1.1                          A bill for an act 
  1.2             relating to health care; modifying the integrated 
  1.3             service network act; removing the term "integrated 
  1.4             service networks"; defining a managed care 
  1.5             organization; providing for a report to the 
  1.6             legislature regarding quality assurance regulations 
  1.7             for managed care organizations; amending Minnesota 
  1.8             Statutes 1994, sections 62N.01, subdivision 1; 62N.22; 
  1.9             62N.23; 62N.26; 62N.381, subdivision 1; and 256.9363, 
  1.10            subdivision 1; Minnesota Statutes 1995 Supplement, 
  1.11            sections 62N.381, subdivisions 3 and 4; 62N.40; and 
  1.12            62Q.106; proposing coding for new law as Minnesota 
  1.13            Statutes, chapter 62K; repealing Minnesota Statutes 
  1.14            1994, sections 62N.01, subdivision 2; 62N.02, 
  1.15            subdivisions 6, 7, 8, 9, 10, and 12; 62N.03; 62N.05, 
  1.16            subdivisions 1, 2, and 3; 62N.06; 62N.065; 62N.10, 
  1.17            subdivisions 1, 2, 3, 4, 5, and 6; 62N.11, subdivision 
  1.18            2; 62N.12; 62N.14, subdivisions 1, 2, and 4; 62N.24; 
  1.19            62N.26; and 62N.38, subdivisions 1, 2, 3, and 4; 
  1.20            Minnesota Statutes 1995 Supplement, sections 62J.37; 
  1.21            62N.02, subdivisions 4b and 4c; 62N.04; 62N.05, 
  1.22            subdivision 4; 62N.071; 62N.072; 62N.074; 62N.076; 
  1.23            62N.077; 62N.078; 62N.10, subdivision 7; 62N.11, 
  1.24            subdivision 1; 62N.13; 62N.14, subdivision 3; 62N.15; 
  1.25            62N.17; and 62N.18. 
  1.26  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.27     Section 1.  [62K.01] [CITATION.] 
  1.28     This chapter may be cited as the Minnesota managed care 
  1.29  organization act. 
  1.30     Sec. 2.  [62K.02] [DEFINITION; MANAGED CARE ORGANIZATION.] 
  1.31     "Managed care organization" means: 
  1.32     (1) a health maintenance organization operating under 
  1.33  chapter 62D; 
  1.34     (2) a community integrated service network as defined under 
  1.35  section 62N.02, subdivision 4a; 
  2.1      (3) an insurance company licensed under chapter 60A, 
  2.2   nonprofit health service plan corporation operating under 
  2.3   chapter 62C, fraternal benefit society operating under chapter 
  2.4   64B, or cooperatives operating under chapter 62R; or 
  2.5      (4) any other entity which contracts with a payer to 
  2.6   provide health care services to individuals or groups, which 
  2.7   entity: 
  2.8      (i) covers health care services through a preferred 
  2.9   provider organization or a network of selected providers, and 
  2.10     (ii) offers enrollees a financial incentive to utilize a 
  2.11  selected group of providers. 
  2.12     Sec. 3.  [62K.03] [REQUIREMENTS.] 
  2.13     The departments of health and commerce shall submit a 
  2.14  report to the legislature which shall make recommendations for 
  2.15  quality assurance regulation of managed care organizations as 
  2.16  defined in section 62K.02 and which shall include draft 
  2.17  legislation for quality assurance regulation of managed care 
  2.18  organizations.  The report from the commissioners shall be made 
  2.19  available to the legislature by February 1, 1997. 
  2.20     Sec. 4.  Minnesota Statutes 1994, section 62N.01, 
  2.21  subdivision 1, is amended to read: 
  2.22     Subdivision 1.  [CITATION.] This chapter may be cited as 
  2.23  the "Minnesota community integrated service network act." 
  2.24     Sec. 5.  Minnesota Statutes 1994, section 62N.22, is 
  2.25  amended to read: 
  2.26     62N.22 [DISCLOSURE OF COMMISSIONS.] 
  2.27     Before selling any coverage or enrollment in a community 
  2.28  integrated service network ~~or an integrated service network~~, a 
  2.29  person selling the coverage or enrollment shall disclose in 
  2.30  writing to the prospective purchaser the amount of any 
  2.31  commission or other compensation the person will receive as a 
  2.32  direct result of the sale.  The disclosure may be expressed in 
  2.33  dollars or as a percentage of the premium.  The amount disclosed 
  2.34  need not include any anticipated renewal commissions. 
  2.35     Sec. 6.  Minnesota Statutes 1994, section 62N.23, is 
  2.36  amended to read: 
  3.1      62N.23 [TECHNICAL ASSISTANCE; LOANS.] 
  3.2      (a) The commissioner shall provide technical assistance to 
  3.3   parties interested in establishing or operating a community 
  3.4   integrated service network ~~or an integrated service network~~.  
  3.5   This shall be known as the community integrated service network 
  3.6   technical assistance program (ISNTAP). 
  3.7      The technical assistance program shall offer seminars on 
  3.8   the establishment and operation of community integrated service 
  3.9   networks ~~or integrated service networks~~ in all regions of 
  3.10  Minnesota.  The commissioner shall advertise these seminars in 
  3.11  local and regional newspapers, and attendance at these seminars 
  3.12  shall be free. 
  3.13     The commissioner shall write a guide to establishing and 
  3.14  operating a community integrated service network ~~or an~~ 
  3.15  ~~integrated service network~~.  The guide must provide basic 
  3.16  instructions for parties wishing to establish a community 
  3.17  integrated service network ~~or an integrated service network~~.  
  3.18  The guide must be provided free of charge to interested 
  3.19  parties.  The commissioner shall update this guide when 
  3.20  appropriate. 
  3.21     The commissioner shall establish a toll-free telephone line 
  3.22  that interested parties may call to obtain assistance in 
  3.23  establishing or operating a community integrated service network 
  3.24  ~~or an integrated service network~~. 
  3.25     (b) The commissioner shall grant loans for organizational 
  3.26  and start-up expenses to entities forming community integrated 
  3.27  service networks ~~or integrated service networks~~, or to networks 
  3.28  less than one year old, to the extent of any appropriation for 
  3.29  that purpose.  The commissioner shall allocate the available 
  3.30  funds among applicants based upon the following criteria, as 
  3.31  evaluated by the commissioner within the commissioner's 
  3.32  discretion: 
  3.33     (1) the applicant's need for the loan; 
  3.34     (2) the likelihood that the loan will foster the formation 
  3.35  or growth of a network; and 
  3.36     (3) the likelihood of repayment. 
  4.1      The commissioner shall determine any necessary application 
  4.2   deadlines and forms and is exempt from rulemaking in doing so. 
  4.3      Sec. 7.  Minnesota Statutes 1994, section 62N.26, is 
  4.4   amended to read: 
  4.5      62N.26 [SHARED SERVICES COOPERATIVE.] 
  4.6      The commissioner of health shall establish, or assist in 
  4.7   establishing, a shared services cooperative organized under 
  4.8   chapter 308A to make available administrative and legal 
  4.9   services, technical assistance, provider contracting and billing 
  4.10  services, and other services to those community integrated 
  4.11  service networks ~~and integrated service networks~~ that choose to 
  4.12  participate in the cooperative.  The commissioner shall provide, 
  4.13  to the extent funds are appropriated, start-up loans sufficient 
  4.14  to maintain the shared services cooperative until its operations 
  4.15  can be maintained by fees and contributions.  The cooperative 
  4.16  must not be staffed, administered, or supervised by the 
  4.17  commissioner of health.  The cooperative shall make use of 
  4.18  existing resources that are already available in the community, 
  4.19  to the extent possible. 
  4.20     Sec. 8.  Minnesota Statutes 1994, section 62N.381, 
  4.21  subdivision 1, is amended to read: 
  4.22     Subdivision 1.  [APPLICABILITY.] This section applies to 
  4.23  all reimbursement rate negotiations between ambulance services 
  4.24  and community integrated service networks ~~or integrated service~~ 
  4.25  ~~networks~~. 
  4.26     Sec. 9.  Minnesota Statutes 1995 Supplement, section 
  4.27  62N.381, subdivision 3, is amended to read: 
  4.28     Subd. 3.  [DEVELOPMENT OF CRITERIA.] The emergency medical 
  4.29  services regulatory board, in consultation with representatives 
  4.30  of the Minnesota Ambulance Association, regional emergency 
  4.31  medical services programs, and community integrated service 
  4.32  networks, ~~and integrated service networks,~~ shall develop 
  4.33  guidelines to use in reviewing rate proposals and making a final 
  4.34  reimbursement rate determination. 
  4.35     Sec. 10.  Minnesota Statutes 1995 Supplement, section 
  4.36  62N.381, subdivision 4, is amended to read: 
  5.1      Subd. 4.  [REVIEW OF RATE PROPOSALS.] The emergency medical 
  5.2   services regulatory board, using the guidelines developed under 
  5.3   subdivision 3, shall review the rate proposals of the ambulance 
  5.4   service and community integrated service network ~~or integrated~~ 
  5.5   ~~service network~~ and shall adopt either the network's or the 
  5.6   ambulance service's proposal.  The board shall require the 
  5.7   network and ambulance service to adhere to this reimbursement 
  5.8   rate for the contract period. 
  5.9      Sec. 11.  Minnesota Statutes 1995 Supplement, section 
  5.10  62N.40, is amended to read: 
  5.11     62N.40 [CHEMICAL DEPENDENCY SERVICES.] 
  5.12     Each community integrated service network ~~and integrated~~ 
  5.13  ~~service network~~ regulated under this chapter must ensure that 
  5.14  chemically dependent individuals have access to cost-effective 
  5.15  treatment options that address the specific needs of 
  5.16  individuals.  These include, but are not limited to, the need 
  5.17  for:  treatment that takes into account severity of illness and 
  5.18  comorbidities; provision of a continuum of care, including 
  5.19  treatment and rehabilitation programs licensed under Minnesota 
  5.20  Rules, parts 9530.4100 to 9530.4410 and 9530.5000 to 9530.6500; 
  5.21  the safety of the individual's domestic and community 
  5.22  environment; gender appropriate and culturally appropriate 
  5.23  programs; and access to appropriate social services. 
  5.24     Sec. 12.  Minnesota Statutes 1995 Supplement, section 
  5.25  62Q.106, is amended to read: 
  5.26     62Q.106 [DISPUTE RESOLUTION BY COMMISSIONER.] 
  5.27     A complainant may at any time submit a complaint to the 
  5.28  appropriate commissioner to investigate.  After investigating a 
  5.29  complaint, or reviewing a company's decision, the appropriate 
  5.30  commissioner may order a remedy as authorized under section 
  5.31  ~~62N.04,~~ 62Q.30, chapter 45, 60A, or 62D. 
  5.32     Sec. 13.  Minnesota Statutes 1994, section 256.9363, 
  5.33  subdivision 1, is amended to read: 
  5.34     Subdivision 1.  [SELECTION OF VENDORS.] In order to contain 
  5.35  costs, the commissioner of human services shall select vendors 
  5.36  of medical care who can provide the most economical care 
  6.1   consistent with high medical standards and shall, where 
  6.2   possible, contract with organizations on a prepaid capitation 
  6.3   basis to provide these services.  The commissioner shall 
  6.4   consider proposals by counties and vendors for managed care 
  6.5   plans which may include:  prepaid capitation programs, 
  6.6   competitive bidding programs, or other vendor payment mechanisms 
  6.7   designed to provide services in an economical manner or to 
  6.8   control utilization, with safeguards to ensure that necessary 
  6.9   services are provided.  ~~Managed care plans may include~~ 
  6.10  ~~integrated service networks as defined in section 62N.02.~~ 
  6.11     Sec. 14.  [INSTRUCTION TO REVISOR.] 
  6.12     The revisor of statutes shall delete the term "integrated 
  6.13  service network" wherever it appears in Minnesota Statutes 1996 
  6.14  and subsequent editions of the statutes. 
  6.15     Sec. 15.  [REPEALER.] 
  6.16     Minnesota Statutes 1994, sections 62N.01, subdivision 2; 
  6.17  62N.02, subdivisions 6, 7, 8, 9, 10, and 12; 62N.03; 62N.05, 
  6.18  subdivisions 1, 2, and 3; 62N.06; 62N.065; 62N.10, subdivisions 
  6.19  1, 2, 3, 4, 5, and 6; 62N.11, subdivision 2; 62N.12; 62N.14, 
  6.20  subdivisions 1, 2, and 4; 62N.24; 62N.26; and 62N.38, 
  6.21  subdivisions 1, 2, 3, and 4; Minnesota Statutes 1995 Supplement, 
  6.22  sections 62J.37; 62N.02, subdivisions 4b and 4c; 62N.04; 62N.05, 
  6.23  subdivision 4; 62N.071; 62N.072; 62N.074; 62N.076; 62N.077; 
  6.24  62N.078; 62N.10, subdivision 7; 62N.11, subdivision 1; 62N.13; 
  6.25  62N.14, subdivision 3; 62N.15; 62N.17; and 62N.18, are repealed.