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Key: (1) language to be deleted (2) new language


                         Laws of Minnesota 1989 

                        CHAPTER 327-S.F.No. 491 
           An act relating to health care; creating a health care 
          access commission; requiring an implementation plan 
          for a health care access program; appropriating money; 
          proposing coding for new law as Minnesota Statutes, 
          chapter 62J. 
     Section 1.  [62J.01] [FINDINGS.] 
    The legislature finds that substantial numbers of 
Minnesotans have no health care coverage and that most of these 
residents are wage earners or their dependents.  One-third of 
these individuals are children. 
    The legislature further finds that when these individuals 
enter the health care system they have often foregone preventive 
care and are in need of more expensive treatment that often 
exceeds their financial resources.  Much of the cost for these 
uncompensated services to the uninsured are already in the 
health care system in the form of increased insurance and 
provider rates and property and income taxes. 
    The legislature further finds that these costs, spread 
among the already insured, represent a woefully inefficient 
method for providing basic preventive and acute care for the 
uninsured and represent an added cost to employers now providing 
health insurance to their employees. 
    The legislature further finds that it is necessary to 
ensure basic and affordable health care to all Minnesotans while 
addressing the economic pressures on the health care system as a 
whole in Minnesota. 
    Subdivision 1.  [MEMBERSHIP; COMPENSATION; CHAIR.] The 
Minnesota health care access commission consists of 15 members.  
Five members are appointed by the governor, one of whom must be 
an experienced health care professional, one of whom must be a 
representative of small business, and one of whom must be a 
representative of consumers.  Three members are appointed under 
the rules of the senate and three members are appointed under 
the rules of the house of representatives.  The commissioners of 
health, human services, employee relations, and commerce, or 
their designated representatives are also members.  The governor 
shall appoint the chair of the commission from among the members 
who are not agency commissioners.  The terms, compensation, and 
removal of the members appointed by the governor are as provided 
in section 15.0575. 
    Subd. 2.  [STAFF; OFFICE SPACE; EQUIPMENT.] The commission 
shall select a director to serve at its pleasure as the chief 
administrative officer of the commission.  The director may hire 
advisors, consultants, and employees, as authorized by the 
commission, and prescribe their duties.  Employees are not state 
employees, but are covered by section 3.736.  At the option of 
the commission, the employees may participate in the following 
plans for employees in the unclassified service:  the state 
retirement plan, the state deferred compensation plan, and the 
health insurance and life insurance plans.  The commissioner of 
state planning shall provide to the commission, at a reasonable 
cost, administrative assistance, office space, and access to 
office equipment and services.  
    Subd. 3.  [DUTIES.] The health care access commission, with 
the assistance of the commissioner of state planning, shall 
develop and recommend to the legislature a plan to provide 
access to health care for all state residents.  In developing 
the plan, the commission shall: 
    (1) develop a system to estimate the total number of 
uninsured Minnesotans by age, sex, employment status, income 
level, geography, and other relevant characteristics; 
    (2) explore all potential insurance options including size 
and makeup of risk groups; 
    (3) prepare a legal analysis of restrictions and other 
potential legal issues of the Employee Retirement Income 
Security Act, United States Code, title 29, sections 1001 to 
    (4) study and make recommendations on insurance and health 
care law changes that will improve access to health care; 
    (5) study and make recommendations on incentives and 
disincentives to ensure that employers continue to provide 
health insurance coverage; 
    (6) study and make recommendations regarding benefits to be 
covered by health plans that would be available through the 
health care access program, including preventive, well-child, 
and prenatal care; 
    (7) identify cost savings to public programs that would 
result from implementation of the health care access program; 
    (8) develop a cost containment policy after reviewing cost 
containment methods such as hospital admission precertification, 
concurrent review of hospital stays, discharge planning, 
hospital bill audit prior to discharge, primary gatekeepers, 
claims data analysis, a drug formulary, pharmacy data analysis, 
bulk discounts, emergency room use, outpatient surgery 
oversight, protocols for preventive care and common acute care, 
practice data compared to peers, practitioner rewards and 
penalties, and other cost containment methods; 
    (9) develop a system to administer the health care access 
program, including recommendations for eligibility criteria, 
enrollment procedures, and options for contracting with 
carriers, health plans, and providers, to ensure access to 
affordable health care in all geographic areas of the state; 
    (10) define the number, functions, and duties of 
administrative staff; 
    (11) study alternatives for financing the state share of 
the cost of the premiums in an amount sufficient to generate 
one-half of the total costs of the health care access program, 
but not more than $150,000,000 a year, including, but not 
limited to, an actuarial analysis, a sliding fee scale analysis, 
and reserve fund requirements; 
    (12) develop a system for collection of premium payments; 
    (13) examine and make recommendations on gatekeeping 
mechanisms for access to health care services, different benefit 
and service packages for the minimum core coverage plan, and 
dollar limitations for prescription drug costs; 
    (14) consider limits on provider reimbursement and covered 
services and make recommendations; 
    (15) examine the effect of different copayment levels on 
access to health care for persons with low incomes and provide 
recommendations based on this analysis; 
    (16) examine and make recommendations on maximum lifetime 
    (17) develop methods to ensure representation in service 
delivery by eligible practitioners, without regard to race, 
color, or sex; 
    (18) develop methods to coordinate the health care access 
program with other government-subsidized programs; and 
    (19) conduct other activities it considers necessary to 
carry out the intent of the legislature as expressed in section 
1 and this section. 
    Subd. 4.  [REPORT.] The commission shall report to the 
legislature by February 15, 1990, on its progress in developing 
the plan, including preliminary data analysis and other 
appropriate information.  The commission shall provide a final 
report and implementation plan to the legislature by January 1, 
    The nine-county demonstration project for the uninsured 
authorized in Minnesota Statutes, section 256B.73, shall report 
to the commission by January 1, 1990, on the number and 
percentage of enrollees in the project, benefits provided, and 
the financial commitment of enrollees and employers. 
    Sec. 4.  [REPEALER.] 
    Section 2 is repealed effective July 1, 1991.  
    Sec. 5.  [APPROPRIATION.] 
    Subdivision 1.  [HEALTH CARE ACCESS COMMISSION.] $800,000 
is appropriated from the general fund to the health care access 
commission for purposes of sections 1 and 2, to be available 
until June 30, 1991.  
    Subd. 2.  [COMMISSIONER OF HUMAN SERVICES.] (a) $50,000 is 
appropriated from the general fund to the commissioner of human 
services to provide one-time subsidies to community-based 
clinics, to be available until June 30, 1990.  The commissioner 
shall publish in the State Register a notice of the availability 
of clinic subsidies, a request for applications from clinics 
that desire a subsidy, a notice that a subsidy review committee 
will be convened to allocate the subsidies, and notice that each 
clinic that seeks representation on the committee must submit 
the name, address, and telephone number of its designated 
representative.  Applications from clinics that desire a subsidy 
must include detailed information about the financial condition 
of the clinic, the amounts and sources of financial support 
received by the clinic, and the proportion of patients who are 
uninsured and for whom the clinic does not receive any 
payments.  The commissioner shall convene a committee consisting 
of a representative of each community-based clinic meeting the 
definition in this paragraph that asks to be represented on the 
committee.  Committee members do not receive compensation but 
may be reimbursed out of the appropriation in this subdivision 
for reasonable travel expenses incurred to attend committee 
meetings.  The committee shall determine the recipients and 
amounts of the subsidies.  Subsidies must be awarded to those 
clinics with the greatest financial need due to the number of 
uninsured patients, the inadequacy of grant support and 
charitable contributions, and other factors.  The committee 
shall consider the extent to which the subsidy would enable the 
clinic to continue effectively serving the uninsured.  The 
commissioner must award the subsidies according to the 
recommendations of the committee.  For purposes of this 
paragraph, "community-based clinics" means an entity that: 
    (1) through its staff and supporting resources or through 
its contracts or cooperative arrangements with other public or 
private entities, provides primary health services for all 
intended residents of its service area; 
    (2) was established to serve the primary health needs of 
low-income population groups; 
    (3) uses a sliding fee scale based on ability to pay, and 
does not limit access or care because of the financial 
limitations of the client; 
    (4) has nonprofit status under Minnesota Statutes, chapter 
317; and 
    (5) has a governing board, for which at least 51 percent of 
the membership resides in the local community served by the 
    (b) $175,000 for the fiscal year ending June 30, 1990, and 
$200,000 for the fiscal year ending June 30, 1991, are 
appropriated from the general fund to the commissioner of human 
services to provide a 20 percent increase in medical assistance 
and children's health plan payments for covered services 
provided by clinics enrolled as public health clinics or 
community health clinics under Minnesota Rules, Parts 9505.0380 
and 9505.0255. 
    Presented to the governor May 30, 1989 
    Signed by the governor June 1, 1989, 10:57 p.m.

Official Publication of the State of Minnesota
Revisor of Statutes