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Minnesota Legislature

Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

                            CHAPTER 340-H.F.No. 3122 
                  An act relating to human services; modifying 
                  provisions in health care programs; requiring a study 
                  of group residential housing; clarifying medical 
                  assistance coverage for employed persons with 
                  disabilities; amending Minnesota Statutes 1998, 
                  sections 62Q.19, subdivisions 2 and 6; and 256B.69, 
                  subdivision 23; Minnesota Statutes 1999 Supplement, 
                  sections 256B.057, subdivision 9; 256B.0945, 
                  subdivisions 1, 2, 4, 5, 6, 7, 8, and 9; 256B.69, 
                  subdivision 6b; 256D.03, subdivision 3; and 256L.03, 
                  subdivision 5; Laws 1999, chapter 245, article 8, 
                  section 84; repealing Laws 1998, chapter 407, article 
                  5, section 44. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 1998, section 62Q.19, 
        subdivision 2, is amended to read: 
           Subd. 2.  [APPLICATION.] (a) Any provider may apply to the 
        commissioner for designation as an essential community provider 
        by submitting an application form developed by the 
        commissioner.  Except as provided in paragraph (d), applications 
        must be accepted within two years after the effective date of 
        the rules adopted by the commissioner to implement this section. 
           (b) Each application submitted must be accompanied by an 
        application fee in an amount determined by the commissioner.  
        The fee shall be no more than what is needed to cover the 
        administrative costs of processing the application. 
           (c) The name, address, contact person, and the date by 
        which the commissioner's decision is expected to be made shall 
        be classified as public data under section 13.41.  All other 
        information contained in the application form shall be 
        classified as private data under section 13.41 until the 
        application has been approved, approved as modified, or denied 
        by the commissioner.  Once the decision has been made, all 
        information shall be classified as public data unless the 
        applicant designates and the commissioner determines that the 
        information contains trade secret information. 
           (d) The commissioner shall accept an application for 
        designation as an essential community provider until June 30, 
        2001, from: 
           (1) one applicant that is a nonprofit community health care 
        facility, certified as a medical assistance provider effective 
        April 1, 1998, that provides culturally competent health care to 
        an underserved Southeast Asian immigrant and refugee population 
        residing in the immediate neighborhood of the facility; 
           (2) one applicant that is a nonprofit home health care 
        provider, certified as a Medicare and a medical assistance 
        provider that provides culturally competent home health care 
        services to a low-income culturally diverse population; 
           (3) up to five applicants that are nonprofit community 
        mental health centers certified as medical assistance providers 
        that provide mental health services to children with serious 
        emotional disturbance and their families or to adults with 
        serious and persistent mental illness; and 
           (4) one applicant that is a nonprofit provider certified as 
        a medical assistance provider that provides mental health, child 
        development, and family services to children with physical and 
        mental health disorders and their families. 
           Sec. 2.  Minnesota Statutes 1998, section 62Q.19, 
        subdivision 6, is amended to read: 
           Subd. 6.  [TERMINATION OR RENEWAL OF DESIGNATION; 
        COMMISSIONER REVIEW.] The designation as an essential community 
        provider terminates shall be valid for a five-year period from 
        the date of designation.  Five years after it the designation of 
        essential community provider is granted, or when universal 
        coverage as defined under section 62Q.165 is achieved, whichever 
        is later to a provider, the commissioner shall review the need 
        for and appropriateness of continuing the designation for that 
        provider.  The commissioner may require a provider whose 
        designation is to be reviewed to submit an application to the 
        commissioner for renewal of the designation and may require an 
        application fee to be submitted with the application to cover 
        the administrative costs of processing the application.  Based 
        on that review, the commissioner may renew a provider's 
        essential community provider designation for an additional 
        five-year period or terminate the designation.  Once the 
        designation terminates, the former essential community provider 
        has no rights or privileges beyond those of any other health 
        care provider.  The commissioner shall make a recommendation to 
        the legislature on whether an essential community provider 
        designation should be longer than five years. 
           Sec. 3.  Minnesota Statutes 1999 Supplement, section 
        256B.057, subdivision 9, is amended to read: 
           Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
        assistance may be paid for a person who is employed and who: 
           (1) meets the definition of disabled under the supplemental 
        security income program; 
           (2) is at least 16 but less than 65 years of age; 
           (3) meets the asset limits in paragraph (b); and 
           (3) (4) pays a premium, if required, under paragraph (c).  
        Any spousal income or assets shall be disregarded for purposes 
        of eligibility and premium determinations. 
           (b) For purposes of determining eligibility under this 
        subdivision, a person's assets must not exceed $20,000, 
        excluding: 
           (1) all assets excluded under section 256B.056; 
           (2) retirement accounts, including individual accounts, 
        401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
           (3) medical expense accounts set up through the person's 
        employer. 
           (c) A person whose earned and unearned income is greater 
        than 200 percent of federal poverty guidelines for the 
        applicable family size must pay a premium to be eligible for 
        medical assistance.  The premium shall be equal to ten percent 
        of the person's gross earned and unearned income above 200 
        percent of federal poverty guidelines for the applicable family 
        size up to the cost of coverage. 
           (d) A person's eligibility and premium shall be determined 
        by the local county agency.  Premiums must be paid to the 
        commissioner.  All premiums are dedicated to the commissioner. 
           (e) Any required premium shall be determined at application 
        and redetermined annually at recertification or when a change in 
        income of or family size occurs. 
           (f) Premium payment is due upon notification from the 
        commissioner of the premium amount required.  Premiums may be 
        paid in installments at the discretion of the commissioner. 
           (g) Nonpayment of the premium shall result in denial or 
        termination of medical assistance unless the person demonstrates 
        good cause for nonpayment.  Good cause exists if the 
        requirements specified in Minnesota Rules, part 9506.0040, 
        subpart 7, items B to D, are met.  Nonpayment shall include 
        payment with a returned, refused, or dishonored instrument.  The 
        commissioner may require a guaranteed form of payment as the 
        only means to replace a returned, refused, or dishonored 
        instrument. 
           Sec. 4.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 1, is amended to read: 
           Subdivision 1.  [PROVIDER QUALIFICATIONS.] Counties must 
        arrange to provide residential services for children with severe 
        emotional disturbance according to section sections 245.4882, 
        245.4885, and this section.  Services must be provided by a 
        facility that is licensed according to section 245.4882 and 
        administrative rules promulgated thereunder, and under contract 
        with the county. Facilities providing services under subdivision 
        2, paragraph (a), must be accredited as a psychiatric facility 
        by the Joint Commission on Accreditation of Healthcare 
        Organizations, the Commission on Accreditation of Rehabilitation 
        Facilities, or the Council on Accreditation.  Accreditation is 
        not required for facilities providing services under subdivision 
        2, paragraph (b). 
           Sec. 5.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 2, is amended to read: 
           Subd. 2.  [COVERED SERVICES.] All services must be included 
        in a child's individualized treatment or collaborative family 
        service multiagency plan of care as defined in chapter 245.  
           (a) For facilities that are institutions for mental 
        diseases according to statute and regulation or are not 
        institutions for mental diseases but choose are approved by the 
        commissioner to provide services under this paragraph, medical 
        assistance covers the full contract rate, including room and 
        board if the services meet the requirements of Code of Federal 
        Regulations, title 42, section 440.160.  
           (b) For facilities that are not institutions for mental 
        diseases according to federal statute and regulation and are not 
        providing services under paragraph (a), medical assistance 
        covers mental health related services that are required to be 
        provided by a residential facility under section 245.4882 and 
        administrative rules promulgated thereunder, except for room and 
        board. 
           Sec. 6.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 4, is amended to read: 
           Subd. 4.  [PAYMENT RATES.] (a) Notwithstanding sections 
        256.025, subdivision 2; 256B.19; and 256B.041, payments to 
        counties for residential services provided by a residential 
        facility shall only be made of federal earnings for services 
        provided under this section, and the nonfederal share of costs 
        for services provided under this section shall be paid by the 
        county from sources other than federal funds or funds used to 
        match other federal funds.  Total annual payments for federal 
        earnings shall not exceed the federal medical assistance 
        percentage matching rate multiplied by the total county 
        expenditures for services provided under section 245.4882 for 
        either (1) the calendar year 1999 or (2) the average annual 
        expenditures for the calendar years 1995 to 1999, whichever is 
        greater.  Payment to counties for services provided according to 
        subdivision 2, paragraph (a), shall be the federal share of the 
        contract rate.  Payment to counties for services provided 
        according to subdivision 2, paragraph (b), shall be a proportion 
        of the per day contract rate that relates to rehabilitative 
        mental health services and shall not include payment for costs 
        or services that are billed to the IV-E program as room and 
        board.  
           (b) Annual earnings that exceed a county's limit as 
        established under paragraph (a) shall be retained by the 
        commissioner and managed as grants for community-based 
        children's mental health services under section 245.4886.  The 
        commissioner may target these grant funds as necessary to reduce 
        reliance on residential treatment of children with severe 
        emotional disturbance. 
           (c) (b) The commissioner shall set aside a portion not to 
        exceed five percent of the federal funds earned under this 
        section to cover the state costs of two staff positions and 
        support costs necessary in administering this section.  Any 
        unexpended funds from the set-aside shall be distributed to the 
        counties in proportion to their earnings under this section. 
           Sec. 7.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 5, is amended to read: 
           Subd. 5.  [QUALITY MEASURES.] Counties must collect and 
        report to the commissioner information on outcomes for services 
        provided under this section using standardized tools that 
        measure the impact of residential treatment programs on child 
        functioning and/or behavior, living stability, and parent and 
        child satisfaction consistent with the goals of sections 
        245.4876, subdivision 1, and 256F.01.  The commissioner shall 
        designate standardized tools to be used and shall collect and 
        analyze individualized outcome data on a statewide basis and 
        report to the legislature by December 1, 2003.  The commissioner 
        shall provide standardized tools that measure child and 
        adolescent functional assessment for intake and discharge, child 
        behavior, residential living environment and functionality, 
        placement stability, and satisfaction for youth and family 
        members. 
           Sec. 8.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 6, is amended to read: 
           Subd. 6.  [FEDERAL EARNINGS.] Use of new federal funding 
        earned from services provided under this section is limited to:  
           (1) increasing prevention and early intervention and 
        supportive services to meet the mental health and child welfare 
        needs of the children and families in the system of care; 
           (2) replacing reductions in federal IV-E reimbursement 
        resulting from new medical assistance coverage; and 
           (3) paying the nonfederal share of additional provider 
        costs due to accreditation and new program standards necessary 
        for Medicaid reimbursement; and 
           (4) paying for the costs of complying with the data 
        collection and reporting requirements contained in subdivision 5.
        For purposes of this section, prevention, early intervention, 
        and supportive services for children and families include 
        alternative responses to child maltreatment reports under 
        chapter 626 and nonresidential children's mental health services 
        outlined in sections section 245.4875, subdivision 2, children's 
        mental health, and family preservation services outlined in 
        section 256F.05, subdivision 8, family preservation services.  
           Sec. 9.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 7, is amended to read: 
           Subd. 7.  [MAINTENANCE OF EFFORT.] (a) Counties that 
        receive payment under this section must maintain a level of 
        expenditures such that each year's county expenditures 
        for prevention, early intervention, and supportive services for 
        children and families is at least equal to that county's average 
        expenditures for those services for calendar years 1998 and 
        1999.  For purposes of this section, "county expenditures" are 
        the total expenditures for those services minus the state and 
        federal revenues specifically designated for these services. 
           (b) The commissioner may waive the requirements in 
        paragraph (a) if any of the conditions specified in section 
        256F.13, subdivision 1, paragraph (a), clause (4), items (i) to 
        (iv), are met.  
           Sec. 10.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 8, is amended to read: 
           Subd. 8.  [REPORTS.] The commissioner shall review county 
        expenditures annually using reports required under sections 
        245.482; 256.01, subdivision 2, clause (17); and 256E.08, 
        subdivision 8, to ensure that counties meet their obligation 
        under subdivision 7, and that the base level of expenditures for 
        mental health and child welfare prevention, early intervention, 
        and family support supportive services for children and families 
        and children's mental health residential treatment is continued 
        from sources other than federal funds earned under this section. 
           Sec. 11.  Minnesota Statutes 1999 Supplement, section 
        256B.0945, subdivision 9, is amended to read: 
           Subd. 9.  [SANCTIONS.] The commissioner may suspend, 
        reduce, or terminate the federal reimbursement funds for 
        prevention, early intervention, and supportive services for 
        children and families up to the limit of federal revenue earned 
        under this section to a county that does not meet one or all of 
        the requirements of this section.  If the commissioner finds 
        evidence of children placed in residential treatment who do not 
        meet the criteria outlined in section 245.4885, subdivision 1, 
        the commissioner may take action to limit inappropriate 
        placements in residential treatment. 
           Sec. 12.  Minnesota Statutes 1999 Supplement, section 
        256B.69, subdivision 6b, is amended to read: 
           Subd. 6b.  [HOME AND COMMUNITY-BASED WAIVER SERVICES.] (a) 
        For individuals enrolled in the Minnesota senior health options 
        project authorized under subdivision 23, elderly waiver services 
        shall be covered according to the terms and conditions of the 
        federal agreement governing that demonstration project. 
           (b) For individuals under age 65 with physical disabilities 
        but without a primary diagnosis of mental illness or 
        developmental disabilities, except for related conditions, 
        enrolled in the Minnesota senior health options project 
        demonstrations authorized under subdivision 23, home and 
        community-based waiver services shall be covered according to 
        the terms and conditions of the federal agreement governing that 
        demonstration project. 
           Sec. 13.  Minnesota Statutes 1998, section 256B.69, 
        subdivision 23, is amended to read: 
           Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
        ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
        implement demonstration projects to create alternative 
        integrated delivery systems for acute and long-term care 
        services to elderly persons and disabled persons with 
        disabilities as defined in section 256B.77, subdivision 7a, that 
        provide increased coordination, improve access to quality 
        services, and mitigate future cost increases.  The commissioner 
        may seek federal authority to combine Medicare and Medicaid 
        capitation payments for the purpose of such demonstrations.  
        Medicare funds and services shall be administered according to 
        the terms and conditions of the federal waiver and demonstration 
        provisions.  For the purpose of administering medical assistance 
        funds, demonstrations under this subdivision are subject to 
        subdivisions 1 to 17 22.  The provisions of Minnesota Rules, 
        parts 9500.1450 to 9500.1464, apply to these demonstrations, 
        with the exceptions of parts 9500.1452, subpart 2, item B; and 
        9500.1457, subpart 1, items B and C, which do not apply 
        to elderly persons enrolling in demonstrations under this 
        section.  An initial open enrollment period may be provided.  
        Persons who disenroll from demonstrations under this subdivision 
        remain subject to Minnesota Rules, parts 9500.1450 to 
        9500.1464.  When a person is enrolled in a health plan under 
        these demonstrations and the health plan's participation is 
        subsequently terminated for any reason, the person shall be 
        provided an opportunity to select a new health plan and shall 
        have the right to change health plans within the first 60 days 
        of enrollment in the second health plan.  Persons required to 
        participate in health plans under this section who fail to make 
        a choice of health plan shall not be randomly assigned to health 
        plans under these demonstrations. Notwithstanding section 
        256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, 
        subpart 1, item A, if adopted, for the purpose of demonstrations 
        under this subdivision, the commissioner may contract with 
        managed care organizations, including counties, to serve only 
        elderly persons eligible for medical assistance, elderly and 
        disabled persons, or disabled persons only.  For persons with 
        primary diagnoses of mental retardation or a related condition, 
        serious and persistent mental illness, or serious emotional 
        disturbance, the commissioner must ensure that the county 
        authority has approved the demonstration and contracting 
        design.  Enrollment in these projects shall be voluntary until 
        July 1, 2001.  The commissioner shall not implement any 
        demonstration project under this subdivision for persons with 
        primary diagnoses of mental retardation or a related condition, 
        serious and persistent mental illness, or serious emotional 
        disturbance, without approval of the county board of the county 
        in which the demonstration is being implemented. 
           Before implementation of a demonstration project for 
        disabled persons, the commissioner must provide information to 
        appropriate committees of the house of representatives and 
        senate and must involve representatives of affected disability 
        groups in the design of the demonstration projects. 
           (b) A nursing facility reimbursed under the alternative 
        reimbursement methodology in section 256B.434 may, in 
        collaboration with a hospital, clinic, or other health care 
        entity provide services under paragraph (a).  The commissioner 
        shall amend the state plan and seek any federal waivers 
        necessary to implement this paragraph. 
           Sec. 14.  Minnesota Statutes 1999 Supplement, section 
        256D.03, subdivision 3, is amended to read: 
           Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
        (a) General assistance medical care may be paid for any person 
        who is not eligible for medical assistance under chapter 256B, 
        including eligibility for medical assistance based on a 
        spenddown of excess income according to section 256B.056, 
        subdivision 5, or MinnesotaCare as defined in paragraph (b), 
        except as provided in paragraph (c); and: 
           (1) who is receiving assistance under section 256D.05, 
        except for families with children who are eligible under 
        Minnesota family investment program-statewide (MFIP-S), who is 
        having a payment made on the person's behalf under sections 
        256I.01 to 256I.06, or who resides in group residential housing 
        as defined in chapter 256I and can meet a spenddown using the 
        cost of remedial services received through group residential 
        housing; or 
           (2)(i) who is a resident of Minnesota; and whose equity in 
        assets is not in excess of $1,000 per assistance unit.  Exempt 
        assets, the reduction of excess assets, and the waiver of excess 
        assets must conform to the medical assistance program in chapter 
        256B, with the following exception:  the maximum amount of 
        undistributed funds in a trust that could be distributed to or 
        on behalf of the beneficiary by the trustee, assuming the full 
        exercise of the trustee's discretion under the terms of the 
        trust, must be applied toward the asset maximum; and 
           (ii) who has countable income not in excess of the 
        assistance standards established in section 256B.056, 
        subdivision 4, or whose excess income is spent down according to 
        section 256B.056, subdivision 5, using a six-month budget 
        period.  The method for calculating earned income disregards and 
        deductions for a person who resides with a dependent child under 
        age 21 shall follow section 256B.056, subdivision 1a.  However, 
        if a disregard of $30 and one-third of the remainder has been 
        applied to the wage earner's income, the disregard shall not be 
        applied again until the wage earner's income has not been 
        considered in an eligibility determination for general 
        assistance, general assistance medical care, medical assistance, 
        or MFIP-S for 12 consecutive months.  The earned income and work 
        expense deductions for a person who does not reside with a 
        dependent child under age 21 shall be the same as the method 
        used to determine eligibility for a person under section 
        256D.06, subdivision 1, except the disregard of the first $50 of 
        earned income is not allowed; 
           (3) who would be eligible for medical assistance except 
        that the person resides in a facility that is determined by the 
        commissioner or the federal Health Care Financing Administration 
        to be an institution for mental diseases; or 
           (4) who is ineligible for medical assistance under chapter 
        256B or general assistance medical care under any other 
        provision of this section, and is receiving care and 
        rehabilitation services from a nonprofit center established to 
        serve victims of torture.  These individuals are eligible for 
        general assistance medical care only for the period during which 
        they are receiving services from the center.  During this period 
        of eligibility, individuals eligible under this clause shall not 
        be required to participate in prepaid general assistance medical 
        care.  
           (b) Beginning January 1, 2000, applicants or recipients who 
        meet all eligibility requirements of MinnesotaCare as defined in 
        sections 256L.01 to 256L.16, and are: 
           (i) adults with dependent children under 21 whose gross 
        family income is equal to or less than 275 percent of the 
        federal poverty guidelines; or 
           (ii) adults without children with earned income and whose 
        family gross income is between 75 percent of the federal poverty 
        guidelines and the amount set by section 256L.04, subdivision 7, 
        shall be terminated from general assistance medical care upon 
        enrollment in MinnesotaCare. 
           (c) For services rendered on or after July 1, 1997, 
        eligibility is limited to one month prior to application if the 
        person is determined eligible in the prior month.  A 
        redetermination of eligibility must occur every 12 months.  
        Beginning January 1, 2000, Minnesota health care program 
        applications completed by recipients and applicants who are 
        persons described in paragraph (b), may be returned to the 
        county agency to be forwarded to the department of human 
        services or sent directly to the department of human services 
        for enrollment in MinnesotaCare.  If all other eligibility 
        requirements of this subdivision are met, eligibility for 
        general assistance medical care shall be available in any month 
        during which a MinnesotaCare eligibility determination and 
        enrollment are pending.  Upon notification of eligibility for 
        MinnesotaCare, notice of termination for eligibility for general 
        assistance medical care shall be sent to an applicant or 
        recipient.  If all other eligibility requirements of this 
        subdivision are met, eligibility for general assistance medical 
        care shall be available until enrollment in MinnesotaCare 
        subject to the provisions of paragraph (e). 
           (d) The date of an initial Minnesota health care program 
        application necessary to begin a determination of eligibility 
        shall be the date the applicant has provided a name, address, 
        and social security number, signed and dated, to the county 
        agency or the department of human services.  If the applicant is 
        unable to provide an initial application when health care is 
        delivered due to a medical condition or disability, a health 
        care provider may act on the person's behalf to complete the 
        initial application.  The applicant must complete the remainder 
        of the application and provide necessary verification before 
        eligibility can be determined.  The county agency must assist 
        the applicant in obtaining verification if necessary.  On the 
        basis of information provided on the completed application, an 
        applicant who meets the following criteria shall be determined 
        eligible beginning in the month of application: 
           (1) has gross income less than 90 percent of the applicable 
        income standard; 
           (2) has liquid assets that total within $300 of the asset 
        standard; 
           (3) does not reside in a long-term care facility; and 
           (4) meets all other eligibility requirements. 
        The applicant must provide all required verifications within 30 
        days' notice of the eligibility determination or eligibility 
        shall be terminated. 
           (e) County agencies are authorized to use all automated 
        databases containing information regarding recipients' or 
        applicants' income in order to determine eligibility for general 
        assistance medical care or MinnesotaCare.  Such use shall be 
        considered sufficient in order to determine eligibility and 
        premium payments by the county agency. 
           (f) General assistance medical care is not available for a 
        person in a correctional facility unless the person is detained 
        by law for less than one year in a county correctional or 
        detention facility as a person accused or convicted of a crime, 
        or admitted as an inpatient to a hospital on a criminal hold 
        order, and the person is a recipient of general assistance 
        medical care at the time the person is detained by law or 
        admitted on a criminal hold order and as long as the person 
        continues to meet other eligibility requirements of this 
        subdivision.  
           (g) General assistance medical care is not available for 
        applicants or recipients who do not cooperate with the county 
        agency to meet the requirements of medical assistance.  General 
        assistance medical care is limited to payment of emergency 
        services only for applicants or recipients as described in 
        paragraph (b), whose MinnesotaCare coverage is denied or 
        terminated for nonpayment of premiums as required by sections 
        256L.06 and 256L.07.  
           (h) In determining the amount of assets of an individual, 
        there shall be included any asset or interest in an asset, 
        including an asset excluded under paragraph (a), that was given 
        away, sold, or disposed of for less than fair market value 
        within the 60 months preceding application for general 
        assistance medical care or during the period of eligibility.  
        Any transfer described in this paragraph shall be presumed to 
        have been for the purpose of establishing eligibility for 
        general assistance medical care, unless the individual furnishes 
        convincing evidence to establish that the transaction was 
        exclusively for another purpose.  For purposes of this 
        paragraph, the value of the asset or interest shall be the fair 
        market value at the time it was given away, sold, or disposed 
        of, less the amount of compensation received.  For any 
        uncompensated transfer, the number of months of ineligibility, 
        including partial months, shall be calculated by dividing the 
        uncompensated transfer amount by the average monthly per person 
        payment made by the medical assistance program to skilled 
        nursing facilities for the previous calendar year.  The 
        individual shall remain ineligible until this fixed period has 
        expired.  The period of ineligibility may exceed 30 months, and 
        a reapplication for benefits after 30 months from the date of 
        the transfer shall not result in eligibility unless and until 
        the period of ineligibility has expired.  The period of 
        ineligibility begins in the month the transfer was reported to 
        the county agency, or if the transfer was not reported, the 
        month in which the county agency discovered the transfer, 
        whichever comes first.  For applicants, the period of 
        ineligibility begins on the date of the first approved 
        application. 
           (i) When determining eligibility for any state benefits 
        under this subdivision, the income and resources of all 
        noncitizens shall be deemed to include their sponsor's income 
        and resources as defined in the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996, title IV, Public Law 
        Number 104-193, sections 421 and 422, and subsequently set out 
        in federal rules. 
           (j)(1) An undocumented noncitizen or a nonimmigrant is 
        ineligible for general assistance medical care other than 
        emergency services.  For purposes of this subdivision, a 
        nonimmigrant is an individual in one or more of the classes 
        listed in United States Code, title 8, section 1101(a)(15), and 
        an undocumented noncitizen is an individual who resides in the 
        United States without the approval or acquiescence of the 
        Immigration and Naturalization Service. 
           (2) This paragraph does not apply to a child under age 18, 
        to a Cuban or Haitian entrant as defined in Public Law Number 
        96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 
        aged, blind, or disabled as defined in Code of Federal 
        Regulations, title 42, sections 435.520, 435.530, 435.531, 
        435.540, and 435.541, or effective October 1, 1998, to an 
        individual eligible for general assistance medical care under 
        paragraph (a), clause (4), who cooperates with the Immigration 
        and Naturalization Service to pursue any applicable immigration 
        status, including citizenship, that would qualify the individual 
        for medical assistance with federal financial participation. 
           (3) (k) For purposes of this paragraph paragraphs (g) and 
        (j), "emergency services" has the meaning given in Code of 
        Federal Regulations, title 42, section 440.255(b)(1), except 
        that it also means services rendered because of suspected or 
        actual pesticide poisoning. 
           (k) (l) Notwithstanding any other provision of law, a 
        noncitizen who is ineligible for medical assistance due to the 
        deeming of a sponsor's income and resources, is ineligible for 
        general assistance medical care. 
           Sec. 15.  Minnesota Statutes 1999 Supplement, section 
        256L.03, subdivision 5, is amended to read: 
           Subd. 5.  [COPAYMENTS AND COINSURANCE.] (a) Except as 
        provided in paragraphs (b) and (c), the MinnesotaCare benefit 
        plan shall include the following copayments and coinsurance 
        requirements for all enrollees except parents and relative 
        caretakers of children under the age of 21 in households with 
        income at or below 175 percent of the federal poverty guidelines 
        and pregnant women and children under the age of 21:  
           (1) ten percent of the paid charges for inpatient hospital 
        services for adult enrollees, subject to an annual inpatient 
        out-of-pocket maximum of $1,000 per individual and $3,000 per 
        family; 
           (2) $3 per prescription for adult enrollees; 
           (3) $25 for eyeglasses for adult enrollees; and 
           (4) effective July 1, 1998, 50 percent of the 
        fee-for-service rate for adult dental care services other than 
        preventive care services for persons eligible under section 
        256L.04, subdivisions 1 to 7, with income equal to or less than 
        175 percent of the federal poverty guidelines. 
           The exceptions described in this paragraph shall only be 
        implemented if required to obtain federal Medicaid funding for 
        these individuals and shall expire July 1, 2000. 
           (b) Effective July 1, 1997, Paragraph (a), clause (1), does 
        not apply to parents and relative caretakers of children under 
        the age of 21 in households with family income equal to or less 
        than 175 percent of the federal poverty guidelines.  Paragraph 
        (a), clause (1), does not apply to parents and relative 
        caretakers of children under the age of 21 in households with 
        family income greater than 175 percent of the federal poverty 
        guidelines for inpatient hospital admissions occurring on or 
        after January 1, 2001.  
           (c) Paragraph (a), clauses (1) to (4), do not apply to 
        pregnant women and children under the age of 21.  
           (d) Adult enrollees with family gross income that exceeds 
        175 percent of the federal poverty guidelines and who are not 
        pregnant shall be financially responsible for the coinsurance 
        amount, if applicable, and amounts which exceed the $10,000 
        inpatient hospital benefit limit. 
           (c) (e) When a MinnesotaCare enrollee becomes a member of a 
        prepaid health plan, or changes from one prepaid health plan to 
        another during a calendar year, any charges submitted towards 
        the $10,000 annual inpatient benefit limit, and any 
        out-of-pocket expenses incurred by the enrollee for inpatient 
        services, that were submitted or incurred prior to enrollment, 
        or prior to the change in health plans, shall be disregarded. 
           Sec. 16.  Laws 1999, chapter 245, article 8, section 84, is 
        amended to read: 
           Sec. 84.  [RECOMMENDATIONS TO THE LEGISLATURE.] 
           The commissioner of human services shall submit to the 
        legislature design and implementation recommendations for the 
        proposals required in sections 82 and 83, including draft 
        legislation, by January 15, 2000 2001, for implementation 
        by July 1, 2000 January 1, 2002, with respect to the proposal in 
        section 82 only.  The proposals shall not include requirements 
        for maintenance of effort and expanded expenditures concerning 
        federal reimbursements earned in these programs. 
           Sec. 17.  [OBSOLETE RULES.] 
           The commissioner shall amend or repeal obsolete provisions 
        of Minnesota Rules, parts 9505.0010 to 9505.0150, governing 
        eligibility for the medical assistance program, under the 
        expedited process of Minnesota Statutes, section 14.389, to 
        bring them into conformance with state and federal law. 
           Sec. 18.  [GROUP RESIDENTIAL HOUSING REVIEW.] 
           The commissioner of human services, in consultation with 
        representatives of affected providers, consumers, and counties, 
        shall review group residential housing (GRH) expenditures that 
        may be eligible for reimbursement under the home and 
        community-based waiver services program for persons with mental 
        retardation or related conditions (MR/RC waiver).  The review 
        may include: 
           (1) an assessment of consumer access to housing as a result 
        of the limits on GRH supplementary room and board rates adopted 
        in Laws 1999, chapter 245, article 3, section 40; 
           (2) an analysis of market rate housing costs for families 
        of comparable size to those funded under the GRH program; 
           (3) an analysis of the impact on GRH costs of providing 
        services and housing to persons with developmental disabilities, 
        including: 
           (i) a breakdown by level of client disability of GRH 
        expenditures for housing costs for persons with developmental 
        disabilities; 
           (ii) a breakdown by level of client disability of GRH 
        expenditures for service costs for persons with developmental 
        disabilities; 
           (iii) an analysis of differences in GRH expenditures for 
        persons with developmental disabilities compared to other GRH 
        residents; and 
           (iv) a determination of GRH expenditures that are a direct 
        result of a resident's disability; 
           (4) a determination of which services now paid for by the 
        GRH program may be eligible under the MR/RC waiver, and an 
        estimate of GRH costs that could be paid by the federal 
        government under the MR/RC waiver.  The commissioner may begin 
        the process of seeking federal approval to fund current group 
        residential housing services under the MR/RC waiver; 
           (5) an assessment of the utilization of the food stamp 
        program and other federal benefit programs by GRH residents; 
           (6) an analysis of the methods other states utilize to 
        reimburse comparable room and board costs and service costs; and 
           (7) a compilation of current MR/RC waiver caps in Minnesota 
        counties, compared with actual MR/RC spending. 
           Sec. 19.  [ALTERNATIVE CARE PILOT PROJECTS.] 
           (a) Expenditures for housing with services and adult foster 
        care shall be excluded when determining average monthly 
        expenditures per client for alternative care pilot projects 
        authorized in Laws 1993, First Special Session chapter 1, 
        article 5, section 133. 
           (b) Alternative care pilot projects shall not expire on 
        June 30, 2001, but shall continue until June 30, 2005. 
           Sec. 20.  [REPEALER.] 
           Laws 1998, chapter 407, article 5, section 44, is repealed. 
           Sec. 21.  [EFFECTIVE DATE.] 
           Sections 1, 15, and 17 are effective the day 
        following final enactment. 
           Presented to the governor April 3, 2000 
           Signed by the governor April 6, 2000, 3:55 p.m.