2004 Minnesota Statutes

CHAPTER 62J. Health care cost containment

     62J.01 Findings. 

    The legislature finds that substantial numbers of 
 Minnesotans have no health care coverage and that most of these 
 residents are wage earners or their dependents.  One-third of 
 these individuals are children. 

    The legislature further finds that when these individuals 
 enter the health care system they have often foregone preventive 
 care and are in need of more expensive treatment that often 
 exceeds their financial resources.  Much of the cost for these 
 uncompensated services to the uninsured are already in the 
 health care system in the form of increased insurance and 
 provider rates and property and income taxes. 

    The legislature further finds that these costs, spread 
 among the already insured, represent a woefully inefficient 
 method for providing basic preventive and acute care for the 
 uninsured and represent an added cost to employers now providing 
 health insurance to their employees. 

    The legislature further finds that it is necessary to 
 ensure basic and affordable health care to all Minnesotans while 
 addressing the economic pressures on the health care system as a 
 whole in Minnesota. 

    HIST: 1989 c 327 s 1 

COST CONTROLS

     62J.015 Purpose. 

    The legislature finds that the staggering growth in health 
 care costs is having a devastating effect on the health and cost 
 of living of Minnesota residents.  The legislature further finds 
 that the number of uninsured and underinsured residents is 
 growing each year and that the cost of health care coverage for 
 our insured residents is increasing annually at a rate that far 
 exceeds the state's overall rate of inflation. 

    The legislature further finds that it must enact immediate 
 and intensive cost containment measures to limit the growth of 
 health care expenditures, reform insurance practices, and 
 finance a plan that offers access to affordable health care for 
 our permanent residents by capturing dollars now lost to 
 inefficiencies in Minnesota's health care system. 

    The legislature further finds that controlling costs is 
 essential to the maintenance of the many factors contributing to 
 the quality of life in Minnesota:  our environment, education 
 system, safe communities, affordable housing, provision of food, 
 economic vitality, purchasing power, and stable population. 

    It is, therefore, the intent of the legislature to lay a 
 new foundation for the delivery and financing of health care in 
 Minnesota and to call this new foundation the MinnesotaCare Act. 

    HIST: 1992 c 549 art 1 s 1; 1993 c 247 art 4 s 11; 1994 c 625 
 art 8 s 72 

     62J.016 Goals of restructuring. 

    The state seeks to bring about changes in the health care 
 delivery and financing system that will assure quality, 
 affordable, and accessible health care for all Minnesotans.  
 This goal will be accomplished by restructuring the delivery 
 system, the financial incentives, and the regulatory environment 
 in a way that will make health care providers and health plan 
 companies more accountable to consumers, group purchasers, and 
 communities for their costs and quality, their effectiveness in 
 meeting the health care needs of all of their patients and 
 enrollees, and their contributions to improving the health of 
 the greater community. 

    HIST: 1994 c 625 art 1 s 1 

     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.  

    HIST: 1994 c 625 art 1 s 2; 1995 c 234 art 3 s 1; 1997 c 225 
 art 2 s 9 

  62J.02 Repealed, 1989 c 327 s 4 

     62J.03 Definitions. 

    Subdivision 1.    Scope of definitions.  For purposes of 
 this chapter, the terms defined in this section have the 
 meanings given. 

    Subd. 2.    Clinically effective.  "Clinically effective"
 means that the use of a particular medical technology improves 
 patient clinical status, as measured by medical condition, 
 survival rates, and other variables, and that the use of the 
 particular technology demonstrates a clinical advantage over 
 alternative technologies. 

    Subd. 3. Repealed, 1997 c 225 art 2 s 63 

    Subd. 4.    Commissioner.  "Commissioner" means the 
 commissioner of health. 

    Subd. 5.    Cost-effective.  "Cost-effective" means that 
 the economic costs of using a particular technology to achieve 
 improvement in a patient's health outcome are justified given a 
 comparison to both the economic costs and the improvement in 
 patient health outcome resulting from the use of alternative 
 technologies. 

    Subd. 6.    Group purchaser.  "Group purchaser" means a 
 person or organization that purchases health care services on 
 behalf of an identified group of persons, regardless of whether 
 the cost of coverage or services is paid for by the purchaser or 
 by the persons receiving coverage or services, as further 
 defined in rules adopted by the commissioner.  "Group purchaser" 
 includes, but is not limited to, community integrated service 
 networks; health insurance companies, health maintenance 
 organizations, nonprofit health service plan corporations, and 
 other health plan companies; employee health plans offered by 
 self-insured employers; trusts established in a collective 
 bargaining agreement under the federal Labor-Management 
 Relations Act of 1947, United States Code, title 29, section 
 141, et seq.; the Minnesota Comprehensive Health Association; 
 group health coverage offered by fraternal organizations, 
 professional associations, or other organizations; state and 
 federal health care programs; state and local public employee 
 health plans; workers' compensation plans; and the medical 
 component of automobile insurance coverage. 

    Subd. 7.    Improvement in health outcome.  "Improvement 
 in health outcome" means an improvement in patient clinical 
 status, and an improvement in patient quality-of-life status, as 
 measured by ability to function, ability to return to work, and 
 other variables. 

    Subd. 8.    Provider or health care provider.  
 "Provider" or "health care provider" means a person or 
 organization other than a nursing home that provides health care 
 or medical care services within Minnesota for a fee and is 
 eligible for reimbursement under the medical assistance program 
 under chapter 256B.  For purposes of this subdivision, "for a 
 fee" includes traditional fee-for-service arrangements, 
 capitation arrangements, and any other arrangement in which a 
 provider receives compensation for providing health care 
 services or has the authority to directly bill a group 
 purchaser, health carrier, or individual for providing health 
 care services.  For purposes of this subdivision, "eligible for 
 reimbursement under the medical assistance program" means that 
 the provider's services would be reimbursed by the medical 
 assistance program if the services were provided to medical 
 assistance enrollees and the provider sought reimbursement, or 
 that the services would be eligible for reimbursement under 
 medical assistance except that those services are characterized 
 as experimental, cosmetic, or voluntary. 

    Subd. 9.    Safety.  "Safety" means a judgment of the 
 acceptability of risk of using a technology in a specified 
 situation. 

    Subd. 10.    Health plan company.  "Health plan company" 
 means a health plan company as defined in section 62Q.01, 
 subdivision 4. 

    HIST: 1992 c 549 art 1 s 2; 1993 c 345 art 3 s 1; art 4 s 1; 
 art 6 s 1; 1994 c 625 art 8 s 14,15; 1997 c 225 art 2 s 62 

     62J.04 Monitoring the rate of growth of health care 
  spending. 

    Subdivision 1.    Cost containment goals.  (a) The 
 commissioner of health shall set annual cost containment goals 
 for public and private spending on health care services for 
 Minnesota residents, as provided in paragraph (b).  The cost 
 containment goals must be set at levels the commissioner 
 determines to be realistic and achievable but that will reduce 
 the rate of growth in health care spending by at least ten 
 percent per year for the next five years.  The commissioner 
 shall set cost containment goals based on available data on 
 spending and growth trends, including data from group 
 purchasers, national data on public and private sector health 
 care spending and cost trends, and trend information from other 
 states. 

    (b) The commissioner shall set the following annual cost 
 containment goals for public and private spending on health care 
 services for Minnesota residents: 

    (1) for calendar year 1994, the cost containment goal must 
 not exceed the change in the regional Consumer Price Index for 
 urban consumers for calendar year 1993 plus 6.5 percentage 
 points; 

    (2) for calendar year 1995, the cost containment goal must 
 not exceed the change in the regional Consumer Price Index for 
 urban consumers for calendar year 1994 plus 5.3 percentage 
 points; 

    (3) for calendar year 1996, the cost containment goal must 
 not exceed the change in the regional Consumer Price Index for 
 urban consumers for calendar year 1995 plus 4.3 percentage 
 points; 

    (4) for calendar year 1997, the cost containment goal must 
 not exceed the change in the regional Consumer Price Index for 
 urban consumers for calendar year 1996 plus 3.4 percentage 
 points; and 

    (5) for calendar year 1998, the cost containment goal must 
 not exceed the change in the regional Consumer Price Index for 
 urban consumers for calendar year 1997 plus 2.6 percentage 
 points. 

    The commissioner shall adjust the cost containment goal set 
 for calendar year 1995 to recover savings in health care 
 spending required for the period July 1, 1993, to December 31, 
 1993. 

    (c) The commissioner shall publish: 

    (1) the projected cost containment goal in the State 
 Register by April 15 of the year immediately preceding the year 
 in which the cost containment goal will be effective except for 
 the year 1993, in which the cost containment goal shall be 
 published by July 1, 1993; 

    (2) the quarterly change in the regional Consumer Price 
 Index for urban consumers; and 

    (3) the Centers for Medicare and Medicaid Services forecast 
 for total growth in the national health care expenditures.  

    Subd. 1a.    Cost containment goals.  The commissioner 
 shall publish the final adjusted cost containment goal in the 
 State Register by January 31 of the year that the cost 
 containment goal is to be in effect.  The adjusted cost 
 containment goal must reflect the actual regional Consumer Price 
 Index for urban consumers for the previous calendar year, and 
 may deviate from the previously published projected cost 
 containment goal to reflect differences between the actual 
 regional Consumer Price Index for urban consumers and the 
 projected Consumer Price Index for urban consumers.  The 
 commissioner shall report to the legislature by February 15 of 
 each year on the implementation of the cost containment goal.  
 This annual report shall describe the differences between the 
 projected increase in health care expenditures, the actual 
 expenditures based on data collected, and the impact and 
 validity of cost containment goals within the overall health 
 care reform strategy. 

    Subd. 2. Renumbered 62J.35, subdivision 1 

    Subd. 2a.  Renumbered 62J.35, subd 2 

    Subd. 2b.  Renumbered 62J.35, subd 3 

    Subd. 3.    Cost containment duties.  The commissioner 
 shall: 

    (1) establish statewide and regional cost containment goals 
 for total health care spending under this section and collect 
 data as described in sections 62J.38 to 62J.41 to monitor 
 statewide achievement of the cost containment goals; 

    (2) divide the state into no fewer than four regions, with 
 one of those regions being the Minneapolis/St. Paul metropolitan 
 statistical area but excluding Chisago, Isanti, Wright, and 
 Sherburne Counties, for purposes of fostering the development of 
 regional health planning and coordination of health care 
 delivery among regional health care systems and working to 
 achieve the cost containment goals; 

    (3) monitor the quality of health care throughout the state 
 and take action as necessary to ensure an appropriate level of 
 quality; 

    (4) issue recommendations regarding uniform billing forms, 
 uniform electronic billing procedures and data interchanges, 
 patient identification cards, and other uniform claims and 
 administrative procedures for health care providers and private 
 and public sector payers.  In developing the recommendations, 
 the commissioner shall review the work of the work group on 
 electronic data interchange (WEDI) and the American National 
 Standards Institute (ANSI) at the national level, and the work 
 being done at the state and local level.  The commissioner may 
 adopt rules requiring the use of the Uniform Bill 82/92 form, 
 the National Council of Prescription Drug Providers (NCPDP) 3.2 
 electronic version, the Centers for Medicare and Medicaid 
 Services 1500 form, or other standardized forms or procedures; 

    (5) undertake health planning responsibilities; 

    (6) authorize, fund, or promote research and 
 experimentation on new technologies and health care procedures; 

    (7) within the limits of appropriations for these purposes, 
 administer or contract for statewide consumer education and 
 wellness programs that will improve the health of Minnesotans 
 and increase individual responsibility relating to personal 
 health and the delivery of health care services, undertake 
 prevention programs including initiatives to improve birth 
 outcomes, expand childhood immunization efforts, and provide 
 start-up grants for worksite wellness programs; 

    (8) undertake other activities to monitor and oversee the 
 delivery of health care services in Minnesota with the goal of 
 improving affordability, quality, and accessibility of health 
 care for all Minnesotans; and 

    (9) make the cost containment goal data available to the 
 public in a consumer-oriented manner. 

    Subd. 4. Repealed, 1997 c 225 art 2 s 63 

    Subd. 5.    Appeals.  A person aggrieved may appeal a 
 decision made under this chapter through a contested case 
 proceeding governed under chapter 14.  The notice of appeal must 
 be served on the commissioner within 30 days of receiving notice 
 of the decision.  The commissioner shall decide the contested 
 case. 

    Subd. 6.    Rulemaking.  The commissioner shall adopt 
 rules under chapter 14 to implement this chapter. 

    Subd. 7. Repealed, 1997 c 225 art 2 s 63 

    Subd. 8. Repealed, 1994 c 625 art 8 s 74 

    Subd. 9.    Growth limits; federal programs.  The 
 commissioners of health and human services shall establish a 
 rate methodology for Medicare and Medicaid risk-based 
 contracting with health plan companies that is consistent with 
 statewide growth limits.  The methodology shall be presented for 
 review by the Minnesota Health Care Commission and the 
 Legislative Commission on Health Care Access prior to the 
 submission of a waiver request to the Centers for Medicare and 
 Medicaid Services and subsequent implementation of the 
 methodology. 

    HIST: 1992 c 549 art 1 s 3; 1993 c 247 art 1 s 1-6; 1993 c 345 
 art 1 s 1; art 3 s 2-4,18; art 5 s 7,8; art 6 s 2,3; 1994 c 625 
 art 8 s 16-18; 1995 c 234 art 3 s 2; art 5 s 2; 1997 c 150 s 
 1-3; 1997 c 187 art 1 s 5; 1998 c 254 art 1 s 11; 1999 c 245 art 
 2 s 2; 2000 c 260 s 83; 2002 c 277 s 32; 1Sp2003 c 14 art 7 s 88 

     62J.041 Interim health plan company cost containment 
  goals. 

    Subdivision 1.    Definitions.  (a) For purposes of this 
 section, the following definitions apply. 

    (b) "Health plan company" has the definition provided in 
 section 62Q.01. 

    (c) "Total expenditures" means incurred claims or 
 expenditures on health care services, administrative expenses, 
 charitable contributions, and all other payments made by health 
 plan companies out of premium revenues. 

    (d) "Net expenditures" means total expenditures minus 
 exempted taxes and assessments and payments or allocations made 
 to establish or maintain reserves.  

    (e) "Exempted taxes and assessments" means direct payments 
 for taxes to government agencies, contributions to the Minnesota 
 Comprehensive Health Association, the medical assistance 
 provider's surcharge under section 256.9657, the MinnesotaCare 
 provider tax under section 295.52, assessments by the Health 
 Coverage Reinsurance Association, assessments by the Minnesota 
 Life and Health Insurance Guaranty Association, assessments by 
 the Minnesota Risk Adjustment Association, and any new 
 assessments imposed by federal or state law. 

    (f) "Consumer cost-sharing or subscriber liability" means 
 enrollee coinsurance, co-payment, deductible payments, and 
 amounts in excess of benefit plan maximums. 

    Subd. 2.    Establishment.  The commissioner of health 
 shall establish cost containment goals for the increase in net 
 expenditures by each health plan company for calendar years 
 1994, 1995, 1996, and 1997.  The cost containment goals must be 
 the same as the annual cost containment goals for health care 
 spending established under section 62J.04, subdivision 1, 
 paragraph (b).  Health plan companies that are affiliates may 
 elect to meet one combined cost containment goal. 

    Subd. 3.    Determination of expenditures.  Health plan 
 companies shall submit to the commissioner of health, by April 
 1, 1994, for calendar year 1993; April 1, 1995, for calendar 
 year 1994; April 1, 1996, for calendar year 1995; April 1, 1997, 
 for calendar year 1996; and April 1, 1998, for calendar year 
 1997 all information the commissioner determines to be necessary 
 to implement this section.  The information must be submitted in 
 the form specified by the commissioner.  The information must 
 include, but is not limited to, expenditures per member per 
 month or cost per employee per month, and detailed information 
 on revenues and reserves.  The commissioner, to the extent 
 possible, shall coordinate the submittal of the information 
 required under this section with the submittal of the financial 
 data required under chapter 62J, to minimize the administrative 
 burden on health plan companies.  The commissioner may adjust 
 final expenditure figures for demographic changes, risk 
 selection, changes in basic benefits, and legislative 
 initiatives that materially change health care costs, as long as 
 these adjustments are consistent with the methodology submitted 
 by the health plan company to the commissioner, and approved by 
 the commissioner as actuarially justified.  The methodology to 
 be used for adjustments and the election to meet one cost 
 containment goal for affiliated health plan companies must be 
 submitted to the commissioner by September 1, 1994.  Community 
 integrated service networks may submit the information with 
 their application for licensure.  The commissioner shall also 
 accept changes to methodologies already submitted.  The 
 adjustment methodology submitted and approved by the 
 commissioner must apply to the data submitted for calendar years 
 1994 and 1995.  The commissioner may allow changes to accepted 
 adjustment methodologies for data submitted for calendar years 
 1996 and 1997.  Changes to the adjustment methodology must be 
 received by September 1, 1996, and must be approved by the 
 commissioner. 

    Subd. 4.    Monitoring of reserves.  (a) The 
 commissioners of health and commerce shall monitor health plan 
 company reserves and net worth as established under chapters 
 60A, 62C, 62D, 62H, and 64B, with respect to the health plan 
 companies that each commissioner respectively regulates to 
 assess the degree to which savings resulting from the 
 establishment of cost containment goals are passed on to 
 consumers in the form of lower premium rates.  

    (b) Health plan companies shall fully reflect in the 
 premium rates the savings generated by the cost containment 
 goals.  No premium rate, currently reviewed by the Department 
 of Health or Commerce, may be approved for those health plan 
 companies unless the health plan company establishes to the 
 satisfaction of the commissioner of commerce or the commissioner 
 of health, as appropriate, that the proposed new rate would 
 comply with this paragraph. 

    (c) Health plan companies, except those licensed under 
 chapter 60A to sell accident and sickness insurance under 
 chapter 62A, shall annually before the end of the fourth fiscal 
 quarter provide to the commissioner of health or commerce, as 
 applicable, a projection of the level of reserves the company 
 expects to attain during each quarter of the following fiscal 
 year.  These health plan companies shall submit with required 
 quarterly financial statements a calculation of the actual 
 reserve level attained by the company at the end of each quarter 
 including identification of the sources of any significant 
 changes in the reserve level and an updated projection of the 
 level of reserves the health plan company expects to attain by 
 the end of the fiscal year.  In cases where the health plan 
 company has been given a certificate to operate a new health 
 maintenance organization under chapter 62D, or been licensed as 
 a community integrated service network under chapter 62N, or 
 formed an affiliation with one of these organizations, the 
 health plan company shall also submit with its quarterly 
 financial statement, total enrollment at the beginning and end 
 of the quarter and enrollment changes within each service area 
 of the new organization.  The reserve calculations shall be 
 maintained by the commissioners as trade secret information, 
 except to the extent that such information is also required to 
 be filed by another provision of state law and is not treated as 
 trade secret information under such other provisions. 

    (d) Health plan companies in paragraph (c) whose reserves 
 are less than the required minimum or more than the required 
 maximum at the end of the fiscal year shall submit a plan of 
 corrective action to the commissioner of health or commerce 
 under subdivision 7. 

    (e) The commissioner of commerce, in consultation with the 
 commissioner of health, shall report to the legislature no later 
 than January 15, 1995, as to whether the concept of a reserve 
 corridor or other mechanism for purposes of monitoring reserves 
 is adaptable for use with indemnity health insurers that do 
 business in multiple states and that must comply with their 
 domiciliary state's reserves requirements. 

    Subd. 5.    Notice.  The commissioner of health shall 
 publish in the State Register and make available to the public 
 by July 1, 1995, a list of all health plan companies that 
 exceeded their cost containment goal for the 1994 calendar 
 year.  The commissioner shall publish in the State Register and 
 make available to the public by July 1, 1996, a list of all 
 health plan companies that exceeded their combined cost 
 containment goal for calendar years 1994 and 1995.  The 
 commissioner shall notify each health plan company that the 
 commissioner has determined that the health plan company 
 exceeded its cost containment goal, at least 30 days before 
 publishing the list, and shall provide each health plan company 
 with ten days to provide an explanation for exceeding the cost 
 containment goal.  The commissioner shall review the explanation 
 and may change a determination if the commissioner determines 
 the explanation to be valid. 

    Subd. 6.    Assistance by the commissioner of commerce.  
 The commissioner of commerce shall provide assistance to the 
 commissioner of health in monitoring health plan companies 
 regulated by the commissioner of commerce.  

    Subd. 7. Repealed by amendment, 1997 c 150 s 4 

    HIST: 1993 c 345 art 2 s 4; 1994 c 625 art 3 s 4; 1995 c 234 
 art 3 s 9; 1997 c 150 s 4; 1997 c 225 art 2 s 62 

  62J.042 Repealed, 1997 c 150 s 6 

  62J.045 Repealed, 1995 c 234 art 8 s 57 

  62J.05 Repealed, 1997 c 225 art 2 s 63 

  62J.051 Repealed, 1997 c 225 art 2 s 63 

     62J.06 Immunity from liability. 

    No member of the Health Technology Advisory Committee 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.  

    HIST: 1993 c 247 art 1 s 7; 1995 c 234 art 5 s 3; 1997 c 225 
 art 2 s 10; 1999 c 245 art 2 s 3; 1Sp2003 c 14 art 7 s 88 

     62J.07 Legislative oversight commission. 

    Subdivision 1.    Legislative oversight.  The 
 Legislative Commission on Health Care Access reviews the 
 activities of the commissioner of health, 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.  

    Subd. 2.    Membership.  The Legislative Commission on 
 Health Care Access consists of five members of the senate 
 appointed under the rules of the senate and five members of the 
 house of representatives appointed under the rules of the house 
 of representatives.  The Legislative Commission on Health Care 
 Access must include three members of the majority party and two 
 members of the minority party in each house.  

    Subd. 3.    Reports to the commission.  The commissioner 
 of health and the Health Technology Advisory Committee shall 
 report on their activities 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 
 chapter 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. 

    Subd. 4. Repealed, 1995 c 234 art 8 s 57 

    HIST: 1992 c 549 art 1 s 5; 1993 c 247 art 4 s 11; 1994 c 625 
 art 8 s 72; 1997 c 225 art 2 s 11,12; 1999 c 245 art 2 s 4,5 

  62J.09 Repealed, 1999 c 245 art 2 s 6 

    62J.15 Subdivision 1. Repealed, 1Sp2003 c 14 art 7 s 
 89 

    Subd. 1a. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 2. Repealed, 1993 c 345 art 4 s 7; 1Sp2003 c 14 
 art 7 s 89 

    62J.152 Subdivision 1. Repealed, 1Sp2003 c 14 art 7 s 
 89 

    Subd. 1a. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 2. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 3. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 4. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 5. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 6. Repealed, 1995 c 234 art 3 s 10; 1Sp2003 c 14 
 art 7 s 89 

    Subd. 7. Repealed, 1Sp2003 c 14 art 7 s 89 

    Subd. 8. Repealed, 1Sp2003 c 14 art 7 s 89 

     62J.156 Closed committee hearings. 

    Notwithstanding chapter 13D, the Health Technology Advisory 
 Committee may meet in closed session to discuss a specific 
 technology or procedure that involves data received that have 
 been classified as nonpublic data, where disclosure of the data 
 would cause harm to the competitive or economic position of the 
 source of the data. 

    HIST: 1993 c 345 art 4 s 5; 1Sp2003 c 14 art 7 s 88 

     62J.17 Expenditure reporting. 

    Subdivision 1.    Purpose.  To ensure access to 
 affordable health care services for all Minnesotans it is 
 necessary to restrain the rate of growth in health care costs.  
 An important factor believed to contribute to escalating costs 
 may be the purchase of costly new medical equipment, major 
 capital expenditures, and the addition of new specialized 
 services.  After spending limits are established under section 
 62J.04, providers, patients, and communities will have the 
 opportunity to decide for themselves whether they can afford 
 capital expenditures or new equipment or specialized services 
 within the constraints of a spending limit.  In this 
 environment, the state's role in reviewing these spending 
 commitments can be more limited.  However, during the interim 
 period until spending targets are established, it is important 
 to prevent unrestrained major spending commitments that will 
 contribute further to the escalation of health care costs and 
 make future cost containment efforts more difficult.  In 
 addition, it is essential to protect against the possibility 
 that the legislature's expression of its attempt to control 
 health care costs may lead a provider to make major spending 
 commitments before targets or other cost containment constraints 
 are fully implemented because the provider recognizes that the 
 spending commitment may not be considered appropriate, needed, 
 or affordable within the context of a fixed budget for health 
 care spending.  Therefore, the legislature finds that a 
 requirement for reporting health care expenditures is necessary. 

    Subd. 2.    Definitions.  For purposes of this section, 
 the terms defined in this subdivision have the meanings given. 

    (a) "Access" means the financial, temporal, and geographic 
 availability of health care to individuals who need it. 

    (b) "Capital expenditure" means an expenditure which, under 
 generally accepted accounting principles, is not properly 
 chargeable as an expense of operation and maintenance. 

    (c) "Cost" means the amount paid by consumers or third 
 party payers for health care services or products. 

    (d) "Date of the major spending commitment" means the date 
 the provider formally obligated itself to the major spending 
 commitment.  The obligation may be incurred by entering into a 
 contract, making a down payment, issuing bonds or entering a 
 loan agreement to provide financing for the major spending 
 commitment, or taking some other formal, tangible action 
 evidencing the provider's intention to make the major spending 
 commitment.  

    (e) "Health care service" means: 

    (1) a service or item that would be covered by the medical 
 assistance program under chapter 256B if provided in accordance 
 with medical assistance requirements to an eligible medical 
 assistance recipient; and 

    (2) a service or item that would be covered by medical 
 assistance except that it is characterized as experimental, 
 cosmetic, or voluntary. 

    "Health care service" does not include retail, 
 over-the-counter sales of nonprescription drugs and other retail 
 sales of health-related products that are not generally paid for 
 by medical assistance and other third-party coverage. 

    (f) "Major spending commitment" means an expenditure in 
 excess of $1,000,000 for: 

    (1) acquisition of a unit of medical equipment; 

    (2) a capital expenditure for a single project for the 
 purposes of providing health care services, other than for the 
 acquisition of medical equipment; 

    (3) offering a new specialized service not offered before; 

    (4) planning for an activity that would qualify as a major 
 spending commitment under this paragraph; or 

    (5) a project involving a combination of two or more of the 
 activities in clauses (1) to (4). 

    The cost of acquisition of medical equipment, and the 
 amount of a capital expenditure, is the total cost to the 
 provider regardless of whether the cost is distributed over time 
 through a lease arrangement or other financing or payment 
 mechanism.  

    (g) "Medical equipment" means fixed and movable equipment 
 that is used by a provider in the provision of a health care 
 service.  "Medical equipment" includes, but is not limited to, 
 the following: 

    (1) an extracorporeal shock wave lithotripter; 

    (2) a computerized axial tomography (CAT) scanner; 

    (3) a magnetic resonance imaging (MRI) unit; 

    (4) a positron emission tomography (PET) scanner; and 

    (5) emergency and nonemergency medical transportation 
 equipment and vehicles. 

    (h) "New specialized service" means a specialized health 
 care procedure or treatment regimen offered by a provider that 
 was not previously offered by the provider, including, but not 
 limited to:  

    (1) cardiac catheterization services involving high-risk 
 patients as defined in the Guidelines for Coronary Angiography 
 established by the American Heart Association and the American 
 College of Cardiology; 

    (2) heart, heart-lung, liver, kidney, bowel, or pancreas 
 transplantation service, or any other service for 
 transplantation of any other organ; 

    (3) megavoltage radiation therapy; 

    (4) open heart surgery; 

    (5) neonatal intensive care services; and 

    (6) any new medical technology for which premarket approval 
 has been granted by the United States Food and Drug 
 Administration, excluding implantable and wearable devices. 

    Subd. 3.    Hospital and nursing home moratoria preserved; 
 nursing homes exempt.  Nothing in this section supersedes or 
 limits the applicability of section 144.551 or 144A.071.  This 
 section does not apply to major spending commitments made by 
 nursing homes or intermediate care facilities that are related 
 to the provision of long-term care services to residents. 

    Subd. 4. Repealed, 1993 c 345 art 6 s 26 

    Subd. 4a.    Expenditure reporting.  (a) A provider 
 making a major spending commitment after April 1, 1992, shall 
 submit notification of the expenditure to the commissioner and 
 provide the commissioner with any relevant background 
 information.  

    (b) Notification must include a report, submitted within 60 
 days after the date of the major spending commitment, using 
 terms conforming to the definitions in section 62J.03 and this 
 section.  Each report is subject to retrospective review and 
 must contain:  

    (1) a detailed description of the major spending 
 commitment, including the specific dollar amount of each 
 expenditure, and its purpose; 

    (2) the date of the major spending commitment; 

    (3) a statement of the expected impact that the major 
 spending commitment will have on charges by the provider to 
 patients and third party payers; 

    (4) a statement of the expected impact on the clinical 
 effectiveness or quality of care received by the patients that 
 the provider expects to serve; 

    (5) a statement of the extent to which equivalent services 
 or technology are already available to the provider's actual and 
 potential patient population; 

    (6) a statement of the distance from which the nearest 
 equivalent services or technology are already available to the 
 provider's actual and potential population; 

    (7) a statement describing the pursuit of any lawful 
 collaborative arrangements; and 

    (8) a statement of assurance that the provider will not 
 use, purchase, or perform health care technologies and 
 procedures that are not clinically effective and cost-effective, 
 unless the technology is used for experimental or research 
 purposes to determine whether a technology or procedure is 
 clinically effective and cost-effective.  

    The provider may submit any additional information that it 
 deems relevant.  

    (c) The commissioner may request additional information 
 from a provider for the purpose of review of a report submitted 
 by that provider, and may consider relevant information from 
 other sources.  A provider shall provide any information 
 requested by the commissioner within the time period stated in 
 the request, or within 30 days after the date of the request if 
 the request does not state a time.  

    (d) If the provider fails to submit a complete and timely 
 expenditure report, including any additional information 
 requested by the commissioner, the commissioner may make the 
 provider's subsequent major spending commitments subject to the 
 procedures of prospective review and approval under subdivision 
 6a.  

    Subd. 5. Repealed, 1993 c 345 art 6 s 26 

    Subd. 5a.    Retrospective review.  (a) The commissioner 
 shall retrospectively review each major spending commitment and 
 notify the provider of the results of the review.  The 
 commissioner shall determine whether the major spending 
 commitment was appropriate.  In making the determination, the 
 commissioner may consider the following criteria:  the major 
 spending commitment's impact on the cost, access, and quality of 
 health care; the clinical effectiveness and cost-effectiveness 
 of the major spending commitment; and the alternatives available 
 to the provider. 

    (b) The commissioner may not prevent or prohibit a major 
 spending commitment subject to retrospective review.  However, 
 if the provider fails the retrospective review, any major 
 spending commitments by that provider for the five-year period 
 following the commissioner's decision are subject to prospective 
 review under subdivision 6a.  

    Subd. 6. Repealed, 1993 c 345 art 6 s 26 

    Subd. 6a.    Prospective review and approval.  (a) 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) 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) 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 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) The commissioner of health has the authority to issue 
 fines, seek injunctions, and pursue other remedies as provided 
 by law. 

    Subd. 7.    Exceptions.  (a) The retrospective review 
 process as described in subdivision 5a and the prospective 
 review and approval process as described in subdivision 6a do 
 not apply to: 

    (1) a major spending commitment to replace existing 
 equipment with comparable equipment used for direct patient 
 care, upgrades of equipment beyond the current model, or 
 comparable model must be reported; 

    (2) a major spending commitment made by a research and 
 teaching institution for purposes of conducting medical 
 education, medical research supported or sponsored by a medical 
 school, or by a federal or foundation grant or clinical trials; 

    (3) a major spending commitment to repair, remodel, or 
 replace existing buildings or fixtures if, in the judgment of 
 the commissioner, the project does not involve a substantial 
 expansion of service capacity or a substantial change in the 
 nature of health care services provided; 

    (4) a major spending commitment for building maintenance 
 including heating, water, electricity, and other 
 maintenance-related expenditures; 

    (5) a major spending commitment for activities, not 
 directly related to the delivery of patient care services, 
 including food service, laundry, housekeeping, and other 
 service-related activities; and 

    (6) a major spending commitment for computer equipment or 
 data systems not directly related to the delivery of patient 
 care services, including computer equipment or data systems 
 related to medical record automation. 

    (b) In addition to the exceptions listed in paragraph (a), 
 the prospective review and approval process described in 
 subdivision 6a does not apply to mergers, acquisitions, and 
 other changes in ownership or control that, in the judgment of 
 the commissioner, do not involve a substantial expansion of 
 service capacity or a substantial change in the nature of health 
 care services provided. 

    Subd. 8.    Radiation therapy facilities.  This 
 subdivision shall apply only to those major spending commitments 
 that are related to the purchase, construction, or leasing of a 
 radiation therapy facility. 

    (a) The term "provider" shall mean:  

    (1) a provider as defined in section 62J.03, subdivision 8; 

    (2) a person or organization that, upon engaging in an 
 activity related to a major spending commitment, will become a 
 provider as defined in section 62J.03, subdivision 8; 

    (3) an organization under common control with an 
 organization described in clause (1) or (2); or 

    (4) an organization that manages a person or organization 
 described in clause (1), (2), or (3). 

    (b) In conducting the retrospective or prospective review, 
 the commissioner shall consider the criteria described in 
 subdivision 5a, paragraph (a), in determining whether the major 
 spending commitment was appropriate.  In addition, the 
 commissioner shall consider the following criteria: 

    (1) the alternatives available to patients in terms of 
 avoiding an unwarranted duplication based on whether additional 
 capacity is needed of services, facilities, or equipment in and 
 around the location of the major spending commitment; and 

    (2) the best interests of the patients, including conflicts 
 of interest that may be present in influencing the utilization 
 of the services, facility, or equipment relating to the major 
 spending commitment.  

    (c) In addition to subdivision 6a, paragraph (c), the 
 commissioner has the authority to pursue the following remedies: 

    (1) assessment of fines against providers violating 
 subdivision 6a, paragraph (a), of up to triple the amount of the 
 major spending commitment; 

    (2) securing a permanent injunction against providers 
 violating subdivision 6a, paragraph (a), halting the purchase or 
 construction of a facility, prohibiting the operation of a 
 facility, or the providing of a service related to the major 
 spending commitment; and 

    (3) obtaining a court order to invalidate any purchase 
 agreement, management agreement, lease, or other contract 
 relating to the major spending commitment or the conduct of any 
 activity relating to the major spending commitment.  

    (d) If a provider fails the retrospective review of a major 
 spending commitment that is identified under this subdivision, 
 the prospective review and approval required under subdivision 
 6a shall be limited to major spending commitments that are 
 identified under this subdivision. 

    (e) The provisions of this subdivision do not apply to 
 radiation therapy facilities owned and operated or managed by a 
 hospital licensed under chapter 144. 

    HIST: 1992 c 549 art 1 s 8; 1993 c 345 art 6 s 9-11; 1995 c 
 234 art 8 s 8-10; 1997 c 225 art 2 s 21; 1998 c 254 art 1 s 12; 
 2000 c 307 s 1; 1Sp2003 c 14 art 7 s 11 

  62J.19 Repealed, 1995 c 234 art 8 s 57 

  62J.21 Repealed, 1993 c 247 art 1 s 21 

     62J.212 Public health goals. 

    The commissioner shall establish specific public health 
 goals including, but not limited to, increased delivery of 
 prenatal care, improved birth outcomes, and expanded childhood 
 immunizations.  The commissioner shall consider the community 
 public health goals and the input of the statewide advisory 
 committee on community health in establishing the statewide 
 goals. 

    HIST: 1993 c 345 art 5 s 9; 1995 c 234 art 5 s 4 

     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 submit waiver requests and 
 take other action necessary to obtain federal approval to allow 
 participation of the medical assistance program.  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. 

    HIST: 1992 c 549 art 1 s 11; 1997 c 225 art 2 s 22 

     62J.23 Provider conflicts of interest. 

    Subdivision 1.    Rules prohibiting conflicts of interest. 
  The commissioner of health shall adopt rules restricting 
 financial relationships or payment arrangements involving health 
 care providers under which a person benefits financially by 
 referring a patient to another person, recommending another 
 person, or furnishing or recommending an item or service.  The 
 rules must be compatible with, and no less restrictive than, the 
 federal Medicare antikickback statute, in section 1128B(b) of 
 the Social Security Act, United States Code, title 42, section 
 1320a-7b(b), and regulations adopted under it.  However, the 
 commissioner's rules may be more restrictive than the federal 
 law and regulations and may apply to additional provider groups 
 and business and professional arrangements.  When the state 
 rules restrict an arrangement or relationship that is 
 permissible under federal laws and regulations, including an 
 arrangement or relationship expressly permitted under the 
 federal safe harbor regulations, the fact that the state 
 requirement is more restrictive than federal requirements must 
 be clearly stated in the rule.  

    Subd. 2.    Restrictions.  (a) From July 1, 1992, until 
 rules are adopted by the commissioner under this section, the 
 restrictions in the federal Medicare antikickback statutes in 
 section 1128B(b) of the Social Security Act, United States Code, 
 title 42, section 1320a-7b(b), and rules adopted under the 
 federal statutes, apply to all persons in the state, regardless 
 of whether the person participates in any state health care 
 program.  

    (b) Nothing in paragraph (a) shall be construed to prohibit 
 an individual from receiving a discount or other reduction in 
 price or a limited-time free supply or samples of a prescription 
 drug, medical supply, or medical equipment offered by a 
 pharmaceutical manufacturer, medical supply or device 
 manufacturer, health plan company, or pharmacy benefit manager, 
 so long as: 

    (1) the discount or reduction in price is provided to the 
 individual in connection with the purchase of a prescription 
 drug, medical supply, or medical equipment prescribed for that 
 individual; 

    (2) it otherwise complies with the requirements of state 
 and federal law applicable to enrollees of state and federal 
 public health care programs; 

    (3) the discount or reduction in price does not exceed the 
 amount paid directly by the individual for the prescription 
 drug, medical supply, or medical equipment; and 

    (4) the limited-time free supply or samples are provided by 
 a physician or pharmacist, as provided by the federal 
 Prescription Drug Marketing Act. 

    (c) No benefit, reward, remuneration, or incentive for 
 continued product use may be provided to an individual or an 
 individual's family by a pharmaceutical manufacturer, medical 
 supply or device manufacturer, or pharmacy benefit manager, 
 except that this prohibition does not apply to: 

    (1) activities permitted under paragraph (b); 

    (2) a pharmaceutical manufacturer, medical supply or device 
 manufacturer, health plan company, or pharmacy benefit manager 
 providing to a patient, at a discount or reduced price or free 
 of charge, ancillary products necessary for treatment of the 
 medical condition for which the prescription drug, medical 
 supply, or medical equipment was prescribed or provided; and 

    (3) a pharmaceutical manufacturer, medical supply or device 
 manufacturer, health plan company, or pharmacy benefit manager 
 providing to a patient a trinket or memento of insignificant 
 value. 

    (d) Nothing in this subdivision shall be construed to 
 prohibit a health plan company from offering a tiered formulary 
 with different co-payment or cost-sharing amounts for different 
 drugs. 

    Subd. 3.    Penalty.  The commissioner may assess a fine 
 against a person who violates this section.  The amount of the 
 fine is $1,000 or 110 percent of the estimated financial benefit 
 that the person realized as a result of the prohibited financial 
 arrangement or payment relationship, whichever is greater.  A 
 person who is in compliance with a transition plan approved by 
 the commissioner under subdivision 2, or who is making a good 
 faith effort to obtain the commissioner's approval of a 
 transition plan, is not in violation of this section. 

    Subd. 4.    Chapter 62N networks.  (a) The legislature 
 finds that the formation and operation of community integrated 
 service networks will accomplish the purpose of the federal 
 Medicare antikickback statute, which is to reduce the 
 overutilization and overcharging that may result from 
 inappropriate provider incentives.  Accordingly, it is the 
 public policy of the state of Minnesota to support the 
 development of community integrated service networks.  The 
 legislature finds that the federal Medicare antikickback laws 
 should not be interpreted to interfere with the development of 
 community integrated service networks or to impose liability for 
 arrangements between an integrated service network or a 
 community integrated service network and its participating 
 entities. 

    (b) An arrangement between a community integrated service 
 network and any or all of its participating entities is not 
 subject to liability under subdivisions 1 and 2. 

    Subd. 5.    Audits of exempt providers.  The 
 commissioner may audit the referral patterns of providers that 
 qualify for exceptions under the federal Stark Law, United 
 States Code, title 42, section 1395nn.  The commissioner has 
 access to provider records according to section 144.99, 
 subdivision 2.  The commissioner shall report to the legislature 
 any audit results that reveal a pattern of referrals by a 
 provider for the furnishing of health services to an entity with 
 which the provider has a direct or indirect financial 
 relationship. 

    HIST: 1992 c 549 art 1 s 12; 1993 c 247 art 1 s 17; 1993 c 345 
 art 6 s 13; 1994 c 625 art 8 s 23; 1997 c 225 art 2 s 62; 
 1Sp2003 c 14 art 7 s 12; 2004 c 280 s 1; 2004 c 288 art 6 s 7 

     62J.25 Mandatory Medicare assignment. 

    (a) Effective January 1, 1993, a health care provider 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 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 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 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 144E.001, subdivision 3, or medical supplies 
 and equipment.  A vendor of medical supplies and equipment that 
 does not accept assignment under the federal Medicare program 
 with respect to a purchase or lease of Medicare-covered supplies 
 or equipment shall notify any purchaser who is a Medicare 
 beneficiary and Minnesota resident, prior to the purchase, or at 
 any time upon the request of the purchaser, that the vendor 
 charges an amount in excess of the Medicare-approved amount. 

    HIST: 1992 c 549 art 1 s 13; 1997 c 199 s 14; 1997 c 225 art 2 
 s 23; 1998 c 339 s 1 

     62J.26 Evaluation of proposed health coverage mandates. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, the following terms have the meanings given unless the 
 context otherwise requires:  

    (1) "commissioner" means the commissioner of commerce; 

    (2) "health plan" means a health plan as defined in section 
 62A.011, subdivision 3, but includes coverage listed in clauses 
 (7) and (10) of that definition; 

    (3) "mandated health benefit proposal" means a proposal 
 that would statutorily require a health plan to do the following:

    (i) provide coverage or increase the amount of coverage for 
 the treatment of a particular disease, condition, or other 
 health care need; 

    (ii) provide coverage or increase the amount of coverage of 
 a particular type of health care treatment or service or of 
 equipment, supplies, or drugs used in connection with a health 
 care treatment or service; or 

    (iii) provide coverage for care delivered by a specific 
 type of provider. 

    "Mandated health benefit proposal" does not include health 
 benefit proposals amending the scope of practice of a licensed 
 health care professional. 

    Subd. 2.    Evaluation process and content.  (a) The 
 commissioner, in consultation with the commissioners of health 
 and employee relations, must evaluate mandated health benefit 
 proposals as provided under subdivision 3.  

    (b) The purpose of the evaluation is to provide the 
 legislature with a complete and timely analysis of all 
 ramifications of any mandated health benefit proposal.  The 
 evaluation must include, in addition to other relevant 
 information, the following: 

    (1) scientific and medical information on the proposed 
 health benefit, on the potential for harm or benefit to the 
 patient, and on the comparative benefit or harm from alternative 
 forms of treatment; 

    (2) public health, economic, and fiscal impacts of the 
 proposed mandate on persons receiving health services in 
 Minnesota, on the relative cost-effectiveness of the benefit, 
 and on the health care system in general; 

    (3) the extent to which the service is generally utilized 
 by a significant portion of the population; 

    (4) the extent to which insurance coverage for the proposed 
 mandated benefit is already generally available; 

    (5) the extent to which the mandated coverage will increase 
 or decrease the cost of the service; and 

    (6) the commissioner may consider actuarial analysis done 
 by health insurers in determining the cost of the proposed 
 mandated benefit. 

    (c) The commissioner must summarize the nature and quality 
 of available information on these issues, and, if possible, must 
 provide preliminary information to the public.  The commissioner 
 may conduct research on these issues or may determine that 
 existing research is sufficient to meet the informational needs 
 of the legislature.  The commissioner may seek the assistance 
 and advice of researchers, community leaders, or other persons 
 or organizations with relevant expertise.  

    Subd. 3.    Requests for evaluation.  (a) Whenever a 
 legislative measure containing a mandated health benefit 
 proposal is introduced as a bill or offered as an amendment to a 
 bill, or is likely to be introduced as a bill or offered as an 
 amendment, a chair of any standing legislative committee that 
 has jurisdiction over the subject matter of the proposal may 
 request that the commissioner complete an evaluation of the 
 proposal under this section, to inform any committee of floor 
 action by either house of the legislature.  

    (b) The commissioner must conduct an evaluation described 
 in subdivision 2 of each mandated health benefit proposal for 
 which an evaluation is requested under paragraph (a), unless the 
 commissioner determines under paragraph (c) or subdivision 4 
 that priorities and resources do not permit its evaluation. 

    (c) If requests for evaluation of multiple proposals are 
 received, the commissioner must consult with the chairs of the 
 standing legislative committees having jurisdiction over the 
 subject matter of the mandated health benefit proposals to 
 prioritize the requests and establish a reporting date for each 
 proposal to be evaluated.  The commissioner is not required to 
 direct an unreasonable quantity of the commissioner's resources 
 to these evaluations.  

    Subd. 4.    Sources of funding.  (a) The commissioner 
 need not use any funds for purposes of this section other than 
 as provided in this subdivision or as specified in an 
 appropriation. 

    (b) The commissioner may seek and accept funding from 
 sources other than the state to pay for evaluations under this 
 section to supplement or replace state appropriations.  Any 
 money received under this paragraph must be deposited in the 
 state treasury, credited to a separate account for this purpose 
 in the special revenue fund, and is appropriated to the 
 commissioner for purposes of this section. 

    (c) If a request for an evaluation under this section has 
 been made, the commissioner may use for purposes of the 
 evaluation: 

    (1) any funds appropriated to the commissioner specifically 
 for purposes of this section; or 

    (2) funds available under paragraph (b), if use of the 
 funds for evaluation of that mandated health benefit proposal is 
 consistent with any restrictions imposed by the source of the 
 funds. 

    (d) The commissioner must ensure that the source of the 
 funding has no influence on the process or outcome of the 
 evaluation. 

    Subd. 5.    Report to legislature.  The commissioner 
 must submit a written report on the evaluation to the 
 legislature no later than 180 days after the request.  The 
 report must be submitted in compliance with sections 3.195 and 
 3.197. 

    HIST: 1Sp2003 c 14 art 7 s 13 

  62J.29 Repealed, 1993 c 345 art 6 s 26 

  62J.2911 Repealed, 1997 c 237 s 22 

  62J.2912 Repealed, 1997 c 237 s 22 

  62J.2913 Repealed, 1997 c 237 s 22 

  62J.2914 Repealed, 1997 c 237 s 22 

  62J.2915 Repealed, 1997 c 237 s 22 

  62J.2916 Repealed, 1997 c 237 s 22 

  62J.2917 Repealed, 1997 c 237 s 22 

  62J.2918 Repealed, 1997 c 237 s 22 

  62J.2919 Repealed, 1997 c 237 s 22 

  62J.2920 Repealed, 1997 c 237 s 22 

  62J.2921 Repealed, 1997 c 237 s 22 

INFORMATION CLEARINGHOUSE

     62J.2930 Information clearinghouse. 

    Subdivision 1.    Establishment.  The commissioner of 
 health shall establish an information clearinghouse within the 
 Department of Health to facilitate the ability of consumers, 
 employers, providers, health plan companies, and others to 
 obtain information on health reform activities in Minnesota.  
 The commissioner shall make available through the clearinghouse 
 updates on federal and state health reform activities, including 
 information developed or collected by the Department of Health 
 on cost containment or other research initiatives, the 
 development of voluntary purchasing pools, action plans 
 submitted by health plan companies, reports or recommendations 
 of the Health Technology Advisory Committee and other entities 
 on technology assessments, and reports or recommendations from 
 other formal committees applicable to health reform activities.  
 The clearinghouse shall also refer requestors to sources of 
 further information or assistance.  The clearinghouse is subject 
 to chapter 13. 

    Subd. 2.    Information on health plan companies.  The 
 information clearinghouse shall provide information on all 
 health plan companies operating in a specific geographic area to 
 consumers and purchasers who request it. 

    Subd. 3.    Consumer information.  (a) The information 
 clearinghouse or another entity designated by the commissioner 
 shall provide consumer information to health plan company 
 enrollees to: 

    (1) assist enrollees in understanding their rights; 

    (2) explain and assist in the use of all available 
 complaint systems, including internal complaint systems within 
 health carriers, community integrated service networks, and the 
 Departments of Health and Commerce; 

    (3) provide information on coverage options in each region 
 of the state; 

    (4) provide information on the availability of purchasing 
 pools and enrollee subsidies; and 

    (5) help consumers use the health care system to obtain 
 coverage. 

    (b) The information clearinghouse or other entity 
 designated by the commissioner for the purposes of this 
 subdivision shall not: 

    (1) provide legal services to consumers; 

    (2) represent a consumer or enrollee; or 

    (3) serve as an advocate for consumers in disputes with 
 health plan companies.  

    (c) Nothing in this subdivision shall interfere with the 
 ombudsman program established under section 256B.031, 
 subdivision 6, or other existing ombudsman programs. 

    Subd. 4.    Coordination.  To the extent possible, the 
 commissioner shall coordinate the activities of the 
 clearinghouse with the activities of the Minnesota Health Data 
 Institute. 

    HIST: 1995 c 234 art 5 s 5; 1997 c 225 art 2 s 62; 1999 c 245 
 art 2 s 7 

DATA COLLECTION AND RESEARCH INITIATIVES

  62J.30 Repealed, 1995 c 234 art 5 s 24 

     62J.301 Research and data initiatives. 

    Subdivision 1.    Definitions.  For purposes of sections 
 62J.2930 to 62J.42, the following definitions apply: 

    (a) "Health outcomes data" means data used in research 
 designed to identify and analyze the outcomes and costs of 
 alternative interventions for a given clinical condition, in 
 order to determine the most appropriate and cost-effective means 
 to prevent, diagnose, treat, or manage the condition, or in 
 order to develop and test methods for reducing inappropriate or 
 unnecessary variations in the type and frequency of 
 interventions. 

    (b) "Encounter level data" means data related to the 
 utilization of health care services by, and the provision of 
 health care services to individual patients, enrollees, or 
 insureds, including claims data, abstracts of medical records, 
 and data from patient interviews and patient surveys. 

    Subd. 2.    Statement of purpose.  The commissioner of 
 health shall conduct data and research initiatives in order to 
 monitor and improve the efficiency and effectiveness of health 
 care in Minnesota. 

    Subd. 3.    General duties.  The commissioner shall: 

    (1) collect and maintain data which enable population-based 
 monitoring and trending of the access, utilization, quality, and 
 cost of health care services within Minnesota; 

    (2) collect and maintain data for the purpose of estimating 
 total Minnesota health care expenditures and trends; 

    (3) collect and maintain data for the purposes of setting 
 cost containment goals under section 62J.04, and measuring cost 
 containment goal compliance; 

    (4) conduct applied research using existing and new data 
 and promote applications based on existing research; 

    (5) develop and implement data collection procedures to 
 ensure a high level of cooperation from health care providers 
 and health plan companies, as defined in section 62Q.01, 
 subdivision 4; 

    (6) work closely with health plan companies and health care 
 providers to promote improvements in health care efficiency and 
 effectiveness; and 

    (7) participate as a partner or sponsor of private sector 
 initiatives that promote publicly disseminated applied research 
 on health care delivery, outcomes, costs, quality, and 
 management. 

    Subd. 4.    Information to be collected.  (a) The data 
 collected may include health outcomes data, patient functional 
 status, and health status.  The data collected may include 
 information necessary to measure and make adjustments for 
 differences in the severity of patient condition across 
 different health care providers, and may include data obtained 
 directly from the patient or from patient medical records, as 
 provided in section 62J.321, subdivision 1. 

    (b) The commissioner may: 

    (1) collect the encounter level data required for the 
 research and data initiatives of sections 62J.301 to 62J.42, 
 using, to the greatest extent possible, standardized forms and 
 procedures; and 

    (2) process the data collected to ensure validity, 
 consistency, accuracy, and completeness, and as appropriate, 
 merge data collected from different sources. 

    (c) For purposes of estimating total health care spending 
 and forecasting rates of growth in health care spending, the 
 commissioner may collect from health care providers data on 
 patient revenues and health care spending during a time period 
 specified by the commissioner.  The commissioner may also 
 collect data on health care revenues and spending from group 
 purchasers of health care.  Health care providers and group 
 purchasers doing business in the state shall provide the data 
 requested by the commissioner at the times and in the form 
 specified by the commissioner.  Professional licensing boards 
 and state agencies responsible for licensing, registering, or 
 regulating providers and group purchasers shall cooperate fully 
 with the commissioner in achieving compliance with the reporting 
 requirements. 

    Subd. 5.    Nonlimiting.  Nothing in this chapter shall 
 be construed to limit the powers granted to the commissioner of 
 health under chapter 62D, 62N, 144, or 144A. 

    HIST: 1995 c 234 art 5 s 6; 1997 c 150 s 5 

  62J.31 Repealed, 1995 c 234 art 5 s 24 

     62J.311 Analysis and use of data. 

    Subdivision 1.    Data analysis.  The commissioner shall 
 analyze the data collected to: 

    (1) assist the state in developing and refining its health 
 policy in the areas of access, utilization, quality, and cost; 

    (2) assist the state in promoting efficiency and 
 effectiveness in the financing and delivery of health services; 

    (3) monitor and track accessibility, utilization, quality, 
 and cost of health care services within the state; 

    (4) evaluate the impact of health care reform activities; 

    (5) assist the state in its public health activities; and 

    (6) evaluate and determine the most appropriate methods for 
 ongoing data collection. 

    Subd. 2.    Criteria for data and research initiatives.  
 (a) Data and research initiatives by the commissioner, pursuant 
 to sections 62J.301 to 62J.42, must: 

    (1) serve the needs of the general public, public sector 
 health care programs, employers and other purchasers of health 
 care, health care providers, including providers serving large 
 numbers of people with low-income, and health plan companies as 
 applicable; 

    (2) be based on scientifically sound and statistically 
 valid methods; 

    (3) be statewide in scope, to the extent feasible, in order 
 to benefit health care purchasers and providers in all parts of 
 Minnesota and to ensure broad and representative health care 
 data for research comparisons and applications; 

    (4) emphasize data that is useful, relevant, and 
 nonredundant of existing data.  The initiatives may duplicate 
 existing private data collection activities, if necessary to 
 ensure that the data collected will be in the public domain; 

    (5) be structured to minimize the administrative burden on 
 health plan companies, health care providers, and the health 
 care delivery system, and minimize any privacy impact on 
 individuals; and 

    (6) promote continuous improvement in the efficiency and 
 effectiveness of health care delivery. 

    (b) Data and research initiatives related to public sector 
 health care programs must: 

    (1) assist the state's current health care financing and 
 delivery programs to deliver and purchase health care in a 
 manner that promotes improvements in health care efficiency and 
 effectiveness; 

    (2) assist the state in its public health activities, 
 including the analysis of disease prevalence and trends and the 
 development of public health responses; 

    (3) assist the state in developing and refining its overall 
 health policy, including policy related to health care costs, 
 quality, and access; and 

    (4) provide data that allows the evaluation of state health 
 care financing and delivery programs. 

    HIST: 1995 c 234 art 5 s 7 

  62J.32 Repealed, 1995 c 234 art 5 s 24 

     62J.321 Data collection and processing procedures. 

    Subdivision 1.    Data collection.  (a) The commissioner 
 shall collect data from health care providers, health plan 
 companies, and individuals in the most cost-effective manner, 
 which does not unduly burden them.  The commissioner may require 
 health care providers and health plan companies to collect and 
 provide patient health records and claim files, and cooperate in 
 other ways with the data collection process.  The commissioner 
 may also require health care providers and health plan companies 
 to provide mailing lists of patients.  Patient consent shall not 
 be required for the release of data to the commissioner pursuant 
 to sections 62J.301 to 62J.42 by any group purchaser, health 
 plan company, health care provider; or agent, contractor, or 
 association acting on behalf of a group purchaser or health care 
 provider.  Any group purchaser, health plan company, health care 
 provider; or agent, contractor, or association acting on behalf 
 of a group purchaser or health care provider, that releases data 
 to the commissioner in good faith pursuant to sections 62J.301 
 to 62J.42 shall be immune from civil liability and criminal 
 prosecution. 

    (b) When a group purchaser, health plan company, or health 
 care provider submits patient identifying data to the 
 commissioner pursuant to sections 62J.301 to 62J.42, and the 
 data is submitted to the commissioner in electronic form, or 
 through other electronic means including, but not limited to, 
 the electronic data interchange system, the group purchaser, 
 health plan company, or health care provider shall submit the 
 patient identifying data in encrypted form, using an encryption 
 method specified by the commissioner.  Submission of encrypted 
 data as provided in this paragraph satisfies the requirements of 
 section 144.335, subdivision 3b. 

    (c) The commissioner shall require all health care 
 providers, group purchasers, and state agencies to use a 
 standard patient identifier and a standard identifier for 
 providers and health plan companies when reporting data under 
 this chapter.  The commissioner must encrypt patient identifiers 
 to prevent identification of individual patients and to enable 
 release of otherwise private data to researchers, providers, and 
 group purchasers in a manner consistent with chapter 13 and 
 sections 62J.55 and 144.335.  This encryption must ensure that 
 any data released must be in a form that makes it impossible to 
 identify individual patients.  

    Subd. 2.    Failure to provide data.  The intentional 
 failure to provide the data requested under this chapter is 
 grounds for disciplinary or regulatory action against a 
 regulated provider or group purchaser.  The commissioner may 
 assess a fine against a provider or group purchaser who refuses 
 to provide data required by the commissioner.  If a provider or 
 group purchaser refuses to provide the data required, the 
 commissioner may obtain a court order requiring the provider or 
 group purchaser to produce documents and allowing the 
 commissioner to inspect the records of the provider or group 
 purchaser for purposes of obtaining the data required. 

    Subd. 3.    Data collection and review.  Data collection 
 must continue for a sufficient time to permit:  adequate 
 analysis by researchers and appropriate providers, including 
 providers who will be impacted by the data; feedback to 
 providers; monitoring for changes in practice patterns; and the 
 data and research criteria of section 62J.311, subdivision 2, to 
 be fulfilled. 

    Subd. 4.    Use of existing data.  (a) The commissioner 
 shall negotiate with private sector organizations currently 
 collecting health care data of interest to the commissioner to 
 obtain required data in a cost-effective manner and minimize 
 administrative costs.  The commissioner shall attempt to 
 establish links between the health care data collected to 
 fulfill sections 62J.301 to 62J.42 and existing private sector 
 data and shall consider and implement methods to streamline data 
 collection in order to reduce public and private sector 
 administrative costs. 

    (b) The commissioner shall use existing public sector data, 
 such as those existing for medical assistance and Medicare, to 
 the greatest extent possible.  The commissioner shall establish 
 links between existing public sector data and consider and 
 implement methods to streamline public sector data collection in 
 order to reduce public and private sector administrative costs. 

    Subd. 5.    Data classification.  (a) Data collected to 
 fulfill the data and research initiatives authorized by sections 
 62J.301 to 62J.42 that identify individual patients or providers 
 are private data on individuals.  Data not on individuals are 
 nonpublic data.  The commissioner shall establish procedures and 
 safeguards to ensure that data released by the commissioner is 
 in a form that does not identify specific patients, providers, 
 employers, individual or group purchasers, or other specific 
 individuals and organizations, except with the permission of the 
 affected individual or organization, or as permitted elsewhere 
 in this chapter. 

    (b) Raw unaggregated data collected from household and 
 employer surveys used by the commissioner to monitor the number 
 of uninsured individuals, reasons for lack of insurance 
 coverage, and to evaluate the effectiveness of health care 
 reform, are subject to the same data classifications as data 
 collected pursuant to sections 62J.301 to 62J.42. 

    (c) Notwithstanding sections 13.03, subdivisions 6 to 8; 
 13.10, subdivisions 1 to 4; and 138.17, data received by the 
 commissioner pursuant to sections 62J.301 to 62J.42, shall 
 retain the classification designated under this section and 
 shall not be disclosed other than pursuant to this section. 

    (d) Summary data collected to fulfill the data and research 
 initiatives authorized by sections 62J.301 to 62J.42 may be 
 disseminated under section 13.05, subdivision 7.  For the 
 purposes of this section, summary data includes nonpublic data 
 not on individuals. 

    (e) Notwithstanding paragraph (a), the commissioner may 
 publish nonpublic or private data collected pursuant to sections 
 62J.301 to 62J.42 on health care costs and spending, quality and 
 outcomes, and utilization for health care institutions, 
 individual health care professionals and groups of health care 
 professionals, and group purchasers, with a description of the 
 methodology used for analysis.  The commissioner may not make 
 public any patient identifying information except as specified 
 in law.  The commissioner shall not reveal the name of an 
 institution, group of professionals, individual health care 
 professional, or group purchaser until after the institution, 
 group of professionals, individual health care professional, or 
 group purchaser has had 21 days to review the data and comment.  
 The commissioner shall include comments received in the release 
 of the data. 

    (f) A provider or group purchaser may contest whether the 
 data meets the criteria of section 62J.311, subdivision 2, 
 paragraph (a), clause (2), in accordance with a contested case 
 proceeding as set forth in sections 14.57 to 14.62, subject to 
 appeal in accordance with sections 14.63 to 14.68.  To obtain a 
 contested case hearing, the provider or group purchaser must 
 make a written request to the commissioner before the end of the 
 time period for review and comment.  Within ten days of the 
 assignment of an administrative law judge, the provider or group 
 purchaser shall make a clear showing to the administrative law 
 judge of probable success in a hearing on the issue of whether 
 the data are accurate and valid and were collected based on the 
 criteria of section 62J.311, subdivision 2, paragraph (a), 
 clause (2).  If the administrative law judge determines that the 
 provider or group purchaser has made such a showing, the data 
 shall remain private or nonpublic during the contested case 
 proceeding and appeal.  If the administrative law judge 
 determines that the provider or group purchaser has not made 
 such a showing, the commissioner may publish the data 
 immediately, with comments received in the release of the data.  
 The contested case proceeding and subsequent appeal is not an 
 exclusive remedy and any person may seek a remedy pursuant to 
 section 13.08, subdivisions 1 to 4, or as otherwise authorized 
 by law. 

    Subd. 5a.    Prescription drug price disclosure data.  
 Notwithstanding subdivisions 1 and 5, data collected under 
 section 62J.381 shall be classified as public data. 

    Subd. 6.    Rulemaking.  The commissioner may adopt 
 rules to implement sections 62J.301 to 62J.42. 

    Subd. 7.    Federal and other grants.  The commissioner 
 may seek federal funding, and funding from private and other 
 nonstate sources, for data and research initiatives. 

    Subd. 8.    Contracts and grants.  To carry out the 
 duties assigned in sections 62J.301 to 62J.42, the commissioner 
 may contract with or provide grants to private sector entities.  
 Any contract or grant must require the private sector entity to 
 maintain the data which it receives according to the statutory 
 provisions applicable to the data. 

    HIST: 1995 c 234 art 5 s 8; 1997 c 225 art 2 s 62; 1998 c 407 
 art 2 s 3; 1Sp2003 c 14 art 7 s 88 

     62J.322 Provider information pilot study. 

    The commissioner shall develop a pilot study to collect 
 comparative data from health care providers on opportunities and 
 barriers to the provision of quality, cost-effective health 
 care.  The provider information pilot study shall include 
 providers in community integrated service networks, health 
 maintenance organizations, preferred provider organizations, 
 indemnity insurance plans, public programs, and other health 
 plan companies.  Health plan companies and group purchasers 
 shall provide to the commissioner providers' names, health plan 
 assignment, and other appropriate data necessary for the 
 commissioner to conduct the study.  The provider information 
 pilot study shall examine factors that increase and hinder 
 access to the provision of quality, cost-effective health care.  
 The study may examine: 

    (1) administrative barriers and facilitators; 

    (2) time spent obtaining permission for appropriate and 
 necessary treatments; 

    (3) latitude to order appropriate and necessary tests, 
 pharmaceuticals, and referrals to specialty providers; 

    (4) assistance available for decreasing administrative and 
 other routine paperwork activities; 

    (5) continuing education opportunities provided; 

    (6) access to readily available information on diagnoses, 
 diseases, outcomes, and new technologies; 

    (7) continuous quality improvement activities; 

    (8) inclusion in administrative decision making; 

    (9) access to social services and other services that 
 facilitate continuity of care; 

    (10) economic incentives and disincentives; 

    (11) peer review procedures; and 

    (12) the prerogative to address public health needs. 

    In selecting additional data for collection, the 
 commissioner shall consider the:  (i) statistical validity of 
 the data; (ii) public need for the data; (iii) estimated expense 
 of collecting and reporting the data; and (iv) usefulness of the 
 data to identify barriers and opportunities to improve quality 
 care provision within health plan companies. 

    HIST: 1995 c 234 art 5 s 9; 1997 c 225 art 2 s 62 

  62J.33 Repealed, 1995 c 234 art 5 s 24 

  62J.34 Repealed, 1995 c 234 art 5 s 24 

  62J.35 Repealed, 1995 c 234 art 5 s 24 

  62J.37 Repealed, 1997 c 225 art 2 s 63 

     62J.38 Cost containment data from group purchasers. 

    (a) The commissioner shall require group purchasers to 
 submit detailed data on total health care spending for each 
 calendar year.  Group purchasers shall submit data for the 1993 
 calendar year by April 1, 1994, and each April 1 thereafter 
 shall submit data for the preceding calendar year. 

    (b) The commissioner shall require each group purchaser to 
 submit data on revenue, expenses, and member months, as 
 applicable.  Revenue data must distinguish between premium 
 revenue and revenue from other sources and must also include 
 information on the amount of revenue in reserves and changes in 
 reserves.  Expenditure data must distinguish between costs 
 incurred for patient care and administrative costs.  Patient 
 care and administrative costs must include only expenses 
 incurred on behalf of health plan members and must not include 
 the cost of providing health care services for nonmembers at 
 facilities owned by the group purchaser or affiliate.  
 Expenditure data must be provided separately for the following 
 categories and for other categories required by the 
 commissioner:  physician services, dental services, other 
 professional services, inpatient hospital services, outpatient 
 hospital services, emergency, pharmacy services and other 
 nondurable medical goods, mental health, and chemical dependency 
 services, other expenditures, subscriber liability, and 
 administrative costs.  Administrative costs must include costs 
 for marketing; advertising; overhead; salaries and benefits of 
 central office staff who do not provide direct patient care; 
 underwriting; lobbying; claims processing; provider contracting 
 and credentialing; detection and prevention of payment for 
 fraudulent or unjustified requests for reimbursement or 
 services; clinical quality assurance and other types of medical 
 care quality improvement efforts; concurrent or prospective 
 utilization review as defined in section 62M.02; costs incurred 
 to acquire a hospital, clinic, or health care facility, or the 
 assets thereof; capital costs incurred on behalf of a hospital 
 or clinic; lease payments; or any other costs incurred pursuant 
 to a partnership, joint venture, integration, or affiliation 
 agreement with a hospital, clinic, or other health care 
 provider.  Capital costs and costs incurred must be recorded 
 according to standard accounting principles.  The reports of 
 this data must also separately identify expenses for local, 
 state, and federal taxes, fees, and assessments.  The 
 commissioner may require each group purchaser to submit any 
 other data, including data in unaggregated form, for the 
 purposes of developing spending estimates, setting spending 
 limits, and monitoring actual spending and costs.  In addition 
 to reporting administrative costs incurred to acquire a 
 hospital, clinic, or health care facility, or the assets 
 thereof; or any other costs incurred pursuant to a partnership, 
 joint venture, integration, or affiliation agreement with a 
 hospital, clinic, or other health care provider; reports 
 submitted under this section also must include the payments made 
 during the calendar year for these purposes.  The commissioner 
 shall make public, by group purchaser data collected under this 
 paragraph in accordance with section 62J.321, subdivision 5.  
 Workers' compensation insurance plans and automobile insurance 
 plans are exempt from complying with this paragraph as it 
 relates to the submission of administrative costs. 

    (c) The commissioner may collect information on: 

    (1) premiums, benefit levels, managed care procedures, and 
 other features of health plan companies; 

    (2) prices, provider experience, and other information for 
 services less commonly covered by insurance or for which 
 patients commonly face significant out-of-pocket expenses; and 

    (3) information on health care services not provided 
 through health plan companies, including information on prices, 
 costs, expenditures, and utilization. 

    (d) All group purchasers shall provide the required data 
 using a uniform format and uniform definitions, as prescribed by 
 the commissioner. 

    HIST: 1993 c 345 art 3 s 10; 1994 c 625 art 8 s 28; 1995 c 234 
 art 5 s 11; 1Sp2001 c 9 art 16 s 4; 2002 c 379 art 1 s 113 

     62J.381 Prescription drug price disclosure. 

    By April 1, 1999, and annually thereafter, hospitals 
 licensed under chapter 144 and group purchasers required to file 
 a full report under section 62J.38 and the rules promulgated 
 thereunder, must submit to the commissioner of health the total 
 amount of: 

    (1) aggregate purchases of or payments for prescription 
 drugs; and 

    (2) aggregate cash rebates, discounts, other payments 
 received, and any fees associated with education, data 
 collection, research, training, or market share movement, which 
 are received during the previous calendar year from a 
 manufacturer as defined under section 151.44, paragraph (c), or 
 wholesale drug distributor as defined under section 151.44, 
 paragraph (d). 

 The data collected under this section shall be distributed 
 through the information clearinghouse under section 62J.2930.  
 The identification of individual manufacturers or wholesalers or 
 specific drugs shall not be required under this section.  

    HIST: 1998 c 407 art 2 s 4 

     62J.40 Cost containment data from state agencies and 
  other governmental units. 

    (a) All state departments or agencies that administer one 
 or more health care programs shall provide to the commissioner 
 of health any additional data on the health care programs they 
 administer that is requested by the commissioner of health, 
 including data in unaggregated form, for purposes of developing 
 estimates of spending, setting spending limits, and monitoring 
 actual spending.  The data must be provided at the times and in 
 the form specified by the commissioner of health. 

    (b) For purposes of estimating total health care spending 
 as provided in section 62J.301, subdivision 4, clause (c), all 
 local governmental units shall provide expenditure data to the 
 commissioner.  The commissioner shall consult with 
 representatives of the affected local government units in 
 establishing definitions, reporting formats, and reporting time 
 frames.  As much as possible, the data shall be collected in a 
 manner that ensures that the data collected is consistent with 
 data collected from the private sector and minimizes the 
 reporting burden to local government. 

    HIST: 1993 c 345 art 3 s 11; 1995 c 234 art 5 s 12 

     62J.41 Data from providers. 

    Subdivision 1.    Cost containment data to be collected 
 from providers.  The commissioner shall require health care 
 providers to collect and provide both patient specific 
 information and descriptive and financial aggregate data on: 

    (1) the total number of patients served; 

    (2) the total number of patients served by state of 
 residence and Minnesota county; 

    (3) the site or sites where the health care provider 
 provides services; 

    (4) the number of individuals employed, by type of 
 employee, by the health care provider; 

    (5) the services and their costs for which no payment was 
 received; 

    (6) total revenue by type of payer or by groups of payers, 
 including but not limited to, revenue from Medicare, medical 
 assistance, MinnesotaCare, nonprofit health service plan 
 corporations, commercial insurers, health maintenance 
 organizations, and individual patients; 

    (7) revenue from research activities; 

    (8) revenue from educational activities; 

    (9) revenue from out-of-pocket payments by patients; 

    (10) revenue from donations; and 

    (11) any other data required by the commissioner, including 
 data in unaggregated form, for the purposes of developing 
 spending estimates, setting spending limits, monitoring actual 
 spending, and monitoring costs.  

 The commissioner may, by rule, modify the data submission 
 categories listed above if the commissioner determines that this 
 will reduce the reporting burden on providers without having a 
 significant negative effect on necessary data collection efforts.

    Subd. 2.    Annual monitoring and estimates.  The 
 commissioner shall require health care providers to submit the 
 required data for the period July 1, 1993 to December 31, 1993, 
 by April 1, 1994.  Health care providers shall submit data for 
 the 1994 calendar year by April 1, 1995, and each April 1 
 thereafter shall submit data for the preceding calendar year.  
 The commissioner of revenue may collect health care service 
 revenue data from health care providers, if the commissioner of 
 revenue and the commissioner agree that this is the most 
 efficient method of collecting the data.  The commissioners of 
 health and revenue shall have the authority to share data 
 collected pursuant to this section. 

    Subd. 3. Repealed, 1995 c 234 art 5 s 24 

    Subd. 4. Repealed, 1995 c 234 art 5 s 24 

    HIST: 1993 c 345 art 3 s 12; 1994 c 625 art 8 s 29; 1995 c 234 
 art 5 s 13,14; 1997 c 225 art 2 s 62 

     62J.42 Quality, utilization, and outcome data. 

    The commissioner shall also require group purchasers and 
 health care providers to maintain and periodically report 
 information on quality of care, utilization, and outcomes.  The 
 information must be provided at the times and in the form 
 specified by the commissioner. 

    HIST: 1993 c 345 art 3 s 13 

     62J.43 Best practices and quality improvement. 

    (a) To improve quality and reduce health care costs, state 
 agencies shall encourage the adoption of best practice 
 guidelines and participation in best practices measurement 
 activities by physicians, other health care providers, and 
 health plan companies.  The commissioner of health shall 
 facilitate access to best practice guidelines and quality of 
 care measurement information to providers, purchasers, and 
 consumers by: 

    (1) identifying and promoting local community-based, 
 physician-designed best practices care across the Minnesota 
 health care system; 

    (2) disseminating information available to the commissioner 
 on adherence to best practices care by physicians and other 
 health care providers in Minnesota; 

    (3) educating consumers and purchasers on how to 
 effectively use this information in choosing their providers and 
 in making purchasing decisions; and 

    (4) making best practices and quality care measurement 
 information available to enrollees and program participants 
 through the Department of Health's Web site.  The commissioner 
 may convene an advisory committee to ensure that the Web site is 
 designed to provide user friendly and easy accessibility. 

    (b) The commissioner of health shall collaborate with a 
 nonprofit Minnesota quality improvement organization 
 specializing in best practices and quality of care measurements 
 to provide best practices criteria and assist in the collection 
 of the data.  

    (c) The initial best practices and quality of care 
 measurement criteria developed shall include asthma, diabetes, 
 and at least two other preventive health measures.  Hypertension 
 and coronary artery disease shall be included within one year 
 following availability.  

    (d) The commissioners of human services and employee 
 relations may use the data to make decisions about contracts 
 they enter into with health plan companies.  

    (e) This section does not apply if the best practices 
 guidelines authorize or recommend denial of treatment, food, or 
 fluids necessary to sustain life on the basis of the patient's 
 age or expected length of life or the patient's present or 
 predicted disability, degree of medical dependency, or quality 
 of life. 

    (f) The commissioner of health, human services, and 
 employee relations shall report to the legislature by January 
 15, 2005, on the status of best practices and quality of care 
 initiatives, and shall present recommendations to the 
 legislature on any statutory changes needed to increase the 
 effectiveness of these initiatives. 

    (g) This section expires June 30, 2006.  

    HIST: 2004 c 288 art 7 s 2 

  62J.44 Repealed, 1995 c 234 art 5 s 24 

  62J.45 Repealed, 1995 c 234 art 5 s 24 

  62J.451 Repealed, 1Sp2003 c 14 art 7 s 89 

  62J.452 Repealed, 1Sp2003 c 14 art 7 s 89 

     62J.46 Monitoring and reports. 

    Subdivision 1.    Long-term care costs.  The 
 commissioner shall use existing state data resources to monitor 
 trends in public and private spending on long-term care costs 
 and spending in Minnesota.  The commissioner shall recommend to 
 the legislature any additional data collection activities needed 
 to monitor these trends.  State agencies collecting information 
 on long-term care spending and costs shall coordinate with the 
 Interagency Long-Term Care Planning Committee and the 
 commissioner to facilitate the monitoring of long-term care 
 expenditures in the state. 

    Subd. 2.    Cost shifting.  The commissioner shall 
 monitor the extent to which reimbursement rates for government 
 health care programs lead to the shifting of costs to private 
 payers.  By January 1, 1995, the commissioner shall report any 
 evidence of cost shifting to the legislature and make 
 recommendations on adjustments to the cost containment plan that 
 should be made due to cost shifting. 

    HIST: 1993 c 345 art 3 s 16; 2001 c 161 s 13 

  62J.47 Repealed, 1999 c 86 art 1 s 83 

     62J.48 Criteria for reimbursement. 

    All ambulance services licensed under section 144E.10 are 
 eligible for reimbursement under health plan companies. The 
 commissioner shall require health plan companies to adopt the 
 following reimbursement policies. 

    (1) All scheduled or prearranged air and ground ambulance 
 transports must be reimbursed if requested by an attending 
 physician or nurse, and, if the person is an enrollee in a 
 health plan company, if approved by a designated representative 
 of a health plan company who is immediately available on a 
 24-hour basis.  The designated representative must be a 
 registered nurse or a physician assistant with at least three 
 years of critical care or trauma experience, or a licensed 
 physician. 

    (2) Reimbursement must be provided for all emergency 
 ambulance calls in which a patient is transported or medical 
 treatment rendered. 

    (3) Special transportation services must not be billed or 
 reimbursed if the patient needs medical attention immediately 
 before transportation. 

    HIST: 1994 c 625 art 4 s 1; 1995 c 234 art 8 s 11; 1997 c 199 
 s 14 

     62J.49 Ambulance services financial data. 

    Subdivision 1.    Establishment.  The Emergency Medical 
 Services Regulatory Board established under chapter 144 shall 
 establish a financial data collection system for all ambulance 
 services licensed in this state.  To establish the financial 
 database, the Emergency Medical Services Regulatory Board may 
 contract with an entity that has experience in ambulance service 
 financial data collection. 

    Subd. 2.    Data classification.  All financial data 
 collected by the Emergency Medical Services Regulatory Board 
 shall be classified as nonpublic data under section 13.02, 
 subdivision 9. 

    HIST: 1997 c 203 art 2 s 1 

HEALTH CARE ADMINISTRATIVE

SIMPLIFICATION ACT OF 1994

     62J.50 Citation and purpose. 

    Subdivision 1.    Citation.  Sections 62J.50 to 62J.61 
 may be cited as the Minnesota Health Care Administrative 
 Simplification Act of 1994. 

    Subd. 2.    Purpose.  The legislature finds that 
 significant savings throughout the health care industry can be 
 accomplished by implementing a set of administrative standards 
 and simplified procedures and by setting forward a plan toward 
 the use of electronic methods of data interchange.  The 
 legislature finds that initial steps have been taken at the 
 national level by the federal Health Care Financing 
 Administration in its implementation of nationally accepted 
 electronic transaction sets for its Medicare program.  The 
 legislature further recognizes the work done by the workgroup 
 for electronic data interchange and the American National 
 Standards Institute and its accredited standards committee X12, 
 at the national level, and the Minnesota administrative 
 uniformity committee, a statewide, voluntary, public-private 
 group representing payers, hospitals, state programs, 
 physicians, and other health care providers in their work toward 
 administrative simplification in the health care industry. 

    HIST: 1994 c 625 art 9 s 1 

     62J.51 Definitions. 

    Subdivision 1.    Scope.  For purposes of sections 
 62J.50 to 62J.61, the following definitions apply. 

    Subd. 2.    ANSI.  "ANSI" means the American National 
 Standards Institute. 

    Subd. 3.    ASC X12.  "ASC X12" means the American 
 National Standards Institute committee X12. 

    Subd. 3a.    Card issuer.  "Card issuer" means the group 
 purchaser who is responsible for printing and distributing 
 identification cards to members or insureds. 

    Subd. 4.    Category I industry participants.  "Category 
 I industry participants" means the following:  group purchasers, 
 providers, and other health care organizations doing business in 
 Minnesota including public and private payers; hospitals; claims 
 clearinghouses; third-party administrators; billing service 
 bureaus; value added networks; self-insured plans and employers 
 with more than 100 employees; clinic laboratories; durable 
 medical equipment suppliers with a volume of at least 50,000 
 claims or encounters per year; and group practices with 20 or 
 more physicians. 

    Subd. 5.    Category II industry participants.  
 "Category II industry participants" means all group purchasers 
 and providers doing business in Minnesota not classified as 
 category I industry participants. 

    Subd. 6.    Claim payment/advice transaction set (ANSI ASC 
 X12 835).  "Claim payment/advice transaction set (ANSI ASC X12 
 835)" means the electronic transaction format developed and 
 approved for implementation in October 1991, and used for 
 electronic remittance advice and electronic funds transfer. 

    Subd. 6a.    Claim status transaction set (ANSI ASC X12 
 276/277).  "Claim status transaction set (ANSI ASC X12 
 276/277)" means the transaction format developed and approved 
 for implementation in December 1993 and used by providers to 
 request and receive information on the status of a health care 
 claim or encounter that has been submitted to a group purchaser. 

    Subd. 6b.    Claim submission address.  "Claim 
 submission address" means the address to which the group 
 purchaser requires health care providers, members, or insureds 
 to send health care claims for processing. 

    Subd. 6c.    Claim submission number.  "Claim submission 
 number" means the unique identification number to identify group 
 purchasers as described in section 62J.54, with its suffix 
 identifying the claim submission address. 

    Subd. 7.    Claim submission transaction set (ANSI ASC X12 
 837).  "Claim submission transaction set (ANSI ASC X12 837)" 
 means the electronic transaction format developed and approved 
 for implementation in October 1992, and used to submit all 
 health care claims information. 

    Subd. 8.    EDI or electronic data interchange.  "EDI" 
 or "electronic data interchange" means the computer application 
 to computer application exchange of information using nationally 
 accepted standard formats. 

    Subd. 9.    Eligibility transaction set (ANSI ASC X12 
 270/271).  "Eligibility transaction set (ANSI ASC X12 270/271)"
 means the transaction format developed and approved for 
 implementation in February 1993, and used by providers to 
 request and receive coverage information on the member or 
 insured. 

    Subd. 10.    Enrollment transaction set (ANSI ASC X12 
 834).  "Enrollment transaction set (ANSI ASC X12 834)" means 
 the electronic transaction format developed and approved for 
 implementation in February 1992, and used to transmit enrollment 
 and benefit information from the employer to the payer for the 
 purpose of enrolling in a benefit plan. 

    Subd. 11.    Group purchaser.  "Group purchaser" has the 
 meaning given in section 62J.03, subdivision 6. 

    Subd. 12.    ISO.  "ISO" means the International 
 Standardization Organization. 

    Subd. 13.    NCPDP.  "NCPDP" means the National Council 
 for Prescription Drug Programs, Inc. 

    Subd. 14.    NCPDP telecommunication standard format 3.2. 
  "NCPDP telecommunication standard format 3.2" means the 
 recommended transaction sets for claims transactions adopted by 
 the membership of NCPDP in 1992. 

    Subd. 15.    NCPDP tape billing and payment format 2.0.  
 "NCPDP tape billing and payment format 2.0" means the 
 recommended transaction standards for batch processing claims 
 adopted by the membership of the NCPDP in 1993. 

    Subd. 16.    Provider.  "Provider" or "health care 
 provider" has the meaning given in section 62J.03, subdivision 8.

    Subd. 17.    Uniform billing form HCFA 1450.  "Uniform 
 billing form HCFA 1450" means the uniform billing form known as 
 the HCFA 1450 or UB92, developed by the National Uniform Billing 
 Committee in 1992 and approved for implementation in October 
 1993. 

    Subd. 18.    Uniform billing form HCFA 1500.  "Uniform 
 billing form HCFA 1500" means the 1990 version of the health 
 insurance claim form, HCFA 1500, developed by the uniform claims 
 form task force of the federal Health Care Financing 
 Administration. 

    Subd. 19.    Uniform dental billing form.  "Uniform 
 dental billing form" means the most current version of the 
 uniform dental claim form developed by the American Dental 
 Association. 

    Subd. 19a.    Uniform explanation of benefits document.  
 "Uniform explanation of benefits document" means the document 
 associated with and explaining the details of a group 
 purchaser's claim adjudication for services rendered, which is 
 sent to a patient. 

    Subd. 19b.    Uniform remittance advice report.  
 "Uniform remittance advice report" means the document associated 
 with and explaining the details of a group purchaser's claim 
 adjudication for services rendered, which is sent to a provider. 

    Subd. 20.    Uniform pharmacy billing form.  "Uniform 
 pharmacy billing form" means the National Council for 
 Prescription Drug Programs/universal claim form (NCPDP/UCF). 

    Subd. 21.    WEDI.  "WEDI" means the National Workgroup 
 for Electronic Data Interchange report issued in October 1993.  

    HIST: 1994 c 625 art 9 s 2; 1996 c 440 art 1 s 22-25; 2000 c 
 460 s 2,3; 2002 c 307 art 2 s 3; 2002 c 330 s 19 

     62J.52 Establishment of uniform billing forms. 

    Subdivision 1.    Uniform billing form HCFA 1450.  (a) 
 On and after January 1, 1996, all institutional inpatient 
 hospital services, ancillary services, institutionally owned or 
 operated outpatient services rendered by providers in Minnesota, 
 and institutional or noninstitutional home health services that 
 are not being billed using an equivalent electronic billing 
 format, must be billed using the uniform billing form HCFA 1450, 
 except as provided in subdivision 5. 

    (b) The instructions and definitions for the use of the 
 uniform billing form HCFA 1450 shall be in accordance with the 
 uniform billing form manual specified by the commissioner.  In 
 promulgating these instructions, the commissioner may utilize 
 the manual developed by the National Uniform Billing Committee, 
 as adopted and finalized by the Minnesota Uniform Billing 
 Committee.  

    (c) Services to be billed using the uniform billing form 
 HCFA 1450 include:  institutional inpatient hospital services 
 and distinct units in the hospital such as psychiatric unit 
 services, physical therapy unit services, swing bed (SNF)  
 services, inpatient state psychiatric hospital services, 
 inpatient skilled nursing facility services, home health 
 services (Medicare part A), and hospice services; ancillary 
 services, where benefits are exhausted or patient has no 
 Medicare part A, from hospitals, state psychiatric hospitals, 
 skilled nursing facilities, and home health (Medicare part B); 
 institutional owned or operated outpatient services such as 
 waivered services, hospital outpatient services, including 
 ambulatory surgical center services, hospital referred 
 laboratory services, hospital-based ambulance services, and 
 other hospital outpatient services, skilled nursing facilities, 
 home health, freestanding renal dialysis centers, comprehensive 
 outpatient rehabilitation facilities (CORF), outpatient 
 rehabilitation facilities (ORF), rural health clinics, and 
 community mental health centers; home health services such as 
 home health intravenous therapy providers, waivered services, 
 personal care attendants, and hospice; and any other health care 
 provider certified by the Medicare program to use this form. 

    (d) On and after January 1, 1996, a mother and newborn 
 child must be billed separately, and must not be combined on one 
 claim form. 

    Subd. 2.    Uniform billing form HCFA 1500.  (a) On and 
 after January 1, 1996, all noninstitutional health care services 
 rendered by providers in Minnesota except dental or pharmacy 
 providers, that are not currently being billed using an 
 equivalent electronic billing format, must be billed using the 
 health insurance claim form HCFA 1500, except as provided in 
 subdivision 5. 

    (b) The instructions and definitions for the use of the 
 uniform billing form HCFA 1500 shall be in accordance with the 
 manual developed by the Administrative Uniformity Committee 
 entitled standards for the use of the HCFA 1500 form, dated 
 February 1994, as further defined by the commissioner. 

    (c) Services to be billed using the uniform billing form 
 HCFA 1500 include physician services and supplies, durable 
 medical equipment, noninstitutional ambulance services, 
 independent ancillary services including occupational therapy, 
 physical therapy, speech therapy and audiology, home infusion 
 therapy, podiatry services, optometry services, mental health 
 licensed professional services, substance abuse licensed 
 professional services, nursing practitioner professional 
 services, certified registered nurse anesthetists, 
 chiropractors, physician assistants, laboratories, medical 
 suppliers, and other health care providers such as day activity 
 centers and freestanding ambulatory surgical centers. 

    Subd. 3.    Uniform dental billing form.  (a) On and 
 after January 1, 1996, all dental services provided by dental 
 care providers in Minnesota, that are not currently being billed 
 using an equivalent electronic billing format, shall be billed 
 using the American Dental Association uniform dental billing 
 form. 

    (b) The instructions and definitions for the use of the 
 uniform dental billing form shall be in accordance with the 
 manual developed by the Administrative Uniformity Committee 
 dated February 1994, and as amended or further defined by the 
 commissioner. 

    Subd. 4.    Uniform pharmacy billing form.  (a) On and 
 after January 1, 1996, all pharmacy services provided by 
 pharmacists in Minnesota that are not currently being billed 
 using an equivalent electronic billing format shall be billed 
 using the NCPDP/universal claim form, except as provided in 
 subdivision 5. 

    (b) The instructions and definitions for the use of the 
 uniform claim form shall be in accordance with instructions 
 specified by the commissioner of health, except as provided in 
 subdivision 5. 

    Subd. 5.    State and federal health care programs.  (a) 
 Skilled nursing facilities and ICF/MR services billed to state 
 and federal health care programs administered by the Department 
 of Human Services shall use the form designated by the 
 Department of Human Services. 

    (b) On and after July 1, 1996, state and federal health 
 care programs administered by the Department of Human Services 
 shall accept the HCFA 1450 for community mental health center 
 services and shall accept the HCFA 1500 for freestanding 
 ambulatory surgical center services. 

    (c) State and federal health care programs administered by 
 the Department of Human Services shall be authorized to use the 
 forms designated by the Department of Human Services for 
 pharmacy services. 

    (d) State and federal health care programs administered by 
 the Department of Human Services shall accept the form 
 designated by the Department of Human Services, and the HCFA 
 1500 for supplies, medical supplies, or durable medical 
 equipment.  Health care providers may choose which form to 
 submit. 

    (e) Personal care attendant and waivered services billed on 
 a fee-for-service basis directly to state and federal health 
 care programs administered by the Department of Human Services 
 shall use either the HCFA 1450 or the HCFA 1500 form, as 
 designated by the Department of Human Services. 

    HIST: 1994 c 625 art 9 s 3; 2000 c 460 s 4-6; 1Sp2003 c 14 art 
 7 s 14,15 

     62J.53 Acceptance of uniform billing forms by group 
  purchasers. 

    On and after January 1, 1996, all category I and II group 
 purchasers in Minnesota shall accept the uniform billing forms 
 prescribed under section 62J.52 as the only nonelectronic 
 billing forms used for payment processing purposes. 

    HIST: 1994 c 625 art 9 s 4 

     62J.535 Uniform billing requirements for claim 
  transactions. 

    Subdivision 1. Repealed, 2002 c 307 art 2 s 9; 2002 c 
 330 s 35 

    Subd. 1a.    Electronic claim transactions.  Group 
 purchasers, including government programs, not defined as 
 covered entities under United States Code, title 42, sections 
 1320d to 1320d-8, as amended from time to time, and the 
 regulations promulgated under those sections, that voluntarily 
 agree with providers to accept electronic claim transactions, 
 must accept them in the ANSI X12N 837 standard electronic format 
 as established by federal law.  Nothing in this section requires 
 acceptance of electronic claim transactions by entities not 
 covered under United States Code, title 42, sections 1320d to 
 1320d-8, as amended from time to time, and the regulations 
 promulgated under those sections.  Notwithstanding the above, 
 nothing in this section or other state law prohibits group 
 purchasers not defined as covered entities under United States 
 Code, title 42, sections 1320d to 1320d-8, as amended from time 
 to time, and the regulations promulgated under those sections, 
 from requiring, as authorized by Minnesota law or rule, 
 additional information associated with a claim submitted by a 
 provider. 

    Subd. 1b.    Paper claim transactions.  All group 
 purchasers that accept paper claim transactions must accept, and 
 health care providers submitting paper claim transactions must 
 submit, these transactions with use of the applicable medical 
 and nonmedical data code sets specified in the federal 
 electronic claim transaction standards adopted under United 
 States Code, title 42, sections 1320d to 1320d-8, as amended 
 from time to time, and the regulations promulgated under those 
 sections.  The paper claim transaction must also be conducted 
 using the uniform billing forms as specified in section 62J.52 
 and the identifiers specified in section 62J.54, on and after 
 the compliance date required by law.  Notwithstanding the above, 
 nothing in this section or other state law prohibits group 
 purchasers not defined as covered entities under United States 
 Code, title 42, sections 1320d to 1320d-8, as amended from time 
 to time, and the regulations promulgated under those sections, 
 from requiring, as authorized by Minnesota law or rule, 
 additional information associated with a claim submitted by a 
 provider. 

    Subd. 2.    Compliance.  Subdivision 1a is effective 
 concurrent with the date of required compliance for covered 
 entities established under United States Code, title 42, 
 sections 1320d to 1320d-8, as amended from time to time. 

    HIST: 1999 c 245 art 2 s 8; 2000 c 483 s 16; 2000 c 488 art 11 
 s 1; 2002 c 307 art 2 s 4-6,8; 2002 c 330 s 20-22,33 

     62J.54 Identification and implementation of unique 
  identifiers. 

    Subdivision 1.    Unique identification number for health 
 care provider organizations.  (a) Not later than 24 months 
 after the date on which a unique health identifier for health 
 care providers is adopted or established under United States 
 Code, title 42, sections 1320d to 1320d-8 (1996 and subsequent 
 amendments), all group purchasers and health care providers in 
 Minnesota shall use a unique identification number to identify 
 health care provider organizations, except as provided in 
 paragraph (b). 

    (b) Small health plans, as defined by the federal Secretary 
 of Health and Human Services under United States Code, title 42, 
 section 1320d-4 (1996 and subsequent amendments), shall use a 
 unique identification number to identify health provider 
 organizations no later than 36 months after the date on which a 
 unique health identifier for health care providers is adopted or 
 established under United States Code, title 42, sections 1320d 
 to 1320d-8 (1996 and subsequent amendments). 

    (c) The unique health identifier for health care providers 
 adopted or established by the federal Secretary of Health and 
 Human Services under United States Code, title 42, sections 
 1320d to 1320d-8 (1996 and subsequent amendments), shall be used 
 as the unique identification number for health care provider 
 organizations. 

    (d) Provider organizations required to have a unique health 
 identifier are:  

    (1) hospitals licensed under chapter 144; 

    (2) nursing homes and hospices licensed under chapter 144A; 

    (3) subacute care facilities; 

    (4) individual providers organized as a clinic or group 
 practice; 

    (5) independent laboratory, pharmacy, surgery, radiology, 
 or outpatient facilities; 

    (6) ambulance services licensed under chapter 144; 

    (7) special transportation services certified under chapter 
 174; and 

    (8) other provider organizations as required by the federal 
 Secretary of Health and Human Services under United States Code, 
 title 42, sections 1320d to 1320d-8 (1996 and subsequent 
 amendments).  

    Provider organizations shall obtain a unique health 
 identifier from the federal Secretary of Health and Human 
 Services using the process prescribed by the Secretary. 

    (e) Only the unique health care provider organization 
 identifier shall be used for purposes of submitting and 
 receiving claims, and in conjunction with other data collection 
 and reporting functions. 

    (f) The commissioner of health may contract with the 
 federal Secretary of Health and Human Services or the 
 Secretary's agent to implement this subdivision. 

    Subd. 2.    Unique identification number for individual 
 health care providers.  (a) Not later than 24 months after the 
 date on which a unique health identifier for health care 
 providers is adopted or established under United States Code, 
 title 42, sections 1320d to 1320d-8 (1996 and subsequent 
 amendments), all group purchasers and health care providers in 
 Minnesota shall use a unique identification number to identify 
 an individual health care provider, except as provided in 
 paragraph (b). 

    (b) Small health plans, as defined by the federal Secretary 
 of Health and Human Services under United States Code, title 42, 
 section 1320d-4 (1996 and subsequent amendments), shall use a 
 unique identification number to identify an individual health 
 care provider no later than 36 months after the date on which a 
 unique health identifier for health care providers is adopted or 
 established under United States Code, title 42, sections 1320d 
 to 1320d-8 (1996 and subsequent amendments). 

    (c) The unique health identifier for health care providers 
 adopted or established by the federal Secretary of Health and 
 Human Services under United States Code, title 42, sections 
 1320d to 1320d-8 (1996 and subsequent amendments), shall be used 
 as the unique identification number for individual health care 
 providers.  

    (d) Individual providers required to have a unique health 
 identifier are:  

    (1) physicians licensed under chapter 147; 

    (2) dentists licensed under chapter 150A; 

    (3) chiropractors licensed under chapter 148; 

    (4) podiatrists licensed under chapter 153; 

    (5) physician assistants as defined under section 147A.01; 

    (6) advanced practice nurses as defined under section 
 62A.15; 

    (7) doctors of optometry licensed under section 148.57; 

    (8) pharmacists licensed under chapter 151; 

    (9) individual providers who may bill Medicare for medical 
 and other health services as defined in United States Code, 
 title 42, section 1395x(s); 

    (10) individual providers who are providers for state and 
 federal health care programs administered by the commissioner of 
 human services; and 

    (11) other individual providers as required by the federal 
 Secretary of Health and Human Services under United States Code, 
 title 42, sections 1320d to 1320d-8 (1996 and subsequent 
 amendments). 

    Providers shall obtain a unique health identifier from the 
 federal Secretary of Health and Human Services using the process 
 prescribed by the Secretary.  

    (e) Only the unique individual health care provider 
 identifier shall be used for purposes of submitting and 
 receiving claims, and in conjunction with other data collection 
 and reporting functions. 

    (f) The commissioner of health may contract with the 
 federal Secretary of Health and Human Services or the 
 Secretary's agent to implement this subdivision. 

    Subd. 3.    Unique identification number for group 
 purchasers.  (a) Not later than 24 months after the date on 
 which a unique health identifier for employers and health plans 
 is adopted or established under United States Code, title 42, 
 sections 1320d to 1320d-8 (1996 and subsequent amendments), all 
 group purchasers and health care providers in Minnesota shall 
 use a unique identification number to identify group purchasers, 
 except as provided in paragraph (b). 

    (b) Small health plans, as defined by the federal Secretary 
 of Health and Human Services under United States Code, title 42, 
 section 1320d-4 (1996 and subsequent amendments), shall use a 
 unique identification number to identify group purchasers no 
 later than 36 months after the date on which a unique health 
 identifier for employers and health plans is adopted or 
 established under United States Code, title 42, sections 1320d 
 to 1320d-8 (1996 and subsequent amendments).  

    (c) The unique health identifier for health plans and 
 employers adopted or established by the federal Secretary of 
 Health and Human Services under United States Code, title 42, 
 sections 1320d to 1320d-8 (1996 and subsequent amendments), 
 shall be used as the unique identification number for group 
 purchasers.  

    (d) Group purchasers shall obtain a unique health 
 identifier from the federal Secretary of Health and Human 
 Services using the process prescribed by the Secretary. 

    (e) The unique group purchaser identifier, as described in 
 this section, shall be used for purposes of submitting and 
 receiving claims, and in conjunction with other data collection 
 and reporting functions. 

    (f) The commissioner of health may contract with the 
 federal Secretary of Health and Human Services or the 
 Secretary's agent to implement this subdivision. 

    Subd. 4.    Unique patient identification number.  (a) 
 Not later than 24 months after the date on which a unique health 
 identifier for individuals is adopted or established under 
 United States Code, title 42, sections 1320d to 1320d-8 (1996 
 and subsequent amendments), all group purchasers and health care 
 providers in Minnesota shall use a unique identification number 
 to identify each patient who receives health care services in 
 Minnesota, except as provided in paragraph (b). 

    (b) Small health plans, as defined by the federal Secretary 
 of Health and Human Services under United States Code, title 42, 
 section 1320d-4 (1996 and subsequent amendments), shall use a 
 unique identification number to identify each patient who 
 receives health care services in Minnesota no later than 36 
 months after the date on which a unique health identifier for 
 individuals is adopted or established under United States Code, 
 title 42, sections 1320d to 1320d-8 (1996 and subsequent 
 amendments). 

    (c) The unique health identifier for individuals adopted or 
 established by the federal Secretary of Health and Human 
 Services under United States Code, title 42, sections 1320d to 
 1320d-8 (1996 and subsequent amendments), shall be used as the 
 unique patient identification number, except as provided in 
 paragraphs (e) and (f). 

    (d) The unique patient identification number shall be used 
 by group purchasers and health care providers for purposes of 
 submitting and receiving claims, and in conjunction with other 
 data collection and reporting functions. 

    (e) Within the limits of available appropriations, the 
 commissioner shall develop a proposal for an alternate numbering 
 system for patients who do not have or refuse to provide their 
 Social Security numbers, if: 

    (1) a unique health identifier for individuals is adopted 
 or established under United States Code, title 42, sections 
 1320d to 1320d-8 (1996 and subsequent amendments); 

    (2) the unique health identifier is the Social Security 
 number of the patient; 

    (3) there is no federal alternate numbering system for 
 patients who do not have or refuse to provide their Social 
 Security numbers; and 

    (4) federal law or the federal Secretary of Health and 
 Human Services explicitly allows a state to develop an alternate 
 numbering system for patients who do not have or refuse to 
 provide their Social Security numbers. 

    (f) If an alternate numbering system is developed under 
 paragraph (e), patients who use numbers issued by the alternate 
 numbering system are not required to provide their Social 
 Security numbers and group purchasers or providers may not 
 demand the Social Security numbers of patients who provide 
 numbers issued by the alternate numbering system.  If an 
 alternate numbering system is developed under paragraph (e), 
 group purchasers and health care providers shall establish 
 procedures to notify patients that they can elect not to have 
 their Social Security number used as the unique patient 
 identifier. 

    (g)  The commissioner of health may contract with the 
 federal Secretary of Health and Human Services or the 
 Secretary's agent to implement this subdivision. 

    HIST: 1994 c 625 art 9 s 5; 1995 c 234 art 5 s 17; 1996 c 440 
 art 1 s 26-28; 1997 c 228 s 2; 1Sp1997 c 5 s 16 

     62J.55 Privacy of unique identifiers. 

    (a) When the unique identifiers specified in section 62J.54 
 are used for data collection purposes, the identifiers must be 
 encrypted, as required in section 62J.321, subdivision 1.  
 Encryption must follow encryption standards set by the National 
 Bureau of Standards and approved by the American National 
 Standards Institute as ANSIX3. 92-1982/R 1987 to protect the 
 confidentiality of the data.  Social Security numbers must not 
 be maintained in unencrypted form in the database, and the data 
 must never be released in a form that would allow for the 
 identification of individuals.  The encryption algorithm and 
 hardware used must not use clipper chip technology.  

    (b) Providers and group purchasers shall treat medical 
 records, including the Social Security number if it is used as a 
 unique patient identifier, in accordance with section 144.335.  
 The Social Security number may be disclosed by providers and 
 group purchasers to the commissioner as necessary to allow 
 performance of those duties set forth in section 144.05.  

    HIST: 1994 c 625 art 9 s 6; 1995 c 234 art 5 s 18 

     62J.56 Implementation of electronic data interchange 
  standards. 

    Subdivision 1.    General provisions.  (a) The 
 legislature finds that there is a need to advance the use of 
 electronic methods of data interchange among all health care 
 participants in the state in order to achieve significant 
 administrative cost savings.  The legislature also finds that in 
 order to advance the use of health care electronic data 
 interchange in a cost-effective manner, the state needs to 
 implement electronic data interchange standards that are 
 nationally accepted, widely recognized, and available for 
 immediate use.  The legislature intends to set forth a plan for 
 a systematic phase in of uniform health care electronic data 
 interchange standards in all segments of the health care 
 industry. 

    (b) The commissioner of health, with the advice of the 
 Minnesota Health Data Institute and the Minnesota Administrative 
 Uniformity Committee, shall administer the implementation of and 
 monitor compliance with, electronic data interchange standards 
 of health care participants, according to the plan provided in 
 this section. 

    (c) The commissioner may grant exemptions to category I and 
 II industry participants from the requirements to implement some 
 or all of the provisions in this section if the commissioner 
 determines that the cost of compliance would place the 
 organization in financial distress, or if the commissioner 
 determines that appropriate technology is not available to the 
 organization. 

    Subd. 2.    Identification of core transaction sets.  (a)
 All category I and II industry participants in Minnesota shall 
 comply with the standards developed by the ANSI ASC X12 for the 
 following core transaction sets, according to the implementation 
 plan outlined for each transaction set. 

    (1) ANSI ASC X12 835 health care claim payment/advice 
 transaction set. 

    (2) ANSI ASC X12 837 health care claim transaction set. 

    (3) ANSI ASC X12 834 health care enrollment transaction set.

    (4) ANSI ASC X12 270/271 health care eligibility 
 transaction set. 

    (5) ANSI ASC X12 276/277 health care claims status 
 request/notification transaction set. 

    (b) The commissioner, with the advice of the Minnesota 
 Health Data Institute and the Minnesota Administrative 
 Uniformity Committee, and in coordination with federal efforts, 
 may approve the use of new ASC X12 standards, or new versions of 
 existing standards, as they become available, or other 
 nationally recognized standards, where appropriate ASC X12 
 standards are not available for use.  These alternative 
 standards may be used during a transition period while ASC X12 
 standards are developed. 

    Subd. 3.    Implementation guides.  (a) The 
 commissioner, with the advice of the Minnesota Administrative 
 Uniformity Committee, and the Minnesota Center for Health Care 
 Electronic Data Interchange shall review and recommend the use 
 of guides to implement the core transaction sets.  
 Implementation guides must contain the background and technical 
 information required to allow health care participants to 
 implement the transaction set in the most cost-effective way. 

    (b) The commissioner shall promote the development of 
 implementation guides among health care participants for those 
 business transaction types for which implementation guides are 
 not available, to allow providers and group purchasers to 
 implement electronic data interchange.  In promoting the 
 development of these implementation guides, the commissioner 
 shall review the work done by the American Hospital Association 
 through the national Uniform Billing Committee and its state 
 representative organization; the American Medical Association 
 through the Uniform Claim Task Force; the American Dental 
 Association; the National Council of Prescription Drug Programs; 
 and the Workgroup for Electronic Data Interchange. 

    HIST: 1994 c 625 art 9 s 7; 1996 c 440 art 1 s 29 

     62J.57 Minnesota Center for Health Care Electronic Data 
  Interchange. 

    (a) It is the intention of the legislature to support, to 
 the extent of funds appropriated for that purpose, the creation 
 of the Minnesota Center for Health Care Electronic Data 
 Interchange as a broad-based effort of public and private 
 organizations representing group purchasers, health care 
 providers, and government programs to advance the use of health 
 care electronic data interchange in the state.  The center shall 
 attempt to obtain private sector funding to supplement 
 legislative appropriations, and shall become self-supporting by 
 the end of the second year. 

    (b) The Minnesota Center for Health Care Electronic Data 
 Interchange shall facilitate the statewide implementation of 
 electronic data interchange standards in the health care 
 industry by: 

    (1) coordinating and ensuring the availability of quality 
 electronic data interchange education and training in the state; 

    (2) developing an extensive, cohesive health care 
 electronic data interchange education curriculum; 

    (3) developing a communications and marketing plan to 
 publicize electronic data interchange education activities, and 
 the products and services available to support the 
 implementation of electronic data interchange in the state; 

    (4) administering a resource center that will serve as a 
 clearinghouse for information relative to electronic data 
 interchange, including the development and maintenance of a 
 health care constituents database, health care directory and 
 resource library, and a health care communications network 
 through the use of electronic bulletin board services and other 
 network communications applications; and 

    (5) providing technical assistance in the development of 
 implementation guides, and in other issues including 
 legislative, legal, and confidentiality requirements.  

    HIST: 1994 c 625 art 9 s 8 

     62J.58 Implementation of standard transaction sets. 

    Subdivision 1.    Claims payment.  Six months from the 
 date the commissioner formally recommends the use of guides to 
 implement core transaction sets pursuant to section 62J.56, 
 subdivision 3, all category I industry participants and all 
 category II industry participants, except pharmacists, shall be 
 able to submit or accept, as appropriate, the ANSI ASC X12 835 
 health care claim payment/advice transaction set (draft standard 
 for trial use version/release 3051) for electronic submission of 
 payment information to health care providers. 

    Subd. 2.    Claims submission.  Six months from the date 
 the commissioner formally recommends the use of guides to 
 implement core transaction sets pursuant to section 62J.56, 
 subdivision 3, all category I and category II industry 
 participants, except pharmacists, shall be able to accept or 
 submit, as appropriate, the ANSI ASC X12 837 health care claim 
 transaction set (draft standard for trial use version/release 
 3051) for the electronic transfer of health care claim 
 information.  

    Subd. 2a.    Claim status information.  Six months from 
 the date the commissioner formally recommends the use of guides 
 to implement core transaction sets under section 62J.56, 
 subdivision 3, all category I and II industry participants, 
 excluding pharmacists, may accept or submit the ANSI ASC X12 
 276/277 health care claim status transaction set (draft standard 
 for trial use version/release 3051) for the electronic transfer 
 of health care claim status information. 

    Subd. 3.    Enrollment information.  Six months from the 
 date the commissioner formally recommends the use of guides to 
 implement core transaction sets pursuant to section 62J.56, 
 subdivision 3, all category I and category II industry 
 participants, excluding pharmacists, shall be able to accept or 
 submit, as appropriate, the ANSI ASC X12 834 health care 
 enrollment transaction set (draft standard for trial use 
 version/release 3051) for the electronic transfer of enrollment 
 and health benefit information.  

    Subd. 4.    Eligibility information.  Six months from 
 the date the commissioner formally recommends the use of guides 
 to implement core transaction sets pursuant to section 62J.56, 
 subdivision 3, all category I and category II industry 
 participants, except pharmacists, shall be able to accept or 
 submit, as appropriate, the ANSI ASC X12 270/271 health care 
 eligibility transaction set (draft standard for trial use 
 version/release 3051) for the electronic transfer of health 
 benefit eligibility information.  

    Subd. 5.    Applicability.  This section does not 
 require a group purchaser, health care provider, or employer to 
 use electronic data interchange or to have the capability to do 
 so.  This section applies only to the extent that a group 
 purchaser, health care provider, or employer chooses to use 
 electronic data interchange. 

    HIST: 1994 c 625 art 9 s 9; 1995 c 234 art 5 s 19; 1996 c 440 
 art 1 s 30 

     62J.581 Standards for Minnesota uniform health care 
  reimbursement documents. 

    Subdivision 1.    Minnesota uniform remittance advice 
 report.  (a) All group purchasers shall provide a uniform 
 remittance advice report to health care providers when a claim 
 is adjudicated.  The uniform remittance advice report shall 
 comply with the standards prescribed in this section.  

    (b) Notwithstanding paragraph (a), this section does not 
 apply to group purchasers not included as covered entities under 
 United States Code, title 42, sections 1320d to 1320d-8, as 
 amended from time to time, and the regulations promulgated under 
 those sections. 

    Subd. 2.    Minnesota uniform explanation of benefits 
 document.  (a) All group purchasers shall provide a uniform 
 explanation of benefits document to health care patients when an 
 explanation of benefits document is provided as otherwise 
 required or permitted by law.  The uniform explanation of 
 benefits document shall comply with the standards prescribed in 
 this section.  

    (b) Notwithstanding paragraph (a), this section does not 
 apply to group purchasers not included as covered entities under 
 United States Code, title 42, sections 1320d to 1320d-8, as 
 amended from time to time, and the regulations promulgated under 
 those sections. 

    Subd. 3.    Scope.  For purposes of sections 62J.50 to 
 62J.61, the uniform remittance advice report and the uniform 
 explanation of benefits document format specified in subdivision 
 4 shall apply to all health care services delivered by a health 
 care provider or health care provider organization in Minnesota, 
 regardless of the location of the payer.  Health care services 
 not paid on an individual claims basis, such as capitated 
 payments, are not included in this section.  A health plan 
 company is excluded from the requirements in subdivisions 1 and 
 2 if they comply with section 62A.01, subdivisions 2 and 3. 

    Subd. 4.    Specifications.  The uniform remittance 
 advice report and the uniform explanation of benefits document 
 shall be provided by use of a paper document conforming to the 
 specifications in this section or by use of the ANSI X12N 835 
 standard electronic format as established under United States 
 Code, title 42, sections 1320d to 1320d-8, and as amended from 
 time to time for the remittance advice.  The commissioner, after 
 consulting with the Administrative Uniformity Committee, shall 
 specify the data elements and definitions for the uniform 
 remittance advice report and the uniform explanation of benefits 
 document.  The commissioner and the Administrative Uniformity 
 Committee must consult with the Minnesota Dental Association and 
 Delta Dental Plan of Minnesota before requiring under this 
 section the use of a paper document for the uniform explanation 
 of benefits document or the uniform remittance advice report for 
 dental care services.  

    Subd. 5.    Effective date.  The requirements in 
 subdivisions 1 and 2 are effective October 16, 2004.  The 
 requirements in subdivisions 1 and 2 apply regardless of when 
 the health care service was provided to the patient. 

    HIST: 2000 c 460 s 7; 2002 c 307 art 2 s 7; 2002 c 330 s 23 

     62J.59 Implementation of NCPDP telecommunications 
  standard for pharmacy claims. 

    (a) Beginning January 1, 1996, all category I and II 
 pharmacists licensed in this state shall accept the NCPDP 
 telecommunication standard format 3.2 or the NCPDP tape billing 
 and payment format 2.0 for the electronic submission of claims 
 as appropriate. 

    (b) Beginning January 1, 1996, all category I and category 
 II group purchasers in this state shall use the NCPDP 
 telecommunication standard format 3.2 or NCPDP tape billing and 
 payment format 2.0 for electronic submission of payment 
 information to pharmacists. 

    HIST: 1994 c 625 art 9 s 10 

     62J.60 Standards for the Minnesota uniform health care 
  identification card. 

    Subdivision 1.    Minnesota uniform health care 
 identification card.  All individuals with health care 
 coverage shall be issued Minnesota uniform health care 
 identification cards by group purchasers as of January 1, 1998, 
 unless the requirements of section 62A.01, subdivisions 2 and 3, 
 are met.  If a health benefit plan issued by a group purchaser 
 provides coverage for prescription drugs, the group purchaser 
 shall include uniform prescription drug information on the 
 uniform health care identification card issued to its enrollees 
 on or after July 1, 2003.  Nothing in this section requires a 
 group purchaser to issue a separate card containing uniform 
 prescription drug information, provided that the Minnesota 
 uniform health care identification card can accommodate the 
 information necessary to process prescription drug claims as 
 required by this section.  The Minnesota uniform health care 
 identification cards shall comply with the standards prescribed 
 in this section. 

    Subd. 1a.    Definition; health benefit plan.  For 
 purposes of this section, "health benefit plan" means a policy, 
 contract, or certificate offered, sold, issued, or renewed by a 
 group purchaser for the coverage of medical and hospital 
 benefits.  A health benefit plan does not include coverage that 
 is: 

    (1) limited to disability or income protection coverage; 

    (2) automobile or homeowners medical payment coverage; 

    (3) liability insurance or supplemental to liability 
 insurance; 

    (4) accident-only coverage; 

    (5) credit accident and health insurance issued under 
 chapter 62B; 

    (6) designed solely to provide dental or vision care; 

    (7) designed solely to provide coverage for a specified 
 disease or illness; 

    (8) coverage under which benefits are payable with or 
 without regard to fault and that is statutorily required to be 
 contained in any liability insurance policy or equivalent 
 self-insurance; or 

    (9) hospital income or indemnity. 

    Subd. 2.    General characteristics.  (a) The Minnesota 
 uniform health care identification card must be a preprinted 
 card constructed of plastic, paper, or any other medium that 
 conforms with ANSI and ISO 7810 physical characteristics 
 standards.  The card dimensions must also conform to ANSI and 
 ISO 7810 physical characteristics standard.  The use of a 
 signature panel is optional.  The uniform prescription drug 
 information contained on the card must conform with the format 
 adopted by the NCPDP and, except as provided in subdivision 3, 
 paragraph (a), clause (2), must include all of the fields 
 required to submit a claim in conformance with the most recent 
 pharmacy identification card implementation guide produced by 
 the NCPDP.  All information required to submit a prescription 
 drug claim, exclusive of information provided on a prescription 
 that is required by law, must be included on the card in a 
 clear, readable, and understandable manner.  If a health benefit 
 plan requires a conditional or situational field, as defined by 
 the NCPDP, the conditional or situational field must conform to 
 the most recent pharmacy information card implementation guide 
 produced by the NCPDP. 

    (b) The Minnesota uniform health care identification card 
 must have an essential information window on the front side with 
 the following data elements left justified in the following top 
 to bottom sequence:  card issuer name, electronic transaction 
 routing information, card issuer identification number, 
 cardholder (insured) identification number, and cardholder 
 (insured) identification name.  No optional data may be 
 interspersed between these data elements.  The window must be 
 left justified.  

    (c) Standardized labels are required next to human readable 
 data elements and must come before the human readable data 
 elements.  

    Subd. 2a.    Issuance.  A new Minnesota uniform health 
 care identification card must be issued to individuals upon 
 enrollment.  Except for the medical assistance, general 
 assistance medical care, and MinnesotaCare programs, a new card 
 must be issued upon any change in an individual's health care 
 coverage that impacts the content or format of the data included 
 on the card or no later than 24 months after adoption of any 
 change in the NCPDP implementation guide or successor document 
 that affects the content or format of the data included on the 
 card.  Anytime that a card is issued upon enrollment or replaced 
 by the medical assistance, general assistance medical care, or 
 MinnesotaCare program, the card must conform to the adopted 
 NCPDP standards in effect and to the implementation guide in use 
 at the time of issuance.  Newly issued cards must conform to the 
 adopted NCPDP standards in effect at the time of issuance and to 
 the implementation guide in use at the time of issuance.  
 Stickers or other methodologies may be used to update cards 
 temporarily. 

    Subd. 3.    Human readable data elements.  (a) The 
 following are the minimum human readable data elements that must 
 be present on the front side of the Minnesota uniform health 
 care identification card: 

    (1) card issuer name or logo, which is the name or logo 
 that identifies the card issuer.  The card issuer name or logo 
 may be located at the top of the card.  No standard label is 
 required for this data element; 

    (2) complete electronic transaction routing information 
 including, at a minimum, the international identification 
 number.  The standardized label of this data element is "RxBIN." 
 Processor control numbers and group numbers are required if 
 needed to electronically process a prescription drug claim.  The 
 standardized label for the process control numbers data element 
 is "RxPCN" and the standardized label for the group numbers data 
 element is "RxGrp," except that if the group number data element 
 is a universal element to be used by all health care providers, 
 the standardized label may be "Grp."  To conserve vertical space 
 on the card, the international identification number and the 
 processor control number may be printed on the same line; 

    (3) card issuer identification number.  The standardized 
 label for this element is "Issuer"; 

    (4) cardholder (insured) identification number, which is 
 the unique identification number of the individual card holder 
 established and defined under this section.  The standardized 
 label for the data element is "ID"; 

    (5) cardholder (insured) identification name, which is the 
 name of the individual card holder.  The identification name 
 must be formatted as follows:  first name, space, optional 
 middle initial, space, last name, optional space and name 
 suffix.  The standardized label for this data element is "Name"; 

    (6) care type, which is the description of the group 
 purchaser's plan product under which the beneficiary is 
 covered.  The description shall include the health plan company 
 name and the plan or product name.  The standardized label for 
 this data element is "Care Type"; 

    (7) service type, which is the description of coverage 
 provided such as hospital, dental, vision, prescription, or 
 mental health.  The standard label for this data element is "Svc 
 Type"; and 

    (8) provider/clinic name, which is the name of the primary 
 care clinic the card holder is assigned to by the health plan 
 company.  The standard label for this field is "PCP."  This 
 information is mandatory only if the health plan company assigns 
 a specific primary care provider to the card holder. 

    (b) The following human readable data elements shall be 
 present on the back side of the Minnesota uniform health care 
 identification card.  These elements must be left justified, and 
 no optional data elements may be interspersed between them:  

    (1) claims submission names and addresses, which are the 
 names and addresses of the entity or entities to which claims 
 should be submitted.  If different destinations are required for 
 different types of claims, this must be labeled; 

    (2) telephone numbers and names that pharmacies and other 
 health care providers may call for assistance.  These telephone 
 numbers and names are required on the back side of the card only 
 if one of the contacts listed in clause (3) cannot provide 
 pharmacies or other providers with assistance or with the 
 telephone numbers and names of contacts for assistance; and 

    (3) telephone numbers and names; which are the telephone 
 numbers and names of the following contacts with a standardized 
 label describing the service function as applicable:  

    (i) eligibility and benefit information; 

    (ii) utilization review; 

    (iii) precertification; or 

    (iv) customer services. 

    (c) The following human readable data elements are 
 mandatory on the back side of the Minnesota uniform health care 
 identification card for health maintenance organizations: 

    (1) emergency care authorization telephone number or 
 instruction on how to receive authorization for emergency care.  
 There is no standard label required for this information; and 

    (2) one of the following: 

    (i) telephone number to call to appeal to or file a 
 complaint with the commissioner of health; or 

    (ii) for persons enrolled under section 256B.69, 256D.03, 
 or 256L.12, the telephone number to call to file a complaint 
 with the ombudsperson designated by the commissioner of human 
 services under section 256B.69 and the address to appeal to the 
 commissioner of human services.  There is no standard label 
 required for this information. 

    (d) All human readable data elements not required under 
 paragraphs (a) to (c) are optional and may be used at the 
 issuer's discretion. 

    Subd. 4.    Machine readable data content.  The 
 Minnesota uniform health care identification card may be machine 
 readable or nonmachine readable.  If the card is machine 
 readable, the card must contain a magnetic stripe that conforms 
 to ANSI and ISO standards for Tracks 1.  

    Subd. 5.    Annual reporting.  As part of an annual 
 filing made with the commissioner of health or commerce on or 
 after January 1, 2003, a group purchaser shall certify 
 compliance with this section and shall submit to the 
 commissioner of health or commerce a copy of the Minnesota 
 uniform health care identification card used by the group 
 purchaser. 

    HIST: 1994 c 625 art 9 s 11; 1996 c 440 art 1 s 31,32; 1997 c 
 205 s 17; 1997 c 225 art 2 s 62; 2000 c 460 s 8; 2001 c 110 s 1 

     62J.61 Rulemaking; implementation. 

    Subdivision 1.    Exemption.  The commissioner of health 
 is exempt from chapter 14, including section 14.386, in 
 implementing sections 62J.50 to 62J.54, subdivision 3, and 
 62J.56 to 62J.59. 

    Subd. 2.    Procedure.  (a) The commissioner shall 
 publish proposed rules in the State Register or, if the 
 commissioner determines that publishing the text of the proposed 
 rules would be unduly cumbersome, shall publish notice of the 
 proposed rules that contains a detailed description of the rules 
 along with a statement that a free copy of the entire set of 
 rules is available upon request to the agency. 

    (b) Interested parties have 30 days to comment on the 
 proposed rules.  After the commissioner has considered all 
 comments, the commissioner shall publish notice in the State 
 Register that the rules have been adopted 30 days before they 
 are to take effect. 

    (c) If the adopted rules are the same as the proposed 
 rules, the notice shall state that the rules have been adopted 
 as proposed and shall cite the prior publication.  If the 
 adopted rules differ from the proposed rules, the portions of 
 the adopted rules which differ from the proposed rules shall be 
 included in the notice of adoption together with a citation to 
 the prior State Register that contained the notice of the 
 proposed rules. 

    (d) The commissioner may use rulemaking to implement 
 sections 62J.54, subdivision 4, 62J.55, and 62J.60. 

    Subd. 3.    Restrictions.  The commissioner shall not 
 adopt any rules requiring patients to provide their Social 
 Security numbers unless and until federal laws are modified to 
 allow or require such action nor shall the commissioner adopt 
 rules which allow medical records, claims, or other treatment or 
 clinical data to be included on the health care identification 
 card, except as specifically provided in this chapter. 

    Subd. 4.    Patient privacy.  The commissioner shall 
 seek comments from the Ethics and Confidentiality Committee of 
 the Minnesota Health Data Institute and the Department of 
 Administration, Public Information Policy Analysis Division, 
 before adopting or publishing final rules relating to issues of 
 patient privacy and medical records. 

    Subd. 5.    Biennial review of rulemaking procedures and 
 rules.  The commissioner shall biennially seek comments from 
 affected parties about the effectiveness of and continued need 
 for the rulemaking procedures set out in subdivision 2 and about 
 the quality and effectiveness of rules adopted using these 
 procedures.  The commissioner shall seek comments by holding a 
 meeting and by publishing a notice in the State Register that 
 contains the date, time, and location of the meeting and a 
 statement that invites oral or written comments.  The notice 
 must be published at least 30 days before the meeting date.  The 
 commissioner shall write a report summarizing the comments and 
 shall submit the report to the Minnesota Health Data Institute 
 and to the Minnesota Administrative Uniformity Committee by 
 January 15 of every even-numbered year. 

    HIST: 1994 c 625 art 9 s 12; 1997 c 187 art 4 s 3; 1998 c 254 
 art 1 s 14 

  62J.65 Repealed, 1995 c 234 art 8 s 57 

  62J.66 Repealed, 1Sp2003 c 14 art 2 s 57 

  62J.68 Repealed, 1Sp2003 c 14 art 2 s 57 

  62J.685 Repealed, 1998 c 407 art 2 s 109 

  62J.69 Repealed, 1999 c 245 art 2 s 45 

MEDICAL EDUCATION AND RESEARCH

     62J.691 Purpose. 

    The legislature finds that medical education and research 
 are important to the health and economic well being of 
 Minnesotans.  The legislature further finds that, as a result of 
 competition in the health care marketplace, these teaching and 
 research institutions are facing increased difficulty funding 
 medical education and research.  The purpose of sections 62J.692 
 and 62J.693 is to help offset lost patient care revenue for 
 those teaching institutions affected by increased competition in 
 the health care marketplace and to help ensure the continued 
 excellence of health care research in Minnesota. 

    HIST: 1999 c 245 art 2 s 9 

     62J.692 Medical education. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, the following definitions apply: 

    (a) "Accredited clinical training" means the clinical 
 training provided by a medical education program that is 
 accredited through an organization recognized by the Department 
 of Education, the Centers for Medicare and Medicaid Services, or 
 another national body who reviews the accrediting organizations 
 for multiple disciplines and whose standards for recognizing 
 accrediting organizations are reviewed and approved by the 
 commissioner of health in consultation with the Medical 
 Education and Research Advisory Committee. 

    (b) "Commissioner" means the commissioner of health. 

    (c) "Clinical medical education program" means the 
 accredited clinical training of physicians (medical students and 
 residents), doctor of pharmacy practitioners, doctors of 
 chiropractic, dentists, advanced practice nurses (clinical nurse 
 specialists, certified registered nurse anesthetists, nurse 
 practitioners, and certified nurse midwives), and physician 
 assistants. 

    (d) "Sponsoring institution" means a hospital, school, or 
 consortium located in Minnesota that sponsors and maintains 
 primary organizational and financial responsibility for a 
 clinical medical education program in Minnesota and which is 
 accountable to the accrediting body. 

    (e) "Teaching institution" means a hospital, medical 
 center, clinic, or other organization that conducts a clinical 
 medical education program in Minnesota. 

    (f) "Trainee" means a student or resident involved in a 
 clinical medical education program.  

    (g) "Eligible trainee FTEs" means the number of trainees, 
 as measured by full-time equivalent counts, that are at training 
 sites located in Minnesota with a medical assistance provider 
 number where training occurs in either an inpatient or 
 ambulatory patient care setting and where the training is 
 funded, in part, by patient care revenues. 

    Subd. 2.    Medical Education and Research Advisory 
 Committee.  The commissioner shall appoint an advisory 
 committee to provide advice and oversight on the distribution of 
 funds appropriated for distribution under this section.  In 
 appointing the members, the commissioner shall:  

    (1) consider the interest of all stakeholders; 

    (2) appoint members that represent both urban and rural 
 interests; and 

    (3) appoint members that represent ambulatory care as well 
 as inpatient perspectives.  

 The commissioner shall appoint to the advisory committee 
 representatives of the following groups to ensure appropriate 
 representation of all eligible provider groups and other 
 stakeholders:  public and private medical researchers; public 
 and private academic medical centers, including representatives 
 from academic centers offering accredited training programs for 
 physicians, pharmacists, chiropractors, dentists, nurses, and 
 physician assistants; managed care organizations; employers; 
 consumers and other relevant stakeholders.  The advisory 
 committee is governed by section 15.059. 

    Subd. 3.    Application process.  (a) A clinical medical 
 education program conducted in Minnesota by a teaching 
 institution to train physicians, doctor of pharmacy 
 practitioners, dentists, chiropractors, or physician assistants 
 is eligible for funds under subdivision 4 if the program: 

    (1) is funded, in part, by patient care revenues; 

    (2) occurs in patient care settings that face increased 
 financial pressure as a result of competition with nonteaching 
 patient care entities; and 

    (3) emphasizes primary care or specialties that are in 
 undersupply in Minnesota. 

    (b) A clinical medical education program for advanced 
 practice nursing is eligible for funds under subdivision 4 if 
 the program meets the eligibility requirements in paragraph (a), 
 clauses (1) to (3), and is sponsored by the University of 
 Minnesota Academic Health Center, the Mayo Foundation, or 
 institutions that are part of the Minnesota State Colleges and 
 Universities system or members of the Minnesota Private College 
 Council.  

    (c) Applications must be submitted to the commissioner by a 
 sponsoring institution on behalf of an eligible clinical medical 
 education program and must be received by October 31 of each 
 year for distribution in the following year.  An application for 
 funds must contain the following information: 

    (1) the official name and address of the sponsoring 
 institution and the official name and site address of the 
 clinical medical education programs on whose behalf the 
 sponsoring institution is applying; 

    (2) the name, title, and business address of those persons 
 responsible for administering the funds; 

    (3) for each clinical medical education program for which 
 funds are being sought; the type and specialty orientation of 
 trainees in the program; the name, site address, and medical 
 assistance provider number of each training site used in the 
 program; the total number of trainees at each training site; and 
 the total number of eligible trainee FTEs at each site.  Only 
 those training sites that host 0.5 FTE or more eligible trainees 
 for a program may be included in the program's application; and 

    (4) other supporting information the commissioner deems 
 necessary to determine program eligibility based on the criteria 
 in paragraphs (a) and (b) and to ensure the equitable 
 distribution of funds.  

    (d) An application must include the information specified 
 in clauses (1) to (3) for each clinical medical education 
 program on an annual basis for three consecutive years.  After 
 that time, an application must include the information specified 
 in clauses (1) to (3) in the first year of each biennium:  

    (1) audited clinical training costs per trainee for each 
 clinical medical education program when available or estimates 
 of clinical training costs based on audited financial data; 

    (2) a description of current sources of funding for 
 clinical medical education costs, including a description and 
 dollar amount of all state and federal financial support, 
 including Medicare direct and indirect payments; and 

    (3) other revenue received for the purposes of clinical 
 training.  

    (e) An applicant that does not provide information 
 requested by the commissioner shall not be eligible for funds 
 for the current funding cycle. 

    Subd. 4.    Distribution of funds.  (a) The commissioner 
 shall annually distribute 90 percent of available medical 
 education funds to all qualifying applicants based on a 
 distribution formula that reflects a summation of two factors:  

    (1) an education factor, which is determined by the total 
 number of eligible trainee FTEs and the total statewide average 
 costs per trainee, by type of trainee, in each clinical medical 
 education program; and 

    (2) a public program volume factor, which is determined by 
 the total volume of public program revenue received by each 
 training site as a percentage of all public program revenue 
 received by all training sites in the fund pool.  

    In this formula, the education factor is weighted at 67 
 percent and the public program volume factor is weighted at 33 
 percent. 

    Public program revenue for the distribution formula 
 includes revenue from medical assistance, prepaid medical 
 assistance, general assistance medical care, and prepaid general 
 assistance medical care.  Training sites that receive no public 
 program revenue are ineligible for funds available under this 
 paragraph.  Total statewide average costs per trainee for 
 medical residents is based on audited clinical training costs 
 per trainee in primary care clinical medical education programs 
 for medical residents.  Total statewide average costs per 
 trainee for dental residents is based on audited clinical 
 training costs per trainee in clinical medical education 
 programs for dental students.  Total statewide average costs per 
 trainee for pharmacy residents is based on audited clinical 
 training costs per trainee in clinical medical education 
 programs for pharmacy students. 

    (b) The commissioner shall annually distribute ten percent 
 of total available medical education funds to all qualifying 
 applicants based on the percentage received by each applicant 
 under paragraph (a).  These funds are to be used to offset 
 clinical education costs at eligible clinical training sites 
 based on criteria developed by the clinical medical education 
 program.  Applicants may choose to distribute funds allocated 
 under this paragraph based on the distribution formula described 
 in paragraph (a).  Applicants may also choose to distribute 
 funds to clinical training sites with a valid Minnesota medical 
 assistance identification number that host fewer than 0.5 
 eligible trainee FTEs for a clinical medical education program. 

    (c) Funds distributed shall not be used to displace current 
 funding appropriations from federal or state sources.  

    (d) Funds shall be distributed to the sponsoring 
 institutions indicating the amount to be distributed to each of 
 the sponsor's clinical medical education programs based on the 
 criteria in this subdivision and in accordance with the 
 commissioner's approval letter.  Each clinical medical education 
 program must distribute funds allocated under paragraph (a) to 
 the training sites as specified in the commissioner's approval 
 letter.  Sponsoring institutions, which are accredited through 
 an organization recognized by the Department of Education or the 
 Centers for Medicare and Medicaid Services, may contract 
 directly with training sites to provide clinical training.  To 
 ensure the quality of clinical training, those accredited 
 sponsoring institutions must: 

    (1) develop contracts specifying the terms, expectations, 
 and outcomes of the clinical training conducted at sites; and 

    (2) take necessary action if the contract requirements are 
 not met.  Action may include the withholding of payments under 
 this section or the removal of students from the site.  

    (e) Any funds not distributed in accordance with the 
 commissioner's approval letter must be returned to the medical 
 education and research fund within 30 days of receiving notice 
 from the commissioner.  The commissioner shall distribute 
 returned funds to the appropriate training sites in accordance 
 with the commissioner's approval letter. 

    (f) The commissioner shall distribute by June 30 of each 
 year an amount equal to the funds transferred under subdivision 
 10, plus five percent interest to the University of Minnesota 
 Board of Regents for the instructional costs of health 
 professional programs at the Academic Health Center and for 
 interdisciplinary academic initiatives within the Academic 
 Health Center. 

    (g) A maximum of $150,000 of the funds dedicated to the 
 commissioner under section 297F.10, subdivision 1, paragraph 
 (b), clause (2), may be used by the commissioner for 
 administrative expenses associated with implementing this 
 section. 

    Subd. 5.    Report.  (a) Sponsoring institutions 
 receiving funds under this section must sign and submit a 
 medical education grant verification report (GVR) to verify that 
 the correct grant amount was forwarded to each eligible training 
 site.  If the sponsoring institution fails to submit the GVR by 
 the stated deadline, or to request and meet the deadline for an 
 extension, the sponsoring institution is required to return the 
 full amount of funds received to the commissioner within 30 days 
 of receiving notice from the commissioner.  The commissioner 
 shall distribute returned funds to the appropriate training 
 sites in accordance with the commissioner's approval letter.  

    (b) The reports must provide verification of the 
 distribution of the funds and must include:  

    (1) the total number of eligible trainee FTEs in each 
 clinical medical education program; 

    (2) the name of each funded program and, for each program, 
 the dollar amount distributed to each training site; 

    (3) documentation of any discrepancies between the initial 
 grant distribution notice included in the commissioner's 
 approval letter and the actual distribution; 

    (4) a statement by the sponsoring institution describing 
 the distribution of funds allocated under subdivision 4, 
 paragraph (b), including information on which clinical training 
 sites received funding and the rationale used for determining 
 funding priorities; 

    (5) a statement by the sponsoring institution stating that 
 the completed grant verification report is valid and accurate; 
 and 

    (6) other information the commissioner, with advice from 
 the advisory committee, deems appropriate to evaluate the 
 effectiveness of the use of funds for medical education.  

    (c) By February 15 of each year, the commissioner, with 
 advice from the advisory committee, shall provide an annual 
 summary report to the legislature on the implementation of this 
 section. 

    Subd. 6.    Other available funds.  The commissioner is 
 authorized to distribute, in accordance with subdivision 4, 
 funds made available through: 

    (1) voluntary contributions by employers or other entities; 

    (2) allocations for the commissioner of human services to 
 support medical education and research; and 

    (3) other sources as identified and deemed appropriate by 
 the legislature for inclusion in the fund. 

    Subd. 7.    Transfers from the commissioner of human 
 services.  (a) The amount transferred according to section 
 256B.69, subdivision 5c, paragraph (a), clause (1), shall be 
 distributed by the commissioner annually to clinical medical 
 education programs that meet the qualifications of subdivision 3 
 based on the formula in subdivision 4, paragraph (a). 

    (b) Fifty percent of the amount transferred according to 
 section 256B.69, subdivision 5c, paragraph (a), clause (2), 
 shall be distributed by the commissioner to the University of 
 Minnesota Board of Regents for the purposes described in 
 sections 137.38 to 137.40.  Of the remaining amount transferred 
 according to section 256B.69, subdivision 5c, paragraph (a), 
 clause (2), 24 percent of the amount shall be distributed by the 
 commissioner to the Hennepin County Medical Center for clinical 
 medical education.  The remaining 26 percent of the amount 
 transferred shall be distributed by the commissioner in 
 accordance with subdivision 7a.  If the federal approval is not 
 obtained for the matching funds under section 256B.69, 
 subdivision 5c, paragraph (a), clause (2), 100 percent of the 
 amount transferred under this paragraph shall be distributed by 
 the commissioner to the University of Minnesota Board of Regents 
 for the purposes described in sections 137.38 to 137.40.  

    (c) The amount transferred according to section 256B.69, 
 subdivision 5c, paragraph (a), clause (3), shall be distributed 
 by the commissioner upon receipt to the University of Minnesota 
 Board of Regents for the purposes of clinical graduate medical 
 education. 

    Subd. 7a.    Clinical medical education innovations 
 grants.  (a) The commissioner shall award grants to teaching 
 institutions and clinical training sites for projects that 
 increase dental access for underserved populations and promote 
 innovative clinical training of dental professionals.  In 
 awarding the grants, the commissioner, in consultation with the 
 commissioner of human services, shall consider the following: 

    (1) potential to successfully increase access to an 
 underserved population; 

    (2) the long-term viability of the project to improve 
 access beyond the period of initial funding; 

    (3) evidence of collaboration between the applicant and 
 local communities; 

    (4) the efficiency in the use of the funding; and 

    (5) the priority level of the project in relation to state 
 clinical education, access, and workforce goals. 

    (b) The commissioner shall periodically evaluate the 
 priorities in awarding the innovations grants in order to ensure 
 that the priorities meet the changing workforce needs of the 
 state. 

    Subd. 8.    Federal financial participation.  (a) The 
 commissioner of human services shall seek to maximize federal 
 financial participation in payments for medical education and 
 research costs.  If the commissioner of human services 
 determines that federal financial participation is available for 
 the medical education and research, the commissioner of health 
 shall transfer to the commissioner of human services the amount 
 of state funds necessary to maximize the federal funds 
 available.  The amount transferred to the commissioner of human 
 services, plus the amount of federal financial participation, 
 shall be distributed to medical assistance providers in 
 accordance with the distribution methodology described in 
 subdivision 4. 

    (b) For the purposes of paragraph (a), the commissioner 
 shall use physician clinic rates where possible to maximize 
 federal financial participation. 

    Subd. 9.    Review of eligible providers.  The 
 commissioner and the Medical Education and Research Costs 
 Advisory Committee may review provider groups included in the 
 definition of a clinical medical education program to assure 
 that the distribution of the funds continue to be consistent 
 with the purpose of this section.  The results of any such 
 reviews must be reported to the Legislative Commission on Health 
 Care Access. 

    Subd. 10.    Transfers from University of Minnesota.  Of 
 the funds dedicated to the Academic Health Center under section 
 297F.10, subdivision 1, clause (1), $4,850,000 shall be 
 transferred annually to the commissioner of health no later than 
 April 15 of each year for distribution under subdivision 4, 
 paragraph (f). 

    HIST: 1999 c 245 art 2 s 10; 2000 c 494 s 1-3; 2001 c 161 s 
 14; 1Sp2001 c 9 art 2 s 2,3; 2002 c 220 art 15 s 1,2; 2002 c 277 
 s 32; 2002 c 375 art 3 s 1; 2002 c 379 art 1 s 113; 1Sp2003 c 14 
 art 7 s 16-19; art 12 s 1; 1Sp2003 c 21 art 9 s 1,2; 2004 c 228 
 art 1 s 16 

*   NOTE:  Subdivision 4, paragraph (e), was also stricken by 
*Laws 2003, First Special Session chapter 14, article 7, section 
*17.

     62J.693 Medical research. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, health care research means approved clinical, outcomes, 
 and health services investigations.  

    Subd. 2.    Grant application process.  (a) The 
 commissioner of health shall make recommendations for a process 
 for the submission, review, and approval of research grant 
 applications.  The process shall give priority for grants to 
 applications that are intended to gather preliminary data for 
 submission for a subsequent proposal for funding from a federal 
 agency or foundation, which awards research money on a 
 competitive, peer-reviewed basis.  Grant recipients must be able 
 to demonstrate the ability to comply with federal regulations on 
 human subjects research in accordance with Code of Federal 
 Regulations, title 45, section 46, and shall conduct the 
 proposed research.  Grants may be awarded to the University of 
 Minnesota, the Mayo Clinic, or any other public or private 
 organization in the state involved in medical research.  The 
 commissioner shall report to the legislature by January 15, 
 2000, with recommendations.  

    (b) The commissioner may consult with the Medical Education 
 and Research Advisory Committee established in section 62J.692 
 in developing these recommendations or may appoint a research 
 advisory committee to provide advice and oversight on the grant 
 application process.  If the commissioner appoints a research 
 advisory committee, the committee shall be governed by section 
 15.059 for membership terms and removal of members.  

    HIST: 1999 c 245 art 2 s 11 

MEDICAL EDUCATION ENDOWMENT FUND

     62J.694 Medical education endowment fund. 

    Subdivision 1.    Creation; use of cash reserves.  (a) 
 The medical education endowment fund is created in the state 
 treasury.  The State Board of Investment shall invest the fund 
 under section 11A.24.  All earnings of the fund must be credited 
 to the fund.  The principal of the fund must be maintained 
 inviolate, except that the principal may be used to make 
 expenditures from the fund for the purposes specified in this 
 section when the market value of the fund falls below 105 
 percent of the cumulative total of the tobacco settlement 
 payments received by the state and credited to the tobacco 
 settlement fund under Minnesota Statutes 2002, section 16A.87, 
 subdivision 2.  For purposes of this section, "principal" means 
 an amount equal to the cumulative total of the tobacco 
 settlement payments received by the state and credited to the 
 tobacco settlement fund under Minnesota Statutes 2002, section 
 16A.87, subdivision 2.  

    (b) If the commissioner of finance determines that probable 
 receipts to the general fund will be sufficient to meet the need 
 for expenditures from the general fund for a fiscal biennium, 
 after using the cash reserves of the tobacco use prevention and 
 local public health endowment fund, excluding an amount 
 sufficient to meet the annual appropriations in section 144.395, 
 subdivision 2, the commissioner may use cash reserves of the 
 medical education endowment fund, excluding the amounts needed 
 to meet the appropriations described in subdivisions 2 and 2a, 
 to pay expenses of the general fund.  If cash reserves are 
 transferred to the general fund to meet cash flow needs, the 
 amount transferred, plus interest at a rate comparable to the 
 rate earned by the state on invested commissioner of finance 
 cash, as determined monthly by the commissioner, must be 
 returned to the endowment fund as soon as sufficient cash 
 balances are available in the general fund, but in any event 
 before the end of the fiscal biennium.  An amount necessary to 
 pay the interest is appropriated from the general fund.  If cash 
 reserves of the endowment fund are used to pay expenses for the 
 general fund, notwithstanding subdivision 2, paragraph (d), the 
 Academic Health Center shall be held harmless to the extent 
 possible.  When determining the fair market value of the fund, 
 for the purposes described in subdivisions 2 and 2a, the value 
 of the cash reserves transferred to the general fund must be 
 included in the determination.  

    (c) The Academic Health Center account is created as a 
 separate account in the medical education endowment fund.  The 
 account is invested under paragraph (a).  All earnings of the 
 account must be credited to the account.  The principal of the 
 account must be maintained inviolate, except that the principal 
 may be used to make expenditures from the account for the 
 purposes specified in subdivision 2a when the value of the 
 account falls below an amount equal to deposits made to the 
 account under Minnesota Statutes 2002, section 16A.87, 
 subdivision 3, paragraph (b). 

    Subd. 2.    Expenditures.  (a) Up to five percent of the 
 fair market value of the fund excluding the value of the 
 Academic Health Center account, is annually appropriated for 
 medical education activities in the state of Minnesota.  The 
 appropriations are to be transferred quarterly for the purposes 
 identified in the following paragraphs.  

    (b) For fiscal year 2000, 70 percent of the appropriation 
 in paragraph (a) is for transfer to the Board of Regents for the 
 instructional costs of health professional programs at the 
 Academic Health Center and affiliated teaching institutions, and 
 30 percent of the appropriation is for transfer to the 
 commissioner of health to be distributed for medical education 
 under section 62J.692.  

    (c) For fiscal year 2001, 49 percent of the appropriation 
 in paragraph (a) is for transfer to the Board of Regents for the 
 instructional costs of health professional programs at the 
 Academic Health Center and affiliated teaching institutions, and 
 51 percent is for transfer to the commissioner of health to be 
 distributed for medical education under section 62J.692. 

    (d) For fiscal year 2002, and each year thereafter, 42 
 percent of the appropriation in paragraph (a) is appropriated 
 for the instructional costs of health professional programs at 
 the University of Minnesota Academic Health Center, and 58 
 percent is for transfer to the commissioner of health to be 
 distributed for medical education under section 62J.692. 

    (e) A maximum of $150,000 of each annual appropriation to 
 the commissioner of health in paragraph (d) may be used by the 
 commissioner for administrative expenses associated with 
 implementing section 62J.692. 

    Subd. 2a.    Expenditure; Academic Health Center account. 
  (a) Beginning in January 2002, up to five percent of the fair 
 market value of the Academic Health Center account is annually 
 appropriated to the Board of Regents for the costs of the 
 Academic Health Center.  Appropriations are to be transferred 
 quarterly and may only be used for instructional costs of health 
 professional programs at the Academic Health Center and for 
 interdisciplinary academic initiatives within the Academic 
 Health Center, except as specified in paragraph (b). 

    (b) Of the amount appropriated under paragraph (a), 
 $4,850,000 shall be transferred annually to the commissioner of 
 health no later than April 15 of each year for distribution 
 under section 62J.692, subdivision 4. 

    Subd. 3.    Audits required.  The legislative auditor 
 shall audit endowment fund expenditures to ensure that the money 
 is spent for the purposes set out in this section. 

    Subd. 4.    Sunset.  The medical education endowment 
 fund expires June 30, 2015.  Upon expiration, the commissioner 
 of finance shall transfer the principal and any remaining 
 interest to the general fund. 

    Subd. 5.    Effective date.  This section is only in 
 effect if there are funds available in the medical education 
 endowment fund.  

    HIST: 1999 c 245 art 11 s 2; 2000 c 392 s 3,4; 1Sp2001 c 1 art 
 2 s 3-5; 2002 c 220 art 15 s 3; 2002 c 374 art 8 s 1; 2003 c 112 
 art 2 s 50; 1Sp2003 c 14 art 7 s 20; 2004 c 228 art 1 s 17 

PATIENT PROTECTION ACT

     62J.695 Citation. 

    Sections 62J.695 to 62J.76 may be cited as the "Patient 
 Protection Act." 

    HIST: 1997 c 237 s 1 

     62J.70 Definitions. 

    Subdivision 1.    Applicability.  For purposes of 
 sections 62J.70 to 62J.76, the terms defined in this section 
 have the meanings given them. 

    Subd. 2.    Health care provider or provider.  "Health 
 care provider" or "provider" means: 

    (1) a physician, nurse, or other provider as defined under 
 section 62J.03; 

    (2) a hospital as defined under section 144.696, 
 subdivision 3; 

    (3) an individual or entity that provides health care 
 services under the medical assistance, general assistance 
 medical care, MinnesotaCare, or state employee group insurance 
 program; and 

    (4) an association, partnership, corporation, limited 
 liability corporation, or other organization of persons or 
 entities described in clause (1) or (2) organized for the 
 purposes of providing, arranging, or administering health care 
 services or treatment.  

    This section does not apply to trade associations, 
 membership associations of health care professionals, or other 
 organizations that do not directly provide, arrange, or 
 administer health care services or treatment. 

    Subd. 3.    Health plan company.  "Health plan company" 
 means health plan company as defined in section 62Q.01, 
 subdivision 4. 

    Subd. 4.    Enrollee.  "Enrollee" means an individual 
 covered by a health plan company or health insurance or health 
 coverage plan and includes an insured policyholder, subscriber, 
 contract holder, member, covered person, or certificate holder.  

    HIST: 1997 c 237 s 2 

     62J.701 Governmental programs. 

    Beginning January 1, 1999, the provisions in paragraphs (a) 
 to (d) apply. 

    (a) For purposes of sections 62J.695 to 62J.80, the 
 requirements and other provisions that apply to health plan 
 companies also apply to governmental programs. 

    (b) For purposes of this section, "governmental programs" 
 means the medical assistance program, the MinnesotaCare program, 
 the general assistance medical care program, the state employee 
 group insurance program, the public employees insurance program 
 under section 43A.316, and coverage provided by political 
 subdivisions under section 471.617. 

    (c) Notwithstanding paragraph (a), section 62J.72 does not 
 apply to the fee-for-service programs under medical assistance, 
 MinnesotaCare, and general assistance medical care. 

    (d) If a state commissioner or local unit of government 
 contracts with a health plan company or a third-party 
 administrator, the contract may assign any obligations under 
 paragraph (a) to the health plan company or third-party 
 administrator.  Nothing in this paragraph shall be construed to 
 remove or diminish any enforcement responsibilities of the 
 commissioners of health or commerce provided in sections 62J.695 
 to 62J.80. 

    HIST: 1998 c 407 art 2 s 9 

     62J.71 Prohibited provider contracts. 

    Subdivision 1.    Prohibited agreements and directives.  
 The following types of agreements and directives are contrary to 
 state public policy, are prohibited under this section, and are 
 null and void: 

    (1) any agreement or directive that prohibits a health care 
 provider from communicating with an enrollee with respect to the 
 enrollee's health status, health care, or treatment options, if 
 the health care provider is acting in good faith and within the 
 provider's scope of practice as defined by law; 

    (2) any agreement or directive that prohibits a health care 
 provider from making a recommendation regarding the suitability 
 or desirability of a health plan company, health insurer, or 
 health coverage plan for an enrollee, unless the provider has a 
 financial conflict of interest in the enrollee's choice of 
 health plan company, health insurer, or health coverage plan; 

    (3) any agreement or directive that prohibits a provider 
 from providing testimony, supporting or opposing legislation, or 
 making any other contact with state or federal legislators or 
 legislative staff or with state and federal executive branch 
 officers or staff; 

    (4) any agreement or directive that prohibits a health care 
 provider from disclosing accurate information about whether 
 services or treatment will be paid for by a patient's health 
 plan company or health insurer or health coverage plan; and 

    (5) any agreement or directive that prohibits a health care 
 provider from informing an enrollee about the nature of the 
 reimbursement methodology used by an enrollee's health plan 
 company, health insurer, or health coverage plan to pay the 
 provider. 

    Subd. 2.    Persons and entities affected.  The 
 following persons and entities shall not enter into any 
 agreement or directive that is prohibited under this section: 

    (1) a health plan company; 

    (2) a health care network cooperative as defined under 
 section 62R.04, subdivision 3; or 

    (3) a health care provider as defined in section 62J.70, 
 subdivision 2. 

    Subd. 3.    Retaliation prohibited.  No person, health 
 plan company, or other organization may take retaliatory action 
 against a health care provider solely on the grounds that the 
 provider: 

    (1) refused to enter into an agreement or provide services 
 or information in a manner that is prohibited under this section 
 or took any of the actions listed in subdivision 1; 

    (2) disclosed accurate information about whether a health 
 care service or treatment is covered by an enrollee's health 
 plan company, health insurer, or health coverage plan; 

    (3) discussed diagnostic, treatment, or referral options 
 that are not covered or are limited by the enrollee's health 
 plan company, health insurer, or health coverage plan; 

    (4) criticized coverage of the enrollee's health plan 
 company, health insurer, or health coverage plan; or 

    (5) expressed personal disagreement with a decision made by 
 a person, organization, or health care provider regarding 
 treatment or coverage provided to a patient of the provider, or 
 assisted or advocated for the patient in seeking reconsideration 
 of such a decision, provided the health care provider makes it 
 clear that the provider is acting in a personal capacity and not 
 as a representative of or on behalf of the entity that made the 
 decision. 

    Subd. 4.    Exclusion.  (a) Nothing in this section 
 prohibits an entity that is subject to this section from taking 
 action against a provider if the entity has evidence that the 
 provider's actions are illegal, constitute medical malpractice, 
 or are contrary to accepted medical practices. 

    (b) Nothing in this section prohibits a contract provision 
 or directive that requires any contracting party to keep 
 confidential or to not use or disclose the specific amounts paid 
 to a provider, provider fee schedules, provider salaries, and 
 other proprietary information of a specific entity that is 
 subject to this section.  

    HIST: 1997 c 237 s 3; 1998 c 407 art 2 s 10-12 

     62J.72 Disclosure of health care provider information. 

    Subdivision 1.    Written disclosure.  (a) A health plan 
 company, as defined under section 62J.70, subdivision 3, a 
 health care network cooperative as defined under section 62R.04, 
 subdivision 3, and a health care provider as defined under 
 section 62J.70, subdivision 2, shall, during open enrollment, 
 upon enrollment, and annually thereafter, provide enrollees with 
 a description of the general nature of the reimbursement 
 methodologies used by the health plan company, health insurer, 
 or health coverage plan to pay providers.  The description must 
 explain clearly any aspect of the reimbursement methodology that 
 creates a financial incentive for the health care provider to 
 limit or restrict the health care provided to enrollees.  An 
 entity required to disclose shall also disclose if no 
 reimbursement methodology is used that creates a financial 
 incentive for the health care provider to limit or restrict the 
 health care provided to enrollees.  This description may be 
 incorporated into the member handbook, subscriber contract, 
 certificate of coverage, or other written enrollee 
 communication.  The general reimbursement methodology shall be 
 made available to employers at the time of open enrollment.  

    (b) Health plan companies, health care network 
 cooperatives, and providers must, upon request, provide an 
 enrollee with specific information regarding the reimbursement 
 methodology, including, but not limited to, the following 
 information:  

    (1) a concise written description of the provider payment 
 plan, including any incentive plan applicable to the enrollee; 

    (2) a written description of any incentive to the provider 
 relating to the provision of health care services to enrollees, 
 including any compensation arrangement that is dependent on the 
 amount of health coverage or health care services provided to 
 the enrollee, or the number of referrals to or utilization of 
 specialists; and 

    (3) a written description of any incentive plan that 
 involves the transfer of financial risk to the health care 
 provider. 

    (c) The disclosure statement describing the general nature 
 of the reimbursement methodologies must comply with the 
 Readability of Insurance Policies Act in chapter 72C and must be 
 filed with and approved by the commissioner prior to its use. 

    (d) A disclosure statement that has been filed with the 
 commissioner for approval under paragraph (c) is deemed approved 
 30 days after the date of filing, unless approved or disapproved 
 by the commissioner on or before the end of that 30-day period. 

    (e) The disclosure statement describing the general nature 
 of the reimbursement methodologies must be provided upon request 
 in English, Spanish, Vietnamese, and Hmong.  In addition, 
 reasonable efforts must be made to provide information contained 
 in the disclosure statement to other non-English-speaking 
 enrollees. 

    (f) Health plan companies and providers may enter into 
 agreements to determine how to respond to enrollee requests 
 received by either the provider or the health plan company.  
 This subdivision does not require disclosure of specific amounts 
 paid to a provider, provider fee schedules, provider salaries, 
 or other proprietary information of a specific health plan 
 company or health insurer or health coverage plan or provider. 

    Subd. 2.    Additional written disclosure of provider 
 information.  In the event a health plan company prepares a 
 written disclosure as specified in subdivision 1, in a manner 
 that explicitly makes a comparison of the financial incentives 
 between the providers with whom it contracts, it must describe 
 the incentives that occur at the provider level. 

    Subd. 3.    Information on patients' medical bills.  A 
 health plan company and health care provider shall provide 
 patients and enrollees with a copy of an explicit and 
 intelligible bill whenever the patient or enrollee is sent a 
 bill and is responsible for paying any portion of that bill.  
 The bills must contain descriptive language sufficient to be 
 understood by the average patient or enrollee.  This subdivision 
 does not apply to a flat co-pay paid by the patient or enrollee 
 at the time the service is required. 

    Subd. 4.    Nonapplicability.  Health care providers as 
 defined in section 62J.70, subdivision 2, clause (1), need not 
 individually provide information required under this section if 
 it has been provided by another individual or entity that is 
 subject to this section. 

    HIST: 1997 c 237 s 4; 1998 c 407 art 2 s 13 

     62J.73 Prohibition on exclusive arrangements. 

    Subdivision 1.    Prohibition on exclusive relationships. 
  No provider, group of providers, or health plan company shall 
 restrict a person's right to provide health services or 
 procedures to another provider, group of providers, or health 
 plan company, unless the person is an employee. 

    Subd. 2.    Prohibition on restrictive contract terms.  
 No provider, group of providers, or person providing goods or 
 health services to a provider shall enter into a contract or 
 subcontract with a health plan company or group of providers on 
 terms that require the provider, group of providers, or person 
 not to contract with another health plan company, unless the 
 provider or person is an employee.  

    Subd. 3.    Prohibition regarding essential facilities and 
 services.  (a) No health plan company, provider, or group of 
 providers may withhold from its competitors health care 
 services, which are essential for competition between health 
 care providers within the meaning of the essential facilities 
 doctrine as interpreted by the federal courts. 

    (b) This subdivision should be construed as an instruction 
 to state court in interpreting federal law. 

    Subd. 4.    Violations.  Any provider or other 
 individual who believes provisions of this section may have been 
 violated may file a complaint with the attorney general's office 
 regarding a possible violation of this section. 

    HIST: 1997 c 237 s 5 

     62J.74 Enforcement. 

    Subdivision 1.    Authority.  The commissioners of 
 health and commerce shall each periodically review contracts and 
 arrangements among health care providing entities and health 
 plan companies they regulate to determine compliance with 
 sections 62J.70 to 62J.73.  Any person may submit a contract or 
 arrangement to the relevant commissioner for review if the 
 person believes sections 62J.70 to 62J.73 have been violated.  
 Any provision of a contract or arrangement found by the relevant 
 commissioner to violate this section is null and void, and the 
 relevant commissioner may assess civil penalties against the 
 health plan company in an amount not to exceed $2,500 for each 
 day the contract or arrangement is in effect, and may use the 
 enforcement procedures otherwise available to the commissioner.  
 All due process rights afforded under chapter 14 apply to this 
 section.  

    Subd. 2.    Assistance to licensing boards.  A 
 health-related licensing board as defined under section 214.01, 
 subdivision 2, shall submit a contract or arrangement to the 
 relevant commissioner for review if the board believes sections 
 62J.70 to 62J.73 have been violated.  If the commissioner 
 determines that any provision of a contract or arrangement 
 violates those sections, the board may take disciplinary action 
 against any person who is licensed or regulated by the board who 
 entered into the contract arrangement. 

    HIST: 1997 c 237 s 6 

  62J.75 Expired 

     62J.76 Nonpreemption. 

    Nothing in the Patient Protection Act preempts or replaces 
 requirements related to patient protections that are more 
 protective of patient rights than the requirements established 
 by the Patient Protection Act. 

    HIST: 1997 c 237 s 8 

  62J.77 Repealed, 1999 c 245 art 2 s 45 

  62J.78 Repealed, 1999 c 245 art 2 s 45 

  62J.79 Repealed, 1999 c 245 art 2 s 45 

     62J.80 Retaliation. 

    A health plan company or health care provider shall not 
 retaliate or take adverse action against an enrollee or patient 
 who, in good faith, makes a complaint against a health plan 
 company or health care provider.  If retaliation is suspected, 
 the executive director may report it to the appropriate 
 regulatory authority.  

    HIST: 1998 c 407 art 2 s 18 

     62J.81 Disclosure of payments for health care services. 

    Subdivision 1.    Required disclosure of estimated 
 payment.  A health care provider, as defined in section 
 62J.03, subdivision 8, shall, at the request of a consumer, 
 provide that consumer with a good faith estimate of the 
 reimbursement the provider expects to receive from the health 
 plan company in which the consumer is enrolled.  Health plan 
 companies must allow contracted providers to release this 
 information.  A good faith estimate must also be made available 
 at the request of a consumer who is not enrolled in a health 
 plan company.  Payment information provided by a provider to a 
 patient pursuant to this subdivision does not constitute a 
 legally binding estimate of the cost of services.  

    Subd. 2.    Applicability.  For purposes of this 
 section, "consumer" does not include a medical assistance, 
 MinnesotaCare, or general assistance medical care enrollee, for 
 services covered under those programs. 

    HIST: 2004 c 288 art 7 s 3