1.1    .................... moves to amend H.F. No. 1 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. [16A.726] CHILDREN'S HEALTH SECURITY ACCOUNT.
1.4    A children's health security account is created in a special revenue fund in the
1.5state treasury. The commissioner shall deposit to the credit of the account money made
1.6available to the account. Notwithstanding section 11A.20, any investment income
1.7attributable to the investment of the children's health security account not currently needed
1.8shall be credited to the children's health security account.

1.9    Sec. 2. Minnesota Statutes 2006, section 256B.057, subdivision 8, is amended to read:
1.10    Subd. 8. Children under age two. Medical assistance may be paid for a child under
1.11two years of age whose countable family income is above 275 300 percent of the federal
1.12poverty guidelines for the same size family but less than or equal to 280 305 percent of the
1.13federal poverty guidelines for the same size family.
1.14EFFECTIVE DATE.This section is effective July 1, 2008, or upon federal
1.15approval, whichever is later.

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

1.18    Sec. 4. [256N.02] DEFINITIONS.
1.19    Subdivision 1. Applicability. The terms used in this chapter have the following
1.20meanings unless otherwise provided for by text.
1.21    Subd. 2. Child. "Child" means an individual under age 21.
1.22    Subd. 3. Commissioner. "Commissioner" means the commissioner of human
1.23services.
2.1    Subd. 4. Dependent student. "Dependent student" means an unmarried full-time
2.2student under age 25 who is claimed as a dependent for federal income tax purposes by a
2.3parent, grandparent, foster parent, relative caretaker, or legal guardian.

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

2.9    Sec. 6. [256N.05] ELIGIBILITY.
2.10    Subdivision 1. General requirements. Children meeting the eligibility
2.11requirements of this section are eligible for the children's health security program.
2.12    Subd. 2. Income limit. (a) Children in families with gross household incomes equal
2.13to or less than 300 percent of the federal poverty guidelines are eligible for the children's
2.14health security program. In determining gross income, the commissioner shall use the
2.15income methodology applied to children under the MinnesotaCare program.
2.16    (b) Effective July 1, 2008, a dependent student is eligible for state-funded benefits
2.17under this section.
2.18    (c) Effective July 1, 2010, children in families with household incomes of in excess
2.19of 300 percent of the federal poverty guidelines shall be included in the children's health
2.20security program. The requirements for eligibility, the form of the benefits, and other
2.21terms and conditions of the program shall be determined by the legislature after receiving
2.22the report of the Legislative Task Force on Children's Health Coverage established under
2.23section 18.
2.24    Subd. 3. Residency. (a) To be eligible for health coverage under the children's
2.25health security program, children must be permanent residents of Minnesota. For purposes
2.26of this requirement, a permanent Minnesota resident is a person who has demonstrated,
2.27through persuasive and objective evidence, that the person is domiciled in the state and
2.28intends to live in the state permanently.
2.29(b) To be eligible as a permanent resident, an applicant, or the applicant's parent
2.30or guardian as applicable, must demonstrate the requisite intent to live in the state
2.31permanently by:
2.32(1) showing that the applicant, or the applicant's parent or guardian as applicable,
2.33maintains a residence at a verified address, through the use of evidence of residence
2.34described in paragraph (c); and
3.1(2) signing an affidavit declaring that the applicant currently resides in the state and
3.2intends to reside in the state permanently, and the applicant did not come to the state for
3.3the primary purpose of obtaining medical coverage or treatment.
3.4(c) An applicant, or a parent or guardian of an applicant, may verify a residence
3.5address by presenting a valid state driver's license, a state identification card, a voter
3.6registration card, a rent receipt, a statement by the landlord, apartment or emergency
3.7shelter manager, or homeowner verifying that the individual is residing at the address, or
3.8other form of verification approved by the commissioner.
3.9(d) A child who is temporarily absent from the state does not lose eligibility for the
3.10children's health security program. "Temporarily absent from the state" means the person
3.11is out of the state for a temporary purpose and intends to return when the purpose of the
3.12absence has been accomplished. A person is not temporarily absent from the state if
3.13another state has determined that the person is a resident for any purpose. If temporarily
3.14absent from the state, the person must follow the requirements of the health plan in which
3.15the person is enrolled to receive services.
3.16(e) A child who moved to Minnesota primarily to obtain medical treatment or health
3.17coverage for a preexisting condition is not a permanent resident.
3.18    Subd. 4. Enrollment voluntary. Enrollment in the children's health security
3.19program is voluntary. Parents or guardians may retain private sector or Medicare coverage
3.20for a child as the sole source of coverage. Parents or guardians who have private sector or
3.21Medicare coverage for children may also enroll children in the children's health security
3.22program. If private sector or Medicare coverage is available, coverage under the children's
3.23health security program is secondary to the private sector or Medicare coverage.
3.24    Subd. 5. Emergency services. Payment shall be made for care and services that
3.25are furnished to noncitizens, regardless of immigration status, who otherwise meet the
3.26eligibility requirements of this chapter, if such care and services are necessary for the
3.27treatment of an emergency medical condition, except for organ transplants and related
3.28care and services and routine prenatal care. For purposes of this subdivision, the term
3.29"emergency medical condition" means a medical condition that meets the requirements of
3.30United States Code, Title 42, section 1396b(v).
3.31    Subd. 6. Medical assistance standards and procedures. (a) Unless otherwise
3.32specified in this chapter, the commissioner shall use medical assistance procedures and
3.33methodology when determining eligibility for the children's health security program.
4.1(b) The procedures and income standard specified in section 256B.056, subdivisions
4.25 and 5c, paragraph (a), apply to children who would be eligible for the children's health
4.3security program, except for excess income.
4.4(c) Retroactive coverage for the children's health security program shall be provided
4.5as specified in section 256B.056, subdivision 7.

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

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

4.12    Sec. 9. [256N.11] APPLICATION PROCEDURES; ELIGIBILITY
4.13DETERMINATION.
4.14    Subdivision 1. Application procedure. The application form for the program
4.15must be easily understandable and must not exceed two pages in length. Applications for
4.16the program must be made available to provider offices, local human services agencies,
4.17school districts, schools, community health offices, and other sites willing to cooperate in
4.18program outreach. These sites may accept applications and forward applications to the
4.19commissioner. Applications may also be made directly to the commissioner.
4.20    Subd. 2. Eligibility determination. The commissioner shall determine an
4.21applicant's eligibility for the program within 30 days of the date the application is received
4.22by the commissioner, according to the procedures set forth in 42 Code of Federal
4.23Regulations, section 435.911. The commissioner shall determine the most efficient and
4.24effective administrative agency to process applications.
4.25    Subd. 3. Presumptive eligibility. Coverage under the program is available during a
4.26presumptive eligibility period for children under age 19 whose family income does not
4.27exceed the applicable income standard. The presumptive eligibility period begins on the
4.28date on which a health care provider enrolled in the program, or other entity designated by
4.29the commissioner, determines, based on preliminary information, that the child's family
4.30income does not exceed the applicable income standard. The presumptive eligibility period
4.31ends the earlier of the day on which a determination is made of eligibility under this section
4.32or the last day of the month following the month presumptive eligibility was determined.
4.33    Subd. 4. Renewal of eligibility. The commissioner shall require enrollees to renew
4.34eligibility every 12 months using a passive renewal process. The commissioner shall
4.35send a form to each enrollee that contains eligibility information for that individual. If
5.1the eligibility information on the form is correct, the enrollee can maintain eligibility for
5.2another 12 months without returning the form to the commissioner. If the eligibility
5.3information on the form is not correct, the enrollee must return the form with corrected
5.4information to the commissioner, and the commissioner shall redetermine eligibility for
5.5the enrollee on the basis of the corrected information.
5.6    Subd. 5. Continuous eligibility. Children under the age of 19 who are eligible
5.7under this section shall be continuously eligible until the earlier of the next renewal period,
5.8or the time that a child exceeds age 19.

5.9    Sec. 10. [256N.13] SERVICE DELIVERY.
5.10    Subdivision 1. Contracts for service delivery. The commissioner, within each
5.11county, may contract with managed care organizations, including health maintenance
5.12organizations licensed under chapter 62D, community integrated service networks licensed
5.13under chapter 62N, accountable provider networks licensed under chapter 62T, and
5.14county-based purchasing plans established under section 256B.692, to provide covered
5.15health care services to program enrollees under a managed care system, and may contract
5.16with health care and social service providers to provide services on a fee-for-service basis.
5.17Section 256B.69, subdivision 26, applies to contracts with managed care organizations. In
5.18determining the method for service delivery, the commissioner shall consider the cost and
5.19quality of health care services, the breadth of services offered, including medical, dental
5.20and mental health services, the breadth of choice of medical providers for enrollees, the
5.21ease of access to quality medical care for enrollees, the efficiency and cost-effectiveness of
5.22service delivery, and the integration of best medical practice standards into the children's
5.23health security program.
5.24    Subd. 2. Managed care organization requirements. (a) Managed care
5.25organizations under contract are responsible for coordinating covered health care services
5.26provided to eligible individuals. Managed care organizations under contract:
5.27    (1) shall authorize and arrange for the provision of all needed covered health
5.28services under chapter 256B, with the exception of services available only under a medical
5.29assistance home and community-based waiver, in order to ensure appropriate health care
5.30is delivered to enrollees;
5.31(2) shall comply with the requirements of section 256B.69, subdivision 26;
5.32    (3) shall accept the prospective, per capita payment from the commissioner in return
5.33for the provision of comprehensive and coordinated health care services for enrollees;
5.34    (4) may contract with health care and social service providers to provide covered
5.35services to enrollees; and
6.1    (5) shall institute enrollee grievance procedures according to the method established
6.2by the commissioner, utilizing applicable requirements of chapter 62D and 42 C.F.R.,
6.3section 438, subpart F. Disputes may also be appealed to the commissioner using the
6.4procedures in section 256.045.
6.5    (b) Upon implementation of the children's health security program, the commissioner
6.6shall withhold five percent of managed care organization payments pending completion of
6.7performance targets, including lead screening, well child services, immunizations, vision
6.8screening and customer service performance targets. Effective for services rendered on
6.9or after January 1, 2010, the commissioner shall increase the withhold by an additional
6.10two percent, for a total withhold of seven percent of managed care organization payments
6.11and shall add treatment of asthma and screening for mental health as new performance
6.12targets. Each performance target must apply uniformly to all managed care organizations,
6.13and be qualitative, objective, measurable, and reasonably attainable, except in the case of
6.14a performance target based on federal or state law or rule. Criteria for assessment of each
6.15performance target must be outlined in writing prior to the contract effective date. The
6.16withhold funds must be returned no sooner than July of the following year if performance
6.17targets in the contract are achieved. The success of each managed care organization in
6.18reaching performance targets shall be reported to the legislature annually.
6.19    Subd. 3. Fee-for-service delivery. Disputes related to services provided under
6.20the fee-for-service system may be appealed to the commissioner using the procedures
6.21in section 256.045.
6.22    Subd. 4. Contracts for waiver services. The commissioner, when services
6.23are delivered through managed care, may contract with health care and social service
6.24providers, on a fee-for-service basis, to provide program enrollees with covered services
6.25available only under a medical assistance home and community-based waiver. The
6.26commissioner shall determine eligibility for home and community-based waiver services
6.27using the criteria and procedures in chapter 256B. Disputes related to services provided
6.28on a fee-for-service basis may be appealed to the commissioner using the procedures
6.29in section 256.045.
6.30    Subd. 5. Service delivery for Minnesota disabilities health option recipient.
6.31    Individuals who voluntarily enroll in the Minnesota Disability Health Option (MnDHO),
6.32established under section 256B.69, subdivision 23, shall continue to receive their home
6.33and community-based waiver services through MnDHO.
6.34    Subd. 6. Disabled or blind children. Children eligible for medical assistance due
6.35to blindness or disability as determined by the Social Security Administration or the state
7.1medical review team are exempt from enrolling in a managed care organization and shall
7.2be provided health benefits on a fee-for-service basis.

7.3    Sec. 11. [256N.15] PAYMENT RATES.
7.4    Subdivision 1. Establishment. The commissioner, in consultation with a health
7.5care actuary, shall establish the method and amount of payments for services. The
7.6commissioner shall annually contract with eligible entities to provide services to program
7.7enrollees. The commissioner, in consultation with the risk adjustment association
7.8established under section 62Q.03, subdivision 6, shall develop and implement a risk
7.9adjustment system for the program.
7.10    Subd. 2. Provider rates. In establishing the payment amount under subdivision
7.111, the commissioner shall ensure that fee-for-service payment rates for preventative care
7.12services provided on or after July 1, 2008, are at least five percent above the medical
7.13assistance rates for preventative services in effect on June 30, 2008, and shall ensure that
7.14fee-for-service payment rates for all other services provided on or after July 1, 2008, are at
7.15least three percent above the medical assistance rates for those services in effect on June
7.1630, 2008. The commissioner shall adjust managed care capitation rates to reflect these
7.17increases, and shall require managed care organizations, as a condition of contract, to pass
7.18these increases on to providers under contract.
7.19    Subd. 3. Performance rate bonus. The commissioner shall establish a care
7.20coordination performance target bonus plan for fee-for-service providers and providers
7.21under contract with a managed care organization to serve program clients. The plan
7.22shall establish care coordination and preventative care performance targets for providers.
7.23The performance targets must be qualitative, objective, and measurable. Criteria for
7.24assessment of each performance target must be outlined in writing prior to the contract
7.25effective date. Providers must submit to the commissioner by March 1 of each year
7.26information specified by the commissioner that demonstrates the provider has met the
7.27performance targets for the prior year. If the commissioner determines the provider has
7.28satisfied the performance targets, the commissioner shall pay directly to the provider a
7.29care coordination performance bonus equal to one and one-half percent of all payments
7.30for services under the children's health security program made to that provider during the
7.31prior year. Managed care organizations shall provide to the commissioner, in the form
7.32and manner specified by the commissioner, all information necessary to implement the
7.33performance target bonus plan for providers under contract.

7.34    Sec. 12. [256N.17] CONSUMER ASSISTANCE.
8.1    Subdivision 1. Assistance to applicants. The commissioner shall assist applicants
8.2in choosing a managed care organization or fee-for-service provider by:
8.3    (1) establishing a Web site to provide information about managed care organizations
8.4and fee-for-service providers and to allow online enrollment;
8.5    (2) make information on managed care organizations and fee-for-service providers
8.6available at the sites specified in section 256N.11, subdivision 1;
8.7    (3) make applications and information on managed care organizations and
8.8fee-for-service providers available to applicants and enrollees according to Title VI of the
8.9Civil Rights Act and federal regulations adopted under that law or any guidance from the
8.10United States Department of Health and Human Services; and
8.11    (4) make benefit educators available to assist applicants in choosing a managed care
8.12organization or fee-for-service provider.
8.13    Subd. 2. Ombudsperson. The commissioner shall designate an ombudsperson
8.14to advocate for children enrolled in the children's health security program. The
8.15ombudsperson shall assist enrollees in understanding and making use of complaint and
8.16appeal procedures and ensure that necessary medical services are provided to enrollees. At
8.17the time of enrollment, the commissioner shall inform enrollees about: the ombudsperson
8.18program; the right to a resolution of the enrollee's complaint by the managed care
8.19organization if the enrollee experiences a problem with the managed care organization
8.20or its providers; and appeal rights under section 256.045.

8.21    Sec. 13. [256N.19] MONITORING AND EVALUATION OF QUALITY AND
8.22COSTS.
8.23    (a) The commissioner, as a condition of contract, shall require each participating
8.24managed care organization and participating provider to submit, in the form and manner
8.25specified by the commissioner, data required for assessing enrollee satisfaction, quality
8.26of care, cost, and utilization of services. The commissioner shall evaluate this data, in
8.27order to:
8.28    (1) make summary information on the quality of care across managed care
8.29organizations, medical clinics, and providers available to consumers;
8.30    (2) require managed care organizations and providers, as a condition of contract, to
8.31implement quality improvement plans; and
8.32    (3) compare the cost and quality of services under the program to the cost and
8.33quality of services provided to private sector enrollees.
8.34    (b) The commissioner shall implement this section to the extent allowed by federal
8.35and state laws on data privacy.

9.1    Sec. 14. [256N.21] FEDERAL APPROVAL.
9.2    The commissioner shall seek all federal waivers and approvals necessary to
9.3implement this chapter including, but not limited to, waivers and approvals necessary to:
9.4    (1) coordinate medical assistance and MinnesotaCare coverage for children with the
9.5children's health security program;
9.6    (2) use federal medical assistance and MinnesotaCare dollars to pay for health care
9.7services under the children's health security program;
9.8    (3) maximize receipt of the federal medical assistance match for covered children,
9.9by increasing income standards through the use of more liberal income methodologies as
9.10provided under United States Code, title 42, sections 1396a and 1396u-1;
9.11    (4) extend presumptive eligibility and continuous eligibility to children under age
9.1221; and
9.13(5) use federal medical assistance and MinnesotaCare dollars to provide benefits to
9.14dependent students.

9.15    Sec. 15. [256N.23] RULEMAKING.
9.16    The commissioner shall adopt rules to implement this chapter.

9.17    Sec. 16. [256N.25] CHILDREN'S HEALTH SECURITY PROGRAM
9.18OUTREACH.
9.19    Subdivision 1. Grant awards. The commissioner shall award grants to public or
9.20private organizations to:
9.21    (1) provide information, in areas of the state with high uninsured populations, on the
9.22importance of maintaining insurance coverage and on how to obtain coverage through
9.23the children's health security program; and
9.24    (2) monitor and provide ongoing support to ensure enrolled children remain covered.
9.25    Subd. 2. Criteria. In awarding the grants, the commissioner shall consider the
9.26following:
9.27    (1) geographic areas and populations with high uninsured rates;
9.28    (2) the ability to raise matching funds;
9.29    (3) the ability to contact, effectively communicate with or serve eligible populations;
9.30and
9.31    (4) the applicant's plan to monitor and provide support to ensure enrolled children
9.32remain covered.
9.33    Subd. 3. Monitoring and termination. The commissioner shall monitor the grants
9.34and may terminate a grant if the outreach effort does not increase enrollment in the
9.35children's health security program.

10.1    Sec. 17. IMPLEMENTATION PLAN.
10.2    The commissioner of human services shall develop an implementation plan for the
10.3children's health security coverage program, which includes a health delivery plan based
10.4on the criteria specified in section 256N.13, subdivision 1. The commisioner shall present
10.5this plan, any necessary draft legislation, and a draft of proposed rules to the legislature
10.6by December 15, 2007. The plan must include recommendations for any additional
10.7legislative changes necessary to merge medical assistance and MinnesotaCare coverage
10.8for children into the children's health security program. The commissioner shall evaluate
10.9the provision of services under the program to children with disabilities and shall present
10.10recommendations to the legislature by December 15, 2009, for any program changes
10.11necessary to ensure the quality and continuity of care.

10.12    Sec. 18. LEGISLATIVE TASK FORCE ON CHILDREN'S HEALTH CARE
10.13COVERAGE.
10.14    Subdivision 1. Establishment; membership. The Legislative Task Force on
10.15Children's Health Care Coverage is established. The task force consists of: five members
10.16of the house of representatives appointed under the rules of the house, of whom three
10.17members must be from the majority party and two members from the minority party;
10.18and five members of the senate appointed under the rules of the senate, of whom three
10.19members must be from the majority party and two members from the minority party. Task
10.20force members must be appointed by September 1, 2007.
10.21    Subd. 2. Study; staff support. (a) The task force shall study viable options to extend
10.22coverage to all children as provided in Minnesota Statutes, section 256N.05, subdivision
10.232, paragraph (c), and provide recommendations to the legislature. The study must:
10.24    (1) evaluate methods to achieve universal coverage for children, including, but not
10.25limited to, changes to the employer-based coverage system and an expansion of eligibility
10.26for the children's health security program established under Minnesota Statutes, chapter
10.27256N;
10.28    (2) examine health care reform and cost containment methods that will contain costs
10.29and increase access and improve health outcomes;
10.30    (3) examine how to increase access to preventive care and health care services; and
10.31    (4) examine how to reduce health disparities among minority populations.
10.32    (b) The task force, through the Legislative Coordinating Commission, may hire staff
10.33or contract for staff support for the study.
10.34    (c) The task force, in developing recommendations, shall hold meetings to hear
10.35public testimony at locations throughout the state, including locations outside of the
10.36seven-county metropolitan area.
11.1    Subd. 3. Recommendations. The task force shall report its recommendations to
11.2the legislature by December 15, 2008. Recommendations must be consistent with the
11.3following criteria:
11.4    (1) health care coverage must include preventive care and all other medically
11.5necessary services;
11.6    (2) health care coverage must be affordable for families, with the family share of
11.7premium costs and cost-sharing in total not exceeding five percent of family income;
11.8    (3) the system of coverage must give priority to ensuring access to and the quality
11.9and continuity of care; and
11.10    (4) enrollment must be simple and seamless for families.
11.11    Subd. 4. Expiration. This section expires December 16, 2008.

11.12    Sec. 19. APPROPRIATION.
11.13    (a) $....... is appropriated from the general fund to the commissioner of human
11.14services for the biennium ending June 30, 2009, to develop and implement the Children's
11.15Health Security Act under Minnesota Statutes, chapter 256N.
11.16(b) $....... is appropriated from the health care access fund to the commissioner of
11.17human services for the biennium ending June 30, 2009, to develop and implement the
11.18Children's Health Security Act under Minnesota Statutes, chapter 256N.
11.19    (c) $....... is appropriated from the general fund to the Legislative Coordinating
11.20Commission for the biennium ending June 30, 2009, for staff support provided to the
11.21Legislative Task Force on Children's Health Care Coverage."
11.22Amend the title accordingly