HF 1129

as introduced - 90th Legislature (2017 - 2018) Posted on 02/13/2017 12:23pm

A bill for an act
relating to insurance; making the state of Minnesota a single geographic rating
area for individual health plans; allowing enrollees access to out-of-network referral
centers; amending Minnesota Statutes 2016, section 62A.65, subdivision 3;
proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

Minnesota Statutes 2016, section 62A.65, subdivision 3, is amended to read:

Subd. 3.

Premium rate restrictions.

No individual health plan may be offered, sold,
issued, or renewed to a Minnesota resident unless the premium rate charged is determined
in accordance with the following requirements:

(a) Premium rates may vary based upon the ages of covered persons in accordance with
the provisions of the Affordable Care Act.

deleted text begin (b) Premium rates may vary based upon geographic rating area. The commissioner shall
grant approval if the following conditions are met:
deleted text end

deleted text begin (1) the areas are established in accordance with the Affordable Care Act;
deleted text end

deleted text begin (2) each geographic region must be composed of no fewer than seven counties that create
a contiguous region; and
deleted text end

deleted text begin (3) the health carrier provides actuarial justification acceptable to the commissioner for
the proposed geographic variations in premium rates for each area, establishing that the
variations are based upon differences in the cost to the health carrier of providing coverage.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Premium rates may vary based upon tobacco use, in accordance with the provisions
of the Affordable Care Act.

deleted text begin (d) deleted text end new text begin (c) new text end In developing its premiums for a health plan, a health carrier shall take into
account only deleted text begin the following factors:
deleted text end

deleted text begin (1) deleted text end actuarially valid differences in rating factors permitted under paragraphs (a) and deleted text begin (c);
and deleted text end new text begin (b).
new text end

deleted text begin (2) actuarially valid geographic variations if approved by the commissioner as provided
in paragraph (b).
deleted text end

new text begin (d) The state of Minnesota shall constitute a single geographic rating area for purposes
of setting premium rates.
new text end

(e) The premium charged with respect to any particular individual health plan shall not
be adjusted more frequently than annually or January 1 of the year following initial
enrollment, except that the premium rates may be changed to reflect:

(1) changes to the family composition of the policyholder;

deleted text begin (2) changes in geographic rating area of the policyholder, as provided in paragraph (b);
deleted text end

deleted text begin (3) deleted text end new text begin (2) new text end changes in age, as provided in paragraph (a);

deleted text begin (4) deleted text end new text begin (3) new text end changes in tobacco use, as provided in paragraph deleted text begin (c) deleted text end new text begin (b) new text end ;

deleted text begin (5) deleted text end new text begin (4) new text end transfer to a new health plan requested by the policyholder; or

deleted text begin (6) deleted text end new text begin (5) new text end other changes required by or otherwise expressly permitted by state or federal
law or regulations.

(f) All premium variations must be justified in initial rate filings and upon request of
the commissioner in rate revision filings. All rate variations are subject to approval by the
commissioner.

(g) The loss ratio must comply with the section 62A.021 requirements for individual
health plans.

(h) The rates must not be approved, unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the commissioner shall consider the
growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar year
or years that the proposed premium rate would be in effect and actuarially valid changes in
risks associated with the enrollee populations.

(i) A health carrier may, as part of a minimum lifetime loss ratio guarantee filing under
section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
paragraph. The rating practices guarantee must be in writing and must guarantee that the
policy form will be offered, sold, issued, and renewed only with premium rates and premium
rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices guarantee
must be accompanied by an actuarial memorandum that demonstrates that the premium
rates and premium rating system used in connection with the policy form will satisfy the
guarantee. The guarantee must guarantee refunds of any excess premiums to policyholders
charged premiums that exceed those permitted under subdivision 2, 3, 4, or 5. A health
carrier that complies with this paragraph in connection with a policy form is exempt from
the requirement of prior approval by the commissioner under paragraphs deleted text begin (b), deleted text end (f) deleted text begin , deleted text end and (h).

(j) The commissioner may establish regulations to implement the provisions of this
subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans offered, issued, or
renewed on or after January 1, 2018.
new text end

Sec. 2.

new text begin [62Q.581] ACCESS TO OUT-OF-NETWORK REFERRAL CENTER.
new text end

new text begin Subdivision 1. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "out-of-network referral center"
means a referral center that is not part of a health plan company's network and is:
new text end

new text begin (1) a hospital operated at two campus locations in Rochester, Minnesota, and owned
and operated by a health system that has its principal place of business in Rochester,
Minnesota;
new text end

new text begin (2) a clinic or physician practice for physicians who practice at one or both of the hospital
campus locations in clause (1);
new text end

new text begin (3) a hospital or children's hospital owned by a health system and affiliated with the
University of Minnesota; or
new text end

new text begin (4) a nonprofit clinical practice organization for the faculty of the University of Minnesota
School of Medicine.
new text end

new text begin Subd. 2. new text end

new text begin Enrollee access. new text end

new text begin (a) A health plan company must allow an enrollee to request
access to an out-of-network referral center, at in-network cost sharing, including any
deductible, co-pay, or coinsurance, where there is a clinical need identified by the enrollee's
referring provider and there are no available in-network referral centers for that clinical
need.
new text end

new text begin (b) A health plan company must review requests and make a determination of whether
an enrollee may access an out-of-network referral center within 72 hours for urgent care,
and within 15 calendar days for nonurgent care. If no contractual arrangement exists between
the health plan company and out-of-network referral center, the health plan company shall
reimburse the out-of-network referral center at a rate determined by the amounts generally
billed calculation for the services rendered in section 501(r)(5) of the Internal Revenue Code
of 1986, as amended through December 31, 2016.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans offered, issued, or
renewed on or after January 1, 2018.
new text end