Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 2001, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 203-S.F.No. 1407
An act relating to human services; modifying
provisions in health care access programs; amending
Minnesota Statutes 2000, sections 245B.02, by adding a
subdivision; 245B.03, subdivision 1; 252.28,
subdivisions 3a and 3b; 256B.056, subdivisions 1a and
5a; 256B.0595, subdivisions 1 and 2; 256B.0625,
subdivision 9; 256B.071, subdivision 2; 256B.094,
subdivisions 6 and 8; 256B.5013, subdivision 1;
256B.69, subdivision 3a; 256D.03, subdivision 3; and
256L.15, subdivision 1a; Laws 1996, chapter 451,
article 2, sections 61 and 62; repealing Minnesota
Statutes 2000, section 256B.071, subdivision 5; Laws
1995, chapter 178, article 2, section 46, subdivision
10; Laws 1996, chapter 451, article 2, sections 12,
14, 16, 18, 29, and 30.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2000, section 245B.02, is
amended by adding a subdivision to read:
Subd. 23a. [SUPPORTED EMPLOYMENT.] "Supported employment"
services include individualized counseling, individualized job
development and placement that produce an appropriate job match
for the individual and the employer, on-the-job training in work
and related work skills required for job performance, ongoing
supervision and monitoring of the person's performance,
long-term support services to assure job retention, training in
related skills essential to obtaining and retaining employment
such as the effective use of community resources, use of break
and lunch areas, transportation and mobility training, and
transportation between the individual's place of residence and
the work place when other forms of transportation are
unavailable or inaccessible.
Sec. 2. Minnesota Statutes 2000, section 245B.03,
subdivision 1, is amended to read:
Subdivision 1. [APPLICABILITY.] The standards in this
chapter govern services to persons with mental retardation or
related conditions receiving services from license holders
providing residential-based habilitation; day training and
habilitation services for adults; supported employment;
semi-independent living services; residential programs that
serve more than four consumers, including intermediate care
facilities for persons with mental retardation; and respite care
provided outside the consumer's home for more than four
consumers at the same time at a single site.
Sec. 3. Minnesota Statutes 2000, section 252.28,
subdivision 3a, is amended to read:
Subd. 3a. [LICENSING EXCEPTION.] (a) Notwithstanding the
provisions of subdivision 3, the commissioner may license
service sites, each accommodating up to six residents moving
from a 48-bed intermediate care facility for persons with mental
retardation or related conditions located in Dakota county that
is closing under section 252.292.
(b) Notwithstanding the provisions of any other state law
or administrative rule, the rate provisions of section 256I.05,
subdivision 1, apply to the exception in this subdivision.
(c) If a service site is licensed for six persons according
to this subdivision, the capacity of the license may remain at
six persons.
Sec. 4. Minnesota Statutes 2000, section 252.28,
subdivision 3b, is amended to read:
Subd. 3b. [OLMSTED COUNTY LICENSING EXEMPTION.] (a)
Notwithstanding subdivision 3, the commissioner may license
service sites each accommodating up to five residents moving
from a 43-bed intermediate care facility for persons with mental
retardation or related conditions located in Olmsted county that
is closing under section 252.292.
(b) Notwithstanding the provisions of any other state law
or administrative rule, the rate provisions of section 256I.05,
subdivision 1, apply to the exception in this subdivision.
(c) If a service site is licensed for five persons
according to this subdivision, the capacity of the license may
remain at five persons.
Sec. 5. Minnesota Statutes 2000, section 256B.056,
subdivision 1a, is amended to read:
Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless
specifically required by state law or rule or federal law or
regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons
whose eligibility category is based on blindness, disability, or
age of 65 or more years, the methodologies for the supplemental
security income program shall be used. For families and
children, which includes all other eligibility categories, the
methodologies under the state's AFDC plan in effect as of July
16, 1996, as required by the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (PRWORA), Public Law
Number 104-193, shall be used. Effective upon federal approval,
in-kind contributions to, and payments made on behalf of, a
recipient, by an obligor, in satisfaction of or in addition to a
temporary or permanent order for child support or maintenance,
shall be considered income to the recipient. For these
purposes, a "methodology" does not include an asset or income
standard, or accounting method, or method of determining
effective dates.
Sec. 6. Minnesota Statutes 2000, section 256B.056,
subdivision 5a, is amended to read:
Subd. 5a. [INDIVIDUALS ON FIXED OR EXCLUDED INCOME.]
Recipients of medical assistance who receive only fixed unearned
or excluded income, where such when that income is excluded from
consideration as income or unvarying in amount and timing of
receipt throughout the year, shall report and verify their
income annually.
Sec. 7. Minnesota Statutes 2000, section 256B.0595,
subdivision 1, is amended to read:
Subdivision 1. [PROHIBITED TRANSFERS.] (a) For transfers
of assets made on or before August 10, 1993, if a person or the
person's spouse has given away, sold, or disposed of, for less
than fair market value, any asset or interest therein, except
assets other than the homestead that are excluded under the
supplemental security program, within 30 months before or any
time after the date of institutionalization if the person has
been determined eligible for medical assistance, or within 30
months before or any time after the date of the first approved
application for medical assistance if the person has not yet
been determined eligible for medical assistance, the person is
ineligible for long-term care services for the period of time
determined under subdivision 2.
(b) Effective for transfers made after August 10, 1993, a
person, a person's spouse, or any person, court, or
administrative body with legal authority to act in place of, on
behalf of, at the direction of, or upon the request of the
person or person's spouse, may not give away, sell, or dispose
of, for less than fair market value, any asset or interest
therein, except assets other than the homestead that are
excluded under the supplemental security income program, for the
purpose of establishing or maintaining medical assistance
eligibility. For purposes of determining eligibility for
long-term care services, any transfer of such assets within 36
months before or any time after an institutionalized person
applies for medical assistance, or 36 months before or any time
after a medical assistance recipient becomes institutionalized,
for less than fair market value may be considered. Any such
transfer is presumed to have been made for the purpose of
establishing or maintaining medical assistance eligibility and
the person is ineligible for long-term care services for the
period of time determined under subdivision 2, unless the person
furnishes convincing evidence to establish that the transaction
was exclusively for another purpose, or unless the transfer is
permitted under subdivision 3 or 4. Notwithstanding the
provisions of this paragraph, in the case of payments from a
trust or portions of a trust that are considered transfers of
assets under federal law, any transfers made within 60 months
before or any time after an institutionalized person applies for
medical assistance and within 60 months before or any time after
a medical assistance recipient becomes institutionalized, may be
considered.
(c) This section applies to transfers, for less than fair
market value, of income or assets, including assets that are
considered income in the month received, such as inheritances,
court settlements, and retroactive benefit payments or income to
which the person or the person's spouse is entitled but does not
receive due to action by the person, the person's spouse, or any
person, court, or administrative body with legal authority to
act in place of, on behalf of, at the direction of, or upon the
request of the person or the person's spouse.
(d) This section applies to payments for care or personal
services provided by a relative, unless the compensation was
stipulated in a notarized, written agreement which was in
existence when the service was performed, the care or services
directly benefited the person, and the payments made represented
reasonable compensation for the care or services provided. A
notarized written agreement is not required if payment for the
services was made within 60 days after the service was provided.
(e) This section applies to the portion of any asset or
interest that a person, a person's spouse, or any person, court,
or administrative body with legal authority to act in place of,
on behalf of, at the direction of, or upon the request of the
person or the person's spouse, transfers to any annuity that
exceeds the value of the benefit likely to be returned to the
person or spouse while alive, based on estimated life expectancy
using the life expectancy tables employed by the supplemental
security income program to determine the value of an agreement
for services for life. The commissioner may adopt rules
reducing life expectancies based on the need for long-term care.
(f) For purposes of this section, long-term care services
include services in a nursing facility, services that are
eligible for payment according to section 256B.0625, subdivision
2, because they are provided in a swing bed, intermediate care
facility for persons with mental retardation, and home and
community-based services provided pursuant to sections
256B.0915, 256B.092, and 256B.49. For purposes of this
subdivision and subdivisions 2, 3, and 4, "institutionalized
person" includes a person who is an inpatient in a nursing
facility or in a swing bed, or intermediate care facility for
persons with mental retardation or who is receiving home and
community-based services under sections 256B.0915, 256B.092, and
256B.49.
(g) Effective for transfers made on or after July 1, 1995,
or upon federal approval, whichever is later, a person, a
person's spouse, or any person, court, or administrative body
with legal authority to act in place of, on behalf of, at the
direction of, or upon the request of the person or person's
spouse, may not give away, sell, or dispose of, for less than
fair market value, any asset or interest therein, for the
purpose of establishing or maintaining medical assistance
eligibility. For purposes of determining eligibility for
long-term care services, any transfer of such assets within 60
months before, or any time after, an institutionalized person
applies for medical assistance, or 60 months before, or any time
after, a medical assistance recipient becomes institutionalized,
for less than fair market value may be considered. Any such
transfer is presumed to have been made for the purpose of
establishing or maintaining medical assistance eligibility and
the person is ineligible for long-term care services for the
period of time determined under subdivision 2, unless the person
furnishes convincing evidence to establish that the transaction
was exclusively for another purpose, or unless the transfer is
permitted under subdivision 3 or 4.
Sec. 8. Minnesota Statutes 2000, section 256B.0595,
subdivision 2, is amended to read:
Subd. 2. [PERIOD OF INELIGIBILITY.] (a) For any
uncompensated transfer occurring on or before August 10, 1993,
the number of months of ineligibility for long-term care
services shall be the lesser of 30 months, or the uncompensated
transfer amount divided by the average medical assistance rate
for nursing facility services in the state in effect on the date
of application. The amount used to calculate the average
medical assistance payment rate shall be adjusted each July 1 to
reflect payment rates for the previous calendar year. The
period of ineligibility begins with the month in which the
assets were transferred. If the transfer was not reported to
the local agency at the time of application, and the applicant
received long-term care services during what would have been the
period of ineligibility if the transfer had been reported, a
cause of action exists against the transferee for the cost of
long-term care services provided during the period of
ineligibility, or for the uncompensated amount of the transfer,
whichever is less. The action may be brought by the state or
the local agency responsible for providing medical assistance
under chapter 256G. The uncompensated transfer amount is the
fair market value of the asset at the time it was given away,
sold, or disposed of, less the amount of compensation received.
(b) For uncompensated transfers made after August 10, 1993,
the number of months of ineligibility for long-term care
services shall be the total uncompensated value of the resources
transferred divided by the average medical assistance rate for
nursing facility services in the state in effect on the date of
application. The amount used to calculate the average medical
assistance payment rate shall be adjusted each July 1 to reflect
payment rates for the previous calendar year. The period of
ineligibility begins with the month in which the assets were
transferred except that if one or more uncompensated transfers
are made during a period of ineligibility, the total assets
transferred during the ineligibility period shall be combined
and a penalty period calculated to begin in the month the first
uncompensated transfer was made. If the transfer was not
reported to the local agency at the time of application, and the
applicant received medical assistance services during what would
have been the period of ineligibility if the transfer had been
reported, a cause of action exists against the transferee for
the cost of medical assistance services provided during the
period of ineligibility, or for the uncompensated amount of the
transfer, whichever is less. The action may be brought by the
state or the local agency responsible for providing medical
assistance under chapter 256G. The uncompensated transfer
amount is the fair market value of the asset at the time it was
given away, sold, or disposed of, less the amount of
compensation received. Effective for transfers made on or after
March 1, 1996, involving persons who apply for medical
assistance on or after April 13, 1996, no cause of action exists
for a transfer unless:
(1) the transferee knew or should have known that the
transfer was being made by a person who was a resident of a
long-term care facility or was receiving that level of care in
the community at the time of the transfer;
(2) the transferee knew or should have known that the
transfer was being made to assist the person to qualify for or
retain medical assistance eligibility; or
(3) the transferee actively solicited the transfer with
intent to assist the person to qualify for or retain eligibility
for medical assistance.
(c) If a calculation of a penalty period results in a
partial month, payments for long-term care services shall be
reduced in an amount equal to the fraction, except that in
calculating the value of uncompensated transfers, if the total
value of all uncompensated transfers made in a month not
included in an existing penalty period does not exceed $500,
then such transfers shall be disregarded for each month prior to
the month of application for or during receipt of medical
assistance.
Sec. 9. Minnesota Statutes 2000, section 256B.0625,
subdivision 9, is amended to read:
Subd. 9. [DENTAL SERVICES.] Medical assistance covers
dental services. Dental services include, with prior
authorization, fixed cast metal restorations bridges that are
cost-effective for persons who cannot use removable dentures
because of their medical condition.
Sec. 10. Minnesota Statutes 2000, section 256B.071,
subdivision 2, is amended to read:
Subd. 2. [TECHNICAL ASSISTANCE TO PROVIDERS.] (a) The
commissioner shall establish a technical assistance program to
require providers of services and equipment under this section
to maximize collections from the federal Medicare program. The
technical assistance may include the provision of materials to
help providers determine those services and equipment likely to
be reimbursed by Medicare. The technical assistance may also
include the provision of computer software to providers to
assist in this process. The commissioner may expand the
technical assistance program to include providers of other
services under this chapter.
(b) Any provider of home care services enrolled in the
medical assistance program, or county public health nursing
agency responsible for personal care assessments, or county case
managers for alternative care or medical assistance waiver
programs, is required to use the method developed and supplied
by the department of human services for determining Medicare
coverage for home care equipment and services provided to dual
entitlees to ensure appropriate billing of Medicare. The method
will be developed in two phases; the first phase is a manual
system effective July 1, 1996, and the second phase will
automate the manual procedure by expanding the current Medicaid
Management Information System (MMIS) effective January 1, 1997.
Both methods will determine Medicare coverage for the dates of
service and Medicare coverage for home care services, and create
an audit trail including reports. Both methods will be linked
to prior authorization, therefore, either method must be used
before home care services are authorized and when there is a
change of condition affecting medical assistance authorization.
The department will conduct periodic reviews of participant
performance with the method and upon demonstrating appropriate
referral and billing of Medicare, participants may be determined
exempt from regular performance audits.
Sec. 11. Minnesota Statutes 2000, section 256B.094,
subdivision 6, is amended to read:
Subd. 6. [MEDICAL ASSISTANCE REIMBURSEMENT OF CASE
MANAGEMENT SERVICES.] (a) Medical assistance reimbursement for
services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between
the case manager and the client, client's family, primary
caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of
the goals of the individual service plan regarding the status of
the client, the individual service plan, or the goals for the
client. These contacts must meet the minimum standards in
clauses (1) and (2):
(1) there must be a face-to-face contact at least once a
month except as provided in clause (2); and
(2) for a client placed outside of the county of financial
responsibility, or a client served by tribal social services
placed outside the reservation, in an excluded time facility
under section 256G.02, subdivision 6, or through the Interstate
Compact on the Placement of Children, section 260.851, and the
placement in either case is more than 60 miles beyond the county
or reservation boundaries, there must be at least one contact
per month and not more than two consecutive months without a
face-to-face contact.
(b) Except as provided under paragraph (c), the payment
rate is established using time study data on activities of
provider service staff and reports required under sections
245.482, 256.01, subdivision 2, paragraph (17), and 256E.08,
subdivision 8.
(c) Payments for tribes may be made according to section
256B.0625 or other relevant federally approved rate setting
methodology for child welfare targeted case management provided
by Indian health services and facilities operated by a tribe or
tribal organization.
(d) Payment for case management provided by county or
tribal social services contracted vendors shall be based on a
monthly rate negotiated by the host county or tribal social
services. The negotiated rate must not exceed the rate charged
by the vendor for the same service to other payers. If the
service is provided by a team of contracted vendors, the county
or tribal social services may negotiate a team rate with a
vendor who is a member of the team. The team shall determine
how to distribute the rate among its members. No reimbursement
received by contracted vendors shall be returned to the county
or tribal social services, except to reimburse the county or
tribal social services for advance funding provided by the
county or tribal social services to the vendor.
(e) If the service is provided by a team that includes
contracted vendors and county or tribal social services staff,
the costs for county or tribal social services staff
participation in the team shall be included in the rate for
county or tribal social services provided services. In this
case, the contracted vendor and the county or tribal social
services may each receive separate payment for services provided
by each entity in the same month. To prevent duplication of
services, each entity must document, in the recipient's file,
the need for team case management and a description of the roles
and services of the team members.
Separate payment rates may be established for different
groups of providers to maximize reimbursement as determined by
the commissioner. The payment rate will be reviewed annually
and revised periodically to be consistent with the most recent
time study and other data. Payment for services will be made
upon submission of a valid claim and verification of proper
documentation described in subdivision 7. Federal
administrative revenue earned through the time study, or under
paragraph (c), shall be distributed according to earnings, to
counties, reservations, or groups of counties or reservations
which have the same payment rate under this subdivision, and to
the group of counties or reservations which are not certified
providers under section 256F.10. The commissioner shall modify
the requirements set out in Minnesota Rules, parts 9550.0300 to
9550.0370, as necessary to accomplish this.
Sec. 12. Minnesota Statutes 2000, section 256B.094,
subdivision 8, is amended to read:
Subd. 8. [PAYMENT LIMITATION.] Services that are not
eligible for payment as a child welfare targeted case management
service include, but are not limited to:
(1) assessments prior to opening a case;
(2) therapy and treatment services;
(3) legal services, including legal advocacy, for the
client;
(4) information and referral services that are part of a
county's community social services plan, that are not provided
to an eligible recipient;
(5) outreach services including outreach services provided
through the community support services program;
(6) services that are not documented as required under
subdivision 7 and Minnesota Rules, parts 9505.1800 to
9505.1880 9505.2165 and 9505.2175;
(7) services that are otherwise eligible for payment on a
separate schedule under rules of the department of human
services;
(8) services to a client that duplicate the same case
management service from another case manager;
(9) case management services provided to patients or
residents in a medical assistance facility except as described
under subdivision 2, clause (9); and
(10) for children in foster care, group homes, or
residential care, payment for case management services is
limited to case management services that focus on permanency
planning or return to the family home and that do not duplicate
the facility's discharge planning services.
Sec. 13. Minnesota Statutes 2000, section 256B.5013,
subdivision 1, is amended to read:
Subdivision 1. [VARIABLE RATE ADJUSTMENTS.] For rate years
beginning on or after October 1, 2000, when there is a
documented increase in the resource needs of a current ICF/MR
recipient or recipients, or a person is admitted to a facility
who requires additional resources, the county of financial
responsibility may recommend approval of a variable rate to
enable the facility to meet the individual's increased needs
based on the recipient's screening. Variable rate adjustments
made under this subdivision replace payments for persons with
special needs under section 256B.501, subdivision 8, and
payments for persons with special needs for crisis intervention
services under section 256B.501, subdivision 8a. Resource needs
directly attributable to an individual that may be considered
under the variable rate adjustment include increased direct
staff hours and, other specialized services, and equipment, and
human resources. The guidelines in paragraphs (a) to (d) apply
for the payment rate adjustments under this section.
(a) All persons must be screened according to section
256B.092, subdivisions 7 and 8, prior to implementation of the
new payment system, and annually thereafter, and when a variable
rate is being requested due to changes in the needs of the
recipient. Screening data shall be analyzed to develop broad
profiles of the functional characteristics of recipients.
Screening data shall be used to monitor changes as follows:
Criteria to be used to develop these profiles shall
include, but not be limited to:
(1) the functional ability of a recipient to care for and
maintain the recipient's own basic needs;
(2) the intensity of any aggressive or destructive
behavior; and
(3) any history of obstructive behavior in combination with
a diagnosis of psychosis or neurosis;.
(b) A variable rate may be recommended for increased
service needs such as:
(4) (1) a need for resources due to a change in resident
day program participation because the resident: (i) has reached
the age of 65 or has a change in health condition that makes it
difficult for the person to participate in day training and
habilitation services over an extended period of time because it
is medically contraindicated; and (ii) has expressed a desire
for change through the developmental disabilities mental
retardation and related conditions screening process under
section 256B.092; and
(5) (2) a need for additional resources for intensive
short-term training programming which is necessary prior to a
recipient's discharge to a less restrictive, more integrated
setting.
The recipients' screenings Recommendations for a variable
rate shall be used to link resource needs to funding. The
resource profile shall determine the level of funding. The
variable rate must be applied to expenses related to increased
direct staff hours and, other specialized services, and
equipment, and human resources.
(b) (c) A recipient must be screened by the county of
financial responsibility using the developmental disabilities
screening document completed immediately prior to approval of a
variable rate by the county. A comparison of the updated
screening and the previous screening must demonstrate an
increase in resource needs.
(c) (d) Rate adjustments projected to exceed the authorized
funding level associated with the person's profile must be
submitted to the commissioner.
(d) (e) The county of financial responsibility must
indicate the projected length of time that the additional
funding may be needed for the individual. The need to continue
an individual variable rate must be reviewed at the end of the
anticipated duration of need but at least annually through the
completion of the developmental disabilities screening document.
Sec. 14. Minnesota Statutes 2000, section 256B.69,
subdivision 3a, is amended to read:
Subd. 3a. [COUNTY AUTHORITY.] (a) The commissioner, when
implementing the general assistance medical care, or medical
assistance prepayment program within a county, must include the
county board in the process of development, approval, and
issuance of the request for proposals to provide services to
eligible individuals within the proposed county. County boards
must be given reasonable opportunity to make recommendations
regarding the development, issuance, review of responses, and
changes needed in the request for proposals. The commissioner
must provide county boards the opportunity to review each
proposal based on the identification of community needs under
chapters 145A and 256E and county advocacy activities. If a
county board finds that a proposal does not address certain
community needs, the county board and commissioner shall
continue efforts for improving the proposal and network prior to
the approval of the contract. The county board shall make
recommendations regarding the approval of local networks and
their operations to ensure adequate availability and access to
covered services. The provider or health plan must respond
directly to county advocates and the state prepaid medical
assistance ombudsperson regarding service delivery and must be
accountable to the state regarding contracts with medical
assistance and general assistance medical care funds. The
county board may recommend a maximum number of participating
health plans after considering the size of the enrolling
population; ensuring adequate access and capacity; considering
the client and county administrative complexity; and considering
the need to promote the viability of locally developed health
plans. The county board or a single entity representing a group
of county boards and the commissioner shall mutually select
health plans for participation at the time of initial
implementation of the prepaid medical assistance program in that
county or group of counties and at the time of contract renewal.
The commissioner shall also seek input for contract requirements
from the county or single entity representing a group of county
boards at each contract renewal and incorporate those
recommendations into the contract negotiation process. The
commissioner, in conjunction with the county board, shall
actively seek to develop a mutually agreeable timetable prior to
the development of the request for proposal, but counties must
agree to initial enrollment beginning on or before January 1,
1999, in either the prepaid medical assistance and general
assistance medical care programs or county-based purchasing
under section 256B.692. At least 90 days before enrollment in
the medical assistance and general assistance medical care
prepaid programs begins in a county in which the prepaid
programs have not been established, the commissioner shall
provide a report to the chairs of senate and house committees
having jurisdiction over state health care programs which
verifies that the commissioner complied with the requirements
for county involvement that are specified in this subdivision.
(b) The commissioner shall seek a federal waiver to allow a
fee-for-service plan option to MinnesotaCare enrollees. The
commissioner shall develop an increase of the premium fees
required under section 256L.06 up to 20 percent of the premium
fees for the enrollees who elect the fee-for-service option.
Prior to implementation, the commissioner shall submit this fee
schedule to the chair and ranking minority member of the senate
health care committee, the senate health care and family
services funding division, the house of representatives health
and human services committee, and the house of representatives
health and human services finance division.
(c) At the option of the county board, the board may
develop contract requirements related to the achievement of
local public health goals to meet the health needs of medical
assistance and general assistance medical care enrollees. These
requirements must be reasonably related to the performance of
health plan functions and within the scope of the medical
assistance and general assistance medical care benefit sets. If
the county board and the commissioner mutually agree to such
requirements, the department shall include such requirements in
all health plan contracts governing the prepaid medical
assistance and general assistance medical care programs in that
county at initial implementation of the program in that county
and at the time of contract renewal. The county board may
participate in the enforcement of the contract provisions
related to local public health goals.
(d) (c) For counties in which prepaid medical assistance
and general assistance medical care programs have not been
established, the commissioner shall not implement those programs
if a county board submits acceptable and timely preliminary and
final proposals under section 256B.692, until county-based
purchasing is no longer operational in that county. For
counties in which prepaid medical assistance and general
assistance medical care programs are in existence on or after
September 1, 1997, the commissioner must terminate contracts
with health plans according to section 256B.692, subdivision 5,
if the county board submits and the commissioner accepts
preliminary and final proposals according to that subdivision.
The commissioner is not required to terminate contracts that
begin on or after September 1, 1997, according to section
256B.692 until two years have elapsed from the date of initial
enrollment.
(e) (d) In the event that a county board or a single entity
representing a group of county boards and the commissioner
cannot reach agreement regarding: (i) the selection of
participating health plans in that county; (ii) contract
requirements; or (iii) implementation and enforcement of county
requirements including provisions regarding local public health
goals, the commissioner shall resolve all disputes after taking
into account the recommendations of a three-person mediation
panel. The panel shall be composed of one designee of the
president of the association of Minnesota counties, one designee
of the commissioner of human services, and one designee of the
commissioner of health.
(f) (e) If a county which elects to implement county-based
purchasing ceases to implement county-based purchasing, it is
prohibited from assuming the responsibility of county-based
purchasing for a period of five years from the date it
discontinues purchasing.
(g) (f) Notwithstanding the requirement in this subdivision
that a county must agree to initial enrollment on or before
January 1, 1999, the commissioner shall grant a delay in the
implementation of the county-based purchasing authorized in
section 256B.692 until federal waiver authority and approval has
been granted, if the county or group of counties has submitted a
preliminary proposal for county-based purchasing by September 1,
1997, has not already implemented the prepaid medical assistance
program before January 1, 1998, and has submitted a written
request for the delay to the commissioner by July 1, 1998. In
order for the delay to be continued, the county or group of
counties must also submit to the commissioner the following
information by December 1, 1998. The information must:
(1) identify the proposed date of implementation, as
determined under section 256B.692, subdivision 5;
(2) include copies of the county board resolutions which
demonstrate the continued commitment to the implementation of
county-based purchasing by the proposed date. County board
authorization may remain contingent on the submission of a final
proposal which meets the requirements of section 256B.692,
subdivision 5, paragraph (b);
(3) demonstrate actions taken for the establishment of a
governance structure between the participating counties and
describe how the fiduciary responsibilities of county-based
purchasing will be allocated between the counties, if more than
one county is involved in the proposal;
(4) describe how the risk of a deficit will be managed in
the event expenditures are greater than total capitation
payments. This description must identify how any of the
following strategies will be used:
(i) risk contracts with licensed health plans;
(ii) risk arrangements with providers who are not licensed
health plans;
(iii) risk arrangements with other licensed insurance
entities; and
(iv) funding from other county resources;
(5) include, if county-based purchasing will not contract
with licensed health plans or provider networks, letters of
interest from local providers in at least the categories of
hospital, physician, mental health, and pharmacy which express
interest in contracting for services. These letters must
recognize any risk transfer identified in clause (4), item (ii);
and
(6) describe the options being considered to obtain the
administrative services required in section 256B.692,
subdivision 3, clauses (3) and (5).
(h) (g) For counties which receive a delay under this
subdivision, the final proposals required under section
256B.692, subdivision 5, paragraph (b), must be submitted at
least six months prior to the requested implementation date.
Authority to implement county-based purchasing remains
contingent on approval of the final proposal as required under
section 256B.692.
(i) (h) If the commissioner is unable to provide
county-specific, individual-level fee-for-service claims to
counties by June 4, 1998, the commissioner shall grant a delay
under paragraph (g) (f) of up to 12 months in the implementation
of county-based purchasing, and shall require implementation not
later than January 1, 2000. In order to receive an extension of
the proposed date of implementation under this paragraph, a
county or group of counties must submit a written request for
the extension to the commissioner by August 1, 1998, must submit
the information required under paragraph (g) (f) by December 1,
1998, and must submit a final proposal as provided under
paragraph (h) (g).
(j) (i) Notwithstanding other requirements of this
subdivision, the commissioner shall not require the
implementation of the county-based purchasing authorized in
section 256B.692 until six months after federal waiver approval
has been obtained for county-based purchasing, if the county or
counties have submitted the final plan as required in section
256B.692, subdivision 5. The commissioner shall allow the
county or counties which submitted information under section
256B.692, subdivision 5, to submit supplemental or additional
information which was not possible to submit by April 1, 1999.
A county or counties shall continue to submit the required
information and substantive detail necessary to obtain a prompt
response and waiver approval. If amendments to the final plan
are necessary due to the terms and conditions of the waiver
approval, the commissioner shall allow the county or group of
counties 60 days to make the necessary amendments to the final
plan and shall not require implementation of the county-based
purchasing until six months after the revised final plan has
been submitted.
Sec. 15. Minnesota Statutes 2000, section 256D.03,
subdivision 3, is amended to read:
Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.]
(a) General assistance medical care may be paid for any person
who is not eligible for medical assistance under chapter 256B,
including eligibility for medical assistance based on a
spenddown of excess income according to section 256B.056,
subdivision 5, or MinnesotaCare as defined in paragraph (b),
except as provided in paragraph (c); and:
(1) who is receiving assistance under section 256D.05,
except for families with children who are eligible under
Minnesota family investment program-statewide (MFIP-S), who is
having a payment made on the person's behalf under sections
256I.01 to 256I.06, or who resides in group residential housing
as defined in chapter 256I and can meet a spenddown using the
cost of remedial services received through group residential
housing; or
(2)(i) who is a resident of Minnesota; and whose equity in
assets is not in excess of $1,000 per assistance unit. Exempt
assets, the reduction of excess assets, and the waiver of excess
assets must conform to the medical assistance program in chapter
256B, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or
on behalf of the beneficiary by the trustee, assuming the full
exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum; and
(ii) who has countable income not in excess of the
assistance standards established in section 256B.056,
subdivision 4, or whose excess income is spent down according to
section 256B.056, subdivision 5, using a six-month budget
period. The method for calculating earned income disregards and
deductions for a person who resides with a dependent child under
age 21 shall follow section 256B.056, subdivision 1a. However,
if a disregard of $30 and one-third of the remainder has been
applied to the wage earner's income, the disregard shall not be
applied again until the wage earner's income has not been
considered in an eligibility determination for general
assistance, general assistance medical care, medical assistance,
or MFIP-S for 12 consecutive months. The earned income and work
expense deductions for a person who does not reside with a
dependent child under age 21 shall be the same as the method
used to determine eligibility for a person under section
256D.06, subdivision 1, except the disregard of the first $50 of
earned income is not allowed;
(3) who would be eligible for medical assistance except
that the person resides in a facility that is determined by the
commissioner or the federal Health Care Financing Administration
to be an institution for mental diseases; or
(4) who is ineligible for medical assistance under chapter
256B or general assistance medical care under any other
provision of this section, and is receiving care and
rehabilitation services from a nonprofit center established to
serve victims of torture. These individuals are eligible for
general assistance medical care only for the period during which
they are receiving services from the center. During this period
of eligibility, individuals eligible under this clause shall not
be required to participate in prepaid general assistance medical
care.
(b) Beginning January 1, 2000, applicants or recipients who
meet all eligibility requirements of MinnesotaCare as defined in
sections 256L.01 to 256L.16, and are:
(i) adults with dependent children under 21 whose gross
family income is equal to or less than 275 percent of the
federal poverty guidelines; or
(ii) adults without children with earned income and whose
family gross income is between 75 percent of the federal poverty
guidelines and the amount set by section 256L.04, subdivision 7,
shall be terminated from general assistance medical care upon
enrollment in MinnesotaCare. Earned income is deemed available
to family members as defined in section 256D.02, subdivision 8.
(c) For services rendered on or after July 1, 1997,
eligibility is limited to one month prior to application if the
person is determined eligible in the prior month. A
redetermination of eligibility must occur every 12 months.
Beginning January 1, 2000, Minnesota health care program
applications completed by recipients and applicants who are
persons described in paragraph (b), may be returned to the
county agency to be forwarded to the department of human
services or sent directly to the department of human services
for enrollment in MinnesotaCare. If all other eligibility
requirements of this subdivision are met, eligibility for
general assistance medical care shall be available in any month
during which a MinnesotaCare eligibility determination and
enrollment are pending. Upon notification of eligibility for
MinnesotaCare, notice of termination for eligibility for general
assistance medical care shall be sent to an applicant or
recipient. If all other eligibility requirements of this
subdivision are met, eligibility for general assistance medical
care shall be available until enrollment in MinnesotaCare
subject to the provisions of paragraph (e).
(d) The date of an initial Minnesota health care program
application necessary to begin a determination of eligibility
shall be the date the applicant has provided a name, address,
and social security number, signed and dated, to the county
agency or the department of human services. If the applicant is
unable to provide an initial application when health care is
delivered due to a medical condition or disability, a health
care provider may act on the person's behalf to complete the
initial application. The applicant must complete the remainder
of the application and provide necessary verification before
eligibility can be determined. The county agency must assist
the applicant in obtaining verification if necessary. On the
basis of information provided on the completed application, an
applicant who meets the following criteria shall be determined
eligible beginning in the month of application:
(1) has gross income less than 90 percent of the applicable
income standard;
(2) has liquid assets that total within $300 of the asset
standard;
(3) does not reside in a long-term care facility; and
(4) meets all other eligibility requirements.
The applicant must provide all required verifications within 30
days' notice of the eligibility determination or eligibility
shall be terminated.
(e) County agencies are authorized to use all automated
databases containing information regarding recipients' or
applicants' income in order to determine eligibility for general
assistance medical care or MinnesotaCare. Such use shall be
considered sufficient in order to determine eligibility and
premium payments by the county agency.
(f) General assistance medical care is not available for a
person in a correctional facility unless the person is detained
by law for less than one year in a county correctional or
detention facility as a person accused or convicted of a crime,
or admitted as an inpatient to a hospital on a criminal hold
order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or
admitted on a criminal hold order and as long as the person
continues to meet other eligibility requirements of this
subdivision.
(g) General assistance medical care is not available for
applicants or recipients who do not cooperate with the county
agency to meet the requirements of medical assistance. General
assistance medical care is limited to payment of emergency
services only for applicants or recipients as described in
paragraph (b), whose MinnesotaCare coverage is denied or
terminated for nonpayment of premiums as required by sections
256L.06 and 256L.07.
(h) In determining the amount of assets of an individual,
there shall be included any asset or interest in an asset,
including an asset excluded under paragraph (a), that was given
away, sold, or disposed of for less than fair market value
within the 60 months preceding application for general
assistance medical care or during the period of eligibility.
Any transfer described in this paragraph shall be presumed to
have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes
convincing evidence to establish that the transaction was
exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair
market value at the time it was given away, sold, or disposed
of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility,
including partial months, shall be calculated by dividing the
uncompensated transfer amount by the average monthly per person
payment made by the medical assistance program to skilled
nursing facilities for the previous calendar year. The
individual shall remain ineligible until this fixed period has
expired. The period of ineligibility may exceed 30 months, and
a reapplication for benefits after 30 months from the date of
the transfer shall not result in eligibility unless and until
the period of ineligibility has expired. The period of
ineligibility begins in the month the transfer was reported to
the county agency, or if the transfer was not reported, the
month in which the county agency discovered the transfer,
whichever comes first. For applicants, the period of
ineligibility begins on the date of the first approved
application.
(i) When determining eligibility for any state benefits
under this subdivision, the income and resources of all
noncitizens shall be deemed to include their sponsor's income
and resources as defined in the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996, title IV, Public Law
Number 104-193, sections 421 and 422, and subsequently set out
in federal rules.
(j)(1) An undocumented noncitizen or a nonimmigrant is
ineligible for general assistance medical care other than
emergency services. For purposes of this subdivision, a
nonimmigrant is an individual in one or more of the classes
listed in United States Code, title 8, section 1101(a)(15), and
an undocumented noncitizen is an individual who resides in the
United States without the approval or acquiescence of the
Immigration and Naturalization Service.
(2) This paragraph does not apply to a child under age 18,
to a Cuban or Haitian entrant as defined in Public Law Number
96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is
aged, blind, or disabled as defined in Code of Federal
Regulations, title 42, sections 435.520, 435.530, 435.531,
435.540, and 435.541, or effective October 1, 1998, to an
individual eligible for general assistance medical care under
paragraph (a), clause (4), who cooperates with the Immigration
and Naturalization Service to pursue any applicable immigration
status, including citizenship, that would qualify the individual
for medical assistance with federal financial participation.
(k) For purposes of paragraphs (g) and (j), "emergency
services" has the meaning given in Code of Federal Regulations,
title 42, section 440.255(b)(1), except that it also means
services rendered because of suspected or actual pesticide
poisoning.
(l) Notwithstanding any other provision of law, a
noncitizen who is ineligible for medical assistance due to the
deeming of a sponsor's income and resources, is ineligible for
general assistance medical care.
Sec. 16. Minnesota Statutes 2000, section 256L.15,
subdivision 1a, is amended to read:
Subd. 1a. [PAYMENT OPTIONS.] The commissioner may offer
the following payment options to an enrollee:
(1) payment by check;
(2) payment by credit card;
(3) payment by recurring automatic checking withdrawal;
(4) payment by one-time electronic transfer of funds;
(5) payment by wage withholding with the consent of the
employer and the employee; or
(6) payment by using state tax refund payments.
At application or reapplication, a MinnesotaCare applicant
or enrollee may authorize the commissioner to use the Revenue
Recapture Act in chapter 270A to collect funds from the
applicant's or enrollee's state income tax refund for the
purposes of meeting all or part of the applicant's or enrollee's
MinnesotaCare premium obligation for the forthcoming year. The
applicant or enrollee may authorize the commissioner to apply
for the state working family tax credit on behalf of the
applicant or enrollee. The setoff due under this subdivision
shall not be subject to the $10 fee under section 270A.07,
subdivision 1.
Sec. 17. Laws 1996, chapter 451, article 2, section 61, is
amended to read:
Sec. 61. [REPEALER.]
Minnesota Statutes 1995 Supplement, sections 256B.15,
subdivision 5; 256G.05, subdivision 1; and 256G.07, subdivision
3a, are repealed.
Sec. 18. Laws 1996, chapter 451, article 2, section 62, is
amended to read:
Sec. 62. [EFFECTIVE DATE; APPLICATION.]
(a) Sections 12, 14, 16, 18, 29, 30, and the portion of
section 61 that repeals section 256B.15, subdivision 5, are
effective the day following final enactment to the extent
permitted by federal law. If any provisions of these sections
are prohibited by federal law, the provisions shall become
effective when federal law is changed to permit their
application or a waiver is received. The commissioner of human
services shall notify the revisor of statutes when federal law
is enacted or a waiver is received and publish a notice in the
State Register. The commissioner must include the notice in the
first State Register published after the effective date of the
federal changes.
(b) If, by July 1, 1996, any provisions of the sections
mentioned in paragraph (a) are not effective because of
prohibitions in federal law, the commissioner shall apply to the
federal government for a waiver of those prohibitions, and those
provisions shall become effective upon receipt of a federal
waiver, notification to the revisor of statutes, and publication
of a notice in the State Register to that effect. If the
commissioner applies for a waiver of the lookback period, the
commissioner shall seek the longest lookback period the health
care financing administration will approve, not to exceed 72
months.
(c) Section 54 applies to estates of decedents dying on or
after its effective date. Section 55 applies to estates where
the notice under Minnesota Statutes, section 524.3-801,
paragraph (a), was first published on or after its effective
date. Section 55 does not affect any right or duty to provide
notice to known creditors, including a local agency, before its
effective date.
(d) (b) Sections 7, 13, 15, 17, 33, 34, 35, 38, and 60 are
effective the day following final enactment.
(e) (c) Section 11 is effective retroactive to October 1, 1993.
(f) (d) Sections 8, 22, subdivision 3, and 34 are effective
upon federal approval.
(g) (e) Sections 10 and 31 are effective upon receipt of
federal approval, retroactive to January 1, 1996.
Sec. 19. [REPEALER.]
(a) Laws 1995, chapter 178, article 2, section 46,
subdivision 10; and Laws 1996, chapter 451, article 2, sections
12, 14, 16, 18, 29, and 30, are repealed.
(b) Minnesota Statutes 2000, section 256B.071, subdivision
5, is repealed.
Presented to the governor May 25, 2001
Signed by the governor May 29, 2001, 11:23 a.m.
Official Publication of the State of Minnesota
Revisor of Statutes