HF 402

3rd Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/26/2023 11:06am

A bill for an act
relating to health; establishing requirements for certain health care entity
transactions; changing the expiration date on moratorium conversion transactions;
requiring a health system to return charitable assets received from the state to the
general fund in certain circumstances; requiring a study on the regulation of certain
transactions; requiring a report; appropriating money; amending Minnesota Statutes
2022, section 62U.04, subdivision 11; Laws 2017, First Special Session chapter
6, article 5, section 11, as amended; proposing coding for new law in Minnesota
Statutes, chapter 309; proposing coding for new law as Minnesota Statutes, chapter
145D.

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

Section 1.

Minnesota Statutes 2022, section 62U.04, subdivision 11, is amended to read:

Subd. 11.

Restricted uses of the all-payer claims data.

(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:

(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;

(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; deleted text begin and
deleted text end

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;

(ii) not identify individual patients, payers, or providers;

(iii) be updated by the commissioner, at least annually, with the most current data
available;

(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and

(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) to conduct analyses of the impact of health care transactions on health care costs,
market consolidation, and quality under section 145D.01, subdivision 6.
new text end

(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.

(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.

(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.

(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).

Sec. 2.

new text begin [145D.01] REQUIREMENTS FOR CERTAIN HEALTH CARE ENTITY
TRANSACTIONS.
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 this section, the following terms have
the meanings given.
new text end

new text begin (b) "Captive professional entity" means a professional corporation, limited liability
company, or other entity formed to render professional services in which a beneficial owner
is a health care provider employed by, controlled by, or subject to the direction of a hospital
or hospital system.
new text end

new text begin (c) "Commissioner" means the commissioner of health.
new text end

new text begin (d) "Health care entity" means:
new text end

new text begin (1) a hospital;
new text end

new text begin (2) a hospital system;
new text end

new text begin (3) a captive professional entity;
new text end

new text begin (4) a medical foundation;
new text end

new text begin (5) a health care provider group practice;
new text end

new text begin (6) an entity organized or controlled by an entity listed in clauses (1) to (5); or
new text end

new text begin (7) an entity that owns or exercises substantial control over an entity listed in clauses
(1) to (5).
new text end

new text begin (e) "Health care provider" means a physician licensed under chapter 147, a physician
assistant licensed under chapter 147A, or an advanced practice registered nurse as defined
in section 148.171, subdivision 3, who provides health care services, including but not
limited to medical care, consultation, diagnosis, or treatment.
new text end

new text begin (f) "Health care provider group practice" means two or more health care providers legally
organized in a partnership, professional corporation, limited liability company, medical
foundation, nonprofit corporation, faculty practice plan, or other similar entity:
new text end

new text begin (1) in which each health care provider who is a member of the group provides
substantially the full range of services that a health care provider routinely provides, including
but not limited to medical care, consultation, diagnosis, and treatment, through the joint use
of shared office space, facilities, equipment, or personnel;
new text end

new text begin (2) for which substantially all services of the health care providers who are group
members are provided through the group and are billed in the name of the group practice
and amounts so received are treated as receipts of the group; or
new text end

new text begin (3) in which the overhead expenses of, and the income from, the group are distributed
in accordance with methods previously determined by members of the group.
new text end

new text begin An entity that otherwise meets the definition of health care provider group practice in this
paragraph shall be considered a health care provider group practice even if its shareholders,
partners, or owners include single health care provider professional corporations, limited
liability companies formed to render professional services, or other entities in which
beneficial owners are individual health care providers.
new text end

new text begin (g) "Hospital" means a health care facility licensed as a hospital under sections 144.50
to 144.56.
new text end

new text begin (h) "Medical foundation" means a nonprofit legal entity through which physicians or
other health care providers perform research or provide medical services.
new text end

new text begin (i)(1) "Transaction" means a single action, or a series of actions within a five-year period,
that constitutes:
new text end

new text begin (i) a merger or exchange of a health care entity with another entity;
new text end

new text begin (ii) the sale, lease, or transfer of 40 percent or more of the assets of a health care entity
to another entity;
new text end

new text begin (iii) the granting of a security interest of 40 percent or more of the property and assets
of a health care entity to another entity;
new text end

new text begin (iv) the transfer of 40 percent or more of the shares or other ownership of a health care
entity to another entity;
new text end

new text begin (v) a transfer of control, responsibility for, or governance of a health care entity, including
any transfer of membership interests that effectively constitutes such a transfer;
new text end

new text begin (vi) the creation of a new health care entity; or
new text end

new text begin (vii) substantial investment of 40 percent or more in a health care entity that results in
sharing of revenues without a change in ownership or voting shares.
new text end

new text begin (2) "Transaction" does not include:
new text end

new text begin (i) a mortgage or other secured loan for business improvement purposes entered into by
a health care entity that does not directly affect delivery of health care or governance of the
health care entity;
new text end

new text begin (ii) a clinical affiliation of health care entities formed solely for the purpose of
collaborating on clinical trials or providing graduate medical education;
new text end

new text begin (iii) the mere offer of employment to, or hiring of, a physician or other individual provider
by a health care entity;
new text end

new text begin (iv) a transaction between entities under common ownership or control, either directly
or indirectly through one or more intermediaries; or
new text end

new text begin (v) a single action or series of actions within a five-year period involving only entities
that operate solely as a nursing home licensed under chapter 144A; a boarding care home
licensed under sections 144.50 to 144.56; a supervised living facility licensed under sections
144.50 to 144.56; an assisted living facility licensed under chapter 144G; a foster care setting
licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, for a physical location that
is not the primary residence of the license holder; a community residential setting as defined
in section 245D.02, subdivision 4a; or a home care provider licensed under sections 144A.471
to 144A.483.
new text end

new text begin Subd. 2. new text end

new text begin Notice required. new text end

new text begin (a) This subdivision applies to all transactions where:
new text end

new text begin (1) the health care entity involved in the transaction has average revenue of at least
$40,000,000 per year; or
new text end

new text begin (2) an entity created by the transaction is projected to have average revenue of at least
$40,000,000 per year once the entity is operating at full capacity.
new text end

new text begin (b) A health care entity must provide notice to the attorney general and the commissioner
and comply with this subdivision before entering into a transaction. Notice must be provided
at least 90 days before the proposed completion date of the transaction.
new text end

new text begin (c) As part of the notice required under this subdivision, at least 90 days before the
proposed completion date of the transaction, a health care entity must affirmatively disclose
the following to the attorney general and the commissioner:
new text end

new text begin (1) the entities involved in the transaction;
new text end

new text begin (2) the leadership of the entities involved in the transaction, including all directors, board
members, and officers;
new text end

new text begin (3) the services provided by each entity and the attributed revenue for each entity by
location;
new text end

new text begin (4) the primary service area for each location;
new text end

new text begin (5) the proposed service area for each location;
new text end

new text begin (6) the current relationships between the entities and the affected health care providers
and practices, the locations of affected health care providers and practices, the services
provided by affected health care providers and practices, and the proposed relationships
between the entities and the affected health care providers and practices;
new text end

new text begin (7) the terms of the transaction agreement or agreements;
new text end

new text begin (8) the acquisition price;
new text end

new text begin (9) markets in which the entities expect postmerger synergies to produce a competitive
advantage;
new text end

new text begin (10) potential areas of expansion, whether in existing markets or new markets;
new text end

new text begin (11) plans to close facilities, reduce workforce, or reduce or eliminate services;
new text end

new text begin (12) the experts and consultants used to evaluate the transaction;
new text end

new text begin (13) the number of full-time equivalent positions at each location before and after the
transaction by job category, including administrative and contract positions; and
new text end

new text begin (14) any other information requested by the attorney general or commissioner.
new text end

new text begin (d) As part of the notice required under this subdivision, at least 90 days before the
proposed completion date of the transaction, a health care entity must affirmatively submit
the following to the attorney general and the commissioner:
new text end

new text begin (1) the current governing documents for all entities involved in the transaction and any
amendments to these documents;
new text end

new text begin (2) the transaction agreement or agreements and all related agreements;
new text end

new text begin (3) any collateral agreements related to the principal transaction, including leases,
management contracts, and service contracts;
new text end

new text begin (4) all expert or consultant reports or valuations conducted in evaluating the transaction,
including any valuation of the assets that are subject to the transaction prepared within three
years preceding the anticipated transaction completion date and any reports of financial or
economic analysis conducted in anticipation of the transaction;
new text end

new text begin (5) the results of any projections or modeling of health care utilization or financial
impacts related to the transaction, including but not limited to copies of reports by appraisers,
accountants, investment bankers, actuaries, and other experts;
new text end

new text begin (6) for a transaction as defined in subdivision 1, paragraph (i), clause (1), item (i) or (v),
a financial and economic analysis and report prepared by an independent expert or consultant
on the effects of the transaction;
new text end

new text begin (7) for a transaction as defined in subdivision 1, paragraph (i), clause (1), item (i) or (v),
an impact analysis report prepared by an independent expert or consultant on the effects of
the transaction on communities and the workforce, including any changes in availability or
accessibility of services;
new text end

new text begin (8) all documents reflecting the purposes of or restrictions on any related nonprofit
entity's charitable assets;
new text end

new text begin (9) copies of all filings submitted to federal regulators, including any Hart-Scott-Rodino
filing the entities submitted to the Federal Trade Commission in connection with the
transaction;
new text end

new text begin (10) a certification sworn under oath by each board member and chief executive officer
for any nonprofit entity involved in the transaction containing the following: an explanation
of how the completed transaction is in the public interest, addressing the factors in subdivision
5, paragraph (a); a disclosure of each declarant's compensation and benefits relating to the
transaction for the three years following the transaction's anticipated completion date; and
a disclosure of any conflicts of interest;
new text end

new text begin (11) audited and unaudited financial statements from all entities involved in the
transaction and tax filings for all entities involved in the transaction covering the preceding
five fiscal years; and
new text end

new text begin (12) any other information or documents requested by the attorney general or
commissioner.
new text end

new text begin (e) The attorney general may extend the notice and waiting period required under
paragraph (b) for an additional 90 days by notifying the health care entity in writing of the
extension.
new text end

new text begin (f) The attorney general may waive all or any part of the notice and waiting period
required under paragraph (b).
new text end

new text begin (g) The attorney general or the commissioner may hold public listening sessions or
forums to obtain input on the transaction from providers or community members who may
be impacted by the transaction.
new text end

new text begin (h) The attorney general or the commissioner may bring an action in district court to
compel compliance with the notice requirements in this subdivision.
new text end

new text begin Subd. 3. new text end

new text begin Prohibited transactions. new text end

new text begin No health care entity may enter into a transaction
that will:
new text end

new text begin (1) substantially lessen competition; or
new text end

new text begin (2) tend to create a monopoly or monopsony.
new text end

new text begin Subd. 4. new text end

new text begin Additional requirements for nonprofit health care entities. new text end

new text begin A health care
entity that is incorporated under chapter 317A or organized under section 322C.1101, or
that is a subsidiary of any such entity, must, before entering into a transaction, ensure that:
new text end

new text begin (1) the transaction complies with chapters 317A and 501B and other applicable laws;
new text end

new text begin (2) the transaction does not involve or constitute a breach of charitable trust;
new text end

new text begin (3) the nonprofit health care entity will receive full and fair value for its public benefit
assets. This clause does not apply to a transaction with a public entity or an organization
that is exempt under section 501(c)(3) of the Internal Revenue Code of 1986, or any successor
section, where the discount between the fair value of the assets and the transaction price
will further the charitable purposes of the nonprofit health care entity;
new text end

new text begin (4) the value of the public benefit assets to be transferred has not been manipulated in
a manner that causes or has caused the value of the assets to decrease;
new text end

new text begin (5) the proceeds of the transaction will be used in a manner consistent with the public
benefit for which the assets are held by the nonprofit health care entity;
new text end

new text begin (6) the transaction will not result in a breach of fiduciary duty; and
new text end

new text begin (7) there are procedures and policies in place to prohibit any officer, director, trustee,
or other executive of the nonprofit health care entity from directly or indirectly benefiting
from the transaction.
new text end

new text begin Subd. 5. new text end

new text begin Attorney general enforcement and supplemental authority. new text end

new text begin (a) The attorney
general may bring an action in district court to enjoin or unwind a transaction or seek other
equitable relief necessary to protect the public interest if a health care entity or transaction
violates this section, if the transaction is contrary to the public interest, or if both a health
care entity or transaction violates this section and the transaction is contrary to the public
interest. Factors informing whether a transaction is contrary to the public interest include
but are not limited to whether the transaction:
new text end

new text begin (1) will harm public health;
new text end

new text begin (2) will reduce the affected community's continued access to affordable and quality care
and to the range of services historically provided by the entities or will prevent members
of the affected community from receiving a comparable or better patient experience;
new text end

new text begin (3) will have a detrimental impact on competing health care options within primary and
dispersed service areas;
new text end

new text begin (4) will have a negative impact on wages paid by, or the number of employees employed
by, a health care entity involved in a transaction;
new text end

new text begin (5) will reduce delivery of health care to disadvantaged, uninsured, underinsured, and
underserved populations and to populations enrolled in public health care programs;
new text end

new text begin (6) will have a substantial negative impact on medical education and teaching programs,
health care workforce training, or medical research;
new text end

new text begin (7) will have a negative impact on the market for health care services, health insurance
services, or skilled health care workers;
new text end

new text begin (8) will have a negative impact on wages, collective bargaining units, and collective
bargaining agreements of existing or future workers employed by a health care entity
involved in a transaction;
new text end

new text begin (9) will increase health care costs for patients; or
new text end

new text begin (10) will adversely impact provider cost trends and containment of total health care
spending.
new text end

new text begin (b) The attorney general may enforce this section under section 8.31.
new text end

new text begin (c) Failure of the entities involved in a transaction to provide timely information as
required by the attorney general or the commissioner shall be an independent and sufficient
ground for a court to enjoin the transaction or provide other equitable relief, provided the
attorney general notified the entities of the inadequacy of the information provided and
provided the entities with a reasonable opportunity to remedy the inadequacy.
new text end

new text begin (d) The commissioner shall provide to the attorney general, upon request, data and
research on broader market trends, impacts on prices and outcomes, public health and
population health considerations, and health care access, for the attorney general to use
when evaluating whether a transaction is contrary to the public interest.
new text end

new text begin Subd. 6. new text end

new text begin Supplemental authority of commissioner. new text end

new text begin (a) Notwithstanding any law to
the contrary, the commissioner may use data or information submitted under this section,
section 62U.04, and sections 144.695 to 144.703 to conduct analyses of the aggregate impact
of health care transactions on access to or the cost of health care services, health care market
consolidation, and health care quality.
new text end

new text begin (b) The commissioner shall issue periodic public reports on the number and types of
transactions subject to this section and on the aggregate impact of transactions on health
care cost, quality, and competition in Minnesota.
new text end

new text begin Subd. 7. new text end

new text begin Classification of data. new text end

new text begin (a) Data provided by a health care entity to the attorney
general and the commissioner under this section is classified as protected nonpublic data
as defined in section 13.02, subdivision 13, in the case of data not on individuals or
confidential data on individuals as defined in section 13.02, subdivision 3, in the case of
data on individuals. The attorney general or the commissioner may make any data classified
as confidential or protected nonpublic under this paragraph accessible to any person, agency,
or the public if the attorney general or the commissioner determines that the access will aid
the law enforcement process, promote public health or safety, or dispel widespread rumor
or unrest.
new text end

new text begin (b) Any information exchanged between the attorney general and the commissioner
according to subdivision 5 is classified as confidential data on individuals as defined in
section 13.02, subdivision 3, or protected nonpublic data as defined in section 13.02,
subdivision 13. The commissioner may share with the attorney general, according to section
13.05, subdivision 9, any not public data, as defined in section 13.02, subdivision 8a, held
by the Department of Health to aid in the investigation and review of the transaction, and
the attorney general must maintain this data with the same classification according to section
13.03, subdivision 4, paragraph (d).
new text end

new text begin Subd. 8. new text end

new text begin Relation to other law. new text end

new text begin (a) The powers and authority under this section are in
addition to, and do not affect or limit, all other rights, powers, and authority of the attorney
general or the commissioner under chapters 8, 309, 317A, 325D, and 501B, or other law.
new text end

new text begin (b) Nothing in this section shall suspend any obligation imposed under chapters 8, 309,
317A, 325D, and 501B, or other law on the entities involved in a transaction.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment and
applies to transactions completed on or after that date. In determining whether a transaction
was completed on or after the effective date, any actions or series of actions necessary to
the completion of the transaction must be considered.
new text end

Sec. 3.

new text begin [309.715] CHARITABLE ASSETS; RETURN TO GENERAL FUND;
OWNERSHIP OR CONTROL OF UNIVERSITY OF MINNESOTA HEALTH CARE
FACILITIES.
new text end

new text begin Subdivision 1. new text end

new text begin Return of charitable assets. new text end

new text begin If a nonprofit health maintenance
organization licensed under chapter 62D, or a health system organized as a charitable
organization, sells or transfers control to an out-of-state, nonprofit entity or to any for-profit
entity, the health maintenance organization or health system must return to the general fund
an amount equal to the value of any charitable assets the health maintenance organization
or health system received from the state.
new text end

new text begin Subd. 2. new text end

new text begin University of Minnesota health care facilities; ownership or control. new text end

new text begin The
importance of the University of Minnesota health care facilities, which are the academic
health care facilities licensed by the commissioner of health as M Health Fairview University,
or any successor name, to the state of Minnesota shall be recognized based on their status
as publicly supported academic health care facilities; their relationship with the University
of Minnesota Medical School, a public entity dedicated to medical education, research, and
public service; the status of the University of Minnesota as a constitutionally autonomous
state entity; and the university's mission as a land grant institution. The University of
Minnesota health care facilities, as charitable assets, must remain dedicated to the university's
public health care mission. As such, the University of Minnesota health care facilities shall
not be owned or controlled, directly or indirectly, in whole or in part, by a for-profit entity
or an out-of-state entity, unless the attorney general determines that ownership or control
by a for-profit entity or out-of-state entity is in the public interest. A determination under
this subdivision must be made using the procedures and authority in section 145D.01 and
in consultation with the commissioner of health and the Board of Regents of the University
of Minnesota.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment and
applies to transactions by a health maintenance organization or health system related to
selling or transferring control to an out-of-state nonprofit entity or for-profit entity, and to
transactions related to transferring ownership or control of the University of Minnesota
health care facilities, that are completed on or after that date.
new text end

Sec. 4.

Laws 2017, First Special Session chapter 6, article 5, section 11, as amended by
Laws 2019, First Special Session chapter 9, article 8, section 20, is amended to read:

Sec. 11. MORATORIUM ON CONVERSION TRANSACTIONS.

(a) Notwithstanding Laws 2017, chapter 2, article 2, a nonprofit health service plan
corporation operating under Minnesota Statutes, chapter 62C, or a nonprofit health
maintenance organization operating under Minnesota Statutes, chapter 62D, as of January
1, 2017, may only merge or consolidate with; convert; or transfer, as part of a single
transaction or a series of transactions within a 24-month period, all or a material amount of
its assets to an entity that is a corporation organized under Minnesota Statutes, chapter
317A; or to a Minnesota nonprofit hospital within the same integrated health system as the
health maintenance organization. For purposes of this section, "material amount" means
the lesser of ten percent of such an entity's total admitted net assets as of December 31 of
the previous year, or $50,000,000.

(b) Paragraph (a) does not apply if the nonprofit service plan corporation or nonprofit
health maintenance organization files an intent to dissolve due to insolvency of the
corporation in accordance with Minnesota Statutes, chapter 317A, or insolvency proceedings
are commenced under Minnesota Statutes, chapter 60B.

(c) Nothing in this section shall be construed to authorize a nonprofit health maintenance
organization or a nonprofit service plan corporation to engage in any transaction or activities
not otherwise permitted under state law.

(d) This section expires July 1, deleted text begin 2023 deleted text end new text begin 2026 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. 5. new text begin STUDY AND RECOMMENDATIONS; NONPROFIT HEALTH
MAINTENANCE ORGANIZATION CONVERSIONS AND OTHER
TRANSACTIONS.
new text end

new text begin (a) The commissioner of health shall study and develop recommendations on the
regulation of conversions, mergers, transfers of assets, and other transactions affecting
Minnesota-domiciled nonprofit health maintenance organizations and for-profit health
maintenance organizations. The recommendations must at least address:
new text end

new text begin (1) monitoring and regulation of Minnesota-domiciled for-profit health maintenance
organizations;
new text end

new text begin (2) issues related to public benefit assets held by a nonprofit health maintenance
organization, including identifying the portion of the organization's assets that are considered
public benefit assets to be protected, establishing a fair and independent process to value
the assets, and determining how public benefit assets should be stewarded for the public
good;
new text end

new text begin (3) providing a state agency or executive branch office with authority to review and
approve or disapprove a nonprofit health maintenance organization's plan to convert to a
for-profit organization; and
new text end

new text begin (4) establishing a process for the public to learn about and provide input on a nonprofit
health maintenance organization's proposed conversion to a for-profit organization.
new text end

new text begin (b) To fulfill the requirements under this section, the commissioner:
new text end

new text begin (1) may consult with the commissioners of human services and commerce;
new text end

new text begin (2) may enter into one or more contracts for professional or technical services;
new text end

new text begin (3) notwithstanding any law to the contrary, may use data submitted under Minnesota
Statutes, sections 62U.04 and 144.695 to 144.703, and other data held by the commissioner
for purposes of regulating health maintenance organizations or data already submitted to
the commissioner by health carriers; and
new text end

new text begin (4) may collect from health maintenance organizations and their parent or affiliated
companies, financial data and other information, including nonpublic data and trade secret
data, that are deemed necessary by the commissioner to conduct the study and develop the
recommendations under this section. Health maintenance organizations must provide the
commissioner with any information requested by the commissioner under this clause, in
the form and manner specified by the commissioner. Any data collected by the commissioner
under this clause is classified as confidential data on individuals as defined in Minnesota
Statutes, section 13.02, subdivision 3, or protected nonpublic data as defined in Minnesota
Statutes, section 13.02, subdivision 13.
new text end

new text begin (c) No later than October 1, 2023, the commissioner must seek public comments on the
regulation of conversion transactions involving nonprofit health maintenance organizations.
new text end

new text begin (d) The commissioner may use the enforcement authority in Minnesota Statutes, section
62D.17, if a health maintenance organization fails to comply with a request for information
under paragraph (b), clause (4).
new text end

new text begin (e) The commissioner shall submit preliminary findings from this study to the chairs of
the legislative committees with jurisdiction over health and human services by January 15,
2024, and shall submit a final report and recommendations to the legislature by June 30,
2024.
new text end

Sec. 6. new text begin APPROPRIATIONS.
new text end

new text begin $....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general
fund to the commissioner of health for purposes of Minnesota Statutes, section 145D.01.
new text end