Bill Text: MN SF147 | 2013-2014 | 88th Legislature | Introduced
Bill Title: Medical assistance (MA) benefit plan cost-sharing co-payment waiver for the Hennepin county pilot program
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2013-02-13 - Comm report: To pass and re-referred to Finance [SF147 Detail]
Download: Minnesota-2013-SF147-Introduced.html
1.2relating to human services; modifying medical assistance co-payment
1.3requirements;amending Minnesota Statutes 2012, section 256B.0631,
1.4subdivision 1.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to
1.7read:
1.8 Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
1.9assistance benefit plan shall include the following cost-sharing for all recipients, effective
1.10for services provided on or after September 1, 2011:
1.11 (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
1.12of this subdivision, a visit means an episode of service which is required because of
1.13a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
1.14ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
1.15midwife, advanced practice nurse, audiologist, optician, or optometrist;
1.16 (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
1.17this co-payment shall be increased to $20 upon federal approval;
1.18 (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
1.19subject to a $12 per month maximum for prescription drug co-payments. No co-payments
1.20shall apply to antipsychotic drugs when used for the treatment of mental illness;
1.21(4) effective January 1, 2012, a family deductible equal to the maximum amount
1.22allowed under Code of Federal Regulations, title 42, part 447.54; and
1.23 (5) for individuals identified by the commissioner with income at or below 100
1.24percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
2.1percent of family income. For purposes of this paragraph, family income is the total
2.2earned and unearned income of the individual and the individual's spouse, if the spouse is
2.3enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
2.4 (b) Recipients of medical assistance are responsible for all co-payments and
2.5deductibles in this subdivision.
2.6(c) Notwithstanding paragraph (b), the commissioner, through the contracting
2.7process under sections256B.69 and
256B.692 , may allow managed care plans and
2.8county-based purchasing plans to waive the family deductible under paragraph (a),
2.9clause (4). The value of the family deductible shall not be included in the capitation
2.10payment to managed care plans and county-based purchasing plans. Managed care plans
2.11and county-based purchasing plans shall certify annually to the commissioner the dollar
2.12value of the family deductible.
2.13(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
2.14the family deductible described under paragraph (a), clause (4), from individuals and
2.15allow long-term care and waivered service providers to assume responsibility for payment.
2.16(e) Notwithstanding paragraph (b), the commissioner, through the contracting
2.17process under section 256B.0756 shall allow the pilot program in Hennepin County to
2.18waive co-payments. The value of the co-payments shall not be included in the capitation
2.19amount to the managed care organization.
1.3requirements;amending Minnesota Statutes 2012, section 256B.0631,
1.4subdivision 1.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to
1.7read:
1.8 Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
1.9assistance benefit plan shall include the following cost-sharing for all recipients, effective
1.10for services provided on or after September 1, 2011:
1.11 (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
1.12of this subdivision, a visit means an episode of service which is required because of
1.13a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
1.14ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
1.15midwife, advanced practice nurse, audiologist, optician, or optometrist;
1.16 (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
1.17this co-payment shall be increased to $20 upon federal approval;
1.18 (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
1.19subject to a $12 per month maximum for prescription drug co-payments. No co-payments
1.20shall apply to antipsychotic drugs when used for the treatment of mental illness;
1.21(4) effective January 1, 2012, a family deductible equal to the maximum amount
1.22allowed under Code of Federal Regulations, title 42, part 447.54; and
1.23 (5) for individuals identified by the commissioner with income at or below 100
1.24percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
2.1percent of family income. For purposes of this paragraph, family income is the total
2.2earned and unearned income of the individual and the individual's spouse, if the spouse is
2.3enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
2.4 (b) Recipients of medical assistance are responsible for all co-payments and
2.5deductibles in this subdivision.
2.6(c) Notwithstanding paragraph (b), the commissioner, through the contracting
2.7process under sections
2.8county-based purchasing plans to waive the family deductible under paragraph (a),
2.9clause (4). The value of the family deductible shall not be included in the capitation
2.10payment to managed care plans and county-based purchasing plans. Managed care plans
2.11and county-based purchasing plans shall certify annually to the commissioner the dollar
2.12value of the family deductible.
2.13(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
2.14the family deductible described under paragraph (a), clause (4), from individuals and
2.15allow long-term care and waivered service providers to assume responsibility for payment.
2.16(e) Notwithstanding paragraph (b), the commissioner, through the contracting
2.17process under section 256B.0756 shall allow the pilot program in Hennepin County to
2.18waive co-payments. The value of the co-payments shall not be included in the capitation
2.19amount to the managed care organization.
