HF 3543

as introduced - 90th Legislature (2017 - 2018) Posted on 04/16/2018 04:05pm

A bill for an act
relating to insurance; health; modifying funding for MNsure operations and
authority of MNsure to certify health carriers and health plans; requiring submission
of federal waivers and approvals by certain deadline; placing limitations on
risk-bearing by commissioner of human services; amending Minnesota Statutes
2016, section 62V.05, subdivisions 2, 5, 10; Laws 2015, chapter 71, article 12,
section 8.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2016, section 62V.05, subdivision 2, is amended to read:

Subd. 2.

Operations funding.

deleted text begin (a) Prior to January 1, 2015, MNsure shall retain or collect
up to 1.5 percent of total premiums for individual and small group market health plans and
dental plans sold through MNsure to fund the cash reserves of MNsure, but the amount
collected shall not exceed a dollar amount equal to 25 percent of the funds collected under
section 62E.11, subdivision 6, for calendar year 2012.
deleted text end

deleted text begin (b) Beginning January 1, 2015, MNsure shall retain or collect up to 3.5 percent of total
premiums for individual and small group market health plans and dental plans sold through
MNsure to fund the operations of MNsure, but the amount collected shall not exceed a
dollar amount equal to 50 percent of the funds collected under section 62E.11, subdivision
6, for calendar year 2012.
deleted text end

deleted text begin (c) deleted text end new text begin (a) new text end Beginning January 1, 2016, new text begin through December 31, 2018, new text end MNsure shall retain or
collect up to 3.5 percent of total premiums for individual and small group market health
plans and dental plans sold through MNsure to fund the operations of MNsure, but the
amount collected may never exceed a dollar amount greater than 100 percent of the funds
collected under section 62E.11, subdivision 6, for calendar year 2012.

deleted text begin (d) For fiscal years 2014 and 2015, the commissioner of management and budget is
authorized to provide cash flow assistance of up to $20,000,000 from the special revenue
fund or the statutory general fund under section 16A.671, subdivision 3, paragraph (a), to
MNsure. Any funds provided under this paragraph shall be repaid, with interest, by June
30, 2015.
deleted text end

new text begin (b) Beginning January 1, 2019, MNsure shall retain or collect up to two percent of total
premiums for individual and small group health plans and dental plans sold through MNsure
to fund the operations of MNsure, but the amount collected may never exceed a dollar
amount greater than 25 percent of the funds collected under section 62E.11, subdivision 6,
for calendar year 2012.
new text end

deleted text begin (e) deleted text end new text begin (c) new text end Funding for the operations of MNsure shall cover any compensation provided to
navigators participating in the navigator program.

new text begin (d) Interagency agreements between MNsure and the Department of Human Services,
and the Public Assistance Cost Allocation Plan for the Department of Human Services,
shall not be modified to reflect any changes to the percentage of premiums that MNsure is
allowed to retain or collect under this section, and no additional funding shall be transferred
from the Department of Human Services to MNsure as a result of any changes to the
percentage of premiums that MNsure is allowed to retain or collect under this section.
new text end

Sec. 2.

Minnesota Statutes 2016, section 62V.05, subdivision 5, is amended to read:

Subd. 5.

Health carrier and health plan requirements; participation.

(a) Beginning
January 1, 2015, the board may establish certification requirements for health carriers and
health plans to be offered through MNsure that satisfy federal requirements under deleted text begin section
1311(c)(1) of the Affordable Care Act, Public Law 111-148 deleted text end new text begin United States Code, title 42,
section 18031(c)(1) new text end .

(b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory
requirements that:

(1) apply uniformly to all health carriers and health plans in the individual market;

(2) apply uniformly to all health carriers and health plans in the small group market; and

(3) satisfy minimum federal certification requirements under deleted text begin section 1311(c)(1) of the
Affordable Care Act, Public Law 111-148 deleted text end new text begin United States Code, title 42, section 18031(c)(1) new text end .

(c) In accordance with deleted text begin section 1311(e) of the Affordable Care Act, Public Law 111-148 deleted text end new text begin
United States Code, title 42, section 18031(e) new text end , the board shall establish policies and
procedures for certification and selection of health plans to be offered as qualified health
plans through MNsure. The board shall certify and select a health plan as a qualified health
plan to be offered through MNsure, if:

(1) the health plan meets the minimum certification requirements established in paragraph
(a) or the market regulatory requirements in paragraph (b);

(2) the board determines that making the health plan available through MNsure is in the
interest of qualified individuals and qualified employers;

(3) the health carrier applying to offer the health plan through MNsure also applies to
offer health plans at each actuarial value level and service area that the health carrier currently
offers in the individual and small group markets; and

(4) the health carrier does not apply to offer health plans in the individual and small
group markets through MNsure under a separate license of a parent organization or holding
company under section 60D.15, that is different from what the health carrier offers in the
individual and small group markets outside MNsure.

(d) In determining the interests of qualified individuals and employers under paragraph
(c), clause (2), the board may not exclude a health plan for any reason specified under deleted text begin section
1311(e)(1)(B) of the Affordable Care Act, Public Law 111-148 deleted text end new text begin United States Code, title
42, section 18031(e)(1)(B) new text end . deleted text begin The board may consider:
deleted text end

deleted text begin (1) affordability;
deleted text end

deleted text begin (2) quality and value of health plans;
deleted text end

deleted text begin (3) promotion of prevention and wellness;
deleted text end

deleted text begin (4) promotion of initiatives to reduce health disparities;
deleted text end

deleted text begin (5) market stability and adverse selection;
deleted text end

deleted text begin (6) meaningful choices and access;
deleted text end

deleted text begin (7) alignment and coordination with state agency and private sector purchasing strategies
and payment reform efforts; and
deleted text end

deleted text begin (8) other criteria that the board determines appropriate.
deleted text end

new text begin (e) A health plan that meets the minimum certification requirements under paragraph
(c) and United States Code, title 42, section 18031(c)(1), and any regulations and guidance
issued under that section, is deemed to be in the interest of qualified individuals and qualified
employers. The board shall not establish certification requirements for health carriers and
health plans for participation in MNsure that are in addition to the certification requirements
under paragraph (c) and United States Code, title 42, section 18031(c)(1), and any regulations
and guidance issued under that section. The board shall not determine the cost of, cost-sharing
elements of, or benefits provided in health plans sold through MNsure.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end For qualified health plans offered through MNsure on or after January 1, 2015,
the board shall establish policies and procedures under paragraphs (c) and (d) for selection
of health plans to be offered as qualified health plans through MNsure by February 1 of
each year, beginning February 1, 2014. The board shall consistently and uniformly apply
all policies and procedures and any requirements, standards, or criteria to all health carriers
and health plans. For any policies, procedures, requirements, standards, or criteria that are
defined as rules under section 14.02, subdivision 4, the board may use the process described
in subdivision 9.

deleted text begin (f) For 2014, the board shall not have the power to select health carriers and health plans
for participation in MNsure. The board shall permit all health plans that meet the certification
requirements under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148, to
be offered through MNsure.
deleted text end

(g) Under this subdivision, the board shall have the power to verify that health carriers
and health plans are properly certified to be eligible for participation in MNsure.

(h) The board has the authority to decertify health carriers and health plans that fail to
maintain compliance with deleted text begin section 1311(c)(1) of the Affordable Care Act, Public Law 111-148 deleted text end new text begin
United States Code, title 42, section 18031(c)(1) new text end .

(i) For qualified health plans offered through MNsure beginning January 1, 2015, health
carriers must use the most current addendum for Indian health care providers approved by
the Centers for Medicare and Medicaid Services and the tribes as part of their contracts with
Indian health care providers. MNsure shall comply with all future changes in federal law
with regard to health coverage for the tribes.

Sec. 3.

Minnesota Statutes 2016, section 62V.05, subdivision 10, is amended to read:

Subd. 10.

Limitations; risk-bearing.

(a) The board shall not bear insurance risk or enter
into any agreement with health care providers to pay claims.

(b) Nothing in this subdivision shall prevent MNsure from providing insurance for its
employees.

new text begin (c) The commissioner of human services shall not bear insurance risk or enter into any
agreement with providers to pay claims for any health coverage administered by the
commissioner that is made available for purchase through the MNsure Web site as an
alternative to purchasing a qualifying health plan through MNsure or an individual health
plan offered outside of MNsure.
new text end

new text begin (d) Nothing in this subdivision shall prohibit:
new text end

new text begin (1) the commissioner of human services from administering the medical assistance
program under chapter 256B and the MinnesotaCare program under chapter 256L, as long
as health coverage under these programs is not purchased by the individual through the
MNsure Web site; and
new text end

new text begin (2) employees of the Department of Human Services from obtaining insurance from the
state employee group insurance program.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4.

Laws 2015, chapter 71, article 12, section 8, is amended to read:

Sec. 8. EXPANDED ACCESS TO QUALIFIED HEALTH PLANS AND
SUBSIDIES.

The commissioner of commerce, in consultation with the Board of Directors of MNsure
and the MNsure Legislative Oversight Committee, shall develop a proposal to allow
individuals to purchase qualified health plans outside of MNsure directly from health plan
companies and to allow eligible individuals to receive advanced premium tax credits and
cost-sharing reductions when purchasing these health plans. The commissioner shall seek
all federal waivers and approvals necessary to implement this proposal new text begin and shall submit the
necessary federal waivers and approvals to the federal government no later than July 1,
2018 new text end . The commissioner shall submit a draft proposal to the MNsure board and the MNsure
Legislative Oversight Committee deleted text begin at least 30 days before submitting a final proposal to the
federal government deleted text end new text begin no later than June 1, 2018, new text end and shall notify the board and legislative
oversight committee of any federal decision or action related to the proposal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 5. new text begin RATES FOR INDIVIDUAL MARKET HEALTH AND DENTAL PLANS
FOR 2019.
new text end

new text begin (a) Health carriers must take into account the reduction in the premium withhold
percentage under Minnesota Statutes, section 62V.05, subdivision 2, applicable beginning
in calendar year 2019 for individual market health plans and dental plans sold through
MNsure when setting rates for individual market health plans and dental plans for calendar
year 2019.
new text end

new text begin (b) For purposes of this section, "dental plan," "health carrier," "health plan," and
"individual market" have the meanings given in Minnesota Statutes, section 62V.02.
new text end