1.1                          A bill for an act 
  1.2             relating to human services; making health care 
  1.3             changes; clarifying prescription drug coverage for the 
  1.4             senior drug program; allowing reconsideration of 
  1.5             commissioner's decision that services are not 
  1.6             medically necessary under medical assistance program; 
  1.7             changing medical assistance payments for hospital 
  1.8             providers; establishing performance measurement for 
  1.9             health care; changing a provision for medical 
  1.10            assistance eligibility; establishing medical 
  1.11            assistance income standard for supplemental security 
  1.12            income recipients; adopting income deductions for 
  1.13            medical assistance for institutionalized persons; 
  1.14            changing rehabilitation services review; establishing 
  1.15            telemedicine consultation; improving pharmacy medicine 
  1.16            management; refinancing medical assistance school 
  1.17            reimbursement; modifying provisions for cost-based 
  1.18            payments; providing community-based services for 
  1.19            severely emotionally disturbed children; proscribing 
  1.20            conflicts of interest for Medicaid payments; modifying 
  1.21            nursing facility prohibited practices; requiring 
  1.22            commissioner to assume liability for federal share of 
  1.23            medical education and research payments above the 
  1.24            charge limit; increasing professional provider 
  1.25            payment; improving dental access; clarifying 
  1.26            MinnesotaCare premium payment provisions; clarifying 
  1.27            earned income disregard in the waiver request to 
  1.28            health care financing administration; requiring 
  1.29            commissioner of human services to complete study; 
  1.30            amending Minnesota Statutes 1998, sections 256.955, 
  1.31            subdivisions 3, 4, 7, 8, and 9; 256.9685, subdivision 
  1.32            1a; 256.969, subdivision 1; 256B.04, by adding a 
  1.33            subdivision; 256B.055, subdivision 3a; 256B.056, 
  1.34            subdivision 4; 256B.057, by adding a subdivision; 
  1.35            256B.0575; 256B.0625, subdivisions 8, 8a, 13, 26, 30, 
  1.36            32, 35, and by adding subdivisions; 256B.0635, 
  1.37            subdivision 3; 256B.48, subdivision 1; 256B.69, by 
  1.38            adding a subdivision; 256B.75; 256B.76; 256L.03, 
  1.39            subdivision 5; 256L.04, subdivisions 2, 8, and 13; 
  1.40            256L.05, subdivision 4; 256L.06, subdivision 3; 
  1.41            256L.07; and 256L.15, subdivisions 1, 1b, and 2; Laws 
  1.42            1995, chapter 178, article 2, section 46, subdivision 
  1.43            10; proposing coding for new law in Minnesota 
  1.44            Statutes, chapter 256B. 
  1.45  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  2.1      Section 1.  Minnesota Statutes 1998, section 256.955, 
  2.2   subdivision 3, is amended to read: 
  2.3      Subd. 3.  [PRESCRIPTION DRUG COVERAGE.] ~~Coverage under the~~ 
  2.4   ~~program is limited to prescription drugs covered under the~~ 
  2.5   ~~medical assistance program as described in section 256B.0625,~~ 
  2.6   ~~subdivision 13, subject to a maximum deductible of $300~~ 
  2.7   ~~annually, except drugs cleared by the FDA shall be available to~~ 
  2.8   ~~qualified senior citizens enrolled in the program without~~ 
  2.9   ~~restriction when prescribed for medically accepted indication as~~ 
  2.10  ~~defined in the federal rebate program under section 1927 of~~ 
  2.11  ~~title XIX of the federal Social Security Act.~~  Coverage under 
  2.12  the program shall be limited to those prescription drugs that: 
  2.13     (1) are covered under the medical assistance program as 
  2.14  described in section 256B.0625, subdivision 13; and 
  2.15     (2) are provided by manufacturers that have fully executed 
  2.16  senior drug rebate agreements with the commissioner and comply 
  2.17  with such agreements. 
  2.18     Sec. 2.  Minnesota Statutes 1998, section 256.955, 
  2.19  subdivision 4, is amended to read: 
  2.20     Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
  2.21  MEDICAL ASSISTANCE.] Applications and information on the program 
  2.22  must be made available at county social service agencies, health 
  2.23  care provider offices, and agencies and organizations serving 
  2.24  senior citizens.  Senior citizens shall submit applications and 
  2.25  any information specified by the commissioner as being necessary 
  2.26  to verify eligibility directly to the county social service 
  2.27  agencies:  
  2.28     (1) beginning January 1, 1999, the county social service 
  2.29  agency shall determine medical assistance spenddown eligibility 
  2.30  of individuals who qualify for the senior citizen drug program 
  2.31  of individuals; and 
  2.32     (2) program payments will be used to reduce the spenddown 
  2.33  obligations of individuals who are determined to be eligible for 
  2.34  medical assistance with a spenddown as defined in section 
  2.35  256B.056, subdivision 5. 
  2.36  Seniors who are eligible for medical assistance with a spenddown 
  3.1   shall be financially responsible for the deductible amount up to 
  3.2   the satisfaction of the spenddown.  No deductible applies once 
  3.3   the spenddown has been met.  Payments to providers for 
  3.4   prescription drugs for persons eligible under this subdivision 
  3.5   shall be reduced by the deductible.  
  3.6      County social service agencies shall determine an 
  3.7   applicant's eligibility for the program within 30 days from the 
  3.8   date the application is received.  Eligibility begins the month 
  3.9   after approval. 
  3.10     Sec. 3.  Minnesota Statutes 1998, section 256.955, 
  3.11  subdivision 7, is amended to read: 
  3.12     Subd. 7.  [COST SHARING.] ~~(a) Enrollees shall pay an annual~~ 
  3.13  ~~premium of $120.~~  
  3.14     ~~(b)~~ Program enrollees must satisfy a ~~$300~~ $420 annual 
  3.15  deductible, based upon expenditures for prescription drugs, to 
  3.16  be paid ~~as follows:~~ in $35 monthly increments. 
  3.17     ~~(1) $25 monthly deductible for persons with a monthly~~ 
  3.18  ~~spenddown; or~~ 
  3.19     ~~(2) $150 biannual deductible for persons with a six-month~~ 
  3.20  ~~spenddown.~~  
  3.21     Sec. 4.  Minnesota Statutes 1998, section 256.955, 
  3.22  subdivision 8, is amended to read: 
  3.23     Subd. 8.  [REPORT.] The commissioner shall annually report 
  3.24  to the legislature on the senior citizen drug program.  The 
  3.25  report must include demographic information on enrollees, 
  3.26  per-prescription expenditures, total program expenditures, 
  3.27  hospital and nursing home costs avoided by enrollees, any 
  3.28  savings to medical assistance and Medicare resulting from the 
  3.29  provision of prescription drug coverage under Medicare by health 
  3.30  maintenance organizations, other public and private options for 
  3.31  drug assistance to the senior population, any hardships caused 
  3.32  by the annual ~~premium~~ enrollment fee and deductible, and any 
  3.33  recommendations for changes in the senior drug program. 
  3.34     Sec. 5.  Minnesota Statutes 1998, section 256.955, 
  3.35  subdivision 9, is amended to read: 
  3.36     Subd. 9.  [PROGRAM LIMITATION.] The commissioner shall 
  4.1   administer the senior drug program so that the costs total no 
  4.2   more than funds appropriated plus the drug rebate proceeds.  
  4.3   Senior drug program rebate revenues are appropriated to the 
  4.4   commissioner and shall be expended to augment funding of the 
  4.5   senior drug program.  New enrollment shall cease if the 
  4.6   commissioner determines that, given current enrollment, costs of 
  4.7   the program will exceed appropriated funds and rebate proceeds.  
  4.8   This section shall be repealed upon federal approval of the 
  4.9   waiver to allow the commissioner to provide prescription drug 
  4.10  coverage for qualified Medicare beneficiaries whose income is 
  4.11  less than 150 percent of the federal poverty guidelines. 
  4.12     Sec. 6.  Minnesota Statutes 1998, section 256.9685, 
  4.13  subdivision 1a, is amended to read: 
  4.14     Subd. 1a.  [ADMINISTRATIVE RECONSIDERATION.] 
  4.15  Notwithstanding sections 256B.04, subdivision 15, and 256D.03, 
  4.16  subdivision 7, the commissioner shall establish an 
  4.17  administrative reconsideration process for appeals of inpatient 
  4.18  hospital services determined to be medically unnecessary.  A 
  4.19  physician or hospital may request a reconsideration of the 
  4.20  decision that inpatient hospital services are not medically 
  4.21  necessary by submitting a written request for review to the 
  4.22  commissioner within 30 days after receiving notice of the 
  4.23  decision.  The reconsideration process shall take place prior to 
  4.24  the procedures of subdivision 1b and shall be conducted by 
  4.25  physicians that are independent of the case under 
  4.26  reconsideration.  A majority decision by the physicians is 
  4.27  necessary to make a determination that the services were not 
  4.28  medically necessary.  
  4.29     Sec. 7.  Minnesota Statutes 1998, section 256.969, 
  4.30  subdivision 1, is amended to read: 
  4.31     Subdivision 1.  [HOSPITAL COST INDEX.] (a) The hospital 
  4.32  cost index shall be the change in the Consumer Price Index-All 
  4.33  Items (United States city average) (CPI-U) forecasted by Data 
  4.34  Resources, Inc.  The commissioner shall use the indices as 
  4.35  forecasted in the third quarter of the calendar year prior to 
  4.36  the rate year.  The hospital cost index may be used to adjust 
  5.1   the base year operating payment rate through the rate year on an 
  5.2   annually compounded basis.  
  5.3      (b) For fiscal years beginning on or after July 1, 1993, 
  5.4   the commissioner of human services shall not provide automatic 
  5.5   annual inflation adjustments for hospital payment rates under 
  5.6   medical assistance, nor under general assistance medical care, 
  5.7   except that the inflation adjustments under paragraph (a) for 
  5.8   medical assistance, excluding general assistance medical care, 
  5.9   shall apply through calendar year ~~1999~~ 2001.  The index for 
  5.10  calendar year 2000 shall be reduced 2.5 percentage points to 
  5.11  recover overprojections of the index from 1994 to 1996.  The 
  5.12  commissioner of finance shall include as a budget change request 
  5.13  in each biennial detailed expenditure budget submitted to the 
  5.14  legislature under section 16A.11 annual adjustments in hospital 
  5.15  payment rates under medical assistance and general assistance 
  5.16  medical care, based upon the hospital cost index. 
  5.17     Sec. 8.  Minnesota Statutes 1998, section 256B.04, is 
  5.18  amended by adding a subdivision to read: 
  5.19     Subd. 19.  [PERFORMANCE DATA REPORTING UNIT.] The 
  5.20  commissioner of human services shall establish a performance 
  5.21  data reporting unit that serves counties and the state.  The 
  5.22  department shall support this unit and provide counties 
  5.23  technical assistance and access to the data warehouse.  The 
  5.24  performance data reporting unit, which will operate within the 
  5.25  department's central office and consist of both county and 
  5.26  department staff, shall provide performance data reports to 
  5.27  individual counties, share expertise from counties and the 
  5.28  department perspective, and participate in joint planning to 
  5.29  link with county databases and other county data sources in 
  5.30  order to provide information on services provided to public 
  5.31  clients from state, federal, and county funding sources. 
  5.32     Sec. 9.  Minnesota Statutes 1998, section 256B.055, 
  5.33  subdivision 3a, is amended to read: 
  5.34     Subd. 3a.  [MFIP-S FAMILIES; FAMILIES ELIGIBLE UNDER PRIOR 
  5.35  AFDC RULES.] (a) Beginning January 1, 1998, or on the date that 
  5.36  MFIP-S is implemented in counties, medical assistance may be 
  6.1   paid for a person receiving public assistance under the MFIP-S 
  6.2   program. 
  6.3      (b) Beginning January 1, 1998, medical assistance may be 
  6.4   paid for a person who would have been eligible for public 
  6.5   assistance under the income and resource standards ~~and~~ 
  6.6   ~~deprivation requirements~~, or who would have been eligible but 
  6.7   for excess income or assets, under the state's AFDC plan in 
  6.8   effect as of July 16, 1996, as required by the Personal 
  6.9   Responsibility and Work Opportunity Reconciliation Act of 1996 
  6.10  (PRWORA), Public Law Number 104-193. 
  6.11     Sec. 10.  Minnesota Statutes 1998, section 256B.056, 
  6.12  subdivision 4, is amended to read: 
  6.13     Subd. 4.  [INCOME.] To be eligible for medical assistance, 
  6.14  a person eligible under section 256B.055, subdivision 7, not 
  6.15  receiving supplemental security income program payments, and 
  6.16  families and children may have an income up to 133-1/3 percent 
  6.17  of the AFDC income standard in effect under the July 16, 1996, 
  6.18  AFDC state plan.  For rate years beginning on or after July 1, 
  6.19  1999, the commissioner shall consider increasing the base AFDC 
  6.20  standard in effect on July 16, 1996, by an amount equal to the 
  6.21  percent change in the Consumer Price Index for All Urban 
  6.22  Consumers for the previous October compared to one year 
  6.23  earlier.  Effective January 1, 2000, and each successive 
  6.24  January, recipients of supplemental security income may have an 
  6.25  income up to the supplemental security income standard in effect 
  6.26  on that date.  In computing income to determine eligibility of 
  6.27  persons who are not residents of long-term care facilities, the 
  6.28  commissioner shall disregard increases in income as required by 
  6.29  Public Law Numbers 94-566, section 503; 99-272; and 99-509.  
  6.30  Veterans aid and attendance benefits and Veterans Administration 
  6.31  unusual medical expense payments are considered income to the 
  6.32  recipient. 
  6.33     Sec. 11.  Minnesota Statutes 1998, section 256B.057, is 
  6.34  amended by adding a subdivision to read: 
  6.35     Subd. 9.  [EMPLOYED INDIVIDUALS WITH DISABILITIES.] (a) 
  6.36  Medical assistance may be paid for an employed individual:  (1) 
  7.1   who meets the definition of disabled under the supplemental 
  7.2   security income program; (2) whose countable family income, 
  7.3   excluding the unearned income of the individual, is below 250 
  7.4   percent of the federal poverty guidelines for the applicable 
  7.5   family size; and (3) who pays a premium as provided in paragraph 
  7.6   (c). 
  7.7      (b) For purposes of determining eligibility under this 
  7.8   subdivision, the asset limitations under section 256B.056, 
  7.9   subdivision 3, are increased by $20,000, and any retirement 
  7.10  account of the individual is excluded.  Retirement accounts 
  7.11  include individual retirement accounts, 401(k) plans, 403(b) 
  7.12  plans, Keogh plans, pension plans, and other retirement funds 
  7.13  held by the individual. 
  7.14     (c) The premium shall be equal to ten percent of the amount 
  7.15  of the family's annual gross earned income above 250 percent of 
  7.16  the federal poverty guidelines for the applicable family size, 
  7.17  but shall not exceed the maximum MinnesotaCare premium for one 
  7.18  person under section 256L.15, subdivision 2. 
  7.19     (d) An individual's eligibility and premium amount shall be 
  7.20  determined by the county agency.  Premiums are paid to the 
  7.21  commissioner and dedicated to the commissioner. 
  7.22     (e) The required premium amount is determined at 
  7.23  application and redetermined at annual recertification or when a 
  7.24  change in gross earned income occurs.  Premium payment is due 
  7.25  upon notification and may be accepted in installments at the 
  7.26  commissioner's discretion. 
  7.27     (f) Nonpayment of the premium will result in denial or 
  7.28  termination of medical assistance.  Nonpayment of the premium 
  7.29  includes payment with a returned, refused, or dishonored 
  7.30  instrument.  The commissioner may require a guaranteed form of 
  7.31  payment as the only means to replace a returned, refused, or 
  7.32  dishonored instrument. 
  7.33     Sec. 12.  Minnesota Statutes 1998, section 256B.0575, is 
  7.34  amended to read: 
  7.35     256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED 
  7.36  PERSONS.] 
  8.1      When an institutionalized person is determined eligible for 
  8.2   medical assistance, the income that exceeds the deductions in 
  8.3   paragraphs (a) and (b) must be applied to the cost of 
  8.4   institutional care.  
  8.5      (a) The following amounts must be deducted from the 
  8.6   institutionalized person's income in the following order: 
  8.7      (1) the personal needs allowance under section 256B.35 or, 
  8.8   for a veteran who does not have a spouse or child, or a 
  8.9   surviving spouse of a veteran having no child, the amount of an 
  8.10  improved pension received from the veteran's administration not 
  8.11  exceeding $90 per month; 
  8.12     (2) the personal allowance for disabled individuals under 
  8.13  section 256B.36; 
  8.14     (3) if the institutionalized person has a legally appointed 
  8.15  guardian or conservator, five percent of the recipient's gross 
  8.16  monthly income up to $100 as reimbursement for guardianship or 
  8.17  conservatorship services; 
  8.18     (4) a monthly income allowance determined under section 
  8.19  256B.058, subdivision 2, but only to the extent income of the 
  8.20  institutionalized spouse is made available to the community 
  8.21  spouse; 
  8.22     (5) a monthly allowance for children under age 18 which, 
  8.23  together with the net income of the children, would provide 
  8.24  income equal to the medical assistance standard for families and 
  8.25  children according to section 256B.056, subdivision 4, for a 
  8.26  family size that includes only the minor children.  This 
  8.27  deduction applies only if the children do not live with the 
  8.28  community spouse and only to the extent that the deduction is 
  8.29  not included in the personal needs allowance under section 
  8.30  256B.35, subdivision 1, as child support garnished under a court 
  8.31  order; 
  8.32     (6) a monthly family allowance for other family members, 
  8.33  equal to one-third of the difference between 122 percent of the 
  8.34  federal poverty guidelines and the monthly income for that 
  8.35  family member; 
  8.36     (7) reparations payments made by the Federal Republic of 
  9.1   Germany and reparations payments made by the Netherlands for 
  9.2   victims of Nazi persecution between 1940 and 1945; ~~and~~ 
  9.3      (8) all other exclusions from income for institutionalized 
  9.4   persons as mandated by federal law; and 
  9.5      ~~(8)~~ (9) amounts for reasonable expenses incurred for 
  9.6   necessary medical or remedial care for the institutionalized 
  9.7   spouse that are not medical assistance covered expenses and that 
  9.8   are not subject to payment by a third party.  
  9.9      For purposes of clause (6), "other family member" means a 
  9.10  person who resides with the community spouse and who is a minor 
  9.11  or dependent child, dependent parent, or dependent sibling of 
  9.12  either spouse.  "Dependent" means a person who could be claimed 
  9.13  as a dependent for federal income tax purposes under the 
  9.14  Internal Revenue Code. 
  9.15     (b) Income shall be allocated to an institutionalized 
  9.16  person for a period of up to three calendar months, in an amount 
  9.17  equal to the medical assistance standard for a family size of 
  9.18  one if:  
  9.19     (1) a physician certifies that the person is expected to 
  9.20  reside in the long-term care facility for three calendar months 
  9.21  or less; 
  9.22     (2) if the person has expenses of maintaining a residence 
  9.23  in the community; and 
  9.24     (3) if one of the following circumstances apply:  
  9.25     (i) the person was not living together with a spouse or a 
  9.26  family member as defined in paragraph (a) when the person 
  9.27  entered a long-term care facility; or 
  9.28     (ii) the person and the person's spouse become 
  9.29  institutionalized on the same date, in which case the allocation 
  9.30  shall be applied to the income of one of the spouses.  
  9.31  For purposes of this paragraph, a person is determined to be 
  9.32  residing in a licensed nursing home, regional treatment center, 
  9.33  or medical institution if the person is expected to remain for a 
  9.34  period of one full calendar month or more. 
  9.35     Sec. 13.  Minnesota Statutes 1998, section 256B.0625, 
  9.36  subdivision 8, is amended to read: 
 10.1      Subd. 8.  [PHYSICAL THERAPY.] Medical assistance covers 
 10.2   physical therapy and related services, including specialized 
 10.3   maintenance therapy.  Services provided by a physical therapy 
 10.4   assistant shall be reimbursed at the same rate as services 
 10.5   performed by a physical therapist when the services of the 
 10.6   physical therapy assistant are provided under the direction of a 
 10.7   physical therapist who is on the premises.  Services provided by 
 10.8   a physical therapy assistant that are provided under the 
 10.9   direction of a physical therapist who is not on the premises 
 10.10  shall be reimbursed at 65 percent of the physical therapist rate.
 10.11     Sec. 14.  Minnesota Statutes 1998, section 256B.0625, 
 10.12  subdivision 8a, is amended to read: 
 10.13     Subd. 8a.  [OCCUPATIONAL THERAPY.] Medical assistance 
 10.14  covers occupational therapy and related services, including 
 10.15  specialized maintenance therapy.  Services provided by an 
 10.16  occupational therapy assistant shall be reimbursed at the same 
 10.17  rate as services performed by an occupational therapist when the 
 10.18  services of the occupational therapy assistant are provided 
 10.19  under the direction of the occupational therapist who is on the 
 10.20  premises.  Services provided by an occupational therapy 
 10.21  assistant that are provided under the direction of an 
 10.22  occupational therapist who is not on the premises shall be 
 10.23  reimbursed at 65 percent of the occupational therapist rate. 
 10.24     Sec. 15.  Minnesota Statutes 1998, section 256B.0625, is 
 10.25  amended by adding a subdivision to read: 
 10.26     Subd. 8b.  [SPEECH LANGUAGE PATHOLOGY SERVICES.] Medical 
 10.27  assistance covers speech language pathology and related 
 10.28  services, including specialized maintenance therapy. 
 10.29     Sec. 16.  Minnesota Statutes 1998, section 256B.0625, is 
 10.30  amended by adding a subdivision to read: 
 10.31     Subd. 8c.  [CARE MANAGEMENT; REHABILITATION SERVICES.] (a) 
 10.32  Effective July 1, 1999, one-time thresholds shall replace annual 
 10.33  thresholds for provision of rehabilitation services described in 
 10.34  subdivisions 8, 8a, and 8b.  The one-time thresholds will be the 
 10.35  same in amount and description as the thresholds prescribed by 
 10.36  the department of human services health care programs provider 
 11.1   manual for calendar year 1997, except they will not be renewed 
 11.2   annually, and they will include sensory skills and cognitive 
 11.3   training skills. 
 11.4      (b) A care management approach for authorization of 
 11.5   services beyond the threshold shall be instituted in conjunction 
 11.6   with the one-time thresholds.  The care management approach 
 11.7   shall allow the provider seeking authorization and the 
 11.8   department rehabilitation reviewer to work together directly 
 11.9   through written communication, or telephone communication when 
 11.10  appropriate, to establish a medically necessary care management 
 11.11  plan. 
 11.12     (c) The department shall implement an expedited five-day 
 11.13  turnaround time to review authorization requests for recipients 
 11.14  who need emergency rehabilitation services and who have 
 11.15  exhausted their one-time threshold limit for those services. 
 11.16     Sec. 17.  Minnesota Statutes 1998, section 256B.0625, is 
 11.17  amended by adding a subdivision to read: 
 11.18     Subd. 3b.  [TELEMEDICINE CONSULTATIONS.] Medical assistance 
 11.19  covers telemedicine consultations.  Telemedicine consultations 
 11.20  must be made via two-way, interactive video.  Payments will be 
 11.21  made to both the referring provider and the consulting physician 
 11.22  specialist.  Physician specialist includes any physician 
 11.23  consulting with an emergency department provider. 
 11.24     Sec. 18.  Minnesota Statutes 1998, section 256B.0625, is 
 11.25  amended by adding a subdivision to read: 
 11.26     Subd. 3c.  [CONSULTATION SERVICES BY PHYSICIANS 
 11.27  SPECIALIZING IN CHILD ABUSE AND NEGLECT.] Medical assistance 
 11.28  covers consultation services by physicians specializing in child 
 11.29  abuse and neglect.  Alternative media formats may be used when 
 11.30  the patient is a child being examined for potential abuse or 
 11.31  neglect, the consulting physician is a specialist in child abuse 
 11.32  and neglect, and the use of two-way, interactive video or the 
 11.33  occurrence of a second exam would be medically counter indicated 
 11.34  for the child. 
 11.35     Sec. 19.  Minnesota Statutes 1998, section 256B.0625, is 
 11.36  amended by adding a subdivision to read: 
 12.1      Subd. 9a.  [DENTAL HYGIENIST SERVICES.] Medical assistance 
 12.2   covers preventive dental services provided by dental hygienists 
 12.3   if the services are otherwise covered under this chapter as 
 12.4   dental services, and if the services are within the scope of 
 12.5   practice of a licensed dental hygienist, as defined in section 
 12.6   150A.05. 
 12.7      Sec. 20.  Minnesota Statutes 1998, section 256B.0625, 
 12.8   subdivision 13, is amended to read: 
 12.9      Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
 12.10  except for fertility drugs when specifically used to enhance 
 12.11  fertility, if prescribed by a licensed practitioner and 
 12.12  dispensed by a licensed pharmacist, by a physician enrolled in 
 12.13  the medical assistance program as a dispensing physician, or by 
 12.14  a physician or a nurse practitioner employed by or under 
 12.15  contract with a community health board as defined in section 
 12.16  145A.02, subdivision 5, for the purposes of communicable disease 
 12.17  control.  The commissioner, after receiving recommendations from 
 12.18  professional medical associations and professional pharmacist 
 12.19  associations, shall designate a formulary committee to advise 
 12.20  the commissioner on the names of drugs for which payment is 
 12.21  made, recommend a system for reimbursing providers on a set fee 
 12.22  or charge basis rather than the present system, and develop 
 12.23  methods encouraging use of generic drugs when they are less 
 12.24  expensive and equally effective as trademark drugs.  The 
 12.25  formulary committee shall consist of nine members, four of whom 
 12.26  shall be physicians who are not employed by the department of 
 12.27  human services, and a majority of whose practice is for persons 
 12.28  paying privately or through health insurance, three of whom 
 12.29  shall be pharmacists who are not employed by the department of 
 12.30  human services, and a majority of whose practice is for persons 
 12.31  paying privately or through health insurance, a consumer 
 12.32  representative, and a nursing home representative.  Committee 
 12.33  members shall serve three-year terms and shall serve without 
 12.34  compensation.  Members may be reappointed once.  
 12.35     (b) The commissioner shall establish a drug formulary.  Its 
 12.36  establishment and publication shall not be subject to the 
 13.1   requirements of the Administrative Procedure Act, but the 
 13.2   formulary committee shall review and comment on the formulary 
 13.3   contents.  The formulary committee shall review and recommend 
 13.4   drugs which require prior authorization.  The formulary 
 13.5   committee may recommend drugs for prior authorization directly 
 13.6   to the commissioner, as long as opportunity for public input is 
 13.7   provided.  Prior authorization may be requested by the 
 13.8   commissioner based on medical and clinical criteria before 
 13.9   certain drugs are eligible for payment.  Before a drug may be 
 13.10  considered for prior authorization at the request of the 
 13.11  commissioner:  
 13.12     (1) the drug formulary committee must develop criteria to 
 13.13  be used for identifying drugs; the development of these criteria 
 13.14  is not subject to the requirements of chapter 14, but the 
 13.15  formulary committee shall provide opportunity for public input 
 13.16  in developing criteria; 
 13.17     (2) the drug formulary committee must hold a public forum 
 13.18  and receive public comment for an additional 15 days; and 
 13.19     (3) the commissioner must provide information to the 
 13.20  formulary committee on the impact that placing the drug on prior 
 13.21  authorization will have on the quality of patient care and 
 13.22  information regarding whether the drug is subject to clinical 
 13.23  abuse or misuse.  Prior authorization may be required by the 
 13.24  commissioner before certain formulary drugs are eligible for 
 13.25  payment.  The formulary shall not include:  
 13.26     (i) drugs or products for which there is no federal 
 13.27  funding; 
 13.28     (ii) over-the-counter drugs, except for antacids, 
 13.29  acetaminophen, family planning products, aspirin, insulin, 
 13.30  products for the treatment of lice, vitamins for adults with 
 13.31  documented vitamin deficiencies, vitamins for children under the 
 13.32  age of seven and pregnant or nursing women, and any other 
 13.33  over-the-counter drug identified by the commissioner, in 
 13.34  consultation with the drug formulary committee, as necessary, 
 13.35  appropriate, and cost-effective for the treatment of certain 
 13.36  specified chronic diseases, conditions or disorders, and this 
 14.1   determination shall not be subject to the requirements of 
 14.2   chapter 14; 
 14.3      (iii) anorectics; 
 14.4      (iv) drugs for which medical value has not been 
 14.5   established; and 
 14.6      (v) drugs from manufacturers who have not signed a rebate 
 14.7   agreement with the Department of Health and Human Services 
 14.8   pursuant to section 1927 of title XIX of the Social Security Act 
 14.9   ~~and who have not signed an agreement with the state for drugs~~ 
 14.10  ~~purchased pursuant to the senior citizen drug program~~ 
 14.11  ~~established under section 256.955~~. 
 14.12     The commissioner shall publish conditions for prohibiting 
 14.13  payment for specific drugs after considering the formulary 
 14.14  committee's recommendations.  
 14.15     (c) The basis for determining the amount of payment shall 
 14.16  be the lower of the actual acquisition costs of the drugs plus a 
 14.17  fixed dispensing fee; the maximum allowable cost set by the 
 14.18  federal government or by the commissioner plus the fixed 
 14.19  dispensing fee; or the usual and customary price charged to the 
 14.20  public.  The pharmacy dispensing fee shall be $3.65.  Actual 
 14.21  acquisition cost includes quantity and other special discounts 
 14.22  except time and cash discounts.  The actual acquisition cost of 
 14.23  a drug shall be estimated by the commissioner, at average 
 14.24  wholesale price minus nine percent.  The maximum allowable cost 
 14.25  of a multisource drug may be set by the commissioner and it 
 14.26  shall be comparable to, but no higher than, the maximum amount 
 14.27  paid by other third-party payors in this state who have maximum 
 14.28  allowable cost programs.  The commissioner shall set maximum 
 14.29  allowable costs for multisource drugs that are not on the 
 14.30  federal upper limit list as described in United States Code, 
 14.31  title 42, chapter 7, section 1396r-8(e), the Social Security 
 14.32  Act, and Code of Federal Regulations, title 42, part 447, 
 14.33  section 447.332.  Establishment of the amount of payment for 
 14.34  drugs shall not be subject to the requirements of the 
 14.35  Administrative Procedure Act.  An additional dispensing fee of 
 14.36  $.30 may be added to the dispensing fee paid to pharmacists for 
 15.1   legend drug prescriptions dispensed to residents of long-term 
 15.2   care facilities when a unit dose blister card system, approved 
 15.3   by the department, is used.  Under this type of dispensing 
 15.4   system, the pharmacist must dispense a 30-day supply of drug.  
 15.5   The National Drug Code (NDC) from the drug container used to 
 15.6   fill the blister card must be identified on the claim to the 
 15.7   department.  The unit dose blister card containing the drug must 
 15.8   meet the packaging standards set forth in Minnesota Rules, part 
 15.9   6800.2700, that govern the return of unused drugs to the 
 15.10  pharmacy for reuse.  The pharmacy provider will be required to 
 15.11  credit the department for the actual acquisition cost of all 
 15.12  unused drugs that are eligible for reuse.  Over-the-counter 
 15.13  medications must be dispensed in the manufacturer's unopened 
 15.14  package.  The commissioner may permit the drug clozapine to be 
 15.15  dispensed in a quantity that is less than a 30-day supply.  
 15.16  Whenever a generically equivalent product is available, payment 
 15.17  shall be on the basis of the actual acquisition cost of the 
 15.18  generic drug, unless the prescriber specifically indicates 
 15.19  "dispense as written - brand necessary" on the prescription as 
 15.20  required by section 151.21, subdivision 2. 
 15.21     Sec. 21.  Minnesota Statutes 1998, section 256B.0625, 
 15.22  subdivision 26, is amended to read: 
 15.23     Subd. 26.  [SPECIAL EDUCATION SERVICES.] (a) Medical 
 15.24  assistance covers medical services identified in a recipient's 
 15.25  individualized education plan and covered under the medical 
 15.26  assistance state plan.  The services may be provided by a 
 15.27  Minnesota school district that is enrolled as a medical 
 15.28  assistance provider or its subcontractor, and only if the 
 15.29  services meet all the requirements otherwise applicable if the 
 15.30  service had been provided by a provider other than a school 
 15.31  district, in the following areas:  medical necessity, 
 15.32  physician's orders, documentation, personnel qualifications, and 
 15.33  prior authorization requirements.  Services of a speech-language 
 15.34  pathologist provided under this section are covered 
 15.35  notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item 
 15.36  L, if the person: 
 16.1      (1) holds a masters degree in speech-language pathology; 
 16.2      (2) is licensed by the Minnesota board of teaching as an 
 16.3   educational speech-language pathologist; and 
 16.4      (3) either has a certificate of clinical competence from 
 16.5   the American Speech and Hearing Association, has completed the 
 16.6   equivalent educational requirements and work experience 
 16.7   necessary for the certificate or has completed the academic 
 16.8   program and is acquiring supervised work experience to qualify 
 16.9   for the certificate.  Medical assistance coverage for medically 
 16.10  necessary services provided under other subdivisions in this 
 16.11  section may not be denied solely on the basis that the same or 
 16.12  similar services are covered under this subdivision. 
 16.13     (b) Effective July 1, 2000, medical assistance coverage of 
 16.14  eligible local educational agency services shall be paid at the 
 16.15  rate of 95 percent of the federal share of reimbursement.  The 
 16.16  department of human services shall amend its federal waiver 
 16.17  allowing the state to carve out individual education plan and 
 16.18  individualized family service plan services for children 
 16.19  enrolled in the prepaid medical assistance program and 
 16.20  MinnesotaCare program.  Effective July 1, 2000, or upon federal 
 16.21  approval, medical assistance coverage of eligible individual 
 16.22  education plan and individualized family service plan services 
 16.23  shall not be included in the capitated services for children 
 16.24  enrolled in health plans through the prepaid medical assistance 
 16.25  program and the MinnesotaCare program.  Upon federal approval, 
 16.26  local educational agencies shall bill the department of human 
 16.27  services for these services and claims will be paid on a 
 16.28  fee-for-service basis.  The department of human service shall 
 16.29  develop a methodology for payment of individual education plan 
 16.30  and individualized family service plan services that is packaged 
 16.31  based on the child's needs, for ease of billing, and seek 
 16.32  approval of this rate methodology from the health care financing 
 16.33  administration.  The department of human services shall develop 
 16.34  a cost-based payment structure for payment of these services.  
 16.35  Effective July 1, 2000, medical assistance services provided by 
 16.36  the local educational agencies shall not count against medical 
 17.1   assistance threshholds for that child. 
 17.2      (c) The local educational agency receiving medical 
 17.3   assistant payment for individual educational plan and 
 17.4   individualized family service plan services shall comply with 
 17.5   all health care finance agency requirements for receiving 
 17.6   federal financial participation.  The nonfederal share of 
 17.7   medical assistance coverage shall be paid by the local 
 17.8   educational agency providing individual educational plan and 
 17.9   individualized family service plan services.  Expenditures for 
 17.10  local educational agency services eligible for federal 
 17.11  reimbursement under this section must not be made from federal 
 17.12  funds or funds used to match other federal funds.  Any federal 
 17.13  disallowances are the responsibility of the local educational 
 17.14  agency. The department of children, families, and learning and 
 17.15  the department of human services shall enter into an interagency 
 17.16  agreement by July 1, 2000, outlining data sharing, and family 
 17.17  consent arrangements whereby local educational agencies may 
 17.18  receive payment for medical assistance eligible individual 
 17.19  educational plan and individualized family service plan services 
 17.20  for children receiving special education services as authorized 
 17.21  by section 1903 of the Social Security Act, as amended. 
 17.22     Sec. 22.  Minnesota Statutes 1998, section 256B.0625, 
 17.23  subdivision 30, is amended to read: 
 17.24     Subd. 30.  [OTHER CLINIC SERVICES.] (a) Medical assistance 
 17.25  covers rural health clinic services, federally qualified health 
 17.26  center services, nonprofit community health clinic services, 
 17.27  public health clinic services, and the services of a clinic 
 17.28  meeting the criteria established in rule by the commissioner.  
 17.29  Rural health clinic services and federally qualified health 
 17.30  center services mean services defined in United States Code, 
 17.31  title 42, section 1396d(a)(2)(B) and (C).  Payment for rural 
 17.32  health clinic and federally qualified health center services 
 17.33  shall be made according to applicable federal law and regulation.
 17.34     (b) A federally qualified health center that is beginning 
 17.35  initial operation shall submit an estimate of budgeted costs and 
 17.36  visits for the initial reporting period in the form and detail 
 18.1   required by the commissioner.  A federally qualified health 
 18.2   center that is already in operation shall submit an initial 
 18.3   report using actual costs and visits for the initial reporting 
 18.4   period.  Within 90 days of the end of its reporting period, a 
 18.5   federally qualified health center shall submit, in the form and 
 18.6   detail required by the commissioner, a report of its operations, 
 18.7   including allowable costs actually incurred for the period and 
 18.8   the actual number of visits for services furnished during the 
 18.9   period, and other information required by the commissioner.  
 18.10  Federally qualified health centers that file Medicare cost 
 18.11  reports shall provide the commissioner with a copy of the most 
 18.12  recent Medicare cost report filed with the Medicare program 
 18.13  intermediary for the reporting year which support the costs 
 18.14  claimed on their cost report to the state. 
 18.15     (c) In order to continue cost-based payment under the 
 18.16  medical assistance program according to paragraphs (a) and (b), 
 18.17  a federally qualified health center or rural health clinic must 
 18.18  apply for designation as an essential community provider within 
 18.19  six months of final adoption of rules by the department of 
 18.20  health according to section 62Q.19, subdivision 7.  For those 
 18.21  federally qualified health centers and rural health clinics that 
 18.22  have applied for essential community provider status within the 
 18.23  six-month time prescribed, medical assistance payments will 
 18.24  continue to be made according to paragraphs (a) and (b) for the 
 18.25  first three years after application.  For federally qualified 
 18.26  health centers and rural health clinics that either do not apply 
 18.27  within the time specified above or who have had essential 
 18.28  community provider status for three years, medical assistance 
 18.29  payments for health services provided by these entities shall be 
 18.30  according to the same rates and conditions applicable to the 
 18.31  same service provided by health care providers that are not 
 18.32  federally qualified health centers or rural health clinics.  
 18.33  ~~This paragraph takes effect only if the Minnesota health care~~ 
 18.34  ~~reform waiver is approved by the federal government, and remains~~ 
 18.35  ~~in effect for as long as the Minnesota health care reform waiver~~ 
 18.36  ~~remains in effect.  When the waiver expires, this paragraph~~ 
 19.1   ~~expires, and the commissioner of human services shall publish a~~ 
 19.2   ~~notice in the State Register and notify the revisor of statutes.~~ 
 19.3      (d) Effective July 1, 1999, the provisions of paragraph (c) 
 19.4   requiring a federally qualified health center or a rural health 
 19.5   clinic to make application for an essential community provider 
 19.6   designation in order to have cost-based payments made according 
 19.7   to paragraphs (a) and (b) no longer apply. 
 19.8      (e) Effective January 1, 2000, payments made according to 
 19.9   paragraphs (a) and (b) shall be limited to the cost phase-out 
 19.10  schedule of the Balanced Budget Act of 1997. 
 19.11     Sec. 23.  Minnesota Statutes 1998, section 256B.0625, 
 19.12  subdivision 32, is amended to read: 
 19.13     Subd. 32.  [NUTRITIONAL PRODUCTS.] ~~(a)~~ Medical assistance 
 19.14  covers nutritional products needed for nutritional 
 19.15  supplementation because solid food or nutrients thereof cannot 
 19.16  be properly absorbed by the body or needed for treatment of 
 19.17  phenylketonuria, hyperlysinemia, maple syrup urine disease, a 
 19.18  combined allergy to human milk, cow's milk, and soy formula, or 
 19.19  any other childhood or adult diseases, conditions, or disorders 
 19.20  identified by the commissioner as requiring a similarly 
 19.21  necessary nutritional product.  Nutritional products needed for 
 19.22  the treatment of a combined allergy to human milk, cow's milk, 
 19.23  and soy formula require prior authorization.  Separate payment 
 19.24  shall not be made for nutritional products for residents of 
 19.25  long-term care facilities.  Payment for dietary requirements is 
 19.26  a component of the per diem rate paid to these facilities. 
 19.27     ~~(b) The commissioner shall designate a nutritional~~ 
 19.28  ~~supplementation products advisory committee to advise the~~ 
 19.29  ~~commissioner on nutritional supplementation products for which~~ 
 19.30  ~~payment is made.  The committee shall consist of nine members,~~ 
 19.31  ~~one of whom shall be a physician, one of whom shall be a~~ 
 19.32  ~~pharmacist, two of whom shall be registered dietitians, one of~~ 
 19.33  ~~whom shall be a public health nurse, one of whom shall be a~~ 
 19.34  ~~representative of a home health care agency, one of whom shall~~ 
 19.35  ~~be a provider of long-term care services, and two of whom shall~~ 
 19.36  ~~be consumers of nutritional supplementation products.  Committee~~ 
 20.1   ~~members shall serve two-year terms and shall serve without~~ 
 20.2   ~~compensation.~~ 
 20.3      ~~(c) The advisory committee shall review and recommend~~ 
 20.4   ~~nutritional supplementation products which require prior~~ 
 20.5   ~~authorization.  The commissioner shall develop procedures for~~ 
 20.6   ~~the operation of the advisory committee so that the advisory~~ 
 20.7   ~~committee operates in a manner parallel to the drug formulary~~ 
 20.8   ~~committee.~~ 
 20.9      Sec. 24.  Minnesota Statutes 1998, section 256B.0625, 
 20.10  subdivision 35, is amended to read: 
 20.11     Subd. 35.  [FAMILY COMMUNITY SUPPORT SERVICES.] Medical 
 20.12  assistance covers family community support services as defined 
 20.13  in section 245.4871, subdivision 17.  In addition to the 
 20.14  provisions of section 245.4871, and to the extent authorized by 
 20.15  rules promulgated by the state agency, medical assistance covers 
 20.16  the following services as family community support services: 
 20.17     (1) services identified in an individual treatment plan 
 20.18  when provided by a trained mental health behavioral aide under 
 20.19  the direction of a mental health practitioner or mental health 
 20.20  professional; 
 20.21     (2) mental health crisis intervention and crisis 
 20.22  stabilization services provided outside of hospital inpatient 
 20.23  settings; and 
 20.24     (3) the therapeutic components of preschool and therapeutic 
 20.25  camp programs. 
 20.26     Sec. 25.  Minnesota Statutes 1998, section 256B.0635, 
 20.27  subdivision 3, is amended to read: 
 20.28     Subd. 3.  [MEDICAL ASSISTANCE FOR MFIP-S PARTICIPANTS WHO 
 20.29  OPT TO DISCONTINUE MONTHLY CASH ASSISTANCE.] ~~Upon federal~~ 
 20.30  ~~approval,~~ Medical assistance is available to persons who 
 20.31  ~~received MFIP-S in at least three of the six months preceding~~ 
 20.32  ~~the month in which the person opted~~ opt to discontinue receiving 
 20.33  MFIP-S cash assistance under section 256J.31, subdivision 12.  A 
 20.34  person who is eligible for medical assistance under this section 
 20.35  may receive medical assistance without reapplication as long as 
 20.36  the person meets MFIP-S eligibility requirements~~, unless the~~ 
 21.1   ~~assistance unit does not include a dependent child~~.  Medical 
 21.2   assistance may be paid pursuant to subdivisions 1 and 2 for 
 21.3   persons who are no longer eligible for MFIP-S due to increased 
 21.4   employment or child support.  A person may be eligible for 
 21.5   MinnesotaCare due to increased employment or child support, and 
 21.6   as such must be informed of the option to transition onto 
 21.7   MinnesotaCare. 
 21.8      Sec. 26.  [256B.0914] [CONFLICTS OF INTEREST RELATED TO 
 21.9   MEDICAID EXPENDITURES.] 
 21.10     Subdivision 1.  [DEFINITIONS.] (a) "Contract" means a 
 21.11  written, fully executed agreement for the purchase of goods and 
 21.12  services involving a substantial expenditure of Medicaid 
 21.13  funding.  A contract under a renewal period shall be considered 
 21.14  a separate contract. 
 21.15     (b) "Contractor bid or proposal information" means cost or 
 21.16  pricing data, indirect costs, and proprietary information marked 
 21.17  as such by the bidder in accordance with applicable law. 
 21.18     (c) "Particular expenditure" means a substantial 
 21.19  expenditure as defined below, for a specified term, involving 
 21.20  specific parties.  The renewal of an existing contract for the 
 21.21  substantial expenditure of Medicaid funds is considered a 
 21.22  separate, particular expenditure from the original contract. 
 21.23     (d) "Source selection information" means any of the 
 21.24  following information prepared for use by the state, county, or 
 21.25  independent contractor for the purpose of evaluating a bid or 
 21.26  proposal to enter into a Medicaid procurement contract, if that 
 21.27  information has not been previously made available to the public 
 21.28  or disclosed publicly: 
 21.29     (1) bid prices submitted in response to a solicitation for 
 21.30  sealed bids, or lists of the bid prices before bid opening; 
 21.31     (2) proposed costs or prices submitted in response to a 
 21.32  solicitation, or lists of those proposed costs or prices; 
 21.33     (3) source selection plans; 
 21.34     (4) technical evaluations plans; 
 21.35     (5) technical evaluations of proposals; 
 21.36     (6) cost or price evaluation of proposals; 
 22.1      (7) competitive range determinations that identify 
 22.2   proposals that have a reasonable chance of being selected for 
 22.3   award of a contract; 
 22.4      (8) rankings of bids, proposals, or competitors; 
 22.5      (9) the reports and evaluations of source selection panels, 
 22.6   boards, or advisory councils; and 
 22.7      (10) other information marked as "source selection 
 22.8   information" based on a case-by-case determination by the head 
 22.9   of the agency, contractor, designees, or the contracting officer 
 22.10  that disclosure of the information would jeopardize the 
 22.11  integrity or successful completion of the Medicaid procurement 
 22.12  to which the information relates. 
 22.13     (e) "Substantial expenditure" and "substantial amounts" 
 22.14  mean a purchase of goods or services in excess of $10,000,000 in 
 22.15  Medicaid funding under this chapter or chapter 256L. 
 22.16     Subd. 2.  [APPLICABILITY.] (a) Unless provided otherwise, 
 22.17  this section applies to:  
 22.18     (1) any state or local officer, employee, or independent 
 22.19  contractor who is responsible for the substantial expenditures 
 22.20  of medical assistance or MinnesotaCare funding under this 
 22.21  chapter or chapter 256L for which federal Medicaid matching 
 22.22  funds are available; 
 22.23     (2) any individual who formerly was such an officer, 
 22.24  employee, or independent contractor; and 
 22.25     (3) any partner of such a state or local officer, employee, 
 22.26  or independent contractor. 
 22.27     (b) This section is intended to meet the requirements of 
 22.28  state participation in the Medicaid program at United States 
 22.29  Code, title 42, sections 1396a(a)(4) and 1396u-2(d)(3), which 
 22.30  require that states have in place restrictions against conflicts 
 22.31  of interest in the Medicaid procurement process, that are at 
 22.32  least as stringent as those in effect under United States Code, 
 22.33  title 41, section 423, and title 18, sections 207 and 208, as 
 22.34  they apply to federal employees. 
 22.35     Subd. 3.  [DISCLOSURE OF PROCUREMENT INFORMATION.] A person 
 22.36  described in subdivision 2 may not knowingly disclose contractor 
 23.1   bid or proposal information, or source selection information 
 23.2   before the award by the state, county, or independent contractor 
 23.3   of a Medicaid procurement contract to which the information 
 23.4   relates unless the disclosure is otherwise authorized by law.  
 23.5   No person, other than as provided by law, shall knowingly obtain 
 23.6   contractor bid or proposal information or source selection 
 23.7   information before the award of a Medicaid procurement contract 
 23.8   to which the information relates. 
 23.9      Subd. 4.  [OFFERS OF EMPLOYMENT.] When a person described 
 23.10  in subdivision 2, paragraph (a), is participating personally and 
 23.11  substantially in a Medicaid procurement for a contract contacts 
 23.12  or is contacted by a person who is a bidder or offeror in the 
 23.13  same procurement regarding possible employment outside of the 
 23.14  entity by which the person is currently employed, the person 
 23.15  must:  
 23.16     (1) report the contact in writing to his or her supervisor 
 23.17  and his or her employer's ethics officer; and 
 23.18     (2) either: 
 23.19     (i) reject the possibility of employment with the bidder or 
 23.20  offeror; or 
 23.21     (ii) be disqualified from further participation in the 
 23.22  procurement until the bidder or offeror is no longer involved in 
 23.23  that procurement, or all discussions with the bidder or offeror 
 23.24  regarding possible employment have terminated without an 
 23.25  arrangement for employment.  A bidder or offeror may not engage 
 23.26  in employment discussions with an official who is subject to 
 23.27  this subdivision, until the bidder or offeror is no longer 
 23.28  involved in that procurement. 
 23.29     Subd. 5.  [ACCEPTANCE OF COMPENSATION BY A FORMER 
 23.30  OFFICIAL.] (a) A former official of the state or county, or a 
 23.31  former independent contractor, described in subdivision 2 may 
 23.32  not accept compensation from a Medicaid contractor of a 
 23.33  substantial expenditure as an employee, officer, director, or 
 23.34  consultant of the contractor within one year after the former 
 23.35  official or independent contractor: 
 23.36     (1) served as the procuring contracting officer, the source 
 24.1   selection authority, a member of the source selection evaluation 
 24.2   board, or the chief of a financial or technical evaluation team 
 24.3   in a procurement in which the contractor was selected for award; 
 24.4      (2) served as the program manager, deputy program manager, 
 24.5   or administrative contracting officer for a contract awarded to 
 24.6   the contractor; or 
 24.7      (3) personally made decisions for the state, county, or 
 24.8   independent contractor to: 
 24.9      (i) award a contract, subcontract, modification of a 
 24.10  contract or subcontract, or a task order or delivery order to 
 24.11  the contractor; 
 24.12     (ii) establish overhead or other rates applicable to a 
 24.13  contract or contracts with the contractor; 
 24.14     (iii) approve issuance of a contract payment or payments to 
 24.15  the contractor; or 
 24.16     (iv) pay or settle a claim with the contractor. 
 24.17     (b) Paragraph (a) does not prohibit a former official of 
 24.18  the state, county, or independent contractor from accepting 
 24.19  compensation from any division or affiliate of a contractor not 
 24.20  involved in the same or similar products or services as the 
 24.21  division or affiliate of the contractor that is responsible for 
 24.22  the contract referred to in paragraph (a), clause (1), (2), or 
 24.23  (3). 
 24.24     (c) A contractor shall not provide compensation to a former 
 24.25  official knowing that the former official is accepting that 
 24.26  compensation in violation of this subdivision. 
 24.27     Subd. 6.  [PERMANENT RESTRICTIONS ON REPRESENTATION AND 
 24.28  COMMUNICATION.] (a) A person described in subdivision 2, after 
 24.29  termination of his or her service with state, county, or 
 24.30  independent contractor, is permanently restricted from knowingly 
 24.31  making, with the intent to influence, any communication to or 
 24.32  appearance before an officer or employee of a department, 
 24.33  agency, or court of the United States, the state of Minnesota 
 24.34  and its counties in connection with a particular expenditure: 
 24.35     (1) in which the United States, the state of Minnesota, or 
 24.36  a Minnesota county is a party or has a direct and substantial 
 25.1   interest; 
 25.2      (2) in which the person participated personally and 
 25.3   substantially as an officer, employee, or independent 
 25.4   contractor; and 
 25.5      (3) which involved a specific party or parties at the time 
 25.6   of participation. 
 25.7      (b) For purposes of this subdivision and subdivisions 7 and 
 25.8   9, "participated" means an action taken through decision, 
 25.9   approval, disapproval, recommendation, the rendering of advice, 
 25.10  investigation, or other such action. 
 25.11     Subd. 7.  [TWO-YEAR RESTRICTIONS ON REPRESENTATION AND 
 25.12  COMMUNICATION.] No person described in subdivision 2, within two 
 25.13  years after termination of service with the state, county, or 
 25.14  independent contractor, shall knowingly make, with the intent to 
 25.15  influence, any communication to or appearance before any officer 
 25.16  or employee of any government department, agency, or court in 
 25.17  connection with a particular expenditure: 
 25.18     (1) in which the United States, the state of Minnesota, or 
 25.19  a Minnesota county is a party or has a direct and substantial 
 25.20  interest; 
 25.21     (2) which the person knows or reasonably should know was 
 25.22  actually pending under the official's responsibility as an 
 25.23  officer, employee, or independent contractor within one year 
 25.24  before the termination of the official's service with the state, 
 25.25  county, or independent contractor; and 
 25.26     (3) which involved a specific party or parties at the time 
 25.27  the expenditure was pending. 
 25.28     Subd. 8.  [EXCEPTIONS TO PERMANENT AND TWO-YEAR 
 25.29  RESTRICTIONS ON REPRESENTATION AND COMMUNICATION.] Subdivisions 
 25.30  6 and 7 do not apply to: 
 25.31     (1) communications or representations made in carrying out 
 25.32  official duties on behalf of the United States, the state of 
 25.33  Minnesota or local government, or as an elected official of the 
 25.34  state or local government; 
 25.35     (2) communications made solely for the purpose of 
 25.36  furnishing scientific or technological information; or 
 26.1      (3) giving testimony under oath.  A person subject to 
 26.2   subdivisions 6 and 7 may serve as an expert witness in that 
 26.3   matter, without restriction, for the state, county, or 
 26.4   independent contractor.  Under court order, a person subject to 
 26.5   subdivisions 6 and 7 may serve as an expert witness for others.  
 26.6   Otherwise, the person may not serve as an expert witness in that 
 26.7   matter. 
 26.8      Subd. 9.  [WAIVER.] The commissioner of human services, or 
 26.9   the governor in the case of the commissioner, may grant a waiver 
 26.10  of a restriction in subdivisions 6 and 7 if he or she determines 
 26.11  that a waiver is in the public interest and that the services of 
 26.12  the officer or employee are critically needed for the benefit of 
 26.13  the state or county government. 
 26.14     Subd. 10.  [ACTS AFFECTING A PERSONAL FINANCIAL 
 26.15  INTEREST.] A person described in subdivision 2, paragraph (a), 
 26.16  clause (1), who participates in a particular expenditure in 
 26.17  which the person has knowledge or has a financial interest, is 
 26.18  subject to the penalties in subdivision 12.  For purposes of 
 26.19  this subdivision, "financial interest" also includes the 
 26.20  financial interest of a spouse, minor child, general partner, 
 26.21  organization in which the officer or employee is serving as an 
 26.22  officer, director, trustee, general partner, or employee, or any 
 26.23  person or organization with whom the individual is negotiating 
 26.24  or has any arrangement concerning prospective employment. 
 26.25     Subd. 11.  [EXCEPTIONS TO PROHIBITIONS REGARDING FINANCIAL 
 26.26  INTEREST.] Subdivision 10 does not apply if: 
 26.27     (1) the person first advises the person's supervisor and 
 26.28  the employer's ethics officer regarding the nature and 
 26.29  circumstances of the particular expenditure and makes full 
 26.30  disclosure of the financial interest and receives in advance a 
 26.31  written determination made by the commissioner of human 
 26.32  services, or the governor in the case of the commissioner, that 
 26.33  the interest is not so substantial as to likely affect the 
 26.34  integrity of the services which the government may expect from 
 26.35  the officer, employee, or independent contractor; 
 26.36     (2) the financial interest is listed as an exemption at 
 27.1   Code of Federal Regulations, title 5, sections 2640.201 to 
 27.2   2640.203, as too remote or inconsequential to affect the 
 27.3   integrity of the services of the office, employee, or 
 27.4   independent contractor to which the requirement applies. 
 27.5      Subd. 12.  [CRIMINAL PENALTIES.] (a) A person who violates 
 27.6   subdivisions 3 to 5 for the purpose of either exchanging the 
 27.7   information covered by this section for anything of value, or 
 27.8   for obtaining or giving anyone a competitive advantage in the 
 27.9   award of a Medicaid contract, may be sentenced to imprisonment 
 27.10  for not more than five years or payment of a fine of not more 
 27.11  than $50,000 for each violation, or the amount of compensation 
 27.12  which the person received or offered for the prohibited conduct, 
 27.13  whichever is greater, or both. 
 27.14     (b) A person who violates a provision of subdivisions 6 to 
 27.15  11 may be sentenced to imprisonment for not more than one year 
 27.16  or payment of a fine of not more than $50,000 for each violation 
 27.17  or the amount of compensation which the person received or 
 27.18  offered for the prohibited conduct, whichever amount is greater, 
 27.19  or both.  A person who willfully engages in conduct in violation 
 27.20  of subdivisions 6 to 11 may be sentenced to imprisonment for not 
 27.21  more than five years or to payment of fine of not more than 
 27.22  $50,000 for each violation or the amount of compensation which 
 27.23  the person received or offered for the prohibited conduct, 
 27.24  whichever amount is greater, or both. 
 27.25     (c) Nothing in this section precludes prosecution under 
 27.26  other laws such as section 609.43. 
 27.27     Subd. 13.  [CIVIL PENALTIES AND INJUNCTIVE RELIEF.] (a) The 
 27.28  Minnesota attorney general may bring a civil action in Ramsey 
 27.29  county district court against a person who violates subdivisions 
 27.30  3 to 5.  Upon proof of such conduct by a preponderance of 
 27.31  evidence, the person is subject to a civil penalty.  An 
 27.32  individual who violates subdivisions 3 to 5 is subject to a 
 27.33  civil penalty of not more than $50,000 for each violation plus 
 27.34  twice the amount of compensation which the individual received 
 27.35  or offered for the prohibited conduct.  An organization that 
 27.36  violates subdivisions 3 to 5 is subject to a civil penalty of 
 28.1   not more than $500,000 for each violation plus twice the amount 
 28.2   of compensation which the organization received or offered for 
 28.3   the prohibited conduct. 
 28.4      (b) If the Minnesota attorney general has reason to believe 
 28.5   that a person is engaging in conduct in violation of subdivision 
 28.6   6, 7, or 9, the attorney general may petition the Ramsey county 
 28.7   district court for an order prohibiting that person from 
 28.8   engaging in such conduct.  The court may issue an order 
 28.9   prohibiting that person from engaging in such conduct if the 
 28.10  court finds that the conduct constitutes such a violation.  The 
 28.11  filing of a petition under this subdivision does not preclude 
 28.12  any other remedy which is available by law. 
 28.13     Subd. 14.  [ADMINISTRATIVE ACTIONS.] (a) If a state agency, 
 28.14  local agency, or independent contractor receives information 
 28.15  that a contractor or a person has violated subdivisions 3 to 5, 
 28.16  the state agency, local agency, or independent contractor may: 
 28.17     (1) cancel the procurement if a contract has not already 
 28.18  been awarded; 
 28.19     (2) rescind the contract; or 
 28.20     (3) initiate suspension or debarment proceedings according 
 28.21  to applicable state or federal law. 
 28.22     (b) If the contract is rescinded, the state agency, local 
 28.23  agency, or independent contractor is entitled to recover, in 
 28.24  addition to any penalty prescribed by law, the amount expended 
 28.25  under the contract. 
 28.26     (c) This section does not: 
 28.27     (1) restrict the disclosure of information to or from any 
 28.28  person or class of persons authorized to receive that 
 28.29  information; 
 28.30     (2) restrict a contractor from disclosing the contractor's 
 28.31  bid or proposal information or the recipient from receiving that 
 28.32  information; 
 28.33     (3) restrict the disclosure or receipt of information 
 28.34  relating to a Medicaid procurement after it has been canceled by 
 28.35  the state agency, county agency, or independent contractor 
 28.36  before the contract award unless the agency or independent 
 29.1   contractor plans to resume the procurement; or 
 29.2      (4) limit the applicability of any requirements, sanctions, 
 29.3   contract penalties, and remedies established under any other law 
 29.4   or regulation. 
 29.5      (d) No person may file a protest against the award or 
 29.6   proposed award of a Medicaid contract alleging a violation of 
 29.7   this section unless that person reported the information the 
 29.8   person believes constitutes evidence of the offense to the 
 29.9   applicable state agency, local agency, or independent contractor 
 29.10  responsible for the procurement.  The report must be made no 
 29.11  later than 14 days after the person first discovered the 
 29.12  possible violation. 
 29.13     Sec. 27.  Minnesota Statutes 1998, section 256B.48, 
 29.14  subdivision 1, is amended to read: 
 29.15     Subdivision 1.  [PROHIBITED PRACTICES.] A nursing facility 
 29.16  is not eligible to receive medical assistance payments unless it 
 29.17  refrains from all of the following: 
 29.18     (a) Charging private paying residents rates for similar 
 29.19  services which exceed those which are approved by the state 
 29.20  agency for medical assistance recipients as determined by the 
 29.21  prospective desk audit rate, except under the following 
 29.22  circumstances:  the nursing facility may (1) charge private 
 29.23  paying residents a higher rate for a private room, and (2) 
 29.24  charge for special services which are not included in the daily 
 29.25  rate if medical assistance residents are charged separately at 
 29.26  the same rate for the same services in addition to the daily 
 29.27  rate paid by the commissioner.  Services covered by the payment 
 29.28  rate must be the same regardless of payment source.  Special 
 29.29  services, if offered, must be available to all residents in all 
 29.30  areas of the nursing facility and charged separately at the same 
 29.31  rate.  Residents are free to select or decline special 
 29.32  services.  Special services must not include services which must 
 29.33  be provided by the nursing facility in order to comply with 
 29.34  licensure or certification standards and that if not provided 
 29.35  would result in a deficiency or violation by the nursing 
 29.36  facility.  Services beyond those required to comply with 
 30.1   licensure or certification standards must not be charged 
 30.2   separately as a special service if they were included in the 
 30.3   payment rate for the previous reporting year.  A nursing 
 30.4   facility that charges a private paying resident a rate in 
 30.5   violation of this clause is subject to an action by the state of 
 30.6   Minnesota or any of its subdivisions or agencies for civil 
 30.7   damages.  A private paying resident or the resident's legal 
 30.8   representative has a cause of action for civil damages against a 
 30.9   nursing facility that charges the resident rates in violation of 
 30.10  this clause.  The damages awarded shall include three times the 
 30.11  payments that result from the violation, together with costs and 
 30.12  disbursements, including reasonable attorneys' fees or their 
 30.13  equivalent.  A private paying resident or the resident's legal 
 30.14  representative, the state, subdivision or agency, or a nursing 
 30.15  facility may request a hearing to determine the allowed rate or 
 30.16  rates at issue in the cause of action.  Within 15 calendar days 
 30.17  after receiving a request for such a hearing, the commissioner 
 30.18  shall request assignment of an administrative law judge under 
 30.19  sections 14.48 to 14.56 to conduct the hearing as soon as 
 30.20  possible or according to agreement by the parties.  The 
 30.21  administrative law judge shall issue a report within 15 calendar 
 30.22  days following the close of the hearing.  The prohibition set 
 30.23  forth in this clause shall not apply to facilities licensed as 
 30.24  boarding care facilities which are not certified as skilled or 
 30.25  intermediate care facilities level I or II for reimbursement 
 30.26  through medical assistance. 
 30.27     (b) Requiring an applicant for admission to the facility, 
 30.28  or the guardian or conservator of the applicant, as a condition 
 30.29  of admission, to pay any fee or deposit in excess of $100, loan 
 30.30  any money to the nursing facility, or promise to leave all or 
 30.31  part of the applicant's estate to the facility.  
 30.32     (c) Requiring any resident of the nursing facility to 
 30.33  utilize a vendor of health care services chosen by the nursing 
 30.34  facility.  A nursing facility may require a resident to use 
 30.35  pharmacies that utilize unit dose packing systems or other 
 30.36  medication administration systems approved by the Minnesota 
 31.1   board of pharmacy, and may require a resident to use pharmacies 
 31.2   that are able to meet the nursing facility's standards for safe 
 31.3   and timely administration of medications such as systems with 
 31.4   specific number of doses, prompt delivery of medications, or 
 31.5   access to medications on a 24-hour basis.  Nursing facilities 
 31.6   shall not restrict a resident's choice of pharmacy because the 
 31.7   pharmacy utilizes a specific system of unit dose drug packing, 
 31.8   providing the system is consistent with the other systems used 
 31.9   by the facility. 
 31.10     (d) Providing differential treatment on the basis of status 
 31.11  with regard to public assistance.  
 31.12     (e) Discriminating in admissions, services offered, or room 
 31.13  assignment on the basis of status with regard to public 
 31.14  assistance or refusal to purchase special services.  Admissions 
 31.15  discrimination shall include, but is not limited to:  
 31.16     (1) basing admissions decisions upon assurance by the 
 31.17  applicant to the nursing facility, or the applicant's guardian 
 31.18  or conservator, that the applicant is neither eligible for nor 
 31.19  will seek public assistance for payment of nursing facility care 
 31.20  costs; and 
 31.21     (2) engaging in preferential selection from waiting lists 
 31.22  based on an applicant's ability to pay privately or an 
 31.23  applicant's refusal to pay for a special service. 
 31.24     The collection and use by a nursing facility of financial 
 31.25  information of any applicant pursuant to a preadmission 
 31.26  screening program established by law shall not raise an 
 31.27  inference that the nursing facility is utilizing that 
 31.28  information for any purpose prohibited by this paragraph.  
 31.29     (f) Requiring any vendor of medical care as defined by 
 31.30  section 256B.02, subdivision 7, who is reimbursed by medical 
 31.31  assistance under a separate fee schedule, to pay any amount 
 31.32  based on utilization or service levels or any portion of the 
 31.33  vendor's fee to the nursing facility except as payment for 
 31.34  renting or leasing space or equipment or purchasing support 
 31.35  services from the nursing facility as limited by section 
 31.36  256B.433.  All agreements must be disclosed to the commissioner 
 32.1   upon request of the commissioner.  Nursing facilities and 
 32.2   vendors of ancillary services that are found to be in violation 
 32.3   of this provision shall each be subject to an action by the 
 32.4   state of Minnesota or any of its subdivisions or agencies for 
 32.5   treble civil damages on the portion of the fee in excess of that 
 32.6   allowed by this provision and section 256B.433.  Damages awarded 
 32.7   must include three times the excess payments together with costs 
 32.8   and disbursements including reasonable attorney's fees or their 
 32.9   equivalent.  
 32.10     (g) Refusing, for more than 24 hours, to accept a resident 
 32.11  returning to the same bed or a bed certified for the same level 
 32.12  of care, in accordance with a physician's order authorizing 
 32.13  transfer, after receiving inpatient hospital services. 
 32.14     The prohibitions set forth in clause (b) shall not apply to 
 32.15  a retirement facility with more than 325 beds including at least 
 32.16  150 licensed nursing facility beds and which:  
 32.17     (1) is owned and operated by an organization tax-exempt 
 32.18  under section 290.05, subdivision 1, clause (i); and 
 32.19     (2) accounts for all of the applicant's assets which are 
 32.20  required to be assigned to the facility so that only expenses 
 32.21  for the cost of care of the applicant may be charged against the 
 32.22  account; and 
 32.23     (3) agrees in writing at the time of admission to the 
 32.24  facility to permit the applicant, or the applicant's guardian, 
 32.25  or conservator, to examine the records relating to the 
 32.26  applicant's account upon request, and to receive an audited 
 32.27  statement of the expenditures charged against the applicant's 
 32.28  individual account upon request; and 
 32.29     (4) agrees in writing at the time of admission to the 
 32.30  facility to permit the applicant to withdraw from the facility 
 32.31  at any time and to receive, upon withdrawal, the balance of the 
 32.32  applicant's individual account. 
 32.33     For a period not to exceed 180 days, the commissioner may 
 32.34  continue to make medical assistance payments to a nursing 
 32.35  facility or boarding care home which is in violation of this 
 32.36  section if extreme hardship to the residents would result.  In 
 33.1   these cases the commissioner shall issue an order requiring the 
 33.2   nursing facility to correct the violation.  The nursing facility 
 33.3   shall have 20 days from its receipt of the order to correct the 
 33.4   violation.  If the violation is not corrected within the 20-day 
 33.5   period the commissioner may reduce the payment rate to the 
 33.6   nursing facility by up to 20 percent.  The amount of the payment 
 33.7   rate reduction shall be related to the severity of the violation 
 33.8   and shall remain in effect until the violation is corrected.  
 33.9   The nursing facility or boarding care home may appeal the 
 33.10  commissioner's action pursuant to the provisions of chapter 14 
 33.11  pertaining to contested cases.  An appeal shall be considered 
 33.12  timely if written notice of appeal is received by the 
 33.13  commissioner within 20 days of notice of the commissioner's 
 33.14  proposed action.  
 33.15     In the event that the commissioner determines that a 
 33.16  nursing facility is not eligible for reimbursement for a 
 33.17  resident who is eligible for medical assistance, the 
 33.18  commissioner may authorize the nursing facility to receive 
 33.19  reimbursement on a temporary basis until the resident can be 
 33.20  relocated to a participating nursing facility.  
 33.21     Certified beds in facilities which do not allow medical 
 33.22  assistance intake on July 1, 1984, or after shall be deemed to 
 33.23  be decertified for purposes of section 144A.071 only. 
 33.24     Sec. 28.  Minnesota Statutes 1998, section 256B.69, is 
 33.25  amended by adding a subdivision to read: 
 33.26     Subd. 5a.  [MEDICAL EDUCATION AND RESEARCH PAYMENTS.] For 
 33.27  the calendar years 1999, 2000, and 2001, a hospital that 
 33.28  participates in funding the federal share of the medical 
 33.29  education and research trust fund payment under Laws 1998, 
 33.30  chapter 407, article 1, section 3, shall not be held liable for 
 33.31  any amounts attributable to this payment above the charge limit 
 33.32  of section 256.969, subdivision 3a.  The commissioner of human 
 33.33  services shall assume liability for any corresponding federal 
 33.34  share of the payments above the charge limit. 
 33.35     Sec. 29.  Minnesota Statutes 1998, section 256B.75, is 
 33.36  amended to read: 
 34.1      256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 
 34.2      For outpatient hospital facility fee payments for services 
 34.3   rendered on or after October 1, 1992, the commissioner of human 
 34.4   services shall pay the lower of (1) submitted charge, or (2) 32 
 34.5   percent above the rate in effect on June 30, 1992, except for 
 34.6   those services for which there is a federal maximum allowable 
 34.7   payment.  Effective for services rendered on or after January 1, 
 34.8   2000, payment rates for nonsurgical outpatient hospital facility 
 34.9   fees and emergency room facility fees shall be increased by ten 
 34.10  percent over the rates in effect on December 31, 1999, except 
 34.11  for those services for which there is a federal maximum 
 34.12  allowable payment.  Services for which there is a federal 
 34.13  maximum allowable payment shall be paid at the lower of (1) 
 34.14  submitted charge, or (2) the federal maximum allowable payment.  
 34.15  Total aggregate payment for outpatient hospital facility fee 
 34.16  services shall not exceed the Medicare upper limit.  If it is 
 34.17  determined that a provision of this section conflicts with 
 34.18  existing or future requirements of the United States government 
 34.19  with respect to federal financial participation in medical 
 34.20  assistance, the federal requirements prevail.  The commissioner 
 34.21  may, in the aggregate, prospectively reduce payment rates to 
 34.22  avoid reduced federal financial participation resulting from 
 34.23  rates that are in excess of the Medicare upper limitations. 
 34.24     Sec. 30.  Minnesota Statutes 1998, section 256B.76, is 
 34.25  amended to read: 
 34.26     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
 34.27     (a) The physician reimbursement increase provided in 
 34.28  section 256B.74, subdivision 2, shall not be implemented.  
 34.29  Effective for services rendered on or after October 1, 1992, the 
 34.30  commissioner shall make payments for physician services as 
 34.31  follows: 
 34.32     (1) payment for level one Health Care Finance 
 34.33  Administration's common procedural coding system (HCPCS) codes 
 34.34  titled "office and other outpatient services," "preventive 
 34.35  medicine new and established patient," "delivery, antepartum, 
 34.36  and postpartum care," "critical care," Caesarean delivery and 
 35.1   pharmacologic management provided to psychiatric patients, and 
 35.2   HCPCS level three codes for enhanced services for prenatal high 
 35.3   risk, shall be paid at the lower of (i) submitted charges, or 
 35.4   (ii) 25 percent above the rate in effect on June 30, 1992.  If 
 35.5   the rate on any procedure code within these categories is 
 35.6   different than the rate that would have been paid under the 
 35.7   methodology in section 256B.74, subdivision 2, then the larger 
 35.8   rate shall be paid; 
 35.9      (2) payments for all other services shall be paid at the 
 35.10  lower of (i) submitted charges, or (ii) 15.4 percent above the 
 35.11  rate in effect on June 30, 1992; ~~and~~ 
 35.12     (3) all physician rates shall be converted from the 50th 
 35.13  percentile of 1982 to the 50th percentile of 1989, less the 
 35.14  percent in aggregate necessary to equal the above increases 
 35.15  except that payment rates for home health agency services shall 
 35.16  be the rates in effect on September 30, 1992~~.~~; 
 35.17     (4) effective for services rendered on or after October 1, 
 35.18  1999, payment rates for physician and professional services 
 35.19  shall be increased by four percent over the rates in effect on 
 35.20  September 30, 1999, except for home health agency services; 
 35.21     (5) the department shall present a proposal during the year 
 35.22  2000 legislative session detailing physician and professional 
 35.23  services payment methodology conversion to Resource Based 
 35.24  Relative Value Scale; and 
 35.25     (6) the increases in clause (4) shall be implemented 
 35.26  January 1, 2000, for managed care. 
 35.27     (b) The dental reimbursement increase provided in section 
 35.28  256B.74, subdivision 5, shall not be implemented.  Effective for 
 35.29  services rendered on or after October 1, 1992, the commissioner 
 35.30  shall make payments for dental services as follows: 
 35.31     (1) dental services shall be paid at the lower of (i) 
 35.32  submitted charges, or (ii) 25 percent above the rate in effect 
 35.33  on June 30, 1992; ~~and~~ 
 35.34     (2) dental rates shall be converted from the 50th 
 35.35  percentile of 1982 to the 50th percentile of 1989, less the 
 35.36  percent in aggregate necessary to equal the above increases~~.~~; 
 36.1      (3) effective for services rendered on or after October 1, 
 36.2   1999, payment rates for dental services shall be increased by 
 36.3   five percent over the rates in effect on September 30, 1999; 
 36.4      (4) the department shall increase payments by 20 percent 
 36.5   over the October 1, 1999, fee-for-service rates, for those 
 36.6   fee-for-service providers for whom public programs under MA, 
 36.7   GAMC, and MinnesotaCare account for 20 percent or more of their 
 36.8   practice; 
 36.9      (5) the commissioner shall award grants to community 
 36.10  clinics or other nonprofit community organizations which will 
 36.11  increase the availability of dental services to public program 
 36.12  recipients.  These grants may be used to fund the costs related 
 36.13  to coordinating access for recipients, developing and 
 36.14  implementing patient care criteria, establishing new or 
 36.15  upgrading existing facilities, acquiring furnishings or 
 36.16  equipment, recruiting new providers, or other development costs 
 36.17  that will improve access to dental care in that region.  The 
 36.18  commissioner shall consider the following in awarding the 
 36.19  grants:  (i) potential to successfully increase access to an 
 36.20  underserved population; (ii) the ability to raise matching 
 36.21  funds; (iii) the long-term viability of the project to improve 
 36.22  access beyond the period of initial funding; (iv) the efficiency 
 36.23  in the use of the funding; and (v) the experience of the 
 36.24  proposers in providing services to the target population.  The 
 36.25  commissioner shall monitor the grants and may terminate a grant 
 36.26  if the grantee does not increase dental access for public 
 36.27  program recipients; 
 36.28     (6) the department shall fund two initiatives to improve 
 36.29  dental access that will allow the commissioner to increase rates 
 36.30  if the percentage of public program recipients with at least one 
 36.31  dental visit per year increases; 
 36.32     (7) beginning October 1, 1999, the payment for tooth 
 36.33  sealants and fluoride treatments shall be the lower of (i) 
 36.34  submitted charge, or (ii) 80 percent of median 1997 charges; and 
 36.35     (8) the increases listed in clauses (3, (4), and (7) shall 
 36.36  be implemented January 1, 2000, for managed care. 
 37.1      (c) An entity that operates both a Medicare certified 
 37.2   comprehensive outpatient rehabilitation facility and a facility 
 37.3   which was certified prior to January 1, 1993, that is licensed 
 37.4   under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 37.5   whom at least 33 percent of the clients receiving rehabilitation 
 37.6   services in the most recent calendar year are medical assistance 
 37.7   recipients, shall be reimbursed by the commissioner for 
 37.8   rehabilitation services at rates that are 38 percent greater 
 37.9   than the maximum reimbursement rate allowed under paragraph (a), 
 37.10  clause (2), when those services are (1) provided within the 
 37.11  comprehensive outpatient rehabilitation facility and (2) 
 37.12  provided to residents of nursing facilities owned by the entity. 
 37.13     Sec. 31.  Minnesota Statutes 1998, section 256L.03, 
 37.14  subdivision 5, is amended to read: 
 37.15     Subd. 5.  [COPAYMENTS AND COINSURANCE.] The MinnesotaCare 
 37.16  benefit plan shall include the following copayments and 
 37.17  coinsurance requirements for all enrollees except parents and 
 37.18  relative caretakers of children under 21 in households with 
 37.19  income at or below 175 percent of the federal poverty guidelines 
 37.20  and pregnant women and children under 21:  
 37.21     (1) ten percent of the paid charges for inpatient hospital 
 37.22  services for adult enrollees, subject to an annual inpatient 
 37.23  out-of-pocket maximum of $1,000 per individual and $3,000 per 
 37.24  family; 
 37.25     (2) $3 per prescription for adult enrollees; 
 37.26     (3) $25 for eyeglasses for adult enrollees; and 
 37.27     (4) effective July 1, 1998, 50 percent of the 
 37.28  fee-for-service rate for adult dental care services other than 
 37.29  preventive care services for persons eligible under section 
 37.30  256L.04, subdivisions 1 to 7, with income equal to or less than 
 37.31  175 percent of the federal poverty guidelines. 
 37.32     Effective July 1, 1997, adult enrollees with family gross 
 37.33  income that exceeds 175 percent of the federal poverty 
 37.34  guidelines and who are not pregnant shall be financially 
 37.35  responsible for the coinsurance amount and amounts which exceed 
 37.36  the $10,000 inpatient hospital benefit limit. 
 38.1      When a MinnesotaCare enrollee becomes a member of a prepaid 
 38.2   health plan, or changes from one prepaid health plan to another 
 38.3   during a calendar year, any charges submitted towards the 
 38.4   $10,000 annual inpatient benefit limit, and any out-of-pocket 
 38.5   expenses incurred by the enrollee for inpatient services, that 
 38.6   were submitted or incurred prior to enrollment, or prior to the 
 38.7   change in health plans, shall be disregarded. 
 38.8      Sec. 32.  Minnesota Statutes 1998, section 256L.04, 
 38.9   subdivision 2, is amended to read: 
 38.10     Subd. 2.  [COOPERATION IN ESTABLISHING THIRD-PARTY 
 38.11  LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
 38.12  eligible for MinnesotaCare, individuals and families must 
 38.13  cooperate with the state agency to identify potentially liable 
 38.14  third-party payers and assist the state in obtaining third-party 
 38.15  payments.  "Cooperation" includes, but is not limited to, 
 38.16  identifying any third party who may be liable for care and 
 38.17  services provided under MinnesotaCare to the enrollee, providing 
 38.18  relevant information to assist the state in pursuing a 
 38.19  potentially liable third party, and completing forms necessary 
 38.20  to recover third-party payments. 
 38.21     (b) A parent, guardian, relative caretaker, or child 
 38.22  enrolled in the MinnesotaCare program must cooperate with the 
 38.23  department of human services and the local agency in 
 38.24  establishing the paternity of an enrolled child and in obtaining 
 38.25  medical care support and payments for the child and any other 
 38.26  person for whom the person can legally assign rights, in 
 38.27  accordance with applicable laws and rules governing the medical 
 38.28  assistance program.  A child shall not be ineligible for or 
 38.29  disenrolled from the MinnesotaCare program solely because the 
 38.30  child's parent, relative caretaker, or guardian fails to 
 38.31  cooperate in establishing paternity or obtaining medical support.
 38.32     Sec. 33.  Minnesota Statutes 1998, section 256L.04, 
 38.33  subdivision 8, is amended to read: 
 38.34     Subd. 8.  [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL 
 38.35  ASSISTANCE.] (a) Individuals who receive supplemental security 
 38.36  income or retirement, survivors, or disability benefits due to a 
 39.1   disability, or other disability-based pension, who qualify under 
 39.2   subdivision 7, but who are potentially eligible for medical 
 39.3   assistance without a spenddown shall be allowed to enroll in 
 39.4   MinnesotaCare for a period of 60 days, so long as the applicant 
 39.5   meets all other conditions of eligibility.  The commissioner 
 39.6   shall identify and refer the applications of such individuals to 
 39.7   their county social service agency.  The county and the 
 39.8   commissioner shall cooperate to ensure that the individuals 
 39.9   obtain medical assistance coverage for any months for which they 
 39.10  are eligible. 
 39.11     (b) The enrollee must cooperate with the county social 
 39.12  service agency in determining medical assistance eligibility 
 39.13  within the 60-day enrollment period.  Enrollees who do not 
 39.14  cooperate with medical assistance within the 60-day enrollment 
 39.15  period shall be disenrolled from the plan within one calendar 
 39.16  month.  Persons disenrolled for nonapplication for medical 
 39.17  assistance may not reenroll until they have obtained a medical 
 39.18  assistance eligibility determination.  Persons disenrolled for 
 39.19  noncooperation with medical assistance may not reenroll until 
 39.20  they have cooperated with the county agency and have obtained a 
 39.21  medical assistance eligibility determination. 
 39.22     (c) Beginning January 1, 2000, counties that choose to 
 39.23  become MinnesotaCare enrollment sites shall consider 
 39.24  MinnesotaCare applications ~~of individuals described in paragraph~~ 
 39.25  ~~(a)~~ to also be applications for medical assistance ~~and shall~~ 
 39.26  ~~first determine whether medical assistance eligibility exists~~.  
 39.27  ~~Adults with children with family income under 175 percent of the~~ 
 39.28  ~~federal poverty guidelines for the applicable family size,~~ 
 39.29  ~~pregnant women, and children who qualify under subdivision 1~~ 
 39.30  Applicants who are potentially eligible for medical assistance, 
 39.31  except for those described in paragraph (a), ~~without a spenddown~~ 
 39.32  may choose to enroll in either MinnesotaCare or medical 
 39.33  assistance. 
 39.34     (d) The commissioner shall redetermine provider payments 
 39.35  made under MinnesotaCare to the appropriate medical assistance 
 39.36  payments for those enrollees who subsequently become eligible 
 40.1   for medical assistance. 
 40.2      Sec. 34.  Minnesota Statutes 1998, section 256L.04, 
 40.3   subdivision 13, is amended to read: 
 40.4      Subd. 13.  [FAMILIES WITH ~~GRANDPARENTS,~~ RELATIVE 
 40.5   CARETAKERS, FOSTER PARENTS, OR LEGAL GUARDIANS.] Beginning 
 40.6   January 1, 1999, in families that include a ~~grandparent,~~ 
 40.7   relative caretaker as defined in the medical assistance program, 
 40.8   foster parent, or legal guardian, the ~~grandparent,~~ relative 
 40.9   caretaker, foster parent, or legal guardian may apply as a 
 40.10  family or may apply separately for the children.  If the 
 40.11  caretaker applies separately for the children, only the 
 40.12  children's income is counted and the provisions of subdivision 
 40.13  1, paragraph (b), do not apply.  If the ~~grandparent,~~ relative 
 40.14  caretaker, foster parent, or legal guardian applies with the 
 40.15  children, their income is included in the gross family income 
 40.16  for determining eligibility and premium amount. 
 40.17     Sec. 35.  Minnesota Statutes 1998, section 256L.05, 
 40.18  subdivision 4, is amended to read: 
 40.19     Subd. 4.  [APPLICATION PROCESSING.] The commissioner of 
 40.20  human services shall determine an applicant's eligibility for 
 40.21  MinnesotaCare no more than 30 days from the date that the 
 40.22  application is received by the department of human services.  
 40.23  Beginning January 1, 2000, this requirement also applies to 
 40.24  local county human services agencies that determine eligibility 
 40.25  for MinnesotaCare.  Once annually at application or 
 40.26  reenrollment, to prevent processing delays, applicants or 
 40.27  enrollees who, from the information provided on the application, 
 40.28  appear to meet eligibility requirements shall be enrolled upon 
 40.29  timely payment of premiums. The enrollee must provide all 
 40.30  required verifications within 30 days of ~~enrollment~~ notification 
 40.31  of the eligibility determination or coverage from the program 
 40.32  shall be terminated.  Enrollees who are determined to be 
 40.33  ineligible when verifications are provided shall be disenrolled 
 40.34  from the program. 
 40.35     Sec. 36.  Minnesota Statutes 1998, section 256L.06, 
 40.36  subdivision 3, is amended to read: 
 41.1      Subd. 3.  [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 
 41.2   Premiums are dedicated to the commissioner for MinnesotaCare. 
 41.3      (b) The commissioner shall develop and implement procedures 
 41.4   to:  (1) require enrollees to report changes in income; (2) 
 41.5   adjust sliding scale premium payments, based upon changes in 
 41.6   enrollee income; and (3) disenroll enrollees from MinnesotaCare 
 41.7   for failure to pay required premiums.  ~~Beginning July 1, 1998,~~ 
 41.8   Failure to pay includes payment with a dishonored check ~~and~~, a 
 41.9   returned automatic bank withdrawal, or a refused credit card or 
 41.10  debit card payment.  The commissioner may demand a guaranteed 
 41.11  form of payment, including a cashier's check or a money order, 
 41.12  as the only means to replace a dishonored ~~check~~, returned, or 
 41.13  refused payment. 
 41.14     (c) Premiums are calculated on a calendar month basis and 
 41.15  may be paid on a monthly, quarterly, or annual basis, with the 
 41.16  first payment due upon notice from the commissioner of the 
 41.17  premium amount required.  The commissioner shall inform 
 41.18  applicants and enrollees of these premium payment options. 
 41.19  Premium payment is required before enrollment is complete and to 
 41.20  maintain eligibility in MinnesotaCare.  
 41.21     (d) Nonpayment of the premium will result in disenrollment 
 41.22  from the plan within one calendar month after the due date.  
 41.23  Persons disenrolled for nonpayment or who voluntarily terminate 
 41.24  coverage from the program may not reenroll until four calendar 
 41.25  months have elapsed.  Persons disenrolled for nonpayment who pay 
 41.26  all past due premiums as well as current premiums due, including 
 41.27  premiums due for the period of disenrollment, within 20 days of 
 41.28  disenrollment, shall be reenrolled retroactively to the first 
 41.29  day of disenrollment.  Persons disenrolled for nonpayment or who 
 41.30  voluntarily terminate coverage from the program may not reenroll 
 41.31  for four calendar months unless the person demonstrates good 
 41.32  cause for nonpayment.  Good cause does not exist if a person 
 41.33  chooses to pay other family expenses instead of the premium.  
 41.34  The commissioner shall define good cause in rule. 
 41.35     Sec. 37.  Minnesota Statutes 1998, section 256L.07, is 
 41.36  amended to read: 
 42.1      256L.07 [ELIGIBILITY FOR ~~SUBSIDIZED PREMIUMS BASED ON~~ 
 42.2   ~~SLIDING SCALE~~ MINNESOTACARE.] 
 42.3      Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
 42.4   enrolled in the original children's health plan as of September 
 42.5   30, 1992, children who enrolled in the MinnesotaCare program 
 42.6   after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 42.7   article 4, section 17, and children who have family gross 
 42.8   incomes that are equal to or less than 150 percent of the 
 42.9   federal poverty guidelines are eligible ~~for subsidized premium~~ 
 42.10  ~~payments~~ without meeting the requirements of subdivision 2, as 
 42.11  long as they maintain continuous coverage in the MinnesotaCare 
 42.12  program or medical assistance.  Children who apply for 
 42.13  MinnesotaCare on or after the implementation date of the 
 42.14  employer-subsidized health coverage program as described in Laws 
 42.15  1998, chapter 407, article 5, section 45, who have family gross 
 42.16  incomes that are equal to or less than 150 percent of the 
 42.17  federal poverty guidelines, must meet the requirements of 
 42.18  subdivision 2 to be eligible for MinnesotaCare. 
 42.19     (b) Families enrolled in MinnesotaCare under section 
 42.20  256L.04, subdivision 1, whose income increases above 275 percent 
 42.21  of the federal poverty guidelines, are no longer eligible for 
 42.22  the program and shall be disenrolled by the commissioner.  
 42.23  Individuals enrolled in MinnesotaCare under section 256L.04, 
 42.24  subdivision 7, whose income increases above 175 percent of the 
 42.25  federal poverty guidelines are no longer eligible for the 
 42.26  program and shall be disenrolled by the commissioner.  For 
 42.27  persons disenrolled under this subdivision, MinnesotaCare 
 42.28  coverage terminates the last day of the calendar month following 
 42.29  the month in which the commissioner determines that the income 
 42.30  of a family or individual~~, determined over a four-month period~~ 
 42.31  ~~as required by section 256L.15, subdivision 2,~~ exceeds program 
 42.32  income limits.  
 42.33     (c) Notwithstanding paragraph (b), individuals and families 
 42.34  may remain enrolled in MinnesotaCare if ten percent of their 
 42.35  annual income is less than the annual premium for a policy with 
 42.36  a $500 deductible available through the Minnesota comprehensive 
 43.1   health association.  Individuals and families who are no longer 
 43.2   eligible for MinnesotaCare under this subdivision shall be given 
 43.3   an 18-month notice period from the date that ineligibility is 
 43.4   determined before disenrollment.  
 43.5      Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
 43.6   COVERAGE.] (a) To be eligible ~~for subsidized premium payments~~ 
 43.7   ~~based on a sliding scale~~, a family or individual must not have 
 43.8   access to subsidized health coverage through an employer.  A 
 43.9   family or individual whose employer-subsidized coverage is lost 
 43.10  due to an employer terminating health care coverage as an 
 43.11  employee benefit during the previous 18 months is not eligible.  
 43.12     (b) For purposes of this requirement, subsidized health 
 43.13  coverage means health coverage for which the employer pays at 
 43.14  least 50 percent of the cost of coverage for the employee or 
 43.15  dependent, or a higher percentage as specified by the 
 43.16  commissioner.  Children are eligible for employer-subsidized 
 43.17  coverage through either parent, including the noncustodial 
 43.18  parent.  The commissioner must treat employer contributions to 
 43.19  Internal Revenue Code Section 125 plans and any other employer 
 43.20  benefits intended to pay health care costs as qualified employer 
 43.21  subsidies toward the cost of health coverage for employees for 
 43.22  purposes of this subdivision. 
 43.23     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
 43.24  individuals enrolled in the MinnesotaCare program must have no 
 43.25  health coverage while enrolled or for at least four months prior 
 43.26  to application and renewal.  Children enrolled in the original 
 43.27  children's health plan and children in families with income 
 43.28  equal to or less than 150 percent of the federal poverty 
 43.29  guidelines, who have other health insurance, are eligible if the 
 43.30  ~~other health coverage meets the requirements of Minnesota Rules,~~ 
 43.31  ~~part 9506.0020, subpart 3, item B.~~ coverage: 
 43.32     (1) lacks two or more of the following: 
 43.33     (i) basic hospital insurance; 
 43.34     (ii) medical-surgical insurance; 
 43.35     (iii) prescription drug coverage; 
 43.36     (iv) dental coverage; or 
 44.1      (v) vision coverage; 
 44.2      (2) requires a deductible of $100 or more per person per 
 44.3   year; or 
 44.4      (3) lacks coverage because the child has exceeded the 
 44.5   maximum coverage for a particular diagnosis or the policy 
 44.6   excludes a particular diagnosis. 
 44.7      The commissioner may change this eligibility criterion for 
 44.8   sliding scale premiums in order to remain within the limits of 
 44.9   available appropriations.  The requirement of no health coverage 
 44.10  does not apply to newborns. 
 44.11     (b) For purposes of this section, medical assistance, 
 44.12  general assistance medical care, and civilian health and medical 
 44.13  program of the uniformed service, CHAMPUS, are not considered 
 44.14  insurance or health coverage. 
 44.15     (c) For purposes of this section, Medicare Part A or B 
 44.16  coverage under title XVIII of the Social Security Act, United 
 44.17  States Code, title 42, sections 1395c to 1395w-4, is considered 
 44.18  health coverage.  An applicant or enrollee may not refuse 
 44.19  Medicare coverage to establish eligibility for MinnesotaCare. 
 44.20     (d) Applicants who were recipients of medical assistance or 
 44.21  general assistance medical care within one month of application 
 44.22  must meet the provisions of this subdivision and subdivision 2. 
 44.23     Sec. 38.  Minnesota Statutes 1998, section 256L.15, 
 44.24  subdivision 1, is amended to read: 
 44.25     Subdivision 1.  [PREMIUM DETERMINATION.] Families with 
 44.26  children and individuals shall pay a premium determined 
 44.27  according to a sliding fee based on ~~the cost of coverage as~~ a 
 44.28  percentage of the family's gross family income.  Pregnant women 
 44.29  and children under age two are exempt from the provisions of 
 44.30  section 256L.06, subdivision 3, paragraph (b), clause (3), 
 44.31  requiring disenrollment for failure to pay premiums.  For 
 44.32  pregnant women, this exemption continues until the first day of 
 44.33  the month following the 60th day postpartum.  Women who remain 
 44.34  enrolled during pregnancy or the postpartum period, despite 
 44.35  nonpayment of premiums, shall be disenrolled on the first of the 
 44.36  month following the 60th day postpartum for the penalty period 
 45.1   that otherwise applies under section 256L.06, unless they begin 
 45.2   paying premiums. 
 45.3      Sec. 39.  Minnesota Statutes 1998, section 256L.15, 
 45.4   subdivision 1b, is amended to read: 
 45.5      Subd. 1b.  [PAYMENTS NONREFUNDABLE.] Only MinnesotaCare 
 45.6   premiums ~~are not refundable~~ paid for future months of coverage 
 45.7   for which a health plan capitation fee has not been paid may be 
 45.8   refunded. 
 45.9      Sec. 40.  Minnesota Statutes 1998, section 256L.15, 
 45.10  subdivision 2, is amended to read: 
 45.11     Subd. 2.  [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 
 45.12  GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner shall 
 45.13  establish a sliding fee scale to determine the percentage of 
 45.14  gross individual or family income that households at different 
 45.15  income levels must pay to obtain coverage through the 
 45.16  MinnesotaCare program.  The sliding fee scale must be based on 
 45.17  the enrollee's gross individual or family income ~~during the~~ 
 45.18  ~~previous four months~~.  The sliding fee scale must contain 
 45.19  separate tables based on enrollment of one, two, or three or 
 45.20  more persons.  The sliding fee scale begins with a premium of 
 45.21  1.5 percent of gross individual or family income for individuals 
 45.22  or families with incomes below the limits for the medical 
 45.23  assistance program for families and children in effect on 
 45.24  January 1, 1999, and proceeds through the following ~~evenly~~ 
 45.25  spaced steps:  1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 
 45.26  percent.  These percentages are matched to evenly spaced income 
 45.27  steps ranging from the medical assistance income limit for 
 45.28  families and children in effect on January 1, 1999, to 275 
 45.29  percent of the federal poverty guidelines for the applicable 
 45.30  family size, up to a family size of five.  The sliding fee scale 
 45.31  for a family of five must be used for families of more than 
 45.32  five.  The sliding fee scale and percentages are not subject to 
 45.33  the provisions of chapter 14.  If a family or individual reports 
 45.34  increased income after enrollment, premiums shall not be 
 45.35  adjusted until eligibility renewal. 
 45.36     (b) Enrolled individuals and families whose gross annual 
 46.1   income increases above 275 percent of the federal poverty 
 46.2   guideline shall pay the maximum premium.  The maximum premium is 
 46.3   defined as a base charge for one, two, or three or more 
 46.4   enrollees so that if all MinnesotaCare cases paid the maximum 
 46.5   premium, the total revenue would equal the total cost of 
 46.6   MinnesotaCare medical coverage and administration.  In this 
 46.7   calculation, administrative costs shall be assumed to equal ten 
 46.8   percent of the total.  The costs of medical coverage for 
 46.9   pregnant women and children under age two and the enrollees in 
 46.10  these groups shall be excluded from the total.  The maximum 
 46.11  premium for two enrollees shall be twice the maximum premium for 
 46.12  one, and the maximum premium for three or more enrollees shall 
 46.13  be three times the maximum premium for one. 
 46.14     Sec. 41.  Laws 1995, chapter 178, article 2, section 46, 
 46.15  subdivision 10, is amended to read: 
 46.16     Subd. 10.  [ADDITIONAL WAIVER REQUEST FOR EMPLOYED DISABLED 
 46.17  PERSONS.] The commissioner shall seek a federal waiver in order 
 46.18  to implement a work incentive for disabled persons ~~eligible for~~ 
 46.19  ~~medical assistance~~ who are not residents of long-term care 
 46.20  facilities, when determining their eligibility for medical 
 46.21  assistance.  The waiver shall request authorization to establish 
 46.22  a medical assistance earned income disregard for employed 
 46.23  disabled persons who, but for earned income, are eligible for 
 46.24  SSDI and who ~~receive~~ require personal care assistance under the 
 46.25  Medical Assistance Program.  The disregard shall be equivalent 
 46.26  to the threshold amount applied to persons who qualify under 
 46.27  section 1619(b) of the Social Security Act, except that when a 
 46.28  disabled person's earned income reaches the maximum income 
 46.29  permitted at the threshold under section 1619(b), the person 
 46.30  shall retain medical assistance eligibility and must contribute 
 46.31  to the costs of medical care on a sliding fee basis. 
 46.32     Sec. 42.  [HOME-BASED MENTAL HEALTH SERVICES.] 
 46.33     By January 1, 2000, the commissioner shall amend Minnesota 
 46.34  Rules under the expedited process of Minnesota Statutes, section 
 46.35  14.389, to effect the following changes: 
 46.36     (1) amend Minnesota Rules, part 9505.0324, subpart 2, to 
 47.1   permit a county board to contract with any agency qualified 
 47.2   under Minnesota Rules, part 9505.0324, subparts 4 and 5, as an 
 47.3   eligible provider of home-based mental health services; 
 47.4      (2) amend Minnesota Rules, part 9505.0324, subpart 2, to 
 47.5   permit children's mental health collaboratives approved by the 
 47.6   children's cabinet under Minnesota Statutes, section 245.493, to 
 47.7   provide or to contract with any agency qualified under Minnesota 
 47.8   Rules, part 9505.0324, subparts 4 and 5, as an eligible provider 
 47.9   of home-based mental health services. 
 47.10     Sec. 43.  [AMENDING MEDICAL ASSISTANCE RULES.] 
 47.11     By January 1, 2001, the commissioner shall amend Minnesota 
 47.12  Rules, parts 9505.0323, 9505.0324, 9505.0326, and 9505.0327, as 
 47.13  necessary to implement the changes outlined in Minnesota 
 47.14  Statutes, section 256B.0625, subdivision 23. 
 47.15     Sec. 44.  [PROGRAMS FOR SENIOR CITIZENS.] 
 47.16     The commissioner of human services shall study the 
 47.17  eligibility criteria of and benefits provided to persons age 65 
 47.18  and over through the array of cash assistance and health care 
 47.19  programs administered by the department, and the extent to which 
 47.20  these programs can be combined, simplified, or coordinated to 
 47.21  reduce administrative costs and improve access.  The 
 47.22  commissioner shall also study potential barriers to enrollment 
 47.23  for low-income seniors who would otherwise deplete resources 
 47.24  necessary to maintain independent community living.  At a 
 47.25  minimum, the study must include an evaluation of asset 
 47.26  requirements and enrollment sites.  The commissioner shall 
 47.27  report study findings and recommendations to the legislature by 
 47.28  February 15, 2000.