1.1 	A bill for an act
1.2 	relating to health; establishing the Minnesota
1.3 	Universal Health Board; creating the Minnesota
1.4 	universal health program; establishing the Minnesota
1.5 	health care trust fund; establishing statewide and
1.6 	regional health care budgets; eliminating requirement
1.7 	to establish public health goals; appropriating money;
1.8 	amending Minnesota Statutes 2004, section 145A.12,
1.9 	subdivision 7; proposing coding for new law in
1.10 	Minnesota Statutes, chapter 62J; proposing coding for
1.11 	new law as Minnesota Statutes, chapter 62K; repealing
1.12 	Minnesota Statutes 2004, section 62J.212.
1.13 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.14 	ARTICLE 1
1.15 	PURPOSE

1.16 	Section 1. PURPOSE.
 1.17 	The Minnesota Universal Health Board is created for the
1.18 	purpose of providing a single, publicly financed, statewide
1.19 	program to provide comprehensive coverage for all necessary
1.20 	health care services for residents of Minnesota.

1.21 	ARTICLE 2
1.22 	REGIONAL BOARDS

1.23 	Section 1. [62J.091] REGIONAL BOARDS.
1.24 		Subdivision 1.General duties. (a) The commissioner
1.25 	shall divide the state into six regions, one of these regions
1.26 	being the seven-county metropolitan area.
1.27 	(b) Each region shall establish a regional board consisting
1.28 	of consumers according to subdivision 2.  Regional boards may:
1.29 	(1) undertake voluntary activities to educate consumers and
2.1 	providers about community plans and projects promoting health
2.2 	care cost containment, consumer accountability, access, and 
2.3 	
2.4 	quality and about efforts to achieve public health goals;
2.5 	(2) make recommendations to the commissioner regarding ways
2.6 	of improving affordability, accessibility, and quality of health
2.7 	care in the region and throughout the state;
2.8 	(3) advise the Minnesota Universal Health Board on public
2.9 	health goals, taking into consideration the relevant portions of
2.10 	the community health service plans, plans required by the
2.11 	Minnesota Comprehensive Adult Mental Health Act, the Minnesota
2.12 	Comprehensive Children's Mental Health Act, and the Community
2.13 	Social Service Act plans developed by county boards or community
2.14 	health boards in the region under chapters 145A, 245, and 256E;
2.15 	(4) prepare an annual regional education plan that is
2.16 	consistent with and supportive of public health goals identified
2.17 	by community health boards in the region; and 
2.18 	(5) serve as advisory bodies to identify potential
2.19 	applicants for federal health professional shortage area and
2.20 	federal medically underserved area designation as requested by
2.21 	the commissioner.
2.22 		Subd. 2.Membership; terms. (a) Each regional board
2.23 	shall consist of one member per county as provided in this
2.24 	subdivision and three members per county in the seven-county
2.25 	metropolitan area.  A member may designate a representative to
2.26 	act as a member of the board in the member's absence.  The board
2.27 	shall appoint the chair of each regional board from among its
2.28 	members.
2.29 	(b) A member of a regional board must be a consumer who:
2.30 	(1) does not have and in the past did not have a material
2.31 	interest in the provision of health care services or in an
2.32 	activity directly related to the provision of health care
2.33 	services, such as health insurance sales or health plan
2.34 	administration;
2.35 	(2) is not responsible for or directly involved in the
2.36 	purchasing of health insurance for a business or organization;
2.37 	(3) is not a registered lobbyist in this state; and 
3.1 	(4) is at least 18 years of age and a resident of Minnesota.
3.2 	(c) An individual must apply to the board of the county in
3.3 	which the individual resides to become a member of a regional
3.4 	board.  A county board shall elect its regional board member or
3.5 	members from among eligible applicants.  Prior to electing a
3.6 	regional board member, a county board must hold public hearings
3.7 	with all eligible applicants, to include a statement by each
3.8 	applicant and an opportunity for questioning by the county
3.9 	commissioners.
3.10 	(d) The terms of the members are four years.  The chair of
3.11 	each regional board shall designate as nearly as possible
3.12 	one-fourth of the members to terms expiring each year.

3.13 	Sec. 2. [62J.10] REGIONAL BOARD DUTIES.
3.14 	(a) Each regional board shall submit a recommended regional
3.15 	budget to the commissioner by July 1, 2006.  Beginning July 1,
3.16 	2006, and each July 1 thereafter, each regional board shall
3.17 	submit the recommended regional budget to the Minnesota
3.18 	Universal Health Board established under chapter 62K.
3.19 	(b) Each regional budget must include the following:
3.20 	(1) a budget for health maintenance organizations and for
3.21 	each health plan network based on an estimated number of
3.22 	patients and an estimated per capita cost;
3.23 	(2) fee schedules for individual providers;
3.24 	(3) a budget for institutional providers; and 
3.25 	(4) budgets for the expected cost of patients treated in
3.26 	the region.
3.27 	(c) Before the proposed regional budget is submitted to
3.28 	either the commissioner or the Minnesota Universal Health Board,
3.29 	a regional board shall hold a hearing or hearings after
3.30 	providing public notice.
3.31 	(d) A regional board shall utilize, when circumstances
3.32 	warrant, task forces that address specific concerns, such as
3.33 	regional issues or needs, concerns of specific communities or
3.34 	constituencies, or public health concerns.  Membership of a task
3.35 	force shall include consumers who are not members of the
3.36 	regional board.

4.1 	Sec. 3. [62J.12] BUDGET IMPLEMENTATION SCHEDULE.
4.2 		Subdivision 1.Calendar year 2007 budgets. In carrying
4.3 	out the duties required under section 62J.10, the following
4.4 	schedule shall be followed by the commissioner and regional
4.5 	boards:
4.6 	(1) by July 1, 2006, each regional board shall submit to
4.7 	the commissioner a recommended regional budget for health care
4.8 	spending consisting of budgets for each of the accounts
4.9 	specified in section 62K.09; and 
4.10 	(2) by November 1, 2006, the commissioner shall adopt
4.11 	statewide and regional budgets for each of the accounts
4.12 	specified in section 62K.09.  The budgets must also include fee
4.13 	schedules for individual providers and budgets for institutional
4.14 	providers to take effect January 1, 2007.
4.15 		Subd. 2.2008 and future years. The implementation
4.16 	schedule for 2008 must be identical to the 2007 schedule except
4.17 	that regional boards shall submit budgets to the Minnesota
4.18 	Universal Health Board, not the commissioner of health.  The
4.19 	implementation schedule for 2009 and all future years shall be
4.20 	identical to the 2008 schedule except that the Minnesota
4.21 	Universal Health Board, not the commissioner of health, shall
4.22 	propose statewide and regional budgets by January 1, 2008.
4.23 		Subd. 3.Report. The Minnesota Universal Health Board
4.24 	shall recommend in the annual report due January 1, 2008,
4.25 	whether budgets should be set annually or biennially.

4.26 	Sec. 4. EFFECTIVE DATE.
 4.27 	Sections 1 to 3 are effective January 1, 2006.

4.28 	ARTICLE 3
4.29 	MINNESOTA UNIVERSAL HEALTH BOARD

4.30 	Section 1. [62K.01] DEFINITIONS.
4.31 		Subdivision 1.Scope. For purposes of this chapter, the
4.32 	following terms have the meanings given them.
4.33 		Subd. 2.Board. "Board" means the Minnesota Universal
4.34 	Health Board established under section 62K.02.
4.35 		Subd. 3.Commissioner. "Commissioner" means the
4.36 	commissioner of health.
5.1 		Subd. 4.Department. "Department" means the Department
5.2 	of Health.
5.3 		Subd. 5.Freestanding outpatient facility. "Freestanding
5.4 	outpatient facility" means a health care facility, including,
5.5 	but not limited to, an outpatient surgical center, a diagnostic
5.6 	imaging facility, or a physician clinic, that is not physically
5.7 	attached to a hospital and that provides for the care of human
5.8 	beings.
5.9 		Subd. 6.Health plan company. "Health plan company" has
5.10 	the meaning given under section 62Q.01, subdivision 4.
5.11 		Subd. 7.Individual provider. "Individual provider"
5.12 	means a health care provider licensed or registered by the state
5.13 	who is not an institutional provider.
5.14 		Subd. 8.Institutional provider. "Institutional
5.15 	provider" means an inpatient hospital, nursing facility,
5.16 	intermediate care facility for persons with mental retardation
5.17 	and related conditions, and other providers of inpatient
5.18 	services, including institutions providing inpatient or
5.19 	overnight care and ambulatory diagnostic, treatment, and
5.20 	surgical facilities.
5.21 		Subd. 9.Medically necessary. "Medically necessary"
5.22 	means a health service that is consistent with the recipient's
5.23 	diagnosis or condition, recognized as the prevailing standard or
5.24 	current practice by the provider's peer group, and:
5.25 	(1) rendered to:
5.26 	(i) treat an injury, illness, infection, or pain;
5.27 	(ii) treat a condition that could result in physical or
5.28 	mental disability;
5.29 	(iii) care for a mother and child through a maternity
5.30 	period; or 
5.31 	(iv) achieve a level of physical or mental function
5.32 	consistent with prevailing community standards for the diagnosis
5.33 	or condition; or 
5.34 	(2) a preventive health service.
5.35 		Subd. 10.Program. "Program" means the Minnesota
5.36 	universal health program established under this chapter and
6.1 	administered by the Minnesota Universal Health Board.

6.2 	Sec. 2. [62K.02] MINNESOTA UNIVERSAL HEALTH BOARD.
6.3 		Subdivision 1.Eligibility. A member of the Minnesota
6.4 	Universal Health Board must be a consumer who:
6.5 	(1) does not have and in the past did not have a material
6.6 	interest in the provision of health care services or in any
6.7 	activity directly related to the provision of health care
6.8 	services, such as health insurance sales or health plan
6.9 	administration;
6.10 	(2) is not responsible for or directly involved in the
6.11 	purchasing of health insurance for a business or organization;
6.12 	and 
6.13 	(3) is not a registered lobbyist in this state.
6.14 		Subd. 2.Composition. (a) The Minnesota Universal Health
6.15 	Board shall consist of 12 members selected as follows:
6.16 	(1) the chairs of each of the six regional boards
6.17 	established under section 62J.091, or their designees;
6.18 	(2) two persons appointed by the governor;
6.19 	(3) two persons appointed by the chair of the senate
6.20 	committee having jurisdiction over health policy; and 
6.21 	(4) two persons appointed by the chair of the house
6.22 	committee having jurisdiction over health policy.
6.23 	(b) The appointing authorities shall coordinate their
6.24 	efforts to ensure that the board composition reflects the racial
6.25 	and ethnic diversity of the state and provides representation
6.26 	for persons with disabilities.
6.27 		Subd. 3.Terms; compensation; removal; vacancies. The
6.28 	board is governed by section 15.0575, except that board members
6.29 	shall receive salaries rather than per diems.
6.30 		Subd. 4.Administration. The commissioner shall provide
6.31 	office space, equipment and supplies, and technical support to
6.32 	the board.
6.33 		Subd. 5.Staff. The board may hire an executive director
6.34 	who serves in the unclassified service.  The executive director
6.35 	may hire employees and consultants as authorized by the board
6.36 	and may prescribe their duties.  The attorney general shall
7.1 	provide legal services to the board.
7.2 		Subd. 6.General duties. The board may:
7.3 	(1) implement and administer the Minnesota universal health
7.4 	program;
7.5 	(2) estimate the current cost of universal coverage for all
7.6 	Minnesotans;
7.7 	(3) establish statewide and regional budgets that include
7.8 	budgets for the accounts specified in section 62K.09;
7.9 	(4) approve budgets for each region, including budgets for
7.10 	the accounts specified in section 62K.09;
7.11 	(5) establish fee schedules, which may vary to reflect
7.12 	regional differences;
7.13 	(6) approve budgets for institutional providers;
7.14 	(7) approve capital expenditures for freestanding
7.15 	outpatient facilities;
7.16 	(8) monitor compliance with all budgets and fee schedules
7.17 	and take action to achieve compliance to the extent authorized
7.18 	by law;
7.19 	(9) issue requests for proposals for a contract to process
7.20 	claims submitted by individual providers;
7.21 	(10) provide technical assistance to the regional boards
7.22 	established under section 62J.091;
7.23 	(11) administer the Minnesota health care trust fund
7.24 	created under section 62K.07;
7.25 	(12) monitor the operation of the Minnesota universal
7.26 	health program through consumer surveys and regular data
7.27 	collection and evaluation activities, including evaluations of
7.28 	the adequacy and quality of services furnished under the
7.29 	program, the need for changes in the benefit package, the cost
7.30 	of each type of service, and the effectiveness of cost
7.31 	containment measures under the program;
7.32 	(13) develop and implement enrollment procedures for
7.33 	providers and persons eligible for the program and disseminate,
7.34 	to providers of services and to the public, information
7.35 	concerning the program and the persons eligible to receive
7.36 	benefits under the program;
8.1 	(14) develop and implement cost containment and quality
8.2 	assurance procedures, including a professional peer review
8.3 	system;
8.4 	(15) conduct necessary investigations and inquiries and
8.5 	require the submission of information, documents, and records
8.6 	the board considers necessary to carry out its duties under this
8.7 	chapter; and 
8.8 	(16) conduct other activities the board considers necessary
8.9 	to carry out the purposes of this chapter.
8.10 		Subd. 7.Annual report. The board shall present an
8.11 	annual report to the legislature and the governor by January 1,
8.12 	2007, and each succeeding January, summarizing the activities of
8.13 	the board.  In the report due January 1, 2008, the board shall
8.14 	recommend whether statewide and regional budgets should be set
8.15 	annually or biennially.
8.16 		Subd. 8.Rulemaking. The board may adopt rules as
8.17 	necessary to carry out the duties assigned under this chapter.
8.18 		Subd. 9.Hearings. The board, after providing notice to
8.19 	consumers, providers, and all other interested parties, may hold
8.20 	hearings in connection with any action that it proposes to take
8.21 	under subdivision 6.

8.22 	Sec. 3. [62K.05] MINNESOTA UNIVERSAL HEALTH PROGRAM
8.23 	IMPLEMENTATION SCHEDULE.
8.24 	(a) The board, through the commissioner, shall begin
8.25 	planning and development for the Minnesota universal health
8.26 	program.  The board shall use an implementation schedule that
8.27 	will phase in enrollment for Minnesota residents, with initial
8.28 	enrollment of eligible individuals and families beginning July
8.29 	1, 2007.  All Minnesota residents without health insurance shall
8.30 	be insured by January 1, 2008.  The health insurance that covers
8.31 	all Minnesota residents shall be consolidated into the Minnesota
8.32 	universal health program by January 1, 2009.
8.33 	(b) In carrying out planning and development activities,
8.34 	the board shall:
8.35 	(1) begin initial enrollment of uninsured and underinsured
8.36 	individuals and families with annual incomes of less than 275
9.1 	percent of the federal poverty guidelines who do not have
9.2 	duplicative coverage through a federal, state, or private
9.3 	insurance program or plan by July 1, 2008;
9.4 	(2) provide Medicare supplemental insurance by July 1,
9.5 	2008, to Medicare enrollees with annual incomes of less than 275
9.6 	percent of the federal poverty guidelines;
9.7 	(3) enroll individuals and families with incomes at or
9.8 	above 275 percent of the federal poverty guidelines and
9.9 	individuals and families with incomes below 275 percent of the
9.10 	federal poverty guidelines not eligible for enrollment under
9.11 	clause (1) beginning January 1, 2009;
9.12 	(4) provide Medicare supplemental insurance to Medicare
9.13 	enrollees not eligible for enrollment under clause (2) beginning
9.14 	January 1, 2009;
9.15 	(5) merge the Minnesota universal health program, the
9.16 	MinnesotaCare program, the general assistance medical care
9.17 	program, and the services for children with handicaps program by
9.18 	July 1, 2009, in a way that will not diminish the coverage
9.19 	provided to participants in existing programs and without
9.20 	increasing the financial obligations of public hospitals and
9.21 	other providers that currently serve participants in these
9.22 	programs;
9.23 	(6) assume responsibility for the administration and
9.24 	funding of appropriate components of maternal and child health
9.25 	services currently administered by the commissioner and
9.26 	coordinate outreach, patient education, case management, and
9.27 	related activities with the maternal and child health program,
9.28 	local public health departments, and nonprofit agencies by July
9.29 	1, 2009;
9.30 	(7) merge the consolidated chemical dependency treatment
9.31 	fund with the Minnesota universal health program by July 1,
9.32 	2009;
9.33 	(8) phase out the Minnesota Comprehensive Health
9.34 	Association by July 1, 2009, in a way that will ensure that
9.35 	Minnesota Comprehensive Health Association enrollees receive
9.36 	comparable coverage through the Minnesota universal health
10.1 	program;
10.2 	(9) beginning January 1, 2009, prohibit health plan
10.3 	companies from selling insurance that duplicates benefits
10.4 	provided by the Minnesota universal health program, in a manner
10.5 	that ensures continuity of coverage through the program as
10.6 	duplicate coverage in the private market is prohibited;
10.7 	(10) seek federal waivers in order to phase Medicare and
10.8 	medical assistance recipients into the program by a target date
10.9 	of January 1, 2009; and 
10.10 	(11) phase retirees with retiree health benefits into the
10.11 	program by January 1, 2009.

10.12 	Sec. 4. [62K.07] MINNESOTA HEALTH CARE TRUST FUND.
10.13 		Subdivision 1.Establishment. The Minnesota health care
10.14 	trust fund is established.  The fund shall consist of all money
10.15 	obtained from general fund appropriations; state savings
10.16 	resulting from state health program consolidation; federal
10.17 	payments received as a result of any waiver or requirements
10.18 	granted by the United States Secretary of Health and Human
10.19 	Services under health care programs established under titles 18
10.20 	and 19 of the Social Security Act, United States Code, title 42,
10.21 	section 301; and any other money received by the board.  The
10.22 	budgets of Minnesota state agencies shall remain distinct from
10.23 	the Minnesota health care trust fund, except for portions of
10.24 	those budgets that provide health care services that are
10.25 	provided to all Minnesotans through the Minnesota universal
10.26 	health program.
10.27 		Subd. 2.Reserves. Beginning July 1, 2007, the amount of
10.28 	reserves in the fund at any time must equal at least the amount
10.29 	of expenditures from the fund during the entire three preceding
10.30 	months.

10.31 	Sec. 5. [62K.09] ACCOUNTS WITHIN MINNESOTA HEALTH CARE
10.32 	TRUST FUND.
10.33 		Subdivision 1.Prevention account. The prevention
10.34 	account is created within the Minnesota health care trust fund.
10.35 	Money in the account shall be used solely to establish and
10.36 	maintain primary community prevention programs, including
11.1 	preventive screening tests.
11.2 		Subd. 2.Health services account. The health services
11.3 	account is created within the Minnesota health care trust fund.
11.4 	Money in the account shall be used solely to pay providers in
11.5 	accordance with section 62K.19.
11.6 		Subd. 3.Capital account. The capital account is created
11.7 	within the Minnesota health care trust fund.  Money in the
11.8 	account shall be used solely to:
11.9 	(1) pay for the construction, renovation, and equipping of
11.10 	health care institutions, including institutions providing
11.11 	inpatient or overnight care and ambulatory diagnostic,
11.12 	treatment, and surgical facilities; and 
11.13 	(2) provide health professionals serving in health care
11.14 	shortage areas with assistance in repaying educational loans and
11.15 	establishing medical practices.
11.16 		Subd. 4.Interpretation, communication, and
11.17 	transportation account. (a) The interpretation, communication,
11.18 	and transportation account is created within the Minnesota
11.19 	health care trust fund.  Money in the account shall be used to
11.20 	fund:
11.21 	(1) interpreter services;
11.22 	(2) communication and cooperation improvement efforts; and 
11.23 	(3) transportation projects to provide access for patients
11.24 	unable to reach necessary services, including projects that
11.25 	provide services at the residences of patients unable to travel.
11.26 	(b) Money may be used to fund public education programs and
11.27 	programs that encourage cooperation between institutions funded
11.28 	on an annual basis that lead to more efficient and effective use
11.29 	of health care resources.  All expenditures must comply with
11.30 	rules approved by the board.
11.31 		Subd. 5.Program administration, evaluation, planning,
11.32 	and assessment account. The program administration, evaluation,
11.33 	planning, and assessment account is created within the Minnesota
11.34 	health care trust fund.  Money in the account shall be used by
11.35 	the board to monitor and improve the plan's effectiveness and
11.36 	operations.  The board may establish grant programs, including
12.1 	demonstration projects, for this purpose.
12.2 		Subd. 6.Medical research account. The medical research
12.3 	account is created within the Minnesota health care trust fund.
12.4 	Money in the account shall be used by the board to establish a
12.5 	health care analysis unit.  The results of the unit's research
12.6 	shall be used by the board to improve the quality of health care
12.7 	provided under the Minnesota universal health program and to
12.8 	make decisions about health benefits covered by the program.
12.9 	The board may also establish grant programs, including
12.10 	demonstration projects, for this purpose.  The board shall seek
12.11 	federal and private funds to supplement this allocation.

12.12 	Sec. 6. [62K.11] ELIGIBILITY.
12.13 		Subdivision 1.Citizenship; migrant workers. (a)
12.14 	Eligibility for coverage under the Minnesota universal health
12.15 	program is limited to citizens of the United States and aliens
12.16 	lawfully admitted for permanent residence or otherwise
12.17 	permanently residing in the United States under the color of law.
12.18 	(b) Payment shall also be made for care and services that
12.19 	are furnished to an alien, regardless of immigration status, if
12.20 	the care and services are necessary for the treatment of an
12.21 	emergency medical condition, except for organ transplants and
12.22 	related care and services.  For purposes of this subdivision,
12.23 	the term "emergency medical condition" means a medical
12.24 	condition, including labor and delivery, that if not immediately
12.25 	treated could cause a person physical or mental disability,
12.26 	continuation of severe pain, or death.
12.27 		Subd. 2.Residents receiving care out of state. The
12.28 	board may provide payment for out-of-state care provided to
12.29 	Minnesota residents.  In determining whether payment is to be
12.30 	made, the board shall determine the appropriateness of the care
12.31 	provided, the availability of the service in Minnesota, and the
12.32 	individual's medical condition and personal circumstances.  For
12.33 	travel less than six months in length, the board shall establish
12.34 	guidelines for covering services.
12.35 		Subd. 3.Nonresidents employed in minnesota. The board
12.36 	may extend eligibility to nonresidents employed in Minnesota
13.1 	using a sliding fee scale.
13.2 		Subd. 4.Nonresidents emergency care. Nonresidents in
13.3 	need of emergency services while in Minnesota shall be given
13.4 	care and billed for the services provided.

13.5 	Sec. 7. [62K.13] BENEFITS.
13.6 		Subdivision 1.General. Every Minnesota resident
13.7 	enrolled in the program is entitled to receive benefits for any
13.8 	service covered under subdivision 2 that is medically necessary
13.9 	to maintain the person's health, or necessary for the diagnosis
13.10 	or treatment of, or rehabilitation following, an injury,
13.11 	disability, or disease.  Services provided in Minnesota must be
13.12 	provided by a health care provider who participates in the
13.13 	program.
13.14 		Subd. 2.Covered services; general. The program covers
13.15 	the following services:
13.16 	(1) acute health care;
13.17 	(2) chronic health care;
13.18 	(3) rehabilitative health care;
13.19 	(4) preventive health services;
13.20 	(5) outpatient health services;
13.21 	(6) laboratory and x-ray services;
13.22 	(7) home care and home health care support services;
13.23 	(8) dental care;
13.24 	(9) chiropractic care;
13.25 	(10) inpatient and outpatient mental health care, including
13.26 	care for serious and persistent mental illness;
13.27 	(11) inpatient and outpatient chemical dependency
13.28 	treatment;
13.29 	(12) family planning services;
13.30 	(13) medically necessary cosmetic surgery and
13.31 	reconstructive surgery;
13.32 	(14) public health services formerly provided through state
13.33 	and local government;
13.34 	(15) on or after January 1, 2010, long-term care; and 
13.35 	(16) other medically necessary services.
13.36 		Subd. 3.Covered services; pharmaceuticals and supplies.
 14.1 	The program covers all pharmaceuticals and medical supplies
14.2 	prescribed by a licensed practitioner, including prescription
14.3 	drugs, pharmaceuticals and supplies for eye care, hearing aids,
14.4 	orthopedic aids, home aids, and durable medical equipment.
14.5 		Subd. 4.Covered services; type of practitioner. The
14.6 	program covers medically necessary and appropriate services
14.7 	provided by all licensed or registered health care
14.8 	practitioners, as long as the services are within the scope of
14.9 	practice and meet standards of quality assurance established by
14.10 	the board.  Covered practitioners include, but are not limited
14.11 	to, medical doctors, doctors of chiropractic, osteopathic
14.12 	doctors, nurses, nurse practitioners, physician assistants,
14.13 	dentists, optometrists, pharmacists, mental health providers,
14.14 	chemical dependency counselors, certified nurse midwives,
14.15 	nutritionists, practitioners of complementary and alternative
14.16 	medicine, and physical therapists.
14.17 		Subd. 5.Covered services; site of care. The program
14.18 	covers care provided in all settings approved by the board.
14.19 		Subd. 6.Services not covered. The following services
14.20 	are not covered:
14.21 	(1) services that are not medically necessary;
14.22 	(2) surgery for cosmetic purposes; and 
14.23 	(3) medical examinations conducted and medical reports
14.24 	prepared for purchasing or renewing life insurance or
14.25 	participating as a plaintiff or defendant in a civil action for
14.26 	the recovery or settlement of damages.
14.27 		Subd. 7.Benefits advisory committee; changes in covered
14.28 	services. (a) The board shall establish a benefits advisory
14.29 	committee comprised of consumers, health care providers, experts
14.30 	in medical ethics, and health science researchers to provide
14.31 	recommendations regarding program benefits and limitations on
14.32 	covered services.  The board shall ensure that the composition
14.33 	of the committee reflects the racial and ethnic diversity of the
14.34 	state and provides representation for persons with disabilities.
14.35 	Persons serving on the committee are compensated as provided in
14.36 	section 15.0575.
15.1 	(b) The board may make changes in program benefits or place
15.2 	limitations on covered services only after public hearing.
15.3 		Subd. 8.Choice of providers. An eligible person may
15.4 	choose any provider licensed or registered in Minnesota, or an
15.5 	alternative provider if referred by a licensed Minnesota
15.6 	provider, including practitioners practicing on an independent
15.7 	basis, in group practices, or in health maintenance
15.8 	organizations.

15.9 	Sec. 8. [62K.15] DUPLICATE COVERAGE PROHIBITED.
15.10 	Policies, plans, or contracts of health coverage issued,
15.11 	sold, or renewed by health plan companies on or after January 1,
15.12 	2009, must not offer benefits that duplicate coverage offered
15.13 	under the Minnesota universal health program.  A policy, plan,
15.14 	or contract may offer benefits that do not duplicate coverage
15.15 	that is offered by the program.

15.16 	Sec. 9. [62K.17] PROVIDER RESPONSIBILITIES.
15.17 		Subdivision 1.Provider participation. All licensed
15.18 	providers shall be considered participants in the program unless
15.19 	and until the provider notifies the board of a change in status.
15.20 	Providers shall not bill patients for services covered under the
15.21 	Minnesota universal health program.  The board shall provide
15.22 	providers with notice of these requirements and adopt rules
15.23 	necessary to allow for changes in provider status.
15.24 		Subd. 2.Nondiscrimination. Participating providers
15.25 	shall furnish services to all eligible persons, regardless of
15.26 	race, color, income level, national origin, religion, sex,
15.27 	sexual orientation, or other nonmedical criteria.
15.28 		Subd. 3.Provision of information. Upon the request of
15.29 	the board, every provider shall furnish information that may
15.30 	reasonably be required by the board to ensure or enhance
15.31 	quality, reduce costs, eliminate fraud, estimate health care
15.32 	spending, and set budgets.  A provider shall permit the board to
15.33 	examine its records as necessary for verification of payment.

15.34 	Sec. 10. [62K.19] PROVIDER REIMBURSEMENT.
15.35 		Subdivision 1.Institutional providers. (a) The
15.36 	Minnesota universal health program shall pay the expenses of
16.1 	institutional providers on the basis of annual budgets that are
16.2 	approved by the board.
16.3 	(b) An institutional provider shall negotiate an annual
16.4 	budget with the regional board to cover its anticipated services
16.5 	for the next year based on past performance and projected
16.6 	changes in prices and service levels.  A physician or other
16.7 	provider employed by an annually-budgeted institutional provider
16.8 	shall be paid through and in a manner determined by the
16.9 	institutional provider.
16.10 		Subd. 2.Individual providers. The board may reimburse
16.11 	individual providers of health care services on a
16.12 	fee-for-service basis.  The board shall annually negotiate the
16.13 	fee schedule with the appropriate professional group.  In
16.14 	developing fee schedules, the board may take into account
16.15 	recognized geographic differences in cost of practice.  To the
16.16 	greatest extent possible, fee schedule categories must include
16.17 	payment for all procedures routinely performed for a given
16.18 	diagnosis.  The board may require that certain high-risk or
16.19 	specialized procedures be reimbursed only when performed in
16.20 	certain institutions or by certain providers.
16.21 		Subd. 3.Balance billing prohibited. A provider may not
16.22 	charge rates that are higher than the negotiated reimbursement
16.23 	level.  A provider may not charge separately for services
16.24 	covered under section 62K.13.
16.25 		Subd. 4.Capitated payments. A health maintenance
16.26 	organization may elect to be reimbursed on a capitation basis in
16.27 	place of fee-for-service reimbursement.  Payment on a capitation
16.28 	basis does not cover inpatient services provided by a health
16.29 	maintenance organization for institutional providers.

16.30 	Sec. 11. [62K.21] RULES.
16.31 	The Minnesota Universal Health Board shall adopt rules to
16.32 	establish a review and approval process for regional boards
16.33 	established under chapter 62J.

16.34 	Sec. 12. Minnesota Statutes 2004, section 145A.12,
16.35 	subdivision 7, is amended to read:
16.36 		Subd. 7.Statewide outcomes.  (a) The commissioner, in
17.1 	consultation with the State Community Health Advisory Committee
17.2 	established under section 145A.10, subdivision 10, paragraph
17.3 	(a), shall establish statewide outcomes for local public health
17.4 	grant funds allocated to community health boards between January
17.5 	1, 2004, and December 31, 2005.
17.6 	(b) At least one statewide outcome must be established in
17.7 	each of the following public health areas:
17.8 	(1) preventing diseases;
17.9 	(2) protecting against environmental hazards;
17.10 	(3) preventing injuries;
17.11 	(4) promoting healthy behavior;
17.12 	(5) responding to disasters; and
17.13 	(6) ensuring access to health services.
17.14 	(c) The commissioner shall use Minnesota's public health
17.15 	goals established under section 62J.212 and the essential public
17.16 	health services under section 145A.10, subdivision 5a, as a
17.17 	basis for the development of statewide outcomes.
17.18 	(d) The statewide maternal and child health outcomes
17.19 	established under section 145.8821 shall be included as
17.20 	statewide outcomes under this section.
17.21 	(e) By December 31, 2004, and every five years thereafter,
17.22 	the commissioner, in consultation with the State Community
17.23 	Health Advisory Committee established under section 145A.10,
17.24 	subdivision 10, paragraph (a), and the Maternal and Child Health
17.25 	Advisory Task Force established under section 145.881, shall
17.26 	develop statewide outcomes for the local public health grant
17.27 	established under section 145A.131, based on state and local
17.28 	assessment data regarding the health of Minnesota residents,and 
17.29 	the essential public health services under section 145A.10, and
17.30 	current Minnesota public health goals established under section
17.31 	62J.212.

17.32 	Sec. 13. STUDY AND ASSESSMENT.
 17.33 	The commissioner of health shall study statewide health
17.34 	care spending to enable the Minnesota Universal Health Board and
17.35 	the regional boards to establish and enforce the state and
17.36 	regional health care budgets.  By January 1, 2006, the
18.1 	commissioner shall:
18.2 	(1) assess health care capital needs and expenditures
18.3 	statewide and within each region; and 
18.4 	(2) recommend to the Minnesota Universal Health Board and
18.5 	the regional boards statewide and regional budgets, each
18.6 	consisting of budgets for operating and capital expenditures and
18.7 	fee schedules for health care providers and practitioners.

18.8 	Sec. 14. FUNDING.
 18.9 	Financing of the Minnesota universal health program shall
18.10 	be through the consolidation of funding from existing state and
18.11 	federal programs and a designated progressive income tax.  There
18.12 	shall be no co-payments, deductibles, or other out-of-pocket
18.13 	payments by individuals for services.

18.14 	Sec. 15. APPROPRIATION.
 18.15 	(a) $....... is appropriated from the general fund to the
18.16 	Minnesota Universal Health Board to implement sections 1 to 11.
18.17 	This appropriation is available until June 30, 2009, at which
18.18 	time the board shall repay this amount to the general fund from
18.19 	the Minnesota health care trust fund created in Minnesota
18.20 	Statutes, section 62K.07.
18.21 	(b) $....... is appropriated from the general fund to the
18.22 	commissioner of health for the fiscal year ending June 30, 2006,
18.23 	to provide staffing for the regional boards.

18.24 	Sec. 16. REPEALER.
 18.25 	Minnesota Statutes 2004, section 62J.212, is repealed.

18.26 	Sec. 17. EFFECTIVE DATE.
 18.27 	Sections 1 to 11 are effective January 1, 2006.