HF 2522

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; guaranteeing that all necessary health care is available and
affordable for every Minnesotan; establishing the Minnesota Health Care
Plan; requiring a report; appropriating money; amending Minnesota Statutes
2006, sections 15.01; 15.06, subdivision 1; 15A.0815, subdivision 2; 43A.08,
subdivision 1a; proposing coding for new law as Minnesota Statutes, chapter
62U.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

GENERAL PROVISIONS

Section 1.

new text begin [62U.01] HEALTH CARE PLAN REQUIREMENTS.
new text end

new text begin In order to develop a plan that keeps Minnesotans healthy and provides the best
quality of health care, the Minnesota health care plan must:
new text end

new text begin (1) ensure all Minnesotans receive high quality health care, regardless of their
income;
new text end

new text begin (2) not restrict or deny care or reduce the quality of care to hold down costs, but
instead reduce costs through prevention, efficiency, and reduction of bureaucracy;
new text end

new text begin (3) cover all necessary care, including all coverage currently required by law,
complete mental health services, chemical dependency treatment, prescription drugs,
medical equipment and supplies, dental care, long-term care, and home care services;
new text end

new text begin (4) allow patients to choose their own providers;
new text end

new text begin (5) be funded through premiums and other payments based on the person's ability
to pay, so as not to deny full access to all Minnesotans;
new text end

new text begin (6) focus on preventive care and early intervention to improve the health of all
Minnesotans and reduce costs from untreated illnesses and diseases;
new text end

new text begin (7) ensure an adequate number of qualified health care professionals and facilities to
guarantee availability of, and timely access to quality care throughout the state;
new text end

new text begin (8) continue Minnesota's leadership in medical education, training, research, and
technology; and
new text end

new text begin (9) provide adequate and timely payments to providers.
new text end

Sec. 2.

new text begin [62U.02] GENERAL PROVISIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Short title. new text end

new text begin Chapter 62U may be cited as the "Minnesota Health
Care Act."
new text end

new text begin Subd. 2. new text end

new text begin Establishment; date of operation. new text end

new text begin The Minnesota health care plan is
established, which shall be administered by the Minnesota Health Care Agency, an agency
under the administration of the commissioner of health care. The Minnesota health care
plan must be operational within two years from the date of enactment of this chapter.
new text end

new text begin Subd. 3. new text end

new text begin Prohibition. new text end

new text begin No health plan, as defined in section 62Q.01, subdivision
3, except for the Minnesota health care plan, may be sold in Minnesota for services
provided by the plan.
new text end

new text begin Subd. 4. new text end

new text begin Purpose. new text end

new text begin To meet the requirements in section 62U.01 This chapter shall:
new text end

new text begin (1) provide affordable coverage for all necessary health care with a single standard
of care for all Minnesota residents;
new text end

new text begin (2) control health care costs and the growth of health care spending, subject to the
obligation described in clause (1);
new text end

new text begin (3) achieve measurable improvement in the quality of care and the efficiency of
care delivery;
new text end

new text begin (4) prevent disease and disability and maintain or improve health and functionality;
new text end

new text begin (5) increase health care provider, consumer, employee, and employer satisfaction
with the health care plan; and
new text end

new text begin (6) implement policies that strengthen and improve culturally and linguistically
competent care.
new text end

new text begin Subd. 5. new text end

new text begin Definitions. new text end

new text begin As used in this chapter, the following terms have the meanings
provided:
new text end

new text begin (a) "Agency" means the Minnesota Health Care Agency.
new text end

new text begin (b) "Board" means the Health Care Policy Board.
new text end

new text begin (c) "Clinic" means an organized outpatient health facility that provides direct
medical, surgical, dental, psychological, mental health, optometric, or podiatric advice,
services, or treatment to patients who remain less than 24 hours, and that may also provide
diagnostic or therapeutic services to patients in the home as an alternative to care provided
at the clinic facility.
new text end

new text begin (c) "Commissioner" means the health care commissioner.
new text end

new text begin (d) "Direct care provider" means any licensed health care professional that provides
health care services through direct contact with the patient, either in person or using
approved telemedicine modalities.
new text end

new text begin (e) "Essential provider" means a health facility that has served as part of the state's
health care safety net for low income and traditionally underserved populations in
Minnesota and one that is:
new text end

new text begin (1) a "community clinic";
new text end

new text begin (2) a "free clinic";
new text end

new text begin (3) a "federally qualified health center" as defined under United States Code, title 42,
section 1395x (aa)(4) or (1396d) (1)(2);
new text end

new text begin (4) a "rural health clinic" as defined under United States Code, title 42, section
1395x (aa)(2) or 1396d (l)(1);
new text end

new text begin (5) any clinic conducted, maintained, or operated by a federally recognized Indian
tribe or tribal organization, as defined in United States Code, title 25, section 1603; or
new text end

new text begin (6) any clinic that is operated by a primary care community or free clinic and that
is operated on separate premises from the licensed clinic and is only open for limited
services of no more than 20 hours per week.
new text end

new text begin (f) "Health care provider" means any professional person, medical group,
independent practice association, organization, health facility, or other person or institution
licensed or authorized by the state to deliver or furnish health care services.
new text end

new text begin (g) "Health facility" means any facility, place, or building that is organized,
maintained, and operated for the diagnosis, care, prevention, and treatment of human
illness, physical or mental, including convalescence and rehabilitation, including care
during and after pregnancy, and including skilled nursing care and hospice.
new text end

new text begin (h) "Hospital" means all health facilities to which persons may be admitted for a
24-hour stay or longer and that are licensed under section 144.50. Hospital does not
include a nursing, skilled nursing, intermediate care, or congregate living health facility.
new text end

new text begin (i) "Integrated health care delivery system" means a provider organization that:
new text end

new text begin (1) is fully integrated operationally and clinically to provide a broad range of health
care services, including preventative care, prenatal and well-baby care, immunizations,
screening diagnostics, emergency services, hospital and medical services, surgical
services, and ancillary services;
new text end

new text begin (2) is compensated using capitation or facility budgets, for the provision of health
care services; and
new text end

new text begin (3) provides health care services primarily through direct care providers who are
either employees or partners of the organization, or through arrangements with direct
care providers or one or more groups of physicians, organized on a group practice or
individual practice basis.
new text end

new text begin (j) "Large employer" means a person, firm, proprietary or nonprofit corporation,
partnership, public agency, or association that is actively engaged in business or service,
that, on at least 50 percent of its working days during the preceding calendar year
employed at least 50 employees, or, if the employer was not in business during any part
of the preceding calendar year, employed at least 50 employees on at least 50 percent of
its working days during the preceding calendar quarter.
new text end

new text begin (k) "Primary care provider" means a direct care provider that is a family physician,
internist, general practitioner, pediatrician, obstetrician/gynecologist, or an advance
practice nurse practitioner, or physician assistant practicing under required supervision, or
essential providers who employ primary care providers.
new text end

new text begin (l) "Small employer" means a person, firm, proprietary or nonprofit corporation,
partnership, public agency, or association that is actively engaged in business or service
and that, on at least 50 percent of its working days during the preceding calendar year
employed at least two but no more than 49 employees, or, if the employer was not in
business during any part of the preceding calendar year, employed at least two but no
more than 40 eligible employees on at least 50 percent of its working days during the
preceding calendar quarter.
new text end

new text begin Subd. 6. new text end

new text begin Transition to new plan. new text end

new text begin (a) The transition shall be funded from a loan
from the general fund and from other sources, including private sources identified by
the commissioner.
new text end

new text begin (b) The commissioner shall assess other health plans and insurers for care provided
by the state plan in those cases in which a person's health care coverage extends into the
time period in which the new plan is operative.
new text end

new text begin (c) The commissioner shall assist persons who are displaced from employment as a
result of the initiation of the health care plan, including determining the period of time
during which assistance shall be provided and identifying sources of funds, including
dislocated worker program funds and health insurance funds, to support retraining and
job placement. That support shall be provided for a period of up to five years from the
date that this chapter becomes effective.
new text end

Sec. 3.

new text begin [62U.03] MINNESOTA HEALTH CARE AGENCY.
new text end

new text begin Subdivision 1. new text end

new text begin State agency established. new text end

new text begin The Minnesota Health Care Agency is
established and is the state agency with full authority to supervise every phase of the
administration of the Minnesota health care plan and to receive grants-in-aid made by
federal or state government, or by other sources in order to secure full compliance with the
applicable provisions of state and federal law.
new text end

new text begin Subd. 2. new text end

new text begin Agency. new text end

new text begin The Minnesota Health Care Agency shall be comprised of the
following entities:
new text end

new text begin (1) the Health Care Policy Board;
new text end

new text begin (2) the Office of Health Quality and Planning; and
new text end

new text begin (3) the fund for health care.
new text end

ARTICLE 2

GOVERNANCE

Section 1.

Minnesota Statutes 2006, section 15.01, is amended to read:

15.01 DEPARTMENTS OF THE STATE.

The following agencies are designated as the departments of the state government:
the Department of Administration; the Department of Agriculture; the Department of
Commerce; the Department of Corrections; the Department of Education; the Department
of Employment and Economic Development; the Department of Finance; the Department
of Health; new text begin the Health Care Agency; new text end the Department of Human Rights; the Department
of Labor and Industry; the Department of Military Affairs; the Department of Natural
Resources; the Department of Employee Relations; the Department of Public Safety;
the Department of Human Services; the Department of Revenue; the Department of
Transportation; the Department of Veterans Affairs; and their successor departments.

Sec. 2.

Minnesota Statutes 2006, section 15.06, subdivision 1, is amended to read:

Subdivision 1.

Applicability.

This section applies to the following departments
or agencies: the Departments of Administration, Agriculture, Commerce, Corrections,
Education, Employee Relations, Employment and Economic Development, Finance,
Health, Human Rights, Labor and Industry, Natural Resources, Public Safety, Human
Services, Revenue, Transportation, and Veterans Affairs; new text begin the Health Care, new text end the Housing
Finance new text begin , new text end and Pollution Control Agencies; the Office of Commissioner of Iron Range
Resources and Rehabilitation; the Bureau of Mediation Services; and their successor
departments and agencies. The heads of the foregoing departments or agencies are
"commissioners."

Sec. 3.

Minnesota Statutes 2006, section 15A.0815, subdivision 2, is amended to read:

Subd. 2.

Group I salary limits.

The salaries for positions in this subdivision may
not exceed 95 percent of the salary of the governor:

Commissioner of administration;

Commissioner of agriculture;

Commissioner of education;

Commissioner of commerce;

Commissioner of corrections;

Commissioner of employee relations;

Commissioner of finance;

Commissioner of health;

new text begin Commissioner of health care;
new text end

Executive director, Minnesota Office of Higher Education;

Commissioner, Housing Finance Agency;

Commissioner of human rights;

Commissioner of human services;

Commissioner of labor and industry;

Commissioner of natural resources;

Director of Office of Strategic and Long-Range Planning;

Commissioner, Pollution Control Agency;

Commissioner of public safety;

Commissioner of revenue;

Commissioner of employment and economic development;

Commissioner of transportation; and

Commissioner of veterans affairs.

Sec. 4.

Minnesota Statutes 2006, section 43A.08, subdivision 1a, is amended to read:

Subd. 1a.

Additional unclassified positions.

Appointing authorities for the
following agencies may designate additional unclassified positions according to this
subdivision: the Departments of Administration; Agriculture; Commerce; Corrections;
Education; Employee Relations; Employment and Economic Development; Explore
Minnesota Tourism; Finance; Health; new text begin Health Care Agency; new text end Human Rights; Labor and
Industry; Natural Resources; Public Safety; Human Services; Revenue; Transportation;
and Veterans Affairs; the Housing Finance and Pollution Control Agencies; the State
Lottery; the State Board of Investment; the Office of Administrative Hearings; the Offices
of the Attorney General, Secretary of State, and State Auditor; the Minnesota State
Colleges and Universities; the Minnesota Office of Higher Education; the Perpich Center
for Arts Education; and the Minnesota Zoological Board.

A position designated by an appointing authority according to this subdivision must
meet the following standards and criteria:

(1) the designation of the position would not be contrary to other law relating
specifically to that agency;

(2) the person occupying the position would report directly to the agency head or
deputy agency head and would be designated as part of the agency head's management
team;

(3) the duties of the position would involve significant discretion and substantial
involvement in the development, interpretation, and implementation of agency policy;

(4) the duties of the position would not require primarily personnel, accounting, or
other technical expertise where continuity in the position would be important;

(5) there would be a need for the person occupying the position to be accountable to,
loyal to, and compatible with, the governor and the agency head, the employing statutory
board or commission, or the employing constitutional officer;

(6) the position would be at the level of division or bureau director or assistant
to the agency head; and

(7) the commissioner has approved the designation as being consistent with the
standards and criteria in this subdivision.

Sec. 5.

new text begin [62U.04] HEALTH CARE COMMISSIONER.
new text end

new text begin Subdivision 1. new text end

new text begin Commissioner. new text end

new text begin (a) The commissioner shall be appointed by the
governor on or before January 1, 2009.
new text end

new text begin (b) The commissioner shall not have been employed in any capacity by a for-profit
insurance, pharmaceutical, or medical equipment company that sells products to the
Minnesota health care plan for a period of ten years prior to appointment as commissioner.
new text end

new text begin (c) For ten years after ending service in the Minnesota health care plan, the
commissioner may not receive payments of any kind from, or be employed in any capacity
or act as a paid consultant to, a for-profit insurance, pharmaceutical, or medical equipment
company that sells products to the Minnesota health care plan.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

new text begin (a) The commissioner shall administer all aspects of the Minnesota
Health Care Agency.
new text end

new text begin (b) The commissioner shall carry out the specific duties assigned under this chapter
and other laws related to health care, and shall enforce the execution of those provisions
and laws. The commissioner's powers and duties include, but are not limited to, the power
to establish the Minnesota health care plan budget and to set rates; to establish Minnesota
health care plan goals, standards, and priorities; to hire, fire, and fix the compensation of
agency personnel; to make allocations and reallocations to the health planning regions;
and to promulgate rules concerning matters related to the implementation of this chapter.
new text end

new text begin (c) The commissioner shall appoint the director of the fund for health care and the
director of Health Quality and Planning.
new text end

new text begin (d) The administration of the agency shall be supported from the fund for health
care created under section 62U.19.
new text end

new text begin (e) In order to avoid the appearance of political bias or impropriety, the commissioner
shall not engage in leadership of, or employment by, a political party or a political
organization; public endorsement of a political candidate; contribution of more than $100
to any one candidate in a calendar year or contributions in excess of an aggregate of
$1,000 in a calendar year for all political parties or organizations; and activities attempting
to avoid compliance with this paragraph by making contributions through a spouse
or other family member.
new text end

new text begin Subd. 3. new text end

new text begin Oversight. new text end

new text begin The commissioner shall:
new text end

new text begin (a) oversee the establishment of:
new text end

new text begin (1) the Health Care Policy Board, under section 62U.05;
new text end

new text begin (2) the Ombudsman Office of Patient Advocacy, under section 62U.09;
new text end

new text begin (3) the Office of Health Quality and Planning, under section 62U.45; and
new text end

new text begin (4) the fund for health care, under section 62U.19;
new text end

new text begin (b) determine Minnesota health care plan goals, standards, guidelines, and priorities;
new text end

new text begin (c) oversee the establishment of locally based integrated service networks that
include physicians in fee-for-service, solo and group practice, essential providers, and
ancillary care providers and facilities in order to pool and align resources and form
interdisciplinary teams that share responsibility and accountability for patient care and
provide a continuum of coordinated high-quality primary to tertiary care to all Minnesota
residents which shall be accomplished in collaboration with the director of health
planning, the regional planning boards, and the patient advocate;
new text end

new text begin (d) establish standards based on clinical efficacy to guide delivery of care;
new text end

new text begin (e) implement policies to ensure that all Minnesotans receive culturally and
linguistically competent care, according to section 62U.45, subdivision 2, and develop
mechanisms and incentives to achieve this purpose and monitor the effectiveness of
these efforts;
new text end

new text begin (f) create a systematic approach to the measurement, management, and accountability
for care quality that ensures the delivery of high-quality care to all Minnesota residents,
including a system of performance contracts that contain measurable goals and outcomes;
new text end

new text begin (g) establish a capital management framework and plan for the Minnesota health care
plan, including, but not limited to, a standardized process and format for the development
and submission of regional operating and regional capital budget requests to ensure the
needs for health care capital infrastructure are met according to the goals of the plan;
new text end

new text begin (h) ensure the establishment of policies not governed by the Department of Health
that promote public health;
new text end

new text begin (i) ensure that health care plan policies and providers support all Minnesotans in
achieving and maintaining maximum physical and mental health and functionality;
new text end

new text begin (j) establish a means to identify areas of medical practice where standards of care do
not exist and establish priorities and a timetable for their development;
new text end

new text begin (k) establish a comprehensive budget that ensures adequate funding to meet the
health care needs of the state's population and the compensation for providers for care
provided according to this chapter;
new text end

new text begin (l) establish standards and criteria for allocation of operating and capital funds from
the fund for health care as described in sections 62U.19 and 62U.35;
new text end

new text begin (m) establish standards and criteria for development and submission of provider
operating and capital budget requests;
new text end

new text begin (n) determine the level of funding to be allocated to each health care region;
new text end

new text begin (o) annually assess projected revenues and expenditures to ensure financial solvency
of the plan;
new text end

new text begin (p) during the transition and annually thereafter, determine the appropriate level for
a health care plan reserve fund and implement policies needed to establish the appropriate
reserve;
new text end

new text begin (q) institute necessary cost controls according to section 62U.19, subdivision 3,
to ensure financial solvency of the plan;
new text end

new text begin (r) develop separate formulas for budget allocations and review the formulas
annually to ensure they address disparities in service availability and health care outcomes
and for sufficiency of reimbursement;
new text end

new text begin (s) annually review the impact of the agency and its policies on the health of the
population and on satisfaction with the Minnesota health care plan;
new text end

new text begin (t) negotiate payment for any aspect of the Minnesota health care plan and establish
necessary payment procedures;
new text end

new text begin (u) establish a formulary based on clinical efficacy and cost for all prescription drugs
and medical equipment for use by the Minnesota health care plan;
new text end

new text begin (v) establish guidelines for prescribing medications, nutritional supplements, and
medical equipment that are not included in the health care formularies;
new text end

new text begin (w) negotiate price discounts for prescription drugs and medical equipment for use
by the Minnesota health care plan;
new text end

new text begin (x) create incentives and guidelines for research needed to meet health care plan
goals;
new text end

new text begin (y) implement eligibility standards for the system, including guidelines to prevent an
influx of persons to the state for the purpose of obtaining medical care;
new text end

new text begin (z) determine an appropriate level of, and provide support during the transition for,
training and job placement for persons who are displaced from employment as a result of
the initiation of the new Minnesota health care plan;
new text end

new text begin (aa) establish an enrollment system that ensures all eligible Minnesota residents are
aware of their right to health care and are formally enrolled;
new text end

new text begin (bb) oversee the establishment of the system for resolution of disputes according
to section 62U.53;
new text end

new text begin (cc) establish an electronic claims and payments system for the Minnesota health
care plan, to which all claims shall be filed and from which all payments shall be made,
and implement standardized claims and reporting methods;
new text end

new text begin (dd) establish a technology advisory committee to evaluate the cost and effectiveness
of new medical technology;
new text end

new text begin (ee) ensure that consumers of health care have access to information needed to
support choice of provider;
new text end

new text begin (ff) collaborate with the agencies that license health facilities to ensure that facility
performance is monitored and that deficient practices are recognized and corrected in a
timely fashion and that consumers and providers of health care have access to information
to support choice of facility;
new text end

new text begin (gg) establish a health care Web site that provides information to the public about
the Minnesota health care plan including information on providers and facilities, and that
informs the public about state and regional health care policy board meetings and activities;
new text end

new text begin (hh) establish a process for the system to receive the concerns, opinions, ideas, and
recommendations of the public regarding all aspects of the plan; and
new text end

new text begin (ii) annually report to the legislature on the performance of the Minnesota health care
plan, its fiscal condition and need for payment adjustments, recommendations for statutory
changes, receipt of payments from the federal government and other sources, whether
current year goals and priorities are met, future goals and priorities, major new technology
or prescription drugs, and other circumstances that may affect the cost of health care.
new text end

new text begin Subd. 4. new text end

new text begin Rulemaking. new text end

new text begin The commissioner shall adopt rules under chapter 14 to
implement the provisions of this chapter.
new text end

new text begin Subd. 5. new text end

new text begin Budget preparation. new text end

new text begin (a) The commissioner shall annually prepare a health
care plan budget that includes all expenditures, specifies a limit on total annual state
expenditures, and establishes allocations for each health care region that shall cover a
three-year period and that shall be disbursed on a quarterly basis.
new text end

new text begin (b) The commissioner shall limit the growth of spending on a statewide and on a
regional basis, by reference to average growth in state domestic product across multiple
years, population growth, actuarial demographics and other demographic indicators,
differences in regional costs of living, advances in technology and their anticipated
adoption into the benefit plan, improvements in efficiency of administration and care
delivery, improvements in the quality of care, and projected future state domestic product
growth rates.
new text end

new text begin (c) The commissioner shall project health care plan revenues and expenditures
for three and ten years.
new text end

new text begin (d) The commissioner shall annually convene a health care plan revenue and
expenditure conference to discuss revenue and expenditure projections and future
health care plan policy directions and initiatives, including means to lower the cost of
administration, improve management of and investment in capital assets, and improve the
quality of care and health care management.
new text end

Sec. 6.

new text begin [62U.05] HEALTH CARE POLICY BOARD.
new text end

new text begin (a) The commissioner shall establish a health care policy board and shall serve as
the president of the board.
new text end

new text begin (b) The board shall:
new text end

new text begin (1) establish health care plan goals and priorities, including research and capital
investment priorities;
new text end

new text begin (2) establish the scope of services that will be funded;
new text end

new text begin (3) establish guidelines for evaluating the performance of the health care plan, health
care plan officers, health care regions, and health care providers;
new text end

new text begin (4) establish guidelines for ensuring public input on health care plan policy,
standards, and goals; and
new text end

new text begin (5) the Health Care Policy Board shall establish standards of care based on clinical
efficacy for the health care plan which shall serve as guidelines to support providers in the
delivery of high-quality care. Standards shall be based on the best evidence available at
the time and shall be continually updated. Standards are intended to support the clinical
judgment of individual providers, not to replace it, and to support clinical decisions based
on the needs of individual patients.
new text end

new text begin (c) The board shall consist of the following members:
new text end

new text begin (1) the commissioner;
new text end

new text begin (2) five providers appointed by the commissioner including one primary care
physician, one registered nurse, one mental health provider, one dentist, and one long-term
care provider;
new text end

new text begin (3) four patient advocates, two appointed by the speaker of the house and two
appointed by the chair of the senate Committee on Rules and Administration;
new text end

new text begin (4) the director of Health Quality and Planning; and
new text end

new text begin (5) a representative from each regional planning board appointed by the regional
board.
new text end

Sec. 7.

new text begin [62U.09] OMBUDSMAN OFFICE FOR PATIENT ADVOCACY.
new text end

new text begin (a) The Ombudsman Office for Patient Advocacy is created to represent the interests
of the consumers of health care. The goal of the ombudsman shall be to help residents
of the state secure the health care services and benefits to which they are entitled under
the laws administered by the department and to advocate on behalf of and represent the
interests of consumers in governance bodies created by this chapter and in other forums.
new text end

new text begin (b) The ombudsman shall be a patient advocate appointed by the governor.
The budget for the ombudsman's office shall be determined by the legislature and is
independent from the Health Care Agency which has no oversight or authority over the
ombudsman for patient advocacy. The ombudsman shall establish offices throughout
the state that shall provide convenient access to residents. The ombudsman for patient
advocacy shall:
new text end

new text begin (1) ensure that patient advocacy services are available to all Minnesota residents;
new text end

new text begin (2) establish and maintain the grievance process according to section 62U.53;
new text end

new text begin (3) receive, evaluate, and respond to consumer complaints about the health care plan;
new text end

new text begin (4) provide a means to receive recommendations from the public about ways to
improve the health care plan and hold public hearings at least annually to discuss problems
and receive recommendations from the public;
new text end

new text begin (5) develop educational and informational guides according to section 15.441, for
consumers describing consumer rights and responsibilities and inform consumers about
the right to secure health care services and to participate in the health care plan. The
guides shall be made available to the public by the ombudsman, including access on
the ombudsman's Web site and through public outreach and educational programs and
displayed in provider offices and health care facilities;
new text end

new text begin (6) establish a toll-free telephone number to receive complaints regarding the health
care plan and its services; and
new text end

new text begin (7) report annually to the public, the commissioner, and the legislature about
the consumer perspective on the performance of the health care plan, including
recommendations for needed improvements.
new text end

new text begin (c) The patient advocate, in carrying out assigned duties, shall have unlimited access
to all nonconfidential and all nonprivileged documents in the custody and control of the
Minnesota Health Care Agency.
new text end

Sec. 8.

new text begin [62U.11] INSPECTOR GENERAL FOR THE MINNESOTA HEALTH
CARE PLAN.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin There is within the Office of the Attorney General
an Inspector General for the Minnesota health care plan who is appointed by the attorney
general.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

new text begin The inspector general shall:
new text end

new text begin (1) investigate, audit, and review the financial and business records of individuals,
public and private agencies and institutions, and private corporations that provide services
or products to the plan, the costs of which are reimbursed by the plan;
new text end

new text begin (2) investigate allegations of misconduct on the part of an employee or appointee
of the Minnesota Health Care Agency and on the part of any provider of health care
services that is reimbursed by the plan, and report any findings of misconduct to the
attorney general;
new text end

new text begin (3) investigate patterns of medical practice that may indicate fraud and abuse
related to over or under utilization or other inappropriate utilization of medical products
and services;
new text end

new text begin (4) arrange for the collection and analysis of data needed to investigate the
inappropriate utilization of these products and services; and
new text end

new text begin (5) annually report recommendations for improvements to the plan to the
commissioner.
new text end

Sec. 9.

new text begin [62U.13] TRANSITION ADVISORY GROUP; HEALTH PLANNING
REGIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Health Care Policy Board shall appoint a
transition advisory group to assist with the transition to the health care plan.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

new text begin The transition advisory group shall advise the commissioner on all
aspects of the implementation of this chapter.
new text end

new text begin (b) The transition advisory group shall make recommendations to the commissioner
on how the health care plan shall be regionalized for the purposes of local and
community-based planning for the delivery of high quality, cost-effective care and
efficient service delivery.
new text end

Sec. 10.

new text begin [62U.14] HEALTH PLANNING REGIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner, in consultation with the director
of Health Quality Planning, shall establish at least six health planning regions composed of
geographically contiguous counties grouped on the basis of the following considerations:
new text end

new text begin (1) patterns of utilization of health care services;
new text end

new text begin (2) health care resources, including workforce resources;
new text end

new text begin (3) health needs of the population, including public health needs;
new text end

new text begin (4) geography;
new text end

new text begin (5) population and demographic characteristics; and
new text end

new text begin (6) other considerations as appropriate.
new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin The county boards of each region shall appoint a regional
planning director for the region. Regional planning directors shall serve at the will of the
counties and may serve up to two four-year terms.
new text end

Sec. 11.

new text begin [62U.15] REGIONAL PLANNING.
new text end

new text begin Subdivision 1. new text end

new text begin Regional planning director. new text end

new text begin (a) A regional planning director
shall administer each health planning region. The regional planning director shall be
responsible for all duties, the exercise of all powers and jurisdiction, and the discharge of
all responsibilities vested by law in the regional agency.
new text end

new text begin (b) The regional planning director shall reside in the region in which the director
serves.
new text end

new text begin (c) The regional planning director shall:
new text end

new text begin (1) establish and administer a regional office;
new text end

new text begin (2) establish regional goals and priorities according to standards, goals, priorities,
and guidelines established by the regional board;
new text end

new text begin (3) make needed revenue-sharing arrangements so that regionalization does not limit
a patient's choice of provider; and
new text end

new text begin (4) identify and prioritize regional health care needs and goals in collaboration with
regional health care providers and the regional planning board.
new text end

new text begin Subd. 2. new text end

new text begin Regional planning boards. new text end

new text begin (a) Each region shall have a regional planning
board consisting of 15 members who shall be appointed by the county boards in the
region. Members shall serve four-year terms.
new text end

new text begin (b) Regional planning board members shall have resided for a minimum of two years
in the region in which they serve prior to appointment to the board.
new text end

new text begin (c) Regional planning board members shall reside in the region they serve while
on the board.
new text end

new text begin (d) The board shall consist of the following members:
new text end

new text begin (1) the regional planning director and a public health officer from one of the regional
counties;
new text end

new text begin (2) a representative from the Ombudsman Office of Patient Advocacy;
new text end

new text begin (3) one expert in health care financing;
new text end

new text begin (4) one expert in health care planning;
new text end

new text begin (5) a registered nurse who is a direct patient care provider;
new text end

new text begin (6) a primary care physician who is a direct patient care provider;
new text end

new text begin (7) one member who represents ancillary health care workers;
new text end

new text begin (8) one member representing hospitals;
new text end

new text begin (9) one member representing essential providers;
new text end

new text begin (10) one member representing long-term care providers; and
new text end

new text begin (11) four county commissioners.
new text end

new text begin (e) The regional planning director shall serve as chair of the board.
new text end

new text begin (f) Regional planning boards shall set health policy goals for the regional planning
director on all aspects of regional health care.
new text end

ARTICLE 3

FUNDING

Section 1.

new text begin [62U.19] FUND FOR HEALTH CARE.
new text end

new text begin Subdivision 1. new text end

new text begin General provisions. new text end

new text begin (a) In order to support the agency effectively in
the administration of this chapter, there is established in the state treasury the fund for
health care. The fund shall be administered by a director appointed by the commissioner.
new text end

new text begin (b) All money collected, received, and transferred according to this chapter shall be
transmitted to the state treasury to be deposited to the credit of the fund for health care for
the purpose of financing the Minnesota health care plan.
new text end

new text begin (c) Money deposited in the fund for health care shall be used exclusively to support
this chapter.
new text end

new text begin (d) All claims for health care services rendered shall be made to the fund for health
care.
new text end

new text begin (e) All payments made for health care services shall be disbursed from the fund
for health care.
new text end

new text begin Subd. 2. new text end

new text begin Accounts. new text end

new text begin (a) The director of the fund for health care shall establish
the following accounts within the fund:
new text end

new text begin (1) a system account to provide for all annual state expenditures for health care; and
new text end

new text begin (2) a reserve account.
new text end

new text begin (b) Premiums collected each year shall be sufficient to cover that year's projected
costs.
new text end

new text begin (c) The health care plan shall at all times hold in reserve an amount estimated in the
aggregate to provide for the payment of all losses and claims for which the plan may be
liable, and to provide for the expense of adjustment or settlement of losses and claims.
new text end

new text begin (d) During the transition, the commissioner shall work with the Department of
Commerce and other experts to determine an appropriate level of health plan reserves for
the first year and for future years of health care plan operation.
new text end

new text begin (e) Money currently held in reserve by state, city, and county health programs and
federal money for health care held in reserve in federal trust accounts shall be transferred
to the state health care reserve account when the state assumes financial responsibility for
health care under this chapter that is currently provided by those programs.
new text end

new text begin (f) The commissioner shall implement arrangements to self-insure the system
against unforeseen expenditures or revenue shortfalls not covered by plan reserves and
may borrow funds to cover temporary revenue shortfalls not covered by plan reserves,
including the issuance of bonds for this purpose, whichever is more cost-effective.
new text end

new text begin Subd. 3. new text end

new text begin Cost control. new text end

new text begin (a) The commissioner shall work to ensure appropriate
cost control through:
new text end

new text begin (1) aggressive public health measures, early intervention and preventive care, and
promotion of personal health improvement;
new text end

new text begin (2) changes in the delivery of health care services and administration that improve
efficiency and care quality;
new text end

new text begin (3) negotiations with providers and suppliers; and
new text end

new text begin (4) adjustments of health care provider payments to correct for deficiencies in care
quality and failure to meet compensation contract performance goals.
new text end

new text begin (b) If the commissioner determines that there will be a revenue shortfall despite the
cost control measures in paragraph (a), the commissioner shall report to the legislature
on the causes of the shortfall and the reasons for the failure of cost controls and shall
recommend measures to correct the shortfall, including an increase in health care plan
premium payments.
new text end

Sec. 2.

new text begin [62U.21] PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Procedures. new text end

new text begin (a) The Health Care Policy Board shall review, approve,
reject, and modify all payment contracts and compensation plans established according
to this section.
new text end

new text begin (b) The board shall establish and supervise a uniform payments system for providers
and managers and shall maintain a compensation plan for the following providers and
managers according to the provider and manager budget established by the commissioner:
new text end

new text begin (1) upper level managers including executives employed in private health care
facilities and plans; and
new text end

new text begin (2) health care providers.
new text end

new text begin (c) Health care providers who accept any payment from the Minnesota health care
plan for a covered service shall not bill the patient for that covered service.
new text end

new text begin (d) Health care providers may be compensated as fee-for-service providers or as
salaried providers in the health care plan.
new text end

new text begin (e) No compensation plan or financial incentive may adversely affect the care a
patient receives or the care a health provider recommends.
new text end

new text begin (f) Fee-for-service providers shall be paid within 30 business days for claims filed in
compliance with procedures established by the fund for health care.
new text end

new text begin Subd. 2. new text end

new text begin Regional payments. new text end

new text begin (a) The commissioner shall establish an allocation for
each region to fund regional operating and capital budgets.
new text end

new text begin (b) Integrated health care systems, essential providers, and group medical practices
that provide comprehensive, coordinated services may choose to be reimbursed on the
basis of a capitated system operating budget or a noncapitated system operating budget
that covers all costs of providing health care services.
new text end

new text begin (c) Providers may include in their operating budget requests reimbursement for
ancillary health care or social services that were previously funded by money now
received and disbursed by the fund for health care.
new text end

new text begin (d) No payment may be made from a capitated or noncapitated budget for a capital
expense except as stipulated in section 62U.23.
new text end

new text begin Subd. 3. new text end

new text begin Funds from outside sources. new text end

new text begin Facilities operating under health care plan
operating budgets may raise and expend funds from sources other than the Minnesota
health care plan including, private or foundation donors and other non-Minnesota health
care plan sources for purposes related to the goals of this section and according to the
provisions of this section.
new text end

Sec. 3.

new text begin [62U.23] CAPITAL MANAGEMENT PLAN.
new text end

new text begin Subdivision 1. new text end

new text begin General provisions. new text end

new text begin (a) The commissioner shall develop a capital
management plan that shall include conflict-of-interest standards and that shall govern all
large capital investments and acquisitions undertaken in the Minnesota health care plan.
The commissioner and the regional planning directors shall issue requests for proposals
and oversee a process of competitive bidding for the development of capital projects that
meet the needs of the Minnesota health care plan and to fund, partially fund, or participate
in seeking funding for those capital projects.
new text end

new text begin (b) Providers intending to make capital investments or acquisitions shall prepare a
request including the full life-cycle costs of the project or acquisition and demonstrate
how the investment or acquisition meets the health needs of the population it is intended
to serve. Acquisitions include, but are not limited to, the acquisition of land, operational
property, or administrative office space.
new text end

new text begin (c) The commissioner shall establish standards and a process whereby the regional
planning directors shall evaluate, accept, reject, or modify a business plan for a capital
investment or acquisition. Decisions of a regional planning director may be appealed
through a dispute resolution process established by the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Regional capital development plans. new text end

new text begin (a) Regional planning directors
shall develop a regional capital development plan according to the Minnesota health care
plan capital management plan established by the commissioner.
new text end

new text begin (b) Services provided as a result of capital investments or acquisitions that do not
meet the terms of the regional capital development plan and the capital management plan
developed by the commissioner shall not be reimbursed by the Minnesota health care plan.
new text end

Sec. 4.

new text begin [62U.25] BUDGET.
new text end

new text begin Subdivision 1. new text end

new text begin Prescription drugs and durable and nondurable medical
equipment. new text end

new text begin (a) The commissioner shall establish a budget for the purchase of prescription
drugs and durable and nondurable medical equipment for the health care plan.
new text end

new text begin (b) The commissioner shall negotiate the lowest possible prices for prescription
drugs and durable and nondurable medical equipment.
new text end

new text begin Subd. 2. new text end

new text begin Research and innovation. new text end

new text begin The commissioner shall establish a budget to
support research and innovation that has been recommended by the Health Care Policy
Board and the patient advocates.
new text end

new text begin Subd. 3. new text end

new text begin Training, development, and continuing education. new text end

new text begin (a) The commissioner
shall establish a budget to support the training, development, and continuing education of
health care providers and the health care workforce needed to meet the health care needs
of the population and the goals and standards of the health care plan.
new text end

new text begin (b) During the transition, the commissioner shall determine an appropriate level and
duration of spending to support the retraining and job placement of persons who have been
displaced from employment as a result of the transition to the new health care plan.
new text end

new text begin Subd. 4. new text end

new text begin Budget reserve. new text end

new text begin The commissioner shall establish a budget reserve.
Money in the budget reserve may be used only for the purposes specified in this chapter.
new text end

new text begin Subd. 5. new text end

new text begin System administration. new text end

new text begin (a) The commissioner shall establish a budget
that covers costs of administering the Minnesota health care plan.
new text end

Sec. 5.

new text begin [62U.27] MINNESOTA HEALTH CARE PREMIUM PROPOSAL.
new text end

new text begin Subdivision 1. new text end

new text begin Duties. new text end

new text begin The Minnesota Health Plan Policy Board shall:
new text end

new text begin (1) determine the aggregate costs of providing health care according to this chapter;
and
new text end

new text begin (2) develop an equitable and affordable premium structure that is progressive and
based on the ability to pay and that will generate adequate revenue for the fund for health
care;
new text end

new text begin (3) in consultation with the Department of Revenue, develop an efficient means
of collecting premiums;
new text end

new text begin (4) ensure that all income earners and all employers contribute a premium amount
that is affordable;
new text end

new text begin (5) coordinate with existing, ongoing funding sources from federal and state
programs; and.
new text end

new text begin (6) provide a fair distribution of monetary savings achieved from the establishment
of the state health care plan.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin On or before July 1, 2009, the board shall submit to the governor
and the legislature a detailed recommendation for collecting the revenue to finance the
state health care plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 6.

new text begin [62U.29] GOVERNMENTAL PAYMENTS.
new text end

new text begin (a) The commissioner shall seek all necessary waivers, exemptions, agreements,
or legislation so that all current federal payments to the state for health care are paid
directly to the Minnesota health care plan, which shall then assume responsibility for all
benefits and services previously paid for by the federal government with those funds. In
obtaining the waivers, exemptions, agreements, or legislation, the commissioner shall seek
from the federal government a contribution for health care services in Minnesota that
shall not decrease in relation to the contribution to other states as a result of the waivers,
exemptions, agreements, or legislation.
new text end

new text begin (b) The commissioner shall seek all necessary waivers, exemptions, agreements, or
legislation so that all current state payments for health care are paid directly to the system,
which shall then assume responsibility for all benefits and services previously paid for by
state government with those funds. In obtaining the waivers, exemptions, agreements,
or legislation, the commissioner shall seek from the legislature a contribution for health
care services that shall not decrease in relation to state government expenditures for health
care services in the year that this chapter was enacted, except that it may be corrected for
change in state gross domestic product, the size and age of population, and the number of
residents living below the federal poverty level.
new text end

Sec. 7.

new text begin [62U.31] OTHER GOVERNMENTAL PROGRAMS.
new text end

new text begin (a) The plan's responsibility for providing care shall be secondary to existing federal,
state, or local governmental programs for health care services to the extent that funding for
these programs is not transferred to the fund for health care or that the transfer is delayed
beyond the date on which initial benefits are provided under the plan.
new text end

new text begin (b) In order to minimize the administrative burden of maintaining eligibility records
for programs transferred to the plan, the commissioner shall seek to reach an agreement
with federal, state, and local governments in which their contributions to the fund for
health care shall be fixed to the rate of change of the state gross domestic product, the size
and age of population, and the number of residents living below the federal poverty level.
new text end

Sec. 8.

new text begin [62U.33] FEDERAL PREEMPTION.
new text end

new text begin Subdivision 1. new text end

new text begin Federal waivers. new text end

new text begin (a) The commissioner shall pursue all reasonable
means to secure a repeal or a waiver of any provision of federal law that preempts any
provision of this chapter.
new text end

new text begin (b) In the event that a repeal or a waiver of law or regulations cannot be secured,
the commissioner shall adopt rules, or seek conforming state legislation, consistent with
federal law, in an effort to best fulfill the purposes of this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Employer contract or plan federal preemption. new text end

new text begin (a) To the extent
permitted by federal law, an employee entitled to health or related benefits under a contract
or plan that, under federal law, preempts provisions of this chapter, shall first seek benefits
under that contract or plan before receiving benefits from the plan under this chapter.
new text end

new text begin (b) No benefits shall be denied under the plan created by this chapter unless the
employee has failed to take reasonable steps to secure like benefits from the contract or
plan, if those benefits are available.
new text end

new text begin (c) Nothing in this chapter is intended, nor shall this chapter be construed, to
discourage recourse to contracts or plans that are protected by federal law.
new text end

new text begin (d) To the extent permitted by federal law, a health care provider shall first seek
payment from the contract or plan before submitting bills to the Minnesota health care
plan.
new text end

Sec. 9.

new text begin [62U.35] SUBROGATION.
new text end

new text begin Subdivision 1. new text end

new text begin Collateral source. new text end

new text begin (a) It is the intent of this chapter to establish a
single public payer for all health care in the state of Minnesota. Until the time when the
roles of all other payers for health care have been terminated, health care costs shall be
collected from collateral sources whenever medical services provided to an individual
are, or may be, covered services under a policy of insurance, health care service plan, or
other collateral source available to that individual, or for which the individual has a right
of action for compensation to the extent permitted by law.
new text end

new text begin (b) As used in this section, collateral source includes:
new text end

new text begin (1) insurance policies written by insurers, including the medical components of
automobile, homeowners, and other forms of insurance;
new text end

new text begin (2) health care service plans and pension plans;
new text end

new text begin (3) employers;
new text end

new text begin (4) employee benefit contracts;
new text end

new text begin (5) government benefit programs;
new text end

new text begin (6) a judgment for damages for personal injury; and
new text end

new text begin (7) any third party who is or may be liable to an individual for health care services
or costs.
new text end

new text begin (c) Collateral source does not include:
new text end

new text begin (1) a contract or plan that is subject to federal preemption; or
new text end

new text begin (2) any governmental unit, agency, or service, to the extent that subrogation
is prohibited by law. An entity described in paragraph (b) is not excluded from the
obligations imposed by this section by virtue of a contract or relationship with a
governmental unit, agency, or service.
new text end

new text begin (d) The commissioner shall negotiate waivers, seek federal legislation, or make
other arrangements to incorporate collateral sources in Minnesota into the Minnesota
health care plan.
new text end

new text begin Subd. 2. new text end

new text begin Collateral source; negotiation. new text end

new text begin Whenever an individual receives health
care services under the plan and is entitled to coverage, reimbursement, indemnity, or
other compensation from a collateral source, the individual shall notify the health care
provider and provide information identifying the collateral source, the nature and extent
of coverage or entitlement, and other relevant information. The health care provider
shall forward this information to the commissioner. The individual entitled to coverage,
reimbursement, indemnity, or other compensation from a collateral source shall provide
additional information as requested by the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Reimbursement. new text end

new text begin (a) The plan shall seek reimbursement from the
collateral source for services provided to the individual and may institute appropriate
action, including legal proceedings, to recover the reimbursement. Upon demand, the
collateral source shall pay to the fund for health care the sums it would have paid or
expended on behalf of the individual for the health care services provided by the plan.
new text end

new text begin (b) In addition to any other right to recovery provided in this section, the
commissioner shall have the same right to recover the reasonable value of benefits from
a collateral source as provided to the commissioner of human services under section
256B.37.
new text end

new text begin (c) If a collateral source is exempt from subrogation or the obligation to reimburse
the plan as provided in this section, the commissioner may require that an individual who
is entitled to medical services from the source first seek those services from that source
before seeking those services from the plan.
new text end

new text begin (d) To the extent permitted by federal law, contractual retiree health benefits provided
by employers shall be subject to the same subrogation as other contracts, allowing the
Minnesota health care plan to recover the cost of services provided to individuals covered
by the retiree benefits, unless and until arrangements are made to transfer the revenues
of the benefits directly to the Minnesota health care plan.
new text end

new text begin Subd. 4. new text end

new text begin Defaults, underpayments, and late payments. new text end

new text begin (a) Default, underpayment,
or late payment of any tax or other obligation imposed by this chapter shall result in the
remedies and penalties provided by law, except as provided in this section.
new text end

new text begin (b) Eligibility for benefits under section 62U.37 shall not be impaired by any default,
underpayment, or late payment of any tax or other obligation imposed by this chapter.
new text end

ARTICLE 4

ELIGIBILITY

Section 1.

new text begin [62U.37] ELIGIBILITY.
new text end

new text begin Subdivision 1. new text end

new text begin Residency. new text end

new text begin All Minnesota residents shall be eligible for the
Minnesota health care plan. Residency shall be based upon physical presence in the state
with the intent to reside.
new text end

new text begin Subd. 2. new text end

new text begin Enrollment; identification. new text end

new text begin The commissioner shall establish a procedure
to enroll eligible residents and provide each eligible individual with identification that can
be used by health care providers to determine eligibility for services.
new text end

new text begin Subd. 3. new text end

new text begin Residents temporarily out of state. new text end

new text begin (a) It is the intent of the legislature for
the Minnesota health care plan to provide health care coverage to Minnesota residents who
are temporarily out of the state. The commissioner shall determine eligibility standards for
residents temporarily out of state who intend to return and reside in Minnesota and for
nonresidents temporarily employed in Minnesota.
new text end

new text begin (b) Coverage for emergency care obtained out of state shall be at prevailing local
rates. Coverage for nonemergency care obtained out of state shall be according to rates and
conditions established by the commissioner. The commissioner may require that a resident
be transported back to Minnesota when prolonged treatment of an emergency condition is
necessary and when that transport will not adversely affect a patient's care or condition.
new text end

new text begin Subd. 4. new text end

new text begin Visitors. new text end

new text begin Visitors to Minnesota shall be billed for all services received
under the plan. The commissioner may establish intergovernmental arrangements with
other states and countries to provide reciprocal coverage for temporary visitors.
new text end

new text begin Subd. 5. new text end

new text begin Out-of-state work. new text end

new text begin All persons eligible for health benefits from Minnesota
employers but who are working in another jurisdiction shall be eligible for health benefits
under this chapter provided they make payments equivalent to the payments they would
be required to make if they were residing in Minnesota.
new text end

new text begin Subd. 6. new text end

new text begin Retiree benefits. new text end

new text begin (a) All persons who under an employer-employee
contract are eligible for retiree medical benefits, including retirees who elect to reside
outside of Minnesota, shall remain eligible for those benefits provided the contractually
mandated payments for those benefits are made to the Minnesota fund for health care,
which shall assume financial responsibility for care provided under the terms of the
contract.
new text end

new text begin (b) The commissioner may establish financial arrangements with states and foreign
countries in order to facilitate meeting the terms of the contracts described in paragraph
(a), except that payments for care provided by non-Minnesota providers to Minnesota
retirees shall be reimbursed at rates established by the commissioner.
new text end

new text begin Subd. 7. new text end

new text begin Minors. new text end

new text begin Unmarried, unemancipated minors shall be deemed to have
the residency of their parent or guardian. If a minor's parents are deceased and a legal
guardian has not been appointed, or if a minor has been emancipated by court order, the
minor may establish residency.
new text end

new text begin Subd. 8. new text end

new text begin Presumptive eligibility. new text end

new text begin (a) An individual shall be presumed to be eligible
if the individual arrives at a health facility and is unconscious, comatose, or otherwise
unable, because of the individual's physical or mental condition, to document eligibility or
to act in the individual's own behalf. If the patient is a minor, the patient shall be presumed
to be eligible, and the health facility shall provide care as if the patient were eligible.
new text end

new text begin (b) Any individual shall be presumed to be eligible when brought to a health facility
according to any provision of section 253B.05.
new text end

new text begin (c) Any individual involuntarily committed to an acute psychiatric facility or to a
hospital with psychiatric beds according to any provision of section 253B.05, providing
for involuntary commitment, shall be presumed eligible.
new text end

new text begin (d) All health facilities subject to state and federal provisions governing emergency
medical treatment shall continue to comply with those provisions.
new text end

new text begin (e) To prevent an influx of people into the state for the purposes of receiving medical
care, the commissioner shall establish an eligibility waiting period and other criteria
needed to protect Minnesota premium payers and ensure the fiscal stability of the health
care plan.
new text end

ARTICLE 5

BENEFITS

Section 1.

new text begin [62U.39] BENEFITS.
new text end

new text begin Subdivision 1. new text end

new text begin General provisions. new text end

new text begin Any eligible individual may choose to receive
services under the Minnesota health care plan from any willing professional health care
provider participating in the plan. No health care provider may refuse to care for a
patient solely on the basis that is specified in the definition of unfair employment practice
contained in section 363A.08.
new text end

new text begin Subd. 2. new text end

new text begin Covered benefits. new text end

new text begin Covered benefits in this chapter shall include all
medical care determined to be medically appropriate by the consumer's health care
provider, but are subject to the limitations specified in subdivision 4. Covered benefits
include, but are not limited to, all of the following:
new text end

new text begin (1) inpatient and outpatient health facility services;
new text end

new text begin (2) inpatient and outpatient professional health care provider services by licensed
health care professionals;
new text end

new text begin (3) diagnostic imaging, laboratory services, and other diagnostic and evaluative
services;
new text end

new text begin (4) durable medical equipment, appliances, and assistive technology, including
prosthetics, eyeglasses, and hearing aids and their repair;
new text end

new text begin (5) inpatient and outpatient rehabilitative care;
new text end

new text begin (6) emergency transportation and necessary transportation for health care services
for disabled and indigent persons;
new text end

new text begin (7) language interpretation and translation for health care services, including sign
language for those unable to speak, or hear, or who are language impaired, and Braille
translation or other services for those with no or low vision;
new text end

new text begin (8) child and adult immunizations and preventive care;
new text end

new text begin (9) health education;
new text end

new text begin (10) hospice care;
new text end

new text begin (11) home health care;
new text end

new text begin (12) prescription drugs that are listed on the system formulary; nonformulary
prescription drugs may be included where standards and criteria established by the
commissioner are met;
new text end

new text begin (13) mental and behavioral health care;
new text end

new text begin (14) dental care;
new text end

new text begin (15) podiatric care;
new text end

new text begin (16) chiropractic care;
new text end

new text begin (17) acupuncture;
new text end

new text begin (18) blood and blood products;
new text end

new text begin (19) emergency care services;
new text end

new text begin (20) vision care;
new text end

new text begin (21) adult day care;
new text end

new text begin (22) case management and coordination to ensure services necessary to enable a
person to remain safely in the least restrictive setting;
new text end

new text begin (23) substance abuse treatment;
new text end

new text begin (24) care in a skilled nursing facility;
new text end

new text begin (25) dialysis; and
new text end

new text begin (26) benefits offered by a bona fide church, sect, denomination, or organization
whose principles include healing entirely by prayer or spiritual means provided by a
duly authorized and accredited practitioner or nurse of that bona fide church, sect,
denomination, or organization.
new text end

new text begin Subd. 3. new text end

new text begin Benefit expansion. new text end

new text begin The commissioner may expand benefits beyond the
minimum benefits described in this section when expansion meets the intent of this chapter
and when there are sufficient funds to cover the expansion.
new text end

new text begin Subd. 4. new text end

new text begin Exclusions. new text end

new text begin The following health care services shall be excluded from
coverage by the plan:
new text end

new text begin (1) health care services determined to have no medical indication by the
commissioner;
new text end

new text begin (2) surgery, dermatology, orthodontia, prescription drugs, and other procedures
primarily for cosmetic purposes, unless required to correct a congenital defect, restore or
correct a part of the body that has been altered as a result of injury, disease, or surgery,
or determined to be medically necessary by a qualified, licensed health care provider in
the plan;
new text end

new text begin (3) private rooms in inpatient health facilities where appropriate nonprivate rooms
are available, unless determined to be medically necessary by a qualified, licensed health
care provider in the plan; and
new text end

new text begin (4) services of a professional health care provider or facility that is not licensed or
accredited by the state except for approved services provided to a Minnesota resident
who is temporarily out of the state.
new text end

ARTICLE 6

DELIVERY OF CARE

Section 1.

new text begin [62U.41] PROVIDERS.
new text end

new text begin (a) All health care providers licensed or accredited to practice in Minnesota may
participate in the Minnesota health care plan.
new text end

new text begin (b) No health care provider may refuse to care for a patient on any basis that is
specified in the definition of unfair employment practice contained in section 363A.08.
new text end

new text begin (c) All federal legislation and regulations governing referral fees and fee-splitting,
including, but not limited to, United States Code, title 42, sections 1320a-7b and 1395nn,
shall be applicable to all health care providers of services reimbursed under this chapter,
whether or not the health care provider is paid with funds coming from the federal
government.
new text end

new text begin (d) Choice of provider is subject to the following provisions.
new text end

new text begin (1) Persons eligible for health care services under this chapter may choose the
following providers:
new text end

new text begin (i) primary care providers that include family practitioners, general practitioners,
internists and pediatricians, advance practice nurse practitioners and physician assistants
practicing under supervision as defined in section 147A.01, subdivision 18, and doctors
of osteopathy licensed to practice as general doctors; and
new text end

new text begin (ii) women may choose an obstetrician-gynecologist, in addition to a primary
provider.
new text end

new text begin (2) Persons who choose to enroll with integrated health care systems, group
medical practices, or essential providers that offer comprehensive services, shall retain
membership for at least six months after an initial three-month evaluation period during
which time they may withdraw for any reason.
new text end

new text begin (3) The three-month period shall commence on the date when an enrollee first sees
a primary care provider.
new text end

new text begin (4) Persons who want to withdraw after the initial three-month period shall request a
withdrawal according to dispute resolution procedures established by the commissioner
and may request assistance from the ombudsman for patient advocacy in the dispute
process. The dispute shall be resolved in a timely fashion and shall have no adverse
effect on the care a patient receives.
new text end

new text begin (5) Persons needing to change primary care providers because of health care needs
that their primary care provider cannot meet may change primary care providers at any
time.
new text end

Sec. 2.

new text begin [62U.43] REFERRALS.
new text end

new text begin (a) All patients shall have a primary care provider who shall coordinate the care a
patient receives or shall ensure that a patient's care is coordinated. A specialist may serve
as the primary care provider if the patient and the provider agree to this arrangement, and
if the provider agrees to coordinate the patient's care or to ensure that the care the patient
receives is coordinated.
new text end

new text begin (b) Referrals shall be based on the medical needs of the patient and on guidelines,
which shall be established by the Health Care Policy Board.
new text end

new text begin (c) Referrals shall not be restricted or provided solely because of financial
considerations. The Health Care Policy Board shall monitor referral patterns and intervene
as necessary to ensure that referrals are neither restricted nor provided solely because of
financial considerations.
new text end

new text begin (d) The commissioner may establish or ensure the establishment of a computerized
referral registry to facilitate the referral process.
new text end

Sec. 3.

new text begin [62U.45] OFFICE OF HEALTH QUALITY AND PLANNING.
new text end

new text begin Subdivision 1. new text end

new text begin General provisions. new text end

new text begin The Health Policy Board shall establish an
Office of Health Quality and Planning to provide for the short- and long-term health
needs of the population. The office shall:
new text end

new text begin (1) promote the delivery of high-quality, coordinated health care services that
enhance health; prevent illness, disease, and disability; slow the progression of chronic
diseases; and improve personal health management;
new text end

new text begin (2) establish performance criteria in measurable terms for health care goals;
new text end

new text begin (3) assist the health care regions to develop operating and capital requests according
to health care and finance guidelines established by the commissioner and this chapter. In
assisting regions, the director of the Office of Health Quality and Planning shall:
new text end

new text begin (i) identify medically undeserved areas and health service and asset shortages;
new text end

new text begin (ii) identify disparities in health outcomes;
new text end

new text begin (iii) provide information to support planning, including planning for access to
specialized centers that perform a high volume of procedures for conditions requiring
highly specialized treatments, including emergency and trauma, planning for interregional
access to needed care, and planning for coordinated interregional capital investment; and
new text end

new text begin (iv) evaluate regional budget requests and make recommendations to the
commissioner about regional revenue allocations;
new text end

new text begin (4) estimate the health care workforce required to meet the health needs of the
population, the costs of providing the needed workforce, and, in collaboration with
regional planners, educational institutions, the governor and the legislature, develop short-
and long-term plans to meet those needs, including a plan to finance needed training; and
new text end

new text begin (5) estimate the number and types of health facilities required to meet the short- and
long-term health needs of the population and the projected costs of needed facilities. In
collaboration with the commissioner, regional planning directors, the governor, and the
legislature, the director shall develop plans to finance and build needed facilities.
new text end

new text begin Subd. 2. new text end

new text begin Culturally and linguistically competent care. new text end

new text begin (a) The Office of Health
Quality and Planning shall establish standards for culturally and linguistically competent
care.
new text end

new text begin (b) The director of the Office of Health Quality and Planning shall annually evaluate
the effectiveness of standards for culturally and linguistically competent care and make
recommendations to the commissioner and the ombudsman for patient advocacy.
new text end

new text begin (c) The director shall pursue available federal financial participation for the provision
of a language services program that supports health care plan goals.
new text end

new text begin Subd. 3. new text end

new text begin Health initiatives. new text end

new text begin The Office of Health Quality and Planning shall explore
the feasibility and the value to the health of the population of the following initiatives:
new text end

new text begin (1) integrated statewide health care databases to support health care planning;
new text end

new text begin (2) electronic systems and other means that support the use of standards of care
based on clinical efficacy;
new text end

new text begin (3) development of disease management programs;
new text end

new text begin (4) electronic initiatives that lower administration costs;
new text end

new text begin (5) Web-based, patient-centered information systems that assist people to promote
and maintain health and provide information on health conditions and recent developments
in treatment; and
new text end

new text begin (6) recommend to the commissioner means to link health care research with the
goals and priorities of the health care plan.
new text end

new text begin Subd. 4. new text end

new text begin Additional benefits. new text end

new text begin The Office of Health Quality and Planning shall
consider additional benefits based on clinical efficacy. In considering additional benefits,
the office shall:
new text end

new text begin (1) identify safe and effective treatments;
new text end

new text begin (2) receive comments and recommendations from health care providers about
benefits that meet the needs of their patients;
new text end

new text begin (3) receive comments and recommendations made directly by patients or indirectly
through the patient advocate;
new text end

new text begin (4) identify innovative approaches to health promotion, disease and injury
prevention, education, research, and care delivery; and
new text end

new text begin (5) identify complementary and alternative modalities that have been shown by
the National Institutes of Health, Division of Complementary and Alternative Medicine
to be safe and effective.
new text end

new text begin The office shall establish pharmaceutical and medical equipment formularies based
on clinical efficacy. The formularies shall be updated regularly to reflect new drugs and
medical equipment.
new text end

new text begin (h) The office shall develop standards and criteria and a process for providers to
request authorization for services and treatments, including experimental treatments that
are not included in the plan benefit package.
new text end

new text begin (i) The office shall identify appropriate ratios of general medical providers to
specialty medical providers on a regional basis in order to meet the health care needs of
the population and the goals of the health care plan and recommend incentives and other
means to achieve recommended provider ratios.
new text end

new text begin (j) The office shall oversee coordination of the Minnesota health care plan and
public health programs.
new text end

Sec. 4.

new text begin [62U.53] OMBUDSMAN; GRIEVANCE SYSTEM.
new text end

new text begin Subdivision 1. new text end

new text begin Duties of ombudsman for patient advocacy. new text end

new text begin The ombudsman
for patient advocacy shall establish a grievance system for all complaints. The system
shall provide reasonable procedures that shall ensure adequate consideration of member
grievances and appropriate remedies.
new text end

new text begin Subd. 2. new text end

new text begin Referral of grievances. new text end

new text begin The ombudsman for patient advocacy may
refer any grievance that does not pertain to compliance with this chapter to the federal
Health Care Financing Administration or any other appropriate local, state, and federal
governmental entity for investigation and resolution.
new text end

new text begin Subd. 3. new text end

new text begin Submittal by designated agents and providers. new text end

new text begin A provider may join
with, or otherwise assist, an enrollee to submit the grievance to the patient advocate
without fear of retribution.
new text end

new text begin Subd. 4. new text end

new text begin Review of documents. new text end

new text begin The ombudsman may require additional
information from providers or the commissioner.
new text end

new text begin Subd. 5. new text end

new text begin Written notice of disposition. new text end

new text begin The ombudsman shall send a written notice
of the final disposition of the grievance, and the reasons for the decision, to the member, to
any provider who is assisting the member, and to the commissioner, within 30 calendar
days of receipt of the request for review unless the ombudsman determines that additional
time is reasonably necessary to fully and fairly evaluate the relevant grievance. The
ombudsman's order of corrective action shall be binding on the plan. Decisions of the
ombudsman may only be appealed in district court.
new text end

Sec. 5. new text begin APPROPRIATION.
new text end

new text begin $....... is appropriated from the general fund to the commissioner of health care for
fiscal year 2009 to implement the provisions of this act.
new text end

Sec. 6. new text begin EFFECTIVE DATE.
new text end

new text begin This act is effective the day following final enactment. The commissioner of
finance shall notify the chairs of the house of representatives and senate committees
with jurisdiction over health care that the fund for health care has sufficient revenues to
fund the costs of implementing this act.
new text end