1.1                          A bill for an act 
  1.2             relating to human services; expanding provisions for 
  1.3             health care; amending Minnesota Statutes 1994, 
  1.4             sections 256.9353, subdivisions 1 and 3; 256.9354, 
  1.5             subdivision 5; 256.9363, subdivision 5; 256B.037, 
  1.6             subdivisions 1, 3, 4, and by adding subdivisions; 
  1.7             256B.04, by adding a subdivision; 256B.055, by adding 
  1.8             a subdivision; 256B.057, by adding subdivisions; 
  1.9             256B.0625, subdivision 30; and 256B.69, subdivisions 2 
  1.10            and 4; Laws 1993, First Special Session chapter 1, 
  1.11            article 8, section 30, subdivision 2; proposing coding 
  1.12            for new law in Minnesota Statutes, chapters 256; and 
  1.13            256B; repealing Minnesota Statutes 1994, section 
  1.14            256.9353, subdivisions 4 and 5. 
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16     Section 1.  Minnesota Statutes 1994, section 256.9353, 
  1.17  subdivision 1, is amended to read: 
  1.18     Subdivision 1.  [COVERED HEALTH SERVICES.] "Covered health 
  1.19  services" means the health services reimbursed under chapter 
  1.20  256B, with the exception of inpatient hospital services, special 
  1.21  education services, private duty nursing services, adult dental 
  1.22  care services other than preventive services, orthodontic 
  1.23  services, nonemergency medical transportation services, personal 
  1.24  care assistant and case management services, hospice care 
  1.25  services, nursing home or intermediate care facilities services, 
  1.26  inpatient mental health services, and chemical dependency 
  1.27  services.  Outpatient mental health services covered under the 
  1.28  MinnesotaCare program are limited to diagnostic assessments, 
  1.29  psychological testing, explanation of findings, medication 
  1.30  management by a physician, day treatment, partial 
  2.1   hospitalization, and individual, family, and group 
  2.2   psychotherapy.  Covered health services shall be expanded as 
  2.3   provided in this section. 
  2.4      Sec. 2.  Minnesota Statutes 1994, section 256.9353, 
  2.5   subdivision 3, is amended to read: 
  2.6      Subd. 3.  [INPATIENT HOSPITAL SERVICES.] (a) Beginning July 
  2.7   1, 1993, covered health services shall include inpatient 
  2.8   hospital services, including inpatient hospital mental health 
  2.9   services and inpatient hospital and residential chemical 
  2.10  dependency treatment, subject to those limitations necessary to 
  2.11  coordinate the provision of these services with eligibility 
  2.12  under the medical assistance spenddown.  The inpatient hospital 
  2.13  benefit for adult enrollees is subject to an annual benefit 
  2.14  limit of $10,000.  The commissioner shall provide enrollees with 
  2.15  at least 60 days' notice of coverage for inpatient hospital 
  2.16  services and any premium increase associated with the inclusion 
  2.17  of this benefit. 
  2.18     (b) Enrollees determined by the commissioner to have a 
  2.19  basis of eligibility for medical assistance shall apply for and 
  2.20  cooperate with the requirements of medical assistance by the 
  2.21  last day of the third month following admission to an inpatient 
  2.22  hospital.  If an enrollee fails to apply for medical assistance 
  2.23  within this time period, the enrollee and the enrollee's family 
  2.24  shall be disenrolled from the plan within one calendar month.  
  2.25  Enrollees and enrollees' families disenrolled for not applying 
  2.26  for or not cooperating with medical assistance may not reenroll. 
  2.27     (c) Admissions for inpatient hospital services paid for 
  2.28  under section 256.9362, subdivision 3, must be certified as 
  2.29  medically necessary in accordance with Minnesota Rules, parts 
  2.30  9505.0500 to 9505.0540, except as provided in clauses (1) and 
  2.31  (2): 
  2.32     (1) all admissions must be certified, except those 
  2.33  authorized under rules established under section 254A.03, 
  2.34  subdivision 3, or approved under Medicare; and 
  2.35     (2) payment under section 256.9362, subdivision 3, shall be 
  2.36  reduced by five percent for admissions for which certification 
  3.1   is requested more than 30 days after the day of admission.  The 
  3.2   hospital may not seek payment from the enrollee for the amount 
  3.3   of the payment reduction under this clause. 
  3.4      Sec. 3.  Minnesota Statutes 1994, section 256.9354, 
  3.5   subdivision 5, is amended to read: 
  3.6      Subd. 5.  [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO 
  3.7   CHILDREN.] (a) Beginning October 1, 1994, "eligible persons" 
  3.8   shall include all individuals and households with no children 
  3.9   who have gross family incomes that are equal to or less than 125 
  3.10  percent of the federal poverty guidelines and who are not 
  3.11  eligible for medical assistance without a spenddown under 
  3.12  chapter 256B.  
  3.13     (b) Beginning October 1, 1995, "eligible persons" means all 
  3.14  individuals and families who are not eligible for medical 
  3.15  assistance without a spenddown under chapter 256B.  
  3.16     (c) All eligible persons under paragraphs paragraph (a) and 
  3.17  (b) are eligible for coverage through the MinnesotaCare program 
  3.18  but must pay a premium as determined under sections 256.9357 and 
  3.19  256.9358.  Individuals and families whose income is greater than 
  3.20  the limits established under section 256.9358 may not enroll in 
  3.21  the MinnesotaCare program. 
  3.22     Sec. 4.  Minnesota Statutes 1994, section 256.9363, 
  3.23  subdivision 5, is amended to read: 
  3.24     Subd. 5.  [ELIGIBILITY FOR OTHER STATE PROGRAMS.] 
  3.25  MinnesotaCare enrollees who become eligible for medical 
  3.26  assistance or general assistance medical care will remain in the 
  3.27  same managed care plan if the managed care plan has a contract 
  3.28  for that population.  Contracts between the department of human 
  3.29  services and managed care plans must include MinnesotaCare, and 
  3.30  medical assistance and may, at the option of the commissioner of 
  3.31  human services, also include general assistance medical care. 
  3.32     Sec. 5.  [256.9366] [ELIGIBILITY FOR MINNESOTACARE FOR 
  3.33  FAMILIES AND CHILDREN UNDER THE MINNESOTACARE HEALTH CARE REFORM 
  3.34  WAIVER.] 
  3.35     Subdivision 1.  [FAMILIES WITH CHILDREN; IN 
  3.36  GENERAL.] Families with children with family income equal to or 
  4.1   less than 275 percent of the federal poverty guidelines for the 
  4.2   applicable family size shall be determined eligible for 
  4.3   MinnesotaCare according to this section, and section 256.9354, 
  4.4   subdivisions 2 to 4, shall no longer apply.  All other 
  4.5   provisions of sections 256.9351 to 256.9363, including the 
  4.6   insurance-related barriers to enrollment under section 256.9357, 
  4.7   shall apply unless otherwise specified in section 256.9366 to 
  4.8   256.9369.  
  4.9      Subd. 2.  [CHILDREN.] For purposes of sections 256.9366 to 
  4.10  256.9369, a "child" is an individual under 21 years of age, 
  4.11  including the unborn child of a pregnant woman, and including an 
  4.12  emancipated minor, and the emancipated minor's spouse.  
  4.13     Subd. 3.  [FAMILIES WITH CHILDREN.] For purposes of section 
  4.14  256.9366 to 256.9369, a "family with children" means a parent or 
  4.15  parents and their children, or legal guardians and their wards 
  4.16  who are children, and dependent siblings, residing in the same 
  4.17  household.  The term includes children and dependent siblings 
  4.18  who are temporarily absent from the household in settings such 
  4.19  as schools, camps, or visitation with noncustodial parents.  For 
  4.20  purposes of this section, a "dependent sibling" means an 
  4.21  unmarried child who is a full-time student under the age of 25 
  4.22  years who is financially dependent upon a parent.  Proof of 
  4.23  school enrollment will be required. 
  4.24     Subd. 4.  [CHILDREN IN FAMILIES WITH INCOME AT OR LESS THAN 
  4.25  150 PERCENT OF FEDERAL POVERTY GUIDELINES.] Children who have 
  4.26  gross family incomes that are equal to or less than 150 percent 
  4.27  of the federal poverty guidelines and who are not otherwise 
  4.28  insured for the covered services, are eligible for enrollment 
  4.29  under sections 256.9366 to 256.9369.  For the purposes of this 
  4.30  section, "not otherwise insured for covered services" has the 
  4.31  meaning given in Minnesota Rules, part 9506.0020, subpart 3, 
  4.32  item B.  
  4.33     Subd. 5.  [RESIDENCY.] Families and children who are 
  4.34  otherwise eligible for enrollment under section 256.9366 are 
  4.35  exempt from the Minnesota residency requirements of section 
  4.36  256.9359, if they meet the residency requirements of the medical 
  5.1   assistance program according to chapter 256B.  
  5.2      Subd. 6.  [COOPERATION WITH MEDICAL ASSISTANCE.] Pregnant 
  5.3   women and children applying for MinnesotaCare under this section 
  5.4   are not required to apply for the medical assistance program as 
  5.5   a condition of enrollment.  Other adults enrolled in 
  5.6   MinnesotaCare determined by the commissioner to have a basis of 
  5.7   eligibility for medical assistance must cooperate in completing 
  5.8   an application for medical assistance by the last day of the 
  5.9   third month following admission to an inpatient hospital.  If an 
  5.10  enrollee fails to complete an application for medical assistance 
  5.11  within this time period, the enrollee shall be disenrolled and 
  5.12  may not reenroll. 
  5.13     Subd. 7.  [COOPERATION IN ESTABLISHING PATERNITY AND OTHER 
  5.14  MEDICAL SUPPORT.] Families and children enrolled in the 
  5.15  MinnesotaCare program must cooperate with the department of 
  5.16  human services and the local agency in establishing paternity of 
  5.17  an enrolled child and in obtaining medical care support and 
  5.18  payments for the child and any other person for whom the person 
  5.19  can legally assign rights, in accordance with applicable laws 
  5.20  and rules governing the medical assistance program.  A child 
  5.21  shall not be ineligible for or disenrolled from the 
  5.22  MinnesotaCare program solely because of the child's parent or 
  5.23  caretaker's failure to cooperate in establishing paternity or 
  5.24  obtaining medical support. 
  5.25     Sec. 6.  [256.9367] [COVERED SERVICES FOR PREGNANT WOMEN 
  5.26  AND CHILDREN UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.] 
  5.27     Children and pregnant women are eligible for coverage of 
  5.28  all services that are eligible for reimbursement under the 
  5.29  medical assistance program according to chapter 256B.  Pregnant 
  5.30  women and children are exempt from the provisions of section 
  5.31  256.9353, subdivision 7, regarding copayments.  
  5.32     Sec. 7.  [256.9368] [PREMIUMS.] 
  5.33     Subdivision 1.  [PREMIUM DETERMINATION.] Families and 
  5.34  children enrolled according to sections 256.9366 to 256.9369 
  5.35  shall pay a premium determined according to a sliding fee based 
  5.36  on the cost of coverage as a percentage of the family's gross 
  6.1   family income.  Pregnant women and children under age two are 
  6.2   exempt from the provisions of section 256.9356, subdivision 3, 
  6.3   clause (3), requiring disenrollment for failure to pay 
  6.4   premiums.  For pregnant women, this exemption continues until 
  6.5   the first day of the month following the 60th day postpartum.  
  6.6   Women who remain enrolled during pregnancy or the postpartum 
  6.7   period, despite nonpayment of premiums, shall be disenrolled on 
  6.8   the first of the month following the 60th day postpartum for the 
  6.9   penalty period that otherwise applies under section 256.9356. 
  6.10     Subd. 2.  [SLIDING SCALE TO DETERMINE PERCENTAGE OF GROSS 
  6.11  FAMILY INCOME.] The commissioner shall establish a sliding fee 
  6.12  scale to determine the percentage of gross family income that 
  6.13  households at different income levels must pay to obtain 
  6.14  coverage through the MinnesotaCare program.  The sliding fee 
  6.15  scale must be based on the enrollee's gross family income during 
  6.16  the previous four months.  The sliding fee scale begins with a 
  6.17  premium of 1.5 percent of gross family income for families with 
  6.18  incomes below the limits for the medical assistance program for 
  6.19  families and children and proceeds through the following evenly 
  6.20  spaced steps:  1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 
  6.21  percent.  These percentages are matched to evenly spaced income 
  6.22  steps ranging from the medical assistance income limit for 
  6.23  families and children to 275 percent of the federal poverty 
  6.24  guidelines for the applicable family size.  The sliding fee 
  6.25  scale and percentages are not subject to the provisions of 
  6.26  chapter 14.  If a family reports increased income after 
  6.27  enrollment, premiums shall not be adjusted until eligibility 
  6.28  renewal.  
  6.29     Subd. 3.  [EXCEPTIONS TO SLIDING SCALE.] An annual premium 
  6.30  of $48 is required for all children who are eligible according 
  6.31  to section 256.9366, subdivision 4.  
  6.32     Sec. 8.  [256.9369] [PAYMENT RATES; SERVICES FOR FAMILIES 
  6.33  AND CHILDREN UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.] 
  6.34     Section 256.9362, subdivision 2, shall not apply to 
  6.35  services provided to children who are eligible to receive 
  6.36  expanded services according to section 256.9367. 
  7.1      Sec. 9.  Minnesota Statutes 1994, section 256B.037, 
  7.2   subdivision 1, is amended to read: 
  7.3      Subdivision 1.  [CONTRACT FOR DENTAL SERVICES.] The 
  7.4   commissioner may conduct a demonstration project to contract, on 
  7.5   a prospective per capita payment basis, with an organization or 
  7.6   organizations licensed under chapter 62C or 62D, or 62N for the 
  7.7   provision of all dental care services beginning July 1, 1994, 
  7.8   under the medical assistance, general assistance medical care, 
  7.9   and MinnesotaCare programs, or when necessary waivers are 
  7.10  granted by the secretary of health and human services, whichever 
  7.11  occurs later.  The commissioner shall identify a geographic area 
  7.12  or areas, including both urban and rural areas, where access to 
  7.13  dental services has been inadequate, in which to conduct 
  7.14  demonstration projects.  The commissioner shall seek any federal 
  7.15  waivers or approvals necessary to implement this section from 
  7.16  the secretary of health and human services. 
  7.17     The commissioner may exclude from participation in the 
  7.18  demonstration project any or all groups currently excluded from 
  7.19  participation in the prepaid medical assistance program under 
  7.20  section 256B.69.  Except for persons excluded from participation 
  7.21  in the demonstration project, all persons who have been 
  7.22  determined eligible for medical assistance, general assistance 
  7.23  medical care and, if applicable, MinnesotaCare and reside in the 
  7.24  designated geographic areas are required to enroll in a dental 
  7.25  plan to receive their dental care services.  Except for 
  7.26  emergency services or out-of-plan services authorized by the 
  7.27  dental plan, recipients must receive their dental services from 
  7.28  dental care providers who are part of the dental plan provider 
  7.29  network.  
  7.30     The commissioner shall select either multiple dental plans 
  7.31  or a single dental plan in a designated area.  A dental plan 
  7.32  under contract with the department must serve both medical 
  7.33  assistance recipients and general assistance medical care 
  7.34  recipients in a designated geographic area and may serve 
  7.35  MinnesotaCare recipients.  The commissioner may limit the number 
  7.36  of dental plans with which the department contracts within a 
  8.1   designated geographic area, taking into consideration the number 
  8.2   of recipients within the designated geographic area; the number 
  8.3   of potential dental plan contractors; the size of the provider 
  8.4   network offered by dental plans; the dental care services 
  8.5   offered by a dental plan; qualifications of dental plan 
  8.6   personnel; accessibility of services to recipients; dental plan 
  8.7   assurances of recipient confidentiality; dental plan marketing 
  8.8   and enrollment activities; dental plan compliance with this 
  8.9   section; dental plan performance under other contracts with the 
  8.10  department to serve medical assistance, general assistance 
  8.11  medical care, or MinnesotaCare recipients; or any other factors 
  8.12  necessary to provide the most economical care consistent with 
  8.13  high standards of dental care.  
  8.14     For purposes of this section, "dental plan" means an 
  8.15  organization licensed under chapter 62C, 62D, or 62N that 
  8.16  contracts with the department to provide covered dental care 
  8.17  services to recipients on a prepaid capitation basis.  
  8.18  "Emergency services" has the meaning given in section 256B.0625, 
  8.19  subdivision 4.  "Multiple dental plan area" means a designated 
  8.20  area in which more than one dental plan is offered.  
  8.21  "Participating provider" means a dentist or dental clinic who is 
  8.22  employed by or under contract with a dental plan to provide 
  8.23  dental care services to recipients.  "Single dental plan area" 
  8.24  means a designated area in which only one dental plan is 
  8.25  available. 
  8.26     Sec. 10.  Minnesota Statutes 1994, section 256B.037, is 
  8.27  amended by adding a subdivision to read: 
  8.28     Subd. 1a.  [MULTIPLE DENTAL PLAN AREAS.] After the 
  8.29  department has executed contracts with dental plans to provide 
  8.30  covered dental care services in a multiple dental plan area, the 
  8.31  department shall:  
  8.32     (1) inform applicants and recipients, in writing, of 
  8.33  available dental plans, when written notice of dental plan 
  8.34  selection must be submitted to the department, and when dental 
  8.35  plan participation begins; 
  8.36     (2) randomly assign to a dental plan recipients who fail to 
  9.1   notify the department in writing of their dental plan choice; 
  9.2   and 
  9.3      (3) notify recipients, in writing, of their assigned dental 
  9.4   plan before the effective date of the recipient's dental plan 
  9.5   participation.  
  9.6      Sec. 11.  Minnesota Statutes 1994, section 256B.037, is 
  9.7   amended by adding a subdivision to read: 
  9.8      Subd. 1b.  [SINGLE DENTAL PLAN AREAS.] After the department 
  9.9   has executed a contract with a dental plan to provide covered 
  9.10  dental care services as the sole dental plan in a geographic 
  9.11  area, the provisions in paragraphs (a) to (c) apply.  
  9.12     (a) The department shall assure that applicants and 
  9.13  recipients are informed, in writing, of participating providers 
  9.14  in the dental plan and when dental plan participation begins.  
  9.15     (b) The dental plan may require the recipient to select a 
  9.16  specific dentist or dental clinic and may assign to a specific 
  9.17  dentist or dental clinic recipients who fail to notify the 
  9.18  dental plan of their selection.  
  9.19     (c) The dental plan shall notify recipients in writing of 
  9.20  their assigned providers before the effective date of dental 
  9.21  plan participation.  
  9.22     Sec. 12.  Minnesota Statutes 1994, section 256B.037, is 
  9.23  amended by adding a subdivision to read: 
  9.24     Subd. 1c.  [DENTAL CHOICE.] (a) In multiple dental plan 
  9.25  areas, recipients may change dental plans once within the first 
  9.26  year the recipient participates in a dental plan.  After the 
  9.27  first year of dental plan participation, recipients may change 
  9.28  dental plans during the annual 30-day open enrollment period.  
  9.29     (b) In single dental plan areas, recipients may change 
  9.30  their specific dentist or clinic at least once during the first 
  9.31  year of dental plan participation.  After the first year of 
  9.32  dental plan participation, recipients may change their specific 
  9.33  dentist or clinic at least once annually.  The dental plan shall 
  9.34  notify recipients of this change option.  
  9.35     (c) If a dental plan's contract with the department is 
  9.36  terminated for any reason, recipients in that dental plan shall 
 10.1   select a new dental plan and may change dental plans or a 
 10.2   specific dentist or clinic within the first 60 days of 
 10.3   participation in the second dental plan.  
 10.4      (d) Recipients may change dental plans or a specific 
 10.5   dentist or clinic at any time as follows:  
 10.6      (1) in multiple dental plan areas, if the travel time from 
 10.7   the recipient's residence to a general practice dentist is over 
 10.8   30 minutes, the recipient may change dental plans; 
 10.9      (2) in single dental plan areas, if the travel time from 
 10.10  the recipient's residence to the recipient's specific dentist or 
 10.11  clinic is over 30 minutes, the recipient may change providers; 
 10.12  or 
 10.13     (3) if the recipient's dental plan or specific dentist or 
 10.14  clinic was incorrectly designated due to department or dental 
 10.15  plan error.  
 10.16     (e) Requests for change under this subdivision must be 
 10.17  submitted to the department or dental plan in writing.  The 
 10.18  department or dental plan shall notify recipients whether the 
 10.19  request is approved or denied within 30 days after receipt of 
 10.20  the written request. 
 10.21     Sec. 13.  Minnesota Statutes 1994, section 256B.037, 
 10.22  subdivision 3, is amended to read: 
 10.23     Subd. 3.  [APPEALS.] All recipients of services under this 
 10.24  section have the right to appeal to the commissioner under 
 10.25  section 256.045.  A recipient participating in a dental plan may 
 10.26  utilize the dental plan's internal complaint procedure but is 
 10.27  not required to exhaust the internal complaint procedure before 
 10.28  appealing to the commissioner.  The appeal rights and procedures 
 10.29  in Minnesota Rules, part 9500.1463, apply to recipients who 
 10.30  enroll in dental plans. 
 10.31     Sec. 14.  Minnesota Statutes 1994, section 256B.037, 
 10.32  subdivision 4, is amended to read: 
 10.33     Subd. 4.  [INFORMATION REQUIRED BY COMMISSIONER.] A 
 10.34  contractor shall submit encounter-specific information as 
 10.35  required by the commissioner, including, but not limited to, 
 10.36  information required for assessing client satisfaction, quality 
 11.1   of care, and cost and utilization of services.  Dental plans and 
 11.2   participating providers must provide the commissioner access to 
 11.3   recipient dental records to monitor compliance with the 
 11.4   requirements of this section.  
 11.5      Sec. 15.  Minnesota Statutes 1994, section 256B.037, is 
 11.6   amended by adding a subdivision to read: 
 11.7      Subd. 6.  [RECIPIENT COSTS.] A dental plan and its 
 11.8   participating providers or nonparticipating providers who 
 11.9   provide emergency services or services authorized by the dental 
 11.10  plan shall not charge recipients for any costs for covered 
 11.11  services.  
 11.12     Sec. 16.  Minnesota Statutes 1994, section 256B.037, is 
 11.13  amended by adding a subdivision to read: 
 11.14     Subd. 7.  [FINANCIAL ACCOUNTABILITY.] A dental plan is 
 11.15  accountable to the commissioner for the fiscal management of 
 11.16  covered dental care services.  The state of Minnesota and 
 11.17  recipients shall be held harmless for the payment of obligations 
 11.18  incurred by a dental plan if the dental plan or a participating 
 11.19  provider becomes insolvent and the department has made the 
 11.20  payments due to the dental plan under the contract. 
 11.21     Sec. 17.  Minnesota Statutes 1994, section 256B.037, is 
 11.22  amended by adding a subdivision to read: 
 11.23     Subd. 8.  [QUALITY IMPROVEMENT.] A dental plan shall have 
 11.24  an internal quality improvement system.  A dental plan shall 
 11.25  permit the commissioner or the commissioner's agents to evaluate 
 11.26  the quality, appropriateness, and timeliness of covered dental 
 11.27  care services through inspections, site visits, and review of 
 11.28  dental records.  
 11.29     Sec. 18.  Minnesota Statutes 1994, section 256B.037, is 
 11.30  amended by adding a subdivision to read: 
 11.31     Subd. 9.  [THIRD-PARTY LIABILITY.] To the extent required 
 11.32  under section 62A.046 and Minnesota Rules, part 9506.0080, a 
 11.33  dental plan shall coordinate benefits for or recover the cost of 
 11.34  dental care services provided recipients who have other dental 
 11.35  care coverage.  Coordination of benefits includes the dental 
 11.36  plan paying applicable copayments or deductibles on behalf of a 
 12.1   recipient.  
 12.2      Sec. 19.  Minnesota Statutes 1994, section 256B.037, is 
 12.3   amended by adding a subdivision to read: 
 12.4      Subd. 10.  [FINANCIAL CAPACITY.] A dental plan shall 
 12.5   demonstrate that its financial risk capacity is acceptable to 
 12.6   its participating providers; except, an organization licensed as 
 12.7   a health maintenance organization under chapter 62D, a nonprofit 
 12.8   health service plan under chapter 62C, or an integrated service 
 12.9   network or a community integrated service network under chapter 
 12.10  62N, is not required to demonstrate financial risk capacity 
 12.11  beyond the requirements in those chapters for licensure or a 
 12.12  certificate of authority.  
 12.13     Sec. 20.  Minnesota Statutes 1994, section 256B.037, is 
 12.14  amended by adding a subdivision to read: 
 12.15     Subd. 11.  [DATA PRIVACY.] The contract between the 
 12.16  commissioner and the dental plan must specify that the dental 
 12.17  plan is an agent of the welfare system and shall have access to 
 12.18  welfare data on recipients to the extent necessary to carry out 
 12.19  the dental plan's responsibilities under the contract.  The 
 12.20  dental plan shall comply with chapter 13, the Minnesota 
 12.21  government data practices act. 
 12.22     Sec. 21.  Minnesota Statutes 1994, section 256B.04, is 
 12.23  amended by adding a subdivision to read: 
 12.24     Subd. 18.  [APPLICATIONS FOR MEDICAL ASSISTANCE.] The state 
 12.25  agency may take applications for medical assistance and conduct 
 12.26  eligibility determinations for MinnesotaCare enrollees who are 
 12.27  required to apply for medical assistance according to section 
 12.28  256.9353, subdivision 3, paragraph (b). 
 12.29     Sec. 22.  Minnesota Statutes 1994, section 256B.055, is 
 12.30  amended by adding a subdivision to read: 
 12.31     Subd. 10a.  [CHILDREN.] This subdivision supersedes 
 12.32  subdivision 10, as long as the Minnesota health care reform 
 12.33  waiver remains in effect.  When the waiver expires, this 
 12.34  subdivision expires and the commissioner of human services shall 
 12.35  publish a notice in the State Register and notify the revisor of 
 12.36  statutes.  Medical assistance may be paid for a child less than 
 13.1   two years of age, whose mother was eligible for and receiving 
 13.2   medical assistance at the time of birth and who remains in the 
 13.3   mother's household or who is in a family with countable income 
 13.4   that is equal to or less than the income standard established 
 13.5   under section 256B.057, subdivision 1.  
 13.6      Sec. 23.  Minnesota Statutes 1994, section 256B.057, is 
 13.7   amended by adding a subdivision to read: 
 13.8      Subd. 1b.  [PREGNANT WOMEN AND INFANTS; EXPANSION.] This 
 13.9   subdivision supersedes subdivision 1 as long as the Minnesota 
 13.10  health care reform waiver remains in effect.  When the waiver 
 13.11  expires, the commissioner of human services shall publish a 
 13.12  notice in the State Register and notify the revisor of 
 13.13  statutes.  An infant less than two years of age or a pregnant 
 13.14  woman who has written verification of a positive pregnancy test 
 13.15  from a physician or licensed registered nurse, is eligible for 
 13.16  medical assistance if countable family income is equal to or 
 13.17  less than 275 percent of the federal poverty guideline for the 
 13.18  same family size.  For purposes of this subdivision, "countable 
 13.19  family income" means the amount of income considered available 
 13.20  using the methodology of the AFDC program, except for the earned 
 13.21  income disregard and employment deductions.  An amount equal to 
 13.22  the amount of earned income exceeding 275 percent of the federal 
 13.23  poverty guideline, up to a maximum of the amount by which the 
 13.24  combined total of 185 percent of the federal poverty guideline 
 13.25  plus the earned income disregards and deductions of the AFDC 
 13.26  program exceeds 275 percent of the federal poverty guideline 
 13.27  will be deducted for pregnant women and infants less than two 
 13.28  years of age.  Eligibility for a pregnant woman or infant less 
 13.29  than two years of age under this subdivision must be determined 
 13.30  without regard to asset standards established in section 
 13.31  256B.056, subdivision 3.  
 13.32     An infant born on or after January 1, 1991, to a woman who 
 13.33  was eligible for and receiving medical assistance on the date of 
 13.34  the child's birth shall continue to be eligible for medical 
 13.35  assistance without redetermination until the child's second 
 13.36  birthday, as long as the child remains in the woman's household. 
 14.1      Sec. 24.  Minnesota Statutes 1994, section 256B.057, is 
 14.2   amended by adding a subdivision to read: 
 14.3      Subd. 2b.  [NO ASSET TEST FOR CHILDREN AND THEIR PARENTS; 
 14.4   EXPANSION.] This subdivision supersedes subdivision 2a as long 
 14.5   as the Minnesota health care reform waiver remains in effect.  
 14.6   When the waiver expires, this subdivision expires and the 
 14.7   commissioner of human services shall publish a notice in the 
 14.8   State Register and notify the revisor of statutes.  Eligibility 
 14.9   for medical assistance for a person under age 21, and the 
 14.10  person's parents or relative caretakers as defined in the aid to 
 14.11  families with dependent children program according to chapter 
 14.12  256, who are eligible under section 256B.055, subdivision 3, and 
 14.13  who live in the same household as the person eligible under age 
 14.14  21, must be determined without regard to asset standards 
 14.15  established in section 256B.056. 
 14.16     Sec. 25.  Minnesota Statutes 1994, section 256B.0625, 
 14.17  subdivision 30, is amended to read: 
 14.18     Subd. 30.  [OTHER CLINIC SERVICES.] (a) Medical assistance 
 14.19  covers rural health clinic services, federally qualified health 
 14.20  center services, nonprofit community health clinic services, 
 14.21  public health clinic services, and the services of a clinic 
 14.22  meeting the criteria established in rule by the commissioner.  
 14.23  Rural health clinic services and federally qualified health 
 14.24  center services mean services defined in United States Code, 
 14.25  title 42, section 1396d(a)(2)(B) and (C).  Payment for rural 
 14.26  health clinic and federally qualified health center services 
 14.27  shall be made according to applicable federal law and regulation.
 14.28     (b) A federally qualified health center that is beginning 
 14.29  initial operation shall submit an estimate of budgeted costs and 
 14.30  visits for the initial reporting period in the form and detail 
 14.31  required by the commissioner.  A federally qualified health 
 14.32  center that is already in operation shall submit an initial 
 14.33  report using actual costs and visits for the initial reporting 
 14.34  period.  Within 90 days of the end of its reporting period, a 
 14.35  federally qualified health center shall submit, in the form and 
 14.36  detail required by the commissioner, a report of its operations, 
 15.1   including allowable costs actually incurred for the period and 
 15.2   the actual number of visits for services furnished during the 
 15.3   period, and other information required by the commissioner.  
 15.4   Federally qualified health centers that file Medicare cost 
 15.5   reports shall provide the commissioner with a copy of the most 
 15.6   recent Medicare cost report filed with the Medicare program 
 15.7   intermediary for the reporting year which support the costs 
 15.8   claimed on their cost report to the state. 
 15.9      (c) In order to continue cost-based payment under the 
 15.10  medical assistance program according to paragraphs (a) and (b), 
 15.11  a federally qualified health center or rural health clinic must 
 15.12  apply for designation as an essential community provider within 
 15.13  six months of final adoption of rules by the department of 
 15.14  health according to section 620.19, subdivision 7.  For those 
 15.15  federally qualified health centers and rural health clinics that 
 15.16  have applied for essential community provider status within the 
 15.17  six month time prescribed, medical assistance payments will 
 15.18  continue to be made according to paragraphs (a) and (b) for the 
 15.19  first three years of essential community provider status.  For 
 15.20  federally qualified health centers and rural health clinics that 
 15.21  either do not apply within the time specified above, that are 
 15.22  denied essential community provider status by the department of 
 15.23  health, or who have had essential community provider status for 
 15.24  three years, medical assistance payments for health services 
 15.25  provided by these entities shall be according to the same rates 
 15.26  and conditions applicable to the same service provided by health 
 15.27  care providers that are not federally qualified health centers 
 15.28  or rural health clinics. 
 15.29     This paragraph remains in effect for as long as the 
 15.30  Minnesota health care reform waiver remains in effect.  When the 
 15.31  waiver expires, this paragraph expires, and the commissioner of 
 15.32  human services shall publish a notice in the State Register and 
 15.33  notify the revisor of statutes. 
 15.34     Sec. 26.  [256B.0645] [PROVIDER PAYMENTS; RETROACTIVE 
 15.35  CHANGES IN ELIGIBILITY.] 
 15.36     Payment to a provider for a health care service provided to 
 16.1   a general assistance medical care recipient who is later 
 16.2   determined eligible for medical assistance or MinnesotaCare 
 16.3   according to section 256.9367 for the period in which the health 
 16.4   care service was provided, shall be considered payment in full, 
 16.5   and shall not be adjusted due to the change in eligibility.  
 16.6   This section applies to both fee-for-service payments and 
 16.7   payments made to health plans on a prepaid capitated basis. 
 16.8      Sec. 27.  Minnesota Statutes 1994, section 256B.69, 
 16.9   subdivision 2, is amended to read: 
 16.10     Subd. 2.  [DEFINITIONS.] For the purposes of this section, 
 16.11  the following terms have the meanings given.  
 16.12     (a) "Commissioner" means the commissioner of human services.
 16.13  For the remainder of this section, the commissioner's 
 16.14  responsibilities for methods and policies for implementing the 
 16.15  project will be proposed by the project advisory committees and 
 16.16  approved by the commissioner.  
 16.17     (b) "Demonstration provider" means an individual, agency, 
 16.18  organization, or group of these entities that participates in 
 16.19  the demonstration project according to criteria, standards, 
 16.20  methods, and other requirements established for the project and 
 16.21  approved by the commissioner.  
 16.22     (c) "Eligible individuals" means those persons eligible for 
 16.23  medical assistance benefits as defined in sections 256B.055, 
 16.24  256B.056, and 256B.06. 
 16.25     (d) "Limitation of choice" means suspending freedom of 
 16.26  choice while allowing eligible individuals to choose among the 
 16.27  demonstration providers.  
 16.28     (e) This paragraph supersedes paragraph (c) as long as the 
 16.29  Minnesota health care reform waiver remains in effect.  When the 
 16.30  waiver expires, this paragraph expires and the commissioner of 
 16.31  human services shall publish a notice in the State Register and 
 16.32  notify the revisor of statutes.  "Eligible individuals" means 
 16.33  those persons eligible for medical assistance benefits as 
 16.34  defined in sections 256B.055, 256B.056, and 256B.06.  
 16.35  Notwithstanding sections 256B.055, 256B.056, and 256B.06, an 
 16.36  individual who becomes ineligible for the program because of 
 17.1   failure to submit income reports or recertification forms in a 
 17.2   timely manner, shall remain enrolled in the prepaid health plan 
 17.3   and shall remain eligible to receive medical assistance coverage 
 17.4   through the last day of the month following the month in which 
 17.5   the enrollee became ineligible for the medical assistance 
 17.6   program. 
 17.7      Sec. 28.  Minnesota Statutes 1994, section 256B.69, 
 17.8   subdivision 4, is amended to read: 
 17.9      Subd. 4.  [LIMITATION OF CHOICE.] The commissioner shall 
 17.10  develop criteria to determine when limitation of choice may be 
 17.11  implemented in the experimental counties.  The criteria shall 
 17.12  ensure that all eligible individuals in the county have 
 17.13  continuing access to the full range of medical assistance 
 17.14  services as specified in subdivision 6.  The commissioner shall 
 17.15  exempt the following persons from participation in the project, 
 17.16  in addition to those who do not meet the criteria for limitation 
 17.17  of choice:  (1) persons eligible for medical assistance 
 17.18  according to section 256B.055, subdivision 1, and children under 
 17.19  age 21 who are in foster placement; (2) persons eligible for 
 17.20  medical assistance due to blindness or disability as determined 
 17.21  by the social security administration or the state medical 
 17.22  review team, unless they are 65 years of age or older, or unless 
 17.23  they reside in Itasca county or they reside in a county in which 
 17.24  the commissioner conducts a pilot project under a waiver granted 
 17.25  pursuant to section 1115 of the Social Security Act; (3) 
 17.26  recipients who currently have private coverage through a health 
 17.27  maintenance organization; and (4) recipients who are eligible 
 17.28  for medical assistance by spending down excess income for 
 17.29  medical expenses other than the nursing facility per diem 
 17.30  expense.  Before limitation of choice is implemented, eligible 
 17.31  individuals shall be notified and after notification, shall be 
 17.32  allowed to choose only among demonstration providers.  After 
 17.33  initially choosing a provider, the recipient is allowed to 
 17.34  change that choice only at specified times as allowed by the 
 17.35  commissioner.  If a demonstration provider ends participation in 
 17.36  the project for any reason, a recipient enrolled with that 
 18.1   provider must select a new provider but may change providers 
 18.2   without cause once more within the first 60 days after 
 18.3   enrollment with the second provider. 
 18.4      Sec. 29.  Laws 1993, First Special Session chapter 1, 
 18.5   article 8, section 30, subdivision 2, is amended to read: 
 18.6      Subd. 2.  Sections 1 to 3, 8, 9, 13 to 17, 22, 23, and 26 
 18.7   to 29 are effective July 1, 1994, contingent upon federal 
 18.8   recognition that group residential housing payments qualify as 
 18.9   optional state supplement payments to the supplemental security 
 18.10  income program under title XVI of the Social Security Act and 
 18.11  confer categorical eligibility for medical assistance under the 
 18.12  state plan for medical assistance.  The amendments and repeals 
 18.13  by Laws 1993, First Special Session chapter 1, article 8, 
 18.14  sections 1 to 3, 8, 9, 13 to 17, 22, 23, 26, and 29 are 
 18.15  effective July 1, 1994. 
 18.16     Sec. 30.  [REPEALER.] 
 18.17     Minnesota Statutes 1994, section 256.9353, subdivisions 4 
 18.18  and 5, are repealed. 
 18.19     Sec. 31.  [EFFECTIVE DATE.] 
 18.20     Sections 5 to 8 (256.9366 to 256.9369), 22 to 26 (256B.055, 
 18.21  subdivision 10a; 256B.057, subdivision 1b; 256B.057, subdivision 
 18.22  2b; 256B.0625, subdivision 30; and 256B.69, subdivision 2) are 
 18.23  effective July 1, 1995.  The commissioner of human services 
 18.24  shall publish a notice in the State Register and notify the 
 18.25  revisor of statutes when the waiver expires and the provisions 
 18.26  in this section expire.