1.1    .................... moves to amend H. F. No. 464 as follows:
1.2Page 1, before line 7, insert:

1.5Page 6, after line 26, insert:


1.8    Section 1. [16A.726] CHILDREN'S HEALTH SECURITY ACCOUNT.
1.9    A children's health security account is created in a special revenue fund in the
1.10state treasury. The commissioner shall deposit to the credit of the account money made
1.11available to the account. Notwithstanding section 11A.20, any investment income
1.12attributable to the investment of the children's health security account not currently needed
1.13shall be credited to the children's health security account.

1.14    Sec. 2. Minnesota Statutes 2006, section 256B.057, subdivision 8, is amended to read:
1.15    Subd. 8. Children under age two. Medical assistance may be paid for a child under
1.16two years of age whose countable family income is above 275 300 percent of the federal
1.17poverty guidelines for the same size family but less than or equal to 280 305 percent of the
1.18federal poverty guidelines for the same size family.
1.19EFFECTIVE DATE.This section is effective July 1, 2008, or upon federal
1.20approval, whichever is later.

1.21    Sec. 3. [256N.01] CITATION.
1.22    This chapter may be cited as the "Children's Health Security Act."

1.23    Sec. 4. [256N.02] DEFINITIONS.
1.24    Subdivision 1. Applicability. The terms used in this chapter have the following
1.25meanings unless otherwise provided for by text.
1.26    Subd. 2. Child. "Child" means an individual under age 21.
2.1    Subd. 3. Commissioner. "Commissioner" means the commissioner of human
2.2services.
2.3    Subd. 4. Dependent child. "Dependent child" means an unmarried child under
2.4age 25 who is claimed as a dependent for federal income tax purposes by a parent,
2.5grandparent, foster parent, relative caretaker, or legal guardian.

2.6    Sec. 5. [256N.03] ESTABLISHMENT.
2.7    The commissioner shall establish the children's health security program. The
2.8commissioner shall begin implementation of the program on July 1, 2008, or upon federal
2.9approval, whichever is later. The children's health security program must comply with
2.10title XIX of the Social Security Act, and waivers granted under title XIX.

2.11    Sec. 6. [256N.05] ELIGIBILITY.
2.12    Subdivision 1. General requirements. Children meeting the eligibility
2.13requirements of this section are eligible for the children's health security program.
2.14    Subd. 2. Income limit. (a) Children in families with gross household incomes equal
2.15to or less than 300 percent of the federal poverty guidelines are eligible for the children's
2.16health security program. In determining gross income, the commissioner shall use the
2.17income methodology applied to children under the MinnesotaCare program.
2.18    (b) Effective July 1, 2008, a dependent child is eligible for state-funded benefits
2.19under this section.
2.20    (c) Effective July 1, 2010, children in families with household incomes in excess of
2.21300 percent of the federal poverty guidelines must be included in the children's health
2.22security program. The requirements for eligibility, the form of the benefits, and other
2.23terms and conditions of the program must be determined by the legislature after receiving
2.24the report of the Legislative Task Force on Children's Health Coverage established under
2.25section 19.
2.26    Subd. 3. Residency. (a) To be eligible for health coverage under the children's
2.27health security program, children must be permanent residents of Minnesota. For purposes
2.28of this requirement, a permanent Minnesota resident is a person who has demonstrated,
2.29through persuasive and objective evidence, that the person is domiciled in the state and
2.30intends to live in the state permanently.
2.31    (b) To be eligible as a permanent resident, an applicant, or the applicant's parent
2.32or guardian as applicable, must demonstrate the requisite intent to live in the state
2.33permanently by:
3.1    (1) showing that the applicant, or the applicant's parent or guardian as applicable,
3.2maintains a residence at a verified address, through the use of evidence of residence
3.3described in paragraph (c); and
3.4    (2) signing an affidavit declaring that the applicant currently resides in the state and
3.5intends to reside in the state permanently, and the applicant did not come to the state for
3.6the primary purpose of obtaining medical coverage or treatment.
3.7    (c) An applicant, or a parent or guardian of an applicant, may verify a residence
3.8address by presenting a valid state driver's license, a state identification card, a voter
3.9registration card, a rent receipt, a statement by the landlord, an apartment or emergency
3.10shelter manager, or a homeowner verifying that the individual is residing at the address, or
3.11other form of verification approved by the commissioner.
3.12    (d) A child who is temporarily absent from the state does not lose eligibility for the
3.13children's health security program. "Temporarily absent from the state" means the person
3.14is out of the state for a temporary purpose and intends to return when the purpose of the
3.15absence has been accomplished. A person is not temporarily absent from the state if
3.16another state has determined that the person is a resident for any purpose. If temporarily
3.17absent from the state, the person must follow the requirements of the health plan in which
3.18the person is enrolled to receive services.
3.19    (e) A child who moved to Minnesota primarily to obtain medical treatment or health
3.20coverage for a preexisting condition is not a permanent resident.
3.21    Subd. 4. Enrollment voluntary. Enrollment in the children's health security
3.22program is voluntary. Parents or guardians may retain private sector or Medicare coverage
3.23for a child as the sole source of coverage. Parents or guardians who have private sector or
3.24Medicare coverage for children may also enroll children in the children's health security
3.25program. If private sector or Medicare coverage is available, coverage under the children's
3.26health security program is secondary to the private sector or Medicare coverage.
3.27    Subd. 5. Emergency services. Payment must be made for care and services that
3.28are furnished to noncitizens, regardless of immigration status, who otherwise meet the
3.29eligibility requirements of this chapter, if the care and services are necessary for the
3.30treatment of an emergency medical condition, except for organ transplants and related
3.31care and services and routine prenatal care. For purposes of this subdivision, "emergency
3.32medical condition" means a medical condition that meets the requirements of United
3.33States Code, title 42, section 1396b(v).
3.34    Subd. 6. Medical assistance standards and procedures. (a) Unless otherwise
3.35specified in this chapter, the commissioner shall use medical assistance procedures and
4.1methodology when determining initial eligibility and redetermining eligibility for the
4.2children's health security program.
4.3    (b) The procedures and income standard specified in section 256B.056, subdivisions
4.45 and 5c, paragraph (a), apply to children who would be eligible for the children's health
4.5security program, except for excess income.
4.6    (c) Retroactive coverage for the children's health security program must be provided
4.7as specified in section 256B.056, subdivision 7.

4.8    Sec. 7. [256N.07] COVERED SERVICES.
4.9    Covered services under the children's health security program must consist of all
4.10covered services under chapter 256B.

4.11    Sec. 8. [256N.09] NO ENROLLEE PREMIUMS OR COST SHARING.
4.12    In order to ensure broad access to coverage, the children's health security program
4.13has no enrollee premium or cost-sharing requirements.

4.14    Sec. 9. [256N.11] APPLICATION PROCEDURES; ELIGIBILITY
4.15DETERMINATION.
4.16    Subdivision 1. Application procedure. The application form for the program
4.17must be easily understandable and must not exceed two pages in length. Applications for
4.18the program must be made available to provider offices, local human services agencies,
4.19school districts, schools, community health offices, and other sites willing to cooperate in
4.20program outreach. These sites may accept applications and forward applications to the
4.21commissioner. Applications may also be made directly to the commissioner.
4.22    Subd. 2. Eligibility determination. The commissioner shall determine an
4.23applicant's eligibility for the program within 30 days of the date the application is received
4.24by the commissioner, according to the procedures set forth in Code of Federal Regulations,
4.25title 42, section 435.911.
4.26    Subd. 3. Presumptive eligibility. Coverage under the program is available during a
4.27presumptive eligibility period for children under age 19 whose family income does not
4.28exceed the applicable income standard. The presumptive eligibility period begins on the
4.29date on which a health care provider enrolled in the program, or other entity designated by
4.30the commissioner, determines, based on preliminary information, that the child's family
4.31income does not exceed the applicable income standard. The presumptive eligibility period
4.32ends the earlier of the day on which a determination is made of eligibility under this section
4.33or the last day of the month following the month presumptive eligibility was determined.
4.34    Subd. 4. Renewal of eligibility. The commissioner shall require enrollees to renew
4.35eligibility every 12 months.
5.1    Subd. 5. Continuous eligibility. Children under the age of 19 who are eligible
5.2under this section shall be continuously eligible until the earlier of the next renewal period,
5.3or the time that a child exceeds age 19.

5.4    Sec. 10. [256N.12] COUNTY ROLE.
5.5    Counties may choose to determine eligibility under section 256N.11, provide
5.6assistance to applicants under section 256N.17, subdivision 1, and provide ombudsperson
5.7services under section 256N.17, subdivision 2. This must not limit the ability of the
5.8commissioner to establish reasonable staffing standards that relate to the number of
5.9persons served, and that provide a county option to hire part-time staff or pursue
5.10multicounty implementation models. If a county chooses not to deliver these services,
5.11they must be delivered by the commissioner. If as a result of state assumption of these
5.12roles, county staff with expertise and experience in these areas are laid off, they must be
5.13given hiring consideration by the commissioner in staffing these functions within the
5.14Department of Human Services. State and federal funding to support these services must
5.15be the same, whether delivered by the state or by a county or group of counties.

5.16    Sec. 11. [256N.13] SERVICE DELIVERY.
5.17    Subdivision 1. Contracts for service delivery. The commissioner, within each
5.18county, may contract with managed care organizations, including health maintenance
5.19organizations licensed under chapter 62D, community integrated service networks licensed
5.20under chapter 62N, accountable provider networks licensed under chapter 62T, and
5.21county-based purchasing plans established under section 256B.692, to provide covered
5.22health care services to program enrollees under a managed care system, and may contract
5.23with health care and social service providers to provide services on a fee-for-service basis.
5.24Section 256B.69, subdivision 26, applies to contracts with managed care organizations. In
5.25determining the method for service delivery, the commissioner shall consider the cost and
5.26quality of health care services; the breadth of services offered, including medical, dental
5.27and mental health services; the breadth of choice of medical providers for enrollees; the
5.28ease of access to quality medical care for enrollees; the efficiency and cost-effectiveness of
5.29service delivery; and the integration of best medical practice standards into the children's
5.30health security program.
5.31    Subd. 2. Managed care organization requirements. (a) Managed care
5.32organizations under contract are responsible for coordinating covered health care services
5.33provided to eligible individuals. Managed care organizations under contract:
5.34    (1) shall authorize and arrange for the provision of all needed covered health
5.35services under chapter 256B, with the exception of services available only under a medical
6.1assistance home and community-based waiver, in order to ensure appropriate health care
6.2is delivered to enrollees;
6.3    (2) shall comply with the requirements of section 256B.69, subdivision 26;
6.4    (3) shall accept the prospective, per capita payment from the commissioner in return
6.5for the provision of comprehensive and coordinated health care services for enrollees;
6.6    (4) may contract with health care and social service providers to provide covered
6.7services to enrollees; and
6.8    (5) shall institute enrollee grievance procedures according to the method established
6.9by the commissioner, utilizing applicable requirements of chapter 62D and Code of
6.10Federal Regulations, title 42, section 438, subpart F. Disputes may also be appealed to
6.11the commissioner using the procedures in section 256.045.
6.12    (b) Upon implementation of the children's health security program, the commissioner
6.13shall withhold five percent of managed care organization payments pending completion of
6.14performance targets, including lead screening, well child services, immunizations, vision
6.15screening, and customer service performance targets. Effective for services rendered on
6.16or after January 1, 2010, the commissioner shall increase the withhold by an additional
6.17two percent, for a total withhold of seven percent of managed care organization payments
6.18and shall add treatment of asthma and screening for mental health as new performance
6.19targets. Each performance target must apply uniformly to all managed care organizations,
6.20and be qualitative, objective, measurable, and reasonably attainable, except in the case of
6.21a performance target based on federal or state law or rule. Criteria for assessment of each
6.22performance target must be outlined in writing prior to the contract effective date. The
6.23withhold funds must be returned no sooner than July of the following year if performance
6.24targets in the contract are achieved. The success of each managed care organization in
6.25reaching performance targets must be reported to the legislature annually.
6.26    Subd. 3. Fee-for-service delivery. Disputes related to services provided under
6.27the fee-for-service system may be appealed to the commissioner using the procedures
6.28in section 256.045.
6.29    Subd. 4. Contracts for waiver services. The commissioner, when services
6.30are delivered through managed care, may contract with health care and social service
6.31providers on a fee-for-service basis to provide program enrollees with covered services
6.32available only under a medical assistance home and community-based waiver. The
6.33commissioner shall determine eligibility for home and community-based waiver services
6.34using the criteria and procedures in chapter 256B. Disputes related to services provided
6.35on a fee-for-service basis may be appealed to the commissioner using the procedures
6.36in section 256.045.
7.1    Subd. 5. Service delivery for Minnesota disabilities health option recipient.
7.2    Individuals who voluntarily enroll in the Minnesota Disability Health Option (MnDHO),
7.3established under section 256B.69, subdivision 23, shall continue to receive their home
7.4and community-based waiver services through MnDHO.
7.5    Subd. 6. Disabled or blind children. Children eligible for medical assistance due
7.6to blindness or disability as determined by the Social Security Administration or the state
7.7medical review team are exempt from enrolling in a managed care organization and shall
7.8be provided health benefits on a fee-for-service basis.

7.9    Sec. 12. [256N.15] PAYMENT RATES.
7.10    Subdivision 1. Establishment. The commissioner, in consultation with a health
7.11care actuary, shall establish the method and amount of payments for services. The
7.12commissioner shall annually contract with eligible entities to provide services to program
7.13enrollees. The commissioner, in consultation with the Risk Adjustment Association
7.14established under section 62Q.03, subdivision 6, shall develop and implement a risk
7.15adjustment system for the program.
7.16    Subd. 2. Provider rates. In establishing the payment amount under subdivision
7.171, the commissioner shall ensure that fee-for-service payment rates for preventative care
7.18services provided on or after July 1, 2008, are at least five percent above the medical
7.19assistance rates for preventative services in effect on June 30, 2008, and shall ensure that
7.20fee-for-service payment rates for all other services provided on or after July 1, 2008, are at
7.21least three percent above the medical assistance rates for those services in effect on June
7.2230, 2008. The commissioner shall adjust managed care capitation rates to reflect these
7.23increases, and shall require managed care organizations, as a condition of contract, to pass
7.24these increases on to providers under contract.
7.25    Subd. 3. Performance rate bonus. The commissioner shall establish a care
7.26coordination performance target bonus plan for fee-for-service providers and providers
7.27under contract with a managed care organization to serve program clients. The plan
7.28shall establish care coordination and preventative care performance targets for providers.
7.29The performance targets must be qualitative, objective, and measurable. Criteria for
7.30assessment of each performance target must be outlined in writing prior to the contract
7.31effective date. Providers shall submit to the commissioner by March 1 of each year
7.32information specified by the commissioner that demonstrates the provider has met the
7.33performance targets for the prior year. If the commissioner determines the provider has
7.34satisfied the performance targets, the commissioner shall pay directly to the provider a
7.35care coordination performance bonus equal to one and one-half percent of all payments
8.1for services under the children's health security program made to that provider during the
8.2prior year. Managed care organizations shall provide to the commissioner, in the form
8.3and manner specified by the commissioner, all information necessary to implement the
8.4performance target bonus plan for providers under contract.

8.5    Sec. 13. [256N.17] CONSUMER ASSISTANCE.
8.6    Subdivision 1. Assistance to applicants. The commissioner shall assist applicants
8.7in choosing a managed care organization or fee-for-service provider by:
8.8    (1) establishing a Web site to provide information about managed care organizations
8.9and fee-for-service providers and to allow online enrollment;
8.10    (2) make information on managed care organizations and fee-for-service providers
8.11available at the sites specified in section 256N.11, subdivision 1;
8.12    (3) make applications and information on managed care organizations and
8.13fee-for-service providers available to applicants and enrollees according to Title VI of the
8.14Civil Rights Act and federal regulations adopted under that law or any guidance from the
8.15United States Department of Health and Human Services; and
8.16    (4) make benefit educators available to assist applicants in choosing a managed care
8.17organization or fee-for-service provider.
8.18    Subd. 2. Ombudsperson. The commissioner shall designate an ombudsperson
8.19to advocate for children enrolled in the children's health security program. The
8.20ombudsperson shall assist enrollees in understanding and making use of complaint and
8.21appeal procedures and ensure that necessary medical services are provided to enrollees. At
8.22the time of enrollment, the commissioner shall inform enrollees about the ombudsperson
8.23program, the right to a resolution of the enrollee's complaint by the managed care
8.24organization if the enrollee experiences a problem with the managed care organization
8.25or its providers, and appeal rights under section 256.045.

8.26    Sec. 14. [256N.19] MONITORING AND EVALUATION OF QUALITY AND
8.27COSTS.
8.28    (a) The commissioner, as a condition of contract, shall require each participating
8.29managed care organization and participating provider to submit, in the form and manner
8.30specified by the commissioner, data required for assessing enrollee satisfaction, quality
8.31of care, cost, and utilization of services. The commissioner shall evaluate this data, in
8.32order to:
8.33    (1) make summary information on the quality of care across managed care
8.34organizations, medical clinics, and providers available to consumers;
9.1    (2) require managed care organizations and providers, as a condition of contract, to
9.2implement quality improvement plans; and
9.3    (3) compare the cost and quality of services under the program to the cost and
9.4quality of services provided to private sector enrollees.
9.5    (b) The commissioner shall implement this section to the extent allowed by federal
9.6and state laws on data privacy.

9.7    Sec. 15. [256N.21] FEDERAL APPROVAL.
9.8    The commissioner shall seek all federal waivers and approvals necessary to
9.9implement this chapter including, but not limited to, waivers and approvals necessary to:
9.10    (1) coordinate medical assistance and MinnesotaCare coverage for children with the
9.11children's health security program;
9.12    (2) use federal medical assistance and MinnesotaCare dollars to pay for health care
9.13services under the children's health security program;
9.14    (3) maximize receipt of the federal medical assistance match for covered children,
9.15by increasing income standards through the use of more liberal income methodologies as
9.16provided under United States Code, title 42, sections 1396a and 1396u-1;
9.17    (4) extend presumptive eligibility and continuous eligibility to children under age
9.1821; and
9.19    (5) use federal medical assistance and MinnesotaCare dollars to provide benefits to
9.20dependent children.

9.21    Sec. 16. [256N.23] RULEMAKING.
9.22    The commissioner shall adopt rules to implement this chapter.

9.23    Sec. 17. [256N.25] CHILDREN'S HEALTH SECURITY PROGRAM
9.24OUTREACH.
9.25    Subdivision 1. Grant awards. The commissioner shall award grants to public or
9.26private organizations to:
9.27    (1) provide information, in areas of the state with high uninsured populations, on the
9.28importance of maintaining insurance coverage and on how to obtain coverage through
9.29the children's health security program; and
9.30    (2) monitor and provide ongoing support to ensure enrolled children remain covered.
9.31    Subd. 2. Criteria. In awarding the grants, the commissioner shall consider the
9.32following:
9.33    (1) geographic areas and populations with high uninsured rates;
9.34    (2) the ability to raise matching funds;
10.1    (3) the ability to contact, effectively communicate with, or serve eligible populations;
10.2and
10.3    (4) the applicant's plan to monitor and provide support to ensure enrolled children
10.4remain covered.
10.5    Subd. 3. Monitoring and termination. The commissioner shall monitor the grants
10.6and may terminate a grant if the outreach effort does not increase enrollment in the
10.7children's health security program.

10.8    Sec. 18. IMPLEMENTATION PLAN.
10.9    The commissioner of human services shall develop an implementation plan for
10.10the children's health security coverage program, which includes a health delivery plan
10.11based on the criteria specified in Minnesota Statutes, section 256N.13, subdivision 1.
10.12The commissioner shall present this plan, any necessary draft legislation, and a draft
10.13of proposed rules to the legislature by December 15, 2007. The plan must include
10.14recommendations for any additional legislative changes necessary to merge medical
10.15assistance and MinnesotaCare coverage for children into the children's health security
10.16program. The commissioner shall evaluate the provision of services under the program
10.17to children with disabilities and shall present recommendations to the legislature by
10.18December 15, 2009, for any program changes necessary to ensure the quality and
10.19continuity of care.

10.20    Sec. 19. LEGISLATIVE TASK FORCE ON CHILDREN'S HEALTH CARE
10.21COVERAGE.
10.22    Subdivision 1. Establishment; membership. (a) The Legislative Task Force on
10.23Children's Health Care Coverage is established. The task force is made up of ten voting
10.24members and six nonvoting members.
10.25    (b) The voting members are:
10.26    (1) five members of the house of representatives, of whom three members must
10.27be appointed by the speaker of the house of representatives and two members must be
10.28appointed by the minority leader of the house of representatives; and
10.29    (2) five members of the senate, of whom three members must be appointed by
10.30the majority leader of the senate and two members appointed by the minority leader
10.31of the senate.
10.32    (c) The nonvoting members are one representative selected by each of the following
10.33organizations:
10.34    (1) the American Academy of Pediatrics, Minnesota Chapter;
10.35    (2) the Minnesota Nurses Association;
11.1    (3) the Minnesota Council of Health Plans;
11.2    (4) the Minnesota Children's Platform Coalition;
11.3    (5) the Minnesota Universal Health Care Coalition; and
11.4    (6) the Minnesota Business Partnership.
11.5    (d) The task force members must be appointed by September 1, 2007. The majority
11.6leader of the senate and the speaker of the house of representatives must each designate
11.7a chair from their appointments. The chair appointed by the speaker of the house of
11.8representatives shall convene and chair the first meeting of the task force. The chair
11.9appointed by the majority leader of the senate shall chair the next meeting of the task
11.10force. The chairs shall then alternate for the duration of the task force.
11.11    Subd. 2. Study; staff support. (a) The task force shall study viable options to extend
11.12coverage to all children as provided in Minnesota Statutes, section 256N.05, subdivision
11.132, paragraph (c), and provide recommendations to the legislature. The study must:
11.14    (1) evaluate methods to achieve universal coverage for children, including, but not
11.15limited to, changes to the employer-based coverage system and an expansion of eligibility
11.16for the children's health security program established under Minnesota Statutes, chapter
11.17256N;
11.18    (2) examine health care reform and cost containment methods that will contain costs
11.19and increase access and improve health outcomes;
11.20    (3) examine how to increase access to preventive care and health care services; and
11.21    (4) examine how to reduce health disparities among minority populations.
11.22    (b) The task force, through the Legislative Coordinating Commission, may hire staff
11.23or contract for staff support for the study.
11.24    (c) The task force, in developing recommendations, shall hold meetings to hear
11.25public testimony at locations throughout the state, including locations outside of the
11.26seven-county metropolitan area.
11.27    Subd. 3. Recommendations. The task force shall report its recommendations to
11.28the legislature by December 15, 2008. Recommendations must be consistent with the
11.29following criteria:
11.30    (1) health care coverage must include preventive care and all other medically
11.31necessary services;
11.32    (2) health care coverage must be affordable for families, with the family share of
11.33premium costs and cost-sharing in total not exceeding five percent of family income;
11.34    (3) the system of coverage must give priority to ensuring access to and the quality
11.35and continuity of care; and
11.36    (4) enrollment must be simple and seamless for families.
12.1    Subd. 4. Expiration. This section expires December 16, 2008.

12.2    Sec. 20. APPROPRIATION.
12.3    (a) $....... is appropriated from the general fund to the commissioner of human
12.4services for the biennium ending June 30, 2009, to develop and implement the Children's
12.5Health Security Act under Minnesota Statutes, chapter 256N.
12.6    (b) $....... is appropriated from the health care access fund to the commissioner of
12.7human services for the biennium ending June 30, 2009, to develop and implement the
12.8Children's Health Security Act under Minnesota Statutes, chapter 256N.
12.9    (c) $....... is appropriated from the general fund to the Legislative Coordinating
12.10Commission for the biennium ending June 30, 2009, for staff support provided to the
12.11Legislative Task Force on Children's Health Care Coverage."
12.12Renumber the sections in sequence and correct the internal references
12.13Amend the title accordingly