SF 1982

as introduced - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health; changing the membership of 
  1.3             regional coordinating boards; establishing the 
  1.4             Minnesota universal health board; creating the 
  1.5             Minnesota universal health program; establishing the 
  1.6             Minnesota health care trust fund; establishing 
  1.7             statewide and regional health care budgets; abolishing 
  1.8             the Minnesota health care commission; appropriating 
  1.9             money; amending Minnesota Statutes 1996, section 
  1.10            62J.09, by adding subdivisions; proposing coding for 
  1.11            new law in Minnesota Statutes, chapter 62J; proposing 
  1.12            coding for new law as Minnesota Statutes, chapter 62K; 
  1.13            repealing Minnesota Statutes 1996, sections 62J.05; 
  1.14            62J.09, subdivisions 2 and 8; and 62J.212. 
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16                             ARTICLE 1
  1.17                              PURPOSE
  1.18     Section 1.  [PURPOSE.] 
  1.19     The Minnesota universal health board is created for the 
  1.20  purpose of providing a single, publicly financed, statewide 
  1.21  program to provide comprehensive coverage for all necessary 
  1.22  health care services for residents of Minnesota. 
  1.23                             ARTICLE 2
  1.24                          REGIONAL BOARDS
  1.25     Section 1.  Minnesota Statutes 1996, section 62J.09, is 
  1.26  amended by adding a subdivision to read: 
  1.27     Subd. 1b.  [APPROVAL OF MERGERS AND ACQUISITIONS.] A 
  1.28  regional board shall review and approve or disapprove all 
  1.29  mergers and acquisitions of health plan companies that involve 
  1.30  health plan companies located within its region. 
  2.1      Sec. 2.  Minnesota Statutes 1996, section 62J.09, is 
  2.2   amended by adding a subdivision to read: 
  2.3      Subd. 2a.  [MEMBERSHIP; TERMS.] (a) Each regional board 
  2.4   shall consist of one member per county as provided in this 
  2.5   subdivision and three members per county in the seven-county 
  2.6   metropolitan area.  A member may designate a representative to 
  2.7   act as a member of the board in the member's absence.  The board 
  2.8   shall appoint the chair of each regional board from among its 
  2.9   members. 
  2.10     (b) A member of a regional board must be a consumer who: 
  2.11     (1) does not have and in the past did not have a material 
  2.12  interest in the provision of health care services or in an 
  2.13  activity directly related to the provision of health care 
  2.14  services, such as health insurance sales or health plan 
  2.15  administration; 
  2.16     (2) is not responsible for or directly involved in the 
  2.17  purchasing of health insurance for a business or organization; 
  2.18     (3) is not a registered lobbyist in this state; and 
  2.19     (4) is at least 18 years old and a resident of Minnesota. 
  2.20     (c) An individual must apply to a county board to become a 
  2.21  member of a regional board.  A county board shall elect one or 
  2.22  more regional board members from among eligible applicants.  
  2.23  Prior to electing a regional board member, a county board must 
  2.24  hold public hearings with all eligible applicants, to include a 
  2.25  statement by each applicant and an opportunity for questioning 
  2.26  by the county commissioners. 
  2.27     (d) The terms of the members are four years.  The chair of 
  2.28  each regional board shall designate as nearly as possible 
  2.29  one-fourth of the members to terms expiring each year. 
  2.30     Sec. 3.  [62J.10] [REGIONAL BOARD DUTIES.] 
  2.31     (a) Each regional board shall submit a recommended regional 
  2.32  budget to the commissioner by July 1, 1998.  Beginning July 1, 
  2.33  1998, and each July 1 thereafter, each regional board shall 
  2.34  submit the recommended regional budget to the Minnesota 
  2.35  universal health board established under chapter 62K. 
  2.36     (b) Each regional budget must include the following: 
  3.1      (1) a budget for health plan networks and for each health 
  3.2   plan network based on an estimated number of patients and an 
  3.3   estimated per capita cost; and 
  3.4      (2) a budget for hospitals. 
  3.5      (c) Before the proposed regional budget is submitted to 
  3.6   either the commissioner or the board, a regional board shall 
  3.7   hold a hearing to ensure regional diversity, after providing 
  3.8   notice to consumers, policyholders, providers, and all other 
  3.9   interested parties who may be affected by the regional budget. 
  3.10     (d) A regional board shall utilize, when circumstances 
  3.11  warrant, task forces that address specific concerns, such as 
  3.12  regional issues or needs, concerns of specific communities or 
  3.13  constituencies, or public health concerns.  Membership of a task 
  3.14  force shall include consumers who are not members of the 
  3.15  regional board. 
  3.16     Sec. 4.  [62J.12] [BUDGET IMPLEMENTATION SCHEDULE.] 
  3.17     Subdivision 1.  [CALENDAR YEAR 1999 BUDGETS.] In carrying 
  3.18  out the duties required under section 62J.10, the following 
  3.19  schedule shall be followed by the commissioner and regional 
  3.20  boards: 
  3.21     (1) by July 1, 1998, each regional board shall submit to 
  3.22  the commissioner a recommended regional budget for health care 
  3.23  spending consisting of budgets for operating and capital 
  3.24  expenditures; and 
  3.25     (2) by October 1, 1998, the commissioner shall adopt 
  3.26  statewide and regional budgets for health care providers and 
  3.27  practitioners and capital expenditures, and statewide and 
  3.28  regional fee schedules for health care providers and 
  3.29  practitioners, to take effect January 1, 1999. 
  3.30     Subd. 2.  [2000 AND FUTURE YEARS.] The implementation 
  3.31  schedule for 2000 must be identical to the 1999 schedule except 
  3.32  that regional boards shall submit budgets to the Minnesota 
  3.33  universal health board, not the commissioner of health.  The 
  3.34  implementation schedule for 2001 and all future years shall be 
  3.35  identical to the 2000 schedule except that the Minnesota 
  3.36  universal health board shall propose statewide and regional 
  4.1   budgets by January 1, 2000, not the commissioner of health. 
  4.2      Subd. 3.  [REPORT.] The board shall recommend in the annual 
  4.3   report due January 1, 2000, on whether budgets should be set 
  4.4   annually or biennially. 
  4.5      Sec. 5.  [EFFECTIVE DATE.] 
  4.6      Section 2 is effective January 1, 1998.  
  4.7                              ARTICLE 3
  4.8                   MINNESOTA UNIVERSAL HEALTH BOARD
  4.9      Section 1.  [62K.01] [DEFINITIONS.] 
  4.10     Subdivision 1.  [SCOPE.] For purposes of this chapter, the 
  4.11  following terms have the meanings given them. 
  4.12     Subd. 2.  [BOARD.] "Board" means the Minnesota universal 
  4.13  health board established under section 62K.02. 
  4.14     Subd. 3.  [COMMISSIONER.] "Commissioner" means the 
  4.15  commissioner of health. 
  4.16     Subd. 4.  [CULTURALLY SPECIFIC PROGRAM.] "Culturally 
  4.17  specific program" means a program: 
  4.18     (1) designed to address the unique needs of individuals who 
  4.19  share a common language, racial, ethnic, or social background; 
  4.20     (2) governed with significant input from individuals of 
  4.21  that specific background; and 
  4.22     (3) that employs individuals to provide individual or group 
  4.23  therapy, at least 50 percent of whom are of that specific 
  4.24  background. 
  4.25     Subd. 5.  [DEPARTMENT.] "Department" means the department 
  4.26  of health. 
  4.27     Subd. 6.  [HEALTH PLAN COMPANY.] "Health plan company" 
  4.28  means a health plan company as defined in section 62Q.01, 
  4.29  subdivision 4. 
  4.30     Subd. 7.  [MEDICALLY NECESSARY.] "Medically necessary" 
  4.31  means a health service that is consistent with the recipient's 
  4.32  diagnosis or condition, recognized as the prevailing standard or 
  4.33  current practice by the provider's peer group, and: 
  4.34     (1) rendered: 
  4.35     (i) in response to a life-threatening condition or pain; 
  4.36     (ii) to treat an injury, illness, or infection; 
  5.1      (iii) to treat a condition that could result in physical or 
  5.2   mental disability; 
  5.3      (iv) to care for a mother and child through a maternity 
  5.4   period; or 
  5.5      (v) to achieve a level of physical or mental function 
  5.6   consistent with prevailing community standards for diagnosis or 
  5.7   condition; or 
  5.8      (2) a preventive health service. 
  5.9      Subd. 8.  [PARTICIPATING PROVIDER.] "Participating provider"
  5.10  means a person or institution that is authorized to furnish 
  5.11  covered services under this chapter and rules adopted by the 
  5.12  Minnesota universal health board. 
  5.13     Subd. 9.  [PROGRAM.] "Program" means the Minnesota 
  5.14  universal health program established under this chapter and 
  5.15  administered by the Minnesota universal health board. 
  5.16     Sec. 2.  [62K.02] [MINNESOTA UNIVERSAL HEALTH BOARD.] 
  5.17     Subdivision 1.  [ELIGIBILITY.] A member of the Minnesota 
  5.18  universal health board must be a consumer who: 
  5.19     (1) does not have and in the past did not have a material 
  5.20  interest in the provision of health care services or in an 
  5.21  activity directly related to the provision of health care 
  5.22  services, such as health insurance sales or health plan 
  5.23  administration; 
  5.24     (2) is not responsible for or directly involved in the 
  5.25  purchasing of health insurance for a business or organization; 
  5.26  and 
  5.27     (3) is not a registered lobbyist in this state. 
  5.28     Subd. 2.  [COMPOSITION.] The Minnesota universal health 
  5.29  board shall consist of 23 members selected as follows: 
  5.30     (1) the chairs of each of the six regional boards 
  5.31  established under section 62J.09; 
  5.32     (2) one person, elected by region, from each of the six 
  5.33  regional boards established under section 62J.09; 
  5.34     (3) one person from the Indian affairs council; 
  5.35     (4) one person from the council on Black Minnesotans; 
  5.36     (5) one person from the council on Asian-Pacific 
  6.1   Minnesotans; 
  6.2      (6) one person from the council on affairs of 
  6.3   Chicano/Latino people; 
  6.4      (7) one person appointed by the Minnesota AFL-CIO; 
  6.5      (8) one person from the consortium for citizens with 
  6.6   disabilities; 
  6.7      (9) one person from Minnesotans for affordable health care; 
  6.8      (10) one person from the health care campaign of Minnesota; 
  6.9      (11) one person appointed by the governor; 
  6.10     (12) one person appointed by the chair of the senate health 
  6.11  and family security committee; and 
  6.12     (13) one person appointed by the chair of the house health 
  6.13  and human services committee. 
  6.14     Subd. 3.  [TERMS; COMPENSATION; REMOVAL; AND VACANCIES.] 
  6.15  The board is governed by section 15.0575. 
  6.16     Subd. 4.  [ADMINISTRATION.] The commissioner shall provide 
  6.17  office space, equipment and supplies, and technical support to 
  6.18  the board. 
  6.19     Subd. 5.  [STAFF.] The board may hire an executive director 
  6.20  who serves in the unclassified service.  The executive director 
  6.21  may hire employees and consultants as authorized by the board 
  6.22  and may prescribe their duties.  The attorney general shall 
  6.23  provide legal services to the board. 
  6.24     Subd. 6.  [GENERAL DUTIES.] The board shall: 
  6.25     (1) estimate the current cost of universal coverage for all 
  6.26  Minnesotans; 
  6.27     (2) establish statewide capital and operating budgets.  The 
  6.28  statewide budget must be limited to the cost estimated under 
  6.29  clause (1); 
  6.30     (3) approve budgets for each region including capital and 
  6.31  operating budgets; 
  6.32     (4) establish fee schedules, which may vary to reflect 
  6.33  regional differences; 
  6.34     (5) approve regional budgets for institutional providers; 
  6.35     (6) monitor compliance with all budgets and fee schedules 
  6.36  and take action to achieve compliance to the extent authorized 
  7.1   by law; 
  7.2      (7) issue requests for proposals for a contract to process 
  7.3   claims submitted by individual providers; 
  7.4      (8) provide technical assistance to the regional boards 
  7.5   established under section 62J.09; 
  7.6      (9) monitor the quality of health care throughout the 
  7.7   state, conduct consumer satisfaction surveys, and take action as 
  7.8   necessary to ensure an appropriate level of quality; 
  7.9      (10) implement and administer the Minnesota universal 
  7.10  health program; 
  7.11     (11) contract with health plan companies, hospitals, and 
  7.12  other health care providers to provide health care services to 
  7.13  persons enrolled in the Minnesota universal health program; 
  7.14     (12) administer the Minnesota health care trust fund 
  7.15  created under section 62K.07; 
  7.16     (13) monitor the operation of the Minnesota universal 
  7.17  health program through regular data collection and evaluation 
  7.18  activities, including evaluations of the adequacy and quality of 
  7.19  services furnished under the program, the need for changes in 
  7.20  the benefit package, the cost of each type of service, and the 
  7.21  effectiveness of cost containment measures under the program; 
  7.22     (14) develop and implement enrollment procedures for 
  7.23  providers and persons eligible for the program and disseminate, 
  7.24  to providers of services and to the public, information 
  7.25  concerning the program and the persons eligible to receive 
  7.26  benefits under the program; 
  7.27     (15) develop and implement cost containment and quality 
  7.28  assurance procedures, including a professional peer review 
  7.29  system; 
  7.30     (16) conduct necessary investigations and inquiries and 
  7.31  require the submission of information, documents, and records 
  7.32  the board considers necessary to carry out its duties under this 
  7.33  chapter; and 
  7.34     (17) conduct other activities the board considers necessary 
  7.35  to carry out the purposes of this chapter.  
  7.36     Subd. 7.  [ANNUAL REPORT.] The board shall present an 
  8.1   annual report to the legislature and the governor by January 1, 
  8.2   1999, and each succeeding January summarizing the activities of 
  8.3   the board.  In the report due January 1, 2000, the board shall 
  8.4   recommend whether capital and operating budgets should be set 
  8.5   annually or biennially.  
  8.6      Subd. 8.  [RULEMAKING.] The board may adopt rules as 
  8.7   necessary to carry out the duties assigned under this chapter. 
  8.8      Subd. 9.  [CONTRACTS.] When entering into contracts with 
  8.9   health plan companies and health care providers, the board is 
  8.10  not subject to the competitive bidding requirements under 
  8.11  section 16B.07. 
  8.12     Subd. 10.  [HEARINGS.] The board, after providing notice to 
  8.13  consumers, policyholders, providers, and all other interested 
  8.14  parties, may hold hearings in connection with any action that it 
  8.15  proposes to take under subdivision 5. 
  8.16     Sec. 3.  [62K.05] [MINNESOTA UNIVERSAL HEALTH PROGRAM 
  8.17  IMPLEMENTATION SCHEDULE.] 
  8.18     (a) The board, through the commissioner, shall begin the 
  8.19  planning and development for the Minnesota universal health 
  8.20  program.  The board shall use an implementation schedule that 
  8.21  will phase in enrollment for Minnesota residents, with initial 
  8.22  enrollment of eligible individuals and families beginning July 
  8.23  1, 1999.  All Minnesota residents without health insurance shall 
  8.24  be insured by January 1, 2000.  The health insurance that covers 
  8.25  all Minnesota residents shall be consolidated into the Minnesota 
  8.26  universal health program by January 1, 2002.  
  8.27     (b) In carrying out the planning and development 
  8.28  activities, the board shall: 
  8.29     (1) begin initial enrollment of uninsured and underinsured 
  8.30  individuals and families with annual incomes of less than 275 
  8.31  percent of the federal poverty guideline who do not have 
  8.32  duplicative coverage through a federal, state, or private 
  8.33  insurance program or plan, by July 1, 1999; 
  8.34     (2) provide Medicare supplemental insurance, by July 1, 
  8.35  1999, to Medicare enrollees with annual incomes of less than 275 
  8.36  percent of the federal poverty guideline; 
  9.1      (3) enroll individuals and families with incomes at or 
  9.2   above 275 percent of the federal poverty guideline, and 
  9.3   individuals and families with incomes below 275 percent of the 
  9.4   federal poverty guideline not eligible for enrollment under 
  9.5   clause (1), beginning January 1, 2000; 
  9.6      (4) provide Medicare supplemental insurance to Medicare 
  9.7   enrollees not eligible for enrollment under clause (2), 
  9.8   beginning January 1, 2000; 
  9.9      (5) merge the Minnesota universal health program, the 
  9.10  MinnesotaCare program, the general assistance medical care 
  9.11  program, and the services for children with handicaps program by 
  9.12  July 1, 2000, in a way that will not diminish the coverage 
  9.13  provided to participants in existing programs and without 
  9.14  increasing the financial obligations of public hospitals and 
  9.15  other providers that currently serve participants in these 
  9.16  programs; 
  9.17     (6) assume responsibility for the administration and 
  9.18  funding of appropriate components of maternal and child health 
  9.19  services currently administered by the commissioner and 
  9.20  coordinate outreach, patient education, case management, and 
  9.21  related activities with the maternal and child health program 
  9.22  and local public health departments, by July 1, 2000; 
  9.23     (7) merge the consolidated chemical dependency treatment 
  9.24  fund with the Minnesota universal health program by July 1, 
  9.25  2000; 
  9.26     (8) phase out the Minnesota comprehensive health 
  9.27  association by July 1, 2000, in a way that will ensure that 
  9.28  Minnesota comprehensive health association enrollees receive 
  9.29  comparable coverage through the Minnesota universal health 
  9.30  program; 
  9.31     (9) prohibit health plan companies, beginning January 1, 
  9.32  2002, from selling insurance that duplicates benefits provided 
  9.33  by the Minnesota universal health program, in a manner that 
  9.34  ensures continuity of coverage through the program as duplicate 
  9.35  coverage in the private market is prohibited; 
  9.36     (10) seek federal waivers in order to phase Medicare and 
 10.1   medical assistance recipients into the program by a target date 
 10.2   of January 1, 2002; and 
 10.3      (11) phase retirees with retiree health benefits into the 
 10.4   program by January 1, 2002. 
 10.5      Sec. 4.  [62K.07] [MINNESOTA HEALTH CARE TRUST FUND.] 
 10.6      Subdivision 1.  [ESTABLISHMENT.] The Minnesota health care 
 10.7   trust fund is established.  The fund shall consist of all money 
 10.8   obtained from general fund appropriations, state savings 
 10.9   resulting from state health program consolidation, federal 
 10.10  payments received as a result of any waiver of requirements 
 10.11  granted by the United States Secretary of Health and Human 
 10.12  Services under health care programs established under title 18 
 10.13  and title 19 of the Social Security Act, United States Code, 
 10.14  title 42, section 301, as amended, and any other money received 
 10.15  by the board.  The budgets of Minnesota state agencies shall 
 10.16  remain distinct from the Minnesota health care trust fund, 
 10.17  except for portions of those budgets that provide health care 
 10.18  services that are provided to all Minnesotans through the 
 10.19  Minnesota universal health program.  
 10.20     Subd. 2.  [RESERVES.] Beginning July 1, 2000, the amount of 
 10.21  reserves in the fund at any time must equal at least the amount 
 10.22  of expenditures from the fund during the entire three preceding 
 10.23  months. 
 10.24     Sec. 5.  [62K.09] [ACCOUNTS WITHIN THE MINNESOTA HEALTH 
 10.25  CARE TRUST FUND.] 
 10.26     Subdivision 1.  [PREVENTION ACCOUNT.] The prevention 
 10.27  account is created within the Minnesota health care trust fund.  
 10.28  Money in the account shall be used solely to establish and 
 10.29  maintain primary community prevention programs, including 
 10.30  preventive screening tests.  The board shall administer the 
 10.31  account and determine the amount to be allocated to it. 
 10.32     Subd. 2.  [HEALTH SERVICES ACCOUNT.] The health services 
 10.33  account is created within the Minnesota health care trust fund.  
 10.34  Money in the account shall be used solely to pay participating 
 10.35  providers in accordance with section 62K.19. 
 10.36     Subd. 3.  [CAPITAL ACCOUNT.] The capital account is created 
 11.1   within the Minnesota health care trust fund.  Money in the 
 11.2   account shall be used solely to: 
 11.3      (1) pay for the construction, renovation, and equipping of 
 11.4   health care institutions, including institutions providing 
 11.5   inpatient or overnight care, and ambulatory diagnostic, 
 11.6   treatment, and surgical facilities; and 
 11.7      (2) provide health professionals serving in health care 
 11.8   shortage areas with assistance in the repayment of educational 
 11.9   loans and the establishment of medical practices. 
 11.10     Subd. 4.  [COMMUNICATION AND TRANSPORTATION ACCOUNT.] The 
 11.11  communication and transportation account is created within the 
 11.12  Minnesota health care trust fund.  Money in the account shall be 
 11.13  used solely to fund communication and transportation projects to 
 11.14  provide access for patients unable to reach necessary services.  
 11.15  Money may also be used to fund public education programs and 
 11.16  programs that encourage cooperation between institutions funded 
 11.17  on an annual basis that lead to more efficient and effective use 
 11.18  of health care resources.  All expenditures must comply with 
 11.19  rules approved by the board.  The board shall allocate a portion 
 11.20  of the money allocated for annual budgets to this account.  In 
 11.21  implementing this subdivision, the board shall coordinate its 
 11.22  actions with the commissioner. 
 11.23     Subd. 5.  [EVALUATION, PLANNING, AND ASSESSMENT ACCOUNT.] 
 11.24  The evaluation, planning, and assessment account is created 
 11.25  within the Minnesota health care trust fund.  Money in the 
 11.26  account shall be used by the board to monitor and improve the 
 11.27  plan's effectiveness and operations.  The board may establish 
 11.28  grant programs, including demonstration projects, for this 
 11.29  purpose.  The board shall allocate a portion of the revenue 
 11.30  collected by the Minnesota health care trust fund for this 
 11.31  purpose. 
 11.32     Subd. 6.  [MEDICAL RESEARCH ACCOUNT.] The medical research 
 11.33  account is created within the Minnesota health care trust fund.  
 11.34  Money in the account shall be used by the board to establish a 
 11.35  health care analysis unit.  The results of these initiatives 
 11.36  shall be used by the board to improve the quality of health care 
 12.1   provided under the Minnesota universal health program and to 
 12.2   make decisions about health benefits covered by the program.  
 12.3   The board may also establish grant programs, including 
 12.4   demonstration projects, for this purpose.  The board shall 
 12.5   allocate a portion of the revenue collected by the Minnesota 
 12.6   health care trust fund for this purpose.  The board shall seek 
 12.7   federal and private funds to supplement this allocation. 
 12.8      Sec. 6.  [62K.11] [ELIGIBILITY.] 
 12.9      Subdivision 1.  [RESIDENCY.] (a) To be eligible for health 
 12.10  coverage under the Minnesota universal health program, families 
 12.11  and individuals must be permanent residents of Minnesota. 
 12.12     (b) For purposes of this subdivision, a permanent Minnesota 
 12.13  resident is a person who has demonstrated, through persuasive 
 12.14  and objective evidence, that the person is domiciled in the 
 12.15  state and intends to live in the state permanently. 
 12.16     (c) To be eligible, all applicants must demonstrate the 
 12.17  requisite intent to live in the state permanently by: 
 12.18     (1) showing that the applicant maintains a residence at a 
 12.19  verified address other than a place of public accommodation, 
 12.20  through the use of evidence of residence described in section 
 12.21  256D.02, subdivision 12a, clause (1); 
 12.22     (2) demonstrating that the applicant has been continuously 
 12.23  domiciled in the state for no less than 180 days immediately 
 12.24  before the application; and 
 12.25     (3) signing an affidavit declaring that: 
 12.26     (i) the applicant currently resides in the state and 
 12.27  intends to reside in the state permanently; and 
 12.28     (ii) the applicant did not come to the state for the 
 12.29  primary purpose of obtaining medical coverage or treatment. 
 12.30     (d) An individual or family that moved to Minnesota 
 12.31  primarily to obtain medical treatment or health coverage for a 
 12.32  preexisting condition is not a permanent resident. 
 12.33     Subd. 2.  [CITIZENSHIP; MIGRANT WORKERS.] (a) Eligibility 
 12.34  for coverage under the Minnesota universal health program is 
 12.35  limited to citizens of the United States and aliens lawfully 
 12.36  admitted for permanent residence or otherwise permanently 
 13.1   residing in the United States under the color of law. 
 13.2      (b) Aliens who are seeking legalization under the 
 13.3   Immigration Reform and Control Act of 1986, Public Law Number 
 13.4   99-603, who are under age 18, over age 65, blind, disabled, or 
 13.5   Cuban or Haitian, and who otherwise meet the eligibility 
 13.6   requirements of this section are eligible for coverage under the 
 13.7   Minnesota universal health program.  
 13.8      (c) Pregnant women who are aliens seeking legalization 
 13.9   under the Immigration Reform and Control Act of 1986, Public Law 
 13.10  Number 99-603, and who otherwise meet the eligibility 
 13.11  requirements of this section are eligible for payment of care 
 13.12  and services through the period of pregnancy and six weeks 
 13.13  postpartum.  
 13.14     (d) Payment shall also be made for care and services that 
 13.15  are furnished to an alien, regardless of immigration status, who 
 13.16  otherwise meets the eligibility requirements of this section if 
 13.17  the care and services are necessary for the treatment of an 
 13.18  emergency medical condition, except for organ transplants and 
 13.19  related care and services.  For purposes of this subdivision, 
 13.20  the term "emergency medical condition" means a medical 
 13.21  condition, including labor and delivery, that if not immediately 
 13.22  treated could cause a person physical or mental disability, 
 13.23  continuation of severe pain, or death. 
 13.24     (e) Notwithstanding any law to the contrary, a migrant 
 13.25  worker who meets all of the eligibility requirements of this 
 13.26  section except for having a permanent place of domicile in this 
 13.27  state, shall be eligible for coverage under the Minnesota 
 13.28  universal health program. 
 13.29     Subd. 3.  [PHASE-IN OF ELIGIBILITY FOR RESIDENTS.] The 
 13.30  board shall phase in eligibility for Minnesota residents 
 13.31  according to the implementation schedule established under 
 13.32  section 62K.05.  Initial enrollment in the program is open to 
 13.33  individuals and families with incomes less than 275 percent of 
 13.34  the federal poverty level, who do not have duplicative coverage 
 13.35  through a federal, state, or private insurance program or plan.  
 13.36  The board shall continue phase-in coverage according to the 
 14.1   implementation schedule established under section 62K.05, with 
 14.2   the goal of covering all Minnesota residents by January 1, 2002. 
 14.3      Subd. 4.  [RESIDENTS RECEIVING CARE OUT-OF-STATE.] The 
 14.4   board may provide payment for out-of-state care provided to 
 14.5   Minnesota residents.  In determining whether payment is to be 
 14.6   made, the board shall determine the appropriateness of the care 
 14.7   provided, the availability of the service in Minnesota, and the 
 14.8   individual's medical condition and personal circumstances.  For 
 14.9   travel less than six months in length, the board shall establish 
 14.10  guidelines for covering services. 
 14.11     Subd. 5.  [NONRESIDENTS EMPLOYED IN MINNESOTA.] The board 
 14.12  may provide broader coverage using a sliding fee scale to 
 14.13  nonresidents who are employed in Minnesota. 
 14.14     Subd. 6.  [NONRESIDENTS.] The board may provide coverage to 
 14.15  nonresidents only after all Minnesota residents are covered by 
 14.16  the program.  Once complete coverage for all Minnesota residents 
 14.17  is achieved, the board may provide acute care coverage to 
 14.18  nonresidents not employed in Minnesota. 
 14.19     Sec. 7.  [62K.13] [BENEFITS.] 
 14.20     Subdivision 1.  [GENERAL.] Every Minnesota resident 
 14.21  enrolled in the program is entitled to receive benefits for any 
 14.22  service covered by the program that is necessary to maintain the 
 14.23  person's health, or necessary for the diagnosis or treatment of, 
 14.24  or rehabilitation following, an injury, disability, or disease.  
 14.25  Services provided in Minnesota must be provided by a health care 
 14.26  provider who participates in the program. 
 14.27     Subd. 2.  [COVERED SERVICES; GENERAL.] The program covers 
 14.28  the following services: 
 14.29     (1) acute health care; 
 14.30     (2) chronic health care; 
 14.31     (3) rehabilitative health care; 
 14.32     (4) preventive health services; 
 14.33     (5) outpatient health services; 
 14.34     (6) laboratory and x-ray services; 
 14.35     (7) home care and home health care support services; 
 14.36     (8) dental care; 
 15.1      (9) chiropractic care; 
 15.2      (10) inpatient and outpatient mental health care, including 
 15.3   care for serious and persistent mental illness; 
 15.4      (11) inpatient and outpatient chemical dependency 
 15.5   treatment; 
 15.6      (12) family planning services; 
 15.7      (13) medically necessary cosmetic surgery and 
 15.8   reconstructive surgery; 
 15.9      (14) public health services formerly provided through state 
 15.10  and local government; 
 15.11     (15) on or after January 1, 2003, long-term care; and 
 15.12     (16) other medically necessary and appropriate services. 
 15.13     Subd. 3.  [COVERED SERVICES; PHARMACEUTICALS AND SUPPLIES.] 
 15.14  The program covers all pharmaceuticals and medical supplies 
 15.15  prescribed by a licensed practitioner, including prescription 
 15.16  drugs, pharmaceuticals and supplies for eye care, hearing aids, 
 15.17  orthopedic aids, and home aids. 
 15.18     Subd. 4.  [COVERED SERVICES; TYPE OF PRACTITIONER.] The 
 15.19  program covers medically necessary and appropriate services, 
 15.20  including culturally specific programs, provided by all licensed 
 15.21  health care practitioners, as long as the services are within 
 15.22  the scope of practice, and meet standards of quality assurance 
 15.23  established by the board.  Covered practitioners include, but 
 15.24  are not limited to, medical doctors, doctors of chiropractic, 
 15.25  osteopathic doctors, nurses, nurse practitioners, physicians 
 15.26  assistants, dentists, optometrists, pharmacists, mental health 
 15.27  providers, chemical dependency counselors, certified nurse 
 15.28  midwives, nutritionists, and physical therapists. 
 15.29     Subd. 5.  [COVERED SERVICES; SITE OF CARE.] The program 
 15.30  covers care provided in all settings approved by the board. 
 15.31     Subd. 6.  [SERVICES NOT COVERED.] The following services 
 15.32  are not covered: 
 15.33     (1) services that are not medically necessary; 
 15.34     (2) surgery for cosmetic purposes; and 
 15.35     (3) medical examinations conducted, and medical reports 
 15.36  prepared, for purchasing or renewing life insurance or 
 16.1   participating as a plaintiff or defendant in a civil action for 
 16.2   the recovery or settlement of damages. 
 16.3      Subd. 7.  [BENEFITS ADVISORY COMMITTEE; CHANGES IN COVERED 
 16.4   SERVICES.] (a) The board shall establish a benefits advisory 
 16.5   committee comprised of consumers, health care providers, experts 
 16.6   in medical ethics, and health science researchers to provide 
 16.7   recommendations regarding plan benefits and limitations on 
 16.8   covered services.  Persons serving on this committee are 
 16.9   compensated as provided in section 15.0575. 
 16.10     (b) The board may make changes in plan benefits or place 
 16.11  limitations on covered services only after public hearing. 
 16.12     Subd. 8.  [CHOICE OF PROVIDERS.] An eligible person may 
 16.13  choose any participating provider, including practitioners 
 16.14  practicing on an independent basis, in group practices, or in 
 16.15  health maintenance organizations.  An eligible person who 
 16.16  enrolls in a health maintenance organization may change 
 16.17  providers only at intervals stipulated by the board, and only if 
 16.18  45 days notice is provided to the health maintenance 
 16.19  organization. 
 16.20     Sec. 8.  [62K.15] [DUPLICATE COVERAGE PROHIBITED.] 
 16.21     Policies, plans, or contracts of health coverage issued, 
 16.22  sold, or renewed by health plan companies on or after January 1, 
 16.23  2002, must not offer benefits that duplicate coverage offered 
 16.24  under the Minnesota universal health program.  A policy, plan, 
 16.25  or contract may offer benefits that do not duplicate coverage 
 16.26  that is offered by the program. 
 16.27     Sec. 9.  [62K.17] [PROVIDER RESPONSIBILITIES.] 
 16.28     Subdivision 1.  [PROVIDER PARTICIPATION.] All eligible 
 16.29  health care practitioners and institutions shall be considered 
 16.30  participants in the program unless and until the practitioner or 
 16.31  institution notifies the board of a change in status.  The board 
 16.32  shall provide practitioners and institutions with notice of this 
 16.33  requirement and adopt rules necessary to allow for changes in 
 16.34  provider status. 
 16.35     Subd. 2.  [NONDISCRIMINATION.] Participating providers 
 16.36  shall furnish services to all eligible persons, regardless of 
 17.1   race, color, income level, national origin, religion, sex, 
 17.2   sexual orientation, or other nonmedical criteria. 
 17.3      Subd. 3.  [PROVISION OF INFORMATION.] Every participating 
 17.4   provider shall furnish information that may reasonably be 
 17.5   required by the board for utilization review, quality assurance, 
 17.6   cost containment, payments, and statistical and other studies of 
 17.7   the operation of the plan.  A participating provider shall 
 17.8   permit the board to examine its records as necessary for 
 17.9   verification of payment. 
 17.10     Sec. 10.  [62K.19] [PROVIDER REIMBURSEMENT.] 
 17.11     Subdivision 1.  [INSTITUTIONAL PROVIDERS.] (a) The 
 17.12  Minnesota universal health program shall pay the expenses of 
 17.13  hospitals, nursing homes, health maintenance organizations, and 
 17.14  other institutional providers of inpatient services, including 
 17.15  institutions providing inpatient or overnight care, and 
 17.16  ambulatory diagnostic, treatment, and surgical facilities, on 
 17.17  the basis of annual budgets that are approved by the board.  The 
 17.18  board shall also approve annual regional budgets for 
 17.19  institutional providers that receive public funding from 
 17.20  counties, cities, and other local units of government.  Local 
 17.21  units of government shall terminate public funding of these 
 17.22  institutions once the board establishes an annual budget. 
 17.23     (b) An institutional provider shall negotiate an annual 
 17.24  budget with the regional board to cover its anticipated services 
 17.25  for the next year based on past performance and projected 
 17.26  changes in prices and service levels.  A physician or other 
 17.27  provider employed by an annually budgeted institutional provider 
 17.28  shall be paid through and in a manner determined by the 
 17.29  institutional provider. 
 17.30     Subd. 2.  [NONINSTITUTIONAL PROVIDERS.] The board shall 
 17.31  reimburse noninstitutional providers of health care services on 
 17.32  a fee-for-service basis.  The board shall annually negotiate the 
 17.33  fee schedule with the appropriate professional group.  In 
 17.34  developing fee schedules, the board may take into account 
 17.35  recognized geographic differences in cost of practice.  To the 
 17.36  greatest extent possible, fee schedule categories must include 
 18.1   payment for all procedures routinely performed for a given 
 18.2   diagnosis.  The board may require that certain highly technical 
 18.3   procedures be reimbursed only when performed in certain 
 18.4   institutions or by certain providers. 
 18.5      Subd. 3.  [BALANCE BILLING PROHIBITED.] A provider may not 
 18.6   charge rates that are higher than the negotiated reimbursement 
 18.7   level.  A provider may not charge separately for services 
 18.8   covered under section 62K.13. 
 18.9      Subd. 4.  [CAPITATED PAYMENTS.] A multispecialty 
 18.10  organization of providers may elect to be reimbursed on a 
 18.11  capitation basis, in place of fee-for-service reimbursement.  
 18.12  Payment on a capitation basis does not cover inpatient services 
 18.13  provided by a multispecialty organization for institutional 
 18.14  providers. 
 18.15     Subd. 5.  [OUT-OF-STATE PROVIDERS.] The board shall 
 18.16  reimburse providers that are located outside Minnesota at 
 18.17  reasonable rates for care rendered to enrollees while outside of 
 18.18  Minnesota, upon the determination by the board that a payment is 
 18.19  to be made.  
 18.20     Sec. 11.  [62K.21] [RULES.] 
 18.21     The Minnesota universal health board shall adopt rules to 
 18.22  establish a review and approval process for regional boards 
 18.23  established under chapter 62J. 
 18.24     Sec. 12.  [STUDY AND ASSESSMENT.] 
 18.25     The commissioner shall study statewide health care spending 
 18.26  to enable the Minnesota universal health board and the regional 
 18.27  boards to establish and enforce the state and regional health 
 18.28  care budgets.  By January 1, 1998, the commissioner shall: 
 18.29     (1) assess health care capital needs and expenditures 
 18.30  statewide and within each region; and 
 18.31     (2) recommend to the Minnesota universal health board and 
 18.32  the regional boards statewide and regional budgets, each 
 18.33  consisting of budgets for operating and capital expenditures and 
 18.34  fee schedules for health care providers and practitioners. 
 18.35     Sec. 13.  [TRANSFER OF DUTIES.] 
 18.36     On January 1, 1998, the Minnesota health care commission is 
 19.1   abolished and the remaining duties and responsibilities of the 
 19.2   board are transferred to the Minnesota universal health board as 
 19.3   provided under Minnesota Statutes, section 15.039. 
 19.4      Sec. 14.  [INSTRUCTION TO REVISOR; REPORT.] 
 19.5      (a) The revisor of statutes shall change the terms 
 19.6   "Minnesota health care commission," "state health care 
 19.7   commission," and "health care commission" to "Minnesota 
 19.8   universal health board," as appropriate, wherever they appear in 
 19.9   Minnesota Statutes and Minnesota Rules. 
 19.10     (b) The revisor of statutes shall change the term "regional 
 19.11  coordinating board" to "regional board" wherever it appears in 
 19.12  Minnesota Statutes and Minnesota Rules.  
 19.13     (c) The revisor of statutes shall determine the repeal of 
 19.14  statutory sections and cross-reference changes required as a 
 19.15  result of this act and report recommendations to the appropriate 
 19.16  legislative committees by January 1, 1998.  
 19.17     Sec. 15.  [FUNDING.] 
 19.18     Financing of the Minnesota universal health program shall 
 19.19  be through the consolidation of funding from existing state and 
 19.20  federal programs and designated progressive income tax.  There 
 19.21  shall be no copayments, deductibles, or other out-of-pocket 
 19.22  payments by individuals for services. 
 19.23     Sec. 16.  [APPROPRIATION.] 
 19.24     (a) $....... is appropriated from the general fund to the 
 19.25  Minnesota universal health board to implement sections 1 to 11.  
 19.26  This appropriation is available until June 30, 2000, at which 
 19.27  time the board shall repay this amount to the general fund from 
 19.28  the Minnesota health care trust fund created in section 62K.07. 
 19.29     (b) $350,000 is appropriated from the general fund to the 
 19.30  commissioner of health for the fiscal year ending June 30, 1998, 
 19.31  to provide staffing for the regional boards. 
 19.32     Sec. 17.  [REPEALER.] 
 19.33     (a) Minnesota Statutes 1996, sections 62J.05; and 62J.09, 
 19.34  subdivision 2, are repealed effective January 1, 1998. 
 19.35     (b) Minnesota Statutes 1996, sections 62J.09, subdivision 
 19.36  8; and 62J.212, are repealed. 
 20.1      Sec. 18.  [EFFECTIVE DATE.] 
 20.2      Section 2 is effective January 1, 1998.  Section 8 is 
 20.3   effective January 1, 2002.