STATE OF MINNESOTA
EIGHTY-THIRD SESSION - 2004
_____________________
EIGHTIETH DAY
Saint Paul, Minnesota, Friday, March 26, 2004
The House of Representatives convened at 12:00 noon and was
called to order by Ron Abrams, Speaker pro tempore.
Prayer was offered by the Reverend Kevin G. Schill, Christ
United Methodist Church, Rochester, Minnesota.
The members of the House gave the pledge of allegiance to the
flag of the United States of America.
The roll was called and the following members were present:
Abeler
Abrams
Adolphson
Anderson, B.
Anderson, I.
Atkins
Beard
Bernardy
Biernat
Blaine
Borrell
Boudreau
Bradley
Brod
Buesgens
Carlson
Clark
Cox
Davids
Davnie
DeLaForest
Demmer
Dempsey
Dill
Dorn
Eastlund
Eken
Entenza
Erickson
Fuller
Gerlach
Goodwin
Greiling
Gunther
Haas
Hackbarth
Harder
Hausman
Heidgerken
Hilstrom
Hilty
Holberg
Hoppe
Hornstein
Howes
Huntley
Jacobson
Johnson, J.
Johnson, S.
Juhnke
Kahn
Kelliher
Klinzing
Knoblach
Koenen
Kohls
Krinkie
Kuisle
Lanning
Latz
Lenczewski
Lesch
Lieder
Lindgren
Lindner
Lipman
Magnus
Mahoney
Mariani
Marquart
McNamara
Mullery
Murphy
Nelson, C.
Nelson, M.
Nelson, P.
Newman
Nornes
Olsen, S.
Olson, M.
Opatz
Osterman
Otremba
Otto
Ozment
Paulsen
Paymar
Pelowski
Penas
Powell
Pugh
Rhodes
Samuelson
Seagren
Seifert
Sertich
Severson
Sieben
Simpson
Slawik
Smith
Soderstrom
Solberg
Stang
Swenson
Sykora
Thao
Thissen
Tingelstad
Urdahl
Vandeveer
Wagenius
Walker
Walz
Wardlow
Wasiluk
Westerberg
Westrom
Wilkin
Zellers
A quorum was present.
Anderson, J.; Cornish; Ellison; Erhardt; Finstad; Jaros;
Larson; Meslow; Peterson; Rukavina; Ruth; Strachan and Sviggum were excused.
The Chief Clerk proceeded to read the Journal of the preceding
day. Cox moved that further reading of
the Journal be suspended and that the Journal be approved as corrected by the
Chief Clerk. The motion prevailed.
REPORTS
OF CHIEF CLERK
S. F. No. 2626 and
H. F. No. 2688, which had been referred to the Chief Clerk for
comparison, were examined and found to be identical.
McNamara moved that S. F. No. 2626 be
substituted for H. F. No. 2688 and that the House File be
indefinitely postponed. The motion
prevailed.
PETITIONS AND COMMUNICATIONS
The following communications were received:
STATE
OF MINNESOTA
OFFICE
OF THE GOVERNOR
SAINT
PAUL 55155
March
19, 2004
The Honorable Steve Sviggum
Speaker of the House of
Representatives
The State of Minnesota
Dear Speaker Sviggum:
It is my honor to inform you that I have received, approved,
signed, and deposited in the Office of the Secretary of State the following
House File:
H. F. No. 480, relating to civil actions;
providing protection for disclosure of job reference information; requiring
disclosure of data between school districts and charter schools relating to
acts of violence or inappropriate sexual contact with students; regulating the
right of an employee to inspect personnel records concerning the employee.
Sincerely,
Tim
Pawlenty
Governor
STATE
OF MINNESOTA
OFFICE
OF THE SECRETARY OF STATE
ST.
PAUL 55155
The Honorable Steve Sviggum
Speaker of the House of
Representatives
The Honorable James P.
Metzen
President of the Senate
I have the honor to inform you that the following enrolled Acts
of the 2004 Session of the State Legislature have been received from the Office
of the Governor and are deposited in the Office of the Secretary of State for
preservation, pursuant to the State Constitution, Article IV, Section 23:
S. F. No. |
H. F. No. |
Session Laws Chapter No. |
Time and Date Approved 2004 |
Date Filed 2004 |
480 137 2:30
p.m. March 19 March
22
2182 138 6:52 p.m.
March 19 March
22
1799 139 6:57 p.m.
March 19 March
22
1814 140 7:03 p.m.
March 19 March
22
Sincerely,
Mary
Kiffmeyer
Secretary
of State
REPORTS OF STANDING COMMITTEES
Bradley from the Committee on Health and Human Services Finance
to which was referred:
H. F. No. 1681, A bill for an act relating to health;
conforming to federal tax changes to encourage consumer-driven health plans;
encouraging efficiency in providing health care; reforming medical malpractice
liability; reducing and providing a moratorium on state-imposed private-sector
health coverage mandates; providing a pilot project for health plans that do
not cover all mandated benefits; eliminating capital expenditure reporting
requirements; permitting nonprofit hospitals to garnish state tax refunds;
permitting file-and-use for health insurance policy forms; permitting
for-profit health maintenance organizations; transferring regulatory authority
for health maintenance organizations; addressing the cost-shifting impacts of
public sector health care programs; amending Minnesota Statutes 2002, sections
16A.10, by adding a subdivision; 43A.23, by adding a subdivision; 62A.02,
subdivision 2; 62D.02, subdivision 4, by adding a subdivision; 62D.03, subdivision
1; 62D.04, subdivision 1; 62Q.65; 72A.20, by adding a subdivision; 147.03,
subdivision 1; 256B.04, by adding a subdivision; Minnesota Statutes 2003
Supplement, sections 62J.26, by adding a subdivision; 144.7063, subdivision 3;
270A.03, subdivision 2; 290.01, subdivisions 19, 31; proposing coding for new
law in Minnesota Statutes, chapters 3; 62J; 62L; 62Q; 144; 147; 151; 604;
repealing Minnesota Statutes 2002, sections 62A.309; 62J.17, as amended.
Reported the same back with the following amendments:
Delete everything after the enacting clause and insert:
"ARTICLE
1
HEALTH
CARE COST CONTAINMENT; CONSUMER EMPOWERMENT
Section 1. Minnesota
Statutes 2002, section 43A.23, is amended by adding a subdivision to read:
Subd. 4. [HEALTH
SAVINGS ACCOUNTS.] During collective bargaining negotiations with the
exclusive representatives of state employees, the commissioner must propose
that state employee health coverage include at least one plan of hospital and
medical benefits that combines a high deductible health plan with a health
savings account, so as to qualify the health savings account under section 223
of the Internal Revenue Code, as amended.
Sec. 2. [62J.81]
[DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES.]
Subdivision 1.
[REQUIRED DISCLOSURE OF PAYMENT RANGE.] A health care provider, as
defined in section 62J.03, subdivision 8, shall, at the request of a consumer,
provide that consumer with the beginning and end of the range of payments
received by the provider from health plan companies for a specific service or
services that the consumer may reasonably expect to receive from the provider,
based upon the consumer's medical condition.
The beginning of the range of payments received by a provider is the
lowest amount the provider is paid by a health plan company for a specific
service and the end of the range is the highest amount the provider is paid by
a health plan company for the service, based upon the provider agreements in
force at the time of the request. A
provider is not required to identify the names of health plan companies.
Subd. 2.
[APPLICABILITY.] For purposes of this section, "consumer"
does not include a medical assistance, MinnesotaCare, or general assistance
medical care enrollee, for services covered under those programs, and a health
care provider shall not include in the range, payments from the medical
assistance, MinnesotaCare, and general assistance medical care programs.
Sec. 3. Minnesota
Statutes 2002, section 62Q.65, is amended to read:
62Q.65 [ACCESS TO PROVIDER DISCOUNTS.]
Subdivision 1.
[REQUIREMENT.] A high deductible health plan must, when used in
connection with a medical savings account an Archer MSA or with a
health savings account, provide the enrollee access to any discounted
provider fees for services covered by the high deductible health plan,
regardless of whether the enrollee has satisfied the deductible for the high
deductible health plan.
Subd. 2. [DEFINITIONS.]
For purposes of this section, the following terms have the meanings given:
(1) "high deductible health plan" has the meaning
given under the Internal Revenue Code of 1986, section 220(c)(2) or
223(c)(2);
(2) "medical savings account Archer MSA"
has the meaning given under the Internal Revenue Code of 1986, section
220(d)(1); and
(3) "discounted provider fees" means fees contained
in a provider agreement entered into by the issuer of the high deductible
health plan, or by an affiliate of the issuer, for use in connection
with the high deductible health plan; and
(4) "health savings account" has the meaning given
under the Internal Revenue Code of 1986, section 223(d).
Sec. 4. [151.214]
[PAYMENT DISCLOSURE.]
Subdivision 1.
[EXPLANATION OF PHARMACY BENEFITS.] A pharmacist licensed under this
chapter must provide to a patient, for each prescription dispensed where part
or all of the cost of the prescription is being paid or reimbursed by an
employer-sponsored plan or health plan company, or its contracted pharmacy
benefit manager, the patient's co-payment amount and the usual and customary
price of the prescription or the amount the pharmacy will be paid for the
prescription drug by the patient's employer-sponsored plan or health plan
company, or its contracted pharmacy benefit manager.
Subd. 2.
[NO PROHIBITION ON DISCLOSURE.] No contracting agreement between an
employer-sponsored health plan or health plan company, or its contracted
pharmacy benefit manager, and a resident or nonresident pharmacy registered
under this chapter, may prohibit the pharmacy from disclosing to patients
information a pharmacy is required or given the option to provide under
subdivision 1.
Sec. 5. Minnesota
Statutes 2003 Supplement, section 290.01, subdivision 19, is amended to read:
Subd. 19. [NET INCOME.]
The term "net income" means the federal taxable income, as defined in
section 63 of the Internal Revenue Code of 1986, as amended through the date
named in this subdivision, incorporating any elections made by the taxpayer in
accordance with the Internal Revenue Code in determining federal taxable income
for federal income tax purposes, and with the modifications provided in
subdivisions 19a to 19f.
In the case of a regulated investment company or a fund
thereof, as defined in section 851(a) or 851(g) of the Internal Revenue Code,
federal taxable income means investment company taxable income as defined in
section 852(b)(2) of the Internal Revenue Code, except that:
(1) the exclusion of net capital gain provided in section
852(b)(2)(A) of the Internal Revenue Code does not apply;
(2) the deduction for dividends paid under section 852(b)(2)(D)
of the Internal Revenue Code must be applied by allowing a deduction for
capital gain dividends and exempt-interest dividends as defined in sections
852(b)(3)(C) and 852(b)(5) of the Internal Revenue Code; and
(3) the deduction for dividends paid must also be applied in
the amount of any undistributed capital gains which the regulated investment
company elects to have treated as provided in section 852(b)(3)(D) of the Internal
Revenue Code.
The net income of a real estate investment trust as defined and
limited by section 856(a), (b), and (c) of the Internal Revenue Code means the
real estate investment trust taxable income as defined in section 857(b)(2) of
the Internal Revenue Code.
The net income of a designated settlement fund as defined in
section 468B(d) of the Internal Revenue Code means the gross income as defined
in section 468B(b) of the Internal Revenue Code.
The provisions of sections 1113(a), 1117, 1206(a), 1313(a),
1402(a), 1403(a), 1443, 1450, 1501(a), 1605, 1611(a), 1612, 1616, 1617,
1704(l), and 1704(m) of the Small Business Job Protection Act, Public Law
104-188, the provisions of Public Law 104-117, the provisions of sections
313(a) and (b)(1), 602(a), 913(b), 941, 961, 971, 1001(a) and (b), 1002, 1003,
1012, 1013, 1014, 1061, 1062, 1081, 1084(b), 1086, 1087, 1111(a), 1131(b) and
(c), 1211(b), 1213, 1530(c)(2), 1601(f)(5) and (h), and 1604(d)(1) of the
Taxpayer Relief Act of 1997, Public Law 105-34, the provisions of section 6010
of the Internal Revenue Service Restructuring and Reform Act of 1998, Public
Law 105-206, the provisions of section 4003 of the Omnibus Consolidated and
Emergency Supplemental Appropriations Act, 1999, Public Law 105-277, and the
provisions of section 318 of the Consolidated Appropriation Act of 2001, Public
Law 106-554, shall become effective at the time they become effective for
federal purposes.
The Internal Revenue Code of 1986, as amended through December
31, 1996, shall be in effect for taxable years beginning after December 31,
1996.
The provisions of sections 202(a) and (b), 221(a), 225, 312,
313, 913(a), 934, 962, 1004, 1005, 1052, 1063, 1084(a) and (c), 1089, 1112,
1171, 1204, 1271(a) and (b), 1305(a), 1306, 1307, 1308, 1309, 1501(b), 1502(b),
1504(a), 1505, 1527, 1528, 1530, 1601(d), (e), (f), and (i) and 1602(a), (b),
(c), and (e) of the Taxpayer Relief Act of 1997, Public Law 105-34, the
provisions of sections 6004, 6005, 6012, 6013, 6015, 6016, 7002, and 7003 of
the Internal Revenue Service
Restructuring and Reform Act of 1998, Public Law 105-206, the provisions of
section 3001 of the Omnibus Consolidated and Emergency Supplemental
Appropriations Act, 1999, Public Law 105-277, the provisions of section 3001 of
the Miscellaneous Trade and Technical Corrections Act of 1999, Public Law
106-36, and the provisions of section 316 of the Consolidated Appropriation Act
of 2001, Public Law 106-554, shall become effective at the time they become
effective for federal purposes.
The Internal Revenue Code of 1986, as amended through December
31, 1997, shall be in effect for taxable years beginning after December 31,
1997.
The provisions of sections 5002, 6009, 6011, and 7001 of the
Internal Revenue Service Restructuring and Reform Act of 1998, Public Law
105-206, the provisions of section 9010 of the Transportation Equity Act for
the 21st Century, Public Law 105-178, the provisions of sections 1004, 4002,
and 5301 of the Omnibus Consolidation and Emergency Supplemental Appropriations
Act, 1999, Public Law 105-277, the provision of section 303 of the Ricky Ray
Hemophilia Relief Fund Act of 1998, Public Law 105-369, the provisions of
sections 532, 534, 536, 537, and 538 of the Ticket to Work and Work Incentives
Improvement Act of 1999, Public Law 106-170, the provisions of the Installment
Tax Correction Act of 2000, Public Law 106-573, and the provisions of section
309 of the Consolidated Appropriation Act of 2001, Public Law 106-554, shall
become effective at the time they become effective for federal purposes.
The Internal Revenue Code of 1986, as amended through December
31, 1998, shall be in effect for taxable years beginning after December 31,
1998.
The provisions of the FSC Repeal and Extraterritorial Income
Exclusion Act of 2000, Public Law 106-519, and the provision of section 412 of
the Job Creation and Worker Assistance Act of 2002, Public Law 107-147, shall
become effective at the time it became effective for federal purposes.
The Internal Revenue Code of 1986, as amended through December
31, 1999, shall be in effect for taxable years beginning after December 31,
1999. The provisions of sections 306
and 401 of the Consolidated Appropriation Act of 2001, Public Law 106-554, and
the provision of section 632(b)(2)(A) of the Economic Growth and Tax Relief
Reconciliation Act of 2001, Public Law 107-16, and provisions of sections 101
and 402 of the Job Creation and Worker Assistance Act of 2002, Public Law
107-147, shall become effective at the same time it became effective for
federal purposes.
The Internal Revenue Code of 1986, as amended through December
31, 2000, shall be in effect for taxable years beginning after December 31,
2000. The provisions of sections 659a
and 671 of the Economic Growth and Tax Relief Reconciliation Act of 2001,
Public Law 107-16, the provisions of sections 104, 105, and 111 of the Victims
of Terrorism Tax Relief Act of 2001, Public Law 107-134, and the provisions of
sections 201, 403, 413, and 606 of the Job Creation and Worker Assistance Act
of 2002, Public Law 107-147, shall become effective at the same time it became
effective for federal purposes.
The Internal Revenue Code of 1986, as amended through March 15,
2002, shall be in effect for taxable years beginning after December 31, 2001.
The provisions of sections 101 and 102 of the Victims of
Terrorism Tax Relief Act of 2001, Public Law 107-134, shall become effective at
the same time it becomes effective for federal purposes.
The Internal Revenue Code of 1986, as amended through June 15,
2003, shall be in effect for taxable years beginning after December 31,
2002. The provisions of section 201 of
the Jobs and Growth Tax Relief and Reconciliation Act of 2003, H.R. 2, if it is
enacted into law, are effective at the same time it became effective for
federal purposes.
Section 1201 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, codified as section 223 of the
Internal Revenue Code, as amended, relating to health savings accounts, is
effective at the same time it became effective for federal purposes.
Except as otherwise provided, references to the Internal
Revenue Code in subdivisions 19a to 19g mean the code in effect for purposes of
determining net income for the applicable year.
Sec. 6. Minnesota
Statutes 2003 Supplement, section 290.01, subdivision 31, is amended to read:
Subd. 31. [INTERNAL
REVENUE CODE.] Unless specifically defined otherwise, "Internal Revenue
Code" means the Internal Revenue Code of 1986, as amended through June 15,
2003, and as amended by section 1201 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, codified as section 223 of the
Internal Revenue Code, as amended, relating to health savings accounts.
ARTICLE
2
HEALTH
CARE COST CONTAINMENT; BEST PRACTICES
Section 1. [62J.43]
[BEST PRACTICES AND QUALITY IMPROVEMENT.]
(a) To improve quality and reduce health care costs, state
agencies shall encourage the adoption of best practice guidelines and
participation in best practices measurement activities by physicians, other
health care providers, universities and colleges, health care purchasers, and
health plan companies. The commissioner
of health shall facilitate access to best practice guidelines and quality of
care measurement information for providers, purchasers, and consumers by:
(1) identifying and promoting local, community-based,
physician-designed best practices care across the Minnesota health care system;
(2) disseminating information on adherence to best practices
care by physicians and other health care providers in Minnesota; and
(3) educating consumers and purchasers on how to effectively
use this information in choosing their health care providers and making
purchasing decisions.
(b) The commissioner of health shall collaborate with a
nonprofit Minnesota quality improvement organization specializing in best
practices and quality of care measurements to provide best practices criteria.
(c) The initial best practices and quality of care
measurement criteria developed shall address diabetes and congestive heart
failure.
(d) The commissioners of human services and employee
relations may use the best practices guidelines to assist them in developing
contracting strategies that are appropriate for the populations they
serve. The commissioners shall report
to the legislature by January 1, 2006, on agency use of best practices
guidelines.
(e) This section does not apply if the best practices
guidelines authorizes or recommends denial of treatment, food, or fluids
necessary to sustain life on the basis of the patient's age or expected length
of life or the patient's present or predicted disability, degree of medical
dependency, or quality of life.
Sec. 2. Minnesota Statutes 2003 Supplement, section 144.7063, subdivision
3, is amended to read:
Subd. 3. [FACILITY.]
"Facility" means a hospital licensed under sections 144.50 to 144.58 or
an outpatient surgical center licensed under Minnesota Rules, chapter 4675.
Sec. 3. [256B.075]
[DISEASE MANAGEMENT PROGRAMS.]
Subdivision 1.
[GENERAL.] The commissioner shall implement disease management
initiatives that seek to improve patient care and health outcomes and reduce
health care costs by managing the care provided to recipients with chronic
conditions.
Subd. 2.
[FEE-FOR-SERVICE.] (a) The commissioner shall develop and implement a
disease management program for medical assistance and general assistance
medical care recipients who are not enrolled in the prepaid medical assistance
or prepaid general assistance medical care programs and who are receiving
services on a fee-for-service basis.
The commissioner may contract with an outside organization to provide
these services.
(b) The commissioner shall seek any federal approval
necessary to implement this section and to obtain federal matching funds.
Subd. 3.
[PREPAID MANAGED CARE PROGRAMS.] For the prepaid medical assistance,
prepaid general assistance medical care, and MinnesotaCare programs, the
commissioner shall ensure that contracting health plans implement disease
management programs that are appropriate for Minnesota health care program
recipients and have been designed by the health plan to improve patient care
and health outcomes and reduce health care costs by managing the care provided
to recipients with chronic conditions.
Subd. 4.
[HEMOPHILIA.] The commissioner shall develop a disease management
initiative for Minnesota health care program recipients who have been diagnosed
with hemophilia. In developing the
program, the commissioner shall explore the feasibility of contracting with a
section 340B provider to provide disease management services or coordination of
care in order to maximize the discounted prescription drug prices of the
federal 340B program offered through section 340B of the federal Public Health
Services Act, United States Code, title 42, section 256b (1999).
ARTICLE
3
HEALTH
CARE COST CONTAINMENT; COST-SHIFTING
Section 1. Minnesota
Statutes 2002, section 16A.10, is amended by adding a subdivision to read:
Subd. 4. [LIMIT
ON STATE HEALTH CARE PROGRAM EXPANSION.] No budget proposal shall include
any provision that requests new or increased funding for an expansion of
eligibility or covered services for a state health care program, unless state
health care program reimbursement rates for major service categories, at the
time the expansion is to take effect, will be sufficient to cover estimated
provider costs for each major service category. For purposes of this section, "state health care
program" means the medical assistance, MinnesotaCare, and general
assistance medical care programs.
Sec. 2. [STUDY OF
COST-SHIFTING.]
(a) The commissioner of health shall evaluate the extent to
which state health care program reimbursement rates result in health care
provider cost-shifting to private sector payers and individuals paying for
services out-of-pocket. In conducting
the evaluation, the commissioner shall:
(1) examine the extent to which
average state health care program reimbursement rates for major categories of
services vary from average private sector reimbursement rates;
(2) examine the extent to which average state health care
program reimbursement rates for major categories of services cover average
provider costs;
(3) estimate the amount by which average state health care
program reimbursement rates for major categories of services would need to be
increased to match average private sector reimbursement rates and to cover
average provider costs; and
(4) present recommendations to the legislature on methods of
increasing average state health care program reimbursement rates for major
categories of services, over a six-year period, to the average private sector
reimbursement rate and to a level that covers average provider costs.
(b) The commissioner shall present results and
recommendations to the legislature by December 15, 2004. The commissioner may contract with an
actuarial consulting firm to implement this section. Payment and reimbursement data collected by the commissioner in
the course of implementing this section shall be classified as not public data
under Minnesota Statutes, chapter 13, except that data shall be classified as
public data not on individuals if the information collected was already
accessible to the public under the policies of the private sector entity
providing the data. For purposes of
this section, "state health care program" means the medical
assistance, MinnesotaCare, and general assistance medical care programs.
ARTICLE
4
HEALTH
CARE COST CONTAINMENT; REDUCING GOVERNMENT MANDATES
Section 1. Minnesota
Statutes 2003 Supplement, section 62J.26, is amended by adding a subdivision to
read:
Subd. 6.
[MANDATED BENEFITS MORATORIUM.] (a) No new mandated health benefit
proposal, as defined in subdivision 1, shall be enacted.
(b) This subdivision expires January 1, 2007.
Sec. 2. [62L.056]
[SMALL EMPLOYER ALTERNATIVE BENEFIT PLANS.]
(a) Notwithstanding any provision of this chapter, chapter
363A, or any other law to the contrary, the commissioner of commerce shall by
January 1, 2005, permit health carriers to offer alternative health benefit
plans to small employers if the following requirements are satisfied:
(1) the health carrier is assessed less than ten percent of
the total amount assessed by the Minnesota Comprehensive Health Association;
(2) the health plans must be offered in compliance with this
chapter, except as otherwise permitted in this section;
(3) the health plans to be offered must be designed to
enable employers and covered persons to better manage costs and coverage
options through the use of co-pays, deductibles, and other cost-sharing
arrangements;
(4) the health plans must be issued and administered in
compliance with sections 62E.141; 62L.03, subdivision 6; and 62L.12,
subdivisions 3 and 4, relating to prohibitions against enrolling in the
Minnesota Comprehensive Health Association persons eligible for employer group
coverage;
(5) loss-ratio requirements do not
apply to health plans issued under this section;
(6) the health plans may alter or eliminate coverages that
would otherwise be required by law, except for maternity coverage as required
under federal law;
(7) each health plan must be approved by the commissioner of
commerce; and
(8) the commissioner may limit the types and numbers of
health plan forms permitted under this section, but must permit, as one option,
a health plan form in which a health carrier may exclude or alter coverage of
any or all benefits otherwise mandated by state law, except for maternity
coverage as required under federal law.
(b) The definitions in section 62L.02 apply to this section
as modified by this section.
(c) An employer may provide health plans permitted under
this section to its employees, the employees' dependents, and other persons
eligible for coverage under the employer's plan, notwithstanding chapter 363A
or any other law to the contrary.
Sec. 3. [REPEALER; BONE
MARROW TRANSPLANT MANDATE.]
Minnesota Statutes 2002, section 62A.309, is repealed.
ARTICLE
5
HEALTH
CARE COST CONTAINMENT;
HEALTH
PLAN COMPETITION AND REFORM
Section 1. Minnesota
Statutes 2002, section 62A.02, subdivision 2, is amended to read:
Subd. 2. [APPROVAL.]
(a) The health plan form shall not be issued, nor shall any application, rider,
endorsement, or rate be used in connection with it, until the expiration of 60
days after it has been filed unless the commissioner approves it before that
time.
(b) Notwithstanding paragraph (a), a health plan form or a
rate, filed with respect to a policy of accident and sickness insurance
as defined in section 62A.01 by an insurer licensed under chapter 60A, may be
used on or after the date of filing with the commissioner. Health plan forms and rates that are
not approved or disapproved within the 60-day time period are deemed
approved. This paragraph does not apply
to Medicare-related coverage as defined in section 62A.31, subdivision 3,
paragraph (q).
Sec. 2. Minnesota
Statutes 2002, section 62D.02, subdivision 4, is amended to read:
Subd. 4. [HEALTH
MAINTENANCE ORGANIZATION.] (a) "Health maintenance organization"
means a nonprofit corporation organized under chapter 317A, or person,
including a local governmental unit as defined in subdivision 11,
controlled and operated as provided in sections 62D.01 to 62D.30, which
provides, either directly or through arrangements with providers or other
persons, comprehensive health maintenance services, or arranges for the
provision of these services, to enrollees on the basis of a fixed prepaid sum
without regard to the frequency or extent of services furnished to any
particular enrollee.
Sec. 3. Minnesota Statutes 2002, section 62D.02, is amended by adding a
subdivision to read:
Subd. 17.
[PERSON.] "Person" means a natural or artificial person,
including, but not limited to, individuals, partnerships, limited liability
companies, associations, trusts, corporations, other business entities, or
governmental entities.
Sec. 4. Minnesota
Statutes 2002, section 62D.03, subdivision 1, is amended to read:
Subdivision 1.
[CERTIFICATE OF AUTHORITY REQUIRED.] Notwithstanding any law of this
state to the contrary, any nonprofit corporation organized to do so or a
local governmental unit person may apply to the commissioner of
health for a certificate of authority to establish and operate a health
maintenance organization in compliance with sections 62D.01 to 62D.30. No person shall establish or operate a
health maintenance organization in this state, nor sell or offer to sell, or
solicit offers to purchase or receive advance or periodic consideration in
conjunction with a health maintenance organization or health maintenance
contract unless the organization has a certificate of authority under sections
62D.01 to 62D.30. An out-of-state
corporation may qualify under this chapter, subject to obtaining a certificate
of authority to do business in this state, as an out-of-state corporation under
chapter 303 and compliance with this chapter and other applicable state laws.
Sec. 5. Minnesota
Statutes 2002, section 62D.04, subdivision 1, is amended to read:
Subdivision 1.
[APPLICATION REVIEW.] Upon receipt of an application for a certificate
of authority, the commissioner of health shall determine whether the applicant
for a certificate of authority has:
(a) demonstrated the willingness and potential ability to
assure that health care services will be provided in such a manner as to
enhance and assure both the availability and accessibility of adequate
personnel and facilities;
(b) arrangements for an ongoing evaluation of the quality of
health care;
(c) a procedure to develop, compile, evaluate, and report
statistics relating to the cost of its operations, the pattern of utilization
of its services, the quality, availability and accessibility of its services,
and such other matters as may be reasonably required by regulation of the
commissioner of health;
(d) reasonable provisions for emergency and out of area health
care services;
(e) demonstrated that it is financially responsible and may
reasonably be expected to meet its obligations to enrollees and prospective
enrollees. In making this
determination, the commissioner of health shall require the amounts of net
worth and working capital required in section 62D.042, the deposit required in
section 62D.041, and in addition shall consider:
(1) the financial soundness of its arrangements for health care
services and the proposed schedule of charges used in connection therewith;
(2) arrangements which will guarantee for a reasonable period
of time the continued availability or payment of the cost of health care
services in the event of discontinuance of the health maintenance organization;
and
(3) agreements with providers for the provision of health care
services;
(f) demonstrated that it will assume full financial risk on a
prospective basis for the provision of comprehensive health maintenance
services, including hospital care; provided, however, that the requirement in
this paragraph shall not prohibit the following:
(1) a health maintenance organization
from obtaining insurance or making other arrangements (i) for the cost of
providing to any enrollee comprehensive health maintenance services, the
aggregate value of which exceeds $5,000 in any year, (ii) for the cost of
providing comprehensive health care services to its members on a nonelective
emergency basis, or while they are outside the area served by the organization,
or (iii) for not more than 95 percent of the amount by which the health
maintenance organization's costs for any of its fiscal years exceed 105 percent
of its income for such fiscal years; and
(2) a health maintenance organization from having a provision
in a group health maintenance contract allowing an adjustment of premiums paid
based upon the actual health services utilization of the enrollees covered
under the contract, except that at no time during the life of the contract
shall the contract holder fully self-insure the financial risk of health care
services delivered under the contract.
Risk sharing arrangements shall be subject to the requirements of
sections 62D.01 to 62D.30;
(g) demonstrated that it has made provisions for and adopted a
conflict of interest policy applicable to all members of the board of directors
and the principal officers of the health maintenance organization. The conflict of interest policy shall
include the procedures described in section 317A.255, subdivisions 1 and 2,
or a substantially similar provision contained in the laws under which the
health maintenance organization is incorporated or otherwise organized. However, the commissioner is not precluded
from finding that a particular transaction is an unreasonable expense as
described in section 62D.19 even if the directors follow the required procedures;
and
(h) otherwise met the requirements of sections 62D.01 to
62D.30.
Sec. 6. Minnesota
Statutes 2002, section 62D.05, subdivision 1, is amended to read:
Subdivision 1.
[AUTHORITY GRANTED.] Any nonprofit corporation or local governmental
unit person may, upon obtaining a certificate of authority as
required in sections 62D.01 to 62D.30, operate as a health maintenance
organization.
Sec. 7. Minnesota
Statutes 2003 Supplement, section 62E.08, subdivision 1, is amended to read:
Subdivision 1.
[ESTABLISHMENT.] The association shall establish the following maximum
premiums to be charged for membership in the comprehensive health insurance
plan:
(a) the premium for the number one qualified plan shall range
from a minimum of 101 115 percent to a maximum of 125 135
percent of the weighted average of rates charged by those insurers and health
maintenance organizations with individuals enrolled in:
(1) $1,000 annual deductible individual plans of insurance in
force in Minnesota;
(2) individual health maintenance organization contracts of
coverage with a $1,000 annual deductible which are in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
(b) the premium for the number two qualified plan shall range
from a minimum of 101 115 percent to a maximum of 125 135
percent of the weighted average of rates charged by those insurers and health
maintenance organizations with individuals enrolled in:
(1) $500 annual deductible individual plans of insurance in
force in Minnesota;
(2) individual health maintenance organization contracts
of coverage with a $500 annual deductible which are in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
(c) the premiums for the plans with a $2,000, $5,000, or
$10,000 annual deductible shall range from a minimum of 101 115
percent to a maximum of 125 135 percent of the weighted average
of rates charged by those insurers and health maintenance organizations with
individuals enrolled in:
(1) $2,000, $5,000, or $10,000 annual deductible individual
plans, respectively, in force in Minnesota; and
(2) individual health maintenance organization contracts of
coverage with a $2,000, $5,000, or $10,000 annual deductible, respectively,
which are in force in Minnesota; or
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
(d) the premium for each type of Medicare supplement plan
required to be offered by the association pursuant to section 62E.12 shall
range from a minimum of 101 115 percent to a maximum of 125
135 percent of the weighted average of rates charged by those insurers
and health maintenance organizations with individuals enrolled in:
(1) Medicare supplement plans in force in Minnesota;
(2) health maintenance organization Medicare supplement
contracts of coverage which are in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles; and
(e) the charge for health maintenance organization coverage
shall be based on generally accepted actuarial principles.
The list of insurers and health maintenance organizations whose
rates are used to establish the premium for coverage offered by the association
pursuant to paragraphs (a) to (d) shall be established by the commissioner on
the basis of information which shall be provided to the association by all
insurers and health maintenance organizations annually at the commissioner's
request. This information shall include
the number of individuals covered by each type of plan or contract specified in
paragraphs (a) to (d) that is sold, issued, and renewed by the insurers and
health maintenance organizations, including those plans or contracts available
only on a renewal basis. The
information shall also include the rates charged for each type of plan or
contract.
In establishing premiums pursuant to this section, the
association shall utilize generally accepted actuarial principles, provided
that the association shall not discriminate in charging premiums based upon
sex. In order to compute a weighted
average for each type of plan or contract specified under paragraphs (a) to
(d), the association shall, using the information collected pursuant to this
subdivision, list insurers and health maintenance organizations in rank order
of the total number of individuals covered by each insurer or health
maintenance organization. The
association shall then compute a weighted average of the rates charged for
coverage by all the insurers and health maintenance organizations by:
(1) multiplying the numbers of individuals covered by each
insurer or health maintenance organization by the rates charged for coverage;
(2) separately summing both the number of individuals
covered by all the insurers and health maintenance organizations and all the
products computed under clause (1); and
(3) dividing the total of the products computed under clause
(1) by the total number of individuals covered.
The association may elect to use a sample of information from
the insurers and health maintenance organizations for purposes of computing a
weighted average. In no case, however,
may a sample used by the association to compute a weighted average include
information from fewer than the two insurers or health maintenance organizations
highest in rank order.
Sec. 8. Minnesota
Statutes 2003 Supplement, section 62E.091, is amended to read:
62E.091 [APPROVAL OF STATE PLAN PREMIUMS.]
The association shall submit to the commissioner any premiums
it proposes to become effective for coverage under the comprehensive health
insurance plan, pursuant to section 62E.08, subdivision 3. No later than 45 days before the effective
date for premiums specified in section 62E.08, subdivision 3, the commissioner
shall approve, modify, or reject the proposed premiums on the basis of the
following criteria:
(a) whether the association has complied with the provisions of
section 62E.11, subdivision 11;
(b) whether the association has submitted the proposed premiums
in a manner which provides sufficient time for individuals covered under the
comprehensive insurance plan to receive notice of any premium increase no less
than 30 days prior to the effective date of the increase;
(c) the degree to which the association's computations and
conclusions are consistent with section 62E.08;
(d) the degree to which any sample used to compute a weighted
average by the association pursuant to section 62E.08 reasonably reflects
circumstances existing in the private marketplace for individual coverage;
(e) the degree to which a weighted average computed pursuant to
section 62E.08 that uses information pertaining to individual coverage
available only on a renewal basis reflects the circumstances existing in the
private marketplace for individual coverage;
(f) a comparison of the proposed increases with increases in
the cost of medical care and increases experienced in the private marketplace
for individual coverage;
(g) the financial consequences to enrollees of the proposed
increase;
(h) the actuarially projected effect of the proposed increase
upon both total enrollment in, and the nature of the risks assumed by, the
comprehensive health insurance plan;
(i) the relative solvency of the contributing members; and
(j) other factors deemed relevant by the commissioner.
In no case, however, may the commissioner approve premiums for
those plans of coverage described in section 62E.08, subdivision 1, paragraphs
(a) to (d), that are lower than conclusions addressing each
criterion specified in this section. If
the commissioner does not approve, modify, or reject the premiums proposed by
the association sooner than 45 days before the effective date for premiums
specified in section 62E.08, subdivision 3, the premiums proposed by the
association under this section become effective. 101 115 percent or greater than 125
135 percent of the weighted averages computed by the association
pursuant to section 62E.08. The
commissioner shall support a decision to approve, modify, or reject any premium
proposed by the association with written findings and
Sec. 9. [62Q.37]
[AUDITS CONDUCTED BY NATIONALLY RECOGNIZED INDEPENDENT ORGANIZATION.]
Subdivision 1.
[APPLICABILITY.] This section applies only to (i) a nonprofit health
service plan corporation operating under chapter 62C; (ii) a health maintenance
organization operating under chapter 62D; (iii) a community integrated service
network operating under chapter 62N; and (iv) managed care organizations
operating under chapter 256B, 256D, or 256L.
Subd. 2.
[DEFINITIONS.] For purposes of this section, the following terms have
the meanings given them.
(a) "Commissioner" means the commissioner of
health for purposes of regulating health maintenance organizations and
community integrated service networks, the commissioner of commerce for purposes
of regulating nonprofit health service plan corporations, or the commissioner
of human services for the purpose of contracting with managed care
organizations serving persons enrolled in programs under chapter 256B, 256D, or
256L.
(b) "Health plan company" means (i) a nonprofit
health service plan corporation operating under chapter 62C; (ii) a health
maintenance organization operating under chapter 62D; (iii) a community
integrated service network operating under chapter 62N; or (iv) a managed care
organization operating under chapter 256B, 256D, or 256L.
(c) "Nationally recognized independent
organization" means (i) an organization that sets specific national
standards governing health care quality assurance processes, utilization
review, provider credentialing, marketing, and other topics covered by this
chapter and other chapters and audits and provides accreditation to those
health plan companies that meet those standards. The American Accreditation Health Care Commission (URAC), the
National Committee for Quality Assurance (NCQA), and the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) are, at a minimum, defined as
nationally recognized independent organizations; and (ii) the Centers for
Medicare and Medicaid Services for purposes of reviews or audits conducted of
health plan companies under Part C of Title XVIII of the Social Security Act or
under section 1876 of the Social Security Act.
(d) "Performance standard" means those standards
relating to quality management and improvement, access and availability of
service, utilization review, provider selection, provider credentialing,
marketing, member rights and responsibilities, complaints, appeals, grievance
systems, enrollee information and materials, enrollment and disenrollment,
subcontractual relationships and delegation, confidentiality, continuity and
coordination of care, assurance of adequate capacity and services, coverage and
authorization of services, practice guidelines, health information systems, and
financial solvency.
Subd. 3.
[AUDITS.] (a) The commissioner may conduct routine audits and
investigations as prescribed under the commissioner's respective state
authorizing statutes. If a nationally
recognized independent organization has conducted an audit of the health plan
company using audit procedures that are comparable to or more stringent than
the commissioner's audit procedures:
(1) the commissioner may accept the independent audit and
require no further audit if the results of the independent audit show that the
performance standard being audited meets or exceeds state standards;
(2) the commissioner may accept the independent audit and
limit further auditing if the results of the independent audit show that the
performance standard being audited partially meets state standards;
(3) the health plan company must demonstrate to the
commissioner that the nationally recognized independent organization that
conducted the audit is qualified and that the results of the audit demonstrate
that the particular performance standard partially or fully meets state
standards; and
(4) if the commissioner has partially or fully accepted an
independent audit of the performance standard, the commissioner may use the
finding of a deficiency with regard to statutes or rules by an independent
audit as the basis for a targeted audit or enforcement action.
(b) If a health plan company has formally delegated
activities that are required under either state law or contract to another
organization that has undergone an audit by a nationally recognized independent
organization, that health plan company may use the nationally recognized
accrediting body's determination on its own behalf under this section.
Subd. 4.
[DISCLOSURE OF NATIONAL STANDARDS AND REPORTS.] The health plan
company shall:
(1) request that the nationally recognized independent
organization provide to the commissioner a copy of the current nationally
recognized independent organization's standards upon which the acceptable
accreditation status has been granted; and
(2) provide the commissioner a copy of the most current
final audit report issued by the nationally recognized independent
organization.
Subd. 5.
[ACCREDITATION NOT REQUIRED.] Nothing in this section requires a
health plan company to seek an acceptable accreditation status from a
nationally recognized independent organization.
Subd. 6.
[CONTINUED AUTHORITY.] Nothing in this section precludes the
commissioner from conducting audits and investigations or requesting data as granted
under the commissioner's respective state authorizing statutes.
Subd. 7. [HUMAN
SERVICES.] The commissioner of human services shall implement this section
in a manner that is consistent with applicable federal laws and regulations.
Subd. 8. [CONFIDENTIALITY.]
Any documents provided to the commissioner related to the audit report that
may be accepted under this section are private data on individuals pursuant to
chapter 13 and may only be released as permitted under section 60A.03,
subdivision 9.
Sec. 10. Minnesota
Statutes 2002, section 72A.20, is amended by adding a subdivision to read:
Subd. 37.
[ELECTRONIC TRANSMISSION OF REQUIRED INFORMATION.] A health carrier,
as defined in section 62A.011, subdivision 2, is not in violation of this
chapter for electronically transmitting or electronically making available
information otherwise required to be delivered in writing under chapters 62A to
62Q and 72A to an enrollee as defined in section 62Q.01, subdivision 2a, and
with the requirements of those chapters if the following conditions are met:
(1) the health carrier informs the enrollee that electronic
transmission or access is available and, at the discretion of the health
carrier, the enrollee is given one of the following options:
(i) electronic transmission or access will occur only if the
enrollee affirmatively requests to the health carrier that the required
information be electronically transmitted or available and a record of that
request is retained by the health carrier; or
(ii) electronic transmission or
access will automatically occur if the enrollee has not opted out of that
manner of transmission by request to the health carrier and requested that the
information be provided in writing. If
the enrollee opts out of electronic transmission, a record of that request must
be retained by the health carrier;
(2) the enrollee is allowed to withdraw the request at any
time;
(3) if the information transmitted electronically contains
individually identifiable data, it must be transmitted to a secured
mailbox. If the information made
available electronically contains individually identifiable data, it must be
made available at a password-protected secured Web site;
(4) the enrollee is provided a customer service number on the
enrollee's member card that may be called to request a written copy of the
document; and
(5) the electronic transmission or electronic availability
meets all other requirements of this chapter including, but not limited to,
size of the typeface and any required time frames for distribution.
Sec. 11. [CHANGE OF
HEALTH MAINTENANCE ORGANIZATION REGULATORY AUTHORITY.]
(a) Effective July 1, 2005, regulatory authority for health
maintenance organizations under Minnesota Statutes, chapter 62D; community
health clinics with respect to health care services prepaid option plans
offered under Minnesota Statutes, section 62Q.22; community integrated service
networks, as defined in Minnesota Statutes, section 62N.02, subdivision 4a;
health care cooperatives operating under Minnesota Statutes, chapter 62R;
health care purchasing alliances and accountable provider networks operating
under Minnesota Statutes, chapter 62T; and county-based purchasing programs
operating under Minnesota Statutes, section 256B.692, subdivision 2, is
transferred from the commissioner of health to the commissioner of commerce.
(b) Minnesota Statutes, section 15.039, applies to this
transfer of authority.
(c) The revisor of statutes shall make changes to conform to
paragraph (a) by changing references to the commissioner of health, Department
of Health, and similar references, to the commissioner of commerce, Department
of Commerce, or similar references, and by changing references to both
commissioners or both departments or "the appropriate commissioner"
or similar term to the commissioner or Department of Commerce, as appropriate
in Minnesota Statutes, sections 62A.021, subdivision 1, paragraph (h); 62D.02,
subdivision 3; 62D.12, subdivision 1; 62D.15, subdivision 1; 62D.24, by also
changing the existing reference to "commissioner of commerce" to read
"commissioner of health"; 62E.05, subdivision 2; 62E.11, subdivision
13; 62J.041, subdivision 4; 62J.701; 62J.74, subdivisions 1 and 2; 62L.02,
subdivision 8; 62L.05, subdivision 12; 62L.08, subdivisions 10 and 11; 62L.09,
subdivision 3; 62L.10, subdivision 4; 62L.11, subdivision 2; 62M.11; 62M.16;
62N.02, subdivision 4; 62N.26; 62Q.01, subdivision 2; 62Q.106; 62Q.22,
subdivisions 2, 6, and 7; 62Q.33, subdivision 2, by specifying that the
commissioner referenced in the last sentence is the commissioner of health;
62Q.49, subdivision 2; 62Q.51, subdivision 3; 62Q.525, subdivision 3; 62Q.69,
subdivisions 2 and 3; 62Q.71; 62Q.72; 62Q.73, subdivisions 3, 4, 5, and 6;
62R.04, subdivision 5; 62R.06, subdivision 1; 62T.01; 256B.692, subdivisions 2
and 7. The revisor of statutes shall,
in preparing Minnesota Statutes 2004, make all conforming changes in Minnesota
Statutes, chapter 62D, and other chapters.
ARTICLE
6
HEALTH
CARE COST CONTAINMENT; ADMINISTRATIVE SIMPLIFICATION
Section 1. Minnesota
Statutes 2002, section 147.03, subdivision 1, is amended to read:
Subdivision 1.
[ENDORSEMENT; RECIPROCITY.] (a) The board may issue a license to
practice medicine to any person who satisfies the requirements in paragraphs
(b) to (f).
(b) The applicant shall satisfy all
the requirements established in section 147.02, subdivision 1, paragraphs (a),
(b), (d), (e), and (f).
(c) The applicant shall:
(1) have passed an examination prepared and graded by the
Federation of State Medical Boards, the National Board of Medical Examiners, or
the United States Medical Licensing Examination program in accordance with
section 147.02, subdivision 1, paragraph (c), clause (2); the National Board of
Osteopathic Examiners; or the Medical Council of Canada; and
(2) have a current license from the equivalent licensing agency
in another state or Canada and, if the examination in clause (1) was passed
more than ten years ago, either:
(i) pass the Special Purpose Examination of the Federation of
State Medical Boards with a score of 75 or better within three attempts; or
(ii) have a current certification by a specialty board of the
American Board of Medical Specialties, of the American Osteopathic Association
Bureau of Professional Education, or of the Royal College of Physicians and
Surgeons of Canada.
(d) The applicant shall pay a fee established by the board by
rule. The fee may not be refunded.
(e) The applicant must not be under license suspension or
revocation by the licensing board of the state or jurisdiction in which the
conduct that caused the suspension or revocation occurred.
(f) The applicant must not have engaged in conduct warranting
disciplinary action against a licensee, or have been subject to disciplinary
action other than as specified in paragraph (e). If an applicant does not satisfy the requirements stated in this
paragraph, the board may issue a license only on the applicant's showing that
the public will be protected through issuance of a license with conditions or
limitations the board considers appropriate.
(g) Upon the request of an applicant, the board may conduct
the final interview of the applicant by teleconference.
Sec. 2. Minnesota
Statutes 2002, section 256B.04, is amended by adding a subdivision to read:
Subd. 20.
[INFORMATION WEB SITE FOR INTERPRETER SERVICES.] The commissioner
shall establish an information Web site to assist health care providers in
obtaining oral language interpreter services when these services are needed to
enable a patient to obtain a health care service from a provider. The commissioner must collect and maintain
contact and rate information for providers of oral language interpreter services
and must make this information available to all health care providers, whether
or not the provider is enrolled in a state health care program. The Web site list is not an endorsement by
the commissioner of any particular interpreter.
Sec. 3. [COST OF HEALTH
CARE REPORTING.]
The commissioners of human services, health, and commerce
shall meet with representatives of health plan companies as defined in
Minnesota Statutes, section 62Q.01, subdivision 4, and hospitals to evaluate
reporting requirements for these regulated entities and develop recommendations
for reducing required reports. The
commissioner must meet with the specified representatives prior to August 30,
2004, and must submit a consolidated report to the legislature by January 15,
2005. The report must:
(1) identify the name and scope of each required report;
(2) evaluate the need for and use
of each report, including the value of the report to consumers;
(3) evaluate the extent to which the report is used to
reduce costs and increase quality of care;
(4) identify reports that are no longer required; and
(5) specify any statutory changes necessary to eliminate
required reports.
Sec. 4. [REPEALER.]
Minnesota Statutes 2002, section 62J.17, subdivisions 1, 3,
4a, 5a, 6a, 7, and 8; and Minnesota Statutes 2003 Supplement, section 62J.17,
subdivision 2, are repealed effective the day following final enactment.
ARTICLE
7
CHILD
CARE
Section 1. Minnesota
Statutes 2003 Supplement, section 119B.09, subdivision 9, is amended to read:
Subd. 9. [LICENSED AND
LEGAL NONLICENSED FAMILY CHILD CARE PROVIDERS; ASSISTANCE.] Licensed and legal
nonlicensed family child care providers are not eligible to receive child care
assistance subsidies under this chapter for their own children or children in
their custody family during the hours they are providing child care
or being paid to provide child care.
Child care providers are eligible to receive child care assistance
subsidies for their own children when they are engaged in other work activities
that meet the requirements of this chapter and for which child care assistance
can be paid. The hours for which the
child care provider receives a child care subsidy for their own children must
not overlap with the hours the provider provides child care services.
Sec. 2. Minnesota
Statutes 2003 Supplement, section 119B.13, subdivision 1, is amended to read:
Subdivision 1. [SUBSIDY
RESTRICTIONS.] (a) The maximum rate paid for child care assistance under
the child care fund may not exceed the 75th percentile rate for like-care
arrangements in the county as surveyed by the commissioner.
(b) A rate which includes a provider bonus paid under
subdivision 2 or a special needs rate paid under subdivision 3 may be in
excess of the maximum rate allowed under this subdivision.
(c) The department shall monitor the effect of this
paragraph on provider rates. The county
shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall
determine the maximum rate for each type of care on an hourly, full-day, and
weekly basis, including special needs and handicapped care. Not less than once every two years, the
commissioner shall evaluate market practices for payment of absences and shall
establish policies for payment of absent days that reflect current market
practice.
(d) When the provider charge is greater than the maximum
provider rate allowed, the parent is responsible for payment of the difference
in the rates in addition to any family co-payment fee.
Sec. 3. Minnesota
Statutes 2002, section 119B.13, is amended by adding a subdivision to read:
Subd. 7. [ABSENT
DAYS.] Child care providers may not be reimbursed for more than 25 absent
days per child in a 12-month period, or for more than ten consecutive absent
days, unless the child has a documented medical condition that causes more
frequent absences. Documentation of
medical conditions must be on the forms and submitted according to the
timelines established by the commissioner.
[EFFECTIVE DATE.] This
section is effective July 1, 2004.
Sec. 4. Minnesota Statutes 2003 Supplement, section 245A.10, subdivision
4, is amended to read:
Subd. 4. [ANNUAL
LICENSE OR CERTIFICATION FEE FOR PROGRAMS WITH LICENSED CAPACITY.] (a) Child
care centers and programs with a licensed capacity shall pay an annual
nonrefundable license or certification fee based on the following schedule:
Licensed Capacity
Child Care
Other
Center
Program
License Fee
License Fee
1 to 24 persons
$300 $225 $400
25 to 49 persons
$450 $340 $600
50 to 74 persons
$600 $450 $800
75 to 99 persons
$750 $565 $1,000
100 to 124 persons
$900 $675 $1,200
125 to 149 persons
$1,200 $900 $1,400
150 to 174 persons
$1,400 $1,050 $1,600
175 to 199 persons
$1,600 $1,200 $1,800
200 to 224 persons
$1,800 $1,350 $2,000
225 or more persons
$2,000 $1,500 $2,500
(b) A day training and habilitation program serving persons
with developmental disabilities or related conditions shall be assessed a
license fee based on the schedule in paragraph (a) unless the license holder
serves more than 50 percent of the same persons at two or more locations in the
community. When a day training and
habilitation program serves more than 50 percent of the same persons in two or
more locations in a community, the day training and habilitation program shall
pay a license fee based on the licensed capacity of the largest facility and
the other facility or facilities shall be charged a license fee based on a
licensed capacity of a residential program serving one to 24 persons.
Sec. 5. Laws 2003,
First Special Session chapter 14, article 9, section 34, is amended to read:
Sec. 34. [DIRECTION TO
COMMISSIONER; PROVIDER RATES.]
The provider rates determined under Minnesota Statutes, section
119B.13, for fiscal year 2003 and implemented on July 1, 2002, are to be
continued in effect through June 30, 2005 2007. Counties shall not reduce any child care
center's reimbursement rate below the rate implemented on July 1, 2002. The commissioner of human services is
directed to evaluate the costs of child care in Minnesota, to examine the
differences in the cost of child care in rural and metropolitan areas, and to
make recommendations to the legislature for containing future cost increases in
the child care program under Minnesota Statutes, chapter 119B, in a manner that
complies with federal child care and development block grant requirements for
promoting parental choice and permits the department to track the effect of rate
changes on child care assistance program costs, the availability of different
types of care throughout the state, the length of waiting lists, and the care
options available to program participants.
The commissioner shall also examine the allocation formula under
Minnesota Statutes, section 119B.03, and make recommendations to the
legislature in order to create a more equitable formula. The commissioner shall consider the impact
any recommendations might have on work incentives for low and middle income families
and possible changes to MFIP child care, basic sliding fee child care, and the
dependent care tax credit. The
commissioner shall make recommendations to the legislature by January 15, 2005.
The commissioner shall also study the relationship between
child care assistance subsidies and tax credits or tax incentives related to
child care expenses, and include this information in the January 15, 2005,
report to the legislature under this section.
Sec. 6. [TEMPORARY INELIGIBILITY OF MILITARY PERSONNEL.]
Counties must reserve a family's position under the child
care assistance fund if a family has been receiving child care assistance but
is temporarily ineligible for assistance due to increased income from active
military service. Activated military
personnel may be temporarily ineligible until deactivated. A county must reserve a military family's
position on the basic sliding fee waiting list under the child care assistance
fund if a family is approved to receive child care assistance and reaches the
top of the waiting list but is temporarily ineligible for assistance.
ARTICLE
8
ECONOMIC
SUPPORTS
Section 1. Minnesota
Statutes 2002, section 256D.051, subdivision 1a, is amended to read:
Subd. 1a. [NOTICES AND
SANCTIONS.] (a) At the time the county agency notifies the household that it is
eligible for food stamps, the county agency must inform all mandatory
employment and training services participants as identified in subdivision 1 in
the household that they must comply with all food stamp employment and training
program requirements each month, including the requirement to attend an initial
orientation to the food stamp employment and training program and that food
stamp eligibility will end unless the participants comply with the requirements
specified in the notice.
(b) A participant who fails without good cause to comply with
food stamp employment and training program requirements of this section,
including attendance at orientation, will lose food stamp eligibility for the
following periods:
(1) for the first occurrence, for one month or until the person
complies with the requirements not previously complied with, whichever is
longer;
(2) for the second occurrence, for three months or until the
person complies with the requirements not previously complied with, whichever
is longer; or
(3) for the third and any subsequent occurrence, for six months
or until the person complies with the requirements not previously complied
with, whichever is longer.
If the participant is not the food stamp head of household, the
person shall be considered an ineligible household member for food stamp
purposes. If the participant is the
food stamp head of household, the entire household is ineligible for food
stamps as provided in Code of Federal Regulations, title 7, section
273.7(g). "Good cause" means
circumstances beyond the control of the participant, such as illness or injury,
illness or injury of another household member requiring the participant's
presence, a household emergency, or the inability to obtain child care for
children between the ages of six and 12 or to obtain transportation needed in
order for the participant to meet the food stamp employment and training
program participation requirements.
(c) The county agency shall mail or hand deliver a notice to
the participant not later than five days after determining that the participant
has failed without good cause to comply with food stamp employment and training
program requirements which specifies the requirements that were not complied
with, the factual basis for the determination of noncompliance, and the right
to reinstate eligibility upon a showing of good cause for failure to meet the
requirements. The notice must ask the
reason for the noncompliance and identify the participant's appeal rights. The notice must request that the participant
inform the county agency if the participant believes that good cause existed
for the failure to comply and must state that the county agency intends to
terminate eligibility for food stamp benefits due to failure to comply with
food stamp employment and training program requirements.
(d) If the county agency determines that the participant
did not comply during the month with all food stamp employment and training
program requirements that were in effect, and if the county agency determines
that good cause was not present, the county must provide a ten-day notice of
termination of food stamp benefits. The
amount of food stamps that are withheld from the household and determination of
the impact of the sanction on other household members is governed by Code of
Federal Regulations, title 7, section 273.7.
(e) A participant in the diversionary work program with
children under age six may be required to participate in employment services
under this section, but is not subject to sanction.
(f) The participant may appeal the termination of food
stamp benefits under the provisions of section 256.045.
Sec. 2. Minnesota
Statutes 2002, section 256D.051, subdivision 3a, is amended to read:
Subd. 3a. [PERSONS
REQUIRED TO REGISTER FOR AND PARTICIPATE IN THE FOOD STAMP EMPLOYMENT AND
TRAINING PROGRAM.] (a) To the extent required under Code of Federal
Regulations, title 7, section 273.7(a), each applicant for and recipient of
food stamps is required to register for work as a condition of eligibility for
food stamp benefits. Applicants and
recipients are registered by signing an application or annual reapplication for
food stamps, and must be informed that they are registering for work by signing
the form.
(b) The commissioner shall determine, within federal
requirements, persons required to participate in the food stamp employment and
training (FSET) program.
(c) The following food stamp recipients are exempt from
mandatory participation in food stamp employment and training services:
(1) recipients of benefits under the Minnesota family
investment program, Minnesota supplemental aid program, or the general
assistance program;
(2) a child;
(3) a recipient over age 55 49;
(4) a recipient who has a mental or physical illness, injury,
or incapacity which is expected to continue for at least 30 days and which
impairs the recipient's ability to obtain or retain employment as evidenced by
professional certification or the receipt of temporary or permanent disability
benefits issued by a private or government source;
(5) a parent or other household member responsible for the care
of either a dependent child in the household who is under age six, unless
the parent or other household member is a participant in the diversionary work
program, or a person in the household who is professionally certified as
having a physical or mental illness, injury, or incapacity. Only one parent or other household member
may claim exemption under this provision;
(6) a recipient receiving unemployment compensation or who has
applied for unemployment compensation and has been required to register for
work with the Department of Economic Security as part of the unemployment
compensation application process;
(7) a recipient participating each week in a drug addiction or
alcohol abuse treatment and rehabilitation program, provided the operators of
the treatment and rehabilitation program, in consultation with the county
agency, recommend that the recipient not participate in the food stamp
employment and training program;
(8) a recipient employed or self-employed for 30 or more
hours per week at employment paying at least minimum wage, or who earns wages
from employment equal to or exceeding 30 hours multiplied by the federal
minimum wage; or
(9) a student enrolled at least half time in any school,
training program, or institution of higher education. When determining if a student meets this criteria, the school's,
program's or institution's criteria for being enrolled half time shall be used;
and
(10) a participant in the diversionary work program who
meets the requirements in section 256J.95, subdivision 11, paragraph (d).
Sec. 3. Minnesota
Statutes 2002, section 256D.051, subdivision 6c, is amended to read:
Subd. 6c. [PROGRAM
FUNDING.] Within the limits of available resources, the commissioner shall
reimburse the actual costs of county agencies and their employment and training
service providers for the provision of food stamp employment and training
services, including participant support services, direct program services, and
program administrative activities. The
cost of services for each county's food stamp employment and training program
shall not exceed an average of $400 per participant the annual
allocated amount. No more than 15
percent of program funds may be used for administrative activities. The county agency may expend county funds in
excess of the limits of this subdivision without state reimbursement.
Program funds shall be allocated based on the county's average
number of food stamp cases as compared to the statewide total number of such
cases. The average number of cases
shall be based on counts of cases as of March 31, June 30, September 30, and
December 31 of the previous calendar year.
The commissioner may reallocate unexpended money appropriated under this
section to those county agencies that demonstrate a need for additional funds.
Sec. 4. Minnesota
Statutes 2003 Supplement, section 256J.24, subdivision 6, is amended to read:
Subd. 6. [FAMILY CAP.]
(a) MFIP assistance units shall not receive an increase in the cash portion of
the transitional standard as a result of the birth of a child, unless one of
the conditions under paragraph (b) is met.
The child shall be considered a member of the assistance unit according
to subdivisions 1 to 3, but shall be excluded in determining family size for
purposes of determining the amount of the cash portion of the transitional
standard under subdivision 5. The child
shall be included in determining family size for purposes of determining the
food portion of the transitional standard.
The transitional standard under this subdivision shall be the total of
the cash and food portions as specified in this paragraph. The family wage level under this subdivision
shall be based on the family size used to determine the food portion of the
transitional standard.
(b) A child shall be included in determining family size for
purposes of determining the amount of the cash portion of the MFIP transitional
standard when at least one of the following conditions is met:
(1) for families receiving MFIP assistance on July 1, 2003, the
child is born to the adult parent before May 1, 2004;
(2) for families who apply for the diversionary work program
under section 256J.95 or MFIP assistance on or after July 1, 2003, the child is
born to the adult parent within ten months of the date the family is eligible
for assistance;
(3) the child was conceived as a result of a sexual assault or
incest, provided that the incident has been reported to a law enforcement
agency;
(4) the child's mother is a minor caregiver as defined in
section 256J.08, subdivision 59, and the child, or multiple children, are the
mother's first birth; or
(5) any child previously excluded in determining family size
under paragraph (a) shall be included if the adult parent or parents have not
received benefits from the diversionary work program under section 256J.95 or
MFIP assistance in the previous ten months.
An adult parent or parents who reapply and have received benefits from
the diversionary work program or MFIP assistance in the past ten months shall
be under the ten-month grace period of their previous application under clause
(2).
(c) Income and resources of a child excluded under this
subdivision, except income of the child support received or
distributed on behalf of this child equal to the change in cash standard
due to the family cap, must be considered using the same policies as for other
children when determining the grant amount of the assistance unit.
(d) The caregiver must assign support and cooperate with the
child support enforcement agency to establish paternity and collect child
support on behalf of the excluded child.
Failure to cooperate results in the sanction specified in section
256J.46, subdivisions 2 and 2a. Current
support paid on behalf of the excluded child shall be distributed according to
section 256.741, subdivision 15.
(e) County agencies must inform applicants of the provisions
under this subdivision at the time of each application and at recertification.
(f) Children excluded under this provision shall be deemed MFIP
recipients for purposes of child care under chapter 119B.
Sec. 5. Minnesota
Statutes 2003 Supplement, section 256J.37, subdivision 3a, is amended to read:
Subd. 3a. [RENTAL
SUBSIDIES; UNEARNED INCOME.] (a) Effective July 1, 2003, The county
agency shall count $50 $200 of the value of public and assisted
rental subsidies provided through the Department of Housing and Urban
Development (HUD) as unearned income to the cash portion of the MFIP
grant. The full amount of the subsidy
must be counted as unearned income when the subsidy is less than $50 $200. The income from this subsidy shall be
budgeted according to section 256J.34.
(b) The provisions of this subdivision shall not apply to an
MFIP assistance unit which includes a participant who is:
(1) age 60 or older;
(2) a caregiver who is suffering from an illness, injury, or incapacity
that has been certified by a qualified professional when the illness, injury,
or incapacity is expected to continue for more than 30 days and prevents the
person from obtaining or retaining employment; or
(3) a caregiver whose presence in the home is required due to
the illness or incapacity of another member in the assistance unit, a relative
in the household, or a foster child in the household when the illness or
incapacity and the need for the participant's presence in the home has been certified
by a qualified professional and is expected to continue for more than 30 days.
(c) The provisions of this subdivision shall not apply to an
MFIP assistance unit where the parental relative caregiver is an
SSI recipient.
(d) Prior to implementing this provision, the commissioner must
identify the MFIP participants subject to this provision and provide written
notice to these participants at least 30 days before the first grant
reduction. The notice must inform the
participant of the basis for the potential grant reduction, the exceptions to
the provision, if any, and inform the participant of the
steps necessary to claim an exception.
A person who is found not to meet one of the exceptions to the provision
must be notified and informed of the right to a fair hearing under section
256J.40. The notice must also inform
the participant that the participant may be eligible for a rent reduction
resulting from a reduction in the MFIP grant and encourage the participant to
contact the local housing authority.
Sec. 6. Minnesota
Statutes 2003 Supplement, section 256J.53, subdivision 1, is amended to read:
Subdivision 1. [LENGTH
OF PROGRAM.] In order for a postsecondary education or training program to be
an approved work activity as defined in section 256J.49, subdivision 13, clause
(6), it must be a program lasting 24 12 months or less, and the
participant must meet the requirements of subdivisions 2, 3, and 5.
ARTICLE
9
HEALTH
CARE
Section 1. Minnesota
Statutes 2003 Supplement, section 256.955, subdivision 2a, is amended to read:
Subd. 2a.
[ELIGIBILITY.] An individual satisfying the following requirements and
the requirements described in subdivision 2, paragraph (d), is eligible for the
prescription drug program who:
(1) is at least 65 years of age or older; and
(2) is eligible as a qualified Medicare beneficiary according
to section 256B.057, subdivision 3 or 3a, or is eligible under section
256B.057, subdivision 3 or 3a, and is also eligible for medical assistance or
general assistance medical care with a spenddown as defined in section
256B.056, subdivision 5; and
(3) applies for the Medicare drug discount card, if eligible.
[EFFECTIVE DATE.] Clause
(3) is effective July 1, 2004, or when enrollment for the Medicare drug discount
card is available, whichever is later.
Sec. 2. Minnesota
Statutes 2002, section 256.955, subdivision 2b, is amended to read:
Subd. 2b.
[ELIGIBILITY.] Effective July 1, 2002, an individual satisfying the
following requirements and the requirements described in subdivision 2,
paragraph (d), is eligible for the prescription drug program:
(1) is under 65 years of age; and
(2) is eligible as a qualified Medicare beneficiary according
to section 256B.057, subdivision 3 or 3a or is eligible under section 256B.057,
subdivision 3 or 3a and is also eligible for medical assistance or general
assistance medical care with a spenddown as defined in section 256B.056,
subdivision 5; and
(3) applies for the Medicare drug discount card, if eligible.
[EFFECTIVE DATE.] Clause
(3) is effective July 1, 2004, or when enrollment for the Medicare drug
discount card is available, whichever is later.
Sec. 3. Minnesota
Statutes 2003 Supplement, section 256.955, subdivision 3, is amended to read:
Subd. 3. [PRESCRIPTION
DRUG COVERAGE.] Coverage under the program shall be limited to those
prescription drugs that:
(1) are covered under the medical assistance program as
described in section 256B.0625, subdivision 13;
(2) are provided by manufacturers that have fully executed
senior prescription drug program rebate agreements with
the commissioner and comply with such agreements; and
(3) for a specific enrollee, are not covered under an
assistance program offered by a pharmaceutical manufacturer, as determined by
the board on aging under section 256.975, subdivision 9, except that this shall
not apply to qualified individuals under this section who are also eligible for
medical assistance with a spenddown as described in subdivisions 2a, clause
(2), and 2b, clause (2).; and
(4) for a specific enrollee, are not covered under a
Medicare drug discount card plan subsidy unless:
(i) the prescription drug is not included in the Medicare
discount card plan formulary, but is covered under the prescription drug
program;
(ii) the cost of a prescription drug is more than the
remaining Medicare drug discount card subsidy; or
(iii) a prescribed over-the-counter medication is not
included in the Medicare drug discount card plan formulary, but is covered under
the prescription drug program.
Sec. 4. Minnesota
Statutes 2002, section 256.955, subdivision 4, is amended to read:
Subd. 4. [APPLICATION
PROCEDURES AND COORDINATION WITH MEDICAL ASSISTANCE AND MEDICARE DRUG
DISCOUNT CARD.] Applications and information on the program must be made
available at county social service agencies, health care provider offices, and
agencies and organizations serving senior citizens and persons with
disabilities. Individuals shall submit
applications and any information specified by the commissioner as being
necessary to verify eligibility directly to the county social service agencies:
(1) beginning January 1, 1999, the county social service agency
shall determine medical assistance spenddown eligibility of individuals who
qualify for the prescription drug program; and
(2) program payments will be used to reduce the spenddown
obligations of individuals who are determined to be eligible for medical
assistance with a spenddown as defined in section 256B.056, subdivision 5.
Qualified individuals who
are eligible for medical assistance with a spenddown shall be financially
responsible for the deductible amount up to the satisfaction of the
spenddown. No deductible applies once
the spenddown has been met. Payments to
providers for prescription drugs for persons eligible under this subdivision
shall be reduced by the deductible.
County social service agencies shall determine an applicant's
eligibility for the program within 30 days from the date the application is received. Eligibility begins the month after approval.
Enrollees who are also enrolled in the Medicare drug
discount card plan must obtain prescription drugs at a pharmacy enrolled as a
provider for both the Medicare drug discount plan and the prescription drug
program.
Sec. 5. Minnesota
Statutes 2002, section 256.955, subdivision 6, is amended to read:
Subd. 6. [PHARMACY
REIMBURSEMENT.] The commissioner shall reimburse participating pharmacies for
drug and dispensing costs at the medical assistance reimbursement level, minus
the deductible required under subdivision 7.
The commissioner shall not reimburse enrolled pharmacies until the
Medicare drug discount card subsidy has been exhausted, unless the exceptions
in subdivision 3, clause (3), are met.
Sec. 6. Minnesota Statutes 2003 Supplement, section 256B.056, subdivision
3c, is amended to read:
Subd. 3c. [ASSET
LIMITATIONS FOR FAMILIES AND CHILDREN.] A household of two or more persons must
not own more than $20,000 in total net assets, and a household of one person
must not own more than $10,000 in total net assets. In addition to these maximum amounts, an eligible individual or
family may accrue interest on these amounts, but they must be reduced to the
maximum at the time of an eligibility redetermination. The value of assets that are not considered
in determining eligibility for medical assistance for families and children is
the value of those assets excluded under the AFDC state plan as of July 16,
1996, as required by the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (PRWORA), Public Law 104-193, with the following
exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business up to
$200,000 are not considered;
(3) one motor vehicle is excluded for each person of legal
driving age who is employed or seeking employment;
(4) one burial plot and all other burial expenses equal to
the supplemental security income program asset limit are not considered for
each individual assets designated as burial expenses are excluded to the
same extent excluded by the supplemental security income program. Burial expenses funded by annuity contracts
or life insurance policies must irrevocably designate the individual's estate
as the contingent beneficiary to the extent proceeds are not used for payment
of selected burial expenses;
(5) court-ordered settlements up to $10,000 are not considered;
(6) individual retirement accounts and funds are not considered;
and
(7) assets owned by children are not considered.
Sec. 7. Minnesota
Statutes 2003 Supplement, section 256B.057, subdivision 9, is amended to read:
Subd. 9. [EMPLOYED
PERSONS WITH DISABILITIES.] (a) Medical assistance may be paid for a person who
is employed and who:
(1) meets the definition of disabled under the supplemental
security income program;
(2) is at least 16 but less than 65 years of age;
(3) meets the asset limits in paragraph (b); and
(4) effective November 1, 2003, pays a premium and other
obligations under paragraph (d).
Any spousal income or assets
shall be disregarded for purposes of eligibility and premium determinations.
After the month of enrollment, a person enrolled in medical
assistance under this subdivision who:
(1) is temporarily unable to work and without receipt of earned
income due to a medical condition, as verified by a physician, may retain
eligibility for up to four calendar months; or
(2) effective January 1, 2004, loses
employment for reasons not attributable to the enrollee, may retain eligibility
for up to four consecutive months after the month of job loss. To receive a four-month extension, enrollees
must verify the medical condition or provide notification of job loss. All other eligibility requirements must be
met and the enrollee must pay all calculated premium costs for continued
eligibility.
(b) For purposes of determining eligibility under this
subdivision, a person's assets must not exceed $20,000, excluding:
(1) all assets excluded under section 256B.056;
(2) retirement accounts, including individual accounts, 401(k)
plans, 403(b) plans, Keogh plans, and pension plans; and
(3) medical expense accounts set up through the person's
employer.
(c)(1) Effective January 1, 2004, for purposes of eligibility,
there will be a $65 earned income disregard.
To be eligible, a person applying for medical assistance under this
subdivision must have earned income above the disregard level.
(2) Effective January 1, 2004, to be considered earned income,
Medicare, Social Security, and applicable state and federal income taxes must
be withheld. To be eligible, a person
must document earned income tax withholding.
(d)(1) A person whose earned and unearned income is equal to or
greater than 100 percent of federal poverty guidelines for the applicable
family size must pay a premium to be eligible for medical assistance under this
subdivision. The premium shall be based
on the person's gross earned and unearned income and the applicable family size
using a sliding fee scale established by the commissioner, which begins at one
percent of income at 100 percent of the federal poverty guidelines and
increases to 7.5 percent of income for those with incomes at or above 300 percent
of the federal poverty guidelines.
Annual adjustments in the premium schedule based upon changes in the
federal poverty guidelines shall be effective for premiums due in July of each
year.
(2) Effective January 1, 2004, all enrollees must pay a premium
to be eligible for medical assistance under this subdivision. An enrollee shall pay the greater of a $35
premium or the premium calculated in clause (1).
(3) Effective November 1, 2003, all enrollees who receive
unearned income must pay one-half of one percent of unearned income in addition
to the premium amount.
(4) Effective November 1, 2003, for enrollees whose income does
not exceed 200 percent of the federal poverty guidelines and who are also
enrolled in Medicare, the commissioner must reimburse the enrollee for Medicare
Part B premiums under section 256B.0625, subdivision 15, paragraph (a).
(5) Increases in benefits under Title II of the Social
Security Act shall not be counted as income for purposes of this subdivision
until July 1 of each year.
(e) A person's eligibility and premium shall be determined by
the local county agency. Premiums must
be paid to the commissioner. All
premiums are dedicated to the commissioner.
(f) Any required premium shall be determined at application and
redetermined at the enrollee's six-month income review or when a change in
income or household size is reported.
Enrollees must report any change in income or household size within ten
days of when the change occurs. A
decreased premium resulting from a reported change in
income or household size shall be effective the first day of the next available
billing month after the change is reported.
Except for changes occurring from annual cost-of-living increases, a
change resulting in an increased premium shall not affect the premium amount
until the next six-month review.
(g) Premium payment is due upon notification from the
commissioner of the premium amount required.
Premiums may be paid in installments at the discretion of the
commissioner.
(h) Nonpayment of the premium shall result in denial or
termination of medical assistance unless the person demonstrates good cause for
nonpayment. Good cause exists if the
requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B
to D, are met. Except when an
installment agreement is accepted by the commissioner, all persons disenrolled
for nonpayment of a premium must pay any past due premiums as well as current
premiums due prior to being reenrolled.
Nonpayment shall include payment with a returned, refused, or dishonored
instrument. The commissioner may
require a guaranteed form of payment as the only means to replace a returned,
refused, or dishonored instrument.
[EFFECTIVE DATE.] This
section is effective July 1, 2004.
Sec. 8. Minnesota
Statutes 2003 Supplement, section 256B.06, subdivision 4, is amended to read:
Subd. 4. [CITIZENSHIP
REQUIREMENTS.] (a) Eligibility for medical assistance is limited to citizens of
the United States, qualified noncitizens as defined in this subdivision, and
other persons residing lawfully in the United States.
(b) "Qualified noncitizen" means a person who meets
one of the following immigration criteria:
(1) admitted for lawful permanent residence according to United
States Code, title 8;
(2) admitted to the United States as a refugee according to
United States Code, title 8, section 1157;
(3) granted asylum according to United States Code, title 8,
section 1158;
(4) granted withholding of deportation according to United
States Code, title 8, section 1253(h);
(5) paroled for a period of at least one year according to
United States Code, title 8, section 1182(d)(5);
(6) granted conditional entrant status according to United
States Code, title 8, section 1153(a)(7);
(7) determined to be a battered noncitizen by the United States
Attorney General according to the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996, title V of the Omnibus Consolidated Appropriations
Bill, Public Law 104-200;
(8) is a child of a noncitizen determined to be a battered
noncitizen by the United States Attorney General according to the Illegal
Immigration Reform and Immigrant Responsibility Act of 1996, title V, of the
Omnibus Consolidated Appropriations Bill, Public Law 104-200; or
(9) determined to be a Cuban or Haitian entrant as defined in
section 501(e) of Public Law 96-422, the Refugee Education Assistance Act of
1980.
(c) All qualified noncitizens who were residing in the United
States before August 22, 1996, who otherwise meet the eligibility requirements
of this chapter, are eligible for medical assistance with federal financial
participation.
(d) All qualified noncitizens who
entered the United States on or after August 22, 1996, and who otherwise meet
the eligibility requirements of this chapter, are eligible for medical
assistance with federal financial participation through November 30, 1996.
Beginning December 1, 1996, qualified noncitizens who entered
the United States on or after August 22, 1996, and who otherwise meet the
eligibility requirements of this chapter are eligible for medical assistance
with federal participation for five years if they meet one of the following
criteria:
(i) refugees admitted to the United States according to United
States Code, title 8, section 1157;
(ii) persons granted asylum according to United States Code,
title 8, section 1158;
(iii) persons granted withholding of deportation according to
United States Code, title 8, section 1253(h);
(iv) veterans of the United States armed forces with an
honorable discharge for a reason other than noncitizen status, their spouses
and unmarried minor dependent children; or
(v) persons on active duty in the United States armed forces,
other than for training, their spouses and unmarried minor dependent children.
Beginning December 1, 1996, qualified noncitizens who do not
meet one of the criteria in items (i) to (v) are eligible for medical
assistance without federal financial participation as described in paragraph
(j).
(e) Noncitizens who are not qualified noncitizens as defined in
paragraph (b), who are lawfully residing in the United States and who otherwise
meet the eligibility requirements of this chapter, are eligible for medical
assistance under clauses (1) to (3). These individuals must cooperate with the Immigration and
Naturalization Service to pursue any applicable immigration status, including
citizenship, that would qualify them for medical assistance with federal financial
participation.
(1) Persons who were medical assistance recipients on August
22, 1996, are eligible for medical assistance with federal financial
participation through December 31, 1996.
(2) Beginning January 1, 1997, persons described in clause (1)
are eligible for medical assistance without federal financial participation as
described in paragraph (j).
(3) Beginning December 1, 1996, persons residing in the United
States prior to August 22, 1996, who were not receiving medical assistance and
persons who arrived on or after August 22, 1996, are eligible for medical
assistance without federal financial participation as described in paragraph
(j).
(f) Nonimmigrants who otherwise meet the eligibility
requirements of this chapter are eligible for the benefits as provided in
paragraphs (g) to (i). For purposes of
this subdivision, a "nonimmigrant" is a person in one of the classes
listed in United States Code, title 8, section 1101(a)(15).
(g) Payment shall also be made for care and services that are
furnished to noncitizens, regardless of immigration status, who otherwise meet
the eligibility requirements of this chapter, if such care and services are
necessary for the treatment of an emergency medical condition, except for organ
transplants and related care and services and routine prenatal care.
(h) For purposes of this subdivision, the term "emergency
medical condition" means a medical condition that meets the requirements
of United States Code, title 42, section 1396b(v).
(i) Pregnant noncitizens who are undocumented or,
nonimmigrants, or eligible for medical assistance as described in paragraph
(j), and who are not covered by a group health plan or health insurance
coverage according to Code of Federal Regulations, title 42, section 457.310,
and who otherwise meet the eligibility requirements of this chapter, are
eligible for medical assistance payment without federal financial
participation for care and services through the period of pregnancy, and
including labor and delivery, to the extent federal funds are available
under Title XXI of the Social Security Act, and the state children's health
insurance program, followed by 60 days postpartum, except for labor and
delivery without federal financial participation.
(j) Qualified noncitizens as described in paragraph (d), and all
other noncitizens lawfully residing in the United States as described in
paragraph (e), who are ineligible for medical assistance with federal financial
participation and who otherwise meet the eligibility requirements of chapter
256B and of this paragraph, are eligible for medical assistance without federal
financial participation. Qualified
noncitizens as described in paragraph (d) are only eligible for medical
assistance without federal financial participation for five years from their
date of entry into the United States.
(k) Beginning October 1, 2003, persons who are receiving care
and rehabilitation services from a nonprofit center established to serve
victims of torture and are otherwise ineligible for medical assistance under
this chapter or general assistance medical care under section 256D.03 are
eligible for medical assistance without federal financial participation. These individuals are eligible only for the
period during which they are receiving services from the center. Individuals eligible under this paragraph
shall not be required to participate in prepaid medical assistance.
Sec. 9. Minnesota
Statutes 2003 Supplement, section 256B.0625, subdivision 9, is amended to read:
Subd. 9. [DENTAL
SERVICES.] (a) Medical assistance covers dental services. Dental services include, with prior
authorization, fixed bridges that are cost-effective for persons who cannot use
removable dentures because of their medical condition.
(b) Coverage of dental services for adults age 21 and over who
are not pregnant is subject to a $500 annual benefit limit and covered services
are limited to:
(1) diagnostic and preventative services;
(2) basic restorative services; and
(3) emergency services.
Emergency services, dentures, and extractions related to
dentures are not included in the $500 annual benefit limit.
[EFFECTIVE DATE.] This
section is effective January 1, 2005.
Sec. 10. Minnesota
Statutes 2003 Supplement, section 256B.0631, subdivision 2, is amended to read:
Subd. 2. [EXCEPTIONS.]
Co-payments shall be subject to the following exceptions:
(1) children under the age of 21;
(2) pregnant women for services that relate to the pregnancy or
any other medical condition that may complicate the pregnancy;
(3) recipients expected to reside for at least 30 days
in a hospital, nursing home, or intermediate care facility for the mentally
retarded whose only available income is a personal needs allowance under
section 256B.35 or 256B.36 and whose exemption from co-payments is approved by
the centers for Medicare and Medicaid services;
(4) recipients receiving hospice care;
(5) 100 percent federally funded services provided by an Indian
health service;
(6) emergency services;
(7) family planning services;
(8) services that are paid by Medicare, resulting in the
medical assistance program paying for the coinsurance and deductible; and
(9) co-payments that exceed one per day per provider for
nonpreventive visits, eyeglasses, and nonemergency visits to a hospital-based
emergency room.
[EFFECTIVE DATE.] This
section is effective July 1, 2004, or upon federal approval, whichever is
later.
Sec. 11. Minnesota
Statutes 2003 Supplement, section 256B.69, subdivision 2, is amended to read:
Subd. 2. [DEFINITIONS.]
For the purposes of this section, the following terms have the meanings given.
(a) "Commissioner" means the commissioner of human
services. For the remainder of this
section, the commissioner's responsibilities for methods and policies for
implementing the project will be proposed by the project advisory committees
and approved by the commissioner.
(b) "Demonstration provider" means a health
maintenance organization, community integrated service network, or accountable
provider network authorized and operating under chapter 62D, 62N, or 62T that
participates in the demonstration project according to criteria, standards,
methods, and other requirements established for the project and approved by the
commissioner. For purposes of this
section, a county board, or group of county boards operating under a joint
powers agreement, is considered a demonstration provider if the county or group
of county boards meets the requirements of section 256B.692. Notwithstanding the above, Itasca County may
continue to participate as a demonstration provider until July 1, 2004.
(c) "Eligible individuals" means those persons
eligible for medical assistance benefits as defined in sections 256B.055,
256B.056, and 256B.06.
(d) "Limitation of choice" means suspending freedom
of choice while allowing eligible individuals to choose among the demonstration
providers.
(e) This paragraph supersedes paragraph (c) as long as the
Minnesota health care reform waiver remains in effect. When the waiver expires, this paragraph expires
and the commissioner of human services shall publish a notice in the State
Register and notify the revisor of statutes.
"Eligible individuals" means those persons eligible for
medical assistance benefits as defined in sections 256B.055, 256B.056, and
256B.06. An individual enrolled under
section 256B.055, subdivision 7, who becomes ineligible for the program because
of failure to submit income reports or recertification forms in a timely
manner, shall remain enrolled in the prepaid health plan and shall remain
eligible to receive medical assistance coverage through the last day of the
month following the month in which the enrollee became ineligible for the
medical assistance program.
[EFFECTIVE DATE.] This
section is effective July 1, 2004, or upon federal approval, whichever is
later.
Sec. 12. Minnesota
Statutes 2003 Supplement, section 256D.03, subdivision 3, is amended to read:
Subd. 3. [GENERAL
ASSISTANCE MEDICAL CARE; ELIGIBILITY.] (a) General assistance medical care may
be paid for any person who is not eligible for emergency medical assistance,
or medical assistance under chapter 256B, including eligibility for medical
assistance based on a spenddown of excess income according to section 256B.056,
subdivision 5, or MinnesotaCare as defined in paragraph (b), except as provided
in paragraph (c), and:
(1) who is receiving assistance under section 256D.05, except
for families with children who are eligible under Minnesota family investment
program (MFIP), or who is having a payment made on the person's behalf under
sections 256I.01 to 256I.06; or
(2) who is a resident of Minnesota; and
(i) who has gross countable income not in excess of 75 percent
of the federal poverty guidelines for the family size, using a six-month budget
period and whose equity in assets is not in excess of $1,000 per assistance
unit. Exempt assets, the reduction of
excess assets, and the waiver of excess assets must conform to the medical
assistance program in section 256B.056, subdivision 3, with the following
exception: the maximum amount of
undistributed funds in a trust that could be distributed to or on behalf of the
beneficiary by the trustee, assuming the full exercise of the trustee's
discretion under the terms of the trust, must be applied toward the asset
maximum; or
(ii) who has gross countable income above 75 percent of the
federal poverty guidelines but or assets in excess of the limits in item
(i), but whose income is not in excess of 175 150 percent of
the federal poverty guidelines for the family size, using a six-month budget
period, and whose equity in assets is not in excess of the limits in
section 256B.056, subdivision 3c, and who applies during an inpatient
hospitalization.
(b) General assistance medical care may not be paid for applicants
or recipients who meet all eligibility requirements of MinnesotaCare as defined
in sections 256L.01 to 256L.16, and are adults with dependent children under 21
whose gross family income is equal to or less than 275 percent of the federal
poverty guidelines.
(c) For applications received on or after October 1, 2003,
eligibility may begin no earlier than the date of application. For individuals eligible under paragraph
(a), clause (2), item (i), a redetermination of eligibility must occur every 12
months. Individuals are eligible under
paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization. Beginning January 1, 2000, Minnesota health
care program applications completed by recipients and applicants who are
persons described in paragraph (b), may be returned to the county agency to be
forwarded to the Department of Human Services or sent directly to the
Department of Human Services for enrollment in MinnesotaCare. If all other eligibility requirements of
this subdivision are met, eligibility for general assistance medical care shall
be available in any month during which a MinnesotaCare eligibility
determination and enrollment are pending.
Upon notification of eligibility for MinnesotaCare, notice of
termination for eligibility for general assistance medical care shall be sent
to an applicant or recipient. If
all other eligibility requirements of this subdivision are met, eligibility for
general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraph (e).
(d) The date of an initial Minnesota health care program
application necessary to begin a determination of eligibility shall be the date
the applicant has provided a name, address, and Social Security number, signed
and dated, to the county agency or the Department of Human Services. If the applicant is unable to provide a
name, address, Social Security number, and signature when health care is
delivered due to a medical condition or disability, a health care provider may
act on an applicant's behalf to establish the date of an initial Minnesota
health care program application by
providing the county agency or Department of Human Services with provider
identification and a temporary unique identifier for the applicant. The applicant must complete the remainder of
the application and provide necessary verification before eligibility can be
determined. The county agency must
assist the applicant in obtaining verification if necessary.
(e) County agencies are authorized to use all automated
databases containing information regarding recipients' or applicants' income in
order to determine eligibility for general assistance medical care or MinnesotaCare. Such use shall be considered sufficient in
order to determine eligibility and premium payments by the county agency.
(f) General assistance medical care is not available for a
person in a correctional facility unless the person is detained by law for less
than one year in a county correctional or detention facility as a person
accused or convicted of a crime, or admitted as an inpatient to a hospital on a
criminal hold order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or admitted on a
criminal hold order and as long as the person continues to meet other
eligibility requirements of this subdivision.
(g) General assistance medical care is not available for
applicants or recipients who do not cooperate with the county agency to meet
the requirements of medical assistance.
(h) In determining the amount of assets of an individual
eligible under paragraph (a), clause (2), item (i), there shall be included any
asset or interest in an asset, including an asset excluded under paragraph (a),
that was given away, sold, or disposed of for less than fair market value
within the 60 months preceding application for general assistance medical care
or during the period of eligibility.
Any transfer described in this paragraph shall be presumed to have been
for the purpose of establishing eligibility for general assistance medical
care, unless the individual furnishes convincing evidence to establish that the
transaction was exclusively for another purpose. For purposes of this paragraph, the value of the asset or
interest shall be the fair market value at the time it was given away, sold, or
disposed of, less the amount of compensation received. For any uncompensated transfer, the number
of months of ineligibility, including partial months, shall be calculated by
dividing the uncompensated transfer amount by the average monthly per person
payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The
individual shall remain ineligible until this fixed period has expired. The period of ineligibility may exceed 30
months, and a reapplication for benefits after 30 months from the date of the
transfer shall not result in eligibility unless and until the period of
ineligibility has expired. The period
of ineligibility begins in the month the transfer was reported to the county
agency, or if the transfer was not reported, the month in which the county
agency discovered the transfer, whichever comes first. For applicants, the period of ineligibility
begins on the date of the first approved application.
(i) When determining eligibility for any state benefits under
this subdivision, the income and resources of all noncitizens shall be deemed
to include their sponsor's income and resources as defined in the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996, title IV,
Public Law 104-193, sections 421 and 422, and subsequently set out in federal
rules.
(j) Undocumented noncitizens and nonimmigrants are ineligible
for general assistance medical care, except that an individual eligible
under paragraph (a), clause (4), remains eligible through September 30, 2003,
and an undocumented noncitizen or nonimmigrant who is diagnosed with active or
latent tuberculosis and meets all other eligibility requirements of this
section is eligible for the duration of the need for tuberculosis treatment. For purposes of this subdivision, a
nonimmigrant is an individual in one or more of the classes listed in United
States Code, title 8, section 1101(a)(15), and an undocumented noncitizen is an
individual who resides in the United States without the approval or
acquiescence of the Immigration and Naturalization Service.
(k) Notwithstanding any other provision of law, a
noncitizen who is ineligible for medical assistance due to the deeming of a
sponsor's income and resources, is ineligible for general assistance medical
care.
(l) Effective July 1, 2003, general assistance medical care
emergency services end.
[EFFECTIVE DATE.] This
section is effective July 1, 2004, except that the change in the income limit
for hospital-only coverage in paragraph (a), clause (2), item (ii) is effective
July 1, 2005.
Sec. 13. Minnesota
Statutes 2003 Supplement, section 256D.03, subdivision 4, is amended to read:
Subd. 4. [GENERAL
ASSISTANCE MEDICAL CARE; SERVICES.] (a)(i) For a person who is eligible under
subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):
(1) inpatient hospital services;
(2) outpatient hospital services;
(3) services provided by Medicare certified rehabilitation
agencies;
(4) prescription drugs and other products recommended through
the process established in section 256B.0625, subdivision 13;
(5) equipment necessary to administer insulin and diagnostic
supplies and equipment for diabetics to monitor blood sugar level;
(6) eyeglasses and eye examinations provided by a physician or
optometrist;
(7) hearing aids;
(8) prosthetic devices;
(9) laboratory and X-ray services;
(10) physician's services;
(11) medical transportation except special transportation;
(12) chiropractic services as covered under the medical
assistance program;
(13) podiatric services;
(14) dental services and dentures, subject to the
limitations specified in section 256B.0625, subdivision 9 as covered
under the medical assistance program;
(15) outpatient services provided by a mental health center or
clinic that is under contract with the county board and is established under
section 245.62;
(16) day treatment services for mental illness provided under
contract with the county board;
(17) prescribed medications for
persons who have been diagnosed as mentally ill as necessary to prevent more
restrictive institutionalization;
(18) psychological services, medical supplies and equipment,
and Medicare premiums, coinsurance and deductible payments;
(19) medical equipment not specifically listed in this
paragraph when the use of the equipment will prevent the need for costlier
services that are reimbursable under this subdivision;
(20) services performed by a certified pediatric nurse
practitioner, a certified family nurse practitioner, a certified adult nurse
practitioner, a certified obstetric/gynecological nurse practitioner, a
certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered
under this chapter as a physician service, (2) the service provided on an
inpatient basis is not included as part of the cost for inpatient services
included in the operating payment rate, and (3) the service is within the scope
of practice of the nurse practitioner's license as a registered nurse, as
defined in section 148.171;
(21) services of a certified public health nurse or a
registered nurse practicing in a public health nursing clinic that is a
department of, or that operates under the direct authority of, a unit of government,
if the service is within the scope of practice of the public health nurse's
license as a registered nurse, as defined in section 148.171; and
(22) telemedicine consultations, to the extent they are covered
under section 256B.0625, subdivision 3b.
(ii) Effective October 1, 2003, for a person who is eligible
under subdivision 3, paragraph (a), clause (2), item (ii), general assistance
medical care coverage is limited to inpatient hospital services, including
physician services provided during the inpatient hospital stay. A $1,000 deductible is required for each
inpatient hospitalization.
(b) Gender reassignment surgery and related services are not
covered services under this subdivision unless the individual began receiving
gender reassignment services prior to July 1, 1995.
(c) In order to contain costs, the commissioner of human
services shall select vendors of medical care who can provide the most
economical care consistent with high medical standards and shall where possible
contract with organizations on a prepaid capitation basis to provide these
services. The commissioner shall
consider proposals by counties and vendors for prepaid health plans,
competitive bidding programs, block grants, or other vendor payment mechanisms
designed to provide services in an economical manner or to control utilization,
with safeguards to ensure that necessary services are provided. Before implementing prepaid programs in
counties with a county operated or affiliated public teaching hospital or a
hospital or clinic operated by the University of Minnesota, the commissioner
shall consider the risks the prepaid program creates for the hospital and allow
the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the
patients served by the hospital, provided the terms of participation in the
program are competitive with the terms of other participants considering the
nature of the population served.
Payment for services provided pursuant to this subdivision shall be as
provided to medical assistance vendors of these services under sections
256B.02, subdivision 8, and 256B.0625.
For payments made during fiscal year 1990 and later years, the
commissioner shall consult with an independent actuary in establishing
prepayment rates, but shall retain final control over the rate methodology.
(d) Recipients eligible under subdivision 3, paragraph (a),
clause (2), item (i), shall pay the following co-payments for services provided
on or after October 1, 2003:
(1) $3 per nonpreventive visit. For purposes of this subdivision, a visit means an episode of
service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a
physician or physician ancillary, chiropractor, podiatrist, nurse midwife,
advanced practice nurse, audiologist, optician, or optometrist;
(2) $25 for eyeglasses;
(3) $25 for nonemergency visits to a hospital-based emergency
room; and
(4) $3 per brand-name drug prescription and $1 per generic drug
prescription, subject to a $20 per month maximum for prescription drug
co-payments. No co-payments shall apply
to antipsychotic drugs when used for the treatment of mental illness; and
(5) 50 percent coinsurance on basic restorative dental
services.
(e) Recipients of general assistance medical care are
responsible for all co-payments in this subdivision, except that this
requirement does not apply to recipients receiving group residential housing
payments under chapter 256I whose available income is limited to a personal
needs allowance under section 256B.35.
The general assistance medical care reimbursement to the provider shall
be reduced by the amount of the co-payment, except that reimbursement for
prescription drugs shall not be reduced once a recipient has reached the $20
per month maximum for prescription drug co-payments. The provider collects the co-payment from the recipient. Providers may not deny services to
recipients who are unable to pay the co-payment, except as provided in
paragraph (f).
(f) If it is the routine business practice of a provider to
refuse service to an individual with uncollected debt, the provider may include
uncollected co-payments under this section.
A provider must give advance notice to a recipient with uncollected debt
before services can be denied.
(g) Any county may, from its own resources, provide medical
payments for which state payments are not made.
(h) Chemical dependency services that are reimbursed under
chapter 254B must not be reimbursed under general assistance medical care.
(i) The maximum payment for new vendors enrolled in the general
assistance medical care program after the base year shall be determined from
the average usual and customary charge of the same vendor type enrolled in the
base year.
(j) The conditions of payment for services under this
subdivision are the same as the conditions specified in rules adopted under
chapter 256B governing the medical assistance program, unless otherwise
provided by statute or rule.
(k) Inpatient and outpatient payments shall be reduced by five
percent, effective July 1, 2003. This
reduction is in addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (i).
(l) Payments for all other health services except inpatient,
outpatient, and pharmacy services shall be reduced by five percent, effective
July 1, 2003.
(m) Payments to managed care plans shall be reduced by five percent
for services provided on or after October 1, 2003.
(n) A hospital receiving a reduced payment as a result of this
section may apply the unpaid balance toward satisfaction of the hospital's bad
debts.
[EFFECTIVE DATE.] This
section is effective January 1, 2005, except that the amendments to paragraph
(e) are effective July 1, 2004.
Sec. 14. Minnesota Statutes 2002, section 256L.01, subdivision 5, is
amended to read:
Subd. 5. [INCOME.] (a)
"Income" has the meaning given for earned and unearned income for
families and children in the medical assistance program, according to the
state's aid to families with dependent children plan in effect as of July 16,
1996. The definition does not include
medical assistance income methodologies and deeming requirements. The earned income of full-time and part-time
students under age 19 is not counted as income. Public assistance payments and supplemental security income are
not excluded income.
(b) For purposes of this subdivision, and unless otherwise
specified in this section, the commissioner shall use reasonable methods to
calculate gross earned and unearned income including, but not limited to,
projecting income based on income received within the last 30 days, the last 90
days, or the last 12 months.
[EFFECTIVE DATE.] This
section is effective July 1, 2004.
Sec. 15. Minnesota
Statutes 2003 Supplement, section 256L.03, subdivision 1, is amended to read:
Subdivision 1. [COVERED
HEALTH SERVICES.] For individuals under section 256L.04, subdivision 7, with
income no greater than 75 percent of the federal poverty guidelines or for
families with children under section 256L.04, subdivision 1, all subdivisions
of this section apply. "Covered
health services" means the health services reimbursed under chapter 256B,
with the exception of inpatient hospital services, special education services,
private duty nursing services, adult dental care services other than
services except as covered under section 256B.0625,
subdivision 9, paragraph (b), orthodontic services 3b,
nonemergency medical transportation services, personal care assistant and case
management services, nursing home or intermediate care facilities services,
inpatient mental health services, and chemical dependency services. Outpatient mental health services covered
under the MinnesotaCare program are limited to diagnostic assessments,
psychological testing, explanation of findings, medication management by a
physician, day treatment, partial hospitalization, and individual, family, and
group psychotherapy.
No public funds shall be used for coverage of abortion under
MinnesotaCare except where the life of the female would be endangered or
substantial and irreversible impairment of a major bodily function would result
if the fetus were carried to term; or where the pregnancy is the result of rape
or incest.
Covered health services shall be expanded as provided in this
section.
[EFFECTIVE DATE.] This
section is effective January 1, 2005.
Sec. 16. Minnesota
Statutes 2002, section 256L.03, is amended by adding a subdivision to read:
Subd. 3b.
[DENTAL SERVICES EFFECTIVE JANUARY 1, 2005.] (a) Effective January 1,
2005, the provisions in paragraphs (b) to (c) apply.
(b) For parents, grandparents, foster parents, relative
caretakers, and legal guardians eligible under section 256L.04, subdivision 1,
with incomes not exceeding 75 percent of the federal poverty guidelines, dental
services are covered as provided under section 256B.0625, subdivision 9, except
that no coverage is provided for orthodontic services.
(c) For pregnant women and children under age 21, dental
services are covered as provided under section 256B.0625, subdivision 9.
Sec. 17. Minnesota Statutes 2002, section 256L.03, subdivision 5, is
amended to read:
Subd. 5. [CO-PAYMENTS
AND COINSURANCE.] (a) Except as provided in paragraphs (b) and (c), the
MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:
(1) ten percent of the paid charges for inpatient hospital
services for adult enrollees, subject to an annual inpatient out-of-pocket
maximum of $1,000 per individual and $3,000 per family;
(2) $3 per prescription for adult enrollees;
(3) $25 for eyeglasses for adult enrollees; and
(4) $3 per nonpreventive visit. For purposes of this subdivision, a visit means an episode of
service which is required because of an enrollee's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a
physician or physician ancillary, chiropractor, podiatrist, advanced practice
nurse, audiologist, optician, or optometrist;
(5) $6 for nonemergency visits to a hospital-based emergency
room; and
(6) 50 percent of the fee-for-service rate for adult
dental care services other than preventive care services for persons eligible
under section 256L.04, subdivisions 1 to 7, with income equal to or less than
175 percent of the federal poverty guidelines.
(b) Paragraph (a), clause (1), does not apply to parents and
relative caretakers of children under the age of 21 in households with family
income equal to or less than 175 percent of the federal poverty
guidelines. Paragraph (a), clause (1),
does not apply to parents and relative caretakers of children under the age of
21 in households with family income greater than 175 percent of the federal
poverty guidelines for inpatient hospital admissions occurring on or after
January 1, 2001.
(c) Paragraph (a), clauses (1) to (4) (6), do not
apply to pregnant women and children under the age of 21.
(d) Adult enrollees with family gross income that exceeds 175
percent of the federal poverty guidelines and who are not pregnant shall be
financially responsible for the coinsurance amount, if applicable, and amounts
which exceed the $10,000 inpatient hospital benefit limit.
(e) When a MinnesotaCare enrollee becomes a member of a prepaid
health plan, or changes from one prepaid health plan to another during a
calendar year, any charges submitted towards the $10,000 annual inpatient benefit
limit, and any out-of-pocket expenses incurred by the enrollee for inpatient
services, that were submitted or incurred prior to enrollment, or prior to the
change in health plans, shall be disregarded.
(f) Paragraph (a), clauses (4) and (5), are limited to one
co-payment per day per provider.
[EFFECTIVE DATE.] This
section is effective January 1, 2005.
Sec. 18. Minnesota
Statutes 2003 Supplement, section 256L.035, is amended to read:
256L.035 [LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE ADULTS
AND HOUSEHOLDS WITHOUT CHILDREN.]
(a) "Covered health services" for individuals under
section 256L.04, subdivision 7, with income above 75 percent, but not exceeding
175 percent, of the federal poverty guideline means:
(1) inpatient hospitalization benefits with a ten percent
co-payment up to $1,000 and subject to an annual limitation of $10,000;
(2) physician services provided during an inpatient stay;
and
(3) physician services not provided during an inpatient stay,;
outpatient hospital services,; chiropractic services ,;
lab and diagnostic services,; vision services excluding the
dispensing, fitting, and adjustment of eyeglasses or contacts and eye
examinations to determine refractive state; and prescription drugs,;
and supplies and equipment for diabetic testing and insulin administration,
subject to an aggregate cap of $2,000 per calendar year and the following
co-payments:
(i) $50 co-pay per emergency room visit;
(ii) $3 co-pay per prescription drug; and
(iii) $5 co-pay per nonpreventive physician and optometrist
visit.
For purposes of this subdivision, "a visit" means an
episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory
setting by a physician or, physician ancillary, or optometrist.
Enrollees are responsible for all co-payments in this
subdivision, except that this requirement does not apply to enrollees
receiving group residential housing payments under chapter 256I whose available
income is limited to a personal needs allowance under section 256B.35.
(b) The November 2006 MinnesotaCare forecast for the biennium
beginning July 1, 2007, shall assume an adjustment in the aggregate cap on the
services identified in paragraph (a), clause (3), in $1,000 increments up to a
maximum of $10,000, but not less than $2,000, to the extent that the balance in
the health care access fund is sufficient in each year of the biennium to pay
for this benefit level. The aggregate
cap shall be adjusted according to the forecast.
(c) Reimbursement to the providers shall be reduced by the
amount of the co-payment, except that reimbursement for prescription drugs
shall not be reduced once a recipient has reached the $20 per month maximum for
prescription drug co-payments. The
provider collects the co-payment from the recipient. Providers may not deny services to recipients who are unable to
pay the co-payment, except as provided in paragraph (d).
(d) If it is the routine business practice of a provider to
refuse service to an individual with uncollected debt, the provider may include
uncollected co-payments under this section.
A provider must give advance notice to a recipient with uncollected debt
before services can be denied.
[EFFECTIVE DATE.] This
section is effective January 1, 2005.
Sec. 19. Minnesota
Statutes 2002, section 256L.05, subdivision 3, is amended to read:
Subd. 3. [EFFECTIVE
DATE OF COVERAGE.] (a) The effective date of coverage is the first day of the
month following the month in which eligibility is approved and the first
premium payment has been received. As
provided in section 256B.057, coverage for newborns is automatic from the date
of birth and must be coordinated with other health coverage. The effective date of coverage for eligible
newly adoptive children added to a family receiving covered health services is
the or at renewal, whichever the
family receiving covered health services prefers the change is reported. All eligibility criteria must be met by the
family at the time the new family member is added. The income of the new family member is included with the family's
gross income and the adjusted premium begins in the month the new family member
is added. date of entry into the family.
The month of placement or the month placement is reported,
whichever is later. The effective
date of coverage for other new recipients members added to the
family receiving covered health services is the first day of the month
following the month in which eligibility is approved
(b) The initial premium must be received by the last working
day of the month for coverage to begin the first day of the following month.
(c) Benefits are not available until the day following
discharge if an enrollee is hospitalized on the first day of coverage.
(d) Notwithstanding any other law to the contrary, benefits
under sections 256L.01 to 256L.18 are secondary to a plan of insurance or
benefit program under which an eligible person may have coverage and the
commissioner shall use cost avoidance techniques to ensure coordination of any
other health coverage for eligible persons.
The commissioner shall identify eligible persons who may have coverage
or benefits under other plans of insurance or who become eligible for medical
assistance.
Sec. 20. Minnesota
Statutes 2003 Supplement, section 256L.07, subdivision 1, is amended to read:
Subdivision 1. [GENERAL
REQUIREMENTS.] (a) Children enrolled in the original children's health plan as
of September 30, 1992, children who enrolled in the MinnesotaCare program after
September 30, 1992, pursuant to Laws 1992, chapter 549, article 4, section 17,
and children who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines are eligible without meeting the
requirements of subdivision 2 and the four-month requirement in subdivision 3,
as long as they maintain continuous coverage in the MinnesotaCare program or
medical assistance. Children who apply
for MinnesotaCare on or after the implementation date of the
employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines, must meet the
requirements of subdivision 2 to be eligible for MinnesotaCare.
(b) Families enrolled in MinnesotaCare under section 256L.04,
subdivision 1, whose income increases above 275 percent of the federal poverty
guidelines, are no longer eligible for the program and shall be disenrolled by
the commissioner. Individuals enrolled
in MinnesotaCare under section 256L.04, subdivision 7, whose income increases
above 175 percent of the federal poverty guidelines are no longer eligible for
the program and shall be disenrolled by the commissioner. For persons disenrolled under this
subdivision, MinnesotaCare coverage terminates the last day of the calendar
month following the month in which the commissioner determines that the income
of a family or individual exceeds program income limits.
(c)(1) Notwithstanding paragraph (b), families enrolled in
MinnesotaCare under section 256L.04, subdivision 1, may remain enrolled in
MinnesotaCare if ten percent of their annual income is less than the annual
premium for a policy with a $500 deductible available through the Minnesota
Comprehensive Health Association.
Families who are no longer eligible for MinnesotaCare under this
subdivision shall be given an 18-month notice period from the date that
ineligibility is determined before disenrollment. This clause expires February 1, 2004.
(2) Effective February 1, 2004, notwithstanding paragraph (b),
children may remain enrolled in MinnesotaCare if ten percent of their annual
family income is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health
Association. Children who are no longer
eligible for MinnesotaCare under this clause shall be given a 12-month notice
period from the date that ineligibility is determined before disenrollment. The premium for children remaining eligible
under this clause shall be the maximum premium determined under section
256L.15, subdivision 2, paragraph (b).
(d) Effective July 1, 2003, notwithstanding paragraphs (b)
and (c), parents are no longer eligible for MinnesotaCare if gross household
income exceeds $50,000.
Sec. 21. Minnesota
Statutes 2003 Supplement, section 256L.07, subdivision 3, is amended to read:
Subd. 3. [OTHER HEALTH
COVERAGE.] (a) Families and individuals enrolled in the MinnesotaCare program
must have no health coverage while enrolled or for at least four months prior
to application and renewal. Children
enrolled in the original children's health plan and children in families with
income equal to or less than 150 percent of the federal poverty guidelines, who
have other health insurance, are eligible if the coverage:
(1) lacks two or more of the following:
(i) basic hospital insurance;
(ii) medical-surgical insurance;
(iii) prescription drug coverage;
(iv) dental coverage; or
(v) vision coverage;
(2) requires a deductible of $100 or more per person per year;
or
(3) lacks coverage because the child has exceeded the maximum
coverage for a particular diagnosis or the policy excludes a particular diagnosis.
The commissioner may change this eligibility criterion for
sliding scale premiums in order to remain within the limits of available
appropriations. The requirement of no
health coverage does not apply to newborns.
(b) Medical assistance, general assistance medical care, and
the Civilian Health and Medical Program of the Uniformed Service, CHAMPUS, or
other coverage provided under United States Code, title 10, subtitle A, part
II, chapter 55, are not considered insurance or health coverage for purposes of
the four-month requirement described in this subdivision.
(c) For purposes of this subdivision, Medicare Part A or B
coverage under title XVIII of the Social Security Act, United States Code,
title 42, sections 1395c to 1395w-4, is considered health coverage. An applicant or enrollee may not refuse
who is entitled to Medicare but has failed to apply or refused Medicare
coverage to establish eligibility is not eligible for
MinnesotaCare.
(d) Applicants who were recipients of medical assistance or
general assistance medical care within one month of application must meet the
provisions of this subdivision and subdivision 2.
(e) Effective October 1, 2003, applicants who were
recipients of medical assistance and had Cost-effective health insurance which
that was paid for by medical assistance are exempt from is not
considered health coverage for purposes of the four-month requirement under
this section, except if the insurance continued after medical assistance no
longer considered it cost-effective or after medical assistance closed.
Sec. 22. [FEDERAL
APPROVAL.]
The commissioner of human services shall request federal
approval to exempt from co-payments medical assistance recipients with personal
needs allowances by July 1, 2004, and provide copies of the request to the
chairs of the house Health and Human Services Finance Committee and senate
Health, Human Services and Corrections Budget Division. If federal approval to exempt all recipients
with a personal needs allowance is not obtained, the commissioner shall seek
federal approval to exempt from co-payments all those who can qualify for an
exemption through a state plan amendment or a waiver request.
Sec. 23. [REPEALER.]
Subdivision 1.
[PRESCRIPTION DRUG PROGRAM.] Minnesota Statutes 2002, section
256.955, subdivisions 1, 2, 2b, 4, 5, 6, 7, and 9; and Minnesota Statutes 2003
Supplement, section 256.955, subdivisions 2a, 3, and 4a, are repealed effective
January 1, 2006.
Subd. 2.
[MINNESOTACARE OUTREACH GRANTS.] Minnesota Statutes 2002, section
256L.04, subdivision 11, is repealed effective July 1, 2004.
ARTICLE
10
LONG-TERM
CARE
Section 1. Minnesota
Statutes 2003 Supplement, section 144A.071, subdivision 4c, is amended to read:
Subd. 4c. [EXCEPTIONS
FOR REPLACEMENT BEDS AFTER JUNE 30, 2003.] (a) The commissioner of health, in
coordination with the commissioner of human services, may approve the
renovation, replacement, upgrading, or relocation of a nursing home or boarding
care home, under the following conditions:
(1) to license and certify an 80-bed city-owned facility in
Nicollet County to be constructed on the site of a new city-owned hospital to
replace an existing 85-bed facility attached to a hospital that is also being
replaced. The threshold allowed for this
project under section 144A.073 shall be the maximum amount available to pay the
additional medical assistance costs of the new facility; and
(2) to license and certify 29 beds to be added to an existing
69-bed facility in St. Louis County, provided that the 29 beds must be
transferred from active or layaway status at an existing facility in St. Louis
County that had 235 beds on April 1, 2003.
The licensed capacity at the
235-bed facility must be reduced to 206 beds, but the payment rate at that facility
shall not be adjusted as a result of this transfer. The operating payment rate of the facility adding beds after
completion of this project shall be the same as it was on the day prior to the
day the beds are licensed and certified.
This project shall not proceed unless it is approved and financed under
the provisions of section 144A.073; and
(3) to license and certify a new 60-bed facility in Austin,
provided that:
(i) 45 of the new beds are transferred from a 45-bed
facility in Austin under common ownership that is closed, and 15 of the new
beds are transferred from a 182-bed facility in Albert Lea under common
ownership;
(ii) the commissioner of human services is authorized by the
2004 legislature to negotiate budget-neutral planned nursing facility closures;
and
(iii) money is available from planned closures of
facilities under common ownership to make implementation of this clause
budget-neutral to the state.
The bed capacity of the Albert Lea facility shall be reduced
to 167 beds following the transfer. Of
the 60 beds at the new facility, 20 beds shall be used for a special care unit
for persons with Alzheimer's disease or related dementias.
(b) Projects approved under this subdivision shall be treated
in a manner equivalent to projects approved under subdivision 4a.
Sec. 2. Minnesota
Statutes 2002, section 144A.10, subdivision 1a, is amended to read:
Subd. 1a. [TRAINING AND
EDUCATION FOR NURSING FACILITY PROVIDERS.] The commissioner of health must
establish and implement a prescribed process and program for providing training
and education to providers licensed by the Department of Health, either by
itself or in conjunction with the industry trade associations, before using
any new regulatory guideline, regulation, interpretation, program letter or
memorandum, or any other materials used in surveyor training to survey licensed
providers. The process should include,
but is not limited to, the following key components:
(1) facilitate the implementation of immediate revisions to any
course curriculum for nursing assistants which reflect any new standard of care
practice that has been adopted or referenced by the Health Department
concerning the issue in question;
(2) conduct training of long-term care providers and health
department survey inspectors either jointly or during the same time
frame on the department's new expectations; and
(3) within available resources the commissioner shall cooperate
in the development of clinical standards, work with vendors of supplies and
services regarding hazards, and identify research of interest to the long-term
care community consult with experts in the field to develop or make
available training resources on current standards of practice and the use of
technology.
Sec. 3. Minnesota
Statutes 2002, section 144A.10, is amended by adding a subdivision to read:
Subd. 17.
[AGENCY QUALITY IMPROVEMENT PROGRAM; ANNUAL REPORT ON SURVEY PROCESS.] (a)
The commissioner shall establish a quality improvement program for the nursing
facility survey and complaint processes.
The commissioner must regularly consult with consumers, consumer
advocates, and representatives of the nursing home industry and representatives
of nursing home employees in implementing the program. The commissioner, through the quality
improvement program, shall submit to the legislature an annual survey and
certification quality improvement report, beginning December 15, 2004, and each
December 15 thereafter.
(b) The report must include, but is not limited to, an
analysis of:
(1) the number, scope, and severity of citations by region
within the state;
(2) cross-referencing of citations by region within the
state and between states within the Centers for Medicare and Medicaid Services
region in which Minnesota is located;
(3) the number and outcomes of independent dispute
resolutions;
(4) the number and outcomes of appeals;
(5) compliance with timelines for
survey revisits and complaint investigations;
(6) techniques of surveyors in investigations,
communication, and documentation to identify and support citations;
(7) compliance with timelines for providing facilities with
completed statements of deficiencies; and
(8) other survey statistics relevant to improving the survey
process.
(c) The report must also identify and explain
inconsistencies and patterns across regions of the state, include analyses and
recommendations for quality improvement areas identified by the commissioner,
consumers, consumer advocates, and representatives of the nursing home industry
and nursing home employees, and provide action plans to address problems that
are identified.
Sec. 4. [144A.101]
[PROCEDURES FOR FEDERALLY REQUIRED SURVEY PROCESS.]
Subdivision 1.
[APPLICABILITY.] This section applies to survey certification and
enforcement activities by the commissioner related to regular, expanded, or
extended surveys under Code of Federal Regulations, title 42, part 488.
Subd. 2.
[STATEMENT OF DEFICIENCIES.] The commissioner shall provide nursing
facilities with draft statements of deficiencies at the time of the survey exit
process and shall provide facilities with completed statements of deficiencies
within 15 working days of the exit process.
Subd. 3.
[SURVEYOR NOTES.] The commissioner, upon the request of a nursing
facility, shall provide the facility with copies of formal surveyor notes taken
during the survey, with the exception of the resident, family, and staff
interviews, at the time the completed statement of deficiency is provided to
the facility. The survey notes shall be
redacted to protect the confidentiality of individuals providing information to
the surveyors. A facility requesting
formal surveyor notes must agree to pay the commissioner for the cost of
copying and redacting.
Subd. 4.
[POSTING OF STATEMENTS OF DEFICIENCIES.] The commissioner, when
posting statements of a nursing facility's deficiencies on the agency Web site,
must include in the posting the facility's response to the citations. The Web site must also include the dates
upon which deficiencies are corrected and the date upon which a facility is
considered to be in compliance with survey requirements. If deficiencies are under dispute, the
commissioner must note this on the Web site using a method that clearly identifies
for consumers which citations are under dispute.
Subd. 5. [SURVEY
REVISITS.] The commissioner shall conduct survey revisits within 15 calendar
days of the date by which corrections will be completed, as specified by the
provider in its plan of correction, in cases where category 2 or category 3
remedies are in place. The commissioner
may conduct survey revisits by telephone or written communications for
facilities at which the highest scope and severity score for a violation was
level E or lower.
Subd. 6. [FAMILY
COUNCILS.] Nursing facility family councils shall be interviewed as part of
the survey process and invited to participate in the exit conference.
Sec. 5. Minnesota
Statutes 2002, section 256.01, is amended by adding a subdivision to read:
Subd. 21.
[INTERAGENCY AGREEMENT WITH DEPARTMENT OF HEALTH.] The commissioner
of human services shall amend the interagency agreement with the commissioner
of health to certify nursing facilities for participation in the medical
assistance program, to require the commissioner of health, as a condition of
the agreement, to comply beginning July 1, 2005, with action plans included in
the annual survey and certification quality improvement report required under
section 144A.10, subdivision 17.
Sec. 6. Minnesota Statutes 2002, section 256B.431, is amended by adding a
subdivision to read:
Subd. 40.
[DESIGNATION OF AREAS TO RECEIVE METROPOLITAN RATES.] (a) For rate
years beginning on or after July 1, 2004, and subject to paragraph (b), nursing
facilities located in areas designated as metropolitan areas by the federal
Office of Management and Budget using census bureau data shall be considered
metro, in order to:
(1) determine rate increases under this section, section
256B.434, or any other section; and
(2) establish nursing facility reimbursement rates for the
new nursing facility reimbursement system developed under Laws 2001, First
Special Session chapter 9, article 5, section 35, as amended by Laws 2002,
chapter 220, article 14, section 19.
(b) Paragraph (a) applies only if designation as a metro
facility results in a level of reimbursement that is higher than the level the
facility would have received without application of that paragraph.
[EFFECTIVE DATE.] This
section is effective July 1, 2004.
Sec. 7. Minnesota
Statutes 2002, section 256B.431, is amended by adding a subdivision to read:
Subd. 41.
[PROFESSIONAL LIABILITY COSTS.] (a) After the computations in
subdivision 40, the commissioner shall make available to eligible nursing
facilities reimbursed under this section whose rates are not determined under
Minnesota Rules, part 9549.0057, and to eligible nursing facilities reimbursed
under section 256B.434, an adjustment to the nursing facility's operating cost
per diems for the rate year beginning July 1, 2004, to assist facilities in
paying increased professional liability insurance premiums greater than five
percent. The per diem adjustment shall
be computed by the commissioner using the information described in paragraph
(b) and the method described in paragraph (c).
This adjustment is onetime and must not be included in a facility's base
when calculating operating cost per diems for rate years beginning on or after
July 1, 2005.
(b) A facility is eligible for an adjustment if the facility
experienced a rate of increase in premiums for professional liability insurance
of more than five percent between calendar years 2002 and 2003, and provides to
the commissioner, in the form and manner specified by the commissioner,
information on the amount of premiums paid for professional liability insurance
for calendar years 2002 and 2003. The
information must be delivered to the commissioner by October 1, 2004, or
postmarked by September 30, 2004.
Facilities that do not meet this deadline are ineligible for the rate
adjustment.
(c) The commissioner shall review the information timely
submitted under paragraph (b) to determine each facility's allowable increased
costs. For purposes of this
requirement, "allowable increased costs" is the dollar amount of the
portion of the percentage increase in a facility's professional liability
insurance between calendar years 2002 and 2003 that exceeds five percent. Subject to the limitation in paragraph (d),
the commissioner shall compute a facility's rate adjustment by dividing the
allowable increased costs for that facility by actual resident days from the
most recent reporting year.
(d) If the rate increases are projected to increase the
state share of medical assistance costs by $1,700,000 or less, the rate
adjustments shall be implemented. If
the rate increases are projected to increase the state share of medical
assistance costs by more than $1,700,000, the commissioner shall proportionally
decrease each facility's rate adjustment to levels that project to spending no
more than $1,700,000.
Sec. 8. Minnesota Statutes 2003 Supplement, section 256B.434, subdivision
4, is amended to read:
Subd. 4. [ALTERNATE
RATES FOR NURSING FACILITIES.] (a) For nursing facilities which have their
payment rates determined under this section rather than section 256B.431, the
commissioner shall establish a rate under this subdivision. The nursing facility must enter into a
written contract with the commissioner.
(b) A nursing facility's case mix payment rate for the first
rate year of a facility's contract under this section is the payment rate the
facility would have received under section 256B.431.
(c) A nursing facility's case mix payment rates for the second
and subsequent years of a facility's contract under this section are the
previous rate year's contract payment rates plus an inflation adjustment and,
for facilities reimbursed under this section or section 256B.431, an adjustment
to include the cost of any increase in Health Department licensing fees for the
facility taking effect on or after July 1, 2001. The index for the inflation adjustment must be based on the
change in the Consumer Price Index-All Items (United States City average) (CPI-U)
forecasted by the commissioner of finance's national economic consultant, as
forecasted in the fourth quarter of the calendar year preceding the rate
year. The inflation adjustment must be
based on the 12-month period from the midpoint of the previous rate year to the
midpoint of the rate year for which the rate is being determined. For the rate years beginning on July 1,
1999, July 1, 2000, July 1, 2001, July 1, 2002, July 1, 2003, and July
1, 2004, July 1, 2005, and July 1, 2006, this paragraph shall apply only
to the property-related payment rate, except that adjustments to include the
cost of any increase in Health Department licensing fees taking effect on or
after July 1, 2001, shall be provided.
In determining the amount of the property-related payment rate
adjustment under this paragraph, the commissioner shall determine the
proportion of the facility's rates that are property-related based on the
facility's most recent cost report.
(d) The commissioner shall develop additional incentive-based
payments of up to five percent above the standard contract rate for achieving
outcomes specified in each contract.
The specified facility-specific outcomes must be measurable and approved
by the commissioner. The commissioner
may establish, for each contract, various levels of achievement within an
outcome. After the outcomes have been
specified the commissioner shall assign various levels of payment associated
with achieving the outcome. Any
incentive-based payment cancels if there is a termination of the contract. In establishing the specified outcomes and
related criteria the commissioner shall consider the following state policy
objectives:
(1) improved cost effectiveness and quality of life as measured
by improved clinical outcomes;
(2) successful diversion or discharge to community
alternatives;
(3) decreased acute care costs;
(4) improved consumer satisfaction;
(5) the achievement of quality; or
(6) any additional outcomes proposed by a nursing facility that
the commissioner finds desirable.
Sec. 9. [NURSING FACILITY
SCHOLARSHIP PROGRAM.]
For the rate year beginning July 1, 2004, the amount
determined under Minnesota Statutes, section 256B.431, subdivision 36, shall be
removed from each nursing facility's rate.
Sec. 10. [PROGRESS REPORT.]
The commissioner of health shall include in the December 15,
2004, quality improvement report required under section 2 a progress report and
implementation plan for the following legislatively directed activities:
(1) an analysis of the frequency of defensive documentation
and a plan, developed in consultation with the nursing home industry,
consumers, unions representing nursing home employees, and advocates, to
minimize defensive documentation;
(2) the nursing home providers workgroup established under
Laws 2003, First Special Session chapter 14, article 13C, section 3; and
(3) progress in implementing the independent informal
dispute resolution process required under Minnesota Statutes, section 144A.10,
subdivision 16.
Sec. 11. [RESUBMITTAL
OF REQUESTS FOR FEDERAL WAIVERS AND APPROVALS.]
(a) The commissioner of health shall seek federal waivers,
approvals, and law changes necessary to implement the alternative nursing home
survey process established under Minnesota Statutes, section 144A.37.
(b) The commissioner of health shall seek changes in the
federal policy that mandates the imposition of federal sanctions without
providing an opportunity for a nursing facility to correct deficiencies, solely
as the result of previous deficiencies issued to the nursing facility.
Sec. 12. [REPEALER;
NURSING FACILITY SCHOLARSHIPS.]
Minnesota Statutes 2003 Supplement, section 256B.431,
subdivision 36, is repealed effective July 1, 2004.
ARTICLE
11
CONTINUING
CARE
Section 1. Minnesota
Statutes 2003 Supplement, section 252.27, subdivision 2a, is amended to read:
Subd. 2a. [CONTRIBUTION
AMOUNT.] (a) The natural or adoptive parents of a minor child, including a
child determined eligible for medical assistance without consideration of
parental income, must contribute monthly to the cost of services, unless the
child is married or has been married, parental rights have been terminated, or
the child's adoption is subsidized according to section 259.67 or through title
IV-E of the Social Security Act.
(b) For households with adjusted gross income equal to or
greater than 100 percent of federal poverty guidelines, the parental
contribution shall be computed by applying the following schedule of rates to
the adjusted gross income of the natural or adoptive parents:
(1) if the adjusted gross income is equal to or greater than
100 percent of federal poverty guidelines and less than 175 percent of federal
poverty guidelines, the parental contribution is $4 per month;
(2) if the adjusted gross income is equal to or greater than
175 percent of federal poverty guidelines and less than or equal to 375 540
percent of federal poverty guidelines, the parental contribution shall be
determined using a sliding fee scale established by the commissioner of human
services which begins at one percent of adjusted gross income at 175 percent of
federal poverty guidelines and increases to 7.5 percent of adjusted gross
income for those with adjusted gross income up to 375 540 percent
of federal poverty guidelines;
(3) if the adjusted gross income is greater than 375
540 percent of federal poverty guidelines and less than 675 percent of
federal poverty guidelines, the parental contribution shall be 7.5 percent of
adjusted gross income;
(4) if the adjusted gross income is equal to or greater than
675 percent of federal poverty guidelines and less than 975 percent of federal
poverty guidelines, the parental contribution shall be determined using a
sliding fee scale established by the commissioner of human services which
begins at 7.5 percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to ten percent of adjusted gross income for
those with adjusted gross income up to 975 percent of federal poverty
guidelines; and
(5) if the adjusted gross income is equal to or greater than
975 percent of federal poverty guidelines, the parental contribution shall be
12.5 percent of adjusted gross income.
If the child lives with the parent, the annual adjusted gross
income is reduced by $2,400 prior to calculating the parental
contribution. If the child resides in
an institution specified in section 256B.35, the parent is responsible for the
personal needs allowance specified under that section in addition to the
parental contribution determined under this section. The parental contribution is reduced by any amount required to be
paid directly to the child pursuant to a court order, but only if actually
paid.
(c) The household size to be used in determining the amount of
contribution under paragraph (b) includes natural and adoptive parents and
their dependents under age 21, including the child receiving services. Adjustments in the contribution amount due
to annual changes in the federal poverty guidelines shall be implemented on the
first day of July following publication of the changes.
(d) For purposes of paragraph (b), "income" means the
adjusted gross income of the natural or adoptive parents determined according
to the previous year's federal tax form, except, effective retroactive to
July 1, 2003, taxable capital gains to the extent the funds have been used to
purchase a home shall not be counted as income.
(e) The contribution shall be explained in writing to the
parents at the time eligibility for services is being determined. The contribution shall be made on a monthly
basis effective with the first month in which the child receives services. Annually upon redetermination or at
termination of eligibility, if the contribution exceeded the cost of services
provided, the local agency or the state shall reimburse that excess amount to
the parents, either by direct reimbursement if the parent is no longer required
to pay a contribution, or by a reduction in or waiver of parental fees until
the excess amount is exhausted.
(f) The monthly contribution amount must be reviewed at least
every 12 months; when there is a change in household size; and when there is a
loss of or gain in income from one month to another in excess of ten
percent. The local agency shall mail a
written notice 30 days in advance of the effective date of a change in the
contribution amount. A decrease in the
contribution amount is effective in the month that the parent verifies a
reduction in income or change in household size.
(g) Parents of a minor child who do not live with each other
shall each pay the contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services
shall be deducted from the adjusted gross income of the parent making the
payment prior to calculating the parental contribution under paragraph (b).
(h) The contribution under paragraph (b) shall be increased by
an additional five percent if the local agency determines that insurance
coverage is available but not obtained for the child. For purposes of this section, "available" means the
insurance is a benefit of employment for a family member at an annual cost of
no more than five percent of the family's annual income. For purposes of this section,
"insurance" means health and accident insurance coverage, enrollment
in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.
Parents who have more than one child receiving services
shall not be required to pay more than the amount for the child with the
highest expenditures. There shall be no
resource contribution from the parents.
The parent shall not be required to pay a contribution in excess of the
cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must be given at least 30
days before the increased fee is due.
(i) The contribution under paragraph (b) shall be reduced by
$300 per fiscal year if, in the 12 months prior to July 1:
(1) the parent applied for insurance for the child;
(2) the insurer denied insurance;
(3) the parents submitted a complaint or appeal, in writing to
the insurer, submitted a complaint or appeal, in writing, to the commissioner
of health or the commissioner of commerce, or litigated the complaint or
appeal; and
(4) as a result of the dispute, the insurer reversed its
decision and granted insurance.
For purposes of this section, "insurance" has the
meaning given in paragraph (h).
A parent who has requested a reduction in the contribution
amount under this paragraph shall submit proof in the form and manner
prescribed by the commissioner or county agency, including, but not limited to,
the insurer's denial of insurance, the written letter or complaint of the
parents, court documents, and the written response of the insurer approving
insurance. The determinations of the
commissioner or county agency under this paragraph are not rules subject to
chapter 14.
Sec. 2. Minnesota
Statutes 2003 Supplement, section 256.019, subdivision 1, is amended to read:
Subdivision 1.
[RETENTION RATES.] When an assistance recovery amount is collected and
posted by a county agency under the provisions governing public assistance
programs including general assistance medical care, general assistance, and
Minnesota supplemental aid, the county may keep one-half of the recovery made
by the county agency using any method other than recoupment. For medical assistance, if the recovery is
made by a county agency using any method other than recoupment, the county may
keep one-half of the nonfederal share of the recovery. County agencies may retain 25 percent of
a MinnesotaCare assistance recovery collection when the recovery is collected
and posted by the county.
This does not apply to recoveries from medical providers or to
recoveries begun by the Department of Human Services' Surveillance and
Utilization Review Division, State Hospital Collections Unit, and the Benefit
Recoveries Division or, by the attorney general's office, or child support
collections. In the food stamp or food
support program, the nonfederal share of recoveries in the federal tax offset
program only will be divided equally between the state agency and the involved
county agency.
Sec. 3. Minnesota
Statutes 2002, section 256.9365, subdivision 1, is amended to read:
Subdivision 1. [PROGRAM
ESTABLISHED.] The commissioner of human services shall establish a program to
pay private health plan premiums for persons who have contracted human
immunodeficiency virus (HIV) to enable them to continue coverage under a group
or individual health plan. If a person
is determined to be eligible under subdivision 2, the commissioner shall pay the
portion of the group plan premium for which the individual is responsible, if
the individual is responsible for at least 50 percent of the cost of the
premium, or pay the individual plan premium. The commissioner shall not pay for that
portion of a premium that is attributable to other family members or
dependents. The commissioner shall
establish cost-sharing provisions for individuals participating in this program
that are consistent with provisions in section 256B.057, subdivision 9, for
employed persons with disabilities.
[EFFECTIVE DATE.] This
section is effective July 1, 2004.
Sec. 4. Minnesota
Statutes 2002, section 256B.0916, subdivision 2, is amended to read:
Subd. 2. [DISTRIBUTION
OF FUNDS; PARTNERSHIPS.] (a) Beginning with fiscal year 2000, the commissioner
shall distribute all funding available for home and community-based waiver
services for persons with mental retardation or related conditions to
individual counties or to groups of counties that form partnerships to jointly
plan, administer, and authorize funding for eligible individuals. The commissioner shall encourage counties to
form partnerships that have a sufficient number of recipients and funding to
adequately manage the risk and maximize use of available resources.
(b) Counties must submit a request for funds and a plan for
administering the program as required by the commissioner. The plan must identify the number of clients
to be served, their ages, and their priority listing based on:
(1) requirements in Minnesota Rules, part 9525.1880;
(2) unstable living situations due to the age or incapacity of
the primary caregiver;
(3) the need for services to avoid out-of-home placement of
children; and
(4) the need to serve persons affected by private sector ICF/MR
closures; and
(5) the need to serve persons whose consumer support grant
exception amount was eliminated in 2004.
The plan must also identify
changes made to improve services to eligible persons and to improve program
management.
(c) In allocating resources to counties, priority must be given
to groups of counties that form partnerships to jointly plan, administer, and
authorize funding for eligible individuals and to counties determined by the
commissioner to have sufficient waiver capacity to maximize resource use.
(d) Within 30 days after receiving the county request for funds
and plans, the commissioner shall provide a written response to the plan that
includes the level of resources available to serve additional persons.
(e) Counties are eligible to receive medical assistance
administrative reimbursement for administrative costs under criteria
established by the commissioner.
Sec. 5. Minnesota
Statutes 2003 Supplement, section 256B.19, subdivision 1, is amended to read:
Subdivision 1.
[DIVISION OF COST.] The state and county share of medical assistance
costs not paid by federal funds shall be as follows:
(1) beginning January 1, 1992, 50 percent state funds and 50
percent county funds for the cost of placement of severely emotionally
disturbed children in regional treatment centers;
(2) beginning January 1, 2003, 80 percent state funds and
20 percent county funds for the costs of nursing facility placements of persons
with disabilities under the age of 65 that have exceeded 90 days. This clause shall be subject to chapter 256G
and shall not apply to placements in facilities not certified to participate in
medical assistance; and
(3) beginning July 1, 2004, 80 percent state funds and 20
percent county funds for the costs of placements that have exceeded 90 days in
intermediate care facilities for persons with mental retardation or a related
condition that have seven or more beds.
This provision includes pass-through payments made under section
256B.5015; and
(4) beginning July 1, 2004, when state funds are used to
pay for a nursing facility placement due to the facility's status as an
institution for mental diseases (IMD), the county shall pay 20 percent of the
nonfederal share of costs that have exceeded 90 days. This clause is subject to chapter 256G.
For counties that participate in a Medicaid demonstration
project under sections 256B.69 and 256B.71, the division of the nonfederal
share of medical assistance expenses for payments made to prepaid health plans
or for payments made to health maintenance organizations in the form of prepaid
capitation payments, this division of medical assistance expenses shall be 95
percent by the state and five percent by the county of financial
responsibility.
In counties where prepaid health plans are under contract to
the commissioner to provide services to medical assistance recipients, the cost
of court ordered treatment ordered without consulting the prepaid health plan
that does not include diagnostic evaluation, recommendation, and referral for
treatment by the prepaid health plan is the responsibility of the county of
financial responsibility.
[EFFECTIVE DATE.] This
section is effective the day following final enactment.
Sec. 6. Minnesota
Statutes 2002, section 256B.49, is amended by adding a subdivision to read:
Subd. 21.
[REPORT.] The commissioner shall expand on the annual report required
under section 256B.0916, subdivision 7, to include information on the county of
residence and financial responsibility, age, and major diagnoses for persons
eligible for the home and community-based waivers authorized under subdivision
11 who are:
(1) receiving those services;
(2) screened and waiting for waiver services; and
(3) residing in nursing facilities and are under age 65.
Sec. 7. [ICF/MR PLAN.]
The commissioner of human services shall consult with ICF/MR
providers, advocates, counties, and consumer families to develop
recommendations and legislation concerning the future services provided to
people now served in ICFs/MR. The
recommendations shall be reported to the house and senate committees with
jurisdiction over health and human services policy and finance issues by
December 15, 2004. In preparing the
recommendations, the commissioner shall consider:
(1) consumer choice of services;
(2) consumers' service needs, including, but not limited to,
active treatment;
(3) the total cost of providing services in ICFs/MR and
alternative delivery systems;
(4) whether it is the policy of the state to maintain
an ICF/MR system and, if so, the recommendations shall define the ICF/MR
payment system to ensure adequate resources to meet changing consumer needs,
provide crisis and respite services, and ensure stability when occupancy
changes; and
(5) if alternative services are recommended to support
people now receiving services in an ICF/MR, the recommendations shall ensure
adequate financial resources are available to meet the needs of ICF/MR
recipients.
[EFFECTIVE DATE.] This
section is effective the day following final enactment.
Sec. 8. [CONSUMER
DIRECTED COMMUNITY SUPPORT; INDEPENDENT EVALUATION AND STAKEHOLDER
PARTICIPATION.]
The commissioner shall consult with a group of interested
stakeholders including representatives of persons affected, families,
guardians, advocacy groups, counties, and providers in conducting an
independent evaluation of the new consumer directed community support option
under the home and community-based waiver programs required by the federal
Center for Medicare and Medicaid Services.
The independent evaluation shall include, but not be limited to, an
examination of whether any current consumer directed option participants will
have their funding reduced so significantly that their health, safety, and
welfare at home will be jeopardized and whether replacement services will cost
more or be of lower quality than their current consumer directed services. The preliminary findings of the independent
evaluation shall be provided to the house and senate committees with jurisdiction
over human services policy and finance by February 15, 2005.
ARTICLE
12
DHS
PROGRAM INTEGRITY AND ADMINISTRATION
Section 1. Minnesota
Statutes 2002, section 256.01, is amended by adding a subdivision to read:
Subd. 2a.
[AUTHORIZATION FOR TEST SITES FOR HEALTH CARE PROGRAMS.] In
coordination with the development and implementation of HealthMatch, an
automated eligibility system for medical assistance, general assistance medical
care, and MinnesotaCare, the commissioner, in cooperation with county agencies,
is authorized to test and compare a variety of administrative models to
demonstrate and evaluate outcomes of integrating health care program business
processes and points of access. The
models will be evaluated for ease of enrollment for health care program
applicants and recipients and administrative efficiencies. Test sites will combine the administration
of all three programs and will include both local county and centralized
statewide customer assistance. The
duration of each approved test site shall be no more than one year. Based on the evaluation, the commissioner
shall recommend the most efficient and effective administrative model for
statewide implementation.
Sec. 2. Minnesota
Statutes 2003 Supplement, section 256.046, subdivision 1, is amended to read:
Subdivision 1. [HEARING
AUTHORITY.] A local agency must initiate an administrative fraud
disqualification hearing for individuals, including child care providers caring
for children receiving child care assistance, accused of wrongfully obtaining
assistance or intentional program violations, in lieu of a criminal action when
it has not been pursued, in the aid to families with dependent children program
formerly codified in sections 256.72 to 256.87, MFIP, child care assistance
programs, general assistance, family general assistance program formerly
codified in section 256D.05, subdivision 1, clause (15), Minnesota supplemental
aid, food stamp programs, general assistance medical care, MinnesotaCare for
adults without children, and upon federal approval, all categories of medical
assistance and remaining categories of MinnesotaCare except for children
through age 18. The Department of
Human Services, in lieu of a local agency, may initiate an administrative fraud
disqualification hearing for individuals accused of wrongfully obtaining
assistance or intentional program violations, in lieu of a criminal action when
a criminal action has not been pursued in the MinnesotaCare program for adults
without children, and upon federal approval, all remaining categories of
MinnesotaCare, except for children through age 18. The hearing is subject to the requirements
of section 256.045 and the requirements in Code of Federal Regulations, title
7, section 273.16, for the food stamp program and title 45, section 235.112, as
of September 30, 1995, for the cash grant, medical care programs, and child
care assistance under chapter 119B.
Sec. 3. Minnesota
Statutes 2002, section 256B.02, subdivision 12, is amended to read:
Subd. 12. "Third-party
payer" means a person, entity, or agency or government program that has a
probable obligation to pay all or part of the costs of a medical assistance
recipient's health services. Third-party
payer includes an entity under contract with the recipient to cover all or part
of the recipient's medical costs.
Sec. 4. Minnesota
Statutes 2002, section 256B.04, subdivision 14, is amended to read:
Subd. 14. [COMPETITIVE
BIDDING.] When determined to be effective, economical, and feasible, the commissioner
may utilize volume purchase through competitive bidding and negotiation under
the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner
shall provide for oxygen needed in an emergency situation on a short-term
basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies; and
(4) durable medical equipment, including but not limited to:
(a) hospital beds;
(b) commodes;
(c) glide-about chairs;
(d) patient lift apparatus;
(e) wheelchairs and accessories;
(f) oxygen administration equipment;
(g) respiratory therapy equipment;
(h) electronic diagnostic, therapeutic and life support
systems;
(5) special transportation services; and
(6) drugs.
Rate changes under chapters 256B, 256D, and 256L, do not
effect contract payments under this subdivision unless specifically identified.
Sec. 5. Minnesota Statutes 2002, section 256B.056, subdivision 5, is
amended to read:
Subd. 5. [EXCESS
INCOME.] (a) A person who has excess income is eligible for medical
assistance if the person has expenses for medical care that are more than the
amount of the person's excess income, computed by deducting incurred medical
expenses from the excess income to reduce the excess to the income standard
specified in subdivision 5c. If a
person is ineligible for payment of long-term care services due to an
uncompensated transfer under section 256B.0595, only the current month's
long-term care expenses that are greater than the average medical assistance
rate for nursing facility services in the state, along with other incurred
medical expenses, may be deducted from excess income. The person shall elect to have the medical
expenses deducted at the beginning of a one-month budget period or at the
beginning of a six-month budget period.
(b) The commissioner shall allow persons eligible for
assistance on a one-month spenddown basis under this subdivision to elect to
pay the monthly spenddown amount in advance of the month of eligibility to the
state agency in order to maintain eligibility on a continuous basis. If the recipient does not pay the spenddown
amount on or before the 20th last business day of the month, the
recipient is ineligible for this option for the following month. The local agency shall code the Medicaid
Management Information System (MMIS) to indicate that the recipient has elected
this option. The state agency shall
convey recipient eligibility information relative to the collection of the
spenddown to providers through the Electronic Verification System (EVS). A recipient electing advance payment must
pay the state agency the monthly spenddown amount on or before noon
on the 20th last business day of the month in order to be
eligible for this option in the following month.
[EFFECTIVE DATE.] The
amendment to paragraph (b) is effective upon implementation of HealthMatch.
Sec. 6. Minnesota
Statutes 2002, section 256B.056, is amended by adding a subdivision to read:
Subd. 8a.
[NOTICE.] The state agency must be given notice of monetary claims
against a person, entity, or corporation that may be liable to pay all or part
of all of the cost of medical care when the state agency has paid or becomes
liable for the cost of that care.
Notice must be given as follows:
(a) An applicant for medical assistance shall notify the
state or local agency of any possible claims when the applicant submits the
application. A recipient of medical
assistance shall notify the state or local agency of any possible claims when
those claims arise.
(b) A person providing medical care services to a recipient
of medical assistance shall notify the state agency when the person has reason
to believe that a third party may be liable for payment of the cost of medical
care.
(c) A party to a claim that may be assigned to the state
agency under this section shall notify the state agency of its potential
assignment claim in writing at each of the following stages of a claim:
(1) when a claim is filed;
(2) when an action is commenced; and
(3) when a claim is concluded by payment, award, judgment,
settlement, or otherwise.
Every party involved in any stage of a claim under this
subdivision is required to provide notice to the state agency at that stage of
the claim. However, when one of the
parties to the claim provides notice at that stage, every other party to the
claim is deemed to have provided the required notice for that stage of the
claim. If the required notice under
this paragraph is not provided to the state agency, all parties to the claim
are deemed to have failed to provide
the required notice. A party to the
claim includes the injured person or the person's legal representative, the
plaintiff, the defendants, or persons alleged to be responsible for
compensating the injured person or plaintiff, and any other party to the cause
of action or claim, regardless of whether the party knows the state agency has a
potential or actual assignment claim.
Sec. 7. Minnesota
Statutes 2002, section 256B.056, is amended by adding a subdivision to read:
Subd. 8b.
[JOINDER OF STATE IN ACTIONS AGAINST THIRD PARTIES.] Any medical
assistance recipient or the recipient's legal representative asserting a claim
against a third party potentially liable for all or part of the recipient's
medical costs shall join the state agency as a party to the claim.
Sec. 8. Minnesota
Statutes 2002, section 256B.056, is amended by adding a subdivision to read:
Subd. 8c.
[SETTLEMENT.] Pursuant to United States Code, title 42, section
1396k(b), no judgment, award, or settlement of any action or claim by or on
behalf of a medical assistance recipient to recover damages from a third party
potentially liable for all or part of the recipient's medical costs shall be
acceded to or satisfied by the recipient or the recipient's legal
representative or approved by the court without granting the state agency first
recovery from the liable third party to the full extent of its medical
expenditures, minus pro rata costs and attorney fees, regardless of whether the
recipient has been fully compensated.
Sec. 9. Minnesota
Statutes 2003 Supplement, section 256B.0595, subdivision 2, is amended to read:
Subd. 2. [PERIOD OF
INELIGIBILITY.] (a) For any uncompensated transfer occurring on or before
August 10, 1993, the number of months of ineligibility for long-term care
services shall be the lesser of 30 months, or the uncompensated transfer amount
divided by the average medical assistance rate for nursing facility services in
the state in effect on the date of application. The amount used to calculate the average medical assistance
payment rate shall be adjusted each July 1 to reflect payment rates for the
previous calendar year. The period of
ineligibility begins with the month in which the assets were transferred. If the transfer was not reported to the
local agency at the time of application, and the applicant received long-term
care services during what would have been the period of ineligibility if the
transfer had been reported, a cause of action exists against the transferee for
the cost of long-term care services provided during the period of
ineligibility, or for the uncompensated amount of the transfer, whichever is
less. The action may be brought by the
state or the local agency responsible for providing medical assistance under
chapter 256G. The uncompensated
transfer amount is the fair market value of the asset at the time it was given
away, sold, or disposed of, less the amount of compensation received.
(b) For uncompensated transfers made after August 10, 1993, the
number of months of ineligibility for long-term care services shall be the
total uncompensated value of the resources transferred divided by the average
medical assistance rate for nursing facility services in the state in effect on
the date of application. The amount
used to calculate the average medical assistance payment rate shall be adjusted
each July 1 to reflect payment rates for the previous calendar year. The period of ineligibility begins with the
first day of the month after the month in which the assets were transferred
except that if one or more uncompensated transfers are made during a period of
ineligibility, the total assets transferred during the ineligibility period
shall be combined and a penalty period calculated to begin on the first day of
the month after the month in which the first uncompensated transfer was made. If the transfer was reported to the local
agency after the date advance notice of a period of ineligibility that affects
the next month could be provided to the recipient and the recipient received
medical assistance services, or the transfer was not reported to the local
agency agency
responsible for providing medical assistance under chapter 256G. The uncompensated transfer amount is the
fair market value of the asset at the time it was given away, sold, or disposed
of, less the amount of compensation received.
Effective for transfers made on or after March 1, 1996, involving
persons who apply for medical assistance on or after April 13, 1996, no cause
of action exists for a transfer unless: , and the applicant or recipient received medical
assistance services during what would have been the period of ineligibility if
the transfer had been reported, a cause of action exists against the transferee
for the cost of medical assistance services provided during the period of
ineligibility, or for the uncompensated amount of the transfer, whichever is
less. The action may be brought by the
state or the local
(1) the transferee knew or should have known that the transfer
was being made by a person who was a resident of a long-term care facility or
was receiving that level of care in the community at the time of the transfer;
(2) the transferee knew or should have known that the transfer
was being made to assist the person to qualify for or retain medical assistance
eligibility; or
(3) the transferee actively solicited the transfer with intent
to assist the person to qualify for or retain eligibility for medical
assistance.
(c) If a calculation of a penalty period results in a partial
month, payments for long-term care services shall be reduced in an amount equal
to the fraction, except that in calculating the value of uncompensated
transfers, if the total value of all uncompensated transfers made in a month
not included in an existing penalty period does not exceed $200, then such
transfers shall be disregarded for each month prior to the month of application
for or during receipt of medical assistance.
[EFFECTIVE DATE.] This
section is effective for transfers occurring on or after July 1, 2004.
Sec. 10. Minnesota
Statutes 2003 Supplement, section 256D.03, subdivision 3, is amended to read:
Subd. 3. [GENERAL
ASSISTANCE MEDICAL CARE; ELIGIBILITY.] (a) General assistance medical care may
be paid for any person who is not eligible for medical assistance under chapter
256B, including eligibility for medical assistance based on a spenddown of
excess income according to section 256B.056, subdivision 5, or MinnesotaCare as
defined in paragraph (b), except as provided in paragraph (c), and:
(1) who is receiving assistance under section 256D.05, except
for families with children who are eligible under Minnesota family investment
program (MFIP), or who is having a payment made on the person's behalf under
sections 256I.01 to 256I.06; or
(2) who is a resident of Minnesota; and
(i) who has gross countable income not in excess of 75 percent
of the federal poverty guidelines for the family size, using a six-month budget
period and whose equity in assets is not in excess of $1,000 per assistance
unit. Exempt assets, the reduction of
excess assets, and the waiver of excess assets must conform to the medical
assistance program in section 256B.056, subdivision 3, with the following
exception: the maximum amount of
undistributed funds in a trust that could be distributed to or on behalf of the
beneficiary by the trustee, assuming the full exercise of the trustee's
discretion under the terms of the trust, must be applied toward the asset
maximum; or
(ii) who has gross countable income above 75 percent of the
federal poverty guidelines but not in excess of 175 percent of the federal poverty
guidelines for the family size, using a six-month budget period, whose equity
in assets is not in excess of the limits in section 256B.056, subdivision 3c,
and who applies during an inpatient hospitalization.
(b) General assistance medical care may not be paid for
applicants or recipients who meet all eligibility requirements of MinnesotaCare
as defined in sections 256L.01 to 256L.16, and are adults with dependent
children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines.
(c) For applications received on or after October 1, 2003,
eligibility may begin no earlier than the date of application. For individuals eligible under paragraph
(a), clause (2), item (i), a redetermination of eligibility must occur every 12
months. Individuals are eligible under
paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization. Beginning January 1, 2000, Minnesota health
care program applications completed by recipients and applicants who are
persons described in paragraph (b), may be returned to the county agency to be
forwarded to the Department of Human Services or sent directly to the
Department of Human Services for enrollment in MinnesotaCare. If all other eligibility requirements of
this subdivision are met, eligibility for general assistance medical care shall
be available in any month during which a MinnesotaCare eligibility
determination and enrollment are pending.
Upon notification of eligibility for MinnesotaCare, notice of
termination for eligibility for general assistance medical care shall be sent
to an applicant or recipient. If all
other eligibility requirements of this subdivision are met, eligibility for
general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraph (e).
(d) The date of an initial Minnesota health care program
application necessary to begin a determination of eligibility shall be the date
the applicant has provided a name, address, and Social Security number, signed
and dated, to the county agency or the Department of Human Services. If the applicant is unable to provide a
name, address, Social Security number, and signature when health care is
delivered due to a medical condition or disability, a health care provider may
act on an applicant's behalf to establish the date of an initial Minnesota
health care program application by providing the county agency or Department of
Human Services with provider identification and a temporary unique identifier
for the applicant. The applicant must
complete the remainder of the application and provide necessary verification
before eligibility can be determined.
The county agency must assist the applicant in obtaining verification if
necessary.
(e) County agencies are authorized to use all automated
databases containing information regarding recipients' or applicants' income in
order to determine eligibility for general assistance medical care or
MinnesotaCare. Such use shall be
considered sufficient in order to determine eligibility and premium payments by
the county agency.
(f) General assistance medical care is not available for a
person in a correctional facility unless the person is detained by law for less
than one year in a county correctional or detention facility as a person
accused or convicted of a crime, or admitted as an inpatient to a hospital on a
criminal hold order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or admitted on a
criminal hold order and as long as the person continues to meet other
eligibility requirements of this subdivision.
(g) General assistance medical care is not available for applicants
or recipients who do not cooperate with the county agency to meet the
requirements of medical assistance.
(h) In determining the amount of assets of an individual the transfer shall not result
in eligibility unless and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was
not reported, the month in which the county agency discovered the transfer,
whichever comes first. For applicants,
the period of ineligibility begins on the date of the first approved
application. eligible
under paragraph (a), clause (2), item (i), there shall be included any asset
or interest in an asset, including an asset excluded under paragraph (a), that
was given away, sold, or disposed of for less than fair market value within the
60 months preceding application for general assistance medical care or during
the period of eligibility. Any transfer
described in this paragraph shall be presumed to have been for the purpose of
establishing eligibility for general assistance medical care, unless the
individual furnishes convincing evidence to establish that the transaction was
exclusively for another purpose. For
purposes of this paragraph, the value of the asset or interest shall be the
fair market value at the time it was given away, sold, or disposed of, less the
amount of compensation received. For
any uncompensated transfer, the number of months of ineligibility, including
partial months, shall be calculated by dividing the uncompensated transfer
amount by the average monthly per person payment made by the medical assistance
program to skilled nursing facilities for the previous calendar year. The individual shall remain ineligible until
this fixed period has expired. The
period of ineligibility may exceed 30 months, and a reapplication for benefits
after 30 months from the date of
(i) When determining eligibility for any state benefits under
this subdivision, the income and resources of all noncitizens shall be deemed
to include their sponsor's income and resources as defined in the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996, title IV,
Public Law 104-193, sections 421 and 422, and subsequently set out in federal
rules.
(j) Undocumented noncitizens and nonimmigrants are ineligible
for general assistance medical care, except an individual eligible under
paragraph (a), clause (4), remains eligible through September 30, 2003. For purposes of this subdivision, a
nonimmigrant is an individual in one or more of the classes listed in United
States Code, title 8, section 1101(a)(15), and an undocumented noncitizen is an
individual who resides in the United States without the approval or
acquiescence of the Immigration and Naturalization Service.
(k) Notwithstanding any other provision of law, a noncitizen
who is ineligible for medical assistance due to the deeming of a sponsor's
income and resources, is ineligible for general assistance medical care.
(l) Effective July 1, 2003, general assistance medical care
emergency services end.
Sec. 11. Minnesota
Statutes 2002, section 256D.045, is amended to read:
256D.045 [SOCIAL SECURITY NUMBER REQUIRED.]
To be eligible for general assistance under sections 256D.01 to
256D.21, an individual must provide the individual's Social Security number to
the county agency or submit proof that an application has been made. An individual who refuses to provide a
Social Security number because of a well-established religious objection as
described in Code of Federal Regulations, title 42, section 435.910, may be
eligible for general assistance medical care under section 256D.03. The provisions of this section do not apply
to the determination of eligibility for emergency general assistance under
section 256D.06, subdivision 2. This
provision applies to eligible children under the age of 18 effective July 1,
1997.
Sec. 12. Minnesota
Statutes 2002, section 256L.04, is amended by adding a subdivision to read:
Subd. 1a.
[SOCIAL SECURITY NUMBER REQUIRED.] (a) Individuals and families
applying for MinnesotaCare coverage must provide a Social Security number.
(b) The commissioner shall not deny eligibility to an
otherwise eligible applicant who has applied for a Social Security number and
is awaiting issuance of that Social Security number.
(c) Newborns enrolled under section 256L.05, subdivision 3,
are exempt from the requirements of this subdivision.
(d) Individuals who refuse to provide a Social Security
number because of well-established religious objections are exempt from this
subdivision. The term
"well-established religious objections" has the meaning given in Code
of Federal Regulations, title 42, section 435.910.
Sec. 13. Minnesota
Statutes 2002, section 256L.04, subdivision 2, is amended to read:
Subd. 2. [COOPERATION
IN ESTABLISHING THIRD-PARTY LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.]
(a) To be eligible for MinnesotaCare, individuals and families must cooperate
with the state agency to identify potentially liable third-party payers and
assist the state in obtaining third-party payments. "Cooperation" includes, but is not limited to, complying
with the notice and settlement requirements in section 256B.056, subdivisions
8a and 8c, identifying any third party who may be liable for care and
services provided under MinnesotaCare to the enrollee, providing relevant
information to assist the state in pursuing a potentially liable third party,
and completing forms necessary to recover third-party payments.
(b) A parent, guardian, relative caretaker, or child enrolled
in the MinnesotaCare program must cooperate with the Department of Human
Services and the local agency in establishing the paternity of an enrolled
child and in obtaining medical care support and payments for the child and any
other person for whom the person can legally assign rights, in accordance with
applicable laws and rules governing the medical assistance program. A child shall not be ineligible for or disenrolled
from the MinnesotaCare program solely because the child's parent, relative
caretaker, or guardian fails to cooperate in establishing paternity or
obtaining medical support.
Sec. 14. Minnesota
Statutes 2002, section 256L.04, is amended by adding a subdivision to read:
Subd. 2a. [APPLICATIONS
FOR OTHER BENEFITS.] To be eligible for MinnesotaCare, individuals and
families must take all necessary steps to obtain other benefits as described in
Code of Federal Regulations, title 42, section 435.608. Applicants and enrollees must apply for
other benefits within 30 days.
Sec. 15. Minnesota
Statutes 2002, section 549.02, is amended by adding a subdivision to read:
Subd. 3.
[LIMITATION.] Notwithstanding subdivisions 1 and 2, where the state
agency is joined as a party according to section 256B.056, subdivision 8b, or
brings an independent action to enforce the agency's rights under section
256B.056, the state agency shall not be liable for costs to any prevailing
defendant.
Sec. 16. Minnesota
Statutes 2002, section 549.04, is amended to read:
549.04 [DISBURSEMENTS; TAXATION AND ALLOWANCE.]
Subdivision 1.
[GENERALLY.] In every action in a district court, the prevailing party,
including any public employee who prevails in an action for wrongfully denied
or withheld employment benefits or rights, shall be allowed reasonable
disbursements paid or incurred, including fees and mileage paid for service of
process by the sheriff or by a private person.
Subd. 2.
[LIMITATION.] Notwithstanding subdivision 1, where the state agency is
joined as a party according to section 256B.056, subdivision 8b, or brings an
independent action to enforce its rights under section 256B.056, the state
agency shall not be liable for disbursements to any prevailing defendant.
ARTICLE
13
MISCELLANEOUS
Section 1. Minnesota
Statutes 2002, section 144.148, is amended by adding a subdivision to read:
Subd. 9. [STATUS
OF PREVIOUS AWARDS.] The commissioner must regard grants or loans awarded to
eligible rural hospitals before August 1, 1999, as grants subject to the
conditions of this section and not subject to repayment as loans under
Minnesota Statutes 1998, section 144.148.
Sec. 2. Minnesota
Statutes 2002, section 144D.025, is amended to read:
144D.025 [OPTIONAL REGISTRATION.]
An establishment that meets all the requirements of this
chapter except that fewer than 80 percent of the adult residents are age 55 or
older, or a supportive housing establishment developed and funded in whole
or in part with funds provided specifically as part of the plan to end
long-term homelessness required under Laws 2003, chapter 128, article 15,
section 9, may, at its option, register as a housing with services
establishment.
Sec. 3. [145.417]
[FAMILY PLANNING GRANT FUNDS NOT USED TO SUBSIDIZE ABORTION SERVICES.]
Subdivision 1.
[DEFINITIONS.] (a) For purposes of this section, the following
definitions apply.
(b) "Abortion" means the use or prescription of
any instrument, medicine, drug, or any other substance or device to
intentionally terminate the pregnancy of a female known to be pregnant, with an
intention other than to prevent the death of the female, increase the
probability of a live birth, preserve the life or health of the child after
live birth, or remove a dead fetus.
(c) "Family planning grant funds" means funds
distributed through the maternal and child health block grant program under
sections 145.881 to 145.889, the family planning special projects grant program
under section 145.925, the program to eliminate health disparities under
section 145.928, or any other state grant program whose funds are or may be
used to fund family planning services.
(d) "Family planning services" means preconception
services that limit or enhance fertility, including methods of contraception,
the management of infertility, preconception counseling, education, and general
reproductive health care.
(e) "Nondirective counseling" means providing
patients with:
(1) a list of health care providers and social service
providers that provide prenatal care, childbirth care, infant care, foster
care, adoption services, alternatives to abortion, or abortion services; and
(2) nondirective, nonmarketing information regarding such
providers.
(f) "Public advocacy" means engaging in one or
more of the following:
(1) regularly engaging in efforts to encourage the passage
or defeat of legislation pertaining to the continued or expanded availability
of abortion;
(2) publicly endorsing or recommending the election or
defeat of a candidate for public office based on the candidate's position on
the legality of abortion; or
(3) engaging in civil litigation against a unit of
government as a plaintiff seeking to enjoin or otherwise prohibit enforcement
of a statute, ordinance, rule, or regulation pertaining to abortion.
Subd. 2. [USES
OF FAMILY PLANNING GRANT FUNDS.] No family planning grant funds may be:
(1) expended to directly or indirectly subsidize abortion
services or administrative expenses; or
(2) paid or granted to an organization or an affiliate
of an organization that provides abortion services, unless the affiliate is
independent as provided in subdivision 4.
Subd. 3.
[ORGANIZATIONS RECEIVING FAMILY PLANNING GRANT FUNDS.] An
organization that receives family planning grant funds:
(1) may provide nondirective counseling relating to
pregnancy, but may not directly refer patients who seek abortion services to
any organization that provides abortion services, including an independent
affiliate of the organization receiving family planning grant funds. For purposes of this clause, an affiliate is
independent if it satisfies the criteria in subdivision 4, paragraph (a);
(2) may not display or distribute marketing materials about
abortion services to patients;
(3) may not engage in public advocacy promoting the legality
or accessibility of abortion; and
(4) must be separately incorporated from any affiliated
organization that provides abortion services.
Subd. 4.
[INDEPENDENT AFFILIATES THAT PROVIDE ABORTION SERVICES.] (a) To ensure
that the state does not lend its imprimatur to abortion services and to ensure
that an organization that provides abortion services does not receive a direct
or indirect economic or marketing benefit from family planning grant funds, an
organization that receives family planning grant funds may not be affiliated
with an organization that provides abortion services unless the organizations
are independent from each other. To be
independent, the organizations may not share any of the following:
(1) the same or a similar name;
(2) medical facilities or nonmedical facilities, including,
but not limited to, business offices, treatment rooms, consultation rooms,
examination rooms, and waiting rooms;
(3) expenses;
(4) employee wages or salaries; or
(5) equipment or supplies, including, but not limited to,
computers, telephone systems, telecommunications equipment, and office
supplies.
(b) An organization that receives family planning grant
funds and that is affiliated with an organization that provides abortion
services must maintain financial records that demonstrate strict compliance
with this subdivision and that demonstrate that its independent affiliate that
provides abortion services receives no direct or indirect economic or marketing
benefit from the family planning grant funds.
Subd. 5.
[INDEPENDENT AUDIT.] When an organization applies for family planning
grant funds, the organization must submit with the grant application a copy of
the organization's most recent independent audit to ensure the organization is
in compliance with this section. The
independent audit must have been conducted no more than two years before the
organization submits its grant application.
Subd. 6.
[ORGANIZATIONS RECEIVING TITLE X FUNDS.] Nothing in this section
requires an organization that receives federal funds under Title X of the
Public Health Service Act to refrain from performing any service that is
required to be provided as a condition of receiving Title X funds, as specified
by the provisions of Title X or the Title X program guidelines for project
grants for family planning services published by the United States Department
of Health and Human Services.
Subd. 7. [SEVERABILITY.] If any one or more
provision, word, phrase, clause, sentence, or subdivision of this section, or
the application to any person or circumstance, is found to be unconstitutional,
it is declared to be severable and the balance of this section shall remain
effective notwithstanding such unconstitutionality. The legislature hereby declares that it would have passed this
section, and each provision, word, phrase, clause, sentence, or subdivision of
it, regardless of the fact that any one or more provision, word, phrase,
clause, sentence, or subdivision be declared unconstitutional.
Sec. 4. Minnesota
Statutes 2003 Supplement, section 246B.04, as amended by Laws 2004, chapter
134, section 2, is amended to read:
246B.04 [RULES; EVALUATION.]
Subdivision 1. [PROGRAM
RULES AND EVALUATION.] The commissioner of human services shall adopt rules to
govern the operation, maintenance, and licensure of secure treatment facilities
operated by the Minnesota sex offender program or at any other facility
operated by the commissioner, for a person committed as a sexual psychopathic personality
or a sexually dangerous person. The
commissioner shall establish an evaluation process to measure outcomes and
behavioral changes as a result of treatment compared with incarceration without
treatment, to determine the value, if any, of treatment in protecting the
public.
Subd. 2. [BAN ON
OBSCENE MATERIAL OR PORNOGRAPHIC WORK.] The commissioner shall prohibit persons
civilly committed as sexual psychopathic personalities or sexually dangerous
persons under sections Minnesota Statutes 1978, section 246.43
and section 253B.185 from having or receiving material that is obscene
as defined under section 617.241, subdivision 1, material that depicts sexual
conduct as defined under section 617.241, subdivision 1, or pornographic work
as defined under section 617.246, subdivision 1, while receiving services in
any secure treatment facilities operated by the Minnesota sex offender program
or any other facilities operated by the commissioner.
Sec. 5. Minnesota
Statutes 2002, section 256.01, is amended by adding a subdivision to read:
Subd. 14a.
[SINGLE BENEFIT DEMONSTRATION.] The commissioner may conduct a
demonstration program under a federal Title IV-E waiver to demonstrate the
impact of a single benefit level on the rate of permanency for children in
long-term foster care through transfer of permanent legal custody or
adoption. The commissioner of human
services is authorized to waive enforcement of related statutory program
requirements, rules, and standards in one or more counties for the purpose of
this demonstration. The demonstration
must comply with the requirements of the secretary of health and human services
under federal waiver and be cost neutral to the state.
The commissioner may measure cost neutrality to the state by
the same mechanism approved by the secretary of health and human services to
measure federal cost neutrality. The
commissioner is authorized to accept and administer county funds and to
transfer state and federal funds among the affected programs as necessary for
the conduct of the demonstration.
Sec. 6. Minnesota
Statutes 2003 Supplement, section 256D.44, subdivision 5, is amended to read:
Subd. 5. [SPECIAL
NEEDS.] In addition to the state standards of assistance established in
subdivisions 1 to 4, payments are allowed for the following special needs of
recipients of Minnesota supplemental aid who are not residents of a nursing
home, a regional treatment center, or a group residential housing facility.
(a) The county agency shall pay a monthly allowance for
medically prescribed diets if the cost of those additional dietary needs cannot
be met through some other maintenance benefit.
The need for special diets or dietary items must be prescribed by a
licensed physician. Costs for special
diets shall be determined as percentages of the allotment for a one-person
household under the thrifty food plan as defined by the United States
Department of Agriculture. The types of
diets and the percentages of the thrifty food plan that are covered are as
follows:
(1) high protein diet, at least 80
grams daily, 25 percent of thrifty food plan;
(2) controlled protein diet, 40 to 60 grams and requires
special products, 100 percent of thrifty food plan;
(3) controlled protein diet, less than 40 grams and requires special
products, 125 percent of thrifty food plan;
(4) low cholesterol diet, 25 percent of thrifty food plan;
(5) high residue diet, 20 percent of thrifty food plan;
(6) pregnancy and lactation diet, 35 percent of thrifty food
plan;
(7) gluten-free diet, 25 percent of thrifty food plan;
(8) lactose-free diet, 25 percent of thrifty food plan;
(9) antidumping diet, 15 percent of thrifty food plan;
(10) hypoglycemic diet, 15 percent of thrifty food plan; or
(11) ketogenic diet, 25 percent of thrifty food plan.
(b) Payment for nonrecurring special needs must be allowed for
necessary home repairs or necessary repairs or replacement of household
furniture and appliances using the payment standard of the AFDC program in
effect on July 16, 1996, for these expenses, as long as other funding sources
are not available.
(c) A fee for guardian or conservator service is allowed at a
reasonable rate negotiated by the county or approved by the court. This rate shall not exceed five percent of
the assistance unit's gross monthly income up to a maximum of $100 per
month. If the guardian or conservator
is a member of the county agency staff, no fee is allowed.
(d) The county agency shall continue to pay a monthly allowance
of $68 for restaurant meals for a person who was receiving a restaurant meal
allowance on June 1, 1990, and who eats two or more meals in a restaurant
daily. The allowance must continue
until the person has not received Minnesota supplemental aid for one full
calendar month or until the person's living arrangement changes and the person
no longer meets the criteria for the restaurant meal allowance, whichever
occurs first.
(e) A fee of ten percent of the recipient's gross income or
$25, whichever is less, is allowed for representative payee services provided
by an agency that meets the requirements under SSI regulations to charge a fee
for representative payee services. This
special need is available to all recipients of Minnesota supplemental aid
regardless of their living arrangement.
(f) Notwithstanding the language in this subdivision, an amount
equal to the maximum allotment authorized by the federal Food Stamp Program for
a single individual which is in effect on the first day of January of the
previous year will be added to the standards of assistance established in
subdivisions 1 to 4 for individuals under the age of 65 who are relocating from
an institution or a Department of Human Services Rule 36 facility, and
who are shelter needy. An eligible
individual who receives this benefit prior to age 65 may continue to receive
the benefit after the age of 65.
"Shelter needy" means that the assistance unit incurs
monthly shelter costs that exceed 40 percent of the assistance unit's gross
income before the application of this special needs standard. "Gross income" for the purposes of
this section is the applicant's or recipient's income as defined in section
256D.35, subdivision 10, or the standard specified in subdivision 3, whichever
is greater. A recipient of a federal or
state housing subsidy, that limits shelter costs to a percentage of gross
income, shall not be considered shelter needy for purposes of this paragraph.
Sec. 7. Minnesota Statutes 2002, section 256I.04, subdivision 2a, is
amended to read:
Subd. 2a. [LICENSE
REQUIRED.] A county agency may not enter into an agreement with an
establishment to provide group residential housing unless:
(1) the establishment is licensed by the Department of Health
as a hotel and restaurant; a board and lodging establishment; a residential
care home; a boarding care home before March 1, 1985; or a supervised living
facility, and the service provider for residents of the facility is licensed
under chapter 245A. However, an establishment
licensed by the Department of Health to provide lodging need not also be
licensed to provide board if meals are being supplied to residents under a
contract with a food vendor who is licensed by the Department of Health;
(2) the residence is licensed by the commissioner of human services
under Minnesota Rules, parts 9555.5050 to 9555.6265, or certified by a county
human services agency prior to July 1, 1992, using the standards under
Minnesota Rules, parts 9555.5050 to 9555.6265; or
(3) the establishment is registered under chapter 144D and
provides three meals a day, except that or is an establishment voluntarily
registered under section 144D.025 as a supportive housing
establishment. An establishment
voluntarily registered under section 144D.025, other than a supportive housing
establishment under this subdivision, is not eligible for an agreement
to provide group residential housing.
The requirements under clauses (1), (2), and (3) this
subdivision do not apply to establishments exempt from state licensure
because they are located on Indian reservations and subject to tribal health
and safety requirements.
Sec. 8. Minnesota
Statutes 2003 Supplement, section 295.50, subdivision 9b, is amended to read:
Subd. 9b. [PATIENT
SERVICES.] (a) "Patient services" means inpatient and outpatient
services and other goods and services provided by hospitals, surgical centers,
or health care providers. They include
the following health care goods and services provided to a patient or consumer:
(1) bed and board;
(2) nursing services and other related services;
(3) use of hospitals, surgical centers, or health care provider
facilities;
(4) medical social services;
(5) drugs, biologicals, supplies, appliances, and equipment;
(6) other diagnostic or therapeutic items or services;
(7) medical or surgical services;
(8) items and services furnished to ambulatory patients not
requiring emergency care; and
(9) emergency services; and
(10) covered services listed in section 256B.0625 and in
Minnesota Rules, parts 9505.0170 to 9505.0475.
(b) "Patient services" does
not include:
(1) services provided to nursing homes licensed under chapter
144A;
(2) examinations for purposes of utilization reviews, insurance
claims or eligibility, litigation, and employment, including reviews of medical
records for those purposes;
(3) services provided to and by community residential
mental health facilities licensed under Minnesota Rules, parts 9520.0500 to
9520.0690, and to and by children's residential treatment programs licensed
under Minnesota Rules, parts 9545.0905 to 9545.1125, or its successor;
(4) services provided to and by community support
programs and family community support programs approved under Minnesota Rules,
parts 9535.1700 to 9535.1760 or certified as mental health rehabilitative
services under chapter 256B;
(5) services provided to and by community mental health
centers as defined in section 245.62, subdivision 2;
(6) services provided to and by assisted living programs
and congregate housing programs; and
(7) hospice care services.;
(8) home and community-based waivered services under
sections 256B.0915, 256B.49, 256B.491, and 256B.501;
(9) targeted case management services under sections
256B.0621; 256B.0625, subdivisions 20, 20a, 33, and 44; and 256B.094; and
(10) services provided to the following: supervised living facilities for persons
with mental retardation or related conditions licensed under Minnesota Rules,
parts 4665.0100 to 4665.9900; housing with services establishments required to
be registered under chapter 144D; board and lodging establishments providing
only custodial services that are licensed under chapter 157 and registered
under section 157.17 to provide supportive services or health supervision
services; adult foster homes as defined in Minnesota Rules, part 9555.5105; day
training and habilitation services for adults with mental retardation and
related conditions as defined in section 252.41, subdivision 3; boarding care
homes as defined in Minnesota Rules, part 4655.0100; adult day care centers as
defined in Minnesota Rules, part 9555.9600; and home health agencies as defined
in Minnesota Rules, part 9505.0175, subpart 15.
[EFFECTIVE DATE.] This
section is effective retroactively from January 1, 2004.
Sec. 9. Minnesota
Statutes 2003 Supplement, section 295.53, subdivision 1, is amended to read:
Subdivision 1.
[EXEMPTIONS.] (a) The following payments are excluded from the gross
revenues subject to the hospital, surgical center, or health care provider taxes
under sections 295.50 to 295.59:
(1) payments received for services provided under the Medicare
program, including payments received from the government, and organizations
governed by sections 1833 and 1876 of title XVIII of the federal Social Security
Act, United States Code, title 42, section 1395, and enrollee deductibles,
coinsurance, and co-payments, whether paid by the Medicare enrollee or by a
Medicare supplemental coverage as defined in section 62A.011, subdivision 3,
clause (10), or by Medicaid payments under title XIX of the federal Social
Security Act. Payments for services
not covered by Medicare are taxable;
(2) payments received for home health care services;
(3) payments received from hospitals
or surgical centers for goods and services on which liability for tax is
imposed under section 295.52 or the source of funds for the payment is exempt
under clause (1), (7), (10), or (14);
(4) payments received from health care providers for goods and
services on which liability for tax is imposed under this chapter or the source
of funds for the payment is exempt under clause (1), (7), (10), or (14);
(5) amounts paid for legend drugs, other than nutritional
products, to a wholesale drug distributor who is subject to tax under section 295.52,
subdivision 3, reduced by reimbursements received for legend drugs otherwise
exempt under this chapter;
(6) payments received by a health care provider or the wholly
owned subsidiary of a health care provider for care provided outside Minnesota;
(7) payments received from the chemical dependency fund under
chapter 254B;
(8) payments received in the nature of charitable donations
that are not designated for providing patient services to a specific individual
or group;
(9) payments received for providing patient services incurred
through a formal program of health care research conducted in conformity with
federal regulations governing research on human subjects. Payments received from patients or from
other persons paying on behalf of the patients are subject to tax;
(10) payments received from any governmental agency for
services benefiting the public, not including payments made by the government
in its capacity as an employer or insurer or payments made by the government
for services provided under medical assistance, general assistance
medical care, or the MinnesotaCare program, or the medical assistance
program governed by title XIX of the federal Social Security Act, United States
Code, title 42, sections 1396 to 1396v;
(11) government payments received by a regional treatment
center the commissioner of human services for state-operated services;
(12) payments received by a health care provider for hearing
aids and related equipment or prescription eyewear delivered outside of
Minnesota;
(13) payments received by an educational institution from
student tuition, student activity fees, health care service fees, government
appropriations, donations, or grants, and for services identified in and
provided under an individualized education plan as defined in section 256B.0625
or Code of Federal Regulations, chapter 34, section 300340(a). Fee for service payments and payments for
extended coverage are taxable; and
(14) payments received under the federal Employees Health
Benefits Act, United States Code, title 5, section 8909(f), as amended by the
Omnibus Reconciliation Act of 1990.
(b) Payments received by wholesale drug distributors for legend
drugs sold directly to veterinarians or veterinary bulk purchasing
organizations are excluded from the gross revenues subject to the wholesale
drug distributor tax under sections 295.50 to 295.59.
[EFFECTIVE DATE.] This
section is effective retroactively from January 1, 2004.
ARTICLE 14
HEALTH
AND HUMAN SERVICES FORECAST ADJUSTMENTS
Section 1. Laws 2003,
First Special Session chapter 14, article 13C, section 1, is amended to read:
Section
1. [HEALTH AND HUMAN SERVICES APPROPRIATIONS
FORECAST ADJUSTMENTS.]
The sums shown in the columns marked "APPROPRIATIONS"
are appropriated from the general fund, or any other fund named, to the
agencies and for the purposes specified in the sections of this article, to be
available for the fiscal years indicated for each purpose. The figures "2004" and
"2005" where used in this article, mean that the appropriation or
appropriations listed under them are available for the fiscal year ending June
30, 2004, or June 30, 2005, respectively.
Where a dollar amount appears in parentheses, it means a reduction of an
appropriation.
SUMMARY BY FUND
BIENNIAL
2004
2005 TOTAL
General
$3,765,212,000 $3,727,319,000
$7,492,531,000
$3,500,860,000 $3,746,520,000 $7,247,380,000
State Government Special
Revenue
45,337,000 45,104,000 90,441,000
Health Care Access
294,090,000 308,525,000 602,615,000
280,060,000 308,609,000 588,669,000
Federal TANF
261,552,000 270,364,000 531,916,000
276,425,000 276,363,000 552,788,000
Lottery Prize Fund
1,556,000 1,556,000 3,112,000
Special Revenue
3,340,000 3,340,000 6,680,000
TOTAL
$4,371,087,000 $4,356,208,000
$8,727,295,000
$4,107,578,000 $4,381,492,000 $8,489,070,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
Sec. 2. Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 1, is
amended to read:
Subdivision 1. Total
Appropriation
$4,111,558,000 $4,110,496,000
$3,848,049,000 $4,135,780,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
Summary by Fund
General 3,566,163,000
3,541,854,000
3,301,811,000 3,561,055,000
State Government
Special Revenue
534,000
534,000
Health Care Access 287,753,000 302,188,000
273,723,000
302,272,000
Federal TANF 255,552,000 264,364,000
270,425,000
270,363,000
Lottery Cash Flow 1,556,000 1,556,000
[FEDERAL CONTINGENCY APPROPRIATION.] (a) Any
additional Federal Medicaid funds made available under title IV of the
federal Jobs and Growth Tax Relief Reconciliation Act of 2003 are appropriated
to the commissioner of human services for use in the state's medical assistance
and MinnesotaCare programs. The
commissioners of human services and finance shall report to the legislative
advisory committee on the additional federal Medicaid matching funds that will
be available to the state.
(b) Contingent upon Because of
the availability of these funds, the following policies shall become effective and
necessary funds are appropriated for those purposes:
(1) medical assistance and MinnesotaCare
eligibility and local financial participation changes provided for in this act
may be implemented prior to September 2, 2003, or may be delayed as necessary
to maximize the use of federal funds received under title IV of the Jobs and
Growth Tax Relief Reconciliation Act of 2003;
(2) the aggregate cap on the services
identified in Minnesota Statutes, section 256L.035, paragraph (a), clause (3),
shall be increased from $2,000 to $5,000.
This increase shall expire at the end of fiscal year 2007. Funds may be transferred from the general
fund to the health care access fund as necessary to implement this provision;
and
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(3) the following payment shifts shall not be
implemented:
(i) MFIP payment shift found in subdivision
11;
(ii) the county payment shift found in
subdivision 1; and
(iii) the delay in medical assistance and
general assistance medical care fee-for-service payments found in subdivision
6.
(c) Notwithstanding section 14, paragraphs
(a) and (b) shall expire June 30, 2007.
[RECEIPTS FOR SYSTEMS PROJECTS.]
Appropriations and federal receipts for information system projects for MAXIS,
PRISM, MMIS, and SSIS must be deposited in the state system account authorized
in Minnesota Statutes, section 256.014.
Money appropriated for computer projects approved by the Minnesota
office of technology, funded by the legislature, and approved by the
commissioner of finance may be transferred from one project to another and from
development to operations as the commissioner of human services considers
necessary. Any unexpended balance in
the appropriation for these projects does not cancel but is available for
ongoing development and operations.
[GIFTS.] Notwithstanding Minnesota Statutes,
chapter 7, the commissioner may accept on behalf of the state additional
funding from sources other than state funds for the purpose of financing the
cost of assistance program grants or nongrant administration. All additional funding is appropriated to
the commissioner for use as designated by the grantor of funding.
[SYSTEMS CONTINUITY.] In the event of
disruption of technical systems or computer operations, the commissioner may
use available grant appropriations to ensure continuity of payments for
maintaining the health, safety, and well-being of clients served by programs
administered by the department of human services. Grant funds must be used in a manner consistent with the original
intent of the appropriation.
[NONFEDERAL SHARE TRANSFERS.] The nonfederal
share of activities for which federal administrative reimbursement is
appropriated to the commissioner may be transferred to the special revenue
fund.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[TANF FUNDS APPROPRIATED TO OTHER ENTITIES.]
Any expenditures from the TANF block grant shall be expended in accordance with
the requirements and limitations of part A of title IV of the Social Security
Act, as amended, and any other applicable federal requirement or limitation. Prior to any expenditure of these funds, the
commissioner shall assure that funds are expended in compliance with the
requirements and limitations of federal law and that any reporting requirements
of federal law are met. It shall be the
responsibility of any entity to which these funds are appropriated to implement
a memorandum of understanding with the commissioner that provides the necessary
assurance of compliance prior to any expenditure of funds. The commissioner shall receipt TANF funds
appropriated to other state agencies and coordinate all related interagency
accounting transactions necessary to implement these appropriations. Unexpended TANF funds appropriated to any
state, local, or nonprofit entity cancel at the end of the state fiscal year unless
appropriating language permits otherwise.
[TANF FUNDS TRANSFERRED TO OTHER FEDERAL
GRANTS.] The commissioner must authorize transfers from TANF to other federal
block grants so that funds are available to meet the annual expenditure needs
as appropriated. Transfers may be
authorized prior to the expenditure year with the agreement of the receiving
entity. Transferred funds must be
expended in the year for which the funds were appropriated unless appropriation
language permits otherwise. In accelerating
transfer authorizations, the commissioner must aim to preserve the future
potential transfer capacity from TANF to other block grants.
[TANF MAINTENANCE OF EFFORT.] (a) In order to
meet the basic maintenance of effort (MOE) requirements of the TANF block grant
specified under Code of Federal Regulations, title 45, section 263.1, the
commissioner may only report nonfederal money expended for allowable activities
listed in the following clauses as TANF/MOE expenditures:
(1) MFIP cash, diversionary work program, and
food assistance benefits under Minnesota Statutes, chapter 256J;
(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and 119B.05, and county child care
administrative costs under Minnesota Statutes, section 119B.15;
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(3) state and county MFIP administrative
costs under Minnesota Statutes, chapters 256J and 256K;
(4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters 256J and 256K;
(5) expenditures made on behalf of noncitizen
MFIP recipients who qualify for the medical assistance without federal
financial participation program under Minnesota Statutes, section 256B.06,
subdivision 4, paragraphs (d), (e), and (j); and
(6) qualifying working family credit
expenditures under Minnesota Statutes, section 290.0671.
(b) The commissioner shall ensure that
sufficient qualified nonfederal expenditures are made each year to meet the
state's TANF/MOE requirements. For the
activities listed in paragraph (a), clauses (2) to (6), the commissioner may
only report expenditures that are excluded from the definition of assistance
under Code of Federal Regulations, title 45, section 260.31.
(c) By August 31 of each year, the
commissioner shall make a preliminary calculation to determine the likelihood
that the state will meet its annual federal work participation requirement
under Code of Federal Regulations, title 45, sections 261.21 and 261.23, after
adjustment for any caseload reduction credit under Code of Federal Regulations,
title 45, section 261.41. If the
commissioner determines that the state will meet its federal work participation
rate for the federal fiscal year ending that September, the commissioner may
reduce the expenditure under paragraph (a), clause (1), to the extent allowed
under Code of Federal Regulations, title 45, section 263.1(a)(2).
(d) For fiscal years beginning with state
fiscal year 2003, the commissioner shall assure that the maintenance of effort
used by the commissioner of finance for the February and November forecasts
required under Minnesota Statutes, section 16A.103, contains expenditures under
paragraph (a), clause (1), equal to at least 25 percent of the total required
under Code of Federal Regulations, title 45, section 263.1.
(e) If nonfederal expenditures for the
programs and purposes listed in paragraph (a) are insufficient to meet the
state's TANF/MOE requirements, the commissioner shall recommend additional allowable sources of nonfederal expenditures to the legislature, if
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
the legislature is or will be in session to
take action to specify additional sources of nonfederal expenditures for
TANF/MOE before a federal penalty is imposed.
The commissioner shall otherwise provide notice to the legislative
commission on planning and fiscal policy under paragraph (g).
(f) If the commissioner uses authority
granted under section 11, or similar authority granted by a subsequent
legislature, to meet the state's TANF/MOE requirement in a reporting period,
the commissioner shall inform the chairs of the appropriate legislative
committees about all transfers made under that authority for this purpose.
(g) If the commissioner determines that
nonfederal expenditures under paragraph (a) are insufficient to meet TANF/MOE
expenditure requirements, and if the legislature is not or will not be in
session to take timely action to avoid a federal penalty, the commissioner may
report nonfederal expenditures from other allowable sources as TANF/MOE
expenditures after the requirements of this paragraph are met. The commissioner may report nonfederal
expenditures in addition to those specified under paragraph (a) as nonfederal
TANF/MOE expenditures, but only ten days after the commissioner of finance has
first submitted the commissioner's recommendations for additional allowable
sources of nonfederal TANF/MOE expenditures to the members of the legislative
commission on planning and fiscal policy for their review.
(h) The commissioner of finance shall not
incorporate any changes in federal TANF expenditures or nonfederal expenditures
for TANF/MOE that may result from reporting additional allowable sources of
nonfederal TANF/MOE expenditures under the interim procedures in paragraph (g)
into the February or November forecasts required under Minnesota Statutes,
section 16A.103, unless the commissioner of finance has approved the additional
sources of expenditures under paragraph (g).
(i) Minnesota Statutes, section 256.011,
subdivision 3, which requires that federal grants or aids secured or obtained
under that subdivision be used to reduce any direct appropriations provided by
law, do not apply if the grants or aids are federal TANF funds.
(j) Notwithstanding section 14, paragraph
(a), clauses (1) to (6), and paragraphs (b) to (j) expire June 30, 2007.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[WORKING FAMILY CREDIT EXPENDITURES AS TANF
MOE.] The commissioner may claim as TANF maintenance of effort up to the
following amounts of working family credit expenditures for the following
fiscal years:
(1) fiscal year 2004, $7,013,000;
(2) fiscal year 2005, $25,133,000;
(3) fiscal year 2006, $6,942,000; and
(4) fiscal year 2007, $6,707,000.
[FISCAL YEAR 2003 APPROPRIATIONS
CARRYFORWARD.] Effective the day following final enactment, notwithstanding
Minnesota Statutes, section 16A.28, or any other law to the contrary, state
agencies and constitutional offices may carry forward unexpended and
unencumbered nongrant operating balances from fiscal year 2003 general fund
appropriations into fiscal year 2004 to offset general budget reductions.
[TRANSFER OF GRANT BALANCES.] Effective the
day following final enactment, the commissioner of human services, with the
approval of the commissioner of finance and after notification of the chair of
the senate health, human services and corrections budget division and the chair
of the house of representatives health and human services finance committee,
may transfer unencumbered appropriation balances for the biennium ending June
30, 2003, in fiscal year 2003 among the MFIP, MFIP child care assistance under
Minnesota Statutes, section 119B.05, general assistance, general assistance
medical care, medical assistance, Minnesota supplemental aid, and group
residential housing programs, and the entitlement portion of the chemical
dependency consolidated treatment fund, and between fiscal years of the
biennium.
[TANF APPROPRIATION CANCELLATION.]
Notwithstanding the provisions of Laws 2000, chapter 488, article 1, section
16, any prior appropriations of TANF funds to the department of trade and
economic development or to the job skills partnership board or any transfers of
TANF funds from another agency to the department of trade and economic
development or to the job skills partnership board are not available until
expended, and if unobligated as of June 30, 2003, these appropriations or
transfers shall cancel to the TANF fund.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[SHIFT COUNTY PAYMENT.] The commissioner
shall make up to 100 percent of the calendar year 2005 payments to counties for
developmental disabilities semi-independent living services grants,
developmental disabilities family support grants, and adult mental health
grants from fiscal year 2006 appropriations.
This is a onetime payment shift.
Calendar year 2006 and future payments for these grants are not affected
by this shift. This provision expires
June 30, 2006.
[CAPITATION RATE INCREASE.] Of the health
care access fund appropriations to the University of Minnesota in the higher
education omnibus appropriation bill, $2,157,000 in fiscal year 2004 and
$2,157,000 in fiscal year 2005 are to be used to increase the capitation
payments under Minnesota Statutes, section 256B.69. Notwithstanding the provisions of section 14, this provision
shall not expire.
Sec. 3. Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 3, is
amended to read:
Subd. 3. Revenue and
Pass-Through
Federal TANF 55,855,000 53,315,000
56,643,000 57,275,000
[TANF
TRANSFER TO SOCIAL SERVICES BLOCK GRANT.] $3,137,000 in fiscal year 2005 is
appropriated to the commissioner for the purposes of providing services for
families with children whose incomes are at or below 200 percent of the federal
poverty guidelines. The commissioner
shall authorize a sufficient transfer of funds from the state's federal TANF block
grant to the state's federal social services block grant to meet this
appropriation. The funds shall be
distributed to counties for the children and community services grant according
to the formula for the state appropriations in Minnesota Statutes, chapter
256M.
[TANF
FUNDS FOR FISCAL YEAR 2006 AND FISCAL YEAR 2007 REFINANCING.] $12,692,000
$6,692,000 in fiscal year 2006 and $9,192,000 $3,192,000
in fiscal year 2007 in TANF funds are available to the commissioner to replace
general funds in the amount of $12,692,000 $6,692,000 in fiscal
year 2006 and $9,192,000 $3,192,000 in fiscal year 2007 in
expenditures that may be counted toward TANF maintenance of effort requirements
or as an allowable TANF expenditure.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[ADJUSTMENTS
IN TANF TRANSFER TO CHILD CARE AND DEVELOPMENT FUND.] Transfers of TANF to the
child care development fund for the purposes of MFIP child care assistance
shall be reduced by $116,000 in fiscal year 2004 and shall be increased by
$1,976,000 in fiscal year 2005.
Sec. 4. Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 6, is
amended to read:
Subd. 6. Basic Health
Care Grants
Summary by Fund
General 1,499,941,000
1,533,016,000
1,290,454,000 1,475,996,000
Health Care Access 268,151,000
282,605,000
254,121,000
282,689,000
[UPDATING
FEDERAL POVERTY GUIDELINES.] Annual updates to the federal poverty guidelines
are effective each July 1, following publication by the United States
Department of Health and Human Services for health care programs under
Minnesota Statutes, chapters 256, 256B, 256D, and 256L.
The
amounts that may be spent from this appropriation for each purpose are as
follows:
(a) MinnesotaCare Grants
Health Care Access 267,401,000 281,855,000
253,371,000
281,939,000
[MINNESOTACARE
FEDERAL RECEIPTS.] Receipts received as a result of federal participation
pertaining to administrative costs of the Minnesota health care reform waiver
shall be deposited as nondedicated revenue in the health care access fund. Receipts received as a result of federal
participation pertaining to grants shall be deposited in the federal fund and
shall offset health care access funds for payments to providers.
[MINNESOTACARE
FUNDING.] The commissioner may expend money appropriated from the health care
access fund for MinnesotaCare in either fiscal year of the biennium.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(b) MA Basic Health Care
Grants - Families and Children
General 568,254,000 582,161,000
427,769,000
489,545,000
[SERVICES TO PREGNANT WOMEN.] The
commissioner shall use available federal money for the State-Children's Health
Insurance Program for medical assistance services provided to pregnant women
who are not otherwise eligible for federal financial participation beginning in
fiscal year 2003. This federal money
shall be deposited in the federal fund and shall offset general funds for
payments to providers. Notwithstanding
section 14, this paragraph shall not expire.
[MANAGED CARE RATE INCREASE.] (a) Effective
January 1, 2004, the commissioner of human services shall increase the total
payments to managed care plans under Minnesota Statutes, section 256B.69, by an
amount equal to the cost increases to the managed care plans from by the
elimination of: (1) the exemption from the taxes imposed under Minnesota
Statutes, section 297I.05, subdivision 5, for premiums paid by the state for
medical assistance, general assistance medical care, and the MinnesotaCare
program; and (2) the exemption of gross revenues subject to the taxes imposed
under Minnesota Statutes, sections 295.50 to 295.57, for payments paid by the
state for services provided under medical assistance, general assistance
medical care, and the MinnesotaCare program.
Any increase based on clause (2) must be reflected in provider rates
paid by the managed care plan unless the managed care plan is a staff model
health plan company.
(b) The commissioner of human services shall
increase by two percent the fee-for-service payments under medical assistance,
general assistance medical care, and the MinnesotaCare program for services
subject to the hospital, surgical center, or health care provider taxes under
Minnesota Statutes, sections 295.50 to 295.57, effective for services rendered
on or after January 1, 2004.
(c) The commissioner of finance shall
transfer from the health care access fund to the general fund the following
amounts in the fiscal years indicated: 2004, $16,587,000; 2005, $46,322,000;
2006, $49,413,000; and 2007, $52,659,000.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(d) For fiscal years after 2007, the commissioner of
finance shall transfer from the health care access fund to the general fund an
amount equal to the revenue collected by the commissioner of revenue on the
following:
(1) gross revenues received by hospitals, surgical
centers, and health care providers as payments for services provided under
medical assistance, general assistance medical care, and the MinnesotaCare
program, including payments received directly from the state or from a prepaid
plan, under Minnesota Statutes, sections 295.50 to 295.57; and
(2) premiums paid by the state under medical
assistance, general assistance medical care, and the MinnesotaCare program
under Minnesota Statutes, section 297I.05, subdivision 5.
The commissioner of finance shall monitor and adjust
if necessary the amount transferred each fiscal year from the health care
access fund to the general fund to ensure that the amount transferred equals
the tax revenue collected for the items described in clauses (1) and (2) for
that fiscal year.
(e) Notwithstanding section 14, these provisions
shall not expire.
(c) MA Basic Health Care
Grants - Elderly and Disabled
General 695,421,000 741,605,000
610,518,000
743,858,000
[DELAY MEDICAL ASSISTANCE FEE-FOR-SERVICE - ACUTE
CARE.] The following payments in fiscal year 2005 from the Medicaid Management
Information System that would otherwise have been made to providers for medical
assistance and general assistance medical care services shall be delayed and
included in the first payment in fiscal year 2006:
(1) for hospitals, the last two payments; and
(2) for nonhospital providers, the last payment.
This payment delay shall not include payments to
skilled nursing facilities, intermediate care facilities for mental
retardation, prepaid health plans, home health agencies, personal care nursing providers,
and providers of only waiver services.
The provisions of Minnesota Statutes, section 16A.124, shall not apply
to these delayed payments.
Notwithstanding section 14, this provision shall not expire.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[DEAF AND HARD-OF-HEARING SERVICES.] If,
after making reasonable efforts, the service provider for mental health
services to persons who are deaf or hearing impaired is not able to earn
$227,000 through participation in medical assistance intensive rehabilitation
services in fiscal year 2005, the commissioner shall transfer $227,000 minus
medical assistance earnings achieved by the grantee to deaf and hard-of-hearing
grants to enable the provider to continue providing services to eligible
persons.
(d) General Assistance Medical Care Grants
General 223,960,000 196,617,000
239,861,000
229,960,000
(e) Health Care Grants -
Other Assistance
General 3,067,000 3,407,000
Health Care Access 750,000 750,000
[MINNESOTA PRESCRIPTION DRUG DEDICATED FUND.]
Of the general fund appropriation, $284,000 in fiscal year 2005 is appropriated
to the commissioner for the prescription drug dedicated fund established under
the prescription drug discount program.
[DENTAL ACCESS GRANTS CARRYOVER AUTHORITY.]
Any unspent portion of the appropriation from the health care access fund in
fiscal years 2002 and 2003 for dental access grants under Minnesota Statutes,
section 256B.53, shall not cancel but shall be allowed to carry forward to be
spent in the biennium beginning July 1, 2003, for these purposes.
[STOP-LOSS FUND ACCOUNT.] The appropriation
to the purchasing alliance stop-loss fund account established under Minnesota
Statutes, section 256.956, subdivision 2, for fiscal years 2004 and 2005 shall
only be available for claim reimbursements for qualifying enrollees who are
members of purchasing alliances that meet the requirements described under
Minnesota Statutes, section 256.956, subdivision 1, paragraph (f), clauses (1),
(2), and (3).
(f) Prescription Drug
Program
General 9,239,000 9,226,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[PRESCRIPTION DRUG ASSISTANCE PROGRAM.] Of
the general fund appropriation, $702,000 in fiscal year 2004 and $887,000 in
fiscal year 2005 are for the commissioner to establish and administer the
prescription drug assistance program through the Minnesota board on aging.
[REBATE REVENUE RECAPTURE.] Any funds
received by the state from a drug manufacturer due to errors in the
pharmaceutical pricing used by the manufacturer in determining the prescription
drug rebate are appropriated to the commissioner to augment funding of the
prescription drug program established in Minnesota Statutes, section 256.955.
Sec. 5. Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 7, is
amended to read:
Subd. 7. Health Care
Management
Summary by Fund
General 24,845,000 26,199,000
24,834,000
Health Care Access 14,522,000 14,533,000
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) Health Care Policy
Administration
General 5,523,000 7,223,000
Health Care Access 1,066,000 1,200,000
[PAYMENT
CODE STUDY.] Of this appropriation, $345,000 each year is for a study to
determine the appropriateness of eliminating reimbursement for certain payment
codes under medical assistance, general assistance medical care, or
MinnesotaCare. As part of the study,
the commissioner shall also examine covered services under the Minnesota health
care programs and make recommendations on possible modification of the services
covered under the program. The
commissioner shall report to the legislature by January 15, 2005, with an
analysis of the feasibility of this approach, a list of codes, if any, to be
eliminated from the payment system, and estimates of savings to be obtained
from this approach.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[TRANSFERS
FROM HEALTH CARE ACCESS FUND.] (a) Notwithstanding Minnesota Statutes, section
295.581, to the extent available resources in the health care access fund
exceed expenditures in that fund during fiscal years 2005 to 2007, the excess
annual funds shall be transferred from the health care access fund to the
general fund on June 30 of fiscal years 2005, 2006, and 2007. These transfers shall not be reduced to
accommodate MinnesotaCare expansions.
The estimated amounts to be transferred are:
(1)
in fiscal year 2005, $192,442,000;
(2)
in fiscal year 2006, $52,943,000; and
(3)
in fiscal year 2007, $59,105,000.
These
estimates shall be updated with each forecast, but in no case shall the
transfers exceed the amounts listed in clauses (1) to (3).
(b)
The commissioner shall limit transfers under paragraph (a) in order to avoid
implementation of Minnesota Statutes, section 256L.02, subdivision 3, paragraph
(b).
(c)
For fiscal years 2004 to 2007, MinnesotaCare shall be a forecasted program and,
if necessary, the commissioner shall reduce transfers under paragraph (a) to
meet forecasted expenditures.
(d)
The department of human services in recommending its 2007-2008 budget shall
consider the repayment of the amount transferred in fiscal years 2006 and 2007
from the health care access fund to the general fund to the health care access
fund.
(e)
Notwithstanding section 14, this section is in effect until June 30, 2007.
[MINNESOTACARE
OUTREACH REIMBURSEMENT.] Federal administrative reimbursement resulting from
MinnesotaCare outreach is appropriated to the commissioner for this activity.
[MINNESOTA
SENIOR HEALTH OPTIONS REIMBURSEMENT.] Federal administrative reimbursement
resulting from the Minnesota senior health options project is appropriated to
the commissioner for this activity.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[UTILIZATION
REVIEW.] Federal administrative reimbursement resulting from prior
authorization and inpatient admission certification by a professional review
organization shall be dedicated to the commissioner for these purposes. A portion of these funds must be used for
activities to decrease unnecessary pharmaceutical costs in medical assistance.
(b) Health Care Operations
General 19,322,000 18,976,000
19,311,000
Health Care Access 13,456,000 13,333,000
[PREPAID
MEDICAL PROGRAMS.] For all counties in which the PMAP program has been
operating for 12 or more months, state funding for the nonfederal share of
prepaid medical assistance program administration costs for county managed care
advocacy and enrollment operations is eliminated. State funding will continue for these activities for counties and
tribes establishing new PMAP programs for a maximum of 16 months (four months
prior to beginning PMAP enrollment and through the first 12 months of their
PMAP program operation). Those counties
operating PMAP programs for less than 12 months can continue to receive state
funding for advocacy and enrollment activities through their first year of
operation.
Sec. 6. Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 9, is
amended to read:
Subd. 9. Continuing
Care Grants
Summary by Fund
General 1,504,933,000
1,490,958,000
1,448,029,000 1,567,392,000
Lottery Prize Fund 1,408,000 1,408,000
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) Community Social
Services
General 496,000 371,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(b) Aging and Adult Service
Grant
General 12,998,000 13,951,000
[LONG-TERM
CARE PROGRAM REDUCTIONS.] For the biennium ending June 30, 2005, state funding
for the following state long-term care programs is reduced by 15 percent from
the level of state funding provided on June 30, 2003: SAIL project grants under
Minnesota Statutes, section 256B.0917; senior nutrition programs under
Minnesota Statutes, section 256.9752; foster grandparents program under
Minnesota Statutes, section 256.976; retired senior volunteer program under
Minnesota Statutes, section 256.9753; and the senior companion program under
Minnesota Statutes, section 256.977.
(c) Deaf and Hard-of-hearing
Service Grants
General 1,719,000 1,490,000
(d) Mental Health Grants
General 53,479,000 34,690,000
46,551,000
Lottery Prize Fund 1,408,000 1,408,000
[RESTRUCTURING OF ADULT MENTAL HEALTH
SERVICES.] The commissioner may make transfers that do not increase the state
share of costs to effectively implement the restructuring of adult mental
health services.
[COMPULSIVE GAMBLING.] Of the appropriation
from the lottery prize fund, $250,000 each year is for the following purposes:
(1) $100,000 each year is for a grant to the
Southeast Asian Problem Gambling Consortium.
The consortium must provide statewide compulsive gambling prevention and
treatment services for Lao, Hmong, Vietnamese, and Cambodian families, adults,
and adolescents. The appropriation in
this clause shall not become part of base level funding for the biennium beginning
July 1, 2005. Any unencumbered balance
of the appropriation in the first year does not cancel but is available for the
second year; and
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(2) $150,000 each year is for a grant to a
compulsive gambling council located in St. Louis county. The gambling council must provide a
statewide compulsive gambling prevention and education project for
adolescents. Any unencumbered balance
of the appropriation in the first year of the biennium does not cancel but is
available for the second year.
(e) Community Support Grants
12,523,000
9,093,000
12,024,000
[CENTERS FOR INDEPENDENT LIVING STUDY.] The
commissioner of human services, in consultation with the commissioner of economic
security, the centers for independent living, and consumer representatives,
shall study the financing of the centers for independent living authorized
under Minnesota Statutes, section 268A.11, and make recommendations on options
to maximize federal financial participation.
Study components shall include:
(1) the demographics of individuals served by
the centers for independent living;
(2) the range of services the centers for
independent living provide to these individuals;
(3) other publicly funded services received
by individuals supported by the centers; and
(4) strategies for maximizing federal
financial participation for eligible activities carried out by centers for
independent living.
The commissioner shall report with fiscal and
programmatic recommendations to the chairs of the appropriate house of
representatives and senate finance and policy committees by January 15, 2004.
(f) Medical Assistance
Long-Term Care Waivers and Home Care Grants
General 659,211,000 718,665,000
624,631,000 748,189,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[RATE AND ALLOCATION DECREASES FOR CONTINUING
CARE PROGRAMS.] Notwithstanding any law or rule to the contrary, the
commissioner of human services shall decrease reimbursement rates or reduce
allocations to assure the necessary reductions in state spending for the
providers or programs listed in paragraphs (a) to (d). The decreases are effective for services
rendered on or after July 1, 2003.
(a) Effective July 1, 2003, the commissioner
shall reduce payment rates for services and individual or service limits by one
percent. The rate decreases described
in this section must be applied to:
(1) home and community-based waivered
services for the elderly under Minnesota Statutes, section 256B.0915;
(2) day training and habilitation services
for adults with mental retardation or related conditions under Minnesota
Statutes, sections 252.40 to 252.46;
(3) the group residential housing
supplementary service rate under Minnesota Statutes, section 256I.05,
subdivision 1a;
(4) chemical dependency residential and
nonresidential service rates under Minnesota Statutes, section 245B.03;
(5) consumer support grants under Minnesota
Statutes, section 256.476; and
(6) home and community-based services for
alternative care services under Minnesota Statutes, section 256B.0913.
(b) The commissioner shall reduce allocations
made available to county agencies for home and community-based waivered
services to assure a one-percent reduction in state spending for services
rendered on or after July 1, 2003. The
commissioner shall apply the allocation decreases described in this section to:
(1) persons with mental retardation or
related conditions under Minnesota Statutes, section 256B.501;
(2) waivered services under community
alternatives for disabled individuals under Minnesota Statutes, section
256B.49;
(3) community alternative care waivered
services under Minnesota Statutes, section 256B.49; and
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(4) traumatic brain injury waivered services
under Minnesota Statutes, section 256B.49.
County agencies will be responsible for 100
percent of any spending in excess of the allocation made by the commissioner. Nothing in this section shall be construed
as reducing the county's responsibility to offer and make available feasible
home and community-based options to eligible waiver recipients within the
resources allocated to them for that purpose.
(c) The commissioner shall reduce deaf and
hard-of-hearing grants by one percent on July 1, 2003.
(d) Effective July 1, 2003, the commissioner
shall reduce payment rates for each facility reimbursed under Minnesota
Statutes, section 256B.5012, by decreasing the total operating payment rate for
intermediate care facilities for the mentally retarded by one percent. For each facility, the commissioner shall
multiply the adjustment by the total payment rate, excluding the
property-related payment rate, in effect on June 30, 2003. A facility whose payment rates are governed
by closure agreements, receivership agreements, or Minnesota Rules, part
9553.0075, is not subject to an adjustment otherwise taken under this subdivision.
Notwithstanding section 14, these adjustments
shall not expire.
[REDUCE GROWTH IN MR/RC WAIVER.] The
commissioner shall reduce the growth in the MR/RC waiver by not allocating
the 300 additional diversion allocations that are included in
the February 2003 forecast for the fiscal years that begin on
July 1, 2003, and July 1, 2004.
[MANAGE THE GROWTH IN THE TBI WAIVER.] During
the fiscal years beginning on July 1, 2003, and July 1, 2004, the commissioner
shall allocate money for home and community-based programs covered under
Minnesota Statutes, section 256B.49, to assure a reduction in state spending
that is equivalent to limiting the caseload growth of the TBI waiver to 150 in
each year of the biennium. Priorities
for the allocation of funds shall be for individuals anticipated to be discharged
from institutional settings or who are at imminent risk of a placement in an
institutional setting.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[TARGETED CASE MANAGEMENT FOR HOME CARE
RECIPIENTS.] Implementation of the targeted case management benefit for home
care recipients, according to Minnesota Statutes, section 256B.0621,
subdivisions 2, 3, 5, 6, 7, 9, and 10, will be delayed until July 1, 2005.
[COMMON SERVICE MENU.] Implementation of the
common service menu option within the home and community-based waivers,
according to Minnesota Statutes, section 256B.49, subdivision 16, will be
delayed until July 1, 2005.
[LIMITATION ON COMMUNITY ALTERNATIVES FOR
DISABLED INDIVIDUALS CASELOAD GROWTH.] For the biennium ending June 30, 2005,
the commissioner shall limit the allocations made available in the community
alternatives for disabled individuals waiver program in order not to exceed
average caseload growth of 95 per month from June 2003 program levels, plus any
additional legislatively authorized program growth. The commissioner shall allocate available resources to achieve
the following outcomes:
(1) the establishment of feasible and viable
alternatives for persons in institutional or hospital settings to relocate to
home and community-based settings;
(2) the availability of timely assistance to
persons at imminent risk of institutional or hospital placement or whose health
and safety is at immediate risk; and
(3) the maximum provision of essential
community supports to eligible persons in need of and waiting for home and
community-based service alternatives.
The commissioner may reallocate resources from one county or region to
another if available funding in that county or region is not likely to be spent
and the reallocation is necessary to achieve the outcomes specified in this
paragraph.
(g) Medical Assistance
Long-term Care Facilities Grants
General 543,999,000 514,483,000
513,763,000
536,321,000
(h) Alternative Care Grants
General 75,206,000 66,351,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[ALTERNATIVE CARE TRANSFER.] Any money
allocated to the alternative care program that is not spent for the purposes
indicated does not cancel but shall be transferred to the medical assistance
account.
[ALTERNATIVE CARE APPROPRIATION.] The
commissioner may expend the money appropriated for the alternative care program
for that purpose in either year of the biennium.
[ALTERNATIVE CARE IMPLEMENTATION OF CHANGES TO
FEES AND ELIGIBILITY.] Changes to Minnesota Statutes, section 256B.0913,
subdivision 4, paragraph (d), and subdivision 12, are effective July 1, 2003,
for all persons found eligible for the alternative care program on or after
July 1, 2003. All recipients of
alternative care funding as of June 30, 2003, shall be subject to Minnesota
Statutes, section 256B.0913, subdivision 4, paragraph (d), and subdivision 12,
on the annual reassessment and review of their eligibility after July 1, 2003,
but no later than January 1, 2004.
(i) Group Residential
Housing Grants
General 94,996,000 80,472,000
94,547,000 81,055,000
[GROUP RESIDENTIAL HOUSING COSTS REFINANCED.]
(1) Effective July 1, 2004, the commissioner shall increase the home and
community-based service rates and county allocations provided to programs for
persons with disabilities established under section 1915(c) of the Social
Security Act to the extent that these programs will be paying for the costs
above the rate established in Minnesota Statutes, section 256I.05, subdivision
1.
(2) For persons in receipt of services under
Minnesota Statutes, section 256B.0915, who reside in licensed adult foster care
beds for which a supplemental room and board payment was being made under
Minnesota Statutes, section 256I.05, subdivision 1, counties may request an
exception to the individual caps specified in Minnesota Statutes, section
256B.0915, subdivision 3, paragraph (b), not to exceed the difference between
the individual cap and the client's monthly service expenditures plus the
amount of the supplemental room and board rate. The county must submit a request to exceed the individual cap to
the commissioner for approval.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(j) Chemical Dependency
Entitlement Grants
General 49,251,000 50,337,000
57,612,000 60,034,000
(k) Chemical Dependency
Nonentitlement Grants
General 1,055,000 1,055,000
Sec. 7. Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 11, is
amended to read:
Subd. 11. Economic
Support Grants
Summary by Fund
General 122,647,000 117,198,000
124,697,000
116,985,000
Federal TANF 199,009,000 207,224,000
212,844,000
209,264,000
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) Minnesota Family
Investment Program
General 59,922,000 39,375,000
53,818,000 43,942,000
Federal TANF 106,535,000 110,543,000
114,370,000
106,583,000
(b) Work Grants
General 666,000 14,678,000
8,666,000 8,678,000
Federal TANF 92,474,000 96,681,000
98,474,000 102,681,000
[MFIP SUPPORT SERVICES
COUNTY AND TRIBAL ALLOCATION.] When determining the funds available for the
consolidated MFIP support services grant in the 18-month period ending December
31, 2004, the commissioner shall apportion the funds appropriated for fiscal
year 2005 in such manner as
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
necessary to provide $14,000,000 more to
counties and tribes for the period ending December 31, 2004, than would have
been available had the funds been evenly divided within the fiscal year between
the period before December 31, 2004, and the period after December 31, 2004.
For
allocations for the calendar years starting January 1, 2005, the commissioner
shall apportion the funds appropriated for each fiscal year in such manner as
necessary to provide $14,000,000 more to counties and tribes for the period
ending December 31 of that year than would have been available had the funds
been evenly divided within the fiscal year between the period before December
31 and the period after December 31.
(c) Economic Support Grants - Other
Assistance
General 3,358,000 3,463,000
[SUPPORTIVE
HOUSING.] Of the general fund appropriation, $500,000 each year is to provide
services to families who are participating in the supportive housing and
managed care pilot project under Minnesota Statutes, section 256K.25. This appropriation shall not become part of
base level funding for the biennium beginning July 1, 2007.
(d) Child Support Enforcement Grants
General 3,571,000 3,503,000
(e) General Assistance
Grants
General 24,901,000 24,732,000
26,329,000 26,909,000
[GENERAL
ASSISTANCE STANDARD.] The commissioner shall set the monthly standard of
assistance for general assistance units consisting of an adult recipient who is
childless and unmarried or living apart from parents or a legal guardian at
$203. The commissioner may reduce this
amount according to Laws 1997, chapter 85, article 3, section 54.
[EMERGENCY
GENERAL ASSISTANCE.] The amount appropriated for emergency general assistance
funds is limited to no more than $7,889,812 in each fiscal year of 2004 and
2005. Funds to counties shall be
allocated by the commissioner using the allocation
method specified in Minnesota Statutes, section 256D.06.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(f) Minnesota Supplemental
Aid Grants
General 30,229,000 31,447,000
28,955,000 30,490,000
[EMERGENCY
MINNESOTA SUPPLEMENTAL AID FUNDS.] The amount appropriated for emergency
Minnesota supplemental aid funds is limited to no more than $1,138,707 in
fiscal year 2004 and $1,017,000 in fiscal year 2005. Funds to counties shall be allocated by the commissioner using
the allocation method specified in Minnesota Statutes, section 256D.46.
Sec. 8. Laws 2003,
First Special Session chapter 14, article 13C, section 10, subdivision 1, is
amended to read:
Subdivision 1. Total
Appropriation
$107,829,000 $92,649,000
$106,221,000 $97,564,000
Summary by Fund
General 104,489,000 89,309,000
102,881,000
94,224,000
State Special Revenue 3,340,000 3,340,000
Sec. 9. Laws 2003,
First Special Session chapter 14, article 13C, section 10, subdivision 2, is
amended to read:
Subd. 2. Child Care
[BASIC
SLIDING FEE CHILD CARE.] Of this appropriation, $27,628,000 in fiscal year 2004
and $18,771,000 in fiscal year 2005 are for child care assistance according to
Minnesota Statutes, section 119B.03.
These appropriations are available to be spent either year. The fiscal years 2006 and 2007 general fund
base for basic sliding fee child care is $30,312,000 each year.
[MFIP
CHILD CARE.] Of this appropriation, $69,543,000 $67,935,000 in
fiscal year 2004 and $63,720,000 $68,635,000 in fiscal year 2005
are for MFIP child care.
[CHILD
CARE PROGRAM INTEGRITY.] Of this appropriation, $425,000 in fiscal year 2004,
and $376,000 in fiscal year 2005 are for the administrative costs of program
integrity and fraud prevention for child care assistance under Minnesota
Statutes, chapter 119B.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[CHILD
CARE DEVELOPMENT.] Of this appropriation, $1,115,000 in fiscal year 2004, and
$1,164,000 in fiscal year 2005 are for child care development grants according
to Minnesota Statutes, section 119B.21.
Sec. 10. [EFFECTIVE
DATE.]
Sections 1 to 9 are effective the day following final
enactment, unless a different effective date is specified.
ARTICLE
15
APPROPRIATIONS
Section 1. [HEALTH AND
HUMAN SERVICES APPROPRIATIONS.]
The sums shown in the columns marked "APPROPRIATIONS"
are added to or, if shown in parentheses, are subtracted from the
appropriations in Laws 2003, First Special Session chapter 14, article 13C, or
other law, and are appropriated from the general fund, or any other fund named,
to the agencies and for the purposes specified in the sections of this article,
to be available for the fiscal years indicated for each purpose. The figures "2004" and
"2005" where used in this article, mean that the appropriation or
appropriations listed under them are available for the fiscal year ending June
30, 2004, or June 30, 2005, respectively.
SUMMARY
BY FUND
2004
2005 TOTAL
General
$137,376,000 $(118,240,000) $19,136,000
Health Care Access
41,994,000 (46,286,000) (4,292,000)
Federal TANF
-0- -0- -0-
Lottery Prize Fund
-0- 75,000 75,000
TOTAL
$179,370,000 $(164,301,000) $15,069,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
Sec. 2. COMMISSIONER OF
HUMAN SERVICES
Subdivision 1. Total
Appropriation
$179,370,000 $(163,613,000)
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
Summary by Fund
General 137,376,000 (117,558,000)
Health Care Access 41,994,000 (46,280,000)
Federal TANF -0- -0-
Lottery Prize Fund -0- 75,000
Other Funds -0- 150,000
Subd. 2. Agency
Management
Summary by Fund
General
-0-
(2,300,000)
The amounts that may be
spent from the appropriation for each purpose are as follows:
(a) Financial Operations
General
-0-
(2,300,000)
(b) Legal and Regulatory
Operations
(c) Management Operations
(d) Information Technology
Subd. 3. Revenue and
Pass-Through
Federal TANF -0- 10,652,000
[TANF REFINANCING.] In
addition to the amount of TANF funds available for use with the Minnesota
working family tax credit program under current law appropriations, there is
further appropriated the following amounts:
FY 2005
.....
$10,652,000
FY 2006
.....
$15,113,000
FY 2007
.....
$15,339,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[ADJUSTMENTS IN WORKING
FAMILY CREDIT EXPENDITURES COUNTED AS TANF MOE.] In addition to the amounts
identified in Laws 2003, First Special Session chapter 14, article 13C, section
2, the commissioner may claim up to the following amounts of Working Family
Credit expenditures for the following fiscal years:
FY 2006
.....
$27,656,000
FY 2007
.....
$17,883,000
Subd. 4. Children's
Services Grants
[PRIVATIZED ADOPTION GRANT.] For the biennium
ending June 30, 2005, federal reimbursement for privatized adoption grant and
foster care recruitment grant expenditures is appropriated to the commissioner
for adoption grants and foster care and adoption administrative purposes.
[ADJUSTMENTS IN TANF TRANSFERS TO CHILD CARE
DEVELOPMENT FUND.] Transfers of TANF to the federal Child Care Development Fund
for child care assistance shall be reduced by these amounts in fiscal year
2005:
Basic sliding fee child care
$370,000
MFIP child care
$1,152,000
Subd. 5. Children's
Services Management
Subd. 6. Basic Health
Care Grants
Summary by Fund
General 133,114,000 (138,463,000)
Health Care Access 41,994,000 (46,580,000)
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) MinnesotaCare Grants
Health Care Access 41,944,000 (45,830,000)
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[HEALTH
CARE ACCESS FUND TRANSFER.] Notwithstanding Laws 2003, First Special Session chapter 14,
article 13C, section 2, subdivision 7, the commissioner of finance shall
transfer $70,000,000 from the health care access fund to the general fund on
July 1, 2004. This transfer is in
addition to all other transfers from the health care access fund to the general
fund.
(b) MA Basic Health Care
Grants - Families and Children
General 76,265,000 (80,589,000)
[CAPITATION PAYMENTS.] Capitation payments
and performance withhold payments under Minnesota Statutes, chapters 256B,
256D, and 256L, for the months of June 2004 and July 2004 shall be made prior
to June 30, 2004. This rider is
effective the day following final enactment.
[HEALTH CARE GRANTS FORECAST.] The
commissioner of finance, as part of the November 2004 forecast, shall determine
the extent to which projected state spending for medical assistance, MFIP, and
basic health care grants for the biennium ending June 30, 2007, exceeds the
level of spending projected for that biennium in the February 2004
forecast. If the level of state
spending projected for the biennium ending June 30, 2007, exceeds the level of
state spending projected for that biennium in the February 2004 forecast by
more than $100,000,000, the commissioner of human services shall present to the
legislature, by December 15, 2004, draft legislation to reduce the projected
increase above the February 2004 estimate to an amount no greater than
$100,000,000. The draft legislation
must achieve this reduction without reducing medical assistance reimbursement
rates to providers.
(c) MA Basic Health Care
Grants - Elderly and Disabled
General 28,821,000 (31,301,000)
(d) General Assistance
Medical Care Grants
General 28,028,000 (26,863,000)
(e) Health Care Grants -
Other Assistance
General
-0-
290,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
Health Care Access -0- (750,000)
(f) Prescription Drug
Program
General
-0-
-0-
[PRESCRIPTION DRUG PROGRAM.]
The commissioner may expend the money appropriated for the prescription drug
program in either year of the biennium.
Unexpended funds do not cancel and are available to the commissioner for
fiscal year 2006 prescription drug program expenditures.
Subd. 7. Health Care
Management
Summary by Fund
General
-0-
2,085,000
Health Care Access -0- 300,000
Other Funds -0- 150,000
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) Health Care Policy
Administration
General
-0-
1,965,000
Health Care Access -0- 300,000
Other Funds -0- 150,000
(b) Health Care Operations
General
-0-
120,000
Subd. 8. State-Operated
Services
Summary
by Fund
General 4,262,000 5,520,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[TEMPORARY CONFINEMENT COST OF CARE.] The
cost of care shall be ten percent as specified in Minnesota Statutes, section
246.54, subdivision 2, for any individual for whom a county obtained an order
from a court authorizing temporary confinement, as defined in Minnesota
Statutes, section 253B.045, between January 1, 2004, and June 30, 2004, to the
Minnesota sex offender program as defined in Minnesota Statutes, section
253B.02, subdivision 18a, not 100 percent as required under Minnesota Statutes,
section 253B.045, subdivision 3.
[MINNESOTA SEX OFFENDER PROGRAM.] The
commissioner of human services shall implement cost efficiencies in the
Minnesota sex offender program under Minnesota Statutes, chapter 246B, in order
to reduce base-level operating costs by $5,400,000 over the fiscal year 2006-2007
biennium. The $5,400,000 reduction
shall, at a minimum, seek to lower current year per diem operating costs. This reduction shall not result in fewer
patients served under the Minnesota sex offender program.
Subd. 9. Continuing
Care Grants
Summary
by Fund
General
-0-
15,482,000
Lottery Prize Fund -0- 75,000
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) Community Social
Services
(b) Aging Adult Service
Grant
General
-0-
1,000
(c) Deaf and Hard-of-Hearing
Service Grants
General
-0-
4,000
(d) Mental Health Grants
Lottery Prize Fund -0- 75,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
$75,000 in fiscal year 2005 is appropriated from the
lottery prize fund to the commissioner of human services for a grant to the
Northstar Problem Gambling Alliance, located in Arlington, Minnesota. The Northstar Problem Gambling Alliance must
provide services to increase public awareness of problem gambling, education
and training for individuals and organizations providing services to problem
gamblers and their families, and research relating to problem gambling. This appropriation is contingent on the
demonstration of an equal amount in nonstate matching funds to the commissioner
of finance but may be disbursed in two payments of $37,500 upon receipt of a
commitment for an equal amount of matching nonstate funds.
(e) Community Support Grants
General
-0-
111,000
(f) Medical Assistance
Long-Term Waivers and Home Care Grants
General
-0-
2,295,000
[MANAGE THE GROWTH IN THE TBI WAIVER.] The
commissioner shall allocate funding for home and community-based services
covered under Minnesota Statutes, section 256B.49, so that new TBI waiver
caseload growth is limited to 300 each year of the biennium ending June 30,
2007. State fiscal year 2005 caseload
levels, as determined in the February 2004 forecast, will serve as the base
against which these limits will be established. Priority for new allocations shall be given to individuals
seeking to be discharged from institutional settings or who are at imminent
risk of placement in an institutional setting.
Notwithstanding any provision to the contrary, this paragraph remains in
effect for the biennium ending June 30, 2007.
[MANAGE THE GROWTH IN THE COMMUNITY ALTERNATIVES FOR
DISABLED INDIVIDUALS WAIVER.] The commissioner shall allocate funding for home
and community-based services covered under Minnesota Statutes, section 256B.49,
so that new CADI caseload growth is limited to an average of 160 per month in
each year of the biennium ending June 30, 2007. State fiscal year 2005 caseload levels, as determined in the
February 2004 forecast, will serve as the base against which these limits will
be established. Priority for new
allocations shall be given to individuals seeking to be discharged from
institutional settings or who are at imminent risk of a placement in an
institutional setting. Notwithstanding
any provision to the contrary, this paragraph remains in effect for the
biennium ending June 30, 2007.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(g) Medical Assistance
Long-term Care Facilities Grants
General
-0-
12,591,000
[NURSING FACILITY SCHOLARSHIP PROGRAM.] For
the rate year beginning July 1, 2004, the amount determined under section
256B.431, subdivision 36, shall be removed from each nursing facility's rate.
[RATE AND ALLOCATION INCREASES FOR CONTINUING
CARE PROGRAMS.] Notwithstanding any law or rule to the contrary, including Laws
2003, First Special Session chapter 14, article 13C, section 2, subdivision 9,
the commissioner of human services shall increase reimbursement rates or
increase allocations to assure the necessary increases in state spending for the
providers or programs listed in clauses (1) to (4). The increases are added to base-level funding and are effective
for services rendered on or after July 1, 2004.
(1) Effective July 1, 2004, the commissioner
shall increase payment rates for services and individual or service limits by
up to one-half percent. The rate
increases described in this section must be applied to:
(i) home and community-based waivered
services for the elderly under Minnesota Statutes, section 256B.0915;
(ii) day training and habilitation services
for adults with mental retardation or related conditions under Minnesota
Statutes, sections 252.40 to 252.46;
(iii) the group residential housing
supplementary service rate under Minnesota Statutes, section 256I.05,
subdivision 1a;
(iv) chemical dependency residential and
nonresidential service rates under Minnesota Statutes, section 245B.03;
(v) consumer support grants under Minnesota
Statutes, section 256.476; and
(vi) home and community-based services for
alternative care services under Minnesota Statutes, section 256B.0913.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(2) The commissioner shall increase
allocations made available to county agencies for home and community-based
waivered services to assure up to a one-half percent increase in state spending
for services rendered on or after July 1, 2004. The commissioner shall apply the allocation increases described
in this section to:
(i) persons with mental retardation or
related conditions under Minnesota Statutes, section 256B.501;
(ii) waivered services under community
alternatives for disabled individuals under Minnesota Statutes, section
256B.49;
(iii) community alternative care waivered
services under Minnesota Statutes, section 256B.49; and
(iv) traumatic brain injury waivered services
under Minnesota Statutes, section 256B.49.
County agencies will be responsible for 100
percent of any spending in excess of the allocation made by the
commissioner. Nothing in this section
shall be construed as changing the county's responsibility to offer and make
available feasible home and community-based options to eligible waiver
recipients within the resources allocated to them for that purpose.
(3) The commissioner shall increase deaf and
hard-of-hearing grants by up to one-half percent on July 1, 2004.
(4) Effective July 1, 2004, the commissioner
shall increase payment rates for each facility reimbursed under Minnesota
Statutes, section 256B.5012, by increasing the total operating payment rate for
intermediate care facilities for the mentally retarded by up to one-half
percent. For each facility, the
commissioner shall multiply the adjustment by the total payment rate, excluding
the property-related payment rate, in effect on June 30, 2004. A facility whose payment rates are governed
by closure agreements, receivership agreements, or Minnesota Rules, part
9553.0075, is not subject to an adjustment otherwise taken under this
subdivision.
Notwithstanding any contrary
provision, these adjustments shall not expire.
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
(h) Alternative Care Grants
General
-0-
252,000
(i) Group Residential
Housing Grants
General
-0-
(25,000)
(j) Chemical Dependency
Entitlement Grants
General
-0-
253,000
(k) Chemical Dependency
Nonentitlement Grants
Subd. 10. Continuing
Care Management
Subd. 11. Economic
Support Grants
Summary by Fund
General
-0-
118,000
Federal TANF -0- (10,225,000)
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) Minnesota Family
Investment Program
Federal TANF -0- (10,225,000)
(b) Work Grants
[FOOD STAMPS EMPLOYMENT AND TRAINING FUNDS.]
Notwithstanding Minnesota Statutes, section 256D.051, subdivision 6d, for
fiscal years 2005, 2006, and 2007 only, Federal food stamps employment and
training funds received as reimbursement of Minnesota family investment program
consolidated fund grant expenditures must be deposited in the general
fund. Consistent with the receipt of
these federal funds, the commissioner may adjust the level of working family
credit expenditures claimed as TANF maintenance of effort.
(c) Economic Support Grants
- Other Assistance
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[MEC2 IMPLEMENTATION.] The
commissioner may make up to five percent of a county's subsequent calendar year
basic sliding fee child care assistance allocation available to the county in
the current calendar year to offset the cash flow effect of MEC2
implementation. This adjustment shall
not be considered when calculating future allocation amounts under Minnesota
Statutes, section 119B.03.
[BASIC SLIDING FEE CHILD CARE.] The fiscal
year 2006 and 2007 general fund base for basic sliding fee child care is
reduced by $11,045,000.
(d) Child Support
Enforcement Grants
(e) General Assistance
Grants
(f) Minnesota Supplemental
Aid Grants
General
-0-
118,000
Sec. 3. COMMISSIONER OF
HEALTH
Subdivision 1. Total
Appropriation
-0- 598,000
Summary by Fund
General Fund
-0- (592,000)
Health Care Access Fund
-0- (6,000)
Subd. 2. Health Quality
and Access
Health Care Access Fund
-0- 83,000
Of the Health Care Access Fund appropriation,
$48,000 is for the evaluation of health care providers cost-shifting. This is a onetime appropriation.
Subd. 3. Management and
Support Services
-0- (692,000)
Health Care Access Fund
-0- (89,000)
Subd. 4. Health
Protection General Fund
-0- 100,000
APPROPRIATIONS
Available for the Year
Ending June 30
2004 2005
[TRANSFER OF LEAD ABATEMENT.] The lead
abatement program is transferred from the Department of Education to the
Department of Health. The program shall
be administered according to Minnesota Statutes, section 119A.46.
Sec. 4. BOARD OF
CHIROPRACTIC EXAMINERS
In fiscal year 2004, $200,000 in state
government special revenue funds is transferred from Laws 2003, First Special
Session chapter 1, article 1, section 28, to the Board of Chiropractic
Examiners to pay for contested case activity.
These funds are available until June 30, 2005.
Sec. 5. VETERANS HOMES
BOARD
General Fund
-0- (90,000)"
Delete the title and insert:
"A bill for an act relating to operation of state government; conforming to federal tax changes to encourage consumer-driven health plans; encouraging efficiency in providing health care; requiring disease management initiatives; implementing health care cost containment, cost-shifting provisions, and reduction of government mandates; implementing health plan competition and reform provisions; changing health maintenance organization regulatory authority; changing provisions related to child care, economic supports, health care, long-term care, continuing care, and program integrity and administration; making health and human services forecast adjustments and reductions; appropriating money; amending Minnesota Statutes 2002, sections 16A.10, by adding a subdivision; 43A.23, by adding a subdivision; 62A.02, subdivision 2; 62D.02, subdivision 4, by adding a subdivision; 62D.03, subdivision 1; 62D.04, subdivision 1; 62D.05, subdivision 1; 62Q.65; 72A.20, by adding a subdivision; 119B.13, by adding a subdivision; 144.148, by adding a subdivision; 144A.10, subdivision 1a, by adding a subdivision; 144D.025; 147.03, subdivision 1; 256.01, by adding subdivisions; 256.9365, subdivision 1; 256.955, subdivisions 2b, 4, 6; 256B.02, subdivision 12; 256B.04, subdivision 14, by adding a subdivision; 256B.056, subdivision 5, by adding subdivisions; 256B.0916, subdivision 2; 256B.431, by adding subdivisions; 256B.49, by adding a subdivision; 256D.045; 256D.051, subdivisions 1a, 3a, 6c; 256I.04, subdivision 2a; 256L.01, subdivision 5; 256L.03, subdivision 5, by adding a subdivision; 256L.04, subdivision 2, by adding subdivisions; 256L.05, subdivision 3; 549.02, by adding a subdivision; 549.04; Minnesota Statutes 2003 Supplement, sections 62E.08, subdivision 1; 62E.091; 62J.26, by adding a subdivision; 119B.09, subdivision 9; 119B.13, subdivision 1; 144.7063, subdivision 3; 144A.071, subdivision 4c; 245A.10, subdivision 4; 246B.04, as amended; 252.27, subdivision 2a; 256.019, subdivision 1; 256.046, subdivision 1; 256.955, subdivisions 2a, 3; 256B.056, subdivision 3c; 256B.057, subdivision 9; 256B.0595, subdivision 2; 256B.06, subdivision 4; 256B.0625, subdivision 9; 256B.0631, subdivision 2; 256B.19, subdivision 1; 256B.434, subdivision 4; 256B.69, subdivision 2; 256D.03, subdivisions 3, 4; 256D.44, subdivision 5; 256J.24, subdivision 6; 256J.37, subdivision 3a; 256J.53, subdivision 1; 256L.03, subdivision 1; 256L.035; 256L.07, subdivisions 1, 3; 290.01, subdivisions 19, 31; 295.50, subdivision 9b; 295.53, subdivision 1; Laws 2003, First Special Session chapter 14, article 9, section 34; Laws 2003,