SF 1963

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

A bill for an act
relating to health; requiring annual reports on cost containment goals;
establishing a medical expenditure review committee; establishing a health care
transformation task force; modifying goals for universal coverage; requiring
written hospital charity care policies; modifying performance payments
for medical groups; requiring a payment reform plan; providing grants for
community collaboratives; requiring a contract for nonprofit organization
accountability; appropriating money; amending Minnesota Statutes 2006,
sections 62J.04, subdivision 3; 62J.17, subdivision 6a, by adding a subdivision;
62Q.165, subdivisions 1, 2; 144.56, by adding a subdivision; 256.01, subdivision
2b; proposing coding for new law in Minnesota Statutes, chapter 62J.

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

Section 1.

Minnesota Statutes 2006, section 62J.04, subdivision 3, is amended to read:

Subd. 3.

Cost containment duties.

The commissioner shall:

(1) establish statewide and regional cost containment goals for total health care
spending under this section deleted text begin and deleted text end new text begin , new text end collect data as described in sections 62J.38 to 62J.41 to
monitor statewide achievement of the cost containment goals new text begin , and annually report to the
legislature on whether the goals were achieved and, if not, what action should be taken to
ensure that goals are achieved in the future new text end ;

(2) divide the state into no fewer than four regions, with one of those regions being
the Minneapolis/St. Paul metropolitan statistical area but excluding Chisago, Isanti,
Wright, and Sherburne Counties, for purposes of fostering the development of regional
health planning and coordination of health care delivery among regional health care
systems and working to achieve the cost containment goals;

(3) monitor the quality of health care throughout the state and take action as
necessary to ensure an appropriate level of quality;

(4) issue recommendations regarding uniform billing forms, uniform electronic
billing procedures and data interchanges, patient identification cards, and other uniform
claims and administrative procedures for health care providers and private and public
sector payers. In developing the recommendations, the commissioner shall review the
work of the work group on electronic data interchange (WEDI) and the American National
Standards Institute (ANSI) at the national level, and the work being done at the state and
local level. The commissioner may adopt rules requiring the use of the Uniform Bill
82/92 form, the National Council of Prescription Drug Providers (NCPDP) 3.2 electronic
version, the Centers for Medicare and Medicaid Services 1500 form, or other standardized
forms or procedures;

(5) undertake health planning responsibilities;

(6) authorize, fund, or promote research and experimentation on new technologies
and health care procedures;

(7) within the limits of appropriations for these purposes, administer or contract for
statewide consumer education and wellness programs that will improve the health of
Minnesotans and increase individual responsibility relating to personal health and the
delivery of health care services, undertake prevention programs including initiatives to
improve birth outcomes, expand childhood immunization efforts, and provide start-up
grants for worksite wellness programs;

(8) undertake other activities to monitor and oversee the delivery of health care
services in Minnesota with the goal of improving affordability, quality, and accessibility of
health care for all Minnesotans; and

(9) make the cost containment goal data available to the public in a
consumer-oriented manner.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 2.

Minnesota Statutes 2006, section 62J.17, subdivision 6a, is amended to read:

Subd. 6a.

Prospective review and approval.

(a) No health care provider subject
to prospective review under this subdivision shall make a major spending commitment
unless:

(1) the provider has filed an application with the commissioner to proceed with the
major spending commitment and has provided all supporting documentation and evidence
requested by the commissioner; and

(2) the commissioner determines, based upon this documentation and evidence new text begin
and the report and recommendations of the Minnesota Medical Expenditure Review
Committee new text end , that the major spending commitment is appropriate under the criteria provided
in subdivision 5a in light of the alternatives available to the provider.

(b) A provider subject to prospective review and approval shall submit an application
to the commissioner before proceeding with any major spending commitment. The
application must address each item listed in subdivision 4a, paragraph (a), and must
also include documentation to support the response to each item. The provider may
submit information, with supporting documentation, regarding why the major spending
commitment should be excepted from prospective review under subdivision 7. The
submission may be made either in addition to or instead of the submission of information
relating to the items listed in subdivision 4a, paragraph (a).

(c) The commissioner shall determine, based upon the information submitted,
whether the major spending commitment is appropriate under the criteria provided
in subdivision 5a, or whether it should be excepted from prospective review under
subdivision 7. In making this determination, the commissioner may also consider relevant
information from other sources. At the request of the commissioner, the health technology
advisory committee shall convene an expert review panel made up of persons with
knowledge and expertise regarding medical equipment, specialized services, health care
expenditures, and capital expenditures to review applications and make recommendations
to the commissioner. The commissioner shall make a decision on the application within
60 days after an application is received.

(d) The commissioner of health has the authority to issue fines, seek injunctions, and
pursue other remedies as provided by law.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2006, section 62J.17, is amended by adding a subdivision to
read:

new text begin Subd. 6b. new text end

new text begin Minnesota Medical Expenditure Review Committee. new text end

new text begin (a) The
Minnesota Medical Expenditure Review Committee is established as a permanent
advisory committee to the commissioner of health to act as a consumer voice in the review
of major spending commitments under this section. At least two-thirds of the members
of the committee must be individual members as defined in clause (6). The committee
consists of:
new text end

new text begin (1) the commissioner of health;
new text end

new text begin (2) the commissioner of employee relations;
new text end

new text begin (3) the commissioner of human services;
new text end

new text begin (4) five persons representing employers and other health care purchasers from the
public and private sectors, including at least two representing large employers and at least
one representing small employers, provided that no purchaser representative appointed
under this clause may be a health care professional or employee or board member of a
health care organization or insurer;
new text end

new text begin (5) three experts qualified to assess the impact of major health care expenditures on
the community, including one from an academic institution, one representing a health care
provider organization, and one representing a health plan company; and
new text end

new text begin (6) individuals who are not health care professionals, are not employed
in a health-care-related position, and do not have a direct financial interest in a
health-care-related organization, including one who has health coverage through a large
employer, one who has health coverage through a small employer, one who purchases
health coverage in the individual market, one who is uninsured, and one who receives
coverage through a government program.
new text end

new text begin (b) The committee is governed by section 15.059, except that the committee does
not expire and members receive reimbursement only for expenses.
new text end

new text begin (c) The committee shall collect statewide information that can inform consumers
on major spending commitments and their impact on costs, quality, and access. The
committee shall make recommendations to the commissioner on: what information should
be required from all providers seeking to make a major spending commitment, reporting
thresholds, and information and data requirements that contribute to quality measurement.
new text end

new text begin (d) The committee shall study and report to the commissioner and the legislature
on medical services that are currently available in medical facilities and the capacity and
use of existing medical facilities.
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. 4.

new text begin [62J.84] HEALTH CARE TRANSFORMATION TASK FORCE.
new text end

new text begin Subdivision 1. new text end

new text begin Task force. new text end

new text begin The Health Care Transformation Task Force consists of:
new text end

new text begin (1) the Legislative Commission on Health Care Access established under section
62J.07;
new text end

new text begin (2) the commissioners of human services, health, and commerce;
new text end

new text begin (3) four persons designated by the SmartBuy alliance to represent private sector
purchasers, including one representing public employers, one representing large
employers, one representing small employers, and one representing labor unions; and
new text end

new text begin (4) six persons designated by the partnership for action to transform health care,
a multisector policy alliance of hospitals and health systems, health plan companies,
physicians, and other health care organizations.
new text end

new text begin Subd. 2. new text end

new text begin Public input. new text end

new text begin The commissioner of health shall review available research
and conduct statewide, regional, and local surveys, focus groups, and other activities to
determine Minnesotans' values, preferences, opinions, and perceptions related to health
care and to the issues confronting the task force, and shall report the findings to the task
force.
new text end

new text begin Subd. 3. new text end

new text begin Inventory and assessment of existing activities. new text end

new text begin The task force shall
complete an inventory and assessment of all public and private organized activities,
coalitions, and collaboratives working on tasks relating to health system improvement
including, but not limited to, patient safety, quality measurement and reporting,
evidence-based practice, adoption of health information technology, disease management
and chronic care coordination, medical homes, access to health care, cultural competence,
prevention and public health, consumer incentives, price and cost transparency, nonprofit
organization community benefits, education, research, and health care workforce. By
December 15, 2007, the task force shall present recommendations to the legislature, the
governor, and to those working on these activities on how these activities may be made
more effective and how coordination and communication may be improved.
new text end

new text begin Subd. 4. new text end

new text begin Action plan. new text end

new text begin By December 15, 2007, the task force shall develop and
present, to the legislature and the governor, a statewide action plan for transforming the
health care system to improve affordability, quality, and access. The plan may consist of
legislative actions, administrative actions of governmental entities, collaborative actions,
and actions of individuals and individual organizations. The plan must include specific
and measurable goals and deadlines for affordability, quality, and access. The plan must
include a method of coordination and communication among the activities identified
under subdivision 3.
new text end

Sec. 5.

Minnesota Statutes 2006, section 62Q.165, subdivision 1, is amended to read:

Subdivision 1.

Definition.

It is the commitment of the state to achieve universal
health coverage for all Minnesotans new text begin by the year 2010 new text end . Universal coverage is achieved
when:

(1) every Minnesotan has access to a full range of quality health care services;

(2) every Minnesotan is able to obtain affordable health coverage which pays for the
full range of services, including preventive and primary care; and

(3) every Minnesotan pays into the health care system according to that person's
ability.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 6.

Minnesota Statutes 2006, section 62Q.165, subdivision 2, is amended to read:

Subd. 2.

Goal.

It is the goal of the state to make continuous progress toward
reducing the number of Minnesotans who do not have health coverage so that by January
1, deleted text begin 2000, fewer than four percent of the state's population will be without health coverage deleted text end new text begin
2010, all Minnesota residents have access to affordable health care new text end . The goal will be
achieved by improving access to private health coverage through insurance reforms and
market reforms, by making health coverage more affordable for low-income Minnesotans
through purchasing pools and state subsidies, and by reducing the cost of health coverage
through cost containment programs and methods of ensuring that all Minnesotans are
paying into the system according to their ability.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 7.

Minnesota Statutes 2006, section 144.56, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Charity care and uncompensated care policies; rules on debt collection.
new text end

new text begin The commissioner shall require all hospitals licensed under this chapter to maintain a
written charity care policy, make the policy available to the public by posting it in public
areas of the hospital and on hospital Web sites, and provide information on charity care
policies and state public insurance programs to uninsured patients. The commissioner
shall adopt rules establishing standardized debt collection practices for hospitals.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2008.
new text end

Sec. 8.

Minnesota Statutes 2006, section 256.01, subdivision 2b, is amended to read:

Subd. 2b.

Performance payments.

new text begin (a) new text end The commissioner shall develop and
implement a pay-for-performance system to provide performance payments to new text begin :
new text end

new text begin (1) new text end medical groups that demonstrate optimum care in serving individuals with
chronic diseases who are enrolled in health care programs administered by the
commissioner under chapters 256B, 256D, and 256L new text begin ; and
new text end

new text begin (2) medical groups that implement effective medical home models of patient care
that improve quality and reduce costs through effective primary and preventive care, care
coordination, and management of chronic conditions new text end .

new text begin (b) The commissioner shall also develop and implement a patient incentive health
program to provide incentives and rewards to patients who are enrolled in health care
programs administered by the commissioner under chapters 256B, 256D, and 256L, and
who have agreed to and meet personal health goals established with their primary care
provider to manage a chronic disease or condition including, but not limited to, diabetes,
high blood pressure, and coronary artery disease.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 9. new text begin HEALTH CARE PAYMENT SYSTEM REFORM.
new text end

new text begin Subdivision 1. new text end

new text begin Payment reform plan. new text end

new text begin The commissioners of employee relations,
human services, commerce, and health shall develop a plan for promoting and facilitating
changes in payment rates and methods for paying for health care services, drugs, devices,
supplies, and equipment in order to:
new text end

new text begin (1) reward the provision of cost-effective primary and preventive care;
new text end

new text begin (2) reward the use of evidence-based care;
new text end

new text begin (3) discourage overuse and misuse;
new text end

new text begin (4) reward the use of the most cost-effective settings, drugs, devices, providers,
and treatments; and
new text end

new text begin (5) encourage consumers to maintain good health and use the health care system
appropriately.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin The commissioners shall submit a report to the legislature by
December 15, 2007, describing the payment reform plan. The report must include
proposed legislation for implementing those components of the plan requiring legislative
action or appropriations of money.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 10. new text begin COMMUNITY COLLABORATIVE PILOT PROJECTS TO COVER
THE UNINSURED.
new text end

new text begin Subdivision 1. new text end

new text begin Community collaboratives. new text end

new text begin The commissioner of health shall
provide grants to and authorization for up to three community collaboratives that satisfy
the requirements in this section. To be eligible to receive a grant and authorization under
this section, a community collaborative must include:
new text end

new text begin (1) one or more counties;
new text end

new text begin (2) one or more local hospitals;
new text end

new text begin (3) one or more local employers who collectively provide at least 300 jobs in the
community;
new text end

new text begin (4) one or more health care clinics or physician groups; and
new text end

new text begin (5) a third-party payer, which may be a county-based purchasing plan operating
under Minnesota Statutes, section 256B.692, a self-insured employer, or a health plan
company as defined in Minnesota Statutes, section 62Q.01, subdivision 4.
new text end

new text begin Subd. 2. new text end

new text begin Pilot project requirements. new text end

new text begin (a) Community collaborative pilot projects
must:
new text end

new text begin (1) identify and enroll persons in the community who are uninsured, and who have,
or are at risk of developing, one of the following chronic conditions: mental illness,
diabetes, asthma, hypertension, or other chronic condition designated by the project;
new text end

new text begin (2) assist uninsured persons obtain private-sector health insurance coverage if
possible or enroll in any public health care programs for which they are eligible. If the
uninsured individual is unable to obtain health coverage, the community collaborative
must enroll the individual in a local health care assistance program that provides specified
services to prevent or effectively manage the chronic condition;
new text end

new text begin (3) include components to help uninsured persons retain employment or to become
employable, if currently unemployed;
new text end

new text begin (4) ensure that each uninsured person enrolled in the program has a medical home
responsible for providing, or arranging for, health care services and assisting in the
effective management of the chronic condition;
new text end

new text begin (5) coordinate services between all providers and agencies serving an enrolled
individual; and
new text end

new text begin (6) be coordinated with the state's Q-Care initiative and improve the use of
evidence-based treatments and effective disease management programs in the broader
community, beyond those individuals enrolled in the project.
new text end

new text begin (b) Projects established under this section are not insurance and are not subject to
state-mandated benefit requirements or insurance regulations.
new text end

new text begin Subd. 3. new text end

new text begin Criteria. new text end

new text begin Proposals must be evaluated by actuarial, financial, and clinical
experts based on the likelihood that the project would produce a positive return on
investment for the community. In awarding grants, the commissioner of health shall
give preference to proposals that:
new text end

new text begin (1) have broad community support from local businesses, provider counties, and
other public and private organizations;
new text end

new text begin (2) would provide services to uninsured persons who have, or are at risk of
developing, multiple, co-occurring chronic conditions;
new text end

new text begin (3) integrate or coordinate resources from multiple sources, such as employer
contributions, county funds, social service programs, and provider financial or in-kind
support;
new text end

new text begin (4) provide continuity of treatment and services when uninsured individuals in
the program become eligible for public or private health insurance or when insured
individuals lose their coverage;
new text end

new text begin (5) demonstrate how administrative costs for health plan companies and providers
can be reduced through greater simplification, coordination, consolidation, standardization,
reducing billing errors, or other methods; and
new text end

new text begin (6) involve local contributions to the cost of the pilot projects.
new text end

new text begin Subd. 4. new text end

new text begin Grants. new text end

new text begin The commissioner of health shall provide implementation grants
of up to one-half of the community collaborative's costs for planning, administration, and
evaluation. The commissioner shall also provide grants to community collaboratives to
develop a fund to pay up to 50 percent of the cost of the services provided to uninsured
individuals. The remaining costs must be paid for through other sources or by agreement
of a health care provider to contribute the cost as charity care.
new text end

new text begin Subd. 5. new text end

new text begin Evaluation. new text end

new text begin The commissioner of health shall evaluate the effectiveness
of each community collaborative project awarded a grant, by comparing actual costs
for serving the identified uninsured persons to the predicted costs that would have
been incurred in the absence of early intervention and consistent treatment to manage
the chronic condition, including the costs to medical assistance, MinnesotaCare, and
general assistance medical care. The commissioner shall require community collaborative
projects, as a condition of receipt of a grant award, to provide the commissioner with all
information necessary for this evaluation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2007.
new text end

Sec. 11. new text begin NONPROFIT ORGANIZATION COMMUNITY BENEFIT AND
ACCOUNTABILITY.
new text end

new text begin The commissioner of health shall award a contract to a private organization with the
capacity to convene leaders of health care, business, government, and consumer groups
for the development of standards and guidelines for nonprofit health care organization
community benefit programs, reporting, and public accountability. The organization must:
new text end

new text begin (1) develop and test a model, standardized system for nonprofit health care
organizations to track, quantify, and report on the financial value of benefits provided by a
nonprofit organization to the community including, but not limited to, uncompensated
care provided to uninsured patients and the outcome and effectiveness of community
benefit programs;
new text end

new text begin (2) develop guidelines for nonprofit health care organization boards, executives, and
staff to ensure that the nonprofit organization acts in the best interests of the community;
new text end

new text begin (3) develop written training materials and training curriculum on the model and
guidelines; and
new text end

new text begin (4) submit a preliminary report to the commissioner of health and the legislature
by January 1, 2008, and a final report by January 1, 2009.
new text end

Sec. 12. new text begin APPROPRIATIONS.
new text end

new text begin (a) $....... is appropriated from the general fund to the commissioner of human
services for the biennium beginning July 1, 2007, to provide performance payments under
Minnesota Statutes, section 256.01, subdivision 2b.
new text end

new text begin (b) $....... is appropriated from the general fund to the commissioner of health for
the biennium beginning July 1, 2007, to provide grants to community collaboratives
under section 10.
new text end

new text begin (c) $....... is appropriated from the general fund to the commissioner of health for
the biennium beginning July 1, 2007, for a contract related to nonprofit organization
accountability under section 11.
new text end

new text begin (d) $....... is appropriated from the general fund to the commissioner of health for the
biennium beginning July 1, 2007, for purposes of conducting prospective reviews and for
the costs of the Minnesota Medical Expenditure Review Committee under sections 2 and 3.
new text end

new text begin (e) $....... is appropriated from the general fund to the commissioner of health for the
biennium beginning July 1, 2007, to establish the Health Care Transformation Task Force
under Minnesota Statutes, section 62J.84.
new text end