SF 644

as introduced - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; creating a dentists loan 
  1.3             forgiveness program; establishing a donated dental 
  1.4             services program; repealing the requirement of 
  1.5             participation in state health care programs for dental 
  1.6             providers; requiring the commissioner of human 
  1.7             services to carve out dental services in managed care 
  1.8             contracts; increasing reimbursement rates for dental 
  1.9             care; providing certain immunities for dental 
  1.10            providers; appropriating money; amending Minnesota 
  1.11            Statutes 2000, sections 256B.037, subdivision 1; 
  1.12            256B.0644; 256B.69, subdivisions 5a, 6, and by adding 
  1.13            a subdivision; and 256B.76; proposing coding for new 
  1.14            law in Minnesota Statutes, chapters 144; 256; and 
  1.15            604A; repealing Minnesota Statutes 2000, section 
  1.16            256B.037, subdivision 5. 
  1.17  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.18     Section 1.  [144.1498] [DENTISTS LOAN FORGIVENESS.] 
  1.19     Subdivision 1.  [DEFINITIONS.] For the purposes of this 
  1.20  section, "qualified educational loan" means a government, 
  1.21  commercial, or foundation loan for the actual costs paid for 
  1.22  tuition, reasonable education expenses, and reasonable living 
  1.23  expenses related to graduate or undergraduate education of a 
  1.24  dentist.  
  1.25     Subd. 2.  [CREATION OF ACCOUNT.] A dental education account 
  1.26  is established in the general fund.  The commissioner shall use 
  1.27  money from the account to establish a loan forgiveness program 
  1.28  for dentists agreeing to provide services for a substantial 
  1.29  number of state public assistance program participants and other 
  1.30  low- to moderate-income uninsured patients, as defined by the 
  1.31  commissioner of health.  
  2.1      Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
  2.2   the program, a dental student must submit an application to the 
  2.3   commissioner of health while attending a program of study 
  2.4   designed to prepare the student to become a licensed dentist.  A 
  2.5   dental student who is accepted must sign a contract to agree to 
  2.6   serve a minimum three-year service obligation during which at 
  2.7   least 15 percent of the dentist's yearly patient encounters are 
  2.8   provided to public assistance program enrollees or patients 
  2.9   receiving sliding fee schedule discounts through a formal 
  2.10  sliding fee schedule that meets the standards established in 
  2.11  Code of Federal Regulations, title 42, section 51c.303.  The 
  2.12  service obligation shall begin no later than March 31 of the 
  2.13  first year following completion of training. 
  2.14     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
  2.15  may accept up to 14 applicants per year for participation in the 
  2.16  loan forgiveness program.  Applicants are responsible for 
  2.17  securing their own qualified educational loan.  Applicants 
  2.18  chosen to participate in the loan forgiveness program may 
  2.19  designate, for each year of dentistry study up to a maximum of 
  2.20  four years, an agreed amount, not to exceed $10,000, as a 
  2.21  qualified educational loan.  For each year that a participant 
  2.22  meets the service obligation required under subdivision 3, up to 
  2.23  a maximum of four years, the commissioner shall make annual 
  2.24  disbursements directly to the participant in an amount equal to 
  2.25  $10,000 per year of service, not to exceed $40,000 or the 
  2.26  balance of the qualified educational loan, whichever is less.  
  2.27  The total amount of all disbursements must not exceed the 
  2.28  principal and accrued interest of the qualified educational 
  2.29  loan.  Before receiving loan repayment disbursements, the 
  2.30  participant must complete and return to the commissioner an 
  2.31  affidavit of practice form provided by the commissioner 
  2.32  verifying that the participant's practice meets the requirements 
  2.33  described in subdivision 3.  After each disbursement, the 
  2.34  participant must provide the commissioner with verification that 
  2.35  the full amount of a loan repayment disbursement received by the 
  2.36  participant has been applied toward the qualified educational 
  3.1   loan before the next loan repayment disbursement is made.  
  3.2   Participants who move their practice remain eligible for loan 
  3.3   repayment if the requirements of subdivision 3 continue to be 
  3.4   met.  
  3.5      Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
  3.6   does not fulfill the service commitment as required under 
  3.7   subdivision 3, the commissioner of health shall collect from the 
  3.8   participant 100 percent of any payments made for the qualified 
  3.9   educational loan and interest at a rate established under 
  3.10  section 270.75.  The commissioner shall deposit the money 
  3.11  collected in the dental education account established under 
  3.12  subdivision 2.  
  3.13     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
  3.14  service obligations cancel in the event of a participant's 
  3.15  death.  The commissioner of health may waive or suspend payment 
  3.16  or service obligations in cases of total and permanent 
  3.17  disability or long-term temporary disability lasting for more 
  3.18  than two years.  The commissioner shall evaluate all other 
  3.19  requests for suspension or waivers on a case-by-case basis and 
  3.20  may grant a waiver of all or part of the money owed as a result 
  3.21  of a nonfulfillment penalty if emergency circumstances prevented 
  3.22  fulfillment of the required service commitment. 
  3.23     Sec. 2.  [256.956] [DONATED DENTAL SERVICES.] 
  3.24     Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  3.25  services shall award grants to programs in which dentists 
  3.26  provide donated dental services to low-income uninsured 
  3.27  individuals, as defined by the commissioner.  
  3.28     Subd. 2.  [GRANT ELIGIBILITY.] (a) To be eligible for a 
  3.29  grant under this section, a program must provide:  
  3.30     (1) a network of volunteer dentists, including dental 
  3.31  specialists, volunteer dental laboratories, and other 
  3.32  appropriate volunteer professionals to donate dental services to 
  3.33  eligible individuals; 
  3.34     (2) guidelines to determine individual eligibility for the 
  3.35  program; 
  3.36     (3) a system to refer eligible individuals to appropriate 
  4.1   volunteers; and 
  4.2      (4) a public awareness campaign to educate the public about 
  4.3   the availability of the program.  
  4.4      (b) Volunteers participating in a program receiving grant 
  4.5   funds under this section must not charge an eligible individual 
  4.6   for the cost of the services or supplies provided, except for 
  4.7   certain dental laboratory costs.  Any laboratory costs required 
  4.8   to be paid by the individual must be disclosed to the individual 
  4.9   before any service is provided.  
  4.10     Subd. 3.  [REPORT.] The commissioner of human services 
  4.11  shall submit an annual report to the legislature beginning 
  4.12  January 15, 2003, that: 
  4.13     (1) accounts for the grants awarded for the past fiscal 
  4.14  year; 
  4.15     (2) reports the number of individuals served by the 
  4.16  programs that received grants for the past fiscal year; and 
  4.17     (3) reports the number of volunteers and dental 
  4.18  laboratories participating in the programs that received grants 
  4.19  for the past fiscal year.  
  4.20     Sec. 3.  Minnesota Statutes 2000, section 256B.037, 
  4.21  subdivision 1, is amended to read: 
  4.22     Subdivision 1.  [CONTRACT FOR DENTAL SERVICES.] (a) The 
  4.23  commissioner may conduct a demonstration project to contract, on 
  4.24  a prospective per capita payment basis, with an organization or 
  4.25  organizations licensed under chapter 62C, 62D, or 62N for the 
  4.26  provision of all dental care services beginning July January 1, 
  4.27  1994 2002, under the medical assistance, general assistance 
  4.28  medical care, and MinnesotaCare programs, or when necessary 
  4.29  waivers are granted by the secretary of health and human 
  4.30  services, whichever occurs later.  The commissioner shall 
  4.31  identify a geographic area or areas, including both urban and 
  4.32  rural areas, where access to dental services has been 
  4.33  inadequate, in which to conduct demonstration projects.  The 
  4.34  commissioner shall seek any federal waivers or approvals 
  4.35  necessary to implement this section from the secretary of health 
  4.36  and human services. 
  5.1      (b) The commissioner may exclude from participation in the 
  5.2   demonstration project any or all groups currently excluded from 
  5.3   participation in the prepaid medical assistance program under 
  5.4   section 256B.69.  Except for persons excluded from participation 
  5.5   in the demonstration project, all persons who have been 
  5.6   determined eligible for medical assistance, general assistance 
  5.7   medical care and, if applicable, MinnesotaCare and reside in the 
  5.8   designated geographic areas are required to enroll in a dental 
  5.9   plan to receive their dental care services.  Except for 
  5.10  emergency services or out-of-plan services authorized by the 
  5.11  dental plan, recipients must receive their dental services from 
  5.12  dental care providers who are part of the dental plan provider 
  5.13  network.  
  5.14     (c) The commissioner shall select either multiple dental 
  5.15  plans or a single dental plan in a designated area.  A dental 
  5.16  plan under contract with the department commissioner must serve 
  5.17  both medical assistance recipients and, general assistance 
  5.18  medical care recipients, and MinnesotaCare recipients in a 
  5.19  designated geographic area and may serve MinnesotaCare 
  5.20  recipients.  The commissioner may limit the number of dental 
  5.21  plans with which the department contracts within a designated 
  5.22  geographic area, taking into consideration the number of 
  5.23  recipients within the designated geographic area; the number of 
  5.24  potential dental plan contractors; the size of the provider 
  5.25  network offered by dental plans; the dental care services 
  5.26  offered by a dental plan; qualifications of dental plan 
  5.27  personnel; accessibility of services to recipients; dental plan 
  5.28  assurances of recipient confidentiality; dental plan marketing 
  5.29  and enrollment activities; dental plan compliance with this 
  5.30  section; dental plan performance under other contracts with the 
  5.31  department to serve medical assistance, general assistance 
  5.32  medical care, or MinnesotaCare recipients; or any other factors 
  5.33  necessary to provide the most economical care consistent with 
  5.34  high standards of dental care.  
  5.35     (d) For purposes of this section, "dental plan" means an 
  5.36  organization licensed under chapter 62C, 62D, or 62N that 
  6.1   contracts with the department commissioner to provide covered 
  6.2   dental care services to recipients on a prepaid capitation basis.
  6.3   "Emergency services" has the meaning given in section 256B.0625, 
  6.4   subdivision 4.  "Multiple dental plan area" means a designated 
  6.5   area in which more than one dental plan is offered.  
  6.6   "Participating provider" means a dentist or dental clinic who is 
  6.7   employed by or under contract with a dental plan to provide 
  6.8   dental care services to recipients.  "Single dental plan area" 
  6.9   means a designated area in which only one dental plan is 
  6.10  available. 
  6.11     Sec. 4.  Minnesota Statutes 2000, section 256B.0644, is 
  6.12  amended to read: 
  6.13     256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
  6.14  OTHER STATE HEALTH CARE PROGRAMS.] 
  6.15     (a) Notwithstanding paragraph (b), a vendor of medical 
  6.16  care, as defined in section 256B.02, subdivision 7, and a health 
  6.17  maintenance organization, as defined in chapter 62D, must 
  6.18  participate as a provider or contractor in the medical 
  6.19  assistance program, general assistance medical care program, and 
  6.20  MinnesotaCare as a condition of participating as a provider in 
  6.21  health insurance plans and programs or contractor for state 
  6.22  employees established under section 43A.18, the public employees 
  6.23  insurance program under section 43A.316, for health insurance 
  6.24  plans offered to local statutory or home rule charter city, 
  6.25  county, and school district employees, the workers' compensation 
  6.26  system under section 176.135, and insurance plans provided 
  6.27  through the Minnesota comprehensive health association under 
  6.28  sections 62E.01 to 62E.19.  The limitations on insurance plans 
  6.29  offered to local government employees shall not be applicable in 
  6.30  geographic areas where provider participation is limited by 
  6.31  managed care contracts with the department of human services.  
  6.32  For providers other than health maintenance organizations, 
  6.33  participation in the medical assistance program means that (1) 
  6.34  the provider accepts new medical assistance, general assistance 
  6.35  medical care, and MinnesotaCare patients or (2) at least 20 
  6.36  percent of the provider's patients are covered by medical 
  7.1   assistance, general assistance medical care, and MinnesotaCare 
  7.2   as their primary source of coverage.  The commissioner shall 
  7.3   establish participation requirements for health maintenance 
  7.4   organizations.  The commissioner shall provide lists of 
  7.5   participating medical assistance providers on a quarterly basis 
  7.6   to the commissioner of employee relations, the commissioner of 
  7.7   labor and industry, and the commissioner of commerce.  Each of 
  7.8   the commissioners shall develop and implement procedures to 
  7.9   exclude as participating providers in the program or programs 
  7.10  under their jurisdiction those providers who do not participate 
  7.11  in the medical assistance program.  The commissioner of employee 
  7.12  relations shall implement this section through contracts with 
  7.13  participating health and dental carriers. 
  7.14     (b) This section does not apply to dental services 
  7.15  providers. 
  7.16     Sec. 5.  Minnesota Statutes 2000, section 256B.69, 
  7.17  subdivision 5a, is amended to read: 
  7.18     Subd. 5a.  [MANAGED CARE CONTRACTS.] Managed care contracts 
  7.19  under this section and sections 256L.12 and 256D.03, shall be 
  7.20  entered into or renewed on a calendar year basis beginning 
  7.21  January 1, 1996.  Managed care contracts which were in effect on 
  7.22  June 30, 1995, and set to renew on July 1, 1995, shall be 
  7.23  renewed for the period July 1, 1995 through December 31, 1995 at 
  7.24  the same terms that were in effect on June 30, 1995.  Managed 
  7.25  care contracts entered into or renewed on or after January 1, 
  7.26  2002, shall not include dental services as part of the health 
  7.27  services required to be provided.  Beginning January 1, 2002, 
  7.28  dental services shall be covered in accordance with subdivision 
  7.29  6c.  
  7.30     A prepaid health plan providing covered health services for 
  7.31  eligible persons pursuant to chapters 256B, 256D, and 256L, is 
  7.32  responsible for complying with the terms of its contract with 
  7.33  the commissioner.  Requirements applicable to managed care 
  7.34  programs under chapters 256B, 256D, and 256L, established after 
  7.35  the effective date of a contract with the commissioner take 
  7.36  effect when the contract is next issued or renewed. 
  8.1      Sec. 6.  Minnesota Statutes 2000, section 256B.69, 
  8.2   subdivision 6, is amended to read: 
  8.3      Subd. 6.  [SERVICE DELIVERY.] (a) Each demonstration 
  8.4   provider shall be responsible for the health care coordination 
  8.5   for eligible individuals, except for dental services.  
  8.6   Demonstration providers: 
  8.7      (1) shall authorize and arrange for the provision of all 
  8.8   needed health services, except dental services, including, but 
  8.9   not limited to, the full range of services listed in sections 
  8.10  256B.02, subdivision 8, and 256B.0625, subdivisions 1 to 8c and 
  8.11  10 to 42, in order to ensure appropriate health care is 
  8.12  delivered to enrollees; 
  8.13     (2) shall accept the prospective, per capita payment from 
  8.14  the commissioner in return for the provision of comprehensive 
  8.15  and coordinated health care services for eligible individuals 
  8.16  enrolled in the program; 
  8.17     (3) may contract with other health care and social service 
  8.18  practitioners to provide services to enrollees; and 
  8.19     (4) shall institute recipient grievance procedures 
  8.20  according to the method established by the project, utilizing 
  8.21  applicable requirements of chapter 62D.  Disputes not resolved 
  8.22  through this process shall be appealable to the commissioner as 
  8.23  provided in subdivision 11.  
  8.24     (b) Demonstration providers must comply with the standards 
  8.25  for claims settlement under section 72A.201, subdivisions 4, 5, 
  8.26  7, and 8, when contracting with other health care and social 
  8.27  service practitioners to provide services to enrollees.  A 
  8.28  demonstration provider must pay a clean claim, as defined in 
  8.29  Code of Federal Regulations, title 42, section 447.45(b), within 
  8.30  30 business days of the date of acceptance of the claim.  
  8.31     Sec. 7.  Minnesota Statutes 2000, section 256B.69, is 
  8.32  amended by adding a subdivision to read: 
  8.33     Subd. 6c.  [DENTAL SERVICES.] The commissioner may contract 
  8.34  on a prospective per capita payment basis for dental services 
  8.35  with an organization or organizations licensed under chapter 
  8.36  62C, 62D, or 62N in accordance with section 256B.037 or may 
  9.1   establish and administer a fee for service system for the 
  9.2   reimbursement of dental services.  
  9.3      Sec. 8.  Minnesota Statutes 2000, section 256B.76, is 
  9.4   amended to read: 
  9.5      256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  9.6      (a) Effective for services rendered on or after October 1, 
  9.7   1992, the commissioner shall make payments for physician 
  9.8   services as follows: 
  9.9      (1) payment for level one Health Care Finance 
  9.10  Administration's common procedural coding system (HCPCS) codes 
  9.11  titled "office and other outpatient services," "preventive 
  9.12  medicine new and established patient," "delivery, antepartum, 
  9.13  and postpartum care," "critical care," Caesarean cesarean 
  9.14  delivery and pharmacologic management provided to psychiatric 
  9.15  patients, and HCPCS level three codes for enhanced services for 
  9.16  prenatal high risk, shall be paid at the lower of (i) submitted 
  9.17  charges, or (ii) 25 percent above the rate in effect on June 30, 
  9.18  1992.  If the rate on any procedure code within these categories 
  9.19  is different than the rate that would have been paid under the 
  9.20  methodology in section 256B.74, subdivision 2, then the larger 
  9.21  rate shall be paid; 
  9.22     (2) payments for all other services shall be paid at the 
  9.23  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  9.24  rate in effect on June 30, 1992; 
  9.25     (3) all physician rates shall be converted from the 50th 
  9.26  percentile of 1982 to the 50th percentile of 1989, less the 
  9.27  percent in aggregate necessary to equal the above increases 
  9.28  except that payment rates for home health agency services shall 
  9.29  be the rates in effect on September 30, 1992; 
  9.30     (4) effective for services rendered on or after January 1, 
  9.31  2000, payment rates for physician and professional services 
  9.32  shall be increased by three percent over the rates in effect on 
  9.33  December 31, 1999, except for home health agency and family 
  9.34  planning agency services; and 
  9.35     (5) the increases in clause (4) shall be implemented 
  9.36  January 1, 2000, for managed care. 
 10.1      (b) Effective for services rendered on or after October 1, 
 10.2   1992, the commissioner shall make payments for dental services 
 10.3   as follows: 
 10.4      (1) dental services shall be paid at the lower of (i) 
 10.5   submitted charges, or (ii) 25 percent above the rate in effect 
 10.6   on June 30, 1992; 
 10.7      (2) dental rates shall be converted from the 50th 
 10.8   percentile of 1982 to the 50th percentile of 1989, less the 
 10.9   percent in aggregate necessary to equal the above increases; 
 10.10     (3) effective for services rendered on or after January 1, 
 10.11  2000, payment rates for dental services shall be increased by 
 10.12  three percent over the rates in effect on December 31, 1999; 
 10.13     (4) the commissioner shall award grants to community 
 10.14  clinics or other nonprofit community organizations, political 
 10.15  subdivisions, professional associations, or other organizations 
 10.16  that demonstrate the ability to provide dental services 
 10.17  effectively to public program recipients.  Grants may be used to 
 10.18  fund the costs related to coordinating access for recipients, 
 10.19  developing and implementing patient care criteria, upgrading or 
 10.20  establishing new facilities, acquiring furnishings or equipment, 
 10.21  recruiting new providers, or other development costs that will 
 10.22  improve access to dental care in a region.  In awarding grants, 
 10.23  the commissioner shall give priority to applicants that plan to 
 10.24  serve areas of the state in which the number of dental providers 
 10.25  is not currently sufficient to meet the needs of recipients of 
 10.26  public programs or uninsured individuals.  The commissioner 
 10.27  shall consider the following in awarding the grants:  (i) 
 10.28  potential to successfully increase access to an underserved 
 10.29  population; (ii) the ability to raise matching funds; (iii) the 
 10.30  long-term viability of the project to improve access beyond the 
 10.31  period of initial funding; (iv) the efficiency in the use of the 
 10.32  funding; and (v) the experience of the proposers in providing 
 10.33  services to the target population. 
 10.34     The commissioner shall monitor the grants and may terminate 
 10.35  a grant if the grantee does not increase dental access for 
 10.36  public program recipients.  The commissioner shall consider 
 11.1   grants for the following: 
 11.2      (i) implementation of new programs or continued expansion 
 11.3   of current access programs that have demonstrated success in 
 11.4   providing dental services in underserved areas; 
 11.5      (ii) a pilot program for utilizing hygienists outside of a 
 11.6   traditional dental office to provide dental hygiene services; 
 11.7   and 
 11.8      (iii) a program that organizes a network of volunteer 
 11.9   dentists, establishes a system to refer eligible individuals to 
 11.10  volunteer dentists, and through that network provides donated 
 11.11  dental care services to public program recipients or uninsured 
 11.12  individuals. 
 11.13     (5) beginning October 1, 1999, the payment for tooth 
 11.14  sealants and fluoride treatments shall be the lower of (i) 
 11.15  submitted charge, or (ii) 80 percent of median 1997 charges; and 
 11.16     (6) the increases listed in clauses (3) and (5) shall be 
 11.17  implemented January 1, 2000, for managed care; and 
 11.18     (7) effective for services rendered on or after July 1, 
 11.19  2001, payment rates for dental services shall be the median 
 11.20  statewide dental charge for that service for the most recent 
 11.21  calendar year for which the information is available.  The 
 11.22  increases in rates generated from this clause must be 
 11.23  implemented by January 1, 2002, for managed care.  
 11.24     (c) An entity that operates both a Medicare certified 
 11.25  comprehensive outpatient rehabilitation facility and a facility 
 11.26  which was certified prior to January 1, 1993, that is licensed 
 11.27  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 11.28  whom at least 33 percent of the clients receiving rehabilitation 
 11.29  services in the most recent calendar year are medical assistance 
 11.30  recipients, shall be reimbursed by the commissioner for 
 11.31  rehabilitation services at rates that are 38 percent greater 
 11.32  than the maximum reimbursement rate allowed under paragraph (a), 
 11.33  clause (2), when those services are (1) provided within the 
 11.34  comprehensive outpatient rehabilitation facility and (2) 
 11.35  provided to residents of nursing facilities owned by the entity. 
 11.36     Sec. 9.  [604A.115] [DENTAL PROVIDERS; IMMUNITY FROM 
 12.1   LIABILITY.] 
 12.2      Subdivision 1.  [IMMUNITY.] No dentist licensed under 
 12.3   chapter 150A who provides dental services without compensation 
 12.4   except for reimbursement for supplies is liable for civil 
 12.5   damages to the patient as a result of the dentist's acts or 
 12.6   omissions in providing the service.  
 12.7      Subd. 2.  [LIMITATION.] Subdivision 1 does not apply if: 
 12.8      (1) the dentist acts in a willful and wanton or reckless 
 12.9   manner in providing the service; or 
 12.10     (2) the dentist acts in violation of chapter 150A or in 
 12.11  violation of federal or other state law.  
 12.12     Sec. 10.  [APPROPRIATION.] 
 12.13     (a) $560,000 is appropriated for each year in the biennium 
 12.14  beginning July 1, 2001, from the general fund to the 
 12.15  commissioner of health for the dentists loan forgiveness program 
 12.16  created under Minnesota Statutes, section 144.1498. 
 12.17     (b) $120,000 is appropriated for each year in the biennium 
 12.18  beginning July 1, 2001, from the general fund to the 
 12.19  commissioner of human services for grants to programs providing 
 12.20  donated dental services in accordance with Minnesota Statutes, 
 12.21  section 256.956. 
 12.22     (c) $....... is appropriated from the general fund to the 
 12.23  commissioner of human services for the biennium beginning July 
 12.24  1, 2001, for the increase in dental rates described in Minnesota 
 12.25  Statutes, section 256B.76. 
 12.26     Sec. 11.  [REPEALER.] 
 12.27     Minnesota Statutes 2000, section 256B.037, subdivision 5, 
 12.28  is repealed. 
 12.29     Sec. 12.  [EFFECTIVE DATES.] 
 12.30     Sections 5 and 6 are effective January 1, 2002, and apply 
 12.31  to all managed care contracts entered into or renewed on or 
 12.32  after that date.  Sections 7 and 11 are effective January 1, 
 12.33  2002.  Section 9 is effective for services provided on or after 
 12.34  July 1, 2001.