KEY: stricken = removed, old language.underscored = new language to be added
scs-hhs-healthcare--art6
A bill for an act
relating to BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:180.25 Section 1. Minnesota Statutes 2012, section 245.03, subdivision 1, is amended to read:
180.26 Subdivision 1. Establishment. There is created a Department of Human Services.
180.27A commissioner of human services shall be appointed by the governor under the
180.28provisions of section
180.29experience in welfare and without regard to political affiliations. The commissioner
180.30 may appoint
180.31 Sec. 2. Minnesota Statutes 2012, section 256.9657, subdivision 3, is amended to read:
180.32 Subd. 3. Surcharge on HMOs and community integrated service networks. (a)
180.33Effective October 1, 1992, each health maintenance organization with a certificate of
180.34authority issued by the commissioner of health under chapter 62D and each community
181.1integrated service network licensed by the commissioner under chapter 62N shall pay to
181.2the commissioner of human services a surcharge equal to six-tenths of one percent of the
181.3total premium revenues of the health maintenance organization or community integrated
181.4service network as reported to the commissioner of health according to the schedule in
181.5subdivision 4.
181.6(b) Effective July 1, 2013, to June 30, 2015, the surcharge under paragraph (a) is
181.7increased to 1.48 percent.
181.8(c) For purposes of this subdivision, total premium revenue means:
181.9(1) premium revenue recognized on a prepaid basis from individuals and groups
181.10for provision of a specified range of health services over a defined period of time which
181.11is normally one month, excluding premiums paid to a health maintenance organization
181.12or community integrated service network from the Federal Employees Health Benefit
181.13Program;
181.14(2) premiums from Medicare wraparound subscribers for health benefits which
181.15supplement Medicare coverage;
181.16(3) Medicare revenue, as a result of an arrangement between a health maintenance
181.17organization or a community integrated service network and the Centers for Medicare
181.18and Medicaid Services of the federal Department of Health and Human Services, for
181.19services to a Medicare beneficiary, excluding Medicare revenue that states are prohibited
181.20from taxing under sections 1854, 1860D-12, and 1876 of title XVIII of the federal Social
181.21Security Act, codified as United States Code, title 42, sections 1395mm, 1395w-112, and
181.221395w-24, respectively, as they may be amended from time to time; and
181.23(4) medical assistance revenue, as a result of an arrangement between a health
181.24maintenance organization or community integrated service network and a Medicaid state
181.25agency, for services to a medical assistance beneficiary.
181.26If advance payments are made under clause (1) or (2) to the health maintenance
181.27organization or community integrated service network for more than one reporting period,
181.28the portion of the payment that has not yet been earned must be treated as a liability.
181.29(
181.30network merges or consolidates with or is acquired by another health maintenance
181.31organization or community integrated service network, the surviving corporation or the
181.32new corporation shall be responsible for the annual surcharge originally imposed on
181.33each of the entities or corporations subject to the merger, consolidation, or acquisition,
181.34regardless of whether one of the entities or corporations does not retain a certificate of
181.35authority under chapter 62D or a license under chapter 62N.
182.1
182.2corporation's surcharge shall be based on the revenues earned in the second previous
182.3calendar year by all of the entities or corporations subject to the merger, consolidation,
182.4or acquisition regardless of whether one of the entities or corporations does not retain a
182.5certificate of authority under chapter 62D or a license under chapter 62N until the total
182.6premium revenues of the surviving corporation include the total premium revenues of all
182.7the merged entities as reported to the commissioner of health.
182.8
182.9network, which is subject to liability for the surcharge under this chapter, transfers,
182.10assigns, sells, leases, or disposes of all or substantially all of its property or assets, liability
182.11for the surcharge imposed by this chapter is imposed on the transferee, assignee, or buyer
182.12of the health maintenance organization or community integrated service network.
182.13
182.14service network converts its licensure to a different type of entity subject to liability
182.15for the surcharge under this chapter, but survives in the same or substantially similar
182.16form, the surviving entity remains liable for the surcharge regardless of whether one of
182.17the entities or corporations does not retain a certificate of authority under chapter 62D
182.18or a license under chapter 62N.
182.19
182.20integrated service network ends when the entity ceases providing services for premiums
182.21and the cessation is not connected with a merger, consolidation, acquisition, or conversion.
182.22 Sec. 3. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
182.23 Subd. 3a. Payments. (a) Acute care hospital billings under the medical
182.24assistance program must not be submitted until the recipient is discharged. However,
182.25the commissioner shall establish monthly interim payments for inpatient hospitals that
182.26have individual patient lengths of stay over 30 days regardless of diagnostic category.
182.27Except as provided in section
182.28of mental illness shall be reimbursed based on diagnostic classifications. Individual
182.29hospital payments established under this section and sections
182.31the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
182.32inpatient services paid for the same period of time to the hospital. This payment limitation
182.33shall be calculated separately for medical assistance and general assistance medical
182.34care services. The limitation on general assistance medical care shall be effective for
182.35admissions occurring on or after July 1, 1991. Services that have rates established under
183.1subdivision 11 or 12, must be limited separately from other services. After consulting with
183.2the affected hospitals, the commissioner may consider related hospitals one entity and
183.3may merge the payment rates while maintaining separate provider numbers. The operating
183.4and property base rates per admission or per day shall be derived from the best Medicare
183.5and claims data available when rates are established. The commissioner shall determine
183.6the best Medicare and claims data, taking into consideration variables of recency of the
183.7data, audit disposition, settlement status, and the ability to set rates in a timely manner.
183.8The commissioner shall notify hospitals of payment rates by December 1 of the year
183.9preceding the rate year. The rate setting data must reflect the admissions data used to
183.10establish relative values. Base year changes from 1981 to the base year established for the
183.11rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
183.12to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
183.131. The commissioner may adjust base year cost, relative value, and case mix index data
183.14to exclude the costs of services that have been discontinued by the October 1 of the year
183.15preceding the rate year or that are paid separately from inpatient services. Inpatient stays
183.16that encompass portions of two or more rate years shall have payments established based
183.17on payment rates in effect at the time of admission unless the date of admission preceded
183.18the rate year in effect by six months or more. In this case, operating payment rates for
183.19services rendered during the rate year in effect and established based on the date of
183.20admission shall be adjusted to the rate year in effect by the hospital cost index.
183.21 (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
183.22payment, before third-party liability and spenddown, made to hospitals for inpatient
183.23services is reduced by .5 percent from the current statutory rates.
183.24 (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
183.25admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
183.26before third-party liability and spenddown, is reduced five percent from the current
183.27statutory rates. Mental health services within diagnosis related groups 424 to 432, and
183.28facilities defined under subdivision 16 are excluded from this paragraph.
183.29 (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
183.30fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
183.31inpatient services before third-party liability and spenddown, is reduced 6.0 percent
183.32from the current statutory rates. Mental health services within diagnosis related groups
183.33424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
183.34Notwithstanding section
183.35assistance does not include general assistance medical care. Payments made to managed
184.1care plans shall be reduced for services provided on or after January 1, 2006, to reflect
184.2this reduction.
184.3 (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
184.4fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
184.5to hospitals for inpatient services before third-party liability and spenddown, is reduced
184.63.46 percent from the current statutory rates. Mental health services with diagnosis related
184.7groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
184.8paragraph. Payments made to managed care plans shall be reduced for services provided
184.9on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
184.10 (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
184.11fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
184.12to hospitals for inpatient services before third-party liability and spenddown, is reduced
184.131.9 percent from the current statutory rates. Mental health services with diagnosis related
184.14groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
184.15paragraph. Payments made to managed care plans shall be reduced for services provided
184.16on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
184.17 (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
184.18for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
184.19inpatient services before third-party liability and spenddown, is reduced 1.79 percent
184.20from the current statutory rates. Mental health services with diagnosis related groups
184.21424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
184.22Payments made to managed care plans shall be reduced for services provided on or after
184.23July 1, 2011, to reflect this reduction.
184.24(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
184.25payment for fee-for-service admissions occurring on or after July 1, 2009, made to
184.26hospitals for inpatient services before third-party liability and spenddown, is reduced
184.27one percent from the current statutory rates. Facilities defined under subdivision 16 are
184.28excluded from this paragraph. Payments made to managed care plans shall be reduced for
184.29services provided on or after October 1, 2009, to reflect this reduction.
184.30(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
184.31payment for fee-for-service admissions occurring on or after July 1, 2011, made to
184.32hospitals for inpatient services before third-party liability and spenddown, is reduced
184.331.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
184.34excluded from this paragraph. Payments made to managed care plans shall be reduced for
184.35services provided on or after January 1, 2011, to reflect this reduction.
185.1(j) For admissions occurring on or after January 1, 2015, the rate for inpatient
185.2hospital services must be increased 1.4 percent from the rate in effect on December 31,
185.32014. Payments made to managed care plans and county-based purchasing plans shall
185.4not be adjusted to reflect payments under this paragraph.
185.5 Sec. 4. Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:
185.6 Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an
185.7inmate of a correctional facility who is conditionally released as authorized under section
185.9detention facility and is housed in a halfway house or community correction center, or
185.10under house arrest and monitored by electronic surveillance in a residence approved
185.11by the commissioner of corrections, and if the individual meets the other eligibility
185.12requirements of this chapter.
185.13 (b) An individual who is enrolled in medical assistance, and who is charged with a
185.14crime and incarcerated for less than 12 months shall be suspended from eligibility at the
185.15time of incarceration until the individual is released. Upon release, medical assistance
185.16eligibility is reinstated without reapplication using a reinstatement process and form, if the
185.17individual is otherwise eligible.
185.18 (c) An individual, regardless of age, who is considered an inmate of a public
185.19institution as defined in Code of Federal Regulations, title 42, section 435.1010, and
185.20who meets the eligibility requirements in section 256B.056, is not eligible for medical
185.21assistance, except for covered services received while an inpatient in a medical institution
185.22as defined in the Code of Federal Regulations, title 42, section 435.1010. Security issues,
185.23including costs, related to the inpatient treatment of an inmate are the responsibility of the
185.24entity with jurisdiction over the inmate.
185.25EFFECTIVE DATE.This section is effective January 1, 2014.
185.26 Sec. 5. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
185.27 Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
185.28to citizens of the United States, qualified noncitizens as defined in this subdivision, and
185.29other persons residing lawfully in the United States. Citizens or nationals of the United
185.30States must cooperate in obtaining satisfactory documentary evidence of citizenship or
185.31nationality according to the requirements of the federal Deficit Reduction Act of 2005,
185.32Public Law 109-171.
185.33(b) "Qualified noncitizen" means a person who meets one of the following
185.34immigration criteria:
186.1(1) admitted for lawful permanent residence according to United States Code, title 8;
186.2(2) admitted to the United States as a refugee according to United States Code,
186.3title 8, section 1157;
186.4(3) granted asylum according to United States Code, title 8, section 1158;
186.5(4) granted withholding of deportation according to United States Code, title 8,
186.6section 1253(h);
186.7(5) paroled for a period of at least one year according to United States Code, title 8,
186.8section 1182(d)(5);
186.9(6) granted conditional entrant status according to United States Code, title 8,
186.10section 1153(a)(7);
186.11(7) determined to be a battered noncitizen by the United States Attorney General
186.12according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
186.13title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
186.14(8) is a child of a noncitizen determined to be a battered noncitizen by the United
186.15States Attorney General according to the Illegal Immigration Reform and Immigrant
186.16Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
186.17Public Law 104-200; or
186.18(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
186.19Law 96-422, the Refugee Education Assistance Act of 1980.
186.20(c) All qualified noncitizens who were residing in the United States before August
186.2122, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
186.22medical assistance with federal financial participation.
186.23(d) Beginning December 1, 1996, qualified noncitizens who entered the United
186.24States on or after August 22, 1996, and who otherwise meet the eligibility requirements
186.25of this chapter are eligible for medical assistance with federal participation for five years
186.26if they meet one of the following criteria:
186.27(1) refugees admitted to the United States according to United States Code, title 8,
186.28section 1157;
186.29(2) persons granted asylum according to United States Code, title 8, section 1158;
186.30(3) persons granted withholding of deportation according to United States Code,
186.31title 8, section 1253(h);
186.32(4) veterans of the United States armed forces with an honorable discharge for
186.33a reason other than noncitizen status, their spouses and unmarried minor dependent
186.34children; or
186.35(5) persons on active duty in the United States armed forces, other than for training,
186.36their spouses and unmarried minor dependent children.
187.1 Beginning July 1, 2010, children and pregnant women who are noncitizens
187.2described in paragraph (b) or who are lawfully present in the United States as defined
187.3in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
187.4eligibility requirements of this chapter, are eligible for medical assistance with federal
187.5financial participation as provided by the federal Children's Health Insurance Program
187.6Reauthorization Act of 2009, Public Law 111-3.
187.7(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
187.8are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
187.9subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
187.10Code, title 8, section 1101(a)(15).
187.11(f) Payment shall also be made for care and services that are furnished to noncitizens,
187.12regardless of immigration status, who otherwise meet the eligibility requirements of
187.13this chapter, if such care and services are necessary for the treatment of an emergency
187.14medical condition.
187.15(g) For purposes of this subdivision, the term "emergency medical condition" means
187.16a medical condition that meets the requirements of United States Code, title 42, section
187.171396b(v).
187.18(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
187.19of an emergency medical condition are limited to the following:
187.20(i) services delivered in an emergency room or by an ambulance service licensed
187.21under chapter 144E that are directly related to the treatment of an emergency medical
187.22condition;
187.23(ii) services delivered in an inpatient hospital setting following admission from an
187.24emergency room or clinic for an acute emergency condition; and
187.25(iii) follow-up services that are directly related to the original service provided
187.26to treat the emergency medical condition and are covered by the global payment made
187.27to the provider.
187.28 (2) Services for the treatment of emergency medical conditions do not include:
187.29(i) services delivered in an emergency room or inpatient setting to treat a
187.30nonemergency condition;
187.31(ii) organ transplants, stem cell transplants, and related care;
187.32(iii) services for routine prenatal care;
187.33(iv) continuing care, including long-term care, nursing facility services, home health
187.34care, adult day care, day training, or supportive living services;
187.35(v) elective surgery;
188.1(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
188.2part of an emergency room visit;
188.3(vii) preventative health care and family planning services;
188.4
188.5
188.6
188.7
188.8
188.9
188.10
188.11
188.12
188.13
188.14
188.15
188.16
188.17
188.18
188.19
188.20
188.21(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
188.22nonimmigrants, or lawfully present in the United States as defined in Code of Federal
188.23Regulations, title 8, section 103.12, are not covered by a group health plan or health
188.24insurance coverage according to Code of Federal Regulations, title 42, section 457.310,
188.25and who otherwise meet the eligibility requirements of this chapter, are eligible for
188.26medical assistance through the period of pregnancy, including labor and delivery, and 60
188.27days postpartum, to the extent federal funds are available under title XXI of the Social
188.28Security Act, and the state children's health insurance program.
188.29(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
188.30services from a nonprofit center established to serve victims of torture and are otherwise
188.31ineligible for medical assistance under this chapter are eligible for medical assistance
188.32without federal financial participation. These individuals are eligible only for the period
188.33during which they are receiving services from the center. Individuals eligible under this
188.34paragraph shall not be required to participate in prepaid medical assistance.
189.1(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
189.2emergency medical conditions under paragraph (f) except where coverage is prohibited
189.3under federal law:
189.4(1) dialysis services provided in a hospital or freestanding dialysis facility; and
189.5(2) surgery and the administration of chemotherapy, radiation, and related services
189.6necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission
189.7and requires surgery, chemotherapy, or radiation treatment.
189.8 Sec. 6. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
189.9subdivision to read:
189.10 Subd. 28b. Doula services. Medical assistance covers doula services provided by a
189.11certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For
189.12purposes of this section, "doula services" means childbirth education and support services,
189.13including emotional and physical support provided during pregnancy, labor, birth, and
189.14postpartum.
189.15EFFECTIVE DATE.This section is effective July 1, 2014, or upon federal
189.16approval, whichever is later, and applies to services provided on or after the effective date.
189.17 Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to read:
189.18 Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical
189.19supplies and equipment. Separate payment outside of the facility's payment rate shall
189.20be made for wheelchairs and wheelchair accessories for recipients who are residents
189.21of intermediate care facilities for the developmentally disabled. Reimbursement for
189.22wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
189.23conditions and limitations as coverage for recipients who do not reside in institutions. A
189.24wheelchair purchased outside of the facility's payment rate is the property of the recipient.
189.25The commissioner may set reimbursement rates for specified categories of medical
189.26supplies at levels below the Medicare payment rate.
189.27(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
189.28must enroll as a Medicare provider.
189.29(c) When necessary to ensure access to durable medical equipment, prosthetics,
189.30orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
189.31enrollment requirement if:
189.32(1) the vendor supplies only one type of durable medical equipment, prosthetic,
189.33orthotic, or medical supply;
189.34(2) the vendor serves ten or fewer medical assistance recipients per year;
190.1(3) the commissioner finds that other vendors are not available to provide same or
190.2similar durable medical equipment, prosthetics, orthotics, or medical supplies; and
190.3(4) the vendor complies with all screening requirements in this chapter and Code of
190.4Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
190.5the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
190.6and Medicaid Services approved national accreditation organization as complying with
190.7the Medicare program's supplier and quality standards and the vendor serves primarily
190.8pediatric patients.
190.9(d) Durable medical equipment means a device or equipment that:
190.10(1) can withstand repeated use;
190.11(2) is generally not useful in the absence of an illness, injury, or disability; and
190.12(3) is provided to correct or accommodate a physiological disorder or physical
190.13condition or is generally used primarily for a medical purpose.
190.14(e) Electronic tablets may be considered durable medical equipment if the electronic
190.15tablet will be used as an augmentative and alternative communication system as defined
190.16under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
190.17must be locked in order to prevent use not related to communication.
190.18 Sec. 8. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
190.19subdivision to read:
190.20 Subd. 31b. Preferred diabetic testing supply program. (a) The commissioner
190.21shall adopt and implement a point of sale preferred diabetic testing supply program by
190.22January 1, 2014. Medical assistance coverage for diabetic testing supplies shall conform
190.23to the limitations established under the program. The commissioner may enter into a
190.24contract with a vendor for the purpose of participating in a preferred diabetic testing
190.25supply list and supplemental rebate program. The commissioner shall ensure that any
190.26contract meets all federal requirements and maximizes federal financial participation. The
190.27commissioner shall maintain an accurate and up-to-date list on the department's Web site.
190.28(b) The commissioner may add to, delete from, and otherwise modify the preferred
190.29diabetic testing supply program drug list after consulting with the Drug Formulary
190.30Committee and appropriate medial specialists and providing public notice and the
190.31opportunity for public comment.
190.32(c) The commissioner shall adopt and administer the preferred diabetic testing
190.33supply program as part of the administration of the diabetic testing supply rebate program.
190.34Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply
190.35list may be subject to prior authorization.
191.1(d) All claims for diabetic testing supplies in categories on the preferred diabetic
191.2testing supply list must be submitted by enrolled pharmacy providers using the most
191.3current National Council of Prescription Drug Providers electronic claims standard.
191.4(e) For purposes of this subdivision, "preferred diabetic testing supply list" means a
191.5list of diabetic testing supplies selected by the commissioner, for which prior authorization
191.6is not required.
191.7(f) The commissioner shall seek any federal waivers or approvals necessary to
191.8implement this subdivision.
191.9 Sec. 9. Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to read:
191.10 Subd. 39. Childhood immunizations. Providers who administer pediatric vaccines
191.11within the scope of their licensure, and who are enrolled as a medical assistance provider,
191.12must enroll in the pediatric vaccine administration program established by section 13631
191.13of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay
191.14
191.15assistance. Medical assistance does not pay for vaccines that are available at no cost from
191.16the pediatric vaccine administration program.
191.17 Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to
191.18read:
191.19 Subd. 58. Early and periodic screening, diagnosis, and treatment services.
191.20Medical assistance covers early and periodic screening, diagnosis, and treatment services
191.21(EPSDT). The payment amount for a complete EPSDT screening shall not include charges
191.22for vaccines that are available at no cost to the provider and shall not exceed the rate
191.23established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.
191.24 Sec. 11. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
191.25subdivision to read:
191.26 Subd. 61. Payment for multiple services provided on the same day. The
191.27commissioner shall not prohibit payment, including supplemental payments, for mental
191.28health services or dental services provided to a patient by a clinic or health care
191.29professional solely because the mental health or dental services were provided on the same
191.30day as other covered health services furnished by the same provider.
191.31 Sec. 12. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:
192.1 Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
192.2assistance benefit plan shall include the following cost-sharing for all recipients, effective
192.3for services provided on or after September 1, 2011:
192.4 (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
192.5of this subdivision, a visit means an episode of service which is required because of
192.6a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
192.7ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
192.8midwife, advanced practice nurse, audiologist, optician, or optometrist;
192.9 (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
192.10this co-payment shall be increased to $20 upon federal approval;
192.11 (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
192.12subject to a $12 per month maximum for prescription drug co-payments. No co-payments
192.13shall apply to antipsychotic drugs when used for the treatment of mental illness;
192.14(4) effective January 1, 2012, a family deductible equal to the maximum amount
192.15allowed under Code of Federal Regulations, title 42, part 447.54; and
192.16 (5) for individuals identified by the commissioner with income at or below 100
192.17percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
192.18percent of family income. For purposes of this paragraph, family income is the total
192.19earned and unearned income of the individual and the individual's spouse, if the spouse is
192.20enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
192.21 (b) Recipients of medical assistance are responsible for all co-payments and
192.22deductibles in this subdivision.
192.23(c) Notwithstanding paragraph (b), the commissioner, through the contracting
192.24process under sections
192.25county-based purchasing plans to waive the family deductible under paragraph (a),
192.26clause (4). The value of the family deductible shall not be included in the capitation
192.27payment to managed care plans and county-based purchasing plans. Managed care plans
192.28and county-based purchasing plans shall certify annually to the commissioner the dollar
192.29value of the family deductible.
192.30(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
192.31the family deductible described under paragraph (a), clause (4), from individuals and
192.32allow long-term care and waivered service providers to assume responsibility for payment.
192.33(e) Notwithstanding paragraph (b), the commissioner, through the contracting
192.34process under section 256B.0756 shall allow the pilot program in Hennepin County to
192.35waive co-payments. The value of the co-payments shall not be included as part of the
192.36payment system for the integrated health care delivery networks under the pilot program.
193.1 Sec. 13. Minnesota Statutes 2012, section 256B.0756, is amended to read:
193.2256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
193.3(a) The commissioner, upon federal approval of a new waiver request or amendment
193.4of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
193.5County, or both, to test alternative and innovative integrated health care delivery networks.
193.6(b) Individuals eligible for the pilot program shall be individuals who are eligible for
193.7medical assistance under section 256B.055
193.8County or Ramsey County. The commissioner may identify individuals to be enrolled
193.9in the Hennepin County pilot program by zip code or by whether the individuals would
193.10benefit from an integrated health care delivery network.
193.11(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
193.12health care delivery network in their county of residence. The integrated health care
193.13delivery network in Hennepin County shall be a network, such as an accountable care
193.14organization or a community-based collaborative care network, created by or including
193.15Hennepin County Medical Center. The integrated health care delivery network in Ramsey
193.16County shall be a network, such as an accountable care organization or community-based
193.17collaborative care network, created by or including Regions Hospital.
193.18
193.19
193.20
193.21shall establish a total cost of care for the recipients enrolled in the pilot programs that
193.22equals the cost of care that would otherwise be spent for these enrollees in the prepaid
193.23medical assistance program.
193.24
193.25
193.26
193.27
193.28cooperate with counties, providers, or other entities that are applying for any applicable
193.29grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
193.30Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
193.31111-152, that would further the purposes of or assist in the creation of an integrated health
193.32care delivery network for the purposes of this subdivision, including, but not limited to, a
193.33global payment demonstration or the community-based collaborative care network grants.
193.34 Sec. 14. Minnesota Statutes 2012, section 256B.196, subdivision 2, is amended to read:
194.1 Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
194.2subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
194.3services upper payment limit for nonstate government hospitals. The commissioner shall
194.4then determine the amount of a supplemental payment to Hennepin County Medical
194.5Center and Regions Hospital for these services that would increase medical assistance
194.6spending in this category to the aggregate upper payment limit for all nonstate government
194.7hospitals in Minnesota. In making this determination, the commissioner shall allot the
194.8available increases between Hennepin County Medical Center and Regions Hospital
194.9based on the ratio of medical assistance fee-for-service outpatient hospital payments to
194.10the two facilities. The commissioner shall adjust this allotment as necessary based on
194.11federal approvals, the amount of intergovernmental transfers received from Hennepin and
194.12Ramsey Counties, and other factors, in order to maximize the additional total payments.
194.13The commissioner shall inform Hennepin County and Ramsey County of the periodic
194.14intergovernmental transfers necessary to match federal Medicaid payments available
194.15under this subdivision in order to make supplementary medical assistance payments to
194.16Hennepin County Medical Center and Regions Hospital equal to an amount that when
194.17combined with existing medical assistance payments to nonstate governmental hospitals
194.18would increase total payments to hospitals in this category for outpatient services to
194.19the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
194.20receipt of these periodic transfers, the commissioner shall make supplementary payments
194.21to Hennepin County Medical Center and Regions Hospital.
194.22 (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
194.23determine an upper payment limit for physicians and other billing professionals affiliated
194.24with Hennepin County Medical Center and with Regions Hospital. The upper payment
194.25limit shall be based on the average commercial rate or be determined using another method
194.26acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
194.27inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
194.28necessary to match the federal Medicaid payments available under this subdivision in order
194.29to make supplementary payments to physicians and other billing professionals affiliated
194.30with Hennepin County Medical Center and to make supplementary payments to physicians
194.31and other billing professionals affiliated with Regions Hospital through HealthPartners
194.32Medical Group equal to the difference between the established medical assistance
194.33payment for physician and other billing professional services and the upper payment limit.
194.34Upon receipt of these periodic transfers, the commissioner shall make supplementary
194.35payments to physicians and other billing professionals affiliated with Hennepin County
195.1Medical Center and shall make supplementary payments to physicians and other billing
195.2professionals affiliated with Regions Hospital through HealthPartners Medical Group.
195.3 (c) Beginning January 1, 2010, Hennepin County and Ramsey County may make
195.4monthly voluntary intergovernmental transfers to the commissioner in amounts not to
195.5exceed $12,000,000 per year from Hennepin County and $6,000,000 per year from
195.6Ramsey County. The commissioner shall increase the medical assistance capitation
195.7payments to any licensed health plan under contract with the medical assistance program
195.8that agrees to make enhanced payments to Hennepin County Medical Center or Regions
195.9Hospital. The increase shall be in an amount equal to the annual value of the monthly
195.10transfers plus federal financial participation, with each health plan receiving its pro rata
195.11share of the increase based on the pro rata share of medical assistance admissions to
195.12Hennepin County Medical Center and Regions Hospital by those plans. Upon the request
195.13of the commissioner, health plans shall submit individual-level cost data for verification
195.14purposes. The commissioner may ratably reduce these payments on a pro rata basis in
195.15order to satisfy federal requirements for actuarial soundness. If payments are reduced,
195.16transfers shall be reduced accordingly. Any licensed health plan that receives increased
195.17medical assistance capitation payments under the intergovernmental transfer described in
195.18this paragraph shall increase its medical assistance payments to Hennepin County Medical
195.19Center and Regions Hospital by the same amount as the increased payments received in
195.20the capitation payment described in this paragraph.
195.21 (d) For the purposes of this subdivision and subdivision 3, the commissioner shall
195.22determine an upper payment limit for ambulance services affiliated with Hennepin County
195.23Medical Center. The upper payment limit shall be based on the average commercial
195.24rate or be determined using another method acceptable to the Centers for Medicare and
195.25Medicaid Services. The commissioner shall inform Hennepin County of the periodic
195.26intergovernmental transfers necessary to match the federal Medicaid payments available
195.27under this subdivision in order to make supplementary payments to Hennepin County
195.28Medical Center equal to the difference between the established medical assistance
195.29payment for ambulance services and the upper payment limit. Upon receipt of these
195.30periodic transfers, the commissioner shall make supplementary payments to Hennepin
195.31County Medical Center.
195.32 (e) The commissioner shall inform the transferring governmental entities on an
195.33ongoing basis of the need for any changes needed in the intergovernmental transfers in
195.34order to continue the payments under paragraphs (a) to
195.35including increases in upper payment limits, changes in the federal Medicaid match, and
195.36other factors.
196.1
196.2of each other, subject to federal approval and to the receipt of transfers under subdivision 3.
196.3 Sec. 15. Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:
196.4 Subd. 5c. Medical education and research fund. (a) The commissioner of human
196.5services shall transfer each year to the medical education and research fund established
196.6under section
196.7calculate the following:
196.8(1) an amount equal to the reduction in the prepaid medical assistance payments as
196.9specified in this clause. Until January 1, 2002, the county medical assistance capitation
196.10base rate prior to plan specific adjustments and after the regional rate adjustments under
196.11subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
196.12metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
196.13January 1, 2002, the county medical assistance capitation base rate prior to plan specific
196.14adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
196.15metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
196.16facility and elderly waiver payments and demonstration project payments operating
196.17under subdivision 23 are excluded from this reduction. The amount calculated under
196.18this clause shall not be adjusted for periods already paid due to subsequent changes to
196.19the capitation payments;
196.20(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
196.21section;
196.22(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
196.23paid under this section; and
196.24(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
196.25under this section.
196.26(b) This subdivision shall be effective upon approval of a federal waiver which
196.27allows federal financial participation in the medical education and research fund. The
196.28amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
196.29transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
196.30paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
196.31reduce the amount specified under paragraph (a), clause (1).
196.32(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
196.33shall transfer $21,714,000 each fiscal year to the medical education and research fund.
196.34(d) Beginning September 1, 2011, of the amount in paragraph (a), following the
196.35transfer under paragraph (c), the commissioner shall transfer to the medical education
197.1research fund $23,936,000 in fiscal years 2012 and 2013 and
197.2fiscal year 2014 and thereafter.
197.3 Sec. 16. Minnesota Statutes 2012, section 256B.69, is amended by adding a
197.4subdivision to read:
197.5 Subd. 5l. Risk corridors. (a) Effective for services rendered on or after January 1,
197.62014, the commissioner shall establish risk corridors that are actuarially sound for each
197.7managed care plan and each county-based purchasing plan providing services under this
197.8section and section 256B.692. The risk corridors shall be calculated annually based on the
197.9calendar year's net underwriting gain or loss. If the managed care plan or county-based
197.10purchasing plan achieved a net underwriting gain of greater than three percent of revenue,
197.11any excess must be repaid to the commissioner by July 31 of the year following calculation
197.12of the risk corridor year. If the managed care plan or county-based purchasing plan has
197.13incurred a net underwriting loss greater than three percent of total revenue, any excess must
197.14be repaid to the managed care plan or county-based purchasing plan by the commissioner
197.15by July 31 of the year following calculation of the risk corridor year. Determination of total
197.16revenues and net underwriting gain or loss must be based on the Minnesota supplement
197.17report #1 that is filed on April 1 of the year following calculation of the risk corridor and
197.18adjusted for the actual withhold calculation under sections 256B.69, subdivisions 5a, and
197.19256L.12, subdivision 9. The report must be filed with the commissioner of health and
197.20must be made available on the Department of Health's Web site.
197.21(b) This subdivision shall not apply to the special demonstration projects under
197.22subdivisions 23 and 28.
197.23 Sec. 17. Minnesota Statutes 2012, section 256B.69, subdivision 31, is amended to read:
197.24 Subd. 31. Payment reduction. (a) Beginning September 1, 2011, the commissioner
197.25shall reduce payments and limit future rate increases paid to managed care plans and
197.26county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved
197.27on a statewide aggregate basis by program. The commissioner may use competitive
197.28bidding, payment reductions, or other reductions to achieve the reductions and limits
197.29in this subdivision.
197.30(b) Beginning September 1, 2011, the commissioner shall reduce payments to
197.31managed care plans and county-based purchasing plans as follows:
197.32(1) 2.0 percent for medical assistance elderly basic care. This shall not apply
197.33to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
197.34services;
198.1(2) 2.82 percent for medical assistance families and children;
198.2(3) 10.1 percent for medical assistance adults without children; and
198.3(4) 6.0 percent for MinnesotaCare families and children.
198.4(c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed
198.5care plans and county-based purchasing plans for calendar year 2012 to a percentage of
198.6the rates in effect on August 31, 2011, as follows:
198.7(1) 98 percent for medical assistance elderly basic care. This shall not apply to
198.8Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
198.9services;
198.10(2) 97.18 percent for medical assistance families and children;
198.11(3) 89.9 percent for medical assistance adults without children; and
198.12(4) 94 percent for MinnesotaCare families and children.
198.13(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit
198.14the maximum annual trend increases to rates paid to managed care plans and county-based
198.15purchasing plans as follows:
198.16(1) 7.5 percent for medical assistance elderly basic care. This shall not apply
198.17to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver
198.18services;
198.19(2) 5.0 percent for medical assistance special needs basic care;
198.20(3) 2.0 percent for medical assistance families and children;
198.21(4) 3.0 percent for medical assistance adults without children;
198.22(5) 3.0 percent for MinnesotaCare families and children; and
198.23(6) 3.0 percent for MinnesotaCare adults without children.
198.24(e) The commissioner may limit trend increases to less than the maximum.
198.25Beginning
198.26increases to rates paid to managed care plans and county-based purchasing plans as
198.27follows for calendar years 2014
198.28(1)
198.29to
198.30services;
198.31(2)
198.32(3)
198.33(4)
198.34(5) 3.0 percent for MinnesotaCare families and children; and
198.35(6) 4.0 percent for MinnesotaCare adults without children.
198.36The commissioner may limit trend increases to less than the maximum.
199.1 Sec. 18. Minnesota Statutes 2012, section 256B.76, subdivision 1, is amended to read:
199.2 Subdivision 1. Physician reimbursement. (a) Effective for services rendered on
199.3or after October 1, 1992, the commissioner shall make payments for physician services
199.4as follows:
199.5 (1) payment for level one Centers for Medicare and Medicaid Services' common
199.6procedural coding system codes titled "office and other outpatient services," "preventive
199.7medicine new and established patient," "delivery, antepartum, and postpartum care,"
199.8"critical care," cesarean delivery and pharmacologic management provided to psychiatric
199.9patients, and level three codes for enhanced services for prenatal high risk, shall be paid
199.10at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
199.1130, 1992. If the rate on any procedure code within these categories is different than the
199.12rate that would have been paid under the methodology in section
199.13then the larger rate shall be paid;
199.14 (2) payments for all other services shall be paid at the lower of (i) submitted charges,
199.15or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
199.16 (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
199.17percentile of 1989, less the percent in aggregate necessary to equal the above increases
199.18except that payment rates for home health agency services shall be the rates in effect
199.19on September 30, 1992.
199.20 (b) Effective for services rendered on or after January 1, 2000, payment rates for
199.21physician and professional services shall be increased by three percent over the rates
199.22in effect on December 31, 1999, except for home health agency and family planning
199.23agency services. The increases in this paragraph shall be implemented January 1, 2000,
199.24for managed care.
199.25(c) Effective for services rendered on or after July 1, 2009, payment rates for
199.26physician and professional services shall be reduced by five percent, except that for the
199.27period July 1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent
199.28for the medical assistance and general assistance medical care programs, over the rates in
199.29effect on June 30, 2009. This reduction and the reductions in paragraph (d) do not apply
199.30to office or other outpatient visits, preventive medicine visits and family planning visits
199.31billed by physicians, advanced practice nurses, or physician assistants in a family planning
199.32agency or in one of the following primary care practices: general practice, general internal
199.33medicine, general pediatrics, general geriatrics, and family medicine. This reduction
199.34and the reductions in paragraph (d) do not apply to federally qualified health centers,
199.35rural health centers, and Indian health services. Effective October 1, 2009, payments
200.1made to managed care plans and county-based purchasing plans under sections
200.3(d) Effective for services rendered on or after July 1, 2010, payment rates for
200.4physician and professional services shall be reduced an additional seven percent over
200.5the five percent reduction in rates described in paragraph (c). This additional reduction
200.6does not apply to physical therapy services, occupational therapy services, and speech
200.7pathology and related services provided on or after July 1, 2010. This additional reduction
200.8does not apply to physician services billed by a psychiatrist or an advanced practice nurse
200.9with a specialty in mental health. Effective October 1, 2010, payments made to managed
200.10care plans and county-based purchasing plans under sections
200.12(e) Effective for services rendered on or after September 1, 2011, through June 30,
200.132013, payment rates for physician and professional services shall be reduced three percent
200.14from the rates in effect on August 31, 2011. This reduction does not apply to physical
200.15therapy services, occupational therapy services, and speech pathology and related services.
200.16(f) Effective for services rendered on or after January 1, 2015, payment rates for
200.17physician and professional services, including physical therapy, occupational therapy,
200.18speech pathology, and mental health services shall be increased by five percent from
200.19the rates in effect on December 31, 2014. This increase does not apply to federally
200.20qualified health centers, rural health centers, and Indian health services. Payments made to
200.21managed care plans and county-based purchasing plans shall not be adjusted to reflect
200.22payments under this paragraph.
200.23 Sec. 19. Minnesota Statutes 2012, section 256B.76, subdivision 4, is amended to read:
200.24 Subd. 4. Critical access dental providers. (a) Effective for dental services rendered
200.25on or after January 1, 2002, the commissioner shall increase reimbursements to dentists
200.26and dental clinics deemed by the commissioner to be critical access dental providers.
200.27For dental services rendered on or after July 1, 2007, the commissioner shall increase
200.28reimbursement by
200.29paid to the critical access dental provider. The commissioner shall pay the managed
200.30care plans and county-based purchasing plans in amounts sufficient to reflect increased
200.31reimbursements to critical access dental providers as approved by the commissioner.
200.32(b) The commissioner shall designate the following dentists and dental clinics as
200.33critical access dental providers:
200.34 (1) nonprofit community clinics that:
200.35(i) have nonprofit status in accordance with chapter 317A;
201.1(ii) have tax exempt status in accordance with the Internal Revenue Code, section
201.2501(c)(3);
201.3(iii) are established to provide oral health services to patients who are low income,
201.4uninsured, have special needs, and are underserved;
201.5(iv) have professional staff familiar with the cultural background of the clinic's
201.6patients;
201.7(v) charge for services on a sliding fee scale designed to provide assistance to
201.8low-income patients based on current poverty income guidelines and family size;
201.9(vi) do not restrict access or services because of a patient's financial limitations
201.10or public assistance status; and
201.11(vii) have free care available as needed;
201.12 (2) federally qualified health centers, rural health clinics, and public health clinics;
201.13 (3) city or county owned and operated hospital-based dental clinics;
201.14(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
201.15accordance with chapter 317A with more than 10,000 patient encounters per year with
201.16patients who are uninsured or covered by medical assistance,
201.17
201.18(5) a dental clinic owned and operated by the University of Minnesota or the
201.19Minnesota State Colleges and Universities system
201.20(6) private practicing dentists if:
201.21(i) the dentist's office is located within a health professional shortage area as defined
201.22under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
201.23section 254E;
201.24(ii) more than 50 percent of the dentist's patient encounters per year are with patients
201.25who are uninsured or covered by medical assistance or MinnesotaCare;
201.26(iii) the dentist does not restrict access or services because of a patient's financial
201.27limitations or public assistance status; and
201.28(iv) the level of service provided by the dentist is critical to maintaining adequate
201.29levels of patient access within the service area in which the dentist operates.
201.30
201.31
201.32
201.33
201.34
201.35specified in paragraph (a) for dental services provided off site at a private dental office if
201.36the following requirements are met:
202.1(1) the designated critical access dental clinic is located within a health professional
202.2shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
202.3States Code, title 42, section 254E, and is located outside the seven-county metropolitan
202.4area;
202.5(2) the designated critical access dental clinic is not able to provide the service
202.6and refers the patient to the off-site dentist;
202.7(3) the service, if provided at the critical access dental clinic, would be reimbursed
202.8at the critical access reimbursement rate;
202.9(4) the dentist and allied dental professionals providing the services off site are
202.10licensed and in good standing under chapter 150A;
202.11(5) the dentist providing the services is enrolled as a medical assistance provider;
202.12(6) the critical access dental clinic submits the claim for services provided off site
202.13and receives the payment for the services; and
202.14(7) the critical access dental clinic maintains dental records for each claim submitted
202.15under this paragraph, including the name of the dentist, the off-site location, and the
202.16license number of the dentist and allied dental professionals providing the services.
202.17 Sec. 20. Minnesota Statutes 2012, section 256B.76, is amended by adding a
202.18subdivision to read:
202.19 Subd. 7. Payment for certain primary care services and immunization
202.20administration. Payment for certain primary care services and immunization
202.21administration services rendered on or after January 1, 2013, through December 31, 2014,
202.22shall be made in accordance with section 1902(a)(13) of the Social Security Act.
202.23 Sec. 21. Minnesota Statutes 2012, section 256B.764, is amended to read:
202.24256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
202.25 (a) Effective for services rendered on or after July 1, 2007, payment rates for family
202.26planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
202.27when these services are provided by a community clinic as defined in section
202.28subdivision 1.
202.29 (b) Effective for services rendered on or after July 1, 2014, payment rates for
202.30family planning services shall be increased by 20 percent over the rates in effect June
202.3130, 2014, when these services are provided by a community clinic as defined in section
202.32145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care
202.33and county-based purchasing plans to reflect this increase, and shall require plans to pass
203.1on the full amount of the rate increase to eligible community clinics, in the form of higher
203.2payment rates for family planning services.
203.3 Sec. 22. Minnesota Statutes 2012, section 256B.766, is amended to read:
203.4256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
203.5(a) Effective for services provided on or after July 1, 2009, total payments for basic
203.6care services, shall be reduced by three percent, except that for the period July 1, 2009,
203.7through June 30, 2011, total payments shall be reduced by 4.5 percent for the medical
203.8assistance and general assistance medical care programs, prior to third-party liability and
203.9spenddown calculation. Effective July 1, 2010, the commissioner shall classify physical
203.10therapy services, occupational therapy services, and speech-language pathology and
203.11related services as basic care services. The reduction in this paragraph shall apply to
203.12physical therapy services, occupational therapy services, and speech-language pathology
203.13and related services provided on or after July 1, 2010.
203.14(b) Payments made to managed care plans and county-based purchasing plans shall
203.15be reduced for services provided on or after October 1, 2009, to reflect the reduction
203.16effective July 1, 2009, and payments made to the plans shall be reduced effective October
203.171, 2010, to reflect the reduction effective July 1, 2010.
203.18(c) Effective for services provided on or after September 1, 2011, through June 30,
203.192013, total payments for outpatient hospital facility fees shall be reduced by five percent
203.20from the rates in effect on August 31, 2011.
203.21(d) Effective for services provided on or after September 1, 2011, through June
203.2230, 2013, total payments for ambulatory surgery centers facility fees, medical supplies
203.23and durable medical equipment not subject to a volume purchase contract, prosthetics
203.24and orthotics, renal dialysis services, laboratory services, public health nursing services,
203.25physical therapy services, occupational therapy services, speech therapy services,
203.26eyeglasses not subject to a volume purchase contract, hearing aids not subject to a volume
203.27purchase contract, and anesthesia services
203.28percent from the rates in effect on August 31, 2011.
203.29(e) Effective for services provided on or after January 1, 2015, payments for
203.30ambulatory surgery centers facility fees, medical supplies and durable medical equipment
203.31not subject to a volume purchase contract, prosthetics and orthotics, hospice services,
203.32renal dialysis services, laboratory services, public health nursing services, eyeglasses
203.33not subject to a volume purchase contract, and hearing aids not subject to a volume
203.34purchase contract shall be increased by three percent. Payments made to managed care
204.1plans and county-based purchasing plans shall not be adjusted to reflect payments under
204.2this paragraph.
204.3
204.4hospital services, family planning services, mental health services, dental services,
204.5prescription drugs, medical transportation, federally qualified health centers, rural health
204.6centers, Indian health services, and Medicare cost-sharing.
204.7 Sec. 23. Minnesota Statutes 2012, section 295.52, subdivision 8, is amended to read:
204.8 Subd. 8. Contingent reduction in tax rate. (a) By December 1 of each year,
204.9beginning in 2011, the commissioner of management and budget shall determine the
204.10projected balance in the health care access fund for the biennium.
204.11(b) If the commissioner of management and budget determines that the projected
204.12balance in the health care access fund for the biennium reflects a ratio of revenues to
204.13expenditures and transfers greater than 125 percent, and if the actual cash balance in the
204.14fund is adequate, as determined by the commissioner of management and budget, the
204.15commissioner, in consultation with the commissioner of revenue, shall reduce the tax rates
204.16levied under subdivisions 1, 1a, 2, 3, and 4, for the subsequent calendar year sufficient
204.17to reduce the structural balance in the fund. The rate may be reduced to the extent that
204.18the projected revenues for the biennium do not exceed 125 percent of expenditures and
204.19transfers. The new rate shall be rounded to the nearest one-tenth of one percent. The rate
204.20reduction under this paragraph expires at the end of each calendar year and is subject to an
204.21annual redetermination by the commissioner of management and budget.
204.22
204.23
204.24
204.25 Sec. 24. Laws 2012, chapter 247, article 1, section 28, is amended to read:
204.26 Sec. 28. EMERGENCY MEDICAL ASSISTANCE STUDY.
204.27(a) The commissioner of human services shall convene a work group to develop a
204.28plan to provide coordinated and cost-effective health care and coverage for individuals
204.29who meet eligibility standards for emergency medical assistance and who are ineligible for
204.30other state public programs. The
204.31of representatives of relevant stakeholders
204.32not limited to, safety net hospitals, nonprofit health care coverage programs, nonprofit
204.33community clinics, and counties. The
204.34following elements:
205.1(1) strategies to provide individuals with the most appropriate care in the appropriate
205.2setting, utilizing higher quality and lower cost providers;
205.3(2) payment mechanisms to encourage providers to manage the care of these
205.4populations, and to produce lower cost of care and better patient outcomes;
205.5(3) ensure coverage and payment options that address the unique needs of those
205.6needing episodic care, chronic care, and long-term care services;
205.7(4) strategies for coordinating health care and nonhealth care services, and
205.8integrating with existing coverage; and
205.9(5) other issues and strategies to ensure cost-effective and coordinated delivery
205.10of coverage and services.
205.11(b) The commissioner shall submit the plan of the work group to the chairs and
205.12ranking minority members of the legislative committees with jurisdiction over health and
205.13human services policy and financing by
205.14EFFECTIVE DATE.This section is effective the day following final enactment.
205.15 Sec. 25. Laws 2013, chapter 1, section 6, is amended to read:
205.16 Sec. 6. TRANSFER.
205.17(a) The commissioner of management and budget shall transfer from the health care
205.18access fund to the general fund up to $21,319,000 in fiscal year 2014; up to $42,314,000
205.19in fiscal year 2015; up to $56,147,000 in fiscal year 2016; and up to $64,683,000 in fiscal
205.20year 2017.
205.21(b) The commissioner of human services shall determine the difference between the
205.22actual cost to the medical assistance program of adding 19 and 20 year old and caretaker
205.23populations with income between 100 and 138 percent of the federal poverty guidelines
205.24and the cost of adding those populations that was estimated during the 2013 legislative
205.25session based on the data from the February 2013 forecast.
205.26(c) For each fiscal year 2014 to 2017, the commissioner of human services shall
205.27certify and report to the commissioner of management and budget the actual cost difference
205.28of adding 19 and 20 year old and caretaker populations with income between 100 and 138
205.29percent of the federal poverty guidelines, as determined under paragraph (b), by June 30
205.30of each fiscal year. In each fiscal year, the commissioner of management and budget
205.31shall reduce the transfer under paragraph (a) by the amount of the costs certified under
205.32paragraph (b). If, for any fiscal year, the amount of the cost difference determined under
205.33paragraph (b) exceeds the amount of the transfer, the transfer for that year must be zero.
206.1 Sec. 26. 340B PROVIDER PRESCRIPTION DRUGS REIMBURSEMENT
206.2STUDY.
206.3(a) The commissioner of human services shall study and make recommendations on
206.4changes to standardize the medical assistance reimbursement rates for prescription drugs
206.5obtained through the federal 340B Program and dispensed to medical assistance enrollees.
206.6The study must examine the current medical assistance rate 340B providers are receiving
206.7through claims submissions and make recommendations on an overall reimbursement
206.8discount that will pay the same for drugs dispensed through the 340B Program as is paid
206.9for drugs dispensed by non340B providers, taking into consideration any federal rebate.
206.10(b) The commissioner shall consult with 340B providers that would be most affected
206.11by a change in the reimbursement formula, including, but not limited to, safety net
206.12hospitals, children's hospitals, community health centers, and family planning clinics.
206.13(c) The commissioner shall submit recommendations to the chairs and ranking
206.14minority members of the legislative committees and divisions with jurisdiction over health
206.15and human services policy and finance by January 15, 2014.
206.16 Sec. 27. DENTAL ACCESS AND REIMBURSEMENT REPORT.
206.17 Subdivision 1. Study. (a) The commissioner of human services shall study the
206.18current oral health and dental services delivery system for Minnesota public health
206.19care programs to improve access and ensure cost-effective delivery of services. The
206.20commissioner shall make recommendations on modifying the delivery of services and
206.21reimbursement methods, including modifications to the critical access dental provider
206.22payments under Minnesota Statutes, section 256B.76, subdivision 4.
206.23(b) The commissioner shall consult with dental providers enrolled in Minnesota
206.24health care programs, including providers who serve substantial numbers of low-income
206.25and uninsured patients and are currently receiving enhanced critical access dental provider
206.26payments.
206.27 Subd. 2. Service delivery and reimbursement methods. The recommendations
206.28must address:
206.29(1) targeting state funding and critical access dental payments to improve access
206.30to oral health services for individuals enrolled in Minnesota health care programs who
206.31are not receiving timely and appropriate dental services;
206.32(2) encouraging the use of cost-effective service delivery methods, workforce
206.33innovations, and the delivery of preventive services, including, but not limited to, dental
206.34sealants that will reduce dental disease and future costs of treatment;
207.1(3) improving access in all geographic areas of the state;
207.2(4) encouraging the use of tele-dentistry and mobile dental equipment to serve
207.3underserved patients and communities;
207.4(5) evaluating the use of a single administrator delivery model;
207.5(6) compensating providers for the added costs to providers of serving low-income
207.6and underserved patients and populations who experience the greatest oral health
207.7disparities in terms of incidence of oral health disease and access to and utilization of
207.8needed oral health services;
207.9(7) encouraging coordination of oral health care with other health care services;
207.10(8) preventing overtreatment, fraud, and abuse; and
207.11(9) reducing administrative costs for the state and for dental providers.
207.12 Subd. 3. Report. The commissioner shall submit a report on the recommendations to
207.13the chairs and ranking minority members of the of the legislative committees and divisions
207.14with jurisdiction over health and human services policy and finance by December 15, 2013.
207.15 Sec. 28. REPEALER.
207.16Laws 2011, First Special Session chapter 9, article 6, section 97, subdivision 6, is
207.17repealed.