1.1    .................... moves to amend H.F. No. 3391, the first committee engrossment,
1.2as follows:
1.3Page 2, line 30, delete "and provide"
1.4Page 2, line 31, delete "financial or other incentives for"
1.5Page 3, line 8, delete everything after the period
1.6Page 3, delete lines 9 to 12
1.7Page 4, line 3, after the period insert "The commissioner may waive some
1.8requirements in order to certify providers and clinicians with health care home models
1.9in existence on March 1, 2008, that serve special patient populations of diverse race,
1.10language, or ethnicity."
1.11Page 4, line 21, after the period insert "Care coordination must be provided in a
1.12manner appropriate to the patient's race, ethnicity, and language."
1.13Page 5, line 15, after the period insert "The comprehensive care plan must be
1.14culturally appropriate."
1.15Page 5, line 17, after the period insert "Care coordinators must be trained to provide
1.16services that are appropriate for the race, ethnicity, and language of the patient."
1.17Page 6, line 11, after "conditions" insert "and those who face racial, ethnic, or
1.18language barriers"
1.19Page 7, line 4, after the period insert "Quality measures must include measures of
1.20disparities in treatment, health status, and outcomes, based on race, ethnicity, or language."
1.21Page 7, line 13, after "families" insert "including minority ethnic groups" and after
1.22"plans," insert "providers serving low-income and culturally diverse populations,"
1.23Page 7, line 25, after the comma insert "culturally appropriate,"
1.24Page 7, line 29, after "accessibility" insert "and cultural appropriateness"
1.25Page 8, line 8, after the comma insert "broken down by income, race, ethnicity,
1.26and language whenever possible,"
1.27Page 8, line 12, after the comma insert "the estimated impact on health disparities,"
2.1Page 10, after line 7, insert:

2.2    "Sec. 10. HEALTH CARE ACCESS FUND TRANSFER.
2.3    On July 1, 2008, the commissioner of finance shall transfer $1,390,000 from the
2.4health care access fund to the general fund."
2.5Pages 10 to 11, delete sections 1 and 2
2.6Page 11, line 28, delete everything after "recipient" and insert "reports total
2.7countable assets."
2.8Page 11, line 29, delete "of the applicable asset limit."
2.9Page 11, line 30, after the period insert "This paragraph does not apply to applicants
2.10or recipients applying for or receiving medical assistance payment of long-term care
2.11services, including services under sections 256B.0915, 256B.092, or 256B.49."
2.12Page 11, delete lines 31 to 34
2.13Page 12, delete lines 1 to 4 and insert
2.14    "(d) The commissioner shall designate locations where enrollees may submit
2.15renewal forms, including but not limited to community clinics and health care providers'
2.16offices. These designated sites shall forward the renewal forms to the commissioner."
2.17Page 12, delete lines 6 to 8
2.18Page 12, after line 8, insert:

2.19    "Section 1. Minnesota Statutes 2006, section 256B.057, subdivision 8, is amended to
2.20read:
2.21    Subd. 8. Children under age two. Medical assistance may be paid for a child under
2.22two years of age whose countable family income is above 275 percent of the federal
2.23poverty guidelines for the same size family but less than or equal to 280 305 percent of the
2.24federal poverty guidelines for the same size family.
2.25EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
2.26approval, whichever is later."
2.27Pages 12 to 13, delete sections 4 and 5
2.28Page 13, line 30, delete "enrollees for" and insert "single adults and households with
2.29no children enrolled under section 256L.07, subdivision 4,"
2.30Page 13, line 31, delete "whom federal funding is not available," and delete
2.31"January" and insert "July"
2.32Page 13, line 32, delete everything after ", for" and insert "adults in families with
2.33children enrolled under section 256L.04, subdivision 1. The"
2.34Page 14, line 30, delete "enrollees for" and insert "single adults and households with
2.35no children enrolled under section 256L.04, subdivision 7,"
3.1Page 14, line 31, delete everything before "and" and delete "January" and insert
3.2"July"
3.3Page 14, line 32, delete everything after ", for" and insert "adults in families with
3.4children enrolled under section 256L.04, subdivision 1. The"
3.5Page 15, line 23, delete "January" and insert "July"
3.6Page 16, lines 9 to 11, delete the new language and insert "The commissioner shall
3.7designate locations where enrollees may submit renewal forms, including but not limited
3.8to community clinics and health care providers' offices. The designated sites shall forward
3.9the renewal forms to the commissioner."
3.10Page 16, line 33, delete "beginning in the month of application." and insert "and
3.11enrolled upon payment of premiums in accordance with section 256L.05, subdivision 3."
3.12Page 16, line 35, delete "terminated." and insert "denied or cancelled." and delete
3.13"terminated" and insert "denied or cancelled"
3.14Page 17, line 1, delete "to apply"
3.15Page 19, line 6, delete "January" and insert "July"
3.16Page 19, lines 29 to 31, reinstate the stricken language
3.17Page 19, line 32, reinstate the stricken language
3.18Page 19, line 32 strike "the four-month requirement described in"
3.19Page 21, line 8, delete "January" and insert "July"
3.20Page 21, line 12, delete "January" and insert "July"
3.21Page 22, delete section 1
3.22Page 22, after line 22, insert

3.23    "Sec. 19. APPROPRIATION.
3.24    $....... is appropriated from the health care access fund to the commissioner of
3.25human services for fiscal year 2009, to study insurance coverage for long-term care
3.26workers under section 17."
3.27Page 27, delete section 1
3.28Page 32, delete section 2
3.29Page 34, delete sections 3 and 4
3.30Page 36, delete section 5
3.31Page 37, delete subdivisions 6, and 10
3.32Page 37, delete section 7
3.33Page 43, delete section 8
3.34Page 45, line 20, after "operations," insert "health disparities, culturally competent
3.35care,"
3.36Page 45, line 33, delete "(a)"
4.1Page 46, line 6, delete everything after "definition" and insert "and methodology for
4.2calculating the relative utilization and health care costs for providers in treating patients,
4.3including but not limited to patients with coronary artery and heart disease, diabetes,
4.4asthma, chronic obstructive pulmonary disease, depression, and other chronic conditions.
4.5The methodology must include"
4.6Page 46, line 25, before "and" insert "(9) establish uniform definitions for packages
4.7of services used to provide care to patients, including but not limited to patients with
4.8coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary disease,
4.9depression, and other chronic conditions, for the purpose of establishing package pricing."
4.10Page 46, line 25, delete "1" and insert "2"
4.11Page 46, line 26, delete "(9)" and insert "(10)"
4.12Page 46, delete lines 27 to 36
4.13Page 47, delete subdivision 7
4.14Page 47, line 4, delete everything after "changes"
4.15Page 47, delete line 5
4.16Page 47, line 6, delete "the legislative session"
4.17Page 47, line 28, delete "2011" and insert "2012"
4.18Page 48, line 9, delete "Minnesota Health Insurance Exchange" and insert
4.19"commissioner of health"
4.20Page 48, line 31, delete everything after "be"
4.21Page 48, line 32, delete everything before the second "the"
4.22Page 48, line 33, after the period, insert "In addition, each health plan company that
4.23issues coverage in the individual or small-employer market in this state must offer at least
4.24one health plan that complies with the benefit design in each of these two markets in
4.25which it issues coverage."
4.26Page 50, line 9, delete "SAVINGS RECAPTURE ASSESSMENT" and insert
4.27"PROJECTED SPENDING"
4.28Page 50, line 22, delete "(a)"
4.29Page 50, delete lines 27 to 32
4.30Page 51, delete subdivisions 4 and 5
4.31Page 52, line 15, delete everything after "62U.04"
4.32Page 52, line 16, delete everything before the semicolon
4.33Page 52, line 28, delete everything after "62U.04"
4.34Page 52, line 29, delete everything before the semicolon
4.35Page 53, line 8, delete "Minnesota Health Insurance Exchange" and insert
4.36"employee's health plan company"
5.1Page 53, line 10, delete "Minnesota Health Insurance Exchange" and insert
5.2"employee's health plan company"
5.3Page 54, line 6, delete "quality measures" and insert "the quality targets used in
5.4clause (1)"
5.5Page 54, line 8, after the semicolon insert "(7) payment methods must adjust for
5.6racial, ethnic, or language factors that affect outcomes;"
5.7Page 54, line 9, delete "(7)" and insert "(8)"
5.8Page 54, line 11, delete "measures of efficiency for specific procedures,"
5.9Page 54, line 11, after "results," insert "disparities between racial and ethnic
5.10populations,"
5.11Page 55, line 6, delete "employing" and insert "utilizing"
5.12Page 55, line 8, delete "fee must be determined by the commission, and"and insert
5.13"payment system"
5.14Page 55, line 9, after "vary" insert "the fees paid"
5.15Page 55, line 12, delete "the commission" and insert "group purchasers as defined in
5.16section 62J.03, subdivision 6,"
5.17Page 55, line 15, delete the first "must" and insert "may"
5.18Page 55, line 17, delete the first and second "and efficiency"
5.19Page 55, line 19, delete everything after the period
5.20Page 55 delete lines 20 and 21
5.21Page 56, line 7, delete everything after "Development." and insert:
5.22    "(a) By January 15, 2009, the Health Care Transformation Commission shall report
5.23to the legislature recommendations for advancing an innovative payment system for
5.24providing necessary services to patients, including but not limited to patients with
5.25coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
5.26disease, and depression.
5.27    (b) By January 1, 2010, the Health Care Transformation Commission shall report to
5.28the legislature additional changes necessary to accomplish comprehensive payment reform
5.29designed to support an innovative payment system to reduce costs and improve quality.
5.30    (c) By January 1, 2010, the Health Care Transformation Commission, in cooperation
5.31with the commissioner of human services, shall develop a comparable payment system
5.32for non-elderly and non-disabled enrollees in the state's public health care programs.
5.33This must include an assessment of the impact on enrollee access to quality care and the
5.34financial status of the state's health care programs.
6.1    (d) By January 1, 2011, the Health Care Transformation Commission shall develop
6.2rules to implement a comprehensive payment system that encourages provider innovation
6.3to reduce costs and improve quality."
6.4Page 56, delete lines 8 and 9
6.5Page 56, delete lines 34 and 35
6.6Page 57, delete lines 1 to 3 and insert
6.7    "(e) The commission shall report back to providers analyses and reports that identify
6.8specific providers. The provider shall have 21 days to review the data for accuracy.
6.9    (f) The commission shall establish an appeals process to resolve disputes from
6.10providers regarding the accuracy of the analyses and reports."
6.11Page 57, delete lines 4 to 36
6.12Page 58, delete lines 1 to 29 and insert:
6.13    "Subd. 3. Utilization and health care costs. (a) The commission shall establish
6.14a uniform definition and methodology for calculating the relative utilization and health
6.15care costs of providers. The methodology must include risk adjustment mechanisms
6.16that address at least the following factors:
6.17    (i) the health status of the individual in the year the individual enters the provider's
6.18care;
6.19    (ii) a worsening of the patient's health condition that was not reasonably preventable
6.20by action that the provider could have taken;
6.21    (iii) socioeconomic and cultural factors that bear directly on the cost of care; and
6.22    (iv) the percentage of individuals served by the provider or care system whose care
6.23is paid for by public health insurance programs. The risk adjustment must be developed in
6.24accordance with generally accepted risk adjustment methodologies.
6.25    (b) Beginning April 1, 2010, the commission shall disseminate information to
6.26providers on their utilization and cost in comparison to an appropriate peer group.
6.27    (c) The commission shall develop a system to index providers based on their
6.28risk-adjusted resource use and on quality of care for the conditions specified in subdivision
6.291, paragraph (a). In developing this system, the commission shall consult and coordinate
6.30with health care providers as defined in section 62J.03, subdivision 8, health plan
6.31companies, and organizations that work to improve health care quality in Minnesota.
6.32    Subd. 4. Care package pricing. (a) The commission shall develop a standard
6.33method and format for providers to use for submitting package prices for the conditions
6.34specified in subdivision 1, paragraph (a). This method shall be published in the State
6.35Register and must be made available to all providers.
7.1    (b) Beginning July 1, 2010, using the information developed in subdivision 3,
7.2providers may submit package prices to the commission for the cost of providing
7.3necessary services for the conditions specified in subdivision 1, paragraph (a), based on
7.4their disclosed prices under section 62U.15 combined with their actual risk-adjusted
7.5resource use for the most recent analytic period. The package prices submitted must
7.6reflect the providers' commitment to manage their treatment of the patients and chronic
7.7conditions specified in subdivision 1, paragraph (a).
7.8    (c) Until January 1, 2013, no provider shall submit package prices for the
7.9risk-adjusted total cost of care for the conditions specified in subdivision 1, paragraph
7.10(a) that represents an increase of more than the increase in the previous calendar year's
7.11Consumer Price Index for all urban consumers plus two percentage points, or a decrease
7.12of more than 15 percent below the provider's risk adjusted cost of care calculated based on
7.13their average pricing levels for the previous calendar year.
7.14    (d) Beginning January 1, 2011, the commission shall annually publish the results of
7.15the process described in paragraph (b), and shall include only providers who choose to
7.16submit package prices. The results that are published must be on a risk-neutral basis.
7.17    Subd. 5. Provider assistance. The commissioner shall provide education and
7.18technical assistance to providers on how to calculate and submit package prices for the
7.19risk-adjusted cost of care for the conditions specified in subdivision 1, paragraph (a).
7.20    Subd. 6. Payments. The commission shall establish a method by which providers
7.21who have submitted package prices shall be paid for their cost of care in treating the
7.22conditions specified in subdivision 1, paragraph (a), with periodic adjustments to the
7.23payment they receive to reflect their actual risk-adjusted cost relative to the package price.
7.24The commission shall report to the legislature recommendations on how to implement
7.25these adjustments.
7.26    Subd. 7. Implementation. By January 1, 2012:
7.27    (1) the commissioner of human services, by January 1, 2012, or upon federal
7.28approval, whichever is later, shall pay providers based on their package prices for all
7.29enrollees in the state's public health care programs;
7.30    (2) the commissioner of employee relations shall pay providers based on their
7.31package prices for all participants in the state employee group insurance program;
7.32    (3) all political subdivisions, as defined in section 13.02, subdivision 11, that offer
7.33health benefits to their employees must pay providers based on their package prices for all
7.34participants, or purchase a health plan that uses this payment system;
8.1    (4) all health plan companies shall use the information and methods developed
8.2under this section to develop health plans that encourage consumers to use high-quality,
8.3low-cost providers; and
8.4    (5) health plan companies that issue health plans in the individual market or the small
8.5employer market must offer at least one health plan that uses the information developed
8.6under subdivision 3 to establish financial incentives for consumers to use high-quality,
8.7low-cost providers through enrollee cost-sharing or selective provider networks."
8.8Page 58, line 32, after "service," insert "package of services,"
8.9Page 58, line 35, after the period insert "Providers may update this list periodically
8.10to reflect new services, supply cost changes, and other factors."
8.11Page 59, delete section 21
8.12Page 59, delete lines 6 to 12
8.13Page 59, line 14, after "(a)" insert "Effective July 1, 2010,"
8.14Page 59, line 19, after "Medicare" insert ", workers compensation, no fault auto
8.15insurance,"
8.16Page 60, line 7, delete "SHARING" and insert "ADJUSTMENT"
8.17Page 60, line 8, delete "Sharing" and insert "Adjustment"
8.18Page 60, line 15, delete "council" and insert "Health Care Transformation
8.19Commission"
8.20Page 60, line 16, delete "Legislative Commission on Health Care Access" and
8.21insert "legislature"
8.22Page 60, line 17, delete everything after the period
8.23Page 60, delete lines 18 to 20
8.24Page 60, before line 21, insert:

8.25    "Sec. 24. GLOBAL MODELING OF HEALTH CARE REFORMS.
8.26    Subdivision 1. Reform modeling tool. To the extent of available appropriations,
8.27the commissioner of health shall award a grant to the University of Minnesota School
8.28of Public Health, health policy and management division, to develop a model that will
8.29assess the impact of proposed health care reforms or major health care-related legislation
8.30on all sectors of the health care system, including access to the full range of health care,
8.31public health, public and private health insurance coverage, long-term and continuing
8.32care, programs for persons with disabilities, social services and other sectors related to
8.33Minnesotans' health. The model must be:
8.34    (1) developed with safeguards to make sure that the model and its assumptions and
8.35formulas are based on valid and objective data, research, and expert opinions;
9.1    (2) designed to enable policy makers and state agencies to enter into the model and
9.2study each component of health care reform, including access to all aspects of health care
9.3services, health care homes, payment reforms, population-wide prevention, health status
9.4of Minnesotans, and incidence of chronic disease;
9.5    (3) capable of assessing the interaction of different legislative and policy changes
9.6to determine the net effect on costs, access, and health status within sectors of the health
9.7care system, and the net overall impact across all sectors;
9.8    (4) designed to identify risks of unpredictable or unintended consequences, cost
9.9shifting between or within sectors of the health care system, and opportunities to make
9.10changes in one sector that will produce a benefit to other sectors; and
9.11    (5) capable of being adjusted based on both the proposed changes and the resulting
9.12impact in the following areas:
9.13    (i) access to all aspects of health care services;
9.14    (ii) health status of Minnesotans, including the incidence of chronic disease, health
9.15disparities, and risk factors such as obesity and smoking;
9.16    (iii) utilization of preventive care services such as screenings, immunizations, and
9.17physical examinations; and
9.18    (iv) costs and cost distribution, including costs to individuals and families,
9.19businesses, and government, including for total cost of health care, health-related services,
9.20and social services.
9.21    Subd. 2. Fiscal notes on health care reform legislation. (a) The University of
9.22Minnesota model shall be available to state agencies and the legislature to:
9.23    (1) conduct a global impact assessment of major health policy changes proposed
9.24in legislation;
9.25    (2) measure the impact of the proposed legislation on health and well-being; and
9.26    (3) quantify the costs and savings in every part of the state's budget, in local
9.27government budgets, and for individuals and businesses.
9.28    (b) The commissioners of human services, finance, and health, in consultation with
9.29the chairs of the senate and house health care policy and finance committees, shall develop
9.30recommendations for the governor and the legislature on changes to state budgeting
9.31approaches and legislative processes that will bridge across traditional budget boundaries
9.32in order to both assess the impact of proposed legislative changes across these boundaries
9.33and to allow the reallocation of resources across boundaries. These approaches shall also
9.34cover a time period longer than the existing two-year budgeting cycle so that longer
9.35term return-on-investment projections can be considered when making short-term budget
9.36decisions.
10.1EFFECTIVE DATE.This section is effective the day following final enactment.

10.2    Sec. 25. ECONOMIC ANALYSIS OF HEALTH CARE REFORM PLANS.
10.3    (a) To the extent of available appropriations, the commissioner of health shall
10.4award a grant to the University of Minnesota School of Public Health, health policy and
10.5management division, to conduct a study and economic analysis of costs and benefits
10.6of various health care reform proposals, including an analysis of the recommendations
10.7of the Legislative Health Care Access Commission, the governor's transformation task
10.8force, and a single statewide plan.
10.9    (b) The analysis of each proposal should measure the impact on total public and
10.10private health care spending in Minnesota that would result from each proposal, including
10.11whether there are savings or additional costs due to:
10.12    (1) increased or reduced insurance, billing, underwriting, marketing, and other
10.13administrative functions;
10.14    (2) timely and appropriate use of medical care;
10.15    (3) market-driven or negotiated prices on medical services and products, including
10.16pharmaceuticals;
10.17    (4) a shortage or excess capacity of medical facilities and equipment;
10.18    (5) increased utilization, better health outcomes, increased wellness due to
10.19prevention, early intervention, and health-promoting activities;
10.20    (6) increases or decreases in administrative expenses and health care expenses
10.21due to payment reforms;
10.22    (7) increases or decreases in administrative expenses and health care expenses due
10.23to coordination of care;
10.24    (8) increases or decreases in up-front and long-term utilization due to access to
10.25comprehensive medically necessary benefits, including dental care, mental health care,
10.26prescription drugs, and other health care; and
10.27    (9) nonhealth care impacts on state and local expenditures such as reduced
10.28out-of-home placement or crime costs due to mental health or chemical dependency
10.29coverage.
10.30    (c) The study should also analyze for each proposal the number of Minnesotans
10.31without access to health care, including those lacking access to certain types of medical
10.32care, such as dental care, mental health care, and prescription drugs.
10.33EFFECTIVE DATE.This section is effective the day following final enactment."
10.34Page 61, line 21, delete "general fund" and insert "health care access fund"
10.35Renumber the sections in sequence and correct the internal references
11.1Amend the title accordingly