1.1 	A bill for an act
1.2 	relating to health; establishing practice standards and evidence-based guidelines 
1.3 	for treating patients; implementing health care cost-containment measures; 
1.4 	requiring a study of hospital uncompensated care; allowing discounted payment 
1.5 	for health care under certain circumstances; allowing entity certain specific 
1.6 	administrative efficiency reports to be published on the state agency Web sites; 
1.7 	requiring a medical malpractice insurance report; adding provisions for service 
1.8 	cooperatives contracts; appropriating money;amending Minnesota Statutes 
1.9 	2004, sections 62D.095, subdivisions 3, 4; 72A.20, by adding a subdivision; 
1.10 	123A.21, subdivision 7; 151.214, subdivision 1; Minnesota Statutes 2005 
1.11 	Supplement, section 214.071; proposing coding for new law in Minnesota 
1.12 	Statutes, chapters 62J; 62M; 62Q; 144; 147; 214; 256B; repealing Minnesota 
1.13 	Statutes 2005 Supplement, section 62Q.251.
1.14 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.15 	ARTICLE 1
1.16 	HEALTH CARE COST-CONTAINMENT

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

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

2.22 	Sec. 3. [62M.071] PRIOR AUTHORIZATION.
2.23 	Health plan companies, in cooperation with health care providers, shall review prior 
2.24 	authorization procedures administered by utilization review organizations and health plan 
2.25 	companies to ensure the cost-effective use of prior authorization and minimization of 
2.26 	provider, clinic, and central office administrative burden.

2.27 	Sec. 4. [62M.072] USE OF EVIDENCE-BASED STANDARDS.
2.28 	If no independently developed evidence-based standards exist for a particular 
2.29 	treatment, testing, or imaging procedure, then an insurer or utilization review organization 
2.30 	shall not deny coverage of the treatment, testing, or imaging based solely on the grounds 
2.31 	that the treatment, testing, or imaging does not meet an evidence-based standard. 

2.32 	Sec. 5. [144.0506] AGENCY WEB SITES.
3.1 		Subdivision 1.Information to be posted. The commissioner of health may post the 
3.2 	following information on agency Web sites, including minnesotahealthinfo.com: 
3.3 	(1) healthy lifestyle and preventive health care information, organized by sex and 
3.4 	age, with procedures and treatments categorized by level of effectiveness and reliability of 
3.5 	the supporting evidence on effectiveness;  
3.6 	(2) health plan company administrative efficiency report cards;
3.7 	(3) health care provider charges for common procedures, based on information 
3.8 	available under section 62J.052;  
3.9 	(4) evidence-based medicine guidelines and related information for use as resources 
3.10 	by health care professionals, and summaries of the guidelines and related information for 
3.11 	use by patients and consumers;  
3.12 	(5) resources and Web links related to improving efficiency in medical clinics and 
3.13 	health care professional practices; and 
3.14 	(6) lists of nonprofit and charitable entities that accept donations of used medical 
3.15 	equipment and supplies, such as crutches and walkers.
3.16 		Subd. 2.Other Internet resources. The commissioner of health, in implementing 
3.17 	subdivision 1, shall include relevant Web links and materials from private sector and other 
3.18 	government sources in order to avoid duplication and reduce state administrative costs.
3.19 		Subd. 3.Cooperation with commissioner of commerce. The commissioner of 
3.20 	health shall consult and work in cooperation with the commissioner of commerce when 
3.21 	posting on the Web site information collected from health plan companies regulated by 
3.22 	the commissioner of commerce.

3.23 	Sec. 6. [147.37] INFORMATION PROVISION; PHARMACEUTICAL 
3.24 	ASSISTANCE PROGRAMS.
3.25 	The board shall encourage licensees to make available to patients information on 
3.26 	free and discounted prescription drug programs offered by pharmaceutical manufacturers 
3.27 	when the information is provided to the licensees at no cost.

3.28 	Sec. 7. Minnesota Statutes 2004, section 151.214, subdivision 1, is amended to read:
3.29 		Subdivision 1.Explanation of pharmacy benefits. A pharmacist licensed under 
3.30 	this chapter must provide to a patient, for each prescription dispensed where part or all 
3.31 	of the cost of the prescription is being paid or reimbursed by an employer-sponsored 
3.32 	plan or health plan company, or its contracted pharmacy benefit manager, the patient's 
3.33 	co-payment amount and the pharmacy's own usual and customary price of the prescription 
3.34 	or the amount the pharmacy will be paid for the prescription drug by the patient's 
4.1 	employer-sponsored plan or health plan company, or its contracted pharmacy benefit 
4.2 	manager.

4.3 	Sec. 8. Minnesota Statutes 2005 Supplement, section 214.071, is amended to read:
4.4 	214.071 HEALTH BOARDS; DIRECTORY OF LICENSEES.
4.5 	By July 1, 2009, each health health-related licensing board under chapters 147, 148, 
4.6 	148B, and 150A, as defined in section 214.01, subdivision 2, shall establish a directory of 
4.7 	licensees that includes biographical data for each licensee.

4.8 	EFFECTIVE DATE. This section is effective July 1, 2007.

4.9 	Sec. 9. [214.121] PRICE DISCLOSURE REMINDER.
4.10 	Each health-related licensing board shall at least annually inform and remind its 
4.11 	licensees of the price disclosure requirements of section 62J.052 or 151.214, as applicable, 
4.12 	through the board's regular means of communicating with its licensees.

4.13 	Sec. 10. [256B.043] COST CONTAINMENT EFFORTS.
4.14 		Subdivision 1.Alternative and complementary health care. The commissioner of 
4.15 	human services, through the medical director and in consultation with the health services 
4.16 	policy committee established under section 256B.0625, subdivision 3c, as part of the 
4.17 	commissioner's ongoing duties, shall consider the potential for improving quality and 
4.18 	obtaining cost savings through greater use of alternative and complementary treatment 
4.19 	methods that are supported by the findings of evidence-based research; shall incorporate 
4.20 	these methods into the medical assistance, MinnesotaCare, and general assistance medical 
4.21 	care programs; and shall make related legislative recommendations as appropriate.
4.22 		Subd. 2.Access to care. (a) The commissioners of human services and health, 
4.23 	as part of their ongoing duties, shall consider the adequacy of the current system of 
4.24 	community health clinics and centers both statewide and in urban areas with significant 
4.25 	disparities in health status and access to services across racial and ethnic groups, including:
4.26 	(1) methods to provide 24-hour availability of care through the clinics and centers;
4.27 	(2) methods to expand the availability of care through the clinics and centers;
4.28 	(3) the use of grants to expand the number of clinics and centers, the services 
4.29 	provided, and the availability of care; and
4.30 	(4) the extent to which increased use of physician assistants, nurse practitioners, 
4.31 	medical residents and interns, and other allied health professionals in clinics and centers 
4.32 	would increase the availability of services.
5.1 	(b) The commissioners shall make departmental modifications and legislative 
5.2 	recommendations as appropriate on the basis of their considerations under paragraph (a).

5.3 	Sec. 11. REPORTING OF ACQUIRED INFECTIONS.
 5.4 	(a) The commissioner of health may consult with infection control specialists, health 
5.5 	care facility representatives, and consumers for the purpose of obtaining recommendations 
5.6 	regarding a determination of the need for action to implement health care associated 
5.7 	infection control reporting in hospitals and nursing homes. If the outcome of the 
5.8 	determination warrants, the commissioner shall consult with the group regarding: 
5.9 	(1) the selection of reporting measures relating to health care associated infections;  
5.10 	(2) design, implementation, validation, and ongoing evaluation of the reporting 
5.11 	system; and  
5.12 	(3) ensuring that the reporting measures remain flexible and adaptable to changing 
5.13 	national standards.  
5.14 	(b) If the commissioner determines that there is a need for the action described in 
5.15 	paragraph (a), the commissioner shall make written  recommendations to the legislature. 

5.16 	Sec. 12. STUDY OF HOSPITAL UNCOMPENSATED CARE.
 5.17 	(a) The commissioner of health shall study and report to the legislature by January 
5.18 	15, 2007, the following:
5.19 	(1) trends in hospitals' cost of providing uncompensated care, separately identifying 
5.20 	charity care and bad debt as components of uncompensated care;
5.21 	(2) the impact of any changes in hospitals' charity care policies and debt collection 
5.22 	practices in the past three years on the amount of uncompensated care provided and the 
5.23 	number of patients receiving uncompensated care; and
5.24 	(3) the value of hospital uncompensated care and community benefits in comparison 
5.25 	to the value of tax exemptions received as a result of nonprofit status.
5.26 	(b) The commissioner's report to the legislature shall include recommendations on: 
5.27 	(1) the need for more uniform hospital charity care policies and debt collection practices; 
5.28 	and (2) the need for more uniform reporting of community benefits provided by nonprofit 
5.29 	hospitals.

5.30 	Sec. 13. APPROPRIATION.
 5.31 	In fiscal year 2007, $50,000 is appropriated from the general fund to the 
5.32 	commissioner of human services for the efforts required under Minnesota Statutes, section 
5.33 	256B.043.

6.1 	ARTICLE 2
6.2 	CHARITY CARE BY HEALTH CARE PROVIDERS

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

6.9 	Sec. 2. Minnesota Statutes 2004, section 72A.20, is amended by adding a subdivision 
6.10 	to read:
6.11 		Subd. 39.Discounted payments by health care providers; effect on use of 
6.12 	usual and customary payments. An insurer, including, but not limited to, a health plan 
6.13 	company as defined in section 62Q.01, subdivision 4; a reparation obligor as defined in 
6.14 	section 65B.43, subdivision 9; and a workers' compensation insurer shall not consider in 
6.15 	determining a health care provider's usual and customary payment, standard payment, or 
6.16 	allowable payment used as a basis for determining the provider's payment by the insurer, 
6.17 	the following discounted payment situations:
6.18 	(1) care provided to relatives of the provider;
6.19 	(2) care for which a discount or free care is given in hardship situations; and
6.20 	(3) care for which a discount is given in exchange for cash payment.
6.21 	For purposes of this subdivision, "health care provider" and "provider" have the 
6.22 	meaning given in section 62J.03, subdivision 8.

6.23 	Sec. 3.  REPEALER.
 6.24 	Minnesota Statutes 2005 Supplement, section 62Q.251, is repealed.

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

6.27 	ARTICLE 3
6.28 	PRIVATE SECTOR HEALTH COVERAGE PROVISIONS

6.29 	Section 1. Minnesota Statutes 2004, section 62D.095, subdivision 3, is amended to 
6.30 	read:
7.1 		Subd. 3.Deductibles. (a) A health maintenance contract issued by a health 
7.2 	maintenance organization that is assessed less than three percent of the total annual amount 
7.3 	assessed by the Minnesota comprehensive health association may impose deductibles not 
7.4 	to exceed $3,000 $5,000 per person, per year and $6,000 $10,000 per family, per year. For 
7.5 	purposes of the percentage calculation, a health maintenance organization's assessments 
7.6 	include those of its affiliates.
7.7 	(b) All other health maintenance contracts may impose deductibles not to exceed 
7.8 	$2,250 per person, per year and $4,500 per family, per year.

7.9 	Sec. 2. Minnesota Statutes 2004, section 62D.095, subdivision 4, is amended to read:
7.10 		Subd. 4.Annual out-of-pocket maximums. (a) A health maintenance contract 
7.11 	issued by a health maintenance organization that is assessed less than three percent of the 
7.12 	total annual amount assessed by the Minnesota comprehensive health association must 
7.13 	include a limitation not to exceed $4,500 $5,000 per person and $7,500 $10,000 per 
7.14 	family on total annual out-of-pocket enrollee cost-sharing expenses. For purposes of the 
7.15 	percentage calculation, a health maintenance organization's assessments include those 
7.16 	of its affiliates.
7.17 	(b) All other health maintenance contracts must include a limitation not to 
7.18 	exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee 
7.19 	cost-sharing expenses.

7.20 	Sec. 3. [62Q.645] DISTRIBUTION OF INFORMATION; ADMINISTRATIVE 
7.21 	EFFICIENCY AND COVERAGE OPTIONS.
7.22 	(a) The commissioner may use reports submitted by health  plan companies, service 
7.23 	cooperatives, and the public employee  insurance program created in section 43A.316 
7.24 	to compile entity specific administrative efficiency reports; may make these reports 
7.25 	available on state agency Web sites,  including minnesotahealthinfo.com; and may include 
7.26 	information  on: 
7.27 	(1) number of covered lives;  
7.28 	(2) covered services;  
7.29 	(3) geographic availability;  
7.30 	(4) whom to contact to obtain current premium rates;  
7.31 	(5) administrative costs, using the definition of  administrative costs developed under 
7.32 	section 62J.38;  
7.33 	(6) Internet links to information on the health plan, if  available; and  
8.1 	(7) any other information about the health plan identified  by the commissioner 
8.2 	as being useful for employers, consumers,  providers, and others in evaluating health 
8.3 	plan options. 
8.4 	(b) This section does not apply to a health plan company  unless its annual Minnesota 
8.5 	premiums exceed $50,000,000 based on the most recent assessment base of the Minnesota 
8.6 	Comprehensive Health Association. For purposes of this  determination, the premiums of a 
8.7 	health plan company include  those of its affiliates. 

8.8 	Sec. 4. MEDICAL MALPRACTICE INSURANCE REPORT.
 8.9 	(a) The commissioner of commerce shall provide to the legislature annually a brief 
8.10 	written report on the status of the market for medical malpractice insurance in Minnesota. 
8.11 	The report must summarize, interpret, explain, and analyze information on that subject 
8.12 	available to the commissioner, through annual statements filed by insurance companies, 
8.13 	information obtained under paragraph (c), and other sources. 
8.14 	(b) The annual report must consider, to the extent possible, using definitions 
8.15 	developed by the commissioner, Minnesota-specific data on market shares; premiums 
8.16 	received; amounts paid to settle claims that were not litigated, claims that were settled 
8.17 	after litigation began, and claims that were litigated to court judgment; amounts spent 
8.18 	on processing, investigation, litigation, and otherwise handling claims; other sales and 
8.19 	administrative costs; and the loss ratios of the insurers. 
8.20 	(c) Each insurance company that provides medical malpractice insurance in this state 
8.21 	shall, no later than June 1 each year, file with the commissioner of commerce, on a form 
8.22 	prescribed by the commissioner and using definitions developed by the commissioner, 
8.23 	the Minnesota-specific data referenced in paragraph (b), other than market share, for the 
8.24 	previous calendar year for that insurance company, shown separately for various categories 
8.25 	of coverages including, if possible, hospitals, medical clinics, nursing homes, physicians 
8.26 	who provide emergency medical care, obstetrician gynecologists, and ambulance services. 
8.27 	An insurance company need not comply with this paragraph if its direct premium written 
8.28 	in the state for the previous calendar year is less than $2,000,000.

8.29 	ARTICLE 4
8.30 	SERVICE COOPERATIVES

8.31 	Section 1. Minnesota Statutes 2004, section 123A.21, subdivision 7, is amended to 
8.32 	read:
8.33 		Subd. 7.Educational programs and services. (a) The board of directors of each 
8.34 	SC shall submit annually a plan to the members. The plan shall identify the programs and 
9.1 	services which are suggested for implementation by the SC during the following year and 
9.2 	shall contain components of long-range planning determined by the SC. These programs 
9.3 	and services may include, but are not limited to, the following areas:
9.4 	(1) administrative services;
9.5 	(2) curriculum development;
9.6 	(3) data processing;
9.7 	(4) distance learning and other telecommunication services;
9.8 	(5) evaluation and research;
9.9 	(6) staff development;
9.10 	(7) media and technology centers;
9.11 	(8) publication and dissemination of materials;
9.12 	(9) pupil personnel services;
9.13 	(10) planning;
9.14 	(11) secondary, postsecondary, community, adult, and adult vocational education;
9.15 	(12) teaching and learning services, including services for students with special 
9.16 	talents and special needs;
9.17 	(13) employee personnel services;
9.18 	(14) vocational rehabilitation;
9.19 	(15) health, diagnostic, and child development services and centers;
9.20 	(16) leadership or direction in early childhood and family education;
9.21 	(17) community services;
9.22 	(18) shared time programs;
9.23 	(19) fiscal services and risk management programs;
9.24 	(20) technology planning, training, and support services;
9.25 	(21) health and safety services;
9.26 	(22) student academic challenges; and
9.27 	(23) cooperative purchasing services.
9.28 	(b) A group health, dental, or long-term disability coverage program provided by 
9.29 	one or more service cooperatives:
9.30 	(1) must rebid contracts for insurance and third-party administration at least every 
9.31 	four years. The contracts may be regional or statewide in the discretion of the SC; and
9.32 	(2) may determine premiums for its health, dental, or long-term disability coverage 
9.33 	individually for specific employers or may determine them on a pooled or other basis 
9.34 	established by the SC.

9.35 	EFFECTIVE DATE. This section is effective the day following final enactment.