HF 3717

3rd Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/17/2022 03:42pm

A bill for an act
relating to state government; modifying the comprehensive health association;
modifying the Minnesota premium security plan; modifying provisions governing
health insurance; requiring certain additional coverage under health plans;
establishing a Mental Health Parity and Substance Abuse Accountability Office;
requiring a proposal for a public option; requiring a report; transferring money;
appropriating money; amending Minnesota Statutes 2020, sections 62E.10, by
adding a subdivision; 62E.23, subdivision 3; 62K.06, subdivision 2; 62Q.81, by
adding a subdivision; 256B.0625, by adding a subdivision; 256L.03, subdivision
5; Laws 2017, chapter 13, article 1, section 15, as amended; Laws 2021, First
Special Session chapter 7, article 15, section 3; proposing coding for new law in
Minnesota Statutes, chapter 62Q; repealing Minnesota Statutes 2020, section
62E.10, subdivision 2.

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

Section 1.

Minnesota Statutes 2020, section 62E.10, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Board of directors; organization. new text end

new text begin The board of directors of the association
shall be made up of 19 members as follows:
new text end

new text begin (1) the commissioner of commerce or a designee;
new text end

new text begin (2) the commissioner of health or a designee;
new text end

new text begin (3) the chief executive officer of MNsure or a designee;
new text end

new text begin (4) one director selected by the speaker of the house and one director selected by the
house minority leader;
new text end

new text begin (5) one director selected by the senate majority leader and one director selected by the
senate minority leader;
new text end

new text begin (6) two directors selected by the commissioner of human services, one of whom must
represent hospitals and one of whom must represent health care providers;
new text end

new text begin (7) five directors selected by contributing members, each representing a different
contributing member and subject to approval by the commissioner of commerce, one of
whom must be a health actuary; and
new text end

new text begin (8) five public directors selected by the commissioner of commerce, at least two of
whom must be enrollees in the individual market and one of whom must be a licensed
insurance agent. At least two of the public directors must reside outside of the seven-county
metropolitan area.
new text end

Sec. 2.

Minnesota Statutes 2020, section 62E.23, subdivision 3, is amended to read:

Subd. 3.

Operation.

(a) The board shall propose to the commissioner the payment
parameters for the next benefit year by January 15 of the year before the applicable benefit
year. The commissioner shall approve or reject the payment parameters no later than 14
days following the board's proposal. If the commissioner fails to approve or reject the
payment parameters within 14 days following the board's proposal, the proposed payment
parameters are final and effective.

(b) If the amount in the premium security plan account in section 62E.25, subdivision
1, is not anticipated to be adequate to fully fund the approved payment parameters as of
July 1 of the year before the applicable benefit year, the board, in consultation with the
commissioner and the commissioner of management and budget, shall propose payment
parameters within the available appropriations. The commissioner must permit an eligible
health carrier to revise an applicable rate filing based on the final payment parameters for
the next benefit year.

(c) Notwithstanding paragraph (a), the payment parameters for benefit deleted text begin year 2020 deleted text end new text begin years
2023 through 2027 new text end are:

(1) an attachment point of $50,000;

(2) a coinsurance rate of 80 percent; and

(3) a reinsurance cap of $250,000.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the continuation
of the state innovation waiver described in Laws 2021, First Special Session chapter 7,
article 15, section 4. The commissioner of commerce shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2020, section 62K.06, subdivision 2, is amended to read:

Subd. 2.

Minimum levels.

(a) A health carrier that offers a catastrophic plan or a bronze
level health plan within a service area in either the individual or small group market must
also offer a silver level deleted text begin and deleted text end new text begin , new text end a gold new text begin level, and a platinum new text end level health plan in that market
and within that service area.

(b) A health carrier with less than five percent market share in the respective individual
or small group market in Minnesota is exempt from paragraph (a), until January 1, 2017,
unless the health carrier offers a qualified health plan through MNsure. If the health carrier
offers a qualified health plan through MNsure, the health carrier must comply with paragraph
(a).

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 4.

new text begin [62Q.521] POSTNATAL CARE.
new text end

new text begin (a) For purposes of this section, "comprehensive postnatal visit" means a visit with a
health care provider that includes a full assessment of the mother's and infant's physical,
social, and psychological well-being, including but not limited to: mood and emotional
well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and
fatigue; physical recovery from birth; chronic disease management; and health maintenance.
new text end

new text begin (b) A health plan must provide coverage for the following:
new text end

new text begin (1) a comprehensive postnatal visit with a health care provider not more than three weeks
from the date of delivery;
new text end

new text begin (2) any postnatal visits recommended by a health care provider between three and 11
weeks from the date of delivery; and
new text end

new text begin (3) a comprehensive postnatal visit with a health care provider 12 weeks from the date
of delivery.
new text end

new text begin (c) The requirements of this section are separate from and cannot be met by a visit made
pursuant to section 62A.0411.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 5.

Minnesota Statutes 2020, section 62Q.81, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Prescription drug benefits. new text end

new text begin (a) A health plan company that offers individual
health plans must ensure that no fewer than 25 percent of the individual health plans the
company offers in each geographic area that the health plan company services at each level
of coverage described in subdivision 1, paragraph (b), clause (3), that the health plan company
offers, apply a predeductible, flat-dollar amount co-payment structure to the entire drug
benefit, including all tiers.
new text end

new text begin (b) A health plan company that offers small group health plans must ensure that no fewer
than 25 percent of the small group health plans the company offers in each geographic area
that the health plan company services at each level of coverage described in subdivision 1,
paragraph (b), clause (3), that the health plan company offers, apply a predeductible,
flat-dollar amount co-payment structure to the entire drug benefit, including all tiers.
new text end

new text begin (c) The highest allowable co-payment for the highest cost drug tier for health plans
offered pursuant to this subdivision must be no greater than 1/12 of the plan's out-of-pocket
maximum for an individual.
new text end

new text begin (d) The flat-dollar amount co-payment tier structure for prescription drugs under this
subdivision must be graduated and proportionate.
new text end

new text begin (e) All individual and small group health plans offered pursuant to this subdivision must
be:
new text end

new text begin (1) clearly and appropriately named to aid the purchaser in the selection process;
new text end

new text begin (2) marketed in the same manner as other health plans offered by the health plan company;
and
new text end

new text begin (3) offered for purchase to any individual or small group.
new text end

new text begin (f) This subdivision does not apply to catastrophic plans, grandfathered plans, large
group health plans, health savings accounts, qualified high deductible health benefit plans,
limited health benefit plans, or short-term limited-duration health insurance policies.
new text end

new text begin (g) Neither a health plan company nor a pharmacy benefit manager, as defined in section
62W.02, subdivision 15, shall delay or divide payment to a pharmacy or pharmacy provider,
as defined in section 62W.02, subdivision 14, because of the co-payment structure of a
health plan offered pursuant to this subdivision.
new text end

new text begin (h) Health plan companies must meet the requirements in this subdivision separately for
plans offered through MNsure under chapter 62V and plans offered outside of MNsure.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to individual
and small group health plans offered, issued, or renewed on or after that date.
new text end

Sec. 6.

Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 3i. new text end

new text begin Postnatal care. new text end

new text begin Medical assistance covers comprehensive postnatal visits, as
defined in section 62Q.521, and coverage must meet the requirements of section 62Q.521.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023.
new text end

Sec. 7.

Minnesota Statutes 2020, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Cost-sharing.

(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.

(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit deleted text begin to deleted text end new text begin at no less
than new text end 94 percent. The cost-sharing changes described in this paragraph do not apply to eligible
recipients or services exempt from cost-sharing under state law. The cost-sharing changes
described in this paragraph shall not be implemented prior to January 1, 2016.

(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.

Sec. 8.

Laws 2017, chapter 13, article 1, section 15, as amended by Laws 2017, First
Special Session chapter 6, article 5, section 10, Laws 2019, First Special Session chapter
9, article 8, section 19, and Laws 2021, First Special Session chapter 7, article 15, section
1, is amended to read:

Sec. 15. MINNESOTA PREMIUM SECURITY PLAN FUNDING.

(a) The Minnesota Comprehensive Health Association shall fund the operational and
administrative costs and reinsurance payments of the Minnesota security plan and association
using the following amounts deposited in the premium security plan account in Minnesota
Statutes, section 62E.25, subdivision 1, in the following order:

(1) any federal funding available;

(2) funds deposited under article 1, sections 12 and 13;

(3) any state funds from the health care access fund; and

(4) any state funds from the general fund.

(b) The association shall transfer from the premium security plan account any remaining
state funds not used for the Minnesota premium security plan by June 30, deleted text begin 2024 deleted text end new text begin 2029 new text end , to the
commissioner of commerce. Any amount transferred to the commissioner of commerce
shall be deposited in the health care access fund in Minnesota Statutes, section 16A.724.

(c) The Minnesota Comprehensive Health Association may not spend more than
$271,000,000 for benefit year 2018 and not more than $271,000,000 for benefit year 2019
for the operational and administrative costs of, and reinsurance payments under, the
Minnesota premium security plan.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the continuation
of the state innovation waiver described in Laws 2021, First Special Session chapter 7,
article 15, section 4. The commissioner of commerce shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 9.

Laws 2021, First Special Session chapter 7, article 15, section 3, is amended to
read:

Sec. 3. PLAN YEAR deleted text begin 2022 deleted text end new text begin 2023 new text end PROPOSED RATE FILINGS FOR THE
INDIVIDUAL MARKET.

The rate filing deadline for individual health plans, as defined in Minnesota Statutes,
section 62E.21, subdivision 9, to be offered, issued, sold, or renewed on or after January 1,
deleted text begin 2022 deleted text end new text begin 2023, and before January 1, 2024 new text end , is July 9, deleted text begin 2021 deleted text end new text begin 2022 new text end . Eligible health carriers under
Minnesota Statutes, section 62E.21, subdivision 8, filing individual health plans to be offered,
issued, sold, or renewed for benefit deleted text begin year 2022 deleted text end new text begin years 2023 through 2027 new text end shall include the
impact of the Minnesota premium security plan payment parameters in the proposed
individual health plan rates. Notwithstanding Minnesota Statutes, section 60A.08, subdivision
15, paragraph (g), the commissioner must provide public access on the Department of
Commerce's website to compiled data of the proposed changes to rates for individual health
plans and small group health plans, as defined in Minnesota Statutes, section 62K.03,
subdivision 12, separated by health plan and geographic rating area, no later than July 23,
deleted text begin 2021 deleted text end new text begin 2022 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective upon federal approval of the continuation
of the state innovation waiver described in Laws 2021, First Special Session chapter 7,
article 15, section 4. The commissioner of commerce shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 10. new text begin MENTAL HEALTH PARITY AND SUBSTANCE ABUSE
ACCOUNTABILITY OFFICE.
new text end

new text begin The Mental Health Parity and Substance Abuse Accountability Office is established
within the Department of Commerce to create and execute effective strategies for
implementing the requirements of Minnesota Statutes, section 62Q.47; federal Mental Health
Parity Act of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008; the Affordable Care Act; and any amendments
to, and federal guidance or regulations issued under, those acts. The Mental Health Parity
and Substance Abuse Accountability Office may oversee compliance reviews, conduct and
lead stakeholder engagement, review consumer and provider complaints, and serve as a
resource for ensuring health plan compliance with mental health and substance abuse
requirements.
new text end

Sec. 11. new text begin DELIVERY REFORM ANALYSIS REPORT.
new text end

new text begin (a) The commissioner of human services shall present to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance,
by January 15, 2024, a report comparing service delivery and payment system models for
delivering services to medical assistance enrollees for whom income eligibility is determined
using the modified adjusted gross income methodology under Minnesota Statutes, section
256B.056, subdivision 1a, paragraph (b), clause (1), and MinnesotaCare enrollees eligible
under Minnesota Statutes, chapter 256L. The report must compare the current delivery
model with at least two alternative models. The alternative models must include a state-based
model in which the state holds the plan risk as the insurer and may contract with a third-party
administrator for claims processing and plan administration. The alternative models may
include but are not limited to:
new text end

new text begin (1) expanding the use of integrated health partnerships under Minnesota Statutes, section
256B.0755;
new text end

new text begin (2) delivering care under fee-for-service through a primary care case management system;
and
new text end

new text begin (3) continuing to contract with managed care and county-based purchasing plans for
some or all enrollees under modified contracts.
new text end

new text begin (b) The report must include:
new text end

new text begin (1) a description of how each model would address:
new text end

new text begin (i) racial and other inequities in the delivery of health care and health care outcomes;
new text end

new text begin (ii) geographic inequities in the delivery of health care;
new text end

new text begin (iii) the provision of incentives for preventive care and other best practices;
new text end

new text begin (iv) reimbursing providers for high-quality, value-based care at levels sufficient to sustain
or increase enrollee access to care; and
new text end

new text begin (v) transparency and simplicity for enrollees, health care providers, and policymakers;
new text end

new text begin (2) a comparison of the projected cost of each model; and
new text end

new text begin (3) an implementation timeline for each model that includes the earliest date by which
each model could be implemented if authorized during the 2024 legislative session and a
discussion of barriers to implementation.
new text end

Sec. 12. new text begin PROPOSAL FOR A PUBLIC OPTION.
new text end

new text begin (a) The commissioner of human services shall consult with the Centers for Medicare
and Medicaid Services, the Internal Revenue Service, and other relevant federal agencies
to develop a proposal for a public option program. The proposal may consider multiple
public option structures, at least one of which must be through expanded enrollment into
MinnesotaCare. Each option must:
new text end

new text begin (1) allow individuals with incomes above the maximum income eligibility limit under
Minnesota Statutes, section 256L.04, subdivision 1 or 7, the option of purchasing coverage
through the public option;
new text end

new text begin (2) allow undocumented noncitizens the option of purchasing through the public option;
new text end

new text begin (3) establish a small employer public option that allows employers with 50 or fewer
employees to offer the public option to the employer's employees and contribute to the
employees' premiums;
new text end

new text begin (4) allow the state to:
new text end

new text begin (i) receive the maximum pass through of federal dollars that would otherwise be used
to provide coverage for eligible public option enrollees if the enrollees were instead covered
through qualified health plans with premium tax credits, emergency medical assistance, or
other relevant programs; and
new text end

new text begin (ii) continue to receive basic health program payments for eligible MinnesotaCare
enrollees; and
new text end

new text begin (5) be administered in coordination with the existing MinnesotaCare program to maximize
efficiency and improve continuity of care, consistent with the requirements of Minnesota
Statutes, sections 256L.06, 256L.10, and 256L.11.
new text end

new text begin (b) Each public option proposal must include:
new text end

new text begin (1) a premium scale for public option enrollees that at least meets the Affordable Care
Act affordability standard for each income level;
new text end

new text begin (2) an analysis of the impact of the public option on MNsure enrollment and the consumer
assistance program and, if necessary, a proposal to ensure that the public option has an
adequate enrollment infrastructure and consumer assistance capacity;
new text end

new text begin (3) actuarial and financial analyses necessary to project program enrollment and costs;
and
new text end

new text begin (4) an analysis of the cost of implementing the public option using current eligibility
and enrollment technology systems and, at the option of the commissioner, an analysis of
alternative eligibility and enrollment systems that may reduce initial and ongoing costs and
improve functionality and accessibility.
new text end

new text begin (c) The commissioner shall incorporate into the design of the public option mechanisms
to ensure the long-term financial sustainability of MinnesotaCare and mitigate any adverse
financial impacts to MNsure. These mechanisms must minimize: (1) adverse selection; (2)
state financial risk and expenditures; and (3) potential impacts on premiums in the individual
and group insurance markets.
new text end

new text begin (d) The commissioner shall present the proposal to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance
by December 15, 2023. The proposal must include recommendations on any legislative
changes necessary to implement the public option. Any implementation of the proposal that
requires a state financial contribution must be contingent on legislative approval.
new text end

Sec. 13. new text begin TRANSFER.
new text end

new text begin The commissioner of management and budget shall transfer $110,673,087 from the
general fund to the health care access fund by June 30, 2024, for state basic health plan
costs related to the loss of federal revenue associated with the extension of the premium
security plan through plan year 2023. This is a onetime transfer.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2023, but only if the
continuation of the state innovation waiver described in Laws 2021, First Special Session
chapter 7, article 15, section 4, is approved and results in a loss of federal revenue for the
state basic health plan for plan year 2023. The commissioner of management and budget
shall notify the revisor of statutes upon this occurrence.
new text end

Sec. 14. new text begin APPROPRIATION.
new text end

new text begin (a) $500,000 in fiscal year 2023 is appropriated from the general fund to the commissioner
of commerce to create and operate the Mental Health Parity and Substance Abuse
Accountability Office.
new text end

new text begin (b) $3,929,000 in fiscal year 2023 is appropriated from the general fund to the
commissioner of human services to compare health care service delivery and payment
system models under section 11 and to develop proposals for a public option program under
section 12. This money is available until June 30, 2024.
new text end

Sec. 15. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2020, section 62E.10, subdivision 2, new text end new text begin is repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: H3717-3

62E.10 COMPREHENSIVE HEALTH ASSOCIATION.

Subd. 2.

Board of directors; organization.

The board of directors of the association shall be made up of 13 members as follows: six directors selected by contributing members, subject to approval by the commissioner, one of which must be a health actuary; two directors selected by the commissioner of human services, one of whom must represent hospitals and one of whom must represent health care providers; five public directors selected by the commissioner, at least two of whom must be enrollees in the individual market and one of whom must be a licensed insurance agent. At least two of the public directors must reside outside of the seven-county metropolitan area. In determining voting rights at members' meetings, each member shall be entitled to vote in person or proxy. In approving directors of the board, the commissioner shall consider, among other things, whether all types of members are fairly represented. Directors selected by contributing members may be reimbursed from the money of the association for expenses incurred by them as directors, but shall not otherwise be compensated by the association for their services.