HF 3611

as introduced - 86th Legislature (2009 - 2010) Posted on 03/10/2010 03:38pm

A bill for an act
relating to health; regulating flexible benefits plans; providing for primary
care provider tiering; amending Minnesota Statutes 2008, section 256B.0754,
by adding subdivisions; proposing coding for new law in Minnesota Statutes,
chapter 62L; repealing Minnesota Statutes 2008, section 62L.056.

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

Section 1.

new text begin [62L.0561] FLEXIBLE BENEFITS PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For the purposes of this section, the terms used in this
section have the meanings given in section 62Q.01, except that "health plan" includes
individual and group coverage.
new text end

new text begin Subd. 2. new text end

new text begin Flexible benefits plan. new text end

new text begin Notwithstanding any provision of this chapter,
chapter 363A, or any other law to the contrary, a health plan company may offer, sell,
issue, and renew a health plan that is a flexible benefits plan under this section if the
following requirements are satisfied:
new text end

new text begin (1) the health plan must be offered in compliance with the laws of this state, except
as otherwise permitted in this section;
new text end

new text begin (2) the health plan must be designed to enable covered persons to better manage
costs and coverage options through the use of co-pays, deductibles, and other cost-sharing
arrangements;
new text end

new text begin (3) the health plan may modify or exclude any or all coverages of benefits that would
otherwise be required by law, except for maternity benefits and other benefits required
under federal law, and except that any type of provider licensed or registered to provide a
covered benefit must be allowed to provide that benefit;
new text end

new text begin (4) each health plan and plan's premiums must be approved by the commissioner
of health or commerce, whichever is appropriate under section 62Q.01, subdivision 2,
but neither commissioner may disapprove a plan on the grounds of a modification or
exclusion permitted under clause (3); and
new text end

new text begin (5) prior to sale of the health plan, the purchaser must be given a written list of the
coverages otherwise required by law that are modified or excluded in the health plan.
The list must include a description of each coverage in the list and indicate whether the
coverage is modified or excluded. If coverage is modified, the list must describe the
modification. The list may, but is not required to, also list any or all coverages otherwise
required by law that are included in the health plan and indicate that they are included.
The health plan company must require that a copy of this written list be provided, prior
to the effective date of the health plan, to each enrollee or employee who is eligible for
health coverage under the plan.
new text end

new text begin Subd. 3. new text end

new text begin Employer health plan. new text end

new text begin An employer may provide a health plan permitted
under this section to its employees, the employees' dependents, and other persons eligible
for coverage under the employer's plan, notwithstanding chapter 363A or any other law
to the contrary.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0754, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Primary care provider tiering. new text end

new text begin (a) The commissioner shall adjust
the rates paid to providers participating in Minnesota health care programs annually.
Adjustments across provider rates made under this subdivision must be adjusted for the
number of enrollees and compared to peer provider payments made during the previous
year. Adjustments to rates shall not include the rate paid for care coordination services
to certified health care homes under section 256B.0753.
new text end

new text begin (b) Providers who are above one standard deviation above the mean in annual cost
per patient in the previous year will have 30 percent of their payment withheld. An
amount that would raise the total annual payment per patient to the 84th percentile or an
amount that would reduce the total program cost by ten percent, whichever is less, must be
returned to the provider as soon as practical following the contract or calendar year end.
new text end

new text begin (c) Health care homes certified under section 256B.0751, rural health clinics, and
federally qualified health care clinics are not included under this subdivision.
new text end

new text begin (d) Providers reimbursed on a cost basis are not subject to rate adjustments under
this section.
new text end

new text begin (e) The commissioner may phase in the tiering system by service type. The tiering
system must be implemented first with primary care providers.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for services rendered in calendar
year 2010 and thereafter.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.0754, is amended by adding a
subdivision to read:

new text begin Subd. 4. new text end

new text begin Provider tiering patient incentives. new text end

new text begin The commissioner shall seek federal
approval to allow incentives for enrollees to choose high-performing providers established
under section 62U.04. The incentives must be implemented no later than 120 days after
the federal approval is granted. The incentives may include an enrollee credit used to
pay for co-pays on prescription drugs. Enrollees choosing a high-performing provider
as their primary care provider (PCP) shall be eligible for the credit for their enrollment
period. The enrollees are eligible for the same credit in the next enrollment period if they
continue to designate a high-performing PCP.
new text end

Sec. 4. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, section 62L.056, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end