Subd. 2.

Transfers.

(a) deleted text begin Notwithstanding section 295.581,deleted text end To the extent available
resources in the health care access fund exceed expenditures in that fund, effective for the
biennium beginning July 1, 2007, the commissioner of management and budget shall transfer
the excess funds from the health care access fund to the general fund on June 30 of each
year, provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000,
the amount in fiscal year 2017 shall not exceed $122,000,000, the amount in fiscal year
2024 shall not exceed $70,215,000, and the amount in any fiscal biennium thereafter shall
not exceed $244,000,000. The purpose of this transfer is to meet the rate increase required
under section 256B.04, subdivision 25.

(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if
necessary, the commissioner shall reduce these transfers from the health care access fund
to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer
sufficient funds from the general fund to the health care access fund to meet annual
MinnesotaCare expenditures.

Subdivision 1.

Definitions.

(a) For purposes of this section, the following definitions
apply.

(b) "Health plan company" has the definition provided in section 62Q.01.

(c) "Total expenditures" means incurred claims or expenditures on health care services,
administrative expenses, charitable contributions, and all other payments made by health
plan companies out of premium revenues.

(d) "Net expenditures" means total expenditures minus exempted taxes and assessments
and payments or allocations made to establish or maintain reserves.

(e) "Exempted taxes and assessments" means direct payments for taxes to government
agencies, contributions to the Minnesota Comprehensive Health Association, the medical
assistance provider's surcharge under section 256.9657, deleted text begin the MinnesotaCare provider tax
under section 295.52,deleted text end assessments by the Health Coverage Reinsurance Association,
assessments by the Minnesota Life and Health Insurance Guaranty Association, assessments
by the Minnesota Risk Adjustment Association, and any new assessments imposed by
federal or state law.

(f) "Consumer cost-sharing or subscriber liability" means enrollee coinsurance,
co-payment, deductible payments, and amounts in excess of benefit plan maximums.

Subd. 3.

Grounds for disciplinary action.

The board shall take disciplinary action,
which may include license revocation, against a regulated person for:

(1) intentional failure to provide the commissioner of health with the data required under
chapter 62J;new text begin and
new text end

deleted text begin (2) intentional failure to provide the commissioner of revenue with data on gross revenue
and other information required for the commissioner to implement sections 295.50 to 295.58;
deleted text end

deleted text begin (3) intentional failure to pay the health care provider tax required under section 295.52;
and
deleted text end

deleted text begin (4)deleted text end new text begin (2)new text end entering into a contract or arrangement that is prohibited under sections 62J.70
to 62J.73.

Subd. 25.

Medical assistance and MinnesotaCare payment increase.

deleted text begin (a) The
commissioner shall increase medical assistance and MinnesotaCare fee-for-service payments
by an amount equal to the tax rate defined for hospitals, surgical centers, or health care
providers under sections 295.50 to 295.57 for all services subject to those taxes.
deleted text end

deleted text begin (b)deleted text end The commissioner shall reflect in the total payments made to managed care
organizations, county-based purchasing plans, and other participating entities contracted
with the commissioner under section 256B.69, the cost ofdeleted text begin : (1) payments made to providers
for the tax on the services outlined in paragraph (a); and (2)deleted text end the taxes imposed under sections
297I.05, subdivision 5, and 256.9657, subdivision 3, on premium revenue paid by the state
for medical assistance and the MinnesotaCare program. Any increase deleted text begin based on clause (2)deleted text end
must be reflected in provider rates paid by the managed care organization, county-based
purchasing plan, or other participating entity, unless the managed care organization,
county-based purchasing plan, or other participating entity is a staff model health plan
company.

Subd. 13e.

Payment rates.

(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
$10.77 for prescriptions filled with legend drugs meeting the definition of "covered outpatient
drugs" according to United States Code, title 42, section 1396r-8(k)(2). The dispensing fee
for intravenous solutions that must be compounded by the pharmacist shall be $10.77 per
claim. The professional dispensing fee for prescriptions filled with over-the-counter drugs
meeting the definition of covered outpatient drugs shall be $10.77 for dispensed quantities
equal to or greater than the number of units contained in the manufacturer's original package.
The professional dispensing fee shall be prorated based on the percentage of the package
dispensed when the pharmacy dispenses a quantity less than the number of units contained
in the manufacturer's original package. The pharmacy dispensing fee for prescribed
over-the-counter drugs not meeting the definition of covered outpatient drugs shall be $3.65
for quantities equal to or greater than the number of units contained in the manufacturer's
original package and shall be prorated based on the percentage of the package dispensed
when the pharmacy dispenses a quantity less than the number of units contained in the
manufacturer's original package. The National Average Drug Acquisition Cost (NADAC)
shall be used to determine the ingredient cost of a drug. For drugs for which a NADAC is
not reported, the commissioner shall estimate the ingredient cost at the wholesale acquisition
cost minus two percent. The ingredient cost of a drug for a provider participating in the
federal 340B Drug Pricing Program shall be either the 340B Drug Pricing Program ceiling
price established by the Health Resources and Services Administration or NADAC,
whichever is lower. Wholesale acquisition cost is defined as the manufacturer's list price
for a drug or biological to wholesalers or direct purchasers in the United States, not including
prompt pay or other discounts, rebates, or reductions in price, for the most recent month for
which information is available, as reported in wholesale price guides or other publications
of drug or biological pricing data. The maximum allowable cost of a multisource drug may
be set by the commissioner and it shall be comparable to the actual acquisition cost of the
drug product and no higher than the NADAC of the generic product. Establishment of the
amount of payment for drugs shall not be subject to the requirements of the Administrative
Procedure Act.

(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility resident