1.1 	A bill for an act
1.2 	relating to health care; establishing a community-based health care coverage 
1.3 	program demonstration project; proposing coding for new law in Minnesota 
1.4 	Statutes, chapter 62A.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. [62A.67] COMMUNITY-BASED HEALTH CARE COVERAGE 
1.7 	PROGRAM.
1.8 		Subdivision 1.Scope. A community-based health care initiative may develop and 
1.9 	operate a community-based health care coverage program that offers to eligible individuals 
1.10 	and their dependents the option of purchasing through their employer health care coverage 
1.11 	on a fixed prepaid basis without meeting the requirements of chapter 60A, 62A, 62C, 62D, 
1.12 	62Q, or 62T, or any other law or rule that applies to entities licensed under these chapters.
1.13 		Subd. 2.Definitions.  For purposes of this section, the following definitions apply: 
1.14 	(a) "Community-based" means located in or primarily relating to the community 
1.15 	of geographically contiguous political subdivisions, as determined by the board of a 
1.16 	community-based health initiative that is served by the community-based health care 
1.17 	coverage program. 
1.18 	(b) "Community-based health care coverage program" or "program" means a 
1.19 	program administered by a community-based health initiative that provides health care 
1.20 	services through provider members of a community-based health network or combination 
1.21 	of networks to eligible individuals and their dependents who are enrolled in the program. 
1.22 	(c) "Community-based health initiative" means a nonprofit corporation that is 
1.23 	governed by a board that has at least 80 percent of its members residing in the community 
1.24 	and includes representatives of the participating network providers and employers. 
2.1 	(d) "Community-based health network" means a contract-based network organized 
2.2 	by the community-based health initiative to provide or support the delivery of health 
2.3 	care services to enrollees of the community-based health care coverage program on a 
2.4 	risk-sharing or nonrisk-sharing basis. 
2.5 	(e) "Dependent" means an eligible employee's spouse or unmarried child who is 
2.6 	under the age of 19 years. 
2.7 		Subd. 3.Approval.  Prior to the operation of a community-based health care 
2.8 	coverage program, a community-based health initiative shall submit to the commissioner 
2.9 	of health for approval the community-based health care coverage program developed by 
2.10 	the initiative. The commissioner shall only approve a program that has been awarded 
2.11 	a community access program grant from the United States Department of Health and 
2.12 	Human Services. The commissioner shall ensure that the program meets the federal grant 
2.13 	requirements and any requirements described in this section and is actuarially sound based 
2.14 	on a review of appropriate records and methods utilized by the community-based health 
2.15 	initiative in establishing premium rates for the community-based health care coverage 
2.16 	program. 
2.17 		Subd. 4.Establishment.  The initiative shall establish and operate upon approval 
2.18 	by the commissioner of health a community-based health care coverage program. The 
2.19 	operational structure established by the initiative shall include, but is not limited to: 
2.20 	(1) establishing a process for enrolling eligible individuals and their dependents; 
2.21 	(2) collecting and coordinating premiums from enrollees and employers of enrollees;
2.22 	(3) providing payment to participating providers; 
2.23 	(4) establishing a basic benefit set according to subdivision 7 and establishing 
2.24 	premium rates and cost-sharing requirements; 
2.25 	(5) creating incentives to encourage primary care and wellness services; and 
2.26 	(6) initiating disease management services, as appropriate. 
2.27 	The payments collected under clause (2) may be used to capture available federal 
2.28 	funds.
2.29 		Subd. 5.Qualifying employees.  To be eligible for the community-based health 
2.30 	care coverage program, an individual must: 
2.31 	(1) reside in or work within the designated community-based geographic area 
2.32 	served by the program; 
2.33 	(2) be employed by a qualifying employer or be an employee's dependent; 
2.34 	(3) have no other health coverage while enrolled; and 
2.35 	(4) not be enrolled in medical assistance, MinnesotaCare, or Medicare.
3.1 		Subd. 6.Qualifying employers.  (a) To qualify for participation in the 
3.2 	community-based health care coverage program, an employer must: 
3.3 	(1) employ at least one but no more than 50 employees at the time of initial 
3.4 	enrollment in the program; 
3.5 	(2) pay its employees a median wage of $12.50 per hour or less; and 
3.6 	(3) not have offered employer-subsidized health coverage to its employees for 
3.7 	at least 12 months prior to the initial enrollment in the program. For purposes of this 
3.8 	section, "employer-subsidized health coverage" means health care coverage for which the 
3.9 	employer pays at least 50 percent of the cost of coverage for the employee.
3.10 	(b) To participate in the program, a qualifying employer agrees to: 
3.11 	(1) offer health care coverage through the program to all eligible employees and 
3.12 	their dependents regardless of health status; 
3.13 	(2) participate in the program for an initial term of at least one year; and 
3.14 	(3) provide the initiative with any employee information deemed necessary by the 
3.15 	initiative to determine eligibility and premium payments. 
3.16 		Subd. 7.Coverage.  (a) The initiative shall establish the health care benefits offered 
3.17 	through the community-based health care coverage program. The benefits established 
3.18 	shall include, at a minimum: 
3.19 	(1) child health supervision services up to age 18, as defined under section 62A.047; 
3.20 	and 
3.21 	(2) preventive services, including: 
3.22 	(i) health education and wellness services; 
3.23 	(ii) health supervision, evaluation, and follow-up; 
3.24 	(iii) immunizations; and 
3.25 	(iv) early disease detection. 
3.26 	(b) Coverage of health care services offered by the program may be limited to 
3.27 	participating health care providers or health networks. All services covered under the 
3.28 	program must be services that are offered within the scope of practice of the participating 
3.29 	health care providers. 
3.30 	(c) The initiative may establish an annual aggregate benefit cap and cost-sharing 
3.31 	requirements. Any co-payment or deductible provisions established may not discriminate 
3.32 	on the basis of age, sex, race, disability, economic status, or length of enrollment in the 
3.33 	program. 
3.34 		Subd. 8.Enrollee information. (a) The initiative must provide an individual or 
3.35 	family who enrolls in the program a clear and concise written statement that includes 
3.36 	the following information: 
4.1 	(1) health care services that are provided under the program; 
4.2 	(2) any exclusions or limitations on the health care services offered, including any 
4.3 	cost-sharing arrangements or prior authorization requirements; 
4.4 	(3) a list of where the health care services can be obtained and the fact that all 
4.5 	health care services must be provided by or through a participating health care provider or 
4.6 	community-based health network; 
4.7 	(4) a description of the program's method for resolving enrollee complaints, 
4.8 	including how an enrollee can file a complaint with the Department of Health; and 
4.9 	(5) the conditions under which the program or coverage through the program may be 
4.10 	canceled or terminated. 
4.11 	(b) The commissioner of health must approve a copy of the written statement prior 
4.12 	to the operation of the program. 
4.13 		Subd. 9.Complaint process. The initiative must establish a complaint resolution 
4.14 	process. The process must ensure that complaints are resolved within 60 days of receiving 
4.15 	the complaint. The initiative must report any complaint that is not resolved within 60 
4.16 	days to the commissioner of health. 
4.17 		Subd. 10.Limitations on enrollment. (a) The initiative may limit enrollment in the 
4.18 	program. If enrollment is limited, a waiting list must be established. 
4.19 	(b) The initiative shall not restrict or deny enrollment in the program except for 
4.20 	nonpayment of premiums, fraud or misrepresentation, or as otherwise permitted under 
4.21 	this section. 
4.22 	(c) The initiative may require a certain percentage of participation from eligible 
4.23 	employees of a participating employer before coverage can be offered through the 
4.24 	program. 
4.25 		Subd. 11.Report.  (a) The initiative shall submit a report to the commissioner 
4.26 	of health and the legislature on or before March 15 of each year, beginning March 15, 
4.27 	2008. The report shall include: 
4.28 	(1) an analysis of the financial status of the program, including the premium rates, 
4.29 	cost per member per month, claims paid out, premiums received, and administrative 
4.30 	expenses; 
4.31 	(2) a description of the health care benefits offered and an analysis of the services 
4.32 	utilized; 
4.33 	(3) data on the number of employers participating, employees and dependents 
4.34 	covered under the program, and the number of health care providers participating; and 
4.35 	(4) any other information requested by the commissioner of health or the legislature. 
5.1 	(b) The report shall include any recommendations on improving and expanding the 
5.2 	community-based health care coverage program to other geographical areas of the state. 
5.3 		Subd. 12.Sunset. This section expires December 31, 2011.