HF 107

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 01/13/2017 10:05am

A bill for an act
relating to government operation; providing a temporary program to help pay for
health insurance premiums; providing transition of care coverage; appropriating
money.

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

ARTICLE 1

PREMIUM ASSISTANCE

Section 1. new text begin PREMIUM ASSISTANCE PROGRAM ESTABLISHED.
new text end

new text begin The commissioner of Minnesota Management and Budget, in consultation with the
commissioner of commerce and the commissioner of revenue, shall establish and administer
a premium assistance program to help eligible individuals pay expenses for qualified health
coverage in 2017.
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

Sec. 2. new text begin DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin For purposes of sections 1 to 5, the following terms have the
meanings given, unless the context clearly indicates otherwise.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of Minnesota
Management and Budget.
new text end

new text begin Subd. 3. new text end

new text begin Eligible individual. new text end

new text begin "Eligible individual" means an individual who:
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new text begin (1) is a resident of Minnesota;
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new text begin (2) purchased qualified health coverage for calendar year 2017;
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new text begin (3) meets the income eligibility requirements under section 3, subdivision 3;
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new text begin (4) is not receiving a premium assistance credit under section 36B of the Internal Revenue
Code for calendar year 2017; and
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new text begin (5) is approved by the commissioner as qualifying for premium assistance.
new text end

new text begin Subd. 4. new text end

new text begin Health plan. new text end

new text begin "Health plan" has the meaning provided in Minnesota Statutes,
section 62A.011, subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Health plan company. new text end

new text begin "Health plan company" means a health carrier, as
defined in Minnesota Statutes, section 62A.011, subdivision 2, that provides qualified health
coverage in the individual market through MNsure or outside of MNsure to Minnesota
resident individuals in 2017.
new text end

new text begin Subd. 6. new text end

new text begin Individual market. new text end

new text begin "Individual market" means the individual market as defined
in Minnesota Statutes, section 62A.011, subdivision 5.
new text end

new text begin Subd. 7. new text end

new text begin Internal Revenue Code. new text end

new text begin "Internal Revenue Code" means the Internal Revenue
Code as amended through December 31, 2016.
new text end

new text begin Subd. 8. new text end

new text begin Modified adjusted gross income. new text end

new text begin "Modified adjusted gross income" means
the modified adjusted gross income for taxable year 2016, as defined in section 36B(d)(2)(B)
of the Internal Revenue Code.
new text end

new text begin Subd. 9. new text end

new text begin Premium assistance. new text end

new text begin "Premium assistance," "assistance amount," or "assistance"
means the amount allowed to an eligible individual as determined by the commissioner
under section 3 as a percentage of the qualified premium.
new text end

new text begin Subd. 10. new text end

new text begin Program. new text end

new text begin "Program" means the premium assistance program established
under section 1.
new text end

new text begin Subd. 11. new text end

new text begin Qualified health coverage. new text end

new text begin "Qualified health coverage" means health coverage
provided under a qualified health plan, as defined in Minnesota Statutes, section 62V.02,
subdivision 11, or provided under a health plan that meets the standards of a qualified health
plan except that it is not purchased through MNsure, and is:
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new text begin (1) offered to individuals in the individual market;
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new text begin (2) not a grandfathered health plan, as defined in section 36B of the Internal Revenue
Code; and
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new text begin (3) provided by a health plan company through MNsure or outside of MNsure.
new text end

new text begin Subd. 12. new text end

new text begin Qualified premium. new text end

new text begin "Qualified premium" means the premium for qualified
health coverage purchased by an eligible individual.
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

Sec. 3. new text begin PREMIUM ASSISTANCE AMOUNT.
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new text begin Subdivision 1. new text end

new text begin Applications by individuals; notification of eligibility. new text end

new text begin (a) An eligible
individual may apply to the commissioner to receive premium assistance under this section
at any time after purchase of qualified health coverage, but no later than January 31, 2018.
The commissioner shall prescribe the manner and form for applications, including requiring
any information the commissioner considers necessary or useful in determining whether an
applicant is eligible and the assistance amount allowed to the individual under this section.
The commissioner shall make application forms available on the agency's Web site.
new text end

new text begin (b) The commissioner shall notify applicants of their eligibility status under the program,
including, for applicants determined to be eligible, their premium assistance amount.
new text end

new text begin Subd. 2. new text end

new text begin Health plan companies. new text end

new text begin (a) By the first of each month, and any other times
the commissioner requires, each health plan company shall provide to the commissioner an
effectuated coverage list with the following information for each individual for whom it
provides qualified health coverage:
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new text begin (1) name, address, and age of each individual covered by the health plan, and any other
identifying information that the commissioner determines appropriate to administer the
program;
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new text begin (2) the qualified premium for the coverage;
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new text begin (3) whether the coverage is individual or family coverage;
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new text begin (4) whether the individual is receiving advance payment of the credit under section 36B
of the Internal Revenue Code; and
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new text begin (5) any additional information the commissioner determines appropriate to administer
the program.
new text end

new text begin (b) A health plan company must notify the commissioner of coverage terminations of
eligible individuals within ten business days.
new text end

new text begin (c) Each health plan company shall make the application forms developed by the
commissioner under subdivision 1 available on the company's Web site, and shall include
application forms with premium notices for individual health coverage.
new text end

new text begin Subd. 3. new text end

new text begin Income eligibility rules. new text end

new text begin (a) Individuals with incomes that meet the requirements
of this subdivision satisfy the income eligibility requirements for the program. For purposes
of this subdivision, "poverty line" has the meaning used in section 36B of the Internal
Revenue Code, except that modified adjusted gross income, as reported on the individual's
federal income tax return for tax year 2016, must be used instead of household income. For
married separate filers claiming eligibility for family coverage, modified adjusted gross
income equals the sum of that income reported by both spouses on their returns.
new text end

new text begin (b) Individuals are eligible for premium assistance if their modified adjusted gross income
is greater than 300 percent but does not exceed 800 percent of the poverty line.
new text end

new text begin Subd. 4. new text end

new text begin Determination of assistance amounts. new text end

new text begin (a) For the period January 1, 2017,
through December 31, 2017, eligible individuals qualify for premium assistance equal to
25 percent of the qualified premium for effectuated coverage.
new text end

new text begin (b) The commissioner shall determine premium assistance amounts as provided under
this subdivision so that the estimated sum of all premium assistance for eligible individuals
does not exceed the appropriation for this purpose. The commissioner may adjust premium
assistance amounts using a sliding scale based on income, if this is necessary to remain
within the limits of the appropriation.
new text end

new text begin Subd. 5. new text end

new text begin Provision of premium assistance to eligible individuals. new text end

new text begin (a) The commissioner
shall provide the premium assistance amount calculated under subdivision 4 on a monthly
basis to each eligible individual. The commissioner shall provide each eligible individual
with the option of receiving premium assistance through direct deposit to a financial
institution.
new text end

new text begin (b) If the commissioner, for administrative reasons, is unable to provide an eligible
individual with the premium assistance owed for one or more months for which the eligible
individual had effectuated coverage, the commissioner shall include the premium assistance
owed for that period with the premium assistance payment for the first month for which the
commissioner is able to provide premium assistance in a timely manner.
new text end

new text begin (c) The commissioner may require an eligible individual to provide any documentation
and substantiation of payment of the qualified premium that the commissioner considers
appropriate.
new text end

new text begin Subd. 6. new text end

new text begin Contracting. new text end

new text begin The commissioner may contract with a third-party administrator
to determine eligibility for and administer premium assistance under this section.
new text end

new text begin Subd. 7. new text end

new text begin Verification. new text end

new text begin The commissioner shall verify that persons applying for premium
assistance are residents of Minnesota. The commissioner may access information from the
Department of Employment and Economic Development and the Minnesota Department
of Revenue when verifying residency.
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

Sec. 4. new text begin AUDIT AND PROGRAM INTEGRITY.
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new text begin Subdivision 1. new text end

new text begin Audit. new text end

new text begin The legislative auditor shall audit implementation of the premium
assistance program by the commissioner to determine whether premium assistance payments
align with the criteria established in sections 2 and 3. The legislative auditor shall present
a report summarizing findings of the audit to the legislative committees with jurisdiction
over insurance and health by June 1, 2018.
new text end

new text begin Subd. 2. new text end

new text begin Program integrity. new text end

new text begin The commissioner of revenue shall ensure that only eligible
individuals, as defined in section 2, subdivision 3, have received premium assistance. The
commissioner of revenue shall review information available from Minnesota Management
and Budget, the Department of Human Services, MNsure, and the most recent Minnesota
tax records to identify ineligible individuals who received premium assistance. The
commissioner of revenue shall recover the amount of any premium assistance paid on behalf
of an ineligible individual from the ineligible individual, in the manner provided by law for
the collection of unpaid taxes or erroneously paid refunds of taxes.
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

Sec. 5. new text begin TRANSFER.
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new text begin $300,157,000 in fiscal year 2017 is transferred from the budget reserve account in
Minnesota Statutes, section 16A.152, subdivision 1a, to the general fund.
new text end

Sec. 6. new text begin APPROPRIATIONS.
new text end

new text begin (a) $285,000,000 in fiscal year 2017 is appropriated from the general fund to the
commissioner of Minnesota Management and Budget for purposes of providing premium
assistance under section 3. No more than three percent of this appropriation is available to
the commissioner for administrative costs. This is a onetime appropriation and is available
until June 30, 2018.
new text end

new text begin (b) $157,000 in fiscal year 2017 is appropriated from the general fund to the legislative
auditor to conduct the audit required by section 4. This is a onetime appropriation and is
available until expended.
new text end

ARTICLE 2

TRANSITION OF CARE COVERAGE

Section 1. new text begin TRANSITION OF CARE COVERAGE FOR CALENDAR YEAR 2017;
INVOLUNTARY TERMINATION OF COVERAGE.
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new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Enrollee" has the meaning given in Minnesota Statutes, section 62Q.01, subdivision
2b.
new text end

new text begin (c) "Health plan" has the meaning given in Minnesota Statutes, section 62Q.01,
subdivision 3.
new text end

new text begin (d) "Health plan company" has the meaning given in Minnesota Statutes, section 62Q.01,
subdivision 4.
new text end

new text begin (e) "Individual market" has the meaning given in Minnesota Statutes, section 62A.011,
subdivision 5.
new text end

new text begin (f) "Involuntary termination of coverage" means the termination of a health plan due to
a health plan company's refusal to renew the health plan in the individual market because
the health plan company elects to cease offering individual market health plans in all or
some geographic rating areas of the state.
new text end

new text begin Subd. 2. new text end

new text begin Application. new text end

new text begin This section applies to an enrollee who is subject to a change in
health plans in the individual market due to an involuntary termination of coverage from a
health plan in the individual market after October 31, 2016, and before January 1, 2017,
and who enrolls in a new health plan in the individual market for all or a portion of calendar
year 2017 that goes into effect after December 31, 2016, and before March 2, 2017.
new text end

new text begin Subd. 3. new text end

new text begin Change in health plans; transition of care coverage. new text end

new text begin (a) If an enrollee satisfies
the criteria in subdivision 2, the enrollee's new health plan company must provide, upon
request of the enrollee or the enrollee's health care provider, authorization to receive services
that are otherwise covered under the terms of the enrollee's calendar year 2017 health plan
from a provider who provided care on an in-network basis to the enrollee during calendar
year 2016 but who is out of network in the enrollee's calendar year 2017 health plan:
new text end

new text begin (1) for up to 120 days if the enrollee has received a diagnosis of, or is engaged in a
current course of treatment for, one or more of the following conditions:
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new text begin (i) an acute condition;
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new text begin (ii) a life-threatening mental or physical illness;
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new text begin (iii) pregnancy beyond the first trimester of pregnancy;
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new text begin (iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided the disability has lasted or can be expected to last for at least one
year or can be expected to result in death; or
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new text begin (v) a disabling or chronic condition that is in an acute phase; or
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new text begin (2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
new text end

new text begin (b) For all requests for authorization under this subdivision, the health plan company
must grant the request for authorization unless the enrollee does not meet the criteria in
paragraph (a) or subdivision 2.
new text end

new text begin (c) The commissioner of Minnesota Management and Budget must reimburse the
enrollee's new health plan company for costs attributed to services authorized under this
subdivision. Costs eligible for reimbursement under this paragraph are the difference between
the health plan company's reimbursement rate for in-network providers for a service
authorized under this subdivision and its rate for out-of-network providers for the service.
The health plan company must seek reimbursement from the commissioner for costs
attributed to services authorized under this subdivision, in a form and manner mutually
agreed upon by the commissioner and the affected health plan companies. Total state
reimbursements to health plan companies under this paragraph are subject to the limits of
the available appropriation. In the event that funding for reimbursements to health plan
companies is not sufficient to fully reimburse health plan companies for the costs attributed
to services authorized under this subdivision, health plan companies must continue to cover
services authorized under this subdivision.
new text end

new text begin Subd. 4. new text end

new text begin Limitations. new text end

new text begin (a) Subdivision 3 applies only if the enrollee's health care provider
agrees to:
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new text begin (1) accept as payment in full the lesser of:
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new text begin (i) the health plan company's reimbursement rate for in-network providers for the same
or similar service; or
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new text begin (ii) the provider's regular fee for that service;
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new text begin (2) request authorization for services in the form and manner specified by the enrollee's
new health plan company, if the provider chooses to request authorization; and
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new text begin (3) provide the enrollee's new health plan company with all necessary medical information
related to the care provided to the enrollee.
new text end

new text begin (b) Nothing in this section requires a health plan company to provide coverage for a
health care service or treatment that is not covered under the enrollee's health plan.
new text end

new text begin Subd. 5. new text end

new text begin Request for authorization. new text end

new text begin The enrollee's health plan company may require
medical records and other supporting documentation to be submitted with a request for
authorization under subdivision 3. If authorization is denied, the health plan company must
explain the criteria used to make its decision on the request for authorization and must
explain the enrollee's right to appeal the decision. If an enrollee chooses to appeal a denial,
the enrollee must appeal the denial within five business days of the date on which the enrollee
receives the denial. If authorization is granted, the health plan company must provide the
enrollee, within five business days of granting the authorization, with an explanation of
how transition of care will be provided.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans issued after December
31, 2016, and before March 2, 2017, and that are in effect for all or a portion of calendar
year 2017. This section expires June 30, 2018.
new text end

Sec. 2. new text begin APPROPRIATION; COVERAGE FOR TRANSITION OF CARE.
new text end

new text begin $15,000,000 in fiscal year 2017 is appropriated from the general fund to the commissioner
of Minnesota Management and Budget to reimburse health plan companies for costs attributed
to coverage of transition of care services under section 1. No more than three percent of
this appropriation is available to the commissioner for administrative costs. This is a onetime
appropriation and is available until expended.
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