1.1 	A bill for an act
1.2 	relating to health care reform; increasing affordability and continuity of care 
1.3 	for state health care programs; modifying health care provisions; providing 
1.4 	subsidies for employee share of employer-subsidized insurance; establishing the 
1.5 	Minnesota Health Insurance Exchange; requiring certain employers to offer 
1.6 	Section 125 Plan; establishing the Health Care Transformation Commission; 
1.7 	creating an affordability standard; requiring mandated reports; appropriating 
1.8 	money;amending Minnesota Statutes 2006, sections 62A.65, subdivision 3; 
1.9 	62E.141; 62L.12, subdivisions 2, 4; 256.01, by adding subdivisions; 256B.061; 
1.10 	256B.69, by adding a subdivision; 256D.03, by adding a subdivision; 256L.05, 
1.11 	by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision 3; 
1.12 	256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement, sections 
1.13 	13.46, subdivision 2; 256B.056, subdivision 10; 256L.03, subdivisions 3, 5; 
1.14 	256L.04, subdivisions 1, 7; 256L.05, subdivision 3a; 256L.07, subdivision 1; 
1.15 	256L.15, subdivision 2; proposing coding for new law in Minnesota Statutes, 
1.16 	chapter 256B; proposing coding for new law as Minnesota Statutes, chapter 62U; 
1.17 	repealing Minnesota Statutes 2006, section 256L.15, subdivision 3.
1.18 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.19 	ARTICLE 1
1.20 	HEALTH CARE HOMES

1.21 	Section 1. [256B.0431] ENROLLEE REQUIREMENTS RELATED TO HEALTH 
1.22 	CARE HOMES.
1.23 		Subdivision 1.Selection of primary care clinic. Beginning January 1, 2009, the 
1.24 	commissioner shall require state health care program enrollees eligible for services 
1.25 	under the fee-for-service system to select a primary care clinic or medical group, within 
1.26 	two months of enrollment. Beginning July 1, 2009, the commissioner shall encourage 
1.27 	enrollees who have a complex or chronic condition to select a primary care clinic or 
1.28 	medical group with clinicians who have been certified as health care homes under section 
1.29 	256B.0751, subdivision 3. The commissioner and county social service agencies shall 
2.1 	provide enrollees with lists of primary care clinics, medical groups, and clinicians certified 
2.2 	as health care homes, and shall establish a toll-free number to provide enrollees with 
2.3 	assistance in choosing a clinic, medical group, or health care home.
2.4 		Subd. 2.Initial health assessment. The commissioner shall encourage state health 
2.5 	care program enrollees eligible for services under the fee-for-service system to complete an 
2.6 	initial health assessment at their selected primary care clinic or medical group, within one 
2.7 	month of selection, in order to identify individuals with, or who are at risk of developing, 
2.8 	complex or chronic health conditions, and to identify preventative health care needs.
2.9 		Subd. 3.Education and outreach. Beginning January 1, 2009, the commissioner 
2.10 	shall provide patient education and outreach to state health care program enrollees and 
2.11 	potential applicants related to the importance of choosing a primary care clinic or medical 
2.12 	group and a health care home. Education and outreach must be targeted to underserved 
2.13 	or special populations. The commissioner shall also develop and implement an outreach 
2.14 	program to enroll eligible persons in state health care programs, by providing a per 
2.15 	enrollee bonus to licensed producers under chapter 60K and nonprofit health care or social 
2.16 	service organizations who provide assistance in enrolling applicants.
2.17 		Subd. 4.State health care program.  For purposes of this section, "state health 
2.18 	care program" means the medical assistance, MinnesotaCare, and general assistance 
2.19 	medical care programs.

2.20 	Sec. 2. [256B.0751] HEALTH CARE HOMES; DEFINITIONS; 
2.21 	ESTABLISHMENT.
2.22 		Subdivision 1.Definitions. (a) For purposes of sections 256B.0751 to 256B.0754, 
2.23 	the definitions in this subdivision apply.
2.24 	(b) "Commissioner" means the commissioner of human services.
2.25 	(c) "Commissioners" means the commissioner of human services and the 
2.26 	commissioner of health acting jointly.
2.27 	(d) "State health care program" means the medical assistance, MinnesotaCare, and 
2.28 	general assistance medical care programs.
2.29 		Subd. 2.Establishment of health care homes. The commissioners shall establish 
2.30 	health care homes for all state health care program enrollees, beginning first with 
2.31 	enrollees who have, or are at risk of developing, complex or chronic health conditions. In 
2.32 	establishing health care homes, the commissioners shall consider, and when appropriate 
2.33 	incorporate, features of the medical home model developed for the provider-directed care 
2.34 	coordination program authorized under section 256B.0625, subdivision 51.
3.1 		Subd. 3.Certification. By July 1, 2009, the commissioners shall begin certification 
3.2 	of individual clinicians, who participate as providers in state health care programs and 
3.3 	meet the requirements of section 256B.0752, as health care homes. Clinicians may enter 
3.4 	into collaborative agreements with other clinicians to develop the components of a health 
3.5 	care home. Clinician certification as a health care home is voluntary. Clinicians certified 
3.6 	as health care homes shall renew their certification annually, in order to maintain their 
3.7 	status as health care homes.

3.8 	Sec. 3. [256B.0752] HEALTH CARE HOME REQUIREMENTS.
3.9 		Subdivision 1.Requirement. In order to be certified as a health care home, a 
3.10 	clinician shall meet the criteria specified in this section.
3.11 		Subd. 2.Patient-provider relationship; care teams. Each patient of a health care 
3.12 	home shall have an ongoing, long-term relationship with a provider trained as a personal 
3.13 	clinician to provide first contact, continuous, and comprehensive care for all of a patient's 
3.14 	health care needs. Appropriate specialists and other health care professionals who do not 
3.15 	practice in a traditional primary care field, and advanced practice registered nurses, shall 
3.16 	be allowed to serve as personal clinicians, if they provide care according to this section.
3.17 		Subd. 3.Care coordination. The personal clinician, in coordination with other 
3.18 	health care providers, is responsible for providing for all the patient's health care needs 
3.19 	or for arranging appropriate care with other qualified professionals. Health care must be 
3.20 	coordinated across all provider types, all care locations, and the greater community. This 
3.21 	requirement applies to care for all stages of life, including preventive care, acute care, 
3.22 	chronic care, and end-of-life care. Care coordination must include ongoing planning 
3.23 	to prepare for patient transitions across different types of care and provider types. The 
3.24 	primary care team shall also coordinate with those providing for the social service needs 
3.25 	of the individual, if this is necessary to ensure a successful health outcome.
3.26 		Subd. 4.Care delivery. (a) A health care home must provide or arrange for access 
3.27 	to care 24 hours a day, seven days a week.
3.28 	(b) Health care homes must encourage the patient, and when authorized and 
3.29 	appropriate, the family, to actively participate in decision making and in health care home 
3.30 	quality improvement initiatives, as a full member of the primary care team. Health care 
3.31 	homes must consider patients and families as partners in decision making, and must 
3.32 	provide access to a patient-directed, decision-making process, including appropriate 
3.33 	decision aids, when available.
4.1 	(c) Care delivery must be facilitated by the use of health information technology and 
4.2 	through systematic patient follow-up using internal clinic patient registries, according to 
4.3 	minimum standards specified by the commissioners.
4.4 	(d) Care must be provided in a culturally and linguistically appropriate manner.
4.5 	(e) Within the context of a system of continuous quality improvement, care 
4.6 	delivery, whenever possible, must be based on evidence-based medicine and use clinical 
4.7 	decision-support tools.
4.8 	(f) A health care home must provide enhanced access to care, using methods such 
4.9 	as open scheduling, expanded hours, and new communication methods, such as e-mail, 
4.10 	phone consultations, and e-consults.
4.11 		Subd. 5.Quality of care. Health care homes must meet process, outcome, and 
4.12 	quality standards as developed and specified by the commissioners. Health care homes 
4.13 	must measure and publicly report all data necessary for the commissioners to monitor 
4.14 	compliance with these standards.
4.15 		Subd. 6.Comprehensive health assessment. Health care homes must complete 
4.16 	a comprehensive health assessment for each enrollee determined, by the initial health 
4.17 	assessment required under section 256B.0431, subdivision 2, to have, or be at risk of 
4.18 	developing, a complex or chronic health condition. The comprehensive health assessment 
4.19 	must be completed within 90 days of the initial health assessment. Health care homes 
4.20 	must develop and implement a comprehensive care plan to manage complex or chronic 
4.21 	conditions based upon the comprehensive health assessment and other information. The 
4.22 	comprehensive care plans must meet criteria specified by the commissioners.
4.23 		Subd. 7.Care coordinators. Health care homes must employ care coordinators 
4.24 	to manage the care provided to patients with complex or chronic conditions. Care 
4.25 	coordinators may be social workers, nurses, or other clinicians. Care coordinators are 
4.26 	responsible for:
4.27 	(1) identifying patients with complex or chronic conditions eligible for care 
4.28 	coordination;
4.29 	(2) assisting primary care providers in care coordination and education;
4.30 	(3) helping patients coordinate their care or access needed services, including 
4.31 	preventative care;
4.32 	(4) communicating the care needs and concerns of the patient to the health care 
4.33 	home; and
4.34 	(5) collecting data on process and outcome measures.

4.35 	Sec. 4. [256B.0753] CARE COORDINATION FEE.
5.1 		Subdivision 1.Care coordination fee. (a) The commissioner shall pay each health 
5.2 	care home a per-person per-month care coordination fee for providing care coordination 
5.3 	services. The fee must be paid for each fee-for-service state health care program enrollee 
5.4 	eligible for a health care home, who is served by a personal clinician certified as a health 
5.5 	care home.
5.6 	(b) Payment of the care coordination fee is contingent on the health care home 
5.7 	meeting the certification standards for health care homes. The care coordination fee is in 
5.8 	addition to reimbursement received by a health care home under the medical assistance 
5.9 	fee-for-service payment system for health care services.
5.10 		Subd. 2.Amount of fee. The care coordination fee must not exceed an average 
5.11 	of $50 per person per month. The care coordination fee must be determined by the 
5.12 	commissioner in contracts with health care homes, and must vary by thresholds of care 
5.13 	complexity, with the highest fees being paid for care provided to individuals requiring the 
5.14 	most intensive care coordination, such as those with very complex health care needs or 
5.15 	several chronic conditions.
5.16 		Subd. 3.Cost neutrality. The commissioner may reduce payment rates for 
5.17 	nonprimary care services, if initial savings from implementation of health care homes are 
5.18 	not sufficient to allow implementation of the care coordination fee in a cost-neutral manner.

5.19 	Sec. 5. [256B.0754] DUTIES OF THE COMMISSIONERS.
5.20 		Subdivision 1.Establishment of certification standards and other criteria. (a) 
5.21 	By January 1, 2009, the commissioners shall establish certification standards for health 
5.22 	care homes consistent with the criteria in section 256B.0752.
5.23 	(b) By January 1, 2009, the commissioners shall develop care complexity thresholds 
5.24 	and payment amounts for the care coordination fee established under section 256B.0753.
5.25 	(c) By January 1, 2009, the commissioners shall identify criteria to determine 
5.26 	enrollees eligible for and in need of care coordination, and who would benefit from having 
5.27 	a comprehensive care plan for their condition.
5.28 	(d) By January 1, 2009, the commissioners shall establish criteria and data collection 
5.29 	procedures for evaluating health care homes.
5.30 	(e) By January 1, 2009, the commissioners shall develop health care home 
5.31 	requirements for managed care plan contracts, performance incentives, and withholds, 
5.32 	and shall develop the methodology for identifying and recapturing managed care savings 
5.33 	resulting from implementation of the health care home model.
5.34 		Subd. 2.Monitoring and evaluation. The commissioners shall ensure the 
5.35 	collection from health care homes of data necessary to monitor implementation of the 
6.1 	health care home model, measure and evaluate quality of care and outcomes, measure 
6.2 	and evaluate patient experience, and determine cost savings from implementation of 
6.3 	the health care home model. The commissioners shall collect and evaluate this data 
6.4 	directly, but may contract with an appropriate private sector entity for technical assistance. 
6.5 	The commissioners shall provide health care homes with practice profiles measuring 
6.6 	utilization, cost, and quality.
6.7 		Subd. 3.Care Coordination Advisory Committee. By July 1, 2008, the 
6.8 	commissioners shall establish a Care Coordination Advisory Committee to assist the 
6.9 	Departments of Human Services and Health in administering the health care home model, 
6.10 	developing the criteria and standards required under subdivision 1, collecting data, 
6.11 	and measuring and evaluating health outcomes and cost savings. The commissioners 
6.12 	may satisfy this requirement by continuing the advisory committee established for the 
6.13 	provider-directed care coordination program. If newly established, the committee must 
6.14 	include representatives of: primary care and specialist physicians, advanced practice 
6.15 	registered nurses, patients and their families, health plans, the Institute for Clinical 
6.16 	Systems Improvement, Minnesota Community Measurement, and other relevant entities. 
6.17 	If newly established, membership terms and compensation and removal of members are 
6.18 	governed by section 15.059. The committee does not expire.
6.19 		Subd. 4.Health care home collaborative. By July 1, 2009, the commissioners 
6.20 	shall establish a health care home collaborative to provide an opportunity for health care 
6.21 	homes and state agencies to exchange information related to quality improvement and 
6.22 	best practices.
6.23 		Subd. 5.Patient-directed, decision-making process. By January 1, 2009, 
6.24 	the commissioners, in consultation with the Care Coordination Advisory Committee 
6.25 	and the Institute of Clinical Systems Improvement, shall develop a patient-directed, 
6.26 	decision-making support model to be used by health care homes. The commissioners shall:
6.27 	(1) establish protocols that include identifying the use of a patient-directed, 
6.28 	decision-making process and incorporating effectively the use of patient-decision aids, 
6.29 	when appropriate;
6.30 	(2) ensure the quality of the patient-decision aids available to the patient;
6.31 	(3) ensure accessibility of the patient-decision aids, including the use of translators, 
6.32 	when necessary; and
6.33 	(4) ensure that providers are trained to use patient-decision aids effectively.
6.34 		Subd. 6.Report on standards; annual reports. (a) By November 15, 2008, the 
6.35 	commissioners must report drafts of certification standards, care complexity thresholds, 
6.36 	and other criteria, procedures, and payment amounts necessary to implement subdivision 
7.1 	1 to the chairs and lead minority members of the legislative committees with jurisdiction 
7.2 	over health care policy and finance.  These standards, thresholds, criteria, procedures, and 
7.3 	payment amount are not subject to chapter 14, and section 14.386 does not apply.
7.4 	(b) The commissioners shall report annually to the legislature on the implementation 
7.5 	and administration of the health care home model for state health care program enrollees 
7.6 	in the fee-for-service, managed care, and county-based purchasing sectors, beginning 
7.7 	December 15, 2009, and each December 15 thereafter. The report must include 
7.8 	information on the number of state health care program enrollees in health care homes, 
7.9 	the number and characteristics of enrollees with complex or chronic conditions, the 
7.10 	number and geographic distribution of health care home providers, the performance 
7.11 	and quality of care of health care homes, measures of preventative care, costs related 
7.12 	to implementation and payment of care coordination fees, health care home payment 
7.13 	arrangements, and estimates of savings from implementation of the health care home 
7.14 	model for the fee-for-service, managed care, and county-based purchasing sectors relative 
7.15 	to the health care spending baseline calculated under section 62U.07.

7.16 	Sec. 6. Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision 
7.17 	to read:
7.18 		Subd. 29.Health care home model. (a) The commissioner shall require 
7.19 	demonstration providers, as a condition of contract, to adopt by July 1, 2009, a health care 
7.20 	home model for providing care to state health care program enrollees. The health care 
7.21 	home model must meet the criteria specified in this section and section 256B.0752. The 
7.22 	commissioner, in consultation with the commissioner of health, may waive or modify 
7.23 	criteria for demonstration providers if the commissioners of health and human services 
7.24 	determine that performance and quality standards would still be met.
7.25 	(b) The commissioner, as a condition of contract, shall require demonstration 
7.26 	providers, as part of their implementation of the health care home model, to pay providers 
7.27 	a care coordination fee. The care coordination fee must meet the requirements of section 
7.28 	256B.0753. Demonstration providers shall fund the care coordination fee through savings 
7.29 	that result from implementation of the health care home model and, if necessary, through 
7.30 	reductions in administrative costs and provider payment rates for nonprimary care 
7.31 	services. The commissioner shall not adjust current or future capitation rates for costs 
7.32 	related to payment of the care coordination fee.
7.33 	(c) The commissioners of health and human services shall require demonstration 
7.34 	providers to: (1) collect from health care homes the data necessary to monitor 
7.35 	implementation of the health care home model, measure and evaluate quality of care 
8.1 	and outcomes, measure and evaluate patient experience, and determine cost savings 
8.2 	from implementation of the health care home model; and (2) submit this data to 
8.3 	the commissioners. The commissioners of health and human services shall provide 
8.4 	demonstration providers and health care homes with practice profiles measuring 
8.5 	utilization, cost, and quality. Before establishing or amending general standards for data 
8.6 	collection under this paragraph, the commissioners must report the draft standards to the 
8.7 	chairs and lead minority members of the legislative committees with jurisdiction over 
8.8 	health care policy and finance. Standards for data collection are not subject to chapter 14, 
8.9 	and section 14.386 does not apply.
8.10 	(d) Savings from the use of health care homes must be split among the state, health 
8.11 	care providers, and demonstration providers. The state must retain one-half of the 
8.12 	savings, the demonstration providers may retain up to one-fourth of the savings, and at 
8.13 	least one-fourth of the savings must be passed on to health care providers in the form 
8.14 	of higher payment rates.
8.15 	(e) Beginning July 1, 2009, the commissioner shall provide a performance 
8.16 	incentive for expenses related to the operation of health care homes that would reimburse 
8.17 	upfront costs related to implementation of health care homes after a one-year lag. 
8.18 	The commissioners of health and human services shall establish in contracts with 
8.19 	demonstration providers quality and performance standards for health care homes, and 
8.20 	beginning July 1, 2009, these standards shall be subject to the capitation rate withhold 
8.21 	under subdivision 5a, paragraph (c).
8.22 	(f) Demonstration providers must require state health care program enrollees to 
8.23 	complete an initial health assessment within three months from the time of enrollment, in 
8.24 	order to identify individuals with, or who are at risk of developing, complex or chronic 
8.25 	health conditions, and to identify preventative health care needs.
8.26 	(g) Beginning July 1, 2009, the commissioner shall require demonstration providers 
8.27 	to complete a comprehensive health assessment for each enrollee determined, by the 
8.28 	initial health assessment required under section 256B.0431, subdivision 2, to have, or be 
8.29 	at risk of developing, a complex or chronic health condition. The commissioner shall pay 
8.30 	demonstration providers a one-time health assessment fee for each enrollee who completes 
8.31 	a comprehensive health assessment. Comprehensive health assessments must meet the 
8.32 	criteria established for health care homes under section 256B.0752, subdivision 6.
8.33 	(h) Beginning July 1, 2009, the commissioner shall implement financial 
8.34 	arrangements for demonstration providers to ensure that plans require each enrollee to 
8.35 	choose a provider to serve as a health care home.

9.1 	Sec. 7. PAYMENT OF CARE COORDINATION FEE UNDER STATE 
9.2 	MANAGED CARE PROGRAMS.
 9.3 	The commissioner of human services shall study the feasibility of paying the 
9.4 	care coordination fee required under Minnesota Statutes, section 256B.69, subdivision 
9.5 	29, paragraph (b), directly to health care providers under contract with demonstration 
9.6 	providers to serve state health care program enrollees, and shall present recommendations 
9.7 	to the legislature by December 15, 2008.

9.8 	ARTICLE 2
9.9 	INCREASING ACCESS; CONTINUITY OF CARE

9.10 	Section 1. Minnesota Statutes 2006, section 256.01, is amended by adding a 
9.11 	subdivision to read:
9.12 		Subd. 27.Automation and coordination for state health care programs. (a) For 
9.13 	purposes of this subdivision, "state health care program" means the medical assistance, 
9.14 	MinnesotaCare, or general assistance medical care programs.
9.15 	(b) By July 1, 2009, the commissioner shall improve coordination between state 
9.16 	health care programs and social service programs including but not limited to WIC, free 
9.17 	and reduced school lunch programs, and food stamps, and shall develop and use automated 
9.18 	systems to identify persons served by social service programs who may be eligible for, but 
9.19 	are not enrolled in, a state health care program. The system must also permit enrollees to 
9.20 	renew state health care program enrollment through these social services programs. By 
9.21 	January 15, 2009, the commissioner shall, as necessary, identify and recommend to the 
9.22 	legislature statutory changes to state health care and social service programs necessary to 
9.23 	improve coordination and automation of outreach and enrollment efforts.
9.24 	(c) By January 15, 2009, the commissioner shall establish and implement an 
9.25 	automated process to send out state health care program renewal forms in the most 
9.26 	common foreign languages to those state health care program enrollees who request 
9.27 	renewal forms in those foreign languages. The commissioner, as part of the initial 
9.28 	enrollment process, shall inform applicants of the availability of this option.
9.29 	(d) Beginning July 1, 2008, the commissioner, county social service agencies, and 
9.30 	health care providers shall update state health care program enrollee addresses and related 
9.31 	contact information at the time of each enrollee contact.

9.32 	EFFECTIVE DATE. This section is effective July 1, 2008.

10.1 	Sec. 2. Minnesota Statutes 2007 Supplement, section 256B.056, subdivision 10, 
10.2 	is amended to read:
10.3 		Subd. 10.Eligibility verification. (a) The commissioner shall require women who 
10.4 	are applying for the continuation of medical assistance coverage following the end of the 
10.5 	60-day postpartum period to update their income and asset information and to submit 
10.6 	any required income or asset verification.
10.7 	(b) The commissioner shall determine the eligibility of private-sector health care 
10.8 	coverage for infants less than one year of age eligible under section 256B.055, subdivision 
10.9 	10, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage 
10.10 	if this is determined to be cost-effective.
10.11 	(c) The commissioner shall verify assets and income for all applicants, and for 
10.12 	all recipients upon renewal. The commissioner shall verify liquid assets for applicants, 
10.13 	and for recipients upon renewal, only if the applicant or recipient is within ten percent 
10.14 	of the applicable asset limit. The commissioner may verify nonliquid assets, but is not 
10.15 	required to do so.
10.16 	(d) An enrollee who fails to submit renewal forms and related documentation 
10.17 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
10.18 	for one additional month beyond the end of the current eligibility period, before being 
10.19 	disenrolled.
10.20 	(e) If there is no change in an enrollee's income or asset information, the enrollee 
10.21 	may renew eligibility at designated locations that include community clinics and health 
10.22 	care providers' offices. These designated sites shall forward the renewal forms to the 
10.23 	commissioner.

10.24 	EFFECTIVE DATE. The amendment to paragraph (c) is effective January 1, 2009. 
10.25 	The amendment to paragraph (d) is effective January 1, 2010, or upon federal approval, 
10.26 	whichever is later. The commissioner of human services shall notify the revisor of statutes 
10.27 	when federal approval is obtained.

10.28 	Sec. 3. Minnesota Statutes 2006, section 256B.061, is amended to read:
10.29 	256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS; 
10.30 	DELAYED VERIFICATION.
10.31 	(a) If any individual has been determined to be eligible for medical assistance, it 
10.32 	will be made available for care and services included under the plan and furnished in or 
10.33 	after the third month before the month in which the individual made application for such 
10.34 	assistance, if such individual was, or upon application would have been, eligible for 
11.1 	medical assistance at the time the care and services were furnished. The commissioner 
11.2 	may limit, restrict, or suspend the eligibility of an individual for up to one year upon 
11.3 	that individual's conviction of a criminal offense related to application for or receipt of 
11.4 	medical assistance benefits.
11.5 	(b) On the basis of information provided on the completed application, an applicant 
11.6 	who meets the following criteria must be determined eligible beginning in the month 
11.7 	of application:
11.8 	(1) gross income is less than 90 percent of the applicable income standard;
11.9 	(2) total liquid assets are less than 90 percent of the asset limit;
11.10 	(3) does not reside in a long-term care facility; and
11.11 	(4) meets all other eligibility requirements, including compliance at the time of 
11.12 	application with citizenship or nationality documentation requirements under section 
11.13 	256B.06, subdivision 4.
11.14 	The applicant shall provide all required verifications within 60 days' notice of the 
11.15 	eligibility determination or eligibility shall be terminated. Applicants who are terminated 
11.16 	for failure to provide all required verifications are not eligible to apply for coverage using 
11.17 	the delayed verification procedures specified in this paragraph for 12 months.

11.18 	EFFECTIVE DATE. This section is effective January 1, 2010.

11.19 	Sec. 4. Minnesota Statutes 2006, section 256D.03, is amended by adding a subdivision 
11.20 	to read:
11.21 		Subd. 7a.Additional duties of the commissioner. In administering the general 
11.22 	assistance medical care program, the commissioner shall: (1) apply the delayed verification 
11.23 	procedure specified in section 256B.061, paragraph (b), to general assistance medical care 
11.24 	applicants; and (2) provide general assistance medical care enrollees who fail to submit 
11.25 	renewal forms and related documentation necessary to verify continued eligibility with an 
11.26 	additional month of eligibility beyond the end of the current eligibility period.

11.27 	EFFECTIVE DATE. This section is effective January 1, 2010.

11.28 	Sec. 5. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 3, is 
11.29 	amended to read:
11.30 		Subd. 3.Inpatient hospital services. (a) Covered health services shall include 
11.31 	inpatient hospital services, including inpatient hospital mental health services and inpatient 
11.32 	hospital and residential chemical dependency treatment, subject to those limitations 
11.33 	necessary to coordinate the provision of these services with eligibility under the medical 
12.1 	assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 
12.2 	section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 
12.3 	2, with family gross income that exceeds 200 percent of the federal poverty guidelines or 
12.4 	215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 
12.5 	pregnant, is subject to an annual limit of $10,000 $20,000. 
12.6 	(b) Admissions for inpatient hospital services paid for under section 256L.11, 
12.7 	subdivision 3, must be certified as medically necessary in accordance with Minnesota 
12.8 	Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2): 
12.9 	(1) all admissions must be certified, except those authorized under rules established 
12.10 	under section 254A.03, subdivision 3, or approved under Medicare; and 
12.11 	(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent 
12.12 	for admissions for which certification is requested more than 30 days after the day of 
12.13 	admission. The hospital may not seek payment from the enrollee for the amount of the 
12.14 	payment reduction under this clause. 

12.15 	EFFECTIVE DATE. This section is effective January 1, 2009, for enrollees for 
12.16 	whom federal funding is not available, and is effective January 1, 2009, or upon federal 
12.17 	approval, whichever is later, for enrollees for whom federal funding is available. The 
12.18 	commissioner of human services shall notify the revisor of statutes when federal approval 
12.19 	is obtained.

12.20 	Sec. 6. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 5, is 
12.21 	amended to read:
12.22 		Subd. 5.Co-payments and coinsurance. (a) Except as provided in paragraphs (b) 
12.23 	and (c), the MinnesotaCare benefit plan shall include the following co-payments and 
12.24 	coinsurance requirements for all enrollees:
12.25 	(1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 
12.26 	subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and 
12.27 	$3,000 per family;
12.28 	(2) $3 per prescription for adult enrollees;
12.29 	(3) $25 for eyeglasses for adult enrollees;
12.30 	(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 
12.31 	episode of service which is required because of a recipient's symptoms, diagnosis, or 
12.32 	established illness, and which is delivered in an ambulatory setting by a physician or 
12.33 	physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 
12.34 	audiologist, optician, or optometrist; and
12.35 	(5) $6 for nonemergency visits to a hospital-based emergency room.
13.1 	(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of 
13.2 	children under the age of 21.
13.3 	(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
13.4 	(d) Paragraph (a), clause (4), does not apply to mental health services.
13.5 	(e) Adult enrollees with family gross income that exceeds 200 percent of the federal 
13.6 	poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 
13.7 	and who are not pregnant shall be financially responsible for the coinsurance amount, if 
13.8 	applicable, and amounts which exceed the $10,000 $20,000 inpatient hospital benefit limit.
13.9 	(f) When a MinnesotaCare enrollee becomes a member of a prepaid health 
13.10 	plan, or changes from one prepaid health plan to another during a calendar year, any 
13.11 	charges submitted towards the $10,000 $20,000 annual inpatient benefit limit, and any 
13.12 	out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted 
13.13 	or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

13.14 	EFFECTIVE DATE. This section is effective January 1, 2009, for enrollees for 
13.15 	whom federal funding is not available, and is effective January 1, 2009, or upon federal 
13.16 	approval, whichever is later, for enrollees for whom federal funding is available. The 
13.17 	commissioner of human services shall notify the revisor of statutes when federal approval 
13.18 	is obtained.

13.19 	Sec. 7. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is 
13.20 	amended to read:
13.21 		Subdivision 1.Families with children. (a) Families with children with family 
13.22 	income equal to or less than 275 300 percent of the federal poverty guidelines for the 
13.23 	applicable family size shall be eligible for MinnesotaCare according to this section. All 
13.24 	other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 
13.25 	to enrollment under section 256L.07, shall apply unless otherwise specified. 
13.26 	(b) Parents who enroll in the MinnesotaCare program must also enroll their children, 
13.27 	if the children are eligible. Children may be enrolled separately without enrollment by 
13.28 	parents. However, if one parent in the household enrolls, both parents must enroll, unless 
13.29 	other insurance is available. If one child from a family is enrolled, all children must 
13.30 	be enrolled, unless other insurance is available. If one spouse in a household enrolls, 
13.31 	the other spouse in the household must also enroll, unless other insurance is available. 
13.32 	Families cannot choose to enroll only certain uninsured members.
13.33 	(c) Beginning October 1, 2003, the dependent sibling definition no longer applies 
13.34 	to the MinnesotaCare program. These persons are no longer counted in the parental 
13.35 	household and may apply as a separate household.
14.1 	(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are 
14.2 	not eligible for MinnesotaCare if their gross income exceeds $50,000.
14.3 	(e) Children formerly enrolled in medical assistance and automatically deemed 
14.4 	eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 
14.5 	from the requirements of this section until renewal.

14.6 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
14.7 	approval, whichever is later. The commissioner of human services shall notify the revisor 
14.8 	of statutes when federal approval is obtained.

14.9 	Sec. 8. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is 
14.10 	amended to read:
14.11 		Subd. 7.Single adults and households with no children. The definition of eligible 
14.12 	persons includes all individuals and households with no children who have gross family 
14.13 	incomes that are equal to or less than 200 percent of the federal poverty guidelines. 
14.14 	Effective July January 1, 2009, the definition of eligible persons includes all individuals 
14.15 	and households with no children who have gross family incomes that are equal to or less 
14.16 	than 215 300 percent of the federal poverty guidelines.

14.17 	EFFECTIVE DATE. This section is effective January 1, 2009.

14.18 	Sec. 9. Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a, is 
14.19 	amended to read:
14.20 		Subd. 3a.Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 
14.21 	must be renewed every 12 months. The 12-month period begins in the month after the 
14.22 	month the application is approved.
14.23 	(b) Each new period of eligibility must take into account any changes in 
14.24 	circumstances that impact eligibility and premium amount. An enrollee must provide all 
14.25 	the information needed to redetermine eligibility by the first day of the month that ends 
14.26 	the eligibility period. If there is no change in circumstances, the enrollee may renew 
14.27 	eligibility at designated locations that include community clinics and health care providers' 
14.28 	offices. The designated sites shall forward the renewal forms to the commissioner. The 
14.29 	premium for the new period of eligibility must be received as provided in section 256L.06
14.30 	in order for eligibility to continue.
14.31 	(c) For single adults and households with no children formerly enrolled in general 
14.32 	assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 
15.1 	subdivision 3, the first period of eligibility begins the month the enrollee submitted the 
15.2 	application or renewal for general assistance medical care.
15.3 	(d) An enrollee who fails to submit renewal forms and related documentation 
15.4 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
15.5 	for one additional month beyond the end of the current eligibility period before being 
15.6 	disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 
15.7 	additional month.

15.8 	EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal 
15.9 	approval, whichever is later. The commissioner of human services shall notify the revisor 
15.10 	of statutes when federal approval is obtained.

15.11 	Sec. 10. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision 
15.12 	to read:
15.13 		Subd. 6.Delayed verification. On the basis of information provided on the 
15.14 	completed application, an applicant whose gross income is less than 90 percent of 
15.15 	the applicable income standard and meets all other eligibility requirements, including 
15.16 	compliance at the time of application with citizenship or nationality documentation 
15.17 	requirements under section 256L.04, subdivision 10, must be determined eligible 
15.18 	beginning in the month of application. The applicant shall provide all required 
15.19 	verifications within 60 days' notice of the eligibility determination, or eligibility shall be 
15.20 	terminated. Applicants who are terminated for failure to provide all required verifications 
15.21 	are not eligible to apply for coverage using the delayed verification procedures specified in 
15.22 	this subdivision for 12 months.

15.23 	EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal 
15.24 	approval, whichever is later. The commissioner of human services shall notify the revisor 
15.25 	of statutes when federal approval is obtained.

15.26 	Sec. 11. Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:
15.27 		Subd. 3.Commissioner's duties and payment. (a) Premiums are dedicated to the 
15.28 	commissioner for MinnesotaCare.
15.29 	(b) The commissioner shall develop and implement procedures to: (1) require 
15.30 	enrollees to report changes in income; (2) adjust sliding scale premium payments, based 
15.31 	upon both increases and decreases in enrollee income, at the time the change in income 
15.32 	is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required 
15.33 	premiums. Failure to pay includes payment with a dishonored check, a returned automatic 
16.1 	bank withdrawal, or a refused credit card or debit card payment. The commissioner may 
16.2 	demand a guaranteed form of payment, including a cashier's check or a money order, as 
16.3 	the only means to replace a dishonored, returned, or refused payment.
16.4 	(c) Premiums are calculated on a calendar month basis and may be paid on a 
16.5 	monthly, quarterly, or semiannual basis, with the first payment due upon notice from the 
16.6 	commissioner of the premium amount required. The commissioner shall inform applicants 
16.7 	and enrollees of these premium payment options. Premium payment is required before 
16.8 	enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments 
16.9 	received before noon are credited the same day. Premium payments received after noon 
16.10 	are credited on the next working day.
16.11 	(d) Nonpayment of the premium will result in disenrollment from the plan effective 
16.12 	forthe first day of the calendar month following the calendar month for which the 
16.13 	premium was due. Persons disenrolled for nonpayment or who voluntarily terminate 
16.14 	coverage from the program may not reenroll until four calendar months have elapsed. 
16.15 	Persons disenrolled for nonpayment who pay all past due premiums as well as current 
16.16 	premiums due, including premiums due for the period of disenrollment, within 20 days 
16.17 	of disenrollment, shall be reenrolled retroactively to the first day of disenrollment The 
16.18 	commissioner shall waive premiums for coverage provided under this paragraph to 
16.19 	persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b. 
16.20 	Persons disenrolled for nonpayment or who voluntarily terminate coverage from the 
16.21 	program may not reenroll for four calendar months unless the person demonstrates good 
16.22 	cause for nonpayment. Good cause does not exist if a person chooses to pay other family 
16.23 	expenses instead of the premium. The commissioner shall define good cause in rule.

16.24 	EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal 
16.25 	approval, whichever is later. The commissioner of human services shall notify the revisor 
16.26 	of statutes when federal approval is obtained.

16.27 	Sec. 12. Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is 
16.28 	amended to read:
16.29 		Subdivision 1.General requirements. (a) Children enrolled in the original 
16.30 	children's health plan as of September 30, 1992, children who enrolled in the 
16.31 	MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 
16.32 	article 4, section 17, and children who have family gross incomes that are equal to or 
16.33 	less than 150 percent of the federal poverty guidelines are eligible without meeting 
16.34 	the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 
16.35 	long as they maintain continuous coverage in the MinnesotaCare program or medical 
17.1 	assistance. Children who apply for MinnesotaCare on or after the implementation date 
17.2 	of the employer-subsidized health coverage program as described in Laws 1998, chapter 
17.3 	407, article 5, section 45, who have family gross incomes that are equal to or less than 150 
17.4 	percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 
17.5 	be eligible for MinnesotaCare.
17.6 	Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose 
17.7 	income increases above 275 300 percent of the federal poverty guidelines, are no longer 
17.8 	eligible for the program and shall be disenrolled by the commissioner. Beginning January 
17.9 	1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, 
17.10 	whose income increases above 200 percent of the federal poverty guidelines or 215 300
17.11 	percent of the federal poverty guidelines on or after July January 1, 2009, are no longer 
17.12 	eligible for the program and shall be disenrolled by the commissioner. For persons 
17.13 	disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of 
17.14 	the calendar month following the month in which the commissioner determines that the 
17.15 	income of a family or individual exceeds program income limits.
17.16 	(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare 
17.17 	if ten percent of their gross individual or gross family income as defined in section 
17.18 	256L.01, subdivision 4, is less than the annual premium for a policy with a $500 
17.19 	deductible available through the Minnesota Comprehensive Health Association. Children 
17.20 	who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 
17.21 	notice period from the date that ineligibility is determined before disenrollment. The 
17.22 	premium for children remaining eligible under this clause shall be the maximum premium 
17.23 	determined under section 256L.15, subdivision 2, paragraph (b).
17.24 	(c) Notwithstanding paragraphs (a) and (b), parents are not eligible for 
17.25 	MinnesotaCare if gross household income exceeds $50,000 for the 12-month period 
17.26 	of eligibility.

17.27 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
17.28 	approval, whichever is later, except that the amendment to paragraph (a) related to the 
17.29 	four-month requirement is effective January 1, 2010, or upon federal approval, whichever 
17.30 	is later. The commissioner of human services shall notify the revisor of statutes when 
17.31 	federal approval is obtained.

17.32 	Sec. 13. Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:
17.33 		Subd. 3.Other health coverage. (a) Families and individuals enrolled in the 
17.34 	MinnesotaCare program must have no health coverage while enrolled or for at least four 
17.35 	months prior to application and renewal. Children enrolled in the original children's health 
18.1 	plan and children in families with income equal to or less than 150 percent of the federal 
18.2 	poverty guidelines, who have other health insurance, are eligible if the coverage:
18.3 	(1) lacks two or more of the following:
18.4 	(i) basic hospital insurance;
18.5 	(ii) medical-surgical insurance;
18.6 	(iii) prescription drug coverage;
18.7 	(iv) dental coverage; or
18.8 	(v) vision coverage;
18.9 	(2) requires a deductible of $100 or more per person per year; or
18.10 	(3) lacks coverage because the child has exceeded the maximum coverage for a 
18.11 	particular diagnosis or the policy excludes a particular diagnosis.
18.12 	The commissioner may change this eligibility criterion for sliding scale premiums 
18.13 	in order to remain within the limits of available appropriations. The requirement of no 
18.14 	health coverage does not apply to newborns.
18.15 	(b) Medical assistance, general assistance medical care, and the Civilian Health and 
18.16 	Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under 
18.17 	United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or 
18.18 	health coverage for purposes of the four-month requirement described in this subdivision.
18.19 	(c) For purposes of this subdivision, an applicant or enrollee who is entitled to 
18.20 	Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 
18.21 	Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to 
18.22 	have health coverage. An applicant or enrollee who is entitled to premium-free Medicare 
18.23 	Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility 
18.24 	for MinnesotaCare.
18.25 	(d) (c) Applicants who were recipients of medical assistance or general assistance 
18.26 	medical care within one month of application must meet the provisions of this subdivision 
18.27 	and subdivision 2.
18.28 	(e) Cost-effective health insurance that was paid for by medical assistance is not 
18.29 	considered health coverage for purposes of the four-month requirement under this 
18.30 	section, except if the insurance continued after medical assistance no longer considered it 
18.31 	cost-effective or after medical assistance closed.

18.32 	EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal 
18.33 	approval, whichever is later. The commissioner of human services shall notify the revisor 
18.34 	of statutes when federal approval is obtained.

19.1 	Sec. 14. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is 
19.2 	amended to read:
19.3 		Subd. 2.Sliding fee scale; monthly gross individual or family income. (a) The 
19.4 	commissioner shall establish a sliding fee scale to determine the percentage of monthly 
19.5 	gross individual or family income that households at different income levels must pay 
19.6 	to obtain coverage through the MinnesotaCare program. The sliding fee scale must be 
19.7 	based on the enrollee's monthly gross individual or family income. The sliding fee scale 
19.8 	must contain separate tables based on enrollment of one, two, or three or more persons. 
19.9 	Until December 31, 2008, the sliding fee scale begins with a premium of 1.5 percent of 
19.10 	monthly gross individual or family income for individuals or families with incomes below 
19.11 	the limits for the medical assistance program for families and children in effect on January 
19.12 	1, 1999, and proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 
19.13 	5.9, 7.4, and 8.8 percent. These percentages are matched to evenly spaced income steps 
19.14 	ranging from the medical assistance income limit for families and children in effect on 
19.15 	January 1, 1999, to 275 percent of the federal poverty guidelines for the applicable family 
19.16 	size, up to a family size of five. The sliding fee scale for a family of five must be used 
19.17 	for families of more than five. The sliding fee scale and percentages are not subject to 
19.18 	the provisions of chapter 14. If a family or individual reports increased income after 
19.19 	enrollment, premiums shall be adjusted at the time the change in income is reported.
19.20 	(b) FamiliesChildren whose gross income is above 275 300 percent of the federal 
19.21 	poverty guidelines shall pay the maximum premium. The maximum premium is defined 
19.22 	as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 
19.23 	cases paid the maximum premium, the total revenue would equal the total cost of 
19.24 	MinnesotaCare medical coverage and administration. In this calculation, administrative 
19.25 	costs shall be assumed to equal ten percent of the total. The costs of medical coverage 
19.26 	for pregnant women and children under age two and the enrollees in these groups shall 
19.27 	be excluded from the total. The maximum premium for two enrollees shall be twice the 
19.28 	maximum premium for one, and the maximum premium for three or more enrollees shall 
19.29 	be three times the maximum premium for one.
19.30 	(c) Beginning January 1, 2009, MinnesotaCare enrollees shall pay premiums 
19.31 	according to the affordability scale established in section 62U.08 with the exception that 
19.32 	children in families with income at or below 150 percent of the federal poverty guidelines 
19.33 	shall pay a monthly premium of $4.

19.34 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
19.35 	approval, whichever is later. The commissioner of human services shall notify the revisor 
19.36 	of statutes when federal approval is obtained.

20.1 	Sec. 15. Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision 
20.2 	to read:
20.3 		Subd. 5.First month premium exemption. New enrollee households are exempt 
20.4 	from premiums for the first month of MinnesotaCare enrollment. For purposes of this 
20.5 	exemption, a "new enrollee household" is a household which has not been enrolled in 
20.6 	MinnesotaCare for at least one year prior to application.

20.7 	EFFECTIVE DATE. This section is effective January 1, 2010, or upon federal 
20.8 	approval, whichever is later. The commissioner of human services shall notify the revisor 
20.9 	of statutes when federal approval is obtained.

20.10 	Sec. 16. INSURANCE COVERAGE FOR LONG-TERM CARE WORKERS.
 20.11 	(a) By December 15, 2008, the commissioner of human services shall study and 
20.12 	report to the legislature with recommendations for a rate increase to long-term care 
20.13 	employers dedicated to the purchase of employee health insurance in the private market. 
20.14 	The commissioner shall collect necessary actuarial data, employment data, current 
20.15 	coverage data, and other needed information.
20.16 	(b) The commissioner shall develop cost estimates for three levels of insurance 
20.17 	coverage for long-term care workers:
20.18 	(1) the coverage provided to state employees;
20.19 	(2) the coverage provided to MinnesotaCare enrollees; and
20.20 	(3) the benefits provided under an average private market insurance product, but 
20.21 	with a deductible limited to $100 per person.
20.22 	Premium cost sharing, waiting periods for eligibility, definitions of full- and 
20.23 	part-time employment, and other parameters under the three options must be identical to 
20.24 	those under the state employees' health plan.
20.25 	(c) For purposes of this section, a long-term care worker is a person employed by a 
20.26 	nursing facility, an intermediate care facility for persons with developmental disabilities, 
20.27 	or a service provider that:
20.28 	(1) is eligible under Laws 2007, chapter 147, article 7, section 71; and 
20.29 	(2) provides long-term care services.
20.30 	The commissioner may recommend a different definition of long-term care worker if 
20.31 	this definition presents insurmountable implementation issues.
20.32 	(d) The recommendations must include measures to:
20.33 	(1) ensure equitable treatment between employers that currently have different levels 
20.34 	of expenditure for employee health insurance costs; and
21.1 	(2) enforce the requirement that the rate increase be expended for the intended 
21.2 	purpose.

21.3 	Sec. 17.  REPEALER.
 21.4 	Minnesota Statutes 2006, section 256L.15, subdivision 3, is repealed.

21.5 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
21.6 	approval of the amendments to section 14, whichever is later. The commissioner of human 
21.7 	services shall notify the revisor of statutes when federal approval is obtained.

21.8 	ARTICLE 3
21.9 	INSURANCE REFORM

21.10 	Section 1. UNIFORM OUTCOME MEASURES WORKING GROUP.
 21.11 	(a) The Health Care Transformation Commission, established under Minnesota 
21.12 	Statutes, section 62U.04, shall establish an informal working group to create a 
21.13 	standardized limited set of measures by which to measure performance of health care 
21.14 	providers for use in establishing statewide health improvement goals and in measuring 
21.15 	progress on these goals. The group shall focus first on the most common areas of data 
21.16 	collection for pay-for-performance systems.
21.17 	(b) The working group must be known as the Uniform Outcome Measures Working 
21.18 	Group. The commission shall determine its members and the number of members. 
21.19 	The working group must include representatives of health care providers, health care 
21.20 	purchasers, health insurers, public health agencies, and consumers.
21.21 	(c) The working group shall attempt to determine uniform definitions, measures, and 
21.22 	forms for submission of data, to the greatest extent possible.
21.23 	(d) The working group shall seek to reduce the administrative burden on health 
21.24 	care providers and health care purchasers.
21.25 	(e) The working group shall invite and use the expertise of existing organizations 
21.26 	experienced in health care quality measurement.
21.27 	(f) The working group shall encourage participation by the public.
21.28 	(g) The commission shall encourage use of the working group recommendations.
21.29 	(h) By December 15, 2008, the commission shall provide to the legislature a written 
21.30 	report under Minnesota Statutes, section 3.195, summarizing the work of the working 
21.31 	group. The report must include recommendations for: (1) a standardized set of health 
21.32 	care provider performance measures to be enacted by the legislature; and (2) a payment 
21.33 	methodology to reduce capitation rates paid by the commissioner of human services 
22.1 	under Minnesota Statutes, section 256B.69, to demonstration providers that use provider 
22.2 	performance measures other than those included in the standardized set under clause (1).
22.3 	(i) The working group expires on June 30, 2009, unless the commission determines 
22.4 	that the group's continued existence would be beneficial.

22.5 	Sec. 2. COMMUNITY BENEFIT STANDARDS AND REPORTING; 
22.6 	NONPROFIT HEALTH PLAN COMPANIES; RECOMMENDATIONS.
 22.7 	(a) By December 15, 2008, the commissioner of health shall recommend to the 
22.8 	legislature community benefit standards to be required by law of nonprofit health plan 
22.9 	companies doing business in the state. The expectations of the community benefits 
22.10 	provided and reported should be related to the statutory expectations in Minnesota 
22.11 	Statutes, sections 62C.01 and 62D.01, and thus focus on advocating public health, 
22.12 	improving the art and science of medical care, and addressing the need for financial 
22.13 	assistance to access ongoing coverage, and not related to general philanthropic endeavors. 
22.14 	The commissioner shall seek public input regarding the range of options to be explored 
22.15 	and the accountability measures.
22.16 	(b) The recommendations must include a procedure by which each nonprofit health 
22.17 	plan company would periodically and uniformly report to the state and to the public 
22.18 	regarding the company's compliance with the requirements.
22.19 	(c) The commissioner shall recommend a fair and effective enforcement and 
22.20 	remediation mechanism.

22.21 	ARTICLE 4
22.22 	HEALTH INSURANCE PURCHASING AND AFFORDABILITY

22.23 	Section 1. Minnesota Statutes 2007 Supplement, section 13.46, subdivision 2, is 
22.24 	amended to read:
22.25 		Subd. 2.General. (a) Unless the data is summary data or a statute specifically 
22.26 	provides a different classification, data on individuals collected, maintained, used, or 
22.27 	disseminated by the welfare system is private data on individuals, and shall not be 
22.28 	disclosed except:
22.29 	(1) according to section 13.05;
22.30 	(2) according to court order;
22.31 	(3) according to a statute specifically authorizing access to the private data;
22.32 	(4) to an agent of the welfare system, including a law enforcement person, attorney, 
22.33 	or investigator acting for it in the investigation or prosecution of a criminal or civil 
22.34 	proceeding relating to the administration of a program;
23.1 	(5) to personnel of the welfare system who require the data to verify an individual's 
23.2 	identity; determine eligibility, amount of assistance, and the need to provide services to 
23.3 	an individual or family across programs; evaluate the effectiveness of programs; assess 
23.4 	parental contribution amounts; and investigate suspected fraud;
23.5 	(6) to administer federal funds or programs;
23.6 	(7) between personnel of the welfare system working in the same program;
23.7 	(8) to the Department of Revenue to assess parental contribution amounts for 
23.8 	purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit 
23.9 	programs and to identify individuals who may benefit from these programs. The following 
23.10 	information may be disclosed under this paragraph: an individual's and their dependent's 
23.11 	names, dates of birth, Social Security numbers, income, addresses, and other data as 
23.12 	required, upon request by the Department of Revenue. Disclosures by the commissioner 
23.13 	of revenue to the commissioner of human services for the purposes described in this clause 
23.14 	are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include, 
23.15 	but are not limited to, the dependent care credit under section 290.067, the Minnesota 
23.16 	working family credit under section 290.0671, the property tax refund and rental credit 
23.17 	under section 290A.04, and the Minnesota education credit under section 290.0674;
23.18 	(9) between the Department of Human Services, the Department of Employment 
23.19 	and Economic Development, and when applicable, the Department of Education, for 
23.20 	the following purposes:
23.21 	(i) to monitor the eligibility of the data subject for unemployment benefits, for any 
23.22 	employment or training program administered, supervised, or certified by that agency;
23.23 	(ii) to administer any rehabilitation program or child care assistance program, 
23.24 	whether alone or in conjunction with the welfare system;
23.25 	(iii) to monitor and evaluate the Minnesota family investment program or the child 
23.26 	care assistance program by exchanging data on recipients and former recipients of food 
23.27 	support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance 
23.28 	under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and
23.29 	(iv) to analyze public assistance employment services and program utilization, 
23.30 	cost, effectiveness, and outcomes as implemented under the authority established in Title 
23.31 	II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of 
23.32 	1999. Health records governed by sections 144.291 to 144.298 and "protected health 
23.33 	information" as defined in Code of Federal Regulations, title 45, section 160.103, and 
23.34 	governed by Code of Federal Regulations, title 45, parts 160-164, including health care 
23.35 	claims utilization information, must not be exchanged under this clause;
24.1 	(10) to appropriate parties in connection with an emergency if knowledge of 
24.2 	the information is necessary to protect the health or safety of the individual or other 
24.3 	individuals or persons;
24.4 	(11) data maintained by residential programs as defined in section 245A.02 may 
24.5 	be disclosed to the protection and advocacy system established in this state according 
24.6 	to Part C of Public Law 98-527 to protect the legal and human rights of persons with 
24.7 	developmental disabilities or other related conditions who live in residential facilities for 
24.8 	these persons if the protection and advocacy system receives a complaint by or on behalf 
24.9 	of that person and the person does not have a legal guardian or the state or a designee of 
24.10 	the state is the legal guardian of the person;
24.11 	(12) to the county medical examiner or the county coroner for identifying or locating 
24.12 	relatives or friends of a deceased person;
24.13 	(13) data on a child support obligor who makes payments to the public agency 
24.14 	may be disclosed to the Minnesota Office of Higher Education to the extent necessary to 
24.15 	determine eligibility under section 136A.121, subdivision 2, clause (5);
24.16 	(14) participant Social Security numbers and names collected by the telephone 
24.17 	assistance program may be disclosed to the Department of Revenue to conduct an 
24.18 	electronic data match with the property tax refund database to determine eligibility under 
24.19 	section 237.70, subdivision 4a;
24.20 	(15) the current address of a Minnesota family investment program participant 
24.21 	may be disclosed to law enforcement officers who provide the name of the participant 
24.22 	and notify the agency that:
24.23 	(i) the participant:
24.24 	(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after 
24.25 	conviction, for a crime or attempt to commit a crime that is a felony under the laws of the 
24.26 	jurisdiction from which the individual is fleeing; or
24.27 	(B) is violating a condition of probation or parole imposed under state or federal law;
24.28 	(ii) the location or apprehension of the felon is within the law enforcement officer's 
24.29 	official duties; and
24.30 	(iii) the request is made in writing and in the proper exercise of those duties;
24.31 	(16) the current address of a recipient of general assistance or general assistance 
24.32 	medical care may be disclosed to probation officers and corrections agents who are 
24.33 	supervising the recipient and to law enforcement officers who are investigating the 
24.34 	recipient in connection with a felony level offense;
24.35 	(17) information obtained from food support applicant or recipient households may 
24.36 	be disclosed to local, state, or federal law enforcement officials, upon their written request, 
25.1 	for the purpose of investigating an alleged violation of the Food Stamp Act, according 
25.2 	to Code of Federal Regulations, title 7, section 272.1(c);
25.3 	(18) the address, Social Security number, and, if available, photograph of any 
25.4 	member of a household receiving food support shall be made available, on request, to a 
25.5 	local, state, or federal law enforcement officer if the officer furnishes the agency with the 
25.6 	name of the member and notifies the agency that:
25.7 	(i) the member:
25.8 	(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a 
25.9 	crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;
25.10 	(B) is violating a condition of probation or parole imposed under state or federal 
25.11 	law; or
25.12 	(C) has information that is necessary for the officer to conduct an official duty related 
25.13 	to conduct described in subitem (A) or (B);
25.14 	(ii) locating or apprehending the member is within the officer's official duties; and
25.15 	(iii) the request is made in writing and in the proper exercise of the officer's official 
25.16 	duty;
25.17 	(19) the current address of a recipient of Minnesota family investment program, 
25.18 	general assistance, general assistance medical care, or food support may be disclosed to 
25.19 	law enforcement officers who, in writing, provide the name of the recipient and notify the 
25.20 	agency that the recipient is a person required to register under section 243.166, but is not 
25.21 	residing at the address at which the recipient is registered under section 243.166;
25.22 	(20) certain information regarding child support obligors who are in arrears may be 
25.23 	made public according to section 518A.74;
25.24 	(21) data on child support payments made by a child support obligor and data on 
25.25 	the distribution of those payments excluding identifying information on obligees may be 
25.26 	disclosed to all obligees to whom the obligor owes support, and data on the enforcement 
25.27 	actions undertaken by the public authority, the status of those actions, and data on the 
25.28 	income of the obligor or obligee may be disclosed to the other party;
25.29 	(22) data in the work reporting system may be disclosed under section 256.998, 
25.30 	subdivision 7;
25.31 	(23) to the Department of Education for the purpose of matching Department of 
25.32 	Education student data with public assistance data to determine students eligible for free 
25.33 	and reduced price meals, meal supplements, and free milk according to United States 
25.34 	Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and 
25.35 	state funds that are distributed based on income of the student's family; and to verify 
25.36 	receipt of energy assistance for the telephone assistance plan;
26.1 	(24) the current address and telephone number of program recipients and emergency 
26.2 	contacts may be released to the commissioner of health or a local board of health as 
26.3 	defined in section 145A.02, subdivision 2, when the commissioner or local board of health 
26.4 	has reason to believe that a program recipient is a disease case, carrier, suspect case, or at 
26.5 	risk of illness, and the data are necessary to locate the person;
26.6 	(25) to other state agencies, statewide systems, and political subdivisions of this 
26.7 	state, including the attorney general, and agencies of other states, interstate information 
26.8 	networks, federal agencies, and other entities as required by federal regulation or law for 
26.9 	the administration of the child support enforcement program;
26.10 	(26) to personnel of public assistance programs as defined in section 256.741, for 
26.11 	access to the child support system database for the purpose of administration, including 
26.12 	monitoring and evaluation of those public assistance programs;
26.13 	(27) to monitor and evaluate the Minnesota family investment program by 
26.14 	exchanging data between the Departments of Human Services and Education, on 
26.15 	recipients and former recipients of food support, cash assistance under chapter 256, 256D, 
26.16 	256J, or 256K, child care assistance under chapter 119B, or medical programs under 
26.17 	chapter 256B, 256D, or 256L;
26.18 	(28) to evaluate child support program performance and to identify and prevent 
26.19 	fraud in the child support program by exchanging data between the Department of Human 
26.20 	Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a) 
26.21 	and (b), without regard to the limitation of use in paragraph (c), Department of Health, 
26.22 	Department of Employment and Economic Development, and other state agencies as is 
26.23 	reasonably necessary to perform these functions; or
26.24 	(29) counties operating child care assistance programs under chapter 119B may 
26.25 	disseminate data on program participants, applicants, and providers to the commissioner 
26.26 	of education; or
26.27 	(30) according to section 256.01, subdivision 27, between the welfare system and the 
26.28 	Minnesota Health Insurance Exchange under section 62U.02, in order to collect premiums 
26.29 	from individuals in the medical assistance employed persons with disabilities program 
26.30 	and the MinnesotaCare program under chapters 256B and 256L, and to administer the 
26.31 	individual's and the individual's families' participation in the exchange.
26.32 	(b) Information on persons who have been treated for drug or alcohol abuse may 
26.33 	only be disclosed according to the requirements of Code of Federal Regulations, title 
26.34 	42, sections 2.1 to 2.67.
26.35 	(c) Data provided to law enforcement agencies under paragraph (a), clause (15), 
26.36 	(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected 
27.1 	nonpublic while the investigation is active. The data are private after the investigation 
27.2 	becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).
27.3 	(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is 
27.4 	not subject to the access provisions of subdivision 10, paragraph (b).
27.5 	For the purposes of this subdivision, a request will be deemed to be made in writing 
27.6 	if made through a computer interface system.

27.7 	Sec. 2. Minnesota Statutes 2006, section 62A.65, subdivision 3, is amended to read:
27.8 		Subd. 3.Premium rate restrictions. No individual health plan may be offered, 
27.9 	sold, issued, or renewed to a Minnesota resident unless the premium rate charged is 
27.10 	determined in accordance with the following requirements:
27.11 	(a) Except for policies issued under section 62U.03, subdivision 5, paragraph (b), 
27.12 	premium rates must be no more than 25 percent above and no more than 25 percent below 
27.13 	the index rate charged to individuals for the same or similar coverage, adjusted pro 
27.14 	rata for rating periods of less than one year. The premium variations permitted by this 
27.15 	paragraph must be based only upon health status, claims experience, and occupation. For 
27.16 	purposes of this paragraph, health status includes refraining from tobacco use or other 
27.17 	actuarially valid lifestyle factors associated with good health, provided that the lifestyle 
27.18 	factor and its effect upon premium rates have been determined by the commissioner to 
27.19 	be actuarially valid and have been approved by the commissioner. Variations permitted 
27.20 	under this paragraph must not be based upon age or applied differently at different ages. 
27.21 	This paragraph does not prohibit use of a constant percentage adjustment for factors 
27.22 	permitted to be used under this paragraph.
27.23 	(b) Premium rates may vary based upon the ages of covered persons only as 
27.24 	provided in this paragraph. In addition to the variation permitted under paragraph (a), 
27.25 	each health carrier may use an additional premium variation based upon age of up to 
27.26 	plus or minus 50 percent of the index rate.
27.27 	(c) A health carrier may request approval by the commissioner to establish separate 
27.28 	geographic regions determined by the health carrier and to establish separate index rates 
27.29 	for each such region. The commissioner shall grant approval if the following conditions 
27.30 	are met: 
27.31 	(1) the geographic regions must be applied uniformly by the health carrier;
27.32 	(2) each geographic region must be composed of no fewer than seven counties that 
27.33 	create a contiguous region; and
28.1 	(3) the health carrier provides actuarial justification acceptable to the commissioner 
28.2 	for the proposed geographic variations in index rates, establishing that the variations are 
28.3 	based upon differences in the cost to the health carrier of providing coverage.
28.4 	(d) Health carriers may use rate cells and must file with the commissioner the rate 
28.5 	cells they use. Rate cells must be based upon the number of adults or children covered 
28.6 	under the policy and may reflect the availability of Medicare coverage. The rates for 
28.7 	different rate cells must not in any way reflect generalized differences in expected costs 
28.8 	between principal insureds and their spouses.
28.9 	(e) In developing its index rates and premiums for a health plan, a health carrier shall 
28.10 	take into account only the following factors:
28.11 	(1) actuarially valid differences in rating factors permitted under paragraphs (a) 
28.12 	and (b); and
28.13 	(2) actuarially valid geographic variations if approved by the commissioner as 
28.14 	provided in paragraph (c).
28.15 	(f) All premium variations must be justified in initial rate filings and upon request of 
28.16 	the commissioner in rate revision filings. All rate variations are subject to approval by 
28.17 	the commissioner.
28.18 	(g) The loss ratio must comply with the section 62A.021 requirements for individual 
28.19 	health plans. 
28.20 	(h) The rates must not be approved, unless the commissioner has determined that the 
28.21 	rates are reasonable. In determining reasonableness, the commissioner shall consider the 
28.22 	growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar 
28.23 	year or years that the proposed premium rate would be in effect, actuarially valid changes 
28.24 	in risks associated with the enrollee populations, and actuarially valid changes as a result 
28.25 	of statutory changes in Laws 1992, chapter 549. 
28.26 	(i) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under 
28.27 	section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this 
28.28 	paragraph. The rating practices guarantee must be in writing and must guarantee that 
28.29 	the policy form will be offered, sold, issued, and renewed only with premium rates and 
28.30 	premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices 
28.31 	guarantee must be accompanied by an actuarial memorandum that demonstrates that the 
28.32 	premium rates and premium rating system used in connection with the policy form will 
28.33 	satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to 
28.34 	policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4, 
28.35 	or 5. An insurer that complies with this paragraph in connection with a policy form is 
29.1 	exempt from the requirement of prior approval by the commissioner under paragraphs 
29.2 	(c), (f), and (h).

29.3 	Sec. 3. Minnesota Statutes 2006, section 62E.141, is amended to read:
29.4 	62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
29.5 	No employee of an employer that offers a group health plan, under which the 
29.6 	employee is eligible for coverage, is eligible to enroll, or continue to be enrolled, in 
29.7 	the comprehensive health association, except for enrollment or continued enrollment 
29.8 	necessary to cover conditions that are subject to an unexpired preexisting condition 
29.9 	limitation, preexisting condition exclusion, or exclusionary rider under the employer's 
29.10 	health plan. This section does not apply to persons enrolled in the Comprehensive Health 
29.11 	Association as of June 30, 1993. With respect to persons eligible to enroll in the health 
29.12 	plan of an employer that has more than 29 current employees, as defined in section 
29.13 	62L.02, this section does not apply to persons enrolled in the Comprehensive Health 
29.14 	Association as of December 31, 1994. 

29.15 	Sec. 4. Minnesota Statutes 2006, section 62L.12, subdivision 2, is amended to read:
29.16 		Subd. 2.Exceptions. (a) A health carrier may sell, issue, or renew individual 
29.17 	conversion policies to eligible employees otherwise eligible for conversion coverage under 
29.18 	section 62D.104 as a result of leaving a health maintenance organization's service area.
29.19 	(b) A health carrier may sell, issue, or renew individual conversion policies to 
29.20 	eligible employees otherwise eligible for conversion coverage as a result of the expiration 
29.21 	of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21, 
29.22 	62C.142, 62D.101, and 62D.105.
29.23 	(c) A health carrier may sell, issue, or renew conversion policies under section 
29.24 	62E.16 to eligible employees.
29.25 	(d) A health carrier may sell, issue, or renew individual continuation policies to 
29.26 	eligible employees as required.
29.27 	(e) A health carrier may sell, issue, or renew individual health plans if the coverage 
29.28 	is appropriate due to an unexpired preexisting condition limitation or exclusion applicable 
29.29 	to the person under the employer's group health plan or due to the person's need for health 
29.30 	care services not covered under the employer's group health plan.
29.31 	(f) A health carrier may sell, issue, or renew an individual health plan, if the 
29.32 	individual has elected to buy the individual health plan not as part of a general plan to 
29.33 	substitute individual health plans for a group health plan nor as a result of any violation of 
29.34 	subdivision 3 or 4.
30.1 	(g) Nothing in this subdivision relieves a health carrier of any obligation to provide 
30.2 	continuation or conversion coverage otherwise required under federal or state law.
30.3 	(h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage 
30.4 	issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or 
30.5 	contracts that supplement Medicare issued by health maintenance organizations, or those 
30.6 	contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social 
30.7 	Security Act, United States Code, title 42, section 1395 et seq., as amended.
30.8 	(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual 
30.9 	health plans necessary to comply with a court order.
30.10 	(j) A health carrier may offer, issue, sell, or renew an individual health plan to 
30.11 	persons eligible for an employer group health plan, if the individual health plan is a high 
30.12 	deductible health plan for use in connection with an existing health savings account, in 
30.13 	compliance with the Internal Revenue Code, section 223. In that situation, the same or 
30.14 	a different health carrier may offer, issue, sell, or renew a group health plan to cover 
30.15 	the other eligible employees in the group.
30.16 	(k) A health carrier may offer, sell, issue, or renew an individual health plan to one 
30.17 	or more employees of a small employer if the individual health plan is marketed directly to 
30.18 	all employees or through the Minnesota Health Insurance Exchange under section 62U.02 
30.19 	to all employees of the small employer and the small employer does not contribute directly 
30.20 	or indirectly to the premiums or facilitate the administration of the individual health plan. 
30.21 	Except as provided in section 62U.03, subdivision 5, paragraph (b), the requirement to 
30.22 	market an individual health plan to all employees does not require the health carrier to 
30.23 	offer or issue an individual health plan to any employee. For purposes of this paragraph, 
30.24 	an employer is not contributing to the premiums or facilitating the administration of the 
30.25 	individual health plan if the employer does not contribute to the premium and merely 
30.26 	collects the premiums from an employee's wages or salary through payroll deductions 
30.27 	and submits payment for the premiums of one or more employees in a lump sum to the 
30.28 	health carrier or to the Minnesota Health Insurance Exchange under section 62U.02. 
30.29 	Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the 
30.30 	request of an employee, the health carrier or the Minnesota Health Insurance Exchange 
30.31 	under section 62U.02 may bill the employer for the premiums payable by the employee, 
30.32 	provided that the employer is not liable for payment except from payroll deductions for 
30.33 	that purpose. If an employer is submitting payments under this paragraph, the health 
30.34 	carrier or the Minnesota Health Insurance Exchange, as applicable, shall provide a 
30.35 	cancellation notice directly to the primary insured at least ten days prior to termination 
30.36 	of coverage for nonpayment of premium. Individual coverage under this paragraph may 
31.1 	be offered only if the small employer has not provided coverage under section 62L.03 to 
31.2 	the employees within the past 12 months.
31.3 	The employer must provide a written and signed statement to the health carrier or 
31.4 	the Minnesota Health Insurance Exchange, as applicable, stating that the employer is not 
31.5 	contributing directly or indirectly to the employee's premiums. The Minnesota Health 
31.6 	Insurance Exchange under section 62U.02 shall provide all health carriers with enrolled 
31.7 	employees of the employer with a copy of the employer's statement. The health carrier 
31.8 	may rely on the employer's statement and is not required to guarantee-issue individual 
31.9 	health plans to the employer's other current or future employees, except as required under 
31.10 	section 62U.03, subdivision 5, paragraph (b).

31.11 	Sec. 5. Minnesota Statutes 2006, section 62L.12, subdivision 4, is amended to read:
31.12 		Subd. 4.Employer prohibition. A small employer offering a health benefit plan 
31.13 	shall not encourage or direct an employee or applicant to:
31.14 	(1) refrain from filing an application for health coverage when other similarly 
31.15 	situated employees may file an application for health coverage;
31.16 	(2) file an application for health coverage during initial eligibility for coverage, 
31.17 	the acceptance of which is contingent on health status, when other similarly situated 
31.18 	employees may apply for health coverage, the acceptance of which is not contingent on 
31.19 	health status;
31.20 	(3) seek coverage from another health carrier, including, but not limited to, MCHA; 
31.21 	or
31.22 	(4) cause coverage to be issued on different terms because of the health status or 
31.23 	claims experience of that person or the person's dependents.

31.24 	Sec. 6. [62U.01] DEFINITIONS.
31.25 		Subdivision 1.Applicability. For purposes of this chapter, the terms defined in this 
31.26 	section have the meanings given, unless otherwise specified.
31.27 		Subd. 2.Advisory committee. "Advisory committee" means the Health Benefit Set 
31.28 	and Design Advisory Committee established in section 62U.055.
31.29 		Subd. 3.Clinically effective. "Clinically effective" means that the use of a 
31.30 	particular health technology improves patient clinical status, as measured by medical 
31.31 	condition, survival rates, and other variables, and that the use of the particular technology 
31.32 	demonstrates a clinical advantage over alternative technologies.
31.33 		Subd. 4.Commission. "Commission" means the Health Care Transformation 
31.34 	Commission established in section 62U.04.
32.1 		Subd. 5.Cost effective. "Cost effective" means that the economic costs of using 
32.2 	a particular service, device, or health technology to achieve improvement in a patient's 
32.3 	health outcome are justified given the comparison to both the economic costs and the 
32.4 	improvement in patient health outcome resulting from the use of an alternative service, 
32.5 	device, or technology, or from not providing the service, device, or technology.
32.6 		Subd. 6.Exchange. "Exchange" means the Minnesota Health Insurance Exchange 
32.7 	established in section 62U.02.
32.8 		Subd. 7.Health plan. "Health plan" means a health plan as defined in section 
32.9 	62A.011.
32.10 		Subd. 8.Health plan company. "Health plan company" has the meaning provided 
32.11 	in section 62Q.01, subdivision 4.
32.12 		Subd. 9.Health technology. "Health technology" means medical and surgical 
32.13 	devices and procedures, medical equipment, and diagnostic tests.
32.14 		Subd. 10.Section 125 Plan. "Section 125 Plan" means a cafeteria or premium-only 
32.15 	plan under section 125 of the Internal Revenue Code that allows employees to pay for 
32.16 	health insurance premiums with pretax dollars.
32.17 		Subd. 11.State health care program. "State health care program" means the 
32.18 	medical assistance, MinnesotaCare, and general assistance medical care programs.
32.19 		Subd. 12.Third-party administrators. "Third-party administrators" means a 
32.20 	vendor of risk-management services or an entity administering a self-insurance or health 
32.21 	insurance plan under section 60A.23.

32.22 	Sec. 7. [62U.02] MINNESOTA HEALTH INSURANCE EXCHANGE.
32.23 		Subdivision 1.Title; citation. This section may be cited as the "Minnesota Health 
32.24 	Insurance Exchange."
32.25 		Subd. 2.Creation; tax exemption. The Minnesota Health Insurance Exchange 
32.26 	is created for the limited purpose of providing individuals with greater access, choice, 
32.27 	portability, and affordability of health insurance products. The Minnesota Health 
32.28 	Insurance Exchange is created as an unincorporated association and shall promptly 
32.29 	incorporate as a nonprofit corporation under chapter 317A and apply for qualification 
32.30 	under section 501(c) of the Internal Revenue Code.
32.31 		Subd. 3.Definitions. For purposes of this section, the following terms have the 
32.32 	meanings given them.
32.33 	(a) "Board" means the Board of Directors of the Minnesota Health Insurance 
32.34 	Exchange under subdivision 13.
32.35 	(b) "Commissioner" means: 
33.1 	(1) the commissioner of commerce for health plan companies subject to the 
33.2 	jurisdiction of the Department of Commerce; 
33.3 	(2) the commissioner of health for health plan companies subject to the jurisdiction 
33.4 	of the Department of Health; or 
33.5 	(3) either commissioner's designated representative.
33.6 	(c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
33.7 	(d) "Individual market health plan" means a health plan as defined in section 
33.8 	62A.011, that is designed for sale in the individual market and that may cover either an 
33.9 	individual or an individual and the individual's dependents.
33.10 	(e) "Small employer" means a small employer as defined in section 62L.02, 
33.11 	subdivision 26.
33.12 	(f) "Small employer health benefit plan" means a health benefit plan as defined in 
33.13 	section 62L.02, subdivision 15.
33.14 		Subd. 4.Health plan company and health plan participation and availability.
 33.15 	(a) Only individual market health plans and small employer health benefit plans offered by 
33.16 	a health plan company licensed to issue health plans in Minnesota may be made available 
33.17 	for purchase through the exchange.
33.18 	(b) Each health plan made available by a health plan company through the exchange 
33.19 	must meet the minimum benefit set and design requirements provided under section 
33.20 	62U.04, subdivision 5.
33.21 	(c) Any health plan company that issues health plans in the individual or small 
33.22 	employer market in this state must offer through the exchange at least one health plan 
33.23 	that meets the benefit set and design established by the Health Care Transformation 
33.24 	Commission under section 62U.04.
33.25 	(d) Health plans offered through the Minnesota Comprehensive Health Association 
33.26 	as defined in section 62E.10 must be available for sale through the exchange as determined 
33.27 	by the Minnesota Comprehensive Health Association.
33.28 	(e) Health plans offered through the MinnesotaCare program must be available 
33.29 	through the exchange to individuals and families who meet the eligibility requirements 
33.30 	for MinnesotaCare, as determined by the commissioner of human services, and who pay 
33.31 	premiums through an employer Section 125 Plan.
33.32 	(f) Nothing in this section restricts the sale of individual market health plans and 
33.33 	small employer health benefit plans outside of the exchange. The requirements applicable 
33.34 	to issuance, renewal, cancellation, and pricing of coverage are the same for health plans 
33.35 	purchased inside and outside the exchange, except as described under section 62U.03, 
33.36 	subdivision 5, paragraph (b).
34.1 		Subd. 5.Comparison of health plans. The exchange shall help consumers 
34.2 	understand and compare the standardized health plan options established under section 
34.3 	62U.04. The exchange shall also make consumers aware of eligibility for premium 
34.4 	assistance under section 62U.09 based on the employer's contribution and the employee's 
34.5 	income. Within each standardized plan grouping, the exchange shall provide easy ways 
34.6 	for consumers to select among the offerings by comparing quality ratings, searching for 
34.7 	a particular provider in its network, or by cost factors. This information must be made 
34.8 	available via the Internet as well as by toll-free telephone assistance and written materials.
34.9 		Subd. 6.Individual participation and eligibility. (a) Individuals are eligible to 
34.10 	purchase health plans directly through the exchange or through an employer Section 
34.11 	125 Plan under section 62U.03.
34.12 	(b) Nothing in this section requires guaranteed issue of individual market health 
34.13 	plans offered through the exchange except as provided under section 62U.03, subdivision 
34.14 	5, paragraph (b).
34.15 	(c) Individuals are eligible to purchase individual market health plans through the 
34.16 	exchange by meeting one or more of the following qualifications:
34.17 	(1) the individual is a Minnesota resident, meaning the individual is physically 
34.18 	residing on a permanent basis in a place in this state that is the person's principal residence 
34.19 	and from which the person is absent only for temporary purposes;
34.20 	(2) the individual is a student attending an institution outside of Minnesota and 
34.21 	maintains Minnesota residency;
34.22 	(3) the individual is not a Minnesota resident but is employed by an employer 
34.23 	physically located within the state and the individual's employer is required to offer a 
34.24 	Section 125 Plan under section 62U.03; or
34.25 	(4) the individual is a dependent as defined in section 62L.02, of another individual 
34.26 	who is eligible to participate in the exchange.
34.27 	(d) A self-employed individual, including a partner of a partnership, a member of 
34.28 	a limited liability company, or other owner of a business, who may not be eligible to 
34.29 	participate in a Section 125 plan, may obtain coverage through the exchange either as an 
34.30 	individual under paragraph (c) or as an employee covered under a small employer health 
34.31 	benefit plan if permitted under chapter 62L.
34.32 		Subd. 7.Small employer participation and eligibility. Small employers, as 
34.33 	defined in section 62L.02, may purchase small employer health benefit plans through 
34.34 	the exchange.
34.35 		Subd. 8.Responsibilities of the exchange. The exchange may serve as a 
34.36 	coordinating entity for enrollment and collection and transfer of premium payments for 
35.1 	health plans sold to individuals and small employers through the exchange. The exchange 
35.2 	must be responsible for the following functions:
35.3 	(1) publicize the exchange, including, but not limited to, its functions, eligibility 
35.4 	rules, and enrollment procedures;
35.5 	(2) provide assistance to employers to establish Section 125 Plans under section 
35.6 	62U.03;
35.7 	(3) provide education and assistance to employers to help them understand the 
35.8 	requirements of Section 125 Plans and compliance with applicable regulations;
35.9 	(4) create a system to allow individuals to compare and enroll in health plans 
35.10 	offered through the exchange, including a system of comparative rating of health plans 
35.11 	and benefits set;
35.12 	(5) create a system to collect and transmit to the applicable health plan companies 
35.13 	all premium payments made by individuals and small employers, including developing 
35.14 	mechanisms to receive and process automatic payroll deductions for individuals who 
35.15 	purchase coverage through employer Section 125 Plans;
35.16 	(6) for participating employers, bill the employer for the premiums payable by the 
35.17 	employer for a small employer health benefit plan;
35.18 	(7) for individuals purchasing individual market health plans through a Section 125 
35.19 	Plan, bill the individual's employer for premiums payable by the employee, provided that 
35.20 	the employer is not liable for payment except from payroll deductions for that purpose;
35.21 	(8) provide information on public insurance programs to individuals who may 
35.22 	qualify for these programs, and provide application assistance if needed on applying 
35.23 	for these programs;
35.24 	(9) establish a mechanism with the Department of Human Services to transfer 
35.25 	premiums paid by Minnesota health care program enrollees from Section 125 Plans;
35.26 	(10) establish procedures to account for all funds received and disbursed by the 
35.27 	exchange; and
35.28 	(11) make available to the public, within 90 days after the end of each fiscal year, a 
35.29 	report of an independent audit of the exchange's accounts.
35.30 		Subd. 9.State not liable. The state of Minnesota is not liable for the actions of 
35.31 	the exchange.
35.32 		Subd. 10.Powers of the exchange. The exchange shall have the power to:
35.33 	(1) contract with insurance producers licensed in accident and health insurance 
35.34 	under chapter 60K and vendors to perform one or more of the functions specified in 
35.35 	subdivision 8;
36.1 	(2) contract with employers to collect premiums for small employer health benefit 
36.2 	plans and for individual market health plans purchased through a Section 125 Plan;
36.3 	(3) establish and assess fees on health plan premiums of small employer health 
36.4 	benefit plans and individual market health plans to fund the cost of administering the 
36.5 	exchange;
36.6 	(4) seek and directly receive grant funding from government agencies or private 
36.7 	philanthropic organizations, other than those connected with Minnesota-based nonprofit 
36.8 	health providers or health plan companies, to defray the costs of operating the exchange;
36.9 	(5) establish and administer rules and procedures governing the operations of the 
36.10 	exchange;
36.11 	(6) establish one or more service centers within Minnesota;
36.12 	(7) sue or be sued or otherwise take any necessary or proper legal action;
36.13 	(8) establish bank accounts and borrow money; and
36.14 	(9) enter into agreements with the commissioners of commerce, health, human 
36.15 	services, revenue, employment and economic development, and other state agencies as 
36.16 	necessary for the exchange to implement the provisions of this section.
36.17 		Subd. 11.Dispute resolution. The exchange shall establish procedures for 
36.18 	resolving disputes with respect to the eligibility of an individual to participate in the 
36.19 	exchange. The exchange shall not have the authority or responsibility to intervene in or 
36.20 	resolve disputes between an individual and a health plan or health plan company. If the 
36.21 	exchange receives complaints involving such disputes from individuals participating in 
36.22 	the exchange, the exchange shall inform the individual about the right to make such 
36.23 	complaints to the commissioner to be resolved according to sections 62Q.68 to 62Q.73.
36.24 		Subd. 12.Governance. The exchange shall be governed by a board of directors 
36.25 	with 11 members. The board shall convene on or before July 1, 2008, after the initial board 
36.26 	members have been selected. The initial board membership consists of the following:
36.27 	(1) the commissioner of commerce;
36.28 	(2) the commissioner of human services;
36.29 	(3) the commissioner of health; and
36.30 	(4) eight members with knowledge and experience related to health insurance 
36.31 	and health insurance markets, appointed to serve three-year terms as follows: two 
36.32 	nonlegislators appointed by the Subcommittee on Committees of the Committee on Rules 
36.33 	and Administration of the senate; two nonlegislators appointed by the speaker of the house 
36.34 	of representatives; and four members appointed by the governor.
36.35 		Subd. 13.Subsequent board membership. (a) Effective July 1, 2011, ongoing 
36.36 	membership of the exchange consists of the following:
37.1 	(1) the commissioner of commerce;
37.2 	(2) the commissioner of human services;
37.3 	(3) the commissioner of health;
37.4 	(4) two members appointed as follows: one nonlegislator appointed by the 
37.5 	Subcommittee on Committees of the Committee on Rules and Administration of the 
37.6 	senate; and one nonlegislator appointed by the speaker of the house of representatives to 
37.7 	serve two-year terms. These appointed members are eligible to be reappointed for one 
37.8 	additional term; and
37.9 	(5) four members elected by the membership of the exchange of which two are 
37.10 	elected to serve a two-year term and two are elected to serve a three-year term.
37.11 	(b) Elected members may serve more than one term. At least one of the elected 
37.12 	members must represent a small employer and at least one member must be a person who 
37.13 	purchases an individual market health plan through the exchange.
37.14 		Subd. 14.Operations of the board. Officers of the board of directors are elected by 
37.15 	members of the board and serve one-year terms. Six members of the board constitute a 
37.16 	quorum, and the affirmative vote of six members of the board is necessary and sufficient 
37.17 	for any action taken by the board. Board members serve without pay, but are reimbursed 
37.18 	for actual expenses incurred in the performance of their duties. Board meetings must be 
37.19 	open to the public, except as specified in the bylaws of the exchange.
37.20 		Subd. 15.Operations of the exchange. The board of directors shall appoint an 
37.21 	exchange director who shall:
37.22 	(1) be a full-time employee of the exchange;
37.23 	(2) administer all of the activities and contracts of the exchange; and 
37.24 	(3) hire and supervise the staff of the exchange.
37.25 		Subd. 16.Investment of assets. The exchange must certify to the State Board of 
37.26 	Investment that a portion of the assets of the exchange which, in the judgment of the 
37.27 	exchange director, are not required for immediate use. Investment earnings on assets 
37.28 	transferred to the State Board of Investment under this subdivision must be maintained in 
37.29 	an account in the state treasury. Money in the account may be spent, as appropriated by 
37.30 	law, for purposes related to assisting individuals in paying health insurance premiums, 
37.31 	and for making health insurance products more affordable.
37.32 		Subd. 17.Audit. The legislative auditor must audit the exchange, as provided in 
37.33 	sections 3.971 and 3.972.
37.34 		Subd. 18.Insurance producers. An individual has the right to choose any 
37.35 	insurance producer licensed in accident and health insurance under chapter 60K to assist 
37.36 	the individual in purchasing an individual market health plan through the exchange. When 
38.1 	a producer licensed in accident and health insurance under chapter 60K enrolls an eligible 
38.2 	individual in the exchange, the health plan company chosen by the individual may pay the 
38.3 	producer a commission.
38.4 		Subd. 19.Implementation. Health plan coverage through the exchange begins on 
38.5 	July 1, 2009. The exchange must be operational to assist employers and individuals by 
38.6 	January 1, 2009, and be prepared for enrollment by June 1, 2009.

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

38.8 	Sec. 8. [62U.03] SECTION 125 PLANS.
38.9 		Subdivision 1.Definitions. The following terms have the meanings given them.
38.10 	(a) "Current employee" means an employee currently on an employer's payroll other 
38.11 	than a retiree or disabled former employee.
38.12 	(b) "Employer" means a person, firm, corporation, partnership, association, business 
38.13 	trust, or other entity employing one or more persons, including a political subdivision of 
38.14 	the state, filing payroll tax information on such employed person or persons.
38.15 	(c) "Exchange" means the Minnesota Health Insurance Exchange in section 62U.02.
38.16 	(d) "Exchange director" means the appointed director under section 62U.02, 
38.17 	subdivision 15.
38.18 		Subd. 2.Section 125 Plan requirement. (a) Effective January 1, 2010, each 
38.19 	employer that has three or more current employees shall establish a Section 125 Plan to 
38.20 	either allow its employees to purchase individual market health plan coverage or allow 
38.21 	its employees to pay the employee's share of premiums for employer-based health plan 
38.22 	coverage with pretax dollars. Nothing in this section requires an employer to offer or 
38.23 	purchase group health insurance coverage for its employees. An employer that has no 
38.24 	employees who are eligible to participate in a Section 125 Plan is exempt from this 
38.25 	requirement.
38.26 	(b) An employer that offers a Section 125 Plan may enter into an agreement with the 
38.27 	exchange to administer the employer's Section 125 Plan.
38.28 		Subd. 3.Tracking compliance. By July 1, 2010, the exchange, in consultation with 
38.29 	the commissioners of commerce, health, employment and economic development, and 
38.30 	revenue shall establish a method for tracking employer compliance with the Section 125 
38.31 	Plan requirement.
38.32 		Subd. 4.Employer requirements. (a) Employers that do not offer a group health 
38.33 	insurance plan as defined in section 62A.10 and that are required to offer or choose 
38.34 	to offer a Section 125 Plan shall:
39.1 	(1) allow employees to purchase an individual market health plan for themselves 
39.2 	and their dependents;
39.3 	(2) allow employees to choose any insurance producer licensed in accident and health 
39.4 	insurance under chapter 60K to assist them in purchasing an individual market health plan;
39.5 	(3) upon an employee's request, deduct premium amounts on a pretax basis in an 
39.6 	amount not to exceed an employee's wages, and remit these employee payments to the 
39.7 	health plan company or the exchange; and
39.8 	(4) provide notice to employees that individual market health plans purchased 
39.9 	by employees through payroll deduction are not employer-sponsored or administered. 
39.10 	Employers shall be held harmless from any and all liability claims related to the individual 
39.11 	market health plans purchased by employees under a Section 125 Plan.
39.12 	(b) Employees earning less than $30,000 per year may choose to opt in to Section 
39.13 	125 plan participation after being provided, by their employer, information developed by 
39.14 	the exchange on the potential negative impact on their Social Security retirement benefits. 
39.15 	Employers may not in any way attempt to influence those employees in their decision on 
39.16 	whether or not to participate in the Section 125 plan pretax premium payment. Those not 
39.17 	choosing to opt in to Section 125 plan participation shall still remain eligible for premium 
39.18 	collection and payment via the exchange. This also applies to anyone who may not be 
39.19 	eligible for Section 125 plan benefits due to federal definitions of eligibility. Persons with 
39.20 	dependents who differ in their eligibility must have their participation in the Section 125 
39.21 	pretax benefit plan proportionately established.
39.22 		Subd. 5.Health plan company requirements. (a) Individuals who are eligible 
39.23 	to use an employer Section 125 Plan may use it to pay for an individual market health 
39.24 	plan for which the individual is eligible and purchase it through the exchange, including 
39.25 	an individual market health plan, MinnesotaCare, and the Minnesota Comprehensive 
39.26 	Health Association.
39.27 	(b) Individuals who purchase an individual market health plan through a Section 125 
39.28 	Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment 
39.29 	period that coincides with the open enrollment period for their employer's Section 125 
39.30 	Plan or upon experiencing a qualifying event as defined in United States Code, title 43, 
39.31 	section 4980B. Nothing in this section precludes a health plan company from issuing 
39.32 	coverage with preexisting condition limitations as allowed elsewhere in law. Health plans 
39.33 	may not charge higher or lower premiums based on health status for individuals who 
39.34 	purchase coverage on a guaranteed issue basis under this section, except for variations in 
39.35 	premium that are allowable based on tobacco use.

40.1 	Sec. 9. [62U.04] HEALTH CARE TRANSFORMATION COMMISSION.
40.2 		Subdivision 1.Creation. The Health Care Transformation Commission is created 
40.3 	for the purpose of coordinating the health care transformation activities within Minnesota.
40.4 		Subd. 2.Members. (a) The Health Care Transformation Commission shall consist 
40.5 	of ten members who are appointed as follows:
40.6 	(1) three nonlegislators appointed by the Subcommittee on Committees of the 
40.7 	Committee on Rules and Administration of the senate;
40.8 	(2) three nonlegislators appointed by the speaker of the house of representatives; and
40.9 	(3) four members appointed by the governor, two of whom shall be state 
40.10 	commissioners from the agencies listed in section 15.01.
40.11 	(b) The appointed members who are not commissioners must have expertise in 
40.12 	health care financing, health care delivery, health care quality improvement, health 
40.13 	economics, actuarial science, business operations, social services funded through medical 
40.14 	assistance and property tax resources, or be an informed consumer representative.
40.15 	(c) If a member is no longer able or eligible to perform the required duties, a new 
40.16 	member shall be appointed by the entity that appointed the outgoing member.
40.17 		Subd. 3.Operations of the commission. (a) The commission shall convene on or 
40.18 	before July 1, 2008, following the initial appointment of the members.
40.19 	(b) The commission shall elect a chair among its members.
40.20 	(c) The commission members shall not be compensated for commission activities 
40.21 	except for actual expenses incurred in the performance of their duties. Expenses shall be 
40.22 	compensated according to section 15.0575.
40.23 		Subd. 4.Immunity of liability. No member of the commission shall be held civilly 
40.24 	liable for an act or omission by that member if the act or omission was in good faith and 
40.25 	within the scope of the member's responsibilities under this chapter.
40.26 		Subd. 5.Responsibilities of the commission. The Health Care Transformation 
40.27 	Commission shall:
40.28 	(1) collect data from providers on health care prices and quality, including measures 
40.29 	of process, outcomes, and patient satisfaction, and publish comparative price and quality 
40.30 	information in a manner that is easily understandable and accessible to consumers;
40.31 	(2) develop a design and implementation plan for health care payment system reform 
40.32 	as required under sections 62U.11 and 62U.12;
40.33 	(3) establish a uniform definition for total cost of care for a patient group, including 
40.34 	risk adjustment mechanisms that address at least the following factors:
40.35 	(i) the health status of the individual in the year the individual enters the provider's 
40.36 	care;
41.1 	(ii) a worsening of the patient's health condition that was not reasonably preventable 
41.2 	by action that the provider could have taken;
41.3 	(iii) socioeconomic and cultural factors that bear directly on the cost of care; and
41.4 	(iv) the percentage of individuals served by the provider or care system whose care 
41.5 	is paid for by public health insurance programs;
41.6 	(4) provide education, technical assistance, and materials necessary for providers to 
41.7 	participate in the restructured payment system;
41.8 	(5) implement and administer the payment system reform;
41.9 	(6) make recommendations to the governor and legislature as to additional actions 
41.10 	that are needed in order to successfully achieve health care transformation in Minnesota;
41.11 	(7) consult and coordinate with the commissioners of health and human services, 
41.12 	health care providers, health plan companies, organizations that work to improve health 
41.13 	care quality in Minnesota, consumers, and employers;
41.14 	(8) convene a health technology advisory committee as required under section 
41.15 	62U.05;
41.16 	(9) establish a Uniform Outcome Measures Working Group and make 
41.17 	recommendations on community benefit standards, as required under article 3, section 
41.18 	1; and
41.19 	(10) carry out other duties assigned in this chapter and this act.
41.20 		Subd. 6.Powers of the commission. The commission shall have the power to:
41.21 	(1) advise the commissioner of human services to negotiate with the Centers for 
41.22 	Medicare and Medicaid Services and work with the Minnesota congressional delegation 
41.23 	to gain approval for any demonstration programs or changes in federal policy necessary to 
41.24 	enable transformation of Minnesota's health care system; and
41.25 	(2) contract with other organizations to carry out all or part of its responsibilities.
41.26 		Subd. 7.Rulemaking; exemption from administrative procedures. To carry 
41.27 	out the purposes of this section and sections 62U.05 and 62U.055, the commission may 
41.28 	adopt rules under chapter 14.
41.29 		Subd. 8.Standard benefit set and design. (a) Based on the recommendations 
41.30 	submitted by the Health Benefit Set and Design Advisory Committee, the commission 
41.31 	shall establish a standard benefit set and design by July 1, 2009.
41.32 	(b) The standard health benefit set and design must meet the requirements described 
41.33 	in section 62U.055.
41.34 	(c) Prior to establishing the standard benefit set and design, the commission shall 
41.35 	convene public hearings throughout the state.
42.1 		Subd. 9.Reports. Beginning January 15, 2010, and each January 15 thereafter, the 
42.2 	commission shall submit an annual report to the governor and legislature on the following:
42.3 	(1) the extent to which health care providers have reduced their costs and fees;
42.4 	(2) the extent to which costs and cost growth are likely to be maintained or reduced 
42.5 	in future years;
42.6 	(3) the extent to which the quality of health care services has improved;
42.7 	(4) the extent to which all Minnesotans have access to quality, affordable health 
42.8 	care; and
42.9 	(5) recommendations on additional actions that are needed in order to successfully 
42.10 	achieve health care transformation in Minnesota.
42.11 		Subd. 10.Expiration. The commission shall expire December 31, 2011. Upon 
42.12 	expiration, the duties of the commission shall transfer to the board of directors of the 
42.13 	Minnesota Health Insurance Exchange.

42.14 	Sec. 10. [62U.05] HEALTH TECHNOLOGY ASSESSMENT.
42.15 		Subdivision 1.Technology Advisory Committee. (a) The Health Care 
42.16 	Transformation Commission shall convene an advisory committee to make 
42.17 	recommendations to the commission regarding the inclusion of new and existing health 
42.18 	technologies to the standard benefit set and design.
42.19 	(b) The advisory committee shall be made up of 11 members appointed by the 
42.20 	commission, in consultation with the Institute for Clinical Systems Improvement, the 
42.21 	Health Services Advisory Council, and the University of Minnesota. The members shall 
42.22 	consist of:
42.23 	(1) six practicing physicians licensed under chapter 147; and
42.24 	(2) five other practicing health care professionals who use health technology in 
42.25 	their scope of practice.
42.26 	(c) No member of the advisory committee shall have a substantial financial interest 
42.27 	in a health technology company or be employed by or under contract with a health 
42.28 	technology manufacturer during their term or for 18 months before their appointment.
42.29 	(d) The members shall be immune from civil liability for any official acts performed 
42.30 	in good faith as members of the committee.
42.31 	(e) The advisory committee shall be governed under section 15.059, except that 
42.32 	the committee shall not expire. Upon the expiration of the Health Care Transformation 
42.33 	Commission, the Health Technology Assessment Committee shall continue to exist under 
42.34 	the oversight of the Minnesota Health Insurance Exchange.
43.1 		Subd. 2.Technology selection process. The commission, in consultation with the 
43.2 	advisory committee, shall select existing and new health technologies to be reviewed by 
43.3 	the committee. In making a selection, priority must be given to any technology for which:
43.4 	(1) there are concerns about its safety, efficacy, or cost effectiveness;
43.5 	(2) actual or expected expenditures are high due to demand for the technology, 
43.6 	its cost, or both; and
43.7 	(3) there is adequate evidence available to conduct a complete review.
43.8 		Subd. 3.Technology review. (a) Upon the selection of a health technology for 
43.9 	review, the committee shall contract for a systematic evidence-based assessment of 
43.10 	the technology's safety, efficacy, and cost effectiveness. The contract must be with an 
43.11 	evidence-based practice center designated as such by the federal agency for health care 
43.12 	research and quality, or another appropriate entity as designated by the commission.
43.13 	(b) The committee shall provide notification to the public when a health technology 
43.14 	has been selected for review. The notification must indicate when that review is to be 
43.15 	initiated and how an interested party may submit evidence or provide public comment for 
43.16 	consideration during the review.
43.17 		Subd. 4.Committee determination. (a) Upon reviewing the completed assessment 
43.18 	and any other evidence submitted regarding the safety, efficacy, and cost effectiveness of 
43.19 	the technology, the committee shall recommend to the commission:
43.20 	(1) the conditions, if any, under which the health technology should be included 
43.21 	as a covered benefit; and
43.22 	(2) if covered, the criteria to be used to decide whether the technology is medically 
43.23 	necessary, or proper and necessary treatment.
43.24 	(b) The commissioners of human services, employee relations, and corrections may 
43.25 	use the committee's recommendation in making coverage and reimbursement decisions, 
43.26 	unless the recommendation conflicts with an applicable federal statute or regulation.

43.27 	Sec. 11. [62U.055] STANDARD BENEFIT SET AND DESIGN.
43.28 		Subdivision 1.Creation. The Health Care Transformation Commission shall 
43.29 	convene a health benefit set and design advisory committee to make recommendations to 
43.30 	the commission on a standard benefit set and design. The advisory committee shall consist 
43.31 	of seven members. The members shall be appointed by the commission and must have 
43.32 	expertise in benefit design and development, actuarial analysis, or knowledge relating to 
43.33 	the analysis of the cost impact of coverage of specified benefits.
44.1 		Subd. 2.Operations of the committee. (a) The advisory committee shall convene 
44.2 	on or before September 1, 2008, upon the appointment of the initial committee and must 
44.3 	meet at least once a year, and at other times as necessary.
44.4 	(b) The commission shall provide office space, equipment and supplies, and 
44.5 	technical support to the committee.
44.6 	(c) The committee shall be governed by section 15.059, except the committee shall 
44.7 	not expire. Upon the expiration of the Health Care Transformation Commission, the 
44.8 	Health Benefit Set and Design Advisory Committee shall continue to exist under the 
44.9 	oversight of the Minnesota Health Insurance Exchange.
44.10 		Subd. 3.Immunity of liability. No member of the committee shall be held civilly 
44.11 	liable for an act or omission by that member if the act or omission was in good faith and 
44.12 	within the scope of the member's responsibilities under this chapter.
44.13 		Subd. 4.Duties of the committee. (a) By January 1, 2009, the committee shall 
44.14 	develop and submit to the commission a benefit set and design that provides individuals 
44.15 	access to a broad range of health care services, including preventive health care, without 
44.16 	incurring severe financial loss as a result of serious illness or injury. The benefit set 
44.17 	must include necessary health care services, procedures, and diagnostic tests that are 
44.18 	scientifically proven to be both clinically effective and cost effective. In establishing 
44.19 	the benefit set, the committee may contract with the Institute for Clinical Systems 
44.20 	Improvement (ICSI) to assemble existing scientifically based practice standards. The 
44.21 	committee shall consider cultural, ethnic, and religious values and beliefs to ensure that 
44.22 	the health care needs of all Minnesota residents will be addressed in the benefit set.
44.23 	(b) The benefit set must identify and include preventive services, chronic care 
44.24 	coordination services, and early diagnostic tests that, if included in the benefit set, with 
44.25 	minimal or no cost-sharing requirements, would result in savings that are equal to or 
44.26 	greater than the cost of providing the services.
44.27 	(c) The benefit set must include evidence-based outpatient care for asthma, heart 
44.28 	disease, diabetes, and depression with no cost-sharing requirements, or with minimal 
44.29 	cost-sharing requirements that would not impose an economic barrier to accessing the 
44.30 	care. The committee may consult with ICSI in identifying standards for care.
44.31 	(d) The benefit design must be used as a minimum requirement for health plans 
44.32 	offered throughout the exchange and be the only benefit plan eligible for premium 
44.33 	subsidies under section 62U.09. The benefit design must establish a limited number of 
44.34 	maximum cost-sharing variations based upon deductibles and maximum out-of-pocket 
44.35 	costs. There must be no maximum lifetime benefit.
45.1 		Subd. 5.Continued review. The committee shall review the benefit set and design 
45.2 	on an ongoing periodic basis and shall adjust the benefit set and design as necessary, to 
45.3 	ensure that the benefit set and design continues to be safe, effective, and scientifically 
45.4 	based.

45.5 	Sec. 12. [62U.06] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT 
45.6 	INDIVIDUAL RESPONSIBILITY REQUIREMENT.
45.7 		Subdivision 1.Phase-in goals. The state's phase-in goals for progress toward 
45.8 	universal health coverage for Minnesota residents are:
45.9 	(1) 94 percent insured by end of fiscal year 2009;
45.10 	(2) 96 percent insured by end of fiscal year 2011;
45.11 	(3) 97 percent insured by end of fiscal year 2012; and
45.12 	(4) 98 percent insured by end of fiscal year 2013 and thereafter.
45.13 		Subd. 2.Measurement of percent insured. The determination of the percent 
45.14 	of Minnesota residents insured must be based on an annual survey of the Minnesota 
45.15 	population younger than age 65 to be conducted or contracted for by the commissioner 
45.16 	of health which must include questions related to the type of insurance, amount of 
45.17 	cost-sharing, and potential barriers to public program enrollment.
45.18 		Subd. 3.Contingent individual responsibility requirement. (a) If the increased 
45.19 	affordability, cost containment, insurance reform, and voluntary efforts provided for 
45.20 	under this act fail to achieve universal coverage, an individual responsibility requirement 
45.21 	must have been proven to be necessary.
45.22 	(b) If any one of the phase-in goals specified in subdivision 1 for fiscal year 2011 or 
45.23 	later is not met, as determined by the commissioner of health, in spite of implementation 
45.24 	of the increased affordability, cost containment, insurance reform, and voluntary efforts 
45.25 	provided for under sections 62U.01 to 62U.09, an individual responsibility requirement, 
45.26 	requiring every Minnesota resident to obtain and maintain health coverage from a public 
45.27 	or private sector source of the person's choice, must become effective 12 months after the 
45.28 	end of that fiscal year, provided that the commissioner certifies that health plans that meet 
45.29 	the affordability standard under section 62U.08 are available to Minnesotans.
45.30 	(c) Failure to comply with the individual responsibility requirement is not a crime, 
45.31 	but must subject the person to a financial penalty to be specified in law.

45.32 	Sec. 13. [62U.07] SAVINGS RECAPTURE ASSESSMENT.
45.33 		Subdivision 1.Projected spending baseline. (a) The commissioner of health shall 
45.34 	calculate the annual projected total health care spending for the state and establish a health 
46.1 	care spending baseline beginning for the year 2008 and for the next five years based on 
46.2 	the annual projected growth in spending.
46.3 	(b) In establishing the health care spending baseline, the commissioner shall use 
46.4 	the Center of Medicare and Medicaid Services forecast for total growth in national health 
46.5 	care expenditures, and adjust this forecast to reflect the demographics, health status, and 
46.6 	other factors deemed necessary by the commissioner. The commissioner shall contract 
46.7 	with an actuarial consultant to make recommendations as to the adjustments needed to 
46.8 	specifically reflect projected spending for Minnesota residents.
46.9 	(c) The commissioner may adjust the projected baseline as necessary to reflect any 
46.10 	updated federal projections or account for unanticipated changes in federal policy.
46.11 		Subd. 2.Actual spending. (a) By February 15 of each year, beginning February 15, 
46.12 	2010, the commissioner shall determine the actual private and public health care spending 
46.13 	for the calendar year preceding the current calendar year and shall determine the difference 
46.14 	between the projected spending as determined under subdivision 1 and the actual spending 
46.15 	for that year. The actual spending must be certified by an independent actuarial consultant. 
46.16 	If the actual spending is less than the projected spending, the commissioner shall 
46.17 	determine an aggregate savings offset amount not to exceed 40 percent of the difference. 
46.18 	(b) Based on this calculation, the commissioner shall determine annually a savings 
46.19 	offset amount to be paid by health plan companies and third-party administrators. The 
46.20 	aggregate savings offset amount may not exceed 40 percent of the aggregate savings 
46.21 	reflected in the difference between the actual spending and the projected spending.
46.22 		Subd. 3.Publication of spending. By February 15 of each year, beginning February 
46.23 	15, 2010, the commissioner shall publish in the State Register the projected spending 
46.24 	baseline, including any adjustments, and the actual spending for the preceding year.
46.25 		Subd. 4.Savings offset assessments. (a) Each health plan company and third-party 
46.26 	administrator shall pay a savings offset assessment. The commissioner shall calculate the 
46.27 	savings offset assessments as a percentage of paid claims as follows:
46.28 	(1) for health plan companies, the savings offset assessment may not exceed four 
46.29 	percent of annual paid health care claims on policies that insure residents of this state; and
46.30 	(2) for third-party administrators, the savings offset assessment may not exceed four 
46.31 	percent of annual paid claims for health care for residents of this state.
46.32 	(b) A health plan company may not be required to pay a savings offset assessment 
46.33 	on policies or contracts insuring federal employees.
46.34 	(c) Savings offset assessments apply to claims paid for plan years beginning on 
46.35 	or after January 1, 2010.
47.1 	(d) Savings offset assessments must be made quarterly to the commissioner of 
47.2 	revenue within 60 days of the close of each quarter, beginning April 15, 2010.
47.3 		Subd. 5.Deposit of assessments. The commissioner of revenue shall deposit the 
47.4 	revenue derived from the assessments into the health care access fund.

47.5 	Sec. 14. [62U.08] AFFORDABILITY STANDARD.
47.6 		Subdivision 1.Definition of affordability. For purposes of this section, coverage is 
47.7 	"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an 
47.8 	individual or family for health coverage does not exceed the applicable percentage of the 
47.9 	individual or family's gross monthly income specified in subdivision 2.
47.10 		Subd. 2.Affordability standard. The following affordability standard is 
47.11 	established for individuals and households with gross family incomes of 400 percent 
47.12 	of the federal poverty guidelines or less:

47.13	AFFORDABILITY STANDARD

47.14
47.15		Federal Poverty 
Guideline Range
		Percent of Average Gross 
Monthly Income
		
47.16		0-33% 
			minimum
			
47.17		33-54%
			1.1%
			
47.18		55-81%
			1.2%
			
47.19		82-109%
			1.6%
			
47.20		110-136%
			2.4%
			
47.21		137-164%
			2.9%
			
47.22		165-191%
			3.9%
			
47.23		192-219%
			4.6%
			
47.24		220-248%
			5.4%
			
47.25		248-274%
			6.0%
			
47.26		275-300%
			6.0%
			
47.27		301-324%
			6.5%
			
47.28		325-349%
			7.2%
			
47.29		350-374%
			7.8%
			
47.30		375-400%
			8.0%

47.31 	Sec. 15. [62U.09] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED 
47.32 	HEALTH COVERAGE.
47.33 		Subdivision 1.Establishment of subsidy program. The commissioner of human 
47.34 	services shall establish a subsidy program for eligible employees and dependents 
47.35 	with access to employer-subsidized health coverage. For purposes of this section, 
48.1 	employer-subsidized health coverage has the meaning provided in section 256L.07, 
48.2 	subdivision 2, paragraph (c).
48.3 		Subd. 2.Eligible employees and dependents. In order to be eligible for a subsidy 
48.4 	under this section, an employee or dependent shall:
48.5 	(1) be covered by employer-subsidized health coverage that meets the benefits set 
48.6 	and design requirements established under section 62U.04 and is purchased through the 
48.7 	Health Insurance Exchange established under section 62U.02; and
48.8 	(2) meet all eligibility criteria for the MinnesotaCare program established under 
48.9 	chapter 256L, except for the requirements related to:
48.10 	(i) no access to employer-subsidized coverage under section 256L.07, subdivision 
48.11 	2; and
48.12 	(ii) no other health coverage under section 256L.07, subdivision 3.
48.13 		Subd. 3.Amount of subsidy. The subsidy must equal the amount the employee 
48.14 	is required to pay for health coverage for the employee and any dependents, including 
48.15 	premiums, deductibles, and other cost sharing, minus an amount based on the affordability 
48.16 	standard specified in section 62U.08. The maximum subsidy must not exceed the amount 
48.17 	of the subsidy that would have been provided under the MinnesotaCare program, if the 
48.18 	employee and any dependents were eligible for that program.
48.19 		Subd. 4.Payment of subsidy. The commissioner shall pay the subsidy amount 
48.20 	for an employee and any dependents to the Minnesota Health Insurance Exchange, and 
48.21 	this payment shall be credited toward the employee's share of premium. Any additional 
48.22 	amount paid by the commissioner to the Minnesota Health Insurance Exchange that 
48.23 	exceeds the employee's share of premium must be credited first toward the employee 
48.24 	deductible and then toward any employee cost-sharing obligation.

48.25 	EFFECTIVE DATE. This section is effective July 1, 2010.

48.26 	Sec. 16. [62U.11] PAYMENT RESTRUCTURING; PAYMENTS BASED ON 
48.27 	QUALITY AND EFFICIENCY OF CARE.
48.28 		Subdivision 1.Development. By January 15, 2009, the Health Care Transformation 
48.29 	Commission shall report to the legislature in the manner specified in section 3.195 on rules 
48.30 	to implement a payment system that links the level of payments to providers to the quality 
48.31 	and efficiency of care. The payment system must incorporate payments to primary care 
48.32 	physicians, specialty care physicians, health care clinics, hospitals, and other providers 
48.33 	who provide services included in the evidence-based benefit set and design developed 
48.34 	under section 62U.04. Before January 1, 2010, the commission must adopt rules necessary 
48.35 	to implement this payment system.
49.1 		Subd. 2.Payment system criteria. The payment system must meet the following 
49.2 	criteria:
49.3 	(1) providers meeting specified targets, or who demonstrate a significant amount of 
49.4 	improvement over time, must be eligible for quality and efficiency-based payments that 
49.5 	are in addition to existing payment levels;
49.6 	(2) priority must be placed on measures of health care outcomes, rather than process 
49.7 	measures, wherever possible;
49.8 	(3) quality measures for primary care providers must focus on preventive services, 
49.9 	coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary 
49.10 	disease, depression, and other conditions or procedures for which, in the determination of 
49.11 	the commission, improved outcomes will lead to significant cost savings;
49.12 	(4) quality measures for specialty care must be designated by the commission, and 
49.13 	initially based on quality indicators measured and reported publicly by specialty societies;
49.14 	(5) hospital payments must be adjusted for quality and efficiency using existing 
49.15 	measures where available, which focus on health conditions or procedures for which, in 
49.16 	the determination of the commission, improved outcomes will lead to significant cost 
49.17 	savings; and
49.18 	(6) other indicators of care quality and efficiency must be incorporated where 
49.19 	appropriate. These indicators may include care infrastructure, collection and reporting of 
49.20 	results, measures of efficiency for specific procedures, and measures of overall cost of 
49.21 	care for individuals.
49.22 		Subd. 3.Uniform measures required. Once the payment system required by this 
49.23 	section is established, health plan companies shall not require providers to use and report 
49.24 	health plan company-specific quality and outcome measures.
49.25 		Subd. 4.Implementation. (a) By January 1, 2010, the commissioner of human 
49.26 	services shall implement this payment system for all state health care program enrollees 
49.27 	served under fee-for-service, and shall require demonstration providers serving state health 
49.28 	care program enrollees to implement this payment system by January 1, 2010, for all state 
49.29 	health care program enrollees served under managed care and county-based purchasing.
49.30 	(b) By January 1, 2010, the commissioner of employee relations shall implement 
49.31 	this payment system for all participants in the State Employee Group Insurance Program.
49.32 	(c) By January 1, 2010, all health plan companies shall implement this payment 
49.33 	system for all participating providers.

49.34 	Sec. 17. [62U.12] PAYMENT RESTRUCTURING; CARE COORDINATION 
49.35 	PAYMENTS FOR HEALTH CARE HOMES.
50.1 		Subdivision 1.Development. The Health Care Transformation Commission, 
50.2 	in cooperation with the commissioners of health and human services, shall develop a 
50.3 	payment system that provides care coordination payments to health care providers. 
50.4 	In order to be eligible for a care coordination payment, a health care provider must be 
50.5 	certified as a health care home by the commissioners of human services and health based 
50.6 	on the certification standards for health care homes established under section 256B.0754.
50.7 		Subd. 2.Care coordination fee. (a) Under the payment system, health care homes 
50.8 	must receive a per-person per-month care coordination fee for providing care coordination 
50.9 	services and employing care coordinators, as specified in section 256B.0752, subdivisions 
50.10 	3 and 7.
50.11 	(b) The care coordination fee must not exceed an average of $50 per-person 
50.12 	per-month. The care coordination fee must be determined by the commission, and must 
50.13 	vary by thresholds of care complexity, with the highest fees being paid for care provided 
50.14 	to individuals requiring the most intensive care coordination, such as those with very 
50.15 	complex health care needs or several chronic conditions.
50.16 	(c) In setting care coordination fees, the commission shall consider the additional 
50.17 	time and resources needed by patients with limited English-language skills, cultural 
50.18 	differences, or other barriers to health care.
50.19 	(d) Care coordination fees must be phased in, and must be applied first to persons 
50.20 	who have, or are at risk of developing, complex or chronic health conditions.
50.21 		Subd. 3.Quality and efficiency-based payments. The quality and efficiency-based 
50.22 	payments under section 62U.11, when established, must also be included in the care 
50.23 	coordination payment system. Providers whose quality or efficiency does not allow them 
50.24 	to qualify for payments under section 62U.11 are not eligible to receive care coordination 
50.25 	fees.
50.26 		Subd. 4.Implementation. (a) By July 1, 2009, the commissioner of human 
50.27 	services shall implement this payment system for all state health care program enrollees 
50.28 	served under fee-for-service as provided under section 256B.0753 and shall require 
50.29 	demonstration providers serving state health care program enrollees to implement this 
50.30 	payment system by July 1, 2009, for all state health care program enrollees served under 
50.31 	managed care and county-based purchasing.
50.32 	(b) By July 1, 2009, the commissioner of employee relations shall implement this 
50.33 	payment system for all participants in the State Employee Group Insurance Program.
50.34 	(c) By July 1, 2009, all health plan companies shall implement this payment system 
50.35 	for all participating providers.

51.1 	Sec. 18. [62U.13] COORDINATION WITH THE PRIVATE SECTOR.
51.2 	In developing the payment systems required under sections 62U.11 and 62U.12, 
51.3 	the Health Care Transformation Commission shall consult and coordinate with the 
51.4 	commissioners of human services and health, organizations that work to improve health 
51.5 	care quality in Minnesota, health care providers, health plan companies, consumers, and 
51.6 	employers and other payors. The commissioners shall publicize and promote the payment 
51.7 	systems required under sections 62U.11 and 62U.12, and shall make technical assistance 
51.8 	available to entities adopting the payment systems.

51.9 	Sec. 19. Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision 
51.10 	to read:
51.11 		Subd. 28.Exchange of data. An entity that is part of the welfare system as defined 
51.12 	in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance 
51.13 	Exchange under section 62U.02 may exchange private data about individuals without 
51.14 	the individual's consent in order to collect premiums from individuals in the medical 
51.15 	assistance employed persons with disabilities program and the MinnesotaCare program 
51.16 	under chapters 256B and 256L. This subdivision only applies if the entity that is part of 
51.17 	the welfare system and the Minnesota Health Insurance Exchange have entered into an 
51.18 	agreement that complies with the requirements in Code of Federal Regulations, title 
51.19 	45, section 164.314.

51.20 	Sec. 20. AMENDMENTS TO CURRENT HEALTH BENEFIT SETS.
 51.21 	The commissioners of health, commerce, and employee relations shall report to the 
51.22 	legislature under Minnesota Statutes, section 3.195, on necessary changes to current 
51.23 	mandated benefit sets to align these with the standard benefit set and design developed by 
51.24 	the Health Care Transformation Commission established in Minnesota Statutes, section 
51.25 	62U.04.

51.26 	Sec. 21. RISK SHARING.
 51.27 	The Risk Sharing Advisory Council shall review Minnesota Comprehensive Health 
51.28 	Association financing and whether the affordability needs of persons with health problems 
51.29 	can be addressed through guaranteed issue, with no premium penalty for health history 
51.30 	and not allowing preexisting condition limitations. This must include assessing whether 
51.31 	stability of the insurance market could be managed through risk sharing that transfers funds 
51.32 	between health plan companies. The goal is to discontinue Minnesota Comprehensive 
51.33 	Health Association assessment and replace it with a broader and fairer funding mechanism, 
52.1 	preferably one that does not involve a fee-based mechanism. The council shall make 
52.2 	recommendations to the Legislative Commission on Health Care Access by November 
52.3 	1, 2009. The Risk Sharing Advisory Council shall include representatives of insurance 
52.4 	companies, the Minnesota Comprehensive Health Association's board of directors, safety 
52.5 	net providers, and consumer representatives. It shall be convened by the commissioner of 
52.6 	commerce with staffing from that agency and the Minnesota Department of Health.

52.7 	Sec. 22. APPROPRIATION.
 52.8 	$....... is appropriated in fiscal year 2009 from the health care access fund to the 
52.9 	Health Care Transformation Commission. This is a onetime appropriation.