1.1 	A bill for an act
1.2 	relating to health care; modifying premium rate
1.3 	restrictions; establishing expenditure limits;
1.4 	modifying cost containment provisions; modifying
1.5 	utilization review provisions; modifying certain loan
1.6 	forgiveness programs; modifying medical assistance,
1.7 	general assistance medical care, and MinnesotaCare
1.8 	programs; requiring reports; appropriating money;
1.9 	amending Minnesota Statutes 2004, sections 62A.65,
1.10 	subdivision 3; 62D.12, subdivision 19; 62J.04,
1.11 	subdivision 3, by adding a subdivision; 62J.041;
1.12 	62J.301, subdivision 3; 62J.38; 62J.692, subdivision
1.13 	3; 62L.08, subdivision 8; 62M.06, subdivisions 2, 3;
1.14 	144.1501, subdivisions 2, 4; 256.045, subdivision 3a;
1.15 	256.9693; 256B.0625, subdivision 3b, by adding a
1.16 	subdivision; 256B.0627, subdivisions 1, 4, 9;
1.17 	256B.0631, by adding a subdivision; 256D.03,
1.18 	subdivision 4; 256L.07, subdivision 1; proposing
1.19 	coding for new law in Minnesota Statutes, chapters
1.20 	62J; 62Q; 256; 256B; 256L.
1.21 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.22 	Section 1. Minnesota Statutes 2004, section 62A.65,
1.23 	subdivision 3, is amended to read:
1.24 		Subd. 3.Premium rate restrictions.  No individual health
1.25 	plan may be offered, sold, issued, or renewed to a Minnesota
1.26 	resident unless the premium rate charged is determined in
1.27 	accordance with the following requirements:
1.28 	(a) Premium rates must be no more than 25 percent above and
1.29 	no more than 25 percent below the index rate charged to
1.30 	individuals for the same or similar coverage, adjusted pro rata
1.31 	for rating periods of less than one year.  The premium
1.32 	variations permitted by this paragraph must be based only upon
1.33 	health status, claims experience, and occupation.  For purposes
2.1 	of this paragraph, health status includes refraining from
2.2 	tobacco use or other actuarially valid lifestyle factors
2.3 	associated with good health, provided that the lifestyle factor
2.4 	and its effect upon premium rates have been determined by the
2.5 	commissioner to be actuarially valid and have been approved by
2.6 	the commissioner.  Variations permitted under this paragraph
2.7 	must not be based upon age or applied differently at different
2.8 	ages.  This paragraph does not prohibit use of a constant
2.9 	percentage adjustment for factors permitted to be used under
2.10 	this paragraph.
2.11 	(b) Premium rates may vary based upon the ages of covered
2.12 	persons only as provided in this paragraph.  In addition to the
2.13 	variation permitted under paragraph (a), each health carrier may
2.14 	use an additional premium variation based upon age of up to plus
2.15 	or minus 50 percent of the index rate.
2.16 	(c) A health carrier may request approval by the
2.17 	commissioner to establish no more than three geographic regions
2.18 	and to establish separate index rates for each region, provided
2.19 	that the index rates do not vary between any two regions by more
2.20 	than 20 percent.  Health carriers that do not do business in the
2.21 	Minneapolis/St. Paul metropolitan area may request approval for
2.22 	no more than two geographic regions, and clauses (2) and (3) do
2.23 	not apply to approval of requests made by those health
2.24 	carriers.  The commissioner may grant approval if the following
2.25 	conditions are met:
2.26 	(1) the geographic regions must be applied uniformly by the
2.27 	health carrier;
2.28 	(2) one geographic region must be based on the
2.29 	Minneapolis/St. Paul metropolitan area;
2.30 	(3) for each geographic region that is rural, the index
2.31 	rate for that region must not exceed the index rate for the
2.32 	Minneapolis/St. Paul metropolitan area; and
2.33 	(4) the health carrier provides actuarial justification
2.34 	acceptable to the commissioner for the proposed geographic
2.35 	variations in index rates, establishing that the variations are
2.36 	based upon differences in the cost to the health carrier of
3.1 	providing coverage.
3.2 	(d) Health carriers may use rate cells and must file with
3.3 	the commissioner the rate cells they use.  Rate cells must be
3.4 	based upon the number of adults or children covered under the
3.5 	policy and may reflect the availability of Medicare coverage.
3.6 	The rates for different rate cells must not in any way reflect
3.7 	generalized differences in expected costs between principal
3.8 	insureds and their spouses.
3.9 	(e) In developing its index rates and premiums for a health
3.10 	plan, a health carrier shall take into account only the
3.11 	following factors:
3.12 	(1) actuarially valid differences in rating factors
3.13 	permitted under paragraphs (a) and (b); and
3.14 	(2) actuarially valid geographic variations if approved by
3.15 	the commissioner as provided in paragraph (c).
3.16 	(f) All premium variations must be justified in initial
3.17 	rate filings and upon request of the commissioner in rate
3.18 	revision filings.  All rate variations are subject to approval
3.19 	by the commissioner.
3.20 	(g) The loss ratio must comply with the section 62A.021
3.21 	requirements for individual health plans.
3.22 	(h) Notwithstanding paragraphs (a) to (g),the rates must
3.23 	not be approved,unless the commissioner has determined that the
3.24 	rates are reasonable.  In determining reasonableness, the
3.25 	commissioner shall consider the growth rates applied under
3.26 	section 62J.04, subdivision 1, paragraph (b) apply the premium
3.27 	growth limits established under section 62J.04, subdivision 1b,
3.28 	to the calendar year or years that the proposed premium rate
3.29 	would be in effect, and shall consider actuarially valid changes
3.30 	in risks associated with the enrollee populations,and
3.31 	actuarially valid changes as a result of statutory changes in
3.32 	Laws 1992, chapter 549.

3.33 	Sec. 2. Minnesota Statutes 2004, section 62D.12,
3.34 	subdivision 19, is amended to read:
3.35 		Subd. 19.Coverage of service.  A health maintenance
3.36 	organization may not deny or limit coverage of a service which
4.1 	the enrollee has already received solely on the basis of lack of
4.2 	prior authorization or second opinion, to the extent that the
4.3 	service would otherwise have been covered under the member's
4.4 	contract by the health maintenance organization had prior
4.5 	authorization or second opinion been obtained. This subdivision
4.6 	does not apply to health maintenance organizations for services
4.7 	provided in the prepaid health programs administered under
4.8 	chapter 256B, 256D, or 256L.

4.9 	Sec. 3. Minnesota Statutes 2004, section 62J.04, is
4.10 	amended by adding a subdivision to read:
4.11 		Subd. 1b.Premium growth limits. (a) For calendar year
4.12 	2005 and each year thereafter, the commissioner shall set annual
4.13 	premium growth limits for health plan companies.  The premium
4.14 	limits set by the commissioner for calendar years 2005 to 2010
4.15 	shall not exceed the regional Consumer Price Index for urban
4.16 	consumers for the preceding calendar year plus two percentage
4.17 	points and an additional one percentage point to be used to
4.18 	finance the implementation of the electronic medical record
4.19 	system described under section 62J.565.  The commissioner shall
4.20 	ensure that the additional percentage point is being used to
4.21 	provide financial assistance to health care providers to
4.22 	implement electronic medical record systems either directly or
4.23 	through an increase in reimbursement.
4.24 	(b) For the calendar years beyond 2010, the rate of premium
4.25 	growth shall be limited to the change in the Consumer Price
4.26 	Index for urban consumers for the previous calendar year plus
4.27 	two percentage points.  The commissioners of health and commerce
4.28 	shall make a recommendation to the legislature by January 15,
4.29 	2009, regarding the continuation of the additional percentage
4.30 	point to the growth limit described in paragraph (a).  The
4.31 	recommendation shall be based on the progress made by health
4.32 	care providers in instituting an electronic medical record
4.33 	system and in creating a statewide interactive electronic health
4.34 	record system.
4.35 	(c) The commissioner may add additional percentage points
4.36 	as needed to the premium limit for a calendar year if a major
5.1 	disaster, bioterrorism, or a public health emergency occurs that
5.2 	results in higher health care costs.  Any additional percentage
5.3 	points must reflect the additional cost to the health care
5.4 	system directly attributed to the disaster or emergency.
5.5 	(d) The commissioner shall publish the annual premium
5.6 	growth limits in the State Register by January 31 of the year
5.7 	that the limits are to be in effect.
5.8 	(e) For the purpose of this subdivision, premium growth is
5.9 	measured as the percentage change in per member, per month
5.10 	premium revenue from the current year to the previous year.
5.11 	Premium growth rates shall be calculated for the following lines
5.12 	of business:  individual, small group, and large group.  Data
5.13 	used for premium growth rate calculations shall be submitted as
5.14 	part of the cost containment filing under section 62J.38.
5.15 	(f) For purposes of this subdivision, "health plan company"
5.16 	has the meaning given in section 62J.041.
5.17 	(g) For coverage that is provided by a health plan company
5.18 	under the terms of a contract with the Department of Employee
5.19 	Relations, the commissioner of employee relations shall direct
5.20 	the contracting health plan companies to reduce reimbursement to
5.21 	providers in order to meet the premium growth limitations
5.22 	required by this section.

5.23 	Sec. 4. Minnesota Statutes 2004, section 62J.04,
5.24 	subdivision 3, is amended to read:
5.25 		Subd. 3.Cost containment duties.  The commissioner shall:
5.26 	(1) establish statewide and regional cost containment goals
5.27 	for total health care spending under this section and collect
5.28 	data as described in sections 62J.38 to 62J.41 to monitor
5.29 	statewide achievement of the cost containment goals and premium
5.30 	growth limits;
5.31 	(2) divide the state into no fewer than four regions, with
5.32 	one of those regions being the Minneapolis/St. Paul metropolitan
5.33 	statistical area but excluding Chisago, Isanti, Wright, and
5.34 	Sherburne Counties, for purposes of fostering the development of
5.35 	regional health planning and coordination of health care
5.36 	delivery among regional health care systems and working to
6.1 	achieve the cost containment goals;
6.2 	(3) monitor the quality of health care throughout the state
6.3 	and take action as necessary to ensure an appropriate level of
6.4 	quality;
6.5 	(4) issue recommendations regarding uniform billing forms,
6.6 	uniform electronic billing procedures and data interchanges,
6.7 	patient identification cards, and other uniform claims and
6.8 	administrative procedures for health care providers and private
6.9 	and public sector payers.  In developing the recommendations,
6.10 	the commissioner shall review the work of the work group on
6.11 	electronic data interchange (WEDI) and the American National
6.12 	Standards Institute (ANSI) at the national level, and the work
6.13 	being done at the state and local level.  The commissioner may
6.14 	adopt rules requiring the use of the Uniform Bill 82/92 form,
6.15 	the National Council of Prescription Drug Providers (NCPDP) 3.2
6.16 	electronic version, the Centers for Medicare and Medicaid
6.17 	Services 1500 form, or other standardized forms or procedures;
6.18 	(5) undertake health planning responsibilities;
6.19 	(6) authorize, fund, or promote research and
6.20 	experimentation on new technologies and health care procedures;
6.21 	(7) within the limits of appropriations for these purposes,
6.22 	administer or contract for statewide consumer education and
6.23 	wellness programs that will improve the health of Minnesotans
6.24 	and increase individual responsibility relating to personal
6.25 	health and the delivery of health care services, undertake
6.26 	prevention programs including initiatives to improve birth
6.27 	outcomes, expand childhood immunization efforts, and provide
6.28 	start-up grants for worksite wellness programs;
6.29 	(8) undertake other activities to monitor and oversee the
6.30 	delivery of health care services in Minnesota with the goal of
6.31 	improving affordability, quality, and accessibility of health
6.32 	care for all Minnesotans; and
6.33 	(9) make the cost containment goal and premium growth limit 
6.34 	data available to the public in a consumer-oriented manner.

6.35 	Sec. 5. Minnesota Statutes 2004, section 62J.041, is
6.36 	amended to read:
7.1 	62J.041  INTERIM HEALTH PLAN COMPANY COST CONTAINMENT GOALS 
7.2 	HEALTH CARE EXPENDITURE LIMITS.
7.3 		Subdivision 1.Definitions. (a) For purposes of this
7.4 	section, the following definitions apply.
7.5 	(b) "Health plan company" has the definition provided in
7.6 	section 62Q.01and also includes employee health plans offered
7.7 	by self-insured employers.
7.8 	(c) " Total Health care expenditures" means incurred claims
7.9 	or expenditures on health care services, administrative
7.10 	expenses, charitable contributions, and all other payments made
7.11 	by health plan companies out of premium revenues.
7.12 	(d) "Net expenditures" means total expenditures minus
7.13 	exempted taxes and assessments and payments or allocations made
7.14 	to establish or maintain reserves.
7.15 	(e) "Exempted taxes and assessments" means direct payments
7.16 	for taxes to government agencies, contributions to the Minnesota
7.17 	Comprehensive Health Association, the medical assistance
7.18 	provider's surcharge under section 256.9657, the MinnesotaCare
7.19 	provider tax under section 295.52, assessments by the Health
7.20 	Coverage Reinsurance Association, assessments by the Minnesota
7.21 	Life and Health Insurance Guaranty Association, assessments by
7.22 	the Minnesota Risk Adjustment Association, and any new
7.23 	assessments imposed by federal or state law.
7.24 	(f) "Consumer cost-sharing or subscriber liability" means
7.25 	enrollee coinsurance, co-payment, deductible payments, and
7.26 	amounts in excess of benefit plan maximums.
7.27 		Subd. 2.Establishment. The commissioner of health shall
7.28 	establish cost containment goals health care expenditure limits 
7.29 	for the increase in net calendar year 2006, and each year
7.30 	thereafter, for health care expenditures by each health plan
7.31 	company for calendar years 1994, 1995, 1996, and 1997.  The cost
7.32 	containment goals must be the same as the annual cost
7.33 	containment goals for health care spending established under
7.34 	section 62J.04, subdivision 1, paragraph (b).  Health plan
7.35 	companies that are affiliates may elect to meet one
7.36 	combined cost containment goal health care expenditure limit.
8.1 	The limits set by the commissioner shall not exceed the premium
8.2 	limits established in section 62J.04, subdivision 1b.
8.3 		Subd. 3.Determination of expenditures. Health plan
8.4 	companies shall submit to the commissioner of health, by April
8.5 	1, 1994, for calendar year 1993; April 1, 1995, for calendar
8.6 	year 1994; April 1, 1996, for calendar year 1995; April 1, 1997,
8.7 	for calendar year 1996; and April 1, 1998, for calendar year
8.8 	1997 of each year beginning 2006,all information the
8.9 	commissioner determines to be necessary to implement this
8.10 	section.  The information must be submitted in the form
8.11 	specified by the commissioner.  The information must include,
8.12 	but is not limited to, health care expenditures per member per
8.13 	month or cost per employee per month, and detailed information
8.14 	on revenues and reserves.  The commissioner, to the extent
8.15 	possible, shall coordinate the submittal of the information
8.16 	required under this section with the submittal of the financial
8.17 	data required under chapter 62J, to minimize the administrative
8.18 	burden on health plan companies.  The commissioner may adjust
8.19 	final expenditure figures for demographic changes, risk
8.20 	selection, changes in basic benefits, and legislative
8.21 	initiatives that materially change health care costs, as long as
8.22 	these adjustments are consistent with the methodology submitted
8.23 	by the health plan company to the commissioner, and approved by
8.24 	the commissioner as actuarially justified. The methodology to
8.25 	be used for adjustments and the election to meet one cost
8.26 	containment goal for affiliated health plan companies must be
8.27 	submitted to the commissioner by September 1, 1994.  Community
8.28 	integrated service networks may submit the information with
8.29 	their application for licensure.  The commissioner shall also
8.30 	accept changes to methodologies already submitted.  The
8.31 	adjustment methodology submitted and approved by the
8.32 	commissioner must apply to the data submitted for calendar years
8.33 	1994 and 1995.  The commissioner may allow changes to accepted
8.34 	adjustment methodologies for data submitted for calendar years
8.35 	1996 and 1997.  Changes to the adjustment methodology must be
8.36 	received by September 1, 1996, and must be approved by the
9.1 	commissioner.
9.2 		Subd. 4.Monitoring of reserves. (a) The commissioners
9.3 	of health and commerce shall monitor health plan company
9.4 	reserves and net worth as established under chapters 60A, 62C,
9.5 	62D, 62H, and 64B, with respect to the health plan companies
9.6 	that each commissioner respectively regulates to assess the
9.7 	degree to which savings resulting from the establishment of cost
9.8 	containment goals are passed on to consumers in the form of
9.9 	lower premium rates.
9.10 	(b) Health plan companies shall fully reflect in the
9.11 	premium rates the savings generated by the cost containment
9.12 	goals.  No premium rate, currently reviewed by the Department of
9.13 	Health or Commerce, may be approved for those health plan
9.14 	companies unless the health plan company establishes to the
9.15 	satisfaction of the commissioner of commerce or the commissioner
9.16 	of health, as appropriate, that the proposed new rate would
9.17 	comply with this paragraph.
9.18 	(c) Health plan companies, except those licensed under
9.19 	chapter 60A to sell accident and sickness insurance under
9.20 	chapter 62A, shall annually before the end of the fourth fiscal
9.21 	quarter provide to the commissioner of health or commerce, as
9.22 	applicable, a projection of the level of reserves the company
9.23 	expects to attain during each quarter of the following fiscal
9.24 	year.  These health plan companies shall submit with required
9.25 	quarterly financial statements a calculation of the actual
9.26 	reserve level attained by the company at the end of each quarter
9.27 	including identification of the sources of any significant
9.28 	changes in the reserve level and an updated projection of the
9.29 	level of reserves the health plan company expects to attain by
9.30 	the end of the fiscal year.  In cases where the health plan
9.31 	company has been given a certificate to operate a new health
9.32 	maintenance organization under chapter 62D, or been licensed as
9.33 	a community integrated service network under chapter 62N, or
9.34 	formed an affiliation with one of these organizations, the
9.35 	health plan company shall also submit with its quarterly
9.36 	financial statement, total enrollment at the beginning and end
10.1 	of the quarter and enrollment changes within each service area
10.2 	of the new organization.  The reserve calculations shall be
10.3 	maintained by the commissioners as trade secret information,
10.4 	except to the extent that such information is also required to
10.5 	be filed by another provision of state law and is not treated as
10.6 	trade secret information under such other provisions.
10.7 	(d) Health plan companies in paragraph (c) whose reserves
10.8 	are less than the required minimum or more than the required
10.9 	maximum at the end of the fiscal year shall submit a plan of
10.10 	corrective action to the commissioner of health or commerce
10.11 	under subdivision 7.
10.12 	(e) The commissioner of commerce, in consultation with the
10.13 	commissioner of health, shall report to the legislature no later
10.14 	than January 15, 1995, as to whether the concept of a reserve
10.15 	corridor or other mechanism for purposes of monitoring reserves
10.16 	is adaptable for use with indemnity health insurers that do
10.17 	business in multiple states and that must comply with their
10.18 	domiciliary state's reserves requirements.
10.19 		Subd. 5.Notice. The commissioner of health shall
10.20 	publish in the State Register and make available to the public
10.21 	by July 1, 1995 2007, and each year thereafter,a list of all
10.22 	health plan companies that exceeded their cost containment goal 
10.23 	health care expenditure limit for the 1994 previous calendar
10.24 	year. The commissioner shall publish in the State Register and
10.25 	make available to the public by July 1, 1996, a list of all
10.26 	health plan companies that exceeded their combined cost
10.27 	containment goal for calendar years 1994 and 1995.The
10.28 	commissioner shall notify each health plan company that the
10.29 	commissioner has determined that the health plan company
10.30 	exceeded its cost containment goal,health care expenditure
10.31 	limit at least 30 days before publishing the list, and shall
10.32 	provide each health plan company with ten days to provide an
10.33 	explanation for exceeding the cost containment goal health care
10.34 	expenditure limit.  The commissioner shall review the
10.35 	explanation and may change a determination if the commissioner
10.36 	determines the explanation to be valid.
11.1 		Subd. 6.Assistance by the commissioner of commerce. The
11.2 	commissioner of commerce shall provide assistance to the
11.3 	commissioner of health in monitoring health plan companies
11.4 	regulated by the commissioner of commerce.

11.5 	Sec. 6. [62J.255] HEALTH RISK INFORMATION SHEET.
11.6 	(a) A health plan company shall provide to each enrollee on
11.7 	an annual basis information on the increased personal health
11.8 	risks and the additional costs to the health care system due to
11.9 	obesity and to the use of tobacco.
11.10 	(b) The commissioner, in consultation with the Minnesota
11.11 	Medical Association, shall develop an information sheet on the
11.12 	personal health risks of obesity and smoking and on the
11.13 	additional costs to the health care system due to obesity and
11.14 	due to smoking.  The information sheet shall be posted on the
11.15 	Minnesota Department of Health's Web site.
11.16 	(c) When providing the information required in paragraph
11.17 	(a), the health plan company must also provide each enrollee
11.18 	with information on the best practices care guidelines and
11.19 	quality of care measurement criteria identified in section
11.20 	62J.43 as well as the availability of this information on the
11.21 	department's Web site.
11.22 	(d) This section does not apply to health plan companies
11.23 	offering only limited dental or vision plans.

11.24 	Sec. 7. Minnesota Statutes 2004, section 62J.301,
11.25 	subdivision 3, is amended to read:
11.26 		Subd. 3.General duties.  The commissioner shall:
11.27 	(1) collect and maintain data which enable population-based
11.28 	monitoring and trending of the access, utilization, quality, and
11.29 	cost of health care services within Minnesota;
11.30 	(2) collect and maintain data for the purpose of estimating
11.31 	total Minnesota health care expenditures and trends;
11.32 	(3) collect and maintain data for the purposes of setting
11.33 	cost containment goals and premium growth limits under section
11.34 	62J.04, and measuring cost containment goal and premium growth
11.35 	limit compliance;
11.36 	(4) conduct applied research using existing and new data
12.1 	and promote applications based on existing research;
12.2 	(5) develop and implement data collection procedures to
12.3 	ensure a high level of cooperation from health care providers
12.4 	and health plan companies, as defined in section 62Q.01,
12.5 	subdivision 4;
12.6 	(6) work closely with health plan companies and health care
12.7 	providers to promote improvements in health care efficiency and
12.8 	effectiveness; and
12.9 	(7) participate as a partner or sponsor of private sector
12.10 	initiatives that promote publicly disseminated applied research
12.11 	on health care delivery, outcomes, costs, quality, and
12.12 	management.

12.13 	Sec. 8. Minnesota Statutes 2004, section 62J.38, is
12.14 	amended to read:
12.15 	62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.
12.16 	(a) The commissioner shall require group purchasers to
12.17 	submit detailed data on total health care spending for each
12.18 	calendar year.  Group purchasers shall submit data for the 1993
12.19 	calendar year by April 1, 1994, and each April 1 thereafter
12.20 	shall submit data for the preceding calendar year.
12.21 	(b) The commissioner shall require each group purchaser to
12.22 	submit data on revenue, expenses, and member months, as
12.23 	applicable.  Revenue data must distinguish between premium
12.24 	revenue and revenue from other sources and must also include
12.25 	information on the amount of revenue in reserves and changes in
12.26 	reserves. Premium revenue data, information on aggregate
12.27 	enrollment, and data on member months must be broken down to
12.28 	distinguish between individual market, small group market, and
12.29 	large group market.  Filings under this section for calendar
12.30 	year 2005 must also include information broken down by
12.31 	individual market, small group market, and large group market
12.32 	for calendar year 2004.Expenditure data must distinguish
12.33 	between costs incurred for patient care and administrative
12.34 	costs.  Patient care and administrative costs must include only
12.35 	expenses incurred on behalf of health plan members and must not
12.36 	include the cost of providing health care services for
13.1 	nonmembers at facilities owned by the group purchaser or
13.2 	affiliate.  Expenditure data must be provided separately for the
13.3 	following categories and for other categories required by the
13.4 	commissioner:  physician services, dental services, other
13.5 	professional services, inpatient hospital services, outpatient
13.6 	hospital services, emergency, pharmacy services and other
13.7 	nondurable medical goods, mental health, and chemical dependency
13.8 	services, other expenditures, subscriber liability, and
13.9 	administrative costs.  Administrative costs must include costs
13.10 	for marketing; advertising; overhead; salaries and benefits of
13.11 	central office staff who do not provide direct patient care;
13.12 	underwriting; lobbying; claims processing; provider contracting
13.13 	and credentialing; detection and prevention of payment for
13.14 	fraudulent or unjustified requests for reimbursement or
13.15 	services; clinical quality assurance and other types of medical
13.16 	care quality improvement efforts; concurrent or prospective
13.17 	utilization review as defined in section 62M.02; costs incurred
13.18 	to acquire a hospital, clinic, or health care facility, or the
13.19 	assets thereof; capital costs incurred on behalf of a hospital
13.20 	or clinic; lease payments; or any other costs incurred pursuant
13.21 	to a partnership, joint venture, integration, or affiliation
13.22 	agreement with a hospital, clinic, or other health care
13.23 	provider.  Capital costs and costs incurred must be recorded
13.24 	according to standard accounting principles.  The reports of
13.25 	this data must also separately identify expenses for local,
13.26 	state, and federal taxes, fees, and assessments.  The
13.27 	commissioner may require each group purchaser to submit any
13.28 	other data, including data in unaggregated form, for the
13.29 	purposes of developing spending estimates, setting spending
13.30 	limits, and monitoring actual spending and costs.  In addition
13.31 	to reporting administrative costs incurred to acquire a
13.32 	hospital, clinic, or health care facility, or the assets
13.33 	thereof; or any other costs incurred pursuant to a partnership,
13.34 	joint venture, integration, or affiliation agreement with a
13.35 	hospital, clinic, or other health care provider; reports
13.36 	submitted under this section also must include the payments made
14.1 	during the calendar year for these purposes.  The commissioner
14.2 	shall make public, by group purchaser data collected under this
14.3 	paragraph in accordance with section 62J.321, subdivision 5.
14.4 	Workers' compensation insurance plans and automobile insurance
14.5 	plans are exempt from complying with this paragraph as it
14.6 	relates to the submission of administrative costs.
14.7 	(c) The commissioner may collect information on:
14.8 	(1) premiums, benefit levels, managed care procedures, and
14.9 	other features of health plan companies;
14.10 	(2) prices, provider experience, and other information for
14.11 	services less commonly covered by insurance or for which
14.12 	patients commonly face significant out-of-pocket expenses; and
14.13 	(3) information on health care services not provided
14.14 	through health plan companies, including information on prices,
14.15 	costs, expenditures, and utilization.
14.16 	(d) All group purchasers shall provide the required data
14.17 	using a uniform format and uniform definitions, as prescribed by
14.18 	the commissioner.

14.19 	Sec. 9. Minnesota Statutes 2004, section 62J.692,
14.20 	subdivision 3, is amended to read:
14.21 		Subd. 3.Application process.  (a) A clinical medical
14.22 	education program conducted in Minnesota by a teaching
14.23 	institution to train physicians, doctor of pharmacy
14.24 	practitioners, dentists, chiropractors, or physician assistants
14.25 	is eligible for funds under subdivision 4 if the program:
14.26 	(1) is funded, in part, by patient care revenues;
14.27 	(2) occurs in patient care settings that face increased
14.28 	financial pressure as a result of competition with nonteaching
14.29 	patient care entities; and
14.30 	(3) emphasizes primary care or specialties that are in
14.31 	undersupply in Minnesota.
14.32 	A clinical medical education program that trains
14.33 	pediatricians is requested to include in its program curriculum
14.34 	training in case management and medication management for
14.35 	children suffering from mental illness to be eligible for funds
14.36 	under subdivision 4.
15.1 	(b) A clinical medical education program for advanced
15.2 	practice nursing is eligible for funds under subdivision 4 if
15.3 	the program meets the eligibility requirements in paragraph (a),
15.4 	clauses (1) to (3), and is sponsored by the University of
15.5 	Minnesota Academic Health Center, the Mayo Foundation, or
15.6 	institutions that are part of the Minnesota State Colleges and
15.7 	Universities system or members of the Minnesota Private College
15.8 	Council.
15.9 	(c) Applications must be submitted to the commissioner by a
15.10 	sponsoring institution on behalf of an eligible clinical medical
15.11 	education program and must be received by October 31 of each
15.12 	year for distribution in the following year.  An application for
15.13 	funds must contain the following information:
15.14 	(1) the official name and address of the sponsoring
15.15 	institution and the official name and site address of the
15.16 	clinical medical education programs on whose behalf the
15.17 	sponsoring institution is applying;
15.18 	(2) the name, title, and business address of those persons
15.19 	responsible for administering the funds;
15.20 	(3) for each clinical medical education program for which
15.21 	funds are being sought; the type and specialty orientation of
15.22 	trainees in the program; the name, site address, and medical
15.23 	assistance provider number of each training site used in the
15.24 	program; the total number of trainees at each training site; and
15.25 	the total number of eligible trainee FTEs at each site.  Only
15.26 	those training sites that host 0.5 FTE or more eligible trainees
15.27 	for a program may be included in the program's application; and
15.28 	(4) other supporting information the commissioner deems
15.29 	necessary to determine program eligibility based on the criteria
15.30 	in paragraphs (a) and (b) and to ensure the equitable
15.31 	distribution of funds.
15.32 	(d) An application must include the information specified
15.33 	in clauses (1) to (3) for each clinical medical education
15.34 	program on an annual basis for three consecutive years.  After
15.35 	that time, an application must include the information specified
15.36 	in clauses (1) to (3) in the first year of each biennium:
16.1 	(1) audited clinical training costs per trainee for each
16.2 	clinical medical education program when available or estimates
16.3 	of clinical training costs based on audited financial data;
16.4 	(2) a description of current sources of funding for
16.5 	clinical medical education costs, including a description and
16.6 	dollar amount of all state and federal financial support,
16.7 	including Medicare direct and indirect payments; and
16.8 	(3) other revenue received for the purposes of clinical
16.9 	training.
16.10 	(e) An applicant that does not provide information
16.11 	requested by the commissioner shall not be eligible for funds
16.12 	for the current funding cycle.

16.13 	Sec. 10. Minnesota Statutes 2004, section 62L.08,
16.14 	subdivision 8, is amended to read:
16.15 		Subd. 8.Filing requirement. (a) No later than July 1,
16.16 	1993, and each year thereafter, a health carrier that offers,
16.17 	sells, issues, or renews a health benefit plan for small
16.18 	employers shall file with the commissioner the index rates and
16.19 	must demonstrate that all rates shall be within the rating
16.20 	restrictions defined in this chapter.  Such demonstration must
16.21 	include the allowable range of rates from the index rates and a
16.22 	description of how the health carrier intends to use demographic
16.23 	factors including case characteristics in calculating the
16.24 	premium rates.
16.25 	(b) Notwithstanding paragraph (a),the rates shall not be
16.26 	approved,unless the commissioner has determined that the rates
16.27 	are reasonable.  In determining reasonableness, the commissioner
16.28 	shall consider the growth rates applied under section 62J.04,
16.29 	subdivision 1, paragraph (b) apply the premium growth limits
16.30 	established under section 62J.04, subdivision 1b, to the
16.31 	calendar year or years that the proposed premium rate would be
16.32 	in effect, and shall consider actuarially valid changes in risk
16.33 	associated with the enrollee population, and actuarially valid
16.34 	changes as a result of statutory changes in Laws 1992, chapter
16.35 	549. For premium rates proposed to go into effect between July
16.36 	1, 1993 and December 31, 1993, the pertinent growth rate is the
17.1 	growth rate applied under section 62J.04, subdivision 1,
17.2 	paragraph (b), to calendar year 1994.

17.3 	Sec. 11. Minnesota Statutes 2004, section 62M.06,
17.4 	subdivision 2, is amended to read:
17.5 		Subd. 2.Expedited appeal.  (a) When an initial
17.6 	determination not to certify a health care service is made prior
17.7 	to or during an ongoing service requiring review and the
17.8 	attending health care professional believes that the
17.9 	determination warrants an expedited appeal, the utilization
17.10 	review organization must ensure that the enrollee and the
17.11 	attending health care professional have an opportunity to appeal
17.12 	the determination over the telephone on an expedited basis.  In
17.13 	such an appeal, the utilization review organization must ensure
17.14 	reasonable access to its consulting physician or health care
17.15 	provider. For review of initial determinations not to certify a
17.16 	service for prepaid health care programs under chapter 256B,
17.17 	256D, or 256L, the health care provider must follow published
17.18 	evidence-based care guidelines as established by a nonprofit
17.19 	Minnesota quality improvement organization or by the
17.20 	professional association of the specialty that typically
17.21 	provides the service.
17.22 	(b) The utilization review organization shall notify the
17.23 	enrollee and attending health care professional by telephone of
17.24 	its determination on the expedited appeal as expeditiously as
17.25 	the enrollee's medical condition requires, but no later than 72
17.26 	hours after receiving the expedited appeal.
17.27 	(c) If the determination not to certify is not reversed
17.28 	through the expedited appeal, the utilization review
17.29 	organization must include in its notification the right to
17.30 	submit the appeal to the external appeal process described in
17.31 	section 62Q.73 and the procedure for initiating the process.
17.32 	This information must be provided in writing to the enrollee and
17.33 	the attending health care professional as soon as practical.

17.34 	Sec. 12. Minnesota Statutes 2004, section 62M.06,
17.35 	subdivision 3, is amended to read:
17.36 		Subd. 3.Standard appeal.  The utilization review
18.1 	organization must establish procedures for appeals to be made
18.2 	either in writing or by telephone.
18.3 	(a) A utilization review organization shall notify in
18.4 	writing the enrollee, attending health care professional, and
18.5 	claims administrator of its determination on the appeal within
18.6 	30 days upon receipt of the notice of appeal.  If the
18.7 	utilization review organization cannot make a determination
18.8 	within 30 days due to circumstances outside the control of the
18.9 	utilization review organization, the utilization review
18.10 	organization may take up to 14 additional days to notify the
18.11 	enrollee, attending health care professional, and claims
18.12 	administrator of its determination.  If the utilization review
18.13 	organization takes any additional days beyond the initial 30-day
18.14 	period to make its determination, it must inform the enrollee,
18.15 	attending health care professional, and claims administrator, in
18.16 	advance, of the extension and the reasons for the extension.
18.17 	(b) The documentation required by the utilization review
18.18 	organization may include copies of part or all of the medical
18.19 	record and a written statement from the attending health care
18.20 	professional.
18.21 	(c) Prior to upholding the initial determination not to
18.22 	certify for clinical reasons, the utilization review
18.23 	organization shall conduct a review of the documentation by a
18.24 	physician who did not make the initial determination not to
18.25 	certify. For review of initial determinations not to certify a
18.26 	service for prepaid health care programs under chapter 256B,
18.27 	256D, or 256L, the physician must follow publicly available
18.28 	evidence-based care guidelines as established by a nonprofit
18.29 	Minnesota quality improvement organization or by the
18.30 	professional association of the specialty that typically
18.31 	provides the service.
18.32 	(d) The process established by a utilization review
18.33 	organization may include defining a period within which an
18.34 	appeal must be filed to be considered.  The time period must be
18.35 	communicated to the enrollee and attending health care
18.36 	professional when the initial determination is made.
19.1 	(e) An attending health care professional or enrollee who
19.2 	has been unsuccessful in an attempt to reverse a determination
19.3 	not to certify shall, consistent with section 72A.285, be
19.4 	provided the following:
19.5 	(1) a complete summary of the review findings;
19.6 	(2) qualifications of the reviewers, including any license,
19.7 	certification, or specialty designation; and
19.8 	(3) the relationship between the enrollee's diagnosis and
19.9 	the review criteria used as the basis for the decision,
19.10 	including the specific rationale for the reviewer's decision.
19.11 	(f) In cases of appeal to reverse a determination not to
19.12 	certify for clinical reasons, the utilization review
19.13 	organization must ensure that a physician of the utilization
19.14 	review organization's choice in the same or a similar specialty
19.15 	as typically manages the medical condition, procedure, or
19.16 	treatment under discussion is reasonably available to review the
19.17 	case.
19.18 	(g) If the initial determination is not reversed on appeal,
19.19 	the utilization review organization must include in its
19.20 	notification the right to submit the appeal to the external
19.21 	review process described in section 62Q.73 and the procedure for
19.22 	initiating the external process.

19.23 	Sec. 13. [62Q.175] COVERAGE EXEMPTIONS.
19.24 	Notwithstanding any law to the contrary, no health plan
19.25 	company is required to provide coverage for any health care
19.26 	service included on the list established under section
19.27 	256B.0625, subdivision 46.

19.28 	Sec. 14. Minnesota Statutes 2004, section 144.1501,
19.29 	subdivision 2, is amended to read:
19.30 		Subd. 2.Creation of account. (a) A health professional
19.31 	education loan forgiveness program account is established.  The
19.32 	commissioner of health shall use money from the account to
19.33 	establish a loan forgiveness program:
19.34 	(1) for medical residents agreeing to practice in
19.35 	designated rural areas or underserved urban communities,or
19.36 	specializing in the area of pediatric psychiatry;
20.1 	(2) for midlevel practitioners agreeing to practice in
20.2 	designated rural areas,;and
20.3 	(3) for nurses who agree to practice in a Minnesota nursing
20.4 	home or intermediate care facility for persons with mental
20.5 	retardation or related conditions.
20.6 	(b) Appropriations made to the account do not cancel and
20.7 	are available until expended, except that at the end of each
20.8 	biennium, any remaining balance in the account that is not
20.9 	committed by contract and not needed to fulfill existing
20.10 	commitments shall cancel to the fund.

20.11 	Sec. 15. Minnesota Statutes 2004, section 144.1501,
20.12 	subdivision 4, is amended to read:
20.13 		Subd. 4.Loan forgiveness.  The commissioner of health
20.14 	may select applicants each year for participation in the loan
20.15 	forgiveness program, within the limits of available funding. The
20.16 	commissioner shall distribute available funds for loan
20.17 	forgiveness proportionally among the eligible professions
20.18 	according to the vacancy rate for each profession in the
20.19 	required geographic area or ,facility type, or specialty area 
20.20 	specified in subdivision 2.  The commissioner shall allocate
20.21 	funds for physician loan forgiveness so that 75 50 percent of
20.22 	the funds available are used for rural physician loan
20.23 	forgiveness and ,25 percent of the funds available are used for
20.24 	underserved urban communities loan forgiveness, and 25 percent
20.25 	of the funds available are used for pediatric psychiatry loan
20.26 	forgiveness.  If the commissioner does not receive enough
20.27 	qualified applicants each year to use the entire allocation of
20.28 	funds for urban underserved communities, the remaining funds may
20.29 	be allocated for rural physician loan forgiveness.  Applicants
20.30 	are responsible for securing their own qualified educational
20.31 	loans.  The commissioner shall select participants based on
20.32 	their suitability for practice serving the required geographic
20.33 	area or ,facility type, or specialty area specified in
20.34 	subdivision 2, as indicated by experience or training.  The
20.35 	commissioner shall give preference to applicants closest to
20.36 	completing their training.  For each year that a participant
21.1 	meets the service obligation required under subdivision 3, up to
21.2 	a maximum of four years, the commissioner shall make annual
21.3 	disbursements directly to the participant equivalent to 15
21.4 	percent of the average educational debt for indebted graduates
21.5 	in their profession in the year closest to the applicant's
21.6 	selection for which information is available, not to exceed the
21.7 	balance of the participant's qualifying educational loans.
21.8 	Before receiving loan repayment disbursements and as requested,
21.9 	the participant must complete and return to the commissioner an
21.10 	affidavit of practice form provided by the commissioner
21.11 	verifying that the participant is practicing as required under
21.12 	subdivisions 2 and 3.  The participant must provide the
21.13 	commissioner with verification that the full amount of loan
21.14 	repayment disbursement received by the participant has been
21.15 	applied toward the designated loans.  After each disbursement,
21.16 	verification must be received by the commissioner and approved
21.17 	before the next loan repayment disbursement is made.
21.18 	Participants who move their practice remain eligible for loan
21.19 	repayment as long as they practice as required under subdivision
21.20 	2.

21.21 	Sec. 16. Minnesota Statutes 2004, section 256.045,
21.22 	subdivision 3a, is amended to read:
21.23 		Subd. 3a.Prepaid health plan appeals.  (a) All prepaid
21.24 	health plans under contract to the commissioner under chapter
21.25 	256B or 256D must provide for a complaint system according to
21.26 	section 62D.11.  When a prepaid health plan denies, reduces, or
21.27 	terminates a health service or denies a request to authorize a
21.28 	previously authorized health service, the prepaid health plan
21.29 	must notify the recipient of the right to file a complaint or an
21.30 	appeal.  The notice must include the name and telephone number
21.31 	of the ombudsman and notice of the recipient's right to request
21.32 	a hearing under paragraph (b).  When a complaint is filed, the
21.33 	prepaid health plan must notify the ombudsman within three
21.34 	working days.  Recipients may request the assistance of the
21.35 	ombudsman in the complaint system process.  The prepaid health
21.36 	plan must issue a written resolution of the complaint to the
22.1 	recipient within 30 days after the complaint is filed with the
22.2 	prepaid health plan.  A recipient is not required to exhaust the
22.3 	complaint system procedures in order to request a hearing under
22.4 	paragraph (b).
22.5 	(b) Recipients enrolled in a prepaid health plan under
22.6 	chapter 256B or 256D may contest a prepaid health plan's denial,
22.7 	reduction, or termination of health services, a prepaid health
22.8 	plan's denial of a request to authorize a previously authorized
22.9 	health service, or the prepaid health plan's written resolution
22.10 	of a complaint by submitting a written request for a hearing
22.11 	according to subdivision 3.  A state human services referee
22.12 	shall conduct a hearing on the matter and shall recommend an
22.13 	order to the commissioner of human services. The referee may
22.14 	not overturn a decision by a prepaid health plan to deny or
22.15 	limit coverage for services if the prepaid health plan has used
22.16 	evidence-based criteria or guidelines in making the
22.17 	determination.The commissioner need not grant a hearing if the
22.18 	sole issue raised by a recipient is the commissioner's authority
22.19 	to require mandatory enrollment in a prepaid health plan in a
22.20 	county where prepaid health plans are under contract with the
22.21 	commissioner.  The state human services referee may order a
22.22 	second medical opinion from the prepaid health plan or may order
22.23 	a second medical opinion from a nonprepaid health plan provider
22.24 	at the expense of the prepaid health plan.  Recipients may
22.25 	request the assistance of the ombudsman in the appeal process.
22.26 	(c) In the written request for a hearing to appeal from a
22.27 	prepaid health plan's denial, reduction, or termination of a
22.28 	health service, a prepaid health plan's denial of a request to
22.29 	authorize a previously authorized service, or the prepaid health
22.30 	plan's written resolution to a complaint, a recipient may
22.31 	request an expedited hearing.  If an expedited appeal is
22.32 	warranted, the state human services referee shall hear the
22.33 	appeal and render a decision within a time commensurate with the
22.34 	level of urgency involved, based on the individual circumstances
22.35 	of the case.

22.36 	Sec. 17. [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
23.1 		Subdivision 1.Establishment; administration. The
23.2 	commissioner shall establish and administer the prescription
23.3 	drug discount program, effective July 1, 2005.
23.4 	Subd. 2.[COMMISSIONER'S AUTHORITY.] The commissioner
23.5 	shall administer a drug rebate program for drugs purchased
23.6 	according to the prescription drug discount program.  The
23.7 	commissioner shall require a rebate agreement from all
23.8 	manufacturers of covered drugs as defined in section 256B.0625,
23.9 	subdivision 13.  For each drug, the amount of the rebate shall
23.10 	be equal to the rebate as defined for purposes of the federal
23.11 	rebate program in United States Code, title 42, section
23.12 	1396r-8.  The rebate program shall utilize the terms and
23.13 	conditions used for the federal rebate program established
23.14 	according to section 1927 of title XIX of the federal Social
23.15 	Security Act.
23.16 		Subd. 3.Definitions. For the purpose of this section,
23.17 	the following terms have the meanings given them.
23.18 	(a) "Commissioner" means the commissioner of human services.
23.19 	(b) "Manufacturer" means a manufacturer as defined in
23.20 	section 151.44, paragraph (c).
23.21 	(c) "Covered prescription drug" means a prescription drug
23.22 	as defined in section 151.44, paragraph (d), that is covered
23.23 	under medical assistance as described in section 256B.0625,
23.24 	subdivision 13, and that is provided by a manufacturer that has
23.25 	a fully executed rebate agreement with the commissioner under
23.26 	this section and complies with that agreement.
23.27 	(d) "Health carrier" means an insurance company licensed
23.28 	under chapter 60A to offer, sell, or issue an individual or
23.29 	group policy of accident and sickness insurance as defined in
23.30 	section 62A.01; a nonprofit health service plan corporation
23.31 	operating under chapter 62C; a health maintenance organization
23.32 	operating under chapter 62D; a joint self-insurance employee
23.33 	health plan operating under chapter 62H; a community integrated
23.34 	systems network licensed under chapter 62N; a fraternal benefit
23.35 	society operating under chapter 64B; a city, county, school
23.36 	district, or other political subdivision providing self-insured
24.1 	health coverage under section 471.617 or sections 471.98 to
24.2 	471.982; and a self-funded health plan under the Employee
24.3 	Retirement Income Security Act of 1974, as amended.
24.4 	(e) "Participating pharmacy" means a pharmacy as defined in
24.5 	section 151.01, subdivision 2, that agrees to participate in the
24.6 	prescription drug discount program.
24.7 	(f) "Enrolled individual" means a person who is eligible
24.8 	for the program under subdivision 4 and has enrolled in the
24.9 	program according to subdivision 5.
24.10 		Subd. 4.Eligible persons. To be eligible for the
24.11 	program, an applicant must:
24.12 	(1) be a permanent resident of Minnesota as defined in
24.13 	section 256L.09, subdivision 4;
24.14 	(2) not be enrolled in Medicare, medical assistance,
24.15 	general assistance medical care, or MinnesotaCare;
24.16 	(3) not be enrolled in and have currently available
24.17 	prescription drug coverage under a health plan offered by a
24.18 	health carrier or employer or under a pharmacy benefit program
24.19 	offered by a pharmaceutical manufacturer; and 
24.20 	(4) not be enrolled in and have currently available
24.21 	prescription drug coverage under a Medicare supplement plan, as
24.22 	defined in sections 62A.31 to 62A.44, or policies, contracts, or
24.23 	certificates that supplement Medicare issued by health
24.24 	maintenance organizations or those policies, contracts, or
24.25 	certificates governed by section 1833 or 1876 of the federal
24.26 	Social Security Act, United States Code, title 42, section 1395,
24.27 	et seq., as amended.
24.28 		Subd. 5.Application procedure. (a) Applications and
24.29 	information on the program must be made available at county
24.30 	social services agencies, health care provider offices, and
24.31 	agencies and organizations serving senior citizens.  Individuals
24.32 	shall submit applications and any information specified by the
24.33 	commissioner as being necessary to verify eligibility directly
24.34 	to the commissioner.  The commissioner shall determine an
24.35 	applicant's eligibility for the program within 30 days from the
24.36 	date the application is received.  Upon notice of approval, the
25.1 	applicant must submit to the commissioner the enrollment fee
25.2 	specified in subdivision 10.  Eligibility begins the month after
25.3 	the enrollment fee is received by the commissioner.
25.4 	(b) An enrollee's eligibility must be renewed every 12
25.5 	months with the 12-month period beginning in the month after the
25.6 	application is approved.
25.7 	(c) The commissioner shall develop an application form that
25.8 	does not exceed one page in length and requires information
25.9 	necessary to determine eligibility for the program.
25.10 		Subd. 6.Participating pharmacy. According to a valid
25.11 	prescription, a participating pharmacy must sell a covered
25.12 	prescription drug to an enrolled individual at the pharmacy's
25.13 	usual and customary retail price, minus an amount that is equal
25.14 	to the rebate amount described in subdivision 8, plus the amount
25.15 	of any switch fee established by the commissioner under
25.16 	subdivision 10.  Each participating pharmacy shall provide the
25.17 	commissioner with all information necessary to administer the
25.18 	program, including, but not limited to, information on
25.19 	prescription drug sales to enrolled individuals and usual and
25.20 	customary retail prices.
25.21 		Subd. 7.Notification of rebate amount. The commissioner
25.22 	shall notify each drug manufacturer, each calendar quarter or
25.23 	according to a schedule to be established by the commissioner,
25.24 	of the amount of the rebate owed on the prescription drugs sold
25.25 	by participating pharmacies to enrolled individuals.
25.26 		Subd. 8.Provision of rebate. To the extent that a
25.27 	manufacturer's prescription drugs are prescribed to a resident
25.28 	of this state, the manufacturer must provide a rebate equal to
25.29 	the rebate provided under the medical assistance program for any
25.30 	prescription drug distributed by the manufacturer that is
25.31 	purchased by an enrolled individual at a participating
25.32 	pharmacy.  The manufacturer must provide full payment within 30
25.33 	days of receipt of the state invoice for the rebate, or
25.34 	according to a schedule to be established by the commissioner.
25.35 	The commissioner shall deposit all rebates received into the
25.36 	Minnesota prescription drug dedicated fund established under
26.1 	subdivision 11.  The manufacturer must provide the commissioner
26.2 	with any information necessary to verify the rebate determined
26.3 	per drug.
26.4 		Subd. 9.Payment to pharmacies. The commissioner shall
26.5 	distribute on a biweekly basis an amount that is equal to an
26.6 	amount collected under subdivision 8 to each participating
26.7 	pharmacy based on the prescription drugs sold by that pharmacy
26.8 	to enrolled individuals.
26.9 		Subd. 10.Enrollment fee; switch fee. (a) The
26.10 	commissioner shall establish an annual enrollment fee that
26.11 	covers the commissioner's expenses for enrollment, processing
26.12 	claims, and distributing rebates under this program.
26.13 	(b) The commissioner shall establish a reasonable switch
26.14 	fee that covers expenses incurred by pharmacies in formatting
26.15 	for electronic submission claims for prescription drugs sold to
26.16 	enrolled individuals.
26.17 		Subd. 11.Dedicated fund; creation; use of fund. (a) The
26.18 	Minnesota prescription drug dedicated fund is established as an
26.19 	account in the state treasury.  The commissioner of finance
26.20 	shall credit to the dedicated fund all rebates paid under
26.21 	subdivision 8, any federal funds received for the program, all
26.22 	enrollment fees paid by the enrollees, and any appropriations or
26.23 	allocations designated for the fund.  The commissioner of
26.24 	finance shall ensure that fund money is invested under section
26.25 	11A.25.  All money earned by the fund must be credited to the
26.26 	fund.  The fund shall earn a proportionate share of the total
26.27 	state annual investment income.
26.28 	(b) Money in the fund is appropriated to the commissioner
26.29 	to reimburse participating pharmacies for prescription drug
26.30 	discounts provided to enrolled individuals under this section;
26.31 	to reimburse the commissioner for costs related to enrollment,
26.32 	processing claims, and distributing rebates and for other
26.33 	reasonable administrative costs related to administration of the
26.34 	prescription drug discount program; and to repay the
26.35 	appropriation provided for this section.  The commissioner must
26.36 	administer the program so that the costs total no more than
27.1 	funds appropriated plus the drug rebate proceeds.

27.2 	Sec. 18. Minnesota Statutes 2004, section 256.9693, is
27.3 	amended to read:
27.4 	256.9693 CONTINUING CARE PROGRAM FOR PERSONS WITH MENTAL
27.5 	ILLNESS.
27.6 	The commissioner shall establish a continuing care benefit
27.7 	program for persons with mental illness in which persons with
27.8 	mental illness may obtain acute care hospital inpatient
27.9 	treatment for mental illness for up to 45 days beyond that
27.10 	allowed by section 256.969.  Persons with mental illness who are
27.11 	eligible for medical assistance or general assistance medical
27.12 	care may obtain inpatient treatment under this program in
27.13 	hospital beds for which the commissioner contracts under this
27.14 	section.  The commissioner may selectively contract with
27.15 	hospitals to provide this benefit through competitive bidding
27.16 	when reasonable geographic access by recipients can be assured.
27.17 	Payments under this section shall not affect payments under
27.18 	section 256.969.  The commissioner may contract externally with
27.19 	a utilization review organization to authorize persons with
27.20 	mental illness to access the continuing care benefit program.
27.21 	The commissioner, as part of the contracts with hospitals, shall
27.22 	establish admission criteria to allow persons with mental
27.23 	illness to access the continuing care benefit program.  If a
27.24 	court orders acute care hospital inpatient treatment for mental
27.25 	illness for a person, the person may obtain the treatment under
27.26 	the continuing care benefit program.  The commissioner shall not
27.27 	require, as part of the admission criteria, any commitment or
27.28 	petition under chapter 253B as a condition of accessing the
27.29 	program.  This benefit is not available for people who are also
27.30 	eligible for Medicare and who have not exhausted their annual or
27.31 	lifetime inpatient psychiatric benefit under Medicare.  If a
27.32 	recipient is enrolled in a prepaid plan, this program is
27.33 	included in the plan's coverage.

27.34 	Sec. 19. Minnesota Statutes 2004, section 256B.0625,
27.35 	subdivision 3b, is amended to read:
27.36 		Subd. 3b.Telemedicine consultations.  Medical assistance
28.1 	covers telemedicine consultations.  Telemedicine consultations
28.2 	must be made via two-way, interactive video or store-and-forward
28.3 	technology.  Store-and-forward technology includes telemedicine
28.4 	consultations that do not occur in real time via synchronous
28.5 	transmissions, and that do not require a face-to-face encounter
28.6 	with the patient for all or any part of any such telemedicine
28.7 	consultation.  The patient record must include a written opinion
28.8 	from the consulting physician providing the telemedicine
28.9 	consultation.  A communication between two physicians that
28.10 	consists solely of a telephone conversation is not a
28.11 	telemedicine consultation, unless the communication is between a
28.12 	pediatrician and psychiatrist for the purpose of managing the
28.13 	medications of a child with mental health needs.  Coverage is
28.14 	limited to three telemedicine consultations per recipient per
28.15 	calendar week.  Telemedicine consultations shall be paid at the
28.16 	full allowable rate.

28.17 	Sec. 20. Minnesota Statutes 2004, section 256B.0625, is
28.18 	amended by adding a subdivision to read:
28.19 		Subd. 46.List of health care services not eligible for
28.20 	coverage. (a) The commissioner of human services, in
28.21 	consultation with the commissioner of health, shall biennially
28.22 	establish a list of diagnosis/treatment pairings that are not
28.23 	eligible for reimbursement under this chapter and chapters 256D
28.24 	and 256L, effective for services provided on or after July 1,
28.25 	2007.  The commissioner shall review the list in effect for the
28.26 	prior biennium and shall make any additions or deletions from
28.27 	the list as appropriate, taking into consideration the following:
28.28 	(1) scientific and medical information;
28.29 	(2) clinical assessment;
28.30 	(3) cost-effectiveness of treatment;
28.31 	(4) prevention of future costs; and 
28.32 	(5) medical ineffectiveness.
28.33 	(b) The commissioner may appoint an ad hoc advisory panel
28.34 	made up of physicians, consumers, nurses, dentists,
28.35 	chiropractors, and other experts to assist the commissioner in
28.36 	reviewing and establishing the list.  The commissioner shall
29.1 	solicit comments and recommendations from any interested persons
29.2 	and organizations and shall schedule at least one public hearing.
29.3 	(c) The list must be established by January 15, 2007, for
29.4 	the list effective July 1, 2007, and by October 1 of the
29.5 	even-numbered years beginning October 1, 2008, for the lists
29.6 	effective the following July 1.  The commissioner shall publish
29.7 	the list in the State Register by November 1 of the
29.8 	even-numbered years beginning November 1, 2008.  The list shall
29.9 	be submitted to the legislature by January 15 of the
29.10 	odd-numbered years beginning January 15, 2007.

29.11 	Sec. 21. Minnesota Statutes 2004, section 256B.0627,
29.12 	subdivision 1, is amended to read:
29.13 		Subdivision 1.Definition.  (a) "Activities of daily
29.14 	living" includes eating, toileting, grooming, dressing, bathing,
29.15 	transferring, mobility, and positioning.
29.16 	(b) "Assessment" means a review and evaluation of a
29.17 	recipient's need for home care services conducted in person.
29.18 	Assessments for private duty nursing shall be conducted by a
29.19 	registered private duty nurse.  Assessments for home health
29.20 	agency services shall be conducted by a home health agency
29.21 	nurse.  Assessments for personal care assistant services shall
29.22 	be conducted by the county public health nurse or a certified
29.23 	public health nurse under contract with the county.  A
29.24 	face-to-face assessment must include:  documentation of health
29.25 	status, determination of need, evaluation of service
29.26 	effectiveness, identification of appropriate services, service
29.27 	plan development or modification, coordination of services,
29.28 	referrals and follow-up to appropriate payers and community
29.29 	resources, completion of required reports, recommendation of
29.30 	service authorization, and consumer education.  Once the need
29.31 	for personal care assistant services is determined under this
29.32 	section, the county public health nurse or certified public
29.33 	health nurse under contract with the county is responsible for
29.34 	communicating this recommendation to the commissioner and the
29.35 	recipient.  A face-to-face assessment for personal care
29.36 	assistant services is conducted on those recipients who have
30.1 	never had a county public health nurse assessment.  A
30.2 	face-to-face assessment must occur at least annually or when
30.3 	there is a significant change in the recipient's condition or
30.4 	when there is a change in the need for personal care assistant
30.5 	services.  A service update may substitute for the annual
30.6 	face-to-face assessment when there is not a significant change
30.7 	in recipient condition or a change in the need for personal care
30.8 	assistant service.  A service update or review for temporary
30.9 	increase includes a review of initial baseline data, evaluation
30.10 	of service effectiveness, redetermination of service need,
30.11 	modification of service plan and appropriate referrals, update
30.12 	of initial forms, obtaining service authorization, and on going
30.13 	consumer education.  Assessments for medical assistance home
30.14 	care services for mental retardation or related conditions and
30.15 	alternative care services for developmentally disabled home and
30.16 	community-based waivered recipients may be conducted by the
30.17 	county public health nurse to ensure coordination and avoid
30.18 	duplication.  Assessments must be completed on forms provided by
30.19 	the commissioner within 30 days of a request for home care
30.20 	services by a recipient or responsible party. Assessments shall
30.21 	not be conducted by the same agency, individual, or organization
30.22 	providing the care services.
30.23 	(c) "Care plan" means a written description of personal
30.24 	care assistant services developed by the qualified professional
30.25 	or the recipient's physician with the recipient or responsible
30.26 	party to be used by the personal care assistant with a copy
30.27 	provided to the recipient or responsible party.
30.28 	(d) "Complex and regular private duty nursing care" means:
30.29 	(1) complex care is private duty nursing provided to
30.30 	recipients who are ventilator dependent or for whom a physician
30.31 	has certified that were it not for private duty nursing the
30.32 	recipient would meet the criteria for inpatient hospital
30.33 	intensive care unit (ICU) level of care; and
30.34 	(2) regular care is private duty nursing provided to all
30.35 	other recipients.
30.36 	(e) "Health-related functions" means functions that can be
31.1 	delegated or assigned by a licensed health care professional
31.2 	under state law to be performed by a personal care attendant.
31.3 	(f) "Home care services" means a health service, determined
31.4 	by the commissioner as medically necessary, that is ordered by a
31.5 	physician and documented in a service plan that is reviewed by
31.6 	the physician at least once every 60 days for the provision of
31.7 	home health services, or private duty nursing, or at least once
31.8 	every 365 days for personal care.  Home care services are
31.9 	provided to the recipient at the recipient's residence that is a
31.10 	place other than a hospital or long-term care facility or as
31.11 	specified in section 256B.0625.
31.12 	(g) "Instrumental activities of daily living" includes meal
31.13 	planning and preparation, managing finances, shopping for food,
31.14 	clothing, and other essential items, performing essential
31.15 	household chores, communication by telephone and other media,
31.16 	and getting around and participating in the community.
31.17 	(h) "Medically necessary" has the meaning given in
31.18 	Minnesota Rules, parts 9505.0170 to 9505.0475.
31.19 	(i) "Personal care assistant" means a person who:
31.20 	(1) is at least 18 years old, except for persons 16 to 18
31.21 	years of age who participated in a related school-based job
31.22 	training program or have completed a certified home health aide
31.23 	competency evaluation;
31.24 	(2) is able to effectively communicate with the recipient
31.25 	and personal care provider organization;
31.26 	(3) effective July 1, 1996, has completed one of the
31.27 	training requirements as specified in Minnesota Rules, part
31.28 	9505.0335, subpart 3, items A to D;
31.29 	(4) has the ability to, and provides covered personal care
31.30 	assistant services according to the recipient's care plan,
31.31 	responds appropriately to recipient needs, and reports changes
31.32 	in the recipient's condition to the supervising qualified
31.33 	professional or physician;
31.34 	(5) is not a consumer of personal care assistant services;
31.35 	and
31.36 	(6) is subject to criminal background checks and procedures
32.1 	specified in chapter 245C.
32.2 	(j) "Personal care provider organization" means an
32.3 	organization enrolled to provide personal care assistant
32.4 	services under the medical assistance program that complies with
32.5 	the following:  (1) owners who have a five percent interest or
32.6 	more, and managerial officials are subject to a background study
32.7 	as provided in chapter 245C.  This applies to currently enrolled
32.8 	personal care provider organizations and those agencies seeking
32.9 	enrollment as a personal care provider organization.  An
32.10 	organization will be barred from enrollment if an owner or
32.11 	managerial official of the organization has been convicted of a
32.12 	crime specified in chapter 245C, or a comparable crime in
32.13 	another jurisdiction, unless the owner or managerial official
32.14 	meets the reconsideration criteria specified in chapter 245C;
32.15 	(2) the organization must maintain a surety bond and liability
32.16 	insurance throughout the duration of enrollment and provides
32.17 	proof thereof.  The insurer must notify the Department of Human
32.18 	Services of the cancellation or lapse of policy; and (3) the
32.19 	organization must maintain documentation of services as
32.20 	specified in Minnesota Rules, part 9505.2175, subpart 7, as well
32.21 	as evidence of compliance with personal care assistant training
32.22 	requirements.
32.23 	(k) "Responsible party" means an individual who is capable
32.24 	of providing the support necessary to assist the recipient to
32.25 	live in the community, is at least 18 years old, actively
32.26 	participates in planning and directing of personal care
32.27 	assistant services, and is not the personal care assistant.  The
32.28 	responsible party must be accessible to the recipient and the
32.29 	personal care assistant when personal care services are being
32.30 	provided and monitor the services at least weekly according to
32.31 	the plan of care.  The responsible party must be identified at
32.32 	the time of assessment and listed on the recipient's service
32.33 	agreement and care plan.  Responsible parties who are parents of
32.34 	minors or guardians of minors or incapacitated persons may
32.35 	delegate the responsibility to another adult who is not the
32.36 	personal care assistant during a temporary absence of at least
33.1 	24 hours but not more than six months.  The person delegated as
33.2 	a responsible party must be able to meet the definition of
33.3 	responsible party, except that the delegated responsible party
33.4 	is required to reside with the recipient only while serving as
33.5 	the responsible party.  The responsible party must assure that
33.6 	the delegate performs the functions of the responsible party, is
33.7 	identified at the time of the assessment, and is listed on the
33.8 	service agreement and the care plan.  Foster care license
33.9 	holders may be designated the responsible party for residents of
33.10 	the foster care home if case management is provided as required
33.11 	in section 256B.0625, subdivision 19a.  For persons who, as of
33.12 	April 1, 1992, are sharing personal care assistant services in
33.13 	order to obtain the availability of 24-hour coverage, an
33.14 	employee of the personal care provider organization may be
33.15 	designated as the responsible party if case management is
33.16 	provided as required in section 256B.0625, subdivision 19a.
33.17 	(l) "Service plan" means a written description of the
33.18 	services needed based on the assessment developed by the nurse
33.19 	who conducts the assessment together with the recipient or
33.20 	responsible party.  The service plan shall include a description
33.21 	of the covered home care services, frequency and duration of
33.22 	services, and expected outcomes and goals.  The recipient and
33.23 	the provider chosen by the recipient or responsible party must
33.24 	be given a copy of the completed service plan within 30 calendar
33.25 	days of the request for home care services by the recipient or
33.26 	responsible party.
33.27 	(m) "Skilled nurse visits" are provided in a recipient's
33.28 	residence under a plan of care or service plan that specifies a
33.29 	level of care which the nurse is qualified to provide.  These
33.30 	services are:
33.31 	(1) nursing services according to the written plan of care
33.32 	or service plan and accepted standards of medical and nursing
33.33 	practice in accordance with chapter 148;
33.34 	(2) services which due to the recipient's medical condition
33.35 	may only be safely and effectively provided by a registered
33.36 	nurse or a licensed practical nurse;
34.1 	(3) assessments performed only by a registered nurse; and
34.2 	(4) teaching and training the recipient, the recipient's
34.3 	family, or other caregivers requiring the skills of a registered
34.4 	nurse or licensed practical nurse.
34.5 	(n) "Telehomecare" means the use of telecommunications
34.6 	technology by a home health care professional to deliver home
34.7 	health care services, within the professional's scope of
34.8 	practice, to a patient located at a site other than the site
34.9 	where the practitioner is located.

34.10 	Sec. 22. Minnesota Statutes 2004, section 256B.0627,
34.11 	subdivision 4, is amended to read:
34.12 		Subd. 4.Personal care assistant services.  (a) The
34.13 	personal care assistant services that are eligible for payment
34.14 	are services and supports furnished to an individual, as needed,
34.15 	to assist in accomplishing activities of daily living;
34.16 	instrumental activities of daily living; health-related
34.17 	functions through hands-on assistance, supervision, and cuing;
34.18 	and redirection and intervention for behavior including
34.19 	observation and monitoring.
34.20 	(b) Payment for services will be made within the limits
34.21 	approved using the prior authorized process established in
34.22 	subdivision 5.
34.23 	(c) The amount and type of services authorized shall be
34.24 	based on an assessment of the recipient's needs in these areas:
34.25 	(1) bowel and bladder care;
34.26 	(2) skin care to maintain the health of the skin;
34.27 	(3) repetitive maintenance range of motion, muscle
34.28 	strengthening exercises, and other tasks specific to maintaining
34.29 	a recipient's optimal level of function;
34.30 	(4) respiratory assistance;
34.31 	(5) transfers and ambulation;
34.32 	(6) bathing, grooming, and hairwashing necessary for
34.33 	personal hygiene;
34.34 	(7) turning and positioning;
34.35 	(8) assistance with furnishing medication that is
34.36 	self-administered;
35.1 	(9) application and maintenance of prosthetics and
35.2 	orthotics;
35.3 	(10) cleaning medical equipment;
35.4 	(11) dressing or undressing;
35.5 	(12) assistance with eating and meal preparation and
35.6 	necessary grocery shopping;
35.7 	(13) accompanying a recipient to obtain medical diagnosis
35.8 	or treatment;
35.9 	(14) assisting, monitoring, or prompting the recipient to
35.10 	complete the services in clauses (1) to (13);
35.11 	(15) redirection, monitoring, and observation that are
35.12 	medically necessary and an integral part of completing the
35.13 	personal care assistant services described in clauses (1) to
35.14 	(14);
35.15 	(16) redirection and intervention for behavior, including
35.16 	observation and monitoring;
35.17 	(17) interventions for seizure disorders, including
35.18 	monitoring and observation if the recipient has had a seizure
35.19 	that requires intervention within the past three months;
35.20 	(18) tracheostomy suctioning using a clean procedure if the
35.21 	procedure is properly delegated by a registered nurse.  Before
35.22 	this procedure can be delegated to a personal care assistant, a
35.23 	registered nurse must determine that the tracheostomy suctioning
35.24 	can be accomplished utilizing a clean rather than a sterile
35.25 	procedure and must ensure that the personal care assistant has
35.26 	been taught the proper procedure; and
35.27 	(19) incidental household services that are an integral
35.28 	part of a personal care service described in clauses (1) to (18).
35.29 	For purposes of this subdivision, monitoring and observation
35.30 	means watching for outward visible signs that are likely to
35.31 	occur and for which there is a covered personal care service or
35.32 	an appropriate personal care intervention.  For purposes of this
35.33 	subdivision, a clean procedure refers to a procedure that
35.34 	reduces the numbers of microorganisms or prevents or reduces the
35.35 	transmission of microorganisms from one person or place to
35.36 	another.  A clean procedure may be used beginning 14 days after
36.1 	insertion.
36.2 	(d) The personal care assistant services that are not
36.3 	eligible for payment are the following:
36.4 	(1) services not ordered by the physician;
36.5 	(2) assessments by personal care assistant provider
36.6 	organizations or by independently enrolled registered nurses;
36.7 	(3) services that are not in the service plan;
36.8 	(4) services provided by the recipient's spouse, legal
36.9 	guardian for an adult or child recipient, or parent of a
36.10 	recipient under age 18;
36.11 	(5) services provided by a foster care provider of a
36.12 	recipient who cannot direct the recipient's own care, unless
36.13 	monitored by a county or state case manager under section
36.14 	256B.0625, subdivision 19a;
36.15 	(6) services provided by the residential or program license
36.16 	holder in a residence for more than four persons;
36.17 	(7) services that are the responsibility of a residential
36.18 	or program license holder under the terms of a service agreement
36.19 	and administrative rules;
36.20 	(8) sterile procedures;
36.21 	(9) injections of fluids into veins, muscles, or skin;
36.22 	(10) services provided by parents of adult recipients,
36.23 	adult children, or siblings of the recipient, unless these
36.24 	relatives meet one of the following hardship criteria and the
36.25 	commissioner waives this requirement:
36.26 	(i) the relative resigns from a part-time or full-time job
36.27 	to provide personal care for the recipient;
36.28 	(ii) the relative goes from a full-time to a part-time job
36.29 	with less compensation to provide personal care for the
36.30 	recipient;
36.31 	(iii) the relative takes a leave of absence without pay to
36.32 	provide personal care for the recipient;
36.33 	(iv) the relative incurs substantial expenses by providing
36.34 	personal care for the recipient; or 
36.35 	(v) because of labor conditions, special language needs, or
36.36 	intermittent hours of care needed, the relative is needed in
37.1 	order to provide an adequate number of qualified personal care
37.2 	assistants to meet the medical needs of the recipient;
37.3 	(11) homemaker services that are not an integral part of a
37.4 	personal care assistant services;
37.5 	(11) (12) home maintenance or chore services;
37.6 	(12) (13) services not specified under paragraph (a); and
37.7 	(13) (14) services not authorized by the commissioner or
37.8 	the commissioner's designee.
37.9 	(e) The recipient or responsible party may choose to
37.10 	supervise the personal care assistant or to have a qualified
37.11 	professional, as defined in section 256B.0625, subdivision 19c,
37.12 	provide the supervision.  As required under section 256B.0625,
37.13 	subdivision 19c, the county public health nurse, as a part of
37.14 	the assessment, will assist the recipient or responsible party
37.15 	to identify the most appropriate person to provide supervision
37.16 	of the personal care assistant.  Health-related delegated tasks
37.17 	performed by the personal care assistant will be under the
37.18 	supervision of a qualified professional or the direction of the
37.19 	recipient's physician.  If the recipient has a qualified
37.20 	professional, Minnesota Rules, part 9505.0335, subpart 4,
37.21 	applies.
37.22 	(f) The commissioner shall establish an ongoing audit
37.23 	process for potential fraud and abuse for personal care
37.24 	assistant services.

37.25 	Sec. 23. Minnesota Statutes 2004, section 256B.0627,
37.26 	subdivision 9, is amended to read:
37.27 		Subd. 9.Flexible use of personal care assistant hours.
 37.28 	(a) The commissioner may allow for the flexible use of personal
37.29 	care assistant hours."Flexible use" means the scheduled use of
37.30 	authorized hours of personal care assistant services, which vary
37.31 	within the length of the service authorization in order to more
37.32 	effectively meet the needs and schedule of the recipient.
37.33 	Recipients may use their approved hours flexibly within the
37.34 	service authorization period for medically necessary covered
37.35 	services specified in the assessment required in subdivision 1.
37.36 	The flexible use of authorized hours does not increase the total
38.1 	amount of authorized hours available to a recipient as
38.2 	determined under subdivision 5.  The commissioner shall not
38.3 	authorize additional personal care assistant services to
38.4 	supplement a service authorization that is exhausted before the
38.5 	end date under a flexible service use plan, unless the county
38.6 	public health nurse determines a change in condition and a need
38.7 	for increased services is established.
38.8 	(b) The recipient or responsible party, together with the
38.9 	county public health nurse, shall determine whether flexible use
38.10 	is an appropriate option based on the needs and preferences of
38.11 	the recipient or responsible party, and, if appropriate, must
38.12 	ensure that the allocation of hours covers the ongoing needs of
38.13 	the recipient over the entire service authorization period.  As
38.14 	part of the assessment and service planning process, the
38.15 	recipient or responsible party must work with the county public
38.16 	health nurse to develop a written month-to-month plan of the
38.17 	projected use of personal care assistant services that is part
38.18 	of the service plan and ensures:
38.19 	(1) that the health and safety needs of the recipient will
38.20 	be met;
38.21 	(2) that the total annual authorization will not exceed
38.22 	before the end date; and 
38.23 	(3) how actual use of hours will be monitored.
38.24 	(c) If the actual use of personal care assistant service
38.25 	varies significantly from the use projected in the plan, the
38.26 	written plan must be promptly updated by the recipient or
38.27 	responsible party and the county public health nurse.
38.28 	(d) The recipient or responsible party, together with the
38.29 	provider, must work to monitor and document the use of
38.30 	authorized hours and ensure that a recipient is able to manage
38.31 	services effectively throughout the authorized period. The
38.32 	provider must ensure that the month-to-month plan is
38.33 	incorporated into the care plan.Upon request of the recipient
38.34 	or responsible party, the provider must furnish regular updates
38.35 	to the recipient or responsible party on the amount of personal
38.36 	care assistant services used.
39.1 	(e) The recipient or responsible party may revoke the
39.2 	authorization for flexible use of hours by notifying the
39.3 	provider and county public health nurse in writing.
39.4 	(f) If the requirements in paragraphs (a) to (e) have not
39.5 	substantially been met, the commissioner shall deny, revoke, or
39.6 	suspend the authorization to use authorized hours flexibly.  The
39.7 	recipient or responsible party may appeal the commissioner's
39.8 	action according to section 256.045.  The denial, revocation, or
39.9 	suspension to use the flexible hours option shall not affect the
39.10 	recipient's authorized level of personal care assistant services
39.11 	as determined under subdivision 5.

39.12 	Sec. 24. Minnesota Statutes 2004, section 256B.0631, is
39.13 	amended by adding a subdivision to read:
39.14 		Subd. 5.Healthy lifestyle waiver. The co-payments
39.15 	described in subdivision 1 shall be waived by the provider if
39.16 	the recipient is practicing a healthy lifestyle by refraining
39.17 	from tobacco use or is participating in a smoking cessation
39.18 	program.  To obtain the waiver, the recipient must sign a
39.19 	statement stating that the recipient does not use tobacco
39.20 	products or is currently participating in a smoking cessation
39.21 	program.  The provider shall keep the signed statement on file.

39.22 	Sec. 25. [256B.072] PERFORMANCE REPORTING AND QUALITY
39.23 	IMPROVEMENT PAYMENT SYSTEM.
39.24 	(a) The commissioner of human services shall establish a
39.25 	performance reporting and payment system for health care
39.26 	providers who provide health care services to public program
39.27 	recipients covered under chapters 256B, 256D, and 256L.
39.28 	(b) The measures used for the performance reporting and
39.29 	payment system for medical groups or single-physician practices
39.30 	shall include, but are not limited to, measures of care for
39.31 	asthma, diabetes, hypertension, and coronary artery disease and
39.32 	measures of preventive care services.  The measures used for the
39.33 	performance reporting and payment system for inpatient hospitals
39.34 	shall include, but are not limited to, measures of care for
39.35 	acute myocardial infarction, heart failure, and pneumonia, and
39.36 	measures of care and prevention of surgical infections.  In the
40.1 	case of a medical group or single-physician practice, the
40.2 	measures used shall be consistent with measures published by
40.3 	nonprofit Minnesota or national organizations that produce and
40.4 	disseminate health care quality measures or evidence-based
40.5 	health care guidelines.  In the case of inpatient hospital
40.6 	measures, the commissioner shall appoint the Minnesota Hospital
40.7 	Association and Stratis Health to develop the performance
40.8 	measures to be used for hospital reporting.  To enable a
40.9 	consistent measurement process across the community, the
40.10 	commissioner may use measures of care provided for patients in
40.11 	addition to those identified in paragraph (a).  The commissioner
40.12 	shall ensure collaboration with other health care reporting
40.13 	organizations so that the measures described in this section are
40.14 	consistent with those reported by those organizations and used
40.15 	by other purchasers in Minnesota.
40.16 	(c) For recipients seen on or after January 1, 2007, the
40.17 	commissioner shall provide a performance bonus payment to
40.18 	providers who have achieved certain levels of performance
40.19 	established by the commissioner with respect to the measures or
40.20 	who have achieved certain rates of improvement established by
40.21 	the commissioner with respect to the measures or whose rates of
40.22 	achievement have increased over a previous period, as
40.23 	established by the commissioner.  The performance bonus payment
40.24 	may be a fixed dollar amount per patient, paid quarterly or
40.25 	annually, or alternatively payment may be made as a percentage
40.26 	increase over payments allowed elsewhere in statute for the
40.27 	recipients identified in paragraph (a).  In order for providers
40.28 	to be eligible for a performance bonus payment under this
40.29 	section, the commissioner may require the providers to submit
40.30 	information in a required format to a health care reporting
40.31 	organization or to cooperate with the information collection
40.32 	procedures of that organization.  The commissioner may contract
40.33 	with a reporting organization to assist with the collection of
40.34 	reporting information and to prevent duplication of reporting.
40.35 	The commissioner may limit application of the performance bonus
40.36 	payment system to providers that provide a sufficiently large
41.1 	volume of care to permit adequate statistical precision in the
41.2 	measurement of that care, as established by the commissioner,
41.3 	after consulting with other health care quality reporting
41.4 	organizations.
41.5 	(d) The performance bonus payments shall be funded with the
41.6 	projected savings in the program costs due to improved results
41.7 	of these measures with the eligible providers.
41.8 	(e) The commissioner shall publish a description of the
41.9 	proposed performance reporting and payment system for the
41.10 	calendar year beginning January 1, 2007, and each subsequent
41.11 	calendar year, at least three months prior to the beginning of
41.12 	that calendar year.
41.13 	(f) By April 1, 2007, and annually thereafter, the
41.14 	commissioner shall report through a public Web site the results
41.15 	by medical group, single-physician practice, and hospital of the
41.16 	measures and the performance payments under this section, and
41.17 	shall compare the results by medical group, single-physician
41.18 	practice, and hospital for patients enrolled in public programs
41.19 	to patients enrolled in private health plans.  To achieve this
41.20 	reporting, the commissioner may contract with a health care
41.21 	reporting organization that operates a Web site suitable for
41.22 	this purpose.

41.23 	Sec. 26. [256B.0918] EMPLOYEE SCHOLARSHIP COSTS AND
41.24 	TRAINING IN ENGLISH AS A SECOND LANGUAGE.
41.25 	(a) For the fiscal year beginning July 1, 2005, the
41.26 	commissioner shall provide to each provider listed in paragraph
41.27 	(c) a scholarship reimbursement increase of two-tenths percent
41.28 	of the reimbursement rate for that provider to be used:
41.29 	(1) for employee scholarships that satisfy the following
41.30 	requirements:
41.31 	(i) scholarships are available to all employees who work an
41.32 	average of at least 20 hours per week for the provider, except
41.33 	administrators, department supervisors, and registered nurses;
41.34 	and 
41.35 	(ii) the course of study is expected to lead to career
41.36 	advancement with the provider or in long-term care, including
42.1 	home care or care of persons with disabilities, including
42.2 	medical care interpreter services and social work; and 
42.3 	(2) to provide job-related training in English as a second
42.4 	language.
42.5 	(b) A provider receiving a rate adjustment under this
42.6 	subdivision with an annualized value of at least $1,000 shall
42.7 	maintain documentation to be submitted to the commissioner on a
42.8 	schedule determined by the commissioner and on a form supplied
42.9 	by the commissioner of the scholarship rate increase received,
42.10 	including:
42.11 	(1) the amount received from this reimbursement increase;
42.12 	(2) the amount used for training in English as a second
42.13 	language;
42.14 	(3) the number of persons receiving the training;
42.15 	(4) the name of the person or entity providing the
42.16 	training; and 
42.17 	(5) for each scholarship recipient, the name of the
42.18 	recipient, the amount awarded, the educational institution
42.19 	attended, the nature of the educational program, the program
42.20 	completion date, and a determination of the amount spent as a
42.21 	percentage of the provider's reimbursement.
42.22 	The commissioner shall report to the legislature annually,
42.23 	beginning January 15, 2006, with information on the use of these
42.24 	funds.
42.25 	(c) The rate increases described in this section shall be
42.26 	provided to home and community-based waivered services for
42.27 	persons with mental retardation or related conditions under
42.28 	section 256B.501; home and community-based waivered services for
42.29 	the elderly under section 256B.0915; waivered services under
42.30 	community alternatives for disabled individuals under section
42.31 	256B.49; community alternative care waivered services under
42.32 	section 256B.49; traumatic brain injury waivered services under
42.33 	section 256B.49; nursing services and home health services under
42.34 	section 256B.0625, subdivision 6a; personal care services and
42.35 	nursing supervision of personal care services under section
42.36 	256B.0625, subdivision 19a; private duty nursing services under
43.1 	section 256B.0625, subdivision 7; day training and habilitation
43.2 	services for adults with mental retardation or related
43.3 	conditions under sections 252.40 to 252.46; alternative care
43.4 	services under section 256B.0913; adult residential program
43.5 	grants under Minnesota Rules, parts 9535.2000 to 9535.3000;
43.6 	semi-independent living services (SILS) under section 252.275,
43.7 	including SILS funding under county social services grants
43.8 	formerly funded under chapter 256I; community support services
43.9 	for deaf and hard-of-hearing adults with mental illness who use
43.10 	or wish to use sign language as their primary means of
43.11 	communication; the group residential housing supplementary
43.12 	service rate under section 256I.05, subdivision 1a; chemical
43.13 	dependency residential and nonresidential service providers
43.14 	under section 254B.03; and intermediate care facilities for
43.15 	persons with mental retardation under section 256B.5012.
43.16 	(d) These increases shall be included in the provider's
43.17 	reimbursement rate for the purpose of determining future rates
43.18 	for the provider.

43.19 	Sec. 27. Minnesota Statutes 2004, section 256D.03,
43.20 	subdivision 4, is amended to read:
43.21 		Subd. 4.General assistance medical care; services.
 43.22 	(a)(i) For a person who is eligible under subdivision 3,
43.23 	paragraph (a), clause (2), item (i), general assistance medical
43.24 	care covers, except as provided in paragraph (c):
43.25 	(1) inpatient hospital services;
43.26 	(2) outpatient hospital services;
43.27 	(3) services provided by Medicare certified rehabilitation
43.28 	agencies;
43.29 	(4) prescription drugs and other products recommended
43.30 	through the process established in section 256B.0625,
43.31 	subdivision 13;
43.32 	(5) equipment necessary to administer insulin and
43.33 	diagnostic supplies and equipment for diabetics to monitor blood
43.34 	sugar level;
43.35 	(6) eyeglasses and eye examinations provided by a physician
43.36 	or optometrist;
44.1 	(7) hearing aids;
44.2 	(8) prosthetic devices;
44.3 	(9) laboratory and X-ray services;
44.4 	(10) physician's services;
44.5 	(11) medical transportation except special transportation;
44.6 	(12) chiropractic services as covered under the medical
44.7 	assistance program;
44.8 	(13) podiatric services;
44.9 	(14) dental services and dentures, subject to the
44.10 	limitations specified in section 256B.0625, subdivision 9;
44.11 	(15) outpatient services provided by a mental health center
44.12 	or clinic that is under contract with the county board and is
44.13 	established under section 245.62;
44.14 	(16) day treatment services for mental illness provided
44.15 	under contract with the county board;
44.16 	(17) prescribed medications for persons who have been
44.17 	diagnosed as mentally ill as necessary to prevent more
44.18 	restrictive institutionalization;
44.19 	(18) psychological services, medical supplies and
44.20 	equipment, and Medicare premiums, coinsurance and deductible
44.21 	payments;
44.22 	(19) medical equipment not specifically listed in this
44.23 	paragraph when the use of the equipment will prevent the need
44.24 	for costlier services that are reimbursable under this
44.25 	subdivision;
44.26 	(20) services performed by a certified pediatric nurse
44.27 	practitioner, a certified family nurse practitioner, a certified
44.28 	adult nurse practitioner, a certified obstetric/gynecological
44.29 	nurse practitioner, a certified neonatal nurse practitioner, or
44.30 	a certified geriatric nurse practitioner in independent
44.31 	practice, if (1) the service is otherwise covered under this
44.32 	chapter as a physician service, (2) the service provided on an
44.33 	inpatient basis is not included as part of the cost for
44.34 	inpatient services included in the operating payment rate, and
44.35 	(3) the service is within the scope of practice of the nurse
44.36 	practitioner's license as a registered nurse, as defined in
45.1 	section 148.171;
45.2 	(21) services of a certified public health nurse or a
45.3 	registered nurse practicing in a public health nursing clinic
45.4 	that is a department of, or that operates under the direct
45.5 	authority of, a unit of government, if the service is within the
45.6 	scope of practice of the public health nurse's license as a
45.7 	registered nurse, as defined in section 148.171; and
45.8 	(22) telemedicine consultations, to the extent they are
45.9 	covered under section 256B.0625, subdivision 3b.
45.10 	(ii) Effective October 1, 2003, for a person who is
45.11 	eligible under subdivision 3, paragraph (a), clause (2), item
45.12 	(ii), general assistance medical care coverage is limited to
45.13 	inpatient hospital services, including physician services
45.14 	provided during the inpatient hospital stay.  A $1,000
45.15 	deductible is required for each inpatient hospitalization.
45.16 	(b) Gender reassignment surgery and related services are
45.17 	not covered services under this subdivision unless the
45.18 	individual began receiving gender reassignment services prior to
45.19 	July 1, 1995.
45.20 	(c) In order to contain costs, the commissioner of human
45.21 	services shall select vendors of medical care who can provide
45.22 	the most economical care consistent with high medical standards
45.23 	and shall where possible contract with organizations on a
45.24 	prepaid capitation basis to provide these services.  The
45.25 	commissioner shall consider proposals by counties and vendors
45.26 	for prepaid health plans, competitive bidding programs, block
45.27 	grants, or other vendor payment mechanisms designed to provide
45.28 	services in an economical manner or to control utilization, with
45.29 	safeguards to ensure that necessary services are provided.
45.30 	Before implementing prepaid programs in counties with a county
45.31 	operated or affiliated public teaching hospital or a hospital or
45.32 	clinic operated by the University of Minnesota, the commissioner
45.33 	shall consider the risks the prepaid program creates for the
45.34 	hospital and allow the county or hospital the opportunity to
45.35 	participate in the program in a manner that reflects the risk of
45.36 	adverse selection and the nature of the patients served by the
46.1 	hospital, provided the terms of participation in the program are
46.2 	competitive with the terms of other participants considering the
46.3 	nature of the population served.  Payment for services provided
46.4 	pursuant to this subdivision shall be as provided to medical
46.5 	assistance vendors of these services under sections 256B.02,
46.6 	subdivision 8, and 256B.0625.  For payments made during fiscal
46.7 	year 1990 and later years, the commissioner shall consult with
46.8 	an independent actuary in establishing prepayment rates, but
46.9 	shall retain final control over the rate methodology.
46.10 	(d) Recipients eligible under subdivision 3, paragraph (a),
46.11 	clause (2), item (i), shall pay the following co-payments for
46.12 	services provided on or after October 1, 2003:
46.13 	(1) $3 per nonpreventive visit.  For purposes of this
46.14 	subdivision, a visit means an episode of service which is
46.15 	required because of a recipient's symptoms, diagnosis, or
46.16 	established illness, and which is delivered in an ambulatory
46.17 	setting by a physician or physician ancillary, chiropractor,
46.18 	podiatrist, nurse midwife, advanced practice nurse, audiologist,
46.19 	optician, or optometrist;
46.20 	(2) $25 for eyeglasses;
46.21 	(3) $25 for nonemergency visits to a hospital-based
46.22 	emergency room;
46.23 	(4) $3 per brand-name drug prescription and $1 per generic
46.24 	drug prescription, subject to a $20 per month maximum for
46.25 	prescription drug co-payments.  No co-payments shall apply to
46.26 	antipsychotic drugs when used for the treatment of mental
46.27 	illness; and
46.28 	(5) 50 percent coinsurance on restorative dental services.
46.29 	(e) Co-payments shall be limited to one per day per
46.30 	provider for nonpreventive visits, eyeglasses, and nonemergency
46.31 	visits to a hospital-based emergency room.  Recipients of
46.32 	general assistance medical care are responsible for all
46.33 	co-payments in this subdivision.  The general assistance medical
46.34 	care reimbursement to the provider shall be reduced by the
46.35 	amount of the co-payment, except that reimbursement for
46.36 	prescription drugs shall not be reduced once a recipient has
47.1 	reached the $20 per month maximum for prescription drug
47.2 	co-payments.  The provider collects the co-payment from the
47.3 	recipient.  Providers may not deny services to recipients who
47.4 	are unable to pay the co-payment, except as provided in
47.5 	paragraph (f).
47.6 	(f) If it is the routine business practice of a provider to
47.7 	refuse service to an individual with uncollected debt, the
47.8 	provider may include uncollected co-payments under this
47.9 	section.  A provider must give advance notice to a recipient
47.10 	with uncollected debt before services can be denied.
47.11 	(g) The co-payments described in paragraph (d) shall be
47.12 	waived by the provider if the recipient practices a healthy
47.13 	lifestyle by refraining from tobacco use or is participating in
47.14 	a smoking cessation program.  To obtain the waiver, the
47.15 	recipient must sign a statement stating that the recipient does
47.16 	not use tobacco products or is currently participating in a
47.17 	smoking cessation program.  The provider shall keep the signed
47.18 	statement on file.
47.19 	(g) (h) Any county may, from its own resources, provide
47.20 	medical payments for which state payments are not made.
47.21 	(h) (i) Chemical dependency services that are reimbursed
47.22 	under chapter 254B must not be reimbursed under general
47.23 	assistance medical care.
47.24 	(i) (j) The maximum payment for new vendors enrolled in the
47.25 	general assistance medical care program after the base year
47.26 	shall be determined from the average usual and customary charge
47.27 	of the same vendor type enrolled in the base year.
47.28 	(j) (k) The conditions of payment for services under this
47.29 	subdivision are the same as the conditions specified in rules
47.30 	adopted under chapter 256B governing the medical assistance
47.31 	program, unless otherwise provided by statute or rule.
47.32 	(k) (l) Inpatient and outpatient payments shall be reduced
47.33 	by five percent, effective July 1, 2003.  This reduction is in
47.34 	addition to the five percent reduction effective July 1, 2003,
47.35 	and incorporated by reference in paragraph (i).
47.36 	(l) (m) Payments for all other health services except
48.1 	inpatient, outpatient, and pharmacy services shall be reduced by
48.2 	five percent, effective July 1, 2003.
48.3 	(m) (n) Payments to managed care plans shall be reduced by
48.4 	five percent for services provided on or after October 1, 2003.
48.5 	(n) (o) A hospital receiving a reduced payment as a result
48.6 	of this section may apply the unpaid balance toward satisfaction
48.7 	of the hospital's bad debts.

48.8 	Sec. 28. Minnesota Statutes 2004, section 256L.07,
48.9 	subdivision 1, is amended to read:
48.10 		Subdivision 1.General requirements.  (a) Children
48.11 	enrolled in the original children's health plan as of September
48.12 	30, 1992, children who enrolled in the MinnesotaCare program
48.13 	after September 30, 1992, pursuant to Laws 1992, chapter 549,
48.14 	article 4, section 17, and children who have family gross
48.15 	incomes that are equal to or less than 150 percent of the
48.16 	federal poverty guidelines are eligible without meeting the
48.17 	requirements of subdivision 2 and the four-month requirement in
48.18 	subdivision 3, as long as they maintain continuous coverage in
48.19 	the MinnesotaCare program or medical assistance.  Children who
48.20 	apply for MinnesotaCare on or after the implementation date of
48.21 	the employer-subsidized health coverage program as described in
48.22 	Laws 1998, chapter 407, article 5, section 45, who have family
48.23 	gross incomes that are equal to or less than 150 percent of the
48.24 	federal poverty guidelines, must meet the requirements of
48.25 	subdivision 2 to be eligible for MinnesotaCare.
48.26 	(b) Families enrolled in MinnesotaCare under section
48.27 	256L.04, subdivision 1, whose income increases above 275 percent
48.28 	of the federal poverty guidelines, are no longer eligible for
48.29 	the program and shall be disenrolled by the commissioner.
48.30 	Individuals enrolled in MinnesotaCare under section 256L.04,
48.31 	subdivision 7, whose income increases above 175 percent of the
48.32 	federal poverty guidelines are no longer eligible for the
48.33 	program and shall be disenrolled by the commissioner.  For
48.34 	persons disenrolled under this subdivision, MinnesotaCare
48.35 	coverage terminates the last day of the calendar month following
48.36 	the month in which the commissioner determines that the income
49.1 	of a family or individual exceeds program income limits.
49.2 	(c) (1) Notwithstanding paragraph (b), individuals and 
49.3 	families enrolled in MinnesotaCare under section 256L.04,
49.4 	subdivision 1,may remain enrolled in MinnesotaCare if ten
49.5 	percent of their annual income is less than the annual premium
49.6 	for a policy with a $500 deductible available through the
49.7 	Minnesota Comprehensive Health Association. Individuals and 
49.8 	families who are no longer eligible for MinnesotaCare under this
49.9 	subdivision shall be given an 18-month a 12-month notice period
49.10 	from the date that ineligibility is determined before
49.11 	disenrollment. This clause expires February 1, 2004.
49.12 	(2) Effective February 1, 2004, notwithstanding paragraph
49.13 	(b), children may remain enrolled in MinnesotaCare if ten
49.14 	percent of their annual family income is less than the annual
49.15 	premium for a policy with a $500 deductible available through
49.16 	the Minnesota Comprehensive Health Association.  Children who
49.17 	are no longer eligible for MinnesotaCare under this clause shall
49.18 	be given a 12-month notice period from the date that
49.19 	ineligibility is determined before disenrollment.The premium
49.20 	for children individuals and families remaining eligible under
49.21 	this clause paragraph shall be the maximum premium determined
49.22 	under section 256L.15, subdivision 2, paragraph (b).
49.23 	(d) Effective July 1, 2003, notwithstanding paragraphs (b)
49.24 	and (c), parents are no longer eligible for MinnesotaCare if
49.25 	gross household income exceeds $50,000.

49.26 	Sec. 29. [256L.20] MINNESOTACARE OPTION FOR SMALL
49.27 	EMPLOYERS.
49.28 		Subdivision 1.Definitions. (a) For the purpose of this
49.29 	section, the terms used have the meanings given them.
49.30 	(b) "Dependent" means an unmarried child under 21 years of
49.31 	age.
49.32 	(c) "Eligible employer" means a business that employs at
49.33 	least two, but not more than 50, eligible employees, the
49.34 	majority of whom are employed in the state, and includes a
49.35 	municipality that has 50 or fewer employees.
49.36 	(d) "Eligible employee" means an employee who works at
50.1 	least 20 hours per week for an eligible employer.  Eligible
50.2 	employee does not include an employee who works on a temporary
50.3 	or substitute basis or who does not work more than 26 weeks
50.4 	annually.
50.5 	(e) "Maximum premium" has the meaning given under section
50.6 	256L.15, subdivision 2, paragraph (b), clause (3).
50.7 	(f) "Participating employer" means an eligible employer who
50.8 	meets the requirements described in subdivision 3 and applies to
50.9 	the commissioner to enroll its eligible employees and their
50.10 	dependents in the MinnesotaCare program.
50.11 	(g) "Program" means the MinnesotaCare program.
50.12 		Subd. 2.Option. Eligible employees and their dependents
50.13 	may enroll in MinnesotaCare if the eligible employer meets the
50.14 	requirements of subdivision 3.  The effective date of coverage
50.15 	is according to section 256L.05, subdivision 3.
50.16 		Subd. 3.Employer requirements. The commissioner shall
50.17 	establish procedures for an eligible employer to apply for
50.18 	coverage through the program.  In order to participate, an
50.19 	eligible employer must meet the following requirements:
50.20 	(1) agrees to contribute toward the cost of the premium for
50.21 	the employee and the employee's dependents according to
50.22 	subdivision 4;
50.23 	(2) certifies that at least 75 percent of its eligible
50.24 	employees who do not have other creditable health coverage are
50.25 	enrolled in the program;
50.26 	(3) offers coverage to all eligible employees and the
50.27 	dependents of eligible employees; and 
50.28 	(4) has not provided employer-subsidized health coverage as
50.29 	an employee benefit during the previous 12 months, as defined in
50.30 	section 256L.07, subdivision 2, paragraph (c).
50.31 		Subd. 4.Premiums. (a) The premium for MinnesotaCare
50.32 	coverage provided under this section is equal to the maximum
50.33 	premium regardless of the income of the eligible employee.
50.34 	(b) For eligible employees without dependents with income
50.35 	equal to or less than 175 percent of the federal poverty
50.36 	guidelines and for eligible employees with dependents with
51.1 	income equal to or less than 275 percent of the federal poverty
51.2 	guidelines, the participating employer shall pay 50 percent of
51.3 	the maximum premium for the eligible employee and any
51.4 	dependents, if applicable.
51.5 	(c) For eligible employees without dependents with income
51.6 	over 175 percent of the federal poverty guidelines and for
51.7 	eligible employees with dependents with income over 275 percent
51.8 	of the federal poverty guidelines, the participating employer
51.9 	shall pay the full cost of the maximum premium for the eligible
51.10 	employee and any dependents, if applicable.  The participating
51.11 	employer may require the employee to pay a portion of the cost
51.12 	of the premium so long as the employer pays 50 percent of the
51.13 	cost.  If the employer requires the employee to pay a portion of
51.14 	the premium, the employee shall pay the portion of the cost to
51.15 	the employer.
51.16 	(d) The commissioner shall collect premium payments from
51.17 	participating employers for eligible employees and their
51.18 	dependents who are covered by the program as provided under this
51.19 	section.  All premiums collected shall be deposited in the
51.20 	health care access fund.
51.21 		Subd. 5.Coverage. The coverage offered to those
51.22 	enrolled in the program under this section must include all
51.23 	health services described under section 256L.03 and all
51.24 	co-payments and coinsurance requirements described under section
51.25 	256L.03, subdivision 5, apply.
51.26 		Subd. 6.Enrollment. Upon payment of the premium, in
51.27 	accordance with this section and section 256L.06, eligible
51.28 	employees and their dependents shall be enrolled in
51.29 	MinnesotaCare.  For purposes of enrollment under this section,
51.30 	income eligibility limits established under sections 256L.04 and
51.31 	256L.07, subdivision 1, and asset limits established under
51.32 	section 256L.17 do not apply.  The barriers established under
51.33 	section 256L.07, subdivision 2 or 3, do not apply to enrollees
51.34 	eligible under this section.  The commissioner may require
51.35 	eligible employees to provide income verification to determine
51.36 	premiums.

52.1 	Sec. 30. LIMITING COVERAGE OF HEALTH CARE SERVICES FOR
52.2 	MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE, AND
52.3 	MINNESOTACARE PROGRAMS.
 52.4 		Subdivision 1.Prior authorization of services. (a)
52.5 	Effective July 1, 2005, prior authorization is required for the
52.6 	services described in subdivision 2.
52.7 	(b) Prior authorization shall be conducted by the medical
52.8 	director of the Department of Human Services in conjunction with
52.9 	a medical policy advisory council.  To the extent available, the
52.10 	medical director shall use publicly available evidence-based
52.11 	guidelines developed by an independent, nonprofit organization
52.12 	or by the professional association of the specialty that
52.13 	typically provides the service or by a multistate Medicaid
52.14 	evidence-based practice center.  If the commissioner does not
52.15 	have a medical director and medical policy director in place,
52.16 	the commissioner may contract prior authorization to a
52.17 	Minnesota-licensed utilization review organization.
52.18 	(c) This subdivision expires July 1, 2007, or when a list
52.19 	is established according to Minnesota Statutes, section
52.20 	256B.0625, subdivision 46, whichever is earlier.
52.21 		Subd. 2.Services requiring prior authorization. The
52.22 	following services require prior authorization:
52.23 	(1) positive emission tomography (PET) scans;
52.24 	(2) electronic beam computed tomography (EBCT);
52.25 	(3) virtual colonoscopy;
52.26 	(4) spinal fusion, unless in an emergency situation related
52.27 	to trauma;
52.28 	(5) bariatric surgery;
52.29 	(6) chiropractic visits beyond ten visits;
52.30 	(7) circumcision; and 
52.31 	(8) orthodontia.
52.32 		Subd. 3.Services requiring review before addition to
52.33 	public programs benefit sets. No new medical device, brand
52.34 	drug, or medical procedure shall be included in the medical
52.35 	assistance benefit set until a technology assessment has been
52.36 	completed and the potential benefits are proven to outweigh the
53.1 	additional costs of the new device, drug, or procedure.
53.2 	Technology assessments by independent organizations with no
53.3 	conflict of interest should be used in making these
53.4 	determinations.

53.5 	Sec. 31. TASK FORCE ON CHILDHOOD OBESITY.
 53.6 	(a) The commissioner of health, in consultation with the
53.7 	commissioners of human services and education, shall convene a
53.8 	task force to study and make recommendations on reducing the
53.9 	rate of obesity among the children in Minnesota.  The task force
53.10 	shall determine the number of children who are currently obese
53.11 	and set a goal, including measurable outcomes for the state in
53.12 	terms of reducing the rate of childhood obesity.  The task force
53.13 	shall make recommendations on how to achieve this goal,
53.14 	including, but not limited to, increasing physical activities;
53.15 	exploring opportunities to promote physical education and
53.16 	healthy eating programs; improving the nutritional offerings
53.17 	through breakfast and lunch menus; and evaluating the
53.18 	availability and choice of nutritional products offered in
53.19 	public schools.  The members of the task force shall include
53.20 	representatives of the Minnesota Medical Association; the
53.21 	Minnesota Nurses Association; the Local Public Health
53.22 	Association of Minnesota; the Minnesota Dietetic Association;
53.23 	the Minnesota School Food Service Association; the Minnesota
53.24 	Association of Health, Physical Education, Recreation, and
53.25 	Dance; the Minnesota School Boards Association; the Minnesota
53.26 	School Administrators Association; the Minnesota Secondary
53.27 	Principals Association; the vending industry; and consumers.
53.28 	The terms and compensation of the members of the task force
53.29 	shall be in accordance with Minnesota Statutes, section 15.059,
53.30 	subdivision 6.
53.31 	(b) The commissioner must submit the recommendations of the
53.32 	task force to the legislature by January 15, 2007.

53.33 	Sec. 32. IMPLEMENTATION OF AN ELECTRONIC HEALTH RECORDS
53.34 	SYSTEM.
 53.35 	The commissioner of health, in consultation with the
53.36 	electronic health record planning work group established in Laws
54.1 	2004, chapter 288, article 7, section 7, shall develop a
54.2 	statewide plan for all hospitals and physician group practices
54.3 	to have in place an interoperable electronic health records
54.4 	system by January 1, 2015.  In developing the plan, the
54.5 	commissioner shall consider:
54.6 	(1) creating financial assistance to hospitals and
54.7 	providers for implementing or updating an electronic health
54.8 	records system, including, but not limited to, the establishment
54.9 	of grants, financial incentives, or low-interest loans;
54.10 	(2) addressing specific needs and concerns of safety-net
54.11 	hospitals, community health clinics, and other health care
54.12 	providers who serve low-income patients in implementing an
54.13 	electronic records system within the hospital or practice; and 
54.14 	(3) providing assistance in the development of possible
54.15 	alliances or collaborations among providers.
54.16 	The commissioner shall provide preliminary reports to the
54.17 	chairs of the senate and house committees with jurisdiction over
54.18 	health care policy and finance biennially beginning January 15,
54.19 	2007, on the status of reaching the goal for all hospitals and
54.20 	physician group practices to have an interoperable electronic
54.21 	health records system in place by January 1, 2005.  The reports
54.22 	shall include recommendations on statutory language necessary to
54.23 	implement the plan, including possible financing options.

54.24 	Sec. 33. APPROPRIATION.
 54.25 	(a) $....... is appropriated for the biennium beginning
54.26 	July 1, 2005, from the general fund to the Board of Trustees of
54.27 	the Minnesota State Colleges and Universities for the nursing
54.28 	and health care education plan designed to:
54.29 	(1) expand the system's enrollment in registered nursing
54.30 	education programs;
54.31 	(2) support practical nursing programs in regions of high
54.32 	need;
54.33 	(3) address the shortage of nursing faculty; and 
54.34 	(4) provide accessible learning opportunities to students
54.35 	through distance education and simulation experiences.
54.36 	(b) $....... is appropriated for the biennium beginning
55.1 	July 1, 2005, from the general fund to the commissioner of
55.2 	health for the loan forgiveness program in Minnesota Statutes,
55.3 	section 144.1501.