1.1    .................... moves to amend H. F. No. 3391 as follows:
1.2Delete everything after the enacting clause and insert:


1.5    Section 1. [256B.0431] ENROLLEE REQUIREMENTS RELATED TO HEALTH
1.6CARE HOMES.
1.7    Subdivision 1. Selection of primary care clinic. Beginning January 1, 2009, the
1.8commissioner shall require state health care program enrollees eligible for services
1.9under the fee-for-service system to select a primary care clinic or medical group, within
1.10two months of enrollment. Beginning July 1, 2009, the commissioner shall encourage
1.11enrollees who have a complex or chronic condition to select a primary care clinic or
1.12medical group at which clinicians have been certified as health care homes under section
1.13256B.0751, subdivision 3. The commissioner and county social service agencies shall
1.14provide enrollees with lists of primary care clinics, medical groups, and clinicians certified
1.15as health care homes, and shall establish a toll-free number to provide enrollees with
1.16assistance in choosing a clinic, medical group, or health care home.
1.17    Subd. 2. Initial health assessment. The commissioner shall encourage state health
1.18care program enrollees eligible for services under the fee-for-service system to complete an
1.19initial health assessment at their selected primary care clinic or medical group, within one
1.20month of selection, in order to identify individuals with, or who are at risk of developing,
1.21complex or chronic health conditions, and to identify preventative health care needs.
1.22    Subd. 3. Education and outreach. Beginning January 1, 2009, the commissioner
1.23shall provide patient education and outreach to state health care program enrollees and
1.24potential applicants related to the importance of choosing a primary care clinic or medical
1.25group and a health care home. Education and outreach must be targeted to underserved or
1.26special populations.
2.1    Subd. 4. State health care program. For purposes of this section, "state health
2.2care program" means the medical assistance, MinnesotaCare, and general assistance
2.3medical care programs.

2.4    Sec. 2. [256B.0751] HEALTH CARE HOMES; DEFINITIONS;
2.5ESTABLISHMENT.
2.6    Subdivision 1. Definitions. (a) For purposes of sections 256B.0751 to 256B.0754,
2.7the definitions in this subdivision apply.
2.8    (b) "Commissioner" means the commissioner of human services.
2.9    (c) "Commissioners" means the commissioner of human services and the
2.10commissioner of health acting jointly.
2.11    (d) "State health care program" means the medical assistance, MinnesotaCare, and
2.12general assistance medical care programs.
2.13    Subd. 2. Establishment of health care homes. The commissioners shall establish
2.14health care homes for all state health care program enrollees, beginning first with
2.15enrollees who have, or are at risk of developing, complex or chronic health conditions. In
2.16establishing health care homes, the commissioners shall consider, and when appropriate
2.17incorporate, features of the medical home model developed for the provider-directed care
2.18coordination program authorized under section 256B.0625, subdivision 51.
2.19    Subd. 3. Certification. By July 1, 2009, the commissioners shall begin certification
2.20of individual clinicians, who participate as providers in state health care programs and
2.21meet the requirements of section 256B.0752, as health care homes. Clinicians may enter
2.22into collaborative agreements with other clinicians to develop the components of a health
2.23care home. Clinician certification as a health care home is voluntary. Clinicians certified
2.24as health care homes shall renew their certification annually, in order to maintain their
2.25status as health care homes.

2.26    Sec. 3. [256B.0752] HEALTH CARE HOME REQUIREMENTS.
2.27    Subdivision 1. Requirement. In order to be certified as a health care home, a
2.28clinician shall meet the criteria specified in this section.
2.29    Subd. 2. Patient-provider relationship; care teams. Each patient of a health care
2.30home shall have an ongoing, long-term relationship with a provider trained as a personal
2.31clinician to provide first contact, continuous, and comprehensive care for all of a patient's
2.32health care needs. Appropriate specialists and other health care professionals who do not
2.33practice in a traditional primary care field, and advanced practice registered nurses, shall
2.34be allowed to serve as personal clinicians, if they provide care according to this section.
3.1    Subd. 3. Care coordination. The personal clinician, in coordination with other
3.2health care providers, is responsible for providing for all the patient's health care needs
3.3or for arranging appropriate care with other qualified professionals. Health care must be
3.4coordinated across all provider types, all care locations, and the greater community. This
3.5requirement applies to care for all stages of life, including preventive care, acute care,
3.6chronic care, and end-of-life care. Care coordination must include ongoing planning
3.7to prepare for patient transitions across different types of care and provider types. The
3.8primary care team shall also coordinate with those providing for the social service needs
3.9of the individual, if this is necessary to ensure a successful health outcome.
3.10    Subd. 4. Care delivery. (a) A health care home must provide or arrange for access
3.11to care 24-hours a day, seven days a week.
3.12    (b) Health care homes must encourage the patient, and when authorized and
3.13appropriate, the family, to actively participate in decision making and in health care home
3.14quality improvement initiatives, as a full member of the primary care team. Health care
3.15homes must consider patients and families as partners in decision making, and must
3.16provide access to a patient-directed, decision-making process, including appropriate
3.17decision aids, when available.
3.18    (c) Care delivery must be facilitated by the use of health information technology and
3.19through systematic patient follow-up using internal clinic patient registries, according to
3.20minimum standards specified by the commissioners.
3.21    (d) Care must be provided in a culturally and linguistically appropriate manner.
3.22    (e) Within the context of a system of continuous quality improvement, care
3.23delivery, whenever possible, must be based on evidence-based medicine and use clinical
3.24decision-support tools.
3.25    (f) A health care home must provide enhanced access to care, using methods such
3.26as open scheduling, expanded hours, and new communication methods, such as e-mail,
3.27phone consultations, and e-consults.
3.28    Subd. 5. Quality of care. Health care homes must meet process, outcome, and
3.29quality standards as developed and specified by the commissioners. Health care homes
3.30must measure and publicly report all data necessary for the commissioners to monitor
3.31compliance with these standards.
3.32    Subd. 6. Comprehensive health assessment. Health care homes must complete
3.33a comprehensive health assessment for each enrollee determined, by the initial health
3.34assessment required under section 256B.0431, subdivision 2, to have, or be at risk of
3.35developing, a complex or chronic health condition. The comprehensive health assessment
3.36must be completed within 90 days of the initial health assessment. Health care homes
4.1must develop and implement a comprehensive care plan to manage complex or chronic
4.2conditions based upon the comprehensive health assessment and other information. The
4.3comprehensive care plans must meet criteria specified by the commissioners.
4.4    Subd. 7. Care coordinators. Health care homes must employ care coordinators
4.5to manage the care provided to patients with complex or chronic conditions. Care
4.6coordinators may be social workers, nurses, or other clinicians. Care coordinators are
4.7responsible for:
4.8    (1) identifying patients with complex or chronic conditions eligible for care
4.9coordination;
4.10    (2) assisting primary care providers in care coordination and education;
4.11    (3) helping patients coordinate their care or access needed services, including
4.12preventative care;
4.13    (4) communicating the care needs and concerns of the patient to the health care
4.14home; and
4.15    (5) collecting data on process and outcome measures.

4.16    Sec. 4. [256B.0753] CARE COORDINATION FEE.
4.17    Subdivision 1. Care coordination fee. (a) The commissioner shall pay each health
4.18care home a per-person per-month care coordination fee for providing care coordination
4.19services. The fee must be paid for each fee-for-service state health care program enrollee
4.20eligible for a health care home, who is served by a personal clinician certified as a health
4.21care home.
4.22    (b) Payment of the care coordination fee is contingent on the health care home
4.23meeting the certification standards for health care homes. The care coordination fee is in
4.24addition to reimbursement received by a health care home under the medical assistance
4.25fee-for-service payment system for health care services.
4.26    Subd. 2. Amount of fee. The care coordination fee must not exceed an average
4.27of $50 per person per month. The care coordination fee must be determined by the
4.28commissioner, and must vary by thresholds of care complexity, with the highest fees being
4.29paid for care provided to individuals requiring the most intensive care coordination, such
4.30as those with very complex health care needs or several chronic conditions.
4.31    Subd. 3. Cost neutrality. The commissioner may reduce payment rates for
4.32non-primary care services, if initial savings from implementation of health care homes are
4.33not sufficient to allow implementation of the care coordination fee in a cost-neutral manner.

4.34    Sec. 5. [256B.0754] DUTIES OF THE COMMISSIONERS.
5.1    Subdivision 1. Establishment of certification standards and other criteria. (a)
5.2By January 1, 2009, the commissioners shall establish certification standards for health
5.3care homes consistent with the criteria in section 256B.0752.
5.4    (b) By January 1, 2009, the commissioners shall develop care complexity thresholds
5.5and payment amounts for the care coordination fee established under section 256B.0753.
5.6    (c) By January 1, 2009, the commissioners shall identify criteria to determine
5.7enrollees eligible for and in need of care coordination, and who would benefit from having
5.8a comprehensive care plan for their condition.
5.9    (d) By January 1, 2009, the commissioners shall establish criteria and data collection
5.10procedures for evaluating health care homes.
5.11    (e) By January 1, 2009, the commissioners shall develop health care home
5.12requirements for managed care plan contracts, performance incentives, and withholds,
5.13and shall develop the methodology for identifying and recapturing managed care savings
5.14resulting from implementation of the health care home model.
5.15    Subd. 2. Monitoring and evaluation. The commissioners shall ensure the
5.16collection from health care homes of data necessary to monitor implementation of the
5.17health care home model, measure and evaluate quality of care and outcomes, measure
5.18and evaluate patient experience, and determine cost savings from implementation of
5.19the health care home model. The commissioners shall collect and evaluate this data
5.20directly, but may contract with an appropriate private sector entity for technical assistance.
5.21The commissioners shall provide health care homes with practice profiles measuring
5.22utilization, cost, and quality.
5.23    Subd. 3. Care Coordination Advisory Committee. By July 1, 2008, the
5.24commissioners shall establish a Care Coordination Advisory Committee to assist the
5.25Departments of Human Services and Health in administering the health care home model,
5.26developing the criteria and standards required under subdivision 1, collecting data,
5.27and measuring and evaluating health outcomes and cost savings. The commissioners
5.28may satisfy this requirement by continuing the advisory committee established for the
5.29provider-directed care coordination program. If newly established, the committee must
5.30include representatives of: primary care and specialist physicians, advanced practice
5.31registered nurses, patients and their families, health plans, the Institute for Clinical
5.32Systems Improvement, Minnesota Community Measurement, and other relevant entities.
5.33    Subd. 4. Health care home collaborative. By July 1, 2009, the commissioners
5.34shall establish a health care home collaborative to provide an opportunity for health care
5.35homes and state agencies to exchange information related to quality improvement and
5.36best practices.
6.1    Subd. 5. Patient-directed, decision-making process. By January 1, 2009,
6.2the commissioners, in consultation with the Care Coordination Advisory Committee
6.3and the Institute of Clinical Systems Improvement, shall develop a patient-directed,
6.4decision-making support model to be used by health care homes. The commissioners shall:
6.5    (1) establish protocols that include identifying the use of a patient-directed,
6.6decision-making process and incorporating effectively the use of patient-decision aids,
6.7when appropriate;
6.8    (2) ensure the quality of the patient-decision aids available to the patient;
6.9    (3) ensure accessibility of the patient-decision aids, including the use of translators,
6.10when necessary; and
6.11    (4) ensure that providers are trained to use patient-decision aids effectively.
6.12    Subd. 6. Annual reports. The commissioners shall report annually to the legislature
6.13on the implementation and administration of the health care home model for state health
6.14care program enrollees in the fee-for-service, managed care, and county-based purchasing
6.15sectors, beginning December 15, 2009, and each December 15 thereafter. The report must
6.16include information on the number of state health care program enrollees in health care
6.17homes, the number and characteristics of enrollees with complex or chronic conditions,
6.18the number and geographic distribution of health care home providers, the performance
6.19and quality of care of health care homes, measures of preventative care, costs related
6.20to implementation and payment of care coordination fees, health care home payment
6.21arrangements, and estimates of savings from implementation of the health care home
6.22model for the fee-for-service, managed care, and county-based purchasing sectors relative
6.23to the health care spending baseline calculated under section 62U.07.

6.24    Sec. 6. Minnesota Statutes 2006, section 256B.69, is amended by adding a subdivision
6.25to read:
6.26    Subd. 29. Health care home model. (a) The commissioner shall require
6.27demonstration providers, as a condition of contract, to adopt by July 1, 2009, a health care
6.28home model for providing care to state health care program enrollees. The health care
6.29home model must meet the criteria specified in this section and section 256B.0752. The
6.30commissioner, in consultation with the commissioner of health, may waive or modify
6.31criteria for demonstration providers if the commissioners of health and human services
6.32determine that performance and quality standards would still be met.
6.33    (b) The commissioner, as a condition of contract, shall require demonstration
6.34providers, as part of their implementation of the health care home model, to pay providers
6.35a care coordination fee. The care coordination fee must meet the requirements of section
7.1256B.0753. Demonstration providers shall fund the care coordination fee through savings
7.2that result from implementation of the health care home model and if necessary, through
7.3reductions in administrative costs and provider payment rates for non-primary care
7.4services. The commissioner shall not adjust current or future capitation rates for costs
7.5related to payment of the care coordination fee.
7.6    (c) The commissioners of health and human services shall require demonstration
7.7providers to: (1) collect from health care homes the data necessary to monitor
7.8implementation of the health care home model, measure and evaluate quality of care
7.9and outcomes, measure and evaluate patient experience, and determine cost savings
7.10from implementation of the health care home model; and (2) submit this data to
7.11the commissioners. The commissioners of health and human services shall provide
7.12demonstration providers and health care homes with practice profiles measuring
7.13utilization, cost, and quality.
7.14    (d) Savings from the use of health care homes must be split among the state, health
7.15care providers, and demonstration providers. The state must retain one-half of the
7.16savings, the demonstration providers may retain up to one-fourth of the savings, and at
7.17least one-fourth of the savings must be passed on to health care providers in the form
7.18of higher payment rates.
7.19    (e) Beginning July 1, 2009, the commissioner shall provide a performance
7.20incentive for expenses related to the operation of health care homes that would reimburse
7.21upfront costs related to implementation of health care homes after a one-year lag. The
7.22commissioners of health and human services shall establish quality and performance
7.23standards for health care homes, and beginning July 1, 2009, these standards shall be
7.24subject to the capitation rate withhold under subdivision 5a, paragraph (c).
7.25    (f) Demonstration providers must require state health care program enrollees to
7.26complete an initial health assessment within three months from the time of enrollment, in
7.27order to identify individuals with, or who are at risk of developing, complex or chronic
7.28health conditions, and to identify preventative health care needs.
7.29    (g) Beginning July 1, 2009, the commissioner shall require demonstration providers
7.30to complete a comprehensive health assessment for each enrollee determined, by the
7.31initial health assessment required under section 256B.0431, subdivision 2, to have, or be
7.32at risk of developing, a complex or chronic health condition. The commissioner shall pay
7.33demonstration providers a one-time health assessment fee for each enrollee who completes
7.34a comprehensive health assessment. Comprehensive health assessments must meet the
7.35criteria established for health care homes under section 256B.0752, subdivision 6.
8.1    (h) Beginning July 1, 2009, the commissioner shall implement financial
8.2arrangements for demonstration providers to ensure that plans require each enrollee to
8.3choose a provider to serve as a health care home.

8.4    Sec. 7. PAYMENT OF CARE COORDINATION FEE UNDER STATE
8.5MANAGED CARE PROGRAMS.
8.6    The commissioner of human services shall study the feasibility of paying the
8.7care coordination fee required under Minnesota Statutes, section 256B.69, subdivision
8.829, paragraph (b), directly to health care providers under contract with demonstration
8.9providers to serve state health care program enrollees, and shall present recommendations
8.10to the legislature by December 15, 2008.


8.13    Section 1. Minnesota Statutes 2006, section 256.01, is amended by adding a
8.14subdivision to read:
8.15    Subd. 27. Automation and coordination for state health care programs. (a) For
8.16purposes of this subdivision, "state health care program" means the medical assistance,
8.17MinnesotaCare, or general assistance medical care programs.
8.18    (b) By July 1, 2009, the commissioner shall improve coordination between state
8.19health care programs and social service programs including but not limited to WIC, free
8.20and reduced school lunch programs, and food stamps, and shall develop and use automated
8.21systems to identify persons served by social service programs who may be eligible for, but
8.22are not enrolled in, a state health care program. The system must also permit enrollees to
8.23renew state health care program enrollment through these social services programs. By
8.24January 15, 2009, the commissioner shall, as necessary, identify and recommend to the
8.25legislature statutory changes to state health care and social service programs necessary to
8.26improve coordination and automation of outreach and enrollment efforts.
8.27    (c) By January 15, 2009, the commissioner shall establish and implement an
8.28automated process to send out state health care program renewal forms in the most
8.29common foreign languages to those state health care program enrollees who request
8.30renewal forms in those foreign languages. The commissioner, as part of the initial
8.31enrollment process, shall inform applicants of the availability of this option.
8.32    (d) Beginning July 1, 2008, the commissioner, county social service agencies, and
8.33health care providers shall update state health care program enrollee addresses and related
8.34contact information at the time of each enrollee contact.
9.1EFFECTIVE DATE.This section is effective July 1, 2008.

9.2    Sec. 2. Minnesota Statutes 2007 Supplement, section 256B.056, subdivision 10,
9.3is amended to read:
9.4    Subd. 10. Eligibility verification. (a) The commissioner shall require women who
9.5are applying for the continuation of medical assistance coverage following the end of the
9.660-day postpartum period to update their income and asset information and to submit
9.7any required income or asset verification.
9.8    (b) The commissioner shall determine the eligibility of private-sector health care
9.9coverage for infants less than one year of age eligible under section 256B.055, subdivision
9.1010 , or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
9.11if this is determined to be cost-effective.
9.12    (c) The commissioner shall verify assets and income for all applicants, and for
9.13all recipients upon renewal. The commissioner shall verify liquid assets for applicants,
9.14and for recipients upon renewal, only if the applicant or recipient is within ten percent
9.15of the applicable asset limit. The commissioner may verify nonliquid assets, but is not
9.16required to do so.
9.17    (d) An enrollee who fails to submit renewal forms and related documentation
9.18necessary for verification of continued eligibility in a timely manner shall remain eligible
9.19for one additional month beyond the end of the current eligibility period, before being
9.20disenrolled.
9.21    (e) If there is no change in an enrollee's income or asset information, the enrollee
9.22may renew eligibility at designated locations that include community clinics and health
9.23care providers' offices. These designated sites shall forward the renewal forms to the
9.24commissioner.
9.25EFFECTIVE DATE.The amendment to paragraph (c) is effective January 1, 2009.
9.26The amendment to paragraph (d) is effective January 1, 2010, or upon federal approval,
9.27whichever is later. The commissioner of human services shall notify the revisor of statutes
9.28when federal approval is obtained.

9.29    Sec. 3. Minnesota Statutes 2006, section 256B.061, is amended to read:
9.30256B.061 ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS;
9.31DELAYED VERIFICATION.
9.32    (a) If any individual has been determined to be eligible for medical assistance, it
9.33will be made available for care and services included under the plan and furnished in or
9.34after the third month before the month in which the individual made application for such
10.1assistance, if such individual was, or upon application would have been, eligible for
10.2medical assistance at the time the care and services were furnished. The commissioner
10.3may limit, restrict, or suspend the eligibility of an individual for up to one year upon
10.4that individual's conviction of a criminal offense related to application for or receipt of
10.5medical assistance benefits.
10.6    (b) On the basis of information provided on the completed application, an applicant
10.7who meets the following criteria must be determined eligible beginning in the month
10.8of application:
10.9    (1) gross income is less than 90 percent of the applicable income standard;
10.10    (2) total liquid assets are less than 90 percent of the asset limit;
10.11    (3) does not reside in a long-term care facility; and
10.12    (4) meets all other eligibility requirements, including compliance at the time of
10.13application with citizenship or nationality documentation requirements under section
10.14256B.06, subdivision 4.
10.15    The applicant shall provide all required verifications within 60 days' notice of the
10.16eligibility determination or eligibility shall be terminated. Applicants who are terminated
10.17for failure to provide all required verifications are not eligible to apply for coverage using
10.18the delayed verification procedures specified in this paragraph for 12 months.
10.19EFFECTIVE DATE.This section is effective January 1, 2010.

10.20    Sec. 4. Minnesota Statutes 2006, section 256D.03, is amended by adding a subdivision
10.21to read:
10.22    Subd. 7a. Additional duties of the commissioner. In administering the general
10.23assistance medical care program, the commissioner shall: (1) apply the delayed verification
10.24procedure specified in section 256B.061, paragraph (b), to general assistance medical care
10.25applicants; and (2) provide general assistance medical care enrollees who fail to submit
10.26renewal forms and related documentation necessary to verify continued eligibility with an
10.27additional month of eligibility beyond the end of the current eligibility period.
10.28EFFECTIVE DATE.This section is effective January 1, 2010.

10.29    Sec. 5. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 3, is
10.30amended to read:
10.31    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
10.32inpatient hospital services, including inpatient hospital mental health services and inpatient
10.33hospital and residential chemical dependency treatment, subject to those limitations
10.34necessary to coordinate the provision of these services with eligibility under the medical
11.1assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
11.2section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
11.32 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
11.4215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
11.5pregnant, is subject to an annual limit of $10,000 $20,000.
11.6    (b) Admissions for inpatient hospital services paid for under section 256L.11,
11.7subdivision 3 , must be certified as medically necessary in accordance with Minnesota
11.8Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
11.9    (1) all admissions must be certified, except those authorized under rules established
11.10under section 254A.03, subdivision 3, or approved under Medicare; and
11.11    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
11.12for admissions for which certification is requested more than 30 days after the day of
11.13admission. The hospital may not seek payment from the enrollee for the amount of the
11.14payment reduction under this clause.
11.15EFFECTIVE DATE.This section is effective January 1, 2009, for enrollees for
11.16whom federal funding is not available, and is effective January 1, 2009, or upon federal
11.17approval, whichever is later, for enrollees for whom federal funding is available. The
11.18commissioner of human services shall notify the revisor of statutes when federal approval
11.19is obtained.

11.20    Sec. 6. Minnesota Statutes 2007 Supplement, section 256L.03, subdivision 5, is
11.21amended to read:
11.22    Subd. 5. Co-payments and coinsurance. (a) Except as provided in paragraphs (b)
11.23and (c), the MinnesotaCare benefit plan shall include the following co-payments and
11.24coinsurance requirements for all enrollees:
11.25    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
11.26subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
11.27$3,000 per family;
11.28    (2) $3 per prescription for adult enrollees;
11.29    (3) $25 for eyeglasses for adult enrollees;
11.30    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
11.31episode of service which is required because of a recipient's symptoms, diagnosis, or
11.32established illness, and which is delivered in an ambulatory setting by a physician or
11.33physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
11.34audiologist, optician, or optometrist; and
11.35    (5) $6 for nonemergency visits to a hospital-based emergency room.
12.1    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
12.2children under the age of 21.
12.3    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
12.4    (d) Paragraph (a), clause (4), does not apply to mental health services.
12.5    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
12.6poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
12.7and who are not pregnant shall be financially responsible for the coinsurance amount, if
12.8applicable, and amounts which exceed the $10,000 $20,000 inpatient hospital benefit limit.
12.9    (f) When a MinnesotaCare enrollee becomes a member of a prepaid health
12.10plan, or changes from one prepaid health plan to another during a calendar year, any
12.11charges submitted towards the $10,000 $20,000 annual inpatient benefit limit, and any
12.12out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
12.13or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.
12.14EFFECTIVE DATE.This section is effective January 1, 2009, for enrollees for
12.15whom federal funding is not available, and is effective January 1, 2009, or upon federal
12.16approval, whichever is later, for enrollees for whom federal funding is available. The
12.17commissioner of human services shall notify the revisor of statutes when federal approval
12.18is obtained.

12.19    Sec. 7. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 1, is
12.20amended to read:
12.21    Subdivision 1. Families with children. (a) Families with children with family
12.22income equal to or less than 275 300 percent of the federal poverty guidelines for the
12.23applicable family size shall be eligible for MinnesotaCare according to this section. All
12.24other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
12.25to enrollment under section 256L.07, shall apply unless otherwise specified.
12.26    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
12.27if the children are eligible. Children may be enrolled separately without enrollment by
12.28parents. However, if one parent in the household enrolls, both parents must enroll, unless
12.29other insurance is available. If one child from a family is enrolled, all children must
12.30be enrolled, unless other insurance is available. If one spouse in a household enrolls,
12.31the other spouse in the household must also enroll, unless other insurance is available.
12.32Families cannot choose to enroll only certain uninsured members.
12.33    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
12.34to the MinnesotaCare program. These persons are no longer counted in the parental
12.35household and may apply as a separate household.
13.1    (d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
13.2not eligible for MinnesotaCare if their gross income exceeds $50,000.
13.3    (e) Children formerly enrolled in medical assistance and automatically deemed
13.4eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
13.5from the requirements of this section until renewal.
13.6EFFECTIVE DATE.This section is effective January 1, 2009, or upon federal
13.7approval, whichever is later. The commissioner of human services shall notify the revisor
13.8of statutes when federal approval is obtained.

13.9    Sec. 8. Minnesota Statutes 2007 Supplement, section 256L.04, subdivision 7, is
13.10amended to read:
13.11    Subd. 7. Single adults and households with no children. The definition of eligible
13.12persons includes all individuals and households with no children who have gross family
13.13incomes that are equal to or less than 200 percent of the federal poverty guidelines.
13.14Effective July January 1, 2009, the definition of eligible persons includes all individuals
13.15and households with no children who have gross family incomes that are equal to or less
13.16than 215 300 percent of the federal poverty guidelines.
13.17EFFECTIVE DATE.This section is effective January 1, 2009.

13.18    Sec. 9. Minnesota Statutes 2007 Supplement, section 256L.05, subdivision 3a, is
13.19amended to read:
13.20    Subd. 3a. Renewal of eligibility. (a) Beginning July 1, 2007, an enrollee's eligibility
13.21must be renewed every 12 months. The 12-month period begins in the month after the
13.22month the application is approved.
13.23    (b) Each new period of eligibility must take into account any changes in
13.24circumstances that impact eligibility and premium amount. An enrollee must provide all
13.25the information needed to redetermine eligibility by the first day of the month that ends
13.26the eligibility period. If there is no change in circumstances, the enrollee may renew
13.27eligibility at designated locations that include community clinics and health care providers'
13.28offices. The designated sites shall forward the renewal forms to the commissioner. The
13.29premium for the new period of eligibility must be received as provided in section 256L.06
13.30in order for eligibility to continue.
13.31    (c) For single adults and households with no children formerly enrolled in general
13.32assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
13.33subdivision 3 , the first period of eligibility begins the month the enrollee submitted the
13.34application or renewal for general assistance medical care.
14.1    (d) An enrollee who fails to submit renewal forms and related documentation
14.2necessary for verification of continued eligibility in a timely manner shall remain eligible
14.3for one additional month beyond the end of the current eligibility period, before being
14.4disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
14.5additional month.
14.6EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
14.7approval, whichever is later. The commissioner of human services shall notify the revisor
14.8of statutes when federal approval is obtained.

14.9    Sec. 10. Minnesota Statutes 2006, section 256L.05, is amended by adding a subdivision
14.10to read:
14.11    Subd. 6. Delayed verification. On the basis of information provided on the
14.12completed application, an applicant whose gross income is less than 90 percent of
14.13the applicable income standard and meets all other eligibility requirements, including
14.14compliance at the time of application with citizenship or nationality documentation
14.15requirements under section 256L.04, subdivision 10, must be determined eligible
14.16beginning in the month of application. The applicant shall provide all required
14.17verifications within 60 days' notice of the eligibility determination, or eligibility shall be
14.18terminated. Applicants who are terminated for failure to provide all required verifications
14.19are not eligible to apply for coverage using the delayed verification procedures specified in
14.20this subdivision for 12 months.
14.21EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
14.22approval, whichever is later. The commissioner of human services shall notify the revisor
14.23of statutes when federal approval is obtained.

14.24    Sec. 11. Minnesota Statutes 2006, section 256L.06, subdivision 3, is amended to read:
14.25    Subd. 3. Commissioner's duties and payment. (a) Premiums are dedicated to the
14.26commissioner for MinnesotaCare.
14.27    (b) The commissioner shall develop and implement procedures to: (1) require
14.28enrollees to report changes in income; (2) adjust sliding scale premium payments, based
14.29upon both increases and decreases in enrollee income, at the time the change in income
14.30is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
14.31premiums. Failure to pay includes payment with a dishonored check, a returned automatic
14.32bank withdrawal, or a refused credit card or debit card payment. The commissioner may
14.33demand a guaranteed form of payment, including a cashier's check or a money order, as
14.34the only means to replace a dishonored, returned, or refused payment.
15.1    (c) Premiums are calculated on a calendar month basis and may be paid on a
15.2monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
15.3commissioner of the premium amount required. The commissioner shall inform applicants
15.4and enrollees of these premium payment options. Premium payment is required before
15.5enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
15.6received before noon are credited the same day. Premium payments received after noon
15.7are credited on the next working day.
15.8    (d) Nonpayment of the premium will result in disenrollment from the plan effective
15.9for the first day of the calendar month following the calendar month for which the
15.10premium was due. Persons disenrolled for nonpayment or who voluntarily terminate
15.11coverage from the program may not reenroll until four calendar months have elapsed.
15.12Persons disenrolled for nonpayment who pay all past due premiums as well as current
15.13premiums due, including premiums due for the period of disenrollment, within 20 days
15.14of disenrollment, shall be reenrolled retroactively to the first day of disenrollment The
15.15commissioner shall waive premiums for coverage provided under this paragraph to
15.16persons disenrolled for nonpayment who reapply under section 256L.05, subdivision 3b.
15.17Persons disenrolled for nonpayment or who voluntarily terminate coverage from the
15.18program may not reenroll for four calendar months unless the person demonstrates good
15.19cause for nonpayment. Good cause does not exist if a person chooses to pay other family
15.20expenses instead of the premium. The commissioner shall define good cause in rule.
15.21EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
15.22approval, whichever is later. The commissioner of human services shall notify the revisor
15.23of statutes when federal approval is obtained.

15.24    Sec. 12. Minnesota Statutes 2007 Supplement, section 256L.07, subdivision 1, is
15.25amended to read:
15.26    Subdivision 1. General requirements. (a) Children enrolled in the original
15.27children's health plan as of September 30, 1992, children who enrolled in the
15.28MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
15.29article 4, section 17, and children who have family gross incomes that are equal to or
15.30less than 150 percent of the federal poverty guidelines are eligible without meeting
15.31the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
15.32long as they maintain continuous coverage in the MinnesotaCare program or medical
15.33assistance. Children who apply for MinnesotaCare on or after the implementation date
15.34of the employer-subsidized health coverage program as described in Laws 1998, chapter
15.35407, article 5, section 45, who have family gross incomes that are equal to or less than 150
16.1percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
16.2be eligible for MinnesotaCare.
16.3    Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
16.4income increases above 275 300 percent of the federal poverty guidelines, are no longer
16.5eligible for the program and shall be disenrolled by the commissioner. Beginning January
16.61, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7,
16.7whose income increases above 200 percent of the federal poverty guidelines or 215 300
16.8percent of the federal poverty guidelines on or after July January 1, 2009, are no longer
16.9eligible for the program and shall be disenrolled by the commissioner. For persons
16.10disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of
16.11the calendar month following the month in which the commissioner determines that the
16.12income of a family or individual exceeds program income limits.
16.13    (b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare
16.14if ten percent of their gross individual or gross family income as defined in section
16.15256L.01, subdivision 4 , is less than the annual premium for a policy with a $500
16.16deductible available through the Minnesota Comprehensive Health Association. Children
16.17who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
16.18notice period from the date that ineligibility is determined before disenrollment. The
16.19premium for children remaining eligible under this clause shall be the maximum premium
16.20determined under section 256L.15, subdivision 2, paragraph (b).
16.21    (c) Notwithstanding paragraphs (a) and (b), parents are not eligible for
16.22MinnesotaCare if gross household income exceeds $50,000 for the 12-month period
16.23of eligibility.
16.24EFFECTIVE DATE.This section is effective January 1, 2009, or upon federal
16.25approval, whichever is later, except that the amendment to paragraph (a) related to the
16.26four-month requirement is effective January 1, 2010, or upon federal approval, whichever
16.27is later. The commissioner of human services shall notify the revisor of statutes when
16.28federal approval is obtained.

16.29    Sec. 13. Minnesota Statutes 2006, section 256L.07, subdivision 3, is amended to read:
16.30    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the
16.31MinnesotaCare program must have no health coverage while enrolled or for at least four
16.32months prior to application and renewal. Children enrolled in the original children's health
16.33plan and children in families with income equal to or less than 150 percent of the federal
16.34poverty guidelines, who have other health insurance, are eligible if the coverage:
16.35    (1) lacks two or more of the following:
17.1    (i) basic hospital insurance;
17.2    (ii) medical-surgical insurance;
17.3    (iii) prescription drug coverage;
17.4    (iv) dental coverage; or
17.5    (v) vision coverage;
17.6    (2) requires a deductible of $100 or more per person per year; or
17.7    (3) lacks coverage because the child has exceeded the maximum coverage for a
17.8particular diagnosis or the policy excludes a particular diagnosis.
17.9    The commissioner may change this eligibility criterion for sliding scale premiums
17.10in order to remain within the limits of available appropriations. The requirement of no
17.11health coverage does not apply to newborns.
17.12    (b) Medical assistance, general assistance medical care, and the Civilian Health and
17.13Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
17.14United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
17.15health coverage for purposes of the four-month requirement described in this subdivision.
17.16    (c) For purposes of this subdivision, an applicant or enrollee who is entitled to
17.17Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
17.18Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
17.19have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
17.20Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
17.21for MinnesotaCare.
17.22    (d) (c) Applicants who were recipients of medical assistance or general assistance
17.23medical care within one month of application must meet the provisions of this subdivision
17.24and subdivision 2.
17.25    (e) Cost-effective health insurance that was paid for by medical assistance is not
17.26considered health coverage for purposes of the four-month requirement under this
17.27section, except if the insurance continued after medical assistance no longer considered it
17.28cost-effective or after medical assistance closed.
17.29EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
17.30approval, whichever is later. The commissioner of human services shall notify the revisor
17.31of statutes when federal approval is obtained.

17.32    Sec. 14. Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is
17.33amended to read:
17.34    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
17.35commissioner shall establish a sliding fee scale to determine the percentage of monthly
18.1gross individual or family income that households at different income levels must pay
18.2to obtain coverage through the MinnesotaCare program. The sliding fee scale must be
18.3based on the enrollee's monthly gross individual or family income. The sliding fee scale
18.4must contain separate tables based on enrollment of one, two, or three or more persons.
18.5Until December 31, 2008, the sliding fee scale begins with a premium of 1.5 percent of
18.6monthly gross individual or family income for individuals or families with incomes below
18.7the limits for the medical assistance program for families and children in effect on January
18.81, 1999, and proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8,
18.95.9, 7.4, and 8.8 percent. These percentages are matched to evenly spaced income steps
18.10ranging from the medical assistance income limit for families and children in effect on
18.11January 1, 1999, to 275 percent of the federal poverty guidelines for the applicable family
18.12size, up to a family size of five. The sliding fee scale for a family of five must be used
18.13for families of more than five. The sliding fee scale and percentages are not subject to
18.14the provisions of chapter 14. If a family or individual reports increased income after
18.15enrollment, premiums shall be adjusted at the time the change in income is reported.
18.16    (b) Families Children whose gross income is above 275 300 percent of the federal
18.17poverty guidelines shall pay the maximum premium. The maximum premium is defined
18.18as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
18.19cases paid the maximum premium, the total revenue would equal the total cost of
18.20MinnesotaCare medical coverage and administration. In this calculation, administrative
18.21costs shall be assumed to equal ten percent of the total. The costs of medical coverage
18.22for pregnant women and children under age two and the enrollees in these groups shall
18.23be excluded from the total. The maximum premium for two enrollees shall be twice the
18.24maximum premium for one, and the maximum premium for three or more enrollees shall
18.25be three times the maximum premium for one.
18.26    (c) Beginning January 1, 2009, MinnesotaCare enrollees shall pay premiums
18.27according to the affordability scale established in section 62U.08 with the exception that
18.28children in families with income at or below 150 percent of the federal poverty guidelines
18.29shall pay a monthly premium of $4.
18.30EFFECTIVE DATE.This section is effective January 1, 2009, or upon federal
18.31approval, whichever is later. The commissioner of human services shall notify the revisor
18.32of statutes when federal approval is obtained.

18.33    Sec. 15. Minnesota Statutes 2006, section 256L.15, is amended by adding a subdivision
18.34to read:
19.1    Subd. 5. First month premium exemption. New enrollee households are exempt
19.2from premiums for the first month of MinnesotaCare enrollment. For purposes of this
19.3exemption, a "new enrollee household" is a household which has not been enrolled in
19.4MinnesotaCare for at least one year prior to application.
19.5EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
19.6approval, whichever is later. The commissioner of human services shall notify the revisor
19.7of statutes when federal approval is obtained.

19.8    Sec. 16. INSURANCE COVERAGE FOR LONG-TERM CARE WORKERS.
19.9    (a) By December 15, 2008, the commissioner of human services shall study and
19.10report to the legislature with recommendations for a rate increase to long-term care
19.11employers dedicated to the purchase of employee health insurance in the private market.
19.12The commissioner shall collect necessary actuarial data, employment data, current
19.13coverage data, and other needed information.
19.14    (b) The commissioner shall develop cost estimates for three levels of insurance
19.15coverage for long-term care workers:
19.16    (1) the coverage provided to state employees;
19.17    (2) the coverage provided to MinnesotaCare enrollees; and
19.18    (3) the benefits provided under an "average" private market insurance product, but
19.19with a deductible limited to $100 per person.
19.20    Premium cost sharing, waiting periods for eligibility, definitions of full- and
19.21part-time employment, and other parameters under the three options must be identical to
19.22those under the state employees' health plan.
19.23    (c) For purposes of this section, a long-term care worker is a person employed by a
19.24nursing facility, an intermediate care facility for persons with developmental disabilities,
19.25or a service provider that:
19.26    (1) is eligible under Laws 2007, chapter 147, article 7, section 71; and
19.27    (2) provides long-term care services.
19.28    The commissioner may recommend a different definition of long-term care worker if
19.29this definition presents insurmountable implementation issues.
19.30    (d) The recommendations must include measures to:
19.31    (1) ensure equitable treatment between employers that currently have different levels
19.32of expenditure for employee health insurance costs; and
19.33    (2) enforce the requirement that the rate increase be expended for the intended
19.34purpose.

19.35    Sec. 17. REPEALER.
20.1Minnesota Statutes 2006, section 256L.15, subdivision 3, is repealed.
20.2EFFECTIVE DATE.This section is effective January 1, 2009, or upon federal
20.3approval of the amendments to section 14, whichever is later. The commissioner of human
20.4services shall notify the revisor of statutes when federal approval is obtained.


20.7    Section 1. UNIFORM OUTCOME MEASURES WORKING GROUP.
20.8    (a) The Health Care Transformation Commission, established under Minnesota
20.9Statutes, section 62U.04, shall establish an informal working group to create a
20.10standardized limited set of measures by which to measure performance of health care
20.11providers for use in establishing statewide health improvement goals and in measuring
20.12progress on these goals. The group shall focus first on the most common areas of data
20.13collection for pay-for-performance systems.
20.14    (b) The working group must be known as the Uniform Outcome Measures Working
20.15Group. The commission shall determine its members and the number of members.
20.16The working group must include representatives of health care providers, health care
20.17purchasers, health insurers, public health agencies, and consumers.
20.18    (c) The working group shall attempt to determine uniform definitions, measures, and
20.19forms for submission of data, to the greatest extent possible.
20.20    (d) The working group shall seek to reduce the administrative burden on health
20.21care providers and health care purchasers.
20.22    (e) The working group shall invite and use the expertise of existing organizations
20.23experienced in health care quality measurement.
20.24    (f) The working group shall encourage participation by the public.
20.25    (g) The commission shall encourage use of the working group recommendations.
20.26    (h) By December 15, 2008, the commission shall provide to the legislature a written
20.27report under Minnesota Statutes, section 3.195, summarizing the work of the working
20.28group. The report must include recommendations for: (1) a standardized set of health
20.29care provider performance measures to be enacted by the legislature; and (2) a payment
20.30methodology to reduce capitation rates paid by the commissioner of human services
20.31under Minnesota Statutes, section 256B.69, to demonstration providers that use provider
20.32performance measures other than those included in the standardized set under clause (1).
20.33    (i) The working group terminates on June 30, 2009, unless the commission
20.34determines that the group's continued existence would be beneficial.

21.1    Sec. 2. COMMUNITY BENEFIT STANDARDS AND REPORTING;
21.2NONPROFIT HEALTH PLAN COMPANIES; RECOMMENDATIONS.
21.3    (a) By December 15, 2008, the Health Care Transformation Commission, established
21.4under Minnesota Statutes, section 62U.04, shall recommend to the legislature community
21.5benefit standards to be required by law of nonprofit health plan companies doing business
21.6in the state.
21.7    (b) The recommendations must include a procedure by which each nonprofit health
21.8plan company would periodically report to the state and to the public regarding the
21.9company's compliance with the requirements.
21.10    (c) The commission shall recommend a fair and effective enforcement and
21.11remediation mechanism.


21.14    Section 1. Minnesota Statutes 2007 Supplement, section 13.46, subdivision 2, is
21.15amended to read:
21.16    Subd. 2. General. (a) Unless the data is summary data or a statute specifically
21.17provides a different classification, data on individuals collected, maintained, used, or
21.18disseminated by the welfare system is private data on individuals, and shall not be
21.19disclosed except:
21.20    (1) according to section 13.05;
21.21    (2) according to court order;
21.22    (3) according to a statute specifically authorizing access to the private data;
21.23    (4) to an agent of the welfare system, including a law enforcement person, attorney,
21.24or investigator acting for it in the investigation or prosecution of a criminal or civil
21.25proceeding relating to the administration of a program;
21.26    (5) to personnel of the welfare system who require the data to verify an individual's
21.27identity; determine eligibility, amount of assistance, and the need to provide services to
21.28an individual or family across programs; evaluate the effectiveness of programs; assess
21.29parental contribution amounts; and investigate suspected fraud;
21.30    (6) to administer federal funds or programs;
21.31    (7) between personnel of the welfare system working in the same program;
21.32    (8) to the Department of Revenue to assess parental contribution amounts for
21.33purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit
21.34programs and to identify individuals who may benefit from these programs. The following
21.35information may be disclosed under this paragraph: an individual's and their dependent's
22.1names, dates of birth, Social Security numbers, income, addresses, and other data as
22.2required, upon request by the Department of Revenue. Disclosures by the commissioner
22.3of revenue to the commissioner of human services for the purposes described in this clause
22.4are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include,
22.5but are not limited to, the dependent care credit under section 290.067, the Minnesota
22.6working family credit under section 290.0671, the property tax refund and rental credit
22.7under section 290A.04, and the Minnesota education credit under section 290.0674;
22.8    (9) between the Department of Human Services, the Department of Employment
22.9and Economic Development, and when applicable, the Department of Education, for
22.10the following purposes:
22.11    (i) to monitor the eligibility of the data subject for unemployment benefits, for any
22.12employment or training program administered, supervised, or certified by that agency;
22.13    (ii) to administer any rehabilitation program or child care assistance program,
22.14whether alone or in conjunction with the welfare system;
22.15    (iii) to monitor and evaluate the Minnesota family investment program or the child
22.16care assistance program by exchanging data on recipients and former recipients of food
22.17support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance
22.18under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and
22.19    (iv) to analyze public assistance employment services and program utilization,
22.20cost, effectiveness, and outcomes as implemented under the authority established in Title
22.21II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of
22.221999. Health records governed by sections 144.291 to 144.298 and "protected health
22.23information" as defined in Code of Federal Regulations, title 45, section 160.103, and
22.24governed by Code of Federal Regulations, title 45, parts 160-164, including health care
22.25claims utilization information, must not be exchanged under this clause;
22.26    (10) to appropriate parties in connection with an emergency if knowledge of
22.27the information is necessary to protect the health or safety of the individual or other
22.28individuals or persons;
22.29    (11) data maintained by residential programs as defined in section 245A.02 may
22.30be disclosed to the protection and advocacy system established in this state according
22.31to Part C of Public Law 98-527 to protect the legal and human rights of persons with
22.32developmental disabilities or other related conditions who live in residential facilities for
22.33these persons if the protection and advocacy system receives a complaint by or on behalf
22.34of that person and the person does not have a legal guardian or the state or a designee of
22.35the state is the legal guardian of the person;
23.1    (12) to the county medical examiner or the county coroner for identifying or locating
23.2relatives or friends of a deceased person;
23.3    (13) data on a child support obligor who makes payments to the public agency
23.4may be disclosed to the Minnesota Office of Higher Education to the extent necessary to
23.5determine eligibility under section 136A.121, subdivision 2, clause (5);
23.6    (14) participant Social Security numbers and names collected by the telephone
23.7assistance program may be disclosed to the Department of Revenue to conduct an
23.8electronic data match with the property tax refund database to determine eligibility under
23.9section 237.70, subdivision 4a;
23.10    (15) the current address of a Minnesota family investment program participant
23.11may be disclosed to law enforcement officers who provide the name of the participant
23.12and notify the agency that:
23.13    (i) the participant:
23.14    (A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
23.15conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
23.16jurisdiction from which the individual is fleeing; or
23.17    (B) is violating a condition of probation or parole imposed under state or federal law;
23.18    (ii) the location or apprehension of the felon is within the law enforcement officer's
23.19official duties; and
23.20    (iii) the request is made in writing and in the proper exercise of those duties;
23.21    (16) the current address of a recipient of general assistance or general assistance
23.22medical care may be disclosed to probation officers and corrections agents who are
23.23supervising the recipient and to law enforcement officers who are investigating the
23.24recipient in connection with a felony level offense;
23.25    (17) information obtained from food support applicant or recipient households may
23.26be disclosed to local, state, or federal law enforcement officials, upon their written request,
23.27for the purpose of investigating an alleged violation of the Food Stamp Act, according
23.28to Code of Federal Regulations, title 7, section 272.1(c);
23.29    (18) the address, Social Security number, and, if available, photograph of any
23.30member of a household receiving food support shall be made available, on request, to a
23.31local, state, or federal law enforcement officer if the officer furnishes the agency with the
23.32name of the member and notifies the agency that:
23.33    (i) the member:
23.34    (A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
23.35crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;
24.1    (B) is violating a condition of probation or parole imposed under state or federal
24.2law; or
24.3    (C) has information that is necessary for the officer to conduct an official duty related
24.4to conduct described in subitem (A) or (B);
24.5    (ii) locating or apprehending the member is within the officer's official duties; and
24.6    (iii) the request is made in writing and in the proper exercise of the officer's official
24.7duty;
24.8    (19) the current address of a recipient of Minnesota family investment program,
24.9general assistance, general assistance medical care, or food support may be disclosed to
24.10law enforcement officers who, in writing, provide the name of the recipient and notify the
24.11agency that the recipient is a person required to register under section 243.166, but is not
24.12residing at the address at which the recipient is registered under section 243.166;
24.13    (20) certain information regarding child support obligors who are in arrears may be
24.14made public according to section 518A.74;
24.15    (21) data on child support payments made by a child support obligor and data on
24.16the distribution of those payments excluding identifying information on obligees may be
24.17disclosed to all obligees to whom the obligor owes support, and data on the enforcement
24.18actions undertaken by the public authority, the status of those actions, and data on the
24.19income of the obligor or obligee may be disclosed to the other party;
24.20    (22) data in the work reporting system may be disclosed under section 256.998,
24.21subdivision 7 ;
24.22    (23) to the Department of Education for the purpose of matching Department of
24.23Education student data with public assistance data to determine students eligible for free
24.24and reduced price meals, meal supplements, and free milk according to United States
24.25Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and
24.26state funds that are distributed based on income of the student's family; and to verify
24.27receipt of energy assistance for the telephone assistance plan;
24.28    (24) the current address and telephone number of program recipients and emergency
24.29contacts may be released to the commissioner of health or a local board of health as
24.30defined in section 145A.02, subdivision 2, when the commissioner or local board of health
24.31has reason to believe that a program recipient is a disease case, carrier, suspect case, or at
24.32risk of illness, and the data are necessary to locate the person;
24.33    (25) to other state agencies, statewide systems, and political subdivisions of this
24.34state, including the attorney general, and agencies of other states, interstate information
24.35networks, federal agencies, and other entities as required by federal regulation or law for
24.36the administration of the child support enforcement program;
25.1    (26) to personnel of public assistance programs as defined in section 256.741, for
25.2access to the child support system database for the purpose of administration, including
25.3monitoring and evaluation of those public assistance programs;
25.4    (27) to monitor and evaluate the Minnesota family investment program by
25.5exchanging data between the Departments of Human Services and Education, on
25.6recipients and former recipients of food support, cash assistance under chapter 256, 256D,
25.7256J, or 256K, child care assistance under chapter 119B, or medical programs under
25.8chapter 256B, 256D, or 256L;
25.9    (28) to evaluate child support program performance and to identify and prevent
25.10fraud in the child support program by exchanging data between the Department of Human
25.11Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a)
25.12and (b), without regard to the limitation of use in paragraph (c), Department of Health,
25.13Department of Employment and Economic Development, and other state agencies as is
25.14reasonably necessary to perform these functions; or
25.15    (29) counties operating child care assistance programs under chapter 119B may
25.16disseminate data on program participants, applicants, and providers to the commissioner
25.17of education; or
25.18    (30) according to section 256.01, subdivision 27, between the welfare system and the
25.19Minnesota Health Insurance Exchange under section 62U.02, in order to collect premiums
25.20from individuals in the medical assistance employed persons with disabilities program
25.21and the MinnesotaCare program under chapters 256B and 256L and to administer the
25.22individual's and the individual's families' participation in the exchange.
25.23    (b) Information on persons who have been treated for drug or alcohol abuse may
25.24only be disclosed according to the requirements of Code of Federal Regulations, title
25.2542, sections 2.1 to 2.67.
25.26    (c) Data provided to law enforcement agencies under paragraph (a), clause (15),
25.27(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected
25.28nonpublic while the investigation is active. The data are private after the investigation
25.29becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).
25.30    (d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is
25.31not subject to the access provisions of subdivision 10, paragraph (b).
25.32    For the purposes of this subdivision, a request will be deemed to be made in writing
25.33if made through a computer interface system.

25.34    Sec. 2. Minnesota Statutes 2006, section 62A.65, subdivision 3, is amended to read:
26.1    Subd. 3. Premium rate restrictions. No individual health plan may be offered,
26.2sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
26.3determined in accordance with the following requirements:
26.4    (a) Except for policies issued under section 62U.03, subdivision 5, paragraph (b),
26.5premium rates must be no more than 25 percent above and no more than 25 percent below
26.6the index rate charged to individuals for the same or similar coverage, adjusted pro
26.7rata for rating periods of less than one year. The premium variations permitted by this
26.8paragraph must be based only upon health status, claims experience, and occupation. For
26.9purposes of this paragraph, health status includes refraining from tobacco use or other
26.10actuarially valid lifestyle factors associated with good health, provided that the lifestyle
26.11factor and its effect upon premium rates have been determined by the commissioner to
26.12be actuarially valid and have been approved by the commissioner. Variations permitted
26.13under this paragraph must not be based upon age or applied differently at different ages.
26.14This paragraph does not prohibit use of a constant percentage adjustment for factors
26.15permitted to be used under this paragraph.
26.16    (b) Premium rates may vary based upon the ages of covered persons only as
26.17provided in this paragraph. In addition to the variation permitted under paragraph (a),
26.18each health carrier may use an additional premium variation based upon age of up to
26.19plus or minus 50 percent of the index rate.
26.20    (c) A health carrier may request approval by the commissioner to establish separate
26.21geographic regions determined by the health carrier and to establish separate index rates
26.22for each such region. The commissioner shall grant approval if the following conditions
26.23are met:
26.24    (1) the geographic regions must be applied uniformly by the health carrier;
26.25    (2) each geographic region must be composed of no fewer than seven counties that
26.26create a contiguous region; and
26.27    (3) the health carrier provides actuarial justification acceptable to the commissioner
26.28for the proposed geographic variations in index rates, establishing that the variations are
26.29based upon differences in the cost to the health carrier of providing coverage.
26.30    (d) Health carriers may use rate cells and must file with the commissioner the rate
26.31cells they use. Rate cells must be based upon the number of adults or children covered
26.32under the policy and may reflect the availability of Medicare coverage. The rates for
26.33different rate cells must not in any way reflect generalized differences in expected costs
26.34between principal insureds and their spouses.
26.35    (e) In developing its index rates and premiums for a health plan, a health carrier shall
26.36take into account only the following factors:
27.1    (1) actuarially valid differences in rating factors permitted under paragraphs (a)
27.2and (b); and
27.3    (2) actuarially valid geographic variations if approved by the commissioner as
27.4provided in paragraph (c).
27.5    (f) All premium variations must be justified in initial rate filings and upon request of
27.6the commissioner in rate revision filings. All rate variations are subject to approval by
27.7the commissioner.
27.8    (g) The loss ratio must comply with the section 62A.021 requirements for individual
27.9health plans.
27.10    (h) The rates must not be approved, unless the commissioner has determined that the
27.11rates are reasonable. In determining reasonableness, the commissioner shall consider the
27.12growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar
27.13year or years that the proposed premium rate would be in effect, actuarially valid changes
27.14in risks associated with the enrollee populations, and actuarially valid changes as a result
27.15of statutory changes in Laws 1992, chapter 549.
27.16    (i) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under
27.17section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
27.18paragraph. The rating practices guarantee must be in writing and must guarantee that
27.19the policy form will be offered, sold, issued, and renewed only with premium rates and
27.20premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices
27.21guarantee must be accompanied by an actuarial memorandum that demonstrates that the
27.22premium rates and premium rating system used in connection with the policy form will
27.23satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to
27.24policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4,
27.25or 5. An insurer that complies with this paragraph in connection with a policy form is
27.26exempt from the requirement of prior approval by the commissioner under paragraphs
27.27(c), (f), and (h).

27.28    Sec. 3. Minnesota Statutes 2006, section 62E.141, is amended to read:
27.2962E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
27.30    No employee of an employer that offers a group health plan, under which the
27.31employee is eligible for coverage, is eligible to enroll, or continue to be enrolled, in
27.32the comprehensive health association, except for enrollment or continued enrollment
27.33necessary to cover conditions that are subject to an unexpired preexisting condition
27.34limitation, preexisting condition exclusion, or exclusionary rider under the employer's
27.35health plan. This section does not apply to persons enrolled in the Comprehensive Health
28.1Association as of June 30, 1993. With respect to persons eligible to enroll in the health
28.2plan of an employer that has more than 29 current employees, as defined in section
28.362L.02 , this section does not apply to persons enrolled in the Comprehensive Health
28.4Association as of December 31, 1994.

28.5    Sec. 4. Minnesota Statutes 2006, section 62L.12, subdivision 2, is amended to read:
28.6    Subd. 2. Exceptions. (a) A health carrier may sell, issue, or renew individual
28.7conversion policies to eligible employees otherwise eligible for conversion coverage under
28.8section 62D.104 as a result of leaving a health maintenance organization's service area.
28.9    (b) A health carrier may sell, issue, or renew individual conversion policies to
28.10eligible employees otherwise eligible for conversion coverage as a result of the expiration
28.11of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21,
28.1262C.142 , 62D.101, and 62D.105.
28.13    (c) A health carrier may sell, issue, or renew conversion policies under section
28.1462E.16 to eligible employees.
28.15    (d) A health carrier may sell, issue, or renew individual continuation policies to
28.16eligible employees as required.
28.17    (e) A health carrier may sell, issue, or renew individual health plans if the coverage
28.18is appropriate due to an unexpired preexisting condition limitation or exclusion applicable
28.19to the person under the employer's group health plan or due to the person's need for health
28.20care services not covered under the employer's group health plan.
28.21    (f) A health carrier may sell, issue, or renew an individual health plan, if the
28.22individual has elected to buy the individual health plan not as part of a general plan to
28.23substitute individual health plans for a group health plan nor as a result of any violation of
28.24subdivision 3 or 4.
28.25    (g) Nothing in this subdivision relieves a health carrier of any obligation to provide
28.26continuation or conversion coverage otherwise required under federal or state law.
28.27    (h) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage
28.28issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or
28.29contracts that supplement Medicare issued by health maintenance organizations, or those
28.30contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social
28.31Security Act, United States Code, title 42, section 1395 et seq., as amended.
28.32    (i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
28.33health plans necessary to comply with a court order.
28.34    (j) A health carrier may offer, issue, sell, or renew an individual health plan to
28.35persons eligible for an employer group health plan, if the individual health plan is a high
29.1deductible health plan for use in connection with an existing health savings account, in
29.2compliance with the Internal Revenue Code, section 223. In that situation, the same or
29.3a different health carrier may offer, issue, sell, or renew a group health plan to cover
29.4the other eligible employees in the group.
29.5    (k) A health carrier may offer, sell, issue, or renew an individual health plan to one
29.6or more employees of a small employer if the individual health plan is marketed directly to
29.7all employees or through the Minnesota Health Insurance Exchange under section 62U.02
29.8to all employees of the small employer and the small employer does not contribute directly
29.9or indirectly to the premiums or facilitate the administration of the individual health plan.
29.10Except as provided in section 62U.03, subdivision 5, paragraph (b), the requirement to
29.11market an individual health plan to all employees does not require the health carrier to
29.12offer or issue an individual health plan to any employee. For purposes of this paragraph,
29.13an employer is not contributing to the premiums or facilitating the administration of the
29.14individual health plan if the employer does not contribute to the premium and merely
29.15collects the premiums from an employee's wages or salary through payroll deductions
29.16and submits payment for the premiums of one or more employees in a lump sum to the
29.17health carrier or to the Minnesota Health Insurance Exchange under section 62U.02.
29.18Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the
29.19request of an employee, the health carrier or the Minnesota Health Insurance Exchange
29.20under section 62U.02 may bill the employer for the premiums payable by the employee,
29.21provided that the employer is not liable for payment except from payroll deductions for
29.22that purpose. If an employer is submitting payments under this paragraph, the health
29.23carrier or the Minnesota Health Insurance Exchange, as applicable, shall provide a
29.24cancellation notice directly to the primary insured at least ten days prior to termination
29.25of coverage for nonpayment of premium. Individual coverage under this paragraph may
29.26be offered only if the small employer has not provided coverage under section 62L.03 to
29.27the employees within the past 12 months.
29.28    The employer must provide a written and signed statement to the health carrier or
29.29the Minnesota Health Insurance Exchange, as applicable, stating that the employer is not
29.30contributing directly or indirectly to the employee's premiums. The Minnesota Health
29.31Insurance Exchange under section 62U.02 shall provide all health carriers with enrolled
29.32employees of the employer with a copy of the employer's statement. The health carrier
29.33may rely on the employer's statement and is not required to guarantee-issue individual
29.34health plans to the employer's other current or future employees, except as required under
29.35section 62U.03, subdivision 5, paragraph (b).

29.36    Sec. 5. Minnesota Statutes 2006, section 62L.12, subdivision 4, is amended to read:
30.1    Subd. 4. Employer prohibition. A small employer offering a health benefit plan
30.2shall not encourage or direct an employee or applicant to:
30.3    (1) refrain from filing an application for health coverage when other similarly
30.4situated employees may file an application for health coverage;
30.5    (2) file an application for health coverage during initial eligibility for coverage,
30.6the acceptance of which is contingent on health status, when other similarly situated
30.7employees may apply for health coverage, the acceptance of which is not contingent on
30.8health status;
30.9    (3) seek coverage from another health carrier, including, but not limited to, MCHA;
30.10or
30.11    (4) cause coverage to be issued on different terms because of the health status or
30.12claims experience of that person or the person's dependents.

30.13    Sec. 6. [62U.01] DEFINITIONS.
30.14    Subdivision 1. Applicability. For purposes of this chapter, the terms defined in this
30.15section have the meanings given, unless otherwise specified.
30.16    Subd. 2. Advisory committee. "Advisory committee" means the Health Benefit Set
30.17and Design Advisory Committee established in section 62U.055.
30.18    Subd. 3. Clinically effective. "Clinically effective" means that the use of a
30.19particular health technology improves patient clinical status, as measured by medical
30.20condition, survival rates, and other variables, and that the use of the particular technology
30.21demonstrates a clinical advantage over alternative technologies.
30.22    Subd. 4. Commission. "Commission" means the Health Care Transformation
30.23Commission established in section 62U.04.
30.24    Subd. 5. Cost effective. "Cost effective" means that the economic costs of using
30.25a particular service, device, or health technology to achieve improvement in a patient's
30.26health outcome are justified given the comparison to both the economic costs and the
30.27improvement in patient health outcome resulting from the use of an alternative service,
30.28device, or technology, or from not providing the service, device, or technology.
30.29    Subd. 6. Exchange. "Exchange" means the Minnesota Health Insurance Exchange
30.30established in section 62U.02.
30.31    Subd. 7. Health plan. "Health plan" means a health plan as defined in section
30.3262A.011.
30.33    Subd. 8. Health plan company. "Health plan company" has the meaning provided
30.34in section 62Q.01, subdivision 4.
31.1    Subd. 9. Health technology. "Health technology" means medical and surgical
31.2devices and procedures, medical equipment, and diagnostic tests.
31.3    Subd. 10. Section 125 Plan. "Section 125 Plan" means a cafeteria or premium-only
31.4plan under section 125 of the Internal Revenue Code that allows employees to pay for
31.5health insurance premiums with pretax dollars.
31.6    Subd. 11. State health care program. "State health care program" means the
31.7medical assistance, MinnesotaCare, and general assistance medical care programs.
31.8    Subd. 12. Third-party administrators. "Third-party administrators" means a
31.9vendor of risk-management services or an entity administering a self-insurance or health
31.10insurance plan under section 60A.23.

31.11    Sec. 7. [62U.02] MINNESOTA HEALTH INSURANCE EXCHANGE.
31.12    Subdivision 1. Title; citation. This section may be cited as the "Minnesota Health
31.13Insurance Exchange."
31.14    Subd. 2. Creation; tax exemption. The Minnesota Health Insurance Exchange
31.15is created for the limited purpose of providing individuals with greater access, choice,
31.16portability, and affordability of health insurance products. The Minnesota Health
31.17Insurance Exchange is created as an unincorporated association and shall promptly
31.18incorporate as a nonprofit corporation under chapter 317A and apply for qualification
31.19under section 501(c) of the Internal Revenue Code.
31.20    Subd. 3. Definitions. For purposes of this section, the following terms have the
31.21meanings given them.
31.22    (a) "Board" means the Board of Directors of the Minnesota Health Insurance
31.23Exchange under subdivision 13.
31.24    (b) "Commissioner" means:
31.25    (1) the commissioner of commerce for health plan companies subject to the
31.26jurisdiction of the Department of Commerce;
31.27    (2) the commissioner of health for health plan companies subject to the jurisdiction
31.28of the Department of Health; or
31.29    (3) either commissioner's designated representative.
31.30    (c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
31.31    (d) "Individual market health plan" means a health plan as defined in section
31.3262A.011, that is designed for sale in the individual market.
31.33    (e) "Small employer" means a small employer as defined in section 62L.02,
31.34subdivision 26.
32.1    (f) "Small employer health benefit plan" means a health benefit plan as defined in
32.2section 62L.02, subdivision 15.
32.3    Subd. 4. Health plan company and health plan participation and availability.
32.4    (a) Only individual market health plans and small employer health benefit plans offered by
32.5a health plan company licensed to issue health plans in Minnesota may be made available
32.6for purchase through the exchange.
32.7    (b) Each health plan made available by a health plan company through the exchange
32.8must meet the minimum benefit set and design requirements provided under section
32.962U.04, subdivision 5.
32.10    (c) Any health plan company that issues health plans in the individual or small
32.11employer market in this state must offer through the exchange at least one health plan
32.12that meets the benefit set and design established by the Health Care Transformation
32.13Commission under section 62U.04.
32.14    (d) Health plans offered through the Minnesota Comprehensive Health Association
32.15as defined in section 62E.10 must be available for sale through the exchange as determined
32.16by the Minnesota Comprehensive Health Association.
32.17    (e) Health plans offered through the MinnesotaCare program must be available
32.18through the exchange to individuals and families who meet the eligibility requirements
32.19for MinnesotaCare, as determined by the commissioner of human services, and who pay
32.20premiums through an employer Section 125 Plan.
32.21    (f) Nothing in this section restricts the sale of individual market health plans and
32.22small employer health benefit plans outside of the exchange. The requirements applicable
32.23to issuance, renewal, cancelation, and pricing of coverage are the same for health plans
32.24purchased inside and outside the exchange, except as described under section 62U.03,
32.25subdivision 5, paragraph (b).
32.26    Subd. 5. Ranking of health plans. The exchange shall create an Internet-based
32.27system for ranking individual market health plans and small employer health benefit
32.28plans. The ranking system shall consider variation across plans in factors, including, but
32.29not limited to, premiums, deductibles, co-payment and coinsurance requirements, annual
32.30out-of-pocket maximum payments, and lifetime benefit limits, and the system shall rank
32.31plans based on priorities specified by the user.
32.32    Subd. 6. Individual participation and eligibility. (a) Individuals are eligible to
32.33purchase health plans directly through the exchange or through an employer Section
32.34125 Plan under section 62U.03.
33.1    (b) Nothing in this section requires guaranteed issue of individual market health
33.2plans offered through the exchange except as provided under section 62U.03, subdivision
33.35, paragraph (b).
33.4    (c) Individuals are eligible to purchase individual market health plans through the
33.5exchange by meeting one or more of the following qualifications:
33.6    (1) the individual is a Minnesota resident, meaning the individual is physically
33.7residing on a permanent basis in a place in this state that is the person's principal residence
33.8and from which the person is absent only for temporary purposes;
33.9    (2) the individual is a student attending an institution outside of Minnesota and
33.10maintains Minnesota residency;
33.11    (3) the individual is not a Minnesota resident but is employed by an employer
33.12physically located within the state and the individual's employer is required to offer a
33.13Section 125 Plan under section 62U.03; or
33.14    (4) the individual is a dependent as defined in section 62L.02, of another individual
33.15who is eligible to participate in the exchange.
33.16    Subd. 7. Small employer participation and eligibility. Small employers, as
33.17defined in section 62L.02, may purchase small employer health benefit plans through
33.18the exchange.
33.19    Subd. 8. Responsibilities of the exchange. The exchange may serve as a
33.20coordinating entity for enrollment and collection and transfer of premium payments for
33.21health plans sold to individuals through the exchange. The exchange must be responsible
33.22for the following functions:
33.23    (1) publicize the exchange, including but not limited to its functions, eligibility
33.24rules, and enrollment procedures;
33.25    (2) provide assistance to employers to establish Section 125 Plans under section
33.2662U.03;
33.27    (3) provide education and assistance to employers to help them understand the
33.28requirements of Section 125 Plans and compliance with applicable regulations;
33.29    (4) create a system to allow individuals to compare and enroll in health plans
33.30offered through the exchange, including a system of comparative rating of health plans
33.31and benefits set;
33.32    (5) create a system to collect and transmit to the applicable health plan companies
33.33all premium payments made by individuals, including developing mechanisms to receive
33.34and process automatic payroll deductions for individuals who purchase coverage through
33.35employer Section 125 Plans;
34.1    (6) for participating employers, bill the employer for the premiums payable by the
34.2employer for a small employer health benefit plan;
34.3    (7) for individuals purchasing individual market health plans through a Section 125
34.4Plan, bill the individual's employer for premiums payable by the employee, provided that
34.5the employer is not liable for payment except from payroll deductions for that purpose;
34.6    (8) provide information on public insurance programs to individuals who may
34.7qualify for these programs, and provide application assistance, if needed on applying
34.8for these programs;
34.9    (9) establish a mechanism with the Department of Human Services to transfer
34.10premiums paid by Minnesota health care program enrollees from Section 125 Plans;
34.11    (10) establish procedures to account for all funds received and disbursed by the
34.12exchange; and
34.13    (11) make available to the public, within 90 days after the end of each fiscal year, a
34.14report of an independent audit of the exchange's accounts.
34.15    Subd. 9. State not liable. The state of Minnesota is not liable for the actions of
34.16the exchange.
34.17    Subd. 10. Powers of the exchange. The exchange shall have the power to:
34.18    (1) contract with insurance producers licensed in accident and health insurance
34.19under chapter 60K and vendors to perform one or more of the functions specified in
34.20subdivision 8;
34.21    (2) contract with employers to collect premiums for small employer health benefit
34.22plans and for individual market health plans purchased through a Section 125 Plan;
34.23    (3) establish and assess fees on health plan premiums of small employer health
34.24benefit plans and individual market health plans to fund the cost of administering the
34.25exchange;
34.26    (4) seek and directly receive grant funding from government agencies or private
34.27philanthropic organizations to defray the costs of operating the exchange;
34.28    (5) establish and administer rules and procedures governing the operations of the
34.29exchange;
34.30    (6) establish one or more service centers within Minnesota;
34.31    (7) sue or be sued or otherwise take any necessary or proper legal action;
34.32    (8) establish bank accounts and borrow money; and
34.33    (9) enter into agreements with the commissioners of commerce, health, human
34.34services, revenue, employment and economic development, and other state agencies as
34.35necessary for the exchange to implement the provisions of this section.
35.1    Subd. 11. Dispute resolution. The exchange shall establish procedures for
35.2resolving disputes with respect to the eligibility of an individual to participate in the
35.3exchange. The exchange shall not have the authority or responsibility to intervene in or
35.4resolve disputes between an individual and a health plan or health plan company. If the
35.5exchange receives complaints involving such disputes from individuals participating in
35.6the exchange, the exchange shall inform the individual about the right to make such
35.7complaints to the commissioner to be resolved according to sections 62Q.68 to 62Q.73.
35.8    Subd. 12. Governance. The exchange shall be governed by a board of directors
35.9with 11 members. The board shall convene on or before July 1, 2008, after the initial board
35.10members have been selected. The initial board membership consists of the following:
35.11    (1) the commissioner of commerce;
35.12    (2) the commissioner of human services;
35.13    (3) the commissioner of health; and
35.14    (4) eight members with knowledge and experience related to health insurance
35.15and health insurance markets, appointed to serve three-year terms as follows: two
35.16members appointed by the Subcommittee on Committees of the Committee on Rules and
35.17Administration of the senate; two members appointed by the speaker of the house of
35.18representatives; and four members appointed by the governor.
35.19    Subd. 13. Subsequent board membership. (a) Effective July 1, 2011, ongoing
35.20membership of the exchange consists of the following:
35.21    (1) the commissioner of commerce;
35.22    (2) the commissioner of human services;
35.23    (3) the commissioner of health;
35.24    (4) two members appointed as follows: one member appointed by the Subcommittee
35.25on Committees of the Committee on Rules and Administration of the senate; and one
35.26member appointed by the speaker of the house of representatives to serve two-year
35.27terms; and
35.28    (5) four members elected by the membership of the exchange of which two are
35.29elected to serve a two-year term and two are elected to serve a three-year term.
35.30    (b) Elected members may serve more than one term. At least one of the elected
35.31members must represent a small employer, and at least one member must be a person who
35.32purchases an individual market health plan through the exchange.
35.33    Subd. 14. Operations of the board. Officers of the board of directors are elected by
35.34members of the board and serve one-year terms. Six members of the board constitutes a
35.35quorum, and the affirmative vote of six members of the board is necessary and sufficient
36.1for any action taken by the board. Board members serve without pay, but are reimbursed
36.2for actual expenses incurred in the performance of their duties.
36.3    Subd. 15. Operations of the exchange. The board of directors shall appoint an
36.4exchange director who shall:
36.5    (1) be a full-time employee of the exchange;
36.6    (2) administer all of the activities and contracts of the exchange; and
36.7    (3) hire and supervise the staff of the exchange.
36.8    Subd. 16. Insurance producers. An individual has the right to choose any
36.9insurance producer licensed in accident and health insurance under chapter 60K to assist
36.10the individual in purchasing an individual market health plan through the exchange. When
36.11a producer licensed in accident and health insurance under chapter 60K enrolls an eligible
36.12individual in the exchange, the health plan company chosen by the individual may pay the
36.13producer a commission.
36.14    Subd. 17. Implementation. Health plan coverage through the exchange begins on
36.15July 1, 2009. The exchange must be operational to assist employers and individuals by
36.16January 1, 2009, and be prepared for enrollment by June 1, 2009.
36.17EFFECTIVE DATE.This section is effective the day following final enactment.

36.18    Sec. 8. [62U.03] SECTION 125 PLANS.
36.19    Subdivision 1. Definitions. The following terms have the meanings given them.
36.20    (a) "Current employee" means an employee currently on an employer's payroll other
36.21than a retiree or disabled former employee.
36.22    (b) "Employer" means a person, firm, corporation, partnership, association, business
36.23trust, or other entity employing one or more persons, including a political subdivision of
36.24the state, filing payroll tax information on such employed person or persons.
36.25    (c) "Exchange" means the Minnesota Health Insurance Exchange in section 62U.02.
36.26    (d) "Exchange director" means the appointed director under section 62U.02,
36.27subdivision 15.
36.28    Subd. 2. Section 125 Plan requirement. (a) Effective January 1, 2010, each
36.29employer that has three or more current employees shall establish a Section 125 Plan to
36.30either allow its employees to purchase individual market health plan coverage or allow
36.31its employees to pay the employee's share of premiums for employer-based health plan
36.32coverage with pretax dollars. Nothing in this section requires an employer to offer or
36.33purchase group health insurance coverage for its employees. An employer that has no
37.1employees who are eligible to participate in a Section 125 Plan is exempt from this
37.2requirement.
37.3    (b) An employer that offers a Section 125 Plan may enter into an agreement with the
37.4exchange to administer the employer's Section 125 Plan.
37.5    Subd. 3. Tracking compliance. By July 1, 2010, the exchange, in consultation with
37.6the commissioners of commerce, health, employment and economic development, and
37.7revenue shall establish a method for tracking employer compliance with the Section 125
37.8Plan requirement.
37.9    Subd. 4. Employer requirements. Employers that do not offer a group health
37.10insurance plan as defined in section 62A.10 and that are required to offer or choose
37.11to offer a Section 125 Plan shall:
37.12    (1) allow employees to purchase an individual market health plan for themselves
37.13and their dependents;
37.14    (2) allow employees to choose any insurance producer licensed in accident and health
37.15insurance under chapter 60K to assist them in purchasing an individual market health plan;
37.16    (3) upon an employee's request, deduct premium amounts on a pretax basis in an
37.17amount not to exceed an employee's wages, and remit these employee payments to the
37.18health plan company or the exchange; and
37.19    (4) provide notice to employees that individual market health plans purchased
37.20by employees through payroll deduction are not employer-sponsored or administered.
37.21Employers shall be held harmless from any and all liability claims related to the individual
37.22market health plans purchased by employees under a Section 125 Plan.
37.23    Subd. 5. Health plan company requirements. (a) Individuals who are eligible
37.24to use an employer Section 125 Plan may use it to pay for an individual market health
37.25plan for which the individual is eligible and purchase it through the exchange, including
37.26an individual market health plan, MinnesotaCare, and the Minnesota Comprehensive
37.27Health Association.
37.28    (b) Individuals who purchase an individual market health plan through a Section 125
37.29Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment
37.30period that coincides with the open enrollment period for their employer's Section 125
37.31Plan or upon experiencing a qualifying event as defined in United States Code, title 43,
37.32section 4980B. Nothing in this section precludes a health plan company from issuing
37.33coverage with preexisting condition exclusions as allowed elsewhere in law. Health plans
37.34may not charge higher or lower premiums based on health status for individuals who
37.35purchase coverage on a guaranteed issue basis under this section, except for variations in
37.36premium that are allowable based on health behaviors such as tobacco use.

38.1    Sec. 9. [62U.04] HEALTH CARE TRANSFORMATION COMMISSION.
38.2    Subdivision 1. Creation. The Health Care Transformation Commission is created
38.3for the purpose of coordinating the health care transformation activities within Minnesota.
38.4    Subd. 2. Members. (a) The Health Care Transformation Commission shall consist
38.5of ten members who are appointed as follows:
38.6    (1) three members appointed by the Subcommittee on Committees of the Committee
38.7on Rules and Administration of the senate;
38.8    (2) three members appointed by the speaker of the house of representatives; and
38.9    (3) four members appointed by the governor, two of whom shall be state
38.10commissioners from the agencies listed in section 15.01.
38.11    (b) The appointed members who are not commissioners must:
38.12    (1) have expertise in health care financing, health care delivery, health care quality
38.13improvement, health economics, actuarial science, or business operations; and
38.14    (2) not be state employees or employees of a political subdivision.
38.15    (c) If a member is no longer able or eligible to perform the required duties, a new
38.16member shall be appointed by the entity that appointed the outgoing member.
38.17    Subd. 3. Operations of the commission. (a) The commission shall convene on or
38.18before July 1, 2008, following the initial appointment of the members.
38.19    (b) The commission shall elect a chair among its members.
38.20    (c) The commission members shall not be compensated for commission activities
38.21except for actual expenses incurred in the performance of their duties. Expenses shall be
38.22compensated in accordance with section 15.0575.
38.23    Subd. 4. Immunity of liability. No member of the commission shall be held civilly
38.24liable for an act or omission by that member if the act or omission was in good faith and
38.25within the scope of the member's responsibilities under this chapter.
38.26    Subd. 5. Responsibilities of the commission. The Health Care Transformation
38.27Commission shall:
38.28    (1) collect data from providers on health care prices and quality, including measures
38.29of process, outcomes, and patient satisfaction, and publish comparative price and quality
38.30information in a manner that is easily understandable and accessible to consumers;
38.31    (2) develop a design and implementation plan for health care payment system
38.32reform, as required under sections 62U.11 and 62U.12;
38.33    (3) establish a uniform definition for total cost of care for a patient group, including
38.34risk adjustment mechanisms that address at least the following factors:
39.1    (i) the health status of the individual in the year the individual enters the provider's
39.2care;
39.3    (ii) a worsening of the patient's health condition that was not reasonably preventable
39.4by action that the provider could have taken;
39.5    (iii) socioeconomic and cultural factors that bear directly on the cost of care; and
39.6    (iv) the percentage of individuals served by the provider or care system whose care
39.7is paid for by public health insurance programs;
39.8    (4) provide education, technical assistance, and materials necessary for providers to
39.9participate in the restructured payment system;
39.10    (5) implement and administer the payment system reform;
39.11    (6) make recommendations to the governor and legislature as to additional actions
39.12that are needed in order to successfully achieve health care transformation in Minnesota;
39.13    (7) consult and coordinate with the commissioners of health and human services,
39.14health care providers, health plan companies, organizations that work to improve health
39.15care quality in Minnesota, consumers, and employers;
39.16    (8) convene a health technology advisory committee as required under section
39.1762U.05;
39.18    (9) establish a Uniform Outcome Measures Working Group and make
39.19recommendations on community benefit standards, as required under Article 3; and
39.20    (10) carry out other duties assigned in this chapter and this act.
39.21    Subd. 6. Powers of the commission. The commission shall have the power to:
39.22    (1) negotiate with the Centers for Medicare and Medicaid Services and work with
39.23the Minnesota congressional delegation to gain approval for any demonstration programs
39.24or changes in federal policy necessary to enable transformation of Minnesota's health
39.25care system; and
39.26    (2) contract with other organizations to carry out all or part of its responsibilities.
39.27    Subd. 7. Rulemaking; exemption from administrative procedures. To carry out
39.28the purposes of this section and sections 62U.05 and 62U.055, the commission may adopt
39.29rules under chapter 14. The commission is exempt from rulemaking requirements to the
39.30extent rules are necessary to establish the benefit set and design described in subdivision 8
39.31and section 62U.055. The commission may use the provisions of section 14.386, paragraph
39.32(a), clauses (1) and (3). Rules adopted are exempt from section 14.386, paragraph (b).
39.33    Subd. 8. Standard benefit set and design. (a) Based on the recommendations
39.34submitted by the Health Benefit Set and Design Advisory Committee, the commission
39.35shall establish a standard benefit set and design by July 1, 2009.
40.1    (b) The standard health benefit set and design must meet the requirements described
40.2in section 62U.055.
40.3    (c) Prior to establishing the standard benefit set and design, the commission shall
40.4convene public hearings throughout the state.
40.5    Subd. 9. Reports. The commission shall submit an annual report to the governor and
40.6legislature, beginning January 15, 2010, and each January 15 thereafter, on the following:
40.7    (1) the extent to which health care providers have reduced their costs and fees;
40.8    (2) the extent to which costs and cost growth are likely to be maintained or reduced
40.9in future years;
40.10    (3) the extent to which the quality of health care services has improved;
40.11    (4) the extent to which all Minnesotans have access to quality, affordable health
40.12care; and
40.13    (5) recommendations on additional actions that are needed in order to successfully
40.14achieve health care transformation in Minnesota.
40.15    Subd. 10. Sunset. The commission shall expire December 31, 2011. Upon
40.16expiration, the duties of the commission shall transfer to the board of directors of the
40.17Minnesota Health Insurance Exchange.

40.18    Sec. 10. [62U.05] HEALTH TECHNOLOGY ASSESSMENT.
40.19    Subdivision 1. Technology Advisory Committee. (a) The Health Care
40.20Transformation Commission shall convene an advisory committee to make
40.21recommendations to the commission regarding the inclusion of new and existing health
40.22technologies to the standard benefit set and design.
40.23    (b) The advisory committee shall be made up of 11 members appointed by the
40.24commission, in consultation with the Institute for Clinical Systems Improvement, the
40.25Health Services Advisory Council, and the University of Minnesota. The members shall
40.26consist of:
40.27    (1) six practicing physicians licensed under chapter 147; and
40.28    (2) five other practicing health care professionals who use health technology in
40.29their scope of practice.
40.30    (c) No member of the advisory committee shall have a substantial financial interest
40.31in a health technology company or be employed by or under contract with a health
40.32technology manufacturer during their term or for 18 months before their appointment.
40.33    (d) The members shall be immune from civil liability for any official acts performed
40.34in good faith as members of the committee.
41.1    (e) The advisory committee shall be governed under section 15.059, except that
41.2the committee shall not expire. Upon the expiration of the Health Care Transformation
41.3Commission, the Health Technology Assessment Committee shall continue to exist under
41.4the oversight of the Minnesota Health Insurance Exchange.
41.5    Subd. 2. Technology selection process. The commission, in consultation with the
41.6advisory committee, shall select existing and new health technologies to be reviewed by
41.7the committee. In making a selection, priority shall be given to any technology for which:
41.8    (1) there are concerns about its safety, efficacy, or cost effectiveness;
41.9    (2) actual or expected expenditures are high due to demand for the technology,
41.10its cost or both; and
41.11    (3) there is adequate evidence available to conduct a complete review.
41.12    Subd. 3. Technology review. (a) Upon the selection of a health technology for
41.13review, the committee shall contract for a systematic evidence-based assessment of
41.14the technology's safety, efficacy, and cost effectiveness. The contract shall be with an
41.15evidence-based practice center designated as such by the federal agency for health care
41.16research and quality, or another appropriate entity as designated by the commission.
41.17    (b) The committee shall provide notification to the public when a health technology
41.18has been selected for review. The notification must indicate when that review is to be
41.19initiated and how an interested party may submit evidence or provide public comment for
41.20consideration during the review.
41.21    Subd. 4. Committee determination. (a) Upon reviewing the completed assessment
41.22and any other evidence submitted regarding the safety, efficacy, and cost effectiveness of
41.23the technology, the committee shall recommend to the commission:
41.24    (1) the conditions, if any, under which the health technology should be included
41.25as a covered benefit; and
41.26    (2) if covered, the criteria to be used to decide whether the technology is medically
41.27necessary, or proper and necessary treatment.
41.28    (b) The commissioners of human services, employee relations, and corrections may
41.29use the committee's recommendation in making coverage and reimbursement decisions,
41.30unless the recommendation conflicts with an applicable federal statute or regulation.

41.31    Sec. 11. [62U.055] STANDARD BENEFIT SET AND DESIGN.
41.32    Subdivision 1. Creation. The Health Care Transformation Commission shall
41.33convene a health benefit set and design advisory committee to make recommendations to
41.34the commission on a standard benefit set and design. The advisory committee shall consist
41.35of seven members. The members shall be appointed by the commission and must have
42.1expertise in benefit design and development, actuarial analysis, or knowledge relating to
42.2the analysis of the cost impact of coverage of specified benefits.
42.3    Subd. 2. Operations of the committee. (a) The advisory committee shall convene
42.4on or before September 1, 2008, upon the appointment of the initial committee and must
42.5meet at least once a year, and at other times as necessary.
42.6    (b) The commission shall provide office space, equipment and supplies, and
42.7technical support to the committee.
42.8    (c) The committee shall be governed by section 15.059, except the committee shall
42.9not expire. Upon the expiration of the Health Care Transformation Commission, the
42.10Health Benefit Set and Design Advisory Committee shall continue to exist under the
42.11oversight of the Minnesota Health Insurance Exchange.
42.12    Subd. 3. Immunity of liability. No member of the committee shall be held civilly
42.13liable for an act or omission by that member if the act or omission was in good faith and
42.14within the scope of the member's responsibilities under this chapter.
42.15    Subd. 4. Duties of the committee. (a) By January 1, 2009, the committee shall
42.16develop and submit to the commission a benefit set and design that provides individuals
42.17access to a broad range of health care services, including preventive health care, without
42.18incurring severe financial loss as a result of serious illness or injury. The benefit set
42.19must include necessary health care services, procedures, and diagnostic tests that are
42.20scientifically proven to be both clinically effective and cost effective. In establishing
42.21the benefit set, the committee may contract with the Institute for Clinical Systems
42.22Improvement (ICSI) to assemble existing scientifically based practice standards. The
42.23committee shall consider cultural, ethnic, and religious values and beliefs to ensure that
42.24the health care needs of all Minnesota residents will be addressed in the benefit set.
42.25    (b) The benefit set must identify and include preventive services, chronic care
42.26coordination services, and early diagnostic tests, that, if included in the benefit set, with
42.27minimal or no cost-sharing requirements, would result in savings that are equal to or
42.28greater than the cost of providing the services.
42.29    (c) The benefit set must include evidence-based outpatient care for asthma, heart
42.30disease, diabetes, and depression with no cost-sharing requirements, or with minimal
42.31cost-sharing requirements that would not impose an economic barrier to accessing the
42.32care. The committee may consult with ICSI in identifying standards for care.
42.33    (d) The benefit design shall be used as a minimum requirement for health plans
42.34offered throughout the exchange and be the only benefit plan eligible for premium
42.35subsidies under section 62U.09. The benefit design must establish a limited number of
43.1maximum cost-sharing variations based upon deductibles and maximum out-of-pocket
43.2costs. There shall be no maximum lifetime benefit.
43.3    Subd. 5. Continued review. The committee shall review the benefit set and design
43.4on an ongoing periodic basis and shall adjust the benefit set and design as necessary, to
43.5ensure that the benefit set and design continues to be safe, effective, and scientifically
43.6based.

43.7    Sec. 12. [62U.06] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT
43.8INDIVIDUAL RESPONSIBILITY REQUIREMENT.
43.9    Subdivision 1. Phase-in goals. The state's phase-in goals for progress toward
43.10universal health coverage for Minnesota residents are:
43.11    (1) 94 percent insured by end of fiscal year 2009;
43.12    (2) 96 percent insured by end of fiscal year 2011;
43.13    (3) 97 percent insured by end of fiscal year 2012; and
43.14    (4) 98 percent insured by end of fiscal year 2013 and thereafter.
43.15    Subd. 2. Measurement of percent insured. The determination of the percent
43.16of Minnesota residents insured must be based on an annual survey of the Minnesota
43.17population younger than age 65 to be conducted or contracted for by the commissioner
43.18of health which must include questions related to the type of insurance, amount of
43.19cost-sharing, and potential barriers to public program enrollment.
43.20    Subd. 3. Contingent individual responsibility requirement. (a) If the increased
43.21affordability, cost containment, insurance reform, and voluntary efforts provided for under
43.22this act fail to achieve universal coverage, an individual responsibility requirement will
43.23have been proven to be necessary.
43.24    (b) If any one of the phase-in goals specified in subdivision 1 for fiscal year 2011 or
43.25later is not met, as determined by the commissioner of health, in spite of implementation
43.26of the increased affordability, cost containment, insurance reform, and voluntary efforts
43.27provided for under 62U.01 to 62U.09, an individual responsibility requirement, requiring
43.28every Minnesota resident to obtain and maintain health coverage from a public or private
43.29sector source of the person's choice, shall become effective 12 months after the end of
43.30that fiscal year, provided that the commissioner certifies that health plans that meet the
43.31affordability standard under section 62U.08 are available to Minnesotans.
43.32    (c) Failure to comply with the individual responsibility requirement is not a crime,
43.33but will subject the person to a financial penalty to be specified in law.

43.34    Sec. 13. [62U.07] SAVINGS RECAPTURE ASSESSMENT.
44.1    Subdivision 1. Projected spending baseline. (a) The commissioner of health shall
44.2calculate the annual projected total health care spending for the state and establish a health
44.3care spending baseline beginning for the year 2008 and for the next five years based on
44.4the annual projected growth in spending.
44.5    (b) In establishing the health care spending baseline, the commissioner shall use
44.6the Center of Medicare and Medicaid Services forecast for total growth in national health
44.7care expenditures, and adjust this forecast to reflect the demographics, health status, and
44.8other factors deemed necessary by the commissioner. The commissioner shall contract
44.9with an actuarial consultant to make recommendations as to the adjustments needed to
44.10specifically reflect projected spending for Minnesota residents.
44.11    (c) The commissioner may adjust the projected baseline as necessary to reflect any
44.12updated federal projections or account for unanticipated changes in federal policy.
44.13    Subd. 2. Actual spending. (a) By February 15 of each year, beginning February 15,
44.142010, the commissioner shall determine the actual private and public health care spending
44.15for the calendar year preceding the current calendar year and shall determine the difference
44.16between the projected spending as determined under subdivision 1 and the actual spending
44.17for that year. The actual spending must be certified by an independent actuarial consultant.
44.18If the actual spending is less than the projected spending, the commissioner shall
44.19determine an aggregate savings offset amount not to exceed 40 percent of the difference.
44.20    (b) Based on this calculation, the commissioner shall determine annually a savings
44.21offset amount to be paid by health plan companies and third-party administrators. The
44.22aggregate savings offset amount may not exceed 40 percent of the aggregate savings
44.23reflected in the difference between the actual spending and the projected spending.
44.24    Subd. 3. Publication of spending. By February 15 of each year, beginning February
44.2515, 2010, the commissioner shall publish in the State Register the projected spending
44.26baseline, including any adjustments, and the actual spending for the preceding year.
44.27    Subd. 4. Savings offset assessments. (a) Each health plan company and third-party
44.28administrator shall pay a savings offset assessment. The commissioner shall calculate the
44.29savings offset assessments as a percentage of paid claims as follows:
44.30    (1) for health plan companies, the savings offset assessment may not exceed four
44.31percent of annual paid health care claims on policies that insure residents of this state; and
44.32    (2) for third-party administrators, the savings offset assessment may not exceed four
44.33percent of annual paid claims for health care for residents of this state.
44.34    (b) A health plan company may not be required to pay a savings offset assessment
44.35on policies or contracts insuring federal employees.
45.1    (c) Savings offset assessments apply to claims paid for plan years beginning on
45.2or after January 1, 2010.
45.3    (d) Savings offset assessments must be made quarterly to the commissioner of
45.4revenue within 60 days of the close of each quarter, beginning April 15, 2010.
45.5    Subd. 5. Deposit of assessments. The commissioner of revenue shall deposit the
45.6revenue derived from the assessments into the health care access fund.

45.7    Sec. 14. [62U.08] AFFORDABILITY STANDARD.
45.8    Subdivision 1. Definition of affordability. For purposes of this section, coverage is
45.9"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an
45.10individual or family for health coverage does not exceed the applicable percentage of the
45.11individual or family's gross monthly income specified in subdivision 2.
45.12    Subd. 2. Affordability standard. The following affordability standard is
45.13established for individuals and households with gross family incomes of 400 percent
45.14of the federal poverty guidelines or less:

45.15	AFFORDABILITY STANDARD
45.16 45.17		Federal Poverty Guideline Range			Percent of Average Gross Monthly Income
45.18		0-33%			minimum
45.19		33-54%			1.1%
45.20		55-81%			1.2%
45.21		82-109%			1.6%
45.22		110-136%			2.4%
45.23		137-164%			2.9%
45.24		165-191%			3.9%
45.25		192-219%			4.6%
45.26		220-248%			5.4%
45.27		248-274%			6.0%
45.28		275-300%			6.0%
45.29		301-324%			6.5%
45.30		325-349%			7.2%
45.31		350-374%			7.8%
45.32		375-400%			8.0%

45.33    Sec. 15. [62U.09] EMPLOYEE SUBSIDIES FOR EMPLOYER-SUBSIDIZED
45.34HEALTH COVERAGE.
45.35    Subdivision 1. Establishment of subsidy program. The commissioner of human
45.36services shall establish a subsidy program for eligible employees and dependents
45.37with access to employer-subsidized health coverage. For purposes of this section,
46.1employer-subsidized health coverage has the meaning provided in section 256L.07,
46.2subdivision 2, paragraph (c).
46.3    Subd. 2. Eligible employees and dependents. In order to be eligible for a subsidy
46.4under this section, an employee or dependent shall:
46.5    (1) be covered by employer-subsidized health coverage that meets the benefits set
46.6and design requirements established under section 62U.04 and is purchased through the
46.7Health Insurance Exchange established under section 62U.02; and
46.8    (2) meet all eligibility criteria for the MinnesotaCare program established under
46.9chapter 256L, except for the requirements related to:
46.10    (i) no access to employer-subsidized coverage under section 256L.07, subdivision
46.112; and
46.12    (ii) no other health coverage under section 256L.07, subdivision 3.
46.13    Subd. 3. Amount of subsidy. The subsidy must equal the amount the employee
46.14is required to pay for health coverage for the employee and any dependents, including
46.15premiums, deductibles, and other cost sharing, minus an amount based on the affordability
46.16standard specified in section 62U.08. The maximum subsidy must not exceed the amount
46.17of the subsidy that would have been provided under the MinnesotaCare program, if the
46.18employee and any dependents were eligible for that program.
46.19    Subd. 4. Payment of subsidy. The commissioner shall pay the subsidy amount
46.20for an employee and any dependents to the Minnesota Health Insurance Exchange, and
46.21this payment shall be credited toward the employee's share of premium. Any additional
46.22amount paid by the commissioner to the Minnesota Health Insurance Exchange that
46.23exceeds the employee's share of premium must be credited first toward the employee
46.24deductible and then toward any employee cost-sharing obligation.
46.25EFFECTIVE DATE.This section is effective July 1, 2010.

46.26    Sec. 16. [62U.11] PAYMENT RESTRUCTURING; PAYMENTS BASED ON
46.27QUALITY AND EFFICIENCY OF CARE.
46.28    Subdivision 1. Development. By November 1, 2008, the Health Care
46.29Transformation Commission shall develop a payment system that links the level of
46.30payments to providers to the quality and efficiency of care. The payment system must
46.31incorporate payments to primary care physicians, specialty care physicians, health
46.32care clinics, and hospitals, and other providers who provide services included in the
46.33evidence-based benefit set and design developed under section 62U.04.
47.1    Subd. 2. Payment system criteria. The payment system must meet the following
47.2criteria:
47.3    (1) providers meeting specified targets, or who demonstrate a significant amount of
47.4improvement over time, must be eligible for quality and efficiency-based payments that
47.5are in addition to existing payment levels;
47.6    (2) priority must be placed on measures of health care outcomes, rather than process
47.7measures, wherever possible;
47.8    (3) quality measures for primary care providers must focus on preventive services,
47.9coronary artery and heart disease, diabetes, asthma, chronic obstructive pulmonary
47.10disease, depression, and other conditions or procedures for which, in the determination of
47.11the commission, improved outcomes will lead to significant cost savings;
47.12    (4) quality measures for specialty care must be designated by the commission, and
47.13initially based on quality indicators measured and reported publicly by specialty societies;
47.14    (5) hospital payments must be adjusted for quality and efficiency using existing
47.15measures where available, which focus on health conditions or procedures for which, in
47.16the determination of the commission, improved outcomes will lead to significant cost
47.17savings; and
47.18    (6) other indicators of care quality and efficiency must be incorporated where
47.19appropriate. These indicators may include care infrastructure, collection and reporting of
47.20results, measures of efficiency for specific procedures, and measures of overall cost of
47.21care for individuals.
47.22    Subd. 3. Uniform measures required. Once the payment system required by this
47.23section is established, health plan companies shall not require providers to use and report
47.24health plan company-specific quality and outcome measures.
47.25    Subd. 4. Implementation. (a) The commissioner of human services, by January
47.261, 2009, shall implement this payment system for all state health care program enrollees
47.27served under fee-for-service, and shall require demonstration providers serving state health
47.28care program enrollees to implement this payment system by January 1, 2009, for all state
47.29health care program enrollees served under managed care and county-based purchasing.
47.30    (b) The commissioner of employee relations, by January 1, 2009, shall implement
47.31this payment system for all participants in the State Employee Group Insurance Program.
47.32    (c) All health plan companies, by January 1, 2009, shall implement this payment
47.33system for all participating providers.

47.34    Sec. 17. [62U.12] PAYMENT RESTRUCTURING; CARE COORDINATION
47.35PAYMENTS FOR HEALTH CARE HOMES.
48.1    Subdivision 1. Development. The Health Care Transformation Commission,
48.2in cooperation with the commissioners of health and human services, shall develop a
48.3payment system that provides care coordination payments to health care providers.
48.4In order to be eligible for a care coordination payment, a health care provider must be
48.5certified as a health care home by the commissioners of human services and health based
48.6on the certification standards for health care homes established under section 256B.0754.
48.7    Subd. 2. Care coordination fee. (a) Under the payment system, health care homes
48.8must receive a per-person per-month care coordination fee for providing care coordination
48.9services and employing care coordinators, as specified in section 256B.0752, subdivisions
48.103 and 7.
48.11    (b) The care coordination fee must not exceed an average of $50 per person per
48.12month. The care coordination fee must be determined by the commission, and must
48.13vary by thresholds of care complexity, with the highest fees being paid for care provided
48.14to individuals requiring the most intensive care coordination, such as those with very
48.15complex health care needs or several chronic conditions.
48.16    (c) In setting care coordination fees, the commission shall consider the additional
48.17time and resources needed by patients with limited English-language skills, cultural
48.18differences, or other barriers to health care.
48.19    (d) Care coordination fees must be phased-in, and must be applied first to persons
48.20who have, or are at risk of developing, complex or chronic health conditions.
48.21    Subd. 3. Quality/efficiency-based payments. The quality/efficiency-based
48.22payments under section 62U.11 must also be included in the care coordination payment
48.23system. Providers whose quality or efficiency does not allow them to qualify for payments
48.24under section 62U.11 are not be eligible to receive care coordination fees.
48.25    Subd. 4. Implementation. (a) The commissioner of human services, by July 1,
48.262009, shall implement this payment system for all state health care program enrollees
48.27served under fee-for-service as provided under section 256B.0753 and shall require
48.28demonstration providers serving state health care program enrollees to implement this
48.29payment system by July 1, 2009, for all state health care program enrollees served under
48.30managed care and county-based purchasing.
48.31    (b) The commissioner of employee relations, by July 1, 2009, shall implement this
48.32payment system for all participants in the State Employee Group Insurance Program.
48.33    (c) All health plan companies, by July 1, 2009, shall implement this payment system
48.34for all participating providers.

48.35    Sec. 18. [62U.13] COORDINATION WITH THE PRIVATE SECTOR.
49.1    In developing the payment systems required under sections 62U.11 and 62U.12,
49.2the Health Care Transformation Commission shall consult and coordinate with the
49.3commissioners of human services and health, organizations that work to improve health
49.4care quality in Minnesota, health care providers, health plan companies, consumers, and
49.5employers and other payors. The commissioners shall publicize and promote the payment
49.6systems required under sections 62U.11 and 62U.12, and shall make technical assistance
49.7available to entities adopting the payment systems.

49.8    Sec. 19. Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision
49.9to read:
49.10    Subd. 27. Exchange of data. An entity that is part of the welfare system as defined
49.11in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance
49.12Exchange under section 62U.02 may exchange private data about individuals without
49.13the individual's consent in order to collect premiums from individuals in the medical
49.14assistance employed persons with disabilities program and the MinnesotaCare program
49.15under chapters 256B and 256L. This subdivision only applies if the entity that is part of
49.16the welfare system and the Minnesota Health Insurance Exchange have entered into an
49.17agreement that complies with the requirements in Code of Federal Regulations, title
49.1845, section 164.314.

49.19    Sec. 20. AMENDMENTS TO CURRENT HEALTH BENEFIT SETS.
49.20    The commissioners of health, commerce, and employee relations shall report to the
49.21legislature under Minnesota Statutes, section 3.195, on necessary changes to current
49.22mandated benefit sets to align these with the standard benefit set and design developed by
49.23the Health Care Transformation Commission established in Minnesota Statutes, section
49.2462U.04.

49.25    Sec. 21. APPROPRIATION.
49.26    $....... is appropriated in fiscal year 2009 from the health care access fund to the
49.27Health Care Transformation Commission. This is a onetime appropriation."
49.28Delete the title and insert:
49.30relating to health care reform; increasing affordability and continuity of care
49.31for state health care programs; modifying health care provisions; providing
49.32subsidies for employee share of employer-subsidized insurance; establishing the
49.33Minnesota Health Insurance Exchange; requiring certain employers to offer
49.34Section 125 Plan; establishing the Health Care Transformation Commission;
49.35creating an affordability standard; requiring mandated reports; appropriating
49.36money;amending Minnesota Statutes 2006, sections 62A.65, subdivision 3;
49.3762E.141; 62L.12, subdivisions 2, 4; 256.01, by adding a subdivision; 256B.061;
49.38256B.69, by adding a subdivision; 256D.03, by adding a subdivision; 256L.05,
50.1by adding a subdivision; 256L.06, subdivision 3; 256L.07, subdivision 3;
50.2256L.15, by adding a subdivision; Minnesota Statutes 2007 Supplement, sections
50.313.46, subdivision 2; 256B.056, subdivision 10; 256L.03, subdivisions 3, 5;
50.4256L.04, subdivisions 1, 7; 256L.05, subdivision 3a; 256L.07, subdivision 1;
50.5256L.15, subdivision 2; proposing coding for new law in Minnesota Statutes,
50.6chapter 256B; proposing coding for new law as Minnesota Statutes, chapter 62U;
50.7repealing Minnesota Statutes 2006, section 256L.15, subdivision 3."