Minnesota Office of the Revisor of Statutes
[*Add Subtitle/link: Office]

Menu

Revisor of Statutes Menu

Pdf

Minnesota Session Laws

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

CHAPTER 200--S.F.No. 460
An act
relating to health care; establishing mental health urgent care and
consultation services; creating a new general assistance medical care program;
appropriating money;amending Minnesota Statutes 2008, sections 256.969,
subdivision 27; 256B.0625, subdivision 13f, by adding a subdivision; 256B.0644;
256B.69, subdivision 20; 256L.05, subdivisions 1b, 3, 3a, 3c; 517.08, subdivision
1c; Minnesota Statutes 2009 Supplement, sections 256.969, subdivision 3a;
256B.0947, subdivision 1; 256B.196, subdivision 2; 256D.03, subdivision 3;
proposing coding for new law in Minnesota Statutes, chapters 245; 256B; 256D;
repealing Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8;
256B.195, subdivisions 4, 5; 256D.03, subdivision 9; 256L.07, subdivision
6; 256L.15, subdivision 4; 256L.17, subdivision 7; Minnesota Statutes 2009
Supplement, sections 256B.195, subdivisions 1, 2, 3; 256D.03, subdivision 4.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1
GENERAL ASSISTANCE MEDICAL CARE

    Section 1. [245.4862] MENTAL HEALTH URGENT CARE AND PSYCHIATRIC
CONSULTATION.
    Subdivision 1. Mental health urgent care and psychiatric consultation. The
commissioner shall include mental health urgent care and psychiatric consultation
services as part of, but not limited to, the redesign of six community-based behavioral
health hospitals and the Anoka-Metro Regional Treatment Center. These services must
not duplicate existing services in the region, and must be implemented as specified in
subdivisions 3 to 7.
    Subd. 2. Definitions. For purposes of this section:
(a) Mental health urgent care includes:
(1) initial mental health screening;
(2) mobile crisis assessment and intervention;
(3) rapid access to psychiatry, including psychiatric evaluation, initial treatment,
and short-term psychiatry;
(4) nonhospital crisis stabilization residential beds; and
(5) health care navigator services that include, but are not limited to, assisting
uninsured individuals in obtaining health care coverage.
(b) Psychiatric consultation services includes psychiatric consultation to primary
care practitioners.
    Subd. 3. Rapid access to psychiatry. The commissioner shall develop rapid access
to psychiatric services based on the following criteria:
(1) the individuals who receive the psychiatric services must be at risk of
hospitalization and otherwise unable to receive timely services;
(2) where clinically appropriate, the service may be provided via interactive video
where the service is provided in conjunction with an emergency room, a local crisis
service, or a primary care or behavioral care practitioner; and
(3) the commissioner may integrate rapid access to psychiatry with the psychiatric
consultation services in subdivision 4.
    Subd. 4. Collaborative psychiatric consultation. (a) The commissioner shall
establish a collaborative psychiatric consultation service based on the following criteria:
(1) the service may be available via telephone, interactive video, e-mail, or other
means of communication to emergency rooms, local crisis services, mental health
professionals, and primary care practitioners, including pediatricians;
(2) the service shall be provided by a multidisciplinary team including, at a
minimum, a child and adolescent psychiatrist, an adult psychiatrist, and a licensed clinical
social worker;
(3) the service shall include a triage-level assessment to determine the most
appropriate response to each request, including appropriate referrals to other mental health
professionals, as well as provision of rapid psychiatric access when other appropriate
services are not available;
(4) the first priority for this service is to provide the consultations required under
section 256B.0625, subdivision 13j; and
(5) the service must encourage use of cognitive and behavioral therapies and other
evidence-based treatments in addition to or in place of medication, where appropriate.
(b) The commissioner shall appoint an interdisciplinary work group to establish
appropriate medication and psychotherapy protocols to guide the consultative process,
including consultation with the Drug Utilization Review Board, as provided in section
256B.0625, subdivision 13j.
    Subd. 5. Phased availability. (a) The commissioner may phase in the availability
of mental health urgent care services based on the limits of appropriations and the
commissioner's determination of level of need and cost-effectiveness.
(b) For subdivisions 3 and 4, the first phase must focus on adults in Hennepin
and Ramsey Counties and children statewide who are affected by section 256B.0625,
subdivision 13j, and must include tracking of costs for the services provided and
associated impacts on utilization of inpatient, emergency room, and other services.
    Subd. 6. Limited appropriations. The commissioner shall maximize use
of available health care coverage for the services provided under this section. The
commissioner's responsibility to provide these services for individuals without health care
coverage must not exceed the appropriations for this section.
    Subd. 7. Flexible implementation. To implement this section, the commissioner
shall select the structure and funding method that is the most cost-effective for each county
or group of counties. This may include grants, contracts, direct provision by state-operated
services, and public-private partnerships. Where feasible, the commissioner shall make
any grants under this section a part of the integrated adult mental health initiative grants
under section 245.4661.

    Sec. 2. Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is
amended to read:
    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
assistance program must not be submitted until the recipient is discharged. However,
the commissioner shall establish monthly interim payments for inpatient hospitals that
have individual patient lengths of stay over 30 days regardless of diagnostic category.
Except as provided in section 256.9693, medical assistance reimbursement for treatment
of mental illness shall be reimbursed based on diagnostic classifications. Individual
hospital payments established under this section and sections 256.9685, 256.9686, and
256.9695, in addition to third party and recipient liability, for discharges occurring during
the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
inpatient services paid for the same period of time to the hospital. This payment limitation
shall be calculated separately for medical assistance and general assistance medical
care services. The limitation on general assistance medical care shall be effective for
admissions occurring on or after July 1, 1991. Services that have rates established under
subdivision 11 or 12, must be limited separately from other services. After consulting with
the affected hospitals, the commissioner may consider related hospitals one entity and
may merge the payment rates while maintaining separate provider numbers. The operating
and property base rates per admission or per day shall be derived from the best Medicare
and claims data available when rates are established. The commissioner shall determine
the best Medicare and claims data, taking into consideration variables of recency of the
data, audit disposition, settlement status, and the ability to set rates in a timely manner.
The commissioner shall notify hospitals of payment rates by December 1 of the year
preceding the rate year. The rate setting data must reflect the admissions data used to
establish relative values. Base year changes from 1981 to the base year established for the
rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
1. The commissioner may adjust base year cost, relative value, and case mix index data
to exclude the costs of services that have been discontinued by the October 1 of the year
preceding the rate year or that are paid separately from inpatient services. Inpatient stays
that encompass portions of two or more rate years shall have payments established based
on payment rates in effect at the time of admission unless the date of admission preceded
the rate year in effect by six months or more. In this case, operating payment rates for
services rendered during the rate year in effect and established based on the date of
admission shall be adjusted to the rate year in effect by the hospital cost index.
    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
payment, before third-party liability and spenddown, made to hospitals for inpatient
services is reduced by .5 percent from the current statutory rates.
    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Mental health services within diagnosis related groups 424 to 432, and
facilities defined under subdivision 16 are excluded from this paragraph.
    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent
from the current statutory rates. Mental health services within diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
assistance does not include general assistance medical care. Payments made to managed
care plans shall be reduced for services provided on or after January 1, 2006, to reflect
this reduction.
    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010 2011,
made to hospitals for inpatient services before third-party liability and spenddown, is
reduced 1.9 percent from the current statutory rates. Mental health services with diagnosis
related groups 424 to 432 and facilities defined under subdivision 16 are excluded from
this paragraph. Payments made to managed care plans shall be reduced for services
provided on or after July 1, 2009, through June 30, 2010 2011, to reflect this reduction.
    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
for fee-for-service admissions occurring on or after July 1, 2010 2011, made to hospitals
for inpatient services before third-party liability and spenddown, is reduced 1.79 percent
from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
Payments made to managed care plans shall be reduced for services provided on or after
July 1, 2010 2011, to reflect this reduction.
(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
payment for fee-for-service admissions occurring on or after July 1, 2009, made to
hospitals for inpatient services before third-party liability and spenddown, is reduced
one percent from the current statutory rates. Facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after October 1, 2009, to reflect this reduction.
EFFECTIVE DATE.This section is effective April 1, 2010.

    Sec. 3. Minnesota Statutes 2008, section 256.969, subdivision 27, is amended to read:
    Subd. 27. Quarterly payment adjustment. (a) In addition to any other payment
under this section, the commissioner shall make the following payments effective July
1, 2007:
    (1) for a hospital located in Minnesota and not eligible for payments under
subdivision 20, with a medical assistance inpatient utilization rate greater than 17.8
percent of total patient days as of the base year in effect on July 1, 2005, a payment equal
to 13 percent of the total of the operating and property payment rates;
    (2) for a hospital located in Minnesota in a specified urban area outside of the
seven-county metropolitan area and not eligible for payments under subdivision 20, with
a medical assistance inpatient utilization rate less than or equal to 17.8 percent of total
patient days as of the base year in effect on July 1, 2005, a payment equal to ten percent
of the total of the operating and property payment rates. For purposes of this clause, the
following cities are specified urban areas: Detroit Lakes, Rochester, Willmar, Alexandria,
Austin, Cambridge, Brainerd, Hibbing, Mankato, Duluth, St. Cloud, Grand Rapids,
Wyoming, Fergus Falls, Albert Lea, Winona, Virginia, Thief River Falls, and Wadena;
    (3) for a hospital located in Minnesota but not located in a specified urban area
under clause (2), with a medical assistance inpatient utilization rate less than or equal to
17.8 percent of total patient days as of the base year in effect on July 1, 2005, a payment
equal to four percent of the total of the operating and property payment rates. A hospital
located in Woodbury and not in existence during the base year shall be reimbursed under
this clause; and
    (4) in addition to any payments under clauses (1) to (3), for a hospital located in
Minnesota and not eligible for payments under subdivision 20 with a medical assistance
inpatient utilization rate of 17.9 percent of total patient days as of the base year in effect
on July 1, 2005, a payment equal to eight percent of the total of the operating and property
payment rates, and for a hospital located in Minnesota and not eligible for payments
under subdivision 20 with a medical assistance inpatient utilization rate of 59.6 percent
of total patient days as of the base year in effect on July 1, 2005, a payment equal to
nine percent of the total of the operating and property payment rates. After making any
ratable adjustments required under paragraph (b), the commissioner shall proportionately
reduce payments under clauses (2) and (3) by an amount needed to make payments under
this clause.
    (b) The state share of payments under paragraph (a) shall be equal to federal
reimbursements to the commissioner to reimburse expenditures reported under section
256B.199, paragraphs (a) to (d). The commissioner shall ratably reduce or increase
payments under this subdivision in order to ensure that these payments equal the amount
of reimbursement received by the commissioner under section 256B.199, paragraphs (a)
to (d)
, except that payments shall be ratably reduced by an amount equivalent to the state
share of a four percent reduction in MinnesotaCare and medical assistance payments
for inpatient hospital services. Effective July 1, 2009, the ratable reduction shall be
equivalent to the state share of a three percent reduction in these payments. Effective for
federal disproportionate share hospital funds earned on payments reported under section
256B.199, paragraphs (a) to (d), for services rendered on or after April 1, 2010, payments
shall not be made under this subdivision or subdivision 28.
    (c) The payments under paragraph (a) shall be paid quarterly based on each hospital's
operating and property payments from the second previous quarter, beginning on July
15, 2007, or upon federal approval of federal reimbursements under section 256B.199,
paragraphs (a) to (d)
, whichever occurs later.
    (d) The commissioner shall not adjust rates paid to a prepaid health plan under
contract with the commissioner to reflect payments provided in paragraph (a).
    (e) The commissioner shall maximize the use of available federal money for
disproportionate share hospital payments and shall maximize payments to qualifying
hospitals. In order to accomplish these purposes, the commissioner may, in consultation
with the nonstate entities identified in section 256B.199, paragraphs (a) to (d), adjust,
on a pro rata basis if feasible, the amounts reported by nonstate entities under section
256B.199, paragraphs (a) to (d), when application for reimbursement is made to the federal
government, and otherwise adjust the provisions of this subdivision. The commissioner
shall utilize a settlement process based on finalized data to maximize revenue under
section 256B.199, paragraphs (a) to (d), and payments under this section.
    (f) For purposes of this subdivision, medical assistance does not include general
assistance medical care.
EFFECTIVE DATE.This section is effective for services rendered on or after
April 1, 2010.

    Sec. 4. Minnesota Statutes 2008, section 256B.0625, subdivision 13f, is amended to
read:
    Subd. 13f. Prior authorization. (a) The Formulary Committee shall review and
recommend drugs which require prior authorization. The Formulary Committee shall
establish general criteria to be used for the prior authorization of brand-name drugs for
which generically equivalent drugs are available, but the committee is not required to
review each brand-name drug for which a generically equivalent drug is available.
(b) Prior authorization may be required by the commissioner before certain
formulary drugs are eligible for payment. The Formulary Committee may recommend
drugs for prior authorization directly to the commissioner. The commissioner may also
request that the Formulary Committee review a drug for prior authorization. Before the
commissioner may require prior authorization for a drug:
(1) the commissioner must provide information to the Formulary Committee on the
impact that placing the drug on prior authorization may have on the quality of patient care
and on program costs, information regarding whether the drug is subject to clinical abuse
or misuse, and relevant data from the state Medicaid program if such data is available;
(2) the Formulary Committee must review the drug, taking into account medical and
clinical data and the information provided by the commissioner; and
(3) the Formulary Committee must hold a public forum and receive public comment
for an additional 15 days.
The commissioner must provide a 15-day notice period before implementing the prior
authorization.
(c) Except as provided in subdivision 13j, prior authorization shall not be required or
utilized for any atypical antipsychotic drug prescribed for the treatment of mental illness if:
(1) there is no generically equivalent drug available; and
(2) the drug was initially prescribed for the recipient prior to July 1, 2003; or
(3) the drug is part of the recipient's current course of treatment.
This paragraph applies to any multistate preferred drug list or supplemental drug rebate
program established or administered by the commissioner. Prior authorization shall
automatically be granted for 60 days for brand name drugs prescribed for treatment of
mental illness within 60 days of when a generically equivalent drug becomes available,
provided that the brand name drug was part of the recipient's course of treatment at the
time the generically equivalent drug became available.
(d) Prior authorization shall not be required or utilized for any antihemophilic factor
drug prescribed for the treatment of hemophilia and blood disorders where there is no
generically equivalent drug available if the prior authorization is used in conjunction with
any supplemental drug rebate program or multistate preferred drug list established or
administered by the commissioner.
(e) The commissioner may require prior authorization for brand name drugs
whenever a generically equivalent product is available, even if the prescriber specifically
indicates "dispense as written-brand necessary" on the prescription as required by section
151.21, subdivision 2.
(f) Notwithstanding this subdivision, the commissioner may automatically require
prior authorization, for a period not to exceed 180 days, for any drug that is approved by
the United States Food and Drug Administration on or after July 1, 2005. The 180-day
period begins no later than the first day that a drug is available for shipment to pharmacies
within the state. The Formulary Committee shall recommend to the commissioner general
criteria to be used for the prior authorization of the drugs, but the committee is not
required to review each individual drug. In order to continue prior authorizations for a
drug after the 180-day period has expired, the commissioner must follow the provisions
of this subdivision.
EFFECTIVE DATE.This section is effective April 1, 2010.

    Sec. 5. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:
    Subd. 13j. Antipsychotic and attention deficit disorder and attention deficit
hyperactivity disorder medications. (a) The commissioner, in consultation with the
Drug Utilization Review Board established in subdivision 13i and actively practicing
pediatric mental health professionals, must:
(1) identify recommended pediatric dose ranges for atypical antipsychotic drugs
and drugs used for attention deficit disorder or attention deficit hyperactivity disorder
based on available medical, clinical, and safety data and research. The commissioner
shall periodically review the list of medications and pediatric dose ranges and update
the medications and doses listed as needed after consultation with the Drug Utilization
Review Board;
(2) identify situations where a collaborative psychiatric consultation and prior
authorization should be required before the initiation or continuation of drug therapy
in pediatric patients including, but not limited to, high-dose regimens, off-label use of
prescription medication, a patient's young age, and lack of coordination among multiple
prescribing providers; and
(3) track prescriptive practices and the use of psychotropic medications in children
with the goal of reducing the use of medication, where appropriate.
(b) Effective July 1, 2011, the commissioner shall require prior authorization and
a collaborative psychiatric consultation before an atypical antipsychotic and attention
deficit disorder and attention deficit hyperactivity disorder medication meeting the criteria
identified in paragraph (a), clause (2), is eligible for payment. A collaborative psychiatric
consultation must be completed before the identified medications are eligible for payment
unless:
(1) the patient has already been stabilized on the medication regimen; or
(2) the prescriber indicates that the child is in crisis.
If clause (1) or (2) applies, the collaborative psychiatric consultation must be completed
within 90 days for payment to continue.
(c) For purposes of this subdivision, a collaborative psychiatric consultation must
meet the criteria described in section 245.4862, subdivision 4.

    Sec. 6. Minnesota Statutes 2008, section 256B.0644, is amended to read:
256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
PROGRAMS.
    (a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a
health maintenance organization, as defined in chapter 62D, must participate as a provider
or contractor in the medical assistance program, general assistance medical care program,
and MinnesotaCare as a condition of participating as a provider in health insurance plans
and programs or contractor for state employees established under section 43A.18, the
public employees insurance program under section 43A.316, for health insurance plans
offered to local statutory or home rule charter city, county, and school district employees,
the workers' compensation system under section 176.135, and insurance plans provided
through the Minnesota Comprehensive Health Association under sections 62E.01 to
62E.19. The limitations on insurance plans offered to local government employees shall
not be applicable in geographic areas where provider participation is limited by managed
care contracts with the Department of Human Services.
    (b) For providers other than health maintenance organizations, participation in the
medical assistance program means that:
     (1) the provider accepts new medical assistance, general assistance medical care,
and MinnesotaCare patients;
    (2) for providers other than dental service providers, at least 20 percent of the
provider's patients are covered by medical assistance, general assistance medical care,
and MinnesotaCare as their primary source of coverage; or
    (3) for dental service providers, at least ten percent of the provider's patients are
covered by medical assistance, general assistance medical care, and MinnesotaCare as
their primary source of coverage, or the provider accepts new medical assistance and
MinnesotaCare patients who are children with special health care needs. For purposes
of this section, "children with special health care needs" means children up to age 18
who: (i) require health and related services beyond that required by children generally;
and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
neurological diseases; visual impairment or deafness; Down syndrome and other genetic
disorders; autism; fetal alcohol syndrome; and other conditions designated by the
commissioner after consultation with representatives of pediatric dental providers and
consumers.
    (c) Patients seen on a volunteer basis by the provider at a location other than
the provider's usual place of practice may be considered in meeting the participation
requirement in this section. The commissioner shall establish participation requirements
for health maintenance organizations. The commissioner shall provide lists of participating
medical assistance providers on a quarterly basis to the commissioner of management and
budget, the commissioner of labor and industry, and the commissioner of commerce. Each
of the commissioners shall develop and implement procedures to exclude as participating
providers in the program or programs under their jurisdiction those providers who do
not participate in the medical assistance program. The commissioner of management
and budget shall implement this section through contracts with participating health and
dental carriers.
(d) Any hospital or other provider that is participating in a coordinated care
delivery system under section 256D.031, subdivision 6, or receives payments from the
uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to
provide services to any patient enrolled in general assistance medical care regardless of
the availability or the amount of payment.
    (e) For purposes of paragraphs (a) and (b), participation in the general assistance
medical care program applies only to pharmacy providers.

    Sec. 7. Minnesota Statutes 2009 Supplement, section 256B.0947, subdivision 1,
is amended to read:
    Subdivision 1. Scope. Effective November 1, 2010 2011, and subject to federal
approval, medical assistance covers medically necessary, intensive nonresidential
rehabilitative mental health services as defined in subdivision 2, for recipients as defined
in subdivision 3, when the services are provided by an entity meeting the standards
in this section.

    Sec. 8. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2, is
amended to read:
    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
services upper payment limit for nonstate government hospitals. The commissioner shall
then determine the amount of a supplemental payment to Hennepin County Medical
Center and Regions Hospital for these services that would increase medical assistance
spending in this category to the aggregate upper payment limit for all nonstate government
hospitals in Minnesota. In making this determination, the commissioner shall allot the
available increases between Hennepin County Medical Center and Regions Hospital
based on the ratio of medical assistance fee-for-service outpatient hospital payments to
the two facilities. The commissioner shall adjust this allotment as necessary based on
federal approvals, the amount of intergovernmental transfers received from Hennepin and
Ramsey Counties, and other factors, in order to maximize the additional total payments.
The commissioner shall inform Hennepin County and Ramsey County of the periodic
intergovernmental transfers necessary to match federal Medicaid payments available
under this subdivision in order to make supplementary medical assistance payments to
Hennepin County Medical Center and Regions Hospital equal to an amount that when
combined with existing medical assistance payments to nonstate governmental hospitals
would increase total payments to hospitals in this category for outpatient services to
the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to Hennepin County Medical Center and Regions Hospital.
    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians affiliated with Hennepin County Medical
Center and with Regions Hospital. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
Ramsey County of the periodic intergovernmental transfers necessary to match the federal
Medicaid payments available under this subdivision in order to make supplementary
payments to physicians affiliated with Hennepin County Medical Center and Regions
Hospital equal to the difference between the established medical assistance payment for
physician services and the upper payment limit. Upon receipt of these periodic transfers,
the commissioner shall make supplementary payments to physicians of Hennepin Faculty
Associates and HealthPartners.
    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shall may
make monthly voluntary intergovernmental transfers to the commissioner in the following
amounts: $133,333 by not to exceed $12,000,000 per year from Hennepin County
and $100,000 by $6,000,000 per year from Ramsey County. The commissioner shall
increase the medical assistance capitation payments to Metropolitan Health Plan and
HealthPartners by any licensed health plan under contract with the medical assistance
program that agrees to make enhanced payments to Hennepin County Medical Center or
Regions Hospital. The increase shall be in an amount equal to the annual value of the
monthly transfers plus federal financial participation., with each health plan receiving its
pro rata share of the increase based on the pro rata share of medical assistance admissions
to Hennepin County Medical Center and Regions Hospital by those plans. Upon the
request of the commissioner, health plans shall submit individual-level cost data for
verification purposes. The commissioner may ratably reduce these payments on a pro rata
basis in order to satisfy federal requirements for actuarial soundness. If payments are
reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
increased medical assistance capitation payments under the intergovernmental transfer
described in this paragraph shall increase its medical assistance payments to Hennepin
County Medical Center and Regions Hospital by the same amount as the increased
payments received in the capitation payment described in this paragraph.
    (d) The commissioner shall inform Hennepin County and Ramsey County on an
ongoing basis of the need for any changes needed in the intergovernmental transfers
in order to continue the payments under paragraphs (a) to (c), at their maximum level,
including increases in upper payment limits, changes in the federal Medicaid match, and
other factors.
    (e) The payments in paragraphs (a) to (c) shall be implemented independently of
each other, subject to federal approval and to the receipt of transfers under subdivision 3.
EFFECTIVE DATE.This section is effective 60 days after federal approval.

    Sec. 9. [256B.197] INTERGOVERNMENTAL TRANSFERS; INPATIENT
HOSPITAL PAYMENTS.
    Subdivision 1. Federal approval required. This section is effective for federal
fiscal year 2010 and future years contingent on federal approval of the voluntary
intergovernmental transfers and payments authorized under this section and contingent on
payment of the intergovernmental transfers under this section.
    Subd. 2. Eligible nonstate government hospitals. (a) Hennepin County Medical
Center and Regions Hospital are eligible nonstate government hospitals.
(b) If the commissioner obtains federal approval to include other hospitals, including
University of Minnesota Medical Center, Fairview, and SMDC Medical Center, the
commissioner may expand the definition of eligible nonstate government hospitals to
include other hospitals.
    Subd. 3. Commissioner's duties. (a) For the purposes of this subdivision, the
commissioner shall determine the fee-for-service inpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall determine,
for each eligible nonstate government hospital, the amount of a supplemental payment
for inpatient hospital services that would increase medical assistance spending for each
eligible nonstate government hospital up to the amount that Medicare would pay for
the Medicaid fee-for-service inpatient hospital services provided by that hospital. If
the combined amount of such supplemental payment amounts and existing medical
assistance payments for inpatient hospital services to all nonstate government hospitals
is less than the upper payment limit, the commissioner shall increase the supplemental
payment amount for each eligible nonstate government hospital in proportion to the initial
supplemental payments in order to maximize the additional total payments.
(b) The commissioner shall inform each eligible nonstate government hospital and
associated governmental entities of voluntary intergovernmental transfers necessary to
provide the nonfederal share for the supplemental payment amount attributable to each
eligible nonstate government hospital, as calculated under paragraph (a).
(c) Upon receipt of a voluntary intergovernmental transfer from a governmental
entity associated with an eligible nonstate government hospital or from the eligible
nonstate government hospital, the commissioner shall make a supplemental payment,
using the amounts calculated under paragraph (a), to the associated eligible nonstate
government hospital.
(d) The commissioner may implement the payments in this section through use of
periodic payments and voluntary intergovernmental transfers.
(e) The commissioner shall inform eligible nonstate government hospitals and
associated governmental entities on an ongoing basis of the need for any changes needed
in the payment amounts or voluntary intergovernmental transfers in order to continue
the payments under paragraph (c) at their maximum level, including increases in upper
payment limits, changes in the federal Medicaid match, and other factors.

    Sec. 10. Minnesota Statutes 2008, section 256B.69, subdivision 20, is amended to read:
    Subd. 20. Ombudsperson. (a) The commissioner shall designate an ombudsperson
to advocate for persons required to enroll in prepaid health plans under this section. The
ombudsperson shall advocate for recipients enrolled in prepaid health plans through
complaint and appeal procedures and ensure that necessary medical services are provided
either by the prepaid health plan directly or by referral to appropriate social services. At
the time of enrollment in a prepaid health plan, the local agency shall inform recipients
about the ombudsperson program and their right to a resolution of a complaint by the
prepaid health plan if they experience a problem with the plan or its providers.
(b) The commissioner shall designate an ombudsperson to advocate for persons
enrolled in a care coordination delivery system under section 256D.031. The
ombudsperson shall advocate for recipients enrolled in a care coordination delivery
system through the state appeal process and assist enrollees in accessing necessary
medical services through the care coordination delivery systems directly or by referral to
appropriate services. At the time of enrollment in a care coordination delivery system, the
local agency shall inform recipients about the ombudsperson program.

    Sec. 11. Minnesota Statutes 2009 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 for
applicants and recipients defined in paragraph (c), except as provided in paragraph (d),
and: Beginning April 1, 2010, the general assistance medical care program shall be
administered according to section 256D.031, unless otherwise stated, except for outpatient
prescription drug coverage, which shall continue to be administered under this section and
funded under section 256D.031, subdivision 9, beginning June 1, 2010.
(b) Outpatient prescription drug coverage under general assistance medical care is
limited to prescription drugs that:
(1) are covered under the medical assistance program as described in section
256B.0625, subdivisions 13 and 13d; and
(2) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with the agreements.
Outpatient prescription drug coverage under general assistance medical care must conform
to coverage under the medical assistance program according to section 256B.0625,
subdivisions 13 to 13g.
    (1) who is receiving assistance under section 256D.05, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
    (2) who is a resident of Minnesota; and
    (i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
section 256B.056, subdivisions 3 and 3d, 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; or
    (ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the family
size, using a six-month budget period, whose equity in assets is not in excess of the limits
in section 256B.056, subdivision 3c, and who applies during an inpatient hospitalization.
    (b) The commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.
    (c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (f).
    (d) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
subdivision 7
, with covered services as provided in section 256L.03 for the rest of the
six-month general assistance medical care eligibility period, until their six-month renewal.
    (e) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (d), an individual must complete a new
application.
    (f) Applicants and recipients eligible under paragraph (a), clause (2), item (i), are
exempt from the MinnesotaCare enrollment requirements in this subdivision if they:
    (1) have applied for and are awaiting a determination of blindness or disability by
the state medical review team or a determination of eligibility for Supplemental Security
Income or Social Security Disability Insurance by the Social Security Administration;
    (2) fail to meet the requirements of section 256L.09, subdivision 2;
    (3) are homeless as defined by United States Code, title 42, section 11301, et seq.;
    (4) are classified as end-stage renal disease beneficiaries in the Medicare program;
    (5) are enrolled in private health care coverage as defined in section 256B.02,
subdivision 9;
    (6) are eligible under paragraph (k);
    (7) receive treatment funded pursuant to section 254B.02; or
    (8) reside in the Minnesota sex offender program defined in chapter 246B.
    (g) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.
    (h) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(d) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (d), (f), and (g).
    (i) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
applicant must complete the application within the time periods required under the
medical assistance program as specified in Minnesota Rules, parts 9505.0015, subpart
5, and 9505.0090, subpart 2. The county agency must assist the applicant in obtaining
verification if necessary.
    (j) 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.
    (k) 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.
    (l) 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.
    (m) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.
    (n) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.
    (o) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101, subsection
(a), paragraph (15), and an undocumented noncitizen is an individual who resides in
the United States without the approval or acquiescence of the United States Citizenship
and Immigration Services.
    (p) 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.
    (q) Effective July 1, 2003, general assistance medical care emergency services end.
    (c) Outpatient prescription drug coverage does not include drugs administered in a
clinic or other outpatient setting.
EFFECTIVE DATE.This section is effective April 1, 2010.

    Sec. 12. [256D.031] GENERAL ASSISTANCE MEDICAL CARE.
    Subdivision 1. Eligibility. (a) Except as provided under subdivision 2, general
assistance medical care may be paid for any individual 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, and who:
(1) is receiving assistance under section 256D.05, except for families with children
who are eligible under the Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or
(2) is a resident of Minnesota and has gross countable income not in excess of 75
percent of federal poverty guidelines for the family size, using a six-month budget period,
and whose equity in assets is not in excess of $1,000 per assistance unit.
Exempt assets, the reduction of excess assets, and the waiver of excess assets must
conform to the medical assistance program in section 256B.056, subdivisions 3 and 3d,
except that 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.
(b) The commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.
    Subd. 2. Ineligible groups. (a) General assistance medical care may not be paid for
an applicant or a recipient who:
(1) is otherwise eligible for medical assistance but fails to verify the applicant's
or recipient's assets;
(2) is an adult in a family with children as defined in section 256L.01, subdivision 3a;
(3) is enrolled in private health coverage as defined in section 256B.02, subdivision
9;
(4) is in a correctional facility, including an individual in a county correctional or
detention facility as an individual accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order;
(5) resides in the Minnesota sex offender program defined in chapter 246B;
(6) does not cooperate with the county agency to meet the requirements of medical
assistance; or
(7) does not cooperate with a county or state agency or the state medical review team
in determining a disability or for determining eligibility for Supplemental Security Income
or Social Security Disability Insurance by the Social Security Administration.
(b) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101, subsection
(a), paragraph (15), and an undocumented noncitizen is an individual who resides in the
United States without approval or acquiescence of the United States Citizenship and
Immigration Services.
(c) 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.
(d) General assistance medical care recipients who become eligible for medical
assistance shall be terminated from general assistance medical care and transferred to
medical assistance.
    Subd. 3. Eligibility and enrollment procedures. (a) Eligibility for general
assistance medical care shall begin no earlier than the date of application. The date of
application shall be the date the applicant has provided a name, address, and Social
Security number, signed and dated, to the county agency or the Department of Human
Services. If the applicant is unable to provide a name, address, Social Security number,
and signature when health care is delivered due to a medical condition or disability, a
health care provider may act on an applicant's behalf to establish the date of an application
by providing the county agency or Department of Human Services with provider
identification and a temporary unique identifier for the applicant. The applicant must
complete the remainder of the application and provide necessary verification before
eligibility can be determined. The applicant must complete the application within the time
periods required under the medical assistance program as specified in Minnesota Rules,
parts 9505.0015, subpart 5; and 9505.0090, subpart 2. The county agency must assist the
applicant in obtaining verification if necessary.
    (b) 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.
    (c) In determining the amount of assets of an individual eligible under subdivision 1,
paragraph (a), clause (2), there shall be included any asset or interest in an asset, including
an asset excluded under subdivision 1, 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.
    (d) When determining eligibility for any state benefits under this subdivision, the
income and resources of all noncitizens shall be deemed to include the noncitizen's
sponsor's income and resources as defined in the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and
422, and subsequently set out in federal rules.
(e) Applicants and recipients are eligible for general assistance medical care for a
six-month eligibility period, unless a change that affects eligibility is reported. Eligibility
may be renewed for additional six-month periods. During each six-month eligibility
period, recipients who continue to meet the eligibility requirements of this section are
not eligible for MinnesotaCare.
    Subd. 4. General assistance medical care; services. (a) Within the limitations
described in this section, general assistance medical care covers medically necessary
services that include:
(1) inpatient hospital services;
    (2) outpatient hospital services;
    (3) services provided by Medicare-certified rehabilitation agencies;
    (4) prescription drugs;
    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;
    (6) eyeglasses and eye examinations;
    (7) hearing aids;
    (8) prosthetic devices, if not covered by veterans benefits;
    (9) laboratory and x-ray services;
    (10) physicians' services;
    (11) medical transportation except special transportation;
    (12) chiropractic services as covered under the medical assistance program;
    (13) podiatric services;
    (14) dental services;
    (15) mental health services covered under chapter 256B;
    (16) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an inpatient basis is not included
as part of the cost for inpatient services included in the operating payment rate, and (3) the
service is within the scope of practice of the nurse practitioner's license as a registered
nurse, as defined in section 148.171;
    (17) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;
    (18) telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b;
    (19) care coordination and patient education services provided by a community
health worker according to section 256B.0625, subdivision 49; and
(20) regardless of the number of employees that an enrolled health care provider
may have, sign language interpreter services when provided by an enrolled health care
provider during the course of providing a direct, person-to-person covered health care
service to an enrolled recipient who has a hearing loss and uses interpreting services.
(b) Sex reassignment surgery is not covered under this section.
(c) Outpatient prescription drug coverage is covered in accordance with section
256D.03, subdivision 3.
(d) The following co-payments shall apply for services provided:
(1) $25 for nonemergency visits to a hospital-based emergency room; and
(2) $3 per brand-name drug prescription, and $1 per generic drug prescription,
subject to a $7 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness.
(e) Co-payments shall be limited to one per day per provider for nonemergency
visits to a hospital-based emergency room. Recipients of general assistance medical care
are responsible for all co-payments in this subdivision. Reimbursement for prescription
drugs shall be reduced by the amount of the co-payment until the recipient has reached the
$7 per month maximum for prescription drug co-payments. The provider shall collect
the co-payment from the recipient. Providers may not deny services to recipients who
are unable to pay the co-payment.
(f) Chemical dependency services that are reimbursed under chapter 254B shall not
be reimbursed under general assistance medical care.
(g) Inpatient hospital services that are provided in community behavioral health
hospitals operated by state-operated services shall not be reimbursed under general
assistance medical care.
    Subd. 5. Payment rates and contract modification; April 1, 2010, to May 31,
2010. (a) For the period April 1, 2010, to May 31, 2010, general assistance medical
care shall be paid on a fee-for-service basis. Fee-for-service payment rates for services
other than outpatient prescription drugs shall be set at 37 percent of the payment rate in
effect on March 31, 2010.
(b) Outpatient prescription drugs covered under section 256D.03, subdivision 3,
provided on or after April 1, 2010, to May 31, 2010, shall be paid on a fee-for-service
basis according to section 256B.0625, subdivisions 13 to 13g.
    Subd. 6. Coordinated care delivery systems. (a) Effective June 1, 2010, the
commissioner shall contract with hospitals or groups of hospitals that qualify under
paragraph (b) and agree to deliver services according to this subdivision. Contracting
hospitals shall develop and implement a coordinated care delivery system to provide
health care services to individuals who are eligible for general assistance medical care
under this section and who either choose to receive services through the coordinated
care delivery system or who are enrolled by the commissioner under paragraph (c). The
health care services provided by the system must include: (1) the services described in
subdivision 4 with the exception of outpatient prescription drug coverage but shall include
drugs administered in a clinic or other outpatient setting; or (2) a set of comprehensive
and medically necessary health services that the recipients might reasonably require to be
maintained in good health and that has been approved by the commissioner, including at a
minimum, but not limited to, emergency care, medical transportation services, inpatient
hospital and physician care, outpatient health services, preventive health services, mental
health services, and prescription drugs administered in a clinic or other outpatient setting.
Outpatient prescription drug coverage is covered on a fee-for-service basis in accordance
with section 256D.03, subdivision 3, and funded under subdivision 9. A hospital
establishing a coordinated care delivery system under this subdivision must ensure that the
requirements of this subdivision are met.
(b) A hospital or group of hospitals may contract with the commissioner to develop
and implement a coordinated care delivery system as follows:
(1) effective June 1, 2010, a hospital qualifies under this subdivision if: (i) during
calendar year 2008, it received fee-for-service payments for services to general assistance
medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater
than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to
provide geographic access or to ensure that at least 80 percent of enrollees have access to
a coordinated care delivery system; and
(2) effective December 1, 2010, a Minnesota hospital not qualified under clause
(1) may contract with the commissioner under this subdivision if it agrees to satisfy the
requirements of this subdivision.
Participation by hospitals shall become effective quarterly on June 1, September 1,
December 1, or March 1. Hospital participation is effective for a period of 12 months and
may be renewed for successive 12-month periods.
(c) Applicants and recipients may enroll in any available coordinated care delivery
system statewide. If more than one coordinated care delivery system is available, the
applicant or recipient shall be allowed to choose among the systems. The commissioner
may assign an applicant or recipient to a coordinated care delivery system if no choice
is made by the applicant or recipient. The commissioner shall consider a recipient's zip
code, city of residence, county of residence, or distance from a participating coordinated
care delivery system when determining default assignment. An applicant or recipient
may decline enrollment in a coordinated care delivery system. Upon enrollment into a
coordinated care delivery system, the recipient must agree to receive all nonemergency
services through the coordinated care delivery system. Enrollment in a coordinated care
delivery system is for six months and may be renewed for additional six-month periods,
except that initial enrollment is for six months or until the end of a recipient's period
of general assistance medical care eligibility, whichever occurs first. A recipient who
continues to meet the eligibility requirements of this section is not eligible to enroll in
MinnesotaCare during a period of enrollment in a coordinated care delivery system. From
June 1, 2010, to November 30, 2010, applicants and recipients not enrolled in a coordinated
care delivery system may seek services from a hospital eligible for reimbursement under
the temporary uncompensated care pool established under subdivision 8. After November
30, 2010, services are available only through a coordinated care delivery system.
(d) The hospital may contract and coordinate with providers and clinics for the
delivery of services and shall contract with essential community providers as defined
under section 62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the extent
practicable. If a provider or clinic contracts with a hospital to provide services through the
coordinated care delivery system, the provider may not refuse to provide services to any
recipient enrolled in the system, and payment for services shall be negotiated with the
hospital and paid by the hospital from the system's allocation under subdivision 7.
(e) A coordinated care delivery system must:
(1) provide the covered services required under paragraph (a) to recipients enrolled
in the coordinated care delivery system, and comply with the requirements of subdivision
4, paragraphs (b) to (g);
(2) establish a process to monitor enrollment and ensure the quality of care provided;
and
(3) in cooperation with counties, coordinate the delivery of health care services with
existing homeless prevention, supportive housing, and rent subsidy programs and funding
administered by the Minnesota Housing Finance Agency under chapter 462A; and
(4) adopt innovative and cost-effective methods of care delivery and coordination,
which may include the use of allied health professionals, telemedicine, patient educators,
care coordinators, and community health workers.
(f) The hospital may require a recipient to designate a primary care provider or
a primary care clinic. The hospital may limit the delivery of services to a network of
providers who have contracted with the hospital to deliver services in accordance with
this subdivision, and require a recipient to seek services only within this network. The
hospital may also require a referral to a provider before the service is eligible for payment.
A coordinated care delivery system is not required to provide payment to a provider
who is not employed by or under contract with the system for services provided to a
recipient enrolled in the system, except in cases of an emergency. For purposes of this
section, emergency services are defined in accordance with Code of Federal Regulations,
title 42, section 438.114(a).
(g) A recipient enrolled in a coordinated care delivery system has the right to appeal
to the commissioner according to section 256.045.
(h) The state shall not be liable for the payment of any cost or obligation incurred
by the coordinated care delivery system.
(i) The hospital must provide the commissioner with data necessary for assessing
enrollment, quality of care, cost, and utilization of services. Each hospital must provide,
on a quarterly basis on a form prescribed by the commissioner for each recipient served by
the coordinated care delivery system, the services provided, the cost of services provided,
and the actual payment amount for the services provided and any other information the
commissioner deems necessary to claim federal Medicaid match. The commissioner must
provide this data to the legislature on a quarterly basis.
(j) Effective June 1, 2010, the provisions of section 256.9695, subdivision 2,
paragraph (b), do not apply to general assistance medical care provided under this section.
    Subd. 7. Payments; rate setting for the hospital coordinated care delivery
system. (a) Effective for general assistance medical care services, with the exception
of outpatient prescription drug coverage, provided on or after June 1, 2010, through a
coordinated care delivery system, the commissioner shall allocate the annual appropriation
for the coordinated care delivery system to hospitals participating under subdivision
6 in quarterly payments, beginning on the first scheduled warrant on or after June 1,
2010. The payment shall be allocated among all hospitals qualified to participate on the
allocation date. Each hospital or group of hospitals shall receive a pro rata share of the
allocation based on the hospital's or group of hospitals' calendar year 2008 payments for
general assistance medical care services, provided that, for the purposes of this allocation,
payments to Hennepin County Medical Center, Regions Hospital, Saint Mary's Medical
Center, and University of Minnesota Medical Center, Fairview, shall be weighted at 110
percent of the actual amount. The commissioner may prospectively reallocate payments to
participating hospitals on a biannual basis to ensure that final allocations reflect actual
coordinated care delivery system enrollment. The 2008 base year shall be updated by one
calendar year each June 1, beginning June 1, 2011.
(b) In order to be reimbursed under this section, nonhospital providers of health
care services shall contract with one or more hospitals described in paragraph (a) to
provide services to general assistance medical care recipients through the coordinated care
delivery system established by the hospital. The hospital shall reimburse bills submitted
by nonhospital providers participating under this paragraph at a rate negotiated between
the hospital and the nonhospital provider.
(c) The commissioner shall apply for federal matching funds under section
256B.199, paragraphs (a) to (d), for expenditures under this subdivision.
(d) Outpatient prescription drug coverage is provided in accordance with section
256D.03, subdivision 3, and paid on a fee-for-service basis under subdivision 9.
    Subd. 8. Temporary uncompensated care pool. (a) The commissioner shall
establish a temporary uncompensated care pool, effective June 1, 2010. Payments from
the pool must be distributed, within the limits of the available appropriation, to hospitals
that are not part of a coordinated care delivery system established under subdivision 6.
(b) Hospitals seeking reimbursement from this pool must submit an invoice to
the commissioner in a form prescribed by the commissioner for payment for services
provided to an applicant or recipient not enrolled in a coordinated care delivery system. A
payment amount, as calculated under current law, must be determined, but not paid, for
each admission of or service provided to a general assistance medical care recipient on or
after June 1, 2010, to November 30, 2010.
(c) The aggregated payment amounts for each hospital must be calculated as a
percentage of the total calculated amount for all hospitals.
(d) Distributions from the uncompensated care pool for each hospital must be
determined by multiplying the factor in paragraph (c) by the amount of money in the
uncompensated care pool that is available for the six-month period.
(e) The commissioner shall apply for federal matching funds under section
256B.199, paragraphs (a) to (d), for expenditures under this subdivision.
(f) Outpatient prescription drugs are not eligible for payment under this subdivision.
    Subd. 9. Prescription drug pool. (a) The commissioner shall establish an
outpatient prescription drug pool, effective June 1, 2010. Money in the pool must
be used to reimburse pharmacies and other pharmacy service providers as defined in
Minnesota Rules, part 9505.0340, for the covered outpatient prescription drugs dispensed
to recipients. Payment for drugs shall be on a fee-for-service basis according to the rates
established in section 256B.0625, subdivision 13e. Outpatient prescription drug coverage
is subject to the availability of funds in the pool. If the commissioner forecasts that
expenditures under this subdivision will exceed the appropriation for this purpose, the
commissioner may bring recommendations to the Legislative Advisory Commission on
methods to resolve the shortfall.
(b) Effective June 1, 2010, coordinated care delivery systems established under
subdivision 6 shall pay to the commissioner, on a quarterly basis, an assessment equal
to 20 percent of payments for the prescribed drugs for recipients of services through
that coordinated care delivery system, as calculated by the commissioner based on the
most recent available data.
    Subd. 10. Assistance for veterans. Hospitals participating in the coordinated care
delivery system under subdivision 6 shall consult with counties, county veterans service
officers, and the Veterans Administration to identify other programs for which general
assistance medical care recipients enrolled in their system are qualified.
EFFECTIVE DATE.This section is effective for services rendered on or after
April 1, 2010.

    Sec. 13. Minnesota Statutes 2008, section 256L.05, subdivision 1b, is amended to read:
    Subd. 1b. MinnesotaCare enrollment by county agencies. Beginning September
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3. County agencies
shall perform all duties necessary to administer the MinnesotaCare program ongoing for
these enrollees, including the redetermination of MinnesotaCare eligibility at renewal.
EFFECTIVE DATE.This section is effective April 1, 2010.

    Sec. 14. Minnesota Statutes 2008, section 256L.05, subdivision 3, is amended to read:
    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
first day of the month following the month in which eligibility is approved and the first
premium payment has been received. As provided in section 256B.057, coverage for
newborns is automatic from the date of birth and must be coordinated with other health
coverage. The effective date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the month of placement. The effective date
of coverage for other new members added to the family is the first day of the month
following the month in which the change is reported. All eligibility criteria must be met
by the family at the time the new family member is added. The income of the new family
member is included with the family's gross income and the adjusted premium begins in
the month the new family member is added.
(b) The initial premium must be received by the last working day of the month for
coverage to begin the first day of the following month.
(c) Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.
(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
256L.18 are secondary to a plan of insurance or benefit program under which an eligible
person may have coverage and the commissioner shall use cost avoidance techniques to
ensure coordination of any other health coverage for eligible persons. The commissioner
shall identify eligible persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.
(e) The effective date of coverage for single adults and households with no children
formerly enrolled in general assistance medical care and enrolled in MinnesotaCare
according to section 256D.03, subdivision 3, is the first day of the month following the
last day of general assistance medical care coverage.
EFFECTIVE DATE.This section is effective January 1, 2011.

    Sec. 15. Minnesota Statutes 2008, section 256L.05, subdivision 3a, is amended to read:
    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.
    (b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. The
commissioner may establish criteria and timelines for sites to forward applications to the
commissioner or county agencies. The premium for the new period of eligibility must be
received as provided in section 256L.06 in order for eligibility to continue.
    (c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3
, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.
    (d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period before being
disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
additional month.
EFFECTIVE DATE.This section is effective January 1, 2011.

    Sec. 16. Minnesota Statutes 2008, section 256L.05, subdivision 3c, is amended to read:
    Subd. 3c. Retroactive coverage. Notwithstanding subdivision 3, the effective
date of coverage shall be the first day of the month following termination from medical
assistance or general assistance medical care for families and individuals who are eligible
for MinnesotaCare and who submitted a written request for retroactive MinnesotaCare
coverage with a completed application within 30 days of the mailing of notification of
termination from medical assistance or general assistance medical care. The applicant
must provide all required verifications within 30 days of the written request for
verification. For retroactive coverage, premiums must be paid in full for any retroactive
month, current month, and next month within 30 days of the premium billing. General
assistance medical care recipients may qualify for retroactive coverage under this
subdivision at six-month renewal.

    Sec. 17. Minnesota Statutes 2008, section 517.08, subdivision 1c, is amended to read:
    Subd. 1c. Disposition of license fee. (a) Of the marriage license fee collected
pursuant to subdivision 1b, paragraph (a), $25 must be retained by the county. The local
registrar must pay $85 to the commissioner of management and budget to be deposited
as follows:
    (1) $50 $55 in the general fund;
    (2) $3 in the state government special revenue fund to be appropriated to the
commissioner of public safety for parenting time centers under section 119A.37;
    (3) $2 in the special revenue fund to be appropriated to the commissioner of health
for developing and implementing the MN ENABL program under section 145.9255; and
    (4) $25 in the special revenue fund is appropriated to the commissioner of
employment and economic development for the displaced homemaker program under
section 116L.96; and
    (5) $5 in the special revenue fund is appropriated to the commissioner of human
services for the Minnesota Healthy Marriage and Responsible Fatherhood Initiative under
section 256.742.
    (b) Of the $40 fee under subdivision 1b, paragraph (b), $25 must be retained by the
county. The local registrar must pay $15 to the commissioner of management and budget
to be deposited as follows:
    (1) $5 as provided in paragraph (a), clauses (2) and (3); and
    (2) $10 in the special revenue fund is appropriated to the commissioner of
employment and economic development for the displaced homemaker program under
section 116L.96.
    (c) The increase in the marriage license fee under paragraph (a) provided for in Laws
2004, chapter 273, and disbursement of the increase in that fee to the special fund for the
Minnesota Healthy Marriage and Responsible Fatherhood Initiative under paragraph (a),
clause (5), is contingent upon the receipt of federal funding under United States Code, title
42, section 1315, for purposes of the initiative.
EFFECTIVE DATE.This section is effective July 1, 2010.

    Sec. 18. DRUG REBATE PROGRAM.
The commissioner of human services shall continue to administer a drug rebate
program for drugs purchased for persons eligible for the general assistance medical care
program in accordance with Minnesota Statutes, sections 256.01, subdivision 2, paragraph
(cc), and 256D.03.
EFFECTIVE DATE. This section is effective April 1, 2010.

    Sec. 19. TRANSITIONAL MINNESOTACARE PHASEOUT.
    For any applicant or recipient who meets the requirements of Minnesota Statutes
2009 Supplement, section 256D.03, subdivision 3, paragraph (d), before April 1, 2010,
and who is not exempt under Minnesota Statutes 2009 Supplement, section 256D.03,
subdivision 3, paragraph (f), the commissioner of human services shall continue the
process of enrolling the recipient in MinnesotaCare as required under Minnesota Statutes
2009 Supplement, section 256D.03, subdivision 3, paragraph (d), and, upon the completion
of enrollment, the recipient shall receive services under MinnesotaCare in accordance
with Minnesota Statutes, section 256L.03. County agencies shall continue to perform
all duties necessary to administer the MinnesotaCare program ongoing for individuals
enrolled in MinnesotaCare according to Minnesota Statutes 2009 Supplement, section
256D.03, subdivision 3, paragraph (d), including the redetermination of MinnesotaCare
eligibility at renewal.
EFFECTIVE DATE. This section is effective April 1, 2010.

    Sec. 20. REVISOR'S INSTRUCTION.
The revisor of statutes shall edit Minnesota Statutes, sections 256B.69 and 256B.692,
to remove references to the general assistance medical care program.
EFFECTIVE DATE.This section is effective June 1, 2010.

    Sec. 21. REPEALER.
(a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; and 256D.03,
subdivision 9, are repealed effective April 1, 2010.
(b) Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 4, is repealed
effective April 1, 2010.
(c) Minnesota Statutes 2008, section 256B.195, subdivisions 4 and 5, are repealed
effective for federal fiscal year 2010.
(d) Minnesota Statutes 2009 Supplement, section 256B.195, subdivisions 1, 2, and
3, are repealed effective for federal fiscal year 2010.
(e) Minnesota Statutes 2008, sections 256L.07, subdivision 6; 256L.15, subdivision
4; and 256L.17, subdivision 7, are repealed January 1, 2011.

ARTICLE 2
APPROPRIATIONS


Section 1. HUMAN SERVICES APPROPRIATIONS.
The sums shown in the columns marked "Appropriations" are added to or, if shown
in parentheses, subtracted from the appropriations in Laws 2009, chapter 79, as amended
by Laws 2009, chapter 173, or other law to the agencies and for the purposes specified in
this article. The appropriations are from the general fund, or another named fund, and are
available for the fiscal years indicated for each purpose. The figures "2010" and "2011"
used in this article mean that the addition to or subtraction from appropriations listed under
them are available for the fiscal year ending June 30, 2010, or June 30, 2011, respectively.
"The first year" is fiscal year 2010. "The second year" is fiscal year 2011. "The biennium"
is fiscal years 2010 and 2011. Supplemental appropriations and reductions for the fiscal
year ending June 30, 2010, are effective the day following final enactment.

APPROPRIATIONS

Available for the Year

Ending June 30

2010
2011


Sec. 2. HUMAN SERVICES

Subdivision 1.Total Appropriation
$
(7,985,000)
$
(93,128,000)

Appropriations by Fund

2010
2011

General
34,807,000
118,493,000

Health Care Access
(42,792,000)
(211,621,000)
The amounts that may be spent for each
purpose are specified in the following
subdivisions.


Subd. 2.Children Support Enforcement
Grants
-0-
(300,000)
Minnesota Healthy Marriage and
Responsible Fatherhood Initiative Fee.
Notwithstanding Minnesota Statutes, section
517.08, the balance and the fee revenue
available to the commissioner of human
services for the healthy marriage and
responsible fatherhood initiative in the state
government special revenue fund must be
transferred to and deposited into the general
fund by June 30, 2011.


Subd. 3.Children and Economic Assistance
Operations
(1,408,000)
(1,560,000)

Subd. 4.Basic Health Care Grants
The amounts that may be spent from this
appropriation for each purpose are as follows:

(a) MinnesotaCare Grants
(42,792,000)
(211,621,000)
This appropriation reduction is from the
health care access fund.


(b) Medical Assistance Basic Health Care
Grants - Families and Children
-0-
(49,000)


(c) Medical Assistance Basic Health Care
Grants - Elderly and Disabled
-0-
(1,275,000)

(d) General Assistance Medical Care
39,413,000
135,837,000
For general assistance medical care payments
under Minnesota Statutes, section 256D.031.
$5,500,000 in fiscal year 2010 and
$65,500,000 in fiscal year 2011 is for
payments to coordinated care delivery
systems under Minnesota Statutes, section
256D.031, subdivision 7.
$4,375,000 in fiscal year 2010 and
$51,875,000 in fiscal year 2011 is for
payments for prescription drugs under
Minnesota Statutes, section 256D.031,
subdivision 9.
$28,000,000 in fiscal year 2010 is for
provider and prescription drug payments
under Minnesota Statutes, section 256D.031,
subdivision 5.
$1,538,000 in fiscal year 2010 and
$18,462,000 in fiscal year 2011 is for
payments from the temporary uncompensated
care pool under Minnesota Statutes, section
256D.031, subdivision 8.
Any amount under paragraph (d) that is not
spent in the first year does not cancel and is
available for payments in the second year.
The commissioner may transfer any
unexpended amount under Minnesota
Statutes, section 256D.031, subdivision 9,
after the final allocation in fiscal year 2011 to
make payments under Minnesota Statutes,
section 256D.031, subdivision 7.
Any unexpended amount not used for
general assistance medical care expenditures
incurred before April 1, 2010, under
Minnesota Statutes, section 256D.03, shall be
used to make payments under paragraph (d).

Subd. 5.Health Care Management
The amounts that may be spent from the
appropriation for each purpose are as follows:

Health Care Administration.
(2,998,000)
(5,270,000)
Base Adjustment. The general fund base
for health care administration is reduced by
$182,000 in fiscal year 2012 and $182,000 in
fiscal year 2013.

Subd. 6.Continuing Care Grants

(a) Mental Health Grants
(200,000)
(7,904,000)
The general fund appropriation to the
commissioner of human services for adult
mental health grants in Laws 2009, chapter
79, article 13, section 3, subdivision 8, as
amended by Laws 2009, chapter 173, article
2, section 1, subdivision 8, is reduced by
$7,704,000 in fiscal year 2011. This is a
onetime reduction.
$200,000 of the reduction in each year is
to eliminate specialty care grants for the
2007 mental health initiative infrastructure
investments.

(b) Other Continuing Care Grants
-0-
(2,037,000)
HIV Grants. The general fund appropriation
for the HIV drug and insurance grant
program shall be reduced by $2,037,000 in
fiscal year 2011 and increased by $2,037,000
in fiscal year 2013. These adjustments are
onetime and must not be applied to the base.
Notwithstanding any contrary provision, this
provision expires June 30, 2013.

Subd. 7.Continuing Care Management
-0-
1,051,000

Subd. 8.Transfers
The commissioner must transfer $29,538,000
in fiscal year 2010 and $18,462,000 in fiscal
year 2011 from the health care access fund to
the general fund. This is a onetime transfer.
The commissioner must transfer $4,800,000
from the consolidated chemical dependency
treatment fund to the general fund by June
30, 2010.
Compulsive Gambling Special Revenue
Administration. $6,000 for fiscal year
2010 and $4,000 for fiscal year 2011 must
be transferred from the lottery prize fund
appropriation for compulsive gambling
administration to the general fund by June 30
of each respective fiscal year.
EFFECTIVE DATE.This article is effective April 1, 2010.
Presented to the governor March 25, 2010
Signed by the governor March 26, 2010, 12:05 p.m.

700 State Office Building, 100 Rev. Dr. Martin Luther King Jr. Blvd., St. Paul, MN 55155 ♦ Phone: (651) 296-2868 ♦ TTY: 1-800-627-3529 ♦ Fax: (651) 296-0569