SF 2441

as introduced - 87th Legislature (2011 - 2012) Posted on 03/21/2012 01:28pm

A bill for an act
relating to insurance; creating the Minnesota Health Benefits Exchange and
specifying its functions and duties; proposing coding for new law as Minnesota
Statutes, chapter 62V.

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

Section 1.

new text begin [62V.01] CITATION.
new text end

new text begin This act must be known and may be cited as the Minnesota Health Benefits Act.
new text end

Sec. 2.

new text begin [62V.02] PURPOSE.
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new text begin It is the intent of the legislature to create a Minnesota Health Benefits Exchange
for the purposes of improving the health of Minnesotans, providing individuals and
small businesses with a variety of high-quality health insurance options that fit their
needs, streamlining public programs in Minnesota to assure ease of accessibility and
full continuity of coverage, and ensuring that individuals who will be eligible for health
insurance coverage and financial assistance through the exchange obtain that coverage and
assistance to the fullest extent possible under the Minnesota Health Benefits Exchange.
new text end

Sec. 3.

new text begin [62V.03] DEFINITIONS.
new text end

new text begin (a) For purposes of this chapter, the terms defined in this section have the meanings
given.
new text end

new text begin (b) "Advisory committee" means those advisory committees established by the
board as specified under section 62V.06, paragraph (d), clauses (12) and (13).
new text end

new text begin (c) "Board" means the board of directors as specified under section 62V.05.
new text end

new text begin (d) "Commissioner" means the commissioner of commerce for health plans or health
plan companies regulated by that commissioner and the commissioner of health for health
plans or health plan companies regulated by that commissioner.
new text end

new text begin (e) "Exchange" means the Minnesota Health Benefits Exchange created in this act.
new text end

new text begin (f) "Federal act" means the federal Patient Protection and Affordable Care Act,
Public Law 111-148, as amended by the federal Health Care and Education Reconciliation
Act of 2010, Public Law 111-152, and any amendments thereto, or regulations or guidance
issued thereunder.
new text end

new text begin (g) "Health plan company" has the meaning given in section 62Q.01, subdivision 4.
new text end

new text begin (h) "No-wrong-door policy" means a policy that provides a system for individuals
seeking coverage that will ensure: (1) access to the exchange through multiple entry points
that are culturally and linguistically appropriate for all populations served; (2) screenings
for all available public and private health coverage options and any state public benefit
programs or public services; and (3) an enrollment process that does not require additional
application forms or multiple eligibility determinations for each program or plan.
new text end

new text begin (i) "Secretary" means the United States Secretary of Health and Human Services.
new text end

Sec. 4.

new text begin [62V.04] ESTABLISHMENT OF EXCHANGE.
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new text begin (a) The Minnesota Health Benefits Exchange is established as an independent public
entity under section 15.012, paragraph (a).
new text end

new text begin (b) The exchange shall pursue available federal funding for operation of the
exchange and shall promulgate rules necessary to obtain federal recognition of the
exchange as a certified exchange under the federal act.
new text end

new text begin (c) The exchange may accept gifts, grants, and bequests, contract with other persons,
and enter into memoranda of understanding with other governmental agencies to carry
out any of its functions, including agreements with other states to perform administrative
functions.
new text end

new text begin (d) The exchange may enter into information-sharing agreements with federal and
state agencies and other state exchanges to carry out its responsibilities under this act,
provided such agreements include adequate protections with respect to the confidentiality
of the information to be shared and comply with all state and federal laws and regulations.
Notwithstanding any law to the contrary, the exchange shall have access to private
and nonpublic data on providers, health carriers, and third-party administrators that is
maintained by the commissioners of health and commerce and needed by the exchange for
risk adjustment, monitoring adverse selection, and health plan quality. The definitions
in section 13.02 apply to data practices by the exchange.
new text end

new text begin (e) The exchange shall be subject to review by the legislative auditor under section
3.971.
new text end

Sec. 5.

new text begin [62V.05] EXCHANGE BOARD OF DIRECTORS.
new text end

new text begin (a) The operation of the exchange shall be governed by a board of directors.
new text end

new text begin (b) The board shall consist of 19 members. Initial members of the board shall serve
staggered terms not to exceed four years. Members appointed thereafter shall serve
three-year terms.
new text end

new text begin (c) The board membership shall reflect the diversity of individuals who receive
coverage through the exchange, including diversity of ethnicity, geography, and gender,
and consist of the following:
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new text begin (1) four members shall represent the interests of individual consumers served by the
exchange. Those members shall be appointed by the governor;
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new text begin (2) four members shall represent the interests of individual consumers, small
business employees, and small employers, with at least one seat for each of the
three categories. The Subcommittee on Committees of the Committee on Rules and
Administration of the senate shall appoint one member recommended by the majority and
one member recommended by the minority, and the speaker of the house shall appoint one
member recommended by the majority and one member recommended by the minority;
new text end

new text begin (3) four members shall have demonstrated expertise and knowledge in the areas
of public health, health disparities, health care administration and finance, health
benefits administration, health plan purchasing, or health policy issues. The governor,
commissioner of human services, commissioner of health, and commissioner of commerce
shall each appoint one member;
new text end

new text begin (4) four members shall demonstrate knowledge of and experience with the
health care needs of underserved or low-income populations, Minnesota Indian tribes,
mental health and substance abuse, individuals with disabilities, children or youth, or
health-related disorders or illnesses. Those members shall be appointed by the governor;
new text end

new text begin (5) the commissioner of commerce;
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new text begin (6) the commissioner of health; and
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new text begin (7) the commissioner of human services.
new text end

new text begin (d) Section 15.0597 applies to all appointments, except the commissioners.
new text end

new text begin (e) No board member may be appointed if the person's participation in the decisions
of the board could benefit the person's own financial interests or the financial interests of
an entity the person represents. No board member may be or become affiliated with the
health insurance or plan industry, including agents or brokers, employees, representatives,
consultants to or members of the board of directors of either industry.
new text end

new text begin (f) A board member who develops an affiliation or a conflict of interest prohibited
under this section shall act in accordance with section 10A.07 and proceed with resignation
voluntarily or be removed from the board. Removal from the board in such circumstances
shall be provided following notice, a hearing, and a two-thirds vote of the board.
new text end

new text begin (g) All board members, officers, or employees are subject to section 10A.071.
new text end

new text begin (h) Board members may be compensated in accordance with section 15.0575.
new text end

new text begin (i) All meetings of the board shall comply with the open meeting law in chapter 13D,
except meetings regarding labor negotiations and contract negotiations at the discretion
of the board and meetings regarding private, not public, nonpublic, or trade-secret
information or data.
new text end

new text begin (j) A board member, an officer, or an employee of the exchange is not liable for
an act or omission when acting in the person's official capacity in connection with the
administration, management, or conduct of this act if the act or omission was conducted in
good faith and without the intent to defraud.
new text end

Sec. 6.

new text begin [62V.06] DUTIES OF THE EXCHANGE.
new text end

new text begin (a) In partnership with the Departments of Commerce, Health, and Human Services,
the exchange shall operate a consumer-friendly marketplace that provides consumers with
the ability to choose among qualified insurance products, facilitates enrollment in certified
health plans, administers financial assistance to those who are eligible, negotiates with
health plans to achieve high value for consumers, and achieves goals of reducing health
disparities, generating health equity, and ensuring improved health for Minnesotans.
new text end

new text begin (b) The exchange shall also fulfill the requirements under the federal act, including
any related amendments, regulations, or guidance.
new text end

new text begin (c) Laws governing public agencies apply to the exchange unless otherwise specified
in this act.
new text end

new text begin (d) To fulfill these duties, the exchange shall perform, but not be limited to, the
following:
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new text begin (1) implement procedures for the certification, recertification, and decertification,
consistent with guidelines developed by the secretary under section 1311, paragraph (c),
of the federal act, of health benefit plans as qualified health plans, as well as additional
guidelines established by the exchange board;
new text end

new text begin (2) base certification of a health benefit plan on requirements promulgated by the
secretary under section 1311, paragraph (c), of the federal act, as well as additional
standards promulgated by the exchange that shall include the achievement of goals for
health outcomes, network adequacy, essential community providers in underserved
areas, accreditation, uniform enrollment forms and descriptions of coverage, and other
standards promulgated by the exchange. The exchange shall further determine whether
making the plan available through the exchange is in the interest of qualified individuals
and employers in this state. The exchange shall not exclude a health benefit plan on the
basis that the plan is a fee-for-service plan;
new text end

new text begin (3) be active as an active purchaser to negotiate with health plan companies to obtain
the optimal combination of price and quality for plans offered through the exchange;
new text end

new text begin (4) maintain an Internet Web site through which enrollees and prospective enrollees
of qualified health plans may obtain standardized comparative information on such plans;
new text end

new text begin (5) assign a rating to each qualified health plan offered through the exchange in
accordance with the criteria developed by the secretary under section 1311, paragraph (c),
clause (3), of the federal act, as well as additional standards promulgated by the exchange,
and determine each qualified health plan's level of coverage according to regulations
issued by the secretary under section 1302, paragraph (d), clause (2), subitem (A), of
the federal act;
new text end

new text begin (6) use a standardized format for presenting health benefit options in the exchange,
including the use of the uniform outline of coverage established under section 2715 of the
federal Public Health Services Act;
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new text begin (7) in accordance with section 1413 of the federal act, inform individuals of
eligibility requirements for the Medicaid program under title XIX of the Social Security
Act, the Children's Health Insurance Program (CHIP) under title XXI of the Social
Security Act, or any applicable state or local public program, and if through screening of
the application by the exchange, the exchange determines that any individual is eligible for
any such program, enroll or arrange for the enrollment of that individual in that program.
The exchange shall serve as a portal for individuals who may be eligible for those other
public programs to initiate eligibility determination and enrollment in them;
new text end

new text begin (8) perform duties required of the exchange by the secretary or the United States
secretary of the treasury related to determining eligibility for premium tax credits, reduced
cost-sharing, or individual responsibility requirement exemptions;
new text end

new text begin (9) select entities qualified to serve as navigators in accordance with section 1311,
paragraph (i), of the federal act, and standards developed by the secretary, provided
that the navigators must be employed by nonprofit community organizations that have
experience working with low-income and uninsured populations;
new text end

new text begin (10) establish a no-wrong-door policy for the exchange with a protocol for
monitoring and evaluating the effectiveness of the policy on access to the exchange;
new text end

new text begin (11) develop strategies to prevent adverse selection and report on those strategies to
the board;
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new text begin (12) create an advisory committee of experts, consisting of five members with
demonstrated and acknowledged expertise in health insurance, actuarial science, adverse
selection and risk management, or benefit plan administration to allow for the views and
expertise of the health care industry and other stakeholders to be heard in the operation of
the exchange;
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new text begin (13) establish other advisory committees to seek technical advice or expertise when
necessary to execute the powers and duties included in this act;
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new text begin (14) consult with the Indian Affairs Council, established under section 3.922, to
assist with access to, enrollment in, and coverage through the exchange; and
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new text begin (15) submit a report to the legislature by March 15, 2013, on the progress of
establishing the exchange in accordance with this chapter, and an annual report by January
15 of each year thereafter, that includes a report on the performance of the exchange
operations and on meeting the exchange duties, health outcome goals, and an accounting
of the marketplace budget activities.
new text end

Sec. 7.

new text begin [62V.07] RULES.
new text end

new text begin The exchange may adopt rules to implement the provisions of this act. Rules
adopted under this section must not conflict with or prevent the application of rules
adopted by the secretary under the federal act.
new text end

Sec. 8.

new text begin [62V.08] FAIR HEARING.
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new text begin Any person aggrieved by a decision of the exchange about eligibility for any public
program or aggrieved by a subsidy determination by the exchange shall have the right
to a fair hearing under section 256.045.
new text end

Sec. 9.

new text begin [62V.09] RELATION TO OTHER LAWS.
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new text begin Nothing in this act, and no action taken by the exchange under this act, shall be
construed to preempt or supersede the authority of the commissioner to regulate the
business of insurance within this state. Except as expressly provided to the contrary in this
act, all health plan companies offering qualified health plans in this state shall comply
fully with all applicable health insurance laws of this state and regulations adopted and
orders issued by the commissioner.
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Sec. 10. new text begin EFFECTIVE DATE.
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new text begin This act is effective the day following final enactment for purposes of preparing to
carry out the exchange's duties, provided that no health coverage provided under it may be
effective prior to January 1, 2014.
new text end