Journal of the House - 94th Day - Wednesday, April 28, 2010 - Top of Page 10493


 

STATE OF MINNESOTA

 

Journal of the House

 

EIGHTY-SIXTH SESSION - 2010

 

_____________________

 

NINETY-FOURTH DAY

 

Saint Paul, Minnesota, Wednesday, April 28, 2010

 

 

      The House of Representatives convened at 2:00 p.m. and was called to order by Margaret Anderson Kelliher, Speaker of the House.

 

      Prayer was offered by the Reverend Marty Hancer, Trinity Lutheran Church, Princeton, Minnesota.

 

      The members of the House gave the pledge of allegiance to the flag of the United States of America.

 

      The roll was called and the following members were present:

 


Abeler

Anderson, B.

Anderson, P.

Anderson, S.

Anzelc

Atkins

Beard

Benson

Bigham

Bly

Brod

Brown

Brynaert

Buesgens

Bunn

Carlson

Clark

Cornish

Davids

Davnie

Dean

Demmer

Dettmer

Dill

Dittrich

Doepke

Doty

Downey

Drazkowski

Eastlund

Eken

Emmer

Falk

Faust

Fritz

Gardner

Garofalo

Gottwalt

Greiling

Gunther

Hackbarth

Hamilton

Hansen

Hausman

Hayden

Hilstrom

Hilty

Holberg

Hoppe

Hornstein

Hortman

Hosch

Howes

Huntley

Jackson

Johnson

Juhnke

Kahn

Kalin

Kath

Kelly

Kiffmeyer

Knuth

Koenen

Kohls

Laine

Lanning

Lenczewski

Lesch

Liebling

Lieder

Lillie

Loeffler

Loon

Mack

Magnus

Mahoney

Mariani

Marquart

Masin

McFarlane

McNamara

Morgan

Morrow

Mullery

Murdock

Murphy, E.

Murphy, M.

Nelson

Newton

Nornes

Norton

Obermueller

Olin

Otremba

Paymar

Pelowski

Peppin

Persell

Peterson

Poppe

Reinert

Rosenthal

Rukavina

Ruud

Sailer

Sanders

Scalze

Scott

Seifert

Severson

Shimanski

Simon

Slawik

Slocum

Smith

Solberg

Sterner

Swails

Thao

Thissen

Tillberry

Torkelson

Urdahl

Wagenius

Ward

Welti

Westrom

Winkler

Zellers

Spk. Kelliher


 

      A quorum was present.

 

      Champion, Haws and Sertich were excused.

 

      The Chief Clerk proceeded to read the Journal of the preceding day.  Hausman moved that further reading of the Journal be dispensed with and that the Journal be approved as corrected by the Chief Clerk.  The motion prevailed.


Journal of the House - 94th Day - Wednesday, April 28, 2010 - Top of Page 10494


REPORTS OF CHIEF CLERK

 

      S. F. No. 184 and H. F. No. 3448, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Rukavina moved that the rules be so far suspended that S. F. No. 184 be substituted for H. F. No. 3448 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 345 and H. F. No. 1005, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Reinert moved that the rules be so far suspended that S. F. No. 345 be substituted for H. F. No. 1005 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 560 and H. F. No. 891, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Champion moved that the rules be so far suspended that S. F. No. 560 be substituted for H. F. No. 891 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 1060 and H. F. No. 605, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Hortman moved that the rules be so far suspended that S. F. No. 1060 be substituted for H. F. No. 605 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 1905 and H. F. No. 2163, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Loeffler moved that the rules be so far suspended that S. F. No. 1905 be substituted for H. F. No. 2163 and that the House File be indefinitely postponed.  The motion prevailed.


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                S. F. No. 2493 and H. F. No. 2470, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Hilstrom moved that the rules be so far suspended that S. F. No. 2493 be substituted for H. F. No. 2470 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 2510 and H. F. No. 2781, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Obermueller moved that the rules be so far suspended that S. F. No. 2510 be substituted for H. F. No. 2781 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 2756 and H. F. No. 3168, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Nelson moved that the rules be so far suspended that S. F. No. 2756 be substituted for H. F. No. 3168 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 2880 and H. F. No. 2990, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Hilstrom moved that the rules be so far suspended that S. F. No. 2880 be substituted for H. F. No. 2990 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

      S. F. No. 3046 and H. F. No. 3429, which had been referred to the Chief Clerk for comparison, were examined and found to be identical with certain exceptions.

 

SUSPENSION OF RULES

 

      Welti moved that the rules be so far suspended that S. F. No. 3046 be substituted for H. F. No. 3429 and that the House File be indefinitely postponed.  The motion prevailed.

 

 

PETITIONS AND COMMUNICATIONS

 

 

      The following communications were received:


Journal of the House - 94th Day - Wednesday, April 28, 2010 - Top of Page 10496


STATE OF MINNESOTA

OFFICE OF THE GOVERNOR

SAINT PAUL 55155

 

April 22, 2010

 

The Honorable Margaret Anderson Kelliher

Speaker of the House of Representatives

The State of Minnesota

 

Dear Speaker Kelliher:

 

      Please be advised that I have received, approved, signed, and deposited in the Office of the Secretary of State the following House Files: 

 

      H. F. No. 3405, relating to human services; modifying the commissioner's duties related to the state medical review team.

 

      H. F. No. 3151, relating to mortuary science; modifying provisions related to viewing, transporting, and removal of a dead human body.

 

      H. F. No. 776, relating to judgments; enacting the Uniform Foreign-Country Money Judgments Recognition Act adopted and recommended for passage by the National Conference of Commissioners on Uniform State Laws.

 

      H. F. No. 1692, relating to dispute resolution; providing for arbitration of disputes; adopting the Uniform Arbitration Act.

 

      H. F. No. 2851, relating to highways; removing Route No. 297 and a portion of Route No. 332 from trunk highway system.

 

      H. F. No. 3096, relating to state procurement; modifying provisions governing the provision of services by rehabilitation facilities, extended employment providers, and day training and habilitation service programs.

 

      H. F. No. 3393, relating to real property; amending the Minnesota Common Interest Ownership Act; making clarifying, conforming, and technical changes.

 

 

                                                                                                                                Sincerely,

 

                                                                                                                                Tim Pawlenty

                                                                                                                                Governor

 

 

STATE OF MINNESOTA

OFFICE OF THE SECRETARY OF STATE

ST. PAUL 55155

 

 

The Honorable Margaret Anderson Kelliher

Speaker of the House of Representatives

 

The Honorable James P. Metzen

President of the Senate

 

      I have the honor to inform you that the following enrolled Acts of the 2010 Session of the State Legislature have been received from the Office of the Governor and are deposited in the Office of the Secretary of State for preservation, pursuant to the State Constitution, Article IV, Section 23:


Journal of the House - 94th Day - Wednesday, April 28, 2010 - Top of Page 10497


 

S. F.

No.

 

H. F.

No.

 

Session Laws

Chapter No.

Time and

Date Approved

2010

 

Date Filed

2010

 

      2808                                               255                                        11:42 a.m. April 22                                April 22

      3116                                               256                                        11:43 a.m. April 22                                April 22

      2572                                               257                                        11:45 a.m. April 22                                April 22

      2152                                               258                                        11:56 a.m. April 22                                April 22

      2363                                               259                                        11:57 a.m. April 22                                April 22

      2944                                               260                                        11:58 a.m. April 22                                April 22

                                3405                     261                                        11:59 a.m. April 22                                April 22

                                3151                     262                                          4:03 p.m. April 22                                April 22

                                  776                     263                                        12:21 p.m. April 22                                April 22

                                1692                     264                                        12:28 p.m. April 22                                April 22

                                2851                     265                                        12:29 p.m. April 22                                April 22

                                3096                     266                                        12:30 p.m. April 22                                April 22

                                3393                     267                                        12:31 p.m. April 22                                April 22

      2339                                               268                                        12:37 p.m. April 22                                April 22

      2690                                               269                                        12:22 p.m. April 22                                April 22

      2717                                               270                                        12:27 p.m. April 22                                April 22

 

 

                                                                                                                                Sincerely,

 

                                                                                                                                Mark Ritchie

                                                                                                                                Secretary of State

 

 

REPORTS OF STANDING COMMITTEES AND DIVISIONS

 

 

Solberg from the Committee on Ways and Means to which was referred:

 

H. F. No. 2562, A bill for an act relating to human services; extending eligibility for the COBRA premium state subsidy; authorizing carryforward of unexpended funds for COBRA grants; changing appropriations; amending Laws 2009, chapter 79, article 5, section 78, subdivision 5; article 13, section 3, subdivision 6.

 

Reported the same back with the recommendation that the bill pass.

 

      The report was adopted.

 

 

Carlson from the Committee on Finance to which was referred:

 

H. F. No. 2614, A bill for an act relating to human services; establishing an intensive care management program for medical assistance enrollees; reducing funding for the medical assistance program; requiring a request for proposals; requiring a report; appropriating money; amending Laws 2009, chapter 79, article 13, section 3, subdivision 6, as amended; proposing coding for new law in Minnesota Statutes, chapter 256B.

 

Reported the same back with the following amendments:


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Delete everything after the enacting clause and insert:

 

"ARTICLE 1

 

DHS LICENSING

 

Section 1.  Minnesota Statutes 2009 Supplement, section 245C.27, subdivision 1, is amended to read:

 

Subdivision 1.  Fair hearing when disqualification is not set aside rescinded.  (a) If the commissioner does not set aside rescind a disqualification of an individual under section 245C.22 who is disqualified on the basis of a preponderance of evidence that the individual committed an act or acts that meet the definition of any of the crimes listed in section 245C.15; for a determination under section 626.556 or 626.557 of substantiated maltreatment that was serious or recurring under section 245C.15; or for failure to make required reports under section 626.556, subdivision 3; or 626.557, subdivision 3, pursuant to section 245C.15, subdivision 4, paragraph (b), clause (1), the individual may request a fair hearing under section 256.045, unless the disqualification is deemed conclusive under section 245C.29.

 

(b) The fair hearing is the only administrative appeal of the final agency determination for purposes of appeal by the disqualified individual.  The disqualified individual does not have the right to challenge the accuracy and completeness of data under section 13.04.

 

(c) Except as provided under paragraph (e), if the individual was disqualified based on a conviction of, admission to, or Alford Plea to any crimes listed in section 245C.15, subdivisions 1 to 4, or for a disqualification under section 256.98, subdivision 8, the reconsideration decision under section 245C.22 is the final agency determination for purposes of appeal by the disqualified individual and is not subject to a hearing under section 256.045.  If the individual was disqualified based on a judicial determination, that determination is treated the same as a conviction for purposes of appeal.

 

(d) This subdivision does not apply to a public employee's appeal of a disqualification under section 245C.28, subdivision 3.

 

(e) Notwithstanding paragraph (c), if the commissioner does not set aside a disqualification of an individual who was disqualified based on both a preponderance of evidence and a conviction or admission, the individual may request a fair hearing under section 256.045, unless the disqualifications are deemed conclusive under section 245C.29.  The scope of the hearing conducted under section 256.045 with regard to the disqualification based on a conviction or admission shall be limited solely to whether the individual poses a risk of harm, according to section 256.045, subdivision 3b.  In this case, the reconsideration decision under section 245C.22 is not the final agency decision for purposes of appeal by the disqualified individual.

 

Sec. 2.  Minnesota Statutes 2008, section 245C.27, subdivision 2, is amended to read:

 

Subd. 2.  Consolidated fair hearing.  (a) If an individual who is disqualified on the bases of serious or recurring maltreatment requests a fair hearing on the maltreatment determination under section 626.556, subdivision 10i, or 626.557, subdivision 9d, and requests a fair hearing under this section on the disqualification, which has not been set aside rescinded, the scope of the fair hearing under section 256.045 shall include the maltreatment determination and the disqualification. 

 

(b) A fair hearing is the only administrative appeal of the final agency determination.  The disqualified individual does not have the right to challenge the accuracy and completeness of data under section 13.04. 


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(c) This subdivision does not apply to a public employee's appeal of a disqualification under section 245C.28, subdivision 3. 

 

Sec. 3.  Minnesota Statutes 2008, section 245C.28, subdivision 3, is amended to read:

 

Subd. 3.  Employees of public employer.  (a) If the commissioner does not set aside rescind the disqualification of an individual who is an employee of an employer, as defined in section 179A.03, subdivision 15, the individual may request a contested case hearing under chapter 14, unless the disqualification is deemed conclusive under section 245C.29.  The request for a contested case hearing must be made in writing and must be postmarked and sent within 30 calendar days after the employee receives notice that the disqualification has not been set aside rescinded.  If the individual was disqualified based on a conviction or admission to any crimes listed in section 245C.15, the scope of the contested case hearing shall be limited solely to whether the individual poses a risk of harm pursuant to section 245C.22.

 

(b) If the commissioner does not set aside rescind a disqualification that is based on a maltreatment determination, the scope of the contested case hearing must include the maltreatment determination and the disqualification.  In such cases, a fair hearing must not be conducted under section 256.045.

 

(c) If the commissioner does not rescind a disqualification that is based on a preponderance of evidence that the individual committed an act or acts that meet the definition of any of the crimes listed in section 245C.15, the scope of the contested case hearing must include the disqualification decision.  In such cases, a fair hearing must not be conducted under section 256.045.

 

(c) (d) Rules adopted under this chapter may not preclude an employee in a contested case hearing for a disqualification from submitting evidence concerning information gathered under this chapter.

 

(d) (e) When an individual has been disqualified from multiple licensed programs and the disqualifications have not been set aside rescinded under section 245C.22, if at least one of the disqualifications entitles the person to a contested case hearing under this subdivision, the scope of the contested case hearing shall include all disqualifications from licensed programs which were not set aside rescinded.

 

(e) (f) In determining whether the disqualification should be set aside, the administrative law judge shall consider all of the characteristics that cause the individual to be disqualified in order to determine whether the individual poses a risk of harm.  The administrative law judge's recommendation and the commissioner's order to set aside a disqualification that is the subject of the hearing constitutes a determination that the individual does not pose a risk of harm and that the individual may provide direct contact services in the individual program specified in the set aside.

 

Sec. 4.  Minnesota Statutes 2009 Supplement, section 256.045, subdivision 3, is amended to read:

 

Subd. 3.  State agency hearings.  (a) State agency hearings are available for the following:

 

(1) any person applying for, receiving or having received public assistance, medical care, or a program of social services granted by the state agency or a county agency or the federal Food Stamp Act whose application for assistance is denied, not acted upon with reasonable promptness, or whose assistance is suspended, reduced, terminated, or claimed to have been incorrectly paid;

 

(2) any patient or relative aggrieved by an order of the commissioner under section 252.27;

 

(3) a party aggrieved by a ruling of a prepaid health plan;


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(4) except as provided under chapter 245C, any individual or facility determined by a lead agency to have maltreated a vulnerable adult under section 626.557 after they have exercised their right to administrative reconsideration under section 626.557;

 

(5) any person whose claim for foster care payment according to a placement of the child resulting from a child protection assessment under section 626.556 is denied or not acted upon with reasonable promptness, regardless of funding source;

 

(6) any person to whom a right of appeal according to this section is given by other provision of law;

 

(7) an applicant aggrieved by an adverse decision to an application for a hardship waiver under section 256B.15;

 

(8) an applicant aggrieved by an adverse decision to an application or redetermination for a Medicare Part D prescription drug subsidy under section 256B.04, subdivision 4a;

 

(9) except as provided under chapter 245A, an individual or facility determined to have maltreated a minor under section 626.556, after the individual or facility has exercised the right to administrative reconsideration under section 626.556;

 

(10) except as provided under chapter 245C, an individual disqualified under sections 245C.14 and 245C.15, which has not been set aside rescinded under sections 245C.22 and 245C.23, on the basis of serious or recurring maltreatment; a preponderance of the evidence that the individual has committed an act or acts that meet the definition of any of the crimes listed in section 245C.15, subdivisions 1 to 4; or for failing to make reports required under section 626.556, subdivision 3, or 626.557, subdivision 3.  Hearings regarding a maltreatment determination under clause (4) or (9) and a disqualification under this clause in which the basis for a disqualification is serious or recurring maltreatment, which has not been set aside rescinded under sections 245C.22 and 245C.23, shall be consolidated into a single fair hearing.  In such cases, the scope of review by the human services referee shall include both the maltreatment determination and the disqualification.  The failure to exercise the right to an administrative reconsideration shall not be a bar to a hearing under this section if federal law provides an individual the right to a hearing to dispute a finding of maltreatment.  Individuals and organizations specified in this section may contest the specified action, decision, or final disposition before the state agency by submitting a written request for a hearing to the state agency within 30 days after receiving written notice of the action, decision, or final disposition, or within 90 days of such written notice if the applicant, recipient, patient, or relative shows good cause why the request was not submitted within the 30-day time limit; or

 

(11) any person with an outstanding debt resulting from receipt of public assistance, medical care, or the federal Food Stamp Act who is contesting a setoff claim by the Department of Human Services or a county agency.  The scope of the appeal is the validity of the claimant agency's intention to request a setoff of a refund under chapter 270A against the debt.

 

(b) The hearing for an individual or facility under paragraph (a), clause (4), (9), or (10), is the only administrative appeal to the final agency determination specifically, including a challenge to the accuracy and completeness of data under section 13.04.  Hearings requested under paragraph (a), clause (4), apply only to incidents of maltreatment that occur on or after October 1, 1995.  Hearings requested by nursing assistants in nursing homes alleged to have maltreated a resident prior to October 1, 1995, shall be held as a contested case proceeding under the provisions of chapter 14.  Hearings requested under paragraph (a), clause (9), apply only to incidents of maltreatment that occur on or after July 1, 1997.  A hearing for an individual or facility under paragraph (a), clause (9), is only available when there is no juvenile court or adult criminal action pending.  If such action is filed in either court while an administrative review is pending, the administrative review must be suspended until the judicial actions are completed.  If the juvenile court action or criminal charge is dismissed or the criminal action overturned, the matter may be considered in an administrative hearing.


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(c) For purposes of this section, bargaining unit grievance procedures are not an administrative appeal.

 

(d) The scope of hearings involving claims to foster care payments under paragraph (a), clause (5), shall be limited to the issue of whether the county is legally responsible for a child's placement under court order or voluntary placement agreement and, if so, the correct amount of foster care payment to be made on the child's behalf and shall not include review of the propriety of the county's child protection determination or child placement decision.

 

(e) A vendor of medical care as defined in section 256B.02, subdivision 7, or a vendor under contract with a county agency to provide social services is not a party and may not request a hearing under this section, except if assisting a recipient as provided in subdivision 4.

 

(f) An applicant or recipient is not entitled to receive social services beyond the services prescribed under chapter 256M or other social services the person is eligible for under state law.

 

(g) The commissioner may summarily affirm the county or state agency's proposed action without a hearing when the sole issue is an automatic change due to a change in state or federal law.

 

Sec. 5.  Minnesota Statutes 2008, section 626.556, subdivision 10i, is amended to read:

 

Subd. 10i.  Administrative reconsideration; review panel.  (a) Administrative reconsideration is not applicable in family assessments since no determination concerning maltreatment is made.  For investigations, except as provided under paragraph (e), an individual or facility that the commissioner of human services, a local social service agency, or the commissioner of education determines has maltreated a child, an interested person acting on behalf of the child, regardless of the determination, who contests the investigating agency's final determination regarding maltreatment, may request the investigating agency to reconsider its final determination regarding maltreatment.  The request for reconsideration must be submitted in writing to the investigating agency within 15 calendar days after receipt of notice of the final determination regarding maltreatment or, if the request is made by an interested person who is not entitled to notice, within 15 days after receipt of the notice by the parent or guardian of the child.  If mailed, the request for reconsideration must be postmarked and sent to the investigating agency within 15 calendar days of the individual's or facility's receipt of the final determination.  If the request for reconsideration is made by personal service, it must be received by the investigating agency within 15 calendar days after the individual's or facility's receipt of the final determination.  Effective January 1, 2002, an individual who was determined to have maltreated a child under this section and who was disqualified on the basis of serious or recurring maltreatment under sections 245C.14 and 245C.15, may request reconsideration of the maltreatment determination and the disqualification.  The request for reconsideration of the maltreatment determination and the disqualification must be submitted within 30 calendar days of the individual's receipt of the notice of disqualification under sections 245C.16 and 245C.17.  If mailed, the request for reconsideration of the maltreatment determination and the disqualification must be postmarked and sent to the investigating agency within 30 calendar days of the individual's receipt of the maltreatment determination and notice of disqualification.  If the request for reconsideration is made by personal service, it must be received by the investigating agency within 30 calendar days after the individual's receipt of the notice of disqualification.

 

(b) Except as provided under paragraphs (e) and (f), if the investigating agency denies the request or fails to act upon the request within 15 working days after receiving the request for reconsideration, the person or facility entitled to a fair hearing under section 256.045 may submit to the commissioner of human services or the commissioner of education a written request for a hearing under that section.  Section 256.045 also governs hearings requested to contest a final determination of the commissioner of education.  For reports involving maltreatment of a child in a facility, an interested person acting on behalf of the child may request a review by the Child Maltreatment Review Panel under section 256.022 if the investigating agency denies the request or fails to act upon the request or if the interested person contests a reconsidered determination.  The investigating agency shall notify persons who


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request reconsideration of their rights under this paragraph.  The request must be submitted in writing to the review panel and a copy sent to the investigating agency within 30 calendar days of receipt of notice of a denial of a request for reconsideration or of a reconsidered determination.  The request must specifically identify the aspects of the agency determination with which the person is dissatisfied.

 

(c) If, as a result of a reconsideration or review, the investigating agency changes the final determination of maltreatment, that agency shall notify the parties specified in subdivisions 10b, 10d, and 10f.

 

(d) Except as provided under paragraph (f), if an individual or facility contests the investigating agency's final determination regarding maltreatment by requesting a fair hearing under section 256.045, the commissioner of human services shall assure that the hearing is conducted and a decision is reached within 90 days of receipt of the request for a hearing.  The time for action on the decision may be extended for as many days as the hearing is postponed or the record is held open for the benefit of either party.

 

(e) Effective January 1, 2002, If an individual was disqualified under sections 245C.14 and 245C.15, on the basis of a determination of maltreatment, which was serious or recurring, and the individual has requested reconsideration of the maltreatment determination under paragraph (a) and requested reconsideration of the disqualification under sections 245C.21 to 245C.27, reconsideration of the maltreatment determination and reconsideration of the disqualification shall be consolidated into a single reconsideration.  If reconsideration of the maltreatment determination is denied or the disqualification is not set aside rescinded under sections 245C.21 to 245C.27, the individual may request a fair hearing under section 256.045.  If an individual requests a fair hearing on the maltreatment determination and the disqualification, the scope of the fair hearing shall include both the maltreatment determination and the disqualification.

 

(f) Effective January 1, 2002, If a maltreatment determination or a disqualification based on serious or recurring maltreatment is the basis for a denial of a license under section 245A.05 or a licensing sanction under section 245A.07, the license holder has the right to a contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612.  As provided for under section 245A.08, subdivision 2a, the scope of the contested case hearing shall include the maltreatment determination, disqualification, and licensing sanction or denial of a license.  In such cases, a fair hearing regarding the maltreatment determination and disqualification shall not be conducted under section 256.045.  Except for family child care and child foster care, reconsideration of a maltreatment determination as provided under this subdivision, and reconsideration of a disqualification as provided under section 245C.22, shall also not be conducted when:

 

(1) a denial of a license under section 245A.05 or a licensing sanction under section 245A.07, is based on a determination that the license holder is responsible for maltreatment or the disqualification of a license holder based on serious or recurring maltreatment;

 

(2) the denial of a license or licensing sanction is issued at the same time as the maltreatment determination or disqualification; and

 

(3) the license holder appeals the maltreatment determination or disqualification, and denial of a license or licensing sanction. 

 

Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment determination or disqualification, but does not appeal the denial of a license or a licensing sanction, reconsideration of the maltreatment determination shall be conducted under sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the disqualification shall be conducted under section 245C.22.  In such cases, a fair hearing shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.


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If the disqualified subject is an individual other than the license holder and upon whom a background study must be conducted under chapter 245C, the hearings of all parties may be consolidated into a single contested case hearing upon consent of all parties and the administrative law judge.

 

(g) For purposes of this subdivision, "interested person acting on behalf of the child" means a parent or legal guardian; stepparent; grandparent; guardian ad litem; adult stepbrother, stepsister, or sibling; or adult aunt or uncle; unless the person has been determined to be the perpetrator of the maltreatment.

 

Sec. 6.  Minnesota Statutes 2008, section 626.557, subdivision 9d, is amended to read:

 

Subd. 9d.  Administrative reconsideration; review panel.  (a) Except as provided under paragraph (e), any individual or facility which a lead agency determines has maltreated a vulnerable adult, or the vulnerable adult or an interested person acting on behalf of the vulnerable adult, regardless of the lead agency's determination, who contests the lead agency's final disposition of an allegation of maltreatment, may request the lead agency to reconsider its final disposition.  The request for reconsideration must be submitted in writing to the lead agency within 15 calendar days after receipt of notice of final disposition or, if the request is made by an interested person who is not entitled to notice, within 15 days after receipt of the notice by the vulnerable adult or the vulnerable adult's legal guardian.  If mailed, the request for reconsideration must be postmarked and sent to the lead agency within 15 calendar days of the individual's or facility's receipt of the final disposition.  If the request for reconsideration is made by personal service, it must be received by the lead agency within 15 calendar days of the individual's or facility's receipt of the final disposition.  An individual who was determined to have maltreated a vulnerable adult under this section and who was disqualified on the basis of serious or recurring maltreatment under sections 245C.14 and 245C.15, may request reconsideration of the maltreatment determination and the disqualification.  The request for reconsideration of the maltreatment determination and the disqualification must be submitted in writing within 30 calendar days of the individual's receipt of the notice of disqualification under sections 245C.16 and 245C.17.  If mailed, the request for reconsideration of the maltreatment determination and the disqualification must be postmarked and sent to the lead agency within 30 calendar days of the individual's receipt of the notice of disqualification.  If the request for reconsideration is made by personal service, it must be received by the lead agency within 30 calendar days after the individual's receipt of the notice of disqualification.

 

(b) Except as provided under paragraphs (e) and (f), if the lead agency denies the request or fails to act upon the request within 15 working days after receiving the request for reconsideration, the person or facility entitled to a fair hearing under section 256.045, may submit to the commissioner of human services a written request for a hearing under that statute.  The vulnerable adult, or an interested person acting on behalf of the vulnerable adult, may request a review by the Vulnerable Adult Maltreatment Review Panel under section 256.021 if the lead agency denies the request or fails to act upon the request, or if the vulnerable adult or interested person contests a reconsidered disposition.  The lead agency shall notify persons who request reconsideration of their rights under this paragraph.  The request must be submitted in writing to the review panel and a copy sent to the lead agency within 30 calendar days of receipt of notice of a denial of a request for reconsideration or of a reconsidered disposition.  The request must specifically identify the aspects of the agency determination with which the person is dissatisfied.

 

(c) If, as a result of a reconsideration or review, the lead agency changes the final disposition, it shall notify the parties specified in subdivision 9c, paragraph (d).

 

(d) For purposes of this subdivision, "interested person acting on behalf of the vulnerable adult" means a person designated in writing by the vulnerable adult to act on behalf of the vulnerable adult, or a legal guardian or conservator or other legal representative, a proxy or health care agent appointed under chapter 145B or 145C, or an individual who is related to the vulnerable adult, as defined in section 245A.02, subdivision 13.

 

(e) If an individual was disqualified under sections 245C.14 and 245C.15, on the basis of a determination of maltreatment, which was serious or recurring, and the individual has requested reconsideration of the maltreatment determination under paragraph (a) and reconsideration of the disqualification under sections 245C.21 to 245C.27, reconsideration of the maltreatment determination and requested reconsideration of the disqualification shall be


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consolidated into a single reconsideration.  If reconsideration of the maltreatment determination is denied or if the disqualification is not set aside rescinded under sections 245C.21 to 245C.27, the individual may request a fair hearing under section 256.045.  If an individual requests a fair hearing on the maltreatment determination and the disqualification, the scope of the fair hearing shall include both the maltreatment determination and the disqualification.

 

(f) If a maltreatment determination or a disqualification based on serious or recurring maltreatment is the basis for a denial of a license under section 245A.05 or a licensing sanction under section 245A.07, the license holder has the right to a contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612.  As provided for under section 245A.08, the scope of the contested case hearing must include the maltreatment determination, disqualification, and licensing sanction or denial of a license.  In such cases, a fair hearing must not be conducted under section 256.045.  Except for family child care and child foster care, reconsideration of a maltreatment determination under this subdivision, and reconsideration of a disqualification under section 245C.22, must not be conducted when:

 

(1) a denial of a license under section 245A.05, or a licensing sanction under section 245A.07, is based on a determination that the license holder is responsible for maltreatment or the disqualification of a license holder based on serious or recurring maltreatment;

 

(2) the denial of a license or licensing sanction is issued at the same time as the maltreatment determination or disqualification; and

 

(3) the license holder appeals the maltreatment determination or disqualification, and denial of a license or licensing sanction.

 

Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment determination or disqualification, but does not appeal the denial of a license or a licensing sanction, reconsideration of the maltreatment determination shall be conducted under sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the disqualification shall be conducted under section 245C.22.  In such cases, a fair hearing shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.

 

If the disqualified subject is an individual other than the license holder and upon whom a background study must be conducted under chapter 245C, the hearings of all parties may be consolidated into a single contested case hearing upon consent of all parties and the administrative law judge.

 

(g) Until August 1, 2002, an individual or facility that was determined by the commissioner of human services or the commissioner of health to be responsible for neglect under section 626.5572, subdivision 17, after October 1, 1995, and before August 1, 2001, that believes that the finding of neglect does not meet an amended definition of neglect may request a reconsideration of the determination of neglect.  The commissioner of human services or the commissioner of health shall mail a notice to the last known address of individuals who are eligible to seek this reconsideration.  The request for reconsideration must state how the established findings no longer meet the elements of the definition of neglect.  The commissioner shall review the request for reconsideration and make a determination within 15 calendar days.  The commissioner's decision on this reconsideration is the final agency action.

 

(1) For purposes of compliance with the data destruction schedule under subdivision 12b, paragraph (d), when a finding of substantiated maltreatment has been changed as a result of a reconsideration under this paragraph, the date of the original finding of a substantiated maltreatment must be used to calculate the destruction date.


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(2) For purposes of any background studies under chapter 245C, when a determination of substantiated maltreatment has been changed as a result of a reconsideration under this paragraph, any prior disqualification of the individual under chapter 245C that was based on this determination of maltreatment shall be rescinded, and for future background studies under chapter 245C the commissioner must not use the previous determination of substantiated maltreatment as a basis for disqualification or as a basis for referring the individual's maltreatment history to a health-related licensing board under section 245C.31.

 

ARTICLE 2

 

HEALTH CARE

 

Section 1.  Minnesota Statutes 2008, section 144.291, subdivision 2, is amended to read:

 

Subd. 2.  Definitions.  For the purposes of sections 144.291 to 144.298, the following terms have the meanings given.

 

(a) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.

 

(b) "Health information exchange" means a legal arrangement between health care providers and group purchasers to enable and oversee the business and legal issues involved in the electronic exchange of health records between the entities for the delivery of patient care.

 

(c) "Health record" means any information, whether oral or recorded in any form or medium, that relates to the past, present, or future physical or mental health or condition of a patient; the provision of health care to a patient; or the past, present, or future payment for the provision of health care to a patient.

 

(d) "Identifying information" means the patient's name, address, date of birth, gender, parent's or guardian's name regardless of the age of the patient, and other nonclinical data which can be used to uniquely identify a patient.

 

(e) "Individually identifiable form" means a form in which the patient is or can be identified as the subject of the health records.

 

(f) "Medical emergency" means medically necessary care which is immediately needed to preserve life, prevent serious impairment to bodily functions, organs, or parts, or prevent placing the physical or mental health of the patient in serious jeopardy.

 

(g) "Patient" means a natural person who has received health care services from a provider for treatment or examination of a medical, psychiatric, or mental condition, the surviving spouse and parents of a deceased patient, or a person the patient appoints in writing as a representative, including a health care agent acting according to chapter 145C, unless the authority of the agent has been limited by the principal in the principal's health care directive.  Except for minors who have received health care services under sections 144.341 to 144.347, in the case of a minor, patient includes a parent or guardian, or a person acting as a parent or guardian in the absence of a parent or guardian.

 

(h) "Provider" means: 

 

(1) any person who furnishes health care services and is regulated to furnish the services under chapter 147, 147A, 147B, 147C, 147D, 148, 148B, 148C, 148D, 150A, 151, 153, or 153A;

 

(2) a home care provider licensed under section 144A.46;


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(3) a health care facility licensed under this chapter or chapter 144A;

 

(4) a physician assistant registered under chapter 147A; and

 

(5) an unlicensed mental health practitioner regulated under sections 148B.60 to 148B.71.

 

(i) "Record locator service" means an electronic index of patient identifying information that directs providers in a health information exchange to the location of patient health records held by providers and group purchasers.

 

(j) "Related health care entity" means an affiliate, as defined in section 144.6521, subdivision 3, paragraph (b), of the provider releasing the health records, including, but not limited to, affiliates of providers participating in a coordinated care delivery system established under section 256D.031, subdivision 6.

 

Sec. 2.  Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision to read:

 

Subd. 30.  Review and evaluation of studies.  The commissioner shall review all published studies, reports, and program evaluations completed by the Department of Human Services, and those requested by the legislature but not completed, for state fiscal years 2000 through 2010.  For each item, the commissioner shall report the legislature's original appropriation for that work, if any, and the actual reported cost of the completed work by the Department of Human Services.  The commissioner shall make recommendations to the legislature about which studies, reports, and program evaluations required by law are duplicative, unnecessary, or obsolete.  The commissioner shall repeat this review every five fiscal years.

 

Sec. 3.  Minnesota Statutes 2008, section 256.9657, subdivision 3, is amended to read:

 

Subd. 3.  Surcharge on HMOs and community integrated service networks.  (a) Effective October 1, 1992, each health maintenance organization with a certificate of authority issued by the commissioner of health under chapter 62D and each community integrated service network licensed by the commissioner under chapter 62N shall pay to the commissioner of human services a surcharge equal to six-tenths of one percent of the total premium revenues of the health maintenance organization or community integrated service network as reported to the commissioner of health according to the schedule in subdivision 4.

 

(b) Effective June 1, 2010:  (1) the surcharge under paragraph (a) is increased to 2.5 percent; and (2) each county-based purchasing plan authorized under section 256B.692 shall pay to the commissioner a surcharge equal to 2.5 percent of the total premium revenues of the plan, as reported to the commissioner of health, according to the payment schedule in subdivision 4.

 

(c) For purposes of this subdivision, total premium revenue means:

 

(1) premium revenue recognized on a prepaid basis from individuals and groups for provision of a specified range of health services over a defined period of time which is normally one month, excluding premiums paid to a health maintenance organization or community integrated service network from the Federal Employees Health Benefit Program;

 

(2) premiums from Medicare wrap-around subscribers for health benefits which supplement Medicare coverage;

 

(3) Medicare revenue, as a result of an arrangement between a health maintenance organization or a community integrated service network and the Centers for Medicare and Medicaid Services of the federal Department of Health and Human Services, for services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and 1395w-24, respectively, as they may be amended from time to time; and


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(4) medical assistance revenue, as a result of an arrangement between a health maintenance organization or community integrated service network and a Medicaid state agency, for services to a medical assistance beneficiary.

 

If advance payments are made under clause (1) or (2) to the health maintenance organization or community integrated service network for more than one reporting period, the portion of the payment that has not yet been earned must be treated as a liability.

 

(c) (d) When a health maintenance organization or community integrated service network merges or consolidates with or is acquired by another health maintenance organization or community integrated service network, the surviving corporation or the new corporation shall be responsible for the annual surcharge originally imposed on each of the entities or corporations subject to the merger, consolidation, or acquisition, regardless of whether one of the entities or corporations does not retain a certificate of authority under chapter 62D or a license under chapter 62N.

 

(d) (e) Effective July 1 of each year, the surviving corporation's or the new corporation's surcharge shall be based on the revenues earned in the second previous calendar year by all of the entities or corporations subject to the merger, consolidation, or acquisition regardless of whether one of the entities or corporations does not retain a certificate of authority under chapter 62D or a license under chapter 62N until the total premium revenues of the surviving corporation include the total premium revenues of all the merged entities as reported to the commissioner of health.

 

(e) (f) When a health maintenance organization or community integrated service network, which is subject to liability for the surcharge under this chapter, transfers, assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer of the health maintenance organization or community integrated service network.

 

(f) (g) In the event a health maintenance organization or community integrated service network converts its licensure to a different type of entity subject to liability for the surcharge under this chapter, but survives in the same or substantially similar form, the surviving entity remains liable for the surcharge regardless of whether one of the entities or corporations does not retain a certificate of authority under chapter 62D or a license under chapter 62N.

 

(g) (h) The surcharge assessed to a health maintenance organization or community integrated service network ends when the entity ceases providing services for premiums and the cessation is not connected with a merger, consolidation, acquisition, or conversion.

 

EFFECTIVE DATE.  This section is effective June 1, 2010.

 

Sec. 4.  Minnesota Statutes 2009 Supplement, section 256.969, subdivision 3a, is amended to read:

 

Subd. 3a.  Payments.  (a) Acute care hospital billings under the medical assistance program must not be submitted until the recipient is discharged.  However, the commissioner shall establish monthly interim payments for inpatient hospitals that have individual patient lengths of stay over 30 days regardless of diagnostic category.  Except as provided in section 256.9693, medical assistance reimbursement for treatment of mental illness shall be reimbursed based on diagnostic classifications.  Individual hospital payments established under this section and sections 256.9685, 256.9686, and 256.9695, in addition to third party and recipient liability, for discharges occurring during the rate year shall not exceed, in aggregate, the charges for the medical assistance covered inpatient services paid for the same period of time to the hospital.  This payment limitation shall be calculated separately for medical assistance and general assistance medical care services.  The limitation on general assistance medical care shall be effective for admissions occurring on or after July 1, 1991.  Services that have rates established under subdivision 11 or 12, must be limited separately from other services.  After consulting with the affected hospitals, the commissioner may consider related hospitals one entity and may merge the payment rates while maintaining separate provider


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numbers.  The operating and property base rates per admission or per day shall be derived from the best Medicare and claims data available when rates are established.  The commissioner shall determine the best Medicare and claims data, taking into consideration variables of recency of the data, audit disposition, settlement status, and the ability to set rates in a timely manner.  The commissioner shall notify hospitals of payment rates by December 1 of the year preceding the rate year.  The rate setting data must reflect the admissions data used to establish relative values.  Base year changes from 1981 to the base year established for the rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited to the limits ending June 30, 1987, on the maximum rate of increase under subdivision 1.  The commissioner may adjust base year cost, relative value, and case mix index data to exclude the costs of services that have been discontinued by the October 1 of the year preceding the rate year or that are paid separately from inpatient services.  Inpatient stays that encompass portions of two or more rate years shall have payments established based on payment rates in effect at the time of admission unless the date of admission preceded the rate year in effect by six months or more.  In this case, operating payment rates for services rendered during the rate year in effect and established based on the date of admission shall be adjusted to the rate year in effect by the hospital cost index.

 

(b) For fee-for-service admissions occurring on or after July 1, 2002, the total payment, before third-party liability and spenddown, made to hospitals for inpatient services is reduced by .5 percent from the current statutory rates.

 

(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service admissions occurring on or after July 1, 2003, made to hospitals for inpatient services before third-party liability and spenddown, is reduced five percent from the current statutory rates.  Mental health services within diagnosis related groups 424 to 432, and facilities defined under subdivision 16 are excluded from this paragraph.

 

(d) In addition to the reduction in paragraphs (b) and (c), the total payment for fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for inpatient services before third-party liability and spenddown, is reduced 6.0 percent from the current statutory rates.  Mental health services within diagnosis related groups 424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.  Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical assistance does not include general assistance medical care.  Payments made to managed care plans shall be reduced for services provided on or after January 1, 2006, to reflect this reduction.

 

(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made to hospitals for inpatient services before third-party liability and spenddown, is reduced 3.46 percent from the current statutory rates.  Mental health services with diagnosis related groups 424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.  Payments made to managed care plans shall be reduced for services provided on or after January 1, 2009, through June 30, 2009, to reflect this reduction.

 

(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made to hospitals for inpatient services before third-party liability and spenddown, is reduced 1.9 percent from the current statutory rates.  Mental health services with diagnosis related groups 424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.  Payments made to managed care plans shall be reduced for services provided on or after July 1, 2009, through June 30, 2010, to reflect this reduction.

 

(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for inpatient services before third-party liability and spenddown, is reduced 1.79 percent from the current statutory rates.  Mental health services with diagnosis related groups 424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.  Payments made to managed care plans shall be reduced for services provided on or after July 1, 2010, to reflect this reduction.


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(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total payment for fee-for-service admissions occurring on or after July 1, 2009, made to hospitals for inpatient services before third-party liability and spenddown, is reduced one percent from the current statutory rates.  Facilities defined under subdivision 16 are excluded from this paragraph.  Payments made to managed care plans shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.

 

(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total payment for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for inpatient services before third-party liability and spenddown, is reduced 7.5 percent from the current statutory rates.  Facilities defined under subdivision 16 are excluded from this paragraph.  Payments made to managed care plans shall be reduced for services provided on or after January 1, 2012, to reflect this reduction.  Hospitals that, prior to December 31, 2007, received payment to support the training of residents from an approved graduate medical residency training program pursuant to United States Code, title 42, section 256e, are not subject to the provisions of this paragraph.

 

Sec. 5.  Minnesota Statutes 2008, section 256B.04, subdivision 14, is amended to read:

 

Subd. 14.  Competitive bidding.  (a) When determined to be effective, economical, and feasible, the commissioner may utilize volume purchase through competitive bidding and negotiation under the provisions of chapter 16C, to provide items under the medical assistance program including but not limited to the following:

 

(1) eyeglasses;

 

(2) oxygen.  The commissioner shall provide for oxygen needed in an emergency situation on a short-term basis, until the vendor can obtain the necessary supply from the contract dealer;

 

(3) hearing aids and supplies; and

 

(4) durable medical equipment, including but not limited to:

 

(i) hospital beds;

 

(ii) commodes;

 

(iii) glide-about chairs;

 

(iv) patient lift apparatus;

 

(v) wheelchairs and accessories;

 

(vi) oxygen administration equipment;

 

(vii) respiratory therapy equipment;

 

(viii) electronic diagnostic, therapeutic and life-support systems;

 

(5) nonemergency medical transportation level of need determinations, disbursement of public transportation passes and tokens, and volunteer and recipient mileage and parking reimbursements; and

 

(6) drugs; and

 

(7) medical supplies.


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(b) Rate changes under this chapter and chapters 256D and 256L do not affect contract payments under this subdivision unless specifically identified.

 

(c) The commissioner may not utilize volume purchase through competitive bidding and negotiation for special transportation services under the provisions of chapter 16C.

 

Sec. 6.  Minnesota Statutes 2008, section 256B.055, is amended by adding a subdivision to read:

 

Subd. 15.  Adults without children.  Medical assistance may be paid for a person who is over age 21 and under age 65, who is not pregnant, and who is not described in subdivision 4, 7, or another subdivision of this section.

 

EFFECTIVE DATE.  This section is effective upon federal approval and is retroactive from April 1, 2010.

 

Sec. 7.  Minnesota Statutes 2008, section 256B.056, subdivision 4, is amended to read:

 

Subd. 4.  Income.  (a) To be eligible for medical assistance, a person eligible under section 256B.055  subdivisions 7, 7a, and 12, may have income up to 100 percent of the federal poverty guidelines.  Effective January 1, 2000, and each successive January, recipients of supplemental security income may have an income up to the supplemental security income standard in effect on that date. 

 

(b) To be eligible for medical assistance, families and children may have an income up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996, AFDC state plan.  Effective July 1, 2000, the base AFDC standard in effect on July 16, 1996, shall be increased by three percent.

 

(c) Effective July 1, 2002, to be eligible for medical assistance, families and children may have an income up to 100 percent of the federal poverty guidelines for the family size.

 

(d) In computing income to determine eligibility of persons under paragraphs (a) to (c) and (e) who are not residents of long-term care facilities, the commissioner shall disregard increases in income as required by Public Law Numbers 94-566, section 503; 99-272; and 99-509.  Veterans aid and attendance benefits and Veterans Administration unusual medical expense payments are considered income to the recipient.

 

(e) To be eligible for medical assistance, a person eligible under section 256B.055, subdivision 15, may have income up to 75 percent of the federal poverty guidelines for family size.

 

EFFECTIVE DATE.  This section is effective upon federal approval and is retroactive from April 1, 2010.

 

Sec. 8.  Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to read:

 

Subd. 8.  Physical therapy.  Medical assistance covers physical therapy and related services, including specialized maintenance therapy.  Authorization by the commissioner is required to provide services to a recipient beyond any of the following onetime service thresholds:  (1) 80 units of any approved CPT code other than modalities; (2) 20 modality sessions; and (3) three evaluations or reevaluations.  Services provided by a physical therapy assistant shall be reimbursed at the same rate as services performed by a physical therapist when the services of the physical therapy assistant are provided under the direction of a physical therapist who is on the premises.  Services provided by a physical therapy assistant that are provided under the direction of a physical therapist who is not on the premises shall be reimbursed at 65 percent of the physical therapist rate.


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Sec. 9.  Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to read:

 

Subd. 8a.  Occupational therapy.  Medical assistance covers occupational therapy and related services, including specialized maintenance therapy.  Authorization by the commissioner is required to provide services to a recipient beyond any of the following onetime service thresholds:  (1) 120 units of any combination of approved CPT codes; and (2) two evaluations or reevaluations.  Services provided by an occupational therapy assistant shall be reimbursed at the same rate as services performed by an occupational therapist when the services of the occupational therapy assistant are provided under the direction of the occupational therapist who is on the premises.  Services provided by an occupational therapy assistant that are provided under the direction of an occupational therapist who is not on the premises shall be reimbursed at 65 percent of the occupational therapist rate.

 

Sec. 10.  Minnesota Statutes 2008, section 256B.0625, subdivision 8b, is amended to read:

 

Subd. 8b.  Speech language pathology and audiology services.  Medical assistance covers speech language pathology and related services, including specialized maintenance therapy.  Authorization by the commissioner is required to provide services to a recipient beyond any of the following onetime service thresholds:  (1) 50 treatment sessions with any combination of approved CPT codes; and (2) one evaluation.  Medical assistance covers audiology services and related services.  Services provided by a person who has been issued a temporary registration under section 148.5161 shall be reimbursed at the same rate as services performed by a speech language pathologist or audiologist as long as the requirements of section 148.5161, subdivision 3, are met. 

 

Sec. 11.  Minnesota Statutes 2008, section 256B.0625, is amended by adding a subdivision to read:

 

Subd. 8d.  Chiropractic services.  Payment for chiropractic services is limited to one annual evaluation and 12 visits per year unless prior authorization of a greater number of visits is obtained.

 

Sec. 12.  Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9, is amended to read:

 

Subd. 9.  Dental services.  (a) Medical assistance covers dental services.

 

(b) Medical assistance dental coverage for nonpregnant adults is limited to the following services:

 

(1) comprehensive exams, limited to once every five years;

 

(2) periodic exams, limited to one per year;

 

(3) limited exams;

 

(4) bitewing x-rays, limited to one set per year;

 

(5) periapical x-rays;

 

(6) panoramic x-rays or full-mouth radiographs, limited to one every five years, and only if provided in conjunction with a posterior extraction or scheduled outpatient facility procedure, or as medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma.  Panoramic x-rays may be taken once every two years for patients who cannot cooperate for intraoral film due to a developmental disability or medical condition that does not allow for intraoral film placement;

 

(7) prophylaxis, limited to one per year;

 

(8) application of fluoride varnish, limited to one per year;


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(9) posterior fillings, all at the amalgam rate;

 

(10) anterior fillings;

 

(11) endodontics, limited to root canals on the anterior and premolars only, and molar root canal therapy as deemed medically necessary for patients that are at high risk of osteonecrosis from molar extractions;

 

(12) removable prostheses, each dental arch limited to one every six years; including:

 

(i) relines of full dentures once every six years per dental arch;

 

(ii) repair of acrylic bases of full dentures and acrylic partial dentures, limited to one per year; and

 

(iii) adding a maximum of two denture teeth and two wrought wire clasps per year to partial dentures per dental arch;

 

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;

 

(14) palliative treatment and sedative fillings for relief of pain; and

 

(15) full-mouth debridement periodontal scaling and root planing, limited to one every five years; and

 

(16) moderate sedation, deep sedation, and general anesthesia, limited to when provided by an oral maxillofacial surgeon who is board-certified, or actively participating in the American Board of Oral and Maxillofacial Surgery certification process, when medically necessary to allow the surgical management of acute oral and maxillofacial pathology which cannot be accomplished safely with local anesthesia alone and would otherwise require operating room services.

 

(c) In addition to the services specified in paragraph (b), medical assistance covers the following services for adults, if provided in an outpatient hospital setting or freestanding ambulatory surgical center as part of outpatient dental surgery:

 

(1) periodontics, limited to periodontal scaling and root planing once every two years;

 

(2) general anesthesia; and

 

(3) full-mouth survey once every five two years.

 

(d) Medical assistance covers dental services for children that are medically necessary.  The following guidelines apply:

 

(1) posterior fillings are paid at the amalgam rate;

 

(2) application of sealants once every five years per permanent molar; and

 

(3) application of fluoride varnish once every six months.

 

Sec. 13.  Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 13e, is amended to read:

 

Subd. 13e.  Payment rates.  (a) The basis for determining the amount of payment shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee; the maximum allowable cost set by the federal government or by the commissioner plus the fixed dispensing fee; or the usual and customary price charged to the public.  The amount of payment basis must be reduced to reflect all discount amounts applied to the charge by any


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provider/insurer agreement or contract for submitted charges to medical assistance programs.  The net submitted charge may not be greater than the patient liability for the service.  The pharmacy dispensing fee shall be $3.65, except that the dispensing fee for intravenous solutions which must be compounded by the pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral nutritional products dispensed in quantities greater than one liter.  Actual acquisition cost includes quantity and other special discounts except time and cash discounts.  Effective July 1, 2009 July 1, 2010, the actual acquisition cost of a drug shall be estimated by the commissioner, at average wholesale price minus 15 12.5 percent or wholesale acquisition cost plus 5.0 percent, whichever is lower.  The actual acquisition cost of antihemophilic factor drugs shall be estimated at the average wholesale price minus 30 28.12 percent or wholesale acquisition cost minus 13.76 percent, whichever is lower.  Average wholesale price is defined as the price for a drug product listed as the average wholesale price in the commissioner's primary reference source.  Wholesale acquisition cost is defined as the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in the United States, not including prompt pay or other discounts, rebates, or reductions in price, for the most recent month for which information is available, as reported in wholesale price guides or other publications of drug or biological pricing data.  The maximum allowable cost of a multisource drug may be set by the commissioner and it shall be comparable to, but no higher than, the maximum amount paid by other third-party payors in this state who have maximum allowable cost programs.  Establishment of the amount of payment for drugs shall not be subject to the requirements of the Administrative Procedure Act.

 

(b) An additional dispensing fee of $.30 may be added to the dispensing fee paid to pharmacists for legend drug prescriptions dispensed to residents of long-term care facilities when a unit dose blister card system, approved by the department, is used.  Under this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.  The National Drug Code (NDC) from the drug container used to fill the blister card must be identified on the claim to the department.  The unit dose blister card containing the drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, that govern the return of unused drugs to the pharmacy for reuse.  The pharmacy provider will be required to credit the department for the actual acquisition cost of all unused drugs that are eligible for reuse.  Over-the-counter medications must be dispensed in the manufacturer's unopened package.  The commissioner may permit the drug clozapine to be dispensed in a quantity that is less than a 30-day supply.

 

(c) Whenever a generically equivalent product is available, payment shall be on the basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost established by the commissioner.

 

(d) The basis for determining the amount of payment for drugs administered in an outpatient setting shall be the lower of the usual and customary cost submitted by the provider or the amount established for Medicare by the United States Department of Health and Human Services pursuant to title XVIII, section 1847a of the federal Social Security Act.

 

(e) The commissioner may negotiate lower reimbursement rates for specialty pharmacy products than the rates specified in paragraph (a).  The commissioner may require individuals enrolled in the health care programs administered by the department to obtain specialty pharmacy products from providers with whom the commissioner has negotiated lower reimbursement rates.  Specialty pharmacy products are defined as those used by a small number of recipients or recipients with complex and chronic diseases that require expensive and challenging drug regimens.  Examples of these conditions include, but are not limited to:  multiple sclerosis, HIV/AIDS, transplantation, hepatitis C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of cancer.  Specialty pharmaceutical products include injectable and infusion therapies, biotechnology drugs, high-cost therapies, and therapies that require complex care.  The commissioner shall consult with the formulary committee to develop a list of specialty pharmacy products subject to this paragraph.  In consulting with the formulary committee in developing this list, the commissioner shall take into consideration the population served by specialty pharmacy products, the current delivery system and standard of care in the state, and access to care issues.  The commissioner shall have the discretion to adjust the reimbursement rate to prevent access to care issues.

 

EFFECTIVE DATE.  This section is effective July 1, 2010, or upon federal approval, whichever is later.


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Sec. 14.  Minnesota Statutes 2008, section 256B.0625, subdivision 18a, is amended to read:

 

Subd. 18a.  Access to medical services.  (a) Medical assistance reimbursement for meals for persons traveling to receive medical care may not exceed $5.50 for breakfast, $6.50 for lunch, or $8 for dinner.

 

(b) Medical assistance reimbursement for lodging for persons traveling to receive medical care may not exceed $50 per day unless prior authorized by the local agency.

 

(c) Medical assistance direct mileage reimbursement to the eligible person or the eligible person's driver may not exceed 20 cents per mile.

 

(d) Regardless of the number of employees that an enrolled health care provider may have, medical assistance covers sign and oral language interpreter services when provided by an enrolled health care provider during the course of providing a direct, person-to-person covered health care service to an enrolled recipient with limited English proficiency or who has a hearing loss and uses interpreting services.  Coverage for oral language interpreter services shall be provided only if the oral language interpreter used by the enrolled health care provider is listed in the registry or roster established under section 144.058.

 

EFFECTIVE DATE.  This section is effective July 1, 2010.

 

Sec. 15.  Minnesota Statutes 2008, section 256B.0625, subdivision 31, is amended to read:

 

Subd. 31.  Medical supplies and equipment.  Medical assistance covers medical supplies and equipment.  Separate payment outside of the facility's payment rate shall be made for wheelchairs and wheelchair accessories for recipients who are residents of intermediate care facilities for the developmentally disabled.  Reimbursement for wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same conditions and limitations as coverage for recipients who do not reside in institutions.  A wheelchair purchased outside of the facility's payment rate is the property of the recipient.  The commissioner may set reimbursement rates for specified categories of medical supplies at levels below the Medicare payment rate.

 

Sec. 16.  Minnesota Statutes 2008, section 256B.0625, is amended by adding a subdivision to read:

 

Subd. 54.  Services provided in birth centers.  (a) Medical assistance covers services provided in a birth center licensed under section 144.615 by a licensed health professional if the service would otherwise be covered if provided in a hospital.

 

(b) Facility services provided by a birth center shall be paid at the lower of billed charges or 70 percent of the statewide average for a facility payment rate made to a hospital for an uncomplicated vaginal birth as determined using the most recent calendar year for which complete claims data is available.  If a recipient is transported from a birth center to a hospital prior to the delivery, the payment for facility services to the birth center shall be the lower of billed charges or 15 percent of the average facility payment made to a hospital for the services provided for an uncomplicated vaginal delivery as determined using the most recent calendar year for which complete claims data is available.

 

(c) Professional services provided by traditional midwives licensed under chapter 147D shall be paid at the lower of billed charges or 100 percent of the rate paid to a physician performing the same services.  If a recipient is transported from a birth center to a hospital prior to the delivery, a licensed traditional midwife who does not perform the delivery may not bill for any delivery services.  Services are not covered if provided by an unlicensed traditional midwife.


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(d) The commissioner shall apply for any necessary waivers from the Centers for Medicare and Medicaid Services to allow birth centers and birth center providers to be reimbursed.

 

EFFECTIVE DATE.  This section is effective January 1, 2011, or upon federal approval, whichever is later.

 

Sec. 17.  Minnesota Statutes 2008, section 256B.0631, subdivision 1, is amended to read:

 

Subdivision 1.  Co-payments.  (a) Except as provided in subdivision 2, the medical assistance benefit plan shall include the following co-payments for all recipients, effective for services provided on or after October 1, 2003, and before January 1, 2009:

 

(1) $3 per nonpreventive visit.  For purposes of this subdivision, a visit means an episode of service which is required because of a recipient's symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist;

 

(2) $3 for eyeglasses;

 

(3) $6 for nonemergency visits to a hospital-based emergency room; and

 

(4) $3 per brand-name drug prescription and $1 per generic drug prescription, subject to a $12 per month maximum for prescription drug co-payments.  No co-payments shall apply to antipsychotic drugs when used for the treatment of mental illness.

 

(b) Except as provided in subdivision 2, the medical assistance benefit plan shall include the following co-payments for all recipients, effective for services provided on or after January 1, 2009:

 

(1) $6 $3.50 for nonemergency visits to a hospital-based emergency room;

 

(2) $3 per brand-name drug prescription and $1 per generic drug prescription, subject to a $7 $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

 

(3) for individuals identified by the commissioner with income at or below 100 percent of the federal poverty guidelines, total monthly co-payments must not exceed five percent of family income.  For purposes of this paragraph, family income is the total earned and unearned income of the individual and the individual's spouse, if the spouse is enrolled in medical assistance and also subject to the five percent limit on co-payments.

 

(c) Recipients of medical assistance are responsible for all co-payments in this subdivision.

 

EFFECTIVE DATE.  The amendment to paragraph (b), clause (1), related to the co-payment for nonemergency visits is effective January 1, 2011, and the amendment to paragraph (b), clause (2), related to the per month maximum for prescription drug co-payments is effective July 1, 2010.

 

Sec. 18.  Minnesota Statutes 2008, section 256B.0631, subdivision 3, is amended to read:

 

Subd. 3.  Collection.  (a) The medical assistance reimbursement to the provider shall be reduced by the amount of the co-payment, except that reimbursements shall not be reduced:

 

(1) once a recipient has reached the $12 per month maximum or the $7 per month maximum effective January 1, 2009, for prescription drug co-payments; or


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(2) for a recipient identified by the commissioner under 100 percent of the federal poverty guidelines who has met their monthly five percent co-payment limit.

 

(b) The provider collects the co-payment from the recipient.  Providers may not deny services to recipients who are unable to pay the co-payment.

 

(c) Medical assistance reimbursement to fee-for-service providers and payments to managed care plans shall not be increased as a result of the removal of the co-payments effective on or after January 1, 2009.

 

Sec. 19.  Minnesota Statutes 2008, section 256B.0644, as amended by Laws 2010, chapter 200, article 1, section 6, is amended to read:

 

256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE PROGRAMS. 

 

(a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a health maintenance organization, as defined in chapter 62D, must participate as a provider or contractor in the medical assistance program, general assistance medical care program, and MinnesotaCare as a condition of participating as a provider in health insurance plans and programs or contractor for state employees established under section 43A.18, the public employees insurance program under section 43A.316, for health insurance plans offered to local statutory or home rule charter city, county, and school district employees, the workers' compensation system under section 176.135, and insurance plans provided through the Minnesota Comprehensive Health Association under sections 62E.01 to 62E.19.  The limitations on insurance plans offered to local government employees shall not be applicable in geographic areas where provider participation is limited by managed care contracts with the Department of Human Services.

 

(b) For providers other than health maintenance organizations, participation in the medical assistance program means that:

 

(1) the provider accepts new medical assistance, general assistance medical care, and MinnesotaCare patients;

 

(2) for providers other than dental service providers, at least 20 percent of the provider's patients are covered by medical assistance, general assistance medical care, and MinnesotaCare as their primary source of coverage; or

 

(3) for dental service providers, at least ten percent of the provider's patients are covered by medical assistance, general assistance medical care, and MinnesotaCare as their primary source of coverage, or the provider accepts new medical assistance and MinnesotaCare patients who are children with special health care needs.  For purposes of this section, "children with special health care needs" means children up to age 18 who:  (i) require health and related services beyond that required by children generally; and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional condition, including:  bleeding and coagulation disorders; immunodeficiency disorders; cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other neurological diseases; visual impairment or deafness; Down syndrome and other genetic disorders; autism; fetal alcohol syndrome; and other conditions designated by the commissioner after consultation with representatives of pediatric dental providers and consumers.

 

(c) Patients seen on a volunteer basis by the provider at a location other than the provider's usual place of practice may be considered in meeting the participation requirement in this section.  The commissioner shall establish participation requirements for health maintenance organizations.  The commissioner shall provide lists of participating medical assistance providers on a quarterly basis to the commissioner of management and budget, the commissioner of labor and industry, and the commissioner of commerce.  Each of the commissioners shall develop and implement procedures to exclude as participating providers in the program or programs under their jurisdiction those providers who do not participate in the medical assistance program.  The commissioner of management and budget shall implement this section through contracts with participating health and dental carriers.


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(d) Any hospital or other provider that is participating in a coordinated care delivery system under section 256D.031, subdivision 6, or receives payments from the uncompensated care pool under section 256D.031, subdivision 8, shall not refuse to provide services to any patient enrolled in general assistance medical care regardless of the availability or the amount of payment.

 

(e) (d) For purposes of paragraphs (a) and (b), participation in the general assistance medical care program applies only to pharmacy providers dispensing prescription drugs according to section 256D.03, subdivision 3.

 

EFFECTIVE DATE.  The amendment striking the existing paragraph (d) is effective 30 days after federal approval of the amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, whichever is later.  The amendment to the new paragraph (d) is effective June 1, 2010.

 

Sec. 20.  Minnesota Statutes 2009 Supplement, section 256B.0653, subdivision 5, is amended to read:

 

Subd. 5.  Home care therapies.  (a) Home care therapies include the following:  physical therapy, occupational therapy, respiratory therapy, and speech and language pathology therapy services.

 

(b) Home care therapies must be:

 

(1) provided in the recipient's residence after it has been determined the recipient is unable to access outpatient therapy;

 

(2) prescribed, ordered, or referred by a physician and documented in a plan of care and reviewed, according to Minnesota Rules, part 9505.0390;

 

(3) assessed by an appropriate therapist; and

 

(4) provided by a Medicare-certified home health agency enrolled as a Medicaid provider agency.

 

(c) Restorative and specialized maintenance therapies must be provided according to Minnesota Rules, part 9505.0390.  Physical and occupational therapy assistants may be used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.

 

(d) For both physical and occupational therapies, the therapist and the therapist's assistant may not both bill for services provided to a recipient on the same day.

 

Sec. 21.  [256B.0755] PAYMENT REFORM DEMONSTRATION PROJECT FOR SPECIAL PATIENT POPULATIONS. 

 

Subdivision 1.  Demonstration project.  (a) The commissioner of human services, in consultation with the commissioner of health, shall establish a payment reform demonstration project implementing an alternative payment system for health care providers serving an identified group of patients who are enrolled in a state health care program, and are either high utilizers of high-cost health care services or have characteristics that put them at high risk of becoming high utilizers.  The purpose of the demonstration project is to implement and evaluate methods of reducing hospitalizations, emergency room use, high-cost medications and specialty services, admissions to nursing facilities, or use of long-term home and community-based services, in order to reduce the total cost of care and services for the patients. 

 

(b) The commissioner shall give the highest priority to projects that will serve patients who have chronic medical conditions or complex medical needs that are complicated by a physical disability, serious mental illness, or serious socioeconomic factors such as poverty, homelessness, or language or cultural barriers.  The commissioner shall also give the highest priority to providers or groups of providers who have the highest concentrations of patients with these characteristics. 


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(c) The commissioner must implement this payment reform demonstration project in a manner consistent with the payment reform initiative provided in sections 62U.02 to 62U.04.

 

(d) For purposes of this section, "state health care program" means the medical assistance, MinnesotaCare, and general assistance medical care programs.

 

Subd. 2.  Participation.  (a) The commissioner shall request eligible providers or groups of providers to submit a proposal to participate in the demonstration project by September 1, 2010.  The providers who are interested in participating shall negotiate with the commissioner to determine: 

 

(1) the identified group of patients who are to be enrolled in the program;

 

(2) the services that are to be included in the total cost of care calculation;

 

(3) the methodology for calculating the total cost of care, which may take into consideration the impact on costs to other state or local government programs including, but not limited to, social services and income maintenance programs;

 

(4) the time period to be covered under the bid;

 

(5) the implementation of a risk adjustment mechanism to adjust for factors that are beyond the control of the provider including nonclinical factors that will affect the cost or outcomes of treatment;

 

(6) the payment reforms and payment methods to be used under the project, which may include but are not limited to adjustments in fee-for-service payments, payment of care coordination fees, payments for start-up and implementation costs to be recovered or repaid later in the project, payments adjusted based on a provider's proportion of patients who are enrolled in state health care programs; payments adjusted for the clinical or socioeconomic complexity of the patients served, payment incentives tied to use of inpatient and emergency room services, and periodic settle-up adjustments;

 

(7) methods of sharing financial risk and benefit between the commissioner and the provider or groups of providers, which may include but are not limited to stop-loss arrangements to cover high-cost outlier cases or costs that are beyond the control of the provider, and risk-sharing and benefit-sharing corridors; and

 

(8) performance and outcome benchmarks to be used to measure performance, achievement of cost-savings targets, and quality of care provided.

 

(b) A provider or group of providers may submit a proposal for a demonstration project in partnership with a health maintenance organization or county-based purchasing plan for the purposes of sharing risk, claims processing, or administration of the project, or to extend participation in the project to persons who are enrolled in prepaid health care programs.

 

Subd. 3.  Total cost of care agreement.  Based on negotiations, the commissioner must enter into an agreement with interested and eligible providers or groups of providers to implement projects that are designed to reduce the total cost of care for the identified patients.  To the extent possible, the projects shall begin implementation on January 1, 2011, or upon federal approval, whichever is later.

 

Subd. 4.  Eligibility.  To be eligible to participate, providers or groups of providers must meet certification standards for health care homes established by the Department of Health and the Department of Human Services under section 256B.0751.


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Subd. 5.  Alternative payments.  The commissioner shall seek all federal waivers and approvals necessary to implement this section and to obtain federal matching funds.  To the extent authorized by federal law, the commissioner may waive existing fee-for-service payment rates, provider contract or performance requirements, consumer incentive policies, or other requirements in statute or rule in order to allow the providers or groups of providers to utilize alternative payment and financing methods that will appropriately fund necessary and cost-effective primary care and care coordination services; establish appropriate incentives for prevention, health promotion, and care coordination; and mitigate financial harm to participating providers caused by the successful reduction in preventable hospitalization, emergency room use, and other costly services.

 

Subd. 6.  Cost neutrality.  The total cost, including administrative costs, of this demonstration project must not exceed the costs that would otherwise be incurred by the state had services to the state health care program enrollees participating in the demonstration project been provided, as applicable for the enrollee, under fee-for-service or through managed care or county-based purchasing plans.

 

Sec. 22.  [256B.0757] INTENSIVE CARE MANAGEMENT PROGRAM. 

 

Subdivision 1.  Report.  The commissioner shall review medical assistance enrollment and by July 1, 2011, present a report to the legislature that describes the common characteristics and costs of those enrollees age 18 and over whose annual medical costs are greater than 95 percent of all other enrollees, using deidentified data.

 

Subd. 2.  Intensive care management system established.  The commissioner shall implement, by January 1, 2012, or upon federal approval, whichever is later, a program to provide intensive care management to medical assistance enrollees age 18 and over currently served under fee-for-service, managed care, or county-based purchasing, whose annual medical care costs are in the top five percent of all medical assistance enrollees.  The intensive care management program must reduce these enrollees' medical assistance costs by at least 20 percent on average, improve quality of care through care coordination, and provide financial incentives for providers to deliver care efficiently.  The commissioner may require medical assistance enrollees meeting the criteria specified in this subdivision to participate in the intensive care management program, and may reassign enrollees from existing managed care and county-based purchasing plans to those plans that are participating in the demonstration program.  The commissioner shall seek all federal approvals and waivers necessary to implement the intensive care management program.

 

Subd. 3.  Request for proposals.  The commissioner of human services shall request proposals by September 1, 2011, or upon federal approval, whichever is later, from health care providers, managed care plans, and county-based purchasing plans to provide intensive care management services under the requirements of subdivision 1.  Proposals submitted must:

 

(1) designate the medical assistance population and geographic area of the state to be served;

 

(2) describe in detail the proposed intensive care management program;

 

(3) provide estimates of cost savings to the state and the evidence supporting these estimates;

 

(4) describe the extent to which the intensive care management program is consistent with and builds upon current state health care home, care coordination, and payment reform initiatives; and

 

(5) meet quality assurance, data reporting, and other criteria specified by the commissioner in the request for proposals.

 

EFFECTIVE DATE.  This section is effective the day following final enactment.


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Sec. 23.  Minnesota Statutes 2008, section 256B.69, is amended by adding a subdivision to read:

 

Subd. 5k.  Payment rate modification.  For services rendered on or after August 1, 2010, the total payment made to managed care and county-based purchasing plans under the medical assistance program and under MinnesotaCare for families with children shall be increased by 1.4 percent.

 

EFFECTIVE DATE.  This section is effective August 1, 2010.

 

Sec. 24.  Minnesota Statutes 2008, section 256B.69, is amended by adding a subdivision to read:

 

Subd. 5l.  Payment reduction.  For services rendered on or after January 1, 2011, the total payment made to managed care plans for providing covered services under the medical assistance, general assistance medical care, and MinnesotaCare programs is reduced by one percent from their current statutory rates.  This provision excludes payments for nursing home services, home and community-based waivers, home care services covered under section 256B.0651, subdivision 2, payments to demonstration projects for persons with disabilities, and mental health services added as covered benefits after December 31, 2007.

 

Sec. 25.  Minnesota Statutes 2008, section 256B.69, subdivision 20, as amended by Laws 2010, chapter 200, article 1, section 10, is amended to read:

 

Subd. 20.  Ombudsperson.  (a) The commissioner shall designate an ombudsperson to advocate for persons required to enroll in prepaid health plans under this section.  The ombudsperson shall advocate for recipients enrolled in prepaid health plans through complaint and appeal procedures and ensure that necessary medical services are provided either by the prepaid health plan directly or by referral to appropriate social services.  At the time of enrollment in a prepaid health plan, the local agency shall inform recipients about the ombudsperson program and their right to a resolution of a complaint by the prepaid health plan if they experience a problem with the plan or its providers.

 

(b) The commissioner shall designate an ombudsperson to advocate for persons enrolled in a care coordination delivery system under section 256D.031.  The ombudsperson shall advocate for recipients enrolled in a care coordination delivery system through the state appeal process and assist enrollees in accessing necessary medical services through the care coordination delivery systems directly or by referral to appropriate services.  At the time of enrollment in a care coordination delivery system, the local agency shall inform recipients about the ombudsperson program.

 

EFFECTIVE DATE.  This section is effective 30 days after federal approval of the amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, whichever is later.

 

Sec. 26.  Minnesota Statutes 2008, section 256B.69, subdivision 27, is amended to read:

 

Subd. 27.  Information for persons with limited English-language proficiency.  Managed care contracts entered into under this section and sections 256D.03, subdivision 4, paragraph (c), and section 256L.12 must require demonstration providers to provide language assistance to enrollees that ensures meaningful access to its programs and services according to Title VI of the Civil Rights Act and federal regulations adopted under that law or any guidance from the United States Department of Health and Human Services. 

 

EFFECTIVE DATE.  This section is effective retroactively from April 1, 2010.


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Sec. 27.  Minnesota Statutes 2008, section 256B.692, subdivision 1, is amended to read:

 

Subdivision 1.  In general.  County boards or groups of county boards may elect to purchase or provide health care services on behalf of persons eligible for medical assistance and general assistance medical care who would otherwise be required to or may elect to participate in the prepaid medical assistance or prepaid general assistance medical care programs according to sections section 256B.69 and 256D.03.  Counties that elect to purchase or provide health care under this section must provide all services included in prepaid managed care programs according to sections section 256B.69, subdivisions 1 to 22, and 256D.03.  County-based purchasing under this section is governed by section 256B.69, unless otherwise provided for under this section. 

 

EFFECTIVE DATE.  This section is effective retroactively from April 1, 2010.

 

Sec. 28.  Minnesota Statutes 2008, section 256B.75, is amended to read:

 

256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT. 

 

(a) For outpatient hospital facility fee payments for services rendered on or after October 1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge, or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for which there is a federal maximum allowable payment.  Effective for services rendered on or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and emergency room facility fees shall be increased by eight percent over the rates in effect on December 31, 1999, except for those services for which there is a federal maximum allowable payment.  Services for which there is a federal maximum allowable payment shall be paid at the lower of (1) submitted charge, or (2) the federal maximum allowable payment.  Total aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare upper limit.  If it is determined that a provision of this section conflicts with existing or future requirements of the United States government with respect to federal financial participation in medical assistance, the federal requirements prevail.  The commissioner may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial participation resulting from rates that are in excess of the Medicare upper limitations.

 

(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory surgery hospital facility fee services for critical access hospitals designated under section 144.1483, clause (10), shall be paid on a cost-based payment system that is based on the cost-finding methods and allowable costs of the Medicare program.

 

(c) Effective for services provided on or after July 1, 2003, rates that are based on the Medicare outpatient prospective payment system shall be replaced by a budget neutral prospective payment system that is derived using medical assistance data.  The commissioner shall provide a proposal to the 2003 legislature to define and implement this provision.

 

(d) For fee-for-service services provided on or after July 1, 2002, the total payment, before third-party liability and spenddown, made to hospitals for outpatient hospital facility services is reduced by .5 percent from the current statutory rate.

 

(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility services before third-party liability and spenddown, is reduced five percent from the current statutory rates.  Facilities defined under section 256.969, subdivision 16, are excluded from this paragraph.

 

(f) In addition to the reductions in paragraphs (d) and (e), the total payment for fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient hospital facility services before third-party liability and spenddown, is reduced three percent from the current statutory rates.  Mental health services and facilities defined under section 256.969, subdivision 16, are excluded from this paragraph.


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(g) Notwithstanding any contrary provision in this section, payment for all outpatient and emergency services provided by any hospital that, prior to December 31, 2007, has received payment to support the training of residents from an approved graduate medical residency training program under United States Code, title 42, section 256e, must be paid for fiscal years 2012 and 2013 an additional $7,000,000.  Payment rates for subsequent fiscal years are as follows:

 

(1) 2014:  50 percent of costs;

 

(2) 2015:  60 percent of costs;

 

(3) 2016:  70 percent of costs;

 

(4) 2017:  80 percent of costs;

 

(5) 2018:  90 percent of costs; and

 

(6) 2019 and thereafter:  100 percent of costs.

 

Sec. 29.  Minnesota Statutes 2009 Supplement, section 256B.76, subdivision 1, is amended to read:

 

Subdivision 1.  Physician reimbursement.  (a) Effective for services rendered on or after October 1, 1992, the commissioner shall make payments for physician services as follows:

 

(1) payment for level one Centers for Medicare and Medicaid Services' common procedural coding system codes titled "office and other outpatient services," "preventive medicine new and established patient," "delivery, antepartum, and postpartum care," "critical care," cesarean delivery and pharmacologic management provided to psychiatric patients, and level three codes for enhanced services for prenatal high risk, shall be paid at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992.  If the rate on any procedure code within these categories is different than the rate that would have been paid under the methodology in section 256B.74, subdivision 2, then the larger rate shall be paid;

 

(2) payments for all other services shall be paid at the lower of (i) submitted charges, or (ii) 15.4 percent above the rate in effect on June 30, 1992; and

 

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th percentile of 1989, less the percent in aggregate necessary to equal the above increases except that payment rates for home health agency services shall be the rates in effect on September 30, 1992.

 

(b) Effective for services rendered on or after January 1, 2000, payment rates for physician and professional services shall be increased by three percent over the rates in effect on December 31, 1999, except for home health agency and family planning agency services.  The increases in this paragraph shall be implemented January 1, 2000, for managed care.

 

(c) Effective for services rendered on or after July 1, 2009, payment rates for physician and professional services shall be reduced by five percent over the rates in effect on June 30, 2009.  This reduction does not apply to office or other outpatient visits, preventive medicine visits and family planning visits billed by physicians, advanced practice nurses, or physician assistants in a family planning agency or in one of the following primary care practices:  general practice, general internal medicine, general pediatrics, general geriatrics, and family medicine.  This reduction does not apply to federally qualified health centers, rural health centers, and Indian health services.  This reduction does not apply to physical therapy services, occupational therapy services, and speech pathology and related services provided on or after July 1, 2010.  Effective October 1, 2009, payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reduction described in this paragraph.


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(d) Effective for services rendered on or after July 1, 2010, payment rates for physician and professional services shall be reduced by three percent over the rates in effect on June 30, 2010.  This reduction does not apply to those providers and entities exempt from the reduction in paragraph (c).  Effective October 1, 2010, payments made to managed care plans and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment reductions in this paragraph.

 

(e) Effective for services rendered on or after June 1, 2010, payment rates for physician and professional services billed by physicians employed by and clinics that are owned by a nonprofit health maintenance organization shall be increased by 15 percent.  Effective October 1, 2010, payments to managed care and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase described in this paragraph.

 

Sec. 30.  Minnesota Statutes 2008, section 256B.76, subdivision 2, is amended to read:

 

Subd. 2.  Dental reimbursement.  (a) Effective for services rendered on or after October 1, 1992, the commissioner shall make payments for dental services as follows:

 

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992; and

 

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile of 1989, less the percent in aggregate necessary to equal the above increases.

 

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

 

(c) Effective for services rendered on or after January 1, 2000, payment rates for dental services shall be increased by three percent over the rates in effect on December 31, 1999.

 

(d) Effective for services provided on or after January 1, 2002, payment for diagnostic examinations and dental x-rays provided to children under age 21 shall be the lower of (1) the submitted charge, or (2) 85 percent of median 1999 charges.

 

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000, for managed care.

 

(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated dental clinic, payment shall be paid on a cost-based payment system that is based on the cost-finding methods and allowable costs of the Medicare program.  For services performed by a state-operated dental clinic pursuant to a contract between the clinic and a managed care plan or a county-based purchasing plan, a supplemental payment shall be made to the clinic by the commissioner that is equal to the amount by which the amount determined under this paragraph exceeds the amount of the payments provided under the contract.  Managed care plans and county-based purchasing plans participating in medical assistance must provide to the commissioner any expenditure, cost, and revenue information deemed necessary by the commissioner for purposes of obtaining federal Medicaid matching funds for cost-based reimbursement for state-operated dental clinics.  Cost-based reimbursement shall be implemented in managed care contracts beginning January 1, 2011.

 

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a supplemental state payment equal to the difference between the total payments in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated services for the operation of the dental clinics.


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Sec. 31.  Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:

 

Subd. 4.  Critical access dental providers.  Effective for dental services rendered on or after January 1, 2002, the commissioner shall increase reimbursements to dentists and dental clinics deemed by the commissioner to be critical access dental providers.  For dental services rendered on or after July 1, 2007, the commissioner shall increase reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to the critical access dental provider.  The commissioner shall pay the health plan companies in amounts sufficient to reflect increased reimbursements to critical access dental providers as approved by the commissioner.  In determining which dentists and dental clinics shall be deemed critical access dental providers, the commissioner shall review:

 

(1) the utilization rate in the service area in which the dentist or dental clinic operates for dental services to patients covered by medical assistance, general assistance medical care, or MinnesotaCare as their primary source of coverage;

 

(2) the level of services provided by the dentist or dental clinic to patients covered by medical assistance, general assistance medical care, or MinnesotaCare as their primary source of coverage; and.  The commissioner shall pay critical access dental provider payments to a dentist or dental clinic that meets any one of the following criteria: 

 

(i) at least 40 percent of patient encounters are with patients who are uninsured or covered by medical assistance, general assistance medical care, or MinnesotaCare;

 

(ii) the dental clinic or dental group is owned and operated by a nonprofit operation under chapter 317A with more than 10,000 patient encounters per year with patients who are uninsured or covered by medical assistance, general assistance medical care, or MinnesotaCare;

 

(iii) the dental clinic is associated with an oral health or dental education program operated by the University of Minnesota or an institution within the Minnesota State Colleges and Universities system; or

 

(iv) the dental clinic is a state-operated dental clinic;

 

(3) whether the level of services provided by the dentist or dental clinic is critical to maintaining adequate levels of patient access within the a geographic service area, and to ensure that the maximum travel distance or travel time is the lesser of 60 miles or 60 minutes;

 

(4) whether the provider has completed the application for critical access dental provider designation by the due date, and has provided correct information;

 

(5) whether the dentist or dental clinic meets the quality and continuity of care criteria recommended by the dental services advisory committee and adopted by the department; and

 

(6) whether the dentist or dental clinic serves people in all Minnesota health care programs. 

 

In the absence of a critical access dental provider in a service area, the commissioner may designate a dentist or dental clinic as a critical access dental provider if the dentist or dental clinic is willing to provide care to patients covered by medical assistance, general assistance medical care, or MinnesotaCare at a level which significantly increases access to dental care in the service area.

 

EFFECTIVE DATE.  This section is effective January 1, 2011.


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Sec. 32.  Minnesota Statutes 2008, section 256B.76, is amended by adding a subdivision to read:

 

Subd. 4a.  Designation and termination of critical access dental providers.  (a) Notwithstanding the provisions in subdivision 4, the commissioner may review and not designate an individual dentist or dental clinic as a critical access dental provider under subdivision 4 or section 256L.11, subdivision 7, when the dentist or clinic:

 

(1) has been subject to a corrective or disciplinary action by the Board of Dentistry related to fraud or direct patient care.  Designation shall not be made until the provider is no longer subject to a corrective or disciplinary action related to fraud or direct patient care; or

 

(2) has been subject, within the past three years, to a postinvestigation action by the commissioner of human services or issuance of a warning as specified in Minnesota Rules, parts 9505.2160 to 9505.2245.  The provider shall not be considered for critical access dental designation until the January following the year in which the action has ended.

 

(b) The commissioner may terminate a critical access designation of an individual dentist or clinic if the dentist or clinic:

 

(1) becomes subject to a disciplinary or corrective action by the Board of Dentistry related to fraud or direct patient care.  The provider shall not be considered for critical access designation until the January following the year in which the action has ended;

 

(2) becomes subject to a postinvestigation action by the commissioner of human services or issuance of a warning as specified in Minnesota Rules, parts 9505.2160 to 9505.2245;

 

(3) does not meet the quality and continuity of care criteria that have been recommended by the Dental Services Advisory Committee and adopted by the department; or

 

(4) does not serve people in all Minnesota public health care programs.

 

(c) Any termination is effective on the date of notification of the:

 

(1) postinvestigative action;

 

(2) disciplinary or corrective action by the Minnesota Board of Dentistry; or

 

(3) determination of not meeting quality and continuity of care criteria.

 

The commissioner may review postinvestigative actions taken by a health plan under contract to provide dental services to Minnesota health care program enrollees.  After an investigation conducted by the Department of Human Services surveillance unit, the findings of the health plan may be incorporated to determine if a provider will be designated or terminated from the program.

 

(d) A provider who has been terminated or not designated under this section may appeal only through the contested hearing process as defined in section 14.02, subdivision 3, by filing with the commissioner a written request of appeal.  The appeal request must be received by the commissioner no later than 30 days after notification of termination or nondesignation.

 

(e) The commissioner may make an exception to paragraphs (a) and (b) if an action taken by the Board of Dentistry or the commissioner is the result of events not directly related to patient care or that will not affect direct patient care to Minnesota health care program enrollees.

 

EFFECTIVE DATE.  This section is effective the day following final enactment.


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Sec. 33.  Minnesota Statutes 2009 Supplement, section 256B.766, is amended to read: 

 

256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES. 

 

(a) Effective for services provided on or after July 1, 2009, total payments for basic care services, shall be reduced by three percent, prior to third-party liability and spenddown calculation.  This reduction applies to physical therapy services, occupational therapy services, and speech language pathology and related services provided on or after July 1, 2010.  Effective July 1, 2010, the commissioner shall classify physical therapy services, occupational therapy services, and speech language pathology and related services as basic care services.  Payments made to managed care plans and county-based purchasing plans shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.

 

(b) This section does not apply to physician and professional services, inpatient hospital services, family planning services, mental health services, dental services, prescription drugs, medical transportation, federally qualified health centers, rural health centers, Indian health services, and Medicare cost-sharing.

 

Sec. 34.  [256B.767] MEDICARE PAYMENT LIMIT. 

 

Effective for services rendered on or after July 1, 2010, fee-for-service payment rates for physician and professional services under section 256B.76, subdivision 1, and basic care services subject to the rate reduction specified in section 256B.766, shall not exceed the Medicare payment rate for the applicable service.

 

Sec. 35.  [256B.768] FEE-FOR-SERVICE PAYMENT INCREASE. 

 

Effective for services rendered on or after January 1, 2011, the commissioner shall increase fee-for-service payment rates by seven percent for physician and professional services under section 256B.76, subdivision 1, and basic care services subject to the rate reduction specified in section 256B.766.

 

Sec. 36.  Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, as amended by Laws 2010, chapter 200, article 1, section 11, is amended to read:

 

Subd. 3.  General assistance medical care; eligibility.  (a) Beginning April 1, 2010, the general assistance medical care program shall be administered according to section 256D.031, unless otherwise stated, except for outpatient prescription drug coverage, which shall continue to be administered under this section and funded under section 256D.031, subdivision 9, beginning June 1, 2010.

 

(b) Outpatient prescription drug coverage under general assistance medical care is limited to prescription drugs that:

 

(1) are covered under the medical assistance program as described in section 256B.0625, subdivisions 13 and 13d; and

 

(2) are provided by manufacturers that have fully executed general assistance medical care rebate agreements with the commissioner and comply with the agreements.  Outpatient prescription drug coverage under general assistance medical care must conform to coverage under the medical assistance program according to section 256B.0625, subdivisions 13 to 13g 13h.

 

(c) Outpatient prescription drug coverage does not include drugs administered in a clinic or other outpatient setting.


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(d) For the period beginning April 1, 2010, to May 31, 2010, general assistance medical care covers the services listed in subdivision 4.

 

EFFECTIVE DATE.  This section is effective retroactively from April 1, 2010.

 

Sec. 37.  Minnesota Statutes 2008, 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 of representatives 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 management and budget 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, but shall not be implemented before July 1, 2014:  first, stop enrollment of single adults and households without children; and 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 notify the chairs of the house of representatives Ways and Means Committee and the senate Finance Committee, and the Legislative Commission on Health Care Access, and present recommendations to the chairs and commission for limiting expenditures to the estimated amount of revenue.

 

EFFECTIVE DATE.  This section is effective upon federal approval of the amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, subdivision 4.

 

Sec. 38.  Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:

 

Subd. 3.  Inpatient hospital services.  (a) Covered health services shall include inpatient hospital services, including inpatient hospital mental health services and inpatient hospital and residential chemical dependency treatment, subject to those limitations necessary to coordinate the provision of these services with eligibility under the medical assistance spenddown.  The inpatient hospital benefit for adult enrollees who qualify under section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 2, with family gross income that exceeds 200 percent of the federal poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not pregnant, is subject to an annual limit of $10,000, unless supplemental hospital coverage has been purchased under subdivision 3c. 

 

(b) Admissions for inpatient hospital services paid for under section 256L.11, subdivision 3, must be certified as medically necessary in accordance with Minnesota Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2): 


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(1) all admissions must be certified, except those authorized under rules established under section 254A.03, subdivision 3, or approved under Medicare; and

 

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent for admissions for which certification is requested more than 30 days after the day of admission.  The hospital may not seek payment from the enrollee for the amount of the payment reduction under this clause. 

 

EFFECTIVE DATE.  This section is effective January 1, 2011, or upon federal approval, whichever is later.

 

Sec. 39.  Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision to read:

 

Subd. 3c.  Supplemental hospital coverage.  (a) Effective January 1, 2011, or upon federal approval, whichever is later, the commissioner shall offer all MinnesotaCare applicants, and all enrollees during the open enrollment periods specified in paragraph (b), the opportunity to purchase at full cost, supplemental hospital coverage to cover inpatient hospital expenses in excess of the inpatient hospital annual limit established under subdivision 3.  Premiums for this coverage may vary only for age and shall be collected by the commissioner using the procedures established for the sliding scale premium determined under section 256L.15.

 

(b) The commissioner shall notify all persons submitting applications of the option to purchase this coverage at the time of application.  The commissioner shall provide persons enrolled in MinnesotaCare on the effective date of this subdivision with the opportunity to purchase this supplemental coverage during an initial open enrollment period.  Following this initial open enrollment period, the commissioner shall provide all enrollees with the opportunity to purchase this supplemental coverage during an annual open enrollment period during the month of November with coverage to take effect the following January 1.

 

Sec. 40.  Minnesota Statutes 2009 Supplement, section 256L.03, subdivision 5, is amended to read:

 

Subd. 5.  Co-payments and coinsurance.  (a) Except as provided in paragraphs (b) and (c), the MinnesotaCare benefit plan shall include the following co-payments and coinsurance requirements for all enrollees:

 

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees, subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;

 

(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 for services provided through December 31, 2010, and $3.50 effective January 1, 2011.

 

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of children under the age of 21.

 

(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.

 

(d) Paragraph (a), clause (4), does not apply to mental health services.


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(e) Adult enrollees with family gross income that exceeds 200 percent of the federal poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not pregnant shall be financially responsible for the coinsurance amount, if applicable, and if supplemental coverage has not been purchased under subdivision 3c, amounts which exceed the $10,000 inpatient hospital benefit limit.

 

(f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan, or changes from one prepaid health plan to another during a calendar year, any charges submitted towards the $10,000 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.

 

(g) MinnesotaCare reimbursement to fee-for-service providers and payments to managed care plans shall not be increased as a result of the reduction of the co-payments in paragraph (a), clause (5), effective January 1, 2011.

 

EFFECTIVE DATE.  The amendment to paragraph (e) is effective January 1, 2011, or upon federal approval, whichever is later.

 

Sec. 41.  Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision to read:

 

Subd. 6.  Disclosure statement for inpatient hospital limit.  The commissioner shall develop, and include with MinnesotaCare application and renewal materials, a disclosure statement that contains the following or similar language:  "For adults without children, and for parents and relative caretakers with family gross income that exceeds 215 percent of the federal poverty guidelines, who are not pregnant, coverage of inpatient hospital services under MinnesotaCare is subject to an annual limit of $10,000.  Enrollees subject to the limit may be responsible for inpatient hospital costs that exceed the $10,000 annual limit."

 

Sec. 42.  Minnesota Statutes 2008, section 256L.07, is amended by adding a subdivision to read:

 

Subd. 9.  Firefighters; volunteer ambulance attendants.  (a) For purposes of this subdivision, "qualified individual" means:

 

(1) a volunteer firefighter with a department as defined in section 299N.01, subdivision 2, who has passed the probationary period; and

 

(2) a volunteer ambulance attendant as defined in section 144E.001, subdivision 15.

 

(b) A qualified individual who documents to the satisfaction of the commissioner status as a qualified individual by completing and submitting a one-page form developed by the commissioner is eligible for MinnesotaCare without meeting other eligibility requirements of this chapter, but must pay premiums equal to the average expected capitation rate for adults with no children paid under section 256L.12.  Individuals eligible under this subdivision shall receive coverage for the benefit set provided to adults with no children.

 

Sec. 43.  Minnesota Statutes 2009 Supplement, section 256L.11, subdivision 1, is amended to read:

 

Subdivision 1.  Medical assistance rate to be used.  (a) Payment to providers under sections 256L.01 to 256L.11 shall be at the same rates and conditions established for medical assistance, except as provided in subdivisions 2 to 6.

 

(b) Effective for services provided on or after July 1, 2009, total payments for basic care services shall be reduced by three percent, in accordance with section 256B.766.  Payments made to managed care and county-based purchasing plans shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.


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(c) Effective for services provided on or after July 1, 2009, payment rates for physician and professional services shall be reduced as described under section 256B.76, subdivision 1, paragraph (c).  Payments made to managed care and county-based purchasing plans shall be reduced for services provided on or after October 1, 2009, to reflect this reduction.

 

(d) Effective for services provided on or after July 1, 2010, payment rates for physician and professional services shall be reduced as described under section 256B.76, subdivision 1, paragraph (d).  Payments made to managed care plans and county-based purchasing plans shall be reduced for services provided on or after October 1, 2010, to reflect this reduction.

 

Sec. 44.  Minnesota Statutes 2008, section 256L.12, subdivision 5, is amended to read:

 

Subd. 5.  Eligibility for other state programs.  MinnesotaCare enrollees who become eligible for medical assistance or general assistance medical care will remain in the same managed care plan if the managed care plan has a contract for that population.  Effective January 1, 1998, MinnesotaCare enrollees who were formerly eligible for general assistance medical care pursuant to section 256D.03, subdivision 3, within six months of MinnesotaCare enrollment and were enrolled in a prepaid health plan pursuant to section 256D.03, subdivision 4, paragraph (c), must remain in the same managed care plan if the managed care plan has a contract for that population.  Managed care plans must participate in the MinnesotaCare and general assistance medical care programs program under a contract with the Department of Human Services in service areas where they participate in the medical assistance program. 

 

EFFECTIVE DATE.  This section is effective retroactively from April 1, 2010.

 

Sec. 45.  Minnesota Statutes 2008, section 256L.12, subdivision 6, is amended to read:

 

Subd. 6.  Co-payments and benefit limits.  Enrollees are responsible for all co-payments in sections 256L.03, subdivision 5, and 256L.035, and shall pay co-payments to the managed care plan or to its participating providers.  The enrollee is also responsible for payment of inpatient hospital charges which exceed the MinnesotaCare benefit limit, unless supplemental hospital coverage has been purchased under subdivision 3c. 

 

EFFECTIVE DATE.  This section is effective January 1, 2011, or upon federal approval, whichever is later.

 

Sec. 46.  Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:

 

Subd. 9.  Rate setting; performance withholds.  (a) Rates will be prospective, per capita, where possible.  The commissioner may allow health plans to arrange for inpatient hospital services on a risk or nonrisk basis.  The commissioner shall consult with an independent actuary to determine appropriate rates.

 

(b) For services rendered on or after January 1, 2003, to December 31, 2003, the commissioner shall withhold .5 percent of managed care plan payments under this section pending completion of performance targets.  The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year if performance targets in the contract are achieved.  A managed care plan may include as admitted assets under section 62D.044 any amount withheld under this paragraph that is reasonably expected to be returned. 

 

(c) For services rendered on or after January 1, 2004, the commissioner shall withhold five percent of managed care plan payments under this section pending completion of performance targets.  Each performance target must be quantifiable, objective, measurable, and reasonably attainable, except in the case of a performance target based on a federal or state law or rule.  Criteria for assessment of each performance target must be outlined in writing prior to the contract effective date.  The managed care plan must demonstrate, to the commissioner's satisfaction, that the data submitted regarding attainment of the performance target is accurate.  The commissioner shall periodically


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change the administrative measures used as performance targets in order to improve plan performance across a broader range of administrative services.  The performance targets must include measurement of plan efforts to contain spending on health care services and administrative activities.  The commissioner may adopt plan-specific performance targets that take into account factors affecting only one plan, such as characteristics of the plan's enrollee population.  The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if performance targets in the contract are achieved.  A managed care plan or a county-based purchasing plan under section 256B.692 may include as admitted assets under section 62D.044 any amount withheld under this paragraph that is reasonably expected to be returned. 

 

(d) For services rendered on or after January 1, 2011, the commissioner shall withhold an additional three percent of managed care plan payments under this section.  The withheld funds must be returned no sooner than July 1, and no later than July 31 of the following calendar year.  The return of the withhold under this paragraph is not subject to the requirements of paragraph (b) or (c).

 

(e) A managed care plan or a county-based purchasing plan under section 256B.692 may include as admitted assets under section 62D.044 any amount withheld under this section.

 

Sec. 47.  Laws 2009, chapter 79, article 5, section 75, subdivision 1, is amended to read:

 

Subdivision 1.  Medical assistance coverage.  The commissioner of human services shall establish a demonstration project to provide additional medical assistance coverage for a maximum of 200 American Indian children in Minneapolis, St. Paul, and Duluth who are burdened by health disparities associated with the cumulative health impact of toxic environmental exposures.  Under this demonstration project, the additional medical assistance coverage for this population must include, but is not limited to, home environmental assessments for triggers of asthma, in-home asthma education on the proper medical management of asthma by a certified asthma educator or public health nurse with asthma management training limited to two visits per child.  Coverage also includes the following durable medical equipment:  high efficiency particulate air (HEPA) cleaners, HEPA vacuum cleaners, allergy bed and pillow encasements, high filtration filters for forced air gas furnaces, and dehumidifiers with medical tubing to connect the appliance to a floor drain, if the listed item is medically necessary useful to reduce asthma symptoms.  Provision of these items of durable medical equipment must be preceded by a home environmental assessment for triggers of asthma and in-home asthma education on the proper medical management of asthma by a Certified Asthma Educator or public health nurse with asthma management training.

 

Sec. 48.  Laws 2009, chapter 79, article 5, section 78, subdivision 5, is amended to read:

 

Subd. 5.  Expiration.  This section, with the exception of subdivision 4, expires December 31, 2010 June 30, 2011.  Subdivision 4 expires December 31, 2011.

 

Sec. 49.  Laws 2010, chapter 200, article 1, section 12, subdivision 6, is amended to read:

 

Subd. 6.  Coordinated care delivery systems.  (a) Effective June 1, 2010, the commissioner shall contract with hospitals or groups of hospitals that qualify under paragraph (b) and agree to deliver services according to this subdivision.  Contracting hospitals shall develop and implement a coordinated care delivery system to provide health care services to individuals who are eligible for general assistance medical care under this section and who either choose to receive services through the coordinated care delivery system or who are enrolled by the commissioner under paragraph (c).  A contracting hospital may negotiate a limit to the number of general assistance medical care enrollees it serves, but must comply with the emergency care requirements of United States Code, title 42, 1395dd (EMTALA).  The health care services provided by the system must include:  (1) the services described in subdivision 4 with the exception of outpatient prescription drug coverage but shall include drugs administered in a clinic or other outpatient setting; or (2) a set of comprehensive and medically necessary health services that the recipients might reasonably require to be maintained in good health and that has been approved by the


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commissioner, including at a minimum, but not limited to, emergency care, medical transportation services, inpatient hospital and physician care, outpatient health services, preventive health services, mental health services, and prescription drugs administered in a clinic or other outpatient setting.  Outpatient prescription drug coverage is covered on a fee-for-service basis in accordance with section 256D.03, subdivision 3, and funded under subdivision 9.  A hospital establishing a coordinated care delivery system under this subdivision must ensure that the requirements of this subdivision are met.

 

(b) A hospital or group of hospitals may contract with the commissioner to develop and implement a coordinated care delivery system as follows:

 

(1) effective June 1, 2010, a hospital qualifies under this subdivision if:  (i) during calendar year 2008, it received fee-for-service payments for services to general assistance medical care recipients (A) equal to or greater than $1,500,000, or (B) equal to or greater than 1.3 percent of net patient revenue; or (ii) a contract with the hospital is necessary to provide geographic access or to ensure that at least 80 percent of enrollees have access to a coordinated care delivery system; and

 

(2) effective December 1, 2010, a Minnesota hospital not qualified under clause (1) may contract with the commissioner under this subdivision if it agrees to satisfy the requirements of this subdivision.

 

Participation by hospitals shall become effective quarterly on June 1, September 1, December 1, or March 1.  Hospital participation is effective for a period of 12 months and may be renewed for successive 12-month periods.

 

Coordinated care delivery system contracts are in effect from June 1, 2010, to December 31, 2010, or upon the effective date of the expansion of medical assistance coverage to include adults without children, whichever is later.

 

(c) Applicants and recipients may enroll in any available coordinated care delivery system statewide.  If more than one coordinated care delivery system is available, the applicant or recipient shall be allowed to choose among the systems that provide services within 25 miles of the individual's community of residence.  The commissioner may assign an applicant or recipient to a coordinated care delivery system that provides services within 25 miles of the individual's community of residence, if no choice is made by the applicant or recipient.  The commissioner shall consider a recipient's zip code, city of residence, county of residence, or distance from a participating coordinated care delivery system when determining default assignment.  An applicant or recipient may decline enrollment in a coordinated care delivery system.  Upon enrollment into a coordinated care delivery system, the recipient must agree to receive all nonemergency services through the coordinated care delivery system.  Enrollment in a coordinated care delivery system is for six months and may be renewed for additional six-month periods, except that initial enrollment is for six months or until the end of a recipient's period of general assistance medical care eligibility, whichever occurs first.  A recipient who continues to meet the eligibility requirements of this section is not eligible to enroll in MinnesotaCare during a period of enrollment in a coordinated care delivery system.  From June 1, 2010, to November 30, 2010, applicants and recipients not enrolled in a coordinated care delivery system may seek services from a hospital eligible for reimbursement under the temporary uncompensated care pool established under subdivision 8.  After November 30, 2010, services are available only through a coordinated care delivery system.

 

(d) A hospital must provide access to cost-effective outpatient services available in its service area.  The hospital may contract and coordinate with providers and clinics for the delivery of services and shall contract with federally qualified health centers and essential community providers as defined under section 62Q.19, subdivision 1, paragraph (a), clauses (1) and (2), to the extent practicable.  If a provider or clinic contracts with a hospital to provide services through the coordinated care delivery system, the provider may not refuse to provide services to any recipient enrolled in the system, and payment for services shall be negotiated with the hospital and paid by the hospital from the system's allocation under subdivision 7.


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(e) A coordinated care delivery system must:

 

(1) provide the covered services required under paragraph (a) to recipients enrolled in the coordinated care delivery system, and comply with the requirements of subdivision 4, paragraphs (b) to (g);

 

(2) establish a process to monitor enrollment and ensure the quality of care provided; and

 

(3) in cooperation with counties, coordinate the delivery of health care services with existing homeless prevention, supportive housing, and rent subsidy programs and funding administered by the Minnesota Housing Finance Agency under chapter 462A; and

 

(4) adopt innovative and cost-effective methods of care delivery and coordination, which may include the use of allied health professionals, telemedicine, patient educators, care coordinators, and community health workers.

 

(f) The hospital may require a recipient to designate a primary care provider or a primary care clinic.  The hospital may limit the delivery of services to a network of providers who have contracted with the hospital to deliver services in accordance with this subdivision, and require a recipient to seek services only within this network.  The hospital may also require a referral to a provider before the service is eligible for payment.  A coordinated care delivery system is not required to provide payment to a provider who is not employed by or under contract with the system for services provided to a recipient enrolled in the system, except in cases of an emergency.  For purposes of this section, emergency services are defined in accordance with Code of Federal Regulations, title 42, section 438.114 (a).

 

(g) A recipient enrolled in a coordinated care delivery system has the right to appeal to the commissioner according to section 256.045.

 

(h) The state shall not be liable for the payment of any cost or obligation incurred by the coordinated care delivery system.

 

(i) The hospital must provide the commissioner with data necessary for assessing enrollment, quality of care, cost, and utilization of services.  Each hospital must provide, on a quarterly basis on a form prescribed by the commissioner for each recipient served by the coordinated care delivery system, the services provided, the cost of services provided, and the actual payment amount for the services provided and any other information the commissioner deems necessary to claim federal Medicaid match.  The commissioner must provide this data to the legislature on a quarterly basis.

 

(j) Effective June 1, 2010, the provisions of section 256.9695, subdivision 2, paragraph (b), do not apply to general assistance medical care provided under this section.

 

(k) If a recipient is transferred from a hospital that is not participating in a coordinated care delivery system to a hospital participating in a coordinated care delivery system, in order to receive a higher level of care, the transferring hospital remains eligible to receive any available funding through the temporary uncompensated care pool for the care initially provided at that hospital.  The hospital participating in the coordinated care delivery system shall be responsible only for care provided at that hospital, and is not financially liable for the initial care provided by the transferring hospital.

 

Sec. 50.  Laws 2010, chapter 200, article 1, section 12, subdivision 7, is amended to read:

 

Subd. 7.  Payments; rate setting for the hospital coordinated care delivery system.  (a) Effective for general assistance medical care services, with the exception of outpatient prescription drug coverage, provided on or after June 1, 2010, through a coordinated care delivery system, the commissioner shall allocate the annual appropriation


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for the coordinated care delivery system to hospitals participating under subdivision 6 in quarterly payments, beginning on the first scheduled warrant on or after June 1, 2010.  The payment shall be allocated among all hospitals qualified to participate on the allocation date.  Each hospital or group of hospitals shall receive a pro rata share of the allocation based on the hospital's or group of hospitals' calendar year 2008 payments for general assistance medical care services, adjusted for any limits on the number of general assistance medical care enrollees accepted by a hospital, provided that, for the purposes of this allocation, payments to Hennepin County Medical Center, Regions Hospital, Saint Mary's Medical Center, and University of Minnesota Medical Center, Fairview, shall be weighted at 110 percent of the actual amount.  The commissioner may prospectively reallocate payments to participating hospitals on a biannual basis to ensure that final allocations reflect actual coordinated care delivery system enrollment.  The 2008 base year shall be updated by one calendar year each June 1, beginning June 1, 2011.

 

(b) Beginning June 1, 2010, and every quarter beginning in June thereafter, the commissioner shall make one-third of the quarterly payment in June and the remaining two-thirds of the quarterly payment in July to each participating hospital or group of hospitals.

 

(b) (c) In order to be reimbursed under this section, nonhospital providers of health care services shall contract with one or more hospitals described in paragraph (a) to provide services to general assistance medical care recipients through the coordinated care delivery system established by the hospital.  The hospital shall reimburse bills submitted by nonhospital providers participating under this paragraph at a rate negotiated between the hospital and the nonhospital provider.

 

(c) (d) The commissioner shall apply for federal matching funds under section 256B.199, paragraphs (a) to (d), for expenditures under this subdivision.

 

(d) (e) Outpatient prescription drug coverage is provided in accordance with section 256D.03, subdivision 3, and paid on a fee-for-service basis under subdivision 9.

 

Sec. 51.  Laws 2010, chapter 200, article 1, section 12, subdivision 8, is amended to read:

 

Subd. 8.  Temporary uncompensated care pool.  (a) The commissioner shall establish a temporary uncompensated care pool, effective June 1, 2010.  Payments from the pool must be distributed, within the limits of the available appropriation, to hospitals that are not part of a coordinated care delivery system established under subdivision 6.  Payments from the pool must also be distributed, within the limits of the available appropriation, to ambulance services licensed under chapter 144E that respond to a request for an emergency ambulance call or interfacility transfer for a general assistance medical care enrollee, if the call or transfer originates from a location more than 25 miles from the health care facility that receives the enrollee.

 

(b) Hospitals seeking reimbursement from this pool must submit an invoice to the commissioner in a form prescribed by the commissioner for payment for services provided to an applicant or recipient not enrolled in a coordinated care delivery system.  A payment amount, as calculated under current law, must be determined, but not paid, for each admission of or service provided to a general assistance medical care recipient on or after June 1, 2010, to November 30 December 31, 2010, or until medical assistance coverage is expanded to include adults without children, whichever is later.

 

(c) The aggregated payment amounts for each hospital must be calculated as a percentage of the total calculated amount for all hospitals.

 

(d) Distributions from the uncompensated care pool for each hospital must be determined by multiplying the factor in paragraph (c) by the amount of money in the uncompensated care pool that is available for the six‑month period.


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(e) The commissioner shall apply for federal matching funds under section 256B.199, paragraphs (a) to (d), for expenditures under this subdivision.

 

(f) Outpatient prescription drugs are not eligible for payment under this subdivision.

 

Sec. 52.  Laws 2010, chapter 200, article 1, section 12, the effective date, is amended to read:

 

EFFECTIVE DATE.  This section is effective for services rendered on or after April 1, 2010, except that subdivision 4 is effective June 1, 2010.

 

EFFECTIVE DATE.  This section is effective retroactively from April 1, 2010.

 

Sec. 53.  Laws 2010, chapter 200, article 1, section 16, is amended to read:

 

Sec. 16.  Minnesota Statutes 2008, section 256L.05, subdivision 3c, is amended to read:

 

Subd. 3c.  Retroactive coverage.  Notwithstanding subdivision 3, the effective date of coverage shall be the first day of the month following termination from medical assistance 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.  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.  General assistance medical care recipients may qualify for retroactive coverage under this subdivision at six-month renewal.

 

EFFECTIVE DATE.  This section is effective June 1, 2010.

 

Sec. 54.  Laws 2010, chapter 200, article 1, section 21, is amended to read:

 

Sec. 21.  REPEALER. 

 

(a) Minnesota Statutes 2008, sections 256.742; 256.979, subdivision 8; and 256D.03, subdivision 9, are repealed effective April 1, 2010.

 

(b) Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 4, is repealed effective April June 1, 2010.

 

(c) Minnesota Statutes 2008, section 256B.195, subdivisions 4 and 5, are repealed effective for federal fiscal year 2010.

 

(d) Minnesota Statutes 2009 Supplement, section 256B.195, subdivisions 1, 2, and 3, are repealed effective for federal fiscal year 2010.

 

(e) Minnesota Statutes 2008, sections 256L.07, subdivision 6; 256L.15, subdivision 4; and 256L.17, subdivision 7, are repealed January 1, 2011.

 

EFFECTIVE DATE.  This section is effective retroactively from April 1, 2010.

 

Sec. 55.  Laws 2010, chapter 200, article 2, section 2, subdivision 1, is amended to read:

 

Subdivision 1.  Total Appropriation                                                                        $(7,985,000)              $(93,128,000)


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                                Appropriations by Fund

 

                                                       2010                                       2011

 

General                             34,807,000                         118,493,000

 

Health Care Access     (42,792,000)                      (211,621,000)

 

The amounts that may be spent for each purpose are specified in the following subdivisions.

 

Special Revenue Fund Transfers.

 

(1) The commissioner shall transfer the following amounts from special revenue fund balances to the general fund by June 30 of each respective fiscal year:  $410,000 for fiscal year 2010, and $412,000 for fiscal year 2011.

 

(2) Actual transfers made under clause (1) must be separately identified and reported as part of the quarterly reporting of transfers to the chairs of the relevant senate budget division and house of representatives finance division.

 

      EFFECTIVE DATE.  This section is effective the day following final enactment.

 

      Sec. 56.  Laws 2010, chapter 200, article 2, section 2, subdivision 8, is amended to read:

 

      Subd. 8.  Transfers

 

The commissioner must transfer $29,538,000 in fiscal year 2010 and $18,462,000 in fiscal year 2011 from the health care access fund to the general fund.  This is a onetime transfer.

 

The commissioner must transfer $4,800,000 from the consolidated chemical dependency treatment fund to the general fund by June 30, 2010.

 

Compulsive Gambling Special Revenue Administration.  The lottery prize fund appropriation for compulsive gambling administration is reduced by $6,000 for fiscal year 2010 and $4,000 for fiscal year 2011 must be transferred from the lottery prize fund appropriation for compulsive gambling administration to the general fund by June 30 of each respective fiscal year.  These are onetime reductions.

 

EFFECTIVE DATE.  This section is effective the day following final enactment.

 

Sec. 57.  EARLY EXPANSION. 

 

All costs related to implementation of Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, subdivision 4, paragraph (e), shall be paid from the health care access fund.

 

EFFECTIVE DATE.  This section is effective upon federal approval and is retroactive to April 1, 2010.


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Sec. 58.  FISCAL AND ACTUARIAL ANALYSIS. 

 

The commissioner of human services shall offer a request for proposal and accept bids for the completion of a complete fiscal and actuarial analysis of 2010 House File 135 and 2010 Senate File 118.  The commissioner shall report this analysis to the chairs of the health and human services finance and policy divisions in the house of representatives and senate no later than December 15, 2010.

 

Sec. 59.  REPEALER; TRANSFER. 

 

(a) Laws 2010, chapter 200, article 1, section 12, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, and 9, are repealed.

 

(b) Laws 2010, chapter 200, article 1, sections 18; and 19, are repealed.

 

(c) Minnesota Statutes 2008, section 256D.03, subdivisions 3a, 3b, 5, 6, 7, and 8, and Minnesota Statutes 2009 Supplement, section 256D.03, subdivision 3, are repealed.

 

EFFECTIVE DATE.  Paragraphs (a) and (b) are effective 30 days after federal approval of the amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, whichever is later, and all remaining unspent appropriations for the program established by Laws 2010, chapter 200, are transferred to the health care access fund.  Paragraph (c) is effective 30 days after federal approval of the amendments in this article to Minnesota Statutes, sections 256B.055, subdivision 15, and 256B.056, subdivision 4, or January 1, 2011, whichever is later.

 

ARTICLE 3

 

CONTINUING CARE

 

Section 1.  Minnesota Statutes 2009 Supplement, section 252.27, subdivision 2a, is amended to read:

 

Subd. 2a.  Contribution amount.  (a) The natural or adoptive parents of a minor child, including a child determined eligible for medical assistance without consideration of parental income, must contribute to the cost of services used by making monthly payments on a sliding scale based on income, unless the child is married or has been married, parental rights have been terminated, or the child's adoption is subsidized according to section 259.67 or through title IV-E of the Social Security Act.  The parental contribution is a partial or full payment for medical services provided for diagnostic, therapeutic, curing, treating, mitigating, rehabilitation, maintenance, and personal care services as defined in United States Code, title 26, section 213, needed by the child with a chronic illness or disability.

 

(b) For households with adjusted gross income equal to or greater than 100 percent of federal poverty guidelines, the parental contribution shall be computed by applying the following schedule of rates to the adjusted gross income of the natural or adoptive parents:

 

(1) if the adjusted gross income is equal to or greater than 100 percent of federal poverty guidelines and less than 175 percent of federal poverty guidelines, the parental contribution is $4 per month;

 

(2) if the adjusted gross income is equal to or greater than 175 percent of federal poverty guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental contribution shall be determined using a sliding fee scale established by the commissioner of human services which begins at one percent of adjusted gross income at 175 percent of federal poverty guidelines and increases to 7.5 percent of adjusted gross income for those with adjusted gross income up to 545 percent of federal poverty guidelines; and


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(3) if the adjusted gross income is greater than 545 percent of federal poverty guidelines and less than 675 percent of federal poverty guidelines, the parental contribution shall be 7.5 12.5 percent of adjusted gross income;.

 

(4) if the adjusted gross income is equal to or greater than 675 percent of federal poverty guidelines and less than 975 percent of federal poverty guidelines, the parental contribution shall be determined using a sliding fee scale established by the commissioner of human services which begins at 7.5 percent of adjusted gross income at 675 percent of federal poverty guidelines and increases to ten percent of adjusted gross income for those with adjusted gross income up to 975 percent of federal poverty guidelines; and

 

(5) if the adjusted gross income is equal to or greater than 975 percent of federal poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross income.

 

If the child lives with the parent, the annual adjusted gross income is reduced by $2,400 prior to calculating the parental contribution.  If the child resides in an institution specified in section 256B.35, the parent is responsible for the personal needs allowance specified under that section in addition to the parental contribution determined under this section.  The parental contribution is reduced by any amount required to be paid directly to the child pursuant to a court order, but only if actually paid.

 

(c) The household size to be used in determining the amount of contribution under paragraph (b) includes natural and adoptive parents and their dependents, including the child receiving services.  Adjustments in the contribution amount due to annual changes in the federal poverty guidelines shall be implemented on the first day of July following publication of the changes.

 

(d) For purposes of paragraph (b), "income" means the adjusted gross income of the natural or adoptive parents determined according to the previous year's federal tax form, except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds have been used to purchase a home shall not be counted as income.

 

(e) The contribution shall be explained in writing to the parents at the time eligibility for services is being determined.  The contribution shall be made on a monthly basis effective with the first month in which the child receives services.  Annually upon redetermination or at termination of eligibility, if the contribution exceeded the cost of services provided, the local agency or the state shall reimburse that excess amount to the parents, either by direct reimbursement if the parent is no longer required to pay a contribution, or by a reduction in or waiver of parental fees until the excess amount is exhausted.  All reimbursements must include a notice that the amount reimbursed may be taxable income if the parent paid for the parent's fees through an employer's health care flexible spending account under the Internal Revenue Code, section 125, and that the parent is responsible for paying the taxes owed on the amount reimbursed.

 

(f) The monthly contribution amount must be reviewed at least every 12 months; when there is a change in household size; and when there is a loss of or gain in income from one month to another in excess of ten percent.  The local agency shall mail a written notice 30 days in advance of the effective date of a change in the contribution amount.  A decrease in the contribution amount is effective in the month that the parent verifies a reduction in income or change in household size.

 

(g) Parents of a minor child who do not live with each other shall each pay the contribution required under paragraph (a).  An amount equal to the annual court-ordered child support payment actually paid on behalf of the child receiving services shall be deducted from the adjusted gross income of the parent making the payment prior to calculating the parental contribution under paragraph (b).

 

(h) The contribution under paragraph (b) shall be increased by an additional five percent if the local agency determines that insurance coverage is available but not obtained for the child.  For purposes of this section, "available" means the insurance is a benefit of employment for a family member at an annual cost of no more than


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five percent of the family's annual income.  For purposes of this section, "insurance" means health and accident insurance coverage, enrollment in a nonprofit health service plan, health maintenance organization, self-insured plan, or preferred provider organization.

 

Parents who have more than one child receiving services shall not be required to pay more than the amount for the child with the highest expenditures.  There shall be no resource contribution from the parents.  The parent shall not be required to pay a contribution in excess of the cost of the services provided to the child, not counting payments made to school districts for education-related services.  Notice of an increase in fee payment must be given at least 30 days before the increased fee is due.

 

(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in the 12 months prior to July 1:

 

(1) the parent applied for insurance for the child;

 

(2) the insurer denied insurance;

 

(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a complaint or appeal, in writing, to the commissioner of health or the commissioner of commerce, or litigated the complaint or appeal; and

 

(4) as a result of the dispute, the insurer reversed its decision and granted insurance.

 

For purposes of this section, "insurance" has the meaning given in paragraph (h).

 

A parent who has requested a reduction in the contribution amount under this paragraph shall submit proof in the form and manner prescribed by the commissioner or county agency, including, but not limited to, the insurer's denial of insurance, the written letter or complaint of the parents, court documents, and the written response of the insurer approving insurance.  The determinations of the commissioner or county agency under this paragraph are not rules subject to chapter 14.

 

Sec. 2.  Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:

 

Subd. 9.  Employed persons with disabilities.  (a) Medical assistance may be paid for a person who is employed and who:

 

(1) but for excess earnings or assets, meets the definition of disabled under the supplemental security income program;

 

(2) is at least 16 but less than 65 years of age;

 

(3) meets the asset limits in paragraph (c); and

 

(4) effective November 1, 2003, pays a premium and other obligations under paragraph (e).

 

Any spousal income or assets shall be disregarded for purposes of eligibility and premium determinations.

 

(b) After the month of enrollment, a person enrolled in medical assistance under this subdivision who:

 

(1) is temporarily unable to work and without receipt of earned income due to a medical condition, as verified by a physician, may retain eligibility for up to four calendar months; or


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(2) effective January 1, 2004, loses employment for reasons not attributable to the enrollee, may retain eligibility for up to four consecutive months after the month of job loss.  To receive a four-month extension, enrollees must verify the medical condition or provide notification of job loss.  All other eligibility requirements must be met and the enrollee must pay all calculated premium costs for continued eligibility.

 

(c) For purposes of determining eligibility under this subdivision, a person's assets must not exceed $20,000, excluding:

 

(1) all assets excluded under section 256B.056;

 

(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and

 

(3) medical expense accounts set up through the person's employer.

 

(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65 earned income disregard.  To be eligible, a person applying for medical assistance under this subdivision must have earned income above the disregard level.

 

(2) Effective January 1, 2004, to be considered earned income, Medicare, Social Security, and applicable state and federal income taxes must be withheld.  To be eligible, a person must document earned income tax withholding.

 

(e)(1) A person whose earned and unearned income is equal to or greater than 100 percent of federal poverty guidelines for the applicable family size must pay a premium to be eligible for medical assistance under this subdivision.  The premium shall be based on the person's gross earned and unearned income and the applicable family size using a sliding fee scale established by the commissioner, which begins at one percent of income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income for those with incomes at or above 300 percent of the federal poverty guidelines.  Annual adjustments in the premium schedule based upon changes in the federal poverty guidelines shall be effective for premiums due in July of each year.

 

(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for medical assistance under this subdivision.  An enrollee shall pay the greater of a $35 $50 premium or the premium calculated in clause (1).

 

(3) Effective November 1, 2003, all enrollees who receive unearned income must pay one-half of one 2.5 percent of unearned income in addition to the premium amount.

 

(4) Effective November 1, 2003, for enrollees whose income does not exceed 200 percent of the federal poverty guidelines and who are also enrolled in Medicare, the commissioner must reimburse the enrollee for Medicare Part B premiums under section 256B.0625, subdivision 15, paragraph (a).

 

(5) Increases in benefits under title II of the Social Security Act shall not be counted as income for purposes of this subdivision until July 1 of each year.

 

(f) A person's eligibility and premium shall be determined by the local county agency.  Premiums must be paid to the commissioner.  All premiums are dedicated to the commissioner.

 

(g) Any required premium shall be determined at application and redetermined at the enrollee's six-month income review or when a change in income or household size is reported.  Enrollees must report any change in income or household size within ten days of when the change occurs.  A decreased premium resulting from a reported change in income or household size shall be effective the first day of the next available billing month after the change is reported.  Except for changes occurring from annual cost-of-living increases, a change resulting in an increased premium shall not affect the premium amount until the next six-month review.


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(h) Premium payment is due upon notification from the commissioner of the premium amount required.  Premiums may be paid in installments at the discretion of the commissioner.

 

(i) Nonpayment of the premium shall result in denial or termination of medical assistance unless the person demonstrates good cause for nonpayment.  Good cause exists if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to D, are met.  Except when an installment agreement is accepted by the commissioner, all persons disenrolled for nonpayment of a premium must pay any past due premiums as well as current premiums due prior to being reenrolled.  Nonpayment shall include payment with a returned, refused, or dishonored instrument.  The commissioner may require a guaranteed form of payment as the only means to replace a returned, refused, or dishonored instrument.

 

(j) The commissioner shall notify enrollees annually beginning at least 24 months before the person's 65th birthday of the medical assistance eligibility rules affecting income, assets, and treatment of a spouse's income and assets that will be applied upon reaching age 65.

 

EFFECTIVE DATE.  This section is effective January 1, 2011.

 

Sec. 3.  Minnesota Statutes 2009 Supplement, section 256B.0915, subdivision 3a, is amended to read:

 

Subd. 3a.  Elderly waiver cost limits.  (a) The monthly limit for the cost of waivered services to an individual elderly waiver client except for individuals described in paragraph (b) shall be the weighted average monthly nursing facility rate of the case mix resident class to which the elderly waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance needs allowance as described in subdivision 1d, paragraph (a), until the first day of the state fiscal year in which the resident assessment system as described in section 256B.438 for nursing home rate determination is implemented.  Effective on the first day of the state fiscal year in which the resident assessment system as described in section 256B.438 for nursing home rate determination is implemented and the first day of each subsequent state fiscal year, the monthly limit for the cost of waivered services to an individual elderly waiver client shall be the rate of the case mix resident class to which the waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on the last day of the previous state fiscal year, adjusted by the greater of any legislatively adopted home and community-based services percentage rate increase or the average statewide percentage increase in nursing facility payment rates adjustment.

 

(b) The monthly limit for the cost of waivered services to an individual elderly waiver client assigned to a case mix classification A under paragraph (a) with (1) no dependencies in activities of daily living, (2) only one dependency in bathing, dressing, grooming, or walking, or (3) a dependency score of less than three if eating is the only dependency, shall be the lower of the case mix classification amount for case mix A as determined under paragraph (a) or the case mix classification amount for case mix A effective on October 1, 2008, per month for all new participants enrolled in the program on or after July 1, 2009.  This monthly limit shall be applied to all other participants who meet this criteria at reassessment.

 

(c) If extended medical supplies and equipment or environmental modifications are or will be purchased for an elderly waiver client, the costs may be prorated for up to 12 consecutive months beginning with the month of purchase.  If the monthly cost of a recipient's waivered services exceeds the monthly limit established in paragraph (a) or (b), the annual cost of all waivered services shall be determined.  In this event, the annual cost of all waivered services shall not exceed 12 times the monthly limit of waivered services as described in paragraph (a) or (b).

 

Sec. 4.  Minnesota Statutes 2008, section 256B.0915, subdivision 3b, is amended to read:

 

Subd. 3b.  Cost limits for elderly waiver applicants who reside in a nursing facility.  (a) For a person who is a nursing facility resident at the time of requesting a determination of eligibility for elderly waivered services, a monthly conversion limit for the cost of elderly waivered services may be requested.  The monthly conversion limit for the cost of elderly waiver services shall be the resident class assigned under Minnesota Rules, parts 9549.0050 to


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9549.0059, for that resident in the nursing facility where the resident currently resides until July 1 of the state fiscal year in which the resident assessment system as described in section 256B.438 for nursing home rate determination is implemented.  Effective on July 1 of the state fiscal year in which the resident assessment system as described in section 256B.438 for nursing home rate determination is implemented, the monthly conversion limit for the cost of elderly waiver services shall be the per diem nursing facility rate as determined by the resident assessment system as described in section 256B.438 for that resident residents in the nursing facility where the resident currently resides, but in effect on June 30, 2010, and adjusted annually by any legislatively adopted percentage change in the elderly waiver services rates.  That per diem shall be multiplied by 365 and, divided by 12, less and reduced by the recipient's maintenance needs allowance as described in subdivision 1d.  The initially approved conversion rate may must be adjusted by the greater of any subsequent legislatively adopted home and community-based services percentage rate increase or the average statewide percentage increase in nursing facility payment rates adjustment.  The limit under this subdivision only applies to persons discharged from a nursing facility after a minimum 30-day stay and found eligible for waivered services on or after July 1, 1997.  For conversions from the nursing home to the elderly waiver with consumer directed community support services, the conversion rate limit is equal to the nursing facility rate reduced by a percentage equal to the percentage difference between the consumer directed services budget limit that would be assigned according to the federally approved waiver plan and the corresponding community case mix cap, but not to exceed 50 percent.

 

(b) The following costs must be included in determining the total monthly costs for the waiver client:

 

(1) cost of all waivered services, including extended medical specialized supplies and equipment and environmental modifications and accessibility adaptations; and

 

(2) cost of skilled nursing, home health aide, and personal care services reimbursable by medical assistance.

 

Sec. 5.  Minnesota Statutes 2009 Supplement, section 256B.69, subdivision 23, is amended to read:

 

Subd. 23.  Alternative services; elderly and disabled persons.  (a) The commissioner may implement demonstration projects to create alternative integrated delivery systems for acute and long-term care services to elderly persons and persons with disabilities as defined in section 256B.77, subdivision 7a, that provide increased coordination, improve access to quality services, and mitigate future cost increases.  The commissioner may seek federal authority to combine Medicare and Medicaid capitation payments for the purpose of such demonstrations and may contract with Medicare-approved special needs plans to provide Medicaid services.  Medicare funds and services shall be administered according to the terms and conditions of the federal contract and demonstration provisions.  For the purpose of administering medical assistance funds, demonstrations under this subdivision are subject to subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, items B and C, which do not apply to persons enrolling in demonstrations under this section.  An initial open enrollment period may be provided.  Persons who disenroll from demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is enrolled in a health plan under these demonstrations and the health plan's participation is subsequently terminated for any reason, the person shall be provided an opportunity to select a new health plan and shall have the right to change health plans within the first 60 days of enrollment in the second health plan.  Persons required to participate in health plans under this section who fail to make a choice of health plan shall not be randomly assigned to health plans under these demonstrations.  Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, the commissioner may contract with managed care organizations, including counties, to serve only elderly persons eligible for medical assistance, elderly and disabled persons, or disabled persons only.  For persons with a primary diagnosis of developmental disability, serious and persistent mental illness, or serious emotional disturbance, the commissioner must ensure that the county authority has approved the demonstration and contracting design.  Enrollment in these projects for persons with disabilities shall be voluntary.  The commissioner shall not implement any demonstration project under this subdivision for persons with a primary diagnosis of developmental disabilities, serious and persistent mental illness, or serious emotional disturbance, without approval of the county board of the county in which the demonstration is being implemented.


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(b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501 to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to 9525.1330, 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement under this section projects for persons with developmental disabilities.  The commissioner may capitate payments for ICF/MR services, waivered services for developmental disabilities, including case management services, day training and habilitation and alternative active treatment services, and other services as approved by the state and by the federal government.  Case management and active treatment must be individualized and developed in accordance with a person-centered plan.  Costs under these projects may not exceed costs that would have been incurred under fee-for-service.  Beginning July 1, 2003, and until four years after the pilot project implementation date, subcontractor participation in the long-term care developmental disability pilot is limited to a nonprofit long-term care system providing ICF/MR services, home and community-based waiver services, and in-home services to no more than 120 consumers with developmental disabilities in Carver, Hennepin, and Scott Counties.  The commissioner shall report to the legislature prior to expansion of the developmental disability pilot project.  This paragraph expires four years after the implementation date of the pilot project.

 

(c) Before implementation of a demonstration project for disabled persons, the commissioner must provide information to appropriate committees of the house of representatives and senate and must involve representatives of affected disability groups in the design of the demonstration projects.

 

(d) A nursing facility reimbursed under the alternative reimbursement methodology in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity provide services under paragraph (a).  The commissioner shall amend the state plan and seek any federal waivers necessary to implement this paragraph.

 

(e) The commissioner, in consultation with the commissioners of commerce and health, may approve and implement programs for all-inclusive care for the elderly (PACE) according to federal laws and regulations governing that program and state laws or rules applicable to participating providers.  The process for approval of these programs shall begin only after the commissioner receives grant money in an amount sufficient to cover the state share of the administrative and actuarial costs to implement the programs during state fiscal years 2006 and 2007.  Grant amounts for this purpose shall be deposited in an account in the special revenue fund and are appropriated to the commissioner to be used solely for the purpose of PACE administrative and actuarial costs.  A PACE provider is not required to be licensed or certified as a health plan company as defined in section 62Q.01, subdivision 4.  Persons age 55 and older who have been screened by the county and found to be eligible for services under the elderly waiver or community alternatives for disabled individuals or who are already eligible for Medicaid but meet level of care criteria for receipt of waiver services may choose to enroll in the PACE program.  Medicare and Medicaid services will be provided according to this subdivision and federal Medicare and Medicaid requirements governing PACE providers and programs.  PACE enrollees will receive Medicaid home and community-based services through the PACE provider as an alternative to services for which they would otherwise be eligible through home and community-based waiver programs and Medicaid State Plan Services.  The commissioner shall establish Medicaid rates for PACE providers that do not exceed costs that would have been incurred under fee-for-service or other relevant managed care programs operated by the state.

 

(f) The commissioner shall seek federal approval to expand the Minnesota disability health options (MnDHO) program established under this subdivision in stages, first to regional population centers outside the seven-county metro area and then to all areas of the state.  Until July 1, 2009, expansion for MnDHO projects that include home and community-based services is limited to the two projects and service areas in effect on March 1, 2006.  Enrollment in integrated MnDHO programs that include home and community-based services shall remain voluntary.  Costs for home and community-based services included under MnDHO must not exceed costs that would have been incurred under the fee-for-service program.  Notwithstanding whether expansion occurs under this paragraph, in determining MnDHO payment rates and risk adjustment methods for contract years starting in 2012, the commissioner must consider the methods used to determine county allocations for home and community-based program participants.  If necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs for home and community-based services, the commissioner shall achieve the reduction by maintaining the base rate


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for contract years 2010 and 2011 for services provided under the community alternatives for disabled individuals waiver at the same level as for contract year 2009.  The commissioner may apply other reductions to MnDHO rates to implement decreases in provider payment rates required by state law.  In developing program specifications for expansion of integrated programs, the commissioner shall involve and consult the state-level stakeholder group established in subdivision 28, paragraph (d), including consultation on whether and how to include home and community-based waiver programs.  Plans for further expansion of MnDHO projects shall be presented to the chairs of the house of representatives and senate committees with jurisdiction over health and human services policy and finance by February 1, 2007.

 

(g) Notwithstanding section 256B.0261, health plans providing services under this section are responsible for home care targeted case management and relocation targeted case management.  Services must be provided according to the terms of the waivers and contracts approved by the federal government.

 

Sec. 6.  [256.4825] REPORT REGARDING PROGRAMS AND SERVICES FOR PEOPLE WITH DISABILITIES. 

 

The Minnesota State Council on Disability, the Minnesota Consortium for Citizens with Disabilities, and the Arc of Minnesota may submit an annual report by January 15 of each year, beginning in 2012, to the chairs and ranking minority members of the legislative committees with jurisdiction over programs serving people with disabilities as provided in this section.  The report must describe the existing state policies and goals for programs serving people with disabilities including, but not limited to, programs for employment, transportation, housing, education, quality assurance, consumer direction, physical and programmatic access, and health.  The report must provide data and measurements to assess the extent to which the policies and goals are being met.  The commissioner of human services and the commissioners of other state agencies administering programs for people with disabilities shall cooperate with the Minnesota State Council on Disability, the Minnesota Consortium for Citizens with Disabilities, and the Arc of Minnesota and provide those organizations with existing published information and reports that will assist in the preparation of the report.

 

Sec. 7.  CASE MANAGEMENT REFORM. 

 

(a) By February 1, 2011, the commissioner of human services shall provide specific recommendations and language for proposed legislation to:

 

(1) define the administrative and the service functions of case management and make changes to improve the funding for administrative functions;

 

(2) standardize and simplify processes, standards, and timelines for administrative functions of case management within the Department of Human Services, Disability Services Division, including eligibility determinations, resource allocation, management of dollars, provision for assignment of one case manager at a time per person, waiting lists, quality assurance, host county concurrence requirements, county of financial responsibility provisions, and waiver compliance; and

 

(3) increase opportunities for consumer choice of case management functions involving service coordination.

 

(b) In developing these recommendations, the commissioner shall consider the recommendations of the 2007 Redesigning Case Management Services for Persons with Disabilities report and consult with existing stakeholder groups, which include representatives of counties, disability and senior advocacy groups, service providers, and representatives of agencies which provide contracted case management.

 

EFFECTIVE DATE.  This section is effective the day following final enactment.


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Sec. 8.  COMMISSIONER TO SEEK FEDERAL MATCH. 

 

(a) The commissioner of human services shall seek federal financial participation for eligible activity related to fiscal years 2010 and 2011 grants to Advocating Change Together to establish a statewide self-advocacy network for persons with developmental disabilities and for eligible activities under any future grants to the organization.

 

(b) The commissioner shall report to the chairs of the senate Health and Human Services Budget Division and the house of representatives Health Care and Human Services Finance Division by December 15, 2010, with the results of the application for federal matching funds.

 

ARTICLE 4

 

CHILDREN AND FAMILY SERVICES

 

Section 1.  Minnesota Statutes 2008, section 119B.025, subdivision 1, is amended to read:

 

Subdivision 1.  Factors which must be verified.  (a) The county shall verify the following at all initial child care applications using the universal application:

 

(1) identity of adults;

 

(2) presence of the minor child in the home, if questionable;

 

(3) relationship of minor child to the parent, stepparent, legal guardian, eligible relative caretaker, or the spouses of any of the foregoing;

 

(4) age;

 

(5) immigration status, if related to eligibility;

 

(6) Social Security number, if given;

 

(7) income;

 

(8) spousal support and child support payments made to persons outside the household;

 

(9) residence; and

 

(10) inconsistent information, if related to eligibility.

 

(b) If a family did not use the universal application or child care addendum to apply for child care assistance, the family must complete the universal application or child care addendum at its next eligibility redetermination and the county must verify the factors listed in paragraph (a) as part of that redetermination.  Once a family has completed a universal application or child care addendum, the county shall use the redetermination form described in paragraph (c) for that family's subsequent redeterminations.  Eligibility must be redetermined at least every six months.  For a family where at least one parent is under the age of 21, does not have a high school or general equivalency diploma, and is a student in a school district or another similar program that provides or arranges for child care, as well as parenting, social services, career and employment supports, and academic support to achieve high school graduation, the redetermination of eligibility shall be deferred beyond six months, but not to exceed 12 months, to the end of the student's school year.  If a family reports a change in an eligibility factor before the family's next regularly scheduled redetermination, the county must recalculate eligibility without requiring verification of any eligibility factor that did not change.


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(c) The commissioner shall develop a redetermination form to redetermine eligibility and a change report form to report changes that minimize paperwork for the county and the participant.

 

(d) Families have the primary responsibility to verify information.  A county must consider the family's circumstances and ability to produce verification when initiating a request for verification.  If a family is unable to verify an eligibility factor, the county must request written consent from the family to obtain verification from other sources.  A county may not request a specific form of verification if another is more readily available.  When verification of an eligibility factor other than income is not available despite the efforts of the county and the family, the county must accept a signed statement from the family attesting to the correctness of the information if one is provided.  The county must deny or end assistance to families who refuse or deliberately fail to verify information.

 

EFFECTIVE DATE.  This section is effective October 15, 2010.

 

Sec. 2.  Minnesota Statutes 2008, section 119B.09, subdivision 4, is amended to read:

 

Subd. 4.  Eligibility; annual income; calculation.  Annual income of the applicant family is the current monthly income of the family multiplied by 12 or the income for the 12-month period immediately preceding the date of application, or income calculated by the method which provides the most accurate assessment of income available to the family.  Self-employment income must be calculated based on gross receipts less operating expenses.  Income must be recalculated when the family's income changes, but no less often than every six months.  For a family where at least one parent is under the age of 21, does not have a high school or general equivalency diploma, and is a student in a school district or another similar program that provides or arranges for child care, as well as parenting, social services, career and employment supports, and academic support to achieve high school graduation, income must be recalculated when the family's income changes, but otherwise shall be deferred beyond six months, but not to exceed 12 months, to the end of the student's school year.  Income must be verified with documentary evidence.  If the applicant does not have sufficient evidence of income, verification must be obtained from the source of the income.

 

EFFECTIVE DATE.  This section is effective October 15, 2010.

 

Sec. 3.  Minnesota Statutes 2008, section 119B.11, subdivision 1, is amended to read:

 

Subdivision 1.  County contributions required.  (a) In addition to payments from basic sliding fee child care program participants, each county shall contribute from county tax or other sources a fixed local match maintenance of effort equal to its calendar year 1996 required county contribution reduced by the administrative funding loss that would have occurred in state fiscal year 1996 under section 119B.15, except the maintenance of effort for a county must be equal to at least 1.1 percent of the county's basic sliding fee direct services allocation for the previous calendar year and no greater than six percent of the county's basic sliding fee direct services allocation for the previous calendar year.  The commissioner shall recover funds from the county as necessary to bring county expenditures into compliance with this subdivision.  The commissioner may accept county contributions, including contributions above the fixed local match county maintenance of effort, in order to make state payments.

 

(b) The commissioner may accept payments from counties to:

 

(1) fulfill the county contribution as required under subdivision 1;

 

(2) pay for services authorized under this chapter beyond those paid for with federal or state funds or with the required county contributions; or

 

(3) pay for child care services in addition to those authorized under this chapter, as authorized under other federal, state, or local statutes or regulations.


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(c) The county payments must be deposited in an account in the special revenue fund.  Money in this account is appropriated to the commissioner for child care assistance under this chapter and other applicable statutes and regulations and is in addition to other state and federal appropriations.

 

EFFECTIVE DATE.  This section is effective January 1, 2011.

 

Sec. 4.  Minnesota Statutes 2008, section 256D.0515, is amended to read:

 

256D.0515 ASSET LIMITATIONS FOR FOOD STAMP HOUSEHOLDS. 

 

All food stamp households must be determined eligible for the benefit discussed under section 256.029.  Food stamp households must demonstrate that:

 

(1) their gross income meets the federal Food Stamp requirements under United States Code, title 7, section 2014(c); and is equal to or less than 165 percent of the federal poverty guidelines for the same family size.

 

(2) they have financial resources, excluding vehicles, of less than $7,000.

 

Sec. 5.  Minnesota Statutes 2008, section 256J.20, subdivision 3, is amended to read:

 

Subd. 3.  Other property limitations.  To be eligible for MFIP, the equity value of all nonexcluded real and personal property of the assistance unit must not exceed $2,000 for applicants and $5,000 for ongoing participants.  The value of assets in clauses (1) to (19) must be excluded when determining the equity value of real and personal property:

 

(1) a licensed vehicle up to a loan value of less than or equal to $15,000 $7,500.  If the assistance unit owns more than one licensed vehicle, the county agency shall determine the loan value of all additional vehicles and exclude the combined loan value of less than or equal to $7,500.  The county agency shall apply any excess loan value as if it were equity value to the asset limit described in this section,.  If the assistance unit owns more than one licensed vehicle, the county agency shall determine the vehicle with the highest loan value and count only the loan value over $7,500, excluding:  (i) the value of one vehicle per physically disabled person when the vehicle is needed to transport the disabled unit member; this exclusion does not apply to mentally disabled people; (ii) the value of special equipment for a disabled member of the assistance unit; and (iii) any vehicle used for long-distance travel, other than daily commuting, for the employment of a unit member.

 

The county agency shall count the loan value of all other vehicles and apply this amount as if it were equity value to the asset limit described in this section.  To establish the loan value of vehicles, a county agency must use the N.A.D.A.  Official Used Car Guide, Midwest Edition, for newer model cars.  When a vehicle is not listed in the guidebook, or when the applicant or participant disputes the loan value listed in the guidebook as unreasonable given the condition of the particular vehicle, the county agency may require the applicant or participant document the loan value by securing a written statement from a motor vehicle dealer licensed under section 168.27, stating the amount that the dealer would pay to purchase the vehicle.  The county agency shall reimburse the applicant or participant for the cost of a written statement that documents a lower loan value;

 

(2) the value of life insurance policies for members of the assistance unit;

 

(3) one burial plot per member of an assistance unit;

 

(4) the value of personal property needed to produce earned income, including tools, implements, farm animals, inventory, business loans, business checking and savings accounts used at least annually and used exclusively for the operation of a self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use is to produce income and if the vehicles are essential for the self-employment business;


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(5) the value of personal property not otherwise specified which is commonly used by household members in day-to-day living such as clothing, necessary household furniture, equipment, and other basic maintenance items essential for daily living;

 

(6) the value of real and personal property owned by a recipient of Supplemental Security Income or Minnesota supplemental aid;

 

(7) the value of corrective payments, but only for the month in which the payment is received and for the following month;

 

(8) a mobile home or other vehicle used by an applicant or participant as the applicant's or participant's home;

 

(9) money in a separate escrow account that is needed to pay real estate taxes or insurance and that is used for this purpose;

 

(10) money held in escrow to cover employee FICA, employee tax withholding, sales tax withholding, employee worker compensation, business insurance, property rental, property taxes, and other costs that are paid at least annually, but less often than monthly;

 

(11) monthly assistance payments for the current month's or short-term emergency needs under section 256J.626, subdivision 2;

 

(12) the value of school loans, grants, or scholarships for the period they are intended to cover;

 

(13) payments listed in section 256J.21, subdivision 2, clause (9), which are held in escrow for a period not to exceed three months to replace or repair personal or real property;

 

(14) income received in a budget month through the end of the payment month;

 

(15) savings from earned income of a minor child or a minor parent that are set aside in a separate account designated specifically for future education or employment costs;

 

(16) the federal earned income credit, Minnesota working family credit, state and federal income tax refunds, state homeowners and renters credits under chapter 290A, property tax rebates and other federal or state tax rebates in the month received and the following month;

 

(17) payments excluded under federal law as long as those payments are held in a separate account from any nonexcluded funds;

 

(18) the assets of children ineligible to receive MFIP benefits because foster care or adoption assistance payments are made on their behalf; and

 

(19) the assets of persons whose income is excluded under section 256J.21, subdivision 2, clause (43). 

 

EFFECTIVE DATE.  This section is effective October 1, 2010.

 

Sec. 6.  Minnesota Statutes 2008, section 256J.24, subdivision 10, is amended to read:

 

Subd. 10.  MFIP exit level.  The commissioner shall adjust the MFIP earned income disregard to ensure that most participants do not lose eligibility for MFIP until their income reaches at least 115 110 percent of the federal poverty guidelines in effect in October of each fiscal year at the time of the adjustment.  The adjustment to the


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disregard shall be based on a household size of three, and the resulting earned income disregard percentage must be applied to all household sizes.  The adjustment under this subdivision must be implemented at the same time as the October food stamp or whenever there is a food support cost-of-living adjustment is reflected in the food portion of MFIP transitional standard as required under subdivision 5a.

 

EFFECTIVE DATE.  This section is effective October 1, 2010.

 

Sec. 7.  Minnesota Statutes 2008, section 256J.37, subdivision 3a, is amended to read:

 

Subd. 3a.  Rental subsidies; unearned income.  (a) Effective July 1, 2003, The county agency shall count $50 $100 of the value of public and assisted rental subsidies provided through the Department of Housing and Urban Development (HUD) as unearned income to the cash portion of the MFIP grant.  The full amount of the subsidy must be counted as unearned income when the subsidy is less than $50 $100.  The income from this subsidy shall be budgeted according to section 256J.34. 

 

(b) The provisions of this subdivision shall not apply to an MFIP assistance unit which includes a participant who is:

 

(1) age 60 or older;

 

(2) a caregiver who is suffering from an illness, injury, or incapacity that has been certified by a qualified professional when the illness, injury, or incapacity is expected to continue for more than 30 days and prevents the person from obtaining or retaining employment; or

 

(3) a caregiver whose presence in the home is required due to the illness or incapacity of another member in the assistance unit, a relative in the household, or a foster child in the household when the illness or incapacity and the need for the participant's presence in the home has been certified by a qualified professional and is expected to continue for more than 30 days.

 

(c) The provisions of this subdivision shall not apply to an MFIP assistance unit where the parental caregiver is an SSI recipient.

 

(d) Prior to implementing this provision, the commissioner must identify the MFIP participants subject to this provision and provide written notice to these participants at least 30 days before the first grant reduction.  The notice must inform the participant of the basis for the potential grant reduction, the exceptions to the provision, if any, and inform the participant of the steps necessary to claim an exception.  A person who is found not to meet one of the exceptions to the provision must be notified and informed of the right to a fair hearing under section 256J.40.  The notice must also inform the participant that the participant may be eligible for a rent reduction resulting from a reduction in the MFIP grant and encourage the participant to contact the local housing authority. 

 

EFFECTIVE DATE.  This section is effective October 1, 2010.

 

Sec. 8.  Minnesota Statutes 2009 Supplement, section 256J.425, subdivision 3, is amended to read:

 

Subd. 3.  Hard-to-employ participants.  (a) An assistance unit subject to the time limit in section 256J.42, subdivision 1, is eligible to receive months of assistance under a hardship extension if the participant who reached the time limit belongs to any of the following groups: 

 

(1) a person who is diagnosed by a licensed physician, psychological practitioner, or other qualified professional, as developmentally disabled or mentally ill, and the condition severely limits the person's ability to obtain or maintain suitable employment;


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(2) a person who:

 

(i) has been assessed by a vocational specialist or the county agency to be unemployable for purposes of this subdivision; or

 

(ii) has an IQ below 80 who has been assessed by a vocational specialist or a county agency to be employable, but the condition severely limits the person's ability to obtain or maintain suitable employment.  The determination of IQ level must be made by a qualified professional.  In the case of a non-English-speaking person:  (A) the determination must be made by a qualified professional with experience conducting culturally appropriate assessments, whenever possible; (B) the county may accept reports that identify an IQ range as opposed to a specific score; (C) these reports must include a statement of confidence in the results;

 

(3) a person who is determined by a qualified professional to be learning disabled, and the condition severely limits the person's ability to obtain or maintain suitable employment.  For purposes of the initial approval of a learning disability extension, the determination must have been made or confirmed within the previous 12 months.  In the case of a non-English-speaking person:  (i) the determination must be made by a qualified professional with experience conducting culturally appropriate assessments, whenever possible; and (ii) these reports must include a statement of confidence in the results.  If a rehabilitation plan for a participant extended as learning disabled is developed or approved by the county agency, the plan must be incorporated into the employment plan.  However, a rehabilitation plan does not replace the requirement to develop and comply with an employment plan under section 256J.521; or

 

(4) a person who has been granted a family violence waiver, and who is complying with an employment plan under section 256J.521, subdivision 3. 

 

(b) For purposes of this section chapter, "severely limits the person's ability to obtain or maintain suitable employment" means: 

 

(1) that a qualified professional has determined that the person's condition prevents the person from working 20 or more hours per week; or

 

(2) for a person who meets the requirements of paragraph (a), clause (2), item (ii), or clause (3), a qualified professional has determined the person's condition:

 

(i) significantly restricts the range of employment that the person is able to perform; or

 

(ii) significantly interferes with the person's ability to obtain or maintain suitable employment for 20 or more hours per week.

 

Sec. 9.  QUALITY RATING SYSTEM TRAINING, COACHING, CONSULTATION, AND SUPPORTS. 

 

The commissioner of human services shall direct $500,000 in federal child care development funds used for grants under Minnesota Statutes, section 119B.21, in fiscal year 2011 for the purpose of providing statewide child care provider training, coaching, consultation, and supports to prepare for the voluntary Minnesota quality rating system.  This is a onetime appropriation.  In addition, to the extent that private funds are made available, the commissioner shall designate those funds for this purpose.

 

Sec. 10.  CHILD CARE ASSISTANCE REDETERMINATION OF ELIGIBILITY AND INFORMATION VERIFICATION. 

 

The commissioner of human services shall use existing resources to implement the changes in this act related to child care assistance redetermination of eligibility and information verification under Minnesota Statutes, sections 119B.025, subdivision 1, and 119B.09, subdivision 4.


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ARTICLE 5

 

MISCELLANEOUS

 

Section 1.  [62A.3075] CANCER CHEMOTHERAPY TREATMENT COVERAGE. 

 

(a) A health plan company that provides coverage under a health plan for cancer chemotherapy treatment shall not require a higher co-payment, deductible, or coinsurance amount for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells than what the health plan requires for an intravenously administered or injected cancer medication that is provided, regardless of formulation or benefit category determination by the health plan company.

 

(b) A health plan company must not achieve compliance with this section by imposing an increase in co-payment, deductible, or coinsurance amount for an intravenously administered or injected cancer chemotherapy agent covered under the health plan.

 

(c) Nothing in this section shall be interpreted to prohibit a health plan company from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy.

 

(d) A plan offered by the commissioner of management and budget under section 43A.23 is deemed to be at parity and in compliance with this section.

 

EFFECTIVE DATE.  Paragraphs (a) and (c) are effective August 1, 2010, and apply to health plans providing coverage to a Minnesota resident offered, issued, sold, renewed, or continued as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after that date.  Paragraph (b) is effective the day following final enactment.

 

Sec. 2.  [62A.3094] COVERAGE FOR AUTISM SPECTRUM DISORDERS. 

 

Subdivision 1.  Definitions.  (a) For purposes of this section, the terms defined in paragraphs (b) to (e) have the meanings given.

 

(b) "Autism spectrum disorder" means the following conditions as determined by criteria set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association:

 

(1) autism or autistic disorder;

 

(2) Asperger's syndrome; or

 

(3) pervasive developmental disorder - not otherwise specified.

 

(c) "Board-certified behavior analyst" means an individual certified by the Behavior Analyst Certification Board as a board-certified behavior analyst.

 

(d) "Evidence-based," for purposes of this section only, is as described in subdivision 2, paragraph (c), clause (2).

 

(e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.

 

(f) "Manualized approach" means a self-contained volume, text, or set of instructional media, which may include videos or compact discs, that codifies in reasonable detail the procedures for implementing treatment.


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(g) "Medical necessity" or "medically necessary care" has the meaning given in section 62Q.53, subdivision 2.

 

(h) "Mental health professional" has the meaning given in section 245.4871, subdivision 27, clauses (1) to (6).

 

(i) "Qualified mental health behavioral aide" means a mental health behavioral aide as defined in section 256B.0943, subdivision 7.

 

(j) "Qualified mental health practitioner" means a mental health practitioner as defined in section 245.4871, subdivision 26.

 

(k) "Statistically superior outcomes" means a research study in which the probability that the results would be obtained under the null hypothesis is less than five percent.

 

Subd. 2.  Coverage required.  (a) For coverage requirements to apply, an individual must have a diagnosis of autism spectrum disorder made through an evaluation of the patient, completed within the six months prior to the start of treatment, which includes all of the following:

 

(1) a complete medical and psychological evaluation performed by a licensed physician and psychologist using empirically validated tools or tests that incorporate measures for intellectual functioning, language development, adaptive skills, and behavioral problems, which must include:

 

(i) a developmental history of the child, focusing on developmental milestones and delays;

 

(ii) a family history, including whether there are other family members with an autism spectrum disorder, developmental disability, fragile X syndrome, or tuberous sclerosis;

 

(iii) a medical history, including signs of deterioration, seizure activity, brain injury, and head circumference;

 

(iv) a physical examination completed within the past 12 months;

 

(v) an evaluation for intellectual functioning;

 

(vi) a lead screening for those children with a developmental disability; and

 

(vii) other evaluations and testing as indicated by the medical evaluation, which may include neuropsychological testing, occupational therapy, physical therapy, family functioning, genetic testing, imaging laboratory tests, and electrophysiological testing;

 

(2) a communication assessment conducted by a speech pathologist; and

 

(3) a comprehensive hearing test conducted by an audiologist with experience in testing very young children.

 

(b) A health plan must provide coverage for the diagnosis, evaluation, assessment, and medically necessary care of autism spectrum disorders that is evidence-based, including but not limited to:

 

(1) neurodevelopmental and behavioral health treatments, instruction, and management;

 

(2) applied behavior analysis and intensive early intervention services, including service package models such as intensive early intervention behavior therapy services and Lovaas therapy;

 

(3) speech therapy;


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(4) occupational therapy;

 

(5) physical therapy; and

 

(6) prescription medications.

 

(c) Coverage required under this section shall include treatment that is in accordance with:

 

(1) an individualized treatment plan prescribed by the insured's treating physician or mental health professional as defined in this section; and

 

(2) medically and scientifically accepted evidence that meets the criteria of a peer-reviewed, published study that is one of the following:

 

(i) a randomized study with adequate statistical power, including a sample size of 30 or more for each group, that shows statistically superior outcomes to a pill placebo group, psychological placebo group, another treatment group, or a wait list control group, or that is equivalent to another evidence-based treatment that meets the above standard for the specified problem area; or

 

(ii) a series of at least three single-case design experiments with clear specification of the subjects and with clear specification of the treatment approach that:

 

(A) use robust experimental designs;

 

(B) show statistically superior outcomes to pill placebo, psychological placebo, or another treatment group; and

 

(C) either use a manualized approach or are conducted by at least two independent investigators or teams; or

 

(3) where evidence meeting the standards of this subdivision does not exist for the treatment of a diagnosed condition or for an individual matching the demographic characteristics for which the evidence is valid, practice guidelines based on consensus of Minnesota health care professionals knowledgeable in the treatment of individuals with autism spectrum disorders. 

 

(d) Early intensive behavior therapies that meet the criteria set forth in paragraphs (b) and (c) must also meet the following best practices standards:

 

(1) the services must be prescribed by a mental health professional as an appropriate treatment option for the individual child;

 

(2) regular reporting of services provided and the child's progress must be submitted to the prescribing mental health professional;

 

(3) care must include appropriate parent or legal guardian education and involvement;

 

(4) the medically prescribed treatment and frequency of services should be coordinated between the school and provider for all children up to age 21; and

 

(5) services must be provided by a mental health professional or, as appropriate, a board-certified behavior analyst, a qualified mental health practitioner, or a qualified mental health behavioral aide.


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(e) Providers under this section must work with the commissioner in implementing evidence-based practices and, specifically for children under age 21, the Minnesota Evidence-Based Practice Database of research-informed practice elements and specific constituent practices.

 

(f) A health plan company may not refuse to renew or reissue, or otherwise terminate or restrict coverage of an individual solely because the individual is diagnosed with an autism spectrum disorder.

 

(g) A health plan company may request an updated treatment plan only once every six months, unless the health plan company and the treating physician or mental health professional agree that a more frequent review is necessary due to emerging circumstances.

 

Subd. 3.  Supervision, delegation of duties, and observation of qualified mental health practitioner, board-certified behavior analyst, or mental health behavioral aide.  A mental health professional who uses the services of a qualified mental health practitioner, board-certified behavior analyst, or qualified mental health behavioral aide for the purpose of assisting in the provision of services to patients who have autism spectrum disorder is responsible for functions performed by these service providers.  The qualified mental health professional must maintain clinical supervision of services they provide and accept full responsibility for their actions.  The services provided must be medically necessary and identified in the child's individual treatment plan.  Service providers must document their activities in written progress notes that reflect implementation of the individual treatment plan.

 

Subd. 4.  State health care programs.  This section does not affect benefits available under the medical assistance, MinnesotaCare, and general assistance medical care programs, and the state employee group insurance plan offered under sections 43A.22 to 43A.30.  These programs and the state employee group insurance plan must maintain current levels of coverage, and section 256B.0644 shall continue to apply.  The commissioner shall monitor these services and report to the chairs of the house of representatives and senate standing committees that have jurisdiction over health and human services by February 1, 2011, whether there are gaps in the level of service provided by these programs and the state employee group insurance plan, and the level of service provided by private health plans following enactment of this section.

 

Subd. 5.  No effect on other law.  Nothing in this section limits in any way the coverage required under sections 62Q.47 and 62Q.53.

 

EFFECTIVE DATE.  This section is effective August 1, 2010, and applies to coverage offered, issued, sold, renewed, or continued as defined in Minnesota Statutes, section 60A.02, subdivision 2a, on or after that date.

 

Sec. 3.  Minnesota Statutes 2008, section 62J.38, is amended to read:

 

62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS. 

 

(a) The commissioner shall require group purchasers to submit detailed data on total health care spending for each calendar year.  Group purchasers shall submit data for the 1993 calendar year by April 1, 1994, and each April 1 thereafter shall submit data for the preceding calendar year.

 

(b) The commissioner shall require each group purchaser to submit data on revenue, expenses, and member months, as applicable.  Revenue data must distinguish between premium revenue and revenue from other sources and must also include information on the amount of revenue in reserves and changes in reserves.  Expenditure data must distinguish between costs incurred for patient care and administrative costs, including amounts paid to contractors, subcontractors, and other entities for the purpose of managing provider utilization or distributing provider payments.  Patient care and administrative costs must include only expenses incurred on behalf of health plan members and must not include the cost of providing health care services for nonmembers at facilities owned by the group purchaser or affiliate.  Expenditure data must be provided separately for the following categories and for


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other categories required by the commissioner:  physician services, dental services, other professional services, inpatient hospital services, outpatient hospital services, emergency, pharmacy services and other nondurable medical goods, mental health, and chemical dependency services, other expenditures, subscriber liability, and administrative costs.  Administrative costs must include costs for marketing; advertising; overhead; salaries and benefits of central office staff who do not provide direct patient care; underwriting; lobbying; claims processing; provider contracting and credentialing; detection and prevention of payment for fraudulent or unjustified requests for reimbursement or services; clinical quality assurance and other types of medical care quality improvement efforts; concurrent or prospective utilization review as defined in section 62M.02; costs incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; capital costs incurred on behalf of a hospital or clinic; lease payments; or any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation agreement with a hospital, clinic, or other health care provider.  Capital costs and costs incurred must be recorded according to standard accounting principles.  The reports of this data must also separately identify expenses for local, state, and federal taxes, fees, and assessments.  The commissioner may require each group purchaser to submit any other data, including data in unaggregated form, for the purposes of developing spending estimates, setting spending limits, and monitoring actual spending and costs.  In addition to reporting administrative costs incurred to acquire a hospital, clinic, or health care facility, or the assets thereof; or any other costs incurred pursuant to a partnership, joint venture, integration, or affiliation agreement with a hospital, clinic, or other health care provider; reports submitted under this section also must include the payments made during the calendar year for these purposes.  The commissioner shall make public, by group purchaser data collected under this paragraph in accordance with section 62J.321, subdivision 5.  Workers' compensation insurance plans and automobile insurance plans are exempt from complying with this paragraph as it relates to the submission of administrative costs. 

 

(c) The commissioner may collect information on:

 

(1) premiums, benefit levels, managed care procedures, and other features of health plan companies;

 

(2) prices, provider experience, and other information for services less commonly covered by insurance or for which patients commonly face significant out-of-pocket expenses; and

 

(3) information on health care services not provided through health plan companies, including information on prices, costs, expenditures, and utilization.

 

(d) All group purchasers shall provide the required data using a uniform format and uniform definitions, as prescribed by the commissioner.

 

Sec. 4.  [62Q.545] COVERAGE OF PRIVATE DUTY NURSING SERVICES. 

 

(a) A health plan must cover private duty nursing services as provided under section 256B.0625, subdivision 7, for persons who are covered under the health plan and require private duty nursing services.

 

(b) For purposes of this section, a period of private duty nursing services may be subject to the co-payment, coinsurance, deductible, or other enrollee cost-sharing requirements that apply under the health plan.  Cost-sharing requirements for private duty nursing services must not place a greater financial burden on the insured or enrollee than those requirements applied by the health plan to other similar services or benefits.

 

EFFECTIVE DATE.  This section is effective July 1, 2010, and applies to health plans offered, sold, issued, or renewed on or after that date.

 

Sec. 5.  Minnesota Statutes 2008, section 62Q.76, subdivision 1, is amended to read:

 

Subdivision 1.  Applicability.  For purposes of sections 62Q.76 to 62Q.79 62Q.791, the terms defined in this section contract, health care provider, dental plan, dental organization, dentist, and enrollee have the meanings given them in sections 62Q.733 and 62Q.76. 


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Sec. 6.  [62Q.791] CONTRACTS WITH DENTAL CARE PROVIDERS. 

 

(a) Notwithstanding any other provision of law, no contract of any dental organization licensed under chapter 62C for provision of dental care services may:

 

(1) require, directly or indirectly, that a dentist or health care provider provide dental care services to its enrollees at a fee set by the dental organization, unless the services provided are covered dental care services for enrollees under the dental plan or contract; or

 

(2) prohibit, directly or indirectly, the dentist or health care provider from offering or providing dental care services that are not covered dental care services under the dental plan or contract, on terms and conditions acceptable to the enrollee and the dentist or health care provider.  For purposes of this section, "covered dental care services" means dental care services that are expressly covered under the dental plan or contract, including dental care services that are subject to contractual limitations such as deductibles, co-payments, annual maximums, and waiting periods.

 

(b) When making payment or otherwise adjudicating any claim for dental care services provided to an enrollee, a dental organization or dental plan must clearly identify on an explanation of benefits form or other form of claim resolution the amount, if any, that is the enrollee's responsibility to pay to the enrollee's dentist or health care provider.

 

(c) This section does not apply to any contract for the provision of dental care services under any public program sponsored or funded by the state or federal government.

 

EFFECTIVE DATE.  This section is effective August 1, 2010.

 

Sec. 7.  [245.6971] ADVISORY GROUP ON STATE-OPERATED SERVICES REDESIGN. 

 

Subdivision 1.  Establishment.  The Advisory Group on State-Operated Services Redesign is established to make recommendations to the commissioner of human services and the legislature on the continuum of services needed to provide individuals with complex conditions including mental illness and developmental disabilities access to quality care and the appropriate level of care across the state to promote wellness, reduce cost, and improve efficiency.

 

Subd. 2.  Duties.  The Advisory Group on State-Operated Services Redesign shall make recommendations to the commissioner and the legislature no later than December 15, 2010, on the following:

 

(1) transformation needed to improve service delivery and provide a continuum of care, such as transition of current facilities, closure of current facilities, or the development of new models of care;

 

(2) gaps and barriers to accessing quality care, system inefficiencies, and cost pressures;

 

(3) services that are best provided by the state and those that are best provided in the community;

 

(4) an implementation plan to achieve integrated service delivery across the public, private, and nonprofit sectors;

 

(5) an implementation plan to ensure that individuals with complex chemical and mental health needs receive the appropriate level of care to achieve recovery and wellness; and


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(6) financing mechanisms that include all possible revenue sources to maximize federal funding and promote cost efficiencies and sustainability.

 

Subd. 3.  Membership.  The advisory group shall be composed of the following, who will serve at the pleasure of their appointing authority:

 

(1) the commissioner of human services or the commissioner's designee, and two additional representatives from the department;

 

(2) two legislators appointed by the speaker of the house, one from the minority and one from the majority;

 

(3) two legislators appointed by the senate rules committee, one from the minority and one from the majority;

 

(4) one representative appointed by AFSCME Council 5;

 

(5) one representative appointed by the ombudsman for mental health and developmental disabilities;

 

(6) one representative appointed by the Minnesota Association of Professional Employees;

 

(7) one representative appointed by the Minnesota Hospital Association;

 

(8) one representative appointed by the Minnesota Nurses Association;

 

(9) one representative appointed by NAMI-MN;

 

(10) one representative appointed by the Mental Health Association of Minnesota;

 

(11) one representative appointed by the Minnesota Association Of Community Mental Health Programs;

 

(12) one representative appointed by the Minnesota Dental Association;

 

(13) three clients or client family members representing different populations receiving services from state-operated services, who are appointed by the commissioner;

 

(14) one representative appointed by the chair of the state-operated services governing board; and

 

(15) one representative appointed by the Minnesota Disability Law Center.

 

Subd. 4.  Administration.  The commissioner shall convene the first meeting of the advisory group and shall provide administrative support and staff.

 

Subd. 5.  Recommendations.  The advisory group must report its recommendations to the commissioner and to the legislature no later than December 15, 2010.

 

Subd. 6.  Expiration.  This section expires January 31, 2011.

 

Sec. 8.  [245.6972] LEGISLATIVE APPROVAL REQUIRED. 

 

The commissioner of human services shall not redesign or move state-operated services programs without specific legislative approval.  The commissioner may proceed with redesign at the Mankato Crisis Center and the closure of the Community Behavioral Health Hospital in Cold Spring.


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Sec. 9.  Minnesota Statutes 2009 Supplement, section 252.025, subdivision 7, is amended to read:

 

Subd. 7.  Minnesota extended treatment options.  The commissioner shall develop by July 1, 1997, the Minnesota extended treatment options to serve Minnesotans who have developmental disabilities and exhibit severe behaviors which present a risk to public safety.  This program is statewide and must provide specialized residential services in Cambridge and an array of community-based services with sufficient levels of care and a sufficient number of specialists to ensure that individuals referred to the program receive the appropriate care.  The number of beds at the Cambridge facility may be reorganized into two 16-bed facilities, one for individuals with developmental disabilities and one for individuals with developmental disabilities and a co-occurring mental illness, with the remaining beds converted into transitional intensive treatment foster homes.The individuals working in the community-based services under this section are state employees supervised by the commissioner of human services.  No layoffs shall occur as a result of restructuring under this section.

 

EFFECTIVE DATE.  This section is effective the day following final enactment.

 

Sec. 10.  Minnesota Statutes 2008, section 254B.01, subdivision 2, is amended to read:

 

Subd. 2.  American Indian.  For purposes of services provided under section 254B.09, subdivision 7 254B.09, subdivision 8, "American Indian" means a person who is a member of an Indian tribe, and the commissioner shall use the definitions of "Indian" and "Indian tribe" and "Indian organization" provided in Public Law 93-638.  For purposes of services provided under section 254B.09, subdivision 4 254B.09, subdivision 6, "American Indian" means a resident of federally recognized tribal lands who is recognized as an Indian person by the federally recognized tribal governing body. 

 

Sec. 11.  Minnesota Statutes 2008, section 254B.02, subdivision 1, is amended to read:

 

Subdivision 1.  Chemical dependency treatment allocation.  The chemical dependency funds appropriated for allocation treatment appropriation shall be placed in a special revenue account.  The commissioner shall annually transfer funds from the chemical dependency fund to pay for operation of the drug and alcohol abuse normative evaluation system and to pay for all costs incurred by adding two positions for licensing of chemical dependency treatment and rehabilitation programs located in hospitals for which funds are not otherwise appropriated.  Six percent of the remaining money must be reserved for tribal allocation under section 254B.09, subdivisions 4 and 5.  The commissioner shall annually divide the money available in the chemical dependency fund that is not held in reserve by counties from a previous allocation, or allocated to the American Indian chemical dependency tribal account.  Six percent of the remaining money must be reserved for the nonreservation American Indian chemical dependency allocation for treatment of American Indians by eligible vendors under section 254B.05, subdivision 1.  The remainder of the money must be allocated among the counties according to the following formula, using state demographer data and other data sources determined by the commissioner:  in the special revenue account must be used according to the requirements in this chapter. 

 

(a) For purposes of this formula, American Indians and children under age 14 are subtracted from the population of each county to determine the restricted population.

 

(b) The amount of chemical dependency fund expenditures for entitled persons for services not covered by prepaid plans governed by section 256B.69 in the previous year is divided by the amount of chemical dependency fund expenditures for entitled persons for all services to determine the proportion of exempt service expenditures for each county. 

 

(c) The prepaid plan months of eligibility is multiplied by the proportion of exempt service expenditures to determine the adjusted prepaid plan months of eligibility for each county.


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(d) The adjusted prepaid plan months of eligibility is added to the number of restricted population fee for service months of eligibility for the Minnesota family investment program, general assistance, and medical assistance and divided by the county restricted population to determine county per capita months of covered service eligibility.

 

(e) The number of adjusted prepaid plan months of eligibility for the state is added to the number of fee for service months of eligibility for the Minnesota family investment program, general assistance, and medical assistance for the state restricted population and divided by the state restricted population to determine state per capita months of covered service eligibility.

 

(f) The county per capita months of covered service eligibility is divided by the state per capita months of covered service eligibility to determine the county welfare caseload factor.

 

(g) The median married couple income for the most recent three-year period available for the state is divided by the median married couple income for the same period for each county to determine the income factor for each county.

 

(h) The county restricted population is multiplied by the sum of the county welfare caseload factor and the county income factor to determine the adjusted population.

 

(i) $15,000 shall be allocated to each county.

 

(j) The remaining funds shall be allocated proportional to the county adjusted population.

 

Sec. 12.  Minnesota Statutes 2008, section 254B.02, subdivision 5, is amended to read:

 

Subd. 5.  Administrative adjustment.  The commissioner may make payments to local agencies from money allocated under this section to support administrative activities under sections 254B.03 and 254B.04.  The administrative payment must not exceed the lesser of (1) five percent of the first $50,000, four percent of the next $50,000, and three percent of the remaining payments for services from the allocation special revenue account according to subdivision 1; or (2) the local agency administrative payment for the fiscal year ending June 30, 2009, adjusted in proportion to the statewide change in the appropriation for this chapter. 

 

Sec. 13.  Minnesota Statutes 2008, section 254B.03, subdivision 4, is amended to read:

 

Subd. 4.  Division of costs.  Except for services provided by a county under section 254B.09, subdivision 1, or services provided under section 256B.69 or 256D.03, subdivision 4, paragraph (b), the county shall, out of local money, pay the state for 15 16.14 percent of the cost of chemical dependency services, including those services provided to persons eligible for medical assistance under chapter 256B and general assistance medical care under chapter 256D.  Counties may use the indigent hospitalization levy for treatment and hospital payments made under this section.  Fifteen 16.14 percent of any state collections from private or third-party pay, less 15 percent of for the cost of payment and collections, must be distributed to the county that paid for a portion of the treatment under this section.  If all funds allocated according to section 254B.02 are exhausted by a county and the county has met or exceeded the base level of expenditures under section 254B.02, subdivision 3, the county shall pay the state for 15 percent of the costs paid by the state under this section.  The commissioner may refuse to pay state funds for services to persons not eligible under section 254B.04, subdivision 1, if the county financially responsible for the persons has exhausted its allocation. 

 

Sec. 14.  Minnesota Statutes 2008, section 254B.05, subdivision 4, is amended to read:

 

Subd. 4.  Regional treatment centers.  Regional treatment center chemical dependency treatment units are eligible vendors.  The commissioner may expand the capacity of chemical dependency treatment units beyond the capacity funded by direct legislative appropriation to serve individuals who are referred for treatment by counties and whose treatment will be paid for with a county's allocation under section 254B.02 by funding under this chapter


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or other funding sources.  Notwithstanding the provisions of sections 254B.03 to 254B.041, payment for any person committed at county request to a regional treatment center under chapter 253B for chemical dependency treatment and determined to be ineligible under the chemical dependency consolidated treatment fund, shall become the responsibility of the county. 

 

Sec. 15.  Minnesota Statutes 2008, section 254B.06, subdivision 2, is amended to read:

 

Subd. 2.  Allocation of collections.  The commissioner shall allocate all federal financial participation collections to the reserve fund under section 254B.02, subdivision 3 a special revenue account.  The commissioner shall retain 85 allocate 83.86 percent of patient payments and third-party payments to the special revenue account and allocate the collections to the treatment allocation for the county that is financially responsible for the person.  Fifteen 16.14 percent of patient and third-party payments must be paid to the county financially responsible for the patient.  Collections for patient payment and third-party payment for services provided under section 254B.09 shall be allocated to the allocation of the tribal unit which placed the person.  Collections of federal financial participation for services provided under section 254B.09 shall be allocated to the tribal reserve account under section 254B.09, subdivision 5. 

 

Sec. 16.  Minnesota Statutes 2008, section 254B.09, subdivision 8, is amended to read:

 

Subd. 8.  Payments to improve services to American Indians.  The commissioner may set rates for chemical dependency services to American Indians according to the American Indian Health Improvement Act, Public Law 94-437, for eligible vendors.  These rates shall supersede rates set in county purchase of service agreements when payments are made on behalf of clients eligible according to Public Law 94-437.

 

Sec. 17.  [254B.13] PILOT PROJECTS; CHEMICAL HEALTH CARE. 

 

Subdivision 1.  Authorization for pilot projects.  The commissioner of human services may approve and implement pilot projects developed under the planning process required under Laws 2009, chapter 79, article 7, section 26, to provide alternatives to and enhance coordination of the delivery of chemical health services required under section 254B.03.

 

Subd. 2.  Program design and implementation.  (a) The commissioner of human services and counties participating in the pilot projects shall continue to work in partnership to refine and implement the pilot projects initiated under Laws 2009, chapter 79, article 7, section 26.

 

(b) The commissioner and counties participating in the pilot projects shall complete the planning phase by June 30, 2010, and, if approved by the commissioner for implementation, enter into agreements governing the operation of the pilot projects with implementation scheduled no earlier than July 1, 2010.

 

Subd. 3.  Program evaluation.  The commissioner of human services shall evaluate pilot projects under this section and report the results of the evaluation to the legislative committees with jurisdiction over chemical health by June 30, 2013.  Evaluation of the pilot projects must be based on outcome evaluation criteria negotiated with the projects prior to implementation.

 

Subd. 4.  Notice of project discontinuation.  Each county's participation in the pilot project may be discontinued for any reason by the county or the commissioner of human services after 30 days' written notice to the other party.  Any unspent funds held for the exiting county's pro rata share in the special revenue fund under the authority in subdivision 5, paragraph (c), shall be transferred to the general fund following discontinuation of the pilot project.


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Subd. 5.  Duties of commissioner.  (a) Notwithstanding any other provisions in this chapter, the commissioner may authorize pilot projects to use chemical dependency treatment funds to pay for services:

 

(1) in addition to those authorized under section 254B.03, subdivision 2, paragraph (a); and

 

(2) by vendors in addition to those authorized under section 254B.05 when not providing chemical dependency treatment services.

 

(b) State expenditures for chemical dependency services and any other services provided by or through the pilot projects must not be greater than chemical dependency treatment fund expenditures expected in the absence of the pilot projects.  The commissioner may restructure the schedule of payments between the state and participating counties under the local agency share and division of cost provisions under section 254B.03, subdivisions 3 and 4, as necessary to facilitate the operation of the pilot projects.

 

(c) To the extent that state fiscal year expenditures within a pilot project region are less than expected in the absence of the pilot projects, the commissioner may deposit these unexpended funds in the special revenue fund and make these funds available for expenditure by the pilot counties the following year.  To the extent that treatment and pilot project ancillary services expenditures within the pilot project exceed the amount expected in the absence of the pilot projects, the pilot counties are responsible for the portion of nontreatment expenditures in excess of otherwise expected expenditures.

 

(d) The commissioner may waive administrative rule requirements which are incompatible with the implementation of the pilot project.

 

(e) The commissioner shall not approve or enter into any agreement related to pilot projects authorized under this section which puts current or future federal funding at risk.

 

Subd. 6.  Duties of county board.  The county board, or other county entity that is approved to administer a pilot project, shall:

 

(1) administer the pilot project in a manner consistent with the objectives described in subdivision 2 and the planning process in subdivision 5;

 

(2) ensure that no one is denied chemical dependency treatment services for which they would otherwise be eligible under section 254A.03, subdivision 3; and

 

(3) provide the commissioner of human services with timely and pertinent information as negotiated in agreements governing operation of the pilot projects.

 

Sec. 18.  Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision to read:

 

Subd. 30.  Office of Health Care Inspector General.  (a) The commissioner shall create within the Department of Human Services an Office of Health Care Inspector General to enhance antifraud activities and to protect the integrity of the state health care programs, as well as the health and welfare of the beneficiaries of those programs.  The Office of Health Care Inspector General must periodically report to the commissioner and to the legislature program and management problems and recommendations to correct them.

 

(b) The duties of the Office of Health Care Inspector General include, but are not limited to:

 

(1) promoting economy, efficiency, and effectiveness through the elimination of waste, fraud, and abuse;


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(2) conducting and supervising audits, investigations, inspections, and evaluations relating to the state health care programs under chapters 256B, 256D, and 256L;

 

(3) identifying weaknesses giving rise to opportunities for fraud and abuse in the state health care programs and operations and making recommendations to prevent their recurrence;

 

(4) leading and coordinating activities to prevent and detect fraud and abuse in the state health care programs and operations;

 

(5) detecting wrongdoers and abusers of the state health care programs and beneficiaries so appropriate remedies may be brought;

 

(6) keeping the commissioner and the legislature fully and currently informed about problems and deficiencies in the administration of the state health care programs and operations and about the need for and progress of corrective action;

 

(7) operating a toll-free hotline to permit individuals to call in suspected fraud, waste, or abuse, referring the calls for appropriate action by the agency, and analyzing the calls to identify trends and patterns of fraud and abuse needing attention;

 

(8) developing and reviewing legislative, regulatory, and program proposals to reduce vulnerabilities to fraud, waste, and mismanagement; and

 

(9) recommending changes in program policies, regulations, and laws to improve efficiency and effectiveness, and to prevent fraud, waste, abuse, and mismanagement.

 

(c) Beginning July 1, 2011, the commissioner, in consultation with the Office of Health Care Inspector General, shall annually report to the legislature and the governor new results from the two ongoing federal Medicaid audits.  The commissioner shall report (1) the most recent Medicaid Integrity Program (MIP) audit results, with any corrective actions needed, and (2) certify the rate of errors determined for the state health care programs under chapters 256B, 256D, and 256L, as determined from the most recent Payment Error Rate Measurement (PERM) audit results for Minnesota.  When the PERM audit rate for Minnesota is greater than the national rate for the year or the MIP audit determines the need for corrective action, the commissioner shall present a plan to the legislature and the governor for the corrective actions and reduction of the error rate in the next calendar year.

 

Sec. 19.  Laws 2009, chapter 79, article 3, section 18, is amended to read:

 

Sec. 18.  REQUIRING THE DEVELOPMENT OF COMMUNITY-BASED MENTAL HEALTH SERVICES FOR PATIENTS COMMITTED TO THE ANOKA-METRO REGIONAL TREATMENT CENTER. 

 

In consultation with community partners, the commissioner of human services The Advisory Group on State-Operated Services Redesign shall develop recommend an array of community-based services to transform the current services now provided to patients at the Anoka-Metro Regional Treatment Center.  The community-based services may be provided in facilities with 16 or fewer beds, and must provide the appropriate level of care for the patients being admitted to the facilities.  The planning for this transition must be completed by October 1, 2009 2010, with an initial report to the committee chairs of health and human services by November 30, 2009 2010, and a semiannual report on progress until the transition is completed.  The commissioner of human services shall solicit interest from stakeholders and potential community partners.  The individuals working in the community-based services facilities under this section are state employees supervised by the commissioner of human services.  No layoffs shall occur as a result of restructuring under this section.

 

EFFECTIVE DATE.  This section is effective the day following final enactment.


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Sec. 20.  NONSUBMISSION OF HEALTH CARE CLAIM BY CLEARINGHOUSE; SIGNIFICANT DISRUPTION. 

 

(a) A situation shall be considered a significant disruption to normal operations that materially affects the provider's or facility's ability to conduct business in a normal manner and to submit claims on a timely basis under Minnesota Statutes, section 62Q.75, if: 

 

(1) a clearinghouse loses, or otherwise does not submit, a health care claim as required by Minnesota Statutes, section 62J.536; and

 

(2) the provider or facility can substantiate that it submitted a complete claim to the clearinghouse within provisions stated in contract or six months of the date of service, whichever is less.

 

(b) This section expires January 1, 2012.

 

Sec. 21.  REPORT ON HUMAN SERVICES FISCAL NOTES. 

 

The commissioner of human services shall issue a report to the legislature no later than November 15, 2010, making recommendations for the establishment of a legislative budget office division for the preparation and completion of fiscal notes as required by Minnesota Statutes, section 3.98.  The report must include detailed information regarding the necessary financial costs, staff resources, and data protection requirements for a legislative budget office to complete fiscal notes for the Department of Human Services.  The report must describe the methods and procedures used by legislatures in other states that ensure the independence and accuracy of fiscal estimates on legislative proposals.  The report must include proposed bill language for transferring all fiscal note responsibilities to an appropriate nonpartisan office within the legislative branch.

 

Sec. 22.  REPEALER. 

 

Minnesota Statutes 2008, sections 254B.02, subdivisions 2, 3, and 4; and 254B.09, subdivisions 4, 5, and 7, and Laws 2009, chapter 79, article 7, section 26, subdivision 3, are repealed.

 

 

Sec. 23.  EFFECTIVE DATE. 

 

Sections 10 to 14 and 22 are effective for claims paid on or after July 1, 2010.

 

ARTICLE 6

 

DEPARTMENT OF HEALTH

 

Section 1.  Minnesota Statutes 2008, section 62D.08, is amended by adding a subdivision to read:

 

Subd. 7.  Consistent administrative expenses and investment income reporting.  (a) Every health maintenance organization must directly allocate administrative expenses to specific lines of business or products when such information is available.  Remaining expenses that cannot be directly allocated must be allocated based on other methods, as recommended by the Advisory Group on Administrative Expenses.  Health maintenance organizations must submit this information, including administrative expenses for dental services, using the reporting template provided by the commissioner of health.


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(b) Every health maintenance organization must allocate investment income based on cumulative net income over time by business line or product and must submit this information, including investment income for dental services, using the reporting template provided by the commissioner of health.

 

EFFECTIVE DATE.  This section is effective January 1, 2012.

 

Sec. 2.  [62D.31] ADVISORY GROUP ON ADMINISTRATIVE EXPENSES. 

 

Subdivision 1.  Establishment.  The Advisory Group on Administrative Expenses is established to make recommendations on the development of consistent guidelines and reporting requirements, including development of a reporting template, for health maintenance organizations and county-based purchasers that participate in publicly funded programs. 

 

Subd. 2.  Membership.  The membership of the advisory group shall be comprised of the following, who serve at the pleasure of their appointing authority:

 

(1) the commissioner of health or the commissioner's designee;

 

(2) the commissioner of human services or the commissioner's designee;

 

(3) the commissioner of commerce or the commissioner's designee; and

 

(4) representatives of health maintenance organizations and county-based purchasers appointed by the commissioner of health.

 

Subd. 3.  Administration.  The commissioner of health shall convene the first meeting of the advisory group by September 1, 2010, and shall provide administrative support and staff.  The commissioner of health may contract with a consultant to provide professional assistance and expertise to the advisory group.

 

Subd. 4.  Recommendations.  The Advisory Group on Administrative Expenses must report its recommendations, including any proposed legislation necessary to implement the recommendations, to the commissioner of health and to the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health policy and finance by July 1, 2011.

 

Subd. 5.  Expiration.  This section expires after submission of the report required under subdivision 4 or June 30, 2012, whichever is sooner.

 

Sec. 3.  Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 1a, is amended to read:

 

Subd. 1a.  Definitions.  (a) "Certified electronic health record technology" means an electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH Act to meet the standards and implementation specifications adopted under section 3004 as applicable.

 

(b) "Commissioner" means the commissioner of health.

 

(c) "Pharmaceutical electronic data intermediary" means any entity that provides the infrastructure to connect computer systems or other electronic devices utilized by prescribing practitioners with those used by pharmacies, health plans, third-party administrators, and pharmacy benefit managers in order to facilitate the secure transmission of electronic prescriptions, refill authorization requests, communications, and other prescription-related information between such entities.


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(d) "HITECH Act" means the Health Information Technology for Economic and Clinical Health Act in division A, title XIII and division B, title IV of the American Recovery and Reinvestment Act of 2009, including federal regulations adopted under that act.

 

(e) "Interoperable electronic health record" means an electronic health record that securely exchanges health information with another electronic health record system that meets requirements specified in subdivision 3, and national requirements for certification under the HITECH Act.

 

(f) "Qualified electronic health record" means an electronic record of health-related information on an individual that includes patient demographic and clinical health information and has the capacity to:

 

(1) provide clinical decision support;

 

(2) support physician order entry;

 

(3) capture and query information relevant to health care quality; and

 

(4) exchange electronic health information with, and integrate such information from, other sources.

 

Sec. 4.  Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 3, is amended to read:

 

Subd. 3.  Interoperable electronic health record requirements.  To meet the requirements of subdivision 1, hospitals and health care providers must meet the following criteria when implementing an interoperable electronic health records system within their hospital system or clinical practice setting.

 

(a) The electronic health record must be a qualified electronic health record.

 

(b) The electronic health record must be certified by the Office of the National Coordinator pursuant to the HITECH Act.  This criterion only applies to hospitals and health care providers only if a certified electronic health record product for the provider's particular practice setting is available.  This criterion shall be considered met if a hospital or health care provider is using an electronic health records system that has been certified within the last three years, even if a more current version of the system has been certified within the three-year period.

 

(c) The electronic health record must meet the standards established according to section 3004 of the HITECH Act as applicable.

 

(d) The electronic health record must have the ability to generate information on clinical quality measures and other measures reported under sections 4101, 4102, and 4201 of the HITECH Act.

 

(e) The electronic health record system must be connected to a state-certified health information organization either directly or through a connection facilitated by a state-certified health data intermediary as defined in section 62J.498.

 

(e) (f) A health care provider who is a prescriber or dispenser of legend drugs must have an electronic health record system that meets the requirements of section 62J.497.

 

Sec. 5.  Minnesota Statutes 2009 Supplement, section 62J.495, is amended by adding a subdivision to read:

 

Subd. 6.  State agency information system.  Development of a state agency information system necessary to implement this section is subject to the authority of the Office of Enterprise Technology in chapter 16E, including, but not limited to:


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(1) evaluation and approval of the system as specified in section 16E.03, subdivisions 3 and 4;

 

(2) review of the system to ensure compliance with security policies, guidelines, and standards as specified in section 16E.03, subdivision 7; and

 

(3) assurance that the system complies with accessibility standards developed under section 16E.03, subdivision 9.

 

Sec. 6.  [62J.498] HEALTH INFORMATION EXCHANGE. 

 

Subdivision 1.  Definitions.  The following definitions apply to sections 62J.498 to 62J.4982:

 

(a) "Clinical transaction" means any meaningful use transaction that is not covered by section 62J.536.

 

(b) "Commissioner" means the commissioner of health.

 

(c) "Direct health information exchange" means the electronic transmission of health-related information through a direct connection between the electronic health record systems of health care providers without the use of a health data intermediary.

 

(d) "Health care provider" or "provider" means a health care provider or provider as defined in section 62J.03, subdivision 8.

 

(e) "Health data intermediary" means an entity that provides the infrastructure to connect computer systems or other electronic devices used by health care providers, laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit managers to facilitate the secure transmission of health information, including pharmaceutical electronic data intermediaries as defined in section 62J.495.  This does not include health care providers engaged in a direct health information exchange.

 

(f) "Health information exchange" means the electronic transmission of health-related information between organizations according to nationally recognized standards.

 

(g) "Health information exchange service provider" means a health data intermediary or health information organization that has been issued a certificate of authority by the commissioner under section 62J.4981.

 

(h) "Health information organization" means an organization that oversees, governs, and facilitates the exchange of health-related information among organizations according to nationally recognized standards.

 

(i) "HITECH Act" means the Health Information Technology for Economic and Clinical Health Act as defined in section 62J.495.

 

(j) "Major participating entity" means:

 

(1) a participating entity that receives compensation for services that is greater than 30 percent of the health information organization's gross annual revenues from the health information exchange service provider;

 

(2) a participating entity providing administrative, financial, or management services to the health information organization, if the total payment for all services provided by the participating entity exceeds three percent of the gross revenue of the health information organization; and


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(3) a participating entity that nominates or appoints 30 percent or more of the board of directors of the health information organization.

 

(k) "Meaningful use" means use of certified electronic health record technology that includes e-prescribing, and is connected in a manner that provides for the electronic exchange of health information and used for the submission of clinical quality measures as established by the Center for Medicare and Medicaid Services and the Minnesota Department of Human Services pursuant to sections 4101, 4102, and 4201 of the HITECH Act.

 

(l) "Meaningful use transaction" means an electronic transaction that a health care provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.

 

(m) "Participating entity" means any of the following persons, health care providers, companies, or other organizations with which a health information organization or health data intermediary has contracts or other agreements for the provision of health information exchange service providers: 

 

(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise licensed under the laws of this state or registered with the commissioner;

 

(2) a health care provider, and any other health care professional otherwise licensed under the laws of this state or registered with the commissioner;

 

(3) a group, professional corporation, or other organization that provides the services of individuals or entities identified in clause (2), including but not limited to a medical clinic, a medical group, a home health care agency, an urgent care center, and an emergent care center;

 

(4) a health plan as defined in section 62A.011, subdivision 3; and

 

(5) a state agency as defined in section 13.02, subdivision 17.

 

(n) "Reciprocal agreement" means an arrangement in which two or more health information exchange service providers agree to share in-kind services and resources to allow for the pass-through of meaningful use transactions.

 

(o) "State-certified health data intermediary" means a health data intermediary that:

 

(1) provides a subset of the meaningful use transaction capabilities necessary for hospitals and providers to achieve meaningful use of electronic health records;

 

(2) is not exclusively engaged in the exchange of meaningful use transactions covered by section 62J.536; and

 

(3) has been issued a certificate of authority to operate in Minnesota.

 

(p) "State-certified health information organization" means a nonprofit health information organization that provides transaction capabilities necessary to fully support clinical transactions required for meaningful use of electronic health records that has been issued a certificate of authority to operate in Minnesota.

 

Subd. 2.  Health information exchange oversight.  (a) The commissioner shall protect the public interest on matters pertaining to health information exchange.  The commissioner shall:


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(1) review and act on applications from health data intermediaries and health information organizations for certificates of authority to operate in Minnesota;

 

(2) provide ongoing monitoring to ensure compliance with criteria established under sections 62J.498 to 62J.4982;

 

(3) respond to public complaints related to health information exchange services;

 

(4) take enforcement actions as necessary, including the imposition of fines, suspension, or revocation of certificates of authority as outlined in section 62J.4982;

 

(5) provide a biannual report on the status of health information exchange services that includes but is not limited to:

 

(i) recommendations on actions necessary to ensure that health information exchange services are adequate to meet the needs of Minnesota citizens and providers statewide;

 

(ii) recommendations on enforcement actions to ensure that health information exchange service providers act in the public interest without causing disruption in health information exchange services;

 

(iii) recommendations on updates to criteria for obtaining certificates of authority under this section; and

 

(iv) recommendations on standard operating procedures for health information exchange, including but not limited to the management of consumer preferences; and

 

(6) other duties necessary to protect the public interest.

 

(b) As part of the application review process for certification under paragraph (a), prior to issuing a certificate of authority, the commissioner shall:

 

(1) hold public hearings that provide an adequate opportunity for participating entities and consumers to provide feedback and recommendations on the application under consideration.  The commissioner shall make all portions of the application classified as public data available to the public at least ten days in advance of the hearing.  The applicant shall participate in the hearing by presenting an application overview and responding to questions from interested parties;

 

(2) make available all feedback and recommendations from the hearing available to the public prior to issuing a certificate of authority; and

 

(3) consult with hospitals, physicians, and other professionals eligible to receive meaningful use incentive payments or are subject to penalties as established in the HITECH Act, and their respective statewide associations, prior to issuing a certificate of authority.

 

(c)(1) When the commissioner is actively considering a suspension or revocation of a certificate of authority as described in section 62J.4982, subdivision 3, all investigatory data that are collected, created, or maintained related to the suspension or revocation are classified as confidential data on individuals and as protected nonpublic data in the case of data not on individuals.

 

(2) The commissioner may disclose data classified as protected nonpublic or confidential under this paragraph if disclosing the data will protect the health or safety of patients.


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(d) After the commissioner makes a final determination regarding a suspension or revocation of a certificate of authority, all minutes, orders for hearing, findings of fact, conclusions of law, and the specification of the final disciplinary action, are classified as public data.

 

Sec. 7.  [62J.4981] CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH INFORMATION EXCHANGE SERVICES. 

 

Subdivision 1.  Authority to require organizations to apply.  The commissioner shall require an entity providing health information exchange services to apply for a certificate of authority under this section.  An applicant may continue to operate until the commissioner acts on the application.  If the application is denied, the applicant is considered a health information organization whose certificate of authority has been revoked under section 62J.4982, subdivision 2, paragraph (d).

 

Subd. 2.  Certificate of authority for health data intermediaries.  (a) A health data intermediary that provides health information exchange services for the transmission of one or more clinical transactions necessary for hospitals, providers, or eligible professionals to achieve meaningful use must be registered with the state and comply with requirements established in this section.

 

(b) Notwithstanding any law to the contrary, any corporation organized to do so may apply to the commissioner for a certificate of authority to establish and operate as a health data intermediary in compliance with this section.  No person shall establish or operate a health data intermediary in this state, nor sell or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with a health data intermediary contract unless the organization has a certificate of authority or has an application under active consideration under this section.

 

(c) In issuing the certificate of authority, the commissioner shall determine whether the applicant for the certificate of authority has demonstrated that the applicant meets the following minimum criteria:

 

(1) can interoperate with at least one state-certified health information organization;

 

(2) can provide an option for Minnesota entities to connect to their services through at least one state-certified health information organization;

 

(3) has a record locator service as defined in section 144.291, subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8, when conducting meaningful use transactions; and

 

(4) holds reciprocal agreements with at least one state-certified health information organization to enable access to record locator services to find patient data, and for the transmission and receipt of meaningful use transactions consistent with the format and content required by national standards established by Centers for Medicare and Medicaid Services.  Reciprocal agreements must meet the requirements established in subdivision 5.

 

Subd. 3.  Certificate of authority for health information organizations.  (a) A health information organization that provides all electronic capabilities for the transmission of clinical transactions necessary for meaningful use of electronic health records must obtain a certificate of authority from the commissioner and demonstrate compliance with the criteria in paragraph (c).

 

(b) Notwithstanding any law to the contrary, a nonprofit corporation organized to do so may apply for a certificate of authority to establish and operate a health information organization under this section.  No person shall establish or operate a health information organization in this state, or sell or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with a health information organization or health information contract unless the organization has a certificate of authority under this section.


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(c) In issuing the certificate of authority, the commissioner shall determine whether the applicant for the certificate of authority has demonstrated that the applicant meets the following minimum criteria:

 

(1) the entity is a legally established, nonprofit organization;

 

(2) has appropriate insurance, including liability insurance, for the operation of the health information organization is in place and sufficient to protect the interest of the public and participating entities;

 

(3) has strategic and operational plans that clearly address how the organization will expand technical capacity of the health information organization to support providers in achieving meaningful use of electronic health records over time;

 

(4) the entity addresses the parameters to be used with participating entities and other health information organizations for meaningful use transactions, compliance with Minnesota law, and interstate health information exchange in trust agreements;

 

(5) the entity's board of directors is comprised of members that broadly represent the health information organization's participating entities and consumers;

 

(6) the entity maintains a professional staff responsible to the board of directors with the capacity to ensure accountability to the organization's mission;

 

(7) the entity is compliant with criteria established under the Health Information Exchange Accreditation Program of the Electronic Healthcare Network Accreditation Commission (EHNAC) or equivalent criteria established by the commissioner;

 

(8) the entity maintains a record locator service as defined in section 144.291, subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8, when conducting meaningful use transactions;

 

(9) the organization demonstrates interoperability with all other state-certified health information organizations using nationally recognized standards;

 

(10) the organization demonstrates compliance with all privacy and security requirements required by state and federal law; and

 

(11) the organization uses financial policies and procedures consistent with generally accepted accounting principles and has an independent audit of the organization's financials on an annual basis.

 

(d) Health information organizations that have obtained a certificate of authority must:

 

(1) meet the requirements established for connecting to the Nationwide Health Information Network (NHIN) within the federally mandated timeline or within a time frame established by the commissioner and published in the State Register.  If the state timeline for implementation varies from the federal timeline, the State Register notice shall include an explanation for the variation;

 

(2) annually submit strategic and operational plans for review by the commissioner that address:

 

(i) increasing adoption rates to include a sufficient number of participating entities to achieve financial sustainability; and


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(ii) progress in achieving objectives included in previously submitted strategic and operational plans across the following domains:  business and technical operations, technical infrastructure, legal and policy issues, finance, and organizational governance;

 

(3) develop and maintain a business plan that addresses:

 

(i) plans for ensuring the necessary capacity to support meaningful use transactions;

 

(ii) approach for attaining financial sustainability, including public and private financing strategies, and rate structures;

 

(iii) rates of adoption, utilization, and transaction volume, and mechanisms to support health information exchange; and

 

(iv) an explanation of methods employed to address the needs of community clinics, critical access hospitals, and free clinics in accessing health information exchange services;

 

(4) annually submit a rate plan outlining fee structures for health information exchange services for approval by the commissioner.  The commissioner shall approve the rate plan if it:

 

(i) distributes costs equitably among users of health information services;

 

(ii) provides predictable costs for participating entities;

 

(iii) covers all costs associated with conducting the full range of meaningful use clinical transactions, including access to health information retrieved through other state-certified health information exchange service providers; and

 

(iv) provides for a predictable revenue stream for the health information organization and generates sufficient resources to maintain operating costs and develop technical infrastructure necessary to serve the public interest;

 

(5) enter into reciprocal agreements with all other state-certified health information organizations to enable access to record locator services to find patient data, and transmission and receipt of meaningful use transactions consistent with the format and content required by national standards established by Centers for Medicare and Medicaid Services.  Reciprocal agreements must meet the requirements in subdivision 5; and

 

(6) comply with additional requirements for the certification or recertification of health information organizations that may be established by the commissioner.

 

Subd. 4.  Application for certificate of authority for health information exchange service providers.  (a) Each application for a certificate of authority shall be in a form prescribed by the commissioner and verified by an officer or authorized representative of the applicant.  Each application shall include the following:

 

(1) a copy of the basic organizational document, if any, of the applicant and of each major participating entity, such as the articles of incorporation, or other applicable documents, and all amendments to it;

 

(2) a list of the names, addresses, and official positions of the following:

 

(i) all members of the board of directors and the principal officers and, if applicable, shareholders of the applicant organization; and


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(ii) all members of the board of directors and the principal officers of each major participating entity and, if applicable, each shareholder beneficially owning more than ten percent of any voting stock of the major participating entity;

 

(3) the name and address of each participating entity and the agreed-upon duration of each contract or agreement if applicable;

 

(4) a copy of each standard agreement or contract intended to bind the participating entities and the health information organization.  Contractual provisions shall be consistent with the purposes of this section in regard to the services to be performed under the standard agreement or contract, the manner in which payment for services is determined, the nature and extent of responsibilities to be retained by the health information organization, and contractual termination provisions;

 

(5) a copy of each contract intended to bind major participating entities and the health information organization.  Contract information filed with the commissioner under this section shall be nonpublic as defined in section 13.02, subdivision 9;

 

(6) a statement generally describing the health information organization, its health information exchange contracts, facilities, and personnel, including a statement describing the manner in which the applicant proposes to provide participants with comprehensive health information exchange services;

 

(7) financial statements showing the applicant's assets, liabilities, and sources of financial support, including a copy of the applicant's most recent certified financial statement;

 

(8) strategic and operational plans that specifically address how the organization will expand technical capacity of the health information organization to support providers in achieving meaningful use of electronic health records over time, a description of the proposed method of marketing the services, a schedule of proposed charges, and a financial plan that includes a three-year projection of the expenses and income and other sources of future capital;

 

(9) a statement reasonably describing the geographic area or areas to be served and the type or types of participants to be served;

 

(10) a description of the complaint procedures to be used as required under this section;

 

(11) a description of the mechanism by which participating entities will have an opportunity to participate in matters of policy and operation;

 

(12) a copy of any pertinent agreements between the health information organization and insurers, including liability insurers, demonstrating coverage is in place;

 

(13) a copy of the conflict of interest policy that applies to all members of the board of directors and the principal officers of the health information organization; and

 

(14) other information as the commissioner may reasonably require to be provided.

 

(b) Thirty days after the receipt of the application for a certificate of authority, the commissioner shall determine whether or not the application submitted meets the requirements for completion in paragraph (a), and notify the applicant of any further information required for the application to be processed.

 

(c) Ninety days after the receipt of a complete application for a certificate of authority, the commissioner shall issue a certificate of authority to the applicant if the commissioner determines that the applicant meets the minimum criteria requirements of subdivision 2 for health data intermediaries or subdivision 3 for health information organizations.  If the commissioner determines that the applicant is not qualified, the commissioner shall notify the applicant and specify the reasons for disqualification.


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(d) Upon being granted a certificate of authority to operate as a health information organization, the organization must operate in compliance with the provisions of this section.  Noncompliance may result in the imposition of a fine or the suspension or revocation of the certificate of authority according to section 62J.4982.

 

Subd. 5.  Reciprocal agreements between health information exchange entities.  (a) Reciprocal agreements between two health information organizations or between a health information organization and a health data intermediary must include a fair and equitable model for charges between the entities that:

 

(1) does not impede the secure transmission of transactions necessary to achieve meaningful use;

 

(2) does not charge a fee for the exchange of meaningful use transactions transmitted according to nationally recognized standards where no additional value-added service is rendered to the sending or receiving health information organization or health data intermediary either directly or on behalf of the client;

 

(3) is consistent with fair market value and proportionately reflects the value-added services accessed as a result of the agreement; and

 

(4) prevents health care stakeholders from being charged multiple times for the same service.

 

(b) Reciprocal agreements must include comparable quality of service standards that ensure equitable levels of services.

 

(c) Reciprocal agreements are subject to review and approval by the commissioner.

 

(d) Nothing in this section precludes a state-certified health information organization or state-certified health data intermediary from entering into contractual agreements for the provision of value-added services beyond meaningful use. 

 

(e) The commissioner of human services or health, when providing access to data or services through a certified health information organization, must offer the same data or services directly through any certified health information organization at the same pricing, if the health information organization pays for all connection costs to the state data or service.  For all external connectivity to the respective agencies through existing or future information exchange implementations, the respective agency shall establish the required connectivity methods as well as protocol standards to be utilized.

 

Subd. 6.  State participation in health information exchange.  A state agency that connects to a health information exchange service provider for the purpose of exchanging meaningful use transactions must ensure that the contracted health information exchange service provider has reciprocal agreements in place as required by this section.  The reciprocal agreements must provide equal access to information supplied by the agency and necessary for meaningful use by the participating entities of the other health information service providers.

 

Sec. 8.  [62J.4982] ENFORCEMENT AUTHORITY; COMPLIANCE. 

 

Subdivision 1.  Penalties and enforcement.  (a) The commissioner may, for any violation of statute or rule applicable to a health information exchange service provider, levy an administrative penalty in an amount up to $25,000 for each violation.  In determining the level of an administrative penalty, the commissioner shall consider the following factors:

 

(1) the number of participating entities affected by the violation;

 

(2) the effect of the violation on participating entities' access to health information exchange services;


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(3) if only one participating entity is affected, the effect of the violation on the patients of that entity;

 

(4) whether the violation is an isolated incident or part of a pattern of violations;

 

(5) the economic benefits derived by the health information organization or a health data intermediary by virtue of the violation;

 

(6) whether the violation hindered or facilitated an individual's ability to obtain health care;

 

(7) whether the violation was intentional;

 

(8) whether the violation was beyond the direct control of the health information exchange service provider;

 

(9) any history of prior compliance with the provisions of this section, including violations;

 

(10) whether and to what extent the health information exchange service provider attempted to correct previous violations;

 

(11) how the health information exchange service provider responded to technical assistance from the commissioner provided in the context of a compliance effort; and

 

(12) the financial condition of the health information exchange service provider including, but not limited to, whether the health information exchange service provider had financial difficulties that affected its ability to comply or whether the imposition of an administrative monetary penalty would jeopardize the ability of the health information exchange service provider to continue to deliver health information exchange services.

 

Reasonable notice in writing shall be given to the health information exchange service provider of the intent to levy the penalty and the reasons for them.  A health information exchange service provider may have 15 days within which to contest whether the finding of facts constitute a violation of this section and section 62J.4981, according to the contested case and judicial review provisions of sections 14.57 to 14.69.

 

(b) If the commissioner has reason to believe that a violation of this section or section 62J.4981 has occurred or is likely, the commissioner may confer with the persons involved before commencing action under subdivision 2.  The commissioner may notify the health information exchange service provider and the representatives, or other persons who appear to be involved in the suspected violation, to arrange a voluntary conference with the alleged violators or their authorized representatives.  The purpose of the conference is to attempt to learn the facts about the suspected violation and if it appears that a violation has occurred or is threatened, to find a way to correct or prevent it.  The conference is not governed by any formal procedural requirements and may be conducted as the commissioner considers appropriate.

 

(c) The commissioner may issue an order directing a health information exchange service provider or a representative of a health information exchange service provider to cease and desist from engaging in any act or practice in violation of this section and section 62J.4981.

 

(d) Within 20 days after service of the order to cease and desist, a health information exchange service provider may contest whether the finding of facts constitutes a violation of this section and section 62J.4981 according to the contested case and judicial review provisions of sections 14.57 to 14.69.

 

(e) In the event of noncompliance with a cease and desist order issued under this subdivision, the commissioner may institute a proceeding to obtain injunctive relief or other appropriate relief in Ramsey County District Court.


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Subd. 2.  Suspension or revocation of certificates of authority.  (a) The commissioner may suspend or revoke a certificate of authority issued to a health data intermediary or health information organization under section 62J.4981 if the commissioner finds that:

 

(1) the health information exchange service provider is operating significantly in contravention of its basic organizational document, or in a manner contrary to that described in and reasonably inferred from any other information submitted under section 62J.4981, unless amendments to the submissions have been filed with and approved by the commissioner;

 

(2) the health information exchange service provider is unable to fulfill its obligations to furnish comprehensive health information exchange services as required under its health information exchange contract;

 

(3) the health information exchange service provider is no longer financially solvent or may not reasonably be expected to meet its obligations to participating entities;

 

(4) the health information exchange service provider has failed to implement the complaint system in a manner designed to reasonably resolve valid complaints;

 

(5) the health information exchange service provider, or any person acting with its sanction, has advertised or merchandised its services in an untrue, misleading, deceptive, or unfair manner;

 

(6) the continued operation of the health information exchange service provider would be hazardous to its participating entities or the patients served by the participating entities; or

 

(7) the health information exchange service provider has otherwise failed to substantially comply with section 62J.4981 or with any other statute or administrative rule applicable to health information exchange service providers, or has submitted false information in any report required under sections 62J.498 to 62J.4982.

 

(b) A certificate of authority shall be suspended or revoked only after meeting the requirements of subdivision 3.

 

(c) If the certificate of authority of a health information exchange service provider is suspended, the health information exchange service provider shall not, during the period of suspension, enroll any additional participating entities, and shall not engage in any advertising or solicitation.

 

(d) If the certificate of authority of a health information exchange service provider is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as necessary to the orderly conclusion of the affairs of the organization.  The organization shall engage in no further advertising or solicitation.  The commissioner may, by written order, permit further operation of the organization as the commissioner finds to be in the best interest of participating entities, to the end that participating entities will be given the greatest practical opportunity to access continuing health information exchange services.

 

Subd. 3.  Denial, suspension, and revocation; administrative procedures.  (a) When the commissioner has cause to believe that grounds for the denial, suspension, or revocation of a certificate of authority exists, the commissioner shall notify the health information exchange service provider in writing stating the grounds for denial, suspension, or revocation and setting a time within 20 days for a hearing on the matter.

 

(b) After a hearing before the commissioner at which the health information exchange service provider may respond to the grounds for denial, suspension, or revocation, or upon the failure of the health information exchange service provider to appear at the hearing, the commissioner shall take action as deemed necessary and shall issue written findings that shall be mailed to the health information exchange service provider.


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(c) If suspension, revocation, or an administrative penalty is proposed according to this section, the commissioner must deliver, or send by certified mail with return receipt requested, to the health information exchange service provider written notice of the commissioner's intent to impose a penalty.  This notice of proposed determination must include:

 

(1) a reference to the statutory basis for the penalty;

 

(2) a description of the findings of fact regarding the violations with respect to which the penalty is proposed;

 

(3) the nature and amount of the proposed penalty;

 

(4) any circumstances described in subdivision 1, paragraph (a), that were considered in determining the amount of the proposed penalty;

 

(5) instructions for responding to the notice, including a statement of the health information exchange service provider's right to a contested case proceeding and a statement that failure to request a contested case proceeding within 30 calendar days permits the imposition of the proposed penalty; and

 

(6) the address to which the contested case proceeding request must be sent.

 

Subd. 4.  Coordination.  (a) To the extent possible when implementing sections 62J.498 to 62J.4982, the commissioner shall seek the advice of the Minnesota e-Health Advisory Committee, in the review and update of criteria for the certification and recertification of health information exchange service providers.

 

(b) By January 1, 2011, the commissioner shall report to the governor and the chairs of the senate and house of representatives committees having jurisdiction over health information policy issues on the status of the health information exchange in Minnesota and provide recommendations on further action necessary to facilitate the secure electronic movement of health information among health providers that will enable Minnesota providers and hospitals to meet meaningful use exchange requirements.

 

Subd. 5.  Fees and monetary penalties.  (a) Every health information exchange service provider subject to this section and section 62J.4981 shall be assessed fees as follows:

 

(1) filing an application for certificate of authority to operate as a health information organization, $10,500;

 

(2) filing an application for certificate of authority to operate as a health data intermediary, $7,000;

 

(3) annual health information organization certificate fee, $14,000;

 

(4) annual health data intermediary certificate fee, $7,000; and

 

(5) fees for other filings, as specified by rule.

 

(b) Administrative monetary penalties imposed under this subdivision shall be deposited into a revolving fund and are appropriated to the commissioner for the purposes of sections 62J.498 to 62J.4982.

 

Sec. 9.  Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:

 

Subdivision 1.  Designation.  (a) The commissioner shall designate essential community providers.  The criteria for essential community provider designation shall be the following:


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(1) a demonstrated ability to integrate applicable supportive and stabilizing services with medical care for uninsured persons and high-risk and special needs populations, underserved, and other special needs populations; and

 

(2) a commitment to serve low-income and underserved populations by meeting the following requirements:

 

(i) has nonprofit status in accordance with chapter 317A;

 

(ii) has tax exempt status in accordance with the Internal Revenue Service Code, section 501(c)(3);

 

(iii) charges for services on a sliding fee schedule based on current poverty income guidelines; and

 

(iv) does not restrict access or services because of a client's financial limitation;

 

(3) status as a local government unit as defined in section 62D.02, subdivision 11, a hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal government, an Indian health service unit, or a community health board as defined in chapter 145A;

 

(4) a former state hospital that specializes in the treatment of cerebral palsy, spina bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling conditions; or

 

(5) a sole community hospital.  For these rural hospitals, the essential community provider designation applies to all health services provided, including both inpatient and outpatient services.  For purposes of this section, "sole community hospital" means a rural hospital that:

 

(i) is eligible to be classified as a sole community hospital according to Code of Federal Regulations, title 42, section 412.92, or is located in a community with a population of less than 5,000 and located more than 25 miles from a like hospital currently providing acute short-term services;

 

(ii) has experienced net operating income losses in two of the previous three most recent consecutive hospital fiscal years for which audited financial information is available; and

 

(iii) consists of 40 or fewer licensed beds; or

 

(6) a birth center licensed under section 144.615.

 

(b) Prior to designation, the commissioner shall publish the names of all applicants in the State Register.  The public shall have 30 days from the date of publication to submit written comments to the commissioner on the application.  No designation shall be made by the commissioner until the 30-day period has expired.

 

(c) The commissioner may designate an eligible provider as an essential community provider for all the services offered by that provider or for specific services designated by the commissioner.

 

(d) For the purpose of this subdivision, supportive and stabilizing services include at a minimum, transportation, child care, cultural, and linguistic services where appropriate.

 

Sec. 10.  Minnesota Statutes 2008, section 144.226, subdivision 3, is amended to read:

 

Subd. 3.  Birth record surcharge.  (a) In addition to any fee prescribed under subdivision 1, there shall be a nonrefundable surcharge of $3 for each certified birth or stillbirth record and for a certification that the vital record cannot be found.  The local or state registrar shall forward this amount to the commissioner of management and


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budget for deposit into the account for the children's trust fund for the prevention of child abuse established under section 256E.22.  This surcharge shall not be charged under those circumstances in which no fee for a certified birth or stillbirth record is permitted under subdivision 1, paragraph (a).  Upon certification by the commissioner of management and budget that the assets in that fund exceed $20,000,000, this surcharge shall be discontinued.

 

(b) In addition to any fee prescribed under subdivision 1, there shall be a nonrefundable surcharge of $10 for each certified birth record.  The local or state registrar shall forward this amount to the commissioner of finance for deposit in the general fund for the Minnesota Birth Defects Information System established under section 144.2215.  This surcharge shall not be charged under those circumstances in which no fee for a certified birth record is permitted under subdivision 1, paragraph (a).

 

EFFECTIVE DATE.  This section is effective July 1, 2010.