HF 579

as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health; repealing the regulated all-payer 
  1.3             option; striking references to the regulated all-payer 
  1.4             option; amending Minnesota Statutes 1994, sections 
  1.5             62J.04, subdivision 1a; 62J.09, subdivision 1a; 
  1.6             62J.152, subdivision 5; 62J.48; 62J.65; 62N.05, 
  1.7             subdivision 2; 62Q.01, subdivisions 3 and 4; and 
  1.8             62Q.41; repealing Minnesota Statutes 1994, sections 
  1.9             62J.152, subdivision 6; 62P.01; 62P.02; 62P.03; 
  1.10            62P.04; 62P.05; 62P.07; 62P.09; 62P.11; 62P.13; 
  1.11            62P.15; 62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 
  1.12            62P.27; 62P.29; 62P.31; and 62P.33. 
  1.13  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.14     Section 1.  Minnesota Statutes 1994, section 62J.04, 
  1.15  subdivision 1a, is amended to read: 
  1.16     Subd. 1a.  [ADJUSTED GROWTH LIMITS AND ENFORCEMENT.] (a) 
  1.17  The commissioner shall publish the final adjusted growth limit 
  1.18  in the State Register by January 31 of the year that the 
  1.19  expenditure limit is to be in effect.  The adjusted limit must 
  1.20  reflect the actual regional consumer price index for urban 
  1.21  consumers for the previous calendar year, and may deviate from 
  1.22  the previously published projected growth limits to reflect 
  1.23  differences between the actual regional consumer price index for 
  1.24  urban consumers and the projected Consumer Price Index for urban 
  1.25  consumers.  The commissioner shall report to the legislature by 
  1.26  February 15 of each year on differences between the projected 
  1.27  increase in health care expenditures, the actual expenditures 
  1.28  based on data collected, and the impact and validity of growth 
  1.29  limits within the overall health care reform strategy. 
  2.1      (b) The commissioner shall enforce limits on growth in 
  2.2   spending and revenues for integrated service networks and for 
  2.3   the regulated all-payer option.  If the commissioner determines 
  2.4   that artificial inflation or padding of costs or prices has 
  2.5   occurred in anticipation of the implementation of growth limits, 
  2.6   the commissioner may adjust the base year spending totals or 
  2.7   growth limits or take other action to reverse the effect of the 
  2.8   artificial inflation or padding. 
  2.9      (c) The commissioner shall impose and enforce overall 
  2.10  limits on growth in revenues and spending for integrated service 
  2.11  networks, with adjustments for changes in enrollment, benefits, 
  2.12  severity, and risks.  If an integrated service network exceeds 
  2.13  the growth limits, the commissioner may reduce future limits on 
  2.14  growth in aggregate premium revenues for that integrated service 
  2.15  network by up to the amount overspent.  If the integrated 
  2.16  service network system exceeds a systemwide spending limit, the 
  2.17  commissioner may reduce future limits on growth in premium 
  2.18  revenues for the integrated service network system by up to the 
  2.19  amount overspent. 
  2.20     (d) The commissioner shall set prices, utilization 
  2.21  controls, and other requirements for the regulated all-payer 
  2.22  option to ensure that the overall costs of this system, after 
  2.23  adjusting for changes in population, severity, and risk, do not 
  2.24  exceed the growth limits.  If growth limits for a calendar year 
  2.25  are exceeded, the commissioner may reduce reimbursement rates or 
  2.26  otherwise recoup amounts exceeding the limit for all or part of 
  2.27  the next calendar year.  To the extent possible, the 
  2.28  commissioner may reduce reimbursement rates or otherwise recoup 
  2.29  amounts over the limit from individual providers who exceed the 
  2.30  growth limits. 
  2.31     (e) The commissioner, in consultation with the Minnesota 
  2.32  health care commission, shall research and make recommendations 
  2.33  to the legislature regarding the implementation of growth limits 
  2.34  for integrated service networks and the regulated all-payer 
  2.35  option.  The commissioner must consider both spending and 
  2.36  revenue approaches and will report on the implementation of the 
  3.1   interim limits as defined in sections 62P.04 and 62P.05.  The 
  3.2   commissioner must examine and make recommendations on the use of 
  3.3   annual update factors based on volume performance standards as a 
  3.4   mechanism for achieving controls on spending in the all-payer 
  3.5   option.  The commissioner must make recommendations regarding 
  3.6   the enforcement mechanism and must consider mechanisms to adjust 
  3.7   future growth limits as well as mechanisms to establish 
  3.8   financial penalties for noncompliance.  The commissioner must 
  3.9   also address the feasibility of systemwide limits imposed on all 
  3.10  integrated service networks. 
  3.11     (f) The commissioner shall report to the legislative 
  3.12  commission on health care access by December 1, 1994, on trends 
  3.13  in aggregate spending and premium revenue for health plan 
  3.14  companies.  The commissioner shall use data submitted under 
  3.15  section 62P.04 and other available data to complete this report. 
  3.16     Sec. 2.  Minnesota Statutes 1994, section 62J.09, 
  3.17  subdivision 1a, is amended to read: 
  3.18     Subd. 1a.  [DUTIES RELATED TO COST CONTAINMENT.] (a) 
  3.19  [ALLOCATION OF REGIONAL SPENDING LIMITS.] Regional coordinating 
  3.20  boards may advise the commissioner regarding allocation of 
  3.21  annual regional limits on the rate of growth for providers in 
  3.22  the regulated all-payer option in order to: 
  3.23     (1) achieve communitywide and regional public health goals 
  3.24  consistent with those established by the commissioner; and 
  3.25     (2) promote access to and equitable reimbursement of 
  3.26  preventive and primary care providers. 
  3.27     (b) [TECHNICAL ASSISTANCE.] Regional coordinating boards, 
  3.28  in cooperation with the commissioner, shall provide technical 
  3.29  assistance to parties interested in establishing or operating a 
  3.30  community integrated service network or integrated service 
  3.31  network within the region.  This assistance must complement 
  3.32  assistance provided by the commissioner under section 62N.23. 
  3.33     Sec. 3.  Minnesota Statutes 1994, section 62J.152, 
  3.34  subdivision 5, is amended to read: 
  3.35     Subd. 5.  [USE OF TECHNOLOGY EVALUATION.] (a) The final 
  3.36  report on the technology evaluation and the commission's 
  4.1   comments and recommendations may be used: 
  4.2      (1) by the commissioner in retrospective and prospective 
  4.3   review of major expenditures; 
  4.4      (2) by integrated service networks and other group 
  4.5   purchasers and by employers, in making coverage, contracting, 
  4.6   purchasing, and reimbursement decisions; 
  4.7      (3) by government programs and regulators of the regulated 
  4.8   all-payer option, in making coverage, contracting, purchasing, 
  4.9   and reimbursement decisions; 
  4.10     (4) by the commissioner and other organizations in the 
  4.11  development of practice parameters; 
  4.12     (5) by health care providers in making decisions about 
  4.13  adding or replacing technology and the appropriate use of 
  4.14  technology; 
  4.15     (6) by consumers in making decisions about treatment; 
  4.16     (7) by medical device manufacturers in developing and 
  4.17  marketing new technologies; and 
  4.18     (8) as otherwise needed by health care providers, health 
  4.19  care plans, consumers, and purchasers. 
  4.20     (b) At the request of the commissioner, the health care 
  4.21  commission, in consultation with the health technology advisory 
  4.22  committee, shall submit specific recommendations relating to 
  4.23  technologies that have been evaluated under this section for 
  4.24  purposes of retrospective and prospective review of major 
  4.25  expenditures and coverage, contracting, purchasing, and 
  4.26  reimbursement decisions affecting state programs and the 
  4.27  all-payer option. 
  4.28     Sec. 4.  Minnesota Statutes 1994, section 62J.48, is 
  4.29  amended to read: 
  4.30     62J.48 [CRITERIA FOR REIMBURSEMENT.] 
  4.31     All ambulance services licensed under section 144.802 are 
  4.32  eligible for reimbursement under the integrated service network 
  4.33  system and the regulated all-payer option.  The commissioner 
  4.34  shall require community integrated service networks, and 
  4.35  integrated service networks, and all-payer insurers to adopt the 
  4.36  following reimbursement policies. 
  5.1      (1) All scheduled or prearranged air and ground ambulance 
  5.2   transports must be reimbursed if requested by an attending 
  5.3   physician or nurse, and, if the person is an enrollee in an 
  5.4   integrated service network or community integrated service 
  5.5   network, if approved by a designated representative of an 
  5.6   integrated service network or a community service network who is 
  5.7   immediately available on a 24-hour basis.  The designated 
  5.8   representative must be a registered nurse or a physician 
  5.9   assistant with at least three years of critical care or trauma 
  5.10  experience, or a licensed physician. 
  5.11     (2) Reimbursement must be provided for all emergency 
  5.12  ambulance calls in which a patient is transported or medical 
  5.13  treatment rendered. 
  5.14     (3) Special transportation services must not be billed or 
  5.15  reimbursed if the patient needs medical attention immediately 
  5.16  before transportation. 
  5.17     Sec. 5.  Minnesota Statutes 1994, section 62J.65, is 
  5.18  amended to read: 
  5.19     62J.65 [EXEMPTION.] 
  5.20     Patient revenues derived from non-Minnesota patients are 
  5.21  exempt from the regulated all-payer system and Medicare balance 
  5.22  billing prohibition under section 62J.25. 
  5.23     Sec. 6.  Minnesota Statutes 1994, section 62N.05, 
  5.24  subdivision 2, is amended to read: 
  5.25     Subd. 2.  [REQUIREMENTS.] The commissioner shall include in 
  5.26  the rules requirements that will ensure that the annual rate of 
  5.27  growth of an integrated service network's aggregate total 
  5.28  revenues received from purchasers and enrollees, after 
  5.29  adjustments for changes in population size and risk, does not 
  5.30  exceed the growth limit established in section 62J.04.  A 
  5.31  network's aggregate total revenues for purposes of these growth 
  5.32  limits are net of the contributions, surcharges, taxes, and 
  5.33  assessments listed in Minnesota Statutes 1994, section 62P.04, 
  5.34  subdivision 2, that the network pays.  The commissioner may 
  5.35  include in the rules the following: 
  5.36     (1) requirements for licensure, including a fee for initial 
  6.1   application and an annual fee for renewal; 
  6.2      (2) quality standards; 
  6.3      (3) requirements for availability and comprehensiveness of 
  6.4   services; 
  6.5      (4) requirements regarding the defined population to be 
  6.6   served by an integrated service network; 
  6.7      (5) requirements for open enrollment; 
  6.8      (6) provisions for incentives for networks to accept as 
  6.9   enrollees individuals who have high risks for needing health 
  6.10  care services and individuals and groups with special needs; 
  6.11     (7) prohibitions against disenrolling individuals or groups 
  6.12  with high risks or special needs; 
  6.13     (8) requirements that an integrated service network provide 
  6.14  to its enrollees information on coverage, including any 
  6.15  limitations on coverage, deductibles and copayments, optional 
  6.16  services available and the price or prices of those services, 
  6.17  any restrictions on emergency services and services provided 
  6.18  outside of the network's service area, any responsibilities 
  6.19  enrollees have, and describing how an enrollee can use the 
  6.20  network's enrollee complaint resolution system; 
  6.21     (9) requirements for financial solvency and stability; 
  6.22     (10) a deposit requirement; 
  6.23     (11) financial reporting and examination requirements; 
  6.24     (12) limits on copayments and deductibles; 
  6.25     (13) mechanisms to prevent and remedy unfair competition; 
  6.26     (14) provisions to reduce or eliminate undesirable barriers 
  6.27  to the formation of new integrated service networks; 
  6.28     (15) requirements for maintenance and reporting of 
  6.29  information on costs, prices, revenues, volume of services, and 
  6.30  outcomes and quality of services; 
  6.31     (16) a provision allowing an integrated service network to 
  6.32  set credentialing standards for practitioners employed by or 
  6.33  under contract with the network; 
  6.34     (17) a requirement that an integrated service network 
  6.35  employ or contract with practitioners and other health care 
  6.36  providers, and minimum requirements for those contracts if the 
  7.1   commissioner deems requirements to be necessary to ensure that 
  7.2   each network will be able to control expenditures and revenues 
  7.3   or to protect enrollees and potential enrollees; 
  7.4      (18) provisions regarding liability for medical 
  7.5   malpractice; 
  7.6      (19) provisions regarding permissible and impermissible 
  7.7   underwriting criteria applicable to the standard set of 
  7.8   benefits; 
  7.9      (20) a method or methods to facilitate and encourage 
  7.10  appropriate provision of services by midlevel practitioners and 
  7.11  pharmacists; 
  7.12     (21) a method or methods to assure that all integrated 
  7.13  service networks are subject to the same regulatory 
  7.14  requirements.  All health carriers, including health maintenance 
  7.15  organizations, insurers, and nonprofit health service plan 
  7.16  corporations shall be regulated under the same rules, to the 
  7.17  extent that the health carrier is operating an integrated 
  7.18  service network or is a participating entity in an integrated 
  7.19  service network; 
  7.20     (22) provisions for appropriate risk adjusters or other 
  7.21  methods to prevent or compensate for adverse selection of 
  7.22  enrollees into or out of an integrated service network; and 
  7.23     (23) rules prescribing standard measures and methods by 
  7.24  which integrated service networks shall determine and disclose 
  7.25  their prices, copayments, deductibles, out-of-pocket limits, 
  7.26  enrollee satisfaction levels, and anticipated loss ratios.  
  7.27     Sec. 7.  Minnesota Statutes 1994, section 62Q.01, 
  7.28  subdivision 3, is amended to read: 
  7.29     Subd. 3.  [HEALTH PLAN.] "Health plan" means a health plan 
  7.30  as defined in section 62A.011 or a policy, contract, or 
  7.31  certificate issued by a community integrated service network; or 
  7.32  an integrated service network; or an all-payer insurer as 
  7.33  defined in section 62P.02. 
  7.34     Sec. 8.  Minnesota Statutes 1994, section 62Q.01, 
  7.35  subdivision 4, is amended to read: 
  7.36     Subd. 4.  [HEALTH PLAN COMPANY.] "Health plan company" 
  8.1   means: 
  8.2      (1) a health carrier as defined under section 62A.011, 
  8.3   subdivision 2; 
  8.4      (2) an integrated service network as defined under section 
  8.5   62N.02, subdivision 8; or 
  8.6      (3) an all-payer insurer as defined under section 62P.02; 
  8.7   or 
  8.8      (4) a community integrated service network as defined under 
  8.9   section 62N.02, subdivision 4a. 
  8.10     Sec. 9.  Minnesota Statutes 1994, section 62Q.41, is 
  8.11  amended to read: 
  8.12     62Q.41 [ANNUAL IMPLEMENTATION REPORT.] 
  8.13     The commissioner of health, in consultation with the 
  8.14  Minnesota health care commission, shall develop an annual 
  8.15  implementation report to be submitted to the legislature each 
  8.16  year beginning January 1, 1995, describing the progress and 
  8.17  status of rule development and implementation of the integrated 
  8.18  service network system and the regulated all-payer option, and 
  8.19  providing recommendations for legislative changes that the 
  8.20  commissioner determines may be needed.  
  8.21     Sec. 10.  [REPEALER; REGULATED ALL-PAYER OPTION.] 
  8.22     Subdivision 1.  [REGULATED ALL-PAYER OPTION.] Minnesota 
  8.23  Statutes 1994, sections 62P.01; 62P.02; 62P.03; 62P.04; 62P.05; 
  8.24  62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 62P.17; 62P.19; 62P.21; 
  8.25  62P.23; 62P.25; 62P.27; 62P.29; 62P.31; and 62P.33, are repealed.
  8.26     Subd. 2.  [TECHNOLOGY EVALUATION AND REGULATED ALL-PAYER 
  8.27  OPTION.] Minnesota Statutes 1994, section 62J.152, subdivision 
  8.28  6, is repealed. 
  8.29     Sec. 11.  [EFFECTIVE DATE.] 
  8.30     Sections 1 to 10 are effective the day following final 
  8.31  enactment.