1.1                          A bill for an act 
  1.2             relating to human services; establishing an outreach 
  1.3             campaign for health coverage; creating a preventive 
  1.4             services funding pool; reducing income verification 
  1.5             requirements for medical assistance; providing 
  1.6             12-month continuous coverage under medical assistance; 
  1.7             limiting premiums under MinnesotaCare; creating a 
  1.8             demonstration project for presumptive eligibility; 
  1.9             appropriating money; amending Minnesota Statutes 2000, 
  1.10            sections 256B.04, by adding a subdivision; 256B.056, 
  1.11            subdivisions 4b, 7; 256B.061; 256L.05, subdivisions 2, 
  1.12            4; 256L.07, subdivision 3; 256L.15, subdivisions 1, 2, 
  1.13            3; proposing coding for new law in Minnesota Statutes, 
  1.14            chapter 256B; repealing Minnesota Statutes 2000, 
  1.15            section 256B.056, subdivisions 5a, 5b. 
  1.16  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.17     Section 1.  Minnesota Statutes 2000, section 256B.04, is 
  1.18  amended by adding a subdivision to read: 
  1.19     Subd. 3a.  [CHILD APPLICATION FORMS.] The commissioner 
  1.20  shall develop an application form to be used to determine the 
  1.21  eligibility of a child for medical assistance, general 
  1.22  assistance medical care, and the MinnesotaCare program that does 
  1.23  not exceed one page in length.  The one-page application form 
  1.24  shall request necessary information on family income, monthly 
  1.25  medical expenses, and assets to determine potential eligibility 
  1.26  for the child for these programs.  
  1.27     Sec. 2.  Minnesota Statutes 2000, section 256B.056, 
  1.28  subdivision 4b, is amended to read: 
  1.29     Subd. 4b.  [INCOME VERIFICATION.] The local agency shall 
  1.30  not require a monthly income verification form for a recipient 
  2.1   who is a resident of a long-term care facility and who has 
  2.2   monthly earned income of $80 or less.  An applicant must declare 
  2.3   their income on the application form.  The commissioner or 
  2.4   county agency may verify income through requesting information 
  2.5   from other governmental agencies.  No verification of income is 
  2.6   required by the applicant unless there is a discrepancy between 
  2.7   the declared income of the applicant and the information 
  2.8   received from other governmental agencies.  Recipients of 
  2.9   medical assistance shall report their income on an annual basis. 
  2.10     Sec. 3.  Minnesota Statutes 2000, section 256B.056, 
  2.11  subdivision 7, is amended to read: 
  2.12     Subd. 7.  [PERIOD OF ELIGIBILITY.] Eligibility is available 
  2.13  for the month of application and for three months prior to 
  2.14  application if the person was eligible in those prior months.  A 
  2.15  redetermination of eligibility must occur every 12 months.  Once 
  2.16  an applicant is determined to be eligible, the recipient remains 
  2.17  eligible for a 12-month period regardless of a change in 
  2.18  income.  The 12-month period begins the first day of the month 
  2.19  after the month the application is approved or eligibility is 
  2.20  reapproved.  
  2.21     Sec. 4.  Minnesota Statutes 2000, section 256B.061, is 
  2.22  amended to read: 
  2.23     256B.061 [ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.] 
  2.24     (a) If any individual has been determined to be eligible 
  2.25  for medical assistance, it will be made available for care and 
  2.26  services included under the plan and furnished in or after the 
  2.27  third month before the month in which the individual made 
  2.28  application for such assistance, if such individual was, or upon 
  2.29  application would have been, eligible for medical assistance at 
  2.30  the time the care and services were furnished.  The commissioner 
  2.31  may limit, restrict, or suspend the eligibility of an individual 
  2.32  for up to one year upon that individual's conviction of a 
  2.33  criminal offense related to application for or receipt of 
  2.34  medical assistance benefits. 
  2.35     (b) On the basis of information provided on the completed 
  2.36  application, an applicant who meets the following criteria shall 
  3.1   be determined eligible beginning in the month of application: 
  3.2      (1) whose gross income is less than 90 percent of the 
  3.3   applicable income standard; 
  3.4      (2) whose total liquid assets are less than 90 percent of 
  3.5   the asset limit; 
  3.6      (3) does not reside in a long-term care facility; and 
  3.7      (4) meets all other eligibility requirements. 
  3.8   The applicant must provide all required verifications within 30 
  3.9   days' notice of the eligibility determination or eligibility 
  3.10  shall be terminated. 
  3.11     (c) The commissioner shall develop and implement a pilot 
  3.12  project establishing presumptive eligibility for children with 
  3.13  family income at or below the medical assistance guidelines.  
  3.14  The commissioner shall select locations such as provider 
  3.15  offices, hospitals, clinics, and schools where eligibility for 
  3.16  medical assistance shall be determined on site by a trained 
  3.17  staff person.  A child shall be presumed eligible if the child's 
  3.18  family reported income is less than 90 percent of the applicable 
  3.19  income standard.  If a child whose application indicates 
  3.20  presumptive eligibility is subsequently determined ineligible, 
  3.21  the provider shall be reimbursed under medical assistance for 
  3.22  the services provided at the initial visit under the 
  3.23  fee-for-service medical assistance rate.  The commissioner shall 
  3.24  implement presumptive eligibility on a statewide basis effective 
  3.25  July 1, 2002.  
  3.26     Sec. 5.  [256B.78] [OUTREACH EFFORTS.] 
  3.27     Subdivision 1.  [STATEWIDE CAMPAIGN.] The commissioner of 
  3.28  human services shall coordinate a public/private partnership to 
  3.29  provide a statewide outreach campaign on the importance of 
  3.30  health coverage and the availability of coverage through both 
  3.31  public assistance health care programs and the private health 
  3.32  insurance market.  The campaign shall include messages directed 
  3.33  to the general population as well as culturally specific and 
  3.34  community-based messages.  
  3.35     Subd. 2.  [LOCAL OUTREACH GRANTS.] (a) The commissioner 
  3.36  shall award grants to public or private organizations to provide 
  4.1   local community-based outreach to assist families with children 
  4.2   in obtaining health coverage.  
  4.3      (b) In awarding these grants, the commissioner shall 
  4.4   consider the following:  
  4.5      (1) the ability to contact or serve non-English-speaking 
  4.6   families; 
  4.7      (2) the ability to provide trained workers at accessible 
  4.8   outreach centers to assist families with children to enroll in a 
  4.9   health care program; and 
  4.10     (3) the ability to serve geographic areas and populations 
  4.11  with the greatest disparity in health coverage and health status.
  4.12     (c) The commissioner shall include specific performance 
  4.13  expectations that will require grantees to track the number of 
  4.14  enrollees in state programs, monitor these grants, and may 
  4.15  terminate a grant if the outreach effort does not increase 
  4.16  enrollment in the state health care programs.  
  4.17     Subd. 3.  [LOCAL SITES.] The commissioner shall provide 
  4.18  applications and other health care program information to 
  4.19  provider offices, hospitals, local human services agencies, 
  4.20  community health sites, and elementary schools to encourage and 
  4.21  assist these sites in conducting outreach efforts.  These sites 
  4.22  may assist families with children in enrolling in public 
  4.23  assistance programs and may accept applications and forward the 
  4.24  forms to the commissioner.  
  4.25     Subd. 4.  [TOLL-FREE TELEPHONE NUMBER.] The commissioner 
  4.26  shall implement a toll-free resource telephone number to provide 
  4.27  information on health care coverage options, including 
  4.28  information on medical assistance, general assistance medical 
  4.29  care, and the MinnesotaCare program.  
  4.30     Sec. 6.  [256B.79] [HEALTH CARE PREVENTIVE SERVICES POOL.] 
  4.31     The commissioner of human services shall create an 
  4.32  uncompensated care pool to reimburse community clinics and other 
  4.33  health care providers that provide initial health care 
  4.34  screenings and preventive care services to children who are 
  4.35  uninsured.  The commissioner shall establish a process for 
  4.36  clinics to apply for reimbursement.  As a condition of receiving 
  5.1   payment from this pool, the clinic or provider must provide 
  5.2   on-site enrollment and assistance to help uninsured families 
  5.3   with children obtain coverage.  
  5.4      Sec. 7.  Minnesota Statutes 2000, section 256L.05, 
  5.5   subdivision 2, is amended to read: 
  5.6      Subd. 2.  [COMMISSIONER'S DUTIES.] The commissioner shall 
  5.7   use individuals' social security numbers as identifiers for 
  5.8   purposes of administering the plan and conduct data matches to 
  5.9   verify income.  Applicants shall submit evidence of report 
  5.10  individual and family income, earned and unearned, such as the 
  5.11  most recent income tax return, wage slips, or other 
  5.12  documentation that is determined by the commissioner as 
  5.13  necessary to verify income eligibility.  The commissioner shall 
  5.14  perform random audits to verify reported income and 
  5.15  eligibility.  The commissioner may execute data sharing 
  5.16  arrangements with the department of revenue and any other 
  5.17  governmental agency in order to perform income verification 
  5.18  related to eligibility and premium payment under the 
  5.19  MinnesotaCare program. 
  5.20     Sec. 8.  Minnesota Statutes 2000, section 256L.05, 
  5.21  subdivision 4, is amended to read: 
  5.22     Subd. 4.  [APPLICATION PROCESSING.] The commissioner of 
  5.23  human services shall determine an applicant's eligibility for 
  5.24  MinnesotaCare no more than 30 days from the date that the 
  5.25  application is received by the department of human services.  
  5.26  Beginning January 1, 2000, this requirement also applies to 
  5.27  local county human services agencies that determine eligibility 
  5.28  for MinnesotaCare.  Once annually at application or 
  5.29  reenrollment, to prevent processing delays, applicants or 
  5.30  enrollees who, from the information provided on the application, 
  5.31  appear to meet eligibility requirements shall be enrolled upon 
  5.32  timely payment of premiums.  The enrollee must provide all 
  5.33  required verifications within 30 days of notification of the 
  5.34  eligibility determination or coverage from the program shall be 
  5.35  terminated.  Enrollees who are determined to be ineligible when 
  5.36  verifications are provided shall be disenrolled from the program.
  6.1      Sec. 9.  Minnesota Statutes 2000, section 256L.07, 
  6.2   subdivision 3, is amended to read: 
  6.3      Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
  6.4   individuals enrolled in the MinnesotaCare program must have no 
  6.5   health coverage while enrolled or for at least four months prior 
  6.6   to application and renewal.  Children enrolled in the original 
  6.7   children's health plan and children in families with income 
  6.8   equal to or less than 150 percent of the federal poverty 
  6.9   guidelines, who have other health insurance, are eligible if the 
  6.10  coverage: 
  6.11     (1) lacks two or more of the following: 
  6.12     (i) basic hospital insurance; 
  6.13     (ii) medical-surgical insurance; 
  6.14     (iii) prescription drug coverage; 
  6.15     (iv) dental coverage; or 
  6.16     (v) vision coverage; 
  6.17     (2) requires a deductible of $100 or more per person per 
  6.18  year; or 
  6.19     (3) lacks coverage because the child has exceeded the 
  6.20  maximum coverage for a particular diagnosis or the policy 
  6.21  excludes a particular diagnosis. 
  6.22     The commissioner may change this eligibility criterion for 
  6.23  sliding scale premiums in order to remain within the limits of 
  6.24  available appropriations.  The requirement of no health coverage 
  6.25  does not apply to newborns.  
  6.26     (b) This subdivision does not apply to: 
  6.27     (1) newborns; and 
  6.28     (2) families with children with income equal to or less 
  6.29  than 225 percent of the federal poverty guidelines. 
  6.30     (c) Medical assistance, general assistance medical care, 
  6.31  and civilian health and medical program of the uniformed 
  6.32  service, CHAMPUS, are not considered insurance or health 
  6.33  coverage for purposes of the four-month requirement described in 
  6.34  this subdivision. 
  6.35     (c) (d) For purposes of this subdivision, Medicare Part A 
  6.36  or B coverage under title XVIII of the Social Security Act, 
  7.1   United States Code, title 42, sections 1395c to 1395w-4, is 
  7.2   considered health coverage.  An applicant or enrollee may not 
  7.3   refuse Medicare coverage to establish eligibility for 
  7.4   MinnesotaCare. 
  7.5      (d) (e) Applicants who were recipients of medical 
  7.6   assistance or general assistance medical care within one month 
  7.7   of application must meet the provisions of this subdivision and 
  7.8   subdivision 2. 
  7.9      Sec. 10.  Minnesota Statutes 2000, section 256L.15, 
  7.10  subdivision 1, is amended to read: 
  7.11     Subdivision 1.  [PREMIUM DETERMINATION.] Except as provided 
  7.12  in subdivision 3, families with children and individuals shall 
  7.13  pay a premium determined according to a sliding fee based on a 
  7.14  percentage of the family's gross family income.  Pregnant women 
  7.15  and children under age two are exempt from the provisions of 
  7.16  section 256L.06, subdivision 3, paragraph (b), clause (3), 
  7.17  requiring disenrollment for failure to pay premiums.  For 
  7.18  pregnant women, this exemption continues until the first day of 
  7.19  the month following the 60th day postpartum.  Women who remain 
  7.20  enrolled during pregnancy or the postpartum period, despite 
  7.21  nonpayment of premiums, shall be disenrolled on the first of the 
  7.22  month following the 60th day postpartum for the penalty period 
  7.23  that otherwise applies under section 256L.06, unless they begin 
  7.24  paying premiums. 
  7.25     Sec. 11.  Minnesota Statutes 2000, section 256L.15, 
  7.26  subdivision 2, is amended to read: 
  7.27     Subd. 2.  [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 
  7.28  GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner shall 
  7.29  establish a sliding fee scale to determine the percentage of 
  7.30  gross individual or family income that households at different 
  7.31  income levels must pay to obtain coverage through the 
  7.32  MinnesotaCare program.  The sliding fee scale must be based on 
  7.33  the enrollee's gross individual or family income.  The sliding 
  7.34  fee scale must contain separate tables based on enrollment of 
  7.35  one, two, or three or more persons.  The sliding fee scale 
  7.36  begins with a premium of 1.5 percent of gross individual or 
  8.1   family income for individuals or families with incomes below the 
  8.2   limits for the medical assistance program for families and 
  8.3   children in effect on January 1, 1999, and proceeds through the 
  8.4   following evenly spaced steps:  1.8, 2.3, 3.1, 3.8, and 4.8, 
  8.5   5.9, 7.4, and 8.8 percent.  These percentages are matched to 
  8.6   evenly spaced income steps ranging from the medical assistance 
  8.7   income limit for families and children in effect on January 1, 
  8.8   1999, to 275 percent of the federal poverty guidelines for the 
  8.9   applicable family size, up to a family size of five.  Premiums 
  8.10  for families with children must not be greater than five percent 
  8.11  of the family's gross income.  The sliding fee scale for a 
  8.12  family of five must be used for families of more than five.  The 
  8.13  sliding fee scale and percentages are not subject to the 
  8.14  provisions of chapter 14.  If a family or individual reports 
  8.15  increased income after enrollment, premiums shall not be 
  8.16  adjusted until eligibility renewal. 
  8.17     (b) Enrolled individuals and families whose gross annual 
  8.18  income increases above 275 percent of the federal poverty 
  8.19  guideline shall pay the maximum premium.  The maximum premium is 
  8.20  defined as a base charge for one, two, or three or more 
  8.21  enrollees so that if all MinnesotaCare cases paid the maximum 
  8.22  premium, the total revenue would equal the total cost of 
  8.23  MinnesotaCare medical coverage and administration.  In this 
  8.24  calculation, administrative costs shall be assumed to equal ten 
  8.25  percent of the total.  The costs of medical coverage for 
  8.26  pregnant women and children under age two and the enrollees in 
  8.27  these groups shall be excluded from the total.  The maximum 
  8.28  premium for two enrollees shall be twice the maximum premium for 
  8.29  one, and the maximum premium for three or more enrollees shall 
  8.30  be three times the maximum premium for one. 
  8.31     Sec. 12.  Minnesota Statutes 2000, section 256L.15, 
  8.32  subdivision 3, is amended to read: 
  8.33     Subd. 3.  [EXCEPTIONS TO SLIDING SCALE.] An annual premium 
  8.34  of $48 is required for all children in families with income at 
  8.35  or less than 150 percent of federal poverty guidelines.  No 
  8.36  premiums shall be required from families with children whose 
  9.1   income is equal to or less than 185 percent of the federal 
  9.2   poverty guidelines or from American Indian families with 
  9.3   children.  For purposes of this subdivision, "American Indian" 
  9.4   has the same meaning as given in section 254B.01, subdivision 2. 
  9.5      Sec. 13.  [CONSOLIDATION OF PUBLIC HEALTH CARE PROGRAMS.] 
  9.6      The commissioner of human services shall develop a plan to 
  9.7   streamline and consolidate the public health care programs 
  9.8   through merger, transfer, or reconfiguration of existing health 
  9.9   care programs.  At the request of the commissioner of human 
  9.10  services, units of local government shall provide assistance in 
  9.11  evaluating and consolidating existing state and local health 
  9.12  care programs.  The plan must be presented to the legislature by 
  9.13  January 15, 2002, for implementation by July 1, 2003.  
  9.14     Sec. 14.  [ELIGIBILITY COORDINATION.] 
  9.15     The commissioner of human services shall develop and 
  9.16  implement a pilot project establishing automatic eligibility for 
  9.17  children who have been determined eligible for:  medical 
  9.18  assistance; Supplemental Nutrition Program for Women, Infants, 
  9.19  and Children (WIC); National School Lunch program; the Food 
  9.20  Stamp program, and other means-tested public assistance 
  9.21  programs.  The commissioner shall implement the pilot project by 
  9.22  July 1, 2001, and shall submit to the legislature by January 15, 
  9.23  2002, draft legislation to establish automatic eligibility on a 
  9.24  statewide basis for implementation on July 1, 2002.  
  9.25     Sec. 15.  [QUALITY IMPROVEMENT GRANTS.] 
  9.26     The commissioner of human services shall award grants to 
  9.27  improve the quality of health care services provided to 
  9.28  children.  Priority shall be given to grant applications that: 
  9.29     (1) develop "best practices guidelines" for services 
  9.30  provided to children; 
  9.31     (2) establish community-based quality improvement 
  9.32  collaboratives; and 
  9.33     (3) reduce disparities in child access and health status.  
  9.34     Sec. 16.  [UNINSURED AND UNDERSERVED CHILDREN STUDY.] 
  9.35     The commissioner of human services, in consultation with 
  9.36  the commissioner of health, shall evaluate the effects of the 
 10.1   initiatives adopted by the 2001 legislature to increase the 
 10.2   number of insured children, and make recommendations on other 
 10.3   actions needed to provide coverage to all children by the year 
 10.4   2003, including recommendations on ways to improve access to 
 10.5   affordable private health insurance.  The commissioner shall 
 10.6   also report on the effectiveness of state grants for outreach to 
 10.7   improve preventive services for children enrolled in government 
 10.8   health care programs.  The commissioner shall submit an annual 
 10.9   report to the legislature beginning January 15, 2002. 
 10.10     Sec. 17.  [ONLINE APPLICATION PROCESS.] 
 10.11     The commissioner of human services shall develop an online 
 10.12  application process for medical assistance, general assistance 
 10.13  medical care, and the MinnesotaCare program for implementation 
 10.14  by January 1, 2003. 
 10.15     Sec. 18.  [PRIVATE SECTOR INITIATIVES.] 
 10.16     The commissioner of commerce, in consultation with the 
 10.17  commissioners of health, human services, and revenue, shall 
 10.18  develop recommendations for initiatives to encourage the 
 10.19  purchase of private sector health care coverage for children who 
 10.20  are not eligible for public programs.  In developing the 
 10.21  recommendations, the commissioner must consult with 
 10.22  representatives of the health plan companies, including both 
 10.23  health maintenance organizations and indemnity carriers. 
 10.24     At a minimum, the recommendations must include the 
 10.25  following: 
 10.26     (1) education initiatives to inform the public regarding 
 10.27  the availability and accessibility of existing private sector 
 10.28  health care coverage, including policies that provide coverage 
 10.29  for children only; 
 10.30     (2) tax strategies, including greater use of section 125 
 10.31  plans, that would encourage the purchase of dependent coverage 
 10.32  by parents; 
 10.33     (3) market reform strategies to assure access to private 
 10.34  coverage for children, and associated funding recommendations; 
 10.35  and 
 10.36     (4) a coordinated public and private sector information 
 11.1   campaign highlighting the importance of children having health 
 11.2   care coverage and receiving necessary and timely preventive 
 11.3   services. 
 11.4   The recommendations must be submitted to the legislature by 
 11.5   January 15, 2002. 
 11.6      Sec. 19.  [APPROPRIATION.] 
 11.7      (a) $....... is appropriated for the biennium beginning 
 11.8   July 1, 2001, from the general fund to the commissioner of human 
 11.9   services for the outreach efforts described in Minnesota 
 11.10  Statutes, section 256B.78. 
 11.11     (b) $....... is appropriated for the biennium beginning 
 11.12  July 1, 2001, from the general fund to the commissioner of human 
 11.13  services for the health care preventive services funding pool 
 11.14  established under Minnesota Statutes, section 256B.79. 
 11.15     (c) $....... is appropriated for the biennium beginning 
 11.16  July 1, 2001, from the general fund to the commissioner of human 
 11.17  services for the quality improvement grants. 
 11.18     Sec. 20.  [REPEALER.] 
 11.19     Minnesota Statutes 2000, section 256B.056, subdivisions 5a 
 11.20  and 5b, are repealed.