1.1                          A bill for an act 
  1.2             relating to human services; modifying the purchasing 
  1.3             alliance stop-loss fund; amending Minnesota Statutes 
  1.4             2002, section 256.956, subdivisions 1, 2, 3, 4, 5, 9. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  Minnesota Statutes 2002, section 256.956, 
  1.7   subdivision 1, is amended to read: 
  1.8      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.9   section, the following definitions apply:  
  1.10     (a) "Commissioner" means the commissioner of human services.
  1.11     (b) "Health plan" means a policy, contract, or certificate 
  1.12  issued by a health plan company to a qualifying purchasing 
  1.13  alliance.  Any health plan issued to the members of a qualifying 
  1.14  purchasing alliance must meet the requirements of chapter 62L.  
  1.15     (c) "Health plan company" means: 
  1.16     (1) a health carrier as defined under section 62A.011, 
  1.17  subdivision 2; 
  1.18     (2) a community integrated service network operating under 
  1.19  chapter 62N; or 
  1.20     (3) an accountable provider network operating under chapter 
  1.21  62T.  
  1.22     (d) "Qualifying employer" means an employer who: 
  1.23     (1) is a member of a qualifying purchasing alliance; 
  1.24     (2) has at least one employee but no more than ten 
  1.25  employees at the time of initial membership to a qualifying 
  2.1   purchasing alliance or is a sole proprietor or farmer; 
  2.2      (3) did not offer employer-subsidized health care coverage 
  2.3   to its employees for at least 12 months prior to joining the 
  2.4   purchasing alliance; and 
  2.5      (4) is offering health coverage through the purchasing 
  2.6   alliance to all employees who work at least 20 hours per week 
  2.7   unless the employee is eligible for Medicare. 
  2.8   For purposes of this subdivision, "employer-subsidized health 
  2.9   coverage" means health coverage for which the employer pays at 
  2.10  least 50 percent of the cost of coverage for the employee.  
  2.11     (e) "Qualifying enrollee" means an employee of a qualifying 
  2.12  employer or the employee's dependent covered by a health plan.  
  2.13     (f) "Qualifying purchasing alliance" means a purchasing 
  2.14  alliance as defined in section 62T.01, subdivision 2, that: 
  2.15     (1) meets the requirements of chapter 62T; 
  2.16     (2) services a geographic area located in outstate 
  2.17  Minnesota, excluding the city of Duluth; and 
  2.18     (3) is organized and operating before May 1, 2001. 
  2.19     The criteria used by the qualifying purchasing alliance for 
  2.20  membership must be approved by the commissioner of health.  The 
  2.21  commissioner of health shall approve any criteria needed in 
  2.22  order to receive grants from other public or private entities.  
  2.23  A qualifying purchasing alliance may begin enrolling qualifying 
  2.24  employers after July 1, 2001, with enrollment ending by December 
  2.25  31, 2003.  The commissioner of health may waive the requirement 
  2.26  described in clause (3) if this requirement inhibits the 
  2.27  commissioner's ability to obtain grants from other public or 
  2.28  private entities. 
  2.29     Sec. 2.  Minnesota Statutes 2002, section 256.956, 
  2.30  subdivision 2, is amended to read: 
  2.31     Subd. 2.  [CREATION OF ACCOUNT.] (a) A purchasing alliance 
  2.32  stop-loss fund account is established in the general fund.  The 
  2.33  commissioner shall use the money to establish a stop-loss fund 
  2.34  from which a health plan company may receive reimbursement for 
  2.35  claims paid for qualifying enrollees.  The account consists of 
  2.36  money appropriated by the legislature.  Money from the account 
  3.1   must be used for the stop-loss fund.  
  3.2      (b) The commissioner may accept grants from public or 
  3.3   private entities for the purpose of expanding the stop-loss fund.
  3.4   Any money received by the commissioner must be deposited in the 
  3.5   account and distributed in accordance with this section.  
  3.6      Sec. 3.  Minnesota Statutes 2002, section 256.956, 
  3.7   subdivision 3, is amended to read: 
  3.8      Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
  3.9   receive reimbursement from the fund for 90 percent of the 
  3.10  portion of the claim that exceeds payments made, less any 
  3.11  third-party recoveries, for claims incurred in a calendar year 
  3.12  for a qualifying enrollee for services that in aggregate 
  3.13  exceed $30,000 but not of the portion that exceeds of the 
  3.14  payments that exceed $100,000 in a calendar year for a 
  3.15  qualifying enrollee.  
  3.16     (b) Claims shall be reported and funds shall be distributed 
  3.17  on a calendar-year basis.  Claims incurred by a qualifying 
  3.18  enrollee are eligible for reimbursement for a two-year period 
  3.19  beginning from the date of enrollment.  During this two-year 
  3.20  period, claims shall be eligible for reimbursement only for the 
  3.21  calendar year in which the claims were paid incurred.  
  3.22     (c) Once claims paid incurred on behalf of a qualifying 
  3.23  enrollee reach $100,000 in a given calendar year, no further 
  3.24  claims may be submitted for reimbursement on behalf of that 
  3.25  enrollee in that calendar year.  
  3.26     (d) A portion of third-party recoveries that are collected 
  3.27  by a health plan company must be reimbursed by the health plan 
  3.28  company to the stop-loss fund account if the health plan company 
  3.29  received reimbursement under this subdivision for the original 
  3.30  claim.  The amount reimbursed must be 90 percent of the amount 
  3.31  of the recovery that reduces the aggregate incurred claims to 
  3.32  between $100,000 and $30,000 for the calendar year.  This amount 
  3.33  must also be reduced by any pro rata adjustment that was made 
  3.34  under subdivision 5, paragraph (b), to the original distribution 
  3.35  to the health plan company for that calendar year.  
  3.36     Sec. 4.  Minnesota Statutes 2002, section 256.956, 
  4.1   subdivision 4, is amended to read: 
  4.2      Subd. 4.  [REQUEST PROCESS.] (a) Each health plan company 
  4.3   must submit a request for reimbursement from the fund on a form 
  4.4   prescribed by the commissioner.  Requests for payment must be 
  4.5   submitted no later than April 1 following the end of the 
  4.6   calendar year for which the reimbursement request is being made, 
  4.7   beginning April 1, 2002. 
  4.8      (b) The commissioner may require a health plan company to 
  4.9   submit claims data as needed in connection with the 
  4.10  reimbursement request.  
  4.11     Sec. 5.  Minnesota Statutes 2002, section 256.956, 
  4.12  subdivision 5, is amended to read: 
  4.13     Subd. 5.  [DISTRIBUTION.] (a) The commissioner shall 
  4.14  calculate the total claims reimbursement amount for all 
  4.15  qualifying health plan companies for the calendar year for which 
  4.16  claims are being reported and shall distribute the stop-loss 
  4.17  funds on an annual basis before June 30 of the following 
  4.18  calendar year.  
  4.19     (b) In the event that the total amount requested for 
  4.20  reimbursement by the health plan companies for a calendar year 
  4.21  exceeds the funds available for distribution for claims paid by 
  4.22  all health plan companies during the same calendar year, the 
  4.23  commissioner shall provide for the pro rata distribution of the 
  4.24  available funds.  Each health plan company shall be eligible to 
  4.25  receive only a proportionate amount of the available funds as 
  4.26  the health plan company's total eligible claims paid compares to 
  4.27  the total eligible claims paid by all health plan companies.  
  4.28     (c) In the event that funds available for distribution for 
  4.29  claims paid by all health plan companies during a calendar year 
  4.30  exceed the total amount requested for reimbursement by all 
  4.31  health plan companies during the same calendar year, any excess 
  4.32  funds shall be reallocated for distribution in the next calendar 
  4.33  year and may carry over into the next biennium.  
  4.34     Sec. 6.  Minnesota Statutes 2002, section 256.956, 
  4.35  subdivision 9, is amended to read: 
  4.36     Subd. 9.  [SUNSET.] This section shall expire January 1, 
  5.1   2005, or when all funds deposited in the account have been 
  5.2   distributed, whichever is later.