HF 3162

as introduced - 91st Legislature (2019 - 2020) Posted on 03/02/2020 04:22pm

A bill for an act
relating to health care; providing an alternative mechanism for prompt payment
of emergency room and ambulance charges incurred by patients enrolled in very
high deductible health plans; amending Minnesota Statutes 2018, sections 60A.23,
subdivision 8; 62Q.01, by adding a subdivision; 62Q.025, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2018, section 60A.23, subdivision 8, is amended to read:

Subd. 8.

Self-insurance or insurance plan administrators who are vendors of risk
management services.

(1) Scope. This subdivision applies to any vendor of risk management
services and to any entity which administers, for compensation, a self-insurance or insurance
plan. This subdivision does not apply (a) to an insurance company authorized to transact
insurance in this state, as defined by section 60A.06, subdivision 1, clauses (4) and (5); (b)
to a service plan corporation, as defined by section 62C.02, subdivision 6; (c) to a health
maintenance organization, as defined by section 62D.02, subdivision 4; (d) to an employer
directly operating a self-insurance plan for its employees' benefits; (e) to an entity which
administers a program of health benefits established pursuant to a collective bargaining
agreement between an employer, or group or association of employers, and a union or
unions; or (f) to an entity which administers a self-insurance or insurance plan if a licensed
Minnesota insurer is providing insurance to the plan and if the licensed insurer has appointed
the entity administering the plan as one of its licensed agents within this state.

(2) Definitions. For purposes of this subdivision the following terms have the meanings
given them.

(a) "Administering a self-insurance or insurance plan" means (i) processing, reviewing
or paying claims, (ii) establishing or operating funds and accounts, or (iii) otherwise providing
necessary administrative services in connection with the operation of a self-insurance or
insurance plan.

(b) "Employer" means an employer, as defined by section 62E.02, subdivision 2.

(c) "Entity" means any association, corporation, partnership, sole proprietorship, trust,
or other business entity engaged in or transacting business in this state.

(d) "Self-insurance or insurance plan" means a plan for the benefit of employees or
members of an association providing life, medical or hospital care, accident, sickness or
disability insurance, or pharmacy benefits, or a plan providing liability coverage for any
other risk or hazard, which is or is not directly insured or provided by a licensed insurer,
service plan corporation, or health maintenance organization.

(e) "Vendor of risk management services" means an entity providing for compensation
actuarial, financial management, accounting, legal or other services for the purpose of
designing and establishing a self-insurance or insurance plan for an employer.

(3) License. No vendor of risk management services or entity administering a
self-insurance or insurance plan may transact this business in this state unless it is licensed
to do so by the commissioner. An applicant for a license shall state in writing the type of
activities it seeks authorization to engage in and the type of services it seeks authorization
to provide. The license may be granted only when the commissioner is satisfied that the
entity possesses the necessary organization, background, expertise, and financial integrity
to supply the services sought to be offered. The commissioner may issue a license subject
to restrictions or limitations upon the authorization, including the type of services which
may be supplied or the activities which may be engaged in. The license fee is $1,500 for
the initial application and $1,500 for each three-year renewal. All licenses are for a period
of three years.

(4) Regulatory restrictions; powers of the commissioner. To assure that self-insurance
or insurance plans are financially solvent, are administered in a fair and equitable fashion,
and are processing claims and paying benefits in a prompt, fair, and honest manner, vendors
of risk management services and entities administering insurance or self-insurance plans
are subject to the supervision and examination by the commissioner. Vendors of risk
management services, entities administering insurance or self-insurance plans, and insurance
or self-insurance plans established or operated by them are subject to the trade practice
requirements of sections 72A.19 to 72A.30. In lieu of an unlimited guarantee from a parent
corporation for a vendor of risk management services or an entity administering insurance
or self-insurance plans, the commissioner may accept a surety bond in a form satisfactory
to the commissioner in an amount equal to 120 percent of the total amount of claims handled
by the applicant in the prior year. If at any time the total amount of claims handled during
a year exceeds the amount upon which the bond was calculated, the administrator shall
immediately notify the commissioner. The commissioner may require that the bond be
increased accordingly.

No contract entered into after July 1, 2001, between a licensed vendor of risk management
services and a group authorized to self-insure for workers' compensation liabilities under
section 79A.03, subdivision 6, may take effect until it has been filed with the commissioner,
and either (1) the commissioner has approved it or (2) 60 days have elapsed and the
commissioner has not disapproved it as misleading or violative of public policy.

new text begin An entity administering an insurance plan that consists of, includes, or is connected with
a very high deductible health plan (VHDHP), as defined in section 62Q.01, subdivision 8,
must comply with section 62Q.025, subdivision 3. This applies to an entity that is either:
new text end

new text begin (a) acting pursuant to an assumption of responsibility under section 62Q.025, subdivision
3, paragraph (b); or
new text end

new text begin (b) performing under a contract subject to this subdivision.
new text end

new text begin The entity is prohibited from entering into any contractual relationship or performing
any service in connection with a VHDHP that does not by its terms require compliance with
section 62Q.025, subdivision 3, either by the health plan company or by an entity
administering the insurance plan under this subdivision.
new text end

(5) Rulemaking authority. To carry out the purposes of this subdivision, the
commissioner may adopt rules pursuant to sections 14.001 to 14.69. These rules may:

(a) establish reporting requirements for administrators of insurance or self-insurance
plans;

(b) establish standards and guidelines to assure the adequacy of financing, reinsuring,
and administration of insurance or self-insurance plans;

(c) establish bonding requirements or other provisions assuring the financial integrity
of entities administering insurance or self-insurance plans; or

(d) establish other reasonable requirements to further the purposes of this subdivision.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2020, and applies to very high
deductible health plans offered, issued, sold, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62Q.01, is amended by adding a subdivision to
read:

new text begin Subd. 8. new text end

new text begin Very high deductible health plan or VHDHP. new text end

new text begin "Very high deductible health
plan" or "VHDHP" means a high deductible health plan that has an annual maximum
out-of-pocket expense that exceeds $3,000 for individual coverage or $6,000 for family
coverage.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2020, and applies to very high
deductible health plans offered, issued, sold, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2018, section 62Q.025, is amended by adding a subdivision to
read:

new text begin Subd. 3. new text end

new text begin Payment of emergency and ambulance charges. new text end

new text begin (a) A very high deductible
health plan and a health plan company that issues a very high deductible health plan are
subject to this subdivision as a condition of issuing a VHDHP under subdivisions 1 and 2.
new text end

new text begin (b) A health plan company may contract with an entity administering an insurance plan,
as defined in section 60A.23, subdivision 8, to assume the health plan company's duties and
limitations under this subdivision. The health plan company retains ultimate responsibility
for compliance with this subdivision.
new text end

new text begin (c) If an enrollee in a plan described in paragraph (a) incurs charges for care provided
in a hospital emergency room or for ambulance service, as defined in section 144E.001,
subdivision 3, that are not payable under the plan at the time due to the enrollee not having
satisfied the annual deductible, the VHDHP must require the health plan company that
issued the VHDHP to pay those charges directly to the hospital or ambulance service licensee,
as defined in section 144E.001, subdivision 8, within 15 days after receiving notice from
the hospital or ambulance service licensee that the enrollee has not paid the charges within
30 days after the date of treatment.
new text end

new text begin (d) A health plan company that complies with paragraph (c) may seek and obtain from
the enrollee reimbursement for payments made under paragraph (c). The health plan
company's collection procedures must comply with the same restrictions that would have
applied to the health care provider when collecting the charges from the patient. Upon
written request by the health plan company, the hospital or ambulance service licensee must
inform the health plan company in writing of any special restrictions regarding collection
procedures the provider is subject to, whether originating under contract or other agreement,
law, or otherwise. A health plan company is prohibited from canceling, terminating,
suspending, nonrenewing, or otherwise limiting or reducing an enrollee's coverage, or
coverage of the enrollee's family, as a means of collection or as a penalty for failure to
reimburse the health plan company for a payment made under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective August 1, 2020, and applies to very high
deductible health plans offered, issued, sold, or renewed on or after that date.
new text end