HF 1596

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; modifying MinnesotaCare; repealing 
  1.3             the regulated all-payer option; repealing growth 
  1.4             limits; striking references to the regulated all-payer 
  1.5             option and growth limits; amending Minnesota Statutes 
  1.6             1994, sections 62A.65, subdivision 3; 62J.04, 
  1.7             subdivision 3; 62J.045, subdivision 3; 62J.09, 
  1.8             subdivision 1a; 62J.152, subdivision 5; 62J.17, 
  1.9             subdivision 1; 62J.22; 62J.35, subdivision 1; 62J.48; 
  1.10            62J.65; 62L.08, subdivision 8; 62N.05, subdivision 2; 
  1.11            62N.381, subdivision 2; 62Q.01, subdivisions 3 and 4; 
  1.12            62Q.30; and 62Q.41; repealing Minnesota Statutes 1994, 
  1.13            sections 62J.017; 62J.04, subdivisions 1, 1a, 7, and 
  1.14            9; 62J.152, subdivision 6; 62P.01; 62P.02; 62P.03; 
  1.15            62P.04; 62P.05; 62P.07; 62P.09; 62P.11; 62P.13; 
  1.16            62P.15; 62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 
  1.17            62P.27; 62P.29; 62P.31; and 62P.33. 
  1.18  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.19     Section 1.  Minnesota Statutes 1994, section 62A.65, 
  1.20  subdivision 3, is amended to read: 
  1.21     Subd. 3.  [PREMIUM RATE RESTRICTIONS.] No individual health 
  1.22  plan may be offered, sold, issued, or renewed to a Minnesota 
  1.23  resident unless the premium rate charged is determined in 
  1.24  accordance with the following requirements:  
  1.25     (a) Premium rates must be no more than 25 percent above and 
  1.26  no more than 25 percent below the index rate charged to 
  1.27  individuals for the same or similar coverage, adjusted pro rata 
  1.28  for rating periods of less than one year.  The premium 
  1.29  variations permitted by this paragraph must be based only upon 
  1.30  health status, claims experience, and occupation.  For purposes 
  1.31  of this paragraph, health status includes refraining from 
  2.1   tobacco use or other actuarially valid lifestyle factors 
  2.2   associated with good health, provided that the lifestyle factor 
  2.3   and its effect upon premium rates have been determined by the 
  2.4   commissioner to be actuarially valid and have been approved by 
  2.5   the commissioner.  Variations permitted under this paragraph 
  2.6   must not be based upon age or applied differently at different 
  2.7   ages.  This paragraph does not prohibit use of a constant 
  2.8   percentage adjustment for factors permitted to be used under 
  2.9   this paragraph. 
  2.10     (b) Premium rates may vary based upon the ages of covered 
  2.11  persons only as provided in this paragraph.  In addition to the 
  2.12  variation permitted under paragraph (a), each health carrier may 
  2.13  use an additional premium variation based upon age of up to plus 
  2.14  or minus 50 percent of the index rate. 
  2.15     (c) A health carrier may request approval by the 
  2.16  commissioner to establish no more than three geographic regions 
  2.17  and to establish separate index rates for each region, provided 
  2.18  that the index rates do not vary between any two regions by more 
  2.19  than 20 percent.  Health carriers that do not do business in the 
  2.20  Minneapolis/St. Paul metropolitan area may request approval for 
  2.21  no more than two geographic regions, and clauses (2) and (3) do 
  2.22  not apply to approval of requests made by those health 
  2.23  carriers.  The commissioner may grant approval if the following 
  2.24  conditions are met: 
  2.25     (1) the geographic regions must be applied uniformly by the 
  2.26  health carrier; 
  2.27     (2) one geographic region must be based on the 
  2.28  Minneapolis/St. Paul metropolitan area; 
  2.29     (3) for each geographic region that is rural, the index 
  2.30  rate for that region must not exceed the index rate for the 
  2.31  Minneapolis/St. Paul metropolitan area; and 
  2.32     (4) the health carrier provides actuarial justification 
  2.33  acceptable to the commissioner for the proposed geographic 
  2.34  variations in index rates, establishing that the variations are 
  2.35  based upon differences in the cost to the health carrier of 
  2.36  providing coverage. 
  3.1      (d) Health carriers may use rate cells and must file with 
  3.2   the commissioner the rate cells they use.  Rate cells must be 
  3.3   based upon the number of adults or children covered under the 
  3.4   policy and may reflect the availability of Medicare coverage.  
  3.5   The rates for different rate cells must not in any way reflect 
  3.6   generalized differences in expected costs between principal 
  3.7   insureds and their spouses. 
  3.8      (e) In developing its index rates and premiums for a health 
  3.9   plan, a health carrier shall take into account only the 
  3.10  following factors: 
  3.11     (1) actuarially valid differences in rating factors 
  3.12  permitted under paragraphs (a) and (b); and 
  3.13     (2) actuarially valid geographic variations if approved by 
  3.14  the commissioner as provided in paragraph (c). 
  3.15     (f) All premium variations must be justified in initial 
  3.16  rate filings and upon request of the commissioner in rate 
  3.17  revision filings.  All rate variations are subject to approval 
  3.18  by the commissioner. 
  3.19     (g) The loss ratio must comply with the section 62A.021 
  3.20  requirements for individual health plans. 
  3.21     (h) The rates must not be approved, unless the commissioner 
  3.22  has determined that the rates are reasonable.  In determining 
  3.23  reasonableness, the commissioner shall consider the growth rates 
  3.24  applied under section 62J.04, subdivision 1, paragraph (b), to 
  3.25  the calendar year or years that the proposed premium rate would 
  3.26  be in effect, actuarially valid changes in risks associated with 
  3.27  the enrollee populations, and actuarially valid changes as a 
  3.28  result of statutory changes in Laws 1992, chapter 549. 
  3.29     Sec. 2.  Minnesota Statutes 1994, section 62J.04, 
  3.30  subdivision 3, is amended to read: 
  3.31     Subd. 3.  [COST CONTAINMENT DUTIES.] After obtaining the 
  3.32  advice and recommendations of the Minnesota health care 
  3.33  commission, the commissioner shall: 
  3.34     (1) establish statewide and regional limits on growth in 
  3.35  total health care spending under this section, monitor regional 
  3.36  and statewide compliance with the spending limits, and take 
  4.1   action to achieve compliance to the extent authorized by the 
  4.2   legislature; 
  4.3      (2) divide the state into no fewer than four regions, with 
  4.4   one of those regions being the Minneapolis/St. Paul metropolitan 
  4.5   statistical area but excluding Chisago, Isanti, Wright, and 
  4.6   Sherburne counties, for purposes of fostering the development of 
  4.7   regional health planning and coordination of health care 
  4.8   delivery among regional health care systems and working to 
  4.9   achieve spending limits; 
  4.10     (3) (2) provide technical assistance to regional 
  4.11  coordinating boards; 
  4.12     (4) (3) monitor the quality of health care throughout the 
  4.13  state, conduct consumer satisfaction surveys, and take action as 
  4.14  necessary to ensure an appropriate level of quality; 
  4.15     (5) (4) issue recommendations regarding uniform billing 
  4.16  forms, uniform electronic billing procedures and data 
  4.17  interchanges, patient identification cards, and other uniform 
  4.18  claims and administrative procedures for health care providers 
  4.19  and private and public sector payers.  In developing the 
  4.20  recommendations, the commissioner shall review the work of the 
  4.21  work group on electronic data interchange (WEDI) and the 
  4.22  American National Standards Institute (ANSI) at the national 
  4.23  level, and the work being done at the state and local level.  
  4.24  The commissioner may adopt rules requiring the use of the 
  4.25  Uniform Bill 82/92 form, the National Council of Prescription 
  4.26  Drug Providers (NCPDP) 3.2 electronic version, the Health Care 
  4.27  Financing Administration 1500 form, or other standardized forms 
  4.28  or procedures; 
  4.29     (6) (5) undertake health planning responsibilities as 
  4.30  provided in section 62J.15; 
  4.31     (7) (6) monitor and promote the development and 
  4.32  implementation of practice parameters; 
  4.33     (8) (7) authorize, fund, or promote research and 
  4.34  experimentation on new technologies and health care procedures; 
  4.35     (9) (8) designate referral centers for specialized and 
  4.36  high-cost procedures and treatment and establish minimum 
  5.1   standards and requirements for particular procedures or 
  5.2   treatment; 
  5.3      (10) (9) within the limits of appropriations for these 
  5.4   purposes, administer or contract for statewide consumer 
  5.5   education and wellness programs that will improve the health of 
  5.6   Minnesotans and increase individual responsibility relating to 
  5.7   personal health and the delivery of health care services, 
  5.8   undertake prevention programs including initiatives to improve 
  5.9   birth outcomes, expand childhood immunization efforts, and 
  5.10  provide start-up grants for worksite wellness programs; 
  5.11     (11) (10) administer the data analysis unit; and 
  5.12     (12) (11) undertake other activities to monitor and oversee 
  5.13  the delivery of health care services in Minnesota with the goal 
  5.14  of improving affordability, quality, and accessibility of health 
  5.15  care for all Minnesotans. 
  5.16     Sec. 3.  Minnesota Statutes 1994, section 62J.045, 
  5.17  subdivision 3, is amended to read: 
  5.18     Subd. 3.  [COST ALLOCATION FOR EDUCATION AND RESEARCH.] By 
  5.19  January 1, 1994, the commissioner of health, in consultation 
  5.20  with the health care commission and the health technology 
  5.21  advisory committee, shall: 
  5.22     (1) develop mechanisms to gather data and to identify the 
  5.23  annual cost of medical education and research conducted by 
  5.24  hospitals, medical centers, or health maintenance organizations; 
  5.25     (2) determine a percentage of the annual rate of growth 
  5.26  established under section 62J.04 to be allocated for the cost of 
  5.27  education and research and develop a method to assess the 
  5.28  percentage from each group purchaser; 
  5.29     (3) develop mechanisms to collect the assessment from group 
  5.30  purchasers to be deposited in a separate education and research 
  5.31  fund; and 
  5.32     (4) (3) develop a method to allocate the education and 
  5.33  research fund to specific health care providers. 
  5.34     Sec. 4.  Minnesota Statutes 1994, section 62J.09, 
  5.35  subdivision 1a, is amended to read: 
  5.36     Subd. 1a.  [DUTIES RELATED TO COST CONTAINMENT.] (a) [ 
  6.1   ALLOCATION OF REGIONAL SPENDING LIMITS.] Regional coordinating 
  6.2   boards may advise the commissioner regarding allocation of 
  6.3   annual regional limits on the rate of growth for providers in 
  6.4   the regulated all-payer option in order to: 
  6.5      (1) achieve communitywide and regional public health goals 
  6.6   consistent with those established by the commissioner; and 
  6.7      (2) promote access to and equitable reimbursement of 
  6.8   preventive and primary care providers. 
  6.9      (b)  [TECHNICAL ASSISTANCE.] Regional coordinating boards, 
  6.10  in cooperation with the commissioner, shall provide technical 
  6.11  assistance to parties interested in establishing or operating a 
  6.12  community integrated service network or integrated service 
  6.13  network within the region.  This assistance must complement 
  6.14  assistance provided by the commissioner under section 62N.23. 
  6.15     Sec. 5.  Minnesota Statutes 1994, section 62J.152, 
  6.16  subdivision 5, is amended to read: 
  6.17     Subd. 5.  [USE OF TECHNOLOGY EVALUATION.] (a) The final 
  6.18  report on the technology evaluation and the commission's 
  6.19  comments and recommendations may be used: 
  6.20     (1) by the commissioner in retrospective and prospective 
  6.21  review of major expenditures; 
  6.22     (2) by integrated service networks and other group 
  6.23  purchasers and by employers, in making coverage, contracting, 
  6.24  purchasing, and reimbursement decisions; 
  6.25     (3) by government programs and regulators of the regulated 
  6.26  all-payer option, in making coverage, contracting, purchasing, 
  6.27  and reimbursement decisions; 
  6.28     (4) by the commissioner and other organizations in the 
  6.29  development of practice parameters; 
  6.30     (5) by health care providers in making decisions about 
  6.31  adding or replacing technology and the appropriate use of 
  6.32  technology; 
  6.33     (6) by consumers in making decisions about treatment; 
  6.34     (7) by medical device manufacturers in developing and 
  6.35  marketing new technologies; and 
  6.36     (8) as otherwise needed by health care providers, health 
  7.1   care plans, consumers, and purchasers. 
  7.2      (b) At the request of the commissioner, the health care 
  7.3   commission, in consultation with the health technology advisory 
  7.4   committee, shall submit specific recommendations relating to 
  7.5   technologies that have been evaluated under this section for 
  7.6   purposes of retrospective and prospective review of major 
  7.7   expenditures and coverage, contracting, purchasing, and 
  7.8   reimbursement decisions affecting state programs and the 
  7.9   all-payer option. 
  7.10     Sec. 6.  Minnesota Statutes 1994, section 62J.17, 
  7.11  subdivision 1, is amended to read: 
  7.12     Subdivision 1.  [PURPOSE.] To ensure access to affordable 
  7.13  health care services for all Minnesotans it is necessary to 
  7.14  restrain the rate of growth in health care costs.  An important 
  7.15  factor believed to contribute to escalating costs may be the 
  7.16  purchase of costly new medical equipment, major capital 
  7.17  expenditures, and the addition of new specialized services.  
  7.18  After spending limits are established under section 62J.04, 
  7.19  providers, patients, and communities will have the opportunity 
  7.20  to decide for themselves whether they can afford capital 
  7.21  expenditures or new equipment or specialized services within the 
  7.22  constraints of a spending limit.  In this environment, the 
  7.23  state's role in reviewing these spending commitments can be more 
  7.24  limited.  However, during the interim period until spending 
  7.25  targets are established, It is important to prevent unrestrained 
  7.26  major spending commitments that will contribute further to the 
  7.27  escalation of health care costs and make future cost containment 
  7.28  efforts more difficult.  In addition, it is essential to protect 
  7.29  against the possibility that the legislature's expression of its 
  7.30  attempt to control health care costs may lead a provider to make 
  7.31  major spending commitments before targets or other cost 
  7.32  containment constraints are fully implemented because the 
  7.33  provider recognizes that the spending commitment may not be 
  7.34  considered appropriate, needed, or affordable within the context 
  7.35  of a fixed budget for health care spending.  Therefore, the 
  7.36  legislature finds that a requirement for reporting health care 
  8.1   expenditures is necessary. 
  8.2      Sec. 7.  Minnesota Statutes 1994, section 62J.22, is 
  8.3   amended to read: 
  8.4      62J.22 [PARTICIPATION OF FEDERAL PROGRAMS.] 
  8.5      The commissioner of health shall seek the full 
  8.6   participation of federal health care programs under this 
  8.7   chapter, including Medicare, medical assistance, veterans 
  8.8   administration programs, and other federal programs.  The 
  8.9   commissioner of human services shall under the direction of the 
  8.10  health care commission submit waiver requests and take other 
  8.11  action necessary to obtain federal approval to allow 
  8.12  participation of the medical assistance program.  Other state 
  8.13  agencies shall provide assistance at the request of the 
  8.14  commission.  If federal approval is not given for one or more 
  8.15  federal programs, data on the amount of health care spending 
  8.16  that is collected under section 62J.04 shall be adjusted so that 
  8.17  state and regional spending limits take into account the failure 
  8.18  of the federal program to participate. 
  8.19     Sec. 8.  Minnesota Statutes 1994, section 62J.35, 
  8.20  subdivision 1, is amended to read: 
  8.21     Subdivision 1.  [DATA COLLECTION BY COMMISSIONER.] For 
  8.22  purposes of forecasting rates of growth in health care spending 
  8.23  and setting limits under section 62J.04, subdivisions 1 and 1a, 
  8.24  the commissioner may collect from health care providers data on 
  8.25  patient revenues and health care spending received during a time 
  8.26  period specified by the commissioner.  The commissioner may also 
  8.27  collect data on health care revenues and spending from group 
  8.28  purchasers of health care.  Health care providers and group 
  8.29  purchasers doing business in the state shall provide the data 
  8.30  requested by the commissioner at the times and in the form 
  8.31  specified by the commissioner.  Professional licensing boards 
  8.32  and state agencies responsible for licensing, registering, or 
  8.33  regulating providers shall cooperate fully with the commissioner 
  8.34  in achieving compliance with the reporting requirements.  
  8.35     Sec. 9.  Minnesota Statutes 1994, section 62J.48, is 
  8.36  amended to read: 
  9.1      62J.48 [CRITERIA FOR REIMBURSEMENT.] 
  9.2      All ambulance services licensed under section 144.802 are 
  9.3   eligible for reimbursement under the integrated service network 
  9.4   system and the regulated all-payer option.  The commissioner 
  9.5   shall require community integrated service networks, and 
  9.6   integrated service networks, and all-payer insurers to adopt the 
  9.7   following reimbursement policies. 
  9.8      (1) All scheduled or prearranged air and ground ambulance 
  9.9   transports must be reimbursed if requested by an attending 
  9.10  physician or nurse, and, if the person is an enrollee in an 
  9.11  integrated service network or community integrated service 
  9.12  network, if approved by a designated representative of an 
  9.13  integrated service network or a community integrated service 
  9.14  network who is immediately available on a 24-hour basis.  The 
  9.15  designated representative must be a registered nurse or a 
  9.16  physician assistant with at least three years of critical care 
  9.17  or trauma experience, or a licensed physician. 
  9.18     (2) Reimbursement must be provided for all emergency 
  9.19  ambulance calls in which a patient is transported or medical 
  9.20  treatment rendered. 
  9.21     (3) Special transportation services must not be billed or 
  9.22  reimbursed if the patient needs medical attention immediately 
  9.23  before transportation. 
  9.24     Sec. 10.  Minnesota Statutes 1994, section 62J.65, is 
  9.25  amended to read: 
  9.26     62J.65 [EXEMPTION.] 
  9.27     Patient revenues derived from non-Minnesota patients are 
  9.28  exempt from the regulated all-payer system and Medicare balance 
  9.29  billing prohibition under section 62J.25. 
  9.30     Sec. 11.  Minnesota Statutes 1994, section 62L.08, 
  9.31  subdivision 8, is amended to read: 
  9.32     Subd. 8.  [FILING REQUIREMENT.] No later than July 1, 1993, 
  9.33  and each year thereafter, a health carrier that offers, sells, 
  9.34  issues, or renews a health benefit plan for small employers 
  9.35  shall file with the commissioner the index rates and must 
  9.36  demonstrate that all rates shall be within the rating 
 10.1   restrictions defined in this chapter.  Such demonstration must 
 10.2   include the allowable range of rates from the index rates and a 
 10.3   description of how the health carrier intends to use demographic 
 10.4   factors including case characteristics in calculating the 
 10.5   premium rates.  The rates shall not be approved, unless the 
 10.6   commissioner has determined that the rates are reasonable.  In 
 10.7   determining reasonableness, the commissioner shall consider the 
 10.8   growth rates applied under section 62J.04, subdivision 1, 
 10.9   paragraph (b), to the calendar year or years that the proposed 
 10.10  premium rate would be in effect, actuarially valid changes in 
 10.11  risk associated with the enrollee population, and actuarially 
 10.12  valid changes as a result of statutory changes in Laws 1992, 
 10.13  chapter 549.  For premium rates proposed to go into effect 
 10.14  between July 1, 1993 and December 31, 1993, the pertinent growth 
 10.15  rate is the growth rate applied under section 62J.04, 
 10.16  subdivision 1, paragraph (b), to calendar year 1994.  
 10.17     Sec. 12.  Minnesota Statutes 1994, section 62N.05, 
 10.18  subdivision 2, is amended to read: 
 10.19     Subd. 2.  [REQUIREMENTS.] The commissioner shall include in 
 10.20  the rules requirements that will ensure that the annual rate of 
 10.21  growth of an integrated service network's aggregate total 
 10.22  revenues received from purchasers and enrollees, after 
 10.23  adjustments for changes in population size and risk, does not 
 10.24  exceed the growth limit established in section 62J.04.  A 
 10.25  network's aggregate total revenues for purposes of these growth 
 10.26  limits are net of the contributions, surcharges, taxes, and 
 10.27  assessments listed in section 62P.04, subdivision 2, that the 
 10.28  network pays.  The commissioner may include in the rules the 
 10.29  following: 
 10.30     (1) requirements for licensure, including a fee for initial 
 10.31  application and an annual fee for renewal; 
 10.32     (2) quality standards; 
 10.33     (3) requirements for availability and comprehensiveness of 
 10.34  services; 
 10.35     (4) requirements regarding the defined population to be 
 10.36  served by an integrated service network; 
 11.1      (5) requirements for open enrollment; 
 11.2      (6) provisions for incentives for networks to accept as 
 11.3   enrollees individuals who have high risks for needing health 
 11.4   care services and individuals and groups with special needs; 
 11.5      (7) prohibitions against disenrolling individuals or groups 
 11.6   with high risks or special needs; 
 11.7      (8) requirements that an integrated service network provide 
 11.8   to its enrollees information on coverage, including any 
 11.9   limitations on coverage, deductibles and copayments, optional 
 11.10  services available and the price or prices of those services, 
 11.11  any restrictions on emergency services and services provided 
 11.12  outside of the network's service area, any responsibilities 
 11.13  enrollees have, and describing how an enrollee can use the 
 11.14  network's enrollee complaint resolution system; 
 11.15     (9) requirements for financial solvency and stability; 
 11.16     (10) a deposit requirement; 
 11.17     (11) financial reporting and examination requirements; 
 11.18     (12) limits on copayments and deductibles; 
 11.19     (13) mechanisms to prevent and remedy unfair competition; 
 11.20     (14) provisions to reduce or eliminate undesirable barriers 
 11.21  to the formation of new integrated service networks; 
 11.22     (15) requirements for maintenance and reporting of 
 11.23  information on costs, prices, revenues, volume of services, and 
 11.24  outcomes and quality of services; 
 11.25     (16) a provision allowing an integrated service network to 
 11.26  set credentialing standards for practitioners employed by or 
 11.27  under contract with the network; 
 11.28     (17) a requirement that an integrated service network 
 11.29  employ or contract with practitioners and other health care 
 11.30  providers, and minimum requirements for those contracts if the 
 11.31  commissioner deems requirements to be necessary to ensure that 
 11.32  each network will be able to control expenditures and revenues 
 11.33  or to protect enrollees and potential enrollees; 
 11.34     (18) provisions regarding liability for medical 
 11.35  malpractice; 
 11.36     (19) provisions regarding permissible and impermissible 
 12.1   underwriting criteria applicable to the standard set of 
 12.2   benefits; 
 12.3      (20) a method or methods to facilitate and encourage 
 12.4   appropriate provision of services by midlevel practitioners and 
 12.5   pharmacists; 
 12.6      (21) a method or methods to assure that all integrated 
 12.7   service networks are subject to the same regulatory 
 12.8   requirements.  All health carriers, including health maintenance 
 12.9   organizations, insurers, and nonprofit health service plan 
 12.10  corporations shall be regulated under the same rules, to the 
 12.11  extent that the health carrier is operating an integrated 
 12.12  service network or is a participating entity in an integrated 
 12.13  service network; 
 12.14     (22) provisions for appropriate risk adjusters or other 
 12.15  methods to prevent or compensate for adverse selection of 
 12.16  enrollees into or out of an integrated service network; and 
 12.17     (23) rules prescribing standard measures and methods by 
 12.18  which integrated service networks shall determine and disclose 
 12.19  their prices, copayments, deductibles, out-of-pocket limits, 
 12.20  enrollee satisfaction levels, and anticipated loss ratios.  
 12.21     Sec. 13.  Minnesota Statutes 1994, section 62N.381, 
 12.22  subdivision 2, is amended to read: 
 12.23     Subd. 2.  [RANGE OF RATES.] The reimbursement rate 
 12.24  negotiated for a contract period must not be more than 20 
 12.25  percent above or below the individual ambulance service's 
 12.26  current customary charges, plus the a rate of growth allowed 
 12.27  under section 62J.04, subdivision 1 determined by the 
 12.28  commissioner.  If the network and ambulance service cannot agree 
 12.29  on a reimbursement rate, each party shall submit their rate 
 12.30  proposal along with supportive data to the commissioner. 
 12.31     Sec. 14.  Minnesota Statutes 1994, section 62Q.01, 
 12.32  subdivision 3, is amended to read: 
 12.33     Subd. 3.  [HEALTH PLAN.] "Health plan" means a health plan 
 12.34  as defined in section 62A.011 or a policy, contract, or 
 12.35  certificate issued by a community integrated service network;, 
 12.36  an integrated service network;, or an all-payer insurer as 
 13.1   defined in section 62P.02 a health carrier as defined under 
 13.2   section 62A.011, subdivision 2. 
 13.3      Sec. 15.  Minnesota Statutes 1994, section 62Q.01, 
 13.4   subdivision 4, is amended to read: 
 13.5      Subd. 4.  [HEALTH PLAN COMPANY.] "Health plan company" 
 13.6   means: 
 13.7      (1) a health carrier as defined under section 62A.011, 
 13.8   subdivision 2; 
 13.9      (2) an integrated service network as defined under section 
 13.10  62N.02, subdivision 8; or 
 13.11     (3) an all-payer insurer as defined under section 62P.02; 
 13.12  or 
 13.13     (4) a community integrated service network as defined under 
 13.14  section 62N.02, subdivision 4a. 
 13.15     Sec. 16.  Minnesota Statutes 1994, section 62Q.30, is 
 13.16  amended to read: 
 13.17     62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION 
 13.18  PROCESS.] 
 13.19     The commissioner shall establish an expedited fact finding 
 13.20  and dispute resolution process to assist enrollees of integrated 
 13.21  service networks and all-payer insurers health plan companies 
 13.22  with contested treatment, coverage, and service issues to be in 
 13.23  effect July 1, 1997.  The commissioner may order an integrated 
 13.24  service network or an all-payer insurer a health plan company to 
 13.25  provide or pay for a service that is within the universal 
 13.26  standard benefits set.  If the disputed issue relates to whether 
 13.27  a service is appropriate and necessary, the commissioner shall 
 13.28  issue an order only after consulting with appropriate experts 
 13.29  knowledgeable, trained, and practicing in the area in dispute, 
 13.30  reviewing pertinent literature, and considering the availability 
 13.31  of satisfactory alternatives.  The commissioner shall take steps 
 13.32  including but not limited to fining, suspending, or revoking the 
 13.33  license of an integrated service network or an all-payer insurer 
 13.34  a health plan company that is the subject of repeated orders by 
 13.35  the commissioner that suggests a pattern of inappropriate 
 13.36  underutilization. 
 14.1      Sec. 17.  Minnesota Statutes 1994, section 62Q.41, is 
 14.2   amended to read: 
 14.3      62Q.41 [ANNUAL IMPLEMENTATION REPORT.] 
 14.4      The commissioner of health, in consultation with the 
 14.5   Minnesota health care commission, shall develop an annual 
 14.6   implementation report to be submitted to the legislature each 
 14.7   year beginning January 1, 1995, describing the progress and 
 14.8   status of rule development and implementation of the integrated 
 14.9   service network system and the regulated all-payer option, and 
 14.10  providing recommendations for legislative changes that the 
 14.11  commissioner determines may be needed.  
 14.12     Sec. 18.  [REPEALER; REGULATED ALL-PAYER OPTION.] 
 14.13     Subdivision 1.  [RAPO CHAPTER; SHORT-TERM 
 14.14  LIMITS.] Minnesota Statutes 1994, sections 62P.01; 62P.02; 
 14.15  62P.03; 62P.04; 62P.05; 62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 
 14.16  62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 62P.27; 62P.29; 62P.31; 
 14.17  and 62P.33, are repealed. 
 14.18     Subd. 2.  [RAPO TIMETABLE.] Minnesota Statutes 1994, 
 14.19  section 62J.017, is repealed. 
 14.20     Subd. 3.  [TECHNOLOGY EVALUATION AND RAPO.] Minnesota 
 14.21  Statutes 1994, section 62J.152, subdivision 6, is repealed. 
 14.22     Subd. 4.  [GROWTH LIMITS.] Minnesota Statutes 1994, section 
 14.23  62J.04, subdivisions 1, 1a, 7, and 9, are repealed. 
 14.24     Sec. 19.  [EFFECTIVE DATE.] 
 14.25     Sections 1 to 18 are effective the day following final 
 14.26  enactment.