1.1                          A bill for an act 
  1.2             relating to health; clarifying the status of the 
  1.3             comprehensive health association under medical 
  1.4             assistance and general assistance medical care; 
  1.5             clarifying eligibility; opening the process for 
  1.6             selecting a writing carrier; eliminating the 
  1.7             four-month waiting period under MinnesotaCare for 
  1.8             association enrollees; modifying coverage for medical 
  1.9             assistance enrollees; transferring insurance premium 
  1.10            tax revenue to the general fund; appropriating money; 
  1.11            amending Minnesota Statutes 1996, sections 62E.02, 
  1.12            subdivisions 13 and 18; 62E.11, by adding a 
  1.13            subdivision; 62E.13, subdivision 2; 256.9357, 
  1.14            subdivision 3; 256B.056, subdivision 8; 256B.0625, 
  1.15            subdivision 15; 256D.03, subdivision 3b; and 295.58. 
  1.16  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.17     Section 1.  Minnesota Statutes 1996, section 62E.02, 
  1.18  subdivision 13, is amended to read: 
  1.19     Subd. 13.  [ELIGIBLE PERSON.] (a) "Eligible person" means 
  1.20  an individual who: 
  1.21     (1) is currently and has been a resident of Minnesota for 
  1.22  the six months immediately preceding the date of receipt by the 
  1.23  association or its writing carrier of a completed certificate of 
  1.24  eligibility and who; 
  1.25     (2) meets the enrollment requirements of section 62E.14; 
  1.26  and 
  1.27     (3) is not otherwise ineligible under this subdivision. 
  1.28     (b) No individual is eligible for coverage under a 
  1.29  qualified or a Medicare supplement plan issued by the 
  1.30  association for whom a premium is paid or reimbursed by a 
  2.1   federal, state, or local agency as of the first day of any term 
  2.2   for which a premium amount is paid or reimbursed. 
  2.3      Sec. 2.  Minnesota Statutes 1996, section 62E.02, 
  2.4   subdivision 18, is amended to read: 
  2.5      Subd. 18.  [WRITING CARRIER.] "Writing carrier" means the 
  2.6   insurer or insurers, health maintenance organization or 
  2.7   organizations, integrated service network or networks, and 
  2.8   community integrated service network or networks, or other 
  2.9   entity selected by the association and approved by the 
  2.10  commissioner to administer the comprehensive health insurance 
  2.11  plan. 
  2.12     Sec. 3.  Minnesota Statutes 1996, section 62E.11, is 
  2.13  amended by adding a subdivision to read: 
  2.14     Subd. 13.  [REPORT TO LEGISLATURE.] The commissioner shall 
  2.15  report to the legislature annually on the costs incurred by the 
  2.16  association in providing coverage to individuals enrolled in 
  2.17  medical assistance under chapter 256B or general assistance 
  2.18  medical care under chapter 256D.  The report shall be provided 
  2.19  to the chairs of the house committee on health and human 
  2.20  services and the senate committee on health and family security 
  2.21  no later than January 15 of each year.  The report's contents 
  2.22  shall be determined by the commissioner, in consultation with 
  2.23  the department of human services and the association.  At a 
  2.24  minimum, the report shall provide a breakdown, for the 
  2.25  association in aggregate and for each category of individuals 
  2.26  enrolled in medical assistance under chapter 256B or general 
  2.27  assistance medical care under chapter 256D, of: 
  2.28     (1) administrative costs; 
  2.29     (2) claims costs; 
  2.30     (3) premiums paid; 
  2.31     (4) deductibles, coinsurance, and copayments paid; 
  2.32     (5) state payments to providers satisfying deductibles, 
  2.33  coinsurance, or copayments required to be paid under a qualified 
  2.34  or Medicare supplement plan issued by the association; 
  2.35     (6) the number of individuals; 
  2.36     (7) losses; and 
  3.1      (8) appropriated state funds. 
  3.2      The commissioner of human services, the association, and 
  3.3   the writing carrier shall cooperate with the commissioner and 
  3.4   provide all information that the commissioner determines is 
  3.5   necessary to prepare this report. 
  3.6      Sec. 4.  Minnesota Statutes 1996, section 62E.13, 
  3.7   subdivision 2, is amended to read: 
  3.8      Subd. 2.  The association may select policies and 
  3.9   contracts, or parts thereof, submitted by a member or members of 
  3.10  the association, or by the association or others, to develop 
  3.11  specifications for bids from any members entity which wish 
  3.12  wishes to be selected as a writing carrier to administer the 
  3.13  state plan.  The selection of the writing carrier shall be based 
  3.14  upon criteria including established by the board of directors of 
  3.15  the association and approved by the commissioner.  The criteria 
  3.16  shall outline specific qualifications that an entity must 
  3.17  satisfy in order to be selected and, at a minimum, shall include 
  3.18  the member's entity's proven ability to handle large group 
  3.19  accident and health insurance cases, efficient claim paying 
  3.20  capacity, and the estimate of total charges for administering 
  3.21  the plan.  The association may select separate writing carriers 
  3.22  for the two types of qualified plans, the qualified medicare 
  3.23  supplement plan, and the health maintenance organization 
  3.24  contract. 
  3.25     Sec. 5.  Minnesota Statutes 1996, section 256.9357, 
  3.26  subdivision 3, is amended to read: 
  3.27     Subd. 3.  [PERIOD UNINSURED.] To be eligible for subsidized 
  3.28  premium payments based on a sliding scale, families and 
  3.29  individuals initially enrolled in the MinnesotaCare program 
  3.30  under section 256.9354, subdivisions 4 and 5, must have had no 
  3.31  health coverage for at least four months prior to application.  
  3.32  The commissioner may change this eligibility criterion for 
  3.33  sliding scale premiums without complying with rulemaking 
  3.34  requirements in order to remain within the limits of available 
  3.35  appropriations.  The requirement of at least four months of no 
  3.36  health coverage prior to application for the MinnesotaCare 
  4.1   program does not apply to: 
  4.2      (1) families, children, and individuals who want to apply 
  4.3   for the MinnesotaCare program upon termination from the medical 
  4.4   assistance program, general assistance medical care program, or 
  4.5   coverage under a regional demonstration project for the 
  4.6   uninsured funded under section 256B.73, the Hennepin county 
  4.7   assured care program, or the Group Health, Inc., community 
  4.8   health plan; 
  4.9      (2) families and individuals initially enrolled under 
  4.10  section 256.9354, subdivisions 1, paragraph (a), and 2; 
  4.11     (3) children enrolled pursuant to Laws 1992, chapter 549, 
  4.12  article 4, section 17; or 
  4.13     (4) individuals currently serving or who have served in the 
  4.14  military reserves, and dependents of these individuals, if these 
  4.15  individuals:  (i) reapply for MinnesotaCare coverage after a 
  4.16  period of active military service during which they had been 
  4.17  covered by the Civilian Health and Medical Program of the 
  4.18  Uniformed Services (CHAMPUS); (ii) were covered under 
  4.19  MinnesotaCare immediately prior to obtaining coverage under 
  4.20  CHAMPUS; and (iii) have maintained continuous coverage; or 
  4.21     (5) individuals and families whose only health coverage 
  4.22  during the four months prior to application was a qualified or 
  4.23  Medicare supplement plan issued by the Minnesota comprehensive 
  4.24  health association under chapter 62E. 
  4.25     Sec. 6.  Minnesota Statutes 1996, section 256B.056, 
  4.26  subdivision 8, is amended to read: 
  4.27     Subd. 8.  [COOPERATION.] To be eligible for medical 
  4.28  assistance, applicants and recipients must cooperate with the 
  4.29  state and local agency to identify potentially liable 
  4.30  third-party payers and assist the state in obtaining third party 
  4.31  payments, unless good cause for noncooperation is determined 
  4.32  according to Code of Federal Regulations, title 42, part 
  4.33  433.147.  "Cooperation" includes identifying any third party who 
  4.34  may be liable for care and services provided under this chapter 
  4.35  to the applicant, recipient, or any other family member for whom 
  4.36  application is made and providing relevant information to assist 
  5.1   the state in pursuing a potentially liable third party.  
  5.2   Cooperation also includes providing information about a group 
  5.3   health plan for which the person may be eligible and if the plan 
  5.4   is determined cost-effective by the state agency and premiums 
  5.5   are paid by the local agency or there is no cost to the 
  5.6   recipient, they must enroll or remain enrolled with the group.  
  5.7   For purposes of this subdivision, coverage provided by the 
  5.8   Minnesota comprehensive health association under chapter 62E 
  5.9   shall not be considered group health plan coverage or 
  5.10  cost-effective by the state and local agency.  Cost-effective 
  5.11  insurance premiums approved for payment by the state agency and 
  5.12  paid by the local agency are eligible for reimbursement 
  5.13  according to section 256B.19. 
  5.14     Sec. 7.  Minnesota Statutes 1996, section 256B.0625, 
  5.15  subdivision 15, is amended to read: 
  5.16     Subd. 15.  [HEALTH PLAN PREMIUMS AND COPAYMENTS.] (a) 
  5.17  Medical assistance covers health care prepayment plan premiums, 
  5.18  insurance premiums, and copayments if determined to be 
  5.19  cost-effective by the commissioner.  For purposes of obtaining 
  5.20  Medicare part A and part B, and copayments, expenditures may be 
  5.21  made even if federal funding is not available. 
  5.22     (b) Effective for all premiums due on or after June 30, 
  5.23  1997, medical assistance does not cover premiums that a 
  5.24  recipient is required to pay under a qualified or Medicare 
  5.25  supplement plan issued by the Minnesota comprehensive health 
  5.26  association. 
  5.27     Sec. 8.  Minnesota Statutes 1996, section 256D.03, 
  5.28  subdivision 3b, is amended to read: 
  5.29     Subd. 3b.  [COOPERATION.] (a) General assistance or general 
  5.30  assistance medical care applicants and recipients must cooperate 
  5.31  with the state and local agency to identify potentially liable 
  5.32  third-party payors and assist the state in obtaining third-party 
  5.33  payments.  Cooperation includes identifying any third party who 
  5.34  may be liable for care and services provided under this chapter 
  5.35  to the applicant, recipient, or any other family member for whom 
  5.36  application is made and providing relevant information to assist 
  6.1   the state in pursuing a potentially liable third party.  General 
  6.2   assistance medical care applicants and recipients must cooperate 
  6.3   by providing information about any group health plan in which 
  6.4   they may be eligible to enroll.  They must cooperate with the 
  6.5   state and local agency in determining if the plan is 
  6.6   cost-effective.  For purposes of this subdivision, coverage 
  6.7   provided by the Minnesota comprehensive health association under 
  6.8   chapter 62E shall not be considered group health plan coverage 
  6.9   or cost-effective by the state and local agency.  If the plan is 
  6.10  determined cost-effective and the premium will be paid by the 
  6.11  state or local agency or is available at no cost to the person, 
  6.12  they must enroll or remain enrolled in the group health plan.  
  6.13  Cost-effective insurance premiums approved for payment by the 
  6.14  state agency and paid by the local agency are eligible for 
  6.15  reimbursement according to subdivision 6. 
  6.16     (b) Effective for all premiums due on or after June 30, 
  6.17  1997, general assistance medical care does not cover premiums 
  6.18  that a recipient is required to pay under a qualified or 
  6.19  Medicare supplement plan issued by the Minnesota comprehensive 
  6.20  health association. 
  6.21     Sec. 9.  Minnesota Statutes 1996, section 295.58, is 
  6.22  amended to read: 
  6.23     295.58 [DEPOSIT OF REVENUES AND PAYMENT OF REFUNDS.] 
  6.24     (a) The commissioner shall deposit all revenues, including 
  6.25  penalties and interest, derived from the taxes imposed by 
  6.26  sections 295.50 to 295.57 and from the insurance premiums tax on 
  6.27  health maintenance organizations, community integrated service 
  6.28  networks, integrated service networks, and nonprofit health 
  6.29  service plan corporations in the health care access fund in the 
  6.30  state treasury.  Refunds of overpayments must be paid from the 
  6.31  health care access fund in the state treasury.  There is 
  6.32  annually appropriated from the health care access fund to the 
  6.33  commissioner of revenue the amount necessary to make any refunds 
  6.34  required under section 295.54. 
  6.35     (b) The revenues, including penalties and interest, derived 
  6.36  from the tax on insurance premiums imposed by section 60A.15 on 
  7.1   health maintenance organizations, community integrated service 
  7.2   networks, integrated service networks, and nonprofit health 
  7.3   service plan corporations must be deposited in the general fund 
  7.4   and are annually appropriated to the Minnesota comprehensive 
  7.5   health association to offset assessments made to subsidize the 
  7.6   costs of the Minnesota comprehensive insurance plan established 
  7.7   under chapter 62E. 
  7.8      (c) Paragraph (b) is effective for premium tax payments due 
  7.9   for months beginning on or after July 1, 1997. 
  7.10     Sec. 10.  [APPROPRIATION.] 
  7.11     $....... is appropriated in fiscal year 1998 and $....... 
  7.12  is appropriated in fiscal year 1999 from the general fund to the 
  7.13  board of directors of the Minnesota comprehensive health 
  7.14  association to cover the total administrative and claims costs, 
  7.15  net of premiums paid, associated with those individuals who are 
  7.16  covered by a qualified or Medicare supplement plan issued by the 
  7.17  association and who are enrolled in medical assistance under 
  7.18  Minnesota Statutes, chapter 256B or general assistance medical 
  7.19  care under Minnesota Statutes, chapter 256D.  
  7.20     Sec. 11.  [EFFECTIVE DATE.] 
  7.21     Sections 1 to 9 are effective the day following final 
  7.22  enactment.