STATE OF MINNESOTA
EIGHTY-FIFTH SESSION - 2008
_____________________
NINETY-EIGHTH DAY
Saint Paul, Minnesota, Wednesday, April 2,
2008
The House of Representatives convened at 9:00 a.m. and was
called to order by Margaret Anderson Kelliher, Speaker of the House.
Prayer was offered by William F. Davnie, Minister, Presbyterian
Church U.S.A.
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
Anderson, B.
Anderson, S.
Anzelc
Atkins
Beard
Benson
Berns
Bigham
Bly
Brod
Brown
Brynaert
Buesgens
Bunn
Carlson
Clark
Cornish
Davnie
Dean
DeLaForest
Demmer
Dettmer
Dill
Dittrich
Dominguez
Doty
Drazkowski
Eastlund
Eken
Emmer
Erhardt
Erickson
Faust
Finstad
Fritz
Gardner
Garofalo
Gottwalt
Greiling
Gunther
Hackbarth
Hamilton
Hansen
Hausman
Haws
Heidgerken
Hilstrom
Hilty
Holberg
Hoppe
Hornstein
Hortman
Hosch
Howes
Huntley
Jaros
Johnson
Kahn
Kalin
Knuth
Koenen
Kohls
Kranz
Laine
Lanning
Lenczewski
Lesch
Liebling
Lieder
Lillie
Loeffler
Madore
Mahoney
Mariani
Marquart
Masin
McFarlane
McNamara
Moe
Morgan
Morrow
Mullery
Murphy, E.
Murphy, M.
Nelson
Nornes
Norton
Olin
Olson
Otremba
Ozment
Paulsen
Paymar
Pelowski
Peppin
Peterson, A.
Peterson, N.
Peterson, S.
Poppe
Rukavina
Ruth
Ruud
Sailer
Scalze
Seifert
Sertich
Severson
Shimanski
Simon
Simpson
Slawik
Slocum
Smith
Solberg
Swails
Thao
Thissen
Tillberry
Tingelstad
Tschumper
Urdahl
Wagenius
Walker
Ward
Wardlow
Welti
Westrom
Winkler
Wollschlager
Zellers
Spk. Kelliher
A quorum was present.
Juhnke and Magnus were excused.
The Chief Clerk proceeded to read the Journal of the preceding
day. Doty moved that further reading of
the Journal be suspended and that the Journal be approved as corrected by the
Chief Clerk. The motion prevailed.
Sertich moved that the House recess subject to the call of the
Chair. The motion prevailed.
RECESS
RECONVENED
The House reconvened and was called to order by the Speaker.
REPORTS OF STANDING COMMITTEES AND DIVISIONS
Solberg from the Committee on Ways and Means to which was
referred:
H. F. No. 1812, A bill for an act relating to the financing,
organization, and operation of state government; providing for programs in
education, higher education, environment and natural resources, energy,
agriculture, veterans affairs, military affairs, jobs and economic development
activities or programs, transportation, public safety, courts, human rights,
judiciary, housing, public health, health department, and human services; modifying
certain statutory provisions and laws; providing for certain programs for
economic and state affairs; regulating certain activities and practices; fixing
and limiting fees; providing for the taxation of certain corporations;
authorizing rulemaking, requiring studies and reports; providing civil
penalties; making technical corrections; providing for fund transfers;
appropriating money or reducing appropriations; amending Minnesota Statutes
2006, sections 3.30, subdivision 1; 3.855, subdivision 3; 3.971, subdivision 2;
10A.071, subdivision 3; 13.32, subdivision 3, by adding a subdivision; 13.461,
by adding a subdivision; 13.465, subdivision 8; 13.851, by adding a
subdivision; 15A.081, subdivision 8; 15A.0815; 16A.133, subdivision 1; 16B.281,
subdivision 3; 16B.282; 16B.283; 16B.284; 16B.287, subdivision 2; 16C.16,
subdivision 5; 16E.01, subdivision 3; 16E.03, subdivision 1; 16E.04,
subdivision 2; 17.4988, subdivisions 2, 3; 43A.01, subdivision 3; 43A.17,
subdivision 9; 84.788, subdivision 3; 84.82, subdivision 2, by adding a
subdivision; 84.922, subdivision 2; 84.9256, subdivision 1; 85.011; 85.012,
subdivisions 28, 49a; 85.013, subdivision 1; 85.054, subdivision 3, by adding a
subdivision; 86B.401, subdivision 2; 88.15, subdivision 2; 89.715; 93.481, by
adding a subdivision; 97A.055, subdivision 4b; 97A.141, subdivision 1;
103A.204; 103A.43; 103B.151, subdivision 1; 103G.291, by adding a subdivision;
103G.615, subdivision 2; 116J.423, by adding a subdivision; 116J.8731,
subdivision 4; 116L.17, by adding a subdivision; 116U.26; 119A.03, subdivision
1; 120B.131, subdivision 2; 120B.31, as amended; 120B.35, as amended; 120B.36,
as amended; 120B.362; 122A.21; 123B.02, subdivision 21; 123B.59, subdivision 1;
123B.62; 124D.04, subdivisions 3, 6, 8, 9; 124D.05, by adding a subdivision;
124D.10, subdivision 20; 124D.385, subdivision 4; 124D.55; 125A.65, by adding a
subdivision; 125A.76, by adding a subdivision; 126C.10, subdivision 31, by
adding a subdivision; 126C.17, subdivision 9; 126C.21, subdivision 1; 126C.51;
126C.52, subdivision 2, by adding a subdivision; 126C.53; 126C.55; 127A.45,
subdivision 16; 136A.101, subdivision 8; 136A.121, subdivision 5; 136F.90,
subdivision 1; 141.25, by adding a subdivision; 144.1222, subdivision 1a, by
adding subdivisions; 144.1501, subdivision 2; 144.218, subdivision 1; 144.225,
subdivision 2; 144.2252; 144.226, subdivision 1; 157.16, as amended; 168.1255,
by adding a subdivision; 171.29, subdivision 1; 190.19, subdivision 1, by
adding a subdivision; 192.501, by adding subdivisions; 197.585, subdivision 5;
216C.41, subdivision 4; 253B.045, subdivisions 1, 2, by adding a subdivision;
253B.185, subdivision 5; 256.01, by adding a subdivision; 256.741, subdivisions
2, 2a, 3; 256.969, subdivisions 2b, 20; 256B.0571, subdivisions 8, 9;
256B.0621, subdivisions 2, 6, 10; 256B.0917, subdivision 8; 256B.0924,
subdivisions 4, 6; 256B.19, subdivision 1d; 256B.431, subdivision 23; 256B.69,
subdivisions 5a, 6, by adding subdivisions; 256B.692, subdivision 2, by adding
a subdivision; 256D.44, subdivisions 2, 5; 256L.12, subdivision 9; 259.89,
subdivision 1; 260C.317, subdivision 4; 268.125, subdivisions 1, 2, by adding a
subdivision; 290.01, subdivisions 5, 19c, as amended, 19d, as amended, by
adding a subdivision; 290.17, subdivision 4; 298.2214, subdivisions 1, 2, as
amended; 298.223, subdivision 2; 298.28, subdivisions 9b, 9d, as added;
298.292, subdivision 2, as amended; 298.2961, subdivision 2; 341.21, as
amended; 341.23; 341.26; 341.28, as amended; 341.29; 341.30; 341.32, as
amended; 341.33; 341.34, subdivision 1; 341.35; 341.37; 349A.02, subdivision 1;
446A.12, subdivision 1; 462A.22,
subdivision 1; 473.1565, subdivision
3; 518A.50; 518A.53, subdivision 5; 609.531, subdivision 1; Minnesota Statutes
2007 Supplement, sections 3.922, by adding a subdivision; 10A.01, subdivision
35; 16B.328, by adding a subdivision; 80A.28, subdivision 1; 84.8205,
subdivision 1; 103G.291, subdivision 3; 116J.575, subdivision 1a; 116L.17,
subdivision 1; 120B.021, subdivision 1; 120B.024; 120B.30; 123B.143,
subdivision 1; 124D.531, subdivision 1; 126C.21, subdivision 3; 126C.44;
136A.121, subdivision 7a; 136A.126; 136A.127; 136A.128, by adding a
subdivision; 136A.65, subdivisions 1, 3, 5, 6, 7; 136A.66; 136A.67; 136A.69;
136F.02, subdivision 1; 136F.03, subdivision 4; 141.25, subdivision 5; 141.28,
subdivision 1; 141.35; 190.19, subdivision 2; 214.04, subdivision 3; 216C.052,
subdivision 2; 216C.41, subdivision 3; 253B.185, subdivision 1b; 256.741,
subdivision 1; 256B.0625, subdivision 20; 256B.0631, subdivisions 1, 3;
256B.199; 256B.434, subdivision 19; 256J.621; 268.047, subdivisions 1, 2;
268.085, subdivisions 3, 9, 16; 268.125, subdivision 3; 298.227; 341.22;
341.25; 341.27; 341.321; 446A.072, subdivisions 3, 5a; 446A.086; Laws 1999,
chapter 223, article 2, section 72; Laws 2006, chapter 282, article 2, section
27, subdivision 4; Laws 2007, chapter 45, article 2, section 1; Laws 2007,
chapter 54, article 1, section 11; Laws 2007, chapter 57, article 1, section 4,
subdivisions 3, 4, 6; Laws 2007, chapter 135, article 1, section 3,
subdivisions 2, 3; Laws 2007, chapter 144, article 1, sections 3, subdivisions
2, 18; 5, subdivisions 2, 5; Laws 2007, chapter 146, article 1, section 24,
subdivisions 2, 3, 4, 5, 6, 7, 8; article 2, section 46, subdivisions 2, 3, 4,
6, 9, 13; article 3, sections 23, subdivision 2; 24, subdivisions 3, 4, 9;
article 4, section 16, subdivisions 2, 3, 6, 8; article 5, section 13,
subdivisions 2, 3, 4, 5; article 7, section 4; article 9, section 17,
subdivisions 2, 3, 4, 8, 9, 13; Laws 2007, chapter 147, article 2, section 21;
article 19, section 3, subdivisions 1, 4; Laws 2007, chapter 148, article 1,
sections 7; 12, subdivision 4; Laws 2007, First Special Session chapter 2,
article 1, section 11, subdivisions 1, 2, 6; Laws 2008, chapter 152, article 1,
section 6, subdivision 2; proposing coding for new law in Minnesota Statutes,
chapters 5; 13B; 16A; 43A; 115A; 116J; 120B; 121A; 124D; 127A; 136F; 144; 192;
256B; 268; 325F; 341; 446A; repealing Minnesota Statutes 2006, sections
16B.281, subdivisions 2, 4, 5; 16B.285; 84.961, subdivision 4; 85.013,
subdivision 21b; 97A.141, subdivision 2; 121A.67; 125A.16; 125A.19; 125A.20;
125A.57; 168.123, subdivision 2a; 256.741, subdivision 15; 256J.24, subdivision
6; 259.83, subdivision 3; 259.89, subdivisions 2, 3, 4, 5; 290.01, subdivision
6b; 298.28, subdivision 9a; 341.31; 645.44, subdivision 19; Minnesota Statutes
2007 Supplement, section 256.969, subdivision 27; Laws 1989, chapter 335,
article 1, section 21, subdivision 8, as amended; Laws 2004, chapter 188,
section 2; Laws 2006, chapter 263, article 3, section 16; Laws 2007, First
Special Session chapter 2, article 1, section 11, subdivisions 3, 4.
Reported
the same back with the following amendments:
Page
24, line 20, after "to" insert ": (i)"
Page
24, line 22, after "state" insert "; or (ii)
enrollment transfers between Minnesota and a school district in an adjoining
state under a board agreement initiated in fiscal year 2009 to serve students
in grade levels discontinued by the resident district"
Page
221, line 9, delete "(3,608,000)" and insert "(2,608,000)"
Page
221, after line 9, insert:
"The
base is reduced by an additional $1,000,000 in fiscal year 2010 and each year
after."
Page
222, line 18, delete "$1,000,000" and insert "$2,000,000"
Page
225, line 32, after the period, insert "The funds received by the
commissioner for the confinement and nonconfinement costs are appropriated to
the department for these purposes."
Page
234, delete subdivision 3 and insert:
"Sec. 12. APPROPRIATION
TO THE COMMISSIONER OF FINANCE; 2008 BUDGET RESERVE ESCROW ACCOUNT $-0- $14,000,000
$14,000,000 is appropriated
from the budget reserve to the commissioner of finance and shall be placed in
the budget reserve escrow account. The
commissioner of finance may use this appropriation to support a guarantee by
the state of Minnesota that private money will be raised to pay the
Minneapolis-St. Paul Host Committee's share of expenses for the 2008 Republican
National Convention in St. Paul. The
terms of the state guarantee will be negotiated by the commissioner of
finance. Any money advanced to the Host
Committee under the state guarantee must be repaid by the Host Committee to the
commissioner of finance no later than June 30, 2009, and deposited in the
budget reserve fund. Any unspent
portion of the appropriation cancels to the budget reserve on June 30, 2009."
Page 272, after line 23,
insert:
"Sec. 5. [144.058]
INTERPRETER SERVICES QUALITY INITIATIVE.
(a) The commissioner of
health shall establish a voluntary statewide roster, and develop a plan for a
registry and certification process for interpreters who provide high quality,
spoken language health care interpreter services. The roster, registry, and certification process shall be based on
the findings and recommendations set forth by the Interpreter Services Work
Group required under Laws 2007, chapter 147, article 12, section 13. By January 1, 2009, the commissioner shall
do the following:
(1) establish a roster of
all available interpreters to address access concerns, particularly in rural
areas;
(2) develop a plan for a
registry of spoken language health care interpreters, including:
(i) development of standards
for registration that set forth educational requirements, training
requirements, demonstration of language proficiency and interpreting skills,
agreement to abide by a code of ethics, and a criminal background check;
(ii) recommendations for
appropriate alternate requirements in languages for which testing and training
programs do not exist;
(iii) recommendations for
appropriate fees; and
(iv) recommendations for
establishing and maintaining the standards for inclusion in the registry; and
(3) develop a plan for
implementing a certification process based on national testing and certification
processes for spoken language interpreters 12 months after the establishment of
a national certification process.
(b) The commissioner shall
consult with the Interpreter Stakeholder Group of the Upper Midwest Translators
and Interpreters Association for advice on the standards required to plan for
the development of a registry and certification process.
(c) The commissioner shall
charge an annual fee of $50 to include an interpreter in the roster.
EFFECTIVE DATE. This section is effective the day following final enactment."
Page 315, delete section 2
Page 349, line 12, delete
"(56,265,000)" and insert "(50,284,000)"
Page 349, line 15, delete
"(80,296,000)" and insert "(80,069,000)"
Page 349, line 17, delete
"27,323,000" and insert "33,077,000"
Page 349, line 27, delete
"25,000,000" and insert "0" and delete "27,039,000"
and insert "5,754,000"
Page 350, line 15, delete
"(25,947,000)" and insert "(29,959,000)"
Page 350, delete line 20
Page 350, line 21, delete
"and" and insert "shall be" and delete "year"
and insert "years 2010 and"
Page 350, after line 32,
insert:
"(d) Children and Community Services Grants 0 (5,754,000)
Base level
adjustment. This reduction is onetime.
(e) Minnesota Supplemental Aid Grants 0 201,000"
Page 352, line 17, delete
"(2,254,000)" and insert "(2,292,000)"
Page 353, line 22, delete
"100,000" and insert "350,000"
Page 353, after line 22,
insert:
"Base level adjustment. The
general fund base shall be reduced by $210,000 in fiscal years 2010 and 2011
for this activity."
Page 353, line 26, delete
"(2,291,000)" and insert "3,463,000"
Page 354, line 16, delete
"(4,555,000)" and insert "(4,540,000)"
Page 354, after line 16,
insert:
"Base level adjustment. This
reduction is onetime."
Page 354, after line 27,
insert:
"Funding Usage. Up
to 75 percent of the fiscal year 2010 appropriation for adult mental health
grants may be used to fund calendar year 2009 allocations for these programs,
with the resulting calendar year funding pattern continuing into the future."
Page 355, line 32, delete
"$7,633,000" and insert "$7,275,000"
Page 355, line 33, delete
"$5,332,000" and insert "$4,881,000"
Page 357, line 5, delete
"180" and insert "90"
Page 357, line 9, after the
period, insert "The process for withholding funds is governed by
Minnesota Statutes, section 256.017."
Renumber the sections in
sequence and correct the internal references
Correct the title numbers
accordingly
With the recommendation that
when so amended the bill pass.
Olson moved that the Committee Report on H. F. No. 1812 be
rejected.
A roll call was requested and properly seconded.
CALL
OF THE HOUSE
On the motion of Olson and on the demand of 10 members, a call
of the House was ordered. The following
members answered to their names:
Abeler
Anderson, B.
Anderson, S.
Anzelc
Atkins
Beard
Benson
Berns
Bigham
Bly
Brod
Brown
Brynaert
Buesgens
Bunn
Carlson
Clark
Cornish
Davnie
Dean
DeLaForest
Demmer
Dettmer
Dill
Dittrich
Dominguez
Doty
Drazkowski
Eastlund
Eken
Emmer
Erhardt
Erickson
Faust
Finstad
Fritz
Gardner
Garofalo
Gottwalt
Greiling
Gunther
Hackbarth
Hamilton
Hansen
Hausman
Haws
Heidgerken
Hilstrom
Hilty
Holberg
Hoppe
Hornstein
Hortman
Hosch
Howes
Huntley
Jaros
Johnson
Kahn
Kalin
Knuth
Kohls
Kranz
Laine
Lanning
Lenczewski
Lesch
Liebling
Lieder
Lillie
Loeffler
Madore
Mahoney
Mariani
Marquart
McFarlane
McNamara
Moe
Morgan
Morrow
Murphy, E.
Murphy, M.
Nelson
Nornes
Norton
Olson
Otremba
Ozment
Paulsen
Paymar
Pelowski
Peppin
Peterson, A.
Peterson, N.
Peterson, S.
Poppe
Rukavina
Ruth
Ruud
Sailer
Scalze
Seifert
Sertich
Severson
Shimanski
Simon
Simpson
Slawik
Slocum
Smith
Solberg
Swails
Thao
Thissen
Tillberry
Tingelstad
Tschumper
Urdahl
Wagenius
Walker
Ward
Wardlow
Welti
Westrom
Winkler
Wollschlager
Zellers
Spk. Kelliher
Sertich moved that further proceedings of the roll call be
suspended and that the Sergeant at Arms be instructed to bring in the
absentees. The motion prevailed and it
was so ordered.
LAY ON
THE TABLE
Sertich moved that the Olson motion relating to the committee
report on H. F. No. 1812 be laid on the table.
A roll call was requested and properly seconded.
The question was taken on the Sertich motion and the roll was
called.
Sertich moved that those not voting be excused from
voting. The motion prevailed.
There were 84 yeas and 47 nays as follows:
Those who voted in the affirmative were:
Anzelc
Atkins
Benson
Bigham
Bly
Brown
Brynaert
Bunn
Carlson
Clark
Davnie
Dill
Dittrich
Dominguez
Doty
Eken
Faust
Fritz
Gardner
Greiling
Hansen
Hausman
Haws
Hilstrom
Hilty
Hornstein
Hortman
Hosch
Howes
Huntley
Jaros
Johnson
Kahn
Kalin
Knuth
Koenen
Kranz
Laine
Lenczewski
Lesch
Liebling
Lieder
Lillie
Loeffler
Madore
Mahoney
Mariani
Marquart
Masin
Moe
Morgan
Morrow
Murphy, E.
Murphy, M.
Nelson
Norton
Olin
Otremba
Paymar
Pelowski
Peterson, A.
Peterson, S.
Poppe
Rukavina
Ruud
Sailer
Scalze
Sertich
Simon
Slawik
Slocum
Solberg
Swails
Thao
Thissen
Tillberry
Tschumper
Wagenius
Walker
Ward
Welti
Winkler
Wollschlager
Spk. Kelliher
Those who voted in the negative were:
Abeler
Anderson, B.
Anderson, S.
Beard
Berns
Brod
Buesgens
Cornish
Dean
DeLaForest
Demmer
Dettmer
Drazkowski
Eastlund
Emmer
Erhardt
Erickson
Finstad
Garofalo
Gottwalt
Gunther
Hackbarth
Hamilton
Heidgerken
Holberg
Hoppe
Kohls
Lanning
McFarlane
McNamara
Nornes
Olson
Ozment
Paulsen
Peppin
Peterson, N.
Ruth
Seifert
Severson
Shimanski
Simpson
Smith
Tingelstad
Urdahl
Wardlow
Westrom
Zellers
The motion prevailed and the Olson motion relating to H. F. No.
1812 was laid on the table.
The question recurred on the adoption of the Committee Report
on H. F. No. 1812.
A roll call was requested and properly seconded.
The vote was taken on the adoption of the Committee Report on
H. F. No. 1812 and the roll was called.
Sertich moved that those not voting be excused from
voting. The motion prevailed.
There were 84 yeas and 47 nays as follows:
Those who voted in the affirmative were:
Anzelc
Atkins
Benson
Bigham
Bly
Brown
Brynaert
Bunn
Carlson
Clark
Davnie
Dill
Dittrich
Dominguez
Doty
Eken
Faust
Fritz
Gardner
Greiling
Hansen
Hausman
Haws
Hilstrom
Hilty
Hornstein
Hortman
Hosch
Howes
Huntley
Jaros
Johnson
Kahn
Kalin
Knuth
Koenen
Kranz
Laine
Lenczewski
Lesch
Liebling
Lieder
Lillie
Loeffler
Madore
Mahoney
Mariani
Marquart
Masin
Moe
Morgan
Morrow
Murphy, E.
Murphy, M.
Nelson
Norton
Olin
Otremba
Paymar
Pelowski
Peterson, A.
Peterson, S.
Poppe
Rukavina
Ruud
Sailer
Scalze
Sertich
Simon
Slawik
Slocum
Solberg
Swails
Thao
Thissen
Tillberry
Tschumper
Wagenius
Walker
Ward
Welti
Winkler
Wollschlager
Spk. Kelliher
Those who voted in the negative were:
Abeler
Anderson, B.
Anderson, S.
Beard
Berns
Brod
Buesgens
Cornish
Dean
DeLaForest
Demmer
Dettmer
Drazkowski
Eastlund
Emmer
Erhardt
Erickson
Finstad
Garofalo
Gottwalt
Gunther
Hackbarth
Hamilton
Heidgerken
Holberg
Hoppe
Kohls
Lanning
McFarlane
McNamara
Nornes
Olson
Ozment
Paulsen
Peppin
Peterson, N.
Ruth
Seifert
Severson
Shimanski
Simpson
Smith
Tingelstad
Urdahl
Wardlow
Westrom
Zellers
The motion prevailed and the Committee Report on H. F. No. 1812
was adopted.
CALL
OF THE HOUSE LIFTED
Sertich moved that the call of the House be lifted. The motion prevailed and it was so ordered.
REPORTS OF STANDING COMMITTEES AND DIVISIONS,
Continued
Solberg
from the Committee on Ways and Means to which was referred:
H. F. No.
3360, A bill for an act relating to claims against the state; providing for
settlement of various claims; appropriating money.
Reported
the same back with the recommendation that the bill pass.
The report was adopted.
Carlson
from the Committee on Finance to which was referred:
H. F.
No. 3391, A bill for an act relating to health care reform; increasing
affordability and continuity of care for state health care programs; modifying
health care provisions; providing subsidies for employee share of
employer-subsidized insurance; establishing the Minnesota Health Insurance
Exchange; requiring certain employers to offer Section 125 Plan; establishing
the Health Care Transformation Commission; creating an affordability standard;
requiring mandated reports; appropriating money; amending Minnesota Statutes
2006, sections 62A.65, subdivision 3; 62E.141; 62L.12, subdivisions 2, 4; 256.01,
by adding subdivisions; 256B.061; 256B.69, by adding a subdivision; 256D.03, by
adding a subdivision; 256L.05, by adding a subdivision; 256L.06, subdivision 3;
256L.07, subdivision 3; 256L.15, by adding a subdivision; Minnesota Statutes
2007 Supplement, sections 13.46, subdivision 2; 256B.056, subdivision 10;
256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7; 256L.05, subdivision
3a; 256L.07, subdivision 1; 256L.15, subdivision 2; proposing coding for new
law in Minnesota Statutes, chapter 256B; proposing coding for new law as
Minnesota Statutes, chapter 62U; repealing Minnesota Statutes 2006, section
256L.15, subdivision 3.
Reported
the same back with the following amendments:
Delete
everything after the enacting clause and insert:
"ARTICLE
1
HEALTH
CARE HOMES
Section
1. Minnesota Statutes 2007 Supplement,
section 256.01, subdivision 2b, is amended to read:
Subd.
2b. Performance payments. (a)
The commissioner shall develop and implement a pay-for-performance system to
provide performance payments to eligible medical groups and clinics that
demonstrate optimum care in serving individuals with chronic diseases who are
enrolled in health care programs administered by the commissioner under
chapters 256B, 256D, and 256L. The
commissioner may receive any federal matching money that is made available
through the medical assistance program for managed care oversight contracted
through vendors, including consumer surveys, studies, and external quality
reviews as required by the federal Balanced Budget Act of 1997, Code of Federal
Regulations, title 42, part 438-managed care, subpart E-external quality
review. Any federal money received for
managed care oversight is appropriated to the commissioner for this
purpose. The commissioner may expend the
federal money received in either year of the biennium.
(b)
Effective July 1, 2009, or upon federal approval, whichever is later, the
commissioner shall develop and implement a patient incentive health program to
provide incentives and rewards to patients who are enrolled in health care
programs administered by the commissioner under chapters 256B, 256D, and 256L,
and who have agreed to and have met personal health goals established with the
patients' primary care providers to manage a chronic disease or condition,
including but not limited to diabetes, high blood pressure, and coronary artery
disease. The commissioner shall
collaborate with the commissioner of health and with community-based
organizations that conduct chronic disease consumer education programs targeted
at labor, business, faith-based, and health care constituencies to avoid
duplication of efforts.
Sec.
2. [256B.0431]
ENROLLEE REQUIREMENTS RELATED TO HEALTH CARE HOMES.
Subdivision
1. Selection
of primary care clinic. Beginning
January 1, 2009, the commissioner shall encourage state health care program
enrollees eligible for services under the fee-for-service system to select a
primary care clinic or medical group, within two months of enrollment. Beginning July 1, 2009, the commissioner
shall encourage enrollees who have a complex or chronic condition to select a
primary care clinic or medical group with clinicians who have been certified as
health care homes under section 256B.0751, subdivision 3. The commissioner
and
county social service agencies shall provide enrollees with lists of primary
care clinics, medical groups, and clinicians certified as health care homes,
and shall establish a toll-free number to provide enrollees with assistance in
choosing a clinic, medical group, or health care home.
Subd.
2. Initial
health assessment. The
commissioner shall encourage state health care program enrollees eligible for
services under the fee-for-service system to obtain an initial health
assessment at their selected primary care clinic or medical group, within one
month of selection, in order to identify individuals with complex or chronic
health conditions, and to identify preventative health care needs.
Subd.
3. Education
and outreach. Beginning
January 1, 2009, the commissioner shall provide patient education and outreach
to state health care program enrollees and applicants related to the importance
of choosing a primary care clinic or medical group and a health care home. Education and outreach must be targeted to
underserved or special populations. The
commissioner shall also develop and implement an outreach program to enroll
eligible persons in state health care programs, by providing a per enrollee
bonus to licensed producers under chapter 60K and nonprofit health care or
social service organizations who provide assistance in enrolling applicants.
Subd.
4. State
health care program. For purposes of this section, "state
health care program" means the medical assistance, MinnesotaCare, and
general assistance medical care programs.
Sec.
3. [256B.0751]
HEALTH CARE HOMES; DEFINITIONS; ESTABLISHMENT.
Subdivision
1. Definitions. (a) For purposes of sections 256B.0751 to
256B.0754, the definitions in this subdivision apply.
(b)
"Commissioner" means the commissioner of human services.
(c)
"Commissioners" means the commissioner of human services and the
commissioner of health acting jointly.
(d)
"State health care program" means the medical assistance,
MinnesotaCare, and general assistance medical care programs.
Subd.
2. Establishment
of health care homes. The
commissioners shall establish health care homes for state health care program
enrollees who have complex or chronic health conditions. In establishing health care homes, the
commissioners shall consider and, when appropriate, incorporate features of the
medical home model developed for the provider-directed care coordination
program authorized under section 256B.0625, subdivision 51. The commissioner shall study the feasibility
of expanding health care homes to all enrollees and report to the legislature
by January 1, 2011.
Subd.
3. Certification. By July 1, 2009, the commissioners shall
begin certification of individual clinicians, who participate as providers in
state health care programs and meet the requirements of section 256B.0752, as
health care homes. Clinicians may enter
into collaborative agreements with other clinicians to develop the components
of a health care home. Clinician
certification as a health care home is voluntary. Clinicians certified as health care homes shall renew their
certification annually, in order to maintain their status as health care
homes. The commissioner may waive some
requirements in order to certify providers and clinicians with health care home
models in existence on March 1, 2008, that serve special patient populations of
diverse race, language, or ethnicity.
Sec.
4. [256B.0752]
HEALTH CARE HOME REQUIREMENTS.
Subdivision
1. Requirement. In order to be certified as a health care
home, a clinician shall meet the criteria specified in this section.
Subd.
2. Patient-provider
relationship; care teams. Each
patient of a health care home shall have an ongoing, long-term relationship
with a provider trained as a personal clinician to provide first contact,
continuous, and comprehensive care for all of a patient's health care
needs. Appropriate specialists and
other health care professionals who do not practice in a traditional primary
care field, and advanced practice registered nurses, shall be allowed to serve
as personal clinicians, if they provide care according to this section.
Subd.
3. Care
coordination. The personal
clinician, in coordination with other health care providers, is responsible for
providing for all the patient's health care needs or for arranging appropriate
care with other qualified professionals.
Health care must be coordinated across all provider types, all care
locations, and the greater community.
This requirement applies to care for all stages of life, including
preventive care, acute care, chronic care, and end-of-life care. Care coordination must include ongoing
planning to prepare for patient transitions across different types of care and
provider types. The care team shall
also coordinate with those providing for the social service needs of the
individual, if this is necessary to ensure a successful health outcome. Care coordination must be provided in a
manner appropriate to the patient's race, ethnicity, and language.
Subd.
4. Care
delivery. (a) A health care
home must provide or arrange for access to care 24 hours a day, seven days a
week.
(b)
Health care homes must encourage the patient, and when authorized and
appropriate, the family, to actively participate in decision making as a full
member of the primary care team. Health
care homes must consider patients and families as partners in decision making,
and must provide access to a patient-directed, decision-making process,
including appropriate decision aids, when available.
(c)
Care delivery must be facilitated by the use of health information technology
and through systematic patient follow-up using internal clinic patient
registries, according to minimum standards specified by the commissioners.
(d)
Care must be provided in a culturally and linguistically appropriate manner.
(e)
Within the context of a system of continuous quality improvement, care
delivery, whenever possible, must be based on evidence-based medicine and use
clinical decision-support tools.
(f)
A health care home must provide enhanced access to care, using methods such as
open scheduling, expanded hours, and new communication methods, such as e-mail,
phone consultations, and e-consults.
(g)
Providers certified as health care homes must offer their health care home
services to all their patients with complex or chronic health conditions who
are interested in participation.
Subd.
5. Quality
of care. Health care homes
must meet process, outcome, and quality standards as developed and specified by
the commissioners. Health care homes
must measure and publicly report all data necessary for the commissioners to
monitor compliance with these standards.
Subd.
6. Comprehensive
care plan. Health care homes
must develop, maintain, and ensure the implementation of a comprehensive care
plan for each enrollee who has a complex or chronic condition, based upon
health history, tests, assessments, and other information. The comprehensive care plan must meet the
criteria specified by the commissioners.
The comprehensive care plan must be culturally appropriate.
Subd.
7. Care
coordinators. Health care
homes must employ care coordinators to manage the care provided to patients
with complex or chronic conditions.
Care coordinators must be trained to provide services that are
appropriate for the race, ethnicity, and language of the patient. Care coordination includes:
(1)
identifying patients with complex or chronic conditions eligible for care
coordination;
(2)
assisting primary care providers in care coordination and education;
(3)
helping patients coordinate their care or access needed services, including
preventative care;
(4)
communicating the care needs and concerns of the patient to the health care
home;
(5)
collecting data on process and outcome measures;
(6)
overseeing the development, maintenance, and implementation of care plans; and
(7)
meeting other criteria as specified by the commissioner.
Subd.
8. Health
care home collaborative. Health
care homes must participate in the health care home collaborative defined in
section 256B.0754, subdivision 4, as required by the commissioners for
certification.
Sec.
5. [256B.0753]
CARE COORDINATION FEE.
Subdivision
1. Care
coordination fee. (a) The
commissioner shall pay each health care home a per-person per-month care
coordination fee for providing care coordination services. The fee must be paid for each
fee-for-service state health care program enrollee eligible for a health care
home, who is served by a personal clinician certified as a health care home.
(b)
Payment of the care coordination fee is contingent on the health care home
meeting the certification standards for health care homes. The care coordination fee is in addition to
reimbursement received by a health care home under the medical assistance
fee-for-service payment system for health care services.
Subd.
2. Amount
of fee. The care
coordination fee must be determined by the commissioner in contracts with
health care homes, and must vary by thresholds of care complexity, with the
highest fees being paid for care provided to individuals requiring the most
intensive care coordination, such as those with very complex health care needs
or several chronic conditions and those who face racial, ethnic, or language
barriers.
Subd.
3. Cost
neutrality. If initial
savings from implementation of health care homes are not sufficient to allow
implementation of the care coordination fee in a cost-neutral manner, the commissioner
shall reallocate costs within the health care system.
EFFECTIVE DATE. Subdivisions 1 and 2 are effective July 1, 2009, or upon
federal approval, whichever is later.
Sec.
6. [256B.0754]
DUTIES OF THE COMMISSIONERS.
Subdivision
1. Establishment
of certification standards and other criteria. (a) By January 1, 2009, the commissioners
shall establish certification standards for health care homes consistent with
the criteria in section 256B.0752.
(b)
By January 1, 2009, the commissioners shall develop care complexity thresholds
and payment amounts for the care coordination fee established under section
256B.0753.
(c)
By January 1, 2009, the commissioners shall identify criteria to determine
enrollees eligible for and in need of care coordination, and who would benefit
from having a comprehensive care plan for their condition.
(d)
By January 1, 2009, the commissioners shall establish criteria and data
collection procedures for evaluating health care homes.
(e)
By January 1, 2009, the commissioners shall develop health care home
requirements for managed care plan contracts, performance incentives, and
withholds, and shall develop the methodology for identifying and recapturing
managed care savings resulting from implementation of the health care home
model.
Subd.
2. Monitoring
and evaluation. The
commissioners shall ensure the collection from health care homes of data
necessary to monitor implementation of the health care home model, measure and
evaluate quality of care and outcomes, measure and evaluate patient experience,
and determine cost savings from implementation of the health care home model. The commissioners shall collect and evaluate
this data directly, but may contract with an appropriate private sector entity
for technical assistance. The
commissioners shall provide health care homes with practice profiles measuring
utilization, cost, and quality. Quality
measures must include measures of disparities in treatment, health status, and
outcomes based on race, ethnicity, or language.
Subd.
3. Care
Coordination Advisory Committee.
By July 1, 2008, the commissioners shall establish a Care
Coordination Advisory Committee to assist the Departments of Human Services and
Health in administering the health care home model, developing the criteria and
standards required under subdivision 1, collecting data, and measuring and
evaluating health outcomes and cost savings.
The commissioners may satisfy this requirement by continuing the
advisory committee established for the provider-directed care coordination
program. If newly established, the
committee must include representatives of: primary care and specialist
physicians, advanced practice registered nurses, patients and their families
including minority ethnic groups, health plans, providers serving low-income
and culturally diverse populations, organizations with expertise in care
coordination models, and other relevant entities. If newly established, membership terms and compensation and
removal of members are governed by section 15.059. The committee does not expire.
Subd.
4. Health
care home collaborative. By
July 1, 2009, the commissioners shall establish a health care home
collaborative to provide an opportunity for health care homes and state
agencies to exchange information related to quality improvement and best
practices.
Subd.
5. Patient-directed,
decision-making process. By
January 1, 2009, the commissioners, in consultation with the Care Coordination
Advisory Committee and the Institute of Clinical Systems Improvement, shall
develop a patient-directed, decision-making support model to be used by health
care homes. The commissioners shall:
(1)
establish protocols that include identifying the use of a patient-directed,
culturally appropriate decision-making process and effectively incorporating
the use of patient-decision aids, when appropriate;
(2)
ensure the quality of the patient-decision aids available to the patient;
(3)
ensure accessibility and cultural appropriateness of the patient-decision aids,
including the use of translators, when necessary; and
(4)
ensure that providers are trained to use patient-decision aids effectively.
Subd.
6. Report
on standards; annual reports. (a)
By November 15, 2008, the commissioners must report drafts of certification
standards, care complexity thresholds, and other criteria, procedures, and
payment amounts necessary to implement subdivision 1 to the chairs and lead
minority members of the legislative committees with jurisdiction over health
care policy and finance. These
standards, thresholds, criteria, procedures, and payment amount are not subject
to chapter 14, and section 14.386 does not apply.
(b)
The commissioners shall report annually to the legislature on the
implementation and administration of the health care home model for state
health care program enrollees in the fee-for-service, managed care, and
county-based purchasing sectors, beginning December 15, 2009, and each December
15 thereafter. The report must include:
(1) information on the number of state health care program enrollees in health
care homes; (2) the number and characteristics of enrollees with complex or
chronic conditions, broken down by income, race, ethnicity, and language
whenever possible; (3) the number and geographic distribution of health care
home providers; (4) the performance and quality of care of health care homes;
(5) measures of preventative care; (6) costs related to implementation and
payment of care coordination fees; (7) health care home payment arrangements;
(8) the estimated impact on health disparities; and (9) estimates of savings
from implementation of the health care home model for the fee-for-service,
managed care, and county-based purchasing sectors relative to the health care
spending baseline calculated under section 62U.07.
Sec.
7. Minnesota Statutes 2006, section
256B.69, is amended by adding a subdivision to read:
Subd.
29. Health
care home model. (a) The
commissioner shall require demonstration providers, as a condition of contract,
to adopt by July 1, 2009, a health care home model for providing care to state
health care program enrollees. The
health care home model must meet the criteria specified in this section and
section 256B.0752. The commissioner, in
consultation with the commissioner of health, may waive or modify criteria for
demonstration providers if the commissioners of health and human services
determine that performance and quality standards would still be met.
(b)
The commissioner, as a condition of contract, shall require demonstration
providers, as part of their implementation of the health care home model, to
pay providers a care coordination fee.
The care coordination fee must meet the requirements of section
256B.0753. Demonstration providers
shall fund the care coordination fee through savings that result from
implementation of the health care home model and, if necessary, through
reductions in administrative costs and reallocation of other payment rates
within its network. The commissioner
shall not adjust current or future capitation rates for costs related to
payment of the care coordination fee.
(c)
The commissioners of health and human services shall require demonstration
providers to: (1) collect from health care homes the data necessary to monitor
implementation of the health care home model, measure and evaluate quality of
care and outcomes, measure and evaluate patient experience, and determine cost
savings from implementation of the health care home model; and (2) submit this
data to the commissioners. The
commissioners of health and human services shall provide demonstration
providers and health care homes with practice profiles measuring utilization,
cost, and quality. Before establishing
or amending general standards for data collection under this paragraph, the
commissioners must report the draft standards to the chairs and lead minority
members of the legislative committees with jurisdiction over health care policy
and finance. Standards for data
collection are not subject to chapter 14 and section 14.386 does not apply.
(d)
The commissioner shall study the feasibility and method of calculating savings
from the use of health care homes, as required in section 256B.0754,
subdivision 6, paragraph (b). The study
must consider the methodology for distribution of savings. Under the methodology, the state must retain
one-half of the savings, the demonstration providers may retain up to
one-fourth of the savings, and at least one-fourth of the savings must be
passed on to health care providers in the form of higher payment rates.
(e)
Demonstration providers must encourage state health care program enrollees to
complete an initial health assessment within three months from the time of
enrollment, in order to identify individuals with complex or chronic health
conditions, and to identify preventative health care needs.
(f)
Beginning July 1, 2009, the commissioner shall require demonstration providers
to require health care homes to develop, maintain, and ensure the
implementation of a comprehensive care plan, as defined in section 256B.0752,
subdivision 6.
(g)
Beginning July 1, 2009, the commissioner shall implement financial arrangements
for demonstration providers to ensure that plans encourage each enrollee who
has a complex or chronic condition to choose a certified primary care clinic or
medical group to serve as a health care home.
Sec.
8. PAYMENT
OF CARE COORDINATION FEE UNDER STATE MANAGED CARE PROGRAMS.
The
commissioner of human services shall study the feasibility of paying the care
coordination fee required under Minnesota Statutes, section 256B.69,
subdivision 29, paragraph (b), directly to health care providers under contract
with demonstration providers to serve state health care program enrollees, and
shall present recommendations to the legislature by December 15, 2008.
Sec.
9. WORKFORCE
SHORTAGE STUDY.
To
address health care workforce shortages, the Health Care Transformation Commission,
in consultation with health licensing boards and professional associations,
shall study changes necessary in health professional licensure and regulation
to ensure full utilization of advanced practice registered nurses and other
licensed health care professionals in the health care home and primary delivery
system. The Health Care Transformation
Commission shall make recommendations to the legislature by January 15, 2009.
Sec.
10. HEALTH CARE ACCESS FUND TRANSFER.
On
July 1, 2008, the commissioner of finance shall transfer $1,390,000 from the
health care access fund to the general fund.
ARTICLE
2
INCREASING
ACCESS; CONTINUITY OF CARE
Section
1. Minnesota Statutes 2007 Supplement,
section 256B.056, subdivision 10, is amended to read:
Subd. 10. Eligibility
verification. (a) The commissioner
shall require women who are applying for the continuation of medical assistance
coverage following the end of the 60-day postpartum period to update their
income and asset information and to submit any required income or asset
verification.
(b)
The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055,
subdivision 10, or 256B.057, subdivision 1, paragraph (d), and shall pay for
private-sector coverage if this is determined to be cost-effective.
(c)
The commissioner shall verify assets and income for all applicants, and
for all recipients upon renewal. The
commissioner shall verify liquid assets for applicants, and for recipients upon
renewal, only if the applicant or recipient reports total countable
assets. The commissioner may verify
nonliquid assets, but is not required to do so. This paragraph does not apply to applicants or recipients
applying for or receiving medical assistance payment of long-term care
services, including services under section 256B.0915, 256B.092, or 256B.49.
(d)
The commissioner shall designate locations where enrollees may submit renewal
forms, including but not limited to community clinics and health care
providers' offices. The designated
sites shall forward the renewal forms to the commissioner.
EFFECTIVE DATE. The amendment to paragraph (c) is effective January 1, 2009.
Sec.
2. Minnesota Statutes 2006, section
256B.057, subdivision 8, is amended to read:
Subd.
8. Children
under age two. Medical assistance
may be paid for a child under two years of age whose countable family income is
above 275 percent of the federal poverty guidelines for the same size family
but less than or equal to 280 305 percent of the federal poverty
guidelines for the same size family.
EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal
approval, whichever is later.
Sec.
3. Minnesota Statutes 2007 Supplement,
section 256L.03, subdivision 3, is amended to read:
Subd.
3. Inpatient
hospital services. (a) Covered
health services shall include inpatient hospital services, including inpatient
hospital mental health services and inpatient hospital and residential chemical
dependency treatment, subject to those limitations necessary to coordinate the
provision of these services with eligibility under the medical assistance
spenddown. The inpatient hospital
benefit for adult enrollees who qualify under section 256L.04, subdivision 7,
or who qualify under section 256L.04, subdivisions 1 and 2, with family gross
income that exceeds 200 percent of the federal poverty guidelines or 215
percent of the federal poverty guidelines on or after July 1, 2009, and who are
not pregnant, is subject to an annual limit of $10,000 $20,000.
(b)
Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3, must be certified as medically necessary in accordance with
Minnesota Rules, parts 9505.0500 to 9505.0540, except as provided in clauses
(1) and (2):
(1)
all admissions must be certified, except those authorized under rules
established under section 254A.03, subdivision 3, or approved under Medicare;
and
(2)
payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the
day of admission. The hospital may not
seek payment from the enrollee for the amount of the payment reduction under
this clause.
EFFECTIVE DATE. This section is effective January 1, 2009, for single adults
and households with no children enrolled under section 256L.07, subdivision 4,
and is effective July 1, 2009, or upon federal approval, whichever is later,
for adults in families with children enrolled under section 256L.04,
subdivision 1. The commissioner of
human services shall notify the revisor of statutes when federal approval is
obtained.
Sec.
4. Minnesota Statutes 2007 Supplement,
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;
(4) $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; and
(5) $6
for nonemergency visits to a hospital-based emergency room.
(b)
Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.
(c)
Paragraph (a) does not apply to pregnant women and children under the age of
21.
(d)
Paragraph (a), clause (4), does not apply to mental health services.
(e)
Adult enrollees with family gross income that exceeds 200 percent of the
federal poverty guidelines or 215 percent of the federal poverty guidelines on
or after July 1, 2009, and who are not pregnant shall be financially
responsible for the coinsurance amount, if applicable, and amounts which exceed
the $10,000 $20,000 inpatient hospital benefit limit.
(f)
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 $20,000 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.
EFFECTIVE DATE. This section is effective January 1, 2009, for single adults
and households with no children enrolled under section 256L.04, subdivision 7,
and is effective July 1, 2009, or upon federal approval, whichever is later,
for adults in families with children enrolled under section 256L.04,
subdivision 1. The commissioner of
human services shall notify the revisor of statutes when federal approval is
obtained.
Sec.
5. Minnesota Statutes 2007 Supplement,
section 256L.04, subdivision 1, is amended to read:
Subdivision
1. Families
with children. (a) Families with
children with family income equal to or less than 275 300 percent
of the federal poverty guidelines for the applicable family size shall be
eligible for MinnesotaCare according to this section. All other provisions of sections 256L.01 to 256L.18, including
the insurance-related barriers to enrollment under section 256L.07, shall apply
unless otherwise specified.
(b)
Parents who enroll in the MinnesotaCare program must also enroll their
children, if the children are eligible.
Children may be enrolled separately without enrollment by parents. However, if one parent in the household
enrolls, both parents must enroll, unless other insurance is available. If one child from a family is enrolled, all
children must be enrolled, unless other insurance is available. If one spouse in a household enrolls, the
other spouse in the household must also enroll, unless other insurance is
available. Families cannot choose to
enroll only certain uninsured members.
(c)
Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These
persons are no longer counted in the parental household and may apply as a
separate household.
(d) Beginning
July 1, 2003, or upon federal approval, whichever is later, parents are not
eligible for MinnesotaCare if their gross income exceeds $50,000.
(e) Children formerly enrolled
in medical assistance and automatically deemed eligible for MinnesotaCare
according to section 256B.057, subdivision 2c, are exempt from the requirements
of this section until renewal.
EFFECTIVE DATE. This section is effective July 1, 2009, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
6. Minnesota Statutes 2007 Supplement,
section 256L.04, subdivision 7, is amended to read:
Subd.
7. Single
adults and households with no children.
The definition of eligible persons includes all individuals and
households with no children who have gross family incomes that are equal to or
less than 200 percent of the federal poverty guidelines. Effective July 1, 2009, the definition of
eligible persons includes all individuals and households with no children who
have gross family incomes that are equal to or less than 215 300
percent of the federal poverty guidelines.
EFFECTIVE DATE. This section is effective July 1, 2009.
Sec.
7. Minnesota Statutes 2007 Supplement,
section 256L.05, subdivision 3a, is amended to read:
Subd.
3a. Renewal of eligibility. (a)
Beginning July 1, 2007, an enrollee's eligibility must be renewed every 12
months. The 12-month period begins in
the month after the month the application is approved.
(b)
Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all the information
needed to redetermine eligibility by the first day of the month that ends the
eligibility period. The commissioner
shall designate locations where enrollees may submit renewal forms, including
but not limited to community clinics and health care providers' offices. The designated sites shall forward the
renewal forms to the commissioner. The
premium for the new period of eligibility must be received as provided in
section 256L.06 in order for eligibility to continue.
(c)
For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section
256D.03, subdivision 3, the first period of eligibility begins the month the
enrollee submitted the application or renewal for general assistance medical
care.
(d)
An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall
remain eligible for one additional month beyond the end of the current
eligibility period before being disenrolled.
The enrollee remains responsible for MinnesotaCare premiums for the
additional month.
EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
8. Minnesota Statutes 2006, section
256L.05, is amended by adding a subdivision to read:
Subd.
6. Delayed
verification. On the basis
of information provided on the completed application, an applicant whose gross
income is less than 90 percent of the applicable income standard and meets all
other eligibility requirements, including compliance at the time of application
with citizenship or nationality documentation requirements under section
256L.04, subdivision 10, must be determined eligible and enrolled upon payment
of premiums according to subdivision 3.
The applicant shall provide all required verifications within 60 days'
notice of the eligibility determination, or eligibility shall be denied or
cancelled. Applicants who are denied or
cancelled for failure to provide all required verifications are not eligible
for coverage using the delayed verification procedures specified in this
subdivision for 12 months.
EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
9. Minnesota Statutes 2006, section
256L.06, subdivision 3, is amended to read:
Subd.
3. Commissioner's
duties and payment. (a) Premiums
are dedicated to the commissioner for MinnesotaCare.
(b)
The commissioner shall develop and implement procedures to: (1) require
enrollees to report changes in income; (2) adjust sliding scale premium
payments, based upon both increases and decreases in enrollee income, at the
time the change in income is reported; and (3) disenroll enrollees from
MinnesotaCare for failure to pay required premiums. Failure to pay includes payment with a dishonored check, a
returned automatic bank withdrawal, or a refused credit card or debit card payment. The commissioner may demand a guaranteed
form of payment, including a cashier's check or a money order, as the only
means to replace a dishonored, returned, or refused payment.
(c)
Premiums are calculated on a calendar month basis and may be paid on a monthly,
quarterly, or semiannual basis, with the first payment due upon notice from the
commissioner of the premium amount required.
The commissioner shall inform applicants and enrollees of these premium
payment options. Premium payment is
required before enrollment is complete and to maintain eligibility in
MinnesotaCare. Premium payments
received before noon are credited the same day. Premium payments received after noon are credited on the next
working day.
(d)
Nonpayment of the premium will result in disenrollment from the plan effective for
the first day of the calendar month following the calendar month for
which the premium was due. Persons
disenrolled for nonpayment or who voluntarily terminate coverage from the
program may not reenroll until four calendar months have elapsed. Persons disenrolled for nonpayment who
pay all past due premiums as well as current premiums due, including premiums
due for the period of disenrollment, within 20 days of disenrollment, shall be
reenrolled retroactively to the first day of disenrollment The
commissioner shall waive premiums for coverage provided under this paragraph to
persons disenrolled for nonpayment who reapply under section 256L.05,
subdivision 3b. Persons disenrolled
for nonpayment or who voluntarily terminate coverage from the program may not
reenroll for four calendar months unless the person demonstrates good cause for
nonpayment. Good cause does not exist
if a person chooses to pay other family expenses instead of the premium. The commissioner shall define good cause in
rule.
EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
10. Minnesota Statutes 2007 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.
Families
enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose income
increases above 275 300 percent of the federal poverty
guidelines, are no longer eligible for the program and shall be disenrolled by
the commissioner. Beginning January 1,
2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
7, whose income increases above 200 percent of the federal poverty guidelines
or 215 300 percent of the federal poverty guidelines on or after July
January 1, 2009, 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.
(b)
Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare if
ten percent of their gross individual or gross family income as defined in
section 256L.01, subdivision 4, 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).
(c)
Notwithstanding paragraphs (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $50,000 for the 12-month period
of eligibility.
EFFECTIVE DATE. This section is effective July 1, 2009, or upon federal
approval, whichever is later, except that the amendment to paragraph (a)
related to the four-month requirement is effective January 1, 2010, or upon
federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
Sec.
11. Minnesota Statutes 2006, 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, an applicant or enrollee who is entitled to Medicare Part A or
enrolled in Medicare Part B coverage under title XVIII of the Social Security
Act, United States Code, title 42, sections 1395c to 1395w-152, is considered
to have health coverage. An applicant
or enrollee who is entitled to premium-free Medicare Part A may not refuse to
apply for or enroll in Medicare coverage to establish eligibility for
MinnesotaCare.
(d) (c) 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)
Cost-effective health insurance that was paid for by medical assistance 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.
EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
12. Minnesota Statutes 2007 Supplement,
section 256L.15, subdivision 2, is amended to read:
Subd.
2. Sliding
fee scale; monthly gross individual or family income. (a) The commissioner shall establish a
sliding fee scale to determine the percentage of monthly gross individual or
family income that households at different income levels must pay to obtain coverage
through the MinnesotaCare program. The
sliding fee scale must be based on the enrollee's monthly gross individual or
family income. The sliding fee scale
must contain separate tables based on enrollment of one, two, or three or more
persons. Until December 31, 2008, the
sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the
limits for the medical assistance program for families and children in effect on
January 1, 1999, and proceeds through the following evenly spaced steps: 1.8,
2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 percent.
These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on
January 1, 1999, to 275 percent of the federal poverty guidelines for the
applicable family size, up to a family size of five. The sliding fee scale for a family of five must be used for
families of more than five. The sliding
fee scale and percentages are not subject to the provisions of chapter 14. If a family or individual reports increased
income after enrollment, premiums shall be adjusted at the time the change in
income is reported.
(b) Families
Children whose gross income is above 275 300 percent of
the federal poverty guidelines shall pay the maximum premium. The maximum premium is defined as a base
charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative costs shall be assumed to
equal ten percent of the total. The
costs of medical coverage for pregnant women and children under age two and the
enrollees in these groups shall be excluded from the total. The maximum premium for two enrollees shall
be twice the maximum premium for one, and the maximum premium for three or more
enrollees shall be three times the maximum premium for one.
(c)
Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according to
the affordability scale established in section 62U.08 with the exception that
children in families with income at or below 150 percent of the federal poverty
guidelines shall pay a monthly premium of $4.
EFFECTIVE DATE. This section is effective July 1, 2009, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
13. Minnesota Statutes 2006, section
256L.15, is amended by adding a subdivision to read:
Subd.
5. First
month premium exemption. New
enrollee households are exempt from premiums for the first month of
MinnesotaCare enrollment. For purposes
of this exemption, a "new enrollee household" is a household which
has not been enrolled in MinnesotaCare for at least one year prior to
application.
EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal
approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
Sec.
14. INSURANCE COVERAGE FOR LONG-TERM CARE WORKERS.
(a)
By December 15, 2008, the commissioner of human services shall study and report
to the legislature with recommendations for a rate increase to long-term care
employers dedicated to the purchase of employee health insurance in the private
market. The commissioner shall collect
necessary actuarial data, employment data, current coverage data, and other
needed information.
(b)
The commissioner shall develop cost estimates for three levels of insurance
coverage for long-term care workers:
(1)
the coverage provided to state employees;
(2)
the coverage provided to MinnesotaCare enrollees; and
(3)
the benefits provided under an average private market insurance product, but
with a deductible limited to $100 per person.
Premium
cost sharing, waiting periods for eligibility, definitions of full- and
part-time employment, and other parameters under the three options must be
identical to those under the state employees' health plan.
(c)
For purposes of this section, a long-term care worker is a person employed by a
nursing facility, an intermediate care facility for persons with developmental
disabilities, or a service provider that:
(1)
is eligible under Laws 2007, chapter 147, article 7, section 71; and
(2)
provides long-term care services.
The
commissioner may recommend a different definition of long-term care worker if
this definition presents insurmountable implementation issues.
(d)
The recommendations must include measures to:
(1)
ensure equitable treatment between employers that currently have different
levels of expenditure for employee health insurance costs; and
(2)
enforce the requirement that the rate increase be expended for the intended
purpose.
Sec.
15. REPEALER.
Minnesota
Statutes 2006, section 256L.15, subdivision 3, is repealed.
EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal
approval of the amendments to section 11, whichever is later. The commissioner of human services shall
notify the revisor of statutes when federal approval is obtained.
Sec.
16. APPROPRIATION.
$804,000
is appropriated from the health care access fund to the commissioner of human
services for fiscal year 2009, to study insurance coverage for long-term care
workers under section 14.
ARTICLE
3
INSURANCE
REFORM
Section
1. UNIFORM
OUTCOME MEASURES WORKING GROUP.
(a)
The Health Care Transformation Commission, established under Minnesota
Statutes, section 62U.04, shall establish an informal working group to create a
standardized limited set of measures by which to measure performance of health
care providers for use in establishing statewide health improvement goals and
in measuring progress on these goals.
The group shall focus first on the most common areas of data collection
for pay-for-performance systems.
(b)
The working group must be known as the Uniform Outcome Measures Working
Group. The commission shall determine
its members and the number of members.
The working group must include representatives of health care providers,
health care purchasers, health insurers, public health agencies, and consumers.
(c)
The working group shall attempt to determine uniform definitions, measures, and
forms for submission of data, to the greatest extent possible.
(d)
The working group shall seek to reduce the administrative burden on health care
providers and health care purchasers.
(e)
The working group shall invite and use the expertise of existing organizations
experienced in health care quality measurement.
(f)
The working group shall encourage participation by the public.
(g)
The commission shall encourage use of the working group recommendations.
(h)
By December 15, 2008, the commission shall provide to the legislature a written
report under Minnesota Statutes, section 3.195, summarizing the work of the
working group. The report must include
recommendations for: (1) a standardized set of health care provider performance
measures to be enacted by the legislature; and (2) a payment methodology to
reduce capitation rates paid by the commissioner of human services under
Minnesota Statutes, section 256B.69, to demonstration providers that use
provider performance measures other than those included in the standardized set
under clause (1).
(i)
The working group expires on June 30, 2009, unless the commission determines
that the group's continued existence would be beneficial.
Sec.
2. COMMUNITY
BENEFIT STANDARDS AND REPORTING; NONPROFIT HEALTH PLAN COMPANIES;
RECOMMENDATIONS.
(a)
By December 15, 2008, the commissioner of health shall recommend to the
legislature community benefit standards to be required by law of nonprofit
health plan companies doing business in the state. The expectations of the community benefits provided and reported
should be related to the statutory expectations in Minnesota Statutes, sections
62C.01 and 62D.01, and thus focus on advocating public health, improving the
art and science of medical care, and addressing the need for financial
assistance to access ongoing coverage, and not related to general philanthropic
endeavors. The commissioner shall seek
public input regarding the range of options to be explored and the
accountability measures.
(b)
The recommendations must include a procedure by which each nonprofit health
plan company would periodically and uniformly report to the state and to the
public regarding the company's compliance with the requirements.
(c)
The commissioner shall recommend a fair and effective enforcement and
remediation mechanism.
ARTICLE
4
HEALTH
INSURANCE PURCHASING AND AFFORDABILITY
Section
1. [62U.01]
DEFINITIONS.
Subdivision
1. Applicability. For purposes of this chapter, the terms
defined in this section have the meanings given, unless otherwise specified.
Subd.
2. Advisory
committee. "Advisory
committee" means the Health Benefit Set and Design Advisory Committee
established in section 62U.055.
Subd.
3. Clinically
effective. "Clinically
effective" means that the use of a particular health technology or service
improves or prevents a decline in patient clinical status, as measured by medical
condition, survival rates, and other variables, and that the use of the
particular technology or service demonstrates a clinical or outcome advantage
over alternative technologies or services.
Subd.
4. Commission. "Commission" means the Health
Care Transformation Commission established in section 62U.04.
Subd.
5. Cost-effective. "Cost-effective" means that the
economic costs of using a particular service, device, or health technology to
achieve improvement or prevent a decline in a patient's health outcome are
justified given the comparison to both the economic costs and the improvement
in patient health outcome resulting from the use of an alternative service,
device, or technology, or from not providing the service, device, or
technology.
Subd.
6. Health
plan. "Health
plan" means a health plan as defined in section 62A.011.
Subd.
7. Health
plan company. "Health
plan company" has the meaning provided in section 62Q.01, subdivision 4.
Subd.
8. Health
technology. "Health
technology" means medical and surgical devices and procedures, medical
equipment, and diagnostic tests.
Subd.
9. State
health care program. "State
health care program" means the medical assistance, MinnesotaCare, and
general assistance medical care programs.
Subd.
10. Third-party
administrators. "Third-party
administrators" means a vendor of risk management services or an entity
administering a self-insurance or health insurance plan under section 60A.23.
Sec.
2. [62U.04]
HEALTH CARE TRANSFORMATION COMMISSION.
Subdivision
1. Creation. The Health Care Transformation Commission
is created for the purpose of coordinating the health care transformation
activities within Minnesota.
Subd.
2. Members. (a) The Health Care Transformation
Commission shall consist of ten members who are appointed as follows:
(1)
three nonlegislators appointed by the Subcommittee on Committees of the
Committee on Rules and Administration of the senate;
(2)
three nonlegislators appointed by the speaker of the house of representatives;
and
(3)
four members appointed by the governor, two of whom shall be state
commissioners from the agencies listed in section 15.01.
(b)
The appointed members who are not commissioners must have expertise in health
care financing, health care delivery, health care quality improvement, health
economics, actuarial science, business operations, health disparities,
culturally competent care, social services funded through medical assistance
and property tax resources, or be an informed consumer representative.
(c)
If a member is no longer able or eligible to perform the required duties, a new
member shall be appointed by the entity that appointed the outgoing member.
Subd.
3. Operations
of the commission. (a) The
commission shall convene on or before July 1, 2008, following the initial
appointment of the members.
(b)
The commission shall elect a chair among its members.
(c)
The commission members shall not be compensated for commission activities
except for actual expenses incurred in the performance of their duties. Expenses shall be compensated according to
section 15.0575.
Subd.
4. Immunity
of liability. No member of
the commission shall be held civilly liable for an act or omission by that
member if the act or omission was in good faith and within the scope of the
member's responsibilities under this chapter.
Subd.
5. Responsibilities
of the commission. The Health Care Transformation Commission
shall:
(1)
collect data from providers on health care prices and quality, including
measures of process, outcomes, and patient satisfaction, and publish
comparative price and quality information in a manner that is easily
understandable and accessible to consumers;
(2)
develop a design and implementation plan for health care payment system reform
as required under sections 62U.11 and 62U.12;
(3)
establish a uniform definition and methodology for calculating the relative
utilization and health care costs for providers in treating patients, including
but not limited to patients with coronary artery and heart disease, diabetes,
asthma, chronic obstructive pulmonary disease, depression, and other chronic
conditions. The methodology must
include risk adjustment mechanisms that address at least the following factors:
(i)
the health status of the individual in the year the individual enters the
provider's care;
(ii)
a worsening of the patient's health condition that was not reasonably preventable
by action that the provider could have taken;
(iii)
socioeconomic and cultural factors that bear directly on the cost of care; and
(iv)
the percentage of individuals served by the provider or care system whose care
is paid for by public health insurance programs;
(4)
provide education, technical assistance, and materials necessary for providers
to participate in the restructured payment system;
(5)
implement and administer the payment system reform;
(6)
make recommendations to the governor and legislature as to additional actions
that are needed in order to successfully achieve health care transformation in
Minnesota;
(7)
consult and coordinate with the commissioners of health and human services,
health care providers, health plan companies, organizations that work to
improve health care quality in Minnesota, consumers, and employers;
(8)
establish a Uniform Outcome Measures Working Group and make recommendations on
community benefit standards, as required under article 3, section 2;
(9)
establish uniform definitions for packages of services used to provide care to
patients, including but not limited to patients with coronary artery and heart
disease, diabetes, asthma, chronic obstructive pulmonary disease, depression,
and other chronic conditions, for the purpose of establishing package pricing;
and
(10)
carry out other duties assigned in this chapter and this article.
Subd.
6. Powers
of the commission. The
commission shall have the power to:
(1)
advise the commissioner of human services on federal policy changes desirable
for furthering transformation of Minnesota's health care system. The commissioner shall also consult with the
legislature on any federal changes; and
(2)
contract with other organizations to carry out all or part of its
responsibilities.
Subd.
7. Standard
benefit set and design. (a)
Based on the recommendations submitted by the Health Benefit Set and Design
Advisory Committee, the commission shall establish a standard benefit set and
design by July 1, 2009.
(b)
The standard health benefit set and design must meet the requirements described
in section 62U.055.
(c)
Prior to establishing the standard benefit set and design, the commission shall
convene public hearings throughout the state.
Subd.
8. Reports. Beginning January 15, 2010, and each
January 15 thereafter, the commission shall submit an annual report to the
governor and legislature on the following:
(1)
the extent to which health care providers have reduced their costs and fees;
(2)
the extent to which costs and cost growth are likely to be maintained or
reduced in future years;
(3)
the extent to which the quality of health care services has improved;
(4)
the extent to which all Minnesotans have access to quality, affordable health
care; and
(5)
recommendations on additional actions that are needed in order to successfully
achieve health care transformation in Minnesota.
Subd.
9. Expiration. The commission shall expire December 31,
2013.
Sec.
3. [62U.055]
STANDARD BENEFIT SET AND DESIGN.
Subdivision
1. Creation. The Health Care Transformation Commission
shall convene a health benefit set and design advisory committee to make
recommendations to the legislature on a standard benefit set and design. The advisory committee shall consist of
seven members. The members shall be
appointed by the commission and must have expertise in benefit design and
development, actuarial analysis, or knowledge relating to the analysis of the
cost impact of coverage of specified benefits.
Subd.
2. Operations
of the committee. (a) The
advisory committee shall convene on or before September 1, 2008, upon the
appointment of the initial committee and must meet at least once a year, and at
other times as necessary.
(b)
The commission shall provide office space, equipment and supplies, and
technical support to the committee.
(c)
The committee shall be governed by section 15.059, except the committee shall
not expire. Upon the expiration of the
Health Care Transformation Commission, the Health Benefit Set and Design Advisory
Committee shall continue to exist under the oversight of the commissioner of
health.
Subd.
3. Immunity
of liability. No member of
the committee shall be held civilly liable for an act or omission by that
member if the act or omission was in good faith and within the scope of the
member's responsibilities under this chapter.
Subd.
4. Duties
of the committee. (a) By
January 1, 2009, the committee shall develop and submit to the legislature a
benefit set and design that provides individuals access to a broad range of
health care services, including preventive health care, without incurring
severe financial loss as a result of serious illness or injury. The benefit set must include necessary
health care services, procedures, and diagnostic tests that are scientifically
proven to be both clinically effective and cost effective. In establishing the benefit set, the
committee may contract with the Institute for Clinical Systems Improvement
(ICSI) to assemble existing scientifically based practice standards. The committee shall consider cultural,
ethnic, and religious values and beliefs to ensure that the health care needs
of all Minnesota residents will be addressed in the benefit set.
(b)
The benefit set must identify and include preventive services, chronic care
coordination services, and early diagnostic tests that, if included in the
benefit set, with minimal or no cost-sharing requirements, would result in
savings that are equal to or greater than the cost of providing the services.
(c)
The benefit set must include evidence-based outpatient care for asthma, heart
disease, diabetes, and depression with no cost-sharing requirements, or with
minimal cost-sharing requirements that would not impose an economic barrier to
accessing the care. The committee may
consult with ICSI in identifying standards for care.
(d)
The benefit design must be the only benefit plan eligible for premium subsidies
under section 62U.09. In addition, each
health plan company that issues coverage in the individual or small employer
market in this state must offer at least one health plan that complies with the
benefit design in each of these two markets in which it issues coverage. The benefit design must establish a limited
number of maximum cost-sharing variations based upon deductibles and maximum
out-of-pocket costs. There must be no
maximum lifetime benefit.
Subd.
5. Continued
review. The committee shall
review the benefit set and design on an ongoing periodic basis and shall adjust
the benefit set and design as necessary, to ensure that the benefit set and
design continues to be safe, effective, and scientifically based.
Sec.
4. [62U.06]
GOALS FOR UNIVERSAL COVERAGE; CONTINGENT INDIVIDUAL RESPONSIBILITY REQUIREMENT.
Subdivision
1. Phase-in
goals. The state's phase-in
goals for progress toward universal health coverage for Minnesota residents
are:
(1)
94 percent insured by end of fiscal year 2009;
(2)
96 percent insured by end of fiscal year 2011;
(3)
97 percent insured by end of fiscal year 2012; and
(4)
98 percent insured by end of fiscal year 2013 and thereafter.
Subd.
2. Measurement
of percent insured. The
determination of the percent of Minnesota residents insured must be based on an
annual survey of the Minnesota population younger than age 65 to be conducted
or contracted for by the commissioner of health which must include questions
related to the type of insurance, amount of cost-sharing, and potential
barriers to public program enrollment.
Subd.
3. Contingent
individual responsibility requirement.
(a) If the increased affordability, cost containment, insurance
reform, and voluntary efforts provided for under this act fail to achieve
universal coverage, an individual responsibility requirement must have been
proven to be necessary.
(b)
If any one of the phase-in goals specified in subdivision 1 for fiscal year
2011 or later is not met, as determined by the commissioner of health, in spite
of implementation of the increased affordability, cost containment, insurance
reform, and voluntary efforts provided for under sections 62U.01 to 62U.09, an
individual responsibility requirement, requiring every Minnesota resident to
obtain and maintain health coverage from a public or private sector source of
the person's choice, must become effective 12 months after the end of that
fiscal year, provided that the commissioner certifies that health plans that
meet the affordability standard under section 62U.08 are available to
Minnesotans.
(c)
Failure to comply with the individual responsibility requirement is not a
crime, but must subject the person to a financial penalty to be specified in
law.
(d)
An individual need not comply with the individual responsibility requirement if
the individual objects to the requirement on the basis of a conscientiously
held religious belief or bona fide religious practice. In the case of a minor child, this paragraph
applies to the belief or practice of the child's parents. An individual may, but is not required to,
apply to the commissioner of health for a written waiver of the requirement
based upon this paragraph. The
commissioner shall approve the waiver if the applicant provides satisfactory proof
of eligibility for the waiver under this paragraph.
(e)
An individual with gross household income that exceeds 400 percent of the
federal poverty guidelines need not comply with the individual responsibility
mandate, if the commissioner certifies that a health plan is not available in
the individual's geographic area for which the sum of premiums, deductibles,
and other out-of-pocket costs paid for health coverage by the individual does
not exceed ten percent of gross income.
Sec.
5. [62U.07]
PROJECTED SPENDING.
Subdivision
1. Projected
spending baseline. (a) The
commissioner of health shall calculate the annual projected total health care
spending for the state and establish a health care spending baseline beginning
for the year 2008 and for the next five years based on the annual projected
growth in spending.
(b)
In establishing the health care spending baseline, the commissioner shall use
the Center of Medicare and Medicaid Services forecast for total growth in
national health care expenditures, and adjust this forecast to reflect the
demographics, health status, and other factors deemed necessary by the
commissioner. The commissioner shall
contract with an actuarial consultant to make recommendations as to the
adjustments needed to specifically reflect projected spending for Minnesota
residents.
(c)
The commissioner may adjust the projected baseline as necessary to reflect any
updated federal projections or account for unanticipated changes in federal
policy.
Subd.
2. Actual
spending. By February 15 of each year, beginning
February 15, 2010, the commissioner shall determine the actual private and
public health care spending for the calendar year preceding the current
calendar year and shall determine the difference between the projected spending
as determined under subdivision 1 and the actual spending for that year. The actual spending must be certified by an independent
actuarial consultant.
Subd.
3. Publication
of spending. By February 15
of each year, beginning February 15, 2010, the commissioner shall publish in
the State Register the projected spending baseline, including any adjustments,
and the actual spending for the preceding year.
Sec.
6. [62U.08]
AFFORDABILITY STANDARD.
Subdivision
1. Definition
of affordability. For
purposes of this section, coverage is "affordable" if the sum of
premiums, deductibles, and other out-of-pocket costs paid by an individual or
family for health coverage does not exceed the applicable percentage of the
individual or family's gross monthly income specified in subdivision 2.
Subd.
2. Affordability
standard. The following
affordability standard is established for individuals and households with gross
family incomes of 400 percent of the federal poverty guidelines or less:
AFFORDABILITY STANDARD
Federal Poverty Percent of Average
Guideline Range Gross Monthly Income
0-33%
minimum
33-54% 1.1%
55-81% 1.2%
82-109% 1.6%
110-136% 2.4%
137-164% 2.9%
165-191% 3.9%
192-219% 4.6%
220-248% 5.4%
248-274% 6.0%
275-300% 6.0%
301-324% 6.5%
325-349% 7.2%
350-374% 7.8%
375-400% 8.0%
Sec. 7. [62U.09]
EMPLOYEE SUBSIDIES FOR HEALTH COVERAGE.
Subdivision 1. Establishment of
subsidy program. The
commissioner of human services shall establish a subsidy program for eligible
employees and dependents to provide assistance in purchasing health coverage.
Subd. 2. Eligible employees and
dependents; incomes not exceeding 300 percent of the federal poverty
guidelines. In order to be
eligible for a subsidy under this section, an employee or dependent with a
gross household income that does not exceed 300 percent of the federal poverty
guidelines must:
(1) be covered by
employer-subsidized health coverage, as defined in section 256L.07, subdivision
2, paragraph (c), that meets the benefits set and design requirements
established under section 62U.04; and
(2) meet all eligibility
criteria for the MinnesotaCare program established under chapter 256L, except
for the requirements related to:
(i) no access to
employer-subsidized coverage under section 256L.07, subdivision 2; and
(ii) no other health
coverage under section 256L.07, subdivision 3.
Subd. 3. Eligible employees and
dependents; incomes greater than 300 percent but not exceeding 400 percent of
the federal poverty guidelines.
In order to be eligible for a subsidy under this section, an employee
or dependent with a gross household income that is greater than 300 percent but
does not exceed 400 percent of the federal poverty guidelines must:
(1) be covered by health
coverage that meets the benefits set and design requirements established under
section 62U.04; and
(2) meet all eligibility
criteria for the MinnesotaCare program established under chapter 256L, except
for the requirements related to:
(i) no access to
employer-subsidized coverage under section 256L.07, subdivision 2;
(ii) no other health
coverage under section 256L.07, subdivision 3; and
(iii) gross household income
under section 256L.04, subdivisions 1 and 7.
Subd. 4. Amount of subsidy. The subsidy must equal the amount the
employee is required to pay for health coverage for the employee and any
dependents, including premiums, deductibles, and other cost sharing, minus an
amount based on the affordability standard specified in section 62U.08. The maximum subsidy must not exceed the
amount of the subsidy that would have been provided under the MinnesotaCare
program, if the employee and any dependents were eligible for that program.
Subd. 5. Payment of subsidy. The commissioner shall pay the subsidy
amount for an employee and any dependents to the employee's health plan
company, and this payment shall be credited toward the employee's share of
premium. Any additional amount paid by
the commissioner to the employee's health plan company that exceeds the
employee's share of premium must be credited first toward the employee
deductible and then toward any employee cost-sharing obligation.
EFFECTIVE DATE. This section is effective July 1, 2010.
Sec. 8. [62U.11]
PAYMENT RESTRUCTURING; PAYMENTS BASED ON QUALITY AND EFFICIENCY OF CARE.
Subdivision 1. Development. By January 15, 2009, the Health Care
Transformation Commission shall report to the legislature in the manner
specified in section 3.195 on rules to implement a payment system that links
the level of payments to providers to the quality and efficiency of care. The payment system must incorporate payments
to primary care physicians, specialty care physicians, health care clinics,
hospitals, and other providers who provide services included in the
evidence-based benefit set and design developed under section 62U.04. Before January 1, 2010, the commission must
adopt rules necessary to implement this payment system.
Subd. 2. Payment system
criteria. The payment system
must meet the following criteria:
(1) providers meeting
specified targets, or who demonstrate a significant amount of improvement over
time, must be eligible for quality and efficiency-based payments that are in
addition to existing payment levels;
(2) priority must be placed
on measures of health care outcomes, rather than process measures, wherever
possible;
(3) quality measures for
primary care providers must focus on preventive services, coronary artery and
heart disease, diabetes, asthma, chronic obstructive pulmonary disease,
depression, and other conditions or procedures for which, in the determination
of the commission, improved outcomes will lead to significant cost savings;
(4) quality measures for
specialty care must be designated by the commission, and initially based on
quality indicators measured and reported publicly by specialty societies;
(5) hospital payments must
be adjusted for quality and efficiency using existing measures where available,
which focus on health conditions or procedures for which, in the determination
of the commission, improved outcomes will lead to significant cost savings;
(6) to the greatest extent
possible, the quality targets used in clause (1) must be adjusted for variation
in patient population to reduce incentives for health care providers to locate
outside of areas with high rates of poverty, a low patient base, or racial or
cultural diversity;
(7) payment methods must adjust
for racial, ethnic, or language factors that affect outcomes; and
(8) other indicators of care
quality and efficiency must be incorporated where appropriate. These indicators may include care
infrastructure, collection and reporting of results, disparities between racial
and ethnic populations, and measures of overall cost of care for individuals.
Subd. 3. Uniform measures
required. Once the payment
system required by this section is established, health plan companies shall not
require providers to use and report health plan company-specific quality and
outcome measures. This shall not,
however, limit the ability of the commissioner of human services to establish
by contract and monitor, as part of its quality assurance obligations for state
health care programs, outcome and performance measures for nonmedical services
and health issues likely to occur in low-income populations or racial or
cultural groups disproportionately represented in state health care program
enrollment that would likely be underrepresented when using traditional
measures that are based on longer-term enrollment.
Subd. 4. Implementation. (a) By January 1, 2010, the commissioner
of human services shall implement this payment system for all state health care
program enrollees served under fee-for-service, and shall require demonstration
providers serving state health care program enrollees to implement this payment
system by January 1, 2010, for all state health care program enrollees served
under managed care and county-based purchasing.
(b) By January 1, 2010, the
commissioner of employee relations shall implement this payment system for all
participants in the State Employee Group Insurance Program.
(c) By January 1, 2010, all
health plan companies shall implement this payment system for all participating
providers.
Sec. 9. [62U.12]
PAYMENT RESTRUCTURING; CARE COORDINATION PAYMENTS FOR HEALTH CARE HOMES.
Subdivision 1. Development. The Health Care Transformation
Commission, in cooperation with the commissioners of health and human services,
shall develop a payment system that provides care coordination payments to
health care providers. In order to be
eligible for a care coordination payment, a health care provider must be
certified as a health care home by the commissioners of human services and
health based on the certification standards for health care homes established
under section 256B.0754.
Subd. 2. Care coordination fee. (a) Under the payment system, health care
homes must receive a per-person per-month care coordination fee for providing
care coordination services and utilizing care coordinators, as specified in
section 256B.0752, subdivisions 3 and 7.
(b) The care coordination
payment system must vary the fees paid by thresholds of care complexity, with
the highest fees being paid for care provided to individuals requiring the most
intensive care coordination, such as those with very complex health care needs
or several chronic conditions.
(c) In setting care
coordination fees, group purchasers as defined in section 62J.03, subdivision
6, shall consider the additional time and resources needed by patients with
limited English-language skills, cultural differences, or other barriers to
health care.
(d) Care coordination fees
may be phased in, and must be applied first to persons who have complex or
chronic health conditions.
Subd. 3. Quality-based payments. The quality-based payments under section
62U.11, when established, must also be included in the care coordination
payment system.
Subd. 4. Implementation. (a) By July 1, 2009, the commissioner of
human services shall implement this payment system for all state health care program
enrollees served under fee-for-service as provided under section 256B.0753 and
shall require demonstration providers serving state health care program
enrollees to implement this payment system by July 1, 2009, for all state
health care program enrollees served under managed care and county-based
purchasing.
(b) By July 1, 2009, the
commissioner of employee relations shall implement this payment system for all
participants in the State Employee Group Insurance Program.
(c) By July 1, 2009, all health
plan companies shall implement this payment system for all participating
providers.
Sec. 10. [62U.13]
COORDINATION WITH THE PRIVATE SECTOR.
In developing the payment
systems required under sections 62U.11 and 62U.12, the Health Care
Transformation Commission shall consult and coordinate with the commissioners
of human services and health, organizations that work to improve health care
quality in Minnesota, health care providers, health plan companies, consumers,
and employers and other payors. The
commissioners shall publicize and promote the payment systems required under
sections 62U.11 and 62U.12, and shall make technical assistance available to
entities adopting the payment systems.
Sec. 11. [62U.14]
PAYMENT RESTRUCTURING: PROVIDER INNOVATION TO IMPROVE COSTS AND QUALITY.
Subdivision 1. Development. (a) By January 15, 2009, the Health Care
Transformation Commission shall report to the legislature recommendations for
advancing an innovative payment system for providing necessary services to
patients, including but not limited to patients with coronary artery and heart
disease, diabetes, asthma, chronic obstructive pulmonary disease, and
depression.
(b) By January 1, 2010, the
Health Care Transformation Commission shall report to the legislature
additional changes necessary to accomplish comprehensive payment reform
designed to support an innovative payment system to reduce costs and improve
quality.
(c) By January 1, 2010, the
Health Care Transformation Commission, in cooperation with the commissioner of
human services, shall develop a comparable payment system for nonelderly and
nondisabled enrollees in the state's public health care programs. This must include an assessment of the
impact on enrollee access to quality care and the financial status of the
state's health care programs.
(d) By January 1, 2011, the
Health Care Transformation Commission shall develop rules to implement a
comprehensive payment system that encourages provider innovation to reduce
costs and improve quality.
Subd. 2. Encounter data. (a) Beginning September 1, 2009, and
every three months thereafter, all health plan companies and third-party
administrators shall submit encounter data to the Health Care Transformation
Commission. The data shall be submitted
in a form and manner specified by the commission subject to the following
requirements:
(1) the data must be
de-identified data as described under the Code of Federal Regulations, title
45, section 164.514;
(2) the data for each
encounter must include an identifier for the patient's health care home if the
patient has selected a health care home; and
(3) except for the
identifier described in clause (2), the data must not include information that
is not included in a health care claim or equivalent encounter information
transaction that is required under section 62J.536.
(b) The commission shall
only use the data submitted under paragraph (a) for the purpose of carrying out
its responsibilities in designing and implementing a payment restructuring
system. If the commission contracts
with other organizations or entities to carry out any of its duties or
responsibilities described in this chapter, the contract must require that the
organization or entity maintain the data that it receives according to the
provisions of this section.
(c) Data on providers
collected under this subdivision are private data on individuals or nonpublic
data, as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02,
subdivision 19, summary data prepared under this section may be derived from
nonpublic data. The commission shall
establish procedures and safeguards to protect the integrity and
confidentiality of any data that it maintains.
(d) The commission shall not
publish analyses or reports that identify, or could potentially identify,
individual patients.
(e) The commission shall
report back to providers analyses and reports that identify specific
providers. The provider shall have 21
days to review the data for accuracy.
(f) The commission shall
establish an appeals process to resolve disputes from providers regarding the
accuracy of the analyses and reports.
Subd. 3. Utilization and health
care costs. (a) The
commission shall establish a uniform definition and methodology for calculating
the relative utilization and health care costs of providers. The methodology must include risk adjustment
mechanisms that address at least the following factors:
(1) the health status of the
individual in the year the individual enters the provider's care;
(2) a worsening of the
patient's health condition that was not reasonably preventable by action that
the provider could have taken;
(3) socioeconomic and
cultural factors that bear directly on the cost of care; and
(4) the percentage of
individuals served by the provider or care system whose care is paid for by
public health insurance programs. The
risk adjustment must be developed according to generally accepted risk
adjustment methodologies.
(b) Beginning April 1, 2010,
the commission shall disseminate information to providers on their utilization
and cost in comparison to an appropriate peer group.
(c) The commission shall
develop a system to index providers based on their risk-adjusted resource use
and on quality of care for the conditions specified in subdivision 1, paragraph
(a). In developing this system, the
commission shall consult and coordinate with health care providers as defined
in section 62J.03, subdivision 8, health plan companies, and organizations that
work to improve health care quality in Minnesota.
Subd. 4. Care package pricing. (a) The commission shall develop a
standard method and format for providers to use for submitting package prices
for the conditions specified in subdivision 1, paragraph (a). The method shall be published in the State
Register and must be made available to all providers.
(b) Beginning July 1, 2010,
using the information developed in subdivision 3, providers may submit package
prices to the commission for the cost of providing necessary services for the
conditions specified in subdivision 1, paragraph (a), based on their disclosed
prices under section 62U.15 combined with their actual risk-adjusted resource
use for the most recent analytic period.
The package prices submitted must reflect the providers' commitment to
manage the providers' treatment of the patients and chronic conditions
specified in subdivision 1, paragraph (a).
(c) Until January 1, 2013,
no provider shall submit package prices for the risk-adjusted total cost of
care for the conditions specified in subdivision 1, paragraph (a), that
represents an increase of more than the increase in the previous calendar
year's Consumer Price Index for all urban consumers plus two percentage points,
or a decrease of more than 15 percent below the providers' risk-adjusted cost
of care calculated based on the providers' average pricing levels for the
previous calendar year.
(d) Beginning January 1,
2011, the commission shall annually publish the results of the process
described in paragraph (b), and shall include only providers who choose to
submit package prices. The results that
are published must be on a risk-neutral basis.
Subd. 5. Provider assistance. The commissioner shall provide education
and technical assistance to providers on how to calculate and submit package
prices for the risk-adjusted cost of care for the conditions specified in
subdivision 1, paragraph (a).
Subd. 6. Payments. The commission shall establish a method
by which providers who have submitted package prices shall be paid for their
cost of care in treating the conditions specified in subdivision 1, paragraph
(a), with periodic adjustments to the payment they receive to reflect their
actual risk-adjusted cost relative to the package price. The commission shall report to the
legislature recommendations on how to implement the adjustments.
Subd. 7. Implementation. By January 1, 2012, or upon federal
approval, whichever is later:
(1) the commissioner of
human services shall pay providers based on their package prices for all
enrollees in the state's public health care programs;
(2) the commissioner of
employee relations shall pay providers based on their package prices for all
participants in the state employee group insurance program;
(3) all political
subdivisions, as defined in section 13.02, subdivision 11, that offer health
benefits to their employees must pay providers based on their package prices
for all participants, or purchase a health plan that uses this payment system;
(4) all health plan
companies shall use the information and methods developed under this section to
develop health plans that encourage consumers to use high-quality, low-cost
providers; and
(5) health plan companies
that issue health plans in the individual market or the small employer market
must offer at least one health plan that uses the information developed under
subdivision 3 to establish financial incentives for consumers to use
high-quality, low-cost providers through enrollee cost-sharing or selective
provider networks.
Sec. 12. [62U.15]
PROVIDER PRICE AND QUALITY DISCLOSURE.
(a) By January 1, 2009, and
annually thereafter, each physician clinic and hospital shall establish a list
of prices for each health care procedure, service, package of services, or
basket of care the provider provides and provide this information
electronically to the Health Care Transformation Commission in the form and
manner specified by the commission, and the commission shall provide this
information at no cost to the public, upon request. Providers may update this list periodically to reflect new
services, supply cost changes, and other factors.
(b) The commission shall develop
a plan to expand the provisions of paragraph (a) to all health care providers
by January 1, 2010. Notwithstanding
this provision, health plan companies shall submit provider price information
to the commission for the purposes of paragraph (a), for providers who do not
submit prices to the commission for analysis and provider cost performance
purposes.
Sec. 13. [62U.16]
PROVIDER PRICING.
(a) Effective July 1, 2010,
no health care provider subject to the requirements of section 62U.14 shall vary
the payment amount that the provider accepts as full payment for a health care
service based upon the identity of the payer, a contractual relationship with a
payer, the identity of the patient, or whether the patient has coverage through
a group purchaser.
(b) This section does not
apply to services provided to patients who are enrolled in Medicare, workers'
compensation, no fault auto insurance, or a state public health care program.
(c) This section does not
affect the right of a provider to provide charity care or care for a reduced
price due to financial hardship of the patient or due to the patient being a
relative or friend of the provider.
Sec. 14. AMENDMENTS
TO CURRENT HEALTH BENEFIT SETS.
The commissioners of health,
commerce, and employee relations shall report to the legislature under
Minnesota Statutes, section 3.195, on necessary changes to current mandated benefit
sets to align these with the standard benefit set and design developed by the
Health Care Transformation Commission established in Minnesota Statutes,
section 62U.04.
Sec. 15. RISK
ADJUSTMENT.
The Risk Adjustment Advisory
Council shall review Minnesota Comprehensive Health Association financing and
whether the affordability needs of persons with health problems can be
addressed through guaranteed issue, with no premium penalty for health history
and not allowing preexisting condition limitations. This must include assessing whether stability of the insurance
market could be managed through risk sharing that transfers funds between
health plan companies. The goal is to
discontinue Minnesota Comprehensive Health Association assessment and replace it
with a broader and fairer funding mechanism, preferably one that does not
involve a fee-based mechanism. The
council shall make recommendations to the legislature by November 1, 2009. The Risk Adjustment Advisory Council shall
include representatives of insurance companies, the Minnesota Comprehensive
Health Association's board of directors, safety net providers, and consumer
representatives. It shall be convened
by the commissioner of commerce with staffing from that agency and the
Minnesota Department of Health.
Sec. 16. GLOBAL
MODELING OF HEALTH CARE REFORMS.
To the extent of available
appropriations, the commissioner of health shall award a grant to the
University of Minnesota School of Public Health, Health Policy and Management
Division, to develop a model that will assess the impact of proposed health
care reforms or major health care-related legislation on all sectors of the
health care system, including access to the full range of health care, public
health, public and private health insurance coverage, long-term and continuing
care, programs for persons with disabilities, social services, and other
sectors related to Minnesotans' health.
The model must be:
(1) developed with
safeguards to make sure that the model and its assumptions and formulas are
based on valid and objective data, research, and expert opinions;
(2) designed to enable
policy makers and state agencies to enter into the model and study each
component of health care reform, including access to all aspects of health care
services, health care homes, payment reforms, populationwide prevention, health
status of Minnesotans, and incidence of chronic disease;
(3) capable of assessing the interaction of
different legislative and policy changes to determine the net effect on costs,
access, and health status within sectors of the health care system, and the net
overall impact across all sectors;
(4) designed to identify
risks of unpredictable or unintended consequences, cost shifting between or
within sectors of the health care system, and opportunities to make changes in
one sector that will produce a benefit to other sectors; and
(5) capable of being
adjusted based on both the proposed changes and the resulting impact in the
following areas:
(i) access to all aspects of
health care services;
(ii) health status of
Minnesotans, including the incidence of chronic disease, health disparities,
and risk factors such as obesity and smoking;
(iii) utilization of
preventive care services such as screenings, immunizations, and physical
examinations; and
(iv) costs and cost
distribution, including costs to individuals and families, businesses, and
government, including for total cost of health care, health-related services,
and social services.
EFFECTIVE DATE. This section is effective the day following final enactment.
Sec. 17. ECONOMIC
ANALYSIS OF HEALTH CARE REFORM PLANS.
(a) To the extent of available
appropriations, the commissioner of health shall award a grant to the
University of Minnesota School of Public Health, Health Policy and Management
Division, to conduct a study and economic analysis of costs and benefits of
various health care reform proposals, including an analysis of the
recommendations of the Legislative Health Care Access Commission, the
governor's Health Care Transformation Task Force, and a single statewide plan.
(b) The analysis of each
proposal must measure the impact on total public and private health care
spending in Minnesota that would result from each proposal, including whether
there are savings or additional costs due to:
(1) increased or reduced
insurance, billing, underwriting, marketing, and other administrative functions;
(2) timely and appropriate
use of medical care;
(3) market-driven or
negotiated prices on medical services and products, including pharmaceuticals;
(4) a shortage or excess
capacity of medical facilities and equipment;
(5) increased utilization, better
health outcomes, increased wellness due to prevention, early intervention, and
health-promoting activities;
(6) increases or decreases
in administrative expenses and health care expenses due to payment reforms;
(7) increases or decreases
in administrative expenses and health care expenses due to coordination of
care;
(8) increases or decreases
in up-front and long-term utilization due to access to comprehensive medically
necessary benefits, including dental care, mental health care, prescription drugs,
and other health care; and
(9) non-health care impacts
on state and local expenditures such as reduced out-of-home placement or crime
costs due to mental health or chemical dependency coverage.
(c) The study must also
analyze for each proposal the number of Minnesotans without access to health
care, including those lacking access to certain types of medical care, such as
dental care, mental health care, and prescription drugs.
EFFECTIVE DATE. This section is effective the day following final enactment.
Sec. 18. APPROPRIATION.
$15,000,000 is appropriated
in fiscal year 2009 from the health care access fund to the Health Care
Transformation Commission. This is a
onetime appropriation.
ARTICLE 5
PUBLIC HEALTH
Section 1. [145.986]
STATEWIDE HEALTH IMPROVEMENT PROGRAM.
Subdivision 1. Goals. The initial goals of the public health
improvement program are to reduce the percentage of Minnesotans who are obese
or overweight to less than 50 percent by the year 2020 and to reduce tobacco
smoking by two percent annually starting in 2011. By 2011, and considering available funding, the commissioner of
health, in consultation with the State Community Health Advisory Committee
established in section 145A.10, subdivision 10, and other stakeholders, may
make recommendations as to future goals related to alcohol use and illegal drug
use.
Subd. 2. Funding local
communities. Beginning
January 1, 2009, the commissioner of health must provide funding to community
health boards to convene, coordinate, and lead locally developed programs
targeted at achieving measurable health improvement goals. Funding to each community health board will
be distributed based on a per capita formula, with a base allocation of $50,000
to each community health board that receives funding. By January 15, 2011, the commissioner of health must recommend
whether additional funding should be distributed to community health boards
based on health disparities demonstrated in the populations served.
Subd. 3. Outcomes. (a) The commissioner of health must set
measurable outcomes to meet the goals specified in subdivision 1, and annually
review the progress of local communities in meeting these outcomes. The commissioner of health must provide
technical assistance and corrective action plans to ensure that local
communities are making sufficient progress.
(b) The commissioner of
health must measure current public health data, using existing measures and
data collection systems when available, to determine baseline data against
which progress shall be monitored.
Subd. 4. Evaluation. The commissioner shall conduct an
evaluation of the statewide health improvement program using outcome measures
established in subdivision 3. Local
communities shall cooperate with the commissioner in the evaluation of this
program.
Sec. 2. APPROPRIATIONS.
$20,000,000 is appropriated
from the health care access fund in fiscal year 2009 to the commissioner of
health to implement the statewide health improvement program under Minnesota
Statutes, section 145.986. Beginning
January 1, 2009, the commissioner of health shall provide funding to community
health boards to implement local public health programs."
Delete the title and insert:
"A bill for an act
relating to health care reform; increasing affordability and continuity of care
for state health care programs; modifying health care provisions; providing
subsidies for employee share of employer-subsidized insurance in certain cases;
establishing the Health Care Transformation Commission; creating an
affordability standard; implementing a statewide health improvement program;
requiring an evaluation of mandated health benefits; requiring a payment system
to encourage provider innovation; requiring studies and reports; appropriating
money; amending Minnesota Statutes 2006, sections 256B.057, subdivision 8;
256B.69, by adding a subdivision; 256L.05, by adding a subdivision; 256L.06,
subdivision 3; 256L.07, subdivision 3; 256L.15, by adding a
subdivision; Minnesota
Statutes 2007 Supplement, sections 256.01, subdivision 2b; 256B.056,
subdivision 10; 256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7;
256L.05, subdivision 3a; 256L.07, subdivision 1; 256L.15, subdivision 2;
proposing coding for new law in Minnesota Statutes, chapters 145; 256B; proposing
coding for new law as Minnesota Statutes, chapter 62U; repealing Minnesota
Statutes 2006, section 256L.15, subdivision 3."
With the recommendation that
when so amended the bill pass and be re-referred to the Committee on Ways and
Means.
The report was adopted.
Solberg
from the Committee on Ways and Means to which was referred:
H. F.
No. 3569, A bill for an act relating to workers' health; directing the
University of Minnesota to study workers' health including lung health;
appropriating money.
Reported
the same back with the recommendation that the bill pass.
The report was adopted.
Carlson
from the Committee on Finance to which was referred:
H. F.
No. 3976, A bill for an act relating to state government; making changes to
continuing care; agency management; state-operated services; children and
family services; health care programs; Department of Health provisions;
appropriating money; amending Minnesota Statutes 2006, sections 144.1222,
subdivision 1a, by adding subdivisions; 157.16, as amended; 256.741,
subdivisions 2, 2a, 3; 256.969, subdivisions 2b, 20; 256B.0571, subdivisions 8,
9; 256B.0621, subdivisions 2, 6, 10; 256B.0625, subdivisions 3c, 13e;
256B.0924, subdivisions 4, 6; 256B.19, subdivision 1d; 256B.431, subdivision
23; 256B.434, by adding a subdivision; 256B.441, by adding a subdivision;
256B.69, subdivisions 5a, 6; 256D.44, subdivisions 2, 5; 256L.12, subdivision
9; 518A.50; 518A.53, subdivision 5; Minnesota Statutes 2007 Supplement,
sections 16A.724, subdivision 2; 256.01, subdivision 2; 256.741, subdivision 1;
256B.0625, subdivision 20; 256B.0631, subdivisions 1, 3; 256B.199; 256J.621;
256L.04, subdivisions 1, 7; 256L.07, subdivision 1; Laws 2006, chapter 282,
article 20, section 37, as amended; Laws 2007, chapter 147, article 2, section
21; article 19, sections 3, subdivisions 1, 4, 6; 4, subdivisions 2, 4;
proposing coding for new law in Minnesota Statutes, chapters 246B; 256B;
repealing Minnesota Statutes 2006, sections 62J.58; 256.741, subdivision 15;
256B.441, subdivision 25; Minnesota Statutes 2007 Supplement, sections 256.962,
subdivision 5; 256.969, subdivision 27; 256B.057, subdivision 2c; 256B.441,
subdivisions 1, 14a, 30, 31, 48, 49, 50, 51, 52, 53, 54, 55, 56, 58; 256L.07,
subdivision 7.
Reported
the same back with the following amendments:
Delete
everything after the enacting clause and insert:
"ARTICLE
1
CONTINUING
CARE
Section
1. Minnesota Statutes 2006, section
256B.0621, subdivision 2, is amended to read:
Subd.
2. Targeted
case management; definitions. For
purposes of subdivisions 3 to 10, the following terms have the meanings given
them:
(1)
"home care service recipients" means those individuals receiving the
following services under sections 256B.0651 to 256B.0656: skilled nursing
visits, home health aide visits, private duty nursing, personal care
assistants, or therapies provided through a home health agency;
(2)
"home care targeted case management" means the provision of targeted
case management services for the purpose of assisting home care service
recipients to gain access to needed services and supports so that they may
remain in the community;
(3)
"institutions" means hospitals, consistent with Code of Federal
Regulations, title 42, section 440.10; regional treatment center inpatient
services, consistent with section 245.474; nursing facilities; and intermediate
care facilities for persons with developmental disabilities;
(4)
"relocation targeted case management" includes the provision of both
county targeted case management and public or private vendor service
coordination services for the purpose of assisting recipients to gain access to
needed services and supports if they choose to move from an institution to the
community. Relocation targeted case
management may be provided during the lesser of:
(i)
the last
180 consecutive days of an eligible recipient's institutional stay; or
(ii)
the limits and conditions which apply to federal Medicaid funding for this
service;
and
(5)
"targeted case management" means case management services provided to
help recipients gain access to needed medical, social, educational, and other
services and supports.
Sec.
2. Minnesota Statutes 2006, section
256B.0621, subdivision 6, is amended to read:
Subd.
6. Eligible
services. (a) Services eligible for
medical assistance reimbursement as targeted case management include:
(1)
assessment of the recipient's need for targeted case management services and
for persons choosing to relocate, the county must provide service coordination
provider options at the first contact and upon request;
(2)
development, completion, and regular review of a written individual service
plan, which is based upon the assessment of the recipient's needs and choices,
and which will ensure access to medical, social, educational, and other related
services and supports;
(3)
routine contact or communication with the recipient, recipient's family,
primary caregiver, legal representative, substitute care provider, service
providers, or other relevant persons identified as necessary to the development
or implementation of the goals of the individual service plan;
(4)
coordinating referrals for, and the provision of, case management services for
the recipient with appropriate service providers, consistent with section
1902(a)(23) of the Social Security Act;
(5)
coordinating and monitoring the overall service delivery and engaging in
advocacy as needed to ensure quality of services, appropriateness, and
continued need;
(6)
completing and maintaining necessary documentation that supports and verifies
the activities in this subdivision;
(7)
assisting individuals in order to access needed services, including travel to
conduct a visit with the recipient or other relevant person necessary to
develop or implement the goals of the individual service plan; and
(8)
coordinating with the institution discharge planner in the 180-day period
before the recipient's discharge.
(b)
Relocation targeted county case management includes services under paragraph
(a), clauses (1), (2), and (4).
Relocation service coordination includes services under paragraph (a),
clauses (3) and (5) to (8). Home care
targeted case management includes services under paragraph (a), clauses (1) to
(8).
Sec.
3. Minnesota Statutes 2006, section
256B.0621, subdivision 10, is amended to read:
Subd.
10. Payment rates. The
commissioner shall set payment rates for targeted case management under this
subdivision. Case managers may bill
according to the following criteria:
(1)
for relocation targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts, in the lesser
of:
(i)
180 days
preceding an eligible recipient's discharge from an institution; or
(ii)
the limits and conditions which apply to federal Medicaid funding for this
service;
(2)
for home care targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts; and
(3)
billings for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
Sec.
4. Minnesota Statutes 2007 Supplement,
section 256B.0625, subdivision 20, is amended to read:
Subd.
20. Mental health case management.
(a) To the extent authorized by rule of the state agency, medical
assistance covers case management services to persons with serious and
persistent mental illness and children with severe emotional disturbance. Services provided under this section must
meet the relevant standards in sections 245.461 to 245.4887, the Comprehensive
Adult and Children's Mental Health Acts, Minnesota Rules, parts 9520.0900 to
9520.0926, and 9505.0322, excluding subpart 10.
(b)
Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible
for medical assistance reimbursement for case management services for children
with severe emotional disturbance when these services meet the program
standards in Minnesota Rules, parts 9520.0900 to 9520.0926 and 9505.0322,
excluding subparts 6 and 10.
(c)
Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In
order to receive payment for an eligible child, the provider must document at
least a face-to-face contact with the child, the child's parents, or the
child's legal representative. To
receive payment for an eligible adult, the provider must document:
(1) at
least a face-to-face contact with the adult or the adult's legal
representative; or
(2) at
least a telephone contact with the adult or the adult's legal representative
and document a face-to-face contact with the adult or the adult's legal
representative within the preceding two months.
(d)
Payment for mental health case management provided by county or state staff
shall be based on the monthly rate methodology under section 256B.094,
subdivision 6, paragraph (b), with separate rates calculated for child welfare
and mental health, and within mental health, separate rates for children and
adults.
(e)
Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or
other relevant federally approved rate setting methodology.
(f)
Payment for mental health case management provided by vendors who contract with
a county or Indian tribe shall be based on a monthly rate negotiated by the
host county or tribe. The negotiated
rate must not exceed the rate charged by the vendor for the same service to
other payers. If the service is
provided by a team of contracted vendors, the county or tribe may negotiate a
team rate with a vendor who is a member of the team. The team shall determine how to distribute the rate among its
members. No reimbursement received by
contracted vendors shall be returned to the county or tribe, except to reimburse
the county or tribe for advance funding provided by the county or tribe to the
vendor.
(g) If
the service is provided by a team which includes contracted vendors, tribal
staff, and county or state staff, the costs for county or state staff
participation in the team shall be included in the rate for county-provided
services. In this case, the contracted
vendor, the tribal agency, and the county may each receive separate payment for
services provided by each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a
description of the roles of the team members.
(h)
Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs
for mental health case management shall be provided by the recipient's county
of responsibility, as defined in sections 256G.01 to 256G.12, from sources
other than federal funds or funds used to match other federal funds. If the service is provided by a tribal agency,
the nonfederal share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall
be provided by the recipient's county of responsibility.
(i)
Notwithstanding any administrative rule to the contrary, prepaid medical
assistance, general assistance medical care, and MinnesotaCare include mental
health case management. When the
service is provided through prepaid capitation, the nonfederal share is paid by
the state and the county pays no share.
(j)
The commissioner may suspend, reduce, or terminate the reimbursement to a
provider that does not meet the reporting or other requirements of this
section. The county of responsibility,
as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal
agency, is responsible for any federal disallowances. The county or tribe may share this responsibility with its
contracted vendors.
(k)
The commissioner shall set aside a portion of the federal funds earned for
county expenditures under this section to repay the special revenue
maximization account under section 256.01, subdivision 2, clause (15). The repayment is limited to:
(1)
the costs of developing and implementing this section; and
(2)
programming the information systems.
(l)
Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided
under this section. When this service
is paid by the state without a federal share through fee-for-service, 50
percent of the cost shall be provided by the state. Payments to county-contracted vendors shall include the federal
earnings, the state share, and the county share.
(m)
Case management services under this subdivision do not include therapy,
treatment, legal, or outreach services.
(n) If
the recipient is a resident of a nursing facility, intermediate care facility,
or hospital, and the recipient's institutional care is paid by medical
assistance, payment for case management services under this subdivision is
limited to the lesser of:
(1)
the last
180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2)
the limits and conditions which apply to federal Medicaid funding for this
service.
(o)
Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
Sec.
5. [256B.0658]
HOUSING ACCESS GRANTS.
The
commissioner of human services shall award through a competitive process
contracts for grants to public and private agencies to support and assist
individuals eligible for publicly funded home and community-based services,
including state plan home care, to access housing. Grants may be awarded to agencies that may include, but are not
limited to, the following supports: assessment to assure suitability of
housing, accompanying an individual to look at housing, filling out
applications and rental agreements, meeting with landlords, helping with
Section 8 or other program applications, helping to develop a budget, obtaining
furniture and household goods, if necessary, and assisting with any problems
that may arise with housing.
Sec.
6. Minnesota Statutes 2006, section
256B.0924, subdivision 4, is amended to read:
Subd.
4. Targeted
case management service activities.
(a) For persons with developmental disabilities, targeted case
management services must meet the provisions of section 256B.092.
(b)
For persons not eligible as a person with a developmental disability, targeted
case management service activities include:
(1) an
assessment of the person's need for targeted case management services;
(2)
the development of a written personal service plan;
(3) a
regular review and revision of the written personal service plan with the
recipient and the recipient's legal representative, and others as identified by
the recipient, to ensure access to necessary services and supports identified
in the plan;
(4)
effective communication with the recipient and the recipient's legal
representative and others identified by the recipient;
(5)
coordination of referrals for needed services with qualified providers;
(6)
coordination and monitoring of the overall service delivery to ensure the
quality and effectiveness of services;
(7)
assistance to the recipient and the recipient's legal representative to help
make an informed choice of services;
(8)
advocating on behalf of the recipient when service barriers are encountered or
referring the recipient and the recipient's legal representative to an
independent advocate;
(9)
monitoring and evaluating services identified in the personal service plan to
ensure personal outcomes are met and to ensure satisfaction with services and
service delivery;
(10)
conducting face-to-face monitoring with the recipient at least twice a year;
(11)
completing and maintaining necessary documentation that supports and verifies
the activities in this section;
(12)
coordinating with the medical assistance facility discharge planner in the
180-day period prior to the recipient's discharge into the community; and
(13) a
personal service plan developed and reviewed at least annually with the
recipient and the recipient's legal representative. The personal service plan must be revised when there is a change
in the recipient's status. The personal
service plan must identify:
(i)
the desired personal short and long-term outcomes;
(ii)
the recipient's preferences for services and supports, including development of
a person-centered plan if requested; and
(iii)
formal and informal services and supports based on areas of assessment, such
as: social, health, mental health, residence, family, educational and
vocational, safety, legal, self-determination, financial, and chemical health
as determined by the recipient and the recipient's legal representative and the
recipient's support network.
Sec.
7. Minnesota Statutes 2006, section
256B.0924, subdivision 6, is amended to read:
Subd.
6. Payment
for targeted case management. (a)
Medical assistance and MinnesotaCare payment for targeted case management shall
be made on a monthly basis. In order to
receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a
face-to-face contact with the adult or the adult's legal representative,
family, primary caregiver, or other relevant persons identified as necessary to
the development or implementation of the goals of the personal service plan.
(b)
Payment for targeted case management provided by county staff under this
subdivision shall be based on the monthly rate methodology under section
256B.094, subdivision 6, paragraph (b), calculated as one combined average rate
together with adult mental health case management under section 256B.0625,
subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section
shall be the same as the rate for adult mental health case management in effect
as of December 31, 2001. Billing and
payment must identify the recipient's primary population group to allow
tracking of revenues.
(c)
Payment for targeted case management provided by county-contracted vendors
shall be based on a monthly rate negotiated by the host county. The negotiated rate must not exceed the rate
charged by the vendor for the same service to other payers. If the service is provided by a team of
contracted vendors, the county may negotiate a team rate with a vendor who is a
member of the team. The team shall
determine how to distribute the rate among its members. No reimbursement received by contracted
vendors shall be returned to the county, except to reimburse the county for
advance funding provided by the county to the vendor.
(d) If
the service is provided by a team that includes contracted vendors and county
staff, the costs for county staff participation on the team shall be included
in the rate for county-provided services.
In this case, the contracted vendor and the county may each receive
separate payment for services provided by each entity in the same month. In order to prevent duplication of services,
the county must document, in the recipient's file, the need for team targeted
case management and a description of the different roles of the team members.
(e)
Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs
for targeted case management shall be provided by the recipient's county of
responsibility, as defined in sections 256G.01 to 256G.12, from sources other
than federal funds or funds used to match other federal funds.
(f)
The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of responsibility, as defined in
sections 256G.01 to 256G.12, is responsible for any federal disallowances. The county may share this responsibility
with its contracted vendors.
(g)
The commissioner shall set aside five percent of the federal funds received
under this section for use in reimbursing the state for costs of developing and
implementing this section.
(h) Payments
to counties for targeted case management expenditures under this section shall
only be made from federal earnings from services provided under this
section. Payments to contracted vendors
shall include both the federal earnings and the county share.
(i)
Notwithstanding section 256B.041, county payments for the cost of case
management services provided by county staff shall not be made to the
commissioner of finance. For the
purposes of targeted case management services provided by county staff under
this section, the centralized disbursement of payments to counties under
section 256B.041 consists only of federal earnings from services provided under
this section.
(j) If
the recipient is a resident of a nursing facility, intermediate care facility,
or hospital, and the recipient's institutional care is paid by medical
assistance, payment for targeted case management services under this
subdivision is limited to the lesser of:
(1)
the last
180 days of the recipient's residency in that facility and may not exceed
more than six months in a calendar year; or
(2)
the limits and conditions which apply to federal Medicaid funding for this
service.
(k)
Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
(l)
Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.
Sec.
8. Minnesota Statutes 2006, section
256B.19, subdivision 1d, is amended to read:
Subd.
1d. Portion of nonfederal share to be paid by certain counties. (a) In addition to the percentage
contribution paid by a county under subdivision 1, the governmental units
designated in this subdivision shall be responsible for an additional portion
of the nonfederal share of medical assistance cost. For purposes of this subdivision, "designated governmental
unit" means the counties of Becker, Beltrami, Clearwater, Cook, Dodge,
Hubbard, Itasca, Lake, Pennington, Pipestone, Ramsey, St. Louis, Steele, Todd,
Traverse, and Wadena.
(b)
Beginning in 1994, each of the governmental units designated in this
subdivision shall transfer before noon on May 31 to the state Medicaid agency
an amount equal to the number of licensed beds in any nursing home owned and
operated by the county on that date, with the county named as licensee,
multiplied by $5,723. If two or more
counties own and operate a nursing home, the payment shall be prorated. These sums shall be part of the designated
governmental unit's portion of the nonfederal share of medical assistance
costs.
(c)
Beginning in 2002, in addition to any transfer under paragraph (b), each of the
governmental units designated in this subdivision shall transfer before noon on
May 31 to the state Medicaid agency an amount equal to the number of licensed
beds in any nursing home owned and operated by the county on that date, with
the county named as licensee, multiplied by $10,784. The provisions of paragraph (b) apply to transfers under this
paragraph.
(d)
Beginning in 2003, in addition to any transfer under paragraphs (b) and (c),
each of the governmental units designated in this subdivision shall transfer
before noon on May 31 to the state Medicaid agency an amount equal to the
number of licensed beds in any nursing home owned and operated by the county on
that date, with the county named as licensee, multiplied by $2,230. The provisions of paragraph (b) apply to
transfers under this paragraph.
(e) (d) The commissioner may reduce
the intergovernmental transfers under paragraphs paragraph (c) and
(d) based on the commissioner's determination of the payment rate in
section 256B.431, subdivision 23, paragraphs (c), and (d), and
(e). Any adjustments must be made
on a per-bed basis and must result in an amount equivalent to the total amount
resulting from the rate adjustment in section 256B.431, subdivision 23, paragraphs
(c), and (d), and (e).
EFFECTIVE DATE. This section is effective the day following final enactment.
Sec.
9. Minnesota Statutes 2006, section
256B.431, subdivision 23, is amended to read:
Subd.
23. County nursing home payment adjustments. (a) Beginning in 1994, the commissioner shall pay a nursing home
payment adjustment on May 31 after noon to a county in which is located a
nursing home that, on that date, was county-owned and operated, with the county
named as licensee by the commissioner of health, and had over 40 beds and
medical assistance occupancy in excess of 50 percent during the reporting year
ending September 30, 1991. The
adjustment shall be an amount equal to $16 per calendar day multiplied by the
number of beds licensed in the facility on that date.
(b)
Payments under paragraph (a) are excluded from medical assistance per diem rate
calculations. These payments are
required notwithstanding any rule prohibiting medical assistance payments from
exceeding payments from private pay residents.
A facility receiving a payment under paragraph (a) may not increase
charges to private pay residents by an amount equivalent to the per diem amount
payments under paragraph (a) would equal if converted to a per diem.
(c)
Beginning in 2002, in addition to any payment under paragraph (a), the
commissioner shall pay to a nursing facility described in paragraph (a) an
adjustment in an amount equal to $29.55 per calendar day multiplied by the
number of beds licensed in the facility on that date. The provisions of paragraphs (a) and (b) apply to payments under
this paragraph.
(d)
Beginning in 2003, in addition to any payment under paragraphs (a) and (c), the
commissioner shall pay to a nursing facility described in paragraph (a) an
adjustment in an amount equal to $6.11 per calendar day multiplied by the
number of beds licensed in the facility on that date. The provisions of paragraphs (a) and (b) apply to payments under
this paragraph.
(e) (d) The commissioner may reduce
payments under paragraphs paragraph (c) and (d) based on
the commissioner's determination of Medicare upper payment limits. Any adjustments must be proportional to
adjustments made under section 256B.19, subdivision 1d, paragraph (e)
(d).
EFFECTIVE DATE. This section is effective the day following final enactment.
Sec.
10. Minnesota Statutes 2007 Supplement,
section 256B.434, subdivision 19, is amended to read:
Subd.
19. Nursing facility rate increases beginning October 1, 2007, and
October 1, 2008. (a) For the
rate year beginning October 1, 2007, the commissioner shall make available to
each nursing facility reimbursed under this section operating payment rate
adjustments equal to 1.87 percent of the operating payment rates in effect on
September 30, 2007. For the rate
year beginning October 1, 2008, the commissioner shall make available to each
nursing facility reimbursed under this section, operating payment rate
adjustments equal to 2.0 percent of the operating payment rates in effect on
September 30, 2008.
(b)
Seventy-five percent of the money resulting from the rate adjustment under
paragraph (a) must be used for increases in compensation-related costs for
employees directly employed by the nursing facility on or after the effective
date of the rate adjustment, except:
(1)
the administrator;
(2)
persons employed in the central office of a corporation that has an ownership
interest in the nursing facility or exercises control over the nursing
facility; and
(3)
persons paid by the nursing facility under a management contract.
(c)
Two-thirds of the money available under paragraph (b) must be used for wage
increases for all employees directly employed by the nursing facility on or
after the effective date of the rate adjustment, except those listed in
paragraph (b), clauses (1) to (3). The
wage adjustment that employees receive under this paragraph must be paid as an
equal hourly percentage wage increase for all eligible employees. All wage increases under this paragraph must
be effective on the same date. Only
costs associated with the portion of the equal hourly percentage wage increase
that goes to all employees shall qualify under this paragraph. Costs associated with wage increases in
excess of the amount of the equal hourly percentage wage increase provided to
all employees shall be allowed only for meeting the requirements in paragraph
(b). This paragraph shall not apply to
employees covered by a collective bargaining agreement.
(d)
The commissioner shall allow as compensation-related costs all costs for:
(1)
wages and salaries;
(2)
FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
compensation;
(3)
the employer's share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, and pensions; and
(4)
other benefits provided, subject to the approval of the commissioner.
(e)
The portion of the rate adjustment under paragraph (a) that is not subject to
the requirements in paragraphs (b) and (c) shall be provided to nursing
facilities effective October 1, 2007, or October 1, 2008, as applicable.
(f)
Nursing facilities may apply for the portion of the rate adjustment under
paragraph (a) that is subject to the requirements in paragraphs (b) and
(c). The application must be submitted
to the commissioner within six months of the effective date of the rate
adjustment, and the nursing facility must provide additional information
required by the commissioner within nine months of the effective date of the
rate adjustment. The commissioner must
respond to all applications within three weeks of receipt. The commissioner may waive the deadlines in
this paragraph under extraordinary circumstances, to be determined at the sole
discretion of the commissioner. The
application must contain:
(1) an
estimate of the amounts of money that must be used as specified in paragraphs
(b) and (c);
(2) a
detailed distribution plan specifying the allowable compensation-related and
wage increases the nursing facility will implement to use the funds available
in clause (1);
(3) a
description of how the nursing facility will notify eligible employees of the
contents of the approved application, which must provide for giving each
eligible employee a copy of the approved application, excluding the information
required in clause (1), or posting a copy of the approved application,
excluding the information required in clause (1), for a period of at least six
weeks in an area of the nursing facility to which all eligible employees have
access; and
(4)
instructions for employees who believe they have not received the
compensation-related or wage increases specified in clause (2), as approved by
the commissioner, and which must include a mailing address, e-mail address, and
the telephone number that may be used by the employee to contact the
commissioner or the commissioner's representative.
(g)
The commissioner shall ensure that cost increases in distribution plans under
paragraph (f), clause (2), that may be included in approved applications,
comply with the following requirements:
(1)
costs to be incurred during the applicable rate year resulting from wage and
salary increases effective after October 1, 2006, and prior to the first day of
the nursing facility's payroll period that includes October 1, 2007
of each year, shall be allowed if they were not used in the prior year's
application;
(2) a
portion of the costs resulting from tenure-related wage or salary increases may
be considered to be allowable wage increases, according to formulas that the
commissioner shall provide, where employee retention is above the average
statewide rate of retention of direct care employees;
(3)
the annualized amount of increases in costs for the employer's share of health
and dental insurance, life insurance, disability insurance, and workers'
compensation shall be allowable compensation-related increases if they are
effective on or after April 1, 2007, of the year in which the rate
adjustments are effective and prior to April 1, 2008 of the
following year; and
(4)
for nursing facilities in which employees are represented by an exclusive
bargaining representative, the commissioner shall approve the application only
upon receipt of a letter of acceptance of the distribution plan, in regard to
members of the bargaining unit, signed by the exclusive bargaining agent and
dated after May 25, 2007. Upon receipt
of the letter of acceptance, the commissioner shall deem all requirements of
this section as having been met in regard to the members of the bargaining
unit.
(h)
The commissioner shall review applications received under paragraph (f) and
shall provide the portion of the rate adjustment under paragraphs (b) and (c)
if the requirements of this subdivision have been met. The rate adjustment shall be effective
October 1. Notwithstanding paragraph
(a), if the approved application distributes less money than is available, the
amount of the rate adjustment shall be reduced so that the amount of money made
available is equal to the amount to be distributed.
Sec.
11. Minnesota Statutes 2006, section
256B.69, subdivision 6, is amended to read:
Subd.
6. Service
delivery. (a) Each demonstration
provider shall be responsible for the health care coordination for eligible
individuals. Demonstration providers:
(1)
shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections
256B.02, subdivision 8, and 256B.0625 in order to ensure appropriate health
care is delivered to enrollees.
Notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide
relocation service coordination to enrolled persons age 65 and over;
(2)
shall accept the prospective, per capita payment from the commissioner in
return for the provision of comprehensive and coordinated health care services
for eligible individuals enrolled in the program;
(3)
may contract with other health care and social service practitioners to provide
services to enrollees; and
(4)
shall institute recipient grievance procedures according to the method
established by the project, utilizing applicable requirements of chapter
62D. Disputes not resolved through this
process shall be appealable to the commissioner as provided in subdivision 11.
(b)
Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other
health care and social service practitioners to provide services to
enrollees. A demonstration provider
must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the
claim.
Sec.
12. Minnesota Statutes 2006, section
256D.44, subdivision 2, is amended to read:
Subd.
2. Standard
of assistance for persons eligible for medical assistance waivers or at risk of
placement in a group residential housing facility. The state standard of assistance for a
person who: (1) is eligible for a medical assistance home and
community-based services waiver or a person who; (2) has been
determined by the local agency to meet the plan requirements for placement in a
group residential housing facility under section 256I.04, subdivision 1a,;
or (3) is eligible for a shelter needy payment under subdivision 5, paragraph
(f); is the standard established in subdivision 3, paragraph (a) or (b).
EFFECTIVE DATE. This section is effective January 1, 2009.
Sec.
13. Minnesota Statutes 2006, section
256D.44, subdivision 5, is amended to read:
Subd.
5. Special
needs. In addition to the state
standards of assistance established in subdivisions 1 to 4, payments are
allowed for the following special needs of recipients of Minnesota supplemental
aid who are not residents of a nursing home, a regional treatment center, or a
group residential housing facility.
(a)
The county agency shall pay a monthly allowance for medically prescribed diets
if the cost of those additional dietary needs cannot be met through some other
maintenance benefit. The need for
special diets or dietary items must be prescribed by a licensed physician. Costs for special diets shall be determined
as percentages of the allotment for a one-person household under the thrifty
food plan as defined by the United States Department of Agriculture. The types of diets and the percentages of
the thrifty food plan that are covered are as follows:
(1)
high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
(2)
controlled protein diet, 40 to 60 grams and requires special products, 100
percent of thrifty food plan;
(3)
controlled protein diet, less than 40 grams and requires special products, 125
percent of thrifty food plan;
(4)
low cholesterol diet, 25 percent of thrifty food plan;
(5)
high residue diet, 20 percent of thrifty food plan;
(6)
pregnancy and lactation diet, 35 percent of thrifty food plan;
(7)
gluten-free diet, 25 percent of thrifty food plan;
(8)
lactose-free diet, 25 percent of thrifty food plan;
(9)
antidumping diet, 15 percent of thrifty food plan;
(10)
hypoglycemic diet, 15 percent of thrifty food plan; or
(11)
ketogenic diet, 25 percent of thrifty food plan.
(b)
Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and
appliances using the payment standard of the AFDC program in effect on July 16,
1996, for these expenses, as long as other funding sources are not available.
(c) A
fee for guardian or conservator service is allowed at a reasonable rate
negotiated by the county or approved by the court. This rate shall not exceed five percent of the assistance unit's
gross monthly income up to a maximum of $100 per month. If the guardian or conservator is a member
of the county agency staff, no fee is allowed.
(d)
The county agency shall continue to pay a monthly allowance of $68 for
restaurant meals for a person who was receiving a restaurant meal allowance on
June 1, 1990, and who eats two or more meals in a restaurant daily. The allowance must continue until the person
has not received Minnesota supplemental aid for one full calendar month or
until the person's living arrangement changes and the person no longer meets
the criteria for the restaurant meal allowance, whichever occurs first.
(e) A
fee of ten percent of the recipient's gross income or $25, whichever is less,
is allowed for representative payee services provided by an agency that meets
the requirements under SSI regulations to charge a fee for representative payee
services. This special need is
available to all recipients of Minnesota supplemental aid regardless of their
living arrangement.
(f) (1)
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 July of
the previous each year will be added to the standards of
assistance established in subdivisions 1 to 4 for individuals adults
under the age of 65 who qualify as shelter needy and are: (i)
relocating from an institution, or an adult mental health residential treatment
program under section 256B.0622, and who are shelter needy; (ii)
eligible for the self-directed supports option as defined under section 256B.0657,
subdivision 2; or (iii) home and community-based waiver recipients living in
their own home or rented or leased apartment which is not owned, operated, or
controlled by a provider of service not related by blood or marriage.
(2)
Notwithstanding subdivision 3, paragraph (c), an individual eligible for the
shelter needy benefit under this paragraph is considered a household of
one. An eligible individual who receives this
benefit prior to age 65 may continue to receive the benefit after the age of 65.
(3)
"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, paragraph (a) or (b), 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.
EFFECTIVE DATE. This section is effective January 1, 2009.
ARTICLE
2
AGENCY
MANAGEMENT
Section
1. Minnesota Statutes 2006, section
13.461, is amended by adding a subdivision to read:
Subd.
24a. Managed
care plans. Data provided to
the commissioner of human services by managed care plans relating to contracts
and provider payment rates are classified under section 256B.69, subdivision
9b.
Sec.
2. Minnesota Statutes 2006, section
256.01, is amended by adding a subdivision to read:
Subd.
27. Automation
and coordination for state health care programs. (a) For purposes of this subdivision,
"state health care program" means the medical assistance,
MinnesotaCare, or general assistance medical care programs.
(b)
By July 1, 2010, the commissioner shall improve coordination between state
health care programs and social service programs including but not limited to
WIC, free and reduced-price school lunch programs, and food stamps, and shall
develop and use automated systems to identify persons served by social service
programs who may be eligible for, but are not enrolled in, a state health care
program. The system must also permit
enrollees to renew state health care program enrollment through these social
services programs. By January 15, 2010,
the commissioner shall, as necessary, identify and recommend to the legislature
statutory changes to state health care and social service programs necessary to
improve coordination and automation of outreach and enrollment efforts, and
report estimated local and state costs of implementation and evaluate funding
alternatives, including possible federal reimbursement.
(c)
By January 15, 2010, the commissioner shall establish and implement an
automated process to send out state health care program renewal forms in the
most common foreign languages to those state health care program enrollees who
request renewal forms in those foreign languages. The commissioner, as part of the initial enrollment process,
shall inform applicants of the availability of this option.
(d)
Beginning July 1, 2010, the commissioner, county social service agencies, and
health care providers shall update state health care program enrollee addresses
and related contact information at the time of each enrollee contact. The commissioner shall report the costs of
automatically updating contact information across programs to health care
providers and county agencies.
Sec.
3. Minnesota Statutes 2006, section
256B.69, subdivision 5a, is amended to read:
Subd.
5a. Managed care contracts. (a)
Managed care contracts under this section and sections 256L.12 and 256D.03,
shall be entered into or renewed on a calendar year basis beginning January 1,
1996. Managed care contracts which were
in effect on June 30, 1995, and set to renew on July 1, 1995, shall be renewed
for the period July 1, 1995 through December 31, 1995 at the same terms that
were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to
services to medical assistance recipients age 65 and older.
(b) A
prepaid health plan providing covered health services for eligible persons
pursuant to chapters 256B, 256D, and 256L, is responsible for complying with
the terms of its contract with the commissioner. Requirements applicable to managed care programs under chapters
256B, 256D, and 256L, established after the effective date of a contract with
the commissioner take effect when the contract is next issued or renewed.
(c)
Effective for services rendered on or after January 1, 2003, the commissioner
shall withhold five percent of managed care plan payments under this section
for the prepaid medical assistance and general assistance medical care programs
pending completion of performance targets.
Each performance target must be quantifiable, objective, measurable, and
reasonably attainable, except in the case of a performance target based on a
federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to
the contract effective date. The
managed care plan must demonstrate, to the commissioner's satisfaction, that
the data submitted regarding attainment of the performance target is
accurate. The commissioner shall
periodically change the administrative measures used as performance targets in
order to improve plan performance across a broader range of administrative
services. The performance targets must
include measurement of plan efforts to contain spending on health care services
and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account
factors affecting only one plan, including characteristics of the plan's
enrollee population. The withheld
funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved.
The commissioner may exclude special demonstration projects under
subdivision 23. A managed care plan or
a county-based purchasing plan under section 256B.692 may include as admitted
assets under section 62D.044 any amount withheld under this paragraph that is
reasonably expected to be returned.
Sec.
4. Minnesota Statutes 2006, section
256B.69, is amended by adding a subdivision to read:
Subd.
5i. Administrative
expenses. (a) Managed care
plan and county-based purchasing plan administrative costs for a prepaid health
plan provided under this section or section 256B.692 must not exceed by more
than five percent that prepaid health plan's or county-based purchasing plan's
actual calculated administrative spending for the previous calendar year as a
percentage of total revenue. The
penalty for exceeding this limit must be the amount of administrative spending
in excess of 105 percent of the actual calculated amount. The commissioner may waive this penalty if
the excess administrative spending is the result of unexpected shifts in
enrollment or member needs or new program requirements.
(b)
Capitated rate payments for administrative costs must be reduced to exclude
onetime or sporadic expenditures in the prior year unless the managed care plan
certifies that the expenditure will recur during the contract year. The commissioner shall verify these
certifications on an annual basis and recoup any payments made for onetime or
sporadic expenditures that did not occur in the prior year.
(c)
Expenses under section 62D.12, subdivision 9a, clause (4), are not allowable
administrative expenses for rate-setting purposes under this section, unless
approved by the commissioner.
Sec.
5. Minnesota Statutes 2006, section
256B.69, is amended by adding a subdivision to read:
Subd.
5j. Treatment
of investment earnings. Capitation
rates shall treat investment income and interest earnings as income to the same
extent that investment-related expenses are treated as administrative
expenditures.
Sec.
6. Minnesota Statutes 2006, section
256B.69, is amended by adding a subdivision to read:
Subd.
9a. Administrative
expense reporting. Each
managed care plan and county-based purchasing plan must provide to the
commissioner detailed information on administrative spending, including:
(1)
itemized lists of costs for claims processing and provider network management;
(2)
detailed reports of costs for contracts with providers and third-party
administrators;
(3)
a detailed analysis of administrative spending for each Minnesota health care
program;
(4)
a detailed analysis of the provider's allocation of administrative expenses
among its public and commercial lines of business;
(5)
a detailed analysis of administrative costs by service category; and
(6)
a detailed analysis of onetime and sporadic expenditures included in the
administrative spending category.
Sec.
7. Minnesota Statutes 2006, section
256B.69, is amended by adding a subdivision to read:
Subd.
9b. Reporting
of subcontracts and provider payment rates. (a) Each managed care plan and county-based purchasing plan
must provide to the commissioner:
(1)
detailed information on contracts with health care providers; and
(2)
detailed information on reimbursement rates paid by the managed care plan to
providers under contract with the plan.
(b)
Data provided to the commissioner under this subdivision are nonpublic data as
defined in section 13.02.
Sec.
8. Minnesota Statutes 2006, section
256B.692, subdivision 2, is amended to read:
Subd.
2. Duties
of commissioner of health. (a)
Notwithstanding chapters 62D and 62N, a county that elects to purchase medical
assistance and general assistance medical care in return for a fixed sum
without regard to the frequency or extent of services furnished to any
particular enrollee is not required to obtain a certificate of authority under
chapter 62D or 62N. The county board of
commissioners is the governing body of a county-based purchasing program. In a multicounty arrangement, the governing
body is a joint powers board established under section 471.59.
(b) A
county that elects to purchase medical assistance and general assistance
medical care services under this section must satisfy the commissioner of
health that the requirements for assurance of consumer protection, provider
protection, and, effective January 1, 2010, fiscal solvency of chapter
62D, applicable to health maintenance organizations, or chapter 62N,
applicable to community integrated service networks, will be met.
according to the following schedule:
(1)
for a county-based purchasing plan approved on or before June 30, 2008, the
plan must have in reserve:
(i)
at least 50 percent of the minimum amount required under chapter 62D as of
January 1, 2010;
(ii)
at least 75 percent of the minimum amount required under chapter 62D as of
January 1, 2011;
(iii)
at least 87.5 percent of the minimum amount required under chapter 62D as of
January 1, 2012; and
(iv)
at least 100 percent of the minimum amount required under chapter 62D as of
January 1, 2013; and
(2)
for a county-based purchasing plan first approved after June 30, 2008, the plan
must have in reserve:
(i)
at least 50 percent of the minimum amount required under chapter 62D at the
time the plan begins enrolling enrollees;
(ii)
at least 75 percent of the minimum amount required under chapter 62D after the
first full calendar year;
(iii)
at least 87.5 percent of the minimum amount required under chapter 62D after
the second full calendar year; and
(iv)
at least 100 percent of the minimum amount required under chapter 62D after the
third full calendar year.
(c) Until
a plan is required to have reserves equaling at least 100 percent of the
minimum amount required under chapter 62D, the plan may demonstrate its ability
to cover any losses by satisfying the requirements of chapter 62N. A county county-based
purchasing plan must also assure
the commissioner of health that the requirements of sections 62J.041; 62J.48;
62J.71 to 62J.73; 62M.01 to 62M.16; all applicable provisions of chapter 62Q,
including sections 62Q.075; 62Q.1055; 62Q.106; 62Q.12; 62Q.135; 62Q.14;
62Q.145; 62Q.19; 62Q.23, paragraph (c); 62Q.43; 62Q.47; 62Q.50; 62Q.52 to 62Q.56;
62Q.58; 62Q.68 to 62Q.72; and 72A.201 will be met.
(d)
All enforcement and rulemaking powers available under chapters 62D, 62J, 62M,
62N, and 62Q are hereby granted to the commissioner of health with respect to
counties that purchase medical assistance and general assistance medical care
services under this section.
(e)
The commissioner, in consultation with county government, shall develop
administrative and financial reporting requirements for county-based purchasing
programs relating to sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28,
62N.29, and 62N.31, and other sections as necessary, that are specific to
county administrative, accounting, and reporting systems and consistent with
other statutory requirements of counties.
Sec.
9. Minnesota Statutes 2006, section
256B.692, is amended by adding a subdivision to read:
Subd.
4a. Expenditure
of revenues. (a) A county
that has elected to participate in a county-based purchasing plan under this
section shall use any excess revenues over expenses that are received by the
county and are not needed for capital reserves under subdivision 2, to increase
payments to providers, or to repay county investments or contributions to the
county-based purchasing plan, for prevention, early intervention, and health
care programs, services, or activities.
(b)
A county-based purchasing plan under this section is subject to the
unreasonable expense provisions of section 62D.19.
Sec.
10. Minnesota Statutes 2006, section
256L.12, subdivision 9, is amended to read:
Subd.
9. Rate
setting; performance withholds. (a)
Rates will be prospective, per capita, where possible. The commissioner may allow health plans to
arrange for inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with an
independent actuary to determine appropriate rates.
(b)
For services rendered on or after January 1, 2003, to December 31, 2003, the
commissioner shall withhold .5 percent of managed care plan payments under this
section pending completion of performance targets. The withheld funds must be returned no sooner than July 1 and no
later than July 31 of the following year if performance targets in the contract
are achieved. A managed care plan may
include as admitted assets under section 62D.044 any amount withheld under this
paragraph that is reasonably expected to be returned.
(c)
For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments under this section pending
completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably
attainable, except in the case of a performance target based on a federal or
state law or rule. Criteria for
assessment of each performance target must be outlined in writing prior to the
contract effective date. The managed
care plan must demonstrate, to the commissioner's satisfaction, that the data
submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change
the administrative measures used as performance targets in order to improve
plan performance across a broader range of administrative services. The performance targets must include
measurement of plan efforts to contain spending on health care services and
administrative activities. The
commissioner may adopt plan-specific performance targets that take into account
factors affecting only one plan, such as characteristics of the plan's enrollee
population. The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following
calendar year if performance targets in the contract are achieved. A managed care plan or a county-based
purchasing plan under section 256B.692 may include as admitted assets under
section 62D.044 any amount withheld under this paragraph that is reasonably
expected to be returned.
Sec.
11. REPORT ON FINANCIAL MANAGEMENT OF HEALTH CARE PROGRAMS.
The
commissioner of human services shall report to the legislature under Minnesota
Statutes, section 3.195, by January 15, 2009, with the following information
regarding financial management of health care programs:
(1)
a status report on implementation of the cost containment strategies identified
in the 2005 "Strategies for Savings" report. The report must include:
(i)
information on progress made towards implementation of cost-saving strategies;
(ii)
an explanation of why certain strategies were not implemented; and
(iii)
where appropriate, alternative strategies to those recommended in 2005 for
containing public health care program costs;
(2)
a description of and, to the extent possible, an explanation of recent differences
between the health plan net revenue targets established by the commissioner for
health plans participating in public health care programs and the actual net
revenue realized by the plans from public programs;
(3)
the adequacy of public health care programs for fee-for-service rates,
including an identification of service areas or geographical regions where
enrollees have difficulty accessing providers as the result of inadequate
provider payments. This report must
include recommendations to increase rates as needed to eliminate identified
access problems; and
(4)
a progress report on implementation of Minnesota Statutes, section 256B.76,
paragraph (e), requiring payments for physician and professional services to be
based on Medicare relative value units, and an estimated completion date for
implementation of this payment system.
Sec.
12. HEALTH PLAN AND COUNTY-BASED PURCHASING PLAN REQUIREMENTS.
(a)
The commissioner of health shall develop and report to the legislature under
Minnesota Statutes, section 3.195, by January 15, 2009, guidelines to ensure
that health plans, and county-based purchasing plans where applicable, have
consistent procedures for allocating administrative expenses and investment
income across their commercial and public lines of business and across
individual public programs. The
guidelines shall be consistent with generally accepted accounting principles
and principles from the National Association of Insurance Commissioners. The guidelines shall not have the effect of
changing allocation for Medicare-related programs as permitted by federal law
and the Centers for Medicare and Medicaid Services.
(b)
The commissioner of health, in cooperation with the commissioners of commerce
and human services, shall develop and report to the legislature under Minnesota
Statutes, section 3.195, by January 15, 2009, detailed standards and procedures
for examining the reasonableness of health plan and county-based purchasing
plan administrative expenditures for publicly funded programs. These standards and procedures must include
a process for detailed examinations of individual programs and functional
areas.
(c)
The commissioner of health shall develop and report to the legislature under
Minnesota Statutes, section 3.195, by January 15, 2009, a more efficient method
for a health plan, and a county-based purchasing plan where appropriate, to
demonstrate to the commissioner that providers in the plan's network have
appropriate credentials. The
commissioner shall review issues regarding:
(1)
the duplicate review of credentials at a health care provider by multiple
health plans;
(2)
the review of the credentials of all staff of a health care provider when only
limited staff will be in the plan network; and
(3)
other duplicative credentialing issues.
Sec.
13. OMBUDSMAN FOR MANAGED CARE STUDY.
The
commissioner of human services, in cooperation with the ombudsman for managed
care, shall study and report to the legislature under Minnesota Statutes,
section 3.195, by January 15, 2009, with recommendations on whether the duties
of the ombudsman should be expanded to include advocating on behalf of public
health care programs fee-for-service enrollees. The report must include:
(1)
a comparison of recourses available to managed care clients versus
fee-for-service clients when service problems occur; and
(2)
an estimate of any net cost increase from this change in the ombudsman's
duties, taking into account any reduction in the commissioner's duties.
Sec.
14. REPORTING MANAGED CARE PERFORMANCE DATA.
The
commissioner of human services, in cooperation with the commissioner of health,
shall report to the legislature under Minnesota Statutes, section 3.195, by
January 15, 2009, with recommendations on the adoption of a single method to
compute and publicly report managed health care performance measures in order
to avoid confusion about the plans' performance levels. The study must include recommendations
regarding coordinated use by the two agencies of the following data sources:
(1)
Healthcare Effectiveness Data and Information Set (HEDIS) from managed care
organizations;
(2)
data that health plans submit to claim reimbursement for health care
procedures; and
(3)
data collected from medical record reviews of randomly selected individuals.
Sec.
15. PUBLIC DENTAL COVERAGE PROGRAM STUDY.
(a)
The commissioner of human services shall undertake a study to determine whether
alternative approaches to offering dental coverage to public programs enrollees
would result in:
(1)
improved access to dental care;
(2)
cost savings to providers and the department; and
(3)
improved quality and outcomes of care.
Alternatives
considered must include moving to a single dental plan administrator, retaining
the current model, and other innovative approaches. Issues relating to chronic disease management, medical and dental
interface, plan payment approaches, and provider payment should also be
addressed. The report must make a
recommendation on whether to alter the current approach to contracting for dental
services, and include a detailed plan on how to implement any changes. The commissioner shall consult with
dentists, safety net dental providers, dental plans, health plans and
county-based purchasing organizations, patients and advocates, and other
interested parties in developing their findings and recommendations.
(b)
By December 15, 2008, the commissioner of human services shall report findings
and recommendations to the chairs of the house of representatives and senate
committees having jurisdiction over health and human services policy and
finance.
EFFECTIVE DATE. This section is effective the day following final enactment.
Sec.
16. WORK GROUP; TARGETED CASE MANAGEMENT.
(a)
The commissioner of human services shall convene a work group and seek
information from counties, juvenile court staff, guardians ad litem, and mental
health and child welfare advocates on the impact of federal regulations that
cut funding for targeted case management services and the child support
administrative collection system. The
work group shall consider the impact these cuts will have on child protection,
mental health, and housing relocation services.
(b)
The commissioner shall issue a report from the work group summarizing the
impact of the federal budget cuts on persons eligible for targeted case
management services and the impact on county budgets. This report shall include budget and policy strategies to restore
service levels to that of the year prior to the effective date of the federal
regulations. A preliminary report shall
be issued on December 15, 2008.
ARTICLE
3
CHILDREN
AND FAMILY SERVICES
Section
1. Minnesota Statutes 2007 Supplement,
section 256.741, subdivision 1, is amended to read:
Subdivision
1. Public
assistance Definitions.
(a) The term "direct support" as used in this chapter and
chapters 257, 518, 518A, and 518C refers to an assigned support payment from an
obligor which is paid directly to a recipient of TANF or MFIP public
assistance.
(b)
The term "public assistance" as used in this chapter and chapters
257, 518, 518A, and 518C, includes any form of assistance provided under the
AFDC program formerly codified in sections 256.72 to 256.87, MFIP and MFIP-R
formerly codified under chapter 256, MFIP under chapter 256J, work first program
formerly codified under chapter 256K; child care assistance provided
through the child care fund under chapter 119B; any form of medical assistance
under chapter 256B; MinnesotaCare under chapter 256L; and foster care as
provided under title IV-E of the Social Security Act.
(c)
The term "child support agency" as used in this section refers to the
public authority responsible for child support enforcement.
(d)
The term "public assistance agency" as used in this section refers to
a public authority providing public assistance to an individual.
(e)
The terms "child support" and "arrears" as used in this
section have the meanings provided in section 518A.26.
(f)
The term "maintenance" as used in this section has the meaning
provided in section 518.003.
Sec.
2. Minnesota Statutes 2006, section
256.741, subdivision 2, is amended to read:
Subd.
2. Assignment
of support and maintenance rights.
(a) An individual receiving public assistance in the form of assistance
under any of the following programs: the AFDC program formerly codified in
sections 256.72 to 256.87, MFIP under chapter 256J, MFIP-R and MFIP formerly
codified under chapter 256, or work first program formerly codified under
chapter 256K is considered to have assigned to the state at the time of
application all rights to child support and maintenance from any other person
the applicant or recipient may have in the individual's own behalf or in the
behalf of any other family member for whom application for public assistance is
made. An assistance unit is ineligible
for the Minnesota family investment program unless the caregiver assigns all
rights to child support and spousal maintenance benefits according to
this section.
(1) An
The assignment made according to this section is effective as to:
(i) any current child support
and current spousal maintenance; and.
(ii)
any accrued child support and spousal maintenance arrears.
(2)
An assignment made after September 30, 1997, is effective as to:
(i)
any current child support and current spousal maintenance;
(ii)
any accrued child support and spousal maintenance arrears collected before
October 1, 2000, or the date the individual terminates assistance, whichever is
later; and
(iii)
any accrued child support and spousal maintenance arrears collected under
federal tax intercept.
(2)
Any child support or maintenance arrears that accrue while an individual is
receiving public assistance in the form of assistance under any of the programs
listed in this paragraph are permanently assigned to the state.
(3)
The assignment of current child support and current maintenance ends on the
date the individual ceases to receive or is no longer eligible to receive
public assistance under any of the programs listed in this paragraph.
(b) An
individual receiving public assistance in the form of medical assistance,
including MinnesotaCare, is considered to have assigned to the state at the
time of application all rights to medical support from any other person the
individual may have in the individual's own behalf or in the behalf of any
other family member for whom medical assistance is provided.
(1)
An
assignment made after September 30, 1997, is effective as to any medical
support accruing after the date of medical assistance or MinnesotaCare
eligibility.
(2)
Any medical support arrears that accrue while an individual is receiving public
assistance in the form of medical assistance, including MinnesotaCare, are
permanently assigned to the state.
(3)
The assignment of current medical support ends on the date the individual
ceases to receive or is no longer eligible to receive public assistance in the
form of medical assistance or MinnesotaCare.
(c) An
individual receiving public assistance in the form of child care assistance
under the child care fund pursuant to chapter 119B is considered to have
assigned to the state at the time of application all rights to child care
support from any other person the individual may have in the individual's own
behalf or in the behalf of any other family member for whom child care
assistance is provided.
An (1) The assignment made
according to this paragraph is effective as to:
(1) any current child care
support and any child care support arrears assigned and accruing after July
1, 1997, that are collected before October 1, 2000; and.
(2) any
accrued child care support arrears collected under federal tax intercept.
Any child care support arrears that accrue while an individual is receiving
public assistance in the form of child care assistance under the child care
fund in chapter 119B are permanently assigned to the state.
(3)
The assignment of current child care support ends on the date the individual
ceases to receive or is no longer eligible to receive public assistance in the
form of child care assistance under the child care fund under chapter 119B.
Sec.
3. Minnesota Statutes 2006, section
256.741, subdivision 2a, is amended to read:
Subd.
2a. Families-first Distribution of child support arrearages. (a) The state shall distribute current
child support and maintenance received by the state to an individual who
assigns the right to that support under subdivision 2, paragraph (a).
(b)
When the
public authority collects child support arrearages on behalf of an
individual who is receiving public assistance provided under MFIP or
MFIP-R under this chapter, MFIP under chapter 256J, or work first under chapter
256K, and the public authority has the option of applying the collection to
arrears permanently assigned to the state or to arrears temporarily assigned to
the state, the public authority shall first apply the collection to satisfy
those arrears that are permanently assigned to the state.
(c)
When the public authority collects child support arrearages on behalf of an
individual who is not receiving public assistance, the public authority shall
first apply the collection to satisfy those arrears that are not permanently
assigned to the state.
(d)
When the public authority collects child support arrearages certified under the
federal tax offset, the public authority shall first apply the collection to
satisfy those arrears that are permanently assigned to the state.
Sec.
4. Minnesota Statutes 2006, section
256.741, subdivision 3, is amended to read:
Subd.
3. Existing
assignments. Assignments based on
the receipt of public assistance in existence prior to July 1, 1997, are
permanently assigned to the state. Arrears
that accrued prior to the receipt of assistance that were assigned to the state
between July 1, 1997, and October 1, 2009, must no longer be assigned as of
October 1, 2009.
EFFECTIVE DATE. This section is effective October 1, 2009.
Sec.
5. Minnesota Statutes 2007 Supplement,
section 256J.621, is amended to read:
256J.621 WORK PARTICIPATION BONUS
FOOD BENEFITS.
(a) Effective
March 1, 2010, upon exiting the diversionary work program (DWP) or upon
terminating the Minnesota family investment program (MFIP) cash
assistance with earnings, a participant who is employed may be eligible for
transitional assistance work participation food benefits of $75
per month to assist in meeting the family's basic needs as the participant
continues to move toward self-sufficiency.
(b) To
be eligible for a transitional assistance payment work participation
food benefits, the participant shall not receive MFIP cash assistance
or diversionary work program assistance during the month and the participant or
participants must meet the following work requirements:
(1) if
the participant is a single caregiver and has a child under six years of age,
the participant must be employed at least 87 hours per month;
(2) if
the participant is a single caregiver and does not have a child under six years
of age, the participant must be employed at least 130 hours per month; or
(3) if
the household is a two-parent family, at least one of the parents must be
employed an average of at least 130 hours per month.
Whenever
a participant exits the diversionary work program or is terminated from MFIP cash
assistance and meets the other criteria in this section, transitional
assistance is work participation food benefits are available for up
to 24 consecutive months.
(c)
Expenditures on the program are maintenance of effort state funds for
participants under paragraph (b), clauses (1) and (2). Expenditures for participants under
paragraph (b), clause (3), are nonmaintenance of effort funds. Months in which a participant receives transitional
assistance work participation food benefits under this section do
not count toward the participant's MFIP 60-month time limit.
Sec.
6. Minnesota Statutes 2006, section
518A.50, is amended to read:
518A.50 PAYMENT TO PUBLIC AGENCY.
(a)
This section applies to all proceedings involving a support order, including,
but not limited to, a support order establishing an order for past support or
reimbursement of public assistance.
(b)
The court shall direct that all payments ordered for maintenance or support be
made to the public authority responsible for child support enforcement so long
as the obligee is receiving or has applied for public assistance, or has
applied for child support or maintenance collection services. Public authorities responsible for child
support enforcement may act on behalf of other public authorities responsible
for child support enforcement, including the authority to represent the legal
interests of or execute documents on behalf of the other public authority in
connection with the establishment, enforcement, and collection of child
support, maintenance, or medical support, and collection on judgments.
(c)
Payments made to the public authority other than payments under section
518A.53 must be credited as of the date the payment is received by the
central collections unit., except that payments made under section
518A.53 may be considered to have been paid as of the date the obligor received
the remainder of the income.
(d)
Monthly amounts received by the public agency responsible for child support
enforcement from the obligor that are greater than the monthly amount of public
assistance granted to the obligee must be remitted to the obligee.
EFFECTIVE DATE. This section is effective October 1, 2009.
Sec.
7. Minnesota Statutes 2006, section
518A.53, subdivision 5, is amended to read:
Subd.
5. Payor
of funds responsibilities. (a) An
order for or notice of withholding is binding on a payor of funds upon
receipt. Withholding must begin no
later than the first pay period that occurs after 14 days following the date of
receipt of the order for or notice of withholding. In the case of a financial institution, preauthorized transfers
must occur in accordance with a court-ordered payment schedule.
(b) A
payor of funds shall withhold from the income payable to the obligor the amount
specified in the order or notice of withholding and amounts specified under
subdivisions 6 and 9 and shall remit the amounts withheld to the public
authority within seven business days of the date the obligor is paid the
remainder of the income. The payor of
funds shall include with the remittance the Social Security number of the
obligor, the case type indicator as provided by the public authority and the
date the obligor is paid the remainder of the income. The obligor is considered to have paid the amount withheld as
of the date the obligor received the remainder of the income. A payor of funds may combine all amounts
withheld from one pay period into one payment to each public authority, but
shall separately identify each obligor making payment.
(c) A
payor of funds shall not discharge, or refuse to hire, or otherwise discipline
an employee as a result of wage or salary withholding authorized by this
section. A payor of funds shall be
liable to the obligee for any amounts required to be withheld. A payor of funds that fails to withhold or
transfer funds in accordance with this section is also liable to the obligee
for interest on the funds at the rate applicable to judgments under section
549.09, computed from the date the funds were required to be withheld or
transferred. A payor of funds is liable
for reasonable attorney fees of the obligee or public authority incurred in
enforcing the liability under this paragraph.
A payor of funds that has failed to comply with the requirements of this
section is subject to contempt sanctions under section 518A.73. If the payor of funds is an employer or independent
contractor and violates this subdivision, a court may award the obligor twice
the wages lost as a result of this violation.
If a court finds a payor of funds violated this subdivision, the court
shall impose a civil fine of not less than $500. The liabilities in this paragraph apply to intentional
noncompliance with this section.
(d) If
a single employee is subject to multiple withholding orders or multiple notices
of withholding for the support of more than one child, the payor of funds shall
comply with all of the orders or notices to the extent that the total amount
withheld from the obligor's income does not exceed the limits imposed under the
Consumer Credit Protection Act, United States Code, title 15, section 1673(b),
giving priority to amounts designated in each order or notice as current
support as follows:
(1) if
the total of the amounts designated in the orders for or notices of withholding
as current support exceeds the amount available for income withholding, the
payor of funds shall allocate to each order or notice an amount for current
support equal to the amount designated in that order or notice as current
support, divided by the total of the amounts designated in the orders or
notices as current support, multiplied by the amount of the income available
for income withholding; and
(2) if
the total of the amounts designated in the orders for or notices of withholding
as current support does not exceed the amount available for income withholding,
the payor of funds shall pay the amounts designated as current support, and
shall allocate to each order or notice an amount for past due support, equal to
the amount designated in that order or notice as past due support, divided by
the total of the amounts designated in the orders or notices as past due
support, multiplied by the amount of income remaining available for income
withholding after the payment of current support.
(e)
When an order for or notice of withholding is in effect and the obligor's
employment is terminated, the obligor and the payor of funds shall notify the
public authority of the termination within ten days of the termination date. The termination notice shall include the
obligor's home address and the name and address of the obligor's new payor of
funds, if known.
(f) A
payor of funds may deduct one dollar from the obligor's remaining salary for
each payment made pursuant to an order for or notice of withholding under this
section to cover the expenses of withholding.
EFFECTIVE DATE. This section is effective October 1, 2009.
Sec.
8. Laws 2007, chapter 147, article 2,
section 21, the effective date, is amended to read:
EFFECTIVE DATE. Subdivision 1 is effective February 1, 2008, and subdivision 2 is
effective May 1, 2008 March 1, 2009.
Sec. 9. Laws 2007,
chapter 147, article 19, section 3, subdivision 1, is amended to read:
Subdivision 1. Total Appropriation $5,294,627,000 $5,695,458,000
Appropriations by Fund
2008 2009
General 4,614,727,000 4,940,293,000
State Government
Special Revenue 549,000 565,000
Health Care Access 426,628,000 492,759,000
Federal TANF 250,537,000 260,051,000
Lottery Prize Fund 2,185,000 1,790,000
The amounts that may be
spent for each purpose are specified in the following subdivisions.
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 Enterprise 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.
Pay for
Performance. (a)
Of the general fund appropriation, $272,000 each year is available to the commissioner
of human services only under the following circumstances:
(1) $272,000 shall be made
available by the commissioner of finance on January 1, 2009, only after
notification by the commissioner of human services to the commissioner of
finance and to the chairs of the relevant house of representatives and senate
finance and policy committees that the average number of days from the receipt
of a MinnesotaCare application at the state processing unit until the initial
eligibility determination of the application was 30 days or less during the
period October 1, 2007, to September 30, 2008.
Applications transferred from counties to the state processing unit are
excluded from this calculation; and
(2) $272,000 shall be made
available by the commissioner of finance on January 1, 2009, only after
notification by the commissioner of human services to the commissioner of
finance and to the chairs of the relevant house of representatives and senate
finance and policy committees that the commissioner initiated a separate
treatment program for persons in the Minnesota sex offenders program who are
between the ages of 18 and 25 by January 1, 2008.
(b) Regardless of whether
these appropriations are made available to the commissioner of human services,
they shall be part of base level funding for the biennium beginning July 1,
2009.
Purchasing
Alliance Fund Transfer. On September 1, 2007, any
remaining balance in the purchasing alliance stop-loss fund account established
under Minnesota Statutes, section 256.956, shall transfer to the general fund.
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.
TANF
Maintenance of Effort. (a) In order to meet the
basic 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;
(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) The commissioner shall
ensure that the MOE 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 16 percent of
the total required under Code of Federal Regulations, title 45, section 263.1.
(d) For the federal
fiscal year beginning October 1, 2007, the commissioner may not claim an amount
of TANF/MOE in excess of the 75 percent standard in Code of Federal
Regulations, title 45, section 263.1(a)(2), except:
(1) to the extent necessary
to meet the 80 percent standard under Code of Federal Regulations, title 45,
section 263.1(a)(1), if it is determined by the commissioner that the state
will not meet the TANF work participation target rate for the current year;
(2) to provide any
additional amounts under Code of Federal Regulations, title 45, section 264.5,
that relate to replacement of TANF funds due to the operation of TANF
penalties;
(3) to provide any
additional amounts that may contribute to avoiding or reducing TANF work
participation penalties through the operation of the excess MOE provisions of
Code of Federal Regulations, title 45, section 261.43(a)(2); and
(4) for the purposes of
clauses (1) to (3), the commissioner may supplement the MOE claim with working
family credit expenditures to the extent such expenditures or other qualified
expenditures are otherwise available after considering the expenditures allowed
in this section.
(e) If allowable by the
federal Office of Family Assistance, the commissioner may claim excess MOE with
respect to federal fiscal years 2006 and 2007 to the extent that working family
credit expenditures are otherwise available to supplement the state's MOE claim
for those years after considering the expenditures allowed in this subdivision.
If other qualified
expenditures are available, the commissioner may use those expenditures as
excess MOE and by April 15, 2009, shall report those expenditures to the chairs
of the senate and house of representatives Finance Committees, the senate
Health and Human Services Budget Division, and house of representatives Health
Care and Human Services Finance Division.
(d) (f) 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, does not apply if the grants or aids are federal TANF funds.
(e) (g) Notwithstanding any
contrary provision in this article, this rider expires June 30, 2011.
Working Family
Credit Expenditures as TANF/MOE. The commissioner may claim
as TANF/MOE up to $6,707,000 per year for fiscal year 2008 through fiscal year
2011. Notwithstanding any contrary
provision in this article, this rider expires June 30, 2011.
Additional
Working Family Credit Expenditures to be Claimed for TANF/MOE. In addition to the amounts provided in this section,
the commissioner may count the following amounts of working family credit
expenditure as TANF/MOE:
(1) fiscal year 2008, $11,097,000
$28,222,000;
(2) fiscal year 2009, $25,401,000
$42,905,000;
(3) fiscal year 2010, $20,398,000
$29,026,000; and
(4) fiscal year 2011, $19,841,000
$28,361,000.
Notwithstanding any contrary
provision in this article, this rider expires June 30, 2011.
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 2008 and $2,157,000 in
fiscal year 2009 are to be used to increase the capitation payments under
Minnesota Statutes, section 256B.69.
Sec. 10. REPEALER.
Minnesota Statutes 2006, sections 256.741, subdivision 15; and 256J.24,
subdivision 6, are repealed.
ARTICLE 4
HEALTH CARE
Section 1. Minnesota Statutes
2006, section 256.969, subdivision 2b, is amended to read:
Subd. 2b. Operating payment rates. In
determining operating payment rates for admissions occurring on or after the
rate year beginning January 1, 1991, and every two years after, or more
frequently as determined by the commissioner, the commissioner shall obtain
operating data from an updated base year and establish operating payment rates
per admission for each hospital based on the cost-finding methods and allowable
costs of the Medicare program in effect during the base year. Rates under the general assistance medical
care, medical assistance, and MinnesotaCare programs shall not be rebased to
more current data on January 1, 1997, and January 1, 2005, and for
the first year of the rebased period beginning January 1, 2009. The base year operating payment rate per
admission is standardized by the case mix index and adjusted by the hospital
cost index, relative values, and disproportionate population adjustment. The cost and charge data used to establish
operating rates shall only reflect inpatient services covered by medical
assistance and shall not include property cost information and costs recognized
in outlier payments.
Sec. 2. Minnesota Statutes
2006, section 256.969, subdivision 20, is amended to read:
Subd. 20. Increases in medical assistance inpatient payments; conditions. (a) Medical assistance inpatient payments
shall increase 20 percent for inpatient hospital originally paid admissions,
excluding Medicare crossovers, that occurred between July 1, 1988 and December
31, 1990, if: (i) the hospital had 100 or fewer Minnesota medical assistance annualized
paid admissions, excluding Medicare crossovers, that were paid by March 1,
1988, for the period January 1, 1987 to June 30, 1987; (ii) the hospital had
100 or fewer licensed beds on March 1, 1988; (iii) the hospital is located in
Minnesota; and (iv) the hospital is not located in a city of the first class as
defined in section 410.01. For purposes
of this paragraph, medical assistance does not include general assistance
medical care.
(b) Medical assistance inpatient payments shall increase 15 percent for
inpatient hospital originally paid admissions, excluding Medicare crossovers,
that occurred between July 1, 1988 and December 31, 1990, if: (i) the hospital
had more than 100 but fewer than 250 Minnesota medical assistance annualized
paid admissions, excluding Medicare crossovers, that were paid by March 1,
1988, for the period January 1, 1987 to June 30, 1987; (ii) the hospital had
100 or fewer licensed beds on March 1, 1988; (iii) the hospital is located in
Minnesota; and (iv) the hospital is not located in a city of the first class as
defined in section 410.01. For purposes
of this paragraph, medical assistance does not include general assistance
medical care.
(c) Medical assistance inpatient payment rates shall increase 20
percent for inpatient hospital originally paid admissions, excluding Medicare
crossovers, that occur on or after October 1, 1992, if: (i) the hospital had
100 or fewer Minnesota medical assistance annualized paid admissions, excluding
Medicare crossovers, that were paid by March 1, 1988, for the period January 1,
1987 to June 30, 1987; (ii) the hospital had 100 or fewer licensed beds on
March 1, 1988; (iii) the hospital is located in Minnesota; and (iv) the
hospital is not located in a city of the first class as defined in section
410.01. For a hospital that qualifies
for an adjustment under this paragraph and under subdivision 9 or 23, the
hospital must be paid the adjustment under subdivisions 9 and 23, as
applicable, plus any amount by which the adjustment under this paragraph
exceeds the adjustment under those subdivisions. For this paragraph, medical assistance does not include general
assistance medical care.
(d) Medical assistance inpatient payment rates shall increase 15
percent for inpatient hospital originally paid admissions, excluding Medicare
crossovers, that occur after September 30, 1992, if: (i) the hospital had more
than 100 but fewer than 250 Minnesota medical assistance annualized paid
admissions, excluding Medicare crossovers, that were paid by March 1, 1988, for
the period January 1, 1987 to June 30, 1987; (ii) the hospital had 100 or fewer
licensed beds on March 1, 1988; (iii) the hospital is located in Minnesota; and
(iv) the hospital is not located in a city of the first class as defined in
section 410.01. For a hospital that
qualifies for an adjustment under this paragraph and under subdivision 9 or 23,
the hospital must be paid the adjustment under subdivisions 9 and 23, as
applicable, plus any amount by which the adjustment under this paragraph
exceeds the adjustment under those subdivisions. For purposes of this paragraph, medical assistance does not
include general assistance medical care.
(e) For admissions occurring on or after July 1, 2008, fee-for-service
inpatient payments must increase eight percent for a hospital with a medical
assistance inpatient utilization rate of 17.95 percent of total patient days as
of the base year in effect on July 1, 2005, and nine percent for a hospital
with a medical assistance inpatient utilization rate of 59.60 percent of total
patient days as of the base year in effect on July 1, 2005. Payments made to managed care plans must not
be increased to reflect this increase.
For purposes of this paragraph, medical assistance does not include
general assistance medical care.
Sec. 3. Minnesota Statutes
2006, section 256B.0571, subdivision 8, is amended to read:
Subd. 8. Program established. (a)
The commissioner, in cooperation with the commissioner of commerce, shall
establish the Minnesota partnership for long-term care program to provide for
the financing of long-term care through a combination of private insurance and
medical assistance.
(b) An individual who meets the requirements in this paragraph is
eligible to participate in the partnership program. The individual must:
(1) be a Minnesota resident at the time coverage first became effective
under the partnership policy; and
(2) be a beneficiary of a partnership policy that (i) is issued on or
after the effective date of the state plan amendment implementing the
partnership program in Minnesota, or (ii) qualifies as a partnership policy
under the provisions of subdivision 8a; and.
(3) have exhausted all of the benefits under the partnership policy as
described in this section. Benefits
received under a long-term care insurance policy before July 1, 2006, do not
count toward the exhaustion of benefits required in this subdivision.
Sec. 4. Minnesota Statutes
2006, section 256B.0571, subdivision 9, is amended to read:
Subd. 9. Medical assistance eligibility.
(a) Upon application for medical assistance program payment of long-term
care services by an individual who meets the requirements described in
subdivision 8, the commissioner shall determine the individual's eligibility
for medical assistance according to paragraphs (b) to (i).
(b) After determining assets subject to the asset limit under section
256B.056, subdivision 3 or 3c, or 256B.057, subdivision 9 or 10, the
commissioner shall allow the individual to designate assets to be protected
from recovery under subdivisions 13 and 15 up to the dollar amount of the
benefits utilized under the partnership policy as of the effective date of
eligibility for medical assistance program payment of long-term care
services. Benefits utilized under a
long-term care insurance policy before July 1, 2006, do not count for the
purpose of determining the amount of assets that can be designated. Designated assets shall be disregarded for
purposes of determining eligibility for payment of long-term care
services. The dollar amount of
benefits utilized must be equal to the amount of claims paid by the issuer
under the policy as verified by the issuer.
(c) The individual shall identify the designated assets and the full
fair market value of those assets and designate them as assets to be protected
at the time of initial application for medical assistance payment of
long-term care services. The full
fair market value of real property or interests in real property shall be based
on the most recent full assessed value for property tax purposes for the real
property, unless the individual provides a complete professional appraisal by a
licensed appraiser to establish the full fair market value. The extent of a life estate in real property
shall be determined using the life estate table in the health care program's
manual. Ownership of any asset in joint
tenancy shall be treated as ownership as tenants in common for purposes of its
designation as a disregarded asset. The
unprotected value of any protected asset is subject to estate recovery
according to subdivisions 13 and 15.
(d) The right to designate assets to be protected is personal to the
individual and ends when the individual dies, except as otherwise provided in
subdivisions 13 and 15. It does not
include the increase in the value of the protected asset and the income,
dividends, or profits from the asset.
It may be exercised by the individual or by anyone with the legal
authority to do so on the individual's behalf.
It shall not be sold, assigned, transferred, or given away.
(e) If the dollar amount of the benefits utilized under a
partnership policy is greater than the full fair market value of all assets
protected at the time of the application for medical assistance long-term care
services, As the individual continues to utilize benefits under a
partnership policy after eligibility for medical assistance payment of
long-term care services begins, the individual may designate, for
additional protection, an increase in the value of protected assets and
additional assets that become available during the individual's lifetime for
protection under this section up to the amount of additional benefits
utilized. The individual must make
the designation in writing to the county agency no later than the last date on which
the individual must report a change in circumstances to the county agency, as
provided for under the medical assistance program. Any excess used for this purpose shall not be available to the
individual's estate to protect assets in the estate from recovery under section
256B.15 or 524.3-1202, or otherwise. The amount used for this purpose
must reduce the unused amount of asset protection available to protect assets
in the individual's estate from recovery under section 256B.15 or 524.3-1202,
or otherwise.
(f) This section applies only to estate recovery under United States
Code, title 42, section 1396p, subsections (a) and (b), and does not apply to
recovery authorized by other provisions of federal law, including, but not
limited to, recovery from trusts under United States Code, title 42, section
1396p, subsection (d)(4)(A) and (C), or to recovery from annuities, or similar
legal instruments, subject to section 6012, subsections (a) and (b), of the
Deficit Reduction Act of 2005, Public Law 109-171.
(g) An individual's protected assets owned by the individual's spouse
who applies for payment of medical assistance long-term care services shall not
be protected assets or disregarded for purposes of eligibility of the
individual's spouse solely because they were protected assets of the
individual.
(h) Assets designated under this subdivision shall not be subject to
penalty under section 256B.0595.
(i) The commissioner shall otherwise determine the individual's
eligibility for payment of long-term care services according to medical
assistance eligibility requirements.
Sec. 5. Minnesota Statutes 2007
Supplement, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1. Co-payments. (a) Except as provided in subdivision 2, the medical assistance
benefit plan shall include the following co-payments for all recipients,
effective for services provided on or after October 1, 2003, and before January
1, 2009:
(1) $3 per nonpreventive visit.
For purposes of this subdivision, a visit means an episode of service
which is required because of a recipient's symptoms, diagnosis, or established
illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice
nurse, audiologist, optician, or optometrist;
(2) $3 for eyeglasses;
(3) $6 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 $12 per month maximum for prescription drug
co-payments. No co-payments shall apply
to antipsychotic drugs when used for the treatment of mental illness.
(b) Except as provided in subdivision 2, the medical assistance benefit
plan shall include the following co-payments for all recipients, effective for
services provided on or after January 1, 2009:
(1) $6 for nonemergency visits to a hospital-based emergency room; and
(2) $3 per brand-name drug prescription and $1 per generic drug
prescription, subject to a $7 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
(3) for individuals identified by the commissioner with income at or
below 100 percent of the federal poverty guidelines, total monthly co-payments
must not exceed five percent of family income.
For purposes of this paragraph, family income is the total earned and
unearned income of the individual and the individual's spouse, if the spouse is
enrolled in medical assistance and also subject to the five percent limit on
co-payments.
(c) Recipients of medical assistance are responsible for all co-payments
in this subdivision.
Sec. 6. Minnesota Statutes 2007
Supplement, section 256B.0631, subdivision 3, is amended to read:
Subd. 3. Collection. (a) The medical
assistance reimbursement to the provider shall be reduced by the amount of the
co-payment, except that reimbursement for prescription drugs
reimbursements shall not be reduced:
(1)
once a recipient has reached the $12 per month maximum or the $7 per month
maximum effective January 1, 2009, for prescription drug co-payments; or
(2) for a recipient identified by the commissioner under 100 percent of
the federal poverty guidelines who has met their monthly five percent
co-payment limit.
(b) The provider collects the co-payment from the recipient. Providers may not deny services to recipients
who are unable to pay the co-payment.
(c) Medical assistance reimbursement to fee-for-service providers and
payments to managed care plans shall not be increased as a result of the
removal of the co-payments effective January 1, 2009.
Sec. 7. [256B.194] FEDERAL PAYMENTS.
Subdivision 1. Payments at actual cost.
Notwithstanding any other statute or rule to the contrary, for
providers that are units of government, the commissioner may limit medical
assistance and MinnesotaCare payments to a provider's actual cost of providing
services, according to the Centers for Medicare and Medicaid Services (CMS)
final rule referenced in this subdivision.
The commissioner may also require medical assistance and MinnesotaCare
providers to provide any information necessary to determine Medicaid-related
costs, and require the cooperation of providers in any audit or review
necessary to ensure payments are limited to cost. This section does not apply to providers who are exempt from the
provisions of the CMS final rule. This subdivision becomes effective when the
CMS final rule, published May 29, 2007, at Federal Register, Vol. 72, No. 100,
governing payments to providers that are units of government goes into effect
at the end of the moratorium imposed by Congress.
Subd. 2. Loss of federal financial participation. For all transfers, certified
expenditures, and medical assistance payments listed in this subdivision, if
the commissioner determines that federal financial participation is no longer
available for the medical assistance payments listed, then related obligations
for the nonfederal share of payments and the medical assistance payments must
terminate. The commissioner shall
notify all affected parties of the loss of federal financial participation, and
the resulting payments and obligations that are terminated. If the commissioner determines that federal
financial participation is no longer
available for any medical assistance payments or contributions to the nonfederal share of medical
assistance payments that have already been made, the commissioner may collect
the medical assistance payments from providers and return contributions of the
nonfederal share to its source. The
transfers, certified expenditures, and medical assistance payments subject to
this section are those specified in section 62J.692, subdivision 7, paragraphs
(b) and (c); 256B.19, subdivisions 1c and 1d; 256B.195; 256B.431, subdivision
23; and 256B.69, subdivision 5c, paragraph (a), clauses (2) to (4); Laws 2002,
chapter 220, article 17, section 2, subdivision 3; and Laws 2005, First Special
Session chapter 4, article 9, section 2, subdivision 1.
Sec. 8. Minnesota Statutes 2007
Supplement, section 256B.199, is amended to read:
256B.199 PAYMENTS REPORTED
BY GOVERNMENTAL ENTITIES.
(a) Effective July 1, 2007, the commissioner shall apply for federal
matching funds for the expenditures in paragraphs (b) and (c).
(b) The commissioner shall apply for federal matching funds for
certified public expenditures as follows:
(1) Hennepin County, and Hennepin County Medical Center,
Ramsey County, Regions Hospital, the University of Minnesota, and
Fairview-University Medical Center shall report quarterly to the
commissioner beginning June 1, 2007, payments made during the second previous
quarter that may qualify for reimbursement under federal law;
(2) based on these reports, the commissioner shall apply for federal
matching funds. These funds are
appropriated to the commissioner for the payments under section 256.969,
subdivision 27 to offset medical assistance expenditures; and
(3) by May 1 of each year, beginning May 1, 2007, the commissioner
shall inform the nonstate entities listed in this paragraph (a)
of the amount of federal disproportionate share hospital payment money expected
to be available in the current federal fiscal year.
(c) The commissioner shall apply for federal matching funds for general
assistance medical care expenditures as follows:
(1) for hospital services occurring on or after July 1, 2007, general
assistance medical care expenditures for fee-for-service inpatient and
outpatient hospital payments made by the department shall be used to apply for
federal matching funds, except as limited below:
(i) only those general assistance medical care expenditures made to an
individual hospital that would not cause the hospital to exceed its individual
hospital limits under section 1923 of the Social Security Act may be
considered; and
(ii) general assistance medical care expenditures may be considered
only to the extent of Minnesota's aggregate allotment under section 1923 of the
Social Security Act; and
(2) all hospitals must provide any necessary expenditure, cost, and
revenue information required by the commissioner as necessary for purposes of
obtaining federal Medicaid matching funds for general assistance medical care
expenditures.
EFFECTIVE DATE. This section is effective retroactively from July 1, 2007.
Sec. 9. Minnesota Statutes
2006, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a. Managed care contracts. (a)
Managed care contracts under this section and sections 256L.12 and 256D.03,
shall be entered into or renewed on a calendar year basis beginning January 1,
1996. Managed care contracts which were
in effect on June 30, 1995, and set to renew on July 1, 1995, shall be renewed
for the period July 1, 1995 through December 31, 1995 at the same terms that
were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements specific to
services to medical assistance recipients age 65 and older.
(b) A prepaid health plan providing covered health services for
eligible persons pursuant to chapters 256B, 256D, and 256L, is responsible for
complying with the terms of its contract with the commissioner. Requirements applicable to managed care
programs under chapters 256B, 256D, and 256L, established after the effective
date of a contract with the commissioner take effect when the contract is next
issued or renewed.
(c) Effective for services rendered on or after January 1, 2003, the
commissioner shall withhold five percent of managed care plan payments under
this section for the prepaid medical assistance and general assistance medical
care programs pending completion of performance targets. Each performance target must be quantifiable,
objective, measurable, and reasonably attainable, except in the case of a
performance target based on a federal or state law or rule. Criteria for assessment of each performance
target must be outlined in writing prior to the contract effective date. The withheld funds must be returned no
sooner than July of the following year if performance targets in the contract
are achieved. The commissioner may
exclude special demonstration projects under subdivision 23. A managed care plan or a county-based
purchasing plan under section 256B.692 may include as admitted assets under
section 62D.044 any amount withheld under this paragraph that is reasonably
expected to be returned.
(d)(1) Effective for services rendered on or after January 1, 2009, the
commissioner shall withhold two percent of managed care plan payments under
this section for the prepaid medical assistance and general assistance medical
care programs. The withheld funds must
be returned no sooner than July 1 and no later than July 31 of the following
year. The commissioner may exclude
special demonstration projects under subdivision 23.
(2) A managed care plan or a county-based purchasing plan under section
256B.692 may include as admitted assets under section 62D.044 any amount withheld
under this paragraph. The return of the
withhold under this paragraph is not subject to the requirements of paragraph
(c).
Sec. 10. Minnesota Statutes
2006, section 256L.12, subdivision 9, is amended to read:
Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective, per capita, where possible. The commissioner may allow health plans to
arrange for inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with an
independent actuary to determine appropriate rates.
(b) For services rendered on or after January 1, 2003, to December 31,
2003, the commissioner shall withhold .5 percent of managed care plan payments
under this section pending completion of performance targets. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year if
performance targets in the contract are achieved. A managed care plan may include as admitted assets under section
62D.044 any amount withheld under this paragraph that is reasonably expected to
be returned.
(c) For services rendered on or after January 1, 2004, the commissioner
shall withhold five percent of managed care plan payments under this section
pending completion of performance targets.
Each performance target must be quantifiable, objective, measurable, and
reasonably attainable, except in the case of a performance target based on a federal
or state law or rule. Criteria for
assessment of each performance target must be outlined in writing prior to the
contract effective date. The withheld
funds must be returned no sooner than July 1 and no later than July 31 of the
following calendar year if performance targets in the contract are
achieved. A managed care plan or a
county-based purchasing plan under section 256B.692 may include as admitted
assets under section 62D.044 any amount withheld under this paragraph that is
reasonably expected to be returned.
(d) For services rendered on or after January 1, 2009, the commissioner
shall withhold two percent of managed care plan payments under this
section. The withheld funds must be
returned no sooner than July 1 and no later than July 31 of the following
calendar year. A managed care plan or a
county-based purchasing plan under section 256B.692 may include as admitted
assets under section 62D.044 any amount withheld under this paragraph.
Sec. 11. FEDERAL APPROVAL FOR INCREASED DISPROPORTIONATE SHARE HOSPITAL
PAYMENTS.
By January 1, 2009, the commissioner of human services, in cooperation
with hospitals with high rates of utilization by medical assistance enrollees,
shall develop and submit for federal approval a proposal to increase disproportionate
share hospital payments to Minnesota hospitals. In developing the proposal, the commissioner shall consider, but
is not required to adopt, disproportionate share hospital payment proposals
from other states that have received federal approval.
Sec. 12. REPEALER.
Minnesota Statutes 2007 Supplement, section 256.969, subdivision 27, is
repealed retroactively from July 1, 2007.
ARTICLE 5
HEALTH AND HUMAN SERVICES APPROPRIATIONS
Section 1. HEALTH AND HUMAN SERVICES APPROPRIATION.
The
sums shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, subtracted from the appropriations in Laws 2007, chapter
147, or other law to the agencies and for the purposes specified in this
article. The appropriations are from
the general fund, or another named fund, and are available for the fiscal years
indicated for each purpose. The figures
"2008" and "2009" used in this article mean that the
addition or subtraction from appropriations listed under them are available for
the fiscal year ending June 30, 2008, or June 30, 2009, respectively. "The
first year" is fiscal year 2008. "The second year" is fiscal
year 2009. "The biennium" is fiscal years 2008 and 2009. Supplemental appropriations and reductions
for the fiscal year ending June 30, 2008, are effective the day following final
enactment.
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
Sec. 2. HUMAN SERVICES
Subdivision 1. Total Appropriation $(34,855,000) $(56,265,000)
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
Appropriations by Fund
2008 2009
General (51,980,000) (80,296,000)
Health Care Access 0 (3,292,000)
Federal TANF 17,125,000 27,323,000
Subd. 2. Agency Management
Financial Operations 0 (5,867,000)
The amounts that may be
spent from the appropriation for each purpose are as follows:
Base
Adjustment. The general fund base is increased $23,000 in fiscal year 2010
and $26,000 in fiscal year 2011.
Subd. 3. Revenue and Pass-Through Revenue
Expenditures
Federal TANF 25,000,000 27,039,000
Additional
TANF Transfer to Social Services Block Grant. In addition to transfers
allowed under prior law, $5,754,000 in fiscal year 2009 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 social services block grant to meet
this appropriation. The funds must be
distributed to counties for the children and community services grant according
to the formula for state appropriations in Minnesota Statutes, chapter 256M.
Subd. 4. Children and Economic Assistance Grants
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) MFIP/DWP Grants
Appropriations by Fund
General (17,125,000) (25,947,000)
Federal TANF 17,125,000 27,311,000
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
(b) MFIP Child Care Assistance Grants 0 0
(c) Children's Services Grants (311,000) (1,663,000)
Base
Adjustment. The general fund base is increased $1,726,000 in fiscal year 2010 and
$1,742,000 in fiscal year 2011 due to the onetime increase in adoption
assistance grants and the onetime decreases in relative custody assistance
grants, and county shift for children's mental health grants.
Funding
Usage. Up to 75 percent of the fiscal year 2010 appropriation for children's
mental health screening grants may be used to fund calendar year 2009
allocations for these programs, with the resulting calendar year funding
pattern continuing into the future.
Subd. 4a. Children and Economic Assistance
Management
General 0 12,000
Children and Economic Assistance Operations
Appropriations by Fund
General 0 12,000
MAXIS
costs. $12,000 is appropriated in fiscal year
2009 for MAXIS systems costs. This
appropriation is onetime only.
Subd. 5. Basic Health Care Grants
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) MinnesotaCare Grants
Health Care Access 0 (3,292,000)
Incentive
Program and Outreach Grants. Of the appropriation for the Minnesota health care outreach program in
Laws 2007, chapter 147, article 19, section 3, subdivision 7, paragraph (b):
(1) $400,000 in fiscal year
2009 from the general fund and $200,000 in fiscal year 2009 from the health
care access fund are for the incentive program under Minnesota Statutes,
section 256.962, subdivision 5. For the
biennium beginning July 1, 2009, base
level funding for this activity shall be $360,000 from the general fund and $160,000 from the health
care access fund; and
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
(2) $100,000 in fiscal year 2009 from the general fund and $50,000
in fiscal year 2009 from the health care access fund are for the outreach
grants under Minnesota Statutes, section 256.962, subdivision 2. For the biennium beginning July 1, 2009,
base level funding for this activity shall be $90,000 from the general fund and
$40,000 from the health care access
fund.
(b) MA Basic Health Care Grants - Families and Children (17,985,000) (24,848,000)
Hospital
Payment Delay. Notwithstanding Laws 2005, First Special Session chapter 4, article 9,
section 2, subdivision 6, payments from the Medicaid Management Information System
that would otherwise have been made for inpatient hospital services for medical
assistance enrollees are delayed as follows: (1) for fiscal year 2008, the last
payments for the month of June must be included in the first payments in fiscal
year 2009; and (2) for fiscal year 2009, the last payments in the month of June
must be included in the first payment of fiscal year 2010. The provisions of Minnesota Statutes,
section 16A.124, shall not apply to these delayed payments.
(c) MA Basic Health Care Grants - Elderly and Disabled (14,028,000) (2,254,000)
Minnesota
Disability Health Options Rate Setting Methodology. The commissioner shall
develop and implement a methodology for risk adjusting payments for community
alternatives for disabled individuals (CADI) and traumatic brain injury (TBI)
home and community-based waiver services delivered under the Minnesota
disability health options program (MnDHO) effective January 1, 2009. The commissioner shall take into account the
weighting system used to determine county waiver allocations in developing the
new payment methodology. Growth in the
number of enrollees receiving CADI or TBI waiver payments through MnDHO is
limited to an increase of 200 enrollees in each calendar year from January 2009
through December 2011. If those limits
are reached, additional members may be enrolled in MnDHO for basic care
services only as defined under Minnesota Statutes, section 256B.69, subdivision
28, and the commissioner may establish a waiting list for future access of MnDHO
members to those waiver services.
Critical
Access Dental Reimbursement. Effective
for fiscal years beginning on or after July 1, 2009, funding for medical
assistance critical access dental reimbursement rates must be paid from the
health care access fund.
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
(d) General Assistance Medical Care Grants 0 (3,729,000)
MinnesotaCare
Outreach Grants Special Revenue Account. The balance in the MinnesotaCare outreach grants
special revenue account at the close of fiscal year 2008 must be transferred to
the general fund.
Subd. 6. Health Care Management
The amounts that may be
spent from the appropriation for each purpose are as follows:
Health Care Administration 0 100,000
Subd. 7. Continuing Care Grants
The amounts that may be
spent from the appropriation for each purpose are as follows:
(a) MA Long-Term Care Facilities Grants (2,306,000) (2,291,000)
(b) MA Long-Term Care Waivers and Home Care Grants 0 (5,397,000)
Manage
Growth in TBI and CADI Waiver. During the fiscal years beginning on July 1, 2008,
July 1, 2009, and July 1, 2010, the commissioner shall allocate money for home
and community-based programs covered under Minnesota Statutes, section 256B.49,
to ensure a reduction in state spending that is equivalent to limiting the
caseload growth of the traumatic brain injury (TBI) waiver to 200 allocations
in each year of the biennium and the community alternatives for disabled
individuals (CADI) waiver to 1,500 allocations each year of the biennium. Priorities for the allocation of funds must
be for individuals anticipated to be discharged from institutional settings or
who are at imminent risk of a placement in an institutional setting. Notwithstanding any contrary section in this
article, this provision expires June 30, 2011.
(c) Mental Health Grants 0 (4,555,000)
Base
Adjustment. The general fund base is increased $5,270,000 in fiscal year 2010 and
$5,450,000 in fiscal year 2011 due to the county payment shift for adult mental
health grants.
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
Targeted
Case Management Work Group. $15,000 is appropriated from the general fund for fiscal year 2009 to
the commissioner of human services for administrative costs directly related to
the operation of the targeted case management work group.
(d) Chemical Dependency Entitlement Grants 0 (1,503,000)
Payments
for Substance Abuse Treatment. For services provided in fiscal year 2009,
county-negotiated rates and provider claims to the consolidated chemical
dependency fund must not exceed rates charged for services in excess of those
in effect on May 31, 2008. If statutes
authorize a cost-of-living adjustment during fiscal year 2009, then notwithstanding
any law to the contrary, fiscal year 2009 rates may not exceed those in effect
on May 31, 2008, plus any authorized cost-of-living adjustments.
Chemical
Dependency Treatment Fund Special Revenue Account. The lesser of the balance of
the consolidated chemical dependency treatment fund at the close of fiscal year
2008 or $2,650,000 must be transferred and deposited into the general fund.
(e) Chemical Dependency Nonentitlement Grants 0 2,150,000
Base Level
Adjustment. The general fund base for chemical dependency nonentitlement treatment
grants shall be increased by $150,000 for fiscal years 2010 and 2011 for
increased grants for methamphetamine treatment.
American
Indian Youth Program. Of the general fund appropriation, $2,000,000 in fiscal year 2009 is
for grants to be awarded competitively to American Indian tribes to purchase or
develop one or more culturally specific treatment programs designed to serve
youth from native cultures. This
appropriation is onetime and available until spent.
(f) Other Continuing Care Grants 0 (4,381,000)
Base Level
Adjustment. The general fund base is increased $7,633,000 in fiscal year 2010 and
$5,332,000 in fiscal year 2011, due to the onetime reduction of HIV grants in
fiscal year 2009, an increase each year for housing grants under Minnesota
Statutes, section 256B.0658, and the adjustment for the county grant payment
shift for developmental disability semi-independent services grants and
developmental disability family support grants.
APPROPRIATIONS
Available for the Year
Ending June 30
2008 2009
Housing
Access Grants. Of the general fund appropriation, $250,000 is appropriated in fiscal
year 2009 for housing access grants under Minnesota Statutes, section
256B.0658.
Funding
Usage. Up to 75 percent of the fiscal year 2010 appropriation for
developmental disability semi-independent living services grants and
developmental disability family support grants may be used to fund calendar
year 2009 allocations for these programs, with the resulting calendar year
funding pattern continuing into the future.
Subd. 8. State-Operated Services
County Past
Due Receivables. The commissioner is
authorized to withhold county federal administrative reimbursement when the
county of financial responsibility for cost-of-care payments due to the state
under Minnesota Statutes, section 246.54 or 253B.045, is 180 days past due. The commissioner shall deposit the federal
administrative withholding into the general fund to settle the claims with the
county of financial responsibility.
Mental Health Services (225,000) (300,000)
Sec. 3. Health Department
Federally
Qualified Health Centers. Effective
for fiscal years beginning on or after July 1, 2009, the general fund
appropriation of $1,500,000 each fiscal year for federally qualified health
centers under Minnesota Statutes, section 145.9269, is eliminated and is
replaced by a $1,500,000 appropriation each fiscal year from the health care
access fund.
MERC
Federal Compliance. Effective for fiscal years beginning on or after July 1, 2009,
the general fund appropriation of $2,000,000 each fiscal year to the Mayo
Clinic for the purpose of providing transition funding while federal compliance
changes are made to the medical education and research cost funding
distribution formula is eliminated and is replaced by a $2,000,000
appropriation each fiscal year from the health care access fund.
ARTICLE 6
HEALTH AND HUMAN SERVICES
FORECAST CHANGES
Section 1. SUMMARY OF APPROPRIATIONS; DEPARTMENT OF
HUMAN SERVICES FORECAST ADJUSTMENT.
The dollar amounts shown are added to or, if shown in
parentheses, are subtracted from the appropriations in Laws 2007, chapter 147,
from the general fund, or any other fund named, to the Department of Human
Services for the purposes specified in this article, to be available for the
fiscal year indicated for each purpose.
The figure "2008" used in this article means that the
appropriation or appropriations listed are available for the fiscal year ending
June 30, 2008. The figure "2009"
used in this article means that the appropriation or appropriations listed are
available for the fiscal year ending June 30, 2009.
2008 2009
General $6,739,000 $52,350,000
Health Care Access (84,156,000) (96,019,000)
TANF (28,427,000) (7,441,000)
Total $(105,844,000) $(51,110,000)
Sec. 2. COMMISSIONER OF HUMAN SERVICES
Subdivision 1. Total Appropriation $(105,844,000) $(51,110,000)
Appropriations by Fund
2008 2009
General 6,739,000 52,350,000
Health Care Access (84,156,000) (96,019,000)
TANF (28,427,000) (7,441,000)
Subd. 2. Revenue and Pass-Through
TANF 1,187,000 1,507,000
Subd. 3. Children and Economic Assistance Grants
General (4,960,000) 5,925,000
TANF (29,614,000) (8,948,000)
The amounts that may be spent
from this appropriation for each purpose are as follows:
(a) MFIP/DWP Grants
Appropriations by Fund
General 25,139,000 11,665,000
TANF (29,614,000) (8,948,000)
(b) MFIP Child Care Assistance Grants (26,141,000) (10,710,000)
(c) General Assistance Grants 2,529,000 6,033,000
(d) Minnesota Supplemental Aid Grants 299,000 500,000
(e) Group Residential Housing Grants (6,786,000) (1,563,000)
Subd. 4. Basic Health Care Grants
General 30,075,000 48,389,000
Health Care Access (84,156,000) (96,019,000)
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) MinnesotaCare
Health Care Access (84,156,000) (96,019,000)
(b) MA Basic Health Care - Families and Children 13,525,000 7,005,000
(c) MA Basic Health Care - Elderly and Disabled (2,292,000) 5,479,000
(d) General Assistance Medical Care 18,842,000 35,905,000
Subd. 5. Continuing Care Grants (18,376,000) (1,964,000)
The amounts that may be
spent from this appropriation for each purpose are as follows:
(a) MA Long-Term Care Facilities (10,986,000) (2,148,000)
(b) MA Long-Term Care Waivers (18,484,000) (13,598,000)
(c) Chemical Dependency Entitlement Grants 11,094,000 13,782,000
ARTICLE 7
APPROPRIATIONS AND TRANSFERS
Section 1. DUPLICATE
APPROPRIATIONS.
Unless another act
explicitly provides otherwise, appropriations and transfers made in this act
and other acts must be implemented only once, even if the provision or a
similar provision with the same fiscal effect in the same fiscal year is
included in another act. This section
applies to laws enacted in the 2008 regular session."
Delete the title and insert:
"A bill for an act
relating to state government; making changes to health and human services
programs; amending continuing care, agency management, children and family
services, and health care; awarding housing access grants; requiring studies
and reports; making supplemental appropriations; reducing certain
appropriations; making forecast adjustments; clarifying appropriations and
transfers; amending Minnesota Statutes 2006, sections 13.461, by adding a
subdivision; 256.01, by adding a subdivision; 256.741, subdivisions 2, 2a, 3;
256.969, subdivisions 2b, 20; 256B.0571, subdivisions 8, 9; 256B.0621,
subdivisions 2, 6, 10; 256B.0924, subdivisions 4, 6; 256B.19, subdivision 1d;
256B.431, subdivision 23; 256B.69, subdivisions 5a, 6, by adding subdivisions;
256B.692, subdivision 2, by adding a subdivision; 256D.44, subdivisions 2, 5;
256L.12, subdivision 9; 518A.50; 518A.53, subdivision 5; Minnesota Statutes
2007 Supplement, sections 256.741, subdivision 1; 256B.0625, subdivision 20;
256B.0631, subdivisions 1, 3; 256B.199; 256B.434, subdivision 19; 256J.621;
Laws 2007, chapter 147, article 2, section 21; article 19, section 3,
subdivision 1; proposing coding for new law in Minnesota Statutes, chapter
256B; repealing Minnesota Statutes 2006, sections 256.741, subdivision 15;
256J.24, subdivision 6; Minnesota Statutes 2007 Supplement, section 256.969,
subdivision 27."
With the recommendation that
when so amended the bill pass and be re-referred to the Committee on Ways and
Means.
The report was adopted.
Carlson
from the Committee on Finance to which was referred:
H. F.
No. 4070, A bill for an act relating to capital improvements; appropriating
money for public facilities; authorizing the sale and issuance of state bonds.
Reported
the same back with the following amendments:
Page
2, after line 33, insert:
"Sec.
3. DUPLICATE
APPROPRIATIONS.
Unless
another act explicitly provides otherwise, appropriations and transfers made in
this act and other acts must be implemented only once even if the provision or
a similar provision with the same fiscal effect in the same fiscal year is
included in another act. This section
applies to laws enacted in the 2008 regular session."
Page
3, line 2, delete "and 2" and insert "to 3"
Renumber
the sections in sequence
With
the recommendation that when so amended the bill pass and be re-referred to the
Committee on Ways and Means.
The report was adopted.
Carlson
from the Committee on Finance to which was referred:
H. F.
No. 4072, A bill for an act relating to capital improvements; appropriating
money for asset preservation at the University of Minnesota and Minnesota State
Colleges and Universities; authorizing the sale and issuance of state
bonds.
Reported
the same back with the following amendments:
Page
1, after line 18, insert:
"Sec.
3. DUPLICATE
APPROPRIATIONS.
Unless
another act explicitly provides otherwise, appropriations and transfers made in
this act and other acts must be implemented only once even if the provision or
a similar provision with the same fiscal effect in the same fiscal year is
included in another act. This section
applies to laws enacted in the 2008 regular session."
Page
1, line 20, delete "and 2" and insert "to 3"
Renumber
the sections in sequence
With
the recommendation that when so amended the bill pass and be re-referred to the
Committee on Ways and Means.
The report was adopted.
Carlson
from the Committee on Finance to which was referred:
S. F.
No. 2564, A bill for an act relating to human services; modifying TANF
maintenance of effort programs; amending Laws 2007, chapter 147, article 19,
section 3, subdivision 1.
Reported
the same back with the recommendation that the bill pass and be re-referred to
the Committee on Ways and Means.
The report was adopted.
SECOND READING OF HOUSE BILLS
H. F. Nos. 1812, 3360 and 3569 were read for the second time.
INTRODUCTION AND FIRST READING OF HOUSE BILLS
The following House Files were introduced:
Dill introduced:
H. F. No. 4158, A bill for an act relating to taxation;
authorizing St. Louis County to impose a mortgage and deed tax; creating an
environmental response fund; proposing coding for new law in Minnesota
Statutes, chapter 383C.
The bill was read for the first time and referred to the
Committee on Taxes.
McFarlane introduced:
H. F. No. 4159, A bill for an act relating to taxation;
property; providing that the Vadnais Lake Area Management Organization is a
special taxing district; amending Minnesota Statutes 2006, section 275.066, as
amended.
The bill was read for the first time and referred to the
Committee on Taxes.
Koenen and Demmer introduced:
H. F. No. 4160, A bill for an act relating to property
taxation; modifying the definition of property classified as agricultural;
defining the classification of rural vacant land; modifying the criteria for
property to be enrolled in the Minnesota agricultural property tax law;
amending Minnesota Statutes 2006, sections 273.11, by adding a subdivision;
273.111, subdivisions 3, as amended, 4, 8, 9, 11, 11a, by adding a subdivision;
273.13, subdivision 23, as amended; repealing Minnesota Statutes 2006, section
273.111, subdivision 6.
The bill was read for the first time and referred to the
Committee on Taxes.
Drazkowski introduced:
H. F. No. 4161, A bill for an act relating to state government;
designating English as the official language; proposing coding for new law in
Minnesota Statutes, chapter 1.
The bill was read for the first time and referred to the
Committee on Governmental Operations, Reform, Technology and Elections.
Lenczewski introduced:
H. F. No. 4162, A bill for an act relating to taxation;
modifying penalties; extending the time to file certain partnership returns;
extending the time for filing certain refund claims; amending Minnesota
Statutes 2006, sections 270C.56, subdivisions 1, as amended, 2, 3, by adding
subdivisions; 289A.19, subdivision 1; 289A.40, subdivision 1.
The bill was read for the first time and referred to the
Committee on Taxes.
Thissen introduced:
H. F. No. 4163, A bill for an act relating to health;
establishing a health care professionals task force; repealing Minnesota
Statutes 2006, sections 147.0001; 147.001; 147.01; 147.011; 147.02,
subdivisions 1a, 2a, 5, 6, 6a; 147.025; 147.03; 147.031; 147.032, subdivisions
1, 2, 3; 147.035; 147.037, subdivisions 1a, 2; 147.038; 147.0381; 147.039;
147.0391; 147.04; 147.081; 147.09; 147.091, subdivisions 1a, 1b, 2, 2a, 3, 4,
5, 7, 8; 147.092; 147.111; 147.121; 147.131; 147.141; 147.151; 147.155; 147.161;
147.162; 147.21; 147.22; 147.231; 147.37; 147A.001; 147A.01; 147A.02; 147A.03;
147A.04; 147A.05; 147A.06; 147A.07; 147A.08; 147A.09; 147A.10; 147A.11;
147A.13, subdivisions 2, 3, 4, 5, 7; 147A.14; 147A.15; 147A.155; 147A.16;
147A.17; 147A.18; 147A.19; 147A.20; 147A.21; 147A.22; 147A.23; 147A.24;
147A.26; 147A.27, subdivisions 1, 3; 147B.01; 147B.02; 147B.03; 147B.04;
147B.05, subdivisions 1, 3; 147B.06; 147B.07; 147B.08; 147C.01; 147C.05;
147C.10; 147C.15; 147C.20; 147C.25; 147C.30; 147C.35, subdivisions 1, 3;
147C.40; 147D.01; 147D.03; 147D.05, subdivisions 1, 2, 3, 4; 147D.07; 147D.09;
147D.11; 147D.13; 147D.15; 147D.17; 147D.19; 147D.21; 147D.23; 147D.25,
subdivisions 1, 3; 147D.27; 148.01; 148.02; 148.03; 148.031; 148.04; 148.05;
148.06; 148.07; 148.08; 148.09; 148.10, subdivisions 2, 3, 4, 5, 6; 148.102;
148.103; 148.104; 148.105; 148.106; 148.108; 148.171; 148.181; 148.191;
148.211; 148.212; 148.231; 148.232; 148.233; 148.234; 148.235, subdivisions 1,
2, 2a, 4, 4a, 4b, 6, 7, 8, 9, 10; 148.241; 148.251; 148.261, subdivision 4;
148.262; 148.263; 148.264; 148.265; 148.266; 148.267; 148.271; 148.281;
148.283; 148.284; 148.285; 148.511; 148.512; 148.513; 148.514; 148.515,
subdivisions 1, 4, 6; 148.516; 148.5161; 148.517; 148.5175; 148.518; 148.519;
148.5191; 148.5192; 148.5193; 148.5194; 148.5195; 148.5196; 148.5197; 148.5198;
148.52; 148.53; 148.54; 148.56; 148.57; 148.571; 148.572; 148.573; 148.574;
148.575; 148.576; 148.577; 148.59; 148.60; 148.603; 148.61; 148.62; 148.621;
148.622; 148.623; 148.624; 148.625; 148.626; 148.627; 148.628; 148.629;
148.630; 148.631; 148.632; 148.633; 148.6401; 148.6402; 148.6403; 148.6404;
148.6405; 148.6408; 148.6410; 148.6412; 148.6415; 148.6418; 148.6420; 148.6423;
148.6425; 148.6428; 148.6430; 148.6432; 148.6435; 148.6438; 148.6440; 148.6443;
148.6445, subdivisions 3, 4, 5, 6, 7, 8, 10, 11; 148.6448; 148.6450; 148.65,
subdivisions 1, 4, 5, 6, 7; 148.66; 148.67, subdivision 2; 148.691,
subdivisions 1, 2; 148.736, subdivisions 2, 3; 148.737; 148.76, subdivision 2;
148.77; 148.7801; 148.7802; 148.7803; 148.7804; 148.7805; 148.7806; 148.7807;
148.7808; 148.7809; 148.7810; 148.7811; 148.7812; 148.7813; 148.7814; 148.7815;
148.88; 148.881; 148.89; 148.90; 148.905; 148.906; 148.907; 148.908; 148.909;
148.9105; 148.911; 148.915; 148.916; 148.925; 148.941, subdivisions 1, 3, 4, 5,
6, 7, 8; 148.952; 148.96; 148.975; 148.98; Minnesota Statutes 2007 Supplement,
sections 147.02, subdivisions 1, 1b; 147.032, subdivision 4; 147.037,
subdivision 1; 147.091, subdivisions 1, 6; 147A.13, subdivisions 1, 6; 147A.27,
subdivision 2; 147B.05, subdivision 2; 147C.35, subdivision 2; 147D.05,
subdivision 5; 147D.25, subdivision 2; 148.10, subdivision 1; 148.235,
subdivisions 11, 12; 148.261, subdivisions 1, 5; 148.515, subdivisions 2, 2a;
148.6445, subdivisions 1, 2; 148.65, subdivisions 2, 3, 8; 148.67, subdivision
1; 148.70; 148.705; 148.706; 148.71; 148.715; 148.721; 148.722; 148.723;
148.724; 148.725; 148.73; 148.735; 148.736, subdivision 1; 148.74; 148.75;
148.754; 148.755; 148.76, subdivision 1; 148.78; 148.941, subdivision 2;
148.965; 148.995; 148.996; 148.997.
The bill was read for the first time and referred to the
Committee on Health and Human Services.
Eken introduced:
H. F. No. 4164, A bill for an act relating to natural
resources; providing for wildlife disease management; providing civil
penalties; amending Minnesota Statutes 2006, section 97A.045, subdivision 11.
The bill was read for the first time and referred to the
Committee on Environment and Natural Resources.
MESSAGES FROM THE SENATE
The following message was received from the Senate:
Madam Speaker:
I hereby announce the passage by the Senate of the following
Senate File, herewith transmitted:
S. F. No. 3099.
Colleen J. Pacheco, Second Assistant Secretary of the Senate
FIRST READING OF SENATE BILLS
S. F. No. 3099, A bill for an act relating to health care;
establishing a statewide health improvement program; monitoring child obesity;
establishing a health improvement fund; establishing a public health
improvement assessment; establishing health care homes; increasing continuity
of care; modifying outreach efforts; establishing primary care education
initiatives; increasing affordability and continuity of care with public health
care programs; creating a health insurance exchange; establishing Section 125
Plans; providing for registration of health insurance access brokers; providing
for fund transfers; providing for health care payment restructuring system;
creating a Health Care Transformation Commission; restructuring the health care
payment system; creating a savings reinvestment fund; establishing a savings
recapture assessment; establishing cost containment goals; specifying an
affordability standard; providing subsidies for employer-subsidized coverage;
requiring providers to list prices; establishing an electronic prescription
drug program; providing for fees; requiring mandated reports; authorizing
rulemaking; appropriating money; amending Minnesota Statutes 2006, sections
13.3806, by adding a subdivision; 62A.65, subdivision 3; 62E.141; 62L.12,
subdivision 4; 62Q.735, subdivision 1; 144.1501, subdivision 2, by adding a
subdivision; 256.01, by adding a subdivision; 256B.69, by adding a subdivision;
256L.05, by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision
3; 256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement,
sections 62J.496, by adding a subdivision; 62J.81, subdivision 1; 62J.82,
subdivision 1; 256.962, subdivisions 5, 6; 256B.056, subdivision 10; 256L.03,
subdivisions 3, 5; 256L.04, subdivisions 1, 7; 256L.05, subdivision 3a;
256L.07, subdivision 1; 256L.15, subdivisions 1, 2; Laws 2007, chapter 147,
article 5, section 19; proposing coding for new law in Minnesota Statutes,
chapters 16A; 62J; 145; 256B; proposing coding for new law as Minnesota
Statutes, chapter 62U; repealing Minnesota Statutes 2006, sections 62A.63;
62A.64; 62Q.49; 62Q.65; 62Q.736; 256L.15, subdivision 3.
The bill was read for the first time and referred to the
Committee on Ways and Means.
The following Conference Committee Report was received:
CONFERENCE
COMMITTEE REPORT ON H. F. NO. 380
A bill for an act relating to capital improvements; authorizing
spending to acquire and better public land and buildings and other improvements
of a capital nature with certain conditions; establishing new programs and
modifying existing programs; authorizing the sale of state bonds; canceling and
modifying previous appropriations; appropriating money; amending Minnesota
Statutes 2006, sections 16B.32, by adding a subdivision; 16B.325; 16B.335,
subdivision 2; 103D.335, subdivision 17; 116.155, subdivisions 2, 3; 116J.423,
by adding a subdivision; 119A.45; 462A.21, by adding a subdivision; Minnesota
Statutes 2007 Supplement, sections 16A.695, subdivision 3; 103G.222,
subdivision 1; Laws 1997, chapter 21, section 1; Laws 2003, First Special
Session chapter 20, article 1, section 12, subdivision 3; Laws 2005, chapter
20, article 1, sections 7, subdivision 21; 17; 23, subdivisions 8, 11, as
amended, 16; Laws 2006, chapter 258, sections 7, subdivisions 7, 11, 22; 16,
subdivision 5; 21, subdivisions 6, 14, 15; 23, subdivision 3; Laws 2006,
chapter 282, article 11, section 2, subdivision 6; proposing coding for new law
in Minnesota Statutes, chapters 116; 137; 462A.
March
31, 2008
The Honorable Margaret
Anderson Kelliher
Speaker of the House of
Representatives
The Honorable James P.
Metzen
President of the Senate
We, the undersigned conferees for H. F. No. 380 report that we
have agreed upon the items in dispute and recommend as follows:
That
the Senate recede from its amendments and that H. F. No. 380 be further amended
as follows:
Delete
everything after the enacting clause and insert:
"Section
1. CAPITAL
IMPROVEMENT APPROPRIATIONS.
The sums shown in the column under "Appropriations" are
appropriated from the bond proceeds fund, or another named fund, to the state
agencies or officials indicated, to be spent for public purposes. Appropriations of bond proceeds must be
spent as authorized by the Minnesota Constitution, article XI, section 5,
paragraph (a), to acquire and better public land and buildings and other public
improvements of a capital nature, or as authorized by the Minnesota
Constitution, article XI, section 5, paragraphs (b) to (j), or article XIV. Unless otherwise specified, the
appropriations in this act are available until the project is completed or
abandoned subject to Minnesota Statutes, section 16A.642.
SUMMARY
University of Minnesota $131,166,000
Minnesota State Colleges and
Universities 280,935,000
Education 19,740,000
Minnesota State Academies 2,800,000
Perpich Center for Arts
Education 355,000
Natural Resources 104,805,000
Pollution Control Agency 30,000,000
Board of Water and Soil
Resources 30,475,000
Agriculture 20,000
Zoological Garden 2,500,000
Administration 15,725,000
Minnesota Amateur Sports
Commission 7,725,000
Military Affairs 6,000,000
Public Safety 13,135,000
Transportation 65,700,000
Metropolitan Council 139,200,000
Human Services 9,505,000
Veterans Affairs 11,282,000
Corrections 32,000,000
Employment and Economic
Development 143,125,000
Public Facilities Authority 49,800,000
Housing Finance Agency 1,000,000
Minnesota Historical Society 9,594,000
Bond Sale Expenses 998,000
Cancellations (27,100,000)
Lewis and Clark 5,282,000
TOTAL $1,085,767,000
Bond Proceeds Fund (General
Fund Debt Service) 934,098,000
Bond Proceeds Fund (User
Financed Debt Service) 72,512,000
Maximum Effort School Loan
Fund 16,000,000
State Transportation Fund 2,000,000
Remediation Fund 25,000,000
General Fund 15,057,000
Trunk Highway Fund 48,200,000
Bond Proceeds Cancellations (27,100,000)
APPROPRIATIONS
Sec. 2. UNIVERSITY OF MINNESOTA
Subdivision 1. Total Appropriation $131,166,000
To the Board of Regents of
the University of Minnesota for the purposes specified in this section.
Subd. 2. Higher Education Asset Preservation and
Replacement (HEAPR) 35,000,000
To be spent in accordance
with Minnesota Statutes, section 135A.046.
Subd. 3. Twin Cities Campus
(a) Scienc