Minnesota Legislature
HF 2432
as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am
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A bill for an act
relating to health; providing evidence-based health care guidelines; regulating
provider performance evaluations; modifying voluntary purchasing pool
requirements; requiring mediation therapy management care in certain situations;
providing for health promotion and wellness; providing for the review of prior
authorization procedures of certain entities; amending Minnesota Statutes 2006,
sections 62J.60, by adding a subdivision; 62Q.17; proposing coding for new law
in Minnesota Statutes, chapters 62J; 62Q; 145.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
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[62J.431] EVIDENCE-BASED HEALTH CARE GUIDELINES.
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Evidence-based guidelines must meet the following criteria:
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(1) the scope and application are clear;
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(2) authorship is stated and any conflicts of interest disclosed;
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(3) authors represent all pertinent clinical fields or other means of input have been
used;
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(4) the development process is explicitly stated;
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(5) the guideline is grounded in evidence;
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(6) the evidence is cited and grated;
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(7) the document itself is clear and practical;
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(8) the document is flexible in use, with exceptions noted or provided for with
general statements;
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(9) measures are included for use in systems improvement; and
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(10) the guideline has scheduled reviews and updating.
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Sec. 2.
Minnesota Statutes 2006, section 62J.60, is amended by adding a subdivision to
read:
new text begin Subd. 3a. new text end
new text begin Required statement. new text end
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An identification card issued to an enrollee by a
health plan company or other entity governed by Minnesota health coverage laws must
contain the following statement: "Subject to Minnesota law."
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Sec. 3.
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[62Q.101] EVALUATION OF PROVIDER PERFORMANCE.
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new text begin Subdivision 1. new text end
new text begin Use of patient-paid charges. new text end
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A health plan company, or a vendor of
risk management services as defined under section 60A.23, subdivision 8, shall not, in
evaluating the performance of a health care provider, include patient-paid costs or charges
as a factor in the performance evaluation.
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new text begin Subd. 2. new text end
new text begin Performance targets; reasonable basis and disclosure required. new text end
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A
health plan company, or a vendor of risk management services as defined under section
60A.23, subdivision 8, shall, in evaluating the performance of a health care provider:
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(1) conduct the evaluation using a bona fide baseline based upon practice experience
of the provider group; and
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(2) disclose the baseline to the health care provider in writing and prior to the
beginning of the time period used for the evaluation.
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Sec. 4.
Minnesota Statutes 2006, section 62Q.17, is amended to read:
62Q.17 VOLUNTARY PURCHASING POOLS.
Subdivision 1.
Permission to form.
Notwithstanding section 62A.10, employers,
groups, and individuals may voluntarily form purchasing pools, solely for the purpose
of negotiating and purchasing health plan coverage from health plan companies for
members of the pool.
Subd. 2.
Common factors.
All participants in a purchasing pool must live within a
common geographic region, be employed in a similar occupation, or share some other
common factor as approved by the commissioner of commerce. The membership criteria
must not be designed to include disproportionately employers, groups, or individuals
likely to have low costs of health coverage, or to exclude disproportionately employers,
groups, or individuals likely to have high costs of health coverage.
Subd. 3.
Governing structure.
Each pool must have a governing structure
controlled by its members. The governing structure of the pool is responsible for
administration of the pool. The governing structure shall review and evaluate all bids for
coverage from health plan companies, shall determine criteria for joining and leaving the
pool, and may design incentives for healthy lifestyles and health promotion programs.
The governing structure may design uniform entrance standards for all employers, except
small employers as defined under section 62L.02. Small employers must be permitted to
enter any pool if the small employer meets the pool's membership requirements. Pools
must provide as much choice in health plans to members as is financially possible. The
governing structure may charge all members a fee for administrative purposes.
Subd. 4.
Enrollment.
Pools must have an annual open enrollment period of not less
than 15 days, during which all individuals or groups that qualify for membership may enter
the pool without any preexisting condition limitations or exclusions or exclusionary riders,
except those permitted under chapter 62L for groups or section 62A.65 for individuals.
Pools must reach and maintain an enrolled population of at least 1,000 members within
deleted text begin six monthsdeleted text end new text begin one yearnew text end of formation. If a pool fails to reach or maintain the minimum
enrollment, all coverage subsequently purchased through the purchasing pool must be
regulated through existing applicable laws and forego all advantages under this section.
Subd. 5.
Members.
The governing structure of the pool shall set a minimum time
period for membershipnew text begin , which must be no less than five yearsnew text end . Members must stay in the
purchasing pool for the entire minimum period to avoid paying a penalty. Penalties for
early withdrawal from the purchasing pool shall be established by the governing structure.
Subd. 6.
Employer-based purchasing pools.
Employer-based purchasing
pools must, with respect to small employers as defined in section 62L.02, meet all the
requirements of chapter 62L. The experience of the pool must be pooled and the rates
blended across all groups. Pools may decide to create tiers within the pool, based on
experience of group members. These tiers must be designed within the requirements
of section 62L.08. The governing structure may establish criteria limiting movement
between tiers. deleted text begin Tiers must be phased out within two years of the pool's creation.deleted text end
Subd. 7.
Individual members.
Purchasing pools that contain individual members
must meet all of the underwriting and rate restrictions found in the individual health
plan market.
Subd. 8.
Reports.
Prior to the initial effective date of coverage, and annually on
July 1 thereafter, each pool shall file a report with the deleted text begin information clearinghouse and
thedeleted text end commissioner of commerce. deleted text begin The information clearinghouse must use the report to
promote the purchasing pools.deleted text end The annual report must contain the following information:
(1) the number of lives in the pool;
(2) the geographic area the pool intends to cover;
(3) the number of health plans offered;
(4) a description of the benefits under each plan;
(5) a description of the premium structure, including any co-payments or deductibles,
of each plan offered;
(6) evidence of compliance with chapter 62L;
(7) a sample of marketing information, including a phone number where the pool
may be contacted; and
(8) a list of all administrative fees charged.
Subd. 9.
Enforcement.
Purchasing pools must register prior to offering coverage,
and annually on July 1 thereafter, with the commissioner of commerce on a form
prescribed by the commissioner. The commissioner of commerce shall enforce this
section and all other state laws with respect to purchasing pools, and has for that purpose
all general rulemaking and enforcement powers otherwise available to the commissioner
of commerce. The commissioner may charge an annual registration fee sufficient to meet
the costs of the commissioner's duties under this section.
new text begin Subd. 10. new text end
new text begin No effect on certain arrangements. new text end
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Nothing in this section precludes
groups of employers, including businesses of one, from forming a multiple employer
welfare arrangement under chapter 62H or a purchasing alliance under chapter 62T, or
precludes such groups from using a combination of chapters 62H and 62T for joint pooling
purposes. Those types of group arrangements are not subject to this section.
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Sec. 5.
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[62Q.676] MEDICATION THERAPY MANAGEMENT CARE.
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A pharmacy benefit manager that provides prescription drug services must provide
medication therapy management services for enrollees taking four or more prescriptions to
treat or prevent two or more chronic medical conditions. For purposes of this subdivision,
"medication therapy management" means the provision of the following pharmaceutical
care services by a Minnesota licensed pharmacist to optimize the therapeutic outcomes of
the patient's medications:
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(1) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
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(2) communicating essential information to the patient's other primary care
providers; and
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(3) providing verbal education and training designed to enhance patient
understanding and appropriate use of the patient's medications.
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Nothing in this section shall be construed to expand or modify the scope of practice
of the pharmacist as defined in section 151.01, subdivision 27.
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Sec. 6.
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[145.985] HEALTH PROMOTION AND WELLNESS.
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Community health boards as defined in section 145A.02, subdivision 5, shall work
with schools, health care providers, and others to coordinate health and wellness programs
in their communities. In order to meet the requirements of this section, community
health boards shall:
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(1) provide instruction, technical assistance, and recommendations on how to
evaluate project outcomes;
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(2) assist with on-site health and wellness programs utilizing volunteers and others
addressing health and wellness topics including smoking, nutrition, obesity, and others; and
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(3) encourage health and wellness programs consistent with the Centers for Disease
Control and Prevention's Community Guide and goals consistent with the Centers for
Disease Control and Prevention's Healthy People 2010 initiative.
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Sec. 7. new text begin PRIOR AUTHORIZATION.
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Health plan companies and third party administrators, in cooperation with health
care providers, shall review prior authorization procedures administered by utilization
review organizations and health plan companies, to ensure the cost-effective use of prior
authorization and minimization of provider, clinic, and central office administrative
burden.
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