.................... moves to amend H. F. No. 297 as follows:
Delete everything after the enacting clause and insert:
Section 1. [62A.67] UNIFORM CLAIMS PROCESSING.
1.6 (a) The commissioner may seek recommendations on standards to establish a
1.7uniform claim form and uniform billing and claim codes from a council of representatives
1.8from the health care industry. Based upon the recommendations of such a council, the
1.9commissioner may issue rules pursuant to section 14.389 requiring the use by all health
1.10plans, health carriers, licensed insurers or third-party administrators, collectively "payers,"
1.11and health care providers, collectively "providers," of a uniform claim form, uniform
1.12billing, or uniform claim codes.
1.13 (b) To the extent that the commissioner does not issue rules establishing a uniform
1.14claim form, uniform billing, and uniform claim codes, beginning January 15, 2008,
1.15the commissioner shall adopt rules pursuant to section 14.389 requiring all payers and
1.16providers to use a uniform claim form and uniform billing and claim codes. Before
1.17adopting such rules, the commissioner shall seek recommendations from a council of
1.18representatives from the health care industry. The commissioner may base the rules
1.19required by this paragraph, in whole or in part, on standards identical to those required by
1.20the Medicare program, or on such alternative standard as the commissioner finds will be
1.21most effective in fulfilling the mandate for uniformity articulated in this section.
1.22 (c) Beginning January 15, 2009, all payers shall offer, and all providers shall
1.23use, compatible systems of electronic billing approved by the commissioner through
1.24rulemaking under section 14.389. The systems approved by the commissioner may
1.25include monitoring and disseminating information concerning eligibility and coverage of
1.26individuals. The systems must be capable of accepting all permissible data elements on a
1.27claim form in order to ensure the most accurate payment and claim determination.
2.1 No payer or provider shall add to or modify these requirements and no payer shall
2.2impose any fee for use of this system.
2.3 (d) For purposes of this section, "health carrier" and "health plan" have the meanings
2.4given in section 62A.011, and "third-party administrator" and "licensed insurer" have the
2.5meanings given in section 62H.10.
2.6EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 2. Minnesota Statutes 2006, section 62E.02, subdivision 7, is amended to read:
Subd. 7. Dependent.
"Dependent" means a spouse or unmarried child
2.9 age of 19 years, a dependent child
under the age of 25 regardless of
2.10whether the dependent child is enrolled in an educational institution
, or a dependent
child of any age who is disabled.
2.12EFFECTIVE DATE.This section is effective January 1, 2008.
Sec. 3. Minnesota Statutes 2006, section 62J.495, is amended to read:
2.1462J.495 HEALTH INFORMATION TECHNOLOGY AND
Establishment; members; duties Implementation. By January
2.171, 2012, all hospitals and health care providers must have in place an interoperable
2.18electronic health records system within their hospital system or clinical practice setting.
2.19The commissioner of health, in consultation with the Health Information Technology and
2.20Infrastructure Advisory Committee, shall develop a statewide plan to meet this goal,
2.21including uniform standards to be used for the interoperable system for sharing and
2.22synchronizing patient data across systems. The standards must be compatible with federal
2.23efforts. The uniform standards must be developed by January 1, 2009, with a status report
2.24on the development of these standards submitted to the legislature by January 15, 2008.
2.25 Subd. 2. Health Information Technology and Infrastructure Advisory
(a) The commissioner shall establish a Health Information Technology
and Infrastructure Advisory Committee governed by section
to advise the
commissioner on the following matters:
(1) assessment of the use of health information technology by the state, licensed
health care providers and facilities, and local public health agencies;
(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for administrative data exchange, clinical support programs, patient privacy requirements,
and maintenance of the security and confidentiality of individual patient data; and
(3) other related issues as requested by the commissioner.
(b) The members of the Health Information Technology and Infrastructure Advisory
Committee shall include the commissioners, or commissioners' designees, of health,
human services, administration, and commerce and additional members to be appointed
by the commissioner to include persons representing Minnesota's local public health
agencies, licensed hospitals and other licensed facilities and providers, private purchasers,
the medical and nursing professions, health insurers and health plans, the state quality
improvement organization, academic and research institutions, consumer advisory
organizations with an interest and expertise in health information technology, and other
stakeholders as identified by the Health Information Technology and Infrastructure
Subd. 2. Annual report. (c)
The commissioner shall prepare and issue an annual
report not later than January 30 of each year outlining progress to date in implementing a
statewide health information infrastructure and recommending future projects.
Subd. 3. Expiration. (d)
expires June 30,
Sec. 4. [62J.496] ELECTRONIC HEALTH RECORD SYSTEM REVOLVING
3.18ACCOUNT AND LOAN PROGRAM.
3.19 Subdivision 1. Account establishment. The commissioner of finance shall
3.20establish and implement a revolving account in the state government special revenue
3.21fund to provide loans to physicians or physician group practices to assist in financing the
3.22installation or support of an interoperable health record system. The system must provide
3.23for the interoperable exchange of health care information between the applicant and, at a
3.24minimum, a hospital system, pharmacy, and a health care clinic or other physician group.
3.25 Subd. 2. Eligibility. To be eligible for a loan under this section, the applicant
3.26must submit a loan application to the commissioner of health on forms prescribed by the
3.27commissioner. The application must include, at a minimum:
3.28 (1) the amount of the loan requested and a description of the purpose or project
3.29for which the loan proceeds will be used;
3.30 (2) a signed contract with a vendor;
3.31 (3) a description of the health care entities and other groups participating in the
3.33 (4) evidence of financial stability and a demonstrated ability to repay the loan; and
4.1 (5) a description of how the system to be financed interconnects or plans in the
4.2future to interconnect with other health care entities and provider groups located in the
4.3same geographical area.
4.4 Subd. 3. Loans. (a) The commissioner of health may make a no interest loan
4.5to a provider or provider group who is eligible under subdivision 2 on a first-come,
4.6first-served basis provided that the applicant is able to comply with this section. The total
4.7accumulative loan principal must not exceed $....... per loan. The commissioner of health
4.8has discretion over the size and number of loans made.
4.9 (b) The commissioner of health may prescribe forms and establish an application
4.10process and, notwithstanding section 16A.1283, may impose a reasonable nonrefundable
4.11application fee to cover the cost of administering the loan program.
4.12 (c) The borrower must begin repaying the principal no later than two years from the
4.13date of the loan. Loans must be amortized no later than 15 years from the date of the loan.
4.14 (d) Repayments must be credited to the account.
Sec. 5. Minnesota Statutes 2006, section 62J.82, is amended to read:
CHARGE INFORMATION REPORTING DISCLOSURE.
4.17 Subdivision 1. Required information.
The Minnesota Hospital Association shall
develop a Web-based system, available to the public free of charge, for reporting
4.19 information the following
, for Minnesota residents
4.20 (1) hospital-specific performance on the measures of care developed under section
4.21256B.072 for acute myocardial infarction, heart failure, and pneumonia;
4.22 (2) by January 1, 2009, hospital-specific performance on the public reporting
4.23measures for hospital-acquired infections as published by the National Quality Forum
4.24and collected by the Minnesota Hospital Association and Stratis Health in collaboration
4.25with infection control practitioners; and
4.26 (3) charge information,
including, but not limited to, number of discharges, average
length of stay, average charge, average charge per day, and median charge, for each of the
50 most common inpatient diagnosis-related groups and the 25 most common outpatient
surgical procedures as specified by the Minnesota Hospital Association.
4.30 Subd. 2. Web site.
The Web site must provide information that compares
hospital-specific data to hospital statewide data. The Web site must be
4.32 October 1, 2006, and must be
updated annually. The commissioner shall provide a link to
4.33this reporting information on the department's Web site.
4.34 Subd. 3. Enforcement. The commissioner shall provide a link to this information
4.35on the department's Web site.
If a hospital does not provide this information to the
Minnesota Hospital Association, the commissioner of health
may require the hospital to
do so in accordance with section 144.55, subdivision 6
The commissioner shall provide a
5.3 link to this information on the department's Web site.
Sec. 6. [62J.84] HEALTH CARE TRANSFORMATION TASK FORCE.
5.5 Subdivision 1. Task force. The Health Care Transformation Task Force consists of:
5.6 (1) the Legislative Commission on Health Care Access established under section
5.8 (2) the commissioners of human services, health, and commerce;
5.9 (3) four persons designated by the SmartBuy alliance to represent private sector
5.10purchasers, including one representing public employers, one representing large
5.11employers, one representing small employers, and one representing labor unions; and
5.12 (4) six persons designated by the partnership for action to transform health care,
5.13a multisector policy alliance of hospitals and health systems, health plan companies,
5.14physicians, and other health care organizations.
5.15 Subd. 2. Public input. The commissioner of health shall review available research
5.16and conduct statewide, regional, and local surveys, focus groups, and other activities to
5.17determine Minnesotans' values, preferences, opinions, and perceptions related to health
5.18care and to the issues confronting the task force, and shall report the findings to the task
5.20 Subd. 3. Inventory and assessment of existing activities. The task force shall
5.21complete an inventory and assessment of all public and private organized activities,
5.22coalitions, and collaboratives working on tasks relating to health system improvement
5.23including, but not limited to, patient safety, quality measurement and reporting,
5.24evidence-based practice, adoption of health information technology, disease management
5.25and chronic care coordination, medical homes, access to health care, cultural competence,
5.26prevention and public health, consumer incentives, price and cost transparency, nonprofit
5.27organization community benefits, education, research, and health care workforce. By
5.28December 15, 2007, the task force shall present recommendations to the legislature, the
5.29governor, and to those working on these activities on how these activities may be made
5.30more effective and how coordination and communication may be improved.
5.31 Subd. 4. Action plan. By December 15, 2007, the task force shall develop and
5.32present, to the legislature and the governor, a statewide action plan for transforming the
5.33health care system to improve affordability, quality, and access. The plan may consist of
5.34legislative actions, administrative actions of governmental entities, collaborative actions,
5.35and actions of individuals and individual organizations. The plan must include specific
6.1and measurable goals and deadlines for affordability, quality, and access. The plan must
6.2include a method of coordination and communication among the activities identified
6.3under subdivision 3.
6.4 Subd. 5. Local school wellness. The task force shall evaluate local school wellness
6.5policies in order to understand the differences between policies, highlight innovation,
6.6and encourage improvement, and shall evaluate continuing education requirements for
6.7nutrition for school lunch program staff. The task force shall present recommendations
6.8to the legislature and the governor by February 1, 2008.
6.9 Subd. 6. Health communities initiative. The task force shall evaluate the use of
6.10grants and financial incentive programs to encourage communities to implement urban
6.11and community planning designs and templates that foster healthy lifestyles. By February
6.121, 2008, the task force shall submit a report to the governor and the legislature containing
6.13recommendations on the administration, funding, and requirements for the programs.
Sec. 7. Minnesota Statutes 2006, section 62L.02, subdivision 11, is amended to read:
Subd. 11. Dependent.
"Dependent" means an eligible employee's spouse,
unmarried child who is
under the age of 19 years, unmarried child
under the age of 25
who is a full-time student as defined in section
62A.301 regardless of whether
6.18the dependent child is enrolled in an educational institution
, dependent child of any age
who is disabled and who meets the eligibility criteria in section
62A.14, subdivision 2
or any other person whom state or federal law requires to be treated as a dependent for
purposes of health plans. For the purpose of this definition, a child includes a child for
whom the employee or the employee's spouse has been appointed legal guardian and an
adoptive child as provided in section
6.24EFFECTIVE DATE.This section is effective January 1, 2008.
Sec. 8. Minnesota Statutes 2006, section 62Q.165, subdivision 1, is amended to read:
Subdivision 1. Definition.
It is the commitment of the state to achieve universal
health coverage for all Minnesotans by the year 2010
. Universal coverage is achieved
(1) every Minnesotan has access to a full range of quality health care services;
(2) every Minnesotan is able to obtain affordable health coverage which pays for the
full range of services, including preventive and primary care; and
(3) every Minnesotan pays into the health care system according to that person's
Sec. 9. Minnesota Statutes 2006, section 62Q.165, subdivision 2, is amended to read:
Subd. 2. Goal.
It is the goal of the state to make continuous progress toward
reducing the number of Minnesotans who do not have health coverage so that by January
fewer than four percent of the state's population will be without health
7.4 coverage all Minnesota residents have access to affordable health care
The goal will be
7.5 achieved by In achieving this goal, a number of options shall be considered, including
improving access to private health coverage through insurance reforms and market
making health coverage more affordable for low-income Minnesotans through
purchasing pools and state subsidies, and
reducing the cost of health coverage through
cost containment programs and methods of ensuring that all Minnesotans are paying
into the system according to their ability.
7.11EFFECTIVE DATE.This section is effective July 1, 2007.
Sec. 10. [145.9269] FEDERALLY QUALIFIED HEALTH CENTERS.
7.13 Subdivision 1. Definitions. For purposes of this section, "federally qualified health
7.14center" means an entity that is receiving a grant under United States Code, title 42,
7.15section 254b, or, based on the recommendation of the Health Resources and Services
7.16Administration within the Public Health Service, is determined by the secretary to meet
7.17the requirements for receiving such a grant.
7.18 Subd. 2. Allocation of subsidies. The commissioner of health shall distribute
7.19subsidies to federally qualified health centers operating in Minnesota to continue, expand,
7.20and improve federally qualified health center services to low-income populations. The
7.21commissioner shall distribute the funds appropriated under this section to federally
7.22qualified health centers operating in Minnesota as of January 1, 2007. The amount of
7.23each subsidy shall be in proportion to each federally qualified health center's amount of
7.24discounts granted to patients during calendar year 2006 as reported on the federal Uniform
7.25Data System report in conformance with the Bureau of Primary Health Care Program
7.26Expectations Policy Information Notice 98-23, except that each eligible federally qualified
7.27health center shall receive at least two percent but no more than 30 percent of the total
7.28amount of money available under this section.
Sec. 11. [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
7.30 Subdivision 1. Establishment; administration. The commissioner shall establish
7.31and administer the prescription drug discount program.
7.32 Subd. 2. Commissioner's authority. The commissioner shall administer a drug
7.33rebate program for drugs purchased according to the prescription drug discount program.
7.34The commissioner shall execute a rebate agreement from all manufacturers that choose to
7.35participate in the program for those drugs covered under the medical assistance program.
8.1For each drug, the amount of the rebate shall be equal to the rebate as defined for purposes
8.2of the federal rebate program in United States Code, title 42, section 1396r-8. The
8.3rebate program shall utilize the terms and conditions used for the federal rebate program
8.4established according to section 1927 of title XIX of the federal Social Security Act.
8.5 Subd. 3. Definitions. For purposes of this section, the following terms have the
8.6meanings given them.
8.7 (a) "Commissioner" means the commissioner of human services.
8.8 (b) "Covered prescription drug" means a prescription drug as defined in section
8.9151.44, paragraph (d), that is covered under medical assistance as described in section
8.10256B.0625, subdivision 13, and that is provided by a participating manufacturer that has a
8.11fully executed rebate agreement with the commissioner under this section and complies
8.12with that agreement.
8.13 (c) "Enrolled individual" means a person who is eligible for the program under
8.14subdivision 4 and has enrolled in the program according to subdivision 5.
8.15 (d) "Health carrier" means an insurance company licensed under chapter 60A to
8.16offer, sell, or issue an individual or group policy of accident and sickness insurance as
8.17defined in section 62A.01; a nonprofit health service plan corporation operating under
8.18chapter 62C; a health maintenance organization operating under chapter 62D; a joint
8.19self-insurance employee health plan operating under chapter 62H; a community integrated
8.20service network licensed under chapter 62N; a fraternal benefit society operating under
8.21chapter 64B; a city, county, school district, or other political subdivision providing
8.22self-insured health coverage under section 471.617 or sections 471.98 to 471.982; and a
8.23self-funded health plan under the Employee Retirement Income Security Act of 1974, as
8.25 (e) "Participating manufacturer" means a manufacturer as defined in section 151.44,
8.26paragraph (c), that agrees to participate in the prescription drug discount program.
8.27 (f) "Participating pharmacy" means a pharmacy as defined in section 151.01,
8.28subdivision 2, that agrees to participate in the prescription drug discount program.
8.29 Subd. 4. Eligibility. (a) To be eligible for the program, an applicant must:
8.30 (1) be a permanent resident of Minnesota as defined in section 256L.09, subdivision
8.32 (2) not be enrolled in medical assistance, general assistance medical care, or
8.34 (3) not be enrolled in and have currently available prescription drug coverage under
8.35a health plan offered by a health carrier or employer or under a pharmacy benefit program
8.36offered by a pharmaceutical manufacturer; and
9.1 (4) not be enrolled in and have currently available prescription drug coverage
9.2under a Medicare supplement policy, as defined in sections 62A.31 to 62A.44, or
9.3policies, contracts, or certificates that supplement Medicare issued by health maintenance
9.4organizations or those policies, contracts, or certificates governed by section 1833 or 1876
9.5of the federal Social Security Act, United States Code, title 42, section 1395, et seq., as
9.7 (b) Notwithstanding paragraph (a), clause (3), an individual who is enrolled in a
9.8Medicare Part D prescription drug plan or Medicare Advantage plan is eligible for the
9.9program but only for drugs that are not covered under the Medicare Part D plan or for
9.10drugs that are covered under the plan, but according to the conditions of the plan, the
9.11individual is responsible for 100 percent of the cost of the prescription drug.
9.12 Subd. 5. Application procedure. (a) Applications and information on the program
9.13must be made available at county social services agencies, health care provider offices, and
9.14agencies and organizations serving senior citizens. Individuals shall submit applications
9.15and any information specified by the commissioner as being necessary to verify eligibility
9.16directly to the commissioner. The commissioner shall determine an applicant's eligibility
9.17for the program within 30 days from the date the application is received. Upon notice of
9.18approval, the applicant must submit to the commissioner the enrollment fee specified in
9.19subdivision 10. Eligibility begins the month after the enrollment fee is received by the
9.21 (b) An enrollee's eligibility must be renewed every 12 months with the 12-month
9.22period beginning in the month after the application is approved.
9.23 (c) The commissioner shall develop an application form that does not exceed one
9.24page in length and requires information necessary to determine eligibility for the program.
9.25 Subd. 6. Participating pharmacy. (a) Upon implementation of the prescription
9.26drug discount program, and until January 1, 2009, a participating pharmacy, with a
9.27valid prescription, must sell a covered prescription drug to an enrolled individual at the
9.28medical assistance rate.
9.29 (b) After January 1, 2009, a participating pharmacy, with a valid prescription, must
9.30sell a covered prescription drug to an enrolled individual at the medical assistance rate,
9.31minus an amount that is equal to the rebate amount described in subdivision 8, plus
9.32the amount of any switch fee established by the commissioner under subdivision 10,
9.34 (c) Each participating pharmacy shall provide the commissioner with all information
9.35necessary to administer the program, including, but not limited to, information on
9.36prescription drug sales to enrolled individuals and usual and customary retail prices.
10.1 Subd. 7. Notification of rebate amount. The commissioner shall notify each
10.2participating manufacturer, each calendar quarter or according to a schedule established
10.3by the commissioner, of the amount of the rebate owed on the prescription drugs sold by
10.4participating pharmacies to enrolled individuals.
10.5 Subd. 8. Provision of rebate. To the extent that a participating manufacturer's
10.6prescription drugs are prescribed to a resident of this state, the manufacturer must provide
10.7a rebate equal to the rebate provided under the medical assistance program for any
10.8prescription drug distributed by the manufacturer that is purchased at a participating
10.9pharmacy by an enrolled individual. The participating manufacturer must provide full
10.10payment within 38 days of receipt of the state invoice for the rebate, or according to
10.11a schedule to be established by the commissioner. The commissioner shall deposit all
10.12rebates received into the Minnesota prescription drug dedicated fund established under
10.13subdivision 11. The manufacturer must provide the commissioner with any information
10.14necessary to verify the rebate determined per drug.
10.15 Subd. 9. Payment to pharmacies. Beginning January 1, 2009, the commissioner
10.16shall distribute on a biweekly basis an amount that is equal to an amount collected under
10.17subdivision 8 to each participating pharmacy based on the prescription drugs sold by that
10.18pharmacy to enrolled individuals on or after January 1, 2009.
10.19 Subd. 10. Enrollment fee; switch fee. (a) The commissioner shall establish an
10.20annual enrollment fee that covers the commissioner's expenses for enrollment, processing
10.21claims, and distributing rebates under this program.
10.22 (b) The commissioner shall establish a reasonable switch fee that covers expenses
10.23incurred by participating pharmacies in formatting for electronic submission claims for
10.24prescription drugs sold to enrolled individuals.
10.25 Subd. 11. Dedicated fund; creation; use of fund. (a) The Minnesota prescription
10.26drug dedicated fund is established as an account in the state treasury. The commissioner
10.27of finance shall credit to the dedicated fund all rebates paid under subdivision 8, any
10.28federal funds received for the program, all enrollment fees paid by the enrollees, and
10.29any appropriations or allocations designated for the fund. The commissioner of finance
10.30shall ensure that fund money is invested under section 11A.25. All money earned by the
10.31fund must be credited to the fund. The fund shall earn a proportionate share of the total
10.32state annual investment income.
10.33 (b) Money in the fund is appropriated to the commissioner to reimburse participating
10.34pharmacies for prescription drugs provided to enrolled individuals under subdivision 6,
10.35paragraph (b); to reimburse the commissioner for costs related to enrollment, processing
11.1claims, distributing rebates, and for other reasonable administrative costs related to
11.2administration of the prescription drug discount program; and to repay the appropriation
11.3provided by law for this section. The commissioner must administer the program so that
11.4the costs total no more than funds appropriated plus the drug rebate proceeds.
11.5EFFECTIVE DATE.This section is effective July 1, 2007.
Sec. 12. [256.962] MINNESOTA HEALTH CARE PROGRAMS OUTREACH.
11.7 Subdivision 1. Public awareness and education. (a) The commissioner shall
11.8design and implement a statewide campaign to raise public awareness on the availability
11.9of health coverage through medical assistance, general assistance medical care, and
11.10MinnesotaCare and to educate the public on the importance of obtaining and maintaining
11.11health care coverage. The campaign shall include multimedia messages directed to the
11.12general population and messages that are culturally specific and community-based,
11.13directed to high-uninsured population areas.
11.14 (b) The commissioner shall collaborate with public and private entities, including,
11.15but not limited to, hospitals, providers, health plans, legal aid offices, pharmacies,
11.16insurance agencies, and faith-based organizations to develop outreach activities and
11.17partnerships to ensure the distribution of information and applications.
11.18 (c) The commissioner shall ensure that all outreach materials are available in
11.19languages other than English.
11.20 Subd. 2. Outreach grants. The commissioner shall award grants to public and
11.21private organizations to provide information, applications, and assistance in obtaining
11.22coverage through Minnesota public health care programs. In awarding these grants, the
11.23commissioner shall give priority to community organizations with a proven ability to
11.24provide multilingual and cultural outreach efforts in areas of high-uninsured populations.
11.25 Subd. 3. Application and assistance. (a) The Minnesota health care programs
11.26application must be made available at provider offices, local human services agencies,
11.27school districts, public and private elementary schools in which 25 percent or more of
11.28the students receive free or reduced price lunches, community health offices, Women,
11.29Infants and Children (WIC) program sites, Head Start program sites, public housing
11.30councils, child care centers, early childhood education and preschool program sites, legal
11.31aid offices, and libraries. The commissioner shall ensure that applications are available in
11.32languages other than English and that individuals and families who need assistance due to
11.33language or cultural barriers receive the necessary services.
11.34 (b) Local human service agencies, hospitals, and health care community clinics
11.35receiving state funds must provide direct assistance in completing the application form,
12.1including the free use of a copy machine and a drop box for applications. Other locations
12.2where applications are required to be available shall either provide direct assistance in
12.3completing the application form or provide information on where an applicant can receive
12.5 (c) Counties must offer applications and application assistance when providing
12.6child support collection services.
12.7 (d) Local public health agencies and counties that provide immunization clinics must
12.8offer applications and application assistance during these clinics.
12.9 Subd. 4. Statewide toll-free telephone number. The commissioner shall provide
12.10funds to establish a statewide toll-free telephone number to provide information on public
12.11and private health coverage options and sources of free and low-cost health care.
12.12 Subd. 5. Incentive program. The commissioner shall establish an incentive
12.13program for organizations that directly identify and assist potential enrollees in filling
12.14out and submitting an application. For each applicant who is successfully enrolled in
12.15MinnesotaCare, medical assistance, or general assistance medical care, the commissioner
12.16shall pay the organization a $25 application assistance fee. The organization may provide
12.17an applicant a gift certificate or other incentive upon enrollment.
12.18 Subd. 6. School districts. (a) At the beginning of each school year, a school district
12.19shall provide information to each student on the availability of health care coverage
12.20through the Minnesota health care programs.
12.21 (b) For each child who is determined to be eligible for a free or reduced priced lunch,
12.22the district shall provide the child's family with an application for the Minnesota health
12.23care programs and information on how to obtain application assistance.
12.24 (c) A district shall also ensure that applications and information on application
12.25assistance are available at early childhood education sites and public schools located
12.26within the district's jurisdiction.
12.27 (d) Each district shall designate an enrollment specialist to provide application
12.28assistance and follow-up services with families who are eligible for the reduced or free
12.29lunch program or who have indicated an interest in receiving information or an application
12.30for the Minnesota health care program.
12.31 (e) Each school district shall provide on their Web site a link to information on how
12.32to obtain an application and application assistance.
12.33 Subd. 7. Renewal notice. (a) The commissioner shall mail a renewal notice to
12.34enrollees notifying the enrollee that their eligibility must be renewed. A notice shall be
12.35sent at 90 days prior to the renewal date and at 60 days prior to the renewal date.
13.1 (b) For enrollees who are receiving services through managed care plans, the
13.2managed care plan must provide a follow-up renewal call at least 60 days prior to the
13.3enrollee's renewal date.
13.4 (c) The commissioner shall include the end of coverage dates on the monthly rosters
13.5of enrollees provided to managed care organizations.
Sec. 13. [256.963] PRIMARY CARE ACCESS INITIATIVE.
13.7 Subdivision 1. Establishment. (a) The commissioner shall award a grant to
13.8implement in Hennepin and Ramsey Counties a Web-based primary care access pilot
13.9project designed as a collaboration between private and public sectors to connect, where
13.10appropriate, a patient with a primary care medical home and schedule patients into
13.11available community-based appointments as an alternative to nonemergency use of the
13.12hospital emergency room. The grantee must establish a program that diverts patients
13.13presenting at an emergency room for nonemergency care to more appropriate outpatient
13.14settings. The program must refer the patient to an appropriate health care professional
13.15based on the patient's health care needs and situation. The program must provide the
13.16patient with a scheduled appointment that is timely, with an appropriate provider who is
13.17conveniently located. If the patient is uninsured and potentially eligible for a Minnesota
13.18health care program, the program must connect the patient to a primary care provider,
13.19community clinic, or agency that can assist the patient with the application process. The
13.20program must also ensure that discharged patients are connected with a community-based
13.21primary care provider and assist in scheduling any necessary follow-up visits before
13.22the patient is discharged.
13.23 (b) The program must not require a provider to pay a fee for accepting charity care
13.24patients or patients enrolled in a Minnesota public health care program.
13.25 Subd. 2. Evaluation. (a) The grantee must report to the commissioner on a quarterly
13.26basis the following information:
13.27 (1) total number of appointments available for scheduling by specialty;
13.28 (2) average length of time between scheduling and actual appointment; and
13.29 (3) total number of patients referred and whether the patient was insured or
13.31 (b) The commissioner, in consultation with the Minnesota Hospital Association,
13.32shall conduct an evaluation of the emergency room diversion pilot project and submit the
13.33results to the legislature by January 15, 2009. The evaluation shall compare the number of
13.34nonemergency visits and repeat visits to hospital emergency rooms for the period before
13.35the commencement of the project and one year after the commencement, and an estimate
13.36of the costs saved from any documented reductions.
Sec. 14. Minnesota Statutes 2006, section 256B.056, subdivision 10, is amended to
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.057, subdivision 1
, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.
(c) The commissioner shall modify the application for Minnesota health care
14.12 programs to require more detailed information related to verification of assets and income,
14.13 and shall verify assets and income for all applicants, and for all recipients upon renewal.
14.14 (d) The commissioner shall require Minnesota health care program recipients to
14.15 report new or an increase in earned income within ten days of the change, and to verify new
14.16 or an increase in earned income that affects eligibility within ten days of notification by
14.17 the agency that the new or increased earned income affects eligibility. Recipients who fail
14.18 to verify new or an increase in earned income that affects eligibility shall be disenrolled.
Sec. 15. Minnesota Statutes 2006, section 256B.0625, subdivision 30, is amended to
Subd. 30. Other clinic services.
(a) Medical assistance covers rural health clinic
services, federally qualified health center services, nonprofit community health clinic
services, public health clinic services, and the services of a clinic meeting the criteria
established in rule by the commissioner. Rural health clinic services and federally
qualified health center services mean services defined in United States Code, title 42,
section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified
health center services shall be made according to applicable federal law and regulation.
(b) A federally qualified health center that is beginning initial operation shall submit
an estimate of budgeted costs and visits for the initial reporting period in the form and
detail required by the commissioner. A federally qualified health center that is already in
operation shall submit an initial report using actual costs and visits for the initial reporting
period. Within 90 days of the end of its reporting period, a federally qualified health
center shall submit, in the form and detail required by the commissioner, a report of
its operations, including allowable costs actually incurred for the period and the actual
number of visits for services furnished during the period, and other information required
by the commissioner. Federally qualified health centers that file Medicare cost reports
shall provide the commissioner with a copy of the most recent Medicare cost report filed
with the Medicare program intermediary for the reporting year which support the costs
claimed on their cost report to the state.
In order to continue cost-based payment under the medical assistance program
15.5 according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
15.6 must apply for designation as an essential community provider within six months of final
15.7 adoption of rules by the Department of Health according to section
. For those federally qualified health centers and rural health clinics that have applied
15.9 for essential community provider status within the six-month time prescribed, medical
15.10 assistance payments will continue to be made according to paragraphs (a) and (b) for the
15.11 first three years after application. For federally qualified health centers and rural health
15.12 clinics that either do not apply within the time specified above or who have had essential
15.13 community provider status for three years, medical assistance payments for health services
15.14 provided by these entities shall be according to the same rates and conditions applicable
15.15 to the same service provided by health care providers that are not federally qualified
15.16 health centers or rural health clinics.
15.17 (d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally
15.18 qualified health center or a rural health clinic to make application for an essential
15.19 community provider designation in order to have cost-based payments made according
15.20 to paragraphs (a) and (b) no longer apply.
Effective January 1, 2000, payments made according to paragraphs (a) and (b)
shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
Effective January 1, 2001, each federally qualified health center and
rural health clinic may elect to be paid either under the prospective payment system
established in United States Code, title 42, section 1396a(aa), or under an alternative
payment methodology consistent with the requirements of United States Code, title 42,
section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services.
The alternative payment methodology shall be 100 percent of
according to by generally accepted accounting principles and annual
principles reports, including Medicaid-eligible cost add-ons
Sec. 16. [256B.0632] MEDICAL ASSISTANCE CO-PAYMENTS.
15.32 Subdivision 1. Co-payment. The medical assistance benefit plan shall include a
15.33$6 co-payment for nonemergency visits to a hospital-based emergency room, except as
15.34provided in subdivision 2.
15.35 Subd. 2. Exceptions. A co-payment shall not be charged to:
15.36 (1) children under the age of 21;
16.1 (2) pregnant women for services that relate to the pregnancy or any other medical
16.2condition that may complicate the pregnancy;
16.3 (3) recipients expected to reside for at least 30 days in a hospital, nursing facility, or
16.4intermediate care facility for the developmentally disabled; and
16.5 (4) recipients receiving hospice care.
Sec. 17. Minnesota Statutes 2006, section 256D.03, subdivision 3, is amended to read:
Subd. 3. General assistance medical care; eligibility.
(a) General assistance
medical care may be paid for any person who is not eligible for medical assistance under
chapter 256B, including eligibility for medical assistance based on a spenddown of excess
income according to section
256B.056, subdivision 5
, or MinnesotaCare as defined in
paragraph (b), except as provided in paragraph (c), and:
(1) who is receiving assistance under section
, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections
(2) who is a resident of Minnesota; and
(i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
256B.056, subdivision 3
, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or on behalf of the beneficiary by
the trustee, assuming the full exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum;
(ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the
family size, using a six-month budget period, whose equity in assets is not in excess
of the limits in section
256B.056, subdivision 3c
, and who applies during an inpatient
(iii) the commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.
(b) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (e).
(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section
, with covered services as provided in section
for the rest of the
eligibility period, until their
(d) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (c), an individual must complete a new
(e) Applicants and recipients eligible under paragraph (a), clause (1); who have
applied for and are awaiting a determination of blindness or disability by the state medical
review team or a determination of eligibility for Supplemental Security Income or Social
Security Disability Insurance by the Social Security Administration; who fail to meet the
requirements of section
256L.09, subdivision 2
; who are homeless as defined by United
17.18States Code, title 42, section 11301, et seq.;
who are classified as end-stage renal disease
beneficiaries in the Medicare program; who are enrolled in private health care coverage as
defined in section
, subdivision 9; who are eligible under paragraph (j); or who
receive treatment funded pursuant to section
are exempt from the MinnesotaCare
enrollment requirements of this subdivision.
(f) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.
(g) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).
(h) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
county agency must assist the applicant in obtaining verification if necessary.
(i) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.
(j) General assistance medical care is not available for a person in a correctional
facility unless the person is detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order, and the person is a recipient of general
assistance medical care at the time the person is detained by law or admitted on a criminal
hold order and as long as the person continues to meet other eligibility requirements
of this subdivision.
(k) General assistance medical care is not available for applicants or recipients who
do not cooperate with the county agency to meet the requirements of medical assistance.
(l) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.
(m) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.
(n) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
an undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service.
(o) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources, is ineligible
for general assistance medical care.
(p) Effective July 1, 2003, general assistance medical care emergency services end.
Sec. 18. Minnesota Statutes 2006, section 256D.03, subdivision 4, is amended to read:
Subd. 4. General assistance medical care; services.
(a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):
(1) inpatient hospital services;
(2) outpatient hospital services;
(3) services provided by Medicare certified rehabilitation agencies;
(4) prescription drugs and other products recommended through the process
established in section
256B.0625, subdivision 13
(5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;
(6) eyeglasses and eye examinations provided by a physician or optometrist;
(7) hearing aids;
(8) prosthetic devices;
(9) laboratory and X-ray services;
(10) physician's services;
(11) medical transportation except special transportation;
(12) chiropractic services as covered under the medical assistance program;
(13) podiatric services;
(14) dental services as covered under the medical assistance program;
(15) outpatient services provided by a mental health center or clinic that is under
contract with the county board and is established under section
(16) day treatment services for mental illness provided under contract with the
(17) prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;
(18) psychological services, medical supplies and equipment, and Medicare
premiums, coinsurance and deductible payments;
(19) medical equipment not specifically listed in this paragraph when the use of
the equipment will prevent the need for costlier services that are reimbursable under
(20) services performed by a certified pediatric nurse practitioner, a certified family
nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
practitioner in independent practice, if (1) the service is otherwise covered under this
chapter as a physician service, (2) the service provided on an inpatient basis is not included
as part of the cost for inpatient services included in the operating payment rate, and (3) the
service is within the scope of practice of the nurse practitioner's license as a registered
nurse, as defined in section
(21) services of a certified public health nurse or a registered nurse practicing in
a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section
(22) telemedicine consultations, to the extent they are covered under section
20.33256B.0625, subdivision 3b
(23) mental health telemedicine and psychiatric consultation as covered under
256B.0625, subdivisions 46 and 48
(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
(b) Effective August 1, 2005, sex reassignment surgery is not covered under this
(c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections
256B.02, subdivision 8
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.
(d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003:
(1) $25 for eyeglasses;
(2) $25 for nonemergency visits to a hospital-based emergency room;
(3) $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; and
(4) 50 percent coinsurance on restorative dental services.
(e) Co-payments shall be limited to one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by
the amount of the co-payment, except that reimbursement for prescription drugs shall not
be reduced once a recipient has reached the $12 per month maximum for prescription
drug co-payments. The provider collects the co-payment from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment, except as
provided in paragraph (f).
(f) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.
(g) Any county may, from its own resources, provide medical payments for which
state payments are not made.
(h) Chemical dependency services that are reimbursed under chapter 254B must not
be reimbursed under general assistance medical care.
(i) The maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.
(j) The conditions of payment for services under this subdivision are the same as the
conditions specified in rules adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.
(k) Inpatient and outpatient payments shall be reduced by five percent, effective July
1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (i).
(l) Payments for all other health services except inpatient, outpatient, and pharmacy
services shall be reduced by five percent, effective July 1, 2003.
(m) Payments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.
(n) A hospital receiving a reduced payment as a result of this section may apply the
unpaid balance toward satisfaction of the hospital's bad debts.
(o) Fee-for-service payments for nonpreventive visits shall be reduced by $3
for services provided on or after January 1, 2006. 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, advance practice nurse,
audiologist, optician, or optometrist.
(p) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.
23.3 (q) Recipients eligible under subdivision 3, paragraph (a), shall pay a $25
23.4co-payment for nonemergency visits to a hospital-based emergency room.
23.5EFFECTIVE DATE.This section is effective July 1, 2007.
Sec. 19. Minnesota Statutes 2006, section 256L.01, subdivision 1, is amended to read:
Subdivision 1. Scope.
For purposes of
256L.18 this chapter
the following terms shall have the meanings given them.
Sec. 20. Minnesota Statutes 2006, section 256L.01, subdivision 4, is amended to read:
Subd. 4. Gross individual or gross family income.
(a) "Gross individual or gross
family income" for nonfarm self-employed means income calculated for the
period of eligibility using the net profit or loss reported on the applicant's
federal income tax form for the previous year and using the medical assistance families
with children methodology for determining allowable and nonallowable self-employment
expenses and countable income.
(b) "Gross individual or gross family income" for farm self-employed means income
calculated for the
period of eligibility using as the baseline the
adjusted gross income reported on the applicant's federal income tax form for the previous
and adding back in reported depreciation amounts that apply to the business in which
23.20 the family is currently engaged
(c) "Gross individual or gross family income" means the total income for all family
members, calculated for the
period of eligibility.
23.23EFFECTIVE DATE.This section is effective July 1, 2007.
Sec. 21. Minnesota Statutes 2006, section 256L.03, subdivision 1, is amended to read:
Subdivision 1. Covered health services.
For individuals under section
, with income no greater than 75 percent of the federal poverty guidelines
23.27 or for families with children under section
256L.04, subdivision 1 , all subdivisions of
23.28 this section apply.
"Covered health services" means the health services reimbursed
under chapter 256B, with the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care services other than services
covered under section
256B.0625, subdivision 9
, orthodontic services, nonemergency
medical transportation services, personal care assistant and case management services,
nursing home or intermediate care facilities services, inpatient mental health services,
and chemical dependency services. Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments, psychological testing,
explanation of findings, mental health telemedicine, psychiatric consultation, medication
management by a physician, day treatment, partial hospitalization, and individual, family,
and group psychotherapy.
No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.
Covered health services shall be expanded as provided in this section.
Sec. 22. Minnesota Statutes 2006, 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
Prior to July 1, 1997, the inpatient hospital benefit for adult
24.16 enrollees is subject to an annual benefit limit of $10,000.
The inpatient hospital benefit for
adult enrollees who qualify under section
256L.04, subdivision 7
, or who qualify under
256L.04, subdivisions 1 and 2
, with family gross income that exceeds
percent of the federal poverty guidelines and who are not pregnant, is subject to an annual
(b) Admissions for inpatient hospital services paid for under section
, 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
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.
Sec. 23. Minnesota Statutes 2006, 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
in households with family income equal to or less than 175
25.11 percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
25.12 parents and relative caretakers of children under the age of 21 in households with family
25.13 income greater than 175 percent of the federal poverty guidelines for inpatient hospital
25.14 admissions occurring on or after January 1, 2001
(c) Paragraph (a), clauses (1) to (4), do not apply to pregnant women and children
under the age of 21.
(d) Adult enrollees with family gross income that exceeds
percent of the
federal poverty guidelines and who are not pregnant shall be financially responsible for
the coinsurance amount, if applicable, and amounts which exceed the
inpatient hospital benefit limit.
(e) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the
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.
Sec. 24. Minnesota Statutes 2006, section 256L.04, subdivision 1a, is amended to read:
Subd. 1a. Social Security number required.
(a) Individuals and families applying
for MinnesotaCare coverage must provide a Social Security number. This requirement
25.29does not apply to an undocumented noncitizen or nonimmigrant who is eligible for
(b) The commissioner shall not deny eligibility to an otherwise eligible applicant
who has applied for a Social Security number and is awaiting issuance of that Social
(c) Newborns enrolled under section
256L.05, subdivision 3
, are exempt from the
requirements of this subdivision.
(d) Individuals who refuse to provide a Social Security number because of
well-established religious objections are exempt from the requirements of this subdivision.
The term "well-established religious objections" has the meaning given in Code of Federal
Regulations, title 42, section
Sec. 25. Minnesota Statutes 2006, 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
percent of the federal poverty guidelines.
Sec. 26. Minnesota Statutes 2006, section 256L.04, subdivision 10, is amended to read:
Subd. 10. Citizenship requirements. (a)
Eligibility for MinnesotaCare is limited
to citizens or nationals of the United States, qualified noncitizens, and other persons
residing lawfully in the United States as described in section
256B.06, subdivision 4
paragraphs (a) to (e) and (j). Undocumented noncitizens and nonimmigrants are ineligible
for MinnesotaCare. This paragraph does not apply to children.
For purposes of this subdivision, a nonimmigrant is an individual in one or
more of the classes listed in United States Code, title 8, section 1101(a)(15), and an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service.
Families with children who are citizens or nationals of the United States must
cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171. State and county workers must assist applicants in obtaining satisfactory
26.23documentary evidence of citizenship or nationality.
Sec. 27. Minnesota Statutes 2006, section 256L.05, subdivision 1, is amended to read:
Subdivision 1. Application and information availability.
26.26 information application assistance
must be made available
provider offices, local
human services agencies, school districts, public and private elementary schools in which
25 percent or more of the students receive free or reduced price lunches, community health
Women, Infants and Children (WIC) program sites, Head Start program sites,
26.30public housing councils, crisis nurseries, child care centers, early childhood education and
26.31preschool program sites, legal aid offices, libraries, and other sites willing to cooperate
26.32in program outreach
. These sites may accept applications and forward the forms to
the commissioner or local county human services agencies that choose to participate
26.34as an enrollment site
. Otherwise, applicants may apply directly to the commissioner
26.35or to participating local county human services agencies
Beginning January 1, 2000,
27.1 MinnesotaCare enrollment sites will be expanded to include local county human services
27.2 agencies which choose to participate.
Sec. 28. Minnesota Statutes 2006, section 256L.05, subdivision 1b, is amended to read:
Subd. 1b. MinnesotaCare enrollment by county agencies.
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
256D.03, subdivision 3
. County agencies shall perform all duties necessary
to administer the MinnesotaCare program ongoing for these enrollees, including the
redetermination of MinnesotaCare eligibility at
Sec. 29. Minnesota Statutes 2006, section 256L.05, subdivision 2, is amended to read:
Subd. 2. Commissioner's duties.
The commissioner or county agency shall
use electronic verification as the primary method of income verification. If there is a
discrepancy between reported income and electronically verified income, an individual
may be required to submit additional verification. In addition, the commissioner shall
perform random audits to verify reported income and eligibility. The commissioner
may execute data sharing arrangements with the Department of Revenue and any other
governmental agency in order to perform income verification related to eligibility and
premium payment under the MinnesotaCare program.
(b) In determining eligibility for MinnesotaCare, the commissioner shall require
27.20 applicants and enrollees seeking renewal of eligibility to verify both earned and unearned
27.21 income. The commissioner shall also require applicants and enrollees to submit the names
27.22 of their employers and a contact name with a telephone number for each employer for
27.23 purposes of verifying whether the applicant or enrollee, and any dependents, are eligible
27.24 for employer-subsidized coverage. Data collected is nonpublic data as defined in section
27.25 13.02, subdivision 9 .
Sec. 30. Minnesota Statutes 2006, section 256L.05, subdivision 3a, is amended to read:
Subd. 3a. Renewal of eligibility.
January 1, 1999 July 1, 2007
enrollee's eligibility must be renewed every 12 months. The 12-month period begins in
the month after the month the application is approved.
Beginning October 1, 2004, an enrollee's eligibility must be renewed every
27.31 six months. The first six-month period of eligibility begins the month the application is
27.32 received by the commissioner. The effective date of coverage within the first six-month
27.33 period of eligibility is as provided in subdivision 3.
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 premium for the new period
of eligibility must be received as provided in section
in order for eligibility to
(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section
, the first
period of eligibility begins the month the enrollee
submitted the application or renewal for general assistance medical care.
Sec. 31. Minnesota Statutes 2006, section 256L.05, subdivision 3c, is amended to read:
Subd. 3c. Retroactive coverage.
Notwithstanding subdivision 3, the effective
date of coverage shall be the
of the month
following termination from medical
assistance or general assistance medical care for families and individuals who are eligible
for MinnesotaCare and who submitted a written request for retroactive MinnesotaCare
coverage with a completed application within 30 days of the mailing of notification of
termination from medical assistance or general assistance medical care. The applicant
must provide all required verifications within 30 days of the written request for
verification. For retroactive coverage, premiums must be paid in full for any retroactive
month, current month, and next month within 30 days of the premium billing.
Sec. 32. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
28.20 Subd. 3d. Presumptive eligibility. Coverage under the program is available during
28.21a presumptive eligibility period for children whose family income does not exceed the
28.22applicable income standard. The presumptive eligibility period begins on the date on
28.23which a health care provider enrolled in the program, or other entity designated by the
28.24commissioner, determines, based on preliminary information, that the child's family
28.25income does not exceed the applicable income standard. The presumptive eligibility period
28.26ends the earlier of the day on which a determination is made of eligibility under this section
28.27or the last day of the month following the month presumptive eligibility was determined.
Sec. 33. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
28.30 Subd. 3e. Continuous eligibility. Children who are eligible under this section
28.31shall be continuously eligible until the earlier of the next renewal period, or the time that
28.32a child exceeds age 21.
Sec. 34. Minnesota Statutes 2006, section 256L.07, subdivision 1, is amended to read:
Subdivision 1. General requirements.
Children enrolled in the original
28.35 children's health plan as of September 30, 1992, children who enrolled in the
29.1 MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
29.2 article 4, section 17, and children who have family gross incomes that are equal to or
29.3 less than 150 percent of the federal poverty guidelines are eligible without meeting
29.4 the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
29.5 long as they maintain continuous coverage in the MinnesotaCare program or medical
29.6 assistance. Children who apply for MinnesotaCare on or after the implementation date
29.7 of the employer-subsidized health coverage program as described in Laws 1998, chapter
29.8 407, article 5, section 45, who have family gross incomes that are equal to or less than 150
29.9 percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
29.10 be eligible for MinnesotaCare.
Families enrolled in MinnesotaCare under section
256L.04, subdivision 1
whose income increases above 275 percent of the federal poverty guidelines, are no
longer eligible for the program and shall be disenrolled by the commissioner, subject to
29.14the continuous eligibility requirement for children under section 256L.05, subdivision
. Individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7
income increases above
percent of the federal poverty guidelines are no longer
eligible for the program and shall be disenrolled by the commissioner. For persons
disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of
the calendar month following the month in which the commissioner determines that the
income of a family or individual exceeds program income limits.
, children may remain enrolled in
MinnesotaCare if ten percent of their gross individual or gross family income as defined
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).
Notwithstanding paragraphs (b) and (c), parents are not eligible for
MinnesotaCare if gross household income exceeds $25,000 for the six-month period
Sec. 35. Minnesota Statutes 2006, section 256L.07, subdivision 2, is amended to read:
Subd. 2. Must not have access to employer-subsidized coverage.
(a) To be
a family or individual an adult
must not have access to subsidized health coverage
through an employer and must not have had access to employer-subsidized coverage
through a current employer for 18 months prior to application or reapplication.
30.1 or individual An adult
whose employer-subsidized coverage is lost due to an employer
terminating health care coverage as an employee benefit during the previous 18 months
is not eligible.
(b) This subdivision does not apply to
a family or individual an adult
enrolled in MinnesotaCare within six months or less of reapplication and who no longer
has employer-subsidized coverage due to the employer terminating health care coverage
as an employee benefit.
(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
30.12 the noncustodial parent.
The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.
30.16 (d) Notwithstanding paragraph (c), if an employer-subsidized health plan requires
30.17the employee to pay more than eight percent of the employee's family gross income in
30.18co-payments, deductibles, or coinsurance, the health coverage offered shall not constitute
30.19employer-subsidized coverage for purposes of determining eligibility for MinnesotaCare.
30.20 (e) This subdivision does not apply to children.
Sec. 36. Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:
Subd. 3. Other health coverage.
Families and individuals Adults
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
30.25 plan and children in families with income equal to or less than 150 percent of the federal
30.26 poverty guidelines, who have other health insurance, are eligible if the coverage:
30.27 (1) lacks two or more of the following:
30.28 (i) basic hospital insurance;
30.29 (ii) medical-surgical insurance;
30.30 (iii) prescription drug coverage;
30.31 (iv) dental coverage; or
30.32 (v) vision coverage;
30.33 (2) requires a deductible of $100 or more per person per year; or
30.34 (3) lacks coverage because the child has exceeded the maximum coverage for a
30.35 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
31.3 coverage This paragraph
does not apply to
(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
(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.
(e) 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.
Sec. 37. Minnesota Statutes 2006, section 256L.07, subdivision 6, is amended to read:
Subd. 6. Exception for certain adults.
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
, are eligible without meeting
the requirements of this section until
Sec. 38. Minnesota Statutes 2006, section 256L.09, subdivision 4, is amended to read:
Subd. 4. Eligibility as Minnesota resident.
(a) For purposes of this section, a
permanent Minnesota resident is a person who has demonstrated, through persuasive and
objective evidence, that the person is domiciled in the state and intends to live in the
(b) To be eligible as a permanent resident, an applicant must demonstrate the
requisite intent to live in the state permanently by:
(1) showing that the applicant maintains a residence at a verified address
other than a
31.34 place of public accommodation
, through the use of evidence of residence described in
256D.02, subdivision 12a
, paragraph (b),
(2) demonstrating that the applicant has been continuously domiciled in the state for
no less than 180 days immediately before the application; and
(3) signing an affidavit declaring that (A) the applicant currently resides in the state
and intends to reside in the state permanently; and (B) the applicant did not come to the
state for the primary purpose of obtaining medical coverage or treatment.
(c) A person who is temporarily absent from the state does not lose eligibility for
MinnesotaCare. "Temporarily absent from the state" means the person is out of the state
for a temporary purpose and intends to return when the purpose of the absence has been
accomplished. A person is not temporarily absent from the state if another state has
determined that the person is a resident for any purpose. If temporarily absent from the
state, the person must follow the requirements of the health plan in which the person is
enrolled to receive services.
Sec. 39. Minnesota Statutes 2006, section 256L.15, subdivision 1, is amended to read:
Subdivision 1. Premium determination.
(a) Families with children and individuals
shall pay a premium determined according to subdivision 2, except that no premium shall
32.16be charged to individuals under the age of 21
(b) Pregnant women
and children under age two
are exempt from the provisions
256L.06, subdivision 3
, paragraph (b), clause (3), requiring disenrollment
for failure to pay premiums. For pregnant women, this exemption continues until the
first day of the month following the 60th day postpartum. Women who remain enrolled
during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
disenrolled on the first of the month following the 60th day postpartum for the penalty
period that otherwise applies under section
, unless they begin paying premiums.
32.24 (c) Members of the military and their families who meet the eligibility criteria
32.25for MinnesotaCare upon eligibility approval made within 24 months following the end
32.26of the member's tour of active duty shall have their premiums paid by the commissioner.
32.27The effective date of coverage for an individual or family who meets the criteria of this
32.28paragraph shall be the first day of the month following the month in which eligibility is
32.29approved. This exemption shall apply for 12 months.
32.30EFFECTIVE DATE.This section is effective July 1, 2007, or upon federal
32.31approval, whichever is later.
Sec. 40. Minnesota Statutes 2006, section 256L.15, subdivision 2, is amended to read:
Subd. 2. Sliding fee scale; monthly gross individual or family income.
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.
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
Effective October 1, 2003, the commissioner shall increase each percentage by 0.5
33.13 percentage points for enrollees with income greater than 100 percent but not exceeding
33.14 200 percent of the federal poverty guidelines and shall increase each percentage by 1.0
33.15 percentage points for families and children with incomes greater than 200 percent of
33.16 the federal poverty guidelines.
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.
Families whose gross income is above 275 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) After calculating the percentage of premium each enrollee shall pay under
33.30 paragraph (a), eight percent shall be added to the premium.
33.31EFFECTIVE DATE.This section is effective July 1, 2007.
Sec. 41. Minnesota Statutes 2006, section 256L.17, subdivision 2, is amended to read:
Subd. 2. Limit on total assets.
(a) Effective July 1, 2002, or upon federal approval,
whichever is later, in order to be eligible for the MinnesotaCare program, a household of
two or more persons must not own more than $20,000 in total net assets, and a household
of one person must not own more than $10,000 in total net assets.
(b) For purposes of this subdivision, assets are determined according to section
34.4256B.056, subdivision 3c
, except that workers' compensation settlements received due to
34.5a work-related injury shall not be considered
(c) State-funded MinnesotaCare is not available for applicants or enrollees who are
otherwise eligible for medical assistance but fail to verify assets. Enrollees who become
eligible for federally funded medical assistance shall be terminated from state-funded
MinnesotaCare and transferred to medical assistance.
Sec. 42. Minnesota Statutes 2006, section 256L.17, subdivision 3, is amended to read:
Subd. 3. Documentation.
(a) The commissioner of human services shall require
individuals and families, at the time of application or renewal, to indicate on a checkoff
form developed by the commissioner whether they satisfy the MinnesotaCare asset
This form must include the following or similar language: "To be eligible for
34.15 MinnesotaCare, individuals and families must not own net assets in excess of $30,000
34.16 for a household of two or more persons or $15,000 for a household of one person, not
34.17 including a homestead, household goods and personal effects, assets owned by children,
34.18 vehicles used for employment, court-ordered settlements up to $10,000, individual
34.19 retirement accounts, and capital and operating assets of a trade or business up to $200,000.
34.20 Do you and your household own net assets in excess of these limits?"
(b) The commissioner may require individuals and families to provide any
information the commissioner determines necessary to verify compliance with the asset
requirement, if the commissioner determines that there is reason to believe that an
individual or family has assets that exceed the program limit.
Sec. 43. Minnesota Statutes 2006, section 256L.17, subdivision 7, is amended to read:
Subd. 7. Exception for certain adults.
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
, are exempt from the
requirements of this section until
Sec. 44. Laws 2005, First Special Session chapter 4, article 9, section 3, subdivision 2,
is amended to read:
|Subd. 2.Community and Family Health
|Summary by Fund
|Health Care Access
FAMILY PLANNING BASE
35.6 REDUCTION. Base level funding for
35.7 the family planning special projects grant
35.8 program is reduced by $1,877,000 each
35.9 year of the biennium beginning July 1,
35.10 2007, provided that this reduction shall
35.11 only take place upon full implementation of
35.12 the family planning project section of the
35.13 1115 waiver. Notwithstanding Minnesota
35.14 Statutes, section
145.925 , the commissioner
35.15 shall give priority to community health care
35.16 clinics providing family planning services
35.17 that either serve a high number of women
35.18 who do not qualify for medical assistance
35.19 or are unable to participate in the medical
35.20 assistance program as a medical assistance
35.21 provider when allocating the remaining
35.22 appropriations. Notwithstanding section 15,
35.23 this paragraph shall not expire.
SHAKEN BABY VIDEO. Of the
state government special revenue fund
appropriation, $13,000 in 2006 is
appropriated to the commissioner of health
to provide a video to hospitals on shaken
baby syndrome. The commissioner of health
shall assess a fee to hospitals to cover the
cost of the approved shaken baby video and
the revenue received is to be deposited in the
state government special revenue fund.
Sec. 45. APPROPRIATION.
35.35 (a) $....... is appropriated from the health care access fund to the commissioner of
35.36human services for the biennium beginning July 1, 2007, for the purpose of Minnesota
36.1health care programs outreach grants and the enrollment incentive programs under
36.2Minnesota Statutes, section 256.962.
36.3 (b) $1,156,000 is appropriated each fiscal year beginning July 1, 2007, from the
36.4general fund to the commissioner of health for family planning grants under Minnesota
36.5Statutes, section 145.925.
36.6 (c) $....... is appropriated for the biennium beginning July 1, 2007, from the general
36.7fund to the commissioner of human services for the critical access dental providers
36.8reimbursement rates under Minnesota Statutes, section 256B.76, paragraph (c).
36.9 (d) $....... is appropriated for the biennium beginning July 1, 2007, from the general
36.10fund to the commissioner of health for the subsidies for federally qualified health centers
36.11under Minnesota Statutes, section 145.9269.
36.12 (e) $....... is appropriated for the biennium beginning July 1, 2007, from the general
36.13fund to the commissioner of human services for the patient incentive health program
36.14established in Minnesota Statutes, section 256.01, subdivision 2b, paragraph (b).
Sec. 46. REPEALER.
36.16Minnesota Statutes 2006, sections 62A.301; 256B.0631; and 256L.035, are repealed.
36.18MINNESOTA HEALTH INSURANCE EXCHANGE; SECTION 125 PLANS
Section 1. Minnesota Statutes 2006, section 13.46, subdivision 2, is amended to read:
Subd. 2. General.
(a) Unless the data is summary data or a statute specifically
provides a different classification, data on individuals collected, maintained, used, or
disseminated by the welfare system is private data on individuals, and shall not be
(1) according to section
(2) according to court order;
(3) according to a statute specifically authorizing access to the private data;
(4) to an agent of the welfare system, including a law enforcement person, attorney,
or investigator acting for it in the investigation or prosecution of a criminal or civil
proceeding relating to the administration of a program;
(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to
an individual or family across programs; evaluate the effectiveness of programs; and
investigate suspected fraud;
(6) to administer federal funds or programs;
(7) between personnel of the welfare system working in the same program;
(8) to the Department of Revenue to administer and evaluate tax refund or tax credit
programs and to identify individuals who may benefit from these programs. The following
information may be disclosed under this paragraph: an individual's and their dependent's
names, dates of birth, Social Security numbers, income, addresses, and other data as
required, upon request by the Department of Revenue. Disclosures by the commissioner
of revenue to the commissioner of human services for the purposes described in this clause
are governed by section
270B.14, subdivision 1
. Tax refund or tax credit programs include,
but are not limited to, the dependent care credit under section
, the Minnesota
working family credit under section
, the property tax refund and rental credit
, and the Minnesota education credit under section
(9) between the Department of Human Services, the Department of Education, and
the Department of Employment and Economic Development for the purpose of monitoring
the eligibility of the data subject for unemployment benefits, for any employment or
training program administered, supervised, or certified by that agency, for the purpose of
administering any rehabilitation program or child care assistance program, whether alone
or in conjunction with the welfare system, or to monitor and evaluate the Minnesota
family investment program by exchanging data on recipients and former recipients of food
support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance
under chapter 119B, or medical programs under chapter 256B, 256D, or 256L;
(10) to appropriate parties in connection with an emergency if knowledge of
the information is necessary to protect the health or safety of the individual or other
individuals or persons;
(11) data maintained by residential programs as defined in section
be disclosed to the protection and advocacy system established in this state according
to Part C of Public Law 98-527 to protect the legal and human rights of persons with
developmental disabilities or other related conditions who live in residential facilities for
these persons if the protection and advocacy system receives a complaint by or on behalf
of that person and the person does not have a legal guardian or the state or a designee of
the state is the legal guardian of the person;
(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;
(13) data on a child support obligor who makes payments to the public agency
may be disclosed to the Minnesota Office of Higher Education to the extent necessary to
determine eligibility under section
136A.121, subdivision 2
, clause (5);
(14) participant Social Security numbers and names collected by the telephone
assistance program may be disclosed to the Department of Revenue to conduct an
electronic data match with the property tax refund database to determine eligibility under
237.70, subdivision 4a
(15) the current address of a Minnesota family investment program participant
may be disclosed to law enforcement officers who provide the name of the participant
and notify the agency that:
(i) the participant:
(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or
(B) is violating a condition of probation or parole imposed under state or federal law;
(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and
(iii) the request is made in writing and in the proper exercise of those duties;
(16) the current address of a recipient of general assistance or general assistance
medical care may be disclosed to probation officers and corrections agents who are
supervising the recipient and to law enforcement officers who are investigating the
recipient in connection with a felony level offense;
(17) information obtained from food support applicant or recipient households may
be disclosed to local, state, or federal law enforcement officials, upon their written request,
for the purpose of investigating an alleged violation of the Food Stamp Act, according
to Code of Federal Regulations, title 7, section 272.1(c);
(18) the address, Social Security number, and, if available, photograph of any
member of a household receiving food support shall be made available, on request, to a
local, state, or federal law enforcement officer if the officer furnishes the agency with the
name of the member and notifies the agency that:
(i) the member:
(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;
(B) is violating a condition of probation or parole imposed under state or federal
(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);
(ii) locating or apprehending the member is within the officer's official duties; and
(iii) the request is made in writing and in the proper exercise of the officer's official
(19) the current address of a recipient of Minnesota family investment program,
general assistance, general assistance medical care, or food support may be disclosed to
law enforcement officers who, in writing, provide the name of the recipient and notify the
agency that the recipient is a person required to register under section
, but is not
residing at the address at which the recipient is registered under section
(20) certain information regarding child support obligors who are in arrears may be
made public according to section
(21) data on child support payments made by a child support obligor and data on
the distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the
income of the obligor or obligee may be disclosed to the other party;
(22) data in the work reporting system may be disclosed under section
(23) to the Department of Education for the purpose of matching Department of
Education student data with public assistance data to determine students eligible for free
and reduced price meals, meal supplements, and free milk according to United States
Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and
state funds that are distributed based on income of the student's family; and to verify
receipt of energy assistance for the telephone assistance plan;
(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a local board of health as
defined in section
145A.02, subdivision 2
, when the commissioner or local board of health
has reason to believe that a program recipient is a disease case, carrier, suspect case, or at
risk of illness, and the data are necessary to locate the person;
(25) to other state agencies, statewide systems, and political subdivisions of this
state, including the attorney general, and agencies of other states, interstate information
networks, federal agencies, and other entities as required by federal regulation or law for
the administration of the child support enforcement program;
(26) to personnel of public assistance programs as defined in section
access to the child support system database for the purpose of administration, including
monitoring and evaluation of those public assistance programs;
(27) to monitor and evaluate the Minnesota family investment program by
exchanging data between the Departments of Human Services and Education, on
recipients and former recipients of food support, cash assistance under chapter 256, 256D,
256J, or 256K, child care assistance under chapter 119B, or medical programs under
chapter 256B, 256D, or 256L;
(28) to evaluate child support program performance and to identify and prevent
fraud in the child support program by exchanging data between the Department of Human
Services, Department of Revenue under section
270B.14, subdivision 1
, paragraphs (a)
and (b), without regard to the limitation of use in paragraph (c), Department of Health,
Department of Employment and Economic Development, and other state agencies as is
reasonably necessary to perform these functions;
(29) counties operating child care assistance programs under chapter 119B may
disseminate data on program participants, applicants, and providers to the commissioner
40.12 (30) pursuant to section 256L.02, subdivision 6, between the welfare system and
40.13the Minnesota Health Insurance Exchange, under section 62A.67, in order to enroll and
40.14collect premiums from individuals in the MinnesotaCare program under chapter 256L and
40.15to administer the individual's and their families' participation in the program.
(b) Information on persons who have been treated for drug or alcohol abuse may
only be disclosed according to the requirements of Code of Federal Regulations, title
42, sections 2.1 to
(c) Data provided to law enforcement agencies under paragraph (a), clause (15),
(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section
13.82, subdivision 5
, paragraph (a) or (b).
(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is
not subject to the access provisions of subdivision 10, paragraph (b).
For the purposes of this subdivision, a request will be deemed to be made in writing
if made through a computer interface system.
Sec. 2. [62A.67] MINNESOTA HEALTH INSURANCE EXCHANGE.
40.28 Subdivision 1. Title; citation. This section may be cited as the "Minnesota Health
40.30 Subd. 2. Creation; tax exemption. The Minnesota Health Insurance Exchange
40.31is created for the limited purpose of providing individuals with greater access, choice,
40.32portability, and affordability of health insurance products. The Minnesota Health
40.33Insurance Exchange is a not-for-profit corporation under chapter 317A and section 501(c)
40.34of the Internal Revenue Code.
41.1 Subd. 3. Definitions. The following terms have the meanings given them unless
41.2otherwise provided in text.
41.3 (a) "Board" means the board of directors of the Minnesota Health Insurance
41.4Exchange under subdivision 13.
41.5 (b) "Commissioner" means:
41.6 (1) the commissioner of commerce for health insurers subject to the jurisdiction
41.7of the Department of Commerce;
41.8 (2) the commissioner of health for health insurers subject to the jurisdiction of the
41.9Department of Health; or
41.10 (3) either commissioner's designated representative.
41.11 (c) "Exchange" means the Minnesota Health Insurance Exchange.
41.12 (d) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
41.13 (e) "Individual market health plans," unless otherwise specified, means individual
41.14market health plans defined in section 62A.011.
41.15 (f) "Section 125 Plan" means a Premium Only Plan under section 125 of the Internal
41.17 Subd. 4. Insurer and health plan participation. All health plans as defined in
41.18section 62A.011, subdivision 3, issued or renewed in the individual market shall participate
41.19in the exchange. No health plans in the individual market may be issued or renewed
41.20outside of the exchange. Group health plans as defined in section 62A.10 shall not be
41.21offered through the exchange. Health plans offered through the Minnesota Comprehensive
41.22Health Association as defined in section 62E.10 are offered through the exchange to
41.23eligible enrollees as determined by the Minnesota Comprehensive Health Association.
41.24Health plans offered through MinnesotaCare under chapter 256L are offered through the
41.25exchange to eligible enrollees as determined by the commissioner of human services.
41.26 Subd. 5. Approval of health plans. No health plan may be offered through the
41.27exchange unless the commissioner has first certified that:
41.28 (1) the insurer seeking to offer the health plan is licensed to issue health insurance in
41.29the state; and
41.30 (2) the health plan meets the requirements of this section, and the health plan and the
41.31insurer are in compliance with all other applicable health insurance laws.
41.32 Subd. 6. Individual market health plans. Individual market health plans offered
41.33through the exchange continue to be regulated by the commissioner as specified in
41.34chapters 62A, 62C, 62D, 62E, 62Q, and 72A, and must include the following provisions
41.35that apply to all health plans issued or renewed through the exchange:
42.1 (1) premiums for children under the age of 19 shall not vary by age in the exchange;
42.3 (2) premiums for children under the age of 19 must be excluded from rating factors
42.4requirements under section 62A.65, subdivision 3, paragraph (b).
42.5 Subd. 7. Individual participation and eligibility. Individuals are eligible to
42.6purchase health plans directly through the exchange or through an employer Section
42.7125 Plan under section 62A.68. Nothing in this section requires guaranteed issue of
42.8individual market health plans offered through the exchange. Individuals are eligible to
42.9purchase individual market health plans through the exchange by meeting one or more
42.10of the following qualifications:
42.11 (1) the individual is a Minnesota resident, meaning the individual is physically
42.12residing on a permanent basis in a place that is the person's principal residence and from
42.13which the person is absent only for temporary purposes;
42.14 (2) the individual is a student attending an institution outside of Minnesota and
42.15maintains Minnesota residency;
42.16 (3) the individual is not a Minnesota resident but is employed by an employer
42.17physically located within the state and the individual's employer does not offer a group
42.18health insurance plan as defined in section 62A.10, but does offer a Section 125 Plan
42.19through the exchange under section 62A.68;
42.20 (4) the individual is not a Minnesota resident but is self-employed and the
42.21individual's principal place of business is in the state; or
42.22 (5) the individual is a dependent as defined in section 62L.02, of another individual
42.23who is eligible to participate in the exchange.
42.24 Subd. 8. Continuation of coverage. Enrollment in a health plan may be canceled
42.25for nonpayment of premiums, fraud, or changes in eligibility for MinnesotaCare under
42.26chapter 256L. Enrollment in an individual market health plan may not be canceled or
42.27renewed because of any change in employer or employment status, marital status, health
42.28status, age, residence, or any other change that does not affect eligibility as defined
42.29in this section.
42.30 Subd. 9. Responsibilities of the exchange. The exchange shall serve as the sole
42.31entity for enrollment and collection and transfer of premium payments for health plans
42.32offered through the exchange. The exchange shall be responsible for the following
42.34 (1) publicize the exchange, including but not limited to its functions, eligibility
42.35rules, and enrollment procedures;
43.1 (2) provide assistance to employers to set up an employer Section 125 Plan under
43.3 (3) create a system to allow individuals to compare and enroll in health plans offered
43.4through the exchange;
43.5 (4) create a system to collect and transmit to the applicable plans all premium
43.6payments or contributions made by or on behalf of individuals, including developing
43.7mechanisms to receive and process automatic payroll deductions for individuals enrolled
43.8in employer Section 125 Plans;
43.9 (5) refer individuals interested in MinnesotaCare under chapter 256L to the
43.10Department of Human Services to determine eligibility;
43.11 (6) establish a mechanism with the Department of Human Services to transfer
43.12premiums and subsidies for MinnesotaCare to qualify for federal matching payments;
43.13 (7) collect and assess information for eligibility for premium incentives under
43.15 (8) upon request, issue certificates of previous coverage according to the provisions
43.16of HIPAA and as referenced in section 62Q.181 to all such individuals who cease to be
43.17covered by a participating health plan through the exchange;
43.18 (9) establish procedures to account for all funds received and disbursed by the
43.19exchange for individual participants of the exchange; and
43.20 (10) make available to the public, at the end of each calendar year, a report of an
43.21independent audit of the exchange's accounts.
43.22 Subd. 10. Powers of the exchange. The exchange shall have the power to:
43.23 (1) contract with insurance producers licensed in accident and health insurance
43.24under chapter 60K and vendors to perform one or more of the functions specified in
43.26 (2) contract with employers to act as the plan administrator for participating
43.27employer Section 125 Plans and to undertake the obligations required by federal law
43.28of a plan administrator;
43.29 (3) establish and assess fees on health plan premiums of health plans purchased
43.30through the exchange to fund the cost of administering the exchange;
43.31 (4) seek and directly receive grant funding from government agencies or private
43.32philanthropic organizations to defray the costs of operating the exchange;
43.33 (5) establish and administer rules and procedures governing the operations of the
43.35 (6) establish one or more service centers within Minnesota;
43.36 (7) sue or be sued or otherwise take any necessary or proper legal action;
44.1 (8) establish bank accounts and borrow money; and
44.2 (9) enter into agreements with the commissioners of commerce, health, human
44.3services, revenue, employment and economic development, and other state agencies as
44.4necessary for the exchange to implement the provisions of this section.
44.5 Subd. 11. Dispute resolution. The exchange shall establish procedures for
44.6resolving disputes with respect to the eligibility of an individual to participate in the
44.7exchange. The exchange does not have the authority or responsibility to intervene in or
44.8resolve disputes between an individual and a health plan or health insurer. The exchange
44.9shall refer complaints from individuals participating in the exchange to the commissioner
44.10of human services to be resolved according to sections 62Q.68 to 62Q.73.
44.11 Subd. 12. Governance. The exchange shall be governed by a board of directors
44.12with 11 members. The board shall convene on or before July 1, 2007, after the initial board
44.13members have been selected. The initial board membership consists of the following:
44.14 (1) the commissioner of commerce;
44.15 (2) the commissioner of human services;
44.16 (3) the commissioner of health;
44.17 (4) four members appointed by a joint committee of the Minnesota senate and the
44.18Minnesota house of representatives to serve three-year terms; and
44.19 (5) four members appointed by the governor to serve three-year terms.
44.20 Subd. 13. Subsequent board membership. Ongoing membership of the exchange
44.21consists of the following effective July 1, 2010:
44.22 (1) the commissioner of commerce;
44.23 (2) the commissioner of human services;
44.24 (3) the commissioner of health;
44.25 (4) four members appointed by the governor with the approval of a joint committee
44.26of the senate and house of representatives to serve two- or three-year terms. Appointed
44.27members may serve more than one term; and
44.28 (5) four members elected by the membership of the exchange of which two are
44.29elected to serve a two-year term and two are elected to serve a three-year term. Elected
44.30members may serve more than one term.
44.31 Subd. 14. Operations of the board. Officers of the board of directors are elected by
44.32members of the board and serve one-year terms. Six members of the board constitutes a
44.33quorum, and the affirmative vote of six members of the board is necessary and sufficient
44.34for any action taken by the board. Board members serve without pay, but are reimbursed
44.35for actual expenses incurred in the performance of their duties.
45.1 Subd. 15. Operations of the exchange. The board of directors shall appoint an
45.2exchange director who shall:
45.3 (1) be a full-time employee of the exchange;
45.4 (2) administer all of the activities and contracts of the exchange; and
45.5 (3) hire and supervise the staff of the exchange.
45.6 Subd. 16. Insurance producers. When a producer licensed in accident and health
45.7insurance under chapter 60K enrolls an eligible individual in the exchange, the health plan
45.8chosen by an individual may pay the producer a commission.
45.9 Subd. 17. Implementation. Health plan coverage through the exchange begins on
45.10January 1, 2009. The exchange must be operational to assist employers and individuals
45.11by September 1, 2008, and be prepared for enrollment by December 1, 2008. Enrollees
45.12of individual market health plans, MinnesotaCare, and the Minnesota Comprehensive
45.13Health Association as of December 2, 2008, are automatically enrolled in the exchange
45.14on January 1, 2009, in the same health plan and at the same premium that they were
45.15enrolled as of December 2, 2008, subject to the provisions of this section. As of January 1,
45.162009, all enrollees of individual market health plans, MinnesotaCare, and the Minnesota
45.17Comprehensive Health Association shall make premium payments to the exchange.
45.18 Subd. 18. Study of insurer issue requirements. In consultation with
45.19the commissioners of commerce and health, the exchange shall study and make
45.20recommendations on rating requirements and risk adjustment mechanisms that could
45.21be implemented to facilitate increased enrollment in the exchange by employers and
45.22employees through employer Section 125 Plans. The exchange shall report study findings
45.23and recommendations to the chairs of house and senate committees having jurisdiction
45.24over commerce and health by January 15, 2011.
Sec. 3. [62A.68] SECTION 125 PLANS.
45.26 Subdivision 1. Definitions. The following terms have the meanings given unless
45.27otherwise provided in text:
45.28 (a) "Current employee" means an employee currently on an employer's payroll other
45.29than a retiree or disabled former employee.
45.30 (b) "Employer" means a person, firm, corporation, partnership, association, business
45.31trust, or other entity employing one or more persons, including a political subdivision of
45.32the state, filing payroll tax information on such employed person or persons.
45.33 (c) "Section 125 Plan" means a Premium Only Plan under section 125 of the Internal
46.1 (d) "Exchange" means the Minnesota Health Insurance Exchange under section
46.3 (e) "Exchange director" means the appointed director under section 62A.67,
46.5 Subd. 2. Section 125 Plan requirement. Effective January 1, 2009, all employers
46.6with 11 or more current employees shall offer a Section 125 Plan through the exchange
46.7to allow their employees to pay for health insurance premiums with pretax dollars. The
46.8following employers are exempt from the Section 125 Plan requirement:
46.9 (1) employers that offer a group health insurance plan as defined in 62A.10;
46.10 (2) employers that offer group health insurance through a self-insured plan as
46.11defined in section 62E.02; and
46.12 (3) employers with fewer than 11 current employees, except that employers under
46.13this clause may voluntarily offer a Section 125 Plan.
46.14 Subd. 3. Tracking compliance. By July 1, 2008, the exchange, in consultation with
46.15the commissioners of commerce, health, employment and economic development, and
46.16revenue shall establish a method for tracking employer compliance with the Section 125
46.18 Subd. 4. Employer requirements. Employers that are required to offer or choose
46.19to offer a Section 125 Plan through the exchange shall enter into an annual binding
46.20agreement with the exchange, which includes the terms in paragraphs (a) to (h).
46.21 (a) The employer shall designate the exchange director to be the plan's administrator
46.22for the employer's plan and the exchange director agrees to undertake the obligations
46.23required of a plan administrator under federal law.
46.24 (b) Only the coverage and benefits offered by participating insurers in the exchange
46.25constitutes the coverage and benefits of the participating employer plan.
46.26 (c) Any individual eligible to participate in the exchange may elect coverage under
46.27any participating health plan for which they are eligible, and neither the employer nor
46.28the exchange shall limit choice of coverage from among all the participating insurance
46.29plans for which the individual is eligible.
46.30 (d) The employer shall deduct premium amounts on a pretax basis in an amount
46.31not to exceed an employee's wages and make payments to the exchange as directed by
46.32employees for health plans employees enroll in through the exchange.
46.33 (e) The employer shall not offer individuals eligible to participate in the exchange
46.34any separate or competing group health plan under section 62A.10.
47.1 (f) The employer reserves the right to determine the terms and amounts of the
47.2employer's contribution to the plan, if any.
47.3 (g) The employer shall make available to the exchange any of the employer's
47.4documents, records, or information, including copies of the employer's federal and state
47.5tax and wage reports that are necessary for the exchange to verify:
47.6 (1) that the employer is in compliance with the terms of its agreement with the
47.7exchange governing the participating employer plan;
47.8 (2) that the participating employer plan is in compliance with applicable state and
47.9federal laws, including those relating to nondiscrimination in coverage; and
47.10 (3) the eligibility of those individuals enrolled in the participating employer plan.
47.11 (h) The exchange shall not provide the participating employer plan with any
47.12additional or different services or benefits not otherwise provided or offered to all other
47.13participating employer plans.
47.14 Subd. 5. Section 125 eligible health plans. Individuals eligible to enroll in health
47.15plans through an employer Section 125 Plan through the exchange may enroll in any
47.16health plan offered through the exchange for which the individual is eligible including
47.17individual market health plans, MinnesotaCare, and the Minnesota Comprehensive Health
Sec. 4. Minnesota Statutes 2006, section 62E.141, is amended to read:
47.2062E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
No employee of an employer that offers a group
health plan, under which the
employee is eligible for coverage, is eligible to enroll, or continue to be enrolled, in
the comprehensive health association, except for enrollment or continued enrollment
necessary to cover conditions that are subject to an unexpired preexisting condition
limitation, preexisting condition exclusion, or exclusionary rider under the employer's
health plan. This section does not apply to persons enrolled in the Comprehensive Health
Association as of June 30, 1993. With respect to persons eligible to enroll in the health
plan of an employer that has more than 29 current employees, as defined in section
, this section does not apply to persons enrolled in the Comprehensive Health
Association as of December 31, 1994.
Sec. 5. Minnesota Statutes 2006, section 62L.12, subdivision 2, is amended to read:
Subd. 2. Exceptions.
(a) A health carrier may sell, issue, or renew individual
conversion policies to eligible employees otherwise eligible for conversion coverage under
as a result of leaving a health maintenance organization's service area.
(b) A health carrier may sell, issue, or renew individual conversion policies to
eligible employees otherwise eligible for conversion coverage as a result of the expiration
of any continuation of group coverage required under sections
(c) A health carrier may sell, issue, or renew conversion policies under section
to eligible employees.
(d) A health carrier may sell, issue, or renew individual continuation policies to
eligible employees as required.
(e) A health carrier may sell, issue, or renew individual health plans if the coverage
is appropriate due to an unexpired preexisting condition limitation or exclusion applicable
to the person under the employer's group health plan or due to the person's need for health
care services not covered under the employer's group health plan.
(f) A health carrier may sell, issue, or renew an individual health plan, if the
individual has elected to buy the individual health plan not as part of a general plan to
substitute individual health plans for a group health plan nor as a result of any violation of
subdivision 3 or 4.
(g) Nothing in this subdivision relieves a health carrier of any obligation to provide
continuation or conversion coverage otherwise required under federal or state law.
(h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage
issued as a supplement to Medicare under sections
, or policies or
contracts that supplement Medicare issued by health maintenance organizations, or those
contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social
Security Act, United States Code, title 42, section 1395 et seq., as amended.
(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
health plans necessary to comply with a court order.
(j) A health carrier may offer, issue, sell, or renew an individual health plan to
persons eligible for an employer group health plan, if the individual health plan is a high
deductible health plan for use in connection with an existing health savings account, in
compliance with the Internal Revenue Code, section 223. In that situation, the same or
a different health carrier may offer, issue, sell, or renew a group health plan to cover
the other eligible employees in the group.
(k) A health carrier may offer, sell, issue, or renew an individual health plan to one
or more employees of a small employer if the individual health plan is marketed directly to
all employees of the small employer and the small employer does not contribute directly
or indirectly to the premiums or facilitate the administration of the individual health plan.
The requirement to market an individual health plan to all employees does not require the
health carrier to offer or issue an individual health plan to any employee. For purposes
of this paragraph, an employer is not contributing to the premiums or facilitating the
administration of the individual health plan if the employer does not contribute to the
premium and merely collects the premiums from an employee's wages or salary through
payroll deductions and submits payment for the premiums of one or more employees in a
lump sum to the health carrier. Except for coverage under section
, subdivision 5,
paragraph (b), or
, at the request of an employee, the health carrier may bill the
employer for the premiums payable by the employee, provided that the employer is not
liable for payment except from payroll deductions for that purpose. If an employer is
submitting payments under this paragraph, the health carrier shall provide a cancellation
notice directly to the primary insured at least ten days prior to termination of coverage for
nonpayment of premium. Individual coverage under this paragraph may be offered only
if the small employer has not provided coverage under section
to the employees
within the past 12 months.
The employer must provide a written and signed statement to the health carrier that
the employer is not contributing directly or indirectly to the employee's premiums. The
health carrier may rely on the employer's statement and is not required to guarantee-issue
individual health plans to the employer's other current or future employees.
49.19 (l) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
49.20health plans through the Minnesota Health Insurance Exchange under section 62A.67
Sec. 6. Minnesota Statutes 2006, section 256L.02, subdivision 3, is amended to read:
Subd. 3. Financial management.
(a) The commissioner shall manage spending
for the MinnesotaCare program in a manner that maintains a minimum reserve. As
part of each state revenue and expenditure forecast, the commissioner must make an
assessment of the expected expenditures for the covered services for the remainder of the
current biennium and for the following biennium. The estimated expenditure, including
the reserve, shall be compared to an estimate of the revenues that will be available in
the health care access fund. Based on this comparison, and after consulting with the
chairs of the house Ways and Means Committee and the senate Finance Committee,
and the Legislative Commission on Health Care Access, the commissioner shall, as
necessary, make the adjustments specified in paragraph (b) to ensure that expenditures
remain within the limits of available revenues for the remainder of the current biennium
and for the following biennium. The commissioner shall not hire additional staff using
appropriations from the health care access fund until the commissioner of finance makes
a determination that the adjustments implemented under paragraph (b) are sufficient to
allow MinnesotaCare expenditures to remain within the limits of available revenues for
the remainder of the current biennium and for the following biennium.
(b) The adjustments the commissioner shall use must be implemented in this order:
first, stop enrollment of single adults and households without children; second, upon 45
days' notice, stop coverage of single adults and households without children already
enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium
subsidy amounts by ten percent for families with gross annual income above 200 percent
of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the premium
subsidy amounts by ten percent for families with gross annual income at or below 200
percent; and fifth, require applicants to be uninsured for at least six months prior to
eligibility in the MinnesotaCare program. If these measures are insufficient to limit the
expenditures to the estimated amount of revenue, the commissioner shall further limit
enrollment or decrease premium subsidies.
50.14 (c) The commissioner shall work in cooperation with the Minnesota Health
50.15Insurance Exchange under section 62A.67 to make adjustments under paragraph (b) as
50.16required under this subdivision.
50.17EFFECTIVE DATE.This section is effective January 1, 2009.
Sec. 7. Minnesota Statutes 2006, section 256L.02, is amended by adding a subdivision
50.20 Subd. 5. Enrollment responsibilities. According to section 256L.05, subdivision 6,
50.21effective January 1, 2009, the Minnesota Health Insurance Exchange under section 62A.67
50.22shall assume responsibility for enrolling eligible applicants and enrollees in a health
50.23plan for MinnesotaCare coverage. The commissioner shall maintain responsibility for
50.24determining eligibility for MinnesotaCare.
50.25EFFECTIVE DATE.This section is effective January 1, 2009.
Sec. 8. Minnesota Statutes 2006, section 256L.02, is amended by adding a subdivision
50.28 Subd. 6. Exchange of data. An entity that is part of the welfare system as defined
50.29in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance
50.30Exchange under section 62A.67 may exchange private data about individuals without
50.31the individual's consent in order to enroll and collect premiums from individuals in the
50.32MinnesotaCare program under chapter 256L and to administer the individual's and the
50.33individual's family's participation in the program. This subdivision only applies if the
50.34entity that is part of the welfare system and the Minnesota Health Insurance Exchange
51.1have entered into an agreement that complies with the requirements in Code of Federal
51.2Regulations, title 45, section 164.314.
Sec. 9. Minnesota Statutes 2006, section 256L.05, subdivision 5, is amended to read:
Subd. 5. Availability of private insurance. (a)
, in consultation
51.5 with the commissioners of health and commerce,
shall provide information regarding the
availability of private health insurance coverage and the
possibility of disenrollment under
256L.07, subdivision 1 , paragraphs (b) and (c), to all: (1) families enrolled in the
51.8 MinnesotaCare program whose gross family income is equal to or more than 225 percent
51.9 of the federal poverty guidelines; and (2) single adults and households without children
51.10 enrolled in the MinnesotaCare program whose gross family income is equal to or more
51.11 than 165 percent of the federal poverty guidelines. This information must be provided
51.12Minnesota Health Insurance Exchange under section 62A.67
upon initial enrollment
and annually thereafter.
The commissioner shall also include information regarding the
51.14 availability of private health insurance coverage in
The notice of ineligibility provided to persons subject to disenrollment under
256L.07, subdivision 1
, paragraphs (b) and (c), must include information about
51.17assistance with identifying and selecting private health insurance coverage provided by
51.18the Minnesota Health Insurance Exchange under section 62A.67
51.19EFFECTIVE DATE.This section is effective January 1, 2009.
Sec. 10. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
51.22 Subd. 6. Minnesota Health Insurance Exchange. The commissioner shall refer
51.23all MinnesotaCare applicants and enrollees to the Minnesota Health Insurance Exchange
51.24under section 62A.67. The Minnesota Health Insurance Exchange shall provide those
51.25referred with assistance in selecting a managed care plan through which to receive
51.26MinnesotaCare covered services and in analyzing health plans available through the
51.27private market. MinnesotaCare applicants and enrollees shall effect enrollment in a
51.28managed care plan or a private market health plan through the Minnesota Health Insurance
51.30EFFECTIVE DATE.This section is effective January 1, 2009.
Sec. 11. Minnesota Statutes 2006, section 256L.12, subdivision 7, is amended to read:
Subd. 7. Managed care plan vendor requirements.
The following requirements
apply to all counties or vendors who contract with the Department of Human Services to
serve MinnesotaCare recipients. Managed care plan contractors:
(1) shall authorize and arrange for the provision of the full range of services listed in
in order to ensure appropriate health care is delivered to enrollees;
(2) shall accept the prospective, per capita payment or other contractually defined
payment from the commissioner in return for the provision and coordination of covered
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;
(4) shall provide for an enrollee grievance process as required by the commissioner
and set forth in the contract with the department;
(5) shall retain all revenue from enrollee co-payments;
(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status
or previous utilization of health services;
(7) shall demonstrate capacity to accept financial risk according to requirements
specified in the contract with the department. A health maintenance organization licensed
under chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required
to demonstrate financial risk capacity, beyond that which is required to comply with
chapters 62C and 62D;
(8) shall submit information as required by the commissioner, including data required
for assessing enrollee satisfaction, quality of care, cost, and utilization of services
52.20 (9) shall participate in the Minnesota Health Insurance Exchange under section
52.2162A.67 for the purpose of enrolling individuals under this chapter.
52.22EFFECTIVE DATE.This section is effective January 1, 2009.
Sec. 12. Minnesota Statutes 2006, section 256L.15, subdivision 1a, is amended to read:
Subd. 1a. Payment options. (a)
The commissioner may offer the following
payment options to an enrollee:
(1) payment by check;
(2) payment by credit card;
(3) payment by recurring automatic checking withdrawal;
(4) payment by onetime electronic transfer of funds;
(5) payment by wage withholding with the consent of the employer and the
(6) payment by using state tax refund payments.
At application or reapplication, a MinnesotaCare applicant or enrollee may authorize
the commissioner to use the Revenue Recapture Act in chapter 270A to collect funds
from the applicant's or enrollee's refund for the purposes of meeting all or part of the
applicant's or enrollee's MinnesotaCare premium obligation. The applicant or enrollee
may authorize the commissioner to apply for the state working family tax credit on behalf
of the applicant or enrollee. The setoff due under this subdivision shall not be subject to
the $10 fee under section
270A.07, subdivision 1
53.5 (b) Effective January 1, 2009, the Minnesota Health Insurance Exchange under
53.6section 62A.67 is responsible for collecting MinnesotaCare premiums.
53.7EFFECTIVE DATE.This section is effective January 1, 2009.
Sec. 13. Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision
53.10 Subd. 5. Premium discount incentive. Adults and families with children are
53.11eligible for a premium reduction of $3 per month for each child who met goals for
53.12preventive care or an adult who met goals for cardiac or diabetes care in the previous
53.13calendar year. The maximum premium reduction may not exceed $15 per month per
53.14family. The commissioner, in consultation with the Minnesota Health Insurance Exchange,
53.15shall establish specific goals for preventive care, including cardiac and diabetes care, that
53.16make an enrollee eligible for the premium reduction. The premium discount incentive is
53.17administered by the Minnesota Health Insurance Exchange under section 62A.67.
53.18EFFECTIVE DATE.This section is effective January 1, 2009.
Section 1. Minnesota Statutes 2006, section 256B.0625, subdivision 3b, is amended to
Subd. 3b. Telemedicine consultations.
Medical assistance covers telemedicine
consultations. Telemedicine consultations must be made via two-way, interactive video
or store-and-forward technology. Store-and-forward technology includes telemedicine
consultations that do not occur in real time via synchronous transmissions, and that
do not require a face-to-face encounter with the patient for all or any part of any such
telemedicine consultation. The patient record must include a written opinion from the
consulting physician providing the telemedicine consultation.
A communication between
53.30 two physicians that consists solely of a telephone conversation is not a telemedicine
Coverage is limited to three telemedicine consultations per recipient per
calendar week. Telemedicine consultations shall be paid at the full allowable rate.
53.33The commissioner shall develop policies for coverage of and payment for additional
53.34telemedicine services including patient communications by e-mail, teleconferencing,
53.35telephone consultations, and other virtual visits or consultations.
Sec. 2. STATEWIDE INFORMATION EXCHANGE.
54.2 The Minnesota health care connection is authorized to build a statewide information
54.3exchange, help organizers of local and regional data exchange efforts, and ensure that
54.4Minnesota's data exchange projects are consistent with national technology platforms
Sec. 3. PAY-FOR-USE PROGRAMS.
54.7 The commissioner of human services shall adopt pay-for-use programs that offer
54.8financial incentives to providers for the implementation and use of health care information
54.9technology in clinical practice. To be eligible for payments under this section, the
54.10information technology must meet national standards for interoperability, functionality,
54.11and security and provide clinicians with data upon which to improve the quality and
54.12safety of patient care.
Sec. 4. APPROPRIATION.
54.14 (a) $....... is appropriated from the health care access fund to the commissioner of
54.15health for the fiscal year ending June 30, 2008, to provide grants under Minnesota Statutes,
54.16section 144.3345, to health care providers in rural and underserved communities for
54.17interoperable and transferable health information technologies.
54.18 (b) $....... for the fiscal year ending June 30, 2008, and $....... for the fiscal year
54.19ending June 30, 2009, are appropriated from the general fund to the commissioner of
54.20human services for electronic health information pay-for-use programs.
Amend the title accordingly