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 the disclosure of executive compensation; establishing liability limits 
1.5 	for certain licensed ambulance services and medical directors; modifying the 
1.6 	qualification standards of certain licenses; establishing certain fees; requiring 
1.7 	a study of hospital uncompensated care; allowing discounted payment for 
1.8 	health care under certain circumstances; regulating eligibility criteria for 
1.9 	medical assistance special transportation services; allowing entity certain 
1.10 	specific administrative efficiency reports to be published on the state agency 
1.11 	Web sites; requiring certain reports; adding provisions for service cooperatives 
1.12 	contracts; appropriating money;amending Minnesota Statutes 2004, sections 
1.13 	62D.095, subdivisions 3, 4; 62Q.64; 72A.20, by adding a subdivision; 123A.21, 
1.14 	subdivision 7; 148.06, subdivision 1; 151.214, subdivision 1; Minnesota Statutes 
1.15 	2005 Supplement, section 214.071;  Laws 2003, First Special Session chapter 14, 
1.16 	article 12, section 93, as amended; proposing coding for new law in Minnesota 
1.17 	Statutes, chapters 62J; 62M; 62Q; 144; 144E; 147; 148; 214; 256B; repealing 
1.18 	Minnesota Statutes 2005 Supplement, section 62Q.251.
1.19 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.20 	ARTICLE 1
1.21 	HEALTH CARE COST-CONTAINMENT

1.22 	Section 1. [62J.431] PRACTICE STANDARDS.
1.23 		Subdivision 1.Health-related boards and provider organizations; practice 
1.24 	standards. The health-related boards, under chapter 148, or professional provider 
1.25 	organizations may establish practice standards for treating patients within their respective 
1.26 	scopes of practice. The boards or provider organizations may utilize the services of 
1.27 	appropriate public or private entities to facilitate the development or review of practice 
1.28 	standards. Each board or provider organization that has established or ratified existing 
1.29 	standards shall report these standards to the legislative committees with jurisdiction over 
2.1 	the public health occupations by January 15, 2007, and shall report subsequent changes 
2.2 	annually thereafter. If a board or provider organization has existing standards, nothing in 
2.3 	this section requires a board or provider organization to establish new standards. Nothing 
2.4 	in this section shall require a health plan company to cover treatments, testing, or imaging, 
2.5 	based on standards developed under this section.
2.6 		Subd. 2.Criteria for practice standards. (a) Practice standards developed under 
2.7 	this section must meet the following criteria:
2.8 	(1) the scope and application are clear for treating specific conditions addressed 
2.9 	by the standards and for treating the specific condition in combination with multiple 
2.10 	medical conditions;
2.11 	(2) authorship is stated and all contributing individuals are listed with any conflicts 
2.12 	of interest disclosed, including sources of funding for development, review and updating;
2.13 	(3) authors represent all pertinent clinical fields or other means of input have been 
2.14 	used;
2.15 	(4) the development process is explicitly stated;
2.16 	(5) the standard is grounded on valid, timely research and clinical practice;
2.17 	(6) the practice standards allow for reasonable situational variations;
2.18 	(7) the research, data and randomized clinical trials used are cited and graded and 
2.19 	based on longitudinally representative samples of the population as appropriate;
2.20 	(8) the document itself is clear and practical;
2.21 	(9) the document is flexible in use for individual patient physiology, including 
2.22 	treatment tolerances and multiple medical conditions, with discretion for practitioner 
2.23 	judgement allowed and noted; and
2.24 	(10) the practice standard has scheduled reviews and updating.
2.25 	(b) Upon request, an entity that is subject to paragraph (a) must disclose its practice 
2.26 	standards and the basis for them.

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

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

3.3 	Sec. 4. [62M.072] USE OF EVIDENCE-BASED STANDARDS.
3.4 	If no independently developed evidence-based standards exist for a particular 
3.5 	treatment, testing, or imaging procedure, then an insurer or utilization review organization 
3.6 	shall not deny coverage of the treatment, testing, or imaging based solely on the grounds 
3.7 	that the treatment, testing, or imaging does not meet an evidence-based standard. This 
3.8 	section does not prohibit an insurer or utilization review organization from denying 
3.9 	coverage for services that are investigational, experimental, or not medically necessary.

3.10 	Sec. 5. Minnesota Statutes 2004, section 62Q.64, is amended to read:
3.11 	62Q.64 DISCLOSURE OF EXECUTIVE COMPENSATION.
3.12 	(a) Each health plan company doing business in this state, each holding company 
3.13 	located in this state that owns a health maintenance organization located in this state or 
3.14 	elsewhere, and each Minnesota hospital shall annually file with the Consumer Advisory 
3.15 	Board created in section  62J.75: 
3.16 	(1) a copy of the health plan company's form 990 filed with the federal Internal 
3.17 	Revenue Service; or
3.18 	(2) if the health plan company did not file a form 990 with the federal Internal 
3.19 	Revenue Service commissioner, a list of the amount and recipients job titles of the health 
3.20 	plan company's five entity's 20 highest salaries, including all types of compensation, 
3.21 	in excess of $50,000 $200,000.
3.22 	(b) A filing under this section is public data under section  13.03, and must be placed 
3.23 	on the minnesotahealthinfo.com Web site. 

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

4.15 	Sec. 7. [144E.20] LIABILITY LIMITS OF NONGOVERNMENT LICENSEES 
4.16 	AND MEDICAL DIRECTORS.
4.17 	(a) A licensee that is not a unit of government is subject to the same liability limits 
4.18 	under chapter 466 as a licensee that is a unit of government. 
4.19 	(b) The medical director of a licensed ambulance service and the medical director's 
4.20 	designee are subject to the same liability limits under chapter 466 as a licensee that is a 
4.21 	unit of government.
4.22 	(c) All actuary based savings from this section must be reflected in the insurance 
4.23 	medical liability premiums for ambulance services.

4.24 	EFFECTIVE DATE; APPLICATION. This section is effective August 1, 2006, 
4.25 	and applies to claims arising from incidents occurring on or after that date.

4.26 	Sec. 8. [147.37] INFORMATION PROVISION; PHARMACEUTICAL 
4.27 	ASSISTANCE PROGRAMS.
4.28 	The board shall encourage licensees to make available to patients information on 
4.29 	free and discounted prescription drug programs offered by pharmaceutical manufacturers 
4.30 	when the information is provided to the licensees at no cost.

4.31 	Sec. 9. Minnesota Statutes 2004, section 148.06, subdivision 1, is amended to read:
4.32 		Subdivision 1.License required; qualifications. No person shall practice 
4.33 	chiropractic in this state without first being licensed by the State Board of Chiropractic 
5.1 	Examiners. The applicant shall have earned at least one-half of all academic credits 
5.2 	required for awarding of a baccalaureate degree from the University of Minnesota, or 
5.3 	other university, college, or community college of equal standing, in subject matter 
5.4 	determined by the board, and taken a four-year resident course of at least eight months 
5.5 	each in a school or college of chiropractic or in a chiropractic program that is accredited 
5.6 	by the Council on Chiropractic Education, holds a recognition agreement with the Council 
5.7 	on Chiropractic Education, or is accredited by an agency approved by the United States 
5.8 	Office of Education or their successors as of January 1, 1988. The board may issue 
5.9 	licenses to practice chiropractic without compliance with prechiropractic or academic 
5.10 	requirements listed above if in the opinion of the board the applicant has the qualifications 
5.11 	equivalent to those required of other applicants, the applicant satisfactorily passes written 
5.12 	and practical examinations as required by the Board of Chiropractic Examiners, and the 
5.13 	applicant is a graduate of a college of chiropractic with a reciprocal recognition agreement 
5.14 	with the Council on Chiropractic Education as of January 1, 1988. The board may 
5.15 	recommend a two-year prechiropractic course of instruction to any university, college, 
5.16 	or community college which in its judgment would satisfy the academic prerequisite 
5.17 	for licensure as established by this section.
5.18 	An examination for a license shall be in writing and shall include testing in:
5.19 	(a) The basic sciences including but not limited to anatomy, physiology, bacteriology, 
5.20 	pathology, hygiene, and chemistry as related to the human body or mind;
5.21 	(b) The clinical sciences including but not limited to the science and art of 
5.22 	chiropractic, chiropractic physiotherapy, diagnosis, roentgenology, and nutrition; and
5.23 	(c) Professional ethics and any other subjects that the board may deem advisable.
5.24 	The board may consider a valid certificate of examination from the National Board 
5.25 	of Chiropractic Examiners as evidence of compliance with the examination requirements 
5.26 	of this subdivision. The applicant shall be required to give practical demonstration in 
5.27 	vertebral palpation, neurology, adjusting and any other subject that the board may deem 
5.28 	advisable. A license, countersigned by the members of the board and authenticated by the 
5.29 	seal thereof, shall be granted to each applicant who correctly answers 75 percent of the 
5.30 	questions propounded in each of the subjects required by this subdivision and meets the 
5.31 	standards of practical demonstration established by the board. Each application shall be 
5.32 	accompanied by a fee set by the board. The fee shall not be returned but the applicant 
5.33 	may, within one year, apply for examination without the payment of an additional fee. The 
5.34 	board may grant a license to an applicant who holds a valid license to practice chiropractic 
5.35 	issued by the appropriate licensing board of another state, provided the applicant meets 
5.36 	the other requirements of this section and satisfactorily passes a practical examination 
6.1 	approved by the board. The burden of proof is on the applicant to demonstrate these 
6.2 	qualifications or satisfaction of these requirements.

6.3 	Sec. 10. [148.108] FEES.
6.4 		Subdivision 1.Fees. In addition to the fees established in Minnesota Rules, chapter 
6.5 	2500, the board is authorized to charge the fees in this section.
6.6 		Subd. 2.Annual renewal of inactive acupuncture registration. The annual 
6.7 	renewal of inactive acupuncture registration fee is $25.
6.8 		Subd. 3.Acupuncture reinstatement. The acupuncture reinstatement fee is $50.

6.9 	Sec. 11. Minnesota Statutes 2004, section 151.214, subdivision 1, is amended to read:
6.10 		Subdivision 1.Explanation of pharmacy benefits. A pharmacist licensed under 
6.11 	this chapter must provide to a patient, for each prescription dispensed where part or all 
6.12 	of the cost of the prescription is being paid or reimbursed by an employer-sponsored 
6.13 	plan or health plan company, or its contracted pharmacy benefit manager, the patient's 
6.14 	co-payment amount and the pharmacy's own usual and customary price of the prescription 
6.15 	or the amount the pharmacy will be paid for the prescription drug by the patient's 
6.16 	employer-sponsored plan or health plan company, or its contracted pharmacy benefit 
6.17 	manager.

6.18 	Sec. 12. Minnesota Statutes 2005 Supplement, section 214.071, is amended to read:
6.19 	214.071 HEALTH BOARDS; DIRECTORY OF LICENSEES.
6.20 	By July 1, 2009, each health health-related licensing board under chapters 147, 148, 
6.21 	148B, and 150A, as defined in section 214.01, subdivision 2, shall establish a directory of 
6.22 	licensees that includes biographical data for each licensee.

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

6.24 	Sec. 13. [214.121] PRICE DISCLOSURE REMINDER.
6.25 	Each health-related licensing board shall at least annually inform and remind its 
6.26 	licensees of the price disclosure requirements of section 62J.052 or 151.214, as applicable, 
6.27 	through the board's regular means of communicating with its licensees.

6.28 	Sec. 14. [256B.043] COST CONTAINMENT EFFORTS.
6.29 		Subdivision 1.Alternative and complementary health care. The commissioner 
6.30 	of human services, through the medical director and in consultation with the health 
7.1 	services policy committee established under section 256B.0625, subdivision 3c, as 
7.2 	part of the commissioner's ongoing duties, shall consider the potential for improving 
7.3 	quality and obtaining cost savings through greater use of alternative and complementary 
7.4 	treatment methods and clinical practice; shall incorporate these methods into the medical 
7.5 	assistance, MinnesotaCare, and general assistance medical care programs; and shall 
7.6 	make related legislative recommendations as appropriate. The commissioner shall post 
7.7 	the recommendations required under this subdivision on agency Web sites according to 
7.8 	chapter 144.0506, subdivision 1.
7.9 		Subd. 2.Access to care. (a) The commissioners of human services and health, 
7.10 	as part of their ongoing duties, shall consider the adequacy of the current system of 
7.11 	community health clinics and centers both statewide and in urban areas with significant 
7.12 	disparities in health status and access to services across racial and ethnic groups, including:
7.13 	(1) methods to provide 24-hour availability of care through the clinics and centers;
7.14 	(2) methods to expand the availability of care through the clinics and centers;
7.15 	(3) the use of grants to expand the number of clinics and centers, the services 
7.16 	provided, and the availability of care; and
7.17 	(4) the extent to which increased use of physician assistants, nurse practitioners, 
7.18 	medical residents and interns, and other allied health professionals in clinics and centers 
7.19 	would increase the availability of services.
7.20 	(b) The commissioners shall make departmental modifications and legislative 
7.21 	recommendations as appropriate on the basis of their considerations under paragraph (a).

7.22 	Sec. 15. REPORTING OF ACQUIRED INFECTIONS.
 7.23 	(a) The commissioner of health may consult with infection control specialists, health 
7.24 	care facility representatives, and consumers for the purpose of obtaining recommendations 
7.25 	regarding a determination of the need for action to implement health care associated 
7.26 	infection control reporting in hospitals and nursing homes. If the outcome of the 
7.27 	determination warrants, the commissioner shall consult with the group regarding: 
7.28 	(1) the selection of reporting measures relating to health care associated infections;  
7.29 	(2) design, implementation, validation, and ongoing evaluation of the reporting 
7.30 	system; and  
7.31 	(3) ensuring that the reporting measures remain flexible and adaptable to changing 
7.32 	national standards.  
7.33 	(b) If the commissioner determines that there is a need for the action described in 
7.34 	paragraph (a), the commissioner shall make written  recommendations to the legislature. 

8.1 	Sec. 16. STUDY OF HOSPITAL UNCOMPENSATED CARE.
 8.2 	(a) The commissioner of health shall study and report to the legislature by January 
8.3 	15, 2007, the following:
8.4 	(1) trends in hospitals' cost of providing uncompensated care, separately identifying 
8.5 	charity care and bad debt as components of uncompensated care;
8.6 	(2) the impact of any changes in hospitals' charity care policies and debt collection 
8.7 	practices in the past three years on the amount of uncompensated care provided and the 
8.8 	number of patients receiving uncompensated care; and
8.9 	(3) the value of hospital uncompensated care and community benefits in comparison 
8.10 	to the value of tax exemptions received as a result of nonprofit status.
8.11 	(b) The commissioner's report to the legislature shall include recommendations on: 
8.12 	(1) the need for more uniform hospital charity care policies and debt collection practices; 
8.13 	and (2) the need for more uniform reporting of community benefits provided by nonprofit 
8.14 	hospitals.

8.15 	Sec. 17. STUDY; REPORT.
 8.16 	The medical director for medical assistance and the assistant commissioner for 
8.17 	chemical and mental health services of the Department of Human Services, in conjunction 
8.18 	with the mental health licensing boards, shall evaluate the requirements for licensed 
8.19 	mental health practitioners to receive medical assistance reimbursement under Minnesota 
8.20 	Statutes, section 256B.0625, subdivision 38. The purpose of this study is to evaluate 
8.21 	qualifications of all licensed mental health practitioners and licensed mental health 
8.22 	professionals and make recommendations regarding requirements for medical assistance 
8.23 	reimbursement. This study is to be completed by January 15, 2007. Written results of 
8.24 	the study are to be submitted to the chairs of the house of representatives and senate 
8.25 	committees with jurisdiction over health related licensing boards.

8.26 	Sec. 18. APPROPRIATIONS.
 8.27 	(a) In fiscal year 2007, $50,000 is appropriated from the general fund to the 
8.28 	commissioner of human services for the efforts required under Minnesota Statutes, section 
8.29 	256B.043.
8.30 	(b) $5,000 is appropriated from the state government special revenue fund in fiscal 
8.31 	year 2006 and $5,000 is appropriated from the state government special revenue fund 
8.32 	in fiscal year 2007 to the Board of Chiropractic Examiners, to correct programming 
8.33 	difficulties incurred during implementation of payment processing changes. This is 
8.34 	a onetime appropriation.

9.1 	ARTICLE 2
9.2 	CHARITY CARE BY HEALTH CARE PROVIDERS

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

9.9 	Sec. 2. Minnesota Statutes 2004, section 72A.20, is amended by adding a subdivision 
9.10 	to read:
9.11 		Subd. 39.Discounted payments by health care providers; effect on use of 
9.12 	usual and customary payments. An insurer, including, but not limited to, a health plan 
9.13 	company as defined in section 62Q.01, subdivision 4; a reparation obligor as defined in 
9.14 	section 65B.43, subdivision 9; and a workers' compensation insurer shall not consider in 
9.15 	determining a health care provider's usual and customary payment, standard payment, or 
9.16 	allowable payment used as a basis for determining the provider's payment by the insurer, 
9.17 	the following discounted payment situations:
9.18 	(1) care provided to relatives of the provider;
9.19 	(2) care for which a discount or free care is given in hardship situations; and
9.20 	(3) care for which a discount is given in exchange for cash payment.
9.21 	For purposes of this subdivision, "health care provider" and "provider" have the 
9.22 	meaning given in section 62J.03, subdivision 8.

9.23 	Sec. 3.  REPEALER.
 9.24 	Minnesota Statutes 2005 Supplement, section 62Q.251, is repealed.

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

9.27 	ARTICLE 3
9.28 	PRIVATE SECTOR HEALTH COVERAGE PROVISIONS

9.29 	Section 1. Minnesota Statutes 2004, section 62D.095, subdivision 3, is amended to 
9.30 	read:
10.1 		Subd. 3.Deductibles. (a) A health maintenance contract issued by a health 
10.2 	maintenance organization that is assessed less than three percent of the total annual amount 
10.3 	assessed by the Minnesota comprehensive health association may impose deductibles not 
10.4 	to exceed $3,000 $4,000 per person, per year and $6,000 $8,000 per family, per year. For 
10.5 	purposes of the percentage calculation, a health maintenance organization's assessments 
10.6 	include those of its affiliates.
10.7 	(b) All other health maintenance contracts may impose deductibles not to exceed 
10.8 	$2,250 per person, per year and $4,500 per family, per year.

10.9 	Sec. 2. Minnesota Statutes 2004, section 62D.095, subdivision 4, is amended to read:
10.10 		Subd. 4.Annual out-of-pocket maximums. (a) A health maintenance contract 
10.11 	issued by a health maintenance organization that is assessed less than three percent of the 
10.12 	total annual amount assessed by the Minnesota comprehensive health association must 
10.13 	include a limitation not to exceed $4,500 $5,000 per person and $7,500 $10,000 per 
10.14 	family on total annual out-of-pocket enrollee cost-sharing expenses. For purposes of the 
10.15 	percentage calculation, a health maintenance organization's assessments include those 
10.16 	of its affiliates.
10.17 	(b) All other health maintenance contracts must include a limitation not to 
10.18 	exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee 
10.19 	cost-sharing expenses.

10.20 	Sec. 3. [62Q.645] DISTRIBUTION OF INFORMATION; ADMINISTRATIVE 
10.21 	EFFICIENCY AND COVERAGE OPTIONS.
10.22 	(a) The commissioner may use reports submitted by health  plan companies, service 
10.23 	cooperatives, and the public employee  insurance program created in section 43A.316 
10.24 	to compile entity specific administrative efficiency reports; may make these reports 
10.25 	available on state agency Web sites,  including minnesotahealthinfo.com; and may include 
10.26 	information  on: 
10.27 	(1) number of covered lives;  
10.28 	(2) covered services;  
10.29 	(3) geographic availability;  
10.30 	(4) whom to contact to obtain current premium rates;  
10.31 	(5) administrative costs, using the definition of  administrative costs developed under 
10.32 	section 62J.38;  
10.33 	(6) Internet links to information on the health plan, if  available; and  
11.1 	(7) any other information about the health plan identified  by the commissioner 
11.2 	as being useful for employers, consumers,  providers, and others in evaluating health 
11.3 	plan options. 
11.4 	(b) This section does not apply to a health plan company  unless its annual Minnesota 
11.5 	premiums exceed $50,000,000 based on the most recent assessment base of the Minnesota 
11.6 	Comprehensive Health Association. For purposes of this  determination, the premiums of a 
11.7 	health plan company include  those of its affiliates. 

11.8 	Sec. 4. MEDICAL MALPRACTICE INSURANCE REPORT.
 11.9 	(a) The commissioner of commerce shall provide to the legislature annually a brief 
11.10 	written report on the status of the market for medical malpractice insurance in Minnesota. 
11.11 	The report must summarize, interpret, explain, and analyze information on that subject 
11.12 	available to the commissioner, through annual statements filed by insurance companies, 
11.13 	information obtained under paragraph (c), and other sources. 
11.14 	(b) The annual report must consider, to the extent possible, using definitions 
11.15 	developed by the commissioner, Minnesota-specific data on market shares; premiums 
11.16 	received; amounts paid to settle claims that were not litigated, claims that were settled 
11.17 	after litigation began, and claims that were litigated to court judgment; amounts spent 
11.18 	on processing, investigation, litigation, and otherwise handling claims; other sales and 
11.19 	administrative costs; and the loss ratios of the insurers. 
11.20 	(c) Each insurance company that provides medical malpractice insurance in this state 
11.21 	shall, no later than June 1 each year, file with the commissioner of commerce, on a form 
11.22 	prescribed by the commissioner and using definitions developed by the commissioner, 
11.23 	the Minnesota-specific data referenced in paragraph (b), other than market share, for the 
11.24 	previous calendar year for that insurance company, shown separately for various categories 
11.25 	of coverages including, if possible, hospitals, medical clinics, nursing homes, physicians 
11.26 	who provide emergency medical care, obstetrician gynecologists, and ambulance services. 
11.27 	An insurance company need not comply with this paragraph if its direct premium written 
11.28 	in the state for the previous calendar year is less than $2,000,000.

11.29 	ARTICLE 4
11.30 	SERVICE COOPERATIVES

11.31 	Section 1. Minnesota Statutes 2004, section 123A.21, subdivision 7, is amended to 
11.32 	read:
11.33 		Subd. 7.Educational programs and services. (a) The board of directors of each 
11.34 	SC shall submit annually a plan to the members. The plan shall identify the programs and 
12.1 	services which are suggested for implementation by the SC during the following year and 
12.2 	shall contain components of long-range planning determined by the SC. These programs 
12.3 	and services may include, but are not limited to, the following areas:
12.4 	(1) administrative services;
12.5 	(2) curriculum development;
12.6 	(3) data processing;
12.7 	(4) distance learning and other telecommunication services;
12.8 	(5) evaluation and research;
12.9 	(6) staff development;
12.10 	(7) media and technology centers;
12.11 	(8) publication and dissemination of materials;
12.12 	(9) pupil personnel services;
12.13 	(10) planning;
12.14 	(11) secondary, postsecondary, community, adult, and adult vocational education;
12.15 	(12) teaching and learning services, including services for students with special 
12.16 	talents and special needs;
12.17 	(13) employee personnel services;
12.18 	(14) vocational rehabilitation;
12.19 	(15) health, diagnostic, and child development services and centers;
12.20 	(16) leadership or direction in early childhood and family education;
12.21 	(17) community services;
12.22 	(18) shared time programs;
12.23 	(19) fiscal services and risk management programs;
12.24 	(20) technology planning, training, and support services;
12.25 	(21) health and safety services;
12.26 	(22) student academic challenges; and
12.27 	(23) cooperative purchasing services.
12.28 	(b) A group health, dental, or long-term disability coverage program provided by 
12.29 	one or more service cooperatives:
12.30 	(1) must rebid contracts for insurance and third-party administration at least every 
12.31 	four years. The contracts may be regional or statewide in the discretion of the SC; and
12.32 	(2) may determine premiums for its health, dental, or long-term disability coverage 
12.33 	individually for specific employers or may determine them on a pooled or other basis 
12.34 	established by the SC.

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

13.1 	Sec. 2. Laws 2003, First Special Session chapter 14,  article 12, section 93, as amended 
13.2 	by Laws 2005, First Special Session chapter 4, article 8, section 80, is amended to read:
13.3 	Sec. 93.  REVIEW OF SPECIAL TRANSPORTATION ELIGIBILITY  
13.4 	CRITERIA AND POTENTIAL COST SAVINGS. 
13.5 	The commissioner of human services, in consultation with  the commissioner of 
13.6 	transportation and special transportation  service providers, shall review eligibility criteria 
13.7 	for medical  assistance special transportation services and shall evaluate  whether the level 
13.8 	of special transportation services provided  should be based on the degree of impairment of 
13.9 	the client, as  well as the medical diagnosis.  The commissioner shall also  evaluate methods 
13.10 	for reducing the cost of special transportation  services, including, but not limited to:  
13.11 	
13.12 	(1) requiring providers to maintain a daily log book  confirming delivery of clients to 
13.13 	medical facilities;  
13.14 	
13.15 	(2) requiring providers to implement commercially available  computer mapping 
13.16 	programs to calculate mileage for purposes of  reimbursement;  
13.17 	
13.18 	(3) restricting special transportation service from being  provided solely for trips 
13.19 	to pharmacies;  
13.20 	
13.21 	(4) modifying eligibility for special transportation;  
13.22 	
13.23 	(5) expanding alternatives to the use of special  transportation services;  
13.24 	
13.25 	(6) improving the process of certifying persons as eligible  for special transportation 
13.26 	services; and  
13.27 	
13.28 	(7) examining the feasibility and benefits of licensing  special transportation 
13.29 	providers.  
13.30 	
13.31 	The commissioner shall present recommendations for changes  in the eligibility 
13.32 	criteria and potential cost-savings for  special transportation services to the chairs and 
13.33 	ranking  minority members of the house and senate committees having  jurisdiction 
13.34 	over health and human services spending by January  15, 2004.  The commissioner 
13.35 	is prohibited from using a broker or  coordinator to manage special transportation 
13.36 	services until July  1,  2006, except for the purposes of checking for recipient  eligibility, 
14.1 	authorizing recipients for appropriate level of  transportation, and monitoring provider 
14.2 	compliance with  Minnesota Statutes, section 256B.0625, subdivision 17, and except 
14.3 	that the commissioner shall extend this prohibition on using a broker or coordinator to 
14.4 	manage special transportation services until July 1, 2007, if this extension can be done on 
14.5 	a budget-neutral basis. The  commissioner shall not amend the initial contract to broker or  
14.6 	manage nonemergency medical transportation to extend beyond two  consecutive years.  
14.7 	The commissioner shall not enter into a  broker or management contract for transportation 
14.8 	services which  denies a medical assistance recipient the free choice of health  service 
14.9 	provider, including a special transportation provider,  as specified in Code of Federal 
14.10 	Regulations, title 42, section  431.51.  This prohibition does not apply to the purchase or  
14.11 	management of common carrier transportation. 
14.12 	

14.13 	EFFECTIVE DATE. This section is effective July 1, 2006.