skip to content

Health Law

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

I. FEDERAL HEALTH CARE REFORM

On March 23, 2010 landmark federal health care reform legislation - the Patient Protection and Affordable Care Act (PPACA) - was enacted. Public Law 111-148 and as amended by the Health Care Education and Reconciliation Act of 2010, Public Law 111-152. See www.healthcare.gov. The following provisions from the federal health care reform legislation have been included here because they have 2010 effective dates and/or are issues of particular interest in Minnesota.

A. American Health Benefit Insurance Exchanges
Creates Health Insurance Exchanges in each state to assist individuals and small employers in purchasing health insurance. Enables people to comparison shop for standardized health insurance packages and facilitates enrollment in coverage, including those eligible for Medicaid. Makes available premium subsidies and cost-sharing tax credits to families with incomes between 133-400% of the federal poverty guidelines (FPG) to help ensure people of all incomes can obtain affordable coverage through an Exchange.
Effective January 1, 2014

B. Eliminating Pre-Existing Condition Exclusions for Children under 19
Prohibits all employer plans and new plans in the individual insurance market from imposing pre-existing condition exclusions on children's coverage. Includes both benefit limitations and outright coverage denials. This protection will be extended to all age groups starting in 2014.
Effective September 23, 2010

C. Individual Mandate
With some exceptions, requires all individuals to have health insurance or pay a yearly financial penalty.
Effective January 1, 2014

D. Insurance Coverage Extended for Dependents
Requires all plans in the individual market and new employer plans that provide dependent coverage for children to continue to make that coverage available up to age 26, but for existing employer plans, applies only to young people not offered their own employer-provided coverage.
Effective September 23, 2010

E. Medicaid (MA) Flexibility for States
Beginning January 1, 2014, states must extend MA to certain individuals with incomes up to 133% of FPG's, with the federal government providing 100% of the funding. Gives Minnesota the option of implementing early MA coverage for childless adults as early as April 1, 2010 through a state plan amendment. (See also Health Care Reform in Minnesota).
Various effective dates

F. Federal High Risk Pools-Pre-existing Condition Insurance Plan (PCIP)
Offers insurance coverage for those who have been previously denied health coverage due to a pre-existing condition. Ends in 2014, when insurance providers will be prohibited from denying coverage for these individuals. (See also Health Care Reform in Minnesota - MCHA).
Effective July 1, 2010


II. HEALTH CARE REFORM IN MINNESOTA

A. Immediate Changes

1. Demonstration Projects and Grants
First Special Session, Chapter 1, Article 22, Section 3 (HF 1)
Effective July 1, 2010

Requires Department of Human Services (DHS) to seek participation in certain demonstration projects or apply for grants as described in federal health care reform legislation, including: (1) evaluation of integrated care around hospitalization; (2) Medicaid global payment; (3) pediatric accountable care organizations; (4) Medicaid emergency psychiatric care; and (5) grants to provide incentives for prevention of chronic diseases. DHS must report to legislature on the status of projects/grant applications.

2. Health Homes and Coordinated Care
First Special Session, Chapter 1, Article 22, Section 2 (HF 1)
Adds Minn. Stat. § 256B.0756
Effective January 1, 2011, or upon federal approval, whichever is later

Modifies health home provisions to comply with the federal requirements of the state option to provide health homes for certain enrollees with chronic conditions. Defines eligibility and the health home services provided. Establishes health teams to support the patient-centered health home and provide the services described. Requires DHS to submit a State plan amendment by January 1, 2011.

3. Minnesota Comprehensive Health Association (MCHA) and Relationship to Temporary Federal High-Risk Pool (Pre-Existing Condition Insurance Plan (PCIP))
First Special Session, Chapter 1, Article 22, Section 1 (HF 1)
Adds Minn. Stat. § 62E.20
Effective July 1, 2010 and as of the date a federal qualified high risk pool begins to provide coverage in Minnesota.

Clarifies the relationship between MCHA and the PCIP and specifies requirements for coordination of these insurance products with state health care programs. Requires the Department of Commerce and MCHA to ensure that applicants are referred to the state public health programs if deemed potentially eligible for those programs. Requires DHS to provide information about coverage under both the federal PCIP and MCHA to applicants determined to be ineligible for coverage under MA or MinnesotaCare.

B. Medical Assistance (MA) State Option for Childless Adults

Provides authority for the current or subsequent governor, contingent upon the issuance of an executive order by January 15, 2011, to expand MA eligibility to childless adults with incomes below 75% of the FPG.

1. Future Implementation State MA Option

Eligibility
First Special Session, Chapter 1, Article 16, Sections 5-7 (HF 1)
Effective July 1, 2010

a. Criteria
Allows MA to be paid for a person over age 21 and under age 65, who is not: (1) pregnant; (2) entitled to Medicare; (3) an adult in a MinnesotaCare family with children; and (4) otherwise eligible for MA.
Amends Minn. Stat. § 256B.055 by adding subd. 15

b. No Asset Limit
Provides that no asset limit applies to persons eligible under section 256B.055, subd. 15, which defines individuals newly eligible for MA under federal law.
Amends Minn. Stat. § 256B.056, subd. 3

c. Income Standard
Establishes the income standard for childless adults eligible for MA under section 256B.055, subd.15, at 75% of FPG.
Amends Minn. Stat. § 256B.056, subd. 4

2. Effective Date
First Special Session, Chapter 1, Article 16, Section 48 (HF 1)
Effective May 22, 2010

Specifies that the current governor must direct by executive order that DHS implement these early MA enrollment sections in order for expansion of MA coverage for childless adults to take effect. Provides that, if the current governor does not issue an order, the succeeding governor, from the start of that governor's term until January 15, 2011, may implement the sections. Requires the governor to consider the following factors when determining whether to issue an executive order: (1) cost of implementation and the availability of funds; (2) potential for increased federal funding; (3) effect of implementation on access to health care services; and (4) alternative approaches that may be available to pursue policy goals.

3. State Plan Amendment; Requirement to Seek Federal Approval
First Special Session, Chapter 1, Article 16, Section 46 (HF 1)
Effective May 22, 2010

Requires DHS to submit: (1) a state plan amendment to receive federal funds for MA coverage of childless adults with income less than or equal to 75% of FPG, with an effective date of July 1, 2010; and (2) a waiver request or amendment to the MinnesotaCare waiver to receive federal funds for MA coverage for single adults and households without children.

4. Repealer
First Special Session, Chapter 1, Article 16, Section 47 (HF 1)
Effective May 22, 2010

Repeals: (1) provisions pertaining to the General Assistance Medical Care program (§ 256D.03) contingent upon implementation of MA coverage for childless adults; and (2) sections of Chapter 200, Article 1, Section 12 (the modified GAMC program) contingent upon implementation of MA coverage for this same group.

III. OTHER HEALTH CARE POLICY

A. COBRA State Premium Subsidy
First Special Session, Chapter 1, Article 16, Section 39 (HF 1), amending
Laws 2009, Chapter 79, Article 5, Section 78, Subdivision 5
Effective July 1, 2010

Extends: (1) the expiration date for the state premium subsidy program for COBRA continuation coverage from December 31, 2010 to August 31, 2011; and (2) the exemption from the four-month uninsured requirement to February 28, 2012, to reflect the extension of the federal premium subsidy program for continuation coverage.

B. Consumer Protection Standards for Long-Term Care Partnership Policies
Chapter 310, Article 4, Section 2 (SF 3027)
Adds Minn. Stat. § 62S.312
Effective August 1, 2010

Requires:

  • Long-term care insurance policies to meet the requirements for being tax qualified as defined in Section 7702B(b) of the Internal Revenue Code and meet certain consumer protection requirements in Section 6021(a)(1)(B)(5)(A) of the Deficit Reduction Act of 2005, Public Law 109-171, which are taken from the National Association of Insurance Commissioners (NAIC) Model Act and Regulation of 2000;
  • Insurance carriers to certify for each policy form to be included in the long-term care partnership that the form complies with the requirements of the NAIC Model Act and Regulation of 2000.

C. State Medical Review Team
Chapter 261, Section 1 (HF 3405)
Amends Minn. Stat. § 256.01, subd. 29
Effective August 1, 2010

Requires DHS to provide information to the legislature on the length of time taken for written decisions to be made on appeals of SMRT disability determinations. Requires appeals of disability determinations made by the SMRT to be decided according to statutory timelines for other appeals within DHS programs, and provides that appeals that do not receive a written decision within these timelines must be immediately reviewed by the chief appeals referee.

IV. CHANGES TO SPECIFIC MINNESOTA HEALTH CARE PROGRAMS

A. All Minnesota Health Care Programs

1. Income Standards for Eligibility
Chapter 310, Article 16, Sections 1-3 (SF 3027)
Amends Minn. Stat. 2009 Supplement § 256B.056, subd. 1c
Amends Minn. Stat. 2009 Supplement § 256D.03, subd. 3 (b)
Amends Minn. Stat. § 256L.04, subd. 7b
Effective July 1, 2010

Clarifies that DHS must annually adjust the income standards under MA, GAMC, and MinnesotaCare each July 1 by the update of the FPG (following publication by the United States Department of Health and Human Services), except that the adjusted income standards for these programs must not go below those in effect on July 1, 2009.

B. General Assistance Medical Care (GAMC)
Chapter 200, Article 1, Section 6, 10, 11, 12, 16, 44 (SF 460)
Amends Minn. Stat. §§ 256L.05, subd 3c; 256B.69, subd. 20; and 256D.03, subd. 3 and 3b
Adds Minn. Stat. § 256D.031
Various effective dates
and
First Special Session, Chapter 1, Article 16, Sections 21, 30, 31, 40 (HF 1), amending Laws 2010, Chapter 200, Article 1, Sections 11, 12, 44
Various Effective Dates

Note: Following the governor's line-item veto of funding for the GAMC program in May, 2009, legislation was enacted in 2010 that continues the program, but at a greatly reduced funding level. This modified GAMC program became law on March 26, 2010 as Chapter 200. Additional changes to GAMC were enacted into law on May 21, 2010 in Article 16 of the only bill considered in the special session First Special Session, Chapter 1. However, the majority of changes to the GAMC program were enacted in Chapter 200.

These changes have resulted in a scaled-back GAMC program with similar eligibility requirements, but which provides significantly reduced health services delivered through a hospital-based Coordinated Care Delivery System (CCDS) model. A temporary uncompensated care pool for reimbursement for non-CCDS hospitals and a prescription drug reimbursement pool are also established within the new GAMC program.

1. Administration
Amends Minn. Stat. § 256D.03, subd. 3
Effective for services rendered on or after April 1, 2010

Provides that the GAMC program is administered according to a new section, 256D.031, unless otherwise stated. Funds outpatient prescription drug coverage, which continues to be administered under section 256D.03, subd. 3, from the new outpatient prescription drug pool (section 256D.031) beginning June 1, 2010. Provides that outpatient prescription drug coverage does not include drugs administered in a clinic or other outpatient setting.

2. Modified GAMC Program
Adds Minn. Stat. § 256D.031
Effective April 1, 2010

Note: This new section establishes a modified general assistance medical care program beginning April 1, 2010.

a. Eligibility

1) Income and Assets
Establishes income and asset eligibility for the redesigned GAMC program. Does not change eligibility, but eliminates the hospital-only coverage for individuals with income greater than 75% of FPG but not exceeding 175% of FPG.

2) Loss of Eligibility
Enumerates individuals who are no longer eligible for the GAMC program, including those who: (i) have private health coverage; (ii) are in a county correctional or detention facility or admitted as an inpatient to a hospital on a criminal hold order; (iii) reside in the sex offender program; (iv) fail to cooperate with a county agency to meet the requirements of MA; and (v) do not cooperate with a county or state agency in determining a disability for supplemental security income (SSI) or Social Security Disability Income (SSDI)).

3) Eligibility and Enrollment Procedures
Clarifies that there are no changes in eligibility and enrollment procedures from the previous program. Provides that eligibility for GAMC: (i) extends for a six-month period, unless a change that affects eligibility is reported; and (ii) may be renewed for additional six-month periods. Provides that, during each six-month period, recipients who continue to meet the eligibility requirements are not eligible for enrollment in MinnesotaCare.

b. Services

1) Medically Necessary Services

a) Services Covered
Specifies the medically necessary services provided under GAMC (subd. 4). Provides that covered prescription drugs include those administered in a clinic or other outpatient setting. (See also CCDS option for providing alternate set of health care services below.)

b) Co-Payments
Specifies the co-payments for medically necessary services covered under the program remain the same. Continues to prohibit providers from denying services to recipients who are unable to pay the co-payment.

2) Outpatient Prescription Drug Pool
Effective June 1, 2010, establishes an outpatient prescription drug pool for outpatient prescription drugs dispensed to recipients. Subjects drug coverage to the availability of funds in the pool. Requires DHS to make recommendations to the Legislative Advisory Commission on how to address the shortfall if expenditures for the pool are forecasted to exceed the appropriation.

3) New Service Delivery Model-Coordinated Care Delivery System
Effective June 1, 2010

a) Contracts with Qualifying Hospitals
Effective June 1, 2010, requires DHS to contract with qualifying hospitals or groups of hospitals to deliver services through a coordinated care delivery system (CCDS) to GAMC recipients who enroll in a CCDS. Reimburses hospitals choosing to participate in the CCDS model through capped block grants.

b) Services Provided
Requires that the health care services provided by a CCDS must include either the services listed in Minn. Stat. § 256D.031, subd. 4 or a set of comprehensive and medically necessary health services that a recipient might reasonably require to be maintained in good health and that has been approved by DHS.

c) Voluntary Enrollment
Allows GAMC applicants and recipients to voluntarily enroll in any available CCDS. Allows applicants or recipients to choose among any of the available CCDS's if more than one CCDS is available. Requires recipients to receive all nonemergency services through their CCDS. Makes recipients enrolled in a CCDS ineligible to enroll in MinnesotaCare during their GAMC enrollment period if they continue to meet the GAMC eligibility requirements.

d) Enrollment Capped
Caps enrollment in each CCDS using a formula based on previous numbers of GAMC enrollees using that hospital system in 2008. (Note: First Special Session, Chapter 1, Article 16, Section 40 (HF 1), amending Laws 2010, Chapter 200, Article 1, Section 12, subd. 6 (SF 460))

e) CCDS Requirements
Requires a CCDS to: (1) provide the covered services to recipients enrolled in the system;
(2) monitor enrollment and ensure quality of care; (3) with the counties, coordinate the delivery of health care services with other homeless prevention supportive housing or rent subsidy programs; and (4) adopt innovative and cost-effective methods of care delivery and coordination.

f) Limitations
Permits a CCDS hospital to: (1) limit the provider network and to require recipients to seek services only through the network; and (2) require a recipient to seek a referral before seeking services. Provides that a system is not required to provide payment to a provider who is not employed by or under contract with the system for services provided to a recipient, except in cases of an emergency.

g) Appeals
Grants a recipient enrolled in a CCDS the right to appeal in accordance with Minn. Stat. § 256.045.

h) Consultation with Other Government Service Providers
Requires hospitals participating in a CCDS to consult with counties, county veteran's service officers, and the Veterans Administration to identify other programs for which GAMC recipients are qualified.

4) Temporary Uncompensated Care Pool (UCP)
Creates a temporary UCP for reimbursement to hospitals serving GAMC enrollees but who have not contracted with DHS for designation as a CCDS. Between June 1, 2010, and February 28, 2011, permits applicants and recipients who are not enrolled in a CCDS to seek services from a hospital eligible for reimbursement under the temporary UCP. After February 28, 2011, requires all services to be received through a CCDS.

5) Retroactive Coverage of GAMC Services
Amends Minn. Stat. § 256D.03, subd. 3
Effective retroactively from April 1, 2010 through May 31, 2010

Clarifies that for the period April 1, 2010 to May 31, 2010, general assistance medical care covers the services listed in subd. 4 of Minn. Stat. § 256D.03 (GAMC). (Note: First Special Session, Chapter 1, Article 16, Section 30 (HF 1), amending Chapter 200, article 1, section 11 (SF 460))

6) Retroactive Coverage for MinnesotaCare
Amends Minn. Stat. § 256L.05, subd. 3c
Effective June 1, 2010

GAMC recipients may qualify for retroactive coverage of MinnesotaCare, but only at their 6 month renewal.

7) Ombudsperson
Amends Minn. Stat. § 256B.69, subd. 20
Effective June 1, 2010

Requires DHS to designate an ombudsperson to advocate for persons enrolled in GAMC and the new CCDS system. Requires the ombudsperson to utilize the state appeal process and assist enrollees to access medically necessary services. Requires the local agency to inform recipients about the ombudsperson program at time of enrollment in a CCDS.

8) Reimbursement Under Other State Health Care Programs
Amends Minn. Stat. § 256B.0644 by adding (d)
Effective June 1, 2010

Prohibits any hospital or provider that is participating in a CCDS system or receives payments under the UCP from refusing to provide services to any patient enrolled in GAMC. (Note: the language in (d) prohibiting the provider from refusing to provide services was deleted per First Special Session, Chapter 1, Article 16, Section 18 (HF 1)).

9) Repealer
First Special Session, Chapter 1, Article 16, Section 44 (HF 1)
Amends Chapter 200, Article 1, Section 21
Effective retroactively from April 1, 2010

Changes the effective date for the repeal of Minn. Stat. § 256D.03, subd. 4 (covered benefits under the old GAMC program) from April 1 to June 1, 2010. Changes the effective date for the repeal of sections dealing with MinnesotaCare enrollees transitioned from GAMC, from January 1, 2011, to July 1, 2010.

Third-Party Payments Cooperation Requirement Eliminated
First Special Session, Chapter 1, Article 16, Section 31 (HF 1)
Amends Minn. Stat. § 256D.03, subd. 3b
Effective July 1, 2010

Eliminates requirement that person enrolled in GAMC coverage cooperate with state in obtaining third-party payments (cost-effective insurance).

** See Disability Law Section for GAMC Chapter 200 provisions relating to Mental Health Changes

C. MA

1. Eligibility

Infants and Automatic Eligibility
Chapter 310, Article 3, Section 1 (SF 3027)
Amends Minn. Stat. § 256B.055, subd. 10
Effective July 1, 2010

Clarifies that one year of automatic eligibility for newborns of MA or MinnesotaCare eligible mothers is allowed, whether or not the newborn resides with the mother.

Infants and Pregnant Women
Chapter 310, Article 3, Section 2 (SF 3027)
Amends Minn. Stat. § 256B.057, subd. 1(d)
Effective July 1, 2010

Makes technical changes and clarifies that eligibility for MA for an infant born to a mother eligible for MA continues without redetermination until the child's first birthday, whether or not the child remains in the woman's household.

2. Services/Benefits

Asthma Demonstration Project
First Special Session, Chapter 1, Article 16, Section 38 (HF 1)
Amends Laws 2009, Chapter 79, Article 5, Section 75, subd. 1
Effective July 1, 2010

Expands coverage under the asthma demonstration project for certain American Indian children to include home environmental assessments for triggers of asthma and in-home asthma education. Limits visits to two per child and sets the home visit payment rate. Requires durable medical equipment to be covered if the item is medically "useful" rather than medically "necessary" to reduce asthma symptoms.

Birth Center Services
First Special Session, Chapter 1, Article 16, Section 15 (HF 1)
Amends Minn. Stat. § 256B.0625 by adding subd. 54
Effective July 1, 2010

Provides that MA covers services provided in a licensed birth center by a licensed health professional if the service would otherwise be covered if provided in a hospital. Establishes payment rates for facility, nursery, and professional services. Denies coverage for services provided by an unlicensed traditional midwife. Directs DHS to apply for any necessary federal waivers to allow birth centers and birth center providers to be reimbursed.

Chiropractic Services
First Special Session, Chapter 1, Article 16, Section 11 (HF 1)
Amends Minn. Stat. § 256B.0625 by adding subd. 8d
Effective July 1, 2010

Limits payment for chiropractic services to one annual evaluation and 12 visits per year unless prior authorization of additional visits is obtained.

Co-payments
First Special Session, Chapter 1, Article 16, Section 16 (HF 1)
Amends Minn. Stat. § 256B.061, subd. 1
Effective January 1, 2011

Reduces the MA co-payment for nonemergency visits to a hospital-based emergency room from $6 to $3.50.

Dental Benefits/Services
Chapter 310, Article 7, Section 1 (SF 3027)
Amends Minn. Stat. § 256B.0625, subd. 9
Effective July 1, 2010

Expands coverage for use of panoramic x-rays in some circumstances. Clarifies that MA covers medically necessary dental services for pregnant women as well as children. Specifies that application of sealants are covered once every five years per permanent molar and orthodontia is eligible for coverage for children only.

Dental Critical Access Providers
First Special Session, Chapter 1, Article 16, Section 27 (HF 1)
Amends Minn. Stat. § 256B.76, subd. 4
Effective July 1, 2010

Modifies the criteria DHS must use to determine which dentists and dental clinics are critical access dental providers. Requires DHS to designate the following as critical access providers:

(1) certain nonprofit community clinics;
(2) federally qualified health centers, rural health clinics;
(3) county owned and operated hospital-based dental clinics;
(4) a dental clinic or dental group owned and operated by a nonprofit operation with more than 10,000 patient encounters per year with patients who are uninsured or covered by MA, GAMC, or MinnesotaCare; and
(5) a dental clinic associated with an oral health or dental education program operated by the University of Minnesota or an institution within the MnSCU system.

Dental Diagnostic, Screening, and Preventive Services for Children
Chapter 307, Section 1 (SF 633)
Amends Minn. Stat. § 256B.0625, subd. 14 by adding (d) and (e)
Effective August 1, 2010

Requires DHS to encourage a primary care health care provider to perform primary caries (cavity) preventive services as part of a child or teen checkup or during an episodic care visit. Primary caries preventive services must include: (1) a general visual examination of the child's mouth; (2) a risk assessment; and (3) the application of a fluoride varnish beginning at age one to those children who are assessed as being high risk. Parental consent is required prior to administering a fluoride treatment. The provider should provide the child's parent or legal guardian with information regarding carries etiology and prevention and dental homes.

Oral Language Interpreter Services
First Special Session, Chapter 1, Article 16, Section 13 (HF 1)
Amends Minn. Stat. § 256B.0625, subd. 18a(d)
Effective January 1, 2011

Provides that MA will cover face-to-face oral language interpreter services only if the interpreter used by the provider is listed in the registry or roster established by MDH under Minn. Stat. § 144.058.

Prior Authorization for Health Services Notice
Chapter 310, Article 8, Section 1 (SF 3027)
Amends Minn. Stat. § 256B.0625, subd. 25
Effective August 1, 2010

Requires DHS to publish in the Minnesota health care programs provider manual and on DHS's website: (1) a list of health services that require prior authorization; and (2) the criteria and standards used to select health services on the list. Deletes the previous requirement that the list be published in the State Register.

D. MINNESOTACARE

1. Eligibility

Firefighters and Ambulance Attendants
First Special Session, Chapter 1, Article 16, Section 35 (HF 1)
Amends Minn. Stat. § 256L.07 by adding subd. 9
Effective April 1, 2011

Makes a qualified volunteer firefighter or ambulance attendant eligible for MinnesotaCare without meeting other eligibility requirements, provided the enrollee pays premiums. Specifies that the benefit set is the same as that available for childless adults.

Retroactive Coverage
Chapter 200, Article 1, Section 16
Amends Minn. Stat. § 256L.05, subd. 3c
Effective June 1, 2010

GAMC recipients may qualify for retroactive coverage of MinnesotaCare, but only at their 6 month renewal.

2. Benefits

Co-payments and Coinsurance
First Special Session, Chapter 1, Article 16, Section 33 (HF 1)
Amends Minn. Stat. § 256L.03, subd. 5
Effective July 1, 2010

Provides that the MinnesotaCare co-payment for nonemergency visits to a hospital-based emergency room is reduced from $6 to $3.50, effective January 1, 2011. Clarifies that reimbursements to providers will not be increased due to this reduction in the nonemergency visit co-payment.