SF 839

as introduced - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; establishing the Minnesota 
  1.3             universal health board; creating the Minnesota 
  1.4             universal health program; establishing the Minnesota 
  1.5             health care trust fund; establishing statewide and 
  1.6             regional health care budgets; appropriating money; 
  1.7             proposing coding for new law as Minnesota Statutes, 
  1.8             chapter 62K; repealing Minnesota Statutes 2000, 
  1.9             section 62J.212. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11                             ARTICLE 1
  1.12                              PURPOSE
  1.13     Section 1.  [PURPOSE.] 
  1.14     The Minnesota universal health board is created for the 
  1.15  purpose of providing a single, publicly financed, statewide 
  1.16  program to provide comprehensive coverage for all necessary 
  1.17  health care services for residents of Minnesota. 
  1.18                             ARTICLE 2
  1.19                  MINNESOTA UNIVERSAL HEALTH BOARD
  1.20     Section 1.  [62K.01] [DEFINITIONS.] 
  1.21     Subdivision 1.  [SCOPE.] For purposes of this chapter, the 
  1.22  following terms have the meanings given them. 
  1.23     Subd. 2.  [BOARD.] "Board" means the Minnesota universal 
  1.24  health board established under section 62K.02. 
  1.25     Subd. 3.  [COMMISSIONER.] "Commissioner" means the 
  1.26  commissioner of health. 
  1.27     Subd. 4.  [CULTURALLY SPECIFIC PROGRAM.] "Culturally 
  2.1   specific program" means a program: 
  2.2      (1) designed to address the unique needs of individuals who 
  2.3   share a common language or racial, ethnic, or social background; 
  2.4      (2) governed with significant input from individuals of 
  2.5   that specific background; and 
  2.6      (3) that employs individuals to provide individual or group 
  2.7   therapy, at least 50 percent of whom are of that specific 
  2.8   background. 
  2.9      Subd. 5.  [DEPARTMENT.] "Department" means the department 
  2.10  of health. 
  2.11     Subd. 6.  [HEALTH PLAN COMPANY.] "Health plan company" 
  2.12  means a health plan company as defined in section 62Q.01, 
  2.13  subdivision 4.  
  2.14     Subd. 7.  [INDIVIDUAL PROVIDER.] "Individual provider" 
  2.15  means a health care provider licensed or registered by the state 
  2.16  who is not an institutional provider. 
  2.17     Subd. 8.  [INSTITUTIONAL PROVIDER.] "Institutional 
  2.18  provider" means an inpatient hospital, nursing facility, health 
  2.19  maintenance organization, intermediate care facility for persons 
  2.20  with mental retardation and related conditions, and other 
  2.21  providers of inpatient services, including institutions 
  2.22  providing inpatient or overnight care and ambulatory diagnostic, 
  2.23  treatment, and surgical facilities. 
  2.24     Subd. 9.  [MEDICALLY NECESSARY.] "Medically necessary" 
  2.25  means a health service that is consistent with the recipient's 
  2.26  diagnosis or condition, recognized as the prevailing standard or 
  2.27  current practice by the provider's peer group, and: 
  2.28     (1) rendered: 
  2.29     (i) to treat an injury, illness, infection, or pain; 
  2.30     (ii) to treat a condition that could result in physical or 
  2.31  mental disability; 
  2.32     (iii) to care for a mother and child through a maternity 
  2.33  period; or 
  2.34     (iv) to achieve a level of physical or mental function 
  2.35  consistent with prevailing community standards for diagnosis or 
  2.36  condition; or 
  3.1      (2) a preventive health service. 
  3.2      Subd. 10.  [PROGRAM.] "Program" means the Minnesota 
  3.3   universal health program established under this chapter and 
  3.4   administered by the Minnesota universal health board. 
  3.5      Sec. 2.  [62K.02] [MINNESOTA UNIVERSAL HEALTH BOARD.] 
  3.6      Subdivision 1.  [ELIGIBILITY.] A member of the Minnesota 
  3.7   universal health board must be a consumer who: 
  3.8      (1) does not have and in the past did not have a material 
  3.9   interest in the provision of health care services or in any 
  3.10  activity directly related to the provision of health care 
  3.11  services, such as health insurance sales or health plan 
  3.12  administration; 
  3.13     (2) is not responsible for or directly involved in the 
  3.14  purchasing of health insurance for a business or organization; 
  3.15  and 
  3.16     (3) is not a registered lobbyist in this state. 
  3.17     Subd. 2.  [COMPOSITION.] (a) The Minnesota universal health 
  3.18  board shall consist of 12 members selected as follows: 
  3.19     (1) four persons appointed by the governor; 
  3.20     (2) four persons appointed by the chair of the senate 
  3.21  health and family security committee; and 
  3.22     (3) four persons appointed by the chair of the house health 
  3.23  and human services committee. 
  3.24     (b) The appointing authorities shall coordinate their 
  3.25  efforts to ensure that the board composition reflects the racial 
  3.26  and ethnic diversity of the state and provides representation 
  3.27  for persons with disabilities. 
  3.28     Subd. 3.  [TERMS; COMPENSATION; REMOVAL; AND 
  3.29  VACANCIES.] The board is governed by section 15.0575, except 
  3.30  that board members shall receive salaries rather than per diems. 
  3.31     Subd. 4.  [ADMINISTRATION.] The commissioner shall provide 
  3.32  office space, equipment and supplies, and technical support to 
  3.33  the board. 
  3.34     Subd. 5.  [STAFF.] The board may hire an executive director 
  3.35  who serves in the unclassified service.  The executive director 
  3.36  may hire employees and consultants as authorized by the board 
  4.1   and may prescribe their duties.  The attorney general shall 
  4.2   provide legal services to the board. 
  4.3      Subd. 6.  [GENERAL DUTIES.] The board may: 
  4.4      (1) implement and administer the Minnesota universal health 
  4.5   program; 
  4.6      (2) estimate the current cost of universal coverage for all 
  4.7   Minnesotans; 
  4.8      (3) establish statewide and regional budgets that include 
  4.9   budgets for the accounts specified in section 62K.09.  The 
  4.10  statewide budget must be limited to the cost estimated under 
  4.11  clause (2); 
  4.12     (4) approve budgets for each region, including budgets for 
  4.13  the accounts specified in section 62K.09; 
  4.14     (5) establish fee schedules, which may vary to reflect 
  4.15  regional differences; 
  4.16     (6) approve regional budgets for institutional providers; 
  4.17     (7) monitor compliance with all budgets and fee schedules 
  4.18  and take action to achieve compliance to the extent authorized 
  4.19  by law; 
  4.20     (8) issue requests for proposals for a contract to process 
  4.21  claims submitted by individual providers; 
  4.22     (9) administer the Minnesota health care trust fund created 
  4.23  under section 62K.07; 
  4.24     (10) monitor the operation of the Minnesota universal 
  4.25  health program through consumer surveys and regular data 
  4.26  collection and evaluation activities, including evaluations of 
  4.27  the adequacy and quality of services furnished under the 
  4.28  program, the need for changes in the benefit package, the cost 
  4.29  of each type of service, and the effectiveness of cost 
  4.30  containment measures under the program; 
  4.31     (11) develop and implement enrollment procedures for 
  4.32  providers and persons eligible for the program and disseminate, 
  4.33  to providers and the public, information concerning the program 
  4.34  and the persons eligible to receive benefits under the program; 
  4.35     (12) develop and implement cost containment and quality 
  4.36  assurance procedures, including a professional peer review 
  5.1   system; 
  5.2      (13) conduct necessary investigations and inquiries and 
  5.3   require the submission of information, documents, and records 
  5.4   the board considers necessary to carry out its duties under this 
  5.5   chapter; and 
  5.6      (14) conduct other activities the board considers necessary 
  5.7   to carry out the purposes of this chapter. 
  5.8      Subd. 7.  [ANNUAL REPORT.] The board shall present an 
  5.9   annual report to the legislature and the governor by January 1, 
  5.10  2003, and each succeeding January, summarizing the activities of 
  5.11  the board.  In the report due January 1, 2004, the board shall 
  5.12  recommend whether statewide and regional budgets should be set 
  5.13  annually or biennially. 
  5.14     Subd. 8.  [RULEMAKING.] The board may adopt rules as 
  5.15  necessary to carry out the duties assigned under this chapter. 
  5.16     Subd. 9.  [HEARINGS.] The board, after providing notice to 
  5.17  consumers, providers, and all other interested parties, may hold 
  5.18  hearings in connection with any action that it proposes to take 
  5.19  under subdivision 6. 
  5.20     Sec. 3.  [62K.05] [MINNESOTA UNIVERSAL HEALTH PROGRAM 
  5.21  IMPLEMENTATION SCHEDULE.] 
  5.22     (a) The board, through the commissioner, shall begin 
  5.23  planning and development for the Minnesota universal health 
  5.24  program.  The board shall use an implementation schedule that 
  5.25  will phase in enrollment for Minnesota residents, with initial 
  5.26  enrollment of eligible individuals and families beginning July 
  5.27  1, 2003.  All Minnesota residents without health insurance shall 
  5.28  be insured by January 1, 2004.  The health insurance that covers 
  5.29  all Minnesota residents shall be consolidated into the Minnesota 
  5.30  universal health program by January 1, 2006. 
  5.31     (b) In carrying out planning and development activities, 
  5.32  the board shall: 
  5.33     (1) begin initial enrollment of uninsured and underinsured 
  5.34  individuals and families with annual incomes of less than 275 
  5.35  percent of the federal poverty guideline who do not have 
  5.36  duplicative coverage through a federal, state, or private 
  6.1   insurance program or plan, by July 1, 2003; 
  6.2      (2) provide Medicare supplemental insurance, by July 1, 
  6.3   2003, to Medicare enrollees with annual incomes of less than 275 
  6.4   percent of the federal poverty guideline; 
  6.5      (3) enroll individuals and families with incomes at or 
  6.6   above 275 percent of the federal poverty guideline, and 
  6.7   individuals and families with incomes below 275 percent of the 
  6.8   federal poverty guidelines not eligible for enrollment under 
  6.9   clause (1), beginning January 1, 2004; 
  6.10     (4) provide Medicare supplemental insurance to Medicare 
  6.11  enrollees not eligible for enrollment under clause (2), 
  6.12  beginning January 1, 2004; 
  6.13     (5) merge the Minnesota universal health program, the 
  6.14  MinnesotaCare program, the general assistance medical care 
  6.15  program, and the services for children with handicaps program by 
  6.16  July 1, 2004, in a way that will not diminish the coverage 
  6.17  provided to participants in existing programs and without 
  6.18  increasing the financial obligations of public hospitals and 
  6.19  other providers that currently serve participants in these 
  6.20  programs; 
  6.21     (6) assume responsibility for the administration and 
  6.22  funding of appropriate components of maternal and child health 
  6.23  services currently administered by the commissioner and 
  6.24  coordinate outreach, patient education, case management, and 
  6.25  related activities with the maternal and child health program, 
  6.26  local public health departments, and nonprofit agencies, by July 
  6.27  1, 2004; 
  6.28     (7) merge the consolidated chemical dependency treatment 
  6.29  fund with the Minnesota universal health program by July 1, 
  6.30  2004; 
  6.31     (8) phase out the Minnesota comprehensive health 
  6.32  association by July 1, 2004, in a way that will ensure that 
  6.33  Minnesota comprehensive health association enrollees receive 
  6.34  comparable coverage through the Minnesota universal health 
  6.35  program; 
  6.36     (9) prohibit health plan companies, beginning January 1, 
  7.1   2004, from selling insurance that duplicates benefits provided 
  7.2   by the Minnesota universal health program, in a manner that 
  7.3   ensures continuity of coverage through the program as duplicate 
  7.4   coverage in the private market is prohibited; 
  7.5      (10) seek federal waivers in order to phase Medicare and 
  7.6   medical assistance recipients into the program by a target date 
  7.7   of January 1, 2006; and 
  7.8      (11) phase retirees with retiree health benefits into the 
  7.9   program by January 1, 2006. 
  7.10     Sec. 4.  [62K.07] [MINNESOTA HEALTH CARE TRUST FUND.] 
  7.11     Subdivision 1.  [ESTABLISHMENT.] The Minnesota health care 
  7.12  trust fund is established.  The fund shall consist of all money 
  7.13  obtained from general fund appropriations, state savings 
  7.14  resulting from state health program consolidation, federal 
  7.15  payments received as a result of any waiver or requirements 
  7.16  granted by the United States Secretary of Health and Human 
  7.17  Services under health care programs established under title 18 
  7.18  and title 19 of the Social Security Act, United States Code, 
  7.19  title 42, section 301, and any other money received by the 
  7.20  board.  The budgets of Minnesota state agencies shall remain 
  7.21  distinct from the Minnesota health care trust fund, except for 
  7.22  portions of those budgets that provide health care services that 
  7.23  are provided to all Minnesotans through the Minnesota universal 
  7.24  health program. 
  7.25     Subd. 2.  [RESERVES.] Beginning July 1, 2004, the amount of 
  7.26  reserves in the fund at any time must equal at least the amount 
  7.27  of expenditures from the fund during the entire three preceding 
  7.28  months. 
  7.29     Sec. 5.  [62K.09] [ACCOUNTS WITHIN MINNESOTA HEALTH CARE 
  7.30  TRUST FUND.] 
  7.31     Subdivision 1.  [PREVENTION ACCOUNT.] The prevention 
  7.32  account is created within the Minnesota health care trust fund.  
  7.33  Money in the account shall be used solely to establish and 
  7.34  maintain primary community prevention programs, including 
  7.35  preventive screening tests. 
  7.36     Subd. 2.  [HEALTH SERVICES ACCOUNT.] The health services 
  8.1   account is created within the Minnesota health care trust fund.  
  8.2   Money in the account shall be used solely to pay providers 
  8.3   according to section 62K.19. 
  8.4      Subd. 3.  [CAPITAL ACCOUNT.] The capital account is created 
  8.5   within the Minnesota health care trust fund.  Money in the 
  8.6   account shall be used solely to: 
  8.7      (1) pay for the construction, renovation, and equipping of 
  8.8   health care institutions, including institutions providing 
  8.9   inpatient or overnight care and ambulatory diagnostic, 
  8.10  treatment, and surgical facilities; and 
  8.11     (2) provide health professionals serving in health care 
  8.12  shortage areas with assistance in repaying educational loans and 
  8.13  establishing medical practices. 
  8.14     Subd. 4.  [COMMUNICATION AND TRANSPORTATION ACCOUNT.] The 
  8.15  communication and transportation account is created within the 
  8.16  Minnesota health care trust fund.  Money in the account shall be 
  8.17  used solely to fund communication and transportation projects to 
  8.18  provide access for patients unable to reach necessary services, 
  8.19  including projects that provide services at the residences of 
  8.20  patients unable to travel.  Money may also be used to fund 
  8.21  public education programs and programs that encourage 
  8.22  cooperation between institutions funded on an annual basis that 
  8.23  lead to more efficient and effective use of health care 
  8.24  resources.  All expenditures must comply with rules approved by 
  8.25  the board. 
  8.26     Subd. 5.  [PROGRAM ADMINISTRATION, EVALUATION, PLANNING, 
  8.27  AND ASSESSMENT ACCOUNT.] The program administration, evaluation, 
  8.28  planning, and assessment account is created within the Minnesota 
  8.29  health care trust fund.  Money in the account shall be used by 
  8.30  the board to monitor and improve the plan's effectiveness and 
  8.31  operations.  The board may establish grant programs, including 
  8.32  demonstration projects, for this purpose. 
  8.33     Subd. 6.  [MEDICAL RESEARCH ACCOUNT.] The medical research 
  8.34  account is created within the Minnesota health care trust fund.  
  8.35  Money in the account shall be used by the board to establish a 
  8.36  health care analysis unit.  The results of the unit's research 
  9.1   shall be used by the board to improve the quality of health care 
  9.2   provided under the Minnesota universal health program and to 
  9.3   make decisions about health benefits covered by the program.  
  9.4   The board may also establish grant programs, including 
  9.5   demonstration projects, for this purpose.  The board shall seek 
  9.6   federal and private funds to supplement this allocation. 
  9.7      Sec. 6.  [62K.11] [ELIGIBILITY.] 
  9.8      Subdivision 1.  [RESIDENCY.] (a) To be eligible, all 
  9.9   applicants must: 
  9.10     (1) show that the applicant maintains a residence at a 
  9.11  verified address other than a hotel or motel, as defined in 
  9.12  section 157.15, subdivision 7, through the use of evidence of 
  9.13  residence described in section 256D.02, subdivision 12a, 
  9.14  paragraph (b), clause (1); and 
  9.15     (2) demonstrate that the applicant has been continuously 
  9.16  domiciled in the state for no less than 180 days immediately 
  9.17  before the application. 
  9.18     (b) An individual or family that moved to Minnesota 
  9.19  primarily to obtain medical treatment or health coverage for a 
  9.20  preexisting condition is not eligible. 
  9.21     Subd. 2.  [CITIZENSHIP; MIGRANT WORKERS.] (a) Eligibility 
  9.22  for coverage under the Minnesota universal health program is 
  9.23  limited to citizens of the United States and aliens lawfully 
  9.24  admitted for permanent residence or otherwise permanently 
  9.25  residing in the United States under the color of law. 
  9.26     (b) Aliens who are seeking legalization under the 
  9.27  Immigration Reform and Control Act of 1986, Public Law Number 
  9.28  99-603, who are under age 18, over age 65, blind, disabled, or 
  9.29  Cuban or Haitian, and who otherwise meet the eligibility 
  9.30  requirements of this section are eligible for coverage under the 
  9.31  Minnesota universal health program. 
  9.32     (c) Pregnant women who are aliens seeking legalization 
  9.33  under the Immigration Reform and Control Act of 1986, Public Law 
  9.34  Number 99-603, and who otherwise meet the eligibility 
  9.35  requirements of this section are eligible for payment of care 
  9.36  and services through the period of pregnancy and six weeks 
 10.1   postpartum. 
 10.2      (d) Payment shall also be made for care and services that 
 10.3   are furnished to an alien, regardless of immigration status, who 
 10.4   otherwise meets the eligibility requirements of this section if 
 10.5   the care and services are necessary for the treatment of an 
 10.6   emergency medical condition, except for organ transplants and 
 10.7   related care and services.  For purposes of this subdivision, 
 10.8   the term "emergency medical condition" means a medical 
 10.9   condition, including labor and delivery, that if not immediately 
 10.10  treated could cause a person physical or mental disability, 
 10.11  continuation of severe pain, or death. 
 10.12     (e) Notwithstanding any law to the contrary, a migrant 
 10.13  worker who meets all of the eligibility requirements of this 
 10.14  section, except for having a permanent place of domicile in this 
 10.15  state, shall be eligible for coverage under the Minnesota 
 10.16  universal health program. 
 10.17     Subd. 3.  [PHASE-IN OF ELIGIBILITY FOR RESIDENTS.] The 
 10.18  board shall phase in eligibility for Minnesota residents 
 10.19  according to the implementation schedule established under 
 10.20  section 62K.05.  
 10.21     Subd. 4.  [RESIDENTS RECEIVING CARE OUT OF STATE.] The 
 10.22  board may provide payment for out-of-state care provided to 
 10.23  Minnesota residents.  In determining whether payment is to be 
 10.24  made, the board shall determine the appropriateness of the care 
 10.25  provided, the availability of the service in Minnesota, and the 
 10.26  individual's medical condition and personal circumstances.  For 
 10.27  travel less than six months in length, the board shall establish 
 10.28  guidelines for covering services. 
 10.29     Subd. 5.  [NONRESIDENTS EMPLOYED IN MINNESOTA.] The board 
 10.30  may extend eligibility to nonresidents employed in Minnesota 
 10.31  using a sliding fee scale. 
 10.32     Subd. 6.  [NONRESIDENTS EMERGENCY CARE.] Nonresidents in 
 10.33  need of emergency services while in Minnesota shall be given 
 10.34  care and billed for the services provided. 
 10.35     Sec. 7.  [62K.13] [BENEFITS.] 
 10.36     Subdivision 1.  [GENERAL.] Every Minnesota resident 
 11.1   enrolled in the program is entitled to receive benefits for any 
 11.2   service covered under subdivision 2 that is medically necessary 
 11.3   to maintain the person's health, or necessary for the diagnosis 
 11.4   or treatment of, or rehabilitation following, an injury, 
 11.5   disability, or disease.  Services provided in Minnesota must be 
 11.6   provided by a health care provider who participates in the 
 11.7   program. 
 11.8      Subd. 2.  [COVERED SERVICES; GENERAL.] The program covers 
 11.9   the following services: 
 11.10     (1) acute health care; 
 11.11     (2) chronic health care; 
 11.12     (3) rehabilitative health care; 
 11.13     (4) preventive health services; 
 11.14     (5) outpatient health services; 
 11.15     (6) laboratory and x-ray services; 
 11.16     (7) home care and home health care support services; 
 11.17     (8) dental care; 
 11.18     (9) chiropractic care; 
 11.19     (10) inpatient and outpatient mental health care, including 
 11.20  care for serious and persistent mental illness; 
 11.21     (11) inpatient and outpatient chemical dependency 
 11.22  treatment; 
 11.23     (12) family planning services; 
 11.24     (13) medically necessary cosmetic surgery and 
 11.25  reconstructive surgery; 
 11.26     (14) public health services formerly provided through state 
 11.27  and local government; 
 11.28     (15) on or after January 1, 2007, long-term care; and 
 11.29     (16) other medically necessary services. 
 11.30     Subd. 3.  [COVERED SERVICES; PHARMACEUTICALS AND SUPPLIES.] 
 11.31  The program covers all pharmaceuticals and medical supplies 
 11.32  prescribed by a licensed practitioner, including prescription 
 11.33  drugs, pharmaceuticals and supplies for eye care, hearing aids, 
 11.34  orthopedic aids, home aids, and durable medical equipment. 
 11.35     Subd. 4.  [COVERED SERVICES; TYPE OF PRACTITIONER.] The 
 11.36  program covers medically necessary and appropriate services, 
 12.1   including culturally specific programs, provided by all licensed 
 12.2   or registered health care practitioners, as long as the services 
 12.3   are within the scope of practice and meet standards of quality 
 12.4   assurance established by the board.  Covered practitioners 
 12.5   include, but are not limited to, medical doctors, doctors of 
 12.6   chiropractic, osteopathic doctors, nurses, nurse practitioners, 
 12.7   physician assistants, dentists, optometrists, pharmacists, 
 12.8   mental health providers, chemical dependency counselors, 
 12.9   certified nurse midwives, nutritionists, practitioners of 
 12.10  complementary and alternative medicine, and physical therapists. 
 12.11     Subd. 5.  [COVERED SERVICES; SITE OF CARE.] The program 
 12.12  covers care provided in all settings approved by the board. 
 12.13     Subd. 6.  [SERVICES NOT COVERED.] The following services 
 12.14  are not covered: 
 12.15     (1) services that are not medically necessary; 
 12.16     (2) surgery for cosmetic purposes; and 
 12.17     (3) medical examinations conducted and medical reports 
 12.18  prepared for purchasing or renewing life insurance or 
 12.19  participating as a plaintiff or defendant in a civil action for 
 12.20  the recovery or settlement of damages. 
 12.21     Subd. 7.  [BENEFITS ADVISORY COMMITTEE; CHANGES IN COVERED 
 12.22  SERVICES.] (a) The board shall establish a benefits advisory 
 12.23  committee comprised of consumers, health care providers, experts 
 12.24  in medical ethics, and health science researchers to provide 
 12.25  recommendations regarding program benefits and limitations on 
 12.26  covered services.  The board shall ensure that the composition 
 12.27  of the committee reflects the racial and ethnic diversity of the 
 12.28  state and provides representation for persons with disabilities. 
 12.29  Persons serving on this committee are compensated as provided in 
 12.30  section 15.0575. 
 12.31     (b) The board may make changes in program benefits or place 
 12.32  limitations on covered services only after public hearing. 
 12.33     Subd. 8.  [CHOICE OF PROVIDERS.] An eligible person may 
 12.34  choose any provider licensed or registered in Minnesota, or an 
 12.35  alternative provider if referred by a licensed Minnesota 
 12.36  provider, including practitioners practicing on an independent 
 13.1   basis, in group practices, or in health maintenance 
 13.2   organizations.  
 13.3      Sec. 8.  [62K.15] [DUPLICATE COVERAGE PROHIBITED.] 
 13.4      Policies, plans, or contracts of health coverage issued, 
 13.5   sold, or renewed by health plan companies on or after January 1, 
 13.6   2006, must not offer benefits that duplicate coverage offered 
 13.7   under the Minnesota universal health program.  A policy, plan, 
 13.8   or contract may offer benefits that do not duplicate coverage 
 13.9   that is offered by the program. 
 13.10     Sec. 9.  [62K.17] [PROVIDER RESPONSIBILITIES.] 
 13.11     Subdivision 1.  [PROVIDER PARTICIPATION.] All licensed 
 13.12  providers shall be considered participants in the program unless 
 13.13  and until the provider notifies the board of a change in status. 
 13.14  Providers shall not bill patients for services covered under the 
 13.15  Minnesota universal health program.  The board shall provide 
 13.16  providers with notice of these requirements and adopt rules 
 13.17  necessary to allow for changes in provider status. 
 13.18     Subd. 2.  [NONDISCRIMINATION.] Participating providers 
 13.19  shall furnish services to all eligible persons, regardless of 
 13.20  race, color, income level, national origin, religion, sex, 
 13.21  sexual orientation, or other nonmedical criteria. 
 13.22     Subd. 3.  [PROVISION OF INFORMATION.] Upon the request of 
 13.23  the board, every provider shall furnish information that may 
 13.24  reasonably be required by the board to ensure or enhance 
 13.25  quality, reduce costs, eliminate fraud, estimate health care 
 13.26  spending, and set budgets.  A provider shall permit the board to 
 13.27  examine the provider's records as necessary for verification of 
 13.28  payment. 
 13.29     Sec. 10.  [62K.19] [PROVIDER REIMBURSEMENT.] 
 13.30     Subdivision 1.  [INSTITUTIONAL PROVIDERS.] (a) The 
 13.31  Minnesota universal health program shall pay the expenses of 
 13.32  institutional providers on the basis of annual budgets that are 
 13.33  approved by the board. 
 13.34     (b) An institutional provider shall negotiate an annual 
 13.35  budget with the board to cover its anticipated services for the 
 13.36  next year based on past performance and projected changes in 
 14.1   prices and service levels.  A physician or other provider 
 14.2   employed by an annually budgeted institutional provider shall be 
 14.3   paid through and in a manner determined by the institutional 
 14.4   provider. 
 14.5      Subd. 2.  [INDIVIDUAL PROVIDERS.] The board may reimburse 
 14.6   individual providers of health care services on a 
 14.7   fee-for-service basis.  The board shall annually negotiate the 
 14.8   fee schedule with the appropriate professional group.  In 
 14.9   developing fee schedules, the board may take into account 
 14.10  recognized geographic differences in cost of practice.  To the 
 14.11  greatest extent possible, fee schedule categories must include 
 14.12  payment for all procedures routinely performed for a given 
 14.13  diagnosis.  The board may require that certain high-risk or 
 14.14  specialized procedures be reimbursed only when performed in 
 14.15  certain institutions or by certain providers. 
 14.16     Subd. 3.  [BALANCE BILLING PROHIBITED.] A provider may not 
 14.17  charge rates that are higher than the negotiated reimbursement 
 14.18  level.  A provider may not charge separately for services 
 14.19  covered under section 62K.13. 
 14.20     Subd. 4.  [CAPITATED PAYMENTS.] A health maintenance 
 14.21  organization may elect to be reimbursed on a capitation basis in 
 14.22  place of fee-for-service reimbursement.  Payment on a capitation 
 14.23  basis does not cover inpatient services provided by a health 
 14.24  maintenance organization for institutional providers. 
 14.25     Sec. 11.  [STUDY AND ASSESSMENT.] 
 14.26     The commissioner shall study statewide health care spending 
 14.27  to enable the Minnesota universal health board to establish and 
 14.28  enforce the state and regional health care budgets.  By January 
 14.29  1, 2002, the commissioner shall: 
 14.30     (1) assess health care capital needs and expenditures 
 14.31  statewide and within each region; and 
 14.32     (2) recommend to the Minnesota universal health board 
 14.33  statewide and regional budgets, each consisting of budgets for 
 14.34  operating and capital expenditures and fee schedules for health 
 14.35  care providers and practitioners. 
 14.36     Sec. 12.  [FUNDING.] 
 15.1      Financing of the Minnesota universal health program shall 
 15.2   be through the consolidation of funding from existing state and 
 15.3   federal programs and a designated progressive income tax.  There 
 15.4   shall be no copayments, deductibles, or other out-of-pocket 
 15.5   payments by individuals for services. 
 15.6      Sec. 13.  [APPROPRIATION.] 
 15.7      $....... is appropriated from the general fund to the 
 15.8   Minnesota universal health board to implement sections 1 to 10.  
 15.9   This appropriation is available until June 30, 2004, at which 
 15.10  time the board shall repay this amount to the general fund from 
 15.11  the Minnesota health care trust fund created in section 62K.07. 
 15.12     Sec. 14.  [REPEALER.] 
 15.13     Minnesota Statutes 2000, section 62J.212, is repealed. 
 15.14     Sec. 15.  [EFFECTIVE DATE.] 
 15.15     Sections 1 to 7, 9, and 10 are effective January 1, 2002.  
 15.16  Section 8 is effective January 1, 2006.