1.1 	A bill for an act
1.2 	relating to human services; modifying provisions related to health care and 
1.3 	health disparities; requiring reports; appropriating money;amending Minnesota 
1.4 	Statutes 2012, sections 62Q.19, subdivision 3; 62U.02, subdivision 1; 145.928, 
1.5 	by adding a subdivision; 256B.06, subdivision 4; 256B.0625, by adding a 
1.6 	subdivision; 256B.0651, by adding subdivisions; 256B.76, subdivision 4, by 
1.7 	adding a subdivision; 256B.763.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2012, section 62Q.19, subdivision 3, is amended to read:
1.10 		Subd. 3.Health plan company Essential community provider affiliation. A 
1.11 	health plan company, MinnesotaCare participating entity, or health carrier offering a 
1.12 	qualified health plan through the Minnesota Insurance Marketplace must offer a provider 
1.13 	contract to any designated essential community provider located within the area served 
1.14 	by the health plan company. A health plan company shall not restrict enrollee access to 
1.15 	services designated to be provided by the essential community provider for the population 
1.16 	that the essential community provider is certified to serve. A health plan company may 
1.17 	also make other providers available for these services. A health plan company may require 
1.18 	an essential community provider to meet all data requirements, utilization review, and 
1.19 	quality assurance requirements on the same basis as other health plan providers.

1.20 	Sec. 2. Minnesota Statutes 2012, section 62U.02, subdivision 1, is amended to read:
1.21 		Subdivision 1.Development. (a) The commissioner of health shall develop a 
1.22 	standardized set of measures by which to assess the quality of health care services offered 
1.23 	by health care providers, including health care providers certified as health care homes 
1.24 	under section 256B.0751. Quality measures must be based on medical evidence and be 
2.1 	developed through a process in which providers participate. The measures shall be used 
2.2 	for the quality incentive payment system developed in subdivision 2 and must:
2.3 	(1) include uniform definitions, measures, and forms for submission of data, to the 
2.4 	greatest extent possible;
2.5 	(2) seek to avoid increasing the administrative burden on health care providers;
2.6 	(3) be initially based on existing quality indicators for physician and hospital 
2.7 	services, which are measured and reported publicly by quality measurement organizations, 
2.8 	including, but not limited to, Minnesota Community Measurement and specialty societies;
2.9 	(4) place a priority on measures of health care outcomes, rather than process 
2.10 	measures, wherever possible; and
2.11 	(5) incorporate measures for primary care, including preventive services, coronary 
2.12 	artery and heart disease, diabetes, asthma, depression, and other measures as determined 
2.13 	by the commissioner;
2.14 	(6) ensure that measures are collected and reported by categories of race, ethnicity, 
2.15 	language, and other patient characteristics that are known to be correlated with poorer 
2.16 	health, access, and quality of care for particular groups of patients, so that the data is 
2.17 	useful in identifying and eliminating health disparities; and
2.18 	(7) ensure that measures used for public reporting or payment incentives are 
2.19 	adjusted for patient characteristics that are known to be correlated with poorer health, 
2.20 	access, and quality of care, so that quality reports and payment incentives do not create a 
2.21 	disadvantage for providers who serve high concentrations of patients who experience the 
2.22 	greatest health disparities.
2.23 	(b) The measures shall be reviewed at least annually by the commissioner.

2.24 	Sec. 3. Minnesota Statutes 2012, section 145.928, is amended by adding a subdivision 
2.25 	to read:
2.26 		Subd. 15.Health disparities. The commissioner of health, in consultation with 
2.27 	the commissioner of human services, shall complete an assessment of the methods used 
2.28 	by state agencies and the legislature to obtain advice and input from the public on health 
2.29 	care programs, policies, and legislation to determine the extent to which the methods 
2.30 	used are effective in obtaining advice and input from those patients and populations that 
2.31 	experience the greatest health disparities, compared to other patients and populations. The 
2.32 	commissioner shall submit a report to the legislature by December 15, 2013, that includes 
2.33 	the assessment and comparison of existing public input activities and identifies a range 
2.34 	of options for ways of improving public input and advice from patients and populations 
2.35 	experiencing the greatest health disparities.

3.1 	Sec. 4. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
3.2 		Subd. 4.Citizenship requirements. (a) Eligibility for medical assistance is limited 
3.3 	to citizens of the United States, qualified noncitizens as defined in this subdivision, and 
3.4 	other persons residing lawfully in the United States. Citizens or nationals of the United 
3.5 	States must cooperate in obtaining satisfactory documentary evidence of citizenship or 
3.6 	nationality according to the requirements of the federal Deficit Reduction Act of 2005, 
3.7 	Public Law 109-171.
3.8 	(b) "Qualified noncitizen" means a person who meets one of the following 
3.9 	immigration criteria:
3.10 	(1) admitted for lawful permanent residence according to United States Code, title 8;
3.11 	(2) admitted to the United States as a refugee according to United States Code, 
3.12 	title 8, section 1157;
3.13 	(3) granted asylum according to United States Code, title 8, section 1158;
3.14 	(4) granted withholding of deportation according to United States Code, title 8, 
3.15 	section 1253(h);
3.16 	(5) paroled for a period of at least one year according to United States Code, title 8, 
3.17 	section 1182(d)(5);
3.18 	(6) granted conditional entrant status according to United States Code, title 8, 
3.19 	section 1153(a)(7);
3.20 	(7) determined to be a battered noncitizen by the United States Attorney General 
3.21 	according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 
3.22 	title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
3.23 	(8) is a child of a noncitizen determined to be a battered noncitizen by the United 
3.24 	States Attorney General according to the Illegal Immigration Reform and Immigrant 
3.25 	Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, 
3.26 	Public Law 104-200; or
3.27 	(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public 
3.28 	Law 96-422, the Refugee Education Assistance Act of 1980.
3.29 	(c) All qualified noncitizens who were residing in the United States before August 
3.30 	22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for 
3.31 	medical assistance with federal financial participation.
3.32 	(d) Beginning December 1, 1996, qualified noncitizens who entered the United 
3.33 	States on or after August 22, 1996, and who otherwise meet the eligibility requirements 
3.34 	of this chapter are eligible for medical assistance with federal participation for five years 
3.35 	if they meet one of the following criteria:
4.1 	(1) refugees admitted to the United States according to United States Code, title 8, 
4.2 	section 1157;
4.3 	(2) persons granted asylum according to United States Code, title 8, section 1158;
4.4 	(3) persons granted withholding of deportation according to United States Code, 
4.5 	title 8, section 1253(h);
4.6 	(4) veterans of the United States armed forces with an honorable discharge for 
4.7 	a reason other than noncitizen status, their spouses and unmarried minor dependent 
4.8 	children; or
4.9 	(5) persons on active duty in the United States armed forces, other than for training, 
4.10 	their spouses and unmarried minor dependent children.
4.11 	 Beginning July 1, 2010, children and pregnant women who are noncitizens 
4.12 	described in paragraph (b) or who are lawfully present in the United States as defined 
4.13 	in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet 
4.14 	eligibility requirements of this chapter, are eligible for medical assistance with federal 
4.15 	financial participation as provided by the federal Children's Health Insurance Program 
4.16 	Reauthorization Act of 2009, Public Law 111-3.
4.17 	(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter 
4.18 	are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this 
4.19 	subdivision, a "nonimmigrant" is a person in one of the classes listed in United States 
4.20 	Code, title 8, section 1101(a)(15).
4.21 	(f) Payment shall also be made for care and services that are furnished to noncitizens, 
4.22 	regardless of immigration status, who otherwise meet the eligibility requirements of 
4.23 	this chapter, if such care and services are necessary for the treatment of an emergency 
4.24 	medical condition.
4.25 	(g) For purposes of this subdivision, the term "emergency medical condition" means 
4.26 	a medical condition that meets the requirements of United States Code, title 42, section 
4.27 	1396b(v).
4.28 	(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment 
4.29 	of an emergency medical condition are limited to the following:
4.30 	(i) services delivered in an emergency room or by an ambulance service licensed 
4.31 	under chapter 144E that are directly related to the treatment of an emergency medical 
4.32 	condition;
4.33 	(ii) services delivered in an inpatient hospital setting following admission from an 
4.34 	emergency room or clinic for an acute emergency condition; and
4.35 	(iii) follow-up services that are directly related to the original service provided to 
4.36 	treat the emergency medical condition and are covered by the global payment made to the 
5.1 	provider provided after discharge from an emergency room or inpatient hospital setting 
5.2 	that are necessary to prevent recurrence of a medical emergency.
5.3 	(2) Services for the treatment of emergency medical conditions do not include:
5.4 	(i) services delivered in an emergency room or inpatient setting to treat a 
5.5 	nonemergency condition;
5.6 	(ii) organ transplants, stem cell transplants, and related care;
5.7 	(iii) services for routine prenatal care;
5.8 	(iv) continuing care, including long-term care, nursing facility services, home 
5.9 	health care, adult day care, day training, or supportive living services, except follow-up 
5.10 	services in these categories that are covered if they are provided after discharge from an 
5.11 	emergency room or inpatient hospital setting and are necessary to prevent recurrence 
5.12 	of a medical emergency;
5.13 	(v) elective surgery;
5.14 	(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as 
5.15 	part of an emergency room visit;
5.16 	(vii) preventative health care and family planning services;
5.17 	(viii) dialysis, except as medically necessary after discharge from an emergency 
5.18 	room or inpatient hospital setting to prevent recurrence of a medical emergency;
5.19 	(ix) chemotherapy or therapeutic radiation services, except as medically necessary 
5.20 	after discharge from an emergency room or inpatient hospital setting to prevent recurrence 
5.21 	of a medical emergency;
5.22 	(x) rehabilitation services;
5.23 	(xi) physical, occupational, or speech therapy;
5.24 	(xii) transportation services;
5.25 	(xiii) case management;
5.26 	(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;
5.27 	(xv) dental services, except as medically necessary after discharge from an 
5.28 	emergency room or inpatient hospital setting to prevent recurrence of a medical emergency;
5.29 	(xvi) hospice care;
5.30 	(xvii) audiology services and hearing aids;
5.31 	(xviii) podiatry services;
5.32 	(xix) chiropractic services;
5.33 	(xx) immunizations;
5.34 	(xxi) vision services and eyeglasses;
5.35 	(xxii) waiver services;
5.36 	(xxiii) individualized education programs; or
6.1 	(xxiv) chemical dependency treatment.
6.2 	(3) Notwithstanding clauses (1) and (2), the commissioner may authorize payment 
6.3 	for alternative services, including, but not limited to, long-term care services, that would 
6.4 	not otherwise be paid for under this section if the commissioner determines that the 
6.5 	alternative services, if provided, would be a lower cost alternative to utilization of 
6.6 	emergency room, inpatient, and other services. The commissioner shall seek a waiver or 
6.7 	federal approval as necessary to implement this clause.
6.8 	(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented, 
6.9 	nonimmigrants, or lawfully present in the United States as defined in Code of Federal 
6.10 	Regulations, title 8, section 103.12, are not covered by a group health plan or health 
6.11 	insurance coverage according to Code of Federal Regulations, title 42, section 457.310, 
6.12 	and who otherwise meet the eligibility requirements of this chapter, are eligible for 
6.13 	medical assistance through the period of pregnancy, including labor and delivery, and 60 
6.14 	days postpartum, to the extent federal funds are available under title XXI of the Social 
6.15 	Security Act, and the state children's health insurance program.
6.16 	(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation 
6.17 	services from a nonprofit center established to serve victims of torture and are otherwise 
6.18 	ineligible for medical assistance under this chapter are eligible for medical assistance 
6.19 	without federal financial participation. These individuals are eligible only for the period 
6.20 	during which they are receiving services from the center. Individuals eligible under this 
6.21 	paragraph shall not be required to participate in prepaid medical assistance.

6.22 	Sec. 5. Minnesota Statutes 2012, section 256B.0625, is amended by adding a 
6.23 	subdivision to read:
6.24 		Subd. 61.Payment for multiple services provided on the same day. The 
6.25 	commissioner shall not prohibit payment, including supplemental payments, for mental 
6.26 	health services or dental services provided to a patient by a clinic or health care 
6.27 	professional solely because the mental health or dental services were provided on the same 
6.28 	day as other covered health services furnished by the same provider.

6.29 	Sec. 6. Minnesota Statutes 2012, section 256B.0651, is amended by adding a 
6.30 	subdivision to read:
6.31 		Subd. 18.Critical access home care services payment rate. Effective for 
6.32 	home care services delivered on or after July 1, 2013, the commissioner shall increase 
6.33 	reimbursements for home care service providers designated by the commissioner to be 
6.34 	critical access home care providers by 30 percent above the reimbursement rate that would 
7.1 	otherwise be paid to the critical access home care provider. The commissioner shall pay 
7.2 	the managed care plans and county-based purchasing plans in an amount sufficient to 
7.3 	reflect increased reimbursement to critical access home care providers as approved by the 
7.4 	commissioner. The commissioner shall designate a home care provider to be a critical 
7.5 	access home care provider if more than 50 percent of the provider's home care patient 
7.6 	encounters per year are with patients who are low-income and uninsured or covered 
7.7 	by medical assistance or MinnesotaCare.

7.8 	Sec. 7. Minnesota Statutes 2012, section 256B.0651, is amended by adding a 
7.9 	subdivision to read:
7.10 		Subd. 19.Critical access provider payment rates. Payments for covered services 
7.11 	provided under the MinnesotaCare program shall include critical access and community 
7.12 	health center payment rates and enhancements and special rate methodologies established 
7.13 	under sections 256B.0625, subdivision 30; 256B.0651, subdivision 18; 256B.76, 
7.14 	subdivision 4; and 256B.763.

7.15 	Sec. 8. Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:
7.16 		Subd. 4.Critical access dental providers.  (a) Effective for dental services rendered 
7.17 	on or after January 1, 2002, the commissioner shall increase reimbursements to dentists 
7.18 	and dental clinics deemed by the commissioner to be critical access dental providers. 
7.19 	For dental services rendered on or after July 1, 2007, the commissioner shall increase 
7.20 	reimbursement by 30 40 percent above the reimbursement rate that would otherwise be 
7.21 	paid to the critical access dental provider. The commissioner shall pay the managed 
7.22 	care plans and county-based purchasing plans in amounts sufficient to reflect increased 
7.23 	reimbursements to critical access dental providers as approved by the commissioner.
7.24 	(b) The commissioner shall designate the following dentists and dental clinics as 
7.25 	critical access dental providers:
7.26 	(1) nonprofit community clinics that:
7.27 	(i) have nonprofit status in accordance with chapter 317A;
7.28 	(ii) have tax exempt status in accordance with the Internal Revenue Code, section 
7.29 	501(c)(3);
7.30 	(iii) are established to provide oral health services to patients who are low income, 
7.31 	uninsured, have special needs, and are underserved;
7.32 	(iv) have professional staff familiar with the cultural background of the clinic's 
7.33 	patients;
8.1 	(v) charge for services on a sliding fee scale designed to provide assistance to 
8.2 	low-income patients based on current poverty income guidelines and family size;
8.3 	(vi) do not restrict access or services because of a patient's financial limitations 
8.4 	or public assistance status; and
8.5 	(vii) have free care available as needed;
8.6 	(2) federally qualified health centers, rural health clinics, and public health clinics;
8.7 	(3) city or county owned and operated hospital-based dental clinics;
8.8 	(4) a dental clinic or dental group owned and operated by a nonprofit corporation in 
8.9 	accordance with chapter 317A with more than 10,000 patient encounters per year with 
8.10 	patients who are uninsured or covered by medical assistance, general assistance medical 
8.11 	care, or MinnesotaCare; and
8.12 	(5) a dental clinic owned and operated by the University of Minnesota or the 
8.13 	Minnesota State Colleges and Universities system.; and
8.14 	(6) privately owned dental clinics or practices, if:
8.15 	(i) the clinic or practice is located within a dental professional shortage area under 
8.16 	Code of Federal Regulations, title 42, part 5, and United States Code, title 42, section 
8.17 	254E, and is located outside the seven-county metropolitan area;
8.18 	(ii) more than 50 percent of the clinic or practice's patient encounters per year 
8.19 	are with patients who are low-income and uninsured or covered by medical assistance 
8.20 	or MinnesotaCare;
8.21 	(iii) the clinic or practice does not restrict access or services because of a patient's 
8.22 	financial limitations or public assistance status and offers free or reduced fee care used on 
8.23 	a sliding fee based on federal poverty guidelines and family size and income; and
8.24 	(iv) the level of service provided by the clinic or practice is critical to maintaining 
8.25 	adequate levels of patient access within the service area in which the dentist operates.
8.26 	(c) The commissioner may designate a dentist or dental clinic as a critical access 
8.27 	dental provider if the dentist or dental clinic is willing to provide care to patients covered 
8.28 	by medical assistance, general assistance medical care, or MinnesotaCare at a level which 
8.29 	significantly increases access to dental care in the service area.
8.30 	(d) (c) A designated critical access clinic shall receive the reimbursement rate 
8.31 	specified in paragraph (a) for dental services provided off site at a private dental office if 
8.32 	the following requirements are met:
8.33 	(1) the designated critical access dental clinic is located within a health professional 
8.34 	shortage area as defined under Code of Federal Regulations, title 42, part 5, and United 
8.35 	States Code, title 42, section 254E, and is located outside the seven-county metropolitan 
8.36 	area;
9.1 	(2) the designated critical access dental clinic is not able to provide the service 
9.2 	and refers the patient to the off-site dentist;
9.3 	(3) the service, if provided at the critical access dental clinic, would be reimbursed 
9.4 	at the critical access reimbursement rate;
9.5 	(4) the dentist and allied dental professionals providing the services off site are 
9.6 	licensed and in good standing under chapter 150A;
9.7 	(5) the dentist providing the services is enrolled as a medical assistance provider;
9.8 	(6) the critical access dental clinic submits the claim for services provided off site 
9.9 	and receives the payment for the services; and
9.10 	(7) the critical access dental clinic maintains dental records for each claim submitted 
9.11 	under this paragraph, including the name of the dentist, the off-site location, and the 
9.12 	license number of the dentist and allied dental professionals providing the services.

9.13 	Sec. 9. Minnesota Statutes 2012, section 256B.76, is amended by adding a subdivision 
9.14 	to read:
9.15 		Subd. 7.Teledentistry and mobile services. Covered dental services provided 
9.16 	remotely using telecommunications equipment or provided in settings outside of a dental 
9.17 	clinic using portable or mobile dental equipment shall be reimbursed at the same rate as if 
9.18 	the service were provided in-person or in a dental clinic.

9.19 	Sec. 10. Minnesota Statutes 2012, section 256B.763, is amended to read:
9.20 	256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.
9.21 	(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, 
9.22 	payment rates shall be increased by 23.7 percent over the rates in effect on January 1, 
9.23 	2006, for:
9.24 	(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;
9.25 	(2) community mental health centers under section 256B.0625, subdivision 5; and
9.26 	(3) mental health clinics and centers certified under Minnesota Rules, parts 
9.27 	9520.0750 to 9520.0870, or hospital outpatient psychiatric departments that are designated 
9.28 	as essential community providers under section 62Q.19.
9.29 	(b) This increase applies to group skills training when provided as a component of 
9.30 	children's therapeutic services and support, psychotherapy, medication management, 
9.31 	evaluation and management, diagnostic assessment, explanation of findings, psychological 
9.32 	testing, neuropsychological services, direction of behavioral aides, and inpatient 
9.33 	consultation.
10.1 	(c) This increase does not apply to rates that are governed by section 256B.0625, 
10.2 	subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are 
10.3 	negotiated with the county, rates that are established by the federal government, or rates 
10.4 	that increased between January 1, 2004, and January 1, 2005.
10.5 	(d) The commissioner shall adjust rates paid to prepaid health plans under contract 
10.6 	with the commissioner to reflect the rate increases provided in paragraphs (a), (e), and 
10.7 	(f). The prepaid health plan must pass this rate increase to the providers identified in 
10.8 	paragraphs (a), (e), (f), and (g).
10.9 	(e) Payment rates shall be increased by 23.7 percent over the rates in effect on 
10.10 	December 31, 2007, for:
10.11 	(1) medication education services provided on or after January 1, 2008, by adult 
10.12 	rehabilitative mental health services providers certified under section 256B.0623; and
10.13 	(2) mental health behavioral aide services provided on or after January 1, 2008, by 
10.14 	children's therapeutic services and support providers certified under section 256B.0943.
10.15 	(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by 
10.16 	children's therapeutic services and support providers certified under section 256B.0943
10.17 	and not already included in paragraph (a), payment rates shall be increased by 23.7 percent 
10.18 	over the rates in effect on December 31, 2007.
10.19 	(g) Payment rates shall be increased by 2.3 percent over the rates in effect on 
10.20 	December 31, 2007, for individual and family skills training provided on or after January 
10.21 	1, 2008, by children's therapeutic services and support providers certified under section 
10.22 	256B.0943.
10.23 	(h) In addition to increases provided under paragraphs (a) through (g), payment rates 
10.24 	shall be increased by ten percent for community mental health center services rendered 
10.25 	on or after July 1, 2013, by community mental health centers under section 256B.0625, 
10.26 	subdivision 5.

10.27 	Sec. 11. OUTREACH AND ENROLLMENT ASSISTANCE.
 10.28 	For the biennium ending June 30, 2015, the payment for outreach and enrollment 
10.29 	assistance services resulting in a successful enrollment in medical assistance or 
10.30 	MinnesotaCare is $250.

10.31 	Sec. 12. FEDERALLY QUALIFIED HEALTH CENTER SUBSIDY.
 10.32 	For the biennium ending June 30, 2015, $5,000,000 per year is appropriated from 
10.33 	the general fund to the commissioner of health for subsidies for federally qualified health 
10.34 	centers under Minnesota Statutes, section 145.9269.

11.1 	Sec. 13. MEDICAL EDUCATION AND RESEARCH COSTS.
 11.2 	For the biennium ending June 30, 2015, $....... per year is appropriated from the 
11.3 	general fund to the commissioner of health for distribution under Minnesota Statutes, 
11.4 	section 62J.692, subdivision 4.

11.5 	Sec. 14. HEALTH DISPARITIES PAYMENT ENHANCEMENT.
 11.6 	The commissioner of human services shall develop a methodology to pay a higher 
11.7 	payment rate for health care providers and services that takes into consideration the higher 
11.8 	cost, complexity, and resources needed to serve patients and populations who experience 
11.9 	the greatest health disparities in order to achieve the same health and quality outcomes that 
11.10 	are achieved for other patients and populations. The commissioner shall submit a report 
11.11 	and recommendations to the legislature by December 15, 2013, including the proposed 
11.12 	methodology for providing a health disparities payment adjustment.