Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 2002, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 277-S.F.No. 3126
An act relating to human services; making technical
changes in health care programs; amending Minnesota
Statutes 2000, sections 13.05, subdivision 4;
245.4932, subdivision 3; 253B.045, subdivision 2;
256.01, subdivision 11; 256.023; 256.9685, subdivision
1; 256.9866; 256B.041, subdivision 5; 256B.0575;
256B.0625, subdivision 27; 256B.0629, subdivision 2;
256B.0915, subdivision 1c; 256B.0945, subdivision 4;
256B.19, subdivisions 1, 1d, 2b; 256B.37, subdivision
5a; 256B.692, subdivision 3; 256F.10, subdivision 9;
256F.13, subdivision 1; 256L.05, subdivision 3;
256L.07, subdivision 3; Minnesota Statutes 2001
Supplement, sections 245.474, subdivision 4;
256B.0623, subdivision 14; 256B.0625, subdivisions 13,
20; 256B.0915, subdivision 3; 256B.0924, subdivision
6; 256B.19, subdivision 1c; 256L.06, subdivision 3;
Laws 2001, First Special Session chapter 9, article 2,
section 76; repealing Minnesota Statutes 2000,
sections 256.025; 256B.0635, subdivision 3; 256B.19,
subdivision 1a; 256B.77, subdivision 24.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2000, section 13.05,
subdivision 4, is amended to read:
Subd. 4. [LIMITATIONS ON COLLECTION AND USE OF DATA.]
Private or confidential data on an individual shall not be
collected, stored, used, or disseminated by political
subdivisions, statewide systems, or state agencies for any
purposes other than those stated to the individual at the time
of collection in accordance with section 13.04, except as
provided in this subdivision.
(a) Data collected prior to August 1, 1975, and which have
not been treated as public data, may be used, stored, and
disseminated for the purposes for which the data was originally
collected or for purposes which are specifically approved by the
commissioner as necessary to public health, safety, or welfare.
(b) Private or confidential data may be used and
disseminated to individuals or agencies specifically authorized
access to that data by state, local, or federal law enacted or
promulgated after the collection of the data.
(c) Private or confidential data may be used and
disseminated to individuals or agencies subsequent to the
collection of the data when the responsible authority
maintaining the data has requested approval for a new or
different use or dissemination of the data and that request has
been specifically approved by the commissioner as necessary to
carry out a function assigned by law.
(d) Private data may be used by and disseminated to any
person or agency if the individual subject or subjects of the
data have given their informed consent. Whether a data subject
has given informed consent shall be determined by rules of the
commissioner. The format for informed consent is as follows,
unless otherwise prescribed by the HIPAA, Standards for Privacy
of Individually Identifiable Health Information, 65 Fed. Reg.
82, 461 (2000) (to be codified as Code of Federal Regulations,
title 45, section 164): informed consent shall not be deemed to
have been given by an individual subject of the data by the
signing of any statement authorizing any person or agency to
disclose information about the individual to an insurer or its
authorized representative, unless the statement is:
(1) in plain language;
(2) dated;
(3) specific in designating the particular persons or
agencies the data subject is authorizing to disclose information
about the data subject;
(4) specific as to the nature of the information the
subject is authorizing to be disclosed;
(5) specific as to the persons or agencies to whom the
subject is authorizing information to be disclosed;
(6) specific as to the purpose or purposes for which the
information may be used by any of the parties named in clause
(5), both at the time of the disclosure and at any time in the
future;
(7) specific as to its expiration date which should be
within a reasonable period of time, not to exceed one year
except in the case of authorizations given in connection with
applications for life insurance or noncancelable or guaranteed
renewable health insurance and identified as such, two years
after the date of the policy.
The responsible authority may require a person requesting
copies of data under this paragraph to pay the actual costs of
making, certifying, and compiling the copies.
(e) Private or confidential data on an individual may be
discussed at a meeting open to the public to the extent provided
in section 13D.05.
Sec. 2. Minnesota Statutes 2001 Supplement, section
245.474, subdivision 4, is amended to read:
Subd. 4. [STAFF SAFETY TRAINING.] The commissioner
shall by rule require all staff in mental health and support
units at regional treatment centers who have contact with
persons with mental illness or severe emotional disturbance to
be appropriately trained in violence reduction and violence
prevention and shall establish criteria for such training.
Training programs shall be developed with input from consumer
advocacy organizations and shall employ violence prevention
techniques as preferable to physical interaction.
Sec. 3. Minnesota Statutes 2000, section 245.4932,
subdivision 3, is amended to read:
Subd. 3. [PAYMENTS.] Notwithstanding section 256.025,
subdivision 2, Payments under sections 245.493 to 245.496 to
providers for services for which the collaborative elects to pay
the nonfederal share of medical assistance shall only be made of
federal earnings from services provided under sections 245.493
to 245.496.
Sec. 4. Minnesota Statutes 2000, section 253B.045,
subdivision 2, is amended to read:
Subd. 2. [FACILITIES.] Each county or a group of counties
shall maintain or provide by contract a facility for confinement
of persons held temporarily for observation, evaluation,
diagnosis, treatment, and care. When the temporary confinement
is provided at a regional center, the commissioner shall charge
the county of financial responsibility for the costs of
confinement of persons hospitalized under section 253B.05,
subdivisions 1 and 2, and section 253B.07, subdivision 2b,
except that the commissioner shall bill the responsible prepaid
plan for medically necessary hospitalizations for individuals
enrolled in a prepaid plan under contract to provide medical
assistance, general assistance medical care, or MinnesotaCare
services. If the prepaid plan determines under the terms of the
medical assistance, general assistance medical care, or
MinnesotaCare contract that a hospitalization was not medically
necessary health plan first. If the person has health plan
coverage, but the hospitalization does not meet the criteria in
subdivision 6 or section 62M.07, 62Q.53, or 62Q.535, the county
is responsible. "County of financial responsibility" means the
county in which the person resides at the time of confinement
or, if the person has no residence in this state, the county
which initiated the confinement. The charge shall be based on
the commissioner's determination of the cost of care pursuant to
section 246.50, subdivision 5. When there is a dispute as to
which county is the county of financial responsibility, the
county charged for the costs of confinement shall pay for them
pending final determination of the dispute over financial
responsibility. Disputes about the county of financial
responsibility shall be submitted to the commissioner to be
settled in the manner prescribed in section 256G.09.
Sec. 5. Minnesota Statutes 2000, section 256.01,
subdivision 11, is amended to read:
Subd. 11. [CENTRALIZED DISBURSEMENT SYSTEM.] The state
agency may establish a system for the centralized disbursement
of food coupons, assistance payments, and related documents.
Benefits shall be issued by the state or county and funded under
this section according to section 256.025, subdivision 3, and
subject to section 256.017.
Sec. 6. Minnesota Statutes 2000, section 256.023, is
amended to read:
256.023 [ONE HUNDRED PERCENT COUNTY ASSISTANCE.]
The commissioner of human services may maintain client
records and issue public assistance benefits that are over state
and federal standards or that are not required by state or
federal law, providing the cost of benefits is paid by the
counties to the department of human services. Payment methods
for this section shall be according to section 256.025,
subdivision 3.
Sec. 7. Minnesota Statutes 2000, section 256.9685,
subdivision 1, is amended to read:
Subdivision 1. [AUTHORITY.] (a) The commissioner shall
establish procedures for determining medical assistance and
general assistance medical care payment rates under a
prospective payment system for inpatient hospital services in
hospitals that qualify as vendors of medical assistance. The
commissioner shall establish, by rule, procedures for
implementing this section and sections 256.9686, 256.969, and
256.9695. Services must meet the requirements of section
256B.04, subdivision 15, or 256D.03, subdivision 7, paragraph
(b), to be eligible for payment.
(b) The commissioner may reduce the types of inpatient
hospital admissions that are required to be certified as
medically necessary after notice in the State Register and a
30-day comment period.
Sec. 8. Minnesota Statutes 2000, section 256.9866, is
amended to read:
256.9866 [COMMUNITY SERVICE AS A COUNTY OBLIGATION.]
Community service shall be an acceptable sentencing option
but shall not reduce the state or federal share of any amount to
be repaid or any subsequent recovery. Any reduction or offset
of any such amount ordered by a court shall be treated as
follows:
(1) any reduction in an overpayment amount, to include the
amount ordered as restitution, shall not reduce the underlying
amount established as an overpayment by the state or county
agency;
(2) total overpayments shall continue as a debt owed and
may be recovered by any civil or administrative means otherwise
available to the state or county agency; and
(3) any amount ordered to be offset against any overpayment
shall be deducted from the county share only of any recovery and
shall be based on the prevailing state minimum wage. To the
extent that any deduction is in fact made against any state or
county share, it shall be reimbursed from the county share of
payments to be made under section 256.025.
Sec. 9. Minnesota Statutes 2000, section 256B.041,
subdivision 5, is amended to read:
Subd. 5. [PAYMENT BY COUNTY TO STATE TREASURER.] If
required by federal law or rules promulgated thereunder, or by
authorized rule of the state agency, each county shall pay to
the state treasurer the portion of medical assistance paid by
the state for which it is responsible. The county's share of
cost shall be ten percent of that portion not met by federal
funds.
The county shall advance ten percent of that portion of
medical assistance costs not met by federal funds, based upon
estimates submitted by the state agency to the county agency,
stating the estimated expenditures for the succeeding month.
Upon the direction of the county agency, payment shall be made
monthly by the county to the state for the estimated
expenditures for each month. Adjustment of any overestimate or
underestimate based on actual expenditures shall be made by the
state agency by adjusting the estimate for any succeeding month.
Beginning July 1, 1991, the state will reimburse counties
according to the payment schedule in section 256.025 for the
county share of local agency expenditures under this subdivision
from January 1, 1991, on. Payment to counties under this
subdivision is subject to the provisions of section 256.017.
Sec. 10. Minnesota Statutes 2000, section 256B.0575, is
amended to read:
256B.0575 [AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
PERSONS.]
When an institutionalized person is determined eligible for
medical assistance, the income that exceeds the deductions in
paragraphs (a) and (b) must be applied to the cost of
institutional care.
(a) The following amounts must be deducted from the
institutionalized person's income in the following order:
(1) the personal needs allowance under section 256B.35 or,
for a veteran who does not have a spouse or child, or a
surviving spouse of a veteran having no child, the amount of an
improved pension received from the veteran's administration not
exceeding $90 per month;
(2) the personal allowance for disabled individuals under
section 256B.36;
(3) if the institutionalized person has a legally appointed
guardian or conservator, five percent of the recipient's gross
monthly income up to $100 as reimbursement for guardianship or
conservatorship services;
(4) a monthly income allowance determined under section
256B.058, subdivision 2, but only to the extent income of the
institutionalized spouse is made available to the community
spouse;
(5) a monthly allowance for children under age 18 which,
together with the net income of the children, would provide
income equal to the medical assistance standard for families and
children according to section 256B.056, subdivision 4, for a
family size that includes only the minor children. This
deduction applies only if the children do not live with the
community spouse and only to the extent that the deduction is
not included in the personal needs allowance under section
256B.35, subdivision 1, as child support garnished under a court
order;
(6) a monthly family allowance for other family members,
equal to one-third of the difference between 122 percent of the
federal poverty guidelines and the monthly income for that
family member;
(7) reparations payments made by the Federal Republic of
Germany and reparations payments made by the Netherlands for
victims of Nazi persecution between 1940 and 1945;
(8) all other exclusions from income for institutionalized
persons as mandated by federal law; and
(9) amounts for reasonable expenses incurred for necessary
medical or remedial care for the institutionalized spouse person
that are not medical assistance covered expenses and that are
not subject to payment by a third party.
For purposes of clause (6), "other family member" means a
person who resides with the community spouse and who is a minor
or dependent child, dependent parent, or dependent sibling of
either spouse. "Dependent" means a person who could be claimed
as a dependent for federal income tax purposes under the
Internal Revenue Code.
(b) Income shall be allocated to an institutionalized
person for a period of up to three calendar months, in an amount
equal to the medical assistance standard for a family size of
one if:
(1) a physician certifies that the person is expected to
reside in the long-term care facility for three calendar months
or less;
(2) if the person has expenses of maintaining a residence
in the community; and
(3) if one of the following circumstances apply:
(i) the person was not living together with a spouse or a
family member as defined in paragraph (a) when the person
entered a long-term care facility; or
(ii) the person and the person's spouse become
institutionalized on the same date, in which case the allocation
shall be applied to the income of one of the spouses.
For purposes of this paragraph, a person is determined to be
residing in a licensed nursing home, regional treatment center,
or medical institution if the person is expected to remain for a
period of one full calendar month or more.
Sec. 11. Minnesota Statutes 2001 Supplement, section
256B.0623, subdivision 14, is amended to read:
Subd. 14. [BILLING WHEN SERVICES ARE PROVIDED BY QUALIFIED
STATE STAFF.] When rehabilitative services are provided by
qualified state staff who are assigned to pilot projects under
section 245.4661, the county or other local entity to which the
qualified state staff are assigned may consider these staff part
of the local provider entity for which certification is sought
under this section and may bill the medical assistance program
for qualifying services provided by the qualified state
staff. Notwithstanding section 256.025, subdivision 2, Payments
for services provided by state staff who are assigned to adult
mental health initiatives shall only be made from federal funds.
Sec. 12. Minnesota Statutes 2001 Supplement, section
256B.0625, subdivision 13, is amended to read:
Subd. 13. [DRUGS.] (a) Medical assistance covers drugs,
except for fertility drugs when specifically used to enhance
fertility, if prescribed by a licensed practitioner and
dispensed by a licensed pharmacist, by a physician enrolled in
the medical assistance program as a dispensing physician, or by
a physician or a nurse practitioner employed by or under
contract with a community health board as defined in section
145A.02, subdivision 5, for the purposes of communicable disease
control. The commissioner, after receiving recommendations from
professional medical associations and professional pharmacist
associations, shall designate a formulary committee to advise
the commissioner on the names of drugs for which payment is
made, recommend a system for reimbursing providers on a set fee
or charge basis rather than the present system, and develop
methods encouraging use of generic drugs when they are less
expensive and equally effective as trademark drugs. The
formulary committee shall consist of nine members, four of whom
shall be physicians who are not employed by the department of
human services, and a majority of whose practice is for persons
paying privately or through health insurance, three of whom
shall be pharmacists who are not employed by the department of
human services, and a majority of whose practice is for persons
paying privately or through health insurance, a consumer
representative, and a nursing home representative. Committee
members shall serve three-year terms and shall serve without
compensation. Members may be reappointed once.
(b) The commissioner shall establish a drug formulary. Its
establishment and publication shall not be subject to the
requirements of the Administrative Procedure Act, but the
formulary committee shall review and comment on the formulary
contents. The formulary committee shall review and recommend
drugs which require prior authorization. The formulary
committee may recommend drugs for prior authorization directly
to the commissioner, as long as opportunity for public input is
provided. Prior authorization may be requested by the
commissioner based on medical and clinical criteria before
certain drugs are eligible for payment. Before a drug may be
considered for prior authorization at the request of the
commissioner:
(1) the drug formulary committee must develop criteria to
be used for identifying drugs; the development of these criteria
is not subject to the requirements of chapter 14, but the
formulary committee shall provide opportunity for public input
in developing criteria;
(2) the drug formulary committee must hold a public forum
and receive public comment for an additional 15 days; and
(3) the commissioner must provide information to the
formulary committee on the impact that placing the drug on prior
authorization will have on the quality of patient care and
information regarding whether the drug is subject to clinical
abuse or misuse. Prior authorization may be required by the
commissioner before certain formulary drugs are eligible for
payment. The formulary shall not include:
(i) drugs or products for which there is no federal
funding;
(ii) over-the-counter drugs, except for antacids,
acetaminophen, family planning products, aspirin, insulin,
products for the treatment of lice, vitamins for adults with
documented vitamin deficiencies, vitamins for children under the
age of seven and pregnant or nursing women, and any other
over-the-counter drug identified by the commissioner, in
consultation with the drug formulary committee, as necessary,
appropriate, and cost-effective for the treatment of certain
specified chronic diseases, conditions or disorders, and this
determination shall not be subject to the requirements of
chapter 14;
(iii) anorectics, except that medically necessary
anorectics shall be covered for a recipient previously diagnosed
as having pickwickian syndrome and currently diagnosed as having
diabetes and being morbidly obese;
(iv) drugs for which medical value has not been
established; and
(v) drugs from manufacturers who have not signed a rebate
agreement with the Department of Health and Human Services
pursuant to section 1927 of title XIX of the Social Security Act.
The commissioner shall publish conditions for prohibiting
payment for specific drugs after considering the formulary
committee's recommendations. An honorarium of $100 per meeting
and reimbursement for mileage shall be paid to each committee
member in attendance.
(c) 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
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. The actual acquisition cost of
a drug shall be estimated by the commissioner, at average
wholesale price minus nine percent, except that where a drug has
had its wholesale price reduced as a result of the actions of
the National Association of Medicaid Fraud Control Units, the
estimated actual acquisition cost shall be the reduced average
wholesale price, without the nine percent deduction. 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. The
commissioner shall set maximum allowable costs for multisource
drugs that are not on the federal upper limit list as described
in United States Code, title 42, chapter 7, section 1396r-8(e),
the Social Security Act, and Code of Federal Regulations, title
42, part 447, section 447.332. Establishment of the amount of
payment for drugs shall not be subject to the requirements of
the Administrative Procedure Act. 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.
Whenever a generically equivalent product is available, payment
shall be on the basis of the actual acquisition cost of the
generic drug, unless the prescriber specifically indicates
"dispense as written - brand necessary" on the prescription as
required by section 151.21, subdivision 2.
(d) For purposes of this subdivision, "multisource drugs"
means covered outpatient drugs, excluding innovator multisource
drugs for which there are two or more drug products, which:
(1) are related as therapeutically equivalent under the
Food and Drug Administration's most recent publication of
"Approved Drug Products with Therapeutic Equivalence
Evaluations";
(2) are pharmaceutically equivalent and bioequivalent as
determined by the Food and Drug Administration; and
(3) are sold or marketed in Minnesota.
"Innovator multisource drug" means a multisource drug that was
originally marketed under an original new drug application
approved by the Food and Drug Administration.
(e) 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; the
average wholesale price minus five percent; or the maximum
allowable cost set by the federal government under United States
Code, title 42, chapter 7, section 1396r-8(e), and Code of
Federal Regulations, title 42, section 447.332, or by the
commissioner under paragraph (c).
Sec. 13. Minnesota Statutes 2001 Supplement, section
256B.0625, subdivision 20, is amended to read:
Subd. 20. [MENTAL HEALTH CASE MANAGEMENT.] (a) To the
extent authorized by rule of the state agency, medical
assistance covers case management services to persons with
serious and persistent mental illness and children with severe
emotional disturbance. Services provided under this section
must meet the relevant standards in sections 245.461 to
245.4888, the Comprehensive Adult and Children's Mental Health
Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and
9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules
governing family community support services as defined in
section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for
children with severe emotional disturbance when these services
meet the program standards in Minnesota Rules, parts 9520.0900
to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental
health case management shall be made on a monthly basis. In
order to receive payment for an eligible child, the provider
must document at least a face-to-face contact with the child,
the child's parents, or the child's legal representative. To
receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the
adult's legal representative; or
(2) at least a telephone contact with the adult or the
adult's legal representative and document a face-to-face contact
with the adult or the adult's legal representative within the
preceding two months.
(d) Payment for mental health case management provided by
county or state staff shall be based on the monthly rate
methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental
health, and within mental health, separate rates for children
and adults.
(e) Payment for mental health case management provided by
Indian health services or by agencies operated by Indian tribes
may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by
vendors who contract with a county or Indian tribe shall be
based on a monthly rate negotiated by the host county or tribe.
The negotiated rate must not exceed the rate charged by the
vendor for the same service to other payers. If the service is
provided by a team of contracted vendors, the county or tribe
may negotiate a team rate with a vendor who is a member of the
team. The team shall determine how to distribute the rate among
its members. No reimbursement received by contracted vendors
shall be returned to the county or tribe, except to reimburse
the county or tribe for advance funding provided by the county
or tribe to the vendor.
(g) If the service is provided by a team which includes
contracted vendors, tribal staff, and county or state staff, the
costs for county or state staff participation in the team shall
be included in the rate for county-provided services. In this
case, the contracted vendor, the tribal agency, and the county
may each receive separate payment for services provided by each
entity in the same month. In order to prevent duplication of
services, each entity must document, in the recipient's file,
the need for team case management and a description of the roles
of the team members.
(h) The commissioner shall calculate the nonfederal share
of actual medical assistance and general assistance medical care
payments for each county, based on the higher of calendar year
1995 or 1996, by service date, project that amount forward to
1999, and transfer one-half of the result from medical
assistance and general assistance medical care to each county's
mental health grants under sections 245.4886 and 256E.12 for
calendar year 1999. The annualized minimum amount added to each
county's mental health grant shall be $3,000 per year for
children and $5,000 per year for adults. The commissioner may
reduce the statewide growth factor in order to fund these
minimums. The annualized total amount transferred shall become
part of the base for future mental health grants for each county.
(i) Any net increase in revenue to the county or tribe as a
result of the change in this section must be used to provide
expanded mental health services as defined in sections 245.461
to 245.4888, the Comprehensive Adult and Children's Mental
Health Acts, excluding inpatient and residential treatment. For
adults, increased revenue may also be used for services and
consumer supports which are part of adult mental health projects
approved under Laws 1997, chapter 203, article 7, section 25.
For children, increased revenue may also be used for respite
care and nonresidential individualized rehabilitation services
as defined in section 245.492, subdivisions 17 and 23.
"Increased revenue" has the meaning given in Minnesota Rules,
part 9520.0903, subpart 3.
(j) Notwithstanding section 256B.19, subdivision 1, the
nonfederal share of costs for mental health case management
shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other
than federal funds or funds used to match other federal funds.
If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe.
(k) The commissioner may suspend, reduce, or terminate the
reimbursement to a provider that does not meet the reporting or
other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or,
if applicable, the tribal agency, is responsible for any federal
disallowances. The county or tribe may share this
responsibility with its contracted vendors.
(l) The commissioner shall set aside a portion of the
federal funds earned under this section to repay the special
revenue maximization account under section 256.01, subdivision
2, clause (15). The repayment is limited to:
(1) the costs of developing and implementing this section;
and
(2) programming the information systems.
(m) Notwithstanding section 256.025, subdivision 2,
Payments to counties and tribal agencies for case management
expenditures under this section shall only be made from federal
earnings from services provided under this section. Payments to
county-contracted vendors shall include both the federal
earnings and the county share.
(n) Notwithstanding section 256B.041, county payments for
the cost of mental health case management services provided by
county or state staff shall not be made to the state treasurer.
For the purposes of mental health case management services
provided by county or state staff under this section, the
centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services
provided under this section.
(o) Case management services under this subdivision do not
include therapy, treatment, legal, or outreach services.
(p) If the recipient is a resident of a nursing facility,
intermediate care facility, or hospital, and the recipient's
institutional care is paid by medical assistance, payment for
case management services under this subdivision is limited to
the last 180 days of the recipient's residency in that facility
and may not exceed more than six months in a calendar year.
(q) Payment for case management services under this
subdivision shall not duplicate payments made under other
program authorities for the same purpose.
(r) By July 1, 2000, the commissioner shall evaluate the
effectiveness of the changes required by this section, including
changes in number of persons receiving mental health case
management, changes in hours of service per person, and changes
in caseload size.
(s) For each calendar year beginning with the calendar year
2001, the annualized amount of state funds for each county
determined under paragraph (h) shall be adjusted by the county's
percentage change in the average number of clients per month who
received case management under this section during the fiscal
year that ended six months prior to the calendar year in
question, in comparison to the prior fiscal year.
(t) For counties receiving the minimum allocation of $3,000
or $5,000 described in paragraph (h), the adjustment in
paragraph (s) shall be determined so that the county receives
the higher of the following amounts:
(1) a continuation of the minimum allocation in paragraph
(h); or
(2) an amount based on that county's average number of
clients per month who received case management under this
section during the fiscal year that ended six months prior to
the calendar year in question, times the average statewide grant
per person per month for counties not receiving the minimum
allocation.
(u) The adjustments in paragraphs (s) and (t) shall be
calculated separately for children and adults.
Sec. 14. Minnesota Statutes 2000, section 256B.0625,
subdivision 27, is amended to read:
Subd. 27. [ORGAN AND TISSUE TRANSPLANTS.] Medical
assistance coverage for organ and tissue transplant procedures
is limited to those procedures covered by the Medicare program;
heart-lung transplants for persons with primary pulmonary
hypertension and or approved by the Advisory Committee on Organ
and Tissue Transplants. All organ transplants must be performed
at Minnesota transplant centers meeting united network for organ
sharing criteria to perform heart-lung transplants; lung
transplants using cadaveric donors and performed at Minnesota
transplant centers meeting united network for organ sharing
criteria to perform lung transplants; pancreas transplants for
uremic diabetic recipients of kidney transplants and performed
at Minnesota facilities meeting united network for organ sharing
criteria to perform pancreas transplants; and allogenic bone
marrow transplants for persons with stage III or IV Hodgkin's
disease or at Medicare-approved organ transplant centers. Stem
cell or bone marrow transplant centers must meet the standards
established by the Foundation for the Accreditation of
Hematopoietic Cell Therapy or be approved by the Advisory
Committee on Organ and Tissue Transplants. Transplant
procedures must comply with all applicable laws, rules, and
regulations governing (1) coverage by the Medicare program, (2)
federal financial participation by the Medicaid program, and (3)
coverage by the Minnesota medical assistance
program. Transplant centers must meet american society of
hematology and clinical oncology criteria for bone marrow
transplants and be located in Minnesota to receive reimbursement
for bone marrow Transplants performed out of Minnesota or the
local trade area must be prior authorized.
Sec. 15. Minnesota Statutes 2000, section 256B.0629,
subdivision 2, is amended to read:
Subd. 2. [FUNCTION AND OBJECTIVES.] The advisory committee
shall meet at least twice a year. The committee's activities
include, but are not limited to:
(1) collection of information on the efficacy and
experience of various forms of transplantation not approved by
Medicare;
(2) collection of information from Minnesota transplant
providers on available services, success rates, and the current
status of transplant activity in the state;
(3) development of guidelines for determining when and
under what conditions organ and tissue transplants not approved
by Medicare should be eligible for reimbursement by medical
assistance and general assistance medical care;
(4) providing recommendations, at least annually, to the
commissioner on: (i) organ and tissue transplant procedures,
beyond those approved by Medicare, that should also be eligible
for reimbursement under medical assistance and general
assistance medical care; and (ii) which transplant centers
should be eligible for reimbursement from medical assistance and
general assistance medical care.
Sec. 16. Minnesota Statutes 2000, section 256B.0915,
subdivision 1c, is amended to read:
Subd. 1c. [CASE MANAGEMENT ACTIVITIES UNDER THE STATE
PLAN.] The commissioner shall seek an amendment to the home and
community-based services waiver for the elderly to implement the
provisions of subdivisions 1a and 1b. If the commissioner is
unable to secure the approval of the secretary of health and
human services for the requested waiver amendment by December
31, 1993, the commissioner shall amend the medical assistance
state plan to provide that case management provided under the
home and community-based services waiver for the elderly is
performed by counties as an administrative function for the
proper and effective administration of the state medical
assistance plan. Notwithstanding section 256.025, subdivision
3, The state shall reimburse counties for the nonfederal share
of costs for case management performed as an administrative
function under the home and community-based services waiver for
the elderly.
Sec. 17. Minnesota Statutes 2001 Supplement, section
256B.0915, subdivision 3, is amended to read:
Subd. 3. [LIMITS OF CASES, RATES, PAYMENTS, AND
FORECASTING.] (a) The number of medical assistance waiver
recipients that a county may serve must be allocated according
to the number of medical assistance waiver cases open on July 1
of each fiscal year. Additional recipients may be served with
the approval of the commissioner.
(b) The monthly limit for the cost of waivered services to
an individual elderly waiver client 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.437 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.437 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 cost-of-living percentage increase or
any legislatively adopted statewide percent rate increase for
nursing facilities.
(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 (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
(b).
(d) 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 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.437 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.437 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.437 for that resident in the nursing
facility where the resident currently resides multiplied by 365
and divided by 12, less the recipient's maintenance needs
allowance as described in subdivision 1d. The limit under this
clause 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. 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 supplies and equipment and environmental modifications;
and
(2) cost of skilled nursing, home health aide, and personal
care services reimbursable by medical assistance.
(e) Medical assistance funding for skilled nursing
services, private duty nursing, home health aide, and personal
care services for waiver recipients must be approved by the case
manager and included in the individual care plan.
(f) A county is not required to contract with a provider of
supplies and equipment if the monthly cost of the supplies and
equipment is less than $250.
(g) The adult foster care rate shall be considered a
difficulty of care payment and shall not include room and
board. The adult foster care service rate shall be negotiated
between the county agency and the foster care provider. The
elderly waiver payment for the foster care service in
combination with the payment for all other elderly waiver
services, including case management, must not exceed the limit
specified in paragraph (b).
(h) Payment for assisted living service shall be a monthly
rate negotiated and authorized by the county agency based on an
individualized service plan for each resident and may not cover
direct rent or food costs.
(1) The individualized monthly negotiated payment for
assisted living services as described in section 256B.0913,
subdivision 5, paragraph (g) or (h), and residential care
services as described in section 256B.0913, subdivision 5,
paragraph (f), shall not exceed the nonfederal share, in effect
on July 1 of the state fiscal year for which the rate limit is
being calculated, of the greater of either the statewide or any
of the geographic groups' weighted average monthly nursing
facility rate of the case mix resident class to which the
elderly waiver eligible client would be assigned under Minnesota
Rules, parts 9549.0050 to 9549.0059, less the maintenance needs
allowance as described in subdivision 1d, paragraph (a), until
the July 1 of the state fiscal year in which the resident
assessment system as described in section 256B.437 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.437 for nursing home rate
determination is implemented and July 1 of each subsequent state
fiscal year, the individualized monthly negotiated payment for
the services described in this clause shall not exceed the limit
described in this clause which was in effect on June 30 of the
previous state fiscal year and which has been adjusted by the
greater of any legislatively adopted home and community-based
services cost-of-living percentage increase or any legislatively
adopted statewide percent rate increase for nursing facilities.
(2) The individualized monthly negotiated payment for
assisted living services described in section 144A.4605 and
delivered by a provider licensed by the department of health as
a class A home care provider or an assisted living home care
provider and provided in a building that is registered as a
housing with services establishment under chapter 144D and that
provides 24-hour supervision in combination with the payment for
other elderly waiver services, including case management, must
not exceed the limit specified in paragraph (b).
(i) The county shall negotiate individual service rates
with vendors and may authorize payment for actual costs up to
the county's current approved rate. Persons or agencies must be
employed by or under a contract with the county agency or the
public health nursing agency of the local board of health in
order to receive funding under the elderly waiver program,
except as a provider of supplies and equipment when the monthly
cost of the supplies and equipment is less than $250.
(j) Reimbursement for the medical assistance recipients
under the approved waiver shall be made from the medical
assistance account through the invoice processing procedures of
the department's Medicaid Management Information System (MMIS),
only with the approval of the client's case manager. The budget
for the state share of the Medicaid expenditures shall be
forecasted with the medical assistance budget, and shall be
consistent with the approved waiver.
(k) To improve access to community services and eliminate
payment disparities between the alternative care program and the
elderly waiver, the commissioner shall establish statewide
maximum service rate limits and eliminate county-specific
service rate limits.
(1) Effective July 1, 2001, for service rate limits, except
those described or defined in paragraphs (g) and (h), the rate
limit for each service shall be the greater of the alternative
care statewide maximum rate or the elderly waiver statewide
maximum rate.
(2) Counties may negotiate individual service rates with
vendors for actual costs up to the statewide maximum service
rate limit.
(l) Beginning July 1, 1991, the state shall reimburse
counties according to the payment schedule in section 256.025
for the county share of costs incurred under this subdivision on
or after January 1, 1991, for individuals who are receiving
medical assistance.
Sec. 18. Minnesota Statutes 2001 Supplement, section
256B.0924, subdivision 6, is amended to read:
Subd. 6. [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a)
Medical assistance and MinnesotaCare payment for targeted case
management shall be made on a monthly basis. In order to
receive payment for an eligible adult, the provider must
document at least one contact per month and not more than two
consecutive months without a face-to-face contact with the adult
or the adult's legal representative.
(b) Payment for targeted case management provided by county
staff under this subdivision shall be based on the monthly rate
methodology under section 256B.094, subdivision 6, paragraph
(b), calculated as one combined average rate together with adult
mental health case management under section 256B.0625,
subdivision 20, except for calendar year 2002. In calendar year
2002, the rate for case management under this section shall be
the same as the rate for adult mental health case management in
effect as of December 31, 2001. Billing and payment must
identify the recipient's primary population group to allow
tracking of revenues.
(c) Payment for targeted case management provided by
county-contracted vendors shall be based on a monthly rate
negotiated by the host county. The negotiated rate must not
exceed the rate charged by the vendor for the same service to
other payers. If the service is provided by a team of
contracted vendors, the county may negotiate a team rate with a
vendor who is a member of the team. The team shall determine
how to distribute the rate among its members. No reimbursement
received by contracted vendors shall be returned to the county,
except to reimburse the county for advance funding provided by
the county to the vendor.
(d) If the service is provided by a team that includes
contracted vendors and county staff, the costs for county staff
participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor
and the county may each receive separate payment for services
provided by each entity in the same month. In order to prevent
duplication of services, the county must document, in the
recipient's file, the need for team targeted case management and
a description of the different roles of the team members.
(e) Notwithstanding section 256B.19, subdivision 1, the
nonfederal share of costs for targeted case management shall be
provided by the recipient's county of responsibility, as defined
in sections 256G.01 to 256G.12, from sources other than federal
funds or funds used to match other federal funds.
(f) The commissioner may suspend, reduce, or terminate
reimbursement to a provider that does not meet the reporting or
other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is
responsible for any federal disallowances. The county may share
this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the
federal funds received under this section for use in reimbursing
the state for costs of developing and implementing this section.
(h) Notwithstanding section 256.025, subdivision 2,
Payments to counties for targeted case management expenditures
under this section shall only be made from federal earnings from
services provided under this section. Payments to contracted
vendors shall include both the federal earnings and the county
share.
(i) Notwithstanding section 256B.041, county payments for
the cost of case management services provided by county staff
shall not be made to the state treasurer. For the purposes of
targeted case management services provided by county staff under
this section, the centralized disbursement of payments to
counties under section 256B.041 consists only of federal
earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility,
intermediate care facility, or hospital, and the recipient's
institutional care is paid by medical assistance, payment for
targeted case management services under this subdivision is
limited to the last 180 days of the recipient's residency in
that facility and may not exceed more than six months in a
calendar year.
(k) Payment for targeted case management services under
this subdivision shall not duplicate payments made under other
program authorities for the same purpose.
(l) Any growth in targeted case management services and
cost increases under this section shall be the responsibility of
the counties.
Sec. 19. Minnesota Statutes 2000, section 256B.0945,
subdivision 4, is amended to read:
Subd. 4. [PAYMENT RATES.] (a) Notwithstanding sections
256.025, subdivision 2; 256B.19; and 256B.041, payments to
counties for residential services provided by a residential
facility shall only be made of federal earnings for services
provided under this section, and the nonfederal share of costs
for services provided under this section shall be paid by the
county from sources other than federal funds or funds used to
match other federal funds. Payment to counties for services
provided according to subdivision 2, paragraph (a), shall be the
federal share of the contract rate. Payment to counties for
services provided according to subdivision 2, paragraph (b),
shall be a proportion of the per day contract rate that relates
to rehabilitative mental health services and shall not include
payment for costs or services that are billed to the IV-E
program as room and board.
(b) The commissioner shall set aside a portion not to
exceed five percent of the federal funds earned under this
section to cover the state costs of administering this section.
Any unexpended funds from the set-aside shall be distributed to
the counties in proportion to their earnings under this section.
Sec. 20. Minnesota Statutes 2000, section 256B.19,
subdivision 1, is amended to read:
Subdivision 1. [DIVISION OF COST.] The state and county
share of medical assistance costs not paid by federal funds
shall be as follows:
(1) ninety percent state funds and ten percent county
funds, unless otherwise provided below;
(2) beginning January 1, 1992, 50 percent state funds and
50 percent county funds for the cost of placement of severely
emotionally disturbed children in regional treatment centers.
For counties that participate in a Medicaid demonstration
project under sections 256B.69 and 256B.71, the division of the
nonfederal share of medical assistance expenses for payments
made to prepaid health plans or for payments made to health
maintenance organizations in the form of prepaid capitation
payments, this division of medical assistance expenses shall be
95 percent by the state and five percent by the county of
financial responsibility.
In counties where prepaid health plans are under contract
to the commissioner to provide services to medical assistance
recipients, the cost of court ordered treatment ordered without
consulting the prepaid health plan that does not include
diagnostic evaluation, recommendation, and referral for
treatment by the prepaid health plan is the responsibility of
the county of financial responsibility.
Sec. 21. Minnesota Statutes 2001 Supplement, section
256B.19, subdivision 1c, is amended to read:
Subd. 1c. [ADDITIONAL PORTION OF NONFEDERAL SHARE.] (a)
Hennepin county shall be responsible for a monthly transfer
payment of $1,500,000, due before noon on the 15th of each month
and the University of Minnesota shall be responsible for a
monthly transfer payment of $500,000 due before noon on the 15th
of each month, beginning July 15, 1995. These sums shall be
part of the designated governmental unit's portion of the
nonfederal share of medical assistance costs, but shall not be
subject to payback provisions of section 256.025.
(b) Beginning July 1, 2001, Hennepin county's payment under
paragraph (a) shall be $2,066,000 each month.
(c) Beginning July 1, 2001, the commissioner shall increase
annual capitation payments to the metropolitan health plan under
section 256B.69 for the prepaid medical assistance program by
approximately $3,400,000, plus any available federal matching
funds, to recognize higher than average medical education costs.
Sec. 22. Minnesota Statutes 2000, section 256B.19,
subdivision 1d, is amended to read:
Subd. 1d. [PORTION OF NONFEDERAL SHARE TO BE PAID BY
CERTAIN COUNTIES.] In addition to the percentage contribution
paid by a county under subdivision 1, the governmental units
designated in this subdivision shall be responsible for an
additional portion of the nonfederal share of medical assistance
cost. For purposes of this subdivision, "designated
governmental unit" means the counties of Becker, Beltrami,
Clearwater, Cook, Dodge, Hubbard, Itasca, Lake, Pennington,
Pipestone, Ramsey, St. Louis, Steele, Todd, Traverse, and Wadena.
Beginning in 1994, each of the governmental units
designated in this subdivision shall transfer before noon on May
31 to the state Medicaid agency an amount equal to the number of
licensed beds in any nursing home owned and operated by the
county, with the county named as licensee, multiplied by $5,723.
If two or more counties own and operate a nursing home, the
payment shall be prorated. These sums shall be part of the
designated governmental unit's portion of the nonfederal share
of medical assistance costs, but shall not be subject to payback
provisions of section 256.025.
Sec. 23. Minnesota Statutes 2000, section 256B.19,
subdivision 2b, is amended to read:
Subd. 2b. [PILOT PROJECT REIMBURSEMENT.] In counties where
a pilot or demonstration project is operated under the medical
assistance program, the state may pay 100 percent of the
administrative costs for the pilot or demonstration project
after June 30, 1990. Reimbursement for these costs is subject
to section 256.025.
Sec. 24. Minnesota Statutes 2000, section 256B.37,
subdivision 5a, is amended to read:
Subd. 5a. [SUPPLEMENTAL PAYMENT BY MEDICAL ASSISTANCE.]
Medical assistance payment will not be made when either covered
charges are paid in full by a third party or the provider has an
agreement to accept payment for less than charges as payment in
full. Payment for patients that are simultaneously covered by
medical assistance and a liable third party other than Medicare
will be determined as the lesser of clauses (1) to (3):
(1) the patient liability according to the provider/insurer
agreement;
(2) covered charges minus the third party payment amount;
or
(3) the medical assistance rate minus the third party
payment amount.
A negative difference will not be implemented.
All providers must reduce their submitted charge to medical
assistance programs to reflect all discount amounts applied to
the charge by any provider/insurer agreement or contract. The
net submitted charge may not be greater than the patient
liability for the service.
Sec. 25. Minnesota Statutes 2000, section 256B.692,
subdivision 3, is amended to read:
Subd. 3. [REQUIREMENTS OF THE COUNTY BOARD.] A county
board that intends to purchase or provide health care under this
section, which may include purchasing all or part of these
services from health plans or individual providers on a
fee-for-service basis, or providing these services directly,
must demonstrate the ability to follow and agree to the
following requirements:
(1) purchase all covered services for a fixed payment from
the state that does not exceed the estimated state and federal
cost that would have occurred under the prepaid medical
assistance and general assistance medical care programs;
(2) ensure that covered services are accessible to all
enrollees and that enrollees have a reasonable choice of
providers, health plans, or networks when possible. If the
county is also a provider of service, the county board shall
develop a process to ensure that providers employed by the
county are not the sole referral source and are not the sole
provider of health care services if other providers, which meet
the same quality and cost requirements are available;
(3) issue payments to participating vendors or networks in
a timely manner;
(4) establish a process to ensure and improve the quality
of care provided;
(5) provide appropriate quality and other required data in
a format required by the state;
(6) provide a system for advocacy, enrollee protection, and
complaints and appeals that is independent of care providers or
other risk bearers and complies with section 256B.69;
(7) for counties within the seven-county metropolitan area,
ensure that the implementation and operation of the Minnesota
senior health options demonstration project and the Minnesota
disability health options demonstration project, authorized
under section 256B.69, subdivision 23, will not be impeded;
(8) ensure that all recipients that are enrolled in the
prepaid medical assistance or general assistance medical care
program will be transferred to county-based purchasing without
utilizing the department's fee-for-service claims payment
system;
(9) ensure that all recipients who are required to
participate in county-based purchasing are given sufficient
information prior to enrollment in order to make informed
decisions; and
(10) ensure that the state and the medical assistance and
general assistance medical care recipients will be held harmless
for the payment of obligations incurred by the county if the
county, or a health plan providing services on behalf of the
county, or a provider participating in county-based purchasing
becomes insolvent, and the state has made the payments due to
the county under this section.
Sec. 26. Minnesota Statutes 2000, section 256F.10,
subdivision 9, is amended to read:
Subd. 9. [PAYMENTS.] Notwithstanding section 256.025,
subdivision 2, Payments to certified providers for child welfare
targeted case management expenditures under section 256B.094 and
this section shall only be made of federal earnings from
services provided under section 256B.094 and this section.
Payments to contracted vendors shall include both the federal
earnings and the nonfederal share.
Sec. 27. Minnesota Statutes 2000, section 256F.13,
subdivision 1, is amended to read:
Subdivision 1. [FEDERAL REVENUE ENHANCEMENT.] (a) [DUTIES
OF THE COMMISSIONER OF HUMAN SERVICES.] The commissioner of
human services may enter into an agreement with one or more
family services collaboratives to enhance federal reimbursement
under Title IV-E of the Social Security Act and federal
administrative reimbursement under Title XIX of the Social
Security Act. The commissioner may contract with the department
of children, families, and learning for purposes of transferring
the federal reimbursement to the commissioner of children,
families, and learning to be distributed to the collaboratives
according to clause (2). The commissioner shall have the
following authority and responsibilities regarding family
services collaboratives:
(1) the commissioner shall submit amendments to state plans
and seek waivers as necessary to implement the provisions of
this section;
(2) the commissioner shall pay the federal reimbursement
earned under this subdivision to each collaborative based on
their earnings. Notwithstanding section 256.025, subdivision 2,
Payments to collaboratives for expenditures under this
subdivision will only be made of federal earnings from services
provided by the collaborative;
(3) the commissioner shall review expenditures of family
services collaboratives using reports specified in the agreement
with the collaborative to ensure that the base level of
expenditures is continued and new federal reimbursement is used
to expand education, social, health, or health-related services
to young children and their families;
(4) the commissioner may reduce, suspend, or eliminate a
family services collaborative's obligations to continue the base
level of expenditures or expansion of services if the
commissioner determines that one or more of the following
conditions apply:
(i) imposition of levy limits that significantly reduce
available funds for social, health, or health-related services
to families and children;
(ii) reduction in the net tax capacity of the taxable
property eligible to be taxed by the lead county or
subcontractor that significantly reduces available funds for
education, social, health, or health-related services to
families and children;
(iii) reduction in the number of children under age 19 in
the county, collaborative service delivery area, subcontractor's
district, or catchment area when compared to the number in the
base year using the most recent data provided by the state
demographer's office; or
(iv) termination of the federal revenue earned under the
family services collaborative agreement;
(5) the commissioner shall not use the federal
reimbursement earned under this subdivision in determining the
allocation or distribution of other funds to counties or
collaboratives;
(6) the commissioner may suspend, reduce, or terminate the
federal reimbursement to a provider that does not meet the
reporting or other requirements of this subdivision;
(7) the commissioner shall recover from the family services
collaborative any federal fiscal disallowances or sanctions for
audit exceptions directly attributable to the family services
collaborative's actions in the integrated fund, or the
proportional share if federal fiscal disallowances or sanctions
are based on a statewide random sample; and
(8) the commissioner shall establish criteria for the
family services collaborative for the accounting and financial
management system that will support claims for federal
reimbursement.
(b) [FAMILY SERVICES COLLABORATIVE RESPONSIBILITIES.] The
family services collaborative shall have the following authority
and responsibilities regarding federal revenue enhancement:
(1) the family services collaborative shall be the party
with which the commissioner contracts. A lead county shall be
designated as the fiscal agency for reporting, claiming, and
receiving payments;
(2) the family services collaboratives may enter into
subcontracts with other counties, school districts, special
education cooperatives, municipalities, and other public and
nonprofit entities for purposes of identifying and claiming
eligible expenditures to enhance federal reimbursement, or to
expand education, social, health, or health-related services to
families and children;
(3) the family services collaborative must continue the
base level of expenditures for education, social, health, or
health-related services to families and children from any state,
county, federal, or other public or private funding source
which, in the absence of the new federal reimbursement earned
under this subdivision, would have been available for those
services, except as provided in subdivision 1, paragraph (a),
clause (4). The base year for purposes of this subdivision
shall be the four-quarter calendar year ending at least two
calendar quarters before the first calendar quarter in which the
new federal reimbursement is earned;
(4) the family services collaborative must use all new
federal reimbursement resulting from federal revenue enhancement
to expand expenditures for education, social, health, or
health-related services to families and children beyond the base
level, except as provided in subdivision 1, paragraph (a),
clause (4);
(5) the family services collaborative must ensure that
expenditures submitted for federal reimbursement are not made
from federal funds or funds used to match other federal funds.
Notwithstanding section 256B.19, subdivision 1, for the purposes
of family services collaborative expenditures under agreement
with the department, the nonfederal share of costs shall be
provided by the family services collaborative from sources other
than federal funds or funds used to match other federal funds;
(6) the family services collaborative must develop and
maintain an accounting and financial management system adequate
to support all claims for federal reimbursement, including a
clear audit trail and any provisions specified in the agreement;
and
(7) the family services collaborative shall submit an
annual report to the commissioner as specified in the agreement.
Sec. 28. Minnesota Statutes 2000, section 256L.05,
subdivision 3, is amended to read:
Subd. 3. [EFFECTIVE DATE OF COVERAGE.] (a) The effective
date of coverage is the first day of the month following the
month in which eligibility is approved and the first premium
payment has been received. As provided in section 256B.057,
coverage for newborns is automatic from the date of birth and
must be coordinated with other health coverage. The effective
date of coverage for eligible newly adoptive children added to a
family receiving covered health services is the date of entry
into the family. The effective date of coverage for other new
recipients added to the family receiving covered health services
is the first day of the month following the month in which
eligibility is approved or at renewal, whichever the family
receiving covered health services prefers. All eligibility
criteria must be met by the family at the time the new family
member is added. The income of the new family member is
included with the family's gross income and the adjusted premium
begins in the month the new family member is added.
(b) The initial premium must be received eight by the last
working days prior to the end day of the month for coverage to
begin the first day of the following month.
(c) Benefits are not available until the day following
discharge if an enrollee is hospitalized on the first day of
coverage.
(d) Notwithstanding any other law to the contrary, benefits
under sections 256L.01 to 256L.18 are secondary to a plan of
insurance or benefit program under which an eligible person may
have coverage and the commissioner shall use cost avoidance
techniques to ensure coordination of any other health coverage
for eligible persons. The commissioner shall identify eligible
persons who may have coverage or benefits under other plans of
insurance or who become eligible for medical assistance.
Sec. 29. Minnesota Statutes 2001 Supplement, section
256L.06, subdivision 3, is amended to read:
Subd. 3. [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a)
Premiums are dedicated to the commissioner for MinnesotaCare.
(b) The commissioner shall develop and implement procedures
to: (1) require enrollees to report changes in income; (2)
adjust sliding scale premium payments, based upon changes in
enrollee income; and (3) disenroll enrollees from MinnesotaCare
for failure to pay required premiums. Failure to pay includes
payment with a dishonored check, a returned automatic bank
withdrawal, or a refused credit card or debit card payment. The
commissioner may demand a guaranteed form of payment, including
a cashier's check or a money order, as the only means to replace
a dishonored, returned, or refused payment.
(c) Premiums are calculated on a calendar month basis and
may be paid on a monthly, quarterly, or annual basis, with the
first payment due upon notice from the commissioner of the
premium amount required. The commissioner shall inform
applicants and enrollees of these premium payment options.
Premium payment is required before enrollment is complete and to
maintain eligibility in MinnesotaCare. Premium payments
received before noon are credited the same day. Premium
payments received after noon are credited on the next working
day.
(d) Nonpayment of the premium will result in disenrollment
from the plan effective for the calendar month for which the
premium was due. Persons disenrolled for nonpayment or who
voluntarily terminate coverage from the program may not reenroll
until four calendar months have elapsed. Persons disenrolled
for nonpayment who pay all past due premiums as well as current
premiums due, including premiums due for the period of
disenrollment, within 20 days of disenrollment, shall be
reenrolled retroactively to the first day of disenrollment.
Persons disenrolled for nonpayment or who voluntarily terminate
coverage from the program may not reenroll for four calendar
months unless the person demonstrates good cause for
nonpayment. Good cause does not exist if a person chooses to
pay other family expenses instead of the premium. The
commissioner shall define good cause in rule.
Sec. 30. Minnesota Statutes 2000, section 256L.07,
subdivision 3, is amended to read:
Subd. 3. [OTHER HEALTH COVERAGE.] (a) Families and
individuals enrolled in the MinnesotaCare program must have no
health coverage while enrolled or for at least four months prior
to application and renewal. Children enrolled in the original
children's health plan and children in families with income
equal to or less than 150 percent of the federal poverty
guidelines, who have other health insurance, are eligible if the
coverage:
(1) lacks two or more of the following:
(i) basic hospital insurance;
(ii) medical-surgical insurance;
(iii) prescription drug coverage;
(iv) dental coverage; or
(v) vision coverage;
(2) requires a deductible of $100 or more per person per
year; or
(3) lacks coverage because the child has exceeded the
maximum coverage for a particular diagnosis or the policy
excludes a particular diagnosis.
The commissioner may change this eligibility criterion for
sliding scale premiums in order to remain within the limits of
available appropriations. The requirement of no health coverage
does not apply to newborns.
(b) Medical assistance, general assistance medical care,
and the Civilian Health and Medical Program of the Uniformed
Service, CHAMPUS, or other coverage provided under United States
Code, title 10, subtitle A, part II, chapter 55, are not
considered insurance or health coverage for purposes of the
four-month requirement described in this subdivision.
(c) For purposes of this subdivision, Medicare Part A or B
coverage under title XVIII of the Social Security Act, United
States Code, title 42, sections 1395c to 1395w-4, is considered
health coverage. An applicant or enrollee may not refuse
Medicare coverage to establish eligibility for MinnesotaCare.
(d) Applicants who were recipients of medical assistance or
general assistance medical care within one month of application
must meet the provisions of this subdivision and subdivision 2.
Sec. 31. Laws 2001, First Special Session chapter 9,
article 2, section 76, is amended to read:
Sec. 76. [REPEALER.]
(a) Minnesota Statutes 2000, section 256B.0635, subdivision
3, and 256B.19, subdivision 1b, are is repealed effective July
1, 2001.
(b) Minnesota Statutes 2000, section 256L.02, subdivision
4, is repealed effective January 1, 2003.
Sec. 32. [REVISOR INSTRUCTION.]
In the next edition of Minnesota Statutes and Minnesota
Rules, the revisor shall replace the terms "Health Care
Financing Administration" and "federal Department of Health,
Education and Welfare" with "Centers for Medicare and Medicaid
Services" wherever it refers to the federal agency that provides
funding for the medical assistance program.
Sec. 33. [REPEALER WITHOUT EFFECT.]
The repeal of Minnesota Statutes 2000, section 256B.0635,
subdivision 3, by Laws 2001, First Special Session chapter 9,
article 2, section 76, with an effective date of July 1, 2001,
is without effect and section 256B.0635, subdivision 3, remains
in effect after June 30, 2001.
Sec. 34. [REPEALER.]
(a) Minnesota Statutes 2000, section 256B.0635, subdivision
3, is repealed effective July 1, 2002.
(b) Minnesota Statutes 2000, sections 256.025; 256B.19,
subdivision 1a; and 256B.77, subdivision 24, are repealed.
Presented to the governor March 22, 2002
Signed by the governor March 25, 2002, 2:17 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes