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 with 
1.7 	public health care programs; creating a health insurance exchange; establishing 
1.8 	Section 125 Plans; providing for registration of health insurance access brokers; 
1.9 	providing for fund transfers; providing for health care payment restructuring 
1.10 	system; creating a Health Care Transformation Commission; restructuring the 
1.11 	health care payment system; creating a savings reinvestment fund; establishing a 
1.12 	savings recapture assessment; establishing cost containment goals; specifying an 
1.13 	affordability standard; providing subsidies for employer-subsidized coverage; 
1.14 	requiring providers to list prices; establishing an electronic prescription drug 
1.15 	program; providing for fees; requiring mandated reports; authorizing rulemaking; 
1.16 	appropriating money;amending Minnesota Statutes 2006, sections 13.3806, 
1.17 	by adding a subdivision; 62A.65, subdivision 3; 62E.141; 62L.12, subdivision 
1.18 	4; 62Q.735, subdivision 1; 144.1501, subdivision 2, by adding a subdivision; 
1.19 	256.01, by adding a subdivision; 256B.69, by adding a subdivision; 256L.05, 
1.20 	by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision 3; 
1.21 	256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement, sections 
1.22 	62J.496, by adding a subdivision; 62J.81, subdivision 1; 62J.82, subdivision 1; 
1.23 	256.962, subdivisions 5, 6; 256B.056, subdivision 10; 256L.03, subdivisions 3, 
1.24 	5; 256L.04, subdivisions 1, 7; 256L.05, subdivision 3a; 256L.07, subdivision 
1.25 	1; 256L.15, subdivisions 1, 2; Laws 2007, chapter 147, article 5, section 19; 
1.26 	proposing coding for new law in Minnesota Statutes, chapters 16A; 62J; 145; 
1.27 	256B; proposing coding for new law as Minnesota Statutes, chapter 62U; 
1.28 	repealing Minnesota Statutes 2006, sections 62A.63; 62A.64; 62Q.49; 62Q.65; 
1.29 	62Q.736; 256L.15, subdivision 3.
1.30 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.31 	ARTICLE 1
1.32 	PUBLIC HEALTH

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

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

4.14 	Sec. 3. [145.9865] PUBLIC HEALTH IMPROVEMENT ASSESSMENT.
4.15 		Subdivision 1.Definitions. (a) The definitions in this subdivision apply to this 
4.16 	section.
4.17 	(b) "Commissioner" means the commissioner of commerce for nonprofit health 
4.18 	plan companies subject to the jurisdiction of the commissioner of commerce, and the 
4.19 	commissioner of health for nonprofit health plan companies subject to the jurisdiction 
4.20 	of the commissioner of health.
4.21 	(c) "Hospital" means a hospital that is required to report to the commissioner of 
4.22 	health under section 144.698, except facilities of the federal Indian Health Service, 
4.23 	Veterans Administration, and state-operated facilities.
4.24 	(d) "Net patient revenue" means net patient revenue, as reported by the hospital to 
4.25 	the health care cost information system under section 144.698 for the fiscal year ending in 
4.26 	the calendar year two years before the current calendar year, excluding net Medicare and 
4.27 	Medicaid revenue.
4.28 	(e) "Nonprofit health plan company" includes a health maintenance organization 
4.29 	operating under chapter 62D and a nonprofit health service plan corporation operating 
4.30 	under chapter 62C.
4.31 	(f) "Total premium revenue" means:
4.32 	(1) premium revenue recognized on a prepaid basis from individuals and groups 
4.33 	for provision of a specified range of health services over a defined period of time that 
4.34 	is normally one month, excluding premiums paid to a nonprofit health plan company 
5.1 	from the Federal Employees Health Benefit Program and revenues received from the 
5.2 	Department of Human Services for state health care programs; and
5.3 	(2) premiums from Medicare wraparound subscribers for health benefits that 
5.4 	supplement Medicare coverage.
5.5 		Subd. 2. Hospital assessment. (a) By June 1, 2009, each hospital shall pay to the 
5.6 	commissioner of health a public health improvement assessment equal to 0.15 percent 
5.7 	of net patient revenue. The commissioner shall credit the assessment to the health 
5.8 	improvement fund established under section 16A.726.
5.9 	(b) By June 1, 2010, and each June 1 thereafter, each hospital shall pay to the 
5.10 	commissioner of health a public health improvement assessment determined by the 
5.11 	commissioner under subdivision 4. The commissioner shall credit the assessment to the 
5.12 	health improvement fund.
5.13 	(c) The commissioner shall notify each hospital by May 1 of each year of the 
5.14 	assessment due by June 1. If, for any year, data needed to determine actual net patient 
5.15 	revenue for the previous calendar year is not available in time to determine the assessment 
5.16 	due, the commissioner may estimate net patient revenue for the purposes of this section 
5.17 	until actual data is available, and must make any necessary adjustments.
5.18 	(d) Assessments under this section may be applied toward a hospital's community 
5.19 	benefit as reported under section 144.699. Nothing in this section requires a hospital to 
5.20 	increase its total level of community benefit beyond its current level.
5.21 		Subd. 3.Health plan company assessment.  (a) By June 1, 2009, each nonprofit 
5.22 	health plan company shall pay to the commissioner of health a public health improvement 
5.23 	assessment equal to 0.15 percent of the total premium revenues of the nonprofit health 
5.24 	plan company for calendar year 2008 as reported to the commissioner.
5.25 	(b) By June 1, 2010, and each June 1 thereafter, each nonprofit health plan company 
5.26 	shall pay to the commissioner of health a public health improvement assessment 
5.27 	determined by the commissioner under subdivision 4. The commissioner shall credit the 
5.28 	assessment to the health improvement fund.
5.29 	(c) The commissioner of health shall notify each nonprofit health plan company by 
5.30 	May 1 of each year of the assessment due by June 1. If, for any year, data needed to 
5.31 	determine actual total premium revenue for the previous calendar year is not available 
5.32 	in time to determine the assessment due, the commissioner of health may estimate total 
5.33 	premium revenue for the purposes of this section until actual data is available, and must 
5.34 	make any necessary adjustments.
5.35 	(d) Assessments under this section may be applied toward a nonprofit health plan 
5.36 	company's community benefit requirements. Nothing in this section requires a nonprofit 
6.1 	health plan company to increase its total level of community benefit beyond its current 
6.2 	level.
6.3 		Subd. 4.Assessment percentage, 2010 and thereafter. The amount assessed 
6.4 	in year 2010 and thereafter is $40,000,000 each year, divided among hospitals under 
6.5 	subdivision 2 in proportion to their net patient revenue and among nonprofit health 
6.6 	plan companies under subdivision 3 in proportion to their total premium revenue. The 
6.7 	commissioner of health shall determine the share to be assessed against hospitals and the 
6.8 	share to be assessed against nonprofit health plan companies and shall set the assessment 
6.9 	as the same percentage of net patient revenue for each hospital and the same percentage 
6.10 	of total premium revenue for each nonprofit health plan company, provided that the 
6.11 	percentage assessed must not be more than 0.3 percent of net patient revenue for hospitals 
6.12 	or 0.3 percent of total premium revenue for nonprofit health plan companies.
6.13 		Subd. 5.Expiration. This section expires July 1, 2013.

6.14 	Sec. 4. [145.987] BMI MONITORING IN CHILDREN AND YOUTH.
6.15 	By July 1, 2009, the commissioner of health shall establish and implement a 
6.16 	program to monitor the trends of children who are overweight and obese in the state by 
6.17 	collecting and analyzing Body Mass Index data. The commissioner must not collect or 
6.18 	use data on individuals as defined in section 13.02, subdivision 5. To the extent possible, 
6.19 	in establishing this Body Mass Index monitoring program, the commissioner shall use 
6.20 	existing child and youth monitoring systems or surveys. The Body Mass Index data 
6.21 	collected shall be used to measure progress in reducing the percentage of overweight 
6.22 	and obese children in the state, and shall be used to accurately target intervention and 
6.23 	prevention services throughout the state. To the extent necessary for implementation and 
6.24 	analysis, the Department of Health may share data collected under this program with the 
6.25 	Department of Education, consistent with the requirements in Minnesota Statutes, chapter 
6.26 	13. Analysis of the data collected and trends of children who are overweight and obese 
6.27 	shall be reported annually to the legislature by the commissioner of health, beginning 
6.28 	January 15, 2011.

6.29 	ARTICLE 2
6.30 	HEALTH CARE HOMES

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

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

8.10 	Sec. 3. [256B.0752] HEALTH CARE HOME REQUIREMENTS.
8.11 		Subdivision 1.Requirement. In order to be certified as a health care home, 
8.12 	a clinician must meet the criteria specified in this section or criteria established by a 
8.13 	managed care plan if the criteria has been approved by the commissioner.
8.14 		Subd. 2.Patient-provider relationship; care teams.  Each patient of a health care 
8.15 	home must have an ongoing, long-term relationship with a primary care provider trained 
8.16 	as a personal clinician to provide first contact, continuous, and comprehensive care for all 
8.17 	of a patient's health care needs. Appropriate specialists and other health care professionals 
8.18 	who do not practice in a traditional primary care field, and advanced practice registered 
8.19 	nurses, must be allowed to serve as personal clinicians, if they provide care according 
8.20 	to this section.
8.21 		Subd. 3.Care coordination. The personal clinician and the team are responsible 
8.22 	for providing for all the patient's health care needs or for arranging appropriate care with 
8.23 	other qualified professionals, as part of a whole-person orientation. Health care must be 
8.24 	coordinated across all provider types, all care locations, and the greater community. This 
8.25 	requirement applies to care for all stages of life, including preventive care, acute care, 
8.26 	chronic care, and end-of-life care. Care coordination must include ongoing planning 
8.27 	to prepare for patient transitions across different types of care and provider types. The 
8.28 	care team must also coordinate with those providing for the social service needs of the 
8.29 	individual, if this is necessary to ensure a successful health outcome.
8.30 		Subd. 4.Care delivery. (a) A health care home must provide or arrange for access 
8.31 	to care 24-hours a day, seven days a week.
8.32 	(b) Health care homes must encourage the patient and when authorized and 
8.33 	appropriate, the family to actively participate in decision making, as a full member of the 
8.34 	care team. Health care homes must consider patients and families as partners in decision 
9.1 	making, and must provide access to a patient-directed, decision-making process, including 
9.2 	appropriate decision aids, when available.
9.3 	(c) Care delivery must be facilitated by the use of health information technology and 
9.4 	through systematic patient follow-up using internal clinic patient registries.
9.5 	(d) Care must be provided in a culturally and linguistically appropriate manner.
9.6 	(e) Within the context of a system of continuous quality improvement, care 
9.7 	delivery, whenever possible, must be based on evidence-based medicine and use clinical 
9.8 	decision-support tools.
9.9 	(f) A health care home must provide enhanced access to care, using methods such 
9.10 	as open scheduling, expanded hours, and new communication methods, such as e-mail, 
9.11 	phone consultations, and e-consults.
9.12 		Subd. 5.Quality of care. Health care homes must meet process, outcome, and 
9.13 	quality standards as developed and specified by the commissioners. Health care homes 
9.14 	must measure and publicly report all data necessary for the commissioners to monitor 
9.15 	compliance with these standards.
9.16 		Subd. 6.Comprehensive health assessment. Health care homes must encourage 
9.17 	enrollees to complete a comprehensive health assessment for each enrollee determined, 
9.18 	by the initial health assessment under section 256B.0431, subdivision 2, to have, or be 
9.19 	at risk of developing, a complex or chronic health condition. Health care homes must 
9.20 	develop, maintain, and ensure implementation of a comprehensive care plan for each 
9.21 	enrollee who has or who is at risk of developing a complex or chronic condition based 
9.22 	upon the comprehensive health assessment, health history, tests, and other information. 
9.23 	The comprehensive care plan must meet the criteria specified by the commissioners.
9.24 		Subd. 7.Care coordinators. (a) Health care homes must directly manage or 
9.25 	employ care coordinators to manage the care provided to patients with complex or chronic 
9.26 	conditions specified by the commissioners.
9.27 	(b) Care coordination includes:
9.28 	(1) identifying patients with complex or chronic conditions eligible for care 
9.29 	coordination;
9.30 	(2) assisting primary care providers in care coordination and education;
9.31 	(3) helping patients coordinate their care or access needed services, including 
9.32 	preventive care;
9.33 	(4) communicating the care needs and concerns of the patient to the health care home; 
9.34 	(5) collecting data on process and outcome measures; and
9.35 	(6) overseeing the development, maintenance, and implementation of care plans.
9.36 	(c) Care coordination must meet the criteria as specified by the commissioner.
10.1 		Subd. 8.Health care home collaborative. Health care homes must participate in 
10.2 	the health care home collaborative described in section 256B.0754, subdivision 4, and as 
10.3 	required by the commissioner for certification.

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

10.23 	EFFECTIVE DATE. Subdivisions 1 and 2 are effective July 1, 2009, or upon 
10.24 	federal approval, whichever is later.

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

12.30 	Sec. 6. Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision 
12.31 	to read:
12.32 		Subd. 29.Health care home model. (a) The commissioner shall require managed 
12.33 	care plans, as a condition of contract, to adopt by July 1, 2009, a health care home 
12.34 	model for providing care to state health care program enrollees who have or are at risk 
12.35 	of developing a complex or chronic health condition. The health care home model must 
13.1 	meet the criteria specified in this section and section 256B.0752. The commissioner, in 
13.2 	consultation with the commissioner of health, may waive or modify criteria for managed 
13.3 	care plans, if the commissioners determine that performance and quality standards would 
13.4 	still be met.
13.5 	(b) The commissioners shall require managed care plans to: (1) collect from 
13.6 	health care homes data necessary to monitor implementation of the health care home 
13.7 	model, measure and evaluate quality of care and outcomes, measure and evaluate 
13.8 	patient experience, and determine cost-savings from implementation of the health care 
13.9 	home model; and (2) submit this data to the commissioners. The commissioners shall 
13.10 	provide managed care plans and their health care homes with practice profiles measuring 
13.11 	utilization, cost, and quality.
13.12 	(c) Managed care plans must encourage state health care program enrollees to 
13.13 	complete an initial health assessment within three months from the time of enrollment, in 
13.14 	order to identify individuals with, or who are at risk of developing, complex or chronic 
13.15 	health conditions, and to identify preventive health care needs.
13.16 	(d) The commissioner shall encourage managed care plans, beginning July 1, 
13.17 	2009, to complete a comprehensive health assessment for each enrollee determined, by 
13.18 	the initial health assessment under paragraph (c), to have, or be at risk of developing, a 
13.19 	complex or chronic health condition. The commissioner shall pay managed care plans 
13.20 	a one-time health assessment fee for each enrollee who completes a comprehensive 
13.21 	health assessment. Comprehensive health assessments must meet the criteria established 
13.22 	for health care homes under section 256B.0752, subdivision 6. Managed care plans 
13.23 	shall require health care homes to develop, maintain, and ensure the implementation of 
13.24 	a comprehensive care plan for each enrollee who has or who is at risk of developing a 
13.25 	complex or chronic condition based on the comprehensive health assessment, health 
13.26 	history, tests, and other relevant information.
13.27 	(e) The commissioner, beginning July 1, 2009, shall implement financial 
13.28 	arrangements for managed care plans to ensure that plans encourage each enrollee who has 
13.29 	or who is at risk of developing a complex or chronic health condition to choose a certified 
13.30 	primary care clinic or medical group to serve as a health care home.

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

14.17 	ARTICLE 3
14.18 	INCREASING ACCESS; CONTINUITY OF CARE

14.19 	Section 1. Minnesota Statutes 2006, section 144.1501, subdivision 2, is amended to 
14.20 	read:
14.21 		Subd. 2.Creation of account. (a) A health professional education loan forgiveness 
14.22 	program account is established. 
14.23 	(b) The commissioner of health shall use money from the account to establish a 
14.24 	loan forgiveness program:
14.25 	(1) for medical residents agreeing to practice in designated rural areas or underserved 
14.26 	urban communities or specializing in the area of pediatric psychiatry;
14.27 	(2) for midlevel practitioners agreeing to practice in designated rural areas or to 
14.28 	teach for at least 20 hours per week in the nursing field in a postsecondary program;
14.29 	(3) for nurses who agree to practice in a Minnesota nursing home or intermediate 
14.30 	care facility for persons with developmental disability or to teach for at least 20 hours per 
14.31 	week in the nursing field in a postsecondary program;
14.32 	(4) for other health care technicians agreeing to teach for at least 20 hours per week 
14.33 	in their designated field in a postsecondary program. The commissioner, in consultation 
14.34 	with the Healthcare Education-Industry Partnership, shall determine the health care fields 
15.1 	where the need is the greatest, including, but not limited to, respiratory therapy, clinical 
15.2 	laboratory technology, radiologic technology, and surgical technology; and
15.3 	(5) for pharmacists who agree to practice in designated rural areas; and.
15.4 	(c) The commissioner shall use money from the account allocated for dental loan 
15.5 	forgiveness:
15.6 	(6) (1) for dentists agreeing who: (i) agree to deliver at least 25 20 percent of the 
15.7 	dentist's yearly patient encounters to state public program enrollees or patients receiving 
15.8 	sliding fee schedule discounts through a formal sliding fee schedule meeting the standards 
15.9 	established by the United States Department of Health and Human Services under Code of 
15.10 	Federal Regulations, title 42, section 51, chapter 303, or (ii) have been trained in a foreign 
15.11 	country, received a dental license from the Board of Dentistry, and who agree to provide 
15.12 	services for a nonprofit organization, community clinic, or federally qualified health clinic 
15.13 	in Minnesota for a period of at least three years; and
15.14 	(2) for the dental school scholarship program under subdivision 7.
15.15 	(b) (d) Appropriations made to the account do not cancel and are available until 
15.16 	expended, except that at the end of each biennium, any remaining balance in the account 
15.17 	that is not committed by contract and not needed to fulfill existing commitments shall 
15.18 	cancel to the fund.

15.19 	Sec. 2. Minnesota Statutes 2006, section 144.1501, is amended by adding a subdivision 
15.20 	to read:
15.21 		Subd. 7.Dental school student scholarship program. The commissioner may 
15.22 	award up to three scholarships each year to:
15.23 	(1) foreign-trained dental students who enroll in the Program for Advanced Standing 
15.24 	Students at the University of Minnesota School of Dentistry and who agree upon 
15.25 	graduation from the program and upon licensure by the Board of Dentistry to provide 
15.26 	dental services in Minnesota for a nonprofit organization, community clinic, or federally 
15.27 	qualified community health center for a period of at least three years; or
15.28 	(2) current dental school students who agree after graduation to provide dental 
15.29 	services in Minnesota for a nonprofit organization, community clinic, or federally qualified 
15.30 	community health center for a period of at least three years.
15.31 	Scholarships awarded under the program must be at least $30,000 each year that the 
15.32 	graduates provide care under the scholarship agreement.

15.33 	Sec. 3. Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision 
15.34 	to read:
16.1 		Subd. 27.Automation and coordination for state health care programs. (a) For 
16.2 	purposes of this subdivision, "state health care program" means the medical assistance, 
16.3 	MinnesotaCare, or general assistance medical care programs.
16.4 	(b) By July 1, 2009, the commissioner shall improve coordination between state 
16.5 	health care programs and social service programs including, but not limited to WIC, free 
16.6 	and reduced school lunch programs, and food stamps, and shall develop and use automated 
16.7 	systems to identify persons served by social service programs who may be eligible for, but 
16.8 	are not enrolled in, a state health care program. By January 15, 2009, the commissioner 
16.9 	shall, as necessary, identify and recommend to the legislature statutory changes to state 
16.10 	health care and social service programs necessary to improve coordination and automation 
16.11 	of outreach and enrollment efforts.
16.12 	(c) By January 15, 2009, the commissioner shall establish and implement an 
16.13 	automated process to send out state health care program renewal forms in the most 
16.14 	common foreign languages, to those state health care program enrollees who request 
16.15 	renewal forms in those foreign languages. The commissioner, as part of the initial 
16.16 	enrollment process, shall inform applicants of the availability of this option.
16.17 	(d) Beginning July 1, 2008, the commissioner, county social service agencies, and 
16.18 	health care providers shall update state health care program enrollee addresses and related 
16.19 	contact information, at the time of each enrollee contact.

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

16.21 	Sec. 4. Minnesota Statutes 2007 Supplement, section 256.962, subdivision 5, is 
16.22 	amended to read:
16.23 		Subd. 5.Incentive program. Beginning January 1, 2008, the commissioner 
16.24 	shall establish an incentive program for organizations that directly identify and assist 
16.25 	potential enrollees in filling out and submitting an application. For each applicant who is 
16.26 	successfully enrolled in MinnesotaCare, medical assistance, or general assistance medical 
16.27 	care, the commissioner, within the available appropriation, shall pay the organization a 
16.28 	$20$25 application assistance bonus. The organization may provide an applicant a gift 
16.29 	certificate or other incentive upon enrollment.

16.30 	Sec. 5. Minnesota Statutes 2007 Supplement, section 256.962, subdivision 6, is 
16.31 	amended to read:
16.32 		Subd. 6.School districts. (a) At the beginning of each school year, a school district 
16.33 	shall provide information to each student on the availability of health care coverage 
16.34 	through the Minnesota health care programs.
17.1 	(b) For each child who is determined to be eligible for athe free orand reduced 
17.2 	pricedschool lunch program, the district shall provide the child's family with an 
17.3 	application for the Minnesota health care programs and information on how to obtain an 
17.4 	application for the Minnesota health care programs and application assistance.
17.5 	(c) A district shall also ensure that applications and information on application 
17.6 	assistance are available at early childhood education sites and public schools located 
17.7 	within the district's jurisdiction. 
17.8 	(d) Each district shall designate an enrollment specialist to provide application 
17.9 	assistance and follow-up services with families who are eligible for the reduced or free 
17.10 	lunch program or who have indicated an interest in receiving information or an application 
17.11 	for the Minnesota health care program. A district is eligible for the application assistance 
17.12 	bonus described in subdivision 5.
17.13 	(e) Each school district shall provide on their Web site a link to information on how 
17.14 	to obtain an application and application assistance.

17.15 	Sec. 6. Minnesota Statutes 2007 Supplement, section 256B.056, subdivision 10, 
17.16 	is amended to read:
17.17 		Subd. 10.Eligibility verification. (a) The commissioner shall require women who 
17.18 	are applying for the continuation of medical assistance coverage following the end of the 
17.19 	60-day postpartum period to update their income and asset information and to submit 
17.20 	any required income or asset verification.
17.21 	(b) The commissioner shall determine the eligibility of private-sector health care 
17.22 	coverage for infants less than one year of age eligible under section 256B.055, subdivision 
17.23 	10, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage 
17.24 	if this is determined to be cost-effective.
17.25 	(c) The commissioner shall verify assets and income for all applicants, and for 
17.26 	all recipients upon renewal. The commissioner shall verify liquid assets for applicants, 
17.27 	and for recipients upon renewal, only if the applicant or recipient is within ten percent 
17.28 	of the applicable asset limit. The commissioner may verify nonliquid assets, but is not 
17.29 	required to do so.
17.30 	(d) If there is no change in an enrollee's income or asset information, the enrollee 
17.31 	may renew eligibility at designated locations that include community clinics and health 
17.32 	care providers' offices. These designated sites shall forward the renewal forms to the 
17.33 	commissioner.

17.34 	EFFECTIVE DATE. The amendments to paragraphs (c) and (d) are effective 
17.35 	January 1, 2009.

18.1 	Sec. 7. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 3, is 
18.2 	amended to read:
18.3 		Subd. 3.Inpatient hospital services. (a) Covered health services shall include 
18.4 	inpatient hospital services, including inpatient hospital mental health services and inpatient 
18.5 	hospital and residential chemical dependency treatment, subject to those limitations 
18.6 	necessary to coordinate the provision of these services with eligibility under the medical 
18.7 	assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 
18.8 	section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 
18.9 	2, with family gross income that exceeds 200 percent of the federal poverty guidelines or 
18.10 	215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 
18.11 	pregnant, is subject to an annual limit of $10,000 $20,000. 
18.12 	(b) Admissions for inpatient hospital services paid for under section 256L.11, 
18.13 	subdivision 3, must be certified as medically necessary in accordance with Minnesota 
18.14 	Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2): 
18.15 	(1) all admissions must be certified, except those authorized under rules established 
18.16 	under section 254A.03, subdivision 3, or approved under Medicare; and 
18.17 	(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent 
18.18 	for admissions for which certification is requested more than 30 days after the day of 
18.19 	admission. The hospital may not seek payment from the enrollee for the amount of the 
18.20 	payment reduction under this clause. 

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

18.24 	Sec. 8. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 5, is 
18.25 	amended to read:
18.26 		Subd. 5.Co-payments and coinsurance. (a) Except as provided in paragraphs (b) 
18.27 	and (c), the MinnesotaCare benefit plan shall include the following co-payments and 
18.28 	coinsurance requirements for all enrollees:
18.29 	(1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 
18.30 	subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and 
18.31 	$3,000 per family;
18.32 	(2) $3 per prescription for adult enrollees;
18.33 	(3) $25 for eyeglasses for adult enrollees;
18.34 	(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 
18.35 	episode of service which is required because of a recipient's symptoms, diagnosis, or 
19.1 	established illness, and which is delivered in an ambulatory setting by a physician or 
19.2 	physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 
19.3 	audiologist, optician, or optometrist; and
19.4 	(5) $6 for nonemergency visits to a hospital-based emergency room.
19.5 	(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of 
19.6 	children under the age of 21.
19.7 	(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
19.8 	(d) Paragraph (a), clause (4), does not apply to mental health services.
19.9 	(e) Adult enrollees with family gross income that exceeds 200 percent of the federal 
19.10 	poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 
19.11 	and who are not pregnant shall be financially responsible for the coinsurance amount, if 
19.12 	applicable, and amounts which exceed the $10,000 $20,000 inpatient hospital benefit limit.
19.13 	(f) When a MinnesotaCare enrollee becomes a member of a prepaid health 
19.14 	plan, or changes from one prepaid health plan to another during a calendar year, any 
19.15 	charges submitted towards the $10,000 $20,000 annual inpatient benefit limit, and any 
19.16 	out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted 
19.17 	or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

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

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

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

20.12 	Sec. 10. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is 
20.13 	amended to read:
20.14 		Subd. 7.Single adults and households with no children. The definition of eligible 
20.15 	persons includes all individuals and households with no children who have gross family 
20.16 	incomes that are equal to or less than 200 percent of the federal poverty guidelines. 
20.17 	Effective July January 1, 2009, the definition of eligible persons includes all individuals 
20.18 	and households with no children who have gross family incomes that are equal to or less 
20.19 	than 215 300 percent of the federal poverty guidelines.

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

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

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

21.14 	Sec. 12. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision 
21.15 	to read:
21.16 		Subd. 6.Delayed verification. On the basis of information provided on the 
21.17 	completed application, an applicant whose gross income is less than 90 percent of 
21.18 	the applicable income standard and meets all other eligibility requirements, including 
21.19 	compliance at the time of application with citizenship or nationality documentation 
21.20 	requirements under section 256L.04, subdivision 10, shall be determined eligible 
21.21 	beginning in the month of application. The applicant must provide all required 
21.22 	verifications within 60 days' notice of the eligibility determination or eligibility shall be 
21.23 	terminated. Applicants who are terminated for failure to provide all required verifications 
21.24 	are not eligible to apply for coverage using the delayed verification procedures specified in 
21.25 	this subdivision for 12 months.

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

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

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

22.28 	Sec. 14. Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is 
22.29 	amended to read:
22.30 		Subdivision 1.General requirements. (a) Children enrolled in the original 
22.31 	children's health plan as of September 30, 1992, children who enrolled in the 
22.32 	MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 
22.33 	article 4, section 17, and children who have family gross incomes that are equal to or 
22.34 	less than 150 percent of the federal poverty guidelines are eligible without meeting 
22.35 	the requirements of subdivision 2 and the four-month requirement in subdivision 3, as 
23.1 	long as they maintain continuous coverage in the MinnesotaCare program or medical 
23.2 	assistance. Children who apply for MinnesotaCare on or after the implementation date 
23.3 	of the employer-subsidized health coverage program as described in Laws 1998, chapter 
23.4 	407, article 5, section 45, who have family gross incomes that are equal to or less than 150 
23.5 	percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 
23.6 	be eligible for MinnesotaCare.
23.7 	Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose 
23.8 	income increases above 275 300 percent of the federal poverty guidelines, are no longer 
23.9 	eligible for the program and shall be disenrolled by the commissioner. Beginning January 
23.10 	1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, 
23.11 	whose income increases above 200 percent of the federal poverty guidelines or 215 300
23.12 	percent of the federal poverty guidelines on or after July January 1, 2009, are no longer 
23.13 	eligible for the program and shall be disenrolled by the commissioner. For persons 
23.14 	disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of 
23.15 	the calendar month following the month in which the commissioner determines that the 
23.16 	income of a family or individual exceeds program income limits.
23.17 	(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare 
23.18 	if ten percent of their gross individual or gross family income as defined in section 
23.19 	256L.01, subdivision 4, is less than the annual premium for a policy with a $500 
23.20 	deductible available through the Minnesota Comprehensive Health Association. Children 
23.21 	who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 
23.22 	notice period from the date that ineligibility is determined before disenrollment. The 
23.23 	premium for children remaining eligible under this clause shall be the maximum premium 
23.24 	determined under section 256L.15, subdivision 2, paragraph (b).
23.25 	(c) Notwithstanding paragraphs (a) and (b), parents are not eligible for 
23.26 	MinnesotaCare if gross household income exceeds $50,000 for the 12-month period 
23.27 	of eligibility.

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

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

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

25.1 	Sec. 16. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 1, is 
25.2 	amended to read:
25.3 		Subdivision 1.Premium determination. (a) Families with children and individuals 
25.4 	shall pay a premium determined according to subdivision 2.
25.5 	(b) Pregnant women and children under age two are exempt from the provisions 
25.6 	of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment 
25.7 	for failure to pay premiums. For pregnant women, this exemption continues until the 
25.8 	first day of the month following the 60th day postpartum. Women who remain enrolled 
25.9 	during pregnancy or the postpartum period, despite nonpayment of premiums, shall be 
25.10 	disenrolled on the first of the month following the 60th day postpartum for the penalty 
25.11 	period that otherwise applies under section 256L.06, unless they begin paying premiums. 
25.12 	(c) Members of the military and their families who meet the eligibility criteria 
25.13 	for MinnesotaCare upon eligibility approval made within 24 months following the end 
25.14 	of the member's tour of active duty shall have their premiums paid by the commissioner. 
25.15 	The effective date of coverage for an individual or family who meets the criteria of this 
25.16 	paragraph shall be the first day of the month following the month in which eligibility is 
25.17 	approved. This exemption applies for 12 months. This paragraph expires June 30, 2010. 

25.18 	Sec. 17. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is 
25.19 	amended to read:
25.20 		Subd. 2.Sliding fee scale; monthly gross individual or family income. (a) The 
25.21 	commissioner shall establish a sliding fee scale to determine the percentage of monthly 
25.22 	gross individual or family income that households at different income levels must pay 
25.23 	to obtain coverage through the MinnesotaCare program. The sliding fee scale must be 
25.24 	based on the enrollee's monthly gross individual or family income. The sliding fee scale 
25.25 	must contain separate tables based on enrollment of one, two, or three or more persons. 
25.26 	Until December 31, 2008, the sliding fee scale begins with a premium of 1.5 percent of 
25.27 	monthly gross individual or family income for individuals or families with incomes below 
25.28 	the limits for the medical assistance program for families and children in effect on January 
25.29 	1, 1999, and proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 
25.30 	5.9, 7.4, and 8.8 percent. These percentages are matched to evenly spaced income steps 
25.31 	ranging from the medical assistance income limit for families and children in effect on 
25.32 	January 1, 1999, to 275 percent of the federal poverty guidelines for the applicable family 
25.33 	size, up to a family size of five. The sliding fee scale for a family of five must be used 
25.34 	for families of more than five. The sliding fee scale and percentages are not subject to 
26.1 	the provisions of chapter 14. If a family or individual reports increased income after 
26.2 	enrollment, premiums shall be adjusted at the time the change in income is reported.
26.3 	(b) FamiliesChildren whose gross income is above 275 300 percent of the federal 
26.4 	poverty guidelines shall pay the maximum premium. The maximum premium is defined 
26.5 	as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare 
26.6 	cases paid the maximum premium, the total revenue would equal the total cost of 
26.7 	MinnesotaCare medical coverage and administration. In this calculation, administrative 
26.8 	costs shall be assumed to equal ten percent of the total. The costs of medical coverage 
26.9 	for pregnant women and children under age two and the enrollees in these groups shall 
26.10 	be excluded from the total. The maximum premium for two enrollees shall be twice the 
26.11 	maximum premium for one, and the maximum premium for three or more enrollees shall 
26.12 	be three times the maximum premium for one.
26.13 	(c) Beginning January 1, 2009, MinnesotaCare enrollees shall pay premiums 
26.14 	according to the affordability scale established in section 62U.15, subdivision 2, with the 
26.15 	exception that children in families with income at or below 150 percent of the federal 
26.16 	poverty guidelines and parents with income at or below 100 percent of federal poverty 
26.17 	guidelines shall not pay a monthly premium.

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

26.23 	Sec. 18. Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision 
26.24 	to read:
26.25 		Subd. 5.First month premium exemption. New enrollee households are exempt 
26.26 	from premiums for the first month of MinnesotaCare enrollment. For purposes of this 
26.27 	exemption, a "new enrollee household" is a household which has not been enrolled in 
26.28 	MinnesotaCare for at least one year prior to application.

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

26.31 	Sec. 19. Laws 2007, chapter 147, article 5, section 19, the effective date, is amended to 
26.32 	read:

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

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

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

27.8 	ARTICLE 4
27.9 	HEALTH INSURANCE PURCHASING AND AFFORDABILITY REFORM

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

27.14 	Sec. 2. [16A.727] HEALTH SAVINGS REINVESTMENT FUND.
27.15 		Subdivision 1.Created. A health savings reinvestment fund is created in the state 
27.16 	treasury. The fund is a direct appropriated special revenue fund. The commissioner 
27.17 	shall deposit to the credit of the fund all revenue from the health savings reinvestment 
27.18 	assessment under section 62U.13.
27.19 		Subd. 2.Transfer; appropriation. (a) On July 1 of each year, beginning in year 
27.20 	2010, the commissioner of finance shall transfer from the health savings reinvestment fund 
27.21 	to the general fund an amount equal to the loss of income tax revenue for the immediately 
27.22 	preceding calendar year attributable to the use of Section 125 Plans under section 62U.03 
27.23 	as determined by the commissioner of revenue. The amount necessary to make the transfer 
27.24 	is appropriated from the health savings reinvestment fund to the commissioner of finance.
27.25 	(b) Any balance in the fund remaining after the transfer under paragraph (a) is 
27.26 	available for direct appropriation by law.

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

29.26 	Sec. 4. Minnesota Statutes 2006, section 62E.141, is amended to read:
29.27 	62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
29.28 	No employee of an employer that offers a group health plan as defined in section 
29.29 	62A.10, under which the employee is eligible for coverage, is eligible to enroll, or 
29.30 	continue to be enrolled, in the comprehensive health association, except for enrollment 
29.31 	or continued enrollment necessary to cover conditions that are subject to an unexpired 
29.32 	preexisting condition limitation, preexisting condition exclusion, or exclusionary rider 
29.33 	under the employer's health plan. This section does not apply to persons enrolled in the 
29.34 	Comprehensive Health Association as of June 30, 1993. With respect to persons eligible 
29.35 	to enroll in the health plan of an employer that has more than 29 current employees, 
30.1 	as defined in section 62L.02, this section does not apply to persons enrolled in the 
30.2 	Comprehensive Health Association as of December 31, 1994. 

30.3 	Sec. 5. Minnesota Statutes 2007 Supplement, section 62J.496, is amended by adding a 
30.4 	subdivision to read:
30.5 		Subd. 5.Interoperable electronic health record requirements. To meet the 
30.6 	requirements of subdivision 1, hospitals and health care providers must meet the following 
30.7 	criteria when implementing an interoperable electronic health records system within their 
30.8 	hospital system or clinical practice setting.
30.9 	(a) The electronic health record must be certified by the Certification Commission 
30.10 	for Healthcare Information Technology, or its successor. This criterion only applies to 
30.11 	hospitals and health care providers whose practice setting is a practice setting covered 
30.12 	by Certification Commission for Healthcare Information Technology certifications. This 
30.13 	criterion shall be considered met if a hospital or health care provider is using an electronic 
30.14 	health records system that has been certified within the last three years, even if a more 
30.15 	current version of the system has been certified within the three-year period.
30.16 	(b) A health care provider who is a prescriber or dispenser of controlled substances 
30.17 	must have an electronic health record system that meets the requirements of section 
30.18 	62J.497.

30.19 	Sec. 6. [62J.497] ELECTRONIC PRESCRIPTION DRUG PROGRAM.
30.20 		Subdivision 1.Definitions. For the purposes of this section, the following terms 
30.21 	have the meanings given.
30.22 	(a) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision 
30.23 	30. Dispensing does not include the direct administering of a controlled substance to a 
30.24 	patient by a licensed health care professional.
30.25 	(b) "Dispenser" means a person authorized by law to dispense a controlled substance, 
30.26 	pursuant to a valid prescription.
30.27 	(c) "Electronic media" has the same meaning given this term under Code of Federal 
30.28 	Regulations, title 45, part 160.103.
30.29 	(d) "E-prescribing" means the transmission using electronic media, of prescription 
30.30 	or prescription-related information between a prescriber, dispenser, pharmacy benefit 
30.31 	manager, or group purchaser, either directly or through an intermediary, including an 
30.32 	e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions 
30.33 	between the point of care and the dispenser.
31.1 	(e) "Electronic prescription drug program" means a program that provides for 
31.2 	e-prescribing.
31.3 	(f) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
31.4 	(g) "HL7 messages" means a standard approved by the standards development 
31.5 	organization known as Health Level Seven.
31.6 	(h) "National Provider Identifier" or "NPI" means the identifier described under 
31.7 	Code of Federal Regulations, title 45, part 162.406.
31.8 	(i) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
31.9 	(j) "NCPDP Formulary and Benefits Standard" means the National Council for 
31.10 	Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide, 
31.11 	Version 1, Release 0, October 2005.
31.12 	(k) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug 
31.13 	Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide 
31.14 	Version 8, Release 1 (Version 8.1), October 2005.
31.15 	(l) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
31.16 	(m) "Prescriber" means a licensed health care professional who is authorized to 
31.17 	prescribe a controlled substance under section 152.12, subdivision 1.
31.18 	(n) "Prescription-related information" means information regarding eligibility for 
31.19 	drug benefits, medication history, or related health or drug information.
31.20 	(o) "Provider" or "health care provider" has the meaning given in section 62J.03, 
31.21 	subdivision 8.
31.22 		Subd. 2.Requirements for electronic prescribing. (a) Effective January 1, 2011, 
31.23 	all providers, group purchasers, prescribers, and dispensers must establish and maintain 
31.24 	an electronic prescription drug program that complies with the applicable standards 
31.25 	in this section for transmitting, directly or through an intermediary, prescriptions and 
31.26 	prescription-related information using electronic media.
31.27 	(b) Nothing in this section requires providers, group purchasers, prescribers, or 
31.28 	dispensers to conduct the transactions described in this section. If transactions described in 
31.29 	this section are conducted, they must be done electronically using the standards described 
31.30 	in this section. Nothing in this section requires providers, group purchasers, prescribers, 
31.31 	or dispensers to electronically conduct transactions that are expressly prohibited by other 
31.32 	sections or federal law.
31.33 	(c) Providers, group purchasers, prescribers, and dispensers must use either HL7 
31.34 	messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related 
31.35 	information internally when the sender and the recipient are part of the same legal entity. If 
31.36 	an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard 
32.1 	or other applicable standards required by this section. Any pharmacy within an entity 
32.2 	must be able to receive electronic prescription transmittals from outside the entity using 
32.3 	the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health 
32.4 	Insurance Portability and Accountability Act (HIPAA) requirement that may require the 
32.5 	use of a HIPAA transaction standard within an organization.
32.6 	(d) Entities transmitting prescriptions or prescription-related information where the 
32.7 	prescriber is required by law to issue a prescription for a patient to a nonprescribing 
32.8 	provider that in turn forwards the prescription to a dispenser are exempt from the 
32.9 	requirement to use the NCPDP SCRIPT Standard when transmitting such prescriptions or 
32.10 	prescription-related information.
32.11 		Subd. 3.Standards for electronic prescribing. (a) Prescribers and dispensers 
32.12 	must use the NCPDP SCRIPT Standard for the communication of a prescription or 
32.13 	prescription-related information. The NCPDP SCRIPT Standard shall be used to conduct 
32.14 	the following transactions:
32.15 	(1) get message transaction;
32.16 	(2) status response transaction;
32.17 	(3) error response transaction;
32.18 	(4) new prescription transaction;
32.19 	(5) prescription change request transaction;
32.20 	(6) prescription change response transaction;
32.21 	(7) refill prescription request transaction;
32.22 	(8) refill prescription response transaction;
32.23 	(9) verification transaction;
32.24 	(10) password change transaction;
32.25 	(11) cancel prescription request transaction; and/or
32.26 	(12) cancel prescription response transaction.
32.27 	(b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP 
32.28 	SCRIPT Standard for communicating and transmitting medication history information.
32.29 	(c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP 
32.30 	Formulary and Benefits Standard for communicating and transmitting formulary and 
32.31 	benefit information.
32.32 	(d) Providers, group purchasers, prescribers, and dispensers must use the national 
32.33 	provider identifier to identify a health care provider in e-prescribing or prescription-related 
32.34 	transactions when a health care provider's identifier is required.
33.1 	(e) Providers, group purchasers, prescribers, and dispensers must communicate 
33.2 	eligibility information and conduct health care eligibility benefit inquiry and response 
33.3 	transactions in accordance with the requirements of section 62J.536.

33.4 	Sec. 7. Minnesota Statutes 2007 Supplement, section 62J.81, subdivision 1, is amended 
33.5 	to read:
33.6 		Subdivision 1.Required disclosure of estimated payment out-of-pocket costs.
 33.7 	(a) A health care provider, as defined in section 62J.03, subdivision 8, or the provider's 
33.8 	designee as agreed to by that designee, shall, at the request of a consumer, and at no cost 
33.9 	to the consumer or the consumer's employer, provide that consumer with a good faith 
33.10 	estimate of the allowable payment the provider has agreed to accept from the consumer's 
33.11 	health plan company for the services specified by the consumer, specifying the amount of 
33.12 	the allowable payment due from the health plan company. Health plan companies must 
33.13 	allow contracted providers, or their designee, to release this information. If a consumer 
33.14 	has no applicable public or private coverage, the health care provider must give the 
33.15 	consumer, and at no cost to the consumer, a good faith estimate of the average allowable 
33.16 	reimbursement the provider accepts as payment from private third-party payers for the 
33.17 	services specified by the consumer and the estimated amount the noncovered consumer 
33.18 	will be required to pay. Payment information provided by a provider, or by the provider's 
33.19 	designee as agreed to by that designee, to a patient pursuant to this subdivision does not 
33.20 	constitute a legally binding estimate of the allowable charge for or cost to the consumer of 
33.21 	services. 
33.22 	(b) A health plan company, as defined in section 62J.03, subdivision 10, shall, at 
33.23 	the request of an enrollee or the enrollee's designee, provide that enrollee with a good 
33.24 	faith estimate of the allowable amount the health plan company has contracted for with a 
33.25 	specified provider within the network as total payment for a health care service specified 
33.26 	by the enrollee and the portion of the allowable amount due from the enrollee and the 
33.27 	enrollee's out-of-pocket costs. An estimate provided to an enrollee under this paragraph is 
33.28 	not a legally binding estimate of the allowable amount or enrollee's out-of-pocket cost.

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

33.30 	Sec. 8. Minnesota Statutes 2007 Supplement, section 62J.82, subdivision 1, is amended 
33.31 	to read:
33.32 		Subdivision 1.Required information. The Minnesota Hospital Association shall 
33.33 	develop a Web-based system, available to the public free of charge, for reporting the 
33.34 	following, for Minnesota residents:
34.1 	(1) hospital-specific performance on the measures of care developed under section 
34.2 	256B.072 for acute myocardial infarction, heart failure, and pneumonia; 
34.3 	(2) by January 1, 2009, hospital-specific performance on the public reporting 
34.4 	measures for hospital-acquired infections as published by the National Quality Forum 
34.5 	and collected by the Minnesota Hospital Association and Stratis Health in collaboration 
34.6 	with infection control practitioners; and 
34.7 	(3) chargeprice information, including, but not limited to, number of discharges, 
34.8 	average length of stay, average charge price, average chargeprice per day, and median 
34.9 	charge price, for each of the 50 most common inpatient diagnosis-related groups and the 
34.10 	25 most common outpatient surgical procedures as specified by the Minnesota Hospital 
34.11 	Association. 

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

34.13 	Sec. 9. Minnesota Statutes 2006, section 62L.12, subdivision 4, is amended to read:
34.14 		Subd. 4.Employer prohibition. A small employer offering a health benefit plan 
34.15 	shall not encourage or direct an employee or applicant to:
34.16 	(1) refrain from filing an application for health coverage when other similarly 
34.17 	situated employees may file an application for health coverage;
34.18 	(2) file an application for health coverage during initial eligibility for coverage, 
34.19 	the acceptance of which is contingent on health status, when other similarly situated 
34.20 	employees may apply for health coverage, the acceptance of which is not contingent on 
34.21 	health status;
34.22 	(3) seek coverage from another health carrier, including, but not limited to, MCHA; 
34.23 	or
34.24 	(4) cause coverage to be issued on different terms because of the health status or 
34.25 	claims experience of that person or the person's dependents.

34.26 	Sec. 10. Minnesota Statutes 2006, section 62Q.735, subdivision 1, is amended to read:
34.27 		Subdivision 1.Contract disclosure. (a) Before requiring a health care provider to 
34.28 	sign a contract, a health plan company shall give to the provider a complete copy of 
34.29 	the proposed contract, including:
34.30 	(1) all attachments and exhibits;
34.31 	(2) operating manuals;
34.32 	(3) a general description of the health plan company's health service coding 
34.33 	guidelines and requirement for procedures and diagnoses with modifiers, and multiple 
34.34 	procedures; and
35.1 	(4) all guidelines and treatment parameters incorporated or referenced in the contract.
35.2 	(b) The health plan company shall make available to the provider the fee schedule or 
35.3 	a method or process that allows the provider to determine the fee schedule for each health 
35.4 	care service to be provided under the contract.
35.5 	(c) Notwithstanding paragraph (b), A health plan company that is a dental 
35.6 	plan organization, as defined in section 62Q.76, shall disclose information related to 
35.7 	the individual contracted provider's expected reimbursement from the dental plan 
35.8 	organization. Nothing in this section requires a dental plan organization to disclose the 
35.9 	plan's aggregate maximum allowable fee table used to determine other providers' fees. 
35.10 	The contracted provider must not release this information in any way that would violate 
35.11 	any state or federal antitrust law. 

35.12 	Sec. 11. [62U.01] DEFINITIONS.
35.13 		Subdivision 1.Applicability. For purposes of this chapter, the terms defined in this 
35.14 	section have the meanings given, unless otherwise specified.
35.15 		Subd. 2.Baskets or baskets of care. "Basket" or "baskets of care" means a 
35.16 	collection of health care services that are paid separately under a fee-for-service system, 
35.17 	but which are ordinarily combined by a provider in delivering a full diagnostic or 
35.18 	treatment procedure to a patient.
35.19 		Subd. 3.Clinically effective. "Clinically effective" means that the use of a 
35.20 	particular health technology improves patient clinical status, as measured by medical 
35.21 	condition, survival rates, and other variables, and that the use of the particular technology 
35.22 	demonstrates a clinical advantage over alternative technologies. This definition shall not 
35.23 	be used to exclude or deny technology or treatment necessary to preserve life on the basis 
35.24 	of an individual's age or expected length of life or of the individual's present or predicted 
35.25 	disability, degree of medical dependency, or quality of life.
35.26 		Subd. 4.Commission. "Commission" means the Health Care Transformation 
35.27 	Commission established under section 62U.04.
35.28 		Subd. 5.Cost effective. "Cost effective" means that the economic costs of using 
35.29 	a particular service, device, or health technology to achieve improvement in a patient's 
35.30 	health outcome are justified given the comparison to both the economic costs and the 
35.31 	improvement in patient health outcome resulting from the use of an alternative service, 
35.32 	device, or technology, or from not providing the service, device, or technology.
35.33 		Subd. 6.Group purchaser. "Group purchaser" has the meaning provided in 
35.34 	section 62J.03.
36.1 		Subd. 7.Health plan. "Health plan" means a health plan as defined in section 
36.2 	62A.011.
36.3 		Subd. 8.Health plan company. "Health plan company" has the meaning provided 
36.4 	in section 62Q.01, subdivision 4.
36.5 		Subd. 9.Health technology. "Health technology" means medical and surgical 
36.6 	devices and procedures, medical equipment, and diagnostic tests.
36.7 		Subd. 10.Participating provider. "Participating provider" means a provider who 
36.8 	has entered into a service agreement with a health plan company.
36.9 		Subd. 11.Provider or health care provider. "Provider" or "health care provider" 
36.10 	means a health care provider as defined in section 62J.03, subdivision 8.
36.11 		Subd. 12.Section 125 Plan. "Section 125 Plan" means a cafeteria or premium-only 
36.12 	plan under section 125 of the Internal Revenue Code that allows employees to pay for 
36.13 	health insurance premiums with pretax dollars.
36.14 		Subd. 13.Service agreement. "Service agreement" means an agreement, contract, 
36.15 	or other arrangement between a health plan company and a provider under which the 
36.16 	provider agrees that when health services are provided for an enrollee, the provider shall 
36.17 	not make a direct charge against the enrollee for those services or parts of services which 
36.18 	are covered by the enrollee's contract, but shall look to the service plan corporation for the 
36.19 	payment for covered services, to the extent they are covered.
36.20 		Subd. 14.Third-party administrators. "Third-party administrators" means a 
36.21 	vendor of risk-management services or an entity administering a self-insurance or health 
36.22 	insurance plan under section 60A.23.

36.23 	Sec. 12. [62U.02] HEALTH INSURANCE ACCESS BROKERS.
36.24 		Subdivision 1.Establishment. Any corporation authorized to do business in the 
36.25 	state may apply to the commissioner of commerce for registration as a health insurance 
36.26 	access broker to establish and operate a health insurance access broker under this section.
36.27 		Subd. 2.Registration criteria. (a) In order to be registered as a health insurance 
36.28 	access broker, a corporation must submit an application to the commissioner of commerce 
36.29 	on a form prescribed by the commissioner and provide evidence to the satisfaction of the 
36.30 	commissioner that the applicant meets the following requirements:
36.31 	(1) is licensed under chapter 60K to sell health and life insurance;
36.32 	(2) has sufficient knowledge of health insurance, the health insurance market, and of 
36.33 	the federal and state laws that are relevant to health insurance;
36.34 	(3) has the ability to assist clients in enrolling in private health coverage by offering 
36.35 	a range of private health plan products from at least four health plan companies;
37.1 	(4) agrees to provide applications and information on how to obtain application 
37.2 	assistance for clients who may be eligible for state health care programs;
37.3 	(5) has the capacity to transact the establishment and administration of Section 125 
37.4 	Plans on behalf of an employer;
37.5 	(6) provides a range of services and transparent information on coverage options 
37.6 	for current and potential clients, including, but not limited to, providing information by 
37.7 	telephone, e-mail, and Web based;
37.8 	(7) the ability to assist employees in understanding health plan coverage options and 
37.9 	in enrolling in appropriate coverage; and
37.10 	(8) has the financial and transactional ability to collect, hold, and disperse funds on 
37.11 	behalf of clients, employers, or health plan companies.
37.12 	(b) The commissioner of commerce may establish a fee to be paid by applicants 
37.13 	and submitted with the application to cover the cost of registration and the cost of the 
37.14 	online registry established under subdivision 4. The fee shall be deposited in the state 
37.15 	government special revenue fund.
37.16 		Subd. 3.Duties by the commissioner of commerce. The commissioner of 
37.17 	commerce shall provide oversight of the health insurance access brokers registered under 
37.18 	this section to ensure that the brokers continue to meet the requirements of this section 
37.19 	and to provide consumer protection. The commissioner may require registered health 
37.20 	insurance access brokers to submit periodic reports to the commissioner as specified by 
37.21 	the commissioner.
37.22 		Subd. 4.Online registry. The commissioner shall establish a Web-based registry 
37.23 	of registered health insurance access brokers, and shall make the registry available to 
37.24 	the public, upon request.

37.25 	Sec. 13. [62U.03] SECTION 125 PLANS.
37.26 		Subdivision 1.Definitions. For purposes of this section, the following terms have 
37.27 	the meanings given them.
37.28 	(a) "Employee" means an employee currently on an employer's payroll other than a 
37.29 	retiree or disabled former employee.
37.30 	(b) "Employer" means a person, firm, corporation, partnership, association, business 
37.31 	trust, or other entity employing one or more persons, including a political subdivision of 
37.32 	the state, filing payroll tax information on such employed person or persons.
37.33 		Subd. 2.Section 125 Plan requirement. (a) Effective July 1, 2009, all employers 
37.34 	with 11 or more current full-time equivalent employees shall establish a Section 125 
37.35 	Plan to allow their employees to purchase individual market or employer-based health 
38.1 	plan coverage with pretax dollars. Nothing in this section requires employers to offer or 
38.2 	purchase group health insurance coverage for their employees.
38.3 	The following employers are exempt from the Section 125 Plan requirement:
38.4 	(1) employers that offer a group health insurance plan as defined in section 62A.10;
38.5 	(2) employers that are self-insured as defined in section 62E.02; or
38.6 	(3) employers with no employees who are eligible to participate in a Section 125 
38.7 	Plan.
38.8 	(b) Employers that offer a Section 125 Plan may enter into an agreement with the 
38.9 	exchange to administer the employer's Section 125 Plan.
38.10 	(c) Notwithstanding paragraph (a), an employer that has been certified by a licensed 
38.11 	insurance broker as having received education and information on the benefits and 
38.12 	advantages of offering Section 125 Plans is not required to establish a Section 125 Plan. 
38.13 	This paragraph expires July 1, 2010.
38.14 		Subd. 3.Tracking compliance. By July 1, 2010,the commissioner of commerce, in 
38.15 	consultation with the commissioners of health, employment and economic development, 
38.16 	and revenue, shall establish a method for tracking employer compliance with the Section 
38.17 	125 Plan requirement.
38.18 		Subd. 4.Employer requirements. (a) Employers that do not offer a group health 
38.19 	insurance plan as defined in section 62A.10 and are required to offer or choose to offer a 
38.20 	Section 125 Plan shall:
38.21 	(1) allow employees to purchase an individual market health plan for themselves 
38.22 	and their dependents;
38.23 	(2) allow employees to choose any insurance producer licensed in accident and health 
38.24 	insurance under chapter 60K to assist them in purchasing an individual market health plan;
38.25 	(3) upon an employee's request, deduct premium amounts on a pretax basis in an 
38.26 	amount not to exceed an employee's wages, and remit these employee payments to the 
38.27 	health plan or the exchange; and
38.28 	(4) provide notice to employees that individual market health plans purchased by 
38.29 	employees through payroll deduction are not employer-sponsored or administered. 
38.30 	(b) Employers shall be held harmless from any and all liability claims related to the 
38.31 	individual market health plans purchased by employees under a Section 125 Plan.
38.32 		Subd. 5.Health plan company requirements.  Individuals who purchase an 
38.33 	individual market health plan through a Section 125 Plan may purchase coverage on a 
38.34 	guaranteed issue basis during an annual open enrollment period that coincides with the 
38.35 	open enrollment period for their employer's Section 125 Plan or upon experiencing a 
38.36 	qualifying event as defined in United States Code, chapter 43, section 4980B. Nothing 
39.1 	in this section precludes a health plan company from issuing coverage with preexisting 
39.2 	condition exclusions as authorized in law. Health plan companies may not charge higher 
39.3 	or lower premiums based on health status for individuals who purchase coverage on 
39.4 	a guaranteed issue basis under this section, except for variations in premium that are 
39.5 	allowable based on health behaviors such as tobacco use.

39.6 	Sec. 14. [62U.04] HEALTH CARE TRANSFORMATION COMMISSION.
39.7 		Subdivision 1.Creation. The Health Care Transformation Commission is created 
39.8 	for the purpose of coordinating the health care transformation activities within Minnesota.
39.9 		Subd. 2.Members. (a) The Health Care Transformation Commission shall consist 
39.10 	of ten members who are appointed as follows:
39.11 	(1) three members appointed by the Subcommittee on Committees of the Committee 
39.12 	on Rules and Administration of the senate, including two public members and one senator;
39.13 	(2) three members appointed by the speaker of the house of representatives, 
39.14 	including two public members and one member of the house; and
39.15 	(3) four members appointed by the governor, two of whom shall be state 
39.16 	commissioners from the agencies listed in section 15.01.
39.17 	(b) The appointing authorities must ensure that the appointed members who are 
39.18 	not legislators or commissioners:
39.19 	(1) have expertise in health care financing, health care delivery, health care quality 
39.20 	improvement, health economics, actuarial science, or business operations;
39.21 	(2) are not state employees or employees of a political subdivision; and
39.22 	(3) do not have a direct financial interest in the outcome of the commission's 
39.23 	business, other than as an individual consumer of health care services.
39.24 	(c) Section 15.0575, subdivision 4, governs the removal of members.
39.25 	(d) For the purposes of section 10A.09, members of the commission are public 
39.26 	officials and must file a statement of economic interest as required under that section.
39.27 		Subd. 3.Operations of the commission. (a) The commissioner of health shall 
39.28 	convene the first meeting of the commission on or before July 1, 2008, following the 
39.29 	initial appointment of the members.
39.30 	(b) The commission shall elect a chair from its membership.
39.31 	(c) Expenses shall be compensated in accordance with section 15.0575.
39.32 	(d) The commission may appoint an executive director who, if appointed, shall:
39.33 	(1) be a state employee;
39.34 	(2) administer all of the activities and contracts of the commission; and
39.35 	(3) hire and supervise staff for the commission.
40.1 		Subd. 4.Advisory committee established; responsibilities of the advisory 
40.2 	committee and commission. (a) There is established an advisory committee to the 
40.3 	commission whose membership shall include, but not be limited to, the following 
40.4 	members:
40.5 	(1) two members appointed by the Minnesota Medical Association; 
40.6 	(2) two members appointed by the Minnesota Council on Health Plans;
40.7 	(3) two members appointed by the Minnesota Hospital Association, at least one of 
40.8 	which must be a rural hospital administrator;
40.9 	(4) two members appointed by the Minnesota Medical Group Managers Association;
40.10 	(5) one member appointed by the Minnesota Business Partnership; and
40.11 	(6) one member appointed by the Minnesota Chamber of Commerce. 
40.12 	The appointing authorities under this paragraph must complete their appointments no 
40.13 	later than July 30, 2008. 
40.14 	(b) The representatives from the Minnesota Hospital Association shall convene the 
40.15 	first meeting of the advisory committee no later than 30 days following the completion 
40.16 	of appointments under paragraph (a). The advisory group may accept staff support and 
40.17 	use meeting facilities provided by the Minnesota Hospital Association. The committee 
40.18 	shall select a chair at its first meeting. At any time, the committee may appoint additional 
40.19 	members by majority vote of the entire committee.
40.20 	(c) The advisory committee shall advise on a design and implementation plan for a 
40.21 	health care payment restructuring system within the parameters described in this chapter. 
40.22 	The plan must provide for the full implementation of the payment restructuring system by 
40.23 	January 1, 2011. The design and plan must include:
40.24 	(1) uniform definitions for the baskets of care and a comprehensive set of services as 
40.25 	required under section 62U.10;
40.26 	(2) a mechanism for soliciting and accepting payment bids from health care 
40.27 	providers and health care systems as required under section 62U.10. The mechanism 
40.28 	must ensure that the bids from different providers and care systems can be compared by 
40.29 	consumers on both quality and cost;
40.30 	(3) procedures to facilitate providers in participating in the payment system and, 
40.31 	if needed, provide technical assistance to providers in assembling bids, contracting with 
40.32 	other providers in order to assemble or submit bids, or otherwise participate in the 
40.33 	payment system; and
40.34 	(4) a method for monitoring, measuring, and evaluating the effectiveness of the 
40.35 	payment restructuring system and for making adjustments, as necessary, to address any 
40.36 	barriers or unintended consequences.
41.1 	(d) In developing the payment restructuring system described in this chapter, the 
41.2 	advisory committee shall consult and coordinate with the commissioners of health and 
41.3 	human services, health care providers, health plan companies, organizations that work to 
41.4 	improve health care quality in Minnesota, consumers, and employers.
41.5 	(e) The advisory committee shall submit the design and implementation plan to 
41.6 	the commission for review and adoption.
41.7 	(f) By July 1, 2009, the commission shall make recommendations to the governor 
41.8 	and the chairs and ranking minority members of the legislative committees and divisions 
41.9 	with jurisdiction over health care policy and finance on how to incorporate Medicare 
41.10 	into the payment restructuring system. In developing these recommendations, the 
41.11 	commission shall negotiate with the Centers for Medicare and Medicaid Services and with 
41.12 	the Minnesota congressional delegation and explore participation in a demonstration 
41.13 	project or advocate for changes in federal law to enable a successful transformation of the 
41.14 	health care system.
41.15 	(g) The commission and the advisory committee may contract with other 
41.16 	organizations and entities to carry out any of the duties described in this chapter, including 
41.17 	evaluating the effectiveness of the payment restructuring system.
41.18 	(h) The advisory committee expires July 1, 2012.
41.19 		Subd. 5.Standard benefit set and design. (a) Based on the recommendations 
41.20 	submitted by the Health Benefit Set and Design Advisory Committee, the commission 
41.21 	shall establish a standard benefit set and design by July 1, 2009.
41.22 	(b) The standard health benefit set and design must meet the requirements described 
41.23 	in section 62U.06.
41.24 	(c) Prior to establishing the standard benefit set and design, the commission shall 
41.25 	convene public hearings throughout the state.
41.26 		Subd. 6.Reports. The commission shall submit a report on January 15 of each year 
41.27 	to the governor and legislature, beginning in 2010, on the following:
41.28 	(1) the extent to which health care providers have reduced their costs and fees;
41.29 	(2) the extent to which costs and cost growth are likely to be maintained or reduced 
41.30 	in future years;
41.31 	(3) the extent to which the quality of health care services has improved;
41.32 	(4) the extent to which all Minnesotans have access to quality, affordable health 
41.33 	care; and
41.34 	(5) recommendations on additional actions that are needed in order to successfully 
41.35 	achieve health care transformation in Minnesota.
42.1 		Subd. 7.Sunset. The commission shall expire June 30, 2012. Upon expiration, the 
42.2 	duties of the commission shall transfer to the Health Care Value Reporting Committee.

42.3 	Sec. 15. [62U.05] HEALTH CARE VALUE REPORTING COMMITTEE.
42.4 		Subdivision 1. Creation. The Health Care Value Reporting Committee is created 
42.5 	for the purpose of collecting, analyzing, and disseminating data on health care quality.
42.6 		Subd. 2.Members. (a) The Health Care Value Reporting Committee shall consist of 
42.7 	seven members who shall be appointed by the Health Care Transformation Commission. 
42.8 	The members must have expertise and knowledge in health care quality improvement 
42.9 	and measurement.
42.10 	(b) Upon the expiration of the Health Care Transformation Commission, the 
42.11 	members shall be appointed as follows:
42.12 	(1) three members appointed by the governor;
42.13 	(2) two members appointed by the Subcommittee on Committees of the Committee 
42.14 	on Rules and Administration of the senate; and
42.15 	(3) two members appointed by the speaker of the house of representatives.
42.16 	(c) Membership terms shall be for four years.
42.17 		Subd. 3.Operation of the committee. (a) The governor's designee shall convene 
42.18 	the first meeting of the committee following the initial appointment of the members.
42.19 	(b) The committee shall elect a chair among its members at the initial meeting.
42.20 	(c) The committee shall be governed under section 15.0575 except that the members 
42.21 	shall not be compensated and the committee shall not expire.
42.22 		Subd. 4.Duties. (a) The Health Care Value Reporting Committee shall be 
42.23 	responsible for collecting, analyzing, and disseminating data on health care quality.
42.24 	(b) The Health Care Value Reporting Committee shall: 
42.25 	(1) establish the standards for measuring health care outcomes; 
42.26 	(2) establish a system for providers to report outcomes and processes associated with 
42.27 	patient care. In establishing these standards and system, the Health Care Value Reporting 
42.28 	Committee shall work with other organizations that are developing quality measurement 
42.29 	and reporting systems to establish a single system for collection and reporting of data 
42.30 	on provider quality;
42.31 	(3) collect standardized electronic information outcomes and processes from health 
42.32 	care providers;
42.33 	(4) establish a system for risk adjusting the measures reported by providers January 
42.34 	1, 2010; and
43.1 	(5) issue annual public reports on provider quality using the data submitted by 
43.2 	providers, adjusted for patient complexity beginning July 1, 2010.
43.3 	(c) The Health Care Value Reporting Committee may contract with organizations 
43.4 	and collaborations of organizations such as the Minnesota Community Measurement or 
43.5 	Stratis Health to carry out any of the duties described in this section.

43.6 	Sec. 16. [62U.06] STANDARD BENEFIT SET AND DESIGN; HEALTH 
43.7 	BENEFIT AND DESIGN ADVISORY COMMITTEE.
43.8 		Subdivision 1.Creation. The Health Care Transformation Commission established 
43.9 	in section 62U.04 shall convene a Health Benefit and Design Advisory Committee to 
43.10 	make recommendations to the commission on a standard benefit set and design. The 
43.11 	advisory committee shall consist of seven members. The members shall be appointed 
43.12 	by the commission by August 15, 2008, and must have expertise in benefit design and 
43.13 	development, actuarial analysis, or knowledge relating to the analysis of the cost impact 
43.14 	of coverage of specified benefits.
43.15 		Subd. 2.Operations of the committee. (a) The chair of the Health Care 
43.16 	Transformation Commission shall convene the first meeting of the advisory committee 
43.17 	on or before September 1, 2008. The committee must meet at least once a year, and at 
43.18 	other times as necessary.
43.19 	(b) The commission shall provide office space, equipment and supplies, and 
43.20 	technical support to the committee.
43.21 	(c) The committee shall be governed by section 15.059, except the committee shall 
43.22 	not expire. Upon the expiration of the Health Care Transformation Commission, the 
43.23 	Health Benefit and Design Advisory Committee shall continue to exist under the oversight 
43.24 	of the Health Care Value Reporting Committee.
43.25 		Subd. 3.Duties of the committee. (a) By January 15, 2009, the committee shall 
43.26 	develop and submit to the commission an initial cost-effective benefit set and design 
43.27 	that provides individuals access to a broad range of health care services, including 
43.28 	preventive health care, including dental care, comprehensive mental health services, 
43.29 	chemical dependency treatment, vision care, language interpreter services, emergency 
43.30 	transportation, and prescription drugs without incurring severe financial loss as a result of 
43.31 	serious illness or injury. The benefit set must include necessary evidence-based health care 
43.32 	services, procedures, and diagnostic tests that are scientifically proven to be both clinically 
43.33 	effective and cost-effective. In establishing the initial benefit set, the committee may 
43.34 	contract with the Institute for Clinical Systems Improvement (ICSI) to assemble existing 
43.35 	scientifically based practice standards. The committee shall consider cultural, ethnic, and 
44.1 	religious values and beliefs to ensure that the health care needs of all Minnesota residents 
44.2 	will be addressed in the benefit set.
44.3 	(b) The benefit set must identify and include preventive services, chronic care 
44.4 	coordination services, and early diagnostic tests, that, if included in the benefit set, with 
44.5 	minimal or no cost-sharing requirements, would result in savings that are equal to or 
44.6 	greater than the cost of providing the services.
44.7 	(c) The benefit set must include ICSI-designated evidence-based outpatient care for 
44.8 	asthma, heart disease, diabetes, and depression with no cost-sharing requirements, or 
44.9 	with minimal cost-sharing requirements that would not impose an economic barrier to 
44.10 	accessing the care.
44.11 	(d) The benefit design must establish a maximum deductible for in-network benefits 
44.12 	and for prescription drugs coverage and a maximum for out-of-pocket costs.
44.13 		Subd. 4.Continued review. The committee shall review the benefit set and design 
44.14 	on an ongoing periodic basis and shall adjust the benefit set and design, as necessary to 
44.15 	ensure that the benefit set and design continues to be safe, effective, and scientifically 
44.16 	based.

44.17 	Sec. 17. [62U.07] HEALTH TECHNOLOGY ASSESSMENT.
44.18 		Subdivision 1.Technology Advisory Committee. (a) The Health Care 
44.19 	Transformation Commission shall appoint an advisory committee to make 
44.20 	recommendations to the commission regarding the inclusion of new and existing health 
44.21 	technologies to the standard benefit set and design.
44.22 	(b) The advisory committee shall be made up of 11 members appointed by the 
44.23 	commission, in consultation with the Institute for Clinical Systems Improvement, the 
44.24 	Health Services Advisory Council, and the University of Minnesota. The membership 
44.25 	shall include:
44.26 	(1) six practicing physicians licensed under chapter 147; and
44.27 	(2) five other practicing health care professionals who use health technology in 
44.28 	their scope of practice.
44.29 	The commission must complete the appointments required by this paragraph by September 
44.30 	1, 2008. The chair of the commission shall convene the first meeting of the Technology 
44.31 	Advisory Committee within 30 days following the completion of the appointments to 
44.32 	the committee.
44.33 	(c) A member of the advisory committee may not: 
44.34 	(1) have a substantial financial interest in a health technology company; or
45.1 	(2) be employed by or under contract with a health technology manufacturer during 
45.2 	their term or for 18 months before their appointment.
45.3 	(d) The advisory committee is subject to section 15.059, except that the committee 
45.4 	shall not expire. Upon the expiration of the Health Care Transformation Commission, the 
45.5 	Health Technology Assessment Committee shall continue to exist under the oversight of 
45.6 	the Health Care Value Reporting Committee.
45.7 		Subd. 2.Technology selection process. The commission, in consultation with the 
45.8 	advisory committee, shall select existing and new health technologies to be reviewed by 
45.9 	the committee. In making a selection, priority shall be given to any technology for which:
45.10 	(1) there are concerns about its safety, efficacy, or cost-effectiveness;
45.11 	(2) actual or expected expenditures are high due to demand for the technology, 
45.12 	its cost or both; and
45.13 	(3) there is adequate evidence available to conduct a complete review.
45.14 		Subd. 3.Technology review. (a) Upon the selection of a health technology for 
45.15 	review, the committee shall contract for a systematic evidence-based assessment of 
45.16 	the technology's safety, efficacy, and cost-effectiveness. The contract shall be with an 
45.17 	evidence-based practice center designated as such by the federal agency for health care 
45.18 	research and quality, or another appropriate entity as designated by the committee.
45.19 	(b) The committee shall provide notification to the public when a health technology 
45.20 	has been selected for review. The notification must indicate when that review is to be 
45.21 	initiated and how an interested party may submit evidence or provide public comment for 
45.22 	consideration during the review.
45.23 		Subd. 4.Committee determination. (a) Upon reviewing the completed assessment 
45.24 	and any other evidence submitted regarding the safety, efficacy, and cost-effectiveness of 
45.25 	the technology, the committee shall recommend to the commission:
45.26 	(1) the conditions, if any, under which the health technology should be included 
45.27 	as a covered benefit; and
45.28 	(2) if covered, the criteria to be used to decide whether the technology is medically 
45.29 	necessary, or proper and necessary treatment.
45.30 	(b) The commissioners of human services, employee relations, and corrections may 
45.31 	use the committee's recommendation in making coverage and reimbursement decisions 
45.32 	unless the recommendation conflicts with an applicable federal statute or regulation.
45.33 	(c) The committee's recommendation may not limit the use of a health technology 
45.34 	necessary to preserve life on the basis of an individual's age or expected length of life 
45.35 	or of an individual's present or predicted disability, degree of medical dependency, or 
45.36 	quality of life.

46.1 	Sec. 18. [62U.08] PAYMENT RESTRUCTURING: INCENTIVE PAYMENTS 
46.2 	BASED ON QUALITY OF CARE.
46.3 		Subdivision 1.Development. (a) By January 1, 2009, the Health Care 
46.4 	Transformation Commission shall develop a system of quality incentive payments that 
46.5 	link the level of payments to providers to the quality of care. The system must incorporate 
46.6 	payments to primary care physicians, specialty care physicians, health care clinics, and 
46.7 	hospitals eligible for these incentive payments.
46.8 	(b) The requirements of section 62Q.101 do not apply under this incentive payment 
46.9 	system.
46.10 		Subd. 2.Payment system criteria. The quality incentive payment system shall 
46.11 	meet the following criteria:
46.12 	(1) providers meeting specified targets, or who demonstrate a significant amount 
46.13 	of improvement over time, shall be eligible for quality incentive payments that are in 
46.14 	addition to existing payment levels;
46.15 	(2) priority shall be placed on measures of health care outcomes, rather than 
46.16 	processes, wherever possible;
46.17 	(3) quality measures for primary care providers shall include preventive services, 
46.18 	coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary 
46.19 	disease, and depression;
46.20 	(4) quality measures for specialty care shall be initially based on quality indicators 
46.21 	measured and reported publicly by specialty societies;
46.22 	(5) hospital measures shall be initially based on existing quality measures; 
46.23 	(6) to the greatest extent possible, quality measures must be adjusted for variation 
46.24 	in patient population; and
46.25 	(7) other indicators of care quality may be incorporated where appropriate. These 
46.26 	indicators may include care infrastructure, collection and reporting of results, and 
46.27 	measures of overall cost of care for individuals.
46.28 		Subd. 3.Implementation. By July 1, 2009: 
46.29 	(1) the commissioner of human services shall implement this incentive payment 
46.30 	system for all enrollees in the state's public health care programs;
46.31 	(2) the commissioner of employee relations shall implement this incentive payment 
46.32 	system for all participants in the state employee group insurance program; and
46.33 	(3) all health plan companies shall implement this incentive payment system for all 
46.34 	participating providers.

47.1 	Sec. 19. [62U.09] PAYMENT RESTRUCTURING: CARE COORDINATION 
47.2 	PAYMENTS.
47.3 		Subdivision 1.Development. By July 1, 2009, the Health Care Transformation 
47.4 	Commission shall develop a system that provides care coordination payments to health 
47.5 	care providers. In order to be eligible for a care coordination payment, a health care 
47.6 	provider must be certified as a health care home by the commissioner of health based on 
47.7 	the certification standards for health care homes established under section 256B.0754.
47.8 		Subd. 2.Care coordination fee. (a) Under the care coordination payments, health 
47.9 	care homes shall receive a per-person per-month care coordination fee for providing care 
47.10 	coordination services and directly managing onsite or employing care coordinators. For 
47.11 	purpose of this section, the specifications of care coordination and care coordinators are 
47.12 	described in section 256B.0752, subdivisions 3 and 7, respectively.
47.13 	(b) The care coordination fee payment system may vary the fees paid by thresholds 
47.14 	of care complexity, with the highest fees being paid for care provided to individuals 
47.15 	requiring the most intensive care coordination, such as those with very complex health 
47.16 	care needs or several chronic conditions.
47.17 	(c) In developing the system of care coordination fees, the commission shall consider 
47.18 	the additional time and resources needed by patients with limited English-language skills, 
47.19 	cultural differences, or other barriers to health care.
47.20 	(d) Care coordination fees may be phased-in, and must be applied first to individuals 
47.21 	who have, or are at risk of developing, complex or chronic health conditions.
47.22 		Subd. 3.Quality-based incentive payments. The care coordination fees paid under 
47.23 	this section are in addition to the quality incentive payments in section 62U.08.
47.24 		Subd. 4.Implementation. (a) By July 1, 2009:
47.25 	(1) the commissioner of human services shall implement the care coordination 
47.26 	payments for enrollees in the state's public health care programs;
47.27 	(2) the commissioner of employee relations shall implement the care coordination 
47.28 	payments for participants in the state employee group insurance program; and
47.29 	(3) all health plan companies shall implement this care coordination payments 
47.30 	for enrollees.
47.31 	(b) The commissioners of human services and employee relations and health plan 
47.32 	companies may begin implementing this care coordination payments for enrollees and 
47.33 	participants who have or are at risk of developing complex and chronic health conditions.

47.34 	Sec. 20. [62U.10] PAYMENT RESTRUCTURING; PROVIDER INNOVATION 
47.35 	TO IMPROVE COSTS AND QUALITY.
48.1 		Subdivision 1.Development. (a) By January 15, 2009, the Health Care 
48.2 	Transformation Commission shall report to the legislature recommendations for advancing 
48.3 	an innovative payment system for the chronic conditions of coronary artery and heart 
48.4 	disease, diabetes, asthma, chronic obstructive pulmonary disease, and depression.
48.5 	(b) By January 15, 2010, the Health Care Transformation Commission shall report to 
48.6 	the legislature additional changes necessary to accomplish comprehensive payment reform 
48.7 	designed to support an innovative payment system to reduce costs and improve quality.
48.8 	(c) By January 1, 2011, the Health Care Transformation Commission shall develop 
48.9 	rules to implement a comprehensive payment system that encourages provider innovation 
48.10 	to reduce costs and improve quality.
48.11 		Subd. 2.Encounter data. (a) Beginning September 1, 2009, and every three months 
48.12 	thereafter, all health plan companies and third-party administrators shall submit encounter 
48.13 	data to the Health Care Transformation Commission. The data shall be submitted in a 
48.14 	form and manner specified by the commission subject to the following requirements:
48.15 	(1) the data must be de-identified data as described under the Code of Federal 
48.16 	Regulations, title 45, section 164.514;
48.17 	(2) the data for each encounter must include an identifier for the patient's health care 
48.18 	home if the patient has selected a health care home; and
48.19 	(3) except for the identifier described in clause (2), the data must not include 
48.20 	information that is not included in a health care claim or equivalent encounter information 
48.21 	transaction that is required under section 62J.536.
48.22 	(b) The commission shall only use the data submitted under paragraph (a) for the 
48.23 	purpose of carrying out its responsibilities in designing and implementing a payment 
48.24 	restructuring system. If the commission contracts with other organizations or entities to 
48.25 	carry out any of its duties or responsibilities described in this chapter, the contract must 
48.26 	require that the organization or entity maintain the data that it receives according to the 
48.27 	provisions of this section.
48.28 	(c) Data on providers collected under this subdivision are private data on individuals 
48.29 	or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary 
48.30 	data in section 13.02, subdivision 19, summary data prepared under this section may be 
48.31 	derived from nonpublic data. The commission shall establish procedures and safeguards 
48.32 	to protect the integrity and confidentiality of any data that it maintains.
48.33 	(d) The commission shall not publish analyses or reports that identify, or could 
48.34 	potentially identify, individual patients.
48.35 	(e) The commission may publish analyses and reports that identify specific providers 
48.36 	but only after the provider has been provided the opportunity by the commission to review 
49.1 	the data and submit comments. The provider shall have 21 days to review and comment, 
49.2 	after which time the commission may release the data along with any comments submitted 
49.3 	by the provider.
49.4 		Subd. 3.Utilization and health care costs. (a) The commission shall develop a 
49.5 	method of calculating the relative utilization and health care costs of providers. The 
49.6 	method must exclude the costs of catastrophic cases and must include risk adjustments 
49.7 	to reflect differences in the demographics, health, and special needs of the providers' 
49.8 	patient population. The risk adjustment must be developed in accordance with generally 
49.9 	accepted risk adjustment methodologies.
49.10 	(b) Beginning April 1, 2010, the commission shall disseminate information to 
49.11 	providers on their utilization and cost in comparison to an appropriate peer group.
49.12 	(c) The commission shall develop a system to index providers based on their 
49.13 	total risk-adjusted resource use and quality of care, and separately for the conditions 
49.14 	of coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary 
49.15 	disease, and depression. In developing this system, the commission shall consult and 
49.16 	coordinate with health care providers, health plan companies, and organizations that work 
49.17 	to improve health care quality in Minnesota.
49.18 		Subd. 4.Chronic care package pricing and total care bids. (a) The commission 
49.19 	shall develop a standard method and format for providers to use for submitting package 
49.20 	prices for the total cost of care or separately for the conditions of coronary artery and heart 
49.21 	disease, diabetes, asthma, chronic obstructive pulmonary disease, or depression. This 
49.22 	method shall be published in the State Register and must be made available to all providers.
49.23 	(b) Beginning July 1, 2010, and annually thereafter, using the information developed 
49.24 	in subdivision 3, providers may submit package prices to the commission for the cost of 
49.25 	providing all necessary services to a patient or separately for the cost of providing services 
49.26 	for patients with the chronic conditions of coronary artery and heart disease, diabetes, 
49.27 	asthma, chronic obstructive pulmonary disease, or depression based on their disclosed 
49.28 	prices under section 62U.11 combined with their actual risk-adjusted resource use for the 
49.29 	most recent analytic period. The package prices submitted must reflect the providers' 
49.30 	commitment to manage their risk-adjusted patient population within this cost.
49.31 	(c) Until January 1, 2013, no provider shall submit a package price for the 
49.32 	risk-adjusted cost of care that represents an increase of more than the increase in the 
49.33 	previous calendar year's Consumer Price Index for all urban consumers plus two 
49.34 	percentage points or a decrease of more than 15 percent below the provider's risk-adjusted 
49.35 	cost of care calculated based on their average pricing levels for the previous calendar year.
50.1 	(d) Beginning January 1, 2011, the commission shall annually publish the results 
50.2 	of the process described in paragraph (b), and shall include only providers who choose 
50.3 	to submit package prices. The results that are published must be on a risk-neutral basis. 
50.4 	Effective January 1, 2012, the published results shall include all providers. For providers 
50.5 	that have not submitted package prices, these results must be based on their weighted 
50.6 	average contract prices for all health plan companies and third-party administrators, 
50.7 	combined with their risk-adjusted historic resource use.
50.8 		Subd. 5.Provider assistance. The commission shall provide education and 
50.9 	technical assistance to providers on how to calculate and submit package prices for the 
50.10 	risk-adjusted cost of care for the total cost of care and separately for the conditions 
50.11 	of coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary 
50.12 	disease, and depression.
50.13 		Subd. 6.Payments. The commission shall establish a method by which providers 
50.14 	who have submitted a package price shall be paid for their total cost of care or separately 
50.15 	for their cost of care in treating patients with the conditions of coronary artery and 
50.16 	heart disease, diabetes, asthma, chronic obstructive pulmonary disease, and depression. 
50.17 	The method must include periodic adjustments to payments to reflect providers' actual 
50.18 	risk-adjusted cost relative to their package price.
50.19 		Subd. 7.Implementation. By January 1, 2012:
50.20 	(1) the commissioner of human services shall pay providers based on their package 
50.21 	prices for all enrollees in the state's public health care programs;
50.22 	(2) the commissioner of employee relations shall pay providers based on their 
50.23 	package prices for participants in the state employee group program;
50.24 	(3) all political subdivisions as defined in section 13.02, subdivision 11, that offer 
50.25 	health benefits to their employees must pay providers based on their package prices or 
50.26 	purchase a health plan that uses this payment system;
50.27 	(4) all health plan companies shall use the information and methods developed 
50.28 	under this section to develop products that encourage consumers to use high-quality, 
50.29 	low-cost providers; and
50.30 	(5) health plan companies that issue health plans in the individual market or the small 
50.31 	employer market must offer at least one health plan that uses the information developed 
50.32 	under subdivision 3 to establish financial incentives for consumers to choose high-quality, 
50.33 	low-cost providers through enrollee cost sharing or selective provider networks.

50.34 	Sec. 21. [62U.11] PROVIDER PRICE AND QUALITY DISCLOSURE.
51.1 	(a) Beginning July 1, 2009, and annually thereafter, each physician clinic and 
51.2 	hospital shall establish a list of prices for each health care procedure, service, package of 
51.3 	services, or basket of care the provider provides and provide this information electronically 
51.4 	to the Health Care Transformation Commission in the form and manner specified by the 
51.5 	commission, and shall be provided to the public at no cost upon request. Providers may 
51.6 	update this periodically to reflect new services, supply cost changes, and other factors.
51.7 	(b) The Health Care Transformation Commission shall develop a plan that requires 
51.8 	all health care providers to comply with paragraph (a) beginning January 1, 2010.
51.9 	(c) By January 1, 2009, each health care provider shall submit standardized 
51.10 	electronic information on the outcomes and processes associated with patient care to the 
51.11 	Health Care Value Reporting Committee.

51.12 	Sec. 22. [62U.12] PROVIDER PRICING.
51.13 	(a) Effective July 1, 2010, no health care provider shall vary the payment amount 
51.14 	that the provider accepts as full payment for a health care service based upon the identity 
51.15 	of the payer, upon a contractual relationship with a payer, upon the identity of the patient, 
51.16 	or upon whether the patient has coverage through a group purchaser.
51.17 	(b) This section does not apply to a variation based upon a payer being a 
51.18 	governmental entity.
51.19 	(c) This section does not apply to workers' compensation or no-fault automobile 
51.20 	insurance payments.
51.21 	(d) This section does not affect the right of a provider to provide charity care or care 
51.22 	for a reduced price due to financial hardship of the patient or due to the patient being a 
51.23 	relative or friend of the provider.

51.24 	Sec. 23. [62U.13] HEALTH SAVINGS REINVESTMENT ASSESSMENT.
51.25 		Subdivision 1.Projected spending baseline. (a) The commissioner of health shall 
51.26 	calculate the annual projected total health care spending for the state and establish a health 
51.27 	care spending baseline beginning for the calendar year 2008 and for the next ten years 
51.28 	based on the annual projected growth in spending.
51.29 	(b) In establishing the health care spending baseline, the commissioner shall use 
51.30 	the Center of Medicare and Medicaid Services forecast for total growth in national health 
51.31 	care expenditures, and adjust this forecast to reflect the demographics, health status, and 
51.32 	other factors deemed necessary by the commissioner. The commissioner shall contract 
51.33 	with an actuarial consultant to make recommendations as to the adjustments needed to 
51.34 	specifically reflect projected spending for Minnesota residents.
52.1 	(c) The commissioner may adjust the projected baseline as necessary, to reflect any 
52.2 	updated federal projections or account for unanticipated changes in federal policy.
52.3 	(d) Medicare and long-term care spending must not be included in the calculations 
52.4 	required under this section.
52.5 		Subd. 2.Actual spending. (a) By June 1 of each year, beginning June 1, 2010, the 
52.6 	commissioner shall determine the actual private and public health care expenditures for the 
52.7 	calendar year preceding the current calendar year based on data collected under chapter 
52.8 	62J and shall determine the difference between the projected spending as determined 
52.9 	under subdivision 1 and the actual spending for that year. The actual spending must be 
52.10 	certified by an independent actuarial consultant. If the actual spending is less than the 
52.11 	projected spending, the commissioner shall determine an aggregate savings reinvestment 
52.12 	amount, not to exceed 33 percent of the difference. 
52.13 	(b) Based on this calculation, the commissioner shall determine annually a savings 
52.14 	reinvestment amount to be paid by health plan companies and third-party administrators. 
52.15 	The aggregate savings reinvestment amount may not exceed 33 percent of the aggregate 
52.16 	savings reflected in the difference between the actual spending and the projected spending.
52.17 		Subd. 3.Publication of spending. The commissioner shall publish in the State 
52.18 	Register by June 15 of each year, beginning June 15, 2010, the projected spending 
52.19 	baseline, including any adjustments, and the actual spending for the preceding year.
52.20 		Subd. 4.Savings reinvestment assessments. (a) Health plan companies and 
52.21 	third-party administrators shall pay a health savings reinvestment assessment. The 
52.22 	commissioner shall calculate the savings reinvestment assessments as follows:
52.23 	(1) for health plan companies, the health savings reinvestment assessment must be 
52.24 	based on a percentage of annual paid health care claims on policies that insure residents of 
52.25 	this state; and
52.26 	(2) for third-party administrators, the health savings reinvestment assessment must 
52.27 	be a fee placed on the third-party administrator for each insured resident of the state in 
52.28 	which the third-party administrator administered benefits for health care. 
52.29 	(b) A health plan company is not required to pay a health savings reinvestment 
52.30 	assessment on policies or contracts insuring federal employees or Medicare beneficiaries, 
52.31 	except private supplemental coverage.
52.32 	(c) Health savings reinvestment assessments apply to claims paid or administration 
52.33 	provided for plan years beginning on or after January 1, 2010.
52.34 	(d) Health savings reinvestment assessments must be paid quarterly to the 
52.35 	commissioner of revenue within 60 days after the close of each quarter, beginning no 
52.36 	later than May 30, 2010.
53.1 		Subd. 5.Credit of assessments. The commissioner of revenue shall credit the 
53.2 	revenue derived from the assessments to the health savings reinvestment fund established 
53.3 	under section 16A.727.

53.4 	Sec. 24. [62U.14] COST CONTAINMENT GOALS; CONTINGENT 
53.5 	EXPANSION TO MINNESOTA CARE.
53.6 		Subdivision 1.Cost containment goals. Based on the projected spending baseline 
53.7 	calculated under section 62U.13, subdivision 1, the following annual cost containment 
53.8 	goals for public and private spending on health care services for Minnesota residents 
53.9 	are established:
53.10 	(1) for calendar year 2009, the cost containment goal is the baseline projected 
53.11 	spending growth for 2009 established in section 62U.13 less one percentage point;
53.12 	(2) for calendar year 2010, the cost containment goal is the baseline projected 
53.13 	spending growth for 2010 less 1.5 percentage points;
53.14 	(3) for calendar years 2011 and 2012, the cost containment goal is the baseline 
53.15 	projected spending growth for 2011 and 2012 less two percentage points; and
53.16 	(4) for calendar years after 2012, the cost containment goal is the projected baseline 
53.17 	spending for 2013 less 2.5 percentage points.
53.18 		Subd. 2.Contingent expansion of MinnesotaCare. (a) By June 1, 2010, the 
53.19 	commissioner of health shall report to the commissioner of human services and the 
53.20 	legislature on whether the cost containment goal for 2009 was met. If the goal was met, 
53.21 	the commissioner of human services shall implement the eligibility expansion to the 
53.22 	MinnesotaCare program for individuals and families with children up to 300 percent of 
53.23 	federal poverty guidelines, to be effective July 1, 2010.
53.24 	(b) If the cost containment goal has not been met, the legislature shall consider an 
53.25 	eligibility expansion to the MinnesotaCare program based on available funding.
53.26 	(c) The commissioner of health shall submit a plan to the legislature by January 15, 
53.27 	2013, if the cost containment goals established in this section have been met and the 
53.28 	uninsured rate for Minnesota residents is greater than three percent. The plan must include 
53.29 	efforts that will increase coverage to at least 97 percent insured.

53.30 	Sec. 25. [62U.15] AFFORDABILITY STANDARD.
53.31 		Subdivision 1.Definition of affordability. For purposes of this section, coverage is 
53.32 	"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an 
53.33 	individual or family for health coverage does not exceed the applicable percentage of the 
53.34 	individual or family's gross monthly income specified in subdivision 2. For individuals 
54.1 	and families with pretax income, the determination of "affordability" for purposes of this 
54.2 	section shall compare the net cost of health coverage that includes pretax savings to the 
54.3 	applicable percentage of the individual's or family's gross monthly income.
54.4 		Subd. 2.Incomes up to 300 percent of the federal poverty guidelines. The 
54.5 	following affordability standard is established for individuals and households with gross 
54.6 	family incomes of 300 percent of the federal poverty guidelines or less:

54.7	AFFORDABILITY STANDARD

54.8
54.9		Federal Poverty 
Guideline Range
		Percent of Average Gross 
Monthly Income
		
54.10		0-33% 
			minimum
			
54.11		33-54%
			1.1%
			
54.12		55-81%
			1.4%
			
54.13		82-109%
			1.9%
			
54.14		110-136%
			2.6%
			
54.15		137-164%
			3.4%
			
54.16		165-191%
			4.4%
			
54.17		192-219%
			5.2%
			
54.18		220-248%
			5.9%
			
54.19		248-274%
			6.5%
			
54.20		275-300%
			7.0%
			
54.21 		Subd. 3.Incomes greater than 300 percent but not exceeding 400 percent of the 
54.22 	federal poverty guidelines. For purposes of determining affordability, the affordability 
54.23 	standard for individuals and households with gross family incomes greater than 300 
54.24 	percent but not exceeding 400 percent of the federal poverty guidelines shall be based 
54.25 	on a continuation of the sliding scale specified in subdivision 2, with the percentage of 
54.26 	average gross monthly income rising proportionately at each income range, to a maximum 
54.27 	of 10.0 percent.

54.28 	Sec. 26. [62U.16] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED 
54.29 	HEALTH COVERAGE PLAN.
54.30 		Subdivision 1.Establishment of subsidy program. The commissioner of human 
54.31 	services shall develop a plan for a subsidy program for eligible employees with access to 
54.32 	employer-subsidized health coverage. For purposes of this section, employer-subsidized 
54.33 	health coverage has the meaning provided in section 256L.07, subdivision 2, paragraph (c).
54.34 		Subd. 2.Eligible employees. In order to be eligible for a subsidy under this plan, 
54.35 	an employee must:
55.1 	(1) be covered by employer-subsidized health coverage that meets or is actuarially 
55.2 	equivalent to the benefit set and design established by the Health Care Transformation 
55.3 	Commission; and
55.4 	(2) meet all eligibility criteria for the MinnesotaCare program established under 
55.5 	chapter 256L, except for the requirements related to:
55.6 	(i) no access to employer-subsidized coverage under section 256L.07, subdivision 
55.7 	2; and
55.8 	(ii) no other health coverage under section 256L.07, subdivision 3.
55.9 		Subd. 3.Amount of subsidy. The subsidy in the plan shall equal the amount the 
55.10 	employee is required to pay for health coverage, including premiums, deductibles, and 
55.11 	other cost sharing, minus an amount based on the affordability standard specified in 
55.12 	section 62U.15. The maximum subsidy shall not exceed the amount of the subsidy that 
55.13 	would have been provided under the MinnesotaCare program, if the employee and any 
55.14 	dependents were eligible for that program.
55.15 		Subd. 4.Payment of subsidy. As part of the plan, the commissioner shall pay the 
55.16 	subsidy amount for an employee and any dependents to the employer, and this payment 
55.17 	shall be credited towards the employee's share of premium. 
55.18 		Subd. 5.Report. The commissioner shall submit the plan creating the subsidy 
55.19 	program to the legislature by January 15, 2009, for implementation by July 1, 2009.

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

55.21 	Sec. 27.  REPEALER.
 55.22 	Minnesota Statutes 2006, sections 62A.63; 62A.64; 62Q.49; 62Q.65; and 62Q.736,
55.23 	are repealed.

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

55.25 	ARTICLE 5 
55.26 	APPROPRIATIONS

55.27	Section 1. SUMMARY OF APPROPRIATIONS.
 	
55.28 	The amounts shown in this section summarize direct appropriations, by fund, made 
55.29 	in this article.

55.30					2009
		Total
	
55.31	General Fund
			$
	200,000
	$
	200,000
	
55.32	Health Care Access Fund
		39,113,000
		39,113,000
	
56.1	Health Improvement Fund
		20,000,000
		20,000,000
	
56.2	Total
			$
	59,313,000
	$
	59,313,000

								

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

56.11				APPROPRIATIONS
	
56.12				Available for the Year
	
56.13				Ending June 30
	
56.14							2009

56.15	Sec. 3. HUMAN SERVICES

56.16	Subdivision 1.Total Appropriation
 			$
	9,725,000

56.17	Appropriations by Fund
	
56.18			2009
	
56.19	General Fund
		200,000
	
56.20
56.21	Health Care Access 
Fund
		9,525,000

				

56.22 	The amounts that may be spent for each 
56.23 	purpose are specified in the following 
56.24 	subdivisions.

56.25
56.26	Subd. 2.Children and Economic Assistance 
Management

56.27	Health Care Access
		6,000
	
56.28 	This is a onetime appropriation.

56.29	Subd. 3.Basic Health Care Grants
 					
57.1 	The amounts that may be spent from the 
57.2 	appropriation for each purpose are as follows:

57.3	(a) MinnesotaCare Grants

57.4	Health Care Access
		4,435,000

57.5
57.6	Medical Assistance Basic Health Care Grants; 
Families and Children

57.7	General Fund
		200,000
	
57.8 	Primary Care Physician Rate Increases.
57.9 	(a) Of the general fund appropriation, 
57.10 	$200,000 is to the commissioner for the 
57.11 	medical assistance reimbursement rate 
57.12 	increase described in Minnesota Statutes, 
57.13 	section 256B.766. 
57.14 	(b) Notwithstanding Minnesota Statutes, 
57.15 	section 295.581, the commissioner of finance 
57.16 	shall reimburse the medical assistance 
57.17 	general fund account from the health 
57.18 	care access fund the amount of general 
57.19 	fund expenditures for this activity. The 
57.20 	amount reimbursed under this paragraph is 
57.21 	appropriated to the commissioner.

57.22	(c) Other Health Care Grants

57.23	Health Care Access
		850,000
	
57.24 	Mobile Dental Unit. (a) Of the health care 
57.25 	access fund appropriation, $500,000 is to be 
57.26 	awarded as a grant to a nonprofit organization 
57.27 	to operate a mobile dental unit within the 
57.28 	seven-county metropolitan area for treating 
57.29 	the dental needs of underserved children and 
57.30 	adults with a comprehensive approach of 
57.31 	education, treatment, and follow-up routine 
57.32 	visits. The organization must show viable 
57.33 	partnerships with the dental community, 
57.34 	community-based organizations, and local 
58.1 	school districts. The services provided by the 
58.2 	organization must include:
58.3 	(1) identifying and treating children with 
58.4 	untreated dental conditions at locations with 
58.5 	the community;
58.6 	(2) educating children and their families 
58.7 	about oral health diseases and the importance 
58.8 	and benefits of a preventive oral health care 
58.9 	program; and
58.10 	(3) connecting local dental health care 
58.11 	professionals and organizations with 
58.12 	underserved children for follow-up and 
58.13 	ongoing dental care services.
58.14 	(b) The organization must report to the 
58.15 	commissioner by January 15, 2010, the 
58.16 	number of children served by the mobile 
58.17 	unit, the services provided by the unit, the 
58.18 	locations where children were served, and if 
58.19 	follow-up services were provided.
58.20 	This is a onetime appropriation.
58.21 	Open Door Health Center. Of the health 
58.22 	care access fund appropriation, $350,000 is 
58.23 	to be awarded as a grant to the Open Door 
58.24 	Health Center to act as a bridge funding to 
58.25 	meet the demand for health care services 
58.26 	in medically underserved areas. This is a 
58.27 	onetime appropriation.
58.28 	Subsidies for Employer-Subsidized Health 
58.29 	Coverage. For the biennium beginning July 
58.30 	1, 2009, base level funding for the subsidy 
58.31 	program described in Minnesota Statutes, 
58.32 	section 62U.16, shall be $20,000,000 from 
58.33 	the health care access fund for the first year 
59.1 	and $35,000,000 from the health care access 
59.2 	fund for the second year.
59.3 	Base Adjustment. The health care access 
59.4 	fund base is increased by $19,150,000 
59.5 	in fiscal year 2010 and increased by 
59.6 	$34,150,000 in fiscal year 2011.

59.7	Subd. 4.Health Care Management
 					
59.8 	The amounts that may be spent from the 
59.9 	appropriation for each purpose are as follows:

59.10	(a) Health Care Policy Administration

59.11	Health Care Access
		182,000
	
59.12 	Base Adjustment. The health care access 
59.13 	fund is increased by $111,000 in fiscal year 
59.14 	2010 and decreased by $171,000 in fiscal 
59.15 	year 2011.
59.16 	Base Adjustment. The general fund base is 
59.17 	increased by $2,121,000 in fiscal year 2010 
59.18 	and increased by $1,792,000 in fiscal year 
59.19 	2011.

59.20	(b) Health Care Operations

59.21	Health Care Access
		3,248,000
	
59.22 	Incentive Program and Outreach Grants.
59.23 	Of the appropriation for the Minnesota health 
59.24 	care outreach program in Laws 2007, chapter 
59.25 	147, article 19, section 3, subdivision 7, 
59.26 	paragraph (b):
59.27 	(1) $400,000 in fiscal year 2009 from the 
59.28 	general fund and $200,000 in fiscal year 2009 
59.29 	from the  health care access fund are for the 
59.30 	incentive  program under Minnesota Statutes, 
59.31 	section  256.962, subdivision 5. For the 
59.32 	biennium  beginning July 1, 2009, base level 
59.33 	funding  for this activity shall be $360,000 
60.1 	from the  general fund and $160,000 from the 
60.2 	health  care access fund; and
60.3 	(2) $100,000 in fiscal year 2009 from the 
60.4 	general fund and $50,000 in fiscal year 2009 
60.5 	from the health care access fund are for the 
60.6 	outreach grants under Minnesota Statutes, 
60.7 	section 256.962, subdivision 2. For the 
60.8 	biennium beginning July 1, 2009, base level 
60.9 	funding for this activity shall be $90,000 
60.10 	from the general fund and $40,000 from the 
60.11 	health  care access fund.
60.12 	Outreach Funding. (a) Of the health care 
60.13 	access fund appropriation, $100,000 is for 
60.14 	the incentive program under Minnesota 
60.15 	Statutes, section 256.962, subdivision 5. 
60.16 	This is in addition to the base level fund 
60.17 	for the biennium beginning July 1, 2009. 
60.18 	For the fiscal year beginning July 1, 2011, 
60.19 	appropriations for this activity shall be from 
60.20 	the health savings reinvestment fund.
60.21 	(b) Notwithstanding Minnesota Statutes, 
60.22 	section 295.581, the commissioner of finance 
60.23 	shall reimburse the medical assistance 
60.24 	general fund account from the health care 
60.25 	access fund by $701,000 in fiscal year 2010 
60.26 	and $1,527,000 in fiscal year 2011 for the 
60.27 	cost to the general fund for the increase in 
60.28 	enrollment to the medical assistance program 
60.29 	for families with children due to the outreach 
60.30 	efforts.
60.31 	Base Adjustment. The health care access 
60.32 	fund base is decreased by $979,000 in fiscal 
60.33 	year 2010 and increased by $556,000 in 
60.34 	fiscal year 2011.

60.35	Subd. 5. Continuing Care Management

61.1	Health Care Access
		804,000
	
61.2 	Long-Term Care Worker Health Coverage 
61.3 	Study. (a) Of the health care access 
61.4 	fund appropriation, $804,000 is for the 
61.5 	commissioner to study and report to the 
61.6 	legislature by December 15, 2008, with 
61.7 	recommendations for a rate increase to 
61.8 	long-term care employers dedicated to the 
61.9 	purchase of employee health insurance in 
61.10 	the private market. The commissioner shall 
61.11 	collect necessary actuarial data, employment 
61.12 	data, current coverage data, and other needed 
61.13 	information.
61.14 	(b) The commissioner shall develop cost 
61.15 	estimates for three levels of insurance 
61.16 	coverage for long-term care workers:
61.17 	(1) the coverage provided to state employees;
61.18 	(2) the coverage provided to MinnesotaCare 
61.19 	enrollees; and
61.20 	(3) the benefits provided under an "average" 
61.21 	private market insurance product, but with a 
61.22 	deductible limited to $100 per person.
61.23 	Premium cost sharing, waiting periods for 
61.24 	eligibility, definitions of full- and part-time 
61.25 	employment, and other parameters under the 
61.26 	three options must be identical to those under 
61.27 	the state employees' health plan.
61.28 	(c) For purposes of this section, a long-term 
61.29 	care worker is a person employed by a 
61.30 	nursing facility, an intermediate care facility 
61.31 	for persons with developmental disabilities, 
61.32 	or a service provider that:
61.33 	(1) is eligible under Laws 2007, chapter 147, 
61.34 	article 7, section 71; and 
62.1 	(2) provides long-term care services.
62.2 	The commissioner may recommend a 
62.3 	different definition of long-term care worker 
62.4 	if this definition presents insurmountable 
62.5 	implementation issues.
62.6 	(d) The recommendations must include 
62.7 	measures to:
62.8 	(1) ensure equitable treatment between 
62.9 	employers that currently have different levels 
62.10 	of expenditure for employee health insurance 
62.11 	costs; and
62.12 	(2) enforce the requirement that the rate 
62.13 	increase be expended for the intended 
62.14 	purpose.
62.15 	This is a onetime appropriation.

62.16	Sec. 4. COMMISSIONER OF HEALTH

62.17	Subdivision 1.Total Appropriation
 			$
	49,588,000

62.18	Appropriations by Fund
	
62.19			2009
	
62.20	Health Care Access 
		21,588,000
	
62.21	Health Improvement 
		20,000,000
	
62.22 	The amounts that may be spent for each 
62.23 	purpose are specified in the following 
62.24 	subdivisions.

62.25
62.26	Subd. 2.Community and Family Health 
Promotion

62.27	Health Improvement
		20,000,000
	
62.28 	Statewide Health Improvement Program.
62.29 	This appropriation is for the statewide 
62.30 	health improvement program under 
62.31 	Minnesota Statutes, section 145.986. Of 
62.32 	this appropriation, $18,600,000 is for 
62.33 	grants to local communities in accordance 
62.34 	with Minnesota Statutes, section 145.986, 
63.1 	subdivision 2. The base level funding for the 
63.2 	statewide health improvement program shall 
63.3 	be $40,000,000 in fiscal year 2010.

63.4	Subd. 3.Policy, Quality, and Compliance

63.5	Health Care Access
		29,588,000
	
63.6 	Dental Loan Forgiveness and Scholarship 
63.7 	Program. Of the health care access fund 
63.8 	appropriation, $400,000 is for the dental 
63.9 	loan forgiveness and scholarship program 
63.10 	described in Minnesota Statutes, section 
63.11 	144.1501.
63.12 	Federally Qualified Health Centers. Of 
63.13 	the health care access fund appropriation, 
63.14 	$4,000,000 is for subsidies to federally 
63.15 	qualified health centers under Minnesota 
63.16 	Statutes, section 145.9269. This amount 
63.17 	shall be added to the base level funding.
63.18 	Health Care Transformation Commission.
63.19 	Of the health care access fund appropriation, 
63.20 	$12,000,000 is for the operation of the Health 
63.21 	Care Transformation Commission. This is a 
63.22 	onetime appropriation and is available until 
63.23 	expended.
63.24 	Electronic Health Records Grants. Of 
63.25 	the health care access fund appropriation, 
63.26 	$1,962,000 is for the electronic health 
63.27 	records grant program in Minnesota Statutes, 
63.28 	section 144.3345. Base level funding for this 
63.29 	activity shall be $3,673,000 in fiscal year 
63.30 	2010 and $3,673,000 in fiscal year 2011. The 
63.31 	appropriation for this activity expires after 
63.32 	the fiscal year 2011 appropriation.
63.33 	Electronic Health Records Revolving 
63.34 	Account and Loan. Of the health care 
64.1 	access fund appropriation, $2,000,000 is for 
64.2 	the electronic health record system revolving 
64.3 	account and loan program in Minnesota 
64.4 	Statutes, section 62J.496. Base level funding 
64.5 	for this activity shall be $3,750,000 in fiscal 
64.6 	year 2010 and $3,750,000 in fiscal year 2011. 
64.7 	The appropriation for this activity expires 
64.8 	after the fiscal year 2011 appropriation.

64.9 	Sec. 5. ADMINISTRATIVE ACTIVITIES FOR THE SAVINGS 
64.10 	REINVESTMENT ASSESSMENT.
 64.11 	$302,000 is appropriated from the health savings investment fund in fiscal year 2010 
64.12 	to the commissioner of health for administrative activities of the health reinvestment 
64.13 	assessment under Minnesota Statutes, section 62U.13. This is a onetime appropriation.

64.14 	Sec. 6. TRANSFERS.
 64.15 	(a) After the transfer to the general fund in accordance with Minnesota Statutes, 
64.16 	section 16A.727, to the extent there are remaining funds in the health savings reinvestment 
64.17 	fund, the commissioner of finance shall transfer to the general fund $2,121,000 in fiscal 
64.18 	year 2010 to be appropriated to the commissioner of human services for the health care 
64.19 	homes under Minnesota Statutes, sections 256B.0751 to 256B.0754.
64.20 	(b) To the extent funds are remaining in the health savings reinvestment fund after 
64.21 	the transfer described in paragraph (a), the commissioner of finance shall transfer to the 
64.22 	general fund $1,250,000 in fiscal year 2010 to be appropriated in equal amounts to: 
64.23 	(1) to the Board of Regents of the Univerity of Minnesota to increase the number 
64.24 	of primary care physicians who practice in underserved communities in the state and the 
64.25 	number of primary care physician slots in residency programs in the state;
64.26 	(2) to the Mayo Medical Foundation for medical school initiatives to increase the 
64.27 	number of primary care physicians who practice in underserved communities in the state 
64.28 	and the number of primary care physician slots in residency programs in the state;
64.29 	(3) to the Office of Higher Education to increase the number of primary care 
64.30 	physicians who practice in underserved communities in the state and the number of 
64.31 	primary care physician slots in residency programs in the state;
64.32 	(4) to the Duluth Graduate Medical Education Council, Inc. for medical school 
64.33 	initiatives to increase the number of primary care physician slots in residency programs in 
64.34 	the state;
65.1 	(5) to the Office of Higher Education to provide grants to schools of nursing in 
65.2 	Minnesota to increase the number of graduates of advanced practice registered nurse 
65.3 	programs;
65.4 	(6) to the Board of Regents of the University of Minnesota to address faculty 
65.5 	shortages in primary care medicine;
65.6 	(7) to the Mayo Medical Foundation to address faculty shortages in primary care 
65.7 	medicine; and
65.8 	(8) to the Office of Higher Education to provide grants to schools of nursing in 
65.9 	Minnesota to address faculty shortages.
65.10 	(c) To the extent funds are remaining in the health savings reinvestment fund after 
65.11 	the transfers described in paragraphs (a) and (b), the commissioner of finance shall transfer 
65.12 	to the health care access fund an amount sufficient to cover any structural deficit in the 
65.13 	health care access fund, beginning in fiscal year 2011.

65.14 	Sec. 7. HEALTH INSURANCE ACCESS BROKER FEES.
 65.15 	All fees received by the commissioner of commerce under Minnesota Statutes, 
65.16 	section 62U.02, and deposited in the state government special revenue fund are 
65.17 	appropriated to the commissioner of commerce for the purpose of implementing 
65.18 	Minnesota Statutes, section 62U.02.

65.19 	Sec. 8. SUNSET OF UNCODIFIED LANGUAGE.
 65.20 	All uncodified language contained in this article expires on June 30, 2009, unless a 
65.21 	different expiration date is specified.

65.22 	Sec. 9. EFFECTIVE DATE.
 65.23 	The provisions in this article are effective July 1, 2008, unless a different effective 
65.24 	date is specified.