Minnesota Legislature
SF 845
8th Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
KEY: stricken = removed, old language.
underscored = added, new language.
Current Version - 8th Engrossment
1.1 A bill for an act 1.2 relating to health; MinnesotaCare; expanding 1.3 provisions of health care; establishing requirements 1.4 for integrated service networks; modifying 1.5 requirements for health plan companies; repealing the 1.6 regulated all-payer option; modifying universal 1.7 coverage and insurance reform provisions; revising the 1.8 research and data initiatives; modifying eligibility 1.9 for the MinnesotaCare program; creating the 1.10 prescription drug purchasing authority; establishing a 1.11 drug purchasing benefit program for senior citizens; 1.12 extending the health care commission and regional 1.13 coordinating boards; making technical changes; 1.14 providing penalties; appropriating money; amending 1.15 Minnesota Statutes 1994, sections 13.99, by adding a 1.16 subdivision; 16A.724; 60A.02, by adding a subdivision; 1.17 60B.02; 60B.03, subdivision 2; 60G.01, subdivisions 2, 1.18 4, and 5; 62A.10, subdivisions 1 and 2; 62A.65, 1.19 subdivisions 5 and 8; 62D.02, subdivision 8; 62D.042, 1.20 subdivision 2; 62D.11, subdivision 1; 62D.181, 1.21 subdivisions 2, 3, 6, and 9; 62E.05; 62E.141; 62H.04; 1.22 62H.08; 62J.017; 62J.04, subdivisions 1a and 3; 1.23 62J.05, subdivisions 2 and 9; 62J.06; 62J.09, 1.24 subdivisions 1, 1a, 2, 6, 8, and by adding a 1.25 subdivision; 62J.152, subdivision 5; 62J.17, 1.26 subdivisions 4a, 6a, and by adding a subdivision; 1.27 62J.212; 62J.37; 62J.38; 62J.40; 62J.41, subdivisions 1.28 1 and 2; 62J.48; 62J.54; 62J.55; 62J.58; 62L.02, 1.29 subdivisions 11, 16, 24, and 26; 62L.03, subdivisions 1.30 3, 4, and 5; 62L.09, subdivision 1; 62L.12, 1.31 subdivision 2; 62L.17, by adding a subdivision; 1.32 62L.18, subdivision 2; 62M.07; 62M.09, subdivision 5; 1.33 62M.10, by adding a subdivision; 62N.02, by adding 1.34 subdivisions; 62N.04; 62N.10, by adding a subdivision; 1.35 62N.11, subdivision 1; 62N.13; 62N.14, subdivision 3; 1.36 62N.25, subdivision 2; 62P.05, subdivision 4, and by 1.37 adding a subdivision; 62Q.01, subdivisions 2, 3, 4, 1.38 and by adding subdivisions; 62Q.03, subdivisions 1, 6, 1.39 7, 8, 9, 10, and by adding subdivisions; 62Q.07, 1.40 subdivisions 1 and 2; 62Q.075, subdivision 4; 62Q.09, 1.41 subdivision 3; 62Q.11, subdivision 2; 62Q.165; 62Q.17, 1.42 subdivisions 2, 6, 8, and by adding a subdivision; 1.43 62Q.18; 62Q.19; 62Q.30; 62Q.32; 62Q.33, subdivisions 4 1.44 and 5; 62Q.41; 72A.20, by adding subdivisions; 1.45 72A.201, by adding a subdivision; 136A.1355, 1.46 subdivisions 3 and 5; 136A.1356, subdivisions 3 and 4; 2.1 144.1464, subdivisions 2, 3, and 4; 144.147, 2.2 subdivision 1; 144.1484, subdivision 1; 144.1486, 2.3 subdivision 4; 144.1487, subdivision 1; 144.1488, 2.4 subdivisions 1 and 4; 144.1489, subdivisions 1, 3, and 2.5 4; 144.1490; 144.1491, subdivision 2; 144.801, by 2.6 adding a subdivision; 144.804, subdivision 1; 145.414; 2.7 148B.32, subdivision 1; 151.48; 214.16, subdivisions 2 2.8 and 3; 256.9354, subdivisions 1, 4, 5, and by adding a 2.9 subdivision; 256.9355, subdivision 2; 256.9357, 2.10 subdivisions 1, 2, and 3; 256.9358, subdivisions 3, 4, 2.11 and by adding a subdivision; 256.9363, subdivision 5; 2.12 256B.037, subdivisions 1, 3, 4, and by adding 2.13 subdivisions; 256B.04, by adding a subdivision; 2.14 256B.055, by adding a subdivision; 256B.057, by adding 2.15 subdivisions; 256B.0625, subdivision 30; 256B.69, 2.16 subdivisions 2 and 4; 270.101, subdivision 1; 295.50, 2.17 subdivisions 3, 4, and 10a; 295.53, subdivisions 1, 3, 2.18 and 4; 295.55, subdivision 4; 295.57; and 295.582; 2.19 Laws 1990, chapter 591, article 4, section 9; Laws 2.20 1993, chapter 224, article 4, section 40; Laws 1993, 2.21 First Special Session chapter 1, article 8, section 2.22 30, subdivision 2; Laws 1994, chapter 625, article 5, 2.23 sections 5, subdivision 1; 7; and 10, subdivision 2; 2.24 proposing coding for new law in Minnesota Statutes, 2.25 chapters 16B; 62J; 62L; 62N; 62Q; 62R; 137; 144; 256; 2.26 256B; and 295; repealing Minnesota Statutes 1994, 2.27 sections 62J.045; 62J.07, subdivision 4; 62J.09, 2.28 subdivision 1a; 62J.152, subdivision 6; 62J.19; 2.29 62J.30; 62J.31; 62J.32; 62J.33; 62J.34; 62J.35; 2.30 62J.41, subdivisions 3 and 4; 62J.44; 62J.45; 62J.65; 2.31 62L.08, subdivision 7a; 62N.34; 62P.01; 62P.02; 2.32 62P.03; 62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 2.33 62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 62P.27; 2.34 62P.29; 62P.31; 62P.33; 62Q.03, subdivisions 2, 3, 4, 2.35 5, and 11; 62Q.18, subdivisions 2, 3, 4, 5, 6, 8, and 2.36 9; 62Q.21; 62Q.27; 144.1488, subdivision 2; 148.236; 2.37 and 256.9353, subdivisions 4 and 5; Laws 1993, chapter 2.38 247, article 1, sections 12, 13, 14, 15, 18, and 19; 2.39 Minnesota Rules, part 4685.1700, subpart 1, item D. 2.40 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 2.41 ARTICLE 1 2.42 INTEGRATED SERVICE NETWORKS 2.43 Section 1. Minnesota Statutes 1994, section 60B.02, is 2.44 amended to read: 2.45 60B.02 [PERSONS COVERED.] 2.46 The proceedings authorized by sections 60B.01 to 60B.61 may 2.47 be applied to: 2.48 (1) All insurers who are doing, or have done, an insurance 2.49 business in this state, and against whom claims arising from 2.50 that business may exist now or in the future; 2.51 (2) All insurers who purport to do an insurance business in 2.52 this state; 2.53 (3) All insurers who have insureds resident in this state; 2.54 (4) All other persons organized or in the process of 2.55 organizing with the intent to do an insurance business in this 3.1 state; and 3.2 (5) All nonprofit service plan corporations incorporated or 3.3 operating under the nonprofit health service plan corporation 3.4 act, any health plan incorporated under chapter 317A, all 3.5 fraternal benefit societies operating under chapter 64B, except 3.6 those associations enumerated in section 64B.38,all assessment3.7benefit associations operating under chapter 63,all township 3.8 mutual or other companies operating under chapter 67A,andall 3.9 reciprocals or interinsurance exchanges operating under chapter 3.10 71A, and all integrated service networks operating under chapter 3.11 62N. 3.12 Sec. 2. Minnesota Statutes 1994, section 60B.03, 3.13 subdivision 2, is amended to read: 3.14 Subd. 2. [COMMISSIONER.] "Commissioner" means the 3.15 commissioner of commerce of the state of Minnesota and, in that 3.16 commissioner's absence or disability, a deputy or other person 3.17 duly designated to act in that commissioner's place. In the 3.18 context of rehabilitation or liquidation of a health maintenance 3.19 organization or integrated service network, "commissioner" means 3.20 the commissioner of health of the state of Minnesota and, in 3.21 that commissioner's absence or disability, a deputy or other 3.22 person duly designated to act in that commissioner's place. 3.23 Sec. 3. Minnesota Statutes 1994, section 60G.01, 3.24 subdivision 2, is amended to read: 3.25 Subd. 2. [COMMISSIONER.] "Commissioner" means the 3.26 commissioner of commerce, except that "commissioner" means the 3.27 commissioner of health for administrative supervision of health 3.28 maintenance organizations and integrated service networks. 3.29 Sec. 4. Minnesota Statutes 1994, section 60G.01, 3.30 subdivision 4, is amended to read: 3.31 Subd. 4. [DEPARTMENT.] "Department" means the department 3.32 of commerce, except that "department" means the department of 3.33 health for administrative supervision of health maintenance 3.34 organizations and integrated service networks. 3.35 Sec. 5. Minnesota Statutes 1994, section 60G.01, 3.36 subdivision 5, is amended to read: 4.1 Subd. 5. [INSURER.] "Insurer" means and includes every 4.2 person engaged as indemnitor, surety, or contractor in the 4.3 business of entering into contracts of insurance or of annuities 4.4 as limited to: 4.5 (1) any insurer who is doing an insurer business, or has 4.6 transacted insurance in this state, and against whom claims 4.7 arising from that transaction may exist now or in the future; 4.8 (2) any fraternal benefit society which is subject to 4.9 chapter 64B; 4.10 (3) nonprofit health service plan corporations subject to 4.11 chapter 62C; 4.12 (4) cooperative life and casualty companies subject to 4.13 sections 61A.39 to 61A.52;and4.14 (5) health maintenance organizations regulated under 4.15 chapter 62D; and 4.16 (6) integrated service networks regulated under chapter 62N. 4.17 Sec. 6. Minnesota Statutes 1994, section 62D.181, 4.18 subdivision 2, is amended to read: 4.19 Subd. 2. [ELIGIBLE INDIVIDUALS.] An individual is eligible 4.20 for alternative coverage under this section if: 4.21 (1) the individual had individual health coverage through a 4.22 health maintenance organization, integrated service network, or 4.23 community integrated service network, the coverage is no longer 4.24 available due to the insolvency of the health maintenance 4.25 organization, integrated service network, or community 4.26 integrated service network, and the individual has not obtained 4.27 alternative coverage; or 4.28 (2) the individual had group health coverage through a 4.29 health maintenance organization, integrated service network, or 4.30 community integrated service network, the coverage is no longer 4.31 available due to the insolvency of the health maintenance 4.32 organization, integrated service network, or community 4.33 integrated service network, and the individual has not obtained 4.34 alternative coverage. 4.35 Sec. 7. Minnesota Statutes 1994, section 62D.181, 4.36 subdivision 3, is amended to read: 5.1 Subd. 3. [APPLICATION AND ISSUANCE.] If a health 5.2 maintenance organization, integrated service network, or 5.3 community integrated service network will be liquidated, 5.4 individuals eligible for alternative coverage under subdivision 5.5 2 may apply to the association to obtain alternative coverage. 5.6 Upon receiving an application and evidence that the applicant 5.7 was enrolled in the health maintenance organization, integrated 5.8 service network, or community integrated service network at the 5.9 time of an order for liquidation, the association shall issue 5.10 policies to eligible individuals, without the limitation on 5.11 preexisting conditions described in section 62E.14, subdivision 5.12 3. 5.13 Sec. 8. Minnesota Statutes 1994, section 62D.181, 5.14 subdivision 6, is amended to read: 5.15 Subd. 6. [DURATION.] The duration of alternative coverage 5.16 issued under this section is: 5.17 (1) for individuals eligible under subdivision 2, clause 5.18 (1), 90 days; and 5.19 (2) for individuals eligible under subdivision 2, clause 5.20 (2), 90 days or the length of time remaining in the group 5.21 contract with the insolvent health maintenance organization, 5.22 integrated service network, or community integrated service 5.23 network, whichever is greater. 5.24 Sec. 9. Minnesota Statutes 1994, section 62D.181, 5.25 subdivision 9, is amended to read: 5.26 Subd. 9. [COORDINATION OF POLICIES.] If an insolvent 5.27 health maintenance organization, integrated service network, or 5.28 community integrated service network has insolvency insurance 5.29 coverage at the time of an order for liquidation, the 5.30 association may coordinate the benefits of the policy issued 5.31 under this section with those of the insolvency insurance policy 5.32 available to the enrollees. The premium level for the combined 5.33 association policy and the insolvency insurance policy may not 5.34 exceed those described in subdivision 5. 5.35 Sec. 10. Minnesota Statutes 1994, section 62N.02, is 5.36 amended by adding a subdivision to read: 6.1 Subd. 4b. [CREDENTIALING.] "Credentialing" means the 6.2 process of collecting, verifying, and reviewing evidence that 6.3 relates to a health care professional's qualifications to 6.4 practice the health care profession as a provider within a 6.5 specific integrated service network. 6.6 Sec. 11. Minnesota Statutes 1994, section 62N.02, is 6.7 amended by adding a subdivision to read: 6.8 Subd. 4c. [CREDENTIALING STANDARDS.] An integrated service 6.9 network may set credentialing standards for providers. A 6.10 network may recredential providers on a recurring basis. If a 6.11 network sets credentialing standards, the network must provide a 6.12 written description of those standards upon request. An 6.13 integrated service network may participate in a centralized 6.14 credentialing program and must provide a written description of 6.15 that program upon request. 6.16 Sec. 12. Minnesota Statutes 1994, section 62N.04, is 6.17 amended to read: 6.18 62N.04 [REGULATION.] 6.19 Integrated service networks are under the supervision of 6.20 the commissioner, who shall enforce this chapter, and the 6.21 requirements of chapter 62Q as they apply to these networks. 6.22 The commissioner has, with respect to this chapter and chapter 6.23 62Q, all enforcement and rulemaking powers available to the 6.24 commissioner under section 62D.17. 6.25 Sec. 13. [62N.071] [DEFINITIONS.] 6.26 Subdivision 1. [APPLICABILITY.] The definitions in this 6.27 section apply to sections 62N.071 to 62N.078. Unless otherwise 6.28 specified, terms used in those sections have the meanings 6.29 required to be used in preparation of the National Association 6.30 of Insurance Commissioners (NAIC) annual statement blanks for 6.31 health maintenance organizations. 6.32 Subd. 2. [ADMITTED ASSETS.] "Admitted assets" means 6.33 admitted assets as defined under section 62D.044, including the 6.34 deposit required under section 62N.074. 6.35 Subd. 3. [NET WORTH.] "Net worth" means admitted assets 6.36 minus liabilities. 7.1 Subd. 4. [LIABILITIES.] "Liabilities" means a network's 7.2 debts and other obligations, including estimates of the 7.3 network's reported and unreported claims incurred for covered 7.4 services and supplies provided to enrollees. Liabilities do not 7.5 include those obligations that are subordinated in the same 7.6 manner as preferred ownership claims under section 60B.44, 7.7 subdivision 10, including promissory notes subordinated to all 7.8 other liabilities of the integrated service network. 7.9 Subd. 5. [UNCOVERED EXPENDITURES.] "Uncovered expenditures" 7.10 means the charges for health care services and supplies that are 7.11 covered by an integrated service network for which an enrollee 7.12 would also be liable if the network becomes insolvent. 7.13 Uncovered expenditures includes charges for covered health care 7.14 services and supplies received by enrollees from providers that 7.15 are not employed by, under contract with, or otherwise 7.16 affiliated with the network. Uncovered expenditures does not 7.17 include amounts that enrollees would not have to pay due to the 7.18 obligations being guaranteed, insured, or assumed by a person 7.19 other than the network. 7.20 Subd. 6. [WORKING CAPITAL.] "Working capital" means 7.21 current assets minus current liabilities. 7.22 Sec. 14. [62N.072] [NET WORTH REQUIREMENT.] 7.23 Subdivision 1. [INITIAL REQUIREMENT.] An integrated 7.24 service network must, at time of licensure, have a minimum net 7.25 worth of the greater of: 7.26 (1) $1,500,000; or 7.27 (2) 8-1/3 percent of the sum of all expenses expected to be 7.28 incurred in the first full year of operation, less 90 percent of 7.29 the expected reinsurance premiums for that period. 7.30 Subd. 2. [ONGOING REQUIREMENT.] After a network's initial 7.31 year of operation, the network must maintain net worth of no 7.32 less than $1,000,000 or 8-1/3 percent of the previous years' 7.33 expenditures, whichever is greater. 7.34 Sec. 15. [62N.074] [DEPOSIT REQUIREMENT.] 7.35 Subdivision 1. [INITIAL DEPOSIT.] An integrated service 7.36 network shall deposit, at time of licensure, a deposit 8.1 consisting of cash and direct United States Treasury obligations 8.2 in the total amount of not less than $300,000. 8.3 Subd. 2. [CUSTODIAL ACCOUNT.] The deposit must be held in 8.4 a custodial or other controlled account under a written account 8.5 agreement acceptable to the commissioner. 8.6 Subd. 3. [ONGOING DEPOSIT.] After the initial year of 8.7 operation, the required amount of the deposit is the greater of 8.8 (1) $300,000; or 8.9 (2) 33-1/3 percent of the network's uncovered expenditures 8.10 incurred in the previous calendar year. 8.11 Subd. 4. [USE OF DEPOSIT.] (a) In the event of any 8.12 delinquency proceeding as defined in section 60B.03, the 8.13 required minimum deposit shall be applied first to pay for or 8.14 reimburse the commissioner for expenses incurred by the 8.15 commissioner in performing the commissioner's duties in 8.16 connection with the insolvency, including any legal, actuarial 8.17 or accounting fees. The balance of the required minimum 8.18 deposit, if any, shall be used to reimburse enrollees for 8.19 uncovered expenditures, on a pro rata basis. 8.20 (b) If a deposit exceeds the required minimum deposit, the 8.21 excess shall be applied first to uncovered expenditures and the 8.22 balance, if any, to the commissioner's expenses. 8.23 (c) The deposit is not subject to garnishment or levy under 8.24 any circumstances. 8.25 Subd. 5. [ACTUAL DEPOSIT REQUIRED.] The deposit must be in 8.26 the form specified in subdivision 1; a guarantee or letter of 8.27 credit are not acceptable, in whole or in part, as substitutes. 8.28 Sec. 16. [62N.075] [WORKING CAPITAL.] 8.29 Subdivision 1. [REQUIREMENT.] An integrated service 8.30 network must maintain a positive working capital at all times. 8.31 Subd. 2. [NOTICE REQUIRED.] If an integrated service 8.32 network's working capital is no longer positive, or is likely to 8.33 soon become no longer positive, the network shall immediately 8.34 notify the commissioner. 8.35 Subd. 3. [PLAN OF CORRECTION.] If at any time an 8.36 integrated service network's net worth, working capital, 9.1 investments, deposits, or guarantees do not conform with the 9.2 provisions of this chapter, the network shall promptly submit to 9.3 the commissioner a written proposed plan of correction. The 9.4 commissioner shall promptly approve, approve as modified, or 9.5 reject the proposed plan. If a plan of correction has been 9.6 approved by the commissioner, the network shall comply with it 9.7 and shall cooperate fully with any activities the commissioner 9.8 undertakes to monitor the network's compliance. 9.9 Subd. 4. [ACTION BY COMMISSIONER.] The commissioner may 9.10 take any action permitted to the commissioner that the 9.11 commissioner deems necessary or appropriate to protect the 9.12 network or its enrollees if: 9.13 (1) the network fails to propose an approved plan of 9.14 correction promptly; 9.15 (2) the network fails to comply with an approved plan of 9.16 correction; or 9.17 (3) the commissioner determines that a deficiency in 9.18 working capital cannot be corrected within a reasonable time. 9.19 Subd. 5. [OTHER REMEDIES.] This section does not limit the 9.20 commissioner's power to use at any time other remedies available 9.21 to the commissioner. 9.22 Sec. 17. [62N.076] [INVESTMENT RESTRICTIONS.] 9.23 Subdivision 1. [INVESTMENT POLICY.] An integrated service 9.24 network shall have a written investment policy to govern 9.25 investment of the network's assets. The written policy must be 9.26 reviewed and approved annually by the network's board of 9.27 directors. 9.28 Subd. 2. [APPROVAL; INVESTMENTS.] A network shall not make 9.29 loans or investments, unless authorized by its board of 9.30 directors, or ratified by the board no later than the next 9.31 regular board meeting. 9.32 Subd. 3. [PERMITTED INVESTMENT.] An integrated service 9.33 network shall make investments only in securities or property 9.34 designated by law as permitted for domestic life insurance 9.35 companies; this restriction includes compliance with percentage 9.36 limitations that apply to domestic life insurance companies. A 10.1 network may, however, invest in real estate, including leasehold 10.2 improvements, for the convenience and accommodation of its 10.3 operations, including the home office, branch offices, medical 10.4 facilities, and field operations, in excess of the percentage 10.5 permitted for a domestic life insurance company, but not to 10.6 exceed 25 percent of its total admitted assets. 10.7 Subd. 4. [CONFLICTS OF INTEREST.] An integrated service 10.8 network shall not make loans to any of its directors or 10.9 principal officers or make loans to or investments in any 10.10 organization in which a director or principal officer has an 10.11 interest. 10.12 Subd. 5. [PROOF OF COMPLIANCE.] An integrated service 10.13 network shall annually file with the commissioner proof of 10.14 compliance with this section in a form and on a date prescribed 10.15 by the commissioner. 10.16 Sec. 18. [62N.077] [USE OF GUARANTEES.] 10.17 Subdivision 1. [GUARANTEE PERMITTED.] An integrated 10.18 service network may, with the consent of the commissioner, 10.19 satisfy up to 50 percent of its minimum net worth requirement by 10.20 means of a guarantee provided by another organization. 10.21 Subd. 2. [SECURITY FOR GUARANTEE.] (a) If the guaranteeing 10.22 organization is regulated for solvency by the commissioner of 10.23 commerce or health, the guarantee must be treated as a liability 10.24 for purposes of solvency regulation of the guaranteeing 10.25 organization. If the guaranteeing organization becomes 10.26 insolvent, a claim by the network on the guarantee must be at 10.27 least of equal priority with claims of enrollees or other policy 10.28 holders of the insolvent guaranteeing organization. 10.29 (b) If the guaranteeing organization is not regulated for 10.30 solvency by the commissioner of commerce or health, the 10.31 organization must maintain assets, except if, when calculated in 10.32 combination with the assets described in section 62D.044, clause 10.33 (17), the total of those assets and the real estate assets 10.34 described in this subdivision do not exceed the total combined 10.35 percent limitations allowable under this section and section 10.36 62D.044, clause (17), or except if permitted by the commissioner 11.1 upon a finding that the percentage of the integrated service 11.2 network's admitted assets is insufficient to provide convenient 11.3 accommodation of the network's business acceptable to the 11.4 commissioner, with a market value at least equal to the amount 11.5 of the guarantee, in a custodial or other controlled account on 11.6 terms acceptable to the commissioner of health. 11.7 Subd. 3. [GOVERNMENTAL ENTITIES.] When a guaranteeing 11.8 organization is a governmental entity, sections 62N.074 and 11.9 62N.076 do not apply. The commissioner may consider factors 11.10 which provide evidence that the governmental entity is a 11.11 financially reliable guaranteeing organization. 11.12 Sec. 19. [62N.078] [FINANCIAL REPORTING AND EXAMINATION.] 11.13 Subdivision 1. [FINANCIAL STATEMENTS.] An integrated 11.14 service network shall file with the commissioner, annually on 11.15 April 1, an audited financial statement. The financial 11.16 statement must include the National Association of Insurance 11.17 Commissioners (NAIC) annual statement blanks for health 11.18 maintenance organizations, prepared in accordance with the NAIC 11.19 annual statement instructions, and using the methods prescribed 11.20 in the NAIC's accounting practices and procedures manual for 11.21 health maintenance organizations. The financial statement must 11.22 also include any other form or information prescribed by the 11.23 commissioner. 11.24 Subd. 2. [QUARTERLY STATEMENTS.] An integrated service 11.25 network shall file with the commissioner quarterly financial 11.26 statements for the first three quarters of each year, on a date 11.27 and form and in a manner prescribed by the commissioner. 11.28 Subd. 3. [OTHER INFORMATION.] An integrated service 11.29 network shall comply promptly and fully with requests by the 11.30 commissioner for other information that the commissioner deems 11.31 necessary to monitor or assess the network's financial solvency. 11.32 Subd. 4. [FINANCIAL EXAMINATION.] The commissioner shall 11.33 conduct a complete financial examination of each integrated 11.34 service network at least once every three years, and more 11.35 frequently if the commissioner deems it necessary. The 11.36 examinations must be conducted according to the standards 12.1 provided in the NAIC examiners handbook. 12.2 Sec. 20. Minnesota Statutes 1994, section 62N.10, is 12.3 amended by adding a subdivision to read: 12.4 Subd. 7. [DATA SUBMISSION.] As a condition of licensure, 12.5 an integrated service network shall comply fully with section 12.6 62J.38. 12.7 Sec. 21. Minnesota Statutes 1994, section 62N.11, 12.8 subdivision 1, is amended to read: 12.9 Subdivision 1. [APPLICABILITY.] Every integrated service 12.10 network enrollee residing in this state is entitled to evidence 12.11 of coverage or contract. The integrated service network or its 12.12 designated representative shall issue the evidence of coverage 12.13 or contract. The commissioner shall adopt rules specifying the 12.14 requirements for contracts and evidence of coverage. "Evidence 12.15 of coverage" means evidence that an enrollee is covered by a 12.16 group contract issued to the group. The evidence of coverage 12.17 must contain a description of provider locations, a list of the 12.18 types of providers available, and information about the types of 12.19 allied and midlevel practitioners and pharmacists that are 12.20 available. 12.21 Sec. 22. Minnesota Statutes 1994, section 62N.13, is 12.22 amended to read: 12.23 62N.13 [ENROLLEE COMPLAINT SYSTEM.] 12.24 Every integrated service network must establish and 12.25 maintain an enrollee complaint system,including an impartial12.26arbitration provisionas required under section 62Q.105, to 12.27 provide reasonable procedures for the resolution of written 12.28 complaints initiated by enrollees concerning the provision of 12.29 health care services. The integrated service network must 12.30 inform enrollees that they may choose to use an alternative 12.31 dispute resolution process. If an enrollee chooses to use an 12.32 alternative dispute resolution process, the network must 12.33 participate. The commissioner shall adopt rules specifying 12.34 requirements relating to enrollee complaints. 12.35 Sec. 23. Minnesota Statutes 1994, section 62N.14, 12.36 subdivision 3, is amended to read: 13.1 Subd. 3. [ENROLLEE MEMBERSHIP CARDS.] Integrated service 13.2 networks shall issue enrollee membership cards to each enrollee 13.3 of the integrated service network. The enrollee card shall 13.4 contain, at minimum, the following information: 13.5 (1) the telephone number of the integrated service 13.6 network's office of consumer services; 13.7 (2) the address, telephone number, and a brief description 13.8 of thestate's office of consumerinformation clearinghouse; and 13.9 (3) the telephone number of the department of healthor13.10local ombudsperson. 13.11 The membership cards shall also conform to the requirements 13.12 set forth in section 62J.60. 13.13 Sec. 24. [62N.15] [PROVIDER REQUIREMENTS.] 13.14 Subdivision 1. [SERVICES.] An integrated service network 13.15 may operate as a staff model as defined in section 295.50, 13.16 subdivision 12b, or may contract with providers or provider 13.17 organizations for the provision of services. 13.18 Subd. 2. [LOCATION.] (a) An integrated service network 13.19 must ensure that primary care providers, including allied 13.20 independent health providers as defined in section 62Q.095, 13.21 subdivision 5, midlevel practitioners as defined in section 13.22 136A.1356, subdivision 1, are located at adequate locations 13.23 within the service area of the network. In determining whether 13.24 locations are adequate, the integrated service network may 13.25 consider the practice and referral patterns in each community 13.26 served throughout the service area. 13.27 (b) Urgent and emergency care providers must be located 13.28 within a distance of 30 miles or a travel time of 30 minutes 13.29 from every enrollee. 13.30 Subd. 3. [NUMBERS.] An integrated service network must 13.31 provide a sufficient number of providers to meet the projected 13.32 needs of its enrollees, including special needs and high-risk 13.33 enrollees, for all covered health care services. 13.34 Subd. 4. [TYPES.] An integrated service network must 13.35 determine what types of providers are needed to deliver all 13.36 appropriate and necessary health services to its enrollees. In 14.1 determining which types of providers are necessary, networks 14.2 shall use allied and midlevel practitioners and pharmacists 14.3 within their respective scopes of practice. 14.4 Subd. 5. [CAPACITY.] An integrated service network shall 14.5 monitor the capacity of the network to provide services to 14.6 enrollees and take steps to increase capacity when parts of the 14.7 network are not able to meet enrollee needs. 14.8 Subd. 6. [ACCESS.] (a) An integrated service network shall 14.9 make available and accessible all covered health care services 14.10 on a 24-hour per day, seven days per week basis. This 14.11 requirement may be fulfilled through the use of: 14.12 (1) regularly scheduled appointments; 14.13 (2) after-hour clinics; 14.14 (3) use of a 24-hour answering service; 14.15 (4) backup coverage by another participating physician; or 14.16 (5) referrals to urgent care centers and to hospital 14.17 emergency care. 14.18 (b) An integrated service network shall arrange for covered 14.19 health care services, including referrals to specialty 14.20 physicians, to be accessible to enrollees on a timely basis in 14.21 accordance with medically appropriate guidelines. An integrated 14.22 service network shall have appointment scheduling guidelines 14.23 based on the type of health care service. 14.24 (c) Nothing in this act shall be construed to require the 14.25 creation or maintenance of abortion clinics or other abortion 14.26 providers within any integrated service network; nor shall 14.27 anything in this act be construed to authorize any agency to 14.28 require the creation or maintenance of abortion clinics or 14.29 abortion providers or to deny certification or any other benefit 14.30 granted by this act to a health plan company based on the number 14.31 of or the presence or absence of abortion clinics or other 14.32 abortion providers in or affiliated with the health plan company. 14.33 Subd. 7. [CONTINUITY.] (a) An integrated service network 14.34 shall provide continuing care for enrollees in the event of 14.35 contract termination between the integrated service network and 14.36 any of its contracted providers or in the event of site closings 15.1 involving a provider with more than one location of service. 15.2 (b) An integrated service network shall provide to its 15.3 enrollees a written disclosure of the process by which 15.4 continuity of care will be provided to all enrollees. 15.5 Subd. 8. [REVIEW.] The commissioner shall review each 15.6 network's compliance with subdivisions 1 to 7. If the 15.7 commissioner determines that a network is not meeting the 15.8 requirements of this section, the commissioner may order the 15.9 network to submit a plan of corrective action, and may order the 15.10 network to comply with the provisions of that plan, as amended 15.11 by the commissioner. 15.12 Sec. 25. [62N.17] [OUT-OF-NETWORK SERVICES.] 15.13 (a) An integrated service network shall provide coverage 15.14 for all emergency services provided outside the network, when 15.15 the care is immediately necessary or believed to be necessary to 15.16 preserve life, prevent impairment of bodily functions, or to 15.17 prevent placing the physical or mental health of the enrollee in 15.18 jeopardy. 15.19 (b) An integrated service network shall include in its 15.20 marketing materials a description of all limitations of coverage 15.21 for out-of-network services, including when enrollees reside or 15.22 travel outside the network's service area. 15.23 Sec. 26. [62N.18] [QUALITY IMPROVEMENT.] 15.24 Subdivision 1. [INTERNAL MEASURES.] Every integrated 15.25 service network shall establish and maintain an internal quality 15.26 improvement process. A network shall disclose these processes 15.27 to enrollees, and to the commissioner upon request. 15.28 Subd. 2. [ENROLLEE SURVEYS.] (a) Every integrated service 15.29 network shall, on at least a biennial basis, survey enrollee 15.30 satisfaction with network performance and quality of care, and 15.31 shall make survey results available to enrollees and potential 15.32 enrollees. Integrated service networks shall also submit survey 15.33 results to the information clearinghouse. 15.34 (b) Every integrated service network shall participate in 15.35 the consumer survey efforts established under section 62J.451, 15.36 subdivision 6b, to evaluate enrollee satisfaction, network 16.1 performance, and quality of care. Participation in the consumer 16.2 survey efforts of section 62J.451, subdivision 6b, shall satisfy 16.3 paragraph (a) of this subdivision. 16.4 Subd. 3. [QUALITY IMPROVEMENT WORKPLANS.] (a) An 16.5 integrated service network shall submit annual quality 16.6 improvement workplans to the commissioner. A workplan must: 16.7 (1) identify the four most common enrollee complaints 16.8 related to service delivery and the four most common enrollee 16.9 complaints related to administration; 16.10 (2) identify the specific measures that the network plans 16.11 to take to address each of these complaint areas; 16.12 (3) provide an assessment of how these complaints affect 16.13 health care outcomes; and 16.14 (4) identify the mechanisms that the network will use to 16.15 communicate and implement the changes needed to address each of 16.16 these complaints identified in clause (1). 16.17 (b) An integrated service network shall disclose in 16.18 marketing materials the complaints identified in paragraph (a), 16.19 and measures that will be taken by the network to address these 16.20 complaints. 16.21 Sec. 27. Minnesota Statutes 1994, section 62N.25, 16.22 subdivision 2, is amended to read: 16.23 Subd. 2. [LICENSURE REQUIREMENTS GENERALLY.] To be 16.24 licensed and to operate as a community integrated service 16.25 network, an applicant must satisfy the requirements of chapter 16.26 62D, and all other legal requirements that apply to entities 16.27 licensed under chapter 62D, except as exempted or modified in 16.28 this section. Community networks must, as a condition of 16.29 licensure, comply with rules adopted under section 256B.0644 16.30 that apply to entities governed by chapter 62D. A community 16.31 integrated service network that phases in its net worth over a 16.32 three-year period is not required to respond to requests for 16.33 proposals under section 256B.0644 during the first 12 months of 16.34 licensure. These community networks are not prohibited from 16.35 responding to requests for proposals, however, if they choose to 16.36 do so during that time period. After the initial 12 months of 17.1 licensure, these community networks are required to respond to 17.2 the requests for proposals as required under section 256B.0644. 17.3 Sec. 28. [62N.40] [CHEMICAL DEPENDENCY SERVICES.] 17.4 Each community integrated service network and integrated 17.5 service network regulated under this chapter must ensure that 17.6 chemically dependent individuals have access to cost-effective 17.7 treatment options that address the specific needs of 17.8 individuals. These include, but are not limited to, the need 17.9 for: treatment that takes into account severity of illness and 17.10 comorbidities; provision of a continuum of care, including 17.11 treatment and rehabilitation programs licensed under Minnesota 17.12 Rules, parts 9530.4100 to 9530.4410 and 9530.5000 to 9530.6500; 17.13 the safety of the individual's domestic and community 17.14 environment; gender appropriate and culturally appropriate 17.15 programs; and access to appropriate social services. 17.16 Sec. 29. [REPEALER.] 17.17 Minnesota Statutes 1994, section 62N.34, is repealed. 17.18 ARTICLE 2 17.19 MODIFICATIONS OF REQUIREMENTS FOR HEALTH PLAN COMPANIES 17.20 Section 1. Minnesota Statutes 1994, section 62D.11, 17.21 subdivision 1, is amended to read: 17.22 Subdivision 1. [ENROLLEE COMPLAINT SYSTEM.] Every health 17.23 maintenance organization shall establish and maintain a 17.24 complaint systemincluding an impartial arbitration17.25provision, as required under section 62Q.105 to provide 17.26 reasonable procedures for the resolution of written complaints 17.27 initiated by enrollees concerning the provision of health care 17.28 services. "Provision of health services" includes, but is not 17.29 limited to, questions of the scope of coverage, quality of care, 17.30 and administrative operations.Arbitration shall be subject to17.31chapter 572, except (a) in the event that an enrollee elects to17.32litigate a complaint prior to submission to arbitration, and (b)17.33no medical malpractice damage claim shall be subject to17.34arbitration unless agreed to by both parties subsequent to the17.35event giving rise to the claim.The health maintenance 17.36 organization must inform enrollees that they may choose to use 18.1 an alternative dispute resolution process. If an enrollee 18.2 chooses to use an alternative dispute resolution process, the 18.3 health maintenance organization must participate. 18.4 Sec. 2. Minnesota Statutes 1994, section 62Q.01, 18.5 subdivision 2, is amended to read: 18.6 Subd. 2. [COMMISSIONER.] "Commissioner" means the 18.7 commissioner of health for purposes of regulating health 18.8 maintenance organizations, community integrated service 18.9 networks, and integrated service networks, or the commissioner 18.10 of commerce for purposes of regulating all other health plan 18.11 companies. For all other purposes, "commissioner" means the 18.12 commissioner of health. 18.13 Sec. 3. Minnesota Statutes 1994, section 62Q.01, is 18.14 amended by adding a subdivision to read: 18.15 Subd. 2a. [ENROLLEE.] "Enrollee" means a natural person 18.16 covered by a health plan and includes an insured, policyholder, 18.17 subscriber, contract holder, member, covered person, or 18.18 certificate holder. 18.19 Sec. 4. Minnesota Statutes 1994, section 62Q.01, 18.20 subdivision 3, is amended to read: 18.21 Subd. 3. [HEALTH PLAN.] "Health plan" means a health plan 18.22 as defined in section 62A.011or; a policy, contract, or 18.23 certificate issued by a community integrated service network; or 18.24 an integrated service network; or an all-payer insurer as18.25defined in section 62P.02. 18.26 Sec. 5. Minnesota Statutes 1994, section 62Q.01, is 18.27 amended by adding a subdivision to read: 18.28 Subd. 5. [MANAGED CARE ORGANIZATION.] "Managed care 18.29 organization" means: (1) a health maintenance organization 18.30 operating under chapter 62D; (2) a community integrated service 18.31 network as defined under section 62N.02, subdivision 4a; (3) an 18.32 integrated service network as defined under section 62N.02, 18.33 subdivision 8; or (4) an insurance company licensed under 18.34 chapter 60A, nonprofit health service plan corporation operating 18.35 under chapter 62C, fraternal benefit society operating under 18.36 chapter 64B, or any other health plan company, to the extent 19.1 that it covers health care services delivered to Minnesota 19.2 residents through a preferred provider organization or a network 19.3 of selected providers. 19.4 Sec. 6. Minnesota Statutes 1994, section 62Q.01, is 19.5 amended by adding a subdivision to read: 19.6 Subd. 6. [MEDICARE-RELATED COVERAGE.] "Medicare-related 19.7 coverage" means a policy, contract, or certificate issued as a 19.8 supplement to Medicare, regulated under sections 62A.31 to 19.9 62A.44, including Medicare select coverage; policies, contracts, 19.10 or certificates that supplement Medicare issued by health 19.11 maintenance organizations; or policies, contracts, or 19.12 certificates governed by section 1833 (known as "cost" or "HCPP" 19.13 contracts) or 1876 (known as "TEFRA" or "risk" contracts) of the 19.14 federal Social Security Act, United States Code, title 42, 19.15 section 1395, et seq., as amended. 19.16 Sec. 7. [62Q.02] [APPLICABILITY OF CHAPTER.] 19.17 (a) This chapter applies only to health plans, as defined 19.18 in section 62Q.01, and not to other types of insurance issued or 19.19 renewed by health plan companies, unless otherwise specified. 19.20 (b) This chapter applies to a health plan company only with 19.21 respect to health plans, as defined in section 62Q.01, issued or 19.22 renewed by the health plan company, unless otherwise specified. 19.23 (c) If a health plan company issues or renews health plans 19.24 in other states, this chapter applies only to health plans 19.25 issued or renewed in this state for Minnesota residents, or to 19.26 cover a resident of the state, unless otherwise specified. 19.27 Sec. 8. Minnesota Statutes 1994, section 62Q.03, 19.28 subdivision 1, is amended to read: 19.29 Subdivision 1. [PURPOSE.]Risk adjustment is a vital19.30element of the state's strategy for achieving a more equitable,19.31efficient system of health care delivery and financing for all19.32state residents.The purpose of risk adjustment is to reduce 19.33 the effects of risk selection on health insurance premiums by 19.34 making monetary transfers from health plan companies that insure 19.35 lower risk populations to health plan companies that insure 19.36 higher risk populations. Risk adjustment is needed to: achieve 20.1 a more equitable, efficient system of health care financing; 20.2 remove current disincentives in the health care system to insure 20.3 andserveprovide adequate access for high risk and special 20.4 needs populations; promote fair competition among health plan 20.5 companies on the basis of their ability to efficiently and 20.6 effectively provide services rather than on thehealthrisk 20.7 status of those in a given insurance pool; and help 20.8assuremaintain the viability ofallhealth plan companies, 20.9including community integrated service networksby protecting 20.10 them from the financial effects of enrolling a disproportionate 20.11 number of high risk individuals. It is the commitment of the 20.12 state to develop and implement a risk adjustment systemby July20.131, 1997, and to continue to improve and refine risk adjustment20.14over time.The process for designing and implementing risk20.15adjustment shall be open, explicit, utilize resources and20.16expertise from both the private and public sectors, and include20.17at least the representation described in subdivision 4. The20.18process shall take into account the formative nature of risk20.19adjustment as an emerging science, and shall develop and20.20implement risk adjustment to allow continual modifications,20.21expansions, and refinements over time. The process shall have20.22at least two stages, as described in subdivisions 2 and 3.The 20.23 risk adjustment system shall: 20.24 (1) possess a reasonable level of accuracy and 20.25 administrative feasibility, be adaptable to changes as methods 20.26 improve, incorporate safeguards against fraud and manipulation, 20.27 and shall neither reward inefficiency nor penalize for 20.28 verifiable improvements in health status; 20.29 (2) require participation by all health plan companies 20.30 providing coverage in the individual, small group, and Medicare 20.31 supplement markets; 20.32 (3) address unequal distribution of risk between health 20.33 plan companies, but shall not address the financing of public 20.34 programs or subsidies for low-income people; and 20.35 (4) be developed and implemented by the risk adjustment 20.36 association with joint oversight by the commissioners of health 21.1 and commerce. 21.2 Sec. 9. Minnesota Statutes 1994, section 62Q.03, is 21.3 amended by adding a subdivision to read: 21.4 Subd. 5a. [PUBLIC PROGRAMS.] (a) A separate risk 21.5 adjustment system must be developed for state-run public 21.6 programs, including medical assistance, general assistance 21.7 medical care, and MinnesotaCare. The system must be developed 21.8 in accordance with the general risk adjustment methodologies 21.9 described in this section, must include factors in addition to 21.10 age and sex adjustment, and may include additional demographic 21.11 factors, different targeted conditions, and/or different payment 21.12 amounts for conditions. The risk adjustment system for public 21.13 programs must attempt to reflect the special needs related to 21.14 poverty, cultural, or language barriers and other needs of the 21.15 public program population. 21.16 (b) The commissioners of health and human services shall 21.17 jointly convene a public programs risk adjustment work group 21.18 responsible for advising the commissioners in the design of the 21.19 public programs risk adjustment system. The commissioner of 21.20 health shall work with the risk adjustment association to ensure 21.21 coordination between the risk adjustment systems for the public 21.22 and private sectors. The commissioner of human services shall 21.23 seek any needed federal approvals necessary for the inclusion of 21.24 the medical assistance program in the public program risk 21.25 adjustment system. 21.26 (c) The public programs risk adjustment work group must be 21.27 representative of the persons served by publicly paid health 21.28 programs and providers and health plans that meet their needs. 21.29 To the greatest extent possible, the appointing authorities 21.30 shall attempt to select representatives that have historically 21.31 served a significant number of persons in publicly paid health 21.32 programs or the uninsured. Membership of the work group shall 21.33 be as follows: 21.34 (1) one provider member appointed by the Minnesota Medical 21.35 Association; 21.36 (2) two provider members appointed by the Minnesota 22.1 Hospital Association, at least one of whom must represent a 22.2 major disproportionate share hospital; 22.3 (3) five members appointed by the Minnesota Council of 22.4 HMOs, one of whom must represent an HMO with fewer than 50,000 22.5 enrollees located outside the metropolitan area and one of whom 22.6 must represent an HMO with at least 50 percent of total 22.7 membership enrolled through a public program; 22.8 (4) two representatives of counties appointed by the 22.9 Association of Minnesota Counties; 22.10 (5) three representatives of organizations representing the 22.11 interests of families, children, childless adults, and elderly 22.12 persons served by the various publicly paid health programs 22.13 appointed by the governor; 22.14 (6) two representatives of persons with mental health, 22.15 developmental or physical disabilities, chemical dependency, or 22.16 chronic illness appointed by the governor; and 22.17 (7) three public members appointed by the governor, at 22.18 least one of whom must represent a community health board. The 22.19 risk adjustment association may appoint a representative, if a 22.20 representative is not otherwise appointed by an appointing 22.21 authority. 22.22 (d) The commissioners of health and human services, with 22.23 the advice of the public programs risk adjustment work group, 22.24 shall develop a work plan and time frame and shall coordinate 22.25 their efforts with the private sector risk adjustment 22.26 association's activities and other state initiatives related to 22.27 public program managed care reimbursement. The commissioners of 22.28 health and human services shall report to the health care 22.29 commission and to the appropriate legislative committees on 22.30 January 15, 1996, and on January 15, 1997, on any policy or 22.31 legislative changes necessary to implement the public program 22.32 risk adjustment system. 22.33 Sec. 10. Minnesota Statutes 1994, section 62Q.03, is 22.34 amended by adding a subdivision to read: 22.35 Subd. 5b. [MEDICARE SUPPLEMENT MARKET.] A risk adjustment 22.36 system may be developed for the Medicare supplement market. The 23.1 Medicare supplement risk adjustment system may include a 23.2 demographic component and may, but is not required to, include a 23.3 condition-specific risk adjustment component. 23.4 Sec. 11. Minnesota Statutes 1994, section 62Q.03, 23.5 subdivision 6, is amended to read: 23.6 Subd. 6. [CREATION OF RISK ADJUSTMENT ASSOCIATION.] The 23.7 Minnesota risk adjustment association is created on July 1, 23.8 1994, and may operate as a nonprofit unincorporated 23.9 association., but is authorized to incorporate under chapter 23.10 317A. 23.11 The provisions of this chapter govern if the provisions of 23.12 chapter 317A conflict with this chapter. The association may 23.13 operate under the approved plan of operation and shall be 23.14 governed in accordance with this chapter and may operate in 23.15 accordance with chapter 317A. If the association incorporates 23.16 as a nonprofit corporation under chapter 317A, the filing of the 23.17 plan of operation meets the requirements of filing articles of 23.18 incorporation. 23.19 The association, its transactions, and all property owned 23.20 by it are exempt from taxation under the laws of this state or 23.21 any of its subdivisions, including, but not limited to, income 23.22 tax, sales tax, use tax, and property tax. The association may 23.23 seek exemption from payment of all fees and taxes levied by the 23.24 federal government. Except as otherwise provided in this 23.25 chapter, the association is not subject to the provisions of 23.26 chapters 14, 60A, 62A, and 62P. The association is not a public 23.27 employer and is not subject to the provisions of chapters 179A 23.28 and 353. The board of directors and health carriers who are 23.29 members of the association are exempt from sections 325D.49 to 23.30 325D.66 in the performance of their duties as directors and 23.31 members of the association. The risk adjustment association is 23.32 subject to the open meeting law. 23.33 Sec. 12. Minnesota Statutes 1994, section 62Q.03, 23.34 subdivision 7, is amended to read: 23.35 Subd. 7. [PURPOSE OF ASSOCIATION.] The association is 23.36established to carry out the purposes of subdivision 1, as24.1further elaborated on by the implementation report described in24.2subdivision 5 and by legislation enacted in 1995 or subsequently.24.3 established to develop and implement a private sector risk 24.4 adjustment system. 24.5 Subject to state oversight set forth in subdivision 10, the 24.6 association shall: 24.7 (1) develop and implement comprehensive risk adjustment 24.8 systems for individual, small group, and Medicare Supplement 24.9 markets consistent with the provisions of this chapter; 24.10 (2) submit a plan for the development of the risk 24.11 adjustment system which identifies appropriate implementation 24.12 dates consistent with the rating and underwriting restrictions 24.13 of each market, recommends whether transfers attributable to 24.14 risk adjustment should be required between the individual and 24.15 small group markets, and makes other appropriate recommendations 24.16 to the commissioners of health and commerce by November 5, 1995; 24.17 (3) develop a combination of a demographic risk adjustment 24.18 system and payments for targeted conditions; 24.19 (4) test an ambulatory care groups (ACGs) and diagnostic 24.20 cost groups (DCGs) system, and recommend whether such a 24.21 methodology should be adopted; 24.22 (5) fund the development and testing of the risk adjustment 24.23 system; 24.24 (6) recommend market conduct guidelines; and 24.25 (7) develop a plan for assessing members for the costs of 24.26 administering the risk adjustment system. 24.27 Sec. 13. Minnesota Statutes 1994, section 62Q.03, 24.28 subdivision 8, is amended to read: 24.29 Subd. 8. [GOVERNANCE.] (a) The association shall be 24.30 governed by an interim 19-member board as follows: one provider 24.31 member appointed by the Minnesota Hospital Association; one 24.32 provider member appointed by the Minnesota Medical Association; 24.33 one provider member appointed by the governor; three members 24.34 appointed by the Minnesota Council of HMOs to include an HMO 24.35 with at least 50 percent of total membership enrolled through a 24.36 public program; three members appointed by Blue Cross and Blue 25.1 Shield of Minnesota, to include a member from a Blue Cross and 25.2 Blue Shield of Minnesota affiliated health plan with fewer than 25.3 50,000 enrollees and located outside the Minneapolis-St. Paul 25.4 metropolitan area; two members appointed by the Insurance 25.5 Federation of Minnesota; one member appointed by the Minnesota 25.6 Association of Counties; and three public members appointed by 25.7 the governor, to include at least one representative of a public 25.8 program. The commissioners of health, commerce, human services, 25.9 and employee relations shall be nonvoting ex officio members. 25.10 (b) The board may elect officers and establish committees 25.11 as necessary. 25.12 (c) A majority of the members of the board constitutes a 25.13 quorum for the transaction of business. 25.14 (d) Approval by a majority of the board members present is 25.15 required for any action of the board. 25.16 (e) Interim board members shall be appointed by July 1, 25.17 1994, and shall serve until a new board is elected according to 25.18 the plan of operation developed by the association. 25.19 (f) A member may designate a representative to act as a 25.20 member of the interim board in the member's absence. 25.21 Sec. 14. Minnesota Statutes 1994, section 62Q.03, is 25.22 amended by adding a subdivision to read: 25.23 Subd. 8a. [PLAN OF OPERATION.] The board shall submit a 25.24 proposed plan of operation by August 15, 1995, to the 25.25 commissioners of health and commerce for review. The 25.26 commissioners of health and commerce shall have the authority to 25.27 approve or reject the plan of operation. 25.28 Amendments to the plan of operation may be made by the 25.29 commissioners or by the directors of the association, subject to 25.30 the approval of the commissioners. 25.31 Sec. 15. Minnesota Statutes 1994, section 62Q.03, 25.32 subdivision 9, is amended to read: 25.33 Subd. 9. [DATA COLLECTION AND DATA PRIVACY.]The board of25.34the association shall consider antitrust implications and25.35establish procedures to assure that pricing and other25.36competitive information is appropriately shared among26.1competitors in the health care market or members of the board.26.2Any information shared shall be distributed only for the26.3purposes of administering or developing any of the tasks26.4identified in subdivisions 2 and 4. In developing these26.5procedures, the board of the association may consider the26.6identification of a state agency or other appropriate third26.7party to receive information of a confidential or competitive26.8nature.The association members shall not have access to 26.9 unaggregated data on individuals or health plan companies. The 26.10 association shall develop, as a part of the plan of operation, 26.11 procedures for ensuring that data is collected by an appropriate 26.12 entity. The commissioners of health and commerce shall have the 26.13 authority to audit and examine data collected by the association 26.14 for the purposes of the development and implementation of the 26.15 risk adjustment system. Data on individuals obtained for the 26.16 purposes of risk adjustment development, testing, and operation 26.17 are designated as private data. Data not on individuals which 26.18 is obtained for the purposes of development, testing, and 26.19 operation of risk adjustment are designated as nonpublic data. 26.20 Except for the proposed and approved plan of operation, the risk 26.21 adjustment methodologies examined, the plan for testing, the 26.22 plan of the risk adjustment system, minutes of meetings, and 26.23 other general operating information are classified as public 26.24 data. Nothing in this section is intended to prohibit the 26.25 preparation of summary data under section 13.05, subdivision 7. 26.26 The association, state agencies, and any contractors having 26.27 access to this data shall maintain it in accordance with this 26.28 classification. The commissioners of health and human services 26.29 have the authority to collect data from health plan companies as 26.30 needed for the purpose of developing a risk adjustment mechanism 26.31 for public programs. 26.32 Sec. 16. Minnesota Statutes 1994, section 62Q.03, 26.33 subdivision 10, is amended to read: 26.34 Subd. 10. [SUPERVISIONSTATE OVERSIGHT OF RISK ADJUSTMENT 26.35 ACTIVITIES.] The association's activities shall be supervised by 26.36 the commissioners of health and commerce. The commissioners 27.1 shall provide specific oversight functions during the 27.2 development and implementation phases of the risk adjustment 27.3 system as follows: 27.4 (1) the commissioners shall approve or reject the 27.5 association's plan for testing risk adjustment methods, the 27.6 methods to be used, and any changes to those methods; 27.7 (2) the commissioners must have the right to attend and 27.8 participate in all meetings of the association and its work 27.9 groups or committees, except for meetings involving privileged 27.10 communication between the association and its counsel as 27.11 permitted under section 471.705, subdivision 1d, paragraph (e); 27.12 (3) the commissioners shall approve any consultants or 27.13 administrators used by the association; 27.14 (4) the commissioners shall approve or reject the 27.15 association's plan of operation; and 27.16 (5) the commissioners shall approve or reject the plan for 27.17 the risk adjustment system described in subdivision 7, clause 27.18 (2). 27.19 If the commissioners reject any of the plans identified in 27.20 clauses (1), (4), and (5) of this subdivision, the directors 27.21 shall submit for review an appropriate revised plan within 30 27.22 days. 27.23 Sec. 17. Minnesota Statutes 1994, section 62Q.03, is 27.24 amended by adding a subdivision to read: 27.25 Subd. 12. [PARTICIPATION BY ALL HEALTH PLAN 27.26 COMPANIES.] Upon its implementation, all health plan companies, 27.27 as a condition of licensure, must participate in the risk 27.28 adjustment system to be implemented under this section. 27.29 Sec. 18. Minnesota Statutes 1994, section 62Q.07, 27.30 subdivision 1, is amended to read: 27.31 Subdivision 1. [ACTION PLANS REQUIRED.] (a) To increase 27.32 public awareness and accountability of health plan companies, 27.33 all health plan companies that issue or renew a health plan, as 27.34 defined in section 62Q.01, must annually file with the 27.35 applicable commissioner an action plan that satisfies the 27.36 requirements of this section beginning July 1, 1994, as a 28.1 condition of doing business in Minnesota. For purposes of this 28.2 subdivision, "health plan" includes the coverages described in 28.3 section 62A.011, subdivision 3, clause (10). Each health plan 28.4 company must also file its action plan with the information 28.5 clearinghouse. Action plans are required solely to provide 28.6 information to consumers, purchasers, and the larger community 28.7 as a first step toward greater accountability of health plan 28.8 companies. The sole function of the commissioner in relation to 28.9 the action plans is to ensure that each health plan company 28.10 files a complete action plan, that the action plan is truthful 28.11 and not misleading, and that the action plan is reviewed by 28.12 appropriate community agencies. 28.13 (b) If a commissioner responsible for regulating a health 28.14 plan company required to file an action plan under this section 28.15 has reason to believe an action plan is false or misleading, the 28.16 commissioner may conduct an investigation to determine whether 28.17 the action plan is truthful and not misleading, and may require 28.18 the health plan company to submit any information that the 28.19 commissioner reasonably deems necessary to complete the 28.20 investigation. If the commissioner determines that an action 28.21 plan is false or misleading, the commissioner may require the 28.22 health plan company to file an amended plan or may take any 28.23 action authorized under chapter 72A. 28.24 Sec. 19. Minnesota Statutes 1994, section 62Q.07, 28.25 subdivision 2, is amended to read: 28.26 Subd. 2. [CONTENTS OF ACTION PLANS.] (a) An action plan 28.27 must include a detailed description of all of the health plan 28.28 company's methods and procedures, standards, qualifications, 28.29 criteria, and credentialing requirements for designating the 28.30 providers who are eligible to participate in the health plan 28.31 company's provider network, including any limitations on the 28.32 numbers of providers to be included in the network. This 28.33 description must be updated by the health plan company and filed 28.34 with the applicable agency on a quarterly basis. 28.35 (b) An action plan must include the number of full-time 28.36 equivalent physicians, by specialty, nonphysician providers, and 29.1 allied health providers used to provide services. The action 29.2 plan must also describe how the health plan company intends to 29.3 encourage the use of nonphysician providers, midlevel 29.4 practitioners, and allied health professionals, through at least 29.5 consumer education, physician education, and referral and 29.6 advisement systems. The annual action plan must also include 29.7 data that is broken down by type of provider, reflecting actual 29.8 utilization of midlevel practitioners and allied professionals 29.9 by enrollees of the health plan company during the previous 29.10 year. Until July 1, 1995, a health plan company may use 29.11 estimates if actual data is not available. For purposes of this 29.12 paragraph, "provider" has the meaning given in section 62J.03, 29.13 subdivision 8. 29.14 (c) An action plan must include a description of the health 29.15 plan company's policy on determining the number and the type of 29.16 providers that are necessary to deliver cost-effective health 29.17 care to its enrollees. The action plan must also include the 29.18 health plan company's strategy, including provider recruitment 29.19 and retention activities, for ensuring that sufficient providers 29.20 are available to its enrollees. 29.21 (d) An action plan must include a description of actions 29.22 taken or planned by the health plan company to ensure that 29.23 information from report cards, outcome studies, and complaints 29.24 is used internally to improve quality of the services provided 29.25 by the health plan company. 29.26 (e) An action plan must include a detailed description of 29.27 the health plan company's policies and procedures for enrolling 29.28 and serving high risk and special needs populations. This 29.29 description must also include the barriers that are present for 29.30 the high risk and special needs population and how the health 29.31 plan company is addressing these barriers in order to provide 29.32 greater access to these populations. "High risk and special 29.33 needs populations" includes, but is not limited to, recipients 29.34 of medical assistance, general assistance medical care, and 29.35 MinnesotaCare; persons with chronic conditions or disabilities; 29.36 individuals within certain racial, cultural, and ethnic 30.1 communities; individuals and families with low income; 30.2 adolescents; the elderly; individuals with limited or no English 30.3 language proficiency; persons with high-cost preexisting 30.4 conditions; homeless persons; chemically dependent persons; 30.5 persons with serious and persistent mental illnessand; children 30.6 with severe emotional disturbance; and persons who are at high 30.7 risk of requiring treatment.The action plan must also reflect30.8actual utilization of providers by enrollees defined by this30.9section as high risk or special needs populations during the30.10previous year.For purposes of this paragraph, "provider" has 30.11 the meaning given in section 62J.03, subdivision 8. 30.12 (f) An action plan must include a general description of 30.13 any action the health plan company has taken and those it 30.14 intends to take to offer health coverage options to rural 30.15 communities and other communities not currently served by the 30.16 health plan company. 30.17 (g) A health plan company other than a large managed care 30.18 plan company may satisfy any of the requirements of the action 30.19 plan in paragraphs (a) to (f) by stating that it has no 30.20 policies, procedures, practices, or requirements, either written 30.21 or unwritten, or formal or informal, and has undertaken no 30.22 activities or plans on the issues required to be addressed in 30.23 the action plan, provided that the statement is truthful and not 30.24 misleading. For purposes of this paragraph, "large managed care 30.25 plan company" means a health maintenance organization, 30.26 integrated service network, or other health plan company that 30.27 employs or contracts with health care providers, that has more 30.28 than 50,000 enrollees in this state. If a health plan company 30.29 employs or contracts with providers for some of its health plans 30.30 and does not do so for other health plans that it offers, the 30.31 health plan company is a large managed care plan company if it 30.32 has more than 50,000 enrollees in this state in health plans for 30.33 which it does employ or contract with providers. 30.34 Sec. 20. Minnesota Statutes 1994, section 62Q.09, 30.35 subdivision 3, is amended to read: 30.36 Subd. 3. [ENFORCEMENT.]EitherThecommissioner31.1 commissioners of healthorand commerce shall each periodically 31.2 review contracts among health care providing entities and health 31.3 plan companies to determine compliance with this section, with 31.4 respect to health plan companies that the commissioners 31.5 respectively regulate. Any provider may submit a contract to 31.6 the relevant commissioner for review if the provider believes 31.7 this section has been violated. Any provision of a contract 31.8 found by the relevant commissioner to violate this section is 31.9 null and void, and the relevant commissioner mayseekassess 31.10 civil penalties against the health plan company in an amount not 31.11 to exceed $25,000 for each such contract, using the enforcement 31.12 procedures otherwise available to the commissioner involved. 31.13 Sec. 21. [62Q.105] [HEALTH PLAN COMPANY COMPLAINT 31.14 PROCEDURE.] 31.15 Subdivision 1. [ESTABLISHMENT.] Each health plan company 31.16 shall establish and make available to enrollees, by July 1, 31.17 1997, an informal complaint resolution process that meets the 31.18 requirements of this section. A health plan company must make 31.19 reasonable efforts to resolve enrollee complaints, and must 31.20 inform complainants in writing of the company's decision within 31.21 30 days of receiving the complaint. The complaint resolution 31.22 process must treat the complaint and information related to it 31.23 as required under sections 72A.49 to 72A.505. 31.24 Subd. 2. [MEDICALLY URGENT COMPLAINTS.] Health plan 31.25 companies shall make reasonable efforts to resolve medically 31.26 urgent enrollee complaints within 72 hours of receiving the 31.27 complaint. 31.28 Subd. 3. [APPEALS PROCESS.] Health plan companies shall 31.29 establish and make available to enrollees an impartial appeals 31.30 process. If a decision by a health plan company regarding a 31.31 complaint is partially or wholly adverse to the complainant, the 31.32 health plan company shall advise the complainant of the right to 31.33 appeal through the impartial appeals process or to the 31.34 commissioner. 31.35 Subd. 4. [ALTERNATIVE DISPUTE RESOLUTION.] Health plan 31.36 companies shall make available to enrollees an alternative 32.1 dispute resolution process, and shall participate in alternative 32.2 dispute resolution at the request of an enrollee, as required 32.3 under section 62Q.11. A health plan company may meet the 32.4 requirements of subdivision 3 by providing an alternative 32.5 dispute resolution process. If the health plan company chooses 32.6 to provide alternative dispute resolution to meet the 32.7 requirements of subdivision 3, the process shall be provided at 32.8 no cost to the enrollee. 32.9 Subd. 5. [REQUIREMENTS FOR MANAGED CARE 32.10 ORGANIZATIONS.] Each managed care organization shall submit all 32.11 health care quality related complaints to its quality review 32.12 board or quality review organization for evaluation and possible 32.13 action. The complaint resolution process for managed care 32.14 organizations must clearly indicate the entity responsible for 32.15 resolving complaints made by enrollees against hospitals, other 32.16 health care facilities, and health care providers, that are 32.17 owned by or under contract with the managed care organization. 32.18 Subd. 6. [RECORD KEEPING.] Health plan companies shall 32.19 maintain records of all enrollee complaints and their 32.20 resolutions. These records must be retained for five years, and 32.21 must be made available to the appropriate commissioner upon 32.22 request. 32.23 Subd. 7. [REPORTING.] Each health plan company shall 32.24 submit to the appropriate commissioner, as part of the company's 32.25 annual filing, data on the number and type of complaints that 32.26 are not resolved within 30 days. A health plan company shall 32.27 also make this information available to the public upon request. 32.28 Subd. 8. [NOTICE TO ENROLLEES.] Health plan companies 32.29 shall provide a clear and complete description of their 32.30 complaint resolution procedures to enrollees as part of their 32.31 evidence of coverage or contract. The description must 32.32 specifically inform enrollees: 32.33 (1) how to file a complaint with the health plan company; 32.34 (2) how to request an impartial appeal; 32.35 (3) that they have the right to request the use of 32.36 alternative methods of dispute resolution; and 33.1 (4) that they have the right to litigate. 33.2 Sec. 22. [62Q.1055] [CHEMICAL DEPENDENCY.] 33.3 All health plan companies shall use the assessment criteria 33.4 in Minnesota Rules, parts 9530.6600 to 9530.6660, when assessing 33.5 and placing enrollees for chemical dependency treatment. 33.6 Sec. 23. [62Q.106] [DISPUTE RESOLUTION BY COMMISSIONER.] 33.7 A complainant may at any time submit a complaint to the 33.8 appropriate commissioner to investigate. After investigating a 33.9 complaint, or reviewing a company's decision, the appropriate 33.10 commissioner may order a remedy as authorized under section 33.11 62N.04, 62Q.30, chapter 45, 60A, or 62D. 33.12 Sec. 24. Minnesota Statutes 1994, section 62Q.11, 33.13 subdivision 2, is amended to read: 33.14 Subd. 2. [REQUIREMENTS.] (a) If an enrollee, health care 33.15 provider, or applicant for network provider status chooses to 33.16 use a dispute resolution process prior to the filing of a formal 33.17 claim or of a lawsuit, the health plan company must participate. 33.18 (b) If an enrollee, health care provider, or applicant for 33.19 network provider status chooses to use a dispute resolution 33.20 process after the filing of a lawsuit, the health plan company 33.21 must participate in dispute resolution, including, but not 33.22 limited to, alternative dispute resolution under rule 114 of the 33.23 Minnesota general rules of practice. 33.24 (c) The commissioners of health and commerce shall inform 33.25 and educate health plan companies' enrollees about dispute 33.26 resolution and its benefits, and shall establish appropriate 33.27 cost-sharing requirements for parties taking part in alternative 33.28 dispute resolution. 33.29 (d) A health plan company may encourage but not require an 33.30 enrollee to submit a complaint to alternative dispute resolution. 33.31 Sec. 25. [62Q.145] [ABORTION AND SCOPE OF PRACTICE.] 33.32 Health plan company policies related to scope of practice 33.33 for allied independent health providers as defined in section 33.34 62Q.095, subdivision 5, midlevel practitioners as defined in 33.35 section 136A.1356, subdivision 1, and other nonphysician health 33.36 care professionals must comply with the requirements governing 34.1 the performance of abortions in section 145.412, subdivision 1. 34.2 Sec. 26. Minnesota Statutes 1994, section 62Q.19, is 34.3 amended to read: 34.4 62Q.19 [ESSENTIAL COMMUNITY PROVIDERS.] 34.5 Subdivision 1. [DESIGNATION.] The commissioner shall 34.6 designate essential community providers. The criteria for 34.7 essential community provider designation shall be the following: 34.8 (1) a demonstrated ability to integrate applicable 34.9 supportive and stabilizing services with medical care for 34.10 uninsured persons and high-risk and special needs populations as 34.11 defined in section 62Q.07, subdivision 2, paragraph (e), 34.12 underserved, and other special needs populations; and 34.13 (2) a commitment to serve low-income and underserved 34.14 populations by meeting the following requirements: 34.15 (i) has nonprofit status in accordance with chapter 317A; 34.16 (ii) has tax exempt status in accordance with the Internal 34.17 Revenue Service Code, section 501(c)(3); 34.18 (iii) charges for services on a sliding fee schedule based 34.19 on current poverty income guidelines; and 34.20 (iv) does not restrict access or services because of a 34.21 client's financial limitation; or 34.22 (3) status as a local government unit as defined in section 34.23 62D.02, subdivision 11, an Indian tribal government, an Indian 34.24 health service unit, or community health board as defined in 34.25 chapter 145A. 34.26 Prior to designation, the commissioner shall publish the 34.27 names of all applicants in the State Register. The public shall 34.28 have 30 days from the date of publication to submit written 34.29 comments to the commissioner on the application. No designation 34.30 shall be made by the commissioner until the 30-day period has 34.31 expired. 34.32 The commissioner may designate an eligible provider as an 34.33 essential community provider for all the services offered by 34.34 that provider or for specific services designated by the 34.35 commissioner. 34.36 For the purpose of this subdivision, supportive and 35.1 stabilizing services include at a minimum, transportation, child 35.2 care, cultural, and linguistic services where appropriate. 35.3 Subd. 2. [APPLICATION.] (a) Any provider may apply to the 35.4 commissioner for designation as an essential community 35.5 provider by submitting an application form developed by the 35.6 commissioner. Applications must be accepted within two years 35.7 after the effective date of the rules adopted by the 35.8 commissioner to implement this section. 35.9 (b) Each application submitted must be accompanied by an 35.10 application fee in an amount determined by the commissioner. 35.11 The fee shall be no more than what is needed to cover the 35.12 administrative costs of processing the application. 35.13 (c) The name, address, contact person, and the date by 35.14 which the commissioner's decision is expected to be made shall 35.15 be classified as public data under section 13.41. All other 35.16 information contained in the application form shall be 35.17 classified as private data under section 13.41 until the 35.18 application has been approved, approved as modified, or denied 35.19 by the commissioner. Once the decision has been made, all 35.20 information shall be classified as public data unless the 35.21 applicant designates and the commissioner determines that the 35.22 information contains trade secret information. 35.23 Subd 2a. [DEFINITION OF HEALTH PLAN COMPANY.] For purposes 35.24 of this section, "health plan company" does not include a health 35.25 plan company as defined in section 62Q.01 with fewer than 50,000 35.26 enrollees, all of whose enrollees are covered under medical 35.27 assistance, general assistance medical care, or MinnesotaCare. 35.28 Subd. 3. [HEALTH PLAN COMPANY AFFILIATION.] A health plan 35.29 company must offer a provider contract to any designated 35.30 essential community provider located within the area served by 35.31 the health plan company. A health plan company shall not 35.32 restrict enrollee access to services designated to be provided 35.33 by the essential community provider for the population that the 35.34 essential community provider is certified to serve. A health 35.35 plan company may also make other providers availableto this35.36same populationfor these services. A health plan company may 36.1 require an essential community provider to meet all data 36.2 requirements, utilization review, and quality assurance 36.3 requirements on the same basis as other health plan providers. 36.4 Subd. 4. [ESSENTIAL COMMUNITY PROVIDER RESPONSIBILITIES.] 36.5 Essential community providers must agree to serve enrollees of 36.6 all health plan companies operating in the areathatin which 36.7 the essential community provider iscertified to servelocated. 36.8 Subd. 5. [CONTRACT PAYMENT RATES.] An essential community 36.9 provider and a health plan company may negotiate the payment 36.10 rate for covered services provided by the essential community 36.11 provider. This rate must becompetitive with rates paid to36.12other health plan providersthe same rate per unit of service as 36.13 is paid to other health plan providers for the same or similar 36.14 services. 36.15 Subd. 5a. [COOPERATION.] Each health plan company and 36.16 essential community provider shall cooperate to facilitate the 36.17 use of the essential community provider by the high risk and 36.18 special needs populations. This includes cooperation on the 36.19 submission and processing of claims, sharing of all pertinent 36.20 records and data, including performance indicators and specific 36.21 outcomes data, and the use of all dispute resolution methods as 36.22 defined in section 62Q.11, subdivision 1. 36.23 Subd. 5b. [ENFORCEMENT.] For any violation of this section 36.24 or any rule applicable to an essential community provider, the 36.25 commissioner may suspend, modify, or revoke an essential 36.26 community provider designation. The commissioner may also use 36.27 the enforcement authority specified in section 62D.17. 36.28 Subd. 6. [TERMINATION.] The designation as an essential 36.29 community provideris terminatedterminates five years after it 36.30 is granted,andor when universal coverage as defined under 36.31 section 62Q.165 is achieved, whichever is later. Once the 36.32 designation terminates, the former essential community provider 36.33 has no rights or privileges beyond those of any other health 36.34 care provider. The commissioner shall make a recommendation to 36.35 the legislature on whether an essential community provider 36.36 designation should be longer than five years. 37.1 Subd. 7. [RECOMMENDATIONS ANDRULEMAKINGON ESSENTIAL37.2COMMUNITY PROVIDERS.](a) As part of the implementation plan due37.3January 1, 1995, the commissioner shall present proposed rules37.4and any necessary recommendations for legislation for defining37.5essential community providers, using the criteria established37.6under subdivision 1, and defining the relationship between37.7essential community providers and health plan companies.37.8(b)By January 1, 1996, the commissioner shall adopt rules 37.9 for establishing essential community providers and for governing 37.10 their relationship with health plan companies. The commissioner 37.11 shall also identify and address any conflict of interest issues 37.12 regarding essential community provider designation for local 37.13 governments. The rules shall require health plan companies to 37.14 comply with all provisions of section 62Q.14 with respect to 37.15 enrollee use of essential community providers. 37.16 Sec. 27. [62Q.43] [GEOGRAPHIC ACCESS.] 37.17 Subdivision 1. [CLOSED-PANEL HEALTH PLAN.] For purposes of 37.18 this section, "closed-panel health plan" means a health plan as 37.19 defined in section 62Q.01 that requires an enrollee to receive 37.20 all or a majority of primary care services from a specific 37.21 clinic or physician designated by the enrollee that is within 37.22 the health plan company's clinic or physician network. 37.23 Subd. 2. [ACCESS REQUIREMENT.] Every closed-panel health 37.24 plan must allow enrollees who are full-time students under the 37.25 age of 25 years to change their designated clinic or physician 37.26 at least once per month, as long as the clinic or physician is 37.27 part of the health plan company's statewide clinic or physician 37.28 network. A health plan company shall not charge enrollees who 37.29 choose this option higher premiums or cost sharing than would 37.30 otherwise apply to enrollees who do not choose this option. A 37.31 health plan company may require enrollees to provide 15 days 37.32 written notice of intent to change their designated clinic or 37.33 physician. 37.34 Sec. 28. [62Q.45] [COVERAGE FOR OUT-OF-AREA PRIMARY CARE.] 37.35 Subdivision 1. [STUDY.] The commissioner of health shall 37.36 develop methods to allow enrollees of managed care organizations 38.1 to obtain primary care health services outside of the service 38.2 area of their managed care organization, from health care 38.3 providers who are employed by or under contract with another 38.4 managed care organization. The commissioner shall make 38.5 recommendations on: (1) whether this out-of-area primary care 38.6 coverage should be available to students and/or other enrollees 38.7 without additional premium charges or cost sharing; (2) methods 38.8 to coordinate the services provided by different managed care 38.9 organizations; (3) methods to manage the quality of care 38.10 provided by different managed care organizations and monitor 38.11 health care outcomes; (4) methods to reimburse managed care 38.12 organizations for care provided to enrollees of other managed 38.13 care organizations; and (5) other issues relevant to the design 38.14 and administration of out-of-area primary care coverage. The 38.15 commissioner shall present recommendations to the legislature by 38.16 January 15, 1996. 38.17 Subd. 2. [DEFINITION.] For purposes of this section, 38.18 "managed care organization" means: (1) a health maintenance 38.19 organization operating under chapter 62D; (2) a community 38.20 integrated service network as defined under section 62N.02, 38.21 subdivision 4a; (3) an integrated service network as defined 38.22 under section 62N.02, subdivision 8; or (4) an insurance company 38.23 licensed under chapter 60A, nonprofit health service plan 38.24 corporation operating under chapter 62C, fraternal benefit 38.25 society operating under chapter 64B, or any other health plan 38.26 company, to the extent that it covers health care services 38.27 delivered to Minnesota residents through a preferred provider 38.28 organization or a network of selected providers. 38.29 Sec. 29. [62Q.47] [MENTAL HEALTH AND CHEMICAL DEPENDENCY 38.30 SERVICES.] 38.31 (a) All health plans, as defined in section 62Q.01, that 38.32 provide coverage for mental health or chemical dependency 38.33 services, must comply with the requirements of this section. 38.34 (b) Cost-sharing requirements and benefit or service 38.35 limitations for outpatient mental health and outpatient chemical 38.36 dependency services, except for persons placed in chemical 39.1 dependency services under Minnesota Rules, parts 9530.6600 to 39.2 9530.6660, must not place a greater financial burden on the 39.3 insured or enrollee, or be more restrictive than those 39.4 requirements and limitations for outpatient medical services. 39.5 (c) Cost-sharing requirements and benefit or service 39.6 limitations for inpatient hospital mental health and inpatient 39.7 hospital and residential chemical dependency services, except 39.8 for persons placed in chemical dependency services under 39.9 Minnesota Rules, parts 9530.6600 to 9530.6660, must not place a 39.10 greater financial burden on the insured or enrollee, or be more 39.11 restrictive than those requirements and limitations for 39.12 inpatient hospital medical services. 39.13 Sec. 30. Minnesota Statutes 1994, section 145.414, is 39.14 amended to read: 39.15 145.414 [ABORTION NOT MANDATORY.] 39.16 (a) No person and no hospital or institution shall be 39.17 coerced, held liable or discriminated against in any manner 39.18 because of a refusal to perform, accommodate, assist or submit 39.19 to an abortion for any reason. 39.20 (b) It is the policy of the state of Minnesota that no 39.21 health plan company as defined under section 62Q.01, subdivision 39.22 4, or health care cooperative as defined under section 62R.04, 39.23 subdivision 2, shall be required to provide or provide coverage 39.24 for an abortion. No provision of this chapter; of chapter 62A, 39.25 62C, 62D, 62H, 62L, 62M, 62N, 62R, 64B, or of any other chapter; 39.26 of Minnesota Rules; or of this act shall be construed as 39.27 requiring a health plan company as defined under section 62Q.01, 39.28 subdivision 4, or a health care cooperative as defined under 39.29 section 62R.04, subdivision 2, to provide or provide coverage 39.30 for an abortion. 39.31 (c) This section supersedes any provision of this act, or 39.32 any act enacted prior to enactment of this act, that in any way 39.33 limits or is inconsistent with this section. No provision of 39.34 any act enacted subsequent to this act shall be construed as in 39.35 any way limiting or being inconsistent with this section, unless 39.36 the act amends this section or expressly provides that it is 40.1 intended to limit or be inconsistent with this section. 40.2 Sec. 31. [SINGLE ENTRY POINT FOR COMPLAINTS.] 40.3 The commissioner of health shall establish a single entry 40.4 point within the health department for consumer complaints about 40.5 the quality and cost of health care services, whether these 40.6 services are delivered by individual providers, health care 40.7 facilities, or health plan companies. The commissioner shall 40.8 present a work plan to the legislature by February 1, 1996. 40.9 Sec. 32. [CHEMICAL DEPENDENCY STANDARDS AND INCENTIVES.] 40.10 Subdivision 1. [STANDARDS.] As part of the department of 40.11 human service's household survey of chemical dependency needs in 40.12 Minnesota, the commissioner of human services shall study 40.13 whether utilization standards pertaining to the number of 40.14 chemical dependency treatment inpatient and outpatient referrals 40.15 per 1,000 enrollees and lengths of stay are needed for the state 40.16 to address chemical dependency treatment needs. 40.17 Subd. 2. [INCENTIVES SYSTEM.] The commissioners of human 40.18 services and health shall develop recommendations for a 40.19 financial or other incentive system for health plan companies to 40.20 meet the standards developed in subdivision 1. The 40.21 commissioners shall report to the health care commission and 40.22 appropriate legislative committees by January 15, 1997. 40.23 Sec. 33. [CONSTRUCTION.] 40.24 Nothing in this act shall be construed to expand existing 40.25 law with respect to coverage of abortion. 40.26 Sec. 34. [STUDY OF HEALTH CARE DELIVERY.] 40.27 The Minnesota health care commission shall study the impact 40.28 of managed care and other methods of health care delivery on the 40.29 quality of life and care provided to terminally ill patients. 40.30 The commission shall also study the impact of managed care and 40.31 other methods of health care delivery on the quality of life and 40.32 care provided to persons with chronic illness or disability. 40.33 The commission shall hold hearings at various sites in Minnesota 40.34 and take testimony from concerned citizens. The commission 40.35 shall present a report on these issues to the legislature and 40.36 the governor by December 15, 1996. 41.1 Sec. 35. [REPEALER; HMO ARBITRATION RULES.] 41.2 Minnesota Rules, part 4685.1700, subpart 1, item D, is 41.3 repealed. 41.4 Sec. 36. [REPEALER.] 41.5 Minnesota Statutes 1994, sections 62Q.03, subdivisions 2, 41.6 3, 4, 5, and 11; 62Q.21; and 62Q.27, are repealed. 41.7 Sec. 37. [EFFECTIVE DATE.] 41.8 Sections 1, 31, and 36 are effective January 1, 1996. 41.9 Section 27 is effective July 1, 1995, and applies to 41.10 closed-panel health plans offered, sold, issued, or renewed on 41.11 or after that date. 41.12 Section 29 is effective August 1, 1995, and applies to 41.13 health plans offered, issued, or renewed on or after that date. 41.14 ARTICLE 3 41.15 REGULATED ALL-PAYER OPTION 41.16 Section 1. Minnesota Statutes 1994, section 62J.017, is 41.17 amended to read: 41.18 62J.017 [IMPLEMENTATION TIMETABLE.] 41.19 The state seeks to complete the restructuring of the health 41.20 care delivery and financing systemby July 1, 1997.The41.21restructured system will have two options: (1) integrated41.22service networks, which will be accountable for meeting state41.23cost containment, quality, and access standards; or (2) a41.24uniform set of price and utilization controls for all health41.25care services for Minnesota residents not provided through an41.26integrated service network. Both systems will operate under the41.27state's growth limits and will be structured to promote41.28competition in the health care marketplace.Beginning July 1, 41.29 1994, measures will be taken to increase the public 41.30 accountability of existing health plan companies, to promote the 41.31 development of small, community-based integrated service 41.32 networks, and to reduce administrative costs by standardizing 41.33 third-party billing forms and procedures and utilization review 41.34 requirements. Voluntary formation of other integrated service 41.35 networks will begin after rules have been adopted, but not 41.36 before July 1, 1996. Statutes and rules for theentire42.1 restructured health care financing and delivery system must be 42.2 enacted or adopted by January 1, 1996, and a phase-in of the42.3all-payer reimbursement system must begin on that date. By July42.41, 1997, all health coverage must be regulated under integrated42.5service network or community integrated service network law42.6pursuant to chapter 62N or all-payer law pursuant to chapter 62P. 42.7 Sec. 2. Minnesota Statutes 1994, section 62J.04, 42.8 subdivision 1a, is amended to read: 42.9 Subd. 1a. [ADJUSTED GROWTH LIMITS AND ENFORCEMENT.] (a) 42.10 The commissioner shall publish the final adjusted growth limit 42.11 in the State Register by January 31 of the year that the 42.12 expenditure limit is to be in effect. The adjusted limit must 42.13 reflect the actual regional consumer price index for urban 42.14 consumers for the previous calendar year, and may deviate from 42.15 the previously published projected growth limits to reflect 42.16 differences between the actual regional consumer price index for 42.17 urban consumers and the projected Consumer Price Index for urban 42.18 consumers. The commissioner shall report to the legislature by 42.19 February 15 of each year on the implementation of the growth 42.20 limits. This annual report shall describe the differences 42.21 between the projected increase in health care expenditures, the 42.22 actual expenditures based on data collected, and the impact and 42.23 validity of growth limits within the overall health care reform 42.24 strategy. 42.25 (b) The commissioner, in consultation with the Minnesota 42.26 health care commission, shall research and include in the annual 42.27 report required in paragraph (a) for 1996, recommendations 42.28 regarding the implementation of growth limits for health plan 42.29 companies and providers. The commissioner shall: 42.30 (1) consider both spending and revenue approaches and 42.31 report on the implementation of the interim limits as defined in 42.32 sections 62J.041 and 62J.042; 42.33 (2) make recommendations regarding the enforcement 42.34 mechanism and consider mechanisms to adjust future growth limits 42.35 as well as mechanisms to establish financial penalties for 42.36 noncompliance; 43.1 (3) address the feasibility of systemwide limits imposed on 43.2 all integrated service networks; and 43.3 (4) make recommendations on the most effective way to 43.4 implement growth limits on the fee-for-service system in the 43.5 absence of a regulated all-payer system. 43.6(b)(c) The commissioner shall enforce limits on growth in 43.7 spendingand revenuesforintegrated service networks and for43.8the regulated all-payer optionhealth plan companies and 43.9 revenues for providers. If the commissioner determines that 43.10 artificial inflation or padding of costs or prices has occurred 43.11 in anticipation of the implementation of growth limits, the 43.12 commissioner may adjust the base year spending totals or growth 43.13 limits or take other action to reverse the effect of the 43.14 artificial inflation or padding. 43.15(c)(d) The commissioner shall impose and enforce overall 43.16 limits on growth inrevenues andspending forintegrated service43.17networkshealth plan companies, with adjustments for changes in 43.18 enrollment, benefits, severity, and risks. Ifan integrated43.19service networka health plan company exceeds the growth limits, 43.20 the commissioner mayreduce future limits on growth in aggregate43.21premium revenues for that integrated service network by up to43.22the amount overspent. If the integrated service network system43.23exceeds a systemwide spending limit, the commissioner may reduce43.24future limits on growth in premium revenues for the integrated43.25service network system by up to the amount overspentimpose 43.26 financial penalties up to the amount exceeding the applicable 43.27 growth limit. 43.28(d) The commissioner shall set prices, utilization43.29controls, and other requirements for the regulated all-payer43.30option to ensure that the overall costs of this system, after43.31adjusting for changes in population, severity, and risk, do not43.32exceed the growth limits. If growth limits for a calendar year43.33are exceeded, the commissioner may reduce reimbursement rates or43.34otherwise recoup amounts exceeding the limit for all or part of43.35the next calendar year. To the extent possible, the43.36commissioner may reduce reimbursement rates or otherwise recoup44.1amounts over the limit from individual providers who exceed the44.2growth limits.44.3(e) The commissioner, in consultation with the Minnesota44.4health care commission, shall research and make recommendations44.5to the legislature regarding the implementation of growth limits44.6for integrated service networks and the regulated all-payer44.7option. The commissioner must consider both spending and44.8revenue approaches and will report on the implementation of the44.9interim limits as defined in sections 62P.04 and 62P.05. The44.10commissioner must examine and make recommendations on the use of44.11annual update factors based on volume performance standards as a44.12mechanism for achieving controls on spending in the all-payer44.13option. The commissioner must make recommendations regarding44.14the enforcement mechanism and must consider mechanisms to adjust44.15future growth limits as well as mechanisms to establish44.16financial penalties for noncompliance. The commissioner must44.17also address the feasibility of systemwide limits imposed on all44.18integrated service networks.44.19(f) The commissioner shall report to the legislative44.20commission on health care access by December 1, 1994, on trends44.21in aggregate spending and premium revenue for health plan44.22companies. The commissioner shall use data submitted under44.23section 62P.04 and other available data to complete this report.44.24 Sec. 3. Minnesota Statutes 1994, section 62J.09, 44.25 subdivision 1a, is amended to read: 44.26 Subd. 1a.[DUTIES RELATED TO COST CONTAINMENT.] (a) [44.27ALLOCATION OF REGIONAL SPENDING LIMITS.] Regional coordinating44.28boards may advise the commissioner regarding allocation of44.29annual regional limits on the rate of growth for providers in44.30the regulated all-payer option in order to:44.31(1) achieve communitywide and regional public health goals44.32consistent with those established by the commissioner; and44.33(2) promote access to and equitable reimbursement of44.34preventive and primary care providers.44.35(b)[TECHNICAL ASSISTANCE.] Regional coordinating boards, 44.36 in cooperation with the commissioner, shall provide technical 45.1 assistance to parties interested in establishing or operating a 45.2 community integrated service network or integrated service 45.3 network within the region. This assistance must complement 45.4 assistance provided by the commissioner under section 62N.23. 45.5 Sec. 4. Minnesota Statutes 1994, section 62J.152, 45.6 subdivision 5, is amended to read: 45.7 Subd. 5. [USE OF TECHNOLOGY EVALUATION.] (a) The final 45.8 report on the technology evaluation and the commission's 45.9 comments and recommendations may be used: 45.10 (1) by the commissioner in retrospective and prospective 45.11 review of major expenditures; 45.12 (2) by integrated service networks and other group 45.13 purchasers and by employers, in making coverage, contracting, 45.14 purchasing, and reimbursement decisions; 45.15 (3)by government programs and regulators of the regulated45.16all-payer option, in making coverage, contracting, purchasing,45.17and reimbursement decisions;45.18(4)bythe commissioner and otherorganizations in the 45.19 development of practice parameters; 45.20(5)(4) by health care providers in making decisions about 45.21 adding or replacing technology and the appropriate use of 45.22 technology; 45.23(6)(5) by consumers in making decisions about treatment; 45.24(7)(6) by medical device manufacturers in developing and 45.25 marketing new technologies; and 45.26(8)(7) as otherwise needed by health care providers, 45.27 health care plans, consumers, and purchasers. 45.28 (b) At the request of the commissioner, the health care 45.29 commission, in consultation with the health technology advisory 45.30 committee, shall submit specific recommendations relating to 45.31 technologies that have been evaluated under this section for 45.32 purposes of retrospective and prospective review of major 45.33 expenditures and coverage, contracting, purchasing, and 45.34 reimbursement decisions affecting state programsand the45.35all-payer option. 45.36 Sec. 5. Minnesota Statutes 1994, section 62Q.01, 46.1 subdivision 4, is amended to read: 46.2 Subd. 4. [HEALTH PLAN COMPANY.] "Health plan company" 46.3 means: 46.4 (1) a health carrier as defined under section 62A.011, 46.5 subdivision 2; 46.6 (2) an integrated service network as defined under section 46.7 62N.02, subdivision 8; or 46.8 (3)an all-payer insurer as defined under section 62P.02;46.9or46.10(4)a community integrated service network as defined under 46.11 section 62N.02, subdivision 4a. 46.12 Sec. 6. Minnesota Statutes 1994, section 62Q.30, is 46.13 amended to read: 46.14 62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION 46.15 PROCESS.] 46.16 The commissioner shall establish an expedited fact finding 46.17 and dispute resolution process to assist enrollees ofintegrated46.18service networks and all-payer insurershealth plan companies 46.19 with contested treatment, coverage, and service issues to be in 46.20 effect July 1, 1997. The commissioner may order an integrated 46.21 service network or an all-payer insurer to provide or pay for a 46.22 service that is within theuniversalstandardbenefits set46.23 health coverage. If the disputed issue relates to whether a 46.24 service is appropriate and necessary, the commissioner shall 46.25 issue an order only after consulting with appropriate experts 46.26 knowledgeable, trained, and practicing in the area in dispute, 46.27 reviewing pertinent literature, and considering the availability 46.28 of satisfactory alternatives. The commissioner shall take steps 46.29 including but not limited to fining, suspending, or revoking the 46.30 license ofan integrated service network or an all-payer insurer46.31 a health plan company that is the subject of repeated orders by 46.32 the commissioner that suggests a pattern of inappropriate 46.33 underutilization. 46.34 Sec. 7. Minnesota Statutes 1994, section 62Q.41, is 46.35 amended to read: 46.36 62Q.41 [ANNUAL IMPLEMENTATION REPORT.] 47.1 (a) The commissioner of health, in consultation with the 47.2 Minnesota health care commission, shall develop an annual 47.3 implementation report to be submitted to the legislature each 47.4 year beginning January 1, 1995, describing the progress and 47.5 status of rule development and implementation of the integrated 47.6 service network systemand the regulated all-payer option, and 47.7 providing recommendations for legislative changes that the 47.8 commissioner determines may be needed. 47.9 (b) As part of the report required in paragraph (a) due for 47.10 1996, the commissioner, in consultation with the health care 47.11 commission, shall make recommendations on the design and 47.12 development of an appropriate framework to apply regulations 47.13 uniformly among all health plan companies and to ensure adequate 47.14 oversight and consumer protection in the absence of a regulated 47.15 all-payer system. 47.16 Sec. 8. Laws 1994, chapter 625, article 5, section 5, 47.17 subdivision 1, is amended to read: 47.18 Subdivision 1. [PROPOSED LEGISLATION.] The commissioners 47.19 of health and commerce, in consultation with the Minnesota 47.20 health care commission and the legislative commission on health 47.21 care access, shall draft proposed legislation to recodify, 47.22 simplify, and standardize all statutes, rules, regulatory 47.23 requirements, and procedures relating to health plan companies. 47.24 The recodification and regulatory reform must become effective 47.25 simultaneously with the full implementation of the integrated 47.26 service network systemand the regulated all-payer optionon 47.27 July 1, 1997. The commissioners of health and commerce shall 47.28 submit to the legislature by January 1, 1996, a report on the 47.29 recodification and regulatory reform with proposed legislation. 47.30 Sec. 9. [INSTRUCTION TO REVISOR; RECODIFICATION OF INTERIM 47.31 LIMITS.] 47.32 The revisor of statutes shall recode Minnesota Statutes, 47.33 section 62P.04, as amended, as section 62J.041, and shall recode 47.34 section 62P.05, as amended, as section 62J.042. 47.35 Sec. 10. [REPEALER.] 47.36 Minnesota Statutes 1994, sections 62J.152, subdivision 6; 48.1 62P.01; 62P.02; 62P.03; 62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 48.2 62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 62P.27; 62P.29; 62P.31; 48.3 and 62P.33, are repealed. 48.4 ARTICLE 4 48.5 UNIVERSAL COVERAGE 48.6 Section 1. Minnesota Statutes 1994, section 62Q.165, is 48.7 amended to read: 48.8 62Q.165 [UNIVERSAL COVERAGE.] 48.9 Subdivision 1. [DEFINITION.] It is the commitment of the 48.10 state to achieve universal health coverage for all 48.11 Minnesotansby July 1, 1997. In order to achieve this48.12commitment, the following goals must be met:48.13(1) every Minnesotan shall have health coverage and shall48.14contribute to the costs of coverage based on ability to pay;48.15(2) no Minnesotan shall be denied coverage or forced to pay48.16more because of health status;48.17(3) quality health care services must be accessible to all48.18Minnesotans;48.19(4) all health care purchasers must be placed on an equal48.20footing in the health care marketplace; and48.21(5) a comprehensive and affordable health plan must be48.22available to all Minnesotans. Universal coverage is achieved 48.23 when: 48.24 (1) every Minnesotan has access to a full range of quality 48.25 health care services; 48.26 (2) every Minnesotan is able to obtain affordable health 48.27 coverage which pays for the full range of services, including 48.28 preventive and primary care; and 48.29 (3) every Minnesotan pays into the health care system 48.30 according to that person's ability. 48.31 Subd. 2. [GOAL.] It is the goal of the state to make 48.32 continuous progress toward reducing the number of Minnesotans 48.33 who do not have health coverage so that by January 1, 2000, 48.34 fewer than four percent of the state's population will be 48.35 without health coverage. The goal will be achieved by improving 48.36 access to private health coverage through insurance reforms and 49.1 market reforms, by making health coverage more affordable for 49.2 low-income Minnesotans through purchasing pools and state 49.3 subsidies, and by reducing the cost of health coverage through 49.4 cost containment programs and methods of ensuring that all 49.5 Minnesotans are paying into the system according to their 49.6 ability. 49.7 Subd. 3. [REPORT ON HEALTH CARE ACCESS.] (a) The health 49.8 care commission shall annually report to the legislature 49.9 regarding the extent to which the state is making progress 49.10 toward the goal of universal coverage described in this 49.11 section. As part of this report, the commission shall monitor 49.12 the number of uninsured in the state. The annual report must be 49.13 submitted no later than January 15 of each year in compliance 49.14 with section 3.195. 49.15 (b) The annual report required under paragraph (a), due 49.16 January 15, 1996, shall advise the legislature regarding 49.17 possible additional steps in insurance reform that would be 49.18 helpful in progressing toward universal coverage. The 49.19 commission shall consider further initiatives involving group 49.20 purchasing pools, narrowing premium variations, guaranteed issue 49.21 and portability requirements, preexisting condition limitations, 49.22 and other provisions that provide greater opportunities to 49.23 obtain affordable health coverage. The commission shall 49.24 consider the small employer reforms contained in the model laws 49.25 recommended by the National Association of Insurance 49.26 Commissioners and shall recommend whether these reforms should 49.27 be adopted. 49.28 (c) The annual report due required under paragraph (a), 49.29 required on January 15, 1996, shall advise the legislature 49.30 regarding possible changes in the individual insurance market. 49.31 The report shall consider initiatives regarding purchasing 49.32 pools, including specific design details of a state-run or 49.33 state-initiated purchasing pool for individuals, specific 49.34 legislative reforms needed to encourage the formation of 49.35 purchasing pools, and point-by-point consideration of the 49.36 obstacles to enactment of these purchasing pools, including 50.1 adverse selection. The report shall consider the creation of a 50.2 standard and objective definition of eligibility for the 50.3 comprehensive health association, and whether the enactment of 50.4 such a definition could be coupled with guaranteed issuance for 50.5 the remainder of the individual market. The report should 50.6 include all other considerations of the commission as to the 50.7 optimal reforms of the individual market. 50.8 (d) The health care commission shall in its annual report 50.9 make recommendations regarding any steps toward achieving 50.10 universal coverage that became feasible as a result of changes 50.11 in federal law that remove barriers to state efforts to expand 50.12 health care access. 50.13 (e) To the extent possible, the health care commission 50.14 shall utilize existing information, including information 50.15 collected by other state or federal agencies and organizations, 50.16 to complete the studies and reports in this subdivision. State 50.17 agencies and organizations shall provide information, technical 50.18 and analytic support, and other assistance to the commission as 50.19 possible, to ensure the timely and efficient completion of the 50.20 studies and reports in this subdivision. Staff from the 50.21 appropriate state agencies shall participate with the commission 50.22 executive director no later than June 15 each year in initial 50.23 planning and coordination for the annual reports and studies of 50.24 this subdivision. Following this initial planning, the 50.25 executive director shall report to the legislative oversight 50.26 commission on health care access by July 1 each year on the 50.27 initial study plan, and on any commission tasks or studies which 50.28 may not be completed as scheduled due to such constraints as 50.29 lack of sufficient available information or resources. 50.30 Sec. 2. Minnesota Statutes 1994, section 62Q.18, is 50.31 amended to read: 50.32 62Q.18 [UNIVERSALPORTABILITY OF COVERAGE; INSURANCE50.33REFORMS.] 50.34 Subdivision 1. [DEFINITION.] For purposes of this section, 50.35 (1) "continuous coverage" has the meaning given in section 50.36 62L.02; 51.1 (2) "guaranteed issue" means: 51.2 (i) for individual health plans, that a health plan company 51.3 shall not decline an application by an individual for any 51.4 individual health plan offered by that health plan company, 51.5 including coverage for a dependent of the individual to whom the 51.6 health plan has been or would be issued; and 51.7 (ii) for group health plans, that a health plan company 51.8 shall not decline an application by a group for any group health 51.9 plan offered by that health plan company and shall not decline 51.10 to cover under the group health plan any person eligible for 51.11 coverage under the group's eligibility requirements, including 51.12 persons who become eligible after initial issuance of the group 51.13 health plan; and 51.14 (3) "qualifying coverage" has the meaning given in section 51.15 62L.02; and51.16(4) "underwriting restrictions" has the meaning given in51.17section 62L.03, subdivision 4. 51.18Subd. 2. [INDIVIDUAL MANDATE.] Effective July 1, 1997,51.19each Minnesota resident shall obtain and maintain qualifying51.20coverage.51.21Subd. 3. [GUARANTEED ISSUE.] (a) Effective July 1, 1997,51.22each health plan company shall offer, sell, issue, or renew each51.23of its individual health plan forms on a guaranteed issue basis51.24to any Minnesota resident.51.25(b) Effective July 1, 1997, each health plan company shall51.26offer, sell, issue, or renew each of its group health plan forms51.27to any employer that has its principal place of business in this51.28state on a guaranteed issue basis, provided that the guaranteed51.29issue requirement does not apply to employees, dependents, or51.30other persons to be covered, who are not residents of this state.51.31Subd. 4. [UNDERWRITING RESTRICTIONS LIMITED.] Effective51.32July 1, 1997, no health plan company shall offer, sell, issue,51.33or renew a health plan that has underwriting restrictions that51.34apply to a Minnesota resident, except as expressly permitted51.35under this section.51.36Subd. 5. [PREEXISTING CONDITION LIMITATIONS.] Effective52.1July 1, 1997, no health plan company shall offer, sell, issue,52.2or renew a health plan that contains a preexisting condition52.3limitation or exclusion or exclusionary rider that applies to a52.4Minnesota resident, except a limitation which is no longer than52.512 months and applies only to a person who has not maintained52.6continuous coverage. An unexpired preexisting condition52.7limitation from previous qualifying coverage may be carried over52.8to new coverage under a health plan, if the unexpired condition52.9is one permitted under this section. A Minnesota resident who52.10has not maintained continuous coverage may be subjected to a new52.1112-month preexisting condition limitation after each break in52.12continuous coverage.52.13Subd. 6. [LIMITS ON PREMIUM RATE VARIATIONS.] (a)52.14Effective July 1, 1995, the premium rate variations permitted52.15under sections 62A.65 and 62L.08 become:52.16(1) for factors other than age and geography, 12.5 percent52.17of the index rate; and52.18(2) for age, 25 percent of the index rate.52.19(b) Effective July 1, 1996, the premium variations52.20permitted under sections 62A.65 and 62L.08 become:52.21(1) for factors other than age and geography, 7.5 percent52.22of the index rate; and52.23(2) for age, 15 percent of the index rate.52.24(c) Effective July 1, 1997, no health plan company shall52.25offer, sell, issue, or renew a health plan, that is subject to52.26section 62A.65 or 62L.08, for which the premium rate varies52.27between covered persons on the basis of any factor other than:52.28(1) for individual health plans, differences in benefits or52.29benefit design, and for group health plans, actuarially valid52.30differences in benefits or benefit design;52.31(2) the number of persons to be covered by the health plan;52.32(3) actuarially valid differences in expected costs between52.33adults and children;52.34(4) healthy lifestyle discounts authorized by statute; and52.35(5) for individual health plans, geographic variations52.36permitted under section 62A.65, and for group health plans,53.1geographic variations permitted under section 62L.08.53.2(d) All premium rate variations permitted under paragraph53.3(c) are subject to the approval of the commissioner.53.4(e) Notwithstanding paragraphs (a), (b), and (c), no health53.5plan company shall renew any individual or group health plan,53.6except in compliance with this paragraph. No premium rate for53.7any policy holder or contract holder shall increase or decrease53.8upon renewal, as a result of this subdivision, by more than 1553.9percent per year. The increase or decrease described in this53.10paragraph is in addition to any premium increase or decrease53.11caused by legally permissible factors other than this53.12subdivision. If a premium increase or decrease is constrained53.13by this paragraph, the health plan company may implement the53.14remaining portion of the increase or decrease at the time of53.15subsequent annual renewals, but never to exceed 15 percent per53.16year for paragraphs (a), (b), and (c) combined.53.17Subd. 7. [PORTABILITY OF COVERAGE.] (a) Effective July 1,53.181997, no health plan company shall offer, sell, issue, or renew53.19any group or individual health plan that does not provide for53.20guaranteed issue, with full credit for previous qualifying53.21coverage against any preexisting condition limitation that would53.22otherwise apply under subdivision 5. No health plan shall be53.23subject to any other type of underwriting restriction.53.24(b) Effective July 1, 1995, no health plan company shall53.25offer, sell, issue, or renew any group or individual health plan53.26that does not, with respect to individuals who maintain53.27continuous coverage and whose immediately preceding qualifying53.28coverage is a health plan issued by medical assistance under53.29chapter 256B, general assistance medical care under chapter53.30256D, or the MinnesotaCare program established under section53.31256.9352,53.32(1) make coverage available on a guaranteed issue basis;53.33and53.34(2) give full credit for previous continuous coverage53.35against any applicable preexisting condition limitation or53.36exclusion.54.1(c) Paragraph (b) applies to individuals whose immediately54.2preceding qualifying coverage is medical assistance under54.3chapter 256B, general assistance medical care under chapter54.4256D, or the MinnesotaCare program established under section54.5256.9352, only if the individual has disenrolled from the public54.6program or will disenroll upon issuance of the new coverage.54.7Paragraph (b) does not apply if the public program uses or will54.8use public funds to pay the premiums for an individual who54.9remains or will remain enrolled in the public program. No54.10public funds may be used to purchase private coverage available54.11under this paragraph. This paragraph does not prohibit public54.12payment of premiums to continue private sector coverage54.13originally obtained prior to enrollment in the public program,54.14where otherwise permitted by state or federal law. Portability54.15coverage under this paragraph is subject to the provisions of54.16section 62A.65, subdivision 5, clause (b).54.17(d)Effective July 1, 1994, no health plan company shall 54.18 offer, sell, issue, or renew any group health plan that does 54.19 not, with respect to individuals who maintain continuous 54.20 coverage and who qualify under the group's eligibility 54.21 requirements: 54.22 (1) make coverage available on a guaranteed issue basis; 54.23 and 54.24 (2) give full credit for previous continuous coverage 54.25 against any applicable preexisting condition limitation or 54.26 preexisting condition exclusion. 54.27 To the extent that thisparagraphsubdivision conflicts 54.28 with chapter 62L,with respect to small employers as defined in54.29section 62L.02,chapter 62L governs, regardless of whether the 54.30 group sponsor is a small employer as defined in section 62L.02, 54.31 except that for group health plans issued to groups that are not 54.32 small employers, this subdivision's requirement that the 54.33 individual have maintained continuous coverage applies. An 54.34 individual who has maintained continuous coverage, but would be 54.35 considered a late entrant under chapter 62L, may be treated as a 54.36 late entrant in the same manner under this subdivision as 55.1 permitted under chapter 62L. 55.2Subd. 8. [COMPREHENSIVE HEALTH ASSOCIATION.] Effective55.3July 1, 1997, the comprehensive health association created in55.4section 62E.10 shall not accept new applicants for enrollment,55.5except for Medicare-related coverage described in section 62E.1255.6and for coverage described in section 62E.18.55.7Subd. 9. [CONTINGENCY; FUTURE LEGISLATION.] This section,55.8except for subdivision 7, paragraphs (b), (c), and (d), is not55.9intended to be implemented prior to legislation enacted to55.10achieve the objectives of section 62Q.165 and Laws 1994, chapter55.11625, article 6, sections 5, 6, and 7. Subdivision 6 is not55.12effective until an effective date is specified in 199555.13legislation.55.14 Sec. 3. [COORDINATION BETWEEN ACUTE AND LONG-TERM CARE.] 55.15 Subdivision 1. [GOAL.] The health care commission shall 55.16 examine the relationship between the acute and long-term care 55.17 systems in order to address fragmentation and cost shifting 55.18 between these two systems. 55.19 Subd. 2. [PLAN.] The commission shall prepare a plan for a 55.20 process to bring about greater coordination between acute and 55.21 long-term care that would maximize quality, overcome cost 55.22 shifting, and contain overall costs. 55.23 (a) The commission's plan shall identify: 55.24 (1) concepts, issues, perceived problems, or concerns to be 55.25 addressed as part of a process to achieve greater coordination 55.26 and improved outcomes in acute and long-term care; 55.27 (2) a suitable process for addressing the issues in clause 55.28 (1), including adequate involvement of appropriate stakeholder 55.29 groups, persons receiving long-term care, and the public; and 55.30 (3) recommendations for appropriate relationships, division 55.31 of responsibilities, resources, and a timetable for the process 55.32 of achieving greater coordination between acute and long-term 55.33 care. 55.34 (b) The commission's plan shall address: 55.35 (1) the need for an appropriate framework for measuring and 55.36 comparing potential costs and benefits of proposals to improve 56.1 coordination between acute and long-term care; 56.2 (2) specific information needs and how the information will 56.3 be developed or obtained; 56.4 (3) the role of the commission and any changes or 56.5 modifications of the commission in assisting the process 56.6 described in the plan; and 56.7 (4) the degree to which the process of coordinating acute 56.8 and long-term care might be undertaken sequentially or 56.9 incrementally, with descriptions of any recommended steps in the 56.10 process. 56.11 (c) In developing the plan, the commission shall take 56.12 testimony from interested persons, review findings of previous 56.13 studies and reports, and consult with other state agencies and 56.14 organizations, including, but not limited to: 56.15 (1) adults with disabilities, parents or guardians of 56.16 children with disabilities, and groups representing children and 56.17 adults with a variety of disabilities; and 56.18 (2) facility based and home and community-based long-term 56.19 care providers. 56.20 (d) The commission's plan shall be reported to the 56.21 legislature by January 15, 1996. 56.22 Sec. 4. [REPEALER; ADDITIONAL INSURANCE REFORMS.] 56.23 Minnesota Statutes 1994, section 62Q.18, subdivisions 2, 3, 56.24 4, 5, 6, 8, and 9, are repealed. 56.25 ARTICLE 5 56.26 DATA COLLECTION AND RESEARCH INITIATIVES 56.27 Section 1. Minnesota Statutes 1994, section 13.99, is 56.28 amended by adding a subdivision to read: 56.29 Subd. 115. [HEALTH DATA INSTITUTE DATA.] Data created, 56.30 collected, received, maintained, or disseminated by the 56.31 Minnesota health data institute established under section 56.32 62J.451 are classified under section 62J.452; access to and 56.33 disclosure of such data are governed by section 62J.452. 56.34 Sec. 2. Minnesota Statutes 1994, section 62J.04, 56.35 subdivision 3, is amended to read: 56.36 Subd. 3. [COST CONTAINMENT DUTIES.] After obtaining the 57.1 advice and recommendations of the Minnesota health care 57.2 commission, the commissioner shall: 57.3 (1) establish statewide and regional limits on growth in 57.4 total health care spending under this section, monitorregional57.5andstatewide compliance with the spending limits, and take 57.6 action to achieve compliance to the extent authorized by the 57.7 legislature; 57.8 (2) divide the state into no fewer than four regions, with 57.9 one of those regions being the Minneapolis/St. Paul metropolitan 57.10 statistical area but excluding Chisago, Isanti, Wright, and 57.11 Sherburne counties, for purposes of fostering the development of 57.12 regional health planning and coordination of health care 57.13 delivery among regional health care systems and working to 57.14 achieve spending limits; 57.15 (3) provide technical assistance to regional coordinating 57.16 boards; 57.17 (4) monitor the quality of health care throughout the 57.18 state, conduct consumer satisfaction surveys,and take action as 57.19 necessary to ensure an appropriate level of quality; 57.20 (5) issue recommendations regarding uniform billing forms, 57.21 uniform electronic billing procedures and data interchanges, 57.22 patient identification cards, and other uniform claims and 57.23 administrative procedures for health care providers and private 57.24 and public sector payers. In developing the recommendations, 57.25 the commissioner shall review the work of the work group on 57.26 electronic data interchange (WEDI) and the American National 57.27 Standards Institute (ANSI) at the national level, and the work 57.28 being done at the state and local level. The commissioner may 57.29 adopt rules requiring the use of the Uniform Bill 82/92 form, 57.30 the National Council of Prescription Drug Providers (NCPDP) 3.2 57.31 electronic version, the Health Care Financing Administration 57.32 1500 form, or other standardized forms or procedures; 57.33 (6) undertake health planning responsibilities as provided 57.34 in section 62J.15; 57.35 (7)monitor and promote the development and implementation57.36of practice parameters;58.1(8)authorize, fund, or promote research and 58.2 experimentation on new technologies and health care procedures; 58.3(9) designate referral centers for specialized and58.4high-cost procedures and treatment and establish minimum58.5standards and requirements for particular procedures or58.6treatment;58.7(10)(8) within the limits of appropriations for these 58.8 purposes, administer or contract for statewide consumer 58.9 education and wellness programs that will improve the health of 58.10 Minnesotans and increase individual responsibility relating to 58.11 personal health and the delivery of health care services, 58.12 undertake prevention programs including initiatives to improve 58.13 birth outcomes, expand childhood immunization efforts, and 58.14 provide start-up grants for worksite wellness programs; and 58.15(11) administer the data analysis unit; and58.16(12)(9) undertake other activities to monitor and oversee 58.17 the delivery of health care services in Minnesota with the goal 58.18 of improving affordability, quality, and accessibility of health 58.19 care for all Minnesotans. 58.20 Sec. 3. Minnesota Statutes 1994, section 62J.06, is 58.21 amended to read: 58.22 62J.06 [IMMUNITY FROM LIABILITY.] 58.23 No member of the Minnesota health care commission 58.24 established under section 62J.05, regional coordinating boards 58.25 established under section 62J.09, or the health 58.26planningtechnology advisory committee established under section 58.27 62J.15,data collection advisory committee established under58.28section 62J.30, or practice parameter advisory committee58.29established under section 62J.32shall be held civilly or 58.30 criminally liable for an act or omission by that person if the 58.31 act or omission was in good faith and within the scope of the 58.32 member's responsibilities under this chapter. 58.33 Sec. 4. Minnesota Statutes 1994, section 62J.212, is 58.34 amended to read: 58.35 62J.212 [COLLABORATION ONPUBLIC HEALTH GOALS.] 58.36The commissioner may increase regional spending limits if59.1public health goals for that region are achieved.The 59.2 commissioner shall establish specific public health goals 59.3 including, but not limited to, increased delivery of prenatal 59.4 care, improved birth outcomes, and expanded childhood 59.5 immunizations. The commissioner shall consider the community 59.6 public health goals and the input of the statewide advisory 59.7 committee on community health in establishing the statewide 59.8 goals. 59.9 Sec. 5. [62J.2930] [INFORMATION CLEARINGHOUSE.] 59.10 Subdivision 1. [ESTABLISHMENT.] The commissioner of health 59.11 shall establish an information clearinghouse within the 59.12 department of health to facilitate the ability of consumers, 59.13 employers, providers, health plan companies, and others to 59.14 obtain information on health reform activities in Minnesota. 59.15 The commissioner shall make available through the clearinghouse 59.16 updates on federal and state health reform activities, including 59.17 information developed or collected by the department of health 59.18 on cost containment or other research initiatives, the 59.19 development of integrated service networks, and voluntary 59.20 purchasing pools, action plans submitted by health plan 59.21 companies, reports or recommendations of the health technology 59.22 advisory committee and other entities on technology assessments, 59.23 and reports or recommendations from other formal committees 59.24 applicable to health reform activities. The clearinghouse shall 59.25 also refer requestors to sources of further information or 59.26 assistance. The clearinghouse is subject to chapter 13. 59.27 Subd. 2. [INFORMATION ON HEALTH PLAN COMPANIES.] The 59.28 information clearinghouse shall provide information on all 59.29 health plan companies operating in a specific geographic area to 59.30 consumers and purchasers who request it. 59.31 Subd. 3. [CONSUMER INFORMATION.] The information 59.32 clearinghouse or another entity designated by the commissioner 59.33 shall provide consumer information to health plan company 59.34 enrollees to: 59.35 (1) assist enrollees in understanding their rights; 59.36 (2) explain and assist in the use of all available 60.1 complaint systems, including internal complaint systems within 60.2 health carriers, community integrated service networks, 60.3 integrated service networks, and the departments of health and 60.4 commerce; 60.5 (3) provide information on coverage options in each 60.6 regional coordinating board region of the state; 60.7 (4) provide information on the availability of purchasing 60.8 pools and enrollee subsidies; and 60.9 (5) help consumers use the health care system to obtain 60.10 coverage. 60.11 The information clearinghouse or other entity designated by 60.12 the commissioner for the purposes of this subdivision shall not: 60.13 (1) provide legal services to consumers; 60.14 (2) represent a consumer or enrollee; or 60.15 (3) serve as an advocate for consumers in disputes with 60.16 health plan companies. 60.17 Nothing in this subdivision shall interfere with the ombudsman 60.18 program established under section 256B.031, subdivision 6, or 60.19 other existing ombudsman programs. 60.20 Subd. 4. [COORDINATION.] To the extent possible, the 60.21 commissioner shall coordinate the activities of the 60.22 clearinghouse with the activities of the Minnesota health data 60.23 institute. 60.24 Sec. 6. [62J.301] [RESEARCH AND DATA INITIATIVES.] 60.25 Subdivision 1. [DEFINITIONS.] For purposes of sections 60.26 62J.2930 to 62J.42, the following definitions apply: 60.27 (a) "Health outcomes data" means data used in research 60.28 designed to identify and analyze the outcomes and costs of 60.29 alternative interventions for a given clinical condition, in 60.30 order to determine the most appropriate and cost-effective means 60.31 to prevent, diagnose, treat, or manage the condition, or in 60.32 order to develop and test methods for reducing inappropriate or 60.33 unnecessary variations in the type and frequency of 60.34 interventions. 60.35 (b) "Encounter level data" means data related to the 60.36 utilization of health care services by, and the provision of 61.1 health care services to individual patients, enrollees, or 61.2 insureds, including claims data, abstracts of medical records, 61.3 and data from patient interviews and patient surveys. 61.4 Subd. 2. [STATEMENT OF PURPOSE.] The commissioner of 61.5 health shall conduct data and research initiatives in order to 61.6 monitor and improve the efficiency and effectiveness of health 61.7 care in Minnesota. 61.8 Subd. 3. [GENERAL DUTIES.] The commissioner shall: 61.9 (1) collect and maintain data which enable population-based 61.10 monitoring and trending of the access, utilization, quality, and 61.11 cost of health care services within Minnesota; 61.12 (2) collect and maintain data for the purpose of estimating 61.13 total Minnesota health care expenditures and trends; 61.14 (3) collect and maintain data for the purposes of setting 61.15 limits under section 62J.04, and measuring growth limit 61.16 compliance; 61.17 (4) conduct applied research using existing and new data 61.18 and promote applications based on existing research; 61.19 (5) develop and implement data collection procedures to 61.20 ensure a high level of cooperation from health care providers 61.21 and health plan companies, as defined in section 62Q.01, 61.22 subdivision 4; 61.23 (6) work closely with health plan companies and health care 61.24 providers to promote improvements in health care efficiency and 61.25 effectiveness; and 61.26 (7) participate as a partner or sponsor of private sector 61.27 initiatives that promote publicly disseminated applied research 61.28 on health care delivery, outcomes, costs, quality, and 61.29 management. 61.30 Subd. 4. [INFORMATION TO BE COLLECTED.] (a) The data 61.31 collected may include health outcomes data, patient functional 61.32 status, and health status. The data collected may include 61.33 information necessary to measure and make adjustments for 61.34 differences in the severity of patient condition across 61.35 different health care providers, and may include data obtained 61.36 directly from the patient or from patient medical records, as 62.1 provided in section 62J.321, subdivision 1. 62.2 (b) The commissioner may: 62.3 (1) collect the encounter level data required for the 62.4 research and data initiatives of sections 62J.301 to 62J.42, 62.5 using, to the greatest extent possible, standardized forms and 62.6 procedures; and 62.7 (2) process the data collected to ensure validity, 62.8 consistency, accuracy, and completeness, and as appropriate, 62.9 merge data collected from different sources. 62.10 (c) For purposes of estimating total health care spending 62.11 and forecasting rates of growth in health care spending, the 62.12 commissioner may collect from health care providers data on 62.13 patient revenues and health care spending during a time period 62.14 specified by the commissioner. The commissioner may also 62.15 collect data on health care revenues and spending from group 62.16 purchasers of health care. Health care providers and group 62.17 purchasers doing business in the state shall provide the data 62.18 requested by the commissioner at the times and in the form 62.19 specified by the commissioner. Professional licensing boards 62.20 and state agencies responsible for licensing, registering, or 62.21 regulating providers and group purchasers shall cooperate fully 62.22 with the commissioner in achieving compliance with the reporting 62.23 requirements. 62.24 Subd. 5. [NONLIMITING.] Nothing in this chapter shall be 62.25 construed to limit the powers granted to the commissioner of 62.26 health under chapter 62D, 62N, 144, or 144A. 62.27 Sec. 7. [62J.311] [ANALYSIS AND USE OF DATA.] 62.28 Subdivision 1. [DATA ANALYSIS.] The commissioner shall 62.29 analyze the data collected to: 62.30 (1) assist the state in developing and refining its health 62.31 policy in the areas of access, utilization, quality, and cost; 62.32 (2) assist the state in promoting efficiency and 62.33 effectiveness in the financing and delivery of health services; 62.34 (3) monitor and track accessibility, utilization, quality, 62.35 and cost of health care services within the state; 62.36 (4) evaluate the impact of health care reform activities; 63.1 (5) assist the state in its public health activities; and 63.2 (6) evaluate and determine the most appropriate methods for 63.3 ongoing data collection. 63.4 Subd. 2. [CRITERIA FOR DATA AND RESEARCH INITIATIVES.] (a) 63.5 Data and research initiatives by the commissioner, pursuant to 63.6 sections 62J.301 to 62J.42, must: 63.7 (1) serve the needs of the general public, public sector 63.8 health care programs, employers and other purchasers of health 63.9 care, health care providers, including providers serving large 63.10 numbers of people with low-income, and health plan companies as 63.11 applicable; 63.12 (2) be based on scientifically sound and statistically 63.13 valid methods; 63.14 (3) be statewide in scope, to the extent feasible, in order 63.15 to benefit health care purchasers and providers in all parts of 63.16 Minnesota and to ensure broad and representative health care 63.17 data for research comparisons and applications; 63.18 (4) emphasize data that is useful, relevant, and 63.19 nonredundant of existing data. The initiatives may duplicate 63.20 existing private data collection activities, if necessary to 63.21 ensure that the data collected will be in the public domain; 63.22 (5) be structured to minimize the administrative burden on 63.23 health plan companies, health care providers, and the health 63.24 care delivery system, and minimize any privacy impact on 63.25 individuals; and 63.26 (6) promote continuous improvement in the efficiency and 63.27 effectiveness of health care delivery. 63.28 (b) Data and research initiatives related to public sector 63.29 health care programs must: 63.30 (1) assist the state's current health care financing and 63.31 delivery programs to deliver and purchase health care in a 63.32 manner that promotes improvements in health care efficiency and 63.33 effectiveness; 63.34 (2) assist the state in its public health activities, 63.35 including the analysis of disease prevalence and trends and the 63.36 development of public health responses; 64.1 (3) assist the state in developing and refining its overall 64.2 health policy, including policy related to health care costs, 64.3 quality, and access; and 64.4 (4) provide data that allows the evaluation of state health 64.5 care financing and delivery programs. 64.6 Sec. 8. [62J.321] [DATA COLLECTION AND PROCESSING 64.7 PROCEDURES.] 64.8 Subdivision 1. [DATA COLLECTION.] (a) The commissioner 64.9 shall collect data from health care providers, health plan 64.10 companies, and individuals in the most cost-effective manner, 64.11 which does not unduly burden them. The commissioner may require 64.12 health care providers and health plan companies to collect and 64.13 provide patient health records and claim files, and cooperate in 64.14 other ways with the data collection process. The commissioner 64.15 may also require health care providers and health plan companies 64.16 to provide mailing lists of patients. Patient consent shall not 64.17 be required for the release of data to the commissioner pursuant 64.18 to sections 62J.301 to 62J.42 by any group purchaser, health 64.19 plan company, health care provider; or agent, contractor, or 64.20 association acting on behalf of a group purchaser or health care 64.21 provider. Any group purchaser, health plan company, health care 64.22 provider; or agent, contractor, or association acting on behalf 64.23 of a group purchaser or health care provider, that releases data 64.24 to the commissioner in good faith pursuant to sections 62J.301 64.25 to 62J.42 shall be immune from civil liability and criminal 64.26 prosecution. 64.27 (b) When a group purchaser, health plan company, or health 64.28 care provider submits patient identifying data, as defined in 64.29 section 62J.451, to the commissioner pursuant to sections 64.30 62J.301 to 62J.42, and the data is submitted to the commissioner 64.31 in electronic form, or through other electronic means including, 64.32 but not limited to, the electronic data interchange system 64.33 defined in section 62J.451, the group purchaser, health plan 64.34 company, or health care provider shall submit the patient 64.35 identifying data in encrypted form, using an encryption method 64.36 specified by the commissioner. Submission of encrypted data as 65.1 provided in this paragraph satisfies the requirements of section 65.2 144.335, subdivision 3b. 65.3 (c) The commissioner shall require all health care 65.4 providers, group purchasers, and state agencies to use a 65.5 standard patient identifier and a standard identifier for 65.6 providers and health plan companies when reporting data under 65.7 this chapter. The commissioner must encrypt patient identifiers 65.8 to prevent identification of individual patients and to enable 65.9 release of otherwise private data to researchers, providers, and 65.10 group purchasers in a manner consistent with chapter 13 and 65.11 sections 62J.55 and 144.335. This encryption must ensure that 65.12 any data released must be in a form that makes it impossible to 65.13 identify individual patients. 65.14 Subd. 2. [FAILURE TO PROVIDE DATA.] The intentional 65.15 failure to provide the data requested under this chapter is 65.16 grounds for disciplinary or regulatory action against a 65.17 regulated provider or group purchaser. The commissioner may 65.18 assess a fine against a provider or group purchaser who refuses 65.19 to provide data required by the commissioner. If a provider or 65.20 group purchaser refuses to provide the data required, the 65.21 commissioner may obtain a court order requiring the provider or 65.22 group purchaser to produce documents and allowing the 65.23 commissioner to inspect the records of the provider or group 65.24 purchaser for purposes of obtaining the data required. 65.25 Subd. 3. [DATA COLLECTION AND REVIEW.] Data collection 65.26 must continue for a sufficient time to permit: adequate 65.27 analysis by researchers and appropriate providers, including 65.28 providers who will be impacted by the data; feedback to 65.29 providers; monitoring for changes in practice patterns; and the 65.30 data and research criteria of section 62J.311, subdivision 2, to 65.31 be fulfilled. 65.32 Subd. 4. [USE OF EXISTING DATA.] (a) The commissioner 65.33 shall negotiate with private sector organizations currently 65.34 collecting health care data of interest to the commissioner to 65.35 obtain required data in a cost-effective manner and minimize 65.36 administrative costs. The commissioner shall attempt to 66.1 establish links between the health care data collected to 66.2 fulfill sections 62J.301 to 62J.42 and existing private sector 66.3 data and shall consider and implement methods to streamline data 66.4 collection in order to reduce public and private sector 66.5 administrative costs. 66.6 (b) The commissioner shall use existing public sector data, 66.7 such as those existing for medical assistance and Medicare, to 66.8 the greatest extent possible. The commissioner shall establish 66.9 links between existing public sector data and consider and 66.10 implement methods to streamline public sector data collection in 66.11 order to reduce public and private sector administrative costs. 66.12 Subd. 5. [DATA CLASSIFICATION.] (a) Data collected to 66.13 fulfill the data and research initiatives authorized by sections 66.14 62J.301 to 62J.42 that identify individual patients or providers 66.15 are private data on individuals. Data not on individuals are 66.16 nonpublic data. The commissioner shall establish procedures and 66.17 safeguards to ensure that data released by the commissioner is 66.18 in a form that does not identify specific patients, providers, 66.19 employers, individual or group purchasers, or other specific 66.20 individuals and organizations, except with the permission of the 66.21 affected individual or organization, or as permitted elsewhere 66.22 in this chapter. 66.23 (b) Raw unaggregated data collected from household and 66.24 employer surveys used by the commissioner to monitor the number 66.25 of uninsured individuals, reasons for lack of insurance 66.26 coverage, and to evaluate the effectiveness of health care 66.27 reform, are subject to the same data classifications as data 66.28 collected pursuant to sections 62J.301 to 62J.42. 66.29 (c) Notwithstanding sections 13.03, subdivisions 6 to 8; 66.30 13.10, subdivisions 1 to 4; and 138.17, data received by the 66.31 commissioner pursuant to sections 62J.301 to 62J.42, shall 66.32 retain the classification designated under this section and 66.33 shall not be disclosed other than pursuant to this section. 66.34 (d) Summary data collected to fulfill the data and research 66.35 initiatives authorized by sections 62J.301 to 62J.42 may be 66.36 disseminated under section 13.05, subdivision 7. For the 67.1 purposes of this section, summary data includes nonpublic data 67.2 not on individuals. 67.3 (e) Notwithstanding paragraph (a), the commissioner may 67.4 publish nonpublic or private data collected pursuant to sections 67.5 62J.301 to 62J.42 on health care costs and spending, quality and 67.6 outcomes, and utilization for health care institutions, 67.7 individual health care professionals and groups of health care 67.8 professionals, group purchasers, and integrated service 67.9 networks, with a description of the methodology used for 67.10 analysis. The commissioner may not make public any patient 67.11 identifying information except as specified in law. The 67.12 commissioner shall not reveal the name of an institution, group 67.13 of professionals, individual health care professional, group 67.14 purchaser, or integrated service network until after the 67.15 institution, group of professionals, individual health care 67.16 professional, group purchaser, or integrated service network has 67.17 had 21 days to review the data and comment. The commissioner 67.18 shall include comments received in the release of the data. 67.19 (f) A provider or group purchaser may contest whether the 67.20 data meets the criteria of section 62J.311, subdivision 2, 67.21 paragraph (a), clause (2), in accordance with a contested case 67.22 proceeding as set forth in sections 14.57 to 14.62, subject to 67.23 appeal in accordance with sections 14.63 to 14.68. To obtain a 67.24 contested case hearing, the provider or group purchaser must 67.25 make a written request to the commissioner before the end of the 67.26 time period for review and comment. Within ten days of the 67.27 assignment of an administrative law judge, the provider or group 67.28 purchaser shall make a clear showing to the administrative law 67.29 judge of probable success in a hearing on the issue of whether 67.30 the data are accurate and valid and were collected based on the 67.31 criteria of section 62J.311, subdivision 2, paragraph (a), 67.32 clause (2). If the administrative law judge determines that the 67.33 provider or group purchaser has made such a showing, the data 67.34 shall remain private or nonpublic during the contested case 67.35 proceeding and appeal. If the administrative law judge 67.36 determines that the provider or group purchaser has not made 68.1 such a showing, the commissioner may publish the data 68.2 immediately, with comments received in the release of the data. 68.3 The contested case proceeding and subsequent appeal is not an 68.4 exclusive remedy and any person may seek a remedy pursuant to 68.5 section 13.08, subdivisions 1 to 4, or as otherwise authorized 68.6 by law. 68.7 Subd. 6. [RULEMAKING.] The commissioner may adopt rules to 68.8 implement sections 62J.301 to 62J.452. 68.9 Subd. 7. [FEDERAL AND OTHER GRANTS.] The commissioner may 68.10 seek federal funding, and funding from private and other 68.11 nonstate sources, for data and research initiatives. 68.12 Subd. 8. [CONTRACTS AND GRANTS.] To carry out the duties 68.13 assigned in sections 62J.301 to 62J.42, the commissioner may 68.14 contract with or provide grants to private sector entities. Any 68.15 contract or grant must require the private sector entity to 68.16 maintain the data which it receives according to the statutory 68.17 provisions applicable to the data. 68.18 Sec. 9. [62J.322] [PROVIDER INFORMATION PILOT STUDY.] 68.19 The commissioner shall develop a pilot study to collect 68.20 comparative data from health care providers on opportunities and 68.21 barriers to the provision of quality, cost-effective health 68.22 care. The provider information pilot study shall include 68.23 providers in community integrated service networks, integrated 68.24 service networks, health maintenance organizations, preferred 68.25 provider organizations, indemnity insurance plans, public 68.26 programs, and other health plan companies. Health plan 68.27 companies and group purchasers shall provide to the commissioner 68.28 providers' names, health plan assignment, and other appropriate 68.29 data necessary for the commissioner to conduct the study. The 68.30 provider information pilot study shall examine factors that 68.31 increase and hinder access to the provision of quality, 68.32 cost-effective health care. The study may examine: 68.33 (1) administrative barriers and facilitators; 68.34 (2) time spent obtaining permission for appropriate and 68.35 necessary treatments; 68.36 (3) latitude to order appropriate and necessary tests, 69.1 pharmaceuticals, and referrals to specialty providers; 69.2 (4) assistance available for decreasing administrative and 69.3 other routine paperwork activities; 69.4 (5) continuing education opportunities provided; 69.5 (6) access to readily available information on diagnoses, 69.6 diseases, outcomes, and new technologies; 69.7 (7) continuous quality improvement activities; 69.8 (8) inclusion in administrative decision making; 69.9 (9) access to social services and other services that 69.10 facilitate continuity of care; 69.11 (10) economic incentives and disincentives; 69.12 (11) peer review procedures; and 69.13 (12) the prerogative to address public health needs. 69.14 In selecting additional data for collection, the 69.15 commissioner shall consider the: (i) statistical validity of 69.16 the data; (ii) public need for the data; (iii) estimated expense 69.17 of collecting and reporting the data; and (iv) usefulness of the 69.18 data to identify barriers and opportunities to improve quality 69.19 care provision within health plan companies. 69.20 Sec. 10. Minnesota Statutes 1994, section 62J.37, is 69.21 amended to read: 69.22 62J.37 [COST CONTAINMENT DATA FROM INTEGRATED SERVICE 69.23 NETWORKS.] 69.24 The commissioner shall require integrated service networks 69.25 operating under section 62N.06, subdivision 1, to submit data on 69.26 health care spending and revenue for calendar year19941996 by 69.27February 15, 1995April 1, 1997. EachFebruary 15April 1 69.28 thereafter, integrated service networks shall submit to the 69.29 commissioner data on health care spending and revenue for the 69.30 preceding calendar year. The data must be provided in the form 69.31 specified by the commissioner. To the extent that an integrated 69.32 service network is operated by a group purchaser under section 69.33 62N.06, subdivision 2, the integrated service network is exempt 69.34 from this section and the group purchaser must provide data on 69.35 the integrated service network under section 62J.38. 69.36 Sec. 11. Minnesota Statutes 1994, section 62J.38, is 70.1 amended to read: 70.2 62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 70.3 (a) The commissioner shall require group purchasers to 70.4 submit detailed data on total health care spending forcalendar70.5years 1990, 1991, and 1992, and foreach calendar year1993 and70.6successive calendar years. Group purchasers shall submit data 70.7 for the 1993 calendar year by April 1, 1994, and each April 1 70.8 thereafter shall submit data for the preceding calendar year. 70.9 (b) The commissioner shall require each group purchaser to 70.10 submit data on revenue, expenses, and member months, as 70.11 applicable. Revenue data must distinguish between premium 70.12 revenue and revenue from other sources and must also include 70.13 information on the amount of revenue in reserves and changes in 70.14 reserves. Expenditure data, including raw data from claims, 70.15mustmay be provided separately for the following categories or 70.16 for other categories required by the commissioner: physician 70.17 services, dental services, other professional services, 70.18 inpatient hospital services, outpatient hospital services, 70.19 emergencyand out-of-area care, pharmacy services and 70.20prescription drugsother nondurable medical goods, mental health 70.21services, and chemical dependency services, other expenditures, 70.22 subscriber liability, and administrative costs. The 70.23 commissioner may require each group purchaser to submit any 70.24 other data, including data in unaggregated form, for the 70.25 purposes of developing spending estimates, setting spending 70.26 limits, and monitoring actual spending and costs. 70.27 (c) The commissioner may collect information on: 70.28 (1) premiums, benefit levels, managed care procedures, and 70.29 other features of health plan companies; 70.30 (2) prices, provider experience, and other information for 70.31 services less commonly covered by insurance or for which 70.32 patients commonly face significant out-of-pocket expenses; and 70.33 (3) information on health care services not provided 70.34 through health plan companies, including information on prices, 70.35 costs, expenditures, and utilization. 70.36(c) State agencies and(d) Allothergroup purchasers shall 71.1 provide the required data using a uniform format and uniform 71.2 definitions, as prescribed by the commissioner. 71.3 Sec. 12. Minnesota Statutes 1994, section 62J.40, is 71.4 amended to read: 71.5 62J.40 [COST CONTAINMENT DATA FROM STATE AGENCIES AND OTHER 71.6 GOVERNMENTAL UNITS.] 71.7In addition to providing the data required under section71.862J.38, the commissioners of human services, commerce, labor and71.9industry, and employee relations and(a) Allotherstate 71.10 departments or agencies that administer one or more health care 71.11 programs shall provide to the commissioner of health any 71.12 additional data on the health care programs they administer that 71.13 is requested by the commissioner of health, including data in 71.14 unaggregated form, for purposes of developing estimates of 71.15 spending, setting spending limits, and monitoring actual 71.16 spending. The data must be provided at the times and in the 71.17 form specified by the commissioner of health. 71.18 (b) For purposes of estimating total health care spending 71.19 as provided in section 62J.301, subdivision 4, clause (c), all 71.20 local governmental units shall provide expenditure data to the 71.21 commissioner. The commissioner shall consult with 71.22 representatives of the affected local government units in 71.23 establishing definitions, reporting formats, and reporting time 71.24 frames. As much as possible, the data shall be collected in a 71.25 manner that ensures that the data collected is consistent with 71.26 data collected from the private sector and minimizes the 71.27 reporting burden to local government. 71.28 Sec. 13. Minnesota Statutes 1994, section 62J.41, 71.29 subdivision 1, is amended to read: 71.30 Subdivision 1. [COST CONTAINMENT DATA TO BE COLLECTED FROM 71.31 PROVIDERS.] The commissioner shall require health care providers 71.32 to collect and provide both patient specific information and 71.33 descriptive and financial aggregate data on: 71.34 (1) the total number of patients served; 71.35 (2) the total number of patients served by state of 71.36 residence and Minnesota county; 72.1 (3) the site or sites where the health care provider 72.2 provides services; 72.3 (4) the number of individuals employed, by type of 72.4 employee, by the health care provider; 72.5 (5) the services and their costs for which no payment was 72.6 received; 72.7 (6) total revenue by type of payer or by groups of payers, 72.8 including but not limited to, revenue from Medicare, medical 72.9 assistance, MinnesotaCare, nonprofit health service plan 72.10 corporations, commercial insurers, integrated service networks, 72.11 health maintenance organizations, and individual patients; 72.12 (7) revenue from research activities; 72.13 (8) revenue from educational activities; 72.14 (9) revenue from out-of-pocket payments by patients; 72.15 (10) revenue from donations; and 72.16 (11) any other data required by the commissioner, including 72.17 data in unaggregated form, for the purposes of developing 72.18 spending estimates, setting spending limits, monitoring actual 72.19 spending, and monitoring costsand quality. 72.20 The commissioner may, by rule, modify the data submission 72.21 categories listed above if the commissioner determines that this 72.22 will reduce the reporting burden on providers without having a 72.23 significant negative effect on necessary data collection efforts. 72.24 Sec. 14. Minnesota Statutes 1994, section 62J.41, 72.25 subdivision 2, is amended to read: 72.26 Subd. 2. [ANNUAL MONITORING AND ESTIMATES.] The 72.27 commissioner shall require health care providers to submit the 72.28 required data for the period July 1, 1993 to December 31, 1993, 72.29 by April 1, 1994. Health care providers shall submit data for 72.30 the 1994 calendar year by April 1, 1995, and each April 1 72.31 thereafter shall submit data for the preceding calendar year. 72.32 The commissioner of revenue may collect health care service 72.33 revenue data from health care providers, if the commissioner of 72.34 revenue and the commissioner agree that this is the most 72.35 efficient method of collecting the data. Thecommissioner of72.36revenue shall provide any data collected to the commissioner of73.1healthcommissioners of health and revenue shall have the 73.2 authority to share data collected pursuant to this section. 73.3 Sec. 15. [62J.451] [MINNESOTA HEALTH DATA INSTITUTE.] 73.4 Subdivision 1. [STATEMENT OF PURPOSE.] It is the intention 73.5 of the legislature to create a partnership between the public 73.6 and the private sectors for the coordination of efforts related 73.7 to the collection, analysis, and dissemination of cost, access, 73.8 quality, utilization, and other performance data, to the extent 73.9 administratively efficient and effective. 73.10 The Minnesota health data institute shall be a partnership 73.11 between the commissioner of health and a board of directors 73.12 representing group purchasers, health care providers, and 73.13 consumers. 73.14 Subd. 2. [DEFINITIONS.] For purposes of this section and 73.15 section 62J.452, the following definitions apply. 73.16 (a) "Analysis" means the identification of selected data 73.17 elements, a description of the methodology used to select or 73.18 analyze those data elements, and any other commentary, 73.19 conclusions, or other descriptive material that the health data 73.20 institute determines is appropriately included, all of which is 73.21 undertaken by the health data institute for one or more of the 73.22 purposes or objectives set forth in subdivisions 1 and 3, or by 73.23 other authorized researchers pursuant to section 62J.452, 73.24 subdivision 6. 73.25 (b) "Board" means the board of directors of the health data 73.26 institute. 73.27 (c) "Contractor" means an agent, association, or other 73.28 individual or entity that has entered into an agreement with an 73.29 industry participant, as defined in section 62J.452, subdivision 73.30 2, paragraph (i), to act on behalf of that industry participant 73.31 for purposes of fulfilling the data collection and reporting 73.32 activities established under this chapter. 73.33 (d) "Database" means a compilation of selected data 73.34 elements by the health data institute for the purpose of 73.35 conducting an analysis or facilitating an analysis by another 73.36 party. 74.1 (e) "Electronic data interchange system" or "EDI system" 74.2 means the electronic data system developed, implemented, 74.3 maintained, or operated by the health data institute, as 74.4 permitted by subdivisions 3, clause (2), and 5, according to 74.5 standards adopted by the health data institute. 74.6 (f) "Encounter level data" means data related to the 74.7 utilization of health care services by, and the provision of 74.8 health care services to, individual patients, enrollees, or 74.9 insureds, including claims data, abstracts of medical records, 74.10 and data from patient interviews and patient surveys. 74.11 (g) "Group purchaser" has the definition provided in 74.12 section 62J.03, subdivision 6. 74.13 (h) "Health data institute" means the public-private 74.14 partnership between the commissioner of health and the board of 74.15 directors established under this section. 74.16 (i) "Health plan company" has the definition provided in 74.17 section 62Q.01, subdivision 4. 74.18 (j) "Industry participant" means any group purchaser, 74.19 employers with employee health benefit plans, regardless of the 74.20 manner in which benefits are provided or paid for under the 74.21 plan, provider, or state agency or political subdivision, with 74.22 the exception of professional licensing boards or law 74.23 enforcement agencies. 74.24 (k) "Industry participant identifying data" means any data 74.25 that identifies a specific industry participant directly, or 74.26 which identifies characteristics which reasonably could uniquely 74.27 identify such specific industry participant circumstantially. 74.28 For purposes of this definition, an industry participant is not 74.29 "directly identified" by the use of a unique identification 74.30 number, provided that the number is coded or encrypted through a 74.31 reliable system that can reasonably assure that such numbers 74.32 cannot be traced back by an unauthorized person to determine the 74.33 identity of an industry participant with a particular number. 74.34 (l) "Patient" is an individual as defined in section 13.02, 74.35 subdivision 8, except that "patient" does not include any 74.36 industry participant acting as an industry participant rather 75.1 than as a consumer of health care services or coverage. 75.2 (m) "Patient identifying data" means data that identifies a 75.3 patient directly, or which identifies characteristics which 75.4 reasonably could uniquely identify such specific patients 75.5 circumstantially. For purposes of this definition, a patient is 75.6 not "directly identified" by the use of a unique identification 75.7 number, provided that the number is coded or encrypted through a 75.8 reliable system that can reasonably assure that such numbers 75.9 cannot be traced back by an unauthorized person to determine the 75.10 identity of a patient with a particular number. 75.11 (n) "Performance" means the degree to which a health plan 75.12 company, provider organization, or other entity delivers 75.13 quality, cost-effective services compared to other similar 75.14 entities, or to a given level of care set as a goal to be 75.15 attained. 75.16 (o) "Provider" or "health care provider" has the meaning 75.17 given in section 62J.03, subdivision 8. 75.18 (p) "Roster data" with regard to the enrollee of a health 75.19 plan company or group purchaser means an enrollee's name, 75.20 address, telephone number, date of birth, gender, and enrollment 75.21 status under a group purchaser's health plan. "Roster data" 75.22 with regard to a patient of a provider means the patient's name, 75.23 address, telephone number, date of birth, gender, and date or 75.24 dates treated, including, if applicable, the date of admission 75.25 and the date of discharge. 75.26 Subd. 3. [OBJECTIVES OF THE HEALTH DATA INSTITUTE.] (a) 75.27 The health data institute shall: 75.28 (1) develop a data collection plan that provides 75.29 coordination for public and private sector data collection 75.30 efforts related to the performance measurement and improvement 75.31 of the health care delivery system; 75.32 (2) establish an electronic data interchange system that 75.33 may be used by the public and private sectors to exchange health 75.34 care data in a cost-efficient manner; 75.35 (3) develop a mechanism to collect, analyze, and 75.36 disseminate information for comparing the cost and quality of 76.1 health care delivery system components, including health plan 76.2 companies and provider organizations; 76.3 (4) develop policies and procedures to protect the privacy 76.4 of individual-identifiable data, and to assure appropriate 76.5 access to and disclosure of information specific to individual 76.6 health plan companies and provider organizations collected 76.7 pursuant to this section; and 76.8 (5) use and build upon existing data sources and 76.9 performance measurement efforts, and improve upon these existing 76.10 data sources and measurement efforts through the integration of 76.11 data systems and the standardization of concepts, to the 76.12 greatest extent possible. 76.13 (b) In carrying out its responsibilities, the health data 76.14 institute may contract with private sector organizations 76.15 currently collecting data on specific health-related areas of 76.16 interest to the health data institute, in order to achieve 76.17 maximum efficiency and cost-effectiveness. The health data 76.18 institute may establish links between the data collected and 76.19 maintained by the health data institute and private sector data 76.20 through the health data institute's electronic data interchange 76.21 system, and may implement methods to streamline data collection 76.22 in order to reduce public and private sector administrative 76.23 costs. The health data institute may use or establish links 76.24 with public sector data, such as that existing for medical 76.25 assistance and Medicare, to the extent permitted by state and 76.26 federal law. The health data institute may also recommend 76.27 methods to streamline public sector data collection in order to 76.28 reduce public and private sector administrative costs. 76.29 (c) Any contract with a private sector entity must require 76.30 the private sector entity to maintain the data collected 76.31 according to the applicable data privacy provisions, as provided 76.32 in section 62J.452. 76.33 Subd. 4. [DATA COLLECTION PLAN.] (a) The health data 76.34 institute shall develop a plan that: 76.35 (1) identifies the health care data needs of consumers, 76.36 group purchasers, providers, and the state regarding the 77.1 performance of health care delivery system components including 77.2 health plan companies and provider organizations; 77.3 (2) specifies data collection objectives, strategies, 77.4 priorities, cost estimates, administrative and operational 77.5 guidelines, and implementation timelines for the health data 77.6 institute; and 77.7 (3) identifies the data needed for the health data 77.8 institute to carry out the duties assigned in this section. The 77.9 plan must take into consideration existing data sources and data 77.10 sources that can easily be made uniform for links to other data 77.11 sets. 77.12 (b) This plan shall be updated on an annual basis. 77.13 Subd. 5. [HEALTH CARE ELECTRONIC DATA INTERCHANGE 77.14 SYSTEM.] (a) The health data institute shall establish an 77.15 electronic data interchange system that electronically 77.16 transmits, collects, archives, and provides users of data with 77.17 the data necessary for their specific interests, in order to 77.18 promote a high quality, cost-effective, consumer-responsive 77.19 health care system. This public-private information system 77.20 shall be developed to make health care claims processing and 77.21 financial settlement transactions more efficient and to provide 77.22 an efficient, unobtrusive method for meeting the shared 77.23 electronic data interchange needs of consumers, group 77.24 purchasers, providers, and the state. 77.25 (b) The health data institute shall operate the Minnesota 77.26 center for health care electronic data interchange established 77.27 in section 62J.57, and shall integrate the goals, objectives, 77.28 and activities of the center with those of the health data 77.29 institute's electronic data interchange system. 77.30 Subd. 6. [PERFORMANCE MEASUREMENT INFORMATION.] (a) The 77.31 health data institute shall develop and implement a performance 77.32 measurement plan to analyze and disseminate health care data to 77.33 address the needs of consumers, group purchasers, providers, and 77.34 the state for performance measurement at various levels of the 77.35 health care system in the state. The plan shall include a 77.36 mechanism to: 78.1 (1) provide comparative information to consumers, 78.2 purchasers, and policymakers for use in performance assessment 78.3 of health care system components, including health plan 78.4 companies and provider organizations; 78.5 (2) complement and enhance, but not replace, existing 78.6 internal performance improvement efforts of health care 78.7 providers and plans; and 78.8 (3) reduce unnecessary administrative costs in the health 78.9 care system by eliminating duplication in the collection of data 78.10 for both evaluation and improvement efforts. 78.11 (b) Performance measurement at the provider organization 78.12 level may be conducted on a condition-specific basis. Criteria 78.13 for selecting conditions for measurement may include: 78.14 (1) relevance to consumers and purchasers; 78.15 (2) prevalence of conditions; 78.16 (3) costs related to diagnosis and treatment; 78.17 (4) demonstrated efficacy of treatments; 78.18 (5) evidence of variability in management; 78.19 (6) existence of risk adjustment methodologies to control 78.20 for patient and other risk factors contributing to variation in 78.21 cost and quality; 78.22 (7) existence of practice guidelines related to the 78.23 condition; and 78.24 (8) relevance of the condition to public health goals. 78.25 (c) Performance measurement on a condition-specific basis 78.26 may consider multiple dimensions of performance, including, but 78.27 not limited to: 78.28 (1) accessibility; 78.29 (2) appropriateness; 78.30 (3) effectiveness, including clinical outcomes, patient 78.31 satisfaction, and functional status; and 78.32 (4) efficiency. 78.33 (d) Collection of data for condition-specific performance 78.34 measurement may be conducted at the patient level. 78.35 Encounter-level data collected for this purpose may include 78.36 unique identifiers for patients, providers, payers, and 79.1 employers in order to link episodes of care across care settings 79.2 and over time. The health data institute must encrypt patient 79.3 identifiers to prevent identification of individual patients and 79.4 to enable release of otherwise private data to researchers, 79.5 providers, and group purchasers in a manner consistent with 79.6 chapter 13 and sections 62J.452 and 144.335. 79.7 Subd. 6a. [HEALTH PLAN COMPANY PERFORMANCE 79.8 MEASUREMENT.] As part of the performance measurement plan 79.9 specified in subdivision 6, the health data institute shall 79.10 develop a mechanism to assess the performance of health plan 79.11 companies, and to disseminate this information through reports 79.12 and other means to consumers, purchasers, policymakers, and 79.13 other interested parties, consistent with the data policies 79.14 specified in section 62J.452. 79.15 Subd. 6b. [CONSUMER SURVEYS.] (a) The health data 79.16 institute shall develop and implement a mechanism for collecting 79.17 comparative data on consumer perceptions of the health care 79.18 system, including consumer satisfaction, through adoption of a 79.19 standard consumer survey. This survey shall include enrollees 79.20 in community integrated service networks, integrated service 79.21 networks, health maintenance organizations, preferred provider 79.22 organizations, indemnity insurance plans, public programs, and 79.23 other health plan companies. The health data institute, in 79.24 consultation with the health care commission, shall determine a 79.25 mechanism for the inclusion of the uninsured. This consumer 79.26 survey may be conducted every two years. A focused survey may 79.27 be conducted on the off years. Health plan companies and group 79.28 purchasers shall provide to the health data institute roster 79.29 data as defined in subdivision 2, including the names, 79.30 addresses, and telephone numbers of enrollees and former 79.31 enrollees and other data necessary for the completion of this 79.32 survey. This roster data provided by the health plan companies 79.33 and group purchasers is classified as provided under section 79.34 62J.452. The health data institute may analyze and prepare 79.35 findings from the raw, unaggregated data, and the findings from 79.36 this survey may be included in the health plan company 80.1 performance reports specified in subdivision 6a, and in other 80.2 reports developed and disseminated by the health data institute 80.3 and the commissioner. The raw, unaggregated data is classified 80.4 as provided under section 62J.452, and may be made available by 80.5 the health data institute to the extent permitted under section 80.6 62J.452. The health data institute shall provide raw, 80.7 unaggregated data to the commissioner. The survey may include 80.8 information on the following subjects: 80.9 (1) enrollees' overall satisfaction with their health care 80.10 plan; 80.11 (2) consumers' perception of access to emergency, urgent, 80.12 routine, and preventive care, including locations, hours, 80.13 waiting times, and access to care when needed; 80.14 (3) premiums and costs; 80.15 (4) technical competence of providers; 80.16 (5) communication, courtesy, respect, reassurance, and 80.17 support; 80.18 (6) choice and continuity of providers; 80.19 (7) continuity of care; 80.20 (8) outcomes of care; 80.21 (9) services offered by the plan, including range of 80.22 services, coverage for preventive and routine services, and 80.23 coverage for illness and hospitalization; 80.24 (10) availability of information; and 80.25 (11) paperwork. 80.26 (b) The health data institute shall appoint a consumer 80.27 advisory group which shall consist of 13 individuals, 80.28 representing enrollees from public and private health plan 80.29 companies and programs and two uninsured consumers, to advise 80.30 the health data institute on issues of concern to consumers. 80.31 The advisory group must have at least one member from each 80.32 regional coordinating board region of the state. The advisory 80.33 group expires June 30, 1996. 80.34 Subd. 6c. [PROVIDER ORGANIZATION PERFORMANCE MEASUREMENT.] 80.35 As part of the performance measurement plan specified in 80.36 subdivision 6, the health data institute shall develop a 81.1 mechanism to assess the performance of hospitals and other 81.2 provider organizations, and to disseminate this information to 81.3 consumers, purchasers, policymakers, and other interested 81.4 parties, consistent with the data policies specified in section 81.5 62J.452. Data to be collected may include structural 81.6 characteristics including staff-mix and nurse-patient ratios. 81.7 In selecting additional data for collection, the health data 81.8 institute may consider: 81.9 (1) feasibility and statistical validity of the indicator; 81.10 (2) purchaser and public demand for the indicator; 81.11 (3) estimated expense of collecting and reporting the 81.12 indicator; and 81.13 (4) usefulness of the indicator for internal improvement 81.14 purposes. 81.15 Subd. 7. [DISSEMINATION OF REPORTS; OTHER 81.16 INFORMATION.] (a) The health data institute shall establish a 81.17 mechanism for the dissemination of reports and other information 81.18 to consumers, group purchasers, health plan companies, 81.19 providers, and the state. When applicable, the health data 81.20 institute shall coordinate its dissemination of information 81.21 responsibilities with those of the commissioner, to the extent 81.22 administratively efficient and effective. 81.23 (b) The health data institute may require those requesting 81.24 data from its databases to contribute toward the cost of data 81.25 collection through the payments of fees. 81.26 (c) The health data institute shall not allow a group 81.27 purchaser or health care provider to use or have access to the 81.28 electronic data interchange system or to access data under 81.29 section 62J.452, subdivision 6 or 7, unless the group purchaser 81.30 or health care provider cooperates with the data collection 81.31 efforts of the health data institute by submitting or making 81.32 available through the EDI system or other means all data 81.33 requested by the health data institute. The health data 81.34 institute shall prohibit group purchasers and health care 81.35 providers from transferring, providing, or sharing data obtained 81.36 from the health data institute under section 62J.452, 82.1 subdivision 6 or 7, with a group purchaser or health care 82.2 provider that does not cooperate with the data collection 82.3 efforts of the health data institute. 82.4 Subd. 8. [ANNUAL REPORT.] (a) The health data institute 82.5 shall submit to the chairs of the senate joint crime prevention 82.6 and judiciary subcommittee on privacy, the house of 82.7 representatives judiciary committee, the legislative commission 82.8 on health care access, the commissioner, and the governor a 82.9 report on the activities of the health data institute by 82.10 February 1 of each year beginning February 1, 1996. The report 82.11 shall include: 82.12 (1) a description of the data initiatives undertaken by the 82.13 health data institute, including a statement of the purpose and 82.14 a summary of the results of the initiative; 82.15 (2) a description of the steps taken by the health data 82.16 institute to comply with the confidentiality requirements of 82.17 this section and other applicable laws, and of the health data 82.18 institute's internal policies and operating procedures relating 82.19 to data privacy and confidentiality; and 82.20 (3) a description of the actions taken by the health data 82.21 institute to ensure that the EDI system being established 82.22 pursuant to section 62J.451, subdivision 3, clause (2), and 82.23 subdivision 5, protects the confidentiality requirements of this 82.24 section and other applicable laws. 82.25 (b) If the health data institute amends or adopts an 82.26 internal policy or operating procedure relating to data privacy 82.27 and confidentiality, it shall submit copies of such policy or 82.28 procedure within 30 days of its adoption to the public officials 82.29 identified in this subdivision. 82.30 Subd. 9. [BOARD OF DIRECTORS.] The health data institute 82.31 is governed by a 20-member board of directors consisting of the 82.32 following members: 82.33 (1) two representatives of hospitals, one appointed by the 82.34 Minnesota Hospital Association and one appointed by the 82.35 Metropolitan HealthCare Council, to reflect a mix of urban and 82.36 rural institutions; 83.1 (2) four representatives of health carriers, two appointed 83.2 by the Minnesota council of health maintenance organizations, 83.3 one appointed by Blue Cross and Blue Shield of Minnesota, and 83.4 one appointed by the Insurance Federation of Minnesota; 83.5 (3) two consumer members, one appointed by the 83.6 commissioner, and one appointed by the AFL-CIO as a labor union 83.7 representative; 83.8 (4) five group purchaser representatives appointed by the 83.9 Minnesota consortium of health care purchasers to reflect a mix 83.10 of urban and rural, large and small, and self-insured 83.11 purchasers; 83.12 (5) two physicians appointed by the Minnesota Medical 83.13 Association, to reflect a mix of urban and rural practitioners; 83.14 (6) one representative of teaching and research 83.15 institutions, appointed jointly by the Mayo Foundation and the 83.16 Minnesota Association of Public Teaching Hospitals; 83.17 (7) one nursing representative appointed by the Minnesota 83.18 Nurses Association; and 83.19 (8) three representatives of state agencies, one member 83.20 representing the department of employee relations, one member 83.21 representing the department of human services, and one member 83.22 representing the department of health. 83.23 Subd. 10. [TERMS; COMPENSATION; REMOVAL; AND 83.24 VACANCIES.] The board is governed by section 15.0575. 83.25 Subd. 11. [STATUTORY GOVERNANCE.] The health data 83.26 institute is subject to chapter 13 and section 471.705 but is 83.27 not otherwise subject to laws governing state agencies except as 83.28 specifically provided in this chapter. 83.29 Subd. 12. [STAFF.] The board may hire an executive 83.30 director. The executive director and other health data 83.31 institute staff are not state employees but are covered by 83.32 section 3.736. The executive director and other health data 83.33 institute staff may participate in the following plans for 83.34 employees in the unclassified service until January 1, 1996: 83.35 the state retirement plan, the state deferred compensation plan, 83.36 and the health, dental, and life insurance plans. The attorney 84.1 general shall provide legal services to the board. 84.2 Subd. 13. [FEDERAL AND OTHER GRANTS.] The health data 84.3 institute may seek federal funding, and funding from private and 84.4 other nonstate sources for the initiative required by the board. 84.5 Subd. 14. [CONTRACTS.] To carry out the duties assigned in 84.6 this section, the health data institute may contract with 84.7 private sector entities. Any contract must require the private 84.8 sector entity to maintain the data which it receives according 84.9 to the statutory provisions applicable to the data and any other 84.10 applicable provision specified in section 62J.452. 84.11 Subd. 15. [NONLIMITING.] Nothing in this section shall be 84.12 construed to limit the powers granted to the commissioner of 84.13 health in chapter 62D, 62N, 144, or 144A. 84.14 Subd. 16. [CLARIFICATION OF INTENT.] This section is 84.15 intended to provide the health data institute with primary 84.16 responsibility for establishing a data collection plan, 84.17 establishing an electronic data interchange system, measuring 84.18 performance at the provider organization and health plan company 84.19 levels, collecting condition-specific data, developing and 84.20 administering consumer surveys, and performing other duties 84.21 specifically assigned in this section. The commissioner of 84.22 health may perform these duties only if the commissioner 84.23 determines that these duties will not be performed by the health 84.24 data institute. 84.25 Sec. 16. [62J.452] [PROTECTION OF PRIVACY AND 84.26 CONFIDENTIALITY OF HEALTH CARE DATA.] 84.27 Subdivision 1. [STATEMENT OF PURPOSE.] The health data 84.28 institute shall adopt data collection, analysis, and 84.29 dissemination policies that reflect the importance of protecting 84.30 the right of privacy of patients in their health care data in 84.31 connection with each data initiative that the health data 84.32 institute intends to undertake. 84.33 Subd. 2. [DATA CLASSIFICATIONS.] (a) Data collected, 84.34 obtained, received, or created by the health data institute 84.35 shall be private or nonpublic, as applicable, unless given a 84.36 different classification in this subdivision. Data classified 85.1 as private or nonpublic under this subdivision may be released 85.2 or disclosed only as permitted under this subdivision and under 85.3 the other subdivisions referenced in this subdivision. For 85.4 purposes of this section, data that identify individual patients 85.5 or industry participants are private data on individuals or 85.6 nonpublic data, as appropriate. Data not on individuals are 85.7 nonpublic data. Notwithstanding sections 13.03, subdivisions 6 85.8 to 8; 13.10, subdivisions 1 to 4; and 138.17, data received by 85.9 the health data institute shall retain the classification 85.10 designated under this chapter and shall not be disclosed other 85.11 than pursuant to this chapter. Nothing in this subdivision 85.12 prevents patients from gaining access to their health record 85.13 information pursuant to section 144.335. 85.14 (b) When industry participants, as defined in section 85.15 62J.451, are required by statute to provide, either directly or 85.16 through a contractor, as defined in section 62J.451, subdivision 85.17 2, paragraph (c), patient identifying data to the commissioner 85.18 pursuant to this chapter or to the health data institute 85.19 pursuant to section 62J.451, the industry participant or its 85.20 contractor shall be able to provide the data with or without 85.21 patient consent, and may not be held liable for doing so. 85.22 (c) When an industry participant submits patient 85.23 identifying data to the health data institute, and the data is 85.24 submitted to the health data institute in electronic form, or 85.25 through other electronic means including, but not limited to, 85.26 the electronic data interchange system defined in section 85.27 62J.451, the industry participant shall submit the patient 85.28 identifying data in encrypted form, using an encryption method 85.29 supplied or specified by the health data institute. Submission 85.30 of encrypted data as provided in this paragraph satisfies the 85.31 requirements of section 144.335, subdivision 3b. 85.32 (d) Patient identifying data may be disclosed only as 85.33 permitted under subdivision 3. 85.34 (e) Industry participant identifying data which is not 85.35 patient identifying data may be disclosed only by being made 85.36 public in an analysis as permitted under subdivisions 4 and 5 or 86.1 through access to an approved researcher, industry participant, 86.2 or contractor as permitted under subdivision 6 or 7. 86.3 (f) Data that is not patient identifying data and not 86.4 industry participant identifying data is public data. 86.5 (g) Data that describes the finances, governance, internal 86.6 operations, policies, or operating procedures of the health data 86.7 institute, and that does not identify patients or industry 86.8 participants or identifies them only in connection with their 86.9 involvement with the health data institute, is public data. 86.10 Subd. 3. [PATIENT IDENTIFYING DATA.] (a) The health data 86.11 institute must not make public any analysis that contains 86.12 patient identifying data. 86.13 (b) The health data institute may disclose patient 86.14 identifying data only as follows: 86.15 (1) to research organizations that meet the requirements 86.16 set forth in subdivision 6, paragraph (a), but only to the 86.17 extent that such disclosure is also permitted by section 86.18 144.335, subdivision 3a, paragraph (a); or 86.19 (2) to a contractor of, or vendor of services to the health 86.20 data institute for the purposes of conducting a survey or 86.21 analysis, provided that such contractor or vendor agrees to 86.22 comply with all data privacy requirements applicable to the 86.23 health data institute, and to destroy or return to the health 86.24 data institute all copies of patient identifying data in the 86.25 possession of such contractor or vendor upon completion of the 86.26 contract. 86.27 Subd. 4. [ANALYSIS TO BE MADE PUBLIC BY THE HEALTH DATA 86.28 INSTITUTE.] (a) Notwithstanding the classification under 86.29 subdivision 2 or other provision of state law of data included 86.30 or used in an analysis, the health data institute may make 86.31 public data in an analysis pursuant to this subdivision and 86.32 subdivision 5. Such analysis may include industry participant 86.33 identifying data but must not include patient identifying data. 86.34 In making its determination as to whether to make an analysis or 86.35 the data used in the analysis public, the health data institute 86.36 shall consider and determine, in accordance with policies and 87.1 criteria developed by the health data institute, that the data 87.2 and analysis are sufficiently accurate, complete, reliable, 87.3 valid, and as appropriate, case-mixed and severity adjusted, and 87.4 statistically and clinically significant. 87.5 (b) Prior to making an analysis public, the health data 87.6 institute must provide to any industry participant identified in 87.7 the analysis an opportunity to use the fair hearing procedure 87.8 established under subdivision 5. 87.9 (c) Accompanying an analysis made public by the health data 87.10 institute, the health data institute shall also make public 87.11 descriptions of the database used in the analysis, the methods 87.12 of adjusting for case mix and severity, and assuring accuracy, 87.13 completeness, reliability, and statistical and clinical 87.14 significance, as appropriate, and appropriate uses of the 87.15 analysis and related analytical data, including precautionary 87.16 statements regarding the limitations of the analysis and related 87.17 analytical data. 87.18 Subd. 5. [FAIR HEARING PROCEDURE PRIOR TO MAKING AN 87.19 ANALYSIS PUBLIC.] (a) The health data institute may not make 87.20 public an analysis that identifies an industry participant 87.21 unless the health data institute first complies with this 87.22 subdivision. A draft of the portion of the analysis that 87.23 identifies an industry participant must be furnished upon an 87.24 industry participant's request to that industry participant 87.25 prior to making that portion of the analysis public. Such draft 87.26 analysis is private or nonpublic, as applicable. The industry 87.27 participants so identified have the right to a hearing, at which 87.28 the industry participants or their contractors, as defined in 87.29 section 62J.451, subdivision 2, paragraph (c), may object to or 87.30 seek modification of the analysis. The cost of the hearing 87.31 shall be borne by the industry participant requesting the 87.32 hearing. 87.33 (b) The health data institute shall establish the hearing 87.34 procedure in writing. The hearing procedure shall include the 87.35 following: 87.36 (1) the provision of reasonable notice of the health data 88.1 institute's intention to make such analysis public; 88.2 (2) an opportunity for the identified industry participants 88.3 to submit written statements to the health data institute board 88.4 of directors or its designate, to be represented by a 88.5 contractor, as defined in section 62J.451, subdivision 2, 88.6 paragraph (c), or other individual or entity acting on behalf of 88.7 and chosen by the industry participant for this purpose, and to 88.8 append a statement to such analysis to be included with it when 88.9 and if the analysis is made public; and 88.10 (3) access by the identified industry participants to 88.11 industry participant identifying data, but only as permitted by 88.12 subdivision 6 or 7. 88.13 (c) The health data institute shall make the hearing 88.14 procedure available in advance to industry participants which 88.15 are identified in an analysis. The written hearing procedure is 88.16 public data. The following data related to a hearing is public: 88.17 (1) the parties involved; 88.18 (2) the dates of the hearing; and 88.19 (3) a general description of the issue and the results of 88.20 the hearing; all other data relating to the hearing is private 88.21 or nonpublic. 88.22 Subd. 6. [ACCESS BY APPROVED RESEARCHERS TO DATA THAT 88.23 IDENTIFIES INDUSTRY PARTICIPANTS BUT DOES NOT IDENTIFY 88.24 PATIENTS.] (a) The health data institute shall provide access to 88.25 industry participant identifying data, but not patient 88.26 identifying data, once those data are in analyzable form, upon 88.27 request to research organizations or individuals that: 88.28 (1) have as explicit goals research purposes that promote 88.29 individual or public health and the release of research results 88.30 to the public as determined by the health data institute 88.31 according to standards it adopts for evaluating such goals; 88.32 (2) enforce strict and explicit policies which protect the 88.33 confidentiality and integrity of data as determined by the 88.34 health data institute according to standards it adopts for 88.35 evaluating such policies; 88.36 (3) agree not to make public, redisclose, or transfer the 89.1 data to any other individual or organization, except as 89.2 permitted under paragraph (b); 89.3 (4) demonstrate a research purpose for the data that can be 89.4 accomplished only if the data are provided in a form that 89.5 identifies specific industry participants as determined by the 89.6 health data institute according to standards it adopts for 89.7 evaluating such research purposes; and 89.8 (5) agree to disclose analysis in a public forum or 89.9 publication only pursuant to subdivisions 4 and 5 and other 89.10 applicable statutes and the health data institute's operating 89.11 rules governing the making of an analysis public by the health 89.12 data institute. 89.13 (b) Contractors of entities that have access under 89.14 paragraph (a) may also have access to industry participant 89.15 identifying data, provided that the contract requires the 89.16 contractor to comply with the confidentiality requirements set 89.17 forth in this section and under any other statute applicable to 89.18 the entity. 89.19 Subd. 7. [ACCESS BY INDUSTRY PARTICIPANTS TO DATA THAT 89.20 IDENTIFIES INDUSTRY PARTICIPANTS BUT DOES NOT IDENTIFY 89.21 PATIENTS.] (a) The health data institute may provide, to an 89.22 industry participant, data that identifies that industry 89.23 participant or other industry participants, to the extent 89.24 permitted under this subdivision. An employer or an employer 89.25 purchasing group may receive data relating to care provided to 89.26 patients for which that employer acts as the payer. A health 89.27 plan company may receive data relating to care provided to 89.28 enrollees of that health plan company. A provider may receive 89.29 data relating to care provided to patients of that provider. 89.30 (b) An industry participant may receive data that 89.31 identifies that industry participant or other industry 89.32 participants and that relates to care purchased or provided by 89.33 industry participants other than the industry participant 89.34 seeking the data. These data must be provided by the health 89.35 data institute only with appropriate authorization from all 89.36 industry participants identified. 90.1 (c) The health data institute must not provide access to 90.2 any data under this subdivision that is patient identifying data 90.3 as defined in section 62J.451, subdivision 2, paragraph (m), 90.4 even if providing that data would otherwise be allowed under 90.5 this subdivision. 90.6 (d) To receive data under this subdivision, an industry 90.7 participant must cooperate with the health data institute as 90.8 provided under section 62J.451, subdivision 7, paragraph (c). 90.9 (e) Contractors of entities that have access under 90.10 paragraph (b) may have access to industry participant 90.11 identifying data, provided that the contract requires the 90.12 contractor to comply with the confidentiality requirements set 90.13 forth in this section and under any other statute applicable to 90.14 the entity. 90.15 Subd. 8. [STATUS OF DATA ON THE ELECTRONIC DATA 90.16 INTERCHANGE SYSTEM.] (a) Data created or generated by or in the 90.17 custody of an industry participant, and transferred 90.18 electronically by that industry participant to another industry 90.19 participant using the EDI system developed, implemented, 90.20 maintained, or operated by the health data institute, as 90.21 permitted by section 62J.451, subdivision 3, clause (2), and 90.22 subdivision 5, is not subject to this section or to chapter 13 90.23 except as provided below. 90.24 (b) Data created or generated by or in the custody of an 90.25 industry participant is subject to the privacy protections 90.26 applicable to the data, including, but not limited to, chapter 90.27 13 with respect to state agencies and political subdivisions, 90.28 the Minnesota insurance fair information reporting act with 90.29 respect to industry participants subject to it, and section 90.30 144.335, with respect to providers and other industry 90.31 participants subject to such section. 90.32 Subd. 9. [AUTHORIZATION OF STATE AGENCIES AND POLITICAL 90.33 SUBDIVISIONS TO PROVIDE DATA.] (a) Notwithstanding any 90.34 limitation in chapter 13 or section 62J.321, subdivision 5, 90.35 regarding the disclosure of not public data, all state agencies 90.36 and political subdivisions, including, but not limited to, 91.1 municipalities, counties, and hospital districts may provide not 91.2 public data relating to health care costs, quality, or outcomes 91.3 to the health data institute for the purposes set forth in 91.4 section 62J.451. 91.5 (b) Data provided by the commissioner pursuant to paragraph 91.6 (a) of this subdivision may not include patient identifying data 91.7 as defined in section 62J.451, subdivision 2, paragraph (m). 91.8 For data provided by the commissioner of health pursuant to 91.9 paragraph (a), the health data institute and anyone receiving 91.10 the data from the health data institute, is prohibited from 91.11 unencrypting or attempting to link the data with other patient 91.12 identifying data sources. 91.13 (c) Any data provided to the health data institute pursuant 91.14 to paragraph (a) shall retain the same classification that it 91.15 had with the state agency or political subdivision that provided 91.16 it. The authorization in this subdivision is subject to any 91.17 federal law restricting or prohibiting such disclosure of the 91.18 data described above. 91.19 (d) Notwithstanding any limitation in chapter 13 or 91.20 sections 62J.451 and 62J.452 regarding the disclosure of 91.21 nonpublic and private data, the health data institute may 91.22 provide nonpublic and private data to any state agency that is a 91.23 member of the board of the health data institute. Any such data 91.24 provided to a state agency shall retain nonpublic or private 91.25 classification, as applicable. 91.26 Subd. 10. [CIVIL REMEDIES.] Violation of any of the 91.27 confidentiality requirements set forth in subdivision 3; 4, 91.28 paragraph (a); 6; or 7, by the health data institute, its board 91.29 members, employees and contractors, any industry participant, or 91.30 by any other person shall be subject to section 13.08, 91.31 including, but not limited to, the immunities set forth in 91.32 section 13.08, subdivisions 5 and 6. The health data institute 91.33 shall not be liable for exercising its discretion in a manner 91.34 that is not an abuse of discretion with respect to matters under 91.35 its discretion by this section or section 62J.451. The health 91.36 data institute shall not be liable for the actions of persons 92.1 not under the direction and control of the health data 92.2 institute, where it has performed its responsibilities to 92.3 protect data privacy by complying with the requirements of this 92.4 section and other applicable laws with regard to the disclosure 92.5 of data. The remedies set forth in this section do not preclude 92.6 any person from pursuing any other remedies authorized by law. 92.7 Subd. 11. [PENALTIES.] (a) Any person who willfully 92.8 violates the confidentiality requirements set forth in 92.9 subdivision 3; 4, paragraph (a); 6; or 7, shall be guilty of a 92.10 misdemeanor. 92.11 (b) Any person who willfully violates the confidentiality 92.12 requirements of subdivision 3, 4, 6, 7, 8, or 9, by willfully 92.13 disclosing patient or industry participant identifying data for 92.14 compensation or remuneration of any kind or for the purpose of 92.15 damaging the reputation of any patient or industry participant 92.16 or any other malicious purpose, shall be guilty of a gross 92.17 misdemeanor. 92.18 Subd. 12. [DISCOVERABILITY OF HEALTH DATA INSTITUTE 92.19 DATA.] (a) Data created, collected, received, maintained, or 92.20 disseminated by the health data institute shall not be subject 92.21 to discovery or introduction into evidence in any civil or 92.22 criminal action. Data created, collected, received, maintained, 92.23 or disseminated by the health data institute that is otherwise 92.24 available from original sources is subject to discovery from 92.25 those sources and may be introduced into evidence in civil or 92.26 criminal actions in accordance with and subject to applicable 92.27 laws and rules of evidence and civil or criminal procedure, as 92.28 applicable. 92.29 (b) Information related to submission of data to the health 92.30 data institute by industry participants or contractors of 92.31 industry participants is not discoverable from the health data 92.32 institute, the industry participants, the contractors, or any 92.33 other person or entity, in any civil or criminal action. 92.34 Discovery requests prohibited under this paragraph include, but 92.35 are not limited to, document requests or interrogatories that 92.36 ask for "all data provided to the Minnesota health data 93.1 institute." 93.2 Sec. 17. Minnesota Statutes 1994, section 62J.54, is 93.3 amended to read: 93.4 62J.54 [IDENTIFICATION AND IMPLEMENTATION OF UNIQUE 93.5 IDENTIFIERS.] 93.6 Subdivision 1. [UNIQUE IDENTIFICATION NUMBER FOR HEALTH 93.7 CARE PROVIDER ORGANIZATIONS.] (a) On and after January 1, 93.819961998, all group purchasers and health care providers in 93.9 Minnesota shall use a unique identification number to identify 93.10 health care provider organizations, except as provided in 93.11 paragraph (d). 93.12 (b) Following the recommendation of the workgroup for 93.13 electronic data interchange, the federal tax identification 93.14 number assigned to each health care provider organization by the 93.15 Internal Revenue Service of the Department of the Treasury shall 93.16 be used as the unique identification number for health care 93.17 provider organizations. 93.18 (c) The unique health care provider organization identifier 93.19 shall be used for purposes of submitting and receiving claims, 93.20 and in conjunction with other data collection and reporting 93.21 functions. 93.22 (d) The state and federal health care programs administered 93.23 by the department of human services shall use the unique 93.24 identification number assigned to health care providers for 93.25 implementation of the Medicaid Management Information System or 93.26 the uniform provider identification number (UPIN) assigned by 93.27 the Health Care Financing Administration. 93.28 Subd. 2. [UNIQUE IDENTIFICATION NUMBER FOR INDIVIDUAL 93.29 HEALTH CARE PROVIDERS.] (a) On and after January 1,19961998, 93.30 all group purchasers and health care providers in Minnesota 93.31 shall use a unique identification number to identify an 93.32 individual health care provider, except as provided in paragraph 93.33 (d). 93.34 (b) The uniform provider identification number (UPIN) 93.35 assigned by the Health Care Financing Administration shall be 93.36 used as the unique identification number for individual health 94.1 care providers. Providers who do not currently have a UPIN 94.2 number shall request one from the health care financing 94.3 administration. 94.4 (c) The unique individual health care provider identifier 94.5 shall be used for purposes of submitting and receiving claims, 94.6 and in conjunction with other data collection and reporting 94.7 functions. 94.8 (d) The state and federal health care programs administered 94.9 by the department of human services shall use the unique 94.10 identification number assigned to health care providers for 94.11 implementation of the Medicaid Management Information System or 94.12 the uniform provider identification number (UPIN) assigned by 94.13 the health care financing administration. 94.14 Subd. 3. [UNIQUE IDENTIFICATION NUMBER FOR GROUP 94.15 PURCHASERS.] (a) On and after January 1,19961998, all group 94.16 purchasers and health care providers in Minnesota shall use a 94.17 unique identification number to identify group purchasers. 94.18 (b) The federal tax identification number assigned to each 94.19 group purchaser by the Internal Revenue Service of the 94.20 Department of the Treasury shall be used as the unique 94.21 identification number for group purchasers. This paragraph 94.22 applies until the codes described in paragraph (c) are available 94.23 and feasible to use, as determined by the commissioner. 94.24 (c) A two-part code, consisting of 11 characters and 94.25 modeled after the National Association of Insurance 94.26 Commissioners company code shall be assigned to each group 94.27 purchaser and used as the unique identification number for group 94.28 purchasers. The first six characters, or prefix, shall contain 94.29 the numeric code, or company code, assigned by the National 94.30 Association of Insurance Commissioners. The last five 94.31 characters, or suffix, which is optional, shall contain further 94.32 codes that will enable group purchasers to further route 94.33 electronic transaction in their internal systems. 94.34 (d) The unique group purchaser identifier shall be used for 94.35 purposes of submitting and receiving claims, and in conjunction 94.36 with other data collection and reporting functions. 95.1 Subd. 4. [UNIQUE PATIENT IDENTIFICATION NUMBER.] (a) On 95.2 and after January 1,19961998, all group purchasers and health 95.3 care providers in Minnesota shall use a unique identification 95.4 number to identify each patient who receives health care 95.5 services in Minnesota, except as provided in paragraph (e). 95.6 (b) Except as provided in paragraph (d), following the 95.7 recommendation of the workgroup for electronic data interchange, 95.8 the social security number of the patient shall be used as the 95.9 unique patient identification number. 95.10 (c) The unique patient identification number shall be used 95.11 by group purchasers and health care providers for purposes of 95.12 submitting and receiving claims, and in conjunction with other 95.13 data collection and reporting functions. 95.14 (d) The commissioner shall develop an alternate numbering 95.15 system for patients who do not have or refuse to provide a 95.16 social security number. This provision does not require that 95.17 patients provide their social security numbers and does not 95.18 require group purchasers or providers to demand that patients 95.19 provide their social security numbers. Group purchasers and 95.20 health care providers shall establish procedures to notify 95.21 patients that they can elect not to have their social security 95.22 number used as the unique patient identification number. 95.23 (e) The state and federal health care programs administered 95.24 by the department of human services shall use the unique person 95.25 master index (PMI) identification number assigned to clients 95.26 participating in programs administered by the department of 95.27 human services. 95.28 Sec. 18. Minnesota Statutes 1994, section 62J.55, is 95.29 amended to read: 95.30 62J.55 [PRIVACY OF UNIQUE IDENTIFIERS.] 95.31 (a) When the unique identifiers specified in section 62J.54 95.32 are used for data collection purposes, the identifiers must be 95.33 encrypted, as required in section62J.3062J.321, subdivision695.34 1. Encryption must follow encryption standards set by the 95.35 National Bureau of Standards and approved by the American 95.36 National Standards Institute as ANSIX3. 92-1982/R 1987 to 96.1 protect the confidentiality of the data. Social security 96.2 numbers must not be maintained in unencrypted form in the 96.3 database, and the data must never be released in a form that 96.4 would allow for the identification of individuals. The 96.5 encryption algorithm and hardware used must not use clipper chip 96.6 technology. 96.7 (b) Providers and group purchasers shall treat medical 96.8 records, including the social security number if it is used as a 96.9 unique patient identifier, in accordance with section 144.335. 96.10 The social security number may be disclosed by providers and 96.11 group purchasers to the commissioner as necessary to allow 96.12 performance of those duties set forth in section 144.05. 96.13 Sec. 19. Minnesota Statutes 1994, section 62J.58, is 96.14 amended to read: 96.15 62J.58 [IMPLEMENTATION OF STANDARD TRANSACTION SETS.] 96.16 Subdivision 1. [CLAIMS PAYMENT.](a) By July 1, 1995Six 96.17 months from the date the commissioner formally recommends the 96.18 use of guides to implement core transaction sets pursuant to 96.19 section 62J.56, subdivision 3, all category I industry 96.20 participants, except pharmacists, shall be able to submit or96.21accept, as appropriate, the ANSI ASC X12 835 health care claim96.22payment/advice transaction set (draft standard for trial use96.23version 3030) for electronic transfer of payment information.96.24(b) By July 1, 1996,and all category II industry 96.25 participants, except pharmacists, shall be able to submit or 96.26 accept, as appropriate, the ANSI ASC X12 835 health care claim 96.27 payment/advice transaction set (draft standard for trial use 96.28 version 3030) for electronic submission of payment information 96.29 to health care providers. 96.30 Subd. 2. [CLAIMS SUBMISSION.]Beginning July 1, 1995Six 96.31 months from the date the commissioner formally recommends the 96.32 use of guides to implement core transaction sets pursuant to 96.33 section 62J.56, subdivision 3, all category I and category II 96.34 industry participants, except pharmacists, shall be able to 96.35 accept or submit, as appropriate, the ANSI ASC X12 837 health 96.36 care claim transaction set (draft standard for trial use version 97.1 3030) for the electronic transfer of health care claim 97.2 information.Category II industry participants, except97.3pharmacists, shall be able to accept or submit, as appropriate,97.4this transaction set, beginning July 1, 1996.97.5 Subd. 3. [ENROLLMENT INFORMATION.]Beginning January 1,97.61996Six months from the date the commissioner formally 97.7 recommends the use of guides to implement core transaction sets 97.8 pursuant to section 62J.56, subdivision 3, all category I and 97.9 category II industry participants, excluding pharmacists, shall 97.10 be able to accept or submit, as appropriate, the ANSI ASC X12 97.11 834 health care enrollment transaction set (draft standard for 97.12 trial use version 3030) for the electronic transfer of 97.13 enrollment and health benefit information.Category II industry97.14participants, except pharmacists, shall be able to accept or97.15submit, as appropriate, this transaction set, beginning January97.161, 1997.97.17 Subd. 4. [ELIGIBILITY INFORMATION.]By January 1, 1996Six 97.18 months from the date the commissioner formally recommends the 97.19 use of guides to implement core transaction sets pursuant to 97.20 section 62J.56, subdivision 3, all category I and category II 97.21 industry participants, except pharmacists, shall be able to 97.22 accept or submit, as appropriate, the ANSI ASC X12 270/271 97.23 health care eligibility transaction set (draft standard for 97.24 trial use version 3030) for the electronic transfer of health 97.25 benefit eligibility information.Category II industry97.26participants, except pharmacists, shall be able to accept or97.27submit, as appropriate, this transaction set, beginning January97.281, 1997.97.29 Subd. 5. [APPLICABILITY.] This section does not require a 97.30 group purchaser, health care provider, or employer to use 97.31 electronic data interchange or to have the capability to do so. 97.32 This section applies only to the extent that a group purchaser, 97.33 health care provider, or employer chooses to use electronic data 97.34 interchange. 97.35 Sec. 20. Minnesota Statutes 1994, section 214.16, 97.36 subdivision 2, is amended to read: 98.1 Subd. 2. [BOARD COOPERATION REQUIRED.] The board shall 98.2 assist the commissioner of healthand the data analysis unitin 98.3 data collection activities required under Laws 1992, chapter 98.4 549, article 7, and shall assist the commissioner of revenue in 98.5 activities related to collection of the health care provider tax 98.6 required under Laws 1992, chapter 549, article 9. Upon the 98.7 request of the commissioner, the data analysis unit,or the 98.8 commissioner of revenue, the board shall make available names 98.9 and addresses of current licensees and provide other information 98.10 or assistance as needed. 98.11 Sec. 21. Minnesota Statutes 1994, section 214.16, 98.12 subdivision 3, is amended to read: 98.13 Subd. 3. [GROUNDS FOR DISCIPLINARY ACTION.] The board 98.14 shall take disciplinary action, which may include license 98.15 revocation, against a regulated person for: 98.16 (1) intentional failure to provide the commissioner of 98.17 healthor the data analysis unit established under section98.1862J.30with the data required under chapter 62J; 98.19 (2) intentional failure to provide the commissioner of 98.20 revenue with data on gross revenue and other information 98.21 required for the commissioner to implement sections 295.50 to 98.22 295.58; and 98.23 (3) intentional failure to pay the health care provider tax 98.24 required under section 295.52. 98.25 Sec. 22. [RULES.] 98.26 Notwithstanding Minnesota Statutes, section 14.05, 98.27 subdivision 1, Minnesota Rules, chapters 4650, 4651, and 4652, 98.28 shall continue in effect under the authority granted in 98.29 Minnesota Statutes, section 62J.321, subdivision 6. 98.30 Sec. 23. [INSTRUCTION TO REVISOR.] 98.31 (a) The revisor of statutes is instructed to change the 98.32 term "data institute" or "institute", where applicable, to 98.33 "health data institute" in the 1996 edition of Minnesota 98.34 Statutes and Minnesota Rules. 98.35 (b) The revisor of statutes is instructed to change any 98.36 statutory reference to the information clearinghouse from 99.1 Minnesota Statutes, section 62J.33 or 62J.33, subdivision 2, to 99.2 62J.2930, in the 1996 edition of Minnesota Statutes and 99.3 Minnesota Rules. 99.4 Sec. 24. [REPEALER.] 99.5 Minnesota Statutes 1994, sections 62J.30; 62J.31; 62J.32; 99.6 62J.33; 62J.34; 62J.35; 62J.41, subdivisions 3 and 4; 62J.44; 99.7 and 62J.45, are repealed. 99.8 ARTICLE 6 99.9 MINNESOTACARE PROGRAM, PRESCRIPTION DRUG COVERAGE, 99.10 AND THE HEALTH CARE REFORM WAIVER 99.11 Section 1. [62J.66] [DEFINITIONS.] 99.12 Subdivision 1. [APPLICABILITY.] For purposes of section 99.13 62J.66 and 62J.68, the following definitions apply. 99.14 Subd. 2. [DISCOUNTED PRICE.] The "discounted price" means 99.15 the lesser of the average wholesale price for a prescription 99.16 drug minus 20 percent or the usual and customary retail price, 99.17 including any dispensing fee, minus five percent. 99.18 Subd. 3. [ELIGIBLE SENIOR.] "Eligible senior" means a 99.19 senior citizen eligible for the senior drug discount program 99.20 under section 62J.68, subdivision 3. 99.21 Subd. 4. [SENIOR CITIZEN.] "Senior citizen" means a 99.22 resident of Minnesota who is age 65 or older. 99.23 Subd. 5. [SENIOR DRUG DISCOUNT PROGRAM.] "Senior drug 99.24 discount program" means the program established in section 99.25 62J.68. 99.26 Subd. 6. [PARTICIPATING DRUG MANUFACTURER.] "Participating 99.27 drug manufacturer" means any manufacturer who agrees to 99.28 voluntarily participate in the senior drug discount program. 99.29 Subd. 7. [PARTICIPATING CLAIMS PROCESSING 99.30 COMPANIES.] "Participating claims processing companies" means 99.31 entities, including, but not limited to, pharmacy benefit 99.32 management companies, that are awarded a contract by the 99.33 department of administration to provide on-line services to 99.34 process payments to participating pharmacies. 99.35 Subd. 8. [AVERAGE MANUFACTURER PRICE.] "Average 99.36 manufacturer price" has the meaning assigned to the term by the