1.1                          A bill for an act
  1.2             relating to health care; establishing protections for 
  1.3             health care patients and consumers; creating a 
  1.4             statewide health care consumer assistance office; 
  1.5             prohibiting contracts that restrict communication 
  1.6             between providers and their patients; requiring 
  1.7             disclosure of health care provider financial 
  1.8             incentives; creating a tax offset for the Minnesota 
  1.9             comprehensive health association assessment to reduce 
  1.10            the premium tax burden on certain purchasers of health 
  1.11            insurance; establishing a process for reviewing 
  1.12            proposed state-mandated health plan benefits; 
  1.13            expanding eligibility for the MinnesotaCare program; 
  1.14            authorizing public information projects to inform 
  1.15            uninsured persons about the availability of health 
  1.16            coverage; encouraging health plans to collaborate with 
  1.17            public health agencies; providing alternative funding 
  1.18            for local public health activities and county social 
  1.19            services; strengthening and enforcing the pass-through 
  1.20            provision of the health care provider tax; reducing 
  1.21            duplicative inspections and regulatory compliance 
  1.22            requirements for health plan companies; authorizing 
  1.23            emergency medical services pilot projects; 
  1.24            appropriating money; amending Minnesota Statutes 1996, 
  1.25            sections 62D.04, by adding a subdivision; 62E.11, by 
  1.26            adding a subdivision; 62Q.075, subdivision 2; 
  1.27            256.9354, subdivision 5, and by adding a subdivision; 
  1.28            295.58; 295.582; and 297.13, subdivision 1; proposing 
  1.29            coding for new law in Minnesota Statutes, chapters 
  1.30            62A; and 144. 
  1.31     BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.32                             ARTICLE 1
  1.33           HEALTH CARE CONSUMER PROTECTION AND ASSISTANCE 
  1.34     Section 1.  [144.6506] [LEGISLATIVE INTENT.] 
  1.35     It is the intent of the legislature in sections 144.6507, 
  1.36  144.6508, and 144.6509 to establish additional state consumer 
  1.37  protections and assistance relating to the coverage for and 
  1.38  delivery of health care treatment and services that will 
  2.1   supplement and complement existing laws and regulations and 
  2.2   further ensure that no patient receiving services or treatment 
  2.3   within Minnesota will be harmed by inappropriate health care 
  2.4   practices or treatment, and to provide improved assistance to 
  2.5   consumers and patients who have questions or problems relating 
  2.6   to their health care coverage or treatment. 
  2.7      Sec. 2.  [144.6507] [PATIENT PROTECTION.] 
  2.8      Subdivision 1.  [DEFINITION.] For purposes of this section, 
  2.9   health care provider or provider means: 
  2.10     (1) a physician, nurse, or other provider as defined under 
  2.11  section 62J.03; 
  2.12     (2) a hospital as defined under section 144.696, 
  2.13  subdivision 3; 
  2.14     (3) an individual or entity that provides health care 
  2.15  coverage or services under the medical assistance, general 
  2.16  assistance medical care, or MinnesotaCare program; 
  2.17     (4) an association, partnership, corporation, cooperative, 
  2.18  limited liability corporation, or other organization of persons 
  2.19  or entities described in clause (1) or (2) organized for the 
  2.20  purposes of providing, arranging, or administering health care 
  2.21  services or treatment.  This section does not apply to a trade 
  2.22  association, membership association of health care 
  2.23  professionals, or other organization that does not directly 
  2.24  provide, arrange, or administer health care services or 
  2.25  treatment. 
  2.26     Subd. 2.  [PROHIBITED PROVIDER CONTRACTS.] (a) The 
  2.27  following contracts or agreements are contrary to state public 
  2.28  policy, are prohibited under this section, and are null and void:
  2.29     (1) [RESTRICTIONS ON COMMUNICATION WITH PATIENTS REGARDING 
  2.30  HEALTH STATUS OR TREATMENT OPTIONS.] A contract or written 
  2.31  agreement that prohibits a health care provider from 
  2.32  communicating with a patient with respect to the patient's 
  2.33  health status, health care, or treatment options, as long as the 
  2.34  health care provider is acting within the provider's scope of 
  2.35  practice as defined by law; 
  2.36     (2) [RESTRICTIONS ON INFORMING PATIENTS ABOUT HEALTH PLAN 
  3.1   COVERAGE.] A contract or written agreement that prohibits a 
  3.2   health care provider from disclosing accurate information about 
  3.3   whether services or treatment will be paid for by a patient's 
  3.4   health insurance, health coverage plan, or other third-party 
  3.5   payment arrangement; 
  3.6      (3) [RESTRICTIONS ON INFORMING PATIENTS ABOUT PROVIDER 
  3.7   PAYMENT PROVISIONS.] A contract or written agreement that 
  3.8   prohibits a health care provider from informing a patient about 
  3.9   the general nature of the reimbursement methodology used by a 
  3.10  health plan to pay the provider.  Nothing in this section 
  3.11  prohibits a contract provision that requires any contracting 
  3.12  party to keep confidential or to not use or disclose proprietary 
  3.13  information of a specific health plan company.  
  3.14     (b) [PERSONS AND ENTITIES AFFECTED.] The following persons 
  3.15  and entities shall not enter into a contract or agreement that 
  3.16  is prohibited under this section: 
  3.17     (1) a health plan company as defined under section 62Q.01, 
  3.18  subdivision 4; 
  3.19     (2) a health care network cooperative as defined under 
  3.20  section 62R.04, subdivision 3; 
  3.21     (3) a health care provider as defined in subdivision 1; and 
  3.22     (4) any other individual or entity that delivers, arranges, 
  3.23  or administers health care services or treatment or administers 
  3.24  a health coverage plan. 
  3.25     Subd. 3.  [RETALIATION PROHIBITED.] No person or 
  3.26  organization that has a contract with a health care provider may 
  3.27  take retaliatory action against the provider solely on the 
  3.28  grounds that the provider: 
  3.29     (1) refused to enter into a contract or agreement that is 
  3.30  prohibited under this section; or 
  3.31     (2) disclosed accurate information about whether health 
  3.32  care services or treatment are covered by a patient's health 
  3.33  insurance or other health coverage plan contract. 
  3.34     Sec. 3.  [144.6508] [HEALTH PLAN PRACTICES AFFECTING 
  3.35  PATIENT CARE.] 
  3.36     Subdivision 1.  [PURPOSE.] The purpose of this section is 
  4.1   to preserve health care quality and access to care, and to 
  4.2   protect patients, by establishing requirements relating to 
  4.3   certain aspects of third-party health coverage that directly 
  4.4   relate to the quality and effectiveness of health care treatment 
  4.5   and access to needed services.  This section shall not be 
  4.6   construed to affect those aspects of the financing or 
  4.7   administration of third-party health coverage that do not 
  4.8   directly relate to health care quality or treatment or access to 
  4.9   needed services.  
  4.10     Subd. 2.  [DISCLOSURE OF PROVIDER FINANCIAL INCENTIVES.] A 
  4.11  health plan company as defined under section 62Q.01, subdivision 
  4.12  4; a health care network cooperative as defined under section 
  4.13  62R.04, subdivision 3; a health care provider as defined under 
  4.14  section 144.6507; and any other individual or entity that 
  4.15  administers a health coverage plan shall upon request disclose 
  4.16  to their enrollees, subscribers, insureds, or patients the 
  4.17  general nature of the reimbursement methodology used to pay a 
  4.18  provider. 
  4.19     Subd. 3.  [COVERAGE OF INPATIENT MASTECTOMY REQUIRED.] (a) 
  4.20  A health plan company as defined under section 62Q.01, 
  4.21  subdivision 4, or any other individual or entity that 
  4.22  administers a health coverage plan shall not deny coverage of a 
  4.23  mastectomy performed on an inpatient hospital basis, if the 
  4.24  mastectomy would otherwise be covered if performed on an 
  4.25  outpatient basis or in any other health care setting. 
  4.26     (b) Paragraph (a) shall be reviewed under the assessment 
  4.27  process established in section 62A.310.  The commissioner of 
  4.28  health shall submit a written report on the results of the 
  4.29  assessment to the legislature in compliance with section 3.195, 
  4.30  no later than January 1, 1999.  
  4.31     Sec. 4.  [144.6509] [STATEWIDE HEALTH CARE CONSUMER 
  4.32  ASSISTANCE.] 
  4.33     Subdivision 1.  [CONSUMER ASSISTANCE OFFICE 
  4.34  ESTABLISHED.] The commissioners of health and commerce, in 
  4.35  consultation with the commissioners of human services, employee 
  4.36  relations, and labor and industry, shall establish a statewide 
  5.1   office to provide assistance to consumers or patients with 
  5.2   complaints or problems relating to their health care or health 
  5.3   coverage plan.  The health care consumer assistance office shall 
  5.4   assist consumers in understanding their health care plan 
  5.5   coverage and locating the appropriate agency or person to 
  5.6   provide further assistance if needed.  The office has no 
  5.7   regulatory power, but may provide assistance to consumers as 
  5.8   necessary to help them understand their health care problem and 
  5.9   identify persons or organizations that can assist them with 
  5.10  their problem.  The office shall not participate in litigation, 
  5.11  mediation, or other formal dispute resolution processes.  The 
  5.12  commissioner of health, in consultation with affected state 
  5.13  agencies, offices, and ombudsman programs, shall submit an 
  5.14  implementation plan to the legislature by January 1, 1998, that 
  5.15  includes draft legislation if required. 
  5.16     Subd. 2.  [CONSOLIDATION AND COORDINATION OF CONSUMER 
  5.17  ASSISTANCE AND ADVOCACY OFFICES.] The implementation plan 
  5.18  required under subdivision 1 must also include recommendations 
  5.19  regarding the feasibility and desirability of consolidating, and 
  5.20  improving coordination of, some or all existing state consumer 
  5.21  assistance, ombudsman, and advocacy activities, in addition to 
  5.22  establishing the statewide consumer assistance office to help 
  5.23  consumers locate these services.  The implementation plan must 
  5.24  include a budget that does not exceed the combined base level 
  5.25  funding of existing programs. 
  5.26     Sec. 5.  [SEVERABILITY.] 
  5.27     If any section, subdivision, clause, phrase, or word of 
  5.28  this act is for any reason held to be unconstitutional or in 
  5.29  violation of federal law, the decision shall not affect the 
  5.30  validity of the remaining portions of this act.  To the extent 
  5.31  allowed by federal law, this act shall be interpreted and 
  5.32  construed to fulfill the intent of the legislature to establish 
  5.33  universal patient protections and consumer assistance that will 
  5.34  protect and assist any Minnesota patient or consumer without 
  5.35  regard to the nature of the individual's health status or 
  5.36  condition, need for care or treatment, type of health care 
  6.1   provider used, health coverage, or status as a recipient of 
  6.2   public assistance. 
  6.3                              ARTICLE 2
  6.4                   AFFORDABILITY OF HEALTH COVERAGE 
  6.5      Section 1.  [62A.310] [ASSESSMENT OF PROPOSED HEALTH 
  6.6   COVERAGE MANDATES.] 
  6.7      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  6.8   section, the following terms have the meanings given: 
  6.9      (a) "Mandated health benefit proposal" means a proposal 
  6.10  that would statutorily require a health plan to do the following:
  6.11     (1) provide coverage, or increase the amount of coverage, 
  6.12  for the treatment of a particular disease, condition, or other 
  6.13  health care need; or 
  6.14     (2) provide coverage, or increase the amount of coverage, 
  6.15  of a particular type of health care treatment or service or of 
  6.16  equipment, supplies, or drugs used in connection with a health 
  6.17  care treatment or service. 
  6.18     (b) "Commissioner" means the commissioner of health. 
  6.19     (c) "Health plan" means a health plan as defined in section 
  6.20  62A.011, subdivision 3, but includes coverage listed in clauses 
  6.21  (7) and (10) of that definition. 
  6.22     Subd. 2.  [HEALTH COVERAGE MANDATE ASSESSMENT PROCESS 
  6.23  ESTABLISHED.] The commissioner of health, in consultation with 
  6.24  the commissioners of commerce, human services, and employee 
  6.25  relations, shall establish and administer a process for the 
  6.26  review, assessment, and cost benefit analysis of mandated health 
  6.27  benefit proposals.  The purpose of the assessment is to provide 
  6.28  the legislature with a cost benefit analysis of the social and 
  6.29  financial impact of each mandated health benefit proposal before 
  6.30  legislative action is taken.  In addition to other appropriate 
  6.31  subjects, the assessment must report on the estimated number of 
  6.32  Minnesotans who already have the coverage as well as the number 
  6.33  who do not, the number of persons who would benefit from the 
  6.34  mandated coverage, the cost impact of the mandate on different 
  6.35  types of purchasers and consumers, including Medicare-related 
  6.36  coverage under section 62A.31, subdivision 3, medical 
  7.1   assistance, and the effect of the mandate on access to coverage 
  7.2   and health care services and on the overall percentages of 
  7.3   Minnesotans who do not have health coverage. 
  7.4      Subd. 3.  [REQUESTS FOR ASSESSMENT.] Whenever a legislative 
  7.5   measure containing a mandated health benefit proposal is 
  7.6   introduced as a bill or offered as an amendment to a bill, or is 
  7.7   likely to be introduced or offered as an amendment, the chairs 
  7.8   of the standing committees having jurisdiction over the proposal 
  7.9   shall request that the commissioner complete an assessment of 
  7.10  the proposal prior to any committee action by either house of 
  7.11  the legislature.  Any person or organization may also request 
  7.12  that the commissioner complete an assessment.  If multiple 
  7.13  requests are received, the commissioner shall consult with the 
  7.14  chairs of the standing legislative committees having 
  7.15  jurisdiction over mandated health benefit proposals to 
  7.16  prioritize the requests. 
  7.17     Subd. 4.  [ASSESSMENT OF PROPOSED MANDATES; REPORT TO THE 
  7.18  LEGISLATURE.] The commissioner shall conduct an assessment of 
  7.19  each mandated health benefit proposal selected for assessment 
  7.20  and submit a report to the legislature no later than 180 days 
  7.21  after the request.  The commissioner shall, in consultation with 
  7.22  the chairs of the standing committees having jurisdiction over 
  7.23  the proposal, develop a reporting date for each proposal to be 
  7.24  assessed.  If the commissioners of health and commerce determine 
  7.25  that the assessment of a particular mandated health benefit 
  7.26  proposal should be completed entirely or in part by the 
  7.27  commissioner of commerce, the commissioners may agree to have 
  7.28  the commissioner of commerce complete the assessment and submit 
  7.29  the report to the legislature.  The commissioner responsible for 
  7.30  completing an assessment may seek the assistance and advice of 
  7.31  consultants, contractors, researchers, or other persons or 
  7.32  organizations with relevant expertise and may request advice or 
  7.33  analysis from the health technology advisory committee. 
  7.34     Subd. 5.  [NONLEGISLATIVE SOLUTIONS.] If, in the course of 
  7.35  reviewing a mandated health benefit proposal, the commissioner 
  7.36  determines that the problem can be solved without legislation 
  8.1   through the exercise of existing state regulatory authority or 
  8.2   other actions, the commissioner may take action to resolve the 
  8.3   problem.  The commissioner shall inform the chairs of the 
  8.4   standing committees having jurisdiction over the mandated health 
  8.5   benefit proposal of any nonlegislative action taken. 
  8.6      Subd. 6.  [PUBLIC HEARINGS.] The commissioner shall solicit 
  8.7   comments and recommendations on a mandated health benefit 
  8.8   proposal from any interested persons and organizations and may 
  8.9   schedule public hearings.  The commissioner shall also seek the 
  8.10  comments and recommendations of representatives of health care 
  8.11  consumers and employers.  The commissioner shall summarize the 
  8.12  various comments and recommendations received in the 
  8.13  commissioner's report to the legislature. 
  8.14     Subd. 7.  [ADVICE AND RECOMMENDATIONS OF THE MINNESOTA 
  8.15  HEALTH CARE COMMISSION.] The commissioner shall seek the advice 
  8.16  and recommendations of the Minnesota health care commission 
  8.17  regarding a mandated health benefit proposal and shall include a 
  8.18  summary of the commission's advice and recommendations in the 
  8.19  commissioner's report to the legislature. 
  8.20     Sec. 2.  Minnesota Statutes 1996, section 62E.11, is 
  8.21  amended by adding a subdivision to read: 
  8.22     Subd. 8a.  [OFFSETS.] Beginning January 1, 1997, any annual 
  8.23  fiscal year end or interim assessment levied against a 
  8.24  contributing member under this chapter may be offset against the 
  8.25  income tax imposed upon that contributing member pursuant to 
  8.26  sections 290.06, subdivision 1, and 290.0921, and the premium 
  8.27  tax payable by that contributing member pursuant to section 
  8.28  60A.15, for the year in which the annual fiscal year end or 
  8.29  interim assessment is levied.  In no event may a contributing 
  8.30  member's total offsets in any given year exceed the total amount 
  8.31  of assessments levied against that contributing member under 
  8.32  subdivision 5.  When offsetting assessments against the premium 
  8.33  tax imposed by section 60A.15, a contributing member's offset in 
  8.34  any year may not exceed one percent of its premiums as defined 
  8.35  in section 60A.15, subdivision 1, paragraph (b), for that year. 
  8.36     Sec. 3.  Minnesota Statutes 1996, section 295.58, is 
  9.1   amended to read: 
  9.2      295.58 [DEPOSIT OF REVENUES AND PAYMENT OF REFUNDS.] 
  9.3      The commissioner shall deposit all revenues, including 
  9.4   penalties and interest, derived from the taxes imposed by 
  9.5   sections 295.50 to 295.57 and from the insurance premiums tax on 
  9.6   health maintenance organizations, community integrated service 
  9.7   networks, integrated service networks, and nonprofit health 
  9.8   service plan corporations and five cents per pack of the tobacco 
  9.9   tax generated under section 297.02 in the health care access 
  9.10  fund in the state treasury.  Refunds of overpayments must be 
  9.11  paid from the health care access fund in the state treasury.  
  9.12  There is annually appropriated from the health care access fund 
  9.13  to the commissioner of revenue the amount necessary to make any 
  9.14  refunds required under section 295.54. 
  9.15     Sec. 4.  Minnesota Statutes 1996, section 297.13, 
  9.16  subdivision 1, is amended to read: 
  9.17     Subdivision 1.  [CIGARETTE TAX APPORTIONMENT.] Revenues 
  9.18  received from taxes, penalties, and interest under sections 
  9.19  297.01 to 297.13 and from license fees and miscellaneous sources 
  9.20  of revenue shall be deposited by the commissioner of revenue in 
  9.21  the state treasury and credited as follows: 
  9.22     (a) first to the general obligation special tax bond debt 
  9.23  service account in each fiscal year the amount required to 
  9.24  increase the balance on hand in the account on each December 1 
  9.25  to an amount equal to the full amount of principal and interest 
  9.26  to come due on all outstanding bonds whose debt service is 
  9.27  payable primarily from the proceeds of the tax to and including 
  9.28  the second following July 1; and 
  9.29     (b) after the requirements of paragraph (a) have been met: 
  9.30     (1) the revenue produced by one mill of the tax on 
  9.31  cigarettes weighing not more than three pounds a thousand and 
  9.32  two mills of the tax on cigarettes weighing more than three 
  9.33  pounds a thousand must be credited to the Minnesota future 
  9.34  resources fund; 
  9.35     (2) the revenue produced by 2.5 mills of the tax on 
  9.36  cigarettes weighing not more than three pounds a thousand must 
 10.1   be credited to the health care access fund in the state 
 10.2   treasury; and 
 10.3      (3) the balance of the revenues derived from taxes, 
 10.4   penalties, and interest under sections 297.01 to 297.13 and from 
 10.5   license fees and miscellaneous sources of revenue shall be 
 10.6   credited to the general fund. 
 10.7      Sec. 5.  [STUDY.] 
 10.8      The commissioners of health, commerce, and revenue shall 
 10.9   jointly submit a written report to the legislature that includes 
 10.10  options and recommendations for alternative funding methods to 
 10.11  replace existing financing mechanisms, including health plan 
 10.12  premium taxes.  The recommendations must include a dedicated 
 10.13  fund that preserves adequate funding for uninsured persons 
 10.14  served by the MinnesotaCare program.  The report must be 
 10.15  submitted to the legislature by January 1, 1998, in compliance 
 10.16  with Minnesota Statutes, section 3.195. 
 10.17                             ARTICLE 3
 10.18                IMPROVING ACCESS TO HEALTH COVERAGE 
 10.19     Section 1.  Minnesota Statutes 1996, section 256.9354, 
 10.20  subdivision 5, is amended to read: 
 10.21     Subd. 5.  [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO 
 10.22  CHILDREN.] (a) Beginning October 1, 1994, the definition of 
 10.23  "eligible persons" is expanded to include all individuals and 
 10.24  households with no children who have gross family incomes that 
 10.25  are equal to or less than 125 percent of the federal poverty 
 10.26  guidelines and who are not eligible for medical assistance 
 10.27  without a spenddown under chapter 256B.  
 10.28     (b) After October 1, 1995, the commissioner of human 
 10.29  services may expand the definition of "eligible persons" to 
 10.30  include all individuals and households with no children who have 
 10.31  gross family incomes that are equal to or less than 135 percent 
 10.32  of federal poverty guidelines and are not eligible for medical 
 10.33  assistance without a spenddown under chapter 256B.  This 
 10.34  expansion may occur only if the financial management 
 10.35  requirements of section 256.9352, subdivision 3, can be met. 
 10.36     (c) The commissioners of health and human services, in 
 11.1   consultation with the legislative commission on health care 
 11.2   access, shall make preliminary recommendations to the 
 11.3   legislature by October 1, 1995, and final recommendations to the 
 11.4   legislature by February 1, 1996, on whether a further expansion 
 11.5   of the definition of "eligible persons" to include all 
 11.6   individuals and households with no children who have gross 
 11.7   family incomes that are equal to or less than 150 percent of 
 11.8   federal poverty guidelines and are not eligible for medical 
 11.9   assistance without a spenddown under chapter 256B would be 
 11.10  allowed under the financial management constraints outlined in 
 11.11  section 256.9352, subdivision 3. 
 11.12     (d) Beginning October 1, 1997, the definition of eligible 
 11.13  persons is expanded to include all individuals and households 
 11.14  with no children who have gross family incomes that are equal to 
 11.15  or less than 175 percent of the federal poverty guidelines and 
 11.16  who are not eligible for medical assistance without a spenddown 
 11.17  under chapter 256B. 
 11.18     (c) All eligible persons under paragraphs (a) and (b) are 
 11.19  eligible for coverage through the MinnesotaCare program but must 
 11.20  pay a premium as determined under sections 256.9357 and 
 11.21  256.9358.  Individuals and families whose income is greater than 
 11.22  the limits established under section 256.9358 may not enroll in 
 11.23  the MinnesotaCare program. 
 11.24     Sec. 2.  Minnesota Statutes 1996, section 256.9354, is 
 11.25  amended by adding a subdivision to read: 
 11.26     Subd. 8.  [MINNESOTACARE OUTREACH.] The commissioner of 
 11.27  human services shall, within the limits of available 
 11.28  appropriations and financial resources, engage in activities to 
 11.29  inform uninsured persons of the importance of maintaining 
 11.30  insurance coverage and provide information on the various 
 11.31  options for obtaining coverage, including the MinnesotaCare 
 11.32  health plan and other state health care programs, Minnesota 
 11.33  comprehensive health association coverage, and private health 
 11.34  coverage options.  The commissioner may accept grants or 
 11.35  contributions from individuals and organizations to support 
 11.36  public information activities and may undertake joint public 
 12.1   information projects with other public or private organizations. 
 12.2      Sec. 3.  [APPROPRIATION.] 
 12.3      $....... is appropriated from the general fund to the 
 12.4   commissioner of human services for public information projects 
 12.5   to inform uninsured persons about their options for obtaining 
 12.6   health coverage.  The appropriation is available until spent. 
 12.7                              ARTICLE 4
 12.8                     COMMUNITY HEALTH IMPROVEMENT 
 12.9      Section 1.  Minnesota Statutes 1996, section 62Q.075, 
 12.10  subdivision 2, is amended to read: 
 12.11     Subd. 2.  [REQUIREMENT.] (a) Beginning October 31, 1997, 
 12.12  all managed care organizations shall file biennially with the 
 12.13  action plans required under section 62Q.07 a plan describing the 
 12.14  actions the managed care organization has taken and those it 
 12.15  intends to take to contribute to achieving public health goals 
 12.16  for each service area in which an enrollee of the managed care 
 12.17  organization resides.  This plan must be jointly developed in 
 12.18  collaboration with the local public health units, appropriate 
 12.19  regional coordinating boards, and other community organizations 
 12.20  providing health services within the same service area as the 
 12.21  managed care organization.  Local government units with 
 12.22  responsibilities and authority defined under chapters 145A and 
 12.23  256E may designate individuals to participate in the 
 12.24  collaborative planning with the managed care organization to 
 12.25  provide expertise and represent community needs and goals as 
 12.26  identified under chapters 145A and 256E. 
 12.27     (b) Local public health agencies may ask managed care 
 12.28  organizations that are not required to collaborate to 
 12.29  collaborate voluntarily.  A managed care organization that is 
 12.30  not required to comply with this section may voluntarily file a 
 12.31  collaboration plan describing the actions the managed care 
 12.32  organization has taken and those it intends to take to 
 12.33  contribute to achieving public health goals. 
 12.34     Sec. 2.  [APPROPRIATION FOR LOCAL PUBLIC HEALTH AND SOCIAL 
 12.35  SERVICE ACTIVITIES.] 
 12.36     $....... is appropriated from the general fund to the 
 13.1   commissioner of health to provide grants to all community health 
 13.2   services boards to support core public health functions.  The 
 13.3   grants shall be made to ensure adequate base level funding to 
 13.4   support core public health activities and to fund public health 
 13.5   activities and services.  The appropriation is available until 
 13.6   spent. 
 13.7                              ARTICLE 5
 13.8                        HEALTH CARE PROVIDERS 
 13.9      Section 1.  Minnesota Statutes 1996, section 295.582, is 
 13.10  amended to read: 
 13.11     295.582 [AUTHORITY.] 
 13.12     (a) A hospital, surgical center, pharmacy, or health care 
 13.13  provider that is subject to a tax under section 295.52, or a 
 13.14  pharmacy that has paid additional expense transferred under this 
 13.15  section by a wholesale drug distributor, may transfer additional 
 13.16  expense generated by section 295.52 obligations on to all 
 13.17  third-party contracts for the purchase of health care services 
 13.18  on behalf of a patient or consumer.  The additional expense 
 13.19  transferred to the third-party purchaser must not exceed two 
 13.20  percent of the gross revenues received under the third-party 
 13.21  contract, and two percent of copayments and deductibles paid by 
 13.22  the individual patient or consumer.  The expense must not be 
 13.23  generated on revenues derived from payments that are excluded 
 13.24  from the tax under section 295.53.  All third-party purchasers 
 13.25  of health care services including, but not limited to, 
 13.26  third-party purchasers regulated under chapter 60A, 62A, 62C, 
 13.27  62D, 62H, 62N, 64B, 65A, 65B, 79, or 79A, or under section 
 13.28  471.61 or 471.617, must pay the transferred expense in addition 
 13.29  to any payments due under existing contracts with the hospital, 
 13.30  surgical center, pharmacy, or health care provider, to the 
 13.31  extent allowed under federal law.  A third-party purchaser of 
 13.32  health care services includes, but is not limited to, a health 
 13.33  carrier, integrated service network, or community integrated 
 13.34  service network that pays for health care services on behalf of 
 13.35  patients or that reimburses, indemnifies, compensates, or 
 13.36  otherwise insures patients for health care services.  A 
 14.1   third-party purchaser shall comply with this section regardless 
 14.2   of whether the third-party purchaser is a for-profit, 
 14.3   not-for-profit, or nonprofit entity.  A wholesale drug 
 14.4   distributor may transfer additional expense generated by section 
 14.5   295.52 obligations to entities that purchase from the 
 14.6   wholesaler, and the entities must pay the additional expense.  
 14.7   Nothing in this section limits the ability of a hospital, 
 14.8   surgical center, pharmacy, wholesale drug distributor, or health 
 14.9   care provider to recover all or part of the section 295.52 
 14.10  obligation by other methods, including increasing fees or 
 14.11  charges. 
 14.12     (b) Each third-party purchaser regulated under any chapter 
 14.13  cited in paragraph (a) shall include with its annual renewal for 
 14.14  certification of authority or licensure documentation indicating 
 14.15  compliance with paragraph (a).  If the commissioner responsible 
 14.16  for regulating the third-party purchaser finds at any time that 
 14.17  the third-party purchaser has not complied with paragraph (a), 
 14.18  the commissioner may by order fine or censure the third-party 
 14.19  purchaser or revoke or suspend the certificate of authority or 
 14.20  license of the third-party purchaser to do business in this 
 14.21  state.  The third-party purchaser may appeal the commissioner's 
 14.22  order through a contested case hearing in accordance with 
 14.23  chapter 14. 
 14.24     (c) The commissioners of health and commerce are authorized 
 14.25  to enforce the pass-through as provided in this section for 
 14.26  those health plan companies they regulate.  A hospital, surgical 
 14.27  center, pharmacy, or health care provider that is subject to a 
 14.28  tax under section 295.52 may file a complaint with the 
 14.29  commissioner responsible for regulating the third-party 
 14.30  purchaser if at any time the third-party purchaser does not 
 14.31  comply with paragraph (a).  The commissioners of health and 
 14.32  commerce may take enforcement action against a regulated health 
 14.33  plan company which is subject to their regulatory jurisdiction 
 14.34  and which does not allow a provider to pass through the tax.  
 14.35  The commissioners of health and commerce may fine or censure a 
 14.36  health plan company, or revoke or suspend the certificate of 
 15.1   authority or license of the health plan company to do business 
 15.2   in this state, if the commissioner finds that the health plan 
 15.3   company has not complied with this section. 
 15.4      Sec. 2.  [EMERGENCY MEDICAL SERVICES PILOT PROJECTS.] 
 15.5      The commissioner of health, in consultation with the 
 15.6   emergency medical services regulatory board, shall establish 
 15.7   pilot projects to explore alternative approaches to reimbursing 
 15.8   emergency medical services providers.  The commissioner may 
 15.9   temporarily waive provisions of Minnesota Statutes, section 
 15.10  62J.48, in order to explore alternative approaches through the 
 15.11  pilot projects.  The commissioner shall request participation in 
 15.12  a pilot project by all emergency medical services providers and 
 15.13  health plan companies whose service area includes a region in 
 15.14  which a pilot project will be conducted.  Participation in the 
 15.15  project is voluntary.  The details of each pilot project shall 
 15.16  be developed and approved by a work group appointed by the 
 15.17  commissioner that includes representatives of emergency medical 
 15.18  services providers, health plan companies, and the emergency 
 15.19  medical services regulatory board.  Pilot projects may be 
 15.20  conducted in accordance with the operational criteria of the 
 15.21  state ambulance laws. 
 15.22     Sec. 3.  [APPROPRIATION.] 
 15.23     $....... is appropriated from the general fund to the 
 15.24  commissioner of health for purposes of the emergency medical 
 15.25  services pilot projects, to be available until June 30, 1999. 
 15.26                             ARTICLE 6
 15.27                       HEALTH PLAN REGULATION 
 15.28     Section 1.  Minnesota Statutes 1996, section 62D.04, is 
 15.29  amended by adding a subdivision to read: 
 15.30     Subd. 6.  [DUPLICATIVE INSPECTIONS AND REGULATORY 
 15.31  REQUIREMENTS.] (a) Beginning July 1, 1997, the commissioner of 
 15.32  health shall treat accreditation of a health maintenance 
 15.33  organization or community integrated service network by a 
 15.34  national accreditation organization to be satisfactory evidence 
 15.35  of compliance with and fulfillment of any state statutory or 
 15.36  regulatory requirements established under this chapter that are 
 16.1   substantially the same as or similar to requirements that are 
 16.2   established and verified by a national accreditation 
 16.3   organization or that relate to a general topic or factor that is 
 16.4   the subject of national accreditation standards.  The 
 16.5   commissioner shall coordinate state regulatory compliance 
 16.6   activities, inspections, and reporting requirements with 
 16.7   national accreditation activities in order to reduce the 
 16.8   administrative costs and burdens incurred by health maintenance 
 16.9   organizations, community integrated service networks, and 
 16.10  nonprofit health service plan corporations to comply with 
 16.11  multiple, duplicative inspections, reports, and compliance 
 16.12  requirements imposed by various regulatory agencies and 
 16.13  accreditation organizations. 
 16.14     (b) For purposes of this subdivision, "national 
 16.15  accreditation organization" includes the joint commission on the 
 16.16  accreditation of health care organizations, the national 
 16.17  committee on quality assurance, and the utilization review and 
 16.18  accreditation commission.