1.1 	A bill for an act
1.2 	relating to health care reform; increasing affordability and eligibility for state 
1.3 	health care programs; establishing the Minnesota Health Insurance Exchange; 
1.4 	continuing payment reform; creating an affordability standard; establishing 
1.5 	goals for universal coverage and a contingent individual responsibility mandate;
1.6 	amending Minnesota Statutes 2008, sections 13.46, subdivision 2; 62E.141; 
1.7 	62L.12, subdivisions 2, 4; 62U.04, subdivisions 3, 8; 62U.05; 62U.07, by 
1.8 	adding a subdivision; 62U.08, subdivision 2; 256.01, by adding a subdivision; 
1.9 	256B.056, subdivision 10; 256B.057, subdivision 8; 256L.03, subdivisions 3, 
1.10 	5; 256L.04, subdivisions 1, 7; 256L.05, by adding a subdivision; 256L.07, 
1.11 	subdivisions 1, 3; 256L.15, by adding a subdivision; proposing coding for new 
1.12 	law in Minnesota Statutes, chapter 62U.
1.13 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.14 	Section 1. Minnesota Statutes 2008, section 13.46, subdivision 2, is amended to read:
1.15 		Subd. 2.General. (a) Unless the data is summary data or a statute specifically 
1.16 	provides a different classification, data on individuals collected, maintained, used, or 
1.17 	disseminated by the welfare system is private data on individuals, and shall not be 
1.18 	disclosed except:
1.19 	(1) according to section 13.05;
1.20 	(2) according to court order;
1.21 	(3) according to a statute specifically authorizing access to the private data;
1.22 	(4) to an agent of the welfare system, including a law enforcement person, attorney, 
1.23 	or investigator acting for it in the investigation or prosecution of a criminal or civil 
1.24 	proceeding relating to the administration of a program;
1.25 	(5) to personnel of the welfare system who require the data to verify an individual's 
1.26 	identity; determine eligibility, amount of assistance, and the need to provide services to 
2.1 	an individual or family across programs; evaluate the effectiveness of programs; assess 
2.2 	parental contribution amounts; and investigate suspected fraud;
2.3 	(6) to administer federal funds or programs;
2.4 	(7) between personnel of the welfare system working in the same program;
2.5 	(8) to the Department of Revenue to assess parental contribution amounts for 
2.6 	purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit 
2.7 	programs and to identify individuals who may benefit from these programs. The following 
2.8 	information may be disclosed under this paragraph: an individual's and their dependent's 
2.9 	names, dates of birth, Social Security numbers, income, addresses, and other data as 
2.10 	required, upon request by the Department of Revenue. Disclosures by the commissioner 
2.11 	of revenue to the commissioner of human services for the purposes described in this clause 
2.12 	are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include, 
2.13 	but are not limited to, the dependent care credit under section 290.067, the Minnesota 
2.14 	working family credit under section 290.0671, the property tax refund and rental credit 
2.15 	under section 290A.04, and the Minnesota education credit under section 290.0674;
2.16 	(9) between the Department of Human Services, the Department of Employment 
2.17 	and Economic Development, and when applicable, the Department of Education, for 
2.18 	the following purposes:
2.19 	(i) to monitor the eligibility of the data subject for unemployment benefits, for any 
2.20 	employment or training program administered, supervised, or certified by that agency;
2.21 	(ii) to administer any rehabilitation program or child care assistance program, 
2.22 	whether alone or in conjunction with the welfare system;
2.23 	(iii) to monitor and evaluate the Minnesota family investment program or the child 
2.24 	care assistance program by exchanging data on recipients and former recipients of food 
2.25 	support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance 
2.26 	under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and
2.27 	(iv) to analyze public assistance employment services and program utilization, 
2.28 	cost, effectiveness, and outcomes as implemented under the authority established in Title 
2.29 	II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of 
2.30 	1999. Health records governed by sections 144.291 to 144.298 and "protected health 
2.31 	information" as defined in Code of Federal Regulations, title 45, section 160.103, and 
2.32 	governed by Code of Federal Regulations, title 45, parts 160-164, including health care 
2.33 	claims utilization information, must not be exchanged under this clause;
2.34 	(10) to appropriate parties in connection with an emergency if knowledge of 
2.35 	the information is necessary to protect the health or safety of the individual or other 
2.36 	individuals or persons;
3.1 	(11) data maintained by residential programs as defined in section 245A.02 may 
3.2 	be disclosed to the protection and advocacy system established in this state according 
3.3 	to Part C of Public Law 98-527 to protect the legal and human rights of persons with 
3.4 	developmental disabilities or other related conditions who live in residential facilities for 
3.5 	these persons if the protection and advocacy system receives a complaint by or on behalf 
3.6 	of that person and the person does not have a legal guardian or the state or a designee of 
3.7 	the state is the legal guardian of the person;
3.8 	(12) to the county medical examiner or the county coroner for identifying or locating 
3.9 	relatives or friends of a deceased person;
3.10 	(13) data on a child support obligor who makes payments to the public agency 
3.11 	may be disclosed to the Minnesota Office of Higher Education to the extent necessary to 
3.12 	determine eligibility under section 136A.121, subdivision 2, clause (5);
3.13 	(14) participant Social Security numbers and names collected by the telephone 
3.14 	assistance program may be disclosed to the Department of Revenue to conduct an 
3.15 	electronic data match with the property tax refund database to determine eligibility under 
3.16 	section 237.70, subdivision 4a;
3.17 	(15) the current address of a Minnesota family investment program participant 
3.18 	may be disclosed to law enforcement officers who provide the name of the participant 
3.19 	and notify the agency that:
3.20 	(i) the participant:
3.21 	(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after 
3.22 	conviction, for a crime or attempt to commit a crime that is a felony under the laws of the 
3.23 	jurisdiction from which the individual is fleeing; or
3.24 	(B) is violating a condition of probation or parole imposed under state or federal law;
3.25 	(ii) the location or apprehension of the felon is within the law enforcement officer's 
3.26 	official duties; and
3.27 	(iii) the request is made in writing and in the proper exercise of those duties;
3.28 	(16) the current address of a recipient of general assistance or general assistance 
3.29 	medical care may be disclosed to probation officers and corrections agents who are 
3.30 	supervising the recipient and to law enforcement officers who are investigating the 
3.31 	recipient in connection with a felony level offense;
3.32 	(17) information obtained from food support applicant or recipient households may 
3.33 	be disclosed to local, state, or federal law enforcement officials, upon their written request, 
3.34 	for the purpose of investigating an alleged violation of the Food Stamp Act, according 
3.35 	to Code of Federal Regulations, title 7, section 272.1(c);
4.1 	(18) the address, Social Security number, and, if available, photograph of any 
4.2 	member of a household receiving food support shall be made available, on request, to a 
4.3 	local, state, or federal law enforcement officer if the officer furnishes the agency with the 
4.4 	name of the member and notifies the agency that:
4.5 	(i) the member:
4.6 	(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a 
4.7 	crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;
4.8 	(B) is violating a condition of probation or parole imposed under state or federal 
4.9 	law; or
4.10 	(C) has information that is necessary for the officer to conduct an official duty related 
4.11 	to conduct described in subitem (A) or (B);
4.12 	(ii) locating or apprehending the member is within the officer's official duties; and
4.13 	(iii) the request is made in writing and in the proper exercise of the officer's official 
4.14 	duty;
4.15 	(19) the current address of a recipient of Minnesota family investment program, 
4.16 	general assistance, general assistance medical care, or food support may be disclosed to 
4.17 	law enforcement officers who, in writing, provide the name of the recipient and notify the 
4.18 	agency that the recipient is a person required to register under section 243.166, but is not 
4.19 	residing at the address at which the recipient is registered under section 243.166;
4.20 	(20) certain information regarding child support obligors who are in arrears may be 
4.21 	made public according to section 518A.74;
4.22 	(21) data on child support payments made by a child support obligor and data on 
4.23 	the distribution of those payments excluding identifying information on obligees may be 
4.24 	disclosed to all obligees to whom the obligor owes support, and data on the enforcement 
4.25 	actions undertaken by the public authority, the status of those actions, and data on the 
4.26 	income of the obligor or obligee may be disclosed to the other party;
4.27 	(22) data in the work reporting system may be disclosed under section 256.998, 
4.28 	subdivision 7;
4.29 	(23) to the Department of Education for the purpose of matching Department of 
4.30 	Education student data with public assistance data to determine students eligible for free 
4.31 	and reduced-price meals, meal supplements, and free milk according to United States 
4.32 	Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and 
4.33 	state funds that are distributed based on income of the student's family; and to verify 
4.34 	receipt of energy assistance for the telephone assistance plan;
4.35 	(24) the current address and telephone number of program recipients and emergency 
4.36 	contacts may be released to the commissioner of health or a local board of health as 
5.1 	defined in section 145A.02, subdivision 2, when the commissioner or local board of health 
5.2 	has reason to believe that a program recipient is a disease case, carrier, suspect case, or at 
5.3 	risk of illness, and the data are necessary to locate the person;
5.4 	(25) to other state agencies, statewide systems, and political subdivisions of this 
5.5 	state, including the attorney general, and agencies of other states, interstate information 
5.6 	networks, federal agencies, and other entities as required by federal regulation or law for 
5.7 	the administration of the child support enforcement program;
5.8 	(26) to personnel of public assistance programs as defined in section 256.741, for 
5.9 	access to the child support system database for the purpose of administration, including 
5.10 	monitoring and evaluation of those public assistance programs;
5.11 	(27) to monitor and evaluate the Minnesota family investment program by 
5.12 	exchanging data between the Departments of Human Services and Education, on 
5.13 	recipients and former recipients of food support, cash assistance under chapter 256, 256D, 
5.14 	256J, or 256K, child care assistance under chapter 119B, or medical programs under 
5.15 	chapter 256B, 256D, or 256L;
5.16 	(28) to evaluate child support program performance and to identify and prevent 
5.17 	fraud in the child support program by exchanging data between the Department of Human 
5.18 	Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a) 
5.19 	and (b), without regard to the limitation of use in paragraph (c), Department of Health, 
5.20 	Department of Employment and Economic Development, and other state agencies as is 
5.21 	reasonably necessary to perform these functions; ~~or~~
5.22 	(29) counties operating child care assistance programs under chapter 119B may 
5.23 	disseminate data on program participants, applicants, and providers to the commissioner 
5.24 	of education; or
5.25 	(30) according to section 256.01, subdivision 27, between the welfare system and the 
5.26 	Minnesota Health Insurance Exchange under section 62U.11, in order to collect premiums 
5.27 	from individuals in the medical assistance employed persons with disabilities program 
5.28 	and the MinnesotaCare program under chapters 256B and 256L, and to administer the 
5.29 	individual's and the individual's family's participation in the exchange.
5.30 	(b) Information on persons who have been treated for drug or alcohol abuse may 
5.31 	only be disclosed according to the requirements of Code of Federal Regulations, title 
5.32 	42, sections 2.1 to 2.67.
5.33 	(c) Data provided to law enforcement agencies under paragraph (a), clause (15), 
5.34 	(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected 
5.35 	nonpublic while the investigation is active. The data are private after the investigation 
5.36 	becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).
6.1 	(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is 
6.2 	not subject to the access provisions of subdivision 10, paragraph (b).
6.3 	For the purposes of this subdivision, a request will be deemed to be made in writing 
6.4 	if made through a computer interface system.

6.5 	Sec. 2. Minnesota Statutes 2008, section 62E.141, is amended to read:
6.6 	62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
6.7 	No employee of an employer that offers a group health plan, under which the 
6.8 	employee is eligible for coverage, is eligible to enroll, or continue to be enrolled, in 
6.9 	the Comprehensive Health Association, except for enrollment or continued enrollment 
6.10 	necessary to cover conditions that are subject to an unexpired preexisting condition 
6.11 	limitation, preexisting condition exclusion, or exclusionary rider under the employer's 
6.12 	group health plan. This section does not apply to persons enrolled in the Comprehensive 
6.13 	Health Association as of June 30, 1993. With respect to persons eligible to enroll in the 
6.14 	group health plan of an employer that has more than 29 current employees, as defined 
6.15 	in section 62L.02, this section does not apply to persons enrolled in the Comprehensive 
6.16 	Health Association as of December 31, 1994.  

6.17 	Sec. 3. Minnesota Statutes 2008, section 62L.12, subdivision 2, is amended to read:
6.18 		Subd. 2.Exceptions. (a) A health carrier may sell, issue, or renew individual 
6.19 	conversion policies to eligible employees otherwise eligible for conversion coverage under 
6.20 	section 62D.104 as a result of leaving a health maintenance organization's service area.
6.21 	(b) A health carrier may sell, issue, or renew individual conversion policies to 
6.22 	eligible employees otherwise eligible for conversion coverage as a result of the expiration 
6.23 	of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21, 
6.24 	62C.142, 62D.101, and 62D.105.
6.25 	(c) A health carrier may sell, issue, or renew conversion policies under section 
6.26 	62E.16 to eligible employees.
6.27 	(d) A health carrier may sell, issue, or renew individual continuation policies to 
6.28 	eligible employees as required.
6.29 	(e) A health carrier may sell, issue, or renew individual health plans if the coverage 
6.30 	is appropriate due to an unexpired preexisting condition limitation or exclusion applicable 
6.31 	to the person under the employer's group health plan or due to the person's need for health 
6.32 	care services not covered under the employer's group health plan.
6.33 	(f) A health carrier may sell, issue, or renew an individual health plan, if the 
6.34 	individual has elected to buy the individual health plan not as part of a general plan to 
7.1 	substitute individual health plans for a group health plan nor as a result of any violation of 
7.2 	subdivision 3 or 4.
7.3 	(g) Nothing in this subdivision relieves a health carrier of any obligation to provide 
7.4 	continuation or conversion coverage otherwise required under federal or state law.
7.5 	(h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage 
7.6 	issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or 
7.7 	contracts that supplement Medicare issued by health maintenance organizations, or those 
7.8 	contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social 
7.9 	Security Act, United States Code, title 42, section 1395 et seq., as amended.
7.10 	(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual 
7.11 	health plans necessary to comply with a court order.
7.12 	(j) A health carrier may offer, issue, sell, or renew an individual health plan to 
7.13 	persons eligible for an employer group health plan, if the individual health plan is a high 
7.14 	deductible health plan for use in connection with an existing health savings account, in 
7.15 	compliance with the Internal Revenue Code, section 223. In that situation, the same or 
7.16 	a different health carrier may offer, issue, sell, or renew a group health plan to cover 
7.17 	the other eligible employees in the group.
7.18 	(k) A health carrier may offer, sell, issue, or renew an individual health plan to one 
7.19 	or more employees of a small employer if the individual health plan is marketed directly to 
7.20 	all employees or through the Minnesota Health Insurance Exchange under section 62U.11
7.21 	to all employees of the small employer and the small employer does not contribute directly 
7.22 	or indirectly to the premiums or facilitate the administration of the individual health plan.
7.23 	Except as provided in section 62U.07, subdivision 5, paragraph (b), the requirement to 
7.24 	market an individual health plan to all employees does not require the health carrier to 
7.25 	offer or issue an individual health plan to any employee. For purposes of this paragraph, 
7.26 	an employer is not contributing to the premiums or facilitating the administration of the 
7.27 	individual health plan if the employer does not contribute to the premium and merely 
7.28 	collects the premiums from an employee's wages or salary through payroll deductions 
7.29 	and submits payment for the premiums of one or more employees in a lump sum to the 
7.30 	health carrier or to the Minnesota Health Insurance Exchange under section 62U.11. 
7.31 	Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the 
7.32 	request of an employee, the health carrier or the Minnesota Health Insurance Exchange 
7.33 	under section 62U.11 may bill the employer for the premiums payable by the employee, 
7.34 	provided that the employer is not liable for payment except from payroll deductions for 
7.35 	that purpose. If an employer is submitting payments under this paragraph, the health 
7.36 	carrier or the Minnesota Health Insurance Exchange, as applicable, shall provide a 
8.1 	cancellation notice directly to the primary insured at least ten days prior to termination 
8.2 	of coverage for nonpayment of premium. Individual coverage under this paragraph may 
8.3 	be offered only if the small employer has not provided coverage under section 62L.03 to 
8.4 	the employees within the past 12 months.
8.5 	The employer must provide a written and signed statement to the health carrier or 
8.6 	the Minnesota Health Insurance Exchange, as applicable, stating that the employer is not 
8.7 	contributing directly or indirectly to the employee's premiums. The Minnesota Health 
8.8 	Insurance Exchange under section 62U.11 shall provide health carriers with enrolled 
8.9 	employees of the employer a copy of the employer's statement. The health carrier may 
8.10 	rely on the employer's statement and is not required to guarantee-issue individual health 
8.11 	plans to the employer's ~~other current or future~~ employees, except as required under section 
8.12 	62U.07, subdivision 5, paragraph (b).

8.13 	Sec. 4. Minnesota Statutes 2008, section 62L.12, subdivision 4, is amended to read:
8.14 		Subd. 4.Employer prohibition. A small employer offering a health benefit plan
8.15 	shall not encourage or direct an employee or applicant to:
8.16 	(1) refrain from filing an application for health coverage when other similarly 
8.17 	situated employees may file an application for health coverage;
8.18 	(2) file an application for health coverage during initial eligibility for coverage, 
8.19 	the acceptance of which is contingent on health status, when other similarly situated 
8.20 	employees may apply for health coverage, the acceptance of which is not contingent on 
8.21 	health status;
8.22 	(3) seek coverage from another health carrier, including, but not limited to, MCHA; 
8.23 	or
8.24 	(4) cause coverage to be issued on different terms because of the health status or 
8.25 	claims experience of that person or the person's dependents.

8.26 	Sec. 5. Minnesota Statutes 2008, section 62U.04, subdivision 3, is amended to read:
8.27 		Subd. 3.Provider peer grouping. (a) The commissioner shall develop a peer 
8.28 	grouping system for providers based on a combined measure that incorporates both 
8.29 	provider risk-adjusted total cost of care and quality of care, and for specific conditions 
8.30 	as determined by the commissioner. In developing this system, the commissioner shall 
8.31 	consult and coordinate with health care providers, health plan companies, state agencies, 
8.32 	and organizations that work to improve health care quality in Minnesota. For purposes of 
8.33 	the final establishment of the peer grouping system, the commissioner shall not contract 
9.1 	with any private entity, organization, or consortium of entities that has or will have a direct 
9.2 	financial interest in the outcome of the system.
9.3 	(b) Beginning June 1, 2010, the commissioner shall disseminate information to 
9.4 	providers on their cost of care, resource use, quality of care, and the results of the grouping 
9.5 	developed under this subdivision in comparison to an appropriate peer group. Any 
9.6 	analyses or reports that identify providers may only be published after the provider has 
9.7 	been provided the opportunity by the commissioner to review the underlying data and 
9.8 	submit comments. The provider shall have 21 days to review the data for accuracy. 
9.9 	(c) The commissioner shall establish an appeals process to resolve disputes from 
9.10 	providers regarding the accuracy of the data used to develop analyses or reports.
9.11 	(d) Beginning September 1, 2010, the commissioner shall, no less than annually, 
9.12 	publish information on providers' cost, quality, and the results of the peer grouping 
9.13 	process. The results that are published must be on a risk-adjusted basis. 

9.14 	Sec. 6. Minnesota Statutes 2008, section 62U.04, subdivision 8, is amended to read:
9.15 		Subd. 8.Provider innovation to reduce health care costs and improve quality.
 9.16 	(a) Nothing in this section shall prohibit group purchasers and health care providers, 
9.17 	upon mutual agreement, from entering into arrangements that establish package prices 
9.18 	for a comprehensive set of services or separately for the cost of care for specific health 
9.19 	conditions in addition to the ~~baskets of care established in~~ package prices established 
9.20 	under  section 62U.05, in order to give providers the flexibility to innovate on ways to 
9.21 	reduce health care costs while improving overall quality of care and health outcomes.
9.22 	(b) The commissioner of health may convene working groups of private sector 
9.23 	payers and health care providers to discuss and develop new strategies for reforming 
9.24 	health care payment systems to promote innovative care delivery that reduces health 
9.25 	care costs and improves quality.

9.26 	Sec. 7. Minnesota Statutes 2008, section 62U.05, is amended to read:
9.27 	62U.05 PROVIDER PRICING FOR BASKETS OF CARE AND TOTAL 
9.28 	COST OF CARE.
9.29 		Subdivision 1.Establishment of definitions. (a) By July 1, 2009, the commissioner 
9.30 	of health shall establish uniform definitions for baskets of care beginning with a minimum 
9.31 	of seven baskets of care. In selecting health conditions for which baskets of care should 
9.32 	be defined, the commissioner shall consider coronary artery and heart disease, diabetes, 
9.33 	asthma, and depression. In selecting health conditions, the commissioner shall also 
10.1 	consider the prevalence of the health conditions, the cost of treating the health conditions, 
10.2 	and the potential for innovations to reduce cost and improve quality.
10.3 	(b) The commissioner shall convene one or more work groups to assist in 
10.4 	establishing these definitions. Each work group shall include members appointed by 
10.5 	statewide associations representing relevant health care providers and health plan 
10.6 	companies, and organizations that work to improve health care quality in Minnesota.
10.7 	(c) To the extent possible, the baskets of care and the total cost of care as specified 
10.8 	under paragraph (d) must incorporate a patient-directed, decision-making support model.
10.9 	(d) By July 1, 2010, the commissioner shall establish uniform definitions for the 
10.10 	total cost of providing all necessary services to a patient, and shall develop a standard 
10.11 	method and format for providers to use for submitting package prices for the total cost of 
10.12 	care. This method shall be published in the State Register and must be made available to 
10.13 	all providers.
10.14 		Subd. 2.Package prices. (a) Beginning January 1, 2010, health care providers 
10.15 	may establish package prices for the baskets of care defined under subdivision 1. By 
10.16 	January 1, 2011, health care providers may establish package prices for the total cost of 
10.17 	care defined under subdivision 1.
10.18 	(b) Beginning January 1, 2010, no health care provider or group of providers that 
10.19 	has established a package price for a basket of care under this section, and beginning 
10.20 	January 1, 2011, no health care provider or group of providers that has established a 
10.21 	package price for the total cost of care under this section shall vary the payment amount 
10.22 	that the provider accepts as full payment for a health care service based upon the identity 
10.23 	of the payer, upon a contractual relationship with a payer, upon the identity of the patient, 
10.24 	or upon whether the patient has coverage through a group purchaser. This paragraph 
10.25 	applies only to health care services provided to Minnesota residents or to non-Minnesota 
10.26 	residents who obtain health insurance through a Minnesota employer. This paragraph does 
10.27 	not apply to services paid for by Medicare, state public health care programs through 
10.28 	fee-for-service or prepaid arrangements, workers' compensation, or no-fault automobile 
10.29 	insurance. This paragraph does not affect the right of a provider to provide charity care 
10.30 	or care for a reduced price due to financial hardship of the patient or due to the patient 
10.31 	being a relative or friend of the provider. 
10.32 		Subd. 3.Quality measurements for baskets of care. (a) The commissioner shall 
10.33 	establish quality measurements for the defined baskets of care by December 31, 2009. The 
10.34 	commissioner shall establish quality measures for the total cost of care by December 31, 
10.35 	2010. The commissioner may contract with an organization that works to improve health 
11.1 	care quality to make recommendations about the use of existing measures or establishing 
11.2 	new measures where no measures currently exist.
11.3 	(b) Beginning July 1, 2010, the commissioner or the commissioner's designee shall 
11.4 	publish comparative price and quality information on the baskets of care in a manner 
11.5 	that is easily accessible and understandable to the public, as this information becomes 
11.6 	available. Beginning July 1, 2011, the commissioner or the commissioner's designee shall 
11.7 	publish comparative price and quality information on total cost of care in a manner that is 
11.8 	easily accessible and understandable to the public, as this information becomes available.

11.9 	Sec. 8. Minnesota Statutes 2008, section 62U.07, is amended by adding a subdivision 
11.10 	to read:
11.11 		Subd. 5.Health plan company requirements. (a) Individuals who are eligible 
11.12 	to use an employer Section 125 Plan may use it to pay for an individual market health 
11.13 	plan for which the individual is eligible and purchase it through the exchange, including 
11.14 	an individual market health plan, MinnesotaCare, and the Minnesota Comprehensive 
11.15 	Health Association.
11.16 	(b) Individuals who purchase an individual market health plan through a Section 125 
11.17 	Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment 
11.18 	period that coincides with the open enrollment period for the employer's Section 125 Plan 
11.19 	or upon experiencing a qualifying event as defined in United States Code, title 43, section 
11.20 	4980B. Nothing in this section precludes a health plan company from issuing coverage 
11.21 	with preexisting condition limitations allowed elsewhere in law. Health plans may not 
11.22 	charge higher or lower premiums based on health status for individuals who purchase 
11.23 	coverage on a guaranteed issue basis under this section, except for variations in premium 
11.24 	that are allowable based on tobacco use.

11.25 	Sec. 9. Minnesota Statutes 2008, section 62U.08, subdivision 2, is amended to read:
11.26 		Subd. 2.Duties. (a) By October 15, 2009, the work group shall develop and submit 
11.27 	to the commissioner an initial essential benefit set and design that includes coverage 
11.28 	for a broad range of services, is based on scientific evidence that services are clinically 
11.29 	effective and cost-effective, and provides lower enrollee cost sharing for services that 
11.30 	have been determined to be cost-effective. The benefit set must include necessary 
11.31 	evidence-based health care services, procedures, diagnostic tests, and technologies that 
11.32 	are scientifically proven to be both clinically effective and cost-effective. In developing 
11.33 	its recommendations, the work group may consult with the Institute for Clinical Systems 
11.34 	Improvement (ICSI) to assemble existing scientifically based practice standards.
12.1 	(b) The benefit set and design must be used as a minimum requirement for health 
12.2 	plans offered through the Minnesota Health Insurance Exchange established under 
12.3 	section 62U.11. The benefit set and design must include a limited number of maximum 
12.4 	cost-sharing variations based upon deductibles and maximum out-of-pocket costs. There 
12.5 	must be no maximum lifetime benefit.
12.6 	(c) The commissioner shall review the benefit set and design on an ongoing periodic 
12.7 	basis and shall adjust the benefit set and design as necessary, to ensure that the benefit set 
12.8 	and design continues to be safe, effective, and scientifically based.

12.9 	Sec. 10. [62U.11] MINNESOTA HEALTH INSURANCE EXCHANGE.
12.10 		Subdivision 1.Title; citation. This section may be cited as the "Minnesota Health 
12.11 	Insurance Exchange."
12.12 		Subd. 2.Creation; tax exemption. The Minnesota Health Insurance Exchange 
12.13 	is created for the limited purpose of providing individuals with greater access, choice, 
12.14 	portability, and affordability of health insurance products. The Minnesota Health 
12.15 	Insurance Exchange is created as an unincorporated association and shall promptly 
12.16 	incorporate as a nonprofit corporation under chapter 317A and apply for qualification 
12.17 	under section 501(c) of the Internal Revenue Code.
12.18 		Subd. 3.Definitions. For purposes of this section, the following terms have the 
12.19 	meanings given them.
12.20 	(a) "Board" means the Board of Directors of the Minnesota Health Insurance 
12.21 	Exchange under subdivision 13.
12.22 	(b) "Commissioner" means: 
12.23 	(1) the commissioner of commerce for health plan companies subject to the 
12.24 	jurisdiction of the Department of Commerce; 
12.25 	(2) the commissioner of health for health plan companies subject to the jurisdiction 
12.26 	of the Department of Health; or 
12.27 	(3) either commissioner's designated representative.
12.28 	(c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
12.29 	(d) "Individual market health plan" means a health plan as defined in section 
12.30 	62A.011, that is designed for sale in the individual market and that may cover either an 
12.31 	individual or an individual and the individual's dependents.
12.32 	(e) "Small employer" means a small employer as defined in section 62L.02, 
12.33 	subdivision 26.
12.34 	(f) "Small employer health benefit plan" means a health benefit plan as defined in 
12.35 	section 62L.02, subdivision 15.
13.1 		Subd. 4.Health plan company and health plan participation and availability.
 13.2 	(a) Only individual market health plans and small employer health benefit plans offered by 
13.3 	a health plan company licensed to issue health plans in Minnesota may be made available 
13.4 	for purchase through the exchange.
13.5 	(b) Each health plan made available by a health plan company through the exchange 
13.6 	must meet the essential benefit set and design requirements provided under section 62U.08.
13.7 	(c) Any health plan company that issues health plans in the individual or small 
13.8 	employer market in this state must offer through the exchange at least one health plan that 
13.9 	meets the benefit set and design established under section 62U.08.
13.10 	(d) Health plans offered through the Minnesota Comprehensive Health Association 
13.11 	as defined in section 62E.10 must be available for sale through the exchange as determined 
13.12 	by the Minnesota Comprehensive Health Association.
13.13 	(e) Health plans offered through the MinnesotaCare program must be available 
13.14 	through the exchange to individuals and families who meet the eligibility requirements 
13.15 	for MinnesotaCare, as determined by the commissioner of human services, and who pay 
13.16 	premiums through an employer Section 125 Plan.
13.17 	(f) Nothing in this section restricts the sale of individual market health plans and 
13.18 	small employer health benefit plans outside of the exchange. The requirements applicable 
13.19 	to issuance, renewal, cancellation, and pricing of coverage are the same for health plans 
13.20 	purchased inside and outside the exchange, except as described under section 62U.07, 
13.21 	subdivision 5, paragraph (b).
13.22 		Subd. 5.Comparison of health plans. The exchange shall help consumers 
13.23 	understand and compare the standardized health plan options established under section 
13.24 	62U.08. Within each standardized plan grouping, the exchange shall provide easy ways 
13.25 	for consumers to select among the offerings by comparing quality ratings, searching for 
13.26 	a particular provider in its network, or by cost factors. This information must be made 
13.27 	available via the Internet as well as by toll-free telephone assistance and written materials.
13.28 		Subd. 6.Individual participation and eligibility. (a) Individuals are eligible to 
13.29 	purchase health plans directly through the exchange or through an employer Section 
13.30 	125 Plan under section 62U.07.
13.31 	(b) Nothing in this section requires guaranteed issue of individual market health 
13.32 	plans offered through the exchange except as provided under section 62U.07, subdivision 
13.33 	5, paragraph (b).
13.34 	(c) Individuals are eligible to purchase individual market health plans through the 
13.35 	exchange by meeting one or more of the following qualifications:
14.1 	(1) the individual is a Minnesota resident, meaning the individual is physically 
14.2 	residing on a permanent basis in a place in this state that is the person's principal residence 
14.3 	and from which the person is absent only for temporary purposes;
14.4 	(2) the individual is a student attending an institution outside of Minnesota and 
14.5 	maintains Minnesota residency;
14.6 	(3) the individual is not a Minnesota resident but is employed by an employer 
14.7 	physically located within the state and the individual's employer is required to offer a 
14.8 	Section 125 Plan under section 62U.07; or
14.9 	(4) the individual is a dependent, as defined in section 62L.02, of another individual 
14.10 	who is eligible to participate in the exchange.
14.11 	(d) A self-employed individual, including a partner of a partnership, a member of 
14.12 	a limited liability company, or other owner of a business, who may not be eligible to 
14.13 	participate in a Section 125 plan, may obtain coverage through the exchange either as an 
14.14 	individual under paragraph (c) or as an employee covered under a small employer health 
14.15 	benefit plan if permitted under chapter 62L.
14.16 		Subd. 7.Small employer participation and eligibility. Small employers, as 
14.17 	defined in section 62L.02, may purchase small employer health benefit plans through 
14.18 	the exchange.
14.19 		Subd. 8.Responsibilities of exchange. The exchange may serve as a coordinating 
14.20 	entity for enrollment and collection and transfer of premium payments for health plans 
14.21 	sold to individuals and small employers through the exchange. The exchange must be 
14.22 	responsible for the following functions:
14.23 	(1) publicizing the exchange including, but not limited to, its functions, eligibility 
14.24 	rules, and enrollment procedures;
14.25 	(2) providing assistance to employers to establish Section 125 Plans under section 
14.26 	62U.07;
14.27 	(3) providing education and assistance to employers to help them understand the 
14.28 	requirements of Section 125 Plans and compliance with applicable regulations;
14.29 	(4) creating a system to allow individuals to compare and enroll in health plans 
14.30 	offered through the exchange, including a system of comparative rating of health plans 
14.31 	and benefit sets;
14.32 	(5) creating a system to collect and transmit to the applicable health plan companies 
14.33 	all premium payments made by individuals and small employers, including developing 
14.34 	mechanisms to receive and process automatic payroll deductions for individuals who 
14.35 	purchase coverage through employer Section 125 Plans;
15.1 	(6) for participating employers, billing the employer for the premiums payable by 
15.2 	the employer for a small employer health benefit plan;
15.3 	(7) for individuals purchasing individual market health plans through a Section 125 
15.4 	Plan, billing the individual's employer for premiums payable by the employee, provided 
15.5 	that the employer is not liable for payment except from payroll deductions for that purpose;
15.6 	(8) providing information on public insurance programs to individuals who may 
15.7 	qualify for these programs, and provide application assistance if needed on applying 
15.8 	for these programs;
15.9 	(9) establishing a mechanism with the Department of Human Services to transfer 
15.10 	premiums paid by Minnesota health care program enrollees from Section 125 Plans;
15.11 	(10) establishing procedures to account for all funds received and disbursed by 
15.12 	the exchange; and
15.13 	(11) making available to the public, within 90 days after the end of each fiscal year, a 
15.14 	report of an independent audit of the exchange's accounts.
15.15 		Subd. 9.State not liable. The state is not liable for the actions of the exchange.
15.16 		Subd. 10.Powers of exchange. The exchange shall have the power to:
15.17 	(1) contract with insurance producers licensed in accident and health insurance 
15.18 	under chapter 60K and vendors to perform one or more of the functions in subdivision 8;
15.19 	(2) contract with employers to collect premiums for small employer health benefit 
15.20 	plans and for individual market health plans purchased through a Section 125 Plan;
15.21 	(3) establish and assess fees on health plan premiums of small employer health 
15.22 	benefit plans and individual market health plans to fund the cost of administering the 
15.23 	exchange;
15.24 	(4) seek and directly receive grant funding from government agencies or private 
15.25 	philanthropic organizations, other than those connected with Minnesota-based nonprofit 
15.26 	health providers or health plan companies, to defray the costs of operating the exchange;
15.27 	(5) establish and administer rules and procedures governing the operations of the 
15.28 	exchange;
15.29 	(6) establish one or more service centers within Minnesota;
15.30 	(7) sue or be sued or otherwise take any necessary or proper legal action;
15.31 	(8) establish bank accounts and borrow money; and
15.32 	(9) enter into agreements with the commissioners of commerce, health, human 
15.33 	services, revenue, employment and economic development, and other state agencies as 
15.34 	necessary for the exchange to implement the provisions of this section.
15.35 		Subd. 11.Dispute resolution. The exchange shall establish procedures for 
15.36 	resolving disputes with respect to the eligibility of an individual to participate in the 
16.1 	exchange. The exchange shall not have the authority or responsibility to intervene in or 
16.2 	resolve disputes between an individual and a health plan or health plan company. If the 
16.3 	exchange receives complaints involving such disputes from individuals participating in 
16.4 	the exchange, the exchange shall inform the individual about the right to make such 
16.5 	complaints to the commissioner to be resolved according to sections 62Q.68 to 62Q.73.
16.6 		Subd. 12.Governance. The exchange shall be governed by a board of directors 
16.7 	with 11 members. The board shall convene on or before July 1, 2009, after the initial board 
16.8 	members have been selected. The initial board membership consists of the following:
16.9 	(1) the commissioner of commerce;
16.10 	(2) the commissioner of human services;
16.11 	(3) the commissioner of health; and
16.12 	(4) eight members with knowledge and experience related to health insurance 
16.13 	and health insurance markets, appointed to serve three-year terms as follows: two 
16.14 	nonlegislators appointed by the Subcommittee on Committees of the Committee on Rules 
16.15 	and Administration of the senate; two nonlegislators appointed by the speaker of the 
16.16 	house; and four members appointed by the governor.
16.17 		Subd. 13.Subsequent board membership. (a) Effective July 1, 2012, ongoing 
16.18 	membership of the exchange consists of the following:
16.19 	(1) the commissioner of commerce;
16.20 	(2) the commissioner of human services;
16.21 	(3) the commissioner of health;
16.22 	(4) two members appointed as follows: one nonlegislator appointed by the 
16.23 	Subcommittee on Committees of the Committee on Rules and Administration of the senate 
16.24 	and one nonlegislator appointed by the speaker of the house to serve two-year terms. 
16.25 	These appointed members are eligible to be reappointed for one additional term; and
16.26 	(5) four members elected by the membership of the exchange, of which two are 
16.27 	elected to serve a two-year term and two are elected to serve a three-year term.
16.28 	(b) Elected members may serve more than one term. At least one of the elected 
16.29 	members must represent a small employer and at least one member must be a person who 
16.30 	purchases an individual market health plan through the exchange.
16.31 		Subd. 14.Operations of board. Officers of the board of directors are elected by 
16.32 	members of the board and serve one-year terms. Six members of the board constitute a 
16.33 	quorum, and the affirmative vote of six members of the board is necessary and sufficient 
16.34 	for any action taken by the board. Board members serve without pay, but are reimbursed 
16.35 	for actual expenses incurred in the performance of their duties. Board meetings must be 
16.36 	open to the public, except as specified in the bylaws of the exchange.
17.1 		Subd. 15.Operations of exchange. The board of directors shall appoint an 
17.2 	exchange director who shall:
17.3 	(1) be a full-time employee of the exchange;
17.4 	(2) administer all of the activities and contracts of the exchange; and 
17.5 	(3) hire and supervise the staff of the exchange.
17.6 		Subd. 16.Investment of assets. The exchange must certify to the State Board of 
17.7 	Investment that a portion of the assets of the exchange, in the judgment of the exchange 
17.8 	director, are not required for immediate use. Investment earnings on assets transferred to 
17.9 	the State Board of Investment under this subdivision must be maintained in an account 
17.10 	in the state treasury. Money in the account may be spent, as appropriated by law, for 
17.11 	purposes related to assisting individuals in paying health insurance premiums and for 
17.12 	making health insurance products more affordable.
17.13 		Subd. 17.Audit. The legislative auditor must audit the exchange, as provided in 
17.14 	sections 3.971 and 3.972.
17.15 		Subd. 18.Insurance producers. An individual has the right to choose any 
17.16 	insurance producer licensed in accident and health insurance under chapter 60K to assist 
17.17 	the individual in purchasing an individual market health plan through the exchange. When 
17.18 	a producer licensed in accident and health insurance under chapter 60K enrolls an eligible 
17.19 	individual in the exchange, the health plan company chosen by the individual may pay the 
17.20 	producer a commission.
17.21 		Subd. 19.Implementation. Health plan coverage through the exchange begins on 
17.22 	July 1, 2010. The exchange must be operational to assist employers and individuals by 
17.23 	January 1, 2010, and be prepared for enrollment by June 1, 2010.

17.24 	EFFECTIVE DATE. This section is effective the day following final enactment.

17.25 	Sec. 11. [62U.12] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT 
17.26 	INDIVIDUAL RESPONSIBILITY REQUIREMENT.
17.27 		Subdivision 1.Phase-in goals. The state's phase-in goals for progress toward 
17.28 	universal health coverage for Minnesota residents are:
17.29 	(1) 94 percent insured by end of fiscal year 2010;
17.30 	(2) 96 percent insured by end of fiscal year 2012;
17.31 	(3) 97 percent insured by end of fiscal year 2013; and
17.32 	(4) 98 percent insured by end of fiscal year 2014 and thereafter.
17.33 		Subd. 2.Measurement of percentage insured. The commissioner of health must 
17.34 	determine what percentage of Minnesota residents are insured. The determination must be 
17.35 	based on an annual survey of the Minnesota population younger than 65, to be conducted 
18.1 	or contracted for by the commissioner of health. The survey must include questions 
18.2 	related to the type of insurance, amount of cost sharing, and potential barriers to public 
18.3 	program enrollment.
18.4 		Subd. 3.Contingent individual responsibility requirement. (a) If the increased 
18.5 	affordability, cost containment, insurance reform, and voluntary efforts provided for under 
18.6 	this act and Laws 2008, chapter 358, fail to achieve universal coverage, an individual 
18.7 	responsibility requirement is deemed to be necessary.
18.8 	(b) If any one of the phase-in goals in subdivision 1 for fiscal year 2012 or later is not 
18.9 	met, as determined by the commissioner of health, an individual responsibility requirement 
18.10 	requiring every Minnesota resident to obtain and maintain health coverage from a public 
18.11 	or private sector source of the person's choice must become effective 12 months after the 
18.12 	end of that fiscal year, provided that the commissioner certifies that health plans that meet 
18.13 	the affordability standard under section 62U.13 are available to Minnesotans.
18.14 	(c) Failure to comply with the individual responsibility requirement is not a crime 
18.15 	but must subject the person to a financial penalty to be specified in law.
18.16 	(d) An individual need not comply with the individual responsibility requirement if 
18.17 	the individual objects to the requirement on the basis of a conscientiously held religious 
18.18 	belief or bona fide religious practice. In the case of a minor child, this paragraph applies 
18.19 	to the belief or practice of the child's parents. An individual may, but is not required to, 
18.20 	apply to the commissioner of health for a written waiver of the requirement based upon 
18.21 	this paragraph. The commissioner shall approve the waiver if the applicant provides 
18.22 	satisfactory proof of eligibility for the waiver under this paragraph.
18.23 	(e) An individual with gross household income that exceeds 400 percent of the 
18.24 	federal poverty guidelines need not comply with the individual responsibility mandate if 
18.25 	the commissioner certifies that a health plan is not available in the individual's geographic 
18.26 	area for which the sum of premiums, deductibles, and other out-of-pocket costs paid for 
18.27 	health coverage by the individual does not exceed ten percent of gross income.

18.28 	Sec. 12. [62U.13] AFFORDABILITY STANDARD.
18.29 		Subdivision 1.Definition of affordability. For purposes of this section, coverage is 
18.30 	"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an 
18.31 	individual or family for health coverage does not exceed the applicable percentage of the 
18.32 	individual or family's gross monthly income specified in subdivision 2.
18.33 		Subd. 2.Affordability standard. The following affordability standard is 
18.34 	established for individuals and households with gross family incomes of 400 percent 
18.35 	of the federal poverty guidelines or less.

19.1 | AFFORDABILITY STANDARD
19.2

19.3

Federal Poverty Guideline 
Range

Percentage of Average 
Gross Monthly Income

19.4 | | 0-33% | | | minimum | |
19.5 | | 33-54% | | | 1.1% | |
19.6 | | 55-81% | | | 1.2% | |
19.7 | | 82-109% | | | 1.6% | |
19.8 | | 110-136% | | | 2.4% | |
19.9 | | 137-164% | | | 2.9% | |
19.10 | | 165-191% | | | 3.9% | |
19.11 | | 192-219% | | | 4.6% | |
19.12 | | 220-248% | | | 5.4% | |
19.13 | | 248-274% | | | 6.0% | |
19.14 | | 275-300% | | | 6.0% | |
19.15 | | 301-324% | | | 6.5% | |
19.16 | | 325-349% | | | 7.2% | |
19.17 | | 350-374% | | | 7.8% | |
19.18 | | 375-400% | | | 8.0% | |
19.19 	For purposes of this subdivision, "minimum" means a monthly premium of $4.

19.20 	Sec. 13. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision 
19.21 	to read:
19.22 		Subd. 29.Exchange of data. An entity that is part of the welfare system as defined 
19.23 	in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance 
19.24 	Exchange under section 62U.11 may exchange private data about individuals without 
19.25 	the individual's consent in order to collect premiums from individuals in the medical 
19.26 	assistance employed persons with disabilities program and the MinnesotaCare program 
19.27 	under chapters 256B and 256L. This subdivision only applies if the entity that is part of 
19.28 	the welfare system and the Minnesota Health Insurance Exchange have entered into an 
19.29 	agreement that complies with the requirements in Code of Federal Regulations, title 
19.30 	45, section 164.314.

19.31 	Sec. 14. Minnesota Statutes 2008, section 256B.056, subdivision 10, is amended to 
19.32 	read:
19.33 		Subd. 10.Eligibility verification. (a) The commissioner shall require women who 
19.34 	are applying for the continuation of medical assistance coverage following the end of the 
19.35 	60-day postpartum period to update their income and asset information and to submit 
19.36 	any required income or asset verification.
20.1 	(b) The commissioner shall determine the eligibility of private-sector health care 
20.2 	coverage for infants less than one year of age eligible under section 256B.055, subdivision 
20.3 	10, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage 
20.4 	if this is determined to be cost-effective.
20.5 	(c) The commissioner shall verify ~~assets and~~ income for all applicants, and for all 
20.6 	recipients upon renewal. The commissioner shall verify liquid assets for applicants, and 
20.7 	for recipients upon renewal, only if the applicant or recipient reports total countable 
20.8 	assets within ten percent of the applicable asset limit. The commissioner may verify 
20.9 	nonliquid assets, but is not required to do so. This paragraph does not apply to applicants 
20.10 	or recipients applying for or receiving medical assistance payment of long-term care 
20.11 	services, including services under section 256B.0915, 256B.092, or 256B.49.
20.12 	(d) The commissioner shall designate locations where enrollees may submit renewal 
20.13 	forms including, but not limited to, community clinics and health care providers' offices. 
20.14 	The designated sites shall forward the renewal forms to the commissioner.

20.15 	EFFECTIVE DATE. Paragraph (c) is effective January 1, 2010.

20.16 	Sec. 15. Minnesota Statutes 2008, section 256B.057, subdivision 8, is amended to read:
20.17 		Subd. 8.Children under age two. Medical assistance may be paid for a child under 
20.18 	two years of age whose countable family income is above 275 percent of the federal 
20.19 	poverty guidelines for the same size family but less than or equal to ~~280~~ 305 percent of the 
20.20 	federal poverty guidelines for the same size family.

20.21 	EFFECTIVE DATE. This section is effective January 1, 2011, or upon federal 
20.22 	approval, whichever is later.

20.23 	Sec. 16. Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:
20.24 		Subd. 3.Inpatient hospital services. (a) Covered health services shall include 
20.25 	inpatient hospital services, including inpatient hospital mental health services and inpatient 
20.26 	hospital and residential chemical dependency treatment, subject to those limitations 
20.27 	necessary to coordinate the provision of these services with eligibility under the medical 
20.28 	assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under 
20.29 	section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and 
20.30 	2, with family gross income that exceeds 200 percent of the federal poverty guidelines or 
20.31 	215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not 
20.32 	pregnant, is subject to an annual limit of ~~$10,000~~ $20,000. 
21.1 	(b) Admissions for inpatient hospital services paid for under section 256L.11, 
21.2 	subdivision 3, must be certified as medically necessary in accordance with Minnesota 
21.3 	Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2): 
21.4 	(1) all admissions must be certified, except those authorized under rules established 
21.5 	under section 254A.03, subdivision 3, or approved under Medicare; and 
21.6 	(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent 
21.7 	for admissions for which certification is requested more than 30 days after the day of 
21.8 	admission. The hospital may not seek payment from the enrollee for the amount of the 
21.9 	payment reduction under this clause. 

21.10 	EFFECTIVE DATE. This section is effective January 1, 2010, for single adults 
21.11 	and households with no children enrolled under section 256L.07, subdivision 4, and is 
21.12 	effective July 1, 2010, or upon federal approval, whichever is later, for adults in families 
21.13 	with children enrolled under section 256L.04, subdivision 1. The commissioner of human 
21.14 	services shall notify the revisor of statutes when federal approval is obtained.

21.15 	Sec. 17. Minnesota Statutes 2008, section 256L.03, subdivision 5, is amended to read:
21.16 		Subd. 5.Co-payments and coinsurance. (a) Except as provided in paragraphs (b) 
21.17 	and (c), the MinnesotaCare benefit plan shall include the following co-payments and 
21.18 	coinsurance requirements for all enrollees:
21.19 	(1) ten percent of the paid charges for inpatient hospital services for adult enrollees, 
21.20 	subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and 
21.21 	$3,000 per family;
21.22 	(2) $3 per prescription for adult enrollees;
21.23 	(3) $25 for eyeglasses for adult enrollees;
21.24 	(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an 
21.25 	episode of service which is required because of a recipient's symptoms, diagnosis, or 
21.26 	established illness, and which is delivered in an ambulatory setting by a physician or 
21.27 	physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, 
21.28 	audiologist, optician, or optometrist; and
21.29 	(5) $6 for nonemergency visits to a hospital-based emergency room.
21.30 	(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of 
21.31 	children under the age of 21.
21.32 	(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
21.33 	(d) Paragraph (a), clause (4), does not apply to mental health services.
21.34 	(e) Adult enrollees with family gross income that exceeds 200 percent of the federal 
21.35 	poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009, 
22.1 	and who are not pregnant shall be financially responsible for the coinsurance amount, if 
22.2 	applicable, and amounts which exceed the ~~$10,000~~ $20,000 inpatient hospital benefit limit.
22.3 	(f) When a MinnesotaCare enrollee becomes a member of a prepaid health 
22.4 	plan, or changes from one prepaid health plan to another during a calendar year, any 
22.5 	charges submitted towards the ~~$10,000~~ $20,000 annual inpatient benefit limit, and any 
22.6 	out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted 
22.7 	or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

22.8 	EFFECTIVE DATE. This section is effective January 1, 2010, for single adults 
22.9 	and households with no children enrolled under section 256L.04, subdivision 7, and is 
22.10 	effective July 1, 2010, or upon federal approval, whichever is later, for adults in families 
22.11 	with children enrolled under section 256L.04, subdivision 1. The commissioner of human 
22.12 	services shall notify the revisor of statutes when federal approval is obtained.

22.13 	Sec. 18. Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:
22.14 		Subdivision 1.Families with children. (a) Families with children with family 
22.15 	income equal to or less than ~~275~~ 300 percent of the federal poverty guidelines for the 
22.16 	applicable family size shall be eligible for MinnesotaCare according to this section. All 
22.17 	other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers 
22.18 	to enrollment under section 256L.07, shall apply unless otherwise specified. 
22.19 	(b) Parents who enroll in the MinnesotaCare program must also enroll their children, 
22.20 	if the children are eligible. Children may be enrolled separately without enrollment by 
22.21 	parents. However, if one parent in the household enrolls, both parents must enroll, unless 
22.22 	other insurance is available. If one child from a family is enrolled, all children must 
22.23 	be enrolled, unless other insurance is available. If one spouse in a household enrolls, 
22.24 	the other spouse in the household must also enroll, unless other insurance is available. 
22.25 	Families cannot choose to enroll only certain uninsured members.
22.26 	(c) Beginning October 1, 2003, the dependent sibling definition no longer applies 
22.27 	to the MinnesotaCare program. These persons are no longer counted in the parental 
22.28 	household and may apply as a separate household.
22.29 	(d) ~~Beginning July 1, 2003, or upon federal approval, whichever is later, parents are~~ 
22.30 	~~not eligible for MinnesotaCare if their gross income exceeds $57,500.~~
22.31 	~~(e)~~ Children formerly enrolled in medical assistance and automatically deemed 
22.32 	eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt 
22.33 	from the requirements of this section until renewal.

23.1 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
23.2 	approval, whichever is later. The commissioner of human services shall notify the revisor 
23.3 	of statutes when federal approval is obtained.

23.4 	Sec. 19. Minnesota Statutes 2008, section 256L.04, subdivision 7, is amended to read:
23.5 		Subd. 7.Single adults and households with no children. (a) The definition of 
23.6 	eligible persons includes all individuals and households with no children who have gross 
23.7 	family incomes that are equal to or less than 200 percent of the federal poverty guidelines. 
23.8 	(b) Effective July 1, 2009, the definition of eligible persons includes all individuals 
23.9 	and households with no children who have gross family incomes that are equal to or less 
23.10 	than ~~250~~ 300 percent of the federal poverty guidelines.

23.11 	EFFECTIVE DATE. This section is effective July 1, 2010.

23.12 	Sec. 20. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision 
23.13 	to read:
23.14 		Subd. 6.Delayed verification. On the basis of information provided on the 
23.15 	completed application, an applicant whose gross income is less than 90 percent of 
23.16 	the applicable income standard and meets all other eligibility requirements, including 
23.17 	compliance at the time of application with citizenship or nationality documentation 
23.18 	requirements under section 256L.04, subdivision 10, must be determined eligible and 
23.19 	enrolled upon payment of premiums according to subdivision 3. The applicant shall 
23.20 	provide all required verifications within 60 days' notice of the eligibility determination, 
23.21 	or eligibility shall be denied or canceled. Applicants who are denied or canceled for 
23.22 	failure to provide all required verifications are not eligible for coverage using the delayed 
23.23 	verification procedures in this subdivision for 12 months.

23.24 	EFFECTIVE DATE. This section is effective January 1, 2011, or upon federal 
23.25 	approval, whichever is later. The commissioner of human services shall notify the revisor 
23.26 	of statutes when federal approval is obtained.

23.27 	Sec. 21. Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:
23.28 		Subdivision 1.General requirements. (a) Children enrolled in the original 
23.29 	children's health plan as of September 30, 1992, children who enrolled in the 
23.30 	MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549, 
23.31 	article 4, section 17, and children who have family gross incomes that are equal to or 
23.32 	less than 150 percent of the federal poverty guidelines are eligible without meeting 
24.1 	the requirements of subdivision 2 ~~and the four-month requirement in subdivision 3~~, as 
24.2 	long as they maintain continuous coverage in the MinnesotaCare program or medical 
24.3 	assistance. Children who apply for MinnesotaCare on or after the implementation date 
24.4 	of the employer-subsidized health coverage program as described in Laws 1998, chapter 
24.5 	407, article 5, section 45, who have family gross incomes that are equal to or less than 150 
24.6 	percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to 
24.7 	be eligible for MinnesotaCare.
24.8 	Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose 
24.9 	income increases above ~~275~~ 300 percent of the federal poverty guidelines, are no longer 
24.10 	eligible for the program and shall be disenrolled by the commissioner. Beginning January 
24.11 	1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, 
24.12 	whose income increases above 200 percent of the federal poverty guidelines or ~~250~~ 300
24.13 	percent of the federal poverty guidelines on or after July 1, ~~2009~~ 2010, are no longer 
24.14 	eligible for the program and shall be disenrolled by the commissioner. For persons 
24.15 	disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of 
24.16 	the calendar month following the month in which the commissioner determines that the 
24.17 	income of a family or individual exceeds program income limits.
24.18 	(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare 
24.19 	if ten percent of their gross individual or gross family income as defined in section 
24.20 	256L.01, subdivision 4, is less than the annual premium for a policy with a $500 
24.21 	deductible available through the Minnesota Comprehensive Health Association. Children 
24.22 	who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month 
24.23 	notice period from the date that ineligibility is determined before disenrollment. The 
24.24 	premium for children remaining eligible under this clause shall be the maximum premium 
24.25 	determined under section 256L.15, subdivision 2, paragraph (b).
24.26 	~~(c) Notwithstanding paragraphs (a) and (b), parents are not eligible for~~ 
24.27 	~~MinnesotaCare if gross household income exceeds $57,500 for the 12-month period~~ 
24.28 	~~of eligibility.~~

24.29 	EFFECTIVE DATE. This section is effective July 1, 2010, or upon federal 
24.30 	approval, whichever is later, except that the amendment to paragraph (a) related to the 
24.31 	four-month requirement is effective January 1, 2011, or upon federal approval, whichever 
24.32 	is later. The commissioner of human services shall notify the revisor of statutes when 
24.33 	federal approval is obtained.

24.34 	Sec. 22. Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:
25.1 		Subd. 3.Other health coverage. (a) Families and individuals enrolled in the 
25.2 	MinnesotaCare program must have no health coverage while enrolled ~~or for at least four~~ 
25.3 	~~months prior to application and renewal~~. Children enrolled in the original children's health 
25.4 	plan and children in families with income equal to or less than 150 percent of the federal 
25.5 	poverty guidelines, who have other health insurance, are eligible if the coverage:
25.6 	(1) lacks two or more of the following:
25.7 	(i) basic hospital insurance;
25.8 	(ii) medical-surgical insurance;
25.9 	(iii) prescription drug coverage;
25.10 	(iv) dental coverage; or
25.11 	(v) vision coverage;
25.12 	(2) requires a deductible of $100 or more per person per year; or
25.13 	(3) lacks coverage because the child has exceeded the maximum coverage for a 
25.14 	particular diagnosis or the policy excludes a particular diagnosis.
25.15 	The commissioner may change this eligibility criterion for sliding scale premiums 
25.16 	in order to remain within the limits of available appropriations. The requirement of no 
25.17 	health coverage does not apply to newborns.
25.18 	(b) Medical assistance, general assistance medical care, and the Civilian Health and 
25.19 	Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under 
25.20 	United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or 
25.21 	health coverage for purposes of ~~the four-month requirement described in~~ this subdivision.
25.22 	~~(c)~~ For purposes of this subdivision, an applicant or enrollee who is entitled to 
25.23 	Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social 
25.24 	Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to 
25.25 	have health coverage. An applicant or enrollee who is entitled to premium-free Medicare 
25.26 	Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility 
25.27 	for MinnesotaCare.
25.28 	~~(d)~~ (c) Applicants who were recipients of medical assistance or general assistance 
25.29 	medical care within one month of application must meet the provisions of this subdivision 
25.30 	and subdivision 2.
25.31 	~~(e) Cost-effective health insurance that was paid for by medical assistance is not~~ 
25.32 	~~considered health coverage for purposes of the four-month requirement under this~~ 
25.33 	~~section, except if the insurance continued after medical assistance no longer considered it~~ 
25.34 	~~cost-effective or after medical assistance closed.~~

26.1 	EFFECTIVE DATE. This section is effective January 1, 2011, or upon federal 
26.2 	approval, whichever is later. The commissioner of human services shall notify the revisor 
26.3 	of statutes when federal approval is obtained.

26.4 	Sec. 23. Minnesota Statutes 2008, section 256L.15, is amended by adding a subdivision 
26.5 	to read:
26.6 		Subd. 5.First month premium exemption. New enrollee households are exempt 
26.7 	from premiums for the first month of MinnesotaCare enrollment. For purposes of this 
26.8 	exemption, a "new enrollee household" is a household which has not been enrolled in 
26.9 	MinnesotaCare for at least one year prior to application.

26.10 	EFFECTIVE DATE. This section is effective January 1, 2011, or upon federal 
26.11 	approval, whichever is later. The commissioner of human services shall notify the revisor 
26.12 	of statutes when federal approval is obtained.