SF 1407

  1.1                          A bill for an act 
  1.2             relating to human services; modifying provisions in 
  1.3             health care access programs; amending Minnesota 
  1.4             Statutes 2000, sections 245B.02, by adding a 
  1.5             subdivision; 245B.03, subdivision 1; 252.28, 
  1.6             subdivisions 3a and 3b; 256B.056, subdivisions 1a, 4, 
  1.7             and 5a; 256B.0595, subdivisions 1 and 2; 256B.0625, 
  1.8             subdivision 9; 256B.0635, subdivision 1; 256B.071, 
  1.9             subdivision 2; 256B.094, subdivisions 6 and 8; 
  1.10            256B.5013, subdivision 1; 256B.69, subdivision 3a; 
  1.11            256D.03, subdivision 3; and 256L.15, subdivision 1a; 
  1.12            Laws 1996, chapter 451, article 2, sections 61 and 62; 
  1.13            repealing Minnesota Statutes 2000, section 256B.071, 
  1.14            subdivision 5; Laws 1995, chapter 178, article 2, 
  1.15            section 46, subdivision 10; Laws 1996, chapter 451, 
  1.16            article 2, sections 12, 14, 16, 18, 29, and 30. 
  1.17  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.18     Section 1.  Minnesota Statutes 2000, section 245B.02, is 
  1.19  amended by adding a subdivision to read: 
  1.20     Subd. 23a.  [SUPPORTED EMPLOYMENT.] "Supported employment" 
  1.21  services include individualized counseling, individualized job 
  1.22  development and placement that produce an appropriate job match 
  1.23  for the individual and the employer, on-the-job training in work 
  1.24  and related work skills required for job performance, ongoing 
  1.25  supervision and monitoring of the person's performance, 
  1.26  long-term support services to assure job retention, training in 
  1.27  related skills essential to obtaining and retaining employment 
  1.28  such as the effective use of community resources, use of break 
  1.29  and lunch areas, transportation and mobility training, and 
  1.30  transportation between the individual's place of residence and 
  1.31  the work place when other forms of transportation are 
  2.1   unavailable or inaccessible. 
  2.2      Sec. 2.  Minnesota Statutes 2000, section 245B.03, 
  2.3   subdivision 1, is amended to read: 
  2.4      Subdivision 1.  [APPLICABILITY.] The standards in this 
  2.5   chapter govern services to persons with mental retardation or 
  2.6   related conditions receiving services from license holders 
  2.7   providing residential-based habilitation; day training and 
  2.8   habilitation services for adults; supported employment; 
  2.9   semi-independent living services; residential programs that 
  2.10  serve more than four consumers, including intermediate care 
  2.11  facilities for persons with mental retardation; and respite care 
  2.12  provided outside the consumer's home for more than four 
  2.13  consumers at the same time at a single site. 
  2.14     Sec. 3.  Minnesota Statutes 2000, section 252.28, 
  2.15  subdivision 3a, is amended to read: 
  2.16     Subd. 3a.  [LICENSING EXCEPTION.] (a) Notwithstanding the 
  2.17  provisions of subdivision 3, the commissioner may license 
  2.18  service sites, each accommodating up to six residents moving 
  2.19  from a 48-bed intermediate care facility for persons with mental 
  2.20  retardation or related conditions located in Dakota county that 
  2.21  is closing under section 252.292. 
  2.22     (b) Notwithstanding the provisions of any other state law 
  2.23  or administrative rule, the rate provisions of section 256I.05, 
  2.24  subdivision 1, apply to the exception in this subdivision. 
  2.25     (c) If a service site is licensed for six persons according 
  2.26  to this subdivision, the capacity of the license may remain at 
  2.27  six persons. 
  2.28     Sec. 4.  Minnesota Statutes 2000, section 252.28, 
  2.29  subdivision 3b, is amended to read: 
  2.30     Subd. 3b.  [OLMSTED COUNTY LICENSING EXEMPTION.] (a) 
  2.31  Notwithstanding subdivision 3, the commissioner may license 
  2.32  service sites each accommodating up to five residents moving 
  2.33  from a 43-bed intermediate care facility for persons with mental 
  2.34  retardation or related conditions located in Olmsted county that 
  2.35  is closing under section 252.292. 
  2.36     (b) Notwithstanding the provisions of any other state law 
  3.1   or administrative rule, the rate provisions of section 256I.05, 
  3.2   subdivision 1, apply to the exception in this subdivision. 
  3.3      (c) If a service site is licensed for five persons 
  3.4   according to this subdivision, the capacity of the license may 
  3.5   remain at five persons. 
  3.6      Sec. 5.  Minnesota Statutes 2000, section 256B.056, 
  3.7   subdivision 1a, is amended to read: 
  3.8      Subd. 1a.  [INCOME AND ASSETS GENERALLY.] Unless 
  3.9   specifically required by state law or rule or federal law or 
  3.10  regulation, the methodologies used in counting income and assets 
  3.11  to determine eligibility for medical assistance for persons 
  3.12  whose eligibility category is based on blindness, disability, or 
  3.13  age of 65 or more years, the methodologies for the supplemental 
  3.14  security income program shall be used.  For families and 
  3.15  children, which includes all other eligibility categories, the 
  3.16  methodologies under the state's AFDC plan in effect as of July 
  3.17  16, 1996, as required by the Personal Responsibility and Work 
  3.18  Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
  3.19  Number 104-193, shall be used.  Effective upon federal approval, 
  3.20  in-kind contributions to, and payments made on behalf of, a 
  3.21  recipient, by an obligor, in satisfaction of or in addition to a 
  3.22  temporary or permanent order for child support or maintenance, 
  3.23  shall be considered income to the recipient.  For these 
  3.24  purposes, a "methodology" does not include an asset or income 
  3.25  standard, or accounting method, or method of determining 
  3.26  effective dates. 
  3.27     Sec. 6.  Minnesota Statutes 2000, section 256B.056, 
  3.28  subdivision 4, is amended to read: 
  3.29     Subd. 4.  [INCOME.] To be eligible for medical assistance, 
  3.30  a person eligible under section 256B.055, subdivision 7, not 
  3.31  receiving supplemental security income program payments, and 
  3.32  families and children may have an income up to 133-1/3 percent 
  3.33  of the AFDC income standard in effect under the July 16, 1996, 
  3.34  AFDC state plan.  Effective July 1, 2000, the base AFDC standard 
  3.35  in effect on July 16, 1996, shall be increased by three percent. 
  3.36  Effective January 1, 2000, and each successive January, 
  4.1   recipients of supplemental security income may have an income up 
  4.2   to the supplemental security income standard in effect on that 
  4.3   date.  In computing income to determine eligibility of persons 
  4.4   who are not residents of long-term care facilities, the 
  4.5   commissioner shall disregard increases in income as required by 
  4.6   Public Law Numbers 94-566, section 503; 99-272; and 99-509.  
  4.7   Veterans aid and attendance benefits and Veterans Administration 
  4.8   unusual medical expense payments are considered income to the 
  4.9   recipient.  Cash gifts under $100 per month are excluded from 
  4.10  consideration as income. 
  4.11     Sec. 7.  Minnesota Statutes 2000, section 256B.056, 
  4.12  subdivision 5a, is amended to read: 
  4.13     Subd. 5a.  [INDIVIDUALS ON FIXED OR EXCLUDED INCOME.] 
  4.14  Recipients of medical assistance who receive only fixed unearned 
  4.15  or excluded income, where such when that income is excluded from 
  4.16  consideration as income or unvarying in amount and timing of 
  4.17  receipt throughout the year, shall report and verify their 
  4.18  income annually. 
  4.19     Sec. 8.  Minnesota Statutes 2000, section 256B.0595, 
  4.20  subdivision 1, is amended to read: 
  4.21     Subdivision 1.  [PROHIBITED TRANSFERS.] (a) For transfers 
  4.22  of assets made on or before August 10, 1993, if a person or the 
  4.23  person's spouse has given away, sold, or disposed of, for less 
  4.24  than fair market value, any asset or interest therein, except 
  4.25  assets other than the homestead that are excluded under the 
  4.26  supplemental security program, within 30 months before or any 
  4.27  time after the date of institutionalization if the person has 
  4.28  been determined eligible for medical assistance, or within 30 
  4.29  months before or any time after the date of the first approved 
  4.30  application for medical assistance if the person has not yet 
  4.31  been determined eligible for medical assistance, the person is 
  4.32  ineligible for long-term care services for the period of time 
  4.33  determined under subdivision 2.  
  4.34     (b) Effective for transfers made after August 10, 1993, a 
  4.35  person, a person's spouse, or any person, court, or 
  4.36  administrative body with legal authority to act in place of, on 
  5.1   behalf of, at the direction of, or upon the request of the 
  5.2   person or person's spouse, may not give away, sell, or dispose 
  5.3   of, for less than fair market value, any asset or interest 
  5.4   therein, except assets other than the homestead that are 
  5.5   excluded under the supplemental security income program, for the 
  5.6   purpose of establishing or maintaining medical assistance 
  5.7   eligibility.  For purposes of determining eligibility for 
  5.8   long-term care services, any transfer of such assets within 36 
  5.9   months before or any time after an institutionalized person 
  5.10  applies for medical assistance, or 36 months before or any time 
  5.11  after a medical assistance recipient becomes institutionalized, 
  5.12  for less than fair market value may be considered.  Any such 
  5.13  transfer is presumed to have been made for the purpose of 
  5.14  establishing or maintaining medical assistance eligibility and 
  5.15  the person is ineligible for long-term care services for the 
  5.16  period of time determined under subdivision 2, unless the person 
  5.17  furnishes convincing evidence to establish that the transaction 
  5.18  was exclusively for another purpose, or unless the transfer is 
  5.19  permitted under subdivision 3 or 4.  Notwithstanding the 
  5.20  provisions of this paragraph, in the case of payments from a 
  5.21  trust or portions of a trust that are considered transfers of 
  5.22  assets under federal law, any transfers made within 60 months 
  5.23  before or any time after an institutionalized person applies for 
  5.24  medical assistance and within 60 months before or any time after 
  5.25  a medical assistance recipient becomes institutionalized, may be 
  5.26  considered. 
  5.27     (c) This section applies to transfers, for less than fair 
  5.28  market value, of income or assets, including assets that are 
  5.29  considered income in the month received, such as inheritances, 
  5.30  court settlements, and retroactive benefit payments or income to 
  5.31  which the person or the person's spouse is entitled but does not 
  5.32  receive due to action by the person, the person's spouse, or any 
  5.33  person, court, or administrative body with legal authority to 
  5.34  act in place of, on behalf of, at the direction of, or upon the 
  5.35  request of the person or the person's spouse.  
  5.36     (d) This section applies to payments for care or personal 
  6.1   services provided by a relative, unless the compensation was 
  6.2   stipulated in a notarized, written agreement which was in 
  6.3   existence when the service was performed, the care or services 
  6.4   directly benefited the person, and the payments made represented 
  6.5   reasonable compensation for the care or services provided.  A 
  6.6   notarized written agreement is not required if payment for the 
  6.7   services was made within 60 days after the service was provided. 
  6.8      (e) This section applies to the portion of any asset or 
  6.9   interest that a person, a person's spouse, or any person, court, 
  6.10  or administrative body with legal authority to act in place of, 
  6.11  on behalf of, at the direction of, or upon the request of the 
  6.12  person or the person's spouse, transfers to any annuity that 
  6.13  exceeds the value of the benefit likely to be returned to the 
  6.14  person or spouse while alive, based on estimated life expectancy 
  6.15  using the life expectancy tables employed by the supplemental 
  6.16  security income program to determine the value of an agreement 
  6.17  for services for life.  The commissioner may adopt rules 
  6.18  reducing life expectancies based on the need for long-term care. 
  6.19     (f) For purposes of this section, long-term care services 
  6.20  include services in a nursing facility, services that are 
  6.21  eligible for payment according to section 256B.0625, subdivision 
  6.22  2, because they are provided in a swing bed, intermediate care 
  6.23  facility for persons with mental retardation, and home and 
  6.24  community-based services provided pursuant to sections 
  6.25  256B.0915, 256B.092, and 256B.49.  For purposes of this 
  6.26  subdivision and subdivisions 2, 3, and 4, "institutionalized 
  6.27  person" includes a person who is an inpatient in a nursing 
  6.28  facility or in a swing bed, or intermediate care facility for 
  6.29  persons with mental retardation or who is receiving home and 
  6.30  community-based services under sections 256B.0915, 256B.092, and 
  6.31  256B.49. 
  6.32     (g) Effective for transfers made on or after July 1, 1995, 
  6.33  or upon federal approval, whichever is later, a person, a 
  6.34  person's spouse, or any person, court, or administrative body 
  6.35  with legal authority to act in place of, on behalf of, at the 
  6.36  direction of, or upon the request of the person or person's 
  7.1   spouse, may not give away, sell, or dispose of, for less than 
  7.2   fair market value, any asset or interest therein, for the 
  7.3   purpose of establishing or maintaining medical assistance 
  7.4   eligibility.  For purposes of determining eligibility for 
  7.5   long-term care services, any transfer of such assets within 60 
  7.6   months before, or any time after, an institutionalized person 
  7.7   applies for medical assistance, or 60 months before, or any time 
  7.8   after, a medical assistance recipient becomes institutionalized, 
  7.9   for less than fair market value may be considered.  Any such 
  7.10  transfer is presumed to have been made for the purpose of 
  7.11  establishing or maintaining medical assistance eligibility and 
  7.12  the person is ineligible for long-term care services for the 
  7.13  period of time determined under subdivision 2, unless the person 
  7.14  furnishes convincing evidence to establish that the transaction 
  7.15  was exclusively for another purpose, or unless the transfer is 
  7.16  permitted under subdivision 3 or 4. 
  7.17     Sec. 9.  Minnesota Statutes 2000, section 256B.0595, 
  7.18  subdivision 2, is amended to read: 
  7.19     Subd. 2.  [PERIOD OF INELIGIBILITY.] (a) For any 
  7.20  uncompensated transfer occurring on or before August 10, 1993, 
  7.21  the number of months of ineligibility for long-term care 
  7.22  services shall be the lesser of 30 months, or the uncompensated 
  7.23  transfer amount divided by the average medical assistance rate 
  7.24  for nursing facility services in the state in effect on the date 
  7.25  of application.  The amount used to calculate the average 
  7.26  medical assistance payment rate shall be adjusted each July 1 to 
  7.27  reflect payment rates for the previous calendar year.  The 
  7.28  period of ineligibility begins with the month in which the 
  7.29  assets were transferred.  If the transfer was not reported to 
  7.30  the local agency at the time of application, and the applicant 
  7.31  received long-term care services during what would have been the 
  7.32  period of ineligibility if the transfer had been reported, a 
  7.33  cause of action exists against the transferee for the cost of 
  7.34  long-term care services provided during the period of 
  7.35  ineligibility, or for the uncompensated amount of the transfer, 
  7.36  whichever is less.  The action may be brought by the state or 
  8.1   the local agency responsible for providing medical assistance 
  8.2   under chapter 256G.  The uncompensated transfer amount is the 
  8.3   fair market value of the asset at the time it was given away, 
  8.4   sold, or disposed of, less the amount of compensation received.  
  8.5      (b) For uncompensated transfers made after August 10, 1993, 
  8.6   the number of months of ineligibility for long-term care 
  8.7   services shall be the total uncompensated value of the resources 
  8.8   transferred divided by the average medical assistance rate for 
  8.9   nursing facility services in the state in effect on the date of 
  8.10  application.  The amount used to calculate the average medical 
  8.11  assistance payment rate shall be adjusted each July 1 to reflect 
  8.12  payment rates for the previous calendar year.  The period of 
  8.13  ineligibility begins with the month in which the assets were 
  8.14  transferred except that if one or more uncompensated transfers 
  8.15  are made during a period of ineligibility, the total assets 
  8.16  transferred during the ineligibility period shall be combined 
  8.17  and a penalty period calculated to begin in the month the first 
  8.18  uncompensated transfer was made.  If the transfer was not 
  8.19  reported to the local agency at the time of application, and the 
  8.20  applicant received medical assistance services during what would 
  8.21  have been the period of ineligibility if the transfer had been 
  8.22  reported, a cause of action exists against the transferee for 
  8.23  the cost of medical assistance services provided during the 
  8.24  period of ineligibility, or for the uncompensated amount of the 
  8.25  transfer, whichever is less.  The action may be brought by the 
  8.26  state or the local agency responsible for providing medical 
  8.27  assistance under chapter 256G.  The uncompensated transfer 
  8.28  amount is the fair market value of the asset at the time it was 
  8.29  given away, sold, or disposed of, less the amount of 
  8.30  compensation received.  Effective for transfers made on or after 
  8.31  March 1, 1996, involving persons who apply for medical 
  8.32  assistance on or after April 13, 1996, no cause of action exists 
  8.33  for a transfer unless: 
  8.34     (1) the transferee knew or should have known that the 
  8.35  transfer was being made by a person who was a resident of a 
  8.36  long-term care facility or was receiving that level of care in 
  9.1   the community at the time of the transfer; 
  9.2      (2) the transferee knew or should have known that the 
  9.3   transfer was being made to assist the person to qualify for or 
  9.4   retain medical assistance eligibility; or 
  9.5      (3) the transferee actively solicited the transfer with 
  9.6   intent to assist the person to qualify for or retain eligibility 
  9.7   for medical assistance.  
  9.8      (c) If a calculation of a penalty period results in a 
  9.9   partial month, payments for long-term care services shall be 
  9.10  reduced in an amount equal to the fraction, except that in 
  9.11  calculating the value of uncompensated transfers, if the total 
  9.12  value of all uncompensated transfers made in a month not 
  9.13  included in an existing penalty period does not exceed $500, 
  9.14  then such transfers shall be disregarded for each month prior to 
  9.15  the month of application for or during receipt of medical 
  9.16  assistance. 
  9.17     Sec. 10.  Minnesota Statutes 2000, section 256B.0625, 
  9.18  subdivision 9, is amended to read: 
  9.19     Subd. 9.  [DENTAL SERVICES.] Medical assistance covers 
  9.20  dental services.  Dental services include, with prior 
  9.21  authorization, fixed cast metal restorations bridges that are 
  9.22  cost-effective for persons who cannot use removable dentures 
  9.23  because of their medical condition. 
  9.24     Sec. 11.  Minnesota Statutes 2000, section 256B.0635, 
  9.25  subdivision 1, is amended to read: 
  9.26     Subdivision 1.  [INCREASED EMPLOYMENT.] Beginning January 
  9.27  1, 1998, medical assistance may be paid for persons who received 
  9.28  MFIP-S or medical assistance for families and children in at 
  9.29  least three of six months preceding the month in which the 
  9.30  person became ineligible for MFIP-S or medical assistance, if 
  9.31  the ineligibility was due to an increase in hours of employment 
  9.32  or employment income or due to the loss of an earned income 
  9.33  disregard.  In addition, to receive continued assistance under 
  9.34  this section, persons who received medical assistance for 
  9.35  families and children but did not receive MFIP-S must have had 
  9.36  income less than or equal to the assistance standard for their 
 10.1   family size under the state's AFDC plan in effect as of July 16, 
 10.2   1996, as required by the Personal Responsibility and Work 
 10.3   Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 10.4   Number 104-193, at the time medical assistance eligibility 
 10.5   began.  A person who is eligible for extended medical assistance 
 10.6   is entitled to six 12 months of assistance without 
 10.7   reapplication, unless the assistance unit ceases to include a 
 10.8   dependent child.  For a person under 21 years of age, except 
 10.9   medical assistance may not be discontinued for that dependent 
 10.10  child under 21 years of age within the six-month 12-month period 
 10.11  of extended eligibility until it has been determined that the 
 10.12  person is not otherwise eligible for medical 
 10.13  assistance.  Medical assistance may be continued for an 
 10.14  additional six months if the person meets all requirements for 
 10.15  the additional six months, according to title XIX of the Social 
 10.16  Security Act, as amended by section 303 of the Family Support 
 10.17  Act of 1988, Public Law Number 100-485. 
 10.18     Sec. 12.  Minnesota Statutes 2000, section 256B.071, 
 10.19  subdivision 2, is amended to read: 
 10.20     Subd. 2.  [TECHNICAL ASSISTANCE TO PROVIDERS.] (a) The 
 10.21  commissioner shall establish a technical assistance program to 
 10.22  require providers of services and equipment under this section 
 10.23  to maximize collections from the federal Medicare program.  The 
 10.24  technical assistance may include the provision of materials to 
 10.25  help providers determine those services and equipment likely to 
 10.26  be reimbursed by Medicare.  The technical assistance may also 
 10.27  include the provision of computer software to providers to 
 10.28  assist in this process.  The commissioner may expand the 
 10.29  technical assistance program to include providers of other 
 10.30  services under this chapter. 
 10.31     (b) Any provider of home care services enrolled in the 
 10.32  medical assistance program, or county public health nursing 
 10.33  agency responsible for personal care assessments, or county case 
 10.34  managers for alternative care or medical assistance waiver 
 10.35  programs, is required to use the method developed and supplied 
 10.36  by the department of human services for determining Medicare 
 11.1   coverage for home care equipment and services provided to dual 
 11.2   entitlees to ensure appropriate billing of Medicare.  The method 
 11.3   will be developed in two phases; the first phase is a manual 
 11.4   system effective July 1, 1996, and the second phase will 
 11.5   automate the manual procedure by expanding the current Medicaid 
 11.6   Management Information System (MMIS) effective January 1, 1997.  
 11.7   Both methods will determine Medicare coverage for the dates of 
 11.8   service and Medicare coverage for home care services, and create 
 11.9   an audit trail including reports.  Both methods will be linked 
 11.10  to prior authorization, therefore, either method must be used 
 11.11  before home care services are authorized and when there is a 
 11.12  change of condition affecting medical assistance authorization.  
 11.13  The department will conduct periodic reviews of participant 
 11.14  performance with the method and upon demonstrating appropriate 
 11.15  referral and billing of Medicare, participants may be determined 
 11.16  exempt from regular performance audits.  
 11.17     Sec. 13.  Minnesota Statutes 2000, section 256B.094, 
 11.18  subdivision 6, is amended to read: 
 11.19     Subd. 6.  [MEDICAL ASSISTANCE REIMBURSEMENT OF CASE 
 11.20  MANAGEMENT SERVICES.] (a) Medical assistance reimbursement for 
 11.21  services under this section shall be made on a monthly basis.  
 11.22  Payment is based on face-to-face or telephone contacts between 
 11.23  the case manager and the client, client's family, primary 
 11.24  caregiver, legal representative, or other relevant person 
 11.25  identified as necessary to the development or implementation of 
 11.26  the goals of the individual service plan regarding the status of 
 11.27  the client, the individual service plan, or the goals for the 
 11.28  client.  These contacts must meet the minimum standards in 
 11.29  clauses (1) and (2):  
 11.30     (1) there must be a face-to-face contact at least once a 
 11.31  month except as provided in clause (2); and 
 11.32     (2) for a client placed outside of the county of financial 
 11.33  responsibility, or a client served by tribal social services 
 11.34  placed outside the reservation, in an excluded time facility 
 11.35  under section 256G.02, subdivision 6, or through the Interstate 
 11.36  Compact on the Placement of Children, section 260.851, and the 
 12.1   placement in either case is more than 60 miles beyond the county 
 12.2   or reservation boundaries, there must be at least one contact 
 12.3   per month and not more than two consecutive months without a 
 12.4   face-to-face contact. 
 12.5      (b) Except as provided under paragraph (c), the payment 
 12.6   rate is established using time study data on activities of 
 12.7   provider service staff and reports required under sections 
 12.8   245.482, 256.01, subdivision 2, paragraph (17), and 256E.08, 
 12.9   subdivision 8. 
 12.10     (c) Payments for tribes may be made according to section 
 12.11  256B.0625 or other relevant federally approved rate setting 
 12.12  methodology for child welfare targeted case management provided 
 12.13  by Indian health services and facilities operated by a tribe or 
 12.14  tribal organization. 
 12.15     (d) Payment for case management provided by county or 
 12.16  tribal social services contracted vendors shall be based on a 
 12.17  monthly rate negotiated by the host county or tribal social 
 12.18  services.  The negotiated rate must not exceed the rate charged 
 12.19  by the vendor for the same service to other payers.  If the 
 12.20  service is provided by a team of contracted vendors, the county 
 12.21  or tribal social services may negotiate a team rate with a 
 12.22  vendor who is a member of the team.  The team shall determine 
 12.23  how to distribute the rate among its members.  No reimbursement 
 12.24  received by contracted vendors shall be returned to the county 
 12.25  or tribal social services, except to reimburse the county or 
 12.26  tribal social services for advance funding provided by the 
 12.27  county or tribal social services to the vendor. 
 12.28     (e) If the service is provided by a team that includes 
 12.29  contracted vendors and county or tribal social services staff, 
 12.30  the costs for county or tribal social services staff 
 12.31  participation in the team shall be included in the rate for 
 12.32  county or tribal social services provided services.  In this 
 12.33  case, the contracted vendor and the county or tribal social 
 12.34  services may each receive separate payment for services provided 
 12.35  by each entity in the same month.  To prevent duplication of 
 12.36  services, each entity must document, in the recipient's file, 
 13.1   the need for team case management and a description of the roles 
 13.2   and services of the team members. 
 13.3      Separate payment rates may be established for different 
 13.4   groups of providers to maximize reimbursement as determined by 
 13.5   the commissioner.  The payment rate will be reviewed annually 
 13.6   and revised periodically to be consistent with the most recent 
 13.7   time study and other data.  Payment for services will be made 
 13.8   upon submission of a valid claim and verification of proper 
 13.9   documentation described in subdivision 7.  Federal 
 13.10  administrative revenue earned through the time study, or under 
 13.11  paragraph (c), shall be distributed according to earnings, to 
 13.12  counties, reservations, or groups of counties or reservations 
 13.13  which have the same payment rate under this subdivision, and to 
 13.14  the group of counties or reservations which are not certified 
 13.15  providers under section 256F.10.  The commissioner shall modify 
 13.16  the requirements set out in Minnesota Rules, parts 9550.0300 to 
 13.17  9550.0370, as necessary to accomplish this. 
 13.18     Sec. 14.  Minnesota Statutes 2000, section 256B.094, 
 13.19  subdivision 8, is amended to read: 
 13.20     Subd. 8.  [PAYMENT LIMITATION.] Services that are not 
 13.21  eligible for payment as a child welfare targeted case management 
 13.22  service include, but are not limited to:  
 13.23     (1) assessments prior to opening a case; 
 13.24     (2) therapy and treatment services; 
 13.25     (3) legal services, including legal advocacy, for the 
 13.26  client; 
 13.27     (4) information and referral services that are part of a 
 13.28  county's community social services plan, that are not provided 
 13.29  to an eligible recipient; 
 13.30     (5) outreach services including outreach services provided 
 13.31  through the community support services program; 
 13.32     (6) services that are not documented as required under 
 13.33  subdivision 7 and Minnesota Rules, parts 9505.1800 to 
 13.34  9505.1880 9505.2165 and 9505.2175; 
 13.35     (7) services that are otherwise eligible for payment on a 
 13.36  separate schedule under rules of the department of human 
 14.1   services; 
 14.2      (8) services to a client that duplicate the same case 
 14.3   management service from another case manager; 
 14.4      (9) case management services provided to patients or 
 14.5   residents in a medical assistance facility except as described 
 14.6   under subdivision 2, clause (9); and 
 14.7      (10) for children in foster care, group homes, or 
 14.8   residential care, payment for case management services is 
 14.9   limited to case management services that focus on permanency 
 14.10  planning or return to the family home and that do not duplicate 
 14.11  the facility's discharge planning services. 
 14.12     Sec. 15.  Minnesota Statutes 2000, section 256B.5013, 
 14.13  subdivision 1, is amended to read: 
 14.14     Subdivision 1.  [VARIABLE RATE ADJUSTMENTS.] For rate years 
 14.15  beginning on or after October 1, 2000, when there is a 
 14.16  documented increase in the resource needs of a current ICF/MR 
 14.17  recipient or recipients, or a person is admitted to a facility 
 14.18  who requires additional resources, the county of financial 
 14.19  responsibility may recommend approval of a variable rate to 
 14.20  enable the facility to meet the individual's increased needs 
 14.21  based on the recipient's screening.  Variable rate adjustments 
 14.22  made under this subdivision replace payments for persons with 
 14.23  special needs under section 256B.501, subdivision 8, and 
 14.24  payments for persons with special needs for crisis intervention 
 14.25  services under section 256B.501, subdivision 8a.  Resource needs 
 14.26  directly attributable to an individual that may be considered 
 14.27  under the variable rate adjustment include increased direct 
 14.28  staff hours and, other specialized services, and equipment, and 
 14.29  human resources.  The guidelines in paragraphs (a) to (d) apply 
 14.30  for the payment rate adjustments under this section. 
 14.31     (a) All persons must be screened according to section 
 14.32  256B.092, subdivisions 7 and 8, prior to implementation of the 
 14.33  new payment system, and annually thereafter, and when a variable 
 14.34  rate is being requested due to changes in the needs of the 
 14.35  recipient.  Screening data shall be analyzed to develop broad 
 14.36  profiles of the functional characteristics of recipients. 
 15.1   Screening data shall be used to monitor changes as follows: 
 15.2      Criteria to be used to develop these profiles shall 
 15.3   include, but not be limited to: 
 15.4      (1) the functional ability of a recipient to care for and 
 15.5   maintain the recipient's own basic needs; 
 15.6      (2) the intensity of any aggressive or destructive 
 15.7   behavior; and 
 15.8      (3) any history of obstructive behavior in combination with 
 15.9   a diagnosis of psychosis or neurosis;. 
 15.10     (b) A variable rate may be recommended for increased 
 15.11  service needs such as: 
 15.12     (4) (1) a need for resources due to a change in resident 
 15.13  day program participation because the resident:  (i) has reached 
 15.14  the age of 65 or has a change in health condition that makes it 
 15.15  difficult for the person to participate in day training and 
 15.16  habilitation services over an extended period of time because it 
 15.17  is medically contraindicated; and (ii) has expressed a desire 
 15.18  for change through the developmental disabilities mental 
 15.19  retardation and related conditions screening process under 
 15.20  section 256B.092; and 
 15.21     (5) (2) a need for additional resources for intensive 
 15.22  short-term training programming which is necessary prior to a 
 15.23  recipient's discharge to a less restrictive, more integrated 
 15.24  setting. 
 15.25     The recipients' screenings Recommendations for a variable 
 15.26  rate shall be used to link resource needs to funding.  The 
 15.27  resource profile shall determine the level of funding.  The 
 15.28  variable rate must be applied to expenses related to increased 
 15.29  direct staff hours and, other specialized services, and 
 15.30  equipment, and human resources.  
 15.31     (b) (c) A recipient must be screened by the county of 
 15.32  financial responsibility using the developmental disabilities 
 15.33  screening document completed immediately prior to approval of a 
 15.34  variable rate by the county.  A comparison of the updated 
 15.35  screening and the previous screening must demonstrate an 
 15.36  increase in resource needs. 
 16.1      (c) (d) Rate adjustments projected to exceed the authorized 
 16.2   funding level associated with the person's profile must be 
 16.3   submitted to the commissioner. 
 16.4      (d) (e) The county of financial responsibility must 
 16.5   indicate the projected length of time that the additional 
 16.6   funding may be needed for the individual.  The need to continue 
 16.7   an individual variable rate must be reviewed at the end of the 
 16.8   anticipated duration of need but at least annually through the 
 16.9   completion of the developmental disabilities screening document. 
 16.10     Sec. 16.  Minnesota Statutes 2000, section 256B.69, 
 16.11  subdivision 3a, is amended to read: 
 16.12     Subd. 3a.  [COUNTY AUTHORITY.] (a) The commissioner, when 
 16.13  implementing the general assistance medical care, or medical 
 16.14  assistance prepayment program within a county, must include the 
 16.15  county board in the process of development, approval, and 
 16.16  issuance of the request for proposals to provide services to 
 16.17  eligible individuals within the proposed county.  County boards 
 16.18  must be given reasonable opportunity to make recommendations 
 16.19  regarding the development, issuance, review of responses, and 
 16.20  changes needed in the request for proposals.  The commissioner 
 16.21  must provide county boards the opportunity to review each 
 16.22  proposal based on the identification of community needs under 
 16.23  chapters 145A and 256E and county advocacy activities.  If a 
 16.24  county board finds that a proposal does not address certain 
 16.25  community needs, the county board and commissioner shall 
 16.26  continue efforts for improving the proposal and network prior to 
 16.27  the approval of the contract.  The county board shall make 
 16.28  recommendations regarding the approval of local networks and 
 16.29  their operations to ensure adequate availability and access to 
 16.30  covered services.  The provider or health plan must respond 
 16.31  directly to county advocates and the state prepaid medical 
 16.32  assistance ombudsperson regarding service delivery and must be 
 16.33  accountable to the state regarding contracts with medical 
 16.34  assistance and general assistance medical care funds.  The 
 16.35  county board may recommend a maximum number of participating 
 16.36  health plans after considering the size of the enrolling 
 17.1   population; ensuring adequate access and capacity; considering 
 17.2   the client and county administrative complexity; and considering 
 17.3   the need to promote the viability of locally developed health 
 17.4   plans.  The county board or a single entity representing a group 
 17.5   of county boards and the commissioner shall mutually select 
 17.6   health plans for participation at the time of initial 
 17.7   implementation of the prepaid medical assistance program in that 
 17.8   county or group of counties and at the time of contract renewal. 
 17.9   The commissioner shall also seek input for contract requirements 
 17.10  from the county or single entity representing a group of county 
 17.11  boards at each contract renewal and incorporate those 
 17.12  recommendations into the contract negotiation process.  The 
 17.13  commissioner, in conjunction with the county board, shall 
 17.14  actively seek to develop a mutually agreeable timetable prior to 
 17.15  the development of the request for proposal, but counties must 
 17.16  agree to initial enrollment beginning on or before January 1, 
 17.17  1999, in either the prepaid medical assistance and general 
 17.18  assistance medical care programs or county-based purchasing 
 17.19  under section 256B.692.  At least 90 days before enrollment in 
 17.20  the medical assistance and general assistance medical care 
 17.21  prepaid programs begins in a county in which the prepaid 
 17.22  programs have not been established, the commissioner shall 
 17.23  provide a report to the chairs of senate and house committees 
 17.24  having jurisdiction over state health care programs which 
 17.25  verifies that the commissioner complied with the requirements 
 17.26  for county involvement that are specified in this subdivision. 
 17.27     (b) The commissioner shall seek a federal waiver to allow a 
 17.28  fee-for-service plan option to MinnesotaCare enrollees.  The 
 17.29  commissioner shall develop an increase of the premium fees 
 17.30  required under section 256L.06 up to 20 percent of the premium 
 17.31  fees for the enrollees who elect the fee-for-service option.  
 17.32  Prior to implementation, the commissioner shall submit this fee 
 17.33  schedule to the chair and ranking minority member of the senate 
 17.34  health care committee, the senate health care and family 
 17.35  services funding division, the house of representatives health 
 17.36  and human services committee, and the house of representatives 
 18.1   health and human services finance division. 
 18.2      (c) At the option of the county board, the board may 
 18.3   develop contract requirements related to the achievement of 
 18.4   local public health goals to meet the health needs of medical 
 18.5   assistance and general assistance medical care enrollees.  These 
 18.6   requirements must be reasonably related to the performance of 
 18.7   health plan functions and within the scope of the medical 
 18.8   assistance and general assistance medical care benefit sets.  If 
 18.9   the county board and the commissioner mutually agree to such 
 18.10  requirements, the department shall include such requirements in 
 18.11  all health plan contracts governing the prepaid medical 
 18.12  assistance and general assistance medical care programs in that 
 18.13  county at initial implementation of the program in that county 
 18.14  and at the time of contract renewal.  The county board may 
 18.15  participate in the enforcement of the contract provisions 
 18.16  related to local public health goals. 
 18.17     (d) (c) For counties in which prepaid medical assistance 
 18.18  and general assistance medical care programs have not been 
 18.19  established, the commissioner shall not implement those programs 
 18.20  if a county board submits acceptable and timely preliminary and 
 18.21  final proposals under section 256B.692, until county-based 
 18.22  purchasing is no longer operational in that county.  For 
 18.23  counties in which prepaid medical assistance and general 
 18.24  assistance medical care programs are in existence on or after 
 18.25  September 1, 1997, the commissioner must terminate contracts 
 18.26  with health plans according to section 256B.692, subdivision 5, 
 18.27  if the county board submits and the commissioner accepts 
 18.28  preliminary and final proposals according to that subdivision.  
 18.29  The commissioner is not required to terminate contracts that 
 18.30  begin on or after September 1, 1997, according to section 
 18.31  256B.692 until two years have elapsed from the date of initial 
 18.32  enrollment. 
 18.33     (e) (d) In the event that a county board or a single entity 
 18.34  representing a group of county boards and the commissioner 
 18.35  cannot reach agreement regarding:  (i) the selection of 
 18.36  participating health plans in that county; (ii) contract 
 19.1   requirements; or (iii) implementation and enforcement of county 
 19.2   requirements including provisions regarding local public health 
 19.3   goals, the commissioner shall resolve all disputes after taking 
 19.4   into account the recommendations of a three-person mediation 
 19.5   panel.  The panel shall be composed of one designee of the 
 19.6   president of the association of Minnesota counties, one designee 
 19.7   of the commissioner of human services, and one designee of the 
 19.8   commissioner of health. 
 19.9      (f) (e) If a county which elects to implement county-based 
 19.10  purchasing ceases to implement county-based purchasing, it is 
 19.11  prohibited from assuming the responsibility of county-based 
 19.12  purchasing for a period of five years from the date it 
 19.13  discontinues purchasing. 
 19.14     (g) (f) Notwithstanding the requirement in this subdivision 
 19.15  that a county must agree to initial enrollment on or before 
 19.16  January 1, 1999, the commissioner shall grant a delay in the 
 19.17  implementation of the county-based purchasing authorized in 
 19.18  section 256B.692 until federal waiver authority and approval has 
 19.19  been granted, if the county or group of counties has submitted a 
 19.20  preliminary proposal for county-based purchasing by September 1, 
 19.21  1997, has not already implemented the prepaid medical assistance 
 19.22  program before January 1, 1998, and has submitted a written 
 19.23  request for the delay to the commissioner by July 1, 1998.  In 
 19.24  order for the delay to be continued, the county or group of 
 19.25  counties must also submit to the commissioner the following 
 19.26  information by December 1, 1998.  The information must: 
 19.27     (1) identify the proposed date of implementation, as 
 19.28  determined under section 256B.692, subdivision 5; 
 19.29     (2) include copies of the county board resolutions which 
 19.30  demonstrate the continued commitment to the implementation of 
 19.31  county-based purchasing by the proposed date.  County board 
 19.32  authorization may remain contingent on the submission of a final 
 19.33  proposal which meets the requirements of section 256B.692, 
 19.34  subdivision 5, paragraph (b); 
 19.35     (3) demonstrate actions taken for the establishment of a 
 19.36  governance structure between the participating counties and 
 20.1   describe how the fiduciary responsibilities of county-based 
 20.2   purchasing will be allocated between the counties, if more than 
 20.3   one county is involved in the proposal; 
 20.4      (4) describe how the risk of a deficit will be managed in 
 20.5   the event expenditures are greater than total capitation 
 20.6   payments.  This description must identify how any of the 
 20.7   following strategies will be used: 
 20.8      (i) risk contracts with licensed health plans; 
 20.9      (ii) risk arrangements with providers who are not licensed 
 20.10  health plans; 
 20.11     (iii) risk arrangements with other licensed insurance 
 20.12  entities; and 
 20.13     (iv) funding from other county resources; 
 20.14     (5) include, if county-based purchasing will not contract 
 20.15  with licensed health plans or provider networks, letters of 
 20.16  interest from local providers in at least the categories of 
 20.17  hospital, physician, mental health, and pharmacy which express 
 20.18  interest in contracting for services.  These letters must 
 20.19  recognize any risk transfer identified in clause (4), item (ii); 
 20.20  and 
 20.21     (6) describe the options being considered to obtain the 
 20.22  administrative services required in section 256B.692, 
 20.23  subdivision 3, clauses (3) and (5). 
 20.24     (h) (g) For counties which receive a delay under this 
 20.25  subdivision, the final proposals required under section 
 20.26  256B.692, subdivision 5, paragraph (b), must be submitted at 
 20.27  least six months prior to the requested implementation date.  
 20.28  Authority to implement county-based purchasing remains 
 20.29  contingent on approval of the final proposal as required under 
 20.30  section 256B.692. 
 20.31     (i) (h) If the commissioner is unable to provide 
 20.32  county-specific, individual-level fee-for-service claims to 
 20.33  counties by June 4, 1998, the commissioner shall grant a delay 
 20.34  under paragraph (g) (f) of up to 12 months in the implementation 
 20.35  of county-based purchasing, and shall require implementation not 
 20.36  later than January 1, 2000.  In order to receive an extension of 
 21.1   the proposed date of implementation under this paragraph, a 
 21.2   county or group of counties must submit a written request for 
 21.3   the extension to the commissioner by August 1, 1998, must submit 
 21.4   the information required under paragraph (g) (f) by December 1, 
 21.5   1998, and must submit a final proposal as provided under 
 21.6   paragraph (h) (g). 
 21.7      (j) (i) Notwithstanding other requirements of this 
 21.8   subdivision, the commissioner shall not require the 
 21.9   implementation of the county-based purchasing authorized in 
 21.10  section 256B.692 until six months after federal waiver approval 
 21.11  has been obtained for county-based purchasing, if the county or 
 21.12  counties have submitted the final plan as required in section 
 21.13  256B.692, subdivision 5.  The commissioner shall allow the 
 21.14  county or counties which submitted information under section 
 21.15  256B.692, subdivision 5, to submit supplemental or additional 
 21.16  information which was not possible to submit by April 1, 1999.  
 21.17  A county or counties shall continue to submit the required 
 21.18  information and substantive detail necessary to obtain a prompt 
 21.19  response and waiver approval.  If amendments to the final plan 
 21.20  are necessary due to the terms and conditions of the waiver 
 21.21  approval, the commissioner shall allow the county or group of 
 21.22  counties 60 days to make the necessary amendments to the final 
 21.23  plan and shall not require implementation of the county-based 
 21.24  purchasing until six months after the revised final plan has 
 21.25  been submitted. 
 21.26     Sec. 17.  Minnesota Statutes 2000, section 256D.03, 
 21.27  subdivision 3, is amended to read: 
 21.28     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
 21.29  (a) General assistance medical care may be paid for any person 
 21.30  who is not eligible for medical assistance under chapter 256B, 
 21.31  including eligibility for medical assistance based on a 
 21.32  spenddown of excess income according to section 256B.056, 
 21.33  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
 21.34  except as provided in paragraph (c); and: 
 21.35     (1) who is receiving assistance under section 256D.05, 
 21.36  except for families with children who are eligible under 
 22.1   Minnesota family investment program-statewide (MFIP-S), who is 
 22.2   having a payment made on the person's behalf under sections 
 22.3   256I.01 to 256I.06, or who resides in group residential housing 
 22.4   as defined in chapter 256I and can meet a spenddown using the 
 22.5   cost of remedial services received through group residential 
 22.6   housing; or 
 22.7      (2)(i) who is a resident of Minnesota; and whose equity in 
 22.8   assets is not in excess of $1,000 per assistance unit.  Exempt 
 22.9   assets, the reduction of excess assets, and the waiver of excess 
 22.10  assets must conform to the medical assistance program in chapter 
 22.11  256B, with the following exception:  the maximum amount of 
 22.12  undistributed funds in a trust that could be distributed to or 
 22.13  on behalf of the beneficiary by the trustee, assuming the full 
 22.14  exercise of the trustee's discretion under the terms of the 
 22.15  trust, must be applied toward the asset maximum; and 
 22.16     (ii) who has countable income not in excess of the 
 22.17  assistance standards established in section 256B.056, 
 22.18  subdivision 4, or whose excess income is spent down according to 
 22.19  section 256B.056, subdivision 5, using a six-month budget 
 22.20  period.  The method for calculating earned income disregards and 
 22.21  deductions for a person who resides with a dependent child under 
 22.22  age 21 shall follow section 256B.056, subdivision 1a.  However, 
 22.23  if a disregard of $30 and one-third of the remainder has been 
 22.24  applied to the wage earner's income, the disregard shall not be 
 22.25  applied again until the wage earner's income has not been 
 22.26  considered in an eligibility determination for general 
 22.27  assistance, general assistance medical care, medical assistance, 
 22.28  or MFIP-S for 12 consecutive months.  The earned income and work 
 22.29  expense deductions for a person who does not reside with a 
 22.30  dependent child under age 21 shall be the same as the method 
 22.31  used to determine eligibility for a person under section 
 22.32  256D.06, subdivision 1, except the disregard of the first $50 of 
 22.33  earned income is not allowed; 
 22.34     (3) who would be eligible for medical assistance except 
 22.35  that the person resides in a facility that is determined by the 
 22.36  commissioner or the federal Health Care Financing Administration 
 23.1   to be an institution for mental diseases; or 
 23.2      (4) who is ineligible for medical assistance under chapter 
 23.3   256B or general assistance medical care under any other 
 23.4   provision of this section, and is receiving care and 
 23.5   rehabilitation services from a nonprofit center established to 
 23.6   serve victims of torture.  These individuals are eligible for 
 23.7   general assistance medical care only for the period during which 
 23.8   they are receiving services from the center.  During this period 
 23.9   of eligibility, individuals eligible under this clause shall not 
 23.10  be required to participate in prepaid general assistance medical 
 23.11  care.  
 23.12     (b) Beginning January 1, 2000, applicants or recipients who 
 23.13  meet all eligibility requirements of MinnesotaCare as defined in 
 23.14  sections 256L.01 to 256L.16, and are: 
 23.15     (i) adults with dependent children under 21 whose gross 
 23.16  family income is equal to or less than 275 percent of the 
 23.17  federal poverty guidelines; or 
 23.18     (ii) adults without children with earned income and whose 
 23.19  family gross income is between 75 percent of the federal poverty 
 23.20  guidelines and the amount set by section 256L.04, subdivision 7, 
 23.21  shall be terminated from general assistance medical care upon 
 23.22  enrollment in MinnesotaCare.  Earned income is deemed available 
 23.23  to family members as defined in section 256D.02, subdivision 8.  
 23.24     (c) For services rendered on or after July 1, 1997, 
 23.25  eligibility is limited to one month prior to application if the 
 23.26  person is determined eligible in the prior month.  A 
 23.27  redetermination of eligibility must occur every 12 months.  
 23.28  Beginning January 1, 2000, Minnesota health care program 
 23.29  applications completed by recipients and applicants who are 
 23.30  persons described in paragraph (b), may be returned to the 
 23.31  county agency to be forwarded to the department of human 
 23.32  services or sent directly to the department of human services 
 23.33  for enrollment in MinnesotaCare.  If all other eligibility 
 23.34  requirements of this subdivision are met, eligibility for 
 23.35  general assistance medical care shall be available in any month 
 23.36  during which a MinnesotaCare eligibility determination and 
 24.1   enrollment are pending.  Upon notification of eligibility for 
 24.2   MinnesotaCare, notice of termination for eligibility for general 
 24.3   assistance medical care shall be sent to an applicant or 
 24.4   recipient.  If all other eligibility requirements of this 
 24.5   subdivision are met, eligibility for general assistance medical 
 24.6   care shall be available until enrollment in MinnesotaCare 
 24.7   subject to the provisions of paragraph (e). 
 24.8      (d) The date of an initial Minnesota health care program 
 24.9   application necessary to begin a determination of eligibility 
 24.10  shall be the date the applicant has provided a name, address, 
 24.11  and social security number, signed and dated, to the county 
 24.12  agency or the department of human services.  If the applicant is 
 24.13  unable to provide an initial application when health care is 
 24.14  delivered due to a medical condition or disability, a health 
 24.15  care provider may act on the person's behalf to complete the 
 24.16  initial application.  The applicant must complete the remainder 
 24.17  of the application and provide necessary verification before 
 24.18  eligibility can be determined.  The county agency must assist 
 24.19  the applicant in obtaining verification if necessary.  On the 
 24.20  basis of information provided on the completed application, an 
 24.21  applicant who meets the following criteria shall be determined 
 24.22  eligible beginning in the month of application: 
 24.23     (1) has gross income less than 90 percent of the applicable 
 24.24  income standard; 
 24.25     (2) has liquid assets that total within $300 of the asset 
 24.26  standard; 
 24.27     (3) does not reside in a long-term care facility; and 
 24.28     (4) meets all other eligibility requirements. 
 24.29  The applicant must provide all required verifications within 30 
 24.30  days' notice of the eligibility determination or eligibility 
 24.31  shall be terminated. 
 24.32     (e) County agencies are authorized to use all automated 
 24.33  databases containing information regarding recipients' or 
 24.34  applicants' income in order to determine eligibility for general 
 24.35  assistance medical care or MinnesotaCare.  Such use shall be 
 24.36  considered sufficient in order to determine eligibility and 
 25.1   premium payments by the county agency. 
 25.2      (f) General assistance medical care is not available for a 
 25.3   person in a correctional facility unless the person is detained 
 25.4   by law for less than one year in a county correctional or 
 25.5   detention facility as a person accused or convicted of a crime, 
 25.6   or admitted as an inpatient to a hospital on a criminal hold 
 25.7   order, and the person is a recipient of general assistance 
 25.8   medical care at the time the person is detained by law or 
 25.9   admitted on a criminal hold order and as long as the person 
 25.10  continues to meet other eligibility requirements of this 
 25.11  subdivision.  
 25.12     (g) General assistance medical care is not available for 
 25.13  applicants or recipients who do not cooperate with the county 
 25.14  agency to meet the requirements of medical assistance.  General 
 25.15  assistance medical care is limited to payment of emergency 
 25.16  services only for applicants or recipients as described in 
 25.17  paragraph (b), whose MinnesotaCare coverage is denied or 
 25.18  terminated for nonpayment of premiums as required by sections 
 25.19  256L.06 and 256L.07.  
 25.20     (h) In determining the amount of assets of an individual, 
 25.21  there shall be included any asset or interest in an asset, 
 25.22  including an asset excluded under paragraph (a), that was given 
 25.23  away, sold, or disposed of for less than fair market value 
 25.24  within the 60 months preceding application for general 
 25.25  assistance medical care or during the period of eligibility.  
 25.26  Any transfer described in this paragraph shall be presumed to 
 25.27  have been for the purpose of establishing eligibility for 
 25.28  general assistance medical care, unless the individual furnishes 
 25.29  convincing evidence to establish that the transaction was 
 25.30  exclusively for another purpose.  For purposes of this 
 25.31  paragraph, the value of the asset or interest shall be the fair 
 25.32  market value at the time it was given away, sold, or disposed 
 25.33  of, less the amount of compensation received.  For any 
 25.34  uncompensated transfer, the number of months of ineligibility, 
 25.35  including partial months, shall be calculated by dividing the 
 25.36  uncompensated transfer amount by the average monthly per person 
 26.1   payment made by the medical assistance program to skilled 
 26.2   nursing facilities for the previous calendar year.  The 
 26.3   individual shall remain ineligible until this fixed period has 
 26.4   expired.  The period of ineligibility may exceed 30 months, and 
 26.5   a reapplication for benefits after 30 months from the date of 
 26.6   the transfer shall not result in eligibility unless and until 
 26.7   the period of ineligibility has expired.  The period of 
 26.8   ineligibility begins in the month the transfer was reported to 
 26.9   the county agency, or if the transfer was not reported, the 
 26.10  month in which the county agency discovered the transfer, 
 26.11  whichever comes first.  For applicants, the period of 
 26.12  ineligibility begins on the date of the first approved 
 26.13  application. 
 26.14     (i) When determining eligibility for any state benefits 
 26.15  under this subdivision, the income and resources of all 
 26.16  noncitizens shall be deemed to include their sponsor's income 
 26.17  and resources as defined in the Personal Responsibility and Work 
 26.18  Opportunity Reconciliation Act of 1996, title IV, Public Law 
 26.19  Number 104-193, sections 421 and 422, and subsequently set out 
 26.20  in federal rules. 
 26.21     (j)(1) An undocumented noncitizen or a nonimmigrant is 
 26.22  ineligible for general assistance medical care other than 
 26.23  emergency services.  For purposes of this subdivision, a 
 26.24  nonimmigrant is an individual in one or more of the classes 
 26.25  listed in United States Code, title 8, section 1101(a)(15), and 
 26.26  an undocumented noncitizen is an individual who resides in the 
 26.27  United States without the approval or acquiescence of the 
 26.28  Immigration and Naturalization Service. 
 26.29     (2) This paragraph does not apply to a child under age 18, 
 26.30  to a Cuban or Haitian entrant as defined in Public Law Number 
 26.31  96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 
 26.32  aged, blind, or disabled as defined in Code of Federal 
 26.33  Regulations, title 42, sections 435.520, 435.530, 435.531, 
 26.34  435.540, and 435.541, or effective October 1, 1998, to an 
 26.35  individual eligible for general assistance medical care under 
 26.36  paragraph (a), clause (4), who cooperates with the Immigration 
 27.1   and Naturalization Service to pursue any applicable immigration 
 27.2   status, including citizenship, that would qualify the individual 
 27.3   for medical assistance with federal financial participation. 
 27.4      (k) For purposes of paragraphs (g) and (j), "emergency 
 27.5   services" has the meaning given in Code of Federal Regulations, 
 27.6   title 42, section 440.255(b)(1), except that it also means 
 27.7   services rendered because of suspected or actual pesticide 
 27.8   poisoning. 
 27.9      (l) Notwithstanding any other provision of law, a 
 27.10  noncitizen who is ineligible for medical assistance due to the 
 27.11  deeming of a sponsor's income and resources, is ineligible for 
 27.12  general assistance medical care. 
 27.13     Sec. 18.  Minnesota Statutes 2000, section 256L.15, 
 27.14  subdivision 1a, is amended to read: 
 27.15     Subd. 1a.  [PAYMENT OPTIONS.] The commissioner may offer 
 27.16  the following payment options to an enrollee: 
 27.17     (1) payment by check; 
 27.18     (2) payment by credit card; 
 27.19     (3) payment by recurring automatic checking withdrawal; 
 27.20     (4) payment by one-time electronic transfer of funds; 
 27.21     (5) payment by wage withholding with the consent of the 
 27.22  employer and the employee; or 
 27.23     (6) payment by using state tax refund payments. 
 27.24     At application or reapplication, a MinnesotaCare applicant 
 27.25  or enrollee may authorize the commissioner to use the Revenue 
 27.26  Recapture Act in chapter 270A to collect funds from the 
 27.27  applicant's or enrollee's state income tax refund for the 
 27.28  purposes of meeting all or part of the applicant's or enrollee's 
 27.29  MinnesotaCare premium obligation for the forthcoming year.  The 
 27.30  applicant or enrollee may authorize the commissioner to apply 
 27.31  for the state working family tax credit on behalf of the 
 27.32  applicant or enrollee.  The setoff due under this subdivision 
 27.33  shall not be subject to the $10 fee under section 270A.07, 
 27.34  subdivision 1.  
 27.35     Sec. 19.  Laws 1996, chapter 451, article 2, section 61, is 
 27.36  amended to read: 
 28.1      Sec. 61.  [REPEALER.] 
 28.2      Minnesota Statutes 1995 Supplement, sections 256B.15, 
 28.3   subdivision 5; 256G.05, subdivision 1; and 256G.07, subdivision 
 28.4   3a, are repealed.  
 28.5      Sec. 20.  Laws 1996, chapter 451, article 2, section 62, is 
 28.6   amended to read: 
 28.7      Sec. 62.  [EFFECTIVE DATE; APPLICATION.] 
 28.8      (a) Sections 12, 14, 16, 18, 29, 30, and the portion of 
 28.9   section 61 that repeals section 256B.15, subdivision 5, are 
 28.10  effective the day following final enactment to the extent 
 28.11  permitted by federal law.  If any provisions of these sections 
 28.12  are prohibited by federal law, the provisions shall become 
 28.13  effective when federal law is changed to permit their 
 28.14  application or a waiver is received.  The commissioner of human 
 28.15  services shall notify the revisor of statutes when federal law 
 28.16  is enacted or a waiver is received and publish a notice in the 
 28.17  State Register.  The commissioner must include the notice in the 
 28.18  first State Register published after the effective date of the 
 28.19  federal changes.  
 28.20     (b) If, by July 1, 1996, any provisions of the sections 
 28.21  mentioned in paragraph (a) are not effective because of 
 28.22  prohibitions in federal law, the commissioner shall apply to the 
 28.23  federal government for a waiver of those prohibitions, and those 
 28.24  provisions shall become effective upon receipt of a federal 
 28.25  waiver, notification to the revisor of statutes, and publication 
 28.26  of a notice in the State Register to that effect.  If the 
 28.27  commissioner applies for a waiver of the lookback period, the 
 28.28  commissioner shall seek the longest lookback period the health 
 28.29  care financing administration will approve, not to exceed 72 
 28.30  months. 
 28.31     (c) Section 54 applies to estates of decedents dying on or 
 28.32  after its effective date.  Section 55 applies to estates where 
 28.33  the notice under Minnesota Statutes, section 524.3-801, 
 28.34  paragraph (a), was first published on or after its effective 
 28.35  date.  Section 55 does not affect any right or duty to provide 
 28.36  notice to known creditors, including a local agency, before its 
 29.1   effective date. 
 29.2      (d) Sections 7, 13, 15, 17, 33, 34, 35, 38, and 60 are 
 29.3   effective the day following final enactment. 
 29.4      (e) Section 11 is effective retroactive to October 1, 1993. 
 29.5      (f) Sections 8, 22, subdivision 3, and 34 are effective 
 29.6   upon federal approval. 
 29.7      (g) Sections 10 and 31 are effective upon receipt of 
 29.8   federal approval, retroactive to January 1, 1996. 
 29.9      Sec. 21.  [REPEALER.] 
 29.10     (a) Laws 1995, chapter 178, article 2, section 46, 
 29.11  subdivision 10; and Laws 1996, chapter 451, article 2, sections 
 29.12  12, 14, 16, 18, 29, and 30, are repealed. 
 29.13     (b) Minnesota Statutes 2000, section 256B.071, subdivision 
 29.14  5, is repealed.