HF 8

2nd Engrossment - 87th Legislature (2011 - 2012) Posted on 02/28/2011 03:12pm

A bill for an act
relating to human services; establishing the healthy Minnesota contribution
program; requiring plan to redesign service delivery for lower-income
MinnesotaCare enrollees; requiring the Minnesota Comprehensive Health
Association to offer a high-deductible, basic plan; requiring the commissioner
of human services to seek federal waivers; amending Minnesota Statutes 2010,
sections 62E.08, subdivision 1; 62E.14, by adding a subdivision; 256B.04,
subdivision 18; 256L.05, by adding a subdivision; proposing coding for new law
in Minnesota Statutes, chapters 62E; 256L.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2010, section 62E.08, subdivision 1, is amended to read:

Subdivision 1.

Establishment.

The association shall establish the following
maximum premiums to be charged for membership in the comprehensive health insurance
plan:

(a) the premium for the number one qualified plan shall range from a minimum of
101 percent to a maximum of 125 percent of the weighted average of rates charged by
those insurers and health maintenance organizations with individuals enrolled in:

(1) $1,000 annual deductible individual plans of insurance in force in Minnesota;

(2) individual health maintenance organization contracts of coverage with a $1,000
annual deductible which are in force in Minnesota; and

(3) other plans of coverage similar to plans offered by the association based on
generally accepted actuarial principles;

(b) the premium for the number two qualified plan shall range from a minimum of
101 percent to a maximum of 125 percent of the weighted average of rates charged by
those insurers and health maintenance organizations with individuals enrolled in:

(1) $500 annual deductible individual plans of insurance in force in Minnesota;

(2) individual health maintenance organization contracts of coverage with a $500
annual deductible which are in force in Minnesota; and

(3) other plans of coverage similar to plans offered by the association based on
generally accepted actuarial principles;

(c) the premiums for the plans with a $2,000, $5,000, or $10,000 annual deductible
shall range from a minimum of 101 percent to a maximum of 125 percent of the weighted
average of rates charged by those insurers and health maintenance organizations with
individuals enrolled in:

(1) $2,000, $5,000, or $10,000 annual deductible individual plans, respectively, in
force in Minnesota; and

(2) individual health maintenance organization contracts of coverage with a $2,000,
$5,000, or $10,000 annual deductible, respectively, which are in force in Minnesota; or

(3) other plans of coverage similar to plans offered by the association based on
generally accepted actuarial principles;

(d) the premium for each type of Medicare supplement plan required to be offered
by the association pursuant to section 62E.12 shall range from a minimum of 101 percent
to a maximum of 125 percent of the weighted average of rates charged by those insurers
and health maintenance organizations with individuals enrolled in:

(1) Medicare supplement plans in force in Minnesota;

(2) health maintenance organization Medicare supplement contracts of coverage
which are in force in Minnesota; and

(3) other plans of coverage similar to plans offered by the association based on
generally accepted actuarial principles; deleted text begin and
deleted text end

(e) the charge for health maintenance organization coverage shall be based on
generally accepted actuarial principles deleted text begin . deleted text end new text begin ; and
new text end

new text begin (f) the premium for a high-deductible, basic plan offered under section 62E.121 shall
range from a minimum of 101 percent to a maximum of 125 percent of the weighted
average of rates charged by those insurers and health maintenance organizations offering
comparable plans outside of the Minnesota Comprehensive Health Association.
new text end

The list of insurers and health maintenance organizations whose rates are used to
establish the premium for coverage offered by the association pursuant to paragraphs (a)
to (d) new text begin and (f) new text end shall be established by the commissioner on the basis of information which
shall be provided to the association by all insurers and health maintenance organizations
annually at the commissioner's request. This information shall include the number of
individuals covered by each type of plan or contract specified in paragraphs (a) to (d) new text begin and
(f) new text end that is sold, issued, and renewed by the insurers and health maintenance organizations,
including those plans or contracts available only on a renewal basis. The information shall
also include the rates charged for each type of plan or contract.

In establishing premiums pursuant to this section, the association shall utilize
generally accepted actuarial principles, provided that the association shall not discriminate
in charging premiums based upon sex. In order to compute a weighted average for each
type of plan or contract specified under paragraphs (a) to (d) new text begin and (f) new text end , the association
shall, using the information collected pursuant to this subdivision, list insurers and health
maintenance organizations in rank order of the total number of individuals covered by
each insurer or health maintenance organization. The association shall then compute
a weighted average of the rates charged for coverage by all the insurers and health
maintenance organizations by:

(1) multiplying the numbers of individuals covered by each insurer or health
maintenance organization by the rates charged for coverage;

(2) separately summing both the number of individuals covered by all the insurers
and health maintenance organizations and all the products computed under clause (1); and

(3) dividing the total of the products computed under clause (1) by the total number
of individuals covered.

The association may elect to use a sample of information from the insurers and
health maintenance organizations for purposes of computing a weighted average. In no
case, however, may a sample used by the association to compute a weighted average
include information from fewer than the two insurers or health maintenance organizations
highest in rank order.

Sec. 2.

new text begin [62E.121] HIGH-DEDUCTIBLE, BASIC PLAN.
new text end

new text begin Subdivision 1. new text end

new text begin Required offering. new text end

new text begin The Minnesota Comprehensive Health
Association shall offer a high-deductible, basic plan that meets the requirements specified
in this section. The high-deductible, basic plan is a one-person plan. Any dependents
must be covered separately.
new text end

new text begin Subd. 2. new text end

new text begin Annual deductible; out-of-pocket maximum. new text end

new text begin (a) The plan shall provide
the following in-network annual deductible options: $3,000, $6,000, $9,000, and $12,000.
The in-network annual out-of-pocket maximum for each annual deductible option shall be
$1,000 greater than the amount of the annual deductible.
new text end

new text begin (b) The deductible is subject to an annual increase based on the change in the
Consumer Price Index (CPI).
new text end

new text begin Subd. 3. new text end

new text begin Office visits for nonpreventive care. new text end

new text begin The following co-payments shall
apply for each of the first three office visits per calendar year for nonpreventive care:
new text end

new text begin (1) $30 per visit for the $3,000 annual deductible option;
new text end

new text begin (2) $40 per visit for the $6,000 annual deductible option;
new text end

new text begin (3) $50 per visit for the $9,000 annual deductible option; and
new text end

new text begin (4) $60 per visit for the $12,000 annual deductible option.
new text end

new text begin For the fourth and subsequent visits during the calendar year, 80 percent coverage is
provided under all deductible options, after the deductible is met.
new text end

new text begin Subd. 4. new text end

new text begin Preventive care. new text end

new text begin One hundred percent coverage is provided for preventive
care, and no co-payment, coinsurance, or deductible requirements apply.
new text end

new text begin Subd. 5. new text end

new text begin Prescription drugs. new text end

new text begin A $10 co-payment applies to preferred generic drugs.
Preferred brand-name drugs require an enrollee payment of 100 percent of the health
plan's discounted rate.
new text end

new text begin Subd. 6. new text end

new text begin Convenience care center visits. new text end

new text begin A $20 co-payment applies for the first
three convenience care center visits during a calendar year. For the fourth and subsequent
visits during a calendar year, 80 percent coverage is provided after the deductible is met.
new text end

new text begin Subd. 7. new text end

new text begin Urgent care center visits. new text end

new text begin A $100 co-payment applies for the first urgent
care center visit during a calendar year. For the second and subsequent visits during a
calendar year, 80 percent coverage is provided after the deductible is met.
new text end

new text begin Subd. 8. new text end

new text begin Emergency room visits. new text end

new text begin A $200 co-payment applies for the first
emergency room visit during a calendar year. For the second and subsequent visits during
a calendar year, 80 percent coverage is provided after the deductible is met.
new text end

new text begin Subd. 9. new text end

new text begin Lab and x-ray; hospital services; ambulance; surgery. new text end

new text begin Lab and x-ray
services, hospital services, ambulance services, and surgery are covered at 80 percent
after the deductible is met.
new text end

new text begin Subd. 10. new text end

new text begin Eyewear. new text end

new text begin The health plan pays up to $50 per calendar year for eyewear.
new text end

new text begin Subd. 11. new text end

new text begin Maternity. new text end

new text begin Maternity, labor and delivery, and postpartum care are not
covered. One hundred percent coverage is provided for prenatal care and no deductible
applies.
new text end

new text begin Subd. 12. new text end

new text begin Other eligible health care services. new text end

new text begin Other eligible health care services
are covered at 80 percent after the deductible is met.
new text end

new text begin Subd. 13. new text end

new text begin Option to remove mental health and substance abuse coverage.
new text end

new text begin Enrollees have the option of removing mental health and substance abuse coverage in
exchange for a reduced premium.
new text end

new text begin Subd. 14. new text end

new text begin Option to upgrade prescription drug coverage. new text end

new text begin Enrollees have
the option to upgrade prescription drug coverage to include coverage for preferred
brand-name drugs with a $50 co-payment and coverage for nonpreferred drugs with a
$100 co-payment in exchange for an increased premium.
new text end

new text begin Subd. 15. new text end

new text begin Out-of-network services. new text end

new text begin (a) The out-of-network annual deductible is
double the in-network annual deductible.
new text end

new text begin (b) There is no out-of-pocket maximum for out-of-network services.
new text end

new text begin (c) Benefits for out-of-network services are covered at 60 percent after the deductible
is met.
new text end

new text begin (d) The lifetime maximum benefit for out-of-network services is $1,000,000.
new text end

new text begin Subd. 16. new text end

new text begin Services not covered. new text end

new text begin Services not covered include: custodial care
or rest care; most dental services; cosmetic services; refractive eye surgery; infertility
services; and services that are investigational, not medically necessary, or received while
on military duty.
new text end

Sec. 3.

Minnesota Statutes 2010, section 62E.14, is amended by adding a subdivision
to read:

new text begin Subd. 4f. new text end

new text begin Waiver of preexisting conditions for persons covered by healthy
Minnesota contribution program. new text end

new text begin A person may enroll in the comprehensive plan with
a waiver of the preexisting condition limitation in subdivision 3 if the person is eligible for
the healthy Minnesota contribution program, and has been denied coverage as described
under section 256L.031, subdivision 6.
new text end

Sec. 4.

Minnesota Statutes 2010, section 256B.04, subdivision 18, is amended to read:

Subd. 18.

Applications for medical assistance.

new text begin (a) new text end The state agency may
take applications for medical assistance and conduct eligibility determinations for
MinnesotaCare enrollees.

new text begin (b) The commissioner of human services shall modify the Minnesota health care
programs application form to add a question asking applicants: "Are you a U.S. military
veteran?"
new text end

Sec. 5.

new text begin [256L.031] HEALTHY MINNESOTA CONTRIBUTION PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Defined contributions to enrollees. new text end

new text begin (a) Beginning January 1, 2012,
the commissioner shall provide each MinnesotaCare enrollee eligible under section
256L.04, subdivision 7, with gross family income equal to or greater than 133 percent
of the federal poverty guidelines, with a monthly defined contribution to purchase health
coverage under a health plan as defined in section 62A.011, subdivision 3. Beginning
January 1, 2012, or upon federal approval, whichever is later, the commissioner shall
provide each MinnesotaCare enrollee eligible under section 256L.04, subdivision 1, with
gross family income equal to or greater than 133 percent of the federal poverty guidelines,
with a monthly defined contribution to purchase health coverage under a health plan as
defined in section 62A.011, subdivision 3, offered by a health plan company as defined
in section 62Q.01, subdivision 4.
new text end

new text begin (b) Enrollees eligible under paragraph (a) shall not be charged premiums under
section 256L.15 and are exempt from the managed care enrollment requirement of section
256L.12.
new text end

new text begin (c) Sections 256L.03; 256L.05, subdivision 3; and 256L.11 do not apply to
enrollees eligible under paragraph (a). Covered services, cost-sharing, disenrollment
for nonpayment of premium, enrollee appeal rights and complaint procedures, and the
effective date of coverage for enrollees eligible under paragraph (a) shall be as provided
under the terms of the health plan purchased by the enrollee.
new text end

new text begin (d) Unless otherwise provided in this section, all MinnesotaCare requirements
related to eligibility, income and asset methodology, income reporting, and program
administration continue to apply to enrollees obtaining coverage under this section.
new text end

new text begin Subd. 2. new text end

new text begin Use of defined contribution. new text end

new text begin An enrollee may use up to the monthly
defined contribution to pay premiums for coverage under a health plan as defined in
section 62A.011, subdivision 3.
new text end

new text begin Subd. 3. new text end

new text begin Determination of defined contribution amount. new text end

new text begin (a) The commissioner
shall determine the defined contribution sliding scale using the base contribution specified
in paragraph (b) for the specified age ranges. The commissioner shall use a sliding scale
for defined contributions that provides:
new text end

new text begin (1) persons with household incomes equal to 133 percent of the federal poverty
guidelines with a defined contribution of 150 percent of the base contribution;
new text end

new text begin (2) persons with household incomes equal to 175 percent of the federal poverty
guidelines with a defined contribution of 100 percent of the base contribution;
new text end

new text begin (3) persons with household incomes equal to or greater than 250 percent of
the federal poverty guidelines with a defined contribution of 80 percent of the base
contribution; and
new text end

new text begin (4) persons with household incomes in evenly spaced increments between the
percentages of the federal poverty guideline specified in clauses (1) to (3) with a base
contribution that is a percentage interpolated from the defined contribution percentages
specified in clauses (1) to (3).
new text end

new text begin Age new text end	new text begin Monthly Per-Person Base Contribution new text end
new text begin Under 21 new text end	new text begin $122.79 new text end
new text begin 21-29 new text end	new text begin 122.79 new text end
new text begin 30-31 new text end	new text begin 129.19 new text end
new text begin 32-33 new text end	new text begin 132.38 new text end
new text begin 34-35 new text end	new text begin 134.31 new text end
new text begin 36-37 new text end	new text begin 136.06 new text end
new text begin 38-39 new text end	new text begin 141.02 new text end
new text begin 40-41 new text end	new text begin 151.25 new text end
new text begin 42-43 new text end	new text begin 159.89 new text end
new text begin 44-45 new text end	new text begin 175.08 new text end
new text begin 46-47 new text end	new text begin 191.71 new text end
new text begin 48-49 new text end	new text begin 213.13 new text end
new text begin 50-51 new text end	new text begin 239.51 new text end
new text begin 52-53 new text end	new text begin 266.69 new text end
new text begin 54-55 new text end	new text begin 293.88 new text end
new text begin 56-57 new text end	new text begin 323.77 new text end
new text begin 58-59 new text end	new text begin 341.20 new text end
new text begin 60+ new text end	new text begin 357.19 new text end

new text begin (b) The commissioner shall multiply the defined contribution amounts developed
under paragraph (a) by 1.20 for enrollees who are denied coverage under an individual
health plan by a health plan company and who purchase coverage through the Minnesota
Comprehensive Health Association.
new text end

new text begin (c) Notwithstanding paragraphs (a) and (b), the monthly defined contribution shall
not exceed 90 percent of the monthly premium for the health plan purchased by the
enrollee. If the enrollee purchases coverage under a health plan that does not include
mental health services and chemical dependency treatment services, the monthly defined
contribution amount determined under this subdivision shall be reduced by five percent.
new text end

new text begin Subd. 4. new text end

new text begin Administration by commissioner. new text end

new text begin The commissioner shall administer the
defined contributions. The commissioner shall:
new text end

new text begin (1) calculate and process defined contributions for enrollees; and
new text end

new text begin (2) pay the defined contribution amount to health plan companies or the Minnesota
Comprehensive Health Association, as applicable, for enrollee health plan coverage.
new text end

new text begin Subd. 5. new text end

new text begin Assistance to enrollees. new text end

new text begin The commissioner of human services, in
consultation with the commissioner of commerce, shall develop an efficient and
cost-effective method of referring eligible applicants to professional insurance agent
associations.
new text end

new text begin Subd. 6. new text end

new text begin Minnesota Comprehensive Health Association (MCHA). new text end

new text begin Beginning
January 1, 2012, MinnesotaCare enrollees who are denied coverage under an individual
health plan by a health plan company are eligible for coverage through a health plan
offered by the MCHA and may enroll in MCHA according to section 62E.14. Any
difference between the revenue and covered losses to the MCHA related to implementation
of this section shall be paid to the MCHA from the health care access fund.
new text end

new text begin Subd. 7. new text end

new text begin Federal approval. new text end

new text begin The commissioner shall seek all federal waivers
and approvals necessary to implement coverage under this section for MinnesotaCare
enrollees eligible under section 256L.04, subdivision 1, with gross family incomes equal
to or greater than 133 percent of the federal poverty guidelines, while continuing to
receive federal matching funds.
new text end

Sec. 6.

Minnesota Statutes 2010, section 256L.05, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Referral of veterans. new text end

new text begin The commissioner shall ensure that all applicants
for MinnesotaCare with incomes less than 133 percent of the federal poverty guidelines
who identify themselves as veterans are referred to a county veterans service officer for
assistance in applying to the United States Department of Veterans Affairs for any veterans
benefits for which they may be eligible.
new text end

Sec. 7. new text begin COVERAGE FOR LOWER-INCOME MINNESOTACARE
ENROLLEES.
new text end

new text begin The commissioner of human services shall develop and present to the legislature,
by December 15, 2011, a plan to redesign service delivery for MinnesotaCare enrollees
eligible under Minnesota Statutes, section 256L.04, subdivisions 1 and 7, with incomes
less than 133 percent of the federal poverty guidelines. The plan must be designed to
improve continuity and quality of care, reduce unnecessary emergency room visits, and
reduce average per-enrollee costs. In developing the plan, the commissioner shall consider
innovative methods of service delivery, including but not limited to increasing the use
and choice of private sector health plan coverage and encouraging the use of community
health clinics, as defined in the federal Community Health Care Act of 1964, as health
care homes.
new text end

Sec. 8. new text begin DIRECTION TO COMMISSIONER; FEDERAL WAIVERS.
new text end

new text begin (a) The commissioner of human services shall apply to the Centers for Medicare
and Medicaid Services (CMS) for federal waivers to cover:
new text end

new text begin (1) families with children eligible under Minnesota Statutes, section 256L.04,
subdivision 1; and
new text end

new text begin (2) adults eligible under Minnesota Statutes, section 256L.04, subdivision 1,
under the MinnesotaCare healthy Minnesota contribution program established under
Minnesota Statutes, section 256L.031, by July 1, 2011. The commissioner shall report to
the legislative committees with jurisdiction over health and human services policy and
finance whether or not the federal waiver application was accepted within ten working
days of receipt of the decision.
new text end

new text begin (b) The commissioner of human services shall apply to the CMS for a section
1115(a) demonstration waiver, and any other necessary federal waivers and amendments,
including, but not limited to, a waiver of the appropriate sections of title XIX, United
States Code, title 42, section 1396a, and a waiver of the maintenance of effort provisions
in section 2001 of the Patient Protection and Affordable Care Act, Public Law 111-148,
that would provide Minnesota with medical assistance program flexibility in exchange
for federal budget certainty. The commissioner shall seek federal approval to enter into
an agreement with CMS under which Minnesota would:
new text end

new text begin (1) accept an aggregate annual allotment for the medical assistance program, trended
forward at an agreed upon rate, with protections to cover medical inflation and projected
caseload growth; and
new text end

new text begin (2) receive federal waivers of Medicaid requirements related to: statewideness and
comparability of services; the amount, duration, and scope of services; freedom of choice;
cost-sharing; and other areas of program administration specified by the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end