Minnesota Legislature
HF 4110
as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am
Current Version - as introduced
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A bill for an act
relating to insurance; providing an evaluation of proposed and enacted mandated
health benefits; appropriating money; amending Minnesota Statutes 2006,
section 62J.26.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2006, section 62J.26, is amended to read:
62J.26 EVALUATION OF deleted text begin PROPOSEDdeleted text end HEALTH COVERAGE MANDATES.
Subdivision 1.
Definitions.
For purposes of this section, the following terms have
the meanings given unless the context otherwise requires:
(1) "commissioner" means the commissioner of deleted text begin commercedeleted text end new text begin healthnew text end ;
new text begin
(2) "cost effective" means that the economic costs of using a particular service,
device, or health technology to achieve improvement in a patient's health outcome are
justified given the comparison to both the economic costs and the improvement in patient
health outcome resulting from the use of an alternative service, device, or technology, or
from not providing the service, device, or technology;
new text end
new text begin
(3) "enacted mandated health benefit" means a mandated health benefit that is
already enacted and contained in chapter 62A or 62Q;
new text end
deleted text begin (2)deleted text end new text begin (4)new text end "health plan" means a health plan as defined in section 62A.011, subdivision
3, but includes coverage listed in clauses (7) and (10) of that definition;
deleted text begin (3)deleted text end new text begin (5)new text end "mandated health benefit deleted text begin proposaldeleted text end " means a deleted text begin proposal that would statutorily
requiredeleted text end new text begin statutory or regulatory requirement thatnew text end a health plan deleted text begin todeleted text end do the following:
(i) provide coverage or increase the amount of coverage for the treatment of a
particular disease, condition, or other health care need;
(ii) provide coverage or increase the amount of coverage of a particular type of
health care treatment or service or of equipment, supplies, or drugs used in connection
with a health care treatment or service; or
(iii) provide coverage for care delivered by a specific type of provider.
"Mandated health benefit deleted text begin proposaldeleted text end " does not includenew text begin anew text end health benefit deleted text begin proposals
amendingdeleted text end new text begin provision that solely amendsnew text end the scope of practice of a licensed health care
professionaldeleted text begin .deleted text end new text begin ;
new text end
new text begin
(6) "proposed mandated health benefit" means a mandated health benefit proposed
for enactment in a bill that is pending in the legislature or under consideration as a
regulatory requirement by a state agency;
new text end
new text begin
(7) "regulatory mandated health benefit" means a mandated health benefit that a
regulatory agency of this state has in effect required through an order, action, review,
policy, or approval or denial of a request for approval of a policy or other contract of health
coverage, where there is not an enacted mandated health benefit that clearly supports
the regulatory agency's position.
new text end
Subd. 2.
Evaluation process and content.
(a) The commissioner, in consultation
with the deleted text begin commissioners of health and employee relationsdeleted text end new text begin commissioner of commercenew text end ,
must evaluate mandated health benefit proposals as provided under subdivision 3.
(b) The purpose of the evaluation is to provide deleted text begin the legislature withdeleted text end a complete
and timely analysis of all ramifications of any mandated health benefit proposal. The
evaluation must include, in addition to other relevant information, the following:
new text begin
(1) an evidence-based scientific review of the proposed treatment, service,
equipment, supply, or drug. "Evidence-based scientific review" means a review that
examines reliable scientific evidence regarding safety, effectiveness, and effect on health
outcomes. The standard for the review must use a preponderance of reliable evidence as
described in Minnesota Rules, part 4685.0700, subpart 2, item F;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end scientific and medical information on the deleted text begin proposed health benefit, on the
potential for harm or benefit to the patient, and on thedeleted text end comparative benefit or harm from
alternative forms of treatment;
deleted text begin (2)deleted text end new text begin (3)new text end public health, economic, and fiscal impacts of the proposed deleted text begin mandatedeleted text end new text begin
mandated health benefitnew text end on persons receiving health services in Minnesotadeleted text begin , on the relative
cost-effectiveness of the benefit,deleted text end and on the health care system in general;
new text begin
(4) the extent to which the proposed mandated health benefit would be cost effective;
new text end
deleted text begin (3)deleted text end new text begin (5)new text end the extent to which the deleted text begin servicedeleted text end new text begin proposed mandated health benefitnew text end is generally
utilized by a significant portion of the population;
deleted text begin (4)deleted text end new text begin (6)new text end the extent to which insurance coverage for the proposed mandatednew text begin healthnew text end
benefit is already generally available;
deleted text begin (5)deleted text end new text begin (7)new text end the extent to which the mandated coverage will increase or decrease the
cost of the service; and
deleted text begin (6)deleted text end new text begin (8)new text end the commissioner may consider actuarial analysis done by health deleted text begin insurersdeleted text end new text begin
plan companiesnew text end in determining the cost of the proposed mandated benefit.
(c) The commissioner must summarize the nature and quality of available
information on these issues, and, if possible, must provide preliminary information to
the public. The commissioner may conductnew text begin appropriate newnew text end research on these issues or
may determine that existing research is sufficient deleted text begin to meet the informational needs of the
legislaturedeleted text end .new text begin The commissioner must include the opinion of two or more private firms
that specialize in independent evaluation of health care treatments, services, equipment,
supplies, or drugs, using evidence-based scientific review as defined in this subdivision.
Additionally,new text end the commissioner may seek the assistance and advice of researchers,
community leaders, or other persons or organizations with relevant expertise.
Subd. 3.
Requests for evaluation.
(a) Whenever a legislative measure containing
anew text begin proposednew text end mandated health benefit deleted text begin proposaldeleted text end is introduced as a bill or offered as an
amendment to a bill, deleted text begin or is likely to be introduced as a bill or offered as an amendment,
adeleted text end new text begin thenew text end chair of deleted text begin anydeleted text end new text begin thenew text end standing legislative committee that hasnew text begin primarynew text end jurisdiction over
the subject matter of the proposal deleted text begin maydeleted text end new text begin shallnew text end request that the commissioner complete an
evaluation of the proposal under this section, to inform deleted text begin any committee ofdeleted text end new text begin the legislature
prior tonew text end floor action by either house of the legislature.new text begin The chair may request review of a
proposed mandated health benefit proposal that is likely to be introduced as a bill or
offered as an amendment. The legislature must not act on the measure on the house or
senate floor until it receives the report under subdivision 5.
new text end
new text begin
(b) Whenever a regulatory agency proposes to adopt any regulatory mandated health
benefit, the proponent of the proposed regulatory mandated health benefit shall request the
commissioner to complete an evaluation described in subdivision 2, in order to inform
the proponent prior to final order, action, or contract review. The agency shall not adopt
the proposed regulatory health benefit mandate until completion of the review by a
report described in subdivision 5. If the proponent is the commissioner of health, the
commissioner of commerce shall do the review.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end The commissioner must conduct an evaluation described in subdivision 2
of each mandated health benefit proposal for which an evaluation is requested under
paragraph (a)deleted text begin , unless the commissioner determines under paragraph (c) or subdivision 4
that priorities and resources do not permit its evaluationdeleted text end new text begin or (b)new text end .
deleted text begin (c)deleted text end new text begin (d)new text end If requests for evaluation of multiple proposals are received, the commissioner
must consult with the chairs of the standing legislative committees havingnew text begin primarynew text end
jurisdiction over the subject matter of the mandated health benefit proposalsnew text begin , and the
regulatory agency, in the case of a proposed regulatory mandated health benefit,new text end to
prioritize the requests and establish a reporting date for each proposal to be evaluated. The
commissioner is not required to direct an unreasonable quantity of the commissioner's
resources to these evaluations.
Subd. 4.
Sources of funding.
new text begin
(a) The mandated health benefit review account is
created as an account in the general fund. Money in the account does not cancel and
is available until spent.
new text end
deleted text begin (a)deleted text end new text begin (b)new text end The commissioner need not use any funds for purposes of this section other
than as provided in this subdivision or as specified in an appropriation.
deleted text begin (b)deleted text end new text begin (c)new text end The commissioner may seek and accept funding from sources other than the
state to pay for evaluations under this section to supplement or replace state appropriations.
Any money received under this paragraph must be deposited in the state treasury, credited
to a separate account for this purpose in the special revenue fund, and is appropriated to
the commissioner for purposes of this section.
deleted text begin (c)deleted text end new text begin (d)new text end If a request for an evaluation under this section has been made, the
commissioner may use for purposes of the evaluation:
new text begin
(1) funds in the mandated health benefit review account;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end anynew text begin othernew text end funds appropriated to the commissioner specifically for purposes
of this section; or
deleted text begin (2)deleted text end new text begin (3)new text end funds available under paragraph deleted text begin (b)deleted text end new text begin (c)new text end , if use of the funds for evaluation
of that mandated health benefit proposal is consistent with any restrictions imposed by
the source of the funds.
deleted text begin (d)deleted text end new text begin (e)new text end The commissioner must ensure that the source of the funding has no influence
on the process or outcome of the evaluation.
Subd. 5.
Report deleted text begin to legislaturedeleted text end .
new text begin (a) For a report under subdivision 3, paragraph
(a), new text end the commissioner must submit a written report on the evaluation to the legislature
no later than 180 days after the request. The report must be submitted in compliance
with sections 3.195 and 3.197.
new text begin
(b) For a report under subdivision 3, paragraph (b), the commissioner must submit a
written report on the evaluation to the requesting agency proponent no later than 180 days
after the request and concurrently publish a notice in the State Register of the availability
of the report to the public.
new text end
new text begin Subd. 6. new text end
new text begin Evaluation of enacted mandated health benefits. new text end
new text begin
The commissioner
of health shall contract with an unbiased reputable organization, experienced in analysis
of health care services, to conduct a scientific evaluation of all enacted mandated health
benefits and assess each benefit's cost effectiveness based upon the existing scientific and
medical technology or knowledge. The commissioner shall determine the appropriate
scope of each evaluation based upon the apparent cost and controversy of each enacted
mandated health benefit.
new text end
Sec. 2. new text begin APPROPRIATION.
new text end
new text begin
(a) $....... is appropriated from the general fund to the health benefit review account
for fiscal year 2009 for purposes of Minnesota Statutes, section 62J.26, subdivision 3.
new text end
new text begin
(b) $....... is appropriated from the general fund to the health benefit review account
for fiscal year 2009 for purposes of Minnesota Statutes, section 62J.26, subdivision 6.
new text end