1.1.................... moves to amend H.F. No. 214 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to
1.4read:
1.5    Subd. 3. MinnesotaCare federal receipts. Receipts received as a result of federal
1.6participation pertaining to administrative costs of the Minnesota health care reform waiver
1.7shall be deposited as nondedicated revenue in the health care access fund. Receipts
1.8received as a result of federal participation pertaining to grants shall be deposited in the
1.9federal fund and shall offset health care access funds for payments to providers. All federal
1.10funding received by Minnesota for implementation and administration of MinnesotaCare
1.11as a basic health program, as authorized in section 1331 of the Affordable Care Act
1.12(Public Law 111-148, as amended by Public Law 111-152), is dedicated to that program
1.13and shall be deposited into the health care access fund. Federal funding that is received for
1.14implementing and administering MinnesotaCare as a basic health program and deposited in
1.15the fund shall be used only for that program to purchase health care coverage for enrollees
1.16and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.
1.17EFFECTIVE DATE.This section is effective January 1, 2015.

1.18    Sec. 2. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
1.19to read:
1.20    Subd. 35. Federal approval. (a) The commissioner shall seek federal authority
1.21from the U.S. Department of Health and Human Services necessary to operate a health
1.22insurance program for Minnesotans with incomes up to 275 percent of the federal poverty
1.23guidelines (FPG). The proposal shall seek to secure all federal funding available from at
1.24least the following services:
2.1(1) all premium tax credits and cost sharing subsidies available under United States
2.2Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals
2.3with incomes above 133 percent and at or below 275 percent of the federal poverty
2.4guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as
2.5defined in Minnesota Statutes, section 62V.02, if enacted in 2013 H.F. No. 5/S.F. No. 1;
2.6(2) Medicaid funding; and
2.7(3) other funding sources identified by the commissioner that support coverage or
2.8care redesign in Minnesota.
2.9(b) Funding received shall be used to design and implement a health insurance
2.10program that creates a single streamlined program and meets the needs of Minnesotans with
2.11incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:
2.12(1) payment reform characteristics included in the health care delivery system and
2.13accountable care organization payment models;
2.14(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee
2.15needs in different income and health status situations and can provide a more seamless
2.16transition from public to private health care coverage;
2.17(3) flexibility in co-payment or premium structures to incent patients to seek high
2.18quality, low cost care settings; and
2.19(4) flexibility in premium structures to ease the transition from public to private
2.20health care coverage.
2.21(c) The commissioner shall develop and submit a proposal consistent with the above
2.22criteria and shall seek all federal authority necessary to implement the coverage program.
2.23In developing the request, the commissioner shall consult with appropriate stakeholder
2.24groups and consumers.
2.25(d) The commissioner is authorized to seek any available waivers or federal
2.26approvals to accomplish the goals under paragraph (b) prior to 2017.
2.27(e) The commissioner shall report progress on implementing this section to the
2.28chairs and ranking minority members of the legislative committees with jurisdiction over
2.29the health and human services policy and financing by December 1, 2014.
2.30(f) The commissioner is authorized to accept and expend federal funds that support
2.31the purposes of this section.

2.32    Sec. 3. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
2.33to read:
3.1    Subd. 1b. Affordable Care Act. "Affordable Care Act" means Public Law 111-148,
3.2as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public
3.3Law 111-152), and any amendments to, or regulations or guidance issued under, those acts.

3.4    Sec. 4. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
3.5to read:
3.6    Subd. 4b. Minnesota insurance Marketplace. "Minnesota Insurance Marketplace"
3.7means the Minnesota Insurance Marketplace as defined in Minnesota Statutes, section
3.862V.02, if enacted in 2013 H.F. No. 5/S.F. No. 1.

3.9    Sec. 5. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
3.10to read:
3.11    Subd. 6. MinnesotaCare. "MinnesotaCare" means a health coverage program that
3.12meets the standards of this chapter and the requirements for a basic health program under
3.13section 1331 of the Affordable Care Act.
3.14EFFECTIVE DATE.This section is effective January 1, 2015.

3.15    Sec. 6. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
3.16to read:
3.17    Subd. 7. Modified adjusted gross income and household income. "Modified
3.18adjusted gross income" and "household income" have the meanings provided in section
3.192002 of the Affordable Care Act.
3.20EFFECTIVE DATE.This section is effective January 1, 2014.

3.21    Sec. 7. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
3.22to read:
3.23    Subd. 8. Participating entity. "Participating entity" means a health plan company
3.24as defined in section 62Q.01, subdivision 4; a county-based purchasing plan established
3.25under section 256B.692; an accountable care organization or other entity operating a
3.26health care delivery systems demonstration project authorized under section 256B.0755;
3.27an entity operating a county integrated health care delivery network pilot project
3.28authorized under section 256B.0756; or a network of health care providers established to
3.29offer services under MinnesotaCare.
3.30EFFECTIVE DATE.This section is effective January 1, 2015.

4.1    Sec. 8. Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:
4.2    Subd. 2. Commissioner's duties. The commissioner shall establish an office for
4.3the state administration of this plan. The plan shall be used to provide covered health
4.4services for eligible persons. Payment for these services shall be made to all eligible
4.5providers participating entities under contract with the commissioner. The commissioner
4.6shall adopt rules to administer the MinnesotaCare program as a basic health program in
4.7accordance with section 1331 of the Affordable Care Act and this chapter and shall adopt
4.8any necessary rules. Nothing in this chapter is intended to violate the requirements of the
4.9Affordable Care Act. The commissioner shall not implement any provision of this chapter
4.10if the provision is found to violate the Affordable Care Act. The commissioner shall
4.11establish marketing efforts to encourage potentially eligible persons to receive information
4.12about the program and about other medical care programs administered or supervised by
4.13the Department of Human Services. A toll-free telephone number must be used to provide
4.14information about medical programs and to promote access to the covered services.
4.15EFFECTIVE DATE.This section is effective January 1, 2015.

4.16    Sec. 9. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
4.17to read:
4.18    Subd. 5. Determination of funding adequacy. The commissioners of revenue and
4.19Minnesota Management and Budget, in consultation with the commissioner of human
4.20services, shall conduct an assessment of health care taxes, including the gross premiums
4.21tax, the provider tax, and Medicaid surcharges, and their relationship to the long-term
4.22solvency of the health care access fund, as part of the state revenue and expenditure
4.23forecast in November 2013. The commissioners shall determine the amount of state
4.24funding that will be required after December 31, 2019, in addition to the federal payments
4.25made available under section 1331 of the Affordable Care Act, for the MinnesotaCare
4.26program. The commissioners shall evaluate the stability and likelihood of long-term
4.27federal funding for the MinnesotaCare program under section 1331. The commissioners
4.28shall report the results of this assessment to the legislature by January 15, 2014, along
4.29with recommendations for changes to state revenue for the health care access fund, if state
4.30funding will continue to be required beyond December 31, 2019.

4.31    Sec. 10. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
4.32to read:
4.33    Subd. 6. Federal approval. (a) The commissioner of human services shall seek
4.34federal approval to implement the MinnesotaCare program under this chapter as a basic
5.1health program. In any agreement with the Centers for Medicare and Medicaid Services
5.2to operate MinnesotaCare as a basic health program, the commissioner shall seek to
5.3include procedures to ensure that federal funding is predictable, stable, and sufficient
5.4to sustain ongoing operation of MinnesotaCare. These procedures must address issues
5.5related to the timing of federal payments, payment reconciliation, enrollee risk adjustment,
5.6and minimization of state financial risk. The commissioner shall consult with the
5.7commissioner of Minnesota Management and Budget, when developing the proposal for
5.8establishing MinnesotaCare as a basic health program to be submitted to the Centers for
5.9Medicare and Medicaid Services.
5.10(b) The commissioner of human services, in consultation with the commissioner
5.11of Minnesota Management and Budget, shall work with the Centers for Medicare and
5.12Medicaid Services to establish a process for reconciliation and adjustment of federal
5.13payments that balances state and federal liability over time. The commissioner of human
5.14services shall request that the secretary of health and human services hold the state, and
5.15enrollees, harmless in the reconciliation process for the first three years, to allow the state
5.16to develop a statistically valid methodology for predicting enrollment trends and their
5.17net effect on federal payments.
5.18(c) The commissioner of human services, through December 31, 2015, may modify
5.19the MinnesotaCare program as specified in this chapter, if it is necessary to enhance
5.20health benefits, expand provider access, or reduce cost-sharing and premiums in order
5.21to comply with the terms and conditions of federal approval as a basic health program.
5.22The commissioner may not reduce benefits, impose greater limits on access to providers,
5.23or increase cost-sharing and premiums by enrollees under the authority granted by this
5.24paragraph. If the commissioner modifies the terms and requirements for MinnesotaCare
5.25under this paragraph, the commissioner shall provide the legislature with notice of
5.26implementation of the modifications at least ten working days before notifying enrollees
5.27and participating entities. The costs of any changes to the program necessary to comply
5.28with federal approval shall become part of the program's base funding for purposes of
5.29future budget forecasts.
5.30EFFECTIVE DATE.This section is effective the day following final enactment.

5.31    Sec. 11. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
5.32to read:
5.33    Subd. 7. Coordination with Minnesota Insurance Marketplace. MinnesotaCare
5.34shall be considered a MAGI public health care program for purposes of Minnesota
5.35Statutes, chapter 62V if enacted in 2013 H.F. No. 5/S.F. No. 1.
6.1EFFECTIVE DATE.This section is effective January 1, 2014.

6.2    Sec. 12. Minnesota Statutes 2012, section 256L.03, subdivision 1, is amended to read:
6.3    Subdivision 1. Covered health services. (a) "Covered health services" means the
6.4health services reimbursed under chapter 256B, and all essential health benefits required
6.5under section 1302 of the Affordable Care Act, with the exception of inpatient hospital
6.6services, special education services, private duty nursing services, adult dental care
6.7services other than services covered under section 256B.0625, subdivision 9, orthodontic
6.8services, nonemergency medical transportation services, personal care assistance and case
6.9management services, nursing home or intermediate care facilities services, inpatient
6.10mental health services, and chemical dependency services nursing facility services and
6.11intermediate care facility for persons with developmental disabilities (ICF/DD) services,
6.12and except as provided in this section.
6.13    (b) No public funds shall be used for coverage of abortion under MinnesotaCare
6.14except where the life of the female would be endangered or substantial and irreversible
6.15impairment of a major bodily function would result if the fetus were carried to term; or
6.16where the pregnancy is the result of rape or incest.
6.17    (c) Covered health services shall be expanded as provided in this section.
6.18EFFECTIVE DATE.This section is effective January 1, 2015.

6.19    Sec. 13. Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:
6.20    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
6.21inpatient hospital services, including inpatient hospital mental health services and inpatient
6.22hospital and residential chemical dependency treatment, subject to those limitations
6.23necessary to coordinate the provision of these services with eligibility under the medical
6.24assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
6.25section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
6.262 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
6.27215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
6.28pregnant, is subject to an annual limit of $10,000.
6.29    (b) Admissions for inpatient hospital services paid for under section 256L.11,
6.30subdivision 3 , must be certified as medically necessary in accordance with Minnesota
6.31Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
6.32    (1) all admissions must be certified, except those authorized under rules established
6.33under section 254A.03, subdivision 3, or approved under Medicare; and
7.1    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
7.2for admissions for which certification is requested more than 30 days after the day of
7.3admission. The hospital may not seek payment from the enrollee for the amount of the
7.4payment reduction under this clause.
7.5EFFECTIVE DATE.This section is effective January 1, 2014.

7.6    Sec. 14. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
7.7to read:
7.8    Subd. 4a. Cost-sharing. (a) Except as provided in paragraph (b), the MinnesotaCare
7.9program shall include the following cost-sharing requirements for all enrollees:
7.10(1) $3 per brand-name prescription and $1 per generic drug prescription, subject to a
7.11$12 per month maximum for prescription drug co-payments. No co-payments shall apply
7.12to antipsychotic drugs when used for treatment of mental illness;
7.13(2) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
7.14episode of service which is required because of a recipient's symptoms, diagnosis, or
7.15established illness, and which is delivered in an ambulatory setting by a physician or
7.16physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
7.17audiologist, optician, or optometrist; and
7.18(3) $3.50 for nonemergency visits to a hospital-based emergency room, except that
7.19this co-payment shall be increased to $20 upon federal approval.
7.20(b) Paragraph (a), clause (2), does not apply to mental health services.
7.21(c) The commissioner, through the contracting process under section 256L.121, may
7.22allow participating entities to waive the family deductible described under paragraph (a),
7.23clause (4). The value of the family deductible shall not be included in any capitation or
7.24other payment made by the commissioner to participating entities. Participating entities
7.25shall certify annually to the commissioner the dollar value of the family deductible.
7.26(d) The commissioner may waive the collection of the family deductible described
7.27under paragraph (a), clause (4), from individuals and allow long-term care and waivered
7.28service providers to assume responsibility for payment.
7.29EFFECTIVE DATE.This section is effective January 1, 2015.

7.30    Sec. 15. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
7.31to read:
8.1    Subd. 4b. Loss ratio. Health coverage provided through the MinnesotaCare
8.2program must have a medical loss ratio of at least 85 percent, as defined using the loss
8.3ratio methodology described in section 1001 of the Affordable Care Act.
8.4EFFECTIVE DATE.This section is effective January 1, 2015.

8.5    Sec. 16. Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:
8.6    Subd. 5. Cost-sharing. (a) Except as provided in paragraphs paragraph (b) and (c),
8.7the MinnesotaCare benefit plan shall include the following cost-sharing requirements
8.8for all enrollees:
8.9    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
8.10subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;
8.11    (2) (1) $3 per prescription for adult enrollees;
8.12    (3) (2) $25 for eyeglasses for adult enrollees;
8.13    (4) (3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means
8.14an episode of service which is required because of a recipient's symptoms, diagnosis, or
8.15established illness, and which is delivered in an ambulatory setting by a physician or
8.16physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
8.17audiologist, optician, or optometrist;
8.18    (5) (4) $6 for nonemergency visits to a hospital-based emergency room for services
8.19provided through December 31, 2010, and $3.50 effective January 1, 2011; and
8.20(6) (5) a family deductible equal to the maximum amount allowed under Code of
8.21Federal Regulations, title 42, part 447.54.
8.22    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
8.23children under the age of 21.
8.24    (c) (b) Paragraph (a) does not apply to pregnant women and children under the
8.25age of 21.
8.26    (d) (c) Paragraph (a), clause (4) (3), does not apply to mental health services.
8.27    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
8.28poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
8.29and who are not pregnant shall be financially responsible for the coinsurance amount, if
8.30applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
8.31    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
8.32or changes from one prepaid health plan to another during a calendar year, any charges
8.33submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
8.34expenses incurred by the enrollee for inpatient services, that were submitted or incurred
8.35prior to enrollment, or prior to the change in health plans, shall be disregarded.
9.1(g) (d) MinnesotaCare reimbursements to fee-for-service providers and payments to
9.2managed care plans or county-based purchasing plans shall not be increased as a result of
9.3the reduction of the co-payments in paragraph (a), clause (5) (4), effective January 1, 2011.
9.4(h) (e) The commissioner, through the contracting process under section 256L.12,
9.5may allow managed care plans and county-based purchasing plans to waive the family
9.6deductible under paragraph (a), clause (6) (5). The value of the family deductible shall not
9.7be included in the capitation payment to managed care plans and county-based purchasing
9.8plans. Managed care plans and county-based purchasing plans shall certify annually to the
9.9commissioner the dollar value of the family deductible.
9.10EFFECTIVE DATE.This section is effective January 1, 2014.

9.11    Sec. 17. Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:
9.12    Subd. 6. Lien. When the state agency provides, pays for, or becomes liable for
9.13covered health services, the agency shall have a lien for the cost of the covered health
9.14services upon any and all causes of action accruing to the enrollee, or to the enrollee's
9.15legal representatives, as a result of the occurrence that necessitated the payment for the
9.16covered health services. All liens under this section shall be subject to the provisions
9.17of section 256.015. For purposes of this subdivision, "state agency" includes prepaid
9.18health plans participating entities, under contract with the commissioner according to
9.19sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
9.20purchasing entities under section 256B.692 section 256L.121.
9.21EFFECTIVE DATE.This section is effective January 1, 2015.

9.22    Sec. 18. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
9.23to read:
9.24    Subd. 1c. General requirements. To be eligible for coverage under MinnesotaCare,
9.25a person must meet the eligibility requirements of this section. A person eligible for
9.26MinnesotaCare shall not be treated as a qualified individual under section 1312 of the
9.27Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
9.28through the health benefit exchange under section 1331 of the Affordable Care Act.
9.29EFFECTIVE DATE.This section is effective January 1, 2015.

9.30    Sec. 19. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
9.31to read:
10.1    Subd. 1d. Eligible groups; income limits. (a) To be eligible under MinnesotaCare,
10.2a person must:
10.3(1) be a resident of Minnesota;
10.4(2) not be eligible under medical assistance;
10.5(3) have a household income that is greater than 133 percent but does not exceed 200
10.6percent of the federal poverty guidelines for family size, except that a noncitizen lawfully
10.7present in the United States, who is not eligible for the Medicaid program under title XIX
10.8of the Social Security Act due to immigration status, may have a household income that is
10.9less than or equal to 133 percent of the federal poverty guidelines for family size;
10.10(4) not be eligible for minimum essential coverage, as defined in section 5000A(f)
10.11of the Internal Revenue Code of 1986, except that a person may be eligible for an
10.12employer-sponsored plan that is not affordable coverage, as defined in section 5000A(e)(2)
10.13of the Internal Revenue Code of 1986; and
10.14(5) not have attained the age of 65 as of the beginning of the plan year.
10.15(b) The commissioner shall calculate income eligibility under MinnesotaCare using
10.16modified adjusted gross income and shall apply a standard five percent income disregard,
10.17as provided under section 2012 of the Affordable Care Act.
10.18EFFECTIVE DATE.Paragraph (a) of this section is effective January 1, 2015.
10.19Paragraph (b) of this section is effective January 1, 2014.

10.20    Sec. 20. Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:
10.21    Subdivision 1. Application assistance and information availability. (a) Applicants
10.22may submit applications online, in person, by mail, or by phone in accordance with the
10.23Affordable Care Act, and by any other means by which medical assistance applications
10.24may be submitted. Applicants may submit applications through the Minnesota Insurance
10.25Marketplace or through the MinnesotaCare program. Applications and application
10.26assistance must be made available at provider offices, local human services agencies,
10.27school districts, public and private elementary schools in which 25 percent or more of
10.28the students receive free or reduced price lunches, community health offices, Women,
10.29Infants and Children (WIC) program sites, Head Start program sites, public housing
10.30councils, crisis nurseries, child care centers, early childhood education and preschool
10.31program sites, legal aid offices, and libraries, and at any other locations at which medical
10.32assistance applications must be made available. These sites may accept applications and
10.33forward the forms to the commissioner or local county human services agencies that
10.34choose to participate as an enrollment site. Otherwise, applicants may apply directly to the
10.35commissioner or to participating local county human services agencies.
11.1(b) Application assistance must be available for applicants choosing to file an online
11.2application through the Minnesota Insurance Marketplace.
11.3EFFECTIVE DATE.This section is effective January 1, 2014.

11.4    Sec. 21. Minnesota Statutes 2012, section 256L.05, is amended by adding a subdivision
11.5to read:
11.6    Subd. 1d. Streamlined application and enrollment process. The commissioner
11.7shall work with the board of the Minnesota Insurance Marketplace and local human
11.8services agencies to develop a single, streamlined application and automatic enrollment
11.9process that meets the requirements of the Affordable Care Act, including but not limited
11.10to being structured to maximize an applicant's ability to complete the form satisfactorily,
11.11taking into account the characteristics of individuals who qualify for MinnesotaCare and
11.12medical assistance. Each application shall give an applicant the option, to the extent
11.13feasible, of specifying their current primary care clinic or physician as their primary care
11.14provider for purposes of continuity of care.
11.15EFFECTIVE DATE.This section is effective the day following final enactment.

11.16    Sec. 22. Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:
11.17    Subd. 2. Commissioner's duties. The commissioner or county agency shall use
11.18electronic verification through the Minnesota Insurance Marketplace as the primary
11.19method of income verification. If there is a discrepancy between reported income
11.20and electronically verified income, an individual may be required to submit additional
11.21verification to the extent permitted under the Affordable Care Act. In addition, the
11.22commissioner shall perform random audits to verify reported income and eligibility. The
11.23commissioner may execute data sharing arrangements with the Department of Revenue
11.24and any other governmental agency in order to perform income verification related to
11.25eligibility and premium payment under the MinnesotaCare program.
11.26EFFECTIVE DATE.This section is effective January 1, 2014.

11.27    Sec. 23. Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:
11.28    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
11.29first day of the month following the month in which eligibility is approved and the first
11.30premium payment has been received. As provided in section 256B.057, coverage for
11.31newborns is automatic from the date of birth and must be coordinated with other health
11.32coverage. The effective date of coverage for eligible newly adoptive children added to a
12.1family receiving covered health services is the month of placement. The effective date
12.2of coverage for other new members added to the family is the first day of the month
12.3following the month in which the change is reported. All eligibility criteria must be met
12.4by the family at the time the new family member is added. The income of the new family
12.5member is included with the family's gross income and the adjusted premium begins in
12.6the month the new family member is added.
12.7(b) The initial premium must be received by the last working day of the month for
12.8coverage to begin the first day of the following month.
12.9(c) Benefits are not available until the day following discharge if an enrollee is
12.10hospitalized on the first day of coverage.
12.11(d) (b) Notwithstanding any other law to the contrary, benefits under sections
12.12256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
12.13an eligible person may have coverage and the commissioner shall use cost avoidance
12.14techniques to ensure coordination of any other health coverage for eligible persons. The
12.15commissioner shall identify eligible persons who may have coverage or benefits under
12.16other plans of insurance or who become eligible for medical assistance.
12.17(e) The effective date of coverage for individuals or families who are exempt from
12.18paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first day of
12.19the month following the month in which verification of American Indian status is received
12.20or eligibility is approved, whichever is later.
12.21(f) (c) The effective date of coverage for children eligible under section 256L.07,
12.22subdivision 8, is the first day of the month following the date of termination from foster
12.23care or release from a juvenile residential correctional facility.
12.24EFFECTIVE DATE.This section is effective January 1, 2015.

12.25    Sec. 24. Minnesota Statutes 2012, section 256L.05, subdivision 3a, is amended to read:
12.26    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility
12.27must be renewed every 12 months. The 12-month period begins in the month after the
12.28month the application is approved.
12.29    (b) Each new period of eligibility must take into account any changes in
12.30circumstances that impact eligibility and premium amount. An enrollee must provide all
12.31the information needed to redetermine eligibility by the first day of the month that ends
12.32the eligibility period. The premium for the new period of eligibility must be received as
12.33provided in section 256L.06 in order for eligibility to continue.
12.34(c) For children enrolled in MinnesotaCare under section 256L.07, subdivision 8,
12.35the first period of renewal begins the month the enrollee turns 21 years of age.
13.1EFFECTIVE DATE.This section is effective January 1, 2015.

13.2    Sec. 25. Minnesota Statutes 2012, section 256L.05, subdivision 3c, is amended to read:
13.3    Subd. 3c. Retroactive coverage. Notwithstanding subdivision 3, the effective
13.4date of coverage shall be the first day of the month following termination from medical
13.5assistance for families and individuals who are eligible for MinnesotaCare and who
13.6submitted a written request for retroactive MinnesotaCare coverage with a completed
13.7application within 30 days of the mailing of notification of termination from medical
13.8assistance. The applicant must provide all required verifications within 30 days of the
13.9written request for verification. For retroactive coverage, premiums must be paid in full
13.10for any retroactive month, current month, and next month within 30 days of the premium
13.11billing. General assistance medical care recipients may qualify for retroactive coverage
13.12under this subdivision at six-month renewal.
13.13EFFECTIVE DATE.This section is effective January 1, 2015.

13.14    Sec. 26. Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:
13.15    Subdivision 1. General requirements. (a) Children enrolled in the original
13.16children's health plan as of September 30, 1992, children who enrolled in the
13.17MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
13.18article 4, section 17, and children who have family gross incomes that are equal to or
13.19less than 200 percent of the federal poverty guidelines are eligible without meeting the
13.20requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as
13.21they maintain continuous coverage in the MinnesotaCare program or medical assistance.
13.22    Parents enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
13.23income increases above 275 percent of the federal poverty guidelines, are no longer
13.24eligible for the program and shall be disenrolled by the commissioner. Beginning January
13.251, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
13.267 , whose income increases above 200 percent of the federal poverty guidelines or 250
13.27percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
13.28the program and shall be disenrolled by the commissioner. For persons disenrolled under
13.29this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
13.30following the month in which the commissioner determines that the income of a family or
13.31individual exceeds program income limits.
13.32    (b) Children may remain enrolled in MinnesotaCare if their gross family income as
13.33defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty
14.1guidelines. The premium for children remaining eligible under this paragraph shall be the
14.2maximum premium determined under section 256L.15, subdivision 2, paragraph (b).
14.3    (c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if
14.4gross household income exceeds $57,500 for the 12-month period of eligibility.
14.5EFFECTIVE DATE.This section is effective January 1, 2014.

14.6    Sec. 27. Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:
14.7    Subd. 2. Residency requirement. To be eligible for health coverage under the
14.8MinnesotaCare program, pregnant women, individuals, and families with children must
14.9meet the residency requirements individuals must be a resident of the state as provided
14.10by Code of Federal Regulations, title 42, section 435.403, except that the provisions of
14.11section 256B.056, subdivision 1, shall apply upon receipt of federal approval section
14.121331 of the Affordable Care Act.
14.13EFFECTIVE DATE.This section is effective January 1, 2015.

14.14    Sec. 28. Minnesota Statutes 2012, section 256L.11, subdivision 1, is amended to read:
14.15    Subdivision 1. Medical assistance rate to be used. (a) Payment to providers
14.16under sections 256L.01 to 256L.11 this chapter shall be at the same rates and conditions
14.17established for medical assistance, except as provided in subdivisions 2 to 6 this section.
14.18(b) Effective for services provided on or after July 1, 2009, total payments for basic
14.19care services shall be reduced by three percent, in accordance with section 256B.766.
14.20Payments made to managed care and county-based purchasing plans shall be reduced for
14.21services provided on or after October 1, 2009, to reflect this reduction.
14.22(c) Effective for services provided on or after July 1, 2009, payment rates for
14.23physician and professional services shall be reduced as described under section 256B.76,
14.24subdivision 1, paragraph (c). Payments made to managed care and county-based
14.25purchasing plans shall be reduced for services provided on or after October 1, 2009,
14.26to reflect this reduction.
14.27EFFECTIVE DATE.This section is effective January 1, 2015.

14.28    Sec. 29. Minnesota Statutes 2012, section 256L.11, is amended by adding a subdivision
14.29to read:
14.30    Subd. 1a. Rate increases. Effective for services provided on or after January 1,
14.312015, the commissioner of human services shall increase payments for basic care services,
14.32physician and professional services, and dental services by … percent from the rates in
15.1effect for the MinnesotaCare program on December 31, 2014. Payments to participating
15.2entities established through the competitive process under section 256L.121 must reflect
15.3this increase.
15.4EFFECTIVE DATE.This section is effective January 1, 2015.

15.5    Sec. 30. [256L.121] SERVICE DELIVERY.
15.6    Subdivision 1. Competitive process. The commissioner of human services shall
15.7establish a competitive process for entering into contracts with participating entities for
15.8the offering of standard health plans through MinnesotaCare. Coverage through standard
15.9health plans must be available to enrollees beginning January 1, 2015. Each standard health
15.10plan must cover the health services listed in, and meet the requirements of, section 256L.03.
15.11The competitive process must meet the requirements of section 1331 of the Affordable
15.12Care Act and be designed to ensure enrollee access to high-quality health care coverage
15.13options. The commissioner, to the extent feasible, shall seek to ensure that enrollees have
15.14a choice of coverage from more than one participating entity within a geographic area.
15.15    Subd. 2. Other requirements for participating entities. The commissioner shall
15.16require participating entities, as a condition of contract, to document to the commissioner:
15.17(1) the provision of culturally and linguistically appropriate services, including
15.18marketing materials, to MinnesotaCare enrollees; and
15.19(2) the inclusion in provider networks of providers designated as essential
15.20community providers under section 62Q.19.
15.21    Subd. 3. Coordination with state-administered health programs. The
15.22commissioner shall coordinate the administration of the MinnesotaCare program with
15.23medical assistance to maximize efficiency and improve the continuity of care. This
15.24includes, but is not limited to:
15.25(1) establishing geographic areas for MinnesotaCare that are consistent with the
15.26geographic areas of the medical assistance program, within which participating entities
15.27may offer health plans;
15.28(2) requiring, as a condition of participation in MinnesotaCare, participating entities
15.29to also participate in the medical assistance program; and
15.30(3) providing MinnesotaCare enrollees, to the extent possible, with the option to
15.31remain in the same health plan and provider network, if they later become eligible for
15.32medical assistance or coverage through the Minnesota health benefit exchange.
15.33EFFECTIVE DATE.This section is effective the day following final enactment.

16.1    Sec. 31. PLAN FOR CONSOLIDATION OF PUBLIC PROGRAMS.
16.2The commissioner of human services shall develop and present to the legislature by
16.3January 15, 2014, a plan for a consolidated and streamlined state health care program that
16.4combines the current medical assistance and MinnesotaCare programs, uses a standard
16.5and simplified application process through the Minnesota Insurance Marketplace, and
16.6provides seamless delivery and coordination of care between state health care programs
16.7and health coverage available through the Minnesota Insurance Marketplace.
16.8EFFECTIVE DATE.This section is effective the day following final enactment.

16.9    Sec. 32. REVISOR'S INSTRUCTION.
16.10The revisor shall remove cross-references to the sections repealed in this act
16.11wherever they appear in Minnesota Statutes and Minnesota Rules and make changes
16.12necessary to correct the punctuation, grammar, or structure of the remaining text and
16.13preserve its meaning.

16.14    Sec. 33. REPEALER.
16.15(a) Minnesota Statutes 2012, sections 256L.01, subdivisions 4a and 5; 256L.031;
16.16and 256L.07, subdivisions 2 and 3, are repealed, effective July 1, 2014.
16.17(b) Minnesota Statutes 2012, sections 256L.01, subdivisions 3 and 3a; 256L.02,
16.18subdivision 3; 256L.03, subdivisions 1a, 3, 4, and 5; 256L.04, subdivisions 1, 1b,
16.192a, 7, 7a, 8, 9, and 13; 256L.05, subdivisions 1b, 1c, and 5; 256L.06, subdivision 3;
16.20256L.07, subdivisions 1, 4, 5, 8, and 9; 256L.09, subdivisions 1, 4, 5, 6, and 7; 256L.11,
16.21subdivisions 2a, 3, and 6; 256L.12; 256L.15, subdivisions 1, 1a, 1b, and 2; and 256L.17,
16.22subdivisions 1, 2, 3, 4, and 5, are repealed effective January 1, 2015."
16.23Amend the title accordingly