Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 1997, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 225-S.F.No. 1208
An act relating to health; modifying the MinnesotaCare
program; modifying general assistance medical care
provisions; modifying loss ratio provisions for health
care policies; modifying Medicare supplement plan
provisions; modifying the regional coordinating
boards; modifying the health technology advisory
committee; eliminating the health care commission;
modifying mandatory Medicare assignment; modifying
MinnesotaCare tax provisions; regulating community
purchasing arrangements; modifying disclosure
provisions; eliminating integrated service networks;
modifying community integrated service network
provisions; modifying provisions of the public
programs risk adjustment work group; modifying
essential community provider provisions; modifying
requirements for health plan companies; modifying
provisions of the rural physician education account;
modifying rural hospital provisions; modifying medical
assistance provisions; establishing a senior citizen
drug proram; modifying Minnesota comprehensive health
association provisions; requiring studies; making
technical changes; appropriating money; providing
criminal penalties; amending Minnesota Statutes 1996,
sections 60A.15, subdivision 1; 60A.951, subdivision
5; 62A.021, subdivision 1, and by adding a
subdivision; 62A.316; 62A.61; 62D.02, subdivision 5;
62D.09, subdivision 3; 62E.02, subdivisions 13 and 18;
62E.11, subdivision 5; 62E.13, subdivision 2; 62J.017;
62J.06; 62J.07, subdivisions 1 and 3; 62J.09,
subdivision 1; 62J.15, subdivision 1; 62J.152,
subdivisions 1, 2, 4, 5, and by adding subdivisions;
62J.17, subdivision 6a; 62J.22; 62J.25; 62J.2914,
subdivision 1; 62J.2915; 62J.2916, subdivision 1;
62J.2917, subdivision 2; 62J.2921, subdivision 2;
62J.451, subdivision 6b; 62M.02, subdivision 21;
62N.01, subdivision 1; 62N.22; 62N.23; 62N.25,
subdivision 5; 62N.26; 62N.40; 62Q.01, subdivisions 3,
4, and 5; 62Q.03, subdivision 5a; 62Q.106; 62Q.19,
subdivision 1; 62Q.33, subdivision 2; 62Q.45,
subdivision 2; 136A.1355; 144.147, subdivisions 1, 2,
3, and 4; 144.1484, subdivision 1; 256.01, subdivision
2; 256.045, subdivision 3a; 256.9352, subdivision 3;
256.9353, subdivisions 1, 3, and 7; 256.9354,
subdivisions 4, 5, 6, 7, and by adding a subdivision;
256.9355, subdivisions 1, 4, and by adding a
subdivision; 256.9357, subdivision 3; 256.9358,
subdivision 4; 256.9359, subdivision 2; 256.9362,
subdivision 6; 256.9363, subdivisions 1 and 5;
256.9657, subdivision 3; 256B.056, subdivision 8;
256B.0625, subdivisions 13 and 15; 256B.0911,
subdivision 2, as amended; 256B.0913, subdivision 16,
as added; 256D.03, subdivisions 3 and 3b; 295.50,
subdivisions 3, 4, 6, 7, 13, and 14; 295.51,
subdivision 1; 295.52, subdivision 4, and by adding
subdivisions; 295.53, subdivisions 1, 3, 4, and by
adding a subdivision; 295.54, subdivisions 1 and 2;
295.55, subdivision 2; 295.582; S. F. No. 1908,
article 1, sections 2; 3, subdivision 2; article 4,
sections 70 and 73; and article 9, section 24;
proposing coding for new law in Minnesota Statutes,
chapters 16A; 62Q; 144; and 256; proposing coding for
new law as Minnesota Statutes, chapter 62T; repealing
Minnesota Statutes 1996, sections 62E.11, subdivision
12; 62J.03, subdivision 3; 62J.04, subdivisions 4 and
7; 62J.05; 62J.051; 62J.09, subdivision 3a; 62J.37;
62N.01, subdivision 2; 62N.02, subdivisions 2, 3, 4b,
4c, 6, 7, 8, 9, 10, and 12; 62N.03; 62N.04; 62N.05;
62N.06; 62N.065; 62N.071; 62N.072; 62N.073; 62N.074;
62N.076; 62N.077; 62N.078; 62N.10; 62N.11; 62N.12;
62N.13; 62N.14; 62N.15; 62N.17; 62N.18; 62N.24;
62N.38; 62Q.165, subdivision 3; 62Q.25; 62Q.29;
62Q.41; 147.01, subdivision 6; 295.52, subdivision 1b;
and 295.53, subdivision 5; Laws 1993, chapter 247,
article 4, section 8; Laws 1994, chapter 625, article
5, section 5, as amended; Laws 1995, chapter 96,
section 2; Laws 1995, First Special Session chapter 3,
article 13, section 2; Laws 1997, chapters 31, article
4; and 84, article 4.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
MINNESOTACARE PROGRAM/GAMC
Section 1. Minnesota Statutes 1996, section 256.9353,
subdivision 1, is amended to read:
Subdivision 1. [COVERED HEALTH SERVICES.] "Covered health
services" means the health services reimbursed under chapter
256B, with the exception of inpatient hospital services, special
education services, private duty nursing services, adult dental
care services other than preventive services, orthodontic
services, nonemergency medical transportation services, personal
care assistant and case management services, nursing home or
intermediate care facilities services, inpatient mental health
services, and chemical dependency services. Effective July 1,
1998, adult dental care for nonpreventive services with the
exception of orthodontic services is available to persons who
qualify under section 256.9354, subdivisions 1 to 5, or
256.9366, with family gross income equal to or less than 175
percent of the federal poverty guidelines. Outpatient mental
health services covered under the MinnesotaCare program are
limited to diagnostic assessments, psychological testing,
explanation of findings, medication management by a physician,
day treatment, partial hospitalization, and individual, family,
and group psychotherapy.
No public funds shall be used for coverage of abortion
under MinnesotaCare except where the life of the female would be
endangered or substantial and irreversible impairment of a major
bodily function would result if the fetus were carried to term;
or where the pregnancy is the result of rape or incest.
Covered health services shall be expanded as provided in
this section.
Sec. 2. Minnesota Statutes 1996, section 256.9353,
subdivision 3, is amended to read:
Subd. 3. [INPATIENT HOSPITAL SERVICES.] (a) Beginning July
1, 1993, 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. Prior to July 1, 1997,
the inpatient hospital benefit for adult enrollees is subject to
an annual benefit limit of $10,000. Effective July 1, 1997, the
inpatient hospital benefit for adult enrollees who qualify under
section 256.9354, subdivision 5, or who qualify under section
256.9354, subdivisions 1 to 4a, or section 256.9366 with family
gross income that exceeds 175 percent of the federal poverty
guidelines and who are not pregnant, is subject to an annual
limit of $10,000.
(b) Enrollees who qualify under section 256.9354,
subdivision 5, or who qualify under section 256.9354,
subdivisions 1 to 4a, or section 256.9366 with family gross
income that exceeds 175 percent of the federal poverty
guidelines and who are not pregnant, and are determined by the
commissioner to have a basis of eligibility for medical
assistance shall apply for and cooperate with the requirements
of medical assistance by the last day of the third month
following admission to an inpatient hospital. If an enrollee
fails to apply for medical assistance within this time period,
the enrollee and the enrollee's family shall be disenrolled from
the plan and they may not reenroll until 12 calendar months have
elapsed. Enrollees and enrollees' families disenrolled for not
applying for or not cooperating with medical assistance may not
reenroll.
(c) Admissions for inpatient hospital services paid for
under section 256.9362, 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 256.9362, 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.
(d) Any enrollee or family member of an enrollee who has
previously been permanently disenrolled from MinnesotaCare for
not applying for and cooperating with medical assistance shall
be eligible to reenroll if 12 calendar months have elapsed since
the date of disenrollment.
Sec. 3. Minnesota Statutes 1996, section 256.9353,
subdivision 7, is amended to read:
Subd. 7. [COPAYMENTS AND COINSURANCE.] The MinnesotaCare
benefit plan shall include the following copayments and
coinsurance requirements:
(1) ten percent of the paid charges submitted for inpatient
hospital services for adult enrollees not eligible for medical
assistance, 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; and
(3) $25 for eyeglasses for adult enrollees; and
(4) effective July 1, 1998, 50 percent of the
fee-for-service rate for adult dental care services other than
preventive care services for persons eligible under section
256.9354, subdivisions 1 to 5, or 256.9366, with income equal to
or less than 175 percent of the federal poverty guidelines.
Prior to July 1, 1997, enrollees who are not eligible for
medical assistance with or without a spenddown shall be
financially responsible for the coinsurance amount and amounts
which exceed the $10,000 benefit limit. MinnesotaCare shall be
financially responsible for the spenddown amount up to the
$10,000 benefit limit for enrollees who are eligible for medical
assistance with a spenddown; enrollees who are eligible for
medical assistance with a spenddown are financially responsible
for amounts which exceed the $10,000 benefit limit. Effective
July 1, 1997, adult enrollees who qualify under section
256.9354, subdivision 5, or who qualify under section 256.9354,
subdivisions 1 to 4a, or section 256.9366 with family gross
income that exceeds 175 percent of the federal poverty
guidelines and who are not pregnant, and who are not eligible
for medical assistance with or without a spenddown, shall be
financially responsible for the coinsurance amount and amounts
which exceed the $10,000 inpatient hospital benefit limit.
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
$10,000 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.
Sec. 4. Minnesota Statutes 1996, section 256.9354,
subdivision 4, is amended to read:
Subd. 4. [FAMILIES WITH CHILDREN; ELIGIBILITY BASED ON
PERCENTAGE OF INCOME PAID FOR HEALTH COVERAGE.] Beginning
January 1, 1993, "eligible persons" means children, parents, and
dependent siblings residing in the same household who are not
eligible for medical assistance without a spenddown under
chapter 256B. Children who meet the criteria in subdivision 1
or 4a shall continue to be enrolled pursuant to those
subdivisions. Persons who are eligible under this subdivision
or subdivision 2, 3, or 5 must pay a premium as determined under
sections 256.9357 and 256.9358, and children eligible under
subdivision 1 must pay the premium required under section
256.9356, subdivision 1. Individuals and families whose income
is greater than the limits established under section 256.9358
may not enroll in MinnesotaCare.
Sec. 5. Minnesota Statutes 1996, section 256.9354,
subdivision 5, is amended to read:
Subd. 5. [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO
CHILDREN.] (a) Beginning October 1, 1994, the definition of
"eligible persons" is expanded to include all individuals and
households with no children who have gross family incomes that
are equal to or less than 125 percent of the federal poverty
guidelines and who are not eligible for medical assistance
without a spenddown under chapter 256B.
(b) After October 1, 1995, the commissioner of human
services may expand the definition of "eligible persons" to
include all individuals and households with no children who have
gross family incomes that are equal to or less than 135 percent
of federal poverty guidelines and are not eligible for medical
assistance without a spenddown under chapter 256B. This
expansion may occur only if the financial management
requirements of section 256.9352, subdivision 3, can be met.
(c) The commissioners of health and human services, in
consultation with the legislative commission on health care
access, shall make preliminary recommendations to the
legislature by October 1, 1995, and final recommendations to the
legislature by February 1, 1996, on whether a further expansion
of the definition of "eligible persons" to include all
individuals and households with no children who have gross
family incomes that are equal to or less than 150 percent of
federal poverty guidelines and are not eligible for medical
assistance without a spenddown under chapter 256B would be
allowed under the financial management constraints outlined in
section 256.9352, subdivision 3.
(d) (b) Beginning July 1, 1997, the definition of eligible
persons is expanded to include all individuals and households
with no children who have gross family incomes that are equal to
or less than 175 percent of the federal poverty guidelines and
who are not eligible for medical assistance without a spenddown
under chapter 256B.
(c) All eligible persons under paragraphs (a) and (b) are
eligible for coverage through the MinnesotaCare program but must
pay a premium as determined under sections 256.9357 and
256.9358. Individuals and families whose income is greater than
the limits established under section 256.9358 may not enroll in
the MinnesotaCare program.
Sec. 6. Minnesota Statutes 1996, section 256.9354,
subdivision 6, is amended to read:
Subd. 6. [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL
ASSISTANCE.] Individuals who apply for MinnesotaCare who qualify
under section 256.9354, subdivision 5, but who are potentially
eligible for medical assistance without a spenddown shall be
allowed to enroll in MinnesotaCare for a period of 60 days, so
long as the applicant meets all other conditions of
eligibility. The commissioner shall identify and refer such
individuals to their county social service agency. The enrollee
must cooperate with the county social service agency in
determining medical assistance eligibility within the 60-day
enrollment period. Enrollees who do not apply for and cooperate
with medical assistance within the 60-day enrollment period, and
their other family members, shall be disenrolled from the plan
within one calendar month. Persons disenrolled for
nonapplication for medical assistance may not reenroll until
they have obtained a medical assistance eligibility
determination for the family member or members who were referred
to the county agency. Persons disenrolled for noncooperation
with medical assistance may not reenroll until they have
cooperated with the county agency and have obtained a medical
assistance eligibility determination. The commissioner shall
redetermine provider payments made under MinnesotaCare to the
appropriate medical assistance payments for those enrollees who
subsequently become eligible for medical assistance.
Sec. 7. Minnesota Statutes 1996, section 256.9354,
subdivision 7, is amended to read:
Subd. 7. [GENERAL ASSISTANCE MEDICAL CARE.] A person
cannot have coverage under both MinnesotaCare and general
assistance medical care in the same month, except that a
MinnesotaCare enrollee may be eligible for retroactive general
assistance medical care according to section 256D.03,
subdivision 3, paragraph (b).
Sec. 8. Minnesota Statutes 1996, section 256.9354, is
amended by adding a subdivision to read:
Subd. 9. [MINNESOTACARE OUTREACH.] (a) The commissioner
shall award grants to public or private organizations to provide
information on the importance of maintaining insurance coverage
and on how to obtain coverage through the MinnesotaCare program
in areas of the state with high uninsured populations.
(b) In awarding the grants, the commissioner shall consider
the following:
(1) geographic areas and populations with high uninsured
rates;
(2) the ability to raise matching funds; and
(3) the ability to contact or serve eligible populations.
The commissioner shall monitor the grants and may terminate
a grant if the outreach effort does not increase the
MinnesotaCare program enrollment.
Sec. 9. Minnesota Statutes 1996, section 256.9355,
subdivision 1, is amended to read:
Subdivision 1. [APPLICATION AND INFORMATION AVAILABILITY.]
Applications and other information must be made available to
provider offices, local human services agencies, school
districts, public and private elementary schools in which 25
percent or more of the students receive free or reduced price
lunches, community health offices, and Women, Infants and
Children (WIC) program sites. These sites may accept
applications, collect the enrollment fee or initial premium fee,
and forward the forms and fees to the commissioner. Otherwise,
applicants may apply directly to the commissioner. Beginning
January 1, 2000, MinnesotaCare enrollment sites will be expanded
to include local county human services agencies which choose to
participate.
Sec. 10. Minnesota Statutes 1996, section 256.9355,
subdivision 4, is amended to read:
Subd. 4. [APPLICATION PROCESSING.] The commissioner of
human services shall determine an applicant's eligibility for
MinnesotaCare no more than 30 days from the date that the
application is received by the department of human services.
This requirement shall be suspended for four months following
the dates in which single adults and families without children
become eligible for the program. Beginning July 1, 2000, this
requirement also applies to local county human services agencies
that determine eligibility for MinnesotaCare.
Sec. 11. Minnesota Statutes 1996, section 256.9355, is
amended by adding a subdivision to read:
Subd. 5. [AVAILABILITY OF PRIVATE INSURANCE.] The
commissioner, in consultation with the commissioners of health
and commerce, shall provide information regarding the
availability of private health insurance coverage to all
families and individuals enrolled in the MinnesotaCare program
whose gross family income is equal to or more than 200 percent
of the federal poverty guidelines. This information must be
provided upon initial enrollment and annually thereafter.
Sec. 12. Minnesota Statutes 1996, section 256.9357,
subdivision 3, is amended to read:
Subd. 3. [PERIOD UNINSURED.] To be eligible for subsidized
premium payments based on a sliding scale, families and
individuals initially enrolled in the MinnesotaCare program
under section 256.9354, subdivisions 4 and 5, must have had no
health coverage for at least four months prior to application.
The commissioner may change this eligibility criterion for
sliding scale premiums without complying with rulemaking
requirements in order to remain within the limits of available
appropriations. The requirement of at least four months of no
health coverage prior to application for the MinnesotaCare
program does not apply to:
(1) families, children, and individuals who want to apply
for the MinnesotaCare program upon termination from or as
required by the medical assistance program, general assistance
medical care program, or coverage under a regional demonstration
project for the uninsured funded under section 256B.73, the
Hennepin county assured care program, or the Group Health, Inc.,
community health plan;
(2) families and individuals initially enrolled under
section 256.9354, subdivisions 1, paragraph (a), and 2;
(3) children enrolled pursuant to Laws 1992, chapter 549,
article 4, section 17; or
(4) individuals currently serving or who have served in the
military reserves, and dependents of these individuals, if these
individuals: (i) reapply for MinnesotaCare coverage after a
period of active military service during which they had been
covered by the Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS); (ii) were covered under
MinnesotaCare immediately prior to obtaining coverage under
CHAMPUS; and (iii) have maintained continuous coverage.
Sec. 13. Minnesota Statutes 1996, section 256.9358,
subdivision 4, is amended to read:
Subd. 4. [INELIGIBILITY.] Families with children whose
gross monthly income is above the amount specified in
subdivision 3 are not eligible for the plan. Beginning October
1, 1994, An individual or households with no children whose
gross family income is greater than 125 percent of the federal
poverty guidelines the amount specified in section 256.9354,
subdivision 5, are ineligible for the plan.
Sec. 14. Minnesota Statutes 1996, section 256.9359,
subdivision 2, is amended to read:
Subd. 2. [RESIDENCY REQUIREMENT.] (a) Prior to July 1,
1997, to be eligible for health coverage under the MinnesotaCare
program, families and individuals must be permanent residents of
Minnesota.
(b) Effective July 1, 1997, to be eligible for health
coverage under the MinnesotaCare program, adults without
children must be permanent residents of Minnesota.
(c) Effective July 1, 1997, to be eligible for health
coverage under the MinnesotaCare program, pregnant women,
families, and children must meet the residency requirements as
provided by Code of Federal Regulations, title 42, section
435.403, except that the provisions of section 256B.056,
subdivision 1, shall apply upon receipt of federal approval.
Sec. 15. Minnesota Statutes 1996, section 256.9362,
subdivision 6, is amended to read:
Subd. 6. [ENROLLEES 18 OR OLDER.] Payment by the
MinnesotaCare program for inpatient hospital services provided
to MinnesotaCare enrollees eligible under section 256.9354,
subdivision 5, or who qualify under section 256.9354,
subdivisions 1 to 4a, or section 256.9366 with family gross
income that exceeds 175 percent of the federal poverty
guidelines and who are not pregnant, who are 18 years old or
older on the date of admission to the inpatient hospital must be
in accordance with paragraphs (a) and (b). Payment for adults
who are not pregnant and are eligible under section 256.9354,
subdivisions 1 to 4a, or section 256.9366, and whose incomes are
equal to or less than 175 percent of the federal poverty
guidelines, shall be as provided for under paragraph (c).
(a) If the medical assistance rate minus any copayment
required under section 256.9353, subdivision 6, is less than or
equal to the amount remaining in the enrollee's benefit limit
under section 256.9353, subdivision 3, payment must be the
medical assistance rate minus any copayment required under
section 256.9353, subdivision 6. The hospital must not seek
payment from the enrollee in addition to the copayment. The
MinnesotaCare payment plus the copayment must be treated as
payment in full.
(b) If the medical assistance rate minus any copayment
required under section 256.9353, subdivision 6, is greater than
the amount remaining in the enrollee's benefit limit under
section 256.9353, subdivision 3, payment must be the lesser of:
(1) the amount remaining in the enrollee's benefit limit;
or
(2) charges submitted for the inpatient hospital services
less any copayment established under section 256.9353,
subdivision 6.
The hospital may seek payment from the enrollee for the
amount by which usual and customary charges exceed the payment
under this paragraph. If payment is reduced under section
256.9353, subdivision 3, paragraph (c), the hospital may not
seek payment from the enrollee for the amount of the reduction.
(c) For admissions occurring during the period of July 1,
1997, through June 30, 1998, for adults who are not pregnant and
are eligible under section 256.9354, subdivisions 1 to 4a, or
256.9366, and whose incomes are equal to or less than 175
percent of the federal poverty guidelines, the commissioner
shall pay hospitals directly, up to the medical assistance
payment rate, for inpatient hospital benefits in excess of the
$10,000 annual inpatient benefit limit.
Sec. 16. Minnesota Statutes 1996, section 256.9363,
subdivision 5, is amended to read:
Subd. 5. [ELIGIBILITY FOR OTHER STATE PROGRAMS.]
MinnesotaCare enrollees who become eligible for medical
assistance or general assistance medical care will remain in the
same managed care plan if the managed care plan has a contract
for that population. Effective January 1, 1998, MinnesotaCare
enrollees who were formerly eligible for general assistance
medical care pursuant to section 256D.03, subdivision 3, within
six months of MinnesotaCare enrollment and were enrolled in a
prepaid health plan pursuant to section 256D.03, subdivision 4,
paragraph (d), must remain in the same managed care plan if the
managed care plan has a contract for that population. Contracts
between the department of human services and managed care plans
must include MinnesotaCare, and medical assistance and may, at
the option of the commissioner of human services, also include
general assistance medical care.
Sec. 17. [256.937] [ASSET REQUIREMENT FOR MINNESOTACARE.]
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following definitions apply.
(a) "Asset" means cash and other personal property, as well
as any real property, that a family or individual owns which has
monetary value.
(b) "Homestead" means the home that is owned by, and is the
usual residence of, the family or individual, together with the
surrounding property which is not separated from the home by
intervening property owned by others. Public rights-of-way,
such as roads that run through the surrounding property and
separate it from the home, will not affect the exemption of the
property. "Usual residence" includes the home from which the
family or individual is temporarily absent due to illness,
employment, or education, or because the home is temporarily not
habitable due to casualty or natural disaster.
(c) "Net asset" means the asset's fair market value minus
any encumbrances including, but not limited to, liens and
mortgages.
Subd. 2. [LIMIT ON TOTAL ASSETS.] (a) Effective April 1,
1997, or upon federal approval, whichever is later, in order to
be eligible for the MinnesotaCare program, a household of two or
more persons must not own more than $30,000 in total net assets,
and a household of one person must not own more than $15,000 in
total net assets.
(b) For purposes of this subdivision, total net assets
include all assets, with the following exceptions:
(1) a homestead is not considered;
(2) household goods and personal effects are not
considered;
(3) any assets owned by children;
(4) vehicles used for employment;
(5) court ordered settlements up to $10,000;
(6) individual retirement accounts; and
(7) capital and operating assets of a trade or business up
to $200,000 in net assets are not considered.
(c) If an asset excluded under paragraph (b) has a negative
value, the negative value shall be subtracted from the total net
assets under paragraph (a).
Subd. 3. [DOCUMENTATION.] (a) The commissioner of human
services shall require individuals and families, at the time of
application or renewal, to indicate on a checkoff form developed
by the commissioner whether they satisfy the MinnesotaCare asset
requirement. This form must include the following or similar
language: "To be eligible for MinnesotaCare, individuals and
families must not own net assets in excess of $30,000 for a
household of two or more persons or $15,000 for a household of
one person, not including a homestead, household goods and
personal effects, assets owned by children, vehicles used for
employment, court ordered settlements up to $10,000, individual
retirement accounts, and capital and operating assets of a trade
or business up to $200,000. Do you and your household own net
assets in excess of these limits?"
(b) The commissioner may require individuals and families
to provide any information the commissioner determines necessary
to verify compliance with the asset requirement, if the
commissioner determines that there is reason to believe that an
individual or family has assets that exceed the program limit.
Subd. 4. [PENALTIES.] Individuals or families who are
found to have knowingly misreported the amount of their assets
as described in this section shall be subject to the penalties
in section 256.98. The commissioner shall present
recommendations on additional penalties to the 1998 legislature.
Subd. 5. [EXEMPTION.] This section does not apply to
pregnant women. For purposes of this subdivision, a woman is
considered pregnant for 60 days postpartum.
Sec. 18. [256.9371] [PENALTIES.]
Whoever obtains or attempts to obtain, or aids or abets any
person to obtain by means of a willfully false statement or
representation, or by the intentional withholding or concealment
of a material fact, or by impersonation, or other fraudulent
device:
(1) benefits under the MinnesotaCare program to which the
person is not entitled; or
(2) benefits under the MinnesotaCare program greater than
that to which the person is reasonably entitled;
shall be considered to have violated section 256.98, and shall
be subject to both the criminal and civil penalties provided
under that section.
Sec. 19. Minnesota Statutes 1996, section 256D.03,
subdivision 3, is amended to read:
Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.]
(a) General assistance medical care may be paid for any person
who is not eligible for medical assistance under chapter 256B,
including eligibility for medical assistance based on a
spenddown of excess income according to section 256B.056,
subdivision 5, or MinnesotaCare as defined in clause (4), except
as provided in paragraph (b); and:
(1) who is receiving assistance under section 256D.05, or
except for families with children who are eligible under
Minnesota family investment program-statewide (MFIP-S), who is
having a payment made on the person's behalf under sections
256I.01 to 256I.06, or who resides in group residential housing
as defined in chapter 256I and can meet a spenddown using the
cost of remedial services received through group residential
housing; or
(2)(i) who is a resident of Minnesota; and whose equity in
assets is not in excess of $1,000 per assistance unit. No asset
test shall be applied to children and their parents living in
the same household. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the
medical assistance program in chapter 256B, with the following
exception: the maximum amount of undistributed funds in a trust
that could be distributed to or on behalf of the beneficiary by
the trustee, assuming the full exercise of the trustee's
discretion under the terms of the trust, must be applied toward
the asset maximum; and
(ii) who has countable income not in excess of the
assistance standards established in section 256B.056,
subdivision 4, or whose excess income is spent down pursuant to
section 256B.056, subdivision 5, using a six-month budget
period, except that a one-month budget period must be used for
recipients residing in a long-term care facility. The method
for calculating earned income disregards and deductions for a
person who resides with a dependent child under age 21 shall be
as specified in section 256.74, subdivision 1 follow section
256B.056, subdivision 1a. However, if a disregard of $30 and
one-third of the remainder described in section 256.74,
subdivision 1, clause (4), has been applied to the wage earner's
income, the disregard shall not be applied again until the wage
earner's income has not been considered in an eligibility
determination for general assistance, general assistance medical
care, medical assistance, or aid to families with dependent
children MFIP-S for 12 consecutive months. The earned income
and work expense deductions for a person who does not reside
with a dependent child under age 21 shall be the same as the
method used to determine eligibility for a person under section
256D.06, subdivision 1, except the disregard of the first $50 of
earned income is not allowed; or
(3) who would be eligible for medical assistance except
that the person resides in a facility that is determined by the
commissioner or the federal health care financing administration
to be an institution for mental diseases.
(4) Beginning July 1, 1998, applicants or recipients who
meet all eligibility requirements of MinnesotaCare as defined in
sections 256.9351 to 256.9363 and 256.9366 to 256.9369, and are:
(i) adults with dependent children under 21 whose gross
family income is equal to or less than 275 percent of the
federal poverty guidelines; or
(ii) adults without children with earned income and whose
family gross income is between 75 percent of the federal poverty
guidelines and the amount set by section 256.9354, subdivision
5, shall be terminated from general assistance medical care upon
enrollment in MinnesotaCare.
(b) Eligibility is available for the month of application,
and for three months prior to application if the person was
eligible in those prior months. For services rendered on or
after July 1, 1997, eligibility is limited to one month prior to
application if the person is determined eligible in the prior
month. A redetermination of eligibility must occur every 12
months. Beginning July 1, 1998, Minnesota health care program
applications completed by recipients and applicants who are
persons described in paragraph (a), clause (4), may be returned
to the county agency to be forwarded to the department of human
services or sent directly to the department of human services
for enrollment in MinnesotaCare. If all other eligibility
requirements of this subdivision are met, eligibility for
general assistance medical care shall be available in any month
during which a MinnesotaCare eligibility determination and
enrollment are pending. Upon notification of eligibility for
MinnesotaCare, notice of termination for eligibility for general
assistance medical care shall be sent to an applicant or
recipient. If all other eligibility requirements of this
subdivision are met, eligibility for general assistance medical
care shall be available until enrollment in MinnesotaCare
subject to the provisions of paragraph (d).
(c) The date of an initial Minnesota health care program
application necessary to begin a determination of eligibility
shall be the date the applicant has provided a name, address,
and social security number, signed and dated, to the county
agency or the department of human services. If the applicant is
unable to provide an initial application when health care is
delivered due to a medical condition or disability, a health
care provider may act on the person's behalf to complete the
initial application. The applicant must complete the remainder
of the application and provide necessary verification before
eligibility can be determined. The county agency must assist
the applicant in obtaining verification if necessary.
(d) County agencies are authorized to use all automated
databases containing information regarding recipients' or
applicants' income in order to determine eligibility for general
assistance medical care or MinnesotaCare. Such use shall be
considered sufficient in order to determine eligibility and
premium payments by the county agency.
(c) (e) General assistance medical care is not available
for a person in a correctional facility unless the person is
detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a
crime, or admitted as an inpatient to a hospital on a criminal
hold order, and the person is a recipient of general assistance
medical care at the time the person is detained by law or
admitted on a criminal hold order and as long as the person
continues to meet other eligibility requirements of this
subdivision.
(d) (f) General assistance medical care is not available
for applicants or recipients who do not cooperate with the
county agency to meet the requirements of medical
assistance. General assistance medical care is limited to
payment of emergency services only for applicants or recipients
as described in paragraph (a), clause (4), whose MinnesotaCare
coverage is denied or terminated for nonpayment of premiums as
required by sections 256.9356 to 256.9358.
(e) (g) In determining the amount of assets of an
individual, there shall be included any asset or interest in an
asset, including an asset excluded under paragraph (a), that was
given away, sold, or disposed of for less than fair market value
within the 60 months preceding application for general
assistance medical care or during the period of eligibility.
Any transfer described in this paragraph shall be presumed to
have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes
convincing evidence to establish that the transaction was
exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair
market value at the time it was given away, sold, or disposed
of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility,
including partial months, shall be calculated by dividing the
uncompensated transfer amount by the average monthly per person
payment made by the medical assistance program to skilled
nursing facilities for the previous calendar year. The
individual shall remain ineligible until this fixed period has
expired. The period of ineligibility may exceed 30 months, and
a reapplication for benefits after 30 months from the date of
the transfer shall not result in eligibility unless and until
the period of ineligibility has expired. The period of
ineligibility begins in the month the transfer was reported to
the county agency, or if the transfer was not reported, the
month in which the county agency discovered the transfer,
whichever comes first. For applicants, the period of
ineligibility begins on the date of the first approved
application.
(f)(1) (h) Beginning October 1, 1993, an undocumented alien
or a nonimmigrant is ineligible for general assistance medical
care other than emergency services. For purposes of this
subdivision, a nonimmigrant is an individual in one or more of
the classes listed in United States Code, title 8, section
1101(a)(15), and an undocumented alien is an individual who
resides in the United States without the approval or
acquiescence of the Immigration and Naturalization Service.
(2) (i) This subdivision does not apply to a child under
age 18, to a Cuban or Haitian entrant as defined in Public Law
Number 96-422, section 501(e)(1) or (2)(a), or to an alien who
is aged, blind, or disabled as defined in United States Code,
title 42, section 1382c(a)(1).
(3) (j) For purposes of paragraph paragraphs (f) and (h),
"emergency services" has the meaning given in Code of Federal
Regulations, title 42, section 440.255(b)(1), except that it
also means services rendered because of suspected or actual
pesticide poisoning.
Sec. 20. [TRANSITION PLAN FOR MINNESOTACARE ENROLLEES.]
(a) The commissioner of human services, in consultation
with the legislative commission on health care access and the
commissioners of employee relations, health, and commerce, shall
develop an implementation plan to transition higher-income
MinnesotaCare enrollees to private sector or other nonsubsidized
coverage. In developing the plan, the commissioner shall
examine the feasibility of using the health insurance program
for state employees administered by the commissioner of employee
relations as a source of coverage, and shall also examine
methods to increase the affordability of private sector coverage
for individuals and families transitioning off MinnesotaCare.
The commissioner shall submit the implementation plan to the
legislature by December 15, 1997.
(b) The commissioner of human services shall report to the
legislature by January 15, 1998, on the impact of the outreach
efforts for the MinnesotaCare program, and on the reasons why
enrollees are leaving the MinnesotaCare program, and make
recommendations on:
(1) the affordability of the MinnesotaCare premium
schedule;
(2) the eligibility income level for the MinnesotaCare
program that will result in the greatest number of individuals
having health coverage;
(3) what will encourage greater availability of health
coverage in the private market;
(4) steps to increase the availability of health coverage
in the small employer market;
(5) the need, if any, and the feasibility of increasing the
MinnesotaCare program income eligibility level for individuals
and households without children; and
(6) the possibility of alternative premium payments and of
waiving the premiums for the MinnesotaCare program for certain
low-income enrollees.
Sec. 21. [INPATIENT BENEFIT LIMIT PILOT PROJECT.]
The commissioner of human services shall develop a pilot
project in a designated area of the state to determine whether
the presence of the $10,000 inpatient hospital benefit limit
prevents erosion of the private health insurance market by
eliminating the $10,000 inpatient benefit limit for that area of
the state. The commissioner shall work with the legislative
commission on health care access in designing the elements of
the pilot project.
Sec. 22. [EFFECTIVE DATE.]
Section 3, subdivision 7, clause (1), is effective July 1,
1998.
ARTICLE 2
MISCELLANEOUS CHANGES TO HEALTH CARE REFORM
Section 1. Minnesota Statutes 1996, section 60A.951,
subdivision 5, is amended to read:
Subd. 5. [INSURER.] "Insurer" means insurance company,
risk retention group as defined in section 60E.02, service plan
corporation as defined in section 62C.02, health maintenance
organization as defined in section 62D.02, community integrated
service network as defined in section 62N.02, fraternal benefit
society regulated under chapter 64B, township mutual company
regulated under chapter 67A, joint self-insurance plan or
multiple employer trust regulated under chapter 60F, 62H, or
section 471.617, subdivision 2, persons administering a
self-insurance plan as defined in section 60A.23, subdivision 8,
clause (2), paragraphs (a) and (d), and the workers'
compensation reinsurance association established in section
79.34.
Sec. 2. Minnesota Statutes 1996, section 62A.021,
subdivision 1, is amended to read:
Subdivision 1. [LOSS RATIO STANDARDS.] (a) Notwithstanding
section 62A.02, subdivision 3, relating to loss ratios, health
care policies or certificates shall not be delivered or issued
for delivery to an individual or to a small employer as defined
in section 62L.02, unless the policies or certificates can be
expected, as estimated for the entire period for which rates are
computed to provide coverage, to return to Minnesota
policyholders and certificate holders in the form of aggregate
benefits not including anticipated refunds or credits, provided
under the policies or certificates, (1) at least 75 percent of
the aggregate amount of premiums earned in the case of policies
issued in the small employer market, as defined in section
62L.02, subdivision 27, calculated on an aggregate basis; and
(2) at least 65 percent of the aggregate amount of premiums
earned in the case of each policy form or certificate form
issued in the individual market; calculated on the basis of
incurred claims experience or incurred health care expenses
where coverage is provided by a health maintenance organization
on a service rather than reimbursement basis and earned premiums
for the period and according to accepted actuarial principles
and practices. Assessments by the reinsurance association
created in chapter 62L and any all types of taxes, surcharges,
or assessments created by Laws 1992, chapter 549, or created on
or after April 23, 1992, are included in the calculation of
incurred claims experience or incurred health care expenses.
The applicable percentage for policies and certificates issued
in the small employer market, as defined in section 62L.02,
increases by one percentage point on July 1 of each year,
beginning on July 1, 1994, until an 82 percent loss ratio is
reached on July 1, 2000. The applicable percentage for policy
forms and certificate forms issued in the individual market
increases by one percentage point on July 1 of each year,
beginning on July 1, 1994, until a 72 percent loss ratio is
reached on July 1, 2000. A health carrier that enters a market
after July 1, 1993, does not start at the beginning of the
phase-in schedule and must instead comply with the loss ratio
requirements applicable to other health carriers in that market
for each time period. Premiums earned and claims incurred in
markets other than the small employer and individual markets are
not relevant for purposes of this section.
Notwithstanding section 645.26, any act enacted at the 1992
regular legislative session that amends or repeals section
62A.135 or that otherwise changes the loss ratios provided in
that section is void.
(b) All filings of rates and rating schedules shall
demonstrate that actual expected claims in relation to premiums
comply with the requirements of this section when combined with
actual experience to date. Filings of rate revisions shall also
demonstrate that the anticipated loss ratio over the entire
future period for which the revised rates are computed to
provide coverage can be expected to meet the appropriate loss
ratio standards, and aggregate loss ratio from inception of the
policy form or certificate form shall equal or exceed the
appropriate loss ratio standards.
(c) A health carrier that issues health care policies and
certificates to individuals or to small employers, as defined in
section 62L.02, in this state shall file annually its rates,
rating schedule, and supporting documentation including ratios
of incurred losses to earned premiums by policy form or
certificate form duration for approval by the commissioner
according to the filing requirements and procedures prescribed
by the commissioner. The supporting documentation shall also
demonstrate in accordance with actuarial standards of practice
using reasonable assumptions that the appropriate loss ratio
standards can be expected to be met over the entire period for
which rates are computed. The demonstration shall exclude
active life reserves. If the data submitted does not confirm
that the health carrier has satisfied the loss ratio
requirements of this section, the commissioner shall notify the
health carrier in writing of the deficiency. The health carrier
shall have 30 days from the date of the commissioner's notice to
file amended rates that comply with this section. If the health
carrier fails to file amended rates within the prescribed time,
the commissioner shall order that the health carrier's filed
rates for the nonconforming policy form or certificate form be
reduced to an amount that would have resulted in a loss ratio
that complied with this section had it been in effect for the
reporting period of the supplement. The health carrier's
failure to file amended rates within the specified time or the
issuance of the commissioner's order amending the rates does not
preclude the health carrier from filing an amendment of its
rates at a later time. The commissioner shall annually make the
submitted data available to the public at a cost not to exceed
the cost of copying. The data must be compiled in a form useful
for consumers who wish to compare premium charges and loss
ratios.
(d) Each sale of a policy or certificate that does not
comply with the loss ratio requirements of this section is an
unfair or deceptive act or practice in the business of insurance
and is subject to the penalties in sections 72A.17 to 72A.32.
(e)(1) For purposes of this section, health care policies
issued as a result of solicitations of individuals through the
mail or mass media advertising, including both print and
broadcast advertising, shall be treated as individual policies.
(2) For purposes of this section, (1) (i) "health care
policy" or "health care certificate" is a health plan as defined
in section 62A.011; and (2) (ii) "health carrier" has the
meaning given in section 62A.011 and includes all health
carriers delivering or issuing for delivery health care policies
or certificates in this state or offering these policies or
certificates to residents of this state.
(f) The loss ratio phase-in as described in paragraph (a)
does not apply to individual policies and small employer
policies issued by a health plan company that is assessed less
than three percent of the total annual amount assessed by the
Minnesota comprehensive health association. These policies must
meet a 68 percent loss ratio for individual policies, a 71
percent loss ratio for small employer policies with fewer than
ten employees, and a 75 percent loss ratio for all other small
employer policies.
(g) The commissioners of commerce and health shall each
annually issue a public report listing, by health plan company,
the actual loss ratios experienced in the individual and small
employer markets in this state by the health plan companies that
the commissioners respectively regulate. The commissioners
shall coordinate release of these reports so as to release them
as a joint report or as separate reports issued the same day.
The report or reports shall be released no later than June 1 for
loss ratios experienced for the preceding calendar year. Health
plan companies shall provide to the commissioners any
information requested by the commissioners for purposes of this
paragraph.
Sec. 3. Minnesota Statutes 1996, section 62A.021, is
amended by adding a subdivision to read:
Subd. 3. [LOSS RATIO DISCLOSURE.] (a) Each health care
policy form or health care certificate form for which
subdivision 1 requires compliance with a loss ratio requirement
shall prominently display the disclosure provided in paragraph
(b) on its declarations sheet if it has one and, if not, on its
front page. The disclosure must also be prominently displayed
in any marketing materials used in connection with it.
(b) The disclosure must be in the following format:
Notice: This disclosure is required by Minnesota law.
This policy or certificate is expected to return on average
(fill in anticipated loss ratio approved by the commissioner)
percent of your premium dollar for health care. The lowest
percentage permitted by state law for this policy or certificate
is (fill in applicable minimum loss ratio).
(c) This subdivision applies to policies and certificates
issued on or after January 1, 1998.
Sec. 4. Minnesota Statutes 1996, section 62A.316, is
amended to read:
62A.316 [BASIC MEDICARE SUPPLEMENT PLAN; COVERAGE.]
(a) The basic Medicare supplement plan must have a level of
coverage that will provide:
(1) coverage for all of the Medicare part A inpatient
hospital coinsurance amounts, and 100 percent of all Medicare
part A eligible expenses for hospitalization not covered by
Medicare, after satisfying the Medicare part A deductible;
(2) coverage for the daily copayment amount of Medicare
part A eligible expenses for the calendar year incurred for
skilled nursing facility care;
(3) coverage for the copayment amount of Medicare eligible
expenses under Medicare part B regardless of hospital
confinement, subject to the Medicare part B deductible amount;
(4) 80 percent of the hospital and medical expenses and
supplies incurred during travel outside the United States as a
result of a medical emergency;
(5) coverage for the reasonable cost of the first three
pints of blood, or equivalent quantities of packed red blood
cells as defined under federal regulations under Medicare parts
A and B, unless replaced in accordance with federal regulations;
and
(6) 100 percent of the cost of immunizations and routine
screening procedures for cancer screening including mammograms
and pap smears.
(b) Only the following optional benefit riders may be added
to this plan:
(1) coverage for all of the Medicare part A inpatient
hospital deductible amount;
(2) a minimum of 80 percent of eligible medical expenses
and supplies not covered by Medicare part B, not to exceed any
charge limitation established by the Medicare program or state
law;
(3) coverage for all of the Medicare part B annual
deductible;
(4) coverage for at least 50 percent, or the equivalent of
50 percent, of usual and customary prescription drug expenses;
(5) coverage for the following preventive health services:
(i) an annual clinical preventive medical history and
physical examination that may include tests and services from
clause (ii) and patient education to address preventive health
care measures;
(ii) any one or a combination of the following preventive
screening tests or preventive services, the frequency of which
is considered medically appropriate:
(A) fecal occult blood test and/or digital rectal
examination;
(B) dipstick urinalysis for hematuria, bacteriuria, and
proteinuria;
(C) pure tone (air only) hearing screening test,
administered or ordered by a physician;
(D) serum cholesterol screening every five years;
(E) thyroid function test;
(F) diabetes screening;
(iii) any other tests or preventive measures determined
appropriate by the attending physician.
Reimbursement shall be for the actual charges up to 100
percent of the Medicare-approved amount for each service, as if
Medicare were to cover the service as identified in American
Medical Association current procedural terminology (AMA CPT)
codes, to a maximum of $120 annually under this benefit. This
benefit shall not include payment for a procedure covered by
Medicare;
(6) coverage for services to provide short-term at-home
assistance with activities of daily living for those recovering
from an illness, injury, or surgery:
(i) For purposes of this benefit, the following definitions
apply:
(A) "activities of daily living" include, but are not
limited to, bathing, dressing, personal hygiene, transferring,
eating, ambulating, assistance with drugs that are normally
self-administered, and changing bandages or other dressings;
(B) "care provider" means a duly qualified or licensed home
health aide/homemaker, personal care aid, or nurse provided
through a licensed home health care agency or referred by a
licensed referral agency or licensed nurses registry;
(C) "home" means a place used by the insured as a place of
residence, provided that the place would qualify as a residence
for home health care services covered by Medicare. A hospital
or skilled nursing facility shall not be considered the
insured's place of residence;
(D) "at-home recovery visit" means the period of a visit
required to provide at-home recovery care, without limit on the
duration of the visit, except each consecutive four hours in a
24-hour period of services provided by a care provider is one
visit;
(ii) Coverage requirements and limitations:
(A) at-home recovery services provided must be primarily
services that assist in activities of daily living;
(B) the insured's attending physician must certify that the
specific type and frequency of at-home recovery services are
necessary because of a condition for which a home care plan of
treatment was approved by Medicare;
(C) coverage is limited to:
(I) no more than the number and type of at-home recovery
visits certified as necessary by the insured's attending
physician. The total number of at-home recovery visits shall
not exceed the number of Medicare-approved home care visits
under a Medicare-approved home care plan of treatment;
(II) the actual charges for each visit up to a maximum
reimbursement of $40 per visit;
(III) $1,600 per calendar year;
(IV) seven visits in any one week;
(V) care furnished on a visiting basis in the insured's
home;
(VI) services provided by a care provider as defined in
this section;
(VII) at-home recovery visits while the insured is covered
under the policy or certificate and not otherwise excluded;
(VIII) at-home recovery visits received during the period
the insured is receiving Medicare-approved home care services or
no more than eight weeks after the service date of the last
Medicare-approved home health care visit;
(iii) Coverage is excluded for:
(A) home care visits paid for by Medicare or other
government programs; and
(B) care provided by family members, unpaid volunteers, or
providers who are not care providers.;
(7) coverage for at least 50 percent, or the equivalent of
50 percent, of usual and customary prescription drug expenses to
a maximum of $1,200 paid by the issuer annually under this
benefit. An issuer of Medicare supplement insurance policies
that elects to offer this benefit rider shall also make
available coverage that contains the rider specified in clause
(4).
Sec. 5. Minnesota Statutes 1996, section 62A.61, is
amended to read:
62A.61 [DISCLOSURE OF METHODS USED BY HEALTH CARRIERS TO
DETERMINE USUAL AND CUSTOMARY FEES.]
(a) A health carrier that bases reimbursement to health
care providers upon a usual and customary fee must maintain in
its office a copy of a description of the methodology used to
calculate fees including at least the following:
(1) the frequency of the determination of usual and
customary fees;
(2) a general description of the methodology used to
determine usual and customary fees; and
(3) the percentile of usual and customary fees that
determines the maximum allowable reimbursement.
(b) A health carrier must provide a copy of the information
described in paragraph (a) to the Minnesota health care
commission, the commissioner of health, or the commissioner of
commerce, upon request.
(c) The commissioner of health or the commissioner of
commerce, as appropriate, may use to enforce this section any
enforcement powers otherwise available to the commissioner with
respect to the health carrier. The appropriate commissioner
shall enforce compliance with a request made under this section
by the Minnesota health care commission, at the request of the
commissioner. The commissioner of health or commerce, as
appropriate, may require health carriers to provide the
information required under this section and may use any powers
granted under other laws relating to the regulation of health
carriers to enforce compliance.
(d) For purposes of this section, "health carrier" has the
meaning given in section 62A.011.
Sec. 6. Minnesota Statutes 1996, section 62D.02,
subdivision 5, is amended to read:
Subd. 5. "Evidence of coverage" means any certificate,
agreement or contract, and amendments thereto, issued to an
enrollee which sets out the coverage to which the enrollee is
entitled under the health maintenance contract which covers the
enrollee.
Sec. 7. Minnesota Statutes 1996, section 62D.09,
subdivision 3, is amended to read:
Subd. 3. Every health maintenance organization or its
representative shall annually, before June 1, provide to its
enrollees the following: (1) a summary of its most recent
annual financial statement including a balance sheet and
statement of receipts and disbursements; (2) a description of
the health maintenance organization, its health care plan or
plans, its facilities and personnel, any material changes
therein since the last report; (3) the current evidence of
coverage, or contract amendments thereto; and (4) a statement of
consumer information and rights as described in section 62D.07,
subdivision 3, paragraph (c). Under clause (3), a health
maintenance organization may annually alternate between
providing enrollees with amendments and providing current
evidence of coverage.
Sec. 8. Minnesota Statutes 1996, section 62E.11,
subdivision 5, is amended to read:
Subd. 5. Each contributing member of the association shall
share the losses due to claims expenses of the comprehensive
health insurance plan for plans issued or approved for issuance
by the association, and shall share in the operating and
administrative expenses incurred or estimated to be incurred by
the association incident to the conduct of its affairs. Claims
expenses of the state plan which exceed the premium payments
allocated to the payment of benefits shall be the liability of
the contributing members. Contributing members shall share in
the claims expense of the state plan and operating and
administrative expenses of the association in an amount equal to
the ratio of the contributing member's total accident and health
insurance premium, received from or on behalf of Minnesota
residents as divided by the total accident and health insurance
premium, received by all contributing members from or on behalf
of Minnesota residents, as determined by the commissioner.
Payments made by the state to a contributing member for medical
assistance, MinnesotaCare, or general assistance medical care
services according to chapters 256, 256B, and 256D shall be
excluded when determining a contributing member's total premium.
Sec. 9. Minnesota Statutes 1996, section 62J.017, is
amended to read:
62J.017 [IMPLEMENTATION TIMETABLE.]
The state seeks to complete the restructuring of the health
care delivery and financing system. Beginning July 1, 1994,
measures will be taken to increase the public accountability of
existing health plan companies, to promote the development of
small, community-based integrated service networks, and to
reduce administrative costs by standardizing third-party billing
forms and procedures and utilization review requirements.
Voluntary formation of other integrated service networks will
begin after rules have been adopted, but not before July 1,
1996. Statutes and rules for the restructured health care
financing and delivery system must be enacted or adopted by
January 1, 1996.
Sec. 10. Minnesota Statutes 1996, section 62J.06, is
amended to read:
62J.06 [IMMUNITY FROM LIABILITY.]
No member of the Minnesota health care commission
established under section 62J.05, regional coordinating boards
established under section 62J.09, or the health technology
advisory committee established under section 62J.15, shall be
held civilly or criminally liable for an act or omission by that
person if the act or omission was in good faith and within the
scope of the member's responsibilities under this chapter.
Sec. 11. Minnesota Statutes 1996, section 62J.07,
subdivision 1, is amended to read:
Subdivision 1. [LEGISLATIVE OVERSIGHT.] The legislative
commission on health care access reviews the activities of the
commissioner of health, the state health care
commission regional coordinating boards, the health technology
advisory committee, and all other state agencies involved in the
implementation and administration of this chapter, including
efforts to obtain federal approval through waivers and other
means.
Sec. 12. Minnesota Statutes 1996, section 62J.07,
subdivision 3, is amended to read:
Subd. 3. [REPORTS TO THE COMMISSION.] The commissioner of
health and the Minnesota health care commission, the regional
coordinating boards, and the health technology advisory
committee shall report on their activities and the activities of
the regional boards annually and at other times at the request
of the legislative commission on health care access. The
commissioners of health, commerce, and human services shall
provide periodic reports to the legislative commission on the
progress of rulemaking that is authorized or required under this
act and shall notify members of the commission when a draft of a
proposed rule has been completed and scheduled for publication
in the State Register. At the request of a member of the
commission, a commissioner shall provide a description and a
copy of a proposed rule.
Sec. 13. Minnesota Statutes 1996, section 62J.09,
subdivision 1, is amended to read:
Subdivision 1. [GENERAL DUTIES.] (a) The commissioner
shall divide the state into six regions, one of these regions
being the seven-county metropolitan area.
The (b) Each region shall establish a locally controlled
regional coordinating boards are locally controlled boards board
consisting of providers, health plan companies, employers,
consumers, and elected officials. Regional coordinating boards
may:
(1) undertake voluntary activities to educate consumers,
providers, and purchasers about community plans and projects
promoting health care cost containment, consumer accountability,
access, and quality and efforts to achieve public health goals;
(2) make recommendations to the commissioner regarding ways
of improving affordability, accessibility, and quality of health
care in the region and throughout the state;
(3) provide technical assistance to parties interested in
establishing or operating a community integrated service network
or integrated service network within the region. This
assistance must complement assistance provided by the
commissioner under section 62N.23;
(4) advise the commissioner on public health goals, taking
into consideration the relevant portions of the community health
service plans, plans required by the Minnesota comprehensive
adult mental health act, the Minnesota comprehensive children's
mental health act, and the community social service act plans
developed by county boards or community health boards in the
region under chapters 145A, 245, and 256E;
(5) prepare an annual regional education plan that is
consistent with and supportive of public health goals identified
by community health boards in the region; and
(6) serve as advisory bodies to identify potential
applicants for federal Health Professional Shortage Area and
federal Medically Underserved Area designation as requested by
the commissioner.
Sec. 14. Minnesota Statutes 1996, section 62J.15,
subdivision 1, is amended to read:
Subdivision 1. [HEALTH TECHNOLOGY ADVISORY COMMITTEE.] The
Minnesota health care commission shall convene legislative
commission on health care access may convene or authorize the
commissioner of health to convene an advisory committee to
conduct evaluations of existing research and technology
assessments conducted by other entities of new and existing
health care technologies as designated by the legislative
commission on health care access, the commissioner, or the
advisory committee. The advisory committee may include members
of the state commission and other persons appointed by the
commission. The advisory committee must include at least one
person representing physicians, at least one person representing
hospitals, and at least one person representing the health care
technology industry. Health care technologies include high-cost
drugs, devices, procedures, or processes applied to human health
care, such as high-cost transplants and expensive scanners and
imagers. The advisory committee is governed by section 15.0575,
subdivision 3, except that members do not receive per diem
payments.
Sec. 15. Minnesota Statutes 1996, section 62J.152,
subdivision 1, is amended to read:
Subdivision 1. [GENERALLY.] The health technology advisory
committee established in section 62J.15 shall:
(1) develop criteria and processes for evaluating health
care technology assessments made by other entities;
(2) conduct evaluations of specific technologies and their
specific use and application;
(3) provide the legislature with scientific evaluations of
proposed benefit mandates that utilize health care technologies
for a specific use and application;
(4) report the results of the evaluations to the
commissioner and the Minnesota health care
commission legislative commission on health care access; and
(4) (5) carry out other duties relating to health
technology assigned by the commission legislature or the
legislative commission on health care access.
Sec. 16. Minnesota Statutes 1996, section 62J.152, is
amended by adding a subdivision to read:
Subd. 1a. [LEGISLATIVE ACTION.] Nothing in subdivision 1
shall be construed to:
(1) require the legislature to postpone hearings or
legislative action on a proposed benefit mandate; or
(2) require the legislature to act in accordance with any
recommendations of the health technology advisory committee.
Sec. 17. Minnesota Statutes 1996, section 62J.152,
subdivision 2, is amended to read:
Subd. 2. [PRIORITIES FOR DESIGNATING TECHNOLOGIES CRITERIA
FOR ASSESSMENT EVALUATION.] The health technology advisory
committee shall consider the following criteria in designating
assessing or evaluating technologies for evaluation:
(1) the level of controversy within the medical or
scientific community, including questionable or undetermined
efficacy;
(2) the cost implications;
(3) the potential for rapid diffusion;
(4) the impact on a substantial patient population;
(5) the existence of alternative technologies;
(6) the impact on patient safety and health outcome;
(7) the public health importance;
(8) the level of public and professional demand;
(9) the social, ethical, and legal concerns; and
(10) the prevalence of the disease or condition.
The committee may give different weights or attach different
importance to each of the criteria, depending on the technology
being considered. The committee shall consider any additional
criteria approved by the commissioner and the Minnesota health
care commission legislative commission on health care access.
The committee shall present its list of technologies for
evaluation to the legislative commission on health care access
for review.
Sec. 18. Minnesota Statutes 1996, section 62J.152,
subdivision 4, is amended to read:
Subd. 4. [TECHNOLOGY EVALUATION PROCESS.] (a) The health
technology advisory committee shall collect and evaluate studies
and research findings on the technologies selected for
evaluation from as wide of a range of sources as needed,
including, but not limited to: federal agencies or other units
of government, international organizations conducting health
care technology assessments, health carriers, insurers,
manufacturers, professional and trade associations, nonprofit
organizations, and academic institutions. The health technology
advisory committee may use consultants or experts and solicit
testimony or other input as needed to evaluate a specific
technology.
(b) When the evaluation process on a specific technology
has been completed, the health technology advisory committee
shall submit a preliminary report to the health care
commission commissioner and the legislative commission on health
care access and publish a summary of the preliminary report in
the State Register with a notice that written comments may be
submitted. The preliminary report must include the results of
the technology assessment evaluation, studies and research
findings considered in conducting the evaluation, and the health
technology advisory committee's summary statement about the
evaluation. Any interested persons or organizations may submit
to the health technology advisory committee written comments
regarding the technology evaluation within 30 days from the date
the preliminary report was published in the State Register. The
health technology advisory committee's final report on its
technology evaluation must be submitted to the health care
commission commissioner, to the legislature, and to the
information clearinghouse. A summary of written comments
received by the health technology advisory committee within the
30-day period must be included in the final report. The health
care commission shall review the final report and prepare its
comments and recommendations. Before completing its final
comments and recommendations, the health care commission shall
provide adequate public notice that testimony will be accepted
by the health care commission. The health care commission shall
then forward the final report, its comments and recommendations,
and a summary of the public's comments to the commissioner and
information clearinghouse.
(c) The reports of the health technology advisory committee
and the comments and recommendations of the health care
commission should not eliminate or bar new technology, and are
not rules as defined in the administrative procedure act.
Sec. 19. Minnesota Statutes 1996, section 62J.152,
subdivision 5, is amended to read:
Subd. 5. [USE OF TECHNOLOGY EVALUATION.] (a) The final
report on the technology evaluation and the commission's
comments and recommendations may be used:
(1) by the commissioner in retrospective and prospective
review of major expenditures;
(2) by integrated service networks and other group
purchasers and by employers, in making coverage, contracting,
purchasing, and reimbursement decisions;
(3) by organizations in the development of practice
parameters;
(4) by health care providers in making decisions about
adding or replacing technology and the appropriate use of
technology;
(5) by consumers in making decisions about treatment;
(6) by medical device manufacturers in developing and
marketing new technologies; and
(7) as otherwise needed by health care providers, health
care plans, consumers, and purchasers.
(b) At the request of the commissioner, the health care
commission, in consultation with the health technology advisory
committee, shall submit specific recommendations relating to
technologies that have been evaluated under this section for
purposes of retrospective and prospective review of major
expenditures and coverage, contracting, purchasing, and
reimbursement decisions affecting state programs.
Sec. 20. Minnesota Statutes 1996, section 62J.152, is
amended by adding a subdivision to read:
Subd. 8. [REPEALER.] This section and sections 62J.15 and
62J.156 are repealed effective July 1, 2001.
Sec. 21. Minnesota Statutes 1996, section 62J.17,
subdivision 6a, is amended to read:
Subd. 6a. [PROSPECTIVE REVIEW AND APPROVAL.] (a)
[REQUIREMENT.] No health care provider subject to prospective
review under this subdivision shall make a major spending
commitment unless:
(1) the provider has filed an application with the
commissioner to proceed with the major spending commitment and
has provided all supporting documentation and evidence requested
by the commissioner; and
(2) the commissioner determines, based upon this
documentation and evidence, that the major spending commitment
is appropriate under the criteria provided in subdivision 5a in
light of the alternatives available to the provider.
(b) [APPLICATION.] A provider subject to prospective
review and approval shall submit an application to the
commissioner before proceeding with any major spending
commitment. The application must address each item listed in
subdivision 4a, paragraph (a), and must also include
documentation to support the response to each item. The
provider may submit information, with supporting documentation,
regarding why the major spending commitment should be excepted
from prospective review under subdivision 7. The submission may
be made either in addition to or instead of the submission of
information relating to the items listed in subdivision 4a,
paragraph (a).
(c) [REVIEW.] The commissioner shall determine, based upon
the information submitted, whether the major spending commitment
is appropriate under the criteria provided in subdivision 5a, or
whether it should be excepted from prospective review under
subdivision 7. In making this determination, the commissioner
may also consider relevant information from other sources. At
the request of the commissioner, the Minnesota health care
commission health technology advisory committee shall convene an
expert review panel made up of persons with knowledge and
expertise regarding medical equipment, specialized services,
health care expenditures, and capital expenditures to review
applications and make recommendations to the commissioner. The
commissioner shall make a decision on the application within 60
days after an application is received.
(d) [PENALTIES AND REMEDIES.] The commissioner of health
has the authority to issue fines, seek injunctions, and pursue
other remedies as provided by law.
Sec. 22. Minnesota Statutes 1996, section 62J.22, is
amended to read:
62J.22 [PARTICIPATION OF FEDERAL PROGRAMS.]
The commissioner of health shall seek the full
participation of federal health care programs under this
chapter, including Medicare, medical assistance, veterans
administration programs, and other federal programs. The
commissioner of human services shall under the direction of the
health care commission submit waiver requests and take other
action necessary to obtain federal approval to allow
participation of the medical assistance program. Other state
agencies shall provide assistance at the request of the
commission. If federal approval is not given for one or more
federal programs, data on the amount of health care spending
that is collected under section 62J.04 shall be adjusted so that
state and regional spending limits take into account the failure
of the federal program to participate.
Sec. 23. Minnesota Statutes 1996, section 62J.25, is
amended to read:
62J.25 [MANDATORY MEDICARE ASSIGNMENT.]
(a) Effective January 1, 1993, a health care provider
authorized to participate in the Medicare program shall not
charge to or collect from a Medicare beneficiary who is a
Minnesota resident any amount in excess of 115 percent of the
Medicare-approved amount for any Medicare-covered service
provided.
(b) Effective January 1, 1994, a health care provider
authorized to participate in the Medicare program shall not
charge to or collect from a Medicare beneficiary who is a
Minnesota resident any amount in excess of 110 percent of the
Medicare-approved amount for any Medicare-covered service
provided.
(c) Effective January 1, 1995, a health care provider
authorized to participate in the Medicare program shall not
charge to or collect from a Medicare beneficiary who is a
Minnesota resident any amount in excess of 105 percent of the
Medicare-approved amount for any Medicare-covered service
provided.
(d) Effective January 1, 1996, a health care provider
authorized to participate in the Medicare program shall not
charge to or collect from a Medicare beneficiary who is a
Minnesota resident any amount in excess of the Medicare-approved
amount for any Medicare-covered service provided.
(e) This section does not apply to ambulance services as
defined in section 144.801, subdivision 4, or medical supplies
and equipment.
Sec. 24. Minnesota Statutes 1996, section 62J.2914,
subdivision 1, is amended to read:
Subdivision 1. [DISCLOSURE.] An application for approval
must include, to the extent applicable, disclosure of the
following:
(1) a descriptive title;
(2) a table of contents;
(3) exact names of each party to the application and the
address of the principal business office of each party;
(4) the name, address, and telephone number of the persons
authorized to receive notices and communications with respect to
the application;
(5) a verified statement by a responsible officer of each
party to the application attesting to the accuracy and
completeness of the enclosed information;
(6) background information relating to the proposed
arrangement, including:
(i) a description of the proposed arrangement, including a
list of any services or products that are the subject of the
proposed arrangement;
(ii) an identification of any tangential services or
products associated with the services or products that are the
subject of the proposed arrangement;
(iii) a description of the geographic territory involved in
the proposed arrangement;
(iv) if the geographic territory described in item (iii),
is different from the territory in which the applicants have
engaged in the type of business at issue over the last five
years, a description of how and why the geographic territory
differs;
(v) identification of all products or services that a
substantial share of consumers would consider substitutes for
any service or product that is the subject of the proposed
arrangement;
(vi) identification of whether any services or products of
the proposed arrangement are currently being offered, capable of
being offered, utilized, or capable of being utilized by other
providers or purchasers in the geographic territory described in
item (iii);
(vii) identification of the steps necessary, under current
market and regulatory conditions, for other parties to enter the
territory described in item (iii) and compete with the
applicant;
(viii) a description of the previous history of dealings
between the parties to the application;
(ix) a detailed explanation of the projected effects,
including expected volume, change in price, and increased
revenue, of the arrangement on each party's current businesses,
both generally as well as the aspects of the business directly
involved in the proposed arrangement;
(x) the present market share of the parties to the
application and of others affected by the proposed arrangement,
and projected market shares after implementation of the proposed
arrangement;
(xi) a statement of why the projected levels of cost,
access, or quality could not be achieved in the existing market
without the proposed arrangement; and
(xii) an explanation of how the arrangement relates to any
Minnesota health care commission or applicable regional
coordinating board plans for delivery of health care; and
(7) a detailed explanation of how the transaction will
affect cost, access, and quality. The explanation must address
the factors in section 62J.2917, subdivision 2, paragraphs (b)
to (d), to the extent applicable.
Sec. 25. Minnesota Statutes 1996, section 62J.2915, is
amended to read:
62J.2915 [NOTICE AND COMMENT.]
Subdivision 1. [NOTICE.] The commissioner shall cause the
notice described in section 62J.2914, subdivision 2, to be
published in the State Register and sent to the Minnesota health
care commission, the regional coordinating boards for any
regions that include all or part of the territory covered by the
proposed arrangement, and any person who has requested to be
placed on a list to receive notice of applications. The
commissioner may maintain separate notice lists for different
regions of the state. The commissioner may also send a copy of
the notice to any person together with a request that the person
comment as provided under subdivision 2. Copies of the request
must be provided to the applicant.
Subd. 2. [COMMENTS.] Within 20 days after the notice is
published, any person may mail to the commissioner written
comments with respect to the application. Within 30 days after
the notice is published, the Minnesota health care commission or
any regional coordinating board may mail to the commissioner
comments with respect to the application. Persons submitting
comments shall provide a copy of the comments to the applicant.
The applicant may mail to the commissioner written responses to
any comments within ten days after the deadline for mailing such
comments. The applicant shall send a copy of the response to
the person submitting the comment.
Sec. 26. Minnesota Statutes 1996, section 62J.2916,
subdivision 1, is amended to read:
Subdivision 1. [CHOICE OF PROCEDURES.] After the
conclusion of the period provided in section 62J.2915,
subdivision 2, for the applicant to respond to comments, the
commissioner shall select one of the three procedures provided
in subdivision 2. In determining which procedure to use, the
commissioner shall consider the following criteria:
(1) the size of the proposed arrangement, in terms of
number of parties and amount of money involved;
(2) the complexity of the proposed arrangement;
(3) the novelty of the proposed arrangement;
(4) the substance and quantity of the comments received;
(5) any comments received from the Minnesota health care
commission or regional coordinating boards; and
(6) the presence or absence of any significant gaps in the
factual record.
If the applicant demands a contested case hearing no later
than the conclusion of the period provided in section 62J.2915,
subdivision 2, for the applicant to respond to comments, the
commissioner shall not select a procedure. Instead, the
applicant shall be given a contested case proceeding as a matter
of right.
Sec. 27. Minnesota Statutes 1996, section 62J.2917,
subdivision 2, is amended to read:
Subd. 2. [FACTORS.] (a) [GENERALLY APPLICABLE FACTORS.]
In making a determination about cost, access, and quality, the
commissioner may consider the following factors, to the extent
relevant:
(1) whether the proposal is compatible with the cost
containment plan or other plan of the Minnesota health care
commission or the applicable regional plans of the regional
coordinating boards;
(2) market structure:
(i) actual and potential sellers and buyers, or providers
and purchasers;
(ii) actual and potential consumers;
(iii) geographic market area; and
(iv) entry conditions;
(3) current market conditions;
(4) the historical behavior of the market;
(5) performance of other, similar arrangements;
(6) whether the proposal unnecessarily restrains
competition or restrains competition in ways not reasonably
related to the purposes of this chapter; and
(7) the financial condition of the applicant.
(b) [COST.] The commissioner's analysis of cost must focus
on the individual consumer of health care. Cost savings to be
realized by providers, health carriers, group purchasers, or
other participants in the health care system are relevant only
to the extent that the savings are likely to be passed on to the
consumer. However, where an application is submitted by
providers or purchasers who are paid primarily by third party
payers unaffiliated with the applicant, it is sufficient for the
applicant to show that cost savings are likely to be passed on
to the unaffiliated third party payers; the applicants do not
have the burden of proving that third party payers with whom the
applicants are not affiliated will pass on cost savings to
individuals receiving coverage through the third party payers.
In making determinations as to costs, the commissioner may
consider:
(1) the cost savings likely to result to the applicant;
(2) the extent to which the cost savings are likely to be
passed on to the consumer and in what form;
(3) the extent to which the proposed arrangement is likely
to result in cost shifting by the applicant onto other payers or
purchasers of other products or services;
(4) the extent to which the cost shifting by the applicant
is likely to be followed by other persons in the market;
(5) the current and anticipated supply and demand for any
products or services at issue;
(6) the representations and guarantees of the applicant and
their enforceability;
(7) likely effectiveness of regulation by the commissioner;
(8) inferences to be drawn from market structure;
(9) the cost of regulation, both for the state and for the
applicant; and
(10) any other factors tending to show that the proposed
arrangement is or is not likely to reduce cost.
(c) [ACCESS.] In making determinations as to access, the
commissioner may consider:
(1) the extent to which the utilization of needed health
care services or products by the intended targeted population is
likely to increase or decrease. When a proposed arrangement is
likely to increase access in one geographic area, by lowering
prices or otherwise expanding supply, but limits access in
another geographic area by removing service capabilities from
that second area, the commissioner shall articulate the criteria
employed to balance these effects;
(2) the extent to which the proposed arrangement is likely
to make available a new and needed service or product to a
certain geographic area; and
(3) the extent to which the proposed arrangement is likely
to otherwise make health care services or products more
financially or geographically available to persons who need them.
If the commissioner determines that the proposed
arrangement is likely to increase access and bases that
determination on a projected increase in utilization, the
commissioner shall also determine and make a specific finding
that the increased utilization does not reflect overutilization.
(d) [QUALITY.] In making determinations as to quality, the
commissioner may consider the extent to which the proposed
arrangement is likely to:
(1) decrease morbidity and mortality;
(2) result in faster convalescence;
(3) result in fewer hospital days;
(4) permit providers to attain needed experience or
frequency of treatment, likely to lead to better outcomes;
(5) increase patient satisfaction; and
(6) have any other features likely to improve or reduce the
quality of health care.
Sec. 28. Minnesota Statutes 1996, section 62J.2921,
subdivision 2, is amended to read:
Subd. 2. [NOTICE.] The commissioner shall begin a
proceeding to revoke approval by providing written notice to the
applicant describing in detail the basis for the proposed
revocation. Notice of the proceeding must be published in the
State Register and submitted to the Minnesota health care
commission and the applicable regional coordinating boards. The
notice must invite the submission of comments to the
commissioner.
Sec. 29. Minnesota Statutes 1996, section 62J.451,
subdivision 6b, is amended to read:
Subd. 6b. [CONSUMER SURVEYS.] (a) The health data
institute shall develop and implement a mechanism for collecting
comparative data on consumer perceptions of the health care
system, including consumer satisfaction, through adoption of a
standard consumer survey. This survey shall include enrollees
in community integrated service networks, integrated service
networks, health maintenance organizations, preferred provider
organizations, indemnity insurance plans, public programs, and
other health plan companies. The health data institute, in
consultation with the health care commission, shall determine a
mechanism for the inclusion of the uninsured. This consumer
survey may be conducted every two years. A focused survey may
be conducted on the off years. Health plan companies and group
purchasers shall provide to the health data institute roster
data as defined in subdivision 2, including the names,
addresses, and telephone numbers of enrollees and former
enrollees and other data necessary for the completion of this
survey. This roster data provided by the health plan companies
and group purchasers is classified as provided under section
62J.452. The health data institute may analyze and prepare
findings from the raw, unaggregated data, and the findings from
this survey may be included in the health plan company
performance reports specified in subdivision 6a, and in other
reports developed and disseminated by the health data institute
and the commissioner. The raw, unaggregated data is classified
as provided under section 62J.452, and may be made available by
the health data institute to the extent permitted under section
62J.452. The health data institute shall provide raw,
unaggregated data to the commissioner. The survey may include
information on the following subjects:
(1) enrollees' overall satisfaction with their health care
plan;
(2) consumers' perception of access to emergency, urgent,
routine, and preventive care, including locations, hours,
waiting times, and access to care when needed;
(3) premiums and costs;
(4) technical competence of providers;
(5) communication, courtesy, respect, reassurance, and
support;
(6) choice and continuity of providers;
(7) continuity of care;
(8) outcomes of care;
(9) services offered by the plan, including range of
services, coverage for preventive and routine services, and
coverage for illness and hospitalization;
(10) availability of information; and
(11) paperwork.
(b) The health data institute shall appoint a consumer
advisory group which shall consist of 13 individuals,
representing enrollees from public and private health plan
companies and programs and two uninsured consumers, to advise
the health data institute on issues of concern to consumers.
The advisory group must have at least one member from each
regional coordinating board region of the state. The advisory
group expires June 30, 1996.
Sec. 30. Minnesota Statutes 1996, section 62M.02,
subdivision 21, is amended to read:
Subd. 21. [UTILIZATION REVIEW ORGANIZATION.] "Utilization
review organization" means an entity including but not limited
to an insurance company licensed under chapter 60A to offer,
sell, or issue a policy of accident and sickness insurance as
defined in section 62A.01; a health service plan licensed under
chapter 62C; a health maintenance organization licensed under
chapter 62D; a community integrated service network or an
integrated service network licensed under chapter 62N; a
fraternal benefit society operating under chapter 64B; a joint
self-insurance employee health plan operating under chapter 62H;
a multiple employer welfare arrangement, as defined in section 3
of the Employee Retirement Income Security Act of 1974 (ERISA),
United States Code, title 29, section 1103, as amended; a third
party administrator licensed under section 60A.23, subdivision
8, which conducts utilization review and determines
certification of an admission, extension of stay, or other
health care services for a Minnesota resident; or any entity
performing utilization review that is affiliated with, under
contract with, or conducting utilization review on behalf of, a
business entity in this state.
Sec. 31. Minnesota Statutes 1996, section 62N.01,
subdivision 1, is amended to read:
Subdivision 1. [CITATION.] This chapter may be cited as
the "Minnesota community integrated service network act."
Sec. 32. Minnesota Statutes 1996, section 62N.22, is
amended to read:
62N.22 [DISCLOSURE OF COMMISSIONS.]
Before selling any coverage or enrollment in a community
integrated service network or an integrated service network, a
person selling the coverage or enrollment shall disclose in
writing to the prospective purchaser the amount of any
commission or other compensation the person will receive as a
direct result of the sale. The disclosure may be expressed in
dollars or as a percentage of the premium. The amount disclosed
need not include any anticipated renewal commissions.
Sec. 33. Minnesota Statutes 1996, section 62N.23, is
amended to read:
62N.23 [TECHNICAL ASSISTANCE; LOANS.]
(a) The commissioner shall provide technical assistance to
parties interested in establishing or operating a community
integrated service network or an integrated service network.
This shall be known as the community integrated service network
technical assistance program (ISNTAP) (CISNTAP).
The technical assistance program shall offer seminars on
the establishment and operation of community integrated service
networks or integrated service networks in all regions of
Minnesota. The commissioner shall advertise these seminars in
local and regional newspapers, and attendance at these seminars
shall be free.
The commissioner shall write a guide to establishing and
operating a community integrated service network or an
integrated service network. The guide must provide basic
instructions for parties wishing to establish a community
integrated service network or an integrated service network.
The guide must be provided free of charge to interested
parties. The commissioner shall update this guide when
appropriate.
The commissioner shall establish a toll-free telephone line
that interested parties may call to obtain assistance in
establishing or operating a community integrated service network
or an integrated service network.
(b) The commissioner shall grant loans for organizational
and start-up expenses to entities forming community integrated
service networks or integrated service networks, or to networks
less than one year old, to the extent of any appropriation for
that purpose. The commissioner shall allocate the available
funds among applicants based upon the following criteria, as
evaluated by the commissioner within the commissioner's
discretion:
(1) the applicant's need for the loan;
(2) the likelihood that the loan will foster the formation
or growth of a network; and
(3) the likelihood of repayment.
The commissioner shall determine any necessary application
deadlines and forms and is exempt from rulemaking in doing so.
Sec. 34. Minnesota Statutes 1996, section 62N.25,
subdivision 5, is amended to read:
Subd. 5. [BENEFITS.] Community integrated service networks
must offer the health maintenance organization benefit set, as
defined in chapter 62D, and other laws applicable to entities
regulated under chapter 62D, except that the community
integrated service network may impose a deductible, not to
exceed $1,000 per person per year, provided that out-of-pocket
expenses on covered services do not exceed $3,000 per person or
$5,000 per family per year. The deductible must not apply to
preventive health services as described in Minnesota Rules, part
4685.0801, subpart 8. Community networks and chemical
dependency facilities under contract with a community network
shall use the assessment criteria in Minnesota Rules, parts
9530.6600 to 9530.6660, when assessing enrollees for chemical
dependency treatment.
Sec. 35. Minnesota Statutes 1996, section 62N.26, is
amended to read:
62N.26 [SHARED SERVICES COOPERATIVE.]
The commissioner of health shall establish, or assist in
establishing, a shared services cooperative organized under
chapter 308A to make available administrative and legal
services, technical assistance, provider contracting and billing
services, and other services to those community integrated
service networks and integrated service networks that choose to
participate in the cooperative. The commissioner shall provide,
to the extent funds are appropriated, start-up loans sufficient
to maintain the shared services cooperative until its operations
can be maintained by fees and contributions. The cooperative
must not be staffed, administered, or supervised by the
commissioner of health. The cooperative shall make use of
existing resources that are already available in the community,
to the extent possible.
Sec. 36. Minnesota Statutes 1996, section 62N.40, is
amended to read:
62N.40 [CHEMICAL DEPENDENCY SERVICES.]
Each community integrated service network and integrated
service network regulated under this chapter must ensure that
chemically dependent individuals have access to cost-effective
treatment options that address the specific needs of
individuals. These include, but are not limited to, the need
for: treatment that takes into account severity of illness and
comorbidities; provision of a continuum of care, including
treatment and rehabilitation programs licensed under Minnesota
Rules, parts 9530.4100 to 9530.4410 and 9530.5000 to 9530.6500;
the safety of the individual's domestic and community
environment; gender appropriate and culturally appropriate
programs; and access to appropriate social services.
Sec. 37. Minnesota Statutes 1996, section 62Q.01,
subdivision 3, is amended to read:
Subd. 3. [HEALTH PLAN.] "Health plan" means a health plan
as defined in section 62A.011; a policy, contract, or
certificate issued by a community integrated service network; or
an integrated service network.
Sec. 38. Minnesota Statutes 1996, section 62Q.01,
subdivision 4, is amended to read:
Subd. 4. [HEALTH PLAN COMPANY.] "Health plan company"
means:
(1) a health carrier as defined under section 62A.011,
subdivision 2; or
(2) an integrated service network as defined under section
62N.02, subdivision 8; or
(3) a community integrated service network as defined under
section 62N.02, subdivision 4a.
Sec. 39. Minnesota Statutes 1996, section 62Q.01,
subdivision 5, is amended to read:
Subd. 5. [MANAGED CARE ORGANIZATION.] "Managed care
organization" means: (1) a health maintenance organization
operating under chapter 62D; (2) a community integrated service
network as defined under section 62N.02, subdivision
4a; or (3) an integrated service network as defined under
section 62N.02, subdivision 8; or (4) an insurance company
licensed under chapter 60A, nonprofit health service plan
corporation operating under chapter 62C, fraternal benefit
society operating under chapter 64B, or any other health plan
company, to the extent that it covers health care services
delivered to Minnesota residents through a preferred provider
organization or a network of selected providers.
Sec. 40. Minnesota Statutes 1996, section 62Q.03,
subdivision 5a, is amended to read:
Subd. 5a. [PUBLIC PROGRAMS.] (a) A separate risk
adjustment system must be developed for state-run public
programs, including medical assistance, general assistance
medical care, and MinnesotaCare. The system must be developed
in accordance with the general risk adjustment methodologies
described in this section, must include factors in addition to
age and sex adjustment, and may include additional demographic
factors, different targeted conditions, and/or different payment
amounts for conditions. The risk adjustment system for public
programs must attempt to reflect the special needs related to
poverty, cultural, or language barriers and other needs of the
public program population.
(b) The commissioners of health and human services shall
jointly convene a public programs risk adjustment work group
responsible for advising the commissioners in the design of the
public programs risk adjustment system. The public programs
risk adjustment work group is governed by section 15.059 for
purposes of membership terms and removal of members and shall
terminate on June 30, 1999. The work group shall meet at the
discretion of the commissioners of health and human services.
The commissioner of health shall work with the risk adjustment
association to ensure coordination between the risk adjustment
systems for the public and private sectors. The commissioner of
human services shall seek any needed federal approvals necessary
for the inclusion of the medical assistance program in the
public programs risk adjustment system.
(c) The public programs risk adjustment work group must be
representative of the persons served by publicly paid health
programs and providers and health plans that meet their needs.
To the greatest extent possible, the appointing authorities
shall attempt to select representatives that have historically
served a significant number of persons in publicly paid health
programs or the uninsured. Membership of the work group shall
be as follows:
(1) one provider member appointed by the Minnesota Medical
Association;
(2) two provider members appointed by the Minnesota
Hospital Association, at least one of whom must represent a
major disproportionate share hospital;
(3) five members appointed by the Minnesota Council of
HMOs, one of whom must represent an HMO with fewer than 50,000
enrollees located outside the metropolitan area and one of whom
must represent an HMO with at least 50 percent of total
membership enrolled through a public program;
(4) two representatives of counties appointed by the
Association of Minnesota Counties;
(5) three representatives of organizations representing the
interests of families, children, childless adults, and elderly
persons served by the various publicly paid health programs
appointed by the governor;
(6) two representatives of persons with mental health,
developmental or physical disabilities, chemical dependency, or
chronic illness appointed by the governor; and
(7) three public members appointed by the governor, at
least one of whom must represent a community health board. The
risk adjustment association may appoint a representative, if a
representative is not otherwise appointed by an appointing
authority.
(d) The commissioners of health and human services, with
the advice of the public programs risk adjustment work group,
shall develop a work plan and time frame and shall coordinate
their efforts with the private sector risk adjustment
association's activities and other state initiatives related to
public program managed care reimbursement. The commissioners of
health and human services shall report to the health care
commission and to the appropriate legislative committees on
January 15, 1996, and on January 15, 1997, on any policy or
legislative changes necessary to implement the public program
risk adjustment system.
Sec. 41. Minnesota Statutes 1996, section 62Q.106, is
amended to read:
62Q.106 [DISPUTE RESOLUTION BY COMMISSIONER.]
A complainant may at any time submit a complaint to the
appropriate commissioner to investigate. After investigating a
complaint, or reviewing a company's decision, the appropriate
commissioner may order a remedy as authorized under section
62N.04, 62Q.30, or chapter 45, 60A, or 62D.
Sec. 42. Minnesota Statutes 1996, section 62Q.19,
subdivision 1, is amended to read:
Subdivision 1. [DESIGNATION.] The commissioner shall
designate essential community providers. The criteria for
essential community provider designation shall be the following:
(1) a demonstrated ability to integrate applicable
supportive and stabilizing services with medical care for
uninsured persons and high-risk and special needs populations as
defined in section 62Q.07, subdivision 2, paragraph (e),
underserved, and other special needs populations; and
(2) a commitment to serve low-income and underserved
populations by meeting the following requirements:
(i) has nonprofit status in accordance with chapter 317A;
(ii) has tax exempt status in accordance with the Internal
Revenue Service Code, section 501(c)(3);
(iii) charges for services on a sliding fee schedule based
on current poverty income guidelines; and
(iv) does not restrict access or services because of a
client's financial limitation;
(3) status as a local government unit as defined in section
62D.02, subdivision 11, a hospital district created or
reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health
board as defined in chapter 145A; or
(4) a former state hospital that specializes in the
treatment of cerebral palsy, spina bifida, epilepsy, closed head
injuries, specialized orthopedic problems, and other disabling
conditions; or
(5) a rural hospital that has qualified for a sole
community hospital financial assistance grant in the past three
years under section 144.1484, subdivision 1. For these rural
hospitals, the essential community provider designation applies
to all health services provided, including both inpatient and
outpatient services.
Prior to designation, the commissioner shall publish the
names of all applicants in the State Register. The public shall
have 30 days from the date of publication to submit written
comments to the commissioner on the application. No designation
shall be made by the commissioner until the 30-day period has
expired.
The commissioner may designate an eligible provider as an
essential community provider for all the services offered by
that provider or for specific services designated by the
commissioner.
For the purpose of this subdivision, supportive and
stabilizing services include at a minimum, transportation, child
care, cultural, and linguistic services where appropriate.
Sec. 43. Minnesota Statutes 1996, section 62Q.33,
subdivision 2, is amended to read:
Subd. 2. [REPORT ON SYSTEM DEVELOPMENT.] The commissioner
of health, in consultation with the state community health
services advisory committee and the commissioner of human
services, and representatives of local health departments,
county government, a municipal government acting as a local
board of health, the Minnesota health care commission, area
Indian health services, health care providers, and citizens
concerned about public health, shall coordinate the process for
defining implementation and financing responsibilities of the
local government core public health functions. The commissioner
shall submit recommendations and an initial and final report on
local government core public health functions according to the
timeline established in subdivision 5.
Sec. 44. Minnesota Statutes 1996, section 62Q.45,
subdivision 2, is amended to read:
Subd. 2. [DEFINITION.] For purposes of this section,
"managed care organization" means: (1) a health maintenance
organization operating under chapter 62D; (2) a community
integrated service network as defined under section 62N.02,
subdivision 4a; or (3) an integrated service network as defined
under section 62N.02, subdivision 8; or (4) an insurance company
licensed under chapter 60A, nonprofit health service plan
corporation operating under chapter 62C, fraternal benefit
society operating under chapter 64B, or any other health plan
company, to the extent that it covers health care services
delivered to Minnesota residents through a preferred provider
organization or a network of selected providers.
Sec. 45. [62Q.54] [REFERRALS FOR RESIDENTS OF HEALTH CARE
FACILITIES.]
If an enrollee is a resident of a health care facility
licensed under chapter 144A or a housing with services
establishment registered under chapter 144D, the enrollee's
primary care physician must refer the enrollee to that
facility's skilled nursing unit or that facility's appropriate
care setting, provided that the health plan company and the
provider can best meet the patient's needs in that setting, if
the following conditions are met:
(1) the facility agrees to be reimbursed at that health
plan company's contract rate negotiated with similar providers
for the same services and supplies; and
(2) the facility meets all guidelines established by the
health plan company related to quality of care, utilization,
referral authorization, risk assumption, use of health plan
company network, and other criteria applicable to providers
under contract for the same services and supplies.
Sec. 46. [62Q.65] [ACCESS TO PROVIDER DISCOUNTS.]
Subdivision 1. [REQUIREMENT.] A high deductible health
plan must, when used in connection with a medical savings
account, provide the enrollee access to any discounted provider
fees for services covered by the high deductible health plan,
regardless of whether the enrollee has satisfied the deductible
for the high deductible health plan.
Subd. 2. [DEFINITIONS.] For purposes of this section, the
following terms have the meanings given:
(1) "high deductible health plan" has the meaning given
under the Internal Revenue Code of 1986, section 220(c)(2);
(2) "medical savings account" has the meaning given under
the Internal Revenue Code of 1986, section 220(d)(1); and
(3) "discounted provider fees" means fees contained in a
provider agreement entered into by the issuer of the high
deductible health plan, or an affiliate of the issuer, for use
in connection with the high deductible health plan.
Sec. 47. Minnesota Statutes 1996, section 136A.1355, is
amended to read:
136A.1355 [RURAL PHYSICIANS.]
Subdivision 1. [CREATION OF ACCOUNT.] A rural physician
education account is established in the health care access
fund. The higher education services office shall use money from
the account to establish a loan forgiveness program for
medical students residents agreeing to practice in designated
rural areas, as defined by the commissioner.
Subd. 2. [ELIGIBILITY.] To be eligible to participate in
the program, a prospective physician must submit a letter of
interest to the higher education services office. A student or
resident who is accepted must sign a contract to agree to serve
at least three of the first five years following residency in a
designated rural area.
Subd. 3. [LOAN FORGIVENESS.] For fiscal years beginning on
and after July 1, 1995, the higher education services office may
accept up to four applicants who are fourth year medical
students, three 12 applicants who are medical residents, four
applicants who are pediatric residents, and four six applicants
who are family practice residents, and one applicant who is
an two applicants who are internal medicine resident residents,
per fiscal year for participation in the loan forgiveness
program. If the higher education services office does not
receive enough applicants per fiscal year to fill the number of
residents in the specific areas of practice, the resident
applicants may be from any area of practice. The eight 12
resident applicants may be in any year of training; however,
priority must be given to the following categories of residents
in descending order: third year residents, second year
residents, and first year residents. Applicants are responsible
for securing their own loans. Applicants chosen to participate
in the loan forgiveness program may designate for each year of
medical school, up to a maximum of four years, an agreed amount,
not to exceed $10,000, as a qualified loan. For each year that
a participant serves as a physician in a designated rural area,
up to a maximum of four years, the higher education services
office shall annually pay an amount equal to one year of
qualified loans. Participants who move their practice from one
designated rural area to another remain eligible for loan
repayment. In addition, if a resident participating in the loan
forgiveness program serves at least four weeks during a year of
residency substituting for a rural physician to temporarily
relieve the rural physician of rural practice commitments to
enable the rural physician to take a vacation, engage in
activities outside the practice area, or otherwise be relieved
of rural practice commitments, the participating resident may
designate up to an additional $2,000, above the $10,000 maximum,
for each year of residency during which the resident substitutes
for a rural physician for four or more weeks.
Subd. 4. [PENALTY FOR NONFULFILLMENT.] If a participant
does not fulfill the required three-year minimum commitment of
service in a designated rural area, the higher education
services office shall collect from the participant the amount
paid by the commissioner under the loan forgiveness program.
The higher education services office shall deposit the money
collected in the rural physician education account established
in subdivision 1. The commissioner shall allow waivers of all
or part of the money owed the commissioner if emergency
circumstances prevented fulfillment of the three-year service
commitment.
Subd. 5. [LOAN FORGIVENESS; UNDERSERVED URBAN
COMMUNITIES.] For fiscal years beginning on and after July 1,
1995, the higher education services office may accept up to four
applicants who are either fourth year medical students, or
residents in family practice, pediatrics, or internal medicine
per fiscal year for participation in the urban primary care
physician loan forgiveness program. The resident applicants may
be in any year of residency training; however, priority will be
given to the following categories of residents in descending
order: third year residents, second year residents, and first
year residents. If the higher education services office does
not receive enough qualified applicants per fiscal year to fill
the number of slots for urban underserved communities, the slots
may be allocated to students or residents who have applied for
the rural physician loan forgiveness program in subdivision 1.
Applicants are responsible for securing their own loans. For
purposes of this provision, "qualifying educational loans" are
government and commercial loans for actual costs paid for
tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a
health care professional. Applicants chosen to participate in
the loan forgiveness program may designate for each year of
medical school, up to a maximum of four years, an agreed amount,
not to exceed $10,000, as a qualified loan. For each year that
a participant serves as a physician in a designated underserved
urban area, up to a maximum of four years, the higher education
services office shall annually pay an amount equal to one year
of qualified loans. Participants who move their practice from
one designated underserved urban community to another remain
eligible for loan repayment.
Sec. 48. Minnesota Statutes 1996, section 144.147,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITION.] "Eligible rural hospital"
means any nonfederal, general acute care hospital that:
(1) is either located in a rural area, as defined in the
federal Medicare regulations, Code of Federal Regulations, title
42, section 405.1041, or located in a community with a
population of less than 5,000, according to United States Census
Bureau statistics, outside the seven-county metropolitan area;
(2) has 100 50 or fewer beds; and
(3) is not for profit; and
(4) has not been awarded a grant under the federal rural
health transition grant program, which would be received
concurrently with any portion of the grant period for this
program.
Sec. 49. Minnesota Statutes 1996, section 144.147,
subdivision 2, is amended to read:
Subd. 2. [GRANTS AUTHORIZED.] The commissioner shall
establish a program of grants to assist eligible rural
hospitals. The commissioner shall award grants to hospitals and
communities for the purposes set forth in paragraphs (a) and (b).
(a) Grants may be used by hospitals and their communities
to develop strategic plans for preserving or enhancing access to
health services. At a minimum, a strategic plan must consist of:
(1) a needs assessment to determine what health services
are needed and desired by the community. The assessment must
include interviews with or surveys of area health professionals,
local community leaders, and public hearings;
(2) an assessment of the feasibility of providing needed
health services that identifies priorities and timeliness for
potential changes; and
(3) an implementation plan.
The strategic plan must be developed by a committee that
includes representatives from the hospital, local public health
agencies, other health providers, and consumers from the
community.
(b) The grants may also be used by eligible rural hospitals
that have developed strategic plans to implement transition
projects to modify the type and extent of services provided, in
order to reflect the needs of that plan. Grants may be used by
hospitals under this paragraph to develop hospital-based
physician practices that integrate hospital and existing medical
practice facilities that agree to transfer their practices,
equipment, staffing, and administration to the hospital. The
grants may also be used by the hospital to establish a health
provider cooperative, a telemedicine system, or a rural health
care system. Not more than one-third of any grant shall be used
to offset losses incurred by physicians agreeing to transfer
their practices to hospitals.
Sec. 50. Minnesota Statutes 1996, section 144.147,
subdivision 3, is amended to read:
Subd. 3. [CONSIDERATION OF GRANTS.] In determining which
hospitals will receive grants under this section, the
commissioner shall take into account:
(1) improving community access to hospital or health
services;
(2) changes in service populations;
(3) demand for ambulatory and emergency services;
(4) the extent that the health needs of the community are
not currently being met by other providers in the service area;
(5) the need to recruit and retain health professionals;
(6) the involvement and extent of community support of the
community and local health care providers; and
(7) the coordination with local community organizations,
such as community development and public health agencies; and
(8) the financial condition of the hospital.
Sec. 51. Minnesota Statutes 1996, section 144.147,
subdivision 4, is amended to read:
Subd. 4. [ALLOCATION OF GRANTS.] (a) Eligible hospitals
must apply to the commissioner no later than September 1 of each
fiscal year for grants awarded for that fiscal year. A grant
may be awarded upon signing of a grant contract.
(b) The commissioner must make a final decision on the
funding of each application within 60 days of the deadline for
receiving applications.
(c) Each relevant community health board has 30 days in
which to review and comment to the commissioner on grant
applications from hospitals in their community health service
area.
(d) In determining which hospitals will receive grants
under this section, the commissioner shall consider the
following factors:
(1) Description of the problem, description of the project,
and the likelihood of successful outcome of the project. The
applicant must explain clearly the nature of the health services
problems in their service area, how the grant funds will be
used, what will be accomplished, and the results expected. The
applicant should describe achievable objectives, a timetable,
and roles and capabilities of responsible individuals and
organizations.
(2) The extent of community support for the hospital and
this proposed project. The applicant should demonstrate support
for the hospital and for the proposed project from other local
health service providers and from local community and government
leaders. Evidence of such support may include past commitments
of financial support from local individuals, organizations, or
government entities; and commitment of financial support,
in-kind services or cash, for this project.
(3) The comments, if any, resulting from a review of the
application by the community health board in whose community
health service area the hospital is located.
(e) In evaluating applications, the commissioner shall
score each application on a 100 point scale, assigning the
maximum of 70 points for an applicant's understanding of the
problem, description of the project, and likelihood of
successful outcome of the project; and a maximum of 30 points
for the extent of community support for the hospital and this
project. The commissioner may also take into account other
relevant factors.
(f) A grant to a hospital, including hospitals that submit
applications as consortia, may not exceed $37,500 $50,000 a year
and may not exceed a term of two years. Prior to the receipt of
any grant, the hospital must certify to the commissioner that at
least one-half of the amount, which may include in-kind
services, is available for the same purposes from nonstate
sources. A hospital receiving a grant under this section may
use the grant for any expenses incurred in the development of
strategic plans or the implementation of transition projects
with respect to which the grant is made. Project grants may not
be used to retire debt incurred with respect to any capital
expenditure made prior to the date on which the project is
initiated.
(g) The commissioner may adopt rules to implement this
section.
Sec. 52. [144.1475] [RURAL HOSPITAL DEMONSTRATION
PROJECT.]
Subdivision 1. [ESTABLISHMENT.] The commissioner of
health, for the biennium ending June 30, 1999, shall establish
at least three demonstration projects per fiscal year to assist
rural hospitals in the planning and implementation process to
either consolidate or cooperate with another existing hospital
in its service area to provide better quality health care to its
community. A demonstration project must include at least two
eligible hospitals. For purposes of this section, an "eligible
hospital" means a hospital that:
(1) is located outside the seven-county metropolitan area;
(2) has 50 or fewer licensed beds; and
(3) is located within a 25-mile radius of another hospital.
At least one of the eligible hospitals in a demonstration
project must have had a negative operating margin during one of
the two years prior to application.
Subd. 2. [APPLICATION.] (a) An eligible hospital seeking
to be a participant in a demonstration project must submit an
application to the commissioner of health detailing the
hospital's efforts to consolidate health care delivery in its
service area, cooperate with another hospital in the delivery of
health care, or both consolidate and cooperate. Applications
must be submitted by October 15 of each fiscal year for grants
awarded for that fiscal year.
(b) Applications must:
(1) describe the problem that the proposed consolidation or
cooperation will address, the consolidation or cooperation
project, how the grant funds will be used, what will be
accomplished, and the results expected;
(2) describe achievable objectives, a timetable, and the
roles and capabilities of responsible individuals and
organizations;
(3) include written commitments from the applicant hospital
and at least one other hospital that will participate in the
consolidation or cooperation demonstration project, that specify
the activities the organization will undertake during the
project, the resources the organization will contribute to the
demonstration project, and the expected role and nature of the
organization's involvement in proposed consolidation or
cooperation activities; and
(4) provide evidence of support for the proposed project
from other local health service providers and from local
community and government leaders.
Subd. 3. [GRANTS.] The commissioner of health shall
allocate a grant of up to $100,000 to the highest scoring
applicants each year until available funding is expended.
Grants may be used by eligible hospitals to:
(1) conduct consolidation or cooperation negotiations;
(2) develop consolidation or cooperation plans, including
financial plans and architectural designs;
(3) seek community input and conduct community education on
proposed or planned consolidations or cooperative activities;
and
(4) implement consolidation or cooperation plans.
Subd. 4. [CONSIDERATION OF GRANTS.] In evaluating
applications, the commissioner shall score each application on a
100 point scale, assigning: a maximum of 40 points for an
applicant's understanding of the problem, description of the
project, and likelihood of successful outcome of the project; a
maximum of 30 points for explicit and unequivocal written
commitments from organizations participating in the project; a
maximum of 20 points for matching funds or in-kind services
committed by the applicant or others to the project; and a
maximum of ten points for the extent of community support for
the project. The commissioner shall consider the comments, if
any, resulting from a review of the application by the community
health board in whose community health service area the
applicant is located. The commissioner may also take into
account other relevant factors.
Subd. 5. [EVALUATION.] The commissioner of health shall
evaluate the overall effectiveness of the demonstration projects
and report to the legislature by September 1, 2000. The
commissioner may collect, from the hospitals receiving grants,
any information necessary to evaluate the demonstration project.
Sec. 53. [144.148] [RURAL HOSPITAL CAPITAL IMPROVEMENT
GRANT AND LOAN PROGRAM.]
Subdivision 1. [DEFINITION.] (a) For purposes of this
section, the following definitions apply.
(b) "Eligible rural hospital" means a hospital that:
(1) is located outside the seven-county metropolitan area;
(2) has 50 or fewer licensed hospital beds with a net
hospital operating margin not greater than two percent in the
two fiscal years prior to application; and
(3) is 25 miles or more from another hospital.
(c) "Eligible project" means a modernization project to
update, remodel, or replace aging hospital facilities and
equipment necessary to maintain the operations of a hospital.
Subd. 2. [PROGRAM.] The commissioner of health shall award
rural hospital capital improvement grants or loans to eligible
rural hospitals. A grant or loan shall not exceed $1,500,000
per hospital. Grants or loans shall be interest free. An
eligible rural hospital may apply the funds retroactively to
capital improvements made during the two fiscal years preceding
the fiscal year in which the grant or loan was received,
provided the hospital met the eligibility criteria during that
time period.
Subd. 3. [APPLICATIONS.] Eligible hospitals seeking a
grant or loan shall apply to the commissioner. Applications
must include a description of the problem that the proposed
project will address, a description of the project including
construction and remodeling drawings or specifications, sources
of funds for the project, uses of funds for the project, the
results expected, and a plan to maintain or operate any facility
or equipment included in the project. The applicant must
describe achievable objectives, a timetable, and roles and
capabilities of responsible individuals and organization.
Applicants must submit to the commissioner evidence that
competitive bidding was used to select contractors for the
project.
Subd. 4. [CONSIDERATION OF APPLICATIONS.] The commissioner
shall review each application to determine whether or not the
hospital's application is complete and whether the hospital and
the project are eligible for a grant or loan. In evaluating
applications, the commissioner shall score each application on a
100 point scale, assigning: a maximum of 40 points for an
applicant's clarity and thoroughness in describing the problem
and the project; a maximum of 40 points for the extent to which
the applicant has demonstrated that it has made adequate
provisions to assure proper and efficient operation of the
facility once the project is completed; and a maximum of 20
points for the extent to which the proposed project is
consistent with the hospital's capital improvement plan or
strategic plan. The commissioner may also take into account
other relevant factors. During application review, the
commissioner may request additional information about a proposed
project, including information on project cost. Failure to
provide the information requested disqualifies a loan applicant.
Subd. 5. [PROGRAM OVERSIGHT.] The commissioner of health
shall review audited financial information of the hospital to
assess eligibility. The commissioner shall determine the amount
of a grant or loan to be given to an eligible rural hospital
based on the relative score of each eligible hospital's
application and the funds available to the commissioner. The
grant or loan shall be used to update, remodel, or replace aging
facilities and equipment necessary to maintain the operations of
the hospital.
Subd. 6. [LOAN PAYMENT.] Loans shall be repaid as provided
in this subdivision over a period of 15 years. In those years
when an eligible rural hospital experiences a positive net
operating margin in excess of two percent, the eligible rural
hospital shall pay to the state one-half of the excess above two
percent, up to the yearly payment amount based upon a loan
period of 15 years. If the amount paid back in any year is less
than the yearly payment amount, or if no payment is required
because the eligible rural hospital does not experience a
positive net operating margin in excess of two percent, the
amount unpaid for that year shall be forgiven by the state
without any financial penalty. As a condition of receiving an
award through this program, eligible hospitals must agree to any
and all collection activities the commissioner finds necessary
to collect loan payments in those years a payment is due.
Subd. 7. [ACCOUNTING TREATMENT.] The commissioner of
finance shall record as grants in the state accounting system
funds obligated by this section. Loan payments received under
this section shall be deposited in the health care access fund.
Subd. 8. [EXPIRATION.] This section expires June 30, 1999.
Sec. 54. Minnesota Statutes 1996, section 144.1484,
subdivision 1, is amended to read:
Subdivision 1. [SOLE COMMUNITY HOSPITAL FINANCIAL
ASSISTANCE GRANTS.] The commissioner of health shall award
financial assistance grants to rural hospitals in isolated areas
of the state. To qualify for a grant, a hospital must: (1) be
eligible to be classified as a sole community hospital according
to the criteria in Code of Federal Regulations, title 42,
section 412.92 or be located in a community with a population of
less than 5,000 and located more than 25 miles from a like
hospital currently providing acute short-term services; (2) have
experienced net operating income losses in the two of the
previous three most recent consecutive hospital fiscal years for
which audited financial information is available; (3) consist of
40 or fewer licensed beds; and (4) demonstrate to the
commissioner that it has obtained local support for the hospital
and that any state support awarded under this program will not
be used to supplant local support for the hospital. The
commissioner shall review audited financial statements of the
hospital to assess the extent of local support. Evidence of
local support may include bonds issued by a local government
entity such as a city, county, or hospital district for the
purpose of financing hospital projects; and loans, grants, or
donations to the hospital from local government entities,
private organizations, or individuals. The commissioner shall
determine the amount of the award to be given to each eligible
hospital based on the hospital's operating loss margin (total
operating losses as a percentage of total operating revenue) for
the two of the previous three most recent consecutive fiscal
years for which audited financial information is available and
the total amount of funding available. For purposes of
calculating a hospital's operating loss margin, total operating
revenue does not include grant funding provided under this
subdivision. One hundred percent of the available funds will be
disbursed proportionately based on the operating loss margins of
the eligible hospitals.
Sec. 55. Minnesota Statutes 1996, section 256.045,
subdivision 3a, is amended to read:
Subd. 3a. [PREPAID HEALTH PLAN APPEALS.] (a) All prepaid
health plans under contract to the commissioner under chapter
256B or 256D must provide for a complaint system according to
section 62D.11. When a prepaid health plan denies, reduces, or
terminates a health service or denies a request to authorize a
previously authorized health service, the prepaid health plan
must notify the recipient of the right to file a complaint or an
appeal. The notice must include the name and telephone number
of the ombudsman and notice of the recipient's right to request
a hearing under paragraph (b). When a complaint is filed, the
prepaid health plan must notify the ombudsman within three
working days. Recipients may request the assistance of the
ombudsman in the complaint system process. The prepaid health
plan must issue a written resolution of the complaint to the
recipient within 30 days after the complaint is filed with the
prepaid health plan. A recipient is not required to exhaust the
complaint system procedures in order to request a hearing under
paragraph (b).
(b) Recipients enrolled in a prepaid health plan under
chapter 256B or 256D may contest a prepaid health plan's denial,
reduction, or termination of health services, a prepaid health
plan's denial of a request to authorize a previously authorized
health service, or the prepaid health plan's written resolution
of a complaint by submitting a written request for a hearing
according to subdivision 3. A state human services referee
shall conduct a hearing on the matter and shall recommend an
order to the commissioner of human services. The commissioner
need not grant a hearing if the sole issue raised by a recipient
is the commissioner's authority to require mandatory enrollment
in a prepaid health plan in a county where prepaid health plans
are under contract with the commissioner. The state human
services referee may order a second medical opinion from the
prepaid health plan or may order a second medical opinion from a
nonprepaid health plan provider at the expense of the prepaid
health plan. Recipients may request the assistance of the
ombudsman in the appeal process.
(c) In the written request for a hearing to appeal from a
prepaid health plan's denial, reduction, or termination of a
health service, a prepaid health plan's denial of a request to
authorize a previously authorized service, or the prepaid health
plan's written resolution to a complaint, a recipient may
request an expedited hearing. If an expedited appeal is
warranted, the state human services referee shall hear the
appeal and render a decision within a time commensurate with the
level of urgency involved, based on the individual circumstances
of the case.
Sec. 56. Minnesota Statutes 1996, section 256.9363,
subdivision 1, is amended to read:
Subdivision 1. [SELECTION OF VENDORS.] In order to contain
costs, the commissioner of human services shall select vendors
of medical care who can provide the most economical care
consistent with high medical standards and shall, where
possible, contract with organizations on a prepaid capitation
basis to provide these services. The commissioner shall
consider proposals by counties and vendors for managed care
plans which may include: prepaid capitation programs,
competitive bidding programs, or other vendor payment mechanisms
designed to provide services in an economical manner or to
control utilization, with safeguards to ensure that necessary
services are provided. Managed care plans may include
integrated service networks as defined in section 62N.02.
Sec. 57. Minnesota Statutes 1996, section 256.9657,
subdivision 3, is amended to read:
Subd. 3. [HEALTH MAINTENANCE ORGANIZATION; COMMUNITY
INTEGRATED SERVICE NETWORK SURCHARGE.] (a) Effective October 1,
1992, each health maintenance organization with a certificate of
authority issued by the commissioner of health under chapter 62D
and each integrated service network and community integrated
service network licensed by the commissioner under chapter 62N
shall pay to the commissioner of human services a surcharge
equal to six-tenths of one percent of the total premium revenues
of the health maintenance organization, integrated service
network, or community integrated service network as reported to
the commissioner of health according to the schedule in
subdivision 4.
(b) For purposes of this subdivision, total premium revenue
means:
(1) premium revenue recognized on a prepaid basis from
individuals and groups for provision of a specified range of
health services over a defined period of time which is normally
one month, excluding premiums paid to a health maintenance
organization, integrated service network, or community
integrated service network from the Federal Employees Health
Benefit Program;
(2) premiums from Medicare wrap-around subscribers for
health benefits which supplement Medicare coverage;
(3) Medicare revenue, as a result of an arrangement between
a health maintenance organization, an integrated service
network, or a community integrated service network and the
health care financing administration of the federal Department
of Health and Human Services, for services to a Medicare
beneficiary; and
(4) medical assistance revenue, as a result of an
arrangement between a health maintenance organization,
integrated service network, or community integrated service
network and a Medicaid state agency, for services to a medical
assistance beneficiary.
If advance payments are made under clause (1) or (2) to the
health maintenance organization, integrated service network, or
community integrated service network for more than one reporting
period, the portion of the payment that has not yet been earned
must be treated as a liability.
(c) When a health maintenance organization or an integrated
service network or community integrated service network merges
or consolidates with or is acquired by another health
maintenance organization, integrated service network, or
community integrated service network, the surviving corporation
or the new corporation shall be responsible for the annual
surcharge originally imposed on each of the entities or
corporations subject to the merger, consolidation, or
acquisition, regardless of whether one of the entities or
corporations does not retain a certificate of authority under
chapter 62D or a license under chapter 62N.
(d) Effective July 1 of each year, the surviving
corporation's or the new corporation's surcharge shall be based
on the revenues earned in the second previous calendar year by
all of the entities or corporations subject to the merger,
consolidation, or acquisition regardless of whether one of the
entities or corporations does not retain a certificate of
authority under chapter 62D or a license under chapter 62N until
the total premium revenues of the surviving corporation include
the total premium revenues of all the merged entities as
reported to the commissioner of health.
(e) When a health maintenance organization, integrated
service network, or community integrated service network, which
is subject to liability for the surcharge under this chapter,
transfers, assigns, sells, leases, or disposes of all or
substantially all of its property or assets, liability for the
surcharge imposed by this chapter is imposed on the transferee,
assignee, or buyer of the health maintenance organization,
integrated service network, or community integrated service
network.
(f) In the event a health maintenance organization,
integrated service network, or community integrated service
network converts its licensure to a different type of entity
subject to liability for the surcharge under this chapter, but
survives in the same or substantially similar form, the
surviving entity remains liable for the surcharge regardless of
whether one of the entities or corporations does not retain a
certificate of authority under chapter 62D or a license under
chapter 62N.
(g) The surcharge assessed to a health maintenance
organization, integrated service network, or community
integrated service network ends when the entity ceases providing
services for premiums and the cessation is not connected with a
merger, consolidation, acquisition, or conversion.
Sec. 58. [MEIP STUDY.]
The commissioner of employee relations shall study the
current Minnesota employees insurance program (MEIP) and report
to the legislature by January 15, 1998, on recommendations on
whether this program provides greater accessibility to small
employers for purchasing health insurance and on the continued
viability of the program, including whether the program could be
modified in terms of underwriting, marketing, and advertising to
create a program that would provide a cost incentive for small
employers to purchase health coverage through this program.
Sec. 59. [MCHA STANDARDS STUDY.]
The commissioner of commerce, in consultation with the
commissioner of health, shall study and make recommendations
regarding the feasibility of establishing a comprehensive set of
eligibility standards for coverage under the Minnesota
comprehensive health association and on guaranteed issuance in
the individual market for individuals who do not meet the
eligibility standards for coverage under the Minnesota
comprehensive health association. The recommendations shall be
reported to the legislature by January 15, 1998.
Sec. 60. [PRESCRIPTION DRUG INSURANCE PROGRAM.]
The commissioner of commerce shall study the feasibility of
providing an insurance program to provide prescription drugs to
Minnesotans who are 65 and older. The program shall be
administered by the Minnesota comprehensive health association,
but shall be separate from the health coverage programs operated
by the association under Minnesota Statutes, chapter 62E. In
studying the feasibility of the program, the commissioner shall
incorporate, to the extent feasible, the administrative
procedures and health care delivery methods used by the
association under Minnesota Statutes, chapter 62E. The
commissioner shall study the program based upon independent
actuarial analysis, and shall present recommendations to the
legislature by December 15, 1997.
Sec. 61. [PUBLIC PROGRAMS RATE SETTING AND RISK
ADJUSTMENT.]
The commissioners of health and of human services shall
submit a coordinated report on rate setting and risk adjustment
methods to the legislature by February 1, 1998. An interim
report shall be provided to the legislative commission on health
care access to facilitate a public hearing and testimony prior
to the 1998 legislative session. Changes in the rate setting
and risk adjustment methods shall not be implemented until after
the 1998 legislative session.
Sec. 62. [REVISOR INSTRUCTIONS.]
The revisor of statutes shall delete references to
"integrated service network," but not "community integrated
service network," wherever it appears in Minnesota Statutes and
make conforming changes as necessary.
Sec. 63. [REPEALER.]
(a) Minnesota Statutes 1996, sections 62E.11, subdivision
12; 62J.03, subdivision 3; 62J.04, subdivisions 4 and 7; 62J.05;
62J.051; 62J.09, subdivision 3a; 62J.37; 62N.01, subdivision 2;
62N.02, subdivisions 2, 3, 4b, 4c, 6, 7, 8, 9, 10, and 12;
62N.03; 62N.04; 62N.05; 62N.06; 62N.065; 62N.071; 62N.072;
62N.073; 62N.074; 62N.076; 62N.077; 62N.078; 62N.10; 62N.11;
62N.12; 62N.13; 62N.14; 62N.15; 62N.17; 62N.18; 62N.24; 62N.38;
62Q.165, subdivision 3; 62Q.25; 62Q.29; 62Q.41 and 147.01,
subdivision 6, are repealed.
(b) Laws 1993, chapter 247, article 4, section 8; Laws
1995, chapter 96, section 2; and Laws 1995, First Special
Session chapter 3, article 13, section 2, are repealed.
(c) Laws 1994, chapter 625, article 5, section 5, as
amended by Laws 1995, chapter 234, article 3, section 8, is
repealed.
Sec. 64. [EFFECTIVE DATE.]
Section 23 is effective the day following final enactment.
Section 46 is effective January 1, 1998, and applies to high
deductible health plans issued or renewed on or after that date.
ARTICLE 3
MINNESOTACARE TAXES
Section 1. [16A.76] [FEDERAL RESERVE; HEALTH CARE ACCESS
FUND.]
Subdivision 1. [ESTABLISH RESERVE.] The federal
contingency reserve is established within the health care access
fund for uses necessary to preserve access to basic health care
services when federal funding is significantly reduced.
Subd. 2. [RESERVE FINANCING.] The funds in reserve shall
be equal to the amount of federal financial participation
received since July 1, 1995, for services and administrative
activities funded by the health care access fund up to a reserve
limit of $150,000,000. Investment income attributed to the
federal contingency reserve balances shall also be included in
the total reserve amount.
Subd. 3. [PERMITTED USE.] The federal contingency reserve
is established to protect access to basic health care services
that are publicly funded. Funds held in the federal contingency
reserve are available for appropriation in the event that
federal funds for basic health care services are significantly
reduced such as under federal reform or other significant
changes to federal law.
Subd. 4. [LIMITS ON USE.] The federal contingency reserve
is not available for supplementing reductions in federal funding
resulting from application of current federal law funding
formulas, for funding long-term care services, or for replacing
existing general fund commitments.
Sec. 2. Minnesota Statutes 1996, section 60A.15,
subdivision 1, is amended to read:
Subdivision 1. [DOMESTIC AND FOREIGN COMPANIES.] (a) On or
before April 1, June 1, and December 1 of each year, every
domestic and foreign company, including town and farmers' mutual
insurance companies, domestic mutual insurance companies, marine
insurance companies, health maintenance organizations,
integrated service networks, community integrated service
networks, and nonprofit health service plan corporations, shall
pay to the commissioner of revenue installments equal to
one-third of the insurer's total estimated tax for the current
year. Except as provided in paragraphs (d) and, (e), (g), and
(h), installments must be based on a sum equal to two percent of
the premiums described in paragraph (b).
(b) Installments under paragraph (a), (d), or (e) are
percentages of gross premiums less return premiums on all direct
business received by the insurer in this state, or by its agents
for it, in cash or otherwise, during such year.
(c) Failure of a company to make payments of at least
one-third of either (1) the total tax paid during the previous
calendar year or (2) 80 percent of the actual tax for the
current calendar year shall subject the company to the penalty
and interest provided in this section, unless the total tax for
the current tax year is $500 or less.
(d) For health maintenance organizations, nonprofit health
services service plan corporations, integrated service networks,
and community integrated service networks, the installments must
be based on an amount equal to one percent of premiums described
in paragraph (b) that are paid after December 31,
1995 determined under paragraph (g) or (h).
(e) For purposes of computing installments for town and
farmers' mutual insurance companies and for mutual property
casualty companies with total assets on December 31, 1989, of
$1,600,000,000 or less, the following rates apply:
(1) for all life insurance, two percent;
(2) for town and farmers' mutual insurance companies and
for mutual property and casualty companies with total assets of
$5,000,000 or less, on all other coverages, one percent; and
(3) for mutual property and casualty companies with total
assets on December 31, 1989, of $1,600,000,000 or less, on all
other coverages, 1.26 percent.
(f) Premiums under medical assistance, general assistance
medical care, the MinnesotaCare program, and the Minnesota
comprehensive health insurance plan and all payments, revenues,
and reimbursements received from the federal government for
Medicare-related coverage as defined in section 62A.31,
subdivision 3, paragraph (e), are not subject to tax under this
section.
(g) For calendar years 1998 and 1999, the installments for
health maintenance organizations, community integrated service
networks, and nonprofit health service plan corporations must be
based on an amount equal to one percent of premiums described
under paragraph (b). Health maintenance organizations,
community integrated service networks, and nonprofit health
service plan corporations that have met the cost containment
goals established under section 62J.04 in the individual and
small employer market for calendar year 1996 are exempt from
payment of the tax imposed under this section for premiums paid
after March 30, 1997, and before April 1, 1998. Health
maintenance organizations, community integrated service
networks, and nonprofit health service plan corporations that
have met the cost containment goals established under section
62J.04 in the individual and small employer market for calendar
year 1997 are exempt from payment of the tax imposed under this
section for premiums paid after March 30, 1998, and before April
1, 1999.
(h) For calendar years after 1999, the commissioner of
finance shall determine the balance of the health care access
fund on September 1 of each year beginning September 1, 1999.
If the commissioner determines that there is no structural
deficit for the next fiscal year, no tax shall be imposed under
paragraph (d) for the following calendar year. If the
commissioner determines that there will be a structural deficit
in the fund for the following fiscal year, then the
commissioner, in consultation with the commissioner of revenue,
shall determine the amount needed to eliminate the structural
deficit and a tax shall be imposed under paragraph (d) for the
following calendar year. The commissioner shall determine the
rate of the tax as either one-quarter of one percent, one-half
of one percent, three-quarters of one percent, or one percent of
premiums described in paragraph (b), whichever is the lowest of
those rates that the commissioner determines will produce
sufficient revenue to eliminate the projected structural
deficit. The commissioner of finance shall publish in the State
Register by October 1 of each year the amount of tax to be
imposed for the following calendar year.
(i) In approving the premium rates as required in sections
62L.08, subdivision 8, and 62A.65, subdivision 3, the
commissioners of health and commerce shall ensure that any
exemption from the tax as described in paragraphs (g) and (h) is
reflected in the premium rate.
Sec. 3. Minnesota Statutes 1996, section 256.9352,
subdivision 3, is amended to read:
Subd. 3. [FINANCIAL MANAGEMENT.] (a) The commissioner
shall manage spending for the MinnesotaCare program in a manner
that maintains a minimum reserve equal to five percent of the
expected cost of state premium subsidies in accordance with
section 16A.76. The commissioner must make a quarterly
assessment of the expected expenditures for the covered services
for the remainder of the current biennium and for the following
biennium. The estimated expenditure, including minimum the
reserve requirements described in section 16A.76, shall be
compared to an estimate of the revenues that will be deposited
in the health care access fund. Based on this comparison, and
after consulting with the chairs of the house ways and means
committee and the senate finance committee, and the legislative
commission on health care access, the commissioner shall, as
necessary, make the adjustments specified in paragraph (b) to
ensure that expenditures remain within the limits of available
revenues for the remainder of the current biennium and for the
following biennium. The commissioner shall not hire additional
staff using appropriations from the health care access fund
until the commissioner of finance makes a determination that the
adjustments implemented under paragraph (b) are sufficient to
allow MinnesotaCare expenditures to remain within the limits of
available revenues for the remainder of the current biennium and
for the following biennium.
(b) The adjustments the commissioner shall use must be
implemented in this order: first, stop enrollment of single
adults and households without children; second, upon 45 days'
notice, stop coverage of single adults and households without
children already enrolled in the MinnesotaCare program; third,
upon 90 days' notice, decrease the premium subsidy amounts by
ten percent for families with gross annual income above 200
percent of the federal poverty guidelines; fourth, upon 90 days'
notice, decrease the premium subsidy amounts by ten percent for
families with gross annual income at or below 200 percent; and
fifth, require applicants to be uninsured for at least six
months prior to eligibility in the MinnesotaCare program. If
these measures are insufficient to limit the expenditures to the
estimated amount of revenue, the commissioner shall further
limit enrollment or decrease premium subsidies.
The reserve referred to in this subdivision is appropriated
to the commissioner but may only be used upon approval of the
commissioner of finance, if estimated costs will exceed the
forecasted amount of available revenues after all adjustments
authorized under this subdivision have been made.
By February 1, 1995, the department of human services and
the department of health shall develop a plan to adjust benefit
levels, eligibility guidelines, or other steps necessary to
ensure that expenditures for the MinnesotaCare program are
contained within the two percent taxes imposed under section
295.52 and the gross premiums tax imposed under section 60A.15,
subdivision 1, paragraph (e), for fiscal year 1997.
(c) Notwithstanding paragraphs (a) and (b), the
commissioner shall proceed with the enrollment of single adults
and households without children in accordance with section
256.9354, subdivision 5, paragraph (a), even if the expenditures
do not remain within the limits of available revenues through
fiscal year 1997 to allow the departments of human services and
health to develop the plan required under paragraph (b).
Sec. 4. Minnesota Statutes 1996, section 295.50,
subdivision 3, is amended to read:
Subd. 3. [GROSS REVENUES.] "Gross revenues" are total
amounts received in money or otherwise by:
(1) a hospital for patient services;
(2) a surgical center for patient services;
(3) a health care provider, other than a staff model health
carrier, for patient services;
(4) a wholesale drug distributor for sale or distribution
of legend drugs that are delivered: (i) to a Minnesota resident
by a wholesale drug distributor who is a nonresident pharmacy
directly, by common carrier, or by mail; or (ii) in Minnesota by
the wholesale drug distributor, by common carrier, or by mail,
unless the legend drugs are delivered to another wholesale drug
distributor who sells legend drugs exclusively at wholesale.
Legend drugs do not include nutritional products as defined in
Minnesota Rules, part 9505.0325; and
(5) a staff model health plan company as gross premiums for
enrollees, copayments, deductibles, coinsurance, and fees for
patient services covered under its contracts with groups and
enrollees; and
(6) a pharmacy for medical supplies, appliances, and
equipment.
Sec. 5. Minnesota Statutes 1996, section 295.50,
subdivision 4, is amended to read:
Subd. 4. [HEALTH CARE PROVIDER.] (a) "Health care
provider" means:
(1) a person whose health care occupation is regulated or
required to be regulated by the state of Minnesota furnishing
any or all of the following goods or services directly to a
patient or consumer: medical, surgical, optical, visual,
dental, hearing, nursing services, drugs, medical supplies,
medical appliances, laboratory, diagnostic or therapeutic
services, or any; (2) a person who provides goods and services
not listed above in clause (1) that qualify for reimbursement
under the medical assistance program provided under chapter
256B. For purposes of this clause, "directly to a patient or
consumer" includes goods and services provided in connection
with independent medical examinations under section 65B.56 or
other examinations for purposes of litigation or insurance
claims;
(2) (3) a staff model health plan company; or
(3) (4) an ambulance service required to be licensed; or
(5) a person who sells or repairs hearing aids and related
equipment or prescription eyewear.
(b) Health care provider does not include hospitals,;
medical supplies distributors, except as specified under
paragraph (a), clause (5); nursing homes licensed under chapter
144A or licensed in any other jurisdiction,; pharmacies,;
surgical centers,; bus and taxicab transportation, or any other
providers of transportation services other than ambulance
services required to be licensed,; supervised living facilities
for persons with mental retardation or related conditions,
licensed under Minnesota Rules, parts 4665.0100 to 4665.9900,;
residential care homes licensed under chapter 144B,; board and
lodging establishments providing only custodial services that
are licensed under chapter 157 and registered under section
157.17 to provide supportive services or health supervision
services,; adult foster homes as defined in Minnesota Rules,
part 9555.5105,; day training and habilitation services for
adults with mental retardation and related conditions as defined
in section 252.41, subdivision 3,; and boarding care homes, as
defined in Minnesota Rules, part 4655.0100.
(c) For purposes of this subdivision, "directly to a
patient or consumer" includes goods and services provided in
connection with independent medical examinations under section
65B.56 or other examinations for purposes of litigation or
insurance claims.
Sec. 6. Minnesota Statutes 1996, section 295.50,
subdivision 6, is amended to read:
Subd. 6. [HOME HEALTH CARE SERVICES.] "Home health care
services" are services:
(1) defined under the state medical assistance program as
home health agency services provided by a home health agency,
personal care services and supervision of personal care
services, private duty nursing services, and waivered
services or services by home care providers required to be
licensed under chapter 144A; and
(2) provided at a recipient's residence, if the recipient
does not live in a hospital, nursing facility, as defined in
section 62A.46, subdivision 3, or intermediate care facility for
persons with mental retardation as defined in section 256B.055,
subdivision 12, paragraph (d).
Sec. 7. Minnesota Statutes 1996, section 295.50,
subdivision 7, is amended to read:
Subd. 7. [HOSPITAL.] "Hospital" means a hospital licensed
under chapter 144, or a hospital licensed by any other state or
province or territory of Canada jurisdiction.
Sec. 8. Minnesota Statutes 1996, section 295.50,
subdivision 13, is amended to read:
Subd. 13. [SURGICAL CENTER.] "Surgical center" is an
outpatient surgical center as defined in Minnesota Rules,
chapter 4675 or a similar facility located in any other state or
province or territory of Canada jurisdiction.
Sec. 9. Minnesota Statutes 1996, section 295.50,
subdivision 14, is amended to read:
Subd. 14. [WHOLESALE DRUG DISTRIBUTOR.] "Wholesale drug
distributor" means a wholesale drug distributor required to be
licensed under sections 151.42 to 151.51 or a nonresident
pharmacy required to be registered under section 151.19.
Sec. 10. Minnesota Statutes 1996, section 295.51,
subdivision 1, is amended to read:
Subdivision 1. [BUSINESS TRANSACTIONS IN MINNESOTA.] A
hospital, surgical center, pharmacy, or health care provider is
subject to tax under sections 295.50 to 295.59 if it is
"transacting business in Minnesota." A hospital, surgical
center, pharmacy, or health care provider is transacting
business in Minnesota if it maintains contacts with or presence
in the state of Minnesota sufficient to permit taxation of gross
revenues received for patient services under the United States
Constitution.
Sec. 11. Minnesota Statutes 1996, section 295.52,
subdivision 4, is amended to read:
Subd. 4. [USE TAX; PRESCRIPTION DRUGS.] A person that
receives prescription drugs for resale or use in Minnesota,
other than from a wholesale drug distributor that paid the tax
under subdivision 3, is subject to a tax equal to two percent of
the price paid multiplied by the tax percentage specified in
this section. Liability for the tax is incurred when
prescription drugs are received or delivered in Minnesota by the
person.
Sec. 12. Minnesota Statutes 1996, section 295.52, is
amended by adding a subdivision to read:
Subd. 6. [HEARING AIDS AND PRESCRIPTION EYEWEAR.] The tax
liability of a person who meets the definition of a health care
provider solely because the person sells or repairs hearing aids
and related equipment or prescription eyewear is limited to the
gross revenues received from the sale or repair of these items.
Sec. 13. Minnesota Statutes 1996, section 295.52, is
amended by adding a subdivision to read:
Subd. 7. [TAX REDUCTION.] Notwithstanding subdivisions 1,
1a, 2, 3, and 4, the tax imposed under this section for calendar
years 1998 and 1999 shall be equal to 1.5 percent of the gross
revenues received on or after January 1, 1998, and before
January 1, 2000. The commissioner shall extend the reduced tax
rate of 1.5 percent for gross revenues received on or after
January 1, 2000, and before January 1, 2002, if the commissioner
of finance determines that the health care access fund
structural balance projected for fiscal year 2001 will remain
positive, prior to any increase of the one percent premium tax
under section 60A.15, subdivision 1, paragraph (h), and prior to
any tax expenditures related to the increase in the maximum tax
credit for research expenses under section 295.53, subdivision
4, as amended by this act.
Sec. 14. Minnesota Statutes 1996, section 295.53,
subdivision 1, is amended to read:
Subdivision 1. [EXEMPTIONS.] (a) The following payments
are excluded from the gross revenues subject to the hospital,
surgical center, or health care provider taxes under sections
295.50 to 295.57:
(1) payments received for services provided under the
Medicare program, including payments received from the
government, and organizations governed by sections 1833 and 1876
of title XVIII of the federal Social Security Act, United States
Code, title 42, section 1395, and enrollee deductibles,
coinsurance, and copayments, whether paid by the Medicare
enrollee or by a Medicare supplemental coverage as defined in
section 62A.011, subdivision 3, clause (10). Payments for
services not covered by Medicare are taxable;
(2) medical assistance payments including payments received
directly from the government or from a prepaid plan;
(3) payments received for home health care services;
(4) payments received from hospitals or surgical centers
for goods and services on which liability for tax is imposed
under section 295.52 or the source of funds for the payment is
exempt under clause (1), (2), (7), (8), or (10);
(5) payments received from health care providers for goods
and services on which liability for tax is imposed under this
chapter or the source of funds for the payment is exempt under
clause (1), (2), (7), (8), or (10);
(6) amounts paid for legend drugs, other than nutritional
products, to a wholesale drug distributor who is subject to tax
under section 295.52, subdivision 3, reduced by reimbursements
received for legend drugs under clauses (1), (2), (7), and (8);
(7) payments received under the general assistance medical
care program including payments received directly from the
government or from a prepaid plan;
(8) payments received for providing services under the
MinnesotaCare program including payments received directly from
the government or from a prepaid plan and enrollee deductibles,
coinsurance, and copayments. For purposes of this clause,
coinsurance means the portion of payment that the enrollee is
required to pay for the covered service;
(9) payments received by a health care provider or the
wholly owned subsidiary of a health care provider for care
provided outside Minnesota to a patient who is not domiciled in
Minnesota;
(10) payments received from the chemical dependency fund
under chapter 254B;
(11) payments received in the nature of charitable
donations that are not designated for providing patient services
to a specific individual or group;
(12) payments received for providing patient services
incurred through a formal program of health care research
conducted in conformity with federal regulations governing
research on human subjects. Payments received from patients or
from other persons paying on behalf of the patients are subject
to tax;
(13) payments received from any governmental agency for
services benefiting the public, not including payments made by
the government in its capacity as an employer or insurer;
(14) payments received for services provided by community
residential mental health facilities licensed under Minnesota
Rules, parts 9520.0500 to 9520.0690, community support programs
and family community support programs approved under Minnesota
Rules, parts 9535.1700 to 9535.1760, and community mental health
centers as defined in section 245.62, subdivision 2;
(15) government payments received by a regional treatment
center;
(16) payments received for hospice care services;
(17) payments received by a health care provider for
medical supplies, appliances, and equipment hearing aids and
related equipment or prescription eyewear delivered outside of
Minnesota;
(18) payments received by a post-secondary educational
institution from student tuition, student activity fees, health
care service fees, government appropriations, donations, or
grants. Fee for service payments and payments for extended
coverage are taxable; and
(19) payments received for services provided by: assisted
living programs and congregate housing programs.
(b) Payments received by wholesale drug distributors for
prescription legend drugs sold directly to veterinarians or
veterinary bulk purchasing organizations are excluded from the
gross revenues subject to the wholesale drug distributor tax
under sections 295.50 to 295.59.
Sec. 15. Minnesota Statutes 1996, section 295.53,
subdivision 3, is amended to read:
Subd. 3. [SEPARATE STATEMENT OF TAX.] A hospital, surgical
center, pharmacy, or health care provider must not state the tax
obligation under section 295.52 in a deceptive or misleading
manner. It must not separately state tax obligations on bills
provided to patients, consumers, or other payers when the amount
received for the services or goods is not subject to tax.
Pharmacies that separately state the tax obligations on
bills provided to consumers or to other payers who purchase
legend drugs may state the tax obligation as two percent of the
wholesale price of the legend drugs multiplied by the tax
percentage specified in section 295.52. Pharmacies must not
state the tax obligation as two percent of based on the retail
price.
Whenever the commissioner determines that a person has
engaged in any act or practice constituting a violation of this
subdivision, the commissioner may bring an action in the name of
the state in the district court of the appropriate county to
enjoin the act or practice and to enforce compliance with this
subdivision, or the commissioner may refer the matter to the
attorney general or the county attorney of the appropriate
county. Upon a proper showing, a permanent or temporary
injunction, restraining order, or other appropriate relief must
be granted.
Sec. 16. Minnesota Statutes 1996, section 295.53,
subdivision 4, is amended to read:
Subd. 4. [DEDUCTION FOR RESEARCH.] (a) In addition to the
exemptions allowed under subdivision 1, a hospital or health
care provider which is exempt under section 501(c)(3) of the
Internal Revenue Code of 1986 or is owned and operated under
authority of a governmental unit, may deduct from its gross
revenues subject to the hospital or health care provider taxes
under sections 295.50 to 295.57 revenues equal to expenditures
for qualifying research conducted by an allowable research
programs program.
(b) For purposes of this subdivision, the following
requirements apply:
(1) expenditures for allowable research programs are the
direct and general must be for program costs for activities
which are part of qualifying research conducted by an allowable
research program;
(2) an allowable research program must be a formal program
of medical and health care research approved by the governing
body of the hospital or health care provider which also includes
active solicitation of research funds from government and
private sources. Allowable conducted by an entity which is
exempt under section 501(c)(3) of the Internal Revenue Code of
1986 or is owned and operated under authority of a governmental
unit;
(3) qualifying research must:
(A) be approved in writing by the governing body of the
hospital or health care provider which is taking the deduction
under this subdivision;
(1) (B) have as its purpose the development of new
knowledge in basic or applied science relating to the diagnosis
and treatment of conditions affecting the human body;
(2) (C) be subject to review by individuals with expertise
in the subject matter of the proposed study but who have no
financial interest in the proposed study and are not involved in
the conduct of the proposed study; and
(3) (D) be subject to review and supervision by an
institutional review board operating in conformity with federal
regulations if the research involves human subjects or an
institutional animal care and use committee operating in
conformity with federal regulations if the research involves
animal subjects. Research expenses are not exempt if the study
is a routine evaluation of health care methods or products used
in a particular setting conducted for the purpose of making a
management decision. Costs of clinical research activities paid
directly for the benefit of an individual patient are excluded
from this exemption. Basic research in fields including
biochemistry, molecular biology, and physiology are also
included if such programs are subject to a peer review process.
(c) No deduction shall be allowed under this subdivision
for any revenue received by the hospital or health care provider
in the form of a grant, gift, or otherwise, whether from a
government or nongovernment source, on which the tax liability
under section 295.52 is not imposed or for which the tax
liability under section 295.52 has been received from a third
party as provided for in section 295.582.
(d) Effective beginning with calendar year 1995, the
taxpayer shall not take the deduction under this section into
account in determining estimated tax payments or the payment
made with the annual return under section 295.55. The total
deduction allowable to all taxpayers under this section for
calendar years beginning after December 31, 1994, may not exceed
$65,000,000. To implement this limit, each qualifying hospital
and qualifying health care provider shall submit to the
commissioner by March 15 its total expenditures qualifying for
the deduction under this section for the previous calendar
year. The commissioner shall sum the total expenditures of all
taxpayers qualifying under this section for the calendar year.
If the resulting amount exceeds $65,000,000, the commissioner
shall allocate a part of the $65,000,000 deduction limit to each
qualifying hospital and health care provider in proportion to
its share of the total deductions. The commissioner shall pay a
refund to each qualifying hospital or provider equal to its
share of the deduction limit multiplied by two percent the tax
percentage specified in section 295.52. The commissioner shall
pay the refund no later than May 15 of the calendar year.
(e) This subdivision expires January 1, 2000.
Sec. 17. Minnesota Statutes 1996, section 295.53, is
amended by adding a subdivision to read:
Subd. 4a. [CREDIT FOR RESEARCH.] (a) In addition to the
exemptions allowed under subdivision 1, a hospital or health
care provider may claim an annual credit against the total
amount of tax, if any, the hospital or health care provider owes
for that calendar year under sections 295.50 to 295.57. The
credit shall equal 2.5 percent of revenues for patient services
used to fund expenditures for qualifying research conducted by
an allowable research program. The amount of the credit shall
not exceed the tax liability of the hospital or health care
provider under sections 295.50 to 295.57.
(b) For purposes of this subdivision, the following
requirements apply:
(1) expenditures must be for program costs of qualifying
research conducted by an allowable research program;
(2) an allowable research program must be a formal program
of medical and health care research conducted by an entity which
is exempt under section 501(c)(3) of the Internal Revenue Code
of 1986 or is owned and operated under authority of a
governmental unit;
(3) qualifying research must:
(A) be approved in writing by the governing body of the
hospital or health care provider which is taking the deduction
under this subdivision;
(B) have as its purpose the development of new knowledge in
basic or applied science relating to the diagnosis and treatment
of conditions affecting the human body;
(C) be subject to review by individuals with expertise in
the subject matter of the proposed study but who have no
financial interest in the proposed study and are not involved in
the conduct of the proposed study; and
(D) be subject to review and supervision by an
institutional review board operating in conformity with federal
regulations if the research involves human subjects or an
institutional animal care and use committee operating in
conformity with federal regulations if the research involves
animal subjects. Research expenses are not exempt if the study
is a routine evaluation of health care methods or products used
in a particular setting conducted for the purpose of making a
management decision. Costs of clinical research activities paid
directly for the benefit of an individual patient are excluded
from this exemption. Basic research in fields including
biochemistry, molecular biology, and physiology are also
included if such programs are subject to a peer review process.
(c) No credit shall be allowed under this subdivision for
any revenue received by the hospital or health care provider in
the form of a grant, gift, or otherwise, whether from a
government or nongovernment source, on which the tax liability
under section 295.52 is not imposed.
(d) The taxpayer shall apply for the credit under this
section on the annual return under section 295.55, subdivision 5.
(e) Beginning September 1, 2000, if the actual or estimated
amount paid under this section for the calendar year exceeds
$2,500,000, the commissioner of finance shall determine the rate
of the research credit for the following calendar year to the
nearest one-half percent so that refunds paid under this section
will most closely equal $2,500,000. The commissioner of finance
shall publish in the State Register by October 1 of each year
the rate of the credit for the following calendar year. A
determination under this section is not subject to the
rulemaking provisions of chapter 14.
Sec. 18. Minnesota Statutes 1996, section 295.54,
subdivision 1, is amended to read:
Subdivision 1. [TAXES PAID TO ANOTHER STATE.] A hospital,
surgical center, pharmacy, or health care provider that has paid
taxes to another state or province or territory of
Canada jurisdiction measured by gross revenues and is subject to
tax under sections 295.52 to 295.59 on the same gross revenues
is entitled to a credit for the tax legally due and paid to
another state or province or territory of Canada jurisdiction to
the extent of the lesser of (1) the tax actually paid to the
other state or province or territory of Canada jurisdiction, or
(2) the amount of tax imposed by Minnesota on the gross revenues
subject to tax in the other taxing jurisdictions.
Sec. 19. Minnesota Statutes 1996, section 295.54,
subdivision 2, is amended to read:
Subd. 2. [PHARMACY CREDIT REFUND.] A pharmacy may claim a
quarterly credit an annual refund against the total amount of
tax, if any, the pharmacy owes during that quarter calendar year
under section 295.52, subdivision 1b, as provided in this
subdivision 2. The credit refund shall equal two percent of
the amount paid by the pharmacy to a wholesale drug distributor
subject to tax under section 295.52, subdivision 3, for legend
drugs delivered by the pharmacy outside of Minnesota, multiplied
by the tax percentage specified in section 295.52. If the
amount of the credit refund exceeds the tax liability of the
pharmacy under section 295.52, subdivision 1b, the commissioner
shall provide the pharmacy with a refund equal to the excess
amount. Each qualifying pharmacy must apply for the refund on
the annual return as provided under section 295.55, subdivision
5. The refund must be claimed within one year of the due date
of the return. Interest on refunds paid under this subdivision
will begin to accrue 60 days after the date a claim for refund
is filed. For purposes of this subdivision, the date a claim is
filed is the due date of the return or the date of the actual
claim for refund, whichever is later.
Sec. 20. Minnesota Statutes 1996, section 295.55,
subdivision 2, is amended to read:
Subd. 2. [ESTIMATED TAX; HOSPITALS; SURGICAL CENTERS.] (a)
Each hospital or surgical center must make estimated payments of
the taxes for the calendar year in monthly installments to the
commissioner within ten 15 days after the end of the month.
(b) Estimated tax payments are not required of hospitals or
surgical centers if the tax for the calendar year is less than
$500 or if a hospital has been allowed a grant under section
144.1484, subdivision 2, for the year.
(c) Underpayment of estimated installments bear interest at
the rate specified in section 270.75, from the due date of the
payment until paid or until the due date of the annual return at
the rate specified in section 270.75. An underpayment of an
estimated installment is the difference between the amount paid
and the lesser of (1) 90 percent of one-twelfth of the tax for
the calendar year or (2) the tax for the actual gross revenues
received during the month.
Sec. 21. Minnesota Statutes 1996, section 295.582, is
amended to read:
295.582 [AUTHORITY.]
(a) A hospital, surgical center, pharmacy, or health care
provider that is subject to a tax under section 295.52, or a
pharmacy that has paid additional expense transferred under this
section by a wholesale drug distributor, may transfer additional
expense generated by section 295.52 obligations on to all
third-party contracts for the purchase of health care services
on behalf of a patient or consumer. The additional expense
transferred to the third-party purchaser must not exceed two
percent of the tax percentage specified in section 295.52
multiplied against the gross revenues received under the
third-party contract, and two percent of the tax percentage
specified in section 295.52 multiplied against copayments and
deductibles paid by the individual patient or consumer. The
expense must not be generated on revenues derived from payments
that are excluded from the tax under section 295.53. All
third-party purchasers of health care services including, but
not limited to, third-party purchasers regulated under chapter
60A, 62A, 62C, 62D, 62H, 62N, 64B, 65A, 65B, 79, or 79A, or
under section 471.61 or 471.617, must pay the transferred
expense in addition to any payments due under existing contracts
with the hospital, surgical center, pharmacy, or health care
provider, to the extent allowed under federal law. A
third-party purchaser of health care services includes, but is
not limited to, a health carrier, integrated service network, or
community integrated service network that pays for health care
services on behalf of patients or that reimburses, indemnifies,
compensates, or otherwise insures patients for health care
services. A third-party purchaser shall comply with this
section regardless of whether the third-party purchaser is a
for-profit, not-for-profit, or nonprofit entity. A wholesale
drug distributor may transfer additional expense generated by
section 295.52 obligations to entities that purchase from the
wholesaler, and the entities must pay the additional expense.
Nothing in this section limits the ability of a hospital,
surgical center, pharmacy, wholesale drug distributor, or health
care provider to recover all or part of the section 295.52
obligation by other methods, including increasing fees or
charges.
(b) Each third-party purchaser regulated under any chapter
cited in paragraph (a) shall include with its annual renewal for
certification of authority or licensure documentation indicating
compliance with paragraph (a).
(c) Any hospital, surgical center, or health care provider
subject to a tax under section 295.52 or a pharmacy that has
paid additional expense transferred under this section by a
wholesale drug distributor may file a complaint with the
commissioner responsible for regulating the third-party
purchaser if at any time the third-party purchaser fails to
comply with paragraph (a).
(d) If the commissioner responsible for regulating the
third-party purchaser finds at any time that the third-party
purchaser has not complied with paragraph (a), the commissioner
may take enforcement action against a third-party purchaser
which is subject to the commissioner's regulatory jurisdiction
and which does not allow a hospital, surgical center, pharmacy,
or provider to pass-through the tax. The commissioner may by
order fine or censure the third-party purchaser or revoke or
suspend the certificate of authority or license of the
third-party purchaser to do business in this state if the
commissioner finds that the third-party purchaser has not
complied with this section. The third-party purchaser may
appeal the commissioner's order through a contested case hearing
in accordance with chapter 14.
Sec. 22. [MCHA ASSESSMENT OFFSET.]
In approving the premium rates as required in Minnesota
Statutes, sections 62A.65, subdivision 3, and 62L.08,
subdivision 8, the commissioners of health and commerce shall
ensure that any appropriation to reduce the annual assessment
made on the contributing members to cover the costs of the
Minnesota comprehensive health insurance plan as required under
Minnesota Statutes, section 62E.11, is reflected in the premium
rate of each contributing member.
Sec. 23. [REPEALER.]
(a) Minnesota Statutes 1996, sections 295.52, subdivision
1b; and 295.53, subdivision 5, are repealed.
(b) Laws 1997, chapters 31, article 4; and 84, article 4,
are repealed. Notwithstanding Minnesota Statutes, section
645.34, the sections of statutes amended by the laws repealed
under this paragraph remain in effect as if not so amended.
Sec. 24. [EFFECTIVE DATES.]
Section 2, subdivision 1, paragraph (f), is effective for
payments, revenues, and reimbursements received from the federal
government on or after December 31, 1996.
Sections 1 and 3 are effective July 1, 1997.
Sections 4, 5, 6, 9 to 13, 15, and 19 are effective for
gross revenues received after December 31, 1997.
Section 14, subdivision 1, paragraph (a), clause (6), and
paragraph (b) are effective the day following final enactment.
Section 14, paragraph (a), clause (17), is effective for gross
revenues received for hearing aids and related equipment or
prescription eyewear after December 31, 1997.
Section 18 is effective January 1, 1998. Section 21,
paragraph (a), is effective January 1, 1998.
Section 20 is effective for estimated payments due after
July 1, 1997.
Sections 7, 8, and 21, paragraphs (c) and (d), are
effective the day following final enactment.
Section 16 is effective for research expenditures incurred
after December 31, 1995. Section 17 is effective for research
expenditures incurred after December 31, 1999.
Section 23 is effective January 1, 1998.
ARTICLE 4
SENIOR CITIZEN DRUG PROGRAM
Section 1. Minnesota Statutes 1996, section 256.01,
subdivision 2, is amended to read:
Subd. 2. [SPECIFIC POWERS.] Subject to the provisions of
section 241.021, subdivision 2, the commissioner of human
services shall:
(1) Administer and supervise all forms of public assistance
provided for by state law and other welfare activities or
services as are vested in the commissioner. Administration and
supervision of human services activities or services includes,
but is not limited to, assuring timely and accurate distribution
of benefits, completeness of service, and quality program
management. In addition to administering and supervising human
services activities vested by law in the department, the
commissioner shall have the authority to:
(a) require county agency participation in training and
technical assistance programs to promote compliance with
statutes, rules, federal laws, regulations, and policies
governing human services;
(b) monitor, on an ongoing basis, the performance of county
agencies in the operation and administration of human services,
enforce compliance with statutes, rules, federal laws,
regulations, and policies governing welfare services and promote
excellence of administration and program operation;
(c) develop a quality control program or other monitoring
program to review county performance and accuracy of benefit
determinations;
(d) require county agencies to make an adjustment to the
public assistance benefits issued to any individual consistent
with federal law and regulation and state law and rule and to
issue or recover benefits as appropriate;
(e) delay or deny payment of all or part of the state and
federal share of benefits and administrative reimbursement
according to the procedures set forth in section 256.017; and
(f) make contracts with and grants to public and private
agencies and organizations, both profit and nonprofit, and
individuals, using appropriated funds.
(2) Inform county agencies, on a timely basis, of changes
in statute, rule, federal law, regulation, and policy necessary
to county agency administration of the programs.
(3) Administer and supervise all child welfare activities;
promote the enforcement of laws protecting handicapped,
dependent, neglected and delinquent children, and children born
to mothers who were not married to the children's fathers at the
times of the conception nor at the births of the children;
license and supervise child-caring and child-placing agencies
and institutions; supervise the care of children in boarding and
foster homes or in private institutions; and generally perform
all functions relating to the field of child welfare now vested
in the state board of control.
(4) Administer and supervise all noninstitutional service
to handicapped persons, including those who are visually
impaired, hearing impaired, or physically impaired or otherwise
handicapped. The commissioner may provide and contract for the
care and treatment of qualified indigent children in facilities
other than those located and available at state hospitals when
it is not feasible to provide the service in state hospitals.
(5) Assist and actively cooperate with other departments,
agencies and institutions, local, state, and federal, by
performing services in conformity with the purposes of Laws
1939, chapter 431.
(6) Act as the agent of and cooperate with the federal
government in matters of mutual concern relative to and in
conformity with the provisions of Laws 1939, chapter 431,
including the administration of any federal funds granted to the
state to aid in the performance of any functions of the
commissioner as specified in Laws 1939, chapter 431, and
including the promulgation of rules making uniformly available
medical care benefits to all recipients of public assistance, at
such times as the federal government increases its participation
in assistance expenditures for medical care to recipients of
public assistance, the cost thereof to be borne in the same
proportion as are grants of aid to said recipients.
(7) Establish and maintain any administrative units
reasonably necessary for the performance of administrative
functions common to all divisions of the department.
(8) Act as designated guardian of both the estate and the
person of all the wards of the state of Minnesota, whether by
operation of law or by an order of court, without any further
act or proceeding whatever, except as to persons committed as
mentally retarded.
(9) Act as coordinating referral and informational center
on requests for service for newly arrived immigrants coming to
Minnesota.
(10) The specific enumeration of powers and duties as
hereinabove set forth shall in no way be construed to be a
limitation upon the general transfer of powers herein contained.
(11) Establish county, regional, or statewide schedules of
maximum fees and charges which may be paid by county agencies
for medical, dental, surgical, hospital, nursing and nursing
home care and medicine and medical supplies under all programs
of medical care provided by the state and for congregate living
care under the income maintenance programs.
(12) Have the authority to conduct and administer
experimental projects to test methods and procedures of
administering assistance and services to recipients or potential
recipients of public welfare. To carry out such experimental
projects, it is further provided that the commissioner of human
services is authorized to waive the enforcement of existing
specific statutory program requirements, rules, and standards in
one or more counties. The order establishing the waiver shall
provide alternative methods and procedures of administration,
shall not be in conflict with the basic purposes, coverage, or
benefits provided by law, and in no event shall the duration of
a project exceed four years. It is further provided that no
order establishing an experimental project as authorized by the
provisions of this section shall become effective until the
following conditions have been met:
(a) The proposed comprehensive plan, including estimated
project costs and the proposed order establishing the waiver,
shall be filed with the secretary of the senate and chief clerk
of the house of representatives at least 60 days prior to its
effective date.
(b) The secretary of health, education, and welfare of the
United States has agreed, for the same project, to waive state
plan requirements relative to statewide uniformity.
(c) A comprehensive plan, including estimated project
costs, shall be approved by the legislative advisory commission
and filed with the commissioner of administration.
(13) In accordance with federal requirements, establish
procedures to be followed by local welfare boards in creating
citizen advisory committees, including procedures for selection
of committee members.
(14) Allocate federal fiscal disallowances or sanctions
which are based on quality control error rates for the aid to
families with dependent children, medical assistance, or food
stamp program in the following manner:
(a) One-half of the total amount of the disallowance shall
be borne by the county boards responsible for administering the
programs. For the medical assistance and AFDC programs,
disallowances shall be shared by each county board in the same
proportion as that county's expenditures for the sanctioned
program are to the total of all counties' expenditures for the
AFDC and medical assistance programs. For the food stamp
program, sanctions shall be shared by each county board, with 50
percent of the sanction being distributed to each county in the
same proportion as that county's administrative costs for food
stamps are to the total of all food stamp administrative costs
for all counties, and 50 percent of the sanctions being
distributed to each county in the same proportion as that
county's value of food stamp benefits issued are to the total of
all benefits issued for all counties. Each county shall pay its
share of the disallowance to the state of Minnesota. When a
county fails to pay the amount due hereunder, the commissioner
may deduct the amount from reimbursement otherwise due the
county, or the attorney general, upon the request of the
commissioner, may institute civil action to recover the amount
due.
(b) Notwithstanding the provisions of paragraph (a), if the
disallowance results from knowing noncompliance by one or more
counties with a specific program instruction, and that knowing
noncompliance is a matter of official county board record, the
commissioner may require payment or recover from the county or
counties, in the manner prescribed in paragraph (a), an amount
equal to the portion of the total disallowance which resulted
from the noncompliance, and may distribute the balance of the
disallowance according to paragraph (a).
(15) Develop and implement special projects that maximize
reimbursements and result in the recovery of money to the
state. For the purpose of recovering state money, the
commissioner may enter into contracts with third parties. Any
recoveries that result from projects or contracts entered into
under this paragraph shall be deposited in the state treasury
and credited to a special account until the balance in the
account reaches $1,000,000. When the balance in the account
exceeds $1,000,000, the excess shall be transferred and credited
to the general fund. All money in the account is appropriated
to the commissioner for the purposes of this paragraph.
(16) Have the authority to make direct payments to
facilities providing shelter to women and their children
pursuant to section 256D.05, subdivision 3. Upon the written
request of a shelter facility that has been denied payments
under section 256D.05, subdivision 3, the commissioner shall
review all relevant evidence and make a determination within 30
days of the request for review regarding issuance of direct
payments to the shelter facility. Failure to act within 30 days
shall be considered a determination not to issue direct payments.
(17) Have the authority to establish and enforce the
following county reporting requirements:
(a) The commissioner shall establish fiscal and statistical
reporting requirements necessary to account for the expenditure
of funds allocated to counties for human services programs.
When establishing financial and statistical reporting
requirements, the commissioner shall evaluate all reports, in
consultation with the counties, to determine if the reports can
be simplified or the number of reports can be reduced.
(b) The county board shall submit monthly or quarterly
reports to the department as required by the commissioner.
Monthly reports are due no later than 15 working days after the
end of the month. Quarterly reports are due no later than 30
calendar days after the end of the quarter, unless the
commissioner determines that the deadline must be shortened to
20 calendar days to avoid jeopardizing compliance with federal
deadlines or risking a loss of federal funding. Only reports
that are complete, legible, and in the required format shall be
accepted by the commissioner.
(c) If the required reports are not received by the
deadlines established in clause (b), the commissioner may delay
payments and withhold funds from the county board until the next
reporting period. When the report is needed to account for the
use of federal funds and the late report results in a reduction
in federal funding, the commissioner shall withhold from the
county boards with late reports an amount equal to the reduction
in federal funding until full federal funding is received.
(d) A county board that submits reports that are late,
illegible, incomplete, or not in the required format for two out
of three consecutive reporting periods is considered
noncompliant. When a county board is found to be noncompliant,
the commissioner shall notify the county board of the reason the
county board is considered noncompliant and request that the
county board develop a corrective action plan stating how the
county board plans to correct the problem. The corrective
action plan must be submitted to the commissioner within 45 days
after the date the county board received notice of noncompliance.
(e) The final deadline for fiscal reports or amendments to
fiscal reports is one year after the date the report was
originally due. If the commissioner does not receive a report
by the final deadline, the county board forfeits the funding
associated with the report for that reporting period and the
county board must repay any funds associated with the report
received for that reporting period.
(f) The commissioner may not delay payments, withhold
funds, or require repayment under paragraph (c) or (e) if the
county demonstrates that the commissioner failed to provide
appropriate forms, guidelines, and technical assistance to
enable the county to comply with the requirements. If the
county board disagrees with an action taken by the commissioner
under paragraph (c) or (e), the county board may appeal the
action according to sections 14.57 to 14.69.
(g) Counties subject to withholding of funds under
paragraph (c) or forfeiture or repayment of funds under
paragraph (e) shall not reduce or withhold benefits or services
to clients to cover costs incurred due to actions taken by the
commissioner under paragraph (c) or (e).
(18) Allocate federal fiscal disallowances or sanctions for
audit exceptions when federal fiscal disallowances or sanctions
are based on a statewide random sample for the foster care
program under title IV-E of the Social Security Act, United
States Code, title 42, in direct proportion to each county's
title IV-E foster care maintenance claim for that period.
(19) Have the authority to administer a drug rebate program
for drugs purchased pursuant to the senior citizen drug program
established under section 256.955 after the beneficiary's
satisfaction of any deductible established in the program. The
commissioner shall require a rebate agreement from all
manufacturers of covered drugs as defined in section 256B.0625,
subdivision 13. For each drug, the amount of the rebate shall
be equal to the basic rebate as defined for purposes of the
federal rebate program in United States Code, title 42, section
1396r-8(c)(1). This basic rebate shall be applied to
single-source and multiple-source drugs. The manufacturers must
provide full payment within 30 days of receipt of the state
invoice for the rebate within the terms and conditions used for
the federal rebate program established pursuant to section 1927
of title XIX of the Social Security Act. The manufacturers must
provide the commissioner with any information necessary to
verify the rebate determined per drug. The rebate program shall
utilize the terms and conditions used for the federal rebate
program established pursuant to section 1927 of title XIX of the
Social Security Act.
Sec. 2. [256.955] [SENIOR CITIZEN DRUG PROGRAM.]
Subdivision 1. [ESTABLISHMENT.] The commissioner of human
services shall establish and administer a senior citizen drug
program. Qualified senior citizens shall be eligible for
prescription drug coverage under the program beginning no later
than January 1, 1999.
Subd. 2. [DEFINITIONS.] (a) For purposes of this section,
the following definitions apply.
(b) "Health plan" has the meaning provided in section
62Q.01, subdivision 3.
(c) "Health plan company" has the meaning provided in
section 62Q.01, subdivision 4.
(d) "Qualified senior citizen" means an individual age 65
or older who:
(1) is eligible as a qualified Medicare beneficiary
according to section 256B.057, subdivision 3 or 3a, or is
eligible under section 256B.057, subdivision 3 or 3a, and is
also eligible for medical assistance or general assistance
medical care with a spenddown as defined in section 256B.056,
subdivision 5. Persons who are determined eligible for medical
assistance according to section 256B.0575, who are eligible for
medical assistance or general assistance medical care without a
spenddown, or who are enrolled in MinnesotaCare, are not
eligible for this program;
(2) is not enrolled in prescription drug coverage under a
health plan;
(3) is not enrolled in prescription drug coverage under a
Medicare supplement plan, as defined in sections 62A.31 to
62A.44, or policies, contracts, or certificates that supplement
Medicare issued by health maintenance organizations or those
policies, contracts, or certificates governed by section 1833 or
1876 of the federal Social Security Act, United States Code,
title 42, section 1395, et seq., as amended;
(4) has not had coverage described in clauses (2) and (3)
for at least four months prior to application for the program;
and
(5) is a permanent resident of Minnesota as defined in
section 256.9359.
Subd. 3. [PRESCRIPTION DRUG COVERAGE.] Coverage under the
program is limited to prescription drugs covered under the
medical assistance program as described in section 256B.0625,
subdivision 13, subject to a maximum deductible of $300
annually, except drugs cleared by the FDA shall be available to
qualified senior citizens enrolled in the program without
restriction when prescribed for medically accepted indication as
defined in the federal rebate program under section 1927 of
title XIX of the federal Social Security Act.
Subd. 4. [APPLICATION PROCEDURES AND COORDINATION WITH
MEDICAL ASSISTANCE.] Applications and information on the program
must be made available at county social service agencies, health
care provider offices, and agencies and organizations serving
senior citizens. Senior citizens shall submit applications and
any information specified by the commissioner as being necessary
to verify eligibility directly to the county social service
agencies:
(1) beginning January 1, 1999, the county social service
agency shall determine medical assistance spenddown eligibility
of individuals who qualify for the senior citizen drug program
of individuals; and
(2) program payments will be used to reduce the spenddown
obligations of individuals who are determined to be eligible for
medical assistance with a spenddown as defined in section
256B.056, subdivision 5.
Seniors who are eligible for medical assistance with a spenddown
shall be financially responsible for the deductible amount up to
the satisfaction of the spenddown. No deductible applies once
the spenddown has been met. Payments to providers for
prescription drugs for persons eligible under this subdivision
shall be reduced by the deductible.
County social service agencies shall determine an
applicant's eligibility for the program within 30 days from the
date the application is received.
Subd. 5. [DRUG UTILIZATION REVIEW PROGRAM.] The
commissioner shall utilize the drug utilization review program
as described in section 256B.0625, subdivision 13a.
Subd. 6. [PHARMACY REIMBURSEMENT.] The commissioner shall
reimburse participating pharmacies for drug and dispensing costs
at the medical assistance reimbursement level, minus the
deductible required under subdivision 7.
Subd. 7. [COST SHARING.] (a) Enrollees shall pay an annual
premium of $120.
(b) Program enrollees must satisfy a $300 annual
deductible, based upon expenditures for prescription drugs, to
be paid as follows:
(1) $25 monthly deductible for persons with a monthly
spenddown; or
(2) $150 biannual deductible for persons with a six-month
spenddown.
The commissioner may adjust the annual deductible amount to stay
within the program's appropriation.
Subd. 8. [REPORT.] The commissioner shall annually report
to the legislature on the senior citizen drug program. The
report must include demographic information on enrollees,
per-prescription expenditures, total program expenditures,
hospital and nursing home costs avoided by enrollees, any
savings to medical assistance and Medicare resulting from the
provision of prescription drug coverage under Medicare by health
maintenance organizations, other public and private options for
drug assistance to the senior population, any hardships caused
by the annual premium and deductible, and any recommendations
for changes in the senior drug program.
Subd. 9. [PROGRAM LIMITATION.] This section shall be
repealed upon federal approval of the waiver to allow the
commissioner to provide prescription drug coverage for qualified
Medicare beneficiaries whose income is less than 150 percent of
the federal poverty guidelines.
Sec. 3. Minnesota Statutes 1996, section 256B.0625,
subdivision 13, is amended to read:
Subd. 13. [DRUGS.] (a) Medical assistance covers drugs,
except for fertility drugs when specifically used to enhance
fertility, if prescribed by a licensed practitioner and
dispensed by a licensed pharmacist, by a physician enrolled in
the medical assistance program as a dispensing physician, or by
a physician or a nurse practitioner employed by or under
contract with a community health board as defined in section
145A.02, subdivision 5, for the purposes of communicable disease
control. The commissioner, after receiving recommendations from
professional medical associations and professional pharmacist
associations, shall designate a formulary committee to advise
the commissioner on the names of drugs for which payment is
made, recommend a system for reimbursing providers on a set fee
or charge basis rather than the present system, and develop
methods encouraging use of generic drugs when they are less
expensive and equally effective as trademark drugs. The
formulary committee shall consist of nine members, four of whom
shall be physicians who are not employed by the department of
human services, and a majority of whose practice is for persons
paying privately or through health insurance, three of whom
shall be pharmacists who are not employed by the department of
human services, and a majority of whose practice is for persons
paying privately or through health insurance, a consumer
representative, and a nursing home representative. Committee
members shall serve three-year terms and shall serve without
compensation. Members may be reappointed once.
(b) The commissioner shall establish a drug formulary. Its
establishment and publication shall not be subject to the
requirements of the administrative procedure act, but the
formulary committee shall review and comment on the formulary
contents. The formulary committee shall review and recommend
drugs which require prior authorization. The formulary
committee may recommend drugs for prior authorization directly
to the commissioner, as long as opportunity for public input is
provided. Prior authorization may be requested by the
commissioner based on medical and clinical criteria before
certain drugs are eligible for payment. Before a drug may be
considered for prior authorization at the request of the
commissioner:
(1) the drug formulary committee must develop criteria to
be used for identifying drugs; the development of these criteria
is not subject to the requirements of chapter 14, but the
formulary committee shall provide opportunity for public input
in developing criteria;
(2) the drug formulary committee must hold a public forum
and receive public comment for an additional 15 days; and
(3) the commissioner must provide information to the
formulary committee on the impact that placing the drug on prior
authorization will have on the quality of patient care and
information regarding whether the drug is subject to clinical
abuse or misuse. Prior authorization may be required by the
commissioner before certain formulary drugs are eligible for
payment. The formulary shall not include:
(i) drugs or products for which there is no federal
funding;
(ii) over-the-counter drugs, except for antacids,
acetaminophen, family planning products, aspirin, insulin,
products for the treatment of lice, vitamins for adults with
documented vitamin deficiencies, and vitamins for children under
the age of seven and pregnant or nursing women;
(iii) any other over-the-counter drug identified by the
commissioner, in consultation with the drug formulary committee,
as necessary, appropriate, and cost-effective for the treatment
of certain specified chronic diseases, conditions or disorders,
and this determination shall not be subject to the requirements
of chapter 14;
(iv) anorectics; and
(v) drugs for which medical value has not been established;
and
(vi) drugs from manufacturers who have not signed a rebate
agreement with the Department of Health and Human Services
pursuant to section 1927 of title XIX of the Social Security Act
and who have not signed an agreement with the state for drugs
purchased pursuant to the senior citizen drug program
established under section 256.955.
The commissioner shall publish conditions for prohibiting
payment for specific drugs after considering the formulary
committee's recommendations.
(c) The basis for determining the amount of payment shall
be the lower of the actual acquisition costs of the drugs plus a
fixed dispensing fee; the maximum allowable cost set by the
federal government or by the commissioner plus the fixed
dispensing fee; or the usual and customary price charged to the
public. The pharmacy dispensing fee shall be $3.85. Actual
acquisition cost includes quantity and other special discounts
except time and cash discounts. The actual acquisition cost of
a drug shall be estimated by the commissioner, at average
wholesale price minus nine percent. The maximum allowable cost
of a multisource drug may be set by the commissioner and it
shall be comparable to, but no higher than, the maximum amount
paid by other third-party payors in this state who have maximum
allowable cost programs. Establishment of the amount of payment
for drugs shall not be subject to the requirements of the
administrative procedure act. An additional dispensing fee of
$.30 may be added to the dispensing fee paid to pharmacists for
legend drug prescriptions dispensed to residents of long-term
care facilities when a unit dose blister card system, approved
by the department, is used. Under this type of dispensing
system, the pharmacist must dispense a 30-day supply of drug.
The National Drug Code (NDC) from the drug container used to
fill the blister card must be identified on the claim to the
department. The unit dose blister card containing the drug must
meet the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the
pharmacy for reuse. The pharmacy provider will be required to
credit the department for the actual acquisition cost of all
unused drugs that are eligible for reuse. Over-the-counter
medications must be dispensed in the manufacturer's unopened
package. The commissioner may permit the drug clozapine to be
dispensed in a quantity that is less than a 30-day supply.
Whenever a generically equivalent product is available, payment
shall be on the basis of the actual acquisition cost of the
generic drug, unless the prescriber specifically indicates
"dispense as written - brand necessary" on the prescription as
required by section 151.21, subdivision 2.
Sec. 4. [SENIOR DRUG PROGRAM.]
The commissioner shall administer the senior drug program
so that the costs to the state total no more than $4,000,000
plus the amount of the rebate. The commissioner is authorized
to discontinue enrollment in order to meet this level of funding.
The commissioner shall report to the legislature the
estimated costs of the senior drug program without funding
caps. The report shall be included as part of the November and
February forecasts.
The commissioner of finance shall annually reimburse the
general fund with health care access funds for the estimated
increased costs in the QMB/SLMB program directly associated with
the senior drug program. This reimbursement shall sunset June
30, 2001.
Sec. 5. [STUDY ON DUAL PRESCRIPTION DRUG COVERAGE.]
The commissioner of human services shall study the
implications to the senior citizen drug program if a health plan
company offers within the state a product that provides a
prescription drug benefit as part of the standard coverage for
Medicare enrollees and shall make recommendations on how to
address this issue to the legislature by January 15, 1998.
ARTICLE 5
COMMUNITY PURCHASING ARRANGEMENTS
Section 1. [62T.01] [DEFINITIONS.]
Subdivision 1. [SCOPE.] For purposes of this chapter, the
terms in this section have the meanings given.
Subd. 2. [HEALTH CARE PURCHASING ALLIANCE.] "Health care
purchasing alliance" means a business organization created under
this chapter to negotiate the purchase of health care services
for employers. Nothing in this chapter shall be deemed to
regulate or impose any requirements on a self-insured employer
or labor union. A health care purchasing alliance may include a
grouping of:
(1) businesses, including small businesses with one
employee. The businesses may or may not be organized under
section 62Q.17, as a purchasing pool;
(2) trade association members or church organizations under
section 60A.02, or union members who are not in a self-insured
benefit plan;
(3) multiple employer welfare associations under chapter
62H;
(4) municipalities, townships, or counties;
(5) other government entities; or
(6) any combination of clauses (1) to (5).
The alliance may determine the definition of a business of
one employee, but must adhere to its definition and show no bias
in selection of members, based on that definition.
Subd. 3. [ACCOUNTABLE PROVIDER NETWORK.] "Accountable
provider network" means a group of health care providers
organized to market health care services on a risk-sharing or
nonrisk-sharing basis with a health care purchasing alliance.
Accountable provider networks shall operate as not-for-profit
entities or as health care cooperatives, as allowed under
chapter 62R. This chapter applies only when an accountable
provider network is marketing and selling services and benefits
to the employees of businesses as authorized in section 62T.05.
Subd. 4. [COMMISSIONER.] "Commissioner" means the
commissioner of health.
Sec. 2. [62T.02] [PURCHASING ALLIANCES.]
Subdivision 1. [REGISTRATION.] Purchasing alliances must
register prior to offering coverage, and annually on July 1
thereafter, with the commissioner on a form prescribed by the
commissioner.
Subd. 2. [COMMON FACTORS.] All participants in a
purchasing alliance must live within a common geographic region,
be employed in a similar occupation, or share some other common
factor as approved by the commissioner. The membership criteria
must not be designed to include disproportionately employers,
groups, or individuals likely to have low costs of health
coverage, or to exclude disproportionately employers, groups, or
individuals likely to have high costs of health coverage.
Sec. 3. [62T.03] [APPLICATION OF OTHER LAWS.]
An accountable provider network is subject to all
requirements applicable to a health plan company licensed in the
state, except as otherwise noted in this chapter. An
accountable provider network and a health care purchasing
alliance must comply with all requirements of chapter 62L. A
contracting arrangement between a health care purchasing
alliance and an accountable provider network for provision of
health care benefits must provide consumer protection functions
comparable to those currently required of a health plan company
licensed under section 62N.25, and other statutes referenced in
that section, except for modifications and waivers permitted
under this chapter.
Sec. 4. [62T.04] [COMPLAINT SYSTEM.]
Accountable provider networks must establish and maintain
an enrollee complaint system as required under section 62Q.105.
The accountable provider network may contract with the health
care purchasing alliance or a vendor for operation of this
system.
Sec. 5. [62T.05] [BENEFITS.]
An accountable provider network may offer and sell any
benefits permitted to be offered and sold by health plan
companies under Minnesota law.
Sec. 6. [62T.06] [WAIVERS.]
Subdivision 1. [AUTHORIZATION.] The commissioner may grant
waivers from the requirements of law for the contracting
arrangement between a health care purchasing alliance and an
accountable provider network in the areas listed in subdivisions
2 to 4. The commissioner may not waive the following state
consumer protection and quality assurance laws:
(1) laws requiring that enrollees be informed of any
restrictions, requirements, or limitations on coverage,
services, or access to specialists and other providers;
(2) laws allowing consumers to complain to or appeal to a
state regulatory agency if denied benefits or services;
(3) laws prohibiting gag clauses and other restrictions on
communication between a patient and their physician or provider;
(4) laws allowing consumers to obtain information on
provider financial incentives, which may affect treatment;
(5) laws requiring the submission of information needed to
monitor quality of care and enrollee rights;
(6) laws protecting enrollee privacy and confidentiality of
records;
(7) minimum standards for adequate provider network
capacity and geographic access to services;
(8) laws assuring continuity of care when a patient must
change providers;
(9) laws governing coverage of emergency services;
(10) laws prohibiting excessive or unreasonable
administrative fees or expenses; and
(11) other laws or rules that are directly related to
quality of care, consumer protection, and due process rights.
Subd. 2. [SOLVENCY PROTECTION.] (a) The commissioner may
waive the requirements of sections 62N.27 to 62N.32, and may
substitute capital and surplus requirements that are reduced
from the levels required of other risk-bearing entities in order
to reflect its reduced risk exposure. If risk is being
underwritten, the underwriter cannot have more than 25 percent
of the representation on the governing board of the accountable
provider network. The reduced requirements must include at
least the following levels of capital and surplus: (i) a
deposit of $500,000 plus (ii) the greater of an estimated 15
percent of gross premium revenues or twice the net retained
annual risk up to $750,000 on a single enrollee. Net retained
annual risk may be, for example, the lowest annual deductible
under a provider stop-loss insurance policy that covers all
costs above the deductible. Assets supporting the deposit must
meet the standards for deposits referenced in section 62N.32.
Assets supporting the capital must meet the investment
guidelines referenced in section 62N.27.
(b) An accountable provider network may propose a method of
reporting income, expenses, claims payments, and other financial
information in a manner which adequately demonstrates ongoing
compliance with the standards for capital, surplus, and claims
reserves agreed to under this waiver.
(c) An accountable provider network may demonstrate ability
to continue to deliver the contracted health care services to
the purchasing alliance through arrangements which ensure that,
subject to 60 days' notice of intent to discontinue the
contracting arrangement, provider participants will continue to
meet their obligation to provide health care services to
enrollees for a period of 60 days.
Subd. 3. [MARKETING AND DISCLOSURE.] The accountable
provider network, in conjunction with the health care purchasing
alliance, may propose alternative methods to present marketing
and disclosure information which assure the accountability to
consumers who are offered and who receive their services.
Subd. 4. [QUALITY ASSURANCE.] The accountable provider
network may propose an alternative quality assurance program
which incorporates effective methods for reviewing and
evaluating data related to quality of care and ways to identify
and correct quality problems.
Sec. 7. [62T.07] [CRITERIA FOR GRANTING WAIVERS.]
The commissioner may approve a request for waiver under
section 62T.06 if the applicant demonstrates that the
contracting arrangement between a health care purchasing
alliance and an accountable provider network will meet the
following criteria:
(a) The arrangement would be likely to result in:
(1) more choice in benefits and prices;
(2) lower costs;
(3) increased access to health care coverage by small
businesses;
(4) increased access to providers who have demonstrated a
long-term commitment to the community being serviced; or
(5) increased quality of health care than would otherwise
occur under the existing market conditions. In the event that a
proposed arrangement appears likely to improve one or two of the
criteria at the expense of another one or two of the criteria,
the commissioner shall not approve the waiver.
(b) The proposed alternative methods would provide equal or
improved results in consumer protection than would result under
the existing consumer protections requirements.
Sec. 8. [62T.08] [SUPERVISION AND REVOCATION OF WAIVERS.]
(a) The commissioner shall appropriately supervise and
monitor approved waivers.
(b) The commissioner may revoke approval of a waiver if the
contracting arrangement no longer satisfies the criteria in
section 62T.07, paragraphs (a) and (b).
Sec. 9. [62T.09] [MINNESOTA COMPREHENSIVE HEALTH
ASSOCIATION.]
A health care purchasing alliance must pay the assessment
required of contributing members pursuant to section 62E.11.
Sec. 10. [62T.10] [MINNESOTACARE TAX.]
An accountable provider network is subject to the premium
tax established in section 60A.15 and must pay installments as
described in section 60A.15, subdivision 1, paragraph (d).
Sec. 11. [62T.11] [DUTIES OF COMMISSIONER.]
(a) By July 1, 1997, the commissioner shall make available
application forms for licensure as an accountable provider
network. The accountable provider network may begin doing
business after application has been approved.
(b) Upon receipt of an application for a certificate of
authority, the commissioner shall grant or deny licensure and
waivers requested within 90 days of receipt of a complete
application if all requirements are substantially met. For a
period of one year after the effective date of this chapter, the
commissioner may approve up to five applications, none of which
may be from health plan companies. If no written response has
been received within 90 days, the application is approved. When
the commissioner denies an application or waiver request, the
commissioner shall notify the applicant in writing specifically
stating the grounds for the denial and specific suggestions for
how to remedy the denial. The commissioner will entertain
reconsiderations. Within 90 days after the denial, the
applicant may file a written request for an administrative
hearing and review of the commissioner's determination. The
hearing is subject to judicial review as provided by chapter 14.
(c) All monitoring, enforcement, and rulemaking powers
available under chapter 62N are granted to the commissioner to
assure continued compliance with provisions of this chapter.
(d) The commissioner may contract with other entities as
necessary to carry out the responsibilities in this chapter.
Sec. 12. [62T.12] [FEES.]
Every accountable provider network subject to this chapter
shall pay to the commissioner fees as prescribed by the
commissioner pursuant to section 144.122. The initial fees are:
(1) filing an application for licensure, $500;
(2) filing an amendment to a license, $90;
(3) filing an annual report, $200;
(4) filing of renewal of licensure based on a fee of $1,000
per 1,000 enrollees, with renewal every three years; and
(5) other filing fees as specified by rule.
Sec. 13. [62T.13] [ENROLLMENT.]
An accountable provider network created under this chapter
is limited to a maximum enrollment of 30,000 persons.
ARTICLE 6
MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION
Section 1. Minnesota Statutes 1996, section 62E.02,
subdivision 13, is amended to read:
Subd. 13. [ELIGIBLE PERSON.] (a) "Eligible person" means
an individual who:
(1) is currently and has been a resident of Minnesota for
the six months immediately preceding the date of receipt by the
association or its writing carrier of a completed certificate of
eligibility and who;
(2) meets the enrollment requirements of section 62E.14;
and
(3) is not otherwise ineligible under this subdivision.
(b) No individual is eligible for coverage under a
qualified or a Medicare supplement plan issued by the
association for whom a premium is paid or reimbursed by the
medical assistance program or general assistance medical care
program as of the first day of any term for which a premium
amount is paid or reimbursed.
Sec. 2. Minnesota Statutes 1996, section 62E.02,
subdivision 18, is amended to read:
Subd. 18. [WRITING CARRIER.] "Writing carrier" means the
insurer or insurers, health maintenance organization or
organizations, integrated service network or networks, and
community integrated service network or networks, or other
entity selected by the association and approved by the
commissioner to administer the comprehensive health insurance
plan.
Sec. 3. Minnesota Statutes 1996, section 62E.13,
subdivision 2, is amended to read:
Subd. 2. The association may select policies and
contracts, or parts thereof, submitted by a member or members of
the association, or by the association or others, to develop
specifications for bids from any members entity which wish
wishes to be selected as a writing carrier to administer the
state plan. The selection of the writing carrier shall be based
upon criteria including established by the board of directors of
the association and approved by the commissioner. The criteria
shall outline specific qualifications that an entity must
satisfy in order to be selected and, at a minimum, shall include
the member's entity's proven ability to handle large group
accident and health insurance cases, efficient claim paying
capacity, and the estimate of total charges for administering
the plan. The association may select separate writing carriers
for the two types of qualified plans, the qualified medicare
supplement plan, and the health maintenance organization
contract.
Sec. 4. Minnesota Statutes 1996, section 256B.056,
subdivision 8, is amended to read:
Subd. 8. [COOPERATION.] To be eligible for medical
assistance, applicants and recipients must cooperate with the
state and local agency to identify potentially liable
third-party payers and assist the state in obtaining third party
payments, unless good cause for noncooperation is determined
according to Code of Federal Regulations, title 42, part
433.147. "Cooperation" includes identifying any third party who
may be liable for care and services provided under this chapter
to the applicant, recipient, or any other family member for whom
application is made and providing relevant information to assist
the state in pursuing a potentially liable third party.
Cooperation also includes providing information about a group
health plan for which the person may be eligible and if the plan
is determined cost-effective by the state agency and premiums
are paid by the local agency or there is no cost to the
recipient, they must enroll or remain enrolled with the group.
For purposes of this subdivision, coverage provided by the
Minnesota comprehensive health association under chapter 62E
shall not be considered group health plan coverage or
cost-effective by the state and local agency. Cost-effective
insurance premiums approved for payment by the state agency and
paid by the local agency are eligible for reimbursement
according to section 256B.19.
Sec. 5. Minnesota Statutes 1996, section 256B.0625,
subdivision 15, is amended to read:
Subd. 15. [HEALTH PLAN PREMIUMS AND COPAYMENTS.] (a)
Medical assistance covers health care prepayment plan premiums,
insurance premiums, and copayments if determined to be
cost-effective by the commissioner. For purposes of obtaining
Medicare part A and part B, and copayments, expenditures may be
made even if federal funding is not available.
(b) Effective for all premiums due on or after June 30,
1997, medical assistance does not cover premiums that a
recipient is required to pay under a qualified or Medicare
supplement plan issued by the Minnesota comprehensive health
association. Medical assistance shall continue to cover
premiums for recipients who are covered under a plan issued by
the Minnesota comprehensive health association on June 30, 1997,
for a period of six months following receipt of the notice of
termination or until December 31, 1997, whichever is later.
Sec. 6. Minnesota Statutes 1996, section 256D.03,
subdivision 3b, is amended to read:
Subd. 3b. [COOPERATION.] (a) General assistance or general
assistance medical care applicants and recipients must cooperate
with the state and local agency to identify potentially liable
third-party payors and assist the state in obtaining third-party
payments. Cooperation includes identifying any third party who
may be liable for care and services provided under this chapter
to the applicant, recipient, or any other family member for whom
application is made and providing relevant information to assist
the state in pursuing a potentially liable third party. General
assistance medical care applicants and recipients must cooperate
by providing information about any group health plan in which
they may be eligible to enroll. They must cooperate with the
state and local agency in determining if the plan is
cost-effective. For purposes of this subdivision, coverage
provided by the Minnesota comprehensive health association under
chapter 62E shall not be considered group health plan coverage
or cost-effective by the state and local agency. If the plan is
determined cost-effective and the premium will be paid by the
state or local agency or is available at no cost to the person,
they must enroll or remain enrolled in the group health plan.
Cost-effective insurance premiums approved for payment by the
state agency and paid by the local agency are eligible for
reimbursement according to subdivision 6.
(b) Effective for all premiums due on or after June 30,
1997, general assistance medical care does not cover premiums
that a recipient is required to pay under a qualified or
Medicare supplement plan issued by the Minnesota comprehensive
health association. General assistance medical care shall
continue to cover premiums for recipients who are covered under
a plan issued by the Minnesota comprehensive health association
on June 30, 1997, for a period of six months following receipt
of the notice of termination or until December 31, 1997,
whichever is later.
Sec. 7. [MCHA TERMINATION NOTICE.]
The Minnesota comprehensive health association, in
consultation with the commissioner of human services, shall
provide written notice to all persons whose coverage under the
comprehensive health insurance plan terminates due to the change
in policy described in Minnesota Statutes, sections 256B.056,
subdivision 15, and 256D.03, subdivision 3b.
The notice must include the following information:
(1) the reason for termination;
(2) a description of the eligibility requirements for the
comprehensive health insurance plan;
(3) a description of medical assistance and general
assistance medical care eligibility categories;
(4) a description of the participation requirement to the
prepaid medical assistance program, prepaid general assistance
medical care, and exemptions from participation due to
disability as determined by the social security administration;
and
(5) a telephone number for the department of human services
for specific questions regarding the medical assistance and
general assistance medical care program.
Notice must be given at least six months before coverage is
terminated.
The commissioner of human services shall release to the
association any data necessary to provide the notice required in
this section.
Sec. 8. [SUNSET.]
The amendments made in this article to Minnesota Statutes,
sections 62E.02, subdivision 13; 256B.056, subdivision 8;
256B.0625, subdivision 15; and 256D.03, subdivision 3b, expire
June 30, 1999.
Sec. 9. [EFFECTIVE DATE.]
Sections 2 to 8 are effective the day following final
enactment. Section 1 is effective for coverage provided by the
comprehensive health association on or after January 1, 1998,
subject to the right to retain coverage for six months after
receipt of notice of termination under sections 5 and 6.
ARTICLE 7
APPROPRIATIONS
Section 1. [APPROPRIATIONS; SUMMARY.]
Except as otherwise provided in this act, the sums set
forth in the columns designated "fiscal year 1998" and "fiscal
year 1999" are appropriated from the general fund, or other
named fund, to the agencies for the purposes specified in this
act for the fiscal years ending June 30, 1998, and June 30, 1999.
Sec. 2. APPROPRIATIONS
SUMMARY BY FUND
1998 1999 TOTAL
Health Care
Access Fund $130,613,000 $161,364,000 $291,977,000
General Fund 1,357,000 6,127,000 7,484,000
State Government
Special Revenue Fund 21,000 37,000 58,000
Subdivision 1. Department of Human
Services
Health Care
Access Fund 99,052,000 129,761,000 228,813,000
General Fund 1,357,000 6,127,000 7,484,000
[MEDICAL EDUCATION.] Of the fiscal year
1998 health care access fund
appropriation, $3,500,000 is for
medical education research costs. This
appropriation, plus the federal
financial participation amount shall be
distributed to medical assistance
providers according to the distribution
methodology of the medical education
research trust fund established under
Minnesota Statutes, section 62J.69.
Any unspent funds in this appropriation
do not cancel but may carry forward and
be available in fiscal year 1999.
[GENERAL FUND APPROPRIATION.] The
general fund appropriation is for costs
associated with the senior drug
program, the QMB/SLMB cost increases
resulting from the senior drug program,
and the discontinuation of the MCHA
premium payments for MA and GAMC
recipients. The health care access
fund shall reimburse the general fund
for the QMB/SLMB cost and the GAMC and
MA costs.
[ADMINISTRATIVE COSTS.] Of the health
care access appropriation, $342,000 in
fiscal year 1998 and $1,536,000 in
fiscal year 1999 is for administrative
costs associated with moving parents
and working adults GAMC into the
MinnesotaCare program. Of this
appropriation, only $300,000 shall
become part of the base for the fiscal
2000-2001 biennium.
[SERVICE CHARGES.] For fiscal years
1998 and 1999, the department of human
services is exempt from service charges
imposed by other state agencies when
those charges exceed the base
appropriation provided to the
department for the particular service.
[DENTAL SERVICES REIMBURSEMENT
INCREASE.] Notwithstanding statutory
provisions to the contrary, the
commissioner shall increase
reimbursement rates by 15 percent for
dental services covered under the
MinnesotaCare program and rendered on
or after July 1, 1997. The
commissioner shall increase the prepaid
capitation rates as appropriate to
reflect this rate increase.
Notwithstanding section 5, this
paragraph does not expire.
[FEDERAL RECEIPTS FOR ADMINISTRATION.]
Receipts received as a result of
federal participation pertaining to
administrative costs of the Minnesota
Health Care Reform Waiver shall be
deposited as a nondedicated revenue to
the Health Care Access Fund, while
receipts received as a result of
federal participation pertaining to
grants shall be deposited to the
federal fund and shall offset health
care access funds for payments to
providers.
[MINNESOTA OUTREACH.] Of the health
care access fund appropriation,
$750,000 each year shall be disbursed
for grants to public and private
organizations to provide outreach for
the MinnesotaCare program in areas of
the state with high uninsured
populations.
Subd. 2. Department of Health
Health Care
Access Fund 10,653,000 12,248,000 22,901,000
State Government
Special Revenue Fund 21,000 37,000 58,000
Health care access fund appropriations
for student loan forgiveness programs
for health care providers are available
for either year of the biennium.
[RURAL HOSPITAL CAPITAL GRANTS.] Of
this appropriation, $3,000,000 in
fiscal year 1998 and $4,500,000 in
fiscal year 1999 shall be disbursed for
rural hospital capital improvement
grants or loans. Any unspent funds may
be used for rural hospital planning and
transition grant programs. This
appropriation shall not become part of
the base for the fiscal year 2000-2001
biennium.
[RURAL HOSPITAL DEMONSTRATION
PROJECTS.] Of this appropriation,
$300,000 in each fiscal year shall be
disbursed for rural hospital
demonstration projects. This
appropriation shall not become part of
the base for the fiscal year 2000-2001
biennium.
[ADMINISTRATIVE COSTS.] The base for
administrative costs shall be reduced
by $450,000 for fiscal years 2000 and
2001. The commissioner shall examine
general fund resources to replace this
reduction.
Subd. 3. University of Minnesota
Health Care
Access Fund 2,537,000 2,537,000 5,074,000
[PRIMARY CARE EDUCATION INITIATIVES.]
Of this appropriation, $180,000 in each
fiscal year shall be disbursed to the
board of regents for primary care
physician education and training under
Minnesota Statutes, sections 137.38 to
137.40. This appropriation is
available only if matched by $1 for
each $1 of the appropriation. This
appropriation is in addition to the
current base appropriation for these
activities and shall become part of the
base appropriation for the fiscal year
2000-2001 biennium.
Subd. 4. Department of Revenue
Health Care
Access Fund 3,121,000 1,668,000 4,789,000
[RESEARCH DEDUCTION.] Of this
appropriation, $1,500,000 shall be
disbursed in fiscal year 1998 to be
used for research deduction claims
filed by hospitals and health care
providers under Minnesota Statutes,
section 295.53, subdivision 4, for
research expenditures incurred in
calendar year 1996. These claims must
be filed by August 1, 1997, and the
commissioner must pay the refund no
later than October 1, 1997.
Subd. 5. Department of Commerce
Health Care
Access Fund 15,100,000 15,000,000 30,100,000
[MINNESOTA COMPREHENSIVE HEALTH
ASSOCIATION ASSESSMENT OFFSET.] Of this
appropriation, $15,000,000 in fiscal
year 1998 and $15,000,000 in fiscal
year 1999 is for a grant to the
Minnesota Comprehensive Health
Association and shall be made available
on January 1 of each fiscal year to be
used to offset the annual assessments
for calendar years 1998 and 1999 that
are required to be paid by each
contributing member in accordance with
Minnesota Statutes, section 62E.11.
This appropriation shall not become
part of the base for the fiscal year
2000-2001 biennium.
Subd. 6. Legislative Coordinating
Commission
Health Care
Access Fund 150,000 150,000 300,000
Sec. 3. TRANSFERS
$4,112,000 in fiscal year 1998 and
$4,104,000 in fiscal year 1999 are
transferred from the health care access
fund to the general fund to replace the
revenue lost due to the repeal of the
$400 physician surcharge.
Sec. 4. CARRYOVER
None of the appropriations in this act
which are allowed to be carried forward
from fiscal year 1998 to fiscal year
1999 shall become part of the base
level funding for the 2000-2001
biennial budget, unless specifically
directed by the legislature.
Sec. 5. SUNSET
All uncodified language contained in
this article expires on June 30, 1999,
unless a different expiration is
explicit.
ARTICLE 8
HEALTH AND HUMAN SERVICES TECHNICAL CORRECTIONS
Section 1. S. F. No. 1908, article 1, section 2, if
enacted, is amended by adding a subdivision to read:
Subd. 10a. Visitation Access Funds
[FEDERAL FUNDS FOR VISITATION ACCESS.]
The commissioner may accept on behalf
of the state any federal funding for
the purpose of financing visitation
access programs, and may expend these
funds on services described in Public
Law Number 104-193.
Sec. 2. S. F. No. 1908, article 1, section 3, subdivision
2, if enacted, is amended to read:
Subd. 2. Health Systems
and Special Populations 48,517,000 48,233,000
Summary by Fund
General 39,295,000 38,998,000
State Government
Special Revenue 9,222,000 9,235,000
[FEES; DRUG AND ALCOHOL COUNSELOR
LICENSE.] When setting fees for the
drug and alcohol counselor license, the
department is exempt from Minnesota
Statutes, section 16A.1285, subdivision
2.
[STATE VITAL STATISTICS REDESIGN
PROJECT ACCOUNT.] The amount
appropriated from the state government
special revenue fund for the vital
records redesign project shall be
available until expended for
development and implementation.
[WIC PROGRAM.] Of this appropriation,
$650,000 in 1998 is provided to
maintain services of the program,
$700,000 in 1998 and $700,000 in 1999
is added to the base level funding for
the WIC food program in order to
maintain the existing level of the
program, and $100,000 in 1998 is for
the commissioner to develop and
implement an outreach program to
apprise potential recipients of the WIC
food program of the importance of good
nutrition and the availability of the
program.
[WIC TRANSFERS.] General fund
appropriations for the women, infants,
and children (WIC) food supplement
program are available for either year
of the biennium. Transfers of
appropriations between fiscal years
must be for the purpose of maximizing
federal funds or minimizing
fluctuations in the number of
participants.
[LOCAL PUBLIC HEALTH FINANCING.] Of the
general fund appropriation, $5,000,000
each year shall be disbursed for local
public health financing and shall be
distributed according to the community
health service subsidy formula in
Minnesota Statutes, section 145A.13.
[MINNESOTA CHILDREN WITH SPECIAL HEALTH
NEEDS CARRYOVER.] General fund
appropriations for treatment services
in the services for children with
special health care needs program are
available for either year of the
biennium.
[HEALTH CARE ASSISTANCE FOR DISABLED
CHILDREN INELIGIBLE FOR SSI.]
Notwithstanding the requirements of
Minnesota Rules, part 4705.0100,
subpart 14, children who: (a) are
eligible for medical assistance as of
June 30, 1997, and become ineligible
for medical assistance due to changes
in supplemental security income
disability standards for children
enacted in (PRWORA) Public Law Number
104-193; and (b) are not eligible for
MinnesotaCare, are eligible for health
care services through Minnesota
services for children with special
health care needs under Minnesota
Rules, parts 4705.0100 to 4705.1600 for
the fiscal year ending June 30, 1998,
until eligibility for medical
assistance is reestablished. The
commissioner of health shall report to
the legislature by March 1, 1998, on
the number of children eligible under
this provision, their health care
needs, family income as a percentage of
the federal poverty level, the extent
to which families have employer-based
health coverage, and recommendations on
how to meet the future needs of
children eligible under this provision.
[AMERICAN INDIAN DIABETES.] Of this
appropriation, $90,000 each year shall
be disbursed for a comprehensive
school-based intervention program
designed to reduce the risk factors
associated with diabetes among American
Indian school children in grades 1
through 4. The appropriation for 1998
may be carried forward to 1999. The
appropriation for fiscal year 1999 is
available only if matched by $1 of
nonstate money for each $1 of the
appropriation and may be expended in
either year of the biennium. The
commissioner shall convene an American
Indian diabetes prevention advisory
task force. The task force must
include representatives from the
American Indian tribes located in the
state and urban American Indian
representatives. The task force shall
advise the commissioner on the
adaptation of curricula and the
dissemination of information designed
to reduce the risk factors associated
with diabetes among American Indian
school children in grades 1 through 4.
The curricula and information must be
sensitive to traditional American
Indian values and culture and must
encourage full participation by the
American Indian community.
[HOME VISITING PROGRAMS.] (a) Of this
appropriation, $140,000 in 1998 and
$870,000 in 1999 is for the home
visiting programs for infant care under
Minnesota Statutes, section 145A.16.
These amounts are available until June
30, 1999.
(b) Of this appropriation, $225,000 in
1998 and $180,000 in 1999 is to
continue funding the home visiting
programs that received one-year funding
under Laws 1995, chapter 480, article
1, section 9. This amount is available
until expended.
[FETAL ALCOHOL SYNDROME.] Of the
general fund appropriation, $625,000
each year of the biennium shall be
disbursed to prevent and reduce harm
from fetal alcohol syndrome and fetal
alcohol effect.
[COMPLAINT INVESTIGATIONS.] Of the
appropriation, $127,000 each year from
the state government special revenue
fund, and $75,000 each year from the
general fund, is for the commissioner
to conduct complaint investigations of
nursing facilities, hospitals and home
health care providers.
[COMPLEMENTARY MEDICINE STUDY.] (a) Of
the general fund appropriation, $20,000
in fiscal year 1998 shall be disbursed
for the commissioner of health, in
consultation with the commissioner of
commerce, to conduct a study based on
existing literature, information, and
data on the scope of complementary
medicine offered in this state. The
commissioner shall:
(1) include the types of complementary
medicine therapies available in this
state;
(2) contact national and state
complementary medicine associations for
literature, information, and data;
(3) conduct a general literary review
for information and data on
complementary medicine;
(4) contact the departments of commerce
and human services for information on
existing registrations, licenses,
certificates, credentials, policies,
and regulations; and
(5) determine by sample, if
complementary medicine is currently
covered by health plan companies and
the extent of the coverage.
In conducting this review, the
commissioner shall consult with the
office of alternative medicine through
the National Institute of Health.
(b) The commissioner shall, in
consultation with the advisory
committee, report the study findings to
the legislature by January 15, 1998.
As part of the report, the commissioner
shall make recommendations on whether
the state should credential or regulate
any of the complementary medicine
providers.
(c) The commissioner shall appoint an
advisory committee to provide expertise
and advice on the study. The committee
must include representation from the
following groups: health care
providers, including providers of
complementary medicine; health plan
companies; and consumers. The advisory
committee is governed by Minnesota
Statutes, section 15.059, for
membership terms and removal of members.
(d) For purposes of this study, the
term "complementary medicine" includes,
but is not limited to, acupuncture,
homeopathy, manual healing,
macrobiotics, naturopathy, biofeedback,
mind/body control therapies,
traditional and ethnomedicine
therapies, structural manipulations and
energetic therapies, bioelectromagnetic
therapies, and herbal medicine.
[DOWN'S DOWN SYNDROME.] Of the general
fund appropriation, $15,000 in fiscal
year 1998 shall be disbursed for a
grant to a nonprofit organization that
provides support to individuals
with Down's Down Syndrome and their
families, for the purpose of providing
all obstetricians, certified
nurse-midwives, and family physicians
licensed to practice in this state with
informational packets on Down's Down
Syndrome. The packets must include, at
a minimum, a fact sheet on Down's Down
Syndrome, a list of counseling and
support groups for families with
children with Down's Down Syndrome, and
a list of special needs adoption
resources. The informational packets
must be made available to any pregnant
patient who has tested positive
for Down's Down Syndrome, either
through a screening test or
amniocentesis.
[NEWBORN SCREENING FOR HEARING LOSS
PROGRAM IMPLEMENTATION PLAN.] (a) Of
the general fund appropriation, $18,000
in fiscal year 1998 shall be disbursed
to pay the costs of coordinating with
hospitals, the medical community,
audiologists, insurance companies,
parents, and deaf and hard-of-hearing
citizens to establish and implement a
voluntary plan for hospitals and other
health care facilities to screen all
infants for hearing loss.
(b) The plan to achieve universal
screening of infants for hearing loss
on a voluntary basis shall be
formulated by a department work group,
including the following representatives:
(1) a representative of the health
insurance industry designated by the
health insurance industry;
(2) a representative of the Minnesota
Hospital and Healthcare Partnership;
(3) a total of two representatives from
the following physician groups
designated by the Minnesota Medical
Association: pediatrics, family
practice, and ENT;
(4) two audiologists designated by the
Minnesota Speech-Language-Hearing
Association and the Minnesota Academy
of Audiology;
(5) a representative of hospital
neonatal nurseries;
(6) a representative of part H (IDEA)
early childhood special education;
(7) the commissioner of health or a
designee;
(8) a representative of the department
of human services;
(9) a public health nurse;
(10) a parent of a deaf or
hard-of-hearing child;
(11) a deaf or hard-of-hearing person;
and
(12) a representative of the Minnesota
commission serving deaf and
hard-of-hearing people.
Members of the work group shall not
collect a per diem or compensation as
provided in Minnesota Statutes, section
15.0575.
(c) The plan shall include measurable
goals and timetables for the
achievement of universal screening of
infants for hearing loss throughout the
state and shall include the design and
implementation of needed training to
assist hospitals and other health care
facilities screen infants for hearing
loss according to recognized standards
of care.
(d) The work group shall report to the
legislature by January 15, 1998,
concerning progress toward the
achievement of universal screening of
infants in Minnesota for the purpose of
assisting the legislature to determine
whether this goal can be accomplished
on a voluntary basis.
[INFANT HEARING SCREENING PROGRAM.] Of
the general fund appropriation, $25,000
in fiscal year 1998 shall be disbursed
for a grant to a hospital in Staples,
Minnesota, for the infant hearing
screening program.
[NURSING HOMES DAMAGED BY FLOODS.] The
commissioner shall conduct an expedited
process under Minnesota Statutes,
section 144A.073, solely to review
nursing home moratorium exceptions
necessary to repair or replace nursing
facilities damaged by spring flooding
in 1997. The commissioner may not
issue a request for proposals for
moratorium projects not related to
spring flooding until this expedited
process is completed. For facilities
that require total replacement and the
relocation of residents to other
facilities during construction, the
operating cost payment rates for the
new facility shall be determined using
the interim and settle-up payment
provisions of Minnesota Rules, part
9549.0057, and the reimbursement
provisions of Minnesota Statutes,
section 256B.431, except that
subdivision 25 26, paragraphs (a)
and (b), clause (3), and (d), shall not
apply until the second rate year after
the settle-up cost report is filed.
Property-related reimbursement rates
shall be determined under
Minnesota Rules, chapter 9549 Statutes,
section 256B.431, taking into account
any federal or state flood-related
loans or grants provided to a
facility. The medical assistance costs
of this paragraph shall be paid from
the amount made available in section 2
of this article for moratorium
exceptions. This paragraph is
effective the day following final
enactment and is not subject to section
13 of this article.
Sec. 3. Minnesota Statutes 1996, section 256B.0913,
subdivision 16, as added by S. F. No. 1908, article 4, section
39, if enacted, is amended to read:
Subd. 16. [CONVERSION OF ENROLLMENT.] Upon approval of the
elderly waiver amendments described in section 42 41, persons
currently receiving services shall have their eligibility for
the elderly waiver program determined under section 256B.0915.
Persons currently receiving alternative care services whose
income is under the special income standard according to Code of
Federal Regulations, title 42, section 435.236, who are eligible
for the elderly waiver program shall be transferred to that
program and shall receive priority access to elderly waiver
slots for six months after implementation of this subdivision.
Persons currently enrolled in the alternative care program who
are not eligible for the elderly waiver program shall continue
to be eligible for the alternative care program as long as
continuous eligibility is maintained. Continued eligibility for
the alternative care program shall be reviewed every six
months. Persons who apply for the alternative care program
after approval of the elderly waiver amendments in section 42 41
are not eligible for alternative care if they would qualify for
the elderly waiver, with or without a spenddown.
Sec. 4. S. F. No. 1908, article 4, section 70, if enacted,
is amended to read:
Sec. 70. [WAIVER MODIFICATION.]
The commissioner of human services shall seek federal
approval for any modifications to the health care reform waiver
necessary to implement the asset standard changes in sections 21
to 23 22 to 24, and 28 73, paragraph (a).
Sec. 5. S. F. No. 1908, article 4, section 73, if enacted,
is amended to read:
Sec. 73. [REPEALER.]
(a) Minnesota Statutes 1996, sections 256B.057,
subdivisions 2a and 2b; and 469.154, subdivision 6, are repealed.
(b) Minnesota Statutes 1996, section 256B.0625, subdivision
13b, is repealed the day following final enactment.
(c) Minnesota Rules, part parts 9505.1000 to 9505.1040, is
are repealed.
Sec. 6. Minnesota Statutes 1996, section 256B.0911,
subdivision 2, as amended by S. F. No. 1908, article 9, section
10, if enacted, is amended to read:
Subd. 2. [PERSONS REQUIRED TO BE SCREENED; EXEMPTIONS.]
All applicants to Medicaid certified nursing facilities must be
screened prior to admission, regardless of income, assets, or
funding sources, except the following:
(1) patients who, having entered acute care facilities from
certified nursing facilities, are returning to a certified
nursing facility;
(2) residents transferred from other certified nursing
facilities located within the state of Minnesota;
(3) individuals who have a contractual right to have their
nursing facility care paid for indefinitely by the veteran's
administration;
(4) individuals who are enrolled in the Ebenezer/Group
Health social health maintenance organization project, or
enrolled in a demonstration project under section 256B.69,
subdivision 18, at the time of application to a nursing home;
(5) individuals previously screened and currently being
served under the alternative care program or under a home and
community-based services waiver authorized under section 1915(c)
of the Social Security Act; or
(6) individuals who are admitted to a certified nursing
facility for a short-term stay, which, based upon a physician's
certification, is expected to be 14 days or less in duration,
and who have been screened and approved for nursing facility
admission within the previous six months. This exemption
applies only if the screener determines at the time of the
initial screening of the six-month period that it is appropriate
to use the nursing facility for short-term stays and that there
is an adequate plan of care for return to the home or
community-based setting. If a stay exceeds 14 days, the
individual must be referred no later than the first county
working day following the 14th resident day for a screening,
which must be completed within five working days of the
referral. Payment limitations in subdivision 7 will apply to an
individual found at screening to not meet the level of care
criteria for admission to a certified nursing facility.
Regardless of the exemptions in clauses (2) to (6), persons
who have a diagnosis or possible diagnosis of mental illness,
mental retardation, or a related condition must receive a
preadmission screening before admission unless the admission
prior to screening is authorized by the local mental health
authority or the local developmental disabilities case manager,
or unless authorized by the county agency according to Public
Law Number 101-508.
Before admission to a Medicaid certified nursing home or
boarding care home, all persons must be screened and approved
for admission through an assessment process. The nursing
facility is authorized to conduct case mix assessments which are
not conducted by the county public health nurse under Minnesota
Rules, part 9549.0059. The designated county agency is
responsible for distributing the quality assurance and review
form for all new applicants to nursing homes.
Other persons who are not applicants to nursing facilities
must be screened if a request is made for a screening.
Sec. 7. S. F. No. 1908, article 9, section 24, if enacted,
is amended to read:
Sec. 24. [EFFECTIVE DATE.]
Section Sections 14 and 16, amending Minnesota Statutes
1996, section 518.17, subdivision 1, is are effective the day
following final enactment.
Sec. 8. [EFFECTIVE DATE.]
Section 7 is effective the day following final enactment.
Presented to the governor May 29, 1997
Signed by the governor June 2, 1997, 2:14 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes