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Minnesota Legislature

Office of the Revisor of Statutes

CHAPTER 62J. HEALTH CARE COST CONTAINMENT

Table of Sections
SectionHeadnote
62J.01FINDINGS.

COST CONTROLS

62J.015PURPOSE.
62J.016GOALS OF RESTRUCTURING.
62J.017IMPLEMENTATION TIMETABLE.
62J.02Repealed, 1989 c 327 s 4
62J.03DEFINITIONS.
62J.04MONITORING THE RATE OF GROWTH OF HEALTH CARE SPENDING.
62J.041INTERIM HEALTH PLAN COMPANY COST CONTAINMENT GOALS.
62J.042Repealed, 1997 c 150 s 6
62J.045Repealed, 1995 c 234 art 8 s 57
62J.05Repealed, 1997 c 225 art 2 s 63
62J.051Repealed, 1997 c 225 art 2 s 63
62J.052PROVIDER COST DISCLOSURE.
62J.06IMMUNITY FROM LIABILITY.
62J.07LEGISLATIVE OVERSIGHT COMMISSION.
62J.09Repealed, 1999 c 245 art 2 s 6
62J.15
62J.152
62J.156CLOSED COMMITTEE HEARINGS.
62J.17EXPENDITURE REPORTING.
62J.19Repealed, 1995 c 234 art 8 s 57
62J.21Repealed, 1993 c 247 art 1 s 21
62J.212PUBLIC HEALTH GOALS.
62J.22PARTICIPATION OF FEDERAL PROGRAMS.
62J.23PROVIDER CONFLICTS OF INTEREST.
62J.25MANDATORY MEDICARE ASSIGNMENT.
62J.26EVALUATION OF PROPOSED HEALTH COVERAGE MANDATES.
62J.29Repealed, 1993 c 345 art 6 s 26
62J.2911Repealed, 1997 c 237 s 22
62J.2912Repealed, 1997 c 237 s 22
62J.2913Repealed, 1997 c 237 s 22
62J.2914Repealed, 1997 c 237 s 22
62J.2915Repealed, 1997 c 237 s 22
62J.2916Repealed, 1997 c 237 s 22
62J.2917Repealed, 1997 c 237 s 22
62J.2918Repealed, 1997 c 237 s 22
62J.2919Repealed, 1997 c 237 s 22
62J.2920Repealed, 1997 c 237 s 22
62J.2921Repealed, 1997 c 237 s 22

INFORMATION CLEARINGHOUSE

62J.2930INFORMATION CLEARINGHOUSE.

DATA COLLECTION AND RESEARCH INITIATIVES

62J.30Repealed, 1995 c 234 art 5 s 24
62J.301RESEARCH AND DATA INITIATIVES.
62J.31Repealed, 1995 c 234 art 5 s 24
62J.311ANALYSIS AND USE OF DATA.
62J.32Repealed, 1995 c 234 art 5 s 24
62J.321DATA COLLECTION AND PROCESSING PROCEDURES.
62J.322PROVIDER INFORMATION PILOT STUDY.
62J.33Repealed, 1995 c 234 art 5 s 24
62J.34Repealed, 1995 c 234 art 5 s 24
62J.35Repealed, 1995 c 234 art 5 s 24
62J.37Repealed, 1997 c 225 art 2 s 63
62J.38COST CONTAINMENT DATA FROM GROUP PURCHASERS.
62J.381PRESCRIPTION DRUG PRICE DISCLOSURE.
62J.40COST CONTAINMENT DATA FROM STATE AGENCIES AND OTHER GOVERNMENTAL UNITS.
62J.41DATA FROM PROVIDERS.
62J.42QUALITY, UTILIZATION, AND OUTCOME DATA.
62J.43Expired, 2004 c 288 art 7 s 2
62J.43162J.431 EVIDENCE-BASED HEALTH CARE GUIDELINES.
62J.44Repealed, 1995 c 234 art 5 s 24
62J.45Repealed, 1995 c 234 art 5 s 24
62J.451Repealed, 1Sp2003 c 14 art 7 s 89
62J.452Repealed, 1Sp2003 c 14 art 7 s 89
62J.46MONITORING AND REPORTS.
62J.47Repealed, 1999 c 86 art 1 s 83
62J.48CRITERIA FOR REIMBURSEMENT.
62J.49AMBULANCE SERVICES FINANCIAL DATA.

HEALTH INFORMATION TECHNOLOGY

AND INFRASTRUCTURE ADVISORY COMMITTEE

62J.495HEALTH INFORMATION TECHNOLOGY AND INFRASTRUCTURE.
62J.49662J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING ACCOUNT AND LOAN PROGRAM.

HEALTH CARE ADMINISTRATIVE

SIMPLIFICATION ACT OF 1994

62J.50CITATION AND PURPOSE.
62J.51DEFINITIONS.
62J.52ESTABLISHMENT OF UNIFORM BILLING FORMS.
62J.53ACCEPTANCE OF UNIFORM BILLING FORMS BY GROUP PURCHASERS.
62J.535UNIFORM BILLING REQUIREMENTS FOR CLAIM TRANSACTIONS.
62J.53662J.536 UNIFORM ELECTRONIC TRANSACTIONS AND IMPLEMENTATION GUIDE STANDARDS.
62J.54IDENTIFICATION AND IMPLEMENTATION OF UNIQUE IDENTIFIERS.
62J.55PRIVACY OF UNIQUE IDENTIFIERS.
62J.56IMPLEMENTATION OF ELECTRONIC DATA INTERCHANGE STANDARDS.
62J.57MINNESOTA CENTER FOR HEALTH CARE ELECTRONIC DATA INTERCHANGE.
62J.58IMPLEMENTATION OF STANDARD TRANSACTION SETS.
62J.581STANDARDS FOR MINNESOTA UNIFORM HEALTH CARE REIMBURSEMENT DOCUMENTS.
62J.59IMPLEMENTATION OF NCPDP TELECOMMUNICATIONS STANDARD FOR PHARMACY CLAIMS.
62J.60MINNESOTA UNIFORM HEALTH CARE IDENTIFICATION CARD.
62J.61RULEMAKING; IMPLEMENTATION.
62J.6262J.62 ELECTRONIC BILLING ASSISTANCE.
62J.65Repealed, 1995 c 234 art 8 s 57
62J.66Repealed, 1Sp2003 c 14 art 2 s 57
62J.68Repealed, 1Sp2003 c 14 art 2 s 57
62J.685Repealed, 1998 c 407 art 2 s 109
62J.69Repealed, 1999 c 245 art 2 s 45

MEDICAL EDUCATION AND RESEARCH

62J.691PURPOSE.
62J.692MEDICAL EDUCATION.
62J.693MEDICAL RESEARCH.
62J.694Repealed, 2006 c 282 art 14 s 15

PATIENT PROTECTION ACT

62J.695CITATION.
62J.70DEFINITIONS.
62J.701GOVERNMENTAL PROGRAMS.
62J.71PROHIBITED PROVIDER CONTRACTS.
62J.72DISCLOSURE OF HEALTH CARE PROVIDER INFORMATION.
62J.73PROHIBITION ON EXCLUSIVE ARRANGEMENTS.
62J.74ENFORCEMENT.
62J.75Expired
62J.76NONPREEMPTION.
62J.77Repealed, 1999 c 245 art 2 s 45
62J.78Repealed, 1999 c 245 art 2 s 45
62J.79Repealed, 1999 c 245 art 2 s 45
62J.80RETALIATION.
62J.81DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES.
62J.8262J.82 HOSPITAL INFORMATION REPORTING DISCLOSURE.
62J.82362J.823 HOSPITAL PRICING TRANSPARENCY.
62J.8362J.83 REDUCED PAYMENT AMOUNTS PERMITTED.
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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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]
History: 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.052 PROVIDER COST DISCLOSURE.
    Subdivision 1.[Repealed, 2007 c 147 art 15 s 22]
    Subd. 2. Pharmacies. (a) Each pharmacy, as defined in section 151.01, subdivision 2, shall
provide the following information to a patient upon request:
(1) the pharmacy's own usual and customary price for a prescription drug;
(2) a record, including all transactions on record with the pharmacy both past and present, of
all co-payments and other cost-sharing paid to the pharmacy by the patient for up to two years; and
(3) the total amount of all co-payments and other cost-sharing paid to the pharmacy by the
patient over the previous two years.
(b) The information required under paragraph (a) must be readily available at no cost to
the patient.
History: 2005 c 147 art 11 s 2; 2006 c 255 s 21
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.
History: 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
shall make recommendations to the legislature on how to achieve the goal of universal health
coverage as described in section 62Q.165. The recommendations shall include a timetable in
which measurable progress must be achieved toward this goal. The commission shall submit to
the legislature by January 15, 2008, the recommendations and corresponding timetable.
    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 commissioners of health, human services,
commerce, and other state agencies shall provide assistance and technical support to the
commission at the request of the commission. The commission may convene subcommittees to
provide additional assistance and advice to the commission.
    Subd. 4.[Repealed, 1995 c 234 art 8 s 57]
History: 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; 2007 c 147 art 12 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.
History: 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) "Capital expenditure" means an expenditure which, under generally accepted accounting
principles, is not properly chargeable as an expense of operation and maintenance.
    (b) "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.
    (c) "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.
    (d) "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.
    (e) "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.
    (f) "Specialty care" includes but is not limited to cardiac, neurology, orthopedic, obstetrics,
mental health, chemical dependency, and emergency services.
    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. Each hospital, outpatient surgical center, diagnostic
imaging center, and physician clinic shall report annually to the commissioner on all major
spending commitments, in the form and manner specified by the commissioner. The report shall
include the following information:
    (a) a description of major spending commitments made during the previous year, including
the total dollar amount of major spending commitments and purpose of the expenditures;
    (b) the cost of land acquisition, construction of new facilities, and renovation of existing
facilities;
    (c) the cost of purchased or leased medical equipment, by type of equipment;
    (d) expenditures by type for specialty care and new specialized services;
    (e) information on the amount and types of added capacity for diagnostic imaging services,
outpatient surgical services, and new specialized services; and
    (f) information on investments in electronic medical records systems.
For hospitals and outpatient surgical centers, this information shall be included in reports to
the commissioner that are required under section 144.698. For diagnostic imaging centers, this
information shall be included in reports to the commissioner that are required under section
144.565. For physician clinics, this information shall be included in reports to the commissioner
that are required under section 62J.41. For all other health care providers that are subject to this
reporting requirement, reports must be submitted to the commissioner by March 1 each year for
the preceding calendar year.
    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 provider may submit
information, with supporting documentation, regarding why the major spending commitment
should be excepted from prospective review under subdivision 7.
    (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 reporting requirement in subdivision 4a does not apply to:
    (1) 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;
    (2) a major spending commitment for building maintenance including heating, water,
electricity, and other maintenance-related expenditures; and
    (3) 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.
    (b) In addition to the exceptions listed in paragraph (a), the reporting requirement in
subdivision 4a 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.
History: 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; 2007 c 147 art 9 s 1-4
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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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 144.293, subdivision 7.
(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 144.291 to 144.298. 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.
History: 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; 2007 c 147 art 10 s 15
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.
History: 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.
History: 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.
History: 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.
History: 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;
    (11) a report on health care capital expenditures during the previous year, as required by
section 62J.17; and
    (12) 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]
History: 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; 2007 c 147 art 9 s 5
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.
History: 1993 c 345 art 3 s 13
62J.43 [Expired, 2004 c 288 art 7 s 2]
62J.431 EVIDENCE-BASED HEALTH CARE GUIDELINES.
    Evidence-based guidelines must meet the following criteria:
    (1) the scope and application are clear;
    (2) authorship is stated and any conflicts of interest disclosed;
    (3) authors represent all pertinent clinical fields or other means of input have been used;
    (4) the development process is explicitly stated;
    (5) the guideline is grounded in evidence;
    (6) the evidence is cited and grated;
    (7) the document itself is clear and practical;
    (8) the document is flexible in use, with exceptions noted or provided for with general
statements;
    (9) measures are included for use in systems improvement; and
    (10) the guideline has scheduled reviews and updating.
History: 2007 c 147 art 15 s 1
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.
History: 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.
History: 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.
History: 1997 c 203 art 2 s 1

HEALTH INFORMATION TECHNOLOGY

AND INFRASTRUCTURE ADVISORY COMMITTEE

62J.495 HEALTH INFORMATION TECHNOLOGY AND INFRASTRUCTURE.
    Subdivision 1. Implementation. By January 1, 2015, all hospitals and health care providers
must have in place an interoperable electronic health records system within their hospital
system or clinical practice setting. The commissioner of health, in consultation with the Health
Information Technology and Infrastructure Advisory Committee, shall develop a statewide plan
to meet this goal, including uniform standards to be used for the interoperable system for sharing
and synchronizing patient data across systems. The standards must be compatible with federal
efforts. The uniform standards must be developed by January 1, 2009, with a status report on the
development of these standards submitted to the legislature by January 15, 2008.
    Subd. 2. Health Information Technology and Infrastructure Advisory Committee. (a)
The commissioner shall establish a Health Information Technology and Infrastructure Advisory
Committee governed by section 15.059 to advise the commissioner on the following matters:
    (1) assessment of the use of health information technology by the state, licensed health care
providers and facilities, and local public health agencies;
    (2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards for
administrative data exchange, clinical support programs, patient privacy requirements, and
maintenance of the security and confidentiality of individual patient data;
    (3) recommendations for encouraging use of innovative health care applications using
information technology and systems to improve patient care and reduce the cost of care, including
applications relating to disease management and personal health management that enable remote
monitoring of patients' conditions, especially those with chronic conditions; and
    (4) other related issues as requested by the commissioner.
    (b) The members of the Health Information Technology and Infrastructure Advisory
Committee shall include the commissioners, or commissioners' designees, of health, human
services, administration, and commerce and additional members to be appointed by the
commissioner to include persons representing Minnesota's local public health agencies, licensed
hospitals and other licensed facilities and providers, private purchasers, the medical and nursing
professions, health insurers and health plans, the state quality improvement organization,
academic and research institutions, consumer advisory organizations with an interest and expertise
in health information technology, and other stakeholders as identified by the Health Information
Technology and Infrastructure Advisory Committee.
    (c) The commissioner shall prepare and issue an annual report not later than January 30 of
each year outlining progress to date in implementing a statewide health information infrastructure
and recommending future projects.
(d) Notwithstanding section 15.059, this subdivision expires June 30, 2015.
History: 1Sp2005 c 4 art 6 s 1; 2007 c 147 art 15 s 2
62J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING ACCOUNT AND
LOAN PROGRAM.
    Subdivision 1. Account establishment. An account is established to provide loans to
eligible borrowers to assist in financing the installation or support of an interoperable health
record system. The system must provide for the interoperable exchange of health care information
between the applicant and, at a minimum, a hospital system, pharmacy, and a health care clinic
or other physician group.
    Subd. 2. Eligibility. (a) "Eligible borrower" means one of the following:
    (1) community clinics, as defined under section 145.9268;
    (2) hospitals eligible for rural hospital capital improvement grants, as defined in section
144.148;
    (3) physician clinics located in a community with a population of less than 50,000 according
to United States Census Bureau statistics and outside the seven-county metropolitan area;
    (4) nursing facilities licensed under sections 144A.01 to 144A.27; and
    (5) other providers of health or health care services approved by the commissioner for
which interoperable electronic health record capability would improve quality of care, patient
safety, or community health.
    (b) To be eligible for a loan under this section, the applicant must submit a loan application
to the commissioner of health on forms prescribed by the commissioner. The application must
include, at a minimum:
    (1) the amount of the loan requested and a description of the purpose or project for which the
loan proceeds will be used;
    (2) a quote from a vendor;
    (3) a description of the health care entities and other groups participating in the project;
    (4) evidence of financial stability and a demonstrated ability to repay the loan; and
    (5) a description of how the system to be financed interconnects or plans in the future to
interconnect with other health care entities and provider groups located in the same geographical
area.
    Subd. 3. Loans. (a) The commissioner of health may make a no interest loan to a provider or
provider group who is eligible under subdivision 2 on a first-come, first-served basis provided
that the applicant is able to comply with this section. The total accumulative loan principal
must not exceed $1,500,000 per loan. The commissioner of health has discretion over the size
and number of loans made.
    (b) The commissioner of health may prescribe forms and establish an application process
and, notwithstanding section 16A.1283, may impose a reasonable nonrefundable application fee
to cover the cost of administering the loan program. Any application fees imposed and collected
under the electronic health records system revolving account and loan program in this section are
appropriated to the commissioner of health for the duration of the loan program.
    (c) The borrower must begin repaying the principal no later than two years from the date of
the loan. Loans must be amortized no later than six years from the date of the loan.
    (d) Repayments must be credited to the account.
    Subd. 4. Data classification. Data collected by the commissioner of health on the application
to determine eligibility under subdivision 2 and to monitor borrowers' default risk or collect
payments owed under subdivision 3 are (1) private data on individuals as defined in section 13.02,
subdivision 12
; and (2) nonpublic data as defined in section 13.02, subdivision 9. The names of
borrowers and the amounts of the loans granted are public data.
History: 2007 c 147 art 15 s 3

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.
History: 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 CMS 1450. "Uniform billing form CMS 1450" means the
uniform billing form known as the CMS 1450 or UB92, developed by the National Uniform
Billing Committee in 1992 and approved for implementation in October 1993, and any subsequent
amendments to the form.
    Subd. 18. Uniform billing form CMS 1500. "Uniform billing form CMS 1500" means the
1990 version of the health insurance claim form, CMS 1500, developed by the National Uniform
Claim Committee and any subsequent amendments to the form.
    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.
History: 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; 2005 c 106 s 1,2
62J.52 ESTABLISHMENT OF UNIFORM BILLING FORMS.
    Subdivision 1. Uniform billing form CMS 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 CMS 1450, except as provided in subdivision 5.
    (b) The instructions and definitions for the use of the uniform billing form CMS 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 CMS 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.
    (e) Services provided by Medicare Critical Access Hospitals electing Method II billing
will be allowed an exception to this provision to allow the inclusion of the professional fees on
the CMS 1450.
    Subd. 2. Uniform billing form CMS 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 CMS 1500, except as provided in
subdivision 5.
    (b) The instructions and definitions for the use of the uniform billing form CMS 1500 shall
be in accordance with the manual developed by the Administrative Uniformity Committee
entitled standards for the use of the CMS 1500 form, dated February 1994, as further defined
by the commissioner.
    (c) Services to be billed using the uniform billing form CMS 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.
    (d) Services provided by Medicare Critical Access Hospitals electing Method II billing
will be allowed an exception to this provision to allow the inclusion of the professional fees on
the CMS 1450.
    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 CMS 1450 for community mental health center
services and shall accept the CMS 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 CMS
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 CMS 1450 or the CMS 1500 form, as designated by the Department of Human
Services.
History: 1994 c 625 art 9 s 3; 2000 c 460 s 4-6; 1Sp2003 c 14 art 7 s 14,15; 2005 c 106 s
3-5; 2007 c 147 art 9 s 6,7
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.
History: 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.
History: 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.536 UNIFORM ELECTRONIC TRANSACTIONS AND IMPLEMENTATION GUIDE
STANDARDS.
    Subdivision 1. Electronic claims and eligibility transactions required. (a) Beginning
January 15, 2009, all group purchasers must accept from health care providers the eligibility for a
health plan transaction described under Code of Federal Regulations, title 45, part 162, subpart
L. Beginning July 15, 2009, all group purchasers must accept from health care providers the
health care claims or equivalent encounter information transaction described under Code of
Federal Regulations, title 45, part 162, subpart K.
    (b) Beginning January 15, 2009, all group purchasers must transmit to providers the
eligibility for a health plan transaction described under Code of Federal Regulations, title 45, part
162, subpart L. Beginning December 1, 2009, all group purchasers must transmit to providers
the health care payment and remittance advice transaction described under Code of Federal
Regulations, title 45, part 162, subpart P.
    (c) Beginning January 15, 2009, all health care providers must submit to group purchasers
the eligibility for a health plan transaction described under Code of Federal Regulations, title 45,
part 162, subpart L. Beginning July 15, 2009, all health care providers must submit to group
purchasers the health care claims or equivalent encounter information transaction described under
Code of Federal Regulations, title 45, part 162, subpart K.
    (d) Beginning January 15, 2009, all health care providers must accept from group purchasers
the eligibility for a health plan transaction described under Code of Federal Regulations, title 45,
part 162, subpart L. Beginning December 15, 2009, all health care providers must accept from
group purchasers the health care payment and remittance advice transaction described under Code
of Federal Regulations, title 45, part 162, subpart P.
    (e) Each of the transactions described in paragraphs (a) to (d) shall require the use of a
single, uniform companion guide to the implementation guides described under Code of Federal
Regulations, title 45, part 162. The companion guides will be developed pursuant to subdivision 2.
    (f) Notwithstanding any other provisions in sections 62J.50 to 62J.61, all group purchasers
and health care providers must exchange claims and eligibility information electronically using
the transactions, companion guides, implementation guides, and timelines required under this
subdivision. Group purchasers may not impose any fee on providers for the use of the transactions
prescribed in this subdivision.
    (g) Nothing in this subdivision shall prohibit group purchasers and health care providers
from using a direct data entry, Web-based methodology for complying with the requirements of
this subdivision. Any direct data entry method for conducting the transactions specified in this
subdivision must be consistent with the data content component of the single, uniform companion
guides required in paragraph (e) and the implementation guides described under Code of Federal
Regulations, title 45, part 162.
    Subd. 2. Establishing uniform, standard companion guides. (a) At least 12 months prior
to the timelines required in subdivision 1, the commissioner of health shall promulgate rules
pursuant to section 62J.61 establishing and requiring group purchasers and health care providers
to use the transactions and the uniform, standard companion guides required under subdivision 1,
paragraph (e).
    (b) The commissioner of health must consult with the Minnesota Administrative Uniformity
Committee on the development of the single, uniform companion guides required under
subdivision 1, paragraph (e), for each of the transactions in subdivision 1. The single uniform
companion guides required under subdivision 1, paragraph (e), must specify uniform billing and
coding standards. The commissioner of health shall base the companion guides required under
subdivision 1, paragraph (e), billing and coding rules, and standards on the Medicare program,
with modifications that the commissioner deems appropriate after consulting the Minnesota
Administrative Uniformity Committee.
    (c) No group purchaser or health care provider may add to or modify the single, uniform
companion guides defined in subdivision 1, paragraph (e), through additional companion guides
or other requirements.
    (d) In promulgating the rules in paragraph (a), the commissioner shall not require data
content that is not essential to accomplish the purpose of the transactions in subdivision 1.
    Subd. 3. Definition. Notwithstanding section 62J.03, subdivision 8, for purposes of this
section, "health care provider" includes licensed nursing homes, licensed boarding care homes,
and licensed home care providers.
History: 2007 c 147 art 15 s 4
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 national provider identifier is made
effective under United States Code, title 42, sections 1320d to 1320d-8 (1996 and subsequent
amendments), all group purchasers and any health care provider organization that meets the
definition of a health care provider under United States Code, title 42, sections 1320d to 1320d-8,
as amended, and regulations adopted thereunder shall use a national provider identifier to identify
health care provider organizations in Minnesota, according to this section, 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 national provider identifier to identify health provider organizations no later than 36 months
after the date on which a national provider identifier is made effective under United States Code,
title 42, sections 1320d to 1320d-8 (1996 and subsequent amendments).
(c) The national provider identifier for health care providers 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 in Minnesota under this section.
(d) All health care provider organizations in Minnesota that are eligible to obtain a national
provider identifier according to United States Code, title 42, sections 1320d to 1320d-8, as
amended, and regulations adopted thereunder shall obtain a national provider identifier from the
federal Secretary of Health and Human Services using the process prescribed by the Secretary.
(e) Only the national provider identifier shall be used to identify health care provider
organizations when submitting and receiving paper and electronic claims and remittance advice
notices, and in conjunction with other data collection and reporting functions.
(f) Health care provider organizations in Minnesota shall make available their national
provider identifier to other health care providers when required to be included in the administrative
transactions regulated by United States Code, title 42, sections 1320d to 1320d-8, as amended,
and regulations adopted thereunder.
(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.
    Subd. 2. Unique identification number for individual health care providers. (a) Not later
than 24 months after the date on which a national provider identifier is made effective under
United States Code, title 42, sections 1320d to 1320d-8 (1996 and subsequent amendments), all
group purchasers in Minnesota and any individual health care provider that meets the definition
of a health care provider under United States Code, title 42, sections 1320d to 1320d-8, as
amended, and regulations adopted thereunder shall use the national provider identifier to identify
an individual health care provider in Minnesota, according to this section, 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 the national provider identifier to identify an individual health care provider no later than 36
months after the date on which a national provider identifier for health care providers is made
effective under United States Code, title 42, sections 1320d to 1320d-8 (1996 and subsequent
amendments).
(c) The national provider identifier for health care providers 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) All individual health care providers in Minnesota that are eligible to obtain a national
provider identifier according to United States Code, title 42, sections 1320d to 1320d-8, as
amended, and regulations adopted thereunder shall obtain a national provider identifier from the
federal Secretary of Health and Human Services using the process prescribed by the Secretary.
(e) Only the national provider identifier shall be used to identify individual health care
providers when submitting and receiving paper and electronic claims and remittance advice
notices, and in conjunction with other data collection and reporting functions.
(f) Individual health care providers in Minnesota shall make available their national provider
identifier to other health care providers when required to be included in the administrative
transactions regulated by United States Code, title 42, sections 1320d to 1320d-8, as amended,
and regulations adopted thereunder.
(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.
    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.
History: 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; 2005 c 106 s 6,7
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 sections 144.291 to
144.298
. 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.
History: 1994 c 625 art 9 s 6; 1995 c 234 art 5 s 18; 2007 c 147 art 10 s 15
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.
History: 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.
History: 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.
History: 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 June 30,
2007. The requirements in subdivisions 1 and 2 apply regardless of when the health care service
was provided to the patient.
History: 2000 c 460 s 7; 2002 c 307 art 2 s 7; 2002 c 330 s 23; 2005 c 106 s 8
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.
History: 1994 c 625 art 9 s 10
62J.60 MINNESOTA UNIFORM HEALTH CARE IDENTIFICATION CARD.
    Subdivision 1. Requirements for 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: 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.
    (c) Standardized labels are required next to human readable data elements and must come
before the human 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) 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";
    (4) 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";
    (5) 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";
    (6) 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
    (7) 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.
History: 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; 2006 c 255 s 22,23; 2007 c 147 art 9 s 8,9
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.
History: 1994 c 625 art 9 s 12; 1997 c 187 art 4 s 3; 1998 c 254 art 1 s 14
62J.62 ELECTRONIC BILLING ASSISTANCE.
The commissioner of human services shall, out of existing resources, encourage and assist
providers to adopt and use electronic billing for state programs, including but not limited to the
provision of training.
History: 2006 c 267 art 1 s 1
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.
History: 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 FTE's" means the number of trainees, as measured by full-time
equivalent counts, that are at training sites located in Minnesota with currently active medical
assistance enrollment status and a National Provider Identification (NPI) 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. Training that occurs in nursing facility settings is not eligible for
funding under this section.
    Subd. 2.[Repealed, 2007 c 133 art 2 s 13]
    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.
A clinical medical education program that trains pediatricians is requested to include in its
program curriculum training in case management and medication management for children
suffering from mental illness to be eligible for funds under subdivision 4.
(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; 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) when requested, at
the discretion of the commissioner:
(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) Following the distribution described under paragraph (b),
the commissioner shall annually distribute the available medical education funds to all qualifying
applicants based on a distribution formula that reflects a summation of two factors:
    (1) 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; and
    (2) a supplemental public program volume factor, which is determined by providing a
supplemental payment of 20 percent of each training site's grant to training sites whose public
program revenue accounted for at least 0.98 percent of the total public program revenue received
by all eligible training sites. Grants to training sites whose public program revenue accounted for
less than 0.98 percent of the total public program revenue received by all eligible training sites
shall be reduced by an amount equal to the total value of the supplemental payment.
    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 subdivision. For purposes of determining training-site level grants
to be distributed under paragraph (a), 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) $5,350,000 of the available medical education funds shall be distributed as follows:
    (1) $1,475,000 to the University of Minnesota Medical Center-Fairview;
    (2) $2,075,000 to the University of Minnesota School of Dentistry; and
    (3) $1,800,000 to the Academic Health Center.
    (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) A maximum of $150,000 of the funds dedicated to the commissioner under section
297F.10, subdivision 1, 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 stating that the completed grant verification
report is valid and accurate; and
    (5) 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),
clauses (3) and (4), 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. The commissioner of human services shall seek to
maximize federal financial participation in payments for medical education and research costs.
    The commissioner shall use physician clinic rates where possible to maximize federal
financial participation. Any additional funds that become available must be distributed under
subdivision 4, paragraph (a).
    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.[Repealed, 2007 c 147 art 15 s 22]
History: 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; 2005 c 10 art 1 s 81;
2005 c 84 s 1-3; 1Sp2005 c 4 art 2 s 1; 2007 c 147 art 15 s 5-8
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 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.
History: 1999 c 245 art 2 s 11; 2007 c 133 art 3 s 1
62J.694 [Repealed, 2006 c 282 art 14 s 15]

PATIENT PROTECTION ACT

62J.695 CITATION.
Sections 62J.695 to 62J.76 may be cited as the "Patient Protection Act."
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 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.
History: 1998 c 407 art 2 s 18
62J.81 DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES.
    Subdivision 1. Required disclosure of estimated payment. (a) A health care provider, as
defined in section 62J.03, subdivision 8, or the provider's designee as agreed to by that designee,
shall, at the request of a consumer, and at no cost to the consumer or the consumer's employer,
provide that consumer with a good faith estimate of the allowable payment the provider has
agreed to accept from the consumer's health plan company for the services specified by the
consumer, specifying the amount of the allowable payment due from the health plan company.
Health plan companies must allow contracted providers, or their designee, to release this
information. If a consumer has no applicable public or private coverage, the health care provider
must give the consumer, and at no cost to the consumer, a good faith estimate of the average
allowable reimbursement the provider accepts as payment from private third-party payers for the
services specified by the consumer and the estimated amount the noncovered consumer will be
required to pay. Payment information provided by a provider, or by the provider's designee as
agreed to by that designee, to a patient pursuant to this subdivision does not constitute a legally
binding estimate of the allowable charge for or cost to the consumer of services.
    (b) A health plan company, as defined in section 62J.03, subdivision 10, shall, at the request
of an enrollee or the enrollee's designee, provide that enrollee with a good faith estimate of the
allowable amount the health plan company has contracted for with a specified provider within the
network as total payment for a health care service specified by the enrollee and the portion of
the allowable amount due from the enrollee and the enrollee's out-of-pocket costs. An estimate
provided to an enrollee under this paragraph is not a legally binding estimate of the allowable
amount or enrollee's out-of-pocket cost.
    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.
History: 2004 c 288 art 7 s 3; 2006 c 255 s 24; 2007 c 147 art 15 s 9
62J.82 HOSPITAL INFORMATION REPORTING DISCLOSURE.
    Subdivision 1. Required information. The Minnesota Hospital Association shall develop
a Web-based system, available to the public free of charge, for reporting the following, for
Minnesota residents:
    (1) hospital-specific performance on the measures of care developed under section 256B.072
for acute myocardial infarction, heart failure, and pneumonia;
    (2) by January 1, 2009, hospital-specific performance on the public reporting measures
for hospital-acquired infections as published by the National Quality Forum and collected by
the Minnesota Hospital Association and Stratis Health in collaboration with infection control
practitioners; and
    (3) charge information, including, but not limited to, number of discharges, average length of
stay, average charge, average charge per day, and median charge, for each of the 50 most common
inpatient diagnosis-related groups and the 25 most common outpatient surgical procedures as
specified by the Minnesota Hospital Association.
    Subd. 2. Web site. The Web site must provide information that compares hospital-specific
data to hospital statewide data. The Web site must be updated annually. The commissioner shall
provide a link to this reporting information on the department's Web site.
    Subd. 3. Enforcement. The commissioner shall provide a link to this information on the
department's Web site. If a hospital does not provide this information to the Minnesota Hospital
Association, the commissioner of health may require the hospital to do so in accordance with
section 144.55, subdivision 6.
History: 1Sp2005 c 4 art 8 s 2; 2007 c 147 art 14 s 1
62J.823 HOSPITAL PRICING TRANSPARENCY.
    Subdivision 1. Short title. This section may be cited as the Hospital Pricing Transparency
Act.
    Subd. 2. Definition. For the purposes of this section, "estimate" means the actual price
expected to be billed to the individual or to the individual's health plan company based on the
specific diagnostic-related group code or specific procedure code or codes, reflecting any known
discounts the individual would receive.
    Subd. 3. Applicability and scope. Any hospital, as defined in section 144.696, subdivision
3, and outpatient surgical center, as defined in section 144.696, subdivision 4, shall provide a
written estimate of the cost of a specific service or stay upon the request of a patient, doctor, or the
patient's representative. The request must include:
(1) the health coverage status of the patient, including the specific health plan or other health
coverage under which the patient is enrolled, if any; and
(2) at least one of the following:
(i) the specific diagnostic-related group code;
(ii) the name of the procedure or procedures to be performed;
(iii) the type of treatment to be received; or
(iv) any other information that will allow the hospital or outpatient surgical center to
determine the specific diagnostic-related group or procedure code or codes.
    Subd. 4. Estimate. (a) An estimate provided by the hospital or outpatient surgical center
must contain:
(1) the method used to calculate the estimate;
(2) the specific diagnostic-related group or procedure code or codes used to calculate the
estimate, and a description of the diagnostic-related group or procedure code or codes that is
reasonably understandable to a patient; and
(3) a statement indicating that the estimate, while accurate, may not reflect the actual
billed charges and that the final bill may be higher or lower depending on the patient's specific
circumstances.
(b) The estimate may be provided in any method that meets the needs of the patient and the
hospital or outpatient surgical center, including electronically; however, a paper copy must be
provided if specifically requested.
History: 2006 c 255 s 25
62J.83 REDUCED PAYMENT AMOUNTS PERMITTED.
(a) Notwithstanding any provision of chapter 148 or any other provision of law to the
contrary, a health care provider may provide care to a patient at a discounted payment amount,
including care provided for free.
(b) This section does not apply in a situation in which the discounted payment amount
is not permitted under federal law.
History: 2006 c 255 s 26