Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF932 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to health; guaranteeing that health care is available and affordable for
3	3	1.3 every Minnesotan; establishing the Minnesota Health Plan, Minnesota Health
4	4	1.4 Board, Minnesota Health Fund, Office of Health Quality and Planning, ombudsman
5	5	1.5 for patient advocacy, and auditor general for the Minnesota Health Plan; requesting
6	6	1.6 an Affordable Care Act 1332 waiver; authorizing rulemaking; making conforming
7	7	1.7 changes; requiring a report; appropriating money; amending Minnesota Statutes
8	8	1.8 2024, sections 13.3806, by adding a subdivision; 14.03, subdivisions 2, 3;
9	9	1.9 15A.0815, subdivision 2; proposing coding for new law as Minnesota Statutes,
10	10	1.10 chapter 62X.
11	11	1.11BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
12	12	1.12 ARTICLE 1
13	13	1.13 MINNESOTA HEALTH PLAN
14	14	1.14 Section 1. [62X.01] HEALTH PLAN REQUIREMENTS.
15	15	1.15 In order to keep Minnesota residents healthy and provide the best quality of health care,
16	16	1.16the Minnesota Health Plan must:
17	17	1.17 (1) ensure all Minnesota residents are covered;
18	18	1.18 (2) cover all necessary care, including medical, dental, vision and hearing, mental health,
19	19	1.19chemical dependency treatment, prescription drugs, medical equipment and supplies,
20	20	1.20long-term care, and home care;
21	21	1.21 (3) allow patients to choose their providers;
22	22	1.22 (4) reduce costs by negotiating fair prices and by cutting administrative bureaucracy,
23	23	1.23not by restricting or denying care;
24	24	1Article 1 Section 1.
25	25	25-02772 as introduced01/24/25 REVISOR SGS/LJ
26	26	SENATE
27	27	STATE OF MINNESOTA
28	28	S.F. No. 932NINETY-FOURTH SESSION
29	29	(SENATE AUTHORS: JOHNSON STEWART, Pappas, Mohamed, Fateh and Mitchell)
30	30	OFFICIAL STATUSD-PGDATE
31	31	Introduction and first reading02/03/2025
32	32	Referred to Commerce and Consumer Protection 2.1 (5) be affordable to all through premiums based on ability to pay and elimination of
33	33	2.2co-pays;
34	34	2.3 (6) focus on preventive care and early intervention to improve health;
35	35	2.4 (7) ensure that there are enough health care providers to guarantee timely access to care;
36	36	2.5 (8) continue Minnesota's leadership in medical education, research, and technology;
37	37	2.6 (9) provide adequate and timely payments to providers; and
38	38	2.7 (10) use a simple funding and payment system.
39	39	2.8 Sec. 2. [62X.02] MINNESOTA HEALTH PLAN GENERAL PROVISIONS.
40	40	2.9 Subdivision 1.Short title.This chapter may be cited as the "Minnesota Health Plan."
41	41	2.10 Subd. 2.Purpose.The Minnesota Health Plan shall provide all medically necessary
42	42	2.11health care services for all Minnesota residents in a manner that meets the requirements in
43	43	2.12section 62X.01.
44	44	2.13 Subd. 3.Definitions.As used in this chapter, the following terms have the meanings
45	45	2.14provided:
46	46	2.15 (a) "Board" means the Minnesota Health Board.
47	47	2.16 (b) "Plan" means the Minnesota Health Plan.
48	48	2.17 (c) "Fund" means the Minnesota Health Fund.
49	49	2.18 (d) "Medically necessary" means services or supplies needed to promote health and to
50	50	2.19prevent, diagnose, or treat a particular patient's medical condition that meet accepted
51	51	2.20standards of medical practice within a provider's professional peer group and geographic
52	52	2.21region.
53	53	2.22 (e) "Institutional provider" means an inpatient hospital, nursing facility, rehabilitation
54	54	2.23facility, and other health care facilities that provide overnight care.
55	55	2.24 (f) "Noninstitutional provider" means individual providers, group practices, clinics,
56	56	2.25outpatient surgical centers, imaging centers, and other health facilities that do not provide
57	57	2.26overnight care.
58	58	2Article 1 Sec. 2.
59	59	25-02772 as introduced01/24/25 REVISOR SGS/LJ 3.1 ARTICLE 2
60	60	3.2 ELIGIBILITY
61	61	3.3 Section 1. [62X.03] ELIGIBILITY.
62	62	3.4 Subdivision 1.Residency.All Minnesota residents are eligible for the Minnesota Health
63	63	3.5Plan.
64	64	3.6 Subd. 2.Enrollment; identification.The Minnesota Health Board shall establish a
65	65	3.7procedure to enroll residents and provide each with identification that may be used by health
66	66	3.8care providers to confirm eligibility for services. The application for enrollment shall be no
67	67	3.9more than two pages.
68	68	3.10 Subd. 3.Premium remittance.All Minnesota residents must pay the plan premiums
69	69	3.11beginning on the date when the resident becomes eligible under the plan. Minnesota residents
70	70	3.12are eligible for the plan even if they have not filled out the enrollment form.
71	71	3.13 Subd. 4.Residents temporarily out of state.(a) The Minnesota Health Plan shall
72	72	3.14provide health care coverage to Minnesota residents who are temporarily out of the state
73	73	3.15who intend to return and reside in Minnesota.
74	74	3.16 (b) Coverage for emergency care obtained out of state shall be at prevailing local rates.
75	75	3.17Coverage for nonemergency care obtained out of state, or routine care obtained out of state
76	76	3.18by people living in border communities, shall be according to rates and conditions established
77	77	3.19by the board.
78	78	3.20 Subd. 5.Visitors.Nonresidents visiting Minnesota shall be billed by the board for all
79	79	3.21services received under the Minnesota Health Plan. The board may enter into
80	80	3.22intergovernmental arrangements or contracts with other states and countries to provide
81	81	3.23reciprocal coverage for temporary visitors.
82	82	3.24 Subd. 6.Nonresident employed in Minnesota.The board shall extend eligibility to
83	83	3.25nonresidents employed in Minnesota under a premium schedule set by the board.
84	84	3.26 Subd. 7.Business outside of Minnesota employing Minnesota residents.The board
85	85	3.27shall apply for a federal waiver to collect the employer contribution mandated by federal
86	86	3.28law.
87	87	3.29 Subd. 8.Retiree benefits.All persons who are eligible for retiree medical benefits under
88	88	3.30an employer-employee contract shall remain eligible for those benefits.
89	89	3.31 Subd. 9.Presumptive eligibility.(a) An individual is presumed eligible for coverage
90	90	3.32under the Minnesota Health Plan if the individual arrives at a health facility unconscious,
91	91	3Article 2 Section 1.
92	92	25-02772 as introduced01/24/25 REVISOR SGS/LJ 4.1comatose, or otherwise unable, because of the individual's physical or mental condition, to
93	93	4.2document eligibility or to act on the individual's own behalf. If the patient is a minor, the
94	94	4.3patient is presumed eligible, and the health facility shall provide care as if the patient were
95	95	4.4eligible.
96	96	4.5 (b) Any individual is presumed eligible when brought to a health facility.
97	97	4.6 (c) Any individual involuntarily committed to an acute psychiatric facility or to a hospital
98	98	4.7with psychiatric beds is presumed eligible.
99	99	4.8 (d) All health facilities subject to state and federal provisions governing emergency
100	100	4.9medical treatment must comply with those provisions.
101	101	4.10 Subd. 10.Data.Data collected because an individual applies for or is enrolled in the
102	102	4.11Minnesota Health Plan are private data on individuals as defined in section 13.02, subdivision
103	103	4.1212, but may be released to:
104	104	4.13 (1) providers for purposes of confirming enrollment and processing payments for benefits;
105	105	4.14 (2) the ombudsman for patient advocacy for purposes of performing duties under section
106	106	4.1562X.12 or 62X.13; or
107	107	4.16 (3) the auditor general for purposes of performing duties under section 62X.14.
108	108	4.17 Sec. 2. Minnesota Statutes 2024, section 13.3806, is amended by adding a subdivision to
109	109	4.18read:
110	110	4.19 Subd. 1d.Minnesota Health Plan.Data on enrollees under the Minnesota Health Plan
111	111	4.20are classified under sections 62X.03, subdivision 10, and 62X.13, subdivision 6.
112	112	4.21 ARTICLE 3
113	113	4.22 BENEFITS
114	114	4.23 Section 1. [62X.04] BENEFITS.
115	115	4.24 Subdivision 1.General provisions.Any eligible individual may choose to receive
116	116	4.25services under the Minnesota Health Plan from any participating provider.
117	117	4.26 Subd. 2.Covered benefits.Covered health care benefits in this chapter include all
118	118	4.27medically necessary care subject to the limitations specified in subdivision 4. Covered health
119	119	4.28care benefits for Minnesota Health Plan enrollees include:
120	120	4.29 (1) inpatient and outpatient health facility services;
121	121	4.30 (2) inpatient and outpatient professional health care provider services;
122	122	4Article 3 Section 1.
123	123	25-02772 as introduced01/24/25 REVISOR SGS/LJ 5.1 (3) diagnostic imaging, laboratory services, and other diagnostic and evaluative services;
124	124	5.2 (4) medical equipment, supplies, including prescribed dietary and nutritional therapies,
125	125	5.3appliances, and assistive technology, including prosthetics, eyeglasses, and hearing aids,
126	126	5.4their repair, technical support, and customization needed for individual use;
127	127	5.5 (5) inpatient and outpatient rehabilitative care;
128	128	5.6 (6) emergency care services;
129	129	5.7 (7) emergency transportation;
130	130	5.8 (8) necessary transportation for health care services for persons with disabilities or who
131	131	5.9may qualify as low income;
132	132	5.10 (9) child and adult immunizations and preventive care;
133	133	5.11 (10) reproductive and sexual health care;
134	134	5.12 (11) health and wellness education;
135	135	5.13 (12) hospice care;
136	136	5.14 (13) care in a skilled nursing facility;
137	137	5.15 (14) home health care including health care provided in an assisted living facility;
138	138	5.16 (15) mental health services;
139	139	5.17 (16) substance abuse treatment;
140	140	5.18 (17) dental care;
141	141	5.19 (18) vision care;
142	142	5.20 (19) hearing care;
143	143	5.21 (20) prescription drugs and devices;
144	144	5.22 (21) podiatric care;
145	145	5.23 (22) chiropractic care;
146	146	5.24 (23) acupuncture;
147	147	5.25 (24) therapies which are shown by the National Institutes of Health National Center for
148	148	5.26Complementary and Integrative Health to be safe and effective;
149	149	5.27 (25) blood and blood products;
150	150	5.28 (26) dialysis;
151	151	5Article 3 Section 1.
152	152	25-02772 as introduced01/24/25 REVISOR SGS/LJ 6.1 (27) adult day care;
153	153	6.2 (28) rehabilitative and habilitative services;
154	154	6.3 (29) ancillary health care or social services previously covered by Minnesota's public
155	155	6.4health programs;
156	156	6.5 (30) case management and care coordination;
157	157	6.6 (31) language interpretation and translation for health care services, including sign
158	158	6.7language and Braille or other services needed for individuals with communication barriers;
159	159	6.8and
160	160	6.9 (32) those health care and long-term supportive services currently covered under
161	161	6.10Minnesota Statutes 2016, chapter 256B, for persons on medical assistance, including home
162	162	6.11and community-based waivered services under chapter 256B.
163	163	6.12 Subd. 3.Benefit expansion.The Minnesota Health Board may expand health care
164	164	6.13benefits beyond the minimum benefits described in this section when expansion meets the
165	165	6.14intent of this chapter and when there are sufficient funds to cover the expansion.
166	166	6.15 Subd. 4.Cost-sharing for the room and board portion of long-term care.The
167	167	6.16Minnesota Health Board shall develop income and asset qualifications based on medical
168	168	6.17assistance standards for covered benefits under subdivision 2, clauses (12) and (13). All
169	169	6.18health care services for long-term care in a skilled nursing facility or assisted living facility
170	170	6.19are fully covered but, notwithstanding section 62X.20, subdivision 6, room and board costs
171	171	6.20may be charged to patients who do not meet income and asset qualifications.
172	172	6.21 Subd. 5.Exclusions.The following health care services shall be excluded from coverage
173	173	6.22by the Minnesota Health Plan:
174	174	6.23 (1) health care services determined to have no medical benefit by the board;
175	175	6.24 (2) treatments and procedures primarily for cosmetic purposes, unless required to correct
176	176	6.25a functional or congenital impairment, restore or correct a part of the body that has been
177	177	6.26altered as a result of injury, disease, or surgery, or determined to be medically necessary
178	178	6.27by a qualified, licensed health care provider in the Minnesota Health Plan; and
179	179	6.28 (3) services of a health care provider or facility that is not licensed or accredited by the
180	180	6.29state, except for approved services provided to a Minnesota resident who is temporarily out
181	181	6.30of the state.
182	182	6Article 3 Section 1.
183	183	25-02772 as introduced01/24/25 REVISOR SGS/LJ 7.1 Subd. 6.Prohibition.The Minnesota Health Plan shall not pay for drugs requiring a
184	184	7.2prescription if the pharmaceutical companies directly market those drugs to consumers in
185	185	7.3Minnesota.
186	186	7.4 Sec. 2. [62X.041] PATIENT CARE.
187	187	7.5 (a) All patients shall have a primary care provider and have access to care coordination.
188	188	7.6 (b) Referrals are not required for a patient to see a health care specialist. If a patient sees
189	189	7.7a specialist and does not have a primary care provider, the Minnesota Health Plan may assist
190	190	7.8with choosing a primary care provider.
191	191	7.9 (c) The board may establish an online registry to assist patients in identifying appropriate
192	192	7.10providers.
193	193	7.11 ARTICLE 4
194	194	7.12 FUNDING
195	195	7.13 Section 1. [62X.19] MINNESOTA HEALTH FUND.
196	196	7.14 Subdivision 1.General provisions.(a) The Minnesota Health Fund, a revolving fund,
197	197	7.15is established under the jurisdiction and control of the Minnesota Health Board to implement
198	198	7.16the Minnesota Health Plan and to receive premiums and other sources of revenue. The fund
199	199	7.17shall be administered by a director appointed by the Minnesota Health Board.
200	200	7.18 (b) All money collected, received, and transferred according to this chapter shall be
201	201	7.19deposited in the Minnesota Health Fund.
202	202	7.20 (c) Money deposited in the Minnesota Health Fund shall be used exclusively to finance
203	203	7.21the Minnesota Health Plan.
204	204	7.22 (d) All claims for health care services rendered shall be made to the Minnesota Health
205	205	7.23Fund.
206	206	7.24 (e) All payments made for health care services shall be disbursed from the Minnesota
207	207	7.25Health Fund.
208	208	7.26 (f) Premiums and other revenues collected each year must be sufficient to cover that
209	209	7.27year's projected costs.
210	210	7.28 Subd. 2.Accounts.The Minnesota Health Fund shall have operating, capital, and reserve
211	211	7.29accounts.
212	212	7Article 4 Section 1.
213	213	25-02772 as introduced01/24/25 REVISOR SGS/LJ 8.1 Subd. 3.Operating account.The operating account in the Minnesota Health Fund shall
214	214	8.2be comprised of the accounts specified in paragraphs (a) to (e).
215	215	8.3 (a) Medical services account. The medical services account must be used to provide
216	216	8.4for all medical services and benefits covered under the Minnesota Health Plan.
217	217	8.5 (b) Prevention account. The prevention account must be used to establish and maintain
218	218	8.6primary community prevention programs, including preventive screening tests.
219	219	8.7 (c) Program administration, evaluation, planning, and assessment account. The
220	220	8.8program administration, evaluation, planning, and assessment account must be used to
221	221	8.9monitor and improve the plan's effectiveness and operations. The board may establish grant
222	222	8.10programs including demonstration projects for this purpose.
223	223	8.11 (d) Training and development account. The training and development account must
224	224	8.12be used to incentivize the training and development of health care providers and the health
225	225	8.13care workforce needed to meet the health care needs of the population.
226	226	8.14 (e) Health service research account. The health service research account must be used
227	227	8.15to support research and innovation as determined by the Minnesota Health Board, and
228	228	8.16recommended by the Office of Health Quality and Planning and the Ombudsman for Patient
229	229	8.17Advocacy.
230	230	8.18 Subd. 4.Capital account.The capital account must be used to pay for capital
231	231	8.19expenditures for institutional providers.
232	232	8.20 Subd. 5.Reserve account.(a) The Minnesota Health Plan must at all times hold in
233	233	8.21reserve an amount estimated in the aggregate to provide for the payment of all losses and
234	234	8.22claims for which the Minnesota Health Plan may be liable and to provide for the expense
235	235	8.23of adjustment or settlement of losses and claims.
236	236	8.24 (b) Money currently held in reserve by state, city, and county health programs must be
237	237	8.25transferred to the Minnesota Health Fund when the Minnesota Health Plan replaces those
238	238	8.26programs.
239	239	8.27 (c) The board shall have provisions in place to insure the Minnesota Health Plan against
240	240	8.28unforeseen expenditures or revenue shortfalls not covered by the reserve account. The board
241	241	8.29may borrow money to cover temporary shortfalls.
242	242	8.30 Subd. 6.Assets of the Minnesota Health Plan; functions of the commissioner of
243	243	8.31Minnesota Management and Budget.All money received by the Minnesota Health Fund
244	244	8.32shall be paid to the commissioner of Minnesota Management and Budget as agent of the
245	245	8.33board who shall not commingle these funds with any other money. The money in these
246	246	8Article 4 Section 1.
247	247	25-02772 as introduced01/24/25 REVISOR SGS/LJ 9.1accounts shall be paid out on warrants drawn by the commissioner on requisition by the
248	248	9.2board.
249	249	9.3 Subd. 7.Management.The Minnesota Health Fund shall be separate from the state
250	250	9.4treasury. Management of the fund shall be conducted by the Minnesota Health Board, which
251	251	9.5has exclusive authority over the fund.
252	252	9.6 Sec. 2. [62X.20] REVENUE SOURCES.
253	253	9.7 Subdivision 1.Minnesota Health Plan premium.(a) The Minnesota Health Board
254	254	9.8shall:
255	255	9.9 (1) determine the aggregate cost of providing health care according to this chapter;
256	256	9.10 (2) develop an equitable and affordable premium structure based on income, including
257	257	9.11unearned income, and a business health tax;
258	258	9.12 (3) in consultation with the Department of Revenue, develop an efficient means of
259	259	9.13collecting premiums and the business health tax; and
260	260	9.14 (4) coordinate with existing, ongoing funding sources from federal and state programs.
261	261	9.15 (b) The premium structure must be based on ability to pay.
262	262	9.16 (c) Within one year after the effective date of this act, the board shall submit to the
263	263	9.17governor and the legislature a report on the premium and business health tax structure
264	264	9.18established to finance the Minnesota Health Plan.
265	265	9.19 Subd. 2.Federal receipts.All federal funding received by Minnesota including the
266	266	9.20premium subsidies under the Affordable Care Act, Public Law 111-148, as amended by
267	267	9.21Public Law 111-152, is appropriated to the Minnesota Health Plan Board to be used to
268	268	9.22administer the Minnesota Health Plan under chapter 62X. Federal funding that is received
269	269	9.23for implementing and administering the Minnesota Health Plan must be used to provide
270	270	9.24health care for Minnesota residents.
271	271	9.25 Subd. 3.Funds from outside sources.Institutional providers operating under Minnesota
272	272	9.26Health Plan operating budgets may raise and expend funds from sources other than the
273	273	9.27Minnesota Health Plan including private or foundation donors. Contributions to providers
274	274	9.28in excess of $500,000 must be reported to the board.
275	275	9.29 Subd. 4.Governmental payments.The chief executive officer and, if required under
276	276	9.30federal law, the commissioners of health, human services, and commerce shall seek all
277	277	9.31necessary waivers, exemptions, agreements, or legislation so that all current federal payments
278	278	9.32to the state, including the premium tax credits under the Affordable Care Act, are paid
279	279	9Article 4 Sec. 2.
280	280	25-02772 as introduced01/24/25 REVISOR SGS/LJ 10.1directly to the Minnesota Health Plan. When any required waivers, exemptions, agreements,
281	281	10.2or legislation are obtained, the Minnesota Health Plan shall assume responsibility for all
282	282	10.3health care benefits and health care services previously paid for with federal funds. In
283	283	10.4obtaining the waivers, exemptions, agreements, or legislation, the chief executive officer
284	284	10.5and, if required, commissioners shall seek from the federal government a contribution for
285	285	10.6health care services in Minnesota that reflects: medical inflation, the state gross domestic
286	286	10.7product, the size and age of the population, the number of residents living below the poverty
287	287	10.8level, and the number of Medicare and VA eligible individuals, and that does not decrease
288	288	10.9in relation to the federal contribution to other states as a result of the waivers, exemptions,
289	289	10.10agreements, or savings from implementation of the Minnesota Health Plan.
290	290	10.11 Subd. 5.Federal preemption.(a) The board shall secure a repeal or a waiver of any
291	291	10.12provision of federal law that preempts any provision of this chapter. The commissioners of
292	292	10.13health, human services, and commerce shall provide all necessary assistance.
293	293	10.14 (b) In the section 1332 waiver application, the board shall request to waive any of the
294	294	10.15following provisions of the Patient Protection and Affordable Care Act, to the extent
295	295	10.16necessary to implement this act:
296	296	10.17 (1) United States Code, title 42, sections 18021 to 18024;
297	297	10.18 (2) United States Code, title 42, sections 18031 to 18033;
298	298	10.19 (3) United States Code, title 42, section 18071; and
299	299	10.20 (4) sections 36B and 5000A of the Internal Revenue Code of 1986, as amended.
300	300	10.21 (c) In the event that a repeal or a waiver of law or regulations cannot be secured, the
301	301	10.22board shall adopt rules, or seek conforming state legislation, consistent with federal law, in
302	302	10.23an effort to best fulfill the purposes of this chapter.
303	303	10.24 (d) The Minnesota Health Plan's responsibility for providing care shall be secondary to
304	304	10.25existing federal government programs for health care services to the extent that funding for
305	305	10.26these programs is not transferred to the Minnesota Health Fund or that the transfer is delayed
306	306	10.27beyond the date on which initial benefits are provided under the Minnesota Health Plan.
307	307	10.28 Subd. 6.No cost-sharing.No deductible, co-payment, coinsurance, or other cost-sharing
308	308	10.29shall be imposed with respect to covered benefits.
309	309	10.30Sec. 3. [62X.21] SUBROGATION.
310	310	10.31 Subdivision 1.Collateral source.(a) Health care costs shall be collected from collateral
311	311	10.32sources whenever medical services provided to an individual by the MHP are, or may be,
312	312	10Article 4 Sec. 3.
313	313	25-02772 as introduced01/24/25 REVISOR SGS/LJ 11.1covered services under a policy of insurance, or other collateral source available to that
314	314	11.2individual, or when the individual has a right of action for compensation permitted under
315	315	11.3law.
316	316	11.4 (b) As used in this section, collateral source includes but is not limited to:
317	317	11.5 (1) health insurance policies and the medical components of automobile, homeowners,
318	318	11.6and other forms of insurance;
319	319	11.7 (2) medical components of workers' compensation;
320	320	11.8 (3) a judgment for damages for personal injury;
321	321	11.9 (4) the state of last domicile for individuals moving to Minnesota for medical care who
322	322	11.10have extraordinary medical needs; and
323	323	11.11 (5) any third party who is or may be liable to an individual for health care services or
324	324	11.12costs.
325	325	11.13 (c) An entity described in paragraph (b) is not excluded from the obligations imposed
326	326	11.14by this section by virtue of a contract or relationship with a government unit, agency, or
327	327	11.15service.
328	328	11.16 (d) The board shall negotiate waivers or make other arrangements to incorporate collateral
329	329	11.17sources into the Minnesota Health Plan if necessary.
330	330	11.18 Subd. 2.Notification.When an individual who receives health care services under the
331	331	11.19Minnesota Health Plan is entitled to coverage, reimbursement, indemnity, or other
332	332	11.20compensation from a collateral source, the individual shall notify the health care provider
333	333	11.21and provide information identifying the collateral source, the nature and extent of coverage
334	334	11.22or entitlement, and other relevant information. The health care provider shall forward this
335	335	11.23information to the board. The individual entitled to coverage, reimbursement, indemnity,
336	336	11.24or other compensation from a collateral source shall provide additional information as
337	337	11.25requested by the board.
338	338	11.26 Subd. 3.Reimbursement.(a) The Minnesota Health Plan shall seek reimbursement
339	339	11.27from the collateral source for services provided to the individual and may institute appropriate
340	340	11.28action, including legal proceedings, to recover the reimbursement. Upon demand, the
341	341	11.29collateral source shall pay to the Minnesota Health Fund the sums it would have paid or
342	342	11.30expended on behalf of the individual for the health care services provided by the Minnesota
343	343	11.31Health Plan.
344	344	11Article 4 Sec. 3.
345	345	25-02772 as introduced01/24/25 REVISOR SGS/LJ 12.1 (b) In addition to any other right to recovery provided in this section, the board shall
346	346	12.2have the same right to recover the reasonable value of health care benefits from a collateral
347	347	12.3source as provided to the commissioner of human services under section 256B.37.
348	348	12.4 Subd. 4.Defaults, underpayments, and late payments.(a) Default, underpayment, or
349	349	12.5late payment of any tax or other obligation imposed by this chapter shall result in the remedies
350	350	12.6and penalties provided by law, except as provided in this section.
351	351	12.7 (b) Eligibility for health care benefits under section 62X.04 shall not be impaired by any
352	352	12.8default, underpayment, or late payment of any premium or other obligation imposed by this
353	353	12.9chapter.
354	354	12.10 ARTICLE 5
355	355	12.11 PAYMENTS
356	356	12.12Section 1. [62X.05] PROVIDER PAYMENTS.
357	357	12.13 Subdivision 1.General provisions.(a) All health care providers licensed to practice in
358	358	12.14Minnesota may participate in the Minnesota Health Plan as well as other providers as
359	359	12.15determined by the board.
360	360	12.16 (b) A participating health care provider shall comply with all federal laws and regulations
361	361	12.17governing referral fees and fee splitting including, but not limited to, United States Code,
362	362	12.18title 42, sections 1320a-7b and 1395nn, whether reimbursed by federal funds or not.
363	363	12.19 (c) A fee schedule or financial incentive may not adversely affect the care a patient
364	364	12.20receives or the care a health provider recommends.
365	365	12.21 Subd. 2.Payments to noninstitutional providers.(a) The Minnesota Health Board
366	366	12.22shall establish and oversee a fair and efficient payment system for noninstitutional providers.
367	367	12.23 (b) The board shall pay noninstitutional providers based on rates negotiated with
368	368	12.24providers. Rates shall take into account the need to address provider shortages.
369	369	12.25 (c) The board shall establish payment criteria and methods of payment for care
370	370	12.26coordination for patients especially those with chronic illness and complex medical needs.
371	371	12.27 (d) Providers who accept any payment from the Minnesota Health Plan for a covered
372	372	12.28health care service shall not bill the patient for the covered health care service.
373	373	12.29 (e) Providers shall be paid within 30 business days for claims filed following procedures
374	374	12.30established by the board.
375	375	12Article 5 Section 1.
376	376	25-02772 as introduced01/24/25 REVISOR SGS/LJ 13.1 Subd. 3.Payments to institutional providers.(a) The board shall set annual budgets
377	377	13.2for institutional providers. These budgets shall consist of an operating and a capital budget.
378	378	13.3An institution's annual budget shall be set to cover its anticipated health care services for
379	379	13.4the next year based on past performance and projected changes in prices and health care
380	380	13.5service levels. The annual budget for each individual institutional provider must be set
381	381	13.6separately. The board shall not set a joint budget for a group of more than one institutional
382	382	13.7provider nor for a parent corporation that owns or operates one or more institutional provider.
383	383	13.8 (b) Providers who accept any payment from the Minnesota Health Plan for a covered
384	384	13.9health care service shall not bill the patient for the covered health care service.
385	385	13.10 Subd. 4.Capital management plan.(a) The board shall periodically develop a capital
386	386	13.11investment plan that will serve as a guide in determining the annual budgets of institutional
387	387	13.12providers and in deciding whether to approve applications for approval of capital expenditures
388	388	13.13by noninstitutional providers.
389	389	13.14 (b) Providers who propose to make capital purchases in excess of $500,000 must obtain
390	390	13.15board approval. The board may alter the threshold expenditure level that triggers the
391	391	13.16requirement to submit information on capital expenditures. Institutional providers shall
392	392	13.17propose these expenditures and submit the required information as part of the annual budget
393	393	13.18they submit to the board. Noninstitutional providers shall submit applications for approval
394	394	13.19of these expenditures to the board. The board must respond to capital expenditure applications
395	395	13.20in a timely manner.
396	396	13.21 ARTICLE 6
397	397	13.22 GOVERNANCE
398	398	13.23Section 1. Minnesota Statutes 2024, section 14.03, subdivision 2, is amended to read:
399	399	13.24 Subd. 2.Contested case procedures.The contested case procedures of the
400	400	13.25Administrative Procedure Act provided in sections 14.57 to 14.69 do not apply to (a)
401	401	13.26proceedings under chapter 414, except as specified in that chapter, (b) the commissioner of
402	402	13.27corrections, (c) the unemployment insurance program and the Social Security disability
403	403	13.28determination program in the Department of Employment and Economic Development, (d)
404	404	13.29the commissioner of mediation services, (e) the Workers' Compensation Division in the
405	405	13.30Department of Labor and Industry, (f) the Workers' Compensation Court of Appeals, or (g)
406	406	13.31the Board of Pardons, or (h) the Minnesota Health Plan.
407	407	13Article 6 Section 1.
408	408	25-02772 as introduced01/24/25 REVISOR SGS/LJ 14.1 Sec. 2. Minnesota Statutes 2024, section 15A.0815, subdivision 2, is amended to read:
409	409	14.2 Subd. 2.Agency head salaries.The salary for a position listed in this subdivision shall
410	410	14.3be determined by the Compensation Council under section 15A.082. The commissioner of
411	411	14.4management and budget must publish the salaries on the department's website. This
412	412	14.5subdivision applies to the following positions:
413	413	14.6 Commissioner of administration;
414	414	14.7 Commissioner of agriculture;
415	415	14.8 Commissioner of education;
416	416	14.9 Commissioner of children, youth, and families;
417	417	14.10 Commissioner of commerce;
418	418	14.11 Commissioner of corrections;
419	419	14.12 Commissioner of health;
420	420	14.13 Chief executive officer of the Minnesota Health Plan;
421	421	14.14 Commissioner, Minnesota Office of Higher Education;
422	422	14.15 Commissioner, Minnesota IT Services;
423	423	14.16 Commissioner, Housing Finance Agency;
424	424	14.17 Commissioner of human rights;
425	425	14.18 Commissioner of human services;
426	426	14.19 Commissioner of labor and industry;
427	427	14.20 Commissioner of management and budget;
428	428	14.21 Commissioner of natural resources;
429	429	14.22 Commissioner, Pollution Control Agency;
430	430	14.23 Commissioner of public safety;
431	431	14.24 Commissioner of revenue;
432	432	14.25 Commissioner of employment and economic development;
433	433	14.26 Commissioner of transportation;
434	434	14.27 Commissioner of veterans affairs;
435	435	14.28 Executive director of the Gambling Control Board;
436	436	14Article 6 Sec. 2.
437	437	25-02772 as introduced01/24/25 REVISOR SGS/LJ 15.1 Executive director of the Minnesota State Lottery;
438	438	15.2 Executive director of the Office of Cannabis Management;
439	439	15.3 Commissioner of Iron Range resources and rehabilitation;
440	440	15.4 Commissioner, Bureau of Mediation Services;
441	441	15.5 Ombudsman for mental health and developmental disabilities;
442	442	15.6 Ombudsperson for corrections;
443	443	15.7 Chair, Metropolitan Council;
444	444	15.8 Chair, Metropolitan Airports Commission;
445	445	15.9 School trust lands director;
446	446	15.10 Executive director of pari-mutuel racing;
447	447	15.11 Commissioner, Public Utilities Commission;
448	448	15.12 Chief Executive Officer, Direct Care and Treatment; and
449	449	15.13 Director of the Office of Emergency Medical Services.
450	450	15.14Sec. 3. [62X.06] MINNESOTA HEALTH BOARD.
451	451	15.15 Subdivision 1.Establishment.The Minnesota Health Board is established to promote
452	452	15.16the delivery of high quality, coordinated health care services that enhance health; prevent
453	453	15.17illness, disease, and disability; slow the progression of chronic diseases; and improve personal
454	454	15.18health management. The board shall administer the Minnesota Health Plan. The board shall
455	455	15.19oversee:
456	456	15.20 (1) the Office of Health Quality and Planning under section 62X.09; and
457	457	15.21 (2) the Minnesota Health Fund under section 62X.19.
458	458	15.22 Subd. 2.Board composition.(a) The board shall consist of 15 members, including a
459	459	15.23representative selected by each of the five rural regional health planning boards under section
460	460	15.2462X.08 and three representatives selected by the metropolitan regional health planning
461	461	15.25board under section 62X.08. These members shall appoint the following additional members
462	462	15.26to serve on the board:
463	463	15.27 (1) one patient member and one employer member; and
464	464	15.28 (2) five providers that include one physician, one registered nurse, one mental health
465	465	15.29provider, one dentist, and one facility director.
466	466	15Article 6 Sec. 3.
467	467	25-02772 as introduced01/24/25 REVISOR SGS/LJ 16.1 (b) Each member shall qualify by taking the oath of office to uphold the Minnesota and
468	468	16.2United States Constitution and to operate the Minnesota Health Plan in the public interest
469	469	16.3by upholding the underlying principles of this chapter.
470	470	16.4 Subd. 3.Term and compensation; selection of chair.Board members shall serve four
471	471	16.5years. Board members shall set the board's compensation not to exceed the compensation
472	472	16.6of Public Utilities Commission members. The board shall select the chair from its
473	473	16.7membership.
474	474	16.8 Subd. 4.Removal of board member.A board member may be removed by a two-thirds
475	475	16.9vote of the members voting on removal. After receiving notice and hearing, a member may
476	476	16.10be removed for malfeasance or nonfeasance in performance of the member's duties.
477	477	16.11Conviction of any criminal behavior regardless of how much time has lapsed is grounds for
478	478	16.12immediate removal.
479	479	16.13 Subd. 5.General duties.The board shall:
480	480	16.14 (1) ensure that all of the requirements of section 62X.01 are met;
481	481	16.15 (2) hire a chief executive officer for the Minnesota Health Plan who shall be qualified
482	482	16.16after taking the oath of office specified in subdivision 2 and who shall administer all aspects
483	483	16.17of the plan as directed by the board;
484	484	16.18 (3) hire a director for the Office of Health Quality and Planning who shall be qualified
485	485	16.19after taking the oath of office specified in subdivision 2;
486	486	16.20 (4) hire a director of the Minnesota Health Fund who shall be qualified after taking the
487	487	16.21oath of office specified in subdivision 2;
488	488	16.22 (5) provide technical assistance to the regional boards established under section 62X.08;
489	489	16.23 (6) conduct necessary investigations and inquiries and require the submission of
490	490	16.24information, documents, and records the board considers necessary to carry out the purposes
491	491	16.25of this chapter;
492	492	16.26 (7) establish a process for the board to receive the concerns, opinions, ideas, and
493	493	16.27recommendations of the public regarding all aspects of the Minnesota Health Plan and the
494	494	16.28means of addressing those concerns;
495	495	16.29 (8) conduct other activities the board considers necessary to carry out the purposes of
496	496	16.30this chapter;
497	497	16Article 6 Sec. 3.
498	498	25-02772 as introduced01/24/25 REVISOR SGS/LJ 17.1 (9) collaborate with the agencies that license health facilities to ensure that facility
499	499	17.2performance is monitored and that deficient practices are recognized and corrected in a
500	500	17.3timely manner;
501	501	17.4 (10) adopt rules, policies, and procedures as necessary to carry out the duties assigned
502	502	17.5under this chapter;
503	503	17.6 (11) establish conflict of interest standards that prohibit providers from receiving any
504	504	17.7financial benefit from their medical decisions outside of board reimbursement, including
505	505	17.8any financial benefit for referring a patient for any service, product, or provider, or for
506	506	17.9prescribing, ordering, or recommending any drug, product, or service;
507	507	17.10 (12) establish conflict of interest standards related to pharmaceuticals, medical supplies
508	508	17.11and devices and their marketing to providers so that no provider receives any incentive to
509	509	17.12prescribe, administer, or use any product or service;
510	510	17.13 (13) require all electronic health records used by providers be fully interoperable with
511	511	17.14the open source electronic health records system used by the United States Veterans
512	512	17.15Administration;
513	513	17.16 (14) provide financial help and assistance in retraining and job placement to Minnesota
514	514	17.17workers who may be displaced because of the administrative efficiencies of the Minnesota
515	515	17.18Health Plan;
516	516	17.19 (15) ensure that assistance is provided to all workers and communities who may be
517	517	17.20affected by provisions in this chapter; and
518	518	17.21 (16) work with the Department of Employment and Economic Development (DEED)
519	519	17.22to ensure that funding and program services are promptly and efficiently distributed to all
520	520	17.23affected workers. DEED shall monitor and report on a regular basis on the status of displaced
521	521	17.24workers.
522	522	17.25 There is currently a serious shortage of providers in many health care professions, from
523	523	17.26medical technologists to registered nurses, and many potentially displaced health
524	524	17.27administrative workers already have training in some medical field. To alleviate these
525	525	17.28shortages, the dislocated worker support program should emphasize retraining and placement
526	526	17.29into health care related positions if appropriate. As Minnesota residents, all displaced workers
527	527	17.30shall be covered under the Minnesota Health Plan.
528	528	17.31 Subd. 6.Waiver request duties.Before submitting a waiver application under section
529	529	17.321332 of the Patient Protection and Affordable Care Act, Public Law Number 111-148, as
530	530	17.33amended, the board shall do the following, as required by federal law:
531	531	17Article 6 Sec. 3.
532	532	25-02772 as introduced01/24/25 REVISOR SGS/LJ 18.1 (1) conduct or contract for any necessary actuarial analyses and actuarial certifications
533	533	18.2needed to support the board's estimates that the waiver will comply with the comprehensive
534	534	18.3coverage, affordability, and scope of coverage requirements in federal law;
535	535	18.4 (2) conduct or contract for any necessary economic analyses needed to support the
536	536	18.5board's estimates that the waiver will comply with the comprehensive coverage, affordability,
537	537	18.6scope of coverage, and federal deficit requirements in federal law. These analyses must
538	538	18.7include:
539	539	18.8 (i) a detailed ten-year budget plan; and
540	540	18.9 (ii) a detailed analysis regarding the estimated impact of the waiver on health insurance
541	541	18.10coverage in the state;
542	542	18.11 (3) establish a detailed draft implementation timeline for the waiver plan; and
543	543	18.12 (4) establish quarterly, annual, and cumulative targets for the comprehensive coverage,
544	544	18.13affordability, scope of coverage, and federal deficit requirements in federal law.
545	545	18.14 Subd. 7.Financial duties.The board shall:
546	546	18.15 (1) establish and after enactment into law, collect premiums and the business health tax
547	547	18.16according to section 62X.20, subdivision 1;
548	548	18.17 (2) approve statewide and regional budgets that include budgets for the accounts in
549	549	18.18section 62X.19;
550	550	18.19 (3) negotiate and establish payment rates for providers;
551	551	18.20 (4) monitor compliance with all budgets and payment rates and take action to achieve
552	552	18.21compliance to the extent authorized by law;
553	553	18.22 (5) pay claims for medical products or services as negotiated, and may issue requests
554	554	18.23for proposals from Minnesota nonprofit business corporations for a contract to process
555	555	18.24claims;
556	556	18.25 (6) seek federal approval to bill other states for health care coverage provided to residents
557	557	18.26from out-of-state who come to Minnesota for long-term care or other costly treatment when
558	558	18.27the resident's home state fails to provide such coverage, unless a reciprocal agreement with
559	559	18.28those states to provide similar coverage to Minnesota residents relocating to those states
560	560	18.29can be negotiated;
561	561	18.30 (7) administer the Minnesota Health Fund created under section 62X.19;
562	562	18Article 6 Sec. 3.
563	563	25-02772 as introduced01/24/25 REVISOR SGS/LJ 19.1 (8) annually determine the appropriate level for the Minnesota Health Plan reserve
564	564	19.2account and implement policies needed to establish the appropriate reserve;
565	565	19.3 (9) implement fraud prevention measures necessary to protect the operation of the
566	566	19.4Minnesota Health Plan; and
567	567	19.5 (10) work to ensure appropriate cost control by:
568	568	19.6 (i) instituting aggressive public health measures, early intervention and preventive care,
569	569	19.7health and wellness education, and promotion of personal health improvement;
570	570	19.8 (ii) making changes in the delivery of health care services and administration that improve
571	571	19.9efficiency and care quality;
572	572	19.10 (iii) minimizing administrative costs;
573	573	19.11 (iv) ensuring that the delivery system does not contain excess capacity; and
574	574	19.12 (v) negotiating the lowest reasonable prices for prescription drugs, medical equipment,
575	575	19.13and medical services.
576	576	19.14 Subd. 8.Minnesota Health Board management duties.The board shall:
577	577	19.15 (1) develop and implement enrollment procedures for the Minnesota Health Plan;
578	578	19.16 (2) implement eligibility standards for the Minnesota Health Plan;
579	579	19.17 (3) arrange for health care to be provided at convenient locations, including ensuring
580	580	19.18the availability of school nurses so that all students have access to health care, immunizations,
581	581	19.19and preventive care at public schools and encouraging providers to open small health clinics
582	582	19.20at larger workplaces and retail centers;
583	583	19.21 (4) make recommendations, when needed, to the legislature about changes in the
584	584	19.22geographic boundaries of the health planning regions;
585	585	19.23 (5) establish an electronic claims and payments system for the Minnesota Health Plan;
586	586	19.24 (6) monitor the operation of the Minnesota Health Plan through consumer surveys and
587	587	19.25regular data collection and evaluation activities, including evaluations of the adequacy and
588	588	19.26quality of services furnished under the program, the need for changes in the benefit package,
589	589	19.27the cost of each type of service, and the effectiveness of cost control measures under the
590	590	19.28program;
591	591	19.29 (7) disseminate information and establish a health care website to provide information
592	592	19.30to the public about the Minnesota Health Plan including providers and facilities, and state
593	593	19.31and regional health planning board meetings and activities;
594	594	19Article 6 Sec. 3.
595	595	25-02772 as introduced01/24/25 REVISOR SGS/LJ 20.1 (8) collaborate with public health agencies, schools, and community clinics;
596	596	20.2 (9) ensure that Minnesota Health Plan policies and providers, including public health
597	597	20.3providers, support all Minnesota residents in achieving and maintaining maximum physical
598	598	20.4and mental health; and
599	599	20.5 (10) annually report to the chairs and ranking minority members of the senate and house
600	600	20.6of representatives committees with jurisdiction over health care issues on the performance
601	601	20.7of the Minnesota Health Plan, fiscal condition and need for payment adjustments, any needed
602	602	20.8changes in geographic boundaries of the health planning regions, recommendations for
603	603	20.9statutory changes, receipt of revenue from all sources, whether current year goals and
604	604	20.10priorities are met, future goals and priorities, major new technology or prescription drugs,
605	605	20.11and other circumstances that may affect the cost or quality of health care.
606	606	20.12 Subd. 9.Policy duties.The board shall:
607	607	20.13 (1) develop and implement cost control and quality assurance procedures;
608	608	20.14 (2) ensure strong public health services including education and community prevention
609	609	20.15and clinical services;
610	610	20.16 (3) ensure a continuum of coordinated high-quality primary to tertiary care to all
611	611	20.17Minnesota residents; and
612	612	20.18 (4) implement policies to ensure that all Minnesota residents receive culturally and
613	613	20.19linguistically competent care.
614	614	20.20 Subd. 10.Self-insurance.The board shall determine the feasibility of self-insuring
615	615	20.21providers for malpractice and shall establish a self-insurance system and create a special
616	616	20.22fund for payment of losses incurred if the board determines self-insuring providers would
617	617	20.23reduce costs.
618	618	20.24Sec. 4. [62X.07] HEALTH PLANNING REGIONS.
619	619	20.25 A metropolitan health planning region consisting of the seven-county metropolitan area
620	620	20.26is established. The commissioner of health shall designate five rural health planning regions
621	621	20.27from the greater Minnesota area composed of geographically contiguous counties grouped
622	622	20.28on the basis of the following considerations:
623	623	20.29 (1) patterns of utilization of health care services;
624	624	20.30 (2) health care resources, including workforce resources;
625	625	20.31 (3) health needs of the population, including public health needs;
626	626	20Article 6 Sec. 4.
627	627	25-02772 as introduced01/24/25 REVISOR SGS/LJ 21.1 (4) geography;
628	628	21.2 (5) population and demographic characteristics; and
629	629	21.3 (6) other considerations as appropriate.
630	630	21.4 The commissioner of health shall designate the health planning regions.
631	631	21.5 Sec. 5. [62X.08] REGIONAL HEALTH PLANNING BOARD.
632	632	21.6 Subdivision 1.Regional planning board composition.(a) Each regional board shall
633	633	21.7consist of one county commissioner per county selected by the county board and two county
634	634	21.8commissioners per county selected by the county board in the seven-county metropolitan
635	635	21.9area. A county commissioner may designate a representative to act as a member of the board
636	636	21.10in the member's absence. Each board shall select the chair from among its membership.
637	637	21.11 (b) Board members shall serve for four-year terms and may receive per diems for meetings
638	638	21.12as provided in section 15.059, subdivision 3.
639	639	21.13 Subd. 2.Regional health board duties.Regional health planning boards shall:
640	640	21.14 (1) recommend health standards, goals, priorities, and guidelines for the region;
641	641	21.15 (2) prepare an operating and capital budget for the region to recommend to the Minnesota
642	642	21.16Health Board;
643	643	21.17 (3) hire a regional planning director;
644	644	21.18 (4) address the needs of high risk populations by:
645	645	21.19 (i) collaborating with community health clinics and social service providers through
646	646	21.20planning and financing to provide outreach, medical care, and case management services
647	647	21.21in the community for patients who, because of mental illness, homelessness, or other
648	648	21.22circumstances, are unlikely to obtain needed care; and
649	649	21.23 (ii) collaborating with hospitals, medical and social service providers through planning
650	650	21.24and financing to keep people healthy and reduce hospital readmissions by providing discharge
651	651	21.25planning and services including medical respite and transitional care for patients leaving
652	652	21.26medical facilities and mental health and chemical dependency treatment programs;
653	653	21.27 (5) collaborate with local public health care agencies to educate consumers and providers
654	654	21.28on public health programs;
655	655	21.29 (6) collaborate with public health care agencies to implement public health and wellness
656	656	21.30initiatives; and
657	657	21Article 6 Sec. 5.
658	658	25-02772 as introduced01/24/25 REVISOR SGS/LJ 22.1 (7) ensure that all parts of the region have access to a 24-hour nurse hotline and 24-hour
659	659	22.2urgent care clinics.
660	660	22.3 Sec. 6. [62X.09] OFFICE OF HEALTH QUALITY AND PLANNING.
661	661	22.4 Subdivision 1.Establishment.The Minnesota Health Board shall establish an Office
662	662	22.5of Health Quality and Planning to assess the quality, access, and funding adequacy of the
663	663	22.6Minnesota Health Plan.
664	664	22.7 Subd. 2.General duties.(a) The Office of Health Quality and Planning shall make
665	665	22.8annual recommendations to the board on the overall direction on subjects including:
666	666	22.9 (1) the overall effectiveness of the Minnesota Health Plan in addressing public health
667	667	22.10and wellness;
668	668	22.11 (2) access to health care;
669	669	22.12 (3) quality improvement;
670	670	22.13 (4) efficiency of administration;
671	671	22.14 (5) adequacy of budget and funding;
672	672	22.15 (6) appropriateness of payments for providers;
673	673	22.16 (7) capital expenditure needs;
674	674	22.17 (8) long-term health care;
675	675	22.18 (9) mental health and substance abuse services;
676	676	22.19 (10) staffing levels and working conditions in health care facilities;
677	677	22.20 (11) identification of number and mix of health care facilities and providers required to
678	678	22.21best meet the needs of the Minnesota Health Plan;
679	679	22.22 (12) care for chronically ill patients;
680	680	22.23 (13) educating providers on promoting the use of advance directives with patients to
681	681	22.24enable patients to obtain the health care of their choice;
682	682	22.25 (14) research needs; and
683	683	22.26 (15) integration of disease management programs into health care delivery.
684	684	22.27 (b) Analyze shortages in health care workforce required to meet the needs of the
685	685	22.28population and develop plans to meet those needs in collaboration with regional planners
686	686	22.29and educational institutions.
687	687	22Article 6 Sec. 6.
688	688	25-02772 as introduced01/24/25 REVISOR SGS/LJ 23.1 (c) Analyze methods of paying providers and make recommendations to improve quality
689	689	23.2and control costs.
690	690	23.3 (d) Assist in coordination of the Minnesota Health Plan and public health programs.
691	691	23.4 Subd. 3.Assessment and evaluation of benefits.(a) The Office of Health Quality and
692	692	23.5Planning shall:
693	693	23.6 (1) consider health care benefit additions to the Minnesota Health Plan and evaluate
694	694	23.7them based on evidence of clinical efficacy;
695	695	23.8 (2) establish a process and criteria by which providers may request authorization to
696	696	23.9provide health care services and treatments that are not included in the Minnesota Health
697	697	23.10Plan benefit set, including experimental health care treatments;
698	698	23.11 (3) evaluate proposals to increase the efficiency and effectiveness of the health care
699	699	23.12delivery system, and make recommendations to the board based on the cost-effectiveness
700	700	23.13of the proposals; and
701	701	23.14 (4) identify complementary and alternative health care modalities that have been shown
702	702	23.15to be safe and effective.
703	703	23.16 (b) The board may convene advisory panels as needed.
704	704	23.17Sec. 7. [62X.10] ETHICS AND CONFLICT OF INTEREST.
705	705	23.18 (a) All provisions of section 43A.38 apply to employees and the chief executive officer
706	706	23.19of the Minnesota Health Plan, the members and directors of the Minnesota Health Board,
707	707	23.20the regional health boards, the director of the Office of Health Quality and Planning, the
708	708	23.21director of the Minnesota Health Fund, and the ombudsman for patient advocacy. Failure
709	709	23.22to comply with section 43A.38 shall be grounds for disciplinary action which may include
710	710	23.23termination of employment or removal from the board.
711	711	23.24 (b) In order to avoid the appearance of political bias or impropriety, the Minnesota Health
712	712	23.25Plan chief executive officer shall not:
713	713	23.26 (1) engage in leadership of, or employment by, a political party or a political organization;
714	714	23.27 (2) publicly endorse a political candidate;
715	715	23.28 (3) contribute to any political candidates or political parties and political organizations;
716	716	23.29or
717	717	23.30 (4) attempt to avoid compliance with this subdivision by making contributions through
718	718	23.31a spouse or other family member.
719	719	23Article 6 Sec. 7.
720	720	25-02772 as introduced01/24/25 REVISOR SGS/LJ 24.1 (c) In order to avoid a conflict of interest, individuals specified in paragraph (a) shall
721	721	24.2not be currently employed by a medical provider or a pharmaceutical, medical insurance,
722	722	24.3or medical supply company. This paragraph does not apply to the five provider members
723	723	24.4of the board.
724	724	24.5 Sec. 8. [62X.11] CONFLICT OF INTEREST COMMITTEE.
725	725	24.6 (a) The board shall establish a conflict of interest committee to develop standards of
726	726	24.7practice for individuals or entities doing business with the Minnesota Health Plan, including
727	727	24.8but not limited to, board members, providers, and medical suppliers. The committee shall
728	728	24.9establish guidelines on the duty to disclose the existence of a financial interest and all
729	729	24.10material facts related to that financial interest to the committee.
730	730	24.11 (b) In considering the transaction or arrangement, if the committee determines a conflict
731	731	24.12of interest exists, the committee shall investigate alternatives to the proposed transaction
732	732	24.13or arrangement. After exercising due diligence, the committee shall determine whether the
733	733	24.14Minnesota Health Plan can obtain with reasonable efforts a more advantageous transaction
734	734	24.15or arrangement with a person or entity that would not give rise to a conflict of interest. If
735	735	24.16this is not reasonably possible under the circumstances, the committee shall make a
736	736	24.17recommendation to the board on whether the transaction or arrangement is in the best interest
737	737	24.18of the Minnesota Health Plan, and whether the transaction is fair and reasonable. The
738	738	24.19committee shall provide the board with all material information used to make the
739	739	24.20recommendation. After reviewing all relevant information, the board shall decide whether
740	740	24.21to approve the transaction or arrangement.
741	741	24.22Sec. 9. [62X.12] OMBUDSMAN OFFICE FOR PATIENT ADVOCACY.
742	742	24.23 Subdivision 1.Creation of office.(a) The Ombudsman Office for Patient Advocacy is
743	743	24.24created to represent the interests of the consumers of health care. The ombudsman shall
744	744	24.25help residents of the state secure the health care services and health care benefits they are
745	745	24.26entitled to under the laws administered by the Minnesota Health Board and advocate on
746	746	24.27behalf of and represent the interests of enrollees in entities created by this chapter and in
747	747	24.28other forums.
748	748	24.29 (b) The ombudsman shall be a patient advocate appointed by the governor, who serves
749	749	24.30in the unclassified service and may be removed only for just cause. The ombudsman must
750	750	24.31be selected without regard to political affiliation and must be knowledgeable about and have
751	751	24.32experience in health care services and administration.
752	752	24Article 6 Sec. 9.
753	753	25-02772 as introduced01/24/25 REVISOR SGS/LJ 25.1 (c) The ombudsman may gather information about decisions, acts, and other matters of
754	754	25.2the Minnesota Health Board, health care organization, or a health care program. A person
755	755	25.3may not serve as ombudsman while holding another public office.
756	756	25.4 (d) The budget for the ombudsman's office shall be determined by the legislature and is
757	757	25.5independent from the Minnesota Health Board. The ombudsman shall establish offices to
758	758	25.6provide convenient access to residents.
759	759	25.7 (e) The Minnesota Health Board has no oversight or authority over the ombudsman for
760	760	25.8patient advocacy.
761	761	25.9 Subd. 2.Ombudsman's duties.The ombudsman shall:
762	762	25.10 (1) ensure that patient advocacy services are available to all Minnesota residents;
763	763	25.11 (2) establish and maintain the grievance process according to section 62X.13;
764	764	25.12 (3) receive, evaluate, and respond to consumer complaints about the Minnesota Health
765	765	25.13Plan;
766	766	25.14 (4) establish a process to receive recommendations from the public about ways to improve
767	767	25.15the Minnesota Health Plan;
768	768	25.16 (5) develop educational and informational guides according to communication services
769	769	25.17under section 15.441, describing consumer rights and responsibilities;
770	770	25.18 (6) ensure the guides in clause (5) are widely available to consumers and specifically
771	771	25.19available in provider offices and health care facilities; and
772	772	25.20 (7) prepare an annual report about the consumer perspective on the performance of the
773	773	25.21Minnesota Health Plan, including recommendations for needed improvements.
774	774	25.22Sec. 10. [62X.13] GRIEVANCE SYSTEM.
775	775	25.23 Subdivision 1.Grievance system established.The ombudsman shall establish a
776	776	25.24grievance system for complaints. The system shall provide a process that ensures adequate
777	777	25.25consideration of Minnesota Health Plan enrollee grievances and appropriate remedies.
778	778	25.26 Subd. 2.Referral of grievances.The ombudsman may refer any grievance that does
779	779	25.27not pertain to compliance with this chapter to the federal Centers for Medicare and Medicaid
780	780	25.28Services or any other appropriate local, state, and federal government entity for investigation
781	781	25.29and resolution.
782	782	25.30 Subd. 3.Submittal by designated agents and providers.A provider may join with,
783	783	25.31or otherwise assist, a complainant to submit the grievance to the ombudsman. A provider
784	784	25Article 6 Sec. 10.
785	785	25-02772 as introduced01/24/25 REVISOR SGS/LJ 26.1or an employee of a provider who, in good faith, joins with or assists a complainant in
786	786	26.2submitting a grievance is subject to the protections and remedies under sections 181.931 to
787	787	26.3181.935.
788	788	26.4 Subd. 4.Review of documents.The ombudsman may require additional information
789	789	26.5from health care providers or the board.
790	790	26.6 Subd. 5.Written notice of disposition.The ombudsman shall send a written notice of
791	791	26.7the final disposition of the grievance, and the reasons for the decision, to the complainant,
792	792	26.8to any provider who is assisting the complainant, and to the board, within 30 calendar days
793	793	26.9of receipt of the request for review unless the ombudsman determines that additional time
794	794	26.10is reasonably necessary to fully and fairly evaluate the relevant grievance. The ombudsman's
795	795	26.11order of corrective action shall be binding on the Minnesota Health Plan. A decision of the
796	796	26.12ombudsman is subject to de novo review by the district court.
797	797	26.13 Subd. 6.Data.Data on enrollees collected because an enrollee submits a complaint to
798	798	26.14the ombudsman are private data on individuals as defined in section 13.02, subdivision 12,
799	799	26.15but may be released to a provider who is the subject of the complaint or to the board for
800	800	26.16purposes of this section.
801	801	26.17Sec. 11. [62X.14] AUDITOR GENERAL FOR THE MINNESOTA HEALTH PLAN.
802	802	26.18 Subdivision 1.Establishment.There is within the Office of the Legislative Auditor an
803	803	26.19auditor general for health care fraud and abuse for the Minnesota Health Plan who is
804	804	26.20appointed by the legislative auditor.
805	805	26.21 Subd. 2.Duties.The auditor general shall:
806	806	26.22 (1) investigate, audit, and review the financial and business records of the Minnesota
807	807	26.23Health Plan and the Minnesota Health Fund;
808	808	26.24 (2) investigate, audit, and review the financial and business records of individuals, public
809	809	26.25and private agencies and institutions, and private corporations that provide services or
810	810	26.26products to the Minnesota Health Plan, the costs of which are reimbursed by the Minnesota
811	811	26.27Health Plan;
812	812	26.28 (3) investigate allegations of misconduct on the part of an employee or appointee of the
813	813	26.29Minnesota Health Board and on the part of any provider of health care services that is
814	814	26.30reimbursed by the Minnesota Health Plan, and report any findings of misconduct to the
815	815	26.31attorney general;
816	816	26.32 (4) investigate fraud and abuse;
817	817	26Article 6 Sec. 11.
818	818	25-02772 as introduced01/24/25 REVISOR SGS/LJ 27.1 (5) arrange for the collection and analysis of data needed to investigate the inappropriate
819	819	27.2utilization of these products and services; and
820	820	27.3 (6) annually report recommendations for improvements to the Minnesota Health Plan
821	821	27.4to the board.
822	822	27.5 Sec. 12. [62X.15] MINNESOTA HEALTH PLAN POLICIES AND PROCEDURES;
823	823	27.6RULEMAKING.
824	824	27.7 Subdivision 1.Exempt rules.The Minnesota Health Plan policies and procedures are
825	825	27.8exempt from the Administrative Procedure Act but, to the extent authorized by law to adopt
826	826	27.9rules, the board may use the provisions of section 14.386, paragraph (a), clauses (1) and
827	827	27.10(3). Section 14.386, paragraph (b), does not apply to these rules.
828	828	27.11 Subd. 2.Rulemaking procedures.(a) Whenever the board determines that a rule should
829	829	27.12be adopted under this section establishing, modifying, or revoking a policy or procedure,
830	830	27.13the board shall publish in the State Register the proposed policy or procedure and shall
831	831	27.14afford interested persons a period of 30 days after publication to submit written data or
832	832	27.15comments.
833	833	27.16 (b) On or before the last day of the period provided for the submission of written data
834	834	27.17or comments, any interested person may file with the board written objections to the proposed
835	835	27.18rule, stating the grounds for objection and requesting a public hearing on those objections.
836	836	27.19Within 30 days after the last day for filing objections, the board shall publish in the State
837	837	27.20Register a notice specifying the policy or procedure to which objections have been filed
838	838	27.21and a hearing requested and specifying a time and place for the hearing.
839	839	27.22 Subd. 3.Rule adoption.Within 60 days after the expiration of the period provided for
840	840	27.23the submission of written data or comments, or within 60 days after the completion of any
841	841	27.24hearing, the board shall issue a rule adopting, modifying, or revoking a policy or procedure,
842	842	27.25or make a determination that a rule should not be adopted. The rule may contain a provision
843	843	27.26delaying its effective date for such period as the board determines is necessary.
844	844	27.27Sec. 13. [62X.151] EXEMPTION FROM RULEMAKING.
845	845	27.28 The board and its operation of the Minnesota Health Plan and the Minnesota Health
846	846	27.29Fund is exempt from rulemaking under chapter 14.
847	847	27Article 6 Sec. 13.
848	848	25-02772 as introduced01/24/25 REVISOR SGS/LJ 28.1 Sec. 14. Minnesota Statutes 2024, section 14.03, subdivision 3, is amended to read:
849	849	28.2 Subd. 3.Rulemaking procedures.(a) The definition of a rule in section 14.02,
850	850	28.3subdivision 4, does not include:
851	851	28.4 (1) rules concerning only the internal management of the agency or other agencies that
852	852	28.5do not directly affect the rights of or procedures available to the public;
853	853	28.6 (2) an application deadline on a form; and the remainder of a form and instructions for
854	854	28.7use of the form to the extent that they do not impose substantive requirements other than
855	855	28.8requirements contained in statute or rule;
856	856	28.9 (3) the curriculum adopted by an agency to implement a statute or rule permitting or
857	857	28.10mandating minimum educational requirements for persons regulated by an agency, provided
858	858	28.11the topic areas to be covered by the minimum educational requirements are specified in
859	859	28.12statute or rule;
860	860	28.13 (4) procedures for sharing data among government agencies, provided these procedures
861	861	28.14are consistent with chapter 13 and other law governing data practices.
862	862	28.15 (b) The definition of a rule in section 14.02, subdivision 4, does not include:
863	863	28.16 (1) rules of the commissioner of corrections relating to the release, placement, term, and
864	864	28.17supervision of inmates serving a supervised release or conditional release term, the internal
865	865	28.18management of institutions under the commissioner's control, and rules adopted under
866	866	28.19section 609.105 governing the inmates of those institutions;
867	867	28.20 (2) rules relating to weight limitations on the use of highways when the substance of the
868	868	28.21rules is indicated to the public by means of signs;
869	869	28.22 (3) opinions of the attorney general;
870	870	28.23 (4) the data element dictionary and the annual data acquisition calendar of the Department
871	871	28.24of Education to the extent provided by section 125B.07;
872	872	28.25 (5) the occupational safety and health standards provided in section 182.655;
873	873	28.26 (6) revenue notices and tax information bulletins of the commissioner of revenue;
874	874	28.27 (7) uniform conveyancing forms adopted by the commissioner of commerce under
875	875	28.28section 507.09;
876	876	28.29 (8) standards adopted by the Electronic Real Estate Recording Commission established
877	877	28.30under section 507.0945; or
878	878	28Article 6 Sec. 14.
879	879	25-02772 as introduced01/24/25 REVISOR SGS/LJ 29.1 (9) the interpretive guidelines developed by the commissioner of human services to the
880	880	29.2extent provided in chapter 245A.; or
881	881	29.3 (10) rules, policies, and procedures adopted by the Minnesota Health Board under chapter
882	882	29.462X.
883	883	29.5 ARTICLE 7
884	884	29.6 IMPLEMENTATION
885	885	29.7 Section 1. [62X.16] IMPLEMENTATION.
886	886	29.8 Subdivision 1.Prohibition.On and after the day the Minnesota Health Plan becomes
887	887	29.9operational, a health plan, as defined in section 62Q.01, subdivision 3, may not be sold in
888	888	29.10Minnesota for health services provided by the Minnesota Health Plan.
889	889	29.11 Subd. 2.Analysis; transition.(a) The commissioners of health, human services, and
890	890	29.12commerce shall prepare an analysis of the state's capital expenditure needs for the purpose
891	891	29.13of assisting the board in adopting the statewide capital budget for the year following
892	892	29.14implementation. The commissioners shall submit this analysis to the board.
893	893	29.15 (b) The following timelines shall be implemented:
894	894	29.16 (1) the commissioner of health shall designate the health planning regions utilizing the
895	895	29.17criteria specified in section 62X.07, 30 days after the date of enactment of this act;
896	896	29.18 (2) the regional boards shall be established three months after the date of enactment of
897	897	29.19this act; and
898	898	29.20 (3) the Minnesota Health Board shall be established five months after the date of
899	899	29.21enactment of this act; and
900	900	29.22 (4) the commissioner of health, or the commissioner's designee, shall convene the first
901	901	29.23meeting of each of the regional boards and the Minnesota Health Board within 30 days after
902	902	29.24each of the boards has been established.
903	903	29.25 Subd. 3.Report.Within one year of the effective date of chapter 62X, DEED shall
904	904	29.26provide to the Minnesota Health Board, the governor, and the chairs and ranking members
905	905	29.27of the legislative committees with jurisdiction over health, human services, and commerce
906	906	29.28a report spelling out the appropriations and legislation necessary to assist all affected
907	907	29.29individuals and communities through the transition.
908	908	29Article 7 Section 1.
909	909	25-02772 as introduced01/24/25 REVISOR SGS/LJ 30.1 Sec. 2. APPROPRIATION.
910	910	30.2 $....... in fiscal year 2026 is appropriated from the general fund to the Minnesota Health
911	911	30.3Fund under the Minnesota Health Plan to provide start-up funding for the provisions of
912	912	30.4Minnesota Statutes, chapter 62X.
913	913	30.5 Sec. 3. EFFECTIVE DATE AND TRANSITION.
914	914	30.6 Subdivision 1.Effective date.This act is effective the day following final enactment.
915	915	30.7The commissioner of management and budget and the chief executive officer of the
916	916	30.8Minnesota Health Plan shall regularly update the legislature on the status of planning,
917	917	30.9implementation, and financing of this act.
918	918	30.10 Subd. 2.Timing to implement.The Minnesota Health Plan must be operational within
919	919	30.11two years from the date of final enactment of this act.
920	920	30Article 7 Sec. 3.
921	921	25-02772 as introduced01/24/25 REVISOR SGS/LJ Page.Ln 1.12MINNESOTA HEALTH PLAN.............................................................ARTICLE 1
922	922	Page.Ln 3.1ELIGIBILITY.........................................................................................ARTICLE 2
923	923	Page.Ln 4.21BENEFITS..............................................................................................ARTICLE 3
924	924	Page.Ln 7.11FUNDING..............................................................................................ARTICLE 4
925	925	Page.Ln 12.10PAYMENTS...........................................................................................ARTICLE 5
926	926	Page.Ln 13.21GOVERNANCE.....................................................................................ARTICLE 6
927	927	Page.Ln 29.5IMPLEMENTATION.............................................................................ARTICLE 7
928	928	1
929	929	APPENDIX
930	930	Article locations for 25-02772