3E Relating to health plan regulation; regulating policy and contract coverages; conforming state law to federal requirements; establishing a working group on health plan market rules

ARTICLE 1 - AFFORDABLE CARE ACT CONFORMITY

Expanding and modifying certain statutes to conform to the provisions of the federal affordable care act (ACA), including the federal Health Care and Education Reconciliation Act of 2010, and applicable regulations; modifying certain provisions relating to commissioner of management and budget contracting authority, Minnesota employees insurance program eligibility, classification of insurance contracts filing data, filing and content of policy forms by insurers for purposes of complying all qualified health plans offered through the Minnesota insurance marketplace with the ACA by including a grace period provision; modifying children's health supervision services and prenatal care services; modifying limitations of preauthorizations for emergencies, alcoholics and drug dependents benefits; modifying individual policy conversion provisions, including conversion privileges for insured former spouses and children, coverage for scalp hair prosthesis and coverage of dependents; modifying and conforming the scope of coverage for dependents by plans other than health plans, prohibiting restrictions, specifying compliance requirements, defining dependent, modifying preexisting conditions disclosure methods and certain individual market regulations, modifying individual health plan premium rate restrictions, modifying portability and conversion of coverage requirements; modifying provisions relating to nonprofit health service plan corporations subscriber contracts for disabled dependents and conversion privileges, health maintenance organizations (HMO) evidence of coverage, and enrollee cost sharing; defining essential health benefits under comprehensive health insurance, major medical coverages, minimum benefits of qualified number three plan; modifying the definition of dependent under the small employer insurance reform; excepting small group health plans offered through the Minnesota insurance marketplace (MNSure) from the small employer individual health plan definition; modifying certain underwriting restrictions; modifying restrictions relating to premium rates; modifying utilization review and appeals of health care procedures, health plan companies regulations and coverage requirements, insurance industry trade practices regulations, and municipal joint powers group benefits for officers, employees, and retirees; defining and redefining certain terms relating to health plan companies; prohibiting health plan recessions; providing for coverage for preventative items and services; modifying direct access to obstetric and gynecologic services; providing for coverage for participation in approved clinical trials; modifying certain emergency services provisions; providing for designation of primary care provider; specifying additional required information; prohibiting lifetime and annual limits; modifying certain complaint procedures; modifying enrollee notice provisions; modifying external review of adverse determinations; specifying essential health benefit package requirements; requiring a benefits and coverage explanation; modifying municipal joint powers for group benefits for dependents; repealing certain provisions relating to preexisting conditions disclosed at time of application, comprehensive health insurance individual market regulation guaranteed market regulation, the definition of dependent, policy conversion rights, and relationship to temporary federal high-risk pool, certain provisions relating to small employer plan benefits and phase-in, and audits conducted by independent organization accreditation requirements

ARTICLE 2 - HEALTH PLAN MARKET RULES

"Minnesota Health Plan Market Rules"; specifying applicability to individual market or small group market health plans; defining terms; specifying administrative procedures for enforcement; specifying metal levels (bronze, silver, gold) for mandatory offerings; specifying marketing standards, geographic accessibility, provider network adequacy, service area requirements, and limited scope dental plans; requiring the commissioner of commerce to convene a market rules working group to study and make recommendations on market requirement establishment with uniform application in individual and small group market health plans, specifying certain duties and membership requirements, providing an expiration date; repealing geographic accessibility
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