Section 1 (62V.01) establishes Minnesota Health Plan requirements, including requirements to ensure that all Minnesotans receive high quality care regardless of income; cover all necessary care; allow patients to choose their own providers; be funded through premiums based on ability to pay and other revenues; and to pay providers on an adequate and timely basis.

Section 2 (62V.02) states the title of the act and the purpose of the Minnesota Health Plan and defines terms. It establishes ethical conduct requirements for new state employees to be hired under the bill and requires other state agencies to share data with the new entities being established.

Section 3 (14.03, subdivision 3) exempts the schedules or provisions for payment under Minnesota Statutes, section 62V.05, from chapter 14.

Section 1 (62V.03) makes all Minnesota residents eligible for the Minnesota Health Plan and outlines: coverage and payment rates for Minnesotans temporarily out of the state; payment for services provided to nonresident visitors; eligibility for nonresidents employed in Minnesota; eligibility for retirees covered under an employer plan; and presumptive eligibility in emergencies and other situations.

Section 1 (62V.04) allows eligible persons to receive services from any licensed participating provider. It states that the Minnesota Health Plan covers all medically necessary care, with certain exceptions, and lists benefits that are included in coverage. The Minnesota Health Board, established in this bill, may expand benefits if funds are available. Excluded services include: those with no medical benefit; most cosmetic surgery; private rooms when appropriate nonprivate rooms are available; and services from nonaccredited providers. Also excluded are prescription drugs from pharmaceutical companies that market directly to consumers in Minnesota.

Section 2 (62V.041) describes care coordination provisions.

Section 1 (62V.19) establishes the Minnesota Health Fund, administered by a director appointed by the Minnesota Health Board, as the vehicle to collect and disburse Minnesota Health Plan revenue.

Section 2 (62V.20) requires the Minnesota Health Board to determine aggregate Minnesota Health Plan costs; develop an equitable and affordable premium structure that is based on an individual's ability to pay and a business health tax for businesses that will generate sufficient revenue to pay plan expenses; and submit a report on the structure by January 15, 2010. Federal waivers must be sought to allow federal health payments to be made directly to the plan, which would then assume responsibility for benefits and services previously paid by the federal government. Covered benefits are available without any cost sharing, including deductibles, co-payments, and coinsurance.

Section 3 (62V.21) requires the Minnesota Health Plan to collect from other possible payers, including health insurance policies, pension plans, personal injury judgments, etc., for services provided by the plan. Nonpayment of obligations imposed by the Minnesota Health Plan is subject to remedies and penalties provided by law, but eligibility for benefits is not affected by nonpayment of premiums or other obligations.

Section 1 (62V.05) governs provider payments. It allows all Minnesota-licensed health care providers to participate in the Minnesota Health Plan. It requires the Minnesota Health Board to establish, through negotiation, a uniform fee schedule for noninstitutional providers and a budget for institutional providers. Providers who propose capital purchases in excess of $500,000 must obtain board approval.

Section 1 (14.03, subdivision 2) exempts the Minnesota Health Plan from the contested case procedures in the Administrative Procedure Act.

Section 2 (15A.0815, subdivision 2) establishes the salary range for the Minnesota Health Plan's executive officer.

Section 3 (62V.06) establishes the Minnesota Health Board, composed of 15 members as follows:

• a representative selected by each of five rural regional health planning boards to be established;



• three representatives selected by the Metropolitan Regional Health Planning Board to be established;



• one consumer member and one employer member appointed by the eight regional representatives; and



• five providers appointed by the eight regional representatives.

Board member terms, compensation, and duties are established. Financial duties include approving statewide and regional budgets, establishing payment rates for providers, ensuring appropriate cost control, and implementing measures to correct any revenue shortfall.

Section 4 (62V.07) establishes the seven-county Metropolitan Health Planning Region and five rural planning regions, to be designated by the Commissioner of Health based on listed criteria.

Section 5 (62V.08) establishes the composition for the regional planning board: one county commissioner from each county in greater Minnesota and two commissioners per county in the metropolitan area. Board duties include recommending a regional operating and capital budget to the Minnesota Health Board.

Section 6 (62V.09) establishes the Office of Health Quality and Planning and describes its duties.

Section 7 (62V.10) establishes an Ombudsman Office for Patient Advocacy and describes its duties.

Section 8 (62V.11) requires the Ombudsman to establish a grievance system to process complaints.

Section 9 (62V.12) establishes an Inspector General for the Minnesota Health Plan within the Office of the Attorney General and describes duties.

Section 10 (62V.13) states that the books and operating policies and procedures of the Minnesota Health Board are subject to examination by the legislative auditor.

Section 1 is a blank appropriation to the Minnesota Health Fund.

Section 2 establishes an implementation timetable. The Minnesota Health Plan must be operational within two years of enactment. When the plan becomes operational, other health plans may not be sold in Minnesota to cover services provided by the Minnesota Health Plan. The Commissioner of Health must designate five greater Minnesota planning regions within three months after enactment; the regional boards must be established six months after enactment; and the Minnesota Health Board nine months after enactment.

KC:ph

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