Minnesota Legislature
Office of the Revisor of Statutes
Minnesota Session Laws - 1993, Regular Session
Key: (1) language to be deleted (2) new language
Laws of Minnesota 1993
CHAPTER 247-S.F.No. 419
An act relating to health care; modifying and making
corrections to the health right act; amending
Minnesota Statutes 1992, sections 43A.317,
subdivisions 2, 7, and 10; 62A.011, subdivision 3;
62A.02, subdivision 1; 62A.65, subdivision 5; 62J.04,
subdivisions 2, 3, 4, 5, 6, and 7; 62J.09,
subdivisions 1, 2, and 6; 62J.15, subdivision 2;
62J.17, subdivisions 2, 4, 5, and 6; 62J.19; 62J.23;
62J.29, subdivisions 1 and 4; 62J.30, subdivisions 4,
7, 8, and 10; 62J.31, subdivisions 2 and 3; 62J.32,
subdivisions 1 and 4; 62J.34, subdivisions 2 and 3;
62L.02, subdivisions 8, 11, 15, and 16, and by adding
a subdivision; 62L.03, subdivisions 2 and 5; 62L.05,
subdivision 10; 62L.09, subdivision 2; 62L.13,
subdivisions 1, 3, and 4; 62L.14, subdivisions 1, 2,
3, 4, 5, 6, 7, and 9; 62L.15, subdivision 2; 62L.16,
subdivision 5, and by adding a subdivision; 62L.17,
subdivisions 1 and 4; 62L.19; 62L.20, subdivisions 1
and 2; 144.147, subdivision 4; 144.1481, subdivision
1; 144.1486; 256.045, subdivision 10; 256.9353,
subdivisions 2, 6, and by adding a subdivision;
256.9354; 256.9355, subdivision 3; 256.9356,
subdivision 2; 256.9357; 256B.0644; Laws 1992, chapter
549, articles 1, section 15; 2, sections 24 and 25; 3,
section 24; and 4, section 18; proposing coding for
new law in Minnesota Statutes, chapter 62J; repealing
Minnesota Statutes 1992, sections 62J.05, subdivision
5; 62J.09, subdivision 3; and 62J.21.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
COST CONTAINMENT
Section 1. Minnesota Statutes 1992, section 62J.04,
subdivision 2, is amended to read:
Subd. 2. [DATA COLLECTION.] For purposes of setting limits
under this section, the commissioner shall collect from all
Minnesota health care providers data on patient revenues
received during a time period specified by the commissioner.
The commissioner shall also collect data on health care spending
from all group purchasers of health care. All health care
providers and group purchasers doing business in the state shall
provide the data requested by the commissioner at the times and
in the form specified by the commissioner. Professional
licensing boards and state agencies responsible for licensing,
registering, or regulating providers shall cooperate fully with
the commissioner in achieving compliance with the reporting
requirements. Intentional failure to provide reports requested
under this section is grounds for revocation of a license or
other disciplinary or regulatory action against a regulated
provider. The commissioner may assess a fine against a provider
who refuses to provide information required by the commissioner
under this section. If a provider refuses to provide a report
or information required under this section, the commissioner may
obtain a court order requiring the provider to produce documents
and allowing the commissioner to inspect the records of the
provider for purposes of obtaining the information required
under this section. All data received is private or nonpublic,
trade secret information under section 13.37 except to the
extent that it is given a different classification elsewhere in
this chapter. The commissioner shall establish procedures and
safeguards to ensure that data provided to the Minnesota health
care commission is in a form that does not identify individual
patients, providers, employers, purchasers, or other individuals
and organizations, except with the permission of the affected
individual or organization, or as permitted elsewhere in this
chapter.
Sec. 2. Minnesota Statutes 1992, section 62J.04,
subdivision 3, is amended to read:
Subd. 3. [COST CONTAINMENT DUTIES.] After obtaining the
advice and recommendations of the Minnesota health care
commission, the commissioner shall:
(1) establish statewide and regional limits on growth in
total health care spending under this section, monitor regional
and statewide compliance with the spending limits, and take
action to achieve compliance to the extent authorized by the
legislature;
(2) divide the state into no fewer than four regions, with
one of those regions being the Minneapolis/St. Paul metropolitan
statistical area, for purposes of fostering the development of
regional health planning and coordination of health care
delivery among regional health care systems and working to
achieve spending limits;
(3) provide technical assistance to regional coordinating
boards;
(4) monitor the quality of health care throughout the
state, conduct consumer satisfaction surveys, and take action as
necessary to ensure an appropriate level of quality;
(5) develop uniform billing forms, uniform electronic
billing procedures, and other uniform claims procedures for
health care providers by January 1, 1993;
(6) undertake health planning responsibilities as provided
in section 62J.15;
(7) monitor and promote the development and implementation
of practice parameters;
(8) authorize, fund, or promote research and
experimentation on new technologies and health care procedures;
(9) designate referral centers of excellence for
specialized and high-cost procedures and treatment and establish
minimum standards and requirements for particular procedures or
treatment;
(10) administer or contract for statewide consumer
education and wellness programs that will improve the health of
Minnesotans and increase individual responsibility relating to
personal health and the delivery of health care services;
(11) administer the health care analysis unit under Laws
1992, chapter 549, article 7; and
(12) undertake other activities to monitor and oversee the
delivery of health care services in Minnesota with the goal of
improving affordability, quality, and accessibility of health
care for all Minnesotans.
Sec. 3. Minnesota Statutes 1992, section 62J.04,
subdivision 4, is amended to read:
Subd. 4. [CONSULTATION WITH THE COMMISSION.] Before
undertaking any of the duties required under this chapter, the
commissioner of health shall consult with the Minnesota health
care commission and obtain the commission's advice and
recommendations. If the commissioner intends to depart from the
commission's recommendations, the commissioner shall inform the
commission of the intended departure, provide a written
explanation of the reasons for the departure, and give the
commission an opportunity to comment on the intended departure.
If, after receiving the commission's comment, the commissioner
still intends to depart from the commission's recommendations,
the commissioner shall notify each member of the legislative
oversight commission on health care access of the commissioner's
intent to depart from the recommendations of the Minnesota
health care commission. The notice to the legislative oversight
commission on health care access must be provided at least ten
days before the commissioner takes final action. If emergency
action is necessary that does not allow the commissioner to
obtain the advice and recommendations of the Minnesota health
care commission or to provide advance notice and an opportunity
for comment as required in this subdivision, the commissioner
shall provide a written notice and explanation to the Minnesota
health care commission and the legislative oversight commission
on health care access at the earliest possible time.
Sec. 4. Minnesota Statutes 1992, section 62J.04,
subdivision 5, is amended to read:
Subd. 5. [APPEALS.] A person or organization may appeal a
decision of the commissioner made under this chapter through a
contested case proceeding under chapter 14.
Sec. 5. Minnesota Statutes 1992, section 62J.04,
subdivision 6, is amended to read:
Subd. 6. [RULEMAKING.] The commissioner shall adopt rules
under chapter 14 to implement this chapter, including appeals of
decisions by the Minnesota health care commission and the
regional coordinating boards.
Sec. 6. Minnesota Statutes 1992, section 62J.04,
subdivision 7, is amended to read:
Subd. 7. [PLAN FOR CONTROLLING GROWTH IN SPENDING.] (a) By
January 15, 1993, the Minnesota health care commission shall
submit to the legislature and the governor for approval a plan,
with as much detail as possible, for slowing the growth in
health care spending to the growth rate identified by the
commission commissioner, beginning July 1, 1993. The goal of
the plan shall be to reduce the growth rate of health care
spending, adjusted for population changes, so that it declines
by at least ten percent per year for each of the next five
years. The commission shall use the rate of spending growth in
1991 as the base year for developing its plan. The plan may
include tentative targets for reducing the growth in spending
for consideration by the legislature.
(b) In developing the plan, the commission shall consider
the advisability and feasibility of the following options, but
is not obligated to incorporate them into the plan:
(1) data and methods that could be used to calculate
regional and statewide spending limits and the various options
for expressing spending limits, such as maximum percentage
growth rates or actuarially adjusted average per capita rates
that reflect the demographics of the state or a region of the
state;
(2) methods of adjusting spending limits to account for
patients who are not Minnesota residents, to reflect care
provided to a person outside the person's region, and to adjust
for demographic changes over time;
(3) methods that could be used to monitor compliance with
the limits;
(4) criteria for exempting spending on research and
experimentation on new technologies and medical practices when
setting or enforcing spending limits;
(5) methods that could be used to help providers,
purchasers, consumers, and communities control spending growth;
(6) methods of identifying activities of consumers,
providers, or purchasers that contribute to excessive growth in
spending;
(7) methods of encouraging voluntary activities that will
help keep spending within the limits;
(8) methods of consulting providers and obtaining their
assistance and cooperation and safeguards that are necessary to
protect providers from abrupt changes in revenues or practice
requirements;
(9) methods of avoiding, preventing, or recovering spending
in excess of the rate of growth identified by the commission;
(10) methods of depriving those who benefit financially
from overspending of the benefit of overspending, including the
option of recovering the amount of the excess spending from the
greater provider community or from individual providers or
groups of providers through targeted assessments;
(11) methods of reallocating health care resources among
provider groups to correct existing inequities, reward desirable
provider activities, discourage undesirable activities, or
improve the quality, affordability, and accessibility of health
care services;
(12) methods of imposing mandatory requirements relating to
the delivery of health care, such as practice parameters,
hospital admission protocols, 24-hour emergency care screening
systems, or designated specialty providers;
(13) methods of preventing unfair health care practices
that give a provider or group purchaser an unfair advantage or
financial benefit or that significantly circumvent, subvert, or
obstruct the goals of this chapter;
(14) methods of providing incentives through special
spending allowances or other means to encourage and reward
special projects to improve outcomes or quality of care; and
(15) the advisability or feasibility of a system of
permanent, regional coordinating boards to ensure community
involvement in activities to improve affordability,
accessibility, and quality of health care in each region.
Sec. 7. [62J.06] [IMMUNITY FROM LIABILITY.]
No member of the Minnesota health care commission
established under section 62J.05, regional coordinating boards
established under section 62J.09, health planning advisory
committee established under section 62J.15, data collection
advisory committee established under section 62J.30, or practice
parameter advisory committee established under section 62J.32
shall be held civilly or criminally liable for an act or
omission by that person if the act or omission was in good faith
and within the scope of the member's responsibilities under this
chapter.
Sec. 8. Minnesota Statutes 1992, section 62J.09,
subdivision 1, is amended to read:
Subdivision 1. [GENERAL DUTIES.] The regional coordinating
boards are locally controlled boards consisting of providers,
health plan companies, employers, consumers, and elected
officials. Regional boards may:
(1) recommend that the commissioner sanction approve
voluntary agreements between providers in the region that will
improve quality, access, or affordability of health care but
might constitute a violation of antitrust laws if undertaken
without government direction;
(2) make recommendations to the commissioner regarding
major capital expenditures or the introduction of expensive new
technologies and medical practices that are being proposed or
considered by providers;
(3) undertake voluntary activities to educate consumers,
providers, and purchasers or to promote voluntary, cooperative
community cost containment, access, or quality of care projects;
(4) make recommendations to the commissioner regarding ways
of improving affordability, accessibility, and quality of health
care in the region and throughout the state.
Sec. 9. Minnesota Statutes 1992, section 62J.09,
subdivision 2, is amended to read:
Subd. 2. [MEMBERSHIP.] (a) Each regional health care
management coordinating board consists of 16 17 members as
provided in this subdivision. A member may designate a
representative to act as a member of the commission board in the
member's absence.
(b) [PROVIDER REPRESENTATIVES.] Each regional board must
include four members representing health care providers who
practice in the region. One member is appointed by the
Minnesota Medical Association. One member is appointed by the
Minnesota Hospital Association. One member is appointed by the
Minnesota Nurses' Association. The remaining member is
appointed by the governor to represent providers other than
physicians, hospitals, and nurses.
(c) [HEALTH PLAN COMPANY REPRESENTATIVES.] Each regional
board includes three four members representing health plan
companies who provide coverage for residents of the region,
including one member representing health insurers who is elected
by a vote of all health insurers providing coverage in the
region, one member elected by a vote of all health maintenance
organizations providing coverage in the region, and one member
appointed by Blue Cross and Blue Shield of Minnesota. The
fourth member is appointed by the governor.
(d) [EMPLOYER REPRESENTATIVES.] Regional boards include
three members representing employers in the region. Employer
representatives are elected by a vote of the employers who are
members of chambers of commerce in the region. At least one
member must represent self-insured employers.
(e) [EMPLOYEE UNIONS.] Regional boards include one member
appointed by the AFL-CIO Minnesota who is a union member
residing or working in the region or who is a representative of
a union that is active in the region.
(f) [PUBLIC MEMBERS.] Regional boards include three
consumer members. One consumer member is elected by the
community health boards in the region, with each community
health board having one vote. One consumer member is elected by
the state legislators with districts in the region. One
consumer member is appointed by the governor.
(g) [COUNTY COMMISSIONER.] Regional boards include one
member who is a county board member. The county board member is
elected by a vote of all of the county board members in the
region, with each county board having one vote.
(h) [STATE AGENCY.] Regional boards include one state
agency commissioner appointed by the governor to represent state
health coverage programs.
Sec. 10. Minnesota Statutes 1992, section 62J.09,
subdivision 6, is amended to read:
Subd. 6. [TECHNICAL ASSISTANCE.] The state health care
commission commissioner shall provide technical assistance to
regional coordinating boards.
Sec. 11. Minnesota Statutes 1992, section 62J.15,
subdivision 2, is amended to read:
Subd. 2. [HEALTH PLANNING.] In consultation with the
health planning advisory committee, the Minnesota health care
commission shall:
(1) make recommendations on the types of high-cost
technologies, procedures, and capital expenditures for which a
plan on statewide use and distribution should be made;
(2) develop criteria for evaluating new high-cost health
care technology and procedures and major capital expenditures
that take into consideration the clinical effectiveness,
cost-effectiveness, and health outcome;
(3) recommend to the commissioner of health and the
regional coordinating organizations boards statewide and
regional goals and targets for the distribution and use of new
and existing high-cost health care technologies and procedures
and major capital expenditures;
(4) make recommendations to the commissioner regarding the
designation of referral centers of excellence for transplants
and other specialized medical procedures; and
(5) make recommendations to the commissioner regarding
minimum volume requirements for the performance of certain
procedures by hospitals and other health care facilities or
providers.
Sec. 12. Minnesota Statutes 1992, section 62J.17,
subdivision 2, is amended to read:
Subd. 2. [DEFINITIONS.] For purposes of this section, the
terms defined in this subdivision have the meanings given.
(a) [CAPITAL EXPENDITURE.] "Capital expenditure" means an
expenditure which, under generally accepted accounting
principles, is not properly chargeable as an expense of
operation and maintenance.
(b) [HEALTH CARE SERVICE.] "Health care service" means:
(1) a service or item that would be covered by the medical
assistance program under chapter 256B if provided in accordance
with medical assistance requirements to an eligible medical
assistance recipient; and
(2) a service or item that would be covered by medical
assistance except that it is characterized as experimental,
cosmetic, or voluntary.
"Health care service" does not include retail,
over-the-counter sales of nonprescription drugs and other retail
sales of health-related products that are not generally paid for
by medical assistance and other third-party coverage.
(c) [MAJOR SPENDING COMMITMENT.] "Major spending
commitment" means:
(1) acquisition of a unit of medical equipment;
(2) a capital expenditure for a single project for the
purposes of providing health care services, other than for the
acquisition of medical equipment;
(3) offering a new specialized service not offered before;
(4) planning for an activity that would qualify as a major
spending commitment under this paragraph; or
(5) a project involving a combination of two or more of the
activities in clauses (1) to (4).
The cost of acquisition of medical equipment, and the
amount of a capital expenditure, is the total cost to the
provider regardless of whether the cost is distributed over time
through a lease arrangement or other financing or payment
mechanism.
(d) [MEDICAL EQUIPMENT.] "Medical equipment" means fixed
and movable equipment that is used by a provider in the
provision of a health care service. "Medical equipment"
includes, but is not limited to, the following:
(1) an extracorporeal shock wave lithotripter;
(2) a computerized axial tomography (CAT) scanner;
(3) a magnetic resonance imaging (MRI) unit;
(4) a positron emission tomography (PET) scanner; and
(5) emergency and nonemergency medical transportation
equipment and vehicles.
(e) [NEW SPECIALIZED SERVICE.] "New specialized service"
means a specialized health care procedure or treatment regimen
offered by a provider that was not previously offered by the
provider, including, but not limited to:
(1) cardiac catheterization services involving high-risk
patients as defined in the Guidelines for Coronary Angiography
established by the American Heart Association and the American
College of Cardiology;
(2) heart, heart-lung, liver, kidney, bowel, or pancreas
transplantation service, or any other service for
transplantation of any other organ;
(3) megavoltage radiation therapy;
(4) open heart surgery;
(5) neonatal intensive care services; and
(6) any new medical technology for which premarket approval
has been granted by the United States Food and Drug
Administration, excluding implantable and wearable devices.
(f) [PROVIDER.] "Provider" means an individual,
corporation, association, firm, partnership, or other entity
that is regularly engaged in providing health care services in
Minnesota, or that makes a major spending commitment to become
regularly engaged in providing health care services in Minnesota.
Sec. 13. Minnesota Statutes 1992, section 62J.17,
subdivision 4, is amended to read:
Subd. 4. [EXPENDITURE REPORTING.] Any provider making a
capital expenditure establishing a health care service or new
specialized service, or making a major spending commitment after
April 1, 1992, that is in excess of $500,000, shall submit
notification of this expenditure to the commissioner within 60
days of making the major spending commitment and provide the
commissioner with any relevant background or other information.
The commissioner shall not have any approval or denial
authority, but should use such information in the ongoing
evaluation of statewide and regional progress toward cost
containment and other objectives.
Sec. 14. Minnesota Statutes 1992, section 62J.17,
subdivision 5, is amended to read:
Subd. 5. [RETROSPECTIVE REVIEW.] The commissioner of
health, in consultation with the Minnesota health care
commission, shall retrospectively review capital expenditures
and major spending commitments that are required to be reported
by providers under subdivision 4. In the event that health care
providers refuse to cooperate with attempts by the Minnesota
health care commission and regional coordinating organizations
boards to coordinate the use of health care technologies and
procedures, and reduce the growth rate in health care
expenditures; or in the event that health care providers use,
purchase, or perform health care technologies and procedures
that are not clinically effective and cost-effective and do not
improve health outcomes based on the results of medical
research; or in the event providers have failed to pursue lawful
collaborative arrangements; the commissioner shall require those
health care providers to follow the procedures for prospective
review and approval established in subdivision 6.
Sec. 15. Minnesota Statutes 1992, section 62J.17,
subdivision 6, is amended to read:
Subd. 6. [PROSPECTIVE REVIEW AND APPROVAL.] (a)
[REQUIREMENT.] The commissioner shall prohibit those health care
providers subject to retrospective review under subdivision 5
from making future major spending commitments or capital
expenditures that are required to be reported under subdivision
4 for a period of up to five years, unless: (1) the provider
has filed an application to proceed with the major spending
commitment or capital expenditure with the commissioner and
provided supporting documentation and evidence requested by the
commissioner; and (2) the commissioner determines, based upon
this documentation and evidence, that the spending commitment or
capital expenditure is appropriate. The commissioner shall make
a decision on a completed application within 60 days after an
application is submitted. The Minnesota health care commission
shall convene an expert review panel made up of persons with
knowledge and expertise regarding medical equipment, specialized
services, and health care expenditures to review applications
and make recommendations to the commissioner and the commission.
(b) [EXCEPTIONS.] This subdivision does not apply to:
(1) a major spending commitment to replace existing
equipment with comparable equipment, if the old equipment will
no longer be used in the state;
(2) a major spending commitment made by a research and
teaching institution for purposes of conducting medical
education, medical research supported or sponsored by a medical
school, or by a federal or foundation grant, or clinical trials;
(3) a major spending commitment to repair, remodel, or
replace existing buildings or fixtures if, in the judgment of
the commissioner, the project does not involve a substantial
expansion of service capacity or a substantial change in the
nature of health care services provided; and
(4) mergers, acquisitions, and other changes in ownership
or control that, in the judgment of the commissioner, do not
involve a substantial expansion of service capacity or a
substantial change in the nature of health care services
provided.
(c) [APPEALS.] A provider may appeal a decision of the
commissioner under this section through a contested case
proceeding under chapter 14.
(d) [PENALTIES AND REMEDIES.] The commissioner of health
shall have the authority to issue fines, seek injunctions, and
pursue other remedies as provided by law.
Sec. 16. Minnesota Statutes 1992, section 62J.19, is
amended to read:
62J.19 [SUBMISSION OF REGIONAL PLAN TO COMMISSIONER.]
Each regional coordinating board shall submit its plan to
the commissioner on or before June 30, 1993. In the event that
any major provider, provider group or other entity within the
region chooses to not participate in the regional planning
process, the commissioner may require the participation of that
entity in the planning process or adopt other rules or criteria
for that entity. In the event that a region fails to submit a
plan to the commissioner that satisfactorily promotes the
objectives in section 62J.09, subdivisions 1 and 2, or where
competing plans and regional coordination boards exist, the
commissioner has the authority to establish a public regional
coordinating board for purposes of establishing a regional plan
which will achieve the objectives. The public regional
coordinating board shall be appointed by the commissioner and
under the commissioner's direction.
Sec. 17. Minnesota Statutes 1992, section 62J.23, is
amended to read:
62J.23 [PROVIDER CONFLICTS OF INTEREST.]
Subdivision 1. [RULES PROHIBITING CONFLICTS OF INTEREST.]
The commissioner of health shall adopt rules restricting
financial relationships or payment arrangements involving health
care providers under which a provider person benefits
financially by referring a patient to another provider person,
recommending another provider person, or furnishing or
recommending an item or service. The rules must be compatible
with, and no less restrictive than, the federal Medicare
antikickback statute, in section 1128B(b) of the Social Security
Act, United States Code, title 42, section 1320a-7b(b), and
regulations adopted under it. However, the commissioner's rules
may be more restrictive than the federal law and regulations and
may apply to additional provider groups and business and
professional arrangements. When the state rules restrict an
arrangement or relationship that is permissible under federal
laws and regulations, including an arrangement or relationship
expressly permitted under the federal safe harbor regulations,
the fact that the state requirement is more restrictive than
federal requirements must be clearly stated in the rule.
Subd. 2. [INTERIM RESTRICTIONS.] From July 1, 1992, until
rules are adopted by the commissioner under this section, the
restrictions in the federal Medicare antikickback statutes in
section 1128B(b) of the Social Security Act, United States Code,
title 42, section 1320a-7b(b), and rules adopted under the
federal statutes, apply to all health care providers persons in
the state, regardless of whether the provider person
participates in any state health care program. The commissioner
shall approve a transition plan submitted to the commissioner by
January 1, 1993, by a provider person who is in violation of
this section that provides a reasonable time for the provider
person to modify prohibited practices or divest financial
interests in other providers persons in order to come into
compliance with this section. Transition plans that identify
individuals are private data. Transition plans that do not
identify individuals are nonpublic data.
Subd. 3. [PENALTY.] The commissioner may assess a fine
against a provider person who violates this section. The amount
of the fine is $1,000 or 110 percent of the estimated financial
benefit that the provider person realized as a result of the
prohibited financial arrangement or payment relationship,
whichever is greater. A provider person who is in compliance
with a transition plan approved by the commissioner under
subdivision 2, or who is making a good faith effort to obtain
the commissioner's approval of a transition plan, is not in
violation of this section.
Sec. 18. Minnesota Statutes 1992, section 62J.29,
subdivision 1, is amended to read:
Subdivision 1. [PURPOSE.] The legislature finds that the
goals of controlling health care costs and improving the quality
of and access to health care services will be significantly
enhanced by some cooperative arrangements involving providers or
purchasers that would may be prohibited by state and federal
antitrust laws if undertaken without governmental involvement.
The purpose of this section is to create an opportunity for the
state to review proposed arrangements and to substitute
regulation for competition when an arrangement is likely to
result in lower costs, or greater access or quality, than would
otherwise occur in the competitive marketplace. The legislature
intends that approval of relationships be accompanied by
appropriate conditions, supervision, and regulation to protect
against private abuses of economic power, and that this approval
will make relationships immune from state and federal antitrust
liability.
Sec. 19. Minnesota Statutes 1992, section 62J.29,
subdivision 4, is amended to read:
Subd. 4. [STATE ANTITRUST LAW.] Notwithstanding the
Minnesota antitrust law of 1971, as amended, in sections 325D.49
to 325D.66, contracts, business or financial arrangements, or
other activities, practices, or arrangements involving providers
or purchasers that are approved by the commissioner under this
section do not constitute an unlawful contract, combination, or
conspiracy in unreasonable restraint of trade or commerce under
sections 325D.49 to 325D.66. Approval by the state commission
commissioner is an absolute defense against any action under
state antitrust laws.
Sec. 20. Laws 1992, chapter 549, article 1, section 15, is
amended to read:
Sec. 15. [HOSPITAL PLANNING TASK FORCE.]
The legislative commission on health care access shall
convene a hospital health planning task force to undertake
preliminary planning relating to cost containment, accessibility
of health care services, and quality of care, and to develop
options and recommendations to be presented to the legislative
commission and to the Minnesota health care commission. The
task force consists of interested representatives of Minnesota
hospitals, the commissioner of health or the commissioner's
representatives, and the members of the legislative commission
or their representatives. The task force shall submit reports
to the Minnesota health care commission by August 1, 1992, and
July 1, 1993. The task force expires on August 1, 1993. The
expenses and compensation of members is the responsibility of
the institutions, organizations, or agencies they represent.
Sec. 21. [REPEALER.]
Minnesota Statutes 1992, sections 62J.05, subdivision 5;
62J.09, subdivision 3; and 62J.21, are repealed.
Sec. 22. [EFFECTIVE DATE.]
Sections 1 to 21 are effective the day following final
enactment.
ARTICLE 2
SMALL EMPLOYER INSURANCE REFORM
Section 1. Minnesota Statutes 1992, section 62L.02,
subdivision 8, is amended to read:
Subd. 8. [COMMISSIONER.] "Commissioner" means the
commissioner of commerce for health carriers subject to the
jurisdiction of the department of commerce or the commissioner
of health for health carriers subject to the jurisdiction of the
department of health, or the relevant commissioner's designated
representative. For purposes of sections 62L.13 to 62L.22,
"commissioner" means the commissioner of commerce.
Sec. 2. Minnesota Statutes 1992, section 62L.02,
subdivision 11, is amended to read:
Subd. 11. [DEPENDENT.] "Dependent" means an eligible
employee's spouse, unmarried child who is under the age of 19
years, unmarried child under the age of 25 years who is a
full-time student under the age of 25 years as defined in
section 62A.301 and financially dependent upon the eligible
employee, or dependent child of any age who is handicapped and
who meets the eligibility criteria in section 62A.14,
subdivision 2. For the purpose of this definition, a child may
include a child for whom the employee or the employee's spouse
has been appointed legal guardian.
Sec. 3. Minnesota Statutes 1992, section 62L.02, is
amended by adding a subdivision to read:
Subd. 11a. [DISCOUNTED ELIGIBLE CHARGES.] "Discounted
eligible charges" means, as determined by the board of
directors, eligible charges reduced by the average difference
between eligible charges and the expected liability of the
health carrier for services performed. The board of directors,
in its discretion, may determine additional different discounts,
based upon geographic area and type of delivery system.
Sec. 4. Minnesota Statutes 1992, section 62L.02,
subdivision 15, is amended to read:
Subd. 15. [HEALTH BENEFIT PLAN.] "Health benefit plan"
means a policy, contract, or certificate issued by a health
carrier to a small employer for the coverage of medical and
hospital benefits. Health benefit plan includes a small
employer plan. Health benefit plan does not include coverage
that is:
(1) limited to disability or income protection coverage;
(2) automobile medical payment coverage;
(3) supplemental to liability insurance;
(4) designed solely to provide payments on a per diem,
fixed indemnity, or nonexpense-incurred basis;
(5) credit accident and health insurance issued under
chapter 62B as defined in section 62B.02;
(6) designed solely to provide dental or vision care;
(7) blanket accident and sickness insurance as defined in
section 62A.11;
(8) accident-only coverage;
(9) a long-term care insurance policy as defined in section
62A.46;
(10) issued as a supplement to Medicare, as defined in
sections 62A.31 to 62A.44, or policies that supplement Medicare
issued by health maintenance organizations or those policies
governed by section 1833 or 1876 of the federal Social Security
Act, United States Code, title 42, section 1395, et seq., as
amended through December 31, 1991; or
(11) workers' compensation insurance.; or
(12) issued solely as a companion to a health maintenance
contract as described in section 62D.12, subdivision 1a, so long
as the health maintenance contract meets the definition of a
health benefit plan.
For the purpose of this chapter, a health benefit plan
issued to employees of a small employer who meets the
participation requirements of section 62L.03, subdivision 3, is
considered to have been issued to a small employer. A health
benefit plan issued on behalf of a health carrier is considered
to be issued by the health carrier.
Sec. 5. Minnesota Statutes 1992, section 62L.02,
subdivision 16, is amended to read:
Subd. 16. [HEALTH CARRIER.] "Health carrier" means an
insurance company licensed under chapter 60A to offer, sell, or
issue a policy of accident and sickness insurance as defined in
section 62A.01; a health service plan licensed under chapter
62C; a health maintenance organization licensed under chapter
62D; a fraternal benefit society operating under chapter 64B; a
joint self-insurance employee health plan operating under
chapter 62H; and a multiple employer welfare arrangement, as
defined in United States Code, title 29, section 1002(40), as
amended through December 31, 1991. For the purpose of this
chapter, companies that are affiliated companies or that are
eligible to file a consolidated tax return must be treated as
one health carrier, except that any insurance company or health
service plan corporation that is an affiliate of a health
maintenance organization located in Minnesota, or any health
maintenance organization located in Minnesota that is an
affiliate of an insurance company or health service plan
corporation, or any health maintenance organization that is an
affiliate of another health maintenance organization in
Minnesota, may treat the health maintenance organization as a
separate health carrier.
Sec. 6. Minnesota Statutes 1992, section 62L.03,
subdivision 2, is amended to read:
Subd. 2. [EXCEPTIONS.] (a) No health maintenance
organization is required to offer coverage or accept
applications under subdivision 1 in the case of the following:
(1) with respect to a small employer, where the worksite of
the employees of the small employer is not physically located in
the health maintenance organization's approved service areas; or
(2) with respect to an employee, when the employee does not
work or reside within the health maintenance organization's
approved service areas.
(b) A small employer health carrier participating in the
small employer market shall not be required to offer coverage or
accept applications pursuant to subdivision 1 where the
commissioner finds that the acceptance of an application or
applications would place the small employer health carrier
participating in the small employer market in a financially
impaired condition, provided, however, that a small
employer health carrier participating in the small employer
market that has not offered coverage or accepted applications
pursuant to this paragraph shall not offer coverage or accept
applications for any health benefit plan until 180 days
following a determination by the commissioner that the small
employer carrier has ceased health carrier is not financially
impaired and that offering coverage or accepting applications
under subdivision 1 would not cause the health carrier to be
become financially impaired.
Sec. 7. Minnesota Statutes 1992, section 62L.03,
subdivision 5, is amended to read:
Subd. 5. [CANCELLATIONS AND FAILURES TO RENEW.] (a) No
health carrier shall cancel, decline to issue, or fail to renew
a health benefit plan as a result of the claim experience or
health status of the small employer group persons covered or to
be covered by the health benefit plan. A health carrier may
cancel or fail to renew a health benefit plan:
(1) for nonpayment of the required premium;
(2) for fraud or misrepresentation by the small employer,
or, with respect to coverage of an individual eligible employee
or dependent, fraud or misrepresentation by the eligible
employee or dependent, with respect to eligibility for coverage
or any other material fact;
(3) if eligible employee participation during the preceding
calendar year declines to less than 75 percent, subject to the
waiver of coverage provision in subdivision 3;
(4) if the employer fails to comply with the minimum
contribution percentage legally required by the health carrier;
(5) if the health carrier ceases to do business in the
small employer market under section 62L.09; or
(6) for any other reasons or grounds expressly permitted by
the respective licensing laws and regulations governing a health
carrier, including, but not limited to, service area
restrictions imposed on health maintenance organizations under
section 62D.03, subdivision 4, paragraph (m), to the extent that
these grounds are not expressly inconsistent with this chapter.
(b) A health carrier need not renew a health benefit plan,
and shall not renew a small employer plan, if an employer ceases
to qualify as a small employer as defined in section 62L.02. If
a health benefit plan, other than a small employer plan,
provides terms of renewal that do not exclude an employer that
is no longer a small employer, the health benefit plan may be
renewed according to its own terms. If a health carrier issues
or renews a health plan to an employer that is no longer a small
employer, without interruption of coverage, the health plan is
subject to section 60A.082.
Sec. 8. Minnesota Statutes 1992, section 62L.05,
subdivision 10, is amended to read:
Subd. 10. [MEDICAL EXPENSE REIMBURSEMENT.] Health carriers
may reimburse or pay for medical services, supplies, or articles
provided under a small employer plan in accordance with the
health carrier's provider contract requirements including, but
not limited to, salaried arrangements, capitation, the payment
of usual and customary charges, fee schedules, discounts from
fee-for-service, per diems, diagnostic-related diagnosis-related
groups (DRGs), and other payment arrangements. Nothing in this
chapter requires a health carrier to develop, implement, or
change its provider contract requirements for a small employer
plan. Coinsurance, deductibles, out-of-pocket maximums, and
maximum lifetime benefits must be calculated and determined in
accordance with each health carrier's standard business
practices.
Sec. 9. Minnesota Statutes 1992, section 62L.09,
subdivision 2, is amended to read:
Subd. 2. [NOTICE TO EMPLOYERS.] A health carrier electing
to cease doing business in the small employer market shall
provide 120 days' written notice to each small employer covered
by a health benefit plan issued by the health carrier. A health
carrier that ceases to write new business in the small employer
market shall continue to be governed by this chapter with
respect to continuing small employer business conducted by the
health carrier.
Sec. 10. Minnesota Statutes 1992, section 62L.13,
subdivision 1, is amended to read:
Subdivision 1. [CREATION.] The health coverage reinsurance
association is established as a nonprofit corporation may
operate as a nonprofit unincorporated association, but is
authorized to incorporate under chapter 317A. All health
carriers in the small employer market shall be and remain
members of the association as a condition of their authority to
transact business.
Sec. 11. Minnesota Statutes 1992, section 62L.13,
subdivision 3, is amended to read:
Subd. 3. [EXEMPTIONS.] The association, its transactions,
and all property owned by it are exempt from taxation under the
laws of this state or any of its subdivisions, including, but
not limited to, income tax, sales tax, use tax, and property
tax. The association may seek exemption from payment of all fees
and taxes levied by the federal government. Except as otherwise
provided in this chapter, the association is not subject to the
provisions of chapters 13, 14, 60A, 62A to 62H, and section
471.705. The association is not a public employer and is not
subject to the provisions of chapters 179A and 353. Directors
and health carriers who are members of the association are
exempt from the provisions of sections 325D.49 to 325D.66 in the
performance of their duties as directors and members of the
association.
Sec. 12. Minnesota Statutes 1992, section 62L.13,
subdivision 4, is amended to read:
Subd. 4. [POWERS OF ASSOCIATION.] The association may
exercise all of the powers of a corporation formed under chapter
317A, including, but not limited to, the authority to:
(1) establish operating rules, conditions, and procedures
relating to the reinsurance of members' risks;
(2) assess members in accordance with the provisions of
this section and to make advance interim assessments as may be
reasonable and necessary for organizational and interim
operating expenses;
(3) sue and be sued, including taking any legal action
necessary to recover any assessments;
(4) enter into contracts necessary to carry out the
provisions of this chapter;
(5) establish operating, administrative, and accounting
procedures for the operation of the association; and
(6) borrow money against the future receipt of premiums and
assessments up to the amount of the previous year's assessment,
with the prior approval of the commissioner.
The provisions of this chapter govern if the provisions of
chapter 317A conflict with this chapter. The association shall
adopt bylaws may operate under the plan of operation approved by
the board and shall be governed in accordance with this chapter
and may operate in accordance with chapter 317A. If the
association incorporates as a nonprofit corporation under
chapter 317A, the filing of the plan of operation meets the
requirements of filing articles.
Sec. 13. Minnesota Statutes 1992, section 62L.14,
subdivision 1, is amended to read:
Subdivision 1. [COMPOSITION OF BOARD.] The association
shall exercise its powers through a board of 13 directors. Four
members directors must be public members appointed by the
commissioner. The public members directors must not be
employees of or otherwise affiliated with any member of the
association. The nonpublic members of the board directors must
be representative of the membership of the association and must
be officers, employees, or directors of the members during their
term of office. No member of the association may have more than
three members of the board directors. Directors are
automatically removed if they fail to satisfy this qualification.
Sec. 14. Minnesota Statutes 1992, section 62L.14,
subdivision 2, is amended to read:
Subd. 2. [ELECTION OF BOARD.] On or before July 1, 1992,
the commissioner shall appoint an interim board of directors of
the association who shall serve through the first annual meeting
of the members and for the next two years until the annual
meeting in 1994. Except for the public members directors, the
commissioner's initial appointments must be equally apportioned
among the following three categories: accident and health
insurance companies, nonprofit health service plan corporations,
and health maintenance organizations. Thereafter, members of the
association shall elect the board of directors in accordance
with this chapter and the bylaws of the association plan of
operation, subject to approval by the commissioner. Members of
the association may vote in person or by proxy. The
public members directors shall continue to be appointed by the
commissioner to terms meeting the requirements of subdivision 3.
Sec. 15. Minnesota Statutes 1992, section 62L.14,
subdivision 3, is amended to read:
Subd 3. [TERM OF OFFICE.] The first annual meeting must be
held by December 1, 1992. After the initial two-year period
annual meeting in 1994, each director shall serve a three-year
term, except that the board shall make appropriate arrangements
to stagger the terms of the board members directors so that
approximately one-third of the terms expire each year. Each
director shall hold office until expiration of the director's
term or until the director's successor is duly elected or
appointed and qualified, or until the director's death,
resignation, or removal.
Sec. 16. Minnesota Statutes 1992, section 62L.14,
subdivision 4, is amended to read:
Subd. 4. [RESIGNATION AND REMOVAL.] A director may resign
at any time by giving written notice to the commissioner. The
resignation takes effect at the time the resignation is received
unless the resignation specifies a later date. A nonpublic
director may be removed at any time, with cause, by the
members. If a vacancy occurs for a public director, the
commissioner shall appoint a new public director for the
duration of the unexpired term.
Sec. 17. Minnesota Statutes 1992, section 62L.14,
subdivision 5, is amended to read:
Subd. 5. [QUORUM.] A majority of the members of the board
of directors constitutes a quorum for the transaction of
business. If a vacancy exists by reason of death, resignation,
or otherwise, a majority of the remaining directors constitutes
a quorum.
Sec. 18. Minnesota Statutes 1992, section 62L.14,
subdivision 6, is amended to read:
Subd. 6. [DUTIES OF DIRECTORS.] The board of directors
shall adopt or amend the association's bylaws. The bylaws may
contain any provision for the purpose of administering the
association that is not inconsistent with this chapter. The
board shall manage the association in furtherance of its
purposes and as provided in its bylaws. On or before January 1,
1993, the board or the interim board shall develop a plan of
operation and reasonable operating rules to assure the fair,
reasonable, and equitable administration of the association.
The plan of operation must include the development of procedures
for selecting an administering carrier, establishment of the
powers and duties of the administering carrier, and
establishment of procedures for collecting assessments from
members, including the imposition of interest penalties for late
payments of assessments. The plan of operation must be
submitted to the commissioner for review and approval and must
be submitted to the members for approval at the first meeting of
the members. The board of directors may subsequently amend,
change, or revise the plan of operation without approval by the
members.
Sec. 19. Minnesota Statutes 1992, section 62L.14,
subdivision 7, is amended to read:
Subd. 7. [COMPENSATION.] Members of the board Public
directors may be reimbursed by the association for reasonable
and necessary expenses incurred by them in performing their
duties as directors, but shall not otherwise be compensated by
the association for their services.
Sec. 20. Minnesota Statutes 1992, section 62L.14,
subdivision 9, is amended to read:
Subd. 9. [MAJORITY VOTE.] Approval by a majority of the
board members directors present is required for any action of
the board. The majority vote must include one vote from a board
member director representing an accident and health insurance
company, one vote from a board member director representing a
health service plan corporation, one vote from a board member
director representing a health maintenance organization, and one
vote from a public member director.
Sec. 21. Minnesota Statutes 1992, section 62L.15,
subdivision 2, is amended to read:
Subd. 2. [SPECIAL MEETINGS.] Special meetings of the
members must be held whenever called by any three of the
directors. At least two categories must be represented among
the directors calling a special meeting of the members. The
categories are public directors, accident and health insurance
companies, nonprofit health service plan corporations, and
health maintenance organizations. Special meetings of the
members must be held at a time and place designated in the
notice of the meeting.
Sec. 22. Minnesota Statutes 1992, section 62L.16,
subdivision 5, is amended to read:
Subd. 5. [AUDITS.] The board of directors may conduct
periodic audits to verify the accuracy of financial data and
reports submitted by the administrator. The board may establish
in the plan of operation a uniform audit program. All costs of
the uniform audit program and any additional audits conducted by
the board to verify the accuracy of claims submissions are the
responsibility of the health carrier. Failure of a health
carrier to comply with the requirements of the audit program,
including the failure to pay the costs of an audit, may subject
the health carrier to the penalties described in section 62L.11.
Sec. 23. Minnesota Statutes 1992, section 62L.16, is
amended by adding a subdivision to read:
Subd. 7. [INDEMNIFICATION.] The association shall
indemnify members, directors, officers, employees, and agents to
the same extent that persons may be indemnified by corporations
under section 317A.521.
Sec. 24. Minnesota Statutes 1992, section 62L.17,
subdivision 1, is amended to read:
Subdivision 1. [MINIMUM STANDARDS.] The board of directors
or the interim board shall establish minimum claim processing
and managed care standards which must be met by a health carrier
in order to reinsure business have its business reinsured by the
association.
Sec. 25. Minnesota Statutes 1992, section 62L.17,
subdivision 4, is amended to read:
Subd. 4. [APPEAL.] A health carrier whose application for
nonparticipation has been rejected by the commissioner may
appeal the decision. The association may also appeal a decision
of the commissioner, if approved by a two-thirds majority of the
board. Chapter 14 applies to all appeals under this subdivision.
Sec. 26. Minnesota Statutes 1992, section 62L.19, is
amended to read:
62L.19 [ALLOWED REINSURANCE BENEFITS.]
A health carrier may reinsure through the association only
those benefits described in section 62L.05. The board may
establish guidelines to clarify what coverage is included within
the benefits described in this chapter. If a health plan
conforms to those benefits as clarified by the board, the
benefits are considered to be in accordance with this chapter
for purposes of the association's obligations.
Sec. 27. Minnesota Statutes 1992, section 62L.20,
subdivision 1, is amended to read:
Subdivision 1. [REINSURANCE THRESHOLD.] A health carrier
participating in the association may transfer up to 90 percent
of the risk above a reinsurance threshold of $5,000 of eligible
charges resulting from issuance of a health benefit plan to an
eligible employee or dependent of a small employer group whose
risk has been prospectively ceded to the association. If the
eligible charges exceed $50,000 $55,000, a health carrier
participating in the association may transfer 100 percent of the
risk each policy year not to exceed 12 months.
Satisfaction of the reinsurance threshold must be
determined by the board of directors based on discounted
eligible charges. The board may establish an audit process to
assure consistency in the submission of charge calculations by
health carriers to the association. The association shall
determine the amount to be paid to the health carrier for claims
submitted based on discounted eligible charges. The board may
establish upper limits on the amount paid by the association
based on a usual and customary determination. The board shall
establish in the plan of operation a procedure for determining
the discounted eligible charge.
Sec. 28. Minnesota Statutes 1992, section 62L.20,
subdivision 2, is amended to read:
Subd. 2. [CONVERSION FACTORS.] The board shall establish a
standardized conversion table for determining equivalent charges
for health carriers that use alternative provider reimbursement
methods. If a health carrier establishes to the board that the
health carrier's conversion factor is equivalent to the
association's standardized conversion table, the association
shall accept the health carrier's conversion factor.
Sec. 29. Laws 1992, chapter 549, article 2, section 24, is
amended to read:
Sec. 24. [COMMISSIONER OF COMMERCE STUDY.]
The commissioner of commerce shall study and provide a
written report and recommendations to the legislature that
analyze the effects of this article and future measures that the
legislature could enact to achieve the purpose set forth in
section 62L.01, subdivision 3. The commissioner shall study,
report, and make recommendations on the following:
(1) the effects of this article on availability of
coverage, average premium rates, variations in premium rates,
the number of uninsured and underinsured residents of this
state, the types of health benefit plans chosen by employers,
and other effects on the market for health benefit plans for
small employers;
(2) the desirability and feasibility of achieving the goal
stated in section 62L.01, subdivision 3, in the small employer
market by means of the following timetable:
(i) as of July 1, 1995, a reduction of the age rating bands
to 30 percent on each side of the index rate, accompanied by a
proportional reduction of the general premium rating bands to 15
percent on each side of the index rate;
(ii) as of July 1, 1996, a reduction in the bands
referenced in the preceding clause to 15 percent and 7.5 percent
respectively; and
(iii) as of July 1, 1997, a ban on all rating bands; and
(3) Any other aspects of the small employer market
considered relevant by the commissioner.
The commissioner shall file the written report and
recommendations with the legislature no later than April 1,
1995. The commissioner shall file with the legislature a
written preliminary progress report no later than December 1,
1994.
Sec. 30. Laws 1992, chapter 549, article 2, section 25, is
amended to read:
Sec. 25. [EFFECTIVE DATES.]
Sections 1 3 to 12 and 23 are effective July 1, 1993,
except that section 10, subdivision 5, is effective the day
following final enactment. Sections 1, 2, and 13 to 22 are
effective the day following final enactment.
Sec. 31. [EFFECTIVE DATES.]
Sections 1 to 30 are effective the day following final
enactment.
ARTICLE 3
INSURANCE REFORM: INDIVIDUAL MARKET AND MISCELLANEOUS
Section 1. Minnesota Statutes 1992, section 43A.317,
subdivision 2, is amended to read:
Subd. 2. [DEFINITIONS.] (a) [SCOPE.] For the purposes of
this section, the terms defined have the meaning given them.
(b) [COMMISSIONER.] "Commissioner" means the commissioner
of employee relations.
(c) [ELIGIBLE EMPLOYEE.] "Eligible employee" means an
employee eligible to participate in the program under the terms
described in subdivision 6.
(d) [ELIGIBLE EMPLOYER.] "Eligible employer" means an
employer eligible to participate in the program under the terms
described in subdivision 5.
(e) [ELIGIBLE INDIVIDUAL.] "Eligible individual" means a
person eligible to participate in the program under the terms
described in subdivision 6.
(f) [EMPLOYEE.] "Employee" means a common law an employee
of an eligible employer. "Employee" includes a sole proprietor,
partner of a partnership, member of a limited liability company,
or independent contractor.
(g) [EMPLOYER.] "Employer" means a private person, firm,
corporation, partnership, limited liability company,
association, unit of local government, or other entity actively
engaged in business or public services. "Employer" includes
both for-profit and nonprofit entities.
(h) [PROGRAM.] "Program" means the private employers
insurance program created by this section.
Sec. 2. Minnesota Statutes 1992, section 43A.317,
subdivision 7, is amended to read:
Subd. 7. [COVERAGE.] Coverage is available through the
program beginning on July 1, 1993. At least annually, Until an
arrangement is in place to provide coverage through a transfer
of risk to one or more carriers regulated under chapter 62A,
62C, or 62D, the commissioner shall solicit bids under section
43A.23, from carriers regulated under chapters 62A, 62C, and
62D, to provide coverage of eligible individuals. The
commissioner shall provide coverage through contracts with
carriers, unless the commissioner receives no reasonable bids
from carriers.
(a) [HEALTH COVERAGE.] Health coverage is available to all
employers in the program. The commissioner shall attempt to
establish health coverage options that have strong care
management features to control costs and promote quality and
shall attempt to make a choice of health coverage options
available. Health coverage for a retiree who is eligible for
the federal Medicare program must be administered as though the
retiree is enrolled in Medicare parts A and B. To the extent
feasible as determined by the commissioner and in the best
interests of the program, the commissioner shall model coverage
after the plan established in section 43A.18, subdivision 2.
Health coverage must include at least the benefits required of a
carrier regulated under chapter 62A, 62C, or 62D for comparable
coverage. Coverage under this paragraph must not be provided as
part of the health plans available to state employees.
(b) [OPTIONAL COVERAGES.] In addition to offering health
coverage, the commissioner may arrange to offer dental coverage
through the program. Employers with health coverage may choose
to offer dental coverage according to the terms established by
the commissioner.
(c) [OPEN ENROLLMENT.] The program must meet all
underwriting requirements of chapter 62L and must provide
periodic open enrollments for eligible individuals for those
coverages where a choice exists.
(d) [TECHNICAL ASSISTANCE.] The commissioner may arrange
for technical assistance and referrals for eligible employers in
areas such as health promotion and wellness, employee benefits
structure, tax planning, and health care analysis services as
described in section 62J.33.
Sec. 3. Minnesota Statutes 1992, section 43A.317,
subdivision 10, is amended to read:
Subd. 10. [PROGRAM STATUS.] The private employers
insurance program is a state program to provide the advantages
of a large pool to small employers for purchasing health
coverage, other coverages, and related services from insurance
companies, health maintenance organizations, and other
organizations. The program is not an insurance company.
Coverage under this program shall be considered a certificate of
insurance or similar evidence of coverage and is subject to all
applicable requirements of chapters 60A, 62A, 62C, 62E, 62H,
62L, and 72A, and is subject to regulation by the commissioner
of commerce to the extent applicable. Coverage is subject to
section 471.617, subdivisions 2 and 3, and the bidding
requirements of section 471.6161.
Sec. 4. Minnesota Statutes 1992, section 62A.011,
subdivision 3, is amended to read:
Subd. 3. [HEALTH PLAN.] "Health plan" means a policy or
certificate of accident and sickness insurance as defined in
section 62A.01 offered by an insurance company licensed under
chapter 60A; a subscriber contract or certificate offered by a
nonprofit health service plan corporation operating under
chapter 62C; a health maintenance contract or certificate
offered by a health maintenance organization operating under
chapter 62D; a health benefit certificate offered by a fraternal
benefit society operating under chapter 64B; or health coverage
offered by a joint self-insurance employee health plan operating
under chapter 62H. Health plan means individual and group
coverage, unless otherwise specified. Health plan does not
include coverage that is:
(1) limited to disability or income protection coverage;
(2) automobile medical payment coverage;
(3) supplemental to liability insurance;
(4) designed solely to provide payments on a per diem,
fixed indemnity, or nonexpense-incurred basis;
(5) credit accident and health insurance as defined in
section 62B.02;
(6) designed solely to provide dental or vision care;
(7) blanket accident and sickness insurance as defined in
section 62A.11;
(8) accident-only coverage;
(9) a long-term care policy as defined in section 62A.46;
(10) issued as a supplement to Medicare, as defined in
sections 62A.31 to 62A.44, or policies that supplement Medicare
issued by health maintenance organizations or those policies
governed by section 1833 or 1876 of the federal Social Security
Act, United States Code, title 42, section 1395, et seq., as
amended through December 31, 1991;
(11) workers' compensation insurance; or
(12) issued solely as a companion to a health maintenance
contract as described in section 62D.12, subdivision 1a, so long
as the health maintenance contract meets the definition of a
health plan.
Sec. 5. Minnesota Statutes 1992, section 62A.02,
subdivision 1, is amended to read:
Subdivision 1. [FILING.] For purposes of this section,
"health plan" means a health plan as defined in section 62A.011
or a policy of accident and sickness insurance as defined in
section 62A.01. No health plan as defined in section 62A.011
shall be issued or delivered to any person in this state, nor
shall any application, rider, or endorsement be used in
connection with the health plan, until a copy of its form and of
the classification of risks and the premium rates pertaining to
the form have been filed with the commissioner. The filing for
nongroup health plan forms shall include a statement of
actuarial reasons and data to support the rate. For health
benefit plans as defined in section 62L.02, and for health plans
to be issued to individuals, the health carrier shall file with
the commissioner the information required in section 62L.08,
subdivision 8. For group health plans for which approval is
sought for sales only outside of the small employer market as
defined in section 62L.02, this section applies only to policies
or contracts of accident and sickness insurance. All forms
intended for issuance in the individual or small employer market
must be accompanied by a statement as to the expected loss ratio
for the form. Premium rates and forms relating to specific
insureds or proposed insureds, whether individuals or groups,
need not be filed, unless requested by the commissioner.
Sec. 6. Minnesota Statutes 1992, section 62A.65,
subdivision 5, is amended to read:
Subd. 5. [PORTABILITY OF COVERAGE.] (a) No health benefit
plan may be offered, sold, issued, or renewed to a Minnesota
resident that contains a preexisting condition limitation or
exclusion, unless the limitation or exclusion would be permitted
under chapter 62L. The individual may be treated as a late
entrant, as defined in chapter 62L, unless the individual has
maintained continuous coverage as defined in chapter 62L. An
individual who has maintained continuous coverage may be
subjected to a one-time preexisting condition limitation as
permitted under chapter 62L for persons who are not late
entrants, at the time that the individual first is covered by
individual coverage. Thereafter, the person individual must not
be subject to any preexisting condition limitation, except an
unexpired portion of a limitation under prior coverage, so long
as the individual maintains continuous coverage.
(b) A health carrier must offer individual coverage to any
individual previously covered under a group health benefit plan
issued by that health carrier, so long as the individual
maintained continuous coverage as defined in chapter 62L.
Coverage issued under this paragraph must not contain any
preexisting condition limitation or exclusion, except for any
unexpired limitation or exclusion under the previous coverage.
The initial premium rate for the individual coverage must comply
with subdivision 3. The premium rate upon renewal must comply
with subdivision 2.
Sec. 7. Laws 1992, chapter 549, article 3, section 24, is
amended to read:
Sec. 24. [EFFECTIVE DATE.]
Section 11 is effective July 30, 1992. Sections 1, 3 to
10, 12, 15, 16, 17, 18, and 23 are effective July 1, 1993,
except that section 1, subdivision 9, is effective the day
following final enactment. Sections 2, 19, 20, 21, and 22 are
effective the day following final enactment.
Sec. 8. [EFFECTIVE DATES.]
Sections 1 to 7 are effective the day following final
enactment.
ARTICLE 4
CHILDREN'S HEALTH PLAN EXPANSION
Section 1. Minnesota Statutes 1992, section 256.045,
subdivision 10, is amended to read:
Subd. 10. [PAYMENTS PENDING APPEAL.] If the commissioner
of human services or district court orders monthly assistance or
aid or services paid or provided in any proceeding under this
section, it shall be paid or provided pending appeal to the
commissioner of human services, district court, court of
appeals, or supreme court. The human services referee may order
the local human services agency to reduce or terminate medical
assistance or general assistance medical care to a recipient
before a final order is issued under this section if: (1) the
human services referee determines at the hearing that the sole
issue on appeal is one of a change in state or federal law; and
(2) the commissioner or the local agency notifies the recipient
before the action. The state or county agency has a claim for
food stamps, cash payments, medical assistance, and general
assistance medical care, and MinnesotaCare plan payments made to
or on behalf of a recipient or former recipient while an appeal
is pending if the recipient or former recipient is determined
ineligible for the food stamps, cash payments, medical
assistance, or general assistance medical care, or MinnesotaCare
as a result of the appeal, except for medical assistance and
general assistance medical care made on behalf of a recipient
pursuant to a court order. In enforcing a claim on
MinnesotaCare plan payments, the state or county agency shall
reduce the claim amount by the value of any premium payments
made by a recipient or former recipient during the period for
which the recipient or former recipient has been determined to
be ineligible.
Sec. 2. Minnesota Statutes 1992, section 256.9353,
subdivision 2, is amended to read:
Subd. 2. [ALCOHOL AND DRUG DEPENDENCY.] Beginning October
1, 1992, covered health services shall include up to ten hours
per year of individual outpatient treatment of alcohol or drug
dependency by a qualified health professional or outpatient
program. Two hours of group treatment count as one hour of
individual treatment.
Persons who may need chemical dependency services under the
provisions of this chapter shall be assessed by a local agency
as defined under section 254B.01, and under the assessment
provisions of section 254A.03, subdivision 3. Persons who are
recipients of medical benefits under the provisions of this
chapter and who are financially eligible for consolidated
chemical dependency treatment fund services provided under the
provisions of chapter 254B shall receive chemical dependency
treatment services under the provisions of chapter 254B only if:
(1) they have exhausted the chemical dependency benefits
offered under this chapter; or
(2) an assessment indicates that they need a level of care
not provided under the provisions of this chapter.
Recipients of covered health services under the children's
health plan, as provided in Minnesota Statutes 1990, section
256.936, and as amended by Laws 1991, chapter 292, article 4,
section 17, and recipients of covered health services enrolled
in the children's health plan or the MinnesotaCare plan after
October 1, 1992, pursuant to Laws 1992, chapter 549, article 4,
sections 5 and 17, are eligible to receive alcohol and drug
dependency benefits under this subdivision.
Sec. 3. Minnesota Statutes 1992, section 256.9353,
subdivision 6, is amended to read:
Subd. 6. [COPAYMENTS AND COINSURANCE.] The health right
MinnesotaCare benefit plan shall include the following
copayments and coinsurance requirements:
(1) ten percent for inpatient hospital services for adult
enrollees not eligible for medical assistance, subject to an
annual inpatient out-of-pocket maximum of $2,000 $1,000 per
individual and $3,000 per family;
(2) 50 percent for adult dental services, except for
preventive services;
(3) $3 per prescription for adult enrollees; and
(4) $25 for eyeglasses for adult enrollees.
Enrollees who would be eligible for medical assistance with
a spend-down shall be financially responsible for the
coinsurance amount up to the spend-down limit or the coinsurance
amount, whichever is less, in order to become eligible for the
medical assistance program.
Sec. 4. Minnesota Statutes 1992, section 256.9353, is
amended by adding a subdivision to read:
Subd. 7. [LIEN.] When the state agency provides, pays for,
or becomes liable for covered health services, the agency shall
have a lien for the cost of the covered health services upon any
and all causes of action accruing to the enrollee, or to the
enrollee's legal representatives, as a result of the occurrence
that necessitated the payment for the covered health services.
All liens under this section shall be subject to the provisions
of section 256.015.
Sec. 5. Minnesota Statutes 1992, section 256.9354, is
amended to read:
256.9354 [ELIGIBLE PERSONS.]
Subdivision 1. [CHILDREN; EXPANSION AND CONTINUATION OF
ELIGIBILITY.] (a) [CHILDREN.] "Eligible persons" means children
who are one year of age or older but less than 18 years of age
who have gross family incomes that are equal to or less than 185
percent of the federal poverty guidelines and who are not
eligible for medical assistance under chapter 256B and who are
not otherwise insured for the covered services. The period of
eligibility extends from the first day of the month in which the
child's first birthday occurs to the last day of the month in
which the child becomes 18 years old.
(b) [EXPANSION OF ELIGIBILITY.] Eligibility for the health
right MinnesotaCare plan shall be expanded as provided in
subdivisions 2 to 5. The enrollment requirements in this
paragraph apply to enrollment under subdivisions 2 to 5,.
Parents who enroll in the health right MinnesotaCare plan must
also enroll their children and dependent siblings, if the
children and their dependent siblings are eligible. Children
and dependent siblings may be enrolled separately without
enrollment by parents. However, if one parent in the household
enrolls, both parents must enroll, unless other insurance is
available. If one child from a family is enrolled, all children
must be enrolled, unless other insurance is available. If one
spouse in a household enrolls, the other spouse in the household
must also enroll, unless other insurance is available. Families
cannot choose to enroll only certain uninsured members. For
purposes of this section, a "dependent sibling" means an
unmarried child who is a full-time student under the age of 25
years who is financially dependent upon a parent. Proof of
school enrollment will be required.
(c) [CONTINUATION OF ELIGIBILITY.] Individuals who
initially enroll in the MinnesotaCare plan under the eligibility
criteria in subdivisions 2 to 5 remain eligible for the
MinnesotaCare plan, regardless of age, place of residence, or
the presence or absence of children in the same household, as
long as all other eligibility criteria are met and residence in
Minnesota and continuous enrollment in the MinnesotaCare plan or
medical assistance are maintained. In order for either parent
or either spouse in a household to remain enrolled, both must
remain enrolled, unless other insurance is available.
Subd. 1a. [COOPERATION.] To be eligible for MinnesotaCare,
individuals must cooperate with the state agency to identify
potentially liable third party payers and assist the state in
obtaining third party payments. "Cooperation" includes, but is
not limited to, identifying any third party who may be liable
for care and services provided under MinnesotaCare to the
enrollee, providing relevant information to assist the state in
pursuing a potentially liable third party, and completing forms
necessary to recover third party payments.
Subd. 2. [FAMILIES WITH CHILDREN.] Beginning October 1,
1992, "eligible persons" means children eligible under
subdivision 1, and parents and dependent siblings residing in
the same household as a child eligible under subdivision 1.
Individuals who initially enroll in the health right plan under
the eligibility criteria in this subdivision shall remain
eligible for the health right plan, regardless of age, place of
residence within Minnesota, or the presence or absence of
children in the same household, as long as all other eligibility
requirements are met and continuous enrollment in the health
right plan or medical assistance is maintained.
Subd. 3. [CONTINUATION OF ELIGIBILITY.] Beginning October
1, 1992, individuals who initially enrolled in the health right
MinnesotaCare plan under the eligibility criteria in subdivision
1 or 2 remain eligible even if their gross income after
enrollment exceeds 185 percent of the federal poverty
guidelines, subject to any premium required under section
256.9357, as long as all other eligibility requirements are met
and continuous enrollment in the health right MinnesotaCare plan
or medical assistance is maintained.
Subd. 4. [FAMILIES WITH CHILDREN; ELIGIBILITY BASED ON
PERCENTAGE OF INCOME PAID FOR HEALTH COVERAGE.] Beginning
January 1, 1993, "eligible persons" means children, parents, and
dependent siblings residing in the same household who are not
eligible for medical assistance under chapter 256B. These
persons are eligible for coverage through the health right
MinnesotaCare plan but must pay a premium as determined under
sections 256.9357 and 256.9358. Individuals and families whose
income is greater than the limits established under section
256.9358 may not enroll in the health right MinnesotaCare plan.
Individuals who initially enroll in the health right plan under
the eligibility criteria in this subdivision remain eligible for
the health right plan, regardless of age, place of residence
within Minnesota, or the presence or absence of children in the
same household, as long as all other eligibility requirements
are met and continuous enrollment in the health right plan or
medical assistance is maintained.
Subd. 5. [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO
CHILDREN.] Beginning July 1, 1994, "eligible persons" means all
families and individuals who are not eligible for medical
assistance under chapter 256B. These persons are eligible for
coverage through the health right MinnesotaCare plan but must
pay a premium as determined under sections 256.9357 and
256.9358. Individuals and families whose income is greater than
the limits established under section 256.9358 may not enroll in
the health right MinnesotaCare plan.
Sec. 6. Minnesota Statutes 1992, section 256.9355,
subdivision 3, is amended to read:
Subd. 3. [EFFECTIVE DATE OF COVERAGE.] The effective date
of coverage is the first day of the month following the month in
which a complete application is entered to the eligibility file
is approved and the first premium payment has been
received. The effective date of coverage for eligible newborns
or eligible newly adoptive children added to a family receiving
covered health services is the date of entry into the family.
The effective date of coverage for other new recipients added to
the family receiving covered health services is the first day of
the month following the month in which eligibility is approved
and the first premium payment has been received. Benefits are
not available until the day following discharge if an enrollee
is hospitalized on the first day of coverage. Notwithstanding
any other law to the contrary, benefits under sections 256.9351
to 256.9361 are secondary to a plan of insurance or benefit
program under which an eligible person may have coverage and the
commissioner shall use cost avoidance techniques to ensure
coordination of any other health coverage for eligible persons.
The commissioner shall identify eligible persons who may have
coverage or benefits under other plans of insurance or who
become eligible for medical assistance.
Sec. 7. Minnesota Statutes 1992, section 256.9356,
subdivision 2, is amended to read:
Subd. 2. [PREMIUM PAYMENTS.] Beginning October 1, 1992,
the commissioner shall require health right MinnesotaCare plan
enrollees to pay a premium based on a sliding scale, as
established under section 256.9357. Applicants who are eligible
under section 256.9354, subdivision 1, are exempt from this
requirement until July 1, 1993, if the application is received
by the health right plan staff on or before September 30, 1992.
The following applicants are exempt from this requirement until
July 1, 1993:
(1) applicants who are eligible under section 256.9354,
subdivision 1, if the application is received by MinnesotaCare
staff on or before September 30, 1992; and
(2) children who enroll in the children's health plan after
September 30, 1992, pursuant to Laws 1992, chapter 549, article
4, section 17. Before July 1, 1993, these individuals shall
continue to pay the annual enrollment fee required by
subdivision 1.
Sec. 8. Minnesota Statutes 1992, section 256.9357, is
amended to read:
256.9357 [ELIGIBILITY FOR SUBSIDIZED PREMIUMS BASED ON
SLIDING SCALE.]
Subdivision 1. [GENERAL REQUIREMENTS.] Families and
individuals who enroll on or after October 1, 1992, are eligible
for subsidized premium payments based on a sliding scale under
section 256.9358 only if the family or individual meets the
requirements in subdivisions 2 and 3. Children already enrolled
in the health right MinnesotaCare plan as of September 30, 1992,
and children who enroll in the children's health plan after
September 30, 1992, pursuant to Laws 1992, chapter 549, article
4, section 17, are eligible for subsidized premium payments
without meeting these requirements, as long as they maintain
continuous coverage in the health right MinnesotaCare plan or
medical assistance.
Families and individuals who initially enrolled in the
health right MinnesotaCare plan under section 256.9354, and
whose income increases above the limits established in section
256.9358, may continue enrollment and pay the full cost of
coverage.
Subd. 2. [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED
COVERAGE.] To be eligible for subsidized premium payments based
on a sliding scale, a family or individual must not have access
to subsidized health coverage through an employer, and must not
have had access to subsidized health coverage through an
employer for the 18 months prior to application for subsidized
coverage under the health right MinnesotaCare plan. The
requirement that the family or individual must not have had
access to employer-subsidized coverage during the previous 18
months does not apply if employer-subsidized coverage was lost
for reasons that would not disqualify the individual for
unemployment benefits under section 268.09 and the family or
individual has not had access to employer-subsidized coverage
since the layoff. For purposes of this requirement, subsidized
health coverage means health coverage for which the employer
pays at least 50 percent of the cost of coverage for the
employee, excluding dependent coverage, or a higher percentage
as specified by the commissioner. Children are eligible for
employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer
contributions to Internal Revenue Code Section 125 plans as
qualified employer subsidies toward the cost of health coverage
for employees for purposes of this subdivision.
Subd. 3. [PERIOD UNINSURED.] To be eligible for subsidized
premium payments based on a sliding scale, families and
individuals initially enrolled in the health right MinnesotaCare
plan under section 256.9354, subdivisions 4 and 5, must have had
no health coverage for at least four months prior to
application. The commissioner may change this eligibility
criterion for sliding scale premiums without complying with
rulemaking requirements in order to remain within the limits of
available appropriations. The requirement of at least four
months of no health coverage prior to application for the health
right MinnesotaCare plan does not apply to families, children,
and individuals who want to apply for the health
right MinnesotaCare plan upon termination from the medical
assistance program, general assistance medical care program, or
coverage under a regional demonstration project for the
uninsured funded under section 256B.73, the Hennepin county
assured care program, or the Group Health, Inc., community
health plan. This subdivision does not apply to families and
individuals initially enrolled under sections 256.9354,
subdivisions 1 and 2, or to children enrolled pursuant to Laws
1992, chapter 549, article 4, section 17.
Sec. 9. Minnesota Statutes 1992, section 256B.0644, is
amended to read:
256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER
OTHER STATE HEALTH CARE PROGRAMS.]
A vendor of medical care, as defined in section 256B.02,
subdivision 7, and a health maintenance organization, as defined
in chapter 62D, must participate as a provider or contractor in
the medical assistance program, general assistance medical care
program, and the health right MinnesotaCare plan as a condition
of participating as a provider in health insurance plans or
contractor for state employees established under section 43A.18,
the public employees insurance plan under section 43A.316, the
workers' compensation system under section 176.135, and
insurance plans provided through the Minnesota comprehensive
health association under sections 62E.01 to 62E.17. For
providers other than health maintenance organizations,
participation in the medical assistance program means that (1)
the provider accepts new medical assistance patients or (2) at
least 20 percent of the provider's patients are covered by
medical assistance, general assistance medical care, or the
health right MinnesotaCare plan as their primary source of
coverage. The commissioner shall establish participation
requirements for health maintenance organizations. The
commissioner shall provide lists of participating medical
assistance providers on a quarterly basis to the commissioner of
employee relations, the commissioner of labor and industry, and
the commissioner of commerce. Each of the commissioners shall
develop and implement procedures to exclude as participating
providers in the program or programs under their jurisdiction
those providers who do not participate in the medical assistance
program. The commissioner of employee relations shall implement
this section through contracts with participating health and
dental carriers.
Sec. 10. Laws 1992, chapter 549, article 4, section 18, is
amended to read:
Sec. 18. [IMPACT OF HEALTH RIGHT MINNESOTACARE ON
CHILDREN'S HEALTH PLAN ENROLLEES.]
The commissioner of human services shall examine the impact
of health right MinnesotaCare plan premium costs on access to
health care for children's health plan enrollees. The
commissioner shall examine whether health right MinnesotaCare
plan premiums are affordable for children's health plan
enrollees, and shall examine the degree to which children's
health plan enrollees fail to continue coverage through
the health right MinnesotaCare plan for financial reasons. The
commissioner shall present recommendations to the legislature by
February 15, 1993 April 1, 1994, on methods to ensure continued
access to health care coverage for children's health plan
enrollees.
Sec. 11. [REVISOR INSTRUCTIONS.]
In the next edition of Minnesota Statutes, the revisor of
statutes shall change the words "health right" to
"MinnesotaCare," as appropriate, wherever they appear in
Minnesota Statutes.
Sec. 12. [EFFECTIVE DATE.]
Sections 2 to 10 are effective the day following final
enactment. Section 1 is effective for appeals filed on or after
the day following final enactment.
ARTICLE 5
DATA INITIATIVES; RURAL HEALTH
Section 1. Minnesota Statutes 1992, section 62J.30,
subdivision 4, is amended to read:
Subd. 4. [CRITERIA FOR UNIT INITIATIVES.] Data and
research initiatives by the health care analysis unit must:
(1) serve the needs of the general public, public sector
health care programs, employers and other purchasers of health
care, health care providers, including providers serving large
numbers of low-income people, and health carriers;
(2) promote a significantly accelerated pace of publicly
disseminated, applied research on health care delivery,
outcomes, costs, quality, and management;
(3) conduct research and promote health care applications
based on scientifically sound and statistically valid methods;
(4) be statewide in scope, to the extent feasible, in order
to benefit health care purchasers and providers in all parts of
Minnesota and to ensure a broad and representative data base for
research, comparisons, and applications;
(5) emphasize data that is useful, relevant, and
nonredundant of existing data. The initiatives may duplicate
existing private activities, if this is necessary to ensure that
the data collected will be in the public domain;
(6) be structured to minimize the administrative burden on
health carriers, health care providers, and the health care
delivery system, and minimize any privacy impact on individuals;
and
(7) promote continuous improvement in the efficiency and
effectiveness of health care delivery.
Sec. 2. Minnesota Statutes 1992, section 62J.30,
subdivision 7, is amended to read:
Subd. 7. [DATA CLASSIFICATION.] (a) Data collected through
the large-scale data base initiatives of the health care
analysis unit required by section 62J.31 that identify
individuals individual patients or providers are private data on
individuals. Data not on individuals are nonpublic data. The
commissioner may release private data on individuals and
nonpublic data to researchers affiliated with university
research centers or departments who are conducting research on
health outcomes, practice parameters, and medical practice
style; researchers working under contract with the commissioner;
and individuals purchasing health care services for health
carriers and groups. Prior to releasing any nonpublic or
private data under this paragraph that identify or relate to a
specific health carrier, medical health care provider, or health
care facility, the commissioner shall provide at least 30 days'
notice to the subject of the data, including a copy of the
relevant data, and allow the subject of the data to provide a
brief explanation or comment on the data which must be released
with the data. To the extent reasonably possible, release of
private or, confidential, or nonpublic data under this chapter
shall be made without releasing data that could reveal the
identity of individuals identifies patients and should instead
be released using the identification numbers required by
subdivision 6.
(b) Summary data derived from data collected through the
large-scale data base initiatives of the health care analysis
unit may be provided under section 13.05, subdivision 7, and may
be released in studies produced by the commissioner.
(c) The commissioner shall adopt rules to establish
criteria and procedures to govern access to and the use of data
collected through the initiatives of the health care analysis
unit.
Sec. 3. Minnesota Statutes 1992, section 62J.30,
subdivision 8, is amended to read:
Subd. 8. [DATA COLLECTION ADVISORY COMMITTEE.] The
commissioner shall convene a 15-member data collection advisory
committee consisting of health service researchers, health care
providers, health carrier representatives, representatives of
businesses that purchase health coverage, and consumers. Six
members of this committee must be health care providers. The
advisory committee shall evaluate methods of data collection and
shall recommend to the commissioner methods of data collection
that minimize administrative burdens, address data privacy
concerns, and meet the needs of health service researchers. The
advisory committee is governed by section 15.059, except that
its existence does not terminate and members do not receive per
diem compensation.
Sec. 4. Minnesota Statutes 1992, section 62J.30,
subdivision 10, is amended to read:
Subd. 10. [CONTRACTS AND GRANTS.] To carry out the duties
assigned in sections 62J.30 to 62J.34, the commissioner may
contract with or provide grants to private sector entities. Any
contract or grant must require the private sector entity to
maintain the data on individuals which it receives according to
the statutory provisions applicable to the data.
Sec. 5. Minnesota Statutes 1992, section 62J.31,
subdivision 2, is amended to read:
Subd. 2. [SPECIFIC HEALTH CONDITIONS.] (a) The Data
collected under this section must be collected for specific
health conditions, rather than specific procedures, types of
health care providers, or services. The health care analysis
unit shall designate a limited number of specific health
conditions for which data shall be collected during the first
year of operation. For subsequent years, data may be collected
for additional specific health conditions. The number of
specific conditions for which data is collected is subject to
the availability of appropriations.
(b) The initiative must emphasize conditions that account
for significant total costs, when considering both the frequency
of a condition and the unit cost of treatment. The initial
emphasis must be on the study of conditions commonly treated in
hospitals on an inpatient or outpatient basis, or in
freestanding outpatient surgical centers. This initial emphasis
may be expanded to include entire episodes of care for a given
condition, whether or not treatment includes use of a hospital
or a freestanding outpatient surgical center, if adequate data
collection and evaluation techniques are available for that
condition.
Sec. 6. Minnesota Statutes 1992, section 62J.31,
subdivision 3, is amended to read:
Subd. 3. [INFORMATION TO BE COLLECTED.] The data collected
must include information on health outcomes, including
information on mortality, morbidity, patient functional status
and quality of life, symptoms, and patient satisfaction. The
data collected must include information necessary to measure and
make adjustments for differences in the severity of patient
condition across different health care providers, and may
include data obtained directly from the patient or from patient
medical records, as provided in section 62J.30, subdivisions 6
and 7. The data must be collected in a manner that allows
comparisons to be made between providers, health carriers,
public programs, and other entities.
Sec. 7. Minnesota Statutes 1992, section 62J.32,
subdivision 1, is amended to read:
Subdivision 1. [DATA ANALYSIS.] The health care analysis
unit shall analyze the data collected on specific health
conditions through the large-scale data base using existing
practice parameters and newly researched practice parameters,
including those established through the outcomes research
studies of the federal government. The unit may use the data
collected to develop new practice parameters, if development and
refinement is based on input from and analysis by practitioners,
particularly those practitioners knowledgeable about and
impacted by practice parameters. The unit may also refine
existing practice parameters, and may encourage or coordinate
private sector research efforts designed to develop or refine
practice parameters.
Sec. 8. Minnesota Statutes 1992, section 62J.32,
subdivision 4, is amended to read:
Subd. 4. [PRACTICE PARAMETER ADVISORY COMMITTEE.] The
commissioner shall convene a 15-member practice parameter
advisory committee comprised of eight health care professionals,
and representatives of the research community and the medical
technology industry. The committee shall present
recommendations on the adoption of practice parameters to the
commissioner and the Minnesota health care commission and
provide technical assistance as needed to the commissioner and
the commission. The advisory committee is governed by section
15.059, but does not expire except that its existence does not
terminate and members do not receive per diem compensation.
Sec. 9. Minnesota Statutes 1992, section 62J.34,
subdivision 2, is amended to read:
Subd. 2. [APPROVAL.] The commissioner of health, after
receiving the advice and recommendations of the Minnesota health
care commission, may approve practice parameters that are
endorsed, developed, or revised by the health care analysis
unit. The commissioner is exempt from the rulemaking
requirements of chapter 14 when approving practice parameters
approved by the federal agency for health care policy and
research, practice parameters adopted for use by a national
medical society, or national medical specialty society. The
commissioner shall use rulemaking to approve practice parameters
that are newly developed or substantially revised by the health
care analysis unit. Notice of adoption of practice parameters
adopted without rulemaking must be published in the State
Register and must include a statement that the complete practice
parameter is available free of charge from the commissioner.
Sec. 10. Minnesota Statutes 1992, section 62J.34,
subdivision 3, is amended to read:
Subd. 3. [MEDICAL MALPRACTICE CASES.] (a) In an action
against a provider for malpractice, error, mistake, or failure
to cure, whether based in contract or tort, adherence to a
practice parameter approved by the commissioner of health under
subdivision 2 is an absolute defense against an allegation that
the provider did not comply with accepted standards of practice
in the community.
(b) Evidence of a departure from a practice parameter is
admissible only on the issue of whether the provider is entitled
to an absolute defense under paragraph (a).
(c) Paragraphs (a) and (b) apply to claims arising on or
after August 1, 1993, or 90 days after the date the commissioner
approves the applicable practice parameter, whichever is later.
(d) Nothing in this section changes the standard or burden
of proof in an action alleging a delay in diagnosis, a
misdiagnosis, inappropriate application of a practice parameter,
failure to obtain informed consent, battery or other intentional
tort, breach of contract, or product liability.
Sec. 11. Minnesota Statutes 1992, section 144.147,
subdivision 4, is amended to read:
Subd. 4. [ALLOCATION OF GRANTS.] (a) Eligible hospitals
must apply to the commissioner no later than September 1 of each
fiscal year for grants awarded for the that fiscal
year beginning the following July 1. A grant may be awarded
upon signing of a grant contract.
(b) The commissioner must make a final decision on the
funding of each application within 60 days of the deadline for
receiving applications.
(c) Each relevant community health board has 30 days in
which to review and comment to the commissioner on grant
applications from hospitals in their community health service
area.
(d) In determining which hospitals will receive grants
under this section, the commissioner shall consider the
following factors:
(1) Description of the problem, description of the project,
and the likelihood of successful outcome of the project. The
applicant must explain clearly the nature of the health services
problems in their service area, how the grant funds will be
used, what will be accomplished, and the results expected. The
applicant should describe achievable objectives, a timetable,
and roles and capabilities of responsible individuals and
organizations.
(2) The extent of community support for the hospital and
this proposed project. The applicant should demonstrate support
for the hospital and for the proposed project from other local
health service providers and from local community and government
leaders. Evidence of such support may include past commitments
of financial support from local individuals, organizations, or
government entities; and commitment of financial support,
in-kind services or cash, for this project.
(3) The comments, if any, resulting from a review of the
application by the community health board in whose community
health service area the hospital is located.
(e) In evaluating applications, the commissioner shall
score each application on a 100 point scale, assigning the
maximum of 70 points for an applicant's understanding of the
problem, description of the project, and likelihood of
successful outcome of the project; and a maximum of 30 points
for the extent of community support for the hospital and this
project. The commissioner may also take into account other
relevant factors.
(f) A grant to a hospital, including hospitals that submit
applications as consortia, may not exceed $50,000 a year and may
not exceed a term of two years. Prior to the receipt of any
grant, the hospital must certify to the commissioner that at
least one-half of the amount, which may include in-kind
services, is available for the same purposes from nonstate
sources. A hospital receiving a grant under this section may
use the grant for any expenses incurred in the development of
strategic plans or the implementation of transition projects
with respect to which the grant is made. Project grants may not
be used to retire debt incurred with respect to any capital
expenditure made prior to the date on which the project is
initiated.
(g) The commissioner may adopt rules to implement this
section.
Sec. 12. Minnesota Statutes 1992, section 144.1481,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT; MEMBERSHIP.] The
commissioner of health shall establish a 15-member rural health
advisory committee. The committee shall consist of the
following members, all of whom must reside outside the
seven-county metropolitan area, as defined in section 473.121,
subdivision 2:
(1) two members from the house of representatives of the
state of Minnesota, one from the majority party and one from the
minority party;
(2) two members from the senate of the state of Minnesota,
one from the majority party and one from the minority party;
(3) a volunteer member of an ambulance service based
outside the seven-county metropolitan area;
(4) a representative of a hospital located outside the
seven-county metropolitan area;
(5) a representative of a nursing home located outside the
seven-county metropolitan area;
(6) a medical doctor or doctor of osteopathy licensed under
chapter 147;
(7) a midlevel practitioner;
(8) a registered nurse or licensed practical nurse;
(9) a licensed health care professional from an occupation
not otherwise represented on the committee;
(10) a representative of an institution of higher education
located outside the seven-county metropolitan area that provides
training for rural health care providers; and
(11) three consumers, at least one of whom must be an
advocate for persons who are mentally ill or developmentally
disabled.
The commissioner will make recommendations for committee
membership. Committee members will be appointed by the
governor. In making appointments, the governor shall ensure
that appointments provide geographic balance among those areas
of the state outside the seven-county metropolitan area. The
chair of the committee shall be elected by the members. The
terms, compensation, and removal of members are governed by
section 15.059, except that the existence of the committee does
not terminate and members do not receive per diem compensation.
Sec. 13. Minnesota Statutes 1992, section 144.1486, is
amended to read:
144.1486 [RURAL COMMUNITY HEALTH CENTERS.]
The commissioner of health shall develop and implement a
program to establish community health centers in rural areas of
Minnesota that are underserved by health care providers. The
program shall provide rural communities and community
organizations with technical assistance, capital grants for
start-up costs, and short-term assistance with operating costs.
The technical assistance component of the program must provide
assistance in review of practice management, market analysis,
practice feasibility analysis, medical records system analysis,
and scheduling and patient flow analysis. The program must:
(1) include a local match requirement for state dollars
received; (2) require local communities,
through instrumentalities of the state of Minnesota or nonprofit
boards comprised of local residents, to operate and own their
community's health care program; (3) encourage the use of
midlevel practitioners; and (4) incorporate a quality assurance
strategy that provides regular evaluation of clinical
performance and allows peer review comparisons for rural
practices. The commissioner shall report to the legislature on
implementation of the program by February 15, 1994.
Sec. 14. [EFFECTIVE DATE.]
Sections 1 to 13 are effective the day following final
enactment.
Presented to the governor May 14, 1993
Signed by the governor May 17, 1993, 4:42 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes