Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5793

 

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5794

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:


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5795

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.


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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.


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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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5798

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5799

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.


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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:


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(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;


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(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.


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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:


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(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;


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(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;


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(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 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


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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.

 

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;


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(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


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(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).


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(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;


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(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.


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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.


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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.


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(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;


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(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;


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(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


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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;


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(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.


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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


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(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


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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.


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(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).


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(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;


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(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.


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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


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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.


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(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;


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(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;


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(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.


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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.


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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;


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(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 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


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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.

 

(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).


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(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.


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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


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(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;


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(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.


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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.


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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.


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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;


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(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.


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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


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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;


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(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;


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(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


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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.


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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


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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, 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


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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:

 

(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.


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(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


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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 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.


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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.


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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


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(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.


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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:


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(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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5857

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5858

(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;


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(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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5860

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5861

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5862

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.


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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;


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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


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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.


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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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5867

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.


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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.


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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.


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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.


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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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5872

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5873

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5874

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5875

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5876

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5877

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5878

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5879

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5880

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5881

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5882

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5883

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5884

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)


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5885

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5886

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)


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5887

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


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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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5889

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5890

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5891

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5892

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.


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5893

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5894

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


Journal of the House - 80th Day - Friday, March 26, 2004 - Top of Page 5895

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,