1.1 	A bill for an act
1.2 	relating to health care; establishing a statewide health improvement program; 
1.3 	monitoring child obesity; establishing a health improvement fund; establishing 
1.4 	a public health improvement assessment; establishing health care homes; 
1.5 	increasing continuity of care; modifying outreach efforts; establishing primary 
1.6 	care education initiatives; increasing affordability and continuity of care 
1.7 	with public health care programs; creating a health insurance exchange; 
1.8 	establishing Section 125 Plans; creating a Health Care Transformation 
1.9 	Commission; restructuring the health care payment system; creating a savings 
1.10 	reinvestment fund; establishing a savings recapture assessment; establishing cost 
1.11 	containment goals; specifying an affordability standard; providing subsidies for 
1.12 	employer-subsidized coverage; requiring providers to list prices; establishing an 
1.13 	electronic prescription drug program; requiring mandated reports; authorizing 
1.14 	rulemaking; appropriating money;amending Minnesota Statutes 2006, sections 
1.15 	13.3806, by adding a subdivision; 62A.65, subdivision 3; 62E.141; 62L.12, 
1.16 	subdivisions 2, 4; 62Q.735, subdivision 1; 256.01, by adding subdivisions; 
1.17 	256B.061; 256B.69, by adding a subdivision; 256D.03, by adding a subdivision; 
1.18 	256L.05, by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision 
1.19 	3; 256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement, 
1.20 	sections 13.46, subdivision 2; 62J.496, by adding a subdivision; 62J.81, 
1.21 	subdivision 1; 62J.82, subdivision 1; 256.962, subdivisions 5, 6; 256B.056, 
1.22 	subdivision 10; 256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7; 256L.05, 
1.23 	subdivision 3a; 256L.07, subdivision 1; 256L.15, subdivision 2; proposing 
1.24 	coding for new law in Minnesota Statutes, chapters 16A; 62J; 145; 256B; 
1.25 	proposing coding for new law as Minnesota Statutes, chapter 62U; repealing 
1.26 	Minnesota Statutes 2006, sections 62A.63; 62A.64; 62Q.49; 62Q.65; 62Q.736; 
1.27 	256L.15, subdivision 3.
1.28 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.29 	ARTICLE 1
1.30 	PUBLIC HEALTH

1.31 	Section 1. [16A.726] HEALTH IMPROVEMENT FUND.
1.32 		Subdivision 1.Health improvement fund. There is created in the state treasury 
1.33 	a public health improvement fund to which must be credited revenue from the health 
2.1 	improvement assessment under section 145.9865. The fund is a direct appropriated special 
2.2 	revenue fund. Notwithstanding section 11A.20, all investment income and all investment 
2.3 	losses attributable to the investment of the health improvement fund not currently needed 
2.4 	shall be credited to the public health improvement fund.
2.5 		Subd. 2.Fund reimbursements. Money in the health improvement fund shall be 
2.6 	appropriated for the statewide health improvement program under section 145.986.

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

4.12 	Sec. 3. [145.9865] PUBLIC HEALTH IMPROVEMENT ASSESSMENT.
4.13 		Subdivision 1. Hospital assessment. (a) By June 1, 2009, each Minnesota hospital, 
4.14 	except facilities of the federal Indian Health Service and regional treatment centers, 
4.15 	shall contribute ... percent of net patient revenue excluding net Medicare and Medicaid 
4.16 	revenues for calendar year 2008 as reported by that hospital to the health care cost 
4.17 	information system under section 144.698 to the health improvement fund established 
4.18 	under section 16A.726.
4.19 	(b) By June 1, 2010, and each June 1 thereafter, each Minnesota hospital, except 
4.20 	facilities of the federal Indian Health Service and regional treatment centers, shall 
4.21 	contribute an equal percentage, as determined by the commissioner, of net patient revenue 
4.22 	excluding net Medicare and Medicaid revenues for the previous calendar year as reported 
4.23 	by that hospital to the health care cost information system to the health improvement fund. 
4.24 	The commissioner shall annually adjust this percentage to ensure a total of $40,000,000 
4.25 	in annual contributions from hospitals under this subdivision and nonprofit health plan 
4.26 	companies under subdivision 2.
4.27 	(c) The commissioner shall notify each hospital by May 1 of each year of the 
4.28 	contribution due by June 1. If for any year, data needed to determine actual net patient 
4.29 	revenue for the previous calendar year is not available in time to determine the contribution 
4.30 	due, the commissioner may estimate net patient revenue for the purposes of this section 
4.31 	until actual data is available, and any necessary adjustments shall be made.
4.32 	(d) The contributions shall be collected by the commissioner and deposited in the 
4.33 	health improvement fund established under section 16A.726. Any contributions under 
4.34 	this section may be applied toward a hospital's community benefit as reported under 
4.35 	section 144.669.
5.1 		Subd. 2.Health plan company assessment.  (a) By June 1, 2009, each nonprofit 
5.2 	health plan company shall contribute ... percent of the total premium revenues of the 
5.3 	nonprofit health plan company for calendar year 2008 as reported to the commissioner.
5.4 	(b) By June 1, 2010, and each June 1 thereafter, each nonprofit health plan company 
5.5 	shall contribute an equal percentage, as determined by the commissioner, of the total 
5.6 	premium revenues of the nonprofit health plan company for the previous calendar year. 
5.7 	The commissioner shall annually adjust this percentage to ensure a total of $40,000,000 
5.8 	in annual contributions from nonprofit health plan companies under this subdivision 
5.9 	and hospitals under subdivision 1.
5.10 	(c) The commissioner shall notify each nonprofit health plan company by May 1 
5.11 	of each year of the contribution due by June 1. If for any year, data needed to determine 
5.12 	actual total premium revenue for the previous calendar year is not available in time to 
5.13 	determine the contribution due, the commissioner may estimate total premium revenue for 
5.14 	the purposes of this section until actual data is available, and any necessary adjustments 
5.15 	shall be made.
5.16 	(d) The contributions shall be collected by the commissioner and deposited in the 
5.17 	health improvement fund established under section 16A.726. Any contributions under 
5.18 	this section may be applied toward a nonprofit health plan company's community benefit 
5.19 	requirements.
5.20 	(e) For purposes of this subdivision, total premium revenue means:
5.21 	(1) premium revenue recognized on a prepaid basis from individuals and groups 
5.22 	for provision of a specified range of health services over a defined period of time which 
5.23 	is normally one month, excluding premiums paid to a nonprofit health plan company 
5.24 	from the Federal Employees Health Benefit Program and revenues received from the 
5.25 	Department of Human Services for state health care programs; and
5.26 	(2) premiums from Medicare wrap-around subscribers for health benefits which 
5.27 	supplement Medicare coverage.
5.28 	(f) For purposes of this section, "nonprofit health plan company" includes a health 
5.29 	maintenance organization operating under chapter 62D and a nonprofit health service plan 
5.30 	corporation operating under chapter 62C.
5.31 		Subd. 3.Expiration. This section expires July 1, 2013.

5.32 	Sec. 4. [145.987] BMI MONITORING IN CHILDREN AND YOUTH.
5.33 	By July 1, 2009, the commissioner of health shall establish and implement a 
5.34 	program to monitor the trends of children who are overweight and obese in the state by 
5.35 	collecting and analyzing Body Mass Index data. The commissioner must not collect or 
6.1 	use data on individuals as defined in section 13.02, subdivision 5. To the extent possible, 
6.2 	in establishing this Body Mass Index monitoring program, the commissioner shall use 
6.3 	existing child and youth monitoring systems or surveys. The Body Mass Index data 
6.4 	collected shall be used to measure progress in reducing the percentage of overweight 
6.5 	and obese children in the state, and shall be used to accurately target intervention and 
6.6 	prevention services throughout the state. To the extent necessary for implementation and 
6.7 	analysis, the Department of Health may share data collected under this program with the 
6.8 	Department of Education, consistent with the requirements in Minnesota Statutes, chapter 
6.9 	13. Analysis of the data collected and trends of children who are overweight and obese 
6.10 	shall be reported annually to the legislature by the commissioner of health, beginning 
6.11 	January 15, 2011.

6.12 	Sec. 5. APPROPRIATION.
 6.13 	(a) $20,000,000 is appropriated in fiscal year 2009 from the health improvement 
6.14 	fund to the commissioner of health for the statewide health improvement plan in 
6.15 	Minnesota Statutes, section 145.986. Subject to the availability of funding, beginning 
6.16 	January 1, 2009, the commissioner of health shall make grants to community health boards 
6.17 	to implement local public health programs.
6.18 	(b) $40,000,000 is appropriated in fiscal year 2010, and annually thereafter, from 
6.19 	the health improvement fund to the commissioner of health for the statewide health 
6.20 	improvement plan in Minnesota Statutes, section 145.986.

6.21 	ARTICLE 2
6.22 	HEALTH CARE HOMES

6.23 	Section 1. [256B.0431] ENROLLEE REQUIREMENTS RELATED TO HEALTH 
6.24 	CARE HOMES.
6.25 		Subdivision 1.Selection of primary care clinic. The commissioner, beginning 
6.26 	January 1, 2009, shall require state health care program enrollees eligible for services 
6.27 	under the fee-for-service system to select a primary care clinic or medical group, within 
6.28 	two months of enrollment. The commissioner, beginning July 1, 2009, shall encourage 
6.29 	enrollees who have a complex or chronic condition to select a primary care clinic or 
6.30 	medical group at which clinicians have been certified as health care homes under section 
6.31 	256B.0751, subdivision 3. The commissioner and county social service agencies shall 
6.32 	provide enrollees with lists of primary care clinics, medical groups, and clinicians certified 
6.33 	as health care homes, and shall establish a toll-free number to provide enrollees with 
6.34 	assistance in choosing a clinic, medical group, or health care home.
7.1 		Subd. 2.Initial health assessment. The commissioner shall encourage state health 
7.2 	care program enrollees eligible for services under the fee-for-service system to complete an 
7.3 	initial health assessment at their selected primary care clinic or medical group, within one 
7.4 	month of selection, in order to identify individuals with, or who are at risk of developing, 
7.5 	complex or chronic health conditions, and to identify preventive health care needs.
7.6 		Subd. 3.Education and outreach. The commissioner, beginning January 1, 2009, 
7.7 	shall provide patient education and outreach to state health care program enrollees and 
7.8 	potential applicants related to the importance of choosing a primary care clinic or medical 
7.9 	group and a health care home. Education and outreach must be targeted to underserved or 
7.10 	special populations.
7.11 		Subd. 4.State health care program.  For purposes of this section, "state health 
7.12 	care program" means the medical assistance, MinnesotaCare, and general assistance 
7.13 	medical care programs.

7.14 	Sec. 2. [256B.0751] HEALTH CARE HOMES; DEFINITIONS; 
7.15 	ESTABLISHMENT.
7.16 		Subdivision 1.Definitions. (a) For purposes of sections 256B.0751 to 256B.0754, 
7.17 	the following definitions apply.
7.18 	(b) "Commissioner" means the commissioner of human services.
7.19 	(c) "Commissioners" means the commissioner of human services and the 
7.20 	commissioner of health acting jointly.
7.21 	(d) "State health care program" means the medical assistance, MinnesotaCare, or 
7.22 	general assistance medical care programs.
7.23 		Subd. 2.Establishment of health care homes. The commissioners shall establish 
7.24 	health care homes for all state health care program enrollees, beginning first with 
7.25 	enrollees who have, or are at risk of developing, complex or chronic health conditions. In 
7.26 	establishing health care homes, the commissioners shall consider, and when appropriate 
7.27 	incorporate, features of the medical home model developed for the primary care 
7.28 	coordination (provider-directed care coordination) program authorized under section 
7.29 	256B.0625, subdivision 51.
7.30 		Subd. 3.Certification. The commissioners shall begin certification of individual 
7.31 	clinicians, who participate as providers in state health care programs and meet the 
7.32 	requirements of section 256B.0752, as health care homes, by July 1, 2009. Clinicians may 
7.33 	enter into collaborative agreements with other clinicians to develop the components of a 
7.34 	health care home. Clinician certification as a health care home is voluntary. Clinicians 
8.1 	certified as health care homes must renew their certification annually, in order to maintain 
8.2 	their status as health care homes.

8.3 	Sec. 3. [256B.0752] HEALTH CARE HOME REQUIREMENTS.
8.4 		Subdivision 1.Requirement. In order to be certified as a health care home, a 
8.5 	clinician must meet the criteria specified in this section.
8.6 		Subd. 2.Patient-provider relationship; care teams. (a) Each patient of a health 
8.7 	care home must have an ongoing, long-term relationship with a primary care provider 
8.8 	trained as a personal clinician to provide first contact, continuous, and comprehensive 
8.9 	care for all of a patient's health care needs. Appropriate specialists and other health care 
8.10 	professionals who do not practice in a traditional primary care field, and advanced practice 
8.11 	registered nurses, must be allowed to serve as personal clinicians, if they provide care 
8.12 	according to this section.
8.13 	(b) Care must be provided using an interdisciplinary team of individuals who 
8.14 	collectively take responsibility for the ongoing care of patients, and who practice to the 
8.15 	full extent of their license. The interdisciplinary team must include two patient or parent 
8.16 	partners as team members.
8.17 		Subd. 3.Care coordination. The personal clinician and the team are responsible 
8.18 	for providing for all the patient's health care needs or for arranging appropriate care with 
8.19 	other qualified professionals, as part of a whole-person orientation. Health care must be 
8.20 	coordinated across all provider types, all care locations, and the greater community. This 
8.21 	requirement applies to care for all stages of life, including preventive care, acute care, 
8.22 	chronic care, and end-of-life care. Care coordination must include ongoing planning 
8.23 	to prepare for patient transitions across different types of care and provider types. The 
8.24 	primary care team must also coordinate with those providing for the social service needs 
8.25 	of the individual, if this is necessary to ensure a successful health outcome.
8.26 		Subd. 4.Care delivery. (a) A health care home must provide or arrange for access 
8.27 	to care 24-hours a day, seven days a week.
8.28 	(b) Health care homes must encourage the patient and when authorized and 
8.29 	appropriate, the family to actively participate in decision making and in health care home 
8.30 	quality improvement initiatives, as a full member of the primary care team. Health care 
8.31 	homes must consider patients and families as partners in decision making, and must 
8.32 	provide access to a patient-directed, decision-making process, including appropriate 
8.33 	decision aids, when available.
8.34 	(c) Care delivery must be facilitated by the use of health information technology and 
8.35 	through systematic patient follow-up using internal clinic patient registries.
9.1 	(d) Care must be provided in a culturally and linguistically appropriate manner.
9.2 	(e) Within the context of a system of continuous quality improvement, care 
9.3 	delivery, whenever possible, must be based on evidence-based medicine and use clinical 
9.4 	decision-support tools.
9.5 	(f) A health care home must provide enhanced access to care, using methods such 
9.6 	as open scheduling, expanded hours, and new communication methods, such as e-mail, 
9.7 	phone consultations, and e-consults.
9.8 		Subd. 5.Quality of care. Health care homes must meet process, outcome, and 
9.9 	quality standards as developed and specified by the commissioners. Health care homes 
9.10 	must measure and publicly report all data necessary for the commissioners to monitor 
9.11 	compliance with these standards.
9.12 		Subd. 6.Comprehensive health assessment. Health care homes must encourage 
9.13 	enrollees to complete a comprehensive health assessment for each enrollee determined, by 
9.14 	the initial health assessment under section 256B.0431, subdivision 2, to have, or be at risk 
9.15 	of developing, a complex or chronic health condition. Health care homes must develop 
9.16 	and implement a comprehensive care plan to manage complex or chronic conditions based 
9.17 	upon the comprehensive health assessment and other information. The comprehensive 
9.18 	care plans must meet criteria specified by the commissioners.
9.19 		Subd. 7.Care coordinators. Health care homes must employ care coordinators to 
9.20 	manage the care provided to patients with complex or chronic conditions specified by the 
9.21 	commissioners. Care coordinators may be social workers, nurses, or other clinicians. Care 
9.22 	coordinators are responsible for:
9.23 	(1) identifying patients with complex or chronic conditions eligible for care 
9.24 	coordination;
9.25 	(2) assisting primary care providers in care coordination and education;
9.26 	(3) helping patients coordinate their care or access needed services, including 
9.27 	preventive care;
9.28 	(4) communicating the care needs and concerns of the patient to the health care 
9.29 	home; and
9.30 	(5) collecting data on process and outcome measures.

9.31 	Sec. 4. [256B.0753] CARE COORDINATION FEE.
9.32 		Subdivision 1.Care coordination fee. (a) The commissioner shall pay each health 
9.33 	care home a per-person per-month care coordination fee for providing care coordination 
9.34 	services. The fee must be paid for each fee-for-service state health care program enrollee 
10.1 	eligible for a health care home, who is served by a personal clinician certified as a health 
10.2 	care home.
10.3 	(b) Payment of the care coordination fee is contingent on the health care home 
10.4 	meeting the criteria specified in this section. The care coordination fee is in addition to 
10.5 	reimbursement received by a health care home under the medical assistance fee-for-service 
10.6 	payment system for health care services.
10.7 		Subd. 2.Amount of fee. The care coordination fee must not exceed an average 
10.8 	of $50 per person per month. The care coordination fee must be determined by the 
10.9 	commissioner, and must vary by thresholds of care complexity that include the additional 
10.10 	time and resources needed for patients with limited English language skills, cultural 
10.11 	differences, or other barriers to health care, with the highest fees being paid for care 
10.12 	provided to individuals requiring the most intensive care coordination, such as those with 
10.13 	very complex health care needs or several chronic conditions.
10.14 		Subd. 3.Cost neutrality. The commissioner may reduce payment rates for 
10.15 	nonprimary care services, if initial savings from implementation of health care homes are 
10.16 	not sufficient to allow implementation of the care coordination fee in a cost-neutral manner.

10.17 	Sec. 5. [256B.0754] DUTIES OF THE COMMISSIONERS.
10.18 		Subdivision 1.Establishment of certification standards and other criteria. (a) 
10.19 	The commissioners, by January 1, 2009, shall establish certification standards for health 
10.20 	care homes consistent with the criteria in section 256B.0752.
10.21 	(b) The commissioners, by January 1, 2009, shall develop care complexity thresholds 
10.22 	and payment amounts for the care coordination fee established under section 256B.0753.
10.23 	(c) The commissioners, by January 1, 2009, shall identify criteria to determine 
10.24 	enrollees eligible for and in need of care coordination, and who would benefit from having 
10.25 	a comprehensive care plan for their condition.
10.26 	(d) The commissioners, by January 1, 2009, shall establish criteria and data 
10.27 	collection procedures for evaluating health care homes.
10.28 	(e) The commissioners, by January 1, 2009, shall develop health care home 
10.29 	requirements for managed care plan contracts, performance incentives, and withholds, 
10.30 	and shall develop the methodology for identifying and recapturing managed care savings 
10.31 	resulting from implementation of the health care home model.
10.32 		Subd. 2.Monitoring and evaluation. The commissioners shall ensure the 
10.33 	collection from health care homes of data necessary to monitor implementation of the 
10.34 	health care home model, measure and evaluate quality of care and outcomes, measure 
10.35 	and evaluate patient experience, and determine cost savings from implementation of 
11.1 	the health care home model. The commissioners shall collect and evaluate this data 
11.2 	directly, but may contract with an appropriate private sector entity for technical assistance. 
11.3 	The commissioners shall provide health care homes with practice profiles measuring 
11.4 	utilization, cost, and quality.
11.5 		Subd. 3.Care Coordination Advisory Committee. (a) The commissioners, 
11.6 	by July 1, 2008, shall establish a Care Coordination Advisory Committee to assist 
11.7 	the Departments of Human Services and Health in administering the health care home 
11.8 	model, developing the criteria and standards required under subdivision 1, collecting data, 
11.9 	and measuring and evaluating health outcomes and cost savings.  The commissioners 
11.10 	may satisfy this requirement by designating the advisory committee established for the 
11.11 	provider-directed care coordination (primary care coordination) program as the committee 
11.12 	meeting the requirements of this subdivision. If the commissioners make this designation, 
11.13 	they must notify the chairs of the legislative committees with jurisdiction over health care 
11.14 	policy and finance within ten days following the determination.
11.15 	(b)  If the commissioners elect to establish a new committee, they must select 
11.16 	representatives from: primary care and specialist physicians, advanced practice registered 
11.17 	nurses, patients and their families, health plans, the Institute for Clinical Systems 
11.18 	Improvement, Minnesota Community Measurement, and other relevant entities.
11.19 	(c) The commissioners, or their designee, must convene the first meeting of the 
11.20 	Care Coordination Advisory Committee within 30 days after the completion of the 
11.21 	appointments under paragraph (b) or designating the existing provider-directed Care 
11.22 	Coordination Committee under paragraph (a).
11.23 	(d) The members of the Care Coordination Advisory Committee may not receive 
11.24 	compensation or expenses under section 15.059 for their service on the committee.
11.25 	(e) The commissioners must provide the committee with necessary staff support and 
11.26 	meeting space for the operation of the committee.
11.27 	(f) Notwithstanding section 15.059, the committee expires June 30, 2013.
11.28 		Subd. 4.Health care home collaborative. The commissioners, by July 1, 2009, 
11.29 	shall establish a health care home collaborative to provide an opportunity for health care 
11.30 	homes and state agencies to exchange information related to quality improvement and 
11.31 	best practices.
11.32 		Subd. 5.Patient-directed, decision-making process. By January 1, 2009, 
11.33 	the commissioners, in consultation with the Care Coordination Advisory Committee 
11.34 	and the Institute of Clinical Systems Improvement, shall develop a patient-directed, 
11.35 	decision-making support model to be used by health care homes. The commissioners shall:
12.1 	(1) establish protocols that include identifying the use of a patient-directed, 
12.2 	decision-making process and incorporating effectively the use of patient-decision aids, 
12.3 	when appropriate;
12.4 	(2) ensure the quality of the patient-decision aids available to the patient;
12.5 	(3) ensure accessibility of the patient-decision aids, including the use of translators, 
12.6 	when necessary; and
12.7 	(4) ensure that providers are trained to use patient-decision aids effectively.
12.8 		Subd. 6.Annual reports. Beginning January 15, 2009, and each January 15 
12.9 	thereafter, the commissioners shall report to the chairs of the legislative committees 
12.10 	with jurisdiction over health care policy and finance regarding the implementation and 
12.11 	administration of the health care home model for state health care program enrollees in 
12.12 	both the fee-for-service and managed care sectors. The report must include information 
12.13 	on the number of state health care program enrollees in health care homes, the number 
12.14 	and characteristics of enrollees with complex or chronic conditions, the number and 
12.15 	geographic distribution of health care home providers, the performance and quality of care 
12.16 	of health care homes, measures of preventive care, costs related to implementation and 
12.17 	payment of care coordination fees, health care home payment arrangements for managed 
12.18 	care plans, and estimates of savings from implementation of the health care home model 
12.19 	for both the fee-for-service and managed care sectors relative to the health care spending 
12.20 	baseline calculated under section 62U.13.

12.21 	Sec. 6. Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision 
12.22 	to read:
12.23 		Subd. 29.Health care home model. (a) The commissioner shall require managed 
12.24 	care plans, as a condition of contract, to adopt by July 1, 2009, a health care home 
12.25 	model for providing care to state health care program enrollees who have or are at risk 
12.26 	of developing a complex or chronic health condition. The health care home model must 
12.27 	meet the criteria specified in this section and section 256B.0752. The commissioner, in 
12.28 	consultation with the commissioner of health, may waive or modify criteria for managed 
12.29 	care plans, if the commissioners determine that performance and quality standards would 
12.30 	still be met.
12.31 	(b) The commissioners shall require managed care plans to: (1) collect from 
12.32 	health care homes data necessary to monitor implementation of the health care home 
12.33 	model, measure and evaluate quality of care and outcomes, measure and evaluate 
12.34 	patient experience, and determine cost-savings from implementation of the health care 
12.35 	home model; and (2) submit this data to the commissioners. The commissioners shall 
13.1 	provide managed care plans and their health care homes with practice profiles measuring 
13.2 	utilization, cost, and quality.
13.3 	(c) The commissioner, beginning July 1, 2009, shall provide a performance 
13.4 	incentive for expenses related to the operation of health care homes that would reimburse 
13.5 	upfront costs related to implementation of health care homes after a one-year lag. The 
13.6 	commissioners shall establish quality and performance standards for health care homes, 
13.7 	and beginning July 1, 2009, these standards shall be subject to the capitation rate withhold 
13.8 	under subdivision 5a, paragraph (c).
13.9 	(d) Managed care plans must encourage state health care program enrollees to 
13.10 	complete an initial health assessment within three months from the time of enrollment, in 
13.11 	order to identify individuals with, or who are at risk of developing, complex or chronic 
13.12 	health conditions, and to identify preventive health care needs.
13.13 	(e) The commissioner shall encourage managed care plans, beginning July 1, 2009, 
13.14 	to complete a comprehensive health assessment for each enrollee determined, by the 
13.15 	initial health assessment required under section 256B.0431, subdivision 2, to have, or be 
13.16 	at risk of developing, a complex or chronic health condition. The commissioner shall pay 
13.17 	managed care plans a one-time health assessment fee for each enrollee who completes 
13.18 	a comprehensive health assessment. Comprehensive health assessments must meet the 
13.19 	criteria established for health care homes under section 256B.0752, subdivision 6.
13.20 	(f) The commissioner, beginning July 1, 2009, shall implement financial 
13.21 	arrangements for managed care plans to ensure that plans require each enrollee who has or 
13.22 	who is at risk of developing a complex or chronic health condition to choose a provider 
13.23 	to serve as a health care home.

13.24 	Sec. 7. [256B.766] PRIMARY CARE PHYSICIAN REIMBURSEMENT RATE 
13.25 	INCREASE.
13.26 	(a) Effective for physician services rendered on or after January 1, 2009, the 
13.27 	commissioner shall increase reimbursements to primary care physicians deemed by the 
13.28 	commissioner to meet the requirements in paragraph (b). Reimbursement may be increased 
13.29 	by not more than 50 percent above the reimbursement rate that would otherwise be paid to 
13.30 	the primary care provider. Payments to health plan companies shall be adjusted to reflect 
13.31 	increased reimbursement to primary care physicians as approved by the commissioner.
13.32 	(b) The commissioner, in collaboration with the Office of Rural Health, shall 
13.33 	determine areas of the state in need of primary care physicians. By September 1 of each 
13.34 	year, beginning September 1, 2008, the commissioner shall accept applications from 
13.35 	primary care physicians who agree to practice in a designated area for a period of no less 
14.1 	than five years. The commissioner shall determine participant eligibility based on their 
14.2 	suitability for practice serving a designated geographic area.
14.3 	(c) The commissioner may reconsider the designated areas, as necessary. A primary 
14.4 	care physician who agrees to practice in a designated area shall receive the increased 
14.5 	reimbursement rates for at least a period of five years, unless the physician discontinues 
14.6 	practicing in the designated area during the five-year period.
14.7 	(d) A health care clinic or medical group may submit applications under this section 
14.8 	for primary care physicians who will be hired to fill vacancies, prior to filling the vacant 
14.9 	position.

14.10 	Sec. 8. APPROPRIATION; PRIMARY CARE EDUCATION INITIATIVES.
 14.11 	(a) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.12 	fund to the board of regents of the University of Minnesota, to expand initiatives under 
14.13 	Minnesota Statutes, sections 137.38 to 137.40, to increase the number of graduates of 
14.14 	residency programs who practice primary care.
14.15 	(b) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.16 	fund to the Mayo Medical Foundation for medical school initiatives to increase the 
14.17 	number of graduates of residency programs who practice primary care.
14.18 	(c) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.19 	fund to the Duluth General Medical Education Council for medical school initiatives to 
14.20 	increase the number of graduates of residency programs who practice primary care. 
14.21 	(d) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.22 	fund to the Office of Higher Education to provide grants to schools of nursing in Minnesota 
14.23 	to increase the number of graduates of advanced practice registered nurse programs.
14.24 	(e) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.25 	fund to the board of regents of the University of Minnesota, to address faculty shortages in 
14.26 	primary care medicine.
14.27 	(f) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.28 	fund to the Mayo Medical Foundation, to address faculty shortages in primary care 
14.29 	medicine.
14.30 	(g) $....... is appropriated in fiscal year 2010 from the health savings reinvestment 
14.31 	fund to the Office of Higher Education to provide grants to schools of nursing in 
14.32 	Minnesota to address faculty shortages.
14.33 	(h) $....... is transferred in fiscal year 2009 from the health professional education 
14.34 	loan forgiveness program under Minnesota Statutes, section 144.1501, to the commissioner 
14.35 	of human services for the reimbursement rate increase described in Minnesota Statutes, 
15.1 	section 256B.766. The reduction in the loan forgiveness program shall be taken from 
15.2 	the physician loan forgiveness program.

15.3 	ARTICLE 3
15.4 	INCREASING ACCESS; CONTINUITY OF CARE

15.5 	Section 1. Minnesota Statutes 2006, section 256.01, is amended by adding a 
15.6 	subdivision to read:
15.7 		Subd. 27.Automation and coordination for state health care programs. (a) For 
15.8 	purposes of this subdivision, "state health care program" means the medical assistance, 
15.9 	MinnesotaCare, or general assistance medical care programs.
15.10 	(b) By July 1, 2009, the commissioner shall improve coordination between state 
15.11 	health care programs and social service programs including, but not limited to WIC, free 
15.12 	and reduced school lunch programs, and food stamps, and shall develop and use automated 
15.13 	systems to identify persons served by social service programs who may be eligible for, but 
15.14 	are not enrolled in, a state health care program. The system must also permit enrollees to 
15.15 	renew state health care program enrollment through these social services programs. By 
15.16 	January 15, 2009, the commissioner shall, as necessary, identify and recommend to the 
15.17 	legislature statutory changes to state health care and social service programs necessary to 
15.18 	improve coordination and automation of outreach and enrollment efforts.
15.19 	(c) By January 15, 2009, the commissioner shall establish and implement an 
15.20 	automated process to send out state health care program renewal forms in the most 
15.21 	common foreign languages, to those state health care program enrollees who request 
15.22 	renewal forms in those foreign languages. The commissioner, as part of the initial 
15.23 	enrollment process, shall inform applicants of the availability of this option.
15.24 	(d) Beginning July 1, 2008, the commissioner, county social service agencies, and 
15.25 	health care providers shall update state health care program enrollee addresses and related 
15.26 	contact information, at the time of each enrollee contact.

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

15.28 	Sec. 2. Minnesota Statutes 2007 Supplement, section 256.962, subdivision 5, is 
15.29 	amended to read:
15.30 		Subd. 5.Incentive program. Beginning January 1, 2008, the commissioner 
15.31 	shall establish an incentive program for organizations that directly identify and assist 
15.32 	potential enrollees in filling out and submitting an application. For each applicant who is 
15.33 	successfully enrolled in MinnesotaCare, medical assistance, or general assistance medical 
16.1 	care, the commissioner, within the available appropriation, shall pay the organization a 
16.2 	$20$25 application assistance bonus. The organization may provide an applicant a gift 
16.3 	certificate or other incentive upon enrollment.

16.4 	Sec. 3. Minnesota Statutes 2007 Supplement, section 256.962, subdivision 6, is 
16.5 	amended to read:
16.6 		Subd. 6.School districts. (a) At the beginning of each school year, a school district 
16.7 	shall provide information to each student on the availability of health care coverage 
16.8 	through the Minnesota health care programs.
16.9 	(b) For each child who is determined to be eligible for athe free orand reduced 
16.10 	pricedschool lunch program, the district shall provide the child's family with an 
16.11 	application for the Minnesota health care programs and information on how to obtain an 
16.12 	application for the Minnesota health care programs and application assistance.
16.13 	(c) A district shall also ensure that applications and information on application 
16.14 	assistance are available at early childhood education sites and public schools located 
16.15 	within the district's jurisdiction. 
16.16 	(d) Each district shall designate an enrollment specialist to provide application 
16.17 	assistance and follow-up services with families who are eligible for the reduced or free 
16.18 	lunch program or who have indicated an interest in receiving information or an application 
16.19 	for the Minnesota health care program. A district is eligible for the application assistance 
16.20 	bonus described in subdivision 5.
16.21 	(e) Each school district shall provide on their Web site a link to information on how 
16.22 	to obtain an application and application assistance.

16.23 	Sec. 4. Minnesota Statutes 2007 Supplement, section 256B.056, subdivision 10, 
16.24 	is amended to read:
16.25 		Subd. 10.Eligibility verification. (a) The commissioner shall require women who 
16.26 	are applying for the continuation of medical assistance coverage following the end of the 
16.27 	60-day postpartum period to update their income and asset information and to submit 
16.28 	any required income or asset verification.
16.29 	(b) The commissioner shall determine the eligibility of private-sector health care 
16.30 	coverage for infants less than one year of age eligible under section 256B.055, subdivision 
16.31 	10, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage 
16.32 	if this is determined to be cost-effective.
16.33 	(c) The commissioner shall verify assets and income for all applicants, and for 
16.34 	all recipients upon renewal.The commissioner shall verify liquid assets for applicants, 
17.1 	and for recipients upon renewal, only if the applicant or recipient is within ten percent 
17.2 	of the applicable asset limit. The commissioner may verify nonliquid assets, but is not 
17.3 	required to do so.
17.4 	(d) An enrollee who fails to submit renewal forms and related documentation 
17.5 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
17.6 	for one additional month beyond the end of the current eligibility period, before being 
17.7 	disenrolled.
17.8 	(e) If there is no change in an enrollee's income or asset information, the enrollee 
17.9 	may renew eligibility at designated locations that include community clinics and health 
17.10 	care providers' offices. These designated sites shall forward the renewal forms to the 
17.11 	commissioner.

17.12 	EFFECTIVE DATE. The amendments to paragraphs (c) and (e) are effective 
17.13 	January 1, 2009. Paragraph (d) is effective January 1, 2009, or upon federal approval, 
17.14 	whichever is later.

17.15 	Sec. 5. Minnesota Statutes 2006, section 256B.061, is amended to read:
17.16 	256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS; 
17.17 	DELAYED VERIFICATION.
17.18 	(a) If any individual has been determined to be eligible for medical assistance, it 
17.19 	will be made available for care and services included under the plan and furnished in or 
17.20 	after the third month before the month in which the individual made application for such 
17.21 	assistance, if such individual was, or upon application would have been, eligible for 
17.22 	medical assistance at the time the care and services were furnished. The commissioner 
17.23 	may limit, restrict, or suspend the eligibility of an individual for up to one year upon 
17.24 	that individual's conviction of a criminal offense related to application for or receipt of 
17.25 	medical assistance benefits.
17.26 	(b) On the basis of information provided on the completed application, an applicant 
17.27 	who meets the following criteria shall be determined eligible beginning in the month of 
17.28 	application: (1) whose gross income is less than 90 percent of the applicable income 
17.29 	standard; (2) whose total liquid assets are less than 90 percent of the asset limit; (3) does 
17.30 	not reside in a long-term care facility; and (4) meets all other eligibility requirements, 
17.31 	including compliance at the time of application with citizenship or nationality 
17.32 	documentation requirements under section 256B.06, subdivision 4. The applicant must 
17.33 	provide all required verifications within 60 days' notice of the eligibility determination or 
17.34 	eligibility shall be terminated. Applicants who are terminated for failure to provide all 
18.1 	required verifications are not eligible to apply for coverage using the delayed verification 
18.2 	procedures specified in this paragraph for 12 months.

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

18.4 	Sec. 6. Minnesota Statutes 2006, section 256D.03, is amended by adding a subdivision 
18.5 	to read:
18.6 		Subd. 7a.Additional duties of the commissioner. In administering the general 
18.7 	assistance medical care program, the commissioner shall: (1) apply the delayed verification 
18.8 	procedure specified in section 256B.061, paragraph (b), to general assistance medical care 
18.9 	applicants; and (2) provide general assistance medical care enrollees who fail to submit 
18.10 	renewal forms and related documentation necessary to verify continued eligibility with an 
18.11 	additional month of eligibility beyond the end of the current eligibility period.

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

18.13 	Sec. 7. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 3, is 
18.14 	amended to read:
18.15 		Subd. 3.Inpatient hospital services. (a) Covered health services shall include 
18.16 	inpatient hospital services, including inpatient hospital mental health services and inpatient 
18.17 	hospital and residential chemical dependency treatment, subject to those limitations 
18.18 	necessary to coordinate the provision of these services with eligibility under the medical 
18.19 	assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 
18.20 	section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 
18.21 	2, with family gross income that exceeds 200 percent of the federal poverty guidelines or 
18.22 	215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 
18.23 	pregnant, is subject to an annual limit of $10,000 $20,000. 
18.24 	(b) Admissions for inpatient hospital services paid for under section 256L.11, 
18.25 	subdivision 3, must be certified as medically necessary in accordance with Minnesota 
18.26 	Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2): 
18.27 	(1) all admissions must be certified, except those authorized under rules established 
18.28 	under section 254A.03, subdivision 3, or approved under Medicare; and 
18.29 	(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent 
18.30 	for admissions for which certification is requested more than 30 days after the day of 
18.31 	admission. The hospital may not seek payment from the enrollee for the amount of the 
18.32 	payment reduction under this clause. 

19.1 	EFFECTIVE DATE. This section is effective January 1, 2009, for enrollees for 
19.2 	whom federal funding is not available, and is effective January 1, 2009, or upon federal 
19.3 	approval, whichever is later, for enrollees for whom federal funding is available.

19.4 	Sec. 8. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 5, is 
19.5 	amended to read:
19.6 		Subd. 5.Co-payments and coinsurance. (a) Except as provided in paragraphs (b) 
19.7 	and (c), the MinnesotaCare benefit plan shall include the following co-payments and 
19.8 	coinsurance requirements for all enrollees:
19.9 	(1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 
19.10 	subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and 
19.11 	$3,000 per family;
19.12 	(2) $3 per prescription for adult enrollees;
19.13 	(3) $25 for eyeglasses for adult enrollees;
19.14 	(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 
19.15 	episode of service which is required because of a recipient's symptoms, diagnosis, or 
19.16 	established illness, and which is delivered in an ambulatory setting by a physician or 
19.17 	physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 
19.18 	audiologist, optician, or optometrist; and
19.19 	(5) $6 for nonemergency visits to a hospital-based emergency room.
19.20 	(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of 
19.21 	children under the age of 21.
19.22 	(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
19.23 	(d) Paragraph (a), clause (4), does not apply to mental health services.
19.24 	(e) Adult enrollees with family gross income that exceeds 200 percent of the federal 
19.25 	poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 
19.26 	and who are not pregnant shall be financially responsible for the coinsurance amount, if 
19.27 	applicable, and amounts which exceed the $10,000 $20,000 inpatient hospital benefit limit.
19.28 	(f) When a MinnesotaCare enrollee becomes a member of a prepaid health 
19.29 	plan, or changes from one prepaid health plan to another during a calendar year, any 
19.30 	charges submitted towards the $10,000 $20,000 annual inpatient benefit limit, and any 
19.31 	out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted 
19.32 	or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

19.33 	EFFECTIVE DATE. This section is effective January 1, 2009, for enrollees for 
19.34 	whom federal funding is not available, and is effective January 1, 2009, or upon federal 
19.35 	approval, whichever is later, for enrollees for whom federal funding is available.

20.1 	Sec. 9. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is 
20.2 	amended to read:
20.3 		Subdivision 1.Families with children. (a) Families with children with family 
20.4 	income equal to or less than 275 300 percent of the federal poverty guidelines for the 
20.5 	applicable family size shall be eligible for MinnesotaCare according to this section. All 
20.6 	other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 
20.7 	to enrollment under section 256L.07, shall apply unless otherwise specified. 
20.8 	(b) Parents who enroll in the MinnesotaCare program must also enroll their children, 
20.9 	if the children are eligible. Children may be enrolled separately without enrollment by 
20.10 	parents. However, if one parent in the household enrolls, both parents must enroll, unless 
20.11 	other insurance is available. If one child from a family is enrolled, all children must 
20.12 	be enrolled, unless other insurance is available. If one spouse in a household enrolls, 
20.13 	the other spouse in the household must also enroll, unless other insurance is available. 
20.14 	Families cannot choose to enroll only certain uninsured members.
20.15 	(c) Beginning October 1, 2003, the dependent sibling definition no longer applies 
20.16 	to the MinnesotaCare program. These persons are no longer counted in the parental 
20.17 	household and may apply as a separate household.
20.18 	(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are 
20.19 	not eligible for MinnesotaCare if their gross income exceeds $50,000.
20.20 	(e) Children formerly enrolled in medical assistance and automatically deemed 
20.21 	eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 
20.22 	from the requirements of this section until renewal.

20.23 	EFFECTIVE DATE. The effective date of this section is contingent on meeting 
20.24 	the cost containment goals described in section 62U.14 and having sufficient funding 
20.25 	for the expansion.

20.26 	Sec. 10. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is 
20.27 	amended to read:
20.28 		Subd. 7.Single adults and households with no children. The definition of eligible 
20.29 	persons includes all individuals and households with no children who have gross family 
20.30 	incomes that are equal to or less than 200 percent of the federal poverty guidelines. 
20.31 	Effective July January 1, 2009, the definition of eligible persons includes all individuals 
20.32 	and households with no children who have gross family incomes that are equal to or less 
20.33 	than 215 300 percent of the federal poverty guidelines.

21.1 	EFFECTIVE DATE. The effective date of this section is contingent on meeting 
21.2 	the cost containment goals described in section 62U.14 and having sufficient funding 
21.3 	for the expansion.

21.4 	Sec. 11. Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a, 
21.5 	is amended to read:
21.6 		Subd. 3a.Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility 
21.7 	must be renewed every 12 months. The 12-month period begins in the month after the 
21.8 	month the application is approved.
21.9 	(b) Each new period of eligibility must take into account any changes in 
21.10 	circumstances that impact eligibility and premium amount. An enrollee must provide all 
21.11 	the information needed to redetermine eligibility by the first day of the month that ends 
21.12 	the eligibility period. If there is no change in circumstances, the enrollee may renew 
21.13 	eligibility at designated locations that include community clinics and health care providers' 
21.14 	offices. The designated sites shall forward the renewal forms to the commissioner. The 
21.15 	premium for the new period of eligibility must be received as provided in section 256L.06
21.16 	in order for eligibility to continue.
21.17 	(c) For single adults and households with no children formerly enrolled in general 
21.18 	assistance medical care and enrolled in MinnesotaCare according to section 256D.03, 
21.19 	subdivision 3, the first period of eligibility begins the month the enrollee submitted the 
21.20 	application or renewal for general assistance medical care.
21.21 	(d) An enrollee who fails to submit renewal forms and related documentation 
21.22 	necessary for verification of continued eligibility in a timely manner shall remain eligible 
21.23 	for one additional month beyond the end of the current eligibility period, before being 
21.24 	disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the 
21.25 	additional month.

21.26 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
21.27 	approval, whichever is later.

21.28 	Sec. 12. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision 
21.29 	to read:
21.30 		Subd. 6.Delayed verification. On the basis of information provided on the 
21.31 	completed application, an applicant whose gross income is less than 90 percent of 
21.32 	the applicable income standard and meets all other eligibility requirements, including 
21.33 	compliance at the time of application with citizenship or nationality documentation 
21.34 	requirements under section 256L.04, subdivision 10, shall be determined eligible 
22.1 	beginning in the month of application. The applicant must provide all required 
22.2 	verifications within 60 days' notice of the eligibility determination or eligibility shall be 
22.3 	terminated. Applicants who are terminated for failure to provide all required verifications 
22.4 	are not eligible to apply for coverage using the delayed verification procedures specified in 
22.5 	this subdivision for 12 months.

22.6 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
22.7 	approval, whichever is later.

22.8 	Sec. 13. Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:
22.9 		Subd. 3.Commissioner's duties and payment. (a) Premiums are dedicated to the 
22.10 	commissioner for MinnesotaCare.
22.11 	(b) The commissioner shall develop and implement procedures to: (1) require 
22.12 	enrollees to report changes in income; (2) adjust sliding scale premium payments, based 
22.13 	upon both increases and decreases in enrollee income, at the time the change in income 
22.14 	is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required 
22.15 	premiums. Failure to pay includes payment with a dishonored check, a returned automatic 
22.16 	bank withdrawal, or a refused credit card or debit card payment. The commissioner may 
22.17 	demand a guaranteed form of payment, including a cashier's check or a money order, as 
22.18 	the only means to replace a dishonored, returned, or refused payment.
22.19 	(c) Premiums are calculated on a calendar month basis and may be paid on a 
22.20 	monthly, quarterly, or semiannual basis, with the first payment due upon notice from the 
22.21 	commissioner of the premium amount required. The commissioner shall inform applicants 
22.22 	and enrollees of these premium payment options. Premium payment is required before 
22.23 	enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments 
22.24 	received before noon are credited the same day. Premium payments received after noon 
22.25 	are credited on the next working day.
22.26 	(d) Nonpayment of the premium will result in disenrollment from the plan effective 
22.27 	forthe first day of the calendar month following the calendar month for which the 
22.28 	premium was due. Persons disenrolled for nonpayment or who voluntarily terminate 
22.29 	coverage from the program may not reenroll until four calendar months have elapsed. 
22.30 	Persons disenrolled for nonpayment who pay all past due premiums as well as current 
22.31 	premiums due, including premiums due for the period of disenrollment, within 20 days 
22.32 	of disenrollment, shall be reenrolled retroactively to the first day of disenrollment The 
22.33 	commissioner shall waive premiums for coverage provided under this paragraph to 
22.34 	persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b. 
22.35 	Persons disenrolled for nonpayment or who voluntarily terminate coverage from the 
23.1 	program may not reenroll for four calendar months unless the person demonstrates good 
23.2 	cause for nonpayment. Good cause does not exist if a person chooses to pay other family 
23.3 	expenses instead of the premium. The commissioner shall define good cause in rule.

23.4 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
23.5 	approval, whichever is later.

23.6 	Sec. 14. Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is 
23.7 	amended to read:
23.8 		Subdivision 1.General requirements. (a) Children enrolled in the original 
23.9 	children's health plan as of September 30, 1992, children who enrolled in the 
23.10 	MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 
23.11 	article 4, section 17, and children who have family gross incomes that are equal to or 
23.12 	less than 150 percent of the federal poverty guidelines are eligible without meeting 
23.13 	the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 
23.14 	long as they maintain continuous coverage in the MinnesotaCare program or medical 
23.15 	assistance. Children who apply for MinnesotaCare on or after the implementation date 
23.16 	of the employer-subsidized health coverage program as described in Laws 1998, chapter 
23.17 	407, article 5, section 45, who have family gross incomes that are equal to or less than 150 
23.18 	percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 
23.19 	be eligible for MinnesotaCare.
23.20 	Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose 
23.21 	income increases above 275 300 percent of the federal poverty guidelines, are no longer 
23.22 	eligible for the program and shall be disenrolled by the commissioner. Beginning January 
23.23 	1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, 
23.24 	whose income increases above 200 percent of the federal poverty guidelines or 215 300
23.25 	percent of the federal poverty guidelines on or after July January 1, 2009, are no longer 
23.26 	eligible for the program and shall be disenrolled by the commissioner. For persons 
23.27 	disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of 
23.28 	the calendar month following the month in which the commissioner determines that the 
23.29 	income of a family or individual exceeds program income limits.
23.30 	(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare 
23.31 	if ten percent of their gross individual or gross family income as defined in section 
23.32 	256L.01, subdivision 4, is less than the annual premium for a policy with a $500 
23.33 	deductible available through the Minnesota Comprehensive Health Association. Children 
23.34 	who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 
23.35 	notice period from the date that ineligibility is determined before disenrollment. The 
24.1 	premium for children remaining eligible under this clause shall be the maximum premium 
24.2 	determined under section 256L.15, subdivision 2, paragraph (b).
24.3 	(c) Notwithstanding paragraphs (a) and (b), parents are not eligible for 
24.4 	MinnesotaCare if gross household income exceeds $50,000 for the 12-month period 
24.5 	of eligibility.

24.6 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
24.7 	approval, whichever is later, except that the effective date for the amendment to paragraph 
24.8 	(a) related to the expansion in eligibility to 300 percent of federal poverty guidelines is 
24.9 	contingent on meeting the cost containment goals established in section 62U.14 and 
24.10 	having sufficient funding for the expansion.

24.11 	Sec. 15. Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:
24.12 		Subd. 3.Other health coverage. (a) Families and individuals enrolled in the 
24.13 	MinnesotaCare program must have no health coverage while enrolled or for at least four 
24.14 	months prior to application and renewal. Children enrolled in the original children's health 
24.15 	plan and children in families with income equal to or less than 150 percent of the federal 
24.16 	poverty guidelines, who have other health insurance, are eligible if the coverage:
24.17 	(1) lacks two or more of the following:
24.18 	(i) basic hospital insurance;
24.19 	(ii) medical-surgical insurance;
24.20 	(iii) prescription drug coverage;
24.21 	(iv) dental coverage; or
24.22 	(v) vision coverage;
24.23 	(2) requires a deductible of $100 or more per person per year; or
24.24 	(3) lacks coverage because the child has exceeded the maximum coverage for a 
24.25 	particular diagnosis or the policy excludes a particular diagnosis.
24.26 	The commissioner may change this eligibility criterion for sliding scale premiums 
24.27 	in order to remain within the limits of available appropriations. The requirement of no 
24.28 	health coverage does not apply to newborns.
24.29 	(b) Medical assistance, general assistance medical care, and the Civilian Health and 
24.30 	Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under 
24.31 	United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or 
24.32 	health coverage for purposes of the four-month requirement described in this subdivision.
24.33 	(c) For purposes of this subdivision, an applicant or enrollee who is entitled to 
24.34 	Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 
24.35 	Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to 
25.1 	have health coverage. An applicant or enrollee who is entitled to premium-free Medicare 
25.2 	Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility 
25.3 	for MinnesotaCare.
25.4 	(d) (c) Applicants who were recipients of medical assistance or general assistance 
25.5 	medical care within one month of application must meet the provisions of this subdivision 
25.6 	and subdivision 2.
25.7 	(e) Cost-effective health insurance that was paid for by medical assistance is not 
25.8 	considered health coverage for purposes of the four-month requirement under this 
25.9 	section, except if the insurance continued after medical assistance no longer considered it 
25.10 	cost-effective or after medical assistance closed.

25.11 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
25.12 	approval, whichever is later.

25.13 	Sec. 16. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is 
25.14 	amended to read:
25.15 		Subd. 2.Sliding fee scale; monthly gross individual or family income. (a) The 
25.16 	commissioner shall establish a sliding fee scale to determine the percentage of monthly 
25.17 	gross individual or family income that households at different income levels must pay 
25.18 	to obtain coverage through the MinnesotaCare program. The sliding fee scale must be 
25.19 	based on the enrollee's monthly gross individual or family income. The sliding fee scale 
25.20 	must contain separate tables based on enrollment of one, two, or three or more persons. 
25.21 	Until December 31, 2008, the sliding fee scale begins with a premium of 1.5 percent of 
25.22 	monthly gross individual or family income for individuals or families with incomes below 
25.23 	the limits for the medical assistance program for families and children in effect on January 
25.24 	1, 1999, and proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 
25.25 	5.9, 7.4, and 8.8 percent. These percentages are matched to evenly spaced income steps 
25.26 	ranging from the medical assistance income limit for families and children in effect on 
25.27 	January 1, 1999, to 275 percent of the federal poverty guidelines for the applicable family 
25.28 	size, up to a family size of five. The sliding fee scale for a family of five must be used 
25.29 	for families of more than five. The sliding fee scale and percentages are not subject to 
25.30 	the provisions of chapter 14. If a family or individual reports increased income after 
25.31 	enrollment, premiums shall be adjusted at the time the change in income is reported.
25.32 	(b) FamiliesChildren whose gross income is above 275 300 percent of the federal 
25.33 	poverty guidelines shall pay the maximum premium. The maximum premium is defined 
25.34 	as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 
25.35 	cases paid the maximum premium, the total revenue would equal the total cost of 
26.1 	MinnesotaCare medical coverage and administration. In this calculation, administrative 
26.2 	costs shall be assumed to equal ten percent of the total. The costs of medical coverage 
26.3 	for pregnant women and children under age two and the enrollees in these groups shall 
26.4 	be excluded from the total. The maximum premium for two enrollees shall be twice the 
26.5 	maximum premium for one, and the maximum premium for three or more enrollees shall 
26.6 	be three times the maximum premium for one.
26.7 	(c) Beginning January 1, 2009, MinnesotaCare enrollees shall pay premiums 
26.8 	according to the affordability scale established in section 62U.15, subdivision 2, with the 
26.9 	exception that children in families with income at or below 150 percent of the federal 
26.10 	poverty guidelines shall pay a monthly premium of $4.

26.11 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
26.12 	approval, whichever is later, except that the effective date to the amendment to paragraph 
26.13 	(b) related to the expansion in eligibility to 300 percent of federal poverty guidelines is 
26.14 	contingent on meeting the cost containment goals in section 62U.14 and having sufficient 
26.15 	funding for the expansion.

26.16 	Sec. 17. Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision 
26.17 	to read:
26.18 		Subd. 5.First month premium exemption. New enrollee households are exempt 
26.19 	from premiums for the first month of MinnesotaCare enrollment. For purposes of this 
26.20 	exemption, a "new enrollee household" is a household which has not been enrolled in 
26.21 	MinnesotaCare for at least one year prior to application.

26.22 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
26.23 	approval, whichever is later.

26.24 	Sec. 18. INSURANCE COVERAGE FOR LONG-TERM CARE WORKERS.
 26.25 	(a) The commissioner of human services shall study and report to the legislature 
26.26 	by December 15, 2008, with recommendations for a rate increase to long-term care 
26.27 	employers dedicated to the purchase of employee health insurance in the private market. 
26.28 	The commissioner shall collect necessary actuarial data, employment data, current 
26.29 	coverage data, and other needed information.
26.30 	(b) The commissioner shall develop cost estimates for three levels of insurance 
26.31 	coverage for long-term care workers:
26.32 	(1) the coverage provided to state employees;
26.33 	(2) the coverage provided to MinnesotaCare enrollees; and
27.1 	(3) the benefits provided under an "average" private market insurance product, but 
27.2 	with a deductible limited to $100 per person.
27.3 	Premium cost sharing, waiting periods for eligibility, definitions of full- and 
27.4 	part-time employment, and other parameters under the three options must be identical to 
27.5 	those under the state employees' health plan.
27.6 	(c) For purposes of this section, a long-term care worker is a person employed by 
27.7 	a nursing facility, an intermediate care facility for persons with mental retardation, or 
27.8 	a service provider that:
27.9 	(1) is eligible under Laws 2007, chapter 147, article 7, section 71; and 
27.10 	(2) provides long-term care services.
27.11 	The commissioner may recommend a different definition of long-term care worker if 
27.12 	this definition presents insurmountable implementation issues.
27.13 	(d) The recommendations must include measures to:
27.14 	(1) ensure equitable treatment between employers that currently have different levels 
27.15 	of expenditure for employee health insurance costs; and
27.16 	(2) enforce the requirement that the rate increase be expended for the intended 
27.17 	purpose.

27.18 	Sec. 19. APPROPRIATION.
 27.19 	(a) $....... is appropriated from the general fund to the commissioner of human 
27.20 	services for the fiscal year beginning July 1, 2008, for the purposes of section 18.
27.21 	(b) $250,000 is appropriated in fiscal year 2010 from the general fund to the 
27.22 	commissioner of human services and $100,000 is appropriated in fiscal year 2010 from 
27.23 	the health care access fund to the commissioner of human services for the application 
27.24 	assistance bonus in Minnesota Statutes, section 256.962, subdivision 5.

27.25 	Sec. 20.  REPEALER.
 27.26 	Minnesota Statutes 2006, section 256L.15, subdivision 3, is repealed.

27.27 	EFFECTIVE DATE. This section is effective January 1, 2009, or upon federal 
27.28 	approval of the amendments to Minnesota Statutes, section 256L.15, subdivision 2, 
27.29 	paragraph (c), whichever is later.

28.1 	ARTICLE 4
28.2 	HEALTH INSURANCE PURCHASING AND AFFORDABILITY REFORM

28.3 	Section 1. Minnesota Statutes 2006, section 13.3806, is amended by adding a 
28.4 	subdivision to read:
28.5 		Subd. 1b.Health Care Transformation Commission. Use of data collected by the 
28.6 	Health Care Transformation Commission is governed by section 62U.10, subdivision 2.

28.7 	Sec. 2. Minnesota Statutes 2007 Supplement, section 13.46, subdivision 2, is amended 
28.8 	to read:
28.9 		Subd. 2.General. (a) Unless the data is summary data or a statute specifically 
28.10 	provides a different classification, data on individuals collected, maintained, used, or 
28.11 	disseminated by the welfare system is private data on individuals, and shall not be 
28.12 	disclosed except:
28.13 	(1) according to section 13.05;
28.14 	(2) according to court order;
28.15 	(3) according to a statute specifically authorizing access to the private data;
28.16 	(4) to an agent of the welfare system, including a law enforcement person, attorney, 
28.17 	or investigator acting for it in the investigation or prosecution of a criminal or civil 
28.18 	proceeding relating to the administration of a program;
28.19 	(5) to personnel of the welfare system who require the data to verify an individual's 
28.20 	identity; determine eligibility, amount of assistance, and the need to provide services to 
28.21 	an individual or family across programs; evaluate the effectiveness of programs; assess 
28.22 	parental contribution amounts; and investigate suspected fraud;
28.23 	(6) to administer federal funds or programs;
28.24 	(7) between personnel of the welfare system working in the same program;
28.25 	(8) to the Department of Revenue to assess parental contribution amounts for 
28.26 	purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit 
28.27 	programs and to identify individuals who may benefit from these programs. The following 
28.28 	information may be disclosed under this paragraph: an individual's and their dependent's 
28.29 	names, dates of birth, Social Security numbers, income, addresses, and other data as 
28.30 	required, upon request by the Department of Revenue. Disclosures by the commissioner 
28.31 	of revenue to the commissioner of human services for the purposes described in this clause 
28.32 	are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include, 
28.33 	but are not limited to, the dependent care credit under section 290.067, the Minnesota 
29.1 	working family credit under section 290.0671, the property tax refund and rental credit 
29.2 	under section 290A.04, and the Minnesota education credit under section 290.0674;
29.3 	(9) between the Department of Human Services, the Department of Employment 
29.4 	and Economic Development, and when applicable, the Department of Education, for 
29.5 	the following purposes:
29.6 	(i) to monitor the eligibility of the data subject for unemployment benefits, for any 
29.7 	employment or training program administered, supervised, or certified by that agency;
29.8 	(ii) to administer any rehabilitation program or child care assistance program, 
29.9 	whether alone or in conjunction with the welfare system;
29.10 	(iii) to monitor and evaluate the Minnesota family investment program or the child 
29.11 	care assistance program by exchanging data on recipients and former recipients of food 
29.12 	support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance 
29.13 	under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and
29.14 	(iv) to analyze public assistance employment services and program utilization, 
29.15 	cost, effectiveness, and outcomes as implemented under the authority established in Title 
29.16 	II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of 
29.17 	1999. Health records governed by sections 144.291 to 144.298 and "protected health 
29.18 	information" as defined in Code of Federal Regulations, title 45, section 160.103, and 
29.19 	governed by Code of Federal Regulations, title 45, parts 160-164, including health care 
29.20 	claims utilization information, must not be exchanged under this clause;
29.21 	(10) to appropriate parties in connection with an emergency if knowledge of 
29.22 	the information is necessary to protect the health or safety of the individual or other 
29.23 	individuals or persons;
29.24 	(11) data maintained by residential programs as defined in section 245A.02 may 
29.25 	be disclosed to the protection and advocacy system established in this state according 
29.26 	to Part C of Public Law 98-527 to protect the legal and human rights of persons with 
29.27 	developmental disabilities or other related conditions who live in residential facilities for 
29.28 	these persons if the protection and advocacy system receives a complaint by or on behalf 
29.29 	of that person and the person does not have a legal guardian or the state or a designee of 
29.30 	the state is the legal guardian of the person;
29.31 	(12) to the county medical examiner or the county coroner for identifying or locating 
29.32 	relatives or friends of a deceased person;
29.33 	(13) data on a child support obligor who makes payments to the public agency 
29.34 	may be disclosed to the Minnesota Office of Higher Education to the extent necessary to 
29.35 	determine eligibility under section 136A.121, subdivision 2, clause (5);
30.1 	(14) participant Social Security numbers and names collected by the telephone 
30.2 	assistance program may be disclosed to the Department of Revenue to conduct an 
30.3 	electronic data match with the property tax refund database to determine eligibility under 
30.4 	section 237.70, subdivision 4a;
30.5 	(15) the current address of a Minnesota family investment program participant 
30.6 	may be disclosed to law enforcement officers who provide the name of the participant 
30.7 	and notify the agency that:
30.8 	(i) the participant:
30.9 	(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after 
30.10 	conviction, for a crime or attempt to commit a crime that is a felony under the laws of the 
30.11 	jurisdiction from which the individual is fleeing; or
30.12 	(B) is violating a condition of probation or parole imposed under state or federal law;
30.13 	(ii) the location or apprehension of the felon is within the law enforcement officer's 
30.14 	official duties; and
30.15 	(iii) the request is made in writing and in the proper exercise of those duties;
30.16 	(16) the current address of a recipient of general assistance or general assistance 
30.17 	medical care may be disclosed to probation officers and corrections agents who are 
30.18 	supervising the recipient and to law enforcement officers who are investigating the 
30.19 	recipient in connection with a felony level offense;
30.20 	(17) information obtained from food support applicant or recipient households may 
30.21 	be disclosed to local, state, or federal law enforcement officials, upon their written request, 
30.22 	for the purpose of investigating an alleged violation of the Food Stamp Act, according 
30.23 	to Code of Federal Regulations, title 7, section 272.1(c);
30.24 	(18) the address, Social Security number, and, if available, photograph of any 
30.25 	member of a household receiving food support shall be made available, on request, to a 
30.26 	local, state, or federal law enforcement officer if the officer furnishes the agency with the 
30.27 	name of the member and notifies the agency that:
30.28 	(i) the member:
30.29 	(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a 
30.30 	crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;
30.31 	(B) is violating a condition of probation or parole imposed under state or federal 
30.32 	law; or
30.33 	(C) has information that is necessary for the officer to conduct an official duty related 
30.34 	to conduct described in subitem (A) or (B);
30.35 	(ii) locating or apprehending the member is within the officer's official duties; and
31.1 	(iii) the request is made in writing and in the proper exercise of the officer's official 
31.2 	duty;
31.3 	(19) the current address of a recipient of Minnesota family investment program, 
31.4 	general assistance, general assistance medical care, or food support may be disclosed to 
31.5 	law enforcement officers who, in writing, provide the name of the recipient and notify the 
31.6 	agency that the recipient is a person required to register under section 243.166, but is not 
31.7 	residing at the address at which the recipient is registered under section 243.166;
31.8 	(20) certain information regarding child support obligors who are in arrears may be 
31.9 	made public according to section 518A.74;
31.10 	(21) data on child support payments made by a child support obligor and data on 
31.11 	the distribution of those payments excluding identifying information on obligees may be 
31.12 	disclosed to all obligees to whom the obligor owes support, and data on the enforcement 
31.13 	actions undertaken by the public authority, the status of those actions, and data on the 
31.14 	income of the obligor or obligee may be disclosed to the other party;
31.15 	(22) data in the work reporting system may be disclosed under section 256.998, 
31.16 	subdivision 7;
31.17 	(23) to the Department of Education for the purpose of matching Department of 
31.18 	Education student data with public assistance data to determine students eligible for free 
31.19 	and reduced price meals, meal supplements, and free milk according to United States 
31.20 	Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and 
31.21 	state funds that are distributed based on income of the student's family; and to verify 
31.22 	receipt of energy assistance for the telephone assistance plan;
31.23 	(24) the current address and telephone number of program recipients and emergency 
31.24 	contacts may be released to the commissioner of health or a local board of health as 
31.25 	defined in section 145A.02, subdivision 2, when the commissioner or local board of health 
31.26 	has reason to believe that a program recipient is a disease case, carrier, suspect case, or at 
31.27 	risk of illness, and the data are necessary to locate the person;
31.28 	(25) to other state agencies, statewide systems, and political subdivisions of this 
31.29 	state, including the attorney general, and agencies of other states, interstate information 
31.30 	networks, federal agencies, and other entities as required by federal regulation or law for 
31.31 	the administration of the child support enforcement program;
31.32 	(26) to personnel of public assistance programs as defined in section 256.741, for 
31.33 	access to the child support system database for the purpose of administration, including 
31.34 	monitoring and evaluation of those public assistance programs;
31.35 	(27) to monitor and evaluate the Minnesota family investment program by 
31.36 	exchanging data between the Departments of Human Services and Education, on 
32.1 	recipients and former recipients of food support, cash assistance under chapter 256, 256D, 
32.2 	256J, or 256K, child care assistance under chapter 119B, or medical programs under 
32.3 	chapter 256B, 256D, or 256L;
32.4 	(28) to evaluate child support program performance and to identify and prevent 
32.5 	fraud in the child support program by exchanging data between the Department of Human 
32.6 	Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a) 
32.7 	and (b), without regard to the limitation of use in paragraph (c), Department of Health, 
32.8 	Department of Employment and Economic Development, and other state agencies as is 
32.9 	reasonably necessary to perform these functions; or
32.10 	(29) counties operating child care assistance programs under chapter 119B may 
32.11 	disseminate data on program participants, applicants, and providers to the commissioner 
32.12 	of education; or
32.13 	(30) according to section 256.01, subdivision 27, between the welfare system and 
32.14 	the Minnesota Health Insurance Exchange under section 62U.02, in order to collect 
32.15 	premiums from individuals, enrolled in the MinnesotaCare program under chapter 256L, 
32.16 	and to administer the individual's and their families' participation in the program, to the 
32.17 	extent authorized in section 62U.03.
32.18 	(b) Information on persons who have been treated for drug or alcohol abuse may 
32.19 	only be disclosed according to the requirements of Code of Federal Regulations, title 
32.20 	42, sections 2.1 to 2.67.
32.21 	(c) Data provided to law enforcement agencies under paragraph (a), clause (15), 
32.22 	(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected 
32.23 	nonpublic while the investigation is active. The data are private after the investigation 
32.24 	becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).
32.25 	(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is 
32.26 	not subject to the access provisions of subdivision 10, paragraph (b).
32.27 	For the purposes of this subdivision, a request will be deemed to be made in writing 
32.28 	if made through a computer interface system.

32.29 	Sec. 3. [16A.727] HEALTH SAVINGS REINVESTMENT FUND.
32.30 	A health savings reinvestment fund is created in the state treasury. The fund is a 
32.31 	direct appropriated special revenue fund. The commissioner shall deposit to the credit of 
32.32 	the fund money made available to the fund.

32.33 	Sec. 4. Minnesota Statutes 2006, section 62A.65, subdivision 3, is amended to read:
33.1 		Subd. 3.Premium rate restrictions. No individual health plan may be offered, 
33.2 	sold, issued, or renewed to a Minnesota resident unless the premium rate charged is 
33.3 	determined in accordance with the following requirements:
33.4 	(a) Except for policies issued under section 62U.03, subdivision 5, paragraph (b), 
33.5 	premium rates must be no more than 25 percent above and no more than 25 percent below 
33.6 	the index rate charged to individuals for the same or similar coverage, adjusted pro 
33.7 	rata for rating periods of less than one year. The premium variations permitted by this 
33.8 	paragraph must be based only upon health status, claims experience, and occupation. For 
33.9 	purposes of this paragraph, health status includes refraining from tobacco use or other 
33.10 	actuarially valid lifestyle factors associated with good health, provided that the lifestyle 
33.11 	factor and its effect upon premium rates have been determined by the commissioner to 
33.12 	be actuarially valid and have been approved by the commissioner. Variations permitted 
33.13 	under this paragraph must not be based upon age or applied differently at different ages. 
33.14 	This paragraph does not prohibit use of a constant percentage adjustment for factors 
33.15 	permitted to be used under this paragraph.
33.16 	(b) Premium rates may vary based upon the ages of covered persons only as 
33.17 	provided in this paragraph. In addition to the variation permitted under paragraph (a), 
33.18 	each health carrier may use an additional premium variation based upon age of up to 
33.19 	plus or minus 50 percent of the index rate.
33.20 	(c) A health carrier may request approval by the commissioner to establish separate 
33.21 	geographic regions determined by the health carrier and to establish separate index rates 
33.22 	for each such region. The commissioner shall grant approval if the following conditions 
33.23 	are met: 
33.24 	(1) the geographic regions must be applied uniformly by the health carrier;
33.25 	(2) each geographic region must be composed of no fewer than seven counties that 
33.26 	create a contiguous region; and
33.27 	(3) the health carrier provides actuarial justification acceptable to the commissioner 
33.28 	for the proposed geographic variations in index rates, establishing that the variations are 
33.29 	based upon differences in the cost to the health carrier of providing coverage.
33.30 	(d) Health carriers may use rate cells and must file with the commissioner the rate 
33.31 	cells they use. Rate cells must be based upon the number of adults or children covered 
33.32 	under the policy and may reflect the availability of Medicare coverage. The rates for 
33.33 	different rate cells must not in any way reflect generalized differences in expected costs 
33.34 	between principal insureds and their spouses.
33.35 	(e) In developing its index rates and premiums for a health plan, a health carrier shall 
33.36 	take into account only the following factors:
34.1 	(1) actuarially valid differences in rating factors permitted under paragraphs (a) 
34.2 	and (b); and
34.3 	(2) actuarially valid geographic variations if approved by the commissioner as 
34.4 	provided in paragraph (c).
34.5 	(f) All premium variations must be justified in initial rate filings and upon request of 
34.6 	the commissioner in rate revision filings. All rate variations are subject to approval by 
34.7 	the commissioner.
34.8 	(g) The loss ratio must comply with the section 62A.021 requirements for individual 
34.9 	health plans. 
34.10 	(h) The rates must not be approved, unless the commissioner has determined that the 
34.11 	rates are reasonable. In determining reasonableness, the commissioner shall consider the 
34.12 	growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar 
34.13 	year or years that the proposed premium rate would be in effect, actuarially valid changes 
34.14 	in risks associated with the enrollee populations, and actuarially valid changes as a result 
34.15 	of statutory changes in Laws 1992, chapter 549. 
34.16 	(i) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under 
34.17 	section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this 
34.18 	paragraph. The rating practices guarantee must be in writing and must guarantee that 
34.19 	the policy form will be offered, sold, issued, and renewed only with premium rates and 
34.20 	premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices 
34.21 	guarantee must be accompanied by an actuarial memorandum that demonstrates that the 
34.22 	premium rates and premium rating system used in connection with the policy form will 
34.23 	satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to 
34.24 	policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4, 
34.25 	or 5. An insurer that complies with this paragraph in connection with a policy form is 
34.26 	exempt from the requirement of prior approval by the commissioner under paragraphs 
34.27 	(c), (f), and (h).

34.28 	Sec. 5. Minnesota Statutes 2006, section 62E.141, is amended to read:
34.29 	62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
34.30 	No employee of an employer that offers a group health plan as defined in section 
34.31 	62A.10, under which the employee is eligible for coverage, is eligible to enroll, or 
34.32 	continue to be enrolled, in the comprehensive health association, except for enrollment 
34.33 	or continued enrollment necessary to cover conditions that are subject to an unexpired 
34.34 	preexisting condition limitation, preexisting condition exclusion, or exclusionary rider 
34.35 	under the employer's health plan. This section does not apply to persons enrolled in the 
35.1 	Comprehensive Health Association as of June 30, 1993. With respect to persons eligible 
35.2 	to enroll in the health plan of an employer that has more than 29 current employees, 
35.3 	as defined in section 62L.02, this section does not apply to persons enrolled in the 
35.4 	Comprehensive Health Association as of December 31, 1994. 

35.5 	Sec. 6. Minnesota Statutes 2007 Supplement, section 62J.496, is amended by adding a 
35.6 	subdivision to read:
35.7 		Subd. 5.Interoperable electronic health record requirements. To meet the 
35.8 	requirements of subdivision 1, hospitals and health care providers must meet the following 
35.9 	criteria when implementing an interoperable electronic health records system within their 
35.10 	hospital system or clinical practice setting.
35.11 	(a) The electronic health record must be certified by the Certification Commission 
35.12 	for Healthcare Information Technology, or its successor. This criterion only applies to 
35.13 	hospitals and health care providers whose practice setting is a practice setting covered 
35.14 	by Certification Commission for Healthcare Information Technology certifications. This 
35.15 	criterion shall be considered met if a hospital or health care provider is using an electronic 
35.16 	health records system that has been certified within the last three years, even if a more 
35.17 	current version of the system has been certified within the three-year period.
35.18 	(b) A health care provider who is a prescriber or dispenser of controlled substances 
35.19 	must have an electronic health record system that meets the requirements of section 
35.20 	62J.497.

35.21 	Sec. 7. [62J.497] ELECTRONIC PRESCRIPTION DRUG PROGRAM.
35.22 		Subdivision 1.Definitions. For the purposes of this section, the following terms 
35.23 	have the meanings given.
35.24 	(a) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 
35.25 	30. Dispensing does not include the direct administering of a controlled substance to a 
35.26 	patient by a licensed health care professional.
35.27 	(b) "Dispenser" means a person authorized by law to dispense a controlled substance, 
35.28 	pursuant to a valid prescription.
35.29 	(c) "Electronic media" has the same meaning given this term under Code of Federal 
35.30 	Regulations, title 45, part 160.103.
35.31 	(d) "E-prescribing" means the transmission using electronic media, of prescription 
35.32 	or prescription-related information between a prescriber, dispenser, pharmacy benefit 
35.33 	manager, or group purchaser, either directly or through an intermediary, including an 
36.1 	e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions 
36.2 	between the point of care and the dispenser.
36.3 	(e) "Electronic prescription drug program" means a program that provides for 
36.4 	e-prescribing.
36.5 	(f) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
36.6 	(g) "HL7 messages" means a standard approved by the standards development 
36.7 	organization known as Health Level Seven.
36.8 	(h) "National Provider Identifier" or "NPI" means the identifier described under 
36.9 	Code of Federal Regulations, title 45, part 162.406.
36.10 	(i) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
36.11 	(j) "NCPDP Formulary and Benefits Standard" means the National Council for 
36.12 	Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide, 
36.13 	Version 1, Release 0, October 2005.
36.14 	(k) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug 
36.15 	Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide 
36.16 	Version 8, Release 1 (Version 8.1), October 2005.
36.17 	(l) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
36.18 	(m) "Prescriber" means a licensed health care professional who is authorized to 
36.19 	prescribe a controlled substance under section 152.12, subdivision 1.
36.20 	(n) "Prescription-related information" means information regarding eligibility for 
36.21 	drug benefits, medication history, or related health or drug information.
36.22 	(o) "Provider" or "health care provider" has the meaning given in section 62J.03, 
36.23 	subdivision 8.
36.24 		Subd. 2.Requirements for electronic prescribing. (a) Effective January 1, 2011, 
36.25 	all providers, group purchasers, prescribers, and dispensers must establish and maintain 
36.26 	an electronic prescription drug program that complies with the applicable standards 
36.27 	in this section for transmitting, directly or through an intermediary, prescriptions and 
36.28 	prescription-related information using electronic media.
36.29 	(b) Nothing in this section requires providers, group purchasers, prescribers, or 
36.30 	dispensers to conduct the transactions described in this section. If transactions described in 
36.31 	this section are conducted, they must be done electronically using the standards described 
36.32 	in this section. Nothing in this section requires providers, group purchasers, prescribers, 
36.33 	or dispensers to electronically conduct transactions that are expressly prohibited by other 
36.34 	sections or federal law.
36.35 	(c) Providers, group purchasers, prescribers, and dispensers must use either HL7 
36.36 	messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related 
37.1 	information internally when the sender and the recipient are part of the same legal entity. If 
37.2 	an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard 
37.3 	or other applicable standards required by this section. Any pharmacy within an entity 
37.4 	must be able to receive electronic prescription transmittals from outside the entity using 
37.5 	the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health 
37.6 	Insurance Portability and Accountability Act (HIPAA) requirement that may require the 
37.7 	use of a HIPAA transaction standard within an organization.
37.8 	(d) Entities transmitting prescriptions or prescription-related information where the 
37.9 	prescriber is required by law to issue a prescription for a patient to a nonprescribing 
37.10 	provider that in turn forwards the prescription to a dispenser are exempt from the 
37.11 	requirement to use the NCPDP SCRIPT Standard when transmitting such prescriptions or 
37.12 	prescription-related information.
37.13 		Subd. 3.Standards for electronic prescribing. (a) Prescribers and dispensers 
37.14 	must use the NCPDP SCRIPT Standard for the communication of a prescription or 
37.15 	prescription-related information. The NCPDP SCRIPT Standard shall be used to conduct 
37.16 	the following transactions:
37.17 	(1) get message transaction;
37.18 	(2) status response transaction;
37.19 	(3) error response transaction;
37.20 	(4) new prescription transaction;
37.21 	(5) prescription change request transaction;
37.22 	(6) prescription change response transaction;
37.23 	(7) refill prescription request transaction;
37.24 	(8) refill prescription response transaction;
37.25 	(9) verification transaction;
37.26 	(10) password change transaction;
37.27 	(11) cancel prescription request transaction; and/or
37.28 	(12) cancel prescription response transaction.
37.29 	(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP 
37.30 	SCRIPT Standard for communicating and transmitting medication history information.
37.31 	(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP 
37.32 	Formulary and Benefits Standard for communicating and transmitting formulary and 
37.33 	benefit information.
37.34 	(d) Providers, group purchasers, prescribers, and dispensers must use the national 
37.35 	provider identifier to identify a health care provider in e-prescribing or prescription-related 
37.36 	transactions when a health care provider's identifier is required.
38.1 	(e) Providers, group purchasers, prescribers, and dispensers must communicate 
38.2 	eligibility information and conduct health care eligibility benefit inquiry and response 
38.3 	transactions in accordance with the requirements of section 62J.536.

38.4 	Sec. 8. Minnesota Statutes 2007 Supplement, section 62J.81, subdivision 1, is amended 
38.5 	to read:
38.6 		Subdivision 1.Required disclosure of estimated payment out-of-pocket costs.
 38.7 	(a) A health care provider, as defined in section 62J.03, subdivision 8, or the provider's 
38.8 	designee as agreed to by that designee, shall, at the request of a consumer, and at no cost 
38.9 	to the consumer or the consumer's employer, provide that consumer with a good faith 
38.10 	estimate of the allowable payment the provider has agreed to accept from the consumer's 
38.11 	health plan company for the services specified by the consumer, specifying the amount of 
38.12 	the allowable payment due from the health plan company. Health plan companies must 
38.13 	allow contracted providers, or their designee, to release this information. If a consumer 
38.14 	has no applicable public or private coverage, the health care provider must give the 
38.15 	consumer, and at no cost to the consumer, a good faith estimate of the average allowable 
38.16 	reimbursement the provider accepts as payment from private third-party payers for the 
38.17 	services specified by the consumer and the estimated amount the noncovered consumer 
38.18 	will be required to pay. Payment information provided by a provider, or by the provider's 
38.19 	designee as agreed to by that designee, to a patient pursuant to this subdivision does not 
38.20 	constitute a legally binding estimate of the allowable charge for or cost to the consumer of 
38.21 	services. 
38.22 	(b) A health plan company, as defined in section 62J.03, subdivision 10, shall, at 
38.23 	the request of an enrollee or the enrollee's designee, provide that enrollee with a good 
38.24 	faith estimate of the allowable amount the health plan company has contracted for with a 
38.25 	specified provider within the network as total payment for a health care service specified 
38.26 	by the enrollee and the portion of the allowable amount due from the enrollee and the 
38.27 	enrollee's out-of-pocket costs. An estimate provided to an enrollee under this paragraph is 
38.28 	not a legally binding estimate of the allowable amount or enrollee's out-of-pocket cost.

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

38.30 	Sec. 9. Minnesota Statutes 2007 Supplement, section 62J.82, subdivision 1, is amended 
38.31 	to read:
38.32 		Subdivision 1.Required information. The Minnesota Hospital Association shall 
38.33 	develop a Web-based system, available to the public free of charge, for reporting the 
38.34 	following, for Minnesota residents:
39.1 	(1) hospital-specific performance on the measures of care developed under section 
39.2 	256B.072 for acute myocardial infarction, heart failure, and pneumonia; 
39.3 	(2) by January 1, 2009, hospital-specific performance on the public reporting 
39.4 	measures for hospital-acquired infections as published by the National Quality Forum 
39.5 	and collected by the Minnesota Hospital Association and Stratis Health in collaboration 
39.6 	with infection control practitioners; and 
39.7 	(3) chargecost information, including, but not limited to, number of discharges, 
39.8 	average length of stay, average charge cost, average chargecost per day, and median 
39.9 	charge cost, for each of the 50 most common inpatient diagnosis-related groups and the 
39.10 	25 most common outpatient surgical procedures as specified by the Minnesota Hospital 
39.11 	Association. 

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

39.13 	Sec. 10. Minnesota Statutes 2006, section 62L.12, subdivision 2, is amended to read:
39.14 		Subd. 2.Exceptions. (a) A health carrier may sell, issue, or renew individual 
39.15 	conversion policies to eligible employees otherwise eligible for conversion coverage under 
39.16 	section 62D.104 as a result of leaving a health maintenance organization's service area.
39.17 	(b) A health carrier may sell, issue, or renew individual conversion policies to 
39.18 	eligible employees otherwise eligible for conversion coverage as a result of the expiration 
39.19 	of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21, 
39.20 	62C.142, 62D.101, and 62D.105.
39.21 	(c) A health carrier may sell, issue, or renew conversion policies under section 
39.22 	62E.16 to eligible employees.
39.23 	(d) A health carrier may sell, issue, or renew individual continuation policies to 
39.24 	eligible employees as required.
39.25 	(e) A health carrier may sell, issue, or renew individual health plans if the coverage 
39.26 	is appropriate due to an unexpired preexisting condition limitation or exclusion applicable 
39.27 	to the person under the employer's group health plan or due to the person's need for health 
39.28 	care services not covered under the employer's group health plan.
39.29 	(f) A health carrier may sell, issue, or renew an individual health plan, if the 
39.30 	individual has elected to buy the individual health plan not as part of a general plan to 
39.31 	substitute individual health plans for a group health plan nor as a result of any violation of 
39.32 	subdivision 3 or 4.
39.33 	(g) Nothing in this subdivision relieves a health carrier of any obligation to provide 
39.34 	continuation or conversion coverage otherwise required under federal or state law.
40.1 	(h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage 
40.2 	issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or 
40.3 	contracts that supplement Medicare issued by health maintenance organizations, or those 
40.4 	contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social 
40.5 	Security Act, United States Code, title 42, section 1395 et seq., as amended.
40.6 	(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual 
40.7 	health plans necessary to comply with a court order.
40.8 	(j) A health carrier may offer, issue, sell, or renew an individual health plan to 
40.9 	persons eligible for an employer group health plan, if the individual health plan is a high 
40.10 	deductible health plan for use in connection with an existing health savings account, in 
40.11 	compliance with the Internal Revenue Code, section 223. In that situation, the same or 
40.12 	a different health carrier may offer, issue, sell, or renew a group health plan to cover 
40.13 	the other eligible employees in the group.
40.14 	(k) A health carrier may offer, sell, issue, or renew an individual health plan to one 
40.15 	or more employees of a small employer if the individual health plan is marketed directly to 
40.16 	employees or through the Minnesota Health Insurance Exchange under section 62U.02 to 
40.17 	all employees of the small employer and the small employer does not contribute directly 
40.18 	or indirectly to the premiums or facilitate the administration of the individual health plan. 
40.19 	Except as provided in section 62U.03, subdivision 5, paragraph (b), the requirement to 
40.20 	market an individual health plan to all employees does not require the health carrier to 
40.21 	offer or issue an individual health plan to any employee. For purposes of this paragraph, 
40.22 	an employer is not contributing to the premiums or facilitating the administration of the 
40.23 	individual health plan if the employer does not contribute to the premium and merely 
40.24 	collects the premiums from an employee's wages or salary through payroll deductions 
40.25 	and submits payment for the premiums of one or more employees in a lump sum to the 
40.26 	health carrier or to the Minnesota Health Insurance Exchange under section 62U.02. 
40.27 	Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the 
40.28 	request of an employee, the health carrier or the Minnesota Health Insurance Exchange 
40.29 	under section 62U.02 may bill the employer for the premiums payable by the employee, 
40.30 	provided that the employer is not liable for payment except from payroll deductions for 
40.31 	that purpose. If an employer is submitting payments under this paragraph, the health 
40.32 	carrier or the Minnesota Health Insurance Exchange, as applicable, shall provide a 
40.33 	cancellation notice directly to the primary insured at least ten days prior to termination 
40.34 	of coverage for nonpayment of premium. Individual coverage under this paragraph may 
40.35 	be offered only if the small employer has not provided coverage under section 62L.03 to 
40.36 	the employees within the past 12 months.
41.1 	The employer must provide a written and signed statement to the health carrier or 
41.2 	the Minnesota Health Insurance Exchange, as applicable, stating that the employer is not 
41.3 	contributing directly or indirectly to the employee's premiums. The Minnesota Health 
41.4 	Insurance Exchange under section 62U.02 shall provide all health carriers with enrolled 
41.5 	employees of the employer with a copy of the employer's statement. The health carrier 
41.6 	may rely on the employer's statement and is not required to guarantee-issue individual 
41.7 	health plans to the employer's other current or future employees.

41.8 	Sec. 11. Minnesota Statutes 2006, section 62L.12, subdivision 4, is amended to read:
41.9 		Subd. 4.Employer prohibition. A small employer offering a health benefit plan 
41.10 	shall not encourage or direct an employee or applicant to:
41.11 	(1) refrain from filing an application for health coverage when other similarly 
41.12 	situated employees may file an application for health coverage;
41.13 	(2) file an application for health coverage during initial eligibility for coverage, 
41.14 	the acceptance of which is contingent on health status, when other similarly situated 
41.15 	employees may apply for health coverage, the acceptance of which is not contingent on 
41.16 	health status;
41.17 	(3) seek coverage from another health carrier, including, but not limited to, MCHA; 
41.18 	or
41.19 	(4) cause coverage to be issued on different terms because of the health status or 
41.20 	claims experience of that person or the person's dependents.

41.21 	Sec. 12. Minnesota Statutes 2006, section 62Q.735, subdivision 1, is amended to read:
41.22 		Subdivision 1.Contract disclosure. (a) Before requiring a health care provider to 
41.23 	sign a contract, a health plan company shall give to the provider a complete copy of 
41.24 	the proposed contract, including:
41.25 	(1) all attachments and exhibits;
41.26 	(2) operating manuals;
41.27 	(3) a general description of the health plan company's health service coding 
41.28 	guidelines and requirement for procedures and diagnoses with modifiers, and multiple 
41.29 	procedures; and
41.30 	(4) all guidelines and treatment parameters incorporated or referenced in the contract.
41.31 	(b) The health plan company shall make available to the provider the fee schedule or 
41.32 	a method or process that allows the provider to determine the fee schedule for each health 
41.33 	care service to be provided under the contract.
42.1 	(c) Notwithstanding paragraph (b), A health plan company that is a dental 
42.2 	plan organization, as defined in section 62Q.76, shall disclose information related to 
42.3 	the individual contracted provider's expected reimbursement from the dental plan 
42.4 	organization. Nothing in this section requires a dental plan organization to disclose the 
42.5 	plan's aggregate maximum allowable fee table used to determine other providers' fees. 
42.6 	The contracted provider must not release this information in any way that would violate 
42.7 	any state or federal antitrust law. 

42.8 	Sec. 13. [62U.01] DEFINITIONS.
42.9 		Subdivision 1.Applicability. For purposes of this chapter, the terms defined in this 
42.10 	section have the meanings given, unless otherwise specified.
42.11 		Subd. 2.Baskets or baskets of care. "Basket" or "baskets of care" means a 
42.12 	collection of health care services that are paid separately under a fee-for-service system, 
42.13 	but which are ordinarily combined by a provider in delivering a full diagnostic or 
42.14 	treatment procedure to a patient.
42.15 		Subd. 3.Clinically effective. "Clinically effective" means that the use of a 
42.16 	particular health technology improves patient clinical status, as measured by medical 
42.17 	condition, survival rates, and other variables, and that the use of the particular technology 
42.18 	demonstrates a clinical advantage over alternative technologies.
42.19 		Subd. 4.Commission. "Commission" means the Health Care Transformation 
42.20 	Commission established under section 62U.04.
42.21 		Subd. 5.Cost effective. "Cost effective" means that the economic costs of using 
42.22 	a particular service, device, or health technology to achieve improvement in a patient's 
42.23 	health outcome are justified given the comparison to both the economic costs and the 
42.24 	improvement in patient health outcome resulting from the use of an alternative service, 
42.25 	device, or technology, or from not providing the service, device, or technology.
42.26 		Subd. 6.Exchange. "Exchange" means the Minnesota Health Insurance Exchange 
42.27 	established in section 62U.02.
42.28 		Subd. 7.Group purchaser. "Group purchaser" has the meaning provided in 
42.29 	section 62J.03.
42.30 		Subd. 8.Health plan. "Health plan" means a health plan as defined in section 
42.31 	62A.011.
42.32 		Subd. 9.Health plan company. "Health plan company" has the meaning provided 
42.33 	in section 62Q.01, subdivision 4.
42.34 		Subd. 10.Health technology. "Health technology" means medical and surgical 
42.35 	devices and procedures, medical equipment, and diagnostic tests.
43.1 		Subd. 11.Participating provider. "Participating provider" means a provider who 
43.2 	has entered into a service agreement with a health plan company.
43.3 		Subd. 12.Provider or health care provider. "Provider" or "health care provider" 
43.4 	means a health care provider as defined in section 62J.03, subdivision 8.
43.5 		Subd. 13.Section 125 Plan. "Section 125 Plan" means a cafeteria or premium-only 
43.6 	plan under section 125 of the Internal Revenue Code that allows employees to pay for 
43.7 	health insurance premiums with pretax dollars.
43.8 		Subd. 14.Service agreement. "Service agreement" means an agreement, contract, 
43.9 	or other arrangement between a health plan company and a provider under which the 
43.10 	provider agrees that when health services are provided for an enrollee, the provider shall 
43.11 	not make a direct charge against the enrollee for those services or parts of services which 
43.12 	are covered by the enrollee's contract, but shall look to the service plan corporation for the 
43.13 	payment for covered services, to the extent they are covered.
43.14 		Subd. 15.Third-party administrators. "Third-party administrators" means a 
43.15 	vendor of risk-management services or an entity administering a self-insurance or health 
43.16 	insurance plan under section 60A.23.

43.17 	Sec. 14. [62U.02] MINNESOTA HEALTH INSURANCE EXCHANGE.
43.18 		Subdivision 1.Title; citation. This section may be cited as the "Minnesota Health 
43.19 	Insurance Exchange."
43.20 		Subd. 2.Creation; tax exemption. The Minnesota Health Insurance Exchange 
43.21 	is created for the limited purpose of providing individuals with greater access, choice, 
43.22 	portability, and affordability of health insurance products. The Minnesota Health 
43.23 	Insurance Exchange is a nonprofit corporation under chapter 317A and section 501(c) of 
43.24 	the Internal Revenue Code.
43.25 		Subd. 3.Definitions. For purposes of this section, the following terms have the 
43.26 	meanings given them.
43.27 	(a) "Board" means the board of directors of the Minnesota Health Insurance 
43.28 	Exchange established under subdivision 12.
43.29 	(b) "Commissioner" means: 
43.30 	(1) the commissioner of commerce for health plan companies subject to the 
43.31 	jurisdiction of the Department of Commerce; 
43.32 	(2) the commissioner of health for health plan companies subject to the jurisdiction 
43.33 	of the Department of Health; or 
43.34 	(3) either commissioner's designated representative.
43.35 	(c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
44.1 	(d) "Individual market health plan" means a health plan as defined in section 
44.2 	62A.011.
44.3 	(e) "Small employer" means a small employer as defined in section 62L.02, 
44.4 	subdivision 26.
44.5 	(f) "Small employer plan" means a small employer health plan as defined in section 
44.6 	62L.02, subdivision 15.
44.7 		Subd. 4.Health plan company participation and health plan availability. (a) 
44.8 	All individual market health plans and small employer plans offered by a health plan 
44.9 	company licensed to issue health insurance in Minnesota may be made available for 
44.10 	purchase through the exchange. The health exchange shall limit the number of health 
44.11 	plans to be made available through the exchange. The appropriate number of health plans 
44.12 	shall ensure health plan innovation and consumer choice without being so numerous to 
44.13 	become unmanageable for consumers using the exchange.
44.14 	(b) Nothing in this section restricts the sale of individual market health plans and 
44.15 	small employer plans outside the exchange. The requirements applicable to issuance, 
44.16 	renewal, cancelation, and pricing of coverage are the same for health plans purchased 
44.17 	inside and outside the exchange, except as described under section 62U.03, subdivision 5, 
44.18 	paragraph (b).
44.19 	(c) Health plans offered through the Minnesota Comprehensive Health Association 
44.20 	as defined in section 62E.10 shall be available for sale through the exchange as determined 
44.21 	by the Minnesota Comprehensive Health Association.
44.22 	(d) Health plans offered through the MinnesotaCare program shall be available 
44.23 	through the exchange for individuals and families with children who:
44.24 	(1) have gross household incomes equal to or greater than 200 percent of federal 
44.25 	poverty guidelines;
44.26 	(2) meet the eligibility requirements of the MinnesotaCare program; and
44.27 	(3) pay premiums through an employer Section 125 Plan.
44.28 	(e) Beginning January 1, 2010, any health plan company that issues health plans in 
44.29 	the individual or small employer market must offer through the exchange at least three 
44.30 	health plans that meet the standard benefit set and design established by the Health Care 
44.31 	Transformation Commission. The health plan may impose varying levels of cost sharing 
44.32 	provided it meets the requirements of the standard benefit set and design.
44.33 		Subd. 5.Listing of health plans. The exchange shall create an Internet-based 
44.34 	system for listing individual market health plans and small employer health benefit plans 
44.35 	offered through the exchange. The system shall consider the variation across health plans 
44.36 	in such factors as premiums, deductibles, co-payment and coinsurance requirements, 
45.1 	annual out-of-pocket maximum payments, and lifetime benefit limits, and the system shall 
45.2 	rank the health plans based on priorities specified by the user.
45.3 		Subd. 6.Individual participation and eligibility. Individuals are eligible to 
45.4 	purchase health plans directly through the exchange or through an employer Section 125 
45.5 	Plan under section 62U.03. Nothing in this section requires guaranteed issue of individual 
45.6 	market health plans offered through the exchange except as provided under section 
45.7 	62U.03, subdivision 5, paragraph (b). Individuals are eligible to purchase individual 
45.8 	market health plans through the exchange if the individual meets one or more of the 
45.9 	following qualifications:
45.10 	(1) the individual is a Minnesota resident, meaning the individual is physically 
45.11 	residing on a permanent basis in a place that is the individual's principal residence and 
45.12 	from which the individual is absent only for temporary purposes;
45.13 	(2) the individual is a student attending an institution outside of Minnesota and 
45.14 	maintains Minnesota residency;
45.15 	(3) the individual is not a Minnesota resident but is employed by an employer 
45.16 	physically located within the state and the individual's employer is required to offer a 
45.17 	Section 125 Plan under section 62U.03; or
45.18 	(4) the individual is a dependent as defined in section 62L.02, of another individual 
45.19 	who is eligible to participate in the exchange.
45.20 		Subd. 7.Small employer participation and eligibility. Small employers, as 
45.21 	defined in section 62L.02, may purchase health plans through the exchange.
45.22 		Subd. 8.Responsibilities of the exchange. The exchange may serve as a 
45.23 	coordinating entity for enrollment and collection and transfer of premium payments for 
45.24 	health plans sold to individuals through the exchange. The exchange shall be responsible 
45.25 	for the following functions:
45.26 	(1) publicize the exchange, including but not limited to its functions, eligibility 
45.27 	rules, and enrollment procedures;
45.28 	(2) provide assistance to employers to establish Section 125 Plans under section 
45.29 	62U.03;
45.30 	(3) provide education and assistance to employers to help them understand the 
45.31 	requirements of Section 125 Plans and compliance with applicable regulations;
45.32 	(4) create a system to allow individuals to compare and enroll in health plans 
45.33 	offered through the exchange, including a system of comparative rating of health plans 
45.34 	and benefits set;
45.35 	(5) create a system to collect and transmit to the applicable plans all premium 
45.36 	payments made by individuals, including developing mechanisms to receive and process 
46.1 	automatic payroll deductions for individuals who purchase coverage through employer 
46.2 	Section 125 Plans;
46.3 	(6) for participating employers, bill the employer for the premiums payable by the 
46.4 	employer for a small employer health benefit plan;
46.5 	(7) for individuals purchasing individual market health plans through a Section 125 
46.6 	Plan, bill the individual's employer for premiums payable by the employee, provided that 
46.7 	the employer is not liable for payment except from payroll deductions for that purpose;
46.8 	(8) provide information on public insurance programs to individuals who may 
46.9 	qualify for these programs, and provide application assistance, if needed on applying 
46.10 	for these programs;
46.11 	(9) establish a mechanism with the Department of Human Services to transfer 
46.12 	premiums paid by Minnesota health care program enrollees from Section 125 Plans;
46.13 	(10) establish procedures to account for all funds received and disbursed by the 
46.14 	exchange; and
46.15 	(11) make available to the public, within 90 days from the end of each fiscal year, a 
46.16 	report of an independent audit of the exchange's accounts. 
46.17 		Subd. 9.State not liable. The state of Minnesota shall not be liable for the actions 
46.18 	of the Minnesota Health Insurance Exchange.
46.19 		Subd. 10.Powers of the exchange. The exchange shall have the power to:
46.20 	(1) contract with insurance producers licensed in accident and health insurance 
46.21 	under chapter 60K and vendors to perform one or more of the functions specified in 
46.22 	subdivision 8;
46.23 	(2) contract with employers to collect premiums for small employer plans and for 
46.24 	individual market health plans purchased through a Section 125 Plan;
46.25 	(3) establish and assess fees on health plan premiums of small employer plans and 
46.26 	individual market health plans to fund the cost of administering the exchange;
46.27 	(4) seek and directly receive grant funding from government agencies or private 
46.28 	philanthropic organizations to defray the costs of operating the exchange;
46.29 	(5) establish and administer rules and procedures governing the operations of the 
46.30 	exchange;
46.31 	(6) establish one or more service centers within Minnesota;
46.32 	(7) sue or be sued or otherwise take any necessary or proper legal action;
46.33 	(8) establish bank accounts and borrow money; and
46.34 	(9) enter into agreements with the commissioners of commerce, health, human 
46.35 	services, revenue, employment and economic development, and other state agencies as 
46.36 	necessary for the exchange to implement the provisions of this section.
47.1 		Subd. 11.Dispute resolution. The exchange shall establish procedures for resolving 
47.2 	disputes with respect to the eligibility of an individual to participate in the exchange. The 
47.3 	exchange does not have the authority or responsibility to intervene in or resolve disputes 
47.4 	between an individual and a health plan or health plan company. The exchange shall refer 
47.5 	complaints from individuals participating in the exchange to the commissioner to be 
47.6 	resolved according to sections 62Q.68 to 62Q.73.
47.7 		Subd. 12.Board of directors. The exchange shall be governed by a board of 
47.8 	directors with 11 members. Except as specifically provided in this section, the board of 
47.9 	directors is subject to section 15.0575. The commissioner of commerce shall convene 
47.10 	the first meeting of the board on or before July 1, 2008, after the initial board members 
47.11 	have been selected. Notwithstanding section 15.0575, subdivision 2, the initial board 
47.12 	membership consists of the following:
47.13 	(1) the commissioner of commerce;
47.14 	(2) the commissioner of human services;
47.15 	(3) the commissioner of health; and
47.16 	(4) eight public members with knowledge and experience related to health insurance 
47.17 	and health insurance markets, appointed to serve three-year terms expiring June 30, 
47.18 	2011, as follows: two members appointed by the Subcommittee on Committees of the 
47.19 	Committee on Rules and Administration of the senate; two members appointed by the 
47.20 	speaker of the house of representatives; and four members appointed by the governor. The 
47.21 	appointments required under this section must be completed by June 15, 2008. 
47.22 		Subd. 13.Subsequent board membership. (a) Notwithstanding section 15.0575, 
47.23 	subdivision 2, ongoing membership of the exchange consists of the following effective 
47.24 	July 1, 2011:
47.25 	(1) the commissioner of commerce;
47.26 	(2) the commissioner of human services;
47.27 	(3) the commissioner of health;
47.28 	(4) two public members appointed to serve two-year terms as follows: one 
47.29 	member appointed by the Subcommittee on Committees of the Committee on Rules and 
47.30 	Administration of the senate; and one member appointed by the speaker of the house of 
47.31 	representatives; and
47.32 	(5) four public members elected by the membership of the exchange. The board 
47.33 	must designate two of the elected members to serve a two-year term and two of the elected 
47.34 	members to serve a three-year term. 
48.1 	(b) Elected members may serve more than one term. The board must ensure that at 
48.2 	least one of the elected members represents a small employer, and at least one member is a 
48.3 	person who purchases an individual market health plan through the exchange.
48.4 		Subd. 14.Operations of the board. Officers of the board of directors are elected by 
48.5 	members of the board and serve one-year terms. Six members of the board constitute a 
48.6 	quorum, and the affirmative vote of six members of the board is necessary and sufficient 
48.7 	for any action taken by the board. Board members serve without compensation, but shall 
48.8 	be reimbursed for actual expenses incurred in the performance of their duties, as provided 
48.9 	in section 15.0575. 
48.10 		Subd. 15.Operations of the exchange. The board of directors shall appoint an 
48.11 	exchange director who shall:
48.12 	(1) be a full-time employee of the exchange;
48.13 	(2) administer all of the activities and contracts of the exchange; and 
48.14 	(3) hire and supervise the staff of the exchange.
48.15 		Subd. 16.Insurance producers. An individual has the right to choose any 
48.16 	insurance producer licensed in accident and health insurance under chapter 60K to assist 
48.17 	them in purchasing an individual market health plan through the exchange. When a 
48.18 	producer licensed in accident and health insurance under chapter 60K enrolls an eligible 
48.19 	individual in the exchange, the health plan company chosen by the individual may pay the 
48.20 	producer a commission.
48.21 		Subd. 17.Implementation. Health plan coverage through the exchange begins on 
48.22 	July 1, 2009. The exchange must be operational to assist employers and individuals by 
48.23 	January 1, 2009, and be prepared for enrollment by June 1, 2009.

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

48.25 	Sec. 15. [62U.03] SECTION 125 PLANS.
48.26 		Subdivision 1.Definitions. For purposes of this section, the following terms have 
48.27 	the meanings given them.
48.28 	(a) "Employee" means an employee currently on an employer's payroll other than a 
48.29 	retiree or disabled former employee.
48.30 	(b) "Employer" means a person, firm, corporation, partnership, association, business 
48.31 	trust, or other entity employing one or more persons, including a political subdivision of 
48.32 	the state, filing payroll tax information on such employed person or persons.
48.33 	(c) "Exchange director" means the appointed director of the Minnesota Health 
48.34 	Insurance Exchange under section 62U.03, subdivision 15.
49.1 		Subd. 2.Section 125 Plan requirement. (a) Effective January 1, 2009, all 
49.2 	employers with 11 or more current full-time equivalent employees shall establish a Section 
49.3 	125 Plan to allow their employees to purchase individual market or employer-based health 
49.4 	plan coverage with pretax dollars. Nothing in this section requires employers to offer or 
49.5 	purchase group health insurance coverage for their employees.
49.6 	The following employers are exempt from the Section 125 Plan requirement:
49.7 	(1) employers that offer a group health insurance plan as defined in section 62A.10;
49.8 	(2) employers that are self-insured as defined in section 62E.02; or
49.9 	(3) employers with no employees who are eligible to participate in a Section 125 
49.10 	Plan.
49.11 	(b) Employers that offer a Section 125 Plan may enter into an agreement with the 
49.12 	exchange to administer the employer's Section 125 Plan.
49.13 	(c) Notwithstanding paragraph (a), an employer that has been certified by a licensed 
49.14 	insurance broker as having received education and information on the benefits and 
49.15 	advantages of offering Section 125 Plans is not required to establish a Section 125 Plan. 
49.16 	This paragraph expires January 1, 2010.
49.17 		Subd. 3.Tracking compliance. By July 1, 2010, the exchange, in consultation with 
49.18 	the commissioners of commerce, health, employment and economic development, and 
49.19 	revenue shall establish a method for tracking employer compliance with the Section 125 
49.20 	Plan requirement.
49.21 		Subd. 4.Employer requirements. (a) Employers that do not offer a group health 
49.22 	insurance plan as defined in section 62A.10 and are required to offer or choose to offer a 
49.23 	Section 125 Plan shall:
49.24 	(1) allow employees to purchase an individual market health plan for themselves 
49.25 	and their dependents;
49.26 	(2) allow employees to choose any insurance producer licensed in accident and health 
49.27 	insurance under chapter 60K to assist them in purchasing an individual market health plan;
49.28 	(3) upon an employee's request, deduct premium amounts on a pretax basis in an 
49.29 	amount not to exceed an employee's wages, and remit these employee payments to the 
49.30 	health plan or the exchange; and
49.31 	(4) provide notice to employees that individual market health plans purchased by 
49.32 	employees through payroll deduction are not employer-sponsored or administered. 
49.33 	(b) Employers shall be held harmless from any and all liability claims related to the 
49.34 	individual market health plans purchased by employees under a Section 125 Plan.
49.35 		Subd. 5.Health plan company requirements. (a) Individuals who are eligible to 
49.36 	use an employer Section 125 Plan to pay for an individual market health plan purchased 
50.1 	through the exchange may enroll in any health plan offered through the exchange 
50.2 	for which the individual is eligible, including the individual market health plans, 
50.3 	MinnesotaCare, and the Minnesota Comprehensive Health Association, to the extent 
50.4 	authorized under section 62U.02, subdivision 4.
50.5 	(b) Individuals who purchase an individual market health plan through a Section 125 
50.6 	Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment 
50.7 	period that coincides with the open enrollment period for their employer's Section 125 
50.8 	Plan or upon experiencing a qualifying event as defined in United States Code, chapter 
50.9 	43, section 4980B. Nothing in this section precludes a health plan company from 
50.10 	issuing coverage with preexisting condition exclusions as authorized in law. Health plan 
50.11 	companies may not charge higher or lower premiums based on health status for individuals 
50.12 	who purchase coverage on a guaranteed issue basis under this section, except for variations 
50.13 	in premium that are allowable based on health behaviors such as tobacco use.

50.14 	Sec. 16. [62U.04] HEALTH CARE TRANSFORMATION COMMISSION.
50.15 		Subdivision 1.Creation. The Health Care Transformation Commission is created 
50.16 	for the purpose of coordinating the health care transformation activities within Minnesota.
50.17 		Subd. 2.Members. (a) The Health Care Transformation Commission shall consist 
50.18 	of ten members who are appointed as follows:
50.19 	(1) three members appointed by the Subcommittee on Committees of the Committee 
50.20 	on Rules and Administration of the senate, including two public members and one senator;
50.21 	(2) three members appointed by the speaker of the house of representatives, 
50.22 	including two public members and one member of the house; and
50.23 	(3) four members appointed by the governor, two of whom shall be state 
50.24 	commissioners from the agencies listed in section 15.01.
50.25 	(b) The appointing authorities must ensure that the appointed members who are 
50.26 	not legislators or commissioners:
50.27 	(1) have expertise in health care financing, health care delivery, health care quality 
50.28 	improvement, health economics, actuarial science, or business operations;
50.29 	(2) are not state employees or employees of a political subdivision; and
50.30 	(3) do not have a direct financial interest in the outcome of the commission's 
50.31 	business, other than as an individual consumer of health care services.
50.32 	(c) Section 15.0575, subdivision 4, governs the removal of members.
50.33 		Subd. 3.Operations of the commission. (a) The commissioner of health shall 
50.34 	convene the first meeting of the commission on or before July 1, 2008, following the 
50.35 	initial appointment of the members.
51.1 	(b) The commission shall elect a chair from its membership.
51.2 	(c) The commission members shall not be compensated for commission activities 
51.3 	except for actual expenses incurred in the performance of their duties. Expenses shall be 
51.4 	compensated in accordance with section 15.0575.
51.5 		Subd. 4.Responsibilities of the commission. (a) The commission shall develop a 
51.6 	design and implementation plan for a health care payment restructuring system within the 
51.7 	parameters described in this chapter. The plan must provide for the full implementation of 
51.8 	the payment restructuring system by January 1, 2011. The design and plan must include:
51.9 	(1) uniform definitions for the baskets of care and a comprehensive set of services as 
51.10 	required under section 62U.10;
51.11 	(2) a mechanism for soliciting and accepting payment bids from health care 
51.12 	providers and health care systems as required under section 62U.10. The mechanism 
51.13 	must ensure that the bids from different providers and care systems can be compared by 
51.14 	consumers on both quality and cost;
51.15 	(3) procedures to facilitate providers in participating in the payment system and, 
51.16 	if needed, provide technical assistance to providers in assembling bids, contracting with 
51.17 	other providers in order to assemble or submit bids, or otherwise participate in the 
51.18 	payment system; and
51.19 	(4) a method for monitoring, measuring, and evaluating the effectiveness of the 
51.20 	payment restructuring system and for making adjustments, as necessary, to address any 
51.21 	barriers or unintended consequences.
51.22 	(b) In developing the payment restructuring system described in this chapter, the 
51.23 	commission shall consult and coordinate with the commissioners of health and human 
51.24 	services, health care providers, health plan companies, organizations that work to improve 
51.25 	health care quality in Minnesota, consumers, and employers.
51.26 	(c) By July 1, 2009, the commission must make recommendations to the governor 
51.27 	and the legislative committees with jurisdiction on health care policy and finance on 
51.28 	how to incorporate Medicare into the payment restructuring system. In developing 
51.29 	these recommendations, the commission shall negotiate with the Centers for Medicare 
51.30 	and Medicaid Services and with the Minnesota congressional delegation and explore 
51.31 	participation in a demonstration project or advocate for changes in federal law to enable 
51.32 	the transformation of the health care system to succeed.
51.33 	(d) The commission may contract with other organizations and entities to carry 
51.34 	out any of the duties described in this chapter, including evaluating the effectiveness of 
51.35 	the payment restructuring system.
52.1 		Subd. 5.Standard benefit set and design. (a) Based on the recommendations 
52.2 	submitted by the Health Benefit Set and Design Advisory Committee, the commission 
52.3 	shall establish a standard benefit set and design by July 1, 2009.
52.4 	(b) The standard health benefit set and design must meet the requirements described 
52.5 	in section 62U.06.
52.6 	(c) Prior to establishing the standard benefit set and design, the commission shall 
52.7 	convene public hearings throughout the state.
52.8 		Subd. 6.Reports. The commission shall submit a report on January 15 of each year 
52.9 	to the governor and legislature, beginning in 2010, on the following:
52.10 	(1) the extent to which health care providers have reduced their costs and fees;
52.11 	(2) the extent to which costs and cost growth are likely to be maintained or reduced 
52.12 	in future years;
52.13 	(3) the extent to which the quality of health care services has improved;
52.14 	(4) the extent to which all Minnesotans have access to quality, affordable health 
52.15 	care; and
52.16 	(5) recommendations on additional actions that are needed in order to successfully 
52.17 	achieve health care transformation in Minnesota.
52.18 		Subd. 7.Sunset. The commission shall expire June 30, 2012. Upon expiration, the 
52.19 	duties of the commission shall transfer to the Health Care Value Reporting Committee.

52.20 	Sec. 17. [62U.05] HEALTH CARE VALUE REPORTING COMMITTEE.
52.21 		Subdivision 1. Creation. The Health Care Value Reporting Committee is created 
52.22 	for the purpose of collecting, analyzing, and disseminating data on health care quality.
52.23 		Subd. 2.Members. (a) The Health Care Value Reporting Committee shall consist of 
52.24 	seven members who shall be appointed by the Health Care Transformation Commission. 
52.25 	The members must have expertise and knowledge in health care quality improvement 
52.26 	and measurement.
52.27 	(b) Upon the expiration of the Health Care Transformation Commission, the 
52.28 	members shall be appointed as follows:
52.29 	(1) three members appointed by the governor;
52.30 	(2) two members appointed by the Subcommittee on Committees of the Committee 
52.31 	on Rules and Administration of the senate; and
52.32 	(3) two members appointed by the speaker of the house of representatives.
52.33 	(c) Membership terms shall be for four years.
52.34 		Subd. 3.Operation of the committee. (a) The governor's designee shall convene 
52.35 	the first meeting of the committee following the initial appointment of the members.
53.1 	(b) The committee shall elect a chair among its members at the initial meeting.
53.2 	(c) The committee shall be governed under section 15.0575 except that the members 
53.3 	shall not be compensated and the committee shall not expire.
53.4 		Subd. 4.Duties. (a) The Health Care Value Reporting Committee shall be 
53.5 	responsible for collecting, analyzing, and disseminating data on health care quality.
53.6 	(b) The Health Care Value Reporting Committee shall: 
53.7 	(1) establish the standards for measuring health care outcomes; 
53.8 	(2) establish a system for providers to report outcomes and processes associated with 
53.9 	patient care. In establishing these standards and system, the Health Care Value Reporting 
53.10 	Committee shall work with other organizations that are developing quality measurement 
53.11 	and reporting systems to establish a single system for collection and reporting of data 
53.12 	on provider quality;
53.13 	(3) collect standardized electronic information outcomes and processes from health 
53.14 	care providers;
53.15 	(4) establish a system for risk adjusting the measures reported by providers January 
53.16 	1, 2010; and
53.17 	(5) issue annual public reports on provider quality using the data submitted by 
53.18 	providers, adjusted for patient complexity beginning July 1, 2010.
53.19 	(c) The Health Care Value Reporting Committee may contract with organizations 
53.20 	and collaborations of organizations such as the Minnesota Community Measurement or 
53.21 	Stratis Health to carry out any of the duties described in this section.

53.22 	Sec. 18. [62U.06] STANDARD BENEFIT SET AND DESIGN; HEALTH 
53.23 	BENEFIT AND DESIGN ADVISORY COMMITTEE.
53.24 		Subdivision 1.Creation. The Health Care Transformation Commission established 
53.25 	in section 62U.04 shall convene a Health Benefit and Design Advisory Committee to 
53.26 	make recommendations to the commission on a standard benefit set and design. The 
53.27 	advisory committee shall consist of seven members. The members shall be appointed 
53.28 	by the commission by August 15, 2008, and must have expertise in benefit design and 
53.29 	development, actuarial analysis, or knowledge relating to the analysis of the cost impact 
53.30 	of coverage of specified benefits.
53.31 		Subd. 2.Operations of the committee. (a) The chair of the Health Care 
53.32 	Transformation Commission shall convene the first meeting of the advisory committee 
53.33 	on or before September 1, 2008. The committee must meet at least once a year, and at 
53.34 	other times as necessary.
54.1 	(b) The commission shall provide office space, equipment and supplies, and 
54.2 	technical support to the committee.
54.3 	(c) The committee shall be governed by section 15.059, except the committee shall 
54.4 	not expire. Upon the expiration of the Health Care Transformation Commission, the 
54.5 	Health Benefit and Design Advisory Committee shall continue to exist under the oversight 
54.6 	of the Health Care Value Reporting Committee.
54.7 		Subd. 3.Duties of the committee. (a) By January 15, 2009, the committee shall 
54.8 	develop and submit to the commission an initial cost-effective benefit set and design 
54.9 	that provides individuals access to a broad range of health care services, including 
54.10 	preventive health care, including dental care, comprehensive mental health services, 
54.11 	chemical dependency treatment, vision care, language interpreter services, emergency 
54.12 	transportation, and prescription drugs without incurring severe financial loss as a result of 
54.13 	serious illness or injury. The benefit set must include necessary evidence-based health care 
54.14 	services, procedures, and diagnostic tests that are scientifically proven to be both clinically 
54.15 	effective and cost-effective. In establishing the initial benefit set, the committee may 
54.16 	contract with the Institute for Clinical Systems Improvement (ICSI) to assemble existing 
54.17 	scientifically based practice standards. The committee shall consider cultural, ethnic, and 
54.18 	religious values and beliefs to ensure that the health care needs of all Minnesota residents 
54.19 	will be addressed in the benefit set.
54.20 	(b) The benefit set must identify and include preventive services, chronic care 
54.21 	coordination services, and early diagnostic tests, that, if included in the benefit set, with 
54.22 	minimal or no cost-sharing requirements, would result in savings that are equal to or 
54.23 	greater than the cost of providing the services.
54.24 	(c) The benefit set must include ICSI-designated evidence-based outpatient care for 
54.25 	asthma, heart disease, diabetes, and depression with no cost-sharing requirements, or 
54.26 	with minimal cost-sharing requirements that would not impose an economic barrier to 
54.27 	accessing the care.
54.28 	(d) The benefit design must establish a maximum deductible for in-network benefits 
54.29 	and for prescription drugs coverage and a maximum for out-of-pocket costs.
54.30 		Subd. 4.Continued review. The committee shall review the benefit set and design 
54.31 	on an ongoing periodic basis and shall adjust the benefit set and design, as necessary to 
54.32 	ensure that the benefit set and design continues to be safe, effective, and scientifically 
54.33 	based.

54.34 	Sec. 19. [62U.07] HEALTH TECHNOLOGY ASSESSMENT.
55.1 		Subdivision 1.Technology Advisory Committee. (a) The Health Care 
55.2 	Transformation Commission shall appoint an advisory committee to make 
55.3 	recommendations to the commission regarding the inclusion of new and existing health 
55.4 	technologies to the standard benefit set and design.
55.5 	(b) The advisory committee shall be made up of 11 members appointed by the 
55.6 	commission, in consultation with the Institute for Clinical Systems Improvement, the 
55.7 	Health Services Advisory Council, and the University of Minnesota. The membership 
55.8 	shall include:
55.9 	(1) six practicing physicians licensed under chapter 147; and
55.10 	(2) five other practicing health care professionals who use health technology in 
55.11 	their scope of practice.
55.12 	The commission must complete the appointments required by this paragraph by September 
55.13 	1, 2008. The chair of the commission shall convene the first meeting of the Technology 
55.14 	Advisory Committee within 30 days following the completion of the appointments to 
55.15 	the committee.
55.16 	(c) A member of the advisory committee may not: 
55.17 	(1) have a substantial financial interest in a health technology company; or
55.18 	(2) be employed by or under contract with a health technology manufacturer during 
55.19 	their term or for 18 months before their appointment.
55.20 	(d) The advisory committee is subject to section 15.059, except that the committee 
55.21 	shall not expire. Upon the expiration of the Health Care Transformation Commission, the 
55.22 	Health Technology Assessment Committee shall continue to exist under the oversight of 
55.23 	the Health Care Value Reporting Committee.
55.24 		Subd. 2.Technology selection process. The commission, in consultation with the 
55.25 	advisory committee, shall select existing and new health technologies to be reviewed by 
55.26 	the committee. In making a selection, priority shall be given to any technology for which:
55.27 	(1) there are concerns about its safety, efficacy, or cost-effectiveness;
55.28 	(2) actual or expected expenditures are high due to demand for the technology, 
55.29 	its cost or both; and
55.30 	(3) there is adequate evidence available to conduct a complete review.
55.31 		Subd. 3.Technology review. (a) Upon the selection of a health technology for 
55.32 	review, the committee shall contract for a systematic evidence-based assessment of 
55.33 	the technology's safety, efficacy, and cost-effectiveness. The contract shall be with an 
55.34 	evidence-based practice center designated as such by the federal agency for health care 
55.35 	research and quality, or another appropriate entity as designated by the committee.
56.1 	(b) The committee shall provide notification to the public when a health technology 
56.2 	has been selected for review. The notification must indicate when that review is to be 
56.3 	initiated and how an interested party may submit evidence or provide public comment for 
56.4 	consideration during the review.
56.5 		Subd. 4.Committee determination. (a) Upon reviewing the completed assessment 
56.6 	and any other evidence submitted regarding the safety, efficacy, and cost-effectiveness of 
56.7 	the technology, the committee shall recommend to the commission:
56.8 	(1) the conditions, if any, under which the health technology should be included 
56.9 	as a covered benefit; and
56.10 	(2) if covered, the criteria to be used to decide whether the technology is medically 
56.11 	necessary, or proper and necessary treatment.
56.12 	(b) The commissioners of human services, employee relations, and corrections may 
56.13 	use the committee's recommendation in making coverage and reimbursement decisions 
56.14 	unless the recommendation conflicts with an applicable federal statute or regulation.

56.15 	Sec. 20. [62U.08] PAYMENT RESTRUCTURING: INCENTIVE PAYMENTS 
56.16 	BASED ON QUALITY AND EFFICIENCY OF CARE.
56.17 		Subdivision 1.Development. (a) By November 15, 2008, the Health Care 
56.18 	Transformation Commission shall develop a system of quality and efficiency incentive 
56.19 	payments to providers that meets the criteria listed in subdivision 2. The system must 
56.20 	incorporate payments to primary care physicians, specialty care physicians, health care 
56.21 	clinics, and hospitals eligible for these incentive payments.
56.22 	(b) The requirements of section 62Q.101 do not apply under this incentive payment 
56.23 	system.
56.24 		Subd. 2.Payment system criteria. The quality and efficiency incentive payment 
56.25 	system shall meet the following criteria:
56.26 	(1) providers meeting specified targets, or who demonstrate a significant amount of 
56.27 	improvement over time, shall be eligible for quality and efficiency incentive payments;
56.28 	(2) priority shall be placed on measures of health care outcomes, rather than 
56.29 	processes, wherever possible;
56.30 	(3) quality measures for primary care providers shall include preventive services, 
56.31 	coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary 
56.32 	disease, and depression;
56.33 	(4) quality measures for specialty care shall be initially based on quality indicators 
56.34 	measured and reported publicly by specialty societies;
57.1 	(5) hospital measures shall be initially based on existing quality and efficiency 
57.2 	measures; and
57.3 	(6) other indicators of care quality and efficiency may be incorporated where 
57.4 	appropriate. These indicators may include care infrastructure, collection and reporting of 
57.5 	results, measures of efficiency for specific procedures, and measures of overall cost of 
57.6 	care for individuals.
57.7 		Subd. 3.Implementation. By January 1, 2009: 
57.8 	(1) the commissioner of human services shall implement this incentive payment 
57.9 	system for all enrollees in the state's public health care programs;
57.10 	(2) the commissioner of employee relations shall implement this incentive payment 
57.11 	system for all participants in the state employee group insurance program; and
57.12 	(3) all health plan companies shall implement this incentive payment system for all 
57.13 	participating providers.

57.14 	Sec. 21. [62U.09] PAYMENT RESTRUCTURING: CARE COORDINATION 
57.15 	PAYMENTS.
57.16 		Subdivision 1.Development. By July 1, 2009, the Health Care Transformation 
57.17 	Commission shall develop a system that provides care coordination payments to health 
57.18 	care providers. In order to be eligible for a care coordination payment, a health care 
57.19 	provider must be certified as a health care home by the commissioner of health based on 
57.20 	the certification standards for health care homes established under section 256B.0754.
57.21 		Subd. 2.Care coordination fee. (a) Under the care coordination payments, health 
57.22 	care homes shall receive a per-person per-month care coordination fee for providing 
57.23 	care coordination services and employing care coordinators. For purpose of this section, 
57.24 	the specifications of care coordination and care coordinators are described in section 
57.25 	256B.0752, subdivisions 3 and 7, respectively.
57.26 	(b) The care coordination fee must not exceed an average of $50 per person per 
57.27 	month. The care coordination fee must be determined by the Health Care Transformation 
57.28 	Commission and may vary by thresholds of care complexity, with the highest fees being 
57.29 	paid for care provided to individuals requiring the most intensive care coordination, such 
57.30 	as those with very complex health care needs or several chronic conditions.
57.31 	(c) In developing the system of care coordination fees, the commission shall consider 
57.32 	the additional time and resources needed by patients with limited English-language skills, 
57.33 	cultural differences, or other barriers to health care.
57.34 	(d) Care coordination fees must be phased-in, and must be applied first to individuals 
57.35 	who have, or are at risk of developing, complex or chronic health conditions.
58.1 		Subd. 3.Quality and efficiency-based payments. The care coordination fees paid 
58.2 	under this section are in addition to the quality and efficiency incentive payments in 
58.3 	section 62U.08. Providers whose quality or efficiency does not allow them to qualify for 
58.4 	payments under section 62U.08 are not be eligible to receive care coordination fees.
58.5 		Subd. 4.Implementation. (a) By July 1, 2009:
58.6 	(1) the commissioner of human services shall implement the care coordination 
58.7 	payments for enrollees in the state's public health care programs;
58.8 	(2) the commissioner of employee relations shall implement the care coordination 
58.9 	payments for participants in the state employee group insurance program; and
58.10 	(3) all health plan companies shall implement this care coordination payments 
58.11 	for enrollees.
58.12 	(b) The commissioners of human services and employee relations and health plan 
58.13 	companies may begin implementing this care coordination payments for enrollees and 
58.14 	participants who have or are at risk of developing complex and chronic health conditions.

58.15 	Sec. 22. [62U.10] PAYMENT RESTRUCTURING: PROVIDER INNOVATION 
58.16 	TO IMPROVE COSTS AND QUALITY.
58.17 		Subdivision 1.Development. By January 1, 2010, the Health Care Transformation 
58.18 	Commission shall develop a payment system that encourages provider innovation to 
58.19 	improve costs and quality. 
58.20 		Subd. 2.Encounter data. (a) Beginning September 1, 2008, and every three months 
58.21 	thereafter, all health plan companies and third-party administrators shall submit encounter 
58.22 	data to the Health Care Transformation Commission. The data shall be submitted in a 
58.23 	form and manner specified by the commission subject to the following requirements:
58.24 	(1) the data must be de-identified data as described under the Code of Federal 
58.25 	Regulations, title 45, section 164.514;
58.26 	(2) the data for each encounter must include an identifier for the patient's health care 
58.27 	home if the patient has selected a health care home; and
58.28 	(3) except for the identifier described in clause (2), the data must not include 
58.29 	information that is not included in a health care claim or equivalent encounter information 
58.30 	transaction that is required under section 62J.536.
58.31 	(b) The commission shall only use the data submitted under paragraph (a) for the 
58.32 	purpose of carrying out its responsibilities in designing and implementing a payment 
58.33 	restructuring system. If the commission contracts with other organizations or entities to 
58.34 	carry out any of its duties or responsibilities described in this chapter, the contract must 
59.1 	require that the organization or entity maintain that data that it receives according to the 
59.2 	provisions of this section.
59.3 	(c) Data on providers collected under this subdivision are private data on individuals 
59.4 	or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary 
59.5 	data in section 13.02, subdivision 19, summary data prepared under this section may be 
59.6 	derived from nonpublic data. The commission shall establish procedures and safeguards 
59.7 	to protect the integrity and confidentiality of any data that it maintains.
59.8 	(d) The commission shall not publish analyses or reports that identify or could 
59.9 	potentially identify individual patients.
59.10 	(e) The commission may publish analyses and reports that identify specific providers 
59.11 	but only after the provider has been provided the opportunity by the commission to review 
59.12 	the data and submit comments. The provider shall have 21 days to review and comment, 
59.13 	after which time the commission may release the data along with any comments submitted 
59.14 	by the provider.
59.15 		Subd. 3.Utilization and health care costs. (a) The commission shall develop a 
59.16 	method of calculating the relative utilization and health care costs of providers. The 
59.17 	method must include risk adjustments to reflect the differences in the demographics, 
59.18 	health, and special needs of the providers' patient population. The risk adjustment must be 
59.19 	developed in accordance with generally accepted risk adjustment methodologies.
59.20 	(b) By April 1, 2009, the commission shall disseminate information to providers on 
59.21 	their utilization and cost in comparison to an appropriate peer group.
59.22 	(c) The commission shall develop a system to index providers based on their total 
59.23 	risk-adjusted resource use per person and on quality of care. In developing this system, 
59.24 	the commission shall consult and coordinate with health care providers, health plan 
59.25 	companies, and the Health Care Value Reporting Organization.
59.26 		Subd. 4.Total care bids. (a) The commission shall develop a standard method and 
59.27 	format for providers to use for submitting a bid under this subdivision. This method shall 
59.28 	be published in the State Register and must be made available to all providers.
59.29 	(b) Beginning July 1, 2009, and annually thereafter, using the information developed 
59.30 	in subdivision 3, providers may submit bids to the commission for total costs of providing 
59.31 	care based on their disclosed prices under section 62U.11 combined with their actual 
59.32 	risk-adjusted resource use for the most recent analytic period. The bid submitted must 
59.33 	reflect the providers' commitment to manage their risk-adjusted patient population within 
59.34 	this total cost.
60.1 	(c) A provider who does not want to submit a bid as part of a care system may 
60.2 	submit a bid on the services that the provider offers. The bid must be included in a bid for 
60.3 	total care that may be compiled by the provider, the commission, or another entity.
60.4 	(d) Until January 1, 2012, no provider shall submit a bid for risk-adjusted total cost 
60.5 	of care that represents an increase of more than the increase in the previous calendar year's 
60.6 	Consumer Price Index for all urban consumer plus two percentage points or a decrease of 
60.7 	more than 15 percent below the provider's risk-adjusted total cost of care calculated based 
60.8 	on their average pricing levels for the previous calendar year. 
60.9 	(e) Beginning January 1, 2010, the commission shall annually publish the results 
60.10 	of the process described in paragraph (b), and shall include only providers who choose 
60.11 	to submit bids. The results that are published must be on a risk-neutral basis. Effective 
60.12 	January 1, 2011, the published results shall include all providers.
60.13 		Subd. 5.Provider assistance. The commission shall provide education and 
60.14 	technical assistance to providers on how to calculate and submit bids for the total 
60.15 	risk-adjusted cost of care per patient.
60.16 		Subd. 6.Payments. The commission shall establish a method by which providers 
60.17 	who have submitted a bid shall be paid for their total cost of care, with periodic 
60.18 	adjustments to the payment they receive to reflect their actual risk-adjusted cost relative 
60.19 	to their submitted bid price. Providers who choose not to bid shall be paid based on the 
60.20 	prices they have established under section 62U.11.
60.21 		Subd. 7.Implementation. By January 1, 2010: 
60.22 	(1) the commissioner of human services shall implement this payment system for all 
60.23 	enrollees in the state's public health care programs;
60.24 	(2) the commissioner of employee relations shall implement this payment system for 
60.25 	all participants in the state employee group insurance program;
60.26 	(3) all political subdivisions as defined in section 13.02, subdivision 11, that offer 
60.27 	health benefits to their employees must implement this payment system or purchase a 
60.28 	health plan that uses this payment system;
60.29 	(4) all health plan companies shall use the information and methods developed 
60.30 	under this section to develop health plans that encourage consumers to use high-quality, 
60.31 	low-cost providers; and
60.32 	(5) health plan companies that issue health plans in the individual market or the small 
60.33 	employer market must offer at least one health plan that uses the information developed 
60.34 	under subdivision 3 to establish financial incentives for consumers to choose high-quality, 
60.35 	low-cost providers through enrollee cost-sharing or selective provider networks.

61.1 	Sec. 23. [62U.11] PROVIDER PRICE AND QUALITY DISCLOSURE.
61.2 	(a) By January 1, 2009, and annually thereafter, each health care provider shall 
61.3 	establish a list of prices for each health care procedure, service, or basket of care 
61.4 	the provider provides and provide this information electronically to the Health Care 
61.5 	Transformation Commission in the form and manner specified by the commission, and 
61.6 	shall be provided to the public at no cost upon request.
61.7 	(b) By January 1, 2009, each health care provider shall submit standardized 
61.8 	electronic information on the outcomes and processes associated with patient care to the 
61.9 	Health Care Value Reporting Organization.

61.10 	Sec. 24. [62U.12] PROVIDER PRICING.
61.11 	(a) No health care provider shall vary the payment amount that the provider accepts 
61.12 	as full payment for a health care service based upon the identity of the payer, upon a 
61.13 	contractual relationship with a payer, upon the identity of the patient, or upon whether the 
61.14 	patient has coverage through a group purchaser.
61.15 	(b) This section does not apply to a variation based upon a payer being a 
61.16 	governmental entity.
61.17 	(c) This section does not affect the right of a provider to provide charity care or care 
61.18 	for a reduced price due to financial hardship of the patient or due to the patient being a 
61.19 	relative or friend of the provider.

61.20 	Sec. 25. [62U.13] HEALTH SAVINGS REINVESTMENT ASSESSMENT.
61.21 		Subdivision 1.Projected spending baseline. (a) The commissioner of health shall 
61.22 	calculate the annual projected total health care spending for the state and establish a health 
61.23 	care spending baseline beginning for the calendar year 2008 and for the next ten years 
61.24 	based on the annual projected growth in spending.
61.25 	(b) In establishing the health care spending baseline, the commissioner shall use 
61.26 	the Center of Medicare and Medicaid Services forecast for total growth in national health 
61.27 	care expenditures, and adjust this forecast to reflect the demographics, health status, and 
61.28 	other factors deemed necessary by the commissioner. The commissioner shall contract 
61.29 	with an actuarial consultant to make recommendations as to the adjustments needed to 
61.30 	specifically reflect projected spending for Minnesota residents.
61.31 	(c) The commissioner may adjust the projected baseline as necessary, to reflect any 
61.32 	updated federal projections or account for unanticipated changes in federal policy.
61.33 	(d) Medicare spending shall not be included in the calculations required under 
61.34 	this section.
62.1 		Subd. 2.Actual spending. (a) By June 1 of each year, beginning June 1, 2010, the 
62.2 	commissioner shall determine the actual private and public health care expenditures for the 
62.3 	calendar year preceding the current calendar year based on data collected under chapter 
62.4 	62J and shall determine the difference between the projected spending as determined 
62.5 	under subdivision 1 and the actual spending for that year. The actual spending must be 
62.6 	certified by an independent actuarial consultant. If the actual spending is less than the 
62.7 	projected spending, the commissioner shall determine an aggregate savings offset amount 
62.8 	not to exceed 33 percent of the difference. 
62.9 	(b) Based on this calculation, the commissioner shall determine annually a savings 
62.10 	offset amount to be paid by health plan companies and third-party administrators. The 
62.11 	aggregate savings reinvestment amount may not exceed 33 percent of the aggregate 
62.12 	savings reflected in the difference between the actual spending and the projected spending.
62.13 		Subd. 3.Publication of spending. The commissioner shall publish in the State 
62.14 	Register by June 15 of each year, beginning June 15, 2010, the projected spending 
62.15 	baseline, including any adjustments, and the actual spending for the preceding year.
62.16 		Subd. 4.Savings reinvestment assessments. (a) Health plan companies and 
62.17 	third-party administrators shall pay a health savings reinvestment assessment. The 
62.18 	commissioner shall calculate the savings reinvestment assessments as a percentage of 
62.19 	paid claims as follows:
62.20 	(1) for health plan companies, the health savings reinvestment assessment shall be 
62.21 	based on a percentage of annual paid health care claims on policies that insure residents of 
62.22 	this state; and
62.23 	(2) for third-party administrators, the health savings reinvestment assessment shall 
62.24 	be a fee placed on the third-party administrator for each insured resident of the state in 
62.25 	which the third-party administrator paid claims for health care. 
62.26 	(b) A health plan company shall not be required to pay a health savings reinvestment 
62.27 	assessment on policies or contracts insuring federal employees.
62.28 	(c) Health savings reinvestment assessments shall apply to claims paid for plan 
62.29 	years beginning on or after January 1, 2010.
62.30 	(d) Health savings reinvestment assessments must be made quarterly to the 
62.31 	commissioner of revenue within 60 days of the close of each quarter, beginning June 
62.32 	15, 2010.
62.33 		Subd. 5.Deposit of assessments. The commissioner of revenue shall deposit 
62.34 	the revenue derived from the assessments into the health savings reinvestment fund 
62.35 	established under section 16A.727.

63.1 	Sec. 26. [62U.14] COST CONTAINMENT GOALS; CONTINGENT 
63.2 	EXPANSION TO MINNESOTA CARE.
63.3 		Subdivision 1.Cost containment goals. Based on the projected spending baseline 
63.4 	calculated under section 62U.13, subdivision 1, the following annual cost containment 
63.5 	goals for public and private spending on health care services for Minnesota residents 
63.6 	are established:
63.7 	(1) for calendar year 2009, the cost containment goal is the baseline projected 
63.8 	spending growth for 2009 established in section 62U.13 less one percentage point;
63.9 	(2) for calendar year 2010, the cost containment goal is the baseline projected 
63.10 	spending growth for 2010 less 1.5 percentage points;
63.11 	(3) for calendar years 2011 and 2012, the cost containment goal is the baseline 
63.12 	projected spending growth for 2011 and 2012 less two percentage points; and
63.13 	(4) for calendar years after 2012, the cost containment goal is the projected baseline 
63.14 	spending for 2013 less 2.5 percentage points.
63.15 		Subd. 2.Contingent expansion of MinnesotaCare. (a) By June 1, 2010, the 
63.16 	commissioner of health shall report to the commissioner of human services and the 
63.17 	legislature on whether the cost containment goal for 2009 was met. If the goal was met, 
63.18 	the commissioner of human services shall implement the eligibility expansion to the 
63.19 	MinnesotaCare program for individuals and families with children up to 300 percent of 
63.20 	federal poverty guidelines, to be effective July 1, 2010.
63.21 	(b) If the cost containment goal has not been met, the legislature shall consider an 
63.22 	eligibility expansion to the MinnesotaCare program based on available funding.
63.23 	(c) The commissioner of health shall submit a plan to the legislature by January 15, 
63.24 	2013, if the cost containment goals established in this section have been met and the 
63.25 	uninsured rate for Minnesota residents is greater than three percent. The plan must include 
63.26 	efforts that will increase coverage to at least 97 percent insured, including an individual 
63.27 	responsibility requirement.

63.28 	Sec. 27. [62U.15] AFFORDABILITY STANDARD.
63.29 		Subdivision 1.Definition of affordability. For purposes of this section, coverage is 
63.30 	"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an 
63.31 	individual or family for health coverage does not exceed the applicable percentage of the 
63.32 	individual or family's gross monthly income specified in subdivision 2.
63.33 		Subd. 2.Incomes up to 300 percent of the federal poverty guidelines. The 
63.34 	following affordability standard is established for individuals and households with gross 
63.35 	family incomes of 300 percent of the federal poverty guidelines or less:

64.1	AFFORDABILITY STANDARD

64.2
64.3		Federal Poverty 
Guideline Range
		Percent of Average Gross 
Monthly Income
		
64.4		0-33% 
			minimum
			
64.5		33-54%
			1.1%
			
64.6		55-81%
			1.4%
			
64.7		82-109%
			1.9%
			
64.8		110-136%
			2.6%
			
64.9		137-164%
			3.4%
			
64.10		165-191%
			4.4%
			
64.11		192-219%
			5.2%
			
64.12		220-248%
			5.9%
			
64.13		248-274%
			6.5%
			
64.14		275-300%
			7.0%
			
64.15 		Subd. 3.Incomes greater than 300 percent but not exceeding 400 percent of the 
64.16 	federal poverty guidelines. For purposes of determining affordability, the affordability 
64.17 	standard for individuals and households with gross family incomes greater than 300 
64.18 	percent but not exceeding 400 percent of the federal poverty guidelines shall be based 
64.19 	on a continuation of the sliding scale specified in subdivision 2, with the percentage of 
64.20 	average gross monthly income rising proportionately at each income range, to a maximum 
64.21 	of 10.0 percent.

64.22 	Sec. 28. [62U.16] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED 
64.23 	HEALTH COVERAGE.
64.24 		Subdivision 1.Establishment of subsidy program. The commissioner of 
64.25 	human services shall establish a subsidy program for eligible employees with access to 
64.26 	employer-subsidized health coverage. For purposes of this section, employer-subsidized 
64.27 	health coverage has the meaning provided in section 256L.07, subdivision 2, paragraph (c).
64.28 		Subd. 2.Eligible employees. In order to be eligible for a subsidy under this section, 
64.29 	an employee must:
64.30 	(1) be covered by employer-subsidized health coverage that meets or is actuarially 
64.31 	equivalent to the benefit set and design established by the Health Care Transformation 
64.32 	Commission; and
64.33 	(2) meet all eligibility criteria for the MinnesotaCare program established under 
64.34 	chapter 256L, except for the requirements related to:
64.35 	(i) no access to employer-subsidized coverage under section 256L.07, subdivision 
64.36 	2; and
64.37 	(ii) no other health coverage under section 256L.07, subdivision 3.
65.1 		Subd. 3.Amount of subsidy. The subsidy shall equal the amount the employee 
65.2 	is required to pay for health coverage, including premiums, deductibles, and other cost 
65.3 	sharing, minus an amount based on the affordability standard specified in section 62U.15. 
65.4 	The maximum subsidy shall not exceed the amount of the subsidy that would have been 
65.5 	provided under the MinnesotaCare program, if the employee and any dependents were 
65.6 	eligible for that program.
65.7 		Subd. 4.Payment of subsidy. The commissioner shall pay the subsidy amount for 
65.8 	an employee and any dependents to the Minnesota Health Insurance Exchange, and this 
65.9 	payment shall be credited towards the employee's share of premium. Any additional 
65.10 	amount paid by the commissioner to the Minnesota Health Insurance Exchange that 
65.11 	exceeds the employee's share of premium shall be credited first towards the employee 
65.12 	deductible and then towards any employee cost-sharing obligation.

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

65.14 	Sec. 29. Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision 
65.15 	to read:
65.16 		Subd. 27.Exchange of data. An entity that is part of the welfare system as defined 
65.17 	in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance 
65.18 	Exchange under section 62U.02 may exchange private data on individuals relating to 
65.19 	family size, income, and eligibility for premium discounts in order to determine and 
65.20 	collect premiums from individuals in the MinnesotaCare program under chapter 256L. 
65.21 	This subdivision only applies if the entity that is part of the welfare system and the 
65.22 	Minnesota Health Insurance Exchange have entered into an agreement that complies with 
65.23 	the requirements in Code of Federal Regulations, title 45, section 164.314.

65.24 	Sec. 30. APPROPRIATION.
 65.25 	$20,000,000 is appropriated in fiscal year 2009 from the health care access fund to 
65.26 	the Health Care Transformation Commission. This is a onetime appropriation.

65.27 	Sec. 31.  REPEALER.
 65.28 	Minnesota Statutes 2006, sections 62A.63; 62A.64; 62Q.49; 62Q.65; and 62Q.736,
65.29 	are repealed.

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