SF 460

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

A bill for an act
relating to health; establishing the Minnesota Universal Health Board; creating
the Minnesota universal health program; establishing the Minnesota health care
trust fund; establishing statewide and regional health care budgets; eliminating
requirement to establish public health goals; appropriating money; amending
Minnesota Statutes 2006, section 145A.12, subdivision 7; proposing coding for
new law in Minnesota Statutes, chapter 62J; proposing coding for new law as
Minnesota Statutes, chapter 62K; repealing Minnesota Statutes 2006, section
62J.212.

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

ARTICLE 1

PURPOSE

Section 1. new text begin PURPOSE.
new text end

new text begin The Minnesota Universal Health Board is created for the purpose of providing a
single, publicly financed, statewide program to provide comprehensive coverage for all
necessary health care services for residents of Minnesota.
new text end

ARTICLE 2

REGIONAL BOARDS

Section 1.

new text begin [62J.091] REGIONAL BOARDS.
new text end

new text begin Subdivision 1. new text end

new text begin General duties. new text end

new text begin (a) The commissioner shall divide the state into six
regions, one of these regions being the seven-county metropolitan area.
new text end

new text begin (b) Each region shall establish a regional board consisting of consumers according
to subdivision 2. Regional boards may:
new text end

new text begin (1) undertake voluntary activities to educate consumers and providers about
community plans and projects promoting health care cost containment, consumer
accountability, access, and quality, and about efforts to achieve public health goals;
new text end

new text begin (2) make recommendations to the commissioner regarding ways of improving
affordability, accessibility, and quality of health care in the region and throughout the state;
new text end

new text begin (3) advise the Minnesota Universal Health Board on public health goals, taking
into consideration the relevant portions of the community health service plans, plans
required by the Minnesota Comprehensive Adult Mental Health Act, the Minnesota
Comprehensive Children's Mental Health Act, and the Community Social Service Act
plans developed by county boards or community health boards in the region under
chapters 145A, 245, and 256E;
new text end

new text begin (4) prepare an annual regional education plan that is consistent with and supportive
of public health goals identified by community health boards in the region; and
new text end

new text begin (5) serve as advisory bodies to identify potential applicants for federal health
professional shortage area and federal medically underserved area designation as
requested by the commissioner.
new text end

new text begin Subd. 2. new text end

new text begin Membership; terms. new text end

new text begin (a) Each regional board shall consist of one
member per county as provided in this subdivision and three members per county in the
seven-county metropolitan area. A member may designate a representative to act as a
member of the board in the member's absence. The board shall appoint the chair of each
regional board from among its members.
new text end

new text begin (b) A member of a regional board must be a consumer who:
new text end

new text begin (1) does not have and in the past did not have a material interest in the provision
of health care services or in an activity directly related to the provision of health care
services, such as health insurance sales or health plan administration;
new text end

new text begin (2) is not responsible for or directly involved in the purchasing of health insurance
for a business or organization;
new text end

new text begin (3) is not a registered lobbyist in this state; and
new text end

new text begin (4) is at least 18 years of age and a resident of Minnesota.
new text end

new text begin (c) An individual must apply to the board of the county in which the individual
resides to become a member of a regional board. A county board shall elect its regional
board member or members from among eligible applicants. Prior to electing a regional
board member, a county board must hold public hearings with all eligible applicants, to
include a statement by each applicant and an opportunity for questioning by the county
commissioners.
new text end

new text begin (d) The terms of the members are four years. The chair of each regional board shall
designate as nearly as possible one-fourth of the members to terms expiring each year.
new text end

Sec. 2.

new text begin [62J.10] REGIONAL BOARD DUTIES.
new text end

new text begin (a) Each regional board shall submit a recommended regional budget to the
commissioner by July 1, 2008. Beginning July 1, 2008, and each July 1 thereafter, each
regional board shall submit the recommended regional budget to the Minnesota Universal
Health Board established under chapter 62K.
new text end

new text begin (b) Each regional budget must include the following:
new text end

new text begin (1) a budget for health maintenance organizations and for each health plan network
based on an estimated number of patients and an estimated per capita cost;
new text end

new text begin (2) fee schedules for individual providers;
new text end

new text begin (3) a budget for institutional providers; and
new text end

new text begin (4) budgets for the expected cost of patients treated in the region.
new text end

new text begin (c) Before the proposed regional budget is submitted to either the commissioner or
the Minnesota Universal Health Board, a regional board shall hold a hearing or hearings
after providing public notice.
new text end

new text begin (d) A regional board shall utilize, when circumstances warrant, task forces
that address specific concerns, such as regional issues or needs, concerns of specific
communities or constituencies, or public health concerns. Membership of a task force
shall include consumers who are not members of the regional board.
new text end

Sec. 3.

new text begin [62J.12] BUDGET IMPLEMENTATION SCHEDULE.
new text end

new text begin Subdivision 1. new text end

new text begin Calendar year 2009 budgets. new text end

new text begin In carrying out the duties required
under section 62J.10, the following schedule shall be followed by the commissioner
and regional boards:
new text end

new text begin (1) by July 1, 2008, each regional board shall submit to the commissioner a
recommended regional budget for health care spending consisting of budgets for each of
the accounts specified in section 62K.09; and
new text end

new text begin (2) by November 1, 2008, the commissioner shall adopt statewide and regional
budgets for each of the accounts specified in section 62K.09. The budgets must also
include fee schedules for individual providers and budgets for institutional providers to
take effect January 1, 2009.
new text end

new text begin Subd. 2. new text end

new text begin 2010 and future years. new text end

new text begin The implementation schedule for 2010 must be
identical to the 2009 schedule except that regional boards shall submit budgets to the
Minnesota Universal Health Board, not the commissioner of health. The implementation
schedule for 2011 and all future years shall be identical to the 2010 schedule except that
the Minnesota Universal Health Board, not the commissioner of health, shall propose
statewide and regional budgets by January 1, 2010.
new text end

new text begin Subd. 3. new text end

new text begin Report. new text end

new text begin The Minnesota Universal Health Board shall recommend in the
annual report due January 1, 2010, whether budgets should be set annually or biennially.
new text end

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

new text begin Sections 1 to 3 are effective January 1, 2008.
new text end

ARTICLE 3

MINNESOTA UNIVERSAL HEALTH BOARD

Section 1.

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

new text begin Subdivision 1. new text end

new text begin Scope. new text end

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

new text begin Subd. 2. new text end

new text begin Board. new text end

new text begin "Board" means the Minnesota Universal Health Board established
under section 62K.02.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner. new text end

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

new text begin Subd. 4. new text end

new text begin Department. new text end

new text begin "Department" means the Department of Health.
new text end

new text begin Subd. 5. new text end

new text begin Freestanding outpatient facility. new text end

new text begin "Freestanding outpatient facility"
means a health care facility, including, but not limited to, an outpatient surgical center,
a diagnostic imaging facility, or a physician clinic, that is not physically attached to a
hospital and that provides for the care of human beings.
new text end

new text begin Subd. 6. new text end

new text begin Health plan company. new text end

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

new text begin Subd. 7. new text end

new text begin Individual provider. new text end

new text begin "Individual provider" means a health care provider
licensed or registered by the state who is not an institutional provider.
new text end

new text begin Subd. 8. new text end

new text begin Institutional provider. new text end

new text begin "Institutional provider" means an inpatient
hospital, nursing facility, intermediate care facility for persons with mental retardation
and related conditions, and other providers of inpatient services, including institutions
providing inpatient or overnight care and ambulatory diagnostic, treatment, and surgical
facilities.
new text end

new text begin Subd. 9. new text end

new text begin Medically necessary. new text end

new text begin "Medically necessary" means a health service that
is consistent with the recipient's diagnosis or condition, recognized as the prevailing
standard or current practice by the provider's peer group, and:
new text end

new text begin (1) rendered to:
new text end

new text begin (i) treat an injury, illness, infection, or pain;
new text end

new text begin (ii) treat a condition that could result in physical or mental disability;
new text end

new text begin (iii) care for a mother and child through a maternity period; or
new text end

new text begin (iv) achieve a level of physical or mental function consistent with prevailing
community standards for the diagnosis or condition; or
new text end

new text begin (2) a preventive health service.
new text end

new text begin Subd. 10. new text end

new text begin Program. new text end

new text begin "Program" means the Minnesota universal health program
established under this chapter and administered by the Minnesota Universal Health Board.
new text end

Sec. 2.

new text begin [62K.02] MINNESOTA UNIVERSAL HEALTH BOARD.
new text end

new text begin Subdivision 1. new text end

new text begin Eligibility. new text end

new text begin A member of the Minnesota Universal Health Board
must be a consumer who:
new text end

new text begin (1) does not have and in the past did not have a material interest in the provision
of health care services or in any activity directly related to the provision of health care
services, such as health insurance sales or health plan administration;
new text end

new text begin (2) is not responsible for or directly involved in the purchasing of health insurance
for a business or organization; and
new text end

new text begin (3) is not a registered lobbyist in this state.
new text end

new text begin Subd. 2. new text end

new text begin Composition. new text end

new text begin (a) The Minnesota Universal Health Board shall consist of
12 members selected as follows:
new text end

new text begin (1) the chairs of each of the six regional boards established under section 62J.091,
or their designees;
new text end

new text begin (2) two persons appointed by the governor;
new text end

new text begin (3) two persons appointed by the chair of the senate committee having jurisdiction
over health policy; and
new text end

new text begin (4) two persons appointed by the chair of the house committee having jurisdiction
over health policy.
new text end

new text begin (b) The appointing authorities shall coordinate their efforts to ensure that the board
composition reflects the racial and ethnic diversity of the state and provides representation
for persons with disabilities.
new text end

new text begin Subd. 3. new text end

new text begin Terms; compensation; removal; vacancies. new text end

new text begin The board is governed by
section 15.0575, except that board members shall receive salaries rather than per diems.
new text end

new text begin Subd. 4. new text end

new text begin Administration. new text end

new text begin The commissioner shall provide office space, equipment
and supplies, and technical support to the board.
new text end

new text begin Subd. 5. new text end

new text begin Staff. new text end

new text begin The board may hire an executive director who serves in the
unclassified service. The executive director may hire employees and consultants as
authorized by the board and may prescribe their duties. The attorney general shall provide
legal services to the board.
new text end

new text begin Subd. 6. new text end

new text begin General duties. new text end

new text begin The board may:
new text end

new text begin (1) implement and administer the Minnesota universal health program;
new text end

new text begin (2) estimate the current cost of universal coverage for all Minnesotans;
new text end

new text begin (3) establish statewide and regional budgets that include budgets for the accounts
specified in section 62K.09;
new text end

new text begin (4) approve budgets for each region, including budgets for the accounts specified
in section 62K.09;
new text end

new text begin (5) establish fee schedules, which may vary to reflect regional differences;
new text end

new text begin (6) approve budgets for institutional providers;
new text end

new text begin (7) approve capital expenditures for freestanding outpatient facilities;
new text end

new text begin (8) monitor compliance with all budgets and fee schedules and take action to achieve
compliance to the extent authorized by law;
new text end

new text begin (9) issue requests for proposals for a contract to process claims submitted by
individual providers;
new text end

new text begin (10) provide technical assistance to the regional boards established under section
62J.091;
new text end

new text begin (11) administer the Minnesota health care trust fund created under section 62K.07;
new text end

new text begin (12) monitor the operation of the Minnesota universal health program through
consumer surveys and regular data collection and evaluation activities, including
evaluations of the adequacy and quality of services furnished under the program, the need
for changes in the benefit package, the cost of each type of service, and the effectiveness
of cost containment measures under the program;
new text end

new text begin (13) develop and implement enrollment procedures for providers and persons eligible
for the program and disseminate, to providers of services and to the public, information
concerning the program and the persons eligible to receive benefits under the program;
new text end

new text begin (14) develop and implement cost containment and quality assurance procedures,
including a professional peer review system;
new text end

new text begin (15) conduct necessary investigations and inquiries and require the submission of
information, documents, and records the board considers necessary to carry out its duties
under this chapter; and
new text end

new text begin (16) conduct other activities the board considers necessary to carry out the purposes
of this chapter.
new text end

new text begin Subd. 7. new text end

new text begin Annual report. new text end

new text begin The board shall present an annual report to the legislature
and the governor by January 1, 2009, and each succeeding January, summarizing the
activities of the board. In the report due January 1, 2010, the board shall recommend
whether statewide and regional budgets should be set annually or biennially.
new text end

new text begin Subd. 8. new text end

new text begin Rulemaking. new text end

new text begin The board may adopt rules as necessary to carry out the
duties assigned under this chapter.
new text end

new text begin Subd. 9. new text end

new text begin Hearings. new text end

new text begin The board, after providing notice to consumers, providers,
and all other interested parties, may hold hearings in connection with any action that
it proposes to take under subdivision 6.
new text end

Sec. 3.

new text begin [62K.05] MINNESOTA UNIVERSAL HEALTH PROGRAM
IMPLEMENTATION SCHEDULE.
new text end

new text begin (a) The board, through the commissioner, shall begin planning and development for
the Minnesota universal health program. The board shall use an implementation schedule
that will phase in enrollment for Minnesota residents, with initial enrollment of eligible
individuals and families beginning July 1, 2009. All Minnesota residents without health
insurance shall be insured by January 1, 2010. The health insurance that covers all
Minnesota residents shall be consolidated into the Minnesota universal health program
by January 1, 2011.
new text end

new text begin (b) In carrying out planning and development activities, the board shall:
new text end

new text begin (1) begin initial enrollment of uninsured and underinsured individuals and families
with annual incomes of less than 275 percent of the federal poverty guidelines who do
not have duplicative coverage through a federal, state, or private insurance program or
plan by July 1, 2010;
new text end

new text begin (2) provide Medicare supplemental insurance by July 1, 2010, to Medicare enrollees
with annual incomes of less than 275 percent of the federal poverty guidelines;
new text end

new text begin (3) enroll individuals and families with incomes at or above 275 percent of the
federal poverty guidelines and individuals and families with incomes below 275 percent
of the federal poverty guidelines not eligible for enrollment under clause (1) beginning
January 1, 2011;
new text end

new text begin (4) provide Medicare supplemental insurance to Medicare enrollees not eligible for
enrollment under clause (2) beginning January 1, 2011;
new text end

new text begin (5) merge the Minnesota universal health program, the MinnesotaCare program, the
general assistance medical care program, and the services for children with handicaps
program by July 1, 2011, in a way that will not diminish the coverage provided to
participants in existing programs and without increasing the financial obligations of public
hospitals and other providers that currently serve participants in these programs;
new text end

new text begin (6) assume responsibility for the administration and funding of appropriate
components of maternal and child health services currently administered by the
commissioner and coordinate outreach, patient education, case management, and related
activities with the maternal and child health program, local public health departments,
and nonprofit agencies by July 1, 2011;
new text end

new text begin (7) merge the consolidated chemical dependency treatment fund with the Minnesota
universal health program by July 1, 2011;
new text end

new text begin (8) phase out the Minnesota Comprehensive Health Association by July 1, 2011, in a
way that will ensure that Minnesota Comprehensive Health Association enrollees receive
comparable coverage through the Minnesota universal health program;
new text end

new text begin (9) beginning January 1, 2011, prohibit health plan companies from selling insurance
that duplicates benefits provided by the Minnesota universal health program, in a manner
that ensures continuity of coverage through the program as duplicate coverage in the
private market is prohibited;
new text end

new text begin (10) seek federal waivers in order to phase Medicare and medical assistance
recipients into the program by a target date of January 1, 2011; and
new text end

new text begin (11) phase retirees with retiree health benefits into the program by January 1, 2011.
new text end

Sec. 4.

new text begin [62K.07] MINNESOTA HEALTH CARE TRUST FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Minnesota health care trust fund is established.
The fund shall consist of all money obtained from general fund appropriations; state
savings resulting from state health program consolidation; federal payments received as
a result of any waiver or requirements granted by the United States Secretary of Health
and Human Services under health care programs established under titles 18 and 19 of
the Social Security Act, United States Code, title 42, section 301; and any other money
received by the board. The budgets of Minnesota state agencies shall remain distinct from
the Minnesota health care trust fund, except for portions of those budgets that provide
health care services that are provided to all Minnesotans through the Minnesota universal
health program.
new text end

new text begin Subd. 2. new text end

new text begin Reserves. new text end

new text begin Beginning July 1, 2009, the amount of reserves in the fund at
any time must equal at least the amount of expenditures from the fund during the entire
three preceding months.
new text end

Sec. 5.

new text begin [62K.09] ACCOUNTS WITHIN MINNESOTA HEALTH CARE TRUST
FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Prevention account. new text end

new text begin The prevention account is created within the
Minnesota health care trust fund. Money in the account shall be used solely to establish and
maintain primary community prevention programs, including preventive screening tests.
new text end

new text begin Subd. 2. new text end

new text begin Health services account. new text end

new text begin The health services account is created within
the Minnesota health care trust fund. Money in the account shall be used solely to pay
providers in accordance with section 62K.19.
new text end

new text begin Subd. 3. new text end

new text begin Capital account. new text end

new text begin The capital account is created within the Minnesota
health care trust fund. Money in the account shall be used solely to:
new text end

new text begin (1) pay for the construction, renovation, and equipping of health care institutions,
including institutions providing inpatient or overnight care and ambulatory diagnostic,
treatment, and surgical facilities; and
new text end

new text begin (2) provide health professionals serving in health care shortage areas with assistance
in repaying educational loans and establishing medical practices.
new text end

new text begin Subd. 4. new text end

new text begin Interpretation, communication, and transportation account. new text end

new text begin (a) The
interpretation, communication, and transportation account is created within the Minnesota
health care trust fund. Money in the account shall be used to fund:
new text end

new text begin (1) interpreter services;
new text end

new text begin (2) communication and cooperation improvement efforts; and
new text end

new text begin (3) transportation projects to provide access for patients unable to reach necessary
services, including projects that provide services at the residences of patients unable
to travel.
new text end

new text begin (b) Money may be used to fund public education programs and programs that
encourage cooperation between institutions funded on an annual basis that lead to more
efficient and effective use of health care resources. All expenditures must comply with
rules approved by the board.
new text end

new text begin Subd. 5. new text end

new text begin Program administration, evaluation, planning, and assessment
account. new text end

new text begin The program administration, evaluation, planning, and assessment account is
created within the Minnesota health care trust fund. Money in the account shall be used by
the board to monitor and improve the plan's effectiveness and operations. The board may
establish grant programs, including demonstration projects, for this purpose.
new text end

new text begin Subd. 6. new text end

new text begin Medical research account. new text end

new text begin The medical research account is created within
the Minnesota health care trust fund. Money in the account shall be used by the board to
establish a health care analysis unit. The results of the unit's research shall be used by the
board to improve the quality of health care provided under the Minnesota universal health
program and to make decisions about health benefits covered by the program. The board
may also establish grant programs, including demonstration projects, for this purpose. The
board shall seek federal and private funds to supplement this allocation.
new text end

Sec. 6.

new text begin [62K.11] ELIGIBILITY.
new text end

new text begin Subdivision 1. new text end

new text begin Citizenship; migrant workers. new text end

new text begin (a) Eligibility for coverage under
the Minnesota universal health program is limited to citizens of the United States and
aliens lawfully admitted for permanent residence or otherwise permanently residing in
the United States under the color of law.
new text end

new text begin (b) Payment shall also be made for care and services that are furnished to an alien,
regardless of immigration status, if the care and services are necessary for the treatment
of an emergency medical condition, except for organ transplants and related care and
services. For purposes of this subdivision, the term "emergency medical condition" means
a medical condition, including labor and delivery, that if not immediately treated could
cause a person physical or mental disability, continuation of severe pain, or death.
new text end

new text begin Subd. 2. new text end

new text begin Residents receiving care out of state. new text end

new text begin The board may provide payment
for out-of-state care provided to Minnesota residents. In determining whether payment
is to be made, the board shall determine the appropriateness of the care provided, the
availability of the service in Minnesota, and the individual's medical condition and
personal circumstances. For travel less than six months in length, the board shall establish
guidelines for covering services.
new text end

new text begin Subd. 3. new text end

new text begin Nonresidents employed in Minnesota. new text end

new text begin The board may extend eligibility
to nonresidents employed in Minnesota using a sliding fee scale.
new text end

new text begin Subd. 4. new text end

new text begin Nonresidents emergency care. new text end

new text begin Nonresidents in need of emergency
services while in Minnesota shall be given care and billed for the services provided.
new text end

Sec. 7.

new text begin [62K.13] BENEFITS.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin Every Minnesota resident enrolled in the program is
entitled to receive benefits for any service covered under subdivision 2 that is medically
necessary to maintain the person's health, or necessary for the diagnosis or treatment of, or
rehabilitation following, an injury, disability, or disease. Services provided in Minnesota
must be provided by a health care provider who participates in the program.
new text end

new text begin Subd. 2. new text end

new text begin Covered services; general. new text end

new text begin The program covers the following services:
new text end

new text begin (1) acute health care;
new text end

new text begin (2) chronic health care;
new text end

new text begin (3) rehabilitative health care;
new text end

new text begin (4) preventive health services;
new text end

new text begin (5) outpatient health services;
new text end

new text begin (6) laboratory and x-ray services;
new text end

new text begin (7) home care and home health care support services;
new text end

new text begin (8) dental care;
new text end

new text begin (9) chiropractic care;
new text end

new text begin (10) inpatient and outpatient mental health care, including care for serious and
persistent mental illness;
new text end

new text begin (11) inpatient and outpatient chemical dependency treatment;
new text end

new text begin (12) family planning services;
new text end

new text begin (13) medically necessary cosmetic surgery and reconstructive surgery;
new text end

new text begin (14) public health services formerly provided through state and local government;
new text end

new text begin (15) on or after January 1, 2012, long-term care; and
new text end

new text begin (16) other medically necessary services.
new text end

new text begin Subd. 3. new text end

new text begin Covered services; pharmaceuticals and supplies. new text end

new text begin The program covers
all pharmaceuticals and medical supplies prescribed by a licensed practitioner, including
prescription drugs, pharmaceuticals and supplies for eye care, hearing aids, orthopedic
aids, home aids, and durable medical equipment.
new text end

new text begin Subd. 4. new text end

new text begin Covered services; type of practitioner. new text end

new text begin The program covers medically
necessary and appropriate services provided by all licensed or registered health care
practitioners, as long as the services are within the scope of practice and meet standards
of quality assurance established by the board. Covered practitioners include, but are not
limited to, medical doctors, doctors of chiropractic, osteopathic doctors, nurses, nurse
practitioners, physician assistants, dentists, optometrists, pharmacists, mental health
providers, chemical dependency counselors, certified nurse midwives, nutritionists,
practitioners of complementary and alternative medicine, and physical therapists.
new text end

new text begin Subd. 5. new text end

new text begin Covered services; site of care. new text end

new text begin The program covers care provided in all
settings approved by the board.
new text end

new text begin Subd. 6. new text end

new text begin Services not covered. new text end

new text begin The following services are not covered:
new text end

new text begin (1) services that are not medically necessary;
new text end

new text begin (2) surgery for cosmetic purposes; and
new text end

new text begin (3) medical examinations conducted and medical reports prepared for purchasing
or renewing life insurance or participating as a plaintiff or defendant in a civil action
for the recovery or settlement of damages.
new text end

new text begin Subd. 7. new text end

new text begin Benefits advisory committee; changes in covered services. new text end

new text begin (a) The
board shall establish a benefits advisory committee comprised of consumers, health
care providers, experts in medical ethics, and health science researchers to provide
recommendations regarding program benefits and limitations on covered services. The
board shall ensure that the composition of the committee reflects the racial and ethnic
diversity of the state and provides representation for persons with disabilities. Persons
serving on the committee are compensated as provided in section 15.0575.
new text end

new text begin (b) The board may make changes in program benefits or place limitations on covered
services only after public hearing.
new text end

new text begin Subd. 8. new text end

new text begin Choice of providers. new text end

new text begin An eligible person may choose any provider licensed
or registered in Minnesota, or an alternative provider if referred by a licensed Minnesota
provider, including practitioners practicing on an independent basis, in group practices, or
in health maintenance organizations.
new text end

Sec. 8.

new text begin [62K.15] DUPLICATE COVERAGE PROHIBITED.
new text end

new text begin Policies, plans, or contracts of health coverage issued, sold, or renewed by health
plan companies on or after January 1, 2011, must not offer benefits that duplicate coverage
offered under the Minnesota universal health program. A policy, plan, or contract may
offer benefits that do not duplicate coverage that is offered by the program.
new text end

Sec. 9.

new text begin [62K.17] PROVIDER RESPONSIBILITIES.
new text end

new text begin Subdivision 1. new text end

new text begin Provider participation. new text end

new text begin All licensed providers shall be considered
participants in the program unless and until the provider notifies the board of a change in
status. Providers shall not bill patients for services covered under the Minnesota universal
health program. The board shall provide providers with notice of these requirements and
adopt rules necessary to allow for changes in provider status.
new text end

new text begin Subd. 2. new text end

new text begin Nondiscrimination. new text end

new text begin Participating providers shall furnish services to all
eligible persons, regardless of race, color, income level, national origin, religion, sex,
sexual orientation, or other nonmedical criteria.
new text end

new text begin Subd. 3. new text end

new text begin Provision of information. new text end

new text begin Upon the request of the board, every provider
shall furnish information that may reasonably be required by the board to ensure or
enhance quality, reduce costs, eliminate fraud, estimate health care spending, and set
budgets. A provider shall permit the board to examine its records as necessary for
verification of payment.
new text end

Sec. 10.

new text begin [62K.19] PROVIDER REIMBURSEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Institutional providers. new text end

new text begin (a) The Minnesota universal health program
shall pay the expenses of institutional providers on the basis of annual budgets that are
approved by the board.
new text end

new text begin (b) An institutional provider shall negotiate an annual budget with the regional
board to cover its anticipated services for the next year based on past performance and
projected changes in prices and service levels. A physician or other provider employed
by an annually-budgeted institutional provider shall be paid through and in a manner
determined by the institutional provider.
new text end

new text begin Subd. 2. new text end

new text begin Individual providers. new text end

new text begin The board may reimburse individual providers of
health care services on a fee-for-service basis. The board shall annually negotiate the
fee schedule with the appropriate professional group. In developing fee schedules, the
board may take into account recognized geographic differences in cost of practice. To the
greatest extent possible, fee schedule categories must include payment for all procedures
routinely performed for a given diagnosis. The board may require that certain high-risk
or specialized procedures be reimbursed only when performed in certain institutions
or by certain providers.
new text end

new text begin Subd. 3. new text end

new text begin Balance billing prohibited. new text end

new text begin A provider may not charge rates that are
higher than the negotiated reimbursement level. A provider may not charge separately
for services covered under section 62K.13.
new text end

new text begin Subd. 4. new text end

new text begin Capitated payments. new text end

new text begin A health maintenance organization may elect to
be reimbursed on a capitation basis in place of fee-for-service reimbursement. Payment
on a capitation basis does not cover inpatient services provided by a health maintenance
organization for institutional providers.
new text end

Sec. 11.

new text begin [62K.21] RULES.
new text end

new text begin The Minnesota Universal Health Board shall adopt rules to establish a review and
approval process for regional boards established under chapter 62J.
new text end

Sec. 12.

Minnesota Statutes 2006, section 145A.12, subdivision 7, is amended to read:

Subd. 7.

Statewide outcomes.

(a) The commissioner, in consultation with the State
Community Health Advisory Committee established under section 145A.10, subdivision
10, paragraph (a), shall establish statewide outcomes for local public health grant funds
allocated to community health boards between January 1, 2004, and December 31, 2005.

(b) At least one statewide outcome must be established in each of the following
public health areas:

(1) preventing diseases;

(2) protecting against environmental hazards;

(3) preventing injuries;

(4) promoting healthy behavior;

(5) responding to disasters; and

(6) ensuring access to health services.

(c) The commissioner shall use deleted text begin Minnesota's public health goals established under
section 62J.212 and deleted text end the essential public health services under section 145A.10, subdivision
5a, as a basis for the development of statewide outcomes.

(d) The statewide maternal and child health outcomes established under section
145.8821 shall be included as statewide outcomes under this section.

(e) By December 31, 2004, and every five years thereafter, the commissioner, in
consultation with the State Community Health Advisory Committee established under
section 145A.10, subdivision 10, paragraph (a), and the Maternal and Child Health
Advisory Task Force established under section 145.881, shall develop statewide outcomes
for the local public health grant established under section 145A.131, based on state and
local assessment data regarding the health of Minnesota residents deleted text begin , deleted text end new text begin and new text end the essential
public health services under section 145A.10 deleted text begin , and current Minnesota public health goals
established under section 62J.212 deleted text end .

Sec. 13. new text begin STUDY AND ASSESSMENT.
new text end

new text begin The commissioner of health shall study statewide health care spending to enable the
Minnesota Universal Health Board and the regional boards to establish and enforce the
state and regional health care budgets. By January 1, 2008, the commissioner shall:
new text end

new text begin (1) assess health care capital needs and expenditures statewide and within each
region; and
new text end

new text begin (2) recommend to the Minnesota Universal Health Board and the regional boards
statewide and regional budgets, each consisting of budgets for operating and capital
expenditures and fee schedules for health care providers and practitioners.
new text end

Sec. 14. new text begin FUNDING.
new text end

new text begin Financing of the Minnesota universal health program shall be through the
consolidation of funding from existing state and federal programs and a designated
progressive income tax. There shall be no co-payments, deductibles, or other out-of-pocket
payments by individuals for services.
new text end

Sec. 15. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the general fund to the Minnesota Universal Health
Board to implement sections 1 to 11. This appropriation is available until June 30, 2011,
at which time the board shall repay this amount to the general fund from the Minnesota
health care trust fund created in Minnesota Statutes, section 62K.07.
new text end

new text begin (b) $....... is appropriated from the general fund to the commissioner of health for the
fiscal year ending June 30, 2008, to provide staffing for the regional boards.
new text end

Sec. 16. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 62J.212, new text end new text begin is repealed.
new text end

Sec. 17. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 11 are effective January 1, 2008.
new text end