HF 1862

3rd Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; establishing practice standards and evidence-based guidelines
for treating patients; implementing health care cost-containment measures;
requiring a study of hospital uncompensated care; allowing discounted payment
for health care under certain circumstances; allowing entity certain specific
administrative efficiency reports to be published on the state agency Web sites;
requiring a medical malpractice insurance report; adding provisions for service
cooperatives contracts; appropriating money; amending Minnesota Statutes
2004, sections 62D.095, subdivisions 3, 4; 72A.20, by adding a subdivision;
123A.21, subdivision 7; 151.214, subdivision 1; Minnesota Statutes 2005
Supplement, section 214.071; proposing coding for new law in Minnesota
Statutes, chapters 62J; 62M; 62Q; 144; 147; 214; 256B; repealing Minnesota
Statutes 2005 Supplement, section 62Q.251.

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

ARTICLE 1

HEALTH CARE COST-CONTAINMENT

Section 1.

new text begin [62J.431] EVIDENCE-BASED PRACTICE STANDARDS AND
GUIDELINES.
new text end

new text begin Subdivision 1. new text end

new text begin Health-related boards and provider organizations; practice
standards. new text end

new text begin The health-related boards, under chapter 148, or professional provider
organizations may establish practice standards for treating patients within their respective
scopes of practice. The boards or provider organizations may utilize the services of
appropriate public or private entities to facilitate the development or review of practice
standards and evidence-based guidelines. Each board or provider organization that has
established or ratified existing standards shall report these standards to the legislative
committees with jurisdiction over the public health occupations by January 15, 2007, and
shall report subsequent changes annually thereafter. If a board or provider organization
has existing standards, nothing in this section requires a board or provider organization to
establish new standards. Nothing in this section shall require a health plan company to
cover treatments, testing, or imaging, based on standards developed under this section.
new text end

new text begin Subd. 2. new text end

new text begin Criteria for evidence-based guidelines. new text end

new text begin Guidelines identified under this
section must meet the following criteria:
new text end

new text begin (1) the scope and application are clear;
new text end

new text begin (2) authorship is stated and any conflicts of interest disclosed;
new text end

new text begin (3) authors represent all pertinent clinical fields or other means of input have been
used;
new text end

new text begin (4) the development process is explicitly stated;
new text end

new text begin (5) the guideline is grounded in evidence;
new text end

new text begin (6) the evidence is cited and graded;
new text end

new text begin (7) the document itself is clear and practical;
new text end

new text begin (8) the document is flexible in use, with exceptions noted or provided for with
general statements;
new text end

new text begin (9) measures are included for use in systems improvement; and
new text end

new text begin (10) the guideline has scheduled reviews and updating.
new text end

Sec. 2.

new text begin [62J.62] ELECTRONIC BILLING ASSISTANCE.
new text end

new text begin The commissioner of human services shall, out of existing resources, encourage and
assist providers to adopt and use electronic billing for state programs, including but not
limited to the provision of training.
new text end

Sec. 3.

new text begin [62M.071] PRIOR AUTHORIZATION.
new text end

new text begin Health plan companies, in cooperation with health care providers, shall review prior
authorization procedures administered by utilization review organizations and health plan
companies to ensure the cost-effective use of prior authorization and minimization of
provider, clinic, and central office administrative burden.
new text end

Sec. 4.

new text begin [62M.072] USE OF EVIDENCE-BASED STANDARDS.
new text end

new text begin If no independently developed evidence-based standards exist for a particular
treatment, testing, or imaging procedure, then an insurer or utilization review organization
shall not deny coverage of the treatment, testing, or imaging based solely on the grounds
that the treatment, testing, or imaging does not meet an evidence-based standard.
new text end

Sec. 5.

new text begin [144.0506] AGENCY WEB SITES.
new text end

new text begin Subdivision 1. new text end

new text begin Information to be posted. new text end

new text begin The commissioner of health may post the
following information on agency Web sites, including minnesotahealthinfo.com:
new text end

new text begin (1) healthy lifestyle and preventive health care information, organized by sex and
age, with procedures and treatments categorized by level of effectiveness and reliability of
the supporting evidence on effectiveness;
new text end

new text begin (2) health plan company administrative efficiency report cards;
new text end

new text begin (3) health care provider charges for common procedures, based on information
available under section 62J.052;
new text end

new text begin (4) evidence-based medicine guidelines and related information for use as resources
by health care professionals, and summaries of the guidelines and related information for
use by patients and consumers;
new text end

new text begin (5) resources and Web links related to improving efficiency in medical clinics and
health care professional practices; and
new text end

new text begin (6) lists of nonprofit and charitable entities that accept donations of used medical
equipment and supplies, such as crutches and walkers.
new text end

new text begin Subd. 2. new text end

new text begin Other Internet resources. new text end

new text begin The commissioner of health, in implementing
subdivision 1, shall include relevant Web links and materials from private sector and other
government sources in order to avoid duplication and reduce state administrative costs.
new text end

new text begin Subd. 3. new text end

new text begin Cooperation with commissioner of commerce. new text end

new text begin The commissioner of
health shall consult and work in cooperation with the commissioner of commerce when
posting on the Web site information collected from health plan companies regulated by
the commissioner of commerce.
new text end

Sec. 6.

new text begin [147.37] INFORMATION PROVISION; PHARMACEUTICAL
ASSISTANCE PROGRAMS.
new text end

new text begin The board shall encourage licensees to make available to patients information on
free and discounted prescription drug programs offered by pharmaceutical manufacturers
when the information is provided to the licensees at no cost.
new text end

Sec. 7.

Minnesota Statutes 2004, section 151.214, subdivision 1, is amended to read:

Subdivision 1.

Explanation of pharmacy benefits.

A pharmacist licensed under
this chapter must provide to a patient, for each prescription dispensed where part or all
of the cost of the prescription is being paid or reimbursed by an employer-sponsored
plan or health plan company, or its contracted pharmacy benefit manager, the patient's
co-payment amount and the new text begin pharmacy's own new text end usual and customary price of the prescription
or the amount the pharmacy will be paid for the prescription drug by the patient's
employer-sponsored plan or health plan company, or its contracted pharmacy benefit
manager.

Sec. 8.

Minnesota Statutes 2005 Supplement, section 214.071, is amended to read:

214.071 HEALTH BOARDS; DIRECTORY OF LICENSEES.

new text begin By July 1, 2009, new text end each deleted text begin health deleted text end new text begin health-related licensing new text end board deleted text begin under chapters 147, 148,
148B, and 150A deleted text end new text begin , as defined in section 214.01, subdivision 2 new text end , shall establish a directory of
licensees that includes biographical data for each licensee.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 9.

new text begin [214.121] PRICE DISCLOSURE REMINDER.
new text end

new text begin Each health-related licensing board shall at least annually inform and remind its
licensees of the price disclosure requirements of section 62J.052 or 151.214, as applicable,
through the board's regular means of communicating with its licensees.
new text end

Sec. 10.

new text begin [256B.043] COST CONTAINMENT EFFORTS.
new text end

new text begin Subdivision 1. new text end

new text begin Alternative and complementary health care. new text end

new text begin The commissioner of
human services, through the medical director and in consultation with the health services
policy committee established under section 256B.0625, subdivision 3c, as part of the
commissioner's ongoing duties, shall consider the potential for improving quality and
obtaining cost savings through greater use of alternative and complementary treatment
methods that are supported by the findings of evidence-based research; shall incorporate
these methods into the medical assistance, MinnesotaCare, and general assistance medical
care programs; and shall make related legislative recommendations as appropriate.
new text end

new text begin Subd. 2. new text end

new text begin Access to care. new text end

new text begin (a) The commissioners of human services and health,
as part of their ongoing duties, shall consider the adequacy of the current system of
community health clinics and centers both statewide and in urban areas with significant
disparities in health status and access to services across racial and ethnic groups, including:
new text end

new text begin (1) methods to provide 24-hour availability of care through the clinics and centers;
new text end

new text begin (2) methods to expand the availability of care through the clinics and centers;
new text end

new text begin (3) the use of grants to expand the number of clinics and centers, the services
provided, and the availability of care; and
new text end

new text begin (4) the extent to which increased use of physician assistants, nurse practitioners,
medical residents and interns, and other allied health professionals in clinics and centers
would increase the availability of services.
new text end

new text begin (b) The commissioners shall make departmental modifications and legislative
recommendations as appropriate on the basis of their considerations under paragraph (a).
new text end

Sec. 11. new text begin REPORTING OF ACQUIRED INFECTIONS.
new text end

new text begin (a) The commissioner of health may consult with infection control specialists, health
care facility representatives, and consumers for the purpose of obtaining recommendations
regarding a determination of the need for action to implement health care associated
infection control reporting in hospitals and nursing homes. If the outcome of the
determination warrants, the commissioner shall consult with the group regarding:
new text end

new text begin (1) the selection of reporting measures relating to health care associated infections;
new text end

new text begin (2) design, implementation, validation, and ongoing evaluation of the reporting
system; and
new text end

new text begin (3) ensuring that the reporting measures remain flexible and adaptable to changing
national standards.
new text end

new text begin (b) If the commissioner determines that there is a need for the action described in
paragraph (a), the commissioner shall make written recommendations to the legislature.
new text end

Sec. 12. new text begin STUDY OF HOSPITAL UNCOMPENSATED CARE.
new text end

new text begin (a) The commissioner of health shall study and report to the legislature by January
15, 2007, the following:
new text end

new text begin (1) trends in hospitals' cost of providing uncompensated care, separately identifying
charity care and bad debt as components of uncompensated care;
new text end

new text begin (2) the impact of any changes in hospitals' charity care policies and debt collection
practices in the past three years on the amount of uncompensated care provided and the
number of patients receiving uncompensated care; and
new text end

new text begin (3) the value of hospital uncompensated care and community benefits in comparison
to the value of tax exemptions received as a result of nonprofit status.
new text end

new text begin (b) The commissioner's report to the legislature shall include recommendations on:
(1) the need for more uniform hospital charity care policies and debt collection practices;
and (2) the need for more uniform reporting of community benefits provided by nonprofit
hospitals.
new text end

Sec. 13. new text begin APPROPRIATION.
new text end

new text begin In fiscal year 2007, $50,000 is appropriated from the general fund to the
commissioner of human services for the efforts required under Minnesota Statutes, section
256B.043.
new text end

ARTICLE 2

CHARITY CARE BY HEALTH CARE PROVIDERS

Section 1.

new text begin [62J.83] REDUCED PAYMENT AMOUNTS PERMITTED.
new text end

new text begin (a) Notwithstanding any provision of chapter 148 or any other provision of law to
the contrary, a health care provider may provide care to a patient at a discounted payment
amount, including care provided for free.
new text end

new text begin (b) This section does not apply in a situation in which the discounted payment
amount is not permitted under federal law.
new text end

Sec. 2.

Minnesota Statutes 2004, section 72A.20, is amended by adding a subdivision
to read:

new text begin Subd. 39. new text end

new text begin Discounted payments by health care providers; effect on use of
usual and customary payments. new text end

new text begin An insurer, including, but not limited to, a health plan
company as defined in section 62Q.01, subdivision 4; a reparation obligor as defined in
section 65B.43, subdivision 9; and a workers' compensation insurer shall not consider in
determining a health care provider's usual and customary payment, standard payment, or
allowable payment used as a basis for determining the provider's payment by the insurer,
the following discounted payment situations:
new text end

new text begin (1) care provided to relatives of the provider;
new text end

new text begin (2) care for which a discount or free care is given in hardship situations; and
new text end

new text begin (3) care for which a discount is given in exchange for cash payment.
new text end

new text begin For purposes of this subdivision, "health care provider" and "provider" have the
meaning given in section 62J.03, subdivision 8.
new text end

Sec. 3. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2005 Supplement, section 62Q.251, new text end new text begin is repealed.
new text end

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

new text begin Sections 1 to 3 are effective the day following final enactment.
new text end

ARTICLE 3

PRIVATE SECTOR HEALTH COVERAGE PROVISIONS

Section 1.

Minnesota Statutes 2004, section 62D.095, subdivision 3, is amended to
read:

Subd. 3.

Deductibles.

deleted text begin (a) deleted text end A health maintenance contract issued by a health
maintenance organization deleted text begin that is assessed less than three percent of the total annual amount
assessed by the Minnesota comprehensive health association deleted text end may impose deductibles not
to exceed deleted text begin $3,000 deleted text end new text begin $5,000 new text end per person, per year and deleted text begin $6,000 deleted text end new text begin $10,000 new text end per family, per year. deleted text begin For
purposes of the percentage calculation, a health maintenance organization's assessments
include those of its affiliates.
deleted text end

deleted text begin (b) All other health maintenance contracts may impose deductibles not to exceed
$2,250 per person, per year and $4,500 per family, per year.
deleted text end

new text begin new text end

Sec. 2.

Minnesota Statutes 2004, section 62D.095, subdivision 4, is amended to read:

Subd. 4.

Annual out-of-pocket maximums.

deleted text begin (a) deleted text end A health maintenance contract
issued by a health maintenance organization deleted text begin that is assessed less than three percent of the
total annual amount assessed by the Minnesota comprehensive health association deleted text end must
include a limitation not to exceed deleted text begin $4,500 deleted text end new text begin $5,000 new text end per person and deleted text begin $7,500 deleted text end new text begin $10,000 new text end per
family on total annual out-of-pocket enrollee cost-sharing expenses. deleted text begin For purposes of the
percentage calculation, a health maintenance organization's assessments include those
of its affiliates.
deleted text end

deleted text begin (b) All other health maintenance contracts must include a limitation not to
exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee
cost-sharing expenses.
deleted text end

Sec. 3.

new text begin [62Q.645] DISTRIBUTION OF INFORMATION; ADMINISTRATIVE
EFFICIENCY AND COVERAGE OPTIONS.
new text end

new text begin (a) The commissioner may use reports submitted by health plan companies, service
cooperatives, and the public employee insurance program created in section 43A.316
to compile entity specific administrative efficiency reports; may make these reports
available on state agency Web sites, including minnesotahealthinfo.com; and may include
information on:
new text end

new text begin (1) number of covered lives;
new text end

new text begin (2) covered services;
new text end

new text begin (3) geographic availability;
new text end

new text begin (4) whom to contact to obtain current premium rates;
new text end

new text begin (5) administrative costs, using the definition of administrative costs developed under
section 62J.38;
new text end

new text begin (6) Internet links to information on the health plan, if available; and
new text end

new text begin (7) any other information about the health plan identified by the commissioner
as being useful for employers, consumers, providers, and others in evaluating health
plan options.
new text end

new text begin (b) This section does not apply to a health plan company unless its annual Minnesota
premiums exceed $50,000,000 based on the most recent assessment base of the Minnesota
Comprehensive Health Association. For purposes of this determination, the premiums of a
health plan company include those of its affiliates.
new text end

Sec. 4. new text begin MEDICAL MALPRACTICE INSURANCE REPORT.
new text end

new text begin (a) The commissioner of commerce shall provide to the legislature annually a brief
written report on the status of the market for medical malpractice insurance in Minnesota.
The report must summarize, interpret, explain, and analyze information on that subject
available to the commissioner, through annual statements filed by insurance companies,
information obtained under paragraph (c), and other sources.
new text end

new text begin (b) The annual report must consider, to the extent possible, using definitions
developed by the commissioner, Minnesota-specific data on market shares; premiums
received; amounts paid to settle claims that were not litigated, claims that were settled
after litigation began, and claims that were litigated to court judgment; amounts spent
on processing, investigation, litigation, and otherwise handling claims; other sales and
administrative costs; and the loss ratios of the insurers.
new text end

new text begin (c) Each insurance company that provides medical malpractice insurance in this state
shall, no later than June 1 each year, file with the commissioner of commerce, on a form
prescribed by the commissioner and using definitions developed by the commissioner,
the Minnesota-specific data referenced in paragraph (b), other than market share, for the
previous calendar year for that insurance company, shown separately for various categories
of coverages including, if possible, hospitals, medical clinics, nursing homes, physicians
who provide emergency medical care, obstetrician gynecologists, and ambulance services.
An insurance company need not comply with this paragraph if its direct premium written
in the state for the previous calendar year is less than $2,000,000.
new text end

ARTICLE 4

SERVICE COOPERATIVES

Section 1.

Minnesota Statutes 2004, section 123A.21, subdivision 7, is amended to
read:

Subd. 7.

Educational programs and services.

new text begin (a) new text end The board of directors of each
SC shall submit annually a plan to the members. The plan shall identify the programs and
services which are suggested for implementation by the SC during the following year and
shall contain components of long-range planning determined by the SC. These programs
and services may include, but are not limited to, the following areas:

(1) administrative services;

(2) curriculum development;

(3) data processing;

(4) distance learning and other telecommunication services;

(5) evaluation and research;

(6) staff development;

(7) media and technology centers;

(8) publication and dissemination of materials;

(9) pupil personnel services;

(10) planning;

(11) secondary, postsecondary, community, adult, and adult vocational education;

(12) teaching and learning services, including services for students with special
talents and special needs;

(13) employee personnel services;

(14) vocational rehabilitation;

(15) health, diagnostic, and child development services and centers;

(16) leadership or direction in early childhood and family education;

(17) community services;

(18) shared time programs;

(19) fiscal services and risk management programs;

(20) technology planning, training, and support services;

(21) health and safety services;

(22) student academic challenges; and

(23) cooperative purchasing services.

new text begin (b) A group health, dental, or long-term disability coverage program provided by
one or more service cooperatives:
new text end

new text begin (1) must rebid contracts for insurance and third-party administration at least every
four years. The contracts may be regional or statewide in the discretion of the SC; and
new text end

new text begin (2) may determine premiums for its health, dental, or long-term disability coverage
individually for specific employers or may determine them on a pooled or other basis
established by the SC.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end