1.1                          A bill for an act 
  1.2             relating to human services; exempting individuals 
  1.3             whose only income is a personal needs allowance from 
  1.4             state health care program co-payments; amending 
  1.5             Minnesota Statutes 2003 Supplement, sections 
  1.6             256B.0631, subdivision 2; 256D.03, subdivision 4; 
  1.7             256L.035. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2003 Supplement, section 
  1.10  256B.0631, subdivision 2, is amended to read: 
  1.11     Subd. 2.  [EXCEPTIONS.] Co-payments shall be subject to the 
  1.12  following exceptions: 
  1.13     (1) children under the age of 21; 
  1.14     (2) pregnant women for services that relate to the 
  1.15  pregnancy or any other medical condition that may complicate the 
  1.16  pregnancy; 
  1.17     (3) recipients ~~expected to reside for at least 30 days in a~~ 
  1.18  ~~hospital, nursing home, or intermediate care facility for the~~ 
  1.19  ~~mentally retarded~~ whose only available income is a personal 
  1.20  needs allowance under section 256B.35 or 256B.36; 
  1.21     (4) recipients receiving hospice care; 
  1.22     (5) 100 percent federally funded services provided by an 
  1.23  Indian health service; 
  1.24     (6) emergency services; 
  1.25     (7) family planning services; 
  1.26     (8) services that are paid by Medicare, resulting in the 
  2.1   medical assistance program paying for the coinsurance and 
  2.3   deductible; and 
  2.4      (9) co-payments that exceed one per day per provider for 
  2.5   nonpreventive visits, eyeglasses, and nonemergency visits to a 
  2.6   hospital-based emergency room. 
  2.7      Sec. 2.  Minnesota Statutes 2003 Supplement, section 
  2.8   256D.03, subdivision 4, is amended to read: 
  2.9      Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] 
  2.10  (a)(i) For a person who is eligible under subdivision 3, 
  2.11  paragraph (a), clause (2), item (i), general assistance medical 
  2.12  care covers, except as provided in paragraph (c): 
  2.13     (1) inpatient hospital services; 
  2.14     (2) outpatient hospital services; 
  2.15     (3) services provided by Medicare certified rehabilitation 
  2.16  agencies; 
  2.17     (4) prescription drugs and other products recommended 
  2.18  through the process established in section 256B.0625, 
  2.19  subdivision 13; 
  2.20     (5) equipment necessary to administer insulin and 
  2.21  diagnostic supplies and equipment for diabetics to monitor blood 
  2.22  sugar level; 
  2.23     (6) eyeglasses and eye examinations provided by a physician 
  2.24  or optometrist; 
  2.25     (7) hearing aids; 
  2.26     (8) prosthetic devices; 
  2.27     (9) laboratory and X-ray services; 
  2.28     (10) physician's services; 
  2.29     (11) medical transportation except special transportation; 
  2.30     (12) chiropractic services as covered under the medical 
  2.31  assistance program; 
  2.32     (13) podiatric services; 
  2.33     (14) dental services and dentures, subject to the 
  2.34  limitations specified in section 256B.0625, subdivision 9; 
  2.35     (15) outpatient services provided by a mental health center 
  2.36  or clinic that is under contract with the county board and is 
  2.37  established under section 245.62; 
  3.1      (16) day treatment services for mental illness provided 
  3.2   under contract with the county board; 
  3.3      (17) prescribed medications for persons who have been 
  3.4   diagnosed as mentally ill as necessary to prevent more 
  3.5   restrictive institutionalization; 
  3.6      (18) psychological services, medical supplies and 
  3.7   equipment, and Medicare premiums, coinsurance and deductible 
  3.8   payments; 
  3.9      (19) medical equipment not specifically listed in this 
  3.10  paragraph when the use of the equipment will prevent the need 
  3.11  for costlier services that are reimbursable under this 
  3.12  subdivision; 
  3.13     (20) services performed by a certified pediatric nurse 
  3.14  practitioner, a certified family nurse practitioner, a certified 
  3.15  adult nurse practitioner, a certified obstetric/gynecological 
  3.16  nurse practitioner, a certified neonatal nurse practitioner, or 
  3.17  a certified geriatric nurse practitioner in independent 
  3.18  practice, if (1) the service is otherwise covered under this 
  3.19  chapter as a physician service, (2) the service provided on an 
  3.20  inpatient basis is not included as part of the cost for 
  3.21  inpatient services included in the operating payment rate, and 
  3.22  (3) the service is within the scope of practice of the nurse 
  3.23  practitioner's license as a registered nurse, as defined in 
  3.24  section 148.171; 
  3.25     (21) services of a certified public health nurse or a 
  3.26  registered nurse practicing in a public health nursing clinic 
  3.27  that is a department of, or that operates under the direct 
  3.28  authority of, a unit of government, if the service is within the 
  3.29  scope of practice of the public health nurse's license as a 
  3.30  registered nurse, as defined in section 148.171; and 
  3.31     (22) telemedicine consultations, to the extent they are 
  3.32  covered under section 256B.0625, subdivision 3b.  
  3.33     (ii) Effective October 1, 2003, for a person who is 
  3.34  eligible under subdivision 3, paragraph (a), clause (2), item 
  3.35  (ii), general assistance medical care coverage is limited to 
  3.36  inpatient hospital services, including physician services 
  4.1   provided during the inpatient hospital stay.  A $1,000 
  4.2   deductible is required for each inpatient hospitalization.  
  4.3      (b) Gender reassignment surgery and related services are 
  4.4   not covered services under this subdivision unless the 
  4.5   individual began receiving gender reassignment services prior to 
  4.6   July 1, 1995.  
  4.7      (c) In order to contain costs, the commissioner of human 
  4.8   services shall select vendors of medical care who can provide 
  4.9   the most economical care consistent with high medical standards 
  4.10  and shall where possible contract with organizations on a 
  4.11  prepaid capitation basis to provide these services.  The 
  4.12  commissioner shall consider proposals by counties and vendors 
  4.13  for prepaid health plans, competitive bidding programs, block 
  4.14  grants, or other vendor payment mechanisms designed to provide 
  4.15  services in an economical manner or to control utilization, with 
  4.16  safeguards to ensure that necessary services are provided.  
  4.17  Before implementing prepaid programs in counties with a county 
  4.18  operated or affiliated public teaching hospital or a hospital or 
  4.19  clinic operated by the University of Minnesota, the commissioner 
  4.20  shall consider the risks the prepaid program creates for the 
  4.21  hospital and allow the county or hospital the opportunity to 
  4.22  participate in the program in a manner that reflects the risk of 
  4.23  adverse selection and the nature of the patients served by the 
  4.24  hospital, provided the terms of participation in the program are 
  4.25  competitive with the terms of other participants considering the 
  4.26  nature of the population served.  Payment for services provided 
  4.27  pursuant to this subdivision shall be as provided to medical 
  4.28  assistance vendors of these services under sections 256B.02, 
  4.29  subdivision 8, and 256B.0625.  For payments made during fiscal 
  4.30  year 1990 and later years, the commissioner shall consult with 
  4.31  an independent actuary in establishing prepayment rates, but 
  4.32  shall retain final control over the rate methodology.  
  4.33     (d) Recipients eligible under subdivision 3, paragraph (a), 
  4.34  clause (2), item (i), shall pay the following co-payments for 
  4.35  services provided on or after October 1, 2003: 
  4.36     (1) $3 per nonpreventive visit.  For purposes of this 
  5.1   subdivision, a visit means an episode of service which is 
  5.2   required because of a recipient's symptoms, diagnosis, or 
  5.3   established illness, and which is delivered in an ambulatory 
  5.4   setting by a physician or physician ancillary, chiropractor, 
  5.5   podiatrist, nurse midwife, advanced practice nurse, audiologist, 
  5.6   optician, or optometrist; 
  5.7      (2) $25 for eyeglasses; 
  5.8      (3) $25 for nonemergency visits to a hospital-based 
  5.9   emergency room; 
  5.10     (4) $3 per brand-name drug prescription and $1 per generic 
  5.11  drug prescription, subject to a $20 per month maximum for 
  5.12  prescription drug co-payments.  No co-payments shall apply to 
  5.13  antipsychotic drugs when used for the treatment of mental 
  5.14  illness; and 
  5.15     (5) 50 percent coinsurance on basic restorative dental 
  5.16  services. 
  5.17     (e) Recipients of general assistance medical care are 
  5.18  responsible for all co-payments in this subdivision, except that 
  5.19  this requirement does not apply to recipients receiving group 
  5.20  residential housing payments under chapter 256I whose available 
  5.21  income is limited to a personal needs allowance under section 
  5.22  256B.35.  The general assistance medical care reimbursement to 
  5.23  the provider shall be reduced by the amount of the co-payment, 
  5.24  except that reimbursement for prescription drugs shall not be 
  5.25  reduced once a recipient has reached the $20 per month maximum 
  5.26  for prescription drug co-payments.  The provider collects the 
  5.27  co-payment from the recipient.  Providers may not deny services 
  5.28  to recipients who are unable to pay the co-payment, except as 
  5.29  provided in paragraph (f). 
  5.30     (f) If it is the routine business practice of a provider to 
  5.31  refuse service to an individual with uncollected debt, the 
  5.32  provider may include uncollected co-payments under this 
  5.33  section.  A provider must give advance notice to a recipient 
  5.34  with uncollected debt before services can be denied. 
  5.35     (g) Any county may, from its own resources, provide medical 
  5.36  payments for which state payments are not made. 
  6.1      (h) Chemical dependency services that are reimbursed under 
  6.2   chapter 254B must not be reimbursed under general assistance 
  6.3   medical care. 
  6.4      (i) The maximum payment for new vendors enrolled in the 
  6.5   general assistance medical care program after the base year 
  6.6   shall be determined from the average usual and customary charge 
  6.7   of the same vendor type enrolled in the base year. 
  6.8      (j) The conditions of payment for services under this 
  6.9   subdivision are the same as the conditions specified in rules 
  6.10  adopted under chapter 256B governing the medical assistance 
  6.11  program, unless otherwise provided by statute or rule. 
  6.12     (k) Inpatient and outpatient payments shall be reduced by 
  6.13  five percent, effective July 1, 2003.  This reduction is in 
  6.14  addition to the five percent reduction effective July 1, 2003, 
  6.15  and incorporated by reference in paragraph (i).  
  6.16     (l) Payments for all other health services except 
  6.17  inpatient, outpatient, and pharmacy services shall be reduced by 
  6.18  five percent, effective July 1, 2003.  
  6.19     (m) Payments to managed care plans shall be reduced by five 
  6.20  percent for services provided on or after October 1, 2003. 
  6.21     (n) A hospital receiving a reduced payment as a result of 
  6.22  this section may apply the unpaid balance toward satisfaction of 
  6.23  the hospital's bad debts. 
  6.24     Sec. 3.  Minnesota Statutes 2003 Supplement, section 
  6.25  256L.035, is amended to read: 
  6.26     256L.035 [LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE 
  6.27  ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.] 
  6.28     (a) "Covered health services" for individuals under section 
  6.29  256L.04, subdivision 7, with income above 75 percent, but not 
  6.30  exceeding 175 percent, of the federal poverty guideline means: 
  6.31     (1) inpatient hospitalization benefits with a ten percent 
  6.32  co-payment up to $1,000 and subject to an annual limitation of 
  6.33  $10,000; 
  6.34     (2) physician services provided during an inpatient stay; 
  6.35  and 
  6.36     (3) physician services not provided during an inpatient 
  7.1   stay, outpatient hospital services, chiropractic services, lab 
  7.2   and diagnostic services, and prescription drugs, subject to an 
  7.3   aggregate cap of $2,000 per calendar year and the following 
  7.4   co-payments: 
  7.5      (i) $50 co-pay per emergency room visit; 
  7.6      (ii) $3 co-pay per prescription drug; and 
  7.7      (iii) $5 co-pay per nonpreventive physician visit. 
  7.8      For purposes of this subdivision, "a visit" means an 
  7.9   episode of service which is required because of a recipient's 
  7.10  symptoms, diagnosis, or established illness, and which is 
  7.11  delivered in an ambulatory setting by a physician or physician 
  7.12  ancillary. 
  7.13     Enrollees are responsible for all co-payments in this 
  7.14  subdivision, except that this requirement does not apply to 
  7.15  enrollees receiving group residential housing payments under 
  7.16  chapter 256I whose available income is limited to a personal 
  7.17  needs allowance under section 256B.35. 
  7.18     (b) The November 2006 MinnesotaCare forecast for the 
  7.19  biennium beginning July 1, 2007, shall assume an adjustment in 
  7.20  the aggregate cap on the services identified in paragraph (a), 
  7.21  clause (3), in $1,000 increments up to a maximum of $10,000, but 
  7.22  not less than $2,000, to the extent that the balance in the 
  7.23  health care access fund is sufficient in each year of the 
  7.24  biennium to pay for this benefit level.  The aggregate cap shall 
  7.25  be adjusted according to the forecast. 
  7.26     (c) Reimbursement to the providers shall be reduced by the 
  7.27  amount of the co-payment, except that reimbursement for 
  7.28  prescription drugs shall not be reduced once a recipient has 
  7.29  reached the $20 per month maximum for prescription drug 
  7.30  co-payments.  The provider collects the co-payment from the 
  7.31  recipient.  Providers may not deny services to recipients who 
  7.32  are unable to pay the co-payment, except as provided in 
  7.33  paragraph (d). 
  7.34     (d) If it is the routine business practice of a provider to 
  7.35  refuse service to an individual with uncollected debt, the 
  7.36  provider may include uncollected co-payments under this 
  8.1   section.  A provider must give advance notice to a recipient 
  8.2   with uncollected debt before services can be denied.