Subd. 3.

General assistance medical care; eligibility.

(a) General assistance
medical care may be paid for any person who is not eligible for medical assistance under
chapter 256B, including eligibility for medical assistance based on a spenddown of excess
income according to section 256B.056, subdivision 5, or MinnesotaCare as defined in
paragraph (b), except as provided in paragraph (c), and:

(1) who is receiving assistance under section 256D.05, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or

(2) who is a resident of Minnesota; and

(i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
section 256B.056, subdivision 3, with the following exception: the maximum amount of
undistributed funds in a trust that could be distributed to or on behalf of the beneficiary by
the trustee, assuming the full exercise of the trustee's discretion under the terms of the
trust, must be applied toward the asset maximum;

(ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the
family size, using a six-month budget period, whose equity in assets is not in excess
of the limits in section 256B.056, subdivision 3c, and who applies during an inpatient
hospitalization; or

(iii) the commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.

(b) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (e).

(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
subdivision 7, with covered services as provided in section 256L.03 for the rest of the
six-month eligibility period, until their six-month renewal.

(d) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (c), an individual must complete a new
application.

(e) Applicants and recipients eligible under paragraph (a), clause (1); who have
applied for and are awaiting a determination of blindness or disability by the state medical
review team or a determination of eligibility for Supplemental Security Income or Social
Security Disability Insurance by the Social Security Administration; who fail to meet the
requirements of section 256L.09, subdivision 2; who are classified as end-stage renal
disease beneficiaries in the Medicare program; who are enrolled in private health care
coverage as defined in section 256B.02, subdivision 9; who are eligible under paragraph
(j); or who receive treatment funded pursuant to section 254B.02 are exempt from the
MinnesotaCare enrollment requirements of this subdivision.

(f) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.

(g) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).

(h) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
county agency must assist the applicant in obtaining verification if necessary.

(i) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.

(j) General assistance medical care is not available for a person in a correctional
facility unless the person is detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order, and the person is a recipient of general
assistance medical care at the time the person is detained by law or admitted on a criminal
hold order and as long as the person continues to meet other eligibility requirements
of this subdivision.

(k) General assistance medical care is not available for applicants or recipients who
do not cooperate with the county agency to meet the requirements of medical assistance.

(l) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.

(m) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.

(n) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
an undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the Immigration and Naturalization Service.

(o) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources, is ineligible
for general assistance medical care.

(p) Effective July 1, 2003, general assistance medical care emergency services end.

new text begin (q) Effective July 1, 2007, individuals in a correctional facility who have been
diagnosed with a mental illness as defined in section 245.462, subdivision 20, are
eligible for general assistance medical care for three months from the date of release
from confinement.
new text end

Subd. 20.

Mental illness.

(a) "Mental illness" means an organic disorder of the
brain or a clinically significant disorder of thought, mood, perception, orientation,
memory, or behavior that is listed in the clinical manual of the International Classification
of Diseases (ICD-9-CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0
or the corresponding code in the American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III, and
that seriously limits a person's capacity to function in primary aspects of daily living such
as personal relations, living arrangements, work, and recreation.

(b) An "adult with acute mental illness" means an adult who has a mental illness that
is serious enough to require prompt intervention.

(c) For purposes of case management and community support services, a "person
with serious and persistent mental illness" means an adult who has a mental illness and
meets at least one of the following criteria:

(1) the adult has undergone two or more episodes of inpatient care for a mental
illness within the preceding 24 months;

(2) the adult has experienced a continuous psychiatric hospitalization or residential
treatment exceeding six months' duration within the preceding 12 months;

(3) new text begin the adult has been an inmate at a jail or county regional jail or a prisoner at a
correctional facility two or more times within the preceding 24 months;
new text end

new text begin (4) the adult has experienced continuous confinement in a jail, county regional jail,
or correctional facility for more than six months' duration within the preceding 12 months;
new text end

new text begin (5) the adult has been treated by a crisis team two or more times within the preceding
24 months;
new text end

new text begin (6) new text end the adult:

(i) has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline
personality disorder;

(ii) indicates a significant impairment in functioning; and

(iii) has a written opinion from a mental health professional, in the last three years,
stating that the adult is reasonably likely to have future episodes requiring inpatient or
residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
management or community support services are provided;

deleted text begin (4)deleted text end new text begin (7)new text end the adult has, in the last three years, been committed by a court as a person
who is mentally ill under chapter 253B, or the adult's commitment has been stayed or
continued; or

deleted text begin (5)deleted text end new text begin (8)new text end the adult (i) was eligible under clauses (1) to deleted text begin (4)deleted text end new text begin (7)new text end , but the specified time
period has expired or the adult was eligible as a child under section 245.4871, subdivision
6; and (ii) has a written opinion from a mental health professional, in the last three years,
stating that the adult is reasonably likely to have future episodes requiring inpatient or
residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
management or community support services are provided.

Subd. 5.

Special contracts; bordering states.

(a) An individual who is detained,
committed, or placed on an involuntary basis under chapter 253B may be confined or
treated in a bordering state pursuant to a contract under this section. An individual who is
detained, committed, or placed on an involuntary basis under the civil law of a bordering
state may be confined or treated in Minnesota pursuant to a contract under this section. A
peace or health officer who is acting under the authority of the sending state may transport
an individual to a receiving agency that provides services pursuant to a contract under
this section and may transport the individual back to the sending state under the laws
of the sending state. Court orders valid under the law of the sending state are granted
recognition and reciprocity in the receiving state for individuals covered by a contract
under this section to the extent that the court orders relate to confinement for treatment
or care of mental illness or chemical dependency. Such treatment or care may address
other conditions that may be co-occurring with the mental illness or chemical dependency.
These court orders are not subject to legal challenge in the courts of the receiving state.
Individuals who are detained, committed, or placed under the law of a sending state and
who are transferred to a receiving state under this section continue to be in the legal
custody of the authority responsible for them under the law of the sending state. Except
in emergencies, those individuals may not be transferred, removed, or furloughed from
a receiving agency without the specific approval of the authority responsible for them
under the law of the sending state.

(b) While in the receiving state pursuant to a contract under this section, an
individual shall be subject to the sending state's laws and rules relating to length of
confinement, reexaminations, and extensions of confinement. No individual may be sent
to another state pursuant to a contract under this section until the receiving state has
enacted a law recognizing the validity and applicability of this section.

(c) If an individual receiving services pursuant to a contract under this section leaves
the receiving agency without permission and the individual is subject to involuntary
confinement under the law of the sending state, the receiving agency shall use all
reasonable means to return the individual to the receiving agency. The receiving agency
shall immediately report the absence to the sending agency. The receiving state has the
primary responsibility for, and the authority to direct, the return of these individuals
within its borders and is liable for the cost of the action to the extent that it would be
liable for costs of its own resident.

(d) Responsibility for payment for the cost of care remains with the sending agency.

(e) This subdivision also applies to county contracts under subdivision 2 which
include emergency care and treatment provided to a county resident in a bordering state.

new text begin (f) If a Minnesota resident is admitted to a facility in a bordering state under this
chapter, a physician, licensed psychologist who has a doctoral degree in psychology, or an
advance practice registered nurse certified in mental health, and who is licensed in the
bordering state, may act as an examiner under sections 253B.07, 253B.09, 253B.092, and
253B.12. Any person acting as an examiner under this paragraph must have received
training on the provisions in chapter 253B.
new text end

Subd. 2.

Definitions.

For purposes of this section, the following terms have the
meanings given them.

(a) "Adult rehabilitative mental health services" means mental health services which
are rehabilitative and enable the recipient to develop and enhance psychiatric stability,
social competencies, personal and emotional adjustment, and independent living and
community skills, when these abilities are impaired by the symptoms of mental illness.
Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these services.

(1) Adult rehabilitative mental health services instruct, assist, and support the
recipient in areas such as: interpersonal communication skills, community resource
utilization and integration skills, crisis assistance, relapse prevention skills, health care
directives, budgeting and shopping skills, healthy lifestyle skills and practices, cooking
and nutrition skills, transportation skills, medication education and monitoring, mental
illness symptom management skills, household management skills, employment-related
skills, and transition to community living services.

(2) These services shall be provided to the recipient on a one-to-one basis in the
recipient's home or another community setting or in groups.

(b) "Medication education services" means services provided individually or in
groups which focus on educating the recipient about mental illness and symptoms; the role
and effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians,
pharmacists, physician's assistants, or registered nurses.

(c) "Transition to community living services" means services which maintain
continuity of contact between the rehabilitation services provider and the recipient and
which facilitate discharge from a hospital, residential treatment program under Minnesota
Rules, chapter 9505, board and lodging facility, or nursing home. Transition to community
living services are not intended to provide other areas of adult rehabilitative mental health
services.

new text begin (d) "Family psychoeducation" is a multimodal outpatient therapy and rehabilitative
service that involves parents, families, and others as resources in the treatment, recovery,
and improved functioning of a person with mental illness or emotional disturbance,
in which families learn about the illness, family reactions, and types of treatment and
supports. Families learn to develop skills to handle problems posed by mental illness
including coping, managing stress, ensuring safety, creating social support, identifying
resources, and supporting treatment and recovery goals. Services include family
counseling, family treatment planning, and family support using cognitive, behavioral,
problem-solving, and communication strategies, and may involve individual, family, and
group intervention activities for consumers and families together, families only, or brief
intermittent consultations at critical times in an episode of care. Eligible providers must
be certified to provide both outpatient mental health services and rehabilitative services
under this section.
new text end

Subd. 8.

Diagnostic assessment.

Providers of adult rehabilitative mental health
services must complete a diagnostic assessment as defined in section 245.462, subdivision
9, within five days after the recipient's second visit or within 30 days after intake,
whichever occurs first. new text begin A diagnostic assessment must be reimbursed at the same rate
as a diagnostic assessment under section 256B.49, subdivision 14. new text end In cases where a
diagnostic assessment is available that reflects the recipient's current status, and has been
completed within 180 days preceding admission, an update must be completed. An
update shall include a written summary by a mental health professional of the recipient's
current mental health status and service needs. If the recipient's mental health status
has changed significantly since the adult's most recent diagnostic assessment, a new
diagnostic assessment is required. For initial implementation of adult rehabilitative mental
health services, until June 30, 2005, a diagnostic assessment that reflects the recipient's
current status and has been completed within the past three years preceding admission
is acceptable.

Subd. 12.

Additional requirements.

(a) Providers of adult rehabilitative
mental health services must comply with the requirements relating to referrals for case
management in section 245.467, subdivision 4.

(b) Adult rehabilitative mental health services are provided for most recipients
in the recipient's home and community. Services may also be provided at the home of
a relative or significant other, job site, psychosocial clubhouse, drop-in center, social
setting, classroom, or other places in the community. Except for "transition to community
services," the place of service does not include a regional treatment center, nursing
home, residential treatment facility licensed under Minnesota Rules, parts 9520.0500 to
9520.0670 (Rule 36), or an acute care hospital.

(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and treatment plan. A group is defined
as two to ten clients, at least one of whom is a recipient, who is concurrently receiving a
service which is identified in this section. The service and group must be specified in the
recipient's treatment plan. No more than two qualified staff may bill Medicaid for services
provided to the same group of recipients. If two adult rehabilitative mental health workers
bill for recipients in the same group session, they must each bill for different recipients.

new text begin (d) Adult rehabilitative mental health services include family psychoeducation,
coordination and care management, and collateral contacts.
new text end

Subd. 38.

Payments for mental health services.

new text begin (a) new text end Payments for mental
health services covered under the medical assistance program that are provided by
masters-prepared mental health professionals shall be 80 percent of the rate paid to
doctoral-prepared professionals. Payments for mental health services covered under
the medical assistance program that are provided by masters-prepared mental health
professionals employed by community mental health centers shall be 100 percent of the
rate paid to doctoral-prepared professionals. deleted text begin For purposes of reimbursement of mental
health professionals under the medical assistance program, all
deleted text end

new text begin (b) Payments for mental health services covered under the medical assistance
program that are provided bynew text end social workers who:

(1) have received a master's degree in social work from a program accredited by the
Council on Social Work Education;

(2) are licensed at the level of graduate social worker or independent social worker;
deleted text begin and
deleted text end

(3) are practicing clinical social work under appropriate supervision, as defined by
chapter 148D; new text begin and
new text end

new text begin (4) new text end meet all requirements under Minnesota Rules, part 9505.0323, subpart 24deleted text begin , anddeleted text end new text begin .
Payments under this paragraph new text end shall be paid deleted text begin accordinglydeleted text end new text begin according to Minnesota Rules,
part 9505.0323, subpart 24, unless paragraph (c) is applicablenew text end .

new text begin (c) Payments for mental health services covered under the medical assistance
program that are provided by an individual who:
new text end

new text begin (1) is employed by a community mental health center and who has completed all
requirements for licensure or board certification as a mental health professional except for
the requirements for supervised experience in the delivery of mental health services; or
new text end

new text begin (2) who is a student in a bona fide field placement or internship under a program
leading to completion of the requirements for licensure as a mental health professional
new text end

new text begin shall be reimbursed at 100 percent of the rate paid to a doctoral-prepared professional.
The individual providing the service under this paragraph must be under the clinical
supervision of a fully qualified mental health professional.
new text end

new text begin (d) Medical assistance covers clinical supervision of mental health practitioners by a
mental health professional when clinical supervision is required as part of other medical
assistance services.
new text end

Subd. 43.

Mental health provider travel time.

Medical assistance covers provider
travel time new text begin plus reimbursement for mileage new text end if a recipient's individual treatment plan
requires the provision of mental health services outside of the provider's normal place of
business. deleted text begin Thisdeleted text end new text begin Reimbursement under this subdivisionnew text end does not include any travel time
which is included in other billable services, and is only covered when the mental health
service being provided to a recipient is covered under medical assistance.

Subd. 46.

Mental health telemedicine.

Effective January 1, 2006, and subject to
federal approval, mental health services that are otherwise covered by medical assistance
as direct face-to-face services may be provided via two-way interactive video. Use of
two-way interactive video must be medically appropriate to the condition and needs
of the person being served. Reimbursement is at the same rates and under the same
conditions that would otherwise apply to the servicenew text begin and shall include payment for the
originating facility fee and the cost of broadband connectionsnew text end . The interactive video
equipment and connection must comply with Medicare standards in effect at the time
the service is provided.

Subdivision 1.

Definitions.

For purposes of this section, the following terms have
the meanings given them.

(a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.

(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.

(c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.

(e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.

(f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.

(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11.

(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling, maintaining clinical records, consulting with others
about the client's mental health status, preparing reports, receiving clinical supervision
directly related to the client's psychotherapy session, and revising the client's individual
treatment plan.

(i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).

(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).

(k) new text begin "Family psychoeducation" is a multimodal outpatient therapy and rehabilitative
service that involves parents, families, and others as resources in the treatment, recovery,
and improved functioning of a person with mental illness or emotional disturbance,
in which families learn about the illness, family reactions, and types of treatment and
supports. Families learn to develop skills to handle problems posed by mental illness
including coping, managing stress, ensuring safety, creating social support, identifying
resources, and supporting treatment and recovery goals. Services include family
counseling, family treatment planning, and family support using cognitive, behavioral,
problem-solving, and communication strategies, and may involve individual, family, and
group intervention activities for consumers and families together, families only, or brief
intermittent consultations at critical times in an episode of care. Eligible providers must
be certified to provide both outpatient mental health services and rehabilitative services
under sections 256B.0623 and 256B.0943.
new text end

new text begin (l) new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional or mental health practitioner, under
the clinical supervision of a mental health professional, to guide the work of the mental
health behavioral aide.

deleted text begin (l)deleted text end new text begin (m)new text end "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21.

deleted text begin (m)deleted text end new text begin (n)new text end "Mental health professional" means an individual as defined in section
245.4871, subdivision 27, clauses (1) to (5), or tribal vendor as defined in section 256B.02,
subdivision 7, paragraph (b).

deleted text begin (n)deleted text end new text begin (o)new text end "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.

deleted text begin (o)deleted text end new text begin (p)new text end "Skills training" means individual, family, or group training designed to
improve the basic functioning of the child with emotional disturbance and the child's
family in the activities of daily living and community living, and to improve the social
functioning of the child and the child's family in areas important to the child's maintaining
or reestablishing residency in the community. Individual, family, and group skills training
must:

(1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;

(2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and

(3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance.

Subd. 2.

Covered service components of children's therapeutic services and
supports.

(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible
provider entity under subdivisions 4 and 5 provides to a client eligible under subdivision 3.

(b) The service components of children's therapeutic services and supports are:

(1) individual, family, deleted text begin anddeleted text end group psychotherapynew text begin , and family psychoeducationnew text end ;

(2) individual, family, or group skills training provided by a mental health
professional or mental health practitioner;

(3) crisis assistance;

(4) mental health behavioral aide services; deleted text begin and
deleted text end

(5) direction of a mental health behavioral aidenew text begin ;
new text end

new text begin (6) coordination and care management; and
new text end

new text begin (7) collateral contactsnew text end .

(c) Service components may be combined to constitute therapeutic programs,
including day treatment programs and preschool programs. Although day treatment and
preschool programs have specific client and provider eligibility requirements, medical
assistance only pays for the service components listed in paragraph (b).

Subd. 5g.

Payment for covered services.

For services rendered on or after January
1, 2003, the total payment made to managed care plans for providing covered services
under the medical assistance and general assistance medical care programs is reduced by
.5 percent from their current statutory rates. This provision excludes payments for nursing
home services, home and community-based waivers, and payments to demonstration
projects for persons with disabilitiesnew text begin , and mental health services added as covered benefits
after December 31, 2007new text end .

Subd. 5h.

Payment reduction.

In addition to the reduction in subdivision 5g,
the total payment made to managed care plans under the medical assistance program is
reduced 1.0 percent for services provided on or after October 1, 2003, and an additional
1.0 percent for services provided on or after January 1, 2004. This provision excludes
payments for nursing home services, home and community-based waivers, deleted text begin anddeleted text end payments
to demonstration projects for persons with disabilitiesnew text begin , and mental health services added as
covered benefits after December 1, 2007new text end .

Subd. 4.

General assistance medical care; services.

(a)(i) For a person who is
eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
care covers, except as provided in paragraph (c):

(1) inpatient hospital services;

(2) outpatient hospital services;

(3) services provided by Medicare certified rehabilitation agencies;

(4) prescription drugs and other products recommended through the process
established in section 256B.0625, subdivision 13;

(5) equipment necessary to administer insulin and diagnostic supplies and equipment
for diabetics to monitor blood sugar level;

(6) eyeglasses and eye examinations provided by a physician or optometrist;

(7) hearing aids;

(8) prosthetic devices;

(9) laboratory and X-ray services;

(10) physician's services;

(11) medical transportation except special transportation;

(12) chiropractic services as covered under the medical assistance program;

(13) podiatric services;

(14) dental services as covered under the medical assistance program;

(15) deleted text begin outpatient services provided by a mental health center or clinic that is under
contract with the county board and is established under section 245.62deleted text end new text begin mental health
services covered under chapter 256Bnew text end ;

(16) deleted text begin day treatment services for mental illness provided under contract with the
county board;
deleted text end

deleted text begin (17)deleted text end prescribed medications for persons who have been diagnosed as mentally ill as
necessary to prevent more restrictive institutionalization;

deleted text begin (18) psychological services,deleted text end new text begin (17)new text end medical supplies and equipment, and Medicare
premiums, coinsurance and deductible payments;

deleted text begin (19)deleted text end new text begin (18)new text end medical equipment not specifically listed in this paragraph when the use
of the equipment will prevent the need for costlier services that are reimbursable under
this subdivision;

deleted text begin (20)deleted text end new text begin (19)new text end services performed by a certified pediatric nurse practitioner, a
certified family nurse practitioner, a certified adult nurse practitioner, a certified
obstetric/gynecological nurse practitioner, a certified neonatal nurse practitioner, or a
certified geriatric nurse practitioner in independent practice, if (1) the service is otherwise
covered under this chapter as a physician service, (2) the service provided on an inpatient
basis is not included as part of the cost for inpatient services included in the operating
payment rate, and (3) the service is within the scope of practice of the nurse practitioner's
license as a registered nurse, as defined in section 148.171;

deleted text begin (21)deleted text end new text begin (20)new text end services of a certified public health nurse or a registered nurse practicing
in a public health nursing clinic that is a department of, or that operates under the direct
authority of, a unit of government, if the service is within the scope of practice of the
public health nurse's license as a registered nurse, as defined in section 148.171;

deleted text begin (22)deleted text end new text begin (21)new text end telemedicine consultations, to the extent they are covered under section
256B.0625, subdivision 3b; deleted text begin and
deleted text end

deleted text begin (23) mental health telemedicine and psychiatric consultation as covered under
section 256B.0625, subdivisions 46 and 48
deleted text end

new text begin (22) up to six hours of service per client per year, without authorization, of
consultation and care coordination as directed by an individual treatment plan, and as a
component of childrena??s therapeutic services and supports, adult rehabilitative mental
health services, or community mental health services; and
new text end

new text begin (23) up to six hours of service per client per year for collateral contacts as a
component of childrena??s therapeutic services and supports, adult rehabilitative mental
health services, or community mental health services. These services must be directed
by an individual treatment plan and are solely for the purpose of assisting parents and
others toward understanding, accommodating, and better caregiving of the person with
mental illness or emotional disturbancenew text end .

(ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
to inpatient hospital services, including physician services provided during the inpatient
hospital stay. A $1,000 deductible is required for each inpatient hospitalization.

(b) Effective August 1, 2005, sex reassignment surgery is not covered under this
subdivision.

(c) In order to contain costs, the commissioner of human services shall select
vendors of medical care who can provide the most economical care consistent with high
medical standards and shall where possible contract with organizations on a prepaid
capitation basis to provide these services. The commissioner shall consider proposals by
counties and vendors for prepaid health plans, competitive bidding programs, block grants,
or other vendor payment mechanisms designed to provide services in an economical
manner or to control utilization, with safeguards to ensure that necessary services are
provided. Before implementing prepaid programs in counties with a county operated or
affiliated public teaching hospital or a hospital or clinic operated by the University of
Minnesota, the commissioner shall consider the risks the prepaid program creates for the
hospital and allow the county or hospital the opportunity to participate in the program in a
manner that reflects the risk of adverse selection and the nature of the patients served by
the hospital, provided the terms of participation in the program are competitive with the
terms of other participants considering the nature of the population served. Payment for
services provided pursuant to this subdivision shall be as provided to medical assistance
vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
payments made during fiscal year 1990 and later years, the commissioner shall consult
with an independent actuary in establishing prepayment rates, but shall retain final control
over the rate methodology.

(d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
co-payments for services provided on or after October 1, 2003:

(1) $25 for eyeglasses;

(2) $25 for nonemergency visits to a hospital-based emergency room;

(3) $3 per brand-name drug prescription and $1 per generic drug prescription,
subject to a $12 per month maximum for prescription drug co-payments. No co-payments
shall apply to antipsychotic drugs when used for the treatment of mental illness; and

(4) 50 percent coinsurance on restorative dental services.

(e) Co-payments shall be limited to one per day per provider for nonpreventive visits,
eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of
general assistance medical care are responsible for all co-payments in this subdivision.
The general assistance medical care reimbursement to the provider shall be reduced by
the amount of the co-payment, except that reimbursement for prescription drugs shall not
be reduced once a recipient has reached the $12 per month maximum for prescription
drug co-payments. The provider collects the co-payment from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment, except as
provided in paragraph (f).

(f) If it is the routine business practice of a provider to refuse service to an individual
with uncollected debt, the provider may include uncollected co-payments under this
section. A provider must give advance notice to a recipient with uncollected debt before
services can be denied.

(g) Any county may, from its own resources, provide medical payments for which
state payments are not made.

(h) Chemical dependency services that are reimbursed under chapter 254B must not
be reimbursed under general assistance medical care.

(i) The maximum payment for new vendors enrolled in the general assistance
medical care program after the base year shall be determined from the average usual and
customary charge of the same vendor type enrolled in the base year.

(j) The conditions of payment for services under this subdivision are the same as the
conditions specified in rules adopted under chapter 256B governing the medical assistance
program, unless otherwise provided by statute or rule.

(k) Inpatient and outpatient payments shall be reduced by five percent, effective July
1, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
and incorporated by reference in paragraph (i).

(l) Payments for all other health services except inpatient, outpatient, and pharmacy
services shall be reduced by five percent, effective July 1, 2003.

(m) Payments to managed care plans shall be reduced by five percent for services
provided on or after October 1, 2003.

(n) A hospital receiving a reduced payment as a result of this section may apply the
unpaid balance toward satisfaction of the hospital's bad debts.

(o) Fee-for-service payments for nonpreventive visits shall be reduced by $3
for services provided on or after January 1, 2006. For purposes of this subdivision, a
visit means an episode of service which is required because of a recipient's symptoms,
diagnosis, or established illness, and which is delivered in an ambulatory setting by
a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
audiologist, optician, or optometrist.

(p) Payments to managed care plans shall not be increased as a result of the removal
of the $3 nonpreventive visit co-payment effective January 1, 2006.

new text begin (q) Payments for mental health services added as covered benefits after December 1,
2007, are not subject to the reductions in paragraphs (i), (k), (l), and (m).
new text end

Subd. 5.

Special needs.

In addition to the state standards of assistance established in
subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a group residential housing facility.

(a) The county agency shall pay a monthly allowance for medically prescribed
diets if the cost of those additional dietary needs cannot be met through some other
maintenance benefit. The need for special diets or dietary items must be prescribed by
a licensed physician. Costs for special diets shall be determined as percentages of the
allotment for a one-person household under the thrifty food plan as defined by the United
States Department of Agriculture. The types of diets and the percentages of the thrifty
food plan that are covered are as follows:

(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;

(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
of thrifty food plan;

(3) controlled protein diet, less than 40 grams and requires special products, 125
percent of thrifty food plan;

(4) low cholesterol diet, 25 percent of thrifty food plan;

(5) high residue diet, 20 percent of thrifty food plan;

(6) pregnancy and lactation diet, 35 percent of thrifty food plan;

(7) gluten-free diet, 25 percent of thrifty food plan;

(8) lactose-free diet, 25 percent of thrifty food plan;

(9) antidumping diet, 15 percent of thrifty food plan;

(10) hypoglycemic diet, 15 percent of thrifty food plan; or

(11) ketogenic diet, 25 percent of thrifty food plan.

(b) Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using
the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
as long as other funding sources are not available.

(c) A fee for guardian or conservator service is allowed at a reasonable rate
negotiated by the county or approved by the court. This rate shall not exceed five percent
of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
guardian or conservator is a member of the county agency staff, no fee is allowed.

(d) The county agency shall continue to pay a monthly allowance of $68 for
restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
1990, and who eats two or more meals in a restaurant daily. The allowance must continue
until the person has not received Minnesota supplemental aid for one full calendar month
or until the person's living arrangement changes and the person no longer meets the criteria
for the restaurant meal allowance, whichever occurs first.

(e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
is allowed for representative payee services provided by an agency that meets the
requirements under SSI regulations to charge a fee for representative payee services. This
special need is available to all recipients of Minnesota supplemental aid regardless of
their living arrangement.

(f) Notwithstanding the language in this subdivision, an amount equal to the
maximum allotment authorized by the federal Food Stamp Program for a single individual
which is in effect on the first day of deleted text begin Januarydeleted text end new text begin Julynew text end of the deleted text begin previousdeleted text end new text begin current state fiscalnew text end
year will be added to the standards of assistance established in subdivisions 1 to 4 for
individuals under the age of 65 who are relocating from an institution, deleted text begin ordeleted text end an adult mental
health residential treatment program under section 256B.0622, new text begin or an adult eligible for the
community alternatives for disabled individuals waiver, new text end and who are shelter needy. An
eligible individual who receives this benefit prior to age 65 may continue to receive the
benefit after the age of 65.

"Shelter needy" means that the assistance unit incurs monthly shelter costs that
exceed 40 percent of the assistance unit's gross income before the application of this
special needs standard. "Gross income" for the purposes of this section is the applicant's or
recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
in subdivision 3, whichever is greater. A recipient of a federal or state housing subsidy,
that limits shelter costs to a percentage of gross income, shall not be considered shelter
needy for purposes of this paragraph.

Subdivision 1.

Covered health services.

For individuals under section 256L.04,
subdivision 7, with income no greater than 75 percent of the federal poverty guidelines
or for families with children under section 256L.04, subdivision 1, all subdivisions of
this section apply. "Covered health services" means the health services reimbursed
under chapter 256B, with the exception of inpatient hospital services, special education
services, private duty nursing services, adult dental care services other than services
covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency
medical transportation services, personal care assistant and case management services,
nursing home or intermediate care facilities services, inpatient mental health services,
and chemical dependency services. deleted text begin Outpatient mental health services covered under the
MinnesotaCare program are limited to diagnostic assessments, psychological testing,
explanation of findings, mental health telemedicine, psychiatric consultation, medication
management by a physician, day treatment, partial hospitalization, and individual, family,
and group psychotherapy.
deleted text end

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in this section.

Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21 in households with family income equal to or less than 175
percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
parents and relative caretakers of children under the age of 21 in households with family
income greater than 175 percent of the federal poverty guidelines for inpatient hospital
admissions occurring on or after January 1, 2001.

(c) Paragraph (a), clauses (1) to (4), do not apply to pregnant women and children
under the age of 21.

(d) new text begin Paragraph (a), clause (4), does not apply to mental health services.
new text end

new text begin (e) new text end Adult enrollees with family gross income that exceeds 175 percent of the
federal poverty guidelines and who are not pregnant shall be financially responsible for
the coinsurance amount, if applicable, and amounts which exceed the $10,000 inpatient
hospital benefit limit.

deleted text begin (e)deleted text end new text begin (f)new text end When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
or changes from one prepaid health plan to another during a calendar year, any charges
submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
expenses incurred by the enrollee for inpatient services, that were submitted or incurred
prior to enrollment, or prior to the change in health plans, shall be disregarded.

Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewaldeleted text end . Children enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; deleted text begin or
deleted text end

(v) vision coverage;new text begin or
new text end

new text begin (vi) mental health coverage;
new text end

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.

(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

(d) Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

(e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.

Subd. 9a.

Rate setting; ratable reduction.

For services rendered on or after
October 1, 2003, the total payment made to managed care plans under the MinnesotaCare
program is reduced 1.0 percent.new text begin This provision excludes payments for mental health
services added as covered benefits after December 31, 2007.
new text end