2004 Minnesota Statutes

     62E.10 Comprehensive Health Association. 

    Subdivision 1.    Creation; tax exemption.  There is 
 established a Comprehensive Health Association to promote the 
 public health and welfare of the state of Minnesota with 
 membership consisting of all insurers; self-insurers; 
 fraternals; joint self-insurance plans regulated under chapter 
 62H; the Minnesota employees insurance program established in 
 section 43A.317, effective July 1, 1993; health maintenance 
 organizations; and community integrated service networks 
 licensed or authorized to do business in this state.  The 
 Comprehensive Health Association is exempt from the taxes 
 imposed under chapter 297I and any other laws of this state and 
 all property owned by the association is exempt from taxation. 

    Subd. 2.    Board of directors; organization.  The board 
 of directors of the association shall be made up of eleven 
 members as follows:  six directors selected by contributing 
 members, subject to approval by the commissioner, one of which 
 must be a health actuary; five public directors selected by the 
 commissioner, at least two of whom must be plan enrollees, two 
 of whom must be representatives of employers whose accident and 
 health insurance premiums are part of the association's 
 assessment base, 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.  The vote shall be a weighted vote 
 based upon the member's cost of self-insurance, accident and 
 health insurance premium, subscriber contract charges, health 
 maintenance contract payment, or community integrated service 
 network payment derived from or on behalf of Minnesota residents 
 in the previous calendar year, as determined by the 
 commissioner.  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.  The costs of conducting meetings of the association 
 and its board of directors shall be borne by members of the 
 association. 

    Subd. 2a.    Appeals.  A person may appeal to the 
 commissioner within 30 days after notice of an action, ruling, 
 or decision by the board.  

    A final action or order of the commissioner under this 
 subdivision is subject to judicial review in the manner provided 
 by chapter 14.  

    In lieu of the appeal to the commissioner, a person may 
 seek judicial review of the board's action. 

    Subd. 3.    Mandatory membership.  All members shall 
 maintain their membership in the association as a condition of 
 doing accident and health insurance, self-insurance, health 
 maintenance organization, or community integrated service 
 network business in this state.  The association shall submit 
 its articles, bylaws and operating rules to the commissioner for 
 approval; provided that the adoption and amendment of articles, 
 bylaws and operating rules by the association and the approval 
 by the commissioner thereof shall be exempt from the provisions 
 of sections 14.001 to 14.69. 

    Subd. 4.    Open meetings.  All meetings of the 
 association, its board, and any committees of the association 
 shall comply with the provisions of chapter 13D, except that 
 during any portion of a meeting during which an enrollee's 
 appeal of an action of the writing carrier is being heard, that 
 portion of the meeting must be closed at the enrollee's request. 

    Subd. 5. Repealed, 1979 c 272 s 11 

    Subd. 6.    Antitrust exemption.  In the performance of 
 their duties as members of the association, the members shall be 
 exempt from the provisions of sections 325D.49 to 325D.66. 

    Subd. 7.    General powers.  The association may: 

    (a) Exercise the powers granted to insurers under the laws 
 of this state; 

    (b) Sue or be sued; 

    (c) Enter into contracts with insurers, similar 
 associations in other states or with other persons for the 
 performance of administrative functions including the functions 
 provided for in clauses (e) and (f); 

    (d) Establish administrative and accounting procedures for 
 the operation of the association; 

    (e) Provide for the reinsuring of risks incurred as a 
 result of issuing the coverages required by sections 62E.04 and 
 62E.16 by members of the association.  Each member which elects 
 to reinsure its required risks shall determine the categories of 
 coverage it elects to reinsure in the association.  The 
 categories of coverage are: 

    (1) individual qualified plans, excluding group 
 conversions; 

    (2) group conversions; 

    (3) group qualified plans with fewer than 50 employees or 
 members; and 

    (4) major medical coverage. 

    A separate election may be made for each category of 
 coverage.  If a member elects to reinsure the risks of a 
 category of coverage, it must reinsure the risk of the coverage 
 of every life covered under every policy issued in that 
 category.  A member electing to reinsure risks of a category of 
 coverage shall enter into a contract with the association 
 establishing a reinsurance plan for the risks.  This contract 
 may include provision for the pooling of members' risks 
 reinsured through the association and it may provide for 
 assessment of each member reinsuring risks for losses and 
 operating and administrative expenses incurred, or estimated to 
 be incurred in the operation of the reinsurance plan.  This 
 reinsurance plan shall be approved by the commissioner before it 
 is effective.  Members electing to administer the risks which 
 are reinsured in the association shall comply with the benefit 
 determination guidelines and accounting procedures established 
 by the association.  The fee charged by the association for the 
 reinsurance of risks shall not be less than 110 percent of the 
 total anticipated expenses incurred by the association for the 
 reinsurance; and 

    (f) Provide for the administration by the association of 
 policies which are reinsured pursuant to clause (e).  Each 
 member electing to reinsure one or more categories of coverage 
 in the association may elect to have the association administer 
 the categories of coverage on the member's behalf.  If a member 
 elects to have the association administer the categories of 
 coverage, it must do so for every life covered under every 
 policy issued in that category.  The fee for the administration 
 shall not be less than 110 percent of the total anticipated 
 expenses incurred by the association for the administration. 

    Subd. 8.    Department of state exemption.  The 
 association is exempt from the Administrative Procedure Act but, 
 to the extent authorized by law to adopt rules, the association 
 may use the provisions of section 14.386, paragraph (a), clauses 
 (1) and (3).  Section 14.386, paragraph (b), does not apply to 
 these rules. 

    Subd. 9.    Experimental delivery method.  The 
 association may petition the commissioner of commerce for a 
 waiver to allow the experimental use of alternative means of 
 health care delivery.  The commissioner may approve the use of 
 the alternative means the commissioner considers appropriate.  
 The commissioner may waive any of the requirements of this 
 chapter and chapters 60A, 62A, and 62D in granting the waiver.  
 The commissioner may also grant to the association any 
 additional powers as are necessary to facilitate the specific 
 waiver, including the power to implement a provider payment 
 schedule.  

    Subd. 10.    Cost containment goals.  (a) By July 1, 
 2001, the association shall investigate managed care delivery 
 systems, and if cost effective, enter into contracts with 
 third-party entities as provided in section 62E.101. 

    (b) By July 1, 2001, the association shall establish a 
 system to annually identify individuals insured by the Minnesota 
 Comprehensive Health Association who may be eligible for private 
 health care coverage, medical assistance, state drug programs, 
 or other state or federal programs and notify them about their 
 eligibility for these programs. 

    (c) The association shall endeavor to reduce health care 
 costs using additional methods consistent with effective patient 
 care.  At a minimum, by July 1, 2001, the association shall: 

    (1) develop a focused chronic disease management and case 
 management program; 

    (2) develop a comprehensive program of preventive care; and 

    (3) implement a total drug formulary program. 

    The association may establish an enrollee incentive based 
 on enrollee participation in the chronic disease management and 
 case management program developed under this section.  

    HIST: 1976 c 296 art 1 s 10; 1977 c 409 s 14-16; 1979 c 272 s 
 7; 1981 c 253 s 23; 1982 c 424 s 130; 1Sp1985 c 10 s 63; 1987 c 
 337 s 67-69; 1987 c 384 art 2 s 1; 1988 c 612 s 28; 1990 c 422 s 
 10; 1990 c 523 s 2; 1991 c 165 s 3,4; 1991 c 264 s 1; 1992 c 549 
 art 3 s 14; 1992 c 554 art 1 s 15; 1992 c 564 art 1 s 35; art 4 
 s 11; 1993 c 324 s 4; 1994 c 426 s 12; 1994 c 625 art 8 s 11-13; 
 art 10 s 50; 1997 c 187 art 5 s 10; 1997 c 225 art 2 s 62; 2000 
 c 394 art 2 s 14; 2000 c 398 s 3; 2004 c 268 s 2,3