SF 1745

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/16/2024 09:28am

A bill for an act
relating to state government; requiring accounting procedures for accountable
health care entities receiving eligible state expenditures; authorizing the state
auditor to examine records of accountable health care entities; establishing the
Minnesota Commission for Equitable Health Care Services; requiring reports;
providing appointments; appropriating money; proposing coding for new law in
Minnesota Statutes, chapter 6; proposing coding for new law as Minnesota Statutes,
chapter 145E.

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

Section 1.

new text begin [6.93] ACCOUNTABLE HEALTH CARE ENTITIES; CERTIFICATION.
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) "Accountable health care entity" means any entity that operates in Minnesota and,
as more than an incidental part of the entity's business activities, provides health care services;
offers health insurance; reviews, negotiates, or facilitates transactions related to health care
services or health insurance; sells medical or pharmaceutical equipment, drugs, supplies,
or related goods; or acts as a producer, agent, broker, intermediary, or contractor to perform
or facilitate any of the foregoing activities. Accountable health care entity includes, but is
not limited to the following:
new text end

new text begin (1) an entity formed to provide a professional health care service to individuals;
new text end

new text begin (2) a utilization review organization, as defined in section 62M.02;
new text end

new text begin (3) an entity that owns or controls a facility certified or licensed by the Department of
Health;
new text end

new text begin (4) an entity subject to section 60A.23, subdivision 8;
new text end

new text begin (5) a pharmacy benefit manager, as defined in section 62W.02; and
new text end

new text begin (6) a manufacturer, pharmacy, retailer, wholesaler, third-party logistics provider, group
purchasing organization, distributor, or other entity engaged in supplying a drug or medical
equipment or device.
new text end

new text begin (c) "Commission" means the Minnesota Commission for Equitable Health Care Services
established in section 145E.10.
new text end

new text begin (d) "Eligible state expenditure" means any cash, good, benefit, credit, or other asset
provided by Minnesota to the applicable entity, or any expenditure or cost incurred by
Minnesota for the benefit of the applicable entity, to serve a health care purpose.
new text end

new text begin Subd. 2. new text end

new text begin Certification by accountable health care entities. new text end

new text begin (a) All accountable health
care entities that receive an eligible state expenditure must account, to the fullest extent
practicable, for all receipts, transfers, and uses of eligible state expenditures.
new text end

new text begin (b) All accountable health care entities that receive an eligible state expenditure must
maintain sufficient accounting records to clearly demonstrate, to the fullest extent practicable,
to the state auditor that all eligible state expenditures have been utilized by the accountable
health care entity to effectuate the legislative purpose for the eligible state expenditure.
new text end

new text begin (c) By December 31, 2025, and each year thereafter, all accountable health care entities
that received an eligible state expenditure in the calendar year must certify to the state auditor
that accounting records have been maintained in accordance with paragraph (b) with respect
to all eligible state expenditures.
new text end

new text begin Subd. 3. new text end

new text begin Written accounting policies. new text end

new text begin (a) All entities subject to subdivision 2, paragraph
(c), that do not provide the certification required by subdivision 2 must develop and maintain
written policies and procedures that include a sustainable methodology to implement the
accounting requirements of this section.
new text end

new text begin (b) An accountable health care entity subject to this subdivision must cooperate with
the state auditor in developing such policies and procedures.
new text end

new text begin (c) The written policies and procedures must be made available to: (1) the state auditor;
and (2) any chair of a legislative committee, upon request.
new text end

new text begin Subd. 4. new text end

new text begin Commission requests for examination. new text end

new text begin Upon receipt of a written request for
one of the following by the commission, the state auditor must:
new text end

new text begin (1) examine all potentially relevant accounts and records of an accountable health care
entity for compliance with this section; or
new text end

new text begin (2) examine all potentially relevant accounts and records of an accountable health care
entity, with respect to a particular eligible state expenditure, to determine the following:
new text end

new text begin (i) the necessity for the eligible state expenditure to have been funded by public funds;
and
new text end

new text begin (ii) the accountable health care entity's budgeting considerations and decisions impacting
the necessity analysis required by item (i).
new text end

new text begin Subd. 5. new text end

new text begin Independent state auditor examinations. new text end

new text begin (a) The state auditor is empowered
to examine all accounts and records of an accountable health care entity that received an
eligible state expenditure in the prior calendar year for compliance with this section. A
request by the commission under subdivision 4 is not necessary for the state auditor to use
such authority.
new text end

new text begin (b) The state auditor must facilitate the commission's duties set forth in section 145E.10,
subdivision 11. The state auditor may use all authority under paragraph (a) for the purposes
of this paragraph.
new text end

new text begin Subd. 6. new text end

new text begin Report to the commission. new text end

new text begin The state auditor must report the findings of any
examination under this section to the commission. The state auditor must report findings
resulting from a request under subdivision 4 to the commission within 30 days of the request
to the state auditor. The state auditor's report to the commission must include any information,
including comprehensive financial data of the accountable health care entity, that the state
auditor determines would facilitate the commission's duties set forth in section 145E.10,
subdivision 11.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 2.

new text begin [145E.10] COMMISSION FOR EQUITABLE HEALTH CARE SERVICES.
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 them.
new text end

new text begin (b) "Accountable health care entity" has the meaning given in section 6.93.
new text end

new text begin (c) "Commission" means the Minnesota Commission for Equitable Health Care Services
established in this section.
new text end

new text begin (d) "Eligible state expenditure" has the meaning given in section 6.93.
new text end

new text begin (e) "Personal interest" means that:
new text end

new text begin (1) a person owns or controls, directly or indirectly, at least five percent of the voting
interest or equity interest in the entity;
new text end

new text begin (2) the equity interest in the entity owned by a person represents at least five percent of
that person's net worth; or
new text end

new text begin (3) at least five percent of a person's gross income, other than income from fixed wages
and employment benefits received from the entity, is based, through equity, contract, or
otherwise, on the entity's revenue.
new text end

new text begin Subd. 2. new text end

new text begin Public membership. new text end

new text begin (a) The Minnesota Commission for Equitable Health
Care Services consists of nine public members appointed according to section 15.0597, as
follows:
new text end

new text begin (1) one member who is a resident of congressional district 1 appointed by the attorney
general;
new text end

new text begin (2) one member who is a resident of congressional district 2 appointed by the attorney
general;
new text end

new text begin (3) one member who is a resident of congressional district 3 appointed by the speaker
of the house of representatives;
new text end

new text begin (4) one member who is a resident of congressional district 4 appointed by the governor;
new text end

new text begin (5) one member who is a resident of congressional district 5 appointed by the majority
leader of the senate;
new text end

new text begin (6) one member who is a resident of congressional district 6 appointed by the minority
leader of the house of representatives;
new text end

new text begin (7) one member who is a resident of congressional district 7 appointed by the minority
leader of the senate;
new text end

new text begin (8) one member who is a resident of congressional district 8 appointed by the governor;
and
new text end

new text begin (9) one member who is a representative of Tribal governments appointed by the governor.
new text end

new text begin (b) The appointing authorities under this subdivision must consult with one another to
ensure to the extent practicable that the public membership of the commission represents
the diversity of Minnesotans with respect to gender, race, ethnicity, and geography.
new text end

new text begin (c) The appointing authorities must complete the initial appointments required under
this subdivision by August 1, 2024.
new text end

new text begin (d) The governor shall designate one public member appointed by the governor to serve
as the acting chairperson solely for the purposes of planning and convening the first meeting
of the commission.
new text end

new text begin (e) Public members may be removed as provided in section 15.059, subdivision 4.
new text end

new text begin Subd. 3. new text end

new text begin Commission advisors. new text end

new text begin (a) The commission includes 11 nonvoting commission
advisors appointed according to section 15.0597, as follows:
new text end

new text begin (1) one advisor who is a registered nurse and practices nursing in a hospital setting,
appointed by the Minnesota Nurses Association;
new text end

new text begin (2) one advisor who is a licensed traditional midwife, appointed by the Birth Justice
Collaborative;
new text end

new text begin (3) one advisor who is a mental health provider with rural mental health care experience,
appointed by the National Alliance on Mental Illness, Minnesota;
new text end

new text begin (4) one advisor who is living with a disability, appointed by the Minnesota Council on
Disability;
new text end

new text begin (5) one advisor who is a primary care physician with rural health care experience,
appointed by the Minnesota Medical Association;
new text end

new text begin (6) one advisor who is a licensed practical nurse and practices practical nursing in a rural
health care setting, appointed by the American Federation of State, County, and Municipal
Employees, Council 65;
new text end

new text begin (7) one advisor who is a long-term care provider, appointed by Service Employees
International Union Healthcare Minnesota and Iowa;
new text end

new text begin (8) one advisor who is a representative of the counties, appointed by the Association of
Minnesota Counties;
new text end

new text begin (9) one advisor who is a physician or surgeon whose practice includes trauma and who
practices in a level 1 trauma center, appointed by Hennepin County Medical Center;
new text end

new text begin (10) one advisor who is an employee of a health carrier, as defined in section 62A.011,
appointed by the Minnesota Council of Health Plans; and
new text end

new text begin (11) one advisor who is a hospital administrator with expertise in medical billing,
appointed by the Minnesota Hospital Association.
new text end

new text begin (b) The appointing authorities under this subdivision must consult with one another to
ensure to the extent practicable that the commission advisor membership represents the
diversity of Minnesotans with respect to gender, race, ethnicity, and geography.
new text end

new text begin (c) The appointing authorities must complete the initial appointments required under
this subdivision by August 1, 2024.
new text end

new text begin (d) Commission advisors may be removed as provided in section 15.059, subdivision
4.
new text end

new text begin Subd. 4. new text end

new text begin Legislative membership. new text end

new text begin The commission shall include four nonvoting
legislative members, of whom two must be members of the senate, with one appointed by
the majority leader of the senate and one appointed by the minority leader of the senate;
and of whom two must be members of the house of representatives, with one appointed by
the speaker of the house of representatives and one appointed by the minority leader of the
house of representatives. The appointing authorities must complete the initial appointments
required under this subdivision by August 1, 2024.
new text end

new text begin Subd. 5. new text end

new text begin Ex officio membership. new text end

new text begin (a) The commission shall include five nonvoting ex
officio members, three of whom must be employees of the Department of Health appointed
by the commissioner of health, one of whom must be an employee of the Office of the
Attorney General appointed by the attorney general, and one of whom must be an employee
of the Office of the State Auditor appointed by the state auditor.
new text end

new text begin (b) Of the commissioner of health's appointments, one must have expertise in network
adequacy for managed care plans, one must have expertise in health equity, and one must
have expertise in rural health.
new text end

new text begin (c) The appointing authorities must complete the initial appointments required under
this subdivision by August 1, 2024.
new text end

new text begin Subd. 6. new text end

new text begin Limitations on membership. new text end

new text begin No member of the commission may be a director,
manager, managing partner, officer, or executive of, or may have a personal interest in: (1)
an accountable health care entity; or (2) a direct or indirect affiliate of an accountable health
care entity.
new text end

new text begin Subd. 7. new text end

new text begin Chairperson; executive committee. new text end

new text begin (a) The commission shall elect a
chairperson at its first meeting and other officers as it deems necessary.
new text end

new text begin (b) The executive committee, or the chairperson if the commission chooses not to elect
additional officers, may appoint additional subcommittees and work groups as necessary
to fulfill the duties of the commission.
new text end

new text begin Subd. 8. new text end

new text begin Meetings. new text end

new text begin (a) The appointee of the governor designated by the governor to
serve as acting chairperson for the purposes of convening the first meeting must convene
the first meeting of the commission by September 1, 2024.
new text end

new text begin (b) The commission meets at the call of the chairperson or at the request of a majority
of commission members. Meetings of the commission are subject to section 13D.01, and
notice of its meetings is governed by section 13D.04.
new text end

new text begin Subd. 9. new text end

new text begin Executive director; staff. new text end

new text begin The commission shall appoint an executive director.
The executive director serves as an ex officio nonvoting member of the executive committee.
The commission may delegate to the executive director any powers and duties under this
section that do not require commission approval. The executive director serves in the
unclassified service and may be removed at any time by a majority vote of the commission.
The executive director may employ and direct staff necessary to carry out commission
mandates, policies, activities, and objectives.
new text end

new text begin Subd. 10. new text end

new text begin Office space; equipment; technical assistance. new text end

new text begin (a) The commissioner of
administration shall provide to the commission, at a reasonable cost, administrative assistance,
office space, and access to office equipment and services. The commissioner of administration
may accept outside resources to help support its efforts.
new text end

new text begin (b) The commissioners of all departments of state government shall accommodate any
reasonable requests for technical assistance from the commission as it carries out its duties.
The commissioners shall leverage their existing vendor contracts to provide the requested
technical assistance. The commissioners shall receive expedited review and publication of
competitive procurements for additional vendor support if needed to fulfill the commission's
request.
new text end

new text begin Subd. 11. new text end

new text begin Duties. new text end

new text begin (a) The commission shall develop and recommend to the legislature
a plan to provide meaningful availability of health care services to all state residents. In
developing the plan, the commission shall:
new text end

new text begin (1) consult with a representative sample of Minnesota residents, through regional field
hearings and interviews, regarding their experiences and expectations with respect to
meaningfully accessing health care services for which they have coverage, including coverage
through public health care programs;
new text end

new text begin (2) consult small business owners, local employers, local government leaders, and local
health care providers, representing different regions across Minnesota, regarding their
experiences and expectations with health care costs, coverage, and access to care;
new text end

new text begin (3) develop and implement a method to estimate the contribution to the health care
market in the state attributable to federal, state, and local sources, including direct payments,
capitation payments, tax expenditures, and subsidies;
new text end

new text begin (4) develop and implement a method of investigating the financial and policy instruments
employed by corporate health care entities to advance, deny, and impair meaningful and
equitable health care for Minnesotans;
new text end

new text begin (5) develop and implement a method of investigating the geographic distribution of
resources such as hospital beds and specialty services and limited networks of service
providers, particularly for mental health services, substance use disorder services, obstetrics,
and long-term services and supports;
new text end

new text begin (6) study and make recommendations on transparency of ownership of health care
facilities and systems and of the role of private equity in the health care market in the state;
new text end

new text begin (7) develop and implement a method of investigating the extent and severity of inadequate
availability of culturally competent care;
new text end

new text begin (8) develop and implement a method of investigating incentives to provide equitable,
competent care;
new text end

new text begin (9) study and make recommendations on incentives and disincentives to ensure that
health care entities continue to provide health care services in rural and other underserved
communities; and
new text end

new text begin (10) conduct other activities the commission considers necessary to carry out the intent
of the legislature as expressed in this section.
new text end

new text begin (b) The commission must review accountable health care entities' activities to identify
instances where the accountable health care entity has potentially failed to comply with
section 6.93, including but not limited to where eligible state expenditures have not been
utilized by the accountable health care entity to effectuate the legislative purpose for the
eligible state expenditure.
new text end

new text begin (c) The commission must notify the state auditor of those instances of potential
noncompliance that the commission identifies under paragraph (b).
new text end

new text begin Subd. 12. new text end

new text begin Expenses. new text end

new text begin Public members, commission advisors, and ex officio members
serve without compensation. All members and advisors may have expenses reimbursed as
provided in section 15.059, subdivision 3.
new text end

new text begin Subd. 13. new text end

new text begin Data classification. new text end

new text begin Data collected by the commission, including but not
limited to data obtained from the state auditor under section 6.93, is private data on
individuals as defined in section 13.02, subdivision 12, or nonpublic data as defined in
section 13.02, subdivision 9.
new text end

new text begin Subd. 14. new text end

new text begin Contract authority. new text end

new text begin The commission may contract with one or more third
parties to perform its duties.
new text end

new text begin Subd. 15. new text end

new text begin Reports. new text end

new text begin (a) By January 15, 2025, the commission must submit to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
an initial report on its progress and other appropriate information.
new text end

new text begin (b) By January 15, 2026, and each year thereafter, the commission shall submit to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health a final report with proposals to ensure that all Minnesotans have meaningful access
to equitable health care services, any additional recommendations, draft legislation,
notifications to the state auditor under subdivision 11, paragraph (c), and the findings and
outcomes of any resulting investigations by the state auditor.
new text end

Sec. 3. new text begin APPROPRIATION.
new text end

new text begin Subdivision 1. new text end

new text begin Minnesota Commission for Equitable Health Care Services. new text end

new text begin $.......
in fiscal year 2025 is appropriated from the general fund to the Minnesota Commission for
Equitable Health Care Services for purposes of fulfilling duties assigned to the commission
and is available until June 30, 2027.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner of administration. new text end

new text begin $....... in fiscal year 2025 is appropriated
from the general fund to the commissioner of administration for the commissioner's duties
with respect to the Minnesota Commission for Equitable Health Care Services and is available
until June 30, 2027.
new text end