1.1 	A bill for an act
1.2 	relating to human services; changing health care eligibility provisions; 
1.3 	making changes to individualized education plan requirements; state health 
1.4 	access program; children's health insurance reauthorization act; long-term 
1.5 	care partnership; asset transfers; community clinics; dental benefits; prior 
1.6 	authorization for health services; drug formulary committee; preferred drug list; 
1.7 	multisource drugs; administrative uniformity committee; health plans; claims 
1.8 	against the state;amending Minnesota Statutes 2008, sections 62A.045; 62Q.80; 
1.9 	62S.24, subdivision 8; 256B.055, subdivision 10; 256B.057, subdivision 1; 
1.10 	256B.0571, subdivision 6; 256B.0625, subdivisions 13c, 13g, 25, 30, by adding a 
1.11 	subdivision; Minnesota Statutes 2009 Supplement, sections 15C.13; 256B.0571, 
1.12 	subdivision 8; 256B.0625, subdivisions 9, 13e, 26; proposing coding for new law 
1.13 	in Minnesota Statutes, chapter 62S; repealing Minnesota Statutes 2008, sections 
1.14 	256B.0571, subdivision 10; 256B.0595, subdivisions 1b, 2b, 3b, 4b, 5.
1.15 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.16 	ARTICLE 1
1.17 	INDIVIDUALIZED EDUCATION PLAN SERVICES

1.18 	Section 1. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 26, 
1.19 	is amended to read:
1.20 		Subd. 26.Special education services. (a) Medical assistance covers medical 
1.21 	services identified in a recipient's individualized education plan and covered under the 
1.22 	medical assistance state plan. Covered services include occupational therapy, physical 
1.23 	therapy, speech-language therapy, clinical psychological services, nursing services, 
1.24 	school psychological services, school social work services, personal care assistants 
1.25 	serving as management aides, assistive technology devices, transportation services, 
1.26 	health assessments, and other services covered under the medical assistance state plan. 
1.27 	Mental health services eligible for medical assistance reimbursement must be provided or 
2.1 	coordinated through a children's mental health collaborative where a collaborative exists if 
2.2 	the child is included in the collaborative operational target population. The provision or 
2.3 	coordination of services does not require that the individual education plan be developed 
2.4 	by the collaborative.
2.5 	The services may be provided by a Minnesota school district that is enrolled as a 
2.6 	medical assistance provider or its subcontractor, and only if the services meet all the 
2.7 	requirements otherwise applicable if the service had been provided by a provider other 
2.8 	than a school district, in the following areas: medical necessity, physician's orders, 
2.9 	documentation, personnel qualifications, and prior authorization requirements. The 
2.10 	nonfederal share of costs for services provided under this subdivision is the responsibility 
2.11 	of the local school district as provided in section 125A.74. Services listed in a child's 
2.12 	individual education plan are eligible for medical assistance reimbursement only if those 
2.13 	services meet criteria for federal financial participation under the Medicaid program.
2.14 	(b) Approval of health-related services for inclusion in the individual education plan 
2.15 	does not require prior authorization for purposes of reimbursement under this chapter. 
2.16 	The commissioner may require physician review and approval of the plan not more than 
2.17 	once annually or upon any modification of the individual education plan that reflects a 
2.18 	change in health-related services.
2.19 	(c) Services of a speech-language pathologist provided under this section are covered 
2.20 	notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
2.21 	(1) holds a masters degree in speech-language pathology;
2.22 	(2) is licensed by the Minnesota Board of Teaching as an educational 
2.23 	speech-language pathologist; and
2.24 	(3) either has a certificate of clinical competence from the American Speech and 
2.25 	Hearing Association, has completed the equivalent educational requirements and work 
2.26 	experience necessary for the certificate or has completed the academic program and is 
2.27 	acquiring supervised work experience to qualify for the certificate.
2.28 	(d) Medical assistance coverage for medically necessary services provided under 
2.29 	other subdivisions in this section may not be denied solely on the basis that the same or 
2.30 	similar services are covered under this subdivision.
2.31 	(e) The commissioner shall develop and implement package rates, bundled rates, or 
2.32 	per diem rates for special education services under which separately covered services are 
2.33 	grouped together and billed as a unit in order to reduce administrative complexity.
2.34 	(f) The commissioner shall develop a cost-based payment structure for payment of 
2.35 	these services. Only costs reported through the designated Minnesota Department of 
2.36 	Education data systems qualify for inclusion in the cost-based payment structure. The 
3.1 	commissioner shall reimburse claims submitted based on an interim rate, and shall settle 
3.2 	at a final rate once the department has determined it. The commissioner shall notify 
3.3 	the school district of the final rate. The school district has 60 days to appeal the final 
3.4 	rate. To appeal the final rate, the school district shall file a written appeal request to the 
3.5 	commissioner within 60 days of the date the final rate determination was mailed. The 
3.6 	appeal request shall specify (1) the disputed items and (2) the name and address of the 
3.7 	person to contact regarding the appeal.
3.8 	(g) Effective July 1, 2000, medical assistance services provided under an individual 
3.9 	education plan or an individual family service plan by local school districts shall not count 
3.10 	against medical assistance authorization thresholds for that child.
3.11 	(h) Nursing services as defined in section 148.171, subdivision 15, and provided 
3.12 	as an individual education plan health-related service, are eligible for medical assistance 
3.13 	payment if they are otherwise a covered service under the medical assistance program. 
3.14 	Medical assistance covers the administration of prescription medications by a licensed 
3.15 	nurse who is employed by or under contract with a school district when the administration 
3.16 	of medications is identified in the child's individualized education plan. The simple 
3.17 	administration of medications alone is not covered under medical assistance when 
3.18 	administered by a provider other than a school district or when it is not identified in the 
3.19 	child's individualized education plan.

3.20 	ARTICLE 2
3.21 	STATE HEALTH ACCESS PROGRAM

3.22 	Section 1. Minnesota Statutes 2008, section 62Q.80, is amended to read:
3.23 	62Q.80 COMMUNITY-BASED HEALTH CARE COVERAGE PROGRAM.
3.24 		Subdivision 1.Scope. (a) ~~A~~ Any community-based health care initiative may 
3.25 	develop and operate ~~a~~ community-based health care coverage ~~program~~ programs that 
3.26 	~~offers~~ offer to eligible individuals and their dependents the option of purchasing through 
3.27 	their employer health care coverage on a fixed prepaid basis without meeting the 
3.28 	requirements of chapter 60A, 62A, 62C, 62D, 62M, 62N, 62Q, ~~or~~ 62T, or 62U, or any 
3.29 	other law or rule that applies to entities licensed under these chapters.
3.30 	(b) ~~The~~Each initiative shall establish health outcomes to be achieved through the 
3.31 	~~program~~ programs and performance measurements in order to determine whether these 
3.32 	outcomes have been met. The outcomes must include, but are not limited to:
3.33 	(1) a reduction in uncompensated care provided by providers participating in the 
3.34 	community-based health network; 
4.1 	(2) an increase in the delivery of preventive health care services; and
4.2 	(3) health improvement for enrollees with chronic health conditions through the 
4.3 	management of these conditions.
4.4 	In establishing performance measurements, the initiative shall use measures that are 
4.5 	consistent with measures published by nonprofit Minnesota or national organizations that 
4.6 	produce and disseminate health care quality measures.
4.7 	(c) Any program established under this section shall not constitute a financial 
4.8 	liability for the state, in that any financial risk involved in the operation or termination 
4.9 	of the program shall be borne by the community-based initiative and the participating 
4.10 	health care providers.
4.11 		Subd. 1a.Demonstration project. The commissioner of health and the 
4.12 	commissioner of human services shall award ~~a~~ demonstration project ~~grant~~ grants
4.13 	to ~~a~~ community-based health care ~~initiative~~ initiatives to develop and operate ~~a~~
4.14 	community-based health care coverage ~~program to operate within Carlton, Cook, Lake,~~ 
4.15 	~~and St. Louis Counties~~ programs in Minnesota. The demonstration ~~project~~ projects shall 
4.16 	extend for five years and must comply with the requirements of this section.
4.17 		Subd. 2.Definitions.  For purposes of this section, the following definitions apply: 
4.18 	(a) "Community-based" means located in or primarily relating to the community 
4.19 	~~of geographically contiguous political subdivisions~~, as determined by the board of a 
4.20 	community-based health initiative that is served by the community-based health care 
4.21 	coverage program. 
4.22 	(b) "Community-based health care coverage program" or "program" means a 
4.23 	program administered by a community-based health initiative that provides health care 
4.24 	services through provider members of a community-based health network or combination 
4.25 	of networks to eligible individuals and their dependents who are enrolled in the program.
4.26 	(c) "Community-based health initiative" or "initiative" means a nonprofit corporation 
4.27 	that is governed by a board that has at least 80 percent of its members residing in the 
4.28 	community and includes representatives of the participating network providers and 
4.29 	employers, or a county-based purchasing organization as defined in section 256B.692.
4.30 	(d) "Community-based health network" means a contract-based network of health 
4.31 	care providers organized by the community-based health initiative to provide or support 
4.32 	the delivery of health care services to enrollees of the community-based health care 
4.33 	coverage program on a risk-sharing or nonrisk-sharing basis.
4.34 	(e) "Dependent" means an eligible employee's spouse or unmarried child who is 
4.35 	under the age of 19 years.
5.1 		Subd. 3.Approval.  (a) Prior to the operation of a community-based health 
5.2 	care coverage program, a community-based health initiative, defined in subdivision 
5.3 	2, paragraph (c), and receiving funds from the Department of Health, shall submit to 
5.4 	the commissioner of health for approval the community-based health care coverage 
5.5 	program developed by the initiative. Each community-based health initiative as defined 
5.6 	in subdivision 2, paragraph (c), and receiving State Health Access Program (SHAP) 
5.7 	grant funding shall submit to the commissioner of human services for approval prior 
5.8 	to its operation the community-based health care coverage programs developed by the 
5.9 	initiatives. The ~~commissioner~~ commissioners shall ensure that ~~the~~ each program meets 
5.10 	the federal grant requirements and any requirements described in this section and is 
5.11 	actuarially sound based on a review of appropriate records and methods utilized by the 
5.12 	community-based health initiative in establishing premium rates for the community-based 
5.13 	health care coverage ~~program~~ programs. 
5.14 	(b) Prior to approval, the commissioner shall also ensure that:
5.15 	(1) the benefits offered comply with subdivision 8 and that there are adequate 
5.16 	numbers of health care providers participating in the community-based health network to 
5.17 	deliver the benefits offered under the program;
5.18 	(2) the activities of the program are limited to activities that are exempt under this 
5.19 	section or otherwise from regulation by the commissioner of commerce;
5.20 	(3) the complaint resolution process meets the requirements of subdivision 10; and 
5.21 	(4) the data privacy policies and procedures comply with state and federal law.
5.22 		Subd. 4.Establishment.  The initiative shall establish and operate upon approval 
5.23 	by the ~~commissioner~~commissioners of health ~~a~~and human services community-based 
5.24 	health care coverage ~~program~~ programs. The operational structure established by the 
5.25 	initiative shall include, but is not limited to: 
5.26 	(1) establishing a process for enrolling eligible individuals and their dependents; 
5.27 	(2) collecting and coordinating premiums from enrollees and employers of enrollees;
5.28 	(3) providing payment to participating providers; 
5.29 	(4) establishing a benefit set according to subdivision 8 and establishing premium 
5.30 	rates and cost-sharing requirements; 
5.31 	(5) creating incentives to encourage primary care and wellness services; and 
5.32 	(6) initiating disease management services, as appropriate. 
5.33 		Subd. 5.Qualifying employees.  To be eligible for the community-based health 
5.34 	care coverage program, an individual must: 
5.35 	(1) reside in or work within the designated community-based geographic area 
5.36 	served by the program; 
6.1 	(2) be employed by a qualifying employer ~~or~~, be an employee's dependent, or be 
6.2 	self-employed on a full-time basis; 
6.3 	(3) not be enrolled in or have currently available health coverage, except for 
6.4 	catastrophic health care coverage; and 
6.5 	(4) not be eligible for or enrolled in medical assistance~~,~~or general assistance medical 
6.6 	care, and not be enrolled in MinnesotaCare~~,~~ or Medicare.
6.7 		Subd. 6.Qualifying employers.  (a) To qualify for participation in the 
6.8 	community-based health care coverage program, an employer must: 
6.9 	(1) employ at least one but no more than 50 employees at the time of initial 
6.10 	enrollment in the program; 
6.11 	(2) pay its employees a median wage ~~of $12.50 per hour~~ that equals 350 percent of 
6.12 	the federal poverty guidelines or less; and 
6.13 	(3) not have offered employer-subsidized health coverage to its employees for 
6.14 	at least 12 months prior to the initial enrollment in the program. For purposes of this 
6.15 	section, "employer-subsidized health coverage" means health care coverage for which the 
6.16 	employer pays at least 50 percent of the cost of coverage for the employee.
6.17 	(b) To participate in the program, a qualifying employer agrees to: 
6.18 	(1) offer health care coverage through the program to all eligible employees and 
6.19 	their dependents regardless of health status; 
6.20 	(2) participate in the program for an initial term of at least one year; 
6.21 	(3) pay a percentage of the premium established by the initiative for the employee; 
6.22 	and 
6.23 	(4) provide the initiative with any employee information deemed necessary by the 
6.24 	initiative to determine eligibility and premium payments. 
6.25 		Subd. 7.Participating providers. Any health care provider participating in the 
6.26 	community-based health network must accept as payment in full the payment rate 
6.27 	established by the ~~initiative~~initiatives and may not charge to or collect from an enrollee 
6.28 	any amount in access of this amount for any service covered under the program.
6.29 		Subd. 8.Coverage.  (a) The ~~initiative~~ initiatives shall establish the health care 
6.30 	benefits offered through the community-based health care coverage ~~program~~ programs. 
6.31 	The benefits established shall include, at a minimum: 
6.32 	(1) child health supervision services up to age 18, as defined under section 62A.047; 
6.33 	and 
6.34 	(2) preventive services, including: 
6.35 	(i) health education and wellness services; 
6.36 	(ii) health supervision, evaluation, and follow-up; 
7.1 	(iii) immunizations; and 
7.2 	(iv) early disease detection. 
7.3 	(b) Coverage of health care services offered by the program may be limited to 
7.4 	participating health care providers or health networks. All services covered under the 
7.5 	~~program~~programs must be services that are offered within the scope of practice of the 
7.6 	participating health care providers. 
7.7 	(c) The ~~initiative~~initiatives may establish cost-sharing requirements. Any 
7.8 	co-payment or deductible provisions established may not discriminate on the basis of age, 
7.9 	sex, race, disability, economic status, or length of enrollment in the ~~program~~ programs. 
7.10 	(d) If any of the ~~initiative~~ initiatives amends or alters the benefits offered through 
7.11 	the program from the initial offering, ~~the~~ that initiative must notify the ~~commissioner~~
7.12 	commissioners of health and human services and all enrollees of the benefit change.
7.13 		Subd. 9.Enrollee information. (a) The ~~initiative~~ initiatives must provide an 
7.14 	individual or family who enrolls in the program a clear and concise written statement 
7.15 	that includes the following information: 
7.16 	(1) health care services that are ~~provided~~ covered under the program; 
7.17 	(2) any exclusions or limitations on the health care services ~~offered~~ covered, 
7.18 	including any cost-sharing arrangements or prior authorization requirements; 
7.19 	(3) a list of where the health care services can be obtained and that all health 
7.20 	care services must be provided by or through a participating health care provider or 
7.21 	community-based health network; 
7.22 	(4) a description of the program's complaint resolution process, including how to 
7.23 	submit a complaint; how to file a complaint with the commissioner of health; and how to 
7.24 	obtain an external review of any adverse decisions as provided under subdivision 10; 
7.25 	(5) the conditions under which the program or coverage under the program may 
7.26 	be canceled or terminated; and 
7.27 	(6) a precise statement specifying that this program is not an insurance product and, 
7.28 	as such, is exempt from state regulation of insurance products.
7.29 	(b) The ~~commissioner~~ commissioners of health and human services must approve a 
7.30 	copy of the written statement prior to the operation of the program. 
7.31 		Subd. 10.Complaint resolution process. (a) The ~~initiative~~ initiatives must 
7.32 	establish a complaint resolution process. The process must make reasonable efforts to 
7.33 	resolve complaints and to inform complainants in writing of the initiative's decision within 
7.34 	60 days of receiving the complaint. Any decision that is adverse to the enrollee shall 
7.35 	include a description of the right to an external review as provided in paragraph (c) and 
7.36 	how to exercise this right.
8.1 	(b) The ~~initiative~~ initiatives  must report any complaint that is not resolved within 60 
8.2 	days to the commissioner of health. 
8.3 	(c) The ~~initiative~~ initiatives  must include in the complaint resolution process the 
8.4 	ability of an enrollee to pursue the external review process provided under section 62Q.73
8.5 	with any decision rendered under this external review process binding on the ~~initiative~~
8.6 	initiatives.
8.7 		Subd. 11.Data privacy. The ~~initiative~~ initiatives shall establish data privacy policies 
8.8 	and procedures for the program that comply with state and federal data privacy laws. 
8.9 		Subd. 12.Limitations on enrollment. (a) The ~~initiative~~ initiatives may limit 
8.10 	enrollment in the program. If enrollment is limited, a waiting list must be established. 
8.11 	(b) The ~~initiative~~ initiatives shall not restrict or deny enrollment in the program 
8.12 	except for nonpayment of premiums, fraud or misrepresentation, or as otherwise permitted 
8.13 	under this section. 
8.14 	(c) The ~~initiative~~ initiatives may require a certain percentage of participation from 
8.15 	eligible employees of a qualifying employer before coverage can be offered through the 
8.16 	program. 
8.17 		Subd. 13.Report.  ~~(a) The~~ Each initiative shall submit quarterly status reports to the 
8.18 	commissioner of health on January 15, April 15, July 15, and October 15 of each year, 
8.19 	with the first report due January 15, 2008. ~~The~~ Each initiative receiving funding from the 
8.20 	Department of Human Services shall submit status reports to the commissioner of human 
8.21 	services as defined in the terms of contract with the Department of Human Services. Each
8.22 	status report shall include:
8.23 	(1) the financial status of the program, including the premium rates, cost per member 
8.24 	per month, claims paid out, premiums received, and administrative expenses; 
8.25 	(2) a description of the health care benefits offered and the services utilized; 
8.26 	(3) the number of employers participating, the number of employees and dependents 
8.27 	covered under the program, and the number of health care providers participating; 
8.28 	(4) a description of the health outcomes to be achieved by the program and a status 
8.29 	report on the performance measurements to be used and collected; and 
8.30 	(5) any other information requested by the ~~commissioner~~ commissioners of health,
8.31 	human services, or commerce or the legislature. 
8.32 	~~(b) The initiative shall contract with an independent entity to conduct an evaluation~~ 
8.33 	~~of the program to be submitted to the commissioners of health and commerce and the~~ 
8.34 	~~legislature by January 15, 2010. The evaluation shall include:~~
8.35 	~~(1) an analysis of the health outcomes established by the initiative and the~~ 
8.36 	~~performance measurements to determine whether the outcomes are being achieved;~~
9.1 	~~(2) an analysis of the financial status of the program, including the claims to~~ 
9.2 	~~premiums loss ratio and utilization and cost experience;~~ 
9.3 	~~(3) the demographics of the enrollees, including their age, gender, family income,~~ 
9.4 	~~and the number of dependents;~~ 
9.5 	~~(4) the number of employers and employees who have been denied access to the~~ 
9.6 	~~program and the basis for the denial;~~ 
9.7 	~~(5) specific analysis on enrollees who have aggregate medical claims totaling over~~ 
9.8 	~~$5,000 per year, including data on the enrollee's main diagnosis and whether all the~~ 
9.9 	~~medical claims were covered by the program;~~ 
9.10 	~~(6) number of enrollees referred to state public assistance programs;~~ 
9.11 	~~(7) a comparison of employer-subsidized health coverage provided in a comparable~~ 
9.12 	~~geographic area to the designated community-based geographic area served by the~~ 
9.13 	~~program, including, to the extent available:~~ 
9.14 	~~(i) the difference in the number of employers with 50 or fewer employees offering~~ 
9.15 	~~employer-subsidized health coverage;~~ 
9.16 	~~(ii) the difference in uncompensated care being provided in each area; and~~
9.17 	~~(iii) a comparison of health care outcomes and measurements established by the~~ 
9.18 	~~initiative; and~~ 
9.19 	~~(8) any other information requested by the commissioner of health or commerce.~~
9.20 		Subd. 14.Sunset. This section expires ~~December 31, 2012~~ August 31, 2014.

9.21 	ARTICLE 3
9.22 	CHILDREN'S HEALTH INSURANCE REAUTHORIZATION ACT (CHIPRA)

9.23 	Section 1. Minnesota Statutes 2008, section 256B.055, subdivision 10, is amended to 
9.24 	read:
9.25 		Subd. 10.Infants. Medical assistance may be paid for an infant less than one year 
9.26 	of age, whose mother was eligible for and receiving medical assistance at the time of birth 
9.27 	~~and who remains in the mother's household~~ or who is in a family with countable income 
9.28 	that is equal to or less than the income standard established under section 256B.057, 
9.29 	subdivision 1. 

9.30 	Sec. 2. Minnesota Statutes 2008, section 256B.057, subdivision 1, is amended to read:
9.31 		Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year of 
9.32 	age or a pregnant woman who has written verification of a positive pregnancy test from 
9.33 	a physician or licensed registered nurse is eligible for medical assistance if countable 
9.34 	family income is equal to or less than 275 percent of the federal poverty guideline for the 
10.1 	same family size. For purposes of this subdivision, "countable family income" means the 
10.2 	amount of income considered available using the methodology of the AFDC program 
10.3 	under the state's AFDC plan as of July 16, 1996, as required by the Personal Responsibility 
10.4 	and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193, 
10.5 	except for the earned income disregard and employment deductions. 
10.6 	(2) For applications processed within one calendar month prior to the effective date, 
10.7 	eligibility shall be determined by applying the income standards and methodologies in 
10.8 	effect prior to the effective date for any months in the six-month budget period before 
10.9 	that date and the income standards and methodologies in effect on the effective date for 
10.10 	any months in the six-month budget period on or after that date. The income standards 
10.11 	for each month shall be added together and compared to the applicant's total countable 
10.12 	income for the six-month budget period to determine eligibility. 
10.13 	(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19] 
10.14 	(2) For applications processed within one calendar month prior to July 1, 2003, 
10.15 	eligibility shall be determined by applying the income standards and methodologies in 
10.16 	effect prior to July 1, 2003, for any months in the six-month budget period before July 1, 
10.17 	2003, and the income standards and methodologies in effect on the expiration date for any 
10.18 	months in the six-month budget period on or after July 1, 2003. The income standards 
10.19 	for each month shall be added together and compared to the applicant's total countable 
10.20 	income for the six-month budget period to determine eligibility. 
10.21 	(3) An amount equal to the amount of earned income exceeding 275 percent of 
10.22 	the federal poverty guideline, up to a maximum of the amount by which the combined 
10.23 	total of 185 percent of the federal poverty guideline plus the earned income disregards 
10.24 	and deductions allowed under the state's AFDC plan as of July 16, 1996, as required 
10.25 	by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public 
10.26 	Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for 
10.27 	pregnant women and infants less than one year of age. 
10.28 	(c) Dependent care and child support paid under court order shall be deducted from 
10.29 	the countable income of pregnant women. 
10.30 	(d) An infant born ~~on or after January 1, 1991,~~ to a woman who was eligible for and 
10.31 	receiving medical assistance on the date of the child's birth shall continue to be eligible for 
10.32 	medical assistance without redetermination until the child's first birthday~~, as long as the~~ 
10.33 	~~child remains in the woman's household~~. 

11.1 	ARTICLE 4
11.2 	LONG-TERM CARE PARTNERSHIP

11.3 	Section 1. Minnesota Statutes 2008, section 62S.24, subdivision 8, is amended to read:
11.4 		Subd. 8.Exchange for long-term care partnership policy; addition of policy 
11.5 	rider. (a) ~~If authorized by federal law  or a federal waiver is granted~~ With respect to the 
11.6 	long-term care partnership program referenced in section 256B.0571, issuers of long-term 
11.7 	care policies may voluntarily exchange a current long-term care insurance policy for a 
11.8 	long-term care partnership policy that meets the requirements of Public Law 109-171, 
11.9 	section 6021, after the effective date of the state plan amendment implementing the 
11.10 	partnership program in this state. The exchange may be in the form of: (1) an amendment 
11.11 	or rider; or (2) a disclosure statement indicating that the coverage is now partnership 
11.12 	qualified.
11.13 	(b) ~~If authorized by federal law  or a federal waiver is granted~~ With respect to the 
11.14 	long-term care partnership program referenced in section 256B.0571, ~~allowing~~ to allow
11.15 	an existing long-term care insurance policy to qualify as a partnership policy by addition 
11.16 	of: (1) a policy rider, or amendment; or (2) a disclosure statement, the issuer of the policy 
11.17 	is authorized to add the rider, amendment, or disclosure statement to the policy after the 
11.18 	effective date of the state plan amendment implementing the partnership program in 
11.19 	this state.
11.20 	(c) The commissioner, in cooperation with the commissioner of human services, 
11.21 	shall pursue any federal law changes or waivers necessary to allow the implementation 
11.22 	of paragraphs (a) and (b).

11.23 	Sec. 2. [62S.312] CONSUMER PROTECTION STANDARDS FOR 
11.24 	LONG-TERM CARE PARTNERSHIP POLICIES.
11.25 	To qualify as a long-term care partnership policy under this chapter, long-term 
11.26 	care insurance policies must meet the requirements for being tax qualified as defined in 
11.27 	section 7702B(b) of the Internal Revenue Code and meet certain consumer protection 
11.28 	requirements in Section 6021(a)(1)(B)(5)(A) of the Deficit Reduction Act of 2005, Public 
11.29 	Law 109-171, which are taken from the National Association of Insurance Commissioners 
11.30 	(NAIC) Model Act and Regulation of 2000. Insurance carriers must certify for each policy 
11.31 	form to be included in the long-term care partnership that the form complies with the 
11.32 	requirements of the NAIC Model Act and Regulation of 2000 as implemented in sections 
11.33 	62S.05 to 62S.11; 62S.13 to 62S.18; 62S.19; 62S.20, subdivisions 1 to 5; 62S.21; 62S.22; 
11.34 	62S.24; 62S.25; 62S.266; 62S.28; 62S.29; 62S.30; and 62S.31.

12.1 	Sec. 3. Minnesota Statutes 2008, section 256B.0571, subdivision 6, is amended to read:
12.2 		Subd. 6. Partnership policy. "Partnership policy" means a long-term care insurance 
12.3 	policy that meets the ~~requirements under subdivision 10 and~~criteria in sections 62S.23, 
12.4 	subdivision 1, paragraph (b), and 62S.312 and was issued on or after ~~the effective date of~~ 
12.5 	~~the state plan amendment implementing the partnership program in Minnesota. Policies~~ 
12.6 	~~that are exchanged or that have riders or endorsements added on or after the effective date~~ 
12.7 	~~of the state plan amendment as authorized by the commissioner of commerce qualify~~ 
12.8 	~~as a partnership policy~~ July 1, 2006, or exchanged on or after July 1, 2006, under the 
12.9 	provisions of section 62S.24, subdivision 8. 

12.10 	Sec. 4. Minnesota Statutes 2009 Supplement, section 256B.0571, subdivision 8, 
12.11 	is amended to read:
12.12 		Subd. 8.Program established. (a) The commissioner, in cooperation with the 
12.13 	commissioner of commerce, shall establish the Minnesota partnership for long-term care 
12.14 	program to provide for the financing of long-term care through a combination of private 
12.15 	insurance and medical assistance.
12.16 	(b) An individual becomes eligible to participate in the partnership program by 
12.17 	meeting the requirements of either clause (1) or (2):
12.18 	(1) the individual may qualify as a beneficiary of a partnership policy that ~~either~~ 
12.19 	~~(i) is issued on or after the effective date of the state plan amendment implementing the~~ 
12.20 	~~partnership plan in Minnesota, or (ii) qualifies as a partnership policy as authorized by the~~ 
12.21 	~~commissioner of commerce~~ meets the criteria under subdivision 6. To be eligible under 
12.22 	this clause, the individual must be a Minnesota resident at the time coverage first became 
12.23 	effective under the partnership policy; or
12.24 	(2) the individual may qualify as a beneficiary of a policy recognized under 
12.25 	subdivision 17.

12.26 	Sec. 5.  REPEALER.
 12.27 	Minnesota Statutes 2008, section 256B.0571, subdivision 10, is repealed.

12.28 	ARTICLE 5
12.29 	MODIFICATION TO PROHIBITIONS ON ASSET TRANSFERS

12.30 	Section 1.  REPEALER.
 12.31 	Minnesota Statutes 2008, section 256B.0595, subdivisions 1b, 2b, 3b, 4b, and 5, are 
12.32 	repealed.

13.1 	ARTICLE 6
13.2 	COMMUNITY CLINICS

13.3 	Section 1. Minnesota Statutes 2008, section 256B.0625, subdivision 30, is amended to 
13.4 	read:
13.5 		Subd. 30.Other clinic services. (a) Medical assistance covers rural health clinic 
13.6 	services, federally qualified health center services, nonprofit community health clinic 
13.7 	services, public health clinic services~~, and the services of a clinic meeting the criteria~~ 
13.8 	~~established in rule by the commissioner~~. Rural health clinic services and federally 
13.9 	qualified health center services mean services defined in United States Code, title 42, 
13.10 	section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified 
13.11 	health center services shall be made according to applicable federal law and regulation.
13.12 	(b) A federally qualified health center that is beginning initial operation shall submit 
13.13 	an estimate of budgeted costs and visits for the initial reporting period in the form and 
13.14 	detail required by the commissioner. A federally qualified health center that is already in 
13.15 	operation shall submit an initial report using actual costs and visits for the initial reporting 
13.16 	period. Within 90 days of the end of its reporting period, a federally qualified health 
13.17 	center shall submit, in the form and detail required by the commissioner, a report of 
13.18 	its operations, including allowable costs actually incurred for the period and the actual 
13.19 	number of visits for services furnished during the period, and other information required 
13.20 	by the commissioner. Federally qualified health centers that file Medicare cost reports 
13.21 	shall provide the commissioner with a copy of the most recent Medicare cost report filed 
13.22 	with the Medicare program intermediary for the reporting year which support the costs 
13.23 	claimed on their cost report to the state.
13.24 	(c) In order to continue cost-based payment under the medical assistance program 
13.25 	according to paragraphs (a) and (b), a federally qualified health center or rural health clinic 
13.26 	must apply for designation as an essential community provider within six months of final 
13.27 	adoption of rules by the Department of Health according to section 62Q.19, subdivision 
13.28 	7. For those federally qualified health centers and rural health clinics that have applied 
13.29 	for essential community provider status within the six-month time prescribed, medical 
13.30 	assistance payments will continue to be made according to paragraphs (a) and (b) for the 
13.31 	first three years after application. For federally qualified health centers and rural health 
13.32 	clinics that either do not apply within the time specified above or who have had essential 
13.33 	community provider status for three years, medical assistance payments for health services 
13.34 	provided by these entities shall be according to the same rates and conditions applicable 
14.1 	to the same service provided by health care providers that are not federally qualified 
14.2 	health centers or rural health clinics. 
14.3 	(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally 
14.4 	qualified health center or a rural health clinic to make application for an essential 
14.5 	community provider designation in order to have cost-based payments made according 
14.6 	to paragraphs (a) and (b) no longer apply.
14.7 	(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) 
14.8 	shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
14.9 	(f) Effective January 1, 2001, each federally qualified health center and rural health 
14.10 	clinic may elect to be paid either under the prospective payment system established 
14.11 	in United States Code, title 42, section 1396a(aa), or under an alternative payment 
14.12 	methodology consistent with the requirements of United States Code, title 42, section 
14.13 	1396a(aa), and approved by the Centers for Medicare and Medicaid Services. The 
14.14 	alternative payment methodology shall be 100 percent of cost as determined according to 
14.15 	Medicare cost principles.
14.16 	(g) For purposes of this section, "nonprofit community clinic" is a clinic that:
14.17 	(1) has nonprofit status as specified in chapter 317A;
14.18 	(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
14.19 	(3) is established to provide health services to low-income population groups, 
14.20 	uninsured, high-risk and special needs populations, underserved and other special needs 
14.21 	populations;
14.22 	(4) employs professional staff at least one-half of which are familiar with the 
14.23 	cultural background of their clients;
14.24 	(5) charges for services on a sliding fee scale designed to provide assistance to 
14.25 	low-income clients based on current poverty income guidelines and family size; and
14.26 	(6) does not restrict access or services because of a client's financial limitations or 
14.27 	public assistance status and provides no-cost care as needed.

14.28 	ARTICLE 7
14.29 	DENTAL BENEFIT SET

14.30 	Section 1. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9, 
14.31 	is amended to read:
14.32 		Subd. 9.Dental services. (a) Medical assistance covers dental services.
14.33 	(b) Medical assistance dental coverage for nonpregnant adults is limited to the 
14.34 	following services:
14.35 	(1) comprehensive exams, limited to once every five years;
15.1 	(2) periodic exams, limited to one per year;
15.2 	(3) limited exams;
15.3 	(4) bitewing x-rays, limited to one per year;
15.4 	(5) periapical x-rays;
15.5 	(6) panoramic x-rays, limited to one every five years~~, and only if provided in~~ 
15.6 	~~conjunction with a posterior extraction or scheduled outpatient facility procedure, or~~ 
15.7 	~~as~~ except (1) when medically necessary for the diagnosis and follow-up of oral and 
15.8 	maxillofacial pathology and trauma~~. Panoramic x-rays may be taken~~ or (2) once every two 
15.9 	years for patients who cannot cooperate for intraoral film due to a developmental disability 
15.10 	or medical condition that does not allow for intraoral film placement;
15.11 	(7) prophylaxis, limited to one per year;
15.12 	(8) application of fluoride varnish, limited to one per year;
15.13 	(9) posterior fillings, all at the amalgam rate;
15.14 	(10) anterior fillings;
15.15 	(11) endodontics, limited to root canals on the anterior and premolars only;
15.16 	(12) removable prostheses, each dental arch limited to one every six years;
15.17 	(13) oral surgery, limited to extractions, biopsies, and incision and drainage of 
15.18 	abscesses;
15.19 	(14) palliative treatment and sedative fillings for relief of pain; and
15.20 	(15) full-mouth debridement, limited to one every five years.
15.21 	(c) In addition to the services specified in paragraph (b), medical assistance 
15.22 	covers the following services for adults, if provided in an outpatient hospital setting or 
15.23 	freestanding ambulatory surgical center as part of outpatient dental surgery:
15.24 	(1) periodontics, limited to periodontal scaling and root planing once every two 
15.25 	years;
15.26 	(2) general anesthesia; and
15.27 	(3) full-mouth survey once every five years.
15.28 	(d) Medical assistance covers medically necessary dental services for children ~~that~~ 
15.29 	~~are medically necessary~~ and pregnant women. The following guidelines apply:
15.30 	(1) posterior fillings are paid at the amalgam rate;
15.31 	(2) application of sealants are covered once every five years per permanent molar for 
15.32 	children only; ~~and~~
15.33 	(3) application of fluoride varnish is covered once every six months~~.~~; and
15.34 	(4) orthodontia is eligible for coverage for children only.

16.1 	ARTICLE 8
16.2 	PRIOR AUTHORIZATION FOR HEALTH SERVICES

16.3 	Section 1. Minnesota Statutes 2008, section 256B.0625, subdivision 25, is amended to 
16.4 	read:
16.5 		Subd. 25.Prior authorization required. ~~The commissioner shall publish in the~~ 
16.6 	~~State Register a list of health services that require prior authorization, as well as the~~ 
16.7 	~~criteria and standards used to select health services on the list. The list and the criteria and~~ 
16.8 	~~standards used to formulate it are not subject to the requirements of sections 14.001 to~~ 
16.9 	~~14.69.~~ The commissioner's decision whether prior authorization is required for a health 
16.10 	service is not subject to administrative appeal. 

16.11 	ARTICLE 9
16.12 	DRUG FORMULARY COMMITTEE

16.13 	Section 1. Minnesota Statutes 2008, section 256B.0625, subdivision 13c, is amended to 
16.14 	read:
16.15 		Subd. 13c.Formulary committee. The commissioner, after receiving 
16.16 	recommendations from professional medical associations and professional pharmacy 
16.17 	associations, and consumer groups shall designate a Formulary Committee to carry 
16.18 	out duties as described in subdivisions 13 to 13g. The Formulary Committee shall be 
16.19 	comprised of four licensed physicians actively engaged in the practice of medicine in 
16.20 	Minnesota one of whom must be actively engaged in the treatment of persons with mental 
16.21 	illness; at least three licensed pharmacists actively engaged in the practice of pharmacy 
16.22 	in Minnesota; and one consumer representative; the remainder to be made up of health 
16.23 	care professionals who are licensed in their field and have recognized knowledge in the 
16.24 	clinically appropriate prescribing, dispensing, and monitoring of covered outpatient drugs. 
16.25 	Members of the Formulary Committee shall not be employed by the Department of 
16.26 	Human Services, but the committee shall be staffed by an employee of the department 
16.27 	who shall serve as an ex officio, nonvoting member of the committee. The department's 
16.28 	medical director shall also serve as an ex officio, nonvoting member for the committee. 
16.29 	Committee members shall serve three-year terms and may be reappointed by the 
16.30 	commissioner. The Formulary Committee shall meet at least ~~quarterly~~ biannually. The 
16.31 	commissioner may require more frequent Formulary Committee meetings as needed. An 
16.32 	honorarium of $100 per meeting and reimbursement for mileage shall be paid to each 
16.33 	committee member in attendance.

17.1 	ARTICLE 10
17.2 	PREFERRED DRUG LIST

17.3 	Section 1. Minnesota Statutes 2008, section 256B.0625, subdivision 13g, is amended 
17.4 	to read:
17.5 		Subd. 13g. Preferred drug list. (a) The commissioner shall adopt and implement 
17.6 	a preferred drug list by January 1, 2004. The commissioner may enter into a contract 
17.7 	with a vendor for the purpose of participating in a preferred drug list and supplemental 
17.8 	rebate program. The commissioner shall ensure that any contract meets all federal 
17.9 	requirements and maximizes federal financial participation. The commissioner shall 
17.10 	publish the preferred drug list annually in the State Register and shall maintain an accurate 
17.11 	and up-to-date list on the agency Web site. 
17.12 	(b) The commissioner may add to, delete from, and otherwise modify the preferred 
17.13 	drug list, after consulting with the Formulary Committee and appropriate medical 
17.14 	specialists and providing public notice and the opportunity for public comment. 
17.15 	(c) The commissioner shall adopt and administer the preferred drug list as part of the 
17.16 	administration of the supplemental drug rebate program. Reimbursement for prescription 
17.17 	drugs not on the preferred drug list may be subject to prior authorization~~, unless the drug~~ 
17.18 	~~manufacturer signs a supplemental rebate contract~~. 
17.19 	(d) For purposes of this subdivision, "preferred drug list" means a list of prescription 
17.20 	drugs within designated therapeutic classes selected by the commissioner, for which prior 
17.21 	authorization based on the identity of the drug or class is not required. 
17.22 	(e) The commissioner shall seek any federal waivers or approvals necessary to 
17.23 	implement this subdivision. 

17.24 	ARTICLE 11
17.25 	MULTISOURCE DRUGS

17.26 	Section 1. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 13e, 
17.27 	is amended to read:
17.28 		Subd. 13e.Payment rates. (a) The basis for determining the amount of payment 
17.29 	shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 
17.30 	the maximum allowable cost set by the federal government or by the commissioner plus 
17.31 	the fixed dispensing fee; or the usual and customary price charged to the public. The 
17.32 	amount of payment basis must be reduced to reflect all discount amounts applied to the 
17.33 	charge by any provider/insurer agreement or contract for submitted charges to medical 
18.1 	assistance programs. The net submitted charge may not be greater than the patient liability 
18.2 	for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 
18.3 	for intravenous solutions which must be compounded by the pharmacist shall be $8 per 
18.4 	bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 
18.5 	nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 
18.6 	nutritional products dispensed in quantities greater than one liter. Actual acquisition cost 
18.7 	includes quantity and other special discounts except time and cash discounts. Effective 
18.8 	July 1, 2009, the actual acquisition cost of a drug shall be estimated by the commissioner, 
18.9 	at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic 
18.10 	factor drugs shall be estimated at the average wholesale price minus 30 percent. The 
18.11 	maximum allowable cost of a multisource drug may be set by the commissioner and it 
18.12 	shall be comparable to, but no higher than, the maximum amount paid by other third-party 
18.13 	payors in this state who have maximum allowable cost programs. Establishment of the 
18.14 	amount of payment for drugs shall not be subject to the requirements of the Administrative 
18.15 	Procedure Act.
18.16 	(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 
18.17 	to pharmacists for legend drug prescriptions dispensed to residents of long-term care 
18.18 	facilities when a unit dose blister card system, approved by the department, is used. Under 
18.19 	this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 
18.20 	The National Drug Code (NDC) from the drug container used to fill the blister card must 
18.21 	be identified on the claim to the department. The unit dose blister card containing the 
18.22 	drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 
18.23 	that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 
18.24 	will be required to credit the department for the actual acquisition cost of all unused 
18.25 	drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 
18.26 	manufacturer's unopened package. The commissioner may permit the drug clozapine to be 
18.27 	dispensed in a quantity that is less than a 30-day supply.
18.28 	(c) Whenever a ~~generically equivalent product is available~~ maximum allowable 
18.29 	cost has been set for a multisource drug, payment shall be on the basis of ~~the actual~~ 
18.30 	~~acquisition cost of the generic drug, or on~~ the maximum allowable cost established by 
18.31 	the commissioner unless prior authorization for the brand name product has been granted 
18.32 	according to the criteria established by the Drug Formulary Committee as required by 
18.33 	subdivision 13f, paragraph (a), and the prescriber has indicated "dispense as written" on 
18.34 	the prescription in a manner consistent with section 151.21, subdivision 2.
18.35 	(d) The basis for determining the amount of payment for drugs administered in an 
18.36 	outpatient setting shall be the lower of the usual and customary cost submitted by the 
19.1 	provider or the amount established for Medicare by the United States Department of 
19.2 	Health and Human Services pursuant to title XVIII, section 1847a of the federal Social 
19.3 	Security Act.
19.4 	(e) The commissioner may negotiate lower reimbursement rates for specialty 
19.5 	pharmacy products than the rates specified in paragraph (a). The commissioner may 
19.6 	require individuals enrolled in the health care programs administered by the department 
19.7 	to obtain specialty pharmacy products from providers with whom the commissioner has 
19.8 	negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 
19.9 	used by a small number of recipients or recipients with complex and chronic diseases 
19.10 	that require expensive and challenging drug regimens. Examples of these conditions 
19.11 	include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 
19.12 	C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 
19.13 	of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 
19.14 	biotechnology drugs, high-cost therapies, and therapies that require complex care. The 
19.15 	commissioner shall consult with the formulary committee to develop a list of specialty 
19.16 	pharmacy products subject to this paragraph. In consulting with the formulary committee 
19.17 	in developing this list, the commissioner shall take into consideration the population 
19.18 	served by specialty pharmacy products, the current delivery system and standard of care in 
19.19 	the state, and access to care issues. The commissioner shall have the discretion to adjust 
19.20 	the reimbursement rate to prevent access to care issues.

19.21 	ARTICLE 12
19.22 	ADMINISTRATIVE UNIFORMITY COMMITTEE

19.23 	Section 1. Minnesota Statutes 2008, section 256B.0625, is amended by adding a 
19.24 	subdivision to read:
19.25 		Subd. 8d.Home infusion therapy services.  Home infusion therapy services 
19.26 	provided by home infusion therapy pharmacies must be paid the lower of the submitted 
19.27 	charge or the combined payment rates for component services typically provided.

19.28 	EFFECTIVE DATE. This section is effective upon federal approval.

19.29 	Sec. 2. Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 13e, 
19.30 	is amended to read:
19.31 		Subd. 13e.Payment rates. (a) The basis for determining the amount of payment 
19.32 	shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; 
19.33 	the maximum allowable cost set by the federal government or by the commissioner plus 
20.1 	the fixed dispensing fee; or the usual and customary price charged to the public. The 
20.2 	amount of payment basis must be reduced to reflect all discount amounts applied to the 
20.3 	charge by any provider/insurer agreement or contract for submitted charges to medical 
20.4 	assistance programs. The net submitted charge may not be greater than the patient liability 
20.5 	for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee 
20.6 	for intravenous solutions which must be compounded by the pharmacist shall be $8 per 
20.7 	bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral 
20.8 	nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral 
20.9 	nutritional products dispensed in quantities greater than one liter. Actual acquisition cost 
20.10 	includes quantity and other special discounts except time and cash discounts. Effective 
20.11 	July 1, 2009, the actual acquisition cost of a drug shall be estimated by the commissioner, 
20.12 	at average wholesale price minus 15 percent. The actual acquisition cost of antihemophilic 
20.13 	factor drugs shall be estimated at the average wholesale price minus 30 percent. The 
20.14 	maximum allowable cost of a multisource drug may be set by the commissioner and it 
20.15 	shall be comparable to, but no higher than, the maximum amount paid by other third-party 
20.16 	payors in this state who have maximum allowable cost programs. Establishment of the 
20.17 	amount of payment for drugs shall not be subject to the requirements of the Administrative 
20.18 	Procedure Act.
20.19 	(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid 
20.20 	to pharmacists for legend drug prescriptions dispensed to residents of long-term care 
20.21 	facilities when a unit dose blister card system, approved by the department, is used. Under 
20.22 	this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. 
20.23 	The National Drug Code (NDC) from the drug container used to fill the blister card must 
20.24 	be identified on the claim to the department. The unit dose blister card containing the 
20.25 	drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, 
20.26 	that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider 
20.27 	will be required to credit the department for the actual acquisition cost of all unused 
20.28 	drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the 
20.29 	manufacturer's unopened package. The commissioner may permit the drug clozapine to be 
20.30 	dispensed in a quantity that is less than a 30-day supply.
20.31 	(c) Whenever a generically equivalent product is available, payment shall be on the 
20.32 	basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost 
20.33 	established by the commissioner.
20.34 	(d) The basis for determining the amount of payment for drugs administered in an 
20.35 	outpatient setting shall be the lower of the usual and customary cost submitted by the 
20.36 	provider or the amount established for Medicare by the United States Department of 
21.1 	Health and Human Services pursuant to title XVIII, section 1847a of the federal Social 
21.2 	Security Act.
21.3 	(e) The commissioner may negotiate lower reimbursement rates for specialty 
21.4 	pharmacy products than the rates specified in paragraph (a). The commissioner may 
21.5 	require individuals enrolled in the health care programs administered by the department 
21.6 	to obtain specialty pharmacy products from providers with whom the commissioner has 
21.7 	negotiated lower reimbursement rates. Specialty pharmacy products are defined as those 
21.8 	used by a small number of recipients or recipients with complex and chronic diseases 
21.9 	that require expensive and challenging drug regimens. Examples of these conditions 
21.10 	include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis 
21.11 	C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms 
21.12 	of cancer. Specialty pharmaceutical products include injectable and infusion therapies, 
21.13 	biotechnology drugs, high-cost therapies, and therapies that require complex care. The 
21.14 	commissioner shall consult with the formulary committee to develop a list of specialty 
21.15 	pharmacy products subject to this paragraph. In consulting with the formulary committee 
21.16 	in developing this list, the commissioner shall take into consideration the population 
21.17 	served by specialty pharmacy products, the current delivery system and standard of care in 
21.18 	the state, and access to care issues. The commissioner shall have the discretion to adjust 
21.19 	the reimbursement rate to prevent access to care issues.
21.20 	(f) Home infusion therapy services provided by home infusion therapy pharmacies 
21.21 	must be paid at rates according to subdivision 8d.

21.22 	EFFECTIVE DATE. This section is effective upon federal approval.

21.23 	ARTICLE 13
21.24 	HEALTH PLANS

21.25 	Section 1. Minnesota Statutes 2008, section 62A.045, is amended to read:
21.26 	62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT 
21.27 	HEALTH PROGRAMS.
21.28 	(a) As a condition of doing business in Minnesota or providing coverage to 
21.29 	residents of Minnesota covered by this section, each health insurer shall comply with the 
21.30 	requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171, including 
21.31 	any federal regulations adopted under that act, to the extent that it imposes a requirement 
21.32 	that applies in this state and that is not also required by the laws of this state. This section 
21.33 	does not require compliance with any provision of the federal act prior to the effective date 
21.34 	provided for that provision in the federal act. The commissioner shall enforce this section.
22.1 	For the purpose of this section, "health insurer" includes self-insured plans, group 
22.2 	health plans (as defined in section 607(1) of the Employee Retirement Income Security 
22.3 	Act of 1974), service benefit plans, managed care organizations, pharmacy benefit 
22.4 	managers, or other parties that are by contract legally responsible to pay a claim for a 
22.5 	healthcare item or service for an individual receiving benefits under paragraph (b).
22.6 	(b) No ~~health~~ plan offered by a health insurer issued or renewed to provide coverage 
22.7 	to a Minnesota resident shall contain any provision denying or reducing benefits because 
22.8 	services are rendered to a person who is eligible for or receiving medical benefits pursuant 
22.9 	to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256; 
22.10 	256B; or 256D or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331, 
22.11 	subdivision 2; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health 
22.12 	~~carrier~~ insurer providing benefits under plans covered by this section shall use eligibility 
22.13 	for medical programs named in this section as an underwriting guideline or reason for 
22.14 	nonacceptance of the risk. 
22.15 	(c) If payment for covered expenses has been made under state medical programs 
22.16 	for health care items or services provided to an individual, and a third party has a legal 
22.17 	liability to make payments, the rights of payment and appeal of an adverse coverage 
22.18 	decision for the individual, or in the case of a child their responsible relative or caretaker, 
22.19 	will be subrogated to the state agency. The state agency may assert its rights under this 
22.20 	section within three years of the date the service was rendered. For purposes of this 
22.21 	section, "state agency" includes prepaid health plans under contract with the commissioner 
22.22 	according to sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; 
22.23 	children's mental health collaboratives under section 245.493; demonstration projects for 
22.24 	persons with disabilities under section 256B.77; nursing homes under the alternative 
22.25 	payment demonstration project under section 256B.434; and county-based purchasing 
22.26 	entities under section 256B.692. 
22.27 	(d) Notwithstanding any law to the contrary, when a person covered by a ~~health~~
22.28 	plan offered by a health insurer receives medical benefits according to any statute listed 
22.29 	in this section, payment for covered services or notice of denial for services billed by 
22.30 	the provider must be issued directly to the provider. If a person was receiving medical 
22.31 	benefits through the Department of Human Services at the time a service was provided, the 
22.32 	provider must indicate this benefit coverage on any claim forms submitted by the provider 
22.33 	to the health carrier for those services. If the commissioner of human services notifies 
22.34 	the health carrier that the commissioner has made payments to the provider, payment 
22.35 	for benefits or notices of denials issued by the health carrier must be issued directly to 
22.36 	the commissioner. Submission by the department to the health carrier of the claim on a 
23.1 	Department of Human Services claim form is proper notice and shall be considered proof 
23.2 	of payment of the claim to the provider and supersedes any contract requirements of the 
23.3 	health carrier relating to the form of submission. Liability to the insured for coverage is 
23.4 	satisfied to the extent that payments for those benefits are made by the health carrier to the 
23.5 	provider or the commissioner as required by this section.
23.6 	(e) When a state agency has acquired the rights of an individual eligible for medical 
23.7 	programs named in this section and has health benefits coverage through a health carrier, 
23.8 	the health carrier shall not impose requirements that are different from requirements 
23.9 	applicable to an agent or assignee of any other individual covered.
23.10 	~~(f) For the purpose of this section, health plan includes coverage offered by~~ 
23.11 	~~community integrated service networks, any plan governed under the federal Employee~~ 
23.12 	~~Retirement Income Security Act of 1974 (ERISA), United States Code, title 29, sections~~ 
23.13 	~~1001 to 1461, and coverage offered under the exclusions listed in section 62A.011,~~ 
23.14 	~~subdivision 3, clauses (2), (6), (9), (10), and (12).~~ 

23.15 	ARTICLE 14
23.16 	CLAIMS AGAINST THE STATE

23.17 	Section 1. Minnesota Statutes 2009 Supplement, section 15C.13, is amended to read:
23.18 	15C.13 DISTRIBUTION TO PRIVATE PLAINTIFF IN CERTAIN ACTIONS.
23.19 	If the prosecuting attorney intervenes at the outset in an action brought by a person 
23.20 	under section 15C.05, the person is entitled to receive not less than 15 percent or more 
23.21 	than 25 percent of any recovery in proportion to the person's contribution to the conduct 
23.22 	of the action. If the prosecuting attorney does not intervene in the action at any time, 
23.23 	the person is entitled to receive not less than 25 percent or more than 30 percent of any 
23.24 	recovery of the civil penalty and damages, or settlement, as the court determines is 
23.25 	reasonable. If the prosecuting attorney does not intervene in the action at the outset but 
23.26 	subsequently intervenes, the person is entitled to receive not less than 15 percent or more 
23.27 	than 30 percent of any recovery, as the court determines is reasonable based on the person's 
23.28 	participation in the action before the prosecuting attorney intervened. For recoveries 
23.29 	whose distribution is governed by federal code or rule, the basis for calculating the portion 
23.30 	of the recovery the person is entitled to receive shall not include amounts reserved for 
23.31 	distribution to the federal government or designated in their use by federal code or rule.