HF 481

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; establishing the Minnesota
Universal Health Board; creating the Minnesota
universal health program; establishing the Minnesota
health care trust fund; establishing statewide and
regional health care budgets; eliminating requirement
to establish public health goals; appropriating money;
amending Minnesota Statutes 2004, section 145A.12,
subdivision 7; proposing coding for new law in
Minnesota Statutes, chapter 62J; proposing coding for
new law as Minnesota Statutes, chapter 62K; repealing
Minnesota Statutes 2004, section 62J.212.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

PURPOSE

Section 1. new text begin PURPOSE.
new text end

new text begin The Minnesota Universal Health Board is created for the
purpose of providing a single, publicly financed, statewide
program to provide comprehensive coverage for all necessary
health care services for residents of Minnesota.
new text end

ARTICLE 2

REGIONAL BOARDS

Section 1.

new text begin [62J.091] REGIONAL BOARDS.
new text end

new text begin Subdivision 1. new text end

new text begin General duties. new text end

new text begin (a) The commissioner
shall divide the state into six regions, one of these regions
being the seven-county metropolitan area.
new text end

new text begin (b) Each region shall establish a regional board consisting
of consumers according to subdivision 2. Regional boards may:
new text end

new text begin (1) undertake voluntary activities to educate consumers and
providers about community plans and projects promoting health
care cost containment, consumer accountability, access, and
new text end
quality and about efforts to achieve public health goals;

new text begin (2) make recommendations to the commissioner regarding ways
of improving affordability, accessibility, and quality of health
care in the region and throughout the state;
new text end

new text begin (3) advise the Minnesota Universal Health Board on public
health goals, taking into consideration the relevant portions of
the community health service plans, plans required by the
Minnesota Comprehensive Adult Mental Health Act, the Minnesota
Comprehensive Children's Mental Health Act, and the Community
Social Service Act plans developed by county boards or community
health boards in the region under chapters 145A, 245, and 256E;
new text end

new text begin (4) prepare an annual regional education plan that is
consistent with and supportive of public health goals identified
by community health boards in the region; and
new text end

new text begin (5) serve as advisory bodies to identify potential
applicants for federal health professional shortage area and
federal medically underserved area designation as requested by
the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Membership; terms. new text end

new text begin (a) Each regional board
shall consist of one member per county as provided in this
subdivision and three members per county in the seven-county
metropolitan area. A member may designate a representative to
act as a member of the board in the member's absence. The board
shall appoint the chair of each regional board from among its
members.
new text end

new text begin (b) A member of a regional board must be a consumer who:
new text end

new text begin (1) does not have and in the past did not have a material
interest in the provision of health care services or in an
activity directly related to the provision of health care
services, such as health insurance sales or health plan
administration;
new text end

new text begin (2) is not responsible for or directly involved in the
purchasing of health insurance for a business or organization;
new text end

new text begin (3) is not a registered lobbyist in this state; and
new text end

new text begin (4) is at least 18 years of age and a resident of Minnesota.
new text end

new text begin (c) An individual must apply to the board of the county in
which the individual resides to become a member of a regional
board. A county board shall elect its regional board member or
members from among eligible applicants. Prior to electing a
regional board member, a county board must hold public hearings
with all eligible applicants, to include a statement by each
applicant and an opportunity for questioning by the county
commissioners.
new text end

new text begin (d) The terms of the members are four years. The chair of
each regional board shall designate as nearly as possible
one-fourth of the members to terms expiring each year.
new text end

Sec. 2.

new text begin [62J.10] REGIONAL BOARD DUTIES.
new text end

new text begin (a) Each regional board shall submit a recommended regional
budget to the commissioner by July 1, 2006. Beginning July 1,
2006, and each July 1 thereafter, each regional board shall
submit the recommended regional budget to the Minnesota
Universal Health Board established under chapter 62K.
new text end

new text begin (b) Each regional budget must include the following:
new text end

new text begin (1) a budget for health maintenance organizations and for
each health plan network based on an estimated number of
patients and an estimated per capita cost;
new text end

new text begin (2) fee schedules for individual providers;
new text end

new text begin (3) a budget for institutional providers; and
new text end

new text begin (4) budgets for the expected cost of patients treated in
the region.
new text end

new text begin (c) Before the proposed regional budget is submitted to
either the commissioner or the Minnesota Universal Health Board,
a regional board shall hold a hearing or hearings after
providing public notice.
new text end

new text begin (d) A regional board shall utilize, when circumstances
warrant, task forces that address specific concerns, such as
regional issues or needs, concerns of specific communities or
constituencies, or public health concerns. Membership of a task
force shall include consumers who are not members of the
regional board.
new text end

Sec. 3.

new text begin [62J.12] BUDGET IMPLEMENTATION SCHEDULE.
new text end

new text begin Subdivision 1. new text end

new text begin Calendar year 2007 budgets. new text end

new text begin In carrying
out the duties required under section 62J.10, the following
schedule shall be followed by the commissioner and regional
boards:
new text end

new text begin (1) by July 1, 2006, each regional board shall submit to
the commissioner a recommended regional budget for health care
spending consisting of budgets for each of the accounts
specified in section 62K.09; and
new text end

new text begin (2) by November 1, 2006, the commissioner shall adopt
statewide and regional budgets for each of the accounts
specified in section 62K.09. The budgets must also include fee
schedules for individual providers and budgets for institutional
providers to take effect January 1, 2007.
new text end

new text begin Subd. 2. new text end

new text begin 2008 and future years. new text end

new text begin The implementation
schedule for 2008 must be identical to the 2007 schedule except
that regional boards shall submit budgets to the Minnesota
Universal Health Board, not the commissioner of health. The
implementation schedule for 2009 and all future years shall be
identical to the 2008 schedule except that the Minnesota
Universal Health Board, not the commissioner of health, shall
propose statewide and regional budgets by January 1, 2008.
new text end

new text begin Subd. 3. new text end

new text begin Report. new text end

new text begin The Minnesota Universal Health Board
shall recommend in the annual report due January 1, 2008,
whether budgets should be set annually or biennially.
new text end

Sec. 4. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 3 are effective January 1, 2006.
new text end

ARTICLE 3

MINNESOTA UNIVERSAL HEALTH BOARD

Section 1.

new text begin [62K.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin For purposes of this chapter, the
following terms have the meanings given them.
new text end

new text begin Subd. 2. new text end

new text begin Board. new text end

new text begin "Board" means the Minnesota Universal
Health Board established under section 62K.02.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the
commissioner of health.
new text end

new text begin Subd. 4. new text end

new text begin Department. new text end

new text begin "Department" means the Department
of Health.
new text end

new text begin Subd. 5. new text end

new text begin Freestanding outpatient facility. new text end

new text begin "Freestanding
outpatient facility" means a health care facility, including,
but not limited to, an outpatient surgical center, a diagnostic
imaging facility, or a physician clinic, that is not physically
attached to a hospital and that provides for the care of human
beings.
new text end

new text begin Subd. 6. new text end

new text begin Health plan company. new text end

new text begin "Health plan company" has
the meaning given under section 62Q.01, subdivision 4.
new text end

new text begin Subd. 7. new text end

new text begin Individual provider. new text end

new text begin "Individual provider"
means a health care provider licensed or registered by the state
who is not an institutional provider.
new text end

new text begin Subd. 8. new text end

new text begin Institutional provider. new text end

new text begin "Institutional
provider" means an inpatient hospital, nursing facility,
intermediate care facility for persons with mental retardation
and related conditions, and other providers of inpatient
services, including institutions providing inpatient or
overnight care and ambulatory diagnostic, treatment, and
surgical facilities.
new text end

new text begin Subd. 9. new text end

new text begin Medically necessary. new text end

new text begin "Medically necessary"
means a health service that is consistent with the recipient's
diagnosis or condition, recognized as the prevailing standard or
current practice by the provider's peer group, and:
new text end

new text begin (1) rendered to:
new text end

new text begin (i) treat an injury, illness, infection, or pain;
new text end

new text begin (ii) treat a condition that could result in physical or
mental disability;
new text end

new text begin (iii) care for a mother and child through a maternity
period; or
new text end

new text begin (iv) achieve a level of physical or mental function
consistent with prevailing community standards for the diagnosis
or condition; or
new text end

new text begin (2) a preventive health service.
new text end

new text begin Subd. 10. new text end

new text begin Program. new text end

new text begin "Program" means the Minnesota
universal health program established under this chapter and
administered by the Minnesota Universal Health Board.
new text end

Sec. 2.

new text begin [62K.02] MINNESOTA UNIVERSAL HEALTH BOARD.
new text end

new text begin Subdivision 1. new text end

new text begin Eligibility. new text end

new text begin A member of the Minnesota
Universal Health Board must be a consumer who:
new text end

new text begin (1) does not have and in the past did not have a material
interest in the provision of health care services or in any
activity directly related to the provision of health care
services, such as health insurance sales or health plan
administration;
new text end

new text begin (2) is not responsible for or directly involved in the
purchasing of health insurance for a business or organization;
and
new text end

new text begin (3) is not a registered lobbyist in this state.
new text end

new text begin Subd. 2. new text end

new text begin Composition. new text end

new text begin (a) The Minnesota Universal Health
Board shall consist of 12 members selected as follows:
new text end

new text begin (1) the chairs of each of the six regional boards
established under section 62J.091, or their designees;
new text end

new text begin (2) two persons appointed by the governor;
new text end

new text begin (3) two persons appointed by the chair of the senate
committee having jurisdiction over health policy; and
new text end

new text begin (4) two persons appointed by the chair of the house
committee having jurisdiction over health policy.
new text end

new text begin (b) The appointing authorities shall coordinate their
efforts to ensure that the board composition reflects the racial
and ethnic diversity of the state and provides representation
for persons with disabilities.
new text end

new text begin Subd. 3. new text end

new text begin Terms; compensation; removal; vacancies. new text end

new text begin The
board is governed by section 15.0575, except that board members
shall receive salaries rather than per diems.
new text end

new text begin Subd. 4. new text end

new text begin Administration. new text end

new text begin The commissioner shall provide
office space, equipment and supplies, and technical support to
the board.
new text end

new text begin Subd. 5. new text end

new text begin Staff. new text end

new text begin The board may hire an executive director
who serves in the unclassified service. The executive director
may hire employees and consultants as authorized by the board
and may prescribe their duties. The attorney general shall
provide legal services to the board.
new text end

new text begin Subd. 6. new text end

new text begin General duties. new text end

new text begin The board may:
new text end

new text begin (1) implement and administer the Minnesota universal health
program;
new text end

new text begin (2) estimate the current cost of universal coverage for all
Minnesotans;
new text end

new text begin (3) establish statewide and regional budgets that include
budgets for the accounts specified in section 62K.09;
new text end

new text begin (4) approve budgets for each region, including budgets for
the accounts specified in section 62K.09;
new text end

new text begin (5) establish fee schedules, which may vary to reflect
regional differences;
new text end

new text begin (6) approve budgets for institutional providers;
new text end

new text begin (7) approve capital expenditures for freestanding
outpatient facilities;
new text end

new text begin (8) monitor compliance with all budgets and fee schedules
and take action to achieve compliance to the extent authorized
by law;
new text end

new text begin (9) issue requests for proposals for a contract to process
claims submitted by individual providers;
new text end

new text begin (10) provide technical assistance to the regional boards
established under section 62J.091;
new text end

new text begin (11) administer the Minnesota health care trust fund
created under section 62K.07;
new text end

new text begin (12) monitor the operation of the Minnesota universal
health program through consumer surveys and regular data
collection and evaluation activities, including evaluations of
the adequacy and quality of services furnished under the
program, the need for changes in the benefit package, the cost
of each type of service, and the effectiveness of cost
containment measures under the program;
new text end

new text begin (13) develop and implement enrollment procedures for
providers and persons eligible for the program and disseminate,
to providers of services and to the public, information
concerning the program and the persons eligible to receive
benefits under the program;
new text end

new text begin (14) develop and implement cost containment and quality
assurance procedures, including a professional peer review
system;
new text end

new text begin (15) conduct necessary investigations and inquiries and
require the submission of information, documents, and records
the board considers necessary to carry out its duties under this
chapter; and
new text end

new text begin (16) conduct other activities the board considers necessary
to carry out the purposes of this chapter.
new text end

new text begin Subd. 7. new text end

new text begin Annual report. new text end

new text begin The board shall present an
annual report to the legislature and the governor by January 1,
2007, and each succeeding January, summarizing the activities of
the board. In the report due January 1, 2008, the board shall
recommend whether statewide and regional budgets should be set
annually or biennially.
new text end

new text begin Subd. 8. new text end

new text begin Rulemaking. new text end

new text begin The board may adopt rules as
necessary to carry out the duties assigned under this chapter.
new text end

new text begin Subd. 9. new text end

new text begin Hearings. new text end

new text begin The board, after providing notice to
consumers, providers, and all other interested parties, may hold
hearings in connection with any action that it proposes to take
under subdivision 6.
new text end

Sec. 3.

new text begin [62K.05] MINNESOTA UNIVERSAL HEALTH PROGRAM
IMPLEMENTATION SCHEDULE.
new text end

new text begin (a) The board, through the commissioner, shall begin
planning and development for the Minnesota universal health
program. The board shall use an implementation schedule that
will phase in enrollment for Minnesota residents, with initial
enrollment of eligible individuals and families beginning July
1, 2007. All Minnesota residents without health insurance shall
be insured by January 1, 2008. The health insurance that covers
all Minnesota residents shall be consolidated into the Minnesota
universal health program by January 1, 2009.
new text end

new text begin (b) In carrying out planning and development activities,
the board shall:
new text end

new text begin (1) begin initial enrollment of uninsured and underinsured
individuals and families with annual incomes of less than 275
percent of the federal poverty guidelines who do not have
duplicative coverage through a federal, state, or private
insurance program or plan by July 1, 2008;
new text end

new text begin (2) provide Medicare supplemental insurance by July 1,
2008, to Medicare enrollees with annual incomes of less than 275
percent of the federal poverty guidelines;
new text end

new text begin (3) enroll individuals and families with incomes at or
above 275 percent of the federal poverty guidelines and
individuals and families with incomes below 275 percent of the
federal poverty guidelines not eligible for enrollment under
clause (1) beginning January 1, 2009;
new text end

new text begin (4) provide Medicare supplemental insurance to Medicare
enrollees not eligible for enrollment under clause (2) beginning
January 1, 2009;
new text end

new text begin (5) merge the Minnesota universal health program, the
MinnesotaCare program, the general assistance medical care
program, and the services for children with handicaps program by
July 1, 2009, in a way that will not diminish the coverage
provided to participants in existing programs and without
increasing the financial obligations of public hospitals and
other providers that currently serve participants in these
programs;
new text end

new text begin (6) assume responsibility for the administration and
funding of appropriate components of maternal and child health
services currently administered by the commissioner and
coordinate outreach, patient education, case management, and
related activities with the maternal and child health program,
local public health departments, and nonprofit agencies by July
1, 2009;
new text end

new text begin (7) merge the consolidated chemical dependency treatment
fund with the Minnesota universal health program by July 1,
2009;
new text end

new text begin (8) phase out the Minnesota Comprehensive Health
Association by July 1, 2009, in a way that will ensure that
Minnesota Comprehensive Health Association enrollees receive
comparable coverage through the Minnesota universal health
program;
new text end

new text begin (9) beginning January 1, 2009, prohibit health plan
companies from selling insurance that duplicates benefits
provided by the Minnesota universal health program, in a manner
that ensures continuity of coverage through the program as
duplicate coverage in the private market is prohibited;
new text end

new text begin (10) seek federal waivers in order to phase Medicare and
medical assistance recipients into the program by a target date
of January 1, 2009; and
new text end

new text begin (11) phase retirees with retiree health benefits into the
program by January 1, 2009.
new text end

Sec. 4.

new text begin [62K.07] MINNESOTA HEALTH CARE TRUST FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Minnesota health care
trust fund is established. The fund shall consist of all money
obtained from general fund appropriations; state savings
resulting from state health program consolidation; federal
payments received as a result of any waiver or requirements
granted by the United States Secretary of Health and Human
Services under health care programs established under titles 18
and 19 of the Social Security Act, United States Code, title 42,
section 301; and any other money received by the board. The
budgets of Minnesota state agencies shall remain distinct from
the Minnesota health care trust fund, except for portions of
those budgets that provide health care services that are
provided to all Minnesotans through the Minnesota universal
health program.
new text end

new text begin Subd. 2. new text end

new text begin Reserves. new text end

new text begin Beginning July 1, 2007, the amount of
reserves in the fund at any time must equal at least the amount
of expenditures from the fund during the entire three preceding
months.
new text end

Sec. 5.

new text begin [62K.09] ACCOUNTS WITHIN MINNESOTA HEALTH CARE
TRUST FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Prevention account. new text end

new text begin The prevention
account is created within the Minnesota health care trust fund.
Money in the account shall be used solely to establish and
maintain primary community prevention programs, including
preventive screening tests.
new text end

new text begin Subd. 2. new text end

new text begin Health services account. new text end

new text begin The health services
account is created within the Minnesota health care trust fund.
Money in the account shall be used solely to pay providers in
accordance with section 62K.19.
new text end

new text begin Subd. 3. new text end

new text begin Capital account. new text end

new text begin The capital account is created
within the Minnesota health care trust fund. Money in the
account shall be used solely to:
new text end

new text begin (1) pay for the construction, renovation, and equipping of
health care institutions, including institutions providing
inpatient or overnight care and ambulatory diagnostic,
treatment, and surgical facilities; and
new text end

new text begin (2) provide health professionals serving in health care
shortage areas with assistance in repaying educational loans and
establishing medical practices.
new text end

new text begin Subd. 4. new text end

new text begin Interpretation, communication, and
transportation account. new text end

new text begin (a) The interpretation, communication,
and transportation account is created within the Minnesota
health care trust fund. Money in the account shall be used to
fund:
new text end

new text begin (1) interpreter services;
new text end

new text begin (2) communication and cooperation improvement efforts; and
new text end

new text begin (3) transportation projects to provide access for patients
unable to reach necessary services, including projects that
provide services at the residences of patients unable to travel.
new text end

new text begin (b) Money may be used to fund public education programs and
programs that encourage cooperation between institutions funded
on an annual basis that lead to more efficient and effective use
of health care resources. All expenditures must comply with
rules approved by the board.
new text end

new text begin Subd. 5. new text end

new text begin Program administration, evaluation, planning,
and assessment account. new text end

new text begin The program administration, evaluation,
planning, and assessment account is created within the Minnesota
health care trust fund. Money in the account shall be used by
the board to monitor and improve the plan's effectiveness and
operations. The board may establish grant programs, including
demonstration projects, for this purpose.
new text end

new text begin Subd. 6. new text end

new text begin Medical research account. new text end

new text begin The medical research
account is created within the Minnesota health care trust fund.
Money in the account shall be used by the board to establish a
health care analysis unit. The results of the unit's research
shall be used by the board to improve the quality of health care
provided under the Minnesota universal health program and to
make decisions about health benefits covered by the program.
The board may also establish grant programs, including
demonstration projects, for this purpose. The board shall seek
federal and private funds to supplement this allocation.
new text end

Sec. 6.

new text begin [62K.11] ELIGIBILITY.
new text end

new text begin Subdivision 1. new text end

new text begin Citizenship; migrant workers. new text end

new text begin (a)
Eligibility for coverage under the Minnesota universal health
program is limited to citizens of the United States and aliens
lawfully admitted for permanent residence or otherwise
permanently residing in the United States under the color of law.
new text end

new text begin (b) Payment shall also be made for care and services that
are furnished to an alien, regardless of immigration status, if
the care and services are necessary for the treatment of an
emergency medical condition, except for organ transplants and
related care and services. For purposes of this subdivision,
the term "emergency medical condition" means a medical
condition, including labor and delivery, that if not immediately
treated could cause a person physical or mental disability,
continuation of severe pain, or death.
new text end

new text begin Subd. 2. new text end

new text begin Residents receiving care out of state. new text end

new text begin The
board may provide payment for out-of-state care provided to
Minnesota residents. In determining whether payment is to be
made, the board shall determine the appropriateness of the care
provided, the availability of the service in Minnesota, and the
individual's medical condition and personal circumstances. For
travel less than six months in length, the board shall establish
guidelines for covering services.
new text end

new text begin Subd. 3. new text end

new text begin Nonresidents employed in minnesota. new text end

new text begin The board
may extend eligibility to nonresidents employed in Minnesota
using a sliding fee scale.
new text end

new text begin Subd. 4. new text end

new text begin Nonresidents emergency care. new text end

new text begin Nonresidents in
need of emergency services while in Minnesota shall be given
care and billed for the services provided.
new text end

Sec. 7.

new text begin [62K.13] BENEFITS.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin Every Minnesota resident
enrolled in the program is entitled to receive benefits for any
service covered under subdivision 2 that is medically necessary
to maintain the person's health, or necessary for the diagnosis
or treatment of, or rehabilitation following, an injury,
disability, or disease. Services provided in Minnesota must be
provided by a health care provider who participates in the
program.
new text end

new text begin Subd. 2. new text end

new text begin Covered services; general. new text end

new text begin The program covers
the following services:
new text end

new text begin (1) acute health care;
new text end

new text begin (2) chronic health care;
new text end

new text begin (3) rehabilitative health care;
new text end

new text begin (4) preventive health services;
new text end

new text begin (5) outpatient health services;
new text end

new text begin (6) laboratory and x-ray services;
new text end

new text begin (7) home care and home health care support services;
new text end

new text begin (8) dental care;
new text end

new text begin (9) chiropractic care;
new text end

new text begin (10) inpatient and outpatient mental health care, including
care for serious and persistent mental illness;
new text end

new text begin (11) inpatient and outpatient chemical dependency
treatment;
new text end

new text begin (12) family planning services;
new text end

new text begin (13) medically necessary cosmetic surgery and
reconstructive surgery;
new text end

new text begin (14) public health services formerly provided through state
and local government;
new text end

new text begin (15) on or after January 1, 2010, long-term care; and
new text end

new text begin (16) other medically necessary services.
new text end

new text begin Subd. 3. new text end

new text begin Covered services; pharmaceuticals and supplies.
new text end

new text begin The program covers all pharmaceuticals and medical supplies
prescribed by a licensed practitioner, including prescription
drugs, pharmaceuticals and supplies for eye care, hearing aids,
orthopedic aids, home aids, and durable medical equipment.
new text end

new text begin Subd. 4. new text end

new text begin Covered services; type of practitioner. new text end

new text begin The
program covers medically necessary and appropriate services
provided by all licensed or registered health care
practitioners, as long as the services are within the scope of
practice and meet standards of quality assurance established by
the board. Covered practitioners include, but are not limited
to, medical doctors, doctors of chiropractic, osteopathic
doctors, nurses, nurse practitioners, physician assistants,
dentists, optometrists, pharmacists, mental health providers,
chemical dependency counselors, certified nurse midwives,
nutritionists, practitioners of complementary and alternative
medicine, and physical therapists.
new text end

new text begin Subd. 5. new text end

new text begin Covered services; site of care. new text end

new text begin The program
covers care provided in all settings approved by the board.
new text end

new text begin Subd. 6. new text end

new text begin Services not covered. new text end

new text begin The following services
are not covered:
new text end

new text begin (1) services that are not medically necessary;
new text end

new text begin (2) surgery for cosmetic purposes; and
new text end

new text begin (3) medical examinations conducted and medical reports
prepared for purchasing or renewing life insurance or
participating as a plaintiff or defendant in a civil action for
the recovery or settlement of damages.
new text end

new text begin Subd. 7. new text end

new text begin Benefits advisory committee; changes in covered
services. new text end

new text begin (a) The board shall establish a benefits advisory
committee comprised of consumers, health care providers, experts
in medical ethics, and health science researchers to provide
recommendations regarding program benefits and limitations on
covered services. The board shall ensure that the composition
of the committee reflects the racial and ethnic diversity of the
state and provides representation for persons with disabilities.
Persons serving on the committee are compensated as provided in
section 15.0575.
new text end

new text begin (b) The board may make changes in program benefits or place
limitations on covered services only after public hearing.
new text end

new text begin Subd. 8. new text end

new text begin Choice of providers. new text end

new text begin An eligible person may
choose any provider licensed or registered in Minnesota, or an
alternative provider if referred by a licensed Minnesota
provider, including practitioners practicing on an independent
basis, in group practices, or in health maintenance
organizations.
new text end

Sec. 8.

new text begin [62K.15] DUPLICATE COVERAGE PROHIBITED.
new text end

new text begin Policies, plans, or contracts of health coverage issued,
sold, or renewed by health plan companies on or after January 1,
2009, must not offer benefits that duplicate coverage offered
under the Minnesota universal health program. A policy, plan,
or contract may offer benefits that do not duplicate coverage
that is offered by the program.
new text end

Sec. 9.

new text begin [62K.17] PROVIDER RESPONSIBILITIES.
new text end

new text begin Subdivision 1. new text end

new text begin Provider participation. new text end

new text begin All licensed
providers shall be considered participants in the program unless
and until the provider notifies the board of a change in status.
Providers shall not bill patients for services covered under the
Minnesota universal health program. The board shall provide
providers with notice of these requirements and adopt rules
necessary to allow for changes in provider status.
new text end

new text begin Subd. 2. new text end

new text begin Nondiscrimination. new text end

new text begin Participating providers
shall furnish services to all eligible persons, regardless of
race, color, income level, national origin, religion, sex,
sexual orientation, or other nonmedical criteria.
new text end

new text begin Subd. 3. new text end

new text begin Provision of information. new text end

new text begin Upon the request of
the board, every provider shall furnish information that may
reasonably be required by the board to ensure or enhance
quality, reduce costs, eliminate fraud, estimate health care
spending, and set budgets. A provider shall permit the board to
examine its records as necessary for verification of payment.
new text end

Sec. 10.

new text begin [62K.19] PROVIDER REIMBURSEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Institutional providers. new text end

new text begin (a) The
Minnesota universal health program shall pay the expenses of
institutional providers on the basis of annual budgets that are
approved by the board.
new text end

new text begin (b) An institutional provider shall negotiate an annual
budget with the regional board to cover its anticipated services
for the next year based on past performance and projected
changes in prices and service levels. A physician or other
provider employed by an annually-budgeted institutional provider
shall be paid through and in a manner determined by the
institutional provider.
new text end

new text begin Subd. 2. new text end

new text begin Individual providers. new text end

new text begin The board may reimburse
individual providers of health care services on a
fee-for-service basis. The board shall annually negotiate the
fee schedule with the appropriate professional group. In
developing fee schedules, the board may take into account
recognized geographic differences in cost of practice. To the
greatest extent possible, fee schedule categories must include
payment for all procedures routinely performed for a given
diagnosis. The board may require that certain high-risk or
specialized procedures be reimbursed only when performed in
certain institutions or by certain providers.
new text end

new text begin Subd. 3. new text end

new text begin Balance billing prohibited. new text end

new text begin A provider may not
charge rates that are higher than the negotiated reimbursement
level. A provider may not charge separately for services
covered under section 62K.13.
new text end

new text begin Subd. 4. new text end

new text begin Capitated payments. new text end

new text begin A health maintenance
organization may elect to be reimbursed on a capitation basis in
place of fee-for-service reimbursement. Payment on a capitation
basis does not cover inpatient services provided by a health
maintenance organization for institutional providers.
new text end

Sec. 11.

new text begin [62K.21] RULES.
new text end

new text begin The Minnesota Universal Health Board shall adopt rules to
establish a review and approval process for regional boards
established under chapter 62J.
new text end

Sec. 12.

Minnesota Statutes 2004, section 145A.12,
subdivision 7, is amended to read:

Subd. 7.

Statewide outcomes.

(a) The commissioner, in
consultation with the State Community Health Advisory Committee
established under section 145A.10, subdivision 10, paragraph
(a), shall establish statewide outcomes for local public health
grant funds allocated to community health boards between January
1, 2004, and December 31, 2005.

(b) At least one statewide outcome must be established in
each of the following public health areas:

(1) preventing diseases;

(2) protecting against environmental hazards;

(3) preventing injuries;

(4) promoting healthy behavior;

(5) responding to disasters; and

(6) ensuring access to health services.

(c) The commissioner shall use deleted text begin Minnesota's public health
goals established under section 62J.212 and deleted text end the essential public
health services under section 145A.10, subdivision 5a, as a
basis for the development of statewide outcomes.

(d) The statewide maternal and child health outcomes
established under section 145.8821 shall be included as
statewide outcomes under this section.

(e) By December 31, 2004, and every five years thereafter,
the commissioner, in consultation with the State Community
Health Advisory Committee established under section 145A.10,
subdivision 10, paragraph (a), and the Maternal and Child Health
Advisory Task Force established under section 145.881, shall
develop statewide outcomes for the local public health grant
established under section 145A.131, based on state and local
assessment data regarding the health of Minnesota residents deleted text begin , deleted text end new text begin and
new text end the essential public health services under section 145A.10 deleted text begin , and
current Minnesota public health goals established under section
62J.212 deleted text end .

Sec. 13. new text begin STUDY AND ASSESSMENT.
new text end

new text begin The commissioner of health shall study statewide health
care spending to enable the Minnesota Universal Health Board and
the regional boards to establish and enforce the state and
regional health care budgets. By January 1, 2006, the
commissioner shall:
new text end

new text begin (1) assess health care capital needs and expenditures
statewide and within each region; and
new text end

new text begin (2) recommend to the Minnesota Universal Health Board and
the regional boards statewide and regional budgets, each
consisting of budgets for operating and capital expenditures and
fee schedules for health care providers and practitioners.
new text end

Sec. 14. new text begin FUNDING.
new text end

new text begin Financing of the Minnesota universal health program shall
be through the consolidation of funding from existing state and
federal programs and a designated progressive income tax. There
shall be no co-payments, deductibles, or other out-of-pocket
payments by individuals for services.
new text end

Sec. 15. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the general fund to the
Minnesota Universal Health Board to implement sections 1 to 11.
This appropriation is available until June 30, 2009, at which
time the board shall repay this amount to the general fund from
the Minnesota health care trust fund created in Minnesota
Statutes, section 62K.07.
new text end

new text begin (b) $....... is appropriated from the general fund to the
commissioner of health for the fiscal year ending June 30, 2006,
to provide staffing for the regional boards.
new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, section 62J.212, is repealed.
new text end

Sec. 17. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 11 are effective January 1, 2006.
new text end