statutes 2000, section 256L.05, 34.35 subdivision 3, is amended to read: 34.36 Subd. 3. [EFFECTIVE DATE OF COVERAGE.] (a) The effective 35.1 date of coverage is the first day of the month following the 35.2 month in which eligibility is approved and the first premium 35.3 payment has been received. As provided in section 256B.057, 35.4 coverage for newborns is automatic from the date of birth and 35.5 must be coordinated with other health coverage. The effective 35.6 date of coverage for eligible newly adoptive children added to a 35.7 family receiving covered health services is the date of entry 35.8 into the family. The effective date of coverage for other new 35.9 recipients added to the family receiving covered health services 35.10 is the first day of the month following the month in which 35.11 eligibility is approved or at renewal, whichever the family 35.12 receiving covered health services prefers. All eligibility 35.13 criteria must be met by the family at the time the new family 35.14 member is added. The income of the new family member is 35.15 included with the family's gross income and the adjusted premium 35.16 begins in the month the new family member is added. 35.17 (b) The initial premium must be received eightby the last 35.18 working days prior to the endday of the month for coverage to 35.19 begin the first day of the following month. 35.20 (c) Benefits are not available until the day following 35.21 discharge if an enrollee is hospitalized on the first day of 35.22 coverage. 35.23 (d) Notwithstanding any other law to the contrary, benefits 35.24 under sections 256L.01 to 256L.18 are secondary to a plan of 35.25 insurance or benefit program under which an eligible person may 35.26 have coverage and the commissioner shall use cost avoidance 35.27 techniques to ensure coordination of any other health coverage 35.28 for eligible persons. The commissioner shall identify eligible 35.29 persons who may have coverage or benefits under other plans of 35.30 insurance or who become eligible for medical assistance. 35.31 Sec. 29. Minnesota Statutes 2001 Supplement, section 35.32 256L.06, subdivision 3, is amended to read: 35.33 Subd. 3. [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 35.34 Premiums are dedicated to the commissioner for MinnesotaCare. 35.35 (b) The commissioner shall develop and implement procedures 35.36 to: (1) require enrollees to report changes in income; (2) 36.1 adjust sliding scale premium payments, based upon changes in 36.2 enrollee income; and (3) disenroll enrollees from MinnesotaCare 36.3 for failure to pay required premiums. Failure to pay includes 36.4 payment with a dishonored check, a returned automatic bank 36.5 withdrawal, or a refused credit card or debit card payment. The 36.6 commissioner may demand a guaranteed form of payment, including 36.7 a cashier's check or a money order, as the only means to replace 36.8 a dishonored, returned, or refused payment. 36.9 (c) Premiums are calculated on a calendar month basis and 36.10 may be paid on a monthly, quarterly, or annual basis, with the 36.11 first payment due upon notice from the commissioner of the 36.12 premium amount required. The commissioner shall inform 36.13 applicants and enrollees of these premium payment options. 36.14 Premium payment is required before enrollment is complete and to 36.15 maintain eligibility in MinnesotaCare. Premium payments 36.16 received before noon are credited the same day. Premium 36.17 payments received after noon are credited on the next working 36.18 day. 36.19 (d) Nonpayment of the premium will result in disenrollment 36.20 from the plan effective for the calendar month for which the 36.21 premium was due. Persons disenrolled for nonpayment or who 36.22 voluntarily terminate coverage from the program may not reenroll 36.23 until four calendar months have elapsed. Persons disenrolled 36.24 for nonpayment who pay all past due premiums as well as current 36.25 premiums due, including premiums due for the period of 36.26 disenrollment, within 20 days of disenrollment, shall be 36.27 reenrolled retroactively to the first day of disenrollment. 36.28 Persons disenrolled for nonpayment or who voluntarily terminate 36.29 coverage from the program may not reenroll for four calendar 36.30 months unless the person demonstrates good cause for 36.31 nonpayment. Good cause does not exist if a person chooses to 36.32 pay other family expenses instead of the premium. The 36.33 commissioner shall define good cause in rule. 36.34 Sec. 30. Minnesota Statutes 2000, section 256L.07, 36.35 subdivision 3, is amended to read: 36.36 Subd. 3. [OTHER HEALTH COVERAGE.] (a) Families and 37.1 individuals enrolled in the MinnesotaCare program must have no 37.2 health coverage while enrolled or for at least four months prior 37.3 to application and renewal. Children enrolled in the original 37.4 children's health plan and children in families with income 37.5 equal to or less than 150 percent of the federal poverty 37.6 guidelines, who have other health insurance, are eligible if the 37.7 coverage: 37.8 (1) lacks two or more of the following: 37.9 (i) basic hospital insurance; 37.10 (ii) medical-surgical insurance; 37.11 (iii) prescription drug coverage; 37.12 (iv) dental coverage; or 37.13 (v) vision coverage; 37.14 (2) requires a deductible of $100 or more per person per 37.15 year; or 37.16 (3) lacks coverage because the child has exceeded the 37.17 maximum coverage for a particular diagnosis or the policy 37.18 excludes a particular diagnosis. 37.19 The commissioner may change this eligibility criterion for 37.20 sliding scale premiums in order to remain within the limits of 37.21 available appropriations. The requirement of no health coverage 37.22 does not apply to newborns. 37.23 (b) Medical assistance, general assistance medical care, 37.24 and the Civilian Health and Medical Program of the Uniformed 37.25 Service, CHAMPUS, or other coverage provided under United States 37.26 Code, title 10, subtitle A, part II, chapter 55, are not 37.27 considered insurance or health coverage for purposes of the 37.28 four-month requirement described in this subdivision. 37.29 (c) For purposes of this subdivision, Medicare Part A or B 37.30 coverage under title XVIII of the Social Security Act, United 37.31 States Code, title 42, sections 1395c to 1395w-4, is considered 37.32 health coverage. An applicant or enrollee may not refuse 37.33 Medicare coverage to establish eligibility for MinnesotaCare. 37.34 (d) Applicants who were recipients of medical assistance or 37.35 general assistance medical care within one month of application 37.36 must meet the provisions of this subdivision and subdivision 2. 38.1 Sec. 31. Laws 2001, First Special Session chapter 9, 38.2 article 2, section 76, is amended to read: 38.3 Sec. 76. [REPEALER.] 38.4 (a) Minnesota Statutes 2000, section 256B.0635, subdivision38.5 3, and256B.19, subdivision 1b, areis repealed effective July 38.6 1, 2001. 38.7 (b) Minnesota Statutes 2000, section 256L.02, subdivision 38.8 4, is repealed effective January 1, 2003. 38.9 Sec. 32. [REVISOR INSTRUCTION.] 38.10 In the next edition of Minnesota Statutes and Minnesota 38.11 Rules, the revisor shall replace the terms "Health Care 38.12 Financing Administration" and "federal Department of Health, 38.13 Education and Welfare" with "Centers for Medicare and Medicaid 38.14 Services" wherever it refers to the federal agency that provides 38.15 funding for the medical assistance program. 38.16 Sec. 33. [REPEALER WITHOUT EFFECT.] 38.17 The repeal of Minnesota Statutes 2000, section 256B.0635, 38.18 subdivision 3, by Laws 2001, First Special Session chapter 9, 38.19 article 2, section 76, with an effective date of July 1, 2001, 38.20 is without effect and section 256B.0635, subdivision 3, remains 38.21 in effect after June 30, 2001. 38.22 Sec. 34. [REPEALER.] 38.23 (a) Minnesota Statutes 2000, section 256B.0635, subdivision 38.24 3, is repealed effective July 1, 2002. 38.25 (b) Minnesota Statutes 2000, sections 256.025; 256B.19, 38.26 subdivision 1a; and 256B.77, subdivision 24, are repealed.