SF 3099

8th Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

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; providing for registration of health insurance access brokers;
providing for fund transfers; providing for health care payment restructuring
system; 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; providing for fees; 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, subdivision
4; 62Q.735, subdivision 1; 144.1501, subdivision 2, by adding a subdivision;
256.01, by adding a subdivision; 256B.69, 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
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, subdivisions 1, 2; Laws 2007, chapter 147, article 5, section 19;
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. Notwithstanding section 11A.20, all
investment income and all investment losses attributable to the investment of the health
improvement fund not currently needed must 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 must 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 Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this
section.
new text end

new text begin (b) "Commissioner" means the commissioner of commerce for nonprofit health
plan companies subject to the jurisdiction of the commissioner of commerce, and the
commissioner of health for nonprofit health plan companies subject to the jurisdiction
of the commissioner of health.
new text end

new text begin (c) "Hospital" means a hospital that is required to report to the commissioner of
health under section 144.698, except facilities of the federal Indian Health Service,
Veterans Administration, and state-operated facilities.
new text end

new text begin (d) "Net patient revenue" means net patient revenue, as reported by the hospital to
the health care cost information system under section 144.698 for the fiscal year ending in
the calendar year two years before the current calendar year, excluding net Medicare and
Medicaid revenue.
new text end

new text begin (e) "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 (f) "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 that
is normally one month, excluding premiums paid to a nonprofit health plan company
from the Federal Employees Health Benefit Program and revenues received from the
Department of Human Services for state health care programs; and
new text end

new text begin (2) premiums from Medicare wraparound subscribers for health benefits that
supplement Medicare coverage.
new text end

new text begin Subd. 2. new text end

new text begin Hospital assessment. new text end

new text begin (a) By June 1, 2009, each hospital shall pay to the
commissioner of health a public health improvement assessment equal to 0.15 percent
of net patient revenue. The commissioner shall credit the assessment 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 hospital shall pay to the
commissioner of health a public health improvement assessment determined by the
commissioner under subdivision 4. The commissioner shall credit the assessment to the
health improvement fund.
new text end

new text begin (c) The commissioner shall notify each hospital by May 1 of each year of the
assessment 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 assessment
due, the commissioner may estimate net patient revenue for the purposes of this section
until actual data is available, and must make any necessary adjustments.
new text end

new text begin (d) Assessments under this section may be applied toward a hospital's community
benefit as reported under section 144.699. Nothing in this section requires a hospital to
increase its total level of community benefit beyond its current level.
new text end

new text begin Subd. 3. 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 pay to the commissioner of health a public health improvement
assessment equal to 0.15 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 pay to the commissioner of health a public health improvement assessment
determined by the commissioner under subdivision 4. The commissioner shall credit the
assessment to the health improvement fund.
new text end

new text begin (c) The commissioner of health shall notify each nonprofit health plan company by
May 1 of each year of the assessment 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 assessment due, the commissioner of health may estimate total
premium revenue for the purposes of this section until actual data is available, and must
make any necessary adjustments.
new text end

new text begin (d) Assessments under this section may be applied toward a nonprofit health plan
company's community benefit requirements. Nothing in this section requires a nonprofit
health plan company to increase its total level of community benefit beyond its current
level.
new text end

new text begin Subd. 4. new text end

new text begin Assessment percentage, 2010 and thereafter. new text end

new text begin The amount assessed
in year 2010 and thereafter is $40,000,000 each year, divided among hospitals under
subdivision 2 in proportion to their net patient revenue and among nonprofit health
plan companies under subdivision 3 in proportion to their total premium revenue. The
commissioner of health shall determine the share to be assessed against hospitals and the
share to be assessed against nonprofit health plan companies and shall set the assessment
as the same percentage of net patient revenue for each hospital and the same percentage
of total premium revenue for each nonprofit health plan company, provided that the
percentage assessed must not be more than 0.3 percent of net patient revenue for hospitals
or 0.3 percent of total premium revenue for nonprofit health plan companies.
new text end

new text begin Subd. 5. 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

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 encourage 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
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 state health care program enrollees, 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 or criteria established by a
managed care plan if the criteria has been approved by the commissioner.
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 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 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
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, as a full member of the
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, maintain, and ensure implementation of a comprehensive care plan for each
enrollee who has or who is at risk of developing a complex or chronic condition based
upon the comprehensive health assessment, health history, tests, and other information.
The comprehensive care plan must meet the 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 (a) Health care homes must directly manage or
employ care coordinators to manage the care provided to patients with complex or chronic
conditions specified by the commissioners.
new text end

new text begin (b) Care coordination includes:
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;
new text end

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

new text begin (6) overseeing the development, maintenance, and implementation of care plans.
new text end

new text begin (c) Care coordination must meet the criteria as specified by the commissioner.
new text end

new text begin Subd. 8. new text end

new text begin Health care home collaborative. new text end

new text begin Health care homes must participate in
the health care home collaborative described in section 256B.0754, subdivision 4, and as
required by the commissioner for certification.
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 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

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 and 2 are effective July 1, 2009, or upon
federal approval, whichever is later.
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, organizations with expertise in care
coordination models , 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) 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 (d) 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 under paragraph (c), 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. Managed care plans
shall require health care homes to develop, maintain, and ensure the implementation of
a comprehensive care plan for each enrollee who has or who is at risk of developing a
complex or chronic condition based on the comprehensive health assessment, health
history, tests, and other relevant information.
new text end

new text begin (e) The commissioner, beginning July 1, 2009, shall implement financial
arrangements for managed care plans to ensure that plans encourage each enrollee who has
or who is at risk of developing a complex or chronic health condition to choose a certified
primary care clinic or medical group 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

ARTICLE 3

INCREASING ACCESS; CONTINUITY OF CARE

Section 1.

Minnesota Statutes 2006, section 144.1501, subdivision 2, is amended to
read:

Subd. 2.

Creation of account.

(a) A health professional education loan forgiveness
program account is established.

new text begin (b) new text end The commissioner of health shall use money from the account to establish a
loan forgiveness program:

(1) for medical residents agreeing to practice in designated rural areas or underserved
urban communities or specializing in the area of pediatric psychiatry;

(2) for midlevel practitioners agreeing to practice in designated rural areas or to
teach for at least 20 hours per week in the nursing field in a postsecondary program;

(3) for nurses who agree to practice in a Minnesota nursing home or intermediate
care facility for persons with developmental disability or to teach for at least 20 hours per
week in the nursing field in a postsecondary program;

(4) for other health care technicians agreeing to teach for at least 20 hours per week
in their designated field in a postsecondary program. The commissioner, in consultation
with the Healthcare Education-Industry Partnership, shall determine the health care fields
where the need is the greatest, including, but not limited to, respiratory therapy, clinical
laboratory technology, radiologic technology, and surgical technology; new text begin and
new text end

(5) for pharmacists who agree to practice in designated rural areas deleted text begin ; and deleted text end new text begin .
new text end

new text begin (c) The commissioner shall use money from the account allocated for dental loan
forgiveness:
new text end

deleted text begin (6) deleted text end new text begin (1) new text end for dentists deleted text begin agreeing deleted text end new text begin who: (i) agree new text end to deliver at least deleted text begin 25 deleted text end new text begin 20 new text end percent of the
dentist's yearly patient encounters to state public program enrollees or patients receiving
sliding fee schedule discounts through a formal sliding fee schedule meeting the standards
established by the United States Department of Health and Human Services under Code of
Federal Regulations, title 42, section 51, chapter 303 new text begin , or (ii) have been trained in a foreign
country, received a dental license from the Board of Dentistry, and who agree to provide
services for a nonprofit organization, community clinic, or federally qualified health clinic
in Minnesota for a period of at least three years; and
new text end

new text begin (2) for the dental school scholarship program under subdivision 7 new text end .

deleted text begin (b) deleted text end new text begin (d) new text end Appropriations made to the account do not cancel and are available until
expended, except that at the end of each biennium, any remaining balance in the account
that is not committed by contract and not needed to fulfill existing commitments shall
cancel to the fund.

Sec. 2.

Minnesota Statutes 2006, section 144.1501, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Dental school student scholarship program. new text end

new text begin The commissioner may
award up to three scholarships each year to:
new text end

new text begin (1) foreign-trained dental students who enroll in the Program for Advanced Standing
Students at the University of Minnesota School of Dentistry and who agree upon
graduation from the program and upon licensure by the Board of Dentistry to provide
dental services in Minnesota for a nonprofit organization, community clinic, or federally
qualified community health center for a period of at least three years; or
new text end

new text begin (2) current dental school students who agree after graduation to provide dental
services in Minnesota for a nonprofit organization, community clinic, or federally qualified
community health center for a period of at least three years.
new text end

new text begin Scholarships awarded under the program must be at least $30,000 each year that the
graduates provide care under the scholarship agreement.
new text end

Sec. 3.

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. 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. 4.

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 $20 deleted 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. 5.

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 a deleted text end new text begin the new text end free deleted text begin or deleted text end new text begin and new text end reduced
deleted text begin priced deleted text end new text begin school new text end lunch new text begin program new 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. 6.

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 and deleted 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) 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 (d) are 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 $10,000 deleted text end new text begin $20,000 new 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 $10,000 deleted text end new text begin $20,000 new 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 $10,000 deleted text end new text begin $20,000 new 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 275 deleted text end new text begin 300 new 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 July deleted text end new text begin January new 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 215 deleted text end new text begin 300 new 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 for deleted 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 3 deleted 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 275 deleted text end new text begin 300 new 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 215 deleted text end new text begin 300 new text end
percent of the federal poverty guidelines on or after deleted text begin July deleted text end new text begin January new 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 1, is
amended to read:

Subdivision 1.

Premium determination.

(a) Families with children and individuals
shall pay a premium determined according to subdivision 2.

(b) Pregnant women and children under age two are exempt from the provisions
of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
for failure to pay premiums. For pregnant women, this exemption continues until the
first day of the month following the 60th day postpartum. Women who remain enrolled
during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
disenrolled on the first of the month following the 60th day postpartum for the penalty
period that otherwise applies under section 256L.06, unless they begin paying premiums.

(c) Members of the military and their families who meet the eligibility criteria
for MinnesotaCare upon eligibility approval made within 24 months following the end
of the member's tour of active duty shall have their premiums paid by the commissioner.
The effective date of coverage for an individual or family who meets the criteria of this
paragraph shall be the first day of the month following the month in which eligibility is
approved. This exemption applies for 12 months. deleted text begin This paragraph expires June 30, 2010.
deleted text end

Sec. 17.

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 Families deleted text end new text begin Children new text end whose gross income is above deleted text begin 275 deleted text end new text begin 300 new 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 and parents with income at or below 100 percent of federal poverty
guidelines shall not pay a monthly premium.
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. 18.

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. 19.

Laws 2007, chapter 147, article 5, section 19, the effective date, is amended to
read:

EFFECTIVE DATE.

This section is effective July 1, deleted text begin 2007, or upon federal
approval, whichever is later deleted text end new text begin 2008 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.

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

new text begin Subdivision 1. new text end

new text begin Created. 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 all revenue from the health savings reinvestment
assessment under section 62U.13.
new text end

new text begin Subd. 2. new text end

new text begin Transfer; appropriation. new text end

new text begin (a) On July 1 of each year, beginning in year
2010, the commissioner of finance shall transfer from the health savings reinvestment fund
to the general fund an amount equal to the loss of income tax revenue for the immediately
preceding calendar year attributable to the use of Section 125 Plans under section 62U.03
as determined by the commissioner of revenue. The amount necessary to make the transfer
is appropriated from the health savings reinvestment fund to the commissioner of finance.
new text end

new text begin (b) Any balance in the fund remaining after the transfer under paragraph (a) is
available for direct appropriation by law.
new text end

Sec. 3.

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. 4.

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 plan new 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. 5.

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. 6.

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. 7.

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

Subdivision 1.

Required disclosure of estimated deleted text begin payment deleted text end new text begin out-of-pocket costs new 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. 8.

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 charge deleted text end new text begin price new text end information, including, but not limited to, number of discharges,
average length of stay, average deleted text begin charge deleted text end new text begin price new text end , average deleted text begin charge deleted text end new text begin price new text end per day, and median
deleted text begin charge deleted text end new text begin price new 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. 9.

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. 10.

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. 11.

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. This definition shall not
be used to exclude or deny technology or treatment necessary to preserve life on the basis
of an individual's age or expected length of life or of the individual's present or predicted
disability, degree of medical dependency, or quality of life.
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 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. 7. 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. 8. 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. 9. 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. 10. 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. 11. 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. 12. 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. 13. 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. 14. 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. 12.

new text begin [62U.02] HEALTH INSURANCE ACCESS BROKERS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin Any corporation authorized to do business in the
state may apply to the commissioner of commerce for registration as a health insurance
access broker to establish and operate a health insurance access broker under this section.
new text end

new text begin Subd. 2. new text end

new text begin Registration criteria. new text end

new text begin (a) In order to be registered as a health insurance
access broker, a corporation must submit an application to the commissioner of commerce
on a form prescribed by the commissioner and provide evidence to the satisfaction of the
commissioner that the applicant meets the following requirements:
new text end

new text begin (1) is licensed under chapter 60K to sell health and life insurance;
new text end

new text begin (2) has sufficient knowledge of health insurance, the health insurance market, and of
the federal and state laws that are relevant to health insurance;
new text end

new text begin (3) has the ability to assist clients in enrolling in private health coverage by offering
a range of private health plan products from at least four health plan companies;
new text end

new text begin (4) agrees to provide applications and information on how to obtain application
assistance for clients who may be eligible for state health care programs;
new text end

new text begin (5) has the capacity to transact the establishment and administration of Section 125
Plans on behalf of an employer;
new text end

new text begin (6) provides a range of services and transparent information on coverage options
for current and potential clients, including, but not limited to, providing information by
telephone, e-mail, and Web based;
new text end

new text begin (7) the ability to assist employees in understanding health plan coverage options and
in enrolling in appropriate coverage; and
new text end

new text begin (8) has the financial and transactional ability to collect, hold, and disperse funds on
behalf of clients, employers, or health plan companies.
new text end

new text begin (b) The commissioner of commerce may establish a fee to be paid by applicants
and submitted with the application to cover the cost of registration and the cost of the
online registry established under subdivision 4. The fee shall be deposited in the state
government special revenue fund.
new text end

new text begin Subd. 3. new text end

new text begin Duties by the commissioner of commerce. new text end

new text begin The commissioner of
commerce shall provide oversight of the health insurance access brokers registered under
this section to ensure that the brokers continue to meet the requirements of this section
and to provide consumer protection. The commissioner may require registered health
insurance access brokers to submit periodic reports to the commissioner as specified by
the commissioner.
new text end

new text begin Subd. 4. new text end

new text begin Online registry. new text end

new text begin The commissioner shall establish a Web-based registry
of registered health insurance access brokers, and shall make the registry available to
the public, upon request.
new text end

Sec. 13.

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 Subd. 2. new text end

new text begin Section 125 Plan requirement. new text end

new text begin (a) Effective July 1, 2009, all employers
with 11 or more current full-time equivalent 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.
new text end

new text begin The following employers are exempt from the Section 125 Plan requirement:
new text end

new text begin (1) employers that offer a group health insurance plan as defined in section 62A.10;
new text end

new text begin (2) employers that are self-insured as defined in section 62E.02; or
new text end

new text begin (3) employers with no employees who are eligible to participate in a Section 125
Plan.
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 July 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 commissioner of commerce, in
consultation with the commissioners of 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 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. 14.

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 (d) For the purposes of section 10A.09, members of the commission are public
officials and must file a statement of economic interest as required under that section.
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) Expenses shall be compensated in accordance with section 15.0575.
new text end

new text begin (d) The commission may appoint an executive director who, if appointed, shall:
new text end

new text begin (1) be a state employee;
new text end

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

new text begin (3) hire and supervise staff for the commission.
new text end

new text begin Subd. 4. new text end

new text begin Advisory committee established; responsibilities of the advisory
committee and commission. new text end

new text begin (a) There is established an advisory committee to the
commission whose membership shall include, but not be limited to, the following
members:
new text end

new text begin (1) two members appointed by the Minnesota Medical Association;
new text end

new text begin (2) two members appointed by the Minnesota Council on Health Plans;
new text end

new text begin (3) two members appointed by the Minnesota Hospital Association, at least one of
which must be a rural hospital administrator;
new text end

new text begin (4) two members appointed by the Minnesota Medical Group Managers Association;
new text end

new text begin (5) one member appointed by the Minnesota Business Partnership; and
new text end

new text begin (6) one member appointed by the Minnesota Chamber of Commerce.
new text end

new text begin The appointing authorities under this paragraph must complete their appointments no
later than July 30, 2008.
new text end

new text begin (b) The representatives from the Minnesota Hospital Association shall convene the
first meeting of the advisory committee no later than 30 days following the completion
of appointments under paragraph (a). The advisory group may accept staff support and
use meeting facilities provided by the Minnesota Hospital Association. The committee
shall select a chair at its first meeting. At any time, the committee may appoint additional
members by majority vote of the entire committee.
new text end

new text begin (c) The advisory committee shall advise on 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 (d) In developing the payment restructuring system described in this chapter, the
advisory committee 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 (e) The advisory committee shall submit the design and implementation plan to
the commission for review and adoption.
new text end

new text begin (f) By July 1, 2009, the commission shall make recommendations to the governor
and the chairs and ranking minority members of the legislative committees and divisions
with jurisdiction over 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 a successful transformation of the
health care system.
new text end

new text begin (g) The commission and the advisory committee 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 (h) The advisory committee expires July 1, 2012.
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. 15.

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 first meeting of 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. 16.

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. 17.

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

new text begin (c) The committee's recommendation may not limit the use of a health technology
necessary to preserve life on the basis of an individual's age or expected length of life
or of an individual's present or predicted disability, degree of medical dependency, or
quality of life.
new text end

Sec. 18.

new text begin [62U.08] PAYMENT RESTRUCTURING: INCENTIVE PAYMENTS
BASED ON QUALITY 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 January 1, 2009, the Health Care
Transformation Commission shall develop a system of quality incentive payments that
link the level of payments to providers to the quality of care. 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 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 incentive payments that are in
addition to existing payment levels;
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 measures;
new text end

new text begin (6) to the greatest extent possible, quality measures must be adjusted for variation
in patient population; and
new text end

new text begin (7) other indicators of care quality may be incorporated where appropriate. These
indicators may include care infrastructure, collection and reporting of results, 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 July 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. 19.

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 directly managing onsite or 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 payment system may vary the fees paid 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 may 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-based incentive payments. new text end

new text begin The care coordination fees paid under
this section are in addition to the quality incentive payments in section 62U.08.
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. 20.

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 (a) By January 15, 2009, the Health Care
Transformation Commission shall report to the legislature recommendations for advancing
an innovative payment system for the chronic conditions of coronary artery and heart
disease, diabetes, asthma, chronic obstructive pulmonary disease, and depression.
new text end

new text begin (b) By January 15, 2010, the Health Care Transformation Commission shall report to
the legislature additional changes necessary to accomplish comprehensive payment reform
designed to support an innovative payment system to reduce costs and improve quality.
new text end

new text begin (c) By January 1, 2011, the Health Care Transformation Commission shall develop
rules to implement a comprehensive payment system that encourages provider innovation
to reduce costs and improve 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, 2009, 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 the 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 exclude the costs of catastrophic cases and must include risk adjustments
to reflect 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) Beginning April 1, 2010, 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 and quality of care, and separately for the conditions
of coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
disease, and depression. In developing this system, the commission shall consult and
coordinate with health care providers, health plan companies, and organizations that work
to improve health care quality in Minnesota.
new text end

new text begin Subd. 4. new text end

new text begin Chronic care package pricing and 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 package
prices for the total cost of care or separately for the conditions of coronary artery and heart
disease, diabetes, asthma, chronic obstructive pulmonary disease, or depression. 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, 2010, and annually thereafter, using the information developed
in subdivision 3, providers may submit package prices to the commission for the cost of
providing all necessary services to a patient or separately for the cost of providing services
for patients with the chronic conditions of coronary artery and heart disease, diabetes,
asthma, chronic obstructive pulmonary disease, or depression based on their disclosed
prices under section 62U.11 combined with their actual risk-adjusted resource use for the
most recent analytic period. The package prices submitted must reflect the providers'
commitment to manage their risk-adjusted patient population within this cost.
new text end

new text begin (c) Until January 1, 2013, no provider shall submit a package price for the
risk-adjusted cost of care that represents an increase of more than the increase in the
previous calendar year's Consumer Price Index for all urban consumers plus two
percentage points or a decrease of more than 15 percent below the provider's risk-adjusted
cost of care calculated based on their average pricing levels for the previous calendar year.
new text end

new text begin (d) Beginning January 1, 2011, the commission shall annually publish the results
of the process described in paragraph (b), and shall include only providers who choose
to submit package prices. The results that are published must be on a risk-neutral basis.
Effective January 1, 2012, the published results shall include all providers. For providers
that have not submitted package prices, these results must be based on their weighted
average contract prices for all health plan companies and third-party administrators,
combined with their risk-adjusted historic resource use.
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 package prices for the
risk-adjusted cost of care for the total cost of care and separately for the conditions
of coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
disease, and depression.
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 package price shall be paid for their total cost of care or separately
for their cost of care in treating patients with the conditions of coronary artery and
heart disease, diabetes, asthma, chronic obstructive pulmonary disease, and depression.
The method must include periodic adjustments to payments to reflect providers' actual
risk-adjusted cost relative to their package price.
new text end

new text begin Subd. 7. new text end

new text begin Implementation. new text end

new text begin By January 1, 2012:
new text end

new text begin (1) the commissioner of human services shall pay providers based on their package
prices for all enrollees in the state's public health care programs;
new text end

new text begin (2) the commissioner of employee relations shall pay providers based on their
package prices for participants in the state employee group 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 pay providers based on their package prices 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 products 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. 21.

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

new text begin (a) Beginning July 1, 2009, and annually thereafter, each physician clinic and
hospital shall establish a list of prices for each health care procedure, service, package of
services, 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. Providers may
update this periodically to reflect new services, supply cost changes, and other factors.
new text end

new text begin (b) The Health Care Transformation Commission shall develop a plan that requires
all health care providers to comply with paragraph (a) beginning January 1, 2010.
new text end

new text begin (c) 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 Committee.
new text end

Sec. 22.

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

new text begin (a) Effective July 1, 2010, 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 apply to workers' compensation or no-fault automobile
insurance payments.
new text end

new text begin (d) 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. 23.

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 and long-term care spending must 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 reinvestment
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
reinvestment 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 follows:
new text end

new text begin (1) for health plan companies, the health savings reinvestment assessment must be
based on a percentage 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 must
be a fee placed on the third-party administrator for each insured resident of the state in
which the third-party administrator administered benefits for health care.
new text end

new text begin (b) A health plan company is not required to pay a health savings reinvestment
assessment on policies or contracts insuring federal employees or Medicare beneficiaries,
except private supplemental coverage.
new text end

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

new text begin (d) Health savings reinvestment assessments must be paid quarterly to the
commissioner of revenue within 60 days after the close of each quarter, beginning no
later than May 30, 2010.
new text end

new text begin Subd. 5. new text end

new text begin Credit of assessments. new text end

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

Sec. 24.

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.
new text end

Sec. 25.

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. For individuals
and families with pretax income, the determination of "affordability" for purposes of this
section shall compare the net cost of health coverage that includes pretax savings to the
applicable percentage of the individual's or family's gross monthly income.
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 STANDARD new 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. 26.

new text begin [62U.16] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED
HEALTH COVERAGE PLAN.
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 develop a plan for 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 plan,
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 in the plan 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 As part of the plan, the commissioner shall pay the
subsidy amount for an employee and any dependents to the employer, and this payment
shall be credited towards the employee's share of premium.
new text end

new text begin Subd. 5. new text end

new text begin Report. new text end

new text begin The commissioner shall submit the plan creating the subsidy
program to the legislature by January 15, 2009, for implementation by July 1, 2009.
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. 27. 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

ARTICLE 5

APPROPRIATIONS

Section 1. new text begin SUMMARY OF APPROPRIATIONS. new text end

new text begin The amounts shown in this section summarize direct appropriations, by fund, made
in this article.
new text end

				new text begin 2009 new text end		new text begin Total new text end
new text begin General Fund new text end			new text begin $ new text end	new text begin 200,000 new text end	new text begin $ new text end	new text begin 200,000 new text end
new text begin Health Care Access Fund new text end				new text begin 39,113,000 new text end		new text begin 39,113,000 new text end
new text begin Health Improvement Fund new text end				new text begin 20,000,000 new text end		new text begin 20,000,000 new text end
new text begin Total new text end			new text begin $ new text end	new text begin 59,313,000 new text end	new text begin $ new text end	new text begin 59,313,000 new text end

Sec. 2. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS. new text end

new text begin The sums shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, subtracted from the appropriations in Laws 2007, chapter 147,
article 19, or other law to the agencies and for the purposes specified in this article. The
appropriations are from the general fund, or another named fund, and are available for
the fiscal year indicated for each purpose. The figure "2009" used in this article means
that the addition to or subtraction from the appropriation listed under it is available for the
fiscal year ending June 30, 2009.
new text end

			new text begin APPROPRIATIONS new text end
			new text begin Available for the Year new text end
			new text begin Ending June 30 new text end
						new text begin 2009 new text end

Sec. 3. new text begin HUMAN SERVICES new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 9,725,000 new text end

new text begin Appropriations by Fund new text end
		new text begin 2009 new text end
new text begin General Fund new text end		new text begin 200,000 new text end
new text begin Health Care Access Fund new text end		new text begin 9,525,000 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end new text begin Children and Economic Assistance Management new text end

new text begin Health Care Access new text end

new text begin 6,000 new text end

new text begin This is a onetime appropriation.
new text end

new text begin Subd. 3. new text end new text begin Basic Health Care Grants new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) MinnesotaCare Grants new text end

new text begin Health Care Access new text end

new text begin 4,435,000 new text end

new text begin Medical Assistance Basic Health Care Grants; Families and Children new text end

new text begin General Fund new text end

new text begin 200,000 new text end

new text begin new text begin Primary Care Physician Rate Increases. new text end
(a) Of the general fund appropriation,
$200,000 is to the commissioner for the
medical assistance reimbursement rate
increase described in Minnesota Statutes,
section 256B.766.
new text end

new text begin (b) Notwithstanding Minnesota Statutes,
section 295.581, the commissioner of finance
shall reimburse the medical assistance
general fund account from the health
care access fund the amount of general
fund expenditures for this activity. The
amount reimbursed under this paragraph is
appropriated to the commissioner.
new text end

new text begin (c) Other Health Care Grants new text end

new text begin Health Care Access new text end

new text begin 850,000 new text end

new text begin new text begin Mobile Dental Unit. new text end (a) Of the health care
access fund appropriation, $500,000 is to be
awarded as a grant to a nonprofit organization
to operate a mobile dental unit within the
seven-county metropolitan area for treating
the dental needs of underserved children and
adults with a comprehensive approach of
education, treatment, and follow-up routine
visits. The organization must show viable
partnerships with the dental community,
community-based organizations, and local
school districts. The services provided by the
organization must include:
new text end

new text begin (1) identifying and treating children with
untreated dental conditions at locations with
the community;
new text end

new text begin (2) educating children and their families
about oral health diseases and the importance
and benefits of a preventive oral health care
program; and
new text end

new text begin (3) connecting local dental health care
professionals and organizations with
underserved children for follow-up and
ongoing dental care services.
new text end

new text begin (b) The organization must report to the
commissioner by January 15, 2010, the
number of children served by the mobile
unit, the services provided by the unit, the
locations where children were served, and if
follow-up services were provided.
new text end

new text begin This is a onetime appropriation.
new text end

new text begin new text begin Open Door Health Center. new text end Of the health
care access fund appropriation, $350,000 is
to be awarded as a grant to the Open Door
Health Center to act as a bridge funding to
meet the demand for health care services
in medically underserved areas. This is a
onetime appropriation.
new text end

new text begin new text begin Subsidies for Employer-Subsidized Health
Coverage. new text end For the biennium beginning July
1, 2009, base level funding for the subsidy
program described in Minnesota Statutes,
section 62U.16, shall be $20,000,000 from
the health care access fund for the first year
and $35,000,000 from the health care access
fund for the second year.
new text end

new text begin Base Adjustment. new text end new text begin The health care access
fund base is increased by $19,150,000
in fiscal year 2010 and increased by
$34,150,000 in fiscal year 2011.
new text end

new text begin Subd. 4. new text end new text begin Health Care Management new text end

new text begin The amounts that may be spent from the
appropriation for each purpose are as follows:
new text end

new text begin (a) Health Care Policy Administration new text end

new text begin Health Care Access new text end

new text begin 182,000 new text end

new text begin Base Adjustment. new text end new text begin The health care access
fund is increased by $111,000 in fiscal year
2010 and decreased by $171,000 in fiscal
year 2011.
new text end

new text begin Base Adjustment. new text end new text begin The general fund base is
increased by $2,121,000 in fiscal year 2010
and increased by $1,792,000 in fiscal year
2011.
new text end

new text begin (b) Health Care Operations new text end

new text begin Health Care Access new text end

new text begin 3,248,000 new text end

new text begin Incentive Program and Outreach Grants.
Of the appropriation for the Minnesota health
care outreach program in Laws 2007, chapter
147, article 19, section 3, subdivision 7,
paragraph (b):
new text end

new text begin (1) $400,000 in fiscal year 2009 from the
general fund and $200,000 in fiscal year 2009
from the health care access fund are for the
incentive program under Minnesota Statutes,
section 256.962, subdivision 5. For the
biennium beginning July 1, 2009, base level
funding for this activity shall be $360,000
from the general fund and $160,000 from the
health care access fund; and
new text end

new text begin (2) $100,000 in fiscal year 2009 from the
general fund and $50,000 in fiscal year 2009
from the health care access fund are for the
outreach grants under Minnesota Statutes,
section 256.962, subdivision 2. For the
biennium beginning July 1, 2009, base level
funding for this activity shall be $90,000
from the general fund and $40,000 from the
health care access fund.
new text end

new text begin new text begin Outreach Funding. new text end (a) Of the health care
access fund appropriation, $100,000 is for
the incentive program under Minnesota
Statutes, section 256.962, subdivision 5.
This is in addition to the base level fund
for the biennium beginning July 1, 2009.
For the fiscal year beginning July 1, 2011,
appropriations for this activity shall be from
the health savings reinvestment fund.
new text end

new text begin (b) Notwithstanding Minnesota Statutes,
section 295.581, the commissioner of finance
shall reimburse the medical assistance
general fund account from the health care
access fund by $701,000 in fiscal year 2010
and $1,527,000 in fiscal year 2011 for the
cost to the general fund for the increase in
enrollment to the medical assistance program
for families with children due to the outreach
efforts.
new text end

new text begin Base Adjustment. new text end new text begin The health care access
fund base is decreased by $979,000 in fiscal
year 2010 and increased by $556,000 in
fiscal year 2011.
new text end

new text begin Subd. 5. new text end new text begin Continuing Care Management new text end

new text begin Health Care Access new text end

new text begin 804,000 new text end

new text begin new text begin Long-Term Care Worker Health Coverage
Study. new text end (a) Of the health care access
fund appropriation, $804,000 is for the
commissioner to 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 developmental disabilities,
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

new text begin This is a onetime appropriation.
new text end

Sec. 4. new text begin COMMISSIONER OF HEALTH new text end

new text begin Subdivision 1. new text end new text begin Total Appropriation new text end

new text begin $ new text end

new text begin 49,588,000 new text end

new text begin Appropriations by Fund new text end
		new text begin 2009 new text end
new text begin Health Care Access new text end		new text begin 21,588,000 new text end
new text begin Health Improvement new text end		new text begin 20,000,000 new text end

new text begin The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end

new text begin Subd. 2. new text end new text begin Community and Family Health Promotion new text end

new text begin Health Improvement new text end

new text begin 20,000,000 new text end

new text begin new text begin Statewide Health Improvement Program. new text end
This appropriation is for the statewide
health improvement program under
Minnesota Statutes, section 145.986. Of
this appropriation, $18,600,000 is for
grants to local communities in accordance
with Minnesota Statutes, section 145.986,
subdivision 2. The base level funding for the
statewide health improvement program shall
be $40,000,000 in fiscal year 2010.
new text end

new text begin Subd. 3. new text end new text begin Policy, Quality, and Compliance new text end

new text begin Health Care Access new text end

new text begin 29,588,000 new text end

new text begin new text begin Dental Loan Forgiveness and Scholarship
Program. new text end Of the health care access fund
appropriation, $400,000 is for the dental
loan forgiveness and scholarship program
described in Minnesota Statutes, section
144.1501.
new text end

new text begin new text begin Federally Qualified Health Centers. new text end Of
the health care access fund appropriation,
$4,000,000 is for subsidies to federally
qualified health centers under Minnesota
Statutes, section 145.9269. This amount
shall be added to the base level funding.
new text end

new text begin new text begin Health Care Transformation Commission. new text end
Of the health care access fund appropriation,
$12,000,000 is for the operation of the Health
Care Transformation Commission. This is a
onetime appropriation and is available until
expended.
new text end

new text begin new text begin Electronic Health Records Grants. new text end Of
the health care access fund appropriation,
$1,962,000 is for the electronic health
records grant program in Minnesota Statutes,
section 144.3345. Base level funding for this
activity shall be $3,673,000 in fiscal year
2010 and $3,673,000 in fiscal year 2011. The
appropriation for this activity expires after
the fiscal year 2011 appropriation.
new text end

new text begin new text begin Electronic Health Records Revolving
Account and Loan. new text end Of the health care
access fund appropriation, $2,000,000 is for
the electronic health record system revolving
account and loan program in Minnesota
Statutes, section 62J.496. Base level funding
for this activity shall be $3,750,000 in fiscal
year 2010 and $3,750,000 in fiscal year 2011.
The appropriation for this activity expires
after the fiscal year 2011 appropriation.
new text end

Sec. 5. new text begin ADMINISTRATIVE ACTIVITIES FOR THE SAVINGS
REINVESTMENT ASSESSMENT.
new text end

new text begin $302,000 is appropriated from the health savings investment fund in fiscal year 2010
to the commissioner of health for administrative activities of the health reinvestment
assessment under Minnesota Statutes, section 62U.13. This is a onetime appropriation.
new text end

Sec. 6. new text begin TRANSFERS.
new text end

new text begin (a) After the transfer to the general fund in accordance with Minnesota Statutes,
section 16A.727, to the extent there are remaining funds in the health savings reinvestment
fund, the commissioner of finance shall transfer to the general fund $2,121,000 in fiscal
year 2010 to be appropriated to the commissioner of human services for the health care
homes under Minnesota Statutes, sections 256B.0751 to 256B.0754.
new text end

new text begin (b) To the extent funds are remaining in the health savings reinvestment fund after
the transfer described in paragraph (a), the commissioner of finance shall transfer to the
general fund $1,250,000 in fiscal year 2010 to be appropriated in equal amounts to:
new text end

new text begin (1) to the Board of Regents of the Univerity of Minnesota to increase the number
of primary care physicians who practice in underserved communities in the state and the
number of primary care physician slots in residency programs in the state;
new text end

new text begin (2) to the Mayo Medical Foundation for medical school initiatives to increase the
number of primary care physicians who practice in underserved communities in the state
and the number of primary care physician slots in residency programs in the state;
new text end

new text begin (3) to the Office of Higher Education to increase the number of primary care
physicians who practice in underserved communities in the state and the number of
primary care physician slots in residency programs in the state;
new text end

new text begin (4) to the Duluth Graduate Medical Education Council, Inc. for medical school
initiatives to increase the number of primary care physician slots in residency programs in
the state;
new text end

new text begin (5) 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 (6) to the Board of Regents of the University of Minnesota to address faculty
shortages in primary care medicine;
new text end

new text begin (7) to the Mayo Medical Foundation to address faculty shortages in primary care
medicine; and
new text end

new text begin (8) 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 (c) To the extent funds are remaining in the health savings reinvestment fund after
the transfers described in paragraphs (a) and (b), the commissioner of finance shall transfer
to the health care access fund an amount sufficient to cover any structural deficit in the
health care access fund, beginning in fiscal year 2011.
new text end

Sec. 7. new text begin HEALTH INSURANCE ACCESS BROKER FEES.
new text end

new text begin All fees received by the commissioner of commerce under Minnesota Statutes,
section 62U.02, and deposited in the state government special revenue fund are
appropriated to the commissioner of commerce for the purpose of implementing
Minnesota Statutes, section 62U.02.
new text end

Sec. 8. new text begin SUNSET OF UNCODIFIED LANGUAGE.
new text end

new text begin All uncodified language contained in this article expires on June 30, 2009, unless a
different expiration date is specified.
new text end

Sec. 9. new text begin EFFECTIVE DATE.
new text end

new text begin The provisions in this article are effective July 1, 2008, unless a different effective
date is specified.
new text end