1.1 	A bill for an act
1.2 	relating to health care; establishing a statewide health improvement program; 
1.3 	establishing health care homes and reporting requirements; establishing a care 
1.4 	coordination payment; increasing reimbursements to primary care physicians in 
1.5 	certain areas; requiring a workforce shortage study; establishing requirements for 
1.6 	interoperable health records; establishing electronic prescription drug program; 
1.7 	establishing a value-based benefit set and design for health benefits; providing for 
1.8 	health care payment restructuring; requiring uniform standards; establishing an 
1.9 	affordability standard; requiring development of employee subsidies for health 
1.10 	coverage; requiring a health care spending baseline be developed; establishing a 
1.11 	health care reform review council; establishing Section 125 Plan; providing for 
1.12 	fees; requiring reports; authorizing rulemaking; appropriating money;amending 
1.13 	Minnesota Statutes 2006, sections 256.01, by adding a subdivision; 256B.057, 
1.14 	subdivision 8; 256L.05, by adding a subdivision; 256L.06, subdivision 3; 
1.15 	256L.07, subdivision 3; Minnesota Statutes 2007 Supplement, sections 62J.495, 
1.16 	by adding a subdivision; 256.962, subdivisions 5, 6; 256L.04, subdivisions 1, 
1.17 	7; 256L.05, subdivision 3a; 256L.07, subdivision 1; 256L.15, subdivision 2; 
1.18 	Laws 2007, chapter 147, article 5, section 19; proposing coding for new law in 
1.19 	Minnesota Statutes, chapters 62J; 124D; 145; 256B; proposing coding for new 
1.20 	law as Minnesota Statutes, chapter 62U; repealing Minnesota Statutes 2006, 
1.21 	section 256L.15, subdivision 3.
1.22 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.23 	ARTICLE 1
1.24 	PUBLIC HEALTH

1.25 	Section 1. [145.986] STATEWIDE HEALTH IMPROVEMENT PROGRAM.
1.26 		Subdivision 1.Goals. It is the goal of the state to substantially reduce the percentage 
1.27 	of Minnesotans who are obese or overweight, and to reduce the use of tobacco.
1.28 		Subd. 2.Grants to local communities. (a) Beginning July 1, 2009, the 
1.29 	commissioner of health shall award grants to community health boards established 
1.30 	pursuant to section 145A.09, and tribal governments to convene, coordinate, and 
2.1 	implement evidence-based strategies targeted at reducing the percentage of Minnesotans 
2.2 	who are obese or overweight and to reduce the use of tobacco.
2.3 	(b) Grantee activities shall:
2.4 	(1) be based on scientific evidence;
2.5 	(2) be based on community input;
2.6 	(3) address behavior change at the individual, community, and systems levels;
2.7 	(4) occur in community, school, worksite, and health care settings; and
2.8 	(5) be focused on policy, systems, and environmental changes that support healthy 
2.9 	behaviors.
2.10 	(c) To receive a grant under this section, community health boards and tribal 
2.11 	governments must submit proposals to the commissioner. A local match of ten percent 
2.12 	of the total funding allocation is required. This local match may include funds donated 
2.13 	by community partners.
2.14 	(d) In order to receive a grant, community health boards and tribal governments 
2.15 	must submit a health improvement plan to the commissioner of health for approval. The 
2.16 	commissioner may require the plan to identify a community leadership team, community 
2.17 	partners, and a community action plan that includes an assessment of area strengths and 
2.18 	needs, proposed action strategies, technical assistance needs, and a staffing plan.
2.19 	(e) The grant recipient must implement the health improvement plan, evaluate the 
2.20 	effectiveness of the interventions, and modify or discontinue interventions found to be 
2.21 	ineffective.
2.22 	(f) Grant recipients shall receive the standard base amount and a standard per capita 
2.23 	amount to be established by the commissioner. 
2.24 	(g) By January 15, 2011, the commissioner of health shall recommend whether any 
2.25 	funding should be distributed to community health boards and tribal governments based 
2.26 	on health disparities demonstrated in the populations served.
2.27 	(h) Grant recipients shall report their activities and their progress towards the 
2.28 	outcomes established under subdivision 3 to the commissioner in a format and at a time 
2.29 	specified by the commissioner.
2.30 	(i) All grant recipients shall be held accountable for making progress toward the 
2.31 	measurable outcomes established in subdivision 3. The commissioner shall require a 
2.32 	corrective action plan and may reduce the funding level of grant recipients that do not 
2.33 	make adequate progress toward the measurable outcomes.
2.34 		Subd. 3.Outcomes. (a) The commissioner shall set measurable outcomes to meet 
2.35 	the goals specified in subdivision 1, and annually review the progress of grant recipients 
2.36 	in meeting the outcomes.
3.1 	(b) The commissioner shall measure current public health status, using existing 
3.2 	measures and data collection systems when available, to determine baseline data against 
3.3 	which progress shall be monitored.
3.4 		Subd. 4.Technical assistance and oversight. The commissioner shall provide 
3.5 	content expertise, technical expertise, and training to grant recipients and advice on 
3.6 	evidence-based strategies, including those based on populations and types of communities 
3.7 	served. The commissioner shall ensure that the statewide health improvement program 
3.8 	meets the outcomes established under subdivision 3 by conducting a comprehensive 
3.9 	statewide evaluation and assisting grant recipients to modify or discontinue interventions 
3.10 	found to be ineffective.
3.11 		Subd. 5.Evaluation. Using the outcome measures established in subdivision 3, the 
3.12 	commissioner shall conduct a biennial evaluation of the statewide health improvement 
3.13 	program funded under this section. Grant recipients shall cooperate with the commissioner 
3.14 	in the evaluation and provide the commissioner with the information necessary to conduct 
3.15 	the evaluation.
3.16 		Subd. 6.Report. The commissioner shall submit a biennial report to the legislature 
3.17 	on the statewide health improvement program funded under this section. These reports 
3.18 	must include information on grant recipients, activities that were conducted using grant 
3.19 	funds, evaluation data, and outcome measures, if available. In addition, the commissioner 
3.20 	shall provide recommendations on future areas of focus for health improvement. These 
3.21 	reports are due by January 15 of every other year, beginning in 2010. In the report due 
3.22 	on January 15, 2010, the commissioner shall include recommendations on a sustainable 
3.23 	funding source for the statewide health improvement program other than the health care 
3.24 	access fund.
3.25 		Subd. 7.Supplantation of existing funds. Community health boards and tribal 
3.26 	governments must use funds received under this section to develop new programs, expand 
3.27 	current programs that work to reduce the percentage of Minnesotans who are obese or 
3.28 	overweight, or who use tobacco, or replace discontinued state or federal funds previously 
3.29 	used to reduce the percentage of Minnesotans who are obese or overweight, or who use 
3.30 	tobacco. Funds must not be used to supplant current state or local funding to community 
3.31 	health boards or tribal governments used to reduce the percentage of Minnesotans who are 
3.32 	obese or overweight or to reduce tobacco use.

3.33 	ARTICLE 2
3.34 	HEALTH CARE HOMES

3.35 	Section 1. [256B.0751] HEALTH CARE HOMES.
4.1 		Subdivision 1.Definitions. (a) For purposes of sections 256B.0751 to 256B.0753, 
4.2 	the following definitions apply.
4.3 	(b) "Commissioner" means the commissioner of human services.
4.4 	(c) "Commissioners" means the commissioner of humans services and the 
4.5 	commissioner of health, acting jointly.
4.6 	(d) "Health plan company" has the meaning provided in section 62Q.01, subdivision 
4.7 	4.
4.8 	(e) "Personal clinician" means a physician licensed under chapter 147, a physician 
4.9 	assistant registered and practicing under chapter 147A, an advanced practice nurse 
4.10 	licensed and registered to practice under chapter 148, and other health care providers as 
4.11 	determined by the commissioner of health.
4.12 	(f) "State health care program" means the medical assistance, MinnesotaCare, and 
4.13 	general assistance medical care programs.
4.14 		Subd. 2.Development and implementation of standards. (a) By July 1, 2009, 
4.15 	the commissioners of health and human services shall develop and implement standards 
4.16 	of certification for health care homes for state health care programs. In developing these 
4.17 	standards, the commissioners shall consider existing standards developed by national 
4.18 	independent accrediting and medical home organizations. The standards developed by the 
4.19 	commissioners must meet the following criteria:
4.20 	(1) emphasize, enhance, and encourage the use of primary care, and include the 
4.21 	use of primary care physicians, advanced practice nurses, and physician assistants as 
4.22 	personal clinicians, as well as appropriate specialists if they provide care according 
4.23 	to these standards;
4.24 	(2) focus on delivering high-quality, efficient, and effective health care services, 
4.25 	enhancing the experience of patients and their families, and appropriately engaging 
4.26 	patients and their families in the decision-making process;
4.27 	(3) encourage patient-centered care, including active participation by the patient and 
4.28 	family or a legal guardian, or a health care agent as defined in chapter 145C, as appropriate 
4.29 	in decision making, care plan development, and include patient representation on practice 
4.30 	level quality improvement teams;
4.31 	(4) provide patients with a consistent, ongoing contact with a personal clinician to 
4.32 	ensure continuous and appropriate care for the patient's condition;
4.33 	(5) ensure that health care homes develop and maintain appropriate comprehensive 
4.34 	care plans for their patients with complex or chronic conditions, including the provision 
4.35 	of an initial health assessment in order to identify all of the patient's complex or chronic 
4.36 	health conditions;
5.1 	(6) enable and encourage utilization of a range of qualified health care professionals 
5.2 	to provide care, including dedicated care coordinators, in a manner that enables providers 
5.3 	to practice to the fullest extent of their license;
5.4 	(7) focus initially on patients who have or are at risk of developing chronic health 
5.5 	conditions;
5.6 	(8) provide care that is appropriate to the patient's race, ethnicity, and language;
5.7 	(9) incorporate measures of quality and cost of care;
5.8 	(10) ensure the use of health information technology and systematic follow-up 
5.9 	through the use of patient registries; and
5.10 	(11) encourage the use of evidence-based health care, patient decision-making 
5.11 	aids that provide patients with information about treatment options and their associated 
5.12 	benefits, risks, costs, and comparative outcomes, and other clinical decision support tools.
5.13 	(b) In developing these standards, the commissioners shall consult with national 
5.14 	and local organizations working on health care home models, health care providers, 
5.15 	relevant state agencies, health plans, and hospitals. The commissioners may satisfy this 
5.16 	requirement by continuing the provider directed care coordination advisory committee.
5.17 	(c) For the purposes of developing and implementing these standards, the 
5.18 	commissioners are exempt from the provisions of chapter 14, including the specific 
5.19 	provisions in section 14.386.
5.20 		Subd. 3.Requirements for clinicians certified as health care homes. (a) A 
5.21 	personal clinician or a primary care clinic may be certified as a health care home. If a 
5.22 	primary care clinic is certified, all of the primary care clinics' clinicians must meet the 
5.23 	criteria of a health care home. In order to be certified as a health care home, a clinician or 
5.24 	clinic must meet the standards set by the commissioners in accordance with this section. 
5.25 	Certification as a health care home is voluntary. In order to maintain their status as health 
5.26 	care homes, clinicians or clinics must renew their certification annually.
5.27 	(b) Clinicians or clinics certified as health care homes must offer their health care 
5.28 	home services to all their patients with complex or chronic health conditions who are 
5.29 	interested in participation.
5.30 	(c) Health care homes must participate in the health care home learning collaborative 
5.31 	established under subdivision 5.
5.32 		Subd. 4.Alternative models. Nothing in this section shall preclude the continued 
5.33 	development of existing medical or health care home projects currently operating or under 
5.34 	development by the commissioner of human services or preclude the commissioner from 
5.35 	establishing alternative models and payment mechanisms for persons who are enrolled 
5.36 	in integrated Medicare and Medicaid programs under section 256B.69, subdivisions 23 
6.1 	and 28, are enrolled in managed care long-term care programs under section 256B.69, 
6.2 	subdivision 6, paragraph (b), are dually eligible for Medicare and medical assistance, are 
6.3 	in the waiting period for Medicare, or who have other primary coverage.
6.4 		Subd. 5.Health care home collaborative. By July 1, 2009, the commissioners 
6.5 	shall establish a health care home collaborative to provide an opportunity for health care 
6.6 	homes and state agencies to exchange information related to quality improvement and 
6.7 	best practices.
6.8 		Subd. 6.Evaluation and continued development. (a) For continued certification 
6.9 	under this section, health care homes must meet process, outcome, and quality standards as 
6.10 	developed and specified by the commissioners. The commissioners shall collect data from 
6.11 	health care homes necessary for monitoring compliance with certification standards and 
6.12 	for evaluating the impact of health care homes on health care quality, cost, and outcomes. 
6.13 	(b) The commissioners may contract with a private entity to perform an evaluation of 
6.14 	the effectiveness of health care homes. Data collected under this subdivision is classified 
6.15 	as nonpublic data under chapter 13.
6.16 		Subd. 7.Outreach. Upon implementation of the certification process and standards 
6.17 	under subdivision 1, the commissioner shall encourage state health care program enrollees 
6.18 	who have a complex or chronic condition to select a primary care clinic with clinicians 
6.19 	who have been certified as health care homes.

6.20 	Sec. 2. [256B.0752] CARE COORDINATION FEE.
6.21 		Subdivision 1.Development. The commissioner of human services shall develop 
6.22 	a payment system that provides per-person care coordination payments to health care 
6.23 	providers for providing care coordination services and directly managing onsite or 
6.24 	employing care coordinators. In order to be eligible for a care coordination payment, a 
6.25 	health care provider must be certified as a health care home by the commissioners of 
6.26 	human services and health based on the certification standards for health care homes 
6.27 	established under section 256B.0751. The care coordination payment system must vary 
6.28 	the fees paid by thresholds of care complexity, with the highest fees being paid for care 
6.29 	provided to individuals requiring the most intensive care coordination and those who face 
6.30 	racial, ethnic, or language barriers. The commissioner may determine a schedule for 
6.31 	phasing-in care coordination fees such that the fees will be applied first to individuals who 
6.32 	have, or are at risk of developing, complex or chronic health conditions and coordinate 
6.33 	with the implementation of the provider-directed care coordination payments under 
6.34 	section 256B.0625, subdivision 51. Development of the payment system must be 
6.35 	completed by January 1, 2010.
7.1 		Subd. 2.Payment of care coordination fee.  By July 1, 2010, the commissioner of 
7.2 	human services shall pay each certified health care home a per-person care coordination 
7.3 	fee for providing care coordination services for each state health care program enrollee 
7.4 	served under the fee-for-service system.  The care coordination fee must be determined 
7.5 	by the commissioner in contracts with certified health care homes.  Payment of the care 
7.6 	coordination fee is contingent on the health care home meeting the certification standards 
7.7 	for health care homes described in section 256B.0751. The care coordination fee is in 
7.8 	addition to reimbursement received by a health care home under the medical assistance 
7.9 	fee-for-service payment system for health care services.
7.10 		Subd. 3.Managed care and county-based purchasing. By July 1, 2010, the 
7.11 	commissioner of human services shall require managed care and county-based purchasing 
7.12 	plans serving state health care program enrollees under sections 256B.69 and 256B.692, 
7.13 	and chapters 256D and 256L to implement a care coordination payment system for state 
7.14 	health care program enrollees who are provided care coordination services in health care 
7.15 	homes certified under section 256B.0751.  The payment system shall be designed in 
7.16 	accordance with section 62U.05.
7.17 		Subd. 4.Cost neutrality. If initial savings from implementation of health care 
7.18 	homes are not sufficient to allow implementation of the care coordination fee in a 
7.19 	cost-neutral manner, the commissioner may make recommendations to the legislature on 
7.20 	reallocating costs within the health care system.

7.21 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
7.22 	approval, whichever is later.

7.23 	Sec. 3. [256B.0753] HEALTH CARE HOME REPORTING REQUIREMENTS.
7.24 		Subdivision 1.Standards and criteria review. Prior to implementation, the 
7.25 	commissioners shall report the certification standards and evaluation criteria established 
7.26 	in sections 256B.0751 and 256B.0752 to the Legislative Commission on Health Care 
7.27 	Access. These standards are not subject to chapter 14, and the specific provisions in 
7.28 	section 14.386 do not apply.
7.29 		Subd. 2.Annual reports on implementation and administration. The 
7.30 	commissioners shall report annually to the legislature on the implementation and 
7.31 	administration of the health care home model for state health care program enrollees in the 
7.32 	fee-for-service, managed care, and county-based purchasing sectors, beginning January 
7.33 	15, 2011, and each January 15 thereafter. The annual report must include the cost benefit 
7.34 	analysis of the implementation of the health care home model for the state public health 
7.35 	care programs.
8.1 		Subd. 3.Evaluation reports. The commissioners shall provide to the legislature 
8.2 	comprehensive evaluations of the health care home model three years and five years after 
8.3 	implementation. The report must include: 
8.4 	(1) the number of state health care program enrollees in health care homes, the 
8.5 	number and characteristics of enrollees with complex or chronic conditions, identified 
8.6 	by income, race, ethnicity, and language;
8.7 	(2) the number and geographic distribution of health care home providers;
8.8 	(3) the performance and quality of care of health care homes;
8.9 	(4) measures of preventive care;
8.10 	(5) health care home payment arrangements, and costs related to implementation 
8.11 	and payment of care coordination fees; and 
8.12 	(6) the estimated impact of health care homes on health disparities.

8.13 	Sec. 4. [256B.766] PRIMARY CARE PHYSICIAN REIMBURSEMENT RATE 
8.14 	INCREASE.
8.15 	(a) Effective for physician services rendered on or after January 1, 2009, the 
8.16 	commissioner shall increase reimbursements to primary care physicians deemed by the 
8.17 	commissioner to meet the requirements in paragraph (b). Reimbursement may be increased 
8.18 	by not more than 50 percent above the reimbursement rate that would otherwise be paid to 
8.19 	the primary care provider. Payments to health plan companies shall be adjusted to reflect 
8.20 	increased reimbursement to primary care physicians as approved by the commissioner.
8.21 	(b) The commissioner, in collaboration with the Office of Rural Health, shall 
8.22 	determine areas of the state in need of primary care physicians. By September 1 of each 
8.23 	year, beginning September 1, 2008, the commissioner shall accept applications from 
8.24 	primary care physicians who agree to practice in a designated underserved area for a 
8.25 	period of no less than five years. The commissioner shall determine participant eligibility 
8.26 	based on their suitability for practice serving a designated geographic area.
8.27 	(c) The commissioner may reconsider the designated areas, as necessary. A primary 
8.28 	care physician who agrees to practice in an area designated as underserved shall receive 
8.29 	the increased reimbursement rates for at least a period of five years, unless the physician 
8.30 	discontinues practicing in the designated area during the five-year period.
8.31 	(d) A health care clinic or medical group may submit applications under this section 
8.32 	for primary care physicians who will be hired to fill vacancies, prior to filling the vacant 
8.33 	position.

8.34 	Sec. 5. WORKFORCE SHORTAGE STUDY.
 9.1 	To address health care workforce shortages, the commissioner of health, in 
9.2 	consultation with the health licensing boards and professional associations, shall study 
9.3 	changes necessary in health professional licensure and regulation to ensure full utilization 
9.4 	of advanced practice registered nurses, physician assistants, and other licensed health care 
9.5 	professionals in the health care home and primary delivery system. The commissioner 
9.6 	shall make recommendations to the legislature by January 15, 2009.

9.7 	ARTICLE 3
9.8 	INCREASING ACCESS; CONTINUITY OF CARE

9.9 	Section 1. [124D.1115] FREE AND REDUCED SCHOOL LUNCH PROGRAM 
9.10 	DATA SHARING.
9.11 	(a) Each school participating in the federal school lunch program shall electronically 
9.12 	send to the Department of Education the eligibility information on each child who is 
9.13 	eligible for the free and reduced lunch program, unless the child's parent or legal guardian 
9.14 	after being notified of the potential disclosure of this information for the limited purpose 
9.15 	stated in paragraph (b), elects not to have the information disclosed.
9.16 	(b) Pursuant to United States Code, title 42, section 1758(b)(6)(A), the Department 
9.17 	of Education shall enter into an agreement with the Department of Human Services 
9.18 	to share the eligibility information provided by each school in paragraph (a) for the 
9.19 	limited purpose of identifying children who may be eligible for medical assistance or 
9.20 	MinnesotaCare. The Department of Human Services must ensure that this information 
9.21 	remains confidential and shall only be used for this purpose. Any unauthorized disclosure 
9.22 	shall be subject to a penalty.

9.23 	Sec. 2. Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision 
9.24 	to read:
9.25 		Subd. 27.Automation and coordination for state health care programs. (a) For 
9.26 	purposes of this subdivision, "state health care program" means the medical assistance, 
9.27 	MinnesotaCare, or general assistance medical care programs.
9.28 	(b) By July 1, 2009, the commissioner shall improve coordination between state 
9.29 	health care programs and social service programs including, but not limited to WIC, free 
9.30 	and reduced school lunch programs, and food stamps, and shall develop and use automated 
9.31 	systems to identify persons served by social service programs who may be eligible for, but 
9.32 	are not enrolled in, a state health care program. By January 15, 2009, the commissioner 
9.33 	shall, as necessary, identify and recommend to the legislature statutory changes to state 
10.1 	health care and social service programs necessary to improve coordination and automation 
10.2 	of outreach and enrollment efforts.
10.3 	(c) By January 15, 2009, the commissioner shall establish and implement an 
10.4 	automated process to send out state health care program renewal forms in the most 
10.5 	common foreign languages, to those state health care program enrollees who request 
10.6 	renewal forms in those foreign languages. The commissioner, as part of the initial 
10.7 	enrollment process, shall inform applicants of the availability of this option.
10.8 	(d) Beginning July 1, 2008, the commissioner, county social service agencies, and 
10.9 	health care providers shall update state health care program enrollee addresses and related 
10.10 	contact information, at the time of each enrollee contact.

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

10.12 	Sec. 3. Minnesota Statutes 2007 Supplement, section 256.962, subdivision 5, is 
10.13 	amended to read:
10.14 		Subd. 5.Incentive program. Beginning January 1, 2008, the commissioner 
10.15 	shall establish an incentive program for organizations that directly identify and assist 
10.16 	potential enrollees in filling out and submitting an application. For each applicant who is 
10.17 	successfully enrolled in MinnesotaCare, medical assistance, or general assistance medical 
10.18 	care, the commissioner, within the available appropriation, shall pay the organization a 
10.19 	$20$25 application assistance bonus. The organization may provide an applicant a gift 
10.20 	certificate or other incentive upon enrollment.

10.21 	Sec. 4. Minnesota Statutes 2007 Supplement, section 256.962, subdivision 6, is 
10.22 	amended to read:
10.23 		Subd. 6.School districts. (a) At the beginning of each school year, a school district 
10.24 	shall provide information to each student on the availability of health care coverage 
10.25 	through the Minnesota health care programs.
10.26 	(b) For each child who is determined to be eligible for athe free orand reduced 
10.27 	pricedschool lunch program, the district shall provide the child's family with an 
10.28 	application for the Minnesota health care programs and information on how to obtain an 
10.29 	application for the Minnesota health care programs and application assistance.
10.30 	(c) A district shall also ensure that applications and information on application 
10.31 	assistance are available at early childhood education sites and public schools located 
10.32 	within the district's jurisdiction. 
10.33 	(d) Each district shall designate an enrollment specialist to provide application 
10.34 	assistance and follow-up services with families who are eligible for the reduced or free 
11.1 	lunch program or who have indicated an interest in receiving information or an application 
11.2 	for the Minnesota health care program. A district is eligible for the application assistance 
11.3 	bonus described in subdivision 5.
11.4 	(e) Each school district shall provide on their Web site a link to information on how 
11.5 	to obtain an application and application assistance.

11.6 	Sec. 5. Minnesota Statutes 2006, section 256B.057, subdivision 8, is amended to read:
11.7 		Subd. 8.Children under age two. Medical assistance may be paid for a child under 
11.8 	two years of age whose countable family income is above 275 percent of the federal 
11.9 	poverty guidelines for the same size family but less than or equal to 280 305 percent of the 
11.10 	federal poverty guidelines for the same size family.

11.11 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
11.12 	approval, whichever is later.

11.13 	Sec. 6. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is 
11.14 	amended to read:
11.15 		Subdivision 1.Families with children. (a) Families with children with family 
11.16 	income equal to or less than 275 300 percent of the federal poverty guidelines for the 
11.17 	applicable family size shall be eligible for MinnesotaCare according to this section. All 
11.18 	other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 
11.19 	to enrollment under section 256L.07, shall apply unless otherwise specified. 
11.20 	(b) Parents who enroll in the MinnesotaCare program must also enroll their children, 
11.21 	if the children are eligible. Children may be enrolled separately without enrollment by 
11.22 	parents. However, if one parent in the household enrolls, both parents must enroll, unless 
11.23 	other insurance is available. If one child from a family is enrolled, all children must 
11.24 	be enrolled, unless other insurance is available. If one spouse in a household enrolls, 
11.25 	the other spouse in the household must also enroll, unless other insurance is available. 
11.26 	Families cannot choose to enroll only certain uninsured members.
11.27 	(c) Beginning October 1, 2003, the dependent sibling definition no longer applies 
11.28 	to the MinnesotaCare program. These persons are no longer counted in the parental 
11.29 	household and may apply as a separate household.
11.30 	(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are 
11.31 	not eligible for MinnesotaCare if their gross income exceeds $50,000.
11.32 	(e) Children formerly enrolled in medical assistance and automatically deemed 
11.33 	eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 
11.34 	from the requirements of this section until renewal.

12.1 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
12.2 	approval, whichever is later. The commissioner of human services shall notify the revisor 
12.3 	of statutes when federal approval is obtained.

12.4 	Sec. 7. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is 
12.5 	amended to read:
12.6 		Subd. 7.Single adults and households with no children. (a) The definition of 
12.7 	eligible persons includes all individuals and households with no children who have gross 
12.8 	family incomes that are equal to or less than 200 percent of the federal poverty guidelines. 
12.9 	(b) Effective July 1, 2009, the definition of eligible persons includes all individuals 
12.10 	and households with no children who have gross family incomes that are equal to or less 
12.11 	than 215 percent of the federal poverty guidelines.
12.12 	(c) Effective July 1, 2010, the definition of eligible persons includes all individuals 
12.13 	and households with no children who have gross family incomes that are equal to or less 
12.14 	than 300 percent of the federal poverty guidelines.

12.15 	Sec. 8. Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a, is 
12.16 	amended to read:
12.17 		Subd. 3a.Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 
12.18 	must be renewed every 12 months. The 12-month period begins in the month after the 
12.19 	month the application is approved.
12.20 	(b) Each new period of eligibility must take into account any changes in 
12.21 	circumstances that impact eligibility and premium amount. An enrollee must provide all 
12.22 	the information needed to redetermine eligibility by the first day of the month that ends 
12.23 	the eligibility period. If there is no change in circumstances, the enrollee may renew 
12.24 	eligibility at designated locations that include community clinics and health care providers' 
12.25 	offices. The designated sites shall forward the renewal forms to the commissioner. The 
12.26 	premium for the new period of eligibility must be received as provided in section 256L.06
12.27 	in order for eligibility to continue.
12.28 	(c) For single adults and households with no children formerly enrolled in general 
12.29 	assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 
12.30 	subdivision 3, the first period of eligibility begins the month the enrollee submitted the 
12.31 	application or renewal for general assistance medical care.
12.32 	(d) An enrollee who fails to submit renewal forms and related documentation 
12.33 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
12.34 	for one additional month beyond the end of the current eligibility period, before being 
13.1 	disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 
13.2 	additional month.

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

13.6 	Sec. 9. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision 
13.7 	to read:
13.8 		Subd. 6.Delayed verification. On the basis of information provided on the 
13.9 	completed application, an applicant whose gross income is less than 90 percent of 
13.10 	the applicable income standard and meets all other eligibility requirements, including 
13.11 	compliance at the time of application with citizenship or nationality documentation 
13.12 	requirements under section 256L.04, subdivision 10, must be determined eligible and 
13.13 	enrolled upon payment of premiums according to subdivision 3. The applicant shall 
13.14 	provide all required verifications within 60 days' notice of the eligibility determination, 
13.15 	or eligibility shall be denied or canceled. Applicants who are denied or canceled for 
13.16 	failure to provide all required verifications are not eligible for coverage using the delayed 
13.17 	verification procedures specified in this subdivision for 12 months.

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

13.21 	Sec. 10. Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:
13.22 		Subd. 3.Commissioner's duties and payment. (a) Premiums are dedicated to the 
13.23 	commissioner for MinnesotaCare.
13.24 	(b) The commissioner shall develop and implement procedures to: (1) require 
13.25 	enrollees to report changes in income; (2) adjust sliding scale premium payments, based 
13.26 	upon both increases and decreases in enrollee income, at the time the change in income 
13.27 	is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required 
13.28 	premiums. Failure to pay includes payment with a dishonored check, a returned automatic 
13.29 	bank withdrawal, or a refused credit card or debit card payment. The commissioner may 
13.30 	demand a guaranteed form of payment, including a cashier's check or a money order, as 
13.31 	the only means to replace a dishonored, returned, or refused payment.
13.32 	(c) Premiums are calculated on a calendar month basis and may be paid on a 
13.33 	monthly, quarterly, or semiannual basis, with the first payment due upon notice from the 
14.1 	commissioner of the premium amount required. The commissioner shall inform applicants 
14.2 	and enrollees of these premium payment options. Premium payment is required before 
14.3 	enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments 
14.4 	received before noon are credited the same day. Premium payments received after noon 
14.5 	are credited on the next working day.
14.6 	(d) Nonpayment of the premium will result in disenrollment from the plan effective 
14.7 	forthe first day of the calendar month following the calendar month for which the 
14.8 	premium was due. Persons disenrolled for nonpayment or who voluntarily terminate 
14.9 	coverage from the program may not reenroll until four calendar months have elapsed. 
14.10 	Persons disenrolled for nonpayment who pay all past due premiums as well as current 
14.11 	premiums due, including premiums due for the period of disenrollment, within 20 days 
14.12 	of disenrollment, shall be reenrolled retroactively to the first day of disenrollment The 
14.13 	commissioner shall waive premiums for coverage provided under this paragraph to 
14.14 	persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b. 
14.15 	Persons disenrolled for nonpayment or who voluntarily terminate coverage from the 
14.16 	program may not reenroll for four calendar months unless the person demonstrates good 
14.17 	cause for nonpayment. Good cause does not exist if a person chooses to pay other family 
14.18 	expenses instead of the premium. The commissioner shall define good cause in rule.

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

14.22 	Sec. 11. Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is 
14.23 	amended to read:
14.24 		Subdivision 1.General requirements. (a) Children enrolled in the original 
14.25 	children's health plan as of September 30, 1992, children who enrolled in the 
14.26 	MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 
14.27 	article 4, section 17, and children who have family gross incomes that are equal to or 
14.28 	less than 150 percent of the federal poverty guidelines are eligible without meeting 
14.29 	the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 
14.30 	long as they maintain continuous coverage in the MinnesotaCare program or medical 
14.31 	assistance. Children who apply for MinnesotaCare on or after the implementation date 
14.32 	of the employer-subsidized health coverage program as described in Laws 1998, chapter 
14.33 	407, article 5, section 45, who have family gross incomes that are equal to or less than 150 
14.34 	percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 
14.35 	be eligible for MinnesotaCare.
15.1 	Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose 
15.2 	income increases above 275 300 percent of the federal poverty guidelines, are no longer 
15.3 	eligible for the program and shall be disenrolled by the commissioner. Beginning January 
15.4 	1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 
15.5 	7, whose income increases above 200 percent of the federal poverty guidelines or 215 
15.6 	percent of the federal poverty guidelines on or after July 1, 2009, or 300 percent of federal 
15.7 	poverty guidelines on or after July 1, 2010, are no longer eligible for the program and 
15.8 	shall be disenrolled by the commissioner. For persons disenrolled under this subdivision, 
15.9 	MinnesotaCare coverage terminates the last day of the calendar month following the 
15.10 	month in which the commissioner determines that the income of a family or individual 
15.11 	exceeds program income limits.
15.12 	(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare 
15.13 	if ten percent of their gross individual or gross family income as defined in section 
15.14 	256L.01, subdivision 4, is less than the annual premium for a policy with a $500 
15.15 	deductible available through the Minnesota Comprehensive Health Association. Children 
15.16 	who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 
15.17 	notice period from the date that ineligibility is determined before disenrollment. The 
15.18 	premium for children remaining eligible under this clause shall be the maximum premium 
15.19 	determined under section 256L.15, subdivision 2, paragraph (b).
15.20 	(c) Notwithstanding paragraphs (a) and (b), parents are not eligible for 
15.21 	MinnesotaCare if gross household income exceeds $50,000 for the 12-month period 
15.22 	of eligibility.

15.23 	EFFECTIVE DATE. The effective date for the amendment to paragraph (a) related 
15.24 	to the four-month requirement is effective January 1, 2009, or upon federal approval, 
15.25 	whichever is later. The effective date for the amendment of paragraph (a) related to the 
15.26 	expansion in eligibility to 300 percent of federal poverty guidelines, and the amendment 
15.27 	to paragraph (c), are effective July 1, 2010.

15.28 	Sec. 12. Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:
15.29 		Subd. 3.Other health coverage. (a) Families and individuals enrolled in the 
15.30 	MinnesotaCare program must have no health coverage while enrolled or for at least four 
15.31 	months prior to application and renewal. Children enrolled in the original children's health 
15.32 	plan and children in families with income equal to or less than 150 percent of the federal 
15.33 	poverty guidelines, who have other health insurance, are eligible if the coverage:
15.34 	(1) lacks two or more of the following:
15.35 	(i) basic hospital insurance;
16.1 	(ii) medical-surgical insurance;
16.2 	(iii) prescription drug coverage;
16.3 	(iv) dental coverage; or
16.4 	(v) vision coverage;
16.5 	(2) requires a deductible of $100 or more per person per year; or
16.6 	(3) lacks coverage because the child has exceeded the maximum coverage for a 
16.7 	particular diagnosis or the policy excludes a particular diagnosis.
16.8 	The commissioner may change this eligibility criterion for sliding scale premiums 
16.9 	in order to remain within the limits of available appropriations. The requirement of no 
16.10 	health coverage does not apply to newborns.
16.11 	(b) Medical assistance, general assistance medical care, and the Civilian Health and 
16.12 	Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under 
16.13 	United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or 
16.14 	health coverage for purposes of the four-month requirement described in this subdivision.
16.15 	(c) For purposes of this subdivision, an applicant or enrollee who is entitled to 
16.16 	Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 
16.17 	Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to 
16.18 	have health coverage. An applicant or enrollee who is entitled to premium-free Medicare 
16.19 	Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility 
16.20 	for MinnesotaCare.
16.21 	(d) (c) Applicants who were recipients of medical assistance or general assistance 
16.22 	medical care within one month of application must meet the provisions of this subdivision 
16.23 	and subdivision 2.
16.24 	(e) Cost-effective health insurance that was paid for by medical assistance is not 
16.25 	considered health coverage for purposes of the four-month requirement under this 
16.26 	section, except if the insurance continued after medical assistance no longer considered it 
16.27 	cost-effective or after medical assistance closed.

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

16.31 	Sec. 13. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is 
16.32 	amended to read:
16.33 		Subd. 2.Sliding fee scale; monthly gross individual or family income. (a) The 
16.34 	commissioner shall establish a sliding fee scale to determine the percentage of monthly 
16.35 	gross individual or family income that households at different income levels must pay to 
17.1 	obtain coverage through the MinnesotaCare program. The sliding fee scale must be based 
17.2 	on the enrollee's monthly gross individual or family income. The sliding fee scale must 
17.3 	contain separate tables based on enrollment of one, two, or three or more persons. Until 
17.4 	June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross 
17.5 	individual or family income for individuals or families with incomes below the limits for 
17.6 	the medical assistance program for families and children in effect on January 1, 1999, and 
17.7 	proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 
17.8 	8.8 percent. These percentages are matched to evenly spaced income steps ranging from 
17.9 	the medical assistance income limit for families and children in effect on January 1, 1999, 
17.10 	to 275 percent of the federal poverty guidelines for the applicable family size, up to a 
17.11 	family size of five. The sliding fee scale for a family of five must be used for families of 
17.12 	more than five. The sliding fee scale and percentages are not subject to the provisions of 
17.13 	chapter 14. If a family or individual reports increased income after enrollment, premiums 
17.14 	shall be adjusted at the time the change in income is reported.
17.15 	(b) FamiliesChildren in families whose gross income is above 275 300 percent 
17.16 	of the federal poverty guidelines shall pay the maximum premium. The maximum 
17.17 	premium is defined as a base charge for one, two, or three or more enrollees so that if all 
17.18 	MinnesotaCare cases paid the maximum premium, the total revenue would equal the 
17.19 	total cost of MinnesotaCare medical coverage and administration. In this calculation, 
17.20 	administrative costs shall be assumed to equal ten percent of the total. The costs of 
17.21 	medical coverage for pregnant women and children under age two and the enrollees in 
17.22 	these groups shall be excluded from the total. The maximum premium for two enrollees 
17.23 	shall be twice the maximum premium for one, and the maximum premium for three or 
17.24 	more enrollees shall be three times the maximum premium for one.
17.25 	(c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according 
17.26 	to the affordability scale established in section 62U.08 with the exception that children in 
17.27 	families with income at or below 150 percent of the federal poverty guidelines shall pay a 
17.28 	monthly premium of $4. For purposes of this paragraph, and the affordability standard 
17.29 	under section 62U.09, "minimum" means a monthly premium of $4.

17.30 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
17.31 	approval, whichever is later, except that the amendment to paragraph (b) related to the 
17.32 	expansion in eligibility to 300 percent of federal poverty guidelines is effective July 1, 
17.33 	2010, or upon federal approval, whichever is later. The commissioner of human services 
17.34 	shall notify the revisor of statutes when federal approval is obtained.

18.1 	Sec. 14. Laws 2007, chapter 147, article 5, section 19, the effective date, is amended to 
18.2 	read:

18.3 	EFFECTIVE DATE. This section is effective July 1, 2007, or upon federal 
18.4 	approval, whichever is later 2008.

18.5 	Sec. 15.  REPEALER.
 18.6 	Minnesota Statutes 2006, section 256L.15, subdivision 3, is repealed.

18.7 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
18.8 	approval of the amendments to Minnesota Statutes, section 256L.15, subdivision 2, 
18.9 	paragraph (c), whichever is later. The commissioner of human services shall notify the 
18.10 	revisor of statutes when federal approval is obtained.

18.11 	ARTICLE 4
18.12 	HEALTH INSURANCE PURCHASING AND AFFORDABILITY REFORM

18.13 	Section 1. Minnesota Statutes 2007 Supplement, section 62J.495, is amended by 
18.14 	adding a subdivision to read:
18.15 		Subd. 3.Interoperable electronic health record requirements. To meet the 
18.16 	requirements of subdivision 1, hospitals and health care providers must meet the following 
18.17 	criteria when implementing an interoperable electronic health records system within their 
18.18 	hospital system or clinical practice setting.
18.19 	(a) The electronic health record must be certified by the Certification Commission 
18.20 	for Healthcare Information Technology, or its successor. This criterion only applies to 
18.21 	hospitals and health care providers whose practice setting is a practice setting covered 
18.22 	by Certification Commission for Healthcare Information Technology certifications. This 
18.23 	criterion shall be considered met if a hospital or health care provider is using an electronic 
18.24 	health records system that has been certified within the last three years, even if a more 
18.25 	current version of the system has been certified within the three-year period.
18.26 	(b) A health care provider who is a prescriber or dispenser of controlled substances 
18.27 	must have an electronic health record system that meets the requirements of section 
18.28 	62J.497.

18.29 	Sec. 2. [62J.497] ELECTRONIC PRESCRIPTION DRUG PROGRAM.
18.30 		Subdivision 1.Definitions. For the purposes of this section, the following terms 
18.31 	have the meanings given.
19.1 	(a) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 
19.2 	30. Dispensing does not include the direct administering of a controlled substance to a 
19.3 	patient by a licensed health care professional.
19.4 	(b) "Dispenser" means a person authorized by law to dispense a controlled substance, 
19.5 	pursuant to a valid prescription.
19.6 	(c) "Electronic media" has the same meaning given this term under Code of Federal 
19.7 	Regulations, title 45, part 160.103.
19.8 	(d) "E-prescribing" means the transmission using electronic media, of prescription 
19.9 	or prescription-related information between a prescriber, dispenser, pharmacy benefit 
19.10 	manager, or group purchaser, either directly or through an intermediary, including an 
19.11 	e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions 
19.12 	between the point of care and the dispenser.
19.13 	(e) "Electronic prescription drug program" means a program that provides for 
19.14 	e-prescribing.
19.15 	(f) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
19.16 	(g) "HL7 messages" means a standard approved by the standards development 
19.17 	organization known as Health Level Seven.
19.18 	(h) "National Provider Identifier" or "NPI" means the identifier described under 
19.19 	Code of Federal Regulations, title 45, part 162.406.
19.20 	(i) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
19.21 	(j) "NCPDP Formulary and Benefits Standard" means the National Council for 
19.22 	Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide, 
19.23 	Version 1, Release 0, October 2005.
19.24 	(k) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug 
19.25 	Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide 
19.26 	Version 8, Release 1 (Version 8.1), October 2005.
19.27 	(l) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
19.28 	(m) "Prescriber" means a licensed health care professional who is authorized to 
19.29 	prescribe a controlled substance under section 152.12, subdivision 1.
19.30 	(n) "Prescription-related information" means information regarding eligibility for 
19.31 	drug benefits, medication history, or related health or drug information.
19.32 	(o) "Provider" or "health care provider" has the meaning given in section 62J.03, 
19.33 	subdivision 8.
19.34 		Subd. 2.Requirements for electronic prescribing. (a) Effective January 1, 2011, 
19.35 	all providers, group purchasers, prescribers, and dispensers must establish and maintain 
19.36 	an electronic prescription drug program that complies with the applicable standards 
20.1 	in this section for transmitting, directly or through an intermediary, prescriptions and 
20.2 	prescription-related information using electronic media.
20.3 	(b) Nothing in this section requires providers, group purchasers, prescribers, or 
20.4 	dispensers to conduct the transactions described in this section. If transactions described in 
20.5 	this section are conducted, they must be done electronically using the standards described 
20.6 	in this section. Nothing in this section requires providers, group purchasers, prescribers, 
20.7 	or dispensers to electronically conduct transactions that are expressly prohibited by other 
20.8 	sections or federal law.
20.9 	(c) Providers, group purchasers, prescribers, and dispensers must use either HL7 
20.10 	messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related 
20.11 	information internally when the sender and the recipient are part of the same legal entity. If 
20.12 	an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard 
20.13 	or other applicable standards required by this section. Any pharmacy within an entity 
20.14 	must be able to receive electronic prescription transmittals from outside the entity using 
20.15 	the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health 
20.16 	Insurance Portability and Accountability Act (HIPAA) requirement that may require the 
20.17 	use of a HIPAA transaction standard within an organization.
20.18 	(d) Entities transmitting prescriptions or prescription-related information where the 
20.19 	prescriber is required by law to issue a prescription for a patient to a nonprescribing 
20.20 	provider that in turn forwards the prescription to a dispenser are exempt from the 
20.21 	requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or 
20.22 	prescription-related information.
20.23 		Subd. 3.Standards for electronic prescribing. (a) Prescribers and dispensers 
20.24 	must use the NCPDP SCRIPT Standard for the communication of a prescription or 
20.25 	prescription-related information. The NCPDP SCRIPT Standard shall be used to conduct 
20.26 	the following transactions:
20.27 	(1) get message transaction;
20.28 	(2) status response transaction;
20.29 	(3) error response transaction;
20.30 	(4) new prescription transaction;
20.31 	(5) prescription change request transaction;
20.32 	(6) prescription change response transaction;
20.33 	(7) refill prescription request transaction;
20.34 	(8) refill prescription response transaction;
20.35 	(9) verification transaction;
20.36 	(10) password change transaction;
21.1 	(11) cancel prescription request transaction; and
21.2 	(12) cancel prescription response transaction.
21.3 	(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP 
21.4 	SCRIPT Standard for communicating and transmitting medication history information.
21.5 	(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP 
21.6 	Formulary and Benefits Standard for communicating and transmitting formulary and 
21.7 	benefit information.
21.8 	(d) Providers, group purchasers, prescribers, and dispensers must use the national 
21.9 	provider identifier to identify a health care provider in e-prescribing or prescription related 
21.10 	transactions when a health care provider's identifier is required.
21.11 	(e) Providers, group purchasers, prescribers, and dispensers must communicate 
21.12 	eligibility information and conduct health care eligibility benefit inquiry and response 
21.13 	transactions according to the requirements of section 62J.536.

21.14 	Sec. 3. [62U.01] DEFINITIONS.
21.15 		Subdivision 1.Applicability. For purposes of this chapter, the terms defined in this 
21.16 	section have the meanings given, unless otherwise specified.
21.17 		Subd. 2.Basket or baskets of care. "Basket" or "baskets of care" means a 
21.18 	collection of health care services that are paid separately under a fee-for-service system, 
21.19 	but which are ordinarily combined by a provider in delivering a full diagnostic or 
21.20 	treatment procedure to a patient.
21.21 		Subd. 3.Clinically effective. "Clinically effective" means that the use of a 
21.22 	particular health technology or service improves or prevents a decline in patient clinical 
21.23 	status, as measured by medical condition, survival rates, and other variables, and that the 
21.24 	use of the particular technology or service demonstrates a clinical or outcome advantage 
21.25 	over alternative technologies or services. This definition shall not be used to exclude or 
21.26 	deny technology or treatment necessary to preserve life on the basis of an individual's age 
21.27 	or expected length of life or of the individual's present or predicted disability, degree 
21.28 	of medical dependency, or quality of life.
21.29 		Subd. 4.Cost-effective. "Cost-effective" means that the economic costs of using 
21.30 	a particular service, device, or health technology to achieve improvement or prevent 
21.31 	a decline in a patient's health outcome are justified given the comparison to both the 
21.32 	economic costs and the improvement or prevention of decline in patient health outcome 
21.33 	resulting from the use of an alternative service, device, or technology, or from not 
21.34 	providing the service, device, or technology.
22.1 		Subd. 5.Group purchaser. "Group purchaser" has the meaning provided in 
22.2 	section 62J.03.
22.3 		Subd. 6.Health plan. "Health plan" means a health plan as defined in section 
22.4 	62A.011.
22.5 		Subd. 7.Health plan company. "Health plan company" has the meaning provided 
22.6 	in section 62Q.01, subdivision 4.
22.7 		Subd. 8.Participating provider. "Participating provider" means a provider who 
22.8 	has entered into a service agreement with a health plan company.
22.9 		Subd. 9.Provider or health care provider. "Provider" or "health care provider" 
22.10 	means a health care provider as defined in section 62J.03, subdivision 8.
22.11 		Subd. 10.Service agreement. "Service agreement" means an agreement, contract, 
22.12 	or other arrangement between a health plan company and a provider under which the 
22.13 	provider agrees that when health services are provided for an enrollee, the provider shall 
22.14 	not make a direct charge against the enrollee for those services or parts of services that are 
22.15 	covered by the enrollee's contract, but shall look to the service plan corporation for the 
22.16 	payment for covered services, to the extent they are covered.
22.17 		Subd. 11.State health care program. "State health care program" means the 
22.18 	medical assistance, MinnesotaCare, and general assistance medical care programs.
22.19 		Subd. 12.Third-party administrator. "Third-party administrator" means a 
22.20 	vendor of risk-management services or an entity administering a self-insurance or health 
22.21 	insurance plan under section 60A.23.

22.22 	Sec. 4. [62U.02] VALUE-BASED BENEFIT SET AND DESIGN.
22.23 		Subdivision 1.Creation. By October 15, 2009, the commissioner of health shall 
22.24 	make recommendations to the legislature on the components and design of a value-based 
22.25 	set of health benefits. The commissioner shall convene an advisory committee to assist 
22.26 	in preparing recommendations. Prior to recommending the value-based benefit set 
22.27 	and design, the commissioner and advisory committee shall convene public hearings 
22.28 	throughout the state.
22.29 		Subd. 2.Operations of advisory committee. The advisory committee shall consist 
22.30 	of no more than 11 members. The members shall be appointed by the commissioner and 
22.31 	must have expertise in benefit design and development in terms of outcomes, actuarial 
22.32 	health care analysis, or knowledge relating to the analysis of the cost impact of coverage 
22.33 	of specified benefits. The commissioner shall convene the first meeting on or before 
22.34 	September 1, 2008, upon the appointment of the initial committee and must meet at least 
22.35 	once a year, and at other times as necessary. The commissioner shall provide office 
23.1 	space, equipment and supplies, and technical support to the advisory committee. In 
23.2 	establishing the benefit set, the committee shall consult with organizations with expertise 
23.3 	in formulating scientifically based practice standards. The advisory committee shall be 
23.4 	governed by section 15.059, except the committee shall not expire.
23.5 		Subd. 3.Immunity of liability. No member of the advisory committee shall be held 
23.6 	civilly liable for an act or omission by that member if the act or omission was in good faith 
23.7 	and within the scope of the member's responsibilities under this chapter.
23.8 		Subd. 4.Benefit set design. (a) The value-based set of health benefits must provide 
23.9 	individuals and families with access to a broad range of health care services, including 
23.10 	preventive health care, without incurring severe financial loss as a result of serious illness 
23.11 	or injury. The benefit set must include health care services, procedures, and diagnostic 
23.12 	tests that are scientifically proven to be both clinically effective and cost effective. The 
23.13 	benefit set may require differentiated co-pays and deductibles based upon the clinical 
23.14 	effectiveness and cost effectiveness of a particular health care service. The advisory 
23.15 	committee must consider including cost effective and clinically effective dental care, 
23.16 	mental health services, chemical dependency treatment, vision care, language interpreter 
23.17 	services, emergency transportation, and prescription drugs. The committee shall consider 
23.18 	cultural, ethnic, and religious values and beliefs to ensure that the health care needs of 
23.19 	all Minnesota residents are addressed in the benefit set.
23.20 	(b) The benefit set must identify and include the following services with minimal 
23.21 	or no cost-sharing requirements, if the committee determines that the savings and health 
23.22 	quality improvements associated with broad access are equal to or greater than the cost of 
23.23 	providing the services: preventive services, chronic care coordination, early diagnostic 
23.24 	tests, and outpatient care for asthma, heart disease, diabetes, and depression.
23.25 	(c) The benefit set shall, to the extent possible, be designed to be affordable to 
23.26 	Minnesotans consistent with the affordability standard established in section 62U.09.
23.27 	(d) The benefit design must establish a limited number of maximum cost-sharing 
23.28 	variations based upon deductibles and maximum out-of-pocket costs. There must be no 
23.29 	maximum lifetime benefit.
23.30 	(e) The commissioners of human services and finance shall, to the extent possible, 
23.31 	consider incorporating the benefit design into the state public health care programs and the 
23.32 	state employee group insurance program.
23.33 	(f) The commissioners of health and commerce shall report to the legislature on 
23.34 	necessary changes needed to current mandated benefit sets to incorporate the benefit 
23.35 	design developed under this section.
24.1 		Subd. 5.Continued review. The commissioner and the committee shall review 
24.2 	the benefit set and design on an ongoing periodic basis and shall adjust the benefit set 
24.3 	and design as necessary, to ensure that the benefit set and design continues to be safe, 
24.4 	effective, and scientifically based.

24.5 	Sec. 5. [62U.03] HEALTH TECHNOLOGY ASSESSMENT REVIEW.
24.6 	The commissioner of health , in consultation with the Health Advisory Council, the 
24.7 	Institute for Clinical Systems, and practicing health care providers who either use health 
24.8 	technology in their scope of practice or have an expertise in health technology, shall review 
24.9 	the health technology assessments of new and existing health technologies that have been 
24.10 	conducted by existing programs, including but not limited to, the state of Washington's 
24.11 	health technology assessment program and the Medicaid Evidence-Based Decisions 
24.12 	Project for inclusion to the value-based benefit set and design under section 62U.02.

24.13 	Sec. 6. [62U.04] PAYMENT RESTRUCTURING; INCENTIVE PAYMENTS 
24.14 	BASED ON QUALITY OF CARE.
24.15 		Subdivision 1.Development. (a) The commissioner of health shall develop a 
24.16 	standardized set of measures by which to assess the quality of health care services offered 
24.17 	by health care providers, including health care providers certified as health care homes 
24.18 	under section 256B.0751. Quality measures must be based on medical evidence and be 
24.19 	developed through a process in which providers participate. The measures shall be used 
24.20 	for the quality incentive payment system developed in subdivision 2 and must:
24.21 	(1) include uniform definitions, measures, and forms for submission of data, to the 
24.22 	greatest extent possible;
24.23 	(2) seek to avoid increasing the administrative burden on health care providers;
24.24 	(3) be initially based on existing quality indicators for physician and hospital 
24.25 	services, which are measured and reported publicly by quality measurement organizations 
24.26 	including Minnesota Community Measurement and specialty societies;
24.27 	(4) place a priority on measures of health care outcomes, rather than process 
24.28 	measures, wherever possible; and
24.29 	(5) incorporate measures for primary care, including preventive services, coronary 
24.30 	artery and heart disease, diabetes, asthma, depression, and other measures as determined 
24.31 	by the commissioner.
24.32 	(b) The measures shall be reviewed at least annually by the commissioner.
24.33 		Subd. 2.Quality incentive payments. (a) By July 1, 2009, the commissioner 
24.34 	shall develop a system of quality incentive payments under which providers are eligible 
25.1 	for quality-based payments that are in addition to existing payment levels, based upon 
25.2 	a comparison of provider performance against specified targets, including improvement 
25.3 	over time. The targets must be based upon and consistent with the quality measures 
25.4 	established under subdivision 1. 
25.5 	(b) To the extent possible, the payment system must adjust for variations in patient 
25.6 	population, in order to reduce incentives to health care providers to avoid high-risk 
25.7 	patients or populations. 
25.8 	(c) The requirements of section 62Q.101 do not apply under this incentive payment 
25.9 	system.
25.10 		Subd. 3.Quality transparency. The commissioner shall establish standards for 
25.11 	measuring health outcomes, establish a system for risk adjusting quality measures, and 
25.12 	issue annual public reports on provider quality beginning July 1, 2010. By January 1, 
25.13 	2010, physician clinics and hospitals shall submit standardized electronic information 
25.14 	on the outcomes and processes associated with patient care to the commissioner or the 
25.15 	commissioner's designee. In addition to measures of care processes and outcomes, the 
25.16 	report may include other measures designated by the commissioner, including, but not 
25.17 	limited to, care infrastructure and patient satisfaction. The commissioner shall ensure 
25.18 	that any quality data reporting requirements established under this subdivision are not 
25.19 	duplicative of publicly reported, community-wide quality reporting activities currently 
25.20 	under way in Minnesota. Nothing in this subdivision is intended to replace or duplicate 
25.21 	current privately supported activities related to quality measurement and reporting in 
25.22 	Minnesota.
25.23 		Subd. 4.Contracting. The commissioner may contract with a private entity or 
25.24 	consortium of private entities to complete the tasks in subdivisions 1, 2, and 3. The private 
25.25 	entity or consortium must be nonprofit and have governance that includes representatives 
25.26 	from the following stakeholder groups: health care providers, health plan companies, 
25.27 	consumers, employers or other health care purchasers, and state government. No one 
25.28 	stakeholder group shall have a majority of the votes on any issue or hold extraordinary 
25.29 	powers not granted to any other governance stakeholder. 
25.30 		Subd. 5.Implementation. (a) By January 1, 2010, health plan companies shall use 
25.31 	the standardized quality measures established under this section and shall not require 
25.32 	providers to use and report health plan company-specific quality and outcome measures. 
25.33 	(b) By July 1, 2010, the commissioner of human services shall implement this 
25.34 	incentive payment system for all enrollees in state health care programs consistent with 
25.35 	relevant state and federal statute and rule.
26.1 	(c) By July 1, 2010, the commissioner of finance shall implement this incentive 
26.2 	payment system for all participants in the state employee group insurance program.
26.3 	(d) By July 1, 2010, all health plan company incentive based performance payment 
26.4 	systems shall comply with subdivision 2 for all participating providers.

26.5 	Sec. 7. [62U.05] PAYMENT RESTRUCTURING; CARE COORDINATION 
26.6 	PAYMENTS.
26.7 	By July 1, 2010, health plan companies shall integrate health care homes into 
26.8 	their provider networks and shall develop a payment system that provides per-person 
26.9 	care coordination payments to health care providers for providing care coordination 
26.10 	services and directly managing onsite or employing care coordinators for their members 
26.11 	who choose to enroll in health care homes certified by the commissioners of health and 
26.12 	human services under section 256B.0751. Health plan companies shall develop payment 
26.13 	conditions and terms for the care coordination fee for health care homes participating in 
26.14 	their network in a manner that is consistent with the system developed under section 
26.15 	256B.0751. Nothing in this section shall restrict the ability of health plan companies to 
26.16 	selectively contract with health care providers, including health care homes.

26.17 	Sec. 8. [62U.06] PAYMENT REFORM TO REDUCE HEALTH CARE COSTS 
26.18 	AND IMPROVE QUALITY.
26.19 		Subdivision 1.Development of uniform standards. The commissioner of health 
26.20 	shall develop the uniform standards identified in this section needed to implement 
26.21 	on a broad scale innovative payment reform that rewards quality and efficiency. The 
26.22 	development of the standards must be completed by January 1, 2010. 
26.23 		Subd. 2.Calculation of health care costs and quality. The commissioner shall 
26.24 	develop a method of calculating providers' relative cost of care, defined as a measure of 
26.25 	health care spending including resource use and unit prices, and relative quality of care. In 
26.26 	developing this method, the commissioner must address the following issues:
26.27 	(1) provider attribution of costs and quality;
26.28 	(2) appropriate adjustment for outlier or catastrophic cases;
26.29 	(3) appropriate risk adjustment to reflect differences in the demographics and health 
26.30 	status across provider patient populations, using generally accepted and transparent risk 
26.31 	adjustment methodologies;
26.32 	(4) specific types of providers that should be included in the calculation;
26.33 	(5) specific types of services that should be included in the calculation;
26.34 	(6) appropriate adjustment for variation in payment rates;
27.1 	(7) the appropriate provider level for analysis;
27.2 	(8) payer mix adjustments, including variation across providers in the percentage of 
27.3 	revenue received from government programs; and
27.4 	(9) other factors that the commissioner determines are needed to ensure validity 
27.5 	and comparability of the analysis.
27.6 		Subd. 3.Provider peer grouping. (a) The commissioner shall develop a peer 
27.7 	grouping system for providers based on a measure that incorporates both provider 
27.8 	risk-adjusted cost of care and quality of care for specific conditions as determined by the 
27.9 	commissioner. In developing this system, the commissioner shall consult and coordinate 
27.10 	with health care providers, health plan companies, state agencies, and organizations that 
27.11 	work to improve health care quality in Minnesota. However, in the final development of 
27.12 	this peer grouping system, the commissioner shall not contract with any private entity, 
27.13 	organization, or consortium of entities that has or will have a direct financial interest in the 
27.14 	outcome of this system.
27.15 	(b) Beginning June 1, 2010, the commissioner shall disseminate information to 
27.16 	providers on their cost of care, resource use, quality of care, and the results of the grouping 
27.17 	developed under this subdivision in comparison to an appropriate peer group. Any 
27.18 	analyses or reports that identify providers may only be published after the provider has 
27.19 	been provided the opportunity by the commissioner to review the underlying data and 
27.20 	submit comments. The provider shall have 21 days to review the data for accuracy. 
27.21 	(c) The commissioner shall establish an appeals process to resolve disputes from 
27.22 	providers regarding the accuracy of the data used to develop analyses or reports.
27.23 	(d) Beginning September 1, 2010, the commissioner shall, no less than annually, 
27.24 	publish information on providers' cost, quality, and the results of the peer grouping 
27.25 	process. The results that are published must be on a risk-adjusted basis. 
27.26 		Subd. 4.Encounter data. (a) Beginning July 1, 2009, and every six months 
27.27 	thereafter, all health plan companies and third-party administrators shall submit encounter 
27.28 	data to a private entity designated by the commissioner of health. The data shall be 
27.29 	submitted in a form and manner specified by the commissioner subject to the following 
27.30 	requirements:
27.31 	(1) the data must be de-identified data as described under the Code of Federal 
27.32 	Regulations, title 45, section 164.514;
27.33 	(2) the data for each encounter must include an identifier for the patient's health care 
27.34 	home if the patient has selected a health care home; and
28.1 	(3) except for the identifier described in clause (2), the data must not include 
28.2 	information that is not included in a health care claim or equivalent encounter information 
28.3 	transaction that is required under section 62J.536.
28.4 	(b) The commissioner, or the commissioner's designee, shall only use the data 
28.5 	submitted under paragraph (a) for the purpose of carrying out its responsibilities in this 
28.6 	section, and must maintain the data that it receives according to the provisions of this 
28.7 	section.
28.8 	(c) Data on providers collected under this subdivision are private data on individuals 
28.9 	or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary 
28.10 	data in section 13.02, subdivision 19, summary data prepared under this subdivision 
28.11 	may be derived from nonpublic data. The commissioner shall establish procedures and 
28.12 	safeguards to protect the integrity and confidentiality of any data that it maintains.
28.13 	(d) The commissioner, or the commissioner's designee, shall not publish analyses or 
28.14 	reports that identify, or could potentially identify, individual patients.
28.15 		Subd. 5.Pricing data. (a) Beginning July 1, 2009, and annually on January 1 
28.16 	thereafter, all health plan companies and third-party administrators shall submit data 
28.17 	on their contracted prices with health care providers to a private entity designated by 
28.18 	the commissioner of health for the purposes of performing the analyses required under 
28.19 	this subdivision. The data shall be submitted in the form and manner specified by the 
28.20 	commissioner of health.
28.21 	(b) The commissioner shall only use the data submitted under this subdivision for 
28.22 	the purpose of carrying out its responsibilities under this section.
28.23 	(c) Data collected under this subdivision are nonpublic data as defined in section 
28.24 	13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19, 
28.25 	summary data prepared under this section may be derived from nonpublic data. The 
28.26 	commissioner shall establish procedures and safeguards to protect the integrity and 
28.27 	confidentiality of any data that it maintains.
28.28 		Subd. 6.Contracting. The commissioner may contract with a private entity 
28.29 	or consortium of entities to develop the standards. The private entity or consortium 
28.30 	must be nonprofit and have governance that includes representatives from the following 
28.31 	stakeholder groups: health care providers, health plans, hospitals, consumers, employers 
28.32 	or other health care purchasers, and state government. The entity or consortium must 
28.33 	ensure that the representatives of stakeholder groups in the aggregate reflect all geographic 
28.34 	areas of the state. No one stakeholder group shall have a majority of the votes on any issue 
28.35 	or hold extraordinary powers not granted to any other governance stakeholder.
29.1 		Subd. 7.Provider innovation to reduce health care costs and improve quality.
 29.2 	(a) Nothing in this section shall prohibit group purchasers and health care providers, 
29.3 	upon mutual agreement, from entering into arrangements that establish package prices 
29.4 	for a comprehensive set of services or separately for the cost of care for specific health 
29.5 	conditions in addition to the baskets of care established in section 62U.07, in order to give 
29.6 	providers the flexibility to innovate on ways to reduce health care costs while improving 
29.7 	overall quality of care and health outcomes.
29.8 	(b) The commissioner of health may convene working groups of private sector 
29.9 	payers and health care providers to discuss and develop new strategies for reforming 
29.10 	health care payment systems to promote innovative care delivery that reduces health 
29.11 	care costs and improves quality.
29.12 		Subd. 8.Uses of information. (a) By January 1, 2011:
29.13 	(1) the commissioner of finance shall use the information and methods developed 
29.14 	under subdivision 3 to strengthen incentives for members of the state employee group 
29.15 	insurance program to use high-quality, low-cost providers;
29.16 	(2) the commissioner of human services shall use the information and methods 
29.17 	developed under subdivision 3 to establish a payment system that:
29.18 	(i) rewards high-quality, low-cost providers;
29.19 	(ii) creates enrollee incentives to receive care from high-quality, low-cost providers; 
29.20 	and
29.21 	(iii) fosters collaboration among providers to reduce cost shifting from one part of 
29.22 	the health continuum to another;
29.23 	(3) all political subdivisions, as defined in section 13.02, subdivision 11, that offer 
29.24 	health benefits to their employees must offer plans that differentiate providers on their 
29.25 	cost and quality performance and create incentives for members to use better-performing 
29.26 	providers;
29.27 	(4) all health plan companies shall use the information and methods developed 
29.28 	under subdivision 3 to develop products that encourage consumers to use high-quality, 
29.29 	low-cost providers; and
29.30 	(5) health plan companies that issue health plans in the individual market or the small 
29.31 	employer market must offer at least one health plan that uses the information developed 
29.32 	under subdivision 3 to establish financial incentives for consumers to choose high-quality, 
29.33 	low-cost providers through enrollee cost-sharing or selective provider networks.
29.34 	(b) By January 1, 2011, the commissioner of health shall report to the governor 
29.35 	and the legislature on recommendations to encourage health plan companies to promote 
29.36 	widespread adoption of products that encourage the use of high-quality, low-cost providers. 
30.1 	The commissioner's recommendations may include tax incentives, public reporting of 
30.2 	health plan performance, regulatory incentives or changes, and other strategies.
30.3 	(c) The commissioner of health shall consult with an advisory group comprised of 
30.4 	employers and consumers to utilize the cost and provider quality information developed 
30.5 	under subdivision 3 to identify ways to improve overall health care costs and quality for 
30.6 	residents of Minnesota.

30.7 	Sec. 9. [62U.07] PROVIDER PRICING FOR BASKETS OF CARE.
30.8 		Subdivision 1.Establishment of definitions. (a) The commissioner of health shall 
30.9 	establish uniform definitions for baskets of care beginning with a minimum of 15 baskets 
30.10 	of care. In selecting health conditions for which baskets of care should be defined, the 
30.11 	commissioner shall consider coronary artery and heart disease, diabetes, asthma, and 
30.12 	depression. In selecting health conditions, the commissioner shall also consider the 
30.13 	prevalence of the health conditions, the cost of treating the health conditions, and the 
30.14 	potential for innovations to reduce cost and improve quality resulting from establishing a 
30.15 	basket of care for a specific health condition.
30.16 	(b) The commissioner shall convene one or more work groups to assist in 
30.17 	establishing these definitions. Each work group shall include members appointed by 
30.18 	statewide associations representing relevant health care providers and health plan 
30.19 	companies, and organizations that work to improve health care quality in Minnesota.
30.20 	(c) The baskets of care shall incorporate a patient-directed, decision-making support 
30.21 	model.
30.22 	(d) The commissioner shall submit recommendations to the Legislative Commission 
30.23 	on Health Care Access on establishing a uniform definition of a basket of total cost of care.
30.24 		Subd. 2.Package prices. (a) Beginning January 1, 2010, health care providers may 
30.25 	establish package prices for the baskets of care defined under subdivision 1.
30.26 	(b) Beginning January 1, 2010, no health care provider or group of providers that has 
30.27 	established a package price for a basket of care under this section shall vary the payment 
30.28 	amount that the provider accepts as full payment for a health care service based upon the 
30.29 	identity of the payer, upon a contractual relationship with a payer, upon the identity of 
30.30 	the patient, or upon whether the patient has coverage through a group purchaser. This 
30.31 	paragraph applies only to health care services provided to Minnesota residents or to 
30.32 	non-Minnesota residents who obtain health insurance through a Minnesota employer. This 
30.33 	paragraph does not apply to a variation based upon a payer being a governmental entity, 
30.34 	to workers' compensation, or no-fault automobile insurance payments. This paragraph 
30.35 	does not affect the right of a provider to provide charity care or care for a reduced price 
31.1 	due to financial hardship of the patient or due to the patient being a relative or friend 
31.2 	of the provider. 
31.3 		Subd. 3.Quality measurements for baskets of care. (a) The commissioner shall 
31.4 	establish quality measurements for the defined baskets of care by December 31, 2009. 
31.5 	The commissioner may contract with an organization that works to improve health care 
31.6 	quality to make recommendations about the use of existing measures or establishing new 
31.7 	measures where no measures currently exist.
31.8 	(b) Beginning July 1, 2010, the commissioner shall publish comparative price 
31.9 	and quality information on the baskets of care in a manner that is easily accessible and 
31.10 	understandable to the public, as this information becomes available.

31.11 	Sec. 10. [62U.08] COORDINATION; LEGISLATIVE OVERSIGHT ON 
31.12 	PAYMENT RESTRUCTURING.
31.13 		Subdivision 1.Coordination. In carrying out the responsibilities of this chapter, the 
31.14 	commissioner of health shall ensure that the activities and data collection are implemented 
31.15 	in an integrated and coordinated manner that avoids unnecessary duplication of effort. 
31.16 	To the extent possible, the commissioner shall use existing data sources and implement 
31.17 	methods to streamline data collection in order to reduce public and private sector 
31.18 	administrative costs.
31.19 		Subd. 2.Legislative oversight. Beginning December 1, 2008, the commissioner 
31.20 	of health shall submit to the Legislative Commission on Health Care Access periodic 
31.21 	progress reports on the implementation of this chapter and sections 256B.0751 to 
31.22 	256B.0753 that includes, but is not limited to, the following:
31.23 	(1) the standardized set of measures that are to be used to access the quality of health 
31.24 	care services offered by health care providers developed under section 62U.04;
31.25 	(2) the identification of the evidence supporting each measure developed under 
31.26 	section 62U.04 as an effective method of improving the quality of patient care;
31.27 	(3) the contract terms and the identity of the consortium if the commissioner 
31.28 	contracts with a private entity or consortium of private entities as permitted under sections 
31.29 	62U.04 and 62U.06;
31.30 	(4) methodology for peer grouping of providers under section 62U.06, subdivision 3;
31.31 	(5) methodology for calculating providers' relative cost of care under section 
31.32 	62U.06, subdivision 2; and
31.33 	(6) the uniform definitions of baskets of care under section 62U.07.

31.34 	Sec. 11. [62U.09] AFFORDABILITY STANDARD.
32.1 		Subdivision 1.Definition of affordability. For purposes of this section, coverage is 
32.2 	"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an 
32.3 	individual or family for health coverage does not exceed the applicable percentage of the 
32.4 	individual or family's gross monthly income specified in subdivision 2.
32.5 		Subd. 2.Affordability standard. The following affordability standard is 
32.6 	established for individuals and households with gross family incomes of 400 percent 
32.7 	of the federal poverty guidelines or less:

32.8
32.9	Federal Poverty Guideline Range
	Percent of Average Gross Monthly 
Income
	
32.10	0-45%
	minimum
	
32.11	46-54%
	1.1%
	
32.12	55-81%
	1.4%
	
32.13	82-109%
	1.9%
	
32.14	110-136%
	2.6%
	
32.15	137-164%
	3.4%
	
32.16	165-191%
	4.4%
	
32.17	192-219%
	5.2%
	
32.18	220-248%
	5.9%
	
32.19	249-274%
	6.5%
	
32.20	275-300%
	7.0%
	
32.21	301-325%
	7.7%
	
32.22	326-350%
	8.4%
	
32.23	351-375%
	9.2%
	
32.24	376-400%
	10.0%
	
32.25 		Subd. 3.Application. The affordability standard in this section shall apply only 
32.26 	to subsidies under the MinnesotaCare program and the employee subsidy program 
32.27 	established under section 62U.10. Nothing in this section shall be construed to limit or 
32.28 	restrict the percentage of premiums, deductibles, and other out-of-pocket costs paid by an 
32.29 	individual or family in the private commercial health care coverage market.

32.30 	Sec. 12. [62U.10] EMPLOYEE SUBSIDIES FOR HEALTH COVERAGE.
32.31 		Subdivision 1.Development of subsidy program. The commissioner of health, in 
32.32 	coordination with the commissioner of human services, shall develop a plan and submit 
32.33 	recommendations to the legislature by January 15, 2010, for a subsidy program for 
32.34 	eligible individuals and employees with access to employer-subsidized health coverage. 
32.35 	The plan may include direct subsidies or tax credits and deductions, including refundable 
32.36 	tax credits, or a combination. For purposes of this section, employer-subsidized health 
32.37 	coverage has the meaning provided in section 256L.07, subdivision 2, paragraph (c).
33.1 		Subd. 2.Eligible employees and dependents; incomes not exceeding 300 percent 
33.2 	of federal poverty guidelines. In order to be eligible for a subsidy under this plan, an 
33.3 	employee or dependent with a gross household income that does not exceed 300 percent 
33.4 	of the federal poverty guidelines must:
33.5 	(1) be covered by employer-subsidized health coverage, as defined in section 
33.6 	256L.07, subdivision 2, paragraph (c), that meets the value-based benefit set and design 
33.7 	requirements established under section 62U.02; and
33.8 	(2) meet all eligibility criteria for the MinnesotaCare program established under 
33.9 	chapter 256L, except for the requirements related to:
33.10 	(i) no access to employer-subsidized coverage under section 256L.07, subdivision 
33.11 	2; and
33.12 	(ii) no other health coverage under section 256L.07, subdivision 3.
33.13 		Subd. 3.Eligible individuals, employees and dependents; incomes greater than 
33.14 	300 percent but not exceeding 400 percent of federal poverty guidelines. In order to be 
33.15 	eligible for a subsidy under this plan, an individual, employee, or dependent with a gross 
33.16 	household income that is greater than 300 percent but does not exceed 400 percent of the 
33.17 	federal poverty guidelines must:
33.18 	(1) purchase or be covered by health coverage that meets the value-based benefit set 
33.19 	and design requirements established under section 62U.02; and
33.20 	(2) meet all eligibility criteria for the MinnesotaCare program established under 
33.21 	chapter 256L, except for the requirements related to:
33.22 	(i) no access to employer-subsidized coverage under section 256L.07, subdivision 2;
33.23 	(ii) no other health coverage under section 256L.07, subdivision 3; and
33.24 	(iii) gross household income under section 256L.04, subdivisions 1 and 7.
33.25 		Subd. 4.Amount of subsidy. The subsidy included in this plan must equal the 
33.26 	amount the individual or employee is required to pay for health coverage for the employee 
33.27 	and any dependents, including  premiums, deductibles, and other cost sharing, minus an 
33.28 	amount based on the affordability standard specified in section 62U.09. The maximum 
33.29 	subsidy must not exceed the amount of the subsidy that would have been provided under 
33.30 	the MinnesotaCare program, if the individual or employee and any dependents were 
33.31 	eligible for that program.
33.32 		Subd. 5.Payment of subsidy. The subsidy amount under this plan for an individual 
33.33 	or employee and any dependents to the individual's or employee's health plan company, 
33.34 	shall be credited toward the individual's or employee's share of premium. Any additional 
33.35 	amount paid to the individual's or employee's health plan company that exceeds the 
34.1 	individual's or employee's share of premium must be credited first toward the individual's 
34.2 	or employee's deductible and then toward any other cost-sharing obligation.

34.3 	Sec. 13. [62U.11] PROJECTED AND ACTUAL HEALTH CARE SPENDING.
34.4 		Subdivision 1.Projected spending baseline. (a) The commissioner of health shall 
34.5 	calculate the annual projected total health care spending for the state and establish a health 
34.6 	care spending baseline beginning for the calendar year 2008 and for the next ten years 
34.7 	based on the annual projected growth in spending. 
34.8 	(b) In establishing the health care spending baseline, the commissioner shall use the 
34.9 	Center for Medicare and Medicaid Services forecast for total growth in national health 
34.10 	care expenditures, and adjust this forecast to reflect the demographics, health status, and 
34.11 	other factors deemed necessary by the commissioner. The commissioner shall contract 
34.12 	with an actuarial consultant to make recommendations as to the adjustments needed to 
34.13 	specifically reflect projected spending for Minnesota residents.
34.14 	(c) On an annual basis, the commissioner may adjust the projected baseline as 
34.15 	necessary to reflect any updated federal projections or account for unanticipated changes 
34.16 	in federal policy.
34.17 	(d) Medicare and long-term care spending must not be included in the calculations 
34.18 	required under this section.
34.19 		Subd. 2.Actual spending. By February 15 of each year, beginning February 
34.20 	15, 2010, the commissioner shall determine the actual private and public health care 
34.21 	expenditures for the calendar year two years prior to the current calendar year based on 
34.22 	data collected under chapter 62J and shall determine the difference between the projected 
34.23 	spending as determined under subdivision 1 and the actual spending for that year. The 
34.24 	actual spending must be certified by an independent actuarial consultant.
34.25 		Subd. 3.Publication of spending. By February 15 of each year, beginning 
34.26 	February 15, 2010, the commissioner shall publish in the State Register the projected 
34.27 	spending baseline, including any adjustments, and the actual spending for the calendar 
34.28 	year two years prior to the current calendar year.

34.29 	Sec. 14. [62U.12] HEALTH CARE REFORM REVIEW COUNCIL.
34.30 		Subdivision 1.Establishment. The Health Care Reform Review Council is 
34.31 	established for the purpose of periodically reviewing the progress of implementation of 
34.32 	this chapter and sections 256B.0751 to 256B.0753.
34.33 		Subd. 2.Members. (a) The Health Care Reform Review Council shall consist of 
34.34 	ten members who are appointed as follows:
35.1 	(1) two members appointed by the Minnesota Medical Association, at least one 
35.2 	of whom must represent rural physicians; 
35.3 	(2) one member appointed by the Minnesota Nurses Association;
35.4 	(3) two members appointed by the Minnesota Hospital Association, at least one of 
35.5 	whom must be a rural hospital administrator;
35.6 	(4) one member appointed by the Minnesota Academy of Physician Assistants;
35.7 	(5) one member appointed by the Minnesota Business Partnership;
35.8 	(6) one member appointed by the Minnesota Chamber of Commerce;
35.9 	(7) one member appointed by the SEIU Minnesota State Council; and
35.10 	(8) one member appointed by the AFL-CIO.
35.11 	(b) If a member is no longer able or eligible to participate, a new member shall be 
35.12 	appointed by the entity that appointed the outgoing member.
35.13 		Subd. 3.Operations of council. (a) The commissioner of health shall convene the 
35.14 	first meeting of the council on or before January 15, 2009, following the initial appointment 
35.15 	of the members and the advisory council must meet at least quarterly thereafter.
35.16 	(b) The council is governed by section 15.059, except that members shall not receive 
35.17 	per diems and the council does not expire.
35.18 	(c) The commissioner of health shall provide staff, administrative support, and 
35.19 	office space to the council.
35.20 		Subd. 4.Responsibilities of council. The council shall periodically review the 
35.21 	implementation of this chapter and sections 256B.0571 to 256B.0573, including but 
35.22 	not limited to:
35.23 	(1) the development and implementation of certification, process, outcome, and 
35.24 	quality standards for health care homes;
35.25 	(2) development and implementation of payment restructuring and payment reform 
35.26 	under sections 62U.04, 62U.05, 62U.06, and 62U.07; and
35.27 	(3) development of the plan and recommendations for providing subsidies to 
35.28 	employees for health coverage under section 62U.10.

35.29 	Sec. 15. [62U.13] SECTION 125 PLANS.
35.30 		Subdivision 1.Definitions. For purposes of this section, the following terms have 
35.31 	the meanings given them.
35.32 	(a) "Employee" means an employee currently on an employer's payroll other than a 
35.33 	retiree or disabled former employee.
36.1 	(b) "Employer" means a person, firm, corporation, partnership, association, business 
36.2 	trust, or other entity employing one or more persons, including a political subdivision of 
36.3 	the state, filing payroll tax information on the employed person or persons.
36.4 	(c) "Section 125 Plan" means a cafeteria or premium-only plan under section 125 of 
36.5 	the Internal Revenue Code that allows employees to pay for health coverage premiums 
36.6 	with pretax dollars.
36.7 		Subd. 2.Section 125 Plan requirement. (a) Effective July 1, 2009, all employers 
36.8 	with 11 or more current full-time equivalent employees in this state shall establish and 
36.9 	maintain a Section 125 Plan to allow their employees to purchase individual market or 
36.10 	employer-based health coverage with pretax dollars. Nothing in this section requires 
36.11 	employers to offer or purchase group health coverage for their employees. The following 
36.12 	employers are exempt from the Section 125 Plan requirement:
36.13 	(1) employers that offer a health plan as defined in section 62A.011, subdivision 
36.14 	3, that is group coverage;
36.15 	(2) employers that provide self-insurance as defined in section 62E.02; or
36.16 	(3) employers that have no employees who are eligible to participate in a Section 
36.17 	125 Plan.
36.18 	(b) Notwithstanding paragraph (a), an employer that has been certified by a licensed 
36.19 	insurance producer as having received education and information on the benefits and 
36.20 	advantages of offering Section 125 Plans is not required to establish a Section 125 Plan 
36.21 	and may opt out of the requirement to establish a Section 125 Plan by sending a form to 
36.22 	the commissioner of commerce. The commissioner of commerce shall create a simple 
36.23 	check-box form for employers to opt out. The commissioner of commerce shall make the 
36.24 	form available through their Web site by April 1, 2009.
36.25 		Subd. 3.Employer requirements. (a) Employers that do not offer a health plan as 
36.26 	defined in section 62A.011, subdivision 3, that is group coverage and are required to offer 
36.27 	or choose to offer a Section 125 Plan shall:
36.28 	(1) allow employees to purchase an individual market health plan for themselves 
36.29 	and their dependents;
36.30 	(2) allow employees to choose any insurance producer licensed in accident and health 
36.31 	insurance under chapter 60K to assist them in purchasing an individual market health plan;
36.32 	(3) upon an employee's request, deduct premium amounts on a pretax basis in an 
36.33 	amount not to exceed an employee's wages, and remit these employee payments to the 
36.34 	health plan; and
36.35 	(4) provide written notice to employees that individual market health plans purchased 
36.36 	by employees through payroll deduction are not employer-sponsored or administered.
37.1 	(b) Employers shall be held harmless from any and all claims related to the 
37.2 	individual market health plans purchased by employees under a Section 125 Plan.

37.3 	Sec. 16. [256B.0751] PAYMENT REFORM.
37.4 		Subdivision 1.Quality incentive payments. The commissioner of human services 
37.5 	shall implement quality incentive payments as required under section 62U.04. This does 
37.6 	not limit the ability of the commissioner of human services to establish by contract and 
37.7 	monitor, as part of its quality assurance obligations for state health care programs, outcome 
37.8 	and performance measures for nonmedical services and health issues likely to occur in 
37.9 	low-income populations or racial or cultural groups disproportionately represented in 
37.10 	state health care program enrollment, that would likely be underrepresented when using 
37.11 	traditional measures that are based on longer-term enrollment.
37.12 		Subd. 2.Payment reform. The commissioner of human services shall establish 
37.13 	a payment system to reduce health care costs and improve quality as required under 
37.14 	section 62U.06.

37.15 	Sec. 17. HIGH-DEDUCTIBLE HEALTH PLAN OPTION.
 37.16 	The commissioner of finance shall consider including an option that is compatible 
37.17 	with the definition of a high-deductible health plan in section 223 of the Internal Revenue 
37.18 	Code in the health insurance benefit plans offered under the managerial plan in Minnesota 
37.19 	Statutes, section 43A.18, subdivision 3.

37.20 	Sec. 18. STUDY OF UNIFORM CLAIMS REVIEW PROCESS.
 37.21 	The commissioner of health shall establish a work group including representatives 
37.22 	of the Minnesota Hospital Association, Minnesota Medical Association, and Minnesota 
37.23 	Council of Health Plans to make recommendations on the potential for reducing claims 
37.24 	adjudication costs of health care providers and health plan companies by adopting more 
37.25 	uniform payment methods, and the potential impact of establishing uniform prices that 
37.26 	would replace current prices negotiated individually by providers with separate payers. 
37.27 	The work group shall make its recommendations to the commissioner by January 1, 2010, 
37.28 	and shall identify specific action steps needed to achieve the recommendations.

37.29 	ARTICLE 5
37.30 	APPROPRIATIONS

37.31	Section 1. SUMMARY OF APPROPRIATIONS.
 	
38.1 	The amounts shown in this section summarize direct appropriations, by fund, made 
38.2 	in this article.

38.3					2009
		Total
	
38.4	General Fund
			$
	403,000
	$
	403,000
	
38.5	Health Care Access Fund
		12,883,000
		12,883,000
	
38.6	Total
			$
	13,286,000
	$
	13,286,000

38.7	Sec. 2. HEALTH AND HUMAN SERVICES APPROPRIATIONS.
 	
38.8 	The sums shown in the columns marked "Appropriations" are added to or, if 
38.9 	shown in parentheses, subtracted from the appropriations in Laws 2007, chapter 147, 
38.10 	article 19, or other law to the agencies and for the purposes specified in this article. The 
38.11 	appropriations are from the general fund, or another named fund, and are available for 
38.12 	the fiscal year indicated for each purpose. The figure "2009" used in this article means 
38.13 	that the addition to or subtraction from the appropriation listed under it is available for the 
38.14 	fiscal year ending June 30, 2009. 

38.15				APPROPRIATIONS
	
38.16				Available for the Year
	
38.17				Ending June 30
	
38.18							2009

38.19	Sec. 3. HUMAN SERVICES

38.20	Subdivision 1.Total Appropriation
 			$
	6,175,000

38.21	Appropriations by Fund
	
38.22			2009
	
38.23	General
		1,227,000
	
38.24	Health Care Access 
		4,948,000
	
38.25 	The amounts that may be spent for each 
38.26 	purpose are specified in the following 
38.27 	subdivisions.

38.28
38.29	Subd. 2.Children and Economic Assistance 
Management

38.30	Health Care Access
		6,000
	
38.31 	This is a onetime appropriation.

38.32	Subd. 3.Basic Health Care Grants
 					
38.33 	The amounts that may be spent from the 
38.34 	appropriation for each purpose are as follows:

39.1	(a) MinnesotaCare Grants

39.2	Health Care Access
		1,301,000

39.3	(b) Other Health Care Grants

39.4	Health Care Access
		200,000
	
39.5 	Primary Care Physician Rate Increases.
39.6 	(1) Of the general fund appropriation, 
39.7 	$200,000 is to the commissioner for the 
39.8 	medical assistance reimbursement rate 
39.9 	increase described in Minnesota Statutes, 
39.10 	section 256B.766. 
39.11 	(2) Notwithstanding Minnesota Statutes, 
39.12 	section 295.581, the commissioner of finance 
39.13 	shall reimburse the medical assistance 
39.14 	general fund account from the health 
39.15 	care access fund the amount of general 
39.16 	fund expenditures for this activity. The 
39.17 	amount reimbursed under this paragraph is 
39.18 	appropriated to the commissioner.
39.19 	Subsidies for Employer-Subsidized Health 
39.20 	Coverage. For the biennium beginning July 
39.21 	1, 2009, base level funding for the subsidy 
39.22 	program described in Minnesota Statutes, 
39.23 	section 62U.10, shall be $20,000,000 from 
39.24 	the health care access fund for the first year 
39.25 	and $35,000,000 from the health care access 
39.26 	fund for the second year.
39.27 	Base Adjustment. The health care access 
39.28 	fund base is increased by $3,000,000 in fiscal 
39.29 	year 2010 and increased by $5,000,000 in 
39.30 	fiscal year 2011.

39.31	Subd. 4.Health Care Management
 					
39.32 	The amounts that may be spent from the 
39.33 	appropriation for each purpose are as follows:

40.1	(a) Health Care Policy Administration

40.2	General
		1,008,000
	
40.3	Health Care Access
		282,000
	
40.4 	Base Adjustment. The health care access 
40.5 	fund is decreased by $89,000 in fiscal year 
40.6 	2010 and decreased by $272,000 in fiscal 
40.7 	year 2011.
40.8 	Base Adjustment. The general fund base 
40.9 	is decreased by $80,000 in both fiscal years 
40.10 	2010 and 2011.
40.11 	Department of Education Computer 
40.12 	System. $50,000 is from the health care 
40.13 	access fund for the commissioner to enter 
40.14 	into an agreement with the Department 
40.15 	of Education for the modification of the 
40.16 	department's computer system to implement 
40.17 	Minnesota Statutes, section 124D.1115. This 
40.18 	is a onetime appropriation.
40.19 	Public dental coverage program study. (1) 
40.20 	Of the health care access fund appropriation, 
40.21 	$50,000 in fiscal year 2009 is for the 
40.22 	commissioner of human services to 
40.23 	undertake a study to determine whether 
40.24 	alternative approaches to offering dental 
40.25 	coverage to public program enrollees would 
40.26 	result in:
40.27 	(i) improved access to dental care;
40.28 	(ii) cost savings to providers and the 
40.29 	department; and
40.30 	(iii) improved quality and outcomes of care. 
40.31 	Alternatives considered must include moving 
40.32 	to a single dental plan administrator, retaining 
40.33 	the current model, and other innovative 
40.34 	approaches. Issues relating to chronic disease 
41.1 	management, medical and dental interface, 
41.2 	plan payment approaches, and provider 
41.3 	payment should also be addressed. The report 
41.4 	must make a recommendation on whether 
41.5 	to alter the current approach to contracting 
41.6 	for dental services, and include a detailed 
41.7 	plan on how to implement any changes. The 
41.8 	commissioner shall consult with dentists, 
41.9 	safety net dental providers, dental plans, 
41.10 	health plans and county-based purchasing 
41.11 	organizations, patients and advocates, and 
41.12 	other interested parties in developing their 
41.13 	findings and recommendations. 
41.14 	(2) By December 15, 2008, the commissioner 
41.15 	of human services shall report findings and 
41.16 	recommendations to the chairs of the house 
41.17 	of representatives and senate committees 
41.18 	having jurisdiction over health and human 
41.19 	services policy and finance.

41.20	(b) Health Care Operations

41.21	General
		219,000
	
41.22	Health Care Access
		2,355,000
	
41.23 	This is a onetime appropriation.
41.24 	Incentive Program and Outreach Grants.
41.25 	Of the appropriation for the Minnesota health 
41.26 	care outreach program in Laws 2007, chapter 
41.27 	147, article 19, section 3, subdivision 7, 
41.28 	paragraph (b):
41.29 	(1) $400,000 in fiscal year 2009 from the 
41.30 	general fund and $200,000 in fiscal year 2009 
41.31 	from the  health care access fund are for the 
41.32 	incentive  program under Minnesota Statutes, 
41.33 	section  256.962, subdivision 5. For the 
41.34 	biennium  beginning July 1, 2009, base level 
41.35 	funding  for this activity shall be $360,000 
42.1 	from the  general fund and $160,000 from the 
42.2 	health  care access fund; and
42.3 	(2) $100,000 in fiscal year 2009 from the 
42.4 	general fund and $50,000 in fiscal year 2009 
42.5 	from the health care access fund are for the 
42.6 	outreach grants under Minnesota Statutes, 
42.7 	section 256.962, subdivision 2. For the 
42.8 	biennium beginning July 1, 2009, base level 
42.9 	funding for this activity shall be $90,000 
42.10 	from the general fund and $40,000 from the 
42.11 	health  care access fund.
42.12 	Outreach Funding. (1) Of the health care 
42.13 	access fund appropriation, $100,000 is for 
42.14 	the incentive program under Minnesota 
42.15 	Statutes, section 256.962, subdivision 5. 
42.16 	This is in addition to the base level fund 
42.17 	for the biennium beginning July 1, 2009. 
42.18 	For the fiscal year beginning July 1, 2011, 
42.19 	appropriations for this activity shall be from 
42.20 	the health savings reinvestment fund.
42.21 	(2) Notwithstanding Minnesota Statutes, 
42.22 	section 295.581, the commissioner of finance 
42.23 	shall reimburse the medical assistance 
42.24 	general fund account from the health care 
42.25 	access fund by $701,000 in fiscal year 2010 
42.26 	and $1,527,000 in fiscal year 2011 for the 
42.27 	cost to the general fund for the increase in 
42.28 	enrollment to the medical assistance program 
42.29 	for families with children due to the outreach 
42.30 	efforts.
42.31 	Base Adjustment. The health care access 
42.32 	fund base is decreased by $387,000 in fiscal 
42.33 	year 2010 and increased by $642,000 in 
42.34 	fiscal year 2011.

42.35	Subd. 5. Continuing Care Management

43.1	Health Care Access
		804,000
	
43.2 	Long-Term Care Worker Health Coverage 
43.3 	Study. (a) Of the health care access 
43.4 	fund appropriation, $804,000 is for the 
43.5 	commissioner to study and report to the 
43.6 	legislature by December 15, 2008, with 
43.7 	recommendations for a rate increase to 
43.8 	long-term care employers dedicated to the 
43.9 	purchase of employee health insurance in 
43.10 	the private market. The commissioner shall 
43.11 	collect necessary actuarial data, employment 
43.12 	data, current coverage data, and other needed 
43.13 	information.
43.14 	(b) The commissioner shall develop cost 
43.15 	estimates for three levels of insurance 
43.16 	coverage for long-term care workers:
43.17 	(1) the coverage provided to state employees;
43.18 	(2) the coverage provided to MinnesotaCare 
43.19 	enrollees; and
43.20 	(3) the benefits provided under an "average" 
43.21 	private market insurance product, but with a 
43.22 	deductible limited to $100 per person.
43.23 	Premium cost sharing, waiting periods for 
43.24 	eligibility, definitions of full- and part-time 
43.25 	employment, and other parameters under the 
43.26 	three options must be identical to those under 
43.27 	the state employees' health plan.
43.28 	(c) For purposes of this section, a long-term 
43.29 	care worker is a person employed by a 
43.30 	nursing facility, an intermediate care facility 
43.31 	for persons with developmental disabilities, 
43.32 	or a service provider that:
43.33 	(1) is eligible under Laws 2007, chapter 147, 
43.34 	article 7, section 71; and 
44.1 	(2) provides long-term care services.
44.2 	The commissioner may recommend a 
44.3 	different definition of long-term care worker 
44.4 	if this definition presents insurmountable 
44.5 	implementation issues.
44.6 	(d) The recommendations must include 
44.7 	measures to:
44.8 	(1) ensure equitable treatment between 
44.9 	employers that currently have different levels 
44.10 	of expenditure for employee health insurance 
44.11 	costs; and
44.12 	(2) enforce the requirement that the rate 
44.13 	increase be expended for the intended 
44.14 	purpose.
44.15 	This is a onetime appropriation.

44.16	Sec. 4. COMMISSIONER OF HEALTH

44.17	Subdivision 1.Total Appropriation
 			$
	7,111,000

44.18	Appropriations by Fund
	
44.19			2009
	
44.20	Health Care Access 
		7,935,000
	
44.21	General
		(824,000)
	
44.22 	The amounts that may be spent for each 
44.23 	purpose are specified in the following 
44.24 	subdivisions.

44.25
44.26	Subd. 2.Community and Family Health 
Promotion

44.27	Health Care Access 
		152,000
	
44.28 	$152,000 in fiscal year 2009 is for statewide 
44.29 	health saving research and measurement.
44.30 	Statewide Health Improvement Program.
44.31 	The health care access fund base shall be 
44.32 	increased by $19,587,000 in fiscal year 2010 
44.33 	and $26,175,000 in fiscal year 2011 for 
45.1 	grants to local communities in accordance 
45.2 	with Minnesota Statutes, section 145.986, 
45.3 	subdivision 2; $205,000 in fiscal year 2010 
45.4 	and $424,000 in fiscal year 2011 is for 
45.5 	staffing; $22,000 in fiscal year 2010 and 
45.6 	$42,000 in fiscal year 2011 is for operating 
45.7 	costs; $150,000 in fiscal year 2010 and 
45.8 	$300,000 in fiscal year 2011 is for contracts 
45.9 	for evaluation; and $36,000 in fiscal year 
45.10 	2010 and $60,000 in fiscal year 2011 is 
45.11 	for administrative costs. The base for this 
45.12 	program in fiscal year 2012 is $0.

45.13	Subd. 3.Policy, Quality, and Compliance

45.14	Health Care Access
		7,783,000
	
45.15	General
		(824,000)
	
45.16 	Open Door Health Center. Of the health 
45.17 	care access fund appropriation, $350,000 is 
45.18 	to be awarded as a grant to the Open Door 
45.19 	Health Center to act as bridge funding to 
45.20 	meet the demand for health care services 
45.21 	in medically underserved areas. This is a 
45.22 	onetime appropriation.
45.23 	Of this appropriation, $84,000 is for the 
45.24 	commissioner to make recommendations 
45.25 	to the legislature on community benefit 
45.26 	standards to be required of nonprofit health 
45.27 	plan companies doing business in the state. 
45.28 	The expectations of the community benefits 
45.29 	provided and reported should be related to the 
45.30 	statutory expectations in Minnesota Statutes, 
45.31 	sections 62C.01 and 62D.01, and focus on 
45.32 	supporting public health, improving the art 
45.33 	and science of medical care, and addressing 
45.34 	the need for financial assistance to access 
45.35 	ongoing coverage, and not related to general 
46.1 	philanthropic endeavors. The commissioner 
46.2 	shall seek public input regarding the range of 
46.3 	options to be explored and the accountability 
46.4 	measures. 
46.5 	The recommendations must include a 
46.6 	procedure by which each nonprofit health 
46.7 	plan company would periodically and 
46.8 	uniformly report to the state and to the public 
46.9 	regarding the company's compliance with 
46.10 	the requirements.
46.11 	The commissioner shall recommend a fair 
46.12 	and effective enforcement and remediation 
46.13 	mechanism. This is a onetime appropriation.
46.14 	Federally Qualified Health Centers. Of 
46.15 	the health care access fund appropriation, 
46.16 	$2,824,000 is for subsidies to federally 
46.17 	qualified health centers under Minnesota 
46.18 	Statutes, section 145.9269. The health care 
46.19 	access fund base shall be $3,500,000 for 
46.20 	fiscal years 2010 and 2011.
46.21 	The general fund appropriation for this 
46.22 	program shall be reduced by $824,000 for 
46.23 	fiscal year 2009, and by $1,500,000 in both 
46.24 	fiscal years 2010 and 2011.
46.25 	Base Adjustment. The health care 
46.26 	access fund base shall be further reduced 
46.27 	by $4,104,000 in fiscal year 2010 and 
46.28 	$4,323,000 in fiscal year 2011.

46.29 	Sec. 5. SUNSET OF UNCODIFIED LANGUAGE.
 46.30 	All uncodified language contained in this article expires on June 30, 2009, unless a 
46.31 	different expiration date is specified.

46.32 	Sec. 6. EFFECTIVE DATE.
 47.1 	The provisions in this article are effective July 1, 2008, unless a different effective 
47.2 	date is specified.