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HF 1

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; creating a children's health security account;
establishing the children's health security program; specifying eligibility criteria,
covered services, and administrative procedures; establishing the Legislative
Task Force on Children's Health Care Coverage; requiring reports; appropriating
money; proposing coding for new law in Minnesota Statutes, chapter 16A;
proposing coding for new law as Minnesota Statutes, chapter 256N.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [16A.726] CHILDREN'S HEALTH SECURITY ACCOUNT.
new text end

new text begin A children's health security account is created in a special revenue fund in the
state treasury. The commissioner shall deposit to the credit of the account money made
available to the account. Notwithstanding section 11A.20, any investment income
attributable to the investment of the children's health security account not currently needed
shall be credited to the children's health security account.
new text end

Sec. 2.

new text begin [256N.01] CITATION.
new text end

new text begin This chapter may be cited as the Children's Health Security Act.
new text end

Sec. 3.

new text begin [256N.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin The terms used in this chapter have the following
meanings unless otherwise provided for by text.
new text end

new text begin Subd. 2. new text end

new text begin Child. new text end

new text begin "Child" means (1) an individual under age 19; or (2) an unmarried
child who is a full-time student under the age of 25 years who is financially dependent
upon a parent, grandparent, foster parent, relative caretaker, or legal guardian.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of human
services.
new text end

Sec. 4.

new text begin [256N.03] ESTABLISHMENT.
new text end

new text begin The commissioner shall establish the children's health security program. The
commissioner shall begin implementation of the program on July 1, 2008, or upon federal
approval, whichever is later.
new text end

Sec. 5.

new text begin [256N.05] ELIGIBILITY.
new text end

new text begin Subdivision 1. new text end

new text begin General requirements. new text end

new text begin Children meeting the eligibility
requirements of this section are eligible for the children's health security program.
new text end

new text begin Subd. 2. new text end

new text begin Income limit. new text end

new text begin (a) Children in families with household incomes equal to
or less than 300 percent of the federal poverty guidelines are eligible for the children's
health security program. Children are eligible to enroll effective July 1, 2008, or upon
federal approval, whichever is later.
new text end

new text begin (b) Effective July 1, 2010, eligibility is expanded to include all children in families
with household incomes in excess of 300 percent of the federal poverty guidelines.
new text end

new text begin Subd. 3. new text end

new text begin Residency. new text end

new text begin (a) To be eligible for health coverage under the children's
health security program, children must be permanent residents of Minnesota. For purposes
of this requirement, a permanent Minnesota resident is a person who has demonstrated,
through persuasive and objective evidence, that the person is domiciled in the state and
intends to live in the state permanently.
new text end

new text begin (b) To be eligible as a permanent resident, an applicant, or the applicant's parent
or guardian as applicable, must demonstrate the requisite intent to live in the state
permanently by:
new text end

new text begin (1) showing that the applicant, or the applicant's parent or guardian as applicable,
maintains a residence at a verified address, through the use of evidence of residence
described in paragraph (c); and
new text end

new text begin (2) signing an affidavit declaring that the applicant currently resides in the state and
intends to reside in the state permanently, and the applicant did not come to the state for
the primary purpose of obtaining medical coverage or treatment.
new text end

new text begin (c) An applicant, or a parent or guardian of an applicant, may verify a residence
address by presenting a valid state driver's license, a state identification card, a voter
registration card, a rent receipt, a statement by the landlord, apartment or emergency
shelter manager, or homeowner verifying that the individual is residing at the address, or
other form of verification approved by the commissioner.
new text end

new text begin (d) A child who is temporarily absent from the state does not lose eligibility for the
children's health security program. "Temporarily absent from the state" means the person
is out of the state for a temporary purpose and intends to return when the purpose of the
absence has been accomplished. A person is not temporarily absent from the state if
another state has determined that the person is a resident for any purpose. If temporarily
absent from the state, the person must follow the requirements of the health plan in which
the person is enrolled to receive services.
new text end

new text begin (e) A child who moved to Minnesota primarily to obtain medical treatment or health
coverage for a preexisting condition is not a permanent resident.
new text end

new text begin Subd. 4. new text end

new text begin Enrollment voluntary. new text end

new text begin Enrollment in the children's health security
program is voluntary. Parents or guardians may retain private sector or Medicare coverage
for a child as the sole source of coverage. Parents or guardians who have private sector or
Medicare coverage for children may also enroll children in the children's health security
program. If private sector or Medicare coverage is available, coverage under the children's
health security program is secondary to the private sector or Medicare coverage.
new text end

Sec. 6.

new text begin [256N.07] COVERED SERVICES.
new text end

new text begin Covered services under the children's health security program shall consist of all
covered services under chapter 256B.
new text end

Sec. 7.

new text begin [256N.09] NO ENROLLEE PREMIUMS OR COST SHARING.
new text end

new text begin In order to ensure broad access to coverage, the children's health security program
has no enrollee premium or cost-sharing requirements.
new text end

Sec. 8.

new text begin [256N.11] APPLICATION PROCEDURES; ELIGIBILITY
DETERMINATION.
new text end

new text begin Subdivision 1. new text end

new text begin Application procedure. new text end

new text begin Applications for the program must be made
available to provider offices, local human services agencies, school districts, schools,
community health offices, and other sites willing to cooperate in program outreach. These
sites may accept applications and forward applications to the commissioner. Applications
may also be made directly to the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Eligibility determination. new text end

new text begin The commissioner shall determine an
applicant's eligibility for the program within 30 days of the date the application is received
by the Department of Human Services. The effective date of coverage is the day upon
which eligibility is approved, except in cases of persons applying under presumptive
eligibility.
new text end

new text begin Subd. 3. new text end

new text begin Presumptive eligibility. new text end

new text begin Coverage under the program is available during a
presumptive eligibility period. The presumptive eligibility period begins on the date a
health care provider or other entity designated by the commissioner determines, based
on preliminary information, that the person meets the criteria in section 256N.05. The
presumptive eligibility period ends on the day on which a determination is made as to
the person's eligibility, except that if an application is not submitted by the last day of
the month following the month during which the determination based on preliminary
information is made, the presumptive eligibility period ends on the last day of the month.
new text end

new text begin Subd. 4. new text end

new text begin Renewal of eligibility. new text end

new text begin The commissioner shall require enrollees to renew
eligibility every 12 months using a passive renewal process. The commissioner shall
send a form to each enrollee that contains eligibility information for that individual. If
the eligibility information on the form is correct, the enrollee can maintain eligibility for
another 12 months without returning the form to the commissioner. If the eligibility
information on the form is not correct, the enrollee must return the form with corrected
information to the commissioner, and the commissioner shall redetermine eligibility for
the enrollee on the basis of the corrected information.
new text end

Sec. 9.

new text begin [256N.13] SERVICE DELIVERY.
new text end

new text begin Subdivision 1. new text end

new text begin Contracts with health plan companies. new text end

new text begin The commissioner may
contract with health maintenance organizations licensed under chapter 62D, community
integrated service networks licensed under chapter 62N, and accountable provider
networks licensed under chapter 62T to provide covered health care services to program
enrollees. Health plan companies under contract are responsible for coordinating covered
health care services provided to eligible individuals. Health plan companies under
contract:
new text end

new text begin (1) shall authorize and arrange for the provision of all needed covered health
services under chapter 256B, with the exception of services available only under a medical
assistance home and community-based waiver, in order to ensure appropriate health care
is delivered to enrollees;
new text end

new text begin (2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated health care services for enrollees;
new text end

new text begin (3) may contract with health care and social service providers to provide covered
services to enrollees; and
new text end

new text begin (4) shall institute enrollee grievance procedures according to the method established
by the commissioner, utilizing applicable requirements of chapter 62D. Disputes not
resolved through this process may be appealed to the commissioner using the procedures
in section 256.045.
new text end

new text begin Subd. 2. new text end

new text begin Contract administration. new text end

new text begin The commissioner may contract with a
private sector entity to administer and manage contracts with health plan companies
under subdivision 1.
new text end

new text begin Subd. 3. new text end

new text begin Contracts for waiver services. new text end

new text begin The commissioner shall contract with
health care and social service providers, on a fee-for-service basis, to provide program
enrollees with covered services available only under a medical assistance home and
community-based waiver. The commissioner shall determine eligibility for home and
community-based waiver services using the criteria and procedures in chapter 256B.
Disputes related to services provided on a fee-for-service basis may be appealed to the
commissioner using the procedures in section 256.045.
new text end

Sec. 10.

new text begin [256N.15] PAYMENT RATES.
new text end

new text begin The commissioner, in consultation with a health care actuary, shall establish the
method and amount of payments for services. The commissioner shall annually contract
with eligible entities to provide services to program enrollees. The commissioner, in
consultation with the risk adjustment association established under section 62Q.03,
subdivision 6, shall develop and implement a risk adjustment system for the program.
new text end

Sec. 11.

new text begin [256N.17] CONSUMER ASSISTANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Assistance to applicants. new text end

new text begin The commissioner shall assist applicants
in choosing a health plan company by:
new text end

new text begin (1) establishing a Web site to provide information about health plan companies
and to allow online enrollment;
new text end

new text begin (2) make information on health plan companies available at the sites specified in
section 256N.11, subdivision 1;
new text end

new text begin (3) make applications and information on health plan companies available in
Spanish, Hmong, Laotian, Russian, Somali, Vietnamese, and Cambodian, and provide
language interpreter services as necessary to assist applicants in choosing a health plan
company; and
new text end

new text begin (4) make benefit educators available to assist applicants in choosing a health plan
company.
new text end

new text begin Subd. 2. new text end

new text begin Ombudsperson. new text end

new text begin The commissioner shall designate an ombudsperson
to advocate for children enrolled in the children's health security program. The
ombudsperson shall assist enrollees in understanding and making use of complaint and
appeal procedures and ensure that necessary medical services are provided to enrollees. At
the time of enrollment, the commissioner shall inform enrollees about: the ombudsperson
program; the right to a resolution of the enrollee's complaint by the health plan company
if the enrollee experiences a problem with the health plan company or its providers; and
appeal rights under section 256.045.
new text end

Sec. 12.

new text begin [256N.19] MONITORING AND EVALUATION OF QUALITY AND
COSTS.
new text end

new text begin The commissioner, as a condition of contract, shall require each participating health
plan company and participating provider to submit, in the form and manner specified by
the commissioner, data required for assessing enrollee satisfaction, quality of care, cost,
and utilization of services. The commissioner shall evaluate this data, in order to:
new text end

new text begin (1) make summary information on the quality of care across health plan companies,
medical clinics, and providers available to consumers;
new text end

new text begin (2) require health plan companies and providers, as a condition of contract, to
implement quality improvement plans; and
new text end

new text begin (3) compare the cost and quality of services under the program to the cost and
quality of services provided to private sector enrollees.
new text end

Sec. 13.

new text begin [256N.21] FEDERAL APPROVAL.
new text end

new text begin The commissioner shall seek all federal waivers and approvals necessary to
implement this chapter including, but not limited to, waivers and approvals necessary to:
new text end

new text begin (1) merge medical assistance and MinnesotaCare coverage for children into the
children's health security program;
new text end

new text begin (2) use federal medical assistance and MinnesotaCare dollars to pay for health care
services under the children's health security program; and
new text end

new text begin (3) maximize receipt of the federal medical assistance match for covered children,
by increasing income standards through the use of more liberal income methodologies as
provided under United States Code, title 42, sections 1396a and 1396u-1.
new text end

Sec. 14.

new text begin [256N.23] RULEMAKING.
new text end

new text begin The commissioner shall adopt rules to implement this chapter.
new text end

Sec. 15. new text begin IMPLEMENTATION PLAN.
new text end

new text begin The commissioner of human services shall develop an implementation plan for the
children's health security coverage program and shall present this plan, any necessary draft
legislation, and a draft of proposed rules to the legislature by December 15, 2007. The
commissioner shall evaluate the provision of services under the program to children with
disabilities and shall present recommendations to the legislature by December 15, 2009,
for any program changes necessary to ensure the quality and continuity of care.
new text end

Sec. 16. new text begin LEGISLATIVE TASK FORCE ON CHILDREN'S HEALTH CARE
COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment; membership. new text end

new text begin The Legislative Task Force on
Children's Health Care Coverage is established. The task force consists of: five members
of the house of representatives appointed under the rules of the house, of whom three
members must be from the majority party and two members from the minority party;
and five members of the senate appointed under the rules of the senate, of whom three
members must be from the majority party and two members from the minority party. Task
force members must be appointed by September 1, 2007.
new text end

new text begin Subd. 2. new text end

new text begin Study; staff support. new text end

new text begin (a) The task force shall study viable options to extend
coverage to all children as provided in Minnesota Statutes, section 256N.05, subdivision
2, paragraph (b), and provide recommendations to the legislature. The study must:
new text end

new text begin (1) evaluate methods to achieve universal coverage for children, including, but not
limited to, changes to the employer-based coverage system and an expansion of eligibility
for the children's health security program established under Minnesota Statutes, chapter
256N;
new text end

new text begin (2) examine health care reform and cost containment methods that will contain costs
and increase access and improve health outcomes;
new text end

new text begin (3) examine how to increase access to preventive care and health care services; and
new text end

new text begin (4) examine how to reduce health disparities among minority populations.
new text end

new text begin (b) The task force, through the Legislative Coordinating Commission, may hire staff
or contract for staff support for the study.
new text end

new text begin Subd. 3. new text end

new text begin Recommendations. new text end

new text begin The task force shall report its recommendations
to the legislature by January 15, 2009. Recommendations must be consistent with the
following criteria:
new text end

new text begin (1) health care coverage must include preventive care and all other medically
necessary services;
new text end

new text begin (2) health care coverage must be affordable for families, with the family share of
premium costs and cost-sharing in total not exceeding five percent of family income;
new text end

new text begin (3) the system of coverage must give priority to ensuring access to and the quality
and continuity of care; and
new text end

new text begin (4) enrollment must be simple and seamless for families.
new text end

new text begin Subd. 4. new text end

new text begin Expiration. new text end

new text begin This section expires January 16, 2009.
new text end

Sec. 17. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the general fund to the commissioner of human
services for the fiscal year ending June 30, 2008, to develop and implement the Children's
Health Security Act under Minnesota Statutes, chapter 256N.
new text end

new text begin (b) $....... is appropriated from the general fund to the Legislative Coordinating
Commission for the fiscal year ending June 30, 2008, for staff support provided to the
Legislative Task Force on Children's Health Care Coverage.
new text end