1.1                          A bill for an act 
  1.2             relating to human services; modifying provisions in 
  1.3             health care programs; requiring a study of group 
  1.4             residential housing; clarifying medical assistance 
  1.5             coverage for employed persons with disabilities; 
  1.6             amending Minnesota Statutes 1998, sections 62Q.19, 
  1.7             subdivisions 2 and 6; and 256B.69, subdivision 23; 
  1.8             Minnesota Statutes 1999 Supplement, sections 256B.057, 
  1.9             subdivision 9; 256B.0945, subdivisions 1, 2, 4, 5, 6, 
  1.10            7, 8, and 9; 256B.69, subdivision 6b; 256D.03, 
  1.11            subdivision 3; and 256L.03, subdivision 5; amending 
  1.12            Laws 1999, chapter 245, article 8, section 84; 
  1.13            repealing Laws 1998, chapter 407, article 5, section 
  1.14            44. 
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16     Section 1.  Minnesota Statutes 1998, section 62Q.19, 
  1.17  subdivision 2, is amended to read: 
  1.18     Subd. 2.  [APPLICATION.] (a) Any provider may apply to the 
  1.19  commissioner for designation as an essential community provider 
  1.20  by submitting an application form developed by the 
  1.21  commissioner.  Except as provided in paragraph (d), applications 
  1.22  must be accepted within two years after the effective date of 
  1.23  the rules adopted by the commissioner to implement this section. 
  1.24     (b) Each application submitted must be accompanied by an 
  1.25  application fee in an amount determined by the commissioner.  
  1.26  The fee shall be no more than what is needed to cover the 
  1.27  administrative costs of processing the application. 
  1.28     (c) The name, address, contact person, and the date by 
  1.29  which the commissioner's decision is expected to be made shall 
  1.30  be classified as public data under section 13.41.  All other 
  2.1   information contained in the application form shall be 
  2.2   classified as private data under section 13.41 until the 
  2.3   application has been approved, approved as modified, or denied 
  2.4   by the commissioner.  Once the decision has been made, all 
  2.5   information shall be classified as public data unless the 
  2.6   applicant designates and the commissioner determines that the 
  2.7   information contains trade secret information. 
  2.8      (d) The commissioner shall accept an application for 
  2.9   designation as an essential community provider until June 30, 
  2.10  2001, from: 
  2.11     (1) one applicant that is a nonprofit community health care 
  2.12  facility, certified as a medical assistance provider effective 
  2.13  April 1, 1998, that provides culturally competent health care to 
  2.14  an underserved Southeast Asian immigrant and refugee population 
  2.15  residing in the immediate neighborhood of the facility; 
  2.16     (2) one applicant that is a nonprofit home health care 
  2.17  provider, certified as a Medicare and a medical assistance 
  2.18  provider that provides culturally competent home health care 
  2.19  services to a low-income culturally diverse population; 
  2.20     (3) up to five applicants that are nonprofit community 
  2.21  mental health centers certified as medical assistance providers 
  2.22  that provide mental health services to children with serious 
  2.23  emotional disturbance and their families or to adults with 
  2.24  serious and persistent mental illness; and 
  2.25     (4) one applicant that is a nonprofit provider certified as 
  2.26  a medical assistance provider that provides mental health, child 
  2.27  development, and family services to children with physical and 
  2.28  mental health disorders and their families. 
  2.29     Sec. 2.  Minnesota Statutes 1998, section 62Q.19, 
  2.30  subdivision 6, is amended to read: 
  2.31     Subd. 6.  [TERMINATION OR RENEWAL OF DESIGNATION; 
  2.32  COMMISSIONER REVIEW.] The designation as an essential community 
  2.33  provider ~~terminates~~ shall be valid for a five-year period from 
  2.34  the date of designation.  Five years after ~~it~~ the designation of 
  2.35  essential community provider is granted~~, or when universal~~ 
  2.36  ~~coverage as defined under section 62Q.165 is achieved, whichever~~ 
  3.1   ~~is later~~ to a provider, the commissioner shall review the need 
  3.2   for and appropriateness of continuing the designation for that 
  3.3   provider.  The commissioner may require a provider whose 
  3.4   designation is to be reviewed to submit an application to the 
  3.5   commissioner for renewal of the designation and may require an 
  3.6   application fee to be submitted with the application to cover 
  3.7   the administrative costs of processing the application.  Based 
  3.8   on that review, the commissioner may renew a provider's 
  3.9   essential community provider designation for an additional 
  3.10  five-year period or terminate the designation.  Once the 
  3.11  designation terminates, the former essential community provider 
  3.12  has no rights or privileges beyond those of any other health 
  3.13  care provider.  ~~The commissioner shall make a recommendation to~~ 
  3.14  ~~the legislature on whether an essential community provider~~ 
  3.15  ~~designation should be longer than five years.~~ 
  3.16     Sec. 3.  Minnesota Statutes 1999 Supplement, section 
  3.17  256B.057, subdivision 9, is amended to read: 
  3.18     Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
  3.19  assistance may be paid for a person who is employed and who: 
  3.20     (1) meets the definition of disabled under the supplemental 
  3.21  security income program; 
  3.22     (2) is at least 16 but less than 65 years of age; 
  3.23     (3) meets the asset limits in paragraph (b); and 
  3.24     ~~(3)~~ (4) pays a premium, if required, under paragraph (c).  
  3.25  Any spousal income or assets shall be disregarded for purposes 
  3.26  of eligibility and premium determinations. 
  3.27     (b) For purposes of determining eligibility under this 
  3.28  subdivision, a person's assets must not exceed $20,000, 
  3.29  excluding: 
  3.30     (1) all assets excluded under section 256B.056; 
  3.31     (2) retirement accounts, including individual accounts, 
  3.32  401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
  3.33     (3) medical expense accounts set up through the person's 
  3.34  employer. 
  3.35     (c) A person whose earned and unearned income is greater 
  3.36  than 200 percent of federal poverty guidelines for the 
  4.1   applicable family size must pay a premium to be eligible for 
  4.2   medical assistance.  The premium shall be equal to ten percent 
  4.3   of the person's gross earned and unearned income above 200 
  4.4   percent of federal poverty guidelines for the applicable family 
  4.5   size up to the cost of coverage. 
  4.6      (d) A person's eligibility and premium shall be determined 
  4.7   by the local county agency.  Premiums must be paid to the 
  4.8   commissioner.  All premiums are dedicated to the commissioner. 
  4.9      (e) Any required premium shall be determined at application 
  4.10  and redetermined annually at recertification or when a change in 
  4.11  income ~~of~~ or family size occurs. 
  4.12     (f) Premium payment is due upon notification from the 
  4.13  commissioner of the premium amount required.  Premiums may be 
  4.14  paid in installments at the discretion of the commissioner. 
  4.15     (g) Nonpayment of the premium shall result in denial or 
  4.16  termination of medical assistance unless the person demonstrates 
  4.17  good cause for nonpayment.  Good cause exists if the 
  4.18  requirements specified in Minnesota Rules, part 9506.0040, 
  4.19  subpart 7, items B to D, are met.  Nonpayment shall include 
  4.20  payment with a returned, refused, or dishonored instrument.  The 
  4.21  commissioner may require a guaranteed form of payment as the 
  4.22  only means to replace a returned, refused, or dishonored 
  4.23  instrument. 
  4.24     Sec. 4.  Minnesota Statutes 1999 Supplement, section 
  4.25  256B.0945, subdivision 1, is amended to read: 
  4.26     Subdivision 1.  [PROVIDER QUALIFICATIONS.] Counties must 
  4.27  arrange to provide residential services for children with severe 
  4.28  emotional disturbance according to ~~section~~ sections 245.4882, 
  4.29  245.4885, and this section.  Services must be provided by a 
  4.30  facility that is licensed according to section 245.4882 and 
  4.31  administrative rules promulgated thereunder, and under contract 
  4.32  with the county. Facilities providing services under subdivision 
  4.33  2, paragraph (a), must be accredited as a psychiatric facility 
  4.34  by the Joint Commission on Accreditation of Healthcare 
  4.35  Organizations, the Commission on Accreditation of Rehabilitation 
  4.36  Facilities, or the Council on Accreditation.  Accreditation is 
  5.1   not required for facilities providing services under subdivision 
  5.2   2, paragraph (b). 
  5.3      Sec. 5.  Minnesota Statutes 1999 Supplement, section 
  5.4   256B.0945, subdivision 2, is amended to read: 
  5.5      Subd. 2.  [COVERED SERVICES.] All services must be included 
  5.6   in a child's individualized treatment or ~~collaborative family~~ 
  5.7   ~~service~~ multiagency plan of care as defined in chapter 245.  
  5.8      (a) For facilities that are institutions for mental 
  5.9   diseases according to statute and regulation or are not 
  5.10  institutions for mental diseases but ~~choose~~ are approved by the 
  5.11  commissioner to provide services under this paragraph, medical 
  5.12  assistance covers the full contract rate, including room and 
  5.13  board if the services meet the requirements of Code of Federal 
  5.14  Regulations, title 42, section 440.160.  
  5.15     (b) For facilities that are not institutions for mental 
  5.16  diseases according to federal statute and regulation and are not 
  5.17  providing services under paragraph (a), medical assistance 
  5.18  covers mental health related services that are required to be 
  5.19  provided by a residential facility under section 245.4882 and 
  5.20  administrative rules promulgated thereunder, except for room and 
  5.21  board. 
  5.22     Sec. 6.  Minnesota Statutes 1999 Supplement, section 
  5.23  256B.0945, subdivision 4, is amended to read: 
  5.24     Subd. 4.  [PAYMENT RATES.] (a) Notwithstanding sections 
  5.25  256.025, subdivision 2; 256B.19; and 256B.041, payments to 
  5.26  counties for residential services provided by a residential 
  5.27  facility shall only be made of federal earnings for services 
  5.28  provided under this section, and the nonfederal share of costs 
  5.29  for services provided under this section shall be paid by the 
  5.30  county from sources other than federal funds or funds used to 
  5.31  match other federal funds.  ~~Total annual payments for federal~~ 
  5.32  ~~earnings shall not exceed the federal medical assistance~~ 
  5.33  ~~percentage matching rate multiplied by the total county~~ 
  5.34  ~~expenditures for services provided under section 245.4882 for~~ 
  5.35  ~~either (1) the calendar year 1999 or (2) the average annual~~ 
  5.36  ~~expenditures for the calendar years 1995 to 1999, whichever is~~ 
  6.1   ~~greater.~~  Payment to counties for services provided according to 
  6.2   subdivision 2, paragraph (a), shall be the federal share of the 
  6.3   contract rate.  Payment to counties for services provided 
  6.4   according to subdivision 2, paragraph (b), shall be a proportion 
  6.5   of the per day contract rate that relates to rehabilitative 
  6.6   mental health services and shall not include payment for costs 
  6.7   or services that are billed to the IV-E program as room and 
  6.8   board.  
  6.9      ~~(b) Annual earnings that exceed a county's limit as~~ 
  6.10  ~~established under paragraph (a) shall be retained by the~~ 
  6.11  ~~commissioner and managed as grants for community-based~~ 
  6.12  ~~children's mental health services under section 245.4886.  The~~ 
  6.13  ~~commissioner may target these grant funds as necessary to reduce~~ 
  6.14  ~~reliance on residential treatment of children with severe~~ 
  6.15  ~~emotional disturbance.~~ 
  6.16     ~~(c)~~ (b) The commissioner shall set aside a portion not to 
  6.17  exceed five percent of the federal funds earned under this 
  6.18  section to cover the state costs of ~~two staff positions and~~ 
  6.19  ~~support costs necessary in~~ administering this section.  Any 
  6.20  unexpended funds from the set-aside shall be distributed to the 
  6.21  counties in proportion to their earnings under this section. 
  6.22     Sec. 7.  Minnesota Statutes 1999 Supplement, section 
  6.23  256B.0945, subdivision 5, is amended to read: 
  6.24     Subd. 5.  [QUALITY MEASURES.] Counties must collect and 
  6.25  report to the commissioner information on outcomes for services 
  6.26  provided under this section using standardized tools that 
  6.27  measure the impact of residential treatment programs on child 
  6.28  functioning and/or behavior, living stability, and parent and 
  6.29  child satisfaction consistent with the goals of sections 
  6.30  245.4876, subdivision 1, and 256F.01.  The commissioner shall 
  6.31  designate standardized tools to be used and shall collect and 
  6.32  analyze individualized outcome data on a statewide basis and 
  6.33  report to the legislature by December 1, 2003.  The commissioner 
  6.34  shall provide standardized tools that measure child and 
  6.35  adolescent ~~functional assessment for intake and discharge, child~~ 
  6.36  ~~behavior, residential living environment and~~ functionality, 
  7.1   placement stability, and satisfaction for youth and family 
  7.2   members. 
  7.3      Sec. 8.  Minnesota Statutes 1999 Supplement, section 
  7.4   256B.0945, subdivision 6, is amended to read: 
  7.5      Subd. 6.  [FEDERAL EARNINGS.] Use of new federal funding 
  7.6   earned from services provided under this section is limited to:  
  7.7      (1) increasing prevention and early intervention and 
  7.8   supportive services to meet the mental health and child welfare 
  7.9   needs of the children and families in the system of care; 
  7.10     (2) replacing reductions in federal IV-E reimbursement 
  7.11  resulting from new medical assistance coverage; ~~and~~ 
  7.12     (3) paying the nonfederal share of additional provider 
  7.13  costs due to accreditation and new program standards necessary 
  7.14  for Medicaid reimbursement; and 
  7.15     (4) paying for the costs of complying with the data 
  7.16  collection and reporting requirements contained in subdivision 5.
  7.17  For purposes of this section, prevention, early intervention, 
  7.18  and supportive services for children and families include 
  7.19  alternative responses to child maltreatment reports under 
  7.20  chapter 626 and nonresidential children's mental health services 
  7.21  outlined in ~~sections~~ section 245.4875, subdivision 2, ~~children's~~ 
  7.22  ~~mental health,~~ and family preservation services outlined in 
  7.23  section 256F.05, subdivision 8~~, family preservation services~~.  
  7.24     Sec. 9.  Minnesota Statutes 1999 Supplement, section 
  7.25  256B.0945, subdivision 7, is amended to read: 
  7.26     Subd. 7.  [MAINTENANCE OF EFFORT.] (a) Counties that 
  7.27  receive payment under this section must maintain a level of 
  7.28  expenditures such that each year's county expenditures 
  7.29  for prevention, early intervention, and supportive services for 
  7.30  children and families is at least equal to that county's average 
  7.31  expenditures for those services for calendar years 1998 and 
  7.32  1999.  ~~For purposes of this section, "county expenditures" are~~ 
  7.33  ~~the total expenditures for those services minus the state and~~ 
  7.34  ~~federal revenues specifically designated for these services.~~ 
  7.35     (b) The commissioner may waive the requirements in 
  7.36  paragraph (a) if any of the conditions specified in section 
  8.1   256F.13, subdivision 1, paragraph (a), clause (4), items (i) to 
  8.2   (iv), are met.  
  8.3      Sec. 10.  Minnesota Statutes 1999 Supplement, section 
  8.4   256B.0945, subdivision 8, is amended to read: 
  8.5      Subd. 8.  [REPORTS.] The commissioner shall review county 
  8.6   expenditures annually using reports required under sections 
  8.7   245.482; 256.01, subdivision 2, clause (17); and 256E.08, 
  8.8   subdivision 8, to ensure that counties meet their obligation 
  8.9   under subdivision 7, and that the base level of expenditures for 
  8.10  ~~mental health and child welfare~~ prevention, early intervention, 
  8.11  and ~~family support~~ supportive services for children and families 
  8.12  and children's mental health residential treatment is continued 
  8.13  from sources other than federal funds earned under this section. 
  8.14     Sec. 11.  Minnesota Statutes 1999 Supplement, section 
  8.15  256B.0945, subdivision 9, is amended to read: 
  8.16     Subd. 9.  [SANCTIONS.] The commissioner may suspend, 
  8.17  reduce, or terminate ~~the federal reimbursement~~ funds for 
  8.18  prevention, early intervention, and supportive services for 
  8.19  children and families up to the limit of federal revenue earned 
  8.20  under this section to a county that does not meet one or all of 
  8.21  the requirements of this section.  If the commissioner finds 
  8.22  evidence of children placed in residential treatment who do not 
  8.23  meet the criteria outlined in section 245.4885, subdivision 1, 
  8.24  the commissioner may take action to limit inappropriate 
  8.25  placements in residential treatment. 
  8.26     Sec. 12.  Minnesota Statutes 1999 Supplement, section 
  8.27  256B.69, subdivision 6b, is amended to read: 
  8.28     Subd. 6b.  [HOME AND COMMUNITY-BASED WAIVER SERVICES.] (a) 
  8.29  For individuals enrolled in the Minnesota senior health options 
  8.30  project authorized under subdivision 23, elderly waiver services 
  8.31  shall be covered according to the terms and conditions of the 
  8.32  federal agreement governing that demonstration project. 
  8.33     (b) For individuals under age 65 ~~with physical disabilities~~ 
  8.34  ~~but without a primary diagnosis of mental illness or~~ 
  8.35  ~~developmental disabilities, except for related conditions,~~ 
  8.36  enrolled in ~~the Minnesota senior health options project~~ 
  9.1   demonstrations authorized under subdivision 23, home and 
  9.2   community-based waiver services shall be covered according to 
  9.3   the terms and conditions of the federal agreement governing that 
  9.4   demonstration project. 
  9.5      Sec. 13.  Minnesota Statutes 1998, section 256B.69, 
  9.6   subdivision 23, is amended to read: 
  9.7      Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
  9.8   ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
  9.9   implement demonstration projects to create alternative 
  9.10  integrated delivery systems for acute and long-term care 
  9.11  services to elderly persons and ~~disabled~~ persons with 
  9.12  disabilities as defined in section 256B.77, subdivision 7a, that 
  9.13  provide increased coordination, improve access to quality 
  9.14  services, and mitigate future cost increases.  The commissioner 
  9.15  may seek federal authority to combine Medicare and Medicaid 
  9.16  capitation payments for the purpose of such demonstrations.  
  9.17  Medicare funds and services shall be administered according to 
  9.18  the terms and conditions of the federal waiver and demonstration 
  9.19  provisions.  For the purpose of administering medical assistance 
  9.20  funds, demonstrations under this subdivision are subject to 
  9.21  subdivisions 1 to ~~17~~ 22.  The provisions of Minnesota Rules, 
  9.22  parts 9500.1450 to 9500.1464, apply to these demonstrations, 
  9.23  with the exceptions of parts 9500.1452, subpart 2, item B; and 
  9.24  9500.1457, subpart 1, items B and C, which do not apply 
  9.25  to ~~elderly~~ persons enrolling in demonstrations under this 
  9.26  section.  An initial open enrollment period may be provided.  
  9.27  Persons who disenroll from demonstrations under this subdivision 
  9.28  remain subject to Minnesota Rules, parts 9500.1450 to 
  9.29  9500.1464.  When a person is enrolled in a health plan under 
  9.30  these demonstrations and the health plan's participation is 
  9.31  subsequently terminated for any reason, the person shall be 
  9.32  provided an opportunity to select a new health plan and shall 
  9.33  have the right to change health plans within the first 60 days 
  9.34  of enrollment in the second health plan.  Persons required to 
  9.35  participate in health plans under this section who fail to make 
  9.36  a choice of health plan shall not be randomly assigned to health 
 10.1   plans under these demonstrations. Notwithstanding section 
 10.2   256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, 
 10.3   subpart 1, item A, if adopted, for the purpose of demonstrations 
 10.4   under this subdivision, the commissioner may contract with 
 10.5   managed care organizations, including counties, to serve only 
 10.6   elderly persons eligible for medical assistance, elderly and 
 10.7   disabled persons, or disabled persons only.  For persons with 
 10.8   primary diagnoses of mental retardation or a related condition, 
 10.9   serious and persistent mental illness, or serious emotional 
 10.10  disturbance, the commissioner must ensure that the county 
 10.11  authority has approved the demonstration and contracting 
 10.12  design.  Enrollment in these projects shall be voluntary until 
 10.13  July 1, 2001.  The commissioner shall not implement any 
 10.14  demonstration project under this subdivision for persons with 
 10.15  primary diagnoses of mental retardation or a related condition, 
 10.16  serious and persistent mental illness, or serious emotional 
 10.17  disturbance, without approval of the county board of the county 
 10.18  in which the demonstration is being implemented. 
 10.19     Before implementation of a demonstration project for 
 10.20  disabled persons, the commissioner must provide information to 
 10.21  appropriate committees of the house of representatives and 
 10.22  senate and must involve representatives of affected disability 
 10.23  groups in the design of the demonstration projects. 
 10.24     (b) A nursing facility reimbursed under the alternative 
 10.25  reimbursement methodology in section 256B.434 may, in 
 10.26  collaboration with a hospital, clinic, or other health care 
 10.27  entity provide services under paragraph (a).  The commissioner 
 10.28  shall amend the state plan and seek any federal waivers 
 10.29  necessary to implement this paragraph. 
 10.30     Sec. 14.  Minnesota Statutes 1999 Supplement, section 
 10.31  256D.03, subdivision 3, is amended to read: 
 10.32     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
 10.33  (a) General assistance medical care may be paid for any person 
 10.34  who is not eligible for medical assistance under chapter 256B, 
 10.35  including eligibility for medical assistance based on a 
 10.36  spenddown of excess income according to section 256B.056, 
 11.1   subdivision 5, or MinnesotaCare as defined in paragraph (b), 
 11.2   except as provided in paragraph (c); and: 
 11.3      (1) who is receiving assistance under section 256D.05, 
 11.4   except for families with children who are eligible under 
 11.5   Minnesota family investment program-statewide (MFIP-S), who is 
 11.6   having a payment made on the person's behalf under sections 
 11.7   256I.01 to 256I.06, or who resides in group residential housing 
 11.8   as defined in chapter 256I and can meet a spenddown using the 
 11.9   cost of remedial services received through group residential 
 11.10  housing; or 
 11.11     (2)(i) who is a resident of Minnesota; and whose equity in 
 11.12  assets is not in excess of $1,000 per assistance unit.  Exempt 
 11.13  assets, the reduction of excess assets, and the waiver of excess 
 11.14  assets must conform to the medical assistance program in chapter 
 11.15  256B, with the following exception:  the maximum amount of 
 11.16  undistributed funds in a trust that could be distributed to or 
 11.17  on behalf of the beneficiary by the trustee, assuming the full 
 11.18  exercise of the trustee's discretion under the terms of the 
 11.19  trust, must be applied toward the asset maximum; and 
 11.20     (ii) who has countable income not in excess of the 
 11.21  assistance standards established in section 256B.056, 
 11.22  subdivision 4, or whose excess income is spent down according to 
 11.23  section 256B.056, subdivision 5, using a six-month budget 
 11.24  period.  The method for calculating earned income disregards and 
 11.25  deductions for a person who resides with a dependent child under 
 11.26  age 21 shall follow section 256B.056, subdivision 1a.  However, 
 11.27  if a disregard of $30 and one-third of the remainder has been 
 11.28  applied to the wage earner's income, the disregard shall not be 
 11.29  applied again until the wage earner's income has not been 
 11.30  considered in an eligibility determination for general 
 11.31  assistance, general assistance medical care, medical assistance, 
 11.32  or MFIP-S for 12 consecutive months.  The earned income and work 
 11.33  expense deductions for a person who does not reside with a 
 11.34  dependent child under age 21 shall be the same as the method 
 11.35  used to determine eligibility for a person under section 
 11.36  256D.06, subdivision 1, except the disregard of the first $50 of 
 12.1   earned income is not allowed; 
 12.2      (3) who would be eligible for medical assistance except 
 12.3   that the person resides in a facility that is determined by the 
 12.4   commissioner or the federal Health Care Financing Administration 
 12.5   to be an institution for mental diseases; or 
 12.6      (4) who is ineligible for medical assistance under chapter 
 12.7   256B or general assistance medical care under any other 
 12.8   provision of this section, and is receiving care and 
 12.9   rehabilitation services from a nonprofit center established to 
 12.10  serve victims of torture.  These individuals are eligible for 
 12.11  general assistance medical care only for the period during which 
 12.12  they are receiving services from the center.  During this period 
 12.13  of eligibility, individuals eligible under this clause shall not 
 12.14  be required to participate in prepaid general assistance medical 
 12.15  care.  
 12.16     (b) Beginning January 1, 2000, applicants or recipients who 
 12.17  meet all eligibility requirements of MinnesotaCare as defined in 
 12.18  sections 256L.01 to 256L.16, and are: 
 12.19     (i) adults with dependent children under 21 whose gross 
 12.20  family income is equal to or less than 275 percent of the 
 12.21  federal poverty guidelines; or 
 12.22     (ii) adults without children with earned income and whose 
 12.23  family gross income is between 75 percent of the federal poverty 
 12.24  guidelines and the amount set by section 256L.04, subdivision 7, 
 12.25  shall be terminated from general assistance medical care upon 
 12.26  enrollment in MinnesotaCare. 
 12.27     (c) For services rendered on or after July 1, 1997, 
 12.28  eligibility is limited to one month prior to application if the 
 12.29  person is determined eligible in the prior month.  A 
 12.30  redetermination of eligibility must occur every 12 months.  
 12.31  Beginning January 1, 2000, Minnesota health care program 
 12.32  applications completed by recipients and applicants who are 
 12.33  persons described in paragraph (b), may be returned to the 
 12.34  county agency to be forwarded to the department of human 
 12.35  services or sent directly to the department of human services 
 12.36  for enrollment in MinnesotaCare.  If all other eligibility 
 13.1   requirements of this subdivision are met, eligibility for 
 13.2   general assistance medical care shall be available in any month 
 13.3   during which a MinnesotaCare eligibility determination and 
 13.4   enrollment are pending.  Upon notification of eligibility for 
 13.5   MinnesotaCare, notice of termination for eligibility for general 
 13.6   assistance medical care shall be sent to an applicant or 
 13.7   recipient.  If all other eligibility requirements of this 
 13.8   subdivision are met, eligibility for general assistance medical 
 13.9   care shall be available until enrollment in MinnesotaCare 
 13.10  subject to the provisions of paragraph (e). 
 13.11     (d) The date of an initial Minnesota health care program 
 13.12  application necessary to begin a determination of eligibility 
 13.13  shall be the date the applicant has provided a name, address, 
 13.14  and social security number, signed and dated, to the county 
 13.15  agency or the department of human services.  If the applicant is 
 13.16  unable to provide an initial application when health care is 
 13.17  delivered due to a medical condition or disability, a health 
 13.18  care provider may act on the person's behalf to complete the 
 13.19  initial application.  The applicant must complete the remainder 
 13.20  of the application and provide necessary verification before 
 13.21  eligibility can be determined.  The county agency must assist 
 13.22  the applicant in obtaining verification if necessary.  On the 
 13.23  basis of information provided on the completed application, an 
 13.24  applicant who meets the following criteria shall be determined 
 13.25  eligible beginning in the month of application: 
 13.26     (1) has gross income less than 90 percent of the applicable 
 13.27  income standard; 
 13.28     (2) has liquid assets that total within $300 of the asset 
 13.29  standard; 
 13.30     (3) does not reside in a long-term care facility; and 
 13.31     (4) meets all other eligibility requirements. 
 13.32  The applicant must provide all required verifications within 30 
 13.33  days' notice of the eligibility determination or eligibility 
 13.34  shall be terminated. 
 13.35     (e) County agencies are authorized to use all automated 
 13.36  databases containing information regarding recipients' or 
 14.1   applicants' income in order to determine eligibility for general 
 14.2   assistance medical care or MinnesotaCare.  Such use shall be 
 14.3   considered sufficient in order to determine eligibility and 
 14.4   premium payments by the county agency. 
 14.5      (f) General assistance medical care is not available for a 
 14.6   person in a correctional facility unless the person is detained 
 14.7   by law for less than one year in a county correctional or 
 14.8   detention facility as a person accused or convicted of a crime, 
 14.9   or admitted as an inpatient to a hospital on a criminal hold 
 14.10  order, and the person is a recipient of general assistance 
 14.11  medical care at the time the person is detained by law or 
 14.12  admitted on a criminal hold order and as long as the person 
 14.13  continues to meet other eligibility requirements of this 
 14.14  subdivision.  
 14.15     (g) General assistance medical care is not available for 
 14.16  applicants or recipients who do not cooperate with the county 
 14.17  agency to meet the requirements of medical assistance.  General 
 14.18  assistance medical care is limited to payment of emergency 
 14.19  services only for applicants or recipients as described in 
 14.20  paragraph (b), whose MinnesotaCare coverage is denied or 
 14.21  terminated for nonpayment of premiums as required by sections 
 14.22  256L.06 and 256L.07.  
 14.23     (h) In determining the amount of assets of an individual, 
 14.24  there shall be included any asset or interest in an asset, 
 14.25  including an asset excluded under paragraph (a), that was given 
 14.26  away, sold, or disposed of for less than fair market value 
 14.27  within the 60 months preceding application for general 
 14.28  assistance medical care or during the period of eligibility.  
 14.29  Any transfer described in this paragraph shall be presumed to 
 14.30  have been for the purpose of establishing eligibility for 
 14.31  general assistance medical care, unless the individual furnishes 
 14.32  convincing evidence to establish that the transaction was 
 14.33  exclusively for another purpose.  For purposes of this 
 14.34  paragraph, the value of the asset or interest shall be the fair 
 14.35  market value at the time it was given away, sold, or disposed 
 14.36  of, less the amount of compensation received.  For any 
 15.1   uncompensated transfer, the number of months of ineligibility, 
 15.2   including partial months, shall be calculated by dividing the 
 15.3   uncompensated transfer amount by the average monthly per person 
 15.4   payment made by the medical assistance program to skilled 
 15.5   nursing facilities for the previous calendar year.  The 
 15.6   individual shall remain ineligible until this fixed period has 
 15.7   expired.  The period of ineligibility may exceed 30 months, and 
 15.8   a reapplication for benefits after 30 months from the date of 
 15.9   the transfer shall not result in eligibility unless and until 
 15.10  the period of ineligibility has expired.  The period of 
 15.11  ineligibility begins in the month the transfer was reported to 
 15.12  the county agency, or if the transfer was not reported, the 
 15.13  month in which the county agency discovered the transfer, 
 15.14  whichever comes first.  For applicants, the period of 
 15.15  ineligibility begins on the date of the first approved 
 15.16  application. 
 15.17     (i) When determining eligibility for any state benefits 
 15.18  under this subdivision, the income and resources of all 
 15.19  noncitizens shall be deemed to include their sponsor's income 
 15.20  and resources as defined in the Personal Responsibility and Work 
 15.21  Opportunity Reconciliation Act of 1996, title IV, Public Law 
 15.22  Number 104-193, sections 421 and 422, and subsequently set out 
 15.23  in federal rules. 
 15.24     (j)(1) An undocumented noncitizen or a nonimmigrant is 
 15.25  ineligible for general assistance medical care other than 
 15.26  emergency services.  For purposes of this subdivision, a 
 15.27  nonimmigrant is an individual in one or more of the classes 
 15.28  listed in United States Code, title 8, section 1101(a)(15), and 
 15.29  an undocumented noncitizen is an individual who resides in the 
 15.30  United States without the approval or acquiescence of the 
 15.31  Immigration and Naturalization Service. 
 15.32     (2) This paragraph does not apply to a child under age 18, 
 15.33  to a Cuban or Haitian entrant as defined in Public Law Number 
 15.34  96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 
 15.35  aged, blind, or disabled as defined in Code of Federal 
 15.36  Regulations, title 42, sections 435.520, 435.530, 435.531, 
 16.1   435.540, and 435.541, or effective October 1, 1998, to an 
 16.2   individual eligible for general assistance medical care under 
 16.3   paragraph (a), clause (4), who cooperates with the Immigration 
 16.4   and Naturalization Service to pursue any applicable immigration 
 16.5   status, including citizenship, that would qualify the individual 
 16.6   for medical assistance with federal financial participation. 
 16.7      ~~(3)~~ (k) For purposes of ~~this paragraph~~ paragraphs (g) and 
 16.8   (j), "emergency services" has the meaning given in Code of 
 16.9   Federal Regulations, title 42, section 440.255(b)(1), except 
 16.10  that it also means services rendered because of suspected or 
 16.11  actual pesticide poisoning. 
 16.12     ~~(k)~~ (l) Notwithstanding any other provision of law, a 
 16.13  noncitizen who is ineligible for medical assistance due to the 
 16.14  deeming of a sponsor's income and resources, is ineligible for 
 16.15  general assistance medical care. 
 16.16     Sec. 15.  Minnesota Statutes 1999 Supplement, section 
 16.17  256L.03, subdivision 5, is amended to read: 
 16.18     Subd. 5.  [COPAYMENTS AND COINSURANCE.] (a) Except as 
 16.19  provided in paragraphs (b) and (c), the MinnesotaCare benefit 
 16.20  plan shall include the following copayments and coinsurance 
 16.21  requirements for all enrollees ~~except parents and relative~~ 
 16.22  ~~caretakers of children under the age of 21 in households with~~ 
 16.23  ~~income at or below 175 percent of the federal poverty guidelines~~ 
 16.24  ~~and pregnant women and children under the age of 21~~:  
 16.25     (1) ten percent of the paid charges for inpatient hospital 
 16.26  services for adult enrollees, subject to an annual inpatient 
 16.27  out-of-pocket maximum of $1,000 per individual and $3,000 per 
 16.28  family; 
 16.29     (2) $3 per prescription for adult enrollees; 
 16.30     (3) $25 for eyeglasses for adult enrollees; and 
 16.31     (4) ~~effective July 1, 1998,~~ 50 percent of the 
 16.32  fee-for-service rate for adult dental care services other than 
 16.33  preventive care services for persons eligible under section 
 16.34  256L.04, subdivisions 1 to 7, with income equal to or less than 
 16.35  175 percent of the federal poverty guidelines. 
 16.36     ~~The exceptions described in this paragraph shall only be~~ 
 17.1   ~~implemented if required to obtain federal Medicaid funding for~~ 
 17.2   ~~these individuals and shall expire July 1, 2000.~~ 
 17.3      (b) ~~Effective July 1, 1997,~~ Paragraph (a), clause (1), does 
 17.4   not apply to parents and relative caretakers of children under 
 17.5   the age of 21 in households with family income equal to or less 
 17.6   than 175 percent of the federal poverty guidelines.  Paragraph 
 17.7   (a), clause (1), does not apply to parents and relative 
 17.8   caretakers of children under the age of 21 in households with 
 17.9   family income greater than 175 percent of the federal poverty 
 17.10  guidelines for inpatient hospital admissions occurring on or 
 17.11  after January 1, 2001.  
 17.12     (c) Paragraph (a), clauses (1) to (4), do not apply to 
 17.13  pregnant women and children under the age of 21.  
 17.14     (d) Adult enrollees with family gross income that exceeds 
 17.15  175 percent of the federal poverty guidelines and who are not 
 17.16  pregnant shall be financially responsible for the coinsurance 
 17.17  amount, if applicable, and amounts which exceed the $10,000 
 17.18  inpatient hospital benefit limit. 
 17.19     ~~(c)~~ (e) When a MinnesotaCare enrollee becomes a member of a 
 17.20  prepaid health plan, or changes from one prepaid health plan to 
 17.21  another during a calendar year, any charges submitted towards 
 17.22  the $10,000 annual inpatient benefit limit, and any 
 17.23  out-of-pocket expenses incurred by the enrollee for inpatient 
 17.24  services, that were submitted or incurred prior to enrollment, 
 17.25  or prior to the change in health plans, shall be disregarded. 
 17.26     Sec. 16.  Laws 1999, chapter 245, article 8, section 84, is 
 17.27  amended to read: 
 17.28     Sec. 84.  [RECOMMENDATIONS TO THE LEGISLATURE.] 
 17.29     The commissioner of human services shall submit to the 
 17.30  legislature design and implementation recommendations for the 
 17.31  proposals required in sections 82 and 83, including draft 
 17.32  legislation, by January 15, ~~2000~~ 2001, for implementation 
 17.33  by ~~July 1, 2000~~ January 1, 2002, with respect to the proposal in 
 17.34  section 82 only.  The proposals shall not include requirements 
 17.35  for maintenance of effort and expanded expenditures concerning 
 17.36  federal reimbursements earned in these programs. 
 18.1      Sec. 17.  [OBSOLETE RULES.] 
 18.2      The commissioner shall amend or repeal obsolete provisions 
 18.3   of Minnesota Rules, parts 9505.0010 to 9505.0150, governing 
 18.4   eligibility for the medical assistance program, under the 
 18.5   expedited process of Minnesota Statutes, section 14.389, to 
 18.6   bring them into conformance with state and federal law. 
 18.7      Sec. 18.  [GROUP RESIDENTIAL HOUSING REVIEW.] 
 18.8      The commissioner of human services, in consultation with 
 18.9   representatives of affected providers, consumers, and counties, 
 18.10  shall review group residential housing (GRH) expenditures that 
 18.11  may be eligible for reimbursement under the home and 
 18.12  community-based waiver services program for persons with mental 
 18.13  retardation or related conditions (MR/RC waiver).  The review 
 18.14  may include: 
 18.15     (1) an assessment of consumer access to housing as a result 
 18.16  of the limits on GRH supplementary room and board rates adopted 
 18.17  in Laws 1999, chapter 245, article 3, section 40; 
 18.18     (2) an analysis of market rate housing costs for families 
 18.19  of comparable size to those funded under the GRH program; 
 18.20     (3) an analysis of the impact on GRH costs of providing 
 18.21  services and housing to persons with developmental disabilities, 
 18.22  including: 
 18.23     (i) a breakdown by level of client disability of GRH 
 18.24  expenditures for housing costs for persons with developmental 
 18.25  disabilities; 
 18.26     (ii) a breakdown by level of client disability of GRH 
 18.27  expenditures for service costs for persons with developmental 
 18.28  disabilities; 
 18.29     (iii) an analysis of differences in GRH expenditures for 
 18.30  persons with developmental disabilities compared to other GRH 
 18.31  residents; and 
 18.32     (iv) a determination of GRH expenditures that are a direct 
 18.33  result of a resident's disability; 
 18.34     (4) a determination of which services now paid for by the 
 18.35  GRH program may be eligible under the MR/RC waiver, and an 
 18.36  estimate of GRH costs that could be paid by the federal 
 19.1   government under the MR/RC waiver.  The commissioner may begin 
 19.2   the process of seeking federal approval to fund current group 
 19.3   residential housing services under the MR/RC waiver; 
 19.4      (5) an assessment of the utilization of the food stamp 
 19.5   program and other federal benefit programs by GRH residents; 
 19.6      (6) an analysis of the methods other states utilize to 
 19.7   reimburse comparable room and board costs and service costs; and 
 19.8      (7) a compilation of current MR/RC waiver caps in Minnesota 
 19.9   counties, compared with actual MR/RC spending. 
 19.10     Sec. 19.  [ALTERNATIVE CARE PILOT PROJECTS.] 
 19.11     (a) Expenditures for housing with services and adult foster 
 19.12  care shall be excluded when determining average monthly 
 19.13  expenditures per client for alternative care pilot projects 
 19.14  authorized in Laws 1993, First Special Session chapter 1, 
 19.15  article 5, section 133. 
 19.16     (b) Alternative care pilot projects shall not expire on 
 19.17  June 30, 2001, but shall continue until June 30, 2005. 
 19.18     Sec. 20.  [REPEALER.] 
 19.19     Laws 1998, chapter 407, article 5, section 44, is repealed. 
 19.20     Sec. 21.  [EFFECTIVE DATE.] 
 19.21     Sections 1 (62Q.19, s.2), 15, and 17 are effective the day 
 19.22  following final enactment.