1.1                          A bill for an act 
  1.2             relating to health; establishing the Sustainable 
  1.3             Health Care Act; providing for reform of health care 
  1.4             coverage and public programs for low-income and 
  1.5             working Minnesotans; requiring a report. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [CITATION.] 
  1.8      This act shall be known as the "Sustainable Health Care 
  1.9   Act." 
  1.10     Sec. 2.  [PURPOSE.] 
  1.11     The legislature finds that the projected rate of growth in 
  1.12  health care costs will lead to unsustainable increases in state 
  1.13  spending for health care programs, unsustainable increases in 
  1.14  health insurance premiums paid by employers and individuals, and 
  1.15  unacceptable numbers of persons who are uninsured.  The 
  1.16  legislature further finds that growth in the number of uninsured 
  1.17  and underinsured Minnesotans will have serious, detrimental 
  1.18  consequences for the entire community, including declining 
  1.19  health status of the population, excessive use of emergency 
  1.20  rooms, lack of preventive care and early diagnosis and 
  1.21  treatment, and cost shifting onto private insurers, local 
  1.22  governments, and nonprofit safety net health care providers.  
  1.23  The purpose of this act is to ensure that all Minnesota 
  1.24  residents participate in a health care coverage program for 
  1.25  themselves and their dependents and that all residents 
  2.1   contribute to the cost of their health care according to their 
  2.2   ability.  The legislature finds that this purpose can best be 
  2.3   achieved by increasing consumer engagement and responsibility, 
  2.4   rewarding the use of effective and efficient methods of 
  2.5   delivering health care, promoting better health, reducing waste 
  2.6   and duplication, establishing common standards for measuring and 
  2.7   reporting quality and cost, and leveraging contributions from 
  2.8   both public-private partnerships.  
  2.9      Sec. 3.  [A PURCHASING AND REGULATORY STRATEGY FOR THE 
  2.10  STATE OF MINNESOTA.] 
  2.11     The commissioners of health, employee relations, human 
  2.12  services, commerce, and labor and industry shall jointly develop 
  2.13  a united state purchasing and regulatory strategy.  The strategy 
  2.14  shall be developed in close consultation with private employers, 
  2.15  health plans, and other third-party purchasers.  The purchasing 
  2.16  and regulatory strategy must promote personal choice and 
  2.17  responsibility; must be designed to encourage and promote better 
  2.18  health of patients and state residents; and must seek to 
  2.19  strengthen the privately based health care insurance and health 
  2.20  care delivery system.  All state activities relating to the 
  2.21  purchase of health care and health coverage for public employees 
  2.22  and for persons eligible for state health care programs shall be 
  2.23  based on, and consistent with, the united purchasing strategy.  
  2.24  All state regulatory activities relating to health care services 
  2.25  and health care coverage shall also be based on, and consistent 
  2.26  with, the united strategy.  
  2.27     Sec. 4.  [STATE HEALTH CARE PROGRAMS.] 
  2.28     The commissioner of human services, in consultation with 
  2.29  the commissioner of employee relations, shall prepare a plan, 
  2.30  budget, timeline, and proposed legislation to consolidate and 
  2.31  reform the medical assistance, MinnesotaCare, and general 
  2.32  assistance medical care programs.  Under the reformed system, 
  2.33  low-income Minnesotans can receive public subsidy for health 
  2.34  care coverage.  A MinnesotaCare comprehensive health plan will 
  2.35  be used to provide health coverage for the lowest income 
  2.36  families, children, individuals, elderly, and disabled persons, 
  3.1   including those eligible for medical assistance, through a 
  3.2   state-administered program.  For individuals and families whose 
  3.3   incomes exceed the eligibility limits for the comprehensive 
  3.4   plan, the MinnesotaCare basic health plan will provide a subsidy 
  3.5   to defray the cost of individual or group coverage purchased 
  3.6   through employers or in the private market.  
  3.7      The commissioner of human services shall seek federal 
  3.8   waivers to allow a multiyear trial of the comprehensive and 
  3.9   basic health plans to qualify federal reimbursement of health 
  3.10  services covered under these plans.  Further, in consultation 
  3.11  with the commissioner of revenue, the commissioner of human 
  3.12  services shall prepare recommendations on how advanceable and 
  3.13  refundable tax credits could be used for health insurance 
  3.14  premium subsidies for enrollees in the MinnesotaCare basic 
  3.15  health plan.  
  3.16     Sec. 5.  [PURCHASING POOLS.] 
  3.17     The commissioners of health and commerce shall prepare a 
  3.18  plan for the creation of a public corporation to be established 
  3.19  to offer pooled health coverage to individuals and families that 
  3.20  do not have access to employer-subsidized health coverage or who 
  3.21  wish to purchase an individual insurance product.  The 
  3.22  purchasing pool or pools must offer two or more types of plans, 
  3.23  including at least one that is comparable to the typical small 
  3.24  employer insurance plan issued in Minnesota.  Consideration 
  3.25  shall also be given to creating such a purchasing pool under the 
  3.26  direction of the Minnesota Comprehensive Health Association.  
  3.27  The commissioners shall assess the advantages and disadvantages 
  3.28  of allowing small employers and public employers to participate 
  3.29  in the purchasing pool or pools.  A report on their findings and 
  3.30  recommendations shall be made to the legislature by February 1, 
  3.31  2005.  
  3.32     Sec. 6.  [UNIVERSAL PARTICIPATION IN THE HEALTH CARE 
  3.33  SYSTEM.] 
  3.34     The commissioner of health shall prepare a report 
  3.35  describing the feasibility of various options for assuring that 
  3.36  all Minnesota residents have health coverage, pay for coverage 
  4.1   according to their ability, and receive appropriate health care 
  4.2   services, including preventive care.  Among other options, the 
  4.3   commissioner shall analyze the feasibility of a requirement that 
  4.4   all residents must either maintain health coverage or else pay 
  4.5   into a fund to be used to pay for health care services for 
  4.6   uninsured persons.  
  4.7      Sec. 7.  [PROMOTING BETTER HEALTH.] 
  4.8      The commissioner of health, in consultation with public 
  4.9   health agencies, employers, health care organizations, and other 
  4.10  interested persons and organizations, shall prepare a Minnesota 
  4.11  health improvement plan for diabetes and coronary disease 
  4.12  prevention that identifies priorities for improving the health 
  4.13  of Minnesota residents and recommends strategies for statewide, 
  4.14  regional, and local public-private partnerships.  
  4.15     Sec. 8.  [HEALTH CARE QUALITY.] 
  4.16     Subdivision 1.  [STANDARDS AND QUALITY MEASUREMENT AND 
  4.17  REPORTING.] The commissioner of employee relations, in 
  4.18  cooperation with other commissioners of state agencies with 
  4.19  responsibilities relating to purchasing, regulating, and 
  4.20  providing health care services, shall identify the quality 
  4.21  measures and reporting requirements as developed by or are 
  4.22  endorsed by a private, nonprofit quality improvement 
  4.23  organization that must be included as the standards for 
  4.24  quality-related requirements in state contracts, plans, and 
  4.25  programs for the purchase of health care coverage and health 
  4.26  care services.  Contracts for such services must include payment 
  4.27  withholds relating to quality of care, for contracts entered 
  4.28  into on or after July 1, 2005.  The commissioners of health, 
  4.29  commerce, and labor and industry shall use these guidelines as 
  4.30  the standards for quality-related regulations and requirements 
  4.31  no later than July 1, 2005.  The commissioner of employee 
  4.32  relations shall submit to the legislature by December 1, 2004, 
  4.33  recommendations for legislative changes to laws relating to 
  4.34  state purchasing and regulation as needed to fully implement the 
  4.35  requirements in this section.  
  4.36     Subd. 2.  [MEASURING QUALITY.] To reduce administrative 
  5.1   costs and promote the use of accepted quality standards, the 
  5.2   commissioners of all state agencies engaged in the purchase of 
  5.3   or regulation of health care services shall base their program, 
  5.4   purchasing, and reporting requirements on quality measurements 
  5.5   and performance reports being used by an alliance of private and 
  5.6   public health service purchasers.  
  5.7      Subd. 3.  [ANNUAL REPORTS.] The commissioners shall 
  5.8   annually report to the legislature on their compliance with this 
  5.9   section and provide an explanation for any quality or contract 
  5.10  performance requirements or regulations imposed by a state 
  5.11  agency that differ from or are imposed in addition to 
  5.12  evidence-based, best practice guidelines identified by the 
  5.13  commissioner of health under this section.  
  5.14     Sec. 9.  [HEALTH CARE INFORMATION WEB SITE.] 
  5.15     The commissioner of health, in consultation with private 
  5.16  employers, third-party payers, providers, researchers, and 
  5.17  quality improvement organizations, shall develop and maintain a 
  5.18  health care information Web site that contains information on 
  5.19  health care costs and quality indicators in Minnesota.  Among 
  5.20  other things, the Web site should provide information and links 
  5.21  to enable consumers and policymakers to assess and compare the 
  5.22  measurement of quality and efficiency of Minnesota health care 
  5.23  providers and health plans.  
  5.24     Sec. 10.  [EFFECTIVE DATE.] 
  5.25     This act is effective the day following final enactment.