1.1 	A bill for an act
1.2 	relating to human services; providing for coverage of community health 
1.3 	workers by medical assistance, MinnesotaCare, and general assistance medical 
1.4 	care;amending Minnesota Statutes 2006, sections 256B.0625, by adding a 
1.5 	subdivision; 256D.03, subdivision 4.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2006, section 256B.0625, is amended by adding a 
1.8 	subdivision to read:
1.9 		Subd. 49.Community health worker. Medical assistance covers the services of a 
1.10 	community health worker if the community health worker has earned a certificate from 
1.11 	the Minnesota State Colleges and University System approved community health worker 
1.12 	curriculum. Services provided by community health workers who have at least five years 
1.13 	of supervised experience must be considered eligible for payment but must complete the 
1.14 	certificate program by January 1, 2010. Community health workers shall work under the 
1.15 	supervision of a medical assistance enrolled provider.

1.16 	Sec. 2. Minnesota Statutes 2006, section 256D.03, subdivision 4, is amended to read:
1.17 		Subd. 4.General assistance medical care; services. (a)(i) For a person who is 
1.18 	eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical 
1.19 	care covers, except as provided in paragraph (c):
1.20 	(1) inpatient hospital services;
1.21 	(2) outpatient hospital services;
1.22 	(3) services provided by Medicare certified rehabilitation agencies;
1.23 	(4) prescription drugs and other products recommended through the process 
1.24 	established in section 256B.0625, subdivision 13;
2.1 	(5) equipment necessary to administer insulin and diagnostic supplies and equipment 
2.2 	for diabetics to monitor blood sugar level;
2.3 	(6) eyeglasses and eye examinations provided by a physician or optometrist;
2.4 	(7) hearing aids;
2.5 	(8) prosthetic devices;
2.6 	(9) laboratory and X-ray services;
2.7 	(10) physician's services;
2.8 	(11) medical transportation except special transportation;
2.9 	(12) chiropractic services as covered under the medical assistance program;
2.10 	(13) podiatric services;
2.11 	(14) dental services as covered under the medical assistance program;
2.12 	(15) outpatient services provided by a mental health center or clinic that is under 
2.13 	contract with the county board and is established under section 245.62;
2.14 	(16) day treatment services for mental illness provided under contract with the 
2.15 	county board;
2.16 	(17) prescribed medications for persons who have been diagnosed as mentally ill as 
2.17 	necessary to prevent more restrictive institutionalization;
2.18 	(18) psychological services, medical supplies and equipment, and Medicare 
2.19 	premiums, coinsurance and deductible payments;
2.20 	(19) medical equipment not specifically listed in this paragraph when the use of 
2.21 	the equipment will prevent the need for costlier services that are reimbursable under 
2.22 	this subdivision;
2.23 	(20) services performed by a certified pediatric nurse practitioner, a certified family 
2.24 	nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological 
2.25 	nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse 
2.26 	practitioner in independent practice, if (1) the service is otherwise covered under this 
2.27 	chapter as a physician service, (2) the service provided on an inpatient basis is not included 
2.28 	as part of the cost for inpatient services included in the operating payment rate, and (3) the 
2.29 	service is within the scope of practice of the nurse practitioner's license as a registered 
2.30 	nurse, as defined in section 148.171;
2.31 	(21) services of a certified public health nurse or a registered nurse practicing in 
2.32 	a public health nursing clinic that is a department of, or that operates under the direct 
2.33 	authority of, a unit of government, if the service is within the scope of practice of the 
2.34 	public health nurse's license as a registered nurse, as defined in section 148.171;
2.35 	(22) telemedicine consultations, to the extent they are covered under section 
2.36 	256B.0625, subdivision 3b; and
3.1 	(23) mental health telemedicine and psychiatric consultation as covered under 
3.2 	section 256B.0625, subdivisions 46 and 48.; and
3.3 	(24) services of a community health worker if the community health worker has 
3.4 	earned a certificate from the Minnesota State Colleges and University System approved 
3.5 	community health worker curriculum. Services provided by community health workers 
3.6 	who have at least five years supervised experience must be considered eligible for payment 
3.7 	but must complete the certificate program by January 1, 2010. Community health workers 
3.8 	shall work under the supervision of a medical assistance enrolled provider.
3.9 	(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3, 
3.10 	paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited 
3.11 	to inpatient hospital services, including physician services provided during the inpatient 
3.12 	hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
3.13 	(b) Effective August 1, 2005, sex reassignment surgery is not covered under this 
3.14 	subdivision.
3.15 	(c) In order to contain costs, the commissioner of human services shall select 
3.16 	vendors of medical care who can provide the most economical care consistent with high 
3.17 	medical standards and shall where possible contract with organizations on a prepaid 
3.18 	capitation basis to provide these services. The commissioner shall consider proposals by 
3.19 	counties and vendors for prepaid health plans, competitive bidding programs, block grants, 
3.20 	or other vendor payment mechanisms designed to provide services in an economical 
3.21 	manner or to control utilization, with safeguards to ensure that necessary services are 
3.22 	provided. Before implementing prepaid programs in counties with a county operated or 
3.23 	affiliated public teaching hospital or a hospital or clinic operated by the University of 
3.24 	Minnesota, the commissioner shall consider the risks the prepaid program creates for the 
3.25 	hospital and allow the county or hospital the opportunity to participate in the program in a 
3.26 	manner that reflects the risk of adverse selection and the nature of the patients served by 
3.27 	the hospital, provided the terms of participation in the program are competitive with the 
3.28 	terms of other participants considering the nature of the population served. Payment for 
3.29 	services provided pursuant to this subdivision shall be as provided to medical assistance 
3.30 	vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For 
3.31 	payments made during fiscal year 1990 and later years, the commissioner shall consult 
3.32 	with an independent actuary in establishing prepayment rates, but shall retain final control 
3.33 	over the rate methodology.
3.34 	(d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following 
3.35 	co-payments for services provided on or after October 1, 2003:
3.36 	(1) $25 for eyeglasses;
4.1 	(2) $25 for nonemergency visits to a hospital-based emergency room;
4.2 	(3) $3 per brand-name drug prescription and $1 per generic drug prescription, 
4.3 	subject to a $12 per month maximum for prescription drug co-payments. No co-payments 
4.4 	shall apply to antipsychotic drugs when used for the treatment of mental illness; and
4.5 	(4) 50 percent coinsurance on restorative dental services.
4.6 	(e) Co-payments shall be limited to one per day per provider for nonpreventive visits, 
4.7 	eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of 
4.8 	general assistance medical care are responsible for all co-payments in this subdivision. 
4.9 	The general assistance medical care reimbursement to the provider shall be reduced by 
4.10 	the amount of the co-payment, except that reimbursement for prescription drugs shall not 
4.11 	be reduced once a recipient has reached the $12 per month maximum for prescription 
4.12 	drug co-payments. The provider collects the co-payment from the recipient. Providers 
4.13 	may not deny services to recipients who are unable to pay the co-payment, except as 
4.14 	provided in paragraph (f).
4.15 	(f) If it is the routine business practice of a provider to refuse service to an individual 
4.16 	with uncollected debt, the provider may include uncollected co-payments under this 
4.17 	section. A provider must give advance notice to a recipient with uncollected debt before 
4.18 	services can be denied.
4.19 	(g) Any county may, from its own resources, provide medical payments for which 
4.20 	state payments are not made.
4.21 	(h) Chemical dependency services that are reimbursed under chapter 254B must not 
4.22 	be reimbursed under general assistance medical care.
4.23 	(i) The maximum payment for new vendors enrolled in the general assistance 
4.24 	medical care program after the base year shall be determined from the average usual and 
4.25 	customary charge of the same vendor type enrolled in the base year.
4.26 	(j) The conditions of payment for services under this subdivision are the same as the 
4.27 	conditions specified in rules adopted under chapter 256B governing the medical assistance 
4.28 	program, unless otherwise provided by statute or rule.
4.29 	(k) Inpatient and outpatient payments shall be reduced by five percent, effective July 
4.30 	1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003, 
4.31 	and incorporated by reference in paragraph (i).
4.32 	(l) Payments for all other health services except inpatient, outpatient, and pharmacy 
4.33 	services shall be reduced by five percent, effective July 1, 2003.
4.34 	(m) Payments to managed care plans shall be reduced by five percent for services 
4.35 	provided on or after October 1, 2003.
5.1 	(n) A hospital receiving a reduced payment as a result of this section may apply the 
5.2 	unpaid balance toward satisfaction of the hospital's bad debts.
5.3 	(o) Fee-for-service payments for nonpreventive visits shall be reduced by $3 
5.4 	for services provided on or after January 1, 2006. For purposes of this subdivision, a 
5.5 	visit means an episode of service which is required because of a recipient's symptoms, 
5.6 	diagnosis, or established illness, and which is delivered in an ambulatory setting by 
5.7 	a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse, 
5.8 	audiologist, optician, or optometrist.
5.9 	(p) Payments to managed care plans shall not be increased as a result of the removal 
5.10 	of the $3 nonpreventive visit co-payment effective January 1, 2006.