HF 3391

6th Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health care; establishing a statewide health improvement program;
establishing health care homes and reporting requirements; establishing a care
coordination payment; increasing reimbursements to primary care physicians in
certain areas; requiring a workforce shortage study; establishing requirements for
interoperable health records; establishing electronic prescription drug program;
establishing a value-based benefit set and design for health benefits; providing for
health care payment restructuring; requiring uniform standards; establishing an
affordability standard; requiring development of employee subsidies for health
coverage; requiring a health care spending baseline be developed; establishing a
health care reform review council; establishing Section 125 Plan; providing for
fees; requiring reports; authorizing rulemaking; appropriating money; amending
Minnesota Statutes 2006, sections 256.01, by adding a subdivision; 256B.057,
subdivision 8; 256L.05, by adding a subdivision; 256L.06, subdivision 3;
256L.07, subdivision 3; Minnesota Statutes 2007 Supplement, sections 62J.495,
by adding a subdivision; 256.962, subdivisions 5, 6; 256L.04, subdivisions 1,
7; 256L.05, subdivision 3a; 256L.07, subdivision 1; 256L.15, subdivision 2;
Laws 2007, chapter 147, article 5, section 19; proposing coding for new law in
Minnesota Statutes, chapters 62J; 124D; 145; 256B; proposing coding for new
law as Minnesota Statutes, chapter 62U; repealing Minnesota Statutes 2006,
section 256L.15, subdivision 3.

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

ARTICLE 1

PUBLIC HEALTH

Section 1.

new text begin [145.986] STATEWIDE HEALTH IMPROVEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Goals. new text end

new text begin It is the goal of the state to substantially reduce the percentage
of Minnesotans who are obese or overweight, and to reduce the use of tobacco.
new text end

new text begin Subd. 2. new text end

new text begin Grants to local communities. new text end

new text begin (a) Beginning July 1, 2009, the
commissioner of health shall award grants to community health boards established
pursuant to section 145A.09, and tribal governments to convene, coordinate, and
implement evidence-based strategies targeted at reducing the percentage of Minnesotans
who are obese or overweight and to reduce the use of tobacco.
new text end

new text begin (b) Grantee activities shall:
new text end

new text begin (1) be based on scientific evidence;
new text end

new text begin (2) be based on community input;
new text end

new text begin (3) address behavior change at the individual, community, and systems levels;
new text end

new text begin (4) occur in community, school, worksite, and health care settings; and
new text end

new text begin (5) be focused on policy, systems, and environmental changes that support healthy
behaviors.
new text end

new text begin (c) To receive a grant under this section, community health boards and tribal
governments must submit proposals to the commissioner. A local match of ten percent
of the total funding allocation is required. This local match may include funds donated
by community partners.
new text end

new text begin (d) In order to receive a grant, community health boards and tribal governments
must submit a health improvement plan to the commissioner of health for approval. The
commissioner may require the plan to identify a community leadership team, community
partners, and a community action plan that includes an assessment of area strengths and
needs, proposed action strategies, technical assistance needs, and a staffing plan.
new text end

new text begin (e) The grant recipient must implement the health improvement plan, evaluate the
effectiveness of the interventions, and modify or discontinue interventions found to be
ineffective.
new text end

new text begin (f) Grant recipients shall receive the standard base amount and a standard per capita
amount to be established by the commissioner.
new text end

new text begin (g) By January 15, 2011, the commissioner of health shall recommend whether any
funding should be distributed to community health boards and tribal governments based
on health disparities demonstrated in the populations served.
new text end

new text begin (h) Grant recipients shall report their activities and their progress towards the
outcomes established under subdivision 3 to the commissioner in a format and at a time
specified by the commissioner.
new text end

new text begin (i) All grant recipients shall be held accountable for making progress toward the
measurable outcomes established in subdivision 3. The commissioner shall require a
corrective action plan and may reduce the funding level of grant recipients that do not
make adequate progress toward the measurable outcomes.
new text end

new text begin Subd. 3. new text end

new text begin Outcomes. new text end

new text begin (a) The commissioner shall set measurable outcomes to meet
the goals specified in subdivision 1, and annually review the progress of grant recipients
in meeting the outcomes.
new text end

new text begin (b) The commissioner shall measure current public health status, using existing
measures and data collection systems when available, to determine baseline data against
which progress shall be monitored.
new text end

new text begin Subd. 4. new text end

new text begin Technical assistance and oversight. new text end

new text begin The commissioner shall provide
content expertise, technical expertise, and training to grant recipients and advice on
evidence-based strategies, including those based on populations and types of communities
served. The commissioner shall ensure that the statewide health improvement program
meets the outcomes established under subdivision 3 by conducting a comprehensive
statewide evaluation and assisting grant recipients to modify or discontinue interventions
found to be ineffective.
new text end

new text begin Subd. 5. new text end

new text begin Evaluation. new text end

new text begin Using the outcome measures established in subdivision 3, the
commissioner shall conduct a biennial evaluation of the statewide health improvement
program funded under this section. Grant recipients shall cooperate with the commissioner
in the evaluation and provide the commissioner with the information necessary to conduct
the evaluation.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin The commissioner shall submit a biennial report to the legislature
on the statewide health improvement program funded under this section. These reports
must include information on grant recipients, activities that were conducted using grant
funds, evaluation data, and outcome measures, if available. In addition, the commissioner
shall provide recommendations on future areas of focus for health improvement. These
reports are due by January 15 of every other year, beginning in 2010. In the report due
on January 15, 2010, the commissioner shall include recommendations on a sustainable
funding source for the statewide health improvement program other than the health care
access fund.
new text end

new text begin Subd. 7. new text end

new text begin Supplantation of existing funds. new text end

new text begin Community health boards and tribal
governments must use funds received under this section to develop new programs, expand
current programs that work to reduce the percentage of Minnesotans who are obese or
overweight, or who use tobacco, or replace discontinued state or federal funds previously
used to reduce the percentage of Minnesotans who are obese or overweight, or who use
tobacco. Funds must not be used to supplant current state or local funding to community
health boards or tribal governments used to reduce the percentage of Minnesotans who are
obese or overweight or to reduce tobacco use.
new text end

ARTICLE 2

HEALTH CARE HOMES

Section 1.

new text begin [256B.0751] HEALTH CARE HOMES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of sections 256B.0751 to 256B.0753,
the following definitions apply.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Commissioners" means the commissioner of humans services and the
commissioner of health, acting jointly.
new text end

new text begin (d) "Health plan company" has the meaning provided in section 62Q.01, subdivision
4.
new text end

new text begin (e) "Personal clinician" means a physician licensed under chapter 147, a physician
assistant registered and practicing under chapter 147A, an advanced practice nurse
licensed and registered to practice under chapter 148, and other health care providers as
determined by the commissioner of health.
new text end

new text begin (f) "State health care program" means the medical assistance, MinnesotaCare, and
general assistance medical care programs.
new text end

new text begin Subd. 2. new text end

new text begin Development and implementation of standards. new text end

new text begin (a) By July 1, 2009,
the commissioners of health and human services shall develop and implement standards
of certification for health care homes for state health care programs. In developing these
standards, the commissioners shall consider existing standards developed by national
independent accrediting and medical home organizations. The standards developed by the
commissioners must meet the following criteria:
new text end

new text begin (1) emphasize, enhance, and encourage the use of primary care, and include the
use of primary care physicians, advanced practice nurses, and physician assistants as
personal clinicians, as well as appropriate specialists if they provide care according
to these standards;
new text end

new text begin (2) focus on delivering high-quality, efficient, and effective health care services,
enhancing the experience of patients and their families, and appropriately engaging
patients and their families in the decision-making process;
new text end

new text begin (3) encourage patient-centered care, including active participation by the patient and
family or a legal guardian, or a health care agent as defined in chapter 145C, as appropriate
in decision making, care plan development, and include patient representation on practice
level quality improvement teams;
new text end

new text begin (4) provide patients with a consistent, ongoing contact with a personal clinician to
ensure continuous and appropriate care for the patient's condition;
new text end

new text begin (5) ensure that health care homes develop and maintain appropriate comprehensive
care plans for their patients with complex or chronic conditions, including the provision
of an initial health assessment in order to identify all of the patient's complex or chronic
health conditions;
new text end

new text begin (6) enable and encourage utilization of a range of qualified health care professionals
to provide care, including dedicated care coordinators, in a manner that enables providers
to practice to the fullest extent of their license;
new text end

new text begin (7) focus initially on patients who have or are at risk of developing chronic health
conditions;
new text end

new text begin (8) provide care that is appropriate to the patient's race, ethnicity, and language;
new text end

new text begin (9) incorporate measures of quality and cost of care;
new text end

new text begin (10) ensure the use of health information technology and systematic follow-up
through the use of patient registries; and
new text end

new text begin (11) encourage the use of evidence-based health care, patient decision-making
aids that provide patients with information about treatment options and their associated
benefits, risks, costs, and comparative outcomes, and other clinical decision support tools.
new text end

new text begin (b) In developing these standards, the commissioners shall consult with national
and local organizations working on health care home models, health care providers,
relevant state agencies, health plans, and hospitals. The commissioners may satisfy this
requirement by continuing the provider directed care coordination advisory committee.
new text end

new text begin (c) For the purposes of developing and implementing these standards, the
commissioners are exempt from the provisions of chapter 14, including the specific
provisions in section 14.386.
new text end

new text begin Subd. 3. new text end

new text begin Requirements for clinicians certified as health care homes. new text end

new text begin (a) A
personal clinician or a primary care clinic may be certified as a health care home. If a
primary care clinic is certified, all of the primary care clinics' clinicians must meet the
criteria of a health care home. In order to be certified as a health care home, a clinician or
clinic must meet the standards set by the commissioners in accordance with this section.
Certification as a health care home is voluntary. In order to maintain their status as health
care homes, clinicians or clinics must renew their certification annually.
new text end

new text begin (b) Clinicians or clinics certified as health care homes must offer their health care
home services to all their patients with complex or chronic health conditions who are
interested in participation.
new text end

new text begin (c) Health care homes must participate in the health care home learning collaborative
established under subdivision 5.
new text end

new text begin Subd. 4. new text end

new text begin Alternative models. new text end

new text begin Nothing in this section shall preclude the continued
development of existing medical or health care home projects currently operating or under
development by the commissioner of human services or preclude the commissioner from
establishing alternative models and payment mechanisms for persons who are enrolled
in integrated Medicare and Medicaid programs under section 256B.69, subdivisions 23
and 28, are enrolled in managed care long-term care programs under section 256B.69,
subdivision 6, paragraph (b), are dually eligible for Medicare and medical assistance, are
in the waiting period for Medicare, or who have other primary coverage.
new text end

new text begin Subd. 5. new text end

new text begin Health care home collaborative. new text end

new text begin By July 1, 2009, the commissioners
shall establish a health care home collaborative to provide an opportunity for health care
homes and state agencies to exchange information related to quality improvement and
best practices.
new text end

new text begin Subd. 6. new text end

new text begin Evaluation and continued development. new text end

new text begin (a) For continued certification
under this section, health care homes must meet process, outcome, and quality standards as
developed and specified by the commissioners. The commissioners shall collect data from
health care homes necessary for monitoring compliance with certification standards and
for evaluating the impact of health care homes on health care quality, cost, and outcomes.
new text end

new text begin (b) The commissioners may contract with a private entity to perform an evaluation of
the effectiveness of health care homes. Data collected under this subdivision is classified
as nonpublic data under chapter 13.
new text end

new text begin Subd. 7. new text end

new text begin Outreach. new text end

new text begin Upon implementation of the certification process and standards
under subdivision 1, the commissioner shall encourage state health care program enrollees
who have a complex or chronic condition to select a primary care clinic with clinicians
who have been certified as health care homes.
new text end

Sec. 2.

new text begin [256B.0752] CARE COORDINATION FEE.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin The commissioner of human services shall develop
a payment system that provides per-person care coordination payments to health care
providers for providing care coordination services and directly managing onsite or
employing care coordinators. In order to be eligible for a care coordination payment, a
health care provider must be certified as a health care home by the commissioners of
human services and health based on the certification standards for health care homes
established under section 256B.0751. The care coordination payment system must vary
the fees paid by thresholds of care complexity, with the highest fees being paid for care
provided to individuals requiring the most intensive care coordination and those who face
racial, ethnic, or language barriers. The commissioner may determine a schedule for
phasing-in care coordination fees such that the fees will be applied first to individuals who
have, or are at risk of developing, complex or chronic health conditions and coordinate
with the implementation of the provider-directed care coordination payments under
section 256B.0625, subdivision 51. Development of the payment system must be
completed by January 1, 2010.
new text end

new text begin Subd. 2. new text end

new text begin Payment of care coordination fee. new text end

new text begin By July 1, 2010, the commissioner of
human services shall pay each certified health care home a per-person care coordination
fee for providing care coordination services for each state health care program enrollee
served under the fee-for-service system. The care coordination fee must be determined
by the commissioner in contracts with certified health care homes. Payment of the care
coordination fee is contingent on the health care home meeting the certification standards
for health care homes described in section 256B.0751. The care coordination fee is in
addition to reimbursement received by a health care home under the medical assistance
fee-for-service payment system for health care services.
new text end

new text begin Subd. 3. new text end

new text begin Managed care and county-based purchasing. new text end

new text begin By July 1, 2010, the
commissioner of human services shall require managed care and county-based purchasing
plans serving state health care program enrollees under sections 256B.69 and 256B.692,
and chapters 256D and 256L to implement a care coordination payment system for state
health care program enrollees who are provided care coordination services in health care
homes certified under section 256B.0751. The payment system shall be designed in
accordance with section 62U.05.
new text end

new text begin Subd. 4. new text end

new text begin Cost neutrality. new text end

new text begin If initial savings from implementation of health care
homes are not sufficient to allow implementation of the care coordination fee in a
cost-neutral manner, the commissioner may make recommendations to the legislature on
reallocating costs within the health care system.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 3.

new text begin [256B.0753] HEALTH CARE HOME REPORTING REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Standards and criteria review. new text end

new text begin Prior to implementation, the
commissioners shall report the certification standards and evaluation criteria established
in sections 256B.0751 and 256B.0752 to the Legislative Commission on Health Care
Access. These standards are not subject to chapter 14, and the specific provisions in
section 14.386 do not apply.
new text end

new text begin Subd. 2. new text end

new text begin Annual reports on implementation and administration. new text end

new text begin The
commissioners shall report annually to the legislature on the implementation and
administration of the health care home model for state health care program enrollees in the
fee-for-service, managed care, and county-based purchasing sectors, beginning January
15, 2011, and each January 15 thereafter. The annual report must include the cost benefit
analysis of the implementation of the health care home model for the state public health
care programs.
new text end

new text begin Subd. 3. new text end

new text begin Evaluation reports. new text end

new text begin The commissioners shall provide to the legislature
comprehensive evaluations of the health care home model three years and five years after
implementation. The report must include:
new text end

new text begin (1) the number of state health care program enrollees in health care homes, the
number and characteristics of enrollees with complex or chronic conditions, identified
by income, race, ethnicity, and language;
new text end

new text begin (2) the number and geographic distribution of health care home providers;
new text end

new text begin (3) the performance and quality of care of health care homes;
new text end

new text begin (4) measures of preventive care;
new text end

new text begin (5) health care home payment arrangements, and costs related to implementation
and payment of care coordination fees; and
new text end

new text begin (6) the estimated impact of health care homes on health disparities.
new text end

Sec. 4.

new text begin [256B.766] PRIMARY CARE PHYSICIAN REIMBURSEMENT RATE
INCREASE.
new text end

new text begin (a) Effective for physician services rendered on or after January 1, 2009, the
commissioner shall increase reimbursements to primary care physicians deemed by the
commissioner to meet the requirements in paragraph (b). Reimbursement may be increased
by not more than 50 percent above the reimbursement rate that would otherwise be paid to
the primary care provider. Payments to health plan companies shall be adjusted to reflect
increased reimbursement to primary care physicians as approved by the commissioner.
new text end

new text begin (b) The commissioner, in collaboration with the Office of Rural Health, shall
determine areas of the state in need of primary care physicians. By September 1 of each
year, beginning September 1, 2008, the commissioner shall accept applications from
primary care physicians who agree to practice in a designated underserved area for a
period of no less than five years. The commissioner shall determine participant eligibility
based on their suitability for practice serving a designated geographic area.
new text end

new text begin (c) The commissioner may reconsider the designated areas, as necessary. A primary
care physician who agrees to practice in an area designated as underserved shall receive
the increased reimbursement rates for at least a period of five years, unless the physician
discontinues practicing in the designated area during the five-year period.
new text end

new text begin (d) A health care clinic or medical group may submit applications under this section
for primary care physicians who will be hired to fill vacancies, prior to filling the vacant
position.
new text end

Sec. 5. new text begin WORKFORCE SHORTAGE STUDY.
new text end

new text begin To address health care workforce shortages, the commissioner of health, in
consultation with the health licensing boards and professional associations, shall study
changes necessary in health professional licensure and regulation to ensure full utilization
of advanced practice registered nurses, physician assistants, and other licensed health care
professionals in the health care home and primary delivery system. The commissioner
shall make recommendations to the legislature by January 15, 2009.
new text end

ARTICLE 3

INCREASING ACCESS; CONTINUITY OF CARE

Section 1.

new text begin [124D.1115] FREE AND REDUCED SCHOOL LUNCH PROGRAM
DATA SHARING.
new text end

new text begin (a) Each school participating in the federal school lunch program shall electronically
send to the Department of Education the eligibility information on each child who is
eligible for the free and reduced lunch program, unless the child's parent or legal guardian
after being notified of the potential disclosure of this information for the limited purpose
stated in paragraph (b), elects not to have the information disclosed.
new text end

new text begin (b) Pursuant to United States Code, title 42, section 1758(b)(6)(A), the Department
of Education shall enter into an agreement with the Department of Human Services
to share the eligibility information provided by each school in paragraph (a) for the
limited purpose of identifying children who may be eligible for medical assistance or
MinnesotaCare. The Department of Human Services must ensure that this information
remains confidential and shall only be used for this purpose. Any unauthorized disclosure
shall be subject to a penalty.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 27. new text end

new text begin Automation and coordination for state health care programs. new text end

new text begin (a) For
purposes of this subdivision, "state health care program" means the medical assistance,
MinnesotaCare, or general assistance medical care programs.
new text end

new text begin (b) By July 1, 2009, the commissioner shall improve coordination between state
health care programs and social service programs including, but not limited to WIC, free
and reduced school lunch programs, and food stamps, and shall develop and use automated
systems to identify persons served by social service programs who may be eligible for, but
are not enrolled in, a state health care program. By January 15, 2009, the commissioner
shall, as necessary, identify and recommend to the legislature statutory changes to state
health care and social service programs necessary to improve coordination and automation
of outreach and enrollment efforts.
new text end

new text begin (c) By January 15, 2009, the commissioner shall establish and implement an
automated process to send out state health care program renewal forms in the most
common foreign languages, to those state health care program enrollees who request
renewal forms in those foreign languages. The commissioner, as part of the initial
enrollment process, shall inform applicants of the availability of this option.
new text end

new text begin (d) Beginning July 1, 2008, the commissioner, county social service agencies, and
health care providers shall update state health care program enrollee addresses and related
contact information, at the time of each enrollee contact.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2008.
new text end

Sec. 3.

Minnesota Statutes 2007 Supplement, section 256.962, subdivision 5, is
amended to read:

Subd. 5.

Incentive program.

Beginning January 1, 2008, the commissioner
shall establish an incentive program for organizations that directly identify and assist
potential enrollees in filling out and submitting an application. For each applicant who is
successfully enrolled in MinnesotaCare, medical assistance, or general assistance medical
care, the commissioner, within the available appropriation, shall pay the organization a
deleted text begin $20 deleted text end new text begin $25 new text end application assistance bonus. The organization may provide an applicant a gift
certificate or other incentive upon enrollment.

Sec. 4.

Minnesota Statutes 2007 Supplement, section 256.962, subdivision 6, is
amended to read:

Subd. 6.

School districts.

(a) At the beginning of each school year, a school district
shall provide information to each student on the availability of health care coverage
through the Minnesota health care programs.

(b) For each child who is determined to be eligible for deleted text begin a deleted text end new text begin the new text end free deleted text begin or deleted text end new text begin and new text end reduced
deleted text begin priced deleted text end new text begin school new text end lunch new text begin program new text end , the district shall provide the child's family with deleted text begin an
application for the Minnesota health care programs and deleted text end information on how to obtain new text begin an
application for the Minnesota health care programs and new text end application assistance.

(c) A district shall also ensure that applications and information on application
assistance are available at early childhood education sites and public schools located
within the district's jurisdiction.

(d) Each district shall designate an enrollment specialist to provide application
assistance and follow-up services with families deleted text begin who are eligible for the reduced or free
lunch program or deleted text end who have indicated an interest in receiving information or an application
for the Minnesota health care program. new text begin A district is eligible for the application assistance
bonus described in subdivision 5.
new text end

(e) Each school district shall provide on their Web site a link to information on how
to obtain an application and application assistance.

Sec. 5.

Minnesota Statutes 2006, section 256B.057, subdivision 8, is amended to read:

Subd. 8.

Children under age two.

Medical assistance may be paid for a child under
two years of age whose countable family income is above 275 percent of the federal
poverty guidelines for the same size family but less than or equal to deleted text begin 280 deleted text end new text begin 305 new text end percent of the
federal poverty guidelines for the same size family.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later.
new text end

Sec. 6.

Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is
amended to read:

Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) deleted text begin Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $50,000.
deleted text end

deleted text begin (e) deleted text end Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 7.

Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is
amended to read:

Subd. 7.

Single adults and households with no children.

new text begin (a) new text end The definition of
eligible persons includes all individuals and households with no children who have gross
family incomes that are equal to or less than 200 percent of the federal poverty guidelines.

new text begin (b) new text end Effective July 1, 2009, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than 215 percent of the federal poverty guidelines.

new text begin (c) Effective July 1, 2010, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than 300 percent of the federal poverty guidelines.
new text end

Sec. 8.

Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a, is
amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. new text begin If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. new text end The
premium for the new period of eligibility must be received as provided in section 256L.06
in order for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.

new text begin (d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period, before being
disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
additional month.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 9.

Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Delayed verification. new text end

new text begin On the basis of information provided on the
completed application, an applicant whose gross income is less than 90 percent of
the applicable income standard and meets all other eligibility requirements, including
compliance at the time of application with citizenship or nationality documentation
requirements under section 256L.04, subdivision 10, must be determined eligible and
enrolled upon payment of premiums according to subdivision 3. The applicant shall
provide all required verifications within 60 days' notice of the eligibility determination,
or eligibility shall be denied or canceled. Applicants who are denied or canceled for
failure to provide all required verifications are not eligible for coverage using the delayed
verification procedures specified in this subdivision for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 10.

Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:

Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the
commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require
enrollees to report changes in income; (2) adjust sliding scale premium payments, based
upon both increases and decreases in enrollee income, at the time the change in income
is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
premiums. Failure to pay includes payment with a dishonored check, a returned automatic
bank withdrawal, or a refused credit card or debit card payment. The commissioner may
demand a guaranteed form of payment, including a cashier's check or a money order, as
the only means to replace a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a
monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
commissioner of the premium amount required. The commissioner shall inform applicants
and enrollees of these premium payment options. Premium payment is required before
enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
received before noon are credited the same day. Premium payments received after noon
are credited on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan effective
deleted text begin for deleted text end new text begin the first day of the calendar month following new text end the calendar month for which the
premium was due. Persons disenrolled for nonpayment or who voluntarily terminate
coverage from the program may not reenroll until four calendar months have elapsed.
deleted text begin Persons disenrolled for nonpayment who pay all past due premiums as well as current
premiums due, including premiums due for the period of disenrollment, within 20 days
of disenrollment, shall be reenrolled retroactively to the first day of disenrollment deleted text end new text begin The
commissioner shall waive premiums for coverage provided under this paragraph to
persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b new text end .
Persons disenrolled for nonpayment or who voluntarily terminate coverage from the
program may not reenroll for four calendar months unless the person demonstrates good
cause for nonpayment. Good cause does not exist if a person chooses to pay other family
expenses instead of the premium. The commissioner shall define good cause in rule.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 11.

Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is
amended to read:

Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 deleted text begin and the four-month requirement in subdivision 3 deleted text end , as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.

Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
7, whose income increases above 200 percent of the federal poverty guidelines or 215
percent of the federal poverty guidelines on or after July 1, 2009, new text begin or 300 percent of federal
poverty guidelines on or after July 1, 2010, new text end are no longer eligible for the program and
shall be disenrolled by the commissioner. For persons disenrolled under this subdivision,
MinnesotaCare coverage terminates the last day of the calendar month following the
month in which the commissioner determines that the income of a family or individual
exceeds program income limits.

(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment. The
premium for children remaining eligible under this clause shall be the maximum premium
determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (c) Notwithstanding paragraphs (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $50,000 for the 12-month period
of eligibility.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin The effective date for the amendment to paragraph (a) related
to the four-month requirement is effective January 1, 2009, or upon federal approval,
whichever is later. The effective date for the amendment of paragraph (a) related to the
expansion in eligibility to 300 percent of federal poverty guidelines, and the amendment
to paragraph (c), are effective July 1, 2010.
new text end

Sec. 12.

Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewal deleted text end . Children enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of deleted text begin the four-month requirement described in deleted text end this subdivision.

deleted text begin (c) deleted text end For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

deleted text begin (d) deleted text end new text begin (c) new text end Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

deleted text begin (e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 13.

Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is
amended to read:

Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay to
obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
on the enrollee's monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. new text begin Until
June 30, 2009, new text end the sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the limits for
the medical assistance program for families and children in effect on January 1, 1999, and
proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
8.8 percent. These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on January 1, 1999,
to 275 percent of the federal poverty guidelines for the applicable family size, up to a
family size of five. The sliding fee scale for a family of five must be used for families of
more than five. The sliding fee scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income after enrollment, premiums
shall be adjusted at the time the change in income is reported.

(b) deleted text begin Families deleted text end new text begin Children in families new text end whose gross income is above deleted text begin 275 deleted text end new text begin 300 new text end percent
of the federal poverty guidelines shall pay the maximum premium. The maximum
premium is defined as a base charge for one, two, or three or more enrollees so that if all
MinnesotaCare cases paid the maximum premium, the total revenue would equal the
total cost of MinnesotaCare medical coverage and administration. In this calculation,
administrative costs shall be assumed to equal ten percent of the total. The costs of
medical coverage for pregnant women and children under age two and the enrollees in
these groups shall be excluded from the total. The maximum premium for two enrollees
shall be twice the maximum premium for one, and the maximum premium for three or
more enrollees shall be three times the maximum premium for one.

new text begin (c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
to the affordability scale established in section 62U.08 with the exception that children in
families with income at or below 150 percent of the federal poverty guidelines shall pay a
monthly premium of $4. For purposes of this paragraph, and the affordability standard
under section 62U.09, "minimum" means a monthly premium of $4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later, except that the amendment to paragraph (b) related to the
expansion in eligibility to 300 percent of federal poverty guidelines is effective July 1,
2010, or upon federal approval, whichever is later. The commissioner of human services
shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 14.

Laws 2007, chapter 147, article 5, section 19, the effective date, is amended to
read:

EFFECTIVE DATE.

This section is effective July 1, deleted text begin 2007, or upon federal
approval, whichever is later deleted text end new text begin 2008 new text end .

Sec. 15. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256L.15, subdivision 3, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval of the amendments to Minnesota Statutes, section 256L.15, subdivision 2,
paragraph (c), whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.
new text end

ARTICLE 4

HEALTH INSURANCE PURCHASING AND AFFORDABILITY REFORM

Section 1.

Minnesota Statutes 2007 Supplement, section 62J.495, is amended by
adding a subdivision to read:

new text begin Subd. 3. new text end

new text begin Interoperable electronic health record requirements. new text end

new text begin To meet the
requirements of subdivision 1, hospitals and health care providers must meet the following
criteria when implementing an interoperable electronic health records system within their
hospital system or clinical practice setting.
new text end

new text begin (a) The electronic health record must be certified by the Certification Commission
for Healthcare Information Technology, or its successor. This criterion only applies to
hospitals and health care providers whose practice setting is a practice setting covered
by Certification Commission for Healthcare Information Technology certifications. This
criterion shall be considered met if a hospital or health care provider is using an electronic
health records system that has been certified within the last three years, even if a more
current version of the system has been certified within the three-year period.
new text end

new text begin (b) A health care provider who is a prescriber or dispenser of controlled substances
must have an electronic health record system that meets the requirements of section
62J.497.
new text end

Sec. 2.

new text begin [62J.497] ELECTRONIC PRESCRIPTION DRUG PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For the purposes of this section, the following terms
have the meanings given.
new text end

new text begin (a) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision
30. Dispensing does not include the direct administering of a controlled substance to a
patient by a licensed health care professional.
new text end

new text begin (b) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.
new text end

new text begin (c) "Electronic media" has the same meaning given this term under Code of Federal
Regulations, title 45, part 160.103.
new text end

new text begin (d) "E-prescribing" means the transmission using electronic media, of prescription
or prescription-related information between a prescriber, dispenser, pharmacy benefit
manager, or group purchaser, either directly or through an intermediary, including an
e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions
between the point of care and the dispenser.
new text end

new text begin (e) "Electronic prescription drug program" means a program that provides for
e-prescribing.
new text end

new text begin (f) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
new text end

new text begin (g) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
new text end

new text begin (h) "National Provider Identifier" or "NPI" means the identifier described under
Code of Federal Regulations, title 45, part 162.406.
new text end

new text begin (i) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
new text end

new text begin (j) "NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version 1, Release 0, October 2005.
new text end

new text begin (k) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug
Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide
Version 8, Release 1 (Version 8.1), October 2005.
new text end

new text begin (l) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
new text end

new text begin (m) "Prescriber" means a licensed health care professional who is authorized to
prescribe a controlled substance under section 152.12, subdivision 1.
new text end

new text begin (n) "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
new text end

new text begin (o) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.
new text end

new text begin Subd. 2. new text end

new text begin Requirements for electronic prescribing. new text end

new text begin (a) Effective January 1, 2011,
all providers, group purchasers, prescribers, and dispensers must establish and maintain
an electronic prescription drug program that complies with the applicable standards
in this section for transmitting, directly or through an intermediary, prescriptions and
prescription-related information using electronic media.
new text end

new text begin (b) Nothing in this section requires providers, group purchasers, prescribers, or
dispensers to conduct the transactions described in this section. If transactions described in
this section are conducted, they must be done electronically using the standards described
in this section. Nothing in this section requires providers, group purchasers, prescribers,
or dispensers to electronically conduct transactions that are expressly prohibited by other
sections or federal law.
new text end

new text begin (c) Providers, group purchasers, prescribers, and dispensers must use either HL7
messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
information internally when the sender and the recipient are part of the same legal entity. If
an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
or other applicable standards required by this section. Any pharmacy within an entity
must be able to receive electronic prescription transmittals from outside the entity using
the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
Insurance Portability and Accountability Act (HIPAA) requirement that may require the
use of a HIPAA transaction standard within an organization.
new text end

new text begin (d) Entities transmitting prescriptions or prescription-related information where the
prescriber is required by law to issue a prescription for a patient to a nonprescribing
provider that in turn forwards the prescription to a dispenser are exempt from the
requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or
prescription-related information.
new text end

new text begin Subd. 3. new text end

new text begin Standards for electronic prescribing. new text end

new text begin (a) Prescribers and dispensers
must use the NCPDP SCRIPT Standard for the communication of a prescription or
prescription-related information. The NCPDP SCRIPT Standard shall be used to conduct
the following transactions:
new text end

new text begin (1) get message transaction;
new text end

new text begin (2) status response transaction;
new text end

new text begin (3) error response transaction;
new text end

new text begin (4) new prescription transaction;
new text end

new text begin (5) prescription change request transaction;
new text end

new text begin (6) prescription change response transaction;
new text end

new text begin (7) refill prescription request transaction;
new text end

new text begin (8) refill prescription response transaction;
new text end

new text begin (9) verification transaction;
new text end

new text begin (10) password change transaction;
new text end

new text begin (11) cancel prescription request transaction; and
new text end

new text begin (12) cancel prescription response transaction.
new text end

new text begin (b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
SCRIPT Standard for communicating and transmitting medication history information.
new text end

new text begin (c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and
benefit information.
new text end

new text begin (d) Providers, group purchasers, prescribers, and dispensers must use the national
provider identifier to identify a health care provider in e-prescribing or prescription related
transactions when a health care provider's identifier is required.
new text end

new text begin (e) Providers, group purchasers, prescribers, and dispensers must communicate
eligibility information and conduct health care eligibility benefit inquiry and response
transactions according to the requirements of section 62J.536.
new text end

Sec. 3.

new text begin [62U.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For purposes of this chapter, the terms defined in this
section have the meanings given, unless otherwise specified.
new text end

new text begin Subd. 2. new text end

new text begin Basket or baskets of care. new text end

new text begin "Basket" or "baskets of care" means a
collection of health care services that are paid separately under a fee-for-service system,
but which are ordinarily combined by a provider in delivering a full diagnostic or
treatment procedure to a patient.
new text end

new text begin Subd. 3. new text end

new text begin Clinically effective. new text end

new text begin "Clinically effective" means that the use of a
particular health technology or service improves or prevents a decline in patient clinical
status, as measured by medical condition, survival rates, and other variables, and that the
use of the particular technology or service demonstrates a clinical or outcome advantage
over alternative technologies or services. This definition shall not be used to exclude or
deny technology or treatment necessary to preserve life on the basis of an individual's age
or expected length of life or of the individual's present or predicted disability, degree
of medical dependency, or quality of life.
new text end

new text begin Subd. 4. new text end

new text begin Cost-effective. new text end

new text begin "Cost-effective" means that the economic costs of using
a particular service, device, or health technology to achieve improvement or prevent
a decline in a patient's health outcome are justified given the comparison to both the
economic costs and the improvement or prevention of decline 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 Subd. 5. new text end

new text begin Group purchaser. new text end

new text begin "Group purchaser" has the meaning provided in
section 62J.03.
new text end

new text begin Subd. 6. new text end

new text begin Health plan. new text end

new text begin "Health plan" means a health plan as defined in section
62A.011.
new text end

new text begin Subd. 7. new text end

new text begin Health plan company. new text end

new text begin "Health plan company" has the meaning provided
in section 62Q.01, subdivision 4.
new text end

new text begin Subd. 8. new text end

new text begin Participating provider. new text end

new text begin "Participating provider" means a provider who
has entered into a service agreement with a health plan company.
new text end

new text begin Subd. 9. new text end

new text begin Provider or health care provider. new text end

new text begin "Provider" or "health care provider"
means a health care provider as defined in section 62J.03, subdivision 8.
new text end

new text begin Subd. 10. new text end

new text begin Service agreement. new text end

new text begin "Service agreement" means an agreement, contract,
or other arrangement between a health plan company and a provider under which the
provider agrees that when health services are provided for an enrollee, the provider shall
not make a direct charge against the enrollee for those services or parts of services that are
covered by the enrollee's contract, but shall look to the service plan corporation for the
payment for covered services, to the extent they are covered.
new text end

new text begin Subd. 11. new text end

new text begin State health care program. new text end

new text begin "State health care program" means the
medical assistance, MinnesotaCare, and general assistance medical care programs.
new text end

new text begin Subd. 12. new text end

new text begin Third-party administrator. new text end

new text begin "Third-party administrator" means a
vendor of risk-management services or an entity administering a self-insurance or health
insurance plan under section 60A.23.
new text end

Sec. 4.

new text begin [62U.02] VALUE-BASED BENEFIT SET AND DESIGN.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin By October 15, 2009, the commissioner of health shall
make recommendations to the legislature on the components and design of a value-based
set of health benefits. The commissioner shall convene an advisory committee to assist
in preparing recommendations. Prior to recommending the value-based benefit set
and design, the commissioner and advisory committee shall convene public hearings
throughout the state.
new text end

new text begin Subd. 2. new text end

new text begin Operations of advisory committee. new text end

new text begin The advisory committee shall consist
of no more than 11 members. The members shall be appointed by the commissioner and
must have expertise in benefit design and development in terms of outcomes, actuarial
health care analysis, or knowledge relating to the analysis of the cost impact of coverage
of specified benefits. The commissioner shall convene the first meeting on or before
September 1, 2008, upon the appointment of the initial committee and must meet at least
once a year, and at other times as necessary. The commissioner shall provide office
space, equipment and supplies, and technical support to the advisory committee. In
establishing the benefit set, the committee shall consult with organizations with expertise
in formulating scientifically based practice standards. The advisory committee shall be
governed by section 15.059, except the committee shall not expire.
new text end

new text begin Subd. 3. new text end

new text begin Immunity of liability. new text end

new text begin No member of the advisory committee shall be held
civilly liable for an act or omission by that member if the act or omission was in good faith
and within the scope of the member's responsibilities under this chapter.
new text end

new text begin Subd. 4. new text end

new text begin Benefit set design. new text end

new text begin (a) The value-based set of health benefits must provide
individuals and families with access to a broad range of health care services, including
preventive health care, without incurring severe financial loss as a result of serious illness
or injury. The benefit set must include health care services, procedures, and diagnostic
tests that are scientifically proven to be both clinically effective and cost effective. The
benefit set may require differentiated co-pays and deductibles based upon the clinical
effectiveness and cost effectiveness of a particular health care service. The advisory
committee must consider including cost effective and clinically effective dental care,
mental health services, chemical dependency treatment, vision care, language interpreter
services, emergency transportation, and prescription drugs. The committee shall consider
cultural, ethnic, and religious values and beliefs to ensure that the health care needs of
all Minnesota residents are addressed in the benefit set.
new text end

new text begin (b) The benefit set must identify and include the following services with minimal
or no cost-sharing requirements, if the committee determines that the savings and health
quality improvements associated with broad access are equal to or greater than the cost of
providing the services: preventive services, chronic care coordination, early diagnostic
tests, and outpatient care for asthma, heart disease, diabetes, and depression.
new text end

new text begin (c) The benefit set shall, to the extent possible, be designed to be affordable to
Minnesotans consistent with the affordability standard established in section 62U.09.
new text end

new text begin (d) The benefit design must establish a limited number of maximum cost-sharing
variations based upon deductibles and maximum out-of-pocket costs. There must be no
maximum lifetime benefit.
new text end

new text begin (e) The commissioners of human services and finance shall, to the extent possible,
consider incorporating the benefit design into the state public health care programs and the
state employee group insurance program.
new text end

new text begin (f) The commissioners of health and commerce shall report to the legislature on
necessary changes needed to current mandated benefit sets to incorporate the benefit
design developed under this section.
new text end

new text begin Subd. 5. new text end

new text begin Continued review. new text end

new text begin The commissioner and the committee shall review
the benefit set and design on an ongoing periodic basis and shall adjust the benefit set
and design as necessary, to ensure that the benefit set and design continues to be safe,
effective, and scientifically based.
new text end

Sec. 5.

new text begin [62U.03] HEALTH TECHNOLOGY ASSESSMENT REVIEW.
new text end

new text begin The commissioner of health , in consultation with the Health Advisory Council, the
Institute for Clinical Systems, and practicing health care providers who either use health
technology in their scope of practice or have an expertise in health technology, shall review
the health technology assessments of new and existing health technologies that have been
conducted by existing programs, including but not limited to, the state of Washington's
health technology assessment program and the Medicaid Evidence-Based Decisions
Project for inclusion to the value-based benefit set and design under section 62U.02.
new text end

Sec. 6.

new text begin [62U.04] PAYMENT RESTRUCTURING; INCENTIVE PAYMENTS
BASED ON QUALITY OF CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin (a) The commissioner of health shall develop a
standardized set of measures by which to assess the quality of health care services offered
by health care providers, including health care providers certified as health care homes
under section 256B.0751. Quality measures must be based on medical evidence and be
developed through a process in which providers participate. The measures shall be used
for the quality incentive payment system developed in subdivision 2 and must:
new text end

new text begin (1) include uniform definitions, measures, and forms for submission of data, to the
greatest extent possible;
new text end

new text begin (2) seek to avoid increasing the administrative burden on health care providers;
new text end

new text begin (3) be initially based on existing quality indicators for physician and hospital
services, which are measured and reported publicly by quality measurement organizations
including Minnesota Community Measurement and specialty societies;
new text end

new text begin (4) place a priority on measures of health care outcomes, rather than process
measures, wherever possible; and
new text end

new text begin (5) incorporate measures for primary care, including preventive services, coronary
artery and heart disease, diabetes, asthma, depression, and other measures as determined
by the commissioner.
new text end

new text begin (b) The measures shall be reviewed at least annually by the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Quality incentive payments. new text end

new text begin (a) By July 1, 2009, the commissioner
shall develop a system of quality incentive payments under which providers are eligible
for quality-based payments that are in addition to existing payment levels, based upon
a comparison of provider performance against specified targets, including improvement
over time. The targets must be based upon and consistent with the quality measures
established under subdivision 1.
new text end

new text begin (b) To the extent possible, the payment system must adjust for variations in patient
population, in order to reduce incentives to health care providers to avoid high-risk
patients or populations.
new text end

new text begin (c) The requirements of section 62Q.101 do not apply under this incentive payment
system.
new text end

new text begin Subd. 3. new text end

new text begin Quality transparency. new text end

new text begin The commissioner shall establish standards for
measuring health outcomes, establish a system for risk adjusting quality measures, and
issue annual public reports on provider quality beginning July 1, 2010. By January 1,
2010, physician clinics and hospitals shall submit standardized electronic information
on the outcomes and processes associated with patient care to the commissioner or the
commissioner's designee. In addition to measures of care processes and outcomes, the
report may include other measures designated by the commissioner, including, but not
limited to, care infrastructure and patient satisfaction. The commissioner shall ensure
that any quality data reporting requirements established under this subdivision are not
duplicative of publicly reported, community-wide quality reporting activities currently
under way in Minnesota. Nothing in this subdivision is intended to replace or duplicate
current privately supported activities related to quality measurement and reporting in
Minnesota.
new text end

new text begin Subd. 4. new text end

new text begin Contracting. new text end

new text begin The commissioner may contract with a private entity or
consortium of private entities to complete the tasks in subdivisions 1, 2, and 3. The private
entity or consortium must be nonprofit and have governance that includes representatives
from the following stakeholder groups: health care providers, health plan companies,
consumers, employers or other health care purchasers, and state government. No one
stakeholder group shall have a majority of the votes on any issue or hold extraordinary
powers not granted to any other governance stakeholder.
new text end

new text begin Subd. 5. new text end

new text begin Implementation. new text end

new text begin (a) By January 1, 2010, health plan companies shall use
the standardized quality measures established under this section and shall not require
providers to use and report health plan company-specific quality and outcome measures.
new text end

new text begin (b) By July 1, 2010, the commissioner of human services shall implement this
incentive payment system for all enrollees in state health care programs consistent with
relevant state and federal statute and rule.
new text end

new text begin (c) By July 1, 2010, the commissioner of finance shall implement this incentive
payment system for all participants in the state employee group insurance program.
new text end

new text begin (d) By July 1, 2010, all health plan company incentive based performance payment
systems shall comply with subdivision 2 for all participating providers.
new text end

Sec. 7.

new text begin [62U.05] PAYMENT RESTRUCTURING; CARE COORDINATION
PAYMENTS.
new text end

new text begin By July 1, 2010, health plan companies shall integrate health care homes into
their provider networks and shall develop a payment system that provides per-person
care coordination payments to health care providers for providing care coordination
services and directly managing onsite or employing care coordinators for their members
who choose to enroll in health care homes certified by the commissioners of health and
human services under section 256B.0751. Health plan companies shall develop payment
conditions and terms for the care coordination fee for health care homes participating in
their network in a manner that is consistent with the system developed under section
256B.0751. Nothing in this section shall restrict the ability of health plan companies to
selectively contract with health care providers, including health care homes.
new text end

Sec. 8.

new text begin [62U.06] PAYMENT REFORM TO REDUCE HEALTH CARE COSTS
AND IMPROVE QUALITY.
new text end

new text begin Subdivision 1. new text end

new text begin Development of uniform standards. new text end

new text begin The commissioner of health
shall develop the uniform standards identified in this section needed to implement
on a broad scale innovative payment reform that rewards quality and efficiency. The
development of the standards must be completed by January 1, 2010.
new text end

new text begin Subd. 2. new text end

new text begin Calculation of health care costs and quality. new text end

new text begin The commissioner shall
develop a method of calculating providers' relative cost of care, defined as a measure of
health care spending including resource use and unit prices, and relative quality of care. In
developing this method, the commissioner must address the following issues:
new text end

new text begin (1) provider attribution of costs and quality;
new text end

new text begin (2) appropriate adjustment for outlier or catastrophic cases;
new text end

new text begin (3) appropriate risk adjustment to reflect differences in the demographics and health
status across provider patient populations, using generally accepted and transparent risk
adjustment methodologies;
new text end

new text begin (4) specific types of providers that should be included in the calculation;
new text end

new text begin (5) specific types of services that should be included in the calculation;
new text end

new text begin (6) appropriate adjustment for variation in payment rates;
new text end

new text begin (7) the appropriate provider level for analysis;
new text end

new text begin (8) payer mix adjustments, including variation across providers in the percentage of
revenue received from government programs; and
new text end

new text begin (9) other factors that the commissioner determines are needed to ensure validity
and comparability of the analysis.
new text end

new text begin Subd. 3. new text end

new text begin Provider peer grouping. new text end

new text begin (a) The commissioner shall develop a peer
grouping system for providers based on a measure that incorporates both provider
risk-adjusted cost of care and quality of care for specific conditions as determined by the
commissioner. In developing this system, the commissioner shall consult and coordinate
with health care providers, health plan companies, state agencies, and organizations that
work to improve health care quality in Minnesota. However, in the final development of
this peer grouping system, the commissioner shall not contract with any private entity,
organization, or consortium of entities that has or will have a direct financial interest in the
outcome of this system.
new text end

new text begin (b) Beginning June 1, 2010, the commissioner shall disseminate information to
providers on their cost of care, resource use, quality of care, and the results of the grouping
developed under this subdivision in comparison to an appropriate peer group. Any
analyses or reports that identify providers may only be published after the provider has
been provided the opportunity by the commissioner to review the underlying data and
submit comments. The provider shall have 21 days to review the data for accuracy.
new text end

new text begin (c) The commissioner shall establish an appeals process to resolve disputes from
providers regarding the accuracy of the data used to develop analyses or reports.
new text end

new text begin (d) Beginning September 1, 2010, the commissioner shall, no less than annually,
publish information on providers' cost, quality, and the results of the peer grouping
process. The results that are published must be on a risk-adjusted basis.
new text end

new text begin Subd. 4. new text end

new text begin Encounter data. new text end

new text begin (a) Beginning July 1, 2009, and every six months
thereafter, all health plan companies and third-party administrators shall submit encounter
data to a private entity designated by the commissioner of health. The data shall be
submitted in a form and manner specified by the commissioner subject to the following
requirements:
new text end

new text begin (1) the data must be de-identified data as described under the Code of Federal
Regulations, title 45, section 164.514;
new text end

new text begin (2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care home; and
new text end

new text begin (3) except for the identifier described in clause (2), the data must not include
information that is not included in a health care claim or equivalent encounter information
transaction that is required under section 62J.536.
new text end

new text begin (b) The commissioner, or the commissioner's designee, shall only use the data
submitted under paragraph (a) for the purpose of carrying out its responsibilities in this
section, and must maintain the data that it receives according to the provisions of this
section.
new text end

new text begin (c) Data on providers collected under this subdivision are private data on individuals
or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary
data in section 13.02, subdivision 19, summary data prepared under this subdivision
may be derived from nonpublic data. The commissioner shall establish procedures and
safeguards to protect the integrity and confidentiality of any data that it maintains.
new text end

new text begin (d) The commissioner, or the commissioner's designee, shall not publish analyses or
reports that identify, or could potentially identify, individual patients.
new text end

new text begin Subd. 5. new text end

new text begin Pricing data. new text end

new text begin (a) Beginning July 1, 2009, and annually on January 1
thereafter, all health plan companies and third-party administrators shall submit data
on their contracted prices with health care providers to a private entity designated by
the commissioner of health for the purposes of performing the analyses required under
this subdivision. The data shall be submitted in the form and manner specified by the
commissioner of health.
new text end

new text begin (b) The commissioner shall only use the data submitted under this subdivision for
the purpose of carrying out its responsibilities under this section.
new text end

new text begin (c) Data collected under this subdivision are nonpublic data as defined in section
13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19,
summary data prepared under this section may be derived from nonpublic data. The
commissioner shall establish procedures and safeguards to protect the integrity and
confidentiality of any data that it maintains.
new text end

new text begin Subd. 6. new text end

new text begin Contracting. new text end

new text begin The commissioner may contract with a private entity
or consortium of entities to develop the standards. The private entity or consortium
must be nonprofit and have governance that includes representatives from the following
stakeholder groups: health care providers, health plans, hospitals, consumers, employers
or other health care purchasers, and state government. The entity or consortium must
ensure that the representatives of stakeholder groups in the aggregate reflect all geographic
areas of the state. No one stakeholder group shall have a majority of the votes on any issue
or hold extraordinary powers not granted to any other governance stakeholder.
new text end

new text begin Subd. 7. new text end

new text begin Provider innovation to reduce health care costs and improve quality.
new text end

new text begin (a) Nothing in this section shall prohibit group purchasers and health care providers,
upon mutual agreement, from entering into arrangements that establish package prices
for a comprehensive set of services or separately for the cost of care for specific health
conditions in addition to the baskets of care established in section 62U.07, in order to give
providers the flexibility to innovate on ways to reduce health care costs while improving
overall quality of care and health outcomes.
new text end

new text begin (b) The commissioner of health may convene working groups of private sector
payers and health care providers to discuss and develop new strategies for reforming
health care payment systems to promote innovative care delivery that reduces health
care costs and improves quality.
new text end

new text begin Subd. 8. new text end

new text begin Uses of information. new text end

new text begin (a) By January 1, 2011:
new text end

new text begin (1) the commissioner of finance shall use the information and methods developed
under subdivision 3 to strengthen incentives for members of the state employee group
insurance program to use high-quality, low-cost providers;
new text end

new text begin (2) the commissioner of human services shall use the information and methods
developed under subdivision 3 to establish a payment system that:
new text end

new text begin (i) rewards high-quality, low-cost providers;
new text end

new text begin (ii) creates enrollee incentives to receive care from high-quality, low-cost providers;
and
new text end

new text begin (iii) fosters collaboration among providers to reduce cost shifting from one part of
the health continuum to another;
new text end

new text begin (3) all political subdivisions, as defined in section 13.02, subdivision 11, that offer
health benefits to their employees must offer plans that differentiate providers on their
cost and quality performance and create incentives for members to use better-performing
providers;
new text end

new text begin (4) all health plan companies shall use the information and methods developed
under subdivision 3 to develop products that encourage consumers to use high-quality,
low-cost providers; and
new text end

new text begin (5) health plan companies that issue health plans in the individual market or the small
employer market must offer at least one health plan that uses the information developed
under subdivision 3 to establish financial incentives for consumers to choose high-quality,
low-cost providers through enrollee cost-sharing or selective provider networks.
new text end

new text begin (b) By January 1, 2011, the commissioner of health shall report to the governor
and the legislature on recommendations to encourage health plan companies to promote
widespread adoption of products that encourage the use of high-quality, low-cost providers.
The commissioner's recommendations may include tax incentives, public reporting of
health plan performance, regulatory incentives or changes, and other strategies.
new text end

new text begin (c) The commissioner of health shall consult with an advisory group comprised of
employers and consumers to utilize the cost and provider quality information developed
under subdivision 3 to identify ways to improve overall health care costs and quality for
residents of Minnesota.
new text end

Sec. 9.

new text begin [62U.07] PROVIDER PRICING FOR BASKETS OF CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment of definitions. new text end

new text begin (a) The commissioner of health shall
establish uniform definitions for baskets of care beginning with a minimum of 15 baskets
of care. In selecting health conditions for which baskets of care should be defined, the
commissioner shall consider coronary artery and heart disease, diabetes, asthma, and
depression. In selecting health conditions, the commissioner shall also consider the
prevalence of the health conditions, the cost of treating the health conditions, and the
potential for innovations to reduce cost and improve quality resulting from establishing a
basket of care for a specific health condition.
new text end

new text begin (b) The commissioner shall convene one or more work groups to assist in
establishing these definitions. Each work group shall include members appointed by
statewide associations representing relevant health care providers and health plan
companies, and organizations that work to improve health care quality in Minnesota.
new text end

new text begin (c) The baskets of care shall incorporate a patient-directed, decision-making support
model.
new text end

new text begin (d) The commissioner shall submit recommendations to the Legislative Commission
on Health Care Access on establishing a uniform definition of a basket of total cost of care.
new text end

new text begin Subd. 2. new text end

new text begin Package prices. new text end

new text begin (a) Beginning January 1, 2010, health care providers may
establish package prices for the baskets of care defined under subdivision 1.
new text end

new text begin (b) Beginning January 1, 2010, no health care provider or group of providers that has
established a package price for a basket of care under this section shall vary the payment
amount that the provider accepts as full payment for a health care service based upon the
identity of the payer, upon a contractual relationship with a payer, upon the identity of
the patient, or upon whether the patient has coverage through a group purchaser. This
paragraph applies only to health care services provided to Minnesota residents or to
non-Minnesota residents who obtain health insurance through a Minnesota employer. This
paragraph does not apply to a variation based upon a payer being a governmental entity,
to workers' compensation, or no-fault automobile insurance payments. This paragraph
does not affect the right of a provider to provide charity care or care for a reduced price
due to financial hardship of the patient or due to the patient being a relative or friend
of the provider.
new text end

new text begin Subd. 3. new text end

new text begin Quality measurements for baskets of care. new text end

new text begin (a) The commissioner shall
establish quality measurements for the defined baskets of care by December 31, 2009.
The commissioner may contract with an organization that works to improve health care
quality to make recommendations about the use of existing measures or establishing new
measures where no measures currently exist.
new text end

new text begin (b) Beginning July 1, 2010, the commissioner shall publish comparative price
and quality information on the baskets of care in a manner that is easily accessible and
understandable to the public, as this information becomes available.
new text end

Sec. 10.

new text begin [62U.08] COORDINATION; LEGISLATIVE OVERSIGHT ON
PAYMENT RESTRUCTURING.
new text end

new text begin Subdivision 1. new text end

new text begin Coordination. new text end

new text begin In carrying out the responsibilities of this chapter, the
commissioner of health shall ensure that the activities and data collection are implemented
in an integrated and coordinated manner that avoids unnecessary duplication of effort.
To the extent possible, the commissioner shall use existing data sources and implement
methods to streamline data collection in order to reduce public and private sector
administrative costs.
new text end

new text begin Subd. 2. new text end

new text begin Legislative oversight. new text end

new text begin Beginning December 1, 2008, the commissioner
of health shall submit to the Legislative Commission on Health Care Access periodic
progress reports on the implementation of this chapter and sections 256B.0751 to
256B.0753 that includes, but is not limited to, the following:
new text end

new text begin (1) the standardized set of measures that are to be used to access the quality of health
care services offered by health care providers developed under section 62U.04;
new text end

new text begin (2) the identification of the evidence supporting each measure developed under
section 62U.04 as an effective method of improving the quality of patient care;
new text end

new text begin (3) the contract terms and the identity of the consortium if the commissioner
contracts with a private entity or consortium of private entities as permitted under sections
62U.04 and 62U.06;
new text end

new text begin (4) methodology for peer grouping of providers under section 62U.06, subdivision 3;
new text end

new text begin (5) methodology for calculating providers' relative cost of care under section
62U.06, subdivision 2; and
new text end

new text begin (6) the uniform definitions of baskets of care under section 62U.07.
new text end

Sec. 11.

new text begin [62U.09] AFFORDABILITY STANDARD.
new text end

new text begin Subdivision 1. new text end

new text begin Definition of affordability. new text end

new text begin For purposes of this section, coverage is
"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an
individual or family for health coverage does not exceed the applicable percentage of the
individual or family's gross monthly income specified in subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Affordability standard. new text end

new text begin The following affordability standard is
established for individuals and households with gross family incomes of 400 percent
of the federal poverty guidelines or less:
new text end

new text begin Federal Poverty Guideline Range new text end	new text begin Percent of Average Gross Monthly Income new text end
new text begin 0-45% new text end	new text begin minimum new text end
new text begin 46-54% new text end	new text begin 1.1% new text end
new text begin 55-81% new text end	new text begin 1.4% new text end
new text begin 82-109% new text end	new text begin 1.9% new text end
new text begin 110-136% new text end	new text begin 2.6% new text end
new text begin 137-164% new text end	new text begin 3.4% new text end
new text begin 165-191% new text end	new text begin 4.4% new text end
new text begin 192-219% new text end	new text begin 5.2% new text end
new text begin 220-248% new text end	new text begin 5.9% new text end
new text begin 249-274% new text end	new text begin 6.5% new text end
new text begin 275-300% new text end	new text begin 7.0% new text end
new text begin 301-325% new text end	new text begin 7.7% new text end
new text begin 326-350% new text end	new text begin 8.4% new text end
new text begin 351-375% new text end	new text begin 9.2% new text end
new text begin 376-400% new text end	new text begin 10.0% new text end

new text begin Subd. 3. new text end

new text begin Application. new text end

new text begin The affordability standard in this section shall apply only
to subsidies under the MinnesotaCare program and the employee subsidy program
established under section 62U.10. Nothing in this section shall be construed to limit or
restrict the percentage of premiums, deductibles, and other out-of-pocket costs paid by an
individual or family in the private commercial health care coverage market.
new text end

Sec. 12.

new text begin [62U.10] EMPLOYEE SUBSIDIES FOR HEALTH COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Development of subsidy program. new text end

new text begin The commissioner of health, in
coordination with the commissioner of human services, shall develop a plan and submit
recommendations to the legislature by January 15, 2010, for a subsidy program for
eligible individuals and employees with access to employer-subsidized health coverage.
The plan may include direct subsidies or tax credits and deductions, including refundable
tax credits, or a combination. For purposes of this section, employer-subsidized health
coverage has the meaning provided in section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Eligible employees and dependents; incomes not exceeding 300 percent
of federal poverty guidelines. new text end

new text begin In order to be eligible for a subsidy under this plan, an
employee or dependent with a gross household income that does not exceed 300 percent
of the federal poverty guidelines must:
new text end

new text begin (1) be covered by employer-subsidized health coverage, as defined in section
256L.07, subdivision 2, paragraph (c), that meets the value-based benefit set and design
requirements established under section 62U.02; and
new text end

new text begin (2) meet all eligibility criteria for the MinnesotaCare program established under
chapter 256L, except for the requirements related to:
new text end

new text begin (i) no access to employer-subsidized coverage under section 256L.07, subdivision
2; and
new text end

new text begin (ii) no other health coverage under section 256L.07, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Eligible individuals, employees and dependents; incomes greater than
300 percent but not exceeding 400 percent of federal poverty guidelines. new text end

new text begin In order to be
eligible for a subsidy under this plan, an individual, employee, or dependent with a gross
household income that is greater than 300 percent but does not exceed 400 percent of the
federal poverty guidelines must:
new text end

new text begin (1) purchase or be covered by health coverage that meets the value-based benefit set
and design requirements established under section 62U.02; and
new text end

new text begin (2) meet all eligibility criteria for the MinnesotaCare program established under
chapter 256L, except for the requirements related to:
new text end

new text begin (i) no access to employer-subsidized coverage under section 256L.07, subdivision 2;
new text end

new text begin (ii) no other health coverage under section 256L.07, subdivision 3; and
new text end

new text begin (iii) gross household income under section 256L.04, subdivisions 1 and 7.
new text end

new text begin Subd. 4. new text end

new text begin Amount of subsidy. new text end

new text begin The subsidy included in this plan must equal the
amount the individual or employee is required to pay for health coverage for the employee
and any dependents, including premiums, deductibles, and other cost sharing, minus an
amount based on the affordability standard specified in section 62U.09. The maximum
subsidy must not exceed the amount of the subsidy that would have been provided under
the MinnesotaCare program, if the individual or employee and any dependents were
eligible for that program.
new text end

new text begin Subd. 5. new text end

new text begin Payment of subsidy. new text end

new text begin The subsidy amount under this plan for an individual
or employee and any dependents to the individual's or employee's health plan company,
shall be credited toward the individual's or employee's share of premium. Any additional
amount paid to the individual's or employee's health plan company that exceeds the
individual's or employee's share of premium must be credited first toward the individual's
or employee's deductible and then toward any other cost-sharing obligation.
new text end

Sec. 13.

new text begin [62U.11] PROJECTED AND ACTUAL HEALTH CARE SPENDING.
new text end

new text begin Subdivision 1. new text end

new text begin Projected spending baseline. new text end

new text begin (a) The commissioner of health shall
calculate the annual projected total health care spending for the state and establish a health
care spending baseline beginning for the calendar year 2008 and for the next ten years
based on the annual projected growth in spending.
new text end

new text begin (b) In establishing the health care spending baseline, the commissioner shall use the
Center for Medicare and Medicaid Services forecast for total growth in national health
care expenditures, and adjust this forecast to reflect the demographics, health status, and
other factors deemed necessary by the commissioner. The commissioner shall contract
with an actuarial consultant to make recommendations as to the adjustments needed to
specifically reflect projected spending for Minnesota residents.
new text end

new text begin (c) On an annual basis, the commissioner may adjust the projected baseline as
necessary to reflect any updated federal projections or account for unanticipated changes
in federal policy.
new text end

new text begin (d) Medicare and long-term care spending must not be included in the calculations
required under this section.
new text end

new text begin Subd. 2. new text end

new text begin Actual spending. new text end

new text begin By February 15 of each year, beginning February
15, 2010, the commissioner shall determine the actual private and public health care
expenditures for the calendar year two years prior to the current calendar year based on
data collected under chapter 62J and shall determine the difference between the projected
spending as determined under subdivision 1 and the actual spending for that year. The
actual spending must be certified by an independent actuarial consultant.
new text end

new text begin Subd. 3. new text end

new text begin Publication of spending. new text end

new text begin By February 15 of each year, beginning
February 15, 2010, the commissioner shall publish in the State Register the projected
spending baseline, including any adjustments, and the actual spending for the calendar
year two years prior to the current calendar year.
new text end

Sec. 14.

new text begin [62U.12] HEALTH CARE REFORM REVIEW COUNCIL.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Health Care Reform Review Council is
established for the purpose of periodically reviewing the progress of implementation of
this chapter and sections 256B.0751 to 256B.0753.
new text end

new text begin Subd. 2. new text end

new text begin Members. new text end

new text begin (a) The Health Care Reform Review Council shall consist of
ten members who are appointed as follows:
new text end

new text begin (1) two members appointed by the Minnesota Medical Association, at least one
of whom must represent rural physicians;
new text end

new text begin (2) one member appointed by the Minnesota Nurses Association;
new text end

new text begin (3) two members appointed by the Minnesota Hospital Association, at least one of
whom must be a rural hospital administrator;
new text end

new text begin (4) one member appointed by the Minnesota Academy of Physician Assistants;
new text end

new text begin (5) one member appointed by the Minnesota Business Partnership;
new text end

new text begin (6) one member appointed by the Minnesota Chamber of Commerce;
new text end

new text begin (7) one member appointed by the SEIU Minnesota State Council; and
new text end

new text begin (8) one member appointed by the AFL-CIO.
new text end

new text begin (b) If a member is no longer able or eligible to participate, a new member shall be
appointed by the entity that appointed the outgoing member.
new text end

new text begin Subd. 3. new text end

new text begin Operations of council. new text end

new text begin (a) The commissioner of health shall convene the
first meeting of the council on or before January 15, 2009, following the initial appointment
of the members and the advisory council must meet at least quarterly thereafter.
new text end

new text begin (b) The council is governed by section 15.059, except that members shall not receive
per diems and the council does not expire.
new text end

new text begin (c) The commissioner of health shall provide staff, administrative support, and
office space to the council.
new text end

new text begin Subd. 4. new text end

new text begin Responsibilities of council. new text end

new text begin The council shall periodically review the
implementation of this chapter and sections 256B.0571 to 256B.0573, including but
not limited to:
new text end

new text begin (1) the development and implementation of certification, process, outcome, and
quality standards for health care homes;
new text end

new text begin (2) development and implementation of payment restructuring and payment reform
under sections 62U.04, 62U.05, 62U.06, and 62U.07; and
new text end

new text begin (3) development of the plan and recommendations for providing subsidies to
employees for health coverage under section 62U.10.
new text end

Sec. 15.

new text begin [62U.13] SECTION 125 PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (a) "Employee" means an employee currently on an employer's payroll other than a
retiree or disabled former employee.
new text end

new text begin (b) "Employer" means a person, firm, corporation, partnership, association, business
trust, or other entity employing one or more persons, including a political subdivision of
the state, filing payroll tax information on the employed person or persons.
new text end

new text begin (c) "Section 125 Plan" means a cafeteria or premium-only plan under section 125 of
the Internal Revenue Code that allows employees to pay for health coverage premiums
with pretax dollars.
new text end

new text begin Subd. 2. new text end

new text begin Section 125 Plan requirement. new text end

new text begin (a) Effective July 1, 2009, all employers
with 11 or more current full-time equivalent employees in this state shall establish and
maintain a Section 125 Plan to allow their employees to purchase individual market or
employer-based health coverage with pretax dollars. Nothing in this section requires
employers to offer or purchase group health coverage for their employees. The following
employers are exempt from the Section 125 Plan requirement:
new text end

new text begin (1) employers that offer a health plan as defined in section 62A.011, subdivision
3, that is group coverage;
new text end

new text begin (2) employers that provide self-insurance as defined in section 62E.02; or
new text end

new text begin (3) employers that have no employees who are eligible to participate in a Section
125 Plan.
new text end

new text begin (b) Notwithstanding paragraph (a), an employer that has been certified by a licensed
insurance producer as having received education and information on the benefits and
advantages of offering Section 125 Plans is not required to establish a Section 125 Plan
and may opt out of the requirement to establish a Section 125 Plan by sending a form to
the commissioner of commerce. The commissioner of commerce shall create a simple
check-box form for employers to opt out. The commissioner of commerce shall make the
form available through their Web site by April 1, 2009.
new text end

new text begin Subd. 3. new text end

new text begin Employer requirements. new text end

new text begin (a) Employers that do not offer a health plan as
defined in section 62A.011, subdivision 3, that is group coverage and are required to offer
or choose to offer a Section 125 Plan shall:
new text end

new text begin (1) allow employees to purchase an individual market health plan for themselves
and their dependents;
new text end

new text begin (2) allow employees to choose any insurance producer licensed in accident and health
insurance under chapter 60K to assist them in purchasing an individual market health plan;
new text end

new text begin (3) upon an employee's request, deduct premium amounts on a pretax basis in an
amount not to exceed an employee's wages, and remit these employee payments to the
health plan; and
new text end

new text begin (4) provide written notice to employees that individual market health plans purchased
by employees through payroll deduction are not employer-sponsored or administered.
new text end

new text begin (b) Employers shall be held harmless from any and all claims related to the
individual market health plans purchased by employees under a Section 125 Plan.
new text end

Sec. 16.

new text begin [256B.0751] PAYMENT REFORM.
new text end

new text begin Subdivision 1. new text end

new text begin Quality incentive payments. new text end

new text begin The commissioner of human services
shall implement quality incentive payments as required under section 62U.04. This does
not limit the ability of the commissioner of human services to establish by contract and
monitor, as part of its quality assurance obligations for state health care programs, outcome
and performance measures for nonmedical services and health issues likely to occur in
low-income populations or racial or cultural groups disproportionately represented in
state health care program enrollment, that would likely be underrepresented when using
traditional measures that are based on longer-term enrollment.
new text end

new text begin Subd. 2. new text end

new text begin Payment reform. new text end

new text begin The commissioner of human services shall establish
a payment system to reduce health care costs and improve quality as required under
section 62U.06.
new text end

Sec. 17. new text begin HIGH-DEDUCTIBLE HEALTH PLAN OPTION.
new text end

new text begin The commissioner of finance shall consider including an option that is compatible
with the definition of a high-deductible health plan in section 223 of the Internal Revenue
Code in the health insurance benefit plans offered under the managerial plan in Minnesota
Statutes, section 43A.18, subdivision 3.
new text end

Sec. 18. new text begin STUDY OF UNIFORM CLAIMS REVIEW PROCESS.
new text end

new text begin The commissioner of health shall establish a work group including representatives
of the Minnesota Hospital Association, Minnesota Medical Association, and Minnesota
Council of Health Plans to make recommendations on the potential for reducing claims
adjudication costs of health care providers and health plan companies by adopting more
uniform payment methods, and the potential impact of establishing uniform prices that
would replace current prices negotiated individually by providers with separate payers.
The work group shall make its recommendations to the commissioner by January 1, 2010,
and shall identify specific action steps needed to achieve the recommendations.
new text end

ARTICLE 5

APPROPRIATIONS

Section 1. new text begin SUMMARY OF APPROPRIATIONS. new text end

new text begin The amounts shown in this section summarize direct appropriations, by fund, made
in this article.
new text end

				new text begin 2009 new text end		new text begin Total new text end
new text begin General Fund new text end			new text begin $ new text end	new text begin 403,000 new text end	new text begin $ new text end	new text begin 403,000 new text end
new text begin Health Care Access Fund new text end				new text begin 12,883,000 new text end		new text begin 12,883,000 new text end
new text begin Total new text end			new text begin $ new text end	new text begin 13,286,000 new text end	new text begin $ new text end	new text begin 13,286,000 new text end

Sec. 2. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS. new text end

new text begin The sums shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, subtracted from the appropriations in Laws 2007, chapter 147,
article 19, or other law to the agencies and for the purposes specified in this article. The
appropriations are from the general fund, or another named fund, and are available for
the fiscal year indicated for each purpose. The figure "2009" used in this article means
that the addition to or subtraction from the appropriation listed under it is available for the
fiscal year ending June 30, 2009.
new text end

			new text begin APPROPRIATIONS new text end
			new text begin Available for the Year new text end
			new text begin Ending June 30 new text end
						new text begin 2009 new text end

Sec. 3. new text begin HUMAN SERVICES new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 6,175,000 new text end

new text begin Appropriations by Fund new text end
		new text begin 2009 new text end
new text begin General new text end		new text begin 1,227,000 new text end
new text begin Health Care Access new text end		new text begin 4,948,000 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end new text begin Children and Economic Assistance Management new text end

new text begin Health Care Access new text end

new text begin 6,000 new text end

new text begin This is a onetime appropriation.
new text end

new text begin Subd. 3. new text end new text begin Basic Health Care Grants new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) MinnesotaCare Grants new text end

new text begin Health Care Access new text end

new text begin 1,301,000 new text end

new text begin (b) Other Health Care Grants new text end

new text begin Health Care Access new text end

new text begin 200,000 new text end

new text begin new text begin Primary Care Physician Rate Increases. new text end
(1) Of the general fund appropriation,
$200,000 is to the commissioner for the
medical assistance reimbursement rate
increase described in Minnesota Statutes,
section 256B.766.
new text end

new text begin (2) Notwithstanding Minnesota Statutes,
section 295.581, the commissioner of finance
shall reimburse the medical assistance
general fund account from the health
care access fund the amount of general
fund expenditures for this activity. The
amount reimbursed under this paragraph is
appropriated to the commissioner.
new text end

new text begin new text begin Subsidies for Employer-Subsidized Health
Coverage. new text end For the biennium beginning July
1, 2009, base level funding for the subsidy
program described in Minnesota Statutes,
section 62U.10, shall be $20,000,000 from
the health care access fund for the first year
and $35,000,000 from the health care access
fund for the second year.
new text end

new text begin Base Adjustment. new text end new text begin The health care access
fund base is increased by $3,000,000 in fiscal
year 2010 and increased by $5,000,000 in
fiscal year 2011.
new text end

new text begin Subd. 4. new text end new text begin Health Care Management new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Health Care Policy Administration new text end

new text begin General new text end		new text begin 1,008,000 new text end
new text begin Health Care Access new text end		new text begin 282,000 new text end

new text begin Base Adjustment. new text end new text begin The health care access
fund is decreased by $89,000 in fiscal year
2010 and decreased by $272,000 in fiscal
year 2011.
new text end

new text begin Base Adjustment. new text end new text begin The general fund base
is decreased by $80,000 in both fiscal years
2010 and 2011.
new text end

new text begin Department of Education Computer
System. new text end new text begin $50,000 is from the health care
access fund for the commissioner to enter
into an agreement with the Department
of Education for the modification of the
department's computer system to implement
Minnesota Statutes, section 124D.1115. This
is a onetime appropriation.
new text end

new text begin new text begin Public dental coverage program study. new text end (1)
Of the health care access fund appropriation,
$50,000 in fiscal year 2009 is for the
commissioner of human services to
undertake a study to determine whether
alternative approaches to offering dental
coverage to public program enrollees would
result in:
new text end

new text begin (i) improved access to dental care;
new text end

new text begin (ii) cost savings to providers and the
department; and
new text end

new text begin (iii) improved quality and outcomes of care.
new text end

new text begin Alternatives considered must include moving
to a single dental plan administrator, retaining
the current model, and other innovative
approaches. Issues relating to chronic disease
management, medical and dental interface,
plan payment approaches, and provider
payment should also be addressed. The report
must make a recommendation on whether
to alter the current approach to contracting
for dental services, and include a detailed
plan on how to implement any changes. The
commissioner shall consult with dentists,
safety net dental providers, dental plans,
health plans and county-based purchasing
organizations, patients and advocates, and
other interested parties in developing their
findings and recommendations.
new text end

new text begin (2) By December 15, 2008, the commissioner
of human services shall report findings and
recommendations to the chairs of the house
of representatives and senate committees
having jurisdiction over health and human
services policy and finance.
new text end

new text begin (b) Health Care Operations new text end

new text begin General new text end		new text begin 219,000 new text end
new text begin Health Care Access new text end		new text begin 2,355,000 new text end

new text begin This is a onetime appropriation.
new text end

new text begin Incentive Program and Outreach Grants.
Of the appropriation for the Minnesota health
care outreach program in Laws 2007, chapter
147, article 19, section 3, subdivision 7,
paragraph (b):
new text end

new text begin (1) $400,000 in fiscal year 2009 from the
general fund and $200,000 in fiscal year 2009
from the health care access fund are for the
incentive program under Minnesota Statutes,
section 256.962, subdivision 5. For the
biennium beginning July 1, 2009, base level
funding for this activity shall be $360,000
from the general fund and $160,000 from the
health care access fund; and
new text end

new text begin (2) $100,000 in fiscal year 2009 from the
general fund and $50,000 in fiscal year 2009
from the health care access fund are for the
outreach grants under Minnesota Statutes,
section 256.962, subdivision 2. For the
biennium beginning July 1, 2009, base level
funding for this activity shall be $90,000
from the general fund and $40,000 from the
health care access fund.
new text end

new text begin new text begin Outreach Funding. new text end (1) Of the health care
access fund appropriation, $100,000 is for
the incentive program under Minnesota
Statutes, section 256.962, subdivision 5.
This is in addition to the base level fund
for the biennium beginning July 1, 2009.
For the fiscal year beginning July 1, 2011,
appropriations for this activity shall be from
the health savings reinvestment fund.
new text end

new text begin (2) Notwithstanding Minnesota Statutes,
section 295.581, the commissioner of finance
shall reimburse the medical assistance
general fund account from the health care
access fund by $701,000 in fiscal year 2010
and $1,527,000 in fiscal year 2011 for the
cost to the general fund for the increase in
enrollment to the medical assistance program
for families with children due to the outreach
efforts.
new text end

new text begin Base Adjustment. new text end new text begin The health care access
fund base is decreased by $387,000 in fiscal
year 2010 and increased by $642,000 in
fiscal year 2011.
new text end

new text begin Subd. 5. new text end new text begin Continuing Care Management new text end

new text begin Health Care Access new text end

new text begin 804,000 new text end

new text begin new text begin Long-Term Care Worker Health Coverage
Study. new text end (a) Of the health care access
fund appropriation, $804,000 is for the
commissioner to study and report to the
legislature by December 15, 2008, with
recommendations for a rate increase to
long-term care employers dedicated to the
purchase of employee health insurance in
the private market. The commissioner shall
collect necessary actuarial data, employment
data, current coverage data, and other needed
information.
new text end

new text begin (b) The commissioner shall develop cost
estimates for three levels of insurance
coverage for long-term care workers:
new text end

new text begin (1) the coverage provided to state employees;
new text end

new text begin (2) the coverage provided to MinnesotaCare
enrollees; and
new text end

new text begin (3) the benefits provided under an "average"
private market insurance product, but with a
deductible limited to $100 per person.
new text end

new text begin Premium cost sharing, waiting periods for
eligibility, definitions of full- and part-time
employment, and other parameters under the
three options must be identical to those under
the state employees' health plan.
new text end

new text begin (c) For purposes of this section, a long-term
care worker is a person employed by a
nursing facility, an intermediate care facility
for persons with developmental disabilities,
or a service provider that:
new text end

new text begin (1) is eligible under Laws 2007, chapter 147,
article 7, section 71; and
new text end

new text begin (2) provides long-term care services.
new text end

new text begin The commissioner may recommend a
different definition of long-term care worker
if this definition presents insurmountable
implementation issues.
new text end

new text begin (d) The recommendations must include
measures to:
new text end

new text begin (1) ensure equitable treatment between
employers that currently have different levels
of expenditure for employee health insurance
costs; and
new text end

new text begin (2) enforce the requirement that the rate
increase be expended for the intended
purpose.
new text end

new text begin This is a onetime appropriation.
new text end

Sec. 4. new text begin COMMISSIONER OF HEALTH new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 7,111,000 new text end

new text begin Appropriations by Fund new text end
		new text begin 2009 new text end
new text begin Health Care Access new text end		new text begin 7,935,000 new text end
new text begin General new text end		new text begin (824,000) new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end new text begin Community and Family Health Promotion new text end

new text begin Health Care Access new text end

new text begin 152,000 new text end

new text begin $152,000 in fiscal year 2009 is for statewide
health saving research and measurement.
new text end

new text begin new text begin Statewide Health Improvement Program. new text end
The health care access fund base shall be
increased by $19,587,000 in fiscal year 2010
and $26,175,000 in fiscal year 2011 for
grants to local communities in accordance
with Minnesota Statutes, section 145.986,
subdivision 2; $205,000 in fiscal year 2010
and $424,000 in fiscal year 2011 is for
staffing; $22,000 in fiscal year 2010 and
$42,000 in fiscal year 2011 is for operating
costs; $150,000 in fiscal year 2010 and
$300,000 in fiscal year 2011 is for contracts
for evaluation; and $36,000 in fiscal year
2010 and $60,000 in fiscal year 2011 is
for administrative costs. The base for this
program in fiscal year 2012 is $0.
new text end

new text begin Subd. 3. new text end new text begin Policy, Quality, and Compliance new text end

new text begin Health Care Access new text end		new text begin 7,783,000 new text end
new text begin General new text end		new text begin (824,000) new text end

new text begin new text begin Open Door Health Center. new text end Of the health
care access fund appropriation, $350,000 is
to be awarded as a grant to the Open Door
Health Center to act as bridge funding to
meet the demand for health care services
in medically underserved areas. This is a
onetime appropriation.
new text end

new text begin Of this appropriation, $84,000 is for the
commissioner to make recommendations
to the legislature on community benefit
standards to be required of nonprofit health
plan companies doing business in the state.
The expectations of the community benefits
provided and reported should be related to the
statutory expectations in Minnesota Statutes,
sections 62C.01 and 62D.01, and focus on
supporting public health, improving the art
and science of medical care, and addressing
the need for financial assistance to access
ongoing coverage, and not related to general
philanthropic endeavors. The commissioner
shall seek public input regarding the range of
options to be explored and the accountability
measures.
new text end

new text begin The recommendations must include a
procedure by which each nonprofit health
plan company would periodically and
uniformly report to the state and to the public
regarding the company's compliance with
the requirements.
new text end

new text begin The commissioner shall recommend a fair
and effective enforcement and remediation
mechanism. This is a onetime appropriation.
new text end

new text begin new text begin Federally Qualified Health Centers. new text end Of
the health care access fund appropriation,
$2,824,000 is for subsidies to federally
qualified health centers under Minnesota
Statutes, section 145.9269. The health care
access fund base shall be $3,500,000 for
fiscal years 2010 and 2011.
new text end

new text begin The general fund appropriation for this
program shall be reduced by $824,000 for
fiscal year 2009, and by $1,500,000 in both
fiscal years 2010 and 2011.
new text end

new text begin Base Adjustment. new text end new text begin The health care
access fund base shall be further reduced
by $4,104,000 in fiscal year 2010 and
$4,323,000 in fiscal year 2011.
new text end

Sec. 5. new text begin SUNSET OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2009, unless a
different expiration date is specified.
new text end

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

new text begin The provisions in this article are effective July 1, 2008, unless a different effective
date is specified.
new text end