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Winona Model Legislature Session 2007 Authors of the Bill Senate Author House Author Matt Beyerstedt Ben Richardson Committee Hearing Legislative Action 1. Health and Human Services 2. Ways and Means Bill Number ______________________ 3. [Committee 3] [House Number] House 4. [Committee 4] SF2352 ______________________ Action Taken in Committee Bill Introduced By Senate Ben Richardson 1.____________________ Winona Senior High ______________________ House Governor 2.____________________ A Bill For an Act Relating To ______________________ 3.____________________ Minnesota Health Care Act Override Veto 4.____________________ 1.1A bill for an act 1.2relating to health; guaranteeing that all necessary health care is available and 1.3affordable for every Minnesotan; establishing the Minnesota Health Care 1.4Plan; requiring a report; appropriating money;amending Minnesota Statutes 1.52006, sections 15.01; 15.06, subdivision 1; 15A.0815, subdivision 2; 43A.08, 1.6subdivision 1a; proposing coding for new law as Minnesota Statutes, chapter 1.762U. 1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.9ARTICLE 1 1.10GENERAL PROVISIONS 1.11 Section 1. [62U.01] HEALTH CARE PLAN REQUIREMENTS. 1.12In order to develop a plan that keeps Minnesotans healthy and provides the best 1.13quality of health care, the Minnesota health care plan must: 1.14(1) ensure all Minnesotans receive high quality health care, regardless of their 1.15income; 1.16(2) not restrict or deny care or reduce the quality of care to hold down costs, but 1.17instead reduce costs through prevention, efficiency, and reduction of bureaucracy; 1.18(3) cover all necessary care, including all coverage currently required by law, 1.19complete mental health services, chemical dependency treatment, prescription drugs, 1.20medical equipment and supplies, dental care, long-term care, and home care services; 1.21(4) allow patients to choose their own providers; 1.22(5) be funded through premiums and other payments based on the person's ability 1.23to pay, so as not to deny full access to all Minnesotans; 1.24(6) focus on preventive care and early intervention to improve the health of all 1.25Minnesotans and reduce costs from untreated illnesses and diseases; 2.1(7) ensure an adequate number of qualified health care professionals and facilities to 2.2guarantee availability of, and timely access to quality care throughout the state; 2.3(8) continue Minnesota's leadership in medical education, training, research, and 2.4technology; and 2.5(9) provide adequate and timely payments to providers. 2.6 Sec. 2. [62U.02] GENERAL PROVISIONS. 2.7 Subdivision 1. Short title. Chapter 62U may be cited as the "Minnesota Health 2.8Care Act." 2.9 Subd. 2. Establishment; date of operation. The Minnesota health care plan is 2.10established, which shall be administered by the Minnesota Health Care Agency, an agency 2.11under the administration of the commissioner of health care. The Minnesota health care 2.12plan must be operational within two years from the date of enactment of this chapter. 2.13 Subd. 3. Prohibition. No health plan, as defined in section 62Q.01, subdivision 2.143, except for the Minnesota health care plan, may be sold in Minnesota for services 2.15provided by the plan. 2.16 Subd. 4. Purpose. To meet the requirements in section 62U.01 This chapter shall: 2.17(1) provide affordable coverage for all necessary health care with a single standard 2.18of care for all Minnesota residents; 2.19(2) control health care costs and the growth of health care spending, subject to the 2.20obligation described in clause (1); 2.21(3) achieve measurable improvement in the quality of care and the efficiency of 2.22care delivery; 2.23(4) prevent disease and disability and maintain or improve health and functionality; 2.24(5) increase health care provider, consumer, employee, and employer satisfaction 2.25with the health care plan; and 2.26(6) implement policies that strengthen and improve culturally and linguistically 2.27competent care. 2.28 Subd. 5. Definitions. As used in this chapter, the following terms have the meanings 2.29provided: 2.30(a) "Agency" means the Minnesota Health Care Agency. 2.31(b) "Board" means the Health Care Policy Board. 2.32(c) "Clinic" means an organized outpatient health facility that provides direct 2.33medical, surgical, dental, psychological, mental health, optometric, or podiatric advice, 2.34services, or treatment to patients who remain less than 24 hours, and that may also provide 3.1diagnostic or therapeutic services to patients in the home as an alternative to care provided 3.2at the clinic facility. 3.3(c) "Commissioner" means the health care commissioner. 3.4(d) "Direct care provider" means any licensed health care professional that provides 3.5health care services through direct contact with the patient, either in person or using 3.6approved telemedicine modalities. 3.7(e) "Essential provider" means a health facility that has served as part of the state's 3.8health care safety net for low income and traditionally underserved populations in 3.9Minnesota and one that is: 3.10(1) a "community clinic"; 3.11(2) a "free clinic"; 3.12(3) a "federally qualified health center" as defined under United States Code, title 42, 3.13section 1395x (aa)(4) or (1396d) (1)(2); 3.14(4) a "rural health clinic" as defined under United States Code, title 42, section 3.151395x (aa)(2) or 1396d (l)(1); 3.16(5) any clinic conducted, maintained, or operated by a federally recognized Indian 3.17tribe or tribal organization, as defined in United States Code, title 25, section 1603; or 3.18(6) any clinic that is operated by a primary care community or free clinic and that 3.19is operated on separate premises from the licensed clinic and is only open for limited 3.20services of no more than 20 hours per week. 3.21(f) "Health care provider" means any professional person, medical group, 3.22independent practice association, organization, health facility, or other person or institution 3.23licensed or authorized by the state to deliver or furnish health care services. 3.24(g) "Health facility" means any facility, place, or building that is organized, 3.25maintained, and operated for the diagnosis, care, prevention, and treatment of human 3.26illness, physical or mental, including convalescence and rehabilitation, including care 3.27during and after pregnancy, and including skilled nursing care and hospice. 3.28(h) "Hospital" means all health facilities to which persons may be admitted for a 3.2924-hour stay or longer and that are licensed under section 144.50. Hospital does not 3.30include a nursing, skilled nursing, intermediate care, or congregate living health facility. 3.31(i) "Integrated health care delivery system" means a provider organization that: 3.32(1) is fully integrated operationally and clinically to provide a broad range of health 3.33care services, including preventative care, prenatal and well-baby care, immunizations, 3.34screening diagnostics, emergency services, hospital and medical services, surgical 3.35services, and ancillary services; 4.1(2) is compensated using capitation or facility budgets, for the provision of health 4.2care services; and 4.3(3) provides health care services primarily through direct care providers who are 4.4either employees or partners of the organization, or through arrangements with direct 4.5care providers or one or more groups of physicians, organized on a group practice or 4.6individual practice basis. 4.7(j) "Large employer" means a person, firm, proprietary or nonprofit corporation, 4.8partnership, public agency, or association that is actively engaged in business or service, 4.9that, on at least 50 percent of its working days during the preceding calendar year 4.10employed at least 50 employees, or, if the employer was not in business during any part 4.11of the preceding calendar year, employed at least 50 employees on at least 50 percent of 4.12its working days during the preceding calendar quarter. 4.13(k) "Primary care provider" means a direct care provider that is a family physician, 4.14internist, general practitioner, pediatrician, obstetrician/gynecologist, or an advance 4.15practice nurse practitioner, or physician assistant practicing under required supervision, or 4.16essential providers who employ primary care providers. 4.17(l) "Small employer" means a person, firm, proprietary or nonprofit corporation, 4.18partnership, public agency, or association that is actively engaged in business or service 4.19and that, on at least 50 percent of its working days during the preceding calendar year 4.20employed at least two but no more than 49 employees, or, if the employer was not in 4.21business during any part of the preceding calendar year, employed at least two but no 4.22more than 40 eligible employees on at least 50 percent of its working days during the 4.23preceding calendar quarter. 4.24 Subd. 6. Transition to new plan. (a) The transition shall be funded from a loan 4.25from the general fund and from other sources, including private sources identified by 4.26the commissioner. 4.27(b) The commissioner shall assess other health plans and insurers for care provided 4.28by the state plan in those cases in which a person's health care coverage extends into the 4.29time period in which the new plan is operative. 4.30(c) The commissioner shall assist persons who are displaced from employment as a 4.31result of the initiation of the health care plan, including determining the period of time 4.32during which assistance shall be provided and identifying sources of funds, including 4.33dislocated worker program funds and health insurance funds, to support retraining and 4.34job placement. That support shall be provided for a period of up to five years from the 4.35date that this chapter becomes effective. 5.1 Sec. 3. [62U.03] MINNESOTA HEALTH CARE AGENCY. 5.2 Subdivision 1. State agency established. The Minnesota Health Care Agency is 5.3established and is the state agency with full authority to supervise every phase of the 5.4administration of the Minnesota health care plan and to receive grants-in-aid made by 5.5federal or state government, or by other sources in order to secure full compliance with the 5.6applicable provisions of state and federal law. 5.7 Subd. 2. Agency. The Minnesota Health Care Agency shall be comprised of the 5.8following entities: 5.9(1) the Health Care Policy Board; 5.10(2) the Office of Health Quality and Planning; and 5.11(3) the fund for health care. 5.12ARTICLE 2 5.13GOVERNANCE 5.14 Section 1. Minnesota Statutes 2006, section 15.01, is amended to read: 5.1515.01 DEPARTMENTS OF THE STATE. 5.16The following agencies are designated as the departments of the state government: 5.17the Department of Administration; the Department of Agriculture; the Department of 5.18Commerce; the Department of Corrections; the Department of Education; the Department 5.19of Employment and Economic Development; the Department of Finance; the Department 5.20of Health; the Health Care Agency; the Department of Human Rights; the Department 5.21of Labor and Industry; the Department of Military Affairs; the Department of Natural 5.22Resources; the Department of Employee Relations; the Department of Public Safety; 5.23the Department of Human Services; the Department of Revenue; the Department of 5.24Transportation; the Department of Veterans Affairs; and their successor departments. 5.25 Sec. 2. Minnesota Statutes 2006, section 15.06, subdivision 1, is amended to read: 5.26 Subdivision 1. Applicability. This section applies to the following departments 5.27or agencies: the Departments of Administration, Agriculture, Commerce, Corrections, 5.28Education, Employee Relations, Employment and Economic Development, Finance, 5.29Health, Human Rights, Labor and Industry, Natural Resources, Public Safety, Human 5.30Services, Revenue, Transportation, and Veterans Affairs; the Health Care, the Housing 5.31Finance, and Pollution Control Agencies; the Office of Commissioner of Iron Range 5.32Resources and Rehabilitation; the Bureau of Mediation Services; and their successor 5.33departments and agencies. The heads of the foregoing departments or agencies are 5.34"commissioners." 6.1 Sec. 3. Minnesota Statutes 2006, section 15A.0815, subdivision 2, is amended to read: 6.2 Subd. 2. Group I salary limits. The salaries for positions in this subdivision may 6.3not exceed 95 percent of the salary of the governor: 6.4Commissioner of administration; 6.5Commissioner of agriculture; 6.6Commissioner of education; 6.7Commissioner of commerce; 6.8Commissioner of corrections; 6.9Commissioner of employee relations; 6.10Commissioner of finance; 6.11Commissioner of health; 6.12Commissioner of health care; 6.13Executive director, Minnesota Office of Higher Education; 6.14Commissioner, Housing Finance Agency; 6.15Commissioner of human rights; 6.16Commissioner of human services; 6.17Commissioner of labor and industry; 6.18Commissioner of natural resources; 6.19Director of Office of Strategic and Long-Range Planning; 6.20Commissioner, Pollution Control Agency; 6.21Commissioner of public safety; 6.22Commissioner of revenue; 6.23Commissioner of employment and economic development; 6.24Commissioner of transportation; and 6.25Commissioner of veterans affairs. 6.26 Sec. 4. Minnesota Statutes 2006, section 43A.08, subdivision 1a, is amended to read: 6.27 Subd. 1a. Additional unclassified positions. Appointing authorities for the 6.28following agencies may designate additional unclassified positions according to this 6.29subdivision: the Departments of Administration; Agriculture; Commerce; Corrections; 6.30Education; Employee Relations; Employment and Economic Development; Explore 6.31Minnesota Tourism; Finance; Health; Health Care Agency; Human Rights; Labor and 6.32Industry; Natural Resources; Public Safety; Human Services; Revenue; Transportation; 6.33and Veterans Affairs; the Housing Finance and Pollution Control Agencies; the State 6.34Lottery; the State Board of Investment; the Office of Administrative Hearings; the Offices 6.35of the Attorney General, Secretary of State, and State Auditor; the Minnesota State 7.1Colleges and Universities; the Minnesota Office of Higher Education; the Perpich Center 7.2for Arts Education; and the Minnesota Zoological Board. 7.3A position designated by an appointing authority according to this subdivision must 7.4meet the following standards and criteria: 7.5(1) the designation of the position would not be contrary to other law relating 7.6specifically to that agency; 7.7(2) the person occupying the position would report directly to the agency head or 7.8deputy agency head and would be designated as part of the agency head's management 7.9team; 7.10(3) the duties of the position would involve significant discretion and substantial 7.11involvement in the development, interpretation, and implementation of agency policy; 7.12(4) the duties of the position would not require primarily personnel, accounting, or 7.13other technical expertise where continuity in the position would be important; 7.14(5) there would be a need for the person occupying the position to be accountable to, 7.15loyal to, and compatible with, the governor and the agency head, the employing statutory 7.16board or commission, or the employing constitutional officer; 7.17(6) the position would be at the level of division or bureau director or assistant 7.18to the agency head; and 7.19(7) the commissioner has approved the designation as being consistent with the 7.20standards and criteria in this subdivision. 7.21 Sec. 5. [62U.04] HEALTH CARE COMMISSIONER. 7.22 Subdivision 1. Commissioner. (a) The commissioner shall be appointed by the 7.23governor on or before January 1, 2009. 7.24(b) The commissioner shall not have been employed in any capacity by a for-profit 7.25insurance, pharmaceutical, or medical equipment company that sells products to the 7.26Minnesota health care plan for a period of ten years prior to appointment as commissioner. 7.27(c) For ten years after ending service in the Minnesota health care plan, the 7.28commissioner may not receive payments of any kind from, or be employed in any capacity 7.29or act as a paid consultant to, a for-profit insurance, pharmaceutical, or medical equipment 7.30company that sells products to the Minnesota health care plan. 7.31 Subd. 2. Duties. (a) The commissioner shall administer all aspects of the Minnesota 7.32Health Care Agency. 7.33(b) The commissioner shall carry out the specific duties assigned under this chapter 7.34and other laws related to health care, and shall enforce the execution of those provisions 7.35and laws. The commissioner's powers and duties include, but are not limited to, the power 8.1to establish the Minnesota health care plan budget and to set rates; to establish Minnesota 8.2health care plan goals, standards, and priorities; to hire, fire, and fix the compensation of 8.3agency personnel; to make allocations and reallocations to the health planning regions; 8.4and to promulgate rules concerning matters related to the implementation of this chapter. 8.5(c) The commissioner shall appoint the director of the fund for health care and the 8.6director of Health Quality and Planning. 8.7(d) The administration of the agency shall be supported from the fund for health 8.8care created under section 62U.19. 8.9(e) In order to avoid the appearance of political bias or impropriety, the commissioner 8.10shall not engage in leadership of, or employment by, a political party or a political 8.11organization; public endorsement of a political candidate; contribution of more than $100 8.12to any one candidate in a calendar year or contributions in excess of an aggregate of 8.13$1,000 in a calendar year for all political parties or organizations; and activities attempting 8.14to avoid compliance with this paragraph by making contributions through a spouse 8.15or other family member. 8.16 Subd. 3. Oversight. The commissioner shall: 8.17(a) oversee the establishment of: 8.18(1) the Health Care Policy Board, under section 62U.05; 8.19(2) the Ombudsman Office of Patient Advocacy, under section 62U.09; 8.20(3) the Office of Health Quality and Planning, under section 62U.45; and 8.21(4) the fund for health care, under section 62U.19; 8.22(b) determine Minnesota health care plan goals, standards, guidelines, and priorities; 8.23(c) oversee the establishment of locally based integrated service networks that 8.24include physicians in fee-for-service, solo and group practice, essential providers, and 8.25ancillary care providers and facilities in order to pool and align resources and form 8.26interdisciplinary teams that share responsibility and accountability for patient care and 8.27provide a continuum of coordinated high-quality primary to tertiary care to all Minnesota 8.28residents which shall be accomplished in collaboration with the director of health 8.29planning, the regional planning boards, and the patient advocate; 8.30(d) establish standards based on clinical efficacy to guide delivery of care; 8.31(e) implement policies to ensure that all Minnesotans receive culturally and 8.32linguistically competent care, according to section 62U.45, subdivision 2, and develop 8.33mechanisms and incentives to achieve this purpose and monitor the effectiveness of 8.34these efforts; 9.1(f) create a systematic approach to the measurement, management, and accountability 9.2for care quality that ensures the delivery of high-quality care to all Minnesota residents, 9.3including a system of performance contracts that contain measurable goals and outcomes; 9.4(g) establish a capital management framework and plan for the Minnesota health care 9.5plan, including, but not limited to, a standardized process and format for the development 9.6and submission of regional operating and regional capital budget requests to ensure the 9.7needs for health care capital infrastructure are met according to the goals of the plan; 9.8(h) ensure the establishment of policies not governed by the Department of Health 9.9that promote public health; 9.10(i) ensure that health care plan policies and providers support all Minnesotans in 9.11achieving and maintaining maximum physical and mental health and functionality; 9.12(j) establish a means to identify areas of medical practice where standards of care do 9.13not exist and establish priorities and a timetable for their development; 9.14(k) establish a comprehensive budget that ensures adequate funding to meet the 9.15health care needs of the state's population and the compensation for providers for care 9.16provided according to this chapter; 9.17(l) establish standards and criteria for allocation of operating and capital funds from 9.18the fund for health care as described in sections 62U.19 and 62U.35; 9.19(m) establish standards and criteria for development and submission of provider 9.20operating and capital budget requests; 9.21(n) determine the level of funding to be allocated to each health care region; 9.22(o) annually assess projected revenues and expenditures to ensure financial solvency 9.23of the plan; 9.24(p) during the transition and annually thereafter, determine the appropriate level for 9.25a health care plan reserve fund and implement policies needed to establish the appropriate 9.26reserve; 9.27(q) institute necessary cost controls according to section 62U.19, subdivision 3, 9.28to ensure financial solvency of the plan; 9.29(r) develop separate formulas for budget allocations and review the formulas 9.30annually to ensure they address disparities in service availability and health care outcomes 9.31and for sufficiency of reimbursement; 9.32(s) annually review the impact of the agency and its policies on the health of the 9.33population and on satisfaction with the Minnesota health care plan; 9.34(t) negotiate payment for any aspect of the Minnesota health care plan and establish 9.35necessary payment procedures; 10.1(u) establish a formulary based on clinical efficacy and cost for all prescription drugs 10.2and medical equipment for use by the Minnesota health care plan; 10.3(v) establish guidelines for prescribing medications, nutritional supplements, and 10.4medical equipment that are not included in the health care formularies; 10.5(w) negotiate price discounts for prescription drugs and medical equipment for use 10.6by the Minnesota health care plan; 10.7(x) create incentives and guidelines for research needed to meet health care plan 10.8goals; 10.9(y) implement eligibility standards for the system, including guidelines to prevent an 10.10influx of persons to the state for the purpose of obtaining medical care; 10.11(z) determine an appropriate level of, and provide support during the transition for, 10.12training and job placement for persons who are displaced from employment as a result of 10.13the initiation of the new Minnesota health care plan; 10.14(aa) establish an enrollment system that ensures all eligible Minnesota residents are 10.15aware of their right to health care and are formally enrolled; 10.16(bb) oversee the establishment of the system for resolution of disputes according 10.17to section 62U.53; 10.18(cc) establish an electronic claims and payments system for the Minnesota health 10.19care plan, to which all claims shall be filed and from which all payments shall be made, 10.20and implement standardized claims and reporting methods; 10.21(dd) establish a technology advisory committee to evaluate the cost and effectiveness 10.22of new medical technology; 10.23(ee) ensure that consumers of health care have access to information needed to 10.24support choice of provider; 10.25(ff) collaborate with the agencies that license health facilities to ensure that facility 10.26performance is monitored and that deficient practices are recognized and corrected in a 10.27timely fashion and that consumers and providers of health care have access to information 10.28to support choice of facility; 10.29(gg) establish a health care Web site that provides information to the public about 10.30the Minnesota health care plan including information on providers and facilities, and that 10.31informs the public about state and regional health care policy board meetings and activities; 10.32(hh) establish a process for the system to receive the concerns, opinions, ideas, and 10.33recommendations of the public regarding all aspects of the plan; and 10.34(ii) annually report to the legislature on the performance of the Minnesota health care 10.35plan, its fiscal condition and need for payment adjustments, recommendations for statutory 10.36changes, receipt of payments from the federal government and other sources, whether 11.1current year goals and priorities are met, future goals and priorities, major new technology 11.2or prescription drugs, and other circumstances that may affect the cost of health care. 11.3 Subd. 4. Rulemaking. The commissioner shall adopt rules under chapter 14 to 11.4implement the provisions of this chapter. 11.5 Subd. 5. Budget preparation. (a) The commissioner shall annually prepare a health 11.6care plan budget that includes all expenditures, specifies a limit on total annual state 11.7expenditures, and establishes allocations for each health care region that shall cover a 11.8three-year period and that shall be disbursed on a quarterly basis. 11.9(b) The commissioner shall limit the growth of spending on a statewide and on a 11.10regional basis, by reference to average growth in state domestic product across multiple 11.11years, population growth, actuarial demographics and other demographic indicators, 11.12differences in regional costs of living, advances in technology and their anticipated 11.13adoption into the benefit plan, improvements in efficiency of administration and care 11.14delivery, improvements in the quality of care, and projected future state domestic product 11.15growth rates. 11.16(c) The commissioner shall project health care plan revenues and expenditures 11.17for three and ten years. 11.18(d) The commissioner shall annually convene a health care plan revenue and 11.19expenditure conference to discuss revenue and expenditure projections and future 11.20health care plan policy directions and initiatives, including means to lower the cost of 11.21administration, improve management of and investment in capital assets, and improve the 11.22quality of care and health care management. 11.23 Sec. 6. [62U.05] HEALTH CARE POLICY BOARD. 11.24(a) The commissioner shall establish a health care policy board and shall serve as 11.25the president of the board. 11.26(b) The board shall: 11.27(1) establish health care plan goals and priorities, including research and capital 11.28investment priorities; 11.29(2) establish the scope of services that will be funded; 11.30(3) establish guidelines for evaluating the performance of the health care plan, health 11.31care plan officers, health care regions, and health care providers; 11.32(4) establish guidelines for ensuring public input on health care plan policy, 11.33standards, and goals; and 11.34(5) the Health Care Policy Board shall establish standards of care based on clinical 11.35efficacy for the health care plan which shall serve as guidelines to support providers in the 12.1delivery of high-quality care. Standards shall be based on the best evidence available at 12.2the time and shall be continually updated. Standards are intended to support the clinical 12.3judgment of individual providers, not to replace it, and to support clinical decisions based 12.4on the needs of individual patients. 12.5(c) The board shall consist of the following members: 12.6(1) the commissioner; 12.7(2) five providers appointed by the commissioner including one primary care 12.8physician, one registered nurse, one mental health provider, one dentist, and one long-term 12.9care provider; 12.10(3) four patient advocates, two appointed by the speaker of the house and two 12.11appointed by the chair of the senate Committee on Rules and Administration; 12.12(4) the director of Health Quality and Planning; and 12.13(5) a representative from each regional planning board appointed by the regional 12.14board. 12.15 Sec. 7. [62U.09] OMBUDSMAN OFFICE FOR PATIENT ADVOCACY. 12.16(a) The Ombudsman Office for Patient Advocacy is created to represent the interests 12.17of the consumers of health care. The goal of the ombudsman shall be to help residents 12.18of the state secure the health care services and benefits to which they are entitled under 12.19the laws administered by the department and to advocate on behalf of and represent the 12.20interests of consumers in governance bodies created by this chapter and in other forums. 12.21(b) The ombudsman shall be a patient advocate appointed by the governor. 12.22The budget for the ombudsman's office shall be determined by the legislature and is 12.23independent from the Health Care Agency which has no oversight or authority over the 12.24ombudsman for patient advocacy. The ombudsman shall establish offices throughout 12.25the state that shall provide convenient access to residents. The ombudsman for patient 12.26advocacy shall: 12.27(1) ensure that patient advocacy services are available to all Minnesota residents; 12.28(2) establish and maintain the grievance process according to section 62U.53; 12.29(3) receive, evaluate, and respond to consumer complaints about the health care plan; 12.30(4) provide a means to receive recommendations from the public about ways to 12.31improve the health care plan and hold public hearings at least annually to discuss problems 12.32and receive recommendations from the public; 12.33(5) develop educational and informational guides according to section 15.441, for 12.34consumers describing consumer rights and responsibilities and inform consumers about 12.35the right to secure health care services and to participate in the health care plan. The 13.1guides shall be made available to the public by the ombudsman, including access on 13.2the ombudsman's Web site and through public outreach and educational programs and 13.3displayed in provider offices and health care facilities; 13.4(6) establish a toll-free telephone number to receive complaints regarding the health 13.5care plan and its services; and 13.6(7) report annually to the public, the commissioner, and the legislature about 13.7the consumer perspective on the performance of the health care plan, including 13.8recommendations for needed improvements. 13.9(c) The patient advocate, in carrying out assigned duties, shall have unlimited access 13.10to all nonconfidential and all nonprivileged documents in the custody and control of the 13.11Minnesota Health Care Agency. 13.12 Sec. 8. [62U.11] INSPECTOR GENERAL FOR THE MINNESOTA HEALTH 13.13CARE PLAN. 13.14 Subdivision 1. Establishment. There is within the Office of the Attorney General 13.15an Inspector General for the Minnesota health care plan who is appointed by the attorney 13.16general. 13.17 Subd. 2. Duties. The inspector general shall: 13.18(1) investigate, audit, and review the financial and business records of individuals, 13.19public and private agencies and institutions, and private corporations that provide services 13.20or products to the plan, the costs of which are reimbursed by the plan; 13.21(2) investigate allegations of misconduct on the part of an employee or appointee 13.22of the Minnesota Health Care Agency and on the part of any provider of health care 13.23services that is reimbursed by the plan, and report any findings of misconduct to the 13.24attorney general; 13.25(3) investigate patterns of medical practice that may indicate fraud and abuse 13.26related to over or under utilization or other inappropriate utilization of medical products 13.27and services; 13.28(4) arrange for the collection and analysis of data needed to investigate the 13.29inappropriate utilization of these products and services; and 13.30(5) annually report recommendations for improvements to the plan to the 13.31commissioner. 13.32 Sec. 9. [62U.13] TRANSITION ADVISORY GROUP; HEALTH PLANNING 13.33REGIONS. 14.1 Subdivision 1. Establishment. The Health Care Policy Board shall appoint a 14.2transition advisory group to assist with the transition to the health care plan. 14.3 Subd. 2. Duties. The transition advisory group shall advise the commissioner on all 14.4aspects of the implementation of this chapter. 14.5(b) The transition advisory group shall make recommendations to the commissioner 14.6on how the health care plan shall be regionalized for the purposes of local and 14.7community-based planning for the delivery of high quality, cost-effective care and 14.8efficient service delivery. 14.9 Sec. 10. [62U.14] HEALTH PLANNING REGIONS. 14.10 Subdivision 1. Establishment. The commissioner, in consultation with the director 14.11of Health Quality Planning, shall establish at least six health planning regions composed of 14.12geographically contiguous counties grouped on the basis of the following considerations: 14.13(1) patterns of utilization of health care services; 14.14(2) health care resources, including workforce resources; 14.15(3) health needs of the population, including public health needs; 14.16(4) geography; 14.17(5) population and demographic characteristics; and 14.18(6) other considerations as appropriate. 14.19 Subd. 2. Administration. The county boards of each region shall appoint a regional 14.20planning director for the region. Regional planning directors shall serve at the will of the 14.21counties and may serve up to two four-year terms. 14.22 Sec. 11. [62U.15] REGIONAL PLANNING. 14.23 Subdivision 1. Regional planning director. (a) A regional planning director 14.24shall administer each health planning region. The regional planning director shall be 14.25responsible for all duties, the exercise of all powers and jurisdiction, and the discharge of 14.26all responsibilities vested by law in the regional agency. 14.27(b) The regional planning director shall reside in the region in which the director 14.28serves. 14.29(c) The regional planning director shall: 14.30(1) establish and administer a regional office; 14.31(2) establish regional goals and priorities according to standards, goals, priorities, 14.32and guidelines established by the regional board; 14.33(3) make needed revenue-sharing arrangements so that regionalization does not limit 14.34a patient's choice of provider; and 15.1(4) identify and prioritize regional health care needs and goals in collaboration with 15.2regional health care providers and the regional planning board. 15.3 Subd. 2. Regional planning boards. (a) Each region shall have a regional planning 15.4board consisting of 15 members who shall be appointed by the county boards in the 15.5region. Members shall serve four-year terms. 15.6(b) Regional planning board members shall have resided for a minimum of two years 15.7in the region in which they serve prior to appointment to the board. 15.8(c) Regional planning board members shall reside in the region they serve while 15.9on the board. 15.10(d) The board shall consist of the following members: 15.11(1) the regional planning director and a public health officer from one of the regional 15.12counties; 15.13(2) a representative from the Ombudsman Office of Patient Advocacy; 15.14(3) one expert in health care financing; 15.15(4) one expert in health care planning; 15.16(5) a registered nurse who is a direct patient care provider; 15.17(6) a primary care physician who is a direct patient care provider; 15.18(7) one member who represents ancillary health care workers; 15.19(8) one member representing hospitals; 15.20(9) one member representing essential providers; 15.21(10) one member representing long-term care providers; and 15.22(11) four county commissioners. 15.23(e) The regional planning director shall serve as chair of the board. 15.24(f) Regional planning boards shall set health policy goals for the regional planning 15.25director on all aspects of regional health care. 15.26ARTICLE 3 15.27FUNDING 15.28 Section 1. [62U.19] FUND FOR HEALTH CARE. 15.29 Subdivision 1. General provisions. (a) In order to support the agency effectively in 15.30the administration of this chapter, there is established in the state treasury the fund for 15.31health care. The fund shall be administered by a director appointed by the commissioner. 15.32(b) All money collected, received, and transferred according to this chapter shall be 15.33transmitted to the state treasury to be deposited to the credit of the fund for health care for 15.34the purpose of financing the Minnesota health care plan. 16.1(c) Money deposited in the fund for health care shall be used exclusively to support 16.2this chapter. 16.3(d) All claims for health care services rendered shall be made to the fund for health 16.4care. 16.5(e) All payments made for health care services shall be disbursed from the fund 16.6for health care. 16.7 Subd. 2. Accounts. (a) The director of the fund for health care shall establish 16.8the following accounts within the fund: 16.9(1) a system account to provide for all annual state expenditures for health care; and 16.10(2) a reserve account. 16.11(b) Premiums collected each year shall be sufficient to cover that year's projected 16.12costs. 16.13(c) The health care plan shall at all times hold in reserve an amount estimated in the 16.14aggregate to provide for the payment of all losses and claims for which the plan may be 16.15liable, and to provide for the expense of adjustment or settlement of losses and claims. 16.16(d) During the transition, the commissioner shall work with the Department of 16.17Commerce and other experts to determine an appropriate level of health plan reserves for 16.18the first year and for future years of health care plan operation. 16.19(e) Money currently held in reserve by state, city, and county health programs and 16.20federal money for health care held in reserve in federal trust accounts shall be transferred 16.21to the state health care reserve account when the state assumes financial responsibility for 16.22health care under this chapter that is currently provided by those programs. 16.23(f) The commissioner shall implement arrangements to self-insure the system 16.24against unforeseen expenditures or revenue shortfalls not covered by plan reserves and 16.25may borrow funds to cover temporary revenue shortfalls not covered by plan reserves, 16.26including the issuance of bonds for this purpose, whichever is more cost-effective. 16.27 Subd. 3. Cost control. (a) The commissioner shall work to ensure appropriate 16.28cost control through: 16.29(1) aggressive public health measures, early intervention and preventive care, and 16.30promotion of personal health improvement; 16.31(2) changes in the delivery of health care services and administration that improve 16.32efficiency and care quality; 16.33(3) negotiations with providers and suppliers; and 16.34(4) adjustments of health care provider payments to correct for deficiencies in care 16.35quality and failure to meet compensation contract performance goals. 17.1(b) If the commissioner determines that there will be a revenue shortfall despite the 17.2cost control measures in paragraph (a), the commissioner shall report to the legislature 17.3on the causes of the shortfall and the reasons for the failure of cost controls and shall 17.4recommend measures to correct the shortfall, including an increase in health care plan 17.5premium payments. 17.6 Sec. 2. [62U.21] PAYMENTS. 17.7 Subdivision 1. Procedures. (a) The Health Care Policy Board shall review, approve, 17.8reject, and modify all payment contracts and compensation plans established according 17.9to this section. 17.10(b) The board shall establish and supervise a uniform payments system for providers 17.11and managers and shall maintain a compensation plan for the following providers and 17.12managers according to the provider and manager budget established by the commissioner: 17.13(1) upper level managers including executives employed in private health care 17.14facilities and plans; and 17.15(2) health care providers. 17.16(c) Health care providers who accept any payment from the Minnesota health care 17.17plan for a covered service shall not bill the patient for that covered service. 17.18(d) Health care providers may be compensated as fee-for-service providers or as 17.19salaried providers in the health care plan. 17.20(e) No compensation plan or financial incentive may adversely affect the care a 17.21patient receives or the care a health provider recommends. 17.22(f) Fee-for-service providers shall be paid within 30 business days for claims filed in 17.23compliance with procedures established by the fund for health care. 17.24 Subd. 2. Regional payments. (a) The commissioner shall establish an allocation for 17.25each region to fund regional operating and capital budgets. 17.26(b) Integrated health care systems, essential providers, and group medical practices 17.27that provide comprehensive, coordinated services may choose to be reimbursed on the 17.28basis of a capitated system operating budget or a noncapitated system operating budget 17.29that covers all costs of providing health care services. 17.30(c) Providers may include in their operating budget requests reimbursement for 17.31ancillary health care or social services that were previously funded by money now 17.32received and disbursed by the fund for health care. 17.33(d) No payment may be made from a capitated or noncapitated budget for a capital 17.34expense except as stipulated in section 62U.23. 18.1 Subd. 3. Funds from outside sources. Facilities operating under health care plan 18.2operating budgets may raise and expend funds from sources other than the Minnesota 18.3health care plan including, private or foundation donors and other non-Minnesota health 18.4care plan sources for purposes related to the goals of this section and according to the 18.5provisions of this section. 18.6 Sec. 3. [62U.23] CAPITAL MANAGEMENT PLAN. 18.7 Subdivision 1. General provisions. (a) The commissioner shall develop a capital 18.8management plan that shall include conflict-of-interest standards and that shall govern all 18.9large capital investments and acquisitions undertaken in the Minnesota health care plan. 18.10The commissioner and the regional planning directors shall issue requests for proposals 18.11and oversee a process of competitive bidding for the development of capital projects that 18.12meet the needs of the Minnesota health care plan and to fund, partially fund, or participate 18.13in seeking funding for those capital projects. 18.14(b) Providers intending to make capital investments or acquisitions shall prepare a 18.15request including the full life-cycle costs of the project or acquisition and demonstrate 18.16how the investment or acquisition meets the health needs of the population it is intended 18.17to serve. Acquisitions include, but are not limited to, the acquisition of land, operational 18.18property, or administrative office space. 18.19(c) The commissioner shall establish standards and a process whereby the regional 18.20planning directors shall evaluate, accept, reject, or modify a business plan for a capital 18.21investment or acquisition. Decisions of a regional planning director may be appealed 18.22through a dispute resolution process established by the commissioner. 18.23 Subd. 2. Regional capital development plans. (a) Regional planning directors 18.24shall develop a regional capital development plan according to the Minnesota health care 18.25plan capital management plan established by the commissioner. 18.26(b) Services provided as a result of capital investments or acquisitions that do not 18.27meet the terms of the regional capital development plan and the capital management plan 18.28developed by the commissioner shall not be reimbursed by the Minnesota health care plan. 18.29 Sec. 4. [62U.25] BUDGET. 18.30 Subdivision 1. Prescription drugs and durable and nondurable medical 18.31equipment. (a) The commissioner shall establish a budget for the purchase of prescription 18.32drugs and durable and nondurable medical equipment for the health care plan. 18.33(b) The commissioner shall negotiate the lowest possible prices for prescription 18.34drugs and durable and nondurable medical equipment. 19.1 Subd. 2. Research and innovation. The commissioner shall establish a budget to 19.2support research and innovation that has been recommended by the Health Care Policy 19.3Board and the patient advocates. 19.4 Subd. 3. Training, development, and continuing education. (a) The commissioner 19.5shall establish a budget to support the training, development, and continuing education of 19.6health care providers and the health care workforce needed to meet the health care needs 19.7of the population and the goals and standards of the health care plan. 19.8(b) During the transition, the commissioner shall determine an appropriate level and 19.9duration of spending to support the retraining and job placement of persons who have been 19.10displaced from employment as a result of the transition to the new health care plan. 19.11 Subd. 4. Budget reserve. The commissioner shall establish a budget reserve. 19.12Money in the budget reserve may be used only for the purposes specified in this chapter. 19.13 Subd. 5. System administration. (a) The commissioner shall establish a budget 19.14that covers costs of administering the Minnesota health care plan. 19.15 Sec. 5. [62U.27] MINNESOTA HEALTH CARE PREMIUM PROPOSAL. 19.16 Subdivision 1. Duties. The Minnesota Health Plan Policy Board shall: 19.17(1) determine the aggregate costs of providing health care according to this chapter; 19.18and 19.19(2) develop an equitable and affordable premium structure that is progressive and 19.20based on the ability to pay and that will generate adequate revenue for the fund for health 19.21care; 19.22(3) in consultation with the Department of Revenue, develop an efficient means 19.23of collecting premiums; 19.24(4) ensure that all income earners and all employers contribute a premium amount 19.25that is affordable; 19.26(5) coordinate with existing, ongoing funding sources from federal and state 19.27programs; and. 19.28(6) provide a fair distribution of monetary savings achieved from the establishment 19.29of the state health care plan. 19.30 Subd. 2. Report. On or before July 1, 2009, the board shall submit to the governor 19.31and the legislature a detailed recommendation for collecting the revenue to finance the 19.32state health care plan. 19.33EFFECTIVE DATE.This section is effective the day following final enactment. 19.34 Sec. 6. [62U.29] GOVERNMENTAL PAYMENTS. 20.1(a) The commissioner shall seek all necessary waivers, exemptions, agreements, 20.2or legislation so that all current federal payments to the state for health care are paid 20.3directly to the Minnesota health care plan, which shall then assume responsibility for all 20.4benefits and services previously paid for by the federal government with those funds. In 20.5obtaining the waivers, exemptions, agreements, or legislation, the commissioner shall seek 20.6from the federal government a contribution for health care services in Minnesota that 20.7shall not decrease in relation to the contribution to other states as a result of the waivers, 20.8exemptions, agreements, or legislation. 20.9(b) The commissioner shall seek all necessary waivers, exemptions, agreements, or 20.10legislation so that all current state payments for health care are paid directly to the system, 20.11which shall then assume responsibility for all benefits and services previously paid for by 20.12state government with those funds. In obtaining the waivers, exemptions, agreements, 20.13or legislation, the commissioner shall seek from the legislature a contribution for health 20.14care services that shall not decrease in relation to state government expenditures for health 20.15care services in the year that this chapter was enacted, except that it may be corrected for 20.16change in state gross domestic product, the size and age of population, and the number of 20.17residents living below the federal poverty level. 20.18 Sec. 7. [62U.31] OTHER GOVERNMENTAL PROGRAMS. 20.19(a) The plan's responsibility for providing care shall be secondary to existing federal, 20.20state, or local governmental programs for health care services to the extent that funding for 20.21these programs is not transferred to the fund for health care or that the transfer is delayed 20.22beyond the date on which initial benefits are provided under the plan. 20.23(b) In order to minimize the administrative burden of maintaining eligibility records 20.24for programs transferred to the plan, the commissioner shall seek to reach an agreement 20.25with federal, state, and local governments in which their contributions to the fund for 20.26health care shall be fixed to the rate of change of the state gross domestic product, the size 20.27and age of population, and the number of residents living below the federal poverty level. 20.28 Sec. 8. [62U.33] FEDERAL PREEMPTION. 20.29 Subdivision 1. Federal waivers. (a) The commissioner shall pursue all reasonable 20.30means to secure a repeal or a waiver of any provision of federal law that preempts any 20.31provision of this chapter. 20.32(b) In the event that a repeal or a waiver of law or regulations cannot be secured, 20.33the commissioner shall adopt rules, or seek conforming state legislation, consistent with 20.34federal law, in an effort to best fulfill the purposes of this chapter. 21.1 Subd. 2. Employer contract or plan federal preemption. (a) To the extent 21.2permitted by federal law, an employee entitled to health or related benefits under a contract 21.3or plan that, under federal law, preempts provisions of this chapter, shall first seek benefits 21.4under that contract or plan before receiving benefits from the plan under this chapter. 21.5(b) No benefits shall be denied under the plan created by this chapter unless the 21.6employee has failed to take reasonable steps to secure like benefits from the contract or 21.7plan, if those benefits are available. 21.8(c) Nothing in this chapter is intended, nor shall this chapter be construed, to 21.9discourage recourse to contracts or plans that are protected by federal law. 21.10(d) To the extent permitted by federal law, a health care provider shall first seek 21.11payment from the contract or plan before submitting bills to the Minnesota health care 21.12plan. 21.13 Sec. 9. [62U.35] SUBROGATION. 21.14 Subdivision 1. Collateral source. (a) It is the intent of this chapter to establish a 21.15single public payer for all health care in the state of Minnesota. Until the time when the 21.16roles of all other payers for health care have been terminated, health care costs shall be 21.17collected from collateral sources whenever medical services provided to an individual 21.18are, or may be, covered services under a policy of insurance, health care service plan, or 21.19other collateral source available to that individual, or for which the individual has a right 21.20of action for compensation to the extent permitted by law. 21.21(b) As used in this section, collateral source includes: 21.22(1) insurance policies written by insurers, including the medical components of 21.23automobile, homeowners, and other forms of insurance; 21.24(2) health care service plans and pension plans; 21.25(3) employers; 21.26(4) employee benefit contracts; 21.27(5) government benefit programs; 21.28(6) a judgment for damages for personal injury; and 21.29(7) any third party who is or may be liable to an individual for health care services 21.30or costs. 21.31(c) Collateral source does not include: 21.32(1) a contract or plan that is subject to federal preemption; or 21.33(2) any governmental unit, agency, or service, to the extent that subrogation 21.34is prohibited by law. An entity described in paragraph (b) is not excluded from the 22.1obligations imposed by this section by virtue of a contract or relationship with a 22.2governmental unit, agency, or service. 22.3(d) The commissioner shall negotiate waivers, seek federal legislation, or make 22.4other arrangements to incorporate collateral sources in Minnesota into the Minnesota 22.5health care plan. 22.6 Subd. 2. Collateral source; negotiation. Whenever an individual receives health 22.7care services under the plan and is entitled to coverage, reimbursement, indemnity, or 22.8other compensation from a collateral source, the individual shall notify the health care 22.9provider and provide information identifying the collateral source, the nature and extent 22.10of coverage or entitlement, and other relevant information. The health care provider 22.11shall forward this information to the commissioner. The individual entitled to coverage, 22.12reimbursement, indemnity, or other compensation from a collateral source shall provide 22.13additional information as requested by the commissioner. 22.14 Subd. 3. Reimbursement. (a) The plan shall seek reimbursement from the 22.15collateral source for services provided to the individual and may institute appropriate 22.16action, including legal proceedings, to recover the reimbursement. Upon demand, the 22.17collateral source shall pay to the fund for health care the sums it would have paid or 22.18expended on behalf of the individual for the health care services provided by the plan. 22.19(b) In addition to any other right to recovery provided in this section, the 22.20commissioner shall have the same right to recover the reasonable value of benefits from 22.21a collateral source as provided to the commissioner of human services under section 22.22256B.37. 22.23(c) If a collateral source is exempt from subrogation or the obligation to reimburse 22.24the plan as provided in this section, the commissioner may require that an individual who 22.25is entitled to medical services from the source first seek those services from that source 22.26before seeking those services from the plan. 22.27(d) To the extent permitted by federal law, contractual retiree health benefits provided 22.28by employers shall be subject to the same subrogation as other contracts, allowing the 22.29Minnesota health care plan to recover the cost of services provided to individuals covered 22.30by the retiree benefits, unless and until arrangements are made to transfer the revenues 22.31of the benefits directly to the Minnesota health care plan. 22.32 Subd. 4. Defaults, underpayments, and late payments. (a) Default, underpayment, 22.33or late payment of any tax or other obligation imposed by this chapter shall result in the 22.34remedies and penalties provided by law, except as provided in this section. 22.35(b) Eligibility for benefits under section 62U.37 shall not be impaired by any default, 22.36underpayment, or late payment of any tax or other obligation imposed by this chapter. 23.1ARTICLE 4 23.2ELIGIBILITY 23.3 Section 1. [62U.37] ELIGIBILITY. 23.4 Subdivision 1. Residency. All Minnesota residents shall be eligible for the 23.5Minnesota health care plan. Residency shall be based upon physical presence in the state 23.6with the intent to reside. 23.7 Subd. 2. Enrollment; identification. The commissioner shall establish a procedure 23.8to enroll eligible residents and provide each eligible individual with identification that can 23.9be used by health care providers to determine eligibility for services. 23.10 Subd. 3. Residents temporarily out of state. (a) It is the intent of the legislature for 23.11the Minnesota health care plan to provide health care coverage to Minnesota residents who 23.12are temporarily out of the state. The commissioner shall determine eligibility standards for 23.13residents temporarily out of state who intend to return and reside in Minnesota and for 23.14nonresidents temporarily employed in Minnesota. 23.15(b) Coverage for emergency care obtained out of state shall be at prevailing local 23.16rates. Coverage for nonemergency care obtained out of state shall be according to rates and 23.17conditions established by the commissioner. The commissioner may require that a resident 23.18be transported back to Minnesota when prolonged treatment of an emergency condition is 23.19necessary and when that transport will not adversely affect a patient's care or condition. 23.20 Subd. 4. Visitors. Visitors to Minnesota shall be billed for all services received 23.21under the plan. The commissioner may establish intergovernmental arrangements with 23.22other states and countries to provide reciprocal coverage for temporary visitors. 23.23 Subd. 5. Out-of-state work. All persons eligible for health benefits from Minnesota 23.24employers but who are working in another jurisdiction shall be eligible for health benefits 23.25under this chapter provided they make payments equivalent to the payments they would 23.26be required to make if they were residing in Minnesota. 23.27 Subd. 6. Retiree benefits. (a) All persons who under an employer-employee 23.28contract are eligible for retiree medical benefits, including retirees who elect to reside 23.29outside of Minnesota, shall remain eligible for those benefits provided the contractually 23.30mandated payments for those benefits are made to the Minnesota fund for health care, 23.31which shall assume financial responsibility for care provided under the terms of the 23.32contract. 23.33(b) The commissioner may establish financial arrangements with states and foreign 23.34countries in order to facilitate meeting the terms of the contracts described in paragraph 24.1(a), except that payments for care provided by non-Minnesota providers to Minnesota 24.2retirees shall be reimbursed at rates established by the commissioner. 24.3 Subd. 7. Minors. Unmarried, unemancipated minors shall be deemed to have 24.4the residency of their parent or guardian. If a minor's parents are deceased and a legal 24.5guardian has not been appointed, or if a minor has been emancipated by court order, the 24.6minor may establish residency. 24.7 Subd. 8. Presumptive eligibility. (a) An individual shall be presumed to be eligible 24.8if the individual arrives at a health facility and is unconscious, comatose, or otherwise 24.9unable, because of the individual's physical or mental condition, to document eligibility or 24.10to act in the individual's own behalf. If the patient is a minor, the patient shall be presumed 24.11to be eligible, and the health facility shall provide care as if the patient were eligible. 24.12(b) Any individual shall be presumed to be eligible when brought to a health facility 24.13according to any provision of section 253B.05. 24.14(c) Any individual involuntarily committed to an acute psychiatric facility or to a 24.15hospital with psychiatric beds according to any provision of section 253B.05, providing 24.16for involuntary commitment, shall be presumed eligible. 24.17(d) All health facilities subject to state and federal provisions governing emergency 24.18medical treatment shall continue to comply with those provisions. 24.19(e) To prevent an influx of people into the state for the purposes of receiving medical 24.20care, the commissioner shall establish an eligibility waiting period and other criteria 24.21needed to protect Minnesota premium payers and ensure the fiscal stability of the health 24.22care plan. 24.23ARTICLE 5 24.24BENEFITS 24.25 Section 1. [62U.39] BENEFITS. 24.26 Subdivision 1. General provisions. Any eligible individual may choose to receive 24.27services under the Minnesota health care plan from any willing professional health care 24.28provider participating in the plan. No health care provider may refuse to care for a 24.29patient solely on the basis that is specified in the definition of unfair employment practice 24.30contained in section 363A.08. 24.31 Subd. 2. Covered benefits. Covered benefits in this chapter shall include all 24.32medical care determined to be medically appropriate by the consumer's health care 24.33provider, but are subject to the limitations specified in subdivision 4. Covered benefits 24.34include, but are not limited to, all of the following: 24.35(1) inpatient and outpatient health facility services; 25.1(2) inpatient and outpatient professional health care provider services by licensed 25.2health care professionals; 25.3(3) diagnostic imaging, laboratory services, and other diagnostic and evaluative 25.4services; 25.5(4) durable medical equipment, appliances, and assistive technology, including 25.6prosthetics, eyeglasses, and hearing aids and their repair; 25.7(5) inpatient and outpatient rehabilitative care; 25.8(6) emergency transportation and necessary transportation for health care services 25.9for disabled and indigent persons; 25.10(7) language interpretation and translation for health care services, including sign 25.11language for those unable to speak, or hear, or who are language impaired, and Braille 25.12translation or other services for those with no or low vision; 25.13(8) child and adult immunizations and preventive care; 25.14(9) health education; 25.15(10) hospice care; 25.16(11) home health care; 25.17(12) prescription drugs that are listed on the system formulary; nonformulary 25.18prescription drugs may be included where standards and criteria established by the 25.19commissioner are met; 25.20(13) mental and behavioral health care; 25.21(14) dental care; 25.22(15) podiatric care; 25.23(16) chiropractic care; 25.24(17) acupuncture; 25.25(18) blood and blood products; 25.26(19) emergency care services; 25.27(20) vision care; 25.28(21) adult day care; 25.29(22) case management and coordination to ensure services necessary to enable a 25.30person to remain safely in the least restrictive setting; 25.31(23) substance abuse treatment; 25.32(24) care in a skilled nursing facility; 25.33(25) dialysis; and 25.34(26) benefits offered by a bona fide church, sect, denomination, or organization 25.35whose principles include healing entirely by prayer or spiritual means provided by a 26.1duly authorized and accredited practitioner or nurse of that bona fide church, sect, 26.2denomination, or organization. 26.3 Subd. 3. Benefit expansion. The commissioner may expand benefits beyond the 26.4minimum benefits described in this section when expansion meets the intent of this chapter 26.5and when there are sufficient funds to cover the expansion. 26.6 Subd. 4. Exclusions. The following health care services shall be excluded from 26.7coverage by the plan: 26.8(1) health care services determined to have no medical indication by the 26.9commissioner; 26.10(2) surgery, dermatology, orthodontia, prescription drugs, and other procedures 26.11primarily for cosmetic purposes, unless required to correct a congenital defect, restore or 26.12correct a part of the body that has been altered as a result of injury, disease, or surgery, 26.13or determined to be medically necessary by a qualified, licensed health care provider in 26.14the plan; 26.15(3) private rooms in inpatient health facilities where appropriate nonprivate rooms 26.16are available, unless determined to be medically necessary by a qualified, licensed health 26.17care provider in the plan; and 26.18(4) services of a professional health care provider or facility that is not licensed or 26.19accredited by the state except for approved services provided to a Minnesota resident 26.20who is temporarily out of the state. 26.21ARTICLE 6 26.22DELIVERY OF CARE 26.23 Section 1. [62U.41] PROVIDERS. 26.24(a) All health care providers licensed or accredited to practice in Minnesota may 26.25participate in the Minnesota health care plan. 26.26(b) No health care provider may refuse to care for a patient on any basis that is 26.27specified in the definition of unfair employment practice contained in section 363A.08. 26.28(c) All federal legislation and regulations governing referral fees and fee-splitting, 26.29including, but not limited to, United States Code, title 42, sections 1320a-7b and 1395nn, 26.30shall be applicable to all health care providers of services reimbursed under this chapter, 26.31whether or not the health care provider is paid with funds coming from the federal 26.32government. 26.33(d) Choice of provider is subject to the following provisions. 26.34(1) Persons eligible for health care services under this chapter may choose the 26.35following providers: 27.1(i) primary care providers that include family practitioners, general practitioners, 27.2internists and pediatricians, advance practice nurse practitioners and physician assistants 27.3practicing under supervision as defined in section 147A.01, subdivision 18, and doctors 27.4of osteopathy licensed to practice as general doctors; and 27.5(ii) women may choose an obstetrician-gynecologist, in addition to a primary 27.6provider. 27.7(2) Persons who choose to enroll with integrated health care systems, group 27.8medical practices, or essential providers that offer comprehensive services, shall retain 27.9membership for at least six months after an initial three-month evaluation period during 27.10which time they may withdraw for any reason. 27.11(3) The three-month period shall commence on the date when an enrollee first sees 27.12a primary care provider. 27.13(4) Persons who want to withdraw after the initial three-month period shall request a 27.14withdrawal according to dispute resolution procedures established by the commissioner 27.15and may request assistance from the ombudsman for patient advocacy in the dispute 27.16process. The dispute shall be resolved in a timely fashion and shall have no adverse 27.17effect on the care a patient receives. 27.18(5) Persons needing to change primary care providers because of health care needs 27.19that their primary care provider cannot meet may change primary care providers at any 27.20time. 27.21 Sec. 2. [62U.43] REFERRALS. 27.22(a) All patients shall have a primary care provider who shall coordinate the care a 27.23patient receives or shall ensure that a patient's care is coordinated. A specialist may serve 27.24as the primary care provider if the patient and the provider agree to this arrangement, and 27.25if the provider agrees to coordinate the patient's care or to ensure that the care the patient 27.26receives is coordinated. 27.27(b) Referrals shall be based on the medical needs of the patient and on guidelines, 27.28which shall be established by the Health Care Policy Board. 27.29(c) Referrals shall not be restricted or provided solely because of financial 27.30considerations. The Health Care Policy Board shall monitor referral patterns and intervene 27.31as necessary to ensure that referrals are neither restricted nor provided solely because of 27.32financial considerations. 27.33(d) The commissioner may establish or ensure the establishment of a computerized 27.34referral registry to facilitate the referral process. 28.1 Sec. 3. [62U.45] OFFICE OF HEALTH QUALITY AND PLANNING. 28.2 Subdivision 1. General provisions. The Health Policy Board shall establish an 28.3Office of Health Quality and Planning to provide for the short- and long-term health 28.4needs of the population. The office shall: 28.5(1) promote the delivery of high-quality, coordinated health care services that 28.6enhance health; prevent illness, disease, and disability; slow the progression of chronic 28.7diseases; and improve personal health management; 28.8(2) establish performance criteria in measurable terms for health care goals; 28.9(3) assist the health care regions to develop operating and capital requests according 28.10to health care and finance guidelines established by the commissioner and this chapter. In 28.11assisting regions, the director of the Office of Health Quality and Planning shall: 28.12(i) identify medically undeserved areas and health service and asset shortages; 28.13(ii) identify disparities in health outcomes; 28.14(iii) provide information to support planning, including planning for access to 28.15specialized centers that perform a high volume of procedures for conditions requiring 28.16highly specialized treatments, including emergency and trauma, planning for interregional 28.17access to needed care, and planning for coordinated interregional capital investment; and 28.18(iv) evaluate regional budget requests and make recommendations to the 28.19commissioner about regional revenue allocations; 28.20(4) estimate the health care workforce required to meet the health needs of the 28.21population, the costs of providing the needed workforce, and, in collaboration with 28.22regional planners, educational institutions, the governor and the legislature, develop short- 28.23and long-term plans to meet those needs, including a plan to finance needed training; and 28.24(5) estimate the number and types of health facilities required to meet the short- and 28.25long-term health needs of the population and the projected costs of needed facilities. In 28.26collaboration with the commissioner, regional planning directors, the governor, and the 28.27legislature, the director shall develop plans to finance and build needed facilities. 28.28 Subd. 2. Culturally and linguistically competent care. (a) The Office of Health 28.29Quality and Planning shall establish standards for culturally and linguistically competent 28.30care. 28.31(b) The director of the Office of Health Quality and Planning shall annually evaluate 28.32the effectiveness of standards for culturally and linguistically competent care and make 28.33recommendations to the commissioner and the ombudsman for patient advocacy. 28.34(c) The director shall pursue available federal financial participation for the provision 28.35of a language services program that supports health care plan goals. 29.1 Subd. 3. Health initiatives. The Office of Health Quality and Planning shall explore 29.2the feasibility and the value to the health of the population of the following initiatives: 29.3(1) integrated statewide health care databases to support health care planning; 29.4(2) electronic systems and other means that support the use of standards of care 29.5based on clinical efficacy; 29.6(3) development of disease management programs; 29.7(4) electronic initiatives that lower administration costs; 29.8(5) Web-based, patient-centered information systems that assist people to promote 29.9and maintain health and provide information on health conditions and recent developments 29.10in treatment; and 29.11(6) recommend to the commissioner means to link health care research with the 29.12goals and priorities of the health care plan. 29.13 Subd. 4. Additional benefits. The Office of Health Quality and Planning shall 29.14consider additional benefits based on clinical efficacy. In considering additional benefits, 29.15the office shall: 29.16(1) identify safe and effective treatments; 29.17(2) receive comments and recommendations from health care providers about 29.18benefits that meet the needs of their patients; 29.19(3) receive comments and recommendations made directly by patients or indirectly 29.20through the patient advocate; 29.21(4) identify innovative approaches to health promotion, disease and injury 29.22prevention, education, research, and care delivery; and 29.23(5) identify complementary and alternative modalities that have been shown by 29.24the National Institutes of Health, Division of Complementary and Alternative Medicine 29.25to be safe and effective. 29.26The office shall establish pharmaceutical and medical equipment formularies based 29.27on clinical efficacy. The formularies shall be updated regularly to reflect new drugs and 29.28medical equipment. 29.29(h) The office shall develop standards and criteria and a process for providers to 29.30request authorization for services and treatments, including experimental treatments that 29.31are not included in the plan benefit package. 29.32(i) The office shall identify appropriate ratios of general medical providers to 29.33specialty medical providers on a regional basis in order to meet the health care needs of 29.34the population and the goals of the health care plan and recommend incentives and other 29.35means to achieve recommended provider ratios. 30.1(j) The office shall oversee coordination of the Minnesota health care plan and 30.2public health programs. 30.3 Sec. 4. [62U.53] OMBUDSMAN; GRIEVANCE SYSTEM. 30.4 Subdivision 1. Duties of ombudsman for patient advocacy. The ombudsman 30.5for patient advocacy shall establish a grievance system for all complaints. The system 30.6shall provide reasonable procedures that shall ensure adequate consideration of member 30.7grievances and appropriate remedies. 30.8 Subd. 2. Referral of grievances. The ombudsman for patient advocacy may 30.9refer any grievance that does not pertain to compliance with this chapter to the federal 30.10Health Care Financing Administration or any other appropriate local, state, and federal 30.11governmental entity for investigation and resolution. 30.12 Subd. 3. Submittal by designated agents and providers. A provider may join 30.13with, or otherwise assist, an enrollee to submit the grievance to the patient advocate 30.14without fear of retribution. 30.15 Subd. 4. Review of documents. The ombudsman may require additional 30.16information from providers or the commissioner. 30.17 Subd. 5. Written notice of disposition. The ombudsman shall send a written notice 30.18of the final disposition of the grievance, and the reasons for the decision, to the member, to 30.19any provider who is assisting the member, and to the commissioner, within 30 calendar 30.20days of receipt of the request for review unless the ombudsman determines that additional 30.21time is reasonably necessary to fully and fairly evaluate the relevant grievance. The 30.22ombudsman's order of corrective action shall be binding on the plan. Decisions of the 30.23ombudsman may only be appealed in district court. 30.24 Sec. 5. APPROPRIATION. 30.25$....... is appropriated from the general fund to the commissioner of health care for 30.26fiscal year 2009 to implement the provisions of this act. 30.27 Sec. 6. EFFECTIVE DATE. 30.28This act is effective the day following final enactment. The commissioner of 30.29finance shall notify the chairs of the house of representatives and senate committees 30.30with jurisdiction over health care that the fund for health care has sufficient revenues to 30.31fund the costs of implementing this act. Essay Delete this text and insert your essay with pro and con positions Sources Delete this text and insert 2 pro and 2 con sources
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UE women's soccer unveils 2015 schedule
14 News WFIE Evansville
The University of Evansville women's soccer team unveiled its 2015 schedule Wednesday morning. The Purple Aces will play eight of their 17 regular-season matches on their home pitch at Arad McCutchan Stadium. UE will also host the 2015 Missouri Valley ...
After NBA workouts, Tuttle ready for anything
Feb 25, 2015; Cedar Falls, IA, USA; Northern Iowa Panthers forward Seth Tuttle (10) celebrates a score against the Evansville Purple Aces during the first half at McLeod Center. Mandatory Credit: Jeffrey Becker-USA TODAY Sports. Feb 25, 2015; Cedar ...
and more »
The Gazette: Eastern Iowa Breaking News and Headlines
After NBA workouts, Tuttle ready for anything
The Gazette: Eastern Iowa Breaking News and Headlines
Feb 25, 2015; Cedar Falls, IA, USA; Northern Iowa Panthers forward Seth Tuttle (10) celebrates a score against the Evansville Purple Aces during the first half at McLeod Center. Mandatory Credit: Jeffrey Becker-USA TODAY Sports ...
The Times (subscription)
Skupien 'Aces' D-1 soccer signing
The Times (subscription)
Still, Skupien proved his considerable worth, and that caught the eye of newly-hired Evansville coach Marshall Ray who was brought on in December of last year after the Purple Aces posted an overall record of 10-16-1 and a 4-2 mark in the MVC. "Tommy ...
Aces' Kaczmarski gets picked by Mets
14 News WFIE Evansville
University of Evansville senior Kevin Kaczmarski was selected by the New York Mets in the 9th round (269th pick overall) in the Major League Baseball First-Year Player Draft on Tuesday. The UE outfielder leads ... A Cary, Ill. native, Kaczmarski led ...
and more »
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subset: commoncrawl


text:
Content Writer For Computer Repair Website
This project received 2 bids from talented freelancers with an average bid price of $30 USD.Get free quotes for a project like this
Skills Required
Project Budget$10 - $30 USD
Total Bids2
Project Description
I need some writers regular basis. . I need writers who can write SEO optimized content for my website. You will have to write content on the services we provide. It should be fast and copyscape pass. and free of [url removed, login to view] send some samples to check your quality..thanks .i m willing to pay $30 for 30 Pages. It should 400-500 words per page. Need Some one to do it in maximum 3 days. If you think you can handle it. Kindly bid.
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text:
Empty Bowl Project Feeds Hungry Kids in Texas
Empty Bowl Project Feeds Hungry Kids in Texas
876 results for 'texas'. Showing results 667 - 684
Empty Bowl Project Feeds Hungry Kids in Texas
Occupy Protesters 'Action' a 'Day of Disruption'
GOP Sees Opening, Hispanic Vote Up for Grabs
Homeland Security Advisor Accused of Leaking Docs
Photos 'Deep in the Heart' Promote Adoption Needs
'Adoption Day' Helps Adoptions Get Finalized
'Squatting' New Texas Trend in Homeowning?
Immigration Reform Important to Evangelical Latinos
Texas Courthouse Break-In Causes Bomb Scare
Beating the Odds: Deaf Swimmer Hopes to Inspire
Court: Principals Protected from First Amendment
Five-Year-Old Texas Girl Catches Piranha
Perry Immigration Stance May Draw Hispanic Vote
Listeria Cantaloupe Outbreak Deadliest in a Decade
Texas Teen Suspended for Opposing Homosexuality
Texas Drought Could Hurt State's Rice Farms
Texas Water Shortage Could Last for Years
Texas Fire Evacuees Return to Burned Homes


text:
Fergie officially changes her name
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- Prev
She's the F to the E, R, G, the I, the E. Fergie has officially changed her name: The singer, born Stacy Ann Ferguson, is now Fergie Duhamel.
RELATED: Celebs who changed their names
The Grammy winner's representative confirmed the name change Friday.
RELATED: Fergie's eccentric maternity style
Fergie is one-fourth of the Black Eyed Peas. She released her solo debut, "The Dutchess," in 2006. It launched five big hits, including "Fergalicious" and "Big Girls Don't Cry."
RELATED: Video: Fergie's changing looks
The 38-year-old singer is married to 40-year-old actor Josh Duhamel. She is pregnant with their first child.
RELATED: Celebritots with unusual names
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Well I was kind of going for "Man you just have three hundred dollars to spend on this thing like it's nothing". But yea.
Type: Posts; User: SZF2001; Keyword(s):
Well I was kind of going for "Man you just have three hundred dollars to spend on this thing like it's nothing". But yea.
It's just 300 bux? Man I wish I had that kind of money right now. Drugs are bad kids.
And weren't funny.
When everyone and their grandma already knows Windows, yea, that kind of is crazy.
And was hopefully fired for his entrepreneur tactics.
Yes because you guys are all running a big business, right?
In flames? I've only had one question answered.
Totally original and *hilarious*.
Stupid posts, stupid thread, stupid everything. Two thumbs down.
Well I'll be.
Still doesn't mean you should boycott Lenovo though.
Where is the competition when you can get one thing for free versus something you buy?
And you can make the argument, "Well people will obviously take the free thing versus the thing you buy". But...
We will move this thread to recurring discussion is one future I see.
EDIT: Man am I a freaking prophet or what.
giant letters
Linux isn't a threat, it's a hobby. You can show your Compiz and Linux installs and get people to go "Wow, thats pretty neat!" but it's not going to make them say "Wow, I guess I'll give up...
Compaq nx9030 - it's not horribly old, but when it's running the latest Xubuntu moderately fast instead of blazing fast like the days of old, something is up. :(
Just go for a company that sells computers without any sort of operating system on them. Then you don't have to uninstall any Window installs and you can get back on the Ubuntu forums and continue to...
Quick someone call Time magazine we all care.
That was horrible and YouTube is horrible.
My college uses MSCHAPSv2 and it sucks to get going with NetworkManager. nm-applet is better off than a manual config, but it's still a little tougher and would really alienate a newer person. Since...
Eat your computer it's the only way.
I use it to get wasted and hope that girl across the room digs me, only to find out that her boyfriend was watching me check her out so I get beaten up and then I drink some more to make the pain go...
I hope they make it so when you have your webcam or microphone plugged in it's always recording and sending the feed back to their head quarters so they can blackmail all their users.
I can only...
Wow. So I'm going to assume you haven't been in a office recently.
MICROSHAFTDUR is basically what I could hear.
I'm going to die soon and I'll remember that Ubuntu forum member, clanky, who didn't believe I was paralyzed.
I'll show them. I'll show them all.
Pidgin is just a few steps closer to web cam whores. HELL. YEA.
A few reasons to drop computers altogether:
1. Go outside and meet people
2. Live a life not behind a monitor
3. Get laid
But I'm an exception because I'm paralyzed from the neck down and...


text:
Situated in a pleasant, quiet Cul-de-Sac, 5-10 mins from Luton Airport. Spaces are on a private, brick-laid driveway, under security & street lighting. We accommodate rentals for a period of 1 week or more, for cars only. Transfers are included If we are available, at sociable hours & with prior arrangement (or a taxi costs £6+ one way, depending on time of day). We can provide child car seats.*There is a £2.50 fee each way the airport charges for the drop off area, payable in advance if transfers are given* (there is a free area option too) Occasionally we need to keep your key to let vehicles out, we would advise you on arrival. We are proud to say that we are well established offering this service for over 5 years now, please see our reviews for your peace of mind...Look forward to meeting you..
Reviews (165)
Tomas D
Great service. Erin gave me a lift to the airport at early hours at no cost and provide me with a taxi number on my return as she couldn't pick me up. Will book again (if available) on my next trip to Luton :)
Roxanne T
Great service thanks Erin
Nithin A
3.9miles to the airport. Safe location. Erin was very quick to respond and was kind enough to give us a lift to the airport at no charge. She couldn't pick us up on our return because we arrived after 12 and didnt charge us for the extra hour. The taxi back did cost us around 20 quid which defeated the purpose of parking offsite. But other than that brilliant alternative ! Highly recommend her and the site to anyone.
Ali J
Absolutely brilliant ! Lovely people. Thank you both - such an efficient service and amazing value. Early morning lift to airport, safe place to leave the car and pick up an arrival, couldn't ask for more. Would definitely use again.
John H
Really great location, and a perfect spot if you have a flight booked. Friendly service and a free lift to Luton Airport on my way out. Only a 5 minute bus journey if the owners aren't available to give you a lift!! Highly recommended.
Zag S
Great bunch, highly recommended. I will definitely return. The drop off and pick up are a very welcome service.
Erin BAsk Erin B a question
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24 Jan '10
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Other Parking Spaces
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from £17.50Book instantly
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text:
Original recipe yields 9 servings
Amount per serving ({{servings}} total)
Based on a 2,000 calorie diet
Ready In
Really enjoyed! Just made changes based on others' suggestions and also for fat/calorie content: used nonstick cooking spray on a 9x13" pan, used only 4 taco-sized flour tortillas, added taco se...
This was pretty good. I gave it 4 out of 5 because it seemed to kind of bland without some additions since we all like a lot of flavor. I did add taco seasoning to the beef, sauted the onions, a...
Excellent casserole! My husband and I both enjoyed it. Oh by the way, be sure to follow the recipe and grease the casserole dish. I forgot and learned the hard way.


text:
My Android app is using this code to get the short name of the timezone in which the handset is located.
String shortDisplayName = Calendar.getInstance().getTimeZone().getDisplayName(false, TimeZone.SHORT);
For my user in Strasbourg, France,
shortDisplayName is "HNEC" (I haven't learned yet exactly which locale is in play). I'm trying to determine exactly which TimeZone has that short name. So, I threw together some quick test code:
String[] ids = TimeZone.getAvailableIDs();
Locale[] locales = Locale.getAvailableLocales();
for (String id : ids) {
TimeZone timeZone = TimeZone.getTimeZone(id);
int rawOffset = timeZone.getRawOffset();
for (Locale locale : locales) {
String shortDisplayName = timeZone.getDisplayName(false, TimeZone.SHORT, locale);
if (shortDisplayName.equalsIgnoreCase("HNEC")) {
System.out.println(id + " | " + shortDisplayName + " | " + rawOffset);
When I run that code, no lines are printing. That is, no timezones, using any locale, resolve to a shortname of "HNEC"? How can I figure out which TimeZone has a short name of "HNEC"?


text:
SUMMARY: Looking for ways to improve your eretail conversion rates?
Test sending a special email offer to people who fill out a BizRate survey -- yes, the ones who love you and the ones who are mad as heck.
This is just one of five quick fixes one clever ecommerce marketer used to raise conversions 56%, all based on site analytics. More info, plus creative samples here.
Get the latest research on email, lead gen, and social media along with MarketingSherpa updates and promotions.
Email Marketing: How the Kentucky Derby engages customers with relevant email
Read More »
Enter to Win »
Marketing Analytics by Mike Grigsby


text:
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text:
2004 Cadillac Deville • 100,000 miles
My deville wont turn over. Everything works but engine wont turn over. Security light stays on
Roger wethington
November 30, 2012.
November 30, 2012.
When i start my truck i hear and ticking noise and it does NOT go away after it warms up or it does not go away at all. When i accelerate the ticking noise gets faster and when im ...
4 answers • 2010 Chevrolet Suburban • 143,000 miles
What would be compatible to use for a replacement engine in my Breeze? I am just looking to get something that would work with it to get it up and running. Can I use a different model ...
1 answer • 1999 Plymouth Breeze • 120,000 miles
If i took out my 91 toyota carolla engine what other cars would it be compatible with?
4 answers • 1991 Toyota Corolla
1990 Toyota Camry mileage: 150,000. 1. The oil warning light is on. 2. There are four quarts of oil in the car. 3. The oil filter is dry. 4. The engine sounds rough. 5. There is noise ...
3 answers • 1990 Toyota Camry • 150,000 miles


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Grandma Helen knew the importance of nutrition and good education.
One person I have long admired is someone I never had the chance to meet.
"Whenever I have worked on farms, I have found my thoughts drifting back to the early agricultural parables, perhaps because the very nature of manual work leaves one's mind open to unhampered thinking, and perhaps because many farm chores today are remarkably unremoved from farm chores thousands of years old — shoveling out irrigation canals […]
Rash of recent car accidents is a reminder to talk about safety.
As summer winds toward fall, this has been a year constantly ahead of itself, it seems.
Farm lessons included 'hard work, taking nothing for granted.'
Just this past week, a friend and I got to talking about how certain traditions have been handed down, some by family, others through the law of life's essentials.
Summertime memories of being a kid on the farm.
It has proven to be true: you can take the country boy off of the farm, but you can't sweep the country off the boy.