Skip to main content Skip to office menu Skip to footer
Capital IconMinnesota Legislature

SF 3099

4th Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

KEY: stricken = removed, old language.
underscored = added, new language.
Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28
1.29 1.30
1.31 1.32 1.33 2.1 2.2 2.3 2.4 2.5 2.6
2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11
4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 5.35 5.36 6.1
6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16
6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25
6.26 6.27
6.28 6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19
7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 7.33 7.34 7.35 8.1 8.2 8.3 8.4 8.5 8.6 8.7
8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 8.33 8.34 8.35 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 9.34 9.35
10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20
10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 10.34 10.35 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 11.33 11.34 11.35 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24
12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 12.33 12.34 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28
13.29 13.30 13.31 13.32 13.33 13.34 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15
14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 14.34 14.35 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8
15.9 15.10
15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32
15.33
16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9
16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28
16.29 16.30 16.31 16.32 16.33 16.34 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17
17.18 17.19 17.20
17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8
18.9
18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17
18.18
18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 19.1 19.2 19.3 19.4 19.5 19.6
19.7 19.8 19.9
19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 19.34 19.35 20.1 20.2 20.3
20.4 20.5 20.6
20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28
20.29 20.30 20.31
20.32 20.33 21.1 21.2 21.3 21.4 21.5 21.6
21.7 21.8 21.9
21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31
21.32 21.33
22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12
22.13 22.14
22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 22.33 22.34 22.35 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10
23.11 23.12
23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 23.34 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13
24.14 24.15 24.16 24.17 24.18
24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20
25.21 25.22
25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 25.33 25.34 25.35 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20
26.21 26.22 26.23 26.24 26.25
26.26 26.27 26.28 26.29 26.30 26.31
26.32 26.33
27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27
27.28 27.29 27.30 27.31 27.32 27.33 27.34
28.1 28.2
28.3 28.4 28.5
28.6 28.7
28.8 28.9 28.10 28.11
28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 28.33 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 29.33 29.34 29.35 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 30.35 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 31.35 31.36 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33
32.34 33.1 33.2 33.3
33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 33.35 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32
34.33 34.34 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10
35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26
35.27 35.28 35.29 35.30 35.31 35.32 35.33 35.34 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 36.33 36.34 36.35 36.36 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 37.32 37.33 37.34 37.35 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9
38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 38.34
38.35
39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16
39.17
39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 40.33 40.34 40.35 40.36 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11
41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24
41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32 41.33 41.34 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10
42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 42.33 42.34 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20
43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 43.34 43.35 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 44.34 44.35 44.36 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 45.34 45.35 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 46.34 46.35 46.36 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 47.32 47.33 47.34 47.35 47.36 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26
48.27
48.28 48.29 48.30 48.31 48.32 48.33 48.34 48.35 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 49.34 49.35 49.36 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11
50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19
52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 52.34 52.35 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21
53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 53.33 53.34 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 54.33
54.34 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 55.33 55.34 55.35 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14
56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 56.33 56.34 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13
57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 57.33 57.34 57.35 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14
58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 59.34 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 60.32 60.33 60.34 60.35
61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9
61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19
61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 61.34 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 62.34
63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27
63.28 63.29 63.30 63.31 63.32 63.33 63.34 63.35 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21
64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 64.33 64.34 64.35 64.36 64.37 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12
65.13
65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23
65.24 65.25 65.26
65.27 65.28 65.29
65.30

A bill for an act
relating to health care; establishing a statewide health improvement program;
monitoring child obesity; establishing a health improvement fund; establishing
a public health improvement assessment; establishing health care homes;
increasing continuity of care; modifying outreach efforts; establishing primary
care education initiatives; increasing affordability and continuity of care
with public health care programs; creating a health insurance exchange;
establishing Section 125 Plans; creating a Health Care Transformation
Commission; restructuring the health care payment system; creating a savings
reinvestment fund; establishing a savings recapture assessment; establishing cost
containment goals; specifying an affordability standard; providing subsidies for
employer-subsidized coverage; requiring providers to list prices; establishing an
electronic prescription drug program; requiring mandated reports; authorizing
rulemaking; appropriating money; amending Minnesota Statutes 2006, sections
13.3806, by adding a subdivision; 62A.65, subdivision 3; 62E.141; 62L.12,
subdivisions 2, 4; 62Q.735, subdivision 1; 256.01, by adding subdivisions;
256B.061; 256B.69, by adding a subdivision; 256D.03, by adding a subdivision;
256L.05, by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision
3; 256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement,
sections 13.46, subdivision 2; 62J.496, by adding a subdivision; 62J.81,
subdivision 1; 62J.82, subdivision 1; 256.962, subdivisions 5, 6; 256B.056,
subdivision 10; 256L.03, subdivisions 3, 5; 256L.04, subdivisions 1, 7; 256L.05,
subdivision 3a; 256L.07, subdivision 1; 256L.15, subdivision 2; proposing
coding for new law in Minnesota Statutes, chapters 16A; 62J; 145; 256B;
proposing coding for new law as Minnesota Statutes, chapter 62U; repealing
Minnesota Statutes 2006, sections 62A.63; 62A.64; 62Q.49; 62Q.65; 62Q.736;
256L.15, subdivision 3.

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

ARTICLE 1

PUBLIC HEALTH

Section 1.

new text begin [16A.726] HEALTH IMPROVEMENT FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Health improvement fund. new text end

new text begin There is created in the state treasury
a public health improvement fund to which must be credited revenue from the health
improvement assessment under section 145.9865. The fund is a direct appropriated special
revenue fund. Notwithstanding section 11A.20, all investment income and all investment
losses attributable to the investment of the health improvement fund not currently needed
shall be credited to the public health improvement fund.
new text end

new text begin Subd. 2. new text end

new text begin Fund reimbursements. new text end

new text begin Money in the health improvement fund shall be
appropriated for the statewide health improvement program under section 145.986.
new text end

Sec. 2.

new text begin [145.986] STATEWIDE HEALTH IMPROVEMENT PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Goals. new text end

new text begin It is the goal of the state to substantially reduce the percentage
of Minnesotans who are obese or overweight, use tobacco, or misuse alcohol.
new text end

new text begin Subd. 2. new text end

new text begin Grants to local communities. new text end

new text begin (a) Beginning January 1, 2009, the
commissioner of health shall award grants to community health boards established
pursuant to section 145A.09, and tribal governments to convene, coordinate, and
implement evidence-based strategies targeted at reducing the percentage of Minnesotans
who are obese or overweight, use tobacco, use illegal drugs, or misuse alcohol.
new text end

new text begin (b) Grantee activities shall:
new text end

new text begin (1) be based on scientific evidence;
new text end

new text begin (2) be based on community input;
new text end

new text begin (3) address behavior change at the individual, community, and systems levels;
new text end

new text begin (4) occur in community, school, worksite, and health care settings; and
new text end

new text begin (5) be focused on policy, systems, and environmental changes that support healthy
behaviors.
new text end

new text begin (c) To receive a grant under this section, community health boards and tribal
governments must submit proposals to the commissioner. The funding phases for grants
shall consist of:
new text end

new text begin (1) an initiation phase, during which the grant recipient must complete a community
needs assessment, establish a community leadership team, identify community consortium
members, and complete a staffing plan;
new text end

new text begin (2) a planning phase, during which the grant recipient must complete a community
action plan and an evaluation plan, and will identify strengths and weaknesses, technical
assistance needs, partners, and additional funding resources; and
new text end

new text begin (3) an implementation phase, during which the grant recipient must implement the
community action plan, evaluate the effectiveness of the interventions, and modify or
discontinue interventions found to be ineffective.
new text end

new text begin Grant recipients shall not receive funding at the planning phase level until all the
activities of the initiation phase have been completed and approved by the commissioner.
Grant recipients shall not receive funding at the implementation phase level until all
activities at the planning phase have been completed and approved by the commissioner.
new text end

new text begin (d) Grant recipients in the initiation and planning phases shall receive funding at
a standard base amount to be established by the commissioner. Grant recipients in the
implementation phase shall receive the standard base amount and a standard per capita
amount to be established by the commissioner. By January 15, 2011, the commissioner
of health shall recommend whether any funding should be distributed to community
health boards and tribal governments based on health disparities demonstrated in the
populations served.
new text end

new text begin (e) Grant recipients in all phases shall report their activities and their progress
towards the outcomes established under subdivision 3 to the commissioner in a format and
at a time specified by the commissioner.
new text end

new text begin (f) All grant recipients shall be held accountable for making progress toward the
measurable outcomes established in subdivision 3. The commissioner shall require a
corrective action plan and may reduce the funding level of grant recipients that do not
make adequate progress toward the measurable outcomes.
new text end

new text begin Subd. 3. new text end

new text begin Outcomes. new text end

new text begin (a) The commissioner shall set measurable outcomes to meet
the goals specified in subdivision 1, and annually review the progress of grant recipients
in meeting the outcomes.
new text end

new text begin (b) The commissioner shall measure current public health status, using existing
measures and data collection systems when available, to determine baseline data against
which progress shall be monitored.
new text end

new text begin Subd. 4. new text end

new text begin Technical assistance and oversight. new text end

new text begin The commissioner shall provide
content expertise, technical expertise, and training to grant recipients. The commissioner
shall ensure that the statewide health improvement program meets the outcomes
established under subdivision 3 by conducting a comprehensive statewide evaluation and
assisting grant recipients to modify or discontinue interventions found to be ineffective.
new text end

new text begin Subd. 5. new text end

new text begin Evaluation. new text end

new text begin Using the outcome measures established in subdivision 3, the
commissioner shall conduct a biennial evaluation of the statewide health improvement
program funded under this section. Grant recipients shall cooperate with the commissioner
in the evaluation and provide the commissioner with the information necessary to conduct
the evaluation.
new text end

new text begin Subd. 6. new text end

new text begin Report. new text end

new text begin The commissioner shall submit a biennial report to the legislature
on the statewide health improvement program funded under this section. These reports
must include information on grant recipients, activities that were conducted using grant
funds, evaluation data, and outcome measures, if available. In addition, the commissioner
shall provide recommendations on future areas of focus for health improvement. These
reports are due by January 15 of every other year, beginning in 2010.
new text end

new text begin Subd. 7. new text end

new text begin Supplantation of existing funds. new text end

new text begin Community health boards and tribal
governments must use funds received under this section to develop new programs, expand
current programs that work to reduce the percentage of Minnesotans who are obese or
overweight, use tobacco, or misuse alcohol, or replace discontinued state or federal funds
previously used to reduce the percentage of Minnesotans who are obese or overweight,
use tobacco, use illegal drugs, or misuse alcohol. Funds must not be used to supplant
current state or local funding to community health boards or tribal governments used to
reduce the percentage of Minnesotans who are obese or overweight, use tobacco, use
illegal drugs, or misuse alcohol.
new text end

Sec. 3.

new text begin [145.9865] PUBLIC HEALTH IMPROVEMENT ASSESSMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Hospital assessment. new text end

new text begin (a) By June 1, 2009, each Minnesota hospital,
except facilities of the federal Indian Health Service and regional treatment centers, shall
contribute ... percent of net patient revenue excluding net Medicare revenue for calendar
year 2008 as reported by that hospital to the health care cost information system under
section 144.698 to the health improvement fund established under section 16A.726.
new text end

new text begin (b) By June 1, 2010, and each June 1 thereafter, each Minnesota hospital, except
facilities of the federal Indian Health Service and regional treatment centers, shall
contribute an equal percentage, as determined by the commissioner, of net patient
revenue excluding net Medicare revenue for the previous calendar year as reported by
that hospital to the health care cost information system to the health improvement fund.
The commissioner shall annually adjust this percentage to ensure a total of $40,000,000
in annual contributions from hospitals under this subdivision and nonprofit health plan
companies under subdivision 2.
new text end

new text begin (c) The commissioner shall notify each hospital by May 1 of each year of the
contribution due by June 1. If for any year, data needed to determine actual net patient
revenue for the previous calendar year is not available in time to determine the contribution
due, the commissioner may estimate net patient revenue for the purposes of this section
until actual data is available, and any necessary adjustments shall be made.
new text end

new text begin (d) The contributions shall be collected by the commissioner and deposited in the
health improvement fund established under section 16A.726. Any contributions under
this section may be applied toward a hospital's community benefit as reported under
section 144.669.
new text end

new text begin Subd. 2. new text end

new text begin Health plan company assessment. new text end

new text begin (a) By June 1, 2009, each nonprofit
health plan company shall contribute ... percent of the total premium revenues of the
nonprofit health plan company for calendar year 2008 as reported to the commissioner.
new text end

new text begin (b) By June 1, 2010, and each June 1 thereafter, each nonprofit health plan company
shall contribute an equal percentage, as determined by the commissioner, of the total
premium revenues of the nonprofit health plan company for the previous calendar year.
The commissioner shall annually adjust this percentage to ensure a total of $40,000,000
in annual contributions from nonprofit health plan companies under this subdivision
and hospitals under subdivision 1.
new text end

new text begin (c) The commissioner shall notify each nonprofit health plan company by May 1
of each year of the contribution due by June 1. If for any year, data needed to determine
actual total premium revenue for the previous calendar year is not available in time to
determine the contribution due, the commissioner may estimate total premium revenue for
the purposes of this section until actual data is available, and any necessary adjustments
shall be made.
new text end

new text begin (d) The contributions shall be collected by the commissioner and deposited in the
health improvement fund established under section 16A.726. Any contributions under
this section may be applied toward a nonprofit health plan company's community benefit
requirements.
new text end

new text begin (e) For purposes of this subdivision, total premium revenue means:
new text end

new text begin (1) premium revenue recognized on a prepaid basis from individuals and groups for
provision of a specified range of health services over a defined period of time which is
normally one month, excluding premiums paid to a nonprofit health plan company from
the Federal Employees Health Benefit Program;
new text end

new text begin (2) premiums from Medicare wrap-around subscribers for health benefits which
supplement Medicare coverage; and
new text end

new text begin (3) Medicare revenue, as a result of an arrangement between a nonprofit health plan
company and the Centers for Medicare and Medicaid Services of the federal Department
of Health and Human Services, for services to a Medicare beneficiary, excluding Medicare
revenue that states are prohibited from taxing under sections 1854, 1860D-12, and 1876
of title XVIII of the federal Social Security Act, codified as United States Code, title 42,
sections 1395mm, 1395w-112, and 1395w-24, respectively, as they may be amended
from time to time.
new text end

new text begin (f) For purposes of this section, "nonprofit health plan company" includes a health
maintenance organization operating under chapter 62D and a nonprofit health service plan
corporation operating under chapter 62C.
new text end

new text begin Subd. 3. new text end

new text begin Expiration. new text end

new text begin This section expires July 1, 2013.
new text end

Sec. 4.

new text begin [145.987] BMI MONITORING IN CHILDREN AND YOUTH.
new text end

new text begin By July 1, 2009, the commissioner of health shall establish and implement a
program to monitor the trends of children who are overweight and obese in the state by
collecting and analyzing Body Mass Index data. The commissioner must not collect or
use data on individuals as defined in section 13.02, subdivision 5. To the extent possible,
in establishing this Body Mass Index monitoring program, the commissioner shall use
existing child and youth monitoring systems or surveys. The Body Mass Index data
collected shall be used to measure progress in reducing the percentage of overweight
and obese children in the state, and shall be used to accurately target intervention and
prevention services throughout the state. To the extent necessary for implementation and
analysis, the Department of Health may share data collected under this program with the
Department of Education, consistent with the requirements in Minnesota Statutes, chapter
13. Analysis of the data collected and trends of children who are overweight and obese
shall be reported annually to the legislature by the commissioner of health, beginning
January 15, 2011.
new text end

Sec. 5. new text begin APPROPRIATION.
new text end

new text begin (a) $20,000,000 is appropriated in fiscal year 2009 from the health improvement
fund to the commissioner of health for the statewide health improvement plan in
Minnesota Statutes, section 145.986. Subject to the availability of funding, beginning
January 1, 2009, the commissioner of health shall make grants to community health boards
to implement local public health programs.
new text end

new text begin (b) $40,000,000 is appropriated in fiscal year 2010, and annually thereafter, from
the health improvement fund to the commissioner of health for the statewide health
improvement plan in Minnesota Statutes, section 145.986.
new text end

ARTICLE 2

HEALTH CARE HOMES

Section 1.

new text begin [256B.0431] ENROLLEE REQUIREMENTS RELATED TO HEALTH
CARE HOMES.
new text end

new text begin Subdivision 1. new text end

new text begin Selection of primary care clinic. new text end

new text begin The commissioner, beginning
January 1, 2009, shall require state health care program enrollees eligible for services
under the fee-for-service system to select a primary care clinic or medical group, within
two months of enrollment. The commissioner, beginning July 1, 2009, shall encourage
enrollees who have a complex or chronic condition to select a primary care clinic or
medical group at which clinicians have been certified as health care homes under section
256B.0751, subdivision 3. The commissioner and county social service agencies shall
provide enrollees with lists of primary care clinics, medical groups, and clinicians certified
as health care homes, and shall establish a toll-free number to provide enrollees with
assistance in choosing a clinic, medical group, or health care home.
new text end

new text begin Subd. 2. new text end

new text begin Initial health assessment. new text end

new text begin The commissioner shall encourage state health
care program enrollees eligible for services under the fee-for-service system to complete an
initial health assessment at their selected primary care clinic or medical group, within one
month of selection, in order to identify individuals with, or who are at risk of developing,
complex or chronic health conditions, and to identify preventive health care needs.
new text end

new text begin Subd. 3. new text end

new text begin Education and outreach. new text end

new text begin The commissioner, beginning January 1, 2009,
shall provide patient education and outreach to state health care program enrollees and
potential applicants related to the importance of choosing a primary care clinic or medical
group and a health care home. Education and outreach must be targeted to underserved or
special populations.
new text end

new text begin Subd. 4. new text end

new text begin State health care program. new text end

new text begin For purposes of this section, "state health
care program" means the medical assistance, MinnesotaCare, and general assistance
medical care programs.
new text end

Sec. 2.

new text begin [256B.0751] HEALTH CARE HOMES; DEFINITIONS;
ESTABLISHMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of sections 256B.0751 to 256B.0754,
the following definitions apply.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Commissioners" means the commissioner of human services and the
commissioner of health acting jointly.
new text end

new text begin (d) "State health care program" means the medical assistance, MinnesotaCare, or
general assistance medical care programs.
new text end

new text begin Subd. 2. new text end

new text begin Establishment of health care homes. new text end

new text begin The commissioners shall establish
health care homes for all state health care program enrollees, beginning first with
enrollees who have, or are at risk of developing, complex or chronic health conditions. In
establishing health care homes, the commissioners shall consider, and when appropriate
incorporate, features of the medical home model developed for the primary care
coordination (provider-directed care coordination) program authorized under section
256B.0625, subdivision 51.
new text end

new text begin Subd. 3. new text end

new text begin Certification. new text end

new text begin The commissioners shall begin certification of individual
clinicians, who participate as providers in state health care programs and meet the
requirements of section 256B.0752, as health care homes, by July 1, 2009. Clinicians may
enter into collaborative agreements with other clinicians to develop the components of a
health care home. Clinician certification as a health care home is voluntary. Clinicians
certified as health care homes must renew their certification annually, in order to maintain
their status as health care homes.
new text end

Sec. 3.

new text begin [256B.0752] HEALTH CARE HOME REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Requirement. new text end

new text begin In order to be certified as a health care home, a
clinician must meet the criteria specified in this section.
new text end

new text begin Subd. 2. new text end

new text begin Patient-provider relationship; care teams. new text end

new text begin (a) Each patient of a health
care home must have an ongoing, long-term relationship with a primary care provider
trained as a personal clinician to provide first contact, continuous, and comprehensive
care for all of a patient's health care needs. Appropriate specialists and other health care
professionals who do not practice in a traditional primary care field, and advanced practice
registered nurses, must be allowed to serve as personal clinicians, if they provide care
according to this section.
new text end

new text begin (b) Care must be provided using an interdisciplinary team of individuals who
collectively take responsibility for the ongoing care of patients, and who practice to the
full extent of their license. The interdisciplinary team must include two patient or parent
partners as team members.
new text end

new text begin Subd. 3. new text end

new text begin Care coordination. new text end

new text begin The personal clinician and the team are responsible
for providing for all the patient's health care needs or for arranging appropriate care with
other qualified professionals, as part of a whole-person orientation. Health care must be
coordinated across all provider types, all care locations, and the greater community. This
requirement applies to care for all stages of life, including preventive care, acute care,
chronic care, and end-of-life care. Care coordination must include ongoing planning
to prepare for patient transitions across different types of care and provider types. The
primary care team must also coordinate with those providing for the social service needs
of the individual, if this is necessary to ensure a successful health outcome.
new text end

new text begin Subd. 4. new text end

new text begin Care delivery. new text end

new text begin (a) A health care home must provide or arrange for access
to care 24-hours a day, seven days a week.
new text end

new text begin (b) Health care homes must encourage the patient and when authorized and
appropriate, the family to actively participate in decision making and in health care home
quality improvement initiatives, as a full member of the primary care team. Health care
homes must consider patients and families as partners in decision making, and must
provide access to a patient-directed, decision-making process, including appropriate
decision aids, when available.
new text end

new text begin (c) Care delivery must be facilitated by the use of health information technology and
through systematic patient follow-up using internal clinic patient registries.
new text end

new text begin (d) Care must be provided in a culturally and linguistically appropriate manner.
new text end

new text begin (e) Within the context of a system of continuous quality improvement, care
delivery, whenever possible, must be based on evidence-based medicine and use clinical
decision-support tools.
new text end

new text begin (f) A health care home must provide enhanced access to care, using methods such
as open scheduling, expanded hours, and new communication methods, such as e-mail,
phone consultations, and e-consults.
new text end

new text begin Subd. 5. new text end

new text begin Quality of care. new text end

new text begin Health care homes must meet process, outcome, and
quality standards as developed and specified by the commissioners. Health care homes
must measure and publicly report all data necessary for the commissioners to monitor
compliance with these standards.
new text end

new text begin Subd. 6. new text end

new text begin Comprehensive health assessment. new text end

new text begin Health care homes must encourage
enrollees to complete a comprehensive health assessment for each enrollee determined, by
the initial health assessment under section 256B.0431, subdivision 2, to have, or be at risk
of developing, a complex or chronic health condition. Health care homes must develop
and implement a comprehensive care plan to manage complex or chronic conditions based
upon the comprehensive health assessment and other information. The comprehensive
care plans must meet criteria specified by the commissioners.
new text end

new text begin Subd. 7. new text end

new text begin Care coordinators. new text end

new text begin Health care homes must employ care coordinators to
manage the care provided to patients with complex or chronic conditions specified by the
commissioners. Care coordinators may be social workers, nurses, or other clinicians. Care
coordinators are responsible for:
new text end

new text begin (1) identifying patients with complex or chronic conditions eligible for care
coordination;
new text end

new text begin (2) assisting primary care providers in care coordination and education;
new text end

new text begin (3) helping patients coordinate their care or access needed services, including
preventive care;
new text end

new text begin (4) communicating the care needs and concerns of the patient to the health care
home; and
new text end

new text begin (5) collecting data on process and outcome measures.
new text end

Sec. 4.

new text begin [256B.0753] CARE COORDINATION FEE.
new text end

new text begin Subdivision 1. new text end

new text begin Care coordination fee. new text end

new text begin (a) The commissioner shall pay each health
care home a per-person per-month care coordination fee for providing care coordination
services. The fee must be paid for each fee-for-service state health care program enrollee
eligible for a health care home, who is served by a personal clinician certified as a health
care home.
new text end

new text begin (b) Payment of the care coordination fee is contingent on the health care home
meeting the criteria specified in this section. The care coordination fee is in addition to
reimbursement received by a health care home under the medical assistance fee-for-service
payment system for health care services.
new text end

new text begin Subd. 2. new text end

new text begin Amount of fee. new text end

new text begin The care coordination fee must not exceed an average
of $50 per person per month. The care coordination fee must be determined by the
commissioner, and must vary by thresholds of care complexity that include the additional
time and resources needed for patients with limited English language skills, cultural
differences, or other barriers to health care, with the highest fees being paid for care
provided to individuals requiring the most intensive care coordination, such as those with
very complex health care needs or several chronic conditions.
new text end

new text begin Subd. 3. new text end

new text begin Cost neutrality. new text end

new text begin The commissioner may reduce payment rates for
nonprimary care services, if initial savings from implementation of health care homes are
not sufficient to allow implementation of the care coordination fee in a cost-neutral manner.
new text end

Sec. 5.

new text begin [256B.0754] DUTIES OF THE COMMISSIONERS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment of certification standards and other criteria. new text end

new text begin (a)
The commissioners, by January 1, 2009, shall establish certification standards for health
care homes consistent with the criteria in section 256B.0752.
new text end

new text begin (b) The commissioners, by January 1, 2009, shall develop care complexity thresholds
and payment amounts for the care coordination fee established under section 256B.0753.
new text end

new text begin (c) The commissioners, by January 1, 2009, shall identify criteria to determine
enrollees eligible for and in need of care coordination, and who would benefit from having
a comprehensive care plan for their condition.
new text end

new text begin (d) The commissioners, by January 1, 2009, shall establish criteria and data
collection procedures for evaluating health care homes.
new text end

new text begin (e) The commissioners, by January 1, 2009, shall develop health care home
requirements for managed care plan contracts, performance incentives, and withholds,
and shall develop the methodology for identifying and recapturing managed care savings
resulting from implementation of the health care home model.
new text end

new text begin Subd. 2. new text end

new text begin Monitoring and evaluation. new text end

new text begin The commissioners shall ensure the
collection from health care homes of data necessary to monitor implementation of the
health care home model, measure and evaluate quality of care and outcomes, measure
and evaluate patient experience, and determine cost savings from implementation of
the health care home model. The commissioners shall collect and evaluate this data
directly, but may contract with an appropriate private sector entity for technical assistance.
The commissioners shall provide health care homes with practice profiles measuring
utilization, cost, and quality.
new text end

new text begin Subd. 3. new text end

new text begin Care Coordination Advisory Committee. new text end

new text begin (a) The commissioners,
by July 1, 2008, shall establish a Care Coordination Advisory Committee to assist
the Departments of Human Services and Health in administering the health care home
model, developing the criteria and standards required under subdivision 1, collecting data,
and measuring and evaluating health outcomes and cost savings. The commissioners
may satisfy this requirement by designating the advisory committee established for the
provider-directed care coordination (primary care coordination) program as the committee
meeting the requirements of this subdivision. If the commissioners make this designation,
they must notify the chairs of the legislative committees with jurisdiction over health care
policy and finance within ten days following the determination.
new text end

new text begin (b) If the commissioners elect to establish a new committee, they must select
representatives from: primary care and specialist physicians, advanced practice registered
nurses, patients and their families, health plans, the Institute for Clinical Systems
Improvement, Minnesota Community Measurement, and other relevant entities.
new text end

new text begin (c) The commissioners, or their designee, must convene the first meeting of the
Care Coordination Advisory Committee within 30 days after the completion of the
appointments under paragraph (b) or designating the existing provider-directed Care
Coordination Committee under paragraph (a).
new text end

new text begin (d) The members of the Care Coordination Advisory Committee may not receive
compensation or expenses under section 15.059 for their service on the committee.
new text end

new text begin (e) The commissioners must provide the committee with necessary staff support and
meeting space for the operation of the committee.
new text end

new text begin (f) Notwithstanding section 15.059, the committee expires June 30, 2013.
new text end

new text begin Subd. 4. new text end

new text begin Health care home collaborative. new text end

new text begin The commissioners, by July 1, 2009,
shall establish a health care home collaborative to provide an opportunity for health care
homes and state agencies to exchange information related to quality improvement and
best practices.
new text end

new text begin Subd. 5. new text end

new text begin Patient-directed, decision-making process. new text end

new text begin By January 1, 2009,
the commissioners, in consultation with the Care Coordination Advisory Committee
and the Institute of Clinical Systems Improvement, shall develop a patient-directed,
decision-making support model to be used by health care homes. The commissioners shall:
new text end

new text begin (1) establish protocols that include identifying the use of a patient-directed,
decision-making process and incorporating effectively the use of patient-decision aids,
when appropriate;
new text end

new text begin (2) ensure the quality of the patient-decision aids available to the patient;
new text end

new text begin (3) ensure accessibility of the patient-decision aids, including the use of translators,
when necessary; and
new text end

new text begin (4) ensure that providers are trained to use patient-decision aids effectively.
new text end

new text begin Subd. 6. new text end

new text begin Annual reports. new text end

new text begin Beginning January 15, 2009, and each January 15
thereafter, the commissioners shall report to the chairs of the legislative committees
with jurisdiction over health care policy and finance regarding the implementation and
administration of the health care home model for state health care program enrollees in
both the fee-for-service and managed care sectors. The report must include information
on the number of state health care program enrollees in health care homes, the number
and characteristics of enrollees with complex or chronic conditions, the number and
geographic distribution of health care home providers, the performance and quality of care
of health care homes, measures of preventive care, costs related to implementation and
payment of care coordination fees, health care home payment arrangements for managed
care plans, and estimates of savings from implementation of the health care home model
for both the fee-for-service and managed care sectors relative to the health care spending
baseline calculated under section 62U.13.
new text end

Sec. 6.

Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision
to read:


new text begin Subd. 29. new text end

new text begin Health care home model. new text end

new text begin (a) The commissioner shall require managed
care plans, as a condition of contract, to adopt by July 1, 2009, a health care home
model for providing care to state health care program enrollees who have or are at risk
of developing a complex or chronic health condition. The health care home model must
meet the criteria specified in this section and section 256B.0752. The commissioner, in
consultation with the commissioner of health, may waive or modify criteria for managed
care plans, if the commissioners determine that performance and quality standards would
still be met.
new text end

new text begin (b) The commissioners shall require managed care plans to: (1) collect from
health care homes data necessary to monitor implementation of the health care home
model, measure and evaluate quality of care and outcomes, measure and evaluate
patient experience, and determine cost-savings from implementation of the health care
home model; and (2) submit this data to the commissioners. The commissioners shall
provide managed care plans and their health care homes with practice profiles measuring
utilization, cost, and quality.
new text end

new text begin (c) The commissioner, beginning July 1, 2009, shall provide a performance
incentive for expenses related to the operation of health care homes that would reimburse
upfront costs related to implementation of health care homes after a one-year lag. The
commissioners shall establish quality and performance standards for health care homes,
and beginning July 1, 2009, these standards shall be subject to the capitation rate withhold
under subdivision 5a, paragraph (c).
new text end

new text begin (d) Managed care plans must encourage state health care program enrollees to
complete an initial health assessment within three months from the time of enrollment, in
order to identify individuals with, or who are at risk of developing, complex or chronic
health conditions, and to identify preventive health care needs.
new text end

new text begin (e) The commissioner shall encourage managed care plans, beginning July 1, 2009,
to complete a comprehensive health assessment for each enrollee determined, by the
initial health assessment required under section 256B.0431, subdivision 2, to have, or be
at risk of developing, a complex or chronic health condition. The commissioner shall pay
managed care plans a one-time health assessment fee for each enrollee who completes
a comprehensive health assessment. Comprehensive health assessments must meet the
criteria established for health care homes under section 256B.0752, subdivision 6.
new text end

new text begin (f) The commissioner, beginning July 1, 2009, shall implement financial
arrangements for managed care plans to ensure that plans require each enrollee who has or
who is at risk of developing a complex or chronic health condition to choose a provider
to serve as a health care home.
new text end

Sec. 7.

new text begin [256B.766] PRIMARY CARE PHYSICIAN REIMBURSEMENT RATE
INCREASE.
new text end

new text begin (a) Effective for physician services rendered on or after January 1, 2009, the
commissioner shall increase reimbursements to primary care physicians deemed by the
commissioner to meet the requirements in paragraph (b). Reimbursement may be increased
by not more than 50 percent above the reimbursement rate that would otherwise be paid to
the primary care provider. Payments to health plan companies shall be adjusted to reflect
increased reimbursement to primary care physicians as approved by the commissioner.
new text end

new text begin (b) The commissioner, in collaboration with the Office of Rural Health, shall
determine areas of the state in need of primary care physicians. By September 1 of each
year, beginning September 1, 2008, the commissioner shall accept applications from
primary care physicians who agree to practice in a designated area for a period of no less
than five years. The commissioner shall determine participant eligibility based on their
suitability for practice serving a designated geographic area.
new text end

new text begin (c) The commissioner may reconsider the designated areas, as necessary. A primary
care physician who agrees to practice in a designated area shall receive the increased
reimbursement rates for at least a period of five years, unless the physician discontinues
practicing in the designated area during the five-year period.
new text end

new text begin (d) A health care clinic or medical group may submit applications under this section
for primary care physicians who will be hired to fill vacancies, prior to filling the vacant
position.
new text end

Sec. 8. new text begin APPROPRIATION; PRIMARY CARE EDUCATION INITIATIVES.
new text end

new text begin (a) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the board of regents of the University of Minnesota, to expand initiatives under
Minnesota Statutes, sections 137.38 to 137.40, to increase the number of graduates of
residency programs who practice primary care.
new text end

new text begin (b) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the Mayo Medical Foundation for medical school initiatives to increase the
number of graduates of residency programs who practice primary care.
new text end

new text begin (c) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the Duluth General Medical Education Council for medical school initiatives to
increase the number of graduates of residency programs who practice primary care.
new text end

new text begin (d) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the Office of Higher Education to provide grants to schools of nursing in Minnesota
to increase the number of graduates of advanced practice registered nurse programs.
new text end

new text begin (e) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the board of regents of the University of Minnesota, to address faculty shortages in
primary care medicine.
new text end

new text begin (f) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the Mayo Medical Foundation, to address faculty shortages in primary care
medicine.
new text end

new text begin (g) $....... is appropriated in fiscal year 2010 from the health savings reinvestment
fund to the Office of Higher Education to provide grants to schools of nursing in
Minnesota to address faculty shortages.
new text end

new text begin (h) $....... is transferred in fiscal year 2009 from the health professional education
loan forgiveness program under Minnesota Statutes, section 144.1501, to the commissioner
of human services for the reimbursement rate increase described in Minnesota Statutes,
section 256B.766. The reduction in the loan forgiveness program shall be taken from
the physician loan forgiveness program.
new text end

ARTICLE 3

INCREASING ACCESS; CONTINUITY OF CARE

Section 1.

Minnesota Statutes 2006, section 256.01, is amended by adding a
subdivision to read:


new text begin Subd. 27. new text end

new text begin Automation and coordination for state health care programs. new text end

new text begin (a) For
purposes of this subdivision, "state health care program" means the medical assistance,
MinnesotaCare, or general assistance medical care programs.
new text end

new text begin (b) By July 1, 2009, the commissioner shall improve coordination between state
health care programs and social service programs including, but not limited to WIC, free
and reduced school lunch programs, and food stamps, and shall develop and use automated
systems to identify persons served by social service programs who may be eligible for, but
are not enrolled in, a state health care program. The system must also permit enrollees to
renew state health care program enrollment through these social services programs. By
January 15, 2009, the commissioner shall, as necessary, identify and recommend to the
legislature statutory changes to state health care and social service programs necessary to
improve coordination and automation of outreach and enrollment efforts.
new text end

new text begin (c) By January 15, 2009, the commissioner shall establish and implement an
automated process to send out state health care program renewal forms in the most
common foreign languages, to those state health care program enrollees who request
renewal forms in those foreign languages. The commissioner, as part of the initial
enrollment process, shall inform applicants of the availability of this option.
new text end

new text begin (d) Beginning July 1, 2008, the commissioner, county social service agencies, and
health care providers shall update state health care program enrollee addresses and related
contact information, at the time of each enrollee contact.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

Minnesota Statutes 2007 Supplement, section 256.962, subdivision 5, is
amended to read:


Subd. 5.

Incentive program.

Beginning January 1, 2008, the commissioner
shall establish an incentive program for organizations that directly identify and assist
potential enrollees in filling out and submitting an application. For each applicant who is
successfully enrolled in MinnesotaCare, medical assistance, or general assistance medical
care, the commissioner, within the available appropriation, shall pay the organization a
deleted text begin $20deleted text end new text begin $25 new text end application assistance bonus. The organization may provide an applicant a gift
certificate or other incentive upon enrollment.

Sec. 3.

Minnesota Statutes 2007 Supplement, section 256.962, subdivision 6, is
amended to read:


Subd. 6.

School districts.

(a) At the beginning of each school year, a school district
shall provide information to each student on the availability of health care coverage
through the Minnesota health care programs.

(b) For each child who is determined to be eligible for deleted text begin adeleted text end new text begin the new text end free deleted text begin ordeleted text end new text begin and new text end reduced
deleted text begin priceddeleted text end new text begin school new text end lunchnew text begin programnew text end , the district shall provide the child's family with deleted text begin an
application for the Minnesota health care programs and
deleted text end information on how to obtain new text begin an
application for the Minnesota health care programs and
new text end application assistance.

(c) A district shall also ensure that applications and information on application
assistance are available at early childhood education sites and public schools located
within the district's jurisdiction.

(d) Each district shall designate an enrollment specialist to provide application
assistance and follow-up services with families deleted text begin who are eligible for the reduced or free
lunch program or
deleted text end who have indicated an interest in receiving information or an application
for the Minnesota health care program.new text begin A district is eligible for the application assistance
bonus described in subdivision 5.
new text end

(e) Each school district shall provide on their Web site a link to information on how
to obtain an application and application assistance.

Sec. 4.

Minnesota Statutes 2007 Supplement, section 256B.056, subdivision 10,
is amended to read:


Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10
, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.

(c) The commissioner shall verify deleted text begin assets anddeleted text end income for all applicants, and for
all recipients upon renewal.new text begin The commissioner shall verify liquid assets for applicants,
and for recipients upon renewal, only if the applicant or recipient is within ten percent
of the applicable asset limit. The commissioner may verify nonliquid assets, but is not
required to do so.
new text end

new text begin (d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period, before being
disenrolled.
new text end

new text begin (e) If there is no change in an enrollee's income or asset information, the enrollee
may renew eligibility at designated locations that include community clinics and health
care providers' offices. These designated sites shall forward the renewal forms to the
commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin The amendments to paragraphs (c) and (e) are effective
January 1, 2009. Paragraph (d) is effective January 1, 2009, or upon federal approval,
whichever is later.
new text end

Sec. 5.

Minnesota Statutes 2006, section 256B.061, is amended to read:


256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONSnew text begin ;
DELAYED VERIFICATION
new text end .

new text begin (a) new text end If any individual has been determined to be eligible for medical assistance, it
will be made available for care and services included under the plan and furnished in or
after the third month before the month in which the individual made application for such
assistance, if such individual was, or upon application would have been, eligible for
medical assistance at the time the care and services were furnished. The commissioner
may limit, restrict, or suspend the eligibility of an individual for up to one year upon
that individual's conviction of a criminal offense related to application for or receipt of
medical assistance benefits.

new text begin (b) On the basis of information provided on the completed application, an applicant
who meets the following criteria shall be determined eligible beginning in the month of
application: (1) whose gross income is less than 90 percent of the applicable income
standard; (2) whose total liquid assets are less than 90 percent of the asset limit; (3) does
not reside in a long-term care facility; and (4) meets all other eligibility requirements,
including compliance at the time of application with citizenship or nationality
documentation requirements under section 256B.06, subdivision 4. The applicant must
provide all required verifications within 60 days' notice of the eligibility determination or
eligibility shall be terminated. Applicants who are terminated for failure to provide all
required verifications are not eligible to apply for coverage using the delayed verification
procedures specified in this paragraph for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009.
new text end

Sec. 6.

Minnesota Statutes 2006, section 256D.03, is amended by adding a subdivision
to read:


new text begin Subd. 7a. new text end

new text begin Additional duties of the commissioner. new text end

new text begin In administering the general
assistance medical care program, the commissioner shall: (1) apply the delayed verification
procedure specified in section 256B.061, paragraph (b), to general assistance medical care
applicants; and (2) provide general assistance medical care enrollees who fail to submit
renewal forms and related documentation necessary to verify continued eligibility with an
additional month of eligibility beyond the end of the current eligibility period.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009.
new text end

Sec. 7.

Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 3, is
amended to read:


Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
2
, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of deleted text begin $10,000deleted text end new text begin $20,000new text end .

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3
, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, for enrollees for
whom federal funding is not available, and is effective January 1, 2009, or upon federal
approval, whichever is later, for enrollees for whom federal funding is available.
new text end

Sec. 8.

Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 5, is
amended to read:


Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.

(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.

(d) Paragraph (a), clause (4), does not apply to mental health services.

(e) Adult enrollees with family gross income that exceeds 200 percent of the federal
poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
and who are not pregnant shall be financially responsible for the coinsurance amount, if
applicable, and amounts which exceed the deleted text begin $10,000deleted text end new text begin $20,000new text end inpatient hospital benefit limit.

(f) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the deleted text begin $10,000deleted text end new text begin $20,000new text end annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, for enrollees for
whom federal funding is not available, and is effective January 1, 2009, or upon federal
approval, whichever is later, for enrollees for whom federal funding is available.
new text end

Sec. 9.

Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is
amended to read:


Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than deleted text begin 275deleted text end new text begin 300new text end percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) deleted text begin Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $50,000.
deleted text end

deleted text begin (e)deleted text end Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.

new text begin EFFECTIVE DATE. new text end

new text begin The effective date of this section is contingent on meeting
the cost containment goals described in section 62U.14 and having sufficient funding
for the expansion.
new text end

Sec. 10.

Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is
amended to read:


Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and households with no children who have gross family
incomes that are equal to or less than 200 percent of the federal poverty guidelines.
Effective deleted text begin Julydeleted text end new text begin Januarynew text end 1, 2009, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than deleted text begin 215deleted text end new text begin 300new text end percent of the federal poverty guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin The effective date of this section is contingent on meeting
the cost containment goals described in section 62U.14 and having sufficient funding
for the expansion.
new text end

Sec. 11.

Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a,
is amended to read:


Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. new text begin If there is no change in circumstances, the enrollee may renew
eligibility at designated locations that include community clinics and health care providers'
offices. The designated sites shall forward the renewal forms to the commissioner.
new text end The
premium for the new period of eligibility must be received as provided in section 256L.06
in order for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3
, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.

new text begin (d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period, before being
disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
additional month.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later.
new text end

Sec. 12.

Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Delayed verification. new text end

new text begin On the basis of information provided on the
completed application, an applicant whose gross income is less than 90 percent of
the applicable income standard and meets all other eligibility requirements, including
compliance at the time of application with citizenship or nationality documentation
requirements under section 256L.04, subdivision 10, shall be determined eligible
beginning in the month of application. The applicant must provide all required
verifications within 60 days' notice of the eligibility determination or eligibility shall be
terminated. Applicants who are terminated for failure to provide all required verifications
are not eligible to apply for coverage using the delayed verification procedures specified in
this subdivision for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later.
new text end

Sec. 13.

Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:


Subd. 3.

Commissioner's duties and payment.

(a) Premiums are dedicated to the
commissioner for MinnesotaCare.

(b) The commissioner shall develop and implement procedures to: (1) require
enrollees to report changes in income; (2) adjust sliding scale premium payments, based
upon both increases and decreases in enrollee income, at the time the change in income
is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
premiums. Failure to pay includes payment with a dishonored check, a returned automatic
bank withdrawal, or a refused credit card or debit card payment. The commissioner may
demand a guaranteed form of payment, including a cashier's check or a money order, as
the only means to replace a dishonored, returned, or refused payment.

(c) Premiums are calculated on a calendar month basis and may be paid on a
monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
commissioner of the premium amount required. The commissioner shall inform applicants
and enrollees of these premium payment options. Premium payment is required before
enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
received before noon are credited the same day. Premium payments received after noon
are credited on the next working day.

(d) Nonpayment of the premium will result in disenrollment from the plan effective
deleted text begin fordeleted text end new text begin the first day of the calendar month following new text end the calendar month for which the
premium was due. Persons disenrolled for nonpayment or who voluntarily terminate
coverage from the program may not reenroll until four calendar months have elapsed.
deleted text begin Persons disenrolled for nonpayment who pay all past due premiums as well as current
premiums due, including premiums due for the period of disenrollment, within 20 days
of disenrollment, shall be reenrolled retroactively to the first day of disenrollment
deleted text end new text begin The
commissioner shall waive premiums for coverage provided under this paragraph to
persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b
new text end .
Persons disenrolled for nonpayment or who voluntarily terminate coverage from the
program may not reenroll for four calendar months unless the person demonstrates good
cause for nonpayment. Good cause does not exist if a person chooses to pay other family
expenses instead of the premium. The commissioner shall define good cause in rule.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later.
new text end

Sec. 14.

Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is
amended to read:


Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 deleted text begin and the four-month requirement in subdivision 3deleted text end , as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.

Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above deleted text begin 275deleted text end new text begin 300new text end percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7,
whose income increases above 200 percent of the federal poverty guidelines or deleted text begin 215deleted text end new text begin 300new text end
percent of the federal poverty guidelines on or after deleted text begin Julydeleted text end new text begin Januarynew text end 1, 2009, are no longer
eligible for the program and shall be disenrolled by the commissioner. For persons
disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of
the calendar month following the month in which the commissioner determines that the
income of a family or individual exceeds program income limits.

(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment. The
premium for children remaining eligible under this clause shall be the maximum premium
determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (c) Notwithstanding paragraphs (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $50,000 for the 12-month period
of eligibility.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later, except that the effective date for the amendment to paragraph
(a) related to the expansion in eligibility to 300 percent of federal poverty guidelines is
contingent on meeting the cost containment goals established in section 62U.14 and
having sufficient funding for the expansion.
new text end

Sec. 15.

Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:


Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewal
deleted text end . Children enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) deleted text begin Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.
deleted text end

deleted text begin (c)deleted text end For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

deleted text begin (d)deleted text end new text begin (c)new text end Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

deleted text begin (e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later.
new text end

Sec. 16.

Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is
amended to read:


Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay
to obtain coverage through the MinnesotaCare program. The sliding fee scale must be
based on the enrollee's monthly gross individual or family income. The sliding fee scale
must contain separate tables based on enrollment of one, two, or three or more persons.
new text begin Until December 31, 2008, new text end the sliding fee scale begins with a premium of 1.5 percent of
monthly gross individual or family income for individuals or families with incomes below
the limits for the medical assistance program for families and children in effect on January
1, 1999, and proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8,
5.9, 7.4, and 8.8 percent. These percentages are matched to evenly spaced income steps
ranging from the medical assistance income limit for families and children in effect on
January 1, 1999, to 275 percent of the federal poverty guidelines for the applicable family
size, up to a family size of five. The sliding fee scale for a family of five must be used
for families of more than five. The sliding fee scale and percentages are not subject to
the provisions of chapter 14. If a family or individual reports increased income after
enrollment, premiums shall be adjusted at the time the change in income is reported.

(b) deleted text begin Familiesdeleted text end new text begin Children new text end whose gross income is above deleted text begin 275deleted text end new text begin 300new text end percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

new text begin (c) Beginning January 1, 2009, MinnesotaCare enrollees shall pay premiums
according to the affordability scale established in section 62U.15, subdivision 2, with the
exception that children in families with income at or below 150 percent of the federal
poverty guidelines shall pay a monthly premium of $4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later, except that the effective date to the amendment to paragraph
(b) related to the expansion in eligibility to 300 percent of federal poverty guidelines is
contingent on meeting the cost containment goals in section 62U.14 and having sufficient
funding for the expansion.
new text end

Sec. 17.

Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision
to read:


new text begin Subd. 5. new text end

new text begin First month premium exemption. new text end

new text begin New enrollee households are exempt
from premiums for the first month of MinnesotaCare enrollment. For purposes of this
exemption, a "new enrollee household" is a household which has not been enrolled in
MinnesotaCare for at least one year prior to application.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval, whichever is later.
new text end

Sec. 18. new text begin INSURANCE COVERAGE FOR LONG-TERM CARE WORKERS.
new text end

new text begin (a) The commissioner of human services shall study and report to the legislature
by December 15, 2008, with recommendations for a rate increase to long-term care
employers dedicated to the purchase of employee health insurance in the private market.
The commissioner shall collect necessary actuarial data, employment data, current
coverage data, and other needed information.
new text end

new text begin (b) The commissioner shall develop cost estimates for three levels of insurance
coverage for long-term care workers:
new text end

new text begin (1) the coverage provided to state employees;
new text end

new text begin (2) the coverage provided to MinnesotaCare enrollees; and
new text end

new text begin (3) the benefits provided under an "average" private market insurance product, but
with a deductible limited to $100 per person.
new text end

new text begin Premium cost sharing, waiting periods for eligibility, definitions of full- and
part-time employment, and other parameters under the three options must be identical to
those under the state employees' health plan.
new text end

new text begin (c) For purposes of this section, a long-term care worker is a person employed by
a nursing facility, an intermediate care facility for persons with mental retardation, or
a service provider that:
new text end

new text begin (1) is eligible under Laws 2007, chapter 147, article 7, section 71; and
new text end

new text begin (2) provides long-term care services.
new text end

new text begin The commissioner may recommend a different definition of long-term care worker if
this definition presents insurmountable implementation issues.
new text end

new text begin (d) The recommendations must include measures to:
new text end

new text begin (1) ensure equitable treatment between employers that currently have different levels
of expenditure for employee health insurance costs; and
new text end

new text begin (2) enforce the requirement that the rate increase be expended for the intended
purpose.
new text end

Sec. 19. new text begin APPROPRIATION.
new text end

new text begin (a) $....... is appropriated from the general fund to the commissioner of human
services for the fiscal year beginning July 1, 2008, for the purposes of section 18.
new text end

new text begin (b) $250,000 is appropriated in fiscal year 2010 from the general fund to the
commissioner of human services and $100,000 is appropriated in fiscal year 2010 from
the health care access fund to the commissioner of human services for the application
assistance bonus in Minnesota Statutes, section 256.962, subdivision 5.
new text end

Sec. 20. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256L.15, subdivision 3, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2009, or upon federal
approval of the amendments to Minnesota Statutes, section 256L.15, subdivision 2,
paragraph (c), whichever is later.
new text end

ARTICLE 4

HEALTH INSURANCE PURCHASING AND AFFORDABILITY REFORM

Section 1.

Minnesota Statutes 2006, section 13.3806, is amended by adding a
subdivision to read:


new text begin Subd. 1b. new text end

new text begin Health Care Transformation Commission. new text end

new text begin Use of data collected by the
Health Care Transformation Commission is governed by section 62U.10, subdivision 2.
new text end

Sec. 2.

Minnesota Statutes 2007 Supplement, section 13.46, subdivision 2, is amended
to read:


Subd. 2.

General.

(a) Unless the data is summary data or a statute specifically
provides a different classification, data on individuals collected, maintained, used, or
disseminated by the welfare system is private data on individuals, and shall not be
disclosed except:

(1) according to section 13.05;

(2) according to court order;

(3) according to a statute specifically authorizing access to the private data;

(4) to an agent of the welfare system, including a law enforcement person, attorney,
or investigator acting for it in the investigation or prosecution of a criminal or civil
proceeding relating to the administration of a program;

(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to
an individual or family across programs; evaluate the effectiveness of programs; assess
parental contribution amounts; and investigate suspected fraud;

(6) to administer federal funds or programs;

(7) between personnel of the welfare system working in the same program;

(8) to the Department of Revenue to assess parental contribution amounts for
purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit
programs and to identify individuals who may benefit from these programs. The following
information may be disclosed under this paragraph: an individual's and their dependent's
names, dates of birth, Social Security numbers, income, addresses, and other data as
required, upon request by the Department of Revenue. Disclosures by the commissioner
of revenue to the commissioner of human services for the purposes described in this clause
are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include,
but are not limited to, the dependent care credit under section 290.067, the Minnesota
working family credit under section 290.0671, the property tax refund and rental credit
under section 290A.04, and the Minnesota education credit under section 290.0674;

(9) between the Department of Human Services, the Department of Employment
and Economic Development, and when applicable, the Department of Education, for
the following purposes:

(i) to monitor the eligibility of the data subject for unemployment benefits, for any
employment or training program administered, supervised, or certified by that agency;

(ii) to administer any rehabilitation program or child care assistance program,
whether alone or in conjunction with the welfare system;

(iii) to monitor and evaluate the Minnesota family investment program or the child
care assistance program by exchanging data on recipients and former recipients of food
support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance
under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and

(iv) to analyze public assistance employment services and program utilization,
cost, effectiveness, and outcomes as implemented under the authority established in Title
II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of
1999. Health records governed by sections 144.291 to 144.298 and "protected health
information" as defined in Code of Federal Regulations, title 45, section 160.103, and
governed by Code of Federal Regulations, title 45, parts 160-164, including health care
claims utilization information, must not be exchanged under this clause;

(10) to appropriate parties in connection with an emergency if knowledge of
the information is necessary to protect the health or safety of the individual or other
individuals or persons;

(11) data maintained by residential programs as defined in section 245A.02 may
be disclosed to the protection and advocacy system established in this state according
to Part C of Public Law 98-527 to protect the legal and human rights of persons with
developmental disabilities or other related conditions who live in residential facilities for
these persons if the protection and advocacy system receives a complaint by or on behalf
of that person and the person does not have a legal guardian or the state or a designee of
the state is the legal guardian of the person;

(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;

(13) data on a child support obligor who makes payments to the public agency
may be disclosed to the Minnesota Office of Higher Education to the extent necessary to
determine eligibility under section 136A.121, subdivision 2, clause (5);

(14) participant Social Security numbers and names collected by the telephone
assistance program may be disclosed to the Department of Revenue to conduct an
electronic data match with the property tax refund database to determine eligibility under
section 237.70, subdivision 4a;

(15) the current address of a Minnesota family investment program participant
may be disclosed to law enforcement officers who provide the name of the participant
and notify the agency that:

(i) the participant:

(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or

(B) is violating a condition of probation or parole imposed under state or federal law;

(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and

(iii) the request is made in writing and in the proper exercise of those duties;

(16) the current address of a recipient of general assistance or general assistance
medical care may be disclosed to probation officers and corrections agents who are
supervising the recipient and to law enforcement officers who are investigating the
recipient in connection with a felony level offense;

(17) information obtained from food support applicant or recipient households may
be disclosed to local, state, or federal law enforcement officials, upon their written request,
for the purpose of investigating an alleged violation of the Food Stamp Act, according
to Code of Federal Regulations, title 7, section 272.1(c);

(18) the address, Social Security number, and, if available, photograph of any
member of a household receiving food support shall be made available, on request, to a
local, state, or federal law enforcement officer if the officer furnishes the agency with the
name of the member and notifies the agency that:

(i) the member:

(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;

(B) is violating a condition of probation or parole imposed under state or federal
law; or

(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);

(ii) locating or apprehending the member is within the officer's official duties; and

(iii) the request is made in writing and in the proper exercise of the officer's official
duty;

(19) the current address of a recipient of Minnesota family investment program,
general assistance, general assistance medical care, or food support may be disclosed to
law enforcement officers who, in writing, provide the name of the recipient and notify the
agency that the recipient is a person required to register under section 243.166, but is not
residing at the address at which the recipient is registered under section 243.166;

(20) certain information regarding child support obligors who are in arrears may be
made public according to section 518A.74;

(21) data on child support payments made by a child support obligor and data on
the distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the
income of the obligor or obligee may be disclosed to the other party;

(22) data in the work reporting system may be disclosed under section 256.998,
subdivision 7
;

(23) to the Department of Education for the purpose of matching Department of
Education student data with public assistance data to determine students eligible for free
and reduced price meals, meal supplements, and free milk according to United States
Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and
state funds that are distributed based on income of the student's family; and to verify
receipt of energy assistance for the telephone assistance plan;

(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a local board of health as
defined in section 145A.02, subdivision 2, when the commissioner or local board of health
has reason to believe that a program recipient is a disease case, carrier, suspect case, or at
risk of illness, and the data are necessary to locate the person;

(25) to other state agencies, statewide systems, and political subdivisions of this
state, including the attorney general, and agencies of other states, interstate information
networks, federal agencies, and other entities as required by federal regulation or law for
the administration of the child support enforcement program;

(26) to personnel of public assistance programs as defined in section 256.741, for
access to the child support system database for the purpose of administration, including
monitoring and evaluation of those public assistance programs;

(27) to monitor and evaluate the Minnesota family investment program by
exchanging data between the Departments of Human Services and Education, on
recipients and former recipients of food support, cash assistance under chapter 256, 256D,
256J, or 256K, child care assistance under chapter 119B, or medical programs under
chapter 256B, 256D, or 256L;

(28) to evaluate child support program performance and to identify and prevent
fraud in the child support program by exchanging data between the Department of Human
Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a)
and (b), without regard to the limitation of use in paragraph (c), Department of Health,
Department of Employment and Economic Development, and other state agencies as is
reasonably necessary to perform these functions; deleted text begin or
deleted text end

(29) counties operating child care assistance programs under chapter 119B may
disseminate data on program participants, applicants, and providers to the commissioner
of educationnew text begin ; or
new text end

new text begin (30) according to section 256.01, subdivision 27, between the welfare system and
the Minnesota Health Insurance Exchange under section 62U.02, in order to collect
premiums from individuals, enrolled in the MinnesotaCare program under chapter 256L,
and to administer the individual's and their families' participation in the program, to the
extent authorized in section 62U.03
new text end .

(b) Information on persons who have been treated for drug or alcohol abuse may
only be disclosed according to the requirements of Code of Federal Regulations, title
42, sections 2.1 to 2.67.

(c) Data provided to law enforcement agencies under paragraph (a), clause (15),
(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).

(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is
not subject to the access provisions of subdivision 10, paragraph (b).

For the purposes of this subdivision, a request will be deemed to be made in writing
if made through a computer interface system.

Sec. 3.

new text begin [16A.727] HEALTH SAVINGS REINVESTMENT FUND.
new text end

new text begin A health savings reinvestment fund is created in the state treasury. The fund is a
direct appropriated special revenue fund. The commissioner shall deposit to the credit of
the fund money made available to the fund.
new text end

Sec. 4.

Minnesota Statutes 2006, section 62A.65, subdivision 3, is amended to read:


Subd. 3.

Premium rate restrictions.

No individual health plan may be offered,
sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
determined in accordance with the following requirements:

(a) new text begin Except for policies issued under section 62U.03, subdivision 5, paragraph (b),
new text end premium rates must be no more than 25 percent above and no more than 25 percent below
the index rate charged to individuals for the same or similar coverage, adjusted pro
rata for rating periods of less than one year. The premium variations permitted by this
paragraph must be based only upon health status, claims experience, and occupation. For
purposes of this paragraph, health status includes refraining from tobacco use or other
actuarially valid lifestyle factors associated with good health, provided that the lifestyle
factor and its effect upon premium rates have been determined by the commissioner to
be actuarially valid and have been approved by the commissioner. Variations permitted
under this paragraph must not be based upon age or applied differently at different ages.
This paragraph does not prohibit use of a constant percentage adjustment for factors
permitted to be used under this paragraph.

(b) Premium rates may vary based upon the ages of covered persons only as
provided in this paragraph. In addition to the variation permitted under paragraph (a),
each health carrier may use an additional premium variation based upon age of up to
plus or minus 50 percent of the index rate.

(c) A health carrier may request approval by the commissioner to establish separate
geographic regions determined by the health carrier and to establish separate index rates
for each such region. The commissioner shall grant approval if the following conditions
are met:

(1) the geographic regions must be applied uniformly by the health carrier;

(2) each geographic region must be composed of no fewer than seven counties that
create a contiguous region; and

(3) the health carrier provides actuarial justification acceptable to the commissioner
for the proposed geographic variations in index rates, establishing that the variations are
based upon differences in the cost to the health carrier of providing coverage.

(d) Health carriers may use rate cells and must file with the commissioner the rate
cells they use. Rate cells must be based upon the number of adults or children covered
under the policy and may reflect the availability of Medicare coverage. The rates for
different rate cells must not in any way reflect generalized differences in expected costs
between principal insureds and their spouses.

(e) In developing its index rates and premiums for a health plan, a health carrier shall
take into account only the following factors:

(1) actuarially valid differences in rating factors permitted under paragraphs (a)
and (b); and

(2) actuarially valid geographic variations if approved by the commissioner as
provided in paragraph (c).

(f) All premium variations must be justified in initial rate filings and upon request of
the commissioner in rate revision filings. All rate variations are subject to approval by
the commissioner.

(g) The loss ratio must comply with the section 62A.021 requirements for individual
health plans.

(h) The rates must 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 risks associated with the enrollee populations, and actuarially valid changes as a result
of statutory changes in Laws 1992, chapter 549.

(i) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under
section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
paragraph. The rating practices guarantee must be in writing and must guarantee that
the policy form will be offered, sold, issued, and renewed only with premium rates and
premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices
guarantee must be accompanied by an actuarial memorandum that demonstrates that the
premium rates and premium rating system used in connection with the policy form will
satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to
policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4,
or 5. An insurer that complies with this paragraph in connection with a policy form is
exempt from the requirement of prior approval by the commissioner under paragraphs
(c), (f), and (h).

Sec. 5.

Minnesota Statutes 2006, section 62E.141, is amended to read:


62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.

No employee of an employer that offers a new text begin group new text end health plannew text begin as defined in section
62A.10
new text end , under which the employee is eligible for coverage, is eligible to enroll, or
continue to be enrolled, in the comprehensive health association, except for enrollment
or continued enrollment necessary to cover conditions that are subject to an unexpired
preexisting condition limitation, preexisting condition exclusion, or exclusionary rider
under the employer's health plan. This section does not apply to persons enrolled in the
Comprehensive Health Association as of June 30, 1993. With respect to persons eligible
to enroll in the health plan of an employer that has more than 29 current employees,
as defined in section 62L.02, this section does not apply to persons enrolled in the
Comprehensive Health Association as of December 31, 1994.

Sec. 6.

Minnesota Statutes 2007 Supplement, section 62J.496, is amended by adding a
subdivision to read:


new text begin Subd. 5. new text end

new text begin Interoperable electronic health record requirements. new text end

new text begin To meet the
requirements of subdivision 1, hospitals and health care providers must meet the following
criteria when implementing an interoperable electronic health records system within their
hospital system or clinical practice setting.
new text end

new text begin (a) The electronic health record must be certified by the Certification Commission
for Healthcare Information Technology, or its successor. This criterion only applies to
hospitals and health care providers whose practice setting is a practice setting covered
by Certification Commission for Healthcare Information Technology certifications. This
criterion shall be considered met if a hospital or health care provider is using an electronic
health records system that has been certified within the last three years, even if a more
current version of the system has been certified within the three-year period.
new text end

new text begin (b) A health care provider who is a prescriber or dispenser of controlled substances
must have an electronic health record system that meets the requirements of section
62J.497.
new text end

Sec. 7.

new text begin [62J.497] ELECTRONIC PRESCRIPTION DRUG PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For the purposes of this section, the following terms
have the meanings given.
new text end

new text begin (a) "Dispense" or "dispensing" has the meaning given in section 151.01, subdivision
30. Dispensing does not include the direct administering of a controlled substance to a
patient by a licensed health care professional.
new text end

new text begin (b) "Dispenser" means a person authorized by law to dispense a controlled substance,
pursuant to a valid prescription.
new text end

new text begin (c) "Electronic media" has the same meaning given this term under Code of Federal
Regulations, title 45, part 160.103.
new text end

new text begin (d) "E-prescribing" means the transmission using electronic media, of prescription
or prescription-related information between a prescriber, dispenser, pharmacy benefit
manager, or group purchaser, either directly or through an intermediary, including an
e-prescribing network. E-prescribing includes, but is not limited to, two-way transmissions
between the point of care and the dispenser.
new text end

new text begin (e) "Electronic prescription drug program" means a program that provides for
e-prescribing.
new text end

new text begin (f) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
new text end

new text begin (g) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
new text end

new text begin (h) "National Provider Identifier" or "NPI" means the identifier described under
Code of Federal Regulations, title 45, part 162.406.
new text end

new text begin (i) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
new text end

new text begin (j) "NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version 1, Release 0, October 2005.
new text end

new text begin (k) "NCPDP SCRIPT Standard" means the National Council for Prescription Drug
Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide
Version 8, Release 1 (Version 8.1), October 2005.
new text end

new text begin (l) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
new text end

new text begin (m) "Prescriber" means a licensed health care professional who is authorized to
prescribe a controlled substance under section 152.12, subdivision 1.
new text end

new text begin (n) "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
new text end

new text begin (o) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.
new text end

new text begin Subd. 2. new text end

new text begin Requirements for electronic prescribing. new text end

new text begin (a) Effective January 1, 2011,
all providers, group purchasers, prescribers, and dispensers must establish and maintain
an electronic prescription drug program that complies with the applicable standards
in this section for transmitting, directly or through an intermediary, prescriptions and
prescription-related information using electronic media.
new text end

new text begin (b) Nothing in this section requires providers, group purchasers, prescribers, or
dispensers to conduct the transactions described in this section. If transactions described in
this section are conducted, they must be done electronically using the standards described
in this section. Nothing in this section requires providers, group purchasers, prescribers,
or dispensers to electronically conduct transactions that are expressly prohibited by other
sections or federal law.
new text end

new text begin (c) Providers, group purchasers, prescribers, and dispensers must use either HL7
messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
information internally when the sender and the recipient are part of the same legal entity. If
an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
or other applicable standards required by this section. Any pharmacy within an entity
must be able to receive electronic prescription transmittals from outside the entity using
the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
Insurance Portability and Accountability Act (HIPAA) requirement that may require the
use of a HIPAA transaction standard within an organization.
new text end

new text begin (d) Entities transmitting prescriptions or prescription-related information where the
prescriber is required by law to issue a prescription for a patient to a nonprescribing
provider that in turn forwards the prescription to a dispenser are exempt from the
requirement to use the NCPDP SCRIPT Standard when transmitting such prescriptions or
prescription-related information.
new text end

new text begin Subd. 3. new text end

new text begin Standards for electronic prescribing. new text end

new text begin (a) Prescribers and dispensers
must use the NCPDP SCRIPT Standard for the communication of a prescription or
prescription-related information. The NCPDP SCRIPT Standard shall be used to conduct
the following transactions:
new text end

new text begin (1) get message transaction;
new text end

new text begin (2) status response transaction;
new text end

new text begin (3) error response transaction;
new text end

new text begin (4) new prescription transaction;
new text end

new text begin (5) prescription change request transaction;
new text end

new text begin (6) prescription change response transaction;
new text end

new text begin (7) refill prescription request transaction;
new text end

new text begin (8) refill prescription response transaction;
new text end

new text begin (9) verification transaction;
new text end

new text begin (10) password change transaction;
new text end

new text begin (11) cancel prescription request transaction; and/or
new text end

new text begin (12) cancel prescription response transaction.
new text end

new text begin (b) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
SCRIPT Standard for communicating and transmitting medication history information.
new text end

new text begin (c) Providers, group purchasers, prescribers, and dispensers must use the NCPDP
Formulary and Benefits Standard for communicating and transmitting formulary and
benefit information.
new text end

new text begin (d) Providers, group purchasers, prescribers, and dispensers must use the national
provider identifier to identify a health care provider in e-prescribing or prescription-related
transactions when a health care provider's identifier is required.
new text end

new text begin (e) Providers, group purchasers, prescribers, and dispensers must communicate
eligibility information and conduct health care eligibility benefit inquiry and response
transactions in accordance with the requirements of section 62J.536.
new text end

Sec. 8.

Minnesota Statutes 2007 Supplement, section 62J.81, subdivision 1, is amended
to read:


Subdivision 1.

Required disclosure of estimated deleted text begin paymentdeleted text end new text begin out-of-pocket costsnew text end .

deleted text begin (a) A health care provider, as defined in section 62J.03, subdivision 8, or the provider's
designee as agreed to by that designee, shall, at the request of a consumer, and at no cost
to the consumer or the consumer's employer, provide that consumer with a good faith
estimate of the allowable payment the provider has agreed to accept from the consumer's
health plan company for the services specified by the consumer, specifying the amount of
the allowable payment due from the health plan company. Health plan companies must
allow contracted providers, or their designee, to release this information. If a consumer
has no applicable public or private coverage, the health care provider must give the
consumer, and at no cost to the consumer, a good faith estimate of the average allowable
reimbursement the provider accepts as payment from private third-party payers for the
services specified by the consumer and the estimated amount the noncovered consumer
will be required to pay. Payment information provided by a provider, or by the provider's
designee as agreed to by that designee, to a patient pursuant to this subdivision does not
constitute a legally binding estimate of the allowable charge for or cost to the consumer of
services.
deleted text end

deleted text begin (b)deleted text end A health plan company, as defined in section 62J.03, subdivision 10, shall, at
the request of an enrollee or the enrollee's designee, provide that enrollee with a good
faith estimate of the allowable amount the health plan company has contracted for with a
specified provider within the network as total payment for a health care service specified
by the enrollee and the portion of the allowable amount due from the enrollee and the
enrollee's out-of-pocket costs. An estimate provided to an enrollee under this paragraph is
not a legally binding estimate of the allowable amount or enrollee's out-of-pocket cost.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end

Sec. 9.

Minnesota Statutes 2007 Supplement, section 62J.82, subdivision 1, is amended
to read:


Subdivision 1.

Required information.

The Minnesota Hospital Association shall
develop a Web-based system, available to the public free of charge, for reporting the
following, for Minnesota residents:

(1) hospital-specific performance on the measures of care developed under section
256B.072 for acute myocardial infarction, heart failure, and pneumonia;

(2) by January 1, 2009, hospital-specific performance on the public reporting
measures for hospital-acquired infections as published by the National Quality Forum
and collected by the Minnesota Hospital Association and Stratis Health in collaboration
with infection control practitioners; and

(3) deleted text begin chargedeleted text end new text begin cost new text end information, including, but not limited to, number of discharges,
average length of stay, average deleted text begin chargedeleted text end new text begin costnew text end , average deleted text begin chargedeleted text end new text begin cost new text end per day, and median
deleted text begin chargedeleted text end new text begin costnew text end , for each of the 50 most common inpatient diagnosis-related groups and the
25 most common outpatient surgical procedures as specified by the Minnesota Hospital
Association.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end

Sec. 10.

Minnesota Statutes 2006, section 62L.12, subdivision 2, is amended to read:


Subd. 2.

Exceptions.

(a) A health carrier may sell, issue, or renew individual
conversion policies to eligible employees otherwise eligible for conversion coverage under
section 62D.104 as a result of leaving a health maintenance organization's service area.

(b) A health carrier may sell, issue, or renew individual conversion policies to
eligible employees otherwise eligible for conversion coverage as a result of the expiration
of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21,
62C.142, 62D.101, and 62D.105.

(c) A health carrier may sell, issue, or renew conversion policies under section
62E.16 to eligible employees.

(d) A health carrier may sell, issue, or renew individual continuation policies to
eligible employees as required.

(e) A health carrier may sell, issue, or renew individual health plans if the coverage
is appropriate due to an unexpired preexisting condition limitation or exclusion applicable
to the person under the employer's group health plan or due to the person's need for health
care services not covered under the employer's group health plan.

(f) A health carrier may sell, issue, or renew an individual health plan, if the
individual has elected to buy the individual health plan not as part of a general plan to
substitute individual health plans for a group health plan nor as a result of any violation of
subdivision 3 or 4.

(g) Nothing in this subdivision relieves a health carrier of any obligation to provide
continuation or conversion coverage otherwise required under federal or state law.

(h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage
issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or
contracts that supplement Medicare issued by health maintenance organizations, or those
contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social
Security Act, United States Code, title 42, section 1395 et seq., as amended.

(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
health plans necessary to comply with a court order.

(j) A health carrier may offer, issue, sell, or renew an individual health plan to
persons eligible for an employer group health plan, if the individual health plan is a high
deductible health plan for use in connection with an existing health savings account, in
compliance with the Internal Revenue Code, section 223. In that situation, the same or
a different health carrier may offer, issue, sell, or renew a group health plan to cover
the other eligible employees in the group.

(k) A health carrier may offer, sell, issue, or renew an individual health plan to one
or more employees of a small employer if the individual health plan is marketed directly new text begin to
employees or through the Minnesota Health Insurance Exchange under section 62U.02
new text end to
all employees of the small employer and the small employer does not contribute directly
or indirectly to the premiums or facilitate the administration of the individual health plan.
new text begin Except as provided in section 62U.03, subdivision 5, paragraph (b), new text end the requirement to
market an individual health plan to all employees does not require the health carrier to
offer or issue an individual health plan to any employee. For purposes of this paragraph,
an employer is not contributing to the premiums or facilitating the administration of the
individual health plan if the employer does not contribute to the premium and merely
collects the premiums from an employee's wages or salary through payroll deductions
and submits payment for the premiums of one or more employees in a lump sum to the
health carriernew text begin or to the Minnesota Health Insurance Exchange under section 62U.02new text end .
Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the
request of an employee, the health carrier new text begin or the Minnesota Health Insurance Exchange
under section 62U.02
new text end may bill the employer for the premiums payable by the employee,
provided that the employer is not liable for payment except from payroll deductions for
that purpose. If an employer is submitting payments under this paragraph, the health
carrier new text begin or the Minnesota Health Insurance Exchange, as applicable, new text end shall provide a
cancellation notice directly to the primary insured at least ten days prior to termination
of coverage for nonpayment of premium. Individual coverage under this paragraph may
be offered only if the small employer has not provided coverage under section 62L.03 to
the employees within the past 12 months.

The employer must provide a written and signed statement to the health carrier new text begin or
the Minnesota Health Insurance Exchange, as applicable, stating
new text end that the employer is not
contributing directly or indirectly to the employee's premiums. new text begin The Minnesota Health
Insurance Exchange under section 62U.02 shall provide all health carriers with enrolled
employees of the employer with a copy of the employer's statement.
new text end The health carrier
may rely on the employer's statement and is not required to guarantee-issue individual
health plans to the employer's deleted text begin other current or futuredeleted text end employees.

Sec. 11.

Minnesota Statutes 2006, section 62L.12, subdivision 4, is amended to read:


Subd. 4.

Employer prohibition.

A small employer new text begin offering a health benefit plan
new text end shall not encourage or direct an employee or applicant to:

(1) refrain from filing an application for health coverage when other similarly
situated employees may file an application for health coverage;

(2) file an application for health coverage during initial eligibility for coverage,
the acceptance of which is contingent on health status, when other similarly situated
employees may apply for health coverage, the acceptance of which is not contingent on
health status;

(3) seek coverage from another health carrier, including, but not limited to, MCHA;
or

(4) cause coverage to be issued on different terms because of the health status or
claims experience of that person or the person's dependents.

Sec. 12.

Minnesota Statutes 2006, section 62Q.735, subdivision 1, is amended to read:


Subdivision 1.

Contract disclosure.

(a) Before requiring a health care provider to
sign a contract, a health plan company shall give to the provider a complete copy of
the proposed contract, including:

(1) all attachments and exhibits;

(2) operating manuals;

(3) a general description of the health plan company's health service coding
guidelines and requirement for procedures and diagnoses with modifiers, and multiple
procedures; and

(4) all guidelines and treatment parameters incorporated or referenced in the contract.

(b)deleted text begin The health plan company shall make available to the provider the fee schedule or
a method or process that allows the provider to determine the fee schedule for each health
care service to be provided under the contract.
deleted text end

deleted text begin (c) Notwithstanding paragraph (b),deleted text end A health plan company that is a dental
plan organization, as defined in section 62Q.76, shall disclose information related to
the individual contracted provider's expected reimbursement from the dental plan
organization. Nothing in this section requires a dental plan organization to disclose the
plan's aggregate maximum allowable fee table used to determine other providers' fees.
The contracted provider must not release this information in any way that would violate
any state or federal antitrust law.

Sec. 13.

new text begin [62U.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin For purposes of this chapter, the terms defined in this
section have the meanings given, unless otherwise specified.
new text end

new text begin Subd. 2. new text end

new text begin Baskets or baskets of care. new text end

new text begin "Basket" or "baskets of care" means a
collection of health care services that are paid separately under a fee-for-service system,
but which are ordinarily combined by a provider in delivering a full diagnostic or
treatment procedure to a patient.
new text end

new text begin Subd. 3. new text end

new text begin Clinically effective. new text end

new text begin "Clinically effective" means that the use of a
particular health technology improves patient clinical status, as measured by medical
condition, survival rates, and other variables, and that the use of the particular technology
demonstrates a clinical advantage over alternative technologies.
new text end

new text begin Subd. 4. new text end

new text begin Commission. new text end

new text begin "Commission" means the Health Care Transformation
Commission established under section 62U.04.
new text end

new text begin Subd. 5. new text end

new text begin Cost effective. new text end

new text begin "Cost effective" means that the economic costs of using
a particular service, device, or health technology to achieve improvement in a patient's
health outcome are justified given the comparison to both the economic costs and the
improvement in patient health outcome resulting from the use of an alternative service,
device, or technology, or from not providing the service, device, or technology.
new text end

new text begin Subd. 6. new text end

new text begin Exchange. new text end

new text begin "Exchange" means the Minnesota Health Insurance Exchange
established in section 62U.02.
new text end

new text begin Subd. 7. new text end

new text begin Group purchaser. new text end

new text begin "Group purchaser" has the meaning provided in
section 62J.03.
new text end

new text begin Subd. 8. new text end

new text begin Health plan. new text end

new text begin "Health plan" means a health plan as defined in section
62A.011.
new text end

new text begin Subd. 9. new text end

new text begin Health plan company. new text end

new text begin "Health plan company" has the meaning provided
in section 62Q.01, subdivision 4.
new text end

new text begin Subd. 10. new text end

new text begin Health technology. new text end

new text begin "Health technology" means medical and surgical
devices and procedures, medical equipment, and diagnostic tests.
new text end

new text begin Subd. 11. new text end

new text begin Participating provider. new text end

new text begin "Participating provider" means a provider who
has entered into a service agreement with a health plan company.
new text end

new text begin Subd. 12. new text end

new text begin Provider or health care provider. new text end

new text begin "Provider" or "health care provider"
means a health care provider as defined in section 62J.03, subdivision 8.
new text end

new text begin Subd. 13. new text end

new text begin Section 125 Plan. new text end

new text begin "Section 125 Plan" means a cafeteria or premium-only
plan under section 125 of the Internal Revenue Code that allows employees to pay for
health insurance premiums with pretax dollars.
new text end

new text begin Subd. 14. new text end

new text begin Service agreement. new text end

new text begin "Service agreement" means an agreement, contract,
or other arrangement between a health plan company and a provider under which the
provider agrees that when health services are provided for an enrollee, the provider shall
not make a direct charge against the enrollee for those services or parts of services which
are covered by the enrollee's contract, but shall look to the service plan corporation for the
payment for covered services, to the extent they are covered.
new text end

new text begin Subd. 15. new text end

new text begin Third-party administrators. new text end

new text begin "Third-party administrators" means a
vendor of risk-management services or an entity administering a self-insurance or health
insurance plan under section 60A.23.
new text end

Sec. 14.

new text begin [62U.02] MINNESOTA HEALTH INSURANCE EXCHANGE.
new text end

new text begin Subdivision 1. new text end

new text begin Title; citation. new text end

new text begin This section may be cited as the "Minnesota Health
Insurance Exchange."
new text end

new text begin Subd. 2. new text end

new text begin Creation; tax exemption. new text end

new text begin The Minnesota Health Insurance Exchange
is created for the limited purpose of providing individuals with greater access, choice,
portability, and affordability of health insurance products. The Minnesota Health
Insurance Exchange is a nonprofit corporation under chapter 317A and section 501(c) of
the Internal Revenue Code.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have the
meanings given them.
new text end

new text begin (a) "Board" means the board of directors of the Minnesota Health Insurance
Exchange established under subdivision 12.
new text end

new text begin (b) "Commissioner" means:
new text end

new text begin (1) the commissioner of commerce for health plan companies subject to the
jurisdiction of the Department of Commerce;
new text end

new text begin (2) the commissioner of health for health plan companies subject to the jurisdiction
of the Department of Health; or
new text end

new text begin (3) either commissioner's designated representative.
new text end

new text begin (c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
new text end

new text begin (d) "Individual market health plan" means a health plan as defined in section
62A.011.
new text end

new text begin (e) "Small employer" means a small employer as defined in section 62L.02,
subdivision 26.
new text end

new text begin (f) "Small employer plan" means a small employer health plan as defined in section
62L.02, subdivision 15.
new text end

new text begin Subd. 4. new text end

new text begin Health plan company participation and health plan availability. new text end

new text begin (a)
All individual market health plans and small employer plans offered by a health plan
company licensed to issue health insurance in Minnesota may be made available for
purchase through the exchange. The health exchange shall limit the number of health
plans to be made available through the exchange. The appropriate number of health plans
shall ensure health plan innovation and consumer choice without being so numerous to
become unmanageable for consumers using the exchange.
new text end

new text begin (b) Nothing in this section restricts the sale of individual market health plans and
small employer plans outside the exchange. The requirements applicable to issuance,
renewal, cancelation, and pricing of coverage are the same for health plans purchased
inside and outside the exchange, except as described under section 62U.03, subdivision 5,
paragraph (b).
new text end

new text begin (c) Health plans offered through the Minnesota Comprehensive Health Association
as defined in section 62E.10 shall be available for sale through the exchange as determined
by the Minnesota Comprehensive Health Association.
new text end

new text begin (d) Health plans offered through the MinnesotaCare program shall be available
through the exchange for individuals and families with children who:
new text end

new text begin (1) have gross household incomes equal to or greater than 200 percent of federal
poverty guidelines;
new text end

new text begin (2) meet the eligibility requirements of the MinnesotaCare program; and
new text end

new text begin (3) pay premiums through an employer Section 125 Plan.
new text end

new text begin (e) Beginning January 1, 2010, any health plan company that issues health plans in
the individual or small employer market must offer through the exchange at least three
health plans that meet the standard benefit set and design established by the Health Care
Transformation Commission. The health plan may impose varying levels of cost sharing
provided it meets the requirements of the standard benefit set and design.
new text end

new text begin Subd. 5. new text end

new text begin Listing of health plans. new text end

new text begin The exchange shall create an Internet-based
system for listing individual market health plans and small employer health benefit plans
offered through the exchange. The system shall consider the variation across health plans
in such factors as premiums, deductibles, co-payment and coinsurance requirements,
annual out-of-pocket maximum payments, and lifetime benefit limits, and the system shall
rank the health plans based on priorities specified by the user.
new text end

new text begin Subd. 6. new text end

new text begin Individual participation and eligibility. new text end

new text begin Individuals are eligible to
purchase health plans directly through the exchange or through an employer Section 125
Plan under section 62U.03. Nothing in this section requires guaranteed issue of individual
market health plans offered through the exchange except as provided under section
62U.03, subdivision 5, paragraph (b). Individuals are eligible to purchase individual
market health plans through the exchange if the individual meets one or more of the
following qualifications:
new text end

new text begin (1) the individual is a Minnesota resident, meaning the individual is physically
residing on a permanent basis in a place that is the individual's principal residence and
from which the individual is absent only for temporary purposes;
new text end

new text begin (2) the individual is a student attending an institution outside of Minnesota and
maintains Minnesota residency;
new text end

new text begin (3) the individual is not a Minnesota resident but is employed by an employer
physically located within the state and the individual's employer is required to offer a
Section 125 Plan under section 62U.03; or
new text end

new text begin (4) the individual is a dependent as defined in section 62L.02, of another individual
who is eligible to participate in the exchange.
new text end

new text begin Subd. 7. new text end

new text begin Small employer participation and eligibility. new text end

new text begin Small employers, as
defined in section 62L.02, may purchase health plans through the exchange.
new text end

new text begin Subd. 8. new text end

new text begin Responsibilities of the exchange. new text end

new text begin The exchange may serve as a
coordinating entity for enrollment and collection and transfer of premium payments for
health plans sold to individuals through the exchange. The exchange shall be responsible
for the following functions:
new text end

new text begin (1) publicize the exchange, including but not limited to its functions, eligibility
rules, and enrollment procedures;
new text end

new text begin (2) provide assistance to employers to establish Section 125 Plans under section
62U.03;
new text end

new text begin (3) provide education and assistance to employers to help them understand the
requirements of Section 125 Plans and compliance with applicable regulations;
new text end

new text begin (4) create a system to allow individuals to compare and enroll in health plans
offered through the exchange, including a system of comparative rating of health plans
and benefits set;
new text end

new text begin (5) create a system to collect and transmit to the applicable plans all premium
payments made by individuals, including developing mechanisms to receive and process
automatic payroll deductions for individuals who purchase coverage through employer
Section 125 Plans;
new text end

new text begin (6) for participating employers, bill the employer for the premiums payable by the
employer for a small employer health benefit plan;
new text end

new text begin (7) for individuals purchasing individual market health plans through a Section 125
Plan, bill the individual's employer for premiums payable by the employee, provided that
the employer is not liable for payment except from payroll deductions for that purpose;
new text end

new text begin (8) provide information on public insurance programs to individuals who may
qualify for these programs, and provide application assistance, if needed on applying
for these programs;
new text end

new text begin (9) establish a mechanism with the Department of Human Services to transfer
premiums paid by Minnesota health care program enrollees from Section 125 Plans;
new text end

new text begin (10) establish procedures to account for all funds received and disbursed by the
exchange; and
new text end

new text begin (11) make available to the public, within 90 days from the end of each fiscal year, a
report of an independent audit of the exchange's accounts.
new text end

new text begin Subd. 9. new text end

new text begin State not liable. new text end

new text begin The state of Minnesota shall not be liable for the actions
of the Minnesota Health Insurance Exchange.
new text end

new text begin Subd. 10. new text end

new text begin Powers of the exchange. new text end

new text begin The exchange shall have the power to:
new text end

new text begin (1) contract with insurance producers licensed in accident and health insurance
under chapter 60K and vendors to perform one or more of the functions specified in
subdivision 8;
new text end

new text begin (2) contract with employers to collect premiums for small employer plans and for
individual market health plans purchased through a Section 125 Plan;
new text end

new text begin (3) establish and assess fees on health plan premiums of small employer plans and
individual market health plans to fund the cost of administering the exchange;
new text end

new text begin (4) seek and directly receive grant funding from government agencies or private
philanthropic organizations to defray the costs of operating the exchange;
new text end

new text begin (5) establish and administer rules and procedures governing the operations of the
exchange;
new text end

new text begin (6) establish one or more service centers within Minnesota;
new text end

new text begin (7) sue or be sued or otherwise take any necessary or proper legal action;
new text end

new text begin (8) establish bank accounts and borrow money; and
new text end

new text begin (9) enter into agreements with the commissioners of commerce, health, human
services, revenue, employment and economic development, and other state agencies as
necessary for the exchange to implement the provisions of this section.
new text end

new text begin Subd. 11. new text end

new text begin Dispute resolution. new text end

new text begin The exchange shall establish procedures for resolving
disputes with respect to the eligibility of an individual to participate in the exchange. The
exchange does not have the authority or responsibility to intervene in or resolve disputes
between an individual and a health plan or health plan company. The exchange shall refer
complaints from individuals participating in the exchange to the commissioner to be
resolved according to sections 62Q.68 to 62Q.73.
new text end

new text begin Subd. 12. new text end

new text begin Board of directors. new text end

new text begin The exchange shall be governed by a board of
directors with 11 members. Except as specifically provided in this section, the board of
directors is subject to section 15.0575. The commissioner of commerce shall convene
the first meeting of the board on or before July 1, 2008, after the initial board members
have been selected. Notwithstanding section 15.0575, subdivision 2, the initial board
membership consists of the following:
new text end

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

new text begin (2) the commissioner of human services;
new text end

new text begin (3) the commissioner of health; and
new text end

new text begin (4) eight public members with knowledge and experience related to health insurance
and health insurance markets, appointed to serve three-year terms expiring June 30,
2011, as follows: two members appointed by the Subcommittee on Committees of the
Committee on Rules and Administration of the senate; two members appointed by the
speaker of the house of representatives; and four members appointed by the governor. The
appointments required under this section must be completed by June 15, 2008.
new text end

new text begin Subd. 13. new text end

new text begin Subsequent board membership. new text end

new text begin (a) Notwithstanding section 15.0575,
subdivision 2, ongoing membership of the exchange consists of the following effective
July 1, 2011:
new text end

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

new text begin (2) the commissioner of human services;
new text end

new text begin (3) the commissioner of health;
new text end

new text begin (4) two public members appointed to serve two-year terms as follows: one
member appointed by the Subcommittee on Committees of the Committee on Rules and
Administration of the senate; and one member appointed by the speaker of the house of
representatives; and
new text end

new text begin (5) four public members elected by the membership of the exchange. The board
must designate two of the elected members to serve a two-year term and two of the elected
members to serve a three-year term.
new text end

new text begin (b) Elected members may serve more than one term. The board must ensure that at
least one of the elected members represents a small employer, and at least one member is a
person who purchases an individual market health plan through the exchange.
new text end

new text begin Subd. 14. new text end

new text begin Operations of the board. new text end

new text begin Officers of the board of directors are elected by
members of the board and serve one-year terms. Six members of the board constitute a
quorum, and the affirmative vote of six members of the board is necessary and sufficient
for any action taken by the board. Board members serve without compensation, but shall
be reimbursed for actual expenses incurred in the performance of their duties, as provided
in section 15.0575.
new text end

new text begin Subd. 15. new text end

new text begin Operations of the exchange. new text end

new text begin The board of directors shall appoint an
exchange director who shall:
new text end

new text begin (1) be a full-time employee of the exchange;
new text end

new text begin (2) administer all of the activities and contracts of the exchange; and
new text end

new text begin (3) hire and supervise the staff of the exchange.
new text end

new text begin Subd. 16. new text end

new text begin Insurance producers. new text end

new text begin An individual has the right to choose any
insurance producer licensed in accident and health insurance under chapter 60K to assist
them in purchasing an individual market health plan through the exchange. When a
producer licensed in accident and health insurance under chapter 60K enrolls an eligible
individual in the exchange, the health plan company chosen by the individual may pay the
producer a commission.
new text end

new text begin Subd. 17. new text end

new text begin Implementation. new text end

new text begin Health plan coverage through the exchange begins on
July 1, 2009. The exchange must be operational to assist employers and individuals by
January 1, 2009, and be prepared for enrollment by June 1, 2009.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 15.

new text begin [62U.03] SECTION 125 PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (a) "Employee" means an employee currently on an employer's payroll other than a
retiree or disabled former employee.
new text end

new text begin (b) "Employer" means a person, firm, corporation, partnership, association, business
trust, or other entity employing one or more persons, including a political subdivision of
the state, filing payroll tax information on such employed person or persons.
new text end

new text begin (c) "Exchange director" means the appointed director of the Minnesota Health
Insurance Exchange under section 62U.03, subdivision 15.
new text end

new text begin Subd. 2. new text end

new text begin Section 125 Plan requirement. new text end

new text begin (a) Effective January 1, 2009, all
employers with 11 or more current employees shall establish a Section 125 Plan to allow
their employees to purchase individual market or employer-based health plan coverage
with pretax dollars. Nothing in this section requires employers to offer or purchase group
health insurance coverage for their employees. Employers with no employees who are
eligible to participate in a Section 125 Plan are exempt from this section.
new text end

new text begin (b) Employers that offer a Section 125 Plan may enter into an agreement with the
exchange to administer the employer's Section 125 Plan.
new text end

new text begin (c) Notwithstanding paragraph (a), an employer that has been certified by a licensed
insurance broker as having received education and information on the benefits and
advantages of offering Section 125 Plans is not required to establish a Section 125 Plan.
This paragraph expires January 1, 2010.
new text end

new text begin Subd. 3. new text end

new text begin Tracking compliance. new text end

new text begin By July 1, 2010, the exchange, in consultation with
the commissioners of commerce, health, employment and economic development, and
revenue shall establish a method for tracking employer compliance with the Section 125
Plan requirement.
new text end

new text begin Subd. 4. new text end

new text begin Employer requirements. new text end

new text begin (a) Employers that do not offer a group health
insurance plan as defined in section 62A.10 and are required to offer or choose to offer a
Section 125 Plan shall:
new text end

new text begin (1) allow employees to purchase an individual market health plan for themselves
and their dependents;
new text end

new text begin (2) allow employees to choose any insurance producer licensed in accident and health
insurance under chapter 60K to assist them in purchasing an individual market health plan;
new text end

new text begin (3) upon an employee's request, deduct premium amounts on a pretax basis in an
amount not to exceed an employee's wages, and remit these employee payments to the
health plan or the exchange; and
new text end

new text begin (4) provide notice to employees that individual market health plans purchased by
employees through payroll deduction are not employer-sponsored or administered.
new text end

new text begin (b) Employers shall be held harmless from any and all liability claims related to the
individual market health plans purchased by employees under a Section 125 Plan.
new text end

new text begin Subd. 5. new text end

new text begin Health plan company requirements. new text end

new text begin (a) Individuals who are eligible to
use an employer Section 125 Plan to pay for an individual market health plan purchased
through the exchange may enroll in any health plan offered through the exchange
for which the individual is eligible, including the individual market health plans,
MinnesotaCare, and the Minnesota Comprehensive Health Association, to the extent
authorized under section 62U.02, subdivision 4.
new text end

new text begin (b) Individuals who purchase an individual market health plan through a Section 125
Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment
period that coincides with the open enrollment period for their employer's Section 125
Plan or upon experiencing a qualifying event as defined in United States Code, chapter
43, section 4980B. Nothing in this section precludes a health plan company from
issuing coverage with preexisting condition exclusions as authorized in law. Health plan
companies may not charge higher or lower premiums based on health status for individuals
who purchase coverage on a guaranteed issue basis under this section, except for variations
in premium that are allowable based on health behaviors such as tobacco use.
new text end

Sec. 16.

new text begin [62U.04] HEALTH CARE TRANSFORMATION COMMISSION.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Transformation Commission is created
for the purpose of coordinating the health care transformation activities within Minnesota.
new text end

new text begin Subd. 2. new text end

new text begin Members. new text end

new text begin (a) The Health Care Transformation Commission shall consist
of ten members who are appointed as follows:
new text end

new text begin (1) three members appointed by the Subcommittee on Committees of the Committee
on Rules and Administration of the senate, including two public members and one senator;
new text end

new text begin (2) three members appointed by the speaker of the house of representatives,
including two public members and one member of the house; and
new text end

new text begin (3) four members appointed by the governor, two of whom shall be state
commissioners from the agencies listed in section 15.01.
new text end

new text begin (b) The appointing authorities must ensure that the appointed members who are
not legislators or commissioners:
new text end

new text begin (1) have expertise in health care financing, health care delivery, health care quality
improvement, health economics, actuarial science, or business operations;
new text end

new text begin (2) are not state employees or employees of a political subdivision; and
new text end

new text begin (3) do not have a direct financial interest in the outcome of the commission's
business, other than as an individual consumer of health care services.
new text end

new text begin (c) Section 15.0575, subdivision 4, governs the removal of members.
new text end

new text begin Subd. 3. new text end

new text begin Operations of the commission. new text end

new text begin (a) The commissioner of health shall
convene the first meeting of the commission on or before July 1, 2008, following the
initial appointment of the members.
new text end

new text begin (b) The commission shall elect a chair from its membership.
new text end

new text begin (c) The commission members shall not be compensated for commission activities
except for actual expenses incurred in the performance of their duties. Expenses shall be
compensated in accordance with section 15.0575.
new text end

new text begin Subd. 4. new text end

new text begin Responsibilities of the commission. new text end

new text begin (a) The commission shall develop a
design and implementation plan for a health care payment restructuring system within the
parameters described in this chapter. The plan must provide for the full implementation of
the payment restructuring system by January 1, 2011. The design and plan must include:
new text end

new text begin (1) uniform definitions for the baskets of care and a comprehensive set of services as
required under section 62U.10;
new text end

new text begin (2) a mechanism for soliciting and accepting payment bids from health care
providers and health care systems as required under section 62U.10. The mechanism
must ensure that the bids from different providers and care systems can be compared by
consumers on both quality and cost;
new text end

new text begin (3) procedures to facilitate providers in participating in the payment system and,
if needed, provide technical assistance to providers in assembling bids, contracting with
other providers in order to assemble or submit bids, or otherwise participate in the
payment system; and
new text end

new text begin (4) a method for monitoring, measuring, and evaluating the effectiveness of the
payment restructuring system and for making adjustments, as necessary, to address any
barriers or unintended consequences.
new text end

new text begin (b) In developing the payment restructuring system described in this chapter, the
commission shall consult and coordinate with the commissioners of health and human
services, health care providers, health plan companies, organizations that work to improve
health care quality in Minnesota, consumers, and employers.
new text end

new text begin (c) By July 1, 2009, the commission must make recommendations to the governor
and the legislative committees with jurisdiction on health care policy and finance on
how to incorporate Medicare into the payment restructuring system. In developing
these recommendations, the commission shall negotiate with the Centers for Medicare
and Medicaid Services and with the Minnesota congressional delegation and explore
participation in a demonstration project or advocate for changes in federal law to enable
the transformation of the health care system to succeed.
new text end

new text begin (d) The commission may contract with other organizations and entities to carry
out any of the duties described in this chapter, including evaluating the effectiveness of
the payment restructuring system.
new text end

new text begin Subd. 5. new text end

new text begin Standard benefit set and design. new text end

new text begin (a) Based on the recommendations
submitted by the Health Benefit Set and Design Advisory Committee, the commission
shall establish a standard benefit set and design by July 1, 2009.
new text end

new text begin (b) The standard health benefit set and design must meet the requirements described
in section 62U.06.
new text end

new text begin (c) Prior to establishing the standard benefit set and design, the commission shall
convene public hearings throughout the state.
new text end

new text begin Subd. 6. new text end

new text begin Reports. new text end

new text begin The commission shall submit a report on January 15 of each year
to the governor and legislature, beginning in 2010, on the following:
new text end

new text begin (1) the extent to which health care providers have reduced their costs and fees;
new text end

new text begin (2) the extent to which costs and cost growth are likely to be maintained or reduced
in future years;
new text end

new text begin (3) the extent to which the quality of health care services has improved;
new text end

new text begin (4) the extent to which all Minnesotans have access to quality, affordable health
care; and
new text end

new text begin (5) recommendations on additional actions that are needed in order to successfully
achieve health care transformation in Minnesota.
new text end

new text begin Subd. 7. new text end

new text begin Sunset. new text end

new text begin The commission shall expire June 30, 2012. Upon expiration, the
duties of the commission shall transfer to the Health Care Value Reporting Committee.
new text end

Sec. 17.

new text begin [62U.05] HEALTH CARE VALUE REPORTING COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Value Reporting Committee is created
for the purpose of collecting, analyzing, and disseminating data on health care quality.
new text end

new text begin Subd. 2. new text end

new text begin Members. new text end

new text begin (a) The Health Care Value Reporting Committee shall consist of
seven members who shall be appointed by the Health Care Transformation Commission.
The members must have expertise and knowledge in health care quality improvement
and measurement.
new text end

new text begin (b) Upon the expiration of the Health Care Transformation Commission, the
members shall be appointed as follows:
new text end

new text begin (1) three members appointed by the governor;
new text end

new text begin (2) two members appointed by the Subcommittee on Committees of the Committee
on Rules and Administration of the senate; and
new text end

new text begin (3) two members appointed by the speaker of the house of representatives.
new text end

new text begin (c) Membership terms shall be for four years.
new text end

new text begin Subd. 3. new text end

new text begin Operation of the committee. new text end

new text begin (a) The governor's designee shall convene
the committee following the initial appointment of the members.
new text end

new text begin (b) The committee shall elect a chair among its members at the initial meeting.
new text end

new text begin (c) The committee shall be governed under section 15.0575 except that the members
shall not be compensated and the committee shall not expire.
new text end

new text begin Subd. 4. new text end

new text begin Duties. new text end

new text begin (a) The Health Care Value Reporting Committee shall be
responsible for collecting, analyzing, and disseminating data on health care quality.
new text end

new text begin (b) The Health Care Value Reporting Committee shall:
new text end

new text begin (1) establish the standards for measuring health care outcomes;
new text end

new text begin (2) establish a system for providers to report outcomes and processes associated with
patient care. In establishing these standards and system, the Health Care Value Reporting
Committee shall work with other organizations that are developing quality measurement
and reporting systems to establish a single system for collection and reporting of data
on provider quality;
new text end

new text begin (3) collect standardized electronic information outcomes and processes from health
care providers;
new text end

new text begin (4) establish a system for risk adjusting the measures reported by providers January
1, 2010; and
new text end

new text begin (5) issue annual public reports on provider quality using the data submitted by
providers, adjusted for patient complexity beginning July 1, 2010.
new text end

new text begin (c) The Health Care Value Reporting Committee may contract with organizations
and collaborations of organizations such as the Minnesota Community Measurement or
Stratis Health to carry out any of the duties described in this section.
new text end

Sec. 18.

new text begin [62U.06] STANDARD BENEFIT SET AND DESIGN; HEALTH
BENEFIT AND DESIGN ADVISORY COMMITTEE.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Transformation Commission established
in section 62U.04 shall convene a Health Benefit and Design Advisory Committee to
make recommendations to the commission on a standard benefit set and design. The
advisory committee shall consist of seven members. The members shall be appointed
by the commission by August 15, 2008, and must have expertise in benefit design and
development, actuarial analysis, or knowledge relating to the analysis of the cost impact
of coverage of specified benefits.
new text end

new text begin Subd. 2. new text end

new text begin Operations of the committee. new text end

new text begin (a) The chair of the Health Care
Transformation Commission shall convene the first meeting of the advisory committee
on or before September 1, 2008. The committee must meet at least once a year, and at
other times as necessary.
new text end

new text begin (b) The commission shall provide office space, equipment and supplies, and
technical support to the committee.
new text end

new text begin (c) The committee shall be governed by section 15.059, except the committee shall
not expire. Upon the expiration of the Health Care Transformation Commission, the
Health Benefit and Design Advisory Committee shall continue to exist under the oversight
of the Health Care Value Reporting Committee.
new text end

new text begin Subd. 3. new text end

new text begin Duties of the committee. new text end

new text begin (a) By January 15, 2009, the committee shall
develop and submit to the commission an initial cost-effective benefit set and design
that provides individuals access to a broad range of health care services, including
preventive health care, including dental care, comprehensive mental health services,
chemical dependency treatment, vision care, language interpreter services, emergency
transportation, and prescription drugs without incurring severe financial loss as a result of
serious illness or injury. The benefit set must include necessary evidence-based health care
services, procedures, and diagnostic tests that are scientifically proven to be both clinically
effective and cost-effective. In establishing the initial benefit set, the committee may
contract with the Institute for Clinical Systems Improvement (ICSI) to assemble existing
scientifically based practice standards. The committee shall consider cultural, ethnic, and
religious values and beliefs to ensure that the health care needs of all Minnesota residents
will be addressed in the benefit set.
new text end

new text begin (b) The benefit set must identify and include preventive services, chronic care
coordination services, and early diagnostic tests, that, if included in the benefit set, with
minimal or no cost-sharing requirements, would result in savings that are equal to or
greater than the cost of providing the services.
new text end

new text begin (c) The benefit set must include ICSI-designated evidence-based outpatient care for
asthma, heart disease, diabetes, and depression with no cost-sharing requirements, or
with minimal cost-sharing requirements that would not impose an economic barrier to
accessing the care.
new text end

new text begin (d) The benefit design must establish a maximum deductible for in-network benefits
and for prescription drugs coverage and a maximum for out-of-pocket costs.
new text end

new text begin Subd. 4. new text end

new text begin Continued review. new text end

new text begin The committee shall review the benefit set and design
on an ongoing periodic basis and shall adjust the benefit set and design, as necessary to
ensure that the benefit set and design continues to be safe, effective, and scientifically
based.
new text end

Sec. 19.

new text begin [62U.07] HEALTH TECHNOLOGY ASSESSMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Technology Advisory Committee. new text end

new text begin (a) The Health Care
Transformation Commission shall appoint an advisory committee to make
recommendations to the commission regarding the inclusion of new and existing health
technologies to the standard benefit set and design.
new text end

new text begin (b) The advisory committee shall be made up of 11 members appointed by the
commission, in consultation with the Institute for Clinical Systems Improvement, the
Health Services Advisory Council, and the University of Minnesota. The membership
shall include:
new text end

new text begin (1) six practicing physicians licensed under chapter 147; and
new text end

new text begin (2) five other practicing health care professionals who use health technology in
their scope of practice.
new text end

new text begin The commission must complete the appointments required by this paragraph by September
1, 2008. The chair of the commission shall convene the first meeting of the Technology
Advisory Committee within 30 days following the completion of the appointments to
the committee.
new text end

new text begin (c) A member of the advisory committee may not:
new text end

new text begin (1) have a substantial financial interest in a health technology company; or
new text end

new text begin (2) be employed by or under contract with a health technology manufacturer during
their term or for 18 months before their appointment.
new text end

new text begin (d) The advisory committee is subject to section 15.059, except that the committee
shall not expire. Upon the expiration of the Health Care Transformation Commission, the
Health Technology Assessment Committee shall continue to exist under the oversight of
the Health Care Value Reporting Committee.
new text end

new text begin Subd. 2. new text end

new text begin Technology selection process. new text end

new text begin The commission, in consultation with the
advisory committee, shall select existing and new health technologies to be reviewed by
the committee. In making a selection, priority shall be given to any technology for which:
new text end

new text begin (1) there are concerns about its safety, efficacy, or cost-effectiveness;
new text end

new text begin (2) actual or expected expenditures are high due to demand for the technology,
its cost or both; and
new text end

new text begin (3) there is adequate evidence available to conduct a complete review.
new text end

new text begin Subd. 3. new text end

new text begin Technology review. new text end

new text begin (a) Upon the selection of a health technology for
review, the committee shall contract for a systematic evidence-based assessment of
the technology's safety, efficacy, and cost-effectiveness. The contract shall be with an
evidence-based practice center designated as such by the federal agency for health care
research and quality, or another appropriate entity as designated by the committee.
new text end

new text begin (b) The committee shall provide notification to the public when a health technology
has been selected for review. The notification must indicate when that review is to be
initiated and how an interested party may submit evidence or provide public comment for
consideration during the review.
new text end

new text begin Subd. 4. new text end

new text begin Committee determination. new text end

new text begin (a) Upon reviewing the completed assessment
and any other evidence submitted regarding the safety, efficacy, and cost-effectiveness of
the technology, the committee shall recommend to the commission:
new text end

new text begin (1) the conditions, if any, under which the health technology should be included
as a covered benefit; and
new text end

new text begin (2) if covered, the criteria to be used to decide whether the technology is medically
necessary, or proper and necessary treatment.
new text end

new text begin (b) The commissioners of human services, employee relations, and corrections may
use the committee's recommendation in making coverage and reimbursement decisions
unless the recommendation conflicts with an applicable federal statute or regulation.
new text end

Sec. 20.

new text begin [62U.08] PAYMENT RESTRUCTURING: INCENTIVE PAYMENTS
BASED ON QUALITY AND EFFICIENCY OF CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin (a) By November 15, 2008, the Health Care
Transformation Commission shall develop a system of quality and efficiency incentive
payments to providers that meets the criteria listed in subdivision 2. The system must
incorporate payments to primary care physicians, specialty care physicians, health care
clinics, and hospitals eligible for these incentive payments.
new text end

new text begin (b) The requirements of section 62Q.101 do not apply under this incentive payment
system.
new text end

new text begin Subd. 2. new text end

new text begin Payment system criteria. new text end

new text begin The quality and efficiency incentive payment
system shall meet the following criteria:
new text end

new text begin (1) providers meeting specified targets, or who demonstrate a significant amount of
improvement over time, shall be eligible for quality and efficiency incentive payments;
new text end

new text begin (2) priority shall be placed on measures of health care outcomes, rather than
processes, wherever possible;
new text end

new text begin (3) quality measures for primary care providers shall include preventive services,
coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
disease, and depression;
new text end

new text begin (4) quality measures for specialty care shall be initially based on quality indicators
measured and reported publicly by specialty societies;
new text end

new text begin (5) hospital measures shall be initially based on existing quality and efficiency
measures; and
new text end

new text begin (6) other indicators of care quality and efficiency may be incorporated where
appropriate. These indicators may include care infrastructure, collection and reporting of
results, measures of efficiency for specific procedures, and measures of overall cost of
care for individuals.
new text end

new text begin Subd. 3. new text end

new text begin Implementation. new text end

new text begin By January 1, 2009:
new text end

new text begin (1) the commissioner of human services shall implement this incentive payment
system for all enrollees in the state's public health care programs;
new text end

new text begin (2) the commissioner of employee relations shall implement this incentive payment
system for all participants in the state employee group insurance program; and
new text end

new text begin (3) all health plan companies shall implement this incentive payment system for all
participating providers.
new text end

Sec. 21.

new text begin [62U.09] PAYMENT RESTRUCTURING: CARE COORDINATION
PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin By July 1, 2009, the Health Care Transformation
Commission shall develop a system that provides care coordination payments to health
care providers. In order to be eligible for a care coordination payment, a health care
provider must be certified as a health care home by the commissioner of health based on
the certification standards for health care homes established under section 256B.0754.
new text end

new text begin Subd. 2. new text end

new text begin Care coordination fee. new text end

new text begin (a) Under the care coordination payments, health
care homes shall receive a per-person per-month care coordination fee for providing
care coordination services and employing care coordinators. For purpose of this section,
the specifications of care coordination and care coordinators are described in section
256B.0752, subdivisions 3 and 7, respectively.
new text end

new text begin (b) The care coordination fee must not exceed an average of $50 per person per
month. The care coordination fee must be determined by the Health Care Transformation
Commission and may vary by thresholds of care complexity, with the highest fees being
paid for care provided to individuals requiring the most intensive care coordination, such
as those with very complex health care needs or several chronic conditions.
new text end

new text begin (c) In developing the system of care coordination fees, the commission shall consider
the additional time and resources needed by patients with limited English-language skills,
cultural differences, or other barriers to health care.
new text end

new text begin (d) Care coordination fees must be phased-in, and must be applied first to individuals
who have, or are at risk of developing, complex or chronic health conditions.
new text end

new text begin Subd. 3. new text end

new text begin Quality and efficiency-based payments. new text end

new text begin The care coordination fees paid
under this section are in addition to the quality and efficiency incentive payments in
section 62U.08. Providers whose quality or efficiency does not allow them to qualify for
payments under section 62U.08 are not be eligible to receive care coordination fees.
new text end

new text begin Subd. 4. new text end

new text begin Implementation. new text end

new text begin (a) By July 1, 2009:
new text end

new text begin (1) the commissioner of human services shall implement the care coordination
payments for enrollees in the state's public health care programs;
new text end

new text begin (2) the commissioner of employee relations shall implement the care coordination
payments for participants in the state employee group insurance program; and
new text end

new text begin (3) all health plan companies shall implement this care coordination payments
for enrollees.
new text end

new text begin (b) The commissioners of human services and employee relations and health plan
companies may begin implementing this care coordination payments for enrollees and
participants who have or are at risk of developing complex and chronic health conditions.
new text end

Sec. 22.

new text begin [62U.10] PAYMENT RESTRUCTURING: PROVIDER INNOVATION
TO IMPROVE COSTS AND QUALITY.
new text end

new text begin Subdivision 1. new text end

new text begin Development. new text end

new text begin By January 1, 2010, the Health Care Transformation
Commission shall develop a payment system that encourages provider innovation to
improve costs and quality.
new text end

new text begin Subd. 2. new text end

new text begin Encounter data. new text end

new text begin (a) Beginning September 1, 2008, and every three months
thereafter, all health plan companies and third-party administrators shall submit encounter
data to the Health Care Transformation Commission. The data shall be submitted in a
form and manner specified by the commission subject to the following requirements:
new text end

new text begin (1) the data must be de-identified data as described under the Code of Federal
Regulations, title 45, section 164.514;
new text end

new text begin (2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care home; and
new text end

new text begin (3) except for the identifier described in clause (2), the data must not include
information that is not included in a health care claim or equivalent encounter information
transaction that is required under section 62J.536.
new text end

new text begin (b) The commission shall only use the data submitted under paragraph (a) for the
purpose of carrying out its responsibilities in designing and implementing a payment
restructuring system. If the commission contracts with other organizations or entities to
carry out any of its duties or responsibilities described in this chapter, the contract must
require that the organization or entity maintain that data that it receives according to the
provisions of this section.
new text end

new text begin (c) Data on providers collected under this subdivision are private data on individuals
or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary
data in section 13.02, subdivision 19, summary data prepared under this section may be
derived from nonpublic data. The commission shall establish procedures and safeguards
to protect the integrity and confidentiality of any data that it maintains.
new text end

new text begin (d) The commission shall not publish analyses or reports that identify or could
potentially identify individual patients.
new text end

new text begin (e) The commission may publish analyses and reports that identify specific providers
but only after the provider has been provided the opportunity by the commission to review
the data and submit comments. The provider shall have 21 days to review and comment,
after which time the commission may release the data along with any comments submitted
by the provider.
new text end

new text begin Subd. 3. new text end

new text begin Utilization and health care costs. new text end

new text begin (a) The commission shall develop a
method of calculating the relative utilization and health care costs of providers. The
method must include risk adjustments to reflect the differences in the demographics,
health, and special needs of the providers' patient population. The risk adjustment must be
developed in accordance with generally accepted risk adjustment methodologies.
new text end

new text begin (b) By April 1, 2009, the commission shall disseminate information to providers on
their utilization and cost in comparison to an appropriate peer group.
new text end

new text begin (c) The commission shall develop a system to index providers based on their total
risk-adjusted resource use per person and on quality of care. In developing this system,
the commission shall consult and coordinate with health care providers, health plan
companies, and the Health Care Value Reporting Organization.
new text end

new text begin Subd. 4. new text end

new text begin Total care bids. new text end

new text begin (a) The commission shall develop a standard method and
format for providers to use for submitting a bid under this subdivision. This method shall
be published in the State Register and must be made available to all providers.
new text end

new text begin (b) Beginning July 1, 2009, and annually thereafter, using the information developed
in subdivision 3, providers may submit bids to the commission for total costs of providing
care based on their disclosed prices under section 62U.11 combined with their actual
risk-adjusted resource use for the most recent analytic period. The bid submitted must
reflect the providers' commitment to manage their risk-adjusted patient population within
this total cost.
new text end

new text begin (c) A provider who does not want to submit a bid as part of a care system may
submit a bid on the services that the provider offers. The bid must be included in a bid for
total care that may be compiled by the provider, the commission, or another entity.
new text end

new text begin (d) Until January 1, 2012, no provider shall submit a bid for risk-adjusted total cost
of care that represents an increase of more than the increase in the previous calendar year's
Consumer Price Index for all urban consumer plus two percentage points or a decrease of
more than 15 percent below the provider's risk-adjusted total cost of care calculated based
on their average pricing levels for the previous calendar year.
new text end

new text begin (e) Beginning January 1, 2010, the commission shall annually publish the results
of the process described in paragraph (b), and shall include only providers who choose
to submit bids. The results that are published must be on a risk-neutral basis. Effective
January 1, 2011, the published results shall include all providers.
new text end

new text begin Subd. 5. new text end

new text begin Provider assistance. new text end

new text begin The commission shall provide education and
technical assistance to providers on how to calculate and submit bids for the total
risk-adjusted cost of care per patient.
new text end

new text begin Subd. 6. new text end

new text begin Payments. new text end

new text begin The commission shall establish a method by which providers
who have submitted a bid shall be paid for their total cost of care, with periodic
adjustments to the payment they receive to reflect their actual risk-adjusted cost relative
to their submitted bid price. Providers who choose not to bid shall be paid based on the
prices they have established under section 62U.11.
new text end

new text begin Subd. 7. new text end

new text begin Implementation. new text end

new text begin By January 1, 2010:
new text end

new text begin (1) the commissioner of human services shall implement this payment system for all
enrollees in the state's public health care programs;
new text end

new text begin (2) the commissioner of employee relations shall implement this payment system for
all participants in the state employee group insurance program;
new text end

new text begin (3) all political subdivisions as defined in section 13.02, subdivision 11, that offer
health benefits to their employees must implement this payment system or purchase a
health plan that uses this payment system;
new text end

new text begin (4) all health plan companies shall use the information and methods developed
under this section to develop health plans that encourage consumers to use high-quality,
low-cost providers; and
new text end

new text begin (5) health plan companies that issue health plans in the individual market or the small
employer market must offer at least one health plan that uses the information developed
under subdivision 3 to establish financial incentives for consumers to choose high-quality,
low-cost providers through enrollee cost-sharing or selective provider networks.
new text end

Sec. 23.

new text begin [62U.11] PROVIDER PRICE AND QUALITY DISCLOSURE.
new text end

new text begin (a) By January 1, 2009, and annually thereafter, each health care provider shall
establish a list of prices for each health care procedure, service, or basket of care
the provider provides and provide this information electronically to the Health Care
Transformation Commission in the form and manner specified by the commission, and
shall be provided to the public at no cost upon request.
new text end

new text begin (b) By January 1, 2009, each health care provider shall submit standardized
electronic information on the outcomes and processes associated with patient care to the
Health Care Value Reporting Organization.
new text end

Sec. 24.

new text begin [62U.12] PROVIDER PRICING.
new text end

new text begin (a) No health care provider shall vary the payment amount that the provider accepts
as full payment for a health care service based upon the identity of the payer, upon a
contractual relationship with a payer, upon the identity of the patient, or upon whether the
patient has coverage through a group purchaser.
new text end

new text begin (b) This section does not apply to a variation based upon a payer being a
governmental entity.
new text end

new text begin (c) This section does not affect the right of a provider to provide charity care or care
for a reduced price due to financial hardship of the patient or due to the patient being a
relative or friend of the provider.
new text end

Sec. 25.

new text begin [62U.13] HEALTH SAVINGS REINVESTMENT ASSESSMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Projected spending baseline. new text end

new text begin (a) The commissioner of health shall
calculate the annual projected total health care spending for the state and establish a health
care spending baseline beginning for the calendar year 2008 and for the next ten years
based on the annual projected growth in spending.
new text end

new text begin (b) In establishing the health care spending baseline, the commissioner shall use
the Center of Medicare and Medicaid Services forecast for total growth in national health
care expenditures, and adjust this forecast to reflect the demographics, health status, and
other factors deemed necessary by the commissioner. The commissioner shall contract
with an actuarial consultant to make recommendations as to the adjustments needed to
specifically reflect projected spending for Minnesota residents.
new text end

new text begin (c) The commissioner may adjust the projected baseline as necessary, to reflect any
updated federal projections or account for unanticipated changes in federal policy.
new text end

new text begin (d) Medicare spending shall not be included in the calculations required under
this section.
new text end

new text begin Subd. 2. new text end

new text begin Actual spending. new text end

new text begin (a) By June 1 of each year, beginning June 1, 2010, the
commissioner shall determine the actual private and public health care expenditures for the
calendar year preceding the current calendar year based on data collected under chapter
62J and shall determine the difference between the projected spending as determined
under subdivision 1 and the actual spending for that year. The actual spending must be
certified by an independent actuarial consultant. If the actual spending is less than the
projected spending, the commissioner shall determine an aggregate savings offset amount
not to exceed 33 percent of the difference.
new text end

new text begin (b) Based on this calculation, the commissioner shall determine annually a savings
offset amount to be paid by health plan companies and third-party administrators. The
aggregate savings reinvestment amount may not exceed 33 percent of the aggregate
savings reflected in the difference between the actual spending and the projected spending.
new text end

new text begin Subd. 3. new text end

new text begin Publication of spending. new text end

new text begin The commissioner shall publish in the State
Register by June 15 of each year, beginning June 15, 2010, the projected spending
baseline, including any adjustments, and the actual spending for the preceding year.
new text end

new text begin Subd. 4. new text end

new text begin Savings reinvestment assessments. new text end

new text begin (a) Health plan companies and
third-party administrators shall pay a health savings reinvestment assessment. The
commissioner shall calculate the savings reinvestment assessments as a percentage of
paid claims as follows:
new text end

new text begin (1) for health plan companies, the health savings reinvestment assessment may not
exceed four percent of annual paid health care claims on policies that insure residents of
this state; and
new text end

new text begin (2) for third-party administrators, the health savings reinvestment assessment may
not exceed four percent of annual paid claims for health care for residents of this state.
new text end

new text begin (b) A health plan company shall not be required to pay a health savings reinvestment
assessment on policies or contracts insuring federal employees.
new text end

new text begin (c) Health savings reinvestment assessments shall apply to claims paid for plan
years beginning on or after January 1, 2010.
new text end

new text begin (d) Health savings reinvestment assessments must be made quarterly to the
commissioner of revenue within 60 days of the close of each quarter, beginning June
15, 2010.
new text end

new text begin Subd. 5. new text end

new text begin Deposit of assessments. new text end

new text begin The commissioner of revenue shall deposit
the revenue derived from the assessments into the health savings reinvestment fund
established under section 16A.727.
new text end

Sec. 26.

new text begin [62U.14] COST CONTAINMENT GOALS; CONTINGENT
EXPANSION TO MINNESOTA CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Cost containment goals. new text end

new text begin Based on the projected spending baseline
calculated under section 62U.13, subdivision 1, the following annual cost containment
goals for public and private spending on health care services for Minnesota residents
are established:
new text end

new text begin (1) for calendar year 2009, the cost containment goal is the baseline projected
spending growth for 2009 established in section 62U.13 less one percentage point;
new text end

new text begin (2) for calendar year 2010, the cost containment goal is the baseline projected
spending growth for 2010 less 1.5 percentage points;
new text end

new text begin (3) for calendar years 2011 and 2012, the cost containment goal is the baseline
projected spending growth for 2011 and 2012 less two percentage points; and
new text end

new text begin (4) for calendar years after 2012, the cost containment goal is the projected baseline
spending for 2013 less 2.5 percentage points.
new text end

new text begin Subd. 2. new text end

new text begin Contingent expansion of MinnesotaCare. new text end

new text begin (a) By June 1, 2010, the
commissioner of health shall report to the commissioner of human services and the
legislature on whether the cost containment goal for 2009 was met. If the goal was met,
the commissioner of human services shall implement the eligibility expansion to the
MinnesotaCare program for individuals and families with children up to 300 percent of
federal poverty guidelines, to be effective July 1, 2010.
new text end

new text begin (b) If the cost containment goal has not been met, the legislature shall consider an
eligibility expansion to the MinnesotaCare program based on available funding.
new text end

new text begin (c) The commissioner of health shall submit a plan to the legislature by January 15,
2013, if the cost containment goals established in this section have been met and the
uninsured rate for Minnesota residents is greater than three percent. The plan must include
efforts that will increase coverage to at least 97 percent insured, including an individual
responsibility requirement.
new text end

Sec. 27.

new text begin [62U.15] AFFORDABILITY STANDARD.
new text end

new text begin Subdivision 1. new text end

new text begin Definition of affordability. new text end

new text begin For purposes of this section, coverage is
"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an
individual or family for health coverage does not exceed the applicable percentage of the
individual or family's gross monthly income specified in subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Incomes up to 300 percent of the federal poverty guidelines. new text end

new text begin The
following affordability standard is established for individuals and households with gross
family incomes of 300 percent of the federal poverty guidelines or less:
new text end

new text begin new text begin AFFORDABILITY STANDARDnew text end
new text end
new text begin Federal Poverty
Guideline Range
new text end
new text begin Percent of Average Gross
Monthly Income
new text end
new text begin 0-33%
new text end
new text begin minimum
new text end
new text begin 33-54%
new text end
new text begin 1.1%
new text end
new text begin 55-81%
new text end
new text begin 1.4%
new text end
new text begin 82-109%
new text end
new text begin 1.9%
new text end
new text begin 110-136%
new text end
new text begin 2.6%
new text end
new text begin 137-164%
new text end
new text begin 3.4%
new text end
new text begin 165-191%
new text end
new text begin 4.4%
new text end
new text begin 192-219%
new text end
new text begin 5.2%
new text end
new text begin 220-248%
new text end
new text begin 5.9%
new text end
new text begin 248-274%
new text end
new text begin 6.5%
new text end
new text begin 275-300%
new text end
new text begin 7.0%
new text end

new text begin Subd. 3. new text end

new text begin Incomes greater than 300 percent but not exceeding 400 percent of the
federal poverty guidelines.
new text end

new text begin For purposes of determining affordability, the affordability
standard for individuals and households with gross family incomes greater than 300
percent but not exceeding 400 percent of the federal poverty guidelines shall be based
on a continuation of the sliding scale specified in subdivision 2, with the percentage of
average gross monthly income rising proportionately at each income range, to a maximum
of 10.0 percent.
new text end

Sec. 28.

new text begin [62U.16] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED
HEALTH COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment of subsidy program. new text end

new text begin The commissioner of
human services shall establish a subsidy program for eligible employees with access to
employer-subsidized health coverage. For purposes of this section, employer-subsidized
health coverage has the meaning provided in section 256L.07, subdivision 2, paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Eligible employees. new text end

new text begin In order to be eligible for a subsidy under this section,
an employee must:
new text end

new text begin (1) be covered by employer-subsidized health coverage that meets or is actuarially
equivalent to the benefit set and design established by the Health Care Transformation
Commission; and
new text end

new text begin (2) meet all eligibility criteria for the MinnesotaCare program established under
chapter 256L, except for the requirements related to:
new text end

new text begin (i) no access to employer-subsidized coverage under section 256L.07, subdivision
2; and
new text end

new text begin (ii) no other health coverage under section 256L.07, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Amount of subsidy. new text end

new text begin The subsidy shall equal the amount the employee
is required to pay for health coverage, including premiums, deductibles, and other cost
sharing, minus an amount based on the affordability standard specified in section 62U.15.
The maximum subsidy shall not exceed the amount of the subsidy that would have been
provided under the MinnesotaCare program, if the employee and any dependents were
eligible for that program.
new text end

new text begin Subd. 4. new text end

new text begin Payment of subsidy. new text end

new text begin The commissioner shall pay the subsidy amount for
an employee and any dependents to the Minnesota Health Insurance Exchange, and this
payment shall be credited towards the employee's share of premium. Any additional
amount paid by the commissioner to the Minnesota Health Insurance Exchange that
exceeds the employee's share of premium shall be credited first towards the employee
deductible and then towards any employee cost-sharing obligation.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 29.

Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision
to read:


new text begin Subd. 27. new text end

new text begin Exchange of data. new text end

new text begin An entity that is part of the welfare system as defined
in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance
Exchange under section 62U.02 may exchange private data on individuals relating to
family size, income, and eligibility for premium discounts in order to determine and
collect premiums from individuals in the MinnesotaCare program under chapter 256L.
This subdivision only applies if the entity that is part of the welfare system and the
Minnesota Health Insurance Exchange have entered into an agreement that complies with
the requirements in Code of Federal Regulations, title 45, section 164.314.
new text end

Sec. 30. new text begin APPROPRIATION.
new text end

new text begin $20,000,000 is appropriated in fiscal year 2009 from the health care access fund to
the Health Care Transformation Commission. This is a onetime appropriation.
new text end

Sec. 31. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, sections 62A.63; 62A.64; 62Q.49; 62Q.65; and 62Q.736, new text end new text begin
are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010.
new text end