.................... moves to amend H.F. No. 766 as follows:
Delete everything after the enacting clause and insert:
"Section 1. Minnesota Statutes 2010, section 256B.14, is amended by adding a
subdivision to read:
1.5 Subd. 3b. Spousal contribution. (a) For purposes of this subdivision, the following
1.6terms have the meanings given:
1.7(1) "commissioner" means the commissioner of human services;
1.8(2) "community spouse" means the spouse, who lives in the community, of an
1.9individual receiving long-term care services in a long-term care facility or home care
1.10services pursuant to the Medicaid waiver for elderly services under section 256B.0915
1.11or the alternative care program under section 256B.0913. A community spouse does not
1.12include a spouse living in the community who receives a monthly income allowance under
1.13section 256B.058, subdivision 2, or who receives home care services under the Medicaid
1.14waiver for elderly services under section 256B.0915 or the alternative care program under
1.16(3) "cost of care" means the actual fee for service costs or capitated payments for
1.17the long term care spouse;
1.18(4) "department" means the Department of Human Services;
1.19(5) "disabled child" means a blind or permanently and totally disabled son or
1.20daughter of any age as defined in the Supplemental Security Income program or the State
1.21Medical Review Team;
1.22(6) "income" means earned and unearned income, attributable to the community
1.23spouse, used to calculate the adjusted gross income on the prior year's income tax return.
1.24Evidence of income includes, but is not limited to, W-2 and 1099 forms; and
1.25(7) "long-term care spouse" means the spouse who is receiving long-term care
1.26services in a long-term care facility or home care services pursuant to the Medicaid waiver
2.1for elderly services under to section 256B.0915 or the alternative care program under to
2.3(b) The community spouse of a long-term care spouse who receives medical
2.4assistance or alternative care services has an obligation to contribute to the cost of care.
2.5The community spouse must pay a monthly fee on a sliding fee scale based on the
2.6community spouse's income, unless a minor or disabled child resides with and receives
2.7care from the community spouse, then no fee shall be assessed.
2.8(c) For a community spouse with an income equal to or greater than 250 percent of
2.9the federal poverty guidelines for a family of two and less than 545 percent of the federal
2.10poverty guidelines for a family of two, the spousal contribution shall be determined using
2.11a sliding fee scale established by the commissioner which begins at 7.5 percent of the
2.12community spouse's income and increases to 15 percent for those with an income of up to
2.13545 percent of the federal poverty guidelines for a family of two.
2.14(d) For a community spouse with an income equal to or greater than 545 percent of
2.15the federal poverty guidelines for a family of two and less than 750 percent of the federal
2.16poverty guidelines for a family of two, the spousal contribution shall be determined using
2.17a sliding fee scale established by the commissioner which begins at 15 percent of the
2.18community spouse's income and increases to 25 percent for those with an income of up to
2.19750 percent of the federal poverty guidelines for a family of two.
2.20(e) For a community spouse with an income equal to or greater than 750 percent of
2.21the federal poverty guidelines for a family of two and less than 975 percent of the federal
2.22poverty guidelines for a family of two, the spousal contribution shall be determined using
2.23a sliding fee scale established by the commissioner which begins at 25 percent of the
2.24community spouse's income and increases to 33 percent for those with an income of up to
2.25975 percent of the federal poverty guidelines for a family of two.
2.26(f) For a community spouse with an income equal to or greater than 975 percent of
2.27the federal poverty guidelines for a family of two, the spousal contribution shall be 33
2.28percent of the community spouse's income.
2.29(g) The spousal contribution shall be explained in writing at the time eligibility for
2.30medical assistance or alternative care is being determined. In addition to explaining the
2.31formula used to determine the fee, the commissioner shall provide written information
2.32describing how to request a variance for undue hardship, how a contribution may be
2.33reviewed or redetermined, the right to appeal a contribution determination, and that
2.34the consequences for not complying with a request to provide information shall be an
2.35assessment against the community spouse for the full cost of care for the long-term care
3.1(h) The contribution shall be assessed for each month the long-term care spouse is
3.2eligible for medical assistance or alternative care.
3.3(i) The spousal contribution shall be reviewed at least once every 12 months and
3.4when there is a loss or gain in income in excess of ten percent. Thirty days prior to a
3.5review or redetermination, written notice must be provided to the community spouse
3.6and must contain the amount the spouse is required to contribute, notice of the right to
3.7redetermination and appeal, and the telephone number of the division at the department
3.8that is responsible for redetermination and review. If, after review, the contribution amount
3.9is to be adjusted, the commissioner shall mail a written notice to the community spouse 30
3.10days in advance of the effective date of the change in the amount of the contribution.
3.11(1) The spouse shall notify the commissioner within 30 days of a gain or loss in
3.12income in excess of ten percent and provide the department supporting documentation to
3.13verify the need for redetermination of the fee.
3.14(2) When a spouse requests a review or redetermination of the contribution amount,
3.15a request for information shall be sent to the spouse within ten calendar days after the
3.16commissioner receives the request for review.
3.17(3) No action shall be taken on a review or redetermination until the required
3.18information is received by the commissioner.
3.19(4) The review of the spousal contribution shall be done within ten days after the
3.20commissioner receives completed information that verifies a loss or gain in income
3.21in excess of ten percent.
3.22(5) An increase in the contribution amount is effective in the month in which the
3.23increase in spousal income occurs.
3.24(6) A decrease in the contribution amount is effective in the month the spouse
3.25verifies the reduction in income, retroactive to no longer than six months.
3.26(j) In no case shall the spousal contribution exceed the amount of medical assistance
3.27expended or the cost of alternative care services for the care of the long-term care
3.28spouse. At the time of the review, the total amount of medical assistance paid or costs
3.29of alternative care for the care of the long-term care spouse and the total amount of the
3.30spousal contribution shall be compared. If the total amount of the spousal contribution
3.31exceeds the total amount of medical assistance expended or cost of alternative care, then
3.32the department shall reimburse the community spouse the excess amount if the long-term
3.33care spouse is no longer receiving services, or apply the excess amount to the spousal
3.34contribution due until the excess amount is exhausted.
3.35(k) A spouse who needs to retain the contribution amount for the spouse's personal
3.36medical care may request a variance for undue hardship by submitting a written request
4.1and supporting documentation to the commissioner that states why compliance with
4.2this subdivision would cause undue hardship. The commissioner shall forward to the
4.3spouse a request for financial information within 10 days after receiving a written request
4.4for a variance. A spouse must provide the commissioner with the requested financial
4.5information and any other information sufficient to verify the existence of undue hardship
4.6necessitating a waiver.
4.7(1) A spouse who requests a variance from a notice of an increase in the amount
4.8of spousal contribution shall continue to make monthly payments at the lower amount
4.9pending determination of the variance request. A spouse who requests a variance from
4.10the initial determination shall not be required to make a payment pending determination
4.11of the variance request. Payments made pending outcome of the variance request that
4.12result in overpayment shall be returned to the spouse if the community spouse is no
4.13longer receiving services or applied to the spousal contribution in the current year. If the
4.14variance is denied, the spouse shall pay the additional amount due from the effective date
4.15of the increase or the total amount due from the effective date of the original notice of
4.16determination of the spousal contribution.
4.17(2) A spouse who is granted a variance shall sign a written agreement in which the
4.18spouse agrees to report to the commissioner any changes in circumstances that gave rise
4.19to the undue hardship variance.
4.20(3) When the commissioner receives a request for a variance, written notice of a
4.21grant or denial of the variance shall be mailed to the spouse within 30 calendar days
4.22after the commissioner receives the financial information required in this paragraph. The
4.23granting of a variance will necessitate a written agreement between the spouse and the
4.24commissioner with regard to the specific terms of the variance. The variance will not
4.25become effective until the written agreement is signed by the spouse. If the commissioner
4.26denies in whole or in part the request for a variance, the denial notice shall set forth in
4.27writing the reasons for the denial that address the specific hardship and right to appeal.
4.28(4) If a variance is granted, the term of the variance shall not exceed 12 months
4.29unless otherwise determined by the commissioner.
4.30(5) Undue hardship does not include action taken by a spouse which divested or
4.31diverted income in order to avoid being assessed a spousal contribution.
4.32(l) A spouse aggrieved by an action under this subdivision has the right to appeal
4.33under subdivision 4. If the spouse appeals on or before the effective date of an increase in
4.34the spousal fee, the spouse shall continue to make payments to the commissioner in the
4.35lower amount while the appeal is pending. A spouse appealing an initial determination
4.36of a spousal contribution shall not be required to make monthly payments pending an
5.1appeal decision. Payments made that result in an overpayment shall be reimbursed to the
5.2spouse if the long-term care spouse is no longer receiving services, or applied to the
5.3spousal contribution remaining in the current year. If the commissioner's determination is
5.4affirmed, the community spouse shall pay within 90 calendar days of the order the total
5.5amount due from the effective date of the original notice of determination of the spousal
5.6contribution. The commissioner's order is binding on the spouse and the department and
5.7shall be implemented subject to section 256.045, subdivision 7. No additional notice is
5.8required to enforce the commissioner's order.
5.9(m) Actions to obtain payment shall be taken under subdivision 2.
Amend the title accordingly