Bill Text: MN SF2574 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Home and community based service providers family deductible under medical assistance (MA) exemption
Sponsorship: Moderate Partisan Bill (Republican 4-1)
Status: (Introduced - Dead) 2014-03-12 - Referred to Health, Human Services and Housing [SF2574 Detail]
Download: Minnesota-2013-SF2574-Introduced.html
1.2relating to human services; exempting services provided by providers licensed
1.3under Minnesota Statutes, chapter 245D, from the family deductible under
1.4medical assistance;amending Minnesota Statutes 2012, section 256B.0631,
1.5subdivision 2; Minnesota Statutes 2013 Supplement, section 256B.0631,
1.6subdivision 1.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2013 Supplement, section 256B.0631, subdivision 1,
1.9is amended to read:
1.10 Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
1.11assistance benefit plan shall include the following cost-sharing for all recipients, effective
1.12for services provided on or after September 1, 2011:
1.13 (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
1.14of this subdivision, a visit means an episode of service which is required because of
1.15a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
1.16ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
1.17midwife, advanced practice nurse, audiologist, optician, or optometrist;
1.18 (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
1.19this co-payment shall be increased to $20 upon federal approval;
1.20 (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
1.21subject to a $12 per month maximum for prescription drug co-payments. No co-payments
1.22shall apply to antipsychotic drugs when used for the treatment of mental illness;
1.23(4) effective January 1, 2012, a family deductible equal to the maximum amount
1.24allowed under Code of Federal Regulations, title 42, part 447.54; and
2.1 (5) for individuals identified by the commissioner with income at or below 100
2.2percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
2.3percent of family income. For purposes of this paragraph, family income is the total
2.4earned and unearned income of the individual and the individual's spouse, if the spouse is
2.5enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
2.6 (b) Recipients of medical assistance are responsible for all co-payments and
2.7deductibles in this subdivision.
2.8(c) Notwithstanding paragraph (b), the commissioner, through the contracting
2.9process under sections256B.69 and
256B.692 , may allow managed care plans and
2.10county-based purchasing plans to waive the family deductible under paragraph (a),
2.11clause (4). The value of the family deductible shall not be included in the capitation
2.12payment to managed care plans and county-based purchasing plans. Managed care plans
2.13and county-based purchasing plans shall certify annually to the commissioner the dollar
2.14value of the family deductible.
2.15(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
2.16the family deductible described under paragraph (a), clause (4), from individuals and
2.17allow long-term careand waivered service providers to assume responsibility for payment.
2.18(e) Notwithstanding paragraph (b), the commissioner, through the contracting
2.19process under section256B.0756 shall allow the pilot program in Hennepin County to
2.20waive co-payments. The value of the co-payments shall not be included in the capitation
2.21payment amount to the integrated health care delivery networks under the pilot program.
2.22 Sec. 2. Minnesota Statutes 2012, section 256B.0631, subdivision 2, is amended to read:
2.23 Subd. 2. Exceptions. Co-payments and deductibles shall be subject to the following
2.24exceptions:
2.25(1) children under the age of 21;
2.26(2) pregnant women for services that relate to the pregnancy or any other medical
2.27condition that may complicate the pregnancy;
2.28(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
2.29intermediate care facility for the developmentally disabled;
2.30(4) recipients receiving hospice care;
2.31(5) 100 percent federally funded services provided by an Indian health service;
2.32(6) emergency services;
2.33(7) family planning services;
2.34(8) services that are paid by Medicare, resulting in the medical assistance program
2.35paying for the coinsurance and deductible;
3.1(9) co-payments that exceed one per day per provider for nonpreventive visits,
3.2eyeglasses, and nonemergency visits to a hospital-based emergency room;and
3.3(10) services, fee-for-service payments subject to volume purchase through
3.4competitive bidding; and
3.5(11) services provided by providers licensed under chapter 245D.
1.3under Minnesota Statutes, chapter 245D, from the family deductible under
1.4medical assistance;amending Minnesota Statutes 2012, section 256B.0631,
1.5subdivision 2; Minnesota Statutes 2013 Supplement, section 256B.0631,
1.6subdivision 1.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2013 Supplement, section 256B.0631, subdivision 1,
1.9is amended to read:
1.10 Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
1.11assistance benefit plan shall include the following cost-sharing for all recipients, effective
1.12for services provided on or after September 1, 2011:
1.13 (1) $3 per nonpreventive visit
1.14of this subdivision, a visit means an episode of service which is required because of
1.15a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
1.16ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
1.17midwife, advanced practice nurse, audiologist, optician, or optometrist;
1.18 (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
1.19this co-payment shall be increased to $20 upon federal approval;
1.20 (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
1.21subject to a $12 per month maximum for prescription drug co-payments. No co-payments
1.22shall apply to antipsychotic drugs when used for the treatment of mental illness;
1.23(4) effective January 1, 2012, a family deductible equal to the maximum amount
1.24allowed under Code of Federal Regulations, title 42, part 447.54; and
2.1 (5) for individuals identified by the commissioner with income at or below 100
2.2percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
2.3percent of family income. For purposes of this paragraph, family income is the total
2.4earned and unearned income of the individual and the individual's spouse, if the spouse is
2.5enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
2.6 (b) Recipients of medical assistance are responsible for all co-payments and
2.7deductibles in this subdivision.
2.8(c) Notwithstanding paragraph (b), the commissioner, through the contracting
2.9process under sections
2.10county-based purchasing plans to waive the family deductible under paragraph (a),
2.11clause (4). The value of the family deductible shall not be included in the capitation
2.12payment to managed care plans and county-based purchasing plans. Managed care plans
2.13and county-based purchasing plans shall certify annually to the commissioner the dollar
2.14value of the family deductible.
2.15(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
2.16the family deductible described under paragraph (a), clause (4), from individuals and
2.17allow long-term care
2.18(e) Notwithstanding paragraph (b), the commissioner, through the contracting
2.19process under section
2.20waive co-payments. The value of the co-payments shall not be included in the capitation
2.21payment amount to the integrated health care delivery networks under the pilot program.
2.22 Sec. 2. Minnesota Statutes 2012, section 256B.0631, subdivision 2, is amended to read:
2.23 Subd. 2. Exceptions. Co-payments and deductibles shall be subject to the following
2.24exceptions:
2.25(1) children under the age of 21;
2.26(2) pregnant women for services that relate to the pregnancy or any other medical
2.27condition that may complicate the pregnancy;
2.28(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
2.29intermediate care facility for the developmentally disabled;
2.30(4) recipients receiving hospice care;
2.31(5) 100 percent federally funded services provided by an Indian health service;
2.32(6) emergency services;
2.33(7) family planning services;
2.34(8) services that are paid by Medicare, resulting in the medical assistance program
2.35paying for the coinsurance and deductible;
3.1(9) co-payments that exceed one per day per provider for nonpreventive visits,
3.2eyeglasses, and nonemergency visits to a hospital-based emergency room;
3.3(10) services, fee-for-service payments subject to volume purchase through
3.4competitive bidding; and
3.5(11) services provided by providers licensed under chapter 245D.
