as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to health; regulating health plan 1.3 accountability and competition, regional coordinating 1.4 boards, data, technology, public health and safety, 1.5 health provider liability, and funding for the health 1.6 care access fund; making technical changes; providing 1.7 penalties; amending Minnesota Statutes 1994, sections 1.8 13.99, by adding a subdivision; 43A.316, subdivision 1.9 6; 43A.317, by adding a subdivision; 62J.017; 62J.05, 1.10 subdivision 2; 62J.09, subdivisions 1 and 6; 62J.152; 1.11 62J.35, subdivision 3, and by adding a subdivision; 1.12 62J.44; 62J.45; 62M.02, subdivision 12; 62M.07; 1.13 62M.09, subdivision 5; 62M.10, by adding a 1.14 subdivision; 62Q.03, by adding a subdivision; 62Q.07, 1.15 subdivision 2; 62Q.17, subdivision 3; 62Q.18, 1.16 subdivision 6; 62Q.41; 72A.20, by adding subdivisions; 1.17 84.9256, subdivision 2; 169.222, subdivision 4; 1.18 169.685, subdivision 5; 169.686, subdivision 1; 1.19 169.974, subdivision 4; 549.01; 595.02, subdivision 5; 1.20 and 604.02; Laws 1994, chapter 625, article 5, section 1.21 5; proposing coding for new law in Minnesota Statutes, 1.22 chapters 62H; 62J; 62Q; 84; 290; and 548; repealing 1.23 Minnesota Statutes 1994, sections 62J.30; 62J.31; 1.24 62J.32; 62J.33; 62J.34; 62J.42; 62P.01; 62P.02; 1.25 62P.03; 62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 1.26 62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 62P.29; 1.27 62P.31; 62P.33; 214.16; 295.50; 295.51; 295.52; 1.28 295.53; 295.54; 295.55; and 295.57. 1.29 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.30 ARTICLE 1 1.31 HEALTH PLAN ACCOUNTABILITY AND COMPETITION 1.32 Section 1. Minnesota Statutes 1994, section 43A.316, 1.33 subdivision 6, is amended to read: 1.34 Subd. 6. [COVERAGE.] (a) By January 1, 1989, the 1.35 commissioner shall announce the benefits of the plan. The plan 1.36 shall include employee hospital, medical, dental, and life 1.37 insurance for employees and hospital and medical benefits for 2.1 dependents.Health maintenance organization options and other2.2delivery system options may be provided if they are available,2.3cost-effective, and capable of servicing the number of people2.4covered in the plan.The plan shall offer at least three health 2.5 plan company options to its participating employees. If three 2.6 options are not possible due to geographic restrictions, then 2.7 the plan must offer as many options as is practicable in the 2.8 service area. This requirement becomes effective when the plan 2.9 attains 1,000 participating employees in the service area. 2.10 Participation in optional coverages may be provided by 2.11 collective bargaining agreements. For employees not represented 2.12 by an exclusive representative, the employer may offer the 2.13 optional coverages to eligible employees and their dependents 2.14 provided in the plan. 2.15 (b) The commissioner, with the assistance of the 2.16 labor-management committee, shall periodically assess whether it 2.17 is financially feasible for the plan to offer or to continue an 2.18 individual retiree program that has competitive premium rates 2.19 and benefits. If the commissioner determines it to be feasible 2.20 to offer an individual retiree program, the commissioner shall 2.21 announce the applicable benefits, premium rates, and terms of 2.22 participation. Eligibility to participate in the individual 2.23 retiree program is governed by subdivision 8, but applies to 2.24 retirees of eligible employers that do not participate in the 2.25 plan and to those retirees' dependents and surviving spouses. 2.26 Sec. 2. Minnesota Statutes 1994, section 43A.317, is 2.27 amended by adding a subdivision to read: 2.28 Subd. 7a. [MULTIPLE CHOICES REQUIRED.] The Minnesota 2.29 employers insurance program shall offer at least three health 2.30 plan company options to its members. If three options are not 2.31 possible due to geographic restrictions, then the plan must 2.32 offer as many options as is practicable in the service area. 2.33 This requirement becomes effective when the program attains 2.34 1,000 eligible employees. 2.35 Sec. 3. [62H.165] [MULTIPLE CHOICES REQUIRED.] 2.36 Each Multiple Employer Welfare Arrangement (MEWA) must 3.1 offer its member organizations at least three health plan 3.2 options. If three options are not possible due to geographic 3.3 restrictions, then the MEWA must offer as many options as is 3.4 practicable in the service area. This requirement becomes 3.5 effective when a MEWA attains 1,000 covered employees. 3.6 Sec. 4. Minnesota Statutes 1994, section 62J.017, is 3.7 amended to read: 3.8 62J.017 [IMPLEMENTATION TIMETABLE.] 3.9 The state seeks to complete the restructuring of the health 3.10 care delivery and financing system by July 1, 1997. The 3.11 restructured systemwill have two options: (1) integrated3.12service networks, which will be accountable for meeting state3.13cost containment, quality, and access standards; or (2) a3.14uniform set of price and utilization controls for all health3.15care services for Minnesota residents not provided through an3.16integrated service network. Both systemssets the framework to 3.17 achieve universal coverage, and will be built upon a marketplace 3.18 in which a variety of health plan companies compete for 3.19 enrollees based on cost, quality, and access. Those health plan 3.20 companies will compete within a level regulatory environment 3.21 that holds each of them similarly accountable for cost, quality, 3.22 and access, but continues to allow them maximum flexibility in 3.23 the governance, form of licensure, and organization of health 3.24 care delivery. Under the restructured system, integrated 3.25 service networks will be one of many choices for consumers, 3.26 providers, and health plan companies. All health plan companies 3.27 will operate under the state's growth limits and will be 3.28 structured to promote competition in the health care 3.29 marketplace. The growth limits established in section 62J.04, 3.30 subdivision 1, shall continue until 1997 at which time the 3.31 legislature will assess the marketplace, medical inflation, and 3.32 other pertinent factors to determine whether limits should 3.33 continue. 3.34 Beginning July 1, 1994, measures will be taken to increase 3.35 the public accountability of existing health plan companies, to 3.36 promote the development of small, community-based integrated 4.1 service networks, and to reduce administrative costs by 4.2 standardizing third-party billing forms and procedures and 4.3 utilization review requirements. Voluntary formation of other 4.4 integrated service networks will begin after rules have been 4.5 adopted, but not before July 1, 1996. Statutes and rules for 4.6 the entire restructured health care financing and delivery 4.7 system must be enacted or adopted by January 1, 1996, and a4.8phase-in of the all-payer reimbursement system must begin on4.9that date. By July 1, 1997, all health coverage must be4.10regulated under integrated service network or community4.11integrated service network law pursuant to chapter 62N or4.12all-payer law pursuant to chapter 62P. 4.13 Sec. 5. Minnesota Statutes 1994, section 62M.02, 4.14 subdivision 12, is amended to read: 4.15 Subd. 12. [HEALTH BENEFIT PLAN.] "Health benefit plan" 4.16 means a policy, contract, or certificate issued by a health 4.17 carrier to an employer or individual for the coverage of 4.18 medical, dental, or hospital benefits. A health benefit plan 4.19 does not include coverage that is: 4.20 (1) limited to disability or income protection coverage; 4.21 (2) automobile medical payment coverage; 4.22 (3) supplemental to liability insurance; 4.23 (4) designed solely to provide payments on a per diem, 4.24 fixed indemnity, or nonexpense incurred basis; 4.25 (5) credit accident and health insurance issued under 4.26 chapter 62B; 4.27 (6) blanket accident and sickness insurance as defined in 4.28 section 62A.11; or 4.29 (7) accident only coverage issued by a licensed and tested 4.30 insurance agent; or4.31(8) workers' compensation. 4.32 Sec. 6. Minnesota Statutes 1994, section 62M.07, is 4.33 amended to read: 4.34 62M.07 [PRIOR AUTHORIZATION OF SERVICES.] 4.35 (a) Utilization review organizations conducting prior 4.36 authorization of services must have written standards that meet 5.1 at a minimum the following requirements: 5.2 (1) written procedures and criteria used to determine 5.3 whether care is appropriate, reasonable, or medically necessary; 5.4 (2) a system for providing prompt notification of its 5.5 determinations to enrollees and providers and for notifying the 5.6 provider, enrollee, or enrollee's designee of appeal procedures 5.7 under clause (4); 5.8 (3) compliance with section 72A.201, subdivision 4a, 5.9 regarding time frames for approving and disapproving prior 5.10 authorization requests; 5.11 (4) written procedures for appeals of denials of prior 5.12 authorization which specify the responsibilities of the enrollee 5.13 and provider, and which meet the requirements of section 5.14 72A.285, regarding release of summary review findings;and5.15 (5) procedures to ensure confidentiality of 5.16 patient-specific information, consistent with applicable law; 5.17 and 5.18 (6) a system for making determinations, and notifying 5.19 providers and enrollees of these determinations, during weekends 5.20 to allow 24-hour access for determination. 5.21 (b) No utilization review organization, health plan 5.22 company, or claims administrator may conduct or require prior 5.23 authorization of emergency confinement or emergency treatment. 5.24 The enrollee or the enrollee's authorized representative may be 5.25 required to notify the health plan company, claims 5.26 administrator, or utilization review organization as soon after 5.27 the beginning of the emergency confinement or emergency 5.28 treatment as reasonably possible. 5.29 Sec. 7. Minnesota Statutes 1994, section 62M.09, 5.30 subdivision 5, is amended to read: 5.31 Subd. 5. [WRITTEN CLINICAL CRITERIA.] A utilization review 5.32 organization's decisions must be supported by written clinical 5.33 criteria and review procedures, based on improved patient care 5.34 or proven patient outcomes. Clinical criteria and review 5.35 procedures must be established with appropriate involvement from 5.36 actively practicing physicians. A utilization review 6.1 organization must use written clinical criteria, as required, 6.2 for determining the appropriateness of the certification 6.3 request. The utilization review organization must have a 6.4 procedure for ensuring, at a minimum, theperiodicannual 6.5 evaluation and updating of the written criteria based on sound 6.6 clinical principles. 6.7 Sec. 8. Minnesota Statutes 1994, section 62M.10, is 6.8 amended by adding a subdivision to read: 6.9 Subd. 7. [AVAILABILITY OF CRITERIA.] Upon request, a 6.10 utilization review organization shall provide to an enrollee or 6.11 to an attending physician or provider the criteria used to 6.12 determine the necessity, appropriateness, and efficacy of a 6.13 health care service and identify the database, professional 6.14 treatment guideline, or other basis for the criteria. 6.15 Sec. 9. Minnesota Statutes 1994, section 62Q.03, is 6.16 amended by adding a subdivision to read: 6.17 Subd. 12. [PARTICIPATION BY ALL HEALTH PLAN 6.18 COMPANIES.] Upon its implementation, all health plan companies, 6.19 as a condition of licensure, must participate in the risk 6.20 adjustment system to be implemented under this section. 6.21 Sec. 10. Minnesota Statutes 1994, section 62Q.07, 6.22 subdivision 2, is amended to read: 6.23 Subd. 2. [CONTENTS OF ACTION PLANS.] (a) An action plan 6.24 must include a detailed description of all of the health plan 6.25 company's methods and procedures, standards, qualifications, 6.26 criteria, and credentialing requirements for designating the 6.27 providers who are eligible to participate in the health plan 6.28 company's provider network, including any limitations on the 6.29 numbers of providers to be included in the network. This 6.30 description must be updated by the health plan company and filed 6.31 with the applicable agency on a quarterly basis. 6.32 (b) An action plan must include the number of full-time 6.33 equivalent physicians, by specialty, nonphysician providers, and 6.34 allied health providers used to provide services. The action 6.35 plan must also describe how the health plan company intends to 6.36 encourage the use of nonphysician providers, midlevel 7.1 practitioners, and allied health professionals, through at least 7.2 consumer education, physician education, and referral and 7.3 advisement systems. The annual action plan must also include 7.4 data that is broken down by type of provider, reflecting actual 7.5 utilization of midlevel practitioners and allied professionals 7.6 by enrollees of the health plan company during the previous 7.7 year. Until July 1, 1995, a health plan company may use 7.8 estimates if actual data is not available. For purposes of this 7.9 paragraph, "provider" has the meaning given in section 62J.03, 7.10 subdivision 8. 7.11 (c) An action plan must include a description of the health 7.12 plan company's policy on determining the number and the type of 7.13 providers that are necessary to deliver cost-effective health 7.14 care to its enrollees. The action plan must also include the 7.15 health plan company's strategy, including provider recruitment 7.16 and retention activities, for ensuring that sufficient providers 7.17 are available to its enrollees. 7.18 (d) An action plan must include a description of actions 7.19 taken or planned by the health plan company to ensure that 7.20 information from report cards, outcome studies, and complaints 7.21 is used internally to improve quality of the services provided 7.22 by the health plan company. 7.23 (e) An action plan must include a detailed description of 7.24 the health plan company's policies and procedures for enrolling 7.25 and serving high risk and special needs populations. This 7.26 description must also include the barriers that are present for 7.27 the high risk and special needs population and how the health 7.28 plan company is addressing these barriers in order to provide 7.29 greater access to these populations. This description must 7.30 describe how the health plan company's provider network design, 7.31 policies on access to providers, and marketing strategies 7.32 address, and do not serve to discourage, enrollment and 7.33 appropriate access to care by members of high risk and special 7.34 needs populations. "High risk and special needs populations" 7.35 includes, but is not limited to, recipients of medical 7.36 assistance, general assistance medical care, and MinnesotaCare; 8.1 persons with chronic conditions or disabilities; individuals 8.2 within certain racial, cultural, and ethnic communities; 8.3 individuals and families with low income; adolescents; the 8.4 elderly; individuals with limited or no English language 8.5 proficiency; persons with high-cost preexisting conditions; 8.6 homeless persons; chemically dependent persons; persons with 8.7 serious and persistent mental illness and children with severe 8.8 emotional disturbance; and persons who are at high risk of 8.9 requiring treatment. The action plan must also reflect actual 8.10 utilization of providers by enrollees defined by this section as 8.11 high risk or special needs populations during the previous 8.12 year. For purposes of this paragraph, "provider" has the 8.13 meaning given in section 62J.03, subdivision 8. 8.14 (f) An action plan must include a general description of 8.15 any action the health plan company has taken and those it 8.16 intends to take to offer health coverage options to rural 8.17 communities and other communities not currently served by the 8.18 health plan company. 8.19 (g) An action plan must include a description of any 8.20 utilization review practices and policies used by the health 8.21 plan, either internally or by contract with a utilization review 8.22 organization. 8.23 (h) An action plan must include a list of any types of 8.24 providers or services that can be accessed by enrollees only 8.25 through referral by another provider (gatekeeper), together with 8.26 a description of the types of providers authorized to give these 8.27 referrals and the policies governing when and whether these 8.28 referrals will be given. 8.29 (i) An action plan must include a description of the role 8.30 played by patients and by health care providers in the 8.31 governance and operation of the health plan, including the role 8.32 played by actively practicing providers in determining the 8.33 health plan's medical policies in such areas as quality 8.34 improvement, practice guidelines, coverage decisions, and 8.35 utilization review. 8.36 (j) A health plan company other than a large managed care 9.1 plan company may satisfy any of the requirements of the action 9.2 plan in paragraphs (a) to(f)(i) by stating that it has no 9.3 policies, procedures, practices, or requirements, either written 9.4 or unwritten, or formal or informal, and has undertaken no 9.5 activities or plans on the issues required to be addressed in 9.6 the action plan, provided that the statement is truthful and not 9.7 misleading. For purposes of this paragraph, "large managed care 9.8 plan company" means a health maintenance organization, 9.9 integrated service network, or other health plan company that 9.10 employs or contracts with health care providers, that has more 9.11 than 50,000 enrollees in this state. If a health plan company 9.12 employs or contracts with providers for some of its health plans 9.13 and does not do so for other health plans that it offers, the 9.14 health plan company is a large managed care plan company if it 9.15 has more than 50,000 enrollees in this state in health plans for 9.16 which it does employ or contract with providers. 9.17 Sec. 11. [62Q.125] [ACCESS TO EMERGENCY CARE.] 9.18 A health plan company must pay for emergency services or 9.19 emergency confinement, if these services or confinement are 9.20 covered services, regardless of whether the provider seeking 9.21 payment belongs to the health plan company's provider network. 9.22 A health plan company may require that the enrollee be 9.23 transferred to a hospital or other facility within the health 9.24 plan company's network as soon as the patient is medically able 9.25 to be transferred safely, to the extent that the health plan 9.26 company is authorized by the applicable contract to make such a 9.27 requirement. 9.28 Sec. 12. Minnesota Statutes 1994, section 62Q.17, 9.29 subdivision 3, is amended to read: 9.30 Subd. 3. [GOVERNING STRUCTURE.] Each pool must have a 9.31 governing structure controlled by its members. The governing 9.32 structure of the pool is responsible for administration of the 9.33 pool. The governing structure shall review and evaluate all 9.34 bids for coverage from health plan companies, shall determine 9.35 criteria for joining and leaving the pool, and may design 9.36 incentives for healthy lifestyles and health promotion programs. 10.1 The governing structure may design uniform entrance standards 10.2 for all employers, except small employers as defined under 10.3 section 62L.02. Small employers must be permitted to enter any 10.4 pool if the small employer meets the pool's membership 10.5 requirements. Pools mustprovide as much choice in health plans10.6to members as is financially possibleoffer no fewer than three 10.7 health plan options to its members. If offering three options 10.8 are not possible due to geographic limitations, then the pool 10.9 must offer as many plans as is practicable in the service area. 10.10 This requirement becomes effective when the pool's membership 10.11 reaches 1,000. The governing structure may charge all members a 10.12 fee for administrative purposes. 10.13 Sec. 13. Minnesota Statutes 1994, section 62Q.18, 10.14 subdivision 6, is amended to read: 10.15 Subd. 6. [LIMITS ON PREMIUM RATE VARIATIONS.] (a) 10.16 Effective July 1, 1995, the premium rate variations permitted 10.17 under sections 62A.65 and 62L.08 become: 10.18 (1) for factors other than age and geography, 12.5 percent 10.19 of the index rate; and 10.20 (2) for age, 25 percent of the index rate. If age-based 10.21 premium variations are applied by health plan companies, the 10.22 health plan company may create up to three separate age bracket 10.23 rating bands, each with its own index rate. 10.24 (b) Effective July 1, 1996, the premium variations 10.25 permitted under sections 62A.65 and 62L.08 become: 10.26 (1) for factors other than age and geography, 7.5 percent 10.27 of the index rate; and 10.28 (2) for age, 15 percent of the index rate. If age-based 10.29 premium variations are applied by health plan companies, the 10.30 health plan company may create up to three separate age bracket 10.31 rating bands, each with its own index rate. 10.32 (c) Effective July 1, 1997, no health plan company shall 10.33 offer, sell, issue, or renew a health plan, that is subject to 10.34 section 62A.65 or 62L.08, for which the premium rate varies 10.35 between covered persons on the basis of any factor other than: 10.36 (1) for individual health plans, differences in benefits or 11.1 benefit design, and for group health plans, actuarially valid 11.2 differences in benefits or benefit design; 11.3 (2) the number of persons to be covered by the health plan; 11.4 (3) actuarially valid differences in expected costs between 11.5 adults and children; 11.6 (4) healthy lifestyle discounts authorized by statute;and11.7 (5) for individual health plans, geographic variations 11.8 permitted under section 62A.65, and for group health plans, 11.9 geographic variations permitted under section 62L.08; and 11.10 (6) for age, a health plan company may have up to three 11.11 separate age brackets. 11.12 (d) All premium rate variations permitted under paragraph 11.13 (c) are subject to the approval of the commissioner. 11.14 (e) Notwithstanding paragraphs (a), (b), and (c), no health 11.15 plan company shall renew any individual or group health plan, 11.16 except in compliance with this paragraph. No premium rate for 11.17 any policy holder or contract holder shall increase or decrease 11.18 upon renewal, as a result of this subdivision, by more than 15 11.19 percent per year. The increase or decrease described in this 11.20 paragraph is in addition to any premium increase or decrease 11.21 caused by legally permissible factors other than this 11.22 subdivision. If a premium increase or decrease is constrained 11.23 by this paragraph, the health plan company may implement the 11.24 remaining portion of the increase or decrease at the time of 11.25 subsequent annual renewals, but never to exceed 15 percent per 11.26 year for paragraphs (a), (b), and (c) combined. 11.27 Sec. 14. [62Q.26] [POINT-OF-SERVICE OPTION.] 11.28 Subdivision 1. [DEFINITION.] For purposes for this 11.29 section, "point-of-service product" means a health plan, as 11.30 defined in section 62A.011, under which the health plan company 11.31 will reimburse any appropriately licensed or registered provider 11.32 for providing any covered services to an enrollee, without 11.33 regard to whether the provider belongs to a particular network 11.34 and without regard to whether the enrollee was referred to the 11.35 provider by another provider. For purposes of this definition, 11.36 a health plan offered by a health plan company is a 12.1 point-of-service product only if it includes "comprehensive 12.2 supplemental benefits" in compliance with section 62D.05, 12.3 subdivision 6, and Minnesota Rules, part 4685.1955. 12.4 Subd. 2. [REQUIRED POINT-OF-SERVICE OPTION.] Each health 12.5 plan company operating in the individual, small group, or large 12.6 group market shall offer at least one point-of-service product 12.7 in each such market in which it operates. 12.8 Subd. 3. [RATE APPROVAL.] The premium rates and cost 12.9 sharing requirements for each point-of-service product must be 12.10 submitted for approval to the commissioner of health or the 12.11 commissioner of commerce, as applicable. The applicable 12.12 commissioner shall approve premium rates and cost sharing 12.13 requirements that are actuarially justified. A health plan that 12.14 includes lower enrollee cost sharing for services provided by 12.15 network providers than for services provided by out-of-network 12.16 providers, or lower enrollee cost sharing for services provided 12.17 with a prior authorization or second opinion than for services 12.18 provided without prior authorization or second opinion, may 12.19 still qualify as a point-of-service product, provided that the 12.20 difference is approved by the applicable commissioner as 12.21 actuarially justified and provided that the enrollee 12.22 out-of-pocket expense for services provided by an out-of-network 12.23 provider or for services provided without prior approval or 12.24 second opinion does not exceed 120 percent of the usual and 12.25 customary charges for the services. 12.26 Sec. 15. Minnesota Statutes 1994, section 62Q.41, is 12.27 amended to read: 12.28 62Q.41 [ANNUAL IMPLEMENTATION REPORT.] 12.29 The commissioner of health, in consultation with the 12.30 Minnesota health care commission, shall develop an annual 12.31 implementation report to be submitted to the legislature each 12.32 year beginning January 1, 1995, describing the progress and 12.33 status of rule development and implementation of theintegrated12.34service network system and the regulated all-payer12.35optionreformed system provided for under section 62J.017, and 12.36 providing recommendations for legislative changes that the 13.1 commissioner determines may be needed. 13.2 Sec. 16. [62Q.43] [CITATION.] 13.3 Sections 62Q.43 to 62Q.53 shall be known and may be cited 13.4 as the "medical savings account act." 13.5 Sec. 17. [62Q.45] [DEFINITIONS.] 13.6 Subdivision 1. [APPLICABILITY.] For purposes of sections 13.7 62Q.43 to 62Q.53, the terms defined in this section have the 13.8 meanings given them. 13.9 Subd. 2. [ACCOUNT ADMINISTRATOR.] "Account administrator" 13.10 means any of the following: 13.11 (1) a health plan company as defined in section 62Q.01, 13.12 subdivision 4; 13.13 (2) a third-party administrator; 13.14 (3) a financial institution licensed in this state; 13.15 (4) an employer that participates in the medical care 13.16 savings account program. 13.17 Subd. 3. [DEDUCTIBLE.] "Deductible" means the total 13.18 deductible for an employee and all the dependents of that 13.19 employee for a calendar year. 13.20 Subd. 4. [DEPENDENT.] "Dependent" means the spouse of the 13.21 employee or a child of the employee if the child is any of the 13.22 following: 13.23 (1) under 19 years of age, or under 25 years of age and 13.24 enrolled as a full-time student at an accredited college or 13.25 university; 13.26 (2) legally entitled to the provision of proper or 13.27 necessary subsistence, education, medical care, or other care 13.28 necessary for the child's health, guidance, or well-being and 13.29 not otherwise emancipated, self-supporting, married, or a member 13.30 of the armed forces of the United States; or 13.31 (3) mentally or physically incapacitated to the extent that 13.32 the child is not self-sufficient. 13.33 Subd. 5. [DOMICILE.] "Domicile" means the location of an 13.34 individual's true, fixed, and permanent home or principal 13.35 establishment, to which, whenever absent, the individual intends 13.36 to return. Domicile continues until another permanent home or 14.1 principal establishment is established. 14.2 Subd. 6. [ELIGIBLE MEDICAL EXPENSE.] "Eligible medical 14.3 expense" means an expense paid by the taxpayer for medical care 14.4 described in section 213(d) of the Internal Revenue Code of 14.5 1986, as amended through December 31, 1994. 14.6 Subd. 7. [EMPLOYEE.] "Employee" means the individual for 14.7 whose benefit or for the benefit of whose dependents a medical 14.8 care savings account is established. 14.9 Subd. 8. [ERISA.] "ERISA" means the employer retirement 14.10 income security act of 1974, Public Law Number 93-406. 14.11 Subd. 9. [MEDICAL CARE SAVINGS ACCOUNT OR 14.12 ACCOUNT.] "Medical care savings account" or "account" means an 14.13 interest-bearing account established by an employer as part of a 14.14 medical care savings account program to pay the eligible medical 14.15 expenses of an employee and the employee's dependents. 14.16 Sec. 18. [62Q.47] [ESTABLISHMENT.] 14.17 Subdivision 1. [REQUIREMENTS.] For tax years beginning on 14.18 or after January 1, 1996, an employer, except as otherwise 14.19 provided by law, contract, or a collective bargaining agreement, 14.20 may offer to employees a medical care savings account program. 14.21 An employer that offers a medical care savings account 14.22 program shall inform all employees in writing, before making any 14.23 contributions, of the federal tax status of contributions made 14.24 under sections 62Q.43 to 62Q.53. 14.25 Except as provided in section 62Q.51, principal contributed 14.26 to and interest earned on a medical care savings account and 14.27 money reimbursed to an employee for eligible medical expenses 14.28 are exempt from taxation under chapter 290. 14.29 Subd. 2. [CONTRIBUTIONS.] Employees can contribute to the 14.30 medical savings account in addition to the employer's portion up 14.31 to the following annual maximum contribution: 14.32 (1) not more than $2,000 per employee; 14.33 (2) not more than $1,000 per dependent with a maximum of 14.34 two dependents. 14.35 Sec. 19. [62Q.49] [ADMINISTRATION.] 14.36 Subdivision 1. [USE OF FUNDS.] The account administrator 15.1 shall utilize the funds held in a medical care savings account 15.2 solely for the purpose of paying the eligible medical expenses 15.3 of the employee or the employee's dependents. Funds held in a 15.4 medical care savings account shall not be used to cover medical 15.5 expenses of the employee or the employee's dependents that are 15.6 otherwise covered, including but not limited to, medical 15.7 expenses covered by an automobile insurance policy, workers' 15.8 compensation insurance policy or self-insured plan, or another 15.9 health coverage policy certificate or contract. 15.10 Subd. 2. [REIMBURSEMENT.] Upon receipt of documentation of 15.11 medical expenses incurred by the employee in the tax year, the 15.12 account administrator shall reimburse the employee from the 15.13 employee's account for eligible medical expenses. 15.14 Subd. 3. [ADVANCE TO EMPLOYEE.] If an employer makes 15.15 contributions to a medical care savings account on a periodic 15.16 installment basis, the employer shall advance to the employee, 15.17 interest free, the amount necessary to cover medical expenses 15.18 incurred by the employee that exceed the amount in the 15.19 employee's medical care savings account at the time the expense 15.20 is incurred, as long as the employee agrees to repay the advance 15.21 from future installments. The total amount advanced by an 15.22 employer during a tax year must not exceed the total to be 15.23 contributed by the employer to the employee's medical savings 15.24 account during that tax year. 15.25 Subd. 4. [CARRYOVER.] Money remaining in an employee's 15.26 medical savings account at the end of a taxable year remains in 15.27 the account for the next taxable year, and may be used to pay 15.28 for future eligible medical expenses of the employee or the 15.29 employee's dependents. 15.30 Subd. 5. [PARTICIPATION AT START OF TAX YEAR.] Employers 15.31 that offer a medical savings account program shall allow 15.32 employees to elect participation only for a full tax year. 15.33 Employers may offer alternative health care coverage to 15.34 employees who become eligible for or choose to enroll in 15.35 employee-sponsored health care coverage during the interim 15.36 period before the start of a full tax year. 16.1 Sec. 20. [62Q.51] [TAXATION OF WITHDRAWALS.] 16.2 Subdivision 1. [WITHDRAWALS FOR OTHER PURPOSES.] An 16.3 employee may withdraw money from a medical care savings account 16.4 for any purpose other than a purpose described in section 16.5 62Q.49, subdivision 1, only on the last business day of the 16.6 account administrator's business year. Money withdrawn under 16.7 this subdivision shall be treated as income as provided in 16.8 subdivision 2. 16.9 Subd. 2. [TREATMENT AS INCOME.] Except as provided in 16.10 subdivision 3, if the employee withdraws money for any purpose 16.11 other than a purpose described in section 62Q.49, subdivision 1, 16.12 all of the following apply: 16.13 (1) the amount of the withdrawal is income for the purpose 16.14 of chapter 290; and 16.15 (2) interest earned on the account during the tax year in 16.16 which a withdrawal under this subdivision is made is income for 16.17 purposes of chapter 290. 16.18 Subd. 3. [EXCEPTION.] The amount of a disbursement of any 16.19 assets of a medical care savings account pursuant to a filing 16.20 for protection under United States Code, title 11, sections 101 16.21 to 1330 by an employee or person for whose benefit the account 16.22 was established is not considered a withdrawal for purposes of 16.23 this section. The amount of disbursement is not subject to 16.24 taxation under chapter 290. 16.25 Sec. 21. [62Q.53] [CHANGES IN EMPLOYEE STATUS.] 16.26 Subdivision 1. [DEATH OF EMPLOYEE.] Upon the death of an 16.27 employee, the account administrator shall distribute the 16.28 principal and accumulated interest of the medical care savings 16.29 account to the estate of the employee. 16.30 Subd. 2. [CHANGES IN EMPLOYMENT STATUS.] (a) If an 16.31 employee is no longer employed by an employer that participates 16.32 in a medical care savings account program, the employee may 16.33 transfer the account to a new administrator, if the employee's 16.34 new employer participates in a medical care savings account 16.35 program. The employee must notify the new administrator of the 16.36 request for transfer within 60 days after the employee's final 17.1 day of employment with the previous employer. An employer 17.2 participating in a medical care savings account program shall 17.3 accept all requests for account transfers by new employees, if 17.4 the request for a transfer is made within this 60-day period. 17.5 (b) If the employee does not request a transfer under 17.6 paragraph (a), the employee may request in writing to the former 17.7 employer's account administrator, not later than 60 days after 17.8 the employee's final day of employment, that the account remain 17.9 with that administrator. If the administrator rejects the 17.10 employee's requests, the former employer shall mail a check to 17.11 the former employee at the employee's last known address equal 17.12 to the amount in the former employee's account, not more than 30 17.13 days after the expiration of the 60-day period. That amount is 17.14 subject to taxation under section 62Q.51. 17.15 Sec. 22. Minnesota Statutes 1994, section 72A.20, is 17.16 amended by adding a subdivision to read: 17.17 Subd. 32. [UNFAIR HEALTH RISK AVOIDANCE.] No insurer or 17.18 health plan company may design a network of providers, policies 17.19 on access to providers, or marketing strategy in such a way as 17.20 to discourage enrollment by individuals or groups whose health 17.21 care needs are perceived as likely to be more expensive than the 17.22 average. This subdivision does not prohibit underwriting and 17.23 rating practices that comply with Minnesota law. 17.24 Sec. 23. Minnesota Statutes 1994, section 72A.20, is 17.25 amended by adding a subdivision to read: 17.26 Subd. 33. [PROHIBITION OF INAPPROPRIATE INCENTIVES.] No 17.27 insurer or health plan company may give any financial incentive 17.28 to a health care provider based on the number of requests for 17.29 services or referrals denied by the provider. This subdivision 17.30 does not prohibit capitation or other compensation methods that 17.31 serve to hold health care providers financially accountable for 17.32 the cost of caring for a patient population. 17.33 Sec. 24. Minnesota Statutes 1994, section 72A.20, is 17.34 amended by adding a subdivision to read: 17.35 Subd. 34. [MISLEADING USE OF TERM "PROVIDER".] No insurer 17.36 or health plan company may use the word "provider" in enrollee 18.1 marketing, advertising, or contracting in a misleading or 18.2 inappropriate manner. The type of health care provider must be 18.3 specified. 18.4 Sec. 25. Laws 1994, chapter 625, article 5, section 5, is 18.5 amended to read: 18.6 Sec. 5. [RECODIFICATION AND HEALTH PLAN COMPANY REGULATORY 18.7 REFORM.] 18.8 Subdivision 1. [PROPOSED LEGISLATION.] The commissioners 18.9 of health and commerce, in consultation with the Minnesota 18.10 health care commission and the legislative commission on health 18.11 care access, shall draft a report, including proposed 18.12 legislation, to recodify, simplify, and standardizeallkey 18.13 statutes, rules, regulatory requirements, and procedures 18.14 relating to health plan companies.The recodification and18.15regulatory reform must become effective simultaneously with the18.16full implementation of the integrated service network system and18.17the regulated all-payer option on July 1, 1997.The purpose of 18.18 the proposed legislation shall be to create a system of common 18.19 accountability and a level regulatory environment for health 18.20 plan companies while still allowing health plan companies to 18.21 retain their present forms of licensure and to structure their 18.22 governance and delivery of care in a variety of ways. The 18.23 commissioners of health and commerce shall submit the report to 18.24 the legislature by January 1, 1996, a report on the18.25recodification and regulatory reform with proposed legislation. 18.26 Subd. 2. [CONTENTS OF LEGISLATION; REPORT.] (a) The 18.27 proposed legislation shall include a set of provisions that will 18.28 apply equally to all health plan companies and that will hold 18.29 them accountable for the cost, quality, and access of the health 18.30 coverage they provide. These provisions shall include, among 18.31 other topics: 18.32 (1) a standard set of "insurance reform" provisions 18.33 addressing subjects including guaranteed issuance and 18.34 renewability of coverage, underwriting practices, and rating 18.35 practices, including those due to be implemented on July 1, 18.36 1997; 19.1 (2) a standard set of data reporting and health plan 19.2 company report card provisions; 19.3 (3) a standard set of covered services and of allowable 19.4 forms of enrollee cost sharing; 19.5 (4) appropriately tailored financial solvency provisions, 19.6 which may include a risk based capital mechanism; 19.7 (5) a standard set of patient protection provisions 19.8 including: 19.9 (i) provisions for resolving complaints about coverage 19.10 decisions and quality of service; 19.11 (ii) provisions to assure that patients have access to 19.12 ombudsman or patient advocacy services in dealing with their 19.13 health plan company; 19.14 (iii) provisions to assure that patients receive sufficient 19.15 information about how to access services within their health 19.16 plan company; 19.17 (iv) provisions to assure that a health plan company has 19.18 sufficient providers to provide appropriate geographic access 19.19 and authorizing regulatory intervention to protect enrollees in 19.20 cases where geographic accessibility standards are not met; and 19.21 (v) provisions prohibiting unfair competition and 19.22 misleading or unfair trade practices, including the misleading 19.23 use of the word "provider" in enrollee marketing and contracting 19.24 information; and 19.25 (6) participation in the Minnesota comprehensive health 19.26 association. 19.27 (b) The report submitted by the commissioners of health and 19.28 commerce shall identify regulatory provisions that apply to some 19.29 forms of health plan companies but not to others, and where that 19.30 disparate regulation results in competitive advantages or 19.31 disadvantages in the marketplace. The report shall include 19.32 proposed legislation to eliminate such differences in 19.33 regulation, to the extent feasible and appropriate. Where such 19.34 differences cannot be eliminated, the report shall include 19.35 proposed legislation to minimize the marketplace advantages or 19.36 disadvantages resulting from the state's disparate regulation. 20.1 Subd. 3. [PRESERVATION OF CHOICES.] The proposed 20.2 legislation shall preserve, to the extent possible, the existing 20.3 forms of licensure under which health plan companies currently 20.4 operate, and should provide for licensure as an integrated 20.5 service network as an additional option for health plan 20.6 companies. The proposed legislation shall preserve as much 20.7 flexibility as possible for health plan companies to operate 20.8 under varied corporate structures and systems of governance, and 20.9 to determine for themselves how to organize their delivery of 20.10 health care. 20.11 Subd.2.4. [ADVISORY TASK FORCE.] The commissioner of 20.12 health shall convene an advisory task force to advise the 20.13 commissioner on the recodification and reform of regulatory 20.14 requirements under this section. The task force must include 20.15 representatives of health plan companies, consumers, counties, 20.16 employers, labor unions, providers, and other affected persons. 20.17 Sec. 26. [INSTRUCTION TO REVISOR.] 20.18 The revisor shall delete references to the "regulated 20.19 all-payer option" or the "regulated all-payer system" or similar 20.20 terms in Minnesota Statutes, sections 62J.04, 62J.09, 62J.152, 20.21 and elsewhere in Minnesota Statutes and Minnesota Rules. 20.22 Sec. 27. [REPEALER.] 20.23 Minnesota Statutes 1994, sections 62P.01; 62P.02; 62P.03; 20.24 62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 62P.17; 62P.19; 62P.21; 20.25 62P.23; 62P.25; 62P.29; 62P.31; and 62P.33, are repealed. 20.26 Sec. 28. [EFFECTIVE DATE.] 20.27 Sections 16 to 21 are effective for tax years beginning on 20.28 or after January 1, 1996. 20.29 ARTICLE 2 20.30 REGIONAL COORDINATING BOARDS 20.31 Section 1. Minnesota Statutes 1994, section 62J.05, 20.32 subdivision 2, is amended to read: 20.33 Subd. 2. [MEMBERSHIP.] (a) [NUMBER.] The Minnesota health 20.34 care commission consists of2728 members, as specified in this 20.35 subdivision. A member may designate a representative to act as 20.36 a member of the commission in the member's absence. The 21.1 governor and legislature shall coordinate appointments under 21.2 this subdivision to ensure gender balance and ensure that 21.3 geographic areas of the state are represented in proportion to 21.4 their population. 21.5 (b) [HEALTH PLAN COMPANIES.] The commission includes four 21.6 members representing health plan companies, including one member 21.7 appointed by the Minnesota Council of Health Maintenance 21.8 Organizations, one member appointed by the Insurance Federation 21.9 of Minnesota, one member appointed by Blue Cross and Blue Shield 21.10 of Minnesota, and one member appointed by the governor. 21.11 (c) [HEALTH CARE PROVIDERS.] The commission includes six 21.12 members representing health care providers, including one member 21.13 appointed by the Minnesota Hospital Association, one member 21.14 appointed by the Minnesota Medical Association, one member 21.15 appointed by the Minnesota Nurses' Association, one rural 21.16 physician appointed by the governor, and two members appointed 21.17 by the governor to represent providers other than hospitals, 21.18 physicians, and nurses. 21.19 (d) [EMPLOYERS.] The commission includes four members 21.20 representing employers, including (1) two members appointed by 21.21 the Minnesota Chamber of Commerce, including one self-insured 21.22 employer and one small employer; and (2) two members appointed 21.23 by the governor. 21.24 (e) [CONSUMERS.] The commission includes seven consumer 21.25 members, including three members appointed by the governor, one 21.26 of whom must represent persons over age 65; one member appointed 21.27 by the consortium of citizens with disabilities to represent 21.28 consumers with physical disabilities or chronic illness; one 21.29 member appointed by the mental health association of Minnesota, 21.30 in consultation with the Minnesota chapter of the society of 21.31 Americans for recovery, to represent consumers with mental 21.32 illness or chemical dependency; one appointed under the rules of 21.33 the senate; and one appointed under the rules of the house of 21.34 representatives. 21.35 (f) [EMPLOYEE UNIONS.] The commission includes three 21.36 representatives of labor unions, including two appointed by the 22.1 AFL-CIO Minnesota and one appointed by the governor to represent 22.2 other unions. 22.3 (g) [STATE AGENCIES.] The commission includes the 22.4 commissioners of commerce, employee relations, and human 22.5 services. 22.6 (h) [REGIONAL COORDINATING BOARDS.] The commission 22.7 includes one chair of a regional coordinating board established 22.8 under section 62J.09, appointed by the regional coordinating 22.9 board overview committee established under section 62J.095. 22.10 (i) [CHAIR.] The governor shall designate the chair of the 22.11 commission from among the governor's appointees. 22.12 Sec. 2. Minnesota Statutes 1994, section 62J.09, 22.13 subdivision 1, is amended to read: 22.14 Subdivision 1. [GENERAL DUTIES.] The regional coordinating 22.15 boards are locally controlled boards consisting of providers, 22.16 health plan companies, employers, consumers, and elected 22.17 officials. Regional boards may: 22.18 (1) recommend that the commissioner approve voluntary 22.19 agreements between providers in the region that will improve 22.20 quality, access, or affordability of health care but might 22.21 constitute a violation of antitrust laws if undertaken without 22.22 government direction; 22.23 (2) make recommendations to the commissioner regarding 22.24 major capital expenditures or the introduction of expensive new 22.25 technologies and medical practices that are being proposed or 22.26 considered by providers; 22.27 (3) undertake voluntary activities to educate consumers, 22.28 providers, and purchasers or to promote voluntary, cooperative 22.29 community cost containment, access, or quality of care projects; 22.30 (4) make recommendations to the commissioner regarding ways 22.31 of improving affordability, accessibility, and quality of health 22.32 care in the region and throughout the state.; 22.33 (5) advise the Minnesota health care commission established 22.34 under section 62J.05 on policy matters under consideration by 22.35 the health care commission; 22.36 (6) report periodically to the health care commission on 23.1 developments within the region; and 23.2 (7) educate consumers, providers, and purchasers about 23.3 community plans and projects promoting health care cost 23.4 containment, consumer accountability, access, and quality. 23.5 Regional boards shall prepare a regional education plan each 23.6 year that is consistent with and supportive of public health 23.7 goals identified by community health boards established under 23.8 chapter 145A. 23.9 Sec. 3. Minnesota Statutes 1994, section 62J.09, 23.10 subdivision 6, is amended to read: 23.11 Subd. 6. [TECHNICAL ASSISTANCE.] The commissioner shall 23.12 provide technical assistance to regional coordinating 23.13 boards. Technical assistance includes providing each regional 23.14 board with timely information concerning action plans, 23.15 enrollment data, and health care capital expenditures affecting 23.16 the regional board's region. 23.17 Sec. 4. [62J.095] [REGIONAL COORDINATING BOARD OVERVIEW 23.18 COMMITTEE.] 23.19 Subdivision 1. [GENERAL DUTIES.] The regional coordinating 23.20 board overview committee is created to improve communication and 23.21 coordination between the Minnesota health care commission 23.22 established under section 62J.05 and the regional coordinating 23.23 boards established under section 62J.09. The committee shall 23.24 meet as needed. 23.25 Subd. 2. [MEMBERSHIP.] The regional coordinating board 23.26 overview committee consists of the chairs of each regional 23.27 coordinating board established under section 62J.09 and two 23.28 members of the Minnesota health care commission established 23.29 under section 62J.05. The two committee members selected from 23.30 the Minnesota health care commission are appointed by the chair 23.31 of the commission. One committee member selected from the 23.32 Minnesota health care commission must reside within the 23.33 seven-county metropolitan area and the other must reside outside 23.34 of the seven-county metropolitan area. The members of the 23.35 regional coordinating board overview committee may select a 23.36 committee chair from within the committee's membership. 24.1 Subd. 3. [STAFF SUPPORT.] The commissioner shall provide 24.2 staff support to the regional coordinating board overview 24.3 committee, if requested to by the committee. 24.4 Subd. 4. [REPEALER.] This section is repealed effective 24.5 July 1, 1996. 24.6 ARTICLE 3 24.7 DATA, TECHNOLOGY, AND INFORMATION 24.8 Section 1. Minnesota Statutes 1994, section 13.99, is 24.9 amended by adding a subdivision to read: 24.10 Subd. 115. [HEALTH DATA INSTITUTE DATA.] Data created, 24.11 collected, received, maintained, or disseminated by the 24.12 Minnesota health data institute established under section 62J.45 24.13 are governed by section 62J.451. 24.14 Sec. 2. Minnesota Statutes 1994, section 62J.152, is 24.15 amended to read: 24.16 62J.152 [DUTIES OF HEALTH TECHNOLOGY ADVISORY COMMITTEE.] 24.17 Subdivision 1. [GENERALLY.] The health technology advisory 24.18 committee established in section 62J.15 shall: 24.19 (1) develop criteria and processes for evaluating health 24.20 care technology assessments made by other entities; 24.21 (2) conduct evaluations of specific technologies and their 24.22 specific use and application; 24.23 (3) report the results of the evaluations to the 24.24 commissioner and the Minnesota health care commission;and24.25 (4) develop a communication plan for the dissemination of 24.26 information and reports to providers and other interested 24.27 parties. This communication plan must be submitted to the 24.28 health care commission for review and implementation; and 24.29 (5) carry out other duties relating to health technology 24.30 assigned by the commission. 24.31 The chair of the health technology advisory committee shall 24.32 be a full voting member on the board of the health data 24.33 institute. 24.34 Subd. 2. [PRIORITIES FOR DESIGNATING TECHNOLOGIES FOR 24.35 ASSESSMENT.] The health technology advisory committee shall 24.36 consider the following criteria in designating technologies for 25.1 evaluation: 25.2 (1) the level of controversy within the medical or 25.3 scientific community, including questionable or undetermined 25.4 efficacy; 25.5 (2) the cost implications; 25.6 (3) the potential for rapid diffusion; 25.7 (4) the impact on a substantial patient population; 25.8 (5) the existence of alternative technologies; 25.9 (6) the impact on patient safety and health outcome; 25.10 (7) the public health importance; 25.11 (8) the level of public and professional demand; 25.12 (9) the social, ethical, and legal concerns; and 25.13 (10) the prevalence of the disease or condition. 25.14 The committee may give different weights or attach different 25.15 importance to each of the criteria, depending on the technology 25.16 being considered. The committee shall consider any additional 25.17 criteria approved by the commissioner and the Minnesota health 25.18 care commission. 25.19 Subd. 3. [CRITERIA FOR EVALUATING TECHNOLOGY.] In 25.20 developing the criteria for evaluating specific technologies, 25.21 the health technology advisory committee shall consider safety, 25.22 improvement in health outcomes, and the degree to which a 25.23 technology is clinically effective and cost-effective, and other 25.24 factors. 25.25 Subd. 4. [TECHNOLOGY EVALUATION PROCESS.] (a) The health 25.26 technology advisory committee shall collect and evaluate studies 25.27 and research findings on the technologies selected for 25.28 evaluation from as wide of a range of sources as needed, 25.29 including, but not limited to: federal agencies or other units 25.30 of government, international organizations conducting health 25.31 care technology assessments, health carriers, insurers, 25.32 manufacturers, professional and trade associations, nonprofit 25.33 organizations, and academic institutions. The health technology 25.34 advisory committee may use consultants or experts and solicit 25.35 testimony or other input as needed to evaluate a specific 25.36 technology. 26.1 (b) When the evaluation process on a specific technology 26.2 has been completed, the health technology advisory committee 26.3 shall submit a preliminary report to the health care commission 26.4 and publish a summary of the preliminary report in the State 26.5 Register with a notice that written comments may be submitted. 26.6 The preliminary report must include the results of the 26.7 technology assessment evaluation, studies and research findings 26.8 considered in conducting the evaluation, and the health 26.9 technology advisory committee's summary statement about the 26.10 evaluation. Any interested persons or organizations may submit 26.11 to the health technology advisory committee written comments 26.12 regarding the technology evaluation within 30 days from the date 26.13 the preliminary report was published in the State Register. The 26.14 health technology advisory committee's final report on its 26.15 technology evaluation must be submitted to the health care 26.16 commission. A summary of written comments received by the 26.17 health technology advisory committee within the 30-day period 26.18 must be included in the final report. The health care 26.19 commission shall review the final report and prepare its 26.20 comments and recommendations. Before completing its final 26.21 comments and recommendations, the health care commission shall 26.22 provide adequate public notice that testimony will be accepted 26.23 by the health care commission. The health care commission shall 26.24 then forward the final report, its comments and recommendations, 26.25 and a summary of the public's comments to the commissionerand26.26information clearinghouse. This information shall also be filed 26.27 with and made available to the public by the commissioner of 26.28 health. 26.29 (c) The health technology advisory committee shall develop 26.30 a methodology for studying the efficacy of the committee's 26.31 recommendations. The committee shall, at least annually, review 26.32 its recommendations using the methodology, and shall submit 26.33 reports to the health care commission to include its findings 26.34 and any recommendations for change in prior technology 26.35 assessments. 26.36 (d) The reports of the health technology advisory committee 27.1 and the comments and recommendations of the health care 27.2 commission should not eliminate or bar new technology, and are 27.3 not rules as defined in the administrative procedure act. 27.4 Subd. 5. [USE OF TECHNOLOGY EVALUATION.] (a) The final 27.5 report on the technology evaluation and the commission's 27.6 comments and recommendations may be used: 27.7 (1) by the commissioner in retrospective and prospective 27.8 review of major expenditures; 27.9 (2) byintegrated service networkshealth plan companies 27.10 and other group purchasers and by employers, in making coverage, 27.11 contracting, purchasing, and reimbursement decisions; 27.12 (3) by government programsand regulators of the regulated27.13all-payer option,in making coverage, contracting, purchasing, 27.14 and reimbursement decisions; 27.15 (4) bythe commissioner and otherorganizations in the 27.16 development of practice parameters; 27.17 (5) by health care providers in making decisions about 27.18 adding or replacing technology and the appropriate use of 27.19 technology; 27.20 (6) by consumers in making decisions about treatment; 27.21 (7) by medical device manufacturers in developing and 27.22 marketing new technologies; and 27.23 (8) as otherwise needed by health care providers, health 27.24 care plans, consumers, and purchasers. 27.25 (b) At the request of the commissioner, the health care 27.26 commission, in consultation with the health technology advisory 27.27 committee, shall submit specific recommendations relating to 27.28 technologies that have been evaluated under this section for 27.29 purposes of retrospective and prospective review of major 27.30 expenditures and coverage, contracting, purchasing, and 27.31 reimbursement decisions affecting state programsand the27.32all-payer option. 27.33Subd. 6. [APPLICATION TO THE REGULATED ALL-PAYER OPTION.]27.34The health technology advisory committee shall recommend to the27.35Minnesota health care commission and the commissioner methods to27.36control the diffusion and use of technology within the regulated28.1all-payer option for services provided outside of an integrated28.2service network.28.3 Subd.7.6. [DATA GATHERING.] In evaluating a specific 28.4 technology, the health technology advisory committee may seek 28.5 the use of data collected by manufacturers, health plans, 28.6 professional and trade associations, nonprofit organizations, 28.7 academic institutions, or any other organization or association 28.8 that may have data relevant to the committee's technology 28.9 evaluation. All information obtained under this subdivision 28.10 shall be considered nonpublic data under section 13.02, 28.11 subdivision 9, unless the dataisare already available to the 28.12 public generally or upon request. 28.13 Sec. 3. [62J.301] [STATE DATA COLLECTION INITIATIVES.] 28.14 Subdivision 1. [STATEMENT OF PURPOSE.] In an effort to 28.15 reform the health care delivery system and improve public 28.16 health, the state has undertaken significant data collection 28.17 initiatives. In order to be useful, data collection activities 28.18 must have uniformity, statistical significance, and benefits 28.19 that outweigh the cost. Data privacy and accuracy remain a 28.20 crucial consideration in collection efforts, and it is the 28.21 policy of the legislature to assure the highest standards to the 28.22 people of Minnesota as the state undertakes collection efforts. 28.23 For these reasons, the following standard set of safeguards and 28.24 criteria have been created for the collection of health-related 28.25 data by the state through the department of health and the 28.26 Minnesota health data institute. 28.27 Subd. 2. [GOALS AND CRITERIA FOR DATA INITIATIVES.] Data 28.28 and research initiatives by the department of health and the 28.29 state health data institute must: 28.30 (a) be statewide in scope, to the extent feasible, in order 28.31 to benefit health care purchasers and providers in all parts of 28.32 Minnesota and to ensure a broad and representative database for 28.33 research, comparisons, and applications; 28.34 (b) consider the differences in health care delivery models 28.35 and access to health care services between the urban and rural 28.36 areas of the state; 29.1 (c) develop a plan for valid and statistically significant 29.2 comparisons of health care delivery in rural Minnesota which may 29.3 include, but is not limited to: access, utilization, preventive 29.4 services, admission rates, disease detection and treatment, 29.5 morbidity and mortality. This comparison may be accomplished by 29.6 county or by region involving, at a minimum, a population base 29.7 of 10,000 persons; 29.8 (d) make available to providers information and data that 29.9 will enable them to improve health care delivery through 29.10 internal quality improvement measures; 29.11 (e) emphasize data that are useful, relevant, and not 29.12 redundant of existing data; 29.13 (f) be structured to minimize the administrative burden on 29.14 health carriers, health care providers, and the health care 29.15 delivery system, and maximize the privacy protections of 29.16 individual patients and providers; 29.17 (g) promote continuous improvement in the efficiency and 29.18 effectiveness of health care delivery; 29.19 (h) be analyzed from a cost-benefit perspective to ensure 29.20 that the financial and administrative costs of the initiative do 29.21 not outweigh the expected benefit. This analysis must occur 29.22 before embarking on the data initiative, and the potential 29.23 result must be of significant value as to merit the initiative; 29.24 and 29.25 (i) be disseminated to health care providers through 29.26 educational and other means, and are intended for use in 29.27 continuous quality improvement for providers. 29.28 Subd. 3. [DEPARTMENT OF HEALTH DATA CRITERIA.] The 29.29 department of health data and research initiatives must: 29.30 (a) assist the state's current health care financing and 29.31 delivery programs to deliver and purchase health care in a 29.32 manner that promotes improvements in health care efficiency and 29.33 effectiveness; 29.34 (b) assist the state in its public health activities, 29.35 including the analysis of disease prevalence and trends and the 29.36 development of public health responses; 30.1 (c) assist the state in developing and refining its overall 30.2 health policy, including policy related to health care costs, 30.3 quality, and access; and 30.4 (d) provide a data source that allows the evaluation of 30.5 state health care financing and delivery programs. 30.6 Subd. 4. [HEALTH DATA INSTITUTE DATA COLLECTION.] The 30.7 Minnesota health data institute shall collect data from health 30.8 care providers, health carriers, and individuals in the most 30.9 cost-effective manner, which does not unduly burden them. The 30.10 commissioner may require health care providers and health 30.11 carriers to cooperate with the data collection process. All 30.12 health care providers, group purchasers, and state agencies 30.13 shall be required to use a standard patient identifier and a 30.14 standard identifier for providers and health plans when 30.15 reporting data under this chapter. Patient and provider 30.16 identifiers must be encrypted to prevent identification and to 30.17 enable release of otherwise private data to researchers, 30.18 providers, and group purchasers in a manner consistent with 30.19 chapter 13 and section 144.335. 30.20 Subd. 5. [DATA CLASSIFICATION.] Any person or organization 30.21 receiving either private data on individuals or nonpublic data 30.22 under sections 62J.301 to 62J.451 is required to sign an 30.23 agreement to maintain the data that it receives according to the 30.24 statutory provisions applicable to the data. Release of 30.25 private, confidential, or nonpublic data under this chapter 30.26 shall be made without releasing data that identifies patients or 30.27 providers and should instead be released using the 30.28 identification numbers required by subdivision 4. 30.29 Subd. 6. [FEDERAL AND OTHER GRANTS.] The commissioner and 30.30 the health data institute shall seek federal funding, and 30.31 funding from private and other nonstate sources, for state data 30.32 initiatives. Health data institute solicitation of funding from 30.33 private sources for initiatives of the institute are not be 30.34 subject to section 10A.071. For purposes of this section, 30.35 "state data initiatives" is defined as initiatives of the 30.36 Minnesota health data institute or the department of health. 31.1 Subd. 7. [CONTRACTS AND GRANTS.] To carry out the duties 31.2 assigned in sections 62J.301 to 62J.451, the commissioner and 31.3 the health data institute may contract with or provide grants to 31.4 private sector entities. Any contract or grant must require the 31.5 private sector entity to maintain the data on individuals which 31.6 it receives according to the statutory provisions applicable to 31.7 the data, and are subject to section 13.09. 31.8 Subd. 8. [RULEMAKING.] The commissioner may adopt 31.9 permanent rules to implement sections 62J.301 to 62J.452. 31.10 Sec. 4. [62J.302] [DEPARTMENT OF HEALTH; DATA 31.11 RESPONSIBILITIES.] 31.12 Subdivision 1. [PUBLIC HEALTH DATA AND RESEARCH 31.13 INITIATIVES.] The department's public health data and research 31.14 initiatives shall be as follows: 31.15 (1) perform disease tracking and surveillance; 31.16 (2) conduct population-based studies to determine incidence 31.17 rates; 31.18 (3) develop public health responses; 31.19 (4) serve the needs of the public sector health care 31.20 delivery system; 31.21 (5) issue reports on worksite wellness and disease 31.22 prevention; and 31.23 (6) other public health initiatives specifically authorized 31.24 in statute. 31.25 Subd. 2. [HEALTH CARE SYSTEM DATA AND RESEARCH.] The 31.26 department's health care system data and research initiatives 31.27 shall be as follows: 31.28 (1) collect financial data to measure growth limit 31.29 compliance; 31.30 (2) collect data on premiums, benefit levels, prices, and 31.31 other health plan features; 31.32 (3) participate as a partner of the Minnesota health data 31.33 institute and sponsor of private sector data initiatives that 31.34 promote and improve health care efficiency and effectiveness; 31.35 (4) provide technical assistance to the health technology 31.36 advisory committee; 32.1 (5) assist the state health care financing and delivery 32.2 system in the delivery and purchase of effective and efficient 32.3 health care; 32.4 (6) assist the executive and legislative branches of state 32.5 government in developing and refining the state's overall health 32.6 policy, including policy related to health care costs and access 32.7 to care; 32.8 (7) require group purchasers and health care providers to 32.9 provide data on quality of care and utilization to the health 32.10 data institute; 32.11 (8) define, develop, and implement a financial 32.12 risk-adjustment system; 32.13 (9) provide information on coverage options in each 32.14 regional coordinating board region of the state; 32.15 (10) help consumers use the health care system to obtain 32.16 coverage; 32.17 (11) provide information on the availability of purchasing 32.18 pools and enrollee subsidies; 32.19 (12) explain and assist in the use of all available 32.20 complaint systems including internal complaint systems within 32.21 health plan companies and the departments of health and 32.22 commerce; and 32.23 (13) assist the health data institute in the development of 32.24 a "health information library" which will act as a centralized 32.25 repository of data initiatives of the health data institute and 32.26 the department of health; technology assessments of the health 32.27 technology advisory committee; and of private data initiatives 32.28 voluntarily submitted to the state. 32.29 Sec. 5. Minnesota Statutes 1994, section 62J.35, 32.30 subdivision 3, is amended to read: 32.31 Subd. 3. [DATA PRIVACY.] All data on patients or providers 32.32 received under this section or under section 62J.04, 62J.37, 32.33 62J.38, 62J.41, or 62J.42isare private or nonpublic, except to 32.34 the extent thatit isthey are given a different classification 32.35 elsewhere in this chapter. The commissioner shall establish 32.36 procedures and safeguards to ensure that data released by the 33.1 commissionerisare in a form thatdoesdo not identify specific 33.2 patients, providers, employers, purchasers, or other specific 33.3 individuals and organizations, except with the permission of the 33.4 affected individual or organization, or as permitted elsewhere 33.5 in this chapter. 33.6 Sec. 6. Minnesota Statutes 1994, section 62J.35, is 33.7 amended by adding a subdivision to read: 33.8 Subd. 6. [RELEASE OF DATA WITHOUT PATIENT CONSENT AND 33.9 IMMUNITY.] The release of data to the commissioner or the health 33.10 data institute pursuant to this chapter by any group purchaser 33.11 or health care provider, as defined in section 62J.03, shall not 33.12 require patient consent. Any group purchaser or health care 33.13 provider that releases data to the commissioner or health data 33.14 institute pursuant to this chapter is immune from civil 33.15 liability and criminal prosecution. 33.16 Sec. 7. Minnesota Statutes 1994, section 62J.44, is 33.17 amended to read: 33.18 62J.44 [PUBLICATION OF DATA.] 33.19 (a) Notwithstanding section 62J.35, subdivision 3, the 33.20 commissioner and the health data institute may publish data on 33.21 health care costs and spending, qualityand outcomes, and 33.22 utilization for health care institutions, individual health care 33.23 professionals and groups of health care professionals, group 33.24 purchasers, andintegrated service networkshealth plan 33.25 companies, with a description of the methodology used for 33.26 analysis, in order to provide information to purchasers and 33.27 consumers of health care.The commissioner shall not reveal the33.28name of an institution, group of professionals, individual33.29health care professional, group purchaser, or integrated service33.30network until after the institution, group of professionals,33.31individual health care professional, group purchaser, or33.32integrated service network has had 15 days to review the data33.33and comment. The commissioner shall include any comments33.34received in the release of the data.Notwithstanding any other 33.35 law to the contrary, the commissioner or the health data 33.36 institute shall release identifiable data on an institution, 34.1 group of professionals, individual health care professional, 34.2 group purchaser, or health plan company only at such time as the 34.3 data are reasonably determined by the commissioner or the health 34.4 data institute to be accurate, complete, reliable, case mixed 34.5 and severity adjusted, and statistically and clinically 34.6 significant and valid. The commissioner or the health data 34.7 institute shall provide an institution, group of professionals, 34.8 individual health care professional, group purchaser, or health 34.9 plan company with a reasonable period of time, and in no event 34.10 less than 30 days, to review and comment on the data to be 34.11 released. The commissioner or the health data institute shall 34.12 include any comments received with the release of the data. An 34.13 institution, group of professionals, individual health care 34.14 professional, group purchaser, or health plan company shall have 34.15 the right to contest publication of identifiable data pursuant 34.16 to paragraph (b). 34.17 (b) An institution, group of professionals, individual 34.18 health care professional, group purchaser, or health plan 34.19 company that has received notice of the publication of their 34.20 identifiable data has the right to present concerns in a hearing 34.21 pursuant to a contested case, except that the report of the 34.22 administrative law judge shall be binding on all parties to the 34.23 proceeding and if appropriate shall be implemented by an order 34.24 as provided in this paragraph. The hearing shall be conducted 34.25 at a place designated by the commissioner or the health data 34.26 institute, within the county where the party requesting the 34.27 hearing resides or has a principal place of business. The 34.28 hearing shall be conducted in accordance with sections 14.57 to 34.29 14.62, and is subject to appeal in accordance with sections 34.30 14.63 to 14.68. The administrative law judge shall make 34.31 findings of fact and conclusions of law, and shall determine by 34.32 clear and convincing evidence whether the commissioner or the 34.33 health data institute has reasonably determined that the 34.34 identifiable data to be released is accurate, complete, 34.35 reliable, case mixed and severity adjusted, and statistically 34.36 and clinically significant and valid. If the administrative law 35.1 judge finds that the commissioner or the health data institute 35.2 have not met this burden of proof, the administrative law judge 35.3 shall issue an order directing the commissioner or the health 35.4 data institute to cease and desist from the release of the 35.5 data. The order shall be a final decision of the department. 35.6 If the administrative law judge makes findings of fact, 35.7 conclusions of law, and an order in favor of the commissioner or 35.8 the health data institute, the order shall be a final decision 35.9 of the department or the health data institute. The 35.10 administrative law judge shall cause the findings of fact, 35.11 conclusions of law and order to be served on the party that 35.12 requested the hearing by registered or certified mail, and shall 35.13 furnish copies to the commissioner and the health data 35.14 institute. Attorney's fees shall be awarded pursuant to 35.15 sections 15.471 to 15.475. The hearing procedure and appeal 35.16 process is not an exclusive remedy and any person has the right 35.17 to seek a remedy pursuant to section 13.08, subdivisions 1 to 4, 35.18 or as otherwise authorized by law. Data shall remain private or 35.19 nonpublic during the hearing and appeal process. Nothing in 35.20 this section shall prevent the commissioner or the health data 35.21 institute from voluntarily modifying the data to be released to 35.22 meet the concerns of the party contesting the release before a 35.23 contested hearing or appeal. 35.24 (c) Summary data derived from data collected under this 35.25 chapter may be provided under section 13.05, subdivision 35.26 7, clause (1), and may be released in studies produced by the 35.27 commissioner or the health data institute or otherwise in 35.28 accordance with chapter 13. 35.29 (d) Notwithstanding sections 13.03, subdivisions 6 to 8; 35.30 and 13.10, subdivisions 1 to 4, data received by the 35.31 commissioner or the health data institute pursuant to this 35.32 chapter shall retain the classification designated under this 35.33 chapter and shall not be disclosed other than pursuant to this 35.34 chapter. 35.35 Sec. 8. Minnesota Statutes 1994, section 62J.45, is 35.36 amended to read: 36.1 62J.45 [DATA INSTITUTE.] 36.2 Subdivision 1. [STATEMENT OF PURPOSE.] It is the intention 36.3 of the legislature to create a public-private mechanism for the 36.4 collection of health carecosts,cost and quality, and outcome36.5 data,to the extent administratively efficient and effective. 36.6 This integrated data system will provide clear, usable 36.7 information on the cost, quality, and structure of health care 36.8 services in Minnesota. 36.9 The health reform initiatives being implemented rely 36.10 heavily on the availability of valid, objective data that 36.11 currently are collected in many forms within the health care 36.12 industry. Data collection needs cannot be efficiently met by 36.13 undertaking separate data collection efforts. 36.14 The data institute created in this section will be a 36.15 partnership between the commissioner of health and a board of 36.16 directors representing health carriers and other group 36.17 purchasers, health care providers, and consumers. These 36.18 entities will work together to establish a centralized cost and 36.19 quality data system that will be used by the public and private 36.20 sectors.The data collection advisory committee and the36.21practice parameter advisory committee shall provide assistance36.22to the institute through the commissioner of health.The health 36.23 data institute shall adopt data collection and publication 36.24 policies that reflect the importance of protecting the right of 36.25 privacy of patients in their health care data in connection with 36.26 each data initiative that the health data institute intends to 36.27 undertake. 36.28 Subd. 2. [DEFINITIONS.] For purposes of this section and 36.29 section 62J.451, the following definitions apply. 36.30 (a) "Analysis" means a compilation or identification of 36.31 selected data elements, a description of the methodology used to 36.32 select and/or analyze those data elements, and any other 36.33 commentary, conclusions, or other descriptive material that the 36.34 data institute determines is appropriately included, all of 36.35 which is undertaken by the data institute for one or more of the 36.36 purposes or objectives set forth in subdivisions 1 and 3, or by 37.1 other authorized researchers according to section 62J.451, 37.2 subdivision 6. 37.3 (b) "Board" means the board of directors of the Minnesota 37.4 health data institute. 37.5 (c) "Health data institute" means the public-private 37.6 partnership established under this section. 37.7(b)(d) "Encounter level data" means data related to the 37.8 utilization of health care services by, and the provision of 37.9 health care services to individual patients, enrollees, or 37.10 insureds, including claims data, abstracts of medical records, 37.11 and data from patient interviews and patient surveys. 37.12(c)(e) "Health carrier" has the definition provided in 37.13 section 62A.011, subdivision 2. 37.14 (f) "Health plan company" has the definition provided in 37.15 section 62Q.01, subdivision 4. 37.16 (g) "Patient-identifying data" means data that identify a 37.17 patient directly, or which identifies characteristics which 37.18 reasonably could uniquely identify such specific patients 37.19 circumstantially. For purposes of this definition, a patient is 37.20 not "directly identified" by the use of a unique identification 37.21 number, provided that the number is coded or encrypted through a 37.22 reliable system that can reasonably assure that such numbers 37.23 cannot be traced back by an unauthorized person to determine the 37.24 identity of a patient with a particular number. 37.25 Subd. 3. [OBJECTIVES OF THE HEALTH DATA INSTITUTE.] The 37.26 health data institute shall: 37.27 (1) provide direction and coordination for public and 37.28 private sector data collection efforts; 37.29 (2) establish a data system that electronically transmits, 37.30 collects, archives, and provides users of data with the data 37.31 necessary for their specific interests, in order to promote a 37.32 high quality, cost-effective, consumer-responsive health care 37.33 system; 37.34 (3) use and build upon existing data sources and quality 37.35 measurement efforts, and improve upon these existing data 37.36 sources and measurement efforts through the integration of data 38.1 systems and the standardization ofconcepts, to the greatest38.2extent possibleprocedures, criteria, and elements; 38.3 (4) ensure that each segment of the health care industry 38.4 can obtain data for appropriate purposes in a useful format and 38.5 timely fashion; 38.6 (5) protect the privacy of individuals and minimize 38.7 administrative costs;and38.8 (6) develop a public/private information system to: 38.9 (i) make health care claims processing and financial 38.10 settlement transactions more efficient; 38.11 (ii) provide an efficient, unobtrusive method for meeting 38.12 the shared data needs of the state, consumers, employers, 38.13 providers, and group purchasers; 38.14 (iii)provide the state, consumers, employers, providers,38.15and group purchasers with information on the cost,38.16appropriateness and effectiveness of health care, and wellness38.17and cost containment strategies;38.18(iv)provide employers with the capacity to analyze benefit 38.19 plans and work place health; and 38.20(v)(iv) provide researchers and providers with the 38.21 capacity to analyze clinical effectiveness; 38.22 (7) conduct health plan comparisons by producing health 38.23 plan report cards; 38.24 (8) develop and implement data collection procedures to 38.25 ensure standardization and minimize the administrative burden; 38.26 and 38.27 (9) promote improvements in the efficiency and 38.28 effectiveness of health care delivery. 38.29 The institute shall carry out these activities in 38.30 accordance with the recommendations of the data collection plan 38.31 developed by the data collection advisory committee, the 38.32 Minnesota health care commission, and the commissioner of 38.33 health, under subdivision 4. 38.34 Subd. 3a. [DUTIES.] The Minnesota health data institute 38.35 shall: 38.36 (1) determine uniform specifications for the collection, 39.1 transmission, and maintenance of health care data; and 39.2 (2) conduct studies on the following subjects: 39.3 (i) the relative satisfaction of participants with their 39.4 care; 39.5 (ii) the cost versus the effectiveness of health care 39.6 treatments; and 39.7 (iii) the impact on cost and effectiveness of health care 39.8 of the management techniques and administrative interventions 39.9 used in the state health care programs and other settings. 39.10 Subd. 4. [DATA COLLECTION PLAN.] Thecommissioner, in39.11consultation with theboard of the health data instituteand the39.12data collection advisory committee,shall develop and implement 39.13 a plan that: 39.14 (1) provides data collection objectives, strategies, 39.15 priorities, cost estimates, administrative and operational 39.16 guidelines, and implementation timelines for the health data 39.17 institute;and39.18 (2) identifies the encounter level data neededfor the39.19commissionerto carry out the duties assigned in this chapter. 39.20 The plan must take into consideration existing data sources and 39.21 data sources that can easily be made uniform for linkages to 39.22 other data sets; and 39.23 (3) establish uniform specifications for the collection, 39.24 transmission, and analysis of health data. 39.25 This plan shall beprepared by October 31, 1993updated 39.26 annually and shall be made available to the public through the 39.27 health information library. 39.28 Subd. 4a. [EVALUATION OF CONSUMER SATISFACTION; PROVIDER 39.29 INFORMATION PILOT STUDY.] (a) The commissioner may make a grant 39.30 to the health data institute to develop and implement a 39.31 mechanism for collecting comparative data on consumer 39.32 satisfaction through adoption of a standard consumer 39.33 satisfaction survey. As a condition of receiving this grant, 39.34 the health data institute shall appoint a consumer advisory 39.35 group which shall consist of 13 individuals, representing 39.36 enrollees from public and private health plan companies and 40.1 programs and two uninsured consumers, to advise the health data 40.2 institute on issues of concern to consumers. The advisory group 40.3 must have at least one member from each regional coordinating 40.4 board region of the state. The advisory group expires June 30, 40.5 1997. This survey shall include enrollees in community 40.6 integrated service networks, integrated service networks, health 40.7 maintenance organizations, preferred provider organizations, 40.8 indemnity insurance plans, public programs, and other health 40.9 plan companies. The health data institute shall determine a 40.10 mechanism for the inclusion of the uninsured. Health plan 40.11 companies and group purchasers shall provide enrollment 40.12 information, including the names, addresses, and telephone 40.13 numbers of enrollees and former enrollees and other data 40.14 necessary for the completion of this study to the data 40.15 institute. This enrollment information provided by the health 40.16 plan companies and group purchasers is classified as private 40.17 data on individuals, as defined in section 13.02, subdivision 40.18 12.The data institute shall provide raw unaggregated data to40.19the data analysis unit.The health data institute may analyze 40.20 and prepare findings from the raw, unaggregated data, and the 40.21 findings from this survey may be included in the health plan 40.22companyreport cards, and in other reports developed by the data40.23analysis unit, in consultation with the data institute, to be40.24disseminated by the information clearinghouse. The raw 40.25 unaggregated dataison patients and providers are classified as 40.26 private data on individuals as defined in section 13.02, 40.27 subdivision 12. The survey may include information on the 40.28 following subjects: 40.29 (1) enrollees' overall satisfaction with their health care 40.30 plan; 40.31 (2) consumers' perception of access to emergency, urgent, 40.32 routine, and preventive care, including locations, hours, 40.33 waiting times, and access to care when needed; 40.34 (3) premiums and costs; 40.35 (4)technical competence ofassessment of health condition 40.36 by providers; 41.1 (5) communication, courtesy, respect, reassurance, and 41.2 support; 41.3 (6) choice and continuity of providers; 41.4 (7) continuity of care; 41.5 (8) outcomes of care; 41.6 (9) services offered by the plan, including range of 41.7 services, coverage for preventive and routine services, and 41.8 coverage for illness and hospitalization; 41.9 (10) availability of information; and 41.10 (11) paperwork. 41.11 (b) Thecommissioner, in consultation with thehealth data 41.12 institute,shall develop a pilot study to collect comparative 41.13 data from health care providers on opportunities and barriers to 41.14 the provision of quality, cost-effective health care. The 41.15 provider information pilot study shall include providers in 41.16 community integrated service networks, integrated service 41.17 networks, health maintenance organizations, preferred provider 41.18 organizations, indemnity insurance plans, public programs, and 41.19 other health plan companies. Health plan companies and group 41.20 purchasers shall provide to the commissioner providers' names, 41.21 health plan assignment, and other appropriate data necessary for 41.22 the commissioner to conduct the study. The provider information 41.23 pilot study shall examine factors that increase and hinder 41.24 access to the provision of quality, cost-effective health care. 41.25 The study may examine: 41.26 (1) administrative barriers and facilitators; 41.27 (2) time spent obtaining permission for appropriate and 41.28 necessary treatments; 41.29 (3) latitude to order appropriate and necessary tests, 41.30 pharmaceuticals, and referrals to specialty providers; 41.31 (4) assistance available for decreasing administrative and 41.32 other routine paperwork activities; 41.33 (5) continuing education opportunities provided; 41.34 (6) access to readily available information on diagnoses, 41.35 diseases, outcomes, and new technologies; 41.36 (7) continuous quality improvement activities; 42.1 (8) inclusion in administrative decision-making; 42.2 (9) access to social services and other services that 42.3 facilitate continuity of care; 42.4 (10) economic incentives and disincentives; 42.5 (11) peer review procedures; and 42.6 (12) the prerogative to address public health needs. 42.7 In selecting additional data for collection, the 42.8commissionerhealth data institute shall consider the: (1) 42.9 statistical validity of the indicator; (2) public need for the 42.10 information; (3) estimated expense of collecting and reporting 42.11 the indicator; and (4) usefulness of the indicator to identify 42.12 barriers and opportunities to improve quality care provision 42.13 within health plan companies. 42.14 Initial survey results shall be completed and submitted to 42.15 the legislature by July 1, 1996. The final survey results must 42.16 be submitted to the legislature by January 15, 1997. 42.17 Subd. 4b. [HOSPITAL QUALITY INDICATORS.] Thecommissioner,42.18in consultation with thehealth data institute, shall develop a 42.19 system for collecting data on hospital quality.The42.20commissioner shall requireA licensed hospital shall be required 42.21 to collect and report data as needed for the system. Data to be 42.22 collected shall include structural characteristics including 42.23 staff-mix and nurse-patient ratios. In selecting additional 42.24 data for collection, thecommissionerfollowing shallconsider42.25 be considered: (1) feasibility and statistical validity of the 42.26 indicator; (2) purchaser and public demand for the indicator; 42.27 (3) estimated expense of collecting and reporting the indicator; 42.28 and (4) usefulness of the indicator for internal improvement 42.29 purposes. 42.30 Subd. 4c. [QUALITY REPORT CARDS.] (a) Each health plan 42.31 company shall reportannually by April 1to thecommissioner42.32 health data institute specific quality indicators, in the form 42.33 specified by thecommissioner in consultation with thehealth 42.34 data institute. The quality indicators must be reported using 42.35 standard definitions and measurement processes as specified by 42.36 thecommissionerhealth data institute. Wherever possible, 43.1 thecommissioner'sspecifications must be consistent with any 43.2 outlined in the health plan employer data and information set 43.3 (HEDIS2.0). Thecommissioner, in consultation with thehealth 43.4 data institute, may modify the quality indicators to be reported 43.5 to incorporate improvements in quality measurement tools.When43.6HEDIS 2.0 indicators or health care financing administration43.7approved quality indicators for medical assistance and Medicare43.8are used, the commissioner is exempt from rulemaking.For 43.9 additions or modifications to the HEDIS indicators or if other 43.10 quality indicators are added, thecommissionerhealth data 43.11 institute shall proceed through rulemaking pursuant to chapter 43.12 14. Thedata analysis unithealth data institute shall develop 43.13 quality report cards, and these report cards shall be 43.14 disseminated through the health informationclearinghouse43.15 library. 43.16 (b) Data shall be collected by county and high-risk and 43.17 special needs populations as well as by health plan but shall 43.18 not be reported. The commissioner, in consultation with the 43.19 health data institute and counties, shall provide this data to a 43.20 community health board as defined in section 145A.02 in a manner 43.21 that would not allow the identification of individuals. 43.22 Subd. 5. [COMMISSIONER'S DUTIES.] (a) The commissioner 43.23 shall establish a public/private data institute in conjunction 43.24 with health care providers, health carriers and other group 43.25 purchasers, and consumers, to collect and process encounter 43.26 level data that are required to be submitted to the commissioner 43.27 under this chapter.The commissioner shall not collect43.28 Encounter level data shall not be collected from individual 43.29 health care providers until standardized forms and procedures 43.30 are available. The commissioner shall establish a board of 43.31 directors comprised of members of the public and private sector 43.32 to provide oversight for the administration and operation of the 43.33 institute. 43.34 (b)Until the data institute is operational, the43.35commissioner may collect encounter level data required to be43.36submitted under this chapter.44.1(c)Thecommissioner, with the advice of theboard,shall 44.2 establish policies for the disclosure of data to consumers, 44.3 purchasers, providers, integrated service networks, and plans 44.4 for their use in analysis to meet the goals of this chapter, as 44.5 well as for the public disclosure of data to other interested 44.6 parties. The disclosure policies shall ensure that consumers, 44.7 purchasers, providers, integrated service networks, and health 44.8 plans have access to health data institute data for use in 44.9 analysis to meet the goals of this chapterat the same time that44.10data is provided to the data analysis unit in the department of44.11health. 44.12(d)(c) Thecommissioner, with the advice of the board,44.13 health data institute may require those requesting data from the 44.14 institute to contribute toward the cost of data collection 44.15 through the payments of fees. Entities supplying data to the 44.16 institute shall not be chargedmore than the actual transaction44.17cost of providing the data requesteda fee. 44.18(e)(d) The commissionermay intervene in the direct44.19operation of the institute, if this is necessary in the judgment44.20of the commissioner to accomplish the institute's duties. If44.21the commissioner intends to depart from the advice and44.22recommendations of the board, the commissioner shall inform the44.23board of the intended departure, provide the board with a44.24written explanation of the reasons for the departure, and give44.25the board the opportunity to comment on the departure.is 44.26 required to develop a protocol for reviewing the advice and 44.27 recommendations of the health data institute. Included in the 44.28 protocol shall be a methodology for the commissioner to accept 44.29 or reject health data institute recommendations. 44.30 Subd. 6. [BOARD OF DIRECTORS.] The institute is governed 44.31 by a20-member22-member board of directors consisting of the 44.32 following members: 44.33 (1) two representatives of hospitals, one appointed by the 44.34 Minnesota Hospital Association and one appointed by the 44.35 Metropolitan HealthCare Council, to reflect a mix of urban and 44.36 rural institutions; 45.1 (2) four representatives of health carriers, two appointed 45.2 by the Minnesota Council of Health Maintenance Organizations, 45.3 one appointed by Blue Cross Blue Shield, and one appointed by 45.4 the Insurance Federation of Minnesota; 45.5 (3) two consumer members, one appointed by the 45.6 commissioner, and one appointed by the AFL-CIO as a labor union 45.7 representative; 45.8 (4) five group purchaser representatives appointed by the 45.9 Minnesota Consortium of Healthcare Purchasers to reflect a mix 45.10 of urban and rural, large and small, and self-insured 45.11 purchasers; 45.12 (5)twothree physicians appointed by the Minnesota Medical 45.13 Association, to reflect a mix of urban and rural practitioners; 45.14 (6) one representative of teaching and research 45.15 institutions, appointed jointly by the Mayo Foundation and the 45.16 Minnesota Association of Public Teaching Hospitals; 45.17 (7) one nursing representative appointed by the Minnesota 45.18 Nurses Association;and45.19 (8) three representatives of state agencies, one member 45.20 representing the department of employee relations, one member 45.21 representing the department of human services, and one member 45.22 representing the department of health; and 45.23 (9) the chair of the health technology advisory committee. 45.24 Subd. 7. [TERMS; COMPENSATION; REMOVAL; AND VACANCIES.] 45.25 The board is governed by section 15.0575. 45.26 Subd. 8. [STAFF.] The board may hire an executive director 45.27 and other staff. The executive directorisand other data 45.28 institute staff are notastateemployeeemployees butis45.29 are covered by section 3.736. The executive director and other 45.30 data institute staff may participate in the following plans for 45.31 employees in the unclassified service: the state retirement 45.32 plan, the state deferred compensation plan, and the health 45.33 insurance and life insurance plans. The attorney general shall 45.34 provide legal services to the board. 45.35 Subd. 9. [DUTIES OF MINNESOTA HEALTH DATA INSTITUTE 45.36 BOARD.] The board shallprovide assistance towork 46.1 collaboratively with the commissioner in developing and 46.2 implementing a plan for the public/private information 46.3 system. The board shall focus its efforts on continuous quality 46.4 improvement for health plans, development of report cards and 46.5 consumer satisfaction surveys, and methods for using data 46.6 analysis for educational purposes. In addition, the board shall 46.7 make recommendations to the commissioner on: 46.8 (1) the purpose of initiating data collection initiatives; 46.9 (2) the expected benefit to the state from the initiatives; 46.10 (3) the methodology needed to ensure the validity of the 46.11 initiative without creating an undue burden to providers and 46.12 payers; 46.13 (4) the most appropriate method of collecting the necessary 46.14 data; and 46.15 (5) the projected cost to the state, health care providers, 46.16 health carriers, and other group purchasers to complete the 46.17 initiative. 46.18 The health data institute shall develop a standard set of 46.19 definitions, criteria, and elements for data collection, in 46.20 order to facilitate the efficient and effective collection of 46.21 appropriate data by the institute and the department. 46.22 Subd. 9a. [LAWS GOVERNING HEALTH DATA INSTITUTE.] The 46.23 health data institute is not subject to laws governing state 46.24 agencies except chapters 13, 14, and 16B; and sections 138.17 46.25 and 471.705. 46.26 Subd. 10. [DATA COLLECTION.] Thecommissioner, in46.27consultation with thehealth data institute board,may select a 46.28 vendor to: 46.29 (1) collect the encounter level data required to be 46.30 submitted by group purchasers under sections 62J.38 and 62J.42, 46.31 state agencies under section 62J.40, and health care providers 46.32 under sections 62J.41 and 62J.42, using, to the greatest extent 46.33 possible, standardized forms and procedures; 46.34 (2)collect the encounter level data required for the46.35initiatives of the data analysis unit, under sections 62J.30 to46.3662J.34, using, to the greatest extent possible, standardized47.1forms and procedures;47.2(3)process the data collected to ensure validity, 47.3 consistency, accuracy, and completeness, and as appropriate, 47.4 merge data collected from different sources; 47.5(4) provide unaggregated, encounter level data to the data47.6analysis unit within the department of health; and47.7(5)(3) carry out other duties assigned in this section. 47.8 Subd. 11. [USE OF DATA.] (a) The board of the health data 47.9 institute, with the advice of the data collection advisory47.10committee and the practice parameter advisory committee through47.11the commissioner,is responsible for establishing the 47.12 methodology for the collection of the data and is responsible 47.13 for providing direction on what data would be useful to the 47.14 plans, providers, consumers, and purchasers. 47.15 (b)The data analysis unit is responsible for the analysis47.16of the data and the development and dissemination of reports.47.17(c)The commissioner, in consultation withor the health 47.18 data institute board,shall determine when and under what 47.19 conditions data disclosure to group purchasers, health care 47.20 providers, consumers, researchers, and other appropriate parties 47.21 may occur to meet the state's goals. The commissioner may 47.22 require users of data to contribute toward the cost of data 47.23 collection through the payment of fees. The commissioner shall 47.24 require users of data to maintain the data according to the data 47.25 privacy provisions applicable to the data. 47.26(d)(c) The commissioner and the board shall not allow a 47.27 group purchaser or health care provider to use or have access to 47.28 the electronic data interchange system or to data created, 47.29 collected, received, maintained, or disseminated by the health 47.30 data institute, unless the group purchaser or health care 47.31 provider cooperates with the data collection efforts of the data 47.32 institute by submitting all data requested in the form and 47.33 manner specified by the board. The commissioner and the board 47.34 shall prohibit group purchasers and health care providers from 47.35 transferring, providing, or sharing data obtained from the data 47.36 institute with a group purchaser or health care provider that 48.1 does not cooperate with the data collection efforts of the data 48.2 institute. 48.3 (d) Disclosure of data received from the data institute is 48.4 prohibited. Data shall retain the same classification within 48.5 the receiving entity or organization that it had in the sending 48.6 entity or organization. Individuals and organizations receiving 48.7 data are subject to section 13.09. 48.8 Subd. 12. [CONTRACTING.] The commissioner, in consultation48.9with the board,and the health data institute board may contract 48.10 with private sector entities to carry out the duties assigned in 48.11 this section. The commissioner and the board shall diligently 48.12 seek to enter into contracts with private sector entities. Any 48.13 contract must list the specific data to be collected and the 48.14 methods to be used to collect and validate the data. Any 48.15 contract must require the private sector entity to maintain the 48.16 data collected according to the data privacy provisions 48.17 applicable to the data. 48.18 Subd. 13. [DATA PRIVACY.] The board and the institute are 48.19 subject to chapter 13. 48.20 Subd. 14. [STANDARDS FOR DATA RELEASE.] The data institute 48.21 shall adopt standards for the collection, by the institute,of 48.22 data on costs, spending, quality,outcomes,and utilization. 48.23 The data institute shall also adopt standards for the analysis 48.24 and dissemination, by private sector entities, of data on costs, 48.25 spending, quality, outcomes, and utilization provided to the 48.26 private sector entities by the data institute. Both sets of 48.27 standards must be consistent with data privacy requirements. 48.28Subd. 15. [INFORMATION CLEARINGHOUSE.] The commissioner48.29shall coordinate the activities of the data institute with the48.30activities of the information clearinghouse established in48.31section 62J.33, subdivision 2.48.32 Subd.1615. [FEDERAL AND OTHER GRANTS.] The commissioner, 48.33 in collaboration with the board, shall seek federal funding and 48.34 funding from private and other nonstate sources for the 48.35 initiatives required by the board. 48.36 Subd. 16. [ANNUAL REPORT.] The health data institute shall 49.1 submit to the chairs of the senate joint crime prevention and 49.2 judiciary subcommittee on privacy, the house of representatives 49.3 judiciary committee data privacy subcommittee, the legislative 49.4 commission on health care access, the commissioner, and the 49.5 governor a report on the activities of the data institute by 49.6 February 1 of each year. The report shall include: 49.7 (1) a description of the data initiatives undertaken by the 49.8 data institute, including a statement of the purpose and a 49.9 summary of the results of the initiative; and 49.10 (2) a description of the steps taken by the data institute 49.11 to comply with the privacy and confidentially requirements of 49.12 section 62J.451 and other applicable laws, and of the data 49.13 institute's internal policies and operating procedures relating 49.14 to data privacy and confidentiality. 49.15 If the data institute amends or adopts an internal policy 49.16 or operating procedure relating to data privacy and 49.17 confidentiality, it shall submit copies of such policy or 49.18 procedure within 30 days of its adoption to the public officials 49.19 identified in this subdivision. 49.20 Sec. 9. [62J.451] [HEALTH DATA INSTITUTE PROTECTION OF 49.21 HEALTH CARE DATA.] 49.22 Subdivision 1. [DATA CLASSIFICATIONS.] (a) Data collected, 49.23 obtained, received, or created by the health data institute on 49.24 patients, providers, or group purchasers and any analysis which 49.25 includes provider or group purchaser identifying data shall be 49.26 private or nonpublic, unless given a different classification in 49.27 this subdivision. Notwithstanding sections 13.03, subdivisions 49.28 6 to 8, and 13.10, subdivisions 1 to 4, data received by the 49.29 health data institute pursuant to this chapter shall retain the 49.30 classification designated under this chapter and shall not be 49.31 disclosed other than pursuant to this chapter. Data classified 49.32 as private or nonpublic under this subdivision may be released 49.33 or disclosed only as permitted under this subdivision and under 49.34 the other subdivisions referenced in this subdivision. 49.35 (b) Patient-identifying data may be disclosed only as 49.36 permitted under subdivision 2. 50.1 (c) Provider and group purchaser data that are not 50.2 patient-identifying data may be disclosed only through 50.3 publication in an analysis as permitted under subdivision 3. 50.4 (d) Data that are not patient-identifying data and not 50.5 provider or group purchaser identifying data may be disclosed 50.6 only through publication in an analysis as permitted under 50.7 subdivision 3. 50.8 (e) Data that describe the finances, governance, internal 50.9 operations, policies, or operating procedures of the data 50.10 institute, and that do not identify patients, providers, or 50.11 group purchasers, or identifies them only in connection with 50.12 their involvement with the data institute, are public data. 50.13 Subd. 2. [PATIENT-IDENTIFYING DATA.] (a) The health data 50.14 institute must not publish any analysis that contains 50.15 patient-identifying data. 50.16 (b) The data institute must not develop or maintain a 50.17 database over which the data institute has custody that includes 50.18 any patient-identifying data except for directory data, other 50.19 data necessary to permit the data institute to survey patients 50.20 or to conduct an analysis that cannot be accomplished if the 50.21 data are not in a form that identifies patients, and data 50.22 resulting from such surveys of patients or from such analyses. 50.23 (c) The data institute may disclose patient-identifying 50.24 data only as follows: 50.25 (1) as permitted by section 144.335, subdivision 3a; or 50.26 (2) to a contractor of, or vendor of services to the data 50.27 institute for the purposes of conducting a survey or analysis, 50.28 provided that such contractor or vendor agrees to comply with 50.29 all data privacy requirements applicable to the data institute, 50.30 and to destroy or return to the data institute all copies of 50.31 patient-identifying data in the possession of such contractor or 50.32 vendor upon completion of the contract. 50.33 Subd. 3. [PUBLICATION OF ANALYSES BY THE HEALTH DATA 50.34 INSTITUTE.] (a) Notwithstanding the classification under 50.35 subdivision 1 or other provision of state law of data included 50.36 or used in an analysis, the health data institute may publish 51.1 data in an analysis pursuant to this subdivision and subdivision 51.2 4. The analysis may include provider or group purchaser 51.3 identifying data but must not include patient-identifying data. 51.4 The health data institute may publish an analysis only if before 51.5 publication its board concludes that the analysis is more likely 51.6 to inform and enlighten those who may receive it than it is to 51.7 confuse or mislead them, and the data and the analysis are 51.8 reasonably determined by the board to be accurate, complete, 51.9 reliable, case mixed and severity adjusted, and statistically 51.10 and clinically significant and valid. Before publishing an 51.11 analysis, the health data institute shall provide reasonable 51.12 notice to a provider or group purchaser identified in the 51.13 analysis of the health data institute's intention to publish the 51.14 analysis and the opportunity to use the contested case hearing 51.15 procedure established under chapter 14. 51.16 (b) Accompanying the publication of an analysis, the data 51.17 institute shall also publish any comments received by providers 51.18 or group purchasers identified, descriptions of the database 51.19 used in the analysis, the methods of adjusting for case mix and 51.20 severity and assuring accuracy, completeness, reliability, and 51.21 statistical and clinical significance, as appropriate, and 51.22 appropriate uses of the analysis and related analytical data, 51.23 including precautionary statements regarding the limitations of 51.24 the analysis and related analytical data. 51.25 Subd. 4. [CIVIL REMEDIES.] If the health data institute 51.26 violates any of the confidentiality requirements or other 51.27 provisions pertaining to the release of data in subdivision 2 or 51.28 3, it shall be subject to section 13.08. The health data 51.29 institute shall not be liable for the actions of persons not 51.30 under the direction and control of the health data institute. 51.31 The remedies in this section do not preclude any person from 51.32 pursuing any other remedies authorized by law. 51.33 Subd. 5. [PENALTIES.] (a) If the health data institute 51.34 willfully violates the confidentiality requirements, or other 51.35 provisions pertaining to the release of data in subdivision 2 or 51.36 3, it shall be guilty of a misdemeanor. Willful violation of 52.1 this chapter by any employee of the health data institute 52.2 constitutes just cause for suspension without pay or dismissal 52.3 of the employee. 52.4 (b) If the health data institute willfully violates the 52.5 privacy or confidentiality requirements, or other provisions 52.6 pertaining to the release of data in subdivision 2 or 3, by 52.7 willfully disclosing patient-identifying, provider, or group 52.8 purchaser identifying data for compensation or remuneration of 52.9 any kind, or for the purpose of damaging the reputation of any 52.10 patient, provider, or group purchaser, or any other malicious 52.11 purpose it shall be guilty of a gross misdemeanor. 52.12 Subd. 6. [DISCOVERABILITY OF HEALTH DATA INSTITUTE DATA.] 52.13 Data created, collected, received, maintained, or disseminated 52.14 by the health data institute and the nature or subject matter of 52.15 data disclosed or the nature or subject matter of requests of 52.16 the health data institute made to providers or industry 52.17 participants shall not be subject to discovery or introduction 52.18 into evidence in any civil or criminal action. Data created, 52.19 collected, received, maintained, or disseminated by the health 52.20 data institute that is otherwise available from original sources 52.21 is subject to discovery from those sources and it may be 52.22 introduced into evidence in civil or criminal actions in 52.23 accordance with and subject to applicable laws and rules of 52.24 evidence and civil or criminal procedure, as applicable. 52.25 Nothing in chapter 62J waives any rights established pursuant to 52.26 section 145.64. 52.27 Sec. 10. [62J.452] [HEALTH INFORMATION LIBRARY.] 52.28 The commissioner of health shall provide assistance to the 52.29 health data institute in creation of a health information 52.30 library to facilitate the ability of consumers, employers, 52.31 providers, health carriers, and others to obtain information on 52.32 health care costs and quality in Minnesota. The commissioner 52.33 shall make available through the health information library 52.34 information developed or collected by the department of health 52.35 relating to public health, surveillance, prevention, disease 52.36 tracking, and other initiatives assigned to the department. The 53.1 health data institute shall make available through the health 53.2 information library information developed or collected on 53.3 consumer satisfaction, the costs and quality of health plan 53.4 companies, reports, or recommendations of the health technology 53.5 advisory committee and other entities on technology assessments, 53.6 worksite wellness and prevention programs, other wellness 53.7 programs, consumer education, and other initiatives. The health 53.8 information library is subject to chapter 13. 53.9 Sec. 11. [INSTRUCTION TO REVISOR.] 53.10 (a) The revisor shall delete all references in Minnesota 53.11 Statutes to the "information clearinghouse" and insert in its 53.12 place "health information library." In addition, the revisor 53.13 shall change all references to the "data institute" to state 53.14 "health data institute." 53.15 (b) The revisor shall change the reference to section 53.16 62J.152, subdivision 7 in sections 13.99 and 62J.156 to section 53.17 62J.157, subdivision 6 in Minnesota Statutes and Minnesota Rules. 53.18 Sec. 12. [REPEALER.] 53.19 Minnesota Statutes 1994, sections 62J.30; 62J.31; 62J.32; 53.20 62J.33; 62J.34; and 62J.42, are repealed. 53.21 ARTICLE 4 53.22 PUBLIC HEALTH AND SAFETY 53.23 Section 1. [84.916] [HELMET REQUIRED; PENALTY FOR 53.24 VIOLATION.] 53.25 No person shall operate a snowmobile on public land, public 53.26 waters, or on a public road right-of-way unless wearing a safety 53.27 helmet approved by the commissioner of public safety. Persons 53.28 found in violation of this section shall be guilty of a 53.29 misdemeanor and subject to a $25 fine. 53.30 Sec. 2. Minnesota Statutes 1994, section 84.9256, 53.31 subdivision 2, is amended to read: 53.32 Subd. 2. [HELMET REQUIRED; PENALTY FOR VIOLATION.]ANo 53.33 personless than 18 years of ageshallnotoperate an 53.34 all-terrain vehicle on public land, public waters, or on a 53.35 public road right-of-way unless wearing a safety helmet approved 53.36 by the commissioner of public safety. Persons found in 54.1 violation of this section shall be guilty of a misdemeanor and 54.2 subject to a $25 fine. 54.3 Sec. 3. Minnesota Statutes 1994, section 169.222, 54.4 subdivision 4, is amended to read: 54.5 Subd. 4. [RIDING ON ROADWAYS OR SHOULDERS.] (a) Every 54.6 person operating a bicycle upon a roadway shall ride as close as 54.7 practicable to the right-hand curb or edge of the roadway except 54.8 under any of the following situations: 54.9 (i) When overtaking and passing another vehicle proceeding 54.10 in the same direction. 54.11 (ii) When preparing for a left turn at an intersection or 54.12 into a private road or driveway. 54.13 (iii) When reasonably necessary to avoid conditions, 54.14 including fixed or moving objects, vehicles, pedestrians, 54.15 animals, surface hazards, or narrow width lanes, that make it 54.16 unsafe to continue along the right-hand curb or edge. 54.17 (b) If a bicycle is traveling on a shoulder of a roadway, 54.18 the bicycle shall travel in the same direction as adjacent 54.19 vehicular traffic. 54.20 (c) Persons riding bicycles upon a roadway or shoulder 54.21 shall not ride more than two abreast and shall not impede the 54.22 normal and reasonable movement of traffic and, on a laned 54.23 roadway, shall ride within a single lane. 54.24 (d) No person shall operate or ride a bicycle on a street 54.25 or highway, bikeway, or sidewalk without wearing protective 54.26 headgear that meets the American National Standard for 54.27 Protective Headgear for Bicyclists, ANSI Z90.4-1984, approved by 54.28 the American National Standards Institute, Inc. 54.29 (e) A person operating a bicycle upon a sidewalk, or across 54.30 a roadway or shoulder on a crosswalk, shall yield the 54.31 right-of-way to any pedestrian and shall give an audible signal 54.32 when necessary before overtaking and passing any pedestrian. No 54.33 person shall ride a bicycle upon a sidewalk within a business 54.34 district unless permitted by local authorities. Local 54.35 authorities may prohibit the operation of bicycles on any 54.36 sidewalk or crosswalk under their jurisdiction. 55.1 (f) A person lawfully operating a bicycle on a sidewalk, or 55.2 across a roadway or shoulder on a crosswalk, shall have all the 55.3 rights and duties applicable to a pedestrian under the same 55.4 circumstances. 55.5 Sec. 4. Minnesota Statutes 1994, section 169.685, 55.6 subdivision 5, is amended to read: 55.7 Subd. 5. [VIOLATION; PENALTY.] (a) Every motor vehicle 55.8 operator, when transporting a child under the age of four on the 55.9 streets and highways of this state in a motor vehicle equipped 55.10 with factory-installed seat belts, shall equip and install for 55.11 use in the motor vehicle, according to the manufacturer's 55.12 instructions, a child passenger restraint system meeting federal 55.13 motor vehicle safety standards. 55.14 (b) No motor vehicle operator who is operating a motor 55.15 vehicle on the streets and highways of this state may transport 55.16 a child under the age of four in a seat of a motor vehicle 55.17 equipped with a factory-installed seat belt, unless the child is 55.18 properly fastened in the child passenger restraint system. Any 55.19 motor vehicle operator who violates this subdivision is guilty 55.20 of apettymisdemeanor and may be sentenced to pay a fine of not 55.21 more than$50$100. The fine may be waived or the amount 55.22 reduced if the motor vehicle operator produces evidence that 55.23 within 14 days after the date of the violation a child passenger 55.24 restraint system meeting federal motor vehicle safety standards 55.25 was purchased or obtained for the exclusive use of the operator. 55.26 (c) The fines collected for violations of this subdivision 55.27 must be deposited in the state treasury and credited to a 55.28 special account to be known as the Minnesota child passenger 55.29 restraint and education account. 55.30 Sec. 5. Minnesota Statutes 1994, section 169.686, 55.31 subdivision 1, is amended to read: 55.32 Subdivision 1. [SEAT BELT REQUIREMENT.] A properly 55.33 adjusted and fastened seat belt, including both the shoulder and 55.34 lap belt when the vehicle is so equipped, shall be worn by: 55.35 (1) the driver of a passenger vehicle or commercial motor 55.36 vehicle; 56.1 (2) a passenger riding in the front seat of a passenger 56.2 vehicle or commercial motor vehicle; and 56.3 (3) a passenger riding in any seat of a passenger vehicle 56.4 who is older than threebut younger than 11years of age. 56.5 A person who is 15 years of age or older and who violates 56.6 clause (1) or (2) is subject to a fine of$25$100. The driver 56.7 of the passenger vehicle or commercial motor vehicle in which 56.8 the violation occurred is subject to a$25$100 fine for a 56.9 violation of clause (2) or (3) by a child of the driver under 56.10 the age of 15 or any child under the age of 11.A peace officer56.11may not issue a citation for a violation of this section unless56.12the officer lawfully stopped or detained the driver of the motor56.13vehicle for a moving violation other than a violation involving56.14motor vehicle equipment.The department of public safety shall 56.15 not record a violation of this subdivision on a person's driving 56.16 record. 56.17 Sec. 6. Minnesota Statutes 1994, section 169.974, 56.18 subdivision 4, is amended to read: 56.19 Subd. 4. [EQUIPMENT FOR OPERATORS AND PASSENGERS.] (a) No 56.20 personunder the age of 18shall operate or ride a motorcycle on 56.21 the streets and highways of this state without wearing 56.22 protective headgear that complies with standards established by 56.23 the commissioner of public safety; and no person shall operate a 56.24 motorcycle without wearing an eye-protective device except when 56.25 the motorcycle is equipped with a wind screen. 56.26 (b) The provisions of this subdivision shall not apply to 56.27 persons during their participation in a parade for which parade 56.28 a permit or other official authorization has been granted by a 56.29 local governing body or other governmental authority or to 56.30 persons riding within an enclosed cab. 56.31 Sec. 7. [CIGARETTE TAX INCREASES.] 56.32 The per package tax on cigarettes shall be increased by 40 56.33 cents per package of 20 cigarettes beginning July 1, 1995, with 56.34 an additional increase of 40 cents per package each subsequent 56.35 year through July 1, 2001. 56.36 The commissioner of revenue shall, by order published in 57.1 the State Register on July 1 of each year, increase the mil rate 57.2 in Minnesota Statutes, section 297.02, subdivision 1, the stamp 57.3 discount rate in Minnesota Statutes, section 297.03, subdivision 57.4 5, and the floor stock tax rates and dates referred to in Laws 57.5 1992, chapter 549, article 9, section 17, as necessary to 57.6 reflect the increases required by this section. 57.7 The revenue raised by the increases must be credited to the 57.8 health care access fund in the state treasury. 57.9 ARTICLE 5 57.10 PROFESSIONAL LIABILITY REFORM 57.11 Section 1. [548.041] [PERIODIC PAYMENT OF AWARD.] 57.12 In any negligence action involving a damage award in excess 57.13 of $250,000, the presiding judge shall, after consulting with 57.14 plaintiff and defendant counsel, determine the appropriateness 57.15 of a periodic payment schedule for the award. 57.16 Sec. 2. [548.061] [NONECONOMIC LOSSES; LIMITATION; 57.17 NEGLIGENCE OF A HEALTH CARE PROVIDER.] 57.18 (a) In any action for injury against a health care provider 57.19 based on professional negligence, the injured plaintiff shall be 57.20 entitled to recover noneconomic losses to compensate for pain, 57.21 suffering, inconvenience, physical impairment, disfigurement, 57.22 and other nonpecuniary damage. 57.23 (b) In no action shall the amount of damages for 57.24 noneconomic losses exceed $250,000. 57.25 (c) For purposes of this section, "health care provider" 57.26 means a physician, surgeon, dentist, or other health care 57.27 professional, group practice, clinic, or hospital, including all 57.28 persons or entities providing health care as defined in section 57.29 145.61, subdivisions 2 and 4, or a certified health care 57.30 professional employed by or providing services as an independent 57.31 contractor in a hospital. 57.32 Sec. 3. Minnesota Statutes 1994, section 549.01, is 57.33 amended to read: 57.34 549.01 [AGREEMENT AS TO FEES OF ATTORNEY.] 57.35 Subdivision 1. [DEFINITIONS.] For purposes of this 57.36 section: (1) "health care provider" means a physician, surgeon, 58.1 dentist, or other health care professional, group practice, 58.2 clinic, or hospital, including all persons or entities providing 58.3 health care as defined in section 145.61, subdivisions 2 and 4, 58.4 or a certified health care professional employed by or providing 58.5 services as an independent contractor in a hospital; and (2) 58.6 "contingency fee" means any fee for professional legal services 58.7 which is in whole or in part dependent upon the recovery of any 58.8 amount of damages, whether through judgment or settlement. 58.9 Subd. 2. [FEES GENERALLY.] Other than as provided in 58.10 subdivision 3, a party shall have an unrestricted right to agree 58.11 with an attorney as to compensation for services, and the 58.12 measure and mode thereof; but certain sums may be allowed to the 58.13 prevailing party for expenses in an action, which are termed 58.14 costs. 58.15 Subd. 3. [CONTINGENCY FEES; ACTIONS AGAINST A HEALTH CARE 58.16 PROVIDER.] (a) An attorney shall not contract for or collect a 58.17 contingency fee for representing any person seeking damages in 58.18 connection with an action for injury or damage against a health 58.19 care provider based upon the person's alleged professional 58.20 negligence in excess of the following limits: 58.21 (1) 40 percent of the first $50,000 recovered; 58.22 (2) 33-1/3 percent of the next $50,000 recovered; 58.23 (3) 20 percent of the next $400,000 recovered; 58.24 (4) ten percent of any amount on which the recovery exceeds 58.25 $500,000. 58.26 The limitations apply regardless of whether the recovery is 58.27 by settlement, arbitration, or judgment, or whether the person 58.28 for whom the recovery is made is a responsible adult, an infant, 58.29 or a person of unsound mind. 58.30 (b) An attorney may not receive contingency fees on any 58.31 portion of an award for noneconomic or punitive damages. 58.32 (c) In the event that the judgment or settlement includes 58.33 periodic or future payments of damages, the amount recovered for 58.34 purposes of this section shall be the cost of the annuity or 58.35 trust established to make the payments, or if there is no 58.36 annuity or trust, the present value of the payments. 59.1 Subd. 4. [VIOLATION OF SECTION.] A fee contracted for in 59.2 violation of this section shall be void and unenforceable. A 59.3 claimant affected by a violation of this section may bring an 59.4 action in the court in which the claim was or could have been 59.5 brought, for damages in the amount of three times the fee 59.6 improperly contracted for or collected, reasonable attorney 59.7 fees, and other relief to which the person may be entitled. 59.8 Sec. 4. Minnesota Statutes 1994, section 595.02, 59.9 subdivision 5, is amended to read: 59.10 Subd. 5. [WAIVER OF PRIVILEGE FOR HEALTH CARE PROVIDERS.] 59.11 A party whocommences an actionmakes a claim or files a lawsuit 59.12 for malpractice, error, mistake, or failure to cure, whether 59.13 based on contract or tort, against a health care provider on the 59.14 person's own behalf or in a representative capacity, waives in 59.15 that action any privilege existing under subdivision 1, 59.16 paragraphs (d) and (g), as to any information or opinion in the 59.17 possession of a health care provider who has examined or cared 59.18 for the party or other person whose health or medical condition 59.19 has been placed in controversy in the action. This waiver must 59.20 permit all parties to the action, and their attorneys or 59.21 authorized representatives, to informally discuss the 59.22 information or opinion with the health care provider if the 59.23 provider consents.Prior to an informal discussion with a59.24health care provider, the defendant must mail written notice to59.25the other party at least 15 days before the discussion. The59.26plaintiff's attorney or authorized representative must have the59.27opportunity to be present at any informal discussion.59.28Appropriate medical authorizations permitting discussion must be59.29provided by the party commencing the action upon request from59.30any other party.59.31 A health care provider may refuse to consent to the 59.32 discussion but, in that event, the party seeking the information 59.33 or opinion may take the deposition of the health care provider 59.34 with respect to that information and opinion, without obtaining 59.35 a prior court order. 59.36 For purposes of this subdivision, "health care provider" 60.1 means a physician, surgeon, dentist, or other health care 60.2 professional or hospital, including all persons or entities 60.3 providing health care as defined in section 145.61, subdivisions 60.4 2 and 4, or a certified health care professional employed by or 60.5 providing services as an independent contractor in a hospital. 60.6 Sec. 5. Minnesota Statutes 1994, section 604.02, is 60.7 amended to read: 60.8 604.02 [APPORTIONMENT OF DAMAGES.] 60.9 Subdivision 1. When two or more persons are jointly 60.10 liable, contributions to awards shall be in proportion to the 60.11 percentage of fault attributable to each, except that each is 60.12 jointly and severally liable for the whole award. Except in 60.13 cases where liability arises under chapters 18B - pesticide 60.14 control, 115 - water pollution control, 115A - waste management, 60.15 115B - environmental response and liability, 115C - leaking 60.16 underground storage tanks, and 299J - pipeline safety, public 60.17 nuisance law for damage to the environment or the public health, 60.18 any other environmental or public health law, or any 60.19 environmental or public health ordinance or program of a 60.20 municipality as defined in section 466.01, a person whose fault 60.21 is1530 percent or less is liable for a percentage of the whole 60.22 award no greater thanfour timesthe percentage of fault, 60.23 including any amount reallocated to that person under 60.24 subdivision 2. 60.25If the state or a municipality as defined in section 466.0160.26is jointly liable, and its fault is less than 35 percent, it is60.27jointly and severally liable for a percentage of the whole award60.28no greater than twice the amount of fault, including any amount60.29reallocated to the state or municipality under subdivision 2.60.30 Subd. 2. Upon motion made not later than one year after 60.31 judgment is entered, the court shall determine whether all or 60.32 part of a party's equitable share of the obligation is 60.33 uncollectible from that party and shall reallocate any 60.34 uncollectible amount among the other parties, including a 60.35 claimant at fault, according to their respective percentages of 60.36 fault. A party whose liability is reallocated is nonetheless 61.1 subject to contribution and to any continuing liability to the 61.2 claimant on the judgment. 61.3 Subd. 3. In the case of a claim arising from the 61.4 manufacture, sale, use or consumption of a product, an amount 61.5 uncollectible from any person in the chain of manufacture and 61.6 distribution shall be reallocated among all other persons in the 61.7 chain of manufacture and distribution but not among the claimant 61.8 or others at fault who are not in the chain of manufacture or 61.9 distribution of the product. Provided, however, that a person 61.10 whose fault is less than that of a claimant is liable to the 61.11 claimant only for that portion of the judgment which represents 61.12 the percentage of fault attributable to the person whose fault 61.13 is less. 61.14 Subd. 4. [APPORTIONMENT OF DAMAGES; MEDICAL 61.15 MALPRACTICE.] Notwithstanding subdivisions 1 to 3, for purposes 61.16 of medical malpractice actions, when two or more persons are 61.17 jointly liable, contributions to awards shall be in proportion 61.18 to the percentage of fault attributable to each. 61.19 ARTICLE 6 61.20 FUNDING 61.21 Section 1. [290.9202] [VOLUNTARILY UNINSURED PENALTY.] 61.22 (a) Persons not having proof of health insurance coverage 61.23 are subject to a "voluntarily uninsured penalty." The penalty 61.24 is the loss of an individual's personal tax deduction, and for 61.25 families without coverage, a loss of deductions for each 61.26 dependent. The maximum penalty under this section is $2,000 for 61.27 an individual and $5,000 for a family. 61.28 (b) Proof of health insurance coverage shall occur upon 61.29 filing of the Minnesota income tax form. The commissioner of 61.30 revenue shall incorporate a section into the tax form which asks 61.31 for the name of the insurer and the insurance policy number. 61.32 This data shall be classified as private data on individuals or 61.33 nonpublic data pursuant to chapter 13. 61.34 (c) State revenues attributable to the voluntarily 61.35 uninsured penalty shall be transferred from the general fund and 61.36 deposited into the health care access fund for use by the 62.1 MinnesotaCare insurance program. 62.2 Sec. 2. [TRANSFERS.] 62.3 Subdivision 1. Notwithstanding Laws 1993, chapter 345, 62.4 article 14, section 10, the commissioner of finance shall 62.5 transfer $....... in fiscal year 1995 and $....... in fiscal 62.6 year 1996 from the health care access fund to the general fund. 62.7 Subd. 2. The commissioner of finance shall transfer 62.8 $....... from the department of health to the Minnesota health 62.9 data institute for purposes of completing the data initiatives 62.10 assigned by statute. 62.11 Sec. 3. [REPEALER.] 62.12 Minnesota Statutes 1994, sections 214.16; 295.50; 295.51; 62.13 295.52; 295.53; 295.54; 295.55; and 295.57, are repealed 62.14 effective July 1, 1997.