1.1                          A bill for an act 
  1.2             relating to health; modifying welfare data disclosure; 
  1.3             modifying group purchasers' access to health data; 
  1.4             modifying the membership provisions of the health data 
  1.5             institute's board of directors; modifying the staff 
  1.6             provisions of the health data institute; defining 
  1.7             terms; modifying identification requirements for 
  1.8             health care provider organizations, individual health 
  1.9             care providers, and group purchasers; adding a core 
  1.10            transaction set; modifying standard transaction sets 
  1.11            provisions; modifying requirements for the health care 
  1.12            identification card; modifying the data classification 
  1.13            provision of the risk adjustment association; 
  1.14            establishing procedures for disclosing certain 
  1.15            nonpublic data related to group purchasers; requiring 
  1.16            the office of mental health practice to establish 
  1.17            procedures for the exchange of information; permitting 
  1.18            the office of mental health practice to obtain arrest, 
  1.19            investigative, and conviction information; providing 
  1.20            penalties; amending Minnesota Statutes 1994, sections 
  1.21            62J.51, by adding subdivisions; 62J.56, subdivision 2; 
  1.22            62J.60, subdivisions 2 and 3; 144.225, by adding a 
  1.23            subdivision; 148B.66, by adding a subdivision; 
  1.24            148B.69, by adding a subdivision; and 148B.70, 
  1.25            subdivision 3; Minnesota Statutes 1995 Supplement, 
  1.26            sections 13.46, subdivision 2; 62J.451, subdivisions 
  1.27            7, 9, and 12; 62J.54, subdivisions 1, 2, and 3; 
  1.28            62J.58; and 62Q.03, subdivision 9. 
  1.29  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.30     Section 1.  Minnesota Statutes 1995 Supplement, section 
  1.31  13.46, subdivision 2, is amended to read: 
  1.32     Subd. 2.  [GENERAL.] (a) Unless the data is summary data or 
  1.33  a statute specifically provides a different classification, data 
  1.34  on individuals collected, maintained, used, or disseminated by 
  1.35  the welfare system is private data on individuals, and shall not 
  1.36  be disclosed except:  
  1.37     (1) pursuant to section 13.05; 
  2.1      (2) pursuant to court order; 
  2.2      (3) pursuant to a statute specifically authorizing access 
  2.3   to the private data; 
  2.4      (4) to an agent of the welfare system, including a law 
  2.5   enforcement person, attorney, or investigator acting for it in 
  2.6   the investigation or prosecution of a criminal or civil 
  2.7   proceeding relating to the administration of a program; 
  2.8      (5) to personnel of the welfare system who require the data 
  2.9   to determine eligibility, amount of assistance, and the need to 
  2.10  provide services of additional programs to the individual; 
  2.11     (6) to administer federal funds or programs; 
  2.12     (7) between personnel of the welfare system working in the 
  2.13  same program; 
  2.14     (8) the amounts of cash public assistance and relief paid 
  2.15  to welfare recipients in this state, including their names, 
  2.16  social security numbers, income, addresses, and other data as 
  2.17  required, upon request by the department of revenue to 
  2.18  administer the property tax refund law, supplemental housing 
  2.19  allowance, early refund of refundable tax credits, and the 
  2.20  income tax.  "Refundable tax credits" means the dependent care 
  2.21  credit under section 290.067, the Minnesota working family 
  2.22  credit under section 290.0671, the property tax refund under 
  2.23  section 290A.04, and, if the required federal waiver or waivers 
  2.24  are granted, the federal earned income tax credit under section 
  2.25  32 of the Internal Revenue Code; 
  2.26     (9) to the Minnesota department of economic security for 
  2.27  the purpose of monitoring the eligibility of the data subject 
  2.28  for reemployment insurance, for any employment or training 
  2.29  program administered, supervised, or certified by that agency, 
  2.30  or for the purpose of administering any rehabilitation program, 
  2.31  whether alone or in conjunction with the welfare system, and to 
  2.32  verify receipt of energy assistance for the telephone assistance 
  2.33  plan; 
  2.34     (10) to appropriate parties in connection with an emergency 
  2.35  if knowledge of the information is necessary to protect the 
  2.36  health or safety of the individual or other individuals or 
  3.1   persons; 
  3.2      (11) data maintained by residential programs as defined in 
  3.3   section 245A.02 may be disclosed to the protection and advocacy 
  3.4   system established in this state pursuant to Part C of Public 
  3.5   Law Number 98-527 to protect the legal and human rights of 
  3.6   persons with mental retardation or other related conditions who 
  3.7   live in residential facilities for these persons if the 
  3.8   protection and advocacy system receives a complaint by or on 
  3.9   behalf of that person and the person does not have a legal 
  3.10  guardian or the state or a designee of the state is the legal 
  3.11  guardian of the person; 
  3.12     (12) to the county medical examiner or the county coroner 
  3.13  for identifying or locating relatives or friends of a deceased 
  3.14  person; 
  3.15     (13) data on a child support obligor who makes payments to 
  3.16  the public agency may be disclosed to the higher education 
  3.17  services office to the extent necessary to determine eligibility 
  3.18  under section 136A.121, subdivision 2, clause (5); 
  3.19     (14) participant social security numbers and names 
  3.20  collected by the telephone assistance program may be disclosed 
  3.21  to the department of revenue to conduct an electronic data match 
  3.22  with the property tax refund database to determine eligibility 
  3.23  under section 237.70, subdivision 4a; 
  3.24     (15) the current address of a recipient of aid to families 
  3.25  with dependent children may be disclosed to law enforcement 
  3.26  officers who provide the name and social security number of the 
  3.27  recipient and satisfactorily demonstrate that:  (i) the 
  3.28  recipient is a fugitive felon, including the grounds for this 
  3.29  determination; (ii) the location or apprehension of the felon is 
  3.30  within the law enforcement officer's official duties; and (iii) 
  3.31  the request is made in writing and in the proper exercise of 
  3.32  those duties; 
  3.33     (16) the current address of a recipient of general 
  3.34  assistance, work readiness, or general assistance medical care 
  3.35  may be disclosed to probation officers and corrections agents 
  3.36  who are supervising the recipient, and to law enforcement 
  4.1   officers who are investigating the recipient in connection with 
  4.2   a felony level offense; 
  4.3      (17) information obtained from food stamp applicant or 
  4.4   recipient households may be disclosed to local, state, or 
  4.5   federal law enforcement officials, upon their written request, 
  4.6   for the purpose of investigating an alleged violation of the 
  4.7   food stamp act, in accordance with Code of Federal Regulations, 
  4.8   title 7, section 272.1(c); 
  4.9      (18) data on a child support obligor who is in arrears may 
  4.10  be disclosed for purposes of publishing the data pursuant to 
  4.11  section 518.575; 
  4.12     (19) data on child support payments made by a child support 
  4.13  obligor may be disclosed to the obligee; or 
  4.14     (20) data in the work reporting system may be disclosed 
  4.15  under section 256.998, subdivision 7; or 
  4.16     (21) the current address and phone number of program 
  4.17  recipients and emergency contacts may be released to the 
  4.18  commissioner of health or a local board of health as defined in 
  4.19  section 145A.02, subdivision 2, when the commissioner has reason 
  4.20  to believe that the program recipient is a disease case, 
  4.21  carrier, suspect case, or at risk of illness, and the data are 
  4.22  necessary to locate the person. 
  4.23     (b) Information on persons who have been treated for drug 
  4.24  or alcohol abuse may only be disclosed in accordance with the 
  4.25  requirements of Code of Federal Regulations, title 42, sections 
  4.26  2.1 to 2.67. 
  4.27     (c) Data provided to law enforcement agencies under 
  4.28  paragraph (a), clause (15), (16), or (17), or paragraph (b), are 
  4.29  investigative data and are confidential or protected nonpublic 
  4.30  while the investigation is active.  The data are private after 
  4.31  the investigation becomes inactive under section 13.82, 
  4.32  subdivision 5, paragraph (a) or (b). 
  4.33     (d) Mental health data shall be treated as provided in 
  4.34  subdivisions 7, 8, and 9, but is not subject to the access 
  4.35  provisions of subdivision 10, paragraph (b). 
  4.36     Sec. 2.  Minnesota Statutes 1995 Supplement, section 
  5.1   62J.451, subdivision 7, is amended to read: 
  5.2      Subd. 7.  [DISSEMINATION OF REPORTS; OTHER INFORMATION.] 
  5.3   (a) The health data institute shall establish a mechanism for 
  5.4   the dissemination of reports and other information to consumers, 
  5.5   group purchasers, health plan companies, providers, and the 
  5.6   state.  When applicable, the health data institute shall 
  5.7   coordinate its dissemination of information responsibilities 
  5.8   with those of the commissioner, to the extent administratively 
  5.9   efficient and effective. 
  5.10     (b) The health data institute may require those requesting 
  5.11  data from its databases to contribute toward the cost of data 
  5.12  collection through the payments of fees. 
  5.13     (c) The health data institute shall not allow a group 
  5.14  purchaser or health care provider to use or have access to the 
  5.15  electronic data interchange system or to access data under 
  5.16  section 62J.452, subdivision 6 or 7, unless the group purchaser 
  5.17  or health care provider cooperates with the data collection 
  5.18  efforts of the health data institute by submitting or making 
  5.19  available through the EDI system or other means all data 
  5.20  requested by the health data institute.  The health data 
  5.21  institute shall prohibit group purchasers and health care 
  5.22  providers from transferring, providing, or sharing data obtained 
  5.23  from the health data institute under section 62J.452, 
  5.24  subdivision 6 or 7, with a group purchaser or health care 
  5.25  provider that does not cooperate with the data collection 
  5.26  efforts of the health data institute. 
  5.27     Sec. 3.  Minnesota Statutes 1995 Supplement, section 
  5.28  62J.451, subdivision 9, is amended to read: 
  5.29     Subd. 9.  [BOARD OF DIRECTORS.] The health data institute 
  5.30  is governed by a 20-member board of directors consisting of the 
  5.31  following members: 
  5.32     (1) two representatives of hospitals, one appointed by the 
  5.33  Minnesota Hospital Association and one appointed by the 
  5.34  Metropolitan HealthCare Council and Health Care Partnership, to 
  5.35  reflect a mix of urban and rural institutions; 
  5.36     (2) four representatives of health carriers, two appointed 
  6.1   by the Minnesota council of health maintenance organizations, 
  6.2   one appointed by Blue Cross and Blue Shield of Minnesota, and 
  6.3   one appointed by the Insurance Federation of Minnesota; 
  6.4      (3) two consumer members, one appointed by the 
  6.5   commissioner, and one appointed by the AFL-CIO as a labor union 
  6.6   representative; 
  6.7      (4) five group purchaser representatives appointed by the 
  6.8   Minnesota consortium of health care purchasers to reflect a mix 
  6.9   of urban and rural, large and small, and self-insured 
  6.10  purchasers; 
  6.11     (5) two physicians appointed by the Minnesota Medical 
  6.12  Association, to reflect a mix of urban and rural practitioners; 
  6.13     (6) one representative of teaching and research 
  6.14  institutions, appointed jointly by the Mayo Foundation and the 
  6.15  Minnesota Association of Public Teaching Hospitals; 
  6.16     (7) one nursing representative appointed by the Minnesota 
  6.17  Nurses Association; and 
  6.18     (8) three representatives of state agencies, one member 
  6.19  representing the department of employee relations, one member 
  6.20  representing the department of human services, and one member 
  6.21  representing the department of health. 
  6.22     Sec. 4.  Minnesota Statutes 1995 Supplement, section 
  6.23  62J.451, subdivision 12, is amended to read: 
  6.24     Subd. 12.  [STAFF.] The board may hire an executive 
  6.25  director.  The executive director and other health data 
  6.26  institute staff are not state employees but are covered by 
  6.27  section 3.736.  The executive director and other health data 
  6.28  institute staff may participate in the following plans for 
  6.29  employees in the unclassified service until January 1, 1996:  
  6.30  the state retirement plan, the state deferred compensation plan, 
  6.31  and the health, dental, and life insurance plans.  The attorney 
  6.32  general shall provide legal services to the board. 
  6.33     Sec. 5.  Minnesota Statutes 1994, section 62J.51, is 
  6.34  amended by adding a subdivision to read: 
  6.35     Subd. 3a.  [CARD ISSUER.] "Card issuer" means the group 
  6.36  purchaser who is responsible for printing and distributing 
  7.1   identification cards to members or insureds. 
  7.2      Sec. 6.  Minnesota Statutes 1994, section 62J.51, is 
  7.3   amended by adding a subdivision to read: 
  7.4      Subd. 6a.  [CLAIM STATUS TRANSACTION SET (ANSI ASC X12 
  7.5   276/277).] "Claim status transaction set (ANSI ASC X12 276/277)" 
  7.6   means the transaction format developed and approved for 
  7.7   implementation in December 1993 and used by providers to request 
  7.8   and receive information on the status of a health care claim or 
  7.9   encounter that has been submitted to a group purchaser. 
  7.10     Sec. 7.  Minnesota Statutes 1994, section 62J.51, is 
  7.11  amended by adding a subdivision to read: 
  7.12     Subd. 6b.  [CLAIM SUBMISSION ADDRESS.] "Claim submission 
  7.13  address" means the address to which the group purchaser requires 
  7.14  health care providers, members, or insureds to send health care 
  7.15  claims for processing. 
  7.16     Sec. 8.  Minnesota Statutes 1994, section 62J.51, is 
  7.17  amended by adding a subdivision to read: 
  7.18     Subd. 6c.  [CLAIM SUBMISSION NUMBER.] "Claim submission 
  7.19  number" means the unique identification number to identify group 
  7.20  purchasers as described in section 62J.54, with its suffix 
  7.21  identifying the claim submission address. 
  7.22     Sec. 9.  Minnesota Statutes 1995 Supplement, section 
  7.23  62J.54, subdivision 1, is amended to read: 
  7.24     Subdivision 1.  [UNIQUE IDENTIFICATION NUMBER FOR HEALTH 
  7.25  CARE PROVIDER ORGANIZATIONS.] (a) On and after January 1, 1998, 
  7.26  all group purchasers and health care providers in Minnesota 
  7.27  shall use a unique identification number to identify health care 
  7.28  provider organizations, except as provided in paragraph (d) (e). 
  7.29     (b) Following the recommendation of the workgroup for 
  7.30  electronic data interchange, the federal tax identification 
  7.31  number assigned to each health care provider organization by the 
  7.32  Internal Revenue Service of the Department of the Treasury The 
  7.33  first eight digits of the national provider identifier 
  7.34  maintained by the federal Health Care Financing Administration 
  7.35  shall be used as the unique identification number for health 
  7.36  care provider organizations. 
  8.1      (c) Provider organizations required to have a national 
  8.2   provider identifier are:  
  8.3      (1) hospitals licensed under chapter 144; 
  8.4      (2) nursing homes and hospices licensed under chapter 144A; 
  8.5      (3) subacute care facilities; 
  8.6      (4) individual providers organized as a clinic or group 
  8.7   practice; 
  8.8      (5) independent laboratory, pharmacy, surgery, radiology, 
  8.9   or outpatient facilities; 
  8.10     (6) ambulance services licensed under chapter 144; and 
  8.11     (7) special transportation services certified under chapter 
  8.12  174. 
  8.13     Provider organizations shall obtain a national provider 
  8.14  identifier from the federal Health Care Financing Administration 
  8.15  using the federal Health Care Financing Administration's 
  8.16  prescribed process.  
  8.17     (d) The unique health care provider organization identifier 
  8.18  shall be used for purposes of submitting and receiving claims, 
  8.19  and in conjunction with other data collection and reporting 
  8.20  functions. 
  8.21     (d) (e) The state and federal health care programs 
  8.22  administered by the department of human services shall use the 
  8.23  unique identification number assigned to health care providers 
  8.24  for implementation of the Medicaid Management Information System 
  8.25  or the uniform provider identification number (UPIN) assigned by 
  8.26  the Health Care Financing Administration the national provider 
  8.27  identifier maintained by the federal Health Care Financing 
  8.28  Administration. 
  8.29     (f) The commissioner of health may become a subscriber to 
  8.30  the federal Health Care Financing Administration's national 
  8.31  provider system to implement this subdivision. 
  8.32     Sec. 10.  Minnesota Statutes 1995 Supplement, section 
  8.33  62J.54, subdivision 2, is amended to read: 
  8.34     Subd. 2.  [UNIQUE IDENTIFICATION NUMBER FOR INDIVIDUAL 
  8.35  HEALTH CARE PROVIDERS.] (a) On and after January 1, 1998, all 
  8.36  group purchasers and health care providers in Minnesota shall 
  9.1   use a unique identification number to identify an individual 
  9.2   health care provider, except as provided in paragraph (d) (e). 
  9.3      (b) The uniform provider identification number (UPIN) 
  9.4   assigned by the Health Care Financing Administration The first 
  9.5   eight digits of the national provider identifier maintained by 
  9.6   the federal Health Care Financing Administration's national 
  9.7   provider system shall be used as the unique identification 
  9.8   number for individual health care providers.  Providers who do 
  9.9   not currently have a UPIN number shall request one from the 
  9.10  health care financing administration. 
  9.11     (c) Individual providers required to have a national 
  9.12  provider identifier are:  
  9.13     (1) physicians licensed under chapter 147; 
  9.14     (2) dentists licensed under chapter 150; 
  9.15     (3) chiropractors licensed under chapter 148; 
  9.16     (4) podiatrists licensed under chapter 153; 
  9.17     (5) physician assistants as defined under section 147.34; 
  9.18     (6) advanced practice nurses as defined under section 
  9.19  62A.15; 
  9.20     (7) doctors of optometry licensed under section 148.57; 
  9.21     (8) individual providers who may bill for medical and other 
  9.22  health-related services, as defined in United States Code, title 
  9.23  42, section 1395x, paragraph (s); and 
  9.24     (9) individual providers who are providers for the medical 
  9.25  assistance program.  
  9.26     Providers shall obtain a national provider identifier from 
  9.27  the federal Health Care Financing Administration using the 
  9.28  Health Care Financing Administration's prescribed process.  
  9.29     (d) The unique individual health care provider identifier 
  9.30  shall be used for purposes of submitting and receiving claims, 
  9.31  and in conjunction with other data collection and reporting 
  9.32  functions. 
  9.33     (d) (e) The state and federal health care programs 
  9.34  administered by the department of human services shall use the 
  9.35  unique identification number assigned to health care providers 
  9.36  for implementation of the Medicaid Management Information System 
 10.1   or the uniform provider identification number (UPIN) assigned by 
 10.2   the health care financing administration national provider 
 10.3   identifier maintained by the federal Health Care Financing 
 10.4   Administration. 
 10.5      (f) The commissioner of health may become a subscriber to 
 10.6   the federal Health Care Financing Administration's national 
 10.7   provider system to implement this subdivision. 
 10.8      Sec. 11.  Minnesota Statutes 1995 Supplement, section 
 10.9   62J.54, subdivision 3, is amended to read: 
 10.10     Subd. 3.  [UNIQUE IDENTIFICATION NUMBER FOR GROUP 
 10.11  PURCHASERS.] (a) On and after January 1, 1998, all group 
 10.12  purchasers and health care providers in Minnesota shall use a 
 10.13  unique identification number to identify group purchasers. 
 10.14     (b) The federal tax identification number assigned to each 
 10.15  group purchaser by the Internal Revenue Service of the 
 10.16  Department of the Treasury payer identification number assigned 
 10.17  for the federal Health Care Financing Administration's PAYERID 
 10.18  system shall be used as the unique identification number for 
 10.19  group purchasers.  This paragraph applies until the codes 
 10.20  described in paragraph (c) are available and feasible to use, as 
 10.21  determined by the commissioner. 
 10.22     (c) A two-part code, consisting of 11 characters and 
 10.23  modeled after the National Association of Insurance 
 10.24  Commissioners company code shall be assigned to each group 
 10.25  purchaser and used as the unique identification number for group 
 10.26  purchasers.  The first six characters, or prefix, shall contain 
 10.27  the numeric code, or company code, assigned by the National 
 10.28  Association of Insurance Commissioners.  The last five 
 10.29  characters, or suffix, which is optional, shall contain further 
 10.30  codes that will enable group purchasers to further route 
 10.31  electronic transaction in their internal systems. Group 
 10.32  purchasers shall obtain a payer identifier number from the 
 10.33  federal Health Care Financing Administration using the Health 
 10.34  Care Financing Administration's prescribed process. 
 10.35     (d) The unique group purchaser identifier, as described in 
 10.36  this section, shall be used for purposes of submitting and 
 11.1   receiving claims, and in conjunction with other data collection 
 11.2   and reporting functions. 
 11.3      (e) The commissioner of health may become a registry user 
 11.4   to the federal Health Care Financing Administration's PAYERID 
 11.5   system to implement this subdivision. 
 11.6      Sec. 12.  Minnesota Statutes 1994, section 62J.56, 
 11.7   subdivision 2, is amended to read: 
 11.8      Subd. 2.  [IDENTIFICATION OF CORE TRANSACTION SETS.] (a) 
 11.9   All category I and II industry participants in Minnesota shall 
 11.10  comply with the standards developed by the ANSI ASC X12 for the 
 11.11  following core transaction sets, according to the implementation 
 11.12  plan outlined for each transaction set. 
 11.13     (1) ANSI ASC X12 835 health care claim payment/advice 
 11.14  transaction set. 
 11.15     (2) ANSI ASC X12 837 health care claim transaction set. 
 11.16     (3) ANSI ASC X12 834 health care enrollment transaction set.
 11.17     (4) ANSI ASC X12 270/271 health care eligibility 
 11.18  transaction set. 
 11.19     (5) ANSI ASC X12 276/277 health care claims status 
 11.20  request/notification transaction set. 
 11.21     (b) The commissioner, with the advice of the Minnesota 
 11.22  health data institute and the Minnesota administrative 
 11.23  uniformity committee, and in coordination with federal efforts, 
 11.24  may approve the use of new ASC X12 standards, or new versions of 
 11.25  existing standards, as they become available, or other 
 11.26  nationally recognized standards, where appropriate ASC X12 
 11.27  standards are not available for use.  These alternative 
 11.28  standards may be used during a transition period while ASC X12 
 11.29  standards are developed. 
 11.30     Sec. 13.  Minnesota Statutes 1995 Supplement, section 
 11.31  62J.58, is amended to read: 
 11.32     62J.58 [IMPLEMENTATION OF STANDARD TRANSACTION SETS.] 
 11.33     Subdivision 1.  [CLAIMS PAYMENT.] Six months from the date 
 11.34  the commissioner formally recommends the use of guides to 
 11.35  implement core transaction sets pursuant to section 62J.56, 
 11.36  subdivision 3, all category I industry participants and all 
 12.1   category II industry participants, except pharmacists, shall be 
 12.2   able to submit or accept, as appropriate, the ANSI ASC X12 835 
 12.3   health care claim payment/advice transaction set (draft standard 
 12.4   for trial use version/release 3051 3030) for electronic 
 12.5   submission of payment information to health care providers. 
 12.6      Subd. 2.  [CLAIMS SUBMISSION.] Six months from the date the 
 12.7   commissioner formally recommends the use of guides to implement 
 12.8   core transaction sets pursuant to section 62J.56, subdivision 3, 
 12.9   all category I and category II industry participants, except 
 12.10  pharmacists, shall be able to accept or submit, as appropriate, 
 12.11  the ANSI ASC X12 837 health care claim transaction set (draft 
 12.12  standard for trial use version/release 3051 3030) for the 
 12.13  electronic transfer of health care claim information.  
 12.14     Subd. 2a.  [CLAIM STATUS INFORMATION.] Six months from the 
 12.15  date the commissioner formally recommends the use of guides to 
 12.16  implement core transaction sets under section 62J.56, 
 12.17  subdivision 3, all category I and II industry participants, 
 12.18  excluding pharmacists, may accept or submit the ANSI ASC X12 
 12.19  276/277 health care claim status transaction set (draft standard 
 12.20  for trial use version/release 3051) for the electronic transfer 
 12.21  of health care claim status information. 
 12.22     Subd. 3.  [ENROLLMENT INFORMATION.] Six months from the 
 12.23  date the commissioner formally recommends the use of guides to 
 12.24  implement core transaction sets pursuant to section 62J.56, 
 12.25  subdivision 3, all category I and category II industry 
 12.26  participants, excluding pharmacists, shall be able to accept or 
 12.27  submit, as appropriate, the ANSI ASC X12 834 health care 
 12.28  enrollment transaction set (draft standard for trial use 
 12.29  version/release 3051 3030) for the electronic transfer of 
 12.30  enrollment and health benefit information.  
 12.31     Subd. 4.  [ELIGIBILITY INFORMATION.] Six months from the 
 12.32  date the commissioner formally recommends the use of guides to 
 12.33  implement core transaction sets pursuant to section 62J.56, 
 12.34  subdivision 3, all category I and category II industry 
 12.35  participants, except pharmacists, shall be able to accept or 
 12.36  submit, as appropriate, the ANSI ASC X12 270/271 health care 
 13.1   eligibility transaction set (draft standard for trial use 
 13.2   version/release 3051 3030) for the electronic transfer of health 
 13.3   benefit eligibility information.  
 13.4      Subd. 5.  [APPLICABILITY.] This section does not require a 
 13.5   group purchaser, health care provider, or employer to use 
 13.6   electronic data interchange or to have the capability to do so.  
 13.7   This section applies only to the extent that a group purchaser, 
 13.8   health care provider, or employer chooses to use electronic data 
 13.9   interchange. 
 13.10     Sec. 14.  Minnesota Statutes 1994, section 62J.60, 
 13.11  subdivision 2, is amended to read: 
 13.12     Subd. 2.  [GENERAL CHARACTERISTICS.] (a) The Minnesota 
 13.13  health care identification card must be a preprinted card 
 13.14  constructed of plastic, paper, or any other medium that conforms 
 13.15  with ANSI and ISO 7810 physical characteristics standards.  The 
 13.16  card dimensions must also conform to ANSI and ISO 7810 physical 
 13.17  characteristics standard.  The use of a signature panel is 
 13.18  optional. 
 13.19     (b) The Minnesota health care identification card must have 
 13.20  an essential information window in the front side with the 
 13.21  following data elements left justified in the following top to 
 13.22  bottom sequence:  card issuer name, issuer claim submission 
 13.23  number, identification number, identification name.  No optional 
 13.24  data may be interspersed between these data elements.  The 
 13.25  window must be left justified.  
 13.26     (c) Standardized labels are required next to human readable 
 13.27  data elements.  The card issuer may decide the location of the 
 13.28  standardized label relative to the data element.  
 13.29     Sec. 15.  Minnesota Statutes 1994, section 62J.60, 
 13.30  subdivision 3, is amended to read: 
 13.31     Subd. 3.  [HUMAN READABLE DATA ELEMENTS.] (a) The following 
 13.32  are the minimum human readable data elements that must be 
 13.33  present on the front side of the Minnesota health care 
 13.34  identification card: 
 13.35     (1) card issuer name or logo, which is the name or logo 
 13.36  that identifies the card issuer.  The card issuer name or logo 
 14.1   may be the card's front background.  No standard label is 
 14.2   required for this data element; 
 14.3      (2) issuer claim submission number, which is the unique 
 14.4   card issuer number consisting of a base number assigned by a 
 14.5   registry process followed by a suffix number assigned by the 
 14.6   card issuer.  The use of this element is mandatory within one 
 14.7   year of the establishment of a process for this identifier.  The 
 14.8   standardized label for this element is "Issuer Clm Subm #"; 
 14.9      (3) identification number, which is the unique 
 14.10  identification number of the individual card holder established 
 14.11  and defined under this section.  The standardized label for the 
 14.12  data element is "ID"; 
 14.13     (4) identification name, which is the name of the 
 14.14  individual card holder.  The identification name must be 
 14.15  formatted as follows:  first name, space, optional middle 
 14.16  initial, space, last name, optional space and name suffix.  The 
 14.17  standardized label for this data element is "Name"; 
 14.18     (5) account number(s), which is any other number, such as a 
 14.19  group number, if required for part of the identification or 
 14.20  claims process.  The standardized label for this data element is 
 14.21  "Account"; 
 14.22     (6) care type, which is the description of the group 
 14.23  purchaser's plan product under which the beneficiary is 
 14.24  covered.  The description shall include the health plan company 
 14.25  name and the plan or product name.  The standardized label for 
 14.26  this data element is "Care Type"; 
 14.27     (7) service type, which is the description of coverage 
 14.28  provided such as hospital, dental, vision, prescription, or 
 14.29  mental health.  The standard label for this data element is "Svc 
 14.30  Type"; and 
 14.31     (8) provider/clinic name, which is the name of the primary 
 14.32  care clinic the cardholder is assigned to by the health plan 
 14.33  company.  The standard label for this field is "PCP."  This 
 14.34  information is mandatory only if the health plan company assigns 
 14.35  a specific primary care provider to the cardholder. 
 14.36     (b) The following human readable data elements shall be 
 15.1   present on the back side of the Minnesota health identification 
 15.2   card.  These elements must be left justified, and no optional 
 15.3   data elements may be interspersed between them:  
 15.4      (1) claims submission name(s) and address(es), which are 
 15.5   the name(s) and address(es) of the entity or entities to which 
 15.6   claims should be submitted.  If different destinations are 
 15.7   required for different types of claims, this must be labeled; 
 15.8      (2) telephone number(s) and name(s); which are the 
 15.9   telephone number(s) and name(s) of the following contact(s) with 
 15.10  a standardized label describing the service function as 
 15.11  applicable:  
 15.12     (i) eligibility and benefit information; 
 15.13     (ii) utilization review; 
 15.14     (iii) precertification; or 
 15.15     (iv) customer services. 
 15.16     (c) The following human readable data elements are 
 15.17  mandatory on the back side of the card for health maintenance 
 15.18  organizations and integrated service networks: 
 15.19     (1) emergency care authorization telephone number or 
 15.20  instruction on how to receive authorization for emergency care.  
 15.21  There is no standard label required for this information; and 
 15.22     (2) telephone number to call to appeal to the commissioner 
 15.23  of health.  There is no standard label required for this 
 15.24  information. 
 15.25     (d) All human readable data elements not required under 
 15.26  paragraphs (a) to (c) are optional and may be used at the 
 15.27  issuer's discretion. 
 15.28     Sec. 16.  Minnesota Statutes 1995 Supplement, section 
 15.29  62Q.03, subdivision 9, is amended to read: 
 15.30     Subd. 9.  [DATA COLLECTION AND DATA PRIVACY.] The 
 15.31  association members shall not have access to unaggregated data 
 15.32  on individuals or health plan companies.  The association shall 
 15.33  develop, as a part of the plan of operation, procedures for 
 15.34  ensuring that data is collected by an appropriate entity.  The 
 15.35  commissioners of health and commerce shall have the authority to 
 15.36  audit and examine data collected by the association for the 
 16.1   purposes of the development and implementation of the risk 
 16.2   adjustment system.  Data on individuals obtained for the 
 16.3   purposes of risk adjustment development, testing, and operation 
 16.4   are designated as private data.  Data not on individuals which 
 16.5   is obtained for the purposes of development, testing, and 
 16.6   operation of risk adjustment are designated as nonpublic data., 
 16.7   except for that the proposed and approved plan of operation, the 
 16.8   risk adjustment methodologies examined, the plan for testing, 
 16.9   the plan of the risk adjustment system, minutes of meetings, and 
 16.10  other general operating information are classified as public 
 16.11  data.  Nothing in this section is intended to prohibit the 
 16.12  preparation of summary data under section 13.05, subdivision 7.  
 16.13  The association, state agencies, and any contractors having 
 16.14  access to this data shall maintain it in accordance with this 
 16.15  classification.  The commissioners of health and human services 
 16.16  have the authority to collect data from health plan companies as 
 16.17  needed for the purpose of developing a risk adjustment mechanism 
 16.18  for public programs. 
 16.19     Sec. 17.  Minnesota Statutes 1994, section 144.225, is 
 16.20  amended by adding a subdivision to read: 
 16.21     Subd. 6.  [GROUP PURCHASER IDENTITY; NONPUBLIC DATA; 
 16.22  DISCLOSURE.] (a) Except as otherwise provided in this 
 16.23  subdivision, the named identity of a group purchaser as defined 
 16.24  in section 62J.03, subdivision 6, collected in association with 
 16.25  birth registration is nonpublic data as defined in section 13.02.
 16.26     (b) The commissioner may publish, or by other means release 
 16.27  to the public, the named identity of a group purchaser as part 
 16.28  of an analysis of information collected from the birth 
 16.29  registration process.  Analysis means the identification of 
 16.30  trends in prenatal care and birth outcomes associated with group 
 16.31  purchasers.  The commissioner shall not reveal the named 
 16.32  identity of the group purchaser until the group purchaser has 
 16.33  had 21 days after receipt of the analysis to review the analysis 
 16.34  and comment on it.  The commissioner shall, in releasing data 
 16.35  under this subdivision, include comments received from the group 
 16.36  purchaser related to the scientific soundness and statistical 
 17.1   validity of the methods used in the analysis.  This subdivision 
 17.2   does not authorize the commissioner to make public any 
 17.3   individual identifying data except as permitted by law.  
 17.4      (c) A group purchaser may contest whether an analysis made 
 17.5   public under paragraph (b) is based on scientifically sound and 
 17.6   statistically valid methods in a contested case proceeding under 
 17.7   sections 14.57 to 14.62, subject to appeal under sections 14.63 
 17.8   to 14.68.  To obtain a contested case hearing, the group 
 17.9   purchaser must present a written request to the commissioner 
 17.10  before the end of the time period for review and comment.  
 17.11  Within ten days of the assignment of an administrative law 
 17.12  judge, the group purchaser must demonstrate by clear and 
 17.13  convincing evidence the group purchaser's likelihood of 
 17.14  succeeding on the merits.  If the judge determines that the 
 17.15  group purchaser has made such a demonstration, the data shall 
 17.16  not be released during the contested case proceeding and through 
 17.17  appeal.  If the judge finds that the group purchaser has not 
 17.18  made such a demonstration, the commissioner may immediately 
 17.19  publish, or otherwise make public, the nonpublic group purchaser 
 17.20  data, with comments received as set forth in paragraph (b). 
 17.21     (d) The contested case proceeding and subsequent appeal is 
 17.22  not an exclusive remedy and any person may seek a remedy 
 17.23  pursuant to section 13.08, subdivisions 1 to 4, or as otherwise 
 17.24  authorized by law. 
 17.25     Sec. 18.  Minnesota Statutes 1994, section 148B.66, is 
 17.26  amended by adding a subdivision to read: 
 17.27     Subd. 3.  [EXCHANGING INFORMATION.] (a) The office of 
 17.28  mental health practice shall establish internal operating 
 17.29  procedures for: 
 17.30     (1) exchanging information with: 
 17.31     (i) state boards, 
 17.32     (ii) agencies, including the office of ombudsman for mental 
 17.33  health and mental retardation, 
 17.34     (iii) health related and law enforcement facilities, 
 17.35     (iv) departments responsible for licensing health related 
 17.36  occupations, facilities, and programs, and 
 18.1      (v) law enforcement personnel, in this and other states; 
 18.2   and 
 18.3      (2) coordinating investigations involving matters within 
 18.4   the jurisdiction of more than one regulatory agency.  
 18.5      Establishment of the operating procedures shall not be 
 18.6   subject to rulemaking under chapter 14.  
 18.7      (b) The procedures for exchanging information must provide 
 18.8   for the forwarding to: 
 18.9      (1) state boards; 
 18.10     (2) agencies, including the office of the ombudsman for 
 18.11  mental health and mental retardation; 
 18.12     (3) health related and law enforcement facilities; 
 18.13     (4) departments responsible for licensing health related 
 18.14  occupations, facilities, and programs; and 
 18.15     (5) law enforcement personnel of all information and 
 18.16  evidence, including the results of investigations, that are 
 18.17  relevant to matters within those organizations' regulatory 
 18.18  jurisdiction.  The data shall have the same classification under 
 18.19  sections 13.01 to 13.88, the government data practices act, in 
 18.20  the hands of the agency receiving the data as it had in the 
 18.21  hands of the agency providing the data.  
 18.22     (c) The office of mental health practice shall establish 
 18.23  procedures for exchanging information with other states 
 18.24  regarding disciplinary action against licensed and unlicensed 
 18.25  mental health practitioners.  
 18.26     (d) The office of mental health practice shall forward to 
 18.27  another governmental agency any complaints received by the 
 18.28  office which do not relate to the office's jurisdiction but 
 18.29  which relate to matters within the jurisdiction of the other 
 18.30  governmental agency.  The agency shall advise the office of 
 18.31  mental health practice of the disposition of the complaint.  A 
 18.32  complaint or other information received by another governmental 
 18.33  agency relating to a statute or rule which the office of mental 
 18.34  health practice is empowered to enforce must be forwarded to the 
 18.35  office to be processed in accordance with this section. 
 18.36     (e) The office of mental health practice shall furnish to a 
 19.1   person who made a complaint a description of the actions of the 
 19.2   office relating to the complaint.  
 19.3      Sec. 19.  Minnesota Statutes 1994, section 148B.69, is 
 19.4   amended by adding a subdivision to read: 
 19.5      Subd. 2a.  [ACCESS TO CRIMINAL DATA.] In matters relating 
 19.6   to the lawful activities of the office of mental health 
 19.7   practice, the following agencies or persons may provide to the 
 19.8   office, upon its request, arrest, investigative, or conviction 
 19.9   information for review and copying: 
 19.10     (1) the bureau of criminal apprehension; 
 19.11     (2) a county attorney, county sheriff, or county agency; 
 19.12     (3) a local chief of police; 
 19.13     (4) another state; 
 19.14     (5) a court; or 
 19.15     (6) a national criminal record repository. 
 19.16     Sec. 20.  Minnesota Statutes 1994, section 148B.70, 
 19.17  subdivision 3, is amended to read: 
 19.18     Subd. 3.  [ADDITIONAL POWERS; CRIMINAL PENALTY.] The 
 19.19  issuance of a cease and desist order or injunctive relief 
 19.20  granted under this section does not relieve a practitioner from 
 19.21  criminal prosecution by a competent authority or from 
 19.22  disciplinary action by the commissioner.  A violation of an 
 19.23  order of the commissioner is a gross misdemeanor.