Minnesota Legislature
SF 15
1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am
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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; 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.
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[16A.726] CHILDREN'S HEALTH SECURITY ACCOUNT.
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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. The commissioner of finance shall not transfer
any funds from the health care access fund to the children's health security account.
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Sec. 2.
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[256N.01] CITATION.
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This chapter may be cited as the Children's Health Security Act.
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Sec. 3.
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[256N.02] DEFINITIONS.
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new text begin Subdivision 1. new text end
new text begin Applicability. new text end
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The terms used in this chapter have the following
meanings unless otherwise provided for by text.
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new text begin Subd. 2. new text end
new text begin Child. new text end
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"Child" means an individual under age 19 or 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.
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new text begin Subd. 3. new text end
new text begin Commissioner. new text end
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"Commissioner" means the commissioner of human
services.
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Sec. 4.
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[256N.03] ESTABLISHMENT.
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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.
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Sec. 5.
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[256N.05] ELIGIBILITY.
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new text begin Subdivision 1. new text end
new text begin General requirements. new text end
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Children meeting the eligibility
requirements of this section are eligible for the children's health security program.
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new text begin Subd. 2. new text end
new text begin Phase-in of eligible groups. new text end
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(a) Children in families with income equal to
or less than 300 percent of the federal poverty guidelines are eligible to enroll effective
July 1, 2008, or upon federal approval, whichever is later.
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(b) Effective July 1, 2010, eligibility is expanded to include all children, regardless
of household income or assets.
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new text begin Subd. 3. new text end
new text begin Residency. new text end
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(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.
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(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:
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(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
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(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.
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(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.
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(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.
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(e) A child who moved to Minnesota primarily to obtain medical treatment or health
coverage for a preexisting condition is not a permanent resident.
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new text begin Subd. 4. new text end
new text begin Enrollment voluntary. new text end
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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.
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Sec. 6.
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[256N.07] COVERED SERVICES.
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Covered services under the children's health security program shall consist of all
covered services under chapter 256B.
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Sec. 7.
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[256N.09] NO ENROLLEE PREMIUMS OR COST SHARING.
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In order to ensure broad access to coverage, the children's health security program
has no enrollee premium or cost-sharing requirements.
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Sec. 8.
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[256N.11] APPLICATION PROCEDURES.
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new text begin Subdivision 1. new text end
new text begin Application procedure. new text end
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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.
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new text begin Subd. 2. new text end
new text begin Eligibility determination. new text end
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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.
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new text begin Subd. 3. new text end
new text begin Presumptive eligibility. new text end
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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
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The commissioner shall require enrollees to renew
eligibility every 12 months.
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Sec. 9.
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[256N.13] SERVICE DELIVERY.
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new text begin Subdivision 1. new text end
new text begin Contracts for service delivery. new text end
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The commissioner, within each
county, may contract with health maintenance organizations licensed under chapter 62D,
county-based purchasing plans established under section 256B.692 to provide covered
health care services to program enrollees under a managed care system, and may contract
with health care and social service providers to provide services under a fee-for-service
system. In determining the method for service delivery, the commissioner shall consider
the cost and quality of health care services, the breadth of services offered, including
medical, dental, and mental health services, and the breadth of choice of medical providers
for enrollees, the case of access to quality medical care for enrollees, the efficiency
and cost effectiveness of service delivery, and the integration of best medical practice
standards into the children's health security program. The commissioner shall present a
health care delivery plan, based on the criteria stated in this subdivision, to the Legislative
Commission on Health Care Access by January 15, 2008.
new text end
new text begin Subd. 2. new text end
new text begin Health plan company requirements. new text end
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Health plan companies under
contract are responsible for coordinating covered health care services provided to eligible
individuals. Health plan companies under contract:
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(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;
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(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;
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(3) may contract with health care and social service providers to provide covered
services to enrollees; and
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(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.
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new text begin Subd. 3. new text end
new text begin Fee-for-services delivery. new text end
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Disputes related to services provided under
the fee-for-service system may be appealed to the commissioner using the procedures
in section 256.045.
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new text begin Subd. 4. new text end
new text begin Contracts for waiver services. new text end
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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.
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Sec. 10.
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[256N.15] PAYMENT RATES.
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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.
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Sec. 11.
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[256N.17] CONSUMER ASSISTANCE.
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new text begin Subdivision 1. new text end
new text begin Assistance to applicants. new text end
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The commissioner shall assist applicants
in choosing a health plan company by:
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(1) establishing a Web site to provide information about health plan companies
and to allow online enrollment;
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(2) make information on health plan companies available at the sites specified in
section 256N.11, subdivision 1;
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(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
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(4) make benefit educators available to assist applicants in choosing a health plan
company.
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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.
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Sec. 12.
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[256N.19] MONITORING AND EVALUATION OF QUALITY AND
COSTS.
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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:
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(1) make summary information on the quality of care across health plan companies,
medical clinics, and providers available to consumers;
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(2) require health plan companies and providers, as a condition of contract, to
implement quality improvement plans; and
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(3) compare the cost and quality of services under the program to the cost and
quality of services provided to private sector enrollees.
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Sec. 13. new text begin IMPLEMENTATION PLAN.
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The commissioner 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 January 15, 2008. 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.
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Sec. 14. new text begin FEDERAL APPROVAL.
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The commissioner shall seek all federal waivers and approvals necessary to
implement this chapter including, but not limited to, waivers and approvals necessary to:
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(1) coordinate medical assistance and MinnesotaCare coverage for children;
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(2) use federal medical assistance dollars to pay for health care services under the
children's health security program; and
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(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.
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Sec. 15. 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
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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.
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new text begin Subd. 2. new text end
new text begin Study; staff support. new text end
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(a) The task force shall study health care reform
and cost-containment options for the children's health security program 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:
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(1) examine health care reform and cost-containment methods that will contain costs
and increase access and improve health outcomes;
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(2) examine how to increase access to, and utilization of preventive care and health
care services;
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(3) examine how to reduce health disparities among minority populations; and
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(4) examine best practices in health care delivery and achieving healthy outcomes.
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(b) The task force, through the Legislative Coordinating Commission, may hire staff
or contract for staff support for the study.
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new text begin Subd. 3. new text end
new text begin Recommendations. new text end
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The task force shall report its recommendations to the
Legislative Commission on Health Care Access by January 15, 2009.
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new text begin Subd. 4. new text end
new text begin Expiration. new text end
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This section expires January 16, 2009.
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Sec. 16. new text begin RULEMAKING.
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The commissioner shall adopt rules to implement this act.
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Sec. 17. new text begin APPROPRIATION.
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$....... is appropriated from the general fund to the commissioner of human services
for the biennium beginning July 1, 2007, to develop and implement the Children's Health
Security Act under Minnesota Statutes, chapter 256N.
new text end