1.1                          A bill for an act 
  1.2             relating to human services; state health care 
  1.3             programs; dental care services; appropriating money; 
  1.4             amending Minnesota Statutes 1994, sections 256B.0644; 
  1.5             and 256B.76. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1994, section 256B.0644, is 
  1.8   amended to read: 
  1.9      256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
  1.10  OTHER STATE HEALTH CARE PROGRAMS.] 
  1.11     A vendor of medical care, as defined in section 256B.02, 
  1.12  subdivision 7, and a health maintenance organization, as defined 
  1.13  in chapter 62D, must participate as a provider or contractor in 
  1.14  the medical assistance program, general assistance medical care 
  1.15  program, and MinnesotaCare as a condition of participating as a 
  1.16  provider in health insurance plans or contractor for state 
  1.17  employees established under section 43A.18, the public employees 
  1.18  insurance plan under section 43A.316, for health insurance plans 
  1.19  offered to local statutory or home rule charter city, county, 
  1.20  and school district employees, the workers' compensation system 
  1.21  under section 176.135, and insurance plans provided through the 
  1.22  Minnesota comprehensive health association under sections 62E.01 
  1.23  to 62E.16.  The limitations on insurance plans offered to local 
  1.24  government employees shall not be applicable in geographic areas 
  1.25  where provider participation is limited by managed care 
  2.1   contracts with the department of human services.  For providers 
  2.2   other than health maintenance organizations, participation in 
  2.3   the medical assistance program means that (1) the provider 
  2.4   accepts new medical assistance, general assistance medical care, 
  2.5   and MinnesotaCare patients or (2) at least ~~20~~ ten percent of the 
  2.6   provider's patients are covered by medical assistance, general 
  2.7   assistance medical care, and MinnesotaCare as their primary 
  2.8   source of coverage.  The commissioner shall establish 
  2.9   participation requirements for health maintenance 
  2.10  organizations.  The commissioner shall provide lists of 
  2.11  participating medical assistance providers on a quarterly basis 
  2.12  to the commissioner of employee relations, the commissioner of 
  2.13  labor and industry, and the commissioner of commerce.  Each of 
  2.14  the commissioners shall develop and implement procedures to 
  2.15  exclude as participating providers in the program or programs 
  2.16  under their jurisdiction those providers who do not participate 
  2.17  in the medical assistance program.  The commissioner of employee 
  2.18  relations shall implement this section through contracts with 
  2.19  participating health and dental carriers. 
  2.20     Sec. 2.  Minnesota Statutes 1994, section 256B.76, is 
  2.21  amended to read: 
  2.22     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  2.23     (a) The physician reimbursement increase provided in 
  2.24  section 256B.74, subdivision 2, shall not be implemented.  
  2.25  Effective for services rendered on or after October 1, 1992, the 
  2.26  commissioner shall make payments for physician services as 
  2.27  follows: 
  2.28     (1) payment for level one Health Care Finance 
  2.29  Administration's common procedural coding system (HCPCS) codes 
  2.30  titled "office and other outpatient services," "preventive 
  2.31  medicine new and established patient," "delivery, antepartum, 
  2.32  and postpartum care," "critical care," Caesarean delivery and 
  2.33  pharmacologic management provided to psychiatric patients, and 
  2.34  HCPCS level three codes for enhanced services for prenatal high 
  2.35  risk, shall be paid at the lower of (i) submitted charges, or 
  2.36  (ii) 25 percent above the rate in effect on June 30, 1992.  If 
  3.1   the rate on any procedure code within these categories is 
  3.2   different than the rate that would have been paid under the 
  3.3   methodology in section 256B.74, subdivision 2, then the larger 
  3.4   rate shall be paid; 
  3.5      (2) payments for all other services shall be paid at the 
  3.6   lower of (i) submitted charges, or (ii) 15.4 percent above the 
  3.7   rate in effect on June 30, 1992; and 
  3.8      (3) all physician rates shall be converted from the 50th 
  3.9   percentile of 1982 to the 50th percentile of 1989, less the 
  3.10  percent in aggregate necessary to equal the above increases 
  3.11  except that payment rates for home health agency services shall 
  3.12  be the rates in effect on September 30, 1992. 
  3.13     (b) The dental reimbursement increase provided in section 
  3.14  256B.74, subdivision 5, shall not be implemented.  Effective for 
  3.15  services rendered ~~on or after October 1, 1992~~ after July 1, 
  3.16  1995, the commissioner shall make payments for dental services 
  3.17  ~~as follows~~ at the lower of: 
  3.18     (1) ~~dental services shall be paid at the lower of (i)~~ 
  3.19  submitted charges~~,~~; or ~~(ii) 25 percent above the rate in effect~~ 
  3.20  ~~on June 30, 1992; and~~ 
  3.21     (2) ~~dental rates shall be converted from~~ at the 50th 
  3.22  percentile of ~~1982 to the 50th percentile of 1989, less the~~ 
  3.23  ~~percent in aggregate necessary to equal the above increases~~ the 
  3.24  usual and customary fees based upon billings submitted by all 
  3.25  dental providers of the service in calendar year 1994, minus 25 
  3.26  percent. 
  3.27     (c) An entity that operates both a Medicare certified 
  3.28  comprehensive outpatient rehabilitation facility and a facility 
  3.29  which was certified prior to January 1, 1993, that is licensed 
  3.30  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
  3.31  whom at least 33 percent of the clients receiving rehabilitation 
  3.32  services in the most recent calendar year are medical assistance 
  3.33  recipients, shall be reimbursed by the commissioner for 
  3.34  rehabilitation services at rates that are 38 percent greater 
  3.35  than the maximum reimbursement rate allowed under paragraph (a), 
  3.36  clause (2), when those services are (1) provided within the 
  4.1   comprehensive outpatient rehabilitation facility and (2) 
  4.2   provided to residents of nursing facilities owned by the entity. 
  4.3      Sec. 3.  [APPROPRIATION.] 
  4.4      $....... is appropriated from the general fund to the 
  4.5   commissioner of human services for the purposes of section 2.