Health Care

HEALTH CARE
Prepared by:
Lisa Fink, Staff Attorney
Legal Services Advocacy Project
651-222-3749, ext. 103
lmfink@mnlsap.org

FEDERAL COMPLIANCE CHANGES

A. Data from Social Security
Chapter 79, Article 5, Section 37 (HF 1362)
Adds Minn. Stat. § 256B.08, subd. 4
Effective January 1, 2010

Requires the Department of Human Services (DHS) to accept data from the Social Security Administration related to the determination of eligibility for Medicare prescription drug low-income subsidies.

B. Protections for American Indians
Chapter 79, Article 5, Section 7 (HF 1362)
Adds Minn. Stat. § 256.01, subd. 18b

Chapter173, Article 1, Section 12 (HF 1988)
Amends Minn. Stat. § 256.01, subd. 18b, as added by Laws 2009, Chapter 79, Article 5, Section 7
Effective July 1, 2009

Requires DHS to comply with federal requirements regarding American Indians in cost-sharing, eligibility determinations, and the option to choose an Indian health care provider as specified in the American Recovery and Reinvestment Act of 2009 (ARRA), Public Law 111-5, section 5006.

C. Public Assistance Reporting Information System
Chapter 79, Article 5, Section 6 (HF 1362)
Adds Minn. Stat. § 256.01, subd. 18a
Effective October 1, 2009

Requires DHS to comply with federal requirements in Public Law 110-379 in implementing the Public Assistance Reporting Information system (PARIS) to determine eligibility for all individuals applying for: (1) health care benefits under chapters 256B, 256D, and 256L; and (2) public benefits under chapters 119B, 256D, 256I, and the supplemental nutrition assistance program. Requires eligibility to be determined by performing data matches, including matching with medical assistance, cash, child care, and supplemental assistance programs operated by other states.

OTHER HEALTH CARE POLICY

A. Centers of Excellence For Complex Medical Procedures
Chapter 173, Article 3, Section 10 (HF 1988)
Adds Minn. Stat. § 256B.0625, subd. 53
Effective August 1, 2009 or upon federal approval, whichever is later

Authorizes DHS, in consultation with the Health Services Policy Committee, to limit Medical Assistance (MA) coverage for complex procedures for recipients enrolled on a fee-for-service basis to certain facilities which meet specified Medicare criteria.

B. COBRA Health Insurance State Premium Subsidy
Chapter 79, Article 5, Section 78 (HF 1362)
Effective July 1, 2009 and expires December 31, 2010

1. Eligibility

Provides that an individual and qualified beneficiaries are eligible for a state premium subsidy of 35% of COBRA premiums, if the individual and beneficiaries: (1) are eligible for the 65 % COBRA premium subsidy under ARRA,* (2) elect COBRA coverage; and (3) are eligible for MA, General Assistance Medical Care (GAMC), or MinnesotaCare without application of the four-month uninsured requirement. Extends the state subsidy for as long as individual remains eligible for the federal COBRA subsidy.

2. Subsidy
Requires the state subsidy payment to be paid directly to the entity to which the individual is required to make COBRA premium payments. Specifies other related requirements.**

3. Notification
Requires employers and plan administrators who are required to provide notice under ARRA to include information about the availability of the state subsidy, eligibility, and the application requirements. Requires the Department of Employment and Economic Development to inform applicants for unemployment benefits of the availability of a state subsidy.**

4. Exemption from Four-Month Barrier Requirement
Exempts persons who received a state subsidy under this section and then apply for MinnesotaCare after their COBRA continuation coverage ends from the MinnesotaCare four-month uninsured requirement.

_{*The American Recovery and Reinvestment Act of 2009 (ARRA) provides for premium reductions and additional election opportunities for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA. Eligible individuals pay only 35% of their COBRA premiums and the remaining 65 % is reimbursed to the coverage provider through a tax credit. The premium reduction applies to periods of health coverage beginning on or after February 17, 2009 and extends for up to nine months.}

_{** See DHS web site for COBRA subsidy application and notice information at} _{http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-5847-ENG}

C. Electronic Data Interchange Study
Chapter 155 (HF 384)
Effective August 1, 2009

Requires the Department of Health, along with the Minnesota Administrative Uniformity Committee and DHS, to study and recommend ways to simplify health care billing transactions through electronic interchanges. Mandates that the study must: (1) contain recommendations on establishing a single, standardized system for all group purchasers for transactions and notifications; (2) contain recommendations on technology relationships regarding e-prescribing laws; (3) ensure that any use of technologies among providers and purchasers is consistent with national standards; (4) analyze the readiness of providers and purchasers to implement technologies; and (5) prioritize the implementation of specific technologies.

D. Health Information Technology
Chapter 79, Article 4, Section 1 (HF 1362)
Amends Minn. Stat. § 62J.495, subds. 1 - 4
Effective July 1, 2009

Renews and extends to 2015 the Minnesota e-Health Advisory Committee. Expands the committee's responsibilities to include updating implementation of the e-health provisions of the ARRA, in particular the federal Health Information Technology for Economic and Clinical Health Act, the "HITECH Act." Requires the uniform standards be updated on an ongoing basis and an annual report to the Legislature.

E. Minnesota Sex Offender Program Payment for Services
Chapter 79, Article 3, Sections 13 - 15 (HF 1362)
Adds Minn. Stat. §§ 246B.07 - 246B.09
Effective July 1, 2009

Those admitted into the Minnesota Sex Offender Program will be assessed by DHS on their ability to pay for the cost of care for services provided in the program. A client's guardian of the estate may be required to pay, or DHS can file a claim. Allows DHS to compromise the claim if the estate is needed to support a spouse or dependent children.

F. Safe Patient Handling Act
Chapter 159, Sections 81 - 83 (HF 1760)
Amends Minn. Stat. § 182.6551
Adds Minn. Stat. §§ 182.6552, subd. 5; 182.6554; and 246B.07 - 246B.09
Effective August 1, 2009

Defines clinical settings that move patients and requires these clinics to develop a written safe patient handling plan by July 1, 2010 for implementation by January 1, 2012. Establishes as a goal ensuring the safe handling of patients by: (1) minimizing their manual lifting by direct patient care workers; and (2) utilizing safe patient handling equipment. Requires the Department of Health to develop training materials. Establishes enforcement responsibility.

CHANGES IMPACTING ALL MINNESOTA HEALTH CARE PROGRAMS

A. Dental Care Pilot Projects
Chapter 79, Article 5, Section 10 (HF 1362)
Adds Minn. Stat. § 256.964
Effective July 1, 2009

Requires DHS to authorize pilot projects (and specify program criteria) to reduce hospital emergency room costs for preventable and nonemergency dental services for enrollees of the public health care programs. Allows DHS to: (1) establish special payment rates for urgent dental care services provided as an alternative to emergency room services; and (2) change or waive existing payment policies in order to adequately reimburse community dental clinic or other dental providers for cost-effective alternative services provided in outpatient or urgent care settings.

B. Health Care Provider Rate Cuts
Chapter173, Article 1, Sections 32, 38 and 52 (HF 1988)
Amends Minn. Stat. §§ 256B.76, subd. 1; 256L.11, subd. 1; and 256B.766
Effective July 1, 2009

Imposes a 3% health care provider rate cut for MA, GAMC, and Minnesota Care, with some exceptions including mental health, dental services, prescription drugs, medical transportation, and primary health care providers. Cuts specialists rates by 5%.

Note: the Governor unallotted an additional 1.5% from basic care providers (using the same exceptions as the Legislature) and another 1.5% for specialists.

C. Health Services Policy Committee
Chapter 79, Article 5, Section 26 (HF 1362)
Amends Minn. Stat. § 256B.0625, subd. 3c by adding paragraphs (b) - (e)
Effective July 1, 2009

Chapter173, Article 1, Section 20 (HF 1988)
Amends Minn. Stat. § 256B.0625, subd. 3c, as amended by Laws 2009, Chapter 79, Article 5, Section 26
Effective July 1, 2009

1. Dental Subcommittee
Requires DHS to establish a dental subcommittee, to operate under the Health Services Policy Committee. Specifies membership. Requires the subcommittee to advise the commissioner regarding: (1) the critical access dental provider program; (2) any changes to the critical access dental program necessary to comply with expenditure limits; (3) dental coverage policy; (4) dental delivery models; and (5) dental services to be added or eliminated from § 256B.0625, subdivision 9, paragraph (b).
Adds Minn. Stat. § 256B.0625, subd. 3c(b)

2. Other Public Program Issues
Requires that the committee also address other public program issues, including: (1) studying approaches to provider reimbursement under the public health programs contingent on a patient-centered decision-making process; (2) tracking physician practice patterns for enrollees in state health care programs; and (3) reviewing cesarean section rates for the fee-for-service medical assistance population.
Adds Minn. Stat. § 256B.0625, subd. 3c(c) - (e)

D. Outreach Grants
Chapter 79, Article 5, Section 8 (HF 1362)
Amends Minn. Stat. § 256.962, subd. 2
Effective July 1, 2009

Specifies that outreach grants are available for health care coverage outreach activities targeting geographic areas with high rates of: (1) eligible but unenrolled children, including children who reside in rural areas; or (2) racial and ethnic minorities and health disparity populations.

Note: The Governor unallotted the general fund appropriation for outreach grants. Funding for the grants from the Health Care Access Fund remains.

E. Repealer
Chapter 79, Article 5, Section 80 (HF 1362)
Effective May 14, 2009

Repeals: (1) the requirement that renewal notices for Minnesota health care programs be sent at least 60 and 90 days prior to renewal date (Minn. Stat. § 256.962, subd. 7); and (2) reference to federal waiver request to apply a MinnesotaCare asset test to children (Minn. Stat. § 256L.17, subd. 6).

CHANGES TO SPECIFIC MINNESOTA HEALTH CARE PROGRAMS

I. GENERAL ASSISTANCE MEDICAL CARE

Line-item veto by Governor of all funding ($381 million) for GAMC for fiscal year 2011, to begin April 15, 2010. Attempted House override of the veto failed 87-47. Unallotment by Governor of additional six weeks of GAMC funding. (Elimination of the program funding affects between 30,000 and 40,000 low-income adults per month, more than 70% of whom receive treatment for mental illness or chemical dependency.)

II. MEDICAL ASSISTANCE

A. Benefits

1. Asthma Coverage for American Indian Children
Chapter 79, Article 5, Section 75 (HF 1362)
Effective July 1, 2009

Requires DHS to establish a demonstration project to provide MA coverage for certain durable medical equipment to reduce asthma symptoms for up to 200 American Indian children who meet specified criteria and live in Minneapolis, St. Paul, or Duluth. Contingent on availability of nonstate funds, requires the Department of Health to report on asthma-related school and hospital findings.

2. Colorectal Cancer Treatment
Chapter 79, Article 5, Section 19 (HF 1362)
Amends Minn. Stat. § 256B.057, by adding subd. 11
Effective July 1, 2009 and expires December 31, 2010

Chapter173, Article 1, Section 18 (HF 1988)
Amends Minn. Stat. § 256B.057, subd. 11, as added by Laws 2009, Chapter 79, Article 5, Section 19
Effective July 1, 2009 and expires December 31, 2010

Allows state-only funded MA to be paid for individuals who: (1) have been screened by the colorectal cancer prevention demonstration project; (2) need treatment for colorectal cancer; (3) meet income guidelines for the project; (4) are under age 65; and (5) are not otherwise eligible for federally funded MA or covered under creditable coverage. Limits MA coverage to services provided during the period during which the individual receives treatment for colorectal cancer. Provides an exemption from MA income and asset standards.

3. Dental Services
Chapter 79, Article 5, Section 27 (HF 1362)
Amends Minn. Stat. § 256B.0625, subd. 9
Effective January 1, 2010

- Eliminates coverage for fixed bridges.

- Specifies dental coverage for nonpregnant adults. Limits coverage to:
- comprehensive exams, limited to once every five years;
- periodic exams, once per year;
- limited exams;
- bitewing x-rays, once per year;
- periapical x-rays;
- panoramic x-rays, once every five years and only if certain conditions are met, except that panoramic x-rays are allowed once every two years to certain patients who cannot cooperate for intra-oral film;
- prophylaxis, once per year;
- application of fluoride varnish, once per year;
- posterior fillings at the amalgam rate;
- anterior fillings;
- endodontics, limited to root canals on the anterior and premolars only;
- removable prostheses, each dental arch limited to one every six years;
- oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
- palliative treatment and sedative fillings for relief of pain; and
- full mouth debridement, once every five years.

- Provides that MA also covers the following services for adults, if provided in an outpatient hospital setting or freestanding ambulatory surgical center as part of outpatient dental surgery:
- periodontics, limited to periodontal scaling and root planing once every two years;
- general anesthesia; and
- full mouth survey once every five years.

- Provides that, for children, MA covers dental services that are medically necessary using the following guidelines:
- posterior fillings are paid at the amalgam rate;
- application of sealants once every five years per permanent molar; and
- application of fluoride varnish is limited to once every six months.

4. Diagnostic Imaging Services and Prior Authorization
Chapter 79, Article 5, Section 35 (HF 1362)
Adds Minn. Stat. § 256B.0625, subd. 25a
Effective July 1, 2009

Requires prior authorization or decision support for various diagnostic imaging services at time services are ordered unless specified exceptions apply. Does not apply to recipients enrolled in Medicare, the prepaid medical assistance, GAMC, or the MinnesotaCare programs. Permits DHS to contract with a private entity to provide prior authorization or decision support required.

B. Eligibility

1. Asset Limitations for Families and Children
Chapter 79, Article 5, Section 17 (HF 1362)
Amends Minn. Stat. § 256B.056, subd. 3c
Effective January 1, 2011 or upon federal approval, whichever is later

Provides that a bank account that contains personal income or assets - or is used to pay personal expenses - is no longer considered a capital or operating asset of a trade or business for MA applicants or enrollees who are families and children, and is therefore considered when determining asset amounts for eligibility. Requires specified assets to be: (1) disclosed to the local agency at the time of application or reapplication; and (2) verified upon request of the local agency.

2. Citizenship Documentation Requirements for MA and MNCare for Families with Children

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3 amended the federal Deficit Reduction Act of 2005 (DRA) citizenship documentation requirements as follows:

a. Citizen Documentation Process for Applicants
Applicants for MA and MinnesotaCare for Families with Children must now be approved for eligibility prior to providing citizenship documentation if they meet all other eligibility criteria. Applicants must also be given a reasonable opportunity to provide documentation of citizenship. Costs associated with documentation of U.S. citizenship and identity qualify for 50% federal matching administrative funds.

b. Auto Newborn Exemption
MA and MinnesotaCare auto newborns are now exempt from citizenship and identity documentation requirements.

c. American Indian tribal Enrollment Documents
Level 1 (no separate identity documentation is required) citizenship documentation requirement may now be met by providing a tribal enrollment, membership or affiliation document, or a certificate of degree of Indian blood issued by a federally recognized Indian tribe.

3. Citizenship Requirement Changes for MA Eligibility
Chapter 79, Article 5, Section 23 (HF 1362)
Amends Minn. Stat. § 256B.06, subd. 4
Effective July 1, 2009

Chapter173, Article 1, Section 19 (HF 1988)
Amends Minn. Stat. § 256B.06, subd. 4, as amended by Laws 2009, Chapter 79, Article 5, Section 23
Effective July 1, 2009

a. Children and Pregnant Noncitizens
Allows children and pregnant women who are noncitizens (qualified noncitizens or lawfully present) to be eligible beginning July 1, 2010 for MA with federal financial participation as provided by the federal Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

b. Post-Partum Coverage for Noncitizens
Allows pregnant noncitizens who are undocumented, nonimmigrants, or lawfully present, and who are uninsured and otherwise meet MA eligibility requirements, to be eligible for MA for the 60 days post partum period beginning July 1, 2009, using CHIPRA funding. (Under current law, these post partum services are covered by state-only MA.)

4. Critical Access Dental Care
Eliminated, effective April 1, 2010, per executive action (unallotment authority).

5. Income Disregard
Chapter173, Article 3, Section 6 (HF 1988)
Amends Minn. Stat. § 256B.056, subd. 1c
Effective July 1, 2009

Provides that annual gifts of $2000 or less by a tax-exempt organization to, or for the benefit of, a child 18 years old or younger who has a life-threatening illness must be disregarded from income when determining eligibility.

6. Sponsor-Deeming of Income and Resources
Chapter 79, Article 5, Section 24 (HF 1362)
Amends Minn. Stat. § 256B.06, subd. 5
Effective July 1, 2010

Eliminates the requirement that sponsor's income and resources be considered determining MA eligibility for pregnant women and children who are qualified noncitizens.

III. MINNESOTA CARE

A. Benefits

1. Chiropractic Services
Chapter 79, Article 5, Section 54 (HF 1362)
Adds Minn. Stat. § 256L.03, subd. 3b

Chapter173, Article 1, Section 35 (HF 1988)
Amends Minn. Stat. § 256L.03, subd. 3b as added by Laws 2009,
Chapter 79, Article 5, Section 54
Effective July 1, 2010 or upon federal approval, whichever is later

Provides that MinnesotaCare covers the following chiropractic services: (1) medically necessary exams; (2) manual manipulation of the spine; and (3) x-rays.

B. Eligibility

1. For All Enrollees

a. Elimination of Depreciation for Self-employed Farmers
Chapter 79, Article 5, Section 79 (HF 1362)

Requires DHS to resubmit for federal approval elimination of the depreciation add-back for self-employed farmers in determining eligibility for MinnesotaCare. (See Laws 2007, Chapter 147, article 5, section 19.)

b. Sliding-fee Scale
Chapter173, Article 3, Section 20 (HF 1988)
Amends Minn. Stat. § 256L.15, subd. 2
Effective January 1, 2009, or upon federal approval, whichever is later

Makes certain clarifying changes to the sliding fee scale. Specifies that for family income of between 46% and 54% of the Federal Poverty Guidelines (FPG), the premium payment for adult enrollees is $4 or 1.1% of family income, whichever is greater.

2. For Families with Children

a. Asset Requirements
Chapter 79, Article 5, Section 71 (HF 1362)
Amends Minn. Stat. § 256L.17, subd. 5
Effective July 1, 2009

Clarifies that children are exempt from MinnesotaCare asset limits.

b. Automatic Eligibility for Certain Children
Chapter 79, Article 5, Section 66 (HF 1362)
Adds Minn. Stat. § 256L.07, subd. 8
Effective July 1, 2009, or upon federal approval, whichever is later

Deems automatically eligible for MinnesotaCare upon termination or release until the age of 21 any child who was residing in foster care or a juvenile residential correctional facility on the child's 18th birthday. Exempts the child from: (1) the employer-subsidized insurance (ESI) and four-month insurance barriers; and (2) paying premiums. Requires the child to complete an initial application for MinnesotaCare.

c. Barriers to Coverage for Certain Children Eliminated

1) Employer-Subsidized Insurance
Chapter 79, Article 5, Section 64 (HF 1362)
Amends Minn. Stat. § 256L.07, subd. 2
Effective July 1, 2009, or upon federal approval, whichever is later

Exempts children with family income equal to or less than 200% of FPG from the MinnesotaCare ESI barrier.

2) Four-Months Uninsured Requirement
Chapter 79, Article 5, Section 65 (HF 1362)
Amends Minn. Stat. § 256L.07, subd. 3
Effective July 1, 2009, or upon federal approval, whichever is later

Exempts children with family income less than 200% of FPG from the MinnesotaCare four-months uninsured prior to application requirement. Also increases from 150 to 200 percent of FPG, the income limit for those children exempted from the four-month insurance barrier because they meet the criteria specified for being considered "underinsured."

3. Citizenship Documentation Requirements

a. Documentation Process for Applicants
Applicants for MA and MinnesotaCare for Families with Children must now be approved for eligibility prior to providing citizenship documentation if they meet all other eligibility criteria. Applicants must also be given a reasonable opportunity to provide documentation of citizenship. Costs associated with documentation of U.S. citizenship and identity qualify for 50% federal matching administrative funds.

b. Auto Newborn Exemption
MA and MinnesotaCare auto newborns are now exempt from citizenship and identity documentation requirements.

4. Premium Payments

a) Exemption
Chapter 79, Article 5, Section 68 (HF 1362)
Amends Minn. Stat. § 256L.15, subd. 2
Effective July 1, 2009, or upon federal approval, whichever is later

Exempts children with family income at or below 200% of FPG from paying MinnesotaCare sliding-fee scale premiums.

b) Clarification
Chapter 79, Article 5, Section 69 (HF 1362)
Amends Minn. Stat. § 256L.15, subd. 3
Effective July 1, 2009, or upon federal approval, whichever is later

Clarifies that children with family income at or below 200% of FPG pay no monthly premiums.

5. Children Leaving Foster Home/Juvenile Correctional Facility

a) Exemption
Chapter 79, Article 5, Section 55 (HF 1362)
Ads Minn. Stat. § 256L.04, subd. 1f
Effective July 1, 2009 or upon federal approval, whichever is later

Exempts children who were residing in a foster home or juvenile residential correctional facility on their 18th birthday from the MinnesotaCare eligibility requirements that apply to families with children.

b) Effective Date of Coverage
Chapter 79, Article 5, Section 61 (HF 1362)
Amends Minn. Stat. § 256L.05, subd. 3
Effective July 1, 2009, or upon federal approval, whichever is later

Provides that the effective date of MinnesotaCare coverage for children eligible under Minn. Stat. § 256L.07, (new) subd. 8, is the first day of the month following the date of termination from foster care or release from a juvenile residential correctional facility.

6. Deeming of Sponsor Income and Resources
Chapter 79, Article 5, Section 58 (HF 1362)
Amends Minn. Stat. § 256L.04, subd. 10a
Effective July 1, 2010, or upon federal approval, whichever is later

Exempts pregnant women and children who are qualified noncitizens from deeming of sponsor income and resources when determining MinnesotaCare eligibility.

7. Income Eligibility and Buy-in Option for Children
Chapter 79, Article 5, Section 56 (HF 1362)
Adds Minn. Stat. § 256L.04, subd. 1b
Effective July 1, 2009, or upon federal approval, whichever is later

Extends eligibility for MinnesotaCare to children with family incomes greater than 275% of FPG. (All other MinnesotaCare provisions, including insurance-related barriers to enrollment generally continue to apply.)

8. Income Eligibility and Children
Chapter 79, Article 5, Section 63 (HF 1362)
Amends Minn. Stat. § 256L.07, subd. 1
Effective July 1, 2009, or upon federal approval, whichever is later

Permits children in families with incomes greater than 275% of FPG to remain on MinnesotaCare.

9. Income Eligibility and Parents
Chapter 79, Article 5, Section 57 (HF 1362)
Amends Minn. Stat. § 256L.04, subd. 7a
Effective July 1, 2009, or upon federal approval, whichever is later

Clarifies that adults with income greater than 275% of FPG limit are ineligible for MinnesotaCare, making a conforming change related to Minn. Stat. § 256L.04, subd. 1b.

C. Program/Administrative Simplification

1. Aligning MA and MinnesotaCare for Families and Children
Chapter 79, Article 5, Section 77 (HF 1362)
Effective July 1, 2009

a. Development of Plan
Directs DHS to work with representatives of county agencies and advocacy organizations to develop a plan to align standards, income and asset methodologies, and procedures for families and children under MA and MinnesotaCare. Requires DHS to evaluate the impact of different approaches on: (1) the number of potential enrollees; and (2) administrative, health care, and other costs. Requires DHS to present recommendations to the legislative committees with jurisdiction over health care by September 15, 2010.

b. Pre-Contract Reporting
Requires DHS to report to the legislative chairs of the health care finance committees: (1) before entering into any contracts for streamlined electronic enrollment and eligibility determinations for state health care programs which involve counties; and (2) if the contracts require payment from the general fund or health care access fund.

2. Application Assistance and Information Availability
Chapter 79, Article 5, Section 59 (HF 1362)
Amends Minn. Stat. § 256L.05, subd. 1
Effective July 1, 2009

Requires that application assistance be made available for applicants choosing to file an online application.

3. Application and Enrollment Process for MA and MinnesotaCare
Chapter 79, Article 5, Section 60 (HF 1362)
Amends Minn. Stat. § 256L.05, by adding subd. 1c

Chapter 173, Article 1, Section 37 (HF 1988)
Amends Minn. Stat. § 256L.05, subd. 1c, as added by Laws 2009, Chapter 79, Article 5, Section 60
Effective July 1, 2009 or upon federal approval, which must be requested by the commissioner, whichever is later

a. Streamlined Application and Enrollment Process
Requires DHS to partner with local agencies to develop a streamlined and efficient application and enrollment process for MA and MinnesotaCare enrollees that meets specified criteria.

b. Open Enrollment Recommendations
Directs DHS and the Department of Education to:

- develop recommendations on the creation of an open enrollment process tied to the public education system that must: (1) be developed with consultation from program enrollees, children's advocates and multiple other stakeholders; (2) be based on enrollment and renewal procedures best practices; (3) simplify the enrollment and renewal process, including development of an easily understandable application not to exceed four pages in length for children; and (4) establish a process: (i) to disseminate information on MA and MinnesotaCare to all children in the public education system; and (ii) for DHS to enroll the children and other eligible household members. Requires DHS; and

- provide the recommendations to the Legislature by January 15, 2010.

c. Implementation
Requires DHS and the Department of Education to:

- implement the open enrollment process by August 1, 2010, to be effective beginning with the 2010-2011 school year; and

- submit an implementation plan for the open enrollment period to the Legislature by January 15, 2010.

d. Online Application Process
Requires DHS, along with local agencies, to:

- develop an online application process for MA and MinnesotaCare; and

- submit an implementation plan for the online application process to the Legislature by January 15, 2010.

4. School Districts and Charter Schools
Chapter 79, Article 5, Section 9 (HF 1362)
Amends Minn. Stat. § 256.962, subd. 6
Effective July 1, 2009

Extends the requirement that school districts provide information to students on the availability of health coverage and how to obtain an application to charter schools. Requires those school districts and charter schools that maintain a district Web site to include a link to information on how to obtain an application for the Minnesota health care programs.

5. Renewal of Eligibility for Children
Chapter 79, Article 5, Section 62 (HF 1362)
Adds Minn. Stat. § 256L.05, subd. 3a(e) and (f)
Effective July 1, 2009, or upon federal approval, whichever is later

a. Maintenance of Eligiblity
Provides that children in families with income at or below 275% of FPG, who do not submit renewal forms and related documentation for verification of continued eligibility in a timely manner remain eligible for MinnesotaCare, but must pay premiums. Requires DHS: (1) to use all means available to verify income; and (2) if DHS determines that there has been a change in income that affects premiums, to notify the family of the new premium payment due and that if premium payment not received, the child will be disenrolled effective the first day of the calendar month following the calendar month for which the premium is due.
Adds Minn. Stat. § 256L.05, subd. 3a(e)

b. Renewal Period
Provides that for children enrolled under Minn. Stat. § 256L.07, subd. 8, the first period of renewal begins the month the enrollee becomes 21 years old.
Adds Minn. Stat. § 256L.05, subd. 3a(f)

LONG-TERM CARE

A. Agency Intervention
Chapter 79, Article 5, Section 43 (HF 1362)
Adds Minn. Stat. § 256B.15, subd. 9
Effective July 1, 2009

Permits DHS - after filing and serving notice of such intervention on the other parties - to intervene as a party in any proceeding involving MA estate recovery.

B. Availability of Income for Institutionalized Persons
Chapter 79, Article 5, Section 20 (HF 1362)
Adds Minn. Stat. § 256B.0575, subd. 2
Effective July 1, 2009

Defines "reasonable expenses" and clarifies the expenses incurred for necessary medical or remedial care that may be deducted from an institutionalized person's income as reasonable expenses.

C. Estates

1. Estates Subject to Claims
Chapter 79, Article 5, Section 39 (HF 1362)
Amends Minn. Stat. § 256B.15, subd. 1a
Effective July 1, 2009

a. Definitions

1) Estate
Deletes the definition of what is considered a person's estate from subdivision 1h and moves it to subdivision 1a of Minn. Stat. § 256B.15.

2) Other Arrangement
Defines, for the purposes of recovery in a single person's estate or the estate of a survivor of a married couple, the term "other arrangement" with respect to transfers of property or interest.

b. Recovery from an Estate
Provides that an estate, for the purposes of making a recovery by a surviving spouse, consists of all legal title and interest the recipient spouse had in jointly owned or marital property at the time of the recipient spouse's death. Provides that the recipient spouse who, at death, jointly owned property with the surviving spouse has an interest in the entire property.

2. Estates of Specific Persons Receiving MA
Chapter 79, Article 5, Section 40 (HF 1362)
Amends Minn. Stat. § 256B.15, subd. 1h
Effective July 1, 2009

Strikes paragraph (b) of subdivision 1h (which describes what constitutes the estate of a person receiving MA), relocating it to subdivision 1a of Minn. Stat. § 256B.15.

3. Estate Claims and Medicare Cost-sharing Policy
Chapter 79, Article 5, Section 38 (HF 1362)
Amends Minn. Stat. § 256B.15, subd. 1
Effective July 1, 2009

Provides that "medical assistance" does not include Medicare cost-sharing benefits for the purposes of this section pertaining to claims against estates.

4. Limitations on Claims Against Estate
Chapter 79, Article 5, Section 41 (HF 1362)
Amends Minn. Stat. § 256B.15, subd. 2
Effective July 1, 2009

Provides that a claim against the estate of a surviving spouse is payable from the full value of all of the recipient spouse's assets and interest that are part of the surviving spouse's estate. Defines conditions under which a claim is not payable. Limits claims against marital property to claims against recipients who died on or after July 1, 2009.

5. Reduction of Excess Assets
Chapter 79, Article 5, Section 18 (HF 1362)
Amends Minn. Stat. § 256B.056, subd. 3d
Effective January 1, 2011

a. By Paying Bills for Health Services
Provides that assets may only be reduced by paying bills for health services incurred during the time period specified in the rule for local agencies to act on MA applications (i.e., 45 days for persons who are not aged, blind, or disabled, 60 days for persons who are aged, blind, or disabled) beginning the month of application.

b. Required Spenddown
Requires applicants who have excess income as well as excess assets to first spend excess assets to pay health service bills. Allows applicants to meet income spenddown on remaining bills.

c. Through Designation of Burial Funds
Eliminates the ability of applicants to reduce assets through designation of burial funds in the three months prior to the month of application;

D. Liability of Husband and Wife
Chapter 79, Article 5, Section 73 (HF 1362)
Amends Minn. Stat. § 519.05
Effective July 1, 2009

Specifies that necessary medical services includes claims against an estate for provision of public assistance payments of medical care.

E. State Medical Review Team Process Modified
Chapter 79, Article 8, Sections 12 and 17 (HF 1362)
Amends Minn. Stat. § 256B.055, subd. 7
Adds Minn. Stat. § 256.01, subd. 29
Effective July 1, 2009

Requires DHS to assist applicants for MA who do not meet other bases of eligibility but indicate a disability or chronic condition, to obtain necessary medical and other information. Provides funding for 16 DHS staff positions. Requires annual report to legislative committees, beginning February 1, 2010.

F. Transfers and Period of Ineligibility for Long-term Care Services
Chapter 79, Article 5, Section 22 (HF 1362)
Amends Minn. Stat. § 256B.0595, subd. 2
Effective for periods of ineligibility established on or after January 1, 2011

Permits the period of ineligibility for uncompensated transfers to be eliminated if all the improperly transferred assets, or the full cash value of the assets, are returned within 12 months after the ineligibility period began.

G. Trusts

1. Pooled Trusts and Prohibited Transfers
Chapter 79, Article 5, Section 21 (HF 1362)
Amends Minn. Stat. § 256B.0595, subd. 1
Effective July 1, 2009

Clarifies that pooled trusts are treated consistently with federal law relating to prohibitions on transfers. Requires evaluation of transfers into a qualifying pooled trust as a potential uncompensated transfer when the person/entity requesting MA payment of long-term care services is: (1) a person age 65 or older; (2) the person's spouse; or (3) any person, court, or administrative body on behalf of a person age 65 or older or the person's spouse.

2. Pooled Trusts Requirements
Chapter 173, Article 1, Section 17 (HF 1988)
Amends Minn. Stat. § 256B.056, subd. 3b
Effective for pooled trust accounts established on or after January 1, 2011

Defines pooled trust. Limits the amount of a person's contribution to a pooled trust which may be retained by the trust when the client's participation has terminated. Requires pooled trusts which do not meet new criteria to be counted toward MA asset limits.

3. Supplemental Needs Trusts and Annual Filing Requirement
Chapter 79, Article 5, Section 72 (HF 1362)
Adds Minn. Stat. § 501B.89, subd. 4
Effective for applications for medical assistance and renewals of medical assistance submitted on or after July 1, 2009

Requires the trustee of a supplemental needs trust to submit specified information to DHS at the time of a beneficiary's request for medical assistance and annually.