1.1                          A bill for an act 
  1.2             relating to health; creating an office of health care 
  1.3             consumer assistance, advocacy, and information; 
  1.4             amending the enrollee complaint system for health 
  1.5             maintenance organizations; extending the date of 
  1.6             establishing an informal complaint resolution process; 
  1.7             appropriating money; amending Minnesota Statutes 1997 
  1.8             Supplement, sections 62D.11, subdivision 1; 62J.75; 
  1.9             62Q.105, subdivision 1; and 62Q.30; proposing coding 
  1.10            for new law in Minnesota Statutes, chapter 62J. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.13  62D.11, subdivision 1, is amended to read: 
  1.14     Subdivision 1.  [ENROLLEE COMPLAINT SYSTEM.] Every health 
  1.15  maintenance organization shall establish and maintain a 
  1.16  complaint system, as required under section 62Q.105 to provide 
  1.17  reasonable procedures for the resolution of written complaints 
  1.18  initiated by or on behalf of enrollees concerning the provision 
  1.19  of health care services.  "Provision of health services" 
  1.20  includes, but is not limited to, questions of the scope of 
  1.21  coverage, quality of care, and administrative operations.  The 
  1.22  health maintenance organization must inform enrollees that they 
  1.23  may choose to use alternative dispute resolution to appeal a 
  1.24  health maintenance organization's internal appeal decision.  The 
  1.25  health maintenance organization must also inform enrollees that 
  1.26  they have the right to choose to use an alternative dispute 
  1.27  resolution process to appeal a determination not to certify an 
  1.28  admission, procedure, service, or extension of stay under 
  2.1   section 62M.06.  If an enrollee chooses to use an alternative 
  2.2   dispute resolution process, the health maintenance organization 
  2.3   must participate. 
  2.4      Sec. 2.  Minnesota Statutes 1997 Supplement, section 
  2.5   62J.75, is amended to read: 
  2.6      62J.75 [CONSUMER ADVISORY BOARD.] 
  2.7      (a) The consumer advisory board consists of 18 members 
  2.8   appointed in accordance with paragraph (b).  All members must be 
  2.9   public, consumer members who: 
  2.10     (1) do not have and never had a material interest in either 
  2.11  the provision of health care services or in an activity directly 
  2.12  related to the provision of health care services, such as health 
  2.13  insurance sales or health plan administration; 
  2.14     (2) are not registered lobbyists; and 
  2.15     (3) are not currently responsible for or directly involved 
  2.16  in the purchasing of health insurance for a business or 
  2.17  organization. 
  2.18     (b) The governor, the speaker of the house of 
  2.19  representatives, and the subcommittee on committees of the 
  2.20  committee on rules and administration of the senate shall each 
  2.21  appoint two members.  The Indian affairs council, the council on 
  2.22  affairs of Chicano/Latino people, the council on Black 
  2.23  Minnesotans, the council on Asian-Pacific Minnesotans, 
  2.24  mid-Minnesota legal assistance, and the Minnesota chamber of 
  2.25  commerce shall each appoint one member.  The member appointed by 
  2.26  the Minnesota chamber of commerce must represent small business 
  2.27  interests.  The health care campaign of Minnesota, Minnesotans 
  2.28  for affordable health care, and consortium for citizens with 
  2.29  disabilities shall each appoint two members.  Members serve 
  2.30  without compensation or reimbursement for expenses. 
  2.31     (c) The board shall advise the commissioners of health and 
  2.32  commerce on the following: 
  2.33     (1) the needs of health care consumers and how to better 
  2.34  serve and educate the consumers on health care concerns and 
  2.35  recommend solutions to identified problems; and 
  2.36     (2) consumer protection issues in the self-insured market, 
  3.1   including, but not limited to, public education needs. 
  3.2      The board also may make recommendations to the legislature 
  3.3   on these issues. 
  3.4      (d) The board shall have ongoing communication with the 
  3.5   office of health care consumer assistance, advocacy, and 
  3.6   information and may make recommendations to the executive 
  3.7   director on how to improve the efficiency of the office and on 
  3.8   how to protect health care consumer rights. 
  3.9      (e) The board and this section expire June 30, 2001. 
  3.10             OFFICE OF HEALTH CARE CONSUMER ASSISTANCE, 
  3.11                     ADVOCACY, AND INFORMATION 
  3.12     Sec. 3.  [62J.77] [DEFINITIONS.] 
  3.13     Subdivision 1.  [APPLICABILITY.] For purposes of sections 
  3.14  62J.77 to 62J.80, the terms defined in this section have the 
  3.15  meanings given them. 
  3.16     Subd. 2.  [ENROLLEE.] "Enrollee" means a natural person 
  3.17  covered by a health plan company, health insurance, or health 
  3.18  coverage plan and includes an insured, policyholder, subscriber, 
  3.19  contract holder, member, covered person, or certificate holder. 
  3.20     Subd. 3.  [PATIENT.] "Patient" means a former, current, or 
  3.21  prospective patient of a health care provider. 
  3.22     Sec. 4.  [62J.78] [ESTABLISHMENT; ORGANIZATION.] 
  3.23     Subdivision 1.  [GENERAL.] The office of health care 
  3.24  consumer assistance, advocacy, and information is established 
  3.25  within the office of the ombudsman for mental health and 
  3.26  retardation to provide assistance, advocacy, and information to 
  3.27  all health care consumers within the state.  The office shall 
  3.28  have no regulatory power or authority and shall not provide 
  3.29  legal representation in a court of law. 
  3.30     Subd. 2.  [EXECUTIVE DIRECTOR.] (a) An executive director 
  3.31  shall be appointed by the governor, in consultation with the 
  3.32  consumer advisory board, for a three-year term and may be 
  3.33  removed only for just cause.  
  3.34     (b) The executive director must: 
  3.35     (1) be selected without regard to political affiliation; 
  3.36     (2) have knowledge and experience concerning the needs and 
  4.1   rights of health care consumers; and 
  4.2      (3) be qualified to analyze questions of law, 
  4.3   administrative functions, and public policy.  
  4.4      (c) No person may serve as executive director while holding 
  4.5   another public office. 
  4.6      Subd. 3.  [STAFF.] The executive director shall appoint at 
  4.7   least nine consumer advocates to discharge the responsibilities 
  4.8   and duties of the office.  The director and all other staff 
  4.9   shall serve in the unclassified service.  The executive director 
  4.10  and full-time staff shall be included in the Minnesota state 
  4.11  retirement association. 
  4.12     Subd. 4.  [DELEGATION.] The executive director may delegate 
  4.13  to staff any of the authority or duties of the director, except 
  4.14  the duty of formally making recommendations to the legislature.  
  4.15     Subd. 5.  [TRAINING.] The executive director shall ensure 
  4.16  that the consumer advocates are adequately trained. 
  4.17     Subd. 6.  [STATEWIDE ADVOCACY.] The executive director 
  4.18  shall assign at least one consumer advocate to represent each 
  4.19  regional coordinating board geographic area. 
  4.20     Subd. 7.  [FINANCIAL INTEREST.] The executive director and 
  4.21  staff must not have any personal financial interest in the 
  4.22  health care system except as an individual consumer of health 
  4.23  care services. 
  4.24     Subd. 8.  [ADMINISTRATION.] The office of the ombudsman for 
  4.25  mental health and retardation shall provide office space, 
  4.26  equipment and supplies, and technical support to the office of 
  4.27  health care consumer assistance, advocacy, and information. 
  4.28     Sec. 5.  [62J.79] [DUTIES AND POWERS OF THE OFFICE OF 
  4.29  HEALTH CARE CONSUMER ASSISTANCE, ADVOCACY, AND INFORMATION.] 
  4.30     Subdivision 1.  [DUTIES.] Within the appropriation 
  4.31  allocated, the executive director shall provide information and 
  4.32  assistance to all health care consumers by: 
  4.33     (1) assisting patients and enrollees in understanding and 
  4.34  asserting their contractual and legal rights, including the 
  4.35  rights under an alternative dispute resolution process.  This 
  4.36  assistance may include advocacy for enrollees in administrative 
  5.1   proceedings or other formal or informal dispute resolution 
  5.2   processes; 
  5.3      (2) assisting enrollees in obtaining appropriate health 
  5.4   care referrals under their health plan company, health 
  5.5   insurance, or health coverage plan; 
  5.6      (3) assisting patients and enrollees in accessing the 
  5.7   services of governmental agencies or regulatory boards or other 
  5.8   state consumer assistance programs, ombudsman, or advocacy 
  5.9   services whenever appropriate so that the patient or enrollee 
  5.10  can take full advantage of existing mechanisms for resolving 
  5.11  complaints; 
  5.12     (4) referring patients and enrollees to governmental 
  5.13  agencies and regulatory boards for the investigation of health 
  5.14  care complaints and for enforcement action; 
  5.15     (5) educating and training enrollees about their health 
  5.16  plan company, health insurance, or health coverage plan to 
  5.17  enable them to assert their rights and to understand their 
  5.18  responsibilities; 
  5.19     (6) assisting enrollees in receiving a timely resolution of 
  5.20  their complaints; 
  5.21     (7) monitoring health care consumer complaints addressed by 
  5.22  the office of health care consumer assistance, advocacy, and 
  5.23  information to identify specific complaint patterns or areas of 
  5.24  potential improvement; 
  5.25     (8) collecting public information on consumer satisfaction 
  5.26  and outcomes data on health plan company and health care 
  5.27  provider performances from organizations conducting surveys, 
  5.28  including the Minnesota health data institute; and 
  5.29     (9) recommending to health plan companies ways to identify 
  5.30  and remove any barriers that might delay or impede the health 
  5.31  plan company's effort to resolve consumer complaints.  
  5.32     Subd. 2.  [COMMUNICATION.] The executive director shall 
  5.33  have ongoing communication with the consumer advisory board. 
  5.34     Subd. 3.  [REPORTS.] (a) Beginning January 1, 1999, the 
  5.35  executive director must report, on at least a quarterly basis, 
  5.36  any patterns identified from the consumer complaints addressed 
  6.1   by the office to the commissioners of health and commerce, the 
  6.2   Minnesota council of health plans, the insurance federation of 
  6.3   Minnesota, and the information clearinghouse.  
  6.4      (b) Beginning January 1, 1999, the executive director must 
  6.5   make an annual written report to the legislature regarding 
  6.6   activities of the office, including recommendations on improving 
  6.7   health care consumer assistance and complaint resolution 
  6.8   processes.  Before any recommendations are made to the 
  6.9   legislature, the executive director must consult with the 
  6.10  consumer advisory board and other interested parties. 
  6.11     Sec. 6.  [62J.80] [RETALIATION.] 
  6.12     A health plan company or health care provider shall not 
  6.13  retaliate or take adverse action against an enrollee or patient 
  6.14  who, in good faith, makes a complaint against a health plan 
  6.15  company or health care provider. 
  6.16     Sec. 7.  Minnesota Statutes 1997 Supplement, section 
  6.17  62Q.105, subdivision 1, is amended to read: 
  6.18     Subdivision 1.  [ESTABLISHMENT.] Each health plan company 
  6.19  shall establish and make available to enrollees, by July 1, 1998 
  6.20  1999, an informal complaint resolution process that meets the 
  6.21  requirements of this section.  A health plan company must make 
  6.22  reasonable efforts to resolve enrollee complaints, and must 
  6.23  inform complainants in writing of the company's decision within 
  6.24  30 days of receiving the complaint.  The complaint resolution 
  6.25  process must treat the complaint and information related to it 
  6.26  as required under sections 72A.49 to 72A.505.  
  6.27     Sec. 8.  Minnesota Statutes 1997 Supplement, section 
  6.28  62Q.30, is amended to read: 
  6.29     62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION 
  6.30  PROCESS.] 
  6.31     The commissioner shall establish an expedited fact finding 
  6.32  and dispute resolution process to assist enrollees of health 
  6.33  plan companies with contested treatment, coverage, and service 
  6.34  issues to be in effect July 1, 1998 1999.  If the disputed issue 
  6.35  relates to whether a service is appropriate and necessary, the 
  6.36  commissioner shall issue an order only after consulting with 
  7.1   appropriate experts knowledgeable, trained, and practicing in 
  7.2   the area in dispute, reviewing pertinent literature, and 
  7.3   considering the availability of satisfactory alternatives.  The 
  7.4   commissioner shall take steps including but not limited to 
  7.5   fining, suspending, or revoking the license of a health plan 
  7.6   company that is the subject of repeated orders by the 
  7.7   commissioner that suggests a pattern of inappropriate 
  7.8   underutilization.  
  7.9      Sec. 9.  [COMPLAINT PROCESS STUDY.] 
  7.10     The complaint process work group established by the 
  7.11  commissioners of health and commerce as required under Laws 
  7.12  1997, chapter 237, section 20, shall continue to meet to develop 
  7.13  an informal complaint resolution process for health plan 
  7.14  companies to make available to enrollees as required under 
  7.15  Minnesota Statutes, sections 62Q.105 and 62Q.11.  The 
  7.16  commissioners of health and commerce shall submit a progress 
  7.17  report to the legislative commission on health care access by 
  7.18  September 15, 1998, and shall submit final recommendations to 
  7.19  the legislature, including draft legislation on developing such 
  7.20  a process, by January 15, 1999.  The recommendations may also 
  7.21  include, in consultation with the work group, permanent methods 
  7.22  of financing the office of health care consumer assistance, 
  7.23  advocacy, and information. 
  7.24     Sec. 10.  [APPROPRIATION.] 
  7.25     $....... is appropriated for fiscal year 1999 from the 
  7.26  general fund to the executive director of the office of health 
  7.27  care consumer assistance, advocacy, and information to 
  7.28  administer Minnesota Statutes, sections 62J.77 to 62J.80.