1.1                          A bill for an act 
  1.2             relating to insurance; creating a purchasing alliance 
  1.3             stop-loss fund account; appropriating money; proposing 
  1.4             coding for new law in Minnesota Statutes, chapter 256. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [256.956] [PURCHASING ALLIANCE STOP-LOSS FUND.] 
  1.7      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.8   section, the following definitions apply:  
  1.9      (a) "Commissioner" means the commissioner of human services.
  1.10     (b) "Health plan" means a policy, contract, or certificate 
  1.11  issued by a health plan company to a qualifying purchasing 
  1.12  alliance.  Any health plan issued to the members of a qualifying 
  1.13  purchasing alliance must meet the requirements of chapter 62L.  
  1.14     (c) "Health plan company" means: 
  1.15     (1) a health carrier as defined under section 62A.011, 
  1.16  subdivision 2; 
  1.17     (2) a community integrated service network operating under 
  1.18  chapter 62N; or 
  1.19     (3) an accountable provider network operating under chapter 
  1.20  62T.  
  1.21     (d) "Qualifying employer" means an employer who: 
  1.22     (1) is a member of a qualifying purchasing alliance; 
  1.23     (2) has at least one employee but no more than ten 
  1.24  employees or is a sole proprietor or farmer; 
  1.25     (3) did not offer employer-subsidized health care coverage 
  2.1   to its employees for at least 12 months prior to joining the 
  2.2   purchasing alliance; and 
  2.3      (4) is offering health coverage through the purchasing 
  2.4   alliance to all employees who work at least 20 hours per week 
  2.5   unless the employee is eligible for Medicare. 
  2.6   For purposes of this subdivision, "employer-subsidized health 
  2.7   coverage" means health coverage for which the employer pays at 
  2.8   least 50 percent of the cost of coverage for the employee.  
  2.9      (e) "Qualifying enrollee" means an employee of a qualifying 
  2.10  employer or the employee's dependent covered by a health plan.  
  2.11     (f) "Qualifying purchasing alliance" means a purchasing 
  2.12  alliance as defined in section 62T.01, subdivision 2, that: 
  2.13     (1) meets the requirements of chapter 62T; 
  2.14     (2) services a geographic area located in outstate 
  2.15  Minnesota, excluding the city of Duluth; and 
  2.16     (3) is organized and operating before May 1, 2001. 
  2.17     The criteria used by the qualifying purchasing alliance for 
  2.18  membership must be approved by the commissioner of health.  
  2.19     Subd. 2.  [CREATION OF ACCOUNT.] A purchasing alliance 
  2.20  stop-loss fund account is established in the general fund.  The 
  2.21  commissioner shall use the money to establish a stop-loss fund 
  2.22  from which a health plan company may receive reimbursement for 
  2.23  claims paid for qualifying enrollees.  The account consists of 
  2.24  money appropriated by the legislature.  Money from the account 
  2.25  must be used for the stop-loss fund.  
  2.26     Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
  2.27  receive reimbursement from the fund for 90 percent of the 
  2.28  portion of the claim that exceeds $30,000 but not of the portion 
  2.29  that exceeds $100,000 in a calendar year for a qualifying 
  2.30  enrollee.  
  2.31     (b) Claims shall be reported and funds shall be distributed 
  2.32  on a calendar-year basis.  Claims shall be eligible for 
  2.33  reimbursement only for the calendar year in which the claims 
  2.34  were paid.  
  2.35     (c) Once claims paid on behalf of a qualifying enrollee 
  2.36  reach $100,000 in a given calendar year, no further claims may 
  3.1   be submitted for reimbursement on behalf of that enrollee in 
  3.2   that calendar year.  
  3.3      Subd. 4.  [REQUEST PROCESS.] (a) Each health plan company 
  3.4   must submit a request for reimbursement from the fund on a form 
  3.5   prescribed by the commissioner.  Requests for payment must be 
  3.6   submitted no later than April 1 following the end of the 
  3.7   calendar year for which the reimbursement request is being made, 
  3.8   beginning April 1, 2002. 
  3.9      (b) The commissioner may require a health plan company to 
  3.10  submit claims data as needed in connection with the 
  3.11  reimbursement request.  
  3.12     Subd. 5.  [DISTRIBUTION.] (a) The commissioner shall 
  3.13  calculate the total claims reimbursement amount for all 
  3.14  qualifying health plan companies for the calendar year for which 
  3.15  claims are being reported and shall distribute the stop-loss 
  3.16  funds on an annual basis.  
  3.17     (b) In the event that the total amount requested for 
  3.18  reimbursement by the health plan companies for a calendar year 
  3.19  exceeds the funds available for distribution for claims paid by 
  3.20  all health plan companies during the same calendar year, the 
  3.21  commissioner shall provide for the pro rata distribution of the 
  3.22  available funds.  Each health plan company shall be eligible to 
  3.23  receive only a proportionate amount of the available funds as 
  3.24  the health plan company's total eligible claims paid compares to 
  3.25  the total eligible claims paid by all health plan companies.  
  3.26     (c) In the event that funds available for distribution for 
  3.27  claims paid by all health plan companies during a calendar year 
  3.28  exceed the total amount requested for reimbursement by all 
  3.29  health plan companies during the same calendar year, any excess 
  3.30  funds shall be reallocated for distribution in the next calendar 
  3.31  year.  
  3.32     Subd. 6.  [DATA.] Upon the request of the commissioner, 
  3.33  each health plan company shall furnish such data as the 
  3.34  commissioner deems necessary to administer the fund.  The 
  3.35  commissioner may require that such data be submitted on a per 
  3.36  enrollee, aggregate, or categorical basis.  Any data submitted 
  4.1   under this section shall be classified as private data or 
  4.2   nonpublic data as defined in section 13.02. 
  4.3      Subd. 7.  [DELEGATION.] The commissioner may delegate any 
  4.4   or all of the commissioner's administrative duties to another 
  4.5   state agency or to a private contractor.  
  4.6      Subd. 8.  [REPORT.] The commissioner of commerce, in 
  4.7   consultation with the office of rural health and the qualifying 
  4.8   purchasing alliances, shall evaluate the extent to which the 
  4.9   purchasing alliance stop-loss fund increases the availability of 
  4.10  employer-subsidized health care coverage for residents residing 
  4.11  in the geographic areas served by the qualifying purchasing 
  4.12  alliances.  A preliminary report must be submitted to the 
  4.13  legislature by February 15, 2003, and a final report must be 
  4.14  submitted by February 15, 2004.  
  4.15     Subd. 9.  [SUNSET.] This section shall expire January 1, 
  4.16  2005.  
  4.17     Sec. 2.  [APPROPRIATION.] 
  4.18     (a) $....... is appropriated for the biennium beginning 
  4.19  July 1, 2001, from the general fund to the commissioner of human 
  4.20  services to be deposited in the stop-loss fund account to be 
  4.21  distributed in accordance with section 1. 
  4.22     (b) $200,000 is appropriated for the biennium beginning 
  4.23  July 1, 2001, from the health care access fund to the 
  4.24  commissioner of health for grants to organizations developing 
  4.25  health care purchasing alliances established under Minnesota 
  4.26  Statutes, chapter 62T. 
  4.27     Of this amount, $50,000 in the first year of the biennium 
  4.28  is for a grant to the University of Minnesota-Crookston to 
  4.29  support the northwest purchasing alliance, $50,000 in the first 
  4.30  year of the biennium is for a grant to the southwest regional 
  4.31  development commission to support the southwest purchasing 
  4.32  alliance, and $50,000 in each year of the biennium is for a 
  4.33  grant to the Brainerd Lakes Area Chamber of Commerce Education 
  4.34  Association to support the north central purchasing alliance.  
  4.35  The state grants provided under this section must be matched on 
  4.36  a one-to-one basis by nonstate funds.