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 an individual under age 21.
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

new text begin Subd. 4. new text end

new text begin Dependent child. new text end

new text begin "Dependent child" means an unmarried child under
age 25 who is claimed as a dependent for federal income tax purposes by a parent,
grandparent, foster parent, relative caretaker, or legal guardian.
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 gross household incomes equal
to or less than 300 percent of the federal poverty guidelines are eligible for the children's
health security program. In determining gross income, the commissioner shall use the
income methodology applied to children under the MinnesotaCare program.
new text end

new text begin (b) Effective July 1, 2008, a dependent child is eligible for state-funded benefits
under this section.
new text end

new text begin (c) Effective July 1, 2010, children in families with household incomes in excess of
300 percent of the federal poverty guidelines must be included in the children's health
security program. The requirements for eligibility, the form of the benefits, and other
terms and conditions of the program must be determined by the legislature after receiving
the report of the Legislative Task Force on Children's Health Coverage established under
section 19.
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, an apartment or emergency
shelter manager, or a 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

new text begin Subd. 5. new text end

new text begin Emergency services. new text end

new text begin Payment must be made for care and services that
are furnished to noncitizens, regardless of immigration status, who otherwise meet the
eligibility requirements of this chapter, if the care and services are necessary for the
treatment of an emergency medical condition, except for organ transplants and related
care and services and routine prenatal care. For purposes of this subdivision, "emergency
medical condition" means a medical condition that meets the requirements of United
States Code, title 42, section 1396b(v).
new text end

new text begin Subd. 6. new text end

new text begin Medical assistance standards and procedures. new text end

new text begin (a) Unless otherwise
specified in this chapter, the commissioner shall use medical assistance procedures and
methodology when determining initial eligibility and redetermining eligibility for the
children's health security program.
new text end

new text begin (b) The procedures and income standard specified in section 256B.056, subdivisions
5 and 5c, paragraph (a), apply to children who would be eligible for the children's health
security program, except for excess income.
new text end

new text begin (c) Retroactive coverage for the children's health security program must be provided
as specified in section 256B.056, subdivision 7.
new text end

new text begin Subdivision 1. new text end

new text begin Application procedure. new text end

new text begin The application form for the program
must be easily understandable and must not exceed two pages in length. 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 commissioner, according to the procedures set forth in Code of Federal Regulations,
title 42, section 435.911.
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 for children under age 19 whose family income does not
exceed the applicable income standard. The presumptive eligibility period begins on the
date on which a health care provider enrolled in the program, or other entity designated by
the commissioner, determines, based on preliminary information, that the child's family
income does not exceed the applicable income standard. The presumptive eligibility period
ends the earlier of the day on which a determination is made of eligibility under this section
or the last day of the month following the month presumptive eligibility was determined.
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.
new text end

new text begin Subd. 5. new text end

new text begin Continuous eligibility. new text end

new text begin Children under the age of 19 who are eligible
under this section shall be continuously eligible until the earlier of the next renewal period,
or the time that a child exceeds age 19.
new text end

new text begin Subdivision 1. new text end

new text begin Contracts for service delivery. new text end

new text begin The commissioner, within each
county, may contract with managed care organizations, including health maintenance
organizations licensed under chapter 62D, community integrated service networks licensed
under chapter 62N, accountable provider networks licensed under chapter 62T, and
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 on a fee-for-service basis.
Section 256B.69, subdivision 26, applies to contracts with managed care organizations. 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; the breadth of choice of medical providers for enrollees; the
ease 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.
new text end

new text begin Subd. 2. new text end

new text begin Managed care organization requirements. new text end

new text begin (a) Managed care
organizations under contract are responsible for coordinating covered health care services
provided to eligible individuals. Managed care organizations 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 comply with the requirements of section 256B.69, subdivision 26;
new text end

new text begin (3) 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 (4) may contract with health care and social service providers to provide covered
services to enrollees; and
new text end

new text begin (5) shall institute enrollee grievance procedures according to the method established
by the commissioner, utilizing applicable requirements of chapter 62D and Code of
Federal Regulations, title 42, section 438, subpart F. Disputes may also be appealed to
the commissioner using the procedures in section 256.045.
new text end

new text begin (b) Upon implementation of the children's health security program, the commissioner
shall withhold five percent of managed care organization payments pending completion of
performance targets, including lead screening, well child services, immunizations, vision
screening, and customer service performance targets. Effective for services rendered on
or after January 1, 2010, the commissioner shall increase the withhold by an additional
two percent, for a total withhold of seven percent of managed care organization payments
and shall add treatment of asthma and screening for mental health as new performance
targets. Each performance target must apply uniformly to all managed care organizations,
and be qualitative, objective, measurable, and reasonably attainable, except in the case of
a performance target based on federal or state law or rule. Criteria for assessment of each
performance target must be outlined in writing prior to the contract effective date. The
withhold funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The success of each managed care organization in
reaching performance targets must be reported to the legislature annually.
new text end

new text begin Subd. 3. new text end

new text begin Fee-for-service delivery. new text end

new text begin Disputes related to services provided under
the fee-for-service system may be appealed to the commissioner using the procedures
in section 256.045.
new text end

new text begin Subd. 4. new text end

new text begin Contracts for waiver services. new text end

new text begin The commissioner, when services
are delivered through managed care, may 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

new text begin Subd. 5. new text end

new text begin Service delivery for Minnesota disabilities health option recipient.
new text end

new text begin Individuals who voluntarily enroll in the Minnesota Disability Health Option (MnDHO),
established under section 256B.69, subdivision 23, shall continue to receive their home
and community-based waiver services through MnDHO.
new text end

new text begin Subd. 6. new text end

new text begin Disabled or blind children. new text end

new text begin Children eligible for medical assistance due
to blindness or disability as determined by the Social Security Administration or the state
medical review team are exempt from enrolling in a managed care organization and shall
be provided health benefits on a fee-for-service basis.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. 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

new text begin Subd. 2. new text end

new text begin Provider rates. new text end

new text begin In establishing the payment amount under subdivision
1, the commissioner shall ensure that fee-for-service payment rates for preventative care
services provided on or after July 1, 2008, are at least five percent above the medical
assistance rates for preventative services in effect on June 30, 2008, and shall ensure that
fee-for-service payment rates for all other services provided on or after July 1, 2008, are at
least three percent above the medical assistance rates for those services in effect on June
30, 2008. The commissioner shall adjust managed care capitation rates to reflect these
increases, and shall require managed care organizations, as a condition of contract, to pass
these increases on to providers under contract.
new text end

new text begin Subd. 3. new text end

new text begin Performance rate bonus. new text end

new text begin The commissioner shall establish a care
coordination performance target bonus plan for fee-for-service providers and providers
under contract with a managed care organization to serve program clients. The plan
shall establish care coordination and preventative care performance targets for providers.
The performance targets must be qualitative, objective, and measurable. Criteria for
assessment of each performance target must be outlined in writing prior to the contract
effective date. Providers shall submit to the commissioner by March 1 of each year
information specified by the commissioner that demonstrates the provider has met the
performance targets for the prior year. If the commissioner determines the provider has
satisfied the performance targets, the commissioner shall pay directly to the provider a
care coordination performance bonus equal to one and one-half percent of all payments
for services under the children's health security program made to that provider during the
prior year. Managed care organizations shall provide to the commissioner, in the form
and manner specified by the commissioner, all information necessary to implement the
performance target bonus plan for providers under contract.
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 managed care organization or fee-for-service provider by:
new text end

new text begin (1) establishing a Web site to provide information about managed care organizations
and fee-for-service providers and to allow online enrollment;
new text end

new text begin (2) make information on managed care organizations and fee-for-service providers
available at the sites specified in section 256N.11, subdivision 1;
new text end

new text begin (3) make applications and information on managed care organizations and
fee-for-service providers available to applicants and enrollees according to Title VI of the
Civil Rights Act and federal regulations adopted under that law or any guidance from the
United States Department of Health and Human Services; and
new text end

new text begin (4) make benefit educators available to assist applicants in choosing a managed care
organization or fee-for-service provider.
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 managed care
organization if the enrollee experiences a problem with the managed care organization
or its providers, and appeal rights under section 256.045.
new text end

new text begin Subdivision 1. new text end

new text begin Grant awards. new text end

new text begin The commissioner shall award grants to public or
private organizations to:
new text end

new text begin (1) provide information, in areas of the state with high uninsured populations, on the
importance of maintaining insurance coverage and on how to obtain coverage through
the children's health security program; and
new text end

new text begin (2) monitor and provide ongoing support to ensure enrolled children remain covered.
new text end

new text begin Subd. 2. new text end

new text begin Criteria. new text end

new text begin In awarding the grants, the commissioner shall consider the
following:
new text end

new text begin (1) geographic areas and populations with high uninsured rates;
new text end

new text begin (2) the ability to raise matching funds;
new text end

new text begin (3) the ability to contact, effectively communicate with, or serve eligible populations;
and
new text end

new text begin (4) the applicant's plan to monitor and provide support to ensure enrolled children
remain covered.
new text end

new text begin Subd. 3. new text end

new text begin Monitoring and termination. new text end

new text begin The commissioner shall monitor the grants
and may terminate a grant if the outreach effort does not increase enrollment in the
children's health security program.
new text end