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Minnesota Legislature

Office of the Revisor of Statutes

HF 3391

1st Committee Engrossment - 85th Legislature (2007 - 2008) Posted on 12/22/2009 12:39pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health care reform; increasing affordability and continuity of care
for state health care programs; modifying health care provisions; providing
subsidies for employee share of employer-subsidized insurance; establishing the
Minnesota Health Insurance Exchange; requiring certain employers to offer
Section 125 Plan; establishing the Health Care Transformation Commission;
creating an affordability standard; requiring mandated reports; appropriating
money; amending Minnesota Statutes 2006, sections 62A.65, subdivision 3;
62E.141; 62L.12, subdivisions 2, 4; 256.01, by adding subdivisions; 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,
chapter 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

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 with clinicians who 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. The commissioner shall also develop and implement an outreach
program to enroll eligible persons in state health care programs, by providing a per
enrollee bonus to licensed producers under chapter 60K and nonprofit health care or social
service organizations who provide assistance in enrolling applicants.
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 Each patient of a health care
home shall have an ongoing, long-term relationship with a 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 Subd. 3. new text end

new text begin Care coordination. new text end

new text begin The personal clinician, in coordination with other
health care providers, is responsible for providing for all the patient's health care needs
or for arranging appropriate care with other qualified professionals. 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, according to
minimum standards specified by the commissioners.
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. The comprehensive health assessment
must be completed within 90 days of the initial health assessment. 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. 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 certification standards for health care homes. 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 the fee-for-service, managed care, and county-based purchasing
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, and estimates of savings from implementation of the health care home
model for the fee-for-service, managed care, and county-based purchasing sectors relative
to the health care spending baseline calculated under section 62U.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
demonstration providers, 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 demonstration providers 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 commissioner, as a condition of contract, shall require demonstration
providers, as part of their implementation of the health care home model, to pay providers
a care coordination fee. The care coordination fee must meet the requirements of section
256B.0753. Demonstration providers shall fund the care coordination fee through savings
that result from implementation of the health care home model and, if necessary, through
reductions in administrative costs and provider payment rates for nonprimary care
services. The commissioner shall not adjust current or future capitation rates for costs
related to payment of the care coordination fee.
new text end

new text begin (c) The commissioners of health and human services shall require demonstration
providers 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
demonstration providers and health care homes with practice profiles measuring
utilization, cost, and quality.
new text end

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

new text begin (e) Beginning July 1, 2009, the commissioner shall provide a performance
incentive for expenses related to the operation of health care homes that would reimburse
upfront 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 (f) Demonstration providers 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 (g) Beginning July 1, 2009, the commissioner shall require demonstration providers
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
demonstration providers 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 (h) Beginning July 1, 2009, the commissioner shall implement financial
arrangements for demonstration providers 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 beginPAYMENT OF CARE COORDINATION FEE UNDER STATE
MANAGED CARE PROGRAMS.
new text end

new text begin The commissioner of human services shall study the feasibility of paying the
care coordination fee required under Minnesota Statutes, section 256B.69, subdivision
29, paragraph (b), directly to health care providers under contract with demonstration
providers to serve state health care program enrollees, and shall present recommendations
to the legislature by December 15, 2008.
new text end

ARTICLE 2

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 This section is effective July 1, 2008.
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 beginassets anddeleted 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; RESTRICTIONSnew text begin;
DELAYED VERIFICATION
new text end.

new text begin (a) new text endIf 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$10,000deleted text endnew text begin $20,000new 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$10,000deleted text endnew text begin $20,000new 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$10,000deleted text endnew text begin $20,000new 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 begin275deleted text endnew text begin 300new 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 beginBeginning 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 beginJulydeleted text endnew text begin Januarynew 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 begin215deleted text endnew text begin 300new 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 beginIf 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 endThe
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 fordeleted text end new text beginthe first day of the calendar month following new text endthe 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 endnew 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 beginand the four-month requirement in subdivision 3deleted 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 begin275deleted text endnew text begin 300new 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 begin215deleted text endnew text begin 300new text end
percent of the federal poverty guidelines on or after deleted text beginJulydeleted text endnew text begin Januarynew 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 beginor 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 beginMedical 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 endnew 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 endthe 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 beginFamiliesdeleted text end new text beginChildren new text endwhose gross income is above deleted text begin275deleted text endnew text begin 300new 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 beginINSURANCE 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 3

INSURANCE REFORM

Section 1. new text beginUNIFORM OUTCOME MEASURES WORKING GROUP.
new text end

new text begin (a) The Health Care Transformation Commission, established under Minnesota
Statutes, section 62U.04, shall establish an informal working group to create 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 commission 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 determine 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 commission shall encourage use of the working group recommendations.
new text end

new text begin (h) By December 15, 2008, the commission shall provide to the legislature a written
report under Minnesota Statutes, section 3.195, summarizing the work of the working
group. The report must include recommendations for: (1) a standardized set of health
care provider performance measures to be enacted by the legislature; and (2) a payment
methodology to reduce capitation rates paid by the commissioner of human services
under Minnesota Statutes, section 256B.69, to demonstration providers that use provider
performance measures other than those included in the standardized set under clause (1).
new text end

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

Sec. 2. new text beginCOMMUNITY 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. The expectations of the community benefits
provided and reported should be related to the statutory expectations in Minnesota
Statutes, sections 62C.01 and 62D.01, and thus focus on advocating public health,
improving the art and science of medical care, and addressing the need for financial
assistance to access ongoing coverage, and not related to general philanthropic endeavors.
The commissioner shall seek public input regarding the range of options to be explored
and the accountability measures.
new text end

new text begin (b) The recommendations must include a procedure by which each nonprofit health
plan company would periodically and uniformly 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

ARTICLE 4

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 beginor
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 educationnew 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 beginExcept for policies issued under section 62U.03, subdivision 5, paragraph (b),
new text endpremium 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 begingroup new text endhealth 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 beginto
all employees or through the Minnesota Health Insurance Exchange under section 62U.02
new text endto 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 endthe 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 carriernew text begin or to the Minnesota Health Insurance Exchange under section 62U.02new 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 beginor the Minnesota Health Insurance Exchange
under section 62U.02
new text endmay 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 beginor the Minnesota Health Insurance Exchange, as applicable, new text endshall 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 beginor
the Minnesota Health Insurance Exchange, as applicable, stating
new text endthat the employer is not
contributing directly or indirectly to the employee's premiums. new text beginThe 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 endThe 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 beginother current or futuredeleted text end employeesnew text begin, except as required under
section 62U.03, subdivision 5, paragraph (b)
new text end.

Sec. 5.

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


Subd. 4.

Employer prohibition.

A small employer new text beginoffering a health benefit plan
new text endshall 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 Advisory committee. new text end

new text begin "Advisory committee" means the Health Benefit Set
and Design Advisory Committee established in section 62U.055.
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 Commission. new text end

new text begin "Commission" means the Health Care Transformation
Commission established in section 62U.04.
new text end

new text begin Subd. 5. 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. 6. 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. 7. 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. 8. 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. 9. 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. 10. 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. 11. new text end

new text begin State health care program. new text end

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

new text begin Subd. 12. 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, that is designed for sale in the individual market and that may cover either an
individual or an individual and the individual's dependents.
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 may 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 set 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 in this state must offer through the exchange at least one health plan
that meets the benefit set and design established by the Health Care Transformation
Commission 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 to individuals and families who meet the eligibility requirements
for MinnesotaCare, as determined by the commissioner of human services, 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 of the exchange. The requirements applicable
to issuance, renewal, cancellation, 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 Comparison of health plans. new text end

new text begin The exchange shall help consumers
understand and compare the standardized health plan options established under section
62U.04. The exchange shall also make consumers aware of eligibility for premium
assistance under section 62U.09 based on the employer's contribution and the employee's
income. Within each standardized plan grouping, the exchange shall provide easy ways
for consumers to select among the offerings by comparing quality ratings, searching for
a particular provider in its network, or by cost factors. This information must be made
available via the Internet as well as by toll-free telephone assistance and written materials.
new text end

new text begin Subd. 6. new text end

new text begin Individual participation and eligibility. new text end

new text begin (a) Individuals are eligible to
purchase health plans directly through the exchange or through an employer Section
125 Plan under section 62U.03.
new text end

new text begin (b) 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).
new text end

new text begin (c) 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 in this state 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 (d) A self-employed individual, including a partner of a partnership, a member of
a limited liability company, or other owner of a business, who may not be eligible to
participate in a Section 125 plan, may obtain coverage through the exchange either as an
individual under paragraph (c) or as an employee covered under a small employer health
benefit plan if permitted under chapter 62L.
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 small employer health benefit 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 and small employers 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 health plan companies
all premium payments made by individuals and small employers, 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 after 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, other than those connected with Minnesota-based nonprofit
health providers or health plan companies, 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. If the
exchange receives complaints involving such disputes from individuals participating in
the exchange, the exchange shall inform the individual about the right to make such
complaints 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.
These appointed members are eligible to be reappointed for one additional term; 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 constitute 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. Board meetings must be
open to the public, except as specified in the bylaws of the exchange.
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 Investment of assets. new text end

new text begin The exchange must certify to the State Board of
Investment that a portion of the assets of the exchange which, in the judgment of the
exchange director, are not required for immediate use. Investment earnings on assets
transferred to the State Board of Investment under this subdivision must be maintained in
an account in the state treasury. Money in the account may be spent, as appropriated by
law, for purposes related to assisting individuals in paying health insurance premiums,
and for making health insurance products more affordable.
new text end

new text begin Subd. 17. new text end

new text begin Audit. new text end

new text begin The legislative auditor must audit the exchange, as provided in
sections 3.971 and 3.972.
new text end

new text begin Subd. 18. 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
the individual 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. 19. 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 employee's 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 (a) 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 (b) Employees earning less than $30,000 per year may choose to opt in to Section
125 plan participation after being provided, by their employer, information developed by
the exchange on the potential negative impact on their Social Security retirement benefits.
Employers may not in any way attempt to influence those employees in their decision on
whether or not to participate in the Section 125 plan pretax premium payment. Those not
choosing to opt in to Section 125 plan participation shall still remain eligible for premium
collection and payment via the exchange. This also applies to anyone who may not be
eligible for Section 125 plan benefits due to federal definitions of eligibility. Persons with
dependents who differ in their eligibility must have their participation in the Section 125
pretax benefit plan proportionately established.
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 limitations 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 tobacco use.
new text end

Sec. 9.

new text begin [62U.04] HEALTH CARE TRANSFORMATION COMMISSION.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Transformation Commission is created
for the purpose of coordinating the health care transformation activities within Minnesota.
new text end

new text begin Subd. 2. new text end

new text begin Members. new text end

new text begin (a) The Health Care Transformation Commission shall consist
of ten members who are appointed as follows:
new text end

new text begin (1) three members appointed by the Subcommittee on Committees of the Committee
on Rules and Administration of the senate;
new text end

new text begin (2) three members appointed by the speaker of the house of representatives; and
new text end

new text begin (3) four members appointed by the governor, two of whom shall be state
commissioners from the agencies listed in section 15.01.
new text end

new text begin (b) The appointed members who are not commissioners must have expertise in
health care financing, health care delivery, health care quality improvement, health
economics, actuarial science, business operations, social services funded through medical
assistance and property tax resources, or be an informed consumer representative.
new text end

new text begin (c) If a member is no longer able or eligible to perform the required duties, a new
member shall be appointed by the entity that appointed the outgoing member.
new text end

new text begin Subd. 3. new text end

new text begin Operations of the commission. new text end

new text begin (a) The commission shall convene on or
before July 1, 2008, following the initial appointment of the members.
new text end

new text begin (b) The commission shall elect a chair among its members.
new text end

new text begin (c) The commission members shall not be compensated for commission activities
except for actual expenses incurred in the performance of their duties. Expenses shall be
compensated according to section 15.0575.
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 commission shall 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 Responsibilities of the commission. new text end

new text begin The Health Care Transformation
Commission shall:
new text end

new text begin (1) collect data from providers on health care prices and quality, including measures
of process, outcomes, and patient satisfaction, and publish comparative price and quality
information in a manner that is easily understandable and accessible to consumers;
new text end

new text begin (2) develop a design and implementation plan for health care payment system reform
as required under sections 62U.11 and 62U.12;
new text end

new text begin (3) establish a uniform definition for total cost of care for a patient group, including
risk adjustment mechanisms that address at least the following factors:
new text end

new text begin (i) the health status of the individual in the year the individual enters the provider's
care;
new text end

new text begin (ii) a worsening of the patient's health condition that was not reasonably preventable
by action that the provider could have taken;
new text end

new text begin (iii) socioeconomic and cultural factors that bear directly on the cost of care; and
new text end

new text begin (iv) the percentage of individuals served by the provider or care system whose care
is paid for by public health insurance programs;
new text end

new text begin (4) provide education, technical assistance, and materials necessary for providers to
participate in the restructured payment system;
new text end

new text begin (5) implement and administer the payment system reform;
new text end

new text begin (6) make recommendations to the governor and legislature as to additional actions
that are needed in order to successfully achieve health care transformation in Minnesota;
new text end

new text begin (7) consult and coordinate with the commissioners of health and human services,
health care providers, health plan companies, organizations that work to improve health
care quality in Minnesota, consumers, and employers;
new text end

new text begin (8) convene a health technology advisory committee as required under section
62U.05;
new text end

new text begin (9) establish a Uniform Outcome Measures Working Group and make
recommendations on community benefit standards, as required under article 3, section
1; and
new text end

new text begin (10) carry out other duties assigned in this chapter and this act.
new text end

new text begin Subd. 6. new text end

new text begin Powers of the commission. new text end

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

new text begin (1) advise the commissioner of human services to negotiate with the Centers for
Medicare and Medicaid Services and work with the Minnesota congressional delegation
to gain approval for any demonstration programs or changes in federal policy necessary to
enable transformation of Minnesota's health care system; and
new text end

new text begin (2) contract with other organizations to carry out all or part of its responsibilities.
new text end

new text begin Subd. 7. new text end

new text begin Rulemaking; exemption from administrative procedures. new text end

new text begin To carry out
the purposes of this section and sections 62U.05 and 62U.055, the commission may adopt
rules under chapter 14. The commission is exempt from rulemaking requirements to the
extent rules are necessary to establish the benefit set and design described in subdivision 8
and section 62U.055. The commission 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

new text begin Subd. 8. new text end

new text begin Standard benefit set and design. new text end

new text begin (a) Based on the recommendations
submitted by the Health Benefit Set and Design Advisory Committee, the commission
shall establish a standard benefit set and design by July 1, 2009.
new text end

new text begin (b) The standard health benefit set and design must meet the requirements described
in section 62U.055.
new text end

new text begin (c) Prior to establishing the standard benefit set and design, the commission shall
convene public hearings throughout the state.
new text end

new text begin Subd. 9. new text end

new text begin Reports. new text end

new text begin Beginning January 15, 2010, and each January 15 thereafter, the
commission shall submit an annual report to the governor and legislature on the following:
new text end

new text begin (1) the extent to which health care providers have reduced their costs and fees;
new text end

new text begin (2) the extent to which costs and cost growth are likely to be maintained or reduced
in future years;
new text end

new text begin (3) the extent to which the quality of health care services has improved;
new text end

new text begin (4) the extent to which all Minnesotans have access to quality, affordable health
care; and
new text end

new text begin (5) recommendations on additional actions that are needed in order to successfully
achieve health care transformation in Minnesota.
new text end

new text begin Subd. 10. new text end

new text begin Expiration. new text end

new text begin The commission shall expire December 31, 2011. Upon
expiration, the duties of the commission shall transfer to the board of directors of the
Minnesota Health Insurance Exchange.
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 Care
Transformation Commission shall convene an advisory committee to make
recommendations to the commission regarding the inclusion of new and existing health
technologies to the standard benefit set and design.
new text end

new text begin (b) The advisory committee shall be made up of 11 members appointed by the
commission, 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) No member of the advisory committee shall have a substantial financial interest
in a health technology company or 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. Upon the expiration of the Health Care Transformation
Commission, the Health Technology Assessment Committee shall continue to exist under
the oversight of the Minnesota Health Insurance Exchange.
new text end

new text begin Subd. 2. new text end

new text begin Technology selection process. new text end

new text begin The commission, in consultation with the
advisory committee, shall select existing and new health technologies to be reviewed by
the committee. In making a selection, priority must 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 committee 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 as such by the federal agency for health care
research and quality, or another appropriate entity as designated by the commission.
new text end

new text begin (b) The committee 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 commission:
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.055] STANDARD BENEFIT SET AND DESIGN.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Transformation Commission shall
convene a health benefit set and design advisory committee to make recommendations to
the commission on a standard benefit set and design. The advisory committee shall consist
of seven members. The members shall be appointed by the commission and must 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. 2. new text end

new text begin Operations of the committee. new text end

new text begin (a) The advisory committee shall convene
on or before September 1, 2008, upon the appointment of the initial committee and must
meet at least once a year, and at other times as necessary.
new text end

new text begin (b) The commission shall provide office space, equipment and supplies, and
technical support to the committee.
new text end

new text begin (c) The committee shall be governed by section 15.059, except the committee shall
not expire. Upon the expiration of the Health Care Transformation Commission, the
Health Benefit Set and Design Advisory Committee shall continue to exist under the
oversight of the Minnesota Health Insurance Exchange.
new text end

new text begin Subd. 3. new text end

new text begin Immunity of liability. new text end

new text begin No member of the committee shall 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. 4. new text end

new text begin Duties of the committee. new text end

new text begin (a) By January 1, 2009, the committee shall
develop and submit to the commission a benefit set and design 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 benefit set
must include necessary health care services, procedures, and diagnostic tests that are
scientifically proven to be both clinically effective and cost effective. In establishing
the benefit set, the committee may contract with the Institute for Clinical Systems
Improvement (ICSI) to assemble existing scientifically based practice standards. The
committee shall consider cultural, ethnic, and religious values and beliefs to ensure that
the health care needs of all Minnesota residents will be addressed in the benefit set.
new text end

new text begin (b) The benefit set must identify and include preventive services, chronic care
coordination services, and early diagnostic tests that, if included in the benefit set, with
minimal or no cost-sharing requirements, would result in savings that are equal to or
greater than the cost of providing the services.
new text end

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

new text begin (d) The benefit design must be used as a minimum requirement for health plans
offered throughout 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 must be no maximum lifetime benefit.
new text end

new text begin Subd. 5. new text end

new text begin Continued review. new text end

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

Sec. 12.

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 act fail to achieve universal coverage, an individual responsibility requirement
must 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 sections 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, must become effective 12 months after the
end of that fiscal year, provided that the commissioner certifies that health plans that meet
the affordability standard under section 62U.08 are available to Minnesotans.
new text end

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

Sec. 13.

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. 14.

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 Affordability standard. new text end

new text begin The following affordability standard is
established for individuals and households with gross family incomes of 400 percent
of the federal poverty guidelines or less:
new text end

new text begin new text begin AFFORDABILITY STANDARDnew 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 301-324%
new text end
new text begin 6.5%
new text end
new text begin 325-349%
new text end
new text begin 7.2%
new text end
new text begin 350-374%
new text end
new text begin 7.8%
new text end
new text begin 375-400%
new text end
new text begin 8.0%
new text end

Sec. 15.

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 and dependents
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 and dependents. new text end

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

new text begin (1) be covered by employer-subsidized health coverage that meets the benefits set
and design requirements 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 for the employee and any dependents, 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. 16.

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 By November 1, 2008, the Health Care
Transformation Commission shall develop a payment system that links the level of
payments to providers to the quality and efficiency of care. The payment system must
incorporate payments to primary care physicians, specialty care physicians, health care
clinics, 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 commission, 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 commission, 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 commission, 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

new text begin Subd. 3. new text end

new text begin Uniform measures required. new text end

new text begin Once the payment system required by this
section is established, health plan companies shall not require providers to use and report
health plan company-specific quality and outcome measures.
new text end

new text begin Subd. 4. new text end

new text begin Implementation. new text end

new text begin (a) By January 1, 2009, the commissioner of human
services shall implement this payment system for all state health care program enrollees
served under fee-for-service, and shall require demonstration providers serving state health
care program enrollees to implement this payment system by January 1, 2009, for all state
health care program enrollees served under managed care and county-based purchasing.
new text end

new text begin (b) By January 1, 2009, the commissioner of employee relations shall implement
this payment system for all participants in the State Employee Group Insurance Program.
new text end

new text begin (c) By January 1, 2009, all health plan companies shall implement this payment
system for all participating providers.
new text end

Sec. 17.

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 Health Care Transformation Commission,
in cooperation with the commissioners of health and human services, shall develop 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 commission, 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 commission 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 and efficiency-based payments. new text end

new text begin The quality and 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 eligible to receive care coordination fees.
new text end

new text begin Subd. 4. new text end

new text begin Implementation. new text end

new text begin (a) By July 1, 2009, the commissioner of human
services shall implement this payment system for all state health care program enrollees
served under fee-for-service as provided under section 256B.0753 and shall require
demonstration providers serving state health care program enrollees to implement this
payment system by July 1, 2009, for all state health care program enrollees served under
managed care and county-based purchasing.
new text end

new text begin (b) By July 1, 2009, the commissioner of employee relations shall implement this
payment system for all participants in the State Employee Group Insurance Program.
new text end

new text begin (c) By July 1, 2009, all health plan companies shall implement this payment system
for all participating providers.
new text end

Sec. 18.

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 Health Care Transformation Commission shall consult and coordinate with the
commissioners of human services and health, organizations that work to improve health
care quality in Minnesota, 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 make technical assistance
available to entities adopting the payment systems.
new text end

Sec. 19.

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


new text begin Subd. 28. 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. 20. new text beginAMENDMENTS 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 standard benefit set and design developed by
the Health Care Transformation Commission established in Minnesota Statutes, section
62U.04.
new text end

Sec. 21. new text beginRISK SHARING.
new text end

new text begin The Risk Sharing Advisory Council shall review Minnesota Comprehensive Health
Association financing and whether the affordability needs of persons with health problems
can be addressed through guaranteed issue, with no premium penalty for health history
and not allowing preexisting condition limitations. This must include assessing whether
stability of the insurance market could be managed through risk sharing that transfers funds
between health plan companies. The goal is to discontinue Minnesota Comprehensive
Health Association assessment and replace it with a broader and fairer funding mechanism,
preferably one that does not involve a fee-based mechanism. The council shall make
recommendations to the Legislative Commission on Health Care Access by November
1, 2009. The Risk Sharing Advisory Council shall include representatives of insurance
companies, the Minnesota Comprehensive Health Association's board of directors, safety
net providers, and consumer representatives. It shall be convened by the commissioner of
commerce with staffing from that agency and the Minnesota Department of Health.
new text end

Sec. 22. new text beginAPPROPRIATION.
new text end

new text begin $....... is appropriated in fiscal year 2009 from the health care access fund to the
Health Care Transformation Commission. This is a onetime appropriation.
new text end