1.1                          A bill for an act 
  1.2             relating to health; expanding eligibility and 
  1.3             eliminating the funding cap for the senior drug 
  1.4             program; appropriating money; amending Minnesota 
  1.5             Statutes 1998, section 256.955, subdivisions 1, 2, 3, 
  1.6             and 4; Laws 1997, chapter 225, article 4, section 4. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1998, section 256.955, 
  1.9   subdivision 1, is amended to read: 
  1.10     Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  1.11  services shall establish and administer a senior citizen drug 
  1.12  program.  ~~Qualified~~ Senior citizens and other qualified 
  1.13  individuals shall be eligible for prescription drug coverage 
  1.14  under the program beginning no later than January 1, 1999. 
  1.15     Sec. 2.  Minnesota Statutes 1998, section 256.955, 
  1.16  subdivision 2, is amended to read: 
  1.17     Subd. 2.  [DEFINITIONS.] (a) For purposes of this section, 
  1.18  the following definitions apply. 
  1.19     (b) "Health plan" has the meaning provided in section 
  1.20  62Q.01, subdivision 3. 
  1.21     (c) "Health plan company" has the meaning provided in 
  1.22  section 62Q.01, subdivision 4. 
  1.23     (d) "Qualified ~~senior citizen~~ individual" means an 
  1.24  individual ~~age 65 or older~~ who: 
  1.25     (1) is eligible as a qualified Medicare beneficiary 
  1.26  according to section 256B.057, subdivision 3 or 3a, or is 
  2.1   eligible under section 256B.057, subdivision 3 or 3a, and is 
  2.2   also eligible for medical assistance or general assistance 
  2.3   medical care with a spenddown as defined in section 256B.056, 
  2.4   subdivision 5.  Persons who are determined eligible for medical 
  2.5   assistance according to section 256B.0575, who are eligible for 
  2.6   medical assistance or general assistance medical care without a 
  2.7   spenddown, or who are enrolled in MinnesotaCare, are not 
  2.8   eligible for this program; 
  2.9      (2) is not enrolled in prescription drug coverage under a 
  2.10  health plan; 
  2.11     (3) is not enrolled in prescription drug coverage under a 
  2.12  Medicare supplement plan, as defined in sections 62A.31 to 
  2.13  62A.44, or policies, contracts, or certificates that supplement 
  2.14  Medicare issued by health maintenance organizations or those 
  2.15  policies, contracts, or certificates governed by section 1833 or 
  2.16  1876 of the federal Social Security Act, United States Code, 
  2.17  title 42, section 1395, et seq., as amended; 
  2.18     (4) has not had coverage described in clauses (2) and (3) 
  2.19  for at least four months prior to application for the program; 
  2.20  and 
  2.21     (5) is a permanent resident of Minnesota as defined in 
  2.22  section 256L.09. 
  2.23     Sec. 3.  Minnesota Statutes 1998, section 256.955, 
  2.24  subdivision 3, is amended to read: 
  2.25     Subd. 3.  [PRESCRIPTION DRUG COVERAGE.] Coverage under the 
  2.26  program is limited to prescription drugs covered under the 
  2.27  medical assistance program as described in section 256B.0625, 
  2.28  subdivision 13, subject to a maximum deductible of $300 
  2.29  annually, except drugs cleared by the FDA shall be available to 
  2.30  qualified ~~senior citizens~~ individuals enrolled in the program 
  2.31  without restriction when prescribed for medically accepted 
  2.32  indication as defined in the federal rebate program under 
  2.33  section 1927 of title XIX of the federal Social Security Act. 
  2.34     Sec. 4.  Minnesota Statutes 1998, section 256.955, 
  2.35  subdivision 4, is amended to read: 
  2.36     Subd. 4.  [APPLICATION PROCEDURES AND COORDINATION WITH 
  3.1   MEDICAL ASSISTANCE.] Applications and information on the program 
  3.2   must be made available at county social service agencies, health 
  3.3   care provider offices, and agencies and organizations serving 
  3.4   senior citizens.  ~~Senior citizens~~ Applicants shall submit 
  3.5   applications and any information specified by the commissioner 
  3.6   as being necessary to verify eligibility directly to the county 
  3.7   social service agencies:  
  3.8      (1) beginning January 1, 1999, the county social service 
  3.9   agency shall determine medical assistance spenddown eligibility 
  3.10  of individuals who qualify for the senior citizen drug program 
  3.11  of individuals; and 
  3.12     (2) program payments will be used to reduce the spenddown 
  3.13  obligations of individuals who are determined to be eligible for 
  3.14  medical assistance with a spenddown as defined in section 
  3.15  256B.056, subdivision 5. 
  3.16  ~~Seniors~~ Individuals who are eligible for medical assistance 
  3.17  with a spenddown shall be financially responsible for the 
  3.18  deductible amount up to the satisfaction of the spenddown.  No 
  3.19  deductible applies once the spenddown has been met.  Payments to 
  3.20  providers for prescription drugs for persons eligible under this 
  3.21  subdivision shall be reduced by the deductible.  
  3.22     County social service agencies shall determine an 
  3.23  applicant's eligibility for the program within 30 days from the 
  3.24  date the application is received. 
  3.25     Sec. 5.  Laws 1997, chapter 225, article 4, section 4, is 
  3.26  amended to read: 
  3.27     Sec. 4.  [SENIOR DRUG PROGRAM.] 
  3.28     ~~The commissioner shall administer the senior drug program~~ 
  3.29  ~~so that the costs to the state total no more than $4,000,000~~ 
  3.30  ~~plus the amount of the rebate.  The commissioner is authorized~~ 
  3.31  ~~to discontinue enrollment in order to meet this level of funding.~~
  3.32     The commissioner shall report to the legislature the 
  3.33  estimated costs of the senior drug program ~~without funding~~ 
  3.34  ~~caps~~.  The report shall be included as part of the November and 
  3.35  February forecasts. 
  3.36     The commissioner of finance shall annually reimburse the 
  4.1   general fund with health care access funds for the estimated 
  4.2   increased costs in the QMB/SLMB program directly associated with 
  4.3   the senior drug program.  This reimbursement shall sunset June 
  4.4   30, 2001. 
  4.5      Sec. 6.  [APPROPRIATION.] 
  4.6      $....... is appropriated from the general fund to the 
  4.7   commissioner of human services, for the biennium ending June 30, 
  4.8   2001, to implement sections 1 to 5.