AB40-ASA1,1287,21 12(2c) Supplement to Older Americans Act funding. From the appropriation
13account under section 20.435 (7) (dh) of the statutes, the department of health
14services shall pay moneys to counties and American Indian tribes that have
15reductions in the amount of federal moneys received from grants under title III of the
16Older Americans Act in calendar year 2013 as compared to the amount received in
17calendar year 2012. In the 2013-14 fiscal year, the department of health services
18shall pay to each county and tribe that had a reduction an amount equal to one-half
19of the amount the federal moneys are reduced between calendar years 2012 and 2013
20to be used for the same purposes as federal moneys provided under title III of the
21Older Americans Act.
AB40-ASA1,1287,23 22(3q) Community-based long-term care expansion. Before December 14, 2013,
23the department of health services shall do all of the following:
AB40-ASA1,1287,25 24(a) Develop a comprehensive projection of the expected future change in the
25need for publicly funded community-based long-term care.
AB40-ASA1,1288,1
1(b) Include all of the following in the projection described in paragraph (a):
AB40-ASA1,1288,2 21. The projected future growth trends in populations likely to access services.
AB40-ASA1,1288,4 32. The potential or projected shifts in the use of alternatives that are allowed
4under the federal Medicaid program for the populations identified in subdivision 1.
AB40-ASA1,1288,7 53. The comparative cost efficiency of service options allowed under the federal
6Medicaid program to meet the needs of the populations identified under subdivision
71.
AB40-ASA1,1288,9 84. Strategies to control the growth in long-term care costs in the Medical
9Assistance program.
AB40-ASA1,1288,11 105. Strategies to promote keeping individuals in their own homes to reduce or
11delay entry into publicly funded long-term care programs.
AB40-ASA1,1288,13 12(c) Submit a report summarizing the results of the projection described under
13paragraphs (a) and (b) to the joint committee on finance.
AB40-ASA1,1288,14 14(4c) Disproportionate share hospital payments.
AB40-ASA1,1288,21 15(a) Subject to paragraph (c) and notwithstanding section 49.45 (3) (e) of the
16statutes, from the appropriation accounts in section 20.435 (4) (b) and (o) of the
17statutes, the department of health services shall pay to hospitals that serve a
18disproportionate share of low-income patients a total of $36,792,000 in fiscal year
192013-14 and $36,728,700 in fiscal year 2014-15. The department of health services
20may make a payment to a hospital under this subsection under the calculation
21method described in paragraph (b) if the hospital meets all of the following criteria:
AB40-ASA1,1288,22 221. The hospital is located in this state.
AB40-ASA1,1288,24 232. The hospital provides a wide array of services, including services provided
24through an emergency department.
AB40-ASA1,1289,3
13. The inpatient days for Medical Assistance recipients at the hospital was at
2least 6 percent of the total inpatient days at that hospital during the most recent year
3for which such information is available.
AB40-ASA1,1289,6 44. The hospital meets applicable, minimum requirements to be a
5disproportionate share hospital under 42 USC 1396r-4 and any other applicable
6federal law.
AB40-ASA1,1289,8 7(b) The department of health services shall comply with all of the following
8when making payments to hospitals described in paragraph (a):
AB40-ASA1,1289,11 91. The department of health services shall distribute the total amount of
10moneys described under paragraph (a) to be paid to hospitals with a disproportionate
11share of low-income patients by doing all of the following:
AB40-ASA1,1289,14 12a. Dividing the number of Medical Assistance recipient inpatient days at a
13hospital by the number of total inpatient days at the hospital to obtain the
14percentage of Medical Assistance recipient inpatient days at that hospital.
AB40-ASA1,1289,17 15b. Subject to subdivisions 2. and 3., providing an increase to the inpatient
16fee-for-service base rate for each hospital that qualifies for a disproportionate share
17hospital payment under this subsection.
AB40-ASA1,1289,21 18c. Subject to subdivisions 2. and 3., providing an additional increase to the
19increase under subdivision 1. b. using a slope factor of 0.75 such that a hospital's
20overall fee-for-service add-on percentage under this subsection increases as the
21hospital's percentage of Medical Assistance recipient inpatient days increases.
AB40-ASA1,1289,24 222. The department of health services shall set the addition to the base rate at
23a level that ensures the total amount of moneys available to pay hospitals with a
24disproportionate share of low-income patients is distributed in each fiscal year.
AB40-ASA1,1290,3
13. The department of health services shall limit the maximum payment to
2hospitals such that no single hospital receives more than $2,500,000 in
3disproportionate share hospital payments under this subsection in a fiscal year.
AB40-ASA1,1290,24 4(c) The department of health services shall seek any necessary approval from
5the federal department of health and human services to implement the hospital
6payment methodology described under paragraphs (a) and (b). If approval is
7necessary and approval from the federal department of health and human services
8is received, the department of health services shall implement the payment
9methodology described under paragraphs (a) and (b). If approval is necessary and
10the department of health services and the federal department of health and human
11services negotiate a methodology for making payments to hospitals with a
12disproportionate share of low-income patients that is different from the
13methodology described under paragraphs (a) and (b), the department of health
14services, before implementing the negotiated payment methodology, shall submit to
15the joint committee on finance the negotiated payment methodology. If the
16cochairpersons of the committee do not notify the department of health services
17within 14 working days after the date of the submittal by the department of health
18services that the committee has scheduled a meeting for the purpose of reviewing the
19negotiated payment methodology, the department of health services may implement
20the negotiated payment methodology. If, within 14 working days after the date of the
21submittal by the department of health services, the cochairpersons of the committee
22notify the department of health services that the committee has scheduled a meeting
23for the purpose of reviewing the negotiated payment methodology, the negotiated
24payment methodology may be implemented only on approval of the committee.
AB40-ASA1,1290,25 25(5e) Funding of Family Care enrollees admitted to mental health institutes.
AB40-ASA1,1291,1
1(a) In this subsection:
AB40-ASA1,1291,2 21. "Department" means the department of health services.
AB40-ASA1,1291,4 32. "Family Care program" means the benefit program under section 46.286 of
4the statutes.
AB40-ASA1,1291,6 53. "Mental health institute" has the meaning given in section 51.01 (12) of the
6statutes.
AB40-ASA1,1291,10 7(b) Before September 1, 2013, the department shall submit to the joint
8committee on finance a report that identifies issues relating to cost liability for
9counties with residents who were formerly enrolled in the Family Care program and
10who are admitted to a mental health institute.
AB40-ASA1,1291,20 11(c) After submitting the report under paragraph (b) and during the 2013-15
12fiscal biennium, the department shall submit one or more requests to the joint
13committee on finance under section 13.10 of the statutes to supplement the
14appropriation under section 20.435 (2) (bj) of the statutes from the appropriation
15under section 20.865 (4) (a) of the statutes for the purpose of paying a portion of the
16additional costs counties incur to support services provided by the mental health
17institutes to certain enrollees in the Family Care program. If the joint committee on
18finance releases the moneys, the department may reimburse the county for all of the
19following for a stay of an enrollee of the Family Care program at a mental health
20institute subject to paragraph (d):
AB40-ASA1,1291,23 211. For any portion of a stay longer than 30 days but not longer than 60 days at
22a mental health institute, 50 percent of the state share of the cost of care incurred
23by the county for that portion of the stay.
AB40-ASA1,1292,3
12. For any portion of a stay longer than 60 days but not longer than 90 days,
275 percent of the state share of the cost of care incurred by the county for that portion
3of the stay.
AB40-ASA1,1292,5 43. For any portion of a stay longer than 90 days, all of the state share of the cost
5of care incurred by the county for that portion of the stay.
AB40-ASA1,1292,14 6(d) The department may provide reimbursement to counties for Family Care
7program enrollees admitted to mental health institutes on or after the effective date
8of this paragraph and, if the Family Care program enrollee is still at the mental
9health institute on the effective date of this paragraph, before the effective date of
10this paragraph. For a Family Care program enrollee admitted to a mental health
11institute before the effective date of this paragraph, the department shall base the
12reimbursement on the Family Care program enrollee's total length of stay since
13admission to the mental health institute using the calculations under paragraph (c)
141. to 3.
AB40-ASA1,1292,17 15(e) The financial liability of the state to pay reimbursements for services at a
16mental health institute for Family Care program enrollees under this subsection is
17limited to services provided at a mental health institute before July 1, 2015.
AB40-ASA1,9119 18Section 9119. Nonstatutory provisions; Higher Educational Aids
Board.
AB40-ASA1,9120 19Section 9120. Nonstatutory provisions; Historical Society.
AB40-ASA1,9121 20Section 9121. Nonstatutory provisions; Housing and Economic
Development Authority.
AB40-ASA1,9122 21Section 9122. Nonstatutory provisions; Insurance.
AB40-ASA1,1292,22 22(1L) Dissolution of the Health Insurance Risk-Sharing Plan and Authority.
AB40-ASA1,1292,23 23(a) Definitions. In this subsection:
AB40-ASA1,1293,2
11. "Authority" means the Health Insurance Risk-Sharing Plan Authority
2under subchapter III of chapter 149 of the statutes.
AB40-ASA1,1293,3 32. "Board" means the board of directors of the authority.
AB40-ASA1,1293,4 43. "Commissioner" means the commissioner of insurance.
AB40-ASA1,1293,5 54. "Covered person" means a person who has coverage under the plan.
AB40-ASA1,1293,6 65. "Office" means the office of the commissioner of insurance.
AB40-ASA1,1293,8 76. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II
8of chapter 149 of the statutes.
AB40-ASA1,1293,11 9(b) Dissolution of the plan and authority. Notwithstanding any statute,
10administrative rule, or provision of a policy or contract or of the plan to the contrary,
11the plan and the authority shall be dissolved in accordance with the following:
AB40-ASA1,1293,12 121. `Coverage provisions.'
AB40-ASA1,1293,16 13a. New coverage under the plan may not be issued to any person after December
1431, 2013, except that new coverage under the plan that is funded under a contract
15with the federal department of health and human services may not be issued to any
16person after December 1, 2013.
AB40-ASA1,1293,24 17b. Coverage under the policies issued under the plan terminates on January
181, 2014, or on the date that any health insurance coverage that is accessed through
19an American health benefit exchange, as described in 42 USC 18031, in this state is
20effective, if later than January 1, 2014. At least 60 days before coverage terminates,
21the authority shall provide notice of the date on which coverage terminates to all
22covered persons, all insurers and providers that are affected by the termination of
23the coverage, the office, the legislative audit bureau, and the insurers described in
24subsection (1m) (b) 1.
AB40-ASA1,1294,9
1c. If coverage under the policies issued under the plan terminates on a date that
2is later than January 1, 2014, because no health insurance coverage that is accessed
3through an American health benefit exchange, as described in 42 USC 18031, in this
4state is effective on January 1, 2014, the authority may allow covered persons whose
5coverage under the plan is funded under a contract with the federal department of
6health and human services to elect to be covered, until coverage under the plan
7terminates, under the same coverage provided under the plan to covered persons
8whose coverage under the plan is not funded under a contract with the federal
9department of health and human services.
AB40-ASA1,1294,19 102. `Provider claims.' Providers of medical services and devices and prescription
11drugs to covered persons must file claims for payment no later than 90 days after the
12date coverage terminates under subdivision 1. b. Any claim filed after that date is
13not payable and may not be charged to the covered person who received the service,
14device, or drug. Except for copayments, coinsurance, or deductibles required under
15the plan, during the 90 days after the date coverage terminates under subdivision
161. b., consistent with section 149.14 (3) of the statutes and section 149.142 (2m) of the
17statutes, a provider may not bill a covered person who receives a covered service or
18article and shall accept as payment in full the payment rate determined under
19section 149.142 (1) of the statutes.
AB40-ASA1,1294,20 203. `Grievances and review.'
AB40-ASA1,1294,24 21a. Except for a grievance related to a prior authorization denial, a covered
22person must submit any grievance, in writing, no later than 180 days after the date
23coverage terminates under subdivision 1. b. or be barred from submitting the
24grievance.
AB40-ASA1,1295,6
1b. A covered person must submit any grievance related to a prior authorization
2denial no later than 45 days before the date on which coverage terminates under
3subdivision 1. b. or be barred from submitting the grievance, except that a grievance
4related to a prior authorization denial that meets the requirements for an expedited
5grievance must be submitted no later than the date on which coverage terminates
6under subdivision 1. b. or be barred.
AB40-ASA1,1295,11 7c. A covered person who submits a grievance after the date coverage terminates
8under subdivision 1. b. must request an independent review, if any, with respect to
9the grievance no later than 60 days after he or she receives notice of the disposition
10of the grievance or be barred from requesting an independent review with respect to
11the grievance.
AB40-ASA1,1295,17 124. `Payment of plan costs.' The authority shall pay plan costs incurred in 2013
13and all other costs associated with dissolving the plan that are incurred before
14administrative responsibility for the dissolution of the plan is transferred to the
15office under subdivision 8. The authority and the office shall make every effort to pay
16plan costs in accordance with, or as closely as possible to, the manner provided in
17section 149.143 of the statutes.
AB40-ASA1,1295,20 185. `Contracts.' The authority may extend any administrative contracts that are
19in effect into 2014, regardless of a contract's expiration date and without having to
20comply with the requirements under section 149.47 of the statutes for the extension.
AB40-ASA1,1295,23 216. `Report to legislature.' The authority shall submit a final report on plan
22operation to the legislature under section 13.172 of the statutes no later than
23September 30, 2013.
AB40-ASA1,1295,24 247. `Board responsibilities.' The board shall do all of the following:
AB40-ASA1,1296,8
1a. Develop a proposal, which shall be followed by the office, for the dispensation
2of the plan's cash assets after all financial obligations of the plan and authority are
3satisfied. To the extent feasible and practical, the proposal shall provide for the
4return of any remaining equity to the source from which derived, including insurers,
5providers, and covered persons. The proposal shall provide for alternative
6dispensations in the event that returning any remaining equity is not feasible or
7practical, such as using remaining cash assets in support of activities providing an
8indirect benefit to the insurers, providers, and covered persons.
AB40-ASA1,1296,10 9b. Dispose of the noncash assets of the authority as soon as possible after the
10administrative offices of the authority are closed.
AB40-ASA1,1296,14 11c. Make any other decisions and take any other actions necessary to effectively
12wind up the operations and affairs of the authority and plan and transfer
13responsibility to the office. All actions taken by the board must be consistent with
14the purpose of, and may not endanger the solvency of, the plan.
AB40-ASA1,1296,16 158. `Transfer to the office.' On the date that is 60 days after the date coverage
16under the plan terminates under subdivision 1. b., all of the following shall occur:
AB40-ASA1,1296,25 17a. Administrative responsibility for the dissolution of the plan is transferred
18to the office. The commissioner shall take any action necessary or advisable to wind
19up the affairs of the plan in accordance with the proposal developed by the board
20under subdivision 7. a. and shall notify the legislative audit bureau when the windup
21is completed and provide to the legislative audit bureau the final financial
22statements of the plan. For purposes of chapter 177 of the statutes, as affected by
23this act, the dissolution, and winding up of the affairs, of the plan shall be considered
24a dissolution of an insurer in accordance with section 645.44 of the statutes, except
25that a court order of dissolution is not required to effect the dissolution of the plan.
AB40-ASA1,1297,3
1b. All remaining cash assets of the plan, including the balance in the Health
2Insurance Risk-Sharing Plan fund, are transferred to the appropriation account
3under section 20.145 (5) (g) of the statutes, as created by this act.
AB40-ASA1,1297,5 4c. All tangible personal property, including records, of the authority not already
5disposed of by the board is transferred to the office.
AB40-ASA1,1297,11 6d. All contracts and agreements entered into by the board that are in effect are
7transferred to the office. The office shall carry out any contractual obligations under
8such a contract or agreement until the contract or agreement terminates or is
9modified or rescinded by the office to the extent allowed under the contract or
10agreement. The office may enter into such other contracts as are necessary to carry
11out the dissolution of the plan.
AB40-ASA1,1297,16 12e. Any matters pending with the authority or plan, including grievances and
13independent reviews, payment claims, subrogation claims, drug rebate claims, and
14legal actions or causes of action, are transferred to the office and all materials
15submitted to and actions taken by the office with respect to a pending matter are
16considered as having been submitted to or taken by the authority or plan.
AB40-ASA1,1297,17 179. `Health Insurance Risk-Sharing Plan advisory committee.'
AB40-ASA1,1297,21 18a. There is created, 60 days after the date coverage under the plan terminates
19under subdivision 1. b., a Health Insurance Risk-Sharing Plan advisory committee
20consisting of the commissioner, or his or her designee, and the other 13 members of
21the board holding office on the date the advisory committee is created.
AB40-ASA1,1297,24 22b. If a vacancy occurs on the Health Insurance Risk-Sharing Plan advisory
23committee, the governor shall appoint a successor, who must meet the same
24qualifications and criteria as the member who is being replaced.
AB40-ASA1,1298,4
1c. The Health Insurance Risk-Sharing Plan advisory committee shall advise
2and assist the office with its duties under subdivision 8. related to the dissolution and
3winding up of the plan. The office shall staff and provide funding for the Health
4Insurance Risk-Sharing Plan advisory committee.
AB40-ASA1,1298,7 5d. The Health Insurance Risk-Sharing Plan advisory committee shall
6terminate 60 days after the final audit of the plan is conducted by the legislative
7audit bureau under subdivision 11. b.
AB40-ASA1,1298,8 810. `Dissolution notice, claims, and updates.'
AB40-ASA1,1298,18 9a. On behalf of the commissioner, the authority shall provide notice of the plan's
10dissolution to all persons known, or reasonably expected from the plan's records, to
11have claims against the plan, including all covered persons. The notice shall be sent
12by first class mail to the last-known addresses at least 60 days before the date on
13which coverage terminates under subdivision 1. b. Notice to potential claimants of
14the plan shall require the claimants to file their claims, together with proofs of
15claims, within 90 days after the date on which coverage terminates under
16subdivision 1. b. The notice shall be consistent with any relevant terms of the policies
17under the plan and contracts and with section 645.47 (1) (a) of the statutes. The
18notice shall serve as final notice consistent with section 645.47 (3) of the statutes.
AB40-ASA1,1299,4 19b. Proofs of all claims must be filed with the office in the form provided by the
20office consistent with the proof of claim, as applicable, under section 645.62 of the
21statutes, on or before the last day for filing specified in the notice. For good cause
22shown, the office shall permit a claimant to make a late filing if the existence of the
23claim was not known to the claimant and the claimant files the claim within 30 days
24after learning of the claim, but not more than 210 days after the date on which
25coverage terminates under subdivision 1. b. Any such late claim that would have

1been payable under the policy under the plan if it had been filed timely and that was
2not covered by a succeeding insurer shall be permitted unless the claimant had
3actual notice of the termination of the plan or the notice was mailed to the claimant
4by first class mail at least 10 days before the insured event occurred.
AB40-ASA1,1299,7 5c. The commissioner shall provide periodic updates to the Health Insurance
6Risk-Sharing Plan advisory committee under subdivision 9. regarding the plan's
7dissolution, including, at a minimum, information about expenses and claims paid.
AB40-ASA1,1299,8 811. `Audits.' The legislative audit bureau shall do all of the following:
AB40-ASA1,1299,10 9a. Conduct its annual audit of the plan under section 13.94 (1) (dh) of the
10statutes for calendar year 2013 by June 30, 2014.
AB40-ASA1,1299,13 11b. Complete a final audit of the plan, after the termination of the plan in 2014,
12within 90 days after the office provides the final financial statements of the plan
13under subdivision 8. a.
AB40-ASA1,1299,18 14c. File copies of the reports of both audits with the distributees specified in
15section 13.94 (1) (b) of the statutes. The costs of the audits shall be paid from the
16funds of the authority or from the appropriation under section 20.145 (5) (g) or (k)
17of the statutes, as created by this act, or from any combination of those payment
18sources.
AB40-ASA1,1299,19 19(1m) Medicare supplement and replacement policy issuance.
AB40-ASA1,1299,20 20(a) Definitions. In this subsection:
AB40-ASA1,1299,21 211. "Medicare" has the meaning given in section 149.10 (7) of the statutes.
AB40-ASA1,1299,23 222. "Medicare replacement policy" has the meaning given in section 600.03 (28p)
23of the statutes.
AB40-ASA1,1299,25 243. "Medicare supplement policy" has the meaning given in section 600.03 (28r)
25of the statutes.
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