1.1 	A bill for an act
1.2 	relating to human services; changing MinnesotaCare
1.3 	provisions to align with practice; amending Minnesota
1.4 	Statutes 2004, sections 256.045, subdivision 3a;
1.5 	256B.02, subdivision 12; 256B.056, subdivisions 5, 5a,
1.6 	5b, 7, by adding subdivisions; 256B.057, subdivision
1.7 	1; 256B.0644; 256D.045; 256L.01, subdivisions 4, 5;
1.8 	256L.03, subdivision 1b; 256L.04, subdivision 2, by
1.9 	adding subdivisions; 256L.05, subdivisions 3, 3a;
1.10 	256L.07, subdivisions 1, 3, by adding a subdivision;
1.11 	256L.15, subdivisions 2, 3; 549.02, by adding a
1.12 	subdivision; 549.04.
1.13 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.14 	Section 1. Minnesota Statutes 2004, section 256.045,
1.15 	subdivision 3a, is amended to read:
1.16 		Subd. 3a.Prepaid health plan appeals.  (a) All prepaid
1.17 	health plans under contract to the commissioner under chapter
1.18 	256B or 256D must provide for a complaint system according to
1.19 	section 62D.11.  When a prepaid health plan denies, reduces, or
1.20 	terminates a health service or denies a request to authorize a
1.21 	previously authorized health service, the prepaid health plan
1.22 	must notify the recipient of the right to file a complaint or an
1.23 	appeal.  The notice must include the name and telephone number
1.24 	of the ombudsman and notice of the recipient's right to request
1.25 	a hearing under paragraph (b). When a complaint is filed, the
1.26 	prepaid health plan must notify the ombudsman within three
1.27 	working days.Recipients may request the assistance of the
1.28 	ombudsman in the complaint system process.  The prepaid health
1.29 	plan must issue a written resolution of the complaint to the
2.1 	recipient within 30 days after the complaint is filed with the
2.2 	prepaid health plan.  A recipient is not required to exhaust the
2.3 	complaint system procedures in order to request a hearing under
2.4 	paragraph (b).
2.5 	(b) Recipients enrolled in a prepaid health plan under
2.6 	chapter 256B or 256D may contest a prepaid health plan's denial,
2.7 	reduction, or termination of health services, a prepaid health
2.8 	plan's denial of a request to authorize a previously authorized
2.9 	health service, or the prepaid health plan's written resolution
2.10 	of a complaint by submitting a written request for a hearing
2.11 	according to subdivision 3.  A state human services referee
2.12 	shall conduct a hearing on the matter and shall recommend an
2.13 	order to the commissioner of human services.  The commissioner
2.14 	need not grant a hearing if the sole issue raised by a recipient
2.15 	is the commissioner's authority to require mandatory enrollment
2.16 	in a prepaid health plan in a county where prepaid health plans
2.17 	are under contract with the commissioner.  The state human
2.18 	services referee may order a second medical opinion from the
2.19 	prepaid health plan or may order a second medical opinion from a
2.20 	nonprepaid health plan provider at the expense of the prepaid
2.21 	health plan.  Recipients may request the assistance of the
2.22 	ombudsman in the appeal process.
2.23 	(c) In the written request for a hearing to appeal from a
2.24 	prepaid health plan's denial, reduction, or termination of a
2.25 	health service, a prepaid health plan's denial of a request to
2.26 	authorize a previously authorized service, or the prepaid health
2.27 	plan's written resolution to a complaint, a recipient may
2.28 	request an expedited hearing.  If an expedited appeal is
2.29 	warranted, the state human services referee shall hear the
2.30 	appeal and render a decision within a time commensurate with the
2.31 	level of urgency involved, based on the individual circumstances
2.32 	of the case.

2.33 	Sec. 2. Minnesota Statutes 2004, section 256B.02,
2.34 	subdivision 12, is amended to read:
2.35 		Subd. 12.Third-party payer.  "Third-party payer" means a
2.36 	person, entity, or agency or government program that has a
3.1 	probable obligation to pay all or part of the costs of a medical
3.2 	assistance recipient's health services. Third-party payer
3.3 	includes an entity under contract with the recipient to cover
3.4 	all or part of the recipient's medical costs.

3.5 	Sec. 3. Minnesota Statutes 2004, section 256B.056, is
3.6 	amended by adding a subdivision to read:
3.7 		Subd. 3d.Reduction of excess assets. Assets in excess
3.8 	of the limits set forth in subdivisions 3 to 3c may be reduced
3.9 	to allowable limits as follows:
3.10 	(a) Assets may be reduced in any of the three calendar
3.11 	months before the month of application in which the applicant
3.12 	seeks coverage by:
3.13 	(1) designating burial funds up to $1500 for each
3.14 	applicant, spouse, and MA-eligible dependent child; and 
3.15 	(2) paying health service bills incurred in the retroactive
3.16 	period for which the applicant seeks eligibility, starting with
3.17 	the oldest bill.  After assets are reduced to allowable limits,
3.18 	eligibility begins with the next dollar of MA-covered health
3.19 	services incurred in the retroactive period.  Applicants
3.20 	reducing assets under this subdivision who also have excess
3.21 	income shall first spend excess assets to pay health service
3.22 	bills and may meet the income spenddown on remaining bills.
3.23 	(b) Assets may be reduced beginning the month of
3.24 	application by:
3.25 	(1) paying bills for health services that would otherwise
3.26 	be paid by medical assistance; and 
3.27 	(2) using any means other than a transfer of assets for
3.28 	less than fair market value as defined in section 256B.0595,
3.29 	subdivision 1, paragraph (b).

3.30 	Sec. 4. Minnesota Statutes 2004, section 256B.056,
3.31 	subdivision 5, is amended to read:
3.32 		Subd. 5.Excess income.  A person who has excess income
3.33 	is eligible for medical assistance if the person has expenses
3.34 	for medical care that are more than the amount of the person's
3.35 	excess income, computed by deducting incurred medical expenses
3.36 	from the excess income to reduce the excess to the income
4.1 	standard specified in subdivision 5c.  The person shall elect to
4.2 	have the medical expenses deducted at the beginning of a
4.3 	one-month budget period or at the beginning of a six-month
4.4 	budget period.  The commissioner shall allow persons eligible
4.5 	for assistance on a one-month spenddown basis under this
4.6 	subdivision to elect to pay the monthly spenddown amount in
4.7 	advance of the month of eligibility to the state agency in order
4.8 	to maintain eligibility on a continuous basis.  If the recipient
4.9 	does not pay the spenddown amount on or before the 20th last
4.10 	business day of the month, the recipient is ineligible for this
4.11 	option for the following month.  The local agency shall code the
4.12 	Medicaid Management Information System (MMIS) to indicate that
4.13 	the recipient has elected this option.  The state agency shall
4.14 	convey recipient eligibility information relative to the
4.15 	collection of the spenddown to providers through the Electronic
4.16 	Verification System (EVS).  A recipient electing advance payment
4.17 	must pay the state agency the monthly spenddown amount on or
4.18 	before noon on the 20th last business day of the month in order
4.19 	to be eligible for this option in the following month.
4.20 	
EFFECTIVE DATE. This section is effective March 1, 2006,
4.21 	or upon HealthMatch implementation, whichever is later.

4.22 	Sec. 5. Minnesota Statutes 2004, section 256B.056,
4.23 	subdivision 5a, is amended to read:
4.24 		Subd. 5a.Individuals on fixed or excluded income.
 4.25 	Recipients of medical assistance who receive only fixed unearned
4.26 	or excluded income, when that income is excluded from
4.27 	consideration as income or unvarying in amount and timing of
4.28 	receipt throughout the year, shall report and verify their
4.29 	income annually every 12 months.  The 12-month period begins
4.30 	with the month of application.
4.31 	
EFFECTIVE DATE. This section is effective March 1, 2006,
4.32 	or upon HealthMatch implementation, whichever is later.

4.33 	Sec. 6. Minnesota Statutes 2004, section 256B.056,
4.34 	subdivision 5b, is amended to read:
4.35 		Subd. 5b.Individuals with low income.  Recipients of
4.36 	medical assistance not residing in a long-term care facility who
5.1 	have slightly fluctuating income which is below the medical
5.2 	assistance income limit shall report and verify their income on
5.3 	a semiannual basis every six months.  The six-month period
5.4 	begins the month of application.
5.5 	
EFFECTIVE DATE. This section is effective March 1, 2006,
5.6 	or upon HealthMatch implementation, whichever is later.

5.7 	Sec. 7. Minnesota Statutes 2004, section 256B.056,
5.8 	subdivision 7, is amended to read:
5.9 		Subd. 7.Period of eligibility.  Eligibility is available
5.10 	for the month of application and for three months prior to
5.11 	application if the person was eligible in those prior
5.12 	months. Eligibility for months prior to application is
5.13 	determined independently from eligibility for the month of
5.14 	application and future months.A redetermination of eligibility
5.15 	must occur every 12 months. The 12-month period begins with the
5.16 	month of application.
5.17 	
EFFECTIVE DATE. This section is effective March 1, 2006,
5.18 	or upon HealthMatch implementation, whichever is later.

5.19 	Sec. 8. Minnesota Statutes 2004, section 256B.056, is
5.20 	amended by adding a subdivision to read:
5.21 		Subd. 9.Notice. The state agency must be given notice
5.22 	of monetary claims against a person, entity, or corporation that
5.23 	may be liable to pay all or part of the cost of medical care
5.24 	when the state agency has paid or becomes liable for the cost of
5.25 	that care.  Notice must be given according to paragraphs (a) to
5.26 	(d).
5.27 	(a) An applicant for medical assistance shall notify the
5.28 	state or local agency of any possible claims when the applicant
5.29 	submits the application.  A recipient of medical assistance
5.30 	shall notify the state or local agency of any possible claims
5.31 	when those claims arise.
5.32 	(b) A person providing medical care services to a recipient
5.33 	of medical assistance shall notify the state agency when the
5.34 	person has reason to believe that a third party may be liable
5.35 	for payment of the cost of medical care.
5.36 	(c) A party to a claim that may be assigned to the state
6.1 	agency under this section shall notify the state agency of its
6.2 	potential assignment claim in writing at each of the following
6.3 	stages of a claim:
6.4 	(1) when a claim is filed;
6.5 	(2) when an action is commenced; and 
6.6 	(3) when a claim is concluded by payment, award, judgment,
6.7 	settlement, or otherwise.
6.8 	(d) Every party involved in any stage of a claim under this
6.9 	subdivision is required to provide notice to the state agency at
6.10 	that stage of the claim.  However, when one of the parties to
6.11 	the claim provides notice at that stage, every other party to
6.12 	the claim is deemed to have provided the required notice for
6.13 	that stage of the claim.  If the required notice under this
6.14 	paragraph is not provided to the state agency, all parties to
6.15 	the claim are deemed to have failed to provide the required
6.16 	notice.  A party to the claim includes the injured person or the
6.17 	person's legal representative, the plaintiff, the defendants, or
6.18 	persons alleged to be responsible for compensating the injured
6.19 	person or plaintiff, and any other party to the cause of action
6.20 	or claim, regardless of whether the party knows the state agency
6.21 	has a potential or actual assignment claim.

6.22 	Sec. 9. Minnesota Statutes 2004, section 256B.057,
6.23 	subdivision 1, is amended to read:
6.24 		Subdivision 1.Infants and pregnant women.  (a) (1) An
6.25 	infant less than one year of age is eligible for medical
6.26 	assistance if countable family income is equal to or less than
6.27 	275 percent of the federal poverty guideline for the same family
6.28 	size.  A pregnant woman who has written verification of a
6.29 	positive pregnancy test from a physician or licensed registered
6.30 	nurse is eligible for medical assistance if countable family
6.31 	income is equal to or less than 200 275 percent of the federal
6.32 	poverty guideline for the same family size.  For purposes of
6.33 	this subdivision, "countable family income" means the amount of
6.34 	income considered available using the methodology of the AFDC
6.35 	program under the state's AFDC plan as of July 16, 1996, as
6.36 	required by the Personal Responsibility and Work Opportunity
7.1 	Reconciliation Act of 1996 (PRWORA), Public Law 104-193, except
7.2 	for the earned income disregard and employment deductions.
7.3 	(2) For applications processed within one calendar month
7.4 	prior to the effective date, eligibility shall be determined by
7.5 	applying the income standards and methodologies in effect prior
7.6 	to the effective date for any months in the six-month budget
7.7 	period before that date and the income standards and
7.8 	methodologies in effect on the effective date for any months in
7.9 	the six-month budget period on or after that date.  The income
7.10 	standards for each month shall be added together and compared to
7.11 	the applicant's total countable income for the six-month budget
7.12 	period to determine eligibility.
7.13 	(b) (1)  (Expired, 1Sp2003 c 14 art 12 s 19) 
7.14 	(2) For applications processed within one calendar month
7.15 	prior to July 1, 2003, eligibility shall be determined by
7.16 	applying the income standards and methodologies in effect prior
7.17 	to July 1, 2003, for any months in the six-month budget period
7.18 	before July 1, 2003, and the income standards and methodologies
7.19 	in effect on the expiration date for any months in the six-month
7.20 	budget period on or after July 1, 2003.  The income standards
7.21 	for each month shall be added together and compared to the
7.22 	applicant's total countable income for the six-month budget
7.23 	period to determine eligibility.
7.24 	(c) Dependent care and child support paid under court order
7.25 	shall be deducted from the countable income of pregnant
7.26 	women.An amount equal to the amount of earned income exceeding
7.27 	275 percent of the federal poverty guideline plus the earned
7.28 	income disregards and deductions of the AFDC program under the
7.29 	state's AFDC plan as of July 16, 1996, as required by the
7.30 	Personal Responsibility and Work Opportunity Reconciliation Act
7.31 	of 1996 (PRWORA), Public Law 104-193, that exceeds 275 percent
7.32 	of the federal poverty guideline will be deducted for pregnant
7.33 	women and infants less than one year of age.
7.34 	(d) An infant born on or after January 1, 1991, to a woman
7.35 	who was eligible for and receiving medical assistance on the
7.36 	date of the child's birth shall continue to be eligible for
8.1 	medical assistance without redetermination until the child's
8.2 	first birthday, as long as the child remains in the woman's
8.3 	household.
8.4 	
EFFECTIVE DATE. The amendment to paragraph (a) is
8.5 	effective retroactively from July 1, 2004, and the amendment to
8.6 	paragraph (b) is effective retroactively from October 1, 2003.

8.7 	Sec. 10. Minnesota Statutes 2004, section 256B.0644, is
8.8 	amended to read:
8.9 	256B.0644 PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER
8.10 	OTHER STATE HEALTH CARE PROGRAMS.
8.11 	A vendor of medical care, as defined in section 256B.02,
8.12 	subdivision 7, with the exception of a dental provider,and a
8.13 	health maintenance organization, as defined in chapter 62D, must
8.14 	participate as a provider or contractor in the medical
8.15 	assistance program, general assistance medical care program, and
8.16 	MinnesotaCare as a condition of participating as a provider in
8.17 	health insurance plans and programs or contractor for state
8.18 	employees established under section 43A.18, the public employees
8.19 	insurance program under section 43A.316, for health insurance
8.20 	plans offered to local statutory or home rule charter city,
8.21 	county, and school district employees, the workers' compensation
8.22 	system under section 176.135, and insurance plans provided
8.23 	through the Minnesota Comprehensive Health Association under
8.24 	sections 62E.01 to 62E.19.  The limitations on insurance plans
8.25 	offered to local government employees shall not be applicable in
8.26 	geographic areas where provider participation is limited by
8.27 	managed care contracts with the Department of Human Services.
8.28 	For providers other than health maintenance organizations,
8.29 	participation in the medical assistance program means that (1) 
8.30 	the provider accepts new medical assistance, general assistance
8.31 	medical care, and MinnesotaCare patients or (2) for providers
8.32 	other than dental service providers, and at least 20 percent of
8.33 	the provider's patients are covered by medical assistance,
8.34 	general assistance medical care, and MinnesotaCare as their
8.35 	primary source of coverage, or (3) for dental service providers,
8.36 	at least ten percent of the provider's patients are covered by
9.1 	medical assistance, general assistance medical care, and
9.2 	MinnesotaCare as their primary source of coverage.  Patients
9.3 	seen on a volunteer basis by the provider at a location other
9.4 	than the provider's usual place of practice may be considered in
9.5 	meeting this participation requirement.  The commissioner shall
9.6 	establish participation requirements for health maintenance
9.7 	organizations.  The commissioner shall provide lists of
9.8 	participating medical assistance providers on a quarterly basis
9.9 	to the commissioner of employee relations, the commissioner of
9.10 	labor and industry, and the commissioner of commerce.  Each of
9.11 	the commissioners shall develop and implement procedures to
9.12 	exclude as participating providers in the program or programs
9.13 	under their jurisdiction those providers who do not participate
9.14 	in the medical assistance program.  The commissioner of employee
9.15 	relations shall implement this section through contracts with
9.16 	participating health and dental carriers.

9.17 	Sec. 11. Minnesota Statutes 2004, section 256D.045, is
9.18 	amended to read:
9.19 	256D.045 SOCIAL SECURITY NUMBER REQUIRED.
9.20 	To be eligible for general assistance under sections
9.21 	256D.01 to 256D.21, an individual must provide the individual's
9.22 	Social Security number to the county agency or submit proof that
9.23 	an application has been made. An individual who refuses to
9.24 	provide a Social Security number because of a well-established
9.25 	religious objection as described in Code of Federal Regulations,
9.26 	title 42, section 435.910, may be eligible for general
9.27 	assistance medical care under section 256D.03.The provisions
9.28 	of this section do not apply to the determination of eligibility
9.29 	for emergency general assistance under section 256D.06,
9.30 	subdivision 2.  This provision applies to eligible children
9.31 	under the age of 18 effective July 1, 1997.

9.32 	EFFECTIVE DATE. This section is effective March 1, 2006,
9.33 	or upon HealthMatch implementation, whichever is later.

9.34 	Sec. 12. Minnesota Statutes 2004, section 256L.01,
9.35 	subdivision 4, is amended to read:
9.36 		Subd. 4.Gross individual or gross family income.  (a)
10.1 	"Gross individual or gross family income" for nonfarm
10.2 	self-employed means income calculated for the six-month period
10.3 	of eligibility using as the baseline the adjusted gross income
10.4 	reported on the applicant's federal income tax form for the
10.5 	previous year and adding back in reported depreciation,
10.6 	carryover loss, and net operating loss amounts that apply to the
10.7 	business in which the family is currently engaged.
10.8 	(b) "Gross individual or gross family income" for farm
10.9 	self-employed means income calculated for the six-month period
10.10 	of eligibility using as the baseline the adjusted gross income
10.11 	reported on the applicant's federal income tax form for the
10.12 	previous year and adding back in reported depreciation amounts
10.13 	that apply to the business in which the family is currently
10.14 	engaged.
10.15 	(c) Applicants shall report the most recent financial
10.16 	situation of the family if it has changed from the period of
10.17 	time covered by the federal income tax form.  The report may be
10.18 	in the form of percentage increase or decrease "Gross individual
10.19 	or gross family income" means the total income for all family
10.20 	members, calculated for the six-month period of eligibility.
10.21 	
EFFECTIVE DATE. This section is effective March 1, 2006,
10.22 	or upon HealthMatch implementation, whichever is later.

10.23 	Sec. 13. Minnesota Statutes 2004, section 256L.01,
10.24 	subdivision 5, is amended to read:
10.25 		Subd. 5.Income. (a) "Income" has the meaning given for
10.26 	earned and unearned income for families and children in the
10.27 	medical assistance program, according to the state's aid to
10.28 	families with dependent children plan in effect as of July 16,
10.29 	1996.  The definition does not include medical assistance income
10.30 	methodologies and deeming requirements.  The earned income of
10.31 	full-time and part-time students under age 19 is not counted as
10.32 	income.  Public assistance payments and supplemental security
10.33 	income are not excluded income.
10.34 	(b) For purposes of this subdivision, and unless otherwise
10.35 	specified in this section, the commissioner shall use reasonable
10.36 	methods to calculate gross earned and unearned income including,
11.1 	but not limited to, projecting income based on income received
11.2 	within the past 30 days, the last 90 days, or the last 12 months.
11.3 	
EFFECTIVE DATE. This section is effective July 1, 2005.

11.4 	Sec. 14. Minnesota Statutes 2004, section 256L.03,
11.5 	subdivision 1b, is amended to read:
11.6 		Subd. 1b.Pregnant women; eligibility for full medical
11.7 	assistance services. Beginning January 1, 1999,A pregnant 
11.8 	woman who is enrolled in MinnesotaCare when her pregnancy is
11.9 	diagnosed is eligible for coverage of all services provided
11.10 	under the medical assistance program according to chapter 256B
11.11 	retroactive to the date the pregnancy is medically diagnosed of
11.12 	conception.  Co-payments totaling $30 or more, paid after the
11.13 	date the pregnancy is diagnosed of conception, shall be refunded.

11.14 	Sec. 15. Minnesota Statutes 2004, section 256L.04, is
11.15 	amended by adding a subdivision to read:
11.16 		Subd. 1a.Social security number required. (a)
11.17 	Individuals and families applying for MinnesotaCare coverage
11.18 	must provide a Social Security number.
11.19 	(b) The commissioner shall not deny eligibility to an
11.20 	otherwise eligible applicant who has applied for a Social
11.21 	Security number and is awaiting issuance of that Social Security
11.22 	number.
11.23 	(c) Newborns enrolled under section 256L.05, subdivision 3,
11.24 	are exempt from the requirements of this subdivision.
11.25 	(d) Individuals who refuse to provide a Social Security
11.26 	number because of well-established religious objections are
11.27 	exempt from the requirements of this subdivision.  The term
11.28 	"well-established religious objections" has the meaning given in
11.29 	Code of Federal Regulations, title 42, section 435.910.
11.30 	
EFFECTIVE DATE. This section is effective March 1, 2006,
11.31 	or upon HealthMatch implementation, whichever is later.

11.32 	Sec. 16. Minnesota Statutes 2004, section 256L.04,
11.33 	subdivision 2, is amended to read:
11.34 		Subd. 2.Cooperation in establishing third-party
11.35 	liability, paternity, and other medical support.  (a) To be
11.36 	eligible for MinnesotaCare, individuals and families must
12.1 	cooperate with the state agency to identify potentially liable
12.2 	third-party payers and assist the state in obtaining third-party
12.3 	payments.  "Cooperation" includes, but is not limited
12.4 	to, complying with the notice requirements in section 256B.056,
12.5 	subdivision 9,identifying any third party who may be liable for
12.6 	care and services provided under MinnesotaCare to the enrollee,
12.7 	providing relevant information to assist the state in pursuing a
12.8 	potentially liable third party, and completing forms necessary
12.9 	to recover third-party payments.
12.10 	(b) A parent, guardian, relative caretaker, or child
12.11 	enrolled in the MinnesotaCare program must cooperate with the
12.12 	Department of Human Services and the local agency in
12.13 	establishing the paternity of an enrolled child and in obtaining
12.14 	medical care support and payments for the child and any other
12.15 	person for whom the person can legally assign rights, in
12.16 	accordance with applicable laws and rules governing the medical
12.17 	assistance program.  A child shall not be ineligible for or
12.18 	disenrolled from the MinnesotaCare program solely because the
12.19 	child's parent, relative caretaker, or guardian fails to
12.20 	cooperate in establishing paternity or obtaining medical support.

12.21 	Sec. 17. Minnesota Statutes 2004, section 256L.04, is
12.22 	amended by adding a subdivision to read:
12.23 		Subd. 2a.Applications for other benefits. To be
12.24 	eligible for MinnesotaCare, individuals and families must take
12.25 	all necessary steps to obtain other benefits as described in
12.26 	Code of Federal Regulations, title 42, section 435.608.
12.27 	Applicants and enrollees must apply for other benefits within 30
12.28 	days.
12.29 	
EFFECTIVE DATE. This section is effective March 1, 2006,
12.30 	or upon HealthMatch implementation, whichever is later.

12.31 	Sec. 18. Minnesota Statutes 2004, section 256L.05,
12.32 	subdivision 3, is amended to read:
12.33 		Subd. 3.Effective date of coverage.  (a) The effective
12.34 	date of coverage is the first day of the month following the
12.35 	month in which eligibility is approved and the first premium
12.36 	payment has been received.  As provided in section 256B.057,
13.1 	coverage for newborns is automatic from the date of birth and
13.2 	must be coordinated with other health coverage.  The effective
13.3 	date of coverage for eligible newly adoptive children added to a
13.4 	family receiving covered health services is the date of entry
13.5 	into the family month of placement or the month placement is
13.6 	reported, whichever is later.  The effective date of coverage
13.7 	for other new recipients members added to the family receiving
13.8 	covered health services is the first day of the month following
13.9 	the month in which eligibility is approved or at renewal,
13.10 	whichever the family receiving covered health services
13.11 	prefers the change is reported.  All eligibility criteria must
13.12 	be met by the family at the time the new family member is
13.13 	added.  The income of the new family member is included with the
13.14 	family's gross income and the adjusted premium begins in the
13.15 	month the new family member is added.
13.16 	(b) The initial premium must be received by the last
13.17 	working day of the month for coverage to begin the first day of
13.18 	the following month.
13.19 	(c) Benefits are not available until the day following
13.20 	discharge if an enrollee is hospitalized on the first day of
13.21 	coverage.
13.22 	(d) Notwithstanding any other law to the contrary, benefits
13.23 	under sections 256L.01 to 256L.18 are secondary to a plan of
13.24 	insurance or benefit program under which an eligible person may
13.25 	have coverage and the commissioner shall use cost avoidance
13.26 	techniques to ensure coordination of any other health coverage
13.27 	for eligible persons.  The commissioner shall identify eligible
13.28 	persons who may have coverage or benefits under other plans of
13.29 	insurance or who become eligible for medical assistance.
13.30 	
EFFECTIVE DATE. This section is effective March 1, 2006,
13.31 	or upon HealthMatch implementation, whichever is later.

13.32 	Sec. 19. Minnesota Statutes 2004, section 256L.05,
13.33 	subdivision 3a, is amended to read:
13.34 		Subd. 3a.Renewal of eligibility.  (a) Beginning January
13.35 	1, 1999, an enrollee's eligibility must be renewed every 12
13.36 	months.  The 12-month period begins in the month after the month
14.1 	the application is approved.
14.2 	(b) Beginning October 1, 2004, an enrollee's eligibility
14.3 	must be renewed every six months.  The first six-month period of
14.4 	eligibility begins in the month after the month the application
14.5 	is approved received by the commissioner.  Each new period of
14.6 	eligibility must take into account any changes in circumstances
14.7 	that impact eligibility and premium amount.  An enrollee must
14.8 	provide all the information needed to redetermine eligibility by
14.9 	the first day of the month that ends the eligibility period.
14.10 	The premium for the new period of eligibility must be received
14.11 	as provided in section 256L.06 in order for eligibility to
14.12 	continue.
14.13 	
EFFECTIVE DATE. This section is effective March 1, 2006,
14.14 	or upon HealthMatch implementation, whichever is later.

14.15 	Sec. 20. Minnesota Statutes 2004, section 256L.07,
14.16 	subdivision 1, is amended to read:
14.17 		Subdivision 1.General requirements.  (a) Children
14.18 	enrolled in the original children's health plan as of September
14.19 	30, 1992, children who enrolled in the MinnesotaCare program
14.20 	after September 30, 1992, pursuant to Laws 1992, chapter 549,
14.21 	article 4, section 17, and children who have family gross
14.22 	incomes that are equal to or less than 150 percent of the
14.23 	federal poverty guidelines are eligible without meeting the
14.24 	requirements of subdivision 2 and the four-month requirement in
14.25 	subdivision 3, as long as they maintain continuous coverage in
14.26 	the MinnesotaCare program or medical assistance.  Children who
14.27 	apply for MinnesotaCare on or after the implementation date of
14.28 	the employer-subsidized health coverage program as described in
14.29 	Laws 1998, chapter 407, article 5, section 45, who have family
14.30 	gross incomes that are equal to or less than 150 percent of the
14.31 	federal poverty guidelines, must meet the requirements of
14.32 	subdivision 2 to be eligible for MinnesotaCare.
14.33 	(b) Families enrolled in MinnesotaCare under section
14.34 	256L.04, subdivision 1, whose income increases above 275 percent
14.35 	of the federal poverty guidelines, are no longer eligible for
14.36 	the program and shall be disenrolled by the commissioner.
15.1 	Individuals enrolled in MinnesotaCare under section 256L.04,
15.2 	subdivision 7, whose income increases above 175 percent of the
15.3 	federal poverty guidelines are no longer eligible for the
15.4 	program and shall be disenrolled by the commissioner.  For
15.5 	persons disenrolled under this subdivision, MinnesotaCare
15.6 	coverage terminates the last day of the calendar month following
15.7 	the month in which the commissioner determines that the income
15.8 	of a family or individual exceeds program income limits.
15.9 	(c)(1) Notwithstanding paragraph (b), families enrolled in
15.10 	MinnesotaCare under section 256L.04, subdivision 1, may remain
15.11 	enrolled in MinnesotaCare if ten percent of their annual income
15.12 	is less than the annual premium for a policy with a $500
15.13 	deductible available through the Minnesota Comprehensive Health
15.14 	Association.  Families who are no longer eligible for
15.15 	MinnesotaCare under this subdivision shall be given an 18-month
15.16 	notice period from the date that ineligibility is determined
15.17 	before disenrollment.  This clause expires February 1, 2004.
15.18 	(2) Effective February 1, 2004, notwithstanding paragraph
15.19 	(b), children may remain enrolled in MinnesotaCare if ten
15.20 	percent of their annual gross individual or gross family income
15.21 	as defined in section 256L.01, subdivision 4,is less than the
15.22 	annual premium for a six-month policy with a $500 deductible
15.23 	available through the Minnesota Comprehensive Health
15.24 	Association.  Children who are no longer eligible for
15.25 	MinnesotaCare under this clause shall be given a 12-month notice
15.26 	period from the date that ineligibility is determined before
15.27 	disenrollment.  The premium for children remaining eligible
15.28 	under this clause shall be the maximum premium determined under
15.29 	section 256L.15, subdivision 2, paragraph (b).
15.30 	(d) Effective July 1, 2003, notwithstanding paragraphs (b)
15.31 	and (c), parents are no longer eligible for MinnesotaCare if
15.32 	gross household income exceeds $50,000 $25,000 for the six-month
15.33 	period of eligibility.
15.34 	
EFFECTIVE DATE. This section is effective March 1, 2006,
15.35 	or upon HealthMatch implementation, whichever is later.

15.36 	Sec. 21. Minnesota Statutes 2004, section 256L.07,
16.1 	subdivision 3, is amended to read:
16.2 		Subd. 3.Other health coverage.  (a) Families and
16.3 	individuals enrolled in the MinnesotaCare program must have no
16.4 	health coverage while enrolled or for at least four months prior
16.5 	to application and renewal.  Children enrolled in the original
16.6 	children's health plan and children in families with income
16.7 	equal to or less than 150 percent of the federal poverty
16.8 	guidelines, who have other health insurance, are eligible if the
16.9 	coverage:
16.10 	(1) lacks two or more of the following:
16.11 	(i) basic hospital insurance;
16.12 	(ii) medical-surgical insurance;
16.13 	(iii) prescription drug coverage;
16.14 	(iv) dental coverage; or
16.15 	(v) vision coverage;
16.16 	(2) requires a deductible of $100 or more per person per
16.17 	year; or
16.18 	(3) lacks coverage because the child has exceeded the
16.19 	maximum coverage for a particular diagnosis or the policy
16.20 	excludes a particular diagnosis.
16.21 	The commissioner may change this eligibility criterion for
16.22 	sliding scale premiums in order to remain within the limits of
16.23 	available appropriations.  The requirement of no health coverage
16.24 	does not apply to newborns.
16.25 	(b) Medical assistance, general assistance medical care,
16.26 	and the Civilian Health and Medical Program of the Uniformed
16.27 	Service, CHAMPUS, or other coverage provided under United States
16.28 	Code, title 10, subtitle A, part II, chapter 55, are not
16.29 	considered insurance or health coverage for purposes of the
16.30 	four-month requirement described in this subdivision.
16.31 	(c) For purposes of this subdivision, Medicare Part A or B
16.32 	coverage under title XVIII of the Social Security Act, United
16.33 	States Code, title 42, sections 1395c to 1395w-4, is considered
16.34 	health coverage.  An applicant or enrollee may not refuse
16.35 	Medicare coverage to establish eligibility for MinnesotaCare.
16.36 	(d) Applicants who were recipients of medical assistance or
17.1 	general assistance medical care within one month of application
17.2 	must meet the provisions of this subdivision and subdivision 2.
17.3 	(e) Effective October 1, 2003, applicants who were
17.4 	recipients of medical assistance and had Cost-effective health
17.5 	insurance which that was paid for by medical assistance are
17.6 	exempt from is not considered health coverage for purposes of 
17.7 	the four-month requirement under this section, except if the
17.8 	insurance continued after medical assistance no longer
17.9 	considered it cost-effective or after medical assistance closed.

17.10 	Sec. 22. Minnesota Statutes 2004, section 256L.07, is
17.11 	amended by adding a subdivision to read:
17.12 		Subd. 5.Voluntary disenrollment for members of
17.13 	military. Notwithstanding section 256L.05, subdivision 3b,
17.14 	MinnesotaCare enrollees who are members of the military and
17.15 	their families, who choose to voluntarily disenroll from the
17.16 	program when one or more family members are called to active
17.17 	duty, may reenroll during or following that member's tour of
17.18 	active duty.  Those individuals and families shall be considered
17.19 	to have good cause for voluntary termination under section
17.20 	256L.06, subdivision 3, paragraph (d).  Income and asset
17.21 	increases reported at the time of reenrollment shall be
17.22 	disregarded.  All provisions of sections 256L.01 to 256L.18,
17.23 	shall apply to individuals and families enrolled under this
17.24 	subdivision upon six-month renewal.
17.25 	
EFFECTIVE DATE. This section is effective July 1, 2005.

17.26 	Sec. 23. Minnesota Statutes 2004, section 256L.15,
17.27 	subdivision 2, is amended to read:
17.28 		Subd. 2.Sliding fee scale to determine percentage of
17.29 	monthly gross individual or family income.  (a) The commissioner
17.30 	shall establish a sliding fee scale to determine the percentage
17.31 	of monthly gross individual or family income that households at
17.32 	different income levels must pay to obtain coverage through the
17.33 	MinnesotaCare program.  The sliding fee scale must be based on
17.34 	the enrollee's monthly gross individual or family income.  The
17.35 	sliding fee scale must contain separate tables based on
17.36 	enrollment of one, two, or three or more persons.  The sliding
18.1 	fee scale begins with a premium of 1.5 percent of monthly gross
18.2 	individual or family income for individuals or families with
18.3 	incomes below the limits for the medical assistance program for
18.4 	families and children in effect on January 1, 1999, and proceeds
18.5 	through the following evenly spaced steps:  1.8, 2.3, 3.1, 3.8,
18.6 	4.8, 5.9, 7.4, and 8.8 percent.  These percentages are matched
18.7 	to evenly spaced income steps ranging from the medical
18.8 	assistance income limit for families and children in effect on
18.9 	January 1, 1999, to 275 percent of the federal poverty
18.10 	guidelines for the applicable family size, up to a family size
18.11 	of five.  The sliding fee scale for a family of five must be
18.12 	used for families of more than five.  Effective October 1, 2003,
18.13 	the commissioner shall increase each percentage by 0.5
18.14 	percentage points for enrollees with income greater than 100
18.15 	percent but not exceeding 200 percent of the federal poverty
18.16 	guidelines and shall increase each percentage by 1.0 percentage
18.17 	points for families and children with incomes greater than 200
18.18 	percent of the federal poverty guidelines.  The sliding fee
18.19 	scale and percentages are not subject to the provisions of
18.20 	chapter 14.  If a family or individual reports increased income
18.21 	after enrollment, premiums shall not be adjusted until
18.22 	eligibility renewal.
18.23 	(b)(1) Enrolled families whose gross annual income
18.24 	increases above 275 percent of the federal poverty guideline
18.25 	shall pay the maximum premium.  This clause expires effective
18.26 	February 1, 2004.
18.27 	(2) Effective February 1, 2004, children in families whose
18.28 	gross income is above 275 percent of the federal poverty
18.29 	guidelines shall pay the maximum premium.
18.30 	(3) The maximum premium is defined as a base charge for
18.31 	one, two, or three or more enrollees so that if all
18.32 	MinnesotaCare cases paid the maximum premium, the total revenue
18.33 	would equal the total cost of MinnesotaCare medical coverage and
18.34 	administration.  In this calculation, administrative costs shall
18.35 	be assumed to equal ten percent of the total.  The costs of
18.36 	medical coverage for pregnant women and children under age two
19.1 	and the enrollees in these groups shall be excluded from the
19.2 	total.  The maximum premium for two enrollees shall be twice the
19.3 	maximum premium for one, and the maximum premium for three or
19.4 	more enrollees shall be three times the maximum premium for one.
19.5 	
EFFECTIVE DATE. This section is effective March 1, 2006,
19.6 	or upon implementation of HealthMatch, whichever is later.

19.7 	Sec. 24. Minnesota Statutes 2004, section 256L.15,
19.8 	subdivision 3, is amended to read:
19.9 		Subd. 3.Exceptions to sliding scale. An annual premium
19.10 	of $48 is required for all Children in families with income at
19.11 	or less than below 150 percent of the federal poverty guidelines
19.12 	pay a monthly premium of $4.
19.13 	
EFFECTIVE DATE. This section is effective March 1, 2006,
19.14 	or upon implementation of HealthMatch, whichever is later.

19.15 	Sec. 25. Minnesota Statutes 2004, section 549.02, is
19.16 	amended by adding a subdivision to read:
19.17 		Subd. 3.Limitation. Notwithstanding subdivisions 1 and
19.18 	2, where the state agency is named or intervenes as a party to
19.19 	enforce the agency's rights under section 256B.056, the agency
19.20 	shall not be liable for costs to any prevailing defendant.

19.21 	Sec. 26. Minnesota Statutes 2004, section 549.04, is
19.22 	amended to read:
19.23 	549.04 DISBURSEMENTS; TAXATION AND ALLOWANCE.
19.24 		Subdivision 1.Generally. In every action in a district
19.25 	court, the prevailing party, including any public employee who
19.26 	prevails in an action for wrongfully denied or withheld
19.27 	employment benefits or rights, shall be allowed reasonable
19.28 	disbursements paid or incurred, including fees and mileage paid
19.29 	for service of process by the sheriff or by a private person.
19.30 		Subd. 2.Limitation. Notwithstanding subdivision 1,
19.31 	where the state agency is named or intervenes as a party to
19.32 	enforce the agency's rights under section 256B.056, the agency
19.33 	shall not be liable for disbursements to any prevailing
19.34 	defendant.

19.35 	Sec. 27. PLANNING PROCESS FOR MANAGED CARE.
 19.36 	The commissioner of human services shall develop a planning
20.1 	process for the purposes of implementing at least one additional
20.2 	managed care arrangement to provide medical assistance services,
20.3 	excluding continuing care services, to recipients enrolled in
20.4 	the medical assistance fee-for-service program, effective
20.5 	January 1, 2007.  This planning process shall include an
20.6 	advisory committee composed of current fee-for-service
20.7 	consumers, consumer advocates, and providers, as well as
20.8 	representatives of health plans and other provider organizations
20.9 	qualified to provide basic health care services to persons with
20.10 	disabilities.  The department shall seek any additional federal
20.11 	authority necessary to provide basic health care services
20.12 	through contracted managed care arrangements.