1.1 	A bill for an act
1.2 	relating to human services; creating a program for
1.3 	individuals with HIV; appropriating money; amending
1.4 	Minnesota Statutes 2004, section 256.9365, by adding a
1.5 	subdivision; proposing coding for new law in Minnesota
1.6 	Statutes, chapter 256.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. [256.9370] HIV PREVENTION AND HEALTH CARE
1.9 	ACCESS PROGRAM.
1.10 		Subdivision 1.Purpose. The commissioner of human
1.11 	services shall establish an HIV prevention and health care
1.12 	access program for low-income Minnesotans that:
1.13 	(1) provides access to HIV treatment consistent with the
1.14 	guidelines of the United States Public Health Service;
1.15 	(2) promotes reduction of HIV transmission through
1.16 	continuous and uninterrupted access to treatment consistent with
1.17 	the United States Public Health Service guidelines;
1.18 	(3) provides uniform benefits that are comprehensive as
1.19 	defined by the most recent recommendations of the Institute of
1.20 	Medicine and medically appropriate as established by the United
1.21 	States Public Health Service to best meet HIV needs with a
1.22 	minimum of administrative cost and efforts;
1.23 	(4) ensures service delivery accountability to the people
1.24 	it serves, including due notice; opportunities for community
1.25 	input; and uniform, transparent procedures communicated to
1.26 	current and eligible persons, their health care and social
2.1 	service providers, community planning and advisory groups, and
2.2 	agencies established under the Ryan White Care Act;
2.3 	(5) provides access to HIV treatment inclusive of treatment
2.4 	for substance abuse and mental health treatment as those
2.5 	conditions interfere with HIV treatment adherence; and 
2.6 	(6) provides initial and continued access to HIV treatment
2.7 	that is, to the maximum extent practicable, without regard to
2.8 	the ability of the person to pay for the services and without
2.9 	regard to the current or past health condition of the person
2.10 	with HIV.
2.11 		Subd. 2.Establishment. The commissioner of human
2.12 	services shall establish a program to provide prescription drug
2.13 	coverage and basic early intervention diagnostic services and to
2.14 	pay private health plan premiums for persons who have contracted
2.15 	human immunodeficiency virus (HIV) to enable them to secure or
2.16 	continue coverage under a group or individual health plan and to
2.17 	ensure continuous comprehensive treatment.
2.18 		Subd. 3.Eligibility requirements. (a) To be eligible
2.19 	for the program, an applicant must satisfy the following
2.20 	requirements:
2.21 	(1) the applicant must be HIV positive;
2.22 	(2) the applicant must:
2.23 	(i) have no health insurance coverage, or be undercovered
2.24 	for medications;
2.25 	(ii) have no health insurance coverage because of
2.26 	ineligibility due to a preexisting condition;
2.27 	(iii) face losing health insurance coverage due to a change
2.28 	in employment status; or 
2.29 	(iv) have limited coverage not consistent with the
2.30 	guidelines of the United States Public Health Service for best
2.31 	practice HIV treatment;
2.32 	(3) the applicant's monthly gross family income must not
2.33 	exceed 300 percent of the federal poverty guidelines after
2.34 	deducting medical expenses and insurance premiums; and 
2.35 	(4) the applicant must not own assets with a combined value
2.36 	of more than $30,000, excluding:
3.1 	(i) all assets excluded under section 256B.056;
3.2 	(ii) retirement accounts, Keogh plans, and pension plans;
3.3 	and 
3.4 	(iii) medical expense accounts set up through the
3.5 	individual's employer.
3.6 	(b) To be eligible for drug reimbursement, the applicant
3.7 	may not be a recipient of medical assistance, medical assistance
3.8 	for employed persons with disabilities, or general assistance
3.9 	medical care.
3.10 	(c) Individuals whose income and assets exceed the amounts
3.11 	established in paragraph (a), but who meet all the other
3.12 	eligibility requirements, shall be eligible for this program
3.13 	upon payment of a premium.  The premium shall be based on the
3.14 	person's gross income using a sliding fee scale established by
3.15 	the commissioner.  The premium shall not exceed ten percent of
3.16 	the person's annual gross income.
3.17 		Subd. 4.Benefits. (a) If an individual is determined to
3.18 	be eligible under subdivision 3, the commissioner shall pay that
3.19 	portion of the group plan premium for which the individual is
3.20 	responsible or shall pay the individual plan premium.  The
3.21 	commissioner shall not pay for that portion of a premium that is
3.22 	attributable to other family members or dependents.
3.23 	Requirements for the payment of individual plan premiums under
3.24 	this section must be designed to ensure that the state cost of
3.25 	paying an individual plan premium does not exceed the estimated
3.26 	state cost that would otherwise be incurred in the medical
3.27 	assistance and general assistance medical care program.  The
3.28 	commissioner shall purchase the most cost-effective coverage
3.29 	available for eligible individuals.
3.30 	(b) If an individual is determined to be eligible under
3.31 	subdivision 3, the program benefits shall provide access to HIV
3.32 	drugs and related drug treatments included in the HIV care drug
3.33 	formulary established by the commissioner.  The program benefits
3.34 	shall include those services specified in subdivision 1 and
3.35 	shall also provide access to early intervention treatment,
3.36 	including initial diagnostics, hepatitis B and C, sexually
4.1 	transmitted infections, and tuberculosis screening and tests,
4.2 	and any treatment for HIV that is consistent with the guidelines
4.3 	of the United States Public Health Service for HIV best practice
4.4 	treatment.
4.5 	(c) There shall be no co-payments or premiums or
4.6 	cost-shares charged to any individual determined to be eligible
4.7 	under subdivision 3, paragraph (a).
4.8 	(d) The state may use nonfederal funds to supplement drug
4.9 	assistance benefits available through the Medicare Part D
4.10 	program.
4.11 	(e) The priority use for all funds received through
4.12 	prescription drug rebates through HIV drug purchases must be
4.13 	used to purchase benefits for eligible persons.
4.14 		Subd. 5.Public advisory process. The commissioner shall
4.15 	establish a transparent, public advisory process for
4.16 	establishing and revising an HIV care drug formulary.  At a
4.17 	minimum, the process shall include consultation with HIV health
4.18 	care providers, HIV social service providers, persons living
4.19 	with HIV, the Minnesota HIV Services Planning Council, and
4.20 	entities directly contracted by the federal government to
4.21 	administer funds from the Ryan White Care Act.  Participants in
4.22 	this process shall be appointed in equal numbers by the
4.23 	commissioner and by the Minnesota HIV Services Planning Council.

4.24 	Sec. 2. Minnesota Statutes 2004, section 256.9365, is
4.25 	amended by adding a subdivision to read:
4.26 		Subd. 4.Expiration. This section expires upon
4.27 	implementation of the HIV prevention and health care access
4.28 	program.

4.29 	Sec. 3. APPROPRIATION.
 4.30 	(a) $12,400,000 is appropriated for the biennium ending
4.31 	June 30, 2007, from the general fund to the commissioner of
4.32 	human services for the purposes of section 1.
4.33 	(b) Funding sources include, but are not limited to, drug
4.34 	rebate funds, the Ryan White Care Act, health care access funds,
4.35 	and the general fund.  The commissioner may use 100 percent of
4.36 	the funds available for the AIDS drug assistance program, but no
5.1 	more than 25 percent of the funds received through the Title II
5.2 	formula allocation.

5.3 	Sec. 4. EFFECTIVE DATE.
 5.4 	Sections 1 to 3 are effective July 1, 2005.