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Minnesota Legislature

Office of the Revisor of Statutes

SF 3470

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

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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45.27 45.28 45.29 45.30 45.31 45.32 45.33 45.34 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 46.34 46.35 46.36 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11
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49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 49.34 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8
50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 50.35 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17
51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30
52.31 52.32 52.33 52.34 52.35 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28
53.29 53.30 53.31 53.32 53.33 53.34 53.35 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30
54.31 54.32 54.33 54.34 54.35 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 55.33 55.34 55.35 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 56.32 56.33 56.34 56.35 56.36 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10
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57.30 57.31 57.32 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 58.33 58.34 58.35 58.36 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10
59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 59.34 59.35 60.1 60.2
60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31
60.32 60.33 60.34 60.35 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24
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61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 61.34 61.35
62.1 62.2 62.3
62.4 62.5 62.6
62.7

A bill for an act
relating to health care; establishing a statewide health improvement program;
establishing a program to monitor child obesity; establishing a health
improvement fund; establishing a public health improvement assessment;
establishing health care homes; increasing continuity of care; modifying outreach
efforts; establishing primary care education initiatives; increasing affordability
and continuity of care with public health care programs; creating a health
insurance exchange; establishing Section 125 Plans; creating a Health Care
Transformation Commission; restructuring the health care payment system;
creating a savings reinvestment fund; establishing a savings recapture assessment;
establishing cost containment goals; specifying an affordability standard;
providing subsidies for employer-subsidized coverage; requiring providers to list
prices; establishing an electronic prescription drug program; requiring mandated
reports; authorizing rulemaking; appropriating money; amending Minnesota
Statutes 2006, sections 62A.65, subdivision 3; 62E.141; 62L.12, subdivisions 2,
4; 62Q.735, subdivision 1; 256.01, by adding a subdivision; 256B.061; 256B.69,
by adding a subdivision; 256D.03, by adding a subdivision; 256L.05, by adding a
subdivision; 256L.06, subdivision 3; 256L.07, subdivision 3; 256L.15, by adding
a subdivision; Minnesota Statutes 2007 Supplement, sections 13.46, subdivision
2; 62J.496, by adding a subdivision; 62J.81, subdivision 1; 62J.82, subdivision 1;
256.962, subdivisions 5, 6; 256B.056, subdivision 10; 256L.03, subdivisions 3,
5; 256L.04, subdivisions 1, 7; 256L.05, subdivision 3a; 256L.07, subdivision 1;
256L.15, subdivision 2; proposing coding for new law in Minnesota Statutes,
chapters 16A; 62J; 144; 145; 256B; proposing coding for new law as Minnesota
Statutes, chapter 62U; repealing Minnesota Statutes 2006, sections 62A.63;
62A.64; 62Q.49; 62Q.65; 62Q.736; 256L.15, subdivision 3.

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

ARTICLE 1

PUBLIC HEALTH

Section 1.

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

new text begin Subdivision 1. new text end

new text begin Health improvement fund. new text end

new text begin There is created in the state treasury
a public health improvement fund to which must be credited revenue from the health
improvement assessment under section 144.5501. The fund is a direct appropriated special
revenue fund. Notwithstanding section 11A.20, all investment income and all investment
losses attributable to the investment of the health improvement fund not currently needed
shall be credited to the public health improvement fund.
new text end

new text begin Subd. 2. new text end

new text begin Fund reimbursements. new text end

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

Sec. 2.

new text begin [144.5501] PUBLIC HEALTH IMPROVEMENT ASSESSMENT.
new text end

new text begin (a) By June 1, 2009, each Minnesota hospital, except facilities of the federal
Indian Health Service and regional treatment centers, shall contribute 0.2 percent of net
patient revenue for calendar year 2008 as reported by that hospital to the health care cost
information system under section 144.698 to the health improvement fund established
under section 16A.726.
new text end

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

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

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

Sec. 3.

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

new text begin Subdivision 1. new text end

new text begin Goals. new text end

new text begin The initial goals of the statewide health improvement
program are to reduce the percentage of Minnesotans who are obese or overweight to less
than half by the year 2020 and to reduce tobacco smoking by 2 percent annually starting in
2011. By 2011, the commissioner of health, in consultation with the State Community
Health Advisory Committee established in section 145A.10, subdivision 10, and other
stakeholders, shall make recommendations as to future goals related to alcohol use and
illegal drug use.
new text end

new text begin Subd. 2. new text end

new text begin Grants to local communities. new text end

new text begin Beginning January 1, 2009, the
commissioner of health shall award grants to community health boards to convene,
coordinate, and lead locally developed programs targeted at achieving measurable health
improvement goals. Funding to each community health board shall be distributed based
on a per capita formula, with a base allocation of $50,000 to each community health board
that receives funding. By January 15, 2011, the commissioner of health shall recommend
whether additional funding should be distributed to community health boards based on
health disparities demonstrated in the populations served.
new text end

new text begin Subd. 3. new text end

new text begin Outcomes. new text end

new text begin (a) The commissioner of health shall set performance measures
and annually review the progress of local communities in meeting the performance
measures. The commissioner may provide technical assistance and corrective action plans
to ensure that local communities are making sufficient progress.
new text end

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

new text begin Subd. 4. new text end

new text begin Media campaign. new text end

new text begin The commissioner of health shall conduct a statewide
marketing campaign using public media to reinforce local efforts at addressing health
improvement goals. The commissioner shall develop the statewide campaigns and
determine the timing of these campaigns in consultation with local public health
representatives.
new text end

Sec. 4.

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

new text begin By July 1, 2009, the commissioner of health shall establish and implement a program
to monitor trends of children who are overweight and obese in the state by collecting
and analyzing Body Mass Index data. To the extent possible, in establishing this Body
Mass Index monitoring program, the commissioner shall use existing child and youth
monitoring systems or surveys. The Body Mass Index data collected shall be used to
measure progress in reducing the percentage of overweight and obese children in the state,
and shall be used to accurately target intervention and prevention services throughout the
state. To the extent necessary for implementation and analysis, the Department of Health
may share data collected under this program with the Department of Education, consistent
with the requirements in chapter 13. Beginning January 15, 2011, analysis of the data
collected and trends of children who are overweight and obese shall be reported annually
to the legislature by the commissioner of health according to section 3.195.
new text end

Sec. 5. new text beginAPPROPRIATION.
new text end

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

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

new text begin (c) Of this appropriation, $....... is for the statewide public health media campaign
under Minnesota Statutes, section 145.986, subdivision 4.
new text end

ARTICLE 2

HEALTH CARE HOMES

Section 1.

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

new text begin Subdivision 1. new text end

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

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

new text begin Subd. 2. new text end

new text begin Initial health assessment. new text end

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

new text begin Subd. 3. new text end

new text begin Education and outreach. new text end

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

new text begin Subd. 4. new text end

new text begin State health care program. new text end

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

Sec. 2.

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

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

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

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

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

new text begin Subd. 2. new text end

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

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

new text begin Subd. 3. new text end

new text begin Certification. new text end

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

Sec. 3.

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

new text begin Subdivision 1. new text end

new text begin Requirement. new text end

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

new text begin Subd. 2. new text end

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

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

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

new text begin Subd. 3. new text end

new text begin Care coordination. new text end

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

new text begin Subd. 4. new text end

new text begin Care delivery. new text end

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

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

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

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

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

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

new text begin Subd. 5. new text end

new text begin Quality of care. new text end

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

new text begin Subd. 6. new text end

new text begin Comprehensive health assessment. new text end

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

new text begin Subd. 7. new text end

new text begin Care coordinators. new text end

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

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

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

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

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

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

Sec. 4.

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

new text begin Subdivision 1. new text end

new text begin Care coordination fee. new text end

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

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

new text begin Subd. 2. new text end

new text begin Amount of fee. new text end

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

new text begin Subd. 3. new text end

new text begin Cost neutrality. new text end

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

Sec. 5.

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

new text begin Subdivision 1. new text end

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

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

new text begin (2) develop care complexity thresholds and payment amounts for the care
coordination fee established under section 256B.0753;
new text end

new text begin (3) identify criteria to determine enrollees eligible for and in need of care
coordination, and who would benefit from having a comprehensive care plan for the
enrollee's condition;
new text end

new text begin (4) establish criteria and data collection procedures for evaluating health care
homes; and
new text end

new text begin (5) develop health care home requirements for managed care plan contracts,
performance incentives, and withholds, and shall develop the methodology for identifying
and recapturing managed care savings resulting from implementation of the health care
home model.
new text end

new text begin Subd. 2. new text end

new text begin Monitoring and evaluation. new text end

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

new text begin Subd. 3. new text end

new text begin Care Coordination Advisory Committee. new text end

new text begin By July 1, 2008, the
commissioners shall establish a Care Coordination Advisory Committee to assist the
Departments of Human Services and Health in administering the health care home model,
developing the criteria and standards required under subdivision 1, collecting data,
and measuring and evaluating health outcomes and cost savings. The commissioners
may satisfy this requirement by continuing the advisory committee established for the
provider-directed care coordination program. If newly established, the committee must
include representatives of: primary care and specialist physicians, advanced practice
registered nurses, patients and their families, health plans, the Institute for Clinical
Systems Improvement, Minnesota Community Measurement, and other relevant entities.
new text end

new text begin Subd. 4. new text end

new text begin Health care home collaborative. new text end

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

new text begin Subd. 5. new text end

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

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

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

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

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

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

new text begin Subd. 6. new text end

new text begin Annual reports. new text end

new text begin Beginning December 15, 2009, and each December 15
thereafter, the commissioners shall report to the legislature according to section 3.195 on
the implementation and administration of the health care home model for state health care
program enrollees in both the fee-for-service and managed care sectors. The report must
include information on the number of state health care program enrollees in health care
homes, the number and characteristics of enrollees with complex or chronic conditions,
the number and geographic distribution of health care home providers, the performance
and quality of care of health care homes, measures of preventive care, costs related
to implementation and payment of care coordination fees, health care home payment
arrangements for managed care plans, and estimates of savings from implementation of
the health care home model for both the fee-for-service and managed care sectors relative
to the health care spending baseline calculated under section 62U.13.
new text end

Sec. 6.

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


new text begin Subd. 29. new text end

new text begin Health care home model. new text end

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

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

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

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

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

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

Sec. 7.

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

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

new text begin (b) The commissioner, in collaboration with the Office of Rural Health, shall
determine areas of the state in need of primary care physicians. By September 1 of each
year, beginning September 1, 2008, the commissioner shall accept applications from
primary care physicians who agree to practice in a designated area for a period not less
than five years. The commissioner shall determine participant eligibility based on their
suitability for practice serving a designated geographic area.
new text end

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

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

Sec. 8. new text beginAPPROPRIATION; PRIMARY CARE EDUCATION INITIATIVES.
new text end

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

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

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

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

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

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

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

ARTICLE 3

INCREASING ACCESS; CONTINUITY OF CARE

Section 1.

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


new text begin Subd. 27. new text end

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

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 2.

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


Subd. 5.

Incentive program.

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

Sec. 3.

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


Subd. 6.

School districts.

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

(b) For each child who is determined to be eligible for deleted text beginadeleted text end new text beginthe new text endfree deleted text beginordeleted text end new text beginand new text endreduced
deleted text begin priceddeleted text end new text beginschool new text endlunchnew text begin programnew text end, the district shall provide the child's family with deleted text beginan
application for the Minnesota health care programs and
deleted text end information on how to obtain new text beginan
application for the Minnesota health care programs and
new text endapplication assistance.

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

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

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

Sec. 4.

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


Subd. 10.

Eligibility verification.

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

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 5.

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


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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

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


new text begin Subd. 7a. new text end

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 7.

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


Subd. 3.

Inpatient hospital services.

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 8.

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


Subd. 5.

Co-payments and coinsurance.

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

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

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

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

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

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

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 9.

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


Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than deleted text begin275deleted text endnew text begin 300new text end percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 10.

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


Subd. 7.

Single adults and households with no children.

The definition of eligible
persons includes all individuals and households with no children who have gross family
incomes that are equal to or less than 200 percent of the federal poverty guidelines.
Effective deleted text beginJulydeleted text endnew text begin Januarynew text end 1, 2009, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than deleted text begin215deleted text endnew text begin 300new text end percent of the federal poverty guidelines.

new text begin EFFECTIVE DATE. new text end

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

Sec. 11.

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


Subd. 3a.

Renewal of eligibility.

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 12.

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


new text begin Subd. 6. new text end

new text begin Delayed verification. new text end

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 13.

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


Subd. 3.

Commissioner's duties and payment.

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

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


Subdivision 1.

General requirements.

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

Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above deleted text begin275deleted text endnew text begin 300new text end percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7,
whose income increases above 200 percent of the federal poverty guidelines or deleted text begin215deleted text endnew text begin 300new text end
percent of the federal poverty guidelines on or after deleted text beginJulydeleted text endnew text begin Januarynew text end 1, 2009, are no longer
eligible for the program and shall be disenrolled by the commissioner. For persons
disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of
the calendar month following the month in which the commissioner determines that the
income of a family or individual exceeds program income limits.

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 15.

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


Subd. 3.

Other health coverage.

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

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

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

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

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

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 16.

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


Subd. 2.

Sliding fee scale; monthly gross individual or family income.

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

(b) new text beginChildren in new text endfamilies whose gross income is above deleted text begin275deleted text endnew text begin 300new text end percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 17.

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


new text begin Subd. 5. new text end

new text begin First month premium exemption. new text end

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

new text begin EFFECTIVE DATE. new text end

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 19. new text beginAPPROPRIATION.
new text end

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

ARTICLE 4

HEALTH INSURANCE PURCHASING AND AFFORDABILITY REFORM

Section 1.

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


Subd. 2.

General.

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

(1) according to section 13.05;

(2) according to court order;

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

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

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

(6) to administer federal funds or programs;

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

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

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

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

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

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

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

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

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

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

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

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

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

(i) the participant:

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

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

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

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

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

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

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

(i) the member:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 2.

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

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

Sec. 3.

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


Subd. 3.

Premium rate restrictions.

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

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

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

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

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

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

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

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

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

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

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

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

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

(h) The rates must not be approved, unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the commissioner shall consider the
growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar
year or years that the proposed premium rate would be in effect, actuarially valid changes
in risks associated with the enrollee populations, and actuarially valid changes as a result
of statutory changes in Laws 1992, chapter 549.

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

Sec. 4.

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


62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.

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

Sec. 5.

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


new text begin Subd. 5. new text end

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

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

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

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

Sec. 6.

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

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

new text begin Subd. 2. new text end

new text begin Requirements for electronic prescribing. new text end

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

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

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

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

new text begin Subd. 3. new text end

new text begin Standards for electronic prescribing. new text end

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 7.

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


Subdivision 1.

Required disclosure of estimated deleted text beginpaymentdeleted text endnew text begin out-of-pocket costsnew text end.

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 8.

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


Subdivision 1.

Required information.

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

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

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

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 9.

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


Subd. 2.

Exceptions.

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

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

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

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

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

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

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

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

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

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

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

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

Sec. 10.

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


Subd. 4.

Employer prohibition.

A small employer new text beginoffering a health benefit plan
new text endshall not encourage or direct an employee or applicant to:

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

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

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

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

Sec. 11.

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


Subdivision 1.

Contract disclosure.

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

(1) all attachments and exhibits;

(2) operating manuals;

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

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

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

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

Sec. 12.

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

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

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

new text begin Subd. 2. new text end

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

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

new text begin Subd. 3. new text end

new text begin Clinically effective. new text end

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

new text begin Subd. 4. new text end

new text begin Commission. new text end

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

new text begin Subd. 5. new text end

new text begin Cost effective. new text end

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

new text begin Subd. 6. new text end

new text begin Exchange. new text end

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

new text begin Subd. 7. new text end

new text begin Group purchaser. new text end

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

new text begin Subd. 8. new text end

new text begin Health plan. new text end

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

new text begin Subd. 9. new text end

new text begin Health plan company. new text end

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

new text begin Subd. 10. new text end

new text begin Health technology. new text end

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

new text begin Subd. 11. new text end

new text begin Participating provider. new text end

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

new text begin Subd. 12. new text end

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

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

new text begin Subd. 13. new text end

new text begin Section 125 Plan. new text end

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

new text begin Subd. 14. new text end

new text begin Service agreement. new text end

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

new text begin Subd. 15. new text end

new text begin Third-party administrators. new text end

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

Sec. 13.

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

new text begin Subdivision 1. new text end

new text begin Title; citation. new text end

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

new text begin Subd. 2. new text end

new text begin Creation; tax exemption. new text end

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

new text begin Subd. 3. new text end

new text begin Definitions. new text end

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

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

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

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

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

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

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

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

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

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

new text begin Subd. 4. new text end

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

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

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

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

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

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

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

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

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

new text begin Subd. 5. new text end

new text begin Listing of health plans. new text end

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

new text begin Subd. 6. new text end

new text begin Individual participation and eligibility. new text end

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

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

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

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

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

new text begin Subd. 7. new text end

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

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

new text begin Subd. 8. new text end

new text begin Responsibilities of the exchange. new text end

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

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

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

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

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

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

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

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

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

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

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

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

new text begin Subd. 9. new text end

new text begin State not liable. new text end

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

new text begin Subd. 10. new text end

new text begin Powers of the exchange. new text end

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

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

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

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

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

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

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

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

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

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

new text begin Subd. 11. new text end

new text begin Dispute resolution. new text end

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

new text begin Subd. 12. new text end

new text begin Governance. new text end

new text begin The exchange shall be governed by a board of directors
with 11 members. The board shall convene on or before July 1, 2008, after the initial board
members have been selected. The initial board membership consists of the following:
new text end

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

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

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

new text begin (4) eight members with knowledge and experience related to health insurance
and health insurance markets, appointed to serve three-year terms as follows: two
members appointed by the Subcommittee on Committees of the Committee on Rules and
Administration of the senate; two members appointed by the house of representatives; and
four members appointed by the governor.
new text end

new text begin Subd. 13. new text end

new text begin Subsequent board membership. new text end

new text begin (a) Ongoing membership of the
exchange consists of the following effective July 1, 2011:
new text end

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

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

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

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

new text begin (5) four members elected by the membership of the exchange of which two are
elected to serve a two-year term and two are elected to serve a three-year term.
new text end

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

new text begin Subd. 14. new text end

new text begin Operations of the board. new text end

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

new text begin Subd. 15. new text end

new text begin Operations of the exchange. new text end

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

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

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

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

new text begin Subd. 16. new text end

new text begin Insurance producers. new text end

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

new text begin Subd. 17. new text end

new text begin Implementation. new text end

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

new text begin Subd. 18. new text end

new text begin Exemption from administrative procedures. new text end

new text begin To carry out the purposes
of this section, the board may adopt rules under chapter 14. The board is exempt from
rulemaking requirements to the extent rules are necessary for the operation of the
exchange. The board may use the provisions of section 14.386, paragraph (a), clauses (1)
and (3). Section 14.386, paragraph (b), does not apply to these rules.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 14.

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

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

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

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

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

new text begin Subd. 2. new text end

new text begin Section 125 Plan requirement. new text end

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

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

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

new text begin Subd. 3. new text end

new text begin Tracking compliance. new text end

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

new text begin Subd. 4. new text end

new text begin Employer requirements. new text end

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

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

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

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

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

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

new text begin Subd. 5. new text end

new text begin Health plan company requirements. new text end

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

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

Sec. 15.

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

new text begin Subdivision 1. new text end

new text begin Creation. new text end

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

new text begin Subd. 2. new text end

new text begin Members. new text end

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

new text begin (1) three members appointed by the Subcommittee on Committees of the Committee
on Rules and Administration of the senate, one of which shall be a legislator;
new text end

new text begin (2) three members appointed by the house of representatives, one of which shall
be a legislator; and
new text end

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

new text begin (b) The appointed members who are not legislators or commissioners must:
new text end

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

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

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

new text begin (c) If a member is no longer able or eligible to perform the required duties, a new
member shall be appointed by the entity that appointed the outgoing member.
new text end

new text begin Subd. 3. new text end

new text begin Operations of the commission. new text end

new text begin (a) The commission shall convene on or
before July 1, 2008, following the initial appointment of the members. The commission
members may convene prior to confirmation by the senate.
new text end

new text begin (b) The commission shall elect a chair among its members.
new text end

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

new text begin Subd. 4. new text end

new text begin Immunity of liability. new text end

new text begin No member of the commission shall be held civilly
liable for an act or omission by that member if the act or omission was in good faith and
within the scope of the member's responsibilities under this chapter.
new text end

new text begin Subd. 5. new text end

new text begin Responsibilities of the commission. new text end

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

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

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

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

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

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

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

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

new text begin Subd. 6. new text end

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

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

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

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

new text begin Subd. 7. new text end

new text begin Reports. new text end

new text begin Beginning January 15, 2010, the commission shall submit an
annual report to the governor and legislature according to section 3.195 on the following:
new text end

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

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

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

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

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

new text begin Subd. 8. new text end

new text begin Sunset. new text end

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

Sec. 16.

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

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Transformation Commission shall solicit
proposals from organizations and collaborations of organizations such as the Minnesota
Community Measurement and Stratis Health to serve as the Health Care Value Reporting
Organization.
new text end

new text begin Subd. 2. new text end

new text begin Duties. new text end

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

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

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

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

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

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

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

Sec. 17.

new text begin [62U.06] STANDARD BENEFIT SET AND DESIGN.
new text end

new text begin Subdivision 1. new text end

new text begin Creation. new text end

new text begin The Health Care Transformation Commission shall
convene a health benefit and design advisory committee to make recommendations to the
commission on a standard benefit set and design. The advisory committee shall consist
of seven members. The members shall be appointed by the commission and must have
expertise in benefit design and development, actuarial analysis, or knowledge relating to
the analysis of the cost impact of coverage of specified benefits.
new text end

new text begin Subd. 2. new text end

new text begin Operations of the committee. new text end

new text begin (a) The advisory committee shall convene
on or before September 1, 2008, upon the appointment of the initial committee and must
meet at least once a year, and at other times as necessary.
new text end

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

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

new text begin Subd. 3. new text end

new text begin Immunity of liability. new text end

new text begin No member of the committee shall be held civilly
liable for an act or omission by that member if the act or omission was in good faith and
within the scope of the member's responsibilities under this chapter.
new text end

new text begin Subd. 4. new text end

new text begin Duties of the committee. new text end

new text begin (a) By January 1, 2009, the committee shall
develop and submit to the commission an initial cost-effective benefit set and design that
provides individuals access to a broad range of health care services, including preventive
health care, without incurring severe financial loss as a result of serious illness or injury.
The benefit set must include necessary evidence-based health care services, procedures,
and diagnostic tests that are scientifically proven to be both clinically effective and cost
effective. In establishing the initial benefit set, the committee may contract with the
Institute for Clinical Systems Improvement (ICSI) to assemble existing scientifically
based practice standards. The committee shall consider cultural, ethnic, and religious
values and beliefs to ensure that the health care needs of all Minnesota residents will
be addressed in the benefit set.
new text end

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

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

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

new text begin Subd. 5. new text end

new text begin Continued review. new text end

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

Sec. 18.

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

new text begin Subdivision 1. new text end

new text begin Technology Advisory Committee. new text end

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

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

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

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

new text begin (c) No member of the advisory committee shall have a substantial financial interest
in a health technology company or be employed by or under contract with a health
technology manufacturer during their term or for 18 months before their appointment.
new text end

new text begin (d) The members shall be immune from civil liability for any official acts performed
in good faith as members of the committee.
new text end

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

new text begin Subd. 2. new text end

new text begin Technology selection process. new text end

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

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

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

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

new text begin Subd. 3. new text end

new text begin Technology review. new text end

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

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

new text begin Subd. 4. new text end

new text begin Committee determination. new text end

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

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

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

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

Sec. 19.

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

new text begin Subdivision 1. new text end

new text begin Development. new text end

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

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

new text begin Subd. 2. new text end

new text begin Payment system criteria. new text end

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

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

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

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

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

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

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

new text begin Subd. 3. new text end

new text begin Implementation. new text end

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

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

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

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

Sec. 20.

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

new text begin Subdivision 1. new text end

new text begin Development. new text end

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

new text begin Subd. 2. new text end

new text begin Care coordination fee. new text end

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

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

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

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

new text begin Subd. 3. new text end

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

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

new text begin Subd. 4. new text end

new text begin Implementation. new text end

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

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

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

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

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

Sec. 21.

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

new text begin Subdivision 1. new text end

new text begin Development. new text end

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

new text begin Subd. 2. new text end

new text begin Encounter data. new text end

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

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

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

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

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

new text begin (c) The commission shall establish procedures and safeguards to protect the integrity
and confidentiality of any data that it maintains.
new text end

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

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

new text begin Subd. 3. new text end

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

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

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

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

new text begin Subd. 4. new text end

new text begin Total care bids. new text end

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

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

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

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

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

new text begin Subd. 5. new text end

new text begin Provider assistance. new text end

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

new text begin Subd. 6. new text end

new text begin Payments. new text end

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

new text begin Subd. 7. new text end

new text begin Implementation. new text end

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

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

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

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

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

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

Sec. 22.

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

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

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

Sec. 23.

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

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

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

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

Sec. 24.

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

new text begin Subdivision 1. new text end

new text begin Projected spending baseline. new text end

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

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

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

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

new text begin Subd. 2. new text end

new text begin Actual spending. new text end

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

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

new text begin Subd. 3. new text end

new text begin Publication of spending. new text end

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

new text begin Subd. 4. new text end

new text begin Savings reinvestment assessments. new text end

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

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

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

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

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

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

new text begin Subd. 5. new text end

new text begin Deposit of assessments. new text end

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

Sec. 25.

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

new text begin Subdivision 1. new text end

new text begin Cost containment goals. new text end

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

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

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

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

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

new text begin Subd. 2. new text end

new text begin Contingent expansion of MinnesotaCare. new text end

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

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

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

Sec. 26.

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

new text begin Subdivision 1. new text end

new text begin Definition of affordability. new text end

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

new text begin Subd. 2. new text end

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

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

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

new text begin Subd. 3. new text end

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

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

Sec. 27.

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

new text begin Subdivision 1. new text end

new text begin Establishment of subsidy program. new text end

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

new text begin Subd. 2. new text end

new text begin Eligible employees. new text end

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

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

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

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

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

new text begin Subd. 3. new text end

new text begin Amount of subsidy. new text end

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

new text begin Subd. 4. new text end

new text begin Payment of subsidy. new text end

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

new text begin EFFECTIVE DATE. new text end

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

Sec. 28.

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


new text begin Subd. 27. new text end

new text begin Exchange of data. new text end

new text begin An entity that is part of the welfare system as defined
in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance
Exchange under section 62U.02 may exchange private data about individuals without the
individual's consent in order to collect premiums from individuals in the MinnesotaCare
program under chapter 256L. This subdivision only applies if the entity that is part of
the welfare system and the Minnesota Health Insurance Exchange have entered into an
agreement that complies with the requirements in Code of Federal Regulations, title
45, section 164.314.
new text end

Sec. 29. new text beginAPPROPRIATION.
new text end

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

Sec. 30. new text begin REPEALER.
new text end

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

new text begin EFFECTIVE DATE. new text end

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