Amendment ASA1-AB40

AB40-ASA1,1288,7 3. The comparative cost efficiency of service options allowed under the federal Medicaid program to meet the needs of the populations identified under subdivision 1.

AB40-ASA1,1288,9 4. Strategies to control the growth in long-term care costs in the Medical Assistance program.

AB40-ASA1,1288,11 5. Strategies to promote keeping individuals in their own homes to reduce or delay entry into publicly funded long-term care programs.

AB40-ASA1,1288,13 (c) Submit a report summarizing the results of the projection described under paragraphs (a) and (b) to the joint committee on finance.

AB40-ASA1,1288,14 (4c) Disproportionate share hospital payments.

AB40-ASA1,1288,21 (a) Subject to paragraph (c) and notwithstanding section 49.45 (3) (e) of the statutes, from the appropriation accounts in section 20.435 (4) (b) and (o) of the statutes, the department of health services shall pay to hospitals that serve a disproportionate share of low-income patients a total of $36,792,000 in fiscal year 2013-14 and $36,728,700 in fiscal year 2014-15. The department of health services may make a payment to a hospital under this subsection under the calculation method described in paragraph (b) if the hospital meets all of the following criteria:

AB40-ASA1,1288,22 1. The hospital is located in this state.

AB40-ASA1,1288,24 2. The hospital provides a wide array of services, including services provided through an emergency department.

AB40-ASA1,1289,3 3. The inpatient days for Medical Assistance recipients at the hospital was at least 6 percent of the total inpatient days at that hospital during the most recent year for which such information is available.

AB40-ASA1,1289,6 4. The hospital meets applicable, minimum requirements to be a disproportionate share hospital under 42 USC 1396r-4 and any other applicable federal law.

AB40-ASA1,1289,8 (b) The department of health services shall comply with all of the following when making payments to hospitals described in paragraph (a):

AB40-ASA1,1289,11 1. The department of health services shall distribute the total amount of moneys described under paragraph (a) to be paid to hospitals with a disproportionate share of low-income patients by doing all of the following:

AB40-ASA1,1289,14 a. Dividing the number of Medical Assistance recipient inpatient days at a hospital by the number of total inpatient days at the hospital to obtain the percentage of Medical Assistance recipient inpatient days at that hospital.

AB40-ASA1,1289,17 b. Subject to subdivisions 2. and 3., providing an increase to the inpatient fee-for-service base rate for each hospital that qualifies for a disproportionate share hospital payment under this subsection.

AB40-ASA1,1289,21 c. Subject to subdivisions 2. and 3., providing an additional increase to the increase under subdivision 1. b. using a slope factor of 0.75 such that a hospital's overall fee-for-service add-on percentage under this subsection increases as the hospital's percentage of Medical Assistance recipient inpatient days increases.

AB40-ASA1,1289,24 2. The department of health services shall set the addition to the base rate at a level that ensures the total amount of moneys available to pay hospitals with a disproportionate share of low-income patients is distributed in each fiscal year.

AB40-ASA1,1290,3 3. The department of health services shall limit the maximum payment to hospitals such that no single hospital receives more than $2,500,000 in disproportionate share hospital payments under this subsection in a fiscal year.

AB40-ASA1,1290,24 (c) The department of health services shall seek any necessary approval from the federal department of health and human services to implement the hospital payment methodology described under paragraphs (a) and (b). If approval is necessary and approval from the federal department of health and human services is received, the department of health services shall implement the payment methodology described under paragraphs (a) and (b). If approval is necessary and the department of health services and the federal department of health and human services negotiate a methodology for making payments to hospitals with a disproportionate share of low-income patients that is different from the methodology described under paragraphs (a) and (b), the department of health services, before implementing the negotiated payment methodology, shall submit to the joint committee on finance the negotiated payment methodology. If the cochairpersons of the committee do not notify the department of health services within 14 working days after the date of the submittal by the department of health services that the committee has scheduled a meeting for the purpose of reviewing the negotiated payment methodology, the department of health services may implement the negotiated payment methodology. If, within 14 working days after the date of the submittal by the department of health services, the cochairpersons of the committee notify the department of health services that the committee has scheduled a meeting for the purpose of reviewing the negotiated payment methodology, the negotiated payment methodology may be implemented only on approval of the committee.

AB40-ASA1,1290,25 (5e) Funding of Family Care enrollees admitted to mental health institutes.

AB40-ASA1,1291,1 (a) In this subsection:

AB40-ASA1,1291,2 1. "Department" means the department of health services.

AB40-ASA1,1291,4 2. "Family Care program" means the benefit program under section 46.286 of the statutes.

AB40-ASA1,1291,6 3. "Mental health institute" has the meaning given in section 51.01 (12) of the statutes.

AB40-ASA1,1291,10 (b) Before September 1, 2013, the department shall submit to the joint committee on finance a report that identifies issues relating to cost liability for counties with residents who were formerly enrolled in the Family Care program and who are admitted to a mental health institute.

AB40-ASA1,1291,20 (c) After submitting the report under paragraph (b) and during the 2013-15 fiscal biennium, the department shall submit one or more requests to the joint committee on finance under section 13.10 of the statutes to supplement the appropriation under section 20.435 (2) (bj) of the statutes from the appropriation under section 20.865 (4) (a) of the statutes for the purpose of paying a portion of the additional costs counties incur to support services provided by the mental health institutes to certain enrollees in the Family Care program. If the joint committee on finance releases the moneys, the department may reimburse the county for all of the following for a stay of an enrollee of the Family Care program at a mental health institute subject to paragraph (d):

AB40-ASA1,1291,23 1. For any portion of a stay longer than 30 days but not longer than 60 days at a mental health institute, 50 percent of the state share of the cost of care incurred by the county for that portion of the stay.

AB40-ASA1,1292,3 2. For any portion of a stay longer than 60 days but not longer than 90 days, 75 percent of the state share of the cost of care incurred by the county for that portion of the stay.

AB40-ASA1,1292,5 3. For any portion of a stay longer than 90 days, all of the state share of the cost of care incurred by the county for that portion of the stay.

AB40-ASA1,1292,14 (d) The department may provide reimbursement to counties for Family Care program enrollees admitted to mental health institutes on or after the effective date of this paragraph and, if the Family Care program enrollee is still at the mental health institute on the effective date of this paragraph, before the effective date of this paragraph. For a Family Care program enrollee admitted to a mental health institute before the effective date of this paragraph, the department shall base the reimbursement on the Family Care program enrollee's total length of stay since admission to the mental health institute using the calculations under paragraph (c) 1. to 3.

AB40-ASA1,1292,17 (e) The financial liability of the state to pay reimbursements for services at a mental health institute for Family Care program enrollees under this subsection is limited to services provided at a mental health institute before July 1, 2015.

AB40-ASA1,9119 Section 9119. Nonstatutory provisions; Higher Educational Aids Board.

AB40-ASA1,9120 Section 9120. Nonstatutory provisions; Historical Society.

AB40-ASA1,9121 Section 9121. Nonstatutory provisions; Housing and Economic Development Authority.

AB40-ASA1,9122 Section 9122. Nonstatutory provisions; Insurance.

AB40-ASA1,1292,22 (1L) Dissolution of the Health Insurance Risk-Sharing Plan and Authority.

AB40-ASA1,1292,23 (a) Definitions. In this subsection:

AB40-ASA1,1293,2 1. "Authority" means the Health Insurance Risk-Sharing Plan Authority under subchapter III of chapter 149 of the statutes.

AB40-ASA1,1293,3 2. "Board" means the board of directors of the authority.

AB40-ASA1,1293,4 3. "Commissioner" means the commissioner of insurance.

AB40-ASA1,1293,5 4. "Covered person" means a person who has coverage under the plan.

AB40-ASA1,1293,6 5. "Office" means the office of the commissioner of insurance.

AB40-ASA1,1293,8 6. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II of chapter 149 of the statutes.

AB40-ASA1,1293,11 (b) Dissolution of the plan and authority. Notwithstanding any statute, administrative rule, or provision of a policy or contract or of the plan to the contrary, the plan and the authority shall be dissolved in accordance with the following:

AB40-ASA1,1293,12 1. `Coverage provisions.'

AB40-ASA1,1293,16 a. New coverage under the plan may not be issued to any person after December 31, 2013, except that new coverage under the plan that is funded under a contract with the federal department of health and human services may not be issued to any person after December 1, 2013.

AB40-ASA1,1293,24 b. Coverage under the policies issued under the plan terminates on January 1, 2014, or on the date that any health insurance coverage that is accessed through an American health benefit exchange, as described in 42 USC 18031, in this state is effective, if later than January 1, 2014. At least 60 days before coverage terminates, the authority shall provide notice of the date on which coverage terminates to all covered persons, all insurers and providers that are affected by the termination of the coverage, the office, the legislative audit bureau, and the insurers described in subsection (1m) (b) 1.

AB40-ASA1,1294,9 c. If coverage under the policies issued under the plan terminates on a date that is later than January 1, 2014, because no health insurance coverage that is accessed through an American health benefit exchange, as described in 42 USC 18031, in this state is effective on January 1, 2014, the authority may allow covered persons whose coverage under the plan is funded under a contract with the federal department of health and human services to elect to be covered, until coverage under the plan terminates, under the same coverage provided under the plan to covered persons whose coverage under the plan is not funded under a contract with the federal department of health and human services.

AB40-ASA1,1294,19 2. `Provider claims.' Providers of medical services and devices and prescription drugs to covered persons must file claims for payment no later than 90 days after the date coverage terminates under subdivision 1. b. Any claim filed after that date is not payable and may not be charged to the covered person who received the service, device, or drug. Except for copayments, coinsurance, or deductibles required under the plan, during the 90 days after the date coverage terminates under subdivision 1. b., consistent with section 149.14 (3) of the statutes and section 149.142 (2m) of the statutes, a provider may not bill a covered person who receives a covered service or article and shall accept as payment in full the payment rate determined under section 149.142 (1) of the statutes.

AB40-ASA1,1294,20 3. `Grievances and review.'

AB40-ASA1,1294,24 a. Except for a grievance related to a prior authorization denial, a covered person must submit any grievance, in writing, no later than 180 days after the date coverage terminates under subdivision 1. b. or be barred from submitting the grievance.

AB40-ASA1,1295,6 b. A covered person must submit any grievance related to a prior authorization denial no later than 45 days before the date on which coverage terminates under subdivision 1. b. or be barred from submitting the grievance, except that a grievance related to a prior authorization denial that meets the requirements for an expedited grievance must be submitted no later than the date on which coverage terminates under subdivision 1. b. or be barred.

AB40-ASA1,1295,11 c. A covered person who submits a grievance after the date coverage terminates under subdivision 1. b. must request an independent review, if any, with respect to the grievance no later than 60 days after he or she receives notice of the disposition of the grievance or be barred from requesting an independent review with respect to the grievance.

AB40-ASA1,1295,17 4. `Payment of plan costs.' The authority shall pay plan costs incurred in 2013 and all other costs associated with dissolving the plan that are incurred before administrative responsibility for the dissolution of the plan is transferred to the office under subdivision 8. The authority and the office shall make every effort to pay plan costs in accordance with, or as closely as possible to, the manner provided in section 149.143 of the statutes.

AB40-ASA1,1295,20 5. `Contracts.' The authority may extend any administrative contracts that are in effect into 2014, regardless of a contract's expiration date and without having to comply with the requirements under section 149.47 of the statutes for the extension.

AB40-ASA1,1295,23 6. `Report to legislature.' The authority shall submit a final report on plan operation to the legislature under section 13.172 of the statutes no later than September 30, 2013.

AB40-ASA1,1295,24 7. `Board responsibilities.' The board shall do all of the following:

AB40-ASA1,1296,8 a. Develop a proposal, which shall be followed by the office, for the dispensation of the plan's cash assets after all financial obligations of the plan and authority are satisfied. To the extent feasible and practical, the proposal shall provide for the return of any remaining equity to the source from which derived, including insurers, providers, and covered persons. The proposal shall provide for alternative dispensations in the event that returning any remaining equity is not feasible or practical, such as using remaining cash assets in support of activities providing an indirect benefit to the insurers, providers, and covered persons.

AB40-ASA1,1296,10 b. Dispose of the noncash assets of the authority as soon as possible after the administrative offices of the authority are closed.

AB40-ASA1,1296,14 c. Make any other decisions and take any other actions necessary to effectively wind up the operations and affairs of the authority and plan and transfer responsibility to the office. All actions taken by the board must be consistent with the purpose of, and may not endanger the solvency of, the plan.

AB40-ASA1,1296,16 8. `Transfer to the office.' On the date that is 60 days after the date coverage under the plan terminates under subdivision 1. b., all of the following shall occur:

AB40-ASA1,1296,25 a. Administrative responsibility for the dissolution of the plan is transferred to the office. The commissioner shall take any action necessary or advisable to wind up the affairs of the plan in accordance with the proposal developed by the board under subdivision 7. a. and shall notify the legislative audit bureau when the windup is completed and provide to the legislative audit bureau the final financial statements of the plan. For purposes of chapter 177 of the statutes, as affected by this act, the dissolution, and winding up of the affairs, of the plan shall be considered a dissolution of an insurer in accordance with section 645.44 of the statutes, except that a court order of dissolution is not required to effect the dissolution of the plan.

AB40-ASA1,1297,3 b. All remaining cash assets of the plan, including the balance in the Health Insurance Risk-Sharing Plan fund, are transferred to the appropriation account under section 20.145 (5) (g) of the statutes, as created by this act.

AB40-ASA1,1297,5 c. All tangible personal property, including records, of the authority not already disposed of by the board is transferred to the office.

AB40-ASA1,1297,11 d. All contracts and agreements entered into by the board that are in effect are transferred to the office. The office shall carry out any contractual obligations under such a contract or agreement until the contract or agreement terminates or is modified or rescinded by the office to the extent allowed under the contract or agreement. The office may enter into such other contracts as are necessary to carry out the dissolution of the plan.

AB40-ASA1,1297,16 e. Any matters pending with the authority or plan, including grievances and independent reviews, payment claims, subrogation claims, drug rebate claims, and legal actions or causes of action, are transferred to the office and all materials submitted to and actions taken by the office with respect to a pending matter are considered as having been submitted to or taken by the authority or plan.

AB40-ASA1,1297,17 9. `Health Insurance Risk-Sharing Plan advisory committee.'

AB40-ASA1,1297,21 a. There is created, 60 days after the date coverage under the plan terminates under subdivision 1. b., a Health Insurance Risk-Sharing Plan advisory committee consisting of the commissioner, or his or her designee, and the other 13 members of the board holding office on the date the advisory committee is created.

AB40-ASA1,1297,24 b. If a vacancy occurs on the Health Insurance Risk-Sharing Plan advisory committee, the governor shall appoint a successor, who must meet the same qualifications and criteria as the member who is being replaced.

AB40-ASA1,1298,4 c. The Health Insurance Risk-Sharing Plan advisory committee shall advise and assist the office with its duties under subdivision 8. related to the dissolution and winding up of the plan. The office shall staff and provide funding for the Health Insurance Risk-Sharing Plan advisory committee.

AB40-ASA1,1298,7 d. The Health Insurance Risk-Sharing Plan advisory committee shall terminate 60 days after the final audit of the plan is conducted by the legislative audit bureau under subdivision 11. b.

AB40-ASA1,1298,8 10. `Dissolution notice, claims, and updates.'

AB40-ASA1,1298,18 a. On behalf of the commissioner, the authority shall provide notice of the plan's dissolution to all persons known, or reasonably expected from the plan's records, to have claims against the plan, including all covered persons. The notice shall be sent by first class mail to the last-known addresses at least 60 days before the date on which coverage terminates under subdivision 1. b. Notice to potential claimants of the plan shall require the claimants to file their claims, together with proofs of claims, within 90 days after the date on which coverage terminates under subdivision 1. b. The notice shall be consistent with any relevant terms of the policies under the plan and contracts and with section 645.47 (1) (a) of the statutes. The notice shall serve as final notice consistent with section 645.47 (3) of the statutes.

AB40-ASA1,1299,4 b. Proofs of all claims must be filed with the office in the form provided by the office consistent with the proof of claim, as applicable, under section 645.62 of the statutes, on or before the last day for filing specified in the notice. For good cause shown, the office shall permit a claimant to make a late filing if the existence of the claim was not known to the claimant and the claimant files the claim within 30 days after learning of the claim, but not more than 210 days after the date on which coverage terminates under subdivision 1. b. Any such late claim that would have been payable under the policy under the plan if it had been filed timely and that was not covered by a succeeding insurer shall be permitted unless the claimant had actual notice of the termination of the plan or the notice was mailed to the claimant by first class mail at least 10 days before the insured event occurred.

AB40-ASA1,1299,7 c. The commissioner shall provide periodic updates to the Health Insurance Risk-Sharing Plan advisory committee under subdivision 9. regarding the plan's dissolution, including, at a minimum, information about expenses and claims paid.

AB40-ASA1,1299,8 11. `Audits.' The legislative audit bureau shall do all of the following:

AB40-ASA1,1299,10 a. Conduct its annual audit of the plan under section 13.94 (1) (dh) of the statutes for calendar year 2013 by June 30, 2014.

AB40-ASA1,1299,13 b. Complete a final audit of the plan, after the termination of the plan in 2014, within 90 days after the office provides the final financial statements of the plan under subdivision 8. a.

AB40-ASA1,1299,18 c. File copies of the reports of both audits with the distributees specified in section 13.94 (1) (b) of the statutes. The costs of the audits shall be paid from the funds of the authority or from the appropriation under section 20.145 (5) (g) or (k) of the statutes, as created by this act, or from any combination of those payment sources.

AB40-ASA1,1299,19 (1m) Medicare supplement and replacement policy issuance.

AB40-ASA1,1299,20 (a) Definitions. In this subsection:

AB40-ASA1,1299,21 1. "Medicare" has the meaning given in section 149.10 (7) of the statutes.

AB40-ASA1,1299,23 2. "Medicare replacement policy" has the meaning given in section 600.03 (28p) of the statutes.

AB40-ASA1,1299,25 3. "Medicare supplement policy" has the meaning given in section 600.03 (28r) of the statutes.

AB40-ASA1,1300,2 4. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II of chapter 149 of the statutes.

AB40-ASA1,1300,3 (b) Time-limited guaranteed issue.

AB40-ASA1,1300,6 1. An insurer offering a Medicare supplement policy or a Medicare replacement policy in this state shall provide coverage under the policy to any individual who satisfies all of the following:

AB40-ASA1,1300,7 a. The individual is eligible for Medicare.

AB40-ASA1,1300,8 b. The individual had coverage under the plan.

AB40-ASA1,1300,10 c. The individual's coverage under the plan terminated on the date specified in subsection (1L) (b) 1. b.