1.1                          A bill for an act 
  1.2             relating to health; regulating health plan 
  1.3             accountability and competition, regional coordinating 
  1.4             boards, data, technology, public health and safety, 
  1.5             health provider liability, and funding for the health 
  1.6             care access fund; making technical changes; providing 
  1.7             penalties; amending Minnesota Statutes 1994, sections 
  1.8             13.99, by adding a subdivision; 43A.316, subdivision 
  1.9             6; 43A.317, by adding a subdivision; 62J.017; 62J.05, 
  1.10            subdivision 2; 62J.09, subdivisions 1 and 6; 62J.152; 
  1.11            62J.35, subdivision 3, and by adding a subdivision; 
  1.12            62J.44; 62J.45; 62M.02, subdivision 12; 62M.07; 
  1.13            62M.09, subdivision 5; 62M.10, by adding a 
  1.14            subdivision; 62Q.03, by adding a subdivision; 62Q.07, 
  1.15            subdivision 2; 62Q.17, subdivision 3; 62Q.18, 
  1.16            subdivision 6; 62Q.41; 72A.20, by adding subdivisions; 
  1.17            84.9256, subdivision 2; 169.222, subdivision 4; 
  1.18            169.685, subdivision 5; 169.686, subdivision 1; 
  1.19            169.974, subdivision 4; 549.01; 595.02, subdivision 5; 
  1.20            and 604.02; Laws 1994, chapter 625, article 5, section 
  1.21            5; proposing coding for new law in Minnesota Statutes, 
  1.22            chapters 62H; 62J; 62Q; 84; 290; and 548; repealing 
  1.23            Minnesota Statutes 1994, sections 62J.30; 62J.31; 
  1.24            62J.32; 62J.33; 62J.34; 62J.42; 62P.01; 62P.02; 
  1.25            62P.03; 62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 
  1.26            62P.17; 62P.19; 62P.21; 62P.23; 62P.25; 62P.29; 
  1.27            62P.31; 62P.33; 214.16; 295.50; 295.51; 295.52; 
  1.28            295.53; 295.54; 295.55; and 295.57. 
  1.29  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.30                             ARTICLE 1 
  1.31             HEALTH PLAN ACCOUNTABILITY AND COMPETITION
  1.32     Section 1.  Minnesota Statutes 1994, section 43A.316, 
  1.33  subdivision 6, is amended to read: 
  1.34     Subd. 6.  [COVERAGE.] (a) By January 1, 1989, the 
  1.35  commissioner shall announce the benefits of the plan.  The plan 
  1.36  shall include employee hospital, medical, dental, and life 
  1.37  insurance for employees and hospital and medical benefits for 
  2.1   dependents.  Health maintenance organization options and other 
  2.2   delivery system options may be provided if they are available, 
  2.3   cost-effective, and capable of servicing the number of people 
  2.4   covered in the plan.  The plan shall offer at least three health 
  2.5   plan company options to its participating employees.  If three 
  2.6   options are not possible due to geographic restrictions, then 
  2.7   the plan must offer as many options as is practicable in the 
  2.8   service area.  This requirement becomes effective when the plan 
  2.9   attains 1,000 participating employees in the service area. 
  2.10  Participation in optional coverages may be provided by 
  2.11  collective bargaining agreements.  For employees not represented 
  2.12  by an exclusive representative, the employer may offer the 
  2.13  optional coverages to eligible employees and their dependents 
  2.14  provided in the plan. 
  2.15     (b) The commissioner, with the assistance of the 
  2.16  labor-management committee, shall periodically assess whether it 
  2.17  is financially feasible for the plan to offer or to continue an 
  2.18  individual retiree program that has competitive premium rates 
  2.19  and benefits.  If the commissioner determines it to be feasible 
  2.20  to offer an individual retiree program, the commissioner shall 
  2.21  announce the applicable benefits, premium rates, and terms of 
  2.22  participation.  Eligibility to participate in the individual 
  2.23  retiree program is governed by subdivision 8, but applies to 
  2.24  retirees of eligible employers that do not participate in the 
  2.25  plan and to those retirees' dependents and surviving spouses. 
  2.26     Sec. 2.  Minnesota Statutes 1994, section 43A.317, is 
  2.27  amended by adding a subdivision to read: 
  2.28     Subd. 7a.  [MULTIPLE CHOICES REQUIRED.] The Minnesota 
  2.29  employers insurance program shall offer at least three health 
  2.30  plan company options to its members.  If three options are not 
  2.31  possible due to geographic restrictions, then the plan must 
  2.32  offer as many options as is practicable in the service area.  
  2.33  This requirement becomes effective when the program attains 
  2.34  1,000 eligible employees. 
  2.35     Sec. 3.  [62H.165] [MULTIPLE CHOICES REQUIRED.] 
  2.36     Each Multiple Employer Welfare Arrangement (MEWA) must 
  3.1   offer its member organizations at least three health plan 
  3.2   options.  If three options are not possible due to geographic 
  3.3   restrictions, then the MEWA must offer as many options as is 
  3.4   practicable in the service area.  This requirement becomes 
  3.5   effective when a MEWA attains 1,000 covered employees. 
  3.6      Sec. 4.  Minnesota Statutes 1994, section 62J.017, is 
  3.7   amended to read: 
  3.8      62J.017 [IMPLEMENTATION TIMETABLE.] 
  3.9      The state seeks to complete the restructuring of the health 
  3.10  care delivery and financing system by July 1, 1997.  The 
  3.11  restructured system will have two options:  (1) integrated 
  3.12  service networks, which will be accountable for meeting state 
  3.13  cost containment, quality, and access standards; or (2) a 
  3.14  uniform set of price and utilization controls for all health 
  3.15  care services for Minnesota residents not provided through an 
  3.16  integrated service network.  Both systems sets the framework to 
  3.17  achieve universal coverage, and will be built upon a marketplace 
  3.18  in which a variety of health plan companies compete for 
  3.19  enrollees based on cost, quality, and access.  Those health plan 
  3.20  companies will compete within a level regulatory environment 
  3.21  that holds each of them similarly accountable for cost, quality, 
  3.22  and access, but continues to allow them maximum flexibility in 
  3.23  the governance, form of licensure, and organization of health 
  3.24  care delivery.  Under the restructured system, integrated 
  3.25  service networks will be one of many choices for consumers, 
  3.26  providers, and health plan companies.  All health plan companies 
  3.27  will operate under the state's growth limits and will be 
  3.28  structured to promote competition in the health care 
  3.29  marketplace.  The growth limits established in section 62J.04, 
  3.30  subdivision 1, shall continue until 1997 at which time the 
  3.31  legislature will assess the marketplace, medical inflation, and 
  3.32  other pertinent factors to determine whether limits should 
  3.33  continue. 
  3.34     Beginning July 1, 1994, measures will be taken to increase 
  3.35  the public accountability of existing health plan companies, to 
  3.36  promote the development of small, community-based integrated 
  4.1   service networks, and to reduce administrative costs by 
  4.2   standardizing third-party billing forms and procedures and 
  4.3   utilization review requirements.  Voluntary formation of other 
  4.4   integrated service networks will begin after rules have been 
  4.5   adopted, but not before July 1, 1996.  Statutes and rules for 
  4.6   the entire restructured health care financing and delivery 
  4.7   system must be enacted or adopted by January 1, 1996, and a 
  4.8   phase-in of the all-payer reimbursement system must begin on 
  4.9   that date.  By July 1, 1997, all health coverage must be 
  4.10  regulated under integrated service network or community 
  4.11  integrated service network law pursuant to chapter 62N or 
  4.12  all-payer law pursuant to chapter 62P. 
  4.13     Sec. 5.  Minnesota Statutes 1994, section 62M.02, 
  4.14  subdivision 12, is amended to read: 
  4.15     Subd. 12.  [HEALTH BENEFIT PLAN.] "Health benefit plan" 
  4.16  means a policy, contract, or certificate issued by a health 
  4.17  carrier to an employer or individual for the coverage of 
  4.18  medical, dental, or hospital benefits.  A health benefit plan 
  4.19  does not include coverage that is: 
  4.20     (1) limited to disability or income protection coverage; 
  4.21     (2) automobile medical payment coverage; 
  4.22     (3) supplemental to liability insurance; 
  4.23     (4) designed solely to provide payments on a per diem, 
  4.24  fixed indemnity, or nonexpense incurred basis; 
  4.25     (5) credit accident and health insurance issued under 
  4.26  chapter 62B; 
  4.27     (6) blanket accident and sickness insurance as defined in 
  4.28  section 62A.11; or 
  4.29     (7) accident only coverage issued by a licensed and tested 
  4.30  insurance agent; or 
  4.31     (8) workers' compensation. 
  4.32     Sec. 6.  Minnesota Statutes 1994, section 62M.07, is 
  4.33  amended to read: 
  4.34     62M.07 [PRIOR AUTHORIZATION OF SERVICES.] 
  4.35     (a) Utilization review organizations conducting prior 
  4.36  authorization of services must have written standards that meet 
  5.1   at a minimum the following requirements: 
  5.2      (1) written procedures and criteria used to determine 
  5.3   whether care is appropriate, reasonable, or medically necessary; 
  5.4      (2) a system for providing prompt notification of its 
  5.5   determinations to enrollees and providers and for notifying the 
  5.6   provider, enrollee, or enrollee's designee of appeal procedures 
  5.7   under clause (4); 
  5.8      (3) compliance with section 72A.201, subdivision 4a, 
  5.9   regarding time frames for approving and disapproving prior 
  5.10  authorization requests; 
  5.11     (4) written procedures for appeals of denials of prior 
  5.12  authorization which specify the responsibilities of the enrollee 
  5.13  and provider, and which meet the requirements of section 
  5.14  72A.285, regarding release of summary review findings; and 
  5.15     (5) procedures to ensure confidentiality of 
  5.16  patient-specific information, consistent with applicable law; 
  5.17  and 
  5.18     (6) a system for making determinations, and notifying 
  5.19  providers and enrollees of these determinations, during weekends 
  5.20  to allow 24-hour access for determination. 
  5.21     (b) No utilization review organization, health plan 
  5.22  company, or claims administrator may conduct or require prior 
  5.23  authorization of emergency confinement or emergency treatment.  
  5.24  The enrollee or the enrollee's authorized representative may be 
  5.25  required to notify the health plan company, claims 
  5.26  administrator, or utilization review organization as soon after 
  5.27  the beginning of the emergency confinement or emergency 
  5.28  treatment as reasonably possible. 
  5.29     Sec. 7.  Minnesota Statutes 1994, section 62M.09, 
  5.30  subdivision 5, is amended to read: 
  5.31     Subd. 5.  [WRITTEN CLINICAL CRITERIA.] A utilization review 
  5.32  organization's decisions must be supported by written clinical 
  5.33  criteria and review procedures, based on improved patient care 
  5.34  or proven patient outcomes.  Clinical criteria and review 
  5.35  procedures must be established with appropriate involvement from 
  5.36  actively practicing physicians.  A utilization review 
  6.1   organization must use written clinical criteria, as required, 
  6.2   for determining the appropriateness of the certification 
  6.3   request.  The utilization review organization must have a 
  6.4   procedure for ensuring, at a minimum, the periodic annual 
  6.5   evaluation and updating of the written criteria based on sound 
  6.6   clinical principles. 
  6.7      Sec. 8.  Minnesota Statutes 1994, section 62M.10, is 
  6.8   amended by adding a subdivision to read: 
  6.9      Subd. 7.  [AVAILABILITY OF CRITERIA.] Upon request, a 
  6.10  utilization review organization shall provide to an enrollee or 
  6.11  to an attending physician or provider the criteria used to 
  6.12  determine the necessity, appropriateness, and efficacy of a 
  6.13  health care service and identify the database, professional 
  6.14  treatment guideline, or other basis for the criteria. 
  6.15     Sec. 9.  Minnesota Statutes 1994, section 62Q.03, is 
  6.16  amended by adding a subdivision to read: 
  6.17     Subd. 12.  [PARTICIPATION BY ALL HEALTH PLAN 
  6.18  COMPANIES.] Upon its implementation, all health plan companies, 
  6.19  as a condition of licensure, must participate in the risk 
  6.20  adjustment system to be implemented under this section. 
  6.21     Sec. 10.  Minnesota Statutes 1994, section 62Q.07, 
  6.22  subdivision 2, is amended to read: 
  6.23     Subd. 2.  [CONTENTS OF ACTION PLANS.] (a) An action plan 
  6.24  must include a detailed description of all of the health plan 
  6.25  company's methods and procedures, standards, qualifications, 
  6.26  criteria, and credentialing requirements for designating the 
  6.27  providers who are eligible to participate in the health plan 
  6.28  company's provider network, including any limitations on the 
  6.29  numbers of providers to be included in the network.  This 
  6.30  description must be updated by the health plan company and filed 
  6.31  with the applicable agency on a quarterly basis.  
  6.32     (b) An action plan must include the number of full-time 
  6.33  equivalent physicians, by specialty, nonphysician providers, and 
  6.34  allied health providers used to provide services.  The action 
  6.35  plan must also describe how the health plan company intends to 
  6.36  encourage the use of nonphysician providers, midlevel 
  7.1   practitioners, and allied health professionals, through at least 
  7.2   consumer education, physician education, and referral and 
  7.3   advisement systems.  The annual action plan must also include 
  7.4   data that is broken down by type of provider, reflecting actual 
  7.5   utilization of midlevel practitioners and allied professionals 
  7.6   by enrollees of the health plan company during the previous 
  7.7   year.  Until July 1, 1995, a health plan company may use 
  7.8   estimates if actual data is not available.  For purposes of this 
  7.9   paragraph, "provider" has the meaning given in section 62J.03, 
  7.10  subdivision 8.  
  7.11     (c) An action plan must include a description of the health 
  7.12  plan company's policy on determining the number and the type of 
  7.13  providers that are necessary to deliver cost-effective health 
  7.14  care to its enrollees.  The action plan must also include the 
  7.15  health plan company's strategy, including provider recruitment 
  7.16  and retention activities, for ensuring that sufficient providers 
  7.17  are available to its enrollees. 
  7.18     (d) An action plan must include a description of actions 
  7.19  taken or planned by the health plan company to ensure that 
  7.20  information from report cards, outcome studies, and complaints 
  7.21  is used internally to improve quality of the services provided 
  7.22  by the health plan company. 
  7.23     (e) An action plan must include a detailed description of 
  7.24  the health plan company's policies and procedures for enrolling 
  7.25  and serving high risk and special needs populations.  This 
  7.26  description must also include the barriers that are present for 
  7.27  the high risk and special needs population and how the health 
  7.28  plan company is addressing these barriers in order to provide 
  7.29  greater access to these populations.  This description must 
  7.30  describe how the health plan company's provider network design, 
  7.31  policies on access to providers, and marketing strategies 
  7.32  address, and do not serve to discourage, enrollment and 
  7.33  appropriate access to care by members of high risk and special 
  7.34  needs populations.  "High risk and special needs populations" 
  7.35  includes, but is not limited to, recipients of medical 
  7.36  assistance, general assistance medical care, and MinnesotaCare; 
  8.1   persons with chronic conditions or disabilities; individuals 
  8.2   within certain racial, cultural, and ethnic communities; 
  8.3   individuals and families with low income; adolescents; the 
  8.4   elderly; individuals with limited or no English language 
  8.5   proficiency; persons with high-cost preexisting conditions; 
  8.6   homeless persons; chemically dependent persons; persons with 
  8.7   serious and persistent mental illness and children with severe 
  8.8   emotional disturbance; and persons who are at high risk of 
  8.9   requiring treatment.  The action plan must also reflect actual 
  8.10  utilization of providers by enrollees defined by this section as 
  8.11  high risk or special needs populations during the previous 
  8.12  year.  For purposes of this paragraph, "provider" has the 
  8.13  meaning given in section 62J.03, subdivision 8. 
  8.14     (f) An action plan must include a general description of 
  8.15  any action the health plan company has taken and those it 
  8.16  intends to take to offer health coverage options to rural 
  8.17  communities and other communities not currently served by the 
  8.18  health plan company. 
  8.19     (g) An action plan must include a description of any 
  8.20  utilization review practices and policies used by the health 
  8.21  plan, either internally or by contract with a utilization review 
  8.22  organization. 
  8.23     (h) An action plan must include a list of any types of 
  8.24  providers or services that can be accessed by enrollees only 
  8.25  through referral by another provider (gatekeeper), together with 
  8.26  a description of the types of providers authorized to give these 
  8.27  referrals and the policies governing when and whether these 
  8.28  referrals will be given. 
  8.29     (i) An action plan must include a description of the role 
  8.30  played by patients and by health care providers in the 
  8.31  governance and operation of the health plan, including the role 
  8.32  played by actively practicing providers in determining the 
  8.33  health plan's medical policies in such areas as quality 
  8.34  improvement, practice guidelines, coverage decisions, and 
  8.35  utilization review. 
  8.36     (j) A health plan company other than a large managed care 
  9.1   plan company may satisfy any of the requirements of the action 
  9.2   plan in paragraphs (a) to (f) (i) by stating that it has no 
  9.3   policies, procedures, practices, or requirements, either written 
  9.4   or unwritten, or formal or informal, and has undertaken no 
  9.5   activities or plans on the issues required to be addressed in 
  9.6   the action plan, provided that the statement is truthful and not 
  9.7   misleading.  For purposes of this paragraph, "large managed care 
  9.8   plan company" means a health maintenance organization, 
  9.9   integrated service network, or other health plan company that 
  9.10  employs or contracts with health care providers, that has more 
  9.11  than 50,000 enrollees in this state.  If a health plan company 
  9.12  employs or contracts with providers for some of its health plans 
  9.13  and does not do so for other health plans that it offers, the 
  9.14  health plan company is a large managed care plan company if it 
  9.15  has more than 50,000 enrollees in this state in health plans for 
  9.16  which it does employ or contract with providers. 
  9.17     Sec. 11.  [62Q.125] [ACCESS TO EMERGENCY CARE.] 
  9.18     A health plan company must pay for emergency services or 
  9.19  emergency confinement, if these services or confinement are 
  9.20  covered services, regardless of whether the provider seeking 
  9.21  payment belongs to the health plan company's provider network.  
  9.22  A health plan company may require that the enrollee be 
  9.23  transferred to a hospital or other facility within the health 
  9.24  plan company's network as soon as the patient is medically able 
  9.25  to be transferred safely, to the extent that the health plan 
  9.26  company is authorized by the applicable contract to make such a 
  9.27  requirement. 
  9.28     Sec. 12.  Minnesota Statutes 1994, section 62Q.17, 
  9.29  subdivision 3, is amended to read: 
  9.30     Subd. 3.  [GOVERNING STRUCTURE.] Each pool must have a 
  9.31  governing structure controlled by its members.  The governing 
  9.32  structure of the pool is responsible for administration of the 
  9.33  pool.  The governing structure shall review and evaluate all 
  9.34  bids for coverage from health plan companies, shall determine 
  9.35  criteria for joining and leaving the pool, and may design 
  9.36  incentives for healthy lifestyles and health promotion programs. 
 10.1   The governing structure may design uniform entrance standards 
 10.2   for all employers, except small employers as defined under 
 10.3   section 62L.02.  Small employers must be permitted to enter any 
 10.4   pool if the small employer meets the pool's membership 
 10.5   requirements.  Pools must provide as much choice in health plans 
 10.6   to members as is financially possible offer no fewer than three 
 10.7   health plan options to its members.  If offering three options 
 10.8   are not possible due to geographic limitations, then the pool 
 10.9   must offer as many plans as is practicable in the service area.  
 10.10  This requirement becomes effective when the pool's membership 
 10.11  reaches 1,000.  The governing structure may charge all members a 
 10.12  fee for administrative purposes. 
 10.13     Sec. 13.  Minnesota Statutes 1994, section 62Q.18, 
 10.14  subdivision 6, is amended to read: 
 10.15     Subd. 6.  [LIMITS ON PREMIUM RATE VARIATIONS.] (a) 
 10.16  Effective July 1, 1995, the premium rate variations permitted 
 10.17  under sections 62A.65 and 62L.08 become: 
 10.18     (1) for factors other than age and geography, 12.5 percent 
 10.19  of the index rate; and 
 10.20     (2) for age, 25 percent of the index rate.  If age-based 
 10.21  premium variations are applied by health plan companies, the 
 10.22  health plan company may create up to three separate age bracket 
 10.23  rating bands, each with its own index rate.  
 10.24     (b) Effective July 1, 1996, the premium variations 
 10.25  permitted under sections 62A.65 and 62L.08 become: 
 10.26     (1) for factors other than age and geography, 7.5 percent 
 10.27  of the index rate; and 
 10.28     (2) for age, 15 percent of the index rate.  If age-based 
 10.29  premium variations are applied by health plan companies, the 
 10.30  health plan company may create up to three separate age bracket 
 10.31  rating bands, each with its own index rate.  
 10.32     (c) Effective July 1, 1997, no health plan company shall 
 10.33  offer, sell, issue, or renew a health plan, that is subject to 
 10.34  section 62A.65 or 62L.08, for which the premium rate varies 
 10.35  between covered persons on the basis of any factor other than: 
 10.36     (1) for individual health plans, differences in benefits or 
 11.1   benefit design, and for group health plans, actuarially valid 
 11.2   differences in benefits or benefit design; 
 11.3      (2) the number of persons to be covered by the health plan; 
 11.4      (3) actuarially valid differences in expected costs between 
 11.5   adults and children; 
 11.6      (4) healthy lifestyle discounts authorized by statute; and 
 11.7      (5) for individual health plans, geographic variations 
 11.8   permitted under section 62A.65, and for group health plans, 
 11.9   geographic variations permitted under section 62L.08; and 
 11.10     (6) for age, a health plan company may have up to three 
 11.11  separate age brackets. 
 11.12     (d) All premium rate variations permitted under paragraph 
 11.13  (c) are subject to the approval of the commissioner. 
 11.14     (e) Notwithstanding paragraphs (a), (b), and (c), no health 
 11.15  plan company shall renew any individual or group health plan, 
 11.16  except in compliance with this paragraph.  No premium rate for 
 11.17  any policy holder or contract holder shall increase or decrease 
 11.18  upon renewal, as a result of this subdivision, by more than 15 
 11.19  percent per year.  The increase or decrease described in this 
 11.20  paragraph is in addition to any premium increase or decrease 
 11.21  caused by legally permissible factors other than this 
 11.22  subdivision.  If a premium increase or decrease is constrained 
 11.23  by this paragraph, the health plan company may implement the 
 11.24  remaining portion of the increase or decrease at the time of 
 11.25  subsequent annual renewals, but never to exceed 15 percent per 
 11.26  year for paragraphs (a), (b), and (c) combined. 
 11.27     Sec. 14.  [62Q.26] [POINT-OF-SERVICE OPTION.] 
 11.28     Subdivision 1.  [DEFINITION.] For purposes for this 
 11.29  section, "point-of-service product" means a health plan, as 
 11.30  defined in section 62A.011, under which the health plan company 
 11.31  will reimburse any appropriately licensed or registered provider 
 11.32  for providing any covered services to an enrollee, without 
 11.33  regard to whether the provider belongs to a particular network 
 11.34  and without regard to whether the enrollee was referred to the 
 11.35  provider by another provider.  For purposes of this definition, 
 11.36  a health plan offered by a health plan company is a 
 12.1   point-of-service product only if it includes "comprehensive 
 12.2   supplemental benefits" in compliance with section 62D.05, 
 12.3   subdivision 6, and Minnesota Rules, part 4685.1955. 
 12.4      Subd. 2.  [REQUIRED POINT-OF-SERVICE OPTION.] Each health 
 12.5   plan company operating in the individual, small group, or large 
 12.6   group market shall offer at least one point-of-service product 
 12.7   in each such market in which it operates. 
 12.8      Subd. 3.  [RATE APPROVAL.] The premium rates and cost 
 12.9   sharing requirements for each point-of-service product must be 
 12.10  submitted for approval to the commissioner of health or the 
 12.11  commissioner of commerce, as applicable.  The applicable 
 12.12  commissioner shall approve premium rates and cost sharing 
 12.13  requirements that are actuarially justified.  A health plan that 
 12.14  includes lower enrollee cost sharing for services provided by 
 12.15  network providers than for services provided by out-of-network 
 12.16  providers, or lower enrollee cost sharing for services provided 
 12.17  with a prior authorization or second opinion than for services 
 12.18  provided without prior authorization or second opinion, may 
 12.19  still qualify as a point-of-service product, provided that the 
 12.20  difference is approved by the applicable commissioner as 
 12.21  actuarially justified and provided that the enrollee 
 12.22  out-of-pocket expense for services provided by an out-of-network 
 12.23  provider or for services provided without prior approval or 
 12.24  second opinion does not exceed 120 percent of the usual and 
 12.25  customary charges for the services. 
 12.26     Sec. 15.  Minnesota Statutes 1994, section 62Q.41, is 
 12.27  amended to read: 
 12.28     62Q.41 [ANNUAL IMPLEMENTATION REPORT.] 
 12.29     The commissioner of health, in consultation with the 
 12.30  Minnesota health care commission, shall develop an annual 
 12.31  implementation report to be submitted to the legislature each 
 12.32  year beginning January 1, 1995, describing the progress and 
 12.33  status of rule development and implementation of the integrated 
 12.34  service network system and the regulated all-payer 
 12.35  option reformed system provided for under section 62J.017, and 
 12.36  providing recommendations for legislative changes that the 
 13.1   commissioner determines may be needed.  
 13.2      Sec. 16.  [62Q.43] [CITATION.] 
 13.3      Sections 62Q.43 to 62Q.53 shall be known and may be cited 
 13.4   as the "medical savings account act." 
 13.5      Sec. 17.  [62Q.45] [DEFINITIONS.] 
 13.6      Subdivision 1.  [APPLICABILITY.] For purposes of sections 
 13.7   62Q.43 to 62Q.53, the terms defined in this section have the 
 13.8   meanings given them. 
 13.9      Subd. 2.  [ACCOUNT ADMINISTRATOR.] "Account administrator" 
 13.10  means any of the following: 
 13.11     (1) a health plan company as defined in section 62Q.01, 
 13.12  subdivision 4; 
 13.13     (2) a third-party administrator; 
 13.14     (3) a financial institution licensed in this state; 
 13.15     (4) an employer that participates in the medical care 
 13.16  savings account program. 
 13.17     Subd. 3.  [DEDUCTIBLE.] "Deductible" means the total 
 13.18  deductible for an employee and all the dependents of that 
 13.19  employee for a calendar year. 
 13.20     Subd. 4.  [DEPENDENT.] "Dependent" means the spouse of the 
 13.21  employee or a child of the employee if the child is any of the 
 13.22  following: 
 13.23     (1) under 19 years of age, or under 25 years of age and 
 13.24  enrolled as a full-time student at an accredited college or 
 13.25  university; 
 13.26     (2) legally entitled to the provision of proper or 
 13.27  necessary subsistence, education, medical care, or other care 
 13.28  necessary for the child's health, guidance, or well-being and 
 13.29  not otherwise emancipated, self-supporting, married, or a member 
 13.30  of the armed forces of the United States; or 
 13.31     (3) mentally or physically incapacitated to the extent that 
 13.32  the child is not self-sufficient. 
 13.33     Subd. 5.  [DOMICILE.] "Domicile" means the location of an 
 13.34  individual's true, fixed, and permanent home or principal 
 13.35  establishment, to which, whenever absent, the individual intends 
 13.36  to return.  Domicile continues until another permanent home or 
 14.1   principal establishment is established. 
 14.2      Subd. 6.  [ELIGIBLE MEDICAL EXPENSE.] "Eligible medical 
 14.3   expense" means an expense paid by the taxpayer for medical care 
 14.4   described in section 213(d) of the Internal Revenue Code of 
 14.5   1986, as amended through December 31, 1994. 
 14.6      Subd. 7.  [EMPLOYEE.] "Employee" means the individual for 
 14.7   whose benefit or for the benefit of whose dependents a medical 
 14.8   care savings account is established. 
 14.9      Subd. 8.  [ERISA.] "ERISA" means the employer retirement 
 14.10  income security act of 1974, Public Law Number 93-406. 
 14.11     Subd. 9.  [MEDICAL CARE SAVINGS ACCOUNT OR 
 14.12  ACCOUNT.] "Medical care savings account" or "account" means an 
 14.13  interest-bearing account established by an employer as part of a 
 14.14  medical care savings account program to pay the eligible medical 
 14.15  expenses of an employee and the employee's dependents. 
 14.16     Sec. 18.  [62Q.47] [ESTABLISHMENT.] 
 14.17     Subdivision 1.  [REQUIREMENTS.] For tax years beginning on 
 14.18  or after January 1, 1996, an employer, except as otherwise 
 14.19  provided by law, contract, or a collective bargaining agreement, 
 14.20  may offer to employees a medical care savings account program. 
 14.21     An employer that offers a medical care savings account 
 14.22  program shall inform all employees in writing, before making any 
 14.23  contributions, of the federal tax status of contributions made 
 14.24  under sections 62Q.43 to 62Q.53. 
 14.25     Except as provided in section 62Q.51, principal contributed 
 14.26  to and interest earned on a medical care savings account and 
 14.27  money reimbursed to an employee for eligible medical expenses 
 14.28  are exempt from taxation under chapter 290. 
 14.29     Subd. 2.  [CONTRIBUTIONS.] Employees can contribute to the 
 14.30  medical savings account in addition to the employer's portion up 
 14.31  to the following annual maximum contribution:  
 14.32     (1) not more than $2,000 per employee; 
 14.33     (2) not more than $1,000 per dependent with a maximum of 
 14.34  two dependents. 
 14.35     Sec. 19.  [62Q.49] [ADMINISTRATION.] 
 14.36     Subdivision 1.  [USE OF FUNDS.] The account administrator 
 15.1   shall utilize the funds held in a medical care savings account 
 15.2   solely for the purpose of paying the eligible medical expenses 
 15.3   of the employee or the employee's dependents.  Funds held in a 
 15.4   medical care savings account shall not be used to cover medical 
 15.5   expenses of the employee or the employee's dependents that are 
 15.6   otherwise covered, including but not limited to, medical 
 15.7   expenses covered by an automobile insurance policy, workers' 
 15.8   compensation insurance policy or self-insured plan, or another 
 15.9   health coverage policy certificate or contract. 
 15.10     Subd. 2.  [REIMBURSEMENT.] Upon receipt of documentation of 
 15.11  medical expenses incurred by the employee in the tax year, the 
 15.12  account administrator shall reimburse the employee from the 
 15.13  employee's account for eligible medical expenses. 
 15.14     Subd. 3.  [ADVANCE TO EMPLOYEE.] If an employer makes 
 15.15  contributions to a medical care savings account on a periodic 
 15.16  installment basis, the employer shall advance to the employee, 
 15.17  interest free, the amount necessary to cover medical expenses 
 15.18  incurred by the employee that exceed the amount in the 
 15.19  employee's medical care savings account at the time the expense 
 15.20  is incurred, as long as the employee agrees to repay the advance 
 15.21  from future installments.  The total amount advanced by an 
 15.22  employer during a tax year must not exceed the total to be 
 15.23  contributed by the employer to the employee's medical savings 
 15.24  account during that tax year. 
 15.25     Subd. 4.  [CARRYOVER.] Money remaining in an employee's 
 15.26  medical savings account at the end of a taxable year remains in 
 15.27  the account for the next taxable year, and may be used to pay 
 15.28  for future eligible medical expenses of the employee or the 
 15.29  employee's dependents. 
 15.30     Subd. 5.  [PARTICIPATION AT START OF TAX YEAR.] Employers 
 15.31  that offer a medical savings account program shall allow 
 15.32  employees to elect participation only for a full tax year.  
 15.33  Employers may offer alternative health care coverage to 
 15.34  employees who become eligible for or choose to enroll in 
 15.35  employee-sponsored health care coverage during the interim 
 15.36  period before the start of a full tax year. 
 16.1      Sec. 20.  [62Q.51] [TAXATION OF WITHDRAWALS.] 
 16.2      Subdivision 1.  [WITHDRAWALS FOR OTHER PURPOSES.] An 
 16.3   employee may withdraw money from a medical care savings account 
 16.4   for any purpose other than a purpose described in section 
 16.5   62Q.49, subdivision 1, only on the last business day of the 
 16.6   account administrator's business year.  Money withdrawn under 
 16.7   this subdivision shall be treated as income as provided in 
 16.8   subdivision 2. 
 16.9      Subd. 2.  [TREATMENT AS INCOME.] Except as provided in 
 16.10  subdivision 3, if the employee withdraws money for any purpose 
 16.11  other than a purpose described in section 62Q.49, subdivision 1, 
 16.12  all of the following apply: 
 16.13     (1) the amount of the withdrawal is income for the purpose 
 16.14  of chapter 290; and 
 16.15     (2) interest earned on the account during the tax year in 
 16.16  which a withdrawal under this subdivision is made is income for 
 16.17  purposes of chapter 290. 
 16.18     Subd. 3.  [EXCEPTION.] The amount of a disbursement of any 
 16.19  assets of a medical care savings account pursuant to a filing 
 16.20  for protection under United States Code, title 11, sections 101 
 16.21  to 1330 by an employee or person for whose benefit the account 
 16.22  was established is not considered a withdrawal for purposes of 
 16.23  this section.  The amount of disbursement is not subject to 
 16.24  taxation under chapter 290. 
 16.25     Sec. 21.  [62Q.53] [CHANGES IN EMPLOYEE STATUS.] 
 16.26     Subdivision 1.  [DEATH OF EMPLOYEE.] Upon the death of an 
 16.27  employee, the account administrator shall distribute the 
 16.28  principal and accumulated interest of the medical care savings 
 16.29  account to the estate of the employee. 
 16.30     Subd. 2.  [CHANGES IN EMPLOYMENT STATUS.] (a) If an 
 16.31  employee is no longer employed by an employer that participates 
 16.32  in a medical care savings account program, the employee may 
 16.33  transfer the account to a new administrator, if the employee's 
 16.34  new employer participates in a medical care savings account 
 16.35  program.  The employee must notify the new administrator of the 
 16.36  request for transfer within 60 days after the employee's final 
 17.1   day of employment with the previous employer.  An employer 
 17.2   participating in a medical care savings account program shall 
 17.3   accept all requests for account transfers by new employees, if 
 17.4   the request for a transfer is made within this 60-day period. 
 17.5      (b) If the employee does not request a transfer under 
 17.6   paragraph (a), the employee may request in writing to the former 
 17.7   employer's account administrator, not later than 60 days after 
 17.8   the employee's final day of employment, that the account remain 
 17.9   with that administrator.  If the administrator rejects the 
 17.10  employee's requests, the former employer shall mail a check to 
 17.11  the former employee at the employee's last known address equal 
 17.12  to the amount in the former employee's account, not more than 30 
 17.13  days after the expiration of the 60-day period.  That amount is 
 17.14  subject to taxation under section 62Q.51. 
 17.15     Sec. 22.  Minnesota Statutes 1994, section 72A.20, is 
 17.16  amended by adding a subdivision to read: 
 17.17     Subd. 32.  [UNFAIR HEALTH RISK AVOIDANCE.] No insurer or 
 17.18  health plan company may design a network of providers, policies 
 17.19  on access to providers, or marketing strategy in such a way as 
 17.20  to discourage enrollment by individuals or groups whose health 
 17.21  care needs are perceived as likely to be more expensive than the 
 17.22  average.  This subdivision does not prohibit underwriting and 
 17.23  rating practices that comply with Minnesota law. 
 17.24     Sec. 23.  Minnesota Statutes 1994, section 72A.20, is 
 17.25  amended by adding a subdivision to read: 
 17.26     Subd. 33.  [PROHIBITION OF INAPPROPRIATE INCENTIVES.] No 
 17.27  insurer or health plan company may give any financial incentive 
 17.28  to a health care provider based on the number of requests for 
 17.29  services or referrals denied by the provider.  This subdivision 
 17.30  does not prohibit capitation or other compensation methods that 
 17.31  serve to hold health care providers financially accountable for 
 17.32  the cost of caring for a patient population. 
 17.33     Sec. 24.  Minnesota Statutes 1994, section 72A.20, is 
 17.34  amended by adding a subdivision to read: 
 17.35     Subd. 34.  [MISLEADING USE OF TERM "PROVIDER".] No insurer 
 17.36  or health plan company may use the word "provider" in enrollee 
 18.1   marketing, advertising, or contracting in a misleading or 
 18.2   inappropriate manner.  The type of health care provider must be 
 18.3   specified. 
 18.4      Sec. 25.  Laws 1994, chapter 625, article 5, section 5, is 
 18.5   amended to read: 
 18.6      Sec. 5.  [RECODIFICATION AND HEALTH PLAN COMPANY REGULATORY 
 18.7   REFORM.] 
 18.8      Subdivision 1.  [PROPOSED LEGISLATION.] The commissioners 
 18.9   of health and commerce, in consultation with the Minnesota 
 18.10  health care commission and the legislative commission on health 
 18.11  care access, shall draft a report, including proposed 
 18.12  legislation, to recodify, simplify, and standardize all key 
 18.13  statutes, rules, regulatory requirements, and procedures 
 18.14  relating to health plan companies.  The recodification and 
 18.15  regulatory reform must become effective simultaneously with the 
 18.16  full implementation of the integrated service network system and 
 18.17  the regulated all-payer option on July 1, 1997.  The purpose of 
 18.18  the proposed legislation shall be to create a system of common 
 18.19  accountability and a level regulatory environment for health 
 18.20  plan companies while still allowing health plan companies to 
 18.21  retain their present forms of licensure and to structure their 
 18.22  governance and delivery of care in a variety of ways.  The 
 18.23  commissioners of health and commerce shall submit the report to 
 18.24  the legislature by January 1, 1996, a report on the 
 18.25  recodification and regulatory reform with proposed legislation. 
 18.26     Subd. 2.  [CONTENTS OF LEGISLATION; REPORT.] (a) The 
 18.27  proposed legislation shall include a set of provisions that will 
 18.28  apply equally to all health plan companies and that will hold 
 18.29  them accountable for the cost, quality, and access of the health 
 18.30  coverage they provide.  These provisions shall include, among 
 18.31  other topics: 
 18.32     (1) a standard set of "insurance reform" provisions 
 18.33  addressing subjects including guaranteed issuance and 
 18.34  renewability of coverage, underwriting practices, and rating 
 18.35  practices, including those due to be implemented on July 1, 
 18.36  1997; 
 19.1      (2) a standard set of data reporting and health plan 
 19.2   company report card provisions; 
 19.3      (3) a standard set of covered services and of allowable 
 19.4   forms of enrollee cost sharing; 
 19.5      (4) appropriately tailored financial solvency provisions, 
 19.6   which may include a risk based capital mechanism; 
 19.7      (5) a standard set of patient protection provisions 
 19.8   including: 
 19.9      (i) provisions for resolving complaints about coverage 
 19.10  decisions and quality of service; 
 19.11     (ii) provisions to assure that patients have access to 
 19.12  ombudsman or patient advocacy services in dealing with their 
 19.13  health plan company; 
 19.14     (iii) provisions to assure that patients receive sufficient 
 19.15  information about how to access services within their health 
 19.16  plan company; 
 19.17     (iv) provisions to assure that a health plan company has 
 19.18  sufficient providers to provide appropriate geographic access 
 19.19  and authorizing regulatory intervention to protect enrollees in 
 19.20  cases where geographic accessibility standards are not met; and 
 19.21     (v) provisions prohibiting unfair competition and 
 19.22  misleading or unfair trade practices, including the misleading 
 19.23  use of the word "provider" in enrollee marketing and contracting 
 19.24  information; and 
 19.25     (6) participation in the Minnesota comprehensive health 
 19.26  association. 
 19.27     (b) The report submitted by the commissioners of health and 
 19.28  commerce shall identify regulatory provisions that apply to some 
 19.29  forms of health plan companies but not to others, and where that 
 19.30  disparate regulation results in competitive advantages or 
 19.31  disadvantages in the marketplace.  The report shall include 
 19.32  proposed legislation to eliminate such differences in 
 19.33  regulation, to the extent feasible and appropriate.  Where such 
 19.34  differences cannot be eliminated, the report shall include 
 19.35  proposed legislation to minimize the marketplace advantages or 
 19.36  disadvantages resulting from the state's disparate regulation. 
 20.1      Subd. 3.  [PRESERVATION OF CHOICES.] The proposed 
 20.2   legislation shall preserve, to the extent possible, the existing 
 20.3   forms of licensure under which health plan companies currently 
 20.4   operate, and should provide for licensure as an integrated 
 20.5   service network as an additional option for health plan 
 20.6   companies.  The proposed legislation shall preserve as much 
 20.7   flexibility as possible for health plan companies to operate 
 20.8   under varied corporate structures and systems of governance, and 
 20.9   to determine for themselves how to organize their delivery of 
 20.10  health care. 
 20.11     Subd. 2. 4.  [ADVISORY TASK FORCE.] The commissioner of 
 20.12  health shall convene an advisory task force to advise the 
 20.13  commissioner on the recodification and reform of regulatory 
 20.14  requirements under this section.  The task force must include 
 20.15  representatives of health plan companies, consumers, counties, 
 20.16  employers, labor unions, providers, and other affected persons. 
 20.17     Sec. 26.  [INSTRUCTION TO REVISOR.] 
 20.18     The revisor shall delete references to the "regulated 
 20.19  all-payer option" or the "regulated all-payer system" or similar 
 20.20  terms in Minnesota Statutes, sections 62J.04, 62J.09, 62J.152, 
 20.21  and elsewhere in Minnesota Statutes and Minnesota Rules. 
 20.22     Sec. 27.  [REPEALER.] 
 20.23     Minnesota Statutes 1994, sections 62P.01; 62P.02; 62P.03; 
 20.24  62P.07; 62P.09; 62P.11; 62P.13; 62P.15; 62P.17; 62P.19; 62P.21; 
 20.25  62P.23; 62P.25; 62P.29; 62P.31; and 62P.33, are repealed. 
 20.26     Sec. 28.  [EFFECTIVE DATE.] 
 20.27     Sections 16 to 21 are effective for tax years beginning on 
 20.28  or after January 1, 1996. 
 20.29                             ARTICLE 2
 20.30                    REGIONAL COORDINATING BOARDS 
 20.31     Section 1.  Minnesota Statutes 1994, section 62J.05, 
 20.32  subdivision 2, is amended to read: 
 20.33     Subd. 2.  [MEMBERSHIP.] (a)  [NUMBER.] The Minnesota health 
 20.34  care commission consists of 27 28 members, as specified in this 
 20.35  subdivision.  A member may designate a representative to act as 
 20.36  a member of the commission in the member's absence.  The 
 21.1   governor and legislature shall coordinate appointments under 
 21.2   this subdivision to ensure gender balance and ensure that 
 21.3   geographic areas of the state are represented in proportion to 
 21.4   their population. 
 21.5      (b)  [HEALTH PLAN COMPANIES.] The commission includes four 
 21.6   members representing health plan companies, including one member 
 21.7   appointed by the Minnesota Council of Health Maintenance 
 21.8   Organizations, one member appointed by the Insurance Federation 
 21.9   of Minnesota, one member appointed by Blue Cross and Blue Shield 
 21.10  of Minnesota, and one member appointed by the governor. 
 21.11     (c)  [HEALTH CARE PROVIDERS.] The commission includes six 
 21.12  members representing health care providers, including one member 
 21.13  appointed by the Minnesota Hospital Association, one member 
 21.14  appointed by the Minnesota Medical Association, one member 
 21.15  appointed by the Minnesota Nurses' Association, one rural 
 21.16  physician appointed by the governor, and two members appointed 
 21.17  by the governor to represent providers other than hospitals, 
 21.18  physicians, and nurses. 
 21.19     (d)  [EMPLOYERS.] The commission includes four members 
 21.20  representing employers, including (1) two members appointed by 
 21.21  the Minnesota Chamber of Commerce, including one self-insured 
 21.22  employer and one small employer; and (2) two members appointed 
 21.23  by the governor. 
 21.24     (e)  [CONSUMERS.] The commission includes seven consumer 
 21.25  members, including three members appointed by the governor, one 
 21.26  of whom must represent persons over age 65; one member appointed 
 21.27  by the consortium of citizens with disabilities to represent 
 21.28  consumers with physical disabilities or chronic illness; one 
 21.29  member appointed by the mental health association of Minnesota, 
 21.30  in consultation with the Minnesota chapter of the society of 
 21.31  Americans for recovery, to represent consumers with mental 
 21.32  illness or chemical dependency; one appointed under the rules of 
 21.33  the senate; and one appointed under the rules of the house of 
 21.34  representatives. 
 21.35     (f)  [EMPLOYEE UNIONS.] The commission includes three 
 21.36  representatives of labor unions, including two appointed by the 
 22.1   AFL-CIO Minnesota and one appointed by the governor to represent 
 22.2   other unions. 
 22.3      (g)  [STATE AGENCIES.] The commission includes the 
 22.4   commissioners of commerce, employee relations, and human 
 22.5   services. 
 22.6      (h)  [REGIONAL COORDINATING BOARDS.] The commission 
 22.7   includes one chair of a regional coordinating board established 
 22.8   under section 62J.09, appointed by the regional coordinating 
 22.9   board overview committee established under section 62J.095. 
 22.10     (i)  [CHAIR.] The governor shall designate the chair of the 
 22.11  commission from among the governor's appointees. 
 22.12     Sec. 2.  Minnesota Statutes 1994, section 62J.09, 
 22.13  subdivision 1, is amended to read: 
 22.14     Subdivision 1.  [GENERAL DUTIES.] The regional coordinating 
 22.15  boards are locally controlled boards consisting of providers, 
 22.16  health plan companies, employers, consumers, and elected 
 22.17  officials.  Regional boards may: 
 22.18     (1) recommend that the commissioner approve voluntary 
 22.19  agreements between providers in the region that will improve 
 22.20  quality, access, or affordability of health care but might 
 22.21  constitute a violation of antitrust laws if undertaken without 
 22.22  government direction; 
 22.23     (2) make recommendations to the commissioner regarding 
 22.24  major capital expenditures or the introduction of expensive new 
 22.25  technologies and medical practices that are being proposed or 
 22.26  considered by providers; 
 22.27     (3) undertake voluntary activities to educate consumers, 
 22.28  providers, and purchasers or to promote voluntary, cooperative 
 22.29  community cost containment, access, or quality of care projects; 
 22.30     (4) make recommendations to the commissioner regarding ways 
 22.31  of improving affordability, accessibility, and quality of health 
 22.32  care in the region and throughout the state.; 
 22.33     (5) advise the Minnesota health care commission established 
 22.34  under section 62J.05 on policy matters under consideration by 
 22.35  the health care commission; 
 22.36     (6) report periodically to the health care commission on 
 23.1   developments within the region; and 
 23.2      (7) educate consumers, providers, and purchasers about 
 23.3   community plans and projects promoting health care cost 
 23.4   containment, consumer accountability, access, and quality.  
 23.5   Regional boards shall prepare a regional education plan each 
 23.6   year that is consistent with and supportive of public health 
 23.7   goals identified by community health boards established under 
 23.8   chapter 145A. 
 23.9      Sec. 3.  Minnesota Statutes 1994, section 62J.09, 
 23.10  subdivision 6, is amended to read: 
 23.11     Subd. 6.  [TECHNICAL ASSISTANCE.] The commissioner shall 
 23.12  provide technical assistance to regional coordinating 
 23.13  boards.  Technical assistance includes providing each regional 
 23.14  board with timely information concerning action plans, 
 23.15  enrollment data, and health care capital expenditures affecting 
 23.16  the regional board's region. 
 23.17     Sec. 4.  [62J.095] [REGIONAL COORDINATING BOARD OVERVIEW 
 23.18  COMMITTEE.] 
 23.19     Subdivision 1.  [GENERAL DUTIES.] The regional coordinating 
 23.20  board overview committee is created to improve communication and 
 23.21  coordination between the Minnesota health care commission 
 23.22  established under section 62J.05 and the regional coordinating 
 23.23  boards established under section 62J.09.  The committee shall 
 23.24  meet as needed. 
 23.25     Subd. 2.  [MEMBERSHIP.] The regional coordinating board 
 23.26  overview committee consists of the chairs of each regional 
 23.27  coordinating board established under section 62J.09 and two 
 23.28  members of the Minnesota health care commission established 
 23.29  under section 62J.05.  The two committee members selected from 
 23.30  the Minnesota health care commission are appointed by the chair 
 23.31  of the commission.  One committee member selected from the 
 23.32  Minnesota health care commission must reside within the 
 23.33  seven-county metropolitan area and the other must reside outside 
 23.34  of the seven-county metropolitan area.  The members of the 
 23.35  regional coordinating board overview committee may select a 
 23.36  committee chair from within the committee's membership. 
 24.1      Subd. 3.  [STAFF SUPPORT.] The commissioner shall provide 
 24.2   staff support to the regional coordinating board overview 
 24.3   committee, if requested to by the committee. 
 24.4      Subd. 4.  [REPEALER.] This section is repealed effective 
 24.5   July 1, 1996. 
 24.6                              ARTICLE 3 
 24.7                  DATA, TECHNOLOGY, AND INFORMATION 
 24.8      Section 1.  Minnesota Statutes 1994, section 13.99, is 
 24.9   amended by adding a subdivision to read: 
 24.10     Subd. 115.  [HEALTH DATA INSTITUTE DATA.] Data created, 
 24.11  collected, received, maintained, or disseminated by the 
 24.12  Minnesota health data institute established under section 62J.45 
 24.13  are governed by section 62J.451. 
 24.14     Sec. 2.  Minnesota Statutes 1994, section 62J.152, is 
 24.15  amended to read: 
 24.16     62J.152 [DUTIES OF HEALTH TECHNOLOGY ADVISORY COMMITTEE.] 
 24.17     Subdivision 1.  [GENERALLY.] The health technology advisory 
 24.18  committee established in section 62J.15 shall: 
 24.19     (1) develop criteria and processes for evaluating health 
 24.20  care technology assessments made by other entities; 
 24.21     (2) conduct evaluations of specific technologies and their 
 24.22  specific use and application; 
 24.23     (3) report the results of the evaluations to the 
 24.24  commissioner and the Minnesota health care commission; and 
 24.25     (4) develop a communication plan for the dissemination of 
 24.26  information and reports to providers and other interested 
 24.27  parties.  This communication plan must be submitted to the 
 24.28  health care commission for review and implementation; and 
 24.29     (5) carry out other duties relating to health technology 
 24.30  assigned by the commission. 
 24.31     The chair of the health technology advisory committee shall 
 24.32  be a full voting member on the board of the health data 
 24.33  institute. 
 24.34     Subd. 2.  [PRIORITIES FOR DESIGNATING TECHNOLOGIES FOR 
 24.35  ASSESSMENT.] The health technology advisory committee shall 
 24.36  consider the following criteria in designating technologies for 
 25.1   evaluation: 
 25.2      (1) the level of controversy within the medical or 
 25.3   scientific community, including questionable or undetermined 
 25.4   efficacy; 
 25.5      (2) the cost implications; 
 25.6      (3) the potential for rapid diffusion; 
 25.7      (4) the impact on a substantial patient population; 
 25.8      (5) the existence of alternative technologies; 
 25.9      (6) the impact on patient safety and health outcome; 
 25.10     (7) the public health importance; 
 25.11     (8) the level of public and professional demand; 
 25.12     (9) the social, ethical, and legal concerns; and 
 25.13     (10) the prevalence of the disease or condition. 
 25.14  The committee may give different weights or attach different 
 25.15  importance to each of the criteria, depending on the technology 
 25.16  being considered.  The committee shall consider any additional 
 25.17  criteria approved by the commissioner and the Minnesota health 
 25.18  care commission. 
 25.19     Subd. 3.  [CRITERIA FOR EVALUATING TECHNOLOGY.] In 
 25.20  developing the criteria for evaluating specific technologies, 
 25.21  the health technology advisory committee shall consider safety, 
 25.22  improvement in health outcomes, and the degree to which a 
 25.23  technology is clinically effective and cost-effective, and other 
 25.24  factors. 
 25.25     Subd. 4.  [TECHNOLOGY EVALUATION PROCESS.] (a) The health 
 25.26  technology advisory committee shall collect and evaluate studies 
 25.27  and research findings on the technologies selected for 
 25.28  evaluation from as wide of a range of sources as needed, 
 25.29  including, but not limited to:  federal agencies or other units 
 25.30  of government, international organizations conducting health 
 25.31  care technology assessments, health carriers, insurers, 
 25.32  manufacturers, professional and trade associations, nonprofit 
 25.33  organizations, and academic institutions.  The health technology 
 25.34  advisory committee may use consultants or experts and solicit 
 25.35  testimony or other input as needed to evaluate a specific 
 25.36  technology. 
 26.1      (b) When the evaluation process on a specific technology 
 26.2   has been completed, the health technology advisory committee 
 26.3   shall submit a preliminary report to the health care commission 
 26.4   and publish a summary of the preliminary report in the State 
 26.5   Register with a notice that written comments may be submitted.  
 26.6   The preliminary report must include the results of the 
 26.7   technology assessment evaluation, studies and research findings 
 26.8   considered in conducting the evaluation, and the health 
 26.9   technology advisory committee's summary statement about the 
 26.10  evaluation.  Any interested persons or organizations may submit 
 26.11  to the health technology advisory committee written comments 
 26.12  regarding the technology evaluation within 30 days from the date 
 26.13  the preliminary report was published in the State Register.  The 
 26.14  health technology advisory committee's final report on its 
 26.15  technology evaluation must be submitted to the health care 
 26.16  commission.  A summary of written comments received by the 
 26.17  health technology advisory committee within the 30-day period 
 26.18  must be included in the final report.  The health care 
 26.19  commission shall review the final report and prepare its 
 26.20  comments and recommendations.  Before completing its final 
 26.21  comments and recommendations, the health care commission shall 
 26.22  provide adequate public notice that testimony will be accepted 
 26.23  by the health care commission.  The health care commission shall 
 26.24  then forward the final report, its comments and recommendations, 
 26.25  and a summary of the public's comments to the commissioner and 
 26.26  information clearinghouse.  This information shall also be filed 
 26.27  with and made available to the public by the commissioner of 
 26.28  health. 
 26.29     (c) The health technology advisory committee shall develop 
 26.30  a methodology for studying the efficacy of the committee's 
 26.31  recommendations.  The committee shall, at least annually, review 
 26.32  its recommendations using the methodology, and shall submit 
 26.33  reports to the health care commission to include its findings 
 26.34  and any recommendations for change in prior technology 
 26.35  assessments. 
 26.36     (d) The reports of the health technology advisory committee 
 27.1   and the comments and recommendations of the health care 
 27.2   commission should not eliminate or bar new technology, and are 
 27.3   not rules as defined in the administrative procedure act. 
 27.4      Subd. 5.  [USE OF TECHNOLOGY EVALUATION.] (a) The final 
 27.5   report on the technology evaluation and the commission's 
 27.6   comments and recommendations may be used: 
 27.7      (1) by the commissioner in retrospective and prospective 
 27.8   review of major expenditures; 
 27.9      (2) by integrated service networks health plan companies 
 27.10  and other group purchasers and by employers, in making coverage, 
 27.11  contracting, purchasing, and reimbursement decisions; 
 27.12     (3) by government programs and regulators of the regulated 
 27.13  all-payer option, in making coverage, contracting, purchasing, 
 27.14  and reimbursement decisions; 
 27.15     (4) by the commissioner and other organizations in the 
 27.16  development of practice parameters; 
 27.17     (5) by health care providers in making decisions about 
 27.18  adding or replacing technology and the appropriate use of 
 27.19  technology; 
 27.20     (6) by consumers in making decisions about treatment; 
 27.21     (7) by medical device manufacturers in developing and 
 27.22  marketing new technologies; and 
 27.23     (8) as otherwise needed by health care providers, health 
 27.24  care plans, consumers, and purchasers. 
 27.25     (b) At the request of the commissioner, the health care 
 27.26  commission, in consultation with the health technology advisory 
 27.27  committee, shall submit specific recommendations relating to 
 27.28  technologies that have been evaluated under this section for 
 27.29  purposes of retrospective and prospective review of major 
 27.30  expenditures and coverage, contracting, purchasing, and 
 27.31  reimbursement decisions affecting state programs and the 
 27.32  all-payer option. 
 27.33     Subd. 6.  [APPLICATION TO THE REGULATED ALL-PAYER OPTION.] 
 27.34  The health technology advisory committee shall recommend to the 
 27.35  Minnesota health care commission and the commissioner methods to 
 27.36  control the diffusion and use of technology within the regulated 
 28.1   all-payer option for services provided outside of an integrated 
 28.2   service network. 
 28.3      Subd. 7. 6.  [DATA GATHERING.] In evaluating a specific 
 28.4   technology, the health technology advisory committee may seek 
 28.5   the use of data collected by manufacturers, health plans, 
 28.6   professional and trade associations, nonprofit organizations, 
 28.7   academic institutions, or any other organization or association 
 28.8   that may have data relevant to the committee's technology 
 28.9   evaluation.  All information obtained under this subdivision 
 28.10  shall be considered nonpublic data under section 13.02, 
 28.11  subdivision 9, unless the data is are already available to the 
 28.12  public generally or upon request. 
 28.13     Sec. 3.  [62J.301] [STATE DATA COLLECTION INITIATIVES.] 
 28.14     Subdivision 1.  [STATEMENT OF PURPOSE.] In an effort to 
 28.15  reform the health care delivery system and improve public 
 28.16  health, the state has undertaken significant data collection 
 28.17  initiatives.  In order to be useful, data collection activities 
 28.18  must have uniformity, statistical significance, and benefits 
 28.19  that outweigh the cost.  Data privacy and accuracy remain a 
 28.20  crucial consideration in collection efforts, and it is the 
 28.21  policy of the legislature to assure the highest standards to the 
 28.22  people of Minnesota as the state undertakes collection efforts.  
 28.23  For these reasons, the following standard set of safeguards and 
 28.24  criteria have been created for the collection of health-related 
 28.25  data by the state through the department of health and the 
 28.26  Minnesota health data institute. 
 28.27     Subd. 2.  [GOALS AND CRITERIA FOR DATA INITIATIVES.] Data 
 28.28  and research initiatives by the department of health and the 
 28.29  state health data institute must: 
 28.30     (a) be statewide in scope, to the extent feasible, in order 
 28.31  to benefit health care purchasers and providers in all parts of 
 28.32  Minnesota and to ensure a broad and representative database for 
 28.33  research, comparisons, and applications; 
 28.34     (b) consider the differences in health care delivery models 
 28.35  and access to health care services between the urban and rural 
 28.36  areas of the state; 
 29.1      (c) develop a plan for valid and statistically significant 
 29.2   comparisons of health care delivery in rural Minnesota which may 
 29.3   include, but is not limited to:  access, utilization, preventive 
 29.4   services, admission rates, disease detection and treatment, 
 29.5   morbidity and mortality.  This comparison may be accomplished by 
 29.6   county or by region involving, at a minimum, a population base 
 29.7   of 10,000 persons; 
 29.8      (d) make available to providers information and data that 
 29.9   will enable them to improve health care delivery through 
 29.10  internal quality improvement measures; 
 29.11     (e) emphasize data that are useful, relevant, and not 
 29.12  redundant of existing data; 
 29.13     (f) be structured to minimize the administrative burden on 
 29.14  health carriers, health care providers, and the health care 
 29.15  delivery system, and maximize the privacy protections of 
 29.16  individual patients and providers; 
 29.17     (g) promote continuous improvement in the efficiency and 
 29.18  effectiveness of health care delivery; 
 29.19     (h) be analyzed from a cost-benefit perspective to ensure 
 29.20  that the financial and administrative costs of the initiative do 
 29.21  not outweigh the expected benefit.  This analysis must occur 
 29.22  before embarking on the data initiative, and the potential 
 29.23  result must be of significant value as to merit the initiative; 
 29.24  and 
 29.25     (i) be disseminated to health care providers through 
 29.26  educational and other means, and are intended for use in 
 29.27  continuous quality improvement for providers. 
 29.28     Subd. 3.  [DEPARTMENT OF HEALTH DATA CRITERIA.] The 
 29.29  department of health data and research initiatives must: 
 29.30     (a) assist the state's current health care financing and 
 29.31  delivery programs to deliver and purchase health care in a 
 29.32  manner that promotes improvements in health care efficiency and 
 29.33  effectiveness; 
 29.34     (b) assist the state in its public health activities, 
 29.35  including the analysis of disease prevalence and trends and the 
 29.36  development of public health responses; 
 30.1      (c) assist the state in developing and refining its overall 
 30.2   health policy, including policy related to health care costs, 
 30.3   quality, and access; and 
 30.4      (d) provide a data source that allows the evaluation of 
 30.5   state health care financing and delivery programs. 
 30.6      Subd. 4.  [HEALTH DATA INSTITUTE DATA COLLECTION.] The 
 30.7   Minnesota health data institute shall collect data from health 
 30.8   care providers, health carriers, and individuals in the most 
 30.9   cost-effective manner, which does not unduly burden them.  The 
 30.10  commissioner may require health care providers and health 
 30.11  carriers to cooperate with the data collection process.  All 
 30.12  health care providers, group purchasers, and state agencies 
 30.13  shall be required to use a standard patient identifier and a 
 30.14  standard identifier for providers and health plans when 
 30.15  reporting data under this chapter.  Patient and provider 
 30.16  identifiers must be encrypted to prevent identification and to 
 30.17  enable release of otherwise private data to researchers, 
 30.18  providers, and group purchasers in a manner consistent with 
 30.19  chapter 13 and section 144.335. 
 30.20     Subd. 5.  [DATA CLASSIFICATION.] Any person or organization 
 30.21  receiving either private data on individuals or nonpublic data 
 30.22  under sections 62J.301 to 62J.451 is required to sign an 
 30.23  agreement to maintain the data that it receives according to the 
 30.24  statutory provisions applicable to the data.  Release of 
 30.25  private, confidential, or nonpublic data under this chapter 
 30.26  shall be made without releasing data that identifies patients or 
 30.27  providers and should instead be released using the 
 30.28  identification numbers required by subdivision 4. 
 30.29     Subd. 6.  [FEDERAL AND OTHER GRANTS.] The commissioner and 
 30.30  the health data institute shall seek federal funding, and 
 30.31  funding from private and other nonstate sources, for state data 
 30.32  initiatives.  Health data institute solicitation of funding from 
 30.33  private sources for initiatives of the institute are not be 
 30.34  subject to section 10A.071.  For purposes of this section, 
 30.35  "state data initiatives" is defined as initiatives of the 
 30.36  Minnesota health data institute or the department of health. 
 31.1      Subd. 7.  [CONTRACTS AND GRANTS.] To carry out the duties 
 31.2   assigned in sections 62J.301 to 62J.451, the commissioner and 
 31.3   the health data institute may contract with or provide grants to 
 31.4   private sector entities.  Any contract or grant must require the 
 31.5   private sector entity to maintain the data on individuals which 
 31.6   it receives according to the statutory provisions applicable to 
 31.7   the data, and are subject to section 13.09. 
 31.8      Subd. 8.  [RULEMAKING.] The commissioner may adopt 
 31.9   permanent rules to implement sections 62J.301 to 62J.452. 
 31.10     Sec. 4.  [62J.302] [DEPARTMENT OF HEALTH; DATA 
 31.11  RESPONSIBILITIES.] 
 31.12     Subdivision 1.  [PUBLIC HEALTH DATA AND RESEARCH 
 31.13  INITIATIVES.] The department's public health data and research 
 31.14  initiatives shall be as follows: 
 31.15     (1) perform disease tracking and surveillance; 
 31.16     (2) conduct population-based studies to determine incidence 
 31.17  rates; 
 31.18     (3) develop public health responses; 
 31.19     (4) serve the needs of the public sector health care 
 31.20  delivery system; 
 31.21     (5) issue reports on worksite wellness and disease 
 31.22  prevention; and 
 31.23     (6) other public health initiatives specifically authorized 
 31.24  in statute. 
 31.25     Subd. 2.  [HEALTH CARE SYSTEM DATA AND RESEARCH.] The 
 31.26  department's health care system data and research initiatives 
 31.27  shall be as follows: 
 31.28     (1) collect financial data to measure growth limit 
 31.29  compliance; 
 31.30     (2) collect data on premiums, benefit levels, prices, and 
 31.31  other health plan features; 
 31.32     (3) participate as a partner of the Minnesota health data 
 31.33  institute and sponsor of private sector data initiatives that 
 31.34  promote and improve health care efficiency and effectiveness; 
 31.35     (4) provide technical assistance to the health technology 
 31.36  advisory committee; 
 32.1      (5) assist the state health care financing and delivery 
 32.2   system in the delivery and purchase of effective and efficient 
 32.3   health care; 
 32.4      (6) assist the executive and legislative branches of state 
 32.5   government in developing and refining the state's overall health 
 32.6   policy, including policy related to health care costs and access 
 32.7   to care; 
 32.8      (7) require group purchasers and health care providers to 
 32.9   provide data on quality of care and utilization to the health 
 32.10  data institute; 
 32.11     (8) define, develop, and implement a financial 
 32.12  risk-adjustment system; 
 32.13     (9) provide information on coverage options in each 
 32.14  regional coordinating board region of the state; 
 32.15     (10) help consumers use the health care system to obtain 
 32.16  coverage; 
 32.17     (11) provide information on the availability of purchasing 
 32.18  pools and enrollee subsidies; 
 32.19     (12) explain and assist in the use of all available 
 32.20  complaint systems including internal complaint systems within 
 32.21  health plan companies and the departments of health and 
 32.22  commerce; and 
 32.23     (13) assist the health data institute in the development of 
 32.24  a "health information library" which will act as a centralized 
 32.25  repository of data initiatives of the health data institute and 
 32.26  the department of health; technology assessments of the health 
 32.27  technology advisory committee; and of private data initiatives 
 32.28  voluntarily submitted to the state. 
 32.29     Sec. 5.  Minnesota Statutes 1994, section 62J.35, 
 32.30  subdivision 3, is amended to read: 
 32.31     Subd. 3.  [DATA PRIVACY.] All data on patients or providers 
 32.32  received under this section or under section 62J.04, 62J.37, 
 32.33  62J.38, 62J.41, or 62J.42 is are private or nonpublic, except to 
 32.34  the extent that it is they are given a different classification 
 32.35  elsewhere in this chapter.  The commissioner shall establish 
 32.36  procedures and safeguards to ensure that data released by the 
 33.1   commissioner is are in a form that does do not identify specific 
 33.2   patients, providers, employers, purchasers, or other specific 
 33.3   individuals and organizations, except with the permission of the 
 33.4   affected individual or organization, or as permitted elsewhere 
 33.5   in this chapter. 
 33.6      Sec. 6.  Minnesota Statutes 1994, section 62J.35, is 
 33.7   amended by adding a subdivision to read: 
 33.8      Subd. 6.  [RELEASE OF DATA WITHOUT PATIENT CONSENT AND 
 33.9   IMMUNITY.] The release of data to the commissioner or the health 
 33.10  data institute pursuant to this chapter by any group purchaser 
 33.11  or health care provider, as defined in section 62J.03, shall not 
 33.12  require patient consent.  Any group purchaser or health care 
 33.13  provider that releases data to the commissioner or health data 
 33.14  institute pursuant to this chapter is immune from civil 
 33.15  liability and criminal prosecution. 
 33.16     Sec. 7.  Minnesota Statutes 1994, section 62J.44, is 
 33.17  amended to read: 
 33.18     62J.44 [PUBLICATION OF DATA.] 
 33.19     (a) Notwithstanding section 62J.35, subdivision 3, the 
 33.20  commissioner and the health data institute may publish data on 
 33.21  health care costs and spending, quality and outcomes, and 
 33.22  utilization for health care institutions, individual health care 
 33.23  professionals and groups of health care professionals, group 
 33.24  purchasers, and integrated service networks health plan 
 33.25  companies, with a description of the methodology used for 
 33.26  analysis, in order to provide information to purchasers and 
 33.27  consumers of health care.  The commissioner shall not reveal the 
 33.28  name of an institution, group of professionals, individual 
 33.29  health care professional, group purchaser, or integrated service 
 33.30  network until after the institution, group of professionals, 
 33.31  individual health care professional, group purchaser, or 
 33.32  integrated service network has had 15 days to review the data 
 33.33  and comment.  The commissioner shall include any comments 
 33.34  received in the release of the data.  Notwithstanding any other 
 33.35  law to the contrary, the commissioner or the health data 
 33.36  institute shall release identifiable data on an institution, 
 34.1   group of professionals, individual health care professional, 
 34.2   group purchaser, or health plan company only at such time as the 
 34.3   data are reasonably determined by the commissioner or the health 
 34.4   data institute to be accurate, complete, reliable, case mixed 
 34.5   and severity adjusted, and statistically and clinically 
 34.6   significant and valid.  The commissioner or the health data 
 34.7   institute shall provide an institution, group of professionals, 
 34.8   individual health care professional, group purchaser, or health 
 34.9   plan company with a reasonable period of time, and in no event 
 34.10  less than 30 days, to review and comment on the data to be 
 34.11  released.  The commissioner or the health data institute shall 
 34.12  include any comments received with the release of the data.  An 
 34.13  institution, group of professionals, individual health care 
 34.14  professional, group purchaser, or health plan company shall have 
 34.15  the right to contest publication of identifiable data pursuant 
 34.16  to paragraph (b). 
 34.17     (b) An institution, group of professionals, individual 
 34.18  health care professional, group purchaser, or health plan 
 34.19  company that has received notice of the publication of their 
 34.20  identifiable data has the right to present concerns in a hearing 
 34.21  pursuant to a contested case, except that the report of the 
 34.22  administrative law judge shall be binding on all parties to the 
 34.23  proceeding and if appropriate shall be implemented by an order 
 34.24  as provided in this paragraph.  The hearing shall be conducted 
 34.25  at a place designated by the commissioner or the health data 
 34.26  institute, within the county where the party requesting the 
 34.27  hearing resides or has a principal place of business.  The 
 34.28  hearing shall be conducted in accordance with sections 14.57 to 
 34.29  14.62, and is subject to appeal in accordance with sections 
 34.30  14.63 to 14.68.  The administrative law judge shall make 
 34.31  findings of fact and conclusions of law, and shall determine by 
 34.32  clear and convincing evidence whether the commissioner or the 
 34.33  health data institute has reasonably determined that the 
 34.34  identifiable data to be released is accurate, complete, 
 34.35  reliable, case mixed and severity adjusted, and statistically 
 34.36  and clinically significant and valid.  If the administrative law 
 35.1   judge finds that the commissioner or the health data institute 
 35.2   have not met this burden of proof, the administrative law judge 
 35.3   shall issue an order directing the commissioner or the health 
 35.4   data institute to cease and desist from the release of the 
 35.5   data.  The order shall be a final decision of the department.  
 35.6   If the administrative law judge makes findings of fact, 
 35.7   conclusions of law, and an order in favor of the commissioner or 
 35.8   the health data institute, the order shall be a final decision 
 35.9   of the department or the health data institute.  The 
 35.10  administrative law judge shall cause the findings of fact, 
 35.11  conclusions of law and order to be served on the party that 
 35.12  requested the hearing by registered or certified mail, and shall 
 35.13  furnish copies to the commissioner and the health data 
 35.14  institute.  Attorney's fees shall be awarded pursuant to 
 35.15  sections 15.471 to 15.475.  The hearing procedure and appeal 
 35.16  process is not an exclusive remedy and any person has the right 
 35.17  to seek a remedy pursuant to section 13.08, subdivisions 1 to 4, 
 35.18  or as otherwise authorized by law.  Data shall remain private or 
 35.19  nonpublic during the hearing and appeal process.  Nothing in 
 35.20  this section shall prevent the commissioner or the health data 
 35.21  institute from voluntarily modifying the data to be released to 
 35.22  meet the concerns of the party contesting the release before a 
 35.23  contested hearing or appeal. 
 35.24     (c) Summary data derived from data collected under this 
 35.25  chapter may be provided under section 13.05, subdivision 
 35.26  7, clause (1), and may be released in studies produced by the 
 35.27  commissioner or the health data institute or otherwise in 
 35.28  accordance with chapter 13. 
 35.29     (d) Notwithstanding sections 13.03, subdivisions 6 to 8; 
 35.30  and 13.10, subdivisions 1 to 4, data received by the 
 35.31  commissioner or the health data institute pursuant to this 
 35.32  chapter shall retain the classification designated under this 
 35.33  chapter and shall not be disclosed other than pursuant to this 
 35.34  chapter. 
 35.35     Sec. 8.  Minnesota Statutes 1994, section 62J.45, is 
 35.36  amended to read: 
 36.1      62J.45 [DATA INSTITUTE.] 
 36.2      Subdivision 1.  [STATEMENT OF PURPOSE.] It is the intention 
 36.3   of the legislature to create a public-private mechanism for the 
 36.4   collection of health care costs, cost and quality, and outcome 
 36.5   data, to the extent administratively efficient and effective.  
 36.6   This integrated data system will provide clear, usable 
 36.7   information on the cost, quality, and structure of health care 
 36.8   services in Minnesota. 
 36.9      The health reform initiatives being implemented rely 
 36.10  heavily on the availability of valid, objective data that 
 36.11  currently are collected in many forms within the health care 
 36.12  industry.  Data collection needs cannot be efficiently met by 
 36.13  undertaking separate data collection efforts. 
 36.14     The data institute created in this section will be a 
 36.15  partnership between the commissioner of health and a board of 
 36.16  directors representing health carriers and other group 
 36.17  purchasers, health care providers, and consumers.  These 
 36.18  entities will work together to establish a centralized cost and 
 36.19  quality data system that will be used by the public and private 
 36.20  sectors.  The data collection advisory committee and the 
 36.21  practice parameter advisory committee shall provide assistance 
 36.22  to the institute through the commissioner of health.  The health 
 36.23  data institute shall adopt data collection and publication 
 36.24  policies that reflect the importance of protecting the right of 
 36.25  privacy of patients in their health care data in connection with 
 36.26  each data initiative that the health data institute intends to 
 36.27  undertake.  
 36.28     Subd. 2.  [DEFINITIONS.] For purposes of this section and 
 36.29  section 62J.451, the following definitions apply.  
 36.30     (a) "Analysis" means a compilation or identification of 
 36.31  selected data elements, a description of the methodology used to 
 36.32  select and/or analyze those data elements, and any other 
 36.33  commentary, conclusions, or other descriptive material that the 
 36.34  data institute determines is appropriately included, all of 
 36.35  which is undertaken by the data institute for one or more of the 
 36.36  purposes or objectives set forth in subdivisions 1 and 3, or by 
 37.1   other authorized researchers according to section 62J.451, 
 37.2   subdivision 6. 
 37.3      (b) "Board" means the board of directors of the Minnesota 
 37.4   health data institute. 
 37.5      (c) "Health data institute" means the public-private 
 37.6   partnership established under this section. 
 37.7      (b) (d) "Encounter level data" means data related to the 
 37.8   utilization of health care services by, and the provision of 
 37.9   health care services to individual patients, enrollees, or 
 37.10  insureds, including claims data, abstracts of medical records, 
 37.11  and data from patient interviews and patient surveys. 
 37.12     (c) (e) "Health carrier" has the definition provided in 
 37.13  section 62A.011, subdivision 2. 
 37.14     (f) "Health plan company" has the definition provided in 
 37.15  section 62Q.01, subdivision 4. 
 37.16     (g) "Patient-identifying data" means data that identify a 
 37.17  patient directly, or which identifies characteristics which 
 37.18  reasonably could uniquely identify such specific patients 
 37.19  circumstantially.  For purposes of this definition, a patient is 
 37.20  not "directly identified" by the use of a unique identification 
 37.21  number, provided that the number is coded or encrypted through a 
 37.22  reliable system that can reasonably assure that such numbers 
 37.23  cannot be traced back by an unauthorized person to determine the 
 37.24  identity of a patient with a particular number. 
 37.25     Subd. 3.  [OBJECTIVES OF THE HEALTH DATA INSTITUTE.] The 
 37.26  health data institute shall: 
 37.27     (1) provide direction and coordination for public and 
 37.28  private sector data collection efforts; 
 37.29     (2) establish a data system that electronically transmits, 
 37.30  collects, archives, and provides users of data with the data 
 37.31  necessary for their specific interests, in order to promote a 
 37.32  high quality, cost-effective, consumer-responsive health care 
 37.33  system; 
 37.34     (3) use and build upon existing data sources and quality 
 37.35  measurement efforts, and improve upon these existing data 
 37.36  sources and measurement efforts through the integration of data 
 38.1   systems and the standardization of concepts, to the greatest 
 38.2   extent possible procedures, criteria, and elements; 
 38.3      (4) ensure that each segment of the health care industry 
 38.4   can obtain data for appropriate purposes in a useful format and 
 38.5   timely fashion; 
 38.6      (5) protect the privacy of individuals and minimize 
 38.7   administrative costs; and 
 38.8      (6) develop a public/private information system to: 
 38.9      (i) make health care claims processing and financial 
 38.10  settlement transactions more efficient; 
 38.11     (ii) provide an efficient, unobtrusive method for meeting 
 38.12  the shared data needs of the state, consumers, employers, 
 38.13  providers, and group purchasers; 
 38.14     (iii) provide the state, consumers, employers, providers, 
 38.15  and group purchasers with information on the cost, 
 38.16  appropriateness and effectiveness of health care, and wellness 
 38.17  and cost containment strategies; 
 38.18     (iv) provide employers with the capacity to analyze benefit 
 38.19  plans and work place health; and 
 38.20     (v) (iv) provide researchers and providers with the 
 38.21  capacity to analyze clinical effectiveness; 
 38.22     (7) conduct health plan comparisons by producing health 
 38.23  plan report cards; 
 38.24     (8) develop and implement data collection procedures to 
 38.25  ensure standardization and minimize the administrative burden; 
 38.26  and 
 38.27     (9) promote improvements in the efficiency and 
 38.28  effectiveness of health care delivery. 
 38.29     The institute shall carry out these activities in 
 38.30  accordance with the recommendations of the data collection plan 
 38.31  developed by the data collection advisory committee, the 
 38.32  Minnesota health care commission, and the commissioner of 
 38.33  health, under subdivision 4. 
 38.34     Subd. 3a.  [DUTIES.] The Minnesota health data institute 
 38.35  shall: 
 38.36     (1) determine uniform specifications for the collection, 
 39.1   transmission, and maintenance of health care data; and 
 39.2      (2) conduct studies on the following subjects: 
 39.3      (i) the relative satisfaction of participants with their 
 39.4   care; 
 39.5      (ii) the cost versus the effectiveness of health care 
 39.6   treatments; and 
 39.7      (iii) the impact on cost and effectiveness of health care 
 39.8   of the management techniques and administrative interventions 
 39.9   used in the state health care programs and other settings. 
 39.10     Subd. 4.  [DATA COLLECTION PLAN.] The commissioner, in 
 39.11  consultation with the board of the health data institute and the 
 39.12  data collection advisory committee, shall develop and implement 
 39.13  a plan that:  
 39.14     (1) provides data collection objectives, strategies, 
 39.15  priorities, cost estimates, administrative and operational 
 39.16  guidelines, and implementation timelines for the health data 
 39.17  institute; and 
 39.18     (2) identifies the encounter level data needed for the 
 39.19  commissioner to carry out the duties assigned in this chapter. 
 39.20  The plan must take into consideration existing data sources and 
 39.21  data sources that can easily be made uniform for linkages to 
 39.22  other data sets; and 
 39.23     (3) establish uniform specifications for the collection, 
 39.24  transmission, and analysis of health data.  
 39.25     This plan shall be prepared by October 31, 1993 updated 
 39.26  annually and shall be made available to the public through the 
 39.27  health information library. 
 39.28     Subd. 4a.  [EVALUATION OF CONSUMER SATISFACTION; PROVIDER 
 39.29  INFORMATION PILOT STUDY.] (a) The commissioner may make a grant 
 39.30  to the health data institute to develop and implement a 
 39.31  mechanism for collecting comparative data on consumer 
 39.32  satisfaction through adoption of a standard consumer 
 39.33  satisfaction survey.  As a condition of receiving this grant, 
 39.34  the health data institute shall appoint a consumer advisory 
 39.35  group which shall consist of 13 individuals, representing 
 39.36  enrollees from public and private health plan companies and 
 40.1   programs and two uninsured consumers, to advise the health data 
 40.2   institute on issues of concern to consumers.  The advisory group 
 40.3   must have at least one member from each regional coordinating 
 40.4   board region of the state.  The advisory group expires June 30, 
 40.5   1997.  This survey shall include enrollees in community 
 40.6   integrated service networks, integrated service networks, health 
 40.7   maintenance organizations, preferred provider organizations, 
 40.8   indemnity insurance plans, public programs, and other health 
 40.9   plan companies.  The health data institute shall determine a 
 40.10  mechanism for the inclusion of the uninsured.  Health plan 
 40.11  companies and group purchasers shall provide enrollment 
 40.12  information, including the names, addresses, and telephone 
 40.13  numbers of enrollees and former enrollees and other data 
 40.14  necessary for the completion of this study to the data 
 40.15  institute.  This enrollment information provided by the health 
 40.16  plan companies and group purchasers is classified as private 
 40.17  data on individuals, as defined in section 13.02, subdivision 
 40.18  12.  The data institute shall provide raw unaggregated data to 
 40.19  the data analysis unit.  The health data institute may analyze 
 40.20  and prepare findings from the raw, unaggregated data, and the 
 40.21  findings from this survey may be included in the health plan 
 40.22  company report cards, and in other reports developed by the data 
 40.23  analysis unit, in consultation with the data institute, to be 
 40.24  disseminated by the information clearinghouse.  The raw 
 40.25  unaggregated data is on patients and providers are classified as 
 40.26  private data on individuals as defined in section 13.02, 
 40.27  subdivision 12.  The survey may include information on the 
 40.28  following subjects: 
 40.29     (1) enrollees' overall satisfaction with their health care 
 40.30  plan; 
 40.31     (2) consumers' perception of access to emergency, urgent, 
 40.32  routine, and preventive care, including locations, hours, 
 40.33  waiting times, and access to care when needed; 
 40.34     (3) premiums and costs; 
 40.35     (4) technical competence of assessment of health condition 
 40.36  by providers; 
 41.1      (5) communication, courtesy, respect, reassurance, and 
 41.2   support; 
 41.3      (6) choice and continuity of providers; 
 41.4      (7) continuity of care; 
 41.5      (8) outcomes of care; 
 41.6      (9) services offered by the plan, including range of 
 41.7   services, coverage for preventive and routine services, and 
 41.8   coverage for illness and hospitalization; 
 41.9      (10) availability of information; and 
 41.10     (11) paperwork. 
 41.11     (b) The commissioner, in consultation with the health data 
 41.12  institute, shall develop a pilot study to collect comparative 
 41.13  data from health care providers on opportunities and barriers to 
 41.14  the provision of quality, cost-effective health care.  The 
 41.15  provider information pilot study shall include providers in 
 41.16  community integrated service networks, integrated service 
 41.17  networks, health maintenance organizations, preferred provider 
 41.18  organizations, indemnity insurance plans, public programs, and 
 41.19  other health plan companies.  Health plan companies and group 
 41.20  purchasers shall provide to the commissioner providers' names, 
 41.21  health plan assignment, and other appropriate data necessary for 
 41.22  the commissioner to conduct the study.  The provider information 
 41.23  pilot study shall examine factors that increase and hinder 
 41.24  access to the provision of quality, cost-effective health care.  
 41.25  The study may examine: 
 41.26     (1) administrative barriers and facilitators; 
 41.27     (2) time spent obtaining permission for appropriate and 
 41.28  necessary treatments; 
 41.29     (3) latitude to order appropriate and necessary tests, 
 41.30  pharmaceuticals, and referrals to specialty providers; 
 41.31     (4) assistance available for decreasing administrative and 
 41.32  other routine paperwork activities; 
 41.33     (5) continuing education opportunities provided; 
 41.34     (6) access to readily available information on diagnoses, 
 41.35  diseases, outcomes, and new technologies; 
 41.36     (7) continuous quality improvement activities; 
 42.1      (8) inclusion in administrative decision-making; 
 42.2      (9) access to social services and other services that 
 42.3   facilitate continuity of care; 
 42.4      (10) economic incentives and disincentives; 
 42.5      (11) peer review procedures; and 
 42.6      (12) the prerogative to address public health needs. 
 42.7      In selecting additional data for collection, the 
 42.8   commissioner health data institute shall consider the:  (1) 
 42.9   statistical validity of the indicator; (2) public need for the 
 42.10  information; (3) estimated expense of collecting and reporting 
 42.11  the indicator; and (4) usefulness of the indicator to identify 
 42.12  barriers and opportunities to improve quality care provision 
 42.13  within health plan companies. 
 42.14     Initial survey results shall be completed and submitted to 
 42.15  the legislature by July 1, 1996.  The final survey results must 
 42.16  be submitted to the legislature by January 15, 1997. 
 42.17     Subd. 4b.  [HOSPITAL QUALITY INDICATORS.] The commissioner, 
 42.18  in consultation with the health data institute, shall develop a 
 42.19  system for collecting data on hospital quality.  The 
 42.20  commissioner shall require A licensed hospital shall be required 
 42.21  to collect and report data as needed for the system.  Data to be 
 42.22  collected shall include structural characteristics including 
 42.23  staff-mix and nurse-patient ratios.  In selecting additional 
 42.24  data for collection, the commissioner following shall consider 
 42.25  be considered:  (1) feasibility and statistical validity of the 
 42.26  indicator; (2) purchaser and public demand for the indicator; 
 42.27  (3) estimated expense of collecting and reporting the indicator; 
 42.28  and (4) usefulness of the indicator for internal improvement 
 42.29  purposes.  
 42.30     Subd. 4c.  [QUALITY REPORT CARDS.] (a) Each health plan 
 42.31  company shall report annually by April 1 to the commissioner 
 42.32  health data institute specific quality indicators, in the form 
 42.33  specified by the commissioner in consultation with the health 
 42.34  data institute.  The quality indicators must be reported using 
 42.35  standard definitions and measurement processes as specified by 
 42.36  the commissioner health data institute.  Wherever possible, 
 43.1   the commissioner's specifications must be consistent with any 
 43.2   outlined in the health plan employer data and information set 
 43.3   (HEDIS 2.0).  The commissioner, in consultation with the health 
 43.4   data institute, may modify the quality indicators to be reported 
 43.5   to incorporate improvements in quality measurement tools.  When 
 43.6   HEDIS 2.0 indicators or health care financing administration 
 43.7   approved quality indicators for medical assistance and Medicare 
 43.8   are used, the commissioner is exempt from rulemaking.  For 
 43.9   additions or modifications to the HEDIS indicators or if other 
 43.10  quality indicators are added, the commissioner health data 
 43.11  institute shall proceed through rulemaking pursuant to chapter 
 43.12  14.  The data analysis unit health data institute shall develop 
 43.13  quality report cards, and these report cards shall be 
 43.14  disseminated through the health information clearinghouse 
 43.15  library.  
 43.16     (b) Data shall be collected by county and high-risk and 
 43.17  special needs populations as well as by health plan but shall 
 43.18  not be reported.  The commissioner, in consultation with the 
 43.19  health data institute and counties, shall provide this data to a 
 43.20  community health board as defined in section 145A.02 in a manner 
 43.21  that would not allow the identification of individuals. 
 43.22     Subd. 5.  [COMMISSIONER'S DUTIES.] (a) The commissioner 
 43.23  shall establish a public/private data institute in conjunction 
 43.24  with health care providers, health carriers and other group 
 43.25  purchasers, and consumers, to collect and process encounter 
 43.26  level data that are required to be submitted to the commissioner 
 43.27  under this chapter.  The commissioner shall not collect 
 43.28  Encounter level data shall not be collected from individual 
 43.29  health care providers until standardized forms and procedures 
 43.30  are available.  The commissioner shall establish a board of 
 43.31  directors comprised of members of the public and private sector 
 43.32  to provide oversight for the administration and operation of the 
 43.33  institute. 
 43.34     (b) Until the data institute is operational, the 
 43.35  commissioner may collect encounter level data required to be 
 43.36  submitted under this chapter. 
 44.1      (c) The commissioner, with the advice of the board, shall 
 44.2   establish policies for the disclosure of data to consumers, 
 44.3   purchasers, providers, integrated service networks, and plans 
 44.4   for their use in analysis to meet the goals of this chapter, as 
 44.5   well as for the public disclosure of data to other interested 
 44.6   parties.  The disclosure policies shall ensure that consumers, 
 44.7   purchasers, providers, integrated service networks, and health 
 44.8   plans have access to health data institute data for use in 
 44.9   analysis to meet the goals of this chapter at the same time that 
 44.10  data is provided to the data analysis unit in the department of 
 44.11  health. 
 44.12     (d) (c) The commissioner, with the advice of the board, 
 44.13  health data institute may require those requesting data from the 
 44.14  institute to contribute toward the cost of data collection 
 44.15  through the payments of fees.  Entities supplying data to the 
 44.16  institute shall not be charged more than the actual transaction 
 44.17  cost of providing the data requested a fee. 
 44.18     (e) (d) The commissioner may intervene in the direct 
 44.19  operation of the institute, if this is necessary in the judgment 
 44.20  of the commissioner to accomplish the institute's duties.  If 
 44.21  the commissioner intends to depart from the advice and 
 44.22  recommendations of the board, the commissioner shall inform the 
 44.23  board of the intended departure, provide the board with a 
 44.24  written explanation of the reasons for the departure, and give 
 44.25  the board the opportunity to comment on the departure. is 
 44.26  required to develop a protocol for reviewing the advice and 
 44.27  recommendations of the health data institute.  Included in the 
 44.28  protocol shall be a methodology for the commissioner to accept 
 44.29  or reject health data institute recommendations.  
 44.30     Subd. 6.  [BOARD OF DIRECTORS.] The institute is governed 
 44.31  by a 20-member 22-member board of directors consisting of the 
 44.32  following members: 
 44.33     (1) two representatives of hospitals, one appointed by the 
 44.34  Minnesota Hospital Association and one appointed by the 
 44.35  Metropolitan HealthCare Council, to reflect a mix of urban and 
 44.36  rural institutions; 
 45.1      (2) four representatives of health carriers, two appointed 
 45.2   by the Minnesota Council of Health Maintenance Organizations, 
 45.3   one appointed by Blue Cross Blue Shield, and one appointed by 
 45.4   the Insurance Federation of Minnesota; 
 45.5      (3) two consumer members, one appointed by the 
 45.6   commissioner, and one appointed by the AFL-CIO as a labor union 
 45.7   representative; 
 45.8      (4) five group purchaser representatives appointed by the 
 45.9   Minnesota Consortium of Healthcare Purchasers to reflect a mix 
 45.10  of urban and rural, large and small, and self-insured 
 45.11  purchasers; 
 45.12     (5) two three physicians appointed by the Minnesota Medical 
 45.13  Association, to reflect a mix of urban and rural practitioners; 
 45.14     (6) one representative of teaching and research 
 45.15  institutions, appointed jointly by the Mayo Foundation and the 
 45.16  Minnesota Association of Public Teaching Hospitals; 
 45.17     (7) one nursing representative appointed by the Minnesota 
 45.18  Nurses Association; and 
 45.19     (8) three representatives of state agencies, one member 
 45.20  representing the department of employee relations, one member 
 45.21  representing the department of human services, and one member 
 45.22  representing the department of health; and 
 45.23     (9) the chair of the health technology advisory committee.  
 45.24     Subd. 7.  [TERMS; COMPENSATION; REMOVAL; AND VACANCIES.] 
 45.25  The board is governed by section 15.0575. 
 45.26     Subd. 8.  [STAFF.] The board may hire an executive director 
 45.27  and other staff.  The executive director is and other data 
 45.28  institute staff are not a state employee employees but is 
 45.29  are covered by section 3.736.  The executive director and other 
 45.30  data institute staff may participate in the following plans for 
 45.31  employees in the unclassified service:  the state retirement 
 45.32  plan, the state deferred compensation plan, and the health 
 45.33  insurance and life insurance plans.  The attorney general shall 
 45.34  provide legal services to the board. 
 45.35     Subd. 9.  [DUTIES OF MINNESOTA HEALTH DATA INSTITUTE 
 45.36  BOARD.] The board shall provide assistance to work 
 46.1   collaboratively with the commissioner in developing and 
 46.2   implementing a plan for the public/private information 
 46.3   system.  The board shall focus its efforts on continuous quality 
 46.4   improvement for health plans, development of report cards and 
 46.5   consumer satisfaction surveys, and methods for using data 
 46.6   analysis for educational purposes.  In addition, the board shall 
 46.7   make recommendations to the commissioner on: 
 46.8      (1) the purpose of initiating data collection initiatives; 
 46.9      (2) the expected benefit to the state from the initiatives; 
 46.10     (3) the methodology needed to ensure the validity of the 
 46.11  initiative without creating an undue burden to providers and 
 46.12  payers; 
 46.13     (4) the most appropriate method of collecting the necessary 
 46.14  data; and 
 46.15     (5) the projected cost to the state, health care providers, 
 46.16  health carriers, and other group purchasers to complete the 
 46.17  initiative. 
 46.18     The health data institute shall develop a standard set of 
 46.19  definitions, criteria, and elements for data collection, in 
 46.20  order to facilitate the efficient and effective collection of 
 46.21  appropriate data by the institute and the department. 
 46.22     Subd. 9a.  [LAWS GOVERNING HEALTH DATA INSTITUTE.] The 
 46.23  health data institute is not subject to laws governing state 
 46.24  agencies except chapters 13, 14, and 16B; and sections 138.17 
 46.25  and 471.705. 
 46.26     Subd. 10.  [DATA COLLECTION.] The commissioner, in 
 46.27  consultation with the health data institute board, may select a 
 46.28  vendor to: 
 46.29     (1) collect the encounter level data required to be 
 46.30  submitted by group purchasers under sections 62J.38 and 62J.42, 
 46.31  state agencies under section 62J.40, and health care providers 
 46.32  under sections 62J.41 and 62J.42, using, to the greatest extent 
 46.33  possible, standardized forms and procedures; 
 46.34     (2) collect the encounter level data required for the 
 46.35  initiatives of the data analysis unit, under sections 62J.30 to 
 46.36  62J.34, using, to the greatest extent possible, standardized 
 47.1   forms and procedures; 
 47.2      (3) process the data collected to ensure validity, 
 47.3   consistency, accuracy, and completeness, and as appropriate, 
 47.4   merge data collected from different sources; 
 47.5      (4) provide unaggregated, encounter level data to the data 
 47.6   analysis unit within the department of health; and 
 47.7      (5) (3) carry out other duties assigned in this section. 
 47.8      Subd. 11.  [USE OF DATA.] (a) The board of the health data 
 47.9   institute, with the advice of the data collection advisory 
 47.10  committee and the practice parameter advisory committee through 
 47.11  the commissioner, is responsible for establishing the 
 47.12  methodology for the collection of the data and is responsible 
 47.13  for providing direction on what data would be useful to the 
 47.14  plans, providers, consumers, and purchasers. 
 47.15     (b) The data analysis unit is responsible for the analysis 
 47.16  of the data and the development and dissemination of reports. 
 47.17     (c) The commissioner, in consultation with or the health 
 47.18  data institute board, shall determine when and under what 
 47.19  conditions data disclosure to group purchasers, health care 
 47.20  providers, consumers, researchers, and other appropriate parties 
 47.21  may occur to meet the state's goals.  The commissioner may 
 47.22  require users of data to contribute toward the cost of data 
 47.23  collection through the payment of fees.  The commissioner shall 
 47.24  require users of data to maintain the data according to the data 
 47.25  privacy provisions applicable to the data.  
 47.26     (d) (c) The commissioner and the board shall not allow a 
 47.27  group purchaser or health care provider to use or have access to 
 47.28  the electronic data interchange system or to data created, 
 47.29  collected, received, maintained, or disseminated by the health 
 47.30  data institute, unless the group purchaser or health care 
 47.31  provider cooperates with the data collection efforts of the data 
 47.32  institute by submitting all data requested in the form and 
 47.33  manner specified by the board.  The commissioner and the board 
 47.34  shall prohibit group purchasers and health care providers from 
 47.35  transferring, providing, or sharing data obtained from the data 
 47.36  institute with a group purchaser or health care provider that 
 48.1   does not cooperate with the data collection efforts of the data 
 48.2   institute. 
 48.3      (d) Disclosure of data received from the data institute is 
 48.4   prohibited.  Data shall retain the same classification within 
 48.5   the receiving entity or organization that it had in the sending 
 48.6   entity or organization.  Individuals and organizations receiving 
 48.7   data are subject to section 13.09. 
 48.8      Subd. 12.  [CONTRACTING.] The commissioner, in consultation 
 48.9   with the board, and the health data institute board may contract 
 48.10  with private sector entities to carry out the duties assigned in 
 48.11  this section.  The commissioner and the board shall diligently 
 48.12  seek to enter into contracts with private sector entities.  Any 
 48.13  contract must list the specific data to be collected and the 
 48.14  methods to be used to collect and validate the data.  Any 
 48.15  contract must require the private sector entity to maintain the 
 48.16  data collected according to the data privacy provisions 
 48.17  applicable to the data. 
 48.18     Subd. 13.  [DATA PRIVACY.] The board and the institute are 
 48.19  subject to chapter 13. 
 48.20     Subd. 14.  [STANDARDS FOR DATA RELEASE.] The data institute 
 48.21  shall adopt standards for the collection, by the institute, of 
 48.22  data on costs, spending, quality, outcomes, and utilization.  
 48.23  The data institute shall also adopt standards for the analysis 
 48.24  and dissemination, by private sector entities, of data on costs, 
 48.25  spending, quality, outcomes, and utilization provided to the 
 48.26  private sector entities by the data institute.  Both sets of 
 48.27  standards must be consistent with data privacy requirements. 
 48.28     Subd. 15.  [INFORMATION CLEARINGHOUSE.] The commissioner 
 48.29  shall coordinate the activities of the data institute with the 
 48.30  activities of the information clearinghouse established in 
 48.31  section 62J.33, subdivision 2. 
 48.32     Subd. 16 15.  [FEDERAL AND OTHER GRANTS.] The commissioner, 
 48.33  in collaboration with the board, shall seek federal funding and 
 48.34  funding from private and other nonstate sources for the 
 48.35  initiatives required by the board. 
 48.36     Subd. 16.  [ANNUAL REPORT.] The health data institute shall 
 49.1   submit to the chairs of the senate joint crime prevention and 
 49.2   judiciary subcommittee on privacy, the house of representatives 
 49.3   judiciary committee data privacy subcommittee, the legislative 
 49.4   commission on health care access, the commissioner, and the 
 49.5   governor a report on the activities of the data institute by 
 49.6   February 1 of each year.  The report shall include: 
 49.7      (1) a description of the data initiatives undertaken by the 
 49.8   data institute, including a statement of the purpose and a 
 49.9   summary of the results of the initiative; and 
 49.10     (2) a description of the steps taken by the data institute 
 49.11  to comply with the privacy and confidentially requirements of 
 49.12  section 62J.451 and other applicable laws, and of the data 
 49.13  institute's internal policies and operating procedures relating 
 49.14  to data privacy and confidentiality. 
 49.15     If the data institute amends or adopts an internal policy 
 49.16  or operating procedure relating to data privacy and 
 49.17  confidentiality, it shall submit copies of such policy or 
 49.18  procedure within 30 days of its adoption to the public officials 
 49.19  identified in this subdivision. 
 49.20     Sec. 9.  [62J.451] [HEALTH DATA INSTITUTE PROTECTION OF 
 49.21  HEALTH CARE DATA.] 
 49.22     Subdivision 1.  [DATA CLASSIFICATIONS.] (a) Data collected, 
 49.23  obtained, received, or created by the health data institute on 
 49.24  patients, providers, or group purchasers and any analysis which 
 49.25  includes provider or group purchaser identifying data shall be 
 49.26  private or nonpublic, unless given a different classification in 
 49.27  this subdivision.  Notwithstanding sections 13.03, subdivisions 
 49.28  6 to 8, and 13.10, subdivisions 1 to 4, data received by the 
 49.29  health data institute pursuant to this chapter shall retain the 
 49.30  classification designated under this chapter and shall not be 
 49.31  disclosed other than pursuant to this chapter.  Data classified 
 49.32  as private or nonpublic under this subdivision may be released 
 49.33  or disclosed only as permitted under this subdivision and under 
 49.34  the other subdivisions referenced in this subdivision. 
 49.35     (b) Patient-identifying data may be disclosed only as 
 49.36  permitted under subdivision 2. 
 50.1      (c)  Provider and group purchaser data that are not 
 50.2   patient-identifying data may be disclosed only through 
 50.3   publication in an analysis as permitted under subdivision 3. 
 50.4      (d) Data that are not patient-identifying data and not 
 50.5   provider or group purchaser identifying data may be disclosed 
 50.6   only through publication in an analysis as permitted under 
 50.7   subdivision 3. 
 50.8      (e) Data that describe the finances, governance, internal 
 50.9   operations, policies, or operating procedures of the data 
 50.10  institute, and that do not identify patients, providers, or 
 50.11  group purchasers, or identifies them only in connection with 
 50.12  their involvement with the data institute, are public data. 
 50.13     Subd. 2.  [PATIENT-IDENTIFYING DATA.] (a) The health data 
 50.14  institute must not publish any analysis that contains 
 50.15  patient-identifying data. 
 50.16     (b) The data institute must not develop or maintain a 
 50.17  database over which the data institute has custody that includes 
 50.18  any patient-identifying data except for directory data, other 
 50.19  data necessary to permit the data institute to survey patients 
 50.20  or to conduct an analysis that cannot be accomplished if the 
 50.21  data are not in a form that identifies patients, and data 
 50.22  resulting from such surveys of patients or from such analyses. 
 50.23     (c) The data institute may disclose patient-identifying 
 50.24  data only as follows: 
 50.25     (1) as permitted by section 144.335, subdivision 3a; or 
 50.26     (2) to a contractor of, or vendor of services to the data 
 50.27  institute for the purposes of conducting a survey or analysis, 
 50.28  provided that such contractor or vendor agrees to comply with 
 50.29  all data privacy requirements applicable to the data institute, 
 50.30  and to destroy or return to the data institute all copies of 
 50.31  patient-identifying data in the possession of such contractor or 
 50.32  vendor upon completion of the contract. 
 50.33     Subd. 3.  [PUBLICATION OF ANALYSES BY THE HEALTH DATA 
 50.34  INSTITUTE.] (a) Notwithstanding the classification under 
 50.35  subdivision 1 or other provision of state law of data included 
 50.36  or used in an analysis, the health data institute may publish 
 51.1   data in an analysis pursuant to this subdivision and subdivision 
 51.2   4.  The analysis may include provider or group purchaser 
 51.3   identifying data but must not include patient-identifying data.  
 51.4   The health data institute may publish an analysis only if before 
 51.5   publication its board concludes that the analysis is more likely 
 51.6   to inform and enlighten those who may receive it than it is to 
 51.7   confuse or mislead them, and the data and the analysis are 
 51.8   reasonably determined by the board to be accurate, complete, 
 51.9   reliable, case mixed and severity adjusted, and statistically 
 51.10  and clinically significant and valid.  Before publishing an 
 51.11  analysis, the health data institute shall provide reasonable 
 51.12  notice to a provider or group purchaser identified in the 
 51.13  analysis of the health data institute's intention to publish the 
 51.14  analysis and the opportunity to use the contested case hearing 
 51.15  procedure established under chapter 14. 
 51.16     (b) Accompanying the publication of an analysis, the data 
 51.17  institute shall also publish any comments received by providers 
 51.18  or group purchasers identified, descriptions of the database 
 51.19  used in the analysis, the methods of adjusting for case mix and 
 51.20  severity and assuring accuracy, completeness, reliability, and 
 51.21  statistical and clinical significance, as appropriate, and 
 51.22  appropriate uses of the analysis and related analytical data, 
 51.23  including precautionary statements regarding the limitations of 
 51.24  the analysis and related analytical data. 
 51.25     Subd. 4.  [CIVIL REMEDIES.] If the health data institute 
 51.26  violates any of the confidentiality requirements or other 
 51.27  provisions pertaining to the release of data in subdivision 2 or 
 51.28  3, it shall be subject to section 13.08.  The health data 
 51.29  institute shall not be liable for the actions of persons not 
 51.30  under the direction and control of the health data institute.  
 51.31  The remedies in this section do not preclude any person from 
 51.32  pursuing any other remedies authorized by law. 
 51.33     Subd. 5.  [PENALTIES.] (a) If the health data institute 
 51.34  willfully violates the confidentiality requirements, or other 
 51.35  provisions pertaining to the release of data in subdivision 2 or 
 51.36  3, it shall be guilty of a misdemeanor.  Willful violation of 
 52.1   this chapter by any employee of the health data institute 
 52.2   constitutes just cause for suspension without pay or dismissal 
 52.3   of the employee. 
 52.4      (b) If the health data institute willfully violates the 
 52.5   privacy or confidentiality requirements, or other provisions 
 52.6   pertaining to the release of data in subdivision 2 or 3, by 
 52.7   willfully disclosing patient-identifying, provider, or group 
 52.8   purchaser identifying data for compensation or remuneration of 
 52.9   any kind, or for the purpose of damaging the reputation of any 
 52.10  patient, provider, or group purchaser, or any other malicious 
 52.11  purpose it shall be guilty of a gross misdemeanor. 
 52.12     Subd. 6.  [DISCOVERABILITY OF HEALTH DATA INSTITUTE DATA.] 
 52.13  Data created, collected, received, maintained, or disseminated 
 52.14  by the health data institute and the nature or subject matter of 
 52.15  data disclosed or the nature or subject matter of requests of 
 52.16  the health data institute made to providers or industry 
 52.17  participants shall not be subject to discovery or introduction 
 52.18  into evidence in any civil or criminal action.  Data created, 
 52.19  collected, received, maintained, or disseminated by the health 
 52.20  data institute that is otherwise available from original sources 
 52.21  is subject to discovery from those sources and it may be 
 52.22  introduced into evidence in civil or criminal actions in 
 52.23  accordance with and subject to applicable laws and rules of 
 52.24  evidence and civil or criminal procedure, as applicable.  
 52.25  Nothing in chapter 62J waives any rights established pursuant to 
 52.26  section 145.64. 
 52.27     Sec. 10.  [62J.452] [HEALTH INFORMATION LIBRARY.] 
 52.28     The commissioner of health shall provide assistance to the 
 52.29  health data institute in creation of a health information 
 52.30  library to facilitate the ability of consumers, employers, 
 52.31  providers, health carriers, and others to obtain information on 
 52.32  health care costs and quality in Minnesota.  The commissioner 
 52.33  shall make available through the health information library 
 52.34  information developed or collected by the department of health 
 52.35  relating to public health, surveillance, prevention, disease 
 52.36  tracking, and other initiatives assigned to the department.  The 
 53.1   health data institute shall make available through the health 
 53.2   information library information developed or collected on 
 53.3   consumer satisfaction, the costs and quality of health plan 
 53.4   companies, reports, or recommendations of the health technology 
 53.5   advisory committee and other entities on technology assessments, 
 53.6   worksite wellness and prevention programs, other wellness 
 53.7   programs, consumer education, and other initiatives.  The health 
 53.8   information library is subject to chapter 13. 
 53.9      Sec. 11.  [INSTRUCTION TO REVISOR.] 
 53.10     (a) The revisor shall delete all references in Minnesota 
 53.11  Statutes to the "information clearinghouse" and insert in its 
 53.12  place "health information library."  In addition, the revisor 
 53.13  shall change all references to the "data institute" to state 
 53.14  "health data institute." 
 53.15     (b) The revisor shall change the reference to section 
 53.16  62J.152, subdivision 7 in sections 13.99 and 62J.156 to section 
 53.17  62J.157, subdivision 6 in Minnesota Statutes and Minnesota Rules.
 53.18     Sec. 12.  [REPEALER.] 
 53.19     Minnesota Statutes 1994, sections 62J.30; 62J.31; 62J.32; 
 53.20  62J.33; 62J.34; and 62J.42, are repealed. 
 53.21                             ARTICLE 4
 53.22                      PUBLIC HEALTH AND SAFETY
 53.23     Section 1.  [84.916] [HELMET REQUIRED; PENALTY FOR 
 53.24  VIOLATION.] 
 53.25     No person shall operate a snowmobile on public land, public 
 53.26  waters, or on a public road right-of-way unless wearing a safety 
 53.27  helmet approved by the commissioner of public safety.  Persons 
 53.28  found in violation of this section shall be guilty of a 
 53.29  misdemeanor and subject to a $25 fine. 
 53.30     Sec. 2.  Minnesota Statutes 1994, section 84.9256, 
 53.31  subdivision 2, is amended to read: 
 53.32     Subd. 2.  [HELMET REQUIRED; PENALTY FOR VIOLATION.] A No 
 53.33  person less than 18 years of age shall not operate an 
 53.34  all-terrain vehicle on public land, public waters, or on a 
 53.35  public road right-of-way unless wearing a safety helmet approved 
 53.36  by the commissioner of public safety.  Persons found in 
 54.1   violation of this section shall be guilty of a misdemeanor and 
 54.2   subject to a $25 fine. 
 54.3      Sec. 3.  Minnesota Statutes 1994, section 169.222, 
 54.4   subdivision 4, is amended to read: 
 54.5      Subd. 4.  [RIDING ON ROADWAYS OR SHOULDERS.] (a) Every 
 54.6   person operating a bicycle upon a roadway shall ride as close as 
 54.7   practicable to the right-hand curb or edge of the roadway except 
 54.8   under any of the following situations: 
 54.9      (i) When overtaking and passing another vehicle proceeding 
 54.10  in the same direction. 
 54.11     (ii) When preparing for a left turn at an intersection or 
 54.12  into a private road or driveway. 
 54.13     (iii) When reasonably necessary to avoid conditions, 
 54.14  including fixed or moving objects, vehicles, pedestrians, 
 54.15  animals, surface hazards, or narrow width lanes, that make it 
 54.16  unsafe to continue along the right-hand curb or edge. 
 54.17     (b) If a bicycle is traveling on a shoulder of a roadway, 
 54.18  the bicycle shall travel in the same direction as adjacent 
 54.19  vehicular traffic. 
 54.20     (c) Persons riding bicycles upon a roadway or shoulder 
 54.21  shall not ride more than two abreast and shall not impede the 
 54.22  normal and reasonable movement of traffic and, on a laned 
 54.23  roadway, shall ride within a single lane. 
 54.24     (d) No person shall operate or ride a bicycle on a street 
 54.25  or highway, bikeway, or sidewalk without wearing protective 
 54.26  headgear that meets the American National Standard for 
 54.27  Protective Headgear for Bicyclists, ANSI Z90.4-1984, approved by 
 54.28  the American National Standards Institute, Inc. 
 54.29     (e) A person operating a bicycle upon a sidewalk, or across 
 54.30  a roadway or shoulder on a crosswalk, shall yield the 
 54.31  right-of-way to any pedestrian and shall give an audible signal 
 54.32  when necessary before overtaking and passing any pedestrian.  No 
 54.33  person shall ride a bicycle upon a sidewalk within a business 
 54.34  district unless permitted by local authorities.  Local 
 54.35  authorities may prohibit the operation of bicycles on any 
 54.36  sidewalk or crosswalk under their jurisdiction. 
 55.1      (f) A person lawfully operating a bicycle on a sidewalk, or 
 55.2   across a roadway or shoulder on a crosswalk, shall have all the 
 55.3   rights and duties applicable to a pedestrian under the same 
 55.4   circumstances. 
 55.5      Sec. 4.  Minnesota Statutes 1994, section 169.685, 
 55.6   subdivision 5, is amended to read: 
 55.7      Subd. 5.  [VIOLATION; PENALTY.] (a) Every motor vehicle 
 55.8   operator, when transporting a child under the age of four on the 
 55.9   streets and highways of this state in a motor vehicle equipped 
 55.10  with factory-installed seat belts, shall equip and install for 
 55.11  use in the motor vehicle, according to the manufacturer's 
 55.12  instructions, a child passenger restraint system meeting federal 
 55.13  motor vehicle safety standards.  
 55.14     (b) No motor vehicle operator who is operating a motor 
 55.15  vehicle on the streets and highways of this state may transport 
 55.16  a child under the age of four in a seat of a motor vehicle 
 55.17  equipped with a factory-installed seat belt, unless the child is 
 55.18  properly fastened in the child passenger restraint system.  Any 
 55.19  motor vehicle operator who violates this subdivision is guilty 
 55.20  of a petty misdemeanor and may be sentenced to pay a fine of not 
 55.21  more than $50 $100.  The fine may be waived or the amount 
 55.22  reduced if the motor vehicle operator produces evidence that 
 55.23  within 14 days after the date of the violation a child passenger 
 55.24  restraint system meeting federal motor vehicle safety standards 
 55.25  was purchased or obtained for the exclusive use of the operator. 
 55.26     (c) The fines collected for violations of this subdivision 
 55.27  must be deposited in the state treasury and credited to a 
 55.28  special account to be known as the Minnesota child passenger 
 55.29  restraint and education account. 
 55.30     Sec. 5.  Minnesota Statutes 1994, section 169.686, 
 55.31  subdivision 1, is amended to read: 
 55.32     Subdivision 1.  [SEAT BELT REQUIREMENT.] A properly 
 55.33  adjusted and fastened seat belt, including both the shoulder and 
 55.34  lap belt when the vehicle is so equipped, shall be worn by: 
 55.35     (1) the driver of a passenger vehicle or commercial motor 
 55.36  vehicle; 
 56.1      (2) a passenger riding in the front seat of a passenger 
 56.2   vehicle or commercial motor vehicle; and 
 56.3      (3) a passenger riding in any seat of a passenger vehicle 
 56.4   who is older than three but younger than 11 years of age. 
 56.5      A person who is 15 years of age or older and who violates 
 56.6   clause (1) or (2) is subject to a fine of $25 $100.  The driver 
 56.7   of the passenger vehicle or commercial motor vehicle in which 
 56.8   the violation occurred is subject to a $25 $100 fine for a 
 56.9   violation of clause (2) or (3) by a child of the driver under 
 56.10  the age of 15 or any child under the age of 11.  A peace officer 
 56.11  may not issue a citation for a violation of this section unless 
 56.12  the officer lawfully stopped or detained the driver of the motor 
 56.13  vehicle for a moving violation other than a violation involving 
 56.14  motor vehicle equipment.  The department of public safety shall 
 56.15  not record a violation of this subdivision on a person's driving 
 56.16  record. 
 56.17     Sec. 6.  Minnesota Statutes 1994, section 169.974, 
 56.18  subdivision 4, is amended to read: 
 56.19     Subd. 4.  [EQUIPMENT FOR OPERATORS AND PASSENGERS.] (a) No 
 56.20  person under the age of 18 shall operate or ride a motorcycle on 
 56.21  the streets and highways of this state without wearing 
 56.22  protective headgear that complies with standards established by 
 56.23  the commissioner of public safety; and no person shall operate a 
 56.24  motorcycle without wearing an eye-protective device except when 
 56.25  the motorcycle is equipped with a wind screen. 
 56.26     (b) The provisions of this subdivision shall not apply to 
 56.27  persons during their participation in a parade for which parade 
 56.28  a permit or other official authorization has been granted by a 
 56.29  local governing body or other governmental authority or to 
 56.30  persons riding within an enclosed cab. 
 56.31     Sec. 7.  [CIGARETTE TAX INCREASES.] 
 56.32     The per package tax on cigarettes shall be increased by 40 
 56.33  cents per package of 20 cigarettes beginning July 1, 1995, with 
 56.34  an additional increase of 40 cents per package each subsequent 
 56.35  year through July 1, 2001. 
 56.36     The commissioner of revenue shall, by order published in 
 57.1   the State Register on July 1 of each year, increase the mil rate 
 57.2   in Minnesota Statutes, section 297.02, subdivision 1, the stamp 
 57.3   discount rate in Minnesota Statutes, section 297.03, subdivision 
 57.4   5, and the floor stock tax rates and dates referred to in Laws 
 57.5   1992, chapter 549, article 9, section 17, as necessary to 
 57.6   reflect the increases required by this section. 
 57.7      The revenue raised by the increases must be credited to the 
 57.8   health care access fund in the state treasury. 
 57.9                              ARTICLE 5
 57.10                   PROFESSIONAL LIABILITY REFORM
 57.11     Section 1.  [548.041] [PERIODIC PAYMENT OF AWARD.] 
 57.12     In any negligence action involving a damage award in excess 
 57.13  of $250,000, the presiding judge shall, after consulting with 
 57.14  plaintiff and defendant counsel, determine the appropriateness 
 57.15  of a periodic payment schedule for the award. 
 57.16     Sec. 2.  [548.061] [NONECONOMIC LOSSES; LIMITATION; 
 57.17  NEGLIGENCE OF A HEALTH CARE PROVIDER.] 
 57.18     (a) In any action for injury against a health care provider 
 57.19  based on professional negligence, the injured plaintiff shall be 
 57.20  entitled to recover noneconomic losses to compensate for pain, 
 57.21  suffering, inconvenience, physical impairment, disfigurement, 
 57.22  and other nonpecuniary damage. 
 57.23     (b) In no action shall the amount of damages for 
 57.24  noneconomic losses exceed $250,000. 
 57.25     (c) For purposes of this section, "health care provider" 
 57.26  means a physician, surgeon, dentist, or other health care 
 57.27  professional, group practice, clinic, or hospital, including all 
 57.28  persons or entities providing health care as defined in section 
 57.29  145.61, subdivisions 2 and 4, or a certified health care 
 57.30  professional employed by or providing services as an independent 
 57.31  contractor in a hospital. 
 57.32     Sec. 3.  Minnesota Statutes 1994, section 549.01, is 
 57.33  amended to read: 
 57.34     549.01 [AGREEMENT AS TO FEES OF ATTORNEY.] 
 57.35     Subdivision 1.  [DEFINITIONS.] For purposes of this 
 57.36  section:  (1) "health care provider" means a physician, surgeon, 
 58.1   dentist, or other health care professional, group practice, 
 58.2   clinic, or hospital, including all persons or entities providing 
 58.3   health care as defined in section 145.61, subdivisions 2 and 4, 
 58.4   or a certified health care professional employed by or providing 
 58.5   services as an independent contractor in a hospital; and (2) 
 58.6   "contingency fee" means any fee for professional legal services 
 58.7   which is in whole or in part dependent upon the recovery of any 
 58.8   amount of damages, whether through judgment or settlement.  
 58.9      Subd. 2.  [FEES GENERALLY.] Other than as provided in 
 58.10  subdivision 3, a party shall have an unrestricted right to agree 
 58.11  with an attorney as to compensation for services, and the 
 58.12  measure and mode thereof; but certain sums may be allowed to the 
 58.13  prevailing party for expenses in an action, which are termed 
 58.14  costs.  
 58.15     Subd. 3.  [CONTINGENCY FEES; ACTIONS AGAINST A HEALTH CARE 
 58.16  PROVIDER.] (a) An attorney shall not contract for or collect a 
 58.17  contingency fee for representing any person seeking damages in 
 58.18  connection with an action for injury or damage against a health 
 58.19  care provider based upon the person's alleged professional 
 58.20  negligence in excess of the following limits: 
 58.21     (1) 40 percent of the first $50,000 recovered; 
 58.22     (2) 33-1/3 percent of the next $50,000 recovered; 
 58.23     (3) 20 percent of the next $400,000 recovered; 
 58.24     (4) ten percent of any amount on which the recovery exceeds 
 58.25  $500,000. 
 58.26     The limitations apply regardless of whether the recovery is 
 58.27  by settlement, arbitration, or judgment, or whether the person 
 58.28  for whom the recovery is made is a responsible adult, an infant, 
 58.29  or a person of unsound mind. 
 58.30     (b) An attorney may not receive contingency fees on any 
 58.31  portion of an award for noneconomic or punitive damages. 
 58.32     (c) In the event that the judgment or settlement includes 
 58.33  periodic or future payments of damages, the amount recovered for 
 58.34  purposes of this section shall be the cost of the annuity or 
 58.35  trust established to make the payments, or if there is no 
 58.36  annuity or trust, the present value of the payments. 
 59.1      Subd. 4.  [VIOLATION OF SECTION.] A fee contracted for in 
 59.2   violation of this section shall be void and unenforceable.  A 
 59.3   claimant affected by a violation of this section may bring an 
 59.4   action in the court in which the claim was or could have been 
 59.5   brought, for damages in the amount of three times the fee 
 59.6   improperly contracted for or collected, reasonable attorney 
 59.7   fees, and other relief to which the person may be entitled. 
 59.8      Sec. 4.  Minnesota Statutes 1994, section 595.02, 
 59.9   subdivision 5, is amended to read: 
 59.10     Subd. 5.  [WAIVER OF PRIVILEGE FOR HEALTH CARE PROVIDERS.] 
 59.11  A party who commences an action makes a claim or files a lawsuit 
 59.12  for malpractice, error, mistake, or failure to cure, whether 
 59.13  based on contract or tort, against a health care provider on the 
 59.14  person's own behalf or in a representative capacity, waives in 
 59.15  that action any privilege existing under subdivision 1, 
 59.16  paragraphs (d) and (g), as to any information or opinion in the 
 59.17  possession of a health care provider who has examined or cared 
 59.18  for the party or other person whose health or medical condition 
 59.19  has been placed in controversy in the action.  This waiver must 
 59.20  permit all parties to the action, and their attorneys or 
 59.21  authorized representatives, to informally discuss the 
 59.22  information or opinion with the health care provider if the 
 59.23  provider consents.  Prior to an informal discussion with a 
 59.24  health care provider, the defendant must mail written notice to 
 59.25  the other party at least 15 days before the discussion.  The 
 59.26  plaintiff's attorney or authorized representative must have the 
 59.27  opportunity to be present at any informal discussion.  
 59.28  Appropriate medical authorizations permitting discussion must be 
 59.29  provided by the party commencing the action upon request from 
 59.30  any other party. 
 59.31     A health care provider may refuse to consent to the 
 59.32  discussion but, in that event, the party seeking the information 
 59.33  or opinion may take the deposition of the health care provider 
 59.34  with respect to that information and opinion, without obtaining 
 59.35  a prior court order. 
 59.36     For purposes of this subdivision, "health care provider" 
 60.1   means a physician, surgeon, dentist, or other health care 
 60.2   professional or hospital, including all persons or entities 
 60.3   providing health care as defined in section 145.61, subdivisions 
 60.4   2 and 4, or a certified health care professional employed by or 
 60.5   providing services as an independent contractor in a hospital. 
 60.6      Sec. 5.  Minnesota Statutes 1994, section 604.02, is 
 60.7   amended to read: 
 60.8      604.02 [APPORTIONMENT OF DAMAGES.] 
 60.9      Subdivision 1.  When two or more persons are jointly 
 60.10  liable, contributions to awards shall be in proportion to the 
 60.11  percentage of fault attributable to each, except that each is 
 60.12  jointly and severally liable for the whole award.  Except in 
 60.13  cases where liability arises under chapters 18B - pesticide 
 60.14  control, 115 - water pollution control, 115A - waste management, 
 60.15  115B - environmental response and liability, 115C - leaking 
 60.16  underground storage tanks, and 299J - pipeline safety, public 
 60.17  nuisance law for damage to the environment or the public health, 
 60.18  any other environmental or public health law, or any 
 60.19  environmental or public health ordinance or program of a 
 60.20  municipality as defined in section 466.01, a person whose fault 
 60.21  is 15 30 percent or less is liable for a percentage of the whole 
 60.22  award no greater than four times the percentage of fault, 
 60.23  including any amount reallocated to that person under 
 60.24  subdivision 2. 
 60.25     If the state or a municipality as defined in section 466.01 
 60.26  is jointly liable, and its fault is less than 35 percent, it is 
 60.27  jointly and severally liable for a percentage of the whole award 
 60.28  no greater than twice the amount of fault, including any amount 
 60.29  reallocated to the state or municipality under subdivision 2. 
 60.30     Subd. 2.  Upon motion made not later than one year after 
 60.31  judgment is entered, the court shall determine whether all or 
 60.32  part of a party's equitable share of the obligation is 
 60.33  uncollectible from that party and shall reallocate any 
 60.34  uncollectible amount among the other parties, including a 
 60.35  claimant at fault, according to their respective percentages of 
 60.36  fault.  A party whose liability is reallocated is nonetheless 
 61.1   subject to contribution and to any continuing liability to the 
 61.2   claimant on the judgment. 
 61.3      Subd. 3.  In the case of a claim arising from the 
 61.4   manufacture, sale, use or consumption of a product, an amount 
 61.5   uncollectible from any person in the chain of manufacture and 
 61.6   distribution shall be reallocated among all other persons in the 
 61.7   chain of manufacture and distribution but not among the claimant 
 61.8   or others at fault who are not in the chain of manufacture or 
 61.9   distribution of the product.  Provided, however, that a person 
 61.10  whose fault is less than that of a claimant is liable to the 
 61.11  claimant only for that portion of the judgment which represents 
 61.12  the percentage of fault attributable to the person whose fault 
 61.13  is less. 
 61.14     Subd. 4.  [APPORTIONMENT OF DAMAGES; MEDICAL 
 61.15  MALPRACTICE.] Notwithstanding subdivisions 1 to 3, for purposes 
 61.16  of medical malpractice actions, when two or more persons are 
 61.17  jointly liable, contributions to awards shall be in proportion 
 61.18  to the percentage of fault attributable to each. 
 61.19                             ARTICLE 6
 61.20                              FUNDING
 61.21     Section 1.  [290.9202] [VOLUNTARILY UNINSURED PENALTY.] 
 61.22     (a) Persons not having proof of health insurance coverage 
 61.23  are subject to a "voluntarily uninsured penalty."  The penalty 
 61.24  is the loss of an individual's personal tax deduction, and for 
 61.25  families without coverage, a loss of deductions for each 
 61.26  dependent.  The maximum penalty under this section is $2,000 for 
 61.27  an individual and $5,000 for a family. 
 61.28     (b) Proof of health insurance coverage shall occur upon 
 61.29  filing of the Minnesota income tax form.  The commissioner of 
 61.30  revenue shall incorporate a section into the tax form which asks 
 61.31  for the name of the insurer and the insurance policy number.  
 61.32  This data shall be classified as private data on individuals or 
 61.33  nonpublic data pursuant to chapter 13. 
 61.34     (c) State revenues attributable to the voluntarily 
 61.35  uninsured penalty shall be transferred from the general fund and 
 61.36  deposited into the health care access fund for use by the 
 62.1   MinnesotaCare insurance program. 
 62.2      Sec. 2.  [TRANSFERS.] 
 62.3      Subdivision 1.  Notwithstanding Laws 1993, chapter 345, 
 62.4   article 14, section 10, the commissioner of finance shall 
 62.5   transfer $....... in fiscal year 1995 and $....... in fiscal 
 62.6   year 1996 from the health care access fund to the general fund. 
 62.7      Subd. 2.  The commissioner of finance shall transfer 
 62.8   $....... from the department of health to the Minnesota health 
 62.9   data institute for purposes of completing the data initiatives 
 62.10  assigned by statute. 
 62.11     Sec. 3.  [REPEALER.] 
 62.12     Minnesota Statutes 1994, sections 214.16; 295.50; 295.51; 
 62.13  295.52; 295.53; 295.54; 295.55; and 295.57, are repealed 
 62.14  effective July 1, 1997.