1.1 	A bill for an act
1.2 	relating to health; providing for rural pharmacy
1.3 	preservation; establishing a rural pharmacy grant
1.4 	program; modifying the rural loan forgiveness program;
1.5 	appropriating money; amending Minnesota Statutes 2004,
1.6 	section 144.1501, subdivisions 1, 2, 3; proposing
1.7 	coding for new law in Minnesota Statutes, chapter 144.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. [144.1476] RURAL PHARMACY PLANNING AND
1.10 	TRANSITION GRANT PROGRAM.
1.11 		Subdivision 1.Definitions. (a) For the purposes of this
1.12 	section, the following definitions apply.
1.13 	(b) "Eligible rural community" means:
1.14 	(1) a Minnesota community that is located in a rural area,
1.15 	as defined in the federal Medicare regulations, Code of Federal
1.16 	Regulations, title 42, section 405.1041; or 
1.17 	(2) a Minnesota community that has a population of less
1.18 	than 10,000, according to the United States Bureau of
1.19 	Statistics, and that is outside the seven-county metropolitan
1.20 	area, excluding the cities of Duluth, Mankato, Moorhead,
1.21 	Rochester, and St. Cloud.
1.22 	(c) "Health care provider" means a hospital, clinic,
1.23 	pharmacy, long-term care institution, or other health care
1.24 	facility that is licensed, certified, or otherwise authorized by
1.25 	the laws of this state to provide health care.
1.26 	(d) "Pharmacist" means an individual with a valid license
2.1 	issued under chapter 151 to practice pharmacy.
2.2 	(e) "Pharmacy" has the meaning given under section 151.01,
2.3 	subdivision 2.
2.4 		Subd. 2.Grants authorized; eligibility. (a) The
2.5 	commissioner of health shall establish a program to award grants
2.6 	to eligible rural communities or health care providers in
2.7 	eligible rural communities for planning, establishing, keeping
2.8 	in operation, or providing health care services that preserve
2.9 	access to prescription medications and the skills of a
2.10 	pharmacist according to sections 151.01 to 151.40.
2.11 	(b) To be eligible for a grant, an applicant must develop a
2.12 	strategic plan for preserving or enhancing access to
2.13 	prescription medications and the skills of a pharmacist.  At a
2.14 	minimum, a strategic plan must consist of:
2.15 	(1) a needs assessment to determine what pharmacy services
2.16 	are needed and desired by the community.  The assessment must
2.17 	include interviews with or surveys of area and local health
2.18 	professionals, local community leaders, and public officials;
2.19 	(2) an assessment of the feasibility of providing needed
2.20 	pharmacy services that identifies priorities and timelines for
2.21 	potential changes; and 
2.22 	(3) an implementation plan.
2.23 	(c) A grant may be used by a recipient that has developed a
2.24 	strategic plan to implement transition projects to modify the
2.25 	type and extent of pharmacy services provided, in order to
2.26 	reflect the needs of the community.  Grants may also be used by
2.27 	recipients:
2.28 	(1) to develop pharmacy practices that integrate pharmacy
2.29 	and existing health care provider facilities; or 
2.30 	(2) to establish a pharmacy provider cooperative or
2.31 	initiatives that maintain local access to prescription
2.32 	medications and the skills of a pharmacist.
2.33 		Subd. 3.Funding. Notwithstanding section 214.06,
2.34 	subdivision 1, any revenue collected by the Board of Pharmacy in
2.35 	excess of the board's expenditures shall be credited to a rural
2.36 	pharmacy grant account.  Money in the account is appropriated to
3.1 	the commissioner of health to issue grants under this section.
3.2 	No more than ten percent of the money appropriated may be used
3.3 	to pay for administrative expenses.
3.4 		Subd. 4.Consideration of grants. In determining which
3.5 	applicants shall receive grants under this section, the
3.6 	commissioner of health shall appoint a committee comprised of
3.7 	members with experience and knowledge about rural pharmacy
3.8 	issues including two rural pharmacists with a community pharmacy
3.9 	background, two health care providers from rural communities,
3.10 	one representative from a statewide pharmacist organization, and
3.11 	one representative of the Board of Pharmacy.  A representative
3.12 	of the commissioner may serve on the committee in an ex officio
3.13 	status.  In determining who shall receive a grant, the committee
3.14 	shall take into account:
3.15 	(1) improving or maintaining access to prescription
3.16 	medications and the skills of a pharmacist;
3.17 	(2) changes in service populations;
3.18 	(3) the extent community pharmacy needs are not currently
3.19 	met by other providers in the area;
3.20 	(4) the financial condition of the applicant;
3.21 	(5) the integration of pharmacy services into existing
3.22 	health care services; and 
3.23 	(6) community support.
3.24 		Subd. 5.Allocation of grants. (a) The commissioner
3.25 	shall establish a deadline for receiving applications and must
3.26 	make a final decision on the funding of each application within
3.27 	60 days of the deadline.  An applicant must apply no later than
3.28 	March 1 of each fiscal year for grants awarded for that fiscal
3.29 	year.  Each relevant community board has 30 days in which to
3.30 	review and comment to the commissioner on eligible applications.
3.31 	(b) Any grant awarded must not exceed $50,000 a year and
3.32 	may not exceed a one-year term.
3.33 	(c) Applicants may apply to the program each year they are
3.34 	eligible.
3.35 	(d) Project grants may not be used to retire debt incurred
3.36 	with respect to any capitol expenditure made prior to the date
4.1 	on which the project is initiated.
4.2 		Subd. 6.Evaluation. The grant program shall be
4.3 	evaluated annually in reports by the recipients of the grants.
4.4 	An academic institution that has the expertise in evaluating
4.5 	rural pharmacy outcomes may participate in the program
4.6 	evaluation if asked by a recipient or the commissioner.

4.7 	Sec. 2. Minnesota Statutes 2004, section 144.1501,
4.8 	subdivision 1, is amended to read:
4.9 		Subdivision 1.Definitions.  (a) For purposes of this
4.10 	section, the following definitions apply.
4.11 	(b) "Designated rural area" means:
4.12 	(1) an area in Minnesota outside the counties of Anoka,
4.13 	Carver, Dakota, Hennepin, Ramsey, Scott, and Washington,
4.14 	excluding the cities of Duluth, Mankato, Moorhead, Rochester,
4.15 	and St. Cloud; or
4.16 	(2) a municipal corporation, as defined under section
4.17 	471.634, that is physically located, in whole or in part, in an
4.18 	area defined as a designated rural area under clause (1).
4.19 	(c) "Emergency circumstances" means those conditions that
4.20 	make it impossible for the participant to fulfill the service
4.21 	commitment, including death, total and permanent disability, or
4.22 	temporary disability lasting more than two years.
4.23 	(d) "Medical resident" means an individual participating in
4.24 	a medical residency in family practice, internal medicine,
4.25 	obstetrics and gynecology, pediatrics, or psychiatry.
4.26 	(e) "Midlevel practitioner" means a nurse practitioner,
4.27 	nurse-midwife, nurse anesthetist, advanced clinical nurse
4.28 	specialist, or physician assistant.
4.29 	(f) "Nurse" means an individual who has completed training
4.30 	and received all licensing or certification necessary to perform
4.31 	duties as a licensed practical nurse or registered nurse.
4.32 	(g) "Nurse-midwife" means a registered nurse who has
4.33 	graduated from a program of study designed to prepare registered
4.34 	nurses for advanced practice as nurse-midwives.
4.35 	(h) "Nurse practitioner" means a registered nurse who has
4.36 	graduated from a program of study designed to prepare registered
5.1 	nurses for advanced practice as nurse practitioners.
5.2 	(i) "Pharmacist" means an individual with a valid license
5.3 	issued under chapter 151 to practice pharmacy.
5.4 	(j) "Physician" means an individual who is licensed to
5.5 	practice medicine in the areas of family practice, internal
5.6 	medicine, obstetrics and gynecology, pediatrics, or psychiatry.
5.7 	(j) (k) "Physician assistant" means a person registered
5.8 	under chapter 147A.
5.9 	(k) (l) "Qualified educational loan" means a government,
5.10 	commercial, or foundation loan for actual costs paid for
5.11 	tuition, reasonable education expenses, and reasonable living
5.12 	expenses related to the graduate or undergraduate education of a
5.13 	health care professional.
5.14 	(l) (m) "Underserved urban community" means a Minnesota
5.15 	urban area or population included in the list of designated
5.16 	primary medical care health professional shortage areas (HPSAs),
5.17 	medically underserved areas (MUAs), or medically underserved
5.18 	populations (MUPs) maintained and updated by the United States
5.19 	Department of Health and Human Services.

5.20 	Sec. 3. Minnesota Statutes 2004, section 144.1501,
5.21 	subdivision 2, is amended to read:
5.22 		Subd. 2.Creation of account.  A health professional
5.23 	education loan forgiveness program account is established.  The
5.24 	commissioner of health shall use money from the account to
5.25 	establish a loan forgiveness program for medical residents
5.26 	agreeing to practice in designated rural areas or underserved
5.27 	urban communities, for midlevel practitioners agreeing to
5.28 	practice in designated rural areas, and for nurses who agree to
5.29 	practice in a Minnesota nursing home or intermediate care
5.30 	facility for persons with mental retardation or related
5.31 	conditions, and for pharmacists who agree to practice in
5.32 	designated rural areas.  Appropriations made to the account do
5.33 	not cancel and are available until expended, except that at the
5.34 	end of each biennium, any remaining balance in the account that
5.35 	is not committed by contract and not needed to fulfill existing
5.36 	commitments shall cancel to the fund.

6.1 	Sec. 4. Minnesota Statutes 2004, section 144.1501,
6.2 	subdivision 3, is amended to read:
6.3 		Subd. 3.Eligibility.  (a) To be eligible to participate
6.4 	in the loan forgiveness program, an individual must:
6.5 	(1) be a medical resident or a licensed pharmacist or be
6.6 	enrolled in a midlevel practitioner, registered nurse, or a 
6.7 	licensed practical nurse training program; and
6.8 	(2) submit an application to the commissioner of health.
6.9 	(b) An applicant selected to participate must sign a
6.10 	contract to agree to serve a minimum three-year full-time
6.11 	service obligation according to subdivision 2, which shall begin
6.12 	no later than March 31 following completion of required training.

6.13 	Sec. 5. APPROPRIATION.
 6.14 	$200,000 in fiscal year 2006 and $200,000 in fiscal year
6.15 	2007 are appropriated from the health occupations licensing
6.16 	account in the special revenue fund to the commissioner of
6.17 	health for purposes of Minnesota Statutes, section 144.1476.
6.18 	This is a onetime appropriation.