Health Law

HEALTH LAW


Prepared by:
Ron Elwood, Supervising Attorney
Legal Services Advocacy Project
651-842-6909
relwood@mnlsap.org


Acronyms Used in this Section

ACA = Patient Protection and Affordable Care Act (or Affordable Care Act)
BHP = Basic Health Plan
DHS = Minnesota Department of Human Services
EMA = Emergency Medical Assistance
FPG = Federal Poverty Guidelines
MA = Medical Assistance
MAGI = Modified Adjusted Gross Income
MDH = Minnesota Department of Health
MMB = Minnesota Management and Budget
MNCare = MinnesotaCare
QHP = Qualified Health Plan

NEW STATE HEALTH CARE EXCHANGE ("MNsure")

During the 2013, session, the Minnesota Legislature enacted landmark legislation making Minnesota one of 17 states that have opted to establish a state-operated Health Care Exchange under the Patient Protection and Affordable Care Act (ACA) (Public Law 111-148). The bill was signed on March 20, 2013. The formal name of the state's new Health Care Exchange is the "Minnesota Insurance Marketplace." It has been branded "MNsure."

A corollary bill - known as the Market Rules Bill - was subsequently enacted to establish a set of groundrules applicable both inside MNsure and in the private market, outside MNsure.

Had an Exchange Bill not been signed by March 31st, Minnesota would have defaulted to a federally-operated Exchange.

Note: Not all coverage options offered by health plans will be available through MNsure, and consumers can choose to purchase coverage outside MNsure. MNsure is estimated to ultimately serve 1.3 million people, which includes all of the Medical Assistance and MinnesotaCare program participants.

I. MINNESOTA HEALTH CARE EXCHANGE ("MNsure")
Chapter 9 (HF 5)
Adds Chapter 62V (Minn. Stat. §§ 62V.01 - 62V.11)
Effective March 21, 2013

A. Key Definitions

1. Health Carrier
Defined to mean a "health carrier" as defined in Minn. Stat. § 62A.011, subd. 2.
Adds Minn. Stat. § 62V.02, subd. 5

Note: Minn. Stat. § 62A.011, subd. 2, defines a health carrier as an
Insurance company licensed by the Department of Commerce to offer, sell, or issue a policy.


2. Health Plan
Defined to mean a "health plan" as defined in Minn. Stat. § 62A.011, subd. 3.
Adds Minn. Stat. § 62V.02, subd. 4

Note: Minn. Stat. § 62A.011, subd. 3, defines a health plan an insurance policy for sickness and accident.

3. Navigator
Defined to mean a Navigator as described in section 1311(i) of the ACA and subsequent rules (i.e., an entity that meets the ACA criteria).
Adds Minn. Stat. § 62V.02, subd. 9

Note: The role of a Navigator is to conduct outreach and/or facilitate enrollment. Though Navigator can facilitate enrollment for applicants inside or outside MNsure, the ACA envisions Navigators to fulfill the ACA's objective to include among the insured the underserved and vulnerable population. MNsure must designate community organization applicants and may designate applicants from other categories as Navigators.

4. Public Health Care Program (Public Programs)
Defined to mean any public health care program administered by DHS.
Adds Minn. Stat. § 62V.02, subd. 10

5. Qualified Health Plan (QHP)
Defined to mean a health plan that: (1) meets the definition in section 1301(a) of the ACA and subsequent rules; and (2) been certified by the MNsure board.
Adds Minn. Stat. § 62V.02, subd. 11

Note: The ACA definition cited requires that a health plan (i) is licensed; (ii) contains the essential benefits required under the ACA; and (iii) is priced the same whether it is offered inside or outside MNsure.

B. Creation
Creates a Health Care Exchange: (1) as a board under Minn. Stat. § 15.012, subd. 1(a) delineating different types of state agencies; and (2) in compliance with the ACA.
Adds Minn. Stat. § 62V.03, subd. 1

C. Initial Operation and Transfer of Operations
Directs MMB to: (1) exercise initial authority and carry out the responsibilities of the board; and (2) by September 21, 2013, transfer authority and responsibilities (including assets and contracts) to the board when it has established bylaws, policies, and procedures governing the operations of MNsure.
Uncodified Section

D. Purpose
Sets forth the purposes as, among others, (1) promoting, among others, affordability, suitable and meaningful choices, health improvement, and reduction of health disparities; (2) facilitating and simplifying comparison between and choice of health insurance for individuals, employees, employers; (3) helping individuals access tax credits; (4) help individuals access public programs; and (5) facilitating continuity of coverage and the integration and transition between public programs and QHPs.
Adds Minn. Stat. § 62V.03, subd. 1

E. Governance

1. Board

a. Number and Terms
Establishes a seven-member board. Designates the DHS Commissioner as a permanent member. Requires that the other members serve: (1) staggered terms; and (2) no more than two
Adds Minn. Stat. § 62V.04, subd. 1 (establishment)
Adds Minn. Stat. § 62V.04, subd. 3 (terms)

b. Appointment and Consent
Provides that board members are appointed by the governor with consent of both the Senate and the House of Representatives. act
Adds Minn. Stat. § 62V.04, subd. 2

c. Interests Represented
Requires three members, each of which to represent one of the following interests: (1) individual consumers in the market; (2) public health care programs participants; and (3) small employers. Requires the remaining three to have demonstrated expertise, leadership, and innovation in the areas of: (1) health administration, health care finance, health plan purchasing, and health care delivery systems; (2) public health, health disparities, public health care programs, and the uninsured; and (3) health policy issues related to the small group and individual markets.
Adds Minn. Stat. § 62V.04, subd. 2

2. Conflict of Interest
Establishes criteria that disqualify categories of persons from serving on the board. Disqualifies persons who, at any time during their terms or within one year of a possible appointment: (1) are lobbyists; (2) have spouses who are executives of a health carrier; and (3) are employees, board members, or representatives of: (i) a health care provider; (ii) an insurance company, or (iii) a Navigator.
Adds Minn. Stat. § 62V.03, subd. 4

3. Advisory Committees
Requires the board to establish and maintain advisory committees to provide consumer, industry and other stakeholders with a forum for input into the operations of MNsure. Permits the board to establish additional advisory committees, as necessary.
Adds Minn. Stat. § 62V.03, subd. 13

F. Responsibilities and Powers of the Board

1. Re: Navigators and In-person Assisters

a. Responsibilities of Board
Requires the board, by January 1, 2015, to: (1) establish procedures for the navigator and in-person assister programs; (2) establish a call center and toll-free number for MNsure; (3) develop a variety of training modules, including one on the needs of underserved and vulnerable populations; and (4) ensure information is made available to persons with disabilities.
Adds Minn. Stat. § 62V.05, subd. 4(a), (c), (d), and (e)

Note: The In-person Assister Program is established for 2014 to conduct outreach and/or enroll applicants in QHP's.

b. Interim Policies
Provides that, until January 1, 2015, the Navigator program is the Minnesota Community Application Agent (MNCAA) Program under Minn. Stat. § 256.962.
Adds Minn. Stat. § 62V.05, subd. 4(b)

Note: the MNCAA Program was established in 2007 by the Legislature to provide grants to community organizations to facilitate enrollment of eligible Minnesotans in public programs.

2. Re: Certification and Training of Insurance Agents
Requires the board to establish certification requirements for insurance agents in accordance with the federal rules implementing the ACA. Provides that the health carriers - and not MNsure -- will compensate insurance agents for enrolling applicants. Requires insurance agents to disclose to applicants, orally and in writing at the initial solicitation: (1) which health carriers the agent represents; (2) which health plans offered through MNsure the agent is authorized to sell; (3) that the agent is receiving compensation through the health carriers; and (4) that information about coverage options is available on the MNsure Web site.
Adds Minn. Stat. § 62V.05, subd. 3

3. Re: Health Insurance Carriers and Qualified Health Plans

a. Carrier/Plan Participation in the Exchange in 2014
Requires that, for 2014, the board to permit all health carriers to offer through MNsure any health plan that meet ACA certification requirements.
Adds Minn. Stat. § 62V.05, subd. 5(f)

b. Carrier/Plan Participation in the Exchange in 2015
Directs the board, beginning January 1, 2015, to: (1) establish certification requirements for health carriers; (2) establish certification requirements for health plans; and (3) select specific QHPs that are in the interest of qualified individuals and qualified employers. Permits the board, in selecting QHPs, to consider, among other things: (1) affordability; (2) quality; (3) value; (4) promotion of prevention, wellness, and initiatives to reduce health disparities; (5) meaningful choices and access; and (6) other criteria that the board determines appropriate
Adds Minn. Stat. § 62V.05, subds. 5(a), (c), and (d)

Note: This part of the new law authorizes but does not require the board to exercise the so-called "active selector" or "active purchaser" power.

c. Decertification
Grants the board the power to decertify health carriers and health plans that fail to maintain compliance with the ACA.
Adds Minn. Stat. § 62V.05, subd. 5(h)


d. Health Plans Offered to Tribes
Beginning January 1, 2015, requires health carriers to use the most current addendum for Indian health care providers approved by the Centers for Medicare and Medicaid Services and
the tribes as part of their contracts with Indian health care providers.
Adds Minn. Stat. § 62V.05, subd. 5(i)

4. Re: Dental Plans
Provides that, to the extent practicable, all the provisions applicable to health plans apply, but only to stand-alone dental plans offered through the Exchange.
Adds Minn. Stat. § 62V.05, subd. 9

5. Re: Appeals
Grants the board the power to conduct hearings, appoint hearing officers, and recommend final orders related to appeals of any determinations of MNsure, except appeals of determinations of decisions concerning aggrieved recipients of public assistance programs, which remain governed by Minn. Stat. § 256.045.
Adds Minn. Stat. § 62V.05, subd. 6

6. Re: Rulemaking

a. Special Procedures Until January 1, 2015
Gives interested parties 21 days to comment on proposed rules. Makes final rules effective either: (1) upon publication before January 1, 2014 in the State of the notice of final adoption for rules, or (2) 30 days after publication in the State Register on and after January 1, 2014 of the notice of final adoption for rules.
Adds Minn. Stat. § 62V.05, subd. 8

b. Expedited Process Beginning January 1, 2015
Provides for expedited rulemaking pursuant to Minn. Stat. § 14.389 for rules adopted on or after prior to January 1, 2015.
Adds Minn. Stat. § 62V.05, subd. 8

Note: Under expedited rulemaking, an agency must allow 30 days after publication in the State Register for comment.

G. Treatment of Data

1. On Exchange Participants
Provides that data on individuals, employees, and employers participating in MNsure is classified as private or nonpublic data, as defined in Minn. Stat. § 13.02.
Adds Minn. Stat. § 62V.06, subd. 3

2. On Applicants for Certification
Provides that data on an insurance agent or an entity seeking certification as a navigator or in-person assister - other than the applicant's name - is: (1) private when the application is submitted; and (2) other than trade secret data, public when a determination is made. If an application is denied, the public data must: (1) include the evaluation criteria used by the board; (2) include the specific reasons for the denial; and (3) be published on the MNsure Web site.
Adds Minn. Stat. § 62V.06, subd. 4

3. Data Sharing and Sale of Data
Limits the ability of MNsure to share data to certain circumstances (e.g., pursuant to a court order). Requires disclosures and notices regarding privacy or sharing of data. Prohibits MNsure from selling data.
Adds Minn. Stat. § 62V.06, subd. 5 (sharing)
Adds Minn. Stat. § 62V.06, subd. 6 (disclosures/notices)
Adds Minn. Stat. § 62V.06, subd. 9 (sale)

H. Funding for the Exchange Operations
Funds MNsure from a portion of total premiums collected for individual and small group market health plans and dental plans sold through MNsure. Caps funding at: (1) 1.5% of premiums collected prior to January 1, 2015; and (2) 3.5% of premiums collected thereafter. Specifies that the funding source for MNsure operations also funds navigators.
Adds Minn. Stat. § 62V.05, subd. 2

I. Phase-Out of Minnesota Comprehensive Health Association (MCHA)
Authorizes the Department of Commerce to phase-out MCHA. Prohibits the phase-out from beginning before January 1, 2014 or the effective date of the operation of MNsure, whichever is later. Requires, to the extent practicable, the least amount of disruption to the enrollees' coverage.
Uncodified Section

II. MARKET RULES BILL
Chapter 84, Article 2 (HF 779)
Amends Various Sections
Adds Chapter 62K (Minn. Stat. §§ 62K.01 - 62K.15)
Adds Various Other Sections
Various Effective Dates

This bill contains two articles. Article 1 consists of 93 sections making conforming changes to state law to implement the Affordable Care Act, including repeal of a number of inconsistent statutes.

Article 2 consists of 16 sections comprising the Market Rules, which govern health insurance offered both inside and outside MNsure.

Note: MA and MnCare will be available through MNsure.

A. Categories of Offering (Metal Levels)
Provides that, if a health carrier offers a catastrophic or a bronze level plan in any service area in an individual or group market, it must also offer silver and gold level plans in that same market.
Adds Minn. Stat. § 62K.06
Effective January 1, 2015

Note: Under the ACA, four categories or levels of coverage will be offered: Bronze, Silver, Gold, and Platinum. These are called "metal levels." They are based on "actuarial value," which represents the percentage of costs covered by the plan. The higher the level, the higher the premium cost to the consumer and the greater the coverage: Bronze: 60% costs covered; Silver: 70% costs covered; Gold: 80% costs covered; Platinum: 90% costs covered.

B. Geographic Accessibility

1. Maximum Time/Distance to Basic Services
Provides that the nearest provider of primary care, mental health services, and general hospital services must be within 30 miles or 30 minutes travel distance or time. Applies to carriers that either: (1) own their own networks; or (2) rent networks.
Adds Minn. Stat. § 62K.10, subd. 1 (applicability)
Adds Minn. Stat. § 62K.10, subd. 2 (maximum time and distance)
Effective January 1, 2015

2. Maximum Time/Distance to Specialty Services
Provides that the nearest provider of the following services must be within 60 miles or 60 minutes travel distance or time: (1) specialty physician services; (2) ancillary services; (3) specialized hospital services; and (4) any service other than primary care, mental health, and general hospital service. Applies to carriers that either: (1) own their own networks; or (2) rent networks.
Adds Minn. Stat. § 62K.10, subd. 1 (applicability)
Adds Minn. Stat. § 62K.10, subd. 3 (maximum time and distance)
Effective January 1, 2015

3. Service Area Requirements
Requires health carriers to serve an entire county. Provides that service must be established without regard: (1) race; (2) ethnicity; (3) language; (4) concentrated poverty factors; (4) health status-related factors; or (5) other factors that exclude specific high-utilizing, high-cost, or medically underserved populations.
Adds Minn. Stat. § 62K.13
Effective January 1, 2015

4. Waivers

a. Of Geographic Accessibility Requirements
Permits applications to MDH for a waiver, which expires after four years, if the provider: (1) is unable to meet of the geographic accessibility requirements; (2) can demonstrate with specific data that compliance is not feasible in a particular service area or part of a service area; and (3) details the steps that were and will be taken to address the deficiency.
Adds Minn. Stat. § 62K.10, subd. 5
Effective January 1, 2015

b. Of Service Area Requirements
Permits application to MDH to serve an area smaller than the entire county if the carrier can demonstrate the waiver is: (1) necessary; (2) nondiscriminatory; and (3) in the best interest of enrollees.
Adds Minn. Stat. § 62K.13
Effective January 1, 2015

C. Network Adequacy
Requires provider networks to have a sufficient number and types of providers, including mental health and substance abuse providers, available to all enrollees without unreasonable delay. Charges MDH with considering network adequacy based on criteria, including among other considerations, whether: (1) primary care physician services are available and accessible 24/7 within the network area; (2) a sufficient number of primary care physicians have hospital admitting privileges at one or more participating hospitals within the network area; and (3) specialty physician service is available.
Adds Minn. Stat. § 62K.10, subd. 4
Effective January 1, 2015

D. Billing
Prohibits a network provider from billing an enrollee for more than the allowable amount the health carrier has contracted for with the provider to pay in total for the service. Permits a network provider to bill for: (1) the approved co-pay; (2) the deductible; (3) coinsurance; or (4) services not covered, unless the enrollee has agreed in advance to receive and pay for the services.
Adds Minn. Stat. § 62K.10, subd. 11
Effective January 1, 2014

E. Limited-Scope Pediatric Dental Plans
Requires health carriers to offer limited-scope pediatric dental plans, consistent with the ACA: (1) on a guaranteed issue: (2) on a guaranteed renewable basis; (3) with premiums rated on allowable rating factors used for health plans; and (4) without any exclusions or limitations based on preexisting conditions. Allows discontinuance with prior written notice if the carrier offers the same or a substantially similar dental plan. Requires the dental services are available within 60 miles or 60 minutes' travel time. Deems carriers to be in compliance if they offer stand-alone limited-scope pediatric dental plans, either separately or in conjunction with a health plan.
Adds Minn. Stat. § 62K.14
Effective January 1, 2015


F. Consistent Open Enrollment Periods
Provides that the open enrollment periods for the individual market must conform to the open enrollment periods for plans available through MNsure.
Adds Minn. Stat. § 62K.15
Effective January 1, 2015

MINNESOTA'S PUBLIC HEALTH PROGRAMS


I. DENTAL ACCESS STUDY
Chapter 108, Article 6, Section 35 (HF 1233)
Uncodified Section

Directs DHS to study the current oral health and dental services delivery system for public health care programs to: (1) improve access; (2) ensure cost-effective delivery of services; and (3) recommend modifications, including to the critical access dental provider payments structure. Requires DHS to consult with dental providers serving public program recipients, particularly those who: (1) serve substantial numbers of low-income and uninsured patients; and (2) currently receive enhanced critical access dental provider payments. Requires DHS to submit a report with recommendations to the Legislature by December 15, 2013.

II. EMERGENCY MEDICAL ASSISTANCE (EMA)

A. Coverage of Certain Services for Noncitizens
Chapter 108, Article 6, Section 7 (HF 1233)
Amends Minn. Stat. § 256B.06, subd. 4
Effective July 1, 2013

Extends - except where prohibited under federal law - MA coverage for noncitizens for: (1) dialysis services provided in a hospital or freestanding dialysis facility; and (2) surgery, chemotherapy, radiation, and related services where: (i) cancer is not in remission; and (ii) surgery or treatment is necessary.

B. Studies Regarding EMA Recipients and Uninsured Persons
Chapter 108, Article 6, Sections 33 and 34 (HF 1233)
Uncodified Sections

1. Coordinated Care and Coverage for EMA Recipients and the Uninsured

a. General Charge
Directs DHS to identify alternatives and make recommendations to the Legislature by January 15, 2014 for providing coordinated and cost-effective health care to, and coverage of medically necessary services persons for, individuals who: (1) are eligible for EMA; or (2) are uninsured, below 400% FPG, and ineligible for public programs or public subsidies. Directs DHS to consult with safety net hospitals, nonprofit health care coverage programs and community clinics, counties, and other interested parties.
b. Specific Data Gathering Requirements
Directs DHS to issue a request for information by August 1, 2013 to identify, among other things: (1) medical, dental, and behavioral health services necessary to reduce emergency room and inpatient hospital use; (2) statewide delivery system and funding options; (3) how funding and delivery of services will be coordinated with covered EMA services; and (4) eligibility determination options.

2. Coverage for EMA Recipients for Medically Necessary Services
Effective July 1, 2013

a. General Charge
Directs DHS to issue a request for information by August 1, 2013 to identify and develop options to cover EMA recipients for medically necessary services that are not eligible for federal financial participation. Requires: (1) information to be submitted to DHS by November 1, 2013; and (2) DHS to submit a report with recommendations for coverage options to the Legislature by January 15, 2014.

b. Focus
Requires the request for information to focus on providing coverage for nonemergent services for recipients who have: (1) two or more chronic conditions; and (2) had two or more hospitalizations covered by EMA in a one-year period.

c. Specific Information Requested
Requires the information requested to include, among other things: (1) services necessary to reduce emergency room and inpatient hospital use by EMA recipients; (2) efficient and cost-effective statewide service delivery methods; (3) funding options; and (4) coordination of service delivery and funding with covered EMA services.

C. EMA MA Referral and Assistance Grants
Chapter 108, Article 14, Section 2, Subdivision 6(h) (HF 1233)
Uncodified Section
Effective July 1, 2013

Appropriates $100,000 in fiscal year 2014 and $100,000 in fiscal year 2015 for grants to nonprofit immigration legal services programs that serve clients based on indigency. Directs the grant funds for the provision of legal services for immigration assistance to individuals with emergency medical conditions or complex and chronic health conditions who: (1) are not currently eligible for public health care programs; but (2) may meet eligibility requirements with immigration assistance. Directs grantees to connect the target population with alternative resources and services to assist in meeting their health care needs.


III. MEDICAID EXPANSION
Chapter 1 (HF 9)
Amends Minn. Stat. § 256B.056, subds. 1a, 3c and 4
Adds Minn. Stat. § § 256B.055, subd. 16
Effective January 1, 2014

The first bill to reach the Governor's desk during the 2013 session was the Medicaid Expansion bill. In passing this bill, the Minnesota joined more than 20 states that have chosen to take advantage of an option provided under federal health reform to extend coverage to more Minnesotans through Medical Assistance or MA (as the Medicaid Program is called in Minnesota). An estimated 35,000 additional low-income individuals who earn slightly more than $15,000 annually will now qualify for MA coverage.

A. Eligibility

1. Age
Expands eligibility to children ages 19 and 20.
Adds Minn. Stat. § 256B.055, subd. 16

2. Income

a. Adults Without Children; Parents; Caretaker Relatives
Expands eligibility to those with incomes up to 133% FPG. Disregards as income: (1) certain Veterans benefits; and (2) Veterans Administration unusual medical expense payments.
Amends Minn. Stat. § 256B.056, subdivision 4

b. Methodology
Changes calculation for income eligibility to the modified adjusted gross income (MAGI) methodology, as defined in the ACA for: (1) children under age 19, their parents, and their relative caretakers; (2) children ages 19 to 20; (3) pregnant women; (4) infants; and (5) adults without children. Subtracts from the calculation of income an amount equivalent to 5% FPG from the applicant's MAGI.
Amends Minn. Stat. § 256B.056, subdivision 1a

c. Assets
Beginning January 1, 2014, eliminates the limits of $10,000 in total net assets for a household of one and $20,000 for a household of two or more for all applicants except parents and caretaker relatives.
Amends Minn. Stat. § 256B.056, subdivision 3c


IV. MEDICAL ASSISTANCE (MA) CHANGES

A. Alternative Health Care Delivery Systems
Chapter 108, Article 1, Section 26 (HF 1233)
Amends Minn. Stat. § 256B.0755, subd. 3
Effective July 1, 2013 for contracts entered into or renewed after July 1, 2013

Requires a health care delivery system demonstration projects (including Accountable Care Organizations or ACOs) applying for approval to, among other things: (1) demonstrate how its services will be coordinated with services provided by other providers and county agencies; and (2) document how it will address local needs, priorities, and public health goals.

B. DHS Responsibility Upon Application
Chapter 108, Article 1, Sections 7 and 8 (HF 1233)
Amends Minn. Stat. § 256B.04, subd. 18
Adds Minn. Stat. § 256B.02, subd. 19
Various Effective Dates

1. Acceptance in Multiple Forms
Requires DHS to accept applications for MA: (1) by telephone; (2) via mail; (3) in-person; (4) online; (5) via an Internet Web site; and (6) through other commonly available electronic means.
Amends Minn. Stat. § 256B.04, subd. 18(a)
Effective January 1, 2014

2. Identification and Definition of Other "Insurance Affordability Programs"

a. Definition
Defines "insurance affordability program" to mean: (1) MA; (2) MNCare; (3) a program that provides advance payments of the premium tax credits; or (4) a BHP.
Adds Minn. Stat. § 256B.02, subd. 19
Effective May 24, 2013

b. Identification
Directs DHS to determine if the applicant is potentially eligible for other "insurance affordability programs" if the applicant is ineligible for MA.
Adds Minn. Stat. § 256B.04, subd. 18(c)
Effective January 1, 2014

C. Eligibility
Chapter 108, Article 1, Sections 6, 9 - 25, and 68 (HF 1233)
Amends Minn. Stat. § 256B.055, subds. 3a, 4, 6, 10, 15, and 17; and 256.056, subds. 1 5c, and 10; 256B.057, subd. 1; and 256B.06, subd. 4
Adds Minn. Stat. § 256B.02, subd. 18; 256B.055, subd. 17; 256B.056, subd. 7a; and 256.067, subd. 12
Repeals Minn. Stat. §§ 256B.055, subds. 3, 5, and 10b; 256B.056, subd.5b; and 256B.057, subds. 1c and 2
Various Effective Dates

1. Categories of Eligible Persons

a. Adults Who Were in Foster Care at 18
Extends eligibility for MA to persons under 26 who were: (1) in foster care when they turned 18; and (2) were enrolled in MA while in foster care.
Adds Minn. Stat. § 256B.055, subd. 17
Effective January 1, 2014

b. Adults Without Children
Removes the bar to eligibility for an adult in a family with children. Clarifies that adults without children are not eligible if they are eligible for or enrolled in the Supplemental Security Income Program (SSI).
Amends Minn. Stat. § 256B.055, subd. 15
Effective January 1, 2014

c. "Caretaker Relatives"
Defines a "caretaker relative" as a relative, by blood, adoption, or marriage, of a child under 19 with whom the child is living and who assumes primary responsibility for the child's care.
Adds Minn. Stat. § 256B.02, subd. 18
Effective January 1, 2014

Note: Caretaker relatives are eligible for MA under Minn. Stat. § 256B.055, subd. 3a.

d. Children Under the Age of 19

1) Definition of Dependent Child
Defines a dependent child as a child under 19.
Amends Minn. Stat. § 256B.055, subd. 3a
Effective the later of January 1, 2014 or upon federal approval

Note: Current law refers to children under 18, with certain education-related exceptions for children under 19.

2) Income Limit
Increases the MA income limit for children under 19 to 275% FPG.
Amends Minn. Stat. § 256B.056, subd. 4
Effective January 1, 2014

e. Children Age 19 to 20
Makes a 19 or 20 year old with income up to 133% of FPG eligible for MA.
Amends Minn. Stat. § 256B.056, subd. 4
Effective January 1, 2014

f. Infants Under Two
Expands MA to infants who are: (1) under two; and (2) reside in families with income based on MAGI at or below 275% FPG (i.e., the standard provided under Minn. Stat. § 256B.057, subd. 1).
Amends Minn. Stat. §§ 256B.055, subd. 10; and 256B.057, subd. 1
Effective January 1, 2014

g. Pregnant Women
Eliminates the requirement that pregnant women must have written verification of a positive pregnancy test from a physician or licensed registered nurse to be eligible for MA. Requires, instead, that DHS accept self-attestation of pregnancy, unless DHS has information that is not reasonably compatible with the attestation.
Amends Minn. Stat. §§ 256B.55, subd. 6; and 256B.057, subd. 1
Effective January 1, 2014

h. Stepparents
Expands eligibility for MA to stepparents of children under 19, and removes the requirement that the children be the stepparent's dependent.
Amends Minn. Stat. § 256B.055, subd. 3a
Effective the later of January 1, 2014 or upon federal approval

2. Presumptive Eligibility Determinations by Qualified Hospitals
Directs DHS to establish a process to qualify hospitals to determine presumptive eligibility for MA for applicants who may have a basis of eligibility using MAGI.
Adds Minn. Stat. § 256B.057, subd. 12
Effective January 1, 2014

3. Eligibility Requirements

a. Citizenship
Clarifies that MA coverage, funded through the federal Children's Health Insurance Program, is available for pregnancy related services for pregnant women who are ineligible for federally funded MA because of immigration status.
Amends Minn. Stat. § 256B.06, subd. 4.
Effective January 1, 2014

b. Excess Income Standard
Clarifies that the spend-down standard set at 133% FPG applies to: (1) parents; (2) caretaker relatives; (3) pregnant women; (4) infants; and (5) children ages two through 20.
Amends Minn. Stat. § 256B.056, subd. 5c
Effective January 1, 2014

c. Residency
Aligns the residency standard with the definition in federal rules (i.e., 42 C.F.R. § 435.403), replacing the DHS rules as the standard.
Amends Minn. Stat. § 256B.056, subd. 1
Effective January 1, 2014

4. Eligibility Redeterminations
Adds Minn. Stat. § 256B.056, subd. 7a
Effective January 1, 2014

a. Where Existing Information is Sufficient
Requires DHS to make annual eligibility redeterminations based on existing information in the case file (provided the existing information is sufficient) without requesting additional information from the enrollee.
Adds Minn. Stat. § 256B.056, subd. 7a(a)

b. Where Existing Information is Insufficient
Requires DHS, where existing information is the file is insufficient to redetermine eligibility, to: (1) provide the enrollee with a prepopulated renewal form; (2) permit the enrollee to submit the form with any corrections or additional information: and (3) sign the renewal form by the allowed means of submission.
Adds Minn. Stat. § 256B.056, subd. 7a(b)

c. Reinstatement Where Enrollee Fails to Timely Complete Renewal
Allows an enrollee terminated for failure to timely complete the renewal process to: (1) submit the renewal within four months of termination; and (2) if eligible, have coverage reinstated retroactive to the date of termination.
Adds Minn. Stat. § 256B.056, subd. 7a(c)

d. Enrollees Subject to Spend-Downs
Requires enrollees subject to spend-downs to renew eligibility every six months.
Adds Minn. Stat. § 256B.056, subd. 7a(d)

5. Eligibility Verification
Requires DHS, among other things, to: (1) use information obtained through the U.S. Department of Health and Human Services' electronic service and other available electronic data sources to verify eligibility requirements; (2) establish standards to define when information obtained electronically is reasonably compatible with information provided by applicants and enrollees (including self-attestation); and (3) allow real-time eligibility determinations.
Amends Minn. Stat. § 256B.056, subd. 10
Effective January 1, 2014

6. Repealed Sections and Subdivision
Repeals sections and subdivisions referencing: (1) eligibility of and asset limits applicable to pregnant woman; and (2) eligibility of: (i) AFDC families; (ii) children generally; and (iii) children under two.
Repeals Minn. Stat. §§ 256B.055, subd. 5 (pregnant women; eligibility)
Repeals Minn. Stat. §§ 256B.057, subd. 1c (pregnant women; assets)
Repeals Minn. Stat. § 256B.055, subd. 3 (AFDC families)
Repeals Minn. Stat. §§ 256B.057, subd. 2 (children generally)
Repeals Minn. Stat. § 256B.055, subd. 10b (children under two)
Effective January 1, 2014

D. Childhood Immunizations
Chapter 108, Article 6, Section 14 (HF 1233)
Amends Minn. Stat. § 256B.0625, subd. 39
Effective August 1, 2013

Eliminates the cap of $8.50 per dose that MA will pay for administering pediatric vaccines to eligible children.

E. Coverage of Physical and Occupational Therapy and Speech-Language Pathology
Chapter 81, Sections 4 - 6 (SF 654)
Amends Minn. Stat. §§ 256B.0625, subds. 8, 8a, and 8b
Effective August 1, 2013

Removes the requirement that pre-authorization from DHS that services are medically necessary must be obtained for the following services: (1) physical therapy and related services; (2) occupational therapy and related services; and (3) speech-language pathology and related services.
Amends Minn. Stat. §§ 256B.0625, subds. 8 (physical therapy)
Amends Minn. Stat. §§ 256B.0625, subds. 8a (occupational therapy)
Amends Minn. Stat. §§ 256B.0625, subds. 8b (speech-language pathology)

F. Coverage of Special Transportation
Chapter 81, Section 7 (SF 654)
Amends Minn. Stat. § 256B.0625, subd. 17
Repeals Minn. R., part 9505.0315, subp. 7, item D
Effective August 1, 2013

Eliminates the requirement imposed on special transportation providers to take MA recipients to the "nearest appropriate" health care provider, and establishes a radius limit of 30 miles to a primary care provider or 60 miles to a specialty care provider. Allows the MA recipient to exceed these limits if the recipient receives authorization from the local agency.

G. Dental Coverage
Chapter 108, Article 6, Section 8 (HF 1233)
Amends Minn. Stat. § 256B.0625, subd. 9
Effective August 1, 2013

Extends MA dental coverage for adults to: (1) house calls or extended care facility calls for on-site delivery of covered services; (2) behavioral management, when additional staff time is required and sedation is not used; (3) oral or IV sedation, if the covered service cannot be performed safely without it or would need to be performed under general anesthesia in a hospital or surgical center; and (4) prophylaxis, in accordance with an individualized treatment plan, but no more than four times per year.

H. Diabetic Testing Program
Chapter 108, Article 6, Section 13 (HF 1233)
Adds Minn. Stat. § 256B.0625, subd. 31b
Effective August 1, 2013

Directs DHS to: (1) implement a point-of-sale preferred diabetic testing supply program by January 1, 2014; (2) adopt and administer the preferred diabetic testing supply program as part of the administration of the diabetic testing supply rebate program; and (3) seek any federal waivers or approvals necessary to implement the directive. Grants DHS the authority to add to, delete from, or otherwise modify the preferred diabetic testing supply program drug list after: (1) consulting with the Drug Formulary Committee and appropriate medical specialists; and (2) providing public notice and the opportunity for public comment.

I. Doula Services
Chapter 108, Article 6, Section 11 (HF 1233)
Adds Minn. Stat. § 256B.0625, subd. 28b
Effective the later of January 1, 2014 or upon federal approval, and applies to services provided on or after the effective date.

Extends MA coverage to doula services provided by a certified doula of the mother's choice. Defines "doula services" to mean childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and postpartum.

J. Hennepin Pilot Program
Chapter 108, Article 6, Sections 17 and 18 (HF 1233)
Amends Minn. Stat. §§ 256B.0631, subd. 1; and 256B.0756
Effective August 1, 2013

Makes changes to the statutes governing a pilot program operated by Hennepin County to test alternative and innovative health care delivery networks.

1. Identification of Enrollees Based on Zip Code
Permits DHS to identify individuals to be enrolled in the Hennepin County pilot program: (1) based on zip code; or (2) whether the individuals would benefit from an integrated health care delivery network.
Amends Minn. Stat. § 256B.0756

2. Elimination of Cap on Participants
Removes the enrollment cap of 7,000 enrollees.
Amends Minn. Stat. § 256B.0756

3. Waiver of Co-Payments
Permits Hennepin County's pilot program to waive co-payments. Excludes the value of the co-payments in the capitation payment amount to the integrated health care delivery networks under the pilot program.
Amends Minn. Stat. § 256B.0631, subd. 1

K. Nonemergency Transportation Mandate
Chapter 81, Section 8 (SF 654)
Amends Minn. Stat. § 256B.0625, subd. 18e
Effective August 1, 2013

Extends the time frame within which DHS must submit enabling legislation to implement a single administrative structure and delivery system for nonemergency medical transportation, as required by the 2012 Minnesota Legislature. Pushes back: (1) to January 15, 2014 (from January 15, 2013) the date by which DHS must submit necessary legislation; and (2) to July 1, 2014 (from July 1, 2013) the date by which DHS must implement the new system.

L. Payment for Multiple Services Provided on the Same Day
Chapter 108, Article 6, Section 16 (HF 1233)
Adds Minn. Stat. § 256B.06, subd. 63
Effective August 1, 2013

Directs DHS not to prohibit payments, including supplemental payments, for mental health services or dental services provided to a patient by a clinic or health care professional solely because the services were provided on the same day as other covered health services furnished by the same provider.

M. Public Information
Chapter 81, Section 10 (SF 654)
Amends Minn. Stat. § 256B.0625, subd. 25
Effective August 1, 2013

Adds to the items DHS is required to publish in the Minnesota health care programs provider manual and on its Web site the criteria and standards used to determine whether certain providers must obtain prior authorization for their services.


IV. MINNESOTACARE (MNCare)
Chapter 108, Article 1, Sections 3 and 34 - 68 (HF 1233)
Amends Minn. Stat. §§ 256L.03, subds. 1, 1a, 3, 4b, and 5; 256L.04, subds. 1, 7, 10, and 12; 256L.05, subds. 1 and 3c; 256L.06, subd. 3; 256L.07, subds. 1, 2, and 3; 256L.09, subd. 2; 256L.12, subd. 1; and 256L.15, subd. 2
Adds Minn. Stat. §§ 256.01, subd. 35; 256L.02, subds. 5 and 6; 256L.04, subds. 1c and 14; and 256L.121
Repeals Minn. Stat. §§ 256L.01, subd. 4a; 256L.04, subds. 1b, 9, and 10a; 256L.05, subd. 3b; 256L.07, subds. 1, 5, 8, and 9; 256L.011, subds. 6 and 7; and 256L.17, subds. 1, 2, 3, 4, and 5
Various Effective Dates

Note: MinnesotaCare is continued through 2014, with the changes made under this legislation, under a waiver. The legislation contemplates that MinnesotaCare will become the Basic Health Plan Option (BHP) available under the ACA. Though no decision has been made, it is expected that the new BHP will retain the MinnesotaCare brand.

A. Transition to a Basic Health Plan (BHP)

1. Seeking Federal Approval for BHP
Requires DHS to: (1) seek federal approval and any necessary waivers to operate a BHP for persons with incomes up to 275% FPG; (2) secure all federal funding available, including from premium tax credits and cost-sharing subsidies available under the ACA; and (3) ensure federal funding is predictable, stable and sufficient to sustain the ongoing operation of MNCare. Requires legislative approval for contribution of state funds to cover individuals between 200% and 275% FPG.
Adds Minn. Stat. § 256.01, subd. 35(a) and (d) (federal approval)
Adds Minn. Stat. § 256.01, subd. 35(e) (legislative approval)
Effective August 1, 2013
Adds Minn. Stat. § 256L.02, subd. 5 (sustainability of funding)
Effective May 24, 2013

2. Program Design
Requires federal funding received to be used for the design and implementation of a single streamlined program that incorporates: (1) payment reform characteristics included in the health care delivery system and accountable care organization payment models; (2) benefit set flexibility; (3) co-payment or premium structure flexibility; and (4) seamless transition from public to private coverage.
Adds Minn. Stat. § 256.01, subd. 35(b)
Effective August 1, 2013


3. Progress Report
Mandates DHS to: (1) report to the Legislature by January 15, 2015 on the progress of receiving a federal waiver; and (2) recommend any legislative changes necessary to implement the BHP.
Adds Minn. Stat. § 256.01, subd. 35(e)
Effective August 1, 2013


B. Coordination with MNsure
Declares MNCare to be a public health care program for purposes of the MNsure chapter (new Chapter 62V).
Adds Minn. Stat. § 256L.02, subd. 6
Effective January 1, 2014

C. Coordination with MA

1. Program Administration
Requires DHS to coordinate administration of MA and MNCare to maximize efficiency and improve the continuity of care, including: (1) establishing consistent geographic coverage; (2) requiring entities to participate in both programs; and (3) facilitating continuity of health plan and provider networks.
Adds Minn. Stat. § 256L.121, subd. 3
Effective May 24, 2013

2. Eligibility and Coverage
Requires DHS to coordinate eligibility and coverage to ensure a seamless transition between the programs.
Adds Minn. Stat. § 256L.04, subd. 14(b)
Effective the later of January 1, 2014 or upon federal approval

D. Availability of Applications and Assistance

1. Applications
Allows applicants, in accordance with the ACA, to submit applications: (1) through MNsure; (2) online; (3) in person; (4) by mail; (5) by phone; and (6) any other means by which MA applications may be submitted. Requires MNCare applications to made available at locations at which MA applications must be made available.
Amends Minn. Stat. § 256L.05, subd. 1
Effective January 1, 2014

2. Assistance
Requires MNCare application assistance to be available: (1) at locations at which MA applications must be made available; and (2) online for applicants filing through MNsure.
Amends Minn. Stat. § 256L.05, subd. 1
Effective January 1, 2014

E. Program Changes

1. Eligibility

a. Expansion of Eligibility

1) Based on Citizenship
Makes noncitizens eligible for MNCare who: (1) have incomes at or below 200% FPG; (2) are lawfully present; and (3) are i
ineligible for MA due to immigration statues. Makes nonimmigrants, as defined in federal law, eligible for MNCare.
Amends Minn. Stat. § 256L.04, subd. 10
Effective the later of January 1, 2014 or upon federal approval
2) Inmates Awaiting Disposition of Charges
Expands eligibility for MNCare to enrollees and applicants residing in a correctional or detention facility who are awaiting
disposition of charges.
Amends Minn. Stat. § 256L.04, subd. 12
Effective January 1, 2014
3) Based on Other Coverage
Makes a family or individual with minimum essential health coverage ineligible for MNCare. Deletes the requirement that persons
must have no health coverage: (1) while enrolled; or (2) for at least four months prior to application and renewal.
Amends Minn. Stat. § 256L.07, subd. 3
Effective the later of January 1, 2014 or upon federal approval

b. Limitations/Conditions on Eligibility

1) Elimination of Dual Eligibility
Eliminates: (1) eligibility for MNCare if the applicant is eligible for MA; and (2) the right of choice for a potentially eligible
applicant to enroll in either MA or MNCare. Requires DHS to coordinate eligibility and coverage to ensure a seamless transition
between the programs.
Amends Minn. Stat. § 256L.04, subd. 8 (removal of choice)
Adds Minn. Stat. § 256L.04, subd. 14(a) (no dual eligibility)
Adds Minn. Stat. § 256L.04, subd. 14(b) (coordination)
Effective the later of January 1, 2014 or upon federal approval

2) Ineligibility for QHP
Makes a person eligible for MNCare ineligible to enroll in a QHP offered through MNsure.
Adds Minn. Stat. § 256L.04, subd. 1c
Effective January 1, 2015

3) Based on Income
Establishes the MNCare income limit at 200% FPG.
Amends Minn. Stat. § 256L.07, subd. 1
Effective the later of January 1, 2014 or upon federal approval
4) Based on Access to Employer-Subsidized Coverage
Makes persons ineligible for MNCare if they have access to subsidized health coverage that: (1) is affordable; and (2) provides
minimum value as defined in federal regulations.
Amends Minn. Stat. § 256L.07, subd. 2
Effective the later of January 1, 2014 or upon federal approval
Note: Under current law, persons must not have access to subsidized employer coverage, or have had access through the current
employer, for 18 months prior to application or reapplication.
5) Families with Children
Modifies income eligibility criteria to cover families with children with incomes between 133% and 200% FPG.
Amends Minn. Stat. § 256L.04, subd. 1.
Effective the later of January 1, 2014 or upon federal approval
6) Single Adults and Households With No Children
Makes individuals and families with no children with incomes between 133% and 200% FPG eligible for MNCare.
Amends Minn. Stat. § 256L.04, subd. 7
Effective the later of January 1, 2014 or upon federal approval
7) Pregnant Women
Removes references to pregnant women under MNCare because: (1) pregnant women are eligible for MA; and (2) persons eligible
for MA will no longer be eligible for MNCare.
Amends Minn. Stat. § 256L.03, subd. 1a (covered services)
Amends Minn. Stat. § 256L.09, subd. 2 (residency)
Effective the later of January 1, 2014 or upon federal approval

2. Asset Limits
Repeals asset limit requirements.
Repeals Minn. Stat. § 256L.17, subds. 1, 2, 3, 4, and 5
Effective January 14, 2014

3. Premiums
Decreases the premiums by 10%, and specifies that children 20 or younger do not pay premiums. Changes the specific individual premium payments to:

0% - 55% FPG

$4

55% - 80% FPG

$6

80% - 90% FPG

$8

90% - 100% FPG

$10

100% - 110% FPG

$12

110% - 120% FPG

$15

120% - 130% FPG

$18

130% - 140% FPG

$21

140% - 150% FPG

$25

150% - 160% FPG

$29

160% - 170% FPG

$33

170% - 180% FPG

$38

180% - 190% FPG

$43

190% - 200% FPG

$50

Amends Minn. Stat. § 256L.15, subd. 2
Effective the later of January 1, 2014 or upon federal approval

4. Hospital Cap
Eliminates the annual inpatient hospital cap of $10,000.
Amends Minn. Stat. § 256L.03, subds. 3 and 5
Effective the later of January 1, 2014 or upon federal approval

5. Covered Health Services
Updates the listing of MNCare covered services by striking language excluding coverage of: (1) inpatient hospital services; (2) inpatient mental health services; and (3) chemical dependency services. Requires coverage of essential health benefits.
Amends Minn. Stat. § 256L.03, subd. 1
Effective the later of January 1, 2014 or upon federal approval

6. Loss Ratio
Requires coverage provided through MNCare to have a medical loss ratio of at least 85%.
Adds Minn. Stat. § 256L.03, subd. 4b
Effective January 1, 2015

7. Retroactive Coverage
Provides that the section of statute governing retroactive coverage (i.e., Minn. Stat. § 256L.05, subd.3c) will no longer apply and cannot be implemented by DHS once eligibility determination for MNCare is
conducted by the MNsure eligibility determination system.
Amends Minn. Stat. § 256L.05, subd.3c
Effective January 1, 2014

8. Waiting Period for Re-enrollment
Eliminates the four-month waiting period to re-enroll for persons who: (1) are disenrolled for nonpayment of premium; or (2) voluntarily disenroll.
Amends Minn. Stat. § 256L.06, subd.3
Effective the later of January 1, 2014 or upon federal approval

F. Program Delivery

1. Competitive Process
Requires DHS to establish a competitive process for contracting for standard health plans that is designed increase access to high-quality health care coverage options. Requires applicants to include documentation of the: (1) provision of culturally and linguistically appropriate services, including marketing materials, to enrollees; and (2) inclusion of essential community providers in provider networks. Requires coverage to be available January 1, 2015.
Adds Minn. Stat. § 256L.121, subds. 1 and 2
Effective May 24, 2013

2. Vendors
Requires DHS to consider proposals from "managed care-like entities" defined under the ACA implementing regulations.
Amends Minn. Stat. § 256L.12, subds. 1 and 2
Effective August 1, 2013

G. Program Funding
Requires DHS and MMB to: (1) conduct an assessment of relationship between various health care taxes and surcharges and the long-term solvency of the Health Care Access Fund (HCAF); (2) evaluate the stability and likelihood of long-term federal funding; and (3) determine the amount of state funding - in addition to federal BHP payments - that will be needed after December 31, 2019 for MNCare. Requires a report to the Legislature by January 15, 2014 with recommendations for necessary changes to state revenue for the HCAF.
Uncodified Section
Effective August 1, 2013

H. Healthy Minnesota Contribution Program
Repeals the Healthy Minnesota Contribution Program
Repeals Minn. Stat. § 256L.031

I. Other Repealed Sections
Repeals, among others, sections and subdivisions: (1) defining gross individual or gross family income; (2) defining volunteer firefighters and ambulance attendants as "qualified individuals" for MNCare; (3) referencing the obsolete General Assistance Medical Care program; (4) governing: (i) the voluntary disenrollment of military enrollees and their families; (ii) reapplication procedures generally; and (iii) provider payments; (5) governing general eligibility requirements for MNCare; and (6) governing eligibility for MNCare for: (i) children with family income greater than 275% FPG; and (ii) children residing in foster care or a juvenile residential correctional facility on the child's 18th birthday
Repeals Minn. Stat. § 256L.01, subd. 4a (definition of gross income)
Repeals Minn. Stat. § 256L.07, subd. 9 (volunteer firefighters/ambulance attendants)
Repeals Minn. Stat. § 256L.04, subd. 9 (GAMC)
Repeals Minn. Stat. § 256L.07, subd. 5 (voluntary disenrollment of military)
Repeals Minn. Stat. § 256L.05, subd. 3b (reapplication procedures)
Repeals Minn. Stat. § 256L.11, subds. 5 and 6 (provider payments)
Repeals Minn. Stat. § 256L.07, subd. 1 (general MNCare eligibility requirements)
Repeals Minn. Stat. § 256L.04, subd. 1b (children over 275% FPG)
Repeals Minn. Stat. § 256L.07, subd. 8 (children in foster care or correctional facilities)
Effective January 1, 2014


LONG-TERM CARE


I. LONG TERM CARE: NURSING/BOARDING HOME RESIDENT RELOCATION
Chapter 63, Section 4 (HF 767)
Amends Minn. Stat. § 144A.161
Deletes Minn. Stat. § 144A.161, subds. 5b and 11
Effective August 1, 2013

A. New Key Definition
Defines "responsible party," to mean the resident's legal representative.
Amends Minn. Stat. § 144A.161 by adding subd. 1(j)

B. Admission of New Residents After Decision to Close Facility
Prohibits a facility that is closing from admitting any new residents on or after the date of the written notice of the closing required to be provided to residents.
Amends Minn. Stat. § 144A.161 by adding subd. 2(d)

C. Relocation Plan Amendments

1. Additions to Interdisciplinary Team
Adds the Office of the Ombudsman for Mental Health and Developmental Disabilities to the list of agencies the licensee must include as part of the interdisciplinary team responsible for coordinating and implementing the relocation plan.
Amends Minn. Stat. § 144A.161, subd. 5(a)

2. Addition of Recipients of Notice of Closure
Requires the 60 day notice before the proposed date of closing to be sent to - in addition to the resident and attending physician - the: (1) responsible party (replacing family or other designated representative); (2) resident's managed care organization if known; (3) county social services agency; (4) MDH; (5) DHS; (6) Office of Ombudsman for Long-Term Care; and (7) Office of Ombudsman for Mental Health and Developmental Disabilities.
Amends Minn. Stat. § 144A.161, subd. 5a

3. Addition of Recipients of Weekly Status Reports on Relocation Plans
Adds to the following organizations those to receive the weekly status reports: (1) Ombudsman for Long-Term Care; and (2) Ombudsman for Mental Health and Developmental Disabilities.
Amends Minn. Stat. § 144A.161, subd. 6(b)

4. Additions to Notice to Interdisciplinary Team
Adds the following to the list the licensee must send required information prior to or concurrent with notification to residents: (1) Ombudsman for Long-Term Care; and (2) Ombudsman for Mental Health and Developmental Disabilities. Clarifies that the information must include: (1) county of financial responsibility but only if the resident is enrolled in a Minnesota health care program; (2) only current diagnoses; (3) the responsible party (replacing family or other designated representative); (4) the managed care coordinator, or other care coordinator, if known; and (5) the managed care organization in which the resident is enrolled, if known.
Amends Minn. Stat. § 144A.161, subd. 5(b)

5. Changes to Licensee Responsibilities

a. For Relocation Site Visits and Relocation
Modifies the requirements regarding: (1) resident visits to relocation option sites; and (2) actual relocation. Requires the licensee to make available to the resident at no charge transportation: (1) for up to three site visits to facilities or other living options; and (2) to the new location. Limits the distance of alternative sites to the same county or contiguous counties (replacing within a 50 miles radius).
Amends Minn. Stat. § 144A.161, subd. 5e (site visits)
Amends Minn. Stat. § 144A.161, subd. 6(a) (actual relocation)

b. For Discharge Notice
Requires the licensee to provide, prior to the relocation of the resident: (1) a final written "discharge notice" (replacing "a final written notice"); and (2) the "effective" date of relocation. Removes the requirement to provide the notice seven days prior to relocation. Eliminates the option of a resident to waive the right to the notice.
Amends Minn. Stat. § 144A.161, subd. 5g

6. Relief of Licensee Responsibilities
Relieves the facility of the requirements to: (a) consult with the county social services agency on the availability and development of available resources and on the resident relocation process; and (b) request the attending physician provide or arrange for the release of medical information needed to update resident medical records and prepare all required forms and discharge summaries. Deletes the requirements that
licensees: (1) ensure "appropriate" discharge and relocation; (2) prepare a list of relocation options; and (3) provide residents and agencies with the phone and Web site address of the Senior Linkage Line.
Deletes Minn. Stat. § 144A.161, subd. 5a(c) (consultation of county)
Deletes Minn. Stat. § 144A.161, subd. 5b (attending physician duties)
Amends Minn. Stat. § 144A.161, subd. 5c (appropriateness of discharge)
Deletes Minn. Stat. § 144A.161, subd. 5c(b) (list of relocation options)
Deletes Minn. Stat. § 144A.161, subd. 5c(c) (Senior Linkage Line contact)

7. Change to County Social Service Agency Responsibilities

a. Relocation Costs
Eliminates the responsibility to allocate up to $450 per nursing facility bed that is closing for resident relocation costs.
Deletes Minn. Stat. § 144A.161, subd. 11

b. Notice When Relocation is Halted
Requires, when relocation is halted, the county social services agency to notify the: (1) resident; (2) family; (3) responsible parties; (4) Office of the Ombudsman for Long-Term Care; (5) Office of the Ombudsman for Mental Health and Developmental Disabilities; and (6) resident's managed care organization.
Amends Minn. Stat. § 144A.161, subd. 8

OTHER HEALTH CARE MATTERS


I. HEALTH EQUITY REPORT
Chapter 108, Article 12, Section 102 (HF 1233)
Uncodified Section
Effective August 1, 2013

Directs MDH to report to the Legislature by February 1, 2014 on a plan for advancing health equity in Minnesota. Requires the report to, among other things: (1) assess health disparities in the state; (2) how health disparities relate to health equity; (3) identify policies, processes, and systems that contribute to health Inequity; and (4) identify best practices to provide culturally responsive services and advance health equity.

II. GUARANTEED RENEWABILITY STUDY
Chapter 108, Article 12, Section 103 (HF 1233)
Uncodified Section
Effective August 1, 2013

Directs the Department of Commerce to: (1) study guaranteed renewability of health plans in the individual market; and (2) assess the need for legislation permitting the discontinuance or modification of health plan coverage in the individual market by a health carrier. Requires the Department of Commerce to: (1) consult with MDH, health carriers and consumer advocates; and (2) submit recommendations, with any necessary draft legislation, to the Legislature by February 1, 2014.

III. ATTORNEY GENERAL LEGAL OPINION
Chapter 108, Article 12, Section 107 (HF 1233)
Uncodified Section
Effective August 1, 2013

Directs the Attorney General - by October 1, 2013 - to issue a written legal opinion on whether a health plan is required to provide coverage of treatment for mental health and mental health-related illnesses, including autism spectrum disorders and any other mental health condition, as determined by criteria set forth in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Requires the Attorney General to provide the opinion to: (1) the legislative chairs of the Commerce and Health Policy Committees; (2) the Department of Commerce; (3) DHS; and (4) the MNsure board of directors.