1.1 	A bill for an act
1.2 	relating to health care; modifying premium rate
1.3 	restrictions; establishing expenditure limits;
1.4 	modifying cost containment provisions; providing for
1.5 	an electronic medical record system; modifying certain
1.6 	loan forgiveness programs; modifying medical
1.7 	assistance, general assistance medical care, and
1.8 	MinnesotaCare programs; authorizing the sale of bonds;
1.9 	requiring reports; appropriating money; amending
1.10 	Minnesota Statutes 2004, sections 62A.65, subdivision
1.11 	3; 62J.04, subdivision 3, by adding a subdivision;
1.12 	62J.041; 62J.301, subdivision 3; 62J.38; 62J.43;
1.13 	62J.692, subdivision 3; 62L.08, subdivision 8;
1.14 	144.1501, subdivisions 2, 4; 256.955, subdivisions 2a,
1.15 	2b, 3, 4, 6; 256.9693; 256B.03, subdivision 3;
1.16 	256B.061; 256B.0625, subdivisions 3b, 9, 13e, by
1.17 	adding a subdivision; 256B.0631, by adding a
1.18 	subdivision; 256B.075, subdivisions 1, 2, 3; 256D.03,
1.19 	subdivisions 3, 4; 256L.03, subdivision 1; 256L.05,
1.20 	subdivision 4; 256L.07, subdivision 1; 256L.12,
1.21 	subdivision 6; Laws 2003, First Special Session
1.22 	chapter 14, article 6, section 65; proposing coding
1.23 	for new law in Minnesota Statutes, chapters 62J; 62Q;
1.24 	256; 256B; 256L; repealing Minnesota Statutes 2004,
1.25 	sections 256.955, subdivision 4a; 256B.075,
1.26 	subdivision 5; 256L.035.
1.27 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.28 	Section 1. Minnesota Statutes 2004, section 62A.65,
1.29 	subdivision 3, is amended to read:
1.30 		Subd. 3.Premium rate restrictions.  No individual health
1.31 	plan may be offered, sold, issued, or renewed to a Minnesota
1.32 	resident unless the premium rate charged is determined in
1.33 	accordance with the following requirements:
1.34 	(a) Premium rates must be no more than 25 percent above and
1.35 	no more than 25 percent below the index rate charged to
1.36 	individuals for the same or similar coverage, adjusted pro rata
2.1 	for rating periods of less than one year.  The premium
2.2 	variations permitted by this paragraph must be based only upon
2.3 	health status, claims experience, and occupation.  For purposes
2.4 	of this paragraph, health status includes refraining from
2.5 	tobacco use or other actuarially valid lifestyle factors
2.6 	associated with good health, provided that the lifestyle factor
2.7 	and its effect upon premium rates have been determined by the
2.8 	commissioner to be actuarially valid and have been approved by
2.9 	the commissioner.  Variations permitted under this paragraph
2.10 	must not be based upon age or applied differently at different
2.11 	ages.  This paragraph does not prohibit use of a constant
2.12 	percentage adjustment for factors permitted to be used under
2.13 	this paragraph.
2.14 	(b) Premium rates may vary based upon the ages of covered
2.15 	persons only as provided in this paragraph.  In addition to the
2.16 	variation permitted under paragraph (a), each health carrier may
2.17 	use an additional premium variation based upon age of up to plus
2.18 	or minus 50 percent of the index rate.
2.19 	(c) A health carrier may request approval by the
2.20 	commissioner to establish no more than three geographic regions
2.21 	and to establish separate index rates for each region, provided
2.22 	that the index rates do not vary between any two regions by more
2.23 	than 20 percent.  Health carriers that do not do business in the
2.24 	Minneapolis/St. Paul metropolitan area may request approval for
2.25 	no more than two geographic regions, and clauses (2) and (3) do
2.26 	not apply to approval of requests made by those health
2.27 	carriers.  The commissioner may grant approval if the following
2.28 	conditions are met:
2.29 	(1) the geographic regions must be applied uniformly by the
2.30 	health carrier;
2.31 	(2) one geographic region must be based on the
2.32 	Minneapolis/St. Paul metropolitan area;
2.33 	(3) for each geographic region that is rural, the index
2.34 	rate for that region must not exceed the index rate for the
2.35 	Minneapolis/St. Paul metropolitan area; and
2.36 	(4) the health carrier provides actuarial justification
3.1 	acceptable to the commissioner for the proposed geographic
3.2 	variations in index rates, establishing that the variations are
3.3 	based upon differences in the cost to the health carrier of
3.4 	providing coverage.
3.5 	(d) Health carriers may use rate cells and must file with
3.6 	the commissioner the rate cells they use.  Rate cells must be
3.7 	based upon the number of adults or children covered under the
3.8 	policy and may reflect the availability of Medicare coverage.
3.9 	The rates for different rate cells must not in any way reflect
3.10 	generalized differences in expected costs between principal
3.11 	insureds and their spouses.
3.12 	(e) In developing its index rates and premiums for a health
3.13 	plan, a health carrier shall take into account only the
3.14 	following factors:
3.15 	(1) actuarially valid differences in rating factors
3.16 	permitted under paragraphs (a) and (b); and
3.17 	(2) actuarially valid geographic variations if approved by
3.18 	the commissioner as provided in paragraph (c).
3.19 	(f) All premium variations must be justified in initial
3.20 	rate filings and upon request of the commissioner in rate
3.21 	revision filings.  All rate variations are subject to approval
3.22 	by the commissioner.
3.23 	(g) The loss ratio must comply with the section 62A.021
3.24 	requirements for individual health plans.
3.25 	(h) Notwithstanding paragraphs (a) to (g),the rates must
3.26 	not be approved,unless the commissioner has determined that the
3.27 	rates are reasonable.  In determining reasonableness, the
3.28 	commissioner shall consider the growth rates applied under
3.29 	section 62J.04, subdivision 1, paragraph (b) apply the premium
3.30 	growth limits established under section 62J.04, subdivision 1b,
3.31 	to the calendar year or years that the proposed premium rate
3.32 	would be in effect, and shall consider actuarially valid changes
3.33 	in risks associated with the enrollee populations,and
3.34 	actuarially valid changes as a result of statutory changes in
3.35 	Laws 1992, chapter 549.

3.36 	Sec. 2. Minnesota Statutes 2004, section 62J.04, is
4.1 	amended by adding a subdivision to read:
4.2 		Subd. 1b.Premium growth limits. (a) For calendar year
4.3 	2005 and each year thereafter, the commissioner shall set annual
4.4 	premium growth limits for health plan companies.  The premium
4.5 	limits set by the commissioner for calendar years 2005 to 2010
4.6 	shall not exceed the regional Consumer Price Index for urban
4.7 	consumers for the preceding calendar year plus two percentage
4.8 	points and an additional one percentage point to be used to
4.9 	finance the implementation of the electronic medical record
4.10 	system described under section 62J.565.  The commissioner shall
4.11 	ensure that the additional percentage point is being used to
4.12 	provide financial assistance to health care providers to
4.13 	implement electronic medical record systems either directly or
4.14 	through an increase in reimbursement.
4.15 	(b) For the calendar years beyond 2010, the rate of premium
4.16 	growth shall be limited to the change in the Consumer Price
4.17 	Index for urban consumers for the previous calendar year plus
4.18 	two percentage points.  The commissioners of health and commerce
4.19 	shall make a recommendation to the legislature by January 15,
4.20 	2009, regarding the continuation of the additional percentage
4.21 	point to the growth limit described in paragraph (a).  The
4.22 	recommendation shall be based on the progress made by health
4.23 	care providers in instituting an electronic medical record
4.24 	system and in creating a statewide interactive electronic health
4.25 	record system.
4.26 	(c) The commissioner may add additional percentage points
4.27 	as needed to the premium limit for a calendar year if a major
4.28 	disaster, bioterrorism, or a public health emergency occurs that
4.29 	results in higher health care costs.  Any additional percentage
4.30 	points must reflect the additional cost to the health care
4.31 	system directly attributed to the disaster or emergency.
4.32 	(d) The commissioner shall publish the annual premium
4.33 	growth limits in the State Register by January 31 of the year
4.34 	that the limits are to be in effect.
4.35 	(e) For the purpose of this subdivision, premium growth is
4.36 	measured as the percentage change in per member, per month
5.1 	premium revenue from the current year to the previous year.
5.2 	Premium growth rates shall be calculated for the following lines
5.3 	of business:  individual, small group, and large group.  Data
5.4 	used for premium growth rate calculations shall be submitted as
5.5 	part of the cost containment filing under section 62J.38.
5.6 	(f) For purposes of this subdivision, "health plan
5.7 	company," has the meaning given in section 62J.041.
5.8 	(g) For coverage that is provided by a health plan company
5.9 	under the terms of a contract with the Department of Employee
5.10 	Relations, the commissioner of employee relations shall direct
5.11 	the contracting health plan companies to reduce reimbursement to
5.12 	providers in order to meet the premium growth limitations
5.13 	required by this section.

5.14 	Sec. 3. Minnesota Statutes 2004, section 62J.04,
5.15 	subdivision 3, is amended to read:
5.16 		Subd. 3.Cost containment duties.  The commissioner shall:
5.17 	(1) establish statewide and regional cost containment goals
5.18 	for total health care spending under this section and collect
5.19 	data as described in sections 62J.38 to 62J.41 to monitor
5.20 	statewide achievement of the cost containment goals and premium
5.21 	growth limits;
5.22 	(2) divide the state into no fewer than four regions, with
5.23 	one of those regions being the Minneapolis/St. Paul metropolitan
5.24 	statistical area but excluding Chisago, Isanti, Wright, and
5.25 	Sherburne Counties, for purposes of fostering the development of
5.26 	regional health planning and coordination of health care
5.27 	delivery among regional health care systems and working to
5.28 	achieve the cost containment goals;
5.29 	(3) monitor the quality of health care throughout the state
5.30 	and take action as necessary to ensure an appropriate level of
5.31 	quality;
5.32 	(4) issue recommendations regarding uniform billing forms,
5.33 	uniform electronic billing procedures and data interchanges,
5.34 	patient identification cards, and other uniform claims and
5.35 	administrative procedures for health care providers and private
5.36 	and public sector payers.  In developing the recommendations,
6.1 	the commissioner shall review the work of the work group on
6.2 	electronic data interchange (WEDI) and the American National
6.3 	Standards Institute (ANSI) at the national level, and the work
6.4 	being done at the state and local level.  The commissioner may
6.5 	adopt rules requiring the use of the Uniform Bill 82/92 form,
6.6 	the National Council of Prescription Drug Providers (NCPDP) 3.2
6.7 	electronic version, the Centers for Medicare and Medicaid
6.8 	Services 1500 form, or other standardized forms or procedures;
6.9 	(5) undertake health planning responsibilities;
6.10 	(6) authorize, fund, or promote research and
6.11 	experimentation on new technologies and health care procedures;
6.12 	(7) within the limits of appropriations for these purposes,
6.13 	administer or contract for statewide consumer education and
6.14 	wellness programs that will improve the health of Minnesotans
6.15 	and increase individual responsibility relating to personal
6.16 	health and the delivery of health care services, undertake
6.17 	prevention programs including initiatives to improve birth
6.18 	outcomes, expand childhood immunization efforts, and provide
6.19 	start-up grants for worksite wellness programs;
6.20 	(8) undertake other activities to monitor and oversee the
6.21 	delivery of health care services in Minnesota with the goal of
6.22 	improving affordability, quality, and accessibility of health
6.23 	care for all Minnesotans; and
6.24 	(9) make the cost containment goal and premium growth limit 
6.25 	data available to the public in a consumer-oriented manner.

6.26 	Sec. 4. Minnesota Statutes 2004, section 62J.041, is
6.27 	amended to read:
6.28 	62J.041  INTERIM HEALTH PLAN COMPANY COST CONTAINMENT GOALS 
6.29 	HEALTH CARE EXPENDITURE LIMITS.
6.30 		Subdivision 1.Definitions. (a) For purposes of this
6.31 	section, the following definitions apply.
6.32 	(b) "Health plan company" has the definition provided in
6.33 	section 62Q.01and also includes employee health plans offered
6.34 	by self-insured employers.
6.35 	(c) " Total Health care expenditures" means incurred claims
6.36 	or expenditures on health care services, administrative
7.1 	expenses, charitable contributions, and all other payments made
7.2 	by health plan companies out of premium revenues.
7.3 	(d) "Net expenditures" means total expenditures minus
7.4 	exempted taxes and assessments and payments or allocations made
7.5 	to establish or maintain reserves.
7.6 	(e) "Exempted taxes and assessments" means direct payments
7.7 	for taxes to government agencies, contributions to the Minnesota
7.8 	Comprehensive Health Association, the medical assistance
7.9 	provider's surcharge under section 256.9657, the MinnesotaCare
7.10 	provider tax under section 295.52, assessments by the Health
7.11 	Coverage Reinsurance Association, assessments by the Minnesota
7.12 	Life and Health Insurance Guaranty Association, assessments by
7.13 	the Minnesota Risk Adjustment Association, and any new
7.14 	assessments imposed by federal or state law.
7.15 	(f) "Consumer cost-sharing or subscriber liability" means
7.16 	enrollee coinsurance, co-payment, deductible payments, and
7.17 	amounts in excess of benefit plan maximums.
7.18 		Subd. 2.Establishment. The commissioner of health shall
7.19 	establish cost containment goals health care expenditure limits 
7.20 	for the increase in net calendar year 2006, and each year
7.21 	thereafter, for health care expenditures by each health plan
7.22 	company for calendar years 1994, 1995, 1996, and 1997.  The cost
7.23 	containment goals must be the same as the annual cost
7.24 	containment goals for health care spending established under
7.25 	section 62J.04, subdivision 1, paragraph (b).  Health plan
7.26 	companies that are affiliates may elect to meet one
7.27 	combined cost containment goal health care expenditure limit.
7.28 	The limits set by the commissioner shall not exceed the premium
7.29 	limits established in section 62J.04, subdivision 1b.
7.30 		Subd. 3.Determination of expenditures. Health plan
7.31 	companies shall submit to the commissioner of health, by April
7.32 	1, 1994, for calendar year 1993; April 1, 1995, for calendar
7.33 	year 1994; April 1, 1996, for calendar year 1995; April 1, 1997,
7.34 	for calendar year 1996; and April 1, 1998, for calendar year
7.35 	1997 of each year beginning 2006,all information the
7.36 	commissioner determines to be necessary to implement this
8.1 	section.  The information must be submitted in the form
8.2 	specified by the commissioner.  The information must include,
8.3 	but is not limited to, health care expenditures per member per
8.4 	month or cost per employee per month, and detailed information
8.5 	on revenues and reserves.  The commissioner, to the extent
8.6 	possible, shall coordinate the submittal of the information
8.7 	required under this section with the submittal of the financial
8.8 	data required under chapter 62J, to minimize the administrative
8.9 	burden on health plan companies.  The commissioner may adjust
8.10 	final expenditure figures for demographic changes, risk
8.11 	selection, changes in basic benefits, and legislative
8.12 	initiatives that materially change health care costs, as long as
8.13 	these adjustments are consistent with the methodology submitted
8.14 	by the health plan company to the commissioner, and approved by
8.15 	the commissioner as actuarially justified. The methodology to
8.16 	be used for adjustments and the election to meet one cost
8.17 	containment goal for affiliated health plan companies must be
8.18 	submitted to the commissioner by September 1, 1994.  Community
8.19 	integrated service networks may submit the information with
8.20 	their application for licensure.  The commissioner shall also
8.21 	accept changes to methodologies already submitted.  The
8.22 	adjustment methodology submitted and approved by the
8.23 	commissioner must apply to the data submitted for calendar years
8.24 	1994 and 1995.  The commissioner may allow changes to accepted
8.25 	adjustment methodologies for data submitted for calendar years
8.26 	1996 and 1997.  Changes to the adjustment methodology must be
8.27 	received by September 1, 1996, and must be approved by the
8.28 	commissioner.
8.29 		Subd. 4.Monitoring of reserves. (a) The commissioners
8.30 	of health and commerce shall monitor health plan company
8.31 	reserves and net worth as established under chapters 60A, 62C,
8.32 	62D, 62H, and 64B, with respect to the health plan companies
8.33 	that each commissioner respectively regulates to assess the
8.34 	degree to which savings resulting from the establishment of cost
8.35 	containment goals are passed on to consumers in the form of
8.36 	lower premium rates.
9.1 	(b) Health plan companies shall fully reflect in the
9.2 	premium rates the savings generated by the cost containment
9.3 	goals.  No premium rate, currently reviewed by the Department of
9.4 	Health or Commerce, may be approved for those health plan
9.5 	companies unless the health plan company establishes to the
9.6 	satisfaction of the commissioner of commerce or the commissioner
9.7 	of health, as appropriate, that the proposed new rate would
9.8 	comply with this paragraph.
9.9 	(c) Health plan companies, except those licensed under
9.10 	chapter 60A to sell accident and sickness insurance under
9.11 	chapter 62A, shall annually before the end of the fourth fiscal
9.12 	quarter provide to the commissioner of health or commerce, as
9.13 	applicable, a projection of the level of reserves the company
9.14 	expects to attain during each quarter of the following fiscal
9.15 	year.  These health plan companies shall submit with required
9.16 	quarterly financial statements a calculation of the actual
9.17 	reserve level attained by the company at the end of each quarter
9.18 	including identification of the sources of any significant
9.19 	changes in the reserve level and an updated projection of the
9.20 	level of reserves the health plan company expects to attain by
9.21 	the end of the fiscal year.  In cases where the health plan
9.22 	company has been given a certificate to operate a new health
9.23 	maintenance organization under chapter 62D, or been licensed as
9.24 	a community integrated service network under chapter 62N, or
9.25 	formed an affiliation with one of these organizations, the
9.26 	health plan company shall also submit with its quarterly
9.27 	financial statement, total enrollment at the beginning and end
9.28 	of the quarter and enrollment changes within each service area
9.29 	of the new organization.  The reserve calculations shall be
9.30 	maintained by the commissioners as trade secret information,
9.31 	except to the extent that such information is also required to
9.32 	be filed by another provision of state law and is not treated as
9.33 	trade secret information under such other provisions.
9.34 	(d) Health plan companies in paragraph (c) whose reserves
9.35 	are less than the required minimum or more than the required
9.36 	maximum at the end of the fiscal year shall submit a plan of
10.1 	corrective action to the commissioner of health or commerce
10.2 	under subdivision 7.
10.3 	(e) The commissioner of commerce, in consultation with the
10.4 	commissioner of health, shall report to the legislature no later
10.5 	than January 15, 1995, as to whether the concept of a reserve
10.6 	corridor or other mechanism for purposes of monitoring reserves
10.7 	is adaptable for use with indemnity health insurers that do
10.8 	business in multiple states and that must comply with their
10.9 	domiciliary state's reserves requirements.
10.10 		Subd. 5.Notice. The commissioner of health shall
10.11 	publish in the State Register and make available to the public
10.12 	by July 1, 1995 2007, and each year thereafter,a list of all
10.13 	health plan companies that exceeded their cost containment goal 
10.14 	health care expenditure limit for the 1994 previous calendar
10.15 	year. The commissioner shall publish in the State Register and
10.16 	make available to the public by July 1, 1996, a list of all
10.17 	health plan companies that exceeded their combined cost
10.18 	containment goal for calendar years 1994 and 1995.The
10.19 	commissioner shall notify each health plan company that the
10.20 	commissioner has determined that the health plan company
10.21 	exceeded its cost containment goal,health care expenditure
10.22 	limit at least 30 days before publishing the list, and shall
10.23 	provide each health plan company with ten days to provide an
10.24 	explanation for exceeding the cost containment goal health care
10.25 	expenditure limit.  The commissioner shall review the
10.26 	explanation and may change a determination if the commissioner
10.27 	determines the explanation to be valid.
10.28 		Subd. 6.Assistance by the commissioner of commerce. The
10.29 	commissioner of commerce shall provide assistance to the
10.30 	commissioner of health in monitoring health plan companies
10.31 	regulated by the commissioner of commerce.

10.32 	Sec. 5. [62J.255] HEALTH RISK INFORMATION SHEET.
10.33 	(a) A health plan company shall provide to each enrollee on
10.34 	an annual basis information on the increased personal health
10.35 	risks and the additional costs to the health care system due to
10.36 	obesity and to the use of tobacco.
11.1 	(b) The commissioner, in consultation with the Minnesota
11.2 	Medical Association, shall develop an information sheet on the
11.3 	personal health risks of obesity and smoking and on the
11.4 	additional costs to the health care system due to obesity and
11.5 	due to smoking.  The information sheet shall be posted on the
11.6 	Minnesota Department of Health's Web site.
11.7 	(c) When providing the information required in paragraph
11.8 	(a), the health plan company must also provide each enrollee
11.9 	with information on the best practices care guidelines and
11.10 	quality of care measurement criteria identified in section
11.11 	62J.43 as well as the availability of this information on the
11.12 	department's Web site.

11.13 	Sec. 6. Minnesota Statutes 2004, section 62J.301,
11.14 	subdivision 3, is amended to read:
11.15 		Subd. 3.General duties.  The commissioner shall:
11.16 	(1) collect and maintain data which enable population-based
11.17 	monitoring and trending of the access, utilization, quality, and
11.18 	cost of health care services within Minnesota;
11.19 	(2) collect and maintain data for the purpose of estimating
11.20 	total Minnesota health care expenditures and trends;
11.21 	(3) collect and maintain data for the purposes of setting
11.22 	cost containment goals and premium growth limits under section
11.23 	62J.04, and measuring cost containment goal and premium growth
11.24 	limit compliance;
11.25 	(4) conduct applied research using existing and new data
11.26 	and promote applications based on existing research;
11.27 	(5) develop and implement data collection procedures to
11.28 	ensure a high level of cooperation from health care providers
11.29 	and health plan companies, as defined in section 62Q.01,
11.30 	subdivision 4;
11.31 	(6) work closely with health plan companies and health care
11.32 	providers to promote improvements in health care efficiency and
11.33 	effectiveness; and
11.34 	(7) participate as a partner or sponsor of private sector
11.35 	initiatives that promote publicly disseminated applied research
11.36 	on health care delivery, outcomes, costs, quality, and
12.1 	management.

12.2 	Sec. 7. Minnesota Statutes 2004, section 62J.38, is
12.3 	amended to read:
12.4 	62J.38 COST CONTAINMENT DATA FROM GROUP PURCHASERS.
12.5 	(a) The commissioner shall require group purchasers to
12.6 	submit detailed data on total health care spending for each
12.7 	calendar year.  Group purchasers shall submit data for the 1993
12.8 	calendar year by April 1, 1994, and each April 1 thereafter
12.9 	shall submit data for the preceding calendar year.
12.10 	(b) The commissioner shall require each group purchaser to
12.11 	submit data on revenue, expenses, and member months, as
12.12 	applicable.  Revenue data must distinguish between premium
12.13 	revenue and revenue from other sources and must also include
12.14 	information on the amount of revenue in reserves and changes in
12.15 	reserves. Premium revenue data, information on aggregate
12.16 	enrollment, and data on member months must be broken down to
12.17 	distinguish between individual market, small group market, and
12.18 	large group market.  Filings under this section for calendar
12.19 	year 2005 must also include information broken down by
12.20 	individual market, small group market, and large group market
12.21 	for calendar year 2004.Expenditure data must distinguish
12.22 	between costs incurred for patient care and administrative
12.23 	costs.  Patient care and administrative costs must include only
12.24 	expenses incurred on behalf of health plan members and must not
12.25 	include the cost of providing health care services for
12.26 	nonmembers at facilities owned by the group purchaser or
12.27 	affiliate.  Expenditure data must be provided separately for the
12.28 	following categories and for other categories required by the
12.29 	commissioner:  physician services, dental services, other
12.30 	professional services, inpatient hospital services, outpatient
12.31 	hospital services, emergency, pharmacy services and other
12.32 	nondurable medical goods, mental health, and chemical dependency
12.33 	services, other expenditures, subscriber liability, and
12.34 	administrative costs.  Administrative costs must include costs
12.35 	for marketing; advertising; overhead; salaries and benefits of
12.36 	central office staff who do not provide direct patient care;
13.1 	underwriting; lobbying; claims processing; provider contracting
13.2 	and credentialing; detection and prevention of payment for
13.3 	fraudulent or unjustified requests for reimbursement or
13.4 	services; clinical quality assurance and other types of medical
13.5 	care quality improvement efforts; concurrent or prospective
13.6 	utilization review as defined in section 62M.02; costs incurred
13.7 	to acquire a hospital, clinic, or health care facility, or the
13.8 	assets thereof; capital costs incurred on behalf of a hospital
13.9 	or clinic; lease payments; or any other costs incurred pursuant
13.10 	to a partnership, joint venture, integration, or affiliation
13.11 	agreement with a hospital, clinic, or other health care
13.12 	provider.  Capital costs and costs incurred must be recorded
13.13 	according to standard accounting principles.  The reports of
13.14 	this data must also separately identify expenses for local,
13.15 	state, and federal taxes, fees, and assessments.  The
13.16 	commissioner may require each group purchaser to submit any
13.17 	other data, including data in unaggregated form, for the
13.18 	purposes of developing spending estimates, setting spending
13.19 	limits, and monitoring actual spending and costs.  In addition
13.20 	to reporting administrative costs incurred to acquire a
13.21 	hospital, clinic, or health care facility, or the assets
13.22 	thereof; or any other costs incurred pursuant to a partnership,
13.23 	joint venture, integration, or affiliation agreement with a
13.24 	hospital, clinic, or other health care provider; reports
13.25 	submitted under this section also must include the payments made
13.26 	during the calendar year for these purposes.  The commissioner
13.27 	shall make public, by group purchaser data collected under this
13.28 	paragraph in accordance with section 62J.321, subdivision 5.
13.29 	Workers' compensation insurance plans and automobile insurance
13.30 	plans are exempt from complying with this paragraph as it
13.31 	relates to the submission of administrative costs.
13.32 	(c) The commissioner may collect information on:
13.33 	(1) premiums, benefit levels, managed care procedures, and
13.34 	other features of health plan companies;
13.35 	(2) prices, provider experience, and other information for
13.36 	services less commonly covered by insurance or for which
14.1 	patients commonly face significant out-of-pocket expenses; and
14.2 	(3) information on health care services not provided
14.3 	through health plan companies, including information on prices,
14.4 	costs, expenditures, and utilization.
14.5 	(d) All group purchasers shall provide the required data
14.6 	using a uniform format and uniform definitions, as prescribed by
14.7 	the commissioner.

14.8 	Sec. 8. Minnesota Statutes 2004, section 62J.43, is
14.9 	amended to read:
14.10 	62J.43 BEST PRACTICES AND QUALITY IMPROVEMENT.
14.11 	(a) To improve quality and reduce health care costs, state
14.12 	agencies shall encourage the adoption of best practice
14.13 	guidelines and participation in best practices measurement
14.14 	activities by physicians, other health care providers, and
14.15 	health plan companies.  The commissioner of health shall
14.16 	facilitate access to best practice guidelines and quality of
14.17 	care measurement information to providers, purchasers, and
14.18 	consumers by:
14.19 	(1) identifying and promoting local community-based,
14.20 	physician-designed best practices care across the Minnesota
14.21 	health care system;
14.22 	(2) disseminating information available to the commissioner
14.23 	on adherence to best practices care by physicians and other
14.24 	health care providers in Minnesota;
14.25 	(3) educating consumers and purchasers on how to
14.26 	effectively use this information in choosing their providers and
14.27 	in making purchasing decisions; and
14.28 	(4) making best practices and quality care measurement
14.29 	information available to enrollees and program participants
14.30 	through the Department of Health's Web site.  The commissioner
14.31 	may convene an advisory committee to ensure that the Web site is
14.32 	designed to provide user friendly and easy accessibility.
14.33 	(b) The commissioner of health shall collaborate with a
14.34 	nonprofit Minnesota quality improvement organization
14.35 	specializing in best practices and quality of care measurements
14.36 	to provide best practices criteria and assist in the collection
15.1 	of the data.
15.2 	(c) The initial best practices and quality of care
15.3 	measurement criteria developed shall include asthma, diabetes,
15.4 	and at least two other preventive health measures.  Hypertension
15.5 	and coronary artery disease shall be included within one year
15.6 	following availability.
15.7 	(d) The commissioners of human services and employee
15.8 	relations may shall use the data to make decisions about
15.9 	contracts they enter into with health plan companies and shall
15.10 	establish payment withholds based on best practices and quality
15.11 	of care measurements as part of the contracts in effect January
15.12 	1, 2007.  The health plan companies may pass the withholds
15.13 	through to physicians and other health care providers if the
15.14 	physician or health care provider fails to follow the best
15.15 	practices and quality of care measurement criteria identified in
15.16 	this section.  The withholds established by the commissioner of
15.17 	human services shall be included with the withholds described in
15.18 	sections 256B.69, subdivision 5a, and 256L.12, subdivision 9.
15.19 	If a payment withhold is passed through, a provider may not
15.20 	terminate an existing contract with a health plan company based
15.21 	solely on this withhold.
15.22 	(e) This section does not apply if the best practices
15.23 	guidelines authorize or recommend denial of treatment, food, or
15.24 	fluids necessary to sustain life on the basis of the patient's
15.25 	age or expected length of life or the patient's present or
15.26 	predicted disability, degree of medical dependency, or quality
15.27 	of life.
15.28 	(f) The commissioner of health, human services, and
15.29 	employee relations shall report to the legislature by January
15.30 	15, 2005, on the status of best practices and quality of care
15.31 	initiatives, and shall present recommendations to the
15.32 	legislature on any statutory changes needed to increase the
15.33 	effectiveness of these initiatives.
15.34 	(g) This section expires June 30, 2006.

15.35 	Sec. 9. [62J.565] IMPLEMENTATION OF ELECTRONIC MEDICAL
15.36 	RECORD SYSTEM.
16.1 	(a) By January 1, 2010, all hospitals and health care
16.2 	providers must have in place an electronic medical record system
16.3 	within their hospital system or clinical practice setting.  The
16.4 	commissioner may grant exemptions from this requirement if the
16.5 	commissioner determines that the cost of compliance would place
16.6 	the provider in financial distress or if the commissioner
16.7 	determines that appropriate technology is not available or
16.8 	advantageous to that type of practice.  Before an exemption is
16.9 	granted for financial reasons, the commissioner must ensure that
16.10 	the provider has explored all possible alliances or partnerships
16.11 	with other provider groups in the provider's geographical area
16.12 	to become part of the larger provider group's system.
16.13 	(b) The commissioner shall provide assistance to hospitals
16.14 	and provider groups in establishing an electronic medical record
16.15 	system, including, but not limited to, provider education,
16.16 	facilitation of possible alliances or partnerships among
16.17 	provider groups for purposes of implementing a system,
16.18 	identification or establishment of low-interest financing
16.19 	options for hardware and software, and systems implementation
16.20 	support.
16.21 	(c) The commissioner of human services shall convene an
16.22 	advisory committee with representatives of safety-net hospitals,
16.23 	community health clinics, and other providers who serve
16.24 	low-income patients to address their specific needs and concerns
16.25 	regarding the establishment of an electronic medical record
16.26 	system within their hospital or practice setting.  As part of
16.27 	addressing the specific needs of these providers, the
16.28 	commissioner shall explore the implementation of an accessible
16.29 	interactive system created collaboratively by publicly owned
16.30 	hospitals and clinics.  The commissioner shall also explore
16.31 	financial assistance options, including bonding and federal
16.32 	grants.

16.33 	Sec. 10. Minnesota Statutes 2004, section 62J.692,
16.34 	subdivision 3, is amended to read:
16.35 		Subd. 3.Application process.  (a) A clinical medical
16.36 	education program conducted in Minnesota by a teaching
17.1 	institution to train physicians, doctor of pharmacy
17.2 	practitioners, dentists, chiropractors, or physician assistants
17.3 	is eligible for funds under subdivision 4 if the program:
17.4 	(1) is funded, in part, by patient care revenues;
17.5 	(2) occurs in patient care settings that face increased
17.6 	financial pressure as a result of competition with nonteaching
17.7 	patient care entities; and
17.8 	(3) emphasizes primary care or specialties that are in
17.9 	undersupply in Minnesota.
17.10 	A clinical medical education program that trains
17.11 	pediatricians is requested to include in its program curriculum
17.12 	training in case management and medication management for
17.13 	children suffering from mental illness to be eligible for funds
17.14 	under subdivision 4.
17.15 	(b) A clinical medical education program for advanced
17.16 	practice nursing is eligible for funds under subdivision 4 if
17.17 	the program meets the eligibility requirements in paragraph (a),
17.18 	clauses (1) to (3), and is sponsored by the University of
17.19 	Minnesota Academic Health Center, the Mayo Foundation, or
17.20 	institutions that are part of the Minnesota State Colleges and
17.21 	Universities system or members of the Minnesota Private College
17.22 	Council.
17.23 	(c) Applications must be submitted to the commissioner by a
17.24 	sponsoring institution on behalf of an eligible clinical medical
17.25 	education program and must be received by October 31 of each
17.26 	year for distribution in the following year.  An application for
17.27 	funds must contain the following information:
17.28 	(1) the official name and address of the sponsoring
17.29 	institution and the official name and site address of the
17.30 	clinical medical education programs on whose behalf the
17.31 	sponsoring institution is applying;
17.32 	(2) the name, title, and business address of those persons
17.33 	responsible for administering the funds;
17.34 	(3) for each clinical medical education program for which
17.35 	funds are being sought; the type and specialty orientation of
17.36 	trainees in the program; the name, site address, and medical
18.1 	assistance provider number of each training site used in the
18.2 	program; the total number of trainees at each training site; and
18.3 	the total number of eligible trainee FTEs at each site.  Only
18.4 	those training sites that host 0.5 FTE or more eligible trainees
18.5 	for a program may be included in the program's application; and
18.6 	(4) other supporting information the commissioner deems
18.7 	necessary to determine program eligibility based on the criteria
18.8 	in paragraphs (a) and (b) and to ensure the equitable
18.9 	distribution of funds.
18.10 	(d) An application must include the information specified
18.11 	in clauses (1) to (3) for each clinical medical education
18.12 	program on an annual basis for three consecutive years.  After
18.13 	that time, an application must include the information specified
18.14 	in clauses (1) to (3) in the first year of each biennium:
18.15 	(1) audited clinical training costs per trainee for each
18.16 	clinical medical education program when available or estimates
18.17 	of clinical training costs based on audited financial data;
18.18 	(2) a description of current sources of funding for
18.19 	clinical medical education costs, including a description and
18.20 	dollar amount of all state and federal financial support,
18.21 	including Medicare direct and indirect payments; and
18.22 	(3) other revenue received for the purposes of clinical
18.23 	training.
18.24 	(e) An applicant that does not provide information
18.25 	requested by the commissioner shall not be eligible for funds
18.26 	for the current funding cycle.

18.27 	Sec. 11. [62J.82] ELECTRONIC MEDICAL RECORD SYSTEM LOAN
18.28 	PROGRAM.
18.29 		Subdivision 1.Establishment. The commissioner shall
18.30 	establish and implement a loan program to help physicians or
18.31 	physician group practices obtain the necessary finances to
18.32 	install an electronic medical record system.
18.33 		Subd. 2.Rules. The commissioner may adopt rules to
18.34 	administer the loan program.
18.35 		Subd. 3.Eligibility. To be eligible for a loan under
18.36 	this section, the borrower must:
19.1 	(1) have a signed contract with a vendor;
19.2 	(2) be a physician licensed in this state or a physician
19.3 	group practice located in this state;
19.4 	(3) provide evidence of financial stability;
19.5 	(4) demonstrate an ability to repay the loan;
19.6 	(5) demonstrate that the borrower has explored possible
19.7 	alliances or contractual opportunities with other provider
19.8 	groups located in the same geographical area to become part of
19.9 	the larger provider group's system; and 
19.10 	(6) meet any other requirement the commissioner imposes by
19.11 	administrative procedure or by rule.
19.12 		Subd. 4.Loans. (a) The commissioner may make a direct
19.13 	loan to a provider or provider group who is eligible under
19.14 	subdivision 3.  The total accumulative loan principal must not
19.15 	exceed $65,000 per loan.
19.16 	(b) The commissioner may prescribe forms and establish an
19.17 	application process and, notwithstanding section 16A.1283, may
19.18 	impose a reasonable nonrefundable application fee to cover the
19.19 	cost of administering the loan program.
19.20 	(c) Loan principal balance outstanding plus all assessed
19.21 	interest must be repaid no later than 15 years from the date of
19.22 	the loan.

19.23 	Sec. 12. [62J.83] ELECTRONIC MEDICAL RECORD SYSTEM LOAN
19.24 	FUND.
19.25 		Subdivision 1.Creation. The electronic medical record
19.26 	system loan fund is established as a special account in the
19.27 	state treasury.  All application fees, loan repayments, and
19.28 	other revenue received under section 62J.82 must be credited to
19.29 	the fund.
19.30 		Subd. 2.Bond proceeds account. An electronic medical
19.31 	record system revenue bond proceeds account is established in
19.32 	the electronic medical record system loan fund.  The proceeds of
19.33 	any bonds issued under section 62J.84 must be credited to the
19.34 	account.  Money in the account is appropriated to the
19.35 	commissioner to make loans under section 62J.82.
19.36 		Subd. 3.Debt service account. An electronic medical
20.1 	record system revenue bond debt service account is established
20.2 	in the electronic medical record system loan fund.  There must
20.3 	be credited to this debt service account in each fiscal year
20.4 	from the income to the electronic medical record system loan
20.5 	fund an amount sufficient to increase the balance on hand in the
20.6 	debt service account on each December 1 to an amount equal to
20.7 	the full amount of principal and interest to come due on all
20.8 	outstanding bonds issued under section 62J.84 to and including
20.9 	the second following July 1.  The assets of the account are
20.10 	pledged to and may only be used to pay principal and interest on
20.11 	bonds issued under section 62J.84.  Money in the debt service
20.12 	account is appropriated to the commissioner of finance to pay
20.13 	principal and interest on bonds issued under section 62J.84.
20.14 		Subd. 4.Appropriation. Money in the electronic medical
20.15 	record system loan fund not otherwise appropriated is
20.16 	appropriated to the commissioner to administer the loan program.

20.17 	Sec. 13. [62J.84] ELECTRONIC MEDICAL RECORD SYSTEM
20.18 	REVENUE BONDS.
20.19 		Subdivision 1.Bonding authority. Upon request of the
20.20 	commissioner, the commissioner of finance may sell and issue
20.21 	state revenue bonds to make loans under section 62J.82, to
20.22 	establish a reserve fund or funds, and to pay the cost of
20.23 	issuance of the bonds.
20.24 		Subd. 2.Amount. The principal amount of the bonds
20.25 	issued for the purposes specified in subdivision 1 must not
20.26 	exceed $5,000,000.
20.27 		Subd. 3.Procedure. The commissioner may sell and issue
20.28 	the bonds on the terms and conditions the commissioner
20.29 	determines to be in the best interests of the state.  The bonds
20.30 	may be sold at public or private sale.  The commissioner may
20.31 	enter any agreements or pledges the commissioner determines
20.32 	necessary or useful to sell the bonds that are not inconsistent
20.33 	with sections 62J.82 to 62J.84.  Sections 16A.672 to 16A.675
20.34 	apply to the bonds.
20.35 		Subd. 4.Revenue sources. The bonds are payable only
20.36 	from the following sources:
21.1 	(1) loan repayments credited to the electronic medical
21.2 	record system loan fund;
21.3 	(2) the principal and any investment earnings on the assets
21.4 	of the debt service account; and 
21.5 	(3) other revenues pledged to the payment of the bonds.
21.6 		Subd. 5.Refunding bonds. The commissioner may issue
21.7 	bonds to refund outstanding bonds issued under subdivision 1,
21.8 	including the payment of any redemption premiums on the bonds
21.9 	and any interest accrued or to accrue to the first redemption
21.10 	date after delivery of the refunding bonds.  The proceeds of the
21.11 	refunding bonds may, in the discretion of the commissioner, be
21.12 	applied to the purchases or payment at maturity of the bonds to
21.13 	be refunded, or the redemption of the outstanding bonds on the
21.14 	first redemption date after delivery of the refunding bonds and
21.15 	may, until so used, be placed in escrow to be applied to the
21.16 	purchase, retirement, or redemption.  Refunding bonds issued
21.17 	under this subdivision must be issued and secured in the manner
21.18 	provided by the commissioner.
21.19 		Subd. 6.Not a general or moral obligation. Bonds issued
21.20 	under this section are not public debt, and the full faith,
21.21 	credit, and taxing powers of the state are not pledged for their
21.22 	payment.  The bonds may not be paid directly in whole or part
21.23 	from a tax of statewide application on any class of property,
21.24 	income, transaction, or privilege.  Payment of the bonds is
21.25 	limited to the revenues explicitly authorized to be pledged
21.26 	under this section.  The state neither makes nor has a moral
21.27 	obligation to pay the bonds if the pledged revenues and other
21.28 	legal security for them is insufficient.
21.29 		Subd. 7.Trustee. The commissioner may contract with and
21.30 	appoint a trustee for bondholders.  The trustee has the powers
21.31 	and authority vested in it by the commissioner under the bond
21.32 	and trust indentures.
21.33 		Subd. 8.Pledges. Any pledge made by the commissioner is
21.34 	valid and binding from the time the pledge is made.  The money
21.35 	or property pledged and later received by the commissioner is
21.36 	immediately subject to the lien of the pledge without any
22.1 	physical delivery of the property or money or further act, and
22.2 	the lien of any pledge is valid and binding as against all
22.3 	parties having claims of any kind in tort, contract, or
22.4 	otherwise against the commissioner, whether or not those parties
22.5 	have notice of the lien or pledge.  Neither the order nor any
22.6 	other instrument by which a pledge is created need be recorded.
22.7 		Subd. 9.Bonds; purchase and cancellation. The
22.8 	commissioner, subject to agreements with bondholders that may
22.9 	then exist, may, out of any money available for the purpose,
22.10 	purchase bonds of the commissioner at a price not exceeding:
22.11 	(1) if the bonds are then redeemable, the redemption price
22.12 	then applicable plus accrued interest to the next interest
22.13 	payment date thereon; or 
22.14 	(2) if the bonds are not redeemable, the redemption price
22.15 	applicable on the first date after the purchase upon which the
22.16 	bonds become subject to redemption plus accrued interest to that
22.17 	date.
22.18 		Subd. 10.State pledge against impairment of contracts.
 22.19 	The state pledges and agrees with the holders of any bonds that
22.20 	the state will not limit or alter the rights vested in the
22.21 	commissioner to fulfill the terms of any agreements made with
22.22 	the bondholders, or in any way impair the rights and remedies of
22.23 	the holders until the bonds, together with interest on them,
22.24 	with interest on any unpaid installments of interest, and all
22.25 	costs and expenses in connection with any action or proceeding
22.26 	by or on behalf of the bondholders, are fully met and
22.27 	discharged.  The commissioner may include this pledge and
22.28 	agreement of the state in any agreement with the holders of
22.29 	bonds issued under this section.

22.30 	Sec. 14. Minnesota Statutes 2004, section 62L.08,
22.31 	subdivision 8, is amended to read:
22.32 		Subd. 8.Filing requirement. (a) No later than July 1,
22.33 	1993, and each year thereafter, a health carrier that offers,
22.34 	sells, issues, or renews a health benefit plan for small
22.35 	employers shall file with the commissioner the index rates and
22.36 	must demonstrate that all rates shall be within the rating
23.1 	restrictions defined in this chapter.  Such demonstration must
23.2 	include the allowable range of rates from the index rates and a
23.3 	description of how the health carrier intends to use demographic
23.4 	factors including case characteristics in calculating the
23.5 	premium rates.
23.6 	(b) Notwithstanding paragraph (a),the rates shall not be
23.7 	approved,unless the commissioner has determined that the rates
23.8 	are reasonable.  In determining reasonableness, the commissioner
23.9 	shall consider the growth rates applied under section 62J.04,
23.10 	subdivision 1, paragraph (b) apply the premium growth limits
23.11 	established under section 62J.04, subdivision 1b, to the
23.12 	calendar year or years that the proposed premium rate would be
23.13 	in effect, and shall consider actuarially valid changes in risk
23.14 	associated with the enrollee population, and actuarially valid
23.15 	changes as a result of statutory changes in Laws 1992, chapter
23.16 	549. For premium rates proposed to go into effect between July
23.17 	1, 1993 and December 31, 1993, the pertinent growth rate is the
23.18 	growth rate applied under section 62J.04, subdivision 1,
23.19 	paragraph (b), to calendar year 1994.

23.20 	Sec. 15. [62Q.175] COVERAGE EXEMPTIONS.
23.21 	Notwithstanding any law to the contrary, no health plan
23.22 	company is required to provide coverage for any health care
23.23 	service included on the list established under section
23.24 	256B.0625, subdivision 46.

23.25 	Sec. 16. Minnesota Statutes 2004, section 144.1501,
23.26 	subdivision 2, is amended to read:
23.27 		Subd. 2.Creation of account. (a) A health professional
23.28 	education loan forgiveness program account is established.  The
23.29 	commissioner of health shall use money from the account to
23.30 	establish a loan forgiveness program:
23.31 	(1) for medical residents agreeing to practice in
23.32 	designated rural areas or underserved urban communities,or
23.33 	specializing in the area of pediatric psychiatry;
23.34 	(2) for midlevel practitioners agreeing to practice in
23.35 	designated rural areas,or to teach for at least 20 hours per
23.36 	week in the nursing field in a postsecondary program;and
24.1 	(3) for nurses who agree to practice in a Minnesota nursing
24.2 	home or intermediate care facility for persons with mental
24.3 	retardation or related conditions or to teach for at least 20
24.4 	hours per week in the nursing field in a postsecondary program;
24.5 	and 
24.6 	(4) for other health care technicians agreeing to teach for
24.7 	at least 20 hours per week in their designated field in a
24.8 	postsecondary program.  The commissioner, in consultation with
24.9 	the Healthcare Education-Industry Partnership, shall determine
24.10 	the health care fields where the need is the greatest,
24.11 	including, but not limited to, respiratory therapy, clinical
24.12 	laboratory technology, radiologic technology, and surgical
24.13 	technology.
24.14 	(b) Appropriations made to the account do not cancel and
24.15 	are available until expended, except that at the end of each
24.16 	biennium, any remaining balance in the account that is not
24.17 	committed by contract and not needed to fulfill existing
24.18 	commitments shall cancel to the fund.

24.19 	Sec. 17. Minnesota Statutes 2004, section 144.1501,
24.20 	subdivision 4, is amended to read:
24.21 		Subd. 4.Loan forgiveness.  The commissioner of health
24.22 	may select applicants each year for participation in the loan
24.23 	forgiveness program, within the limits of available funding. The
24.24 	commissioner shall distribute available funds for loan
24.25 	forgiveness proportionally among the eligible professions
24.26 	according to the vacancy rate for each profession in the
24.27 	required geographic area or ,facility type, or teaching area 
24.28 	specified in subdivision 2.  The commissioner shall allocate
24.29 	funds for physician loan forgiveness so that 75 50 percent of
24.30 	the funds available are used for rural physician loan
24.31 	forgiveness and ,25 percent of the funds available are used for
24.32 	underserved urban communities loan forgiveness, and 25 percent
24.33 	of the funds available are used for pediatric psychiatry loan
24.34 	forgiveness.  If the commissioner does not receive enough
24.35 	qualified applicants each year to use the entire allocation of
24.36 	funds for urban underserved communities, the remaining funds may
25.1 	be allocated for rural physician loan forgiveness.  Applicants
25.2 	are responsible for securing their own qualified educational
25.3 	loans.  The commissioner shall select participants based on
25.4 	their suitability for practice serving the required geographic
25.5 	area or ,facility type, or specialty area specified in
25.6 	subdivision 2, as indicated by experience or training.  The
25.7 	commissioner shall give preference to applicants closest to
25.8 	completing their training.  For each year that a participant
25.9 	meets the service obligation required under subdivision 3, up to
25.10 	a maximum of four years, the commissioner shall make annual
25.11 	disbursements directly to the participant equivalent to 15
25.12 	percent of the average educational debt for indebted graduates
25.13 	in their profession in the year closest to the applicant's
25.14 	selection for which information is available, not to exceed the
25.15 	balance of the participant's qualifying educational loans.
25.16 	Before receiving loan repayment disbursements and as requested,
25.17 	the participant must complete and return to the commissioner an
25.18 	affidavit of practice form provided by the commissioner
25.19 	verifying that the participant is practicing as required under
25.20 	subdivisions 2 and 3.  The participant must provide the
25.21 	commissioner with verification that the full amount of loan
25.22 	repayment disbursement received by the participant has been
25.23 	applied toward the designated loans.  After each disbursement,
25.24 	verification must be received by the commissioner and approved
25.25 	before the next loan repayment disbursement is made.
25.26 	Participants who move their practice remain eligible for loan
25.27 	repayment as long as they practice as required under subdivision
25.28 	2.

25.29 	Sec. 18. [256.9545] PRESCRIPTION DRUG DISCOUNT PROGRAM.
25.30 		Subdivision 1.Establishment; administration. The
25.31 	commissioner shall establish and administer the prescription
25.32 	drug discount program, effective July 1, 2005.
25.33 	Subd. 2.[COMMISSIONER'S AUTHORITY.] The commissioner
25.34 	shall administer a drug rebate program for drugs purchased
25.35 	according to the prescription drug discount program.  The
25.36 	commissioner shall require a rebate agreement from all
26.1 	manufacturers of covered drugs as defined in section 256B.0625,
26.2 	subdivision 13.  For each drug, the amount of the rebate shall
26.3 	be equal to the rebate as defined for purposes of the federal
26.4 	rebate program in United States Code, title 42, section
26.5 	1396r-8.  The rebate program shall utilize the terms and
26.6 	conditions used for the federal rebate program established
26.7 	according to section 1927 of title XIX of the federal Social
26.8 	Security Act.
26.9 		Subd. 3.Definitions. For the purpose of this section,
26.10 	the following terms have the meanings given them.
26.11 	(a) "Commissioner" means the commissioner of human services.
26.12 	(b) "Manufacturer" means a manufacturer as defined in
26.13 	section 151.44, paragraph (c).
26.14 	(c) "Covered prescription drug" means a prescription drug
26.15 	as defined in section 151.44, paragraph (d), that is covered
26.16 	under medical assistance as described in section 256B.0625,
26.17 	subdivision 13, and that is provided by a manufacturer that has
26.18 	a fully executed rebate agreement with the commissioner under
26.19 	this section and complies with that agreement.
26.20 	(d) "Health carrier" means an insurance company licensed
26.21 	under chapter 60A to offer, sell, or issue an individual or
26.22 	group policy of accident and sickness insurance as defined in
26.23 	section 62A.01; a nonprofit health service plan corporation
26.24 	operating under chapter 62C; a health maintenance organization
26.25 	operating under chapter 62D; a joint self-insurance employee
26.26 	health plan operating under chapter 62H; a community integrated
26.27 	systems network licensed under chapter 62N; a fraternal benefit
26.28 	society operating under chapter 64B; a city, county, school
26.29 	district, or other political subdivision providing self-insured
26.30 	health coverage under section 471.617 or sections 471.98 to
26.31 	471.982; and a self-funded health plan under the Employee
26.32 	Retirement Income Security Act of 1974, as amended.
26.33 	(e) "Participating pharmacy" means a pharmacy as defined in
26.34 	section 151.01, subdivision 2, that agrees to participate in the
26.35 	prescription drug discount program.
26.36 	(f) "Enrolled individual" means a person who is eligible
27.1 	for the program under subdivision 4 and has enrolled in the
27.2 	program according to subdivision 5.
27.3 		Subd. 4.Eligible persons. To be eligible for the
27.4 	program, an applicant must:
27.5 	(1) be a permanent resident of Minnesota as defined in
27.6 	section 256L.09, subdivision 4;
27.7 	(2) not be enrolled in Medicare, medical assistance,
27.8 	general assistance medical care, MinnesotaCare, or the
27.9 	prescription drug program under section 256.955;
27.10 	(3) not be enrolled in and have currently available
27.11 	prescription drug coverage under a health plan offered by a
27.12 	health carrier or employer or under a pharmacy benefit program
27.13 	offered by a pharmaceutical manufacturer; and 
27.14 	(4) not be enrolled in and have currently available
27.15 	prescription drug coverage under a Medicare supplement plan, as
27.16 	defined in sections 62A.31 to 62A.44, or policies, contracts, or
27.17 	certificates that supplement Medicare issued by health
27.18 	maintenance organizations or those policies, contracts, or
27.19 	certificates governed by section 1833 or 1876 of the federal
27.20 	Social Security Act, United States Code, title 42, section 1395,
27.21 	et seq., as amended.
27.22 		Subd. 5.Application procedure. (a) Applications and
27.23 	information on the program must be made available at county
27.24 	social services agencies, health care provider offices, and
27.25 	agencies and organizations serving senior citizens.  Individuals
27.26 	shall submit applications and any information specified by the
27.27 	commissioner as being necessary to verify eligibility directly
27.28 	to the commissioner.  The commissioner shall determine an
27.29 	applicant's eligibility for the program within 30 days from the
27.30 	date the application is received.  Upon notice of approval, the
27.31 	applicant must submit to the commissioner the enrollment fee
27.32 	specified in subdivision 10.  Eligibility begins the month after
27.33 	the enrollment fee is received by the commissioner.
27.34 	(b) An enrollee's eligibility must be renewed every 12
27.35 	months with the 12-month period beginning in the month after the
27.36 	application is approved.
28.1 	(c) The commissioner shall develop an application form that
28.2 	does not exceed one page in length and requires information
28.3 	necessary to determine eligibility for the program.
28.4 		Subd. 6.Participating pharmacy. According to a valid
28.5 	prescription, a participating pharmacy must sell a covered
28.6 	prescription drug to an enrolled individual at the pharmacy's
28.7 	usual and customary retail price, minus an amount that is equal
28.8 	to the rebate amount described in subdivision 8, plus the amount
28.9 	of any switch fee established by the commissioner under
28.10 	subdivision 10.  Each participating pharmacy shall provide the
28.11 	commissioner with all information necessary to administer the
28.12 	program, including, but not limited to, information on
28.13 	prescription drug sales to enrolled individuals and usual and
28.14 	customary retail prices.
28.15 		Subd. 7.Notification of rebate amount. The commissioner
28.16 	shall notify each drug manufacturer, each calendar quarter or
28.17 	according to a schedule to be established by the commissioner,
28.18 	of the amount of the rebate owed on the prescription drugs sold
28.19 	by participating pharmacies to enrolled individuals.
28.20 		Subd. 8.Provision of rebate. To the extent that a
28.21 	manufacturer's prescription drugs are prescribed to a resident
28.22 	of this state, the manufacturer must provide a rebate equal to
28.23 	the rebate provided under the medical assistance program for any
28.24 	prescription drug distributed by the manufacturer that is
28.25 	purchased by an enrolled individual at a participating
28.26 	pharmacy.  The manufacturer must provide full payment within 30
28.27 	days of receipt of the state invoice for the rebate, or
28.28 	according to a schedule to be established by the commissioner.
28.29 	The commissioner shall deposit all rebates received into the
28.30 	Minnesota prescription drug dedicated fund established under
28.31 	subdivision 11.  The manufacturer must provide the commissioner
28.32 	with any information necessary to verify the rebate determined
28.33 	per drug.
28.34 		Subd. 9.Payment to pharmacies. The commissioner shall
28.35 	distribute on a biweekly basis an amount that is equal to an
28.36 	amount collected under subdivision 8 to each participating
29.1 	pharmacy based on the prescription drugs sold by that pharmacy
29.2 	to enrolled individuals.
29.3 		Subd. 10.Enrollment fee; switch fee. (a) The
29.4 	commissioner shall establish an annual enrollment fee that
29.5 	covers the commissioner's expenses for enrollment, processing
29.6 	claims, and distributing rebates under this program.
29.7 	(b) The commissioner shall establish a reasonable switch
29.8 	fee that covers expenses incurred by pharmacies in formatting
29.9 	for electronic submission claims for prescription drugs sold to
29.10 	enrolled individuals.
29.11 		Subd. 11.Dedicated fund; creation; use of fund. (a) The
29.12 	Minnesota prescription drug dedicated fund is established as an
29.13 	account in the state treasury.  The commissioner of finance
29.14 	shall credit to the dedicated fund all rebates paid under
29.15 	subdivision 8, any federal funds received for the program, all
29.16 	enrollment fees paid by the enrollees, and any appropriations or
29.17 	allocations designated for the fund.  The commissioner of
29.18 	finance shall ensure that fund money is invested under section
29.19 	11A.25.  All money earned by the fund must be credited to the
29.20 	fund.  The fund shall earn a proportionate share of the total
29.21 	state annual investment income.
29.22 	(b) Money in the fund is appropriated to the commissioner
29.23 	to reimburse participating pharmacies for prescription drug
29.24 	discounts provided to enrolled individuals under this section;
29.25 	to reimburse the commissioner for costs related to enrollment,
29.26 	processing claims, and distributing rebates and for other
29.27 	reasonable administrative costs related to administration of the
29.28 	prescription drug discount program; and to repay the
29.29 	appropriation provided for this section.  The commissioner must
29.30 	administer the program so that the costs total no more than
29.31 	funds appropriated plus the drug rebate proceeds.

29.32 	Sec. 19. Minnesota Statutes 2004, section 256.955,
29.33 	subdivision 2a, is amended to read:
29.34 		Subd. 2a.Eligibility.  An individual satisfying the
29.35 	following requirements and the requirements described in
29.36 	subdivision 2, paragraph (d), is eligible for the prescription
30.1 	drug program:
30.2 	(1) is at least 65 years of age or older; and 
30.3 	(2) is eligible as a qualified Medicare beneficiary
30.4 	according to section 256B.057, subdivision 3 or 3a, or is
30.5 	eligible under section 256B.057, subdivision 3 or 3a, and is
30.6 	also eligible for medical assistance with a spenddown as defined
30.7 	in section 256B.056, subdivision 5; and 
30.8 	(3) applies for the Medicare-endorsed drug discount card
30.9 	and for transitional assistance, if eligible.

30.10 	Sec. 20. Minnesota Statutes 2004, section 256.955,
30.11 	subdivision 2b, is amended to read:
30.12 		Subd. 2b.Eligibility.  Effective July 1, 2002, an
30.13 	individual satisfying the following requirements and the
30.14 	requirements described in subdivision 2, paragraph (d), is
30.15 	eligible for the prescription drug program:
30.16 	(1) is under 65 years of age; and 
30.17 	(2) is eligible as a qualified Medicare beneficiary
30.18 	according to section 256B.057, subdivision 3 or 3a or is
30.19 	eligible under section 256B.057, subdivision 3 or 3a and is also
30.20 	eligible for medical assistance with a spenddown as defined in
30.21 	section 256B.056, subdivision 5; and 
30.22 	(3) applies for the Medicare-endorsed drug discount card
30.23 	and for transitional assistance, if eligible.

30.24 	Sec. 21. Minnesota Statutes 2004, section 256.955,
30.25 	subdivision 3, is amended to read:
30.26 		Subd. 3.Prescription drug coverage.  Coverage under the
30.27 	program shall be limited to those prescription drugs that:
30.28 	(1) are covered under the medical assistance program as
30.29 	described in section 256B.0625, subdivision 13;
30.30 	(2) are provided by manufacturers that have fully executed
30.31 	senior prescription drug program rebate agreements with the
30.32 	commissioner and comply with such agreements; and
30.33 	(3) for a specific enrollee, are not covered under an
30.34 	assistance program offered by a pharmaceutical manufacturer, as
30.35 	determined by the board on aging under section 256.975,
30.36 	subdivision 9, except that this shall not apply to qualified
31.1 	individuals under this section who are also eligible for medical
31.2 	assistance with a spenddown as described in subdivisions 2a,
31.3 	clause (2), and 2b, clause (2).a Medicare-endorsed drug
31.4 	discount card transitional assistance unless:
31.5 	(i) the prescription drug is not included in the
31.6 	Medicare-endorsed discount card plan formulary but is covered
31.7 	under the prescription drug program;
31.8 	(ii) the cost of a prescription drug is more than the
31.9 	remaining Medicare-endorsed drug discount card transitional
31.10 	assistance; or 
31.11 	(iii) a prescribed over-the-counter medication is not
31.12 	included in the Medicare-endorsed drug discount card plan
31.13 	formulary but is covered under the prescription drug program.

31.14 	Sec. 22. Minnesota Statutes 2004, section 256.955,
31.15 	subdivision 4, is amended to read:
31.16 		Subd. 4.Application procedures and coordination with
31.17 	medical assistance and medicare-endorsed drug discount card.
 31.18 	(a) Applications and information on the program must be
31.19 	made available at county social service agencies, health care
31.20 	provider offices, and agencies and organizations serving senior
31.21 	citizens and persons with disabilities.  Individuals shall
31.22 	submit applications and any information specified by the
31.23 	commissioner as being necessary to verify eligibility directly
31.24 	to the county social service agencies:
31.25 	(1) beginning January 1, 1999, the county social service
31.26 	agency shall determine medical assistance spenddown eligibility
31.27 	of individuals who qualify for the prescription drug program;
31.28 	and
31.29 	(2) program payments will be used to reduce the spenddown
31.30 	obligations of individuals who are determined to be eligible for
31.31 	medical assistance with a spenddown as defined in section
31.32 	256B.056, subdivision 5.
31.33 	(b) Qualified individuals who are eligible for medical
31.34 	assistance with a spenddown shall be financially responsible for
31.35 	the deductible amount up to the satisfaction of the spenddown.
31.36 	No deductible applies once the spenddown has been met.  Payments
32.1 	to providers for prescription drugs for persons eligible under
32.2 	this subdivision shall be reduced by the deductible.
32.3 	(c) County social service agencies shall determine an
32.4 	applicant's eligibility for the program within 30 days from the
32.5 	date the application is received.  Eligibility begins the month
32.6 	after approval.
32.7 	(d) Enrollees who are also enrolled in the
32.8 	Medicare-endorsed drug discount card plan and for transitional
32.9 	assistance must obtain prescription drugs at a pharmacy enrolled
32.10 	as a provider for both the Medicare-endorsed drug discount plan
32.11 	and the prescription drug program.

32.12 	Sec. 23. Minnesota Statutes 2004, section 256.955,
32.13 	subdivision 6, is amended to read:
32.14 		Subd. 6.Pharmacy reimbursement.  The commissioner shall
32.15 	reimburse participating pharmacies for drug and dispensing costs
32.16 	at the medical assistance reimbursement level, minus the
32.17 	deductible required under subdivision 7. The commissioner shall
32.18 	not reimburse enrolled pharmacies until the Medicare-endorsed
32.19 	drug discount card transitional assistance has been exhausted,
32.20 	unless the exceptions in subdivision 3, clause (3), are met.

32.21 	Sec. 24. Minnesota Statutes 2004, section 256.9693, is
32.22 	amended to read:
32.23 	256.9693 CONTINUING CARE PROGRAM FOR PERSONS WITH MENTAL
32.24 	ILLNESS.
32.25 	The commissioner shall establish a continuing care benefit
32.26 	program for persons with mental illness in which persons with
32.27 	mental illness may obtain acute care hospital inpatient
32.28 	treatment for mental illness for up to 45 days beyond that
32.29 	allowed by section 256.969.  Persons with mental illness who are
32.30 	eligible for medical assistance or general assistance medical
32.31 	care may obtain inpatient treatment under this program in
32.32 	hospital beds for which the commissioner contracts under this
32.33 	section.  The commissioner may selectively contract with
32.34 	hospitals to provide this benefit through competitive bidding
32.35 	when reasonable geographic access by recipients can be assured.
32.36 	Payments under this section shall not affect payments under
33.1 	section 256.969.  The commissioner may contract externally with
33.2 	a utilization review organization to authorize persons with
33.3 	mental illness to access the continuing care benefit program.
33.4 	The commissioner, as part of the contracts with hospitals, shall
33.5 	establish admission criteria to allow persons with mental
33.6 	illness to access the continuing care benefit program.  If a
33.7 	court orders acute care hospital inpatient treatment for mental
33.8 	illness for a person, the person may obtain the treatment under
33.9 	the continuing care benefit program.  The commissioner shall not
33.10 	require, as part of the admission criteria, any commitment or
33.11 	petition under chapter 253B as a condition of accessing the
33.12 	program.  This benefit is not available for people who are also
33.13 	eligible for Medicare and who have not exhausted their annual or
33.14 	lifetime inpatient psychiatric benefit under Medicare.  If a
33.15 	recipient is enrolled in a prepaid plan, this program is
33.16 	included in the plan's coverage.

33.17 	Sec. 25. Minnesota Statutes 2004, section 256B.03,
33.18 	subdivision 3, is amended to read:
33.19 		Subd. 3.Tribal purchasing model.  (a) Notwithstanding
33.20 	subdivision 1 and sections 256B.0625 and 256D.03, subdivision 4,
33.21 	paragraph (i) (h), the commissioner may make payments to
33.22 	federally recognized Indian tribes with a reservation in the
33.23 	state to provide medical assistance and general assistance
33.24 	medical care to Indians, as defined under federal law, who
33.25 	reside on or near the reservation.  The payments may be made in
33.26 	the form of a block grant or other payment mechanism determined
33.27 	in consultation with the tribe.  Any alternative payment
33.28 	mechanism agreed upon by the tribes and the commissioner under
33.29 	this subdivision is not dependent upon county or health plan
33.30 	agreement but is intended to create a direct payment mechanism
33.31 	between the state and the tribe for the administration of the
33.32 	medical assistance and general assistance medical care programs,
33.33 	and for covered services.
33.34 	(b) A tribe that implements a purchasing model under this
33.35 	subdivision shall report to the commissioner at least annually
33.36 	on the operation of the model.  The commissioner and the tribe
34.1 	shall cooperatively determine the data elements, format, and
34.2 	timetable for the report.
34.3 	(c) For purposes of this subdivision, "Indian tribe" means
34.4 	a tribe, band, or nation, or other organized group or community
34.5 	of Indians that is recognized as eligible for the special
34.6 	programs and services provided by the United States to Indians
34.7 	because of their status as Indians and for which a reservation
34.8 	exists as is consistent with Public Law 100-485, as amended.
34.9 	(d) Payments under this subdivision may not result in an
34.10 	increase in expenditures that would not otherwise occur in the
34.11 	medical assistance program under this chapter or the general
34.12 	assistance medical care program under chapter 256D.

34.13 	Sec. 26. Minnesota Statutes 2004, section 256B.061, is
34.14 	amended to read:
34.15 	256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.
34.16 	(a) If any individual has been determined to be eligible
34.17 	for medical assistance, it will be made available for care and
34.18 	services included under the plan and furnished in or after the
34.19 	third month before the month in which the individual made
34.20 	application for such assistance, if such individual was, or upon
34.21 	application would have been, eligible for medical assistance at
34.22 	the time the care and services were furnished.  The commissioner
34.23 	may limit, restrict, or suspend the eligibility of an individual
34.24 	for up to one year upon that individual's conviction of a
34.25 	criminal offense related to application for or receipt of
34.26 	medical assistance benefits.
34.27 	(b) On the basis of information provided on the completed
34.28 	application, an applicant who meets the following criteria shall
34.29 	be determined eligible beginning in the month of application:
34.30 	(1) has gross income less than 90 percent of the applicable
34.31 	income standard;
34.32 	(2) has total liquid assets less than 90 percent of the
34.33 	asset limit;
34.34 	(3) does not reside in a long-term care facility; and 
34.35 	(4) meets all other eligibility requirements.
34.36 	The applicant must provide all required verifications within 30
35.1 	days' notice of the eligibility determination or eligibility
35.2 	shall be terminated.

35.3 	Sec. 27. Minnesota Statutes 2004, section 256B.0625,
35.4 	subdivision 3b, is amended to read:
35.5 		Subd. 3b.Telemedicine consultations.  Medical assistance
35.6 	covers telemedicine consultations.  Telemedicine consultations
35.7 	must be made via two-way, interactive video or store-and-forward
35.8 	technology.  Store-and-forward technology includes telemedicine
35.9 	consultations that do not occur in real time via synchronous
35.10 	transmissions, and that do not require a face-to-face encounter
35.11 	with the patient for all or any part of any such telemedicine
35.12 	consultation.  The patient record must include a written opinion
35.13 	from the consulting physician providing the telemedicine
35.14 	consultation.  A communication between two physicians that
35.15 	consists solely of a telephone conversation is not a
35.16 	telemedicine consultation, unless the communication is between a
35.17 	pediatrician and psychiatrist for the purpose of managing the
35.18 	medications of a child with mental health needs.  Coverage is
35.19 	limited to three telemedicine consultations per recipient per
35.20 	calendar week.  Telemedicine consultations shall be paid at the
35.21 	full allowable rate.

35.22 	Sec. 28. Minnesota Statutes 2004, section 256B.0625,
35.23 	subdivision 9, is amended to read:
35.24 		Subd. 9.Dental services. (a) Medical assistance covers
35.25 	dental services.  Dental services include, with prior
35.26 	authorization, fixed bridges that are cost-effective for persons
35.27 	who cannot use removable dentures because of their medical
35.28 	condition.
35.29 	(b) Coverage of dental services for adults age 21 and over
35.30 	who are not pregnant is subject to a $500 annual benefit limit
35.31 	and covered services are limited to:
35.32 	(1) diagnostic and preventative services;
35.33 	(2) restorative services; and 
35.34 	(3) emergency services.
35.35 	Emergency services, dentures, and extractions related to
35.36 	dentures are not included in the $500 annual benefit limit.

36.1 	Sec. 29. Minnesota Statutes 2004, section 256B.0625,
36.2 	subdivision 13e, is amended to read:
36.3 		Subd. 13e.Payment rates.  (a) The basis for determining
36.4 	the amount of payment shall be the lower of the actual
36.5 	acquisition costs of the drugs plus a fixed dispensing fee; the
36.6 	maximum allowable cost set by the federal government or by the
36.7 	commissioner plus the fixed dispensing fee; or the usual and
36.8 	customary price charged to the public.  The amount of payment
36.9 	basis must be reduced to reflect all discount amounts applied to
36.10 	the charge by any provider/insurer agreement or contract for
36.11 	submitted charges to medical assistance programs.  The net
36.12 	submitted charge may not be greater than the patient liability
36.13 	for the service.  The pharmacy dispensing fee shall be $3.65,
36.14 	except that the dispensing fee for intravenous solutions which
36.15 	must be compounded by the pharmacist shall be $8 per bag, $14
36.16 	per bag for cancer chemotherapy products, and $30 per bag for
36.17 	total parenteral nutritional products dispensed in one liter
36.18 	quantities, or $44 per bag for total parenteral nutritional
36.19 	products dispensed in quantities greater than one liter.  Actual
36.20 	acquisition cost includes quantity and other special discounts
36.21 	except time and cash discounts.  The actual acquisition cost of
36.22 	a drug shall be estimated by the commissioner, at average
36.23 	wholesale price minus 11.5 percent, except that where a drug has
36.24 	had its wholesale price reduced as a result of the actions of
36.25 	the National Association of Medicaid Fraud Control Units, the
36.26 	estimated actual acquisition cost shall be the reduced average
36.27 	wholesale price, without the 11.5 percent deduction. The actual
36.28 	acquisition cost of antihemophilic factor drugs shall be
36.29 	estimated at the average wholesale price minus 30 percent.The
36.30 	maximum allowable cost of a multisource drug may be set by the
36.31 	commissioner and it shall be comparable to, but no higher than,
36.32 	the maximum amount paid by other third-party payors in this
36.33 	state who have maximum allowable cost programs.  Establishment
36.34 	of the amount of payment for drugs shall not be subject to the
36.35 	requirements of the Administrative Procedure Act.
36.36 	(b) An additional dispensing fee of $.30 may be added to
37.1 	the dispensing fee paid to pharmacists for legend drug
37.2 	prescriptions dispensed to residents of long-term care
37.3 	facilities when a unit dose blister card system, approved by the
37.4 	department, is used.  Under this type of dispensing system, the
37.5 	pharmacist must dispense a 30-day supply of drug.  The National
37.6 	Drug Code (NDC) from the drug container used to fill the blister
37.7 	card must be identified on the claim to the department.  The
37.8 	unit dose blister card containing the drug must meet the
37.9 	packaging standards set forth in Minnesota Rules, part
37.10 	6800.2700, that govern the return of unused drugs to the
37.11 	pharmacy for reuse.  The pharmacy provider will be required to
37.12 	credit the department for the actual acquisition cost of all
37.13 	unused drugs that are eligible for reuse.  Over-the-counter
37.14 	medications must be dispensed in the manufacturer's unopened
37.15 	package.  The commissioner may permit the drug clozapine to be
37.16 	dispensed in a quantity that is less than a 30-day supply.
37.17 	(c) Whenever a generically equivalent product is available,
37.18 	payment shall be on the basis of the actual acquisition cost of
37.19 	the generic drug, or on the maximum allowable cost established
37.20 	by the commissioner.
37.21 	(d) The basis for determining the amount of payment for
37.22 	drugs administered in an outpatient setting shall be the lower
37.23 	of the usual and customary cost submitted by the provider, the
37.24 	average wholesale price minus five percent, or the maximum
37.25 	allowable cost set by the federal government under United States
37.26 	Code, title 42, chapter 7, section 1396r-8(e), and Code of
37.27 	Federal Regulations, title 42, section 447.332, or by the
37.28 	commissioner under paragraphs (a) to (c).

37.29 	Sec. 30. Minnesota Statutes 2004, section 256B.0625, is
37.30 	amended by adding a subdivision to read:
37.31 		Subd. 46.List of health care services not eligible for
37.32 	coverage. (a) The commissioner of human services, in
37.33 	consultation with the commissioner of health, shall biennially
37.34 	establish a list of diagnosis/treatment pairings that are not
37.35 	eligible for reimbursement under this chapter and chapters 256D
37.36 	and 256L, effective for services provided on or after July 1,
38.1 	2007.  The commissioner shall review the list in effect for the
38.2 	prior biennium and shall make any additions or deletions from
38.3 	the list as appropriate, taking into consideration the following:
38.4 	(1) scientific and medical information;
38.5 	(2) clinical assessment;
38.6 	(3) cost-effectiveness of treatment;
38.7 	(4) prevention of future costs; and 
38.8 	(5) medical ineffectiveness.
38.9 	(b) The commissioner may appoint an ad hoc advisory panel
38.10 	made up of physicians, consumers, nurses, dentists,
38.11 	chiropractors, and other experts to assist the commissioner in
38.12 	reviewing and establishing the list.  The commissioner shall
38.13 	solicit comments and recommendations from any interested persons
38.14 	and organizations and shall schedule at least one public hearing.
38.15 	(c) The list must be established by January 15, 2007, for
38.16 	the list effective July 1, 2007, and by October 1 of the
38.17 	even-numbered years beginning October 1, 2008, for the lists
38.18 	effective the following July 1.  The commissioner shall publish
38.19 	the list in the State Register by November 1 of the
38.20 	even-numbered years beginning November 1, 2008.  The list shall
38.21 	be submitted to the legislature by January 15 of the
38.22 	odd-numbered years beginning January 15, 2007.

38.23 	Sec. 31. Minnesota Statutes 2004, section 256B.0631, is
38.24 	amended by adding a subdivision to read:
38.25 		Subd. 5.Healthy lifestyle waiver. The co-payments
38.26 	described in subdivision 1 shall be waived by the provider if
38.27 	the recipient is practicing a healthy lifestyle by refraining
38.28 	from tobacco use or is participating in a smoking cessation
38.29 	program.  To obtain the waiver, the recipient must sign a
38.30 	statement stating that the recipient does not use tobacco
38.31 	products or is currently participating in a smoking cessation
38.32 	program.  The provider shall keep the signed statement on file.

38.33 	Sec. 32. Minnesota Statutes 2004, section 256B.075,
38.34 	subdivision 1, is amended to read:
38.35 		Subdivision 1.General.  The commissioner shall implement
38.36 	disease management and care coordination initiatives that seek
39.1 	to improve patient care and health outcomes and reduce health
39.2 	care costs by managing the care provided to recipients with
39.3 	chronic conditions.

39.4 	Sec. 33. Minnesota Statutes 2004, section 256B.075,
39.5 	subdivision 2, is amended to read:
39.6 		Subd. 2.Fee-for-service.  (a) The commissioner shall
39.7 	develop and implement a disease management program for medical
39.8 	assistance and general assistance medical care recipients who
39.9 	are not enrolled in the prepaid medical assistance or prepaid
39.10 	general assistance medical care programs and who are receiving
39.11 	services on a fee-for-service basis.  The commissioner may
39.12 	contract with an outside organization to provide these services.
39.13 	(b) The commissioner shall identify recipients with special
39.14 	health care diagnosis through the use of data analysis software
39.15 	designed to identify persons most likely to need extended or
39.16 	costly health care in the immediate future.  Based on this
39.17 	identification system, the commissioner shall establish a list
39.18 	of care coordinators and primary care providers who are
39.19 	qualified to act as a care manager to coordinate the care of the
39.20 	patient.
39.21 	(c) The commissioner shall request the identified
39.22 	recipients to choose a care coordinator or primary care provider
39.23 	from the list established in paragraph (b).  The care
39.24 	coordinator or primary care provider shall be responsible for:
39.25 	(1) establishing a care team that must include a pharmacist
39.26 	and any health care provider necessary to treat the specific
39.27 	conditions of the identified recipient;
39.28 	(2) performing an initial assessment and developing an
39.29 	individualized care plan with input from the patient;
39.30 	(3) educating the patient in self-management and the
39.31 	importance of adhering to the care plan;
39.32 	(4) providing problem follow-up and new assessments, as
39.33 	needed; and 
39.34 	(5) adhering to evidence-based best practices care
39.35 	strategies.
39.36 	(d) The care coordinator or primary care provider may
40.1 	create incentives for a recipient to ensure cooperation and
40.2 	patient engagement in the care plan and management.
40.3 	(e) The recipient shall be required to seek health care
40.4 	services related to a specific diagnosis identified in paragraph
40.5 	(b) from the care coordinator or primary care provider or from
40.6 	the providers on the recipient's care team.
40.7 	(f) The commissioner shall set a cost-savings target of ten
40.8 	percent reduction in inpatient hospitalization and emergency
40.9 	room costs for fiscal year 2006.  Based on the achievement of
40.10 	this goal, one-half of the savings shall be used as a bonus to
40.11 	the participating primary care providers for the following
40.12 	fiscal year.  The bonus shall be paid on a quarterly basis and
40.13 	shall be based on the percentage of patients treated by the
40.14 	provider who have been identified by the commissioner in
40.15 	accordance with this subdivision.
40.16 	(g) The commissioner shall seek any federal approval
40.17 	necessary to implement this section and to obtain federal
40.18 	matching funds.

40.19 	Sec. 34. Minnesota Statutes 2004, section 256B.075,
40.20 	subdivision 3, is amended to read:
40.21 		Subd. 3.Prepaid managed care programs. (a) For the
40.22 	prepaid medical assistance, prepaid general assistance medical
40.23 	care, and MinnesotaCare programs, the commissioner shall ensure
40.24 	that contracting health plans implement disease management
40.25 	programs that are appropriate for Minnesota health care program
40.26 	recipients and have been designed by the health plan to improve
40.27 	patient care and health outcomes and reduce health care costs by
40.28 	managing the care provided to recipients with chronic conditions.
40.29 	(b) The commissioner shall require all managed care plans
40.30 	entering into contracts under section 256B.69 to develop and
40.31 	implement at least three disease management programs that will
40.32 	improve patient care and health outcomes for those enrollees who
40.33 	are at risk of or diagnosed with a chronic condition.
40.34 	(c) The commissioner shall require the managed care plans
40.35 	to measure and report outcomes according to measurements
40.36 	approved by the commissioner.  In determining outcome
41.1 	measurements, the commissioner shall establish a baseline
41.2 	indicating the prevalence of each disease identified in
41.3 	paragraph (b) in the general population and within identified
41.4 	racial or ethnic groups.  The managed care plan must report the
41.5 	number of enrollees who are at risk based on the baseline
41.6 	measurement; the number of enrollees who have been diagnosed
41.7 	with the disease; and the number of enrollees participating in
41.8 	the managed care plan's disease management program.
41.9 	(d) The commissioner shall establish targets based on the
41.10 	number of enrollees who should be receiving disease management
41.11 	services as determined by the prevalence of the disease within
41.12 	the general population and the number of enrollees who are
41.13 	receiving disease management services.  The targets must also
41.14 	include a specified reduction in inpatient hospitalization costs
41.15 	and in the progression of the chronic diseases for the enrollees
41.16 	identified as being at risk of or diagnosed with a chronic
41.17 	condition.

41.18 	Sec. 35. [256B.0918] EMPLOYEE SCHOLARSHIP COSTS AND
41.19 	TRAINING IN ENGLISH AS A SECOND LANGUAGE.
41.20 	(a) For the fiscal year beginning July 1, 2005, the
41.21 	commissioner shall provide to each provider listed in paragraph
41.22 	(c) a scholarship reimbursement increase of two-tenths percent
41.23 	of the reimbursement rate for that provider to be used:
41.24 	(1) for employee scholarships that satisfy the following
41.25 	requirements:
41.26 	(i) scholarships are available to all employees who work an
41.27 	average of at least 20 hours per week for the provider, except
41.28 	administrators, department supervisors, and registered nurses;
41.29 	and 
41.30 	(ii) the course of study is expected to lead to career
41.31 	advancement with the provider or in long-term care, including
41.32 	home care or care of persons with disabilities, including
41.33 	medical care interpreter services and social work; and 
41.34 	(2) to provide job-related training in English as a second
41.35 	language.
41.36 	(b) A provider receiving a rate adjustment under this
42.1 	subdivision with an annualized value of at least $1,000 shall
42.2 	maintain documentation to be submitted to the commissioner on a
42.3 	schedule determined by the commissioner and on a form supplied
42.4 	by the commissioner of the scholarship rate increase received,
42.5 	including:
42.6 	(1) the amount received from this reimbursement increase;
42.7 	(2) the amount used for training in English as a second
42.8 	language;
42.9 	(3) the number of persons receiving the training;
42.10 	(4) the name of the person or entity providing the
42.11 	training; and 
42.12 	(5) for each scholarship recipient, the name of the
42.13 	recipient, the amount awarded, the educational institution
42.14 	attended, the nature of the educational program, the program
42.15 	completion date, and a determination of the amount spent as a
42.16 	percentage of the provider's reimbursement.
42.17 	The commissioner shall report to the legislature annually,
42.18 	beginning January 15, 2006, with information on the use of these
42.19 	funds.
42.20 	(c) The rate increases described in this section shall be
42.21 	provided to home and community-based waivered services for
42.22 	persons with mental retardation or related conditions under
42.23 	section 256B.501; home and community-based waivered services for
42.24 	the elderly under section 256B.0915; waivered services under
42.25 	community alternatives for disabled individuals under section
42.26 	256B.49; community alternative care waivered services under
42.27 	section 256B.49; traumatic brain injury waivered services under
42.28 	section 256B.49; nursing services and home health services under
42.29 	section 256B.0625, subdivision 6a; personal care services and
42.30 	nursing supervision of personal care services under section
42.31 	256B.0625, subdivision 19a; private duty nursing services under
42.32 	section 256B.0625, subdivision 7; day training and habilitation
42.33 	services for adults with mental retardation or related
42.34 	conditions under sections 252.40 to 252.46; alternative care
42.35 	services under section 256B.0913; adult residential program
42.36 	grants under Minnesota Rules, parts 9535.2000 to 9535.3000;
43.1 	semi-independent living services (SILS) under section 252.275,
43.2 	including SILS funding under county social services grants
43.3 	formerly funded under chapter 256I; community support services
43.4 	for deaf and hard-of-hearing adults with mental illness who use
43.5 	or wish to use sign language as their primary means of
43.6 	communication; the group residential housing supplementary
43.7 	service rate under section 256I.05, subdivision 1a; chemical
43.8 	dependency residential and nonresidential service providers
43.9 	under section 254B.03; and intermediate care facilities for
43.10 	persons with mental retardation under section 256B.5012.
43.11 	(d) These increases shall be included in the provider's
43.12 	reimbursement rate for the purpose of determining future rates
43.13 	for the provider.

43.14 	Sec. 36. Minnesota Statutes 2004, section 256D.03,
43.15 	subdivision 3, is amended to read:
43.16 		Subd. 3.General assistance medical care; eligibility.
 43.17 	(a) General assistance medical care may be paid for any person
43.18 	who is not eligible for medical assistance under chapter 256B,
43.19 	including eligibility for medical assistance based on a
43.20 	spenddown of excess income according to section 256B.056,
43.21 	subdivision 5, or MinnesotaCare as defined in paragraph (b),
43.22 	except as provided in paragraph (c), and:
43.23 	(1) who is receiving assistance under section 256D.05,
43.24 	except for families with children who are eligible under
43.25 	Minnesota family investment program (MFIP), or who is having a
43.26 	payment made on the person's behalf under sections 256I.01 to
43.27 	256I.06; or
43.28 	(2) who is a resident of Minnesota; and
43.29 	(i) who has gross countable income not in excess of 75
43.30 	percent of the federal poverty guidelines for the family size,
43.31 	using a six-month budget period and whose equity in assets is
43.32 	not in excess of $1,000 per assistance unit.  Exempt assets, the
43.33 	reduction of excess assets, and the waiver of excess assets must
43.34 	conform to the medical assistance program in section 256B.056,
43.35 	subdivision 3, with the following exception:  the maximum amount
43.36 	of undistributed funds in a trust that could be distributed to
44.1 	or on behalf of the beneficiary by the trustee, assuming the
44.2 	full exercise of the trustee's discretion under the terms of the
44.3 	trust, must be applied toward the asset maximum; or
44.4 	(ii) who has gross countable income above 75 percent of the
44.5 	federal poverty guidelines but not in excess of 175 percent of
44.6 	the federal poverty guidelines for the family size, using a
44.7 	six-month budget period, whose equity in assets is not in excess
44.8 	of the limits in section 256B.056, subdivision 3c, and who
44.9 	applies during an inpatient hospitalization.
44.10 	(b) General assistance medical care may not be paid for
44.11 	applicants or recipients who meet all eligibility requirements
44.12 	of MinnesotaCare as defined in sections 256L.01 to 256L.16, and
44.13 	are adults with dependent children under 21 whose gross family
44.14 	income is equal to or less than 275 percent of the federal
44.15 	poverty guidelines.
44.16 	(c) For applications received on or after October 1, 2003,
44.17 	eligibility may begin no earlier than the date of application.
44.18 	For individuals eligible under paragraph (a), clause (2), item
44.19 	(i), a redetermination of eligibility must occur every 12
44.20 	months.  Individuals are eligible under paragraph (a), clause
44.21 	(2), item (ii), only during inpatient hospitalization but may
44.22 	reapply if there is a subsequent period of inpatient
44.23 	hospitalization.  Beginning January 1, 2000, Minnesota health
44.24 	care program applications completed by recipients and applicants
44.25 	who are persons described in paragraph (b), may be returned to
44.26 	the county agency to be forwarded to the Department of Human
44.27 	Services or sent directly to the Department of Human Services
44.28 	for enrollment in MinnesotaCare.  If all other eligibility
44.29 	requirements of this subdivision are met, eligibility for
44.30 	general assistance medical care shall be available in any month
44.31 	during which a MinnesotaCare eligibility determination and
44.32 	enrollment are pending.  Upon notification of eligibility for
44.33 	MinnesotaCare, notice of termination for eligibility for general
44.34 	assistance medical care shall be sent to an applicant or
44.35 	recipient.  If all other eligibility requirements of this
44.36 	subdivision are met, eligibility for general assistance medical
45.1 	care shall be available until enrollment in MinnesotaCare
45.2 	subject to the provisions of paragraph (e).
45.3 	(d) The date of an initial Minnesota health care program
45.4 	application necessary to begin a determination of eligibility
45.5 	shall be the date the applicant has provided a name, address,
45.6 	and Social Security number, signed and dated, to the county
45.7 	agency or the Department of Human Services.  If the applicant is
45.8 	unable to provide a name, address, Social Security number, and
45.9 	signature when health care is delivered due to a medical
45.10 	condition or disability, a health care provider may act on an
45.11 	applicant's behalf to establish the date of an initial Minnesota
45.12 	health care program application by providing the county agency
45.13 	or Department of Human Services with provider identification and
45.14 	a temporary unique identifier for the applicant the applicant's
45.15 	name and address.  If the name and address are not available,
45.16 	the provider may submit provider identification and a temporary
45.17 	unique identifier for the applicant by the end of the next
45.18 	business day.  The date of hospital admission shall be
45.19 	considered to be the application date for such requests.  The
45.20 	applicant must complete the remainder of the application and
45.21 	provide necessary verification before eligibility can be
45.22 	determined.  The county agency must assist the applicant in
45.23 	obtaining verification if necessary. On the basis of
45.24 	information provided on the completed application, an applicant
45.25 	who meets the following criteria shall be determined eligible
45.26 	beginning in the month of application:
45.27 	(1) has gross income less than 90 percent of the applicable
45.28 	income standard;
45.29 	(2) has liquid assets that total within $300 of the asset
45.30 	standard;
45.31 	(3) does not reside in a long-term care facility; and 
45.32 	(4) meets all other eligibility requirements.
45.33 	The applicant must provide all required verifications within 30
45.34 	days' notice of the eligibility determination or eligibility
45.35 	shall be terminated.
45.36 	(e) County agencies are authorized to use all automated
46.1 	databases containing information regarding recipients' or
46.2 	applicants' income in order to determine eligibility for general
46.3 	assistance medical care or MinnesotaCare.  Such use shall be
46.4 	considered sufficient in order to determine eligibility and
46.5 	premium payments by the county agency.
46.6 	(f) General assistance medical care is not available for a
46.7 	person in a correctional facility unless the person is detained
46.8 	by law for less than one year in a county correctional or
46.9 	detention facility as a person accused or convicted of a crime,
46.10 	or admitted as an inpatient to a hospital on a criminal hold
46.11 	order, and the person is a recipient of general assistance
46.12 	medical care at the time the person is detained by law or
46.13 	admitted on a criminal hold order and as long as the person
46.14 	continues to meet other eligibility requirements of this
46.15 	subdivision.
46.16 	(g) General assistance medical care is not available for
46.17 	applicants or recipients who do not cooperate with the county
46.18 	agency to meet the requirements of medical assistance.
46.19 	(h) In determining the amount of assets of an individual
46.20 	eligible under paragraph (a), clause (2), item (i), there shall
46.21 	be included any asset or interest in an asset, including an
46.22 	asset excluded under paragraph (a), that was given away, sold,
46.23 	or disposed of for less than fair market value within the 60
46.24 	months preceding application for general assistance medical care
46.25 	or during the period of eligibility.  Any transfer described in
46.26 	this paragraph shall be presumed to have been for the purpose of
46.27 	establishing eligibility for general assistance medical care,
46.28 	unless the individual furnishes convincing evidence to establish
46.29 	that the transaction was exclusively for another purpose.  For
46.30 	purposes of this paragraph, the value of the asset or interest
46.31 	shall be the fair market value at the time it was given away,
46.32 	sold, or disposed of, less the amount of compensation received.
46.33 	For any uncompensated transfer, the number of months of
46.34 	ineligibility, including partial months, shall be calculated by
46.35 	dividing the uncompensated transfer amount by the average
46.36 	monthly per person payment made by the medical assistance
47.1 	program to skilled nursing facilities for the previous calendar
47.2 	year.  The individual shall remain ineligible until this fixed
47.3 	period has expired.  The period of ineligibility may exceed 30
47.4 	months, and a reapplication for benefits after 30 months from
47.5 	the date of the transfer shall not result in eligibility unless
47.6 	and until the period of ineligibility has expired.  The period
47.7 	of ineligibility begins in the month the transfer was reported
47.8 	to the county agency, or if the transfer was not reported, the
47.9 	month in which the county agency discovered the transfer,
47.10 	whichever comes first.  For applicants, the period of
47.11 	ineligibility begins on the date of the first approved
47.12 	application.
47.13 	(i) When determining eligibility for any state benefits
47.14 	under this subdivision, the income and resources of all
47.15 	noncitizens shall be deemed to include their sponsor's income
47.16 	and resources as defined in the Personal Responsibility and Work
47.17 	Opportunity Reconciliation Act of 1996, title IV, Public Law
47.18 	104-193, sections 421 and 422, and subsequently set out in
47.19 	federal rules.
47.20 	(j) Undocumented noncitizens and nonimmigrants are
47.21 	ineligible for general assistance medical care.  For purposes of
47.22 	this subdivision, a nonimmigrant is an individual in one or more
47.23 	of the classes listed in United States Code, title 8, section
47.24 	1101(a)(15), and an undocumented noncitizen is an individual who
47.25 	resides in the United States without the approval or
47.26 	acquiescence of the Immigration and Naturalization Service.
47.27 	(k) Notwithstanding any other provision of law, a
47.28 	noncitizen who is ineligible for medical assistance due to the
47.29 	deeming of a sponsor's income and resources, is ineligible for
47.30 	general assistance medical care.
47.31 	(l) Effective July 1, 2003, general assistance medical care
47.32 	emergency services end.

47.33 	Sec. 37. Minnesota Statutes 2004, section 256D.03,
47.34 	subdivision 4, is amended to read:
47.35 		Subd. 4.General assistance medical care; services.
 47.36 	(a)(i) For a person who is eligible under subdivision 3,
48.1 	paragraph (a), clause (2), item (i), general assistance medical
48.2 	care covers, except as provided in paragraph (c):
48.3 	(1) inpatient hospital services;
48.4 	(2) outpatient hospital services;
48.5 	(3) services provided by Medicare certified rehabilitation
48.6 	agencies;
48.7 	(4) prescription drugs and other products recommended
48.8 	through the process established in section 256B.0625,
48.9 	subdivision 13;
48.10 	(5) equipment necessary to administer insulin and
48.11 	diagnostic supplies and equipment for diabetics to monitor blood
48.12 	sugar level;
48.13 	(6) eyeglasses and eye examinations provided by a physician
48.14 	or optometrist;
48.15 	(7) hearing aids;
48.16 	(8) prosthetic devices;
48.17 	(9) laboratory and X-ray services;
48.18 	(10) physician's services;
48.19 	(11) medical transportation except special transportation;
48.20 	(12) chiropractic services as covered under the medical
48.21 	assistance program;
48.22 	(13) podiatric services;
48.23 	(14) dental services and dentures, subject to the
48.24 	limitations specified in section 256B.0625, subdivision 9;
48.25 	(15) outpatient services provided by a mental health center
48.26 	or clinic that is under contract with the county board and is
48.27 	established under section 245.62;
48.28 	(16) day treatment services for mental illness provided
48.29 	under contract with the county board;
48.30 	(17) prescribed medications for persons who have been
48.31 	diagnosed as mentally ill as necessary to prevent more
48.32 	restrictive institutionalization;
48.33 	(18) psychological services, medical supplies and
48.34 	equipment, and Medicare premiums, coinsurance and deductible
48.35 	payments;
48.36 	(19) medical equipment not specifically listed in this
49.1 	paragraph when the use of the equipment will prevent the need
49.2 	for costlier services that are reimbursable under this
49.3 	subdivision;
49.4 	(20) services performed by a certified pediatric nurse
49.5 	practitioner, a certified family nurse practitioner, a certified
49.6 	adult nurse practitioner, a certified obstetric/gynecological
49.7 	nurse practitioner, a certified neonatal nurse practitioner, or
49.8 	a certified geriatric nurse practitioner in independent
49.9 	practice, if (1) the service is otherwise covered under this
49.10 	chapter as a physician service, (2) the service provided on an
49.11 	inpatient basis is not included as part of the cost for
49.12 	inpatient services included in the operating payment rate, and
49.13 	(3) the service is within the scope of practice of the nurse
49.14 	practitioner's license as a registered nurse, as defined in
49.15 	section 148.171;
49.16 	(21) services of a certified public health nurse or a
49.17 	registered nurse practicing in a public health nursing clinic
49.18 	that is a department of, or that operates under the direct
49.19 	authority of, a unit of government, if the service is within the
49.20 	scope of practice of the public health nurse's license as a
49.21 	registered nurse, as defined in section 148.171; and
49.22 	(22) telemedicine consultations, to the extent they are
49.23 	covered under section 256B.0625, subdivision 3b.
49.24 	(ii) Effective October 1, 2003, for a person who is
49.25 	eligible under subdivision 3, paragraph (a), clause (2), item
49.26 	(ii), general assistance medical care coverage is limited to
49.27 	inpatient hospital services, including physician services
49.28 	provided during the inpatient hospital stay.  A $1,000
49.29 	deductible is required for each inpatient hospitalization.
49.30 	(b) Gender reassignment surgery and related services are
49.31 	not covered services under this subdivision unless the
49.32 	individual began receiving gender reassignment services prior to
49.33 	July 1, 1995.
49.34 	(c) In order to contain costs, the commissioner of human
49.35 	services shall select vendors of medical care who can provide
49.36 	the most economical care consistent with high medical standards
50.1 	and shall where possible contract with organizations on a
50.2 	prepaid capitation basis to provide these services.  The
50.3 	commissioner shall consider proposals by counties and vendors
50.4 	for prepaid health plans, competitive bidding programs, block
50.5 	grants, or other vendor payment mechanisms designed to provide
50.6 	services in an economical manner or to control utilization, with
50.7 	safeguards to ensure that necessary services are provided.
50.8 	Before implementing prepaid programs in counties with a county
50.9 	operated or affiliated public teaching hospital or a hospital or
50.10 	clinic operated by the University of Minnesota, the commissioner
50.11 	shall consider the risks the prepaid program creates for the
50.12 	hospital and allow the county or hospital the opportunity to
50.13 	participate in the program in a manner that reflects the risk of
50.14 	adverse selection and the nature of the patients served by the
50.15 	hospital, provided the terms of participation in the program are
50.16 	competitive with the terms of other participants considering the
50.17 	nature of the population served.  Payment for services provided
50.18 	pursuant to this subdivision shall be as provided to medical
50.19 	assistance vendors of these services under sections 256B.02,
50.20 	subdivision 8, and 256B.0625.  For payments made during fiscal
50.21 	year 1990 and later years, the commissioner shall consult with
50.22 	an independent actuary in establishing prepayment rates, but
50.23 	shall retain final control over the rate methodology.
50.24 	(d) Recipients eligible under subdivision 3, paragraph (a),
50.25 	clause (2), item (i), shall pay the following co-payments for
50.26 	services provided on or after October 1, 2003:
50.27 	(1) $3 per nonpreventive visit.  For purposes of this
50.28 	subdivision, a visit means an episode of service which is
50.29 	required because of a recipient's symptoms, diagnosis, or
50.30 	established illness, and which is delivered in an ambulatory
50.31 	setting by a physician or physician ancillary, chiropractor,
50.32 	podiatrist, nurse midwife, advanced practice nurse, audiologist,
50.33 	optician, or optometrist;
50.34 	(2) $25 for eyeglasses;
50.35 	(3) $25 for nonemergency visits to a hospital-based
50.36 	emergency room;
51.1 	(4) $3 per brand-name drug prescription and $1 per generic
51.2 	drug prescription, subject to a $20 per month maximum for
51.3 	prescription drug co-payments.  No co-payments shall apply to
51.4 	antipsychotic drugs when used for the treatment of mental
51.5 	illness; and
51.6 	(5) 50 percent coinsurance on restorative dental services.
51.7 	(e) Co-payments shall be limited to one per day per
51.8 	provider for nonpreventive visits, eyeglasses, and nonemergency
51.9 	visits to a hospital-based emergency room.  Recipients of
51.10 	general assistance medical care are responsible for all
51.11 	co-payments in this subdivision.  The general assistance medical
51.12 	care reimbursement to the provider shall be reduced by the
51.13 	amount of the co-payment, except that reimbursement for
51.14 	prescription drugs shall not be reduced once a recipient has
51.15 	reached the $20 per month maximum for prescription drug
51.16 	co-payments.  The provider collects the co-payment from the
51.17 	recipient.  Providers may not deny services to recipients who
51.18 	are unable to pay the co-payment, except as provided in
51.19 	paragraph (f).
51.20 	(f) If it is the routine business practice of a provider to
51.21 	refuse service to an individual with uncollected debt, the
51.22 	provider may include uncollected co-payments under this
51.23 	section.  A provider must give advance notice to a recipient
51.24 	with uncollected debt before services can be denied.
51.25 	(g) The co-payments described in paragraph (d) shall be
51.26 	waived by the provider if the recipient practices a healthy
51.27 	lifestyle by refraining from tobacco use or is participating in
51.28 	a smoking cessation program.  To obtain the waiver, the
51.29 	recipient must sign a statement stating that the recipient does
51.30 	not use tobacco products or is currently participating in a
51.31 	smoking cessation program.  The provider shall keep the signed
51.32 	statement on file.
51.33 	(g) (h) Any county may, from its own resources, provide
51.34 	medical payments for which state payments are not made.
51.35 	(h) (i) Chemical dependency services that are reimbursed
51.36 	under chapter 254B must not be reimbursed under general
52.1 	assistance medical care.
52.2 	(i) (j) The maximum payment for new vendors enrolled in the
52.3 	general assistance medical care program after the base year
52.4 	shall be determined from the average usual and customary charge
52.5 	of the same vendor type enrolled in the base year.
52.6 	(j) (k) The conditions of payment for services under this
52.7 	subdivision are the same as the conditions specified in rules
52.8 	adopted under chapter 256B governing the medical assistance
52.9 	program, unless otherwise provided by statute or rule.
52.10 	(k) (l) Inpatient and outpatient payments shall be reduced
52.11 	by five percent, effective July 1, 2003.  This reduction is in
52.12 	addition to the five percent reduction effective July 1, 2003,
52.13 	and incorporated by reference in paragraph (i).
52.14 	(l) (m) Payments for all other health services except
52.15 	inpatient, outpatient, and pharmacy services shall be reduced by
52.16 	five percent, effective July 1, 2003.
52.17 	(m) (n) Payments to managed care plans shall be reduced by
52.18 	five percent for services provided on or after October 1, 2003.
52.19 	(n) (o) A hospital receiving a reduced payment as a result
52.20 	of this section may apply the unpaid balance toward satisfaction
52.21 	of the hospital's bad debts.

52.22 	Sec. 38. Minnesota Statutes 2004, section 256L.03,
52.23 	subdivision 1, is amended to read:
52.24 		Subdivision 1.Covered health services. For individuals
52.25 	under section 256L.04, subdivision 7, with income no greater
52.26 	than 75 percent of the federal poverty guidelines or for
52.27 	families with children under section 256L.04, subdivision 1, all
52.28 	subdivisions of this section apply."Covered health services"
52.29 	means the health services reimbursed under chapter 256B, with
52.30 	the exception of inpatient hospital services, special education
52.31 	services, private duty nursing services, adult dental care
52.32 	services other than preventive services covered under section
52.33 	256B.0625, subdivision 9, paragraph (b), orthodontic services,
52.34 	nonemergency medical transportation services, personal care
52.35 	assistant and case management services, nursing home or
52.36 	intermediate care facilities services, inpatient mental health
53.1 	services, and chemical dependency services. Adult dental care
53.2 	for nonpreventive services, with the exception of orthodontic
53.3 	services, is covered for persons who qualify under section
53.4 	256L.04, subdivisions 1, 2, and 7, with family gross income
53.5 	equal to or less than 175 percent of the federal poverty
53.6 	guidelines.Outpatient mental health services covered under the
53.7 	MinnesotaCare program are limited to diagnostic assessments,
53.8 	psychological testing, explanation of findings, medication
53.9 	management by a physician, day treatment, partial
53.10 	hospitalization, and individual, family, and group psychotherapy.
53.11 	No public funds shall be used for coverage of abortion
53.12 	under MinnesotaCare except where the life of the female would be
53.13 	endangered or substantial and irreversible impairment of a major
53.14 	bodily function would result if the fetus were carried to term;
53.15 	or where the pregnancy is the result of rape or incest.
53.16 	Covered health services shall be expanded as provided in
53.17 	this section.

53.18 	Sec. 39. Minnesota Statutes 2004, section 256L.05,
53.19 	subdivision 4, is amended to read:
53.20 		Subd. 4.Application processing.  The commissioner of
53.21 	human services shall determine an applicant's eligibility for
53.22 	MinnesotaCare no more than 30 days from the date that the
53.23 	application is received by the Department of Human Services.
53.24 	Beginning January 1, 2000, this requirement also applies to
53.25 	local county human services agencies that determine eligibility
53.26 	for MinnesotaCare. At application or reenrollment, to prevent
53.27 	processing delays, applicants or enrollees who, from the
53.28 	information provided on the application, appear to meet
53.29 	eligibility requirements shall be enrolled upon timely payment
53.30 	of premiums.  The enrollee must provide all required
53.31 	verifications within 30 days of notification of the eligibility
53.32 	determination or coverage from the program shall be terminated.
53.33 	Enrollees who are determined to be ineligible when verifications
53.34 	are provided shall be disenrolled from the program.

53.35 	Sec. 40. Minnesota Statutes 2004, section 256L.07,
53.36 	subdivision 1, is amended to read:
54.1 		Subdivision 1.General requirements.  (a) Children
54.2 	enrolled in the original children's health plan as of September
54.3 	30, 1992, children who enrolled in the MinnesotaCare program
54.4 	after September 30, 1992, pursuant to Laws 1992, chapter 549,
54.5 	article 4, section 17, and children who have family gross
54.6 	incomes that are equal to or less than 150 percent of the
54.7 	federal poverty guidelines are eligible without meeting the
54.8 	requirements of subdivision 2 and the four-month requirement in
54.9 	subdivision 3, as long as they maintain continuous coverage in
54.10 	the MinnesotaCare program or medical assistance.  Children who
54.11 	apply for MinnesotaCare on or after the implementation date of
54.12 	the employer-subsidized health coverage program as described in
54.13 	Laws 1998, chapter 407, article 5, section 45, who have family
54.14 	gross incomes that are equal to or less than 150 percent of the
54.15 	federal poverty guidelines, must meet the requirements of
54.16 	subdivision 2 to be eligible for MinnesotaCare.
54.17 	(b) Families enrolled in MinnesotaCare under section
54.18 	256L.04, subdivision 1, whose income increases above 275 percent
54.19 	of the federal poverty guidelines, are no longer eligible for
54.20 	the program and shall be disenrolled by the commissioner.
54.21 	Individuals enrolled in MinnesotaCare under section 256L.04,
54.22 	subdivision 7, whose income increases above 175 percent of the
54.23 	federal poverty guidelines are no longer eligible for the
54.24 	program and shall be disenrolled by the commissioner.  For
54.25 	persons disenrolled under this subdivision, MinnesotaCare
54.26 	coverage terminates the last day of the calendar month following
54.27 	the month in which the commissioner determines that the income
54.28 	of a family or individual exceeds program income limits.
54.29 	(c) (1) Notwithstanding paragraph (b), individuals and 
54.30 	families enrolled in MinnesotaCare under section 256L.04,
54.31 	subdivision 1,may remain enrolled in MinnesotaCare if ten
54.32 	percent of their annual income is less than the annual premium
54.33 	for a policy with a $500 deductible available through the
54.34 	Minnesota Comprehensive Health Association. Individuals and 
54.35 	families who are no longer eligible for MinnesotaCare under this
54.36 	subdivision shall be given an 18-month a 12-month notice period
55.1 	from the date that ineligibility is determined before
55.2 	disenrollment. This clause expires February 1, 2004.
55.3 	(2) Effective February 1, 2004, notwithstanding paragraph
55.4 	(b), children may remain enrolled in MinnesotaCare if ten
55.5 	percent of their annual family income is less than the annual
55.6 	premium for a policy with a $500 deductible available through
55.7 	the Minnesota Comprehensive Health Association.  Children who
55.8 	are no longer eligible for MinnesotaCare under this clause shall
55.9 	be given a 12-month notice period from the date that
55.10 	ineligibility is determined before disenrollment.The premium
55.11 	for children individuals and families remaining eligible under
55.12 	this clause paragraph shall be the maximum premium determined
55.13 	under section 256L.15, subdivision 2, paragraph (b).
55.14 	(d) Effective July 1, 2003, notwithstanding paragraphs (b)
55.15 	and (c), parents are no longer eligible for MinnesotaCare if
55.16 	gross household income exceeds $50,000.

55.17 	Sec. 41. Minnesota Statutes 2004, section 256L.12,
55.18 	subdivision 6, is amended to read:
55.19 		Subd. 6.Co-payments and benefit limits.  Enrollees are
55.20 	responsible for all co-payments in sections section 256L.03,
55.21 	subdivision 5, and 256L.035,and shall pay co-payments to the
55.22 	managed care plan or to its participating providers.  The
55.23 	enrollee is also responsible for payment of inpatient hospital
55.24 	charges which exceed the MinnesotaCare benefit limit.

55.25 	Sec. 42. [256L.20] MINNESOTACARE OPTION FOR SMALL
55.26 	EMPLOYERS.
55.27 		Subdivision 1.Definitions. (a) For the purpose of this
55.28 	section, the terms used have the meanings given them.
55.29 	(b) "Dependent" means an unmarried child under 21 years of
55.30 	age.
55.31 	(c) "Eligible employer" means a business that employs at
55.32 	least two, but not more than 50, eligible employees, the
55.33 	majority of whom are employed in the state, and includes a
55.34 	municipality that has 50 or fewer employees.
55.35 	(d) "Eligible employee" means an employee who works at
55.36 	least 20 hours per week for an eligible employer.  Eligible
56.1 	employee does not include an employee who works on a temporary
56.2 	or substitute basis or who does not work more than 26 weeks
56.3 	annually.
56.4 	(e) "Maximum premium" has the meaning given under section
56.5 	256L.15, subdivision 2, paragraph (b), clause (3).
56.6 	(f) "Participating employer" means an eligible employer who
56.7 	meets the requirements described in subdivision 3 and applies to
56.8 	the commissioner to enroll its eligible employees and their
56.9 	dependents in the MinnesotaCare program.
56.10 	(g) "Program" means the MinnesotaCare program.
56.11 		Subd. 2.Option. Eligible employees and their dependents
56.12 	may enroll in MinnesotaCare if the eligible employer meets the
56.13 	requirements of subdivision 3.  The effective date of coverage
56.14 	is according to section 256L.05, subdivision 3.
56.15 		Subd. 3.Employer requirements. The commissioner shall
56.16 	establish procedures for an eligible employer to apply for
56.17 	coverage through the program.  In order to participate, an
56.18 	eligible employer must meet the following requirements:
56.19 	(1) agrees to contribute toward the cost of the premium for
56.20 	the employee and the employee's dependents according to
56.21 	subdivision 4;
56.22 	(2) certifies that at least 75 percent of its eligible
56.23 	employees who do not have other creditable health coverage are
56.24 	enrolled in the program;
56.25 	(3) offers coverage to all eligible employees and the
56.26 	dependents of eligible employees; and 
56.27 	(4) has not provided employer-subsidized health coverage as
56.28 	an employee benefit during the previous 12 months, as defined in
56.29 	section 256L.07, subdivision 2, paragraph (c).
56.30 		Subd. 4.Premiums. (a) The premium for MinnesotaCare
56.31 	coverage provided under this section is equal to the maximum
56.32 	premium regardless of the income of the eligible employee.
56.33 	(b) For eligible employees without dependents with income
56.34 	equal to or less than 175 percent of the federal poverty
56.35 	guidelines and for eligible employees with dependents with
56.36 	income equal to or less than 275 percent of the federal poverty
57.1 	guidelines, the participating employer shall pay 50 percent of
57.2 	the maximum premium for the eligible employee and any
57.3 	dependents, if applicable.
57.4 	(c) For eligible employees without dependents with income
57.5 	over 175 percent of the federal poverty guidelines and for
57.6 	eligible employees with dependents with income over 275 percent
57.7 	of the federal poverty guidelines, the participating employer
57.8 	shall pay the full cost of the maximum premium for the eligible
57.9 	employee and any dependents, if applicable.  The participating
57.10 	employer may require the employee to pay a portion of the cost
57.11 	of the premium so long as the employer pays 50 percent of the
57.12 	cost.  If the employer requires the employee to pay a portion of
57.13 	the premium, the employee shall pay the portion of the cost to
57.14 	the employer.
57.15 	(d) The commissioner shall collect premium payments from
57.16 	participating employers for eligible employees and their
57.17 	dependents who are covered by the program as provided under this
57.18 	section.  All premiums collected shall be deposited in the
57.19 	health care access fund.
57.20 		Subd. 5.Coverage. The coverage offered to those
57.21 	enrolled in the program under this section must include all
57.22 	health services described under section 256L.03 and all
57.23 	co-payments and coinsurance requirements described under section
57.24 	256L.03, subdivision 5, apply.
57.25 		Subd. 6.Enrollment. Upon payment of the premium, in
57.26 	accordance with this section and section 256L.06, eligible
57.27 	employees and their dependents shall be enrolled in
57.28 	MinnesotaCare.  For purposes of enrollment under this section,
57.29 	income eligibility limits established under sections 256L.04 and
57.30 	256L.07, subdivision 1, and asset limits established under
57.31 	section 256L.17 do not apply.  The barriers established under
57.32 	section 256L.07, subdivision 2 or 3, do not apply to enrollees
57.33 	eligible under this section.  The commissioner may require
57.34 	eligible employees to provide income verification to determine
57.35 	premiums.

57.36 	Sec. 43. Laws 2003, First Special Session chapter 14,
58.1 	article 6, section 65, is amended to read:
58.2 	Sec. 65FEDERAL GRANTS TO MAINTAIN INDEPENDENCE AND
58.3 	EMPLOYMENT.
 58.4 	(a) The commissioner of human services shall seek federal
58.5 	funding to participate in grant activities authorized under
58.6 	Public Law 106-170, the Ticket to Work and Work Incentives
58.7 	Improvement Act of 1999.  The purpose of the federal grant funds
58.8 	are to establish:
58.9 	(1) a demonstration project to improve the availability of
58.10 	health care services and benefits to workers with potentially
58.11 	severe physical or mental impairments that are likely to lead to
58.12 	disability without access to Medicaid services; and
58.13 	(2) a comprehensive initiative to remove employment
58.14 	barriers that includes linkages with non-Medicaid programs,
58.15 	including those administered by the Social Security
58.16 	Administration and the Department of Labor.
58.17 	(b) The state's proposal for a demonstration project in
58.18 	paragraph (a), clause (1), shall focus on assisting workers with:
58.19 	(1) a serious mental illness as defined by the federal
58.20 	Center for Mental Health Services;
58.21 	(2) concurrent mental health and chemical dependency
58.22 	conditions; and 
58.23 	(3) young adults up to the age of 24 who have a physical or
58.24 	mental impairment that is severe and will potentially lead to a
58.25 	determination of disability by the Social Security
58.26 	Administration or state medical review team; and 
58.27 	(4) adults without children who are eligible for
58.28 	MinnesotaCare and who suffer from one or more of the following
58.29 	chronic health conditions:  diabetes, hypertension, coronary
58.30 	artery disease, asthma, thyroid disease, cancer, chronic
58.31 	arthritis, HIV, or multiple sclerosis.
58.32 	(c) The commissioner is authorized to take the actions
58.33 	necessary to design and implement the demonstration project in
58.34 	paragraph (a), clause (1), that include:
58.35 	(1) establishing work-related requirements for
58.36 	participation in the demonstration project;
59.1 	(2) working with stakeholders to establish methods that
59.2 	identify the population that will be served in the demonstration
59.3 	project;
59.4 	(3) seeking funding for activities to design, implement,
59.5 	and evaluate the demonstration project;
59.6 	(4) taking necessary administrative actions to implement
59.7 	the demonstration project by July 1, 2004, or within 180 days of
59.8 	receiving formal notice from the Centers for Medicare and
59.9 	Medicaid Services that a grant has been awarded;
59.10 	(5) establishing limits on income and resources;
59.11 	(6) establishing a method to coordinate health care
59.12 	benefits and payments with other coverage that is available to
59.13 	the participants;
59.14 	(7) establishing premiums based on guidelines that are
59.15 	consistent with those found in Minnesota Statutes, section
59.16 	256B.057, subdivision 9, for employed persons with disabilities;
59.17 	(8) notifying local agencies of potentially eligible
59.18 	individuals in accordance with Minnesota Statutes, section
59.19 	256B.19, subdivision 2c; and
59.20 	(9) limiting the caseload of qualifying individuals
59.21 	participating in the demonstration project.
59.22 	(d) The state's proposal for the comprehensive employment
59.23 	initiative in paragraph (a), clause (2), shall focus on:
59.24 	(1) infrastructure development that creates incentives for
59.25 	greater work effort and participation by people with
59.26 	disabilities or workers with severe physical or mental
59.27 	impairments;
59.28 	(2) consumer access to information and benefit assistance
59.29 	that enables the person to maximize employment and career
59.30 	advancement potential;
59.31 	(3) improved consumer access to essential assistance and
59.32 	support;
59.33 	(4) enhanced linkages between state and federal agencies to
59.34 	decrease the barriers to employment experienced by persons with
59.35 	disabilities or workers with severe physical or mental
59.36 	impairments; and
60.1 	(5) research efforts to provide useful information to guide
60.2 	future policy development on both the state and federal levels.
60.3 	(e) Funds awarded by the federal government for the
60.4 	purposes of this section are appropriated to the commissioner of
60.5 	human services.
60.6 	(f) The commissioner shall report to the chairs of the
60.7 	senate and house of representatives finance divisions having
60.8 	jurisdiction over health care issues on the federal approval of
60.9 	the waiver under this section and the projected savings in the
60.10 	November and February forecasts. Any savings projected for the
60.11 	individuals described in paragraph (b), clause (4), shall be
60.12 	deposited in the health care access fund.
60.13 	The commissioner must consider using the savings to
60.14 	increase GAMC hospital rates to the July 1, 2003 2004, levels as
60.15 	a supplemental budget proposal in the 2004 2005 legislative
60.16 	session.

60.17 	Sec. 44. DISEASE MANAGEMENT PROGRAM ACCOUNTABILITY.
 60.18 	Any savings generated from the disease management
60.19 	initiatives under Minnesota Statutes, section 256B.075, shall be
60.20 	retained by the commissioner of human services and used for
60.21 	provider bonuses in the disease management program as described
60.22 	in Minnesota Statutes, section 256B.075, and for increasing
60.23 	other provider rates within the fee-for-service program.

60.24 	Sec. 45. FEDERAL 340B DRUG PRICING PROGRAM INFORMATION.
 60.25 	The commissioner of human services, in consultation with
60.26 	other state agencies and representatives of health care
60.27 	providers and facilities in the state, shall provide the
60.28 	following information:
60.29 	(1) a description of all health care providers and
60.30 	facilities in the state potentially eligible for designation as
60.31 	a "covered entity" under section 340B of the federal Veterans
60.32 	Health Care Act of 1992, Public Law 102-585, including, but not
60.33 	limited to, all hospitals eligible as disproportionate share
60.34 	hospitals; recipients of grants from the United States Public
60.35 	Health Service; federally qualified health centers;
60.36 	state-operated AIDS drug assistance programs; Ryan White Care
61.1 	Act, title I, title II, and title III programs; family planning
61.2 	and sexually transmitted disease clinics; hemophilia treatment
61.3 	centers; public housing primary care clinics; and clinics for
61.4 	homeless people.  The commissioner may encourage those
61.5 	facilities that are or may be eligible to participate in the
61.6 	program and may provide any necessary technical assistance to
61.7 	access the program; and 
61.8 	(2) a list of potential applications of section 340B and
61.9 	the potential benefits to public, private, and third-party
61.10 	payers, including, but not limited to:
61.11 	(i) evaluating methods to allow community mental health
61.12 	patients to obtain medications through 340B providers;
61.13 	(ii) maximizing the use of 340B providers within
61.14 	state-funded managed care plans;
61.15 	(iii) including 340B providers in state bulk purchasing
61.16 	initiatives; and 
61.17 	(iv) utilizing sole source contracts with 340B providers to
61.18 	furnish high-cost chronic care drugs.

61.19 	Sec. 46. LIMITING COVERAGE OF HEALTH CARE SERVICES FOR
61.20 	MEDICAL ASSISTANCE, GENERAL ASSISTANCE MEDICAL CARE, AND
61.21 	MINNESOTACARE PROGRAMS.
 61.22 		Subdivision 1.General assistance medical care and
61.23 	minnesotacare. (a) Effective July 1, 2005, the
61.24 	diagnosis/treatment pairings described in subdivision 3 shall
61.25 	not be covered under the general assistance medical care program
61.26 	or under the MinnesotaCare program for persons eligible under
61.27 	Minnesota Statutes, section 256L.04, subdivision 7.
61.28 	(b) This subdivision expires July 1, 2007, or when a list
61.29 	is established according to Minnesota Statutes, section
61.30 	256B.0625, subdivision 46, whichever is earlier.
61.31 		Subd. 2.Prior authorization of services for medical
61.32 	assistance. (a) Effective July 1, 2005, prior authorization is
61.33 	required for the diagnosis/treatment pairings described in
61.34 	subdivision 3 for reimbursement under Minnesota Statutes,
61.35 	chapter 256B, and under the MinnesotaCare program for persons
61.36 	eligible under Minnesota Statutes, section 256L.04, subdivision
62.1 	1.
62.2 	(b) This subdivision expires July 1, 2007, or when a list
62.3 	is established according to Minnesota Statutes, section
62.4 	256B.0625, subdivision 46, whichever is earlier.
62.5 		Subd. 3.List of diagnosis/treatment pairings. (a)(1)
62.6 	Diagnosis:  TRIGEMINAL AND OTHER NERVE DISORDERS 
62.7 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
62.8 	ICD-9:  350,352 
62.9 	(2) Diagnosis:  DISRUPTIONS OF THE LIGAMENTS AND TENDONS OF
62.10 	THE ARMS AND LEGS, EXCLUDING THE KNEE, GRADE II AND III 
62.11 	Treatment:  REPAIR 
62.12 	ICD-9:  726.5, 727.59, 727.62-727.65, 727.68-727.69, 728.83,
62.13 	728.89, 840.0-840.3, 840.5-840.9, 841-843, 845.0
62.14 	(3) Diagnosis:  DISORDERS OF SHOULDER 
62.15 	Treatment:  REPAIR/RECONSTRUCTION 
62.16 	ICD-9:  718.01, 718.11, 718.21, 718.31, 718.41, 718.51, 718.81,
62.17 	726.0, 726.10-726.11, 726.19, 726.2, 727.61, 840.4, 840.7
62.18 	(4) Diagnosis:  INTERNAL DERANGEMENT OF KNEE AND
62.19 	LIGAMENTOUS DISRUPTIONS OF THE KNEE, GRADE II AND III 
62.20 	Treatment:  REPAIR, MEDICAL THERAPY 
62.21 	ICD-9:  717.0-717.4, 717.6-717.8, 718.26, 718.36, 718.46,
62.22 	718.56, 727.66, 836.0-836.2, 844 
62.23 	(5) Diagnosis:  MALUNION AND NONUNION OF FRACTURE 
62.24 	Treatment:  SURGICAL TREATMENT 
62.25 	ICD-9:  733.8
62.26 	(6) Diagnosis:  FOREIGN BODY IN UTERUS, VULVA AND VAGINA 
62.27 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
62.28 	ICD-9:  939.1-939.2 
62.29 	(7) Diagnosis:  UTERINE PROLAPSE; CYSTOCELE 
62.30 	Treatment:  SURGICAL REPAIR 
62.31 	ICD-9:  618 
62.32 	(8) Diagnosis:  OSTEOARTHRITIS AND ALLIED DISORDERS 
62.33 	Treatment:  MEDICAL THERAPY, INJECTIONS 
62.34 	ICD-9:  713.5, 715, 716.0-716.1, 716.5-716.6 
62.35 	(9) Diagnosis:  METABOLIC BONE DISEASE 
62.36 	Treatment:  MEDICAL THERAPY 
63.1 	ICD-9:  731.0, 733.0
63.2 	(10) Diagnosis:  SYMPTOMATIC IMPACTED TEETH 
63.3 	Treatment:  SURGERY 
63.4 	ICD-9:  520.6, 524.3-524.4 
63.5 	(11) Diagnosis:  UNSPECIFIED DISEASE OF HARD TISSUES OF
63.6 	TEETH (AVULSION) 
63.7 	Treatment:  INTERDENTAL WIRING 
63.8 	ICD-9:  525.9
63.9 	(12) Diagnosis:  ABSCESSES AND CYSTS OF BARTHOLIN'S GLAND
63.10 	AND VULVA 
63.11 	Treatment:  INCISION AND DRAINAGE, MEDICAL THERAPY 
63.12 	ICD-9:  616.2-616.9 
63.13 	(13) Diagnosis:  CERVICITIS, ENDOCERVICITIS, HEMATOMA OF
63.14 	VULVA, AND NONINFLAMMATORY DISORDERS OF THE VAGINA 
63.15 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
63.16 	ICD-9:  616.0, 623.6, 623.8-623.9, 624.5
63.17 	(14) Diagnosis:  DENTAL CONDITIONS (e.g., TOOTH LOSS) 
63.18 	Treatment:  SPACE MAINTENANCE AND PERIODONTAL MAINTENANCE 
63.19 	ICD-9:  V72.2 
63.20 	(15) Diagnosis:  URINARY INCONTINENCE 
63.21 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
63.22 	ICD-9:  599.81, 625.6, 788.31-788.33 
63.23 	(16) Diagnosis:  HYPOSPADIAS AND EPISPADIAS 
63.24 	Treatment:  REPAIR 
63.25 	ICD-9:  752.6
63.26 	(17) Diagnosis:  RESIDUAL FOREIGN BODY IN SOFT TISSUE 
63.27 	Treatment:  REMOVAL 
63.28 	ICD-9:  374.86, 729.6, 883.1-883.2 
63.29 	(18) Diagnosis:  BRANCHIAL CLEFT CYST 
63.30 	Treatment:  EXCISION, MEDICAL THERAPY 
63.31 	ICD-9:  744.41-744.46, 744.49, 759.2
63.32 	(19) Diagnosis:  EXFOLIATION OF TEETH DUE TO SYSTEMIC
63.33 	CAUSES; SPECIFIC DISORDERS OF THE TEETH AND SUPPORTING
63.34 	STRUCTURES 
63.35 	Treatment:  EXCISION OF DENTOALVEOLAR STRUCTURE 
63.36 	ICD-9:  525.0, 525.8, 525.11
64.1 	(20) Diagnosis:  PTOSIS (ACQUIRED) WITH VISION IMPAIRMENT 
64.2 	Treatment:  PTOSIS REPAIR 
64.3 	ICD-9:  374.2-374.3, 374.41, 374.43, 374.46
64.4 	(21) Diagnosis:  SIMPLE AND SOCIAL PHOBIAS 
64.5 	Treatment:  MEDICAL/PSYCHOTHERAPY 
64.6 	ICD-9:  300.23, 300.29
64.7 	(22) Diagnosis:  RETAINED DENTAL ROOT 
64.8 	Treatment:  EXCISION OF DENTOALVEOLAR STRUCTURE 
64.9 	ICD-9:  525.3
64.10 	(23) Diagnosis:  PERIPHERAL NERVE ENTRAPMENT 
64.11 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
64.12 	ICD-9:  354.0, 354.2, 355.5, 723.3, 728.6
64.13 	(24) Diagnosis:  INCONTINENCE OF FECES 
64.14 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
64.15 	ICD-9:  787.6
64.16 	(25) Diagnosis:  RECTAL PROLAPSE 
64.17 	Treatment:  PARTIAL COLECTOMY 
64.18 	ICD-9:  569.1-569.2 
64.19 	(26) Diagnosis:  BENIGN NEOPLASM OF KIDNEY AND OTHER
64.20 	URINARY ORGANS 
64.21 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
64.22 	ICD-9:  223 
64.23 	(27) Diagnosis:  URETHRAL FISTULA 
64.24 	Treatment:  EXCISION, MEDICAL THERAPY 
64.25 	ICD-9:  599.1-599.2, 599.4
64.26 	(28) Diagnosis:  THROMBOSED AND COMPLICATED HEMORRHOIDS 
64.27 	Treatment:  HEMORRHOIDECTOMY, INCISION 
64.28 	ICD-9:  455.1-455.2, 455.4-455.5, 455.7-455.8 
64.29 	(29) Diagnosis:  VAGINITIS, TRICHOMONIASIS 
64.30 	Treatment:  MEDICAL THERAPY 
64.31 	ICD-9:  112.1, 131, 616.1, 623.5
64.32 	(30) Diagnosis:  BALANOPOSTHITIS AND OTHER DISORDERS OF
64.33 	PENIS 
64.34 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
64.35 	ICD-9:  607.1, 607.81-607.83, 607.89
64.36 	(31) Diagnosis:  CHRONIC ANAL FISSURE; ANAL FISTULA 
65.1 	Treatment:  SPHINCTEROTOMY, FISSURECTOMY, FISTULECTOMY, MEDICAL
65.2 	THERAPY 
65.3 	ICD-9:  565.0-565.1 
65.4 	(32) Diagnosis:  CHRONIC OTITIS MEDIA 
65.5 	Treatment:  PE TUBES/ADENOIDECTOMY/TYMPANOPLASTY, MEDICAL
65.6 	THERAPY 
65.7 	ICD-9:  380.5, 381.1-381.8, 382.1-382.3, 382.9, 383.1-383.2,
65.8 	383.30-383.31, 383.9, 384.2, 384.8-384.9 
65.9 	(33) Diagnosis:  ACUTE CONJUNCTIVITIS 
65.10 	Treatment:  MEDICAL THERAPY 
65.11 	ICD-9:  077, 372.00
65.12 	(34) Diagnosis:  CERUMEN IMPACTION, FOREIGN BODY IN EAR &
65.13 	NOSE 
65.14 	Treatment:  REMOVAL OF FOREIGN BODY 
65.15 	ICD-9:  380.4, 931-932 
65.16 	(35) Diagnosis:  VERTIGINOUS SYNDROMES AND OTHER DISORDERS
65.17 	OF VESTIBULAR SYSTEM 
65.18 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
65.19 	ICD-9:  379.54, 386.1-386.2, 386.4-386.9, 438.6-438.7,
65.20 	438.83-438.85 
65.21 	(36) Diagnosis:  UNSPECIFIED URINARY OBSTRUCTION AND BENIGN
65.22 	PROSTATIC HYPERPLASIA WITHOUT OBSTRUCTION 
65.23 	Treatment:  MEDICAL THERAPY 
65.24 	ICD-9:  599.6, 600 
65.25 	(37) Diagnosis:  PHIMOSIS 
65.26 	Treatment:  SURGICAL TREATMENT 
65.27 	ICD-9:  605 
65.28 	(38) Diagnosis:  CONTACT DERMATITIS, ATOPIC DERMATITIS AND
65.29 	OTHER ECZEMA 
65.30 	Treatment:  MEDICAL THERAPY 
65.31 	ICD-9:  691.8, 692.0-692.6, 692.70-692.74, 692.79, 692.8-692.9 
65.32 	(39) Diagnosis:  PSORIASIS AND SIMILAR DISORDERS 
65.33 	Treatment:  MEDICAL THERAPY 
65.34 	ICD-9:  696.1-696.2, 696.8
65.35 	(40) Diagnosis:  CYSTIC ACNE 
65.36 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
66.1 	ICD-9:  705.83, 706.0-706.1 
66.2 	(41) Diagnosis:  CLOSED FRACTURE OF GREAT TOE 
66.3 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
66.4 	ICD-9:  826.0
66.5 	(42) Diagnosis:  SYMPTOMATIC URTICARIA 
66.6 	Treatment:  MEDICAL THERAPY 
66.7 	ICD-9:  708.0-708.1, 708.5, 708.8, 995.7
66.8 	(43) Diagnosis:  PERIPHERAL NERVE DISORDERS 
66.9 	Treatment:  SURGICAL TREATMENT 
66.10 	ICD-9:  337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 355.4,
66.11 	355.7-355.8, 723.2
66.12 	(44) Diagnosis:  DYSFUNCTION OF NASOLACRIMAL SYSTEM;
66.13 	LACRIMAL SYSTEM LACERATION 
66.14 	Treatment:  MEDICAL AND SURGICAL TREATMENT; CLOSURE 
66.15 	ICD-9:  370.33, 375, 870.2
66.16 	(45) Diagnosis:  NASAL POLYPS, OTHER DISORDERS OF NASAL
66.17 	CAVITY AND SINUSES 
66.18 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
66.19 	ICD-9:  471, 478.1, 993.1
66.20 	(46) Diagnosis:  SIALOLITHIASIS, MUCOCELE, DISTURBANCE OF
66.21 	SALIVARY SECRETION, OTHER AND UNSPECIFIED DISEASES OF SALIVARY
66.22 	GLANDS 
66.23 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
66.24 	ICD-9:  527.5-527.9 
66.25 	(47) Diagnosis:  DENTAL CONDITIONS (e.g., BROKEN APPLIANCES) 
66.26 	Treatment:  PERIODONTICS AND COMPLEX PROSTHETICS 
66.27 	ICD-9:  522.6, 522.8, V72.2 
66.28 	(48) Diagnosis:  IMPULSE DISORDERS 
66.29 	Treatment:  MEDICAL/PSYCHOTHERAPY 
66.30 	ICD-9:  312.31-312.39 
66.31 	(49) Diagnosis:  BENIGN NEOPLASM BONE AND ARTICULAR
66.32 	CARTILAGE, INCLUDING OSTEOID OSTEOMAS; BENIGN NEOPLASM OF
66.33 	CONNECTIVE AND OTHER SOFT TISSUE 
66.34 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
66.35 	ICD-9:  213, 215, 526.0-526.1, 526.81, 719.2, 733.2
66.36 	(50) Diagnosis:  SEXUAL DYSFUNCTION 
67.1 	Treatment:  MEDICAL AND SURGICAL TREATMENT, PSYCHOTHERAPY 
67.2 	ICD-9:  302.7, 607.84
67.3 	(51) Diagnosis:  STOMATITIS AND DISEASES OF LIPS 
67.4 	Treatment:  INCISION AND DRAINAGE/MEDICAL THERAPY 
67.5 	ICD-9:  528.0, 528.5, 528.9, 529.0
67.6 	(52) Diagnosis:  BELL'S PALSY, EXPOSURE
67.7 	KERATOCONJUNCTIVITIS 
67.8 	Treatment:  TARSORRHAPHY 
67.9 	ICD-9:  351.0-351.1, 351.8-351.9, 370.34, 374.44, 374.45, 374.89
67.10 	(53) Diagnosis:  HORDEOLUM AND OTHER DEEP INFLAMMATION OF
67.11 	EYELID; CHALAZION 
67.12 	Treatment:  INCISION AND DRAINAGE/MEDICAL THERAPY 
67.13 	ICD-9:  373.11-373.12, 373.2, 374.50, 374.54, 374.56, 374.84
67.14 	(54) Diagnosis:  ECTROPION, TRICHIASIS OF EYELID, BENIGN
67.15 	NEOPLASM OF EYELID 
67.16 	Treatment:  ECTROPION REPAIR 
67.17 	ICD-9:  216.1, 224, 372.63, 374.1, 374.85
67.18 	(55) Diagnosis:  CHONDROMALACIA 
67.19 	Treatment:  MEDICAL THERAPY 
67.20 	ICD-9:  733.92
67.21 	(56) Diagnosis:  DYSMENORRHEA 
67.22 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
67.23 	ICD-9:  625.3
67.24 	(57) Diagnosis:  SPASTIC DIPLEGIA 
67.25 	Treatment:  RHIZOTOMY 
67.26 	ICD-9:  343.0
67.27 	(58) Diagnosis:  ATROPHY OF EDENTULOUS ALVEOLAR RIDGE 
67.28 	Treatment:  VESTIBULOPLASTY, GRAFTS, IMPLANTS 
67.29 	ICD-9:  525.2
67.30 	(59) Diagnosis:  DEFORMITIES OF UPPER BODY AND ALL LIMBS 
67.31 	Treatment:  REPAIR/REVISION/RECONSTRUCTION/RELOCATION/MEDICAL
67.32 	THERAPY 
67.33 	ICD-9:  718.02-718.05, 718.13-718.15, 718.42-718.46,
67.34 	718.52-718.56, 718.65, 718.82-718.86, 728.79, 732.3, 732.6,
67.35 	732.8-732.9, 733.90-733.91, 736.00-736.04, 736.07, 736.09,
67.36 	736.1, 736.20, 736.29, 736.30, 736.39, 736.4, 736.6, 736.76,
68.1 	736.79, 736.89, 736.9, 738.6, 738.8, 754.42-754.44, 754.61,
68.2 	754.8, 755.50-755.53, 755.56-755.57, 755.59, 755.60,
68.3 	755.63-755.64, 755.69, 755.8, 756.82-756.83, 756.89
68.4 	(60) Diagnosis:  DEFORMITIES OF FOOT 
68.5 	Treatment:  FASCIOTOMY/INCISION/REPAIR/ARTHRODESIS 
68.6 	ICD-9:  718.07, 718.47, 718.57, 718.87, 727.1, 732.5,
68.7 	735.0-735.2, 735.3-735.9, 736.70-736.72, 754.50, 754.59, 754.60,
68.8 	754.69, 754.70, 754.79, 755.65-755.67 
68.9 	(61) Diagnosis:  PERITONEAL ADHESION 
68.10 	Treatment:  SURGICAL TREATMENT 
68.11 	ICD-9:  568.0, 568.82-568.89, 568.9
68.12 	(62) Diagnosis:  PELVIC PAIN SYNDROME, DYSPAREUNIA 
68.13 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
68.14 	ICD-9:  300.81, 614.1, 614.6, 620.6, 625.0-625.2, 625.5,
68.15 	625.8-625.9 
68.16 	(63) Diagnosis:  TENSION HEADACHES 
68.17 	Treatment:  MEDICAL THERAPY 
68.18 	ICD-9:  307.81, 784.0
68.19 	(64) Diagnosis:  CHRONIC BRONCHITIS 
68.20 	Treatment:  MEDICAL THERAPY 
68.21 	ICD-9:  490, 491.0, 491.8-491.9 
68.22 	(65) Diagnosis:  DISORDERS OF FUNCTION OF STOMACH AND OTHER
68.23 	FUNCTIONAL DIGESTIVE DISORDERS 
68.24 	Treatment:  MEDICAL THERAPY 
68.25 	ICD-9:  536.0-536.3, 536.8-536.9, 537.1-537.2, 537.5-537.6,
68.26 	537.89, 537.9, 564.0-564.7, 564.9
68.27 	(66) Diagnosis:  TMJ DISORDER 
68.28 	Treatment:  TMJ SPLINTS 
68.29 	ICD-9:  524.6, 848.1
68.30 	(67) Diagnosis:  URETHRITIS, NONSEXUALLY TRANSMITTED 
68.31 	Treatment:  MEDICAL THERAPY 
68.32 	ICD-9:  597.8, 599.3-599.5, 599.9
68.33 	(68) Diagnosis:  LESION OF PLANTAR NERVE; PLANTAR FASCIAL
68.34 	FIBROMATOSIS 
68.35 	Treatment:  MEDICAL THERAPY, EXCISION 
68.36 	ICD-9:  355.6, 728.71
69.1 	(69) Diagnosis:  GRANULOMA OF MUSCLE, GRANULOMA OF SKIN AND
69.2 	SUBCUTANEOUS TISSUE 
69.3 	Treatment:  REMOVAL OF GRANULOMA 
69.4 	ICD-9:  709.4, 728.82
69.5 	(70) Diagnosis:  DERMATOPHYTOSIS OF NAIL, GROIN, AND FOOT
69.6 	AND OTHER DERMATOMYCOSIS 
69.7 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
69.8 	ICD-9:  110.0-110.6, 110.8-110.9, 111 
69.9 	(71) Diagnosis:  INTERNAL DERANGEMENT OF JOINT OTHER THAN
69.10 	KNEE 
69.11 	Treatment:  REPAIR, MEDICAL THERAPY 
69.12 	ICD-9:  718.09, 718.19, 718.29, 718.48, 718.59, 718.88-718.89,
69.13 	719.81-719.85, 719.87-719.89 
69.14 	(72) Diagnosis:  STENOSIS OF NASOLACRIMAL DUCT (ACQUIRED) 
69.15 	Treatment:  DACRYOCYSTORHINOSTOMY 
69.16 	ICD-9:  375.02, 375.30, 375.32, 375.4, 375.56-375.57, 375.61,
69.17 	771.6 
69.18 	(73) Diagnosis:  PERIPHERAL NERVE DISORDERS 
69.19 	Treatment:  SURGICAL TREATMENT 
69.20 	ICD-9:  337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3, 355.4,
69.21 	355.7-355.8, 723.2
69.22 	(74) Diagnosis:  CAVUS DEFORMITY OF FOOT; FLAT FOOT;
69.23 	POLYDACTYLY AND SYNDACTYLY OF TOES 
69.24 	Treatment:  MEDICAL THERAPY, ORTHOTIC 
69.25 	ICD-9:  734, 736.73, 755.00, 755.02, 755.10, 755.13-755.14 
69.26 	(75) Diagnosis:  PERIPHERAL ENTHESOPATHIES 
69.27 	Treatment:  SURGICAL TREATMENT 
69.28 	ICD-9:  726.12, 726.3-726.9, 728.81
69.29 	(76) Diagnosis:  PERIPHERAL ENTHESOPATHIES 
69.30 	Treatment:  MEDICAL THERAPY 
69.31 	ICD-9:  726.12, 726.3-726.4, 726.6-726.9, 728.81
69.32 	(77) Diagnosis:  DISORDERS OF SOFT TISSUE 
69.33 	Treatment:  MEDICAL THERAPY 
69.34 	ICD-9:  729.0-729.2, 729.31-729.39, 729.4-729.9 
69.35 	(78) Diagnosis:  ENOPHTHALMOS 
69.36 	Treatment:  ORBITAL IMPLANT 
70.1 	ICD-9:  372.64, 376.5
70.2 	(79) Diagnosis:  MACROMASTIA 
70.3 	Treatment:  SUBCUTANEOUS TOTAL MASTECTOMY, BREAST REDUCTION 
70.4 	ICD-9:  611.1
70.5 	(80) Diagnosis:  GALACTORRHEA, MASTODYNIA, ATROPHY, BENIGN
70.6 	NEOPLASMS AND UNSPECIFIED DISORDERS OF THE BREAST 
70.7 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
70.8 	ICD-9:  217, 611.3, 611.4, 611.6, 611.71, 611.9, 757.6
70.9 	(81) Diagnosis:  ACUTE AND CHRONIC DISORDERS OF SPINE
70.10 	WITHOUT NEUROLOGIC IMPAIRMENT 
70.11 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
70.12 	ICD-9:  721.0, 721.2-721.3, 721.7-721.8, 721.90, 722.0-722.6,
70.13 	722.8-722.9, 723.1, 723.5-723.9, 724.1-724.2, 724.5-724.9, 739,
70.14 	839.2, 847 
70.15 	(82) Diagnosis:  CYSTS OF ORAL SOFT TISSUES 
70.16 	Treatment:  INCISION AND DRAINAGE 
70.17 	ICD-9:  527.1, 528.4, 528.8
70.18 	(83) Diagnosis:  FEMALE INFERTILITY, MALE INFERTILITY 
70.19 	Treatment:  ARTIFICIAL INSEMINATION, MEDICAL THERAPY 
70.20 	ICD-9:  606, 628.4-628.9, 629.9, V26.1-V26.2, V26.8-V26.9 
70.21 	(84) Diagnosis:  INFERTILITY DUE TO ANNOVULATION 
70.22 	Treatment:  MEDICAL THERAPY 
70.23 	ICD-9:  626.0-626.1, 628.0, 628.1
70.24 	(85) Diagnosis:  POSTCONCUSSION SYNDROME 
70.25 	Treatment:  MEDICAL THERAPY 
70.26 	ICD-9:  310.2
70.27 	(86) Diagnosis:  SIMPLE AND UNSPECIFIED GOITER, NONTOXIC
70.28 	NODULAR GOITER 
70.29 	Treatment:  MEDICAL THERAPY, THYROIDECTOMY 
70.30 	ICD-9:  240-241 
70.31 	(87) Diagnosis:  CONDUCTIVE HEARING LOSS 
70.32 	Treatment:  AUDIANT BONE CONDUCTORS 
70.33 	ICD-9:  389.0, 389.2
70.34 	(88) Diagnosis:  CANCER OF LIVER AND INTRAHEPATIC BILE
70.35 	DUCTS 
70.36 	Treatment:  LIVER TRANSPLANT 
71.1 	ICD-9:  155.0-155.1, 996.82
71.2 	(89) Diagnosis:  HYPOTENSION 
71.3 	Treatment:  MEDICAL THERAPY 
71.4 	ICD-9:  458 
71.5 	(90) Diagnosis:  VIRAL HEPATITIS, EXCLUDING CHRONIC VIRAL
71.6 	HEPATITIS B AND VIRAL HEPATITIS C WITHOUT HEPATIC COMA 
71.7 	Treatment:  MEDICAL THERAPY 
71.8 	ICD-9:  070.0-070.2, 070.30-070.31, 070.33, 070.4,
71.9 	070.52-070.53, 070.59, 070.6-070.9 
71.10 	(91) Diagnosis:  BENIGN NEOPLASMS OF SKIN AND OTHER SOFT
71.11 	TISSUES 
71.12 	Treatment:  MEDICAL THERAPY 
71.13 	ICD-9:  210, 214, 216, 221, 222.1, 222.4, 228.00-228.01, 228.1,
71.14 	229, 686.1, 686.9
71.15 	(92) Diagnosis:  REDUNDANT PREPUCE 
71.16 	Treatment:  ELECTIVE CIRCUMCISION 
71.17 	ICD-9:  605, V50.2 
71.18 	(93) Diagnosis:  BENIGN NEOPLASMS OF DIGESTIVE SYSTEM 
71.19 	Treatment:  SURGICAL TREATMENT 
71.20 	ICD-9:  211.0-211.2, 211.5-211.6, 211.8-211.9 
71.21 	(94) Diagnosis:  OTHER NONINFECTIOUS GASTROENTERITIS AND
71.22 	COLITIS 
71.23 	Treatment:  MEDICAL THERAPY 
71.24 	ICD-9:  558 
71.25 	(95) Diagnosis:  FACTITIOUS DISORDERS 
71.26 	Treatment:  CONSULTATION 
71.27 	ICD-9:  300.10, 300.16, 300.19, 301.51
71.28 	(96) Diagnosis:  HYPOCHONDRIASIS; SOMATOFORM DISORDER, NOS
71.29 	AND UNDIFFERENTIATED 
71.30 	Treatment:  CONSULTATION 
71.31 	ICD-9:  300.7, 300.9, 306 
71.32 	(97) Diagnosis:  CONVERSION DISORDER, ADULT 
71.33 	Treatment:  MEDICAL/PSYCHOTHERAPY 
71.34 	ICD-9:  300.11
71.35 	(98) Diagnosis:  SPINAL DEFORMITY, NOT CLINICALLY
71.36 	SIGNIFICANT 
72.1 	Treatment:  ARTHRODESIS/REPAIR/RECONSTRUCTION, MEDICAL THERAPY 
72.2 	ICD-9:  721.5-721.6, 723.0, 724.0, 731.0, 737.0-737.3,
72.3 	737.8-737.9, 738.4-738.5, 754.1-754.2, 756.10-756.12,
72.4 	756.13-756.17, 756.19, 756.3
72.5 	(99) Diagnosis:  ASYMPTOMATIC URTICARIA 
72.6 	Treatment:  MEDICAL THERAPY 
72.7 	ICD-9:  708.2-708.4, 708.9
72.8 	(100) Diagnosis:  CIRCUMSCRIBED SCLERODERMA; SENILE PURPURA 
72.9 	Treatment:  MEDICAL THERAPY 
72.10 	ICD-9:  287.2, 287.8-287.9, 701.0
72.11 	(101) Diagnosis:  DERMATITIS DUE TO SUBSTANCES TAKEN
72.12 	INTERNALLY 
72.13 	Treatment:  MEDICAL THERAPY 
72.14 	ICD-9:  693 
72.15 	(102) Diagnosis:  ALLERGIC RHINITIS AND CONJUNCTIVITIS,
72.16 	CHRONIC RHINITIS 
72.17 	Treatment:  MEDICAL THERAPY 
72.18 	ICD-9:  372.01-372.05, 372.14, 372.54, 372.56, 472, 477, 955.3,
72.19 	V07.1 
72.20 	(103) Diagnosis:  PLEURISY 
72.21 	Treatment:  MEDICAL THERAPY 
72.22 	ICD-9:  511.0, 511.9
72.23 	(104) Diagnosis:  CONJUNCTIVAL CYST 
72.24 	Treatment:  EXCISION OF CONJUNCTIVAL CYST 
72.25 	ICD-9:  372.61-372.62, 372.71-372.72, 372.74-372.75 
72.26 	(105) Diagnosis:  HEMATOMA OF AURICLE OR PINNA AND HEMATOMA
72.27 	OF EXTERNAL EAR 
72.28 	Treatment:  DRAINAGE 
72.29 	ICD-9:  380.3, 380.8, 738.7
72.30 	(106) Diagnosis:  ACUTE NONSUPPURATIVE LABYRINTHITIS 
72.31 	Treatment:  MEDICAL THERAPY 
72.32 	ICD-9:  386.30-386.32, 386.34-386.35 
72.33 	(107) Diagnosis:  INFECTIOUS MONONUCLEOSIS 
72.34 	Treatment:  MEDICAL THERAPY 
72.35 	ICD-9:  075 
72.36 	(108) Diagnosis:  ASEPTIC MENINGITIS 
73.1 	Treatment:  MEDICAL THERAPY 
73.2 	ICD-9:  047-049 
73.3 	(109) Diagnosis:  CONGENITAL ANOMALIES OF FEMALE GENITAL
73.4 	ORGANS, EXCLUDING VAGINA 
73.5 	Treatment:  SURGICAL TREATMENT 
73.6 	ICD-9:  752.0-752.3, 752.41
73.7 	(110) Diagnosis:  CONGENITAL DEFORMITIES OF KNEE 
73.8 	Treatment:  ARTHROSCOPIC REPAIR 
73.9 	ICD-9:  755.64, 727.83
73.10 	(111) Diagnosis:  UNCOMPLICATED HERNIA IN ADULTS AGE 18 OR
73.11 	OVER 
73.12 	Treatment:  REPAIR 
73.13 	ICD-9:  550.9, 553.0-553.2, 553.8-553.9 
73.14 	(112) Diagnosis:  ACUTE ANAL FISSURE 
73.15 	Treatment:  FISSURECTOMY, MEDICAL THERAPY 
73.16 	ICD-9:  565.0
73.17 	(113) Diagnosis:  CYST OF KIDNEY, ACQUIRED 
73.18 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
73.19 	ICD-9:  593.2
73.20 	(114) Diagnosis:  PICA 
73.21 	Treatment:  MEDICAL/PSYCHOTHERAPY 
73.22 	ICD-9:  307.52
73.23 	(115) Diagnosis:  DISORDERS OF SLEEP WITHOUT SLEEP APNEA 
73.24 	Treatment:  MEDICAL THERAPY 
73.25 	ICD-9:  307.41-307.45, 307.47-307.49, 780.50, 780.52,
73.26 	780.54-780.56, 780.59
73.27 	(116) Diagnosis:  CYST, HEMORRHAGE, AND INFARCTION OF
73.28 	THYROID 
73.29 	Treatment:  SURGERY - EXCISION 
73.30 	ICD-9:  246.2, 246.3, 246.9
73.31 	(117) Diagnosis:  DEVIATED NASAL SEPTUM, ACQUIRED DEFORMITY
73.32 	OF NOSE, OTHER DISEASES OF UPPER RESPIRATORY TRACT 
73.33 	Treatment:  EXCISION OF CYST/RHINECTOMY/PROSTHESIS 
73.34 	ICD-9:  470, 478.0, 738.0, 754.0
73.35 	(118) Diagnosis:  ERYTHEMA MULTIFORM 
73.36 	Treatment:  MEDICAL THERAPY 
74.1 	ICD-9:  695.1
74.2 	(119) Diagnosis:  HERPES SIMPLEX WITHOUT COMPLICATIONS 
74.3 	Treatment:  MEDICAL THERAPY 
74.4 	ICD-9:  054.2, 054.6, 054.73, 054.9
74.5 	(120) Diagnosis:  CONGENITAL ANOMALIES OF THE EAR WITHOUT
74.6 	IMPAIRMENT OF HEARING; UNILATERAL ANOMALIES OF THE EAR 
74.7 	Treatment:  OTOPLASTY, REPAIR AND AMPUTATION 
74.8 	ICD-9:  744.00-744.04, 744.09, 744.1-744.3 
74.9 	(121) Diagnosis:  BLEPHARITIS 
74.10 	Treatment:  MEDICAL THERAPY 
74.11 	ICD-9:  373.0, 373.8-373.9, 374.87
74.12 	(122) Diagnosis:  HYPERTELORISM OF ORBIT 
74.13 	Treatment:  ORBITOTOMY 
74.14 	ICD-9:  376.41
74.15 	(123) Diagnosis:  INFERTILITY DUE TO TUBAL DISEASE 
74.16 	Treatment:  MICROSURGERY 
74.17 	ICD-9:  608.85, 622.5, 628.2-628.3, 629.9, V26.0 
74.18 	(124) Diagnosis:  KERATODERMA, ACANTHOSIS NIGRICANS, STRIAE
74.19 	ATROPHICAE, AND OTHER HYPERTROPHIC OR ATROPHIC CONDITIONS OF
74.20 	SKIN 
74.21 	Treatment:  MEDICAL THERAPY 
74.22 	ICD-9:  373.3, 690, 698, 701.1-701.3, 701.8, 701.9
74.23 	(125) Diagnosis:  LICHEN PLANUS 
74.24 	Treatment:  MEDICAL THERAPY 
74.25 	ICD-9:  697 
74.26 	(126) Diagnosis:  OBESITY 
74.27 	Treatment:  NUTRITIONAL AND LIFESTYLE COUNSELING 
74.28 	ICD-9:  278.0
74.29 	(127) Diagnosis:  MORBID OBESITY 
74.30 	Treatment:  GASTROPLASTY 
74.31 	ICD-9:  278.01
74.32 	(128) Diagnosis:  CHRONIC DISEASE OF TONSILS AND ADENOIDS 
74.33 	Treatment:  TONSILLECTOMY AND ADENOIDECTOMY 
74.34 	ICD-9:  474.0, 474.1-474.2, 474.9
74.35 	(129) Diagnosis:  HYDROCELE 
74.36 	Treatment:  MEDICAL THERAPY, EXCISION 
75.1 	ICD-9:  603, 608.84, 629.1, 778.6
75.2 	(130) Diagnosis:  KELOID SCAR; OTHER ABNORMAL GRANULATION
75.3 	TISSUE 
75.4 	Treatment:  INTRALESIONAL INJECTIONS/DESTRUCTION/EXCISION,
75.5 	RADIATION THERAPY 
75.6 	ICD-9:  701.4-701.5 
75.7 	(131) Diagnosis:  NONINFLAMMATORY DISORDERS OF CERVIX;
75.8 	HYPERTROPHY OF LABIA 
75.9 	Treatment:  MEDICAL THERAPY 
75.10 	ICD-9:  622.4, 622.6-622.9, 623.4, 624.2-624.3, 624.6-624.9 
75.11 	(132) Diagnosis:  SPRAINS OF JOINTS AND ADJACENT MUSCLES,
75.12 	GRADE I 
75.13 	Treatment:  MEDICAL THERAPY 
75.14 	ICD-9:  355.1-355.3, 355.9, 717, 718.26, 718.36, 718.46, 718.56,
75.15 	836.0-836.2, 840-843, 844.0-844.3, 844.8-844.9, 845.00-845.03,
75.16 	845.1, 846, 848.3, 848.40-848.42, 848.49, 848.5, 848.8-848.9,
75.17 	905.7 
75.18 	(133) Diagnosis:  SYNOVITIS AND TENOSYNOVITIS 
75.19 	Treatment:  MEDICAL THERAPY 
75.20 	ICD-9:  726.12, 727.00, 727.03-727.09 
75.21 	(134) Diagnosis:  OTHER DISORDERS OF SYNOVIUM, TENDON AND
75.22 	BURSA, COSTOCHONDRITIS, AND CHONDRODYSTROPHY 
75.23 	Treatment:  MEDICAL THERAPY 
75.24 	ICD-9:  719.5-719.6, 719.80, 719.86, 727.2-727.3, 727.50,
75.25 	727.60, 727.82, 727.9, 733.5-733.7, 756.4
75.26 	(135) Diagnosis:  DISEASE OF NAILS, HAIR, AND HAIR
75.27 	FOLLICLES 
75.28 	Treatment:  MEDICAL THERAPY 
75.29 	ICD-9:  703.8-703.9, 704.0, 704.1-704.9, 706.3, 706.9,
75.30 	757.4-757.5, V50.0 
75.31 	(136) Diagnosis:  CANDIDIASIS OF MOUTH, SKIN, AND NAILS 
75.32 	Treatment:  MEDICAL THERAPY 
75.33 	ICD-9:  112.0, 112.3, 112.9
75.34 	(137) Diagnosis:  BENIGN LESIONS OF TONGUE 
75.35 	Treatment:  EXCISION 
75.36 	ICD-9:  529.1-529.6, 529.8-529.9 
76.1 	(138) Diagnosis:  MINOR BURNS 
76.2 	Treatment:  MEDICAL THERAPY 
76.3 	ICD-9:  692.76, 941.0-941.2, 942.0-942.2, 943.0-943.2,
76.4 	944.0-944.2, 945.0-945.2, 946.0-946.2, 949.0-949.1 
76.5 	(139) Diagnosis:  MINOR HEAD INJURY:  HEMATOMA/EDEMA WITH
76.6 	NO LOSS OF CONSCIOUSNESS 
76.7 	Treatment:  MEDICAL THERAPY 
76.8 	ICD-9:  800.00-800.01, 801.00-801.01, 803.00-803.01, 850.0,
76.9 	850.9, 851.00-851.01, 851.09, 851.20-851.21, 851.29,
76.10 	851.40-851.41, 851.49, 851.60-851.61, 851.69, 851.80-851.81,
76.11 	851.89 
76.12 	(140) Diagnosis:  CONGENITAL DEFORMITY OF KNEE 
76.13 	Treatment:  MEDICAL THERAPY 
76.14 	ICD-9:  755.64
76.15 	(141) Diagnosis:  PHLEBITIS AND THROMBOPHLEBITIS,
76.16 	SUPERFICIAL 
76.17 	Treatment:  MEDICAL THERAPY 
76.18 	ICD-9:  451.0, 451.2, 451.82, 451.84, 451.89, 451.9
76.19 	(142) Diagnosis:  PROLAPSED URETHRAL MUCOSA 
76.20 	Treatment:  SURGICAL TREATMENT 
76.21 	ICD-9:  599.3, 599.5
76.22 	(143) Diagnosis:  RUPTURE OF SYNOVIUM 
76.23 	Treatment:  REMOVAL OF BAKER'S CYST 
76.24 	ICD-9:  727.51
76.25 	(144) Diagnosis:  PERSONALITY DISORDERS, EXCLUDING
76.26 	BORDERLINE, SCHIZOTYPAL AND ANTISOCIAL 
76.27 	Treatment:  MEDICAL/PSYCHOTHERAPY 
76.28 	ICD-9:  301.0, 301.10-301.12, 301.20-301.21, 301.3-301.4,
76.29 	301.50, 301.59, 301.6, 301.81-301.82, 301.84, 301.89, 301.9
76.30 	(145) Diagnosis:  GENDER IDENTIFICATION DISORDER,
76.31 	PARAPHILIAS AND OTHER PSYCHOSEXUAL DISORDERS 
76.32 	Treatment:  MEDICAL/PSYCHOTHERAPY 
76.33 	ICD-9:  302.0-302.4, 302.50, 302.6, 302.85, 302.9
76.34 	(146) Diagnosis:  FINGERTIP AVULSION 
76.35 	Treatment:  REPAIR WITHOUT PEDICLE GRAFT 
76.36 	ICD-9:  883.0
77.1 	(147) Diagnosis:  ANOMALIES OF RELATIONSHIP OF JAW TO
77.2 	CRANIAL BASE, MAJOR ANOMALIES OF JAW SIZE, OTHER SPECIFIED AND
77.3 	UNSPECIFIED DENTOFACIAL ANOMALIES 
77.4 	Treatment:  OSTEOPLASTY, MAXILLA/MANDIBLE 
77.5 	ICD-9:  524.0-524.2, 524.5, 524.7-524.8, 524.9
77.6 	(148) Diagnosis:  CERVICAL RIB 
77.7 	Treatment:  SURGICAL TREATMENT 
77.8 	ICD-9:  756.2
77.9 	(149) Diagnosis:  GYNECOMASTIA 
77.10 	Treatment:  MASTECTOMY 
77.11 	ICD-9:  611.1
77.12 	(150) Diagnosis:  VIRAL, SELF-LIMITING ENCEPHALITIS,
77.13 	MYELITIS AND ENCEPHALOMYELITIS 
77.14 	Treatment:  MEDICAL THERAPY 
77.15 	ICD-9:  056.0, 056.71, 323.8-323.9 
77.16 	(151) Diagnosis:  GALLSTONES WITHOUT CHOLECYSTITIS 
77.17 	Treatment:  MEDICAL THERAPY, CHOLECYSTECTOMY 
77.18 	ICD-9:  574.2, 575.8
77.19 	(152) Diagnosis:  BENIGN NEOPLASM OF NASAL CAVITIES, MIDDLE
77.20 	EAR AND ACCESSORY SINUSES 
77.21 	Treatment:  EXCISION, RECONSTRUCTION 
77.22 	ICD-9:  212.0
77.23 	(153) Diagnosis:  ACUTE TONSILLITIS OTHER THAN
77.24 	BETA-STREPTOCOCCAL 
77.25 	Treatment:  MEDICAL THERAPY 
77.26 	ICD-9:  463 
77.27 	(154) Diagnosis:  EDEMA AND OTHER CONDITIONS INVOLVING THE
77.28 	INTEGUMENT OF THE FETUS AND NEWBORN 
77.29 	Treatment:  MEDICAL THERAPY 
77.30 	ICD-9:  778.5, 778.7-778.9 
77.31 	(155) Diagnosis:  ACUTE UPPER RESPIRATORY INFECTIONS AND
77.32 	COMMON COLD 
77.33 	Treatment:  MEDICAL THERAPY 
77.34 	ICD-9:  460, 465 
77.35 	(156) Diagnosis:  DIAPER RASH 
77.36 	Treatment:  MEDICAL THERAPY 
78.1 	ICD-9:  691.0
78.2 	(157) Diagnosis:  DISORDERS OF SWEAT GLANDS 
78.3 	Treatment:  MEDICAL THERAPY 
78.4 	ICD-9:  705.0-705.1, 705.81-705.83, 705.89, 705.9, 780.8
78.5 	(158) Diagnosis:  OTHER VIRAL INFECTIONS, EXCLUDING
78.6 	PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER
78.7 	AGE 3 
78.8 	Treatment:  MEDICAL THERAPY 
78.9 	ICD-9:  052, 055, 056.79, 056.8-056.9, 057, 072, 074, 078.0,
78.10 	078.2, 078.4-078.8, 079.0-079.6, 079.88-079.89, 079.9, 480, 487 
78.11 	(159) Diagnosis:  PHARYNGITIS AND LARYNGITIS AND OTHER
78.12 	DISEASES OF VOCAL CORDS 
78.13 	Treatment:  MEDICAL THERAPY 
78.14 	ICD-9:  462, 464.00, 464.50, 476, 478.5
78.15 	(160) Diagnosis:  CORNS AND CALLUSES 
78.16 	Treatment:  MEDICAL THERAPY 
78.17 	ICD-9:  700 
78.18 	(161) Diagnosis:  VIRAL WARTS, EXCLUDING VENEREAL WARTS 
78.19 	Treatment:  MEDICAL AND SURGICAL TREATMENT, CRYOSURGERY 
78.20 	ICD-9:  078.0, 078.10, 078.19
78.21 	(162) Diagnosis:  OLD LACERATION OF CERVIX AND VAGINA 
78.22 	Treatment:  MEDICAL THERAPY 
78.23 	ICD-9:  621.5, 622.3, 624.4
78.24 	(163) Diagnosis:  TONGUE TIE AND OTHER ANOMALIES OF TONGUE 
78.25 	Treatment:  FRENOTOMY, TONGUE TIE 
78.26 	ICD-9:  529.5, 750.0-750.1 
78.27 	(164) Diagnosis:  OPEN WOUND OF INTERNAL STRUCTURES OF
78.28 	MOUTH WITHOUT COMPLICATION 
78.29 	Treatment:  REPAIR SOFT TISSUES 
78.30 	ICD-9:  525.10, 525.12, 525.13, 525.19, 873.6
78.31 	(165) Diagnosis:  CENTRAL SEROUS RETINOPATHY 
78.32 	Treatment:  LASER SURGERY 
78.33 	ICD-9:  362.40-362.41, 362.6-362.7 
78.34 	(166) Diagnosis:  SEBORRHEIC KERATOSIS, DYSCHROMIA, AND
78.35 	VASCULAR DISORDERS, SCAR CONDITIONS, AND FIBROSIS OF SKIN 
78.36 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
79.1 	ICD-9:  278.1, 702.1-702.8, 709.1-709.3, 709.8-709.9 
79.2 	(167) Diagnosis:  UNCOMPLICATED HEMORRHOIDS 
79.3 	Treatment:  HEMORRHOIDECTOMY, MEDICAL THERAPY 
79.4 	ICD-9:  455.0, 455.3, 455.6, 455.9
79.5 	(168) Diagnosis:  GANGLION 
79.6 	Treatment:  EXCISION 
79.7 	ICD-9:  727.02, 727.4
79.8 	(169) Diagnosis:  CHRONIC CONJUNCTIVITIS,
79.9 	BLEPHAROCONJUNCTIVITIS 
79.10 	Treatment:  MEDICAL THERAPY 
79.11 	ICD-9:  372.10-372.13, 372.2-372.3, 372.53, 372.73, 374.55
79.12 	(170) Diagnosis:  TOXIC ERYTHEMA, ACNE ROSACEA, DISCOID
79.13 	LUPUS 
79.14 	Treatment:  MEDICAL THERAPY 
79.15 	ICD-9:  695.0, 695.2-695.9 
79.16 	(171) Diagnosis:  PERIPHERAL NERVE DISORDERS 
79.17 	Treatment:  MEDICAL THERAPY 
79.18 	ICD-9:  337.2, 353, 354.1, 354.3-354.9, 355.0, 355.3,
79.19 	355.7-355.8, 357.5-357.9, 723.2
79.20 	(172) Diagnosis:  OTHER COMPLICATIONS OF A PROCEDURE 
79.21 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
79.22 	ICD-9:  371.82, 457.0, 998.81, 998.9
79.23 	(173) Diagnosis:  RAYNAUD'S SYNDROME 
79.24 	Treatment:  MEDICAL THERAPY 
79.25 	ICD-9:  443.0, 443.89, 443.9
79.26 	(174) Diagnosis:  TMJ DISORDERS 
79.27 	Treatment:  TMJ SURGERY 
79.28 	ICD-9:  524.5, 524.6, 718.08, 718.18, 718.28, 718.38, 718.58
79.29 	(175) Diagnosis:  VARICOSE VEINS OF LOWER EXTREMITIES
79.30 	WITHOUT ULCER OR INFLAMMATION 
79.31 	Treatment:  STRIPPING/SCLEROTHERAPY 
79.32 	ICD-9:  454.9, 459, 607.82
79.33 	(176) Diagnosis:  VULVAL VARICES 
79.34 	Treatment:  VASCULAR SURGERY 
79.35 	ICD-9:  456.6
79.36 	(177) Diagnosis:  CHRONIC PANCREATITIS 
80.1 	Treatment:  SURGICAL TREATMENT 
80.2 	ICD-9:  577.1
80.3 	(178) Diagnosis:  CHRONIC PROSTATITIS, OTHER DISORDERS OF
80.4 	PROSTATE 
80.5 	Treatment:  MEDICAL THERAPY 
80.6 	ICD-9:  601.1, 601.3, 601.9, 602 
80.7 	(179) Diagnosis:  MUSCULAR CALCIFICATION AND OSSIFICATION 
80.8 	Treatment:  MEDICAL THERAPY 
80.9 	ICD-9:  728.1
80.10 	(180) Diagnosis:  CANCER OF VARIOUS SITES WHERE TREATMENT
80.11 	WILL NOT RESULT IN A FIVE PERCENT FIVE-YEAR SURVIVAL 
80.12 	Treatment:  CURATIVE MEDICAL AND SURGICAL TREATMENT 
80.13 	ICD-9:  140-208 
80.14 	(181) Diagnosis:  AGENESIS OF LUNG 
80.15 	Treatment:  MEDICAL THERAPY 
80.16 	ICD-9:  748.5
80.17 	(182) Diagnosis:  DISEASE OF CAPILLARIES 
80.18 	Treatment:  EXCISION 
80.19 	ICD-9:  448.1-448.9 
80.20 	(183) Diagnosis:  BENIGN POLYPS OF VOCAL CORDS 
80.21 	Treatment:  MEDICAL THERAPY, STRIPPING 
80.22 	ICD-9:  478.4
80.23 	(184) Diagnosis:  FRACTURES OF RIBS AND STERNUM, CLOSED 
80.24 	Treatment:  MEDICAL THERAPY 
80.25 	ICD-9:  807.0, 807.2, 805.6, 839.41
80.26 	(185) Diagnosis:  CLOSED FRACTURE OF ONE OR MORE PHALANGES
80.27 	OF THE FOOT, NOT INCLUDING THE GREAT TOE 
80.28 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
80.29 	ICD-9:  826.0
80.30 	(186) Diagnosis:  DISEASES OF THYMUS GLAND 
80.31 	Treatment:  MEDICAL THERAPY 
80.32 	ICD-9:  254 
80.33 	(187) Diagnosis:  DENTAL CONDITIONS WHERE TREATMENT RESULTS
80.34 	IN MARGINAL IMPROVEMENT 
80.35 	Treatment:  ELECTIVE DENTAL SERVICES 
80.36 	ICD-9:  520.7, V72.2 
81.1 	(188) Diagnosis:  ANTISOCIAL PERSONALITY DISORDER 
81.2 	Treatment:  MEDICAL/PSYCHOTHERAPY 
81.3 	ICD-9:  301.7
81.4 	(189) Diagnosis:  SEBACEOUS CYST 
81.5 	Treatment:  MEDICAL AND SURGICAL THERAPY 
81.6 	ICD-9:  685.1, 706.2, 744.47
81.7 	(190) Diagnosis:  CENTRAL RETINAL ARTERY OCCLUSION 
81.8 	Treatment:  PARACENTESIS OF AQUEOUS 
81.9 	ICD-9:  362.31-362.33 
81.10 	(191) Diagnosis:  ORAL APHTHAE 
81.11 	Treatment:  MEDICAL THERAPY 
81.12 	ICD-9:  528.2
81.13 	(192) Diagnosis:  SUBLINGUAL, SCROTAL, AND PELVIC VARICES 
81.14 	Treatment:  VENOUS INJECTION, VASCULAR SURGERY 
81.15 	ICD-9:  456.3-456.5 
81.16 	(193) Diagnosis:  SUPERFICIAL WOUNDS WITHOUT INFECTION AND
81.17 	CONTUSIONS 
81.18 	Treatment:  MEDICAL THERAPY 
81.19 	ICD-9:  910.0, 910.2, 910.4, 910.6, 910.8, 911.0, 911.2, 911.4,
81.20 	911.6, 911.8, 912.0, 912.2, 912.4, 912.6, 912.8, 913.0, 913.2,
81.21 	913.4, 913.6, 913.8, 914.0, 914.2, 914.4, 914.6, 914.8, 915.0,
81.22 	915.2, 915.4, 915.6, 915.8, 916.0, 916.2, 916.4, 916.6, 916.8,
81.23 	917.0, 917.2, 917.4, 917.6, 917.8, 919.0, 919.2, 919.4, 919.6,
81.24 	919.8, 920-924, 959.0-959.8 
81.25 	(194) Diagnosis:  UNSPECIFIED RETINAL VASCULAR OCCLUSION 
81.26 	Treatment:  LASER SURGERY 
81.27 	ICD-9:  362.30
81.28 	(195) Diagnosis:  BENIGN NEOPLASM OF EXTERNAL FEMALE
81.29 	GENITAL ORGANS 
81.30 	Treatment:  EXCISION 
81.31 	ICD-9:  221.1-221.9 
81.32 	(196) Diagnosis:  BENIGN NEOPLASM OF MALE GENITAL ORGANS:
81.33 	TESTIS, PROSTATE, EPIDIDYMIS 
81.34 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
81.35 	ICD-9:  222.0, 222.2, 222.3, 222.8, 222.9
81.36 	(197) Diagnosis:  XEROSIS 
82.1 	Treatment:  MEDICAL THERAPY 
82.2 	ICD-9:  706.8
82.3 	(198) Diagnosis:  CONGENITAL CYSTIC LUNG - SEVERE 
82.4 	Treatment:  LUNG RESECTION 
82.5 	ICD-9:  748.4
82.6 	(199) Diagnosis:  ICHTHYOSIS 
82.7 	Treatment:  MEDICAL THERAPY 
82.8 	ICD-9:  757.1
82.9 	(200) Diagnosis:  LYMPHEDEMA 
82.10 	Treatment:  MEDICAL THERAPY, OTHER OPERATION ON LYMPH CHANNEL 
82.11 	ICD-9:  457.1-457.9, 757.0
82.12 	(201) Diagnosis:  DERMATOLOGICAL CONDITIONS WITH NO
82.13 	EFFECTIVE TREATMENT OR NO TREATMENT NECESSARY 
82.14 	Treatment:  MEDICAL AND SURGICAL TREATMENT 
82.15 	ICD-9:  696.3-696.5, 709.0, 757.2-757.3, 757.8-757.9 
82.16 	(202) Diagnosis:  INFECTIOUS DISEASES WITH NO EFFECTIVE
82.17 	TREATMENTS OR NO TREATMENT NECESSARY 
82.18 	Treatment:  EVALUATION 
82.19 	ICD-9:  071, 136.0, 136.9
82.20 	(203) Diagnosis:  RESPIRATORY CONDITIONS WITH NO EFFECTIVE
82.21 	TREATMENTS OR NO TREATMENT NECESSARY 
82.22 	Treatment:  EVALUATION 
82.23 	ICD-9:  519.3, 519.9, 748.60, 748.69, 748.9
82.24 	(204) Diagnosis:  GENITOURINARY CONDITIONS WITH NO
82.25 	EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
82.26 	Treatment:  EVALUATION 
82.27 	ICD-9:  593.0-593.1, 593.6, 607.9, 608.3, 608.9, 621.6,
82.28 	621.8-621.9, 626.9, 629.8, 752.9
82.29 	(205) Diagnosis:  CARDIOVASCULAR CONDITIONS WITH NO
82.30 	EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
82.31 	Treatment:  EVALUATION 
82.32 	ICD-9:  429.3, 429.81-429.82, 429.89, 429.9, 747.9
82.33 	(206) Diagnosis:  MUSCULOSKELETAL CONDITIONS WITH NO
82.34 	EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
82.35 	Treatment:  EVALUATION 
82.36 	ICD-9:  716.9, 718.00, 718.10, 718.20, 718.40, 718.50, 718.60,
83.1 	718.80, 718.9, 719.7, 719.9, 728.5, 728.84, 728.9, 731.2,
83.2 	738.2-738.3, 738.9, 744.5-744.9, 748.1, 755.9, 756.9
83.3 	(207) Diagnosis:  INTRACRANIAL CONDITIONS WITH NO EFFECTIVE
83.4 	TREATMENTS OR NO TREATMENT NECESSARY 
83.5 	Treatment:  EVALUATION 
83.6 	ICD-9:  348.2, 377.01, 377.02, 377.2, 377.3, 377.5, 377.7,
83.7 	437.7-437.8 
83.8 	(208) Diagnosis:  SENSORY ORGAN CONDITIONS WITH NO
83.9 	EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
83.10 	Treatment:  EVALUATION 
83.11 	ICD-9:  360.30-360.31, 360.33, 362.37, 362.42-362.43,
83.12 	362.8-362.9, 363.21, 364.5, 364.60, 364.9, 371.20, 371.22,
83.13 	371.24, 371.3, 371.81, 371.89, 371.9, 372.40-372.42,
83.14 	372.44-372.45, 372.50-372.52, 372.55, 372.8-372.9,
83.15 	374.52-374.53, 374.81-374.83, 374.9, 376.82, 376.89, 376.9,
83.16 	377.03, 377.1, 377.4, 377.6, 379.24, 379.29, 379.4-379.8, 380.9,
83.17 	747.47 
83.18 	(209) Diagnosis:  ENDOCRINE AND METABOLIC CONDITIONS WITH
83.19 	NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
83.20 	Treatment:  EVALUATION 
83.21 	ICD-9:  251.1-251.2, 259.4, 259.8-259.9, 277.3, 759.1
83.22 	(210) Diagnosis:  GASTROINTESTINAL CONDITIONS WITH NO
83.23 	EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY 
83.24 	Treatment:  EVALUATION 
83.25 	ICD-9:  527.0, 569.9, 573.9
83.26 	(211) Diagnosis:  MENTAL DISORDERS WITH NO EFFECTIVE
83.27 	TREATMENTS OR NO TREATMENT NECESSARY 
83.28 	Treatment:  EVALUATION 
83.29 	ICD-9:  313.1, 313.3, 313.83
83.30 	(212) Diagnosis:  NEUROLOGIC CONDITIONS WITH NO EFFECTIVE
83.31 	TREATMENTS OR NO TREATMENT NECESSARY 
83.32 	Treatment:  EVALUATION 
83.33 	ICD-9:  333.82, 333.84, 333.91, 333.93
83.34 	(213) Diagnosis:  DENTAL CONDITIONS (e.g., ORTHODONTICS) 
83.35 	Treatment:  COSMETIC DENTAL SERVICES 
83.36 	ICD-9:  520.0-520.5, 520.8-520.9, 521.1-521.9, 522.3, V72.2 
84.1 	(214) Diagnosis:  TUBAL DYSFUNCTION AND OTHER CAUSES OF
84.2 	INFERTILITY 
84.3 	Treatment:  IN-VITRO FERTILIZATION, GIFT 
84.4 	ICD-9:  256 
84.5 	(215) Diagnosis:  HEPATORENAL SYNDROME 
84.6 	Treatment:  MEDICAL THERAPY 
84.7 	ICD-9:  572.4
84.8 	(216) Diagnosis:  SPASTIC DYSPHONIA 
84.9 	Treatment:  MEDICAL THERAPY 
84.10 	ICD-9:  478.79
84.11 	(217) Diagnosis:  DISORDERS OF REFRACTION AND ACCOMMODATION 
84.12 	Treatment:  RADIAL KERATOTOMY 
84.13 	ICD-9:  367, 368.1-368.9 
84.14 	(b) The commissioner of human services shall identify the
84.15 	related CPT codes that correspond with the diagnosis/treatment
84.16 	pairings described in this section.  The identification of the
84.17 	related CPT codes is not subject to the requirements of
84.18 	Minnesota Statutes, chapter 14, and Minnesota Statutes, section
84.19 	14.386 does not apply.
84.20 		Subd. 4.Federal approval. The commissioner of human
84.21 	services shall seek federal approval to eliminate medical
84.22 	assistance coverage for the diagnosis/treatment pairings
84.23 	described in subdivision 3.
84.24 		Subd. 5.Nonexpansion of covered services. Nothing in
84.25 	this section shall be construed to expand medical assistance
84.26 	coverage to services that are not currently covered under the
84.27 	medical assistance program as of June 30, 2005.

84.28 	Sec. 47. MINNESOTACARE OPTION FOR SMALL EMPLOYERS.
 84.29 	The commissioner of human services, in consultation with
84.30 	the Minnesota Hospital Association, Minnesota Medical
84.31 	Association, Minnesota Chamber of Commerce, and the Minnesota
84.32 	Business Partnership shall evaluate the effect of the limited
84.33 	hospital benefit under the MinnesotaCare program for single
84.34 	adults without children as it applies to the MinnesotaCare
84.35 	enrollment option for small employers described under Minnesota
84.36 	Statutes, section 256L.20.  In the evaluation, the commissioner
85.1 	shall determine whether this limitation discourages
85.2 	participation in the program by small employers, whether it has
85.3 	added to the amount of uncompensated care provided by hospitals,
85.4 	and the cost to the MinnesotaCare program if the hospital
85.5 	benefit limitation was eliminated for enrollees enrolled under
85.6 	Minnesota Statutes, section 256L.20.  The commissioner shall
85.7 	submit the results of the evaluation to the legislature by
85.8 	January 15, 2006.

85.9 	Sec. 48. QUALITY IMPROVEMENT.
 85.10 	The commissioners of human services and employee relations
85.11 	shall jointly develop a written plan for a provider payment
85.12 	system to be implemented by January 1, 2007.  Under the provider
85.13 	payment system, a minimum of five percent of a provider's
85.14 	payment shall be withheld.  Return of the withhold to a provider
85.15 	will be conditioned on the provider achieving certain quality
85.16 	improvement performance standards.  The commissioners shall
85.17 	consult with local and national quality improvement groups to
85.18 	identify appropriate standards and measures related to
85.19 	performance.  The plan must be submitted to the legislature by
85.20 	March 1, 2006.  This provision does not prohibit the
85.21 	commissioners from negotiating the implementation of
85.22 	performance-based payment terms with particular providers prior
85.23 	to January 1, 2006.

85.24 	Sec. 49. TASK FORCE ON IMPROVING HEALTH STATUS OF STATE'S
85.25 	CHILDREN.
 85.26 	(a) The commissioners of education, health, and human
85.27 	services shall convene a task force to study and make
85.28 	recommendations on the role of public schools in improving the
85.29 	health status of children.  In order to assess the health status
85.30 	of children, the task force shall determine the number of
85.31 	children who are currently obese and set a goal, including
85.32 	measurable outcomes for the state in terms of reducing the rate
85.33 	of childhood obesity.  The task force shall make recommendations
85.34 	on how to achieve this goal, including, but not limited to,
85.35 	increasing physical education activities within the public
85.36 	schools; exploring opportunities to promote physical education
86.1 	and healthy eating programs; improving the nutritional offerings
86.2 	through breakfast and lunch menus; and evaluating the
86.3 	availability and choice of nutritional products offered in
86.4 	public schools.  The members of the task force shall include
86.5 	representatives of the Minnesota Medical Association; the
86.6 	Minnesota Nurses Association; the Local Public Health
86.7 	Association of Minnesota; the Minnesota Dietetic Association;
86.8 	the Minnesota School Food Service Association; the Minnesota
86.9 	Association of Health, Physical Education, Recreation, and
86.10 	Dance; the Minnesota School Boards Association; the Minnesota
86.11 	School Administrators Association; the Minnesota Secondary
86.12 	Principals Association; the vending industry; and consumers.
86.13 	The terms and compensation of the members of the task force
86.14 	shall be in accordance with Minnesota Statutes, section 15.059,
86.15 	subdivision 6.
86.16 	(b) The commissioner must submit the recommendations of the
86.17 	task force to the legislature by January 15, 2006.

86.18 	Sec. 50. APPROPRIATION.
 86.19 	(a) $....... is appropriated for the biennium beginning
86.20 	July 1, 2005, from the general fund to the Board of Trustees of
86.21 	the Minnesota State Colleges and Universities for the nursing
86.22 	and health care education plan designed to:
86.23 	(1) expand the system's enrollment in registered nursing
86.24 	education programs;
86.25 	(2) support practical nursing programs in regions of high
86.26 	need;
86.27 	(3) address the shortage of nursing faculty; and 
86.28 	(4) provide accessible learning opportunities to students
86.29 	through distance education and simulation experiences.
86.30 	(b) $....... is appropriated from the general fund to the
86.31 	commissioner of finance for transfer to the electronic medical
86.32 	record system loan fund to capitalize the fund.  The
86.33 	appropriation is available until expended.
86.34 	(c) $....... is appropriated for the biennium beginning
86.35 	July 1, 2005, from the general fund to the commissioner of
86.36 	health for the loan forgiveness program in Minnesota Statutes,
87.1 	section 144.1501.
87.2 	(d) $500,000 is appropriated for fiscal year 2006 from the
87.3 	health care access fund to the Board of Regents of the
87.4 	University of Minnesota for the University of Minnesota's dental
87.5 	clinic to address dental care access for low-income patients.

87.6 	Sec. 51. REPEALER.
 87.7 	Minnesota Statutes 2004, sections 256.955, subdivision 4a;
87.8 	256B.075, subdivision 5; and 256L.035, are repealed.