1.1                          A bill for an act 
  1.2             relating to human services; establishing payments for 
  1.3             post-kidney transplant maintenance drugs; 
  1.4             appropriating money; proposing coding for new law in 
  1.5             Minnesota Statutes, chapter 256. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [256.9364] [PAYMENTS FOR POST-KIDNEY TRANSPLANT 
  1.8   MAINTENANCE DRUGS.] 
  1.9      (a) The department of human services shall establish and 
  1.10  administer a program to pay recipients for costs of drugs 
  1.11  prescribed exclusively for post-kidney transplant maintenance 
  1.12  when those costs are not otherwise reimbursed.  The department 
  1.13  shall establish eligibility standards and an application process 
  1.14  by rule. 
  1.15     (b) Participation in the program shall be limited to 
  1.16  persons whose household income is not greater than 200 percent 
  1.17  of the federal poverty level as established by the federal 
  1.18  Office of Management and Budget. 
  1.19     (c) The program shall be available only to eligible 
  1.20  Minnesota residents who have resided in Minnesota for at least 
  1.21  12 months, however, a resident shall not be excluded because the 
  1.22  resident received the transplant outside the state of Minnesota. 
  1.23     (d) The department shall pay a maximum amount per kidney 
  1.24  transplant recipient based on the following: 
  1.25     (1) available money; 
  2.1      (2) covered immunosuppressive drugs; 
  2.2      (3) the terms of any contract between the department and 
  2.3   the provider; and 
  2.4      (4) the reimbursement rates shall be the same as the 
  2.5   Medicaid reimbursement rate for the drug, minus the copayment. 
  2.6      (e) Payment shall be made under the program to or on behalf 
  2.7   of a program-eligible recipient only for costs not reimbursed or 
  2.8   eligible for reimbursement by any other third party or 
  2.9   government entity including, without limitation, private or 
  2.10  group insurance, Medicaid, Medicare, or the Veterans 
  2.11  Administration.  The commissioner may waive this requirement for 
  2.12  individual cases if the commissioner determines that enforcement 
  2.13  will deny services to a class of post-kidney transplant patients 
  2.14  because of conflicting state or federal laws or regulations.  
  2.15  The department of human services shall adopt rules to ensure 
  2.16  that all third parties and government entities including, 
  2.17  without limitation, private or group insurance, Medicaid, 
  2.18  Medicare, or the Veterans Administration make all required 
  2.19  benefit payments. 
  2.20     (f) The commissioner may restrict or categorize 
  2.21  reimbursements to meet budgetary limitations. 
  2.22     (g) The commissioner shall maintain an immunosuppressive 
  2.23  drug formulary that shall include all drugs eligible for 
  2.24  reimbursement by the program.  The commissioner shall establish 
  2.25  an internal review procedure for updating the formulary; the 
  2.26  procedure shall allow the addition and deletion of allowable 
  2.27  drugs to the formulary.  The internal review procedure shall 
  2.28  take place at least quarterly during a fiscal year. 
  2.29     (h) Payments made under the program established under this 
  2.30  section shall be made, subject to appropriations, from the 
  2.31  post-kidney transplant maintenance drug fund, a special fund 
  2.32  that is hereby established in the state treasury.  The following 
  2.33  shall be deposited into the fund:  (1) amounts appropriated to 
  2.34  the department for that purpose; and (2) gifts, grants, and 
  2.35  donations for that purpose from public and private sources.  
  2.36  Interest accruing on money in the fund shall remain in the 
  3.1   fund.  Money in the fund may be used only by the department to 
  3.2   make payments for post-kidney transplant maintenance drugs under 
  3.3   the program established under this section. 
  3.4      (i) Money remaining in the post-kidney transplant 
  3.5   maintenance drug fund at the end of the fiscal year may be used 
  3.6   in the following fiscal year. 
  3.7      Sec. 2.  [APPROPRIATION.] 
  3.8      $....... is appropriated from the general fund to the 
  3.9   commissioner of human services for the purposes in section 1.  
  3.10  This appropriation does not cancel and is available until 
  3.11  expended. 
  3.12     Sec. 3.  [EFFECTIVE DATE.] 
  3.13     Sections 1 and 2 are effective July 1, 1997.