SF 2241

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; requiring implementation of
cost-containment initiatives; modifying requirements
for health plan companies and health plans; requiring
disclosure of information to consumers; establishing a
cancer drug repository program; requiring reporting of
acquired infections; modifying requirement for
health-related boards and health care providers;
establishing evidence-based guideline and health
promotion initiatives; requiring studies; amending
Minnesota Statutes 2004, sections 13.3806, by adding a
subdivision; 45.0135, subdivision 7, by adding a
subdivision; 62D.145, subdivision 2; 62E.05,
subdivision 2; 62E.08, subdivision 1; 62J.43; 62L.08,
subdivision 8; 62Q.17; 62Q.64; 62Q.75; 72A.201,
subdivision 4; 144.335, subdivision 3a; 145A.12, by
adding subdivisions; 151.214, subdivision 1; 295.582;
proposing coding for new law in Minnesota Statutes,
chapters 62J; 62M; 62Q; 65B; 144; 144E; 145; 151; 214;
repealing Minnesota Statutes 2004, sections 62E.035;
62Q.095.

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

ARTICLE 1

HEALTH PLAN INNOVATION AND REGULATION

Section 1.

Minnesota Statutes 2004, section 62E.08,
subdivision 1, is amended to read:

Subdivision 1.

Establishment.

The association shall
establish the following maximum premiums to be charged for
membership in the comprehensive health insurance plan:

(a) the premium for the number one qualified plan shall
range from a minimum of deleted text begin 101 deleted text end new text begin 115 new text end percent to a maximum of deleted text begin 125 deleted text end new text begin 135
new text end percent of the weighted average of rates charged by those
insurers and health maintenance organizations with individuals
enrolled in:

(1) $1,000 annual deductible individual plans of insurance
in force in Minnesota;

(2) individual health maintenance organization contracts of
coverage with a $1,000 annual deductible which are in force in
Minnesota; and

(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;

(b) the premium for the number two qualified plan shall
range from a minimum of deleted text begin 101 deleted text end new text begin 115 new text end percent to a maximum of deleted text begin 125 deleted text end new text begin 135
new text end percent of the weighted average of rates charged by those
insurers and health maintenance organizations with individuals
enrolled in:

(1) $500 annual deductible individual plans of insurance in
force in Minnesota;

(2) individual health maintenance organization contracts of
coverage with a $500 annual deductible which are in force in
Minnesota; and

(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;

(c) the premiums for the plans with a $2,000, $5,000, or
$10,000 annual deductible shall range from a minimum of deleted text begin 101 deleted text end new text begin 115
new text end percent to a maximum of deleted text begin 125 deleted text end new text begin 135 new text end percent of the weighted average
of rates charged by those insurers and health maintenance
organizations with individuals enrolled in:

(1) $2,000, $5,000, or $10,000 annual deductible individual
plans, respectively, in force in Minnesota; and

(2) individual health maintenance organization contracts of
coverage with a $2,000, $5,000, or $10,000 annual deductible,
respectively, which are in force in Minnesota; or

(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;

(d) the premium for each type of Medicare supplement plan
required to be offered by the association pursuant to section
62E.12 shall range from a minimum of deleted text begin 101 deleted text end new text begin 115 new text end percent to a
maximum of deleted text begin 125 deleted text end new text begin 135 new text end percent of the weighted average of rates
charged by those insurers and health maintenance organizations
with individuals enrolled in:

(1) Medicare supplement plans in force in Minnesota;

(2) health maintenance organization Medicare supplement
contracts of coverage which are in force in Minnesota; and

(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
and

(e) the charge for health maintenance organization coverage
shall be based on generally accepted actuarial principles.

The list of insurers and health maintenance organizations
whose rates are used to establish the premium for coverage
offered by the association pursuant to paragraphs (a) to (d)
shall be established by the commissioner on the basis of
information which shall be provided to the association by all
insurers and health maintenance organizations annually at the
commissioner's request. This information shall include the
number of individuals covered by each type of plan or contract
specified in paragraphs (a) to (d) that is sold, issued, and
renewed by the insurers and health maintenance organizations,
including those plans or contracts available only on a renewal
basis. The information shall also include the rates charged for
each type of plan or contract.

In establishing premiums pursuant to this section, the
association shall utilize generally accepted actuarial
principles, provided that the association shall not discriminate
in charging premiums based upon sex. In order to compute a
weighted average for each type of plan or contract specified
under paragraphs (a) to (d), the association shall, using the
information collected pursuant to this subdivision, list
insurers and health maintenance organizations in rank order of
the total number of individuals covered by each insurer or
health maintenance organization. The association shall then
compute a weighted average of the rates charged for coverage by
all the insurers and health maintenance organizations by:

(1) multiplying the numbers of individuals covered by each
insurer or health maintenance organization by the rates charged
for coverage;

(2) separately summing both the number of individuals
covered by all the insurers and health maintenance organizations
and all the products computed under clause (1); and

(3) dividing the total of the products computed under
clause (1) by the total number of individuals covered.

The association may elect to use a sample of information
from the insurers and health maintenance organizations for
purposes of computing a weighted average. In no case, however,
may a sample used by the association to compute a weighted
average include information from fewer than the two insurers or
health maintenance organizations highest in rank order.

Sec. 2.

new text begin [62M.071] SMALL CHARGES; NO PRIOR AUTHORIZATION.
new text end

new text begin Claims for amounts payable that do not exceed $10 must not
be subject to prior authorization.
new text end

Sec. 3.

new text begin [62M.072] HIGHER LEVEL SCRUTINY PERMITTED.
new text end

new text begin A utilization review organization may apply greater levels
of scrutiny in prior authorization and in determining medical
necessity for nonemergency imaging, testing, and transport in
order to reduce care that is not medically necessary. A
utilization review organization using this section must develop
a definition of nonemergency care and make it available to
providers.
new text end

Sec. 4.

new text begin [62Q.108] HEALTH PLAN CARD.
new text end

new text begin An identification card issued to an enrollee by a health
plan company must contain the following statement on the back:
"This health plan is subject to Minnesota law."
new text end

Sec. 5.

Minnesota Statutes 2004, section 62Q.17, is
amended to read:

62Q.17 VOLUNTARY PURCHASING POOLS.

Subdivision 1.

Permission to form.

Notwithstanding
section 62A.10, employers, groups, and individuals may
voluntarily form purchasing pools, solely for the purpose of
negotiating and purchasing health plan coverage from health plan
companies for members of the pool.

Subd. 2.

Common factors.

All participants in a
purchasing pool must live within a common geographic region, be
employed in a similar occupation, or share some other common
factor as approved by the commissioner of commerce. The
membership criteria must not be designed to include
disproportionately employers, groups, or individuals likely to
have low costs of health coverage, or to exclude
disproportionately employers, groups, or individuals likely to
have high costs of health coverage.

Subd. 3.

Governing structure.

Each pool must have a
governing structure controlled by its members. The governing
structure of the pool is responsible for administration of the
pool. The governing structure shall review and evaluate all
bids for coverage from health plan companies, shall determine
criteria for joining and leaving the pool, and may design
incentives for healthy lifestyles and health promotion programs.
The governing structure may design uniform entrance standards
for all employers, except small employers as defined under
section 62L.02. Small employers must be permitted to enter any
pool if the small employer meets the pool's membership
requirements. Pools must provide as much choice in health plans
to members as is financially possible. The governing structure
may charge all members a fee for administrative purposes.

Subd. 4.

Enrollment.

new text begin (a) new text end Pools must have an annual open
enrollment period of not less than 15 days, during which all
individuals or groups that qualify for membership may enter the
pool without any preexisting condition limitations or exclusions
or exclusionary riders, except those permitted under chapter 62L
for groups or section 62A.65 for individuals. Pools must reach
and maintain an enrolled population of at least 1,000 members
within deleted text begin six months deleted text end new text begin one year new text end of formation. If a pool fails to
reach or maintain the minimum enrollment, all coverage
subsequently purchased through the purchasing pool must be
regulated through existing applicable laws and forego all
advantages under this section.

new text begin (b) A pool must require an initial contribution to the
pool's reserves at the time of entry, which may be based upon
the entrant's experience.
new text end

Subd. 5.

Members.

The governing structure of the pool
shall set a minimum time period for membership new text begin , which must be no
less than five years new text end . Members must stay in the purchasing pool
for the entire minimum period to avoid paying a penalty.
Penalties for early withdrawal from the purchasing pool shall be
established by the governing structure. new text begin After the minimum
period, a member may withdraw from the pool and receive a refund
of its contributions to reserves, with interest at the average
rate the pool received on its reserves during the member's
enrollment in the pool. The refund may be paid over a period of
up to five years.
new text end

Subd. 6.

Employer-based purchasing pools.

Employer-based
purchasing pools must, with respect to small employers as
defined in section 62L.02, meet all the requirements of chapter
62L. The experience of the pool must be pooled and the rates
blended across all groups. Pools may decide to create tiers
within the pool, based on experience of group members. These
tiers must be designed within the requirements of section
62L.08. The governing structure may establish criteria limiting
movement between tiers. deleted text begin Tiers must be phased out within two
years of the pool's creation.
deleted text end

Subd. 7.

Individual members.

Purchasing pools that
contain individual members must meet all of the underwriting and
rate restrictions found in the individual health plan market.

Subd. 8.

Reports.

Prior to the initial effective date of
coverage, and annually on July 1 thereafter, each pool shall
file a report with the deleted text begin information clearinghouse and the
deleted text end commissioner of commerce. deleted text begin The information clearinghouse must
use the report to promote the purchasing pools. deleted text end The annual
report must contain the following information:

(1) the number of lives in the pool;

(2) the geographic area the pool intends to cover;

(3) the number of health plans offered;

(4) a description of the benefits under each plan;

(5) a description of the premium structure, including any
co-payments or deductibles, of each plan offered;

(6) evidence of compliance with chapter 62L;

(7) a sample of marketing information, including a phone
number where the pool may be contacted; and

(8) a list of all administrative fees charged.

Subd. 9.

Enforcement.

Purchasing pools must register
prior to offering coverage, and annually on July 1 thereafter,
with the commissioner of commerce on a form prescribed by the
commissioner. The commissioner of commerce shall enforce this
section and all other state laws with respect to purchasing
pools, and has for that purpose all general rulemaking and
enforcement powers otherwise available to the commissioner of
commerce. The commissioner may charge an annual registration
fee sufficient to meet the costs of the commissioner's duties
under this section.

Sec. 6.

new text begin [62Q.251] CASH PAYMENT DISCOUNT CARDS.
new text end

new text begin (a) The commissioner of commerce shall issue to any
Minnesota resident a cash payment discount card upon request for
a onetime fee of $25.
new text end

new text begin (b) The card entitles the owner of the card to receive a
discount from a health care provider in exchange for same-day
full payment of the provider's charge for service, supplies, and
prescription drugs.
new text end

new text begin (c) Participation by a provider is voluntary, and the
provider may choose the amount of the discount, up to 25 percent
of the charge for any service or product, which may be stated as
a percentage or fixed dollar amount, and which may vary for
different categories of services, supplies, and medications.
new text end

Sec. 7.

new text begin [62Q.645] DISCLOSURE RELATED TO ADMINISTRATIVE
EFFICIENCY.
new text end

new text begin Health plan companies shall annually report to the
commissioner, in the form and manner specified by the
commissioner, the following information related to
administrative efficiency:
new text end

new text begin (1) administrative costs, including costs related to prior
authorization, claims processing and payment, and provider
reviews, and all costs not included in the actual amount of
reimbursement paid to providers;
new text end

new text begin (2) allocation of premium revenues;
new text end

new text begin (3) average processing time for clean claims; and
new text end

new text begin (4) any other measures of administrative efficiency
identified by the commissioner.
new text end

new text begin The commissioner shall use this information to compile
health plan company-specific administrative efficiency report
cards, and shall make these report cards available on state
agency Web sites, including minnesotahealthinfo.com.
new text end

Sec. 8.

new text begin [62Q.646] DISCLOSURE OF HEALTH COVERAGE OPTIONS.
new text end

new text begin Health plan companies, and service cooperatives established
under chapter 123A, shall annually report to the commissioner,
in the form and manner specified by the commissioner, the
following information for each health plan offered:
new text end

new text begin (1) number of covered lives;
new text end

new text begin (2) covered services, including whether the health plan
provides coverage for procedures and services identified by the
commissioner to be cost-effective alternatives;
new text end

new text begin (3) geographic availability;
new text end

new text begin (4) current premium rates;
new text end

new text begin (5) administrative costs, using the definition of
administrative costs developed under section 62Q.45;
new text end

new text begin (6) Internet links to information on the health plan, if
available; and
new text end

new text begin (7) any other information about the health plan identified
by the commissioner as being useful for consumers in evaluating
health plan options.
new text end

new text begin The commissioner shall make this information available on
state agency Web sites, including minnesotahealthinfo.com.
new text end

Sec. 9.

new text begin [62Q.676] MEDICATION THERAPY MANAGEMENT CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Coverage required. new text end

new text begin A health plan that
provides prescription drug coverage must cover medication
therapy management services for enrollees taking four or more
prescriptions to treat or prevent two or more chronic medical
conditions. For purposes of this subdivision, "medication
therapy management" means the provision of the following
pharmaceutical care services by a licensed pharmacist to
optimize the therapeutic outcomes of the patient's medications:
new text end

new text begin (1) performing or obtaining necessary assessments of the
patient's health status;
new text end

new text begin (2) formulating a medication treatment plan;
new text end

new text begin (3) monitoring and evaluating the patient's response to
therapy, including safety and effectiveness;
new text end

new text begin (4) performing a comprehensive medication review to
identify, resolve, and prevent medication-related problems,
including adverse drug events;
new text end

new text begin (5) documenting the care delivered and communicating
essential information to the patient's other primary care
providers;
new text end

new text begin (6) providing verbal education and training designed to
enhance patient understanding and appropriate use of the
patient's medications;
new text end

new text begin (7) providing information, support services, and resources
designed to enhance patient adherence with the patient's
therapeutic regimens; and
new text end

new text begin (8) coordinating and integrating medication therapy
management services within the broader health care management
services being provided to the patient.
new text end

new text begin Nothing in this subdivision shall be construed to expand or
modify the scope of practice of the pharmacist as defined in
section 151.01, subdivision 27.
new text end

new text begin Subd. 2. new text end

new text begin Pharmacist requirements. new text end

new text begin To be eligible for
reimbursement for services under this section, a pharmacist must
meet the following requirements:
new text end

new text begin (1) have a valid license issued under chapter 151;
new text end

new text begin (2) have graduated from an accredited college of pharmacy
on or after May 1996; or completed a structured and
comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education
for the provision and documentation of pharmaceutical care
management services that has both clinical and didactic
elements;
new text end

new text begin (3) be practicing in an ambulatory care setting as part of
a multidisciplinary team or have developed a structured patient
care process that is offered in a private or semiprivate patient
care area that is separate from the commercial business that
also occurs in the setting; and
new text end

new text begin (4) make use of an electronic patient record system that
meets state standards.
new text end

Sec. 10. new text begin TRANSFER OF HMO REGULATORY RESPONSIBILITIES.
new text end

new text begin (a) Notwithstanding any other provision of law, regulatory
authority over health maintenance organizations under Minnesota
Statutes, chapter 62D, is transferred from the commissioner of
health to the commissioner of commerce, effective July 1, 2006.
This transfer is governed by Minnesota Statutes, section 15.039.
new text end

new text begin (b) The revisor of statutes shall prepare legislation for
the 2006 legislative session making the necessary statutory
changes to comply with paragraph (a).
new text end

ARTICLE 2

PUBLIC HEALTH, HEALTH CARE, AND HEALTH CARE PROVIDERS

Section 1.

Minnesota Statutes 2004, section 13.3806, is
amended by adding a subdivision to read:

new text begin Subd. 14a. new text end

new text begin Acquired infections. new text end

new text begin Data collected by the
commissioner of health in connection with reporting acquired
infections in hospitals and outpatient surgical centers are
classified under section 144.7071, subdivision 6.
new text end

Sec. 2.

Minnesota Statutes 2004, section 45.0135, is
amended by adding a subdivision to read:

new text begin Subd. 8. new text end

new text begin Investigations; health-related boards. new text end

new text begin (a) The
Division of Insurance Fraud Prevention shall consult with the
appropriate health-related board when a licensee, licensed under
chapter 147, 148, 148B, or 150A, is suspected of insurance fraud.
new text end

new text begin (b) In order for an investigation to proceed, the board
shall review the evidence submitted by the Division of Insurance
Fraud Prevention and respond to the Division of Insurance Fraud
Prevention within 60 calendar days of sufficient evidence being
presented to the board. If the response of the board is in the
affirmative, the Division of Insurance Fraud Prevention may
proceed with the investigation. Notwithstanding the limitations
of chapter 13, the Department of Commerce and the health-related
boards may freely exchange information until the investigation
is resolved. The decision of the board that insufficient
grounds exist to continue an investigation does not prohibit the
presentation of additional evidence to the board and review by
the board at a future time.
new text end

new text begin (c) The board may revoke, suspend, condition, limit,
restrict, or qualify a license to practice when clear and
convincing evidence indicates the licensee has committed
insurance fraud or subsequent to a conviction relating to fraud.
new text end

new text begin (d) Costs incurred by the Department of Commerce shall be
taken from existing funds appropriated to the Division of
Insurance Fraud Prevention. Costs for the initial review by the
board shall be taken from existing board funds. Subsequent
board investigations may be funded in part or in whole by the
licensee in the event of a conviction relating to fraud or from
insurance proceeds that are required to be repaid as a result of
a conviction.
new text end

Sec. 3.

new text begin [62J.052] DISCLOSURE OF CHARGES AND PAYMENT
RATES.
new text end

new text begin Each health care provider, as defined in section 62J.03,
subdivision 8, shall report annually to the commissioner, in the
form and manner specified by the commissioner, the following:
new text end

new text begin (1) average charges to individuals paying out-of-pocket for
the 20 services or procedures most commonly provided or
performed;
new text end

new text begin (2) average payment rates for these services and procedures
from private sector health plan companies as an aggregate group,
and from self-insured payors, as an aggregate group; and
new text end

new text begin (3) average payment rates for these services and procedures
from medical assistance.
new text end

new text begin The commissioner may exempt specific provider types from this
requirement, if the commissioner determines that inclusion would
significantly increase administrative costs for those providers
or would not provide useful information for consumers. The
commissioner may specify the 20 most common procedures or
services for specific provider types, and may require providers
to report information for specific procedures and services. The
commissioner shall make the information provided under this
section available on agency Web sites, including
minnesotahealthinfo.com.
new text end

Sec. 4.

Minnesota Statutes 2004, section 62J.43, is
amended to read:

62J.43 deleted text begin BEST PRACTICES deleted text end new text begin EVIDENCE-BASED HEALTH CARE
GUIDELINES new text end AND QUALITY IMPROVEMENT.

deleted text begin (a) deleted text end new text begin Subdivision 1. new text end [ADOPTION OF deleted text begin BEST
PRACTICES deleted text end new text begin EVIDENCE-BASED HEALTH CARE GUIDELINES new text end .] To improve
quality and reduce health care costs, state agencies shall
encourage the deleted text begin adoption deleted text end new text begin use new text end of deleted text begin best practice deleted text end new text begin evidence-based
health care new text end guidelines and participation in deleted text begin best practices
deleted text end new text begin quality of care new text end measurement activities by deleted text begin physicians deleted text end new text begin medical
groups, hospitals new text end , other health care providers, and health plan
companies. The commissioner of health shall facilitate access
to deleted text begin best practice deleted text end new text begin evidence-based health care new text end guidelines and
quality of care measurement information deleted text begin to deleted text end new text begin for new text end providers,
purchasers, and consumers by:

(1) identifying and promoting deleted text begin local community-based,
physician-designed best practices care deleted text end new text begin evidence-based health
care guidelines new text end across the Minnesota health care system new text begin using
local community-based, physician-designed guidelines whenever
they are available and meet the criteria in subdivision 2 new text end ;

(2) disseminating information available to the commissioner
on deleted text begin adherence to best practices care by physicians deleted text end new text begin the
performance of Minnesota medical groups, hospitals, new text end and other
health care providers in deleted text begin Minnesota deleted text end new text begin providing care in accordance
with evidence-based health care guidelines new text end ;

(3) educating consumers and purchasers on how to
deleted text begin effectively deleted text end use this information new text begin effectively new text end in choosing their
providers and in making purchasing decisions; and

(4) making deleted text begin best practices deleted text end new text begin evidence-based health care
guidelines new text end and quality new text begin of new text end care measurement information available
to enrollees and program participants through the Department of
Health's Web site. The commissioner may convene an advisory
committee to ensure that the Web site is deleted text begin designed to provide
deleted text end user friendly and deleted text begin easy accessibility deleted text end new text begin easily accessible new text end .

deleted text begin (b) deleted text end new text begin Subd. 2. new text end [COLLABORATION.] The commissioner of
health deleted text begin shall deleted text end new text begin may new text end collaborate with deleted text begin a nonprofit Minnesota quality
improvement organization deleted text end new text begin one or more health professional
licensing boards, professional associations, institutions of
higher education, and other organizations new text end specializing in deleted text begin best
practices and deleted text end quality of care measurements to provide deleted text begin best
practices deleted text end new text begin evidence-based health care guidelines new text end criteria and
assist in the collection of the data.

deleted text begin (c) deleted text end new text begin Subd. 3. new text end [HEALTH-RELATED BOARDS; PRACTICE
STANDARDS.] new text begin The health-related boards, under chapter 148, may
establish practice standards for treating patients within their
respective scopes of practice. The boards may utilize the
services of appropriate public or private entities to facilitate
the development or review of practice standards and
evidence-based guidelines. Each board that has established or
ratified existing standards shall report these standards to the
legislative committees with jurisdiction over the public health
occupations by January 15, 2006, and shall report subsequent
changes annually thereafter. If a board has existing standards,
nothing in this section requires a board to establish new
standards.
new text end

new text begin Subd. 4. new text end

new text begin Criteria for evidence-based
guidelines. new text end

new text begin Guidelines identified under this section must meet
the following criteria:
new text end

new text begin (1) the scope and application are clear;
new text end

new text begin (2) authorship is stated and any conflicts of interest
disclosed;
new text end

new text begin (3) authors represent all pertinent clinical fields or
other means of input have been used;
new text end

new text begin (4) the development process is explicitly stated;
new text end

new text begin (5) the guideline is grounded in evidence;
new text end

new text begin (6) the evidence is cited and graded;
new text end

new text begin (7) the document itself is clear and practical;
new text end

new text begin (8) the document is flexible in use, with exceptions noted
or provided for with general statements;
new text end

new text begin (9) measures are included for use in systems improvement;
and
new text end

new text begin (10) the guideline has scheduled reviews and updating.
new text end

new text begin Subd. 5. new text end

new text begin Initial evidence-based health care guidelines.
new text end

The deleted text begin initial best practices and quality of care measurement
criteria developed deleted text end new text begin topics of the evidence-based health care
guidelines initially identified and promoted by the commissioner
new text end shall include asthma, diabetes, deleted text begin and at least two other
preventive health measures. Hypertension and coronary artery
diseases shall be included within one year following
availability deleted text end new text begin hypertension, coronary artery disease, depression,
preventive services, acute myocardial infarction, heart failure,
pneumonia, and surgical infections new text end .

new text begin Subd. 6. new text end

new text begin Measurement and reporting of performance. new text end

new text begin In
order to disseminate information on the performance of medical
groups, hospitals, and other health care providers in providing
care in accordance with evidence-based guidelines, the
commissioner of health shall collaborate with Minnesota
organizations that specialize in the development of health care
quality measures derived from evidence-based guidelines,
including, but not limited to, health professional licensing
boards, professional associations, and institutions of higher
education, in the measurement of performance by health care
providers, and in the reporting of performance using publicly
accessible means, including Web sites. The commissioner shall
not measure performance directly but shall determine whether
performance is being measured competently and accurately and
shall provide on the department Web site links to the Web site
or sites of the measuring organizations.
new text end

deleted text begin (d) deleted text end new text begin Subd. 7. new text end [USE IN STATE CONTRACTS WITH HEALTH PLANS.]
The commissioners of human services and employee relations may
use the data to make decisions about contracts they enter into
with health plan companies new text begin , service cooperatives, and health
care providers, and shall develop a financial reward program
that compensates health care practices that implement effective
quality improvement programs or systems in their practices.
These programs or systems may include, but are not limited to,
clinical information systems, patient education and support,
case and disease management, and improvement of outcomes new text end .

deleted text begin (e) deleted text end new text begin Subd. 8. new text end [LIMITATIONS.] This section does not apply if
the deleted text begin best practices deleted text end new text begin evidence-based health care new text end guidelines
authorize or recommend denial of treatment, food, or fluids
necessary to sustain life on the basis of the patient's age or
expected length of life or the patient's present or predicted
disability, degree of medical dependency, or quality of life.

deleted text begin (f) deleted text end new text begin Subd. 9. new text end [REPORT.] The commissioner of health, human
services, and employee relations shall report to the legislature
deleted text begin by deleted text end new text begin annually each new text end January 15 deleted text begin , 2005, deleted text end on the status of best
practices and quality of care initiatives, and shall present
recommendations to the legislature on any statutory changes
needed to increase the effectiveness of these initiatives.

deleted text begin (g) This section expires June 30, 2006.
deleted text end

Sec. 5.

Minnesota Statutes 2004, section 62Q.64, is
amended to read:

62Q.64 DISCLOSURE OF EXECUTIVE COMPENSATION.

(a) Each health plan company doing business in this state new text begin ,
and each hospital under contract with the health plan company,
new text end shall annually file with the deleted text begin Consumer Advisory Board created in
section 62J.75:
deleted text end

deleted text begin (1) a copy of the health plan company's form 990 filed with
the federal Internal Revenue Service; or
deleted text end

deleted text begin (2) if the health plan company did not file a form 990 with
the federal Internal Revenue Service, deleted text end new text begin commissioner of commerce new text end a
list of the amount and deleted text begin recipients deleted text end new text begin job classifications new text end of the
deleted text begin health plan company's five deleted text end new text begin entity's 20 new text end highest salaries,
including all types of compensation, in excess
of deleted text begin $50,000 deleted text end new text begin $200,000 new text end .

(b) A filing under this section is public data under
section 13.03.

new text begin (c) A health plan company shall require each hospital to
comply with this section as a condition of its contract with the
entity.
new text end

Sec. 6.

new text begin [65B.665] EXCESSIVE CLAIMS; HEALTH-RELATED
BOARDS.
new text end

new text begin Insurers may bring excessive claims to the attention of the
appropriate health-related board under chapter 147, 148, 148B,
or 150A. The board shall respond to an insurer that brings a
claim before the board within 60 calendar days as to whether or
not the board agrees that a claim is excessive. Upon a finding
by the board that a claim is excessive, the insurer is relieved
of its duty to pay the claim, and neither the person who was
treated nor the person's guardian, nor the state shall be billed
for payment. If a pattern of excessive charges is determined by
the board, the board may limit the right of the licensee to bill
for payment for no-fault accident claims for a specified period
of time, or the board may impose some other sanction it deems
appropriate. The insurer shall make available sufficient funds
to provide for review of the claims that are submitted on a
cost-based per review basis. The cost of the review may vary
based on the complexity of the review. The boards shall report
on excessive claims annually to the legislature beginning
December 1, 2006.
new text end

Sec. 7.

new text begin [144.0506] AGENCY WEB SITES.
new text end

new text begin Subdivision 1. new text end

new text begin Information to be posted. new text end

new text begin The
commissioner of health shall post the following information on
agency Web sites, including minnesotahealthinfo.com:
new text end

new text begin (1) healthy lifestyle and preventive health care
information, organized by gender and age, with procedures and
treatments categorized by level of effectiveness and reliability
of the supporting evidence on effectiveness;
new text end

new text begin (2) health plan company administrative efficiency report
cards, based on information collected under section 62Q.645;
new text end

new text begin (3) health plan coverage options, based on information
collected under section 62Q.646;
new text end

new text begin (4) health care provider charges for common procedures,
based on information collected under section 62J.052;
new text end

new text begin (5) evidence-based medicine guidelines and related
information for use as resources by health care professionals,
and summaries of these guidelines and related information for
use by patients and consumers;
new text end

new text begin (6) resources and web-links related to improving efficiency
in medical clinics and health care professional practices; and
new text end

new text begin (7) lists of nonprofit and charitable entities that accept
donations of used medical equipment and supplies, such as
crutches and walkers.
new text end

new text begin Subd. 2. new text end

new text begin Other internet resources. new text end

new text begin The commissioner of
health, in implementing subdivision 1, shall include relevant
web links and materials from private sector and other government
sources, in order to avoid duplication and reduce state
administrative costs.
new text end

new text begin Subd. 3. new text end

new text begin Cooperation with commissioner of commerce. new text end

new text begin The
commissioner of health shall consult and work in cooperation
with the commissioner of commerce, when posting on the Web site
information collected from health plan companies regulated by
the commissioner of commerce.
new text end

Sec. 8.

new text begin [144.707] CANCER DRUG REPOSITORY PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this
section, the terms defined in this subdivision have the meanings
given.
new text end

new text begin (b) "Cancer drug" means a prescription drug that is used to
treat:
new text end

new text begin (1) cancer or the side effects of cancer; or
new text end

new text begin (2) the side effects of any prescription drug that is used
to treat cancer or the side effects of cancer.
new text end

new text begin (c) "Cancer drug repository" means a medical facility or
pharmacy that has notified the commissioner of its election to
participate in the cancer drug repository program.
new text end

new text begin (d) "Cancer supply" or "supplies" means prescription and
nonprescription cancer supplies needed to administer a cancer
drug.
new text end

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

new text begin (f) "Dispense" has the meaning given in section 151.01,
subdivision 30.
new text end

new text begin (g) "Distribute" means to deliver, other than by
administering or dispensing.
new text end

new text begin (h) "Medical facility" means an institution defined in
section 144.50, subdivision 2.
new text end

new text begin (i) "Medical supplies" means any prescription and
nonprescription medical supply needed to administer a cancer
drug.
new text end

new text begin (j) "Pharmacist" has the meaning given in section 151.01,
subdivision 3.
new text end

new text begin (k) "Pharmacy" means any pharmacy registered with the Board
of Pharmacy according to section 151.19, subdivision 1.
new text end

new text begin (l) "Practitioner" has the meaning given in section 151.01,
subdivision 23.
new text end

new text begin (m) "Prescription drug" means a legend drug as defined in
section 151.01, subdivision 17.
new text end

new text begin (n) "Side effects of cancer" means symptoms of cancer.
new text end

new text begin (o) "Single-unit-dose packaging" means a single-unit
container for articles intended for administration as a single
dose, direct from the container.
new text end

new text begin (p) "Tamper-evident unit dose packaging" means a container
within which a drug is sealed so that the contents cannot be
opened without obvious destruction of the seal.
new text end

new text begin Subd. 2. new text end

new text begin Establishment. new text end

new text begin The commissioner shall establish
and maintain a cancer drug repository program under which any
person may donate a cancer drug or supply for use by an
individual who meets the eligibility criteria specified under
subdivision 4. Under the program, donations may be made on the
premises of a medical facility or pharmacy that elects to
participate in the program and meets the requirements specified
under subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Requirements for participation by pharmacies and
medical facilities. new text end

new text begin (a) To be eligible for participation in the
cancer drug repository program, a pharmacy or medical facility
must be licensed and in compliance with all applicable federal
and state laws and administrative rules.
new text end

new text begin (b) Participation in the cancer drug repository program is
voluntary. A pharmacy or medical facility may elect to
participate in the cancer drug repository program by submitting
the following information to the commissioner, in a form
provided by the commissioner:
new text end

new text begin (1) the name, street address, and telephone number of the
pharmacy or medical facility;
new text end

new text begin (2) the name and telephone number of a pharmacist who is
employed by or under contract with the pharmacy or medical
facility, or other contact person who is familiar with the
pharmacy's or medical facility's participation in the cancer
drug repository program; and
new text end

new text begin (3) a statement indicating that the pharmacy or medical
facility meets the eligibility requirements under paragraph (a)
and the chosen level of participation under paragraph (c).
new text end

new text begin (c) A pharmacy or medical facility may fully participate in
the cancer drug repository program by accepting, storing, and
dispensing donated drugs and supplies, or may limit its
participation to only accepting and storing donated drugs and
supplies. If a pharmacy or facility chooses to limit its
participation, the pharmacy or facility shall distribute any
donated drugs to a fully participating cancer drug repository in
accordance with subdivision 8.
new text end

new text begin (d) A pharmacy or medical facility may withdraw from
participation in the cancer drug repository program at any time
upon notification to the commissioner. A notice to withdraw
from participation may be given by telephone or regular mail.
new text end

new text begin Subd. 4. new text end

new text begin Individual eligibility requirements. new text end

new text begin Any
Minnesota resident who is diagnosed with cancer is eligible to
receive drugs or supplies under the cancer drug repository
program. Drugs and supplies shall be dispensed according to the
priority given under subdivision 6.
new text end

new text begin Subd. 5. new text end

new text begin Donations of cancer drugs and supplies. new text end

new text begin (a) Any
one of the following persons may donate legally obtained cancer
drugs or supplies to a cancer drug repository if the drugs or
supplies meet the requirements under paragraph (b) or (c) as
determined by a pharmacist who is employed by or under contract
with a cancer drug repository:
new text end

new text begin (1) an individual who is 18 years of age or older; or
new text end

new text begin (2) a pharmacy, medical facility, drug manufacturer, or
wholesale drug distributor, if the donated drugs have not been
previously dispensed.
new text end

new text begin (b) A cancer drug is eligible for donation under the cancer
drug repository program only if the following requirements are
met:
new text end

new text begin (1) the donation is accompanied by a cancer drug repository
donor form described under paragraph (d) that is signed by the
person making the donation or that person's authorized
representative;
new text end

new text begin (2) the drug's expiration date is at least six months later
than the date that the drug was donated;
new text end

new text begin (3) the drug is in its original, unopened, tamper-evident
unit dose packaging that includes the drug's lot number and
expiration date. Single-unit dose drugs may be accepted if the
single-unit-dose packaging is unopened; and
new text end

new text begin (4) the drug is not adulterated or misbranded.
new text end

new text begin (c) Cancer supplies are eligible for donation under the
cancer drug repository program only if the following
requirements are met:
new text end

new text begin (1) the supplies are not adulterated or misbranded;
new text end

new text begin (2) the supplies are in their original, unopened, sealed
packaging; and
new text end

new text begin (3) the donation is accompanied by a cancer drug repository
donor form described under paragraph (d) that is signed by the
person making the donation or that person's authorized
representative.
new text end

new text begin (d) The cancer drug repository donor form must be provided
by the commissioner and shall state that to the best of the
donor's knowledge the donated drug or supply has been properly
stored and that the drug or supply has never been opened, used,
tampered with, adulterated, or misbranded. The commissioner
shall make the cancer drug repository donor form available on
the Department of Health's Web site.
new text end

new text begin (e) Controlled substances and drugs and supplies that do
not meet the criteria under this subdivision are not eligible
for donation or acceptance under the cancer drug repository
program.
new text end

new text begin (f) Drugs and supplies may be donated on the premises of a
cancer drug repository to a pharmacist designated by the
repository. A drop box may not be used to deliver or accept
donations.
new text end

new text begin (g) Cancer drugs and supplies donated under the cancer drug
repository program must be stored in a secure storage area under
environmental conditions appropriate for the drugs or supplies
being stored. Donated drugs and supplies may not be stored with
nondonated inventory.
new text end

new text begin Subd. 6. new text end

new text begin Dispensing requirements. new text end

new text begin (a) Drugs and supplies
must be dispensed by a licensed pharmacist pursuant to a
prescription by a practitioner and in accordance with the
requirements of chapter 151.
new text end

new text begin (b) Before being dispensed, cancer drugs and supplies shall
be visually inspected by the pharmacist for adulteration,
misbranding, and date of expiration. Drugs or supplies that
have expired or appear upon visual inspection to be adulterated,
misbranded, or tampered with in any way may not be dispensed.
new text end

new text begin (c) Before a cancer drug or supply may be dispensed to an
individual, the individual must sign a cancer drug repository
recipient form provided by the commissioner acknowledging that
the individual understands the information stated on the form.
The form shall include the following information:
new text end

new text begin (1) that the drug or supply being dispensed has been
donated and may have been previously dispensed;
new text end

new text begin (2) that a visual inspection has been conducted by the
pharmacist to ensure that the drug has not expired, has not been
adulterated or misbranded, and is in its original, unopened
packaging; and
new text end

new text begin (3) that the dispensing pharmacist, the cancer drug
repository, the Department of Health, and any other participant
in the cancer drug repository program cannot guarantee the
safety of the drug or supply being dispensed and that the
pharmacist has determined that the drug or supply is safe to
dispense based on the accuracy of the donor's form submitted
with the donated drug or supply and the visual inspection
required to be performed by the pharmacist before dispensing.
new text end

new text begin The commissioner shall make the cancer drug repository form
available on the Department of Health's Web site.
new text end

new text begin (d) Drugs and supplies shall only be dispensed to
individuals who meet the eligibility requirements in subdivision
4 and in the following order of priority:
new text end

new text begin (1) individuals who are uninsured;
new text end

new text begin (2) individuals who are enrolled in medical assistance,
general assistance medical care, MinnesotaCare, Medicare, or
other public assistance health care; and
new text end

new text begin (3) all other individuals who are otherwise eligible under
subdivision 4 to receive drugs or supplies from a cancer drug
repository.
new text end

new text begin Subd. 7. new text end

new text begin Handling fees. new text end

new text begin A cancer drug repository may
charge the individual receiving a drug or supply a handling fee
of no more than 250 percent of the medical assistance program
dispensing fee for each cancer drug or supply dispensed.
new text end

new text begin Subd. 8. new text end

new text begin Distribution of donated cancer drugs and
supplies. new text end

new text begin (a) Cancer drug repositories may distribute drugs and
supplies donated under the cancer drug repository program to
other repositories if requested by a participating repository.
new text end

new text begin (b) A cancer drug repository that has elected not to
dispense donated drugs or supplies shall distribute any donated
drugs and supplies to a participating repository upon request of
the repository.
new text end

new text begin (c) If a cancer drug repository distributes drugs or
supplies under paragraph (a) or (b), the repository shall
complete a cancer drug repository donor form provided by the
commissioner. The completed form and a copy of the donor form
that was completed by the original donor under subdivision 5
shall be provided to the fully participating cancer drug
repository at the time of distribution.
new text end

new text begin Subd. 9. new text end

new text begin Resale of donated drugs or supplies. new text end

new text begin Donated
drugs and supplies may not be resold.
new text end

new text begin Subd. 10. new text end

new text begin Record-keeping requirements. new text end

new text begin (a) Cancer drug
repository donor and recipient forms shall be maintained for at
least five years.
new text end

new text begin (b) A record of destruction of donated drugs and supplies
that are not dispensed under subdivision 6 shall be maintained
by the dispensing repository for at least five years. For each
drug or supply destroyed, the record shall include the following
information:
new text end

new text begin (1) the date of destruction;
new text end

new text begin (2) the name, strength, and quantity of the cancer drug
destroyed;
new text end

new text begin (3) the name of the person or firm that destroyed the drug;
and
new text end

new text begin (4) the source of the drugs or supplies destroyed.
new text end

new text begin Subd. 11. new text end

new text begin Liability. new text end

new text begin (a) Unless a manufacturer of a drug
or supply exercises bad faith, the manufacturer is not subject
to criminal or civil liability for injury, death, or loss to a
person or property for matters related to the donation,
acceptance, or dispensing of a cancer drug or supply
manufactured by the manufacturer that is donated by any
individual under this section, including liability for failure
to transfer or communicate product or consumer information or
the expiration date of the donated cancer drug or supply.
new text end

new text begin (b) A medical facility, pharmacy, pharmacist, practitioner,
or donor participating in the program is immune from civil
liability for injury to or for the death of an individual to
whom the cancer drug or supply is dispensed and no disciplinary
action shall be taken for unprofessional conduct for acts or
omissions related to donating, accepting, distributing, or
dispensing a cancer drug or supply under this section, unless
the act or omission involves reckless, wanton, or intentional
misconduct, or malpractice unrelated to the quality of the drug
dispensed.
new text end

Sec. 9.

new text begin [144.7071] REPORTING OF ACQUIRED INFECTIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Citation. new text end

new text begin This section may be cited as
the Minnesota Acquired Infections Disclosure Act.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section,
the following definitions apply.
new text end

new text begin (b) "Acquired infection" means a localized or systemic
condition that:
new text end

new text begin (1) results from adverse reaction to the presence of an
infectious agent or its toxin; and
new text end

new text begin (2) was not present or incubating at the time of admission
to the facility.
new text end

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

new text begin (d) "Facility" means a hospital or outpatient surgical
center licensed under sections 144.50 to 144.56.
new text end

new text begin Subd. 3. new text end

new text begin Data collection. new text end

new text begin (a) Individual facilities must
collect data on acquired infection rates for specific clinical
procedures identified by the commissioner after consultation
with the advisory committee.
new text end

new text begin (b) In developing the methodology for collecting and
analyzing the infection rate data, the commissioner must consult
with the advisory committee and must consider, but is not
required to adopt, existing methodologies and systems for data
collection, such as the Centers for Disease Control's National
Nosocomial Infection Surveillance Program, or its successor.
The commissioner must disclose to the public the data collection
and analysis methodology adopted, prior to public disclosure of
acquired infection rates.
new text end

new text begin (c) The commissioner, in consultation with the advisory
committee, must regularly evaluate the quality and accuracy of
the information submitted by facilities and the adequacy of the
data collection, analysis, risk-adjustment, and dissemination
methodologies.
new text end

new text begin Subd. 4. new text end

new text begin Reports by commissioner. new text end

new text begin (a) The commissioner
must submit to the legislature, beginning December 1, 2006, and
each December 1 thereafter, an annual report summarizing and
analyzing the information received in facility quarterly
reports. The annual report must include the risk-adjusted
acquired infection rates for each facility in the state, an
analysis of the rates of acquired infections by geographic area
and type of facility, and a comparison of rates of acquired
infections over time. The report may also include
recommendations for policy and legislative changes necessary to
reduce the rate of acquired infections or improve the process
for reporting and analyzing rates of acquired infections.
new text end

new text begin (b) The commissioner may submit quarterly reports to the
legislature, summarizing the information submitted in the
facility quarterly reports.
new text end

new text begin (c) The commissioner must publicize the annual reports and
quarterly reports and must provide copies of these documents to
interested parties upon request. The commissioner must also
make the reports available on the agency Web site.
new text end

new text begin Subd. 5. new text end

new text begin Privacy. new text end

new text begin (a) No facility report or disclosure
by the commissioner may contain identifying information for any
of the health care professionals, facility employees, or
patients involved in connection with a specific infection
incident.
new text end

new text begin (b) Data collected as provided under subdivision 3,
paragraph (e), are nonpublic and, to the extent they contain
data on individuals, are confidential data on individuals, as
defined in section 13.02.
new text end

new text begin Subd. 6. new text end

new text begin Advisory committee. new text end

new text begin (a) The commissioner must
establish an advisory committee that includes representatives of
public and private hospitals, including staff from hospital
infection control departments; outpatient surgical centers;
direct care nursing staff; physicians; epidemiologists and
academic researchers with expertise in hospital-acquired
infections; consumer organizations; health plan companies;
organized labor; and employers and other health care
purchasers. A majority of the members of the advisory committee
must represent organizations other than hospitals and outpatient
surgical centers.
new text end

new text begin (b) The advisory committee must assist the commissioner in
the development of procedures for collecting, analyzing, and
reporting the information on acquired infection rates, in
identifying specific clinical procedures for which infection
rates must be reported, and in evaluating the accuracy of the
data on acquired infection rates submitted to the commissioner.
new text end

new text begin (c) Notwithstanding section 15.059, the advisory committee
does not expire.
new text end

new text begin Subd. 7. new text end

new text begin Rulemaking. new text end

new text begin The commissioner must adopt rules
to implement this section.
new text end

Sec. 10.

new text begin [144.999] REPORTING ON UNCOMPENSATED CARE.
new text end

new text begin (a) A health care provider shall file annually with the
commissioner of health, no later than March 1 of each year, a
report of the provider's uncompensated care for the preceding
calendar year. The report must be on a form prescribed by the
commissioner. The form must require the provider to report the
dollar amount of uncompensated care in the following categories
which must be more fully defined on the form:
new text end

new text begin (1) charity care, meaning care that the provider had agreed
with the patient, prior to providing the care, to provide all or
a portion of at no charge or at a reduced charge; and
new text end

new text begin (2) bad debt, meaning amounts owing to the provider by the
patient or other responsible party, which has remained unpaid
for at least six months after the date the care was provided,
whether reduced to judgment or not.
new text end

new text begin (b) Uncompensated care for purposes of this section does
not include:
new text end

new text begin (1) reductions in charges by health plan companies based
upon provider agreements or upon a determination that the
charges exceed the reasonable and customary charge; or
new text end

new text begin (2) differences between what the provider receives under
Medicare, medical assistance, general assistance medical care,
or MinnesotaCare and what the provider might otherwise charge
for that care.
new text end

Sec. 11.

new text begin [144E.20] LIABILITY LIMITS OF NONGOVERNMENT
LICENSEES.
new text end

new text begin A licensee that is not a unit of government is subject to
the same liability limits under chapter 466 as a licensee that
is a unit of government.
new text end

Sec. 12.

new text begin [145.985] HEALTH PROMOTION AND WELLNESS.
new text end

new text begin Community health boards as defined in section 145A.02,
subdivision 5, shall work with schools, health care providers,
and others to coordinate health and wellness programs in their
communities. In order to meet the requirements of this section,
community health boards shall:
new text end

new text begin (1) provide instruction, technical assistance, and
recommendations on how to evaluate project outcomes;
new text end

new text begin (2) assist with on-site health and wellness programs
utilizing volunteers and others addressing health and wellness
topics including smoking, nutrition, obesity, and others; and
new text end

new text begin (3) encourage health and wellness programs consistent with
the Centers for Disease Control and Prevention's Community Guide
and goals consistent with the Centers for Disease Control and
Prevention's Healthy People 2010 initiative.
new text end

Sec. 13.

Minnesota Statutes 2004, section 145A.12, is
amended by adding a subdivision to read:

new text begin Subd. 9. new text end

new text begin Health improvement grant fund. new text end

new text begin The commissioner
shall establish a public health grant fund and program to award
grants to statewide and local health improvement public-private
partnerships to support collaborative actions that will reduce
the rate of increase in health care costs through improvements
in the health status or the prevention of illness and injury in
the population of the state or a local community. The
commissioner shall fund the grants using foundation and other
nonstate resources. The commissioner shall require grantees to
provide an equal match of local funding provided from public or
private sources. Each grant program must include a methodology
approved by the commissioner for measuring the financial and
health improvement impact of the grantees' actions. The
commissioner must submit a report to the legislature by June 30,
2009, describing the impact of the programs funded under this
section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005.
new text end

Sec. 14.

Minnesota Statutes 2004, section 151.214,
subdivision 1, is amended to read:

Subdivision 1.

Explanation of pharmacy benefits.

A
pharmacist licensed under this chapter must provide to a
patient, for each prescription dispensed where part or all of
the cost of the prescription is being paid or reimbursed by an
employer-sponsored plan or health plan company, or its
contracted pharmacy benefit manager, the patient's co-payment
amount and the new text begin pharmacy's own new text end usual and customary price of the
prescription or the amount the pharmacy will be paid for the
prescription drug by the patient's employer-sponsored plan or
health plan company, or its contracted pharmacy benefit manager.

Sec. 15.

new text begin [151.215] PROVISION OF INFORMATION ON
PHARMACEUTICAL ASSISTANCE PROGRAMS.
new text end

new text begin A pharmacist licensed under this chapter must make
available to patients, in a public area of the pharmacy,
brochures on programs offered by pharmaceutical manufacturers
that provide free or discounted drugs or provide coverage for
prescription drugs. This requirement applies only to brochures
that are made available to pharmacists free of charge by
pharmaceutical manufacturers.
new text end

Sec. 16.

new text begin [214.107] HEALTH-RELATED BOARDS; REVIEW OF
JUDGMENTS, CLAIMS, SETTLEMENTS, AND VERDICTS.
new text end

new text begin The health-related boards under chapters 147, 148, 148B,
and 150A, shall be notified by the licensed provider or other
party of all licensee malpractice judgments, claims,
settlements, verdicts, or criminal convictions. Conviction, as
used in this subdivision, includes a conviction of an offense
that if committed in this state would be considered a felony or
gross misdemeanor without regard to its designation elsewhere,
or a criminal proceeding where a finding or verdict of guilt is
made or returned but the adjudication of guilt is either
withheld or not entered.
new text end

Sec. 17.

new text begin [214.206] HEALTH-RELATED BOARDS; NO-FAULT
AUTOMOBILE INJURIES.
new text end

new text begin The health-related boards, under chapter 148, may establish
practice standards for treating patients with injuries sustained
in no-fault automobile accidents and update the standards
periodically as appropriate. The boards may utilize the
services of appropriate public or private entities to facilitate
the development or review of practice standards and
evidence-based guidelines. Each board that has established or
ratified existing standards shall report these standards to the
legislative committees with jurisdiction over the public health
occupations by January 15, 2006, and shall report subsequent
changes annually thereafter. If a board has existing standards,
nothing in this section requires a board to establish new
standards.
new text end

Sec. 18. new text begin HEALTH BOARDS; DIRECTORY OF LICENSEES.
new text end

new text begin Each health board under Minnesota Statutes, chapters 147,
148, 148B, and 150A, shall establish a directory of licensees
that includes biographical data and any malpractice judgments or
other judgments or convictions related to the health license for
each licensee.
new text end

ARTICLE 3

MISCELLANEOUS AND STUDIES

Section 1.

Minnesota Statutes 2004, section 145A.12, is
amended by adding a subdivision to read:

new text begin Subd. 8. new text end

new text begin Coordinated statewide health improvement action
plan. new text end

new text begin The commissioner, in consultation with the state
community health advisory committee and other interested
parties, including employers, health plan companies, schools,
health care professionals, and consumers, shall develop and
implement a statewide action plan for improving the health
status of Minnesotans and promoting primary prevention through
the strategic and coordinated action of communities, businesses,
health care professionals, health care organizations, health
plans, schools, and other public and private entities. The plan
must identify up to three of the statewide public health
outcomes as determined under subdivision 7 and provide for
specific steps to be taken that will produce measurable
improvements in health status and corresponding reductions in
the incidence of disease or injury and related health care
costs. The plan must encourage and facilitate the formation of
local public-private partnerships to take action on the
statewide goals.
new text end

Sec. 2. new text begin NO-FAULT INSURANCE MEDICAL COST STUDY.
new text end

new text begin The commissioner of commerce, the health-related boards
under Minnesota Statutes, chapter 148, professional provider
associations, and automobile insurance carriers that offer
no-fault insurance under Minnesota Statutes, sections 65B.41 to
65B.71, shall study the medical costs associated with no-fault
automobile accidents and report to the legislative committees
with jurisdiction over the public health boards and commerce on
any high medical cost outliers by January 15, 2006. For the
purposes of this section, "high medical cost outliers" means
health providers whose total charges for treating specific
conditions or injuries sustained as a result of no-fault
automobile accidents are at any time found to be above the 95th
percentile or consistently above the 90th percentile.
new text end

new text begin For the purposes of this study, the no-fault automobile
insurance carriers shall provide nonproprietary data for
determining the current usual and customary fees. Such data
shall include information on the data utilized, including where
the data was derived from, the age of the data, the data
demographics, and other pertinent criteria. The data must be
updated no less than annually. The information provided must
include reasonable customary charges on the 100 most commonly
utilized codes by the professionals submitting billings,
including codes for clinical diagnostic parameters, clinical
treatment parameters, and therapeutic parameters.
new text end

Sec. 3. new text begin INFORMATION FOR HEALTH CARE PURCHASING.
new text end

new text begin Subdivision 1. new text end

new text begin Purpose. new text end

new text begin It is the intent of the
legislature to promote and support a health care purchasing
system for public and private purchasers of health care that
promotes individual consumer choice based on the value of health
care services, drugs, equipment, and preventive measures. A
necessary component of value-based health care purchasing is
convenient access to information about differences in quality
and costs.
new text end

new text begin Subd. 2. new text end

new text begin Cost information. new text end

new text begin The commissioner of health,
in cooperation with other appropriate state agencies and in
consultation with an advisory committee representing purchasers,
consumers, physicians and other health care professionals,
health plan companies, health care facilities and other health
care organizations, and other interested persons and groups,
shall develop a plan, no later than January 1, 2006, for the
development of useful, reliable, and valid information on cost
to support purchasing of health care based on value.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2005.
new text end

Sec. 4. new text begin HEALTH CARE COST CONTAINMENT STUDIES.
new text end

new text begin Subdivision 1. new text end

new text begin General requirements for studies. new text end

new text begin (a) The
commissioners of health, commerce, and human services shall
study the health care cost containment issues listed in this
section, and shall present a combined report on these issues to
the legislature by January 15, 2006. The commissioners shall
consult with the commissioner of employee relations and other
agency commissioners as needed. The combined report must:
new text end

new text begin (1) examine the feasibility and benefits of each initiative
being proposed;
new text end

new text begin (2) provide recommendations for addressing each issue and
any draft legislation necessary to implement these
recommendations;
new text end

new text begin (3) present for each separate issue, an estimate of the
savings to the state, other payors, and consumers that would
result from implementation of the recommendations; and
new text end

new text begin (4) provide, where applicable, a unified strategy that
addresses cost containment across separate issue areas and
provides a timetable for staged implementation of various
recommendations across different issue areas.
new text end

new text begin (b) The report may contain preliminary recommendations for
specific issues, if the commissioners determine that additional
time is necessary to fully analyze the issues and develop final
recommendations. The commissioners shall present to the
legislature by December 15, 2006, final recommendations and
draft legislation for these issue areas.
new text end

new text begin (c) In conducting the studies, the commissioners shall
regularly consult with relevant parties, including, but not
limited to, health care consumers, representatives of health
plan companies and other payors, health care providers,
health-related licensing boards, professional associations, and
medical and health policy researchers.
new text end

new text begin (d) The commissioners shall post completed studies,
summaries of study findings, best practices, and evidence-based
medicine on state Web sites, including minnesotahealthinfo.com.
new text end

new text begin (e) For purposes of this section, "commissioners" means the
commissioners of health, commerce, and human services, unless
otherwise indicated.
new text end

new text begin Subd. 2. new text end

new text begin Staff support. new text end

new text begin (a) The commissioners shall
provide staff necessary to conduct the studies. The
commissioners shall pay for staff and administrative costs using
existing financial resources.
new text end

new text begin (b) The commissioners shall seek staff support from health
plan companies, health care provider organizations, consumer
groups, health-related licensing boards, professional
associations, and health policy and medical researchers, in
order to make use of private sector expertise and minimize state
costs.
new text end

new text begin Subd. 3. new text end

new text begin Studies related to quality of care. new text end

new text begin (a) The
commissioners shall study approaches to obtaining more rapid
health plan company and payor approval of new or underutilized
cost-saving procedures that improve quality of care, including,
but not limited to, new procedures for wound care, when these
procedures are supported by findings of evidence-based
medicine. The study must also examine methods to encourage
health plan companies and payors to disallow reimbursement for
procedures that evidence-based medicine findings indicate are
ineffective.
new text end

new text begin (b) The commissioners shall study the potential for
improving quality and obtaining cost savings through greater use
of treatment methods performed by alternative and complementary
health care providers that are supported by the findings of
evidence-based medicine.
new text end

new text begin (c) The commissioners shall study methods to encourage the
use of evidence-based medicine and electronic medical records,
and improving provider access to evidence-based medicine
findings, including recommendations for uniform standards for
electronic data.
new text end

new text begin (d) The commissioners shall study methods to encourage
small providers to adopt and use electronic billing, including,
but not limited to, the use of grants and financial incentives.
new text end

new text begin Subd. 4. new text end

new text begin Studies related to universal participation and
access to care. new text end

new text begin The commissioners shall study the adequacy of
the current system of community health care clinics and centers
both statewide, and in urban areas with significant disparities
in health status and access to services across racial and ethnic
groups. The commissioners shall evaluate:
new text end

new text begin (1) methods to provide 24-hour availability of care through
community clinics and centers;
new text end

new text begin (2) methods to expand the availability of free or
subsidized care through the clinics and centers;
new text end

new text begin (3) the use of health care access fund grants to expand the
number of clinics and centers, the services provided, and the
availability of free or subsidized care; and
new text end

new text begin (4) the extent to which increased use of physician
assistants, nurse practitioners, medical residents and interns,
and other allied health professionals in clinics and centers
would increase the availability of services.
new text end

new text begin Subd. 5. new text end

new text begin Studies related to reducing administrative
costs. new text end

new text begin (a) The commissioners shall study the following:
new text end

new text begin (1) whether any changes are needed to Minnesota Statutes,
sections 62J.50 to 62J.61, the Health Care Administrative
Simplification Act of 1994; and
new text end

new text begin (2) methods of providing universal access to online
verification of health coverage, including allowing health care
providers controlled access to health plan company information
systems.
new text end

new text begin (b) The commissioners shall study and make recommendations
on providing language interpreter services to
limited-English-speaking patients in order to facilitate the
provision of health care services by health care providers and
health care facilities. The recommendations shall include:
new text end

new text begin (1) ways to achieve the needed availability of professional
interpreter services and an accreditation system for language
interpreters, which includes appropriate standards for
education, training, and credentialing; and
new text end

new text begin (2) criteria for determining financial responsibility for
providing interpreter services to enrollees of health plans,
including the responsible party for arranging interpreter
services and for reimbursement for these services.
new text end

Sec. 5. new text begin MEDICAL MALPRACTICE INSURANCE REPORT.
new text end

new text begin (a) The commissioner of commerce shall provide to the
legislature, no later than March 1 of each year, a brief written
report on the status of the market for medical malpractice
insurance in Minnesota. The report must summarize, interpret,
explain, and analyze information on that subject available to
the commissioner, through annual statements filed by insurance
companies, information obtained under paragraph (c), and other
sources.
new text end

new text begin (b) The annual report must consider, to the extent
possible, Minnesota-specific data on market shares; premiums
received; amounts paid to settle claims that were not litigated,
claims that were settled after litigation began, and claims that
were litigated to court judgment; amounts spent on processing,
investigation, litigation, and otherwise handling claims; other
sales and administrative costs; and the loss ratios of the
insurers.
new text end

new text begin (c) Each insurance company that provides medical
malpractice insurance in this state shall, no later than
February 1 of each year, file with the commissioner of commerce,
on a form prescribed by the commissioner, the Minnesota-specifc
data referenced in paragraph (b), other than market share, for
the previous calendar year for that insurance company, shown
separately for the categories of coverage provided to hospitals,
medical clinics, nursing homes, emergency medicine physicians,
and obstetrician-gynecologists. An insurance company need not
comply with this paragraph if its direct premium written in the
state for the previous calendar year is less than $2,000,000.
new text end

Sec. 6. new text begin HEALTH COVERAGE REINSURANCE; STUDY.
new text end

new text begin (a) The commissioners of health and commerce shall study
the possibility of reducing the cost of individual and group
health coverage in this state through the creation of a
state-sponsored reinsurance program available to health plan
companies, self-insured employers, service cooperatives, the
Minnesota Comprehensive Health Association, and other sources of
private sector and public employee health coverage. The study
must include:
new text end

new text begin (1) an evaluation of the current market for reinsurance and
stop-loss insurance for health coverage in this state;
new text end

new text begin (2) analysis of whether a state-sponsored reinsurance
arrangement could reduce the cost of that reinsurance and
stop-loss coverage, through the creation of a large pool to
provide the coverage, possibly subsidized by the state;
new text end

new text begin (3) a comparison of such a reinsurance pool with the
Workers' Compensation Reinsurance Association and with health
reinsurance programs in other states;
new text end

new text begin (4) an exploration of organizational issues, including
operating the pool jointly with the Workers' Compensation
Reinsurance Association; reactivating the Health Coverage
Reinsurance Association established in Minnesota Statutes,
sections 62L.13 to 62L.23, with an expansion of it to include
coverage provided by insured and self-insured employers of any
size; operating the pool jointly with a pool to provide
reinsurance for medical malpractice insurance; whether the
coverage should be offered to self-insured employers on a
voluntary basis in exchange for voluntarily complying with state
laws regulating health coverage; and issues involving the
new text end
building of necessary financial reserves.

new text begin (b) The commissioners shall provide a short written report
to the legislature by January 15, 2006, providing the
conclusions of the study and identifying any related issues that
need further study.
new text end

ARTICLE 4

HEALTH PLAN ADMINISTRATIVE CHANGES

Section 1.

Minnesota Statutes 2004, section 45.0135,
subdivision 7, is amended to read:

Subd. 7.

Assessment.

Each insurer authorized to sell
insurance in the state of Minnesota shall remit an assessment to
the commissioner for deposit in the insurance fraud prevention
account on or before June 1 of each year. The amount of the
assessment shall be based on the insurer's total assets and on
the insurer's total written Minnesota premium, for the preceding
fiscal year, as reported pursuant to section 60A.13. The
assessment is calculated as follows:

Total Assets Assessment
Less than $100,000,000 $ 200
$100,000,000 to $1,000,000,000 $ 750
Over $1,000,000,000 $2,000

Minnesota Written Premium Assessment
Less than $10,000,000 $ 200
$10,000,000 to $100,000,000 $ 750
Over $100,000,000 $2,000

For purposes of this subdivision, the following entities
are not considered to be insurers authorized to sell insurance
in the state of Minnesota: risk retention groups; new text begin or new text end township
mutuals organized under chapter 67A deleted text begin ; or health maintenance
organizations organized under chapter 62D deleted text end .

Sec. 2.

Minnesota Statutes 2004, section 62D.145,
subdivision 2, is amended to read:

Subd. 2.

Health data or information.

(a) A health
maintenance organization is prohibited from disclosing to any
person any individually identifiable data or information held by
the health maintenance organization pertaining to the diagnosis,
treatment, or health of any enrollee, or any application
obtained from any person, except:

(1) to the extent necessary to carry out the purposes of
this chapter, the commissioner and a designee shall have access
to the above data or information but the data removed from the
health maintenance organization or participating entity shall
not identify any particular patient or client by name or contain
any other unique personal identifier;

(2) upon the express consent of the enrollee or applicant;

(3) pursuant to statute or court order for the production
of evidence or the discovery thereof;

(4) in the event of claim or litigation between the person
and the provider or health maintenance organization wherein such
data or information is pertinent;

(5) to meet the requirements of contracts for prepaid
medical services with the commissioner of human services
authorized under chapter 256B, 256D, or 256L;

(6) to meet the requirements of contracts for benefit plans
with the commissioner of employee relations under chapter 43A;
or

(7) as otherwise deleted text begin authorized pursuant to statute deleted text end new text begin permitted
or required by law new text end .

No provision in a contract for a benefit plan under chapter
43A shall authorize dissemination of individually identifiable
health records, unless the dissemination of the health records
is required to carry out the requirements of the contract and
employees whose health records will be disseminated are fully
informed of the dissemination by the Department of Employee
Relations at the time the employees are enrolling for or
changing insurance coverage.

(b) In any case involving a suspected violation of a law
applicable to health maintenance organizations in which access
to health data maintained by the health maintenance organization
or participating entity is necessary, the commissioner and
agents, while maintaining the privacy rights of individuals and
families, shall be permitted to obtain data that identifies any
particular patient or client by name. A health maintenance
organization shall be entitled to claim any statutory privileges
against such disclosure which the provider who furnished the
information to the health maintenance organization is entitled
to claim.

Sec. 3.

Minnesota Statutes 2004, section 62E.05,
subdivision 2, is amended to read:

Subd. 2.

Annual report.

deleted text begin (a) All health plan companies,
as defined in section 62Q.01, shall annually report to the
commissioner responsible for their regulation. The following
information shall be reported to the appropriate commissioner on
February 1 of each year:
deleted text end

deleted text begin (1) the number of individuals and groups who received
coverage in the prior year through the qualified plans; and
deleted text end

deleted text begin (2) the number of individuals and groups who received
coverage in the prior year through each of the unqualified plans
sold by the company.
deleted text end

deleted text begin (b) deleted text end The state of Minnesota or any of its departments,
agencies, programs, instrumentalities, or political
subdivisions, shall report in writing to the association and to
the commissioner of commerce no later than September 15 of each
year regarding the number of persons and the amount of premiums,
deductibles, co-payments, or coinsurance that it paid for on
behalf of enrollees in the Comprehensive Health Association.
This report must contain only summary information and must not
include any individually identifiable data. The report must
cover the 12-month period ending the preceding June 30.

Sec. 4.

Minnesota Statutes 2004, section 62L.08,
subdivision 8, is amended to read:

Subd. 8.

Filing requirement.

deleted text begin No later than July 1, 1993,
and each year thereafter, deleted text end A health carrier that offers, sells,
issues, or renews a health benefit plan for small employers
shall file with the commissioner the index rates and must
demonstrate that all rates shall be within the rating
restrictions defined in this chapter. Such demonstration must
include the allowable range of rates from the index rates and a
description of how the health carrier intends to use demographic
factors including case characteristics in calculating the
premium rates. The rates shall not be approved, unless the
commissioner has determined that the rates are reasonable. In
determining reasonableness, the commissioner shall consider the
growth rates applied under section 62J.04, subdivision 1,
paragraph (b), to the calendar year or years that the proposed
premium rate would be in effect, actuarially valid changes in
risk associated with the enrollee population, and actuarially
valid changes as a result of statutory changes in Laws 1992,
chapter 549. deleted text begin For premium rates proposed to go into effect
between July 1, 1993 and December 31, 1993, the pertinent growth
rate is the growth rate applied under section 62J.04,
subdivision 1, paragraph (b), to calendar year 1994.
deleted text end

Sec. 5.

Minnesota Statutes 2004, section 62Q.64, is
amended to read:

62Q.64 DISCLOSURE OF EXECUTIVE COMPENSATION.

(a) Each health plan company doing business in this state
shall annually file with the deleted text begin Consumer Advisory Board created in
section 62J.75:
deleted text end

deleted text begin (1) a copy of the health plan company's form 990 filed with
the federal Internal Revenue Service; or
deleted text end

deleted text begin (2) if the health plan company did not file a form 990 with
the federal Internal Revenue Service, deleted text end new text begin commissioner of commerce new text end a
list of the amount and recipients of the health plan company's
five highest salaries, including all types of compensation, in
excess of $50,000.

(b) A filing under this section is public data under
section 13.03.

Sec. 6.

Minnesota Statutes 2004, section 62Q.75, is
amended to read:

62Q.75 PROMPT PAYMENT REQUIRED.

Subdivision 1.

Definitions.

(a) For purposes of this
section, the following terms have the meanings given to them.

(b) "Clean claim" means a claim that has no defect or
impropriety, including any lack of any required substantiating
documentation new text begin , including coordination of benefits information new text end ,
or particular circumstance requiring special treatment that
prevents timely payment from being made on a claim under this
section. new text begin Nothing in this section alters an enrollee's
obligation to disclose information as required by law.
new text end

(c) "Third-party administrator" means a third-party
administrator or other entity subject to section 60A.23,
subdivision 8, and Minnesota Rules, chapter 2767.

Subd. 2.

Claims payments.

(a) This section applies to
clean claims submitted to a health plan company or third-party
administrator for services provided by any:

(1) health care provider, as defined in section 62Q.74, but
does not include a provider licensed under chapter 151;

(2) home health care provider, as defined in section
144A.43, subdivision 4; or

(3) health care facility.

All health plan companies and third-party administrators must
pay or deny claims that are clean claims within 30 calendar days
after the date upon which the health plan company or third-party
administrator received the claim.

(b) The health plan company or third-party administrator
shall, upon request, make available to the provider information
about the status of a claim submitted by the provider consistent
with section 62J.581.

(c) If a health plan company or third-party administrator
does not pay or deny a clean claim within the period provided in
paragraph (a), the health plan company or third-party
administrator must pay interest on the claim for the period
beginning on the day after the required payment date specified
in paragraph (a) and ending on the date on which the health plan
company or third-party administrator makes the payment or denies
the claim. In any payment, the health plan company or
third-party administrator must itemize any interest payment
being made separately from other payments being made for
services provided. new text begin The health plan company or third-party
administrator shall not require the health care provider to bill
the health plan company or third-party administrator for the
interest required under this section before any interest payment
is made. new text end Interest payments must be made to the health care
provider no less frequently than quarterly.

(d) The rate of interest paid by a health plan company or
third-party administrator under this subdivision shall be 1.5
percent per month or any part of a month.

(e) A health plan company or third-party administrator is
not required to make an interest payment on a claim for which
payment has been delayed for purposes of reviewing potentially
fraudulent or abusive billing practices.

(f) The commissioner may assess a financial administrative
penalty against a health plan company for violation of this
subdivision when there is a pattern of abuse that demonstrates a
lack of good faith effort and a systematic failure of the health
plan company to comply with this subdivision.

new text begin Subd. 3. new text end

new text begin Claims filing. new text end

new text begin Unless otherwise provided by
contract, by section 16A.124, subdivision 4a, or by federal law,
the health care providers and facilities specified in
subdivision 2 must submit their charges to a health plan company
or third-party administrator within six months from the date of
service or the date the health care provider knew or was
informed of the correct name and address of the responsible
health plan company or third-party administrator, whichever is
later. A health care provider or facility that does not submit
charges within the six-month period shall not be reimbursed for
the charge and may not collect the charge from the recipient of
the service or any other payer. This subdivision also applies
to all health care providers and facilities that submit charges
to workers' compensation payers for treatment of a workers'
compensation injury compensable under chapter 176.
new text end

Sec. 7.

Minnesota Statutes 2004, section 72A.201,
subdivision 4, is amended to read:

Subd. 4.

Standards for claim filing and handling.

The
following acts by an insurer, an adjuster, a self-insured, or a
self-insurance administrator constitute unfair settlement
practices:

(1) except for claims made under a health insurance policy,
after receiving notification of claim from an insured or a
claimant, failing to acknowledge receipt of the notification of
the claim within ten business days, and failing to promptly
provide all necessary claim forms and instructions to process
the claim, unless the claim is settled within ten business
days. The acknowledgment must include the telephone number of
the company representative who can assist the insured or the
claimant in providing information and assistance that is
reasonable so that the insured or claimant can comply with the
policy conditions and the insurer's reasonable requirements. If
an acknowledgment is made by means other than writing, an
appropriate notation of the acknowledgment must be made in the
claim file of the insurer and dated. An appropriate notation
must include at least the following information where the
acknowledgment is by telephone or oral contact:

(i) the telephone number called, if any;

(ii) the name of the person making the telephone call or
oral contact;

(iii) the name of the person who actually received the
telephone call or oral contact;

(iv) the time of the telephone call or oral contact; and

(v) the date of the telephone call or oral contact;

(2) failing to reply, within ten business days of receipt,
to all other communications about a claim from an insured or a
claimant that reasonably indicate a response is requested or
needed;

(3) new text begin (i) new text end unless provided otherwise by new text begin clause (ii) or (iii),
other new text end law new text begin , new text end or in the policy, failing to complete its
investigation and inform the insured or claimant of acceptance
or denial of a claim within 30 business days after receipt of
notification of claim unless the investigation cannot be
reasonably completed within that time. In the event that the
investigation cannot reasonably be completed within that time,
the insurer shall notify the insured or claimant within the time
period of the reasons why the investigation is not complete and
the expected date the investigation will be complete. For
claims made under a health policy the notification of claim must
be in writing;

new text begin (ii) for claims submitted under a health policy, the
insurer must comply with all of the requirements of section
62Q.75;
new text end

new text begin (iii) for claims submitted under a health policy that are
accepted, the insurer must notify the insured or claimant no
less than semiannually of the disposition of claims of the
insured or claimant. For purposes of this clause, acceptance of
a claim means that there is no additional financial liability
for the insured or claimant, either because there is a flat
co-payment amount specified in the health plan or because there
is no co-payment, deductible, or coinsurance owed;
new text end

(4) where evidence of suspected fraud is present, the
requirement to disclose their reasons for failure to complete
the investigation within the time period set forth in clause (3)
need not be specific. The insurer must make this evidence
available to the Department of Commerce if requested;

(5) failing to notify an insured who has made a
notification of claim of all available benefits or coverages
which the insured may be eligible to receive under the terms of
a policy and of the documentation which the insured must supply
in order to ascertain eligibility;

(6) unless otherwise provided by law or in the policy,
requiring an insured to give written notice of loss or proof of
loss within a specified time, and thereafter seeking to relieve
the insurer of its obligations if the time limit is not complied
with, unless the failure to comply with the time limit
prejudices the insurer's rights and then only if the insurer
gave prior notice to the insured of the potential prejudice;

(7) advising an insured or a claimant not to obtain the
services of an attorney or an adjuster, or representing that
payment will be delayed if an attorney or an adjuster is
retained by the insured or the claimant;

(8) failing to advise in writing an insured or claimant who
has filed a notification of claim known to be unresolved, and
who has not retained an attorney, of the expiration of a statute
of limitations at least 60 days prior to that expiration. For
the purposes of this clause, any claim on which the insurer has
received no communication from the insured or claimant for a
period of two years preceding the expiration of the applicable
statute of limitations shall not be considered to be known to be
unresolved and notice need not be sent pursuant to this clause;

(9) demanding information which would not affect the
settlement of the claim;

(10) unless expressly permitted by law or the policy,
refusing to settle a claim of an insured on the basis that the
responsibility should be assumed by others;

(11) failing, within 60 business days after receipt of a
properly executed proof of loss, to advise the insured of the
acceptance or denial of the claim by the insurer. No insurer
shall deny a claim on the grounds of a specific policy
provision, condition, or exclusion unless reference to the
provision, condition, or exclusion is included in the denial.
The denial must be given to the insured in writing with a copy
filed in the claim file;

(12) denying or reducing a claim on the basis of an
application which was altered or falsified by the agent or
insurer without the knowledge of the insured;

(13) failing to notify the insured of the existence of the
additional living expense coverage when an insured under a
homeowners policy sustains a loss by reason of a covered
occurrence and the damage to the dwelling is such that it is not
habitable;

(14) failing to inform an insured or a claimant that the
insurer will pay for an estimate of repair if the insurer
requested the estimate and the insured or claimant had
previously submitted two estimates of repair.

Sec. 8.

Minnesota Statutes 2004, section 144.335,
subdivision 3a, is amended to read:

Subd. 3a.

Patient consent to release of records;
liability.

(a) A provider, or a person who receives health
records from a provider, may not release a patient's health
records to a person without a signed and dated consent from the
patient or the patient's legally authorized representative
authorizing the release, unless the release is deleted text begin specifically
authorized deleted text end new text begin permitted or required new text end by law. Except as provided in
paragraph (c) or (d), a consent is valid for one year or for a
lesser period specified in the consent or for a different period
provided by law.

(b) This subdivision does not prohibit the release of
health records:

(1) for a medical emergency when the provider is unable to
obtain the patient's consent due to the patient's condition or
the nature of the medical emergency; or

(2) to other providers within related health care entities
when necessary for the current treatment of the patient.

(c) Notwithstanding paragraph (a), if a patient explicitly
gives informed consent to the release of health records for the
purposes and pursuant to the restrictions in clauses (1) and
(2), the consent does not expire after one year for:

(1) the release of health records to a provider who is
being advised or consulted with in connection with the current
treatment of the patient;

(2) the release of health records to an accident and health
insurer, health service plan corporation, health maintenance
organization, or third-party administrator for purposes of
payment of claims, fraud investigation, or quality of care
review and studies, provided that:

(i) the use or release of the records complies with
sections 72A.49 to 72A.505;

(ii) further use or release of the records in individually
identifiable form to a person other than the patient without the
patient's consent is prohibited; and

(iii) the recipient establishes adequate safeguards to
protect the records from unauthorized disclosure, including a
procedure for removal or destruction of information that
identifies the patient.

(d) Notwithstanding paragraph (a), health records may be
released to an external researcher solely for purposes of
medical or scientific research only as follows:

(1) health records generated before January 1, 1997, may be
released if the patient has not objected or does not elect to
object after that date;

(2) for health records generated on or after January 1,
1997, the provider must:

(i) disclose in writing to patients currently being treated
by the provider that health records, regardless of when
generated, may be released and that the patient may object, in
which case the records will not be released; and

(ii) use reasonable efforts to obtain the patient's written
general authorization that describes the release of records in
item (i), which does not expire but may be revoked or limited in
writing at any time by the patient or the patient's authorized
representative;

(3) authorization may be established if an authorization is
mailed at least two times to the patient's last known address
with a postage prepaid return envelope and a conspicuous notice
that the patient's medical records may be released if the
patient does not object, and at least 60 days have expired since
the second notice was sent; and the provider must advise the
patient of the rights specified in clause (4); and

(4) the provider must, at the request of the patient,
provide information on how the patient may contact an external
researcher to whom the health record was released and the date
it was released.

In making a release for research purposes the provider
shall make a reasonable effort to determine that:

(i) the use or disclosure does not violate any limitations
under which the record was collected;

(ii) the use or disclosure in individually identifiable
form is necessary to accomplish the research or statistical
purpose for which the use or disclosure is to be made;

(iii) the recipient has established and maintains adequate
safeguards to protect the records from unauthorized disclosure,
including a procedure for removal or destruction of information
that identifies the patient; and

(iv) further use or release of the records in individually
identifiable form to a person other than the patient without the
patient's consent is prohibited.

(e) A person who negligently or intentionally releases a
health record in violation of this subdivision, or who forges a
signature on a consent form, or who obtains under false
pretenses the consent form or health records of another person,
or who, without the person's consent, alters a consent form, is
liable to the patient for compensatory damages caused by an
unauthorized release, plus costs and reasonable attorney's fees.

(f) Upon the written request of a spouse, parent, child, or
sibling of a patient being evaluated for or diagnosed with
mental illness, a provider shall inquire of a patient whether
the patient wishes to authorize a specific individual to receive
information regarding the patient's current and proposed course
of treatment. If the patient so authorizes, the provider shall
communicate to the designated individual the patient's current
and proposed course of treatment. Paragraph (a) applies to
consents given under this paragraph.

(g) Notwithstanding paragraph (a), a provider must disclose
health records relating to a patient's mental health to a law
enforcement agency if the law enforcement agency provides the
name of the patient and communicates that the:

(1) patient is currently involved in an emergency
interaction with the law enforcement agency; and

(2) disclosure of the records is necessary to protect the
health or safety of the patient or of another person.

The scope of disclosure under this paragraph is limited to
the minimum necessary for law enforcement to respond to the
emergency. A law enforcement agency that obtains health records
under this paragraph shall maintain a record of the requestor,
the provider of the information, and the patient's name. Health
records obtained by a law enforcement agency under this
paragraph are private data on individuals as defined in section
13.02 and must not be used by law enforcement for any other
purpose.

(h) In cases where a provider releases health records
without patient consent as authorized by law, the release must
be documented in the patient's health record. In the case of a
release under paragraph (g), the documentation must include the
date and circumstances under which the release was made, the
person or agency to whom the release was made, and the records
that were released.

Sec. 9.

Minnesota Statutes 2004, section 295.582, is
amended to read:

295.582 AUTHORITY.

(a) A hospital, surgical center, or health care provider
that is subject to a tax under section 295.52, or a pharmacy
that has paid additional expense transferred under this section
by a wholesale drug distributor, may transfer additional expense
generated by section 295.52 obligations on to all third-party
contracts for the purchase of health care services on behalf of
a patient or consumer. The additional expense transferred to
the third-party purchaser must not exceed the tax percentage
specified in section 295.52 multiplied against the gross
revenues received under the third-party contract, and the tax
percentage specified in section 295.52 multiplied against
co-payments and deductibles paid by the individual patient or
consumer. The expense must not be generated on revenues derived
from payments that are excluded from the tax under section
295.53. All third-party purchasers of health care services
including, but not limited to, third-party purchasers regulated
under chapter 60A, 62A, 62C, 62D, 62H, 62N, 64B, 65A, 65B, 79,
or 79A, or under section 471.61 or 471.617, must pay the
transferred expense in addition to any payments due under
existing contracts with the hospital, surgical center, pharmacy,
or health care provider, to the extent allowed under federal
law. A third-party purchaser of health care services includes,
but is not limited to, a health carrier or community integrated
service network that pays for health care services on behalf of
patients or that reimburses, indemnifies, compensates, or
otherwise insures patients for health care services. A
third-party purchaser shall comply with this section regardless
of whether the third-party purchaser is a for-profit,
not-for-profit, or nonprofit entity. A wholesale drug
distributor may transfer additional expense generated by section
295.52 obligations to entities that purchase from the
wholesaler, and the entities must pay the additional expense.
Nothing in this section limits the ability of a hospital,
surgical center, pharmacy, wholesale drug distributor, or health
care provider to recover all or part of the section 295.52
obligation by other methods, including increasing fees or
charges.

(b) deleted text begin Each third-party purchaser regulated under any chapter
cited in paragraph (a) shall include with its annual renewal for
certification of authority or licensure documentation indicating
compliance with paragraph (a).
deleted text end

deleted text begin (c) deleted text end Any hospital, surgical center, or health care provider
subject to a tax under section 295.52 or a pharmacy that has
paid additional expense transferred under this section by a
wholesale drug distributor may file a complaint with the
commissioner responsible for regulating the third-party
purchaser if at any time the third-party purchaser fails to
comply with paragraph (a).

deleted text begin (d) deleted text end new text begin (c) new text end If the commissioner responsible for regulating the
third-party purchaser finds at any time that the third-party
purchaser has not complied with paragraph (a), the commissioner
may take enforcement action against a third-party purchaser
which is subject to the commissioner's regulatory jurisdiction
and which does not allow a hospital, surgical center, pharmacy,
or provider to pass-through the tax. The commissioner may by
order fine or censure the third-party purchaser or revoke or
suspend the certificate of authority or license of the
third-party purchaser to do business in this state if the
commissioner finds that the third-party purchaser has not
complied with this section. The third-party purchaser may
appeal the commissioner's order through a contested case hearing
in accordance with chapter 14.

Sec. 10. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2004, sections 62E.035; and 62Q.095, are
repealed.
new text end