1.1                          A bill for an act 
  1.2             relating to health care; prohibiting health plan 
  1.3             companies from denying coverage of a mastectomy 
  1.4             performed on an inpatient hospital basis; clarifying 
  1.5             the status of the comprehensive health association 
  1.6             under medical assistance and general assistance 
  1.7             medical care; opening the process for selecting a 
  1.8             writing carrier; dedicating premium tax revenues to 
  1.9             the Minnesota comprehensive health association; 
  1.10            eliminating the four-month waiting period under 
  1.11            MinnesotaCare for association enrollees; establishing 
  1.12            a process for reviewing proposed state-mandated health 
  1.13            plan benefits; expanding eligibility for the 
  1.14            MinnesotaCare program; authorizing public information 
  1.15            projects to inform uninsured persons about the 
  1.16            availability of health coverage; encouraging health 
  1.17            plans to collaborate with public health agencies; 
  1.18            providing alternative funding for local public health 
  1.19            activities and county social services; strengthening 
  1.20            and enforcing the pass-through provision of the health 
  1.21            care provider tax; appropriating money; amending 
  1.22            Minnesota Statutes 1996, sections 62E.02, subdivisions 
  1.23            13 and 18; 62E.08, by adding a subdivision; 62E.11, by 
  1.24            adding a subdivision; 62E.13, subdivision 2; 62Q.075, 
  1.25            subdivision 2; 256.9354, subdivision 5, and by adding 
  1.26            a subdivision; 256.9357, subdivision 3; 256B.056, 
  1.27            subdivision 8; 256B.0625, subdivision 15; 256D.03, 
  1.28            subdivision 3b; 295.58; and 295.582; proposing coding 
  1.29            for new law in Minnesota Statutes, chapters 62A; and 
  1.30            62Q. 
  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.  [62Q.52] [COVERAGE OF INPATIENT MASTECTOMY 
  1.35  REQUIRED.] 
  1.36     (a) A health plan company as defined under section 62Q.01, 
  1.37  subdivision 4, shall not deny coverage of a mastectomy performed 
  1.38  on an inpatient hospital basis, if the mastectomy would 
  2.1   otherwise be covered if performed on an outpatient basis or in 
  2.2   any other health care setting. 
  2.3      (b) Paragraph (a) shall be reviewed under the assessment 
  2.4   process established in section 62A.310.  The commissioner of 
  2.5   health shall submit a written report on the results of the 
  2.6   assessment to the legislature in compliance with section 3.195, 
  2.7   no later than January 15, 1999.  
  2.8      Sec. 2.  [REPORT.] 
  2.9      The commissioner of health, in consultation with affected 
  2.10  state agencies, offices, and ombudsman programs, shall submit a 
  2.11  report to the legislature regarding the feasibility and 
  2.12  desirability of:  consolidating and improving coordination of 
  2.13  some or all existing state consumer assistance activities; and 
  2.14  the establishment of the statewide consumer assistance office to 
  2.15  help consumers locate these services.  The report must include a 
  2.16  budget that does not exceed the combined base level funding of 
  2.17  existing programs. 
  2.18     Sec. 3.  [EFFECTIVE DATE.] 
  2.19     Section 1, paragraph (a), is effective August 1, 1999.  
  2.20                             ARTICLE 2
  2.21                  AFFORDABILITY OF HEALTH COVERAGE 
  2.22     Section 1.  [62A.310] [ASSESSMENT OF PROPOSED HEALTH 
  2.23  COVERAGE MANDATES.] 
  2.24     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  2.25  section, the following terms have the meanings given:  
  2.26     (1) "mandated health benefit proposal" means a proposal 
  2.27  that would statutorily require a health plan to do the following:
  2.28     (i) provide coverage or increase the amount of coverage for 
  2.29  the treatment of a particular disease, condition, or other 
  2.30  health care need; or 
  2.31     (ii) provide coverage or increase the amount of coverage of 
  2.32  a particular type of health care treatment or service or of 
  2.33  equipment, supplies, or drugs used in connection with a health 
  2.34  care treatment or service. 
  2.35  "Mandated benefit proposal" does not include health benefit 
  2.36  proposals amending the scope of practice of a licensed health 
  3.1   care professional; 
  3.2      (2) "commissioner" means the commissioner of health; and 
  3.3      (3) "health plan" means a health plan as defined in section 
  3.4   62A.011, subdivision 3, but includes coverage listed in clauses 
  3.5   (7) and (10), of that definition.  
  3.6      Subd. 2.  [HEALTH COVERAGE MANDATE ASSESSMENT PROCESS.] The 
  3.7   commissioners of health and commerce, in consultation with the 
  3.8   commissioners of human services and employee relations, shall 
  3.9   establish and administer a process for the review, assessment, 
  3.10  and analysis of mandated health benefit proposals.  The purpose 
  3.11  of the assessment is to provide the legislature with a complete 
  3.12  and timely analysis of all ramifications of any mandated health 
  3.13  benefit proposal.  The assessment must include, in addition to 
  3.14  any other relevant information, the following: 
  3.15     (1) scientific and medical information on the proposed 
  3.16  health benefit, on the potential for harm or benefit to the 
  3.17  patient, and on the comparative benefit or harm from alternative 
  3.18  forms of treatment; and 
  3.19     (2) public health, economic, fiscal, and consumer 
  3.20  information on the impact of the proposed mandate on persons 
  3.21  receiving health services in Minnesota, on the relative cost 
  3.22  effectiveness of the benefit, and on the health care system in 
  3.23  general.  
  3.24     The commissioners of health and commerce shall summarize 
  3.25  the nature and quality of available information in these areas, 
  3.26  and, if possible, shall provide any preliminary information to 
  3.27  the public as part of the public hearing process required in 
  3.28  subdivision 5.  The commissioners may conduct research into 
  3.29  these issues, or may certify existing research as sufficient to 
  3.30  meet the informational needs of the legislature.  
  3.31     Subd. 3.  [REQUESTS FOR ASSESSMENT.] Whenever a legislative 
  3.32  measure containing a mandated health benefit proposal is 
  3.33  introduced as a bill or offered as an amendment to a bill or is 
  3.34  likely to be introduced or offered as an amendment, the chairs 
  3.35  of the standing committees having jurisdiction over the proposal 
  3.36  shall request that the commissioner complete an assessment of 
  4.1   the proposal in order to facilitate any committee action by 
  4.2   either house of the legislature.  Any person or organization may 
  4.3   also request that the commissioner complete an assessment.  If 
  4.4   multiple requests are received, the commissioner shall consult 
  4.5   with the chairs of the standing legislative committees having 
  4.6   jurisdiction over mandated health benefit proposals to 
  4.7   prioritize the requests.  
  4.8      Subd. 4.  [ASSESSMENT OF PROPOSED MANDATES; REPORT TO THE 
  4.9   LEGISLATURE.] The commissioners of health and commerce shall 
  4.10  conduct an assessment of each mandated health benefit proposal 
  4.11  selected for assessment and submit a report to the legislature 
  4.12  no later than 180 days after the request.  The commissioners 
  4.13  shall, in consultation with the chairs of the standing 
  4.14  committees having jurisdiction over the proposal, develop a 
  4.15  reporting date for each proposal to be assessed.  If the 
  4.16  commissioners of health and commerce determine that the 
  4.17  assessment of a particular mandated health benefit proposal 
  4.18  should be completed entirely or in part by one of the two 
  4.19  commissioners, the commissioners may agree to have the 
  4.20  appropriate commissioner complete the assessment and submit the 
  4.21  report to the legislature.  The commissioner responsible for 
  4.22  completing an assessment may seek the assistance and advice of 
  4.23  consultants, contractors, researchers, community leaders, or 
  4.24  other persons or organizations with relevant expertise.  The 
  4.25  commissioner may certify existing research as sufficient to meet 
  4.26  the informational needs of the legislature.  Prior to completion 
  4.27  of an assessment report, the commissioners must gather the 
  4.28  information required under subdivisions 2 and 5.  
  4.29     Subd. 5.  [CITIZENS ADVISORY TASK FORCE.] The commissioner 
  4.30  of health shall appoint a citizens advisory task force in 
  4.31  accordance with section 15.014, subdivision 2, to provide 
  4.32  comments and recommendations to the commissioner on health 
  4.33  benefit mandate proposals.  In preparing these comments and 
  4.34  recommendations, it shall be the purpose of the task force to 
  4.35  determine which approach to a proposed mandated benefit best 
  4.36  serves the general public interest.  Members should be impartial 
  5.1   consumers of health care services.  The citizens advisory task 
  5.2   force shall consist of at least one member from each regional 
  5.3   coordinating board.  The citizens advisory task force shall 
  5.4   solicit comments and recommendations on a mandated health 
  5.5   benefit proposal from any interested persons and organizations 
  5.6   and may hold public hearings.  The citizens advisory task force 
  5.7   shall submit its comments and recommendations to the 
  5.8   commissioner. 
  5.9      Subd. 6.  [ADVICE AND RECOMMENDATIONS.] The commissioner 
  5.10  may appoint an ad hoc advisory panel of providers, consumer 
  5.11  representatives, health plan companies, medical technology 
  5.12  companies, economists, actuaries, and other expert persons to 
  5.13  assist the commissioner in completing a mandate review. 
  5.14     Subd. 7.  [REPORT.] The commissioners shall provide a 
  5.15  summary report of their findings and recommendations to the 
  5.16  relevant committee chairs, to the author of the proposed benefit 
  5.17  mandate, or the entity which requested the assessment. 
  5.18     Sec. 2.  Minnesota Statutes 1996, section 62E.02, 
  5.19  subdivision 13, is amended to read: 
  5.20     Subd. 13.  [ELIGIBLE PERSON.] (a) "Eligible person" means 
  5.21  an individual who: 
  5.22     (1) is currently and has been a resident of Minnesota for 
  5.23  the six months immediately preceding the date of receipt by the 
  5.24  association or its writing carrier of a completed certificate of 
  5.25  eligibility and who; 
  5.26     (2) meets the enrollment requirements of section 62E.14; 
  5.27  and 
  5.28     (3) is not otherwise ineligible under this subdivision. 
  5.29     (b) No individual is eligible for coverage under a 
  5.30  qualified or a Medicare supplement plan issued by the 
  5.31  association for whom a premium is paid or reimbursed by a 
  5.32  federal, state, or local agency as of the first day of any term 
  5.33  for which a premium amount is paid or reimbursed. 
  5.34     Sec. 3.  Minnesota Statutes 1996, section 62E.02, 
  5.35  subdivision 18, is amended to read: 
  5.36     Subd. 18.  [WRITING CARRIER.] "Writing carrier" means the 
  6.1   insurer or insurers, health maintenance organization or 
  6.2   organizations, integrated service network or networks, and 
  6.3   community integrated service network or networks, or other 
  6.4   entity selected by the association and approved by the 
  6.5   commissioner to administer the comprehensive health insurance 
  6.6   plan. 
  6.7      Sec. 4.  Minnesota Statutes 1996, section 62E.08, is 
  6.8   amended by adding a subdivision to read: 
  6.9      Subd. 4.  [SLIDING SCALE PREMIUMS.] The commissioner, in 
  6.10  consultation with the association, shall study implementing a 
  6.11  sliding scale for premiums based upon an enrollee's actual 
  6.12  income.  A report is due no later than January 15, 1998.  A copy 
  6.13  of the report shall be provided to the chairs of the house 
  6.14  committee on health and human services and the senate committee 
  6.15  on health and family security. 
  6.16     Sec. 5.  Minnesota Statutes 1996, section 62E.11, is 
  6.17  amended by adding a subdivision to read: 
  6.18     Subd. 13.  The commissioner shall report to the legislature 
  6.19  annually on the costs incurred by the association in providing 
  6.20  coverage to individuals enrolled in medical assistance under 
  6.21  chapter 256B or general assistance medical care under chapter 
  6.22  256D.  The report shall be provided to the chairs of the house 
  6.23  committee on health and human services and the senate committee 
  6.24  on health and family security no later than January 15 of each 
  6.25  year.  The report's contents shall be determined by the 
  6.26  commissioner, in consultation with the department of human 
  6.27  services and the association.  At a minimum, the report shall 
  6.28  provide, for the association in aggregate and for each category 
  6.29  of individuals enrolled in medical assistance under chapter 256B 
  6.30  or general assistance medical care under chapter 256D, a 
  6.31  breakdown of:  (1) the administrative costs; (2) claims costs; 
  6.32  (3) premiums paid; (4) deductibles, coinsurance, and copayments 
  6.33  paid; (5) state payments to providers satisfying deductibles, 
  6.34  coinsurance, or copayments required to be paid under a qualified 
  6.35  or Medicare supplement plan issued by the association; (6) the 
  6.36  number of individuals; (7) losses; and (8) appropriated state 
  7.1   funds.  The commissioner of the department of human services, 
  7.2   the association, and the writing carrier, shall cooperate with 
  7.3   the commissioner and provide all information that the 
  7.4   commissioner determines is necessary to prepare this report. 
  7.5      Sec. 6.  Minnesota Statutes 1996, section 62E.13, 
  7.6   subdivision 2, is amended to read: 
  7.7      Subd. 2.  The association may select policies and 
  7.8   contracts, or parts thereof, submitted by a member or members of 
  7.9   the association, or by the association or others, to develop 
  7.10  specifications for bids from any members entity which wish 
  7.11  wishes to be selected as a writing carrier to administer the 
  7.12  state plan.  The selection of the writing carrier shall be based 
  7.13  upon criteria including established by the board of directors of 
  7.14  the association and approved by the commissioner.  The criteria 
  7.15  shall outline specific qualifications that an entity must 
  7.16  satisfy in order to be selected and, at a minimum, shall include 
  7.17  the member's entity's proven ability to handle large group 
  7.18  accident and health insurance cases, efficient claim paying 
  7.19  capacity, and the estimate of total charges for administering 
  7.20  the plan.  The association may select separate writing carriers 
  7.21  for the two types of qualified plans, the qualified medicare 
  7.22  supplement plan, and the health maintenance organization 
  7.23  contract. 
  7.24     Sec. 7.  Minnesota Statutes 1996, section 256.9357, 
  7.25  subdivision 3, is amended to read: 
  7.26     Subd. 3.  [PERIOD UNINSURED.] To be eligible for subsidized 
  7.27  premium payments based on a sliding scale, families and 
  7.28  individuals initially enrolled in the MinnesotaCare program 
  7.29  under section 256.9354, subdivisions 4 and 5, must have had no 
  7.30  health coverage for at least four months prior to application.  
  7.31  The commissioner may change this eligibility criterion for 
  7.32  sliding scale premiums without complying with rulemaking 
  7.33  requirements in order to remain within the limits of available 
  7.34  appropriations.  The requirement of at least four months of no 
  7.35  health coverage prior to application for the MinnesotaCare 
  7.36  program does not apply to: 
  8.1      (1) families, children, and individuals who want to apply 
  8.2   for the MinnesotaCare program upon termination from the medical 
  8.3   assistance program, general assistance medical care program, or 
  8.4   coverage under a regional demonstration project for the 
  8.5   uninsured funded under section 256B.73, the Hennepin county 
  8.6   assured care program, or the Group Health, Inc., community 
  8.7   health plan; 
  8.8      (2) families and individuals initially enrolled under 
  8.9   section 256.9354, subdivisions 1, paragraph (a), and 2; 
  8.10     (3) children enrolled pursuant to Laws 1992, chapter 549, 
  8.11  article 4, section 17; or 
  8.12     (4) individuals currently serving or who have served in the 
  8.13  military reserves, and dependents of these individuals, if these 
  8.14  individuals:  (i) reapply for MinnesotaCare coverage after a 
  8.15  period of active military service during which they had been 
  8.16  covered by the Civilian Health and Medical Program of the 
  8.17  Uniformed Services (CHAMPUS); (ii) were covered under 
  8.18  MinnesotaCare immediately prior to obtaining coverage under 
  8.19  CHAMPUS; and (iii) have maintained continuous coverage; or 
  8.20     (5) individuals and families whose only health coverage 
  8.21  during the four months prior to application was a qualified or 
  8.22  Medicare supplement plan issued by the Minnesota comprehensive 
  8.23  health association under chapter 62E. 
  8.24     Sec. 8.  Minnesota Statutes 1996, section 256B.056, 
  8.25  subdivision 8, is amended to read: 
  8.26     Subd. 8.  [COOPERATION.] To be eligible for medical 
  8.27  assistance, applicants and recipients must cooperate with the 
  8.28  state and local agency to identify potentially liable 
  8.29  third-party payers and assist the state in obtaining third party 
  8.30  payments, unless good cause for noncooperation is determined 
  8.31  according to Code of Federal Regulations, title 42, part 
  8.32  433.147.  "Cooperation" includes identifying any third party who 
  8.33  may be liable for care and services provided under this chapter 
  8.34  to the applicant, recipient, or any other family member for whom 
  8.35  application is made and providing relevant information to assist 
  8.36  the state in pursuing a potentially liable third party.  
  9.1   Cooperation also includes providing information about a group 
  9.2   health plan for which the person may be eligible and if the plan 
  9.3   is determined cost-effective by the state agency and premiums 
  9.4   are paid by the local agency or there is no cost to the 
  9.5   recipient, they must enroll or remain enrolled with the group.  
  9.6   For purposes of this subdivision, coverage provided by the 
  9.7   Minnesota comprehensive health association under chapter 62E 
  9.8   shall not be considered group health plan coverage or 
  9.9   cost-effective by the state and local agency, nor shall the 
  9.10  association be considered a potentially liable third party by 
  9.11  the state or local agency.  Cost-effective insurance premiums 
  9.12  approved for payment by the state agency and paid by the local 
  9.13  agency are eligible for reimbursement according to section 
  9.14  256B.19. 
  9.15     Sec. 9.  Minnesota Statutes 1996, section 256B.0625, 
  9.16  subdivision 15, is amended to read: 
  9.17     Subd. 15.  [HEALTH PLAN PREMIUMS AND COPAYMENTS.] (a) 
  9.18  Medical assistance covers health care prepayment plan premiums, 
  9.19  insurance premiums, and copayments if determined to be 
  9.20  cost-effective by the commissioner.  For purposes of obtaining 
  9.21  Medicare part A and part B, and copayments, expenditures may be 
  9.22  made even if federal funding is not available. 
  9.23     (b) Effective for all premiums due on or after June 30, 
  9.24  1997, medical assistance does not cover premiums that a 
  9.25  recipient is required to pay under a qualified or Medicare 
  9.26  supplement plan issued by the Minnesota comprehensive health 
  9.27  association. 
  9.28     Sec. 10.  Minnesota Statutes 1996, section 256D.03, 
  9.29  subdivision 3b, is amended to read: 
  9.30     Subd. 3b.  [COOPERATION.] (a) General assistance or general 
  9.31  assistance medical care applicants and recipients must cooperate 
  9.32  with the state and local agency to identify potentially liable 
  9.33  third-party payors and assist the state in obtaining third-party 
  9.34  payments.  Cooperation includes identifying any third party who 
  9.35  may be liable for care and services provided under this chapter 
  9.36  to the applicant, recipient, or any other family member for whom 
 10.1   application is made and providing relevant information to assist 
 10.2   the state in pursuing a potentially liable third party.  General 
 10.3   assistance medical care applicants and recipients must cooperate 
 10.4   by providing information about any group health plan in which 
 10.5   they may be eligible to enroll.  They must cooperate with the 
 10.6   state and local agency in determining if the plan is 
 10.7   cost-effective.  For purposes of this subdivision, coverage 
 10.8   provided by the Minnesota comprehensive health association under 
 10.9   chapter 62E shall not be considered group health plan coverage 
 10.10  or cost-effective by the state and local agency, nor shall the 
 10.11  association be considered a potentially liable third party by 
 10.12  the state or local agency.  If the plan is determined 
 10.13  cost-effective and the premium will be paid by the state or 
 10.14  local agency or is available at no cost to the person, they must 
 10.15  enroll or remain enrolled in the group health plan.  
 10.16  Cost-effective insurance premiums approved for payment by the 
 10.17  state agency and paid by the local agency are eligible for 
 10.18  reimbursement according to subdivision 6.  
 10.19     (b) Effective for all premiums due on or after June 30, 
 10.20  1997, general assistance medical care does not cover premiums 
 10.21  that a recipient is required to pay under a qualified or 
 10.22  Medicare supplement plan issued by the Minnesota comprehensive 
 10.23  health association. 
 10.24     Sec. 11.  Minnesota Statutes 1996, section 295.58, is 
 10.25  amended to read: 
 10.26     295.58 [DEPOSIT OF REVENUES AND PAYMENT OF REFUNDS.] 
 10.27     (a) The commissioner shall deposit all revenues, including 
 10.28  penalties and interest, derived from the taxes imposed by 
 10.29  sections 295.50 to 295.57 and from the insurance premiums tax on 
 10.30  health maintenance organizations, community integrated service 
 10.31  networks, integrated service networks, and nonprofit health 
 10.32  service plan corporations in the health care access fund in the 
 10.33  state treasury.  Refunds of overpayments must be paid from the 
 10.34  health care access fund in the state treasury.  There is 
 10.35  annually appropriated from the health care access fund to the 
 10.36  commissioner of revenue the amount necessary to make any refunds 
 11.1   required under section 295.54. 
 11.2      (b) The revenues, including penalties and interest, derived 
 11.3   from the insurance premiums imposed by section 60A.15 on health 
 11.4   maintenance organizations, community integrated service 
 11.5   networks, integrated service networks, and nonprofit health 
 11.6   service plan corporations must be deposited in the general fund 
 11.7   and are annually appropriated to the Minnesota comprehensive 
 11.8   health association to offset assessments made to subsidize the 
 11.9   costs of the Minnesota comprehensive insurance plan established 
 11.10  under chapter 62E.  If the commissioner of finance determines 
 11.11  that the costs of the MinnesotaCare program will exceed the 
 11.12  revenues available to the program from the health care access 
 11.13  fund for a fiscal year, and that the commissioner of human 
 11.14  services will therefore be required to stop MinnesotaCare 
 11.15  enrollment or reduce benefits or eligibility under section 
 11.16  256.9352, subdivision 3, paragraph (b), the commissioner of 
 11.17  finance may reduce or cancel the appropriation to the Minnesota 
 11.18  comprehensive health association and transfer a corresponding 
 11.19  amount of money from the general fund to the health care access 
 11.20  fund.  The commissioner of finance shall not transfer more than 
 11.21  the amount needed to avoid stopping MinnesotaCare enrollment or 
 11.22  reducing benefits or eligibility, and shall not transfer more 
 11.23  than the amount of money derived from the insurance premiums tax 
 11.24  on health maintenance organizations, community integrated 
 11.25  service networks, integrated service networks, and nonprofit 
 11.26  health service plan corporations. 
 11.27     Sec. 12.  [STUDY.] 
 11.28     The commissioners of health, commerce, and revenue shall 
 11.29  jointly submit a written report to the legislature that includes 
 11.30  options and recommendations for alternative funding methods to 
 11.31  replace existing financing mechanisms, including provider taxes 
 11.32  and health plan premium taxes.  The recommendations must include 
 11.33  a dedicated fund that preserves adequate funding for uninsured 
 11.34  persons served by the MinnesotaCare program.  The report must be 
 11.35  submitted to the legislature by January 15, 1998, in compliance 
 11.36  with Minnesota Statutes, section 3.195. 
 12.1      Sec. 13.  [APPROPRIATION.] 
 12.2      $....... is appropriated in fiscal year 1998 and $....... 
 12.3   is appropriated in fiscal year 1999 from the general fund to the 
 12.4   board of directors of the Minnesota comprehensive health 
 12.5   association to cover the total administrative and claims costs 
 12.6   associated with those individuals who are covered by a qualified 
 12.7   or Medicare supplement plan issued by the association and who 
 12.8   are enrolled in medical assistance under Minnesota Statutes, 
 12.9   chapter 256B or 256D.  
 12.10     Sec. 14.  [EFFECTIVE DATE.] 
 12.11     Section 2 is effective June 30, 1997.  Sections 3 to 10 and 
 12.12  12 are effective the day following final enactment.  Section 11 
 12.13  is effective July 1, 1997.  
 12.14                             ARTICLE 3
 12.15                IMPROVING ACCESS TO HEALTH COVERAGE 
 12.16     Section 1.  Minnesota Statutes 1996, section 256.9354, 
 12.17  subdivision 5, is amended to read: 
 12.18     Subd. 5.  [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO 
 12.19  CHILDREN.] (a) Beginning October 1, 1994, the definition of 
 12.20  "eligible persons" is expanded to include all individuals and 
 12.21  households with no children who have gross family incomes that 
 12.22  are equal to or less than 125 percent of the federal poverty 
 12.23  guidelines and who are not eligible for medical assistance 
 12.24  without a spenddown under chapter 256B.  
 12.25     (b) After October 1, 1995, the commissioner of human 
 12.26  services may expand the definition of "eligible persons" to 
 12.27  include all individuals and households with no children who have 
 12.28  gross family incomes that are equal to or less than 135 percent 
 12.29  of federal poverty guidelines and are not eligible for medical 
 12.30  assistance without a spenddown under chapter 256B.  This 
 12.31  expansion may occur only if the financial management 
 12.32  requirements of section 256.9352, subdivision 3, can be met. 
 12.33     (c) The commissioners of health and human services, in 
 12.34  consultation with the legislative commission on health care 
 12.35  access, shall make preliminary recommendations to the 
 12.36  legislature by October 1, 1995, and final recommendations to the 
 13.1   legislature by February 1, 1996, on whether a further expansion 
 13.2   of the definition of "eligible persons" to include all 
 13.3   individuals and households with no children who have gross 
 13.4   family incomes that are equal to or less than 150 percent of 
 13.5   federal poverty guidelines and are not eligible for medical 
 13.6   assistance without a spenddown under chapter 256B would be 
 13.7   allowed under the financial management constraints outlined in 
 13.8   section 256.9352, subdivision 3. 
 13.9      (d) Beginning October 1, 1997, the definition of eligible 
 13.10  persons is expanded to include all individuals and households 
 13.11  with no children who have gross family incomes that are equal to 
 13.12  or less than 175 percent of the federal poverty guidelines and 
 13.13  who are not eligible for medical assistance without a spenddown 
 13.14  under chapter 256B. 
 13.15     (c) All eligible persons under paragraphs (a) and (b) are 
 13.16  eligible for coverage through the MinnesotaCare program but must 
 13.17  pay a premium as determined under sections 256.9357 and 
 13.18  256.9358.  Individuals and families whose income is greater than 
 13.19  the limits established under section 256.9358 may not enroll in 
 13.20  the MinnesotaCare program. 
 13.21     Sec. 2.  Minnesota Statutes 1996, section 256.9354, is 
 13.22  amended by adding a subdivision to read: 
 13.23     Subd. 8.  [MINNESOTACARE OUTREACH.] The commissioner of 
 13.24  human services shall, within the limits of available 
 13.25  appropriations and financial resources, engage in activities to 
 13.26  inform uninsured persons of the importance of maintaining 
 13.27  insurance coverage and provide information on the various 
 13.28  options for obtaining coverage, including the MinnesotaCare 
 13.29  health plan and other state health care programs, Minnesota 
 13.30  comprehensive health association coverage, and private health 
 13.31  coverage options.  The commissioner may accept grants or 
 13.32  contributions from individuals and organizations to support 
 13.33  public information activities and may undertake joint public 
 13.34  information projects with other public or private organizations. 
 13.35     Sec. 3.  [APPROPRIATION.] 
 13.36     $....... is appropriated from the general fund to the 
 14.1   commissioner of human services for public information projects 
 14.2   to inform uninsured persons about their options for obtaining 
 14.3   health coverage.  The appropriation is available until spent. 
 14.4                              ARTICLE 4
 14.5                     COMMUNITY HEALTH IMPROVEMENT 
 14.6      Section 1.  Minnesota Statutes 1996, section 62Q.075, 
 14.7   subdivision 2, is amended to read: 
 14.8      Subd. 2.  [REQUIREMENT.] (a) Beginning October 31, 1997, 
 14.9   all managed care organizations shall file biennially with the 
 14.10  action plans required under section 62Q.07 a plan describing the 
 14.11  actions the managed care organization has taken and those it 
 14.12  intends to take to contribute to achieving public health goals 
 14.13  for each service area in which an enrollee of the managed care 
 14.14  organization resides.  This plan must be jointly developed in 
 14.15  collaboration with the local public health units, appropriate 
 14.16  regional coordinating boards, and other community organizations 
 14.17  providing health services within the same service area as the 
 14.18  managed care organization.  Local government units with 
 14.19  responsibilities and authority defined under chapters 145A and 
 14.20  256E may designate individuals to participate in the 
 14.21  collaborative planning with the managed care organization to 
 14.22  provide expertise and represent community needs and goals as 
 14.23  identified under chapters 145A and 256E. 
 14.24     (b) Local public health agencies may ask managed care 
 14.25  organizations that are not required to collaborate to 
 14.26  collaborate voluntarily.  A managed care organization that is 
 14.27  not required to comply with this section may voluntarily file a 
 14.28  collaboration plan describing the actions the managed care 
 14.29  organization has taken and those it intends to take to 
 14.30  contribute to achieving public health goals. 
 14.31     Sec. 2.  [APPROPRIATION FOR LOCAL PUBLIC HEALTH AND SOCIAL 
 14.32  SERVICE ACTIVITIES.] 
 14.33     $....... is appropriated from the general fund to the 
 14.34  commissioner of health to provide grants to all community health 
 14.35  services boards to support core public health functions.  The 
 14.36  grants shall be made to ensure adequate base level funding to 
 15.1   support core public health activities and to fund public health 
 15.2   activities and services.  The appropriation is available until 
 15.3   spent. 
 15.4                              ARTICLE 5
 15.5                        HEALTH CARE PROVIDERS 
 15.6      Section 1.  Minnesota Statutes 1996, section 295.582, is 
 15.7   amended to read: 
 15.8      295.582 [AUTHORITY.] 
 15.9      (a) A hospital, surgical center, pharmacy, or health care 
 15.10  provider that is subject to a tax under section 295.52, or a 
 15.11  pharmacy that has paid additional expense transferred under this 
 15.12  section by a wholesale drug distributor, may transfer additional 
 15.13  expense generated by section 295.52 obligations on to all 
 15.14  third-party contracts for the purchase of health care services 
 15.15  on behalf of a patient or consumer.  The additional expense 
 15.16  transferred to the third-party purchaser must not exceed two 
 15.17  percent of the gross revenues received under the third-party 
 15.18  contract, and two percent of copayments and deductibles paid by 
 15.19  the individual patient or consumer.  The expense must not be 
 15.20  generated on revenues derived from payments that are excluded 
 15.21  from the tax under section 295.53.  All third-party purchasers 
 15.22  of health care services including, but not limited to, 
 15.23  third-party purchasers regulated under chapter 60A, 62A, 62C, 
 15.24  62D, 62H, 62N, 64B, 65A, 65B, 79, or 79A, or under section 
 15.25  471.61 or 471.617, must pay the transferred expense in addition 
 15.26  to any payments due under existing contracts with the hospital, 
 15.27  surgical center, pharmacy, or health care provider, to the 
 15.28  extent allowed under federal law.  A third-party purchaser of 
 15.29  health care services includes, but is not limited to, a health 
 15.30  carrier, integrated service network, or community integrated 
 15.31  service network that pays for health care services on behalf of 
 15.32  patients or that reimburses, indemnifies, compensates, or 
 15.33  otherwise insures patients for health care services.  A 
 15.34  third-party purchaser shall comply with this section regardless 
 15.35  of whether the third-party purchaser is a for-profit, 
 15.36  not-for-profit, or nonprofit entity.  A wholesale drug 
 16.1   distributor may transfer additional expense generated by section 
 16.2   295.52 obligations to entities that purchase from the 
 16.3   wholesaler, and the entities must pay the additional expense.  
 16.4   Nothing in this section limits the ability of a hospital, 
 16.5   surgical center, pharmacy, wholesale drug distributor, or health 
 16.6   care provider to recover all or part of the section 295.52 
 16.7   obligation by other methods, including increasing fees or 
 16.8   charges. 
 16.9      (b) Each third-party purchaser regulated under any chapter 
 16.10  cited in paragraph (a) shall include with its annual renewal for 
 16.11  certification of authority or licensure documentation indicating 
 16.12  compliance with paragraph (a).  If the commissioner responsible 
 16.13  for regulating the third-party purchaser finds at any time that 
 16.14  the third-party purchaser has not complied with paragraph (a), 
 16.15  the commissioner may by order fine or censure the third-party 
 16.16  purchaser or revoke or suspend the certificate of authority or 
 16.17  license of the third-party purchaser to do business in this 
 16.18  state.  The third-party purchaser may appeal the commissioner's 
 16.19  order through a contested case hearing in accordance with 
 16.20  chapter 14. 
 16.21     (c) The commissioners of health and commerce are authorized 
 16.22  to enforce the pass-through as provided in this section for 
 16.23  those health plan companies they regulate.  A hospital, surgical 
 16.24  center, pharmacy, or health care provider that is subject to a 
 16.25  tax under section 295.52 may file a complaint with the 
 16.26  commissioner responsible for regulating the third-party 
 16.27  purchaser if at any time the third-party purchaser does not 
 16.28  comply with paragraph (a).  The commissioners of health and 
 16.29  commerce may take enforcement action against a regulated health 
 16.30  plan company which is subject to their regulatory jurisdiction 
 16.31  and which does not allow a provider to pass through the tax.  
 16.32  The commissioners of health and commerce may fine or censure a 
 16.33  health plan company, or revoke or suspend the certificate of 
 16.34  authority or license of the health plan company to do business 
 16.35  in this state, if the commissioner finds that the health plan 
 16.36  company has not complied with this section. 
 17.1      Sec. 2.  [PROVISION TO SUPERSEDE.] 
 17.2      Notwithstanding Minnesota Statutes, section 645.26, 
 17.3   subdivision 3, or any other law to the contrary, if a bill 
 17.4   styled as S.F. No. 1208 is enacted by the legislature at its 
 17.5   1997 session, any provisions in that bill reducing the rate of 
 17.6   tax imposed under Minnesota Statutes, section 295.52, is 
 17.7   superseded by this provision, and no reduction in the rate shall 
 17.8   be effective. 
 17.9                              ARTICLE 6
 17.10                       HEALTH PLAN REGULATION 
 17.11     Section 1.  [STUDY OF NATIONAL ACCREDITATION 
 17.12  ORGANIZATIONS.] 
 17.13     The commissioner of health shall study the requirements of 
 17.14  national accreditation organizations for health care 
 17.15  organizations and identify any overlaps of these requirements 
 17.16  with the state statutory or regulatory requirements.  The 
 17.17  commissioner shall submit findings from this study to the 
 17.18  legislature by January 15, 1998.