1.1                          A bill for an act 
  1.2             relating to health; establishing the Minnesota 
  1.3             Universal Health Board; creating the Minnesota 
  1.4             universal health program; establishing the Minnesota 
  1.5             health care trust fund; establishing statewide and 
  1.6             regional health care budgets; appropriating money; 
  1.7             proposing coding for new law in Minnesota Statutes, 
  1.8             chapter 62J; proposing coding for new law as Minnesota 
  1.9             Statutes, chapter 62K; repealing Minnesota Statutes 
  1.10            2002, section 62J.212. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12                             ARTICLE 1
  1.13                              PURPOSE
  1.14     Section 1.  [PURPOSE.] 
  1.15     The Minnesota Universal Health Board is created for the 
  1.16  purpose of providing a single, publicly financed, statewide 
  1.17  program to provide comprehensive coverage for all necessary 
  1.18  health care services for residents of Minnesota. 
  1.19                             ARTICLE 2
  1.20                          REGIONAL BOARDS
  1.21     Section 1.  [62J.091] [REGIONAL BOARDS.] 
  1.22     Subdivision 1.  [GENERAL DUTIES.] (a) The commissioner 
  1.23  shall divide the state into six regions, one of these regions 
  1.24  being the seven-county metropolitan area.  
  1.25     (b) Each region shall establish a regional board consisting 
  1.26  of consumers according to subdivision 2.  Regional boards may: 
  1.27     (1) undertake voluntary activities to educate consumers and 
  1.28  providers about community plans and projects promoting health 
  2.1   care cost containment, consumer accountability, access, and 
  2.2   quality and efforts to achieve public health goals; 
  2.3      (2) make recommendations to the commissioner regarding ways 
  2.4   of improving affordability, accessibility, and quality of health 
  2.5   care in the region and throughout the state; 
  2.6      (3) advise the Minnesota Universal Health Board on public 
  2.7   health goals, taking into consideration the relevant portions of 
  2.8   the community health service plans, plans required by the 
  2.9   Minnesota Comprehensive Adult Mental Health Act, the Minnesota 
  2.10  Comprehensive Children's Mental Health Act, and the Community 
  2.11  Social Service Act plans developed by county boards or community 
  2.12  health boards in the region under chapters 145A, 245, and 256E; 
  2.13     (4) prepare an annual regional education plan that is 
  2.14  consistent with and supportive of public health goals identified 
  2.15  by community health boards in the region; and 
  2.16     (5) serve as advisory bodies to identify potential 
  2.17  applicants for federal Health Professional Shortage Area and 
  2.18  federal Medically Underserved Area designation as requested by 
  2.19  the commissioner. 
  2.20     Subd. 2.  [MEMBERSHIP; TERMS.] (a) Each regional board 
  2.21  shall consist of one member per county as provided in this 
  2.22  subdivision and three members per county in the seven-county 
  2.23  metropolitan area.  A member may designate a representative to 
  2.24  act as a member of the board in the member's absence.  The board 
  2.25  shall appoint the chair of each regional board from among its 
  2.26  members. 
  2.27     (b) A member of a regional board must be a consumer who: 
  2.28     (1) does not have and in the past did not have a material 
  2.29  interest in the provision of health care services or in an 
  2.30  activity directly related to the provision of health care 
  2.31  services, such as health insurance sales or health plan 
  2.32  administration; 
  2.33     (2) is not responsible for or directly involved in the 
  2.34  purchasing of health insurance for a business or organization; 
  2.35     (3) is not a registered lobbyist in this state; and 
  2.36     (4) is at least 18 years old and a resident of Minnesota. 
  3.1      (c) An individual must apply to the county board in which 
  3.2   the individual resides to become a member of a regional board.  
  3.3   A county board shall elect its regional board member or members 
  3.4   from among eligible applicants.  Prior to electing a regional 
  3.5   board member, a county board must hold public hearings with all 
  3.6   eligible applicants, to include a statement by each applicant 
  3.7   and an opportunity for questioning by the county commissioners. 
  3.8      (d) The terms of the members are four years.  The chair of 
  3.9   each regional board shall designate as nearly as possible 
  3.10  one-fourth of the members to terms expiring each year. 
  3.11     Sec. 2.  [62J.10] [REGIONAL BOARD DUTIES.] 
  3.12     (a) Each regional board shall submit a recommended regional 
  3.13  budget to the commissioner by July 1, 2004.  Beginning July 1, 
  3.14  2004, and each July 1 thereafter, each regional board shall 
  3.15  submit the recommended regional budget to the Minnesota 
  3.16  Universal Health Board established under chapter 62K. 
  3.17     (b) Each regional budget must include the following: 
  3.18     (1) a budget for health maintenance organizations and for 
  3.19  each health plan network based on an estimated number of 
  3.20  patients and an estimated per capita cost; 
  3.21     (2) fee schedules for individual providers; 
  3.22     (3) a budget for institutional providers; and 
  3.23     (4) budgets for the expected cost of patients treated in 
  3.24  the region. 
  3.25     (c) Before the proposed regional budget is submitted to 
  3.26  either the commissioner or the Minnesota Universal Health Board, 
  3.27  a regional board shall hold a hearing or hearings after 
  3.28  providing public notice. 
  3.29     (d) A regional board shall utilize, when circumstances 
  3.30  warrant, task forces that address specific concerns, such as 
  3.31  regional issues or needs, concerns of specific communities or 
  3.32  constituencies, or public health concerns.  Membership of a task 
  3.33  force shall include consumers who are not members of the 
  3.34  regional board. 
  3.35     Sec. 3.  [62J.12] [BUDGET IMPLEMENTATION SCHEDULE.] 
  3.36     Subdivision 1.  [CALENDAR YEAR 2005 BUDGETS.] In carrying 
  4.1   out the duties required under section 62J.10, the following 
  4.2   schedule shall be followed by the commissioner and regional 
  4.3   boards: 
  4.4      (1) by August 1, 2005, each regional board shall submit to 
  4.5   the commissioner a recommended regional budget for health care 
  4.6   spending consisting of budgets for each of the accounts 
  4.7   specified in section 62K.09; and 
  4.8      (2) by November 1, 2005, the commissioner shall adopt 
  4.9   statewide and regional budgets for each of the accounts 
  4.10  specified in section 62K.09.  The budgets must also include fee 
  4.11  schedules for individual providers and budgets for institutional 
  4.12  providers to take effect January 1, 2006.  
  4.13     Subd. 2.  [2006 AND FUTURE YEARS.] The implementation 
  4.14  schedule for 2006 must be identical to the 2005 schedule except 
  4.15  that regional boards shall submit budgets to the Minnesota 
  4.16  Universal Health Board, not the commissioner of health.  The 
  4.17  implementation schedule for 2007 and all future years shall be 
  4.18  identical to the 2006 schedule except that the Minnesota 
  4.19  Universal Health Board, not the commissioner of health, shall 
  4.20  propose statewide and regional budgets by January 1, 2006. 
  4.21     Subd. 3.  [REPORT.] The Minnesota Universal Health Board 
  4.22  shall recommend in the annual report due January 1, 2006, 
  4.23  whether budgets should be set annually or biennially. 
  4.24     Sec. 4.  [EFFECTIVE DATE.] 
  4.25     Sections 1 to 3 are effective January 1, 2005. 
  4.26                             ARTICLE 3
  4.27                  MINNESOTA UNIVERSAL HEALTH BOARD
  4.28     Section 1.  [62K.01] [DEFINITIONS.] 
  4.29     Subdivision 1.  [SCOPE.] For purposes of this chapter, the 
  4.30  following terms have the meanings given them. 
  4.31     Subd. 2.  [BOARD.] "Board" means the Minnesota Universal 
  4.32  Health Board established under section 62K.02. 
  4.33     Subd. 3.  [COMMISSIONER.] "Commissioner" means the 
  4.34  commissioner of health. 
  4.35     Subd. 4.  [DEPARTMENT.] "Department" means the Department 
  4.36  of Health. 
  5.1      Subd. 5.  [FREESTANDING OUTPATIENT FACILITY.] "Freestanding 
  5.2   outpatient facility" means a health care facility, including, 
  5.3   but not limited to, an outpatient surgical center, a diagnostic 
  5.4   imaging facility, or a physician clinic, that is not physically 
  5.5   attached to a hospital and that provides for the care of human 
  5.6   beings. 
  5.7      Subd. 6.  [HEALTH PLAN COMPANY.] "Health plan company" 
  5.8   means a health plan company as defined in section 62Q.01, 
  5.9   subdivision 4.  
  5.10     Subd. 7.  [INDIVIDUAL PROVIDER.] "Individual provider" 
  5.11  means a health care provider licensed or registered by the state 
  5.12  who is not an institutional provider, as defined in subdivision 
  5.13  8. 
  5.14     Subd. 8.  [INSTITUTIONAL PROVIDER.] "Institutional 
  5.15  provider" means an inpatient hospital, nursing facility, 
  5.16  intermediate care facility for persons with mental retardation 
  5.17  and related conditions, and other providers of inpatient 
  5.18  services, including institutions providing inpatient or 
  5.19  overnight care and ambulatory diagnostic, treatment, and 
  5.20  surgical facilities. 
  5.21     Subd. 9.  [MEDICALLY NECESSARY.] "Medically necessary" 
  5.22  means a health service that is consistent with the recipient's 
  5.23  diagnosis or condition, recognized as the prevailing standard or 
  5.24  current practice by the provider's peer group, and: 
  5.25     (1) rendered to: 
  5.26     (i) treat an injury, illness, infection, or pain; 
  5.27     (ii) treat a condition that could result in physical or 
  5.28  mental disability; 
  5.29     (iii) care for a mother and child through a maternity 
  5.30  period; or 
  5.31     (iv) achieve a level of physical or mental function 
  5.32  consistent with prevailing community standards for diagnosis or 
  5.33  condition; or 
  5.34     (2) a preventive health service. 
  5.35     Subd. 10.  [PROGRAM.] "Program" means the Minnesota 
  5.36  universal health program established under this chapter and 
  6.1   administered by the Minnesota Universal Health Board. 
  6.2      Sec. 2.  [62K.02] [MINNESOTA UNIVERSAL HEALTH BOARD.] 
  6.3      Subdivision 1.  [ELIGIBILITY.] A member of the Minnesota 
  6.4   Universal Health Board must be a consumer who: 
  6.5      (1) does not have and in the past did not have a material 
  6.6   interest in the provision of health care services or in any 
  6.7   activity directly related to the provision of health care 
  6.8   services, such as health insurance sales or health plan 
  6.9   administration; 
  6.10     (2) is not responsible for or directly involved in the 
  6.11  purchasing of health insurance for a business or organization; 
  6.12  and 
  6.13     (3) is not a registered lobbyist in this state. 
  6.14     Subd. 2.  [COMPOSITION.] (a) The Minnesota Universal Health 
  6.15  Board shall consist of 12 members selected as follows: 
  6.16     (1) the chairs of each of the six regional boards 
  6.17  established under section 62J.091, or their designees; 
  6.18     (2) two persons appointed by the governor; 
  6.19     (3) two persons appointed by the chair of the senate Health 
  6.20  and Family Security Committee; and 
  6.21     (4) two persons appointed by the chair of the house Health 
  6.22  and Human Services Committee. 
  6.23     (b) The appointing authorities shall coordinate their 
  6.24  efforts, in order to ensure that the board composition reflects 
  6.25  the racial and ethnic diversity of the state and provides 
  6.26  representation for persons with disabilities. 
  6.27     Subd. 3.  [TERMS; COMPENSATION; REMOVAL; AND 
  6.28  VACANCIES.] The board is governed by section 15.0575, except 
  6.29  that board members shall receive salaries rather than per diems. 
  6.30     Subd. 4.  [ADMINISTRATION.] The commissioner shall provide 
  6.31  office space, equipment and supplies, and technical support to 
  6.32  the board. 
  6.33     Subd. 5.  [STAFF.] The board may hire an executive director 
  6.34  who serves in the unclassified service.  The executive director 
  6.35  may hire employees and consultants as authorized by the board 
  6.36  and may prescribe their duties.  The attorney general shall 
  7.1   provide legal services to the board. 
  7.2      Subd. 6.  [GENERAL DUTIES.] The board may: 
  7.3      (1) implement and administer the Minnesota universal health 
  7.4   program; 
  7.5      (2) estimate the current cost of universal coverage for all 
  7.6   Minnesotans; 
  7.7      (3) establish statewide and regional budgets that include 
  7.8   budgets for the accounts specified in section 62K.09; 
  7.9      (4) approve budgets for each region, including budgets for 
  7.10  the accounts specified in section 62K.09; 
  7.11     (5) establish fee schedules, which may vary to reflect 
  7.12  regional differences; 
  7.13     (6) approve budgets for institutional providers; 
  7.14     (7) approve capital expenditures for freestanding 
  7.15  outpatient facilities; 
  7.16     (8) monitor compliance with all budgets and fee schedules 
  7.17  and take action to achieve compliance to the extent authorized 
  7.18  by law; 
  7.19     (9) issue requests for proposals for a contract to process 
  7.20  claims submitted by individual providers; 
  7.21     (10) provide technical assistance to the regional boards 
  7.22  established under section 62J.091; 
  7.23     (11) administer the Minnesota health care trust fund 
  7.24  created under section 62K.07; 
  7.25     (12) monitor the operation of the Minnesota universal 
  7.26  health program through consumer surveys and regular data 
  7.27  collection and evaluation activities, including evaluations of 
  7.28  the adequacy and quality of services furnished under the 
  7.29  program, the need for changes in the benefit package, the cost 
  7.30  of each type of service, and the effectiveness of cost 
  7.31  containment measures under the program; 
  7.32     (13) develop and implement enrollment procedures for 
  7.33  providers and persons eligible for the program and disseminate, 
  7.34  to providers of services and to the public, information 
  7.35  concerning the program and the persons eligible to receive 
  7.36  benefits under the program; 
  8.1      (14) develop and implement cost containment and quality 
  8.2   assurance procedures, including a professional peer review 
  8.3   system; 
  8.4      (15) conduct necessary investigations and inquiries and 
  8.5   require the submission of information, documents, and records 
  8.6   the board considers necessary to carry out its duties under this 
  8.7   chapter; and 
  8.8      (16) conduct other activities the board considers necessary 
  8.9   to carry out the purposes of this chapter. 
  8.10     Subd. 7.  [ANNUAL REPORT.] The board shall present an 
  8.11  annual report to the legislature and the governor by January 1, 
  8.12  2004, and each succeeding January, summarizing the activities of 
  8.13  the board.  In the report due January 1, 2005, the board shall 
  8.14  recommend whether statewide and regional budgets should be set 
  8.15  annually or biennially. 
  8.16     Subd. 8.  [RULEMAKING.] The board may adopt rules as 
  8.17  necessary to carry out the duties assigned under this chapter. 
  8.18     Subd. 9.  [HEARINGS.] The board, after providing notice to 
  8.19  consumers, providers, and all other interested parties, may hold 
  8.20  hearings in connection with any action that it proposes to take 
  8.21  under subdivision 6. 
  8.22     Sec. 3.  [62K.05] [MINNESOTA UNIVERSAL HEALTH PROGRAM 
  8.23  IMPLEMENTATION SCHEDULE.] 
  8.24     (a) The board, through the commissioner, shall begin 
  8.25  planning and development for the Minnesota universal health 
  8.26  program.  The board shall use an implementation schedule that 
  8.27  will phase in enrollment for Minnesota residents, with initial 
  8.28  enrollment of eligible individuals and families beginning July 
  8.29  1, 2005.  All Minnesota residents without health insurance shall 
  8.30  be insured by January 1, 2006.  The health insurance that covers 
  8.31  all Minnesota residents shall be consolidated into the Minnesota 
  8.32  universal health program by January 1, 2007. 
  8.33     (b) In carrying out planning and development activities, 
  8.34  the board shall: 
  8.35     (1) begin initial enrollment of uninsured and underinsured 
  8.36  individuals and families with annual incomes of less than 275 
  9.1   percent of the federal poverty guideline who do not have 
  9.2   duplicative coverage through a federal, state, or private 
  9.3   insurance program or plan, by July 1, 2006; 
  9.4      (2) provide Medicare supplemental insurance, by July 1, 
  9.5   2006, to Medicare enrollees with annual incomes of less than 275 
  9.6   percent of the federal poverty guideline; 
  9.7      (3) enroll individuals and families with incomes at or 
  9.8   above 275 percent of the federal poverty guideline, and 
  9.9   individuals and families with incomes below 275 percent of the 
  9.10  federal poverty guidelines not eligible for enrollment under 
  9.11  clause (1), beginning January 1, 2007; 
  9.12     (4) provide Medicare supplemental insurance to Medicare 
  9.13  enrollees not eligible for enrollment under clause (2), 
  9.14  beginning January 1, 2007; 
  9.15     (5) merge the Minnesota universal health program, the 
  9.16  MinnesotaCare program, the general assistance medical care 
  9.17  program, and the services for children with handicaps program by 
  9.18  July 1, 2007, in a way that will not diminish the coverage 
  9.19  provided to participants in existing programs and without 
  9.20  increasing the financial obligations of public hospitals and 
  9.21  other providers that currently serve participants in these 
  9.22  programs; 
  9.23     (6) assume responsibility for the administration and 
  9.24  funding of appropriate components of maternal and child health 
  9.25  services currently administered by the commissioner and 
  9.26  coordinate outreach, patient education, case management, and 
  9.27  related activities with the maternal and child health program, 
  9.28  local public health departments, and nonprofit agencies, by July 
  9.29  1, 2007; 
  9.30     (7) merge the consolidated chemical dependency treatment 
  9.31  fund with the Minnesota universal health program by July 1, 
  9.32  2007; 
  9.33     (8) phase out the Minnesota Comprehensive Health 
  9.34  Association by July 1, 2007, in a way that will ensure that 
  9.35  Minnesota Comprehensive Health Association enrollees receive 
  9.36  comparable coverage through the Minnesota universal health 
 10.1   program; 
 10.2      (9) prohibit health plan companies, beginning January 1, 
 10.3   2007, from selling insurance that duplicates benefits provided 
 10.4   by the Minnesota universal health program, in a manner that 
 10.5   ensures continuity of coverage through the program as duplicate 
 10.6   coverage in the private market is prohibited; 
 10.7      (10) seek federal waivers in order to phase Medicare and 
 10.8   medical assistance recipients into the program by a target date 
 10.9   of January 1, 2007; and 
 10.10     (11) phase retirees with retiree health benefits into the 
 10.11  program by January 1, 2007. 
 10.12     Sec. 4.  [62K.07] [MINNESOTA HEALTH CARE TRUST FUND.] 
 10.13     Subdivision 1.  [ESTABLISHMENT.] The Minnesota health care 
 10.14  trust fund is established.  The fund shall consist of all money 
 10.15  obtained from general fund appropriations, state savings 
 10.16  resulting from state health program consolidation, federal 
 10.17  payments received as a result of any waiver or requirements 
 10.18  granted by the United States Secretary of Health and Human 
 10.19  Services under health care programs established under title 18 
 10.20  and title 19 of the Social Security Act, United States Code, 
 10.21  title 42, section 301, and any other money received by the 
 10.22  board.  The budgets of Minnesota state agencies shall remain 
 10.23  distinct from the Minnesota health care trust fund, except for 
 10.24  portions of those budgets that provide health care services that 
 10.25  are provided to all Minnesotans through the Minnesota universal 
 10.26  health program. 
 10.27     Subd. 2.  [RESERVES.] Beginning July 1, 2005, the amount of 
 10.28  reserves in the fund at any time must equal at least the amount 
 10.29  of expenditures from the fund during the entire three preceding 
 10.30  months. 
 10.31     Sec. 5.  [62K.09] [ACCOUNTS WITHIN MINNESOTA HEALTH CARE 
 10.32  TRUST FUND.] 
 10.33     Subdivision 1.  [PREVENTION ACCOUNT.] The prevention 
 10.34  account is created within the Minnesota health care trust fund.  
 10.35  Money in the account shall be used solely to establish and 
 10.36  maintain primary community prevention programs, including 
 11.1   preventive screening tests. 
 11.2      Subd. 2.  [HEALTH SERVICES ACCOUNT.] The health services 
 11.3   account is created within the Minnesota health care trust fund.  
 11.4   Money in the account shall be used solely to pay providers in 
 11.5   accordance with section 62K.19. 
 11.6      Subd. 3.  [CAPITAL ACCOUNT.] The capital account is created 
 11.7   within the Minnesota health care trust fund.  Money in the 
 11.8   account shall be used solely to: 
 11.9      (1) pay for the construction, renovation, and equipping of 
 11.10  health care institutions, including institutions providing 
 11.11  inpatient or overnight care and ambulatory diagnostic, 
 11.12  treatment, and surgical facilities; and 
 11.13     (2) provide health professionals serving in health care 
 11.14  shortage areas with assistance in repaying educational loans and 
 11.15  establishing medical practices. 
 11.16     Subd. 4.  [INTERPRETATION, COMMUNICATION, AND 
 11.17  TRANSPORTATION ACCOUNT.] The interpretation, communication, and 
 11.18  transportation account is created within the Minnesota health 
 11.19  care trust fund.  Money in the account shall be used to fund (1) 
 11.20  interpreter services, (2) communication and cooperation 
 11.21  improvement efforts, and (3) transportation projects to provide 
 11.22  access for patients unable to reach necessary services, 
 11.23  including projects that provide services at the residences of 
 11.24  patients unable to travel.  Money may be used to fund public 
 11.25  education programs and programs that encourage cooperation 
 11.26  between institutions funded on an annual basis that lead to more 
 11.27  efficient and effective use of health care resources.  All 
 11.28  expenditures must comply with rules approved by the board. 
 11.29     Subd. 5.  [PROGRAM ADMINISTRATION, EVALUATION, PLANNING, 
 11.30  AND ASSESSMENT ACCOUNT.] The program administration, evaluation, 
 11.31  planning, and assessment account is created within the Minnesota 
 11.32  health care trust fund.  Money in the account shall be used by 
 11.33  the board to monitor and improve the plan's effectiveness and 
 11.34  operations.  The board may establish grant programs, including 
 11.35  demonstration projects, for this purpose. 
 11.36     Subd. 6.  [MEDICAL RESEARCH ACCOUNT.] The medical research 
 12.1   account is created within the Minnesota health care trust fund.  
 12.2   Money in the account shall be used by the board to establish a 
 12.3   health care analysis unit.  The results of the unit's research 
 12.4   shall be used by the board to improve the quality of health care 
 12.5   provided under the Minnesota universal health program and to 
 12.6   make decisions about health benefits covered by the program.  
 12.7   The board may also establish grant programs, including 
 12.8   demonstration projects, for this purpose.  The board shall seek 
 12.9   federal and private funds to supplement this allocation. 
 12.10     Sec. 6.  [62K.11] [ELIGIBILITY.] 
 12.11     Subdivision 1.  [CITIZENSHIP; MIGRANT WORKERS.] (a) 
 12.12  Eligibility for coverage under the Minnesota universal health 
 12.13  program is limited to citizens of the United States and aliens 
 12.14  lawfully admitted for permanent residence or otherwise 
 12.15  permanently residing in the United States under the color of law.
 12.16     (b) Payment shall also be made for care and services that 
 12.17  are furnished to an alien, regardless of immigration status, if 
 12.18  the care and services are necessary for the treatment of an 
 12.19  emergency medical condition, except for organ transplants and 
 12.20  related care and services.  For purposes of this subdivision, 
 12.21  the term "emergency medical condition" means a medical 
 12.22  condition, including labor and delivery, that if not immediately 
 12.23  treated could cause a person physical or mental disability, 
 12.24  continuation of severe pain, or death. 
 12.25     Subd. 2.  [RESIDENTS RECEIVING CARE OUT OF STATE.] The 
 12.26  board may provide payment for out-of-state care provided to 
 12.27  Minnesota residents.  In determining whether payment is to be 
 12.28  made, the board shall determine the appropriateness of the care 
 12.29  provided, the availability of the service in Minnesota, and the 
 12.30  individual's medical condition and personal circumstances.  For 
 12.31  travel less than six months in length, the board shall establish 
 12.32  guidelines for covering services. 
 12.33     Subd. 3.  [NONRESIDENTS EMPLOYED IN MINNESOTA.] The board 
 12.34  may extend eligibility to nonresidents employed in Minnesota 
 12.35  using a sliding fee scale. 
 12.36     Subd. 4.  [NONRESIDENTS EMERGENCY CARE.] Nonresidents in 
 13.1   need of emergency services while in Minnesota shall be given 
 13.2   care and billed for the services provided. 
 13.3      Sec. 7.  [62K.13] [BENEFITS.] 
 13.4      Subdivision 1.  [GENERAL.] Every Minnesota resident 
 13.5   enrolled in the program is entitled to receive benefits for any 
 13.6   service covered under subdivision 2 that is medically necessary 
 13.7   to maintain the person's health, or necessary for the diagnosis 
 13.8   or treatment of, or rehabilitation following, an injury, 
 13.9   disability, or disease.  Services provided in Minnesota must be 
 13.10  provided by a health care provider who participates in the 
 13.11  program. 
 13.12     Subd. 2.  [COVERED SERVICES; GENERAL.] The program covers 
 13.13  the following services: 
 13.14     (1) acute health care; 
 13.15     (2) chronic health care; 
 13.16     (3) rehabilitative health care; 
 13.17     (4) preventive health services; 
 13.18     (5) outpatient health services; 
 13.19     (6) laboratory and x-ray services; 
 13.20     (7) home care and home health care support services; 
 13.21     (8) dental care; 
 13.22     (9) chiropractic care; 
 13.23     (10) inpatient and outpatient mental health care, including 
 13.24  care for serious and persistent mental illness; 
 13.25     (11) inpatient and outpatient chemical dependency 
 13.26  treatment; 
 13.27     (12) family planning services; 
 13.28     (13) medically necessary cosmetic surgery and 
 13.29  reconstructive surgery; 
 13.30     (14) public health services formerly provided through state 
 13.31  and local government; 
 13.32     (15) on or after January 1, 2008, long-term care; and 
 13.33     (16) other medically necessary services. 
 13.34     Subd. 3.  [COVERED SERVICES; PHARMACEUTICALS AND SUPPLIES.] 
 13.35  The program covers all pharmaceuticals and medical supplies 
 13.36  prescribed by a licensed practitioner, including prescription 
 14.1   drugs, pharmaceuticals and supplies for eye care, hearing aids, 
 14.2   orthopedic aids, home aids, and durable medical equipment. 
 14.3      Subd. 4.  [COVERED SERVICES; TYPE OF PRACTITIONER.] The 
 14.4   program covers medically necessary and appropriate services 
 14.5   provided by all licensed or registered health care 
 14.6   practitioners, as long as the services are within the scope of 
 14.7   practice and meet standards of quality assurance established by 
 14.8   the board.  Covered practitioners include, but are not limited 
 14.9   to, medical doctors, doctors of chiropractic, osteopathic 
 14.10  doctors, nurses, nurse practitioners, physician assistants, 
 14.11  dentists, optometrists, pharmacists, mental health providers, 
 14.12  chemical dependency counselors, certified nurse midwives, 
 14.13  nutritionists, practitioners of complementary and alternative 
 14.14  medicine, and physical therapists. 
 14.15     Subd. 5.  [COVERED SERVICES; SITE OF CARE.] The program 
 14.16  covers care provided in all settings approved by the board. 
 14.17     Subd. 6.  [SERVICES NOT COVERED.] The following services 
 14.18  are not covered: 
 14.19     (1) services that are not medically necessary; 
 14.20     (2) surgery for cosmetic purposes; and 
 14.21     (3) medical examinations conducted and medical reports 
 14.22  prepared for purchasing or renewing life insurance or 
 14.23  participating as a plaintiff or defendant in a civil action for 
 14.24  the recovery or settlement of damages. 
 14.25     Subd. 7.  [BENEFITS ADVISORY COMMITTEE; CHANGES IN COVERED 
 14.26  SERVICES.] (a) The board shall establish a benefits advisory 
 14.27  committee comprised of consumers, health care providers, experts 
 14.28  in medical ethics, and health science researchers to provide 
 14.29  recommendations regarding program benefits and limitations on 
 14.30  covered services.  The board shall ensure that the composition 
 14.31  of the committee reflects the racial and ethnic diversity of the 
 14.32  state and provides representation for persons with disabilities. 
 14.33  Persons serving on this committee are compensated as provided in 
 14.34  section 15.0575. 
 14.35     (b) The board may make changes in program benefits or place 
 14.36  limitations on covered services only after public hearing. 
 15.1      Subd. 8.  [CHOICE OF PROVIDERS.] An eligible person may 
 15.2   choose any provider licensed or registered in Minnesota, or an 
 15.3   alternative provider if referred by a licensed Minnesota 
 15.4   provider, including practitioners practicing on an independent 
 15.5   basis, in group practices, or in health maintenance 
 15.6   organizations.  
 15.7      Sec. 8.  [62K.15] [DUPLICATE COVERAGE PROHIBITED.] 
 15.8      Policies, plans, or contracts of health coverage issued, 
 15.9   sold, or renewed by health plan companies on or after January 1, 
 15.10  2006, must not offer benefits that duplicate coverage offered 
 15.11  under the Minnesota universal health program.  A policy, plan, 
 15.12  or contract may offer benefits that do not duplicate coverage 
 15.13  that is offered by the program. 
 15.14     Sec. 9.  [62K.17] [PROVIDER RESPONSIBILITIES.] 
 15.15     Subdivision 1.  [PROVIDER PARTICIPATION.] All licensed 
 15.16  providers shall be considered participants in the program unless 
 15.17  and until the provider notifies the board of a change in status. 
 15.18  Providers shall not bill patients for services covered under the 
 15.19  Minnesota universal health program.  The board shall provide 
 15.20  providers with notice of these requirements and adopt rules 
 15.21  necessary to allow for changes in provider status. 
 15.22     Subd. 2.  [NONDISCRIMINATION.] Participating providers 
 15.23  shall furnish services to all eligible persons, regardless of 
 15.24  race, color, income level, national origin, religion, sex, 
 15.25  sexual orientation, or other nonmedical criteria. 
 15.26     Subd. 3.  [PROVISION OF INFORMATION.] Upon the request of 
 15.27  the board, every provider shall furnish information that may 
 15.28  reasonably be required by the board to ensure or enhance 
 15.29  quality, reduce costs, eliminate fraud, estimate health care 
 15.30  spending, and set budgets.  A provider shall permit the board to 
 15.31  examine its records as necessary for verification of payment. 
 15.32     Sec. 10.  [62K.19] [PROVIDER REIMBURSEMENT.] 
 15.33     Subdivision 1.  [INSTITUTIONAL PROVIDERS.] (a) The 
 15.34  Minnesota universal health program shall pay the expenses of 
 15.35  institutional providers on the basis of annual budgets that are 
 15.36  approved by the board. 
 16.1      (b) An institutional provider shall negotiate an annual 
 16.2   budget with the regional board to cover its anticipated services 
 16.3   for the next year based on past performance and projected 
 16.4   changes in prices and service levels.  A physician or other 
 16.5   provider employed by an annually budgeted institutional provider 
 16.6   shall be paid through and in a manner determined by the 
 16.7   institutional provider. 
 16.8      Subd. 2.  [INDIVIDUAL PROVIDERS.] The board may reimburse 
 16.9   individual providers of health care services on a 
 16.10  fee-for-service basis.  The board shall annually negotiate the 
 16.11  fee schedule with the appropriate professional group.  In 
 16.12  developing fee schedules, the board may take into account 
 16.13  recognized geographic differences in cost of practice.  To the 
 16.14  greatest extent possible, fee schedule categories must include 
 16.15  payment for all procedures routinely performed for a given 
 16.16  diagnosis.  The board may require that certain high-risk or 
 16.17  specialized procedures be reimbursed only when performed in 
 16.18  certain institutions or by certain providers. 
 16.19     Subd. 3.  [BALANCE BILLING PROHIBITED.] A provider may not 
 16.20  charge rates that are higher than the negotiated reimbursement 
 16.21  level.  A provider may not charge separately for services 
 16.22  covered under section 62K.13. 
 16.23     Subd. 4.  [CAPITATED PAYMENTS.] A health maintenance 
 16.24  organization may elect to be reimbursed on a capitation basis in 
 16.25  place of fee-for-service reimbursement.  Payment on a capitation 
 16.26  basis does not cover inpatient services provided by a health 
 16.27  maintenance organization for institutional providers. 
 16.28     Sec. 11.  [62K.21] [RULES.] 
 16.29     The Minnesota Universal Health Board shall adopt rules to 
 16.30  establish a review and approval process for regional boards 
 16.31  established under chapter 62J.  
 16.32     Sec. 12.  [STUDY AND ASSESSMENT.] 
 16.33     The commissioner shall study statewide health care spending 
 16.34  to enable the Minnesota Universal Health Board and the regional 
 16.35  boards to establish and enforce the state and regional health 
 16.36  care budgets.  By January 1, 2005, the commissioner shall: 
 17.1      (1) assess health care capital needs and expenditures 
 17.2   statewide and within each region; and 
 17.3      (2) recommend to the Minnesota Universal Health Board and 
 17.4   the regional boards statewide and regional budgets, each 
 17.5   consisting of budgets for operating and capital expenditures and 
 17.6   fee schedules for health care providers and practitioners. 
 17.7      Sec. 13.  [FUNDING.] 
 17.8      Financing of the Minnesota universal health program shall 
 17.9   be through the consolidation of funding from existing state and 
 17.10  federal programs and a designated progressive income tax.  There 
 17.11  shall be no co-payments, deductibles, or other out-of-pocket 
 17.12  payments by individuals for services. 
 17.13     Sec. 14.  [APPROPRIATION.] 
 17.14     (a) $....... is appropriated from the general fund to the 
 17.15  Minnesota Universal Health Board to implement sections 1 to 11.  
 17.16  This appropriation is available until June 30, 2007, at which 
 17.17  time the board shall repay this amount to the general fund from 
 17.18  the Minnesota health care trust fund created in section 62K.07. 
 17.19     (b) $....... is appropriated from the general fund to the 
 17.20  commissioner of health for the fiscal year ending June 30, 2005, 
 17.21  to provide staffing for the regional boards. 
 17.22     Sec. 15.  [REPEALER.] 
 17.23     Minnesota Statutes 2002, section 62J.212, is repealed. 
 17.24     Sec. 16.  [EFFECTIVE DATE.] 
 17.25     Sections 1 to 7 and 9 to 11 are effective January 1, 2005.  
 17.26  Section 8 is effective January 1, 2007.