1.1 	A bill for an act
1.2 	relating to health; establishing evidence-based practice standards; requiring a 
1.3 	report on uncompensated care and reporting on acquired infections; authorizing 
1.4 	a study on alternative and complimentary health care; permitting discounted 
1.5 	health care payments under certain circumstances; modifying provisions in the 
1.6 	public employees insurance program; modifying private sector health coverage 
1.7 	provisions; allowing service cooperatives to contract for goods and services 
1.8 	under certain conditions; adding a provision for medical liability; amending 
1.9 	Minnesota Statutes 2004, sections 43A.316, subdivisions 1, 2, 3, 4, 5, 6, 6a, 7, 8, 
1.10 	10, by adding subdivisions; 62D.095, subdivisions 3, 4, by adding a subdivision; 
1.11 	72A.20, by adding a subdivision; 123A.21, subdivision 7; 144.698, by adding a 
1.12 	subdivision; 151.214, subdivision 1; 471.61, by adding a subdivision; 471.617, 
1.13 	subdivision 3, by adding a subdivision; Minnesota Statutes 2005 Supplement, 
1.14 	section 214.071; proposing coding for new law in Minnesota Statutes, chapters 
1.15 	62J; 62M; 62Q; 144; 214; 604; repealing Minnesota Statutes 2005 Supplement, 
1.16 	section 62Q.251.
1.17 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.18 	ARTICLE 1
1.19 	HEALTH CARE COST-CONTAINMENT

1.20 	Section 1. [62J.431] EVIDENCE-BASED PRACTICE STANDARDS AND 
1.21 	GUIDELINES.
1.22 		Subdivision 1.Health-related boards and provider organizations; practice 
1.23 	standards. The health-related boards, under chapter 148, or professional provider 
1.24 	organizations may establish practice standards for treating patients within their respective 
1.25 	scopes of practice. The boards or provider organizations may utilize the services of 
1.26 	appropriate public or private entities to facilitate the development or review of practice 
1.27 	standards and evidence-based guidelines. Each board or provider organization that has 
1.28 	established or ratified existing standards shall report these standards to the legislative 
2.1 	committees with jurisdiction over the public health occupations by January 15, 2007, and 
2.2 	shall report subsequent changes annually thereafter. If a board or provider organization 
2.3 	has existing standards, nothing in this section requires a board or provider organization to 
2.4 	establish new standards. Nothing in this section shall require a health plan company to 
2.5 	cover treatments, testing, or imaging, based on standards developed under this section.
2.6 		Subd. 2.Criteria for evidence-based guidelines. Guidelines identified under this 
2.7 	section must meet the following criteria:
2.8 	(1) the scope and application are clear;
2.9 	(2) authorship is stated and any conflicts of interest disclosed;
2.10 	(3) authors represent all pertinent clinical fields or other means of input have been 
2.11 	used;
2.12 	(4) the development process is explicitly stated;
2.13 	(5) the guideline is grounded in evidence;
2.14 	(6) the evidence is cited and graded;
2.15 	(7) the document itself is clear and practical;
2.16 	(8) the document is flexible in use, with exceptions noted or provided for with 
2.17 	general statements;
2.18 	(9) measures are included for use in systems improvement; and
2.19 	(10) the guideline has scheduled reviews and updating.

2.20 	Sec. 2. [62J.62] ELECTRONIC BILLING ASSISTANCE.
2.21 	The commissioner of human services shall, out of existing resources, encourage and 
2.22 	assist providers to adopt and use electronic billing for state programs, including but not 
2.23 	limited to the provision of training.

2.24 	Sec. 3. [62J.85] PROVISION OF INFORMATION ON PHARMACEUTICAL 
2.25 	ASSISTANCE PROGRAMS.
2.26 	A medical clinic must make available to patients, in a public area of the clinic, 
2.27 	brochures on programs offered by pharmaceutical manufacturers that provide free or 
2.28 	discounted drugs or provide coverage for prescription drugs. This requirement applies 
2.29 	only to brochures that are made available to clinics free of charge by pharmaceutical 
2.30 	manufacturers.  If a Web site is developed that provides this information, a public posting 
2.31 	describing the Web site complies with this requirement.

2.32 	Sec. 4. [62M.071] PRIOR AUTHORIZATION.
3.1 	Health plan companies, in cooperation with health care providers, shall review prior 
3.2 	authorization procedures administered by utilization review organizations and health plan 
3.3 	companies, to ensure the cost-effective use of prior authorization and minimization of 
3.4 	provider, clinic, and central office administrative burden.

3.5 	Sec. 5. [62M.072] USE OF EVIDENCE-BASED STANDARDS.
3.6 	If no independently developed evidence-based standards exist for a particular 
3.7 	treatment, testing, or imaging procedure, then an insurer or utilization review organization 
3.8 	shall not deny coverage of the treatment, testing, or imaging based solely on the grounds 
3.9 	that the treatment, testing, or imaging does not meet an evidence-based standard. 

3.10 	Sec. 6. [62Q.676] MEDICATION THERAPY MANAGEMENT CARE.
3.11 	(a) A health plan company or pharmacy benefit manager that provides prescription 
3.12 	drug coverage must provide or arrange for medication therapy management services for 
3.13 	enrollees taking four or more prescriptions to treat or prevent two or more chronic medical 
3.14 	conditions. For purposes of this section, "medication therapy management" means the 
3.15 	provision of the following pharmaceutical care services by a licensed pharmacist or a 
3.16 	physician licensed under chapter 147 to optimize the therapeutic outcomes of the patient's 
3.17 	medications: 
3.18 	(1) performing or obtaining necessary assessments of the patient's health status in 
3.19 	compliance with applicable health data privacy laws;  
3.20 	(2) formulating a medication treatment plan;  
3.21 	(3) monitoring and evaluating the patient's response to therapy, including safety 
3.22 	and effectiveness;  
3.23 	(4) performing a comprehensive medication review to identify, resolve, and prevent 
3.24 	medication related problems, including adverse drug events;  
3.25 	(5) documenting the care delivered and communicating essential information to 
3.26 	the patient's other primary care providers;  
3.27 	(6) providing verbal education and training designed to enhance patient 
3.28 	understanding and appropriate use of the patient's medications;  
3.29 	(7) providing information, support services, and resources designed to enhance 
3.30 	patient adherence with the patient's therapeutic regimens; and  
3.31 	(8) coordinating and integrating medication therapy management services within the 
3.32 	broader health care management services being provided to the patient.  
3.33 	(b) Nothing in this section shall be construed to expand or modify the scope of 
3.34 	practice of the pharmacist as  defined in section 151.01, subdivision 27.  

4.1 	Sec. 7. [144.0506] AGENCY WEB SITES.
4.2 		Subdivision 1.Information to be posted. The commissioner of health may post the 
4.3 	following information on agency Web sites, including minnesotahealthinfo.com: 
4.4 	(1) healthy lifestyle and preventive health care information, organized by sex and 
4.5 	age, with procedures and treatments categorized by level of effectiveness and reliability of 
4.6 	the supporting evidence on effectiveness;  
4.7 	(2) health plan company administrative efficiency report cards;
4.8 	(3) health care provider charges for common procedures, based on information 
4.9 	available under section 62J.052;  
4.10 	(4) evidence-based medicine guidelines and related information for use as resources 
4.11 	by health care professionals, and summaries of the guidelines and related information for 
4.12 	use by patients and consumers;  
4.13 	(5) resources and Web links related to improving efficiency in medical clinics and 
4.14 	health care professional practices; and 
4.15 	(6) lists of nonprofit and charitable entities that accept donations of used medical 
4.16 	equipment and supplies, such as crutches and walkers.
4.17 		Subd. 2.Other Internet resources. The commissioner of health, in implementing 
4.18 	subdivision 1, shall include relevant Web links and materials from private sector and other 
4.19 	government sources, in order to avoid duplication and reduce state administrative costs.
4.20 		Subd. 3.Cooperation with commissioner of commerce. The commissioner of 
4.21 	health shall consult and work in cooperation with the commissioner of commerce when 
4.22 	posting on the Web site information collected from health plan companies regulated by 
4.23 	the commissioner of commerce.

4.24 	Sec. 8. Minnesota Statutes 2004, section 144.698, is amended by adding a subdivision 
4.25 	to read:
4.26 		Subd. 6.Reporting on uncompensated care. (a) A report on the services provided 
4.27 	to benefit the community, as required under subdivision 1, clause (5), must report charity 
4.28 	care in compliance with the following requirements:
4.29 	(1) For a facility to report amounts as charity care adjustments, the facility must: 
4.30 	(i) generate and record a charge; 
4.31 	(ii) have a policy on the provision of charity care that contains specific eligibility 
4.32 	criteria and is communicated or made available to patients; 
4.33 	(iii) have made a reasonable effort to identify a third-party payer, encourage the 
4.34 	patient to enroll in public programs, and, to the extent possible, aid the patient in the 
4.35 	enrollment process; and 
5.1 	(iv) ensure that the patient meets the charity care criteria of this subdivision. 
5.2 	(2) In determining whether to classify care as charity care, the facility must consider 
5.3 	the following: 
5.4 	(i) charity care may include services that the provider is obligated to render 
5.5 	independently of the ability to collect; 
5.6 	(ii) charity care may include care provided to patients who meet the facility's charity 
5.7 	care guidelines and have partial coverage, but who are unable to pay the remainder of their 
5.8 	medical bills, but this does not apply to that portion of the bill that has been determined to 
5.9 	be the patient's responsibility after a partial charity care classification by the facility; 
5.10 	(iii) charity care may include care provided to low-income patients who may qualify 
5.11 	for a public health insurance program and meet the facility's eligibility criteria for charity 
5.12 	care, but who do not complete the application process for public insurance despite the 
5.13 	facility's reasonable efforts; 
5.14 	(iv) charity care may include care to individuals whose eligibility for charity care 
5.15 	was determined through third-party services for information gathering purposes only; 
5.16 	(v) charity care does not include contractual allowances, which is the difference 
5.17 	between gross charges and payments received under contractual arrangements with 
5.18 	insurance companies and payers; 
5.19 	(vi) charity care does not include bad debt; 
5.20 	(vii) charity care does not include what may be perceived as underpayments for 
5.21 	operating public programs; 
5.22 	(viii) charity care does not include unreimbursed costs of basic or clinical research 
5.23 	or professional education and training; 
5.24 	(ix) charity care does not include professional courtesy discounts; 
5.25 	(x) charity care does not include community service or outreach activities; and 
5.26 	(xi) charity care does not include services for patients against whom collection 
5.27 	actions were taken that resulted in a financial obligation documented on a patient's credit 
5.28 	report with credit bureaus.
5.29 	(3) When reporting charity care adjustments, the facility must report total dollar 
5.30 	amounts and the number of contacts between a patient and a health care provider during 
5.31 	which a service is provided for the following categories: 
5.32 	(i) care to patients with family incomes at or below 275 percent of the federal 
5.33 	poverty guideline; 
5.34 	(ii) care to patients with family incomes above 275 percent of the federal poverty 
5.35 	guideline; and 
6.1 	(iii) care to patients when the facility, with reasonable effort, is unable to determine 
6.2 	family incomes.
6.3 	(b) For the report required under subdivision 1, clause (5), the facility must, in 
6.4 	determining whether to classify care as a bad debt expense:
6.5 	(1) presume that a patient is able and willing to pay until and unless the facility has 
6.6 	reason to consider the care as a charity care case under its charity care policy and the 
6.7 	facility classifies the care as a charity care case; and
6.8 	(2) include as a bad debt expense any unpaid deductibles, coinsurance, co-payments, 
6.9 	noncovered services, and other unpaid patient responsibilities.

6.10 	EFFECTIVE DATE. This section is effective for facility fiscal years ending on or 
6.11 	after December 31, 2006.

6.12 	Sec. 9. Minnesota Statutes 2004, section 151.214, subdivision 1, is amended to read:
6.13 		Subdivision 1.Explanation of pharmacy benefits. A pharmacist licensed under 
6.14 	this chapter must provide to a patient, for each prescription dispensed where part or all 
6.15 	of the cost of the prescription is being paid or reimbursed by an employer-sponsored 
6.16 	plan or health plan company, or its contracted pharmacy benefit manager, the patient's 
6.17 	co-payment amount and the pharmacy's own usual and customary price of the prescription 
6.18 	or the amount the pharmacy will be paid for the prescription drug by the patient's 
6.19 	employer-sponsored plan or health plan company, or its contracted pharmacy benefit 
6.20 	manager.

6.21 	Sec. 10. Minnesota Statutes 2005 Supplement, section 214.071, is amended to read:
6.22 	214.071 HEALTH BOARDS; DIRECTORY OF LICENSEES.
6.23 	Each health health-related licensing board under chapters 147, 148, 148B, and 150A, 
6.24 	as defined in section 214.01, subdivision 2, shall establish a directory of licensees that 
6.25 	includes biographical data for each licensee.

6.26 	Sec. 11. [214.121] PRICE DISCLOSURE REMINDER.
6.27 	Each health-related licensing board shall at least annually inform and remind its 
6.28 	licensees of the price disclosure requirements of section 62J.052 or 151.214, as applicable, 
6.29 	through the board's regular means of communicating with its licensees.

6.30 	Sec. 12. REPORTING OF ACQUIRED INFECTIONS.
 7.1 	(a) The commissioner of health may consult with infection control specialists, 
7.2 	health care facility representatives, and consumers, for the purpose of obtaining 
7.3 	recommendations regarding a determination of the need for action to implement health 
7.4 	care associated infection control reporting in hospitals and nursing homes. If the outcome 
7.5 	of the determination warrants, the commissioner shall consult with the group regarding: 
7.6 	(1) the selection of reporting measures relating to health care associated infections;  
7.7 	(2) design, implementation, validation, and ongoing evaluation of the reporting 
7.8 	system; and  
7.9 	(3) ensuring that the reporting measures remain flexible and adaptable to changing 
7.10 	national standards.  
7.11 	(b) If the commissioner determines that there is a need for the action described in 
7.12 	paragraph (a), the commissioner shall make written  recommendations to the legislature. 

7.13 	Sec. 13. COST CONTAINMENT STUDIES.
 7.14 		Subdivision 1.Alternative and complementary health care. The commissioner of 
7.15 	human services, through the medical director and in consultation with the health services 
7.16 	policy committee established under Minnesota Statutes, section 256B.0625, subdivision 
7.17 	3c, shall study the potential for improving quality and obtaining cost savings through 
7.18 	greater use of alternative and complementary treatment methods that are supported by the 
7.19 	findings of evidence-based research, and shall incorporate these methods into the medical 
7.20 	assistance, MinnesotaCare, and general assistance medical care programs as appropriate.
7.21 		Subd. 2.Studies related to universal participation and access to care. The 
7.22 	commissioners of human services and health shall study the adequacy of the current 
7.23 	system of community health care clinics and centers both statewide, and in urban areas 
7.24 	with significant disparities in health status and access to services across racial and ethnic 
7.25 	groups. The commissioners shall evaluate:
7.26 	(1) methods to provide 24-hour availability of care through the clinics and centers;
7.27 	(2) methods to expand the availability of care through the clinics and centers;
7.28 	(3) the use of health care access fund grants to expand the number of clinics and 
7.29 	centers, the services provided, and the availability of care; and
7.30 	(4) the extent to which increased use of physician assistants, nurse practitioners, 
7.31 	medical residents and interns, and other allied health professionals in clinics and centers 
7.32 	would increase the availability of services.

8.1 	ARTICLE 2
8.2 	CHARITY CARE BY HEALTH CARE PROVIDERS

8.3 	Section 1. [62J.83] REDUCED PAYMENT AMOUNTS PERMITTED.
8.4 	(a) Notwithstanding any provision of chapter 148 or any other provision of law to 
8.5 	the contrary, a health care provider may provide care to a patient at a discounted payment 
8.6 	amount, including care provided for free.
8.7 	(b) This section does not apply in a situation in which the discounted payment 
8.8 	amount is not permitted under federal law.

8.9 	Sec. 2. Minnesota Statutes 2004, section 72A.20, is amended by adding a subdivision 
8.10 	to read:
8.11 		Subd. 39.Discounted payments by health care providers; effect on use of 
8.12 	usual and customary payments. An insurer, including, but not limited to, a health plan 
8.13 	company as defined in section 62Q.01, subdivision 4; a reparation obligor as defined in 
8.14 	section 65B.43, subdivision 9; and a workers' compensation insurer shall not consider in 
8.15 	determining a health care provider's usual and customary payment, standard payment, or 
8.16 	allowable payment used as a basis for determining the provider's payment by the insurer, 
8.17 	the following discounted payment situations:
8.18 	(1) care provided to relatives of the provider;
8.19 	(2) care for which a discount or free care is given in hardship situations; and
8.20 	(3) care for which a discount is given in exchange for cash payment.
8.21 	For purposes of this subdivision, "health care provider" and "provider" have the 
8.22 	meaning given in section 62J.03, subdivision 8.

8.23 	Sec. 3.  REPEALER.
 8.24 	Minnesota Statutes 2005 Supplement, section 62Q.251, is repealed.

8.25 	Sec. 4. EFFECTIVE DATE.
 8.26 	Sections 1 to 3 are effective the day following final enactment.

8.27 	ARTICLE 3
8.28 	PUBLIC EMPLOYEES INSURANCE PROGRAM

8.29 	Section 1. Minnesota Statutes 2004, section 43A.316, subdivision 1, is amended to 
8.30 	read:
9.1 		Subdivision 1.Intent. The legislature finds that the creation of a statewide program 
9.2 	to provide public employees and other eligible persons with life insurance and hospital, 
9.3 	medical, and dental benefit coverage through provider organizations would result in a 
9.4 	greater utilization more efficient use of government resources and would advance the 
9.5 	health and welfare of the citizens of the state.

9.6 	Sec. 2. Minnesota Statutes 2004, section 43A.316, subdivision 2, is amended to read:
9.7 		Subd. 2.Definitions. For the purpose of this section, the terms defined in this 
9.8 	subdivision have the meaning given them.
9.9 	(a)  Commissioner. "Commissioner" means the commissioner of employee relations. 
9.10 	(b)  Employee. "Employee" means: 
9.11 	(1) a person who is a public employee within the definition of section  179A.03, 
9.12 	subdivision 14, who is insurance eligible and is employed by an eligible employer; 
9.13 	(2) an elected public official of an eligible employer who is insurance eligible;
9.14 	(3) a person employed by a labor organization or employee association certified as 
9.15 	an exclusive representative of employees of an eligible employer or by another public 
9.16 	employer approved by the commissioner, so long as the plan meets the requirements of a 
9.17 	governmental plan under United States Code, title 29, section 1002(32); or
9.18 	(4) a person employed by a county or municipal hospital.
9.19 	(c)  Eligible employer. "Eligible employer" means: 
9.20 	(1) a public employer within the definition of section  179A.03, subdivision 15, that 
9.21 	is a town, county, city, school district as defined in section  120A.05, service cooperative 
9.22 	as defined in section  123A.21, intermediate district as defined in section  136D.01, 
9.23 	Cooperative Center for Vocational Education as defined in section  123A.22, regional 
9.24 	management information center as defined in section  123A.23, or an education unit 
9.25 	organized under the joint powers action, section  471.59; or 
9.26 	(2) an exclusive representative of employees, as defined in paragraph (b);
9.27 	(3) a county or municipal hospital; or
9.28 	(4) another public employer approved by the commissioner.
9.29 	(d)  Exclusive representative. "Exclusive representative" means an exclusive 
9.30 	representative as defined in section  179A.03, subdivision 8. 
9.31 	(e)  Labor-Management Committee. "Labor-Management Committee" means the 
9.32 	committee established by subdivision 4. 
9.33 	(f)  Program. "Program" means the statewide public employees insurance buyers 
9.34 	group program created by subdivision 3. 

10.1 	Sec. 3. Minnesota Statutes 2004, section 43A.316, subdivision 3, is amended to read:
10.2 		Subd. 3.Public employee insurance buyers group program. The commissioner 
10.3 	shall be the administrator of the public employee insurance buyers group program 
10.4 	and may determine its funding arrangements. The commissioner may contract with a 
10.5 	qualified entity to perform the administrative functions. The commissioner shall model 
10.6 	the program after the plan established in section  43A.18, subdivision 2, but may modify
10.7 	adopt variations from that plan, in consultation with the Labor-Management Committee.
10.8 	The variations may include different deductibles, coinsurance, co-pays, or other enrollee 
10.9 	cost-sharing provisions. The commissioner may:
10.10 	(1) develop and administer separately or jointly rated programs within the public 
10.11 	buyers group program, including a separately or jointly rated and administered program 
10.12 	for employees of public school districts. Separate programs within the public buyers 
10.13 	group program may be pilot or demonstration programs, or permanent programs;
10.14 	(2) develop, implement, and administer demonstration or pilot programs to help 
10.15 	explore methods for improving the effectiveness and value of the public buyers group 
10.16 	program;
10.17 	(3) conduct evaluations and studies to determine the effectiveness and impact of 
10.18 	pilot, demonstration, or other programs as part of the public buyers group program;
10.19 	(4) develop, adopt, modify, and implement strategies to control health care costs 
10.20 	and to improve health care outcomes, including, but not limited to, health care cost and 
10.21 	quality measurement and reporting strategies, pay-for-performance strategies, value-based 
10.22 	purchasing strategies, use of complementary and alternative care, and other demonstrated 
10.23 	or emerging best practices in health care purchasing;
10.24 	(5) in consultation with the labor management committee in subdivision 4, develop, 
10.25 	adopt, modify, and administer innovative health benefit designs, including possible tiered 
10.26 	arrangements, high deductible plans with health care savings accounts, special provider 
10.27 	networks, incentive programs for healthy behaviors and health improvement, and other 
10.28 	health benefit designs;
10.29 	(6) temporarily suspend or limit new entrant groups into the public buyers group 
10.30 	program if necessary to maintain the quality, effectiveness, and viability of the program;
10.31 	(7) participate as part of broader community, regional, or national alliances or 
10.32 	initiatives, including joint public-private sector efforts to improve health care purchasing, 
10.33 	health care costs, quality, and outcomes; and
10.34 	(8) use and submit additional information to the existing Web site 
10.35 	minnesotahealthinfo.org to provide members and the public with information and a means 
10.36 	to make inquiries to the public buyers group program.

11.1 	Sec. 4. Minnesota Statutes 2004, section 43A.316, is amended by adding a subdivision 
11.2 	to read:
11.3 		Subd. 3a.Health improvement programs. The commissioner is authorized to plan, 
11.4 	develop, purchase, administer, and evaluate disease management and other programs, 
11.5 	strategies, and incentives to improve the health and health outcomes of members.

11.6 	Sec. 5. Minnesota Statutes 2004, section 43A.316, subdivision 4, is amended to read:
11.7 		Subd. 4.Labor-Management Committee. (a) The Labor-Management Committee 
11.8 	consists of ten members appointed by the commissioner. The Labor-Management 
11.9 	Committee must comprise five members who represent employees, including at least 
11.10 	one retired employee, and five members who represent eligible employers. Committee 
11.11 	members are eligible for expense reimbursement in the same manner and amount as 
11.12 	authorized by the commissioner's plan adopted under section  43A.18, subdivision 2. The 
11.13 	commissioner shall consult with the labor-management committee in major decisions 
11.14 	that affect the program. The committee shall study issues and make recommendations
11.15 	relating to the insurance program including, but not limited to, flexible benefits, utilization 
11.16 	review, quality assessment, and cost efficiency. The committee continues to exist while 
11.17 	the program remains in operation. 
11.18 	(b) The five members of the Labor-Management Committee who represent 
11.19 	employees must be chosen by the commissioner from among persons nominated 
11.20 	as provided in this paragraph. Exclusive representatives of employees of counties, 
11.21 	cities, school districts, and townships are entitled to nominate two candidates for the 
11.22 	Labor-Management Committee from each of those four categories, and the commissioner 
11.23 	shall appoint one of those two nominees from each category. The commissioner shall 
11.24 	choose the fifth employee to represent retired employees.
11.25 	(c) The five members of the Labor-Management Committee who represent employers 
11.26 	must be chosen by the commissioner from among persons nominated as provided in 
11.27 	this paragraph. The Association of Minnesota Counties, Minnesota League of Cities, 
11.28 	Minnesota School Boards Association, and the Minnesota Association of Townships are 
11.29 	each entitled to nominate two candidates for the committee, and the commissioner shall 
11.30 	appoint one of those from each group. The commissioner shall select the fifth employer 
11.31 	member from an employer participating in the program and not represented by the other 
11.32 	four employer members, if any, or if that is not reasonably possible, the commissioner 
11.33 	may appoint any other person as the fifth employer representative.

11.34 	Sec. 6. Minnesota Statutes 2004, section 43A.316, subdivision 5, is amended to read:
12.1 		Subd. 5.Public employee participation. (a) Participation in the program is subject 
12.2 	to the conditions in this subdivision.
12.3 	(b) Each exclusive representative for an eligible employer determines whether the 
12.4 	employees it represents will participate in the program. The exclusive representative 
12.5 	shall make that decision with the advice of a health coverage study group appointed by 
12.6 	the exclusive representative. The group must be appointed no later than 90 days before 
12.7 	the expiration date of the collective bargaining agreement preceding the date of entry 
12.8 	into the program. The exclusive representative shall give the employer notice of intent 
12.9 	to participate at least 30 60 days before the expiration date of the collective bargaining 
12.10 	agreement preceding the collective bargaining agreement that covers the date of entry 
12.11 	into the program. Either all or none of the employees represented by an exclusive 
12.12 	representative who participate in the employer's plan must participate in the program. The 
12.13 	exclusive representative and the eligible employer shall give notice to the commissioner 
12.14 	of the determination to participate in the program at least 30 60 days before entry into 
12.15 	the program. Entry into the program is governed by a schedule established by the 
12.16 	commissioner.
12.17 	(c) Employees not represented by exclusive representatives may become members 
12.18 	of the program upon a determination of an eligible employer to include these employees 
12.19 	in the program. Either all or none of the employer's unrepresented employees who 
12.20 	participate in the employer's plan must participate in the program. The eligible employer 
12.21 	shall give at least 30 60 days' notice to the commissioner before entering the program. 
12.22 	Entry into the program is governed by a schedule established by the commissioner.
12.23 	(d) Participation in the program is for a two-year three-year term. Participation is 
12.24 	automatically renewed for an additional two-year three-year term unless the exclusive 
12.25 	representative, or the employer for unrepresented employees, gives the commissioner 
12.26 	notice of withdrawal at least 30 60 days before expiration of the participation period. A 
12.27 	group that withdraws must wait two years before rejoining, except with the approval of 
12.28 	the commissioner. An exclusive representative, or employer for unrepresented employees, 
12.29 	may also withdraw if premiums increase 50 percent by more than 20 percent in excess 
12.30 	of the consumer price index for all urban consumers or more from one insurance year 
12.31 	to the next. The commissioner may modify the participation requirement as part of 
12.32 	a demonstration or pilot effort. Any modifications must be clearly communicated to 
12.33 	all employers who are members of the public buyers group program, and incorporated 
12.34 	into any information about the program, at least 90 days prior to the change becoming 
12.35 	effective. The modifications must apply on an equal basis to all current and prospective 
12.36 	employers enrolled in the program.
13.1 	(e)  To improve the stability and effectiveness of the public buyers group program, 
13.2 	the commissioner, in consultation with the Labor-Management Committee and other 
13.3 	experts, may explore mutual gain-sharing arrangements, discounts, incentives, or penalties 
13.4 	for public employers based on the length of their continuous membership in the public 
13.5 	buyers group program and other factors. Any incentives for long-term membership 
13.6 	in the program must be: (1) consistent with the program's goals of maintaining the 
13.7 	overall integrity and viability of the program; (2) consistent with other applicable laws, 
13.8 	rules, and policies; and (3) available to all groups on equal terms. The terms of any 
13.9 	incentives for long-term participation in the program must be clearly communicated to all 
13.10 	employers who are members of the public buyers group program and incorporated into 
13.11 	any information about the program. Any administration of the incentives or changes must 
13.12 	be communicated at least 90 days prior to each employer's renewal date before the change 
13.13 	may become effective. The commissioner, in consultation with the Labor-Management 
13.14 	Committee, shall report to the legislature and the governor by January 15, 2008, and 
13.15 	annually thereafter, on the adequacy of the participation requirement and any special 
13.16 	incentives based on the length of participation in helping maintain the stability and 
13.17 	effectiveness of the public buyers group program.
13.18 	(f) The exclusive representative shall give the employer shall give notice of intent to 
13.19 	withdraw to the commissioner at least 30 60 days before the expiration date of a collective 
13.20 	bargaining agreement that includes the date on which the term of participation expires.
13.21 	(f) (g) Each participating eligible employer shall notify the commissioner of the 
13.22 	names of individuals who will be participating within two weeks of after the commissioner 
13.23 	receiving receives notice of the parties' intent to participate. The employer shall also 
13.24 	submit other information as required by the commissioner for administration of the 
13.25 	program.
13.26 	(h) An employer that withdraws from the program under circumstances that do not 
13.27 	permit withdrawal under this subdivision is liable to the board for premiums payable by 
13.28 	the employer until the time that the employer is eligible to withdraw, and the employer 
13.29 	shall pay those premiums voluntarily and no later than their due date. If the premiums are 
13.30 	not paid voluntarily, the board has authority to and shall collect these premiums under any 
13.31 	method permitted by law for a governmental or nongovernmental creditor of the employer.

13.32 	Sec. 7. Minnesota Statutes 2004, section 43A.316, is amended by adding a subdivision 
13.33 	to read:
13.34 		Subd. 5a.Participating employers. Employers participating in the public buyers 
13.35 	group program and employers considering participation in the public buyers group 
14.1 	program shall not be refused or impeded by the program in their efforts to obtain the 
14.2 	utilization or claims data needed by the employer to seek alternative bids for insurance 
14.3 	coverage. The ability of participating employers to secure their data for the purposes of 
14.4 	seeking alternative bids for coverage exists regardless of any other program participation 
14.5 	requirements or incentives for long-term participation in the program. Participating 
14.6 	employers must not be charged for the report generated to satisfy this subdivision.

14.7 	Sec. 8. Minnesota Statutes 2004, section 43A.316, is amended by adding a subdivision 
14.8 	to read:
14.9 		Subd. 5b.School district's bids. School districts eligible for the public buyers 
14.10 	group program must request bids for insurance coverage through the public buyers 
14.11 	group program at least once every four years. This subdivision does not require school 
14.12 	districts eligible for the program to purchase coverage through the program. Other public 
14.13 	employers are encouraged to seek bids from the public buyers group program at least 
14.14 	once every four years.

14.15 	Sec. 9. Minnesota Statutes 2004, section 43A.316, subdivision 6, is amended to read:
14.16 		Subd. 6.Coverage. (a) By January 1, 1989, The commissioner shall announce the 
14.17 	benefits of the program. The program shall include employee hospital, medical, and dental, 
14.18 	and life insurance for employees and hospital and medical benefits for dependents. Health 
14.19 	maintenance organization options and other delivery system options may be provided if 
14.20 	they are available, cost-effective, and capable of servicing the number of people covered in 
14.21 	the program. Participation in optional coverages may be provided by collective bargaining 
14.22 	agreements. For employees not represented by an exclusive representative, the employer 
14.23 	may offer the optional coverages to eligible employees and their dependents provided in 
14.24 	the program. Health coverage must include at least the benefits required of a health plan 
14.25 	company regulated under chapter 62A, 62C, 62D, or 62Q.
14.26 	(b) The commissioner, with the assistance of the Labor-Management Committee, 
14.27 	shall periodically assess whether it is financially feasible for the program to offer or to 
14.28 	continue an individual retiree program that has competitive premium rates and benefits. 
14.29 	If the commissioner determines it to be feasible to offer an individual retiree program, 
14.30 	the commissioner shall announce the applicable benefits, premium rates, and terms of 
14.31 	participation. Eligibility to participate in the individual retiree program is governed by 
14.32 	subdivision 8, but applies to retirees of eligible employers that do not participate in the 
14.33 	program and to those retirees' dependents and surviving spouses.

15.1 	Sec. 10. Minnesota Statutes 2004, section 43A.316, subdivision 6a, is amended to read:
15.2 		Subd. 6a.Chiropractic services Choice of type of provider. All benefits provided 
15.3 	by the program or a successor program relating to expenses incurred for medical treatment 
15.4 	or services of a physician health care provider must also include chiropractic treatment 
15.5 	and services of a chiropractor any other type of licensed, certified, or registered health care 
15.6 	provider to the extent that the chiropractic services and treatment are within the scope of 
15.7 	chiropractic licensure the provider's licensure, certification, or registration.
15.8 	This subdivision is intended to provide equal access to benefits for program members 
15.9 	who choose to obtain treatment for illness or injury from a doctor of chiropractic, as long 
15.10 	as the treatment falls within the chiropractor's scope of practice. This subdivision is not 
15.11 	intended to change or add to the benefits provided for in the program.

15.12 	Sec. 11. Minnesota Statutes 2004, section 43A.316, subdivision 7, is amended to read:
15.13 		Subd. 7.Premiums. (a) The proportion of premium paid by the employer and 
15.14 	employee is subject to collective bargaining or personnel policies. If, at the beginning of 
15.15 	the coverage period, no collective bargaining agreement has been finalized, the increased 
15.16 	dollar costs, if any, from the previous year is the sole responsibility of the individual 
15.17 	participant until a collective bargaining agreement states otherwise. Premiums, including 
15.18 	an administration fee, shall be established by the commissioner. The commissioner may 
15.19 	decide to rate specific employers separately for premium purposes, if the commissioner 
15.20 	determines that doing so is in the best interests of the program. Each employer shall pay 
15.21 	monthly the amounts due for employee benefits including the amounts under subdivision 
15.22 	8 to the commissioner no later than the dates established by the commissioner. If an 
15.23 	employer fails to make the payments as required, the commissioner may shall cancel 
15.24 	program benefits and pursue other civil remedies, as provided in subdivision 5, paragraph 
15.25 	(d).
15.26 	(b) The premium charged for an employer's first month in the program may be up to 
15.27 	three times the regular monthly premium charged to that employer, to help establish and 
15.28 	maintain the program's financial resources. The extra premiums, if paid, must be refunded 
15.29 	to the employer if the employer leaves the program, if the refund would not reduce the 
15.30 	program's reserves below the level determined to be appropriate by the commissioner.
15.31 	(c) The commissioner must provide bids, including the premiums to be charged, to 
15.32 	eligible employers that request bids, no later than 90 days prior to the date the coverage 
15.33 	would begin or renew. 

15.34 	Sec. 12. Minnesota Statutes 2004, section 43A.316, subdivision 8, is amended to read:
16.1 		Subd. 8.Continuation of coverage. (a) A former employee of an employer 
16.2 	participating in the program who is receiving a public pension disability benefit or an 
16.3 	annuity or has met the age and service requirements necessary to receive an annuity under 
16.4 	chapter 353, 353C, 354, 354A, 356, 422A, 423, 423A, or 424, and the former employee's 
16.5 	dependents, are eligible to participate in the program. This participation is at the person's 
16.6 	expense unless a collective bargaining agreement or personnel policy provides otherwise. 
16.7 	Premiums for these participants must be established by the commissioner.
16.8 	The commissioner may provide policy exclusions for preexisting conditions 
16.9 	only when there is a break in coverage between a participant's coverage under the 
16.10 	employment-based group insurance program and the participant's coverage under this 
16.11 	section. An employer shall notify an employee of the option to participate under this 
16.12 	paragraph no later than the effective date of retirement. The retired employee or the 
16.13 	employer of a participating group on behalf of a current or retired employee shall notify 
16.14 	the commissioner within 30 days of the effective date of retirement of intent to participate 
16.15 	in the program according to the rules established by the commissioner.
16.16 	(b) The spouse of a deceased employee or former employee may purchase the 
16.17 	benefits provided at premiums established by the commissioner if the spouse was a 
16.18 	dependent under the employee's or former employee's coverage under this section at the 
16.19 	time of the death. The spouse remains eligible to participate in the program as long as 
16.20 	the group that included the deceased employee or former employee participates in the 
16.21 	program spouse chooses to do so. Coverage under this clause must be coordinated with 
16.22 	relevant insurance benefits provided through the federally sponsored Medicare program.
16.23 	(c) The program benefits must continue in the event of strike permitted by section  
16.24 	179A.18, if the exclusive representative chooses to have coverage continue and the 
16.25 	employee pays the total monthly premiums when due. 
16.26 	(d) A participant who discontinues coverage may not reenroll.
16.27 	(d) Persons participating under these paragraphs this subdivision shall make 
16.28 	appropriate premium payments in the time and manner established by the commissioner.
16.29 	They are not subject to the payment of extra payments that may be required under 
16.30 	subdivision 7, paragraph (b).

16.31 	Sec. 13. Minnesota Statutes 2004, section 43A.316, is amended by adding a 
16.32 	subdivision to read:
16.33 		Subd. 9a.Report. The commissioner shall report biennially to the governor and 
16.34 	legislature on March 1 of each odd-numbered year. The report must include information 
16.35 	on membership, finances, operations, effectiveness, and impact of the public buyers group 
17.1 	program. The report may include discussion of changes and innovations, particularly with 
17.2 	respect to improving health care costs, quality, and outcomes, and any issues or challenges 
17.3 	faced by the program and how they might be addressed. The report must be posted on a 
17.4 	Web site maintained by or for the public buyers group program, and must be available 
17.5 	to the public.

17.6 	Sec. 14. Minnesota Statutes 2004, section 43A.316, is amended by adding a 
17.7 	subdivision to read:
17.8 		Subd. 9b.Loan authorization. The commissioner may borrow up to $2,000,000 
17.9 	from the reserve fund of the state employees group insurance program for purposes of 
17.10 	the public employees insurance program. The funds must be used in any way appropriate 
17.11 	to improve the stability and usefulness of the program. Any such loan must be repaid in 
17.12 	regular installments over no more than ten years, with interest at three percent per year. 
17.13 	The loans may be made on an as-needed basis, provided that such loans may never exceed 
17.14 	a total of $2,000,000 at any one time, and all loans must be repaid in full no later than 
17.15 	June 30, 2016.

17.16 	Sec. 15. Minnesota Statutes 2004, section 43A.316, subdivision 10, is amended to read:
17.17 		Subd. 10.Exemption. The public employee insurance buyers group program 
17.18 	and, where applicable, the employers participating in it are exempt from chapters 60A, 
17.19 	62A, 62C, 62D, 62E, and 62H, section  471.617, subdivisions 2 and 3, and the bidding 
17.20 	requirements of section  471.6161, except as otherwise provided in subdivision 6, 
17.21 	paragraph (a). 

17.22 	Sec. 16. Minnesota Statutes 2004, section 43A.316, is amended by adding a 
17.23 	subdivision to read:
17.24 		Subd. 11.Reinsurance. The commissioner may, on behalf of the program, 
17.25 	participate in an insured or self-insured reinsurance pool.

17.26 	ARTICLE 4
17.27 	PRIVATE SECTOR HEALTH COVERAGE PROVISIONS

17.28 	Section 1. Minnesota Statutes 2004, section 62D.095, subdivision 3, is amended to 
17.29 	read:
17.30 		Subd. 3.Deductibles. (a) A health maintenance contract issued by a health 
17.31 	maintenance organization that is assessed less than three percent of the total annual amount 
17.32 	assessed by the Minnesota comprehensive health association may impose deductibles not 
18.1 	to exceed $3,000 $5,000 per person, per year and $6,000 $10,000 per family, per year. For 
18.2 	purposes of the percentage calculation, a health maintenance organization's assessments 
18.3 	include those of its affiliates.
18.4 	(b) All other health maintenance contracts may impose deductibles not to exceed 
18.5 	$2,250 per person, per year and $4,500 per family, per year.

18.6 	Sec. 2. Minnesota Statutes 2004, section 62D.095, subdivision 4, is amended to read:
18.7 		Subd. 4.Annual out-of-pocket maximums. (a) A health maintenance contract 
18.8 	issued by a health maintenance organization that is assessed less than three percent of the 
18.9 	total annual amount assessed by the Minnesota comprehensive health association must 
18.10 	include a limitation not to exceed $4,500 $5,000 per person and $7,500 $10,000 per 
18.11 	family on total annual out-of-pocket enrollee cost-sharing expenses. For purposes of the 
18.12 	percentage calculation, a health maintenance organization's assessments include those 
18.13 	of its affiliates.
18.14 	(b) All other health maintenance contracts must include a limitation not to 
18.15 	exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee 
18.16 	cost-sharing expenses.

18.17 	Sec. 3. Minnesota Statutes 2004, section 62D.095, is amended by adding a subdivision 
18.18 	to read:
18.19 		Subd. 5a. Lifetime maximum benefit. A health maintenance contract issued by 
18.20 	a health maintenance organization may impose a lifetime maximum benefit no less 
18.21 	than $3,000,000. At no time shall a health maintenance organization impose a lifetime 
18.22 	maximum lower than the required lifetime maximum of the comprehensive health 
18.23 	insurance plan under section 62E.12.

18.24 	Sec. 4. [62Q.645] DISTRIBUTION OF INFORMATION; ADMINISTRATIVE 
18.25 	EFFICIENCY AND COVERAGE OPTIONS.
18.26 	(a) The commissioner may use reports submitted by health  plan companies, service 
18.27 	cooperatives, and the public employee  insurance program created in section 43A.316 to 
18.28 	compile  entity specific administrative efficiency report cards; may make  these report 
18.29 	cards available on state agency Web sites,  including minnesotahealthinfo.com; and may 
18.30 	include information  on: 
18.31 	(1) number of covered lives;  
18.32 	(2) covered services;  
18.33 	(3) geographic availability;  
19.1 	(4) whom to contact to obtain current premium rates;  
19.2 	(5) administrative costs, using the definition of  administrative costs developed under 
19.3 	section 62J.38;  
19.4 	(6) Internet links to information on the health plan, if  available; and  
19.5 	(7) any other information about the health plan identified  by the commissioner 
19.6 	as being useful for employers, consumers,  providers, and others in evaluating health 
19.7 	plan options. 
19.8 	(b) This section does not apply to a health plan company  unless its annual Minnesota 
19.9 	premiums exceed $50,000,000 based on the most recent assessment base of the Minnesota 
19.10 	Comprehensive Health Association. For purposes of this  determination, the premiums of a 
19.11 	health plan company include  those of its affiliates. 

19.12 	Sec. 5. MEDICAL MALPRACTICE INSURANCE REPORT.
 19.13 	(a) The commissioner of commerce shall provide to the legislature, no later than 
19.14 	June 1 each year, a brief written report on the status of the market for medical malpractice 
19.15 	insurance in Minnesota. The report must summarize, interpret, explain, and analyze 
19.16 	information on that subject available to the commissioner, through annual statements filed 
19.17 	by insurance companies, information obtained under paragraph (c), and other sources. 
19.18 	(b) The annual report must consider, to the extent possible, Minnesota specific data 
19.19 	on market shares; premiums received; amounts paid to settle claims that were not litigated, 
19.20 	claims that were settled after litigation began, and claims that were litigated to court 
19.21 	judgment; amounts spent on processing, investigation, litigation, and otherwise handling 
19.22 	claims; other sales and administrative costs; and the loss ratios of the insurers. 
19.23 	(c) Each insurance company that provides medical malpractice insurance in this state 
19.24 	shall, no later than April 1 each year, file with the commissioner of commerce, on a form 
19.25 	prescribed by the commissioner, the Minnesota specific data referenced in paragraph (b), 
19.26 	other than market share, for the previous calendar year for that insurance company, shown 
19.27 	separately for the categories of coverage provided to hospitals, medical clinics, nursing 
19.28 	homes, physicians who provide emergency medical care, obstetrician gynecologists, and 
19.29 	ambulance services. An insurance company need not comply with this paragraph if its 
19.30 	direct premium written in the state for the previous calendar year is less than $2,000,000.

19.31 	ARTICLE 5
19.32 	SERVICE COOPERATIVES

19.33 	Section 1. Minnesota Statutes 2004, section 123A.21, subdivision 7, is amended to 
19.34 	read:
20.1 		Subd. 7.Educational programs and services. (a) The board of directors of each 
20.2 	SC shall submit annually a plan to the members. The plan shall identify the programs and 
20.3 	services which are suggested for implementation by the SC during the following year and 
20.4 	shall contain components of long-range planning determined by the SC. These programs 
20.5 	and services may include, but are not limited to, the following areas:
20.6 	(1) administrative services;
20.7 	(2) curriculum development;
20.8 	(3) data processing;
20.9 	(4) distance learning and other telecommunication services;
20.10 	(5) evaluation and research;
20.11 	(6) staff development;
20.12 	(7) media and technology centers;
20.13 	(8) publication and dissemination of materials;
20.14 	(9) pupil personnel services;
20.15 	(10) planning;
20.16 	(11) secondary, postsecondary, community, adult, and adult vocational education;
20.17 	(12) teaching and learning services, including services for students with special 
20.18 	talents and special needs;
20.19 	(13) employee personnel services;
20.20 	(14) vocational rehabilitation;
20.21 	(15) health, diagnostic, and child development services and centers;
20.22 	(16) leadership or direction in early childhood and family education;
20.23 	(17) community services;
20.24 	(18) shared time programs;
20.25 	(19) fiscal services and risk management programs, including health reinsurance 
20.26 	programs;
20.27 	(20) technology planning, training, and support services;
20.28 	(21) health and safety services;
20.29 	(22) student academic challenges; and
20.30 	(23) cooperative purchasing services.
20.31 	(b) A service cooperative may contract for goods and services in conjunction with 
20.32 	its health reinsurance programs, including management, actuarial, investment, and legal 
20.33 	services from others within or without this state to ensure the efficient operation of these 
20.34 	programs. It shall rebid its contracts for reinsurance that it purchases at least every two 
20.35 	years.
20.36 	(c) A health reinsurance program operated by one or more service cooperatives may:
21.1 	(1) provide reinsurance or stop-loss coverage to nursing homes licensed under 
21.2 	chapter 144A and boarding care homes licensed under sections 144.50 to 144.56 and 
21.3 	certified for participation in the medical assistance program located in this state; and
21.4 	(2) determine premiums for its reinsurance or stop-loss coverage individually for 
21.5 	specific employers or may determine them on a pooled or other basis established by the SC.
21.6 	(d) A health coverage program provided by one or more service cooperatives:
21.7 	(1) may provide coverage to nursing homes licensed under chapter 144A and 
21.8 	boarding care homes licensed under sections 144.50 to 144.56 and certified for 
21.9 	participation in the medical assistance program located in this state;
21.10 	(2) must rebid contracts for insurance and third-party administration at least every 
21.11 	four years;
21.12 	(3) must comply with section 72.20, subdivision 26, notwithstanding section 13.203, 
21.13 	and must also provide that same information to exclusive representatives of the employees 
21.14 	upon request. A service cooperative shall not terminate coverage, exclude an employer 
21.15 	from future coverage, or otherwise penalize an employer for seeking bids from other 
21.16 	sources of health coverage; and
21.17 	(4) must provide bids for initial issuance or renewal of coverage upon request to 
21.18 	eligible employers no later than 90 days prior to the expected beginning or renewal date of 
21.19 	coverage.

21.20 	Sec. 2. Minnesota Statutes 2004, section 471.61, is amended by adding a subdivision 
21.21 	to read:
21.22 		Subd. 6.Reinsuring health risks.  Any political subdivision, or any two or more 
21.23 	political subdivisions acting jointly, may provide for the reinsuring of risks incurred as a 
21.24 	result of providing the insurance or protection authorized by this section by participating 
21.25 	in a pool operated by a service cooperative or cooperatives pursuant to section 471.617, 
21.26 	subdivision 3a.

21.27 	Sec. 3. Minnesota Statutes 2004, section 471.617, subdivision 3, is amended to read:
21.28 		Subd. 3.Stop-loss coverage. Any self-insurance plan covering fewer than 1,000 
21.29 	employees shall include excess or stop-loss coverage provided by a licensed insurance 
21.30 	company, an insurance company approved pursuant to sections  60A.195 to  60A.209, 
21.31 	or service plan corporation, but excess or stop-loss coverage need not be obtained for 
21.32 	long-term disability. 
21.33 	This excess or stop-loss coverage shall cover all eligible claims incurred during 
21.34 	the term of the policy or contract. In addition to excess or stop-loss coverage, the 
22.1 	self-insurance plan shall provide for reserving of an appropriate amount of funds to cover 
22.2 	the estimated cost of claims incurred, but unpaid, during the term of the policy or contract 
22.3 	which shall be added to the expected claim level. These funds shall be in addition to funds 
22.4 	reserved to cover the claims paid during the term of the policy or contract. The excess or 
22.5 	stop-loss coverage shall be provided at levels in excess of self-insured retention which is 
22.6 	appropriate, taking into account the number of covered persons in the group.
22.7 	Coverage under subdivision 3a qualifies under this subdivision.

22.8 	Sec. 4. Minnesota Statutes 2004, section 471.617, is amended by adding a subdivision 
22.9 	to read:
22.10 		Subd. 3a.Reinsurance pools.  A statutory or home rule charter city, county, school 
22.11 	district, or instrumentality of any of them may provide for the reinsuring of risks incurred 
22.12 	as a result of providing the health benefits authorized by this section through a pool 
22.13 	operated by a service cooperative or cooperatives established pursuant to section 123A.21.

22.14 	Sec. 5. EFFECTIVE DATE.
 22.15 	Sections 1 to 4 are effective the day following final enactment.

22.16 	ARTICLE 6
22.17 	MEDICAL LIABILITY

22.18 	Section 1. [604.111] MEDICAL LIABILITY; USE OF PROVIDER'S APOLOGY.
22.19 		Subdivision 1.Apology not admission; medical liability. In any civil action 
22.20 	brought by an alleged victim of an unanticipated outcome of medical care, or in any 
22.21 	arbitration proceeding related to such civil action, any and all statements, affirmations, 
22.22 	gestures, or conduct expressing apology, fault, sympathy, commiseration, condolence, 
22.23 	compassion, or a general sense of benevolence, which are made by a health care provider 
22.24 	or an employee of a health care provider to the alleged victim, a relative of the alleged 
22.25 	victim, or a representative of the alleged victim and which relate to the discomfort, pain, 
22.26 	suffering, injury, or death of the alleged victim as a result of the unanticipated outcome of 
22.27 	medical care shall be inadmissible as evidence of an admission of liability or as evidence 
22.28 	of an admission against interest or as an excited utterance.
22.29 		Subd. 2.Definitions. For purposes of this section, unless the context otherwise 
22.30 	requires:
22.31 	(a) "Health care provider" means any person licensed, certified, or registered in this 
22.32 	state to deliver health care and any clinic, pharmacy, hospital, or other health facility 
23.1 	located in this state. The term includes any professional corporation or other professional 
23.2 	entity comprised of such health care providers as permitted by the laws of this state.
23.3 	(b) "Relative" means a victim's spouse, parent, grandparent, stepfather, stepmother, 
23.4 	child, grandchild, brother, sister, half brother, half sister, or spouse's parents. The term 
23.5 	includes those relationships if created as a result of adoption. In addition, relative includes 
23.6 	any person who is a member of the victim's household.
23.7 	(c) "Representative" means a legal guardian, attorney, person designated to make 
23.8 	decisions on behalf of a patient under a health care power of attorney, or any person 
23.9 	recognized in law or custom as a patient's agent.
23.10 	(d) "Unanticipated outcome" means the outcome of a medical treatment or procedure 
23.11 	that differs from an expected result.

23.12 	EFFECTIVE DATE; APPLICATION. This section is effective January 1, 2007, 
23.13 	and applies to causes of action arising on or after that date.