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S.F. No. 3780 - Health Care Reform (Minnesota Laws 2008, Chapter 358)
Author: Senator Linda Berglin
Prepared by: Katie Cavanor, Senate Counsel (651/296-3801)
Date: May 22, 2008


Article 1
Public Health

This article establishes a statewide health improvement program that will provide competitive grants to local community health boards for local programs targeted at reducing the percentage of Minnesotans who are overweight or obese and reducing the use of tobacco.

Section 1 (145.986) establishes a statewide health improvement program.

Subdivision 1 states that beginning July 1, 2009, the Commissioner of Health shall award competitive grants to community health boards and tribal governments to convene, coordinate, and implement evidence-based strategies targeted at achieving health improvement goals. Requires a local match of ten percent of total funding allocation which may include funds donated by community partners.

States that by January 15, 2011, the commissioner must recommend whether funding should be provided to local communities based on health disparities in the populations served.

Subdivision 2 requires the commissioner to set measurable outcomes and annually review the progress of local communities in meeting these outcomes.

Subdivision 3 requires the commissioner to provide content expertise, technical expertise, and training to grant recipients. Requires the commissioner to ensure that the program meets the outcomes by conducting a statewide evaluation and assist recipients to modify interventions if ineffective.

Subdivision 4 requires the commissioner to conduct a biennial evaluation of the program, and requires that grant recipients cooperate in this evaluation and provide the commissioner with necessary information.

Subdivision 5 requires the commissioner to submit a biennial report to the Legislature on the health improvement program by January 15 of every other year, beginning in 2010. Requires that the first report include recommendations on sustainable sources of funding.

Subdivision 6 states that community health boards and tribal governments must use the funds for this program to develop new programs or expand current programs and funds may not supplant current state or federal funding.

Article 2
Health Care Homes

This article establishes certification and other requirements for health care homes, requires payment of care coordination fees, and requires a study of workforce issues.

Section 1 (256B.0751) establishes standards and criteria for health care homes.

Subdivision 1 defines the following and other terms. "Commissioner" is defined as the Commissioner of Human Services and "commissioners" as the Commissioners of Human Services and Health acting jointly. "Personal clinician" is defined as a physician, physician assistant, or an advanced practice nurse. "State health care program" is defined as the MA, MinnesotaCare, and GAMC programs.

Subdivision 2, paragraph (a), by July 1, 2009, requires the commissioners to develop and implement standards of certification for health care homes for state health care programs. Requires the commissioners to consider existing standards developed by national independent accrediting and medical home organizations. Criteria that the standards must meet are specified.

Paragraph (b) requires the commissioners, in developing the standards, to consult with national and local organizations working on health care home models, physicians, relevant state agencies, health plan companies, hospitals, other providers, patients and patient advocates.

Paragraph (c) for purposes of developing and implementing these standards, permits the commissioners to use the expedited rulemaking process.

Subdivision 3, paragraph (a), allows a personal clinician or primary care clinic (at which all of the clinic's clinicians meet the criteria of a health care home) to be certified as a health care home. Clinicians and clinics must meet standards set by the commissioners under this section. Certification as a health care home is voluntary. Annual renewal of certification is required.

Paragraph (b) requires clinicians or clinics certified as health care homes to offer their health care home services to all of their patients with complex or chronic health conditions who are interested in participation.

Paragraph (c) requires health care homes to participate in the health care home learning collaborative.

Subdivision 4 states that this section does not preclude the continued development of existing medical or health care home projects currently operating or under development by the commissioner, and does not preclude the commissioner from establishing alternative models and payment mechanisms for persons who are enrolled in integrated Medicare and Medicaid programs or certain managed care long-term care programs, or are dually eligible, in the waiting period for Medicare, or have other primary coverage.

Subdivision 5, by July 1, 2009, requires the commissioners to establish a health care home collaborative to provide an opportunity for health care homes and state agencies to exchange information related to quality improvement and best practices.

Subdivision 6, paragraph (a), for continued certification, requires health care homes to meet process, outcome, and quality standards as developed and specified by the commissioners. The commissioners are required to collect data from health care homes necessary for monitoring compliance with certification standards and for evaluating the impact of health care homes on quality, cost, and outcomes.

Paragraph (b) allows the commissioners to contract with a private entity to evaluate the effectiveness of health care homes. Data collected under this subdivision is classified as nonpublic.

Subdivision 7, beginning July 1, 2009, requires the commissioner to encourage state health care program enrollees who have a complex or chronic condition to select a primary care clinic with clinicians who have been certified as health care homes.

Section 2 (256B.0752) establishes health care home reporting requirements.

Subdivision 1 requires the commissioners to report annually to the Legislature on the implementation and administration of the health care home model for state health care program enrollees, beginning December 15, 2009.

Subdivision 2 requires the commissioners to provide to the Legislature comprehensive evaluations of the health care home model, three and five years after implementation. Specifies criteria for the evaluation report.

Section 3 (256B.0753) establishes a payment system for providing care coordination services.

Subdivision 1 requires the commissioner to develop a payment system that provides per-person care coordination payments to health care homes for providing care coordination services and directly managing on site or employing care coordinators. The care coordination payment system must vary with thresholds of care complexity, with the highest fees paid for care provided to individuals requiring the most intensive care coordination and those who face racial, ethnic, or language barriers. The commissioner may phase-in care coordination fees, with fees applied first to individuals who have, or are at risk of developing, complex or chronic health conditions. The development of the payment system is required to be completed by January 1, 2010.

Subdivision 2, by July 1, 2010, requires the commissioner to pay implement care coordination payments. For the fee-for-service system the care coordination payment shall be determined in contracts with certified health care homes. For enrollees in managed care or county based purchasing plans, the contracts shall require care coordination fee payments.

Subdivision 3, if initial savings from the implementation of health care homes are not sufficient to allow implementation of the care coordination fee in a cost-neutral manner, allows the commissioner to make recommendations to the Legislature on reallocating costs within the health care system.

Section 4 (256B.0754) specifies the timeline for payment reform implementation.

Subdivision 1 requires the Commissioner of Human Services by July 1, 2010, to implement quality incentive payments as required under section 62U.02. This does not limit the ability of the commissioner to establish by contract and monitor outcome and performance measures related to state health care program enrollees.

Subdivision 2 requires the Commissioner of Human Services by January 1, 2011, to use the information and methods developed under section 62U.04 to establish a payment system to reduce health care costs and improve quality.

Section 5 requires the Commissioner of Health, in consultation with licensing boards and professional associations, to address health care workforce shortages by studying changes in health professional licensure and regulation necessary to ensure full utilization of advanced practice registered nurses, physician assistants, and other licensed health care professionals in the health care home and primary delivery system. The commissioner must make recommendations to the Legislature by January 15, 2009.

Article 3
Increasing Access; Continuity of Care

This article contains provisions relating to increasing access and improving the continuity of care.

Section 1 (124D.1115), paragraph (a), requires each school participating in the federal school lunch program to electronically send to the Department of Education eligibility information on each child participating in the program, unless the child's parent or legal guardian elects not to have this information disclosed.

Paragraph (b) requires the Department of Education to enter into an agreement with the Department of Human Services to share the eligibility information provided under paragraph (a), to identify persons eligible for MA or MinnesotaCare. Duties for the Department of Human Services related to maintaining the privacy of the data are specified.

Section 2 (256.01, subdivision 27), requires the commissioner of human services to make applications and renewals available on the Department's Website in the most common foreign languages.

Section 3 (256.962, subdivision 5) increases the application assistance bonus for organizations that identify and assist potential state health care program enrollees from $20 to $25. Licensed insurance agents are included in the incentive program.

Section 4 (256.962, subdivision 6) modifies the outreach requirements for school districts by requiring the district to provide information on how to obtain an application for the Minnesota health care programs and application assistance instead of mailing an application to families who are eligible for the free or reduced school lunch program. The requirement that districts provide follow-up services to families who are eligible for the free or reduced lunch program is modified, by requiring the district to provide application assistance and follow-up to families who have indicated an interest in receiving information or an application. A district is eligible for the application assistance bonus.

Section 5 (256B.057, subdivision 2a) clarifies that MinnesotaCare eligible children who become ineligible for MA due to excess income shall remain on MA for two additional months and then be deemed automatically eligible for MinnesotaCare until renewal.

Section 6 (256L.04, subdivision 1) Increases the "hard" income limit of $50,000 to $57,500 for parents on MinnesotaCare. Provides an effective date of July 1, 2010, or upon federal approval, whichever is later.

Section 7 (256L.04, subdivision 7) increases the MinnesotaCare income limit for adults with no children from 200 to 250 percent of FPG, effective July 1, 2009. (Under current law, this income limit is scheduled to be increased to 215 percent of FPG, effective July 1, 2009.)

Section 8 (256L.05, subdivision 3a), paragraph (b), allows MinnesotaCare enrollees to renew eligibility at community clinics, provider offices, and other designated locations if there is no change in circumstances that affects eligibility. The designated sites must forward renewal forms to the commissioner. The commissioner may establish criteria and timelines for sites to forward applications.

Paragraph (d) allows MinnesotaCare enrollees who fail to submit renewal forms and related documentation in a timely manner to remain eligible for one additional month beyond the current eligibility period before being disenrolled. The enrollee remains responsible for premiums for the additional month.

Provides an effective date of January 1, 2009, or upon federal approval, whichever is later.

Section 9 (256L.06, subdivision 3) provides that MinnesotaCare enrollees who fail to pay premiums will be disenrolled effective the first day of the calendar month following the month for which the premium was due. (Under current law, disenrollment is effective the month for which the premium is due.) The commissioner must waive premium repayment for this coverage when disenrolled persons reapply under section 256L.05, subdivision 3b. (This section requires persons who reapply after a lapse of one month or more to meet all eligibility criteria. These include criteria in rule that require persons disenrolled for failure to pay premiums to pay any unpaid premiums when re-enrolling.)

Provides an effective date of January 1, 2009, or upon federal approval, whichever is later.

Section 10 (256L.07, subdivision 1) increases the "hard" income cap of $50,000 a year for parents on MinnesotaCare to $57,500.

Section 11 (256L.15, subdivision 2), beginning July 1, 2009, requires MinnesotaCare enrollees to pay premiums based on a new premium scale, which would require a maximum enrollee contribution of 7.2 percent of income for family income of 275 percent of FPG. (Under current law, the maximum MinnesotaCare premium is 9.8 percent of gross household income; this includes a 2003 premium increase that the Legislature eliminated, but for which federal approval of the elimination is still pending.) The $4 monthly premiums for children with family incomes that do not exceed 150 percent of FPG is retained. A conforming change related to the increase in the program income limit is made. Provides an effective date of January 1, 2009, or upon federal approval, whichever is later, except that the change related to the income limit is effective July 1, 2010, or upon federal approval, whichever is later.

Section 12 requires the commissioner of human services to report to the legislature by January 15, 2009, of ways to improve coordination between state health care programs and social services programs.

Section 13 requires the commissioner of human services to study and report to the legislature by December 15, 2008, with recommendations for a rate increase to long term care employers dedicated to the purchase of employee health insurance in the private market. The commissioner is required to collect necessary actuarial data, employment data, current coverage data, and other needed information.

Section 14 repeals Minnesota Statutes, section 256L.15, subdivision 3 ($4 monthly MinnesotaCare premium for low-income children; this provision is reinstated elsewhere in the bill). Provides an effective date of July 1, 2009, or upon federal approval of the amendments to section 256L.15, subdivision 2, paragraph (c), whichever is later.

Article 4
Health Insurance Purchasing and Affordability Reform

This article contains provisions related to health insurance purchasing and making health coverage more affordable. The provisions related to reform include:

Section 1 (43A.23, subdivision 1) requires the commissioner of finance to offer a high deductible health plan option in the commissioner's and managerial's plans.

Section 2 (62J.495, subdivision 3) requires hospitals and health care providers, when implementing an interoperable health records system within their hospital or clinical practice, to use an electronic health record that is certified by the Certification Commission for Healthcare Information Technology or its successor.

Section 3 ( 62J.497) establishes an electronic prescription drug program.

Subdivision 1 defines terms.

Subdivision 2 requires all providers, group purchasers, prescribers, and dispensers to establish and maintain an electronic prescription drug program for transmitting prescriptions and prescription-related information using electronic media. This section does not require the use of electronic transmitting but, if it is used, then it must be done electronically using the standards described in the section.

Subdivision 3 requires prescribers and dispensers to use the NCDP SCRIPT Standard for the communication of a prescription or prescription-related information, and states when this standard is to be used.

Section 4 ( 62U.01) defines terms for chapter 62U.

Section 5 (62U.02) establishes a system of incentive payments based on quality care.

Subdivision 1 requires the commissioner of health to develop a standardized set of measures to access the quality of health care services offered by health care providers. The measures are to be based on medical evidence and be developed through a process in which providers participate. The measures are to be used for the incentive payment system developed under subdivision 2.

Subdivision 2 requires the commissioner by July 1, 2009, to develop a quality incentive payment system where providers would be eligible for quality-based payments that are in addition to existing payment levels, based on provider performance against specified targets and, to the extent possible, adjusted for variations in patient population. The requirements of Minnesota Statutes, section 62Q.101, do not apply under this system.

Subdivision 3 requires the commissioner to establish standards for measuring health outcomes, establish a system for risk adjusting quality measures, and issue annual public reports on provider quality beginning July 1, 2010. By January 1, 2010, physician clinics and hospitals are required to submit standardized electronic information on the outcomes and processes associated with patient care to the commissioner or the commissioner's designee. The commissioner is required to ensure that any quality reporting requirements are not duplicative of quality reporting activities currently underway.

Subdivision 4 authorizes the commissioner to contract with a private entity or consortium of private entities to complete tasks in subdivisions 1, 2, and 3. The private entity or consortium is required to be nonprofit and have governance that includes representatives of various stakeholders. No stakeholder group may have a majority of the votes on any issue or hold extraordinary powers not granted to any other stakeholder.

Subdivision 5 requires, by January 1, 2010, health plan companies (HPCs) to use the standardized quality measures and not require providers to use and report health plan company specific quality and outcomes measures.

By July 1, 2010, the Commissioner of Finance is required to implement the system for participants in the state employees group insurance program (SEGIP).

Section 6 (62U.03) requires HPCs, by January 1, 2010, to integrate health care homes into their provider networks and to develop a payment system that provides care coordination payments to health care providers for providing care coordination services for enrollees who enroll in health care homes certified under section 256B.0751. Nothing in this section shall restrict the ability of HPCs to selectively contract with health care providers, including health care homes. By July 1, 2010, the commissioner of finance is required to implement the care coordination payments for participants in SEGIP.

Section 7 (62U.04) establishes payment reform groundwork to reduce health care costs and improve quality.

Subdivision 1 requires the commissioner of health to develop a plan to create transparent prices, encourage greater innovation and collaboration, reduce administrative burdens associated with submitting and processing claims and provide comparative information to consumers on health care costs and quality across providers. The plan must be developed by January 1, 2010.

Subdivision 2 requires the commissioner to develop a method of calculating providers' (1) relative cost of care, defined as a measure of health care spending, including resource use and unit prices; and (2) relative quality of care. In developing this method the commissioner must address the following issues:

(1) Provider attribution of costs and quality;

(2) Appropriate adjustment for outlier or catastrophic cases;

(3) Appropriate risk adjustment;

(4) Specific types of providers that should be included in the calculation;

(5) Specific types of services that should be included in the calculation;

(6) Appropriate adjustment for variation in payment rates;

(7) The appropriate provider level for analysis;

(8) Payer mix adjustments; and

(9) Other factors that are determined by the commissioner to be needed to ensure validity and comparability of the analysis.

Subdivision 3, paragraph (a), requires the commissioner to develop a peer grouping system for providers based on a combined measure that incorporates their risk-adjusted cost of care and quality of care and for specific conditions as determined by the commissioner. The commissioner shall consult and coordinate with health care providers, health plan companies, state agencies, and organizations that work to improve health care quality in Minnesota. In the final establishment of this system, the commissioner shall not contract with any entity that has or will have a direct financial interest in the outcome fo the system.

Paragraph (b) requires the commissioner to disseminate information to providers on their cost of care, resource use, quality of care, and results of the index developed under this subdivision in comparison to an appropriate peer group, beginning June 1, 2010. Any analyses or reports that identify providers may only be published after the provider has been provided the opportunity by the designee to review the underlying data and submit comments. The provider has 21 days to review the data for accuracy.

Paragraph (c) requires the commissioner to establish an appeals process to resolve disputes from providers regarding the accuracy of the data used to develop analyses and reports.

Paragraph (d) requires the commissioner, beginning September 1, 2010, and no less than annually thereafter, to publish information on provider's cost, quality, and the results of the peer grouping process. The published results must be on a risk adjusted basis.

Subdivision 4, paragraph (a), requires HPCs and third-party administrators to submit encounter data to a private entity designated by the Commissioner of Health, beginning July 1, 2009, and every six months thereafter. The form and the requirements for submitting the data shall be specified by the commissioner.

Paragraph (b) requires the commissioner or the commissioner's designee to use the data only for the purpose of carrying out its responsibilities under paragraph (a), and to maintain the data that it receives in accordance with this section.

Paragraph (c) states that data collected under this subdivision are private data on individuals or nonpublic data as defined in section 13.02. Summary data may be prepared under this section that is derived from nonpublic data. The commissioner or the commissioner's designee is required to establish procedures and safeguards to protect the integrity and confidentiality of any data it maintains.

Paragraph (d) prohibits the commissioner or the commissioner's designee from publishing any analyses or reports that identify or could potentially identify individual patients.

Subdivision 5, paragraph (a), requires HPCs and third-party administrators to submit data on their contract prices with health care providers to a private entity designated by the commissioner beginning July 1, 2009, and annually on January 1 thereafter, for the purpose of performing the analyses required under this section. The data must be submitted in the form and manner specified by the commissioner.

Paragraph (b) limits the commissioner or the commissioner's designee's use of the data submitted to the purpose of carrying out its responsibilities under this section.

Paragraph (c) states that the data collected under this subdivision are nonpublic data as defined in section 13.02. The summary data prepared under this subdivision may be derived from public data. The commissioner is required to establish procedures and safeguards to protect the integrity and confidentiality of any data it maintains.

Subdivision 6 authorizes the commissioner to contract with a private entity or consortium to develop the standards under subdivision 1. The private entity or consortium must be nonprofit and have governance that includes representatives of the various stakeholder groups. No stakeholder group may have a majority of the votes on any issue or hold extraordinary powers not granted to any other stakeholder.

Subdivision 7 requires the commissioner to convene a work group to develop strategies for engaging consumers in understanding the importance of health care cost and quality.

Subdivision 8 states that nothing in this section shall prohibit group purchasers and health care providers, upon mutual agreement, from entering into arrangements that establish package prices for a comprehensive set of services or separately for the cost of care for specific health conditions in addition to the basket of care in section 62U.07. The commissioner may convene working groups to discuss and develop new strategies for reforming health care payment systems.

Subdivision 9, paragraph (a), states that by January 1, 2011:

The commissioner of finance shall use the information and methods developed under subdivision 3, to strengthen incentives for participants of SEGIP to use high quality and low cost providers;

All political subdivisions that offer health benefits to their employees must offer plans that differentiate providers on their cost and quality performance and create incentives for members to use better performing providers;

All health plan companies shall use the information and methods to develop products that encourage consumers to use high-quality , low-cost providers; and

Health plan companies that issue health plans in the individual or the small employer markets shall offer at least one health plan that uses the information to establish financial incentives for consumers to choose high-quality and low-cost providers through enrollee cost sharing or selective provider networks.

Paragraph (b) requires the commissioner to report to the Governor and Legislature on recommendations to encourage health plans to promote widespread adoption of products that encourage the use of high-quality, low-cost providers by January 1, 2011. The recommendations may include tax incentives, pubic reporting of health plan performance, regulatory incentives or changes, and other strategies.

Section 8 (62U.05) establishes provider pricing for baskets of care.

Subdivision 1 requires the commissioner, in consultation with one or more work groups, to establish uniform definitions for basket of care beginning with a minimum of 7 baskets of care. In selecting the health conditions, the commissioner shall consider coronary artery and heart disease, diabetes, asthma, and depression. To the extent possible, the baskets of care must incorporate a patient-directed, decision-making support model.

Subdivision 2, paragraph (a), authorizes providers to establish package prices for the baskets of care beginning January 1, 2010.

Paragraph (b), beginning January 1, 2010, prohibits providers that have established package prices for baskets of care from varying the payment the provider accepts as full payment for a health care service based upon the identity of the payer, contractual relationship with the payer, the identity of the patient, or whether the patient has coverage through a group purchaser. This paragraph applies only to services provided to Minnesota residents or to non-Minnesota residents who obtain health insurance through a Minnesota employer. Medicare, workers' compensation, no fault insurance, and state public health care programs are exempt from these requirements. This paragraph does not affect the right of a provider to provide charity care or care for a reduced price due to financial hardship or the patient or due to the patient being a friend or relative of the provider.

Subdivision 3, paragraph (a) requires the commissioner to establish quality measurements for the defined baskets of care by December 31, 2009. The commissioner may contract with an organization that works to improve health care quality to make recommendations.

Paragraph (b) requires the commissioner to begin to publish comparative price and quality information on the baskets of care so that it is easily accessible and understandable to the public, beginning July 1, 2010.

Section 9 (62U.06) requires the commissioner, beginning December 1, 2008, to submit to the Legislative Commission on Health Care Access periodic progress reports on the implementation of chapter 62U and of sections 256B.0751 to 256B.0753 (health care homes). The commissioner must also ensure that the activities and data collection of this chapter are implemented in an integrated and coordinated manner. The commissioner is authorized to use the expedited rulemaking process under chapter 14.

Section 10 (62U.07) requires certain employers to establish Section 125 Plans with an opt-out option.

Subdivision 1 defines terms.

Subdivision 2, paragraph (a), requires by July 1, 2009, all employers with 11 or more current full-time employees to establish a Section 125 Plan to allow their employees to purchase individual market or employer-based health plan coverage with pretax dollars. States that this does not require an employer to offer or purchase coverage for their employees. Exempts from this requirement employers:

(1) that offer a group health insurance plan;

(2) that are self-insured; and

(3) with no employees who are eligible to participate in a Section 125 Plan.

Paragraph (b) exempts employers that certify by checking a box on a form that they have received education and information on the benefits of offering Section 125 Plans from requiring to set up a Section 125 Plan.

Subdivision 3, paragraph (a), states that employers that do not offer a group health plan and or choose to offer a Section 125 Plan shall:

(1) allow employees to purchase an individual market health plan;

(2) allow employees to choose any licensed insurance producer to assist them in purchasing the plan;

(3) deduct premiums on a pretax basis upon an employee's request, in an amount not to exceed the employee's wages and remit these premiums to the health exchange or health plan; and

(4) provide notice to employees that individual market health plans purchased by employees through payroll deduction are not employer sponsored or administered.

Paragraph (b) states that employers are to be held harmless from any and all liability claims related to individual market health plans.

Subdivision 4 establishes grants to be awarded by the commissioner of employment and economic development to eligible small employers that establish Section 125 Plans. The grants shall be $350.

Section 11 (62U.08) requires the commissioner of health to convene a work group to make recommendations on the design of a health benefit set that provides coverage for a broad range of services and technologies that is based on scientific evidence that the services and technologies are cost-effective and provide lower enrollee cost sharing for services and technologies that are cost effective. The commissioner is required to report the recommendations of the work group to the legislature by January 15, 2010.

Section 12 (62U.09) creates the Health Care Reform Review Council.

Subdivision 1 establishes the Health Care Reform Review Council to periodically review the progress of implementation of this chapter and sections 256B.0751 to 256B.0754.

Subdivision 2, paragraph (a), provides that the council consists of fourteen members, appointed as follows:

(1) two members appointed by the Minnesota Medical Association, at least one of whom must represent rural physicians;

(2) one member appointed by the Minnesota Nurses Association;

(3) two members appointed by the Minnesota Hospital Association, at least one of whom must be a rural hospital administrator;

(4) one member appointed by the Minnesota Academy of Physician Assistants;

(5) one member appointed by the Minnesota Business Partnership;

(6) one member appointed by the Minnesota Chamber of Commerce;

(7) one member appointed by the SEIU Minnesota State Council;

(8) one member appointed by the AFL-CIO;

(9) one member appointed by the Minnesota Council of Health Plans;

(10) one member appointed by Smart Buy Alliance;

(11) one member appointed by the Minnesota Medical Group Association; and

(12) one consumer member appointed by AARP Minnesota.

Paragraph (b), if a member is not able or eligible to participate, requires a new member to be appointed by the entity that appointed the outgoing member.

Subdivision 3, paragraph (a), requires the Commissioner of Health to convene the first meeting of the council by January 15, 2009, and requires the council to meet at least quarterly.

Paragraph (b) provides that the council is governed by section 15.059, except that members shall not receive per diems and the council does not expire.

Section 13 requires the Commissioner of Health to establish a work group to make recommendations on the potential for reducing claims adjudication costs of health care providers and health plan companies by adopting more uniform payment methods, and the potential impact of establishing uniform prices that would replace prices negotiated individually by providers with separate payers. Requires the work group to report recommendations and action steps to the commissioner by January 1, 2010.

Section 14 requires the commissioner of health, in coordination with commissioner of human services, to develop a health care affordability proposal for eligible individuals and employees with access to employer subsidized health coverage with gross family incomes of 300 percent of FPG or less. The commissioner must evaluate and report on direct payments to individuals, tax credits, and tax deductions as mechanisms for providing affordable health coverage. Affordability is defined as the sum of premiums and out-of-pocket costs paid for health coverage that does not exceed the applicable percentage of gross monthly income set forth in Minnesota Statutes, section 256L.15, subdivision 2, paragraph (d). The commissioner must report the recommendations to the legislative by January 15, 2009.

Article 5 contains the appropriation.

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