HF 3391

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to public health; increasing affordability and continuity of care for state
health care programs; modifying health care provisions; establishing a public
health access fund; increasing the tobacco impact fees; providing subsidies for
employee share of employer-subsidized insurance; establishing the Minnesota
Health Insurance Exchange; requiring certain employers to offer Section 125
Plan; creating an affordability standard; requiring mandated reports; authorizing
rulemaking; appropriating money; amending Minnesota Statutes 2006, sections
16A.725, subdivision 1; 62A.65, subdivision 3; 62E.141; 62L.12, subdivisions
2, 4; 256.01, by adding a subdivision; 256.9658, subdivisions 3, 9; 256B.061;
256B.69, by adding a subdivision; 256D.03, by adding a subdivision; 256L.05,
by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision 3;
256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement, sections
13.46, subdivision 2; 256B.056, subdivision 10; 256L.03, subdivisions 3, 5;
256L.04, subdivisions 1, 7; 256L.05, subdivision 3a; 256L.07, subdivision 1;
256L.15, subdivision 2; proposing coding for new law in Minnesota Statutes,
chapters 16A; 145; 256B; proposing coding for new law as Minnesota Statutes,
chapter 62U; repealing Minnesota Statutes 2006, section 256L.15, subdivision 3.

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

ARTICLE 1

PUBLIC HEALTH

Section 1.

Minnesota Statutes 2006, section 16A.725, subdivision 1, is amended to
read:

Subdivision 1.

Health impact fund.

There is created in the state treasury a health
impact fund to which must be credited deleted text begin all deleted text end revenue from the health impact fee new text begin as identified
new text end under section 256.9658 new text begin , subdivision 9, clause (1), new text end and any floor stocks fee enacted into law.

Sec. 2.

new text begin [16A.726] PUBLIC HEALTH ACCESS FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Public health access fund. new text end

new text begin There is created in the state treasury a
public health access fund to which revenue from the health impact fee must be credited
as identified under section 256.9658, subdivision 9, clause (2), and any floor stocks fee
enacted into law. The fund is a direct appropriated special revenue fund. Notwithstanding
section 11A.20, all investment income and all investment losses attributable to the
investment of the public health access fund not currently needed shall be credited to the
public health access fund.
new text end

new text begin Subd. 2. new text end

new text begin Fund reimbursements. new text end

new text begin Notwithstanding any law to the contrary, money
in the public health access fund shall be appropriated only for public health initiatives.
new text end

Sec. 3.

new text begin [145.986] STATEWIDE HEALTH IMPROVEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Goals. new text end

new text begin The initial goals of the public health access fund are to reduce
the percent of Minnesotans who are obese or overweight to less than half by the year
2020 and to reduce tobacco smoking by 2 percent annually starting in 2011. By 2011,
and considering available funding, the commissioner of health, in consultation with the
State Community Health Advisory Committee established in section 145A.10, subdivision
10, and other stakeholders, may make recommendations as to future goals related to
alcohol use and illegal drug use.
new text end

new text begin Subd. 2. new text end

new text begin Grants to local communities. new text end

new text begin Beginning January 1, 2009, the
commissioner of health must provide grants to community health boards to convene,
coordinate, and lead locally developed programs targeted at achieving measurable health
improvement goals. Funding to each community health board will be distributed based on
a per capita formula, with a base allocation of $50,000 to each community health board
that receives funding. By January 15, 2011, the commissioner of health must recommend
whether additional funding should be distributed to community health boards based on
health disparities demonstrated in the populations served.
new text end

new text begin Subd. 3. new text end

new text begin Outcomes. new text end

new text begin (a) The commissioner of health must set performance measures
and annually review the progress of local communities in improving the performance
measures. The commissioner may provide technical assistance and corrective action plans
to ensure that local communities are making sufficient progress.
new text end

new text begin (b) The commissioner must measure current public health data, using existing
measures and data collection systems when available, to determine baseline data against
which progress shall be monitored.
new text end

new text begin Subd. 4. new text end

new text begin Media campaign. new text end

new text begin The commissioner of health must conduct a statewide
marketing campaign using public media to reinforce local efforts at addressing health
improvement goals. The commissioner must develop the statewide campaigns and
determine the timing of these campaigns in consultation with local public health
representatives.
new text end

Sec. 4. new text begin APPROPRIATIONS.
new text end

new text begin (a) $....... is appropriated from the public health access fund in fiscal year 2009,
depending on availability of funds, to the commissioner of health to establish and
implement the statewide health improvement program under section 145.986. Subject to
the availability of funding, beginning January 1, 2009, the commissioner of health shall
make grants to community health boards to implement local public health programs.
new text end

new text begin (b) $....... is appropriated from the public health access fund in fiscal year 2009,
depending on availability of funds, to the commissioner of health for a statewide public
health media campaign. Subject to the availability of funding, the funds shall be made
available to the commissioner of health beginning January 1, 2009.
new text end

Sec. 5.

Minnesota Statutes 2006, section 256.9658, subdivision 3, is amended to read:

Subd. 3.

Fee imposed.

(a) A fee is imposed upon the sale of cigarettes in this
state, upon having cigarettes in possession in this state with intent to sell, upon any
person engaged in business as a distributor, and upon the use or storage by consumers
of cigarettes. The fee is imposed at the following rates:

(1) on cigarettes weighing not more than three pounds per thousand, deleted text begin 37.5 deleted text end new text begin 50 new text end mills
on each cigarette; and

(2) on cigarettes weighing more than three pounds per thousand, deleted text begin 75 deleted text end new text begin 100 new text end mills on
each cigarette.

(b) A fee is imposed upon all tobacco products in this state and upon any person
engaged in business as a distributor in an amount equal to the liability for tax under
section 297F.05, subdivision 3, or on a consumer of tobacco products equal to the tax
under section 297F.05, subdivision 4. Liability for the fee is in addition to the tax under
section 297F.05, subdivision 3 or 4.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for sales and purchases made after
June 30, 2008.
new text end

Sec. 6.

Minnesota Statutes 2006, section 256.9658, subdivision 9, is amended to read:

Subd. 9.

Deposit of revenues.

The commissioner of revenue shall deposit the
revenues from the fee under this section in the state treasury and credit them deleted text begin to the health
impact fund deleted text end new text begin as follows:
new text end

new text begin (1) an amount equal to 75 percent of the revenues received under subdivision 3 to
the health impact fund established under section 16A.725; and
new text end

new text begin (2) an amount equal to 25 percent of the revenues received under subdivision 3 to
the public health access fund established under section 16A.726 new text end .

Sec. 7. new text begin NEW TOBACCO RATES.
new text end

new text begin The commissioner of revenue must determine the change to the weighted average
retail price in Minnesota Statutes, section 297F.25, as a result of this act and publish the
new rates by June 1, 2008, effective for sales after June 30, 2008.
new text end

ARTICLE 2

HEALTH CARE HOMES

Section 1.

new text begin [256B.0431] ENROLLEE REQUIREMENTS RELATED TO HEALTH
CARE HOMES.
new text end

new text begin Subdivision 1. new text end

new text begin Selection of primary care clinic. new text end

new text begin Beginning January 1, 2009, the
commissioner shall require state health care program enrollees eligible for services
under the fee-for-service system to select a primary care clinic or medical group, within
two months of enrollment. Beginning July 1, 2009, the commissioner shall encourage
enrollees who have a complex or chronic condition to select a primary care clinic or
medical group at which clinicians have been certified as health care homes under section
256B.0751, subdivision 3. The commissioner and county social service agencies shall
provide enrollees with lists of primary care clinics, medical groups, and clinicians certified
as health care homes, and shall establish a toll-free number to provide enrollees with
assistance in choosing a clinic, medical group, or health care home.
new text end

new text begin Subd. 2. new text end

new text begin Initial health assessment. new text end

new text begin The commissioner shall encourage state health
care program enrollees eligible for services under the fee-for-service system to complete an
initial health assessment at their selected primary care clinic or medical group, within one
month of selection, in order to identify individuals with, or who are at risk of developing,
complex or chronic health conditions, and to identify preventative health care needs.
new text end

new text begin Subd. 3. new text end

new text begin Education and outreach. new text end

new text begin Beginning January 1, 2009, the commissioner
shall provide patient education and outreach to state health care program enrollees and
potential applicants related to the importance of choosing a primary care clinic or medical
group and a health care home. Education and outreach must be targeted to underserved or
special populations.
new text end

new text begin Subd. 4. new text end

new text begin State health care program. new text end

new text begin For purposes of this section, "state health
care program" means the medical assistance, MinnesotaCare, and general assistance
medical care programs.
new text end

Sec. 2.

new text begin [256B.0751] HEALTH CARE HOMES; DEFINITIONS;
ESTABLISHMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of sections 256B.0751 to 256B.0754,
the definitions in this subdivision apply.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Commissioners" means the commissioner of human services and the
commissioner of health acting jointly.
new text end

new text begin (d) "State health care program" means the medical assistance, MinnesotaCare, and
general assistance medical care programs.
new text end

new text begin Subd. 2. new text end

new text begin Establishment of health care homes. new text end

new text begin The commissioners shall establish
health care homes for all state health care program enrollees, beginning first with
enrollees who have, or are at risk of developing, complex or chronic health conditions. In
establishing health care homes, the commissioners shall consider, and when appropriate
incorporate, features of the medical home model developed for the provider-directed care
coordination program authorized under section 256B.0625, subdivision 51.
new text end

new text begin Subd. 3. new text end

new text begin Certification. new text end

new text begin By July 1, 2009, the commissioners shall begin certification
of individual clinicians, who participate as providers in state health care programs and
meet the requirements of section 256B.0752, as health care homes. Clinicians may enter
into collaborative agreements with other clinicians to develop the components of a health
care home. Clinician certification as a health care home is voluntary. Clinicians certified
as health care homes shall renew their certification annually, in order to maintain their
status as health care homes.
new text end

Sec. 3.

new text begin [256B.0752] HEALTH CARE HOME REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Requirement. new text end

new text begin In order to be certified as a health care home, a
clinician shall meet the criteria specified in this section.
new text end

new text begin Subd. 2. new text end

new text begin Patient-provider relationship; care teams. new text end

new text begin (a) Each patient of a health
care home shall have an ongoing, long-term relationship with a primary care provider
trained as a personal clinician to provide first contact, continuous, and comprehensive
care for all of a patient's health care needs. Appropriate specialists and other health care
professionals who do not practice in a traditional primary care field, and advanced practice
registered nurses, shall be allowed to serve as personal clinicians, if they provide care
according to this section.
new text end

new text begin (b) Care must be provided using an interdisciplinary team of individuals who
collectively take responsibility for the ongoing care of patients, and who practice to the
full extent of the individual's license. The interdisciplinary team shall include two patient
or parent partners as team members.
new text end

new text begin Subd. 3. new text end

new text begin Care coordination. new text end

new text begin The personal clinician and the team are responsible
for providing for all the patient's health care needs or for arranging appropriate care with
other qualified professionals, as part of a whole-person orientation. Health care must be
coordinated across all provider types, all care locations, and the greater community. This
requirement applies to care for all stages of life, including preventive care, acute care,
chronic care, and end-of-life care. Care coordination must include ongoing planning
to prepare for patient transitions across different types of care and provider types. The
primary care team shall also coordinate with those providing for the social service needs
of the individual, if this is necessary to ensure a successful health outcome.
new text end

new text begin Subd. 4. new text end

new text begin Care delivery. new text end

new text begin (a) A health care home must provide or arrange for access
to care 24-hours a day, seven days a week.
new text end

new text begin (b) Health care homes must encourage the patient, and when authorized and
appropriate, the family, to actively participate in decision making and in health care home
quality improvement initiatives, as a full member of the primary care team. Health care
homes must consider patients and families as partners in decision making, and must
provide access to a patient-directed, decision-making process, including appropriate
decision aids, when available.
new text end

new text begin (c) Care delivery must be facilitated by the use of health information technology and
through systematic patient follow-up using internal clinic patient registries.
new text end

new text begin (d) Care must be provided in a culturally and linguistically appropriate manner.
new text end

new text begin (e) Within the context of a system of continuous quality improvement, care
delivery, whenever possible, must be based on evidence-based medicine and use clinical
decision-support tools.
new text end

new text begin (f) A health care home must provide enhanced access to care, using methods such
as open scheduling, expanded hours, and new communication methods, such as e-mail,
phone consultations, and e-consults.
new text end

new text begin Subd. 5. new text end

new text begin Quality of care. new text end

new text begin Health care homes must meet process, outcome, and
quality standards as developed and specified by the commissioners. Health care homes
must measure and publicly report all data necessary for the commissioners to monitor
compliance with these standards.
new text end

new text begin Subd. 6. new text end

new text begin Comprehensive health assessment. new text end

new text begin Health care homes must complete
a comprehensive health assessment for each enrollee determined, by the initial health
assessment required under section 256B.0431, subdivision 2, to have, or be at risk of
developing, a complex or chronic health condition. Health care homes must develop and
implement a comprehensive care plan to manage complex or chronic conditions based
upon the comprehensive health assessment and other information. The comprehensive
care plans must meet criteria specified by the commissioners.
new text end

new text begin Subd. 7. new text end

new text begin Care coordinators. new text end

new text begin Health care homes must employ care coordinators to
manage the care provided to patients with complex or chronic conditions specified by the
commissioners. Care coordinators may be social workers, nurses, or other clinicians. Care
coordinators are responsible for:
new text end

new text begin (1) identifying patients with complex or chronic conditions eligible for care
coordination;
new text end

new text begin (2) assisting primary care providers in care coordination and education;
new text end

new text begin (3) helping patients coordinate their care or access needed services, including
preventative care;
new text end

new text begin (4) communicating the care needs and concerns of the patient to the health care
home; and
new text end

new text begin (5) collecting data on process and outcome measures.
new text end

Sec. 4.

new text begin [256B.0753] CARE COORDINATION FEE.
new text end

new text begin Subdivision 1. new text end

new text begin Care coordination fee. new text end

new text begin (a) The commissioner shall pay each health
care home a per-person per-month care coordination fee for providing care coordination
services. The fee must be paid for each fee-for-service state health care program enrollee
eligible for a health care home, who is served by a personal clinician certified as a health
care home.
new text end

new text begin (b) Payment of the care coordination fee is contingent on the health care home
meeting the criteria specified in this section. The care coordination fee is in addition to
reimbursement received by a health care home under the medical assistance fee-for-service
payment system for health care services.
new text end

new text begin Subd. 2. new text end

new text begin Amount of fee. new text end

new text begin The care coordination fee must not exceed an average
of $50 per person per month. The care coordination fee must be determined by the
commissioner, and must vary by thresholds of care complexity, with the highest fees being
paid for care provided to individuals requiring the most intensive care coordination, such
as those with very complex health care needs or several chronic conditions.
new text end

new text begin Subd. 3. new text end

new text begin Cost neutrality. new text end

new text begin The commissioner may reduce payment rates for
nonprimary care services, if initial savings from implementation of health care homes are
not sufficient to allow implementation of the care coordination fee in a cost-neutral manner.
new text end

Sec. 5.

new text begin [256B.0754] DUTIES OF THE COMMISSIONERS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment of certification standards and other criteria. new text end

new text begin (a)
By January 1, 2009, the commissioners shall establish certification standards for health
care homes consistent with the criteria in section 256B.0752.
new text end

new text begin (b) By January 1, 2009, the commissioners shall develop care complexity thresholds
and payment amounts for the care coordination fee established under section 256B.0753.
new text end

new text begin (c) By January 1, 2009, the commissioners shall identify criteria to determine
enrollees eligible for and in need of care coordination, and who would benefit from having
a comprehensive care plan for their condition.
new text end

new text begin (d) By January 1, 2009, the commissioners shall establish criteria and data collection
procedures for evaluating health care homes.
new text end

new text begin (e) By January 1, 2009, the commissioners shall develop health care home
requirements for managed care plan contracts, performance incentives, and withholds,
and shall develop the methodology for identifying and recapturing managed care savings
resulting from implementation of the health care home model.
new text end

new text begin Subd. 2. new text end

new text begin Monitoring and evaluation. new text end

new text begin The commissioners shall ensure the
collection from health care homes of data necessary to monitor implementation of the
health care home model, measure and evaluate quality of care and outcomes, measure
and evaluate patient experience, and determine cost savings from implementation of
the health care home model. The commissioners shall collect and evaluate this data
directly, but may contract with an appropriate private sector entity for technical assistance.
The commissioners shall provide health care homes with practice profiles measuring
utilization, cost, and quality.
new text end

new text begin Subd. 3. new text end

new text begin Care Coordination Advisory Committee. new text end

new text begin By July 1, 2008, the
commissioners shall establish a Care Coordination Advisory Committee to assist the
Departments of Human Services and Health in administering the health care home model,
developing the criteria and standards required under subdivision 1, collecting data,
and measuring and evaluating health outcomes and cost savings. The commissioners
may satisfy this requirement by continuing the advisory committee established for the
provider-directed care coordination program. If newly established, the committee must
include representatives of: primary care and specialist physicians, advanced practice
registered nurses, patients and their families, health plans, the Institute for Clinical
Systems Improvement, Minnesota Community Measurement, and other relevant entities.
new text end

new text begin Subd. 4. new text end

new text begin Health care home collaborative. new text end

new text begin By July 1, 2009, the commissioners
shall establish a health care home collaborative to provide an opportunity for health care
homes and state agencies to exchange information related to quality improvement and
best practices.
new text end

new text begin Subd. 5. new text end

new text begin Patient-directed, decision-making process. new text end

new text begin By January 1, 2009,
the commissioners, in consultation with the Care Coordination Advisory Committee
and the Institute of Clinical Systems Improvement, shall develop a patient-directed,
decision-making support model to be used by health care homes. The commissioners shall:
new text end

new text begin (1) establish protocols that include identifying the use of a patient-directed,
decision-making process and incorporating effectively the use of patient-decision aids,
when appropriate;
new text end

new text begin (2) ensure the quality of the patient-decision aids available to the patient;
new text end

new text begin (3) ensure accessibility of the patient-decision aids, including the use of translators,
when necessary; and
new text end

new text begin (4) ensure that providers are trained to use patient-decision aids effectively.
new text end

new text begin Subd. 6. new text end

new text begin Annual reports. new text end

new text begin The commissioners shall report annually to the
legislature on the implementation and administration of the health care home model for
state health care program enrollees in both the fee-for-service and managed care sectors,
beginning December 15, 2009, and each December 15 thereafter. The report must include
information on the number of state health care program enrollees in health care homes, the
number and characteristics of enrollees with complex or chronic conditions, the number
and geographic distribution of health care home providers, the performance and quality of
care of health care homes, measures of preventative care, costs related to implementation
and payment of care coordination fees, health care home payment arrangements for
managed care plans, and estimates of savings from implementation of the health care
home model for both the fee-for-service and managed care sectors relative to the health
care spending baseline calculated under section 620.07.
new text end

Sec. 6.

Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 29. new text end

new text begin Health care home model. new text end

new text begin (a) The commissioner shall require managed
care plans, as a condition of contract, to adopt by July 1, 2009, a health care home model
for providing care to state health care program enrollees. The health care home model
must meet the criteria specified in this section and section 256B.0752. The commissioner,
in consultation with the commissioner of health, may waive or modify criteria for managed
care plans if the commissioners of health and human services determine that performance
and quality standards would still be met.
new text end

new text begin (b) The commissioners of health and human services shall require managed care
plans to: (1) collect from health care homes the data necessary to monitor implementation
of the health care home model, measure and evaluate quality of care and outcomes,
measure and evaluate patient experience, and determine cost savings from implementation
of the health care home model; and (2) submit this data to the commissioners. The
commissioners of health and human services shall provide managed care plans and health
care homes with practice profiles measuring utilization, cost, and quality.
new text end

new text begin (c) Savings from the use of health care homes must be split among the state,
providers, and managed care plan. The state must retain one-half of the savings, the plan
may retain up to one-fourth of the savings, and at least one-fourth of the savings must be
passed on to providers in the form of higher payment rates.
new text end

new text begin (d) Beginning July 1, 2009, the commissioner shall provide a performance
incentive for expenses related to the operation of health care homes that would reimburse
up-front costs related to implementation of health care homes after a one-year lag. The
commissioners of health and human services shall establish quality and performance
standards for health care homes, and beginning July 1, 2009, these standards shall be
subject to the capitation rate withhold under subdivision 5a, paragraph (c).
new text end

new text begin (e) Managed care plans must require state health care program enrollees to complete
an initial health assessment within three months from the time of enrollment, in order to
identify individuals with, or who are at risk of developing, complex or chronic health
conditions, and to identify preventative health care needs.
new text end

new text begin (f) Beginning July 1, 2009, the commissioner shall require managed care plans to
complete a comprehensive health assessment for each enrollee determined, by the initial
health assessment required under section 256B.0431, subdivision 2, to have, or be at
risk of developing, a complex or chronic health condition. The commissioner shall pay
managed care plans a one-time health assessment fee for each enrollee who completes
a comprehensive health assessment. Comprehensive health assessments must meet the
criteria established for health care homes under section 256B.0752, subdivision 6.
new text end

new text begin (g) Beginning July 1, 2009, the commissioner shall implement financial
arrangements for managed care plans to ensure that plans require each enrollee to choose a
provider to serve as a health care home.
new text end

Sec. 7.

new text begin [256B.766] PRIMARY CARE PHYSICIANS REIMBURSEMENT RATE
INCREASE.
new text end

new text begin (a) Effective for physician services rendered on or after January 1, 2009, the
commissioner shall increase reimbursements to primary care physicians deemed by the
commissioner to meet the requirements in paragraph (b). Reimbursement may be increased
by not more than 50 percent above the reimbursement rate that would otherwise be paid to
the primary care provider. Payments to health plan companies shall be adjusted to reflect
increased reimbursement to primary care physicians as approved by the commissioner.
new text end

new text begin (b) The commissioner, in collaboration with the Office of Rural Health, shall
determine areas of the state in need of primary care physicians. By September 1 of each
year, beginning September 1, 2008, the commissioner shall accept applications from
primary care physicians who agree to practice in a designated area for a period of no less
than five years. The commissioner shall determine participant eligibility based on their
suitability for practice serving a designated geographic area.
new text end

new text begin (c) The commissioner may reconsider the designated areas, as necessary. A primary
care physician who agrees to practice in a designated area shall receive the increased
reimbursement rates for at least a period of five years, unless the physician discontinues
practicing in the designated area during the five-year period.
new text end

new text begin (d) A health care clinic or medical group may submit applications under this section
for primary care physicians who will be hired to fill vacancies prior to filling the vacant
position.
new text end

Sec. 8. new text begin APPROPRIATION; PRIMARY CARE EDUCATION INITIATIVES.
new text end

new text begin (a) $....... is appropriated for the fiscal year ending June 30, 2009, from the health
care access fund to the Board of Regents of the University of Minnesota, to expand
initiatives under Minnesota Statutes, sections 137.38 to 137.40, to increase the number of
graduates of residency programs who practice primary care.
new text end

new text begin (b) $....... is appropriated for the fiscal year ending June 30, 2009, from the health
care access fund to the Mayo Medical Foundation for medical school initiatives to increase
the number of graduates of residency programs who practice primary care.
new text end

new text begin (c) $....... is appropriated for the fiscal year ending June 30, 2009, from the health
care access fund to the Office of Higher Education to provide grants to schools of nursing
in Minnesota to increase the number of graduates of advanced practice registered nurse
programs.
new text end

new text begin (d) $....... is appropriated for the fiscal year ending June 30, 2009, from the health
care access fund to the Board of Regents of the University of Minnesota, to address faculty
shortages in primary care medicine.
new text end

new text begin (e) $....... is appropriated for the fiscal year ending June 30, 2009, from the health
care access fund to the Mayo Medical Foundation, to address faculty shortages in primary
care medicine.
new text end

new text begin (f) $....... is appropriated for the fiscal year ending June 30, 2009, from the health
care access fund to the Office of Higher Education to provide grants to schools of nursing
in Minnesota to address faculty shortages.
new text end

ARTICLE 3

INCREASING ACCESS; CONTINUITY OF CARE

Section 1.

Minnesota Statutes 2006, section 256.01, is amended by adding a
subdivision to read:

new text begin Subd. 27. new text end

new text begin Automation and coordination for state health care programs. new text end

new text begin (a) For
purposes of this subdivision, "state health care program" means the medical assistance,
MinnesotaCare, or general assistance medical care programs.
new text end

new text begin (b) By July 1, 2009, the commissioner shall improve coordination between state
health care programs and social service programs including but not limited to WIC, free
and reduced school lunch programs, and food stamps, and shall develop and use automated
systems to identify persons served by social service programs who may be eligible for, but
are not enrolled in, a state health care program. The system must also permit enrollees to
renew state health care program enrollment through these social services programs. By
January 15, 2009, the commissioner shall, as necessary, identify and recommend to the
legislature statutory changes to state health care and social service programs necessary to
improve coordination and automation of outreach and enrollment efforts.
new text end

new text begin (c) By January 15, 2009, the commissioner shall establish and implement an
automated process to send out state health care program renewal forms in the most
common foreign languages to those state health care program enrollees who request
renewal forms in those foreign languages. The commissioner, as part of the initial
enrollment process, shall inform applicants of the availability of this option.
new text end

new text begin (d) Beginning July 1, 2008, the commissioner, county social service agencies, and
health care providers shall update state health care program enrollee addresses and related
contact information at the time of each enrollee contact.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraphs (a) and (d) are effective July 1, 2008. Paragraphs
(b) and (c) are effective January 1, 2009.
new text end

Sec. 2.

Minnesota Statutes 2007 Supplement, section 256B.056, subdivision 10,
is amended to read:

Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.

(c) The commissioner shall verify deleted text begin assets and deleted text end income for all applicants, and for
all recipients upon renewal. new text begin The commissioner shall verify liquid assets for applicants,
and for recipients upon renewal, only if the applicant or recipient is within ten percent
of the applicable asset limit. The commissioner may verify nonliquid assets, but is not
required to do so.
new text end

new text begin (d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period, before being
disenrolled.
new text end

new text begin (e) If there is no change in an enrollee's income or asset information, the enrollee
may renew eligibility at designated locations that include community clinics and health
care providers' offices. These designated sites shall forward the renewal forms to the
commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendment to paragraph (c) is effective January 1, 2009.
The amendment to paragraph (d) is effective January 1, 2010, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2006, section 256B.061, is amended to read:

256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS new text begin ;
DELAYED VERIFICATION new text end .

new text begin (a) new text end If any individual has been determined to be eligible for medical assistance, it
will be made available for care and services included under the plan and furnished in or
after the third month before the month in which the individual made application for such
assistance, if such individual was, or upon application would have been, eligible for
medical assistance at the time the care and services were furnished. The commissioner
may limit, restrict, or suspend the eligibility of an individual for up to one year upon
that individual's conviction of a criminal offense related to application for or receipt of
medical assistance benefits.

new text begin (b) On the basis of information provided on the completed application, an applicant
who meets the following criteria must be determined eligible beginning in the month
of application:
new text end

new text begin (1) gross income is less than 90 percent of the applicable income standard;
new text end

new text begin (2) total liquid assets are less than 90 percent of the asset limit;
new text end

new text begin (3) does not reside in a long-term care facility; and
new text end

new text begin (4) meets all other eligibility requirements, including compliance at the time of
application with citizenship or nationality documentation requirements under section
256B.06, subdivision 4.
new text end

new text begin The applicant shall provide all required verifications within 60 days' notice of the
eligibility determination or eligibility shall be terminated. Applicants who are terminated
for failure to provide all required verifications are not eligible to apply for coverage using
the delayed verification procedures specified in this paragraph for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end

Sec. 4.

Minnesota Statutes 2006, section 256D.03, is amended by adding a subdivision
to read:

new text begin Subd. 7a. new text end

new text begin Additional duties of the commissioner. new text end

new text begin In administering the general
assistance medical care program, the commissioner shall: (1) apply the delayed verification
procedure specified in section 256B.061, paragraph (b), to general assistance medical care
applicants; and (2) provide general assistance medical care enrollees who fail to submit
renewal forms and related documentation necessary to verify continued eligibility with an
additional month of eligibility beyond the end of the current eligibility period.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end

Sec. 5.

Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 3, is
amended to read:

Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
2, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of deleted text begin $10,000 deleted text end new text begin $20,000 new text end .

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, for enrollees for
whom federal funding is not available, and is effective January 1, 2009, or upon federal
approval, whichever is later, for enrollees for whom federal funding is available. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 6.

Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 5, is
amended to read:

Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.

(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.

(d) Paragraph (a), clause (4), does not apply to mental health services.

(e) Adult enrollees with family gross income that exceeds 200 percent of the federal
poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
and who are not pregnant shall be financially responsible for the coinsurance amount, if
applicable, and amounts which exceed the deleted text begin $10,000 deleted text end new text begin $20,000 new text end inpatient hospital benefit limit.

(f) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the deleted text begin $10,000 deleted text end new text begin $20,000 new text end annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, for enrollees for
whom federal funding is not available, and is effective January 1, 2009, or upon federal
approval, whichever is later, for enrollees for whom federal funding is available. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 7.

Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is
amended to read:

Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) deleted text begin Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $50,000.
deleted text end

deleted text begin (e) deleted text end Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 8.

Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is
amended to read:

Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and households with no children who have gross family
incomes that are equal to or less than 200 percent of the federal poverty guidelines.
Effective deleted text begin July deleted text end new text begin January new text end 1, 2009, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than deleted text begin 215 deleted text end new text begin 300 new text end percent of the federal poverty guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009.
new text end

Sec. 9.

Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a, is
amended to read:

Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. new text begin If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner. new text end The
premium for the new period of eligibility must be received as provided in section 256L.06
in order for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.

new text begin (d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period, before being
disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
additional month.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 10.

Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Delayed verification. new text end

new text begin On the basis of information provided on the
completed application, an applicant whose gross income is less than 90 percent of
the applicable income standard and meets all other eligibility requirements, including
compliance at the time of application with citizenship or nationality documentation
requirements under section 256L.04, subdivision 10, must be determined eligible
beginning in the month of application. The applicant shall provide all required
verifications within 60 days' notice of the eligibility determination, or eligibility shall be
terminated. Applicants who are terminated for failure to provide all required verifications
are not eligible to apply for coverage using the delayed verification procedures specified in
this subdivision for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 11.

Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:

Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the
commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require
enrollees to report changes in income; (2) adjust sliding scale premium payments, based
upon both increases and decreases in enrollee income, at the time the change in income
is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
premiums. Failure to pay includes payment with a dishonored check, a returned automatic
bank withdrawal, or a refused credit card or debit card payment. The commissioner may
demand a guaranteed form of payment, including a cashier's check or a money order, as
the only means to replace a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a
monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
commissioner of the premium amount required. The commissioner shall inform applicants
and enrollees of these premium payment options. Premium payment is required before
enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
received before noon are credited the same day. Premium payments received after noon
are credited on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan effective
deleted text begin for deleted text end new text begin the first day of the calendar month following new text end the calendar month for which the
premium was due. Persons disenrolled for nonpayment or who voluntarily terminate
coverage from the program may not reenroll until four calendar months have elapsed.
deleted text begin Persons disenrolled for nonpayment who pay all past due premiums as well as current
premiums due, including premiums due for the period of disenrollment, within 20 days
of disenrollment, shall be reenrolled retroactively to the first day of disenrollment deleted text end new text begin The
commissioner shall waive premiums for coverage provided under this paragraph to
persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b new text end .
Persons disenrolled for nonpayment or who voluntarily terminate coverage from the
program may not reenroll for four calendar months unless the person demonstrates good
cause for nonpayment. Good cause does not exist if a person chooses to pay other family
expenses instead of the premium. The commissioner shall define good cause in rule.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 12.

Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is
amended to read:

Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 deleted text begin and the four-month requirement in subdivision 3 deleted text end , as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.

Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7,
whose income increases above 200 percent of the federal poverty guidelines or deleted text begin 215 deleted text end new text begin 300 new text end
percent of the federal poverty guidelines on or after deleted text begin July deleted text end new text begin January new text end 1, 2009, are no longer
eligible for the program and shall be disenrolled by the commissioner. For persons
disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of
the calendar month following the month in which the commissioner determines that the
income of a family or individual exceeds program income limits.

(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment. The
premium for children remaining eligible under this clause shall be the maximum premium
determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (c) Notwithstanding paragraphs (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $50,000 for the 12-month period
of eligibility.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later, except that the amendment to paragraph (a) related to the
four-month requirement is effective January 1, 2010, or upon federal approval, whichever
is later. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 13.

Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewal deleted text end . Children enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) deleted text begin Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.
deleted text end

deleted text begin (c) deleted text end For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

deleted text begin (d) deleted text end new text begin (c) new text end Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

deleted text begin (e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 14.

Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is
amended to read:

Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay
to obtain coverage through the MinnesotaCare program. The sliding fee scale must be
based on the enrollee's monthly gross individual or family income. The sliding fee scale
must contain separate tables based on enrollment of one, two, or three or more persons.
new text begin Until December 31, 2008, new text end the sliding fee scale begins with a premium of 1.5 percent of
monthly gross individual or family income for individuals or families with incomes below
the limits for the medical assistance program for families and children in effect on January
1, 1999, and proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8,
5.9, 7.4, and 8.8 percent. These percentages are matched to evenly spaced income steps
ranging from the medical assistance income limit for families and children in effect on
January 1, 1999, to 275 percent of the federal poverty guidelines for the applicable family
size, up to a family size of five. The sliding fee scale for a family of five must be used
for families of more than five. The sliding fee scale and percentages are not subject to
the provisions of chapter 14. If a family or individual reports increased income after
enrollment, premiums shall be adjusted at the time the change in income is reported.

(b) deleted text begin Families deleted text end new text begin Children new text end whose gross income is above deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

new text begin (c) Beginning January 1, 2009, MinnesotaCare enrollees shall pay premiums
according to the affordability scale established in section 62U.08 with the exception that
children in families with income at or below 150 percent of the federal poverty guidelines
shall pay a monthly premium of $4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 15.

Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin First month premium exemption. new text end

new text begin New enrollee households are exempt
from premiums for the first month of MinnesotaCare enrollment. For purposes of this
exemption, a "new enrollee household" is a household which has not been enrolled in
MinnesotaCare for at least one year prior to application.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 16. new text begin INSURANCE COVERAGE FOR LONG-TERM CARE WORKERS.
new text end

new text begin (a) By December 15, 2008, the commissioner of human services shall study and
report to the legislature with recommendations for a rate increase to long-term care
employers dedicated to the purchase of employee health insurance in the private market.
The commissioner shall collect necessary actuarial data, employment data, current
coverage data, and other needed information.
new text end

new text begin (b) The commissioner shall develop cost estimates for three levels of insurance
coverage for long-term care workers:
new text end

new text begin (1) the coverage provided to state employees;
new text end

new text begin (2) the coverage provided to MinnesotaCare enrollees; and
new text end

new text begin (3) the benefits provided under an "average" private market insurance product, but
with a deductible limited to $100 per person.
new text end

new text begin Premium cost sharing, waiting periods for eligibility, definitions of full- and
part-time employment, and other parameters under the three options must be identical to
those under the state employees' health plan.
new text end

new text begin (c) For purposes of this section, a long-term care worker is a person employed by a
nursing facility, an intermediate care facility for persons with developmental disabilities,
or a service provider that:
new text end

new text begin (1) is eligible under Laws 2007, chapter 147, article 7, section 71; and
new text end

new text begin (2) provides long-term care services.
new text end

new text begin The commissioner may recommend a different definition of long-term care worker if
this definition presents insurmountable implementation issues.
new text end

new text begin (d) The recommendations must include measures to:
new text end

new text begin (1) ensure equitable treatment between employers that currently have different levels
of expenditure for employee health insurance costs; and
new text end

new text begin (2) enforce the requirement that the rate increase be expended for the intended
purpose.
new text end

Sec. 17. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256L.15, subdivision 3, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval of the amendments to section 14, whichever is later. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

ARTICLE 4

INSURANCE REFORM

Section 1. new text begin UNIFORM OUTCOME MEASURES WORKING GROUP.
new text end

new text begin (a) The commissioner of health, or the commissioner's designee, shall create,
convene, and chair an informal working group to attempt to arrive at a standardized,
limited set of measures by which to measure performance of health care providers for
use in establishing statewide health improvement goals and in measuring progress on
these goals. The group shall focus first on the most common areas of data collection
for pay-for-performance systems.
new text end

new text begin (b) The working group must be known as the Uniform Outcome Measures Working
Group. The commissioner shall determine its members and the number of members.
The working group must include representatives of health care providers, health care
purchasers, health insurers, public health agencies, and consumers.
new text end

new text begin (c) The working group shall attempt to arrive at uniform definitions, measures, and
forms for submission of data, to the greatest extent possible.
new text end

new text begin (d) The working group shall seek to reduce the administrative burden on health
care providers and health care purchasers.
new text end

new text begin (e) The working group shall invite and use the expertise of existing organizations
experienced in health care quality measurement.
new text end

new text begin (f) The working group shall encourage participation by the public.
new text end

new text begin (g) The commissioner of health shall encourage use of the working group
recommendations.
new text end

new text begin (h) By December 15, 2008, the commissioner of health shall provide to the
legislature a written report under Minnesota Statutes, section 3.195, summarizing the
work of the working group.
new text end

new text begin (i) The working group terminates on June 30, 2009, unless the commissioner of
health determines that the group's continued existence would be beneficial.
new text end

Sec. 2. new text begin COMMUNITY BENEFIT STANDARDS AND REPORTING;
NONPROFIT HEALTH PLAN COMPANIES; RECOMMENDATIONS.
new text end

new text begin (a) By December 15, 2008, the commissioner of health shall recommend to the
legislature community benefit standards to be required by law of nonprofit health plan
companies doing business in the state.
new text end

new text begin (b) The recommendations must include a procedure by which each nonprofit health
plan company would periodically report to the state and to the public regarding the
company's compliance with the requirements.
new text end

new text begin (c) The commissioner shall recommend a fair and effective enforcement and
remediation mechanism.
new text end

Sec. 3. new text begin ANALYSIS OF PROPOSED INSURANCE MARKET REFORMS.
new text end

new text begin The Legislative Commission on Health Care Access shall review available
information and analysis, and, by December 15, 2008, report to the legislature under
Minnesota Statutes, section 3.195, with recommendations regarding:
new text end

new text begin (1) the effects and possible desirability of increasing the definition of "small
employer" for purposes of the state's small employer health insurance market, in order to
expand that market to include some employers that have more than 50 employees;
new text end

new text begin (2) the effects and possible desirability of restricting or prohibiting the use of health
status and related factors in health insurance premium determination in the individual
and small employer markets, and what lifestyle choices such as smoking should be
considered; and
new text end

new text begin (3) the effects and possible desirability of merging the individual and small employer
markets if the state implements the following:
new text end

new text begin (i) an individual responsibility requirement, requiring all Minnesota residents to
have at least a specified level of health coverage; and
new text end

new text begin (ii) guaranteed issue in the individual market.
new text end

ARTICLE 5

HEALTH INSURANCE PURCHASING AND AFFORDABILITY

Section 1.

Minnesota Statutes 2007 Supplement, section 13.46, subdivision 2, is
amended to read:

Subd. 2.

General.

(a) Unless the data is summary data or a statute specifically
provides a different classification, data on individuals collected, maintained, used, or
disseminated by the welfare system is private data on individuals, and shall not be
disclosed except:

(1) according to section 13.05;

(2) according to court order;

(3) according to a statute specifically authorizing access to the private data;

(4) to an agent of the welfare system, including a law enforcement person, attorney,
or investigator acting for it in the investigation or prosecution of a criminal or civil
proceeding relating to the administration of a program;

(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to
an individual or family across programs; evaluate the effectiveness of programs; assess
parental contribution amounts; and investigate suspected fraud;

(6) to administer federal funds or programs;

(7) between personnel of the welfare system working in the same program;

(8) to the Department of Revenue to assess parental contribution amounts for
purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit
programs and to identify individuals who may benefit from these programs. The following
information may be disclosed under this paragraph: an individual's and their dependent's
names, dates of birth, Social Security numbers, income, addresses, and other data as
required, upon request by the Department of Revenue. Disclosures by the commissioner
of revenue to the commissioner of human services for the purposes described in this clause
are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include,
but are not limited to, the dependent care credit under section 290.067, the Minnesota
working family credit under section 290.0671, the property tax refund and rental credit
under section 290A.04, and the Minnesota education credit under section 290.0674;

(9) between the Department of Human Services, the Department of Employment
and Economic Development, and when applicable, the Department of Education, for
the following purposes:

(i) to monitor the eligibility of the data subject for unemployment benefits, for any
employment or training program administered, supervised, or certified by that agency;

(ii) to administer any rehabilitation program or child care assistance program,
whether alone or in conjunction with the welfare system;

(iii) to monitor and evaluate the Minnesota family investment program or the child
care assistance program by exchanging data on recipients and former recipients of food
support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance
under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and

(iv) to analyze public assistance employment services and program utilization,
cost, effectiveness, and outcomes as implemented under the authority established in Title
II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of
1999. Health records governed by sections 144.291 to 144.298 and "protected health
information" as defined in Code of Federal Regulations, title 45, section 160.103, and
governed by Code of Federal Regulations, title 45, parts 160-164, including health care
claims utilization information, must not be exchanged under this clause;

(10) to appropriate parties in connection with an emergency if knowledge of
the information is necessary to protect the health or safety of the individual or other
individuals or persons;

(11) data maintained by residential programs as defined in section 245A.02 may
be disclosed to the protection and advocacy system established in this state according
to Part C of Public Law 98-527 to protect the legal and human rights of persons with
developmental disabilities or other related conditions who live in residential facilities for
these persons if the protection and advocacy system receives a complaint by or on behalf
of that person and the person does not have a legal guardian or the state or a designee of
the state is the legal guardian of the person;

(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;

(13) data on a child support obligor who makes payments to the public agency
may be disclosed to the Minnesota Office of Higher Education to the extent necessary to
determine eligibility under section 136A.121, subdivision 2, clause (5);

(14) participant Social Security numbers and names collected by the telephone
assistance program may be disclosed to the Department of Revenue to conduct an
electronic data match with the property tax refund database to determine eligibility under
section 237.70, subdivision 4a;

(15) the current address of a Minnesota family investment program participant
may be disclosed to law enforcement officers who provide the name of the participant
and notify the agency that:

(i) the participant:

(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or

(B) is violating a condition of probation or parole imposed under state or federal law;

(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and

(iii) the request is made in writing and in the proper exercise of those duties;

(16) the current address of a recipient of general assistance or general assistance
medical care may be disclosed to probation officers and corrections agents who are
supervising the recipient and to law enforcement officers who are investigating the
recipient in connection with a felony level offense;

(17) information obtained from food support applicant or recipient households may
be disclosed to local, state, or federal law enforcement officials, upon their written request,
for the purpose of investigating an alleged violation of the Food Stamp Act, according
to Code of Federal Regulations, title 7, section 272.1(c);

(18) the address, Social Security number, and, if available, photograph of any
member of a household receiving food support shall be made available, on request, to a
local, state, or federal law enforcement officer if the officer furnishes the agency with the
name of the member and notifies the agency that:

(i) the member:

(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;

(B) is violating a condition of probation or parole imposed under state or federal
law; or

(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);

(ii) locating or apprehending the member is within the officer's official duties; and

(iii) the request is made in writing and in the proper exercise of the officer's official
duty;

(19) the current address of a recipient of Minnesota family investment program,
general assistance, general assistance medical care, or food support may be disclosed to
law enforcement officers who, in writing, provide the name of the recipient and notify the
agency that the recipient is a person required to register under section 243.166, but is not
residing at the address at which the recipient is registered under section 243.166;

(20) certain information regarding child support obligors who are in arrears may be
made public according to section 518A.74;

(21) data on child support payments made by a child support obligor and data on
the distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the
income of the obligor or obligee may be disclosed to the other party;

(22) data in the work reporting system may be disclosed under section 256.998,
subdivision 7;

(23) to the Department of Education for the purpose of matching Department of
Education student data with public assistance data to determine students eligible for free
and reduced price meals, meal supplements, and free milk according to United States
Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and
state funds that are distributed based on income of the student's family; and to verify
receipt of energy assistance for the telephone assistance plan;

(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a local board of health as
defined in section 145A.02, subdivision 2, when the commissioner or local board of health
has reason to believe that a program recipient is a disease case, carrier, suspect case, or at
risk of illness, and the data are necessary to locate the person;

(25) to other state agencies, statewide systems, and political subdivisions of this
state, including the attorney general, and agencies of other states, interstate information
networks, federal agencies, and other entities as required by federal regulation or law for
the administration of the child support enforcement program;

(26) to personnel of public assistance programs as defined in section 256.741, for
access to the child support system database for the purpose of administration, including
monitoring and evaluation of those public assistance programs;

(27) to monitor and evaluate the Minnesota family investment program by
exchanging data between the Departments of Human Services and Education, on
recipients and former recipients of food support, cash assistance under chapter 256, 256D,
256J, or 256K, child care assistance under chapter 119B, or medical programs under
chapter 256B, 256D, or 256L;

(28) to evaluate child support program performance and to identify and prevent
fraud in the child support program by exchanging data between the Department of Human
Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a)
and (b), without regard to the limitation of use in paragraph (c), Department of Health,
Department of Employment and Economic Development, and other state agencies as is
reasonably necessary to perform these functions; deleted text begin or
deleted text end

(29) counties operating child care assistance programs under chapter 119B may
disseminate data on program participants, applicants, and providers to the commissioner
of education new text begin ; or
new text end

new text begin (30) according to section 256.01, subdivision 27, between the welfare system and the
Minnesota Health Insurance Exchange under section 62U.02, in order to collect premiums
from individuals in the medical assistance employed persons with disabilities program
and the MinnesotaCare program under chapters 256B and 256L and to administer the
individual's and the individual's families' participation in the Exchange new text end .

(b) Information on persons who have been treated for drug or alcohol abuse may
only be disclosed according to the requirements of Code of Federal Regulations, title
42, sections 2.1 to 2.67.

(c) Data provided to law enforcement agencies under paragraph (a), clause (15),
(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).

(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is
not subject to the access provisions of subdivision 10, paragraph (b).

For the purposes of this subdivision, a request will be deemed to be made in writing
if made through a computer interface system.

Sec. 2.

Minnesota Statutes 2006, section 62A.65, subdivision 3, is amended to read:

Subd. 3.

Premium rate restrictions.

No individual health plan may be offered,
sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
determined in accordance with the following requirements:

(a) new text begin Except for policies issued under section 62U.03, subdivision 5, paragraph (b),
new text end premium rates must be no more than 25 percent above and no more than 25 percent below
the index rate charged to individuals for the same or similar coverage, adjusted pro
rata for rating periods of less than one year. The premium variations permitted by this
paragraph must be based only upon health status, claims experience, and occupation. For
purposes of this paragraph, health status includes refraining from tobacco use or other
actuarially valid lifestyle factors associated with good health, provided that the lifestyle
factor and its effect upon premium rates have been determined by the commissioner to
be actuarially valid and have been approved by the commissioner. Variations permitted
under this paragraph must not be based upon age or applied differently at different ages.
This paragraph does not prohibit use of a constant percentage adjustment for factors
permitted to be used under this paragraph.

(b) Premium rates may vary based upon the ages of covered persons only as
provided in this paragraph. In addition to the variation permitted under paragraph (a),
each health carrier may use an additional premium variation based upon age of up to
plus or minus 50 percent of the index rate.

(c) A health carrier may request approval by the commissioner to establish separate
geographic regions determined by the health carrier and to establish separate index rates
for each such region. The commissioner shall grant approval if the following conditions
are met:

(1) the geographic regions must be applied uniformly by the health carrier;

(2) each geographic region must be composed of no fewer than seven counties that
create a contiguous region; and

(3) the health carrier provides actuarial justification acceptable to the commissioner
for the proposed geographic variations in index rates, establishing that the variations are
based upon differences in the cost to the health carrier of providing coverage.

(d) Health carriers may use rate cells and must file with the commissioner the rate
cells they use. Rate cells must be based upon the number of adults or children covered
under the policy and may reflect the availability of Medicare coverage. The rates for
different rate cells must not in any way reflect generalized differences in expected costs
between principal insureds and their spouses.

(e) In developing its index rates and premiums for a health plan, a health carrier shall
take into account only the following factors:

(1) actuarially valid differences in rating factors permitted under paragraphs (a)
and (b); and

(2) actuarially valid geographic variations if approved by the commissioner as
provided in paragraph (c).

(f) All premium variations must be justified in initial rate filings and upon request of
the commissioner in rate revision filings. All rate variations are subject to approval by
the commissioner.

(g) The loss ratio must comply with the section 62A.021 requirements for individual
health plans.

(h) The rates must not be approved, unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the commissioner shall consider the
growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar
year or years that the proposed premium rate would be in effect, actuarially valid changes
in risks associated with the enrollee populations, and actuarially valid changes as a result
of statutory changes in Laws 1992, chapter 549.

(i) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under
section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
paragraph. The rating practices guarantee must be in writing and must guarantee that
the policy form will be offered, sold, issued, and renewed only with premium rates and
premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices
guarantee must be accompanied by an actuarial memorandum that demonstrates that the
premium rates and premium rating system used in connection with the policy form will
satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to
policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4,
or 5. An insurer that complies with this paragraph in connection with a policy form is
exempt from the requirement of prior approval by the commissioner under paragraphs
(c), (f), and (h).

Sec. 3.

Minnesota Statutes 2006, section 62E.141, is amended to read:

62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.

No employee of an employer that offers a new text begin group new text end health plan, under which the
employee is eligible for coverage, is eligible to enroll, or continue to be enrolled, in
the comprehensive health association, except for enrollment or continued enrollment
necessary to cover conditions that are subject to an unexpired preexisting condition
limitation, preexisting condition exclusion, or exclusionary rider under the employer's
health plan. This section does not apply to persons enrolled in the Comprehensive Health
Association as of June 30, 1993. With respect to persons eligible to enroll in the health
plan of an employer that has more than 29 current employees, as defined in section
62L.02, this section does not apply to persons enrolled in the Comprehensive Health
Association as of December 31, 1994.

Sec. 4.

Minnesota Statutes 2006, section 62L.12, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

(a) A health carrier may sell, issue, or renew individual
conversion policies to eligible employees otherwise eligible for conversion coverage under
section 62D.104 as a result of leaving a health maintenance organization's service area.

(b) A health carrier may sell, issue, or renew individual conversion policies to
eligible employees otherwise eligible for conversion coverage as a result of the expiration
of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21,
62C.142, 62D.101, and 62D.105.

(c) A health carrier may sell, issue, or renew conversion policies under section
62E.16 to eligible employees.

(d) A health carrier may sell, issue, or renew individual continuation policies to
eligible employees as required.

(e) A health carrier may sell, issue, or renew individual health plans if the coverage
is appropriate due to an unexpired preexisting condition limitation or exclusion applicable
to the person under the employer's group health plan or due to the person's need for health
care services not covered under the employer's group health plan.

(f) A health carrier may sell, issue, or renew an individual health plan, if the
individual has elected to buy the individual health plan not as part of a general plan to
substitute individual health plans for a group health plan nor as a result of any violation of
subdivision 3 or 4.

(g) Nothing in this subdivision relieves a health carrier of any obligation to provide
continuation or conversion coverage otherwise required under federal or state law.

(h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage
issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or
contracts that supplement Medicare issued by health maintenance organizations, or those
contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social
Security Act, United States Code, title 42, section 1395 et seq., as amended.

(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
health plans necessary to comply with a court order.

(j) A health carrier may offer, issue, sell, or renew an individual health plan to
persons eligible for an employer group health plan, if the individual health plan is a high
deductible health plan for use in connection with an existing health savings account, in
compliance with the Internal Revenue Code, section 223. In that situation, the same or
a different health carrier may offer, issue, sell, or renew a group health plan to cover
the other eligible employees in the group.

(k) A health carrier may offer, sell, issue, or renew an individual health plan to one
or more employees of a small employer if the individual health plan is marketed directly new text begin to
employees or through the Minnesota Health Insurance Exchange under section 62U.02 new text end to
all employees of the small employer and the small employer does not contribute directly
or indirectly to the premiums or facilitate the administration of the individual health plan.
new text begin Except as provided in section 62U.03, subdivision 5, paragraph (b), new text end the requirement to
market an individual health plan to all employees does not require the health carrier to
offer or issue an individual health plan to any employee. For purposes of this paragraph,
an employer is not contributing to the premiums or facilitating the administration of the
individual health plan if the employer does not contribute to the premium and merely
collects the premiums from an employee's wages or salary through payroll deductions
and submits payment for the premiums of one or more employees in a lump sum to the
health carrier new text begin or to the Minnesota Health Insurance Exchange under section 62U.02 new text end .
Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the
request of an employee, the health carrier new text begin or the Minnesota Health Insurance Exchange
under section 62U.02 new text end may bill the employer for the premiums payable by the employee,
provided that the employer is not liable for payment except from payroll deductions for
that purpose. If an employer is submitting payments under this paragraph, the health
carrier new text begin or the Minnesota Health Insurance Exchange, as applicable, new text end shall provide a
cancellation notice directly to the primary insured at least ten days prior to termination
of coverage for nonpayment of premium. Individual coverage under this paragraph may
be offered only if the small employer has not provided coverage under section 62L.03 to
the employees within the past 12 months.

The employer must provide a written and signed statement to the health carrier new text begin or
the Minnesota Health Insurance Exchange, as applicable, stating new text end that the employer is not
contributing directly or indirectly to the employee's premiums. new text begin The Minnesota Health
Insurance Exchange under section 62U.02 shall provide all health carriers with enrolled
employees of the employer with a copy of the employer's statement. new text end The health carrier
may rely on the employer's statement and is not required to guarantee-issue individual
health plans to the employer's deleted text begin other current or future deleted text end employees.

Sec. 5.

Minnesota Statutes 2006, section 62L.12, subdivision 4, is amended to read:

Subd. 4.

Employer prohibition.

A small employer new text begin offering a health benefit plan
new text end shall not encourage or direct an employee or applicant to:

(1) refrain from filing an application for health coverage when other similarly
situated employees may file an application for health coverage;

(2) file an application for health coverage during initial eligibility for coverage,
the acceptance of which is contingent on health status, when other similarly situated
employees may apply for health coverage, the acceptance of which is not contingent on
health status;

(3) seek coverage from another health carrier, including, but not limited to, MCHA;
or

(4) cause coverage to be issued on different terms because of the health status or
claims experience of that person or the person's dependents.

Sec. 6.

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

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For purposes of this chapter, the terms defined in this
section have the meanings given, unless otherwise specified.
new text end

new text begin Subd. 2. new text end

new text begin Board. new text end

new text begin "Board" means the Health Benefit and Design Board established
in section 62U.04.
new text end

new text begin Subd. 3. new text end

new text begin Clinically effective. new text end

new text begin "Clinically effective" means that the use of a
particular health technology improves patient clinical status, as measured by medical
condition, survival rates, and other variables, and that the use of the particular technology
demonstrates a clinical advantage over alternative technologies.
new text end

new text begin Subd. 4. new text end

new text begin Cost effective. new text end

new text begin "Cost effective" means that the economic costs of using
a particular service, device, or health technology to achieve improvement in a patient's
health outcome are justified given the comparison to both the economic costs and the
improvement in patient health outcome resulting from the use of an alternative service,
device, or technology, or from not providing the service, device, or technology.
new text end

new text begin Subd. 5. new text end

new text begin Exchange. new text end

new text begin "Exchange" means the Minnesota Health Insurance Exchange
established in section 62U.02.
new text end

new text begin Subd. 6. new text end

new text begin Health plan. new text end

new text begin "Health plan" means a health plan as defined in section
62A.011.
new text end

new text begin Subd. 7. new text end

new text begin Health plan company. new text end

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

new text begin Subd. 8. new text end

new text begin Health technology. new text end

new text begin "Health technology" means medical and surgical
devices and procedures, medical equipment, and diagnostic tests.
new text end

new text begin Subd. 9. new text end

new text begin Section 125 Plan. new text end

new text begin "Section 125 Plan" means a cafeteria or premium-only
plan under section 125 of the Internal Revenue Code that allows employees to pay for
health insurance premiums with pretax dollars.
new text end

new text begin Subd. 10. new text end

new text begin Third-party administrators. new text end

new text begin "Third-party administrators" means a
vendor of risk-management services or an entity administering a self-insurance or health
insurance plan under section 60A.23.
new text end

Sec. 7.

new text begin [62U.02] MINNESOTA HEALTH INSURANCE EXCHANGE.
new text end

new text begin Subdivision 1. new text end

new text begin Title; citation. new text end

new text begin This section may be cited as the "Minnesota Health
Insurance Exchange."
new text end

new text begin Subd. 2. new text end

new text begin Creation; tax exemption. new text end

new text begin The Minnesota Health Insurance Exchange
is created for the limited purpose of providing individuals with greater access, choice,
portability, and affordability of health insurance products. The Minnesota Health
Insurance Exchange is created as an unincorporated association and shall promptly
incorporate as a nonprofit corporation under chapter 317A and apply for qualification
under section 501(c) of the Internal Revenue Code.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

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

new text begin (a) "Board" means the Board of Directors of the Minnesota Health Insurance
Exchange under subdivision 13.
new text end

new text begin (b) "Commissioner" means:
new text end

new text begin (1) the commissioner of commerce for health plan companies subject to the
jurisdiction of the Department of Commerce;
new text end

new text begin (2) the commissioner of health for health plan companies subject to the jurisdiction
of the Department of Health; or
new text end

new text begin (3) either commissioner's designated representative.
new text end

new text begin (c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
new text end

new text begin (d) "Individual market health plan" means a health plan as defined in section
62A.011.
new text end

new text begin (e) "Small employer" means a small employer as defined in section 62L.02,
subdivision 26.
new text end

new text begin (f) "Small employer health benefit plan" means a health benefit plan as defined in
section 62L.02, subdivision 15.
new text end

new text begin Subd. 4. new text end

new text begin Health plan company and health plan participation and availability.
new text end

new text begin (a) Only individual market health plans and small employer health benefit plans offered by
a health plan company licensed to issue health plans in Minnesota must be made available
for purchase through the Exchange.
new text end

new text begin (b) Each health plan made available by a health plan company through the Exchange
must meet the minimum benefit and design requirements provided under section 62U.04,
subdivision 5.
new text end

new text begin (c) Any health plan company that issues health plans in the individual or small
employer market must offer through the Exchange at least one health plan that meets
the benefits set and design established by the Health Benefits and Design Board under
section 62U.04.
new text end

new text begin (d) Health plans offered through the Minnesota Comprehensive Health Association
as defined in section 62E.10 must be available for sale through the Exchange as determined
by the Minnesota Comprehensive Health Association.
new text end

new text begin (e) Health plans offered through the MinnesotaCare program must be available
through the Exchange, as determined by the commissioner of human services, to
individuals and families who meet the eligibility requirements for MinnesotaCare and
who pay premiums through an employer Section 125 Plan.
new text end

new text begin (f) Nothing in this section restricts the sale of individual market health plans and
small employer health benefit plans outside the Exchange. The requirements applicable
to issuance, renewal, cancelation, and pricing of coverage are the same for health plans
purchased inside and outside the Exchange, except as described under section 62U.03,
subdivision 5, paragraph (b).
new text end

new text begin Subd. 5. new text end

new text begin Ranking of health plans. new text end

new text begin The Exchange shall create an Internet-based
system for ranking individual market health plans and small employer health benefit
plans. The ranking system shall consider variation across plans in factors, including, but
not limited to, premiums, deductibles, co-payment and coinsurance requirements, annual
out-of-pocket maximum payments, and lifetime benefit limits, and the system shall rank
plans based on priorities specified by the user.
new text end

new text begin Subd. 6. new text end

new text begin Individual participation and eligibility. new text end

new text begin Individuals are eligible to
purchase health plans directly through the Exchange or through an employer Section
125 Plan under section 62U.03. Nothing in this section requires guaranteed issue of
individual market health plans offered through the Exchange except as provided under
section 62U.03, subdivision 5, paragraph (b). Individuals are eligible to purchase
individual market health plans through the Exchange by meeting one or more of the
following qualifications:
new text end

new text begin (1) the individual is a Minnesota resident, meaning the individual is physically
residing on a permanent basis in a place that is the person's principal residence and from
which the person is absent only for temporary purposes;
new text end

new text begin (2) the individual is a student attending an institution outside of Minnesota and
maintains Minnesota residency;
new text end

new text begin (3) the individual is not a Minnesota resident but is employed by an employer
physically located within the state and the individual's employer is required to offer a
Section 125 Plan under section 62U.03; or
new text end

new text begin (4) the individual is a dependent as defined in section 62L.02, of another individual
who is eligible to participate in the Exchange.
new text end

new text begin Subd. 7. new text end

new text begin Small employer participation and eligibility. new text end

new text begin Small employers, as
defined in section 62L.02, may purchase health plans through the Exchange.
new text end

new text begin Subd. 8. new text end

new text begin Responsibilities of the Exchange. new text end

new text begin The Exchange may serve as a
coordinating entity for enrollment and collection and transfer of premium payments for
health plans sold to individuals through the Exchange. The Exchange must be responsible
for the following functions:
new text end

new text begin (1) publicize the Exchange, including but not limited to its functions, eligibility
rules, and enrollment procedures;
new text end

new text begin (2) provide assistance to employers to establish Section 125 Plans under section
62U.03;
new text end

new text begin (3) provide education and assistance to employers to help them understand the
requirements of Section 125 Plans and compliance with applicable regulations;
new text end

new text begin (4) create a system to allow individuals to compare and enroll in health plans
offered through the Exchange, including a system of comparative rating of health plans
and benefits set;
new text end

new text begin (5) create a system to collect and transmit to the applicable plans all premium
payments made by individuals, including developing mechanisms to receive and process
automatic payroll deductions for individuals who purchase coverage through employer
Section 125 Plans;
new text end

new text begin (6) for participating employers, bill the employer for the premiums payable by the
employer for a small employer health benefit plan;
new text end

new text begin (7) for individuals purchasing individual market health plans through a Section 125
Plan, bill the individual's employer for premiums payable by the employee, provided that
the employer is not liable for payment except from payroll deductions for that purpose;
new text end

new text begin (8) provide information on public insurance programs to individuals who may
qualify for these programs, and provide application assistance, if needed on applying
for these programs;
new text end

new text begin (9) establish a mechanism with the Department of Human Services to transfer
premiums paid by Minnesota health care program enrollees from Section 125 Plans;
new text end

new text begin (10) establish procedures to account for all funds received and disbursed by the
Exchange; and
new text end

new text begin (11) make available to the public, within 90 days from the end of each fiscal year, a
report of an independent audit of the Exchange's accounts.
new text end

new text begin Subd. 9. new text end

new text begin State not liable. new text end

new text begin The state of Minnesota is not liable for the actions of
the Exchange.
new text end

new text begin Subd. 10. new text end

new text begin Powers of the Exchange. new text end

new text begin The Exchange shall have the power to:
new text end

new text begin (1) contract with insurance producers licensed in accident and health insurance
under chapter 60K and vendors to perform one or more of the functions specified in
subdivision 8;
new text end

new text begin (2) contract with employers to collect premiums for small employer health benefit
plans and for individual market health plans purchased through a Section 125 Plan;
new text end

new text begin (3) establish and assess fees on health plan premiums of small employer health
benefit plans and individual market health plans to fund the cost of administering the
Exchange;
new text end

new text begin (4) seek and directly receive grant funding from government agencies or private
philanthropic organizations to defray the costs of operating the Exchange;
new text end

new text begin (5) establish and administer rules and procedures governing the operations of the
Exchange;
new text end

new text begin (6) establish one or more service centers within Minnesota;
new text end

new text begin (7) sue or be sued or otherwise take any necessary or proper legal action;
new text end

new text begin (8) establish bank accounts and borrow money; and
new text end

new text begin (9) enter into agreements with the commissioners of commerce, health, human
services, revenue, employment and economic development, and other state agencies as
necessary for the Exchange to implement the provisions of this section.
new text end

new text begin Subd. 11. new text end

new text begin Dispute resolution. new text end

new text begin The Exchange shall establish procedures for
resolving disputes with respect to the eligibility of an individual to participate in the
Exchange. The Exchange shall not have the authority or responsibility to intervene in or
resolve disputes between an individual and a health plan or health plan company. The
Exchange shall refer complaints from individuals participating in the Exchange to the
commissioner to be resolved according to sections 62Q.68 to 62Q.73.
new text end

new text begin Subd. 12. new text end

new text begin Governance. new text end

new text begin The Exchange shall be governed by a board of directors
with 11 members. The board shall convene on or before July 1, 2008, after the initial board
members have been selected. The initial board membership consists of the following:
new text end

new text begin (1) the commissioner of commerce;
new text end

new text begin (2) the commissioner of human services;
new text end

new text begin (3) the commissioner of health; and
new text end

new text begin (4) eight members with knowledge and experience related to health insurance
and health insurance markets, appointed to serve three-year terms as follows: two
members appointed by the Subcommittee on Committees of the Committee on Rules and
Administration of the senate; two members appointed by the speaker of the house of
representatives; and four members appointed by the governor.
new text end

new text begin Subd. 13. new text end

new text begin Subsequent board membership. new text end

new text begin (a) Effective July 1, 2011, ongoing
membership of the Exchange consists of the following:
new text end

new text begin (1) the commissioner of commerce;
new text end

new text begin (2) the commissioner of human services;
new text end

new text begin (3) the commissioner of health;
new text end

new text begin (4) two members appointed as follows: one member appointed by the Subcommittee
on Committees of the Committee on Rules and Administration of the senate; and one
member appointed by the speaker of the house of representatives to serve two-year
terms; and
new text end

new text begin (5) four members elected by the membership of the Exchange of which two are
elected to serve a two-year term and two are elected to serve a three-year term.
new text end

new text begin (b) Elected members may serve more than one term. At least one of the elected
members must represent a small employer, and at least one member must be a person who
purchases an individual market health plan through the Exchange.
new text end

new text begin Subd. 14. new text end

new text begin Operations of the board. new text end

new text begin Officers of the board of directors are elected by
members of the board and serve one-year terms. Six members of the board constitutes a
quorum, and the affirmative vote of six members of the board is necessary and sufficient
for any action taken by the board. Board members serve without pay, but are reimbursed
for actual expenses incurred in the performance of their duties.
new text end

new text begin Subd. 15. new text end

new text begin Operations of the Exchange. new text end

new text begin The board of directors shall appoint an
Exchange director who shall:
new text end

new text begin (1) be a full-time employee of the Exchange;
new text end

new text begin (2) administer all of the activities and contracts of the Exchange; and
new text end

new text begin (3) hire and supervise the staff of the Exchange.
new text end

new text begin Subd. 16. new text end

new text begin Insurance producers. new text end

new text begin An individual has the right to choose any
insurance producer licensed in accident and health insurance under chapter 60K to assist
them in purchasing an individual market health plan through the Exchange. When a
producer licensed in accident and health insurance under chapter 60K enrolls an eligible
individual in the Exchange, the health plan company chosen by the individual may pay the
producer a commission.
new text end

new text begin Subd. 17. new text end

new text begin Implementation. new text end

new text begin Health plan coverage through the Exchange begins on
July 1, 2009. The Exchange must be operational to assist employers and individuals by
January 1, 2009, and be prepared for enrollment by June 1, 2009.
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

Sec. 8.

new text begin [62U.03] SECTION 125 PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin The following terms have the meanings given them.
new text end

new text begin (a) "Current employee" means an employee currently on an employer's payroll other
than a retiree or disabled former employee.
new text end

new text begin (b) "Employer" means a person, firm, corporation, partnership, association, business
trust, or other entity employing one or more persons, including a political subdivision of
the state, filing payroll tax information on such employed person or persons.
new text end

new text begin (c) "Exchange" means the Minnesota Health Insurance Exchange in section 62U.02.
new text end

new text begin (d) "Exchange director" means the appointed director under section 62U.02,
subdivision 15.
new text end

new text begin Subd. 2. new text end

new text begin Section 125 Plan requirement. new text end

new text begin (a) Effective January 1, 2010, each
employer that has three or more current employees shall establish a Section 125 Plan to
either allow its employees to purchase individual market health plan coverage or allow
its employees to pay the employees share of premiums for employer-based health plan
coverage with pretax dollars. Nothing in this section requires an employer to offer or
purchase group health insurance coverage for its employees. An employer that has no
employees who are eligible to participate in a Section 125 Plan is exempt from this
requirement.
new text end

new text begin (b) An employer that offers a Section 125 Plan may enter into an agreement with the
Exchange to administer the employer's Section 125 Plan.
new text end

new text begin Subd. 3. new text end

new text begin Tracking compliance. new text end

new text begin By July 1, 2010, the Exchange, in consultation with
the commissioners of commerce, health, employment and economic development, and
revenue shall establish a method for tracking employer compliance with the Section 125
Plan requirement.
new text end

new text begin Subd. 4. new text end

new text begin Employer requirements. new text end

new text begin Employers that do not offer a group health
insurance plan as defined in section 62A.10 and that are required to offer or choose
to offer a Section 125 Plan shall:
new text end

new text begin (1) allow employees to purchase an individual market health plan for themselves
and their dependents;
new text end

new text begin (2) allow employees to choose any insurance producer licensed in accident and health
insurance under chapter 60K to assist them in purchasing an individual market health plan;
new text end

new text begin (3) upon an employee's request, deduct premium amounts on a pretax basis in an
amount not to exceed an employee's wages, and remit these employee payments to the
health plan company or the Exchange; and
new text end

new text begin (4) provide notice to employees that individual market health plans purchased
by employees through payroll deduction are not employer-sponsored or administered.
Employers shall be held harmless from any and all liability claims related to the individual
market health plans purchased by employees under a Section 125 Plan.
new text end

new text begin Subd. 5. new text end

new text begin Health plan company requirements. new text end

new text begin (a) Individuals who are eligible
to use an employer Section 125 Plan may use it to pay for an individual market health
plan for which the individual is eligible and purchase it through the Exchange, including
an individual market health plan, MinnesotaCare, and the Minnesota Comprehensive
Health Association.
new text end

new text begin (b) Individuals who purchase an individual market health plan through a Section 125
Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment
period that coincides with the open enrollment period for their employer's Section 125
Plan or upon experiencing a qualifying event as defined in United States Code, title 43,
section 4980B. Nothing in this section precludes a health plan company from issuing
coverage with preexisting condition exclusions as allowed elsewhere in law. Health plans
may not charge higher or lower premiums based on health status for individuals who
purchase coverage on a guaranteed issue basis under this section, except for variations in
premium that are allowable based on health behaviors such as tobacco use.
new text end

Sec. 9.

new text begin [62U.04] COST-EFFECTIVE BENEFITS SET AND DESIGN.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin There is created a Health Benefits and Design Board that
consists of seven voting members and four ex officio nonvoting members.
new text end

new text begin Subd. 2. new text end

new text begin Members. new text end

new text begin (a) The voting membership of the board shall be appointed
to serve three-year terms as follows: three members appointed by the governor; two
members appointed by the Subcommittee on Committees of the Committee on Rules and
Administration of the senate; and two members appointed by the speaker of the house
of representatives.
new text end

new text begin (b) The nonvoting members shall be the commissioners of health, human services,
commerce, and finance, or their designees.
new text end

new text begin (c) No voting members shall have a direct financial interest in the outcome of the
board's proceeding other than as an individual consumer of health care services.
new text end

new text begin (d) The voting members shall have expertise in benefit design and development,
actuarial analysis, or knowledge relating to the analysis of the cost impact of coverage of
specified benefits.
new text end

new text begin Subd. 3. new text end

new text begin Operations of the board. new text end

new text begin (a) The board shall convene on or before
September 1, 2008, upon the appointment of the initial board and shall meet at least once a
year, and at other times at the call of the chair.
new text end

new text begin (b) The board may hire an executive director who shall serve 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 (c) The commissioner of health shall provide office space, equipment and supplies,
and technical support to the board.
new text end

new text begin (d) The board shall be governed by section 15.0575, except the board shall not expire.
new text end

new text begin Subd. 4. new text end

new text begin Immunity of liability. new text end

new text begin No member of the board may be held civilly liable
for an act or omission by that member if the act or omission was in good faith and within
the scope of the member's responsibilities under this chapter.
new text end

new text begin Subd. 5. new text end

new text begin Duties of the board. new text end

new text begin (a) The board shall establish an initial cost-effective,
evidence-based benefit set and design by January 15, 2009, that provides individuals
access to a broad range of health care services, including preventive health care, without
incurring severe financial loss as a result of serious illness or injury. The initial benefit set
must include necessary evidence-based health care services, procedures, and diagnostic
tests that are scientifically proven to be both clinically effective and cost effective. In
establishing the initial benefit set, the board may contract with the Institute for Clinical
Systems Improvement (ICSI) to assemble existing scientifically based practice standards.
The board shall consider cultural, ethnic, and religious values and beliefs to ensure that the
health care needs of all Minnesota residents are addressed in the benefit set.
new text end

new text begin (b) The benefit set must cover preventive services, immunizations, and
early diagnostic tests, that are scientifically proven to be both clinically effective
and cost-effective with no cost-sharing requirements. The benefit set must cover
evidence-based outpatient care for chronic conditions, including but not limited to asthma,
heart disease, diabetes, and depression with no cost-sharing requirements, or cost-sharing
requirements that do not impose an economic barrier to access that care.
new text end

new text begin (c) The benefit set must include ICSI-designated evidence-based outpatient care for
asthma, heart disease, diabetes, and depression with no cost-sharing requirements, or with
cost-sharing requirements that do not impose an economic barrier to accessing the care.
new text end

new text begin (d) Before finalizing the benefit set, the board shall convene public hearings
throughout the state.
new text end

new text begin (e) The benefit set and design shall be used as a minimum requirement for health
plans offered through the Exchange and be the only benefit plan eligible for premium
subsidies under section 62U.09. The benefit design must establish a limited number of
maximum cost-sharing variations based upon deductibles and maximum out-of-pocket
costs. There shall be no maximum lifetime benefit.
new text end

new text begin Subd. 6. new text end

new text begin Continued review. new text end

new text begin The board shall review the benefit set on an ongoing
periodic basis and shall adjust the benefit set as necessary to ensure that the benefit design
continues to be safe, effective, and scientifically based.
new text end

new text begin Subd. 7. new text end

new text begin Exemption from administrative procedures. new text end

new text begin To carry out the purposes
of this section and section 62U.05, the board may adopt rules under chapter 14. The board
is exempt from rulemaking requirements to the extent rules are necessary to establish the
benefit set and design described in subdivision 5. The board may use the provisions of
section 14.386, paragraph (a), clauses (1) and (3). Rules adopted are exempt from section
14.386, paragraph (b).
new text end

Sec. 10.

new text begin [62U.05] HEALTH TECHNOLOGY ASSESSMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Technology Advisory Committee. new text end

new text begin (a) The Health Benefit Set and
Design Board shall convene an advisory committee to make recommendations to the
board regarding the inclusion of new and existing health technologies in the cost-effective
benefit set.
new text end

new text begin (b) The advisory committee must be made up of 11 members appointed by
the board's executive director, in consultation with the Institute for Clinical Systems
Improvement, the Health Services Advisory Council, and the University of Minnesota.
The members shall consist of:
new text end

new text begin (1) six practicing physicians licensed under chapter 147; and
new text end

new text begin (2) five other practicing health care professionals who use health technology in
their scope of practice.
new text end

new text begin (c) A member of the advisory committee shall not have a substantial financial
interest in a health technology company and shall not be employed by or under contract
with a health technology manufacturer during their term or for 18 months before their
appointment.
new text end

new text begin (d) The members shall be immune from civil liability for any official acts performed
in good faith as members of the committee.
new text end

new text begin (e) The advisory committee shall be governed under section 15.059, except that
the committee shall not expire.
new text end

new text begin Subd. 2. new text end

new text begin Technology selection process. new text end

new text begin The board, in consultation with the
advisory committee, shall select existing and new health technologies to be reviewed by
the committee. In making a selection, priority shall be given to any technology for which:
new text end

new text begin (1) there are concerns about its safety, efficacy, or cost effectiveness;
new text end

new text begin (2) actual or expected expenditures are high due to demand for the technology,
its cost, or both; and
new text end

new text begin (3) there is adequate evidence available to conduct a complete review.
new text end

new text begin Subd. 3. new text end

new text begin Technology review. new text end

new text begin (a) Upon the selection of a health technology for
review, the board shall contract for a systematic evidence-based assessment of the
technology's safety, efficacy, and cost effectiveness. The contract must be with an
evidence-based practice center designated by the federal Agency for Health Care Research
and Quality, or another appropriate entity as designated by the board.
new text end

new text begin (b) The board shall provide notification to the public when a health technology
has been selected for review. The notification must indicate when that review is to be
initiated and how an interested party may submit evidence or provide public comment for
consideration during the review.
new text end

new text begin Subd. 4. new text end

new text begin Committee determination. new text end

new text begin (a) Upon reviewing the completed assessment
and any other evidence submitted regarding the safety, efficacy, and cost effectiveness of
the technology, the committee shall recommend to the board:
new text end

new text begin (1) the conditions, if any, under which the health technology should be included
as a covered benefit; and
new text end

new text begin (2) if covered, the criteria to be used to decide whether the technology is medically
necessary, or proper and necessary treatment.
new text end

new text begin (b) The commissioners of human services, employee relations, and corrections may
use the committee's recommendation in making coverage and reimbursement decisions
unless the recommendation conflicts with an applicable federal statute or regulation.
new text end

Sec. 11.

new text begin [62U.06] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT
INDIVIDUAL RESPONSIBILITY REQUIREMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Phase-in goals. new text end

new text begin The state's phase-in goals for progress toward
universal health coverage for Minnesota residents are:
new text end

new text begin (1) 94 percent insured by end of fiscal year 2009;
new text end

new text begin (2) 96 percent insured by end of fiscal year 2011;
new text end

new text begin (3) 97 percent insured by end of fiscal year 2012; and
new text end

new text begin (4) 98 percent insured by end of fiscal year 2013 and thereafter.
new text end

new text begin Subd. 2. new text end

new text begin Measurement of percent insured. new text end

new text begin The determination of the percent
of Minnesota residents insured must be based on an annual survey of the Minnesota
population younger than age 65 to be conducted or contracted for by the commissioner
of health which must include questions related to the type of insurance, amount of
cost-sharing, and potential barriers to public program enrollment.
new text end

new text begin Subd. 3. new text end

new text begin Contingent individual responsibility requirement. new text end

new text begin (a) If the increased
affordability, cost containment, insurance reform, and voluntary efforts provided for under
this section fail to achieve universal coverage, an individual responsibility requirement
will have been proven to be necessary.
new text end

new text begin (b) If any one of the phase-in goals specified in subdivision 1 for fiscal year 2011 or
later is not met, as determined by the commissioner of health, in spite of implementation
of the increased affordability, cost containment, insurance reform, and voluntary efforts
provided for under 62U.01 to 62U.09, an individual responsibility requirement, requiring
every Minnesota resident to obtain and maintain health coverage from a public or private
sector source of the person's choice, shall become effective 12 months after the end of
that fiscal year.
new text end

new text begin (c) Failure to comply with the individual responsibility requirement is not a crime,
but will subject the person to a financial penalty to be specified in law.
new text end

Sec. 12.

new text begin [62U.07] SAVINGS RECAPTURE ASSESSMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Projected spending baseline. new text end

new text begin (a) The commissioner of health shall
calculate the annual projected total health care spending for the state and establish a health
care spending baseline beginning for the year 2008 and for the next five years based on
the annual projected growth in spending.
new text end

new text begin (b) In establishing the health care spending baseline, the commissioner shall use
the Center of Medicare and Medicaid Services forecast for total growth in national health
care expenditures, and adjust this forecast to reflect the demographics, health status, and
other factors deemed necessary by the commissioner. The commissioner shall contract
with an actuarial consultant to make recommendations as to the adjustments needed to
specifically reflect projected spending for Minnesota residents.
new text end

new text begin (c) The commissioner may adjust the projected baseline as necessary to reflect any
updated federal projections or account for unanticipated changes in federal policy.
new text end

new text begin Subd. 2. new text end

new text begin Actual spending. new text end

new text begin (a) By February 15 of each year, beginning February 15,
2010, the commissioner shall determine the actual private and public health care spending
for the calendar year preceding the current calendar year and shall determine the difference
between the projected spending as determined under subdivision 1 and the actual spending
for that year. The actual spending must be certified by an independent actuarial consultant.
If the actual spending is less than the projected spending, the commissioner shall
determine an aggregate savings offset amount not to exceed 40 percent of the difference.
new text end

new text begin (b) Based on this calculation, the commissioner shall determine annually a savings
offset amount to be paid by health plan companies and third-party administrators. The
aggregate savings offset amount may not exceed 40 percent of the aggregate savings
reflected in the difference between the actual spending and the projected spending.
new text end

new text begin Subd. 3. new text end

new text begin Publication of spending. new text end

new text begin By February 15 of each year, beginning February
15, 2010, the commissioner shall publish in the State Register the projected spending
baseline, including any adjustments, and the actual spending for the preceding year.
new text end

new text begin Subd. 4. new text end

new text begin Savings offset assessments. new text end

new text begin (a) Each health plan company and third-party
administrator shall pay a savings offset assessment. The commissioner shall calculate the
savings offset assessments as a percentage of paid claims as follows:
new text end

new text begin (1) for health plan companies, the savings offset assessment may not exceed four
percent of annual paid health care claims on policies that insure residents of this state; and
new text end

new text begin (2) for third-party administrators, the savings offset assessment may not exceed four
percent of annual paid claims for health care for residents of this state.
new text end

new text begin (b) A health plan company may not be required to pay a savings offset assessment
on policies or contracts insuring federal employees.
new text end

new text begin (c) Savings offset assessments apply to claims paid for plan years beginning on
or after January 1, 2010.
new text end

new text begin (d) Savings offset assessments must be made quarterly to the commissioner of
revenue within 60 days of the close of each quarter, beginning April 15, 2010.
new text end

new text begin Subd. 5. new text end

new text begin Deposit of assessments. new text end

new text begin The commissioner of revenue shall deposit the
revenue derived from the assessments into the health care access fund.
new text end

Sec. 13.

new text begin [62U.08] AFFORDABILITY STANDARD.
new text end

new text begin Subdivision 1. new text end

new text begin Definition of affordability. new text end

new text begin For purposes of this section, coverage is
"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an
individual or family for health coverage does not exceed the applicable percentage of the
individual or family's gross monthly income specified in subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Incomes up to 300 percent of the federal poverty guidelines. new text end

new text begin The
following affordability standard is established for individuals and households with gross
family incomes of 300 percent of the federal poverty guidelines or less:
new text end

new text begin new text begin AFFORDABILITY STANDARD new text end new text end
	new text begin Federal Poverty Guideline Range new text end			new text begin Percent of Average Gross Monthly Income new text end
	new text begin 0-33% new text end			new text begin minimum new text end
	new text begin 33-54% new text end			new text begin 1.1% new text end
	new text begin 55-81% new text end			new text begin 1.2% new text end
	new text begin 82-109% new text end			new text begin 1.6% new text end
	new text begin 110-136% new text end			new text begin 2.4% new text end
	new text begin 137-164% new text end			new text begin 2.9% new text end
	new text begin 165-191% new text end			new text begin 3.9% new text end
	new text begin 192-219% new text end			new text begin 4.6% new text end
	new text begin 220-248% new text end			new text begin 5.4% new text end
	new text begin 248-274% new text end			new text begin 6.0% new text end
	new text begin 275-300% new text end			new text begin 6.0% new text end

new text begin Subd. 3. new text end

new text begin Incomes greater than 300 percent but not exceeding 400 percent of the
federal poverty guidelines. new text end

new text begin For purposes of determining affordability, the affordability
standard for individuals and households with gross family incomes greater than 300
percent but not exceeding 400 percent of the federal poverty guidelines shall be based
on a continuation of the sliding scale specified in subdivision 2, with the percentage of
average gross monthly income rising proportionately at each income range, to a maximum
of 8.0 percent.
new text end

Sec. 14.

new text begin [62U.09] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED
HEALTH COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment of subsidy program. new text end

new text begin The commissioner of
human services shall establish a subsidy program for eligible employees with access to
employer-subsidized health coverage. For purposes of this section, employer-subsidized
health coverage has the meaning provided in section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Eligible employees. new text end

new text begin In order to be eligible for a subsidy under this section,
an employee shall:
new text end

new text begin (1) be covered by employer-subsidized health coverage that meets the benefits
set and design established under section 62U.04 and is purchased through the Health
Insurance Exchange established under section 62U.02; and
new text end

new text begin (2) meet all eligibility criteria for the MinnesotaCare program established under
chapter 256L, except for the requirements related to:
new text end

new text begin (i) no access to employer-subsidized coverage under section 256L.07, subdivision
2; and
new text end

new text begin (ii) no other health coverage under section 256L.07, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Amount of subsidy. new text end

new text begin The subsidy must equal the amount the employee
is required to pay for health coverage, including premiums, deductibles, and other cost
sharing, minus an amount based on the affordability standard specified in section 62U.08.
The maximum subsidy must not exceed the amount of the subsidy that would have been
provided under the MinnesotaCare program, if the employee and any dependents were
eligible for that program.
new text end

new text begin Subd. 4. new text end

new text begin Payment of subsidy. new text end

new text begin The commissioner shall pay the subsidy amount
for an employee and any dependents to the Minnesota Health Insurance Exchange, and
this payment shall be credited toward the employee's share of premium. Any additional
amount paid by the commissioner to the Minnesota Health Insurance Exchange that
exceeds the employee's share of premium must be credited first toward the employee
deductible and then toward any employee cost-sharing obligation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 15.

new text begin [62U.11] PAYMENT RESTRUCTURING; PAYMENTS BASED ON
QUALITY AND EFFICIENCY OF CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin The commissioners of human services and health
shall develop a payment system that links the level of payments to providers to the quality
and efficiency of care for voluntary implementation in the private sector beginning January
1, 2009. The payment system must incorporate payments to primary care physicians,
specialty care physicians, health care clinics, and hospitals, and other providers who
provide services included in the evidence-based benefit set and design developed under
section 62U.04.
new text end

new text begin Subd. 2. new text end

new text begin Payment system criteria. new text end

new text begin The payment system must meet the following
criteria:
new text end

new text begin (1) providers meeting specified targets, or who demonstrate a significant amount of
improvement over time, must be eligible for quality and efficiency-based payments that
are in addition to existing payment levels;
new text end

new text begin (2) priority must be placed on measures of health care outcomes, rather than process
measures, wherever possible;
new text end

new text begin (3) quality measures for primary care providers must focus on preventive services,
coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
disease, depression, and other conditions or procedures for which, in the determination of
the commissioners, improved outcomes will lead to significant cost savings;
new text end

new text begin (4) quality measures for specialty care must be designated by the commissioners, and
initially based on quality indicators measured and reported publicly by specialty societies;
new text end

new text begin (5) hospital payments must be adjusted for quality and efficiency using existing
measures where available, which focus on health conditions or procedures for which,
in the determination of the commissioners, improved outcomes will lead to significant
cost savings; and
new text end

new text begin (6) other indicators of care quality and efficiency must be incorporated where
appropriate. These indicators may include care infrastructure, collection and reporting of
results, measures of efficiency for specific procedures, and measures of overall cost of
care for individuals.
new text end

Sec. 16.

new text begin [62U.12] PAYMENT RESTRUCTURING; CARE COORDINATION
PAYMENTS FOR HEALTH CARE HOMES.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin The commissioners of health and human services
shall develop, for voluntary implementation in the private sector beginning July 1, 2009,
a payment system that provides care coordination payments to health care providers.
In order to be eligible for a care coordination payment, a health care provider must be
certified as a health care home by the commissioners of human services and health based
on the certification standards for health care homes established under section 256B.0754.
new text end

new text begin Subd. 2. new text end

new text begin Care coordination fee. new text end

new text begin (a) Under the payment system, health care homes
must receive a per-person per-month care coordination fee for providing care coordination
services and employing care coordinators, as specified in section 256B.0752, subdivisions
3 and 7.
new text end

new text begin (b) The care coordination fee must not exceed an average of $50 per person per
month. The care coordination fee must be determined by the commissioners, and must
vary by thresholds of care complexity, with the highest fees being paid for care provided
to individuals requiring the most intensive care coordination, such as those with very
complex health care needs or several chronic conditions.
new text end

new text begin (c) In setting care coordination fees, the commissioners shall consider the additional
time and resources needed by patients with limited English-language skills, cultural
differences, or other barriers to health care.
new text end

new text begin (d) Care coordination fees must be phased-in, and must be applied first to persons
who have, or are at risk of developing, complex or chronic health conditions.
new text end

new text begin Subd. 3. new text end

new text begin Quality/efficiency-based payments. new text end

new text begin The quality/efficiency-based
payments under section 62U.11 must also be included in the care coordination payment
system. Providers whose quality or efficiency does not allow them to qualify for payments
under section 62U.11 are not be eligible to receive care coordination fees.
new text end

Sec. 17.

new text begin [62U.13] COORDINATION WITH THE PRIVATE SECTOR.
new text end

new text begin In developing the payment systems required under sections 62U.11 and 62U.12, the
commissioners of human services and health shall consult and coordinate with health
care providers, health plan companies, consumers, and employers and other payors.
The commissioners shall publicize and promote the payment systems required under
sections 62U.11 and 62U.12, and shall provide technical assistance to entities interested in
adopting one or both of these payment systems.
new text end

Sec. 18.

Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 27. new text end

new text begin Exchange of data. new text end

new text begin An entity that is part of the welfare system as defined
in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance
Exchange under section 62U.02 may Exchange private data about individuals without
the individual's consent in order to collect premiums from individuals in the medical
assistance employed persons with disabilities program and the MinnesotaCare program
under chapters 256B and 256L. This subdivision only applies if the entity that is part of
the welfare system and the Minnesota Health Insurance Exchange have entered into an
agreement that complies with the requirements in Code of Federal Regulations, title
45, section 164.314.
new text end

Sec. 19. new text begin AMENDMENTS TO CURRENT HEALTH BENEFIT SETS.
new text end

new text begin The commissioners of health, commerce, and employee relations shall report to the
legislature under Minnesota Statutes, section 3.195, on necessary changes to current
mandated benefit sets to align these with the cost-effective benefit set developed by the
Health Benefits and Design Board established in Minnesota Statutes, section 62U.04.
new text end