2nd Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to insurance; regulating Medicare supplement 1.3 insurance; conforming state law to the minimum federal 1.4 standards; regulating loss ratios on health coverages; 1.5 requiring evaluation of certain mandated health 1.6 benefit proposals; amending Minnesota Statutes 2002, 1.7 sections 62A.021, subdivision 1; 62A.31, subdivisions 1.8 1f, 1u, by adding a subdivision; 62A.315; 62A.316; 1.9 62J.52, subdivisions 1, 2; proposing coding for new 1.10 law in Minnesota Statutes, chapter 62J. 1.11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.12 ARTICLE 1 1.13 MEDICARE SUPPLEMENT COVERAGE 1.14 Section 1. Minnesota Statutes 2002, section 62A.31, 1.15 subdivision 1f, is amended to read: 1.16 Subd. 1f. [SUSPENSION BASED ON ENTITLEMENT TO MEDICAL 1.17 ASSISTANCE.] (a) The policy or certificate must provide that 1.18 benefits and premiums under the policy or certificate shall be 1.19 suspended for any period that may be provided by federal 1.20 regulation at the request of the policyholder or certificate 1.21 holder for the period, not to exceed 24 months, in which the 1.22 policyholder or certificate holder has applied for and is 1.23 determined to be entitled to medical assistance under title XIX 1.24 of the Social Security Act, but only if the policyholder or 1.25 certificate holder notifies the issuer of the policy or 1.26 certificate within 90 days after the date the individual becomes 1.27 entitled to this assistance. 1.28 (b) If suspension occurs and if the policyholder or 2.1 certificate holder loses entitlement to this medical assistance, 2.2 the policy or certificate shall be automatically reinstated, 2.3 effective as of the date of termination of this entitlement, if 2.4 the policyholder or certificate holder provides notice of loss 2.5 of the entitlement within 90 days after the date of the loss and 2.6 pays the premium attributable to the period, effective as of the 2.7 date of termination of entitlement. 2.8 (c) The policy must provide that upon reinstatement (1) 2.9 there is no additional waiting period with respect to treatment 2.10 of preexisting conditions, (2) coverage is provided which is 2.11 substantially equivalent to coverage in effect before the date 2.12 of the suspension, and (3) premiums are classified on terms that 2.13 are at least as favorable to the policyholder or certificate 2.14 holder as the premium classification terms that would have 2.15 applied to the policyholder or certificate holder had coverage 2.16 not been suspended. 2.17 Sec. 2. Minnesota Statutes 2002, section 62A.31, 2.18 subdivision 1u, is amended to read: 2.19 Subd. 1u. [GUARANTEED ISSUE FOR ELIGIBLE PERSONS.] (a)(1) 2.20 Eligible persons are those individuals described in paragraph 2.21 (b) who
apply to enroll under the Medicare supplement policy not2.22 later than 63 days after the date of the termination of2.23 enrollment described in paragraph (b),seek to enroll under the 2.24 policy during the period specified in paragraph (c), and who 2.25 submit evidence of the date of termination or disenrollment with 2.26 the application for a Medicare supplement policy. 2.27 (2) With respect to eligible persons, an issuer shall not: 2.28 deny or condition the issuance or effectiveness of a Medicare 2.29 supplement policy described in paragraph (c) that is offered and 2.30 is available for issuance to new enrollees by the issuer; 2.31 discriminate in the pricing of such a Medicare supplement policy 2.32 because of health status, claims experience, receipt of health 2.33 care, medical condition, or age; or impose an exclusion of 2.34 benefits based upon a preexisting condition under such a 2.35 Medicare supplement policy. 2.36 (b) An eligible person is an individual described in any of 3.1 the following: 3.2 (1) the individual is enrolled under an employee welfare 3.3 benefit plan that provides health benefits that supplement the 3.4 benefits under Medicare; and the plan terminates, or the plan 3.5 ceases to provide all such supplemental health benefits to the 3.6 individual; 3.7 (2) the individual is enrolled with a Medicare+Choice 3.8 organization under a Medicare+Choice plan under Medicare part C, 3.9 and any of the following circumstances apply, or the individual 3.10 is 65 years of age or older and is enrolled with a Program of 3.11 All-Inclusive Care for the Elderly (PACE) provider under section 3.12 1894 of the federal Social Security Act, and there are 3.13 circumstances similar to those described in this clause that 3.14 would permit discontinuance of the individual's enrollment with 3.15 the provider if the individual were enrolled in a 3.16 Medicare+Choice plan: 3.17 (i) the organization's or plan's certification under 3.18 Medicare part C has been terminated or the organization has 3.19 terminated or otherwise discontinued providing the plan in the 3.20 area in which the individual resides; 3.21 (ii) the individual is no longer eligible to elect the plan 3.22 because of a change in the individual's place of residence or 3.23 other change in circumstances specified by the secretary, but 3.24 not including termination of the individual's enrollment on the 3.25 basis described in section 1851(g)(3)(B) of the federal Social 3.26 Security Act, United States Code, title 42, section 3.27 1395w-21(g)(3)(b) (where the individual has not paid premiums on 3.28 a timely basis or has engaged in disruptive behavior as 3.29 specified in standards under section 1856 of the federal Social 3.30 Security Act, United States Code, title 42, section 1395w-26), 3.31 or the plan is terminated for all individuals within a residence 3.32 area; 3.33 (iii) the individual demonstrates, in accordance with 3.34 guidelines established by the Secretary, that: 3.35 (A) the organization offering the plan substantially 3.36 violated a material provision of the organization's contract in 4.1 relation to the individual, including the failure to provide an 4.2 enrollee on a timely basis medically necessary care for which 4.3 benefits are available under the plan or the failure to provide 4.4 such covered care in accordance with applicable quality 4.5 standards; or 4.6 (B) the organization, or agent or other entity acting on 4.7 the organization's behalf, materially misrepresented the plan's 4.8 provisions in marketing the plan to the individual; or 4.9 (iv) the individual meets such other exceptional conditions 4.10 as the secretary may provide; 4.11 (3)(i) the individual is enrolled with: 4.12 (A) an eligible organization under a contract under section 4.13 1876 of the federal Social Security Act, United States Code, 4.14 title 42, section 1395mm (Medicare risk orcost); 4.15 (B) a similar organization operating under demonstration 4.16 project authority, effective for periods before April 1, 1999; 4.17 (C) an organization under an agreement under section 4.18 1833(a)(1)(A) of the federal Social Security Act, United States 4.19 Code, title 42, section 1395l(a)(1)(A) (health care prepayment 4.20 plan); or 4.21 (D) an organization under a Medicare Select policy under 4.22 section 62A.318 or the similar law of another state; and 4.23 (ii) the enrollment ceases under the same circumstances 4.24 that would permit discontinuance of an individual's election of 4.25 coverage under clause (2); 4.26 (4) the individual is enrolled under a Medicare supplement 4.27 policy, and the enrollment ceases because: 4.28 (i)(A) of the insolvency of the issuer or bankruptcy of the 4.29 nonissuer organization; or 4.30 (B) of other involuntary termination of coverage or 4.31 enrollment under the policy; 4.32 (ii) the issuer of the policy substantially violated a 4.33 material provision of the policy; or 4.34 (iii) the issuer, or an agent or other entity acting on the 4.35 issuer's behalf, materially misrepresented the policy's 4.36 provisions in marketing the policy to the individual; 5.1 (5)(i) the individual was enrolled under a Medicare 5.2 supplement policy and terminates that enrollment and 5.3 subsequently enrolls, for the first time, with any 5.4 Medicare+Choice organization under a Medicare+Choice plan under 5.5 Medicare part C; any eligible organization under a contract 5.6 under section 1876 of the federal Social Security Act, United 5.7 States Code, title 42, section 1395mm (Medicare risk orcost); 5.8 any similar organization operating under demonstration project 5.9 authority; an organization under an agreement under section5.10 1833(a)(1)(A) of the federal Social Security Act, United States5.11 Code, title 42, section 1395l(a)(1)(A) (health care prepayment5.12 plan);any PACE provider under section 1894 of the federal 5.13 Social Security Act, or a Medicare Select policy under section 5.14 62A.318 or the similar law of another state; and 5.15 (ii) the subsequent enrollment under paragraph (a)item (i) 5.16 is terminated by the enrollee during any period within the first 5.17 12 months of suchthe subsequent enrollment during which the 5.18 enrollee is permitted to terminate the subsequent enrollment 5.19 under section 1851(e) of the federal Social Security Act; or 5.20 (6) the individual, upon first enrolling for benefits under 5.21 Medicare part B, enrolls in a Medicare+Choice plan under 5.22 Medicare part C, or with a PACE provider under section 1894 of 5.23 the federal Social Security Act, and disenrolls from the plan by 5.24 not later than 12 months after the effective date of enrollment. 5.25 (c)(1) In the case of an individual described in paragraph 5.26 (b), clause (1), the guaranteed issue period begins on the date 5.27 the individual receives a notice of termination or cessation of 5.28 all supplemental health benefits or, if a notice is not 5.29 received, notice that a claim has been denied because of a 5.30 termination or cessation, and ends 63 days after the date of the 5.31 applicable notice. 5.32 (2) In the case of an individual described in paragraph 5.33 (b), clause (2), (3), (5), or (6), whose enrollment is 5.34 terminated involuntarily, the guaranteed issue period begins on 5.35 the date that the individual receives a notice of termination 5.36 and ends 63 days after the date the applicable coverage is 6.1 terminated. 6.2 (3) In the case of an individual described in paragraph 6.3 (b), clause (4)(i), the guaranteed issue period begins on the 6.4 earlier of: (i) the date that the individual receives a notice 6.5 of termination, a notice of the issuer's bankruptcy or 6.6 insolvency, or other such similar notice if any; and (ii) the 6.7 date that the applicable coverage is terminated, and ends on the 6.8 date that is 63 days after the date the coverage is terminated. 6.9 (4) In the case of an individual described in paragraph 6.10 (b), clause (2), (4), (5), or (6), who disenrolls voluntarily, 6.11 the guaranteed issue period begins on the date that is 60 days 6.12 before the effective date of the disenrollment and ends on the 6.13 date that is 63 days after the effective date. 6.14 (5) In the case of an individual described in paragraph (b) 6.15 but not described in this paragraph, the guaranteed issue period 6.16 begins on the effective date of disenrollment and ends on the 6.17 date that is 63 days after the effective date. 6.18 (d)(1) In the case of an individual described in paragraph 6.19 (b), clause (5), or deemed to be so described, pursuant to this 6.20 paragraph, whose enrollment with an organization or provider 6.21 described in paragraph (b), clause (5)(i), is involuntarily 6.22 terminated within the first 12 months of enrollment, and who, 6.23 without an intervening enrollment, enrolls with another such 6.24 organization or provider, the subsequent enrollment is deemed to 6.25 be an initial enrollment described in paragraph (b), clause (5). 6.26 (2) In the case of an individual described in paragraph 6.27 (b), clause (6), or deemed to be so described, pursuant to this 6.28 paragraph, whose enrollment with a plan or in a program 6.29 described in paragraph (b), clause (6), is involuntarily 6.30 terminated within the first 12 months of enrollment, and who, 6.31 without an intervening enrollment, enrolls in another such plan 6.32 or program, the subsequent enrollment is deemed to be an initial 6.33 enrollment described in paragraph (b), clause (6). 6.34 (3) For purposes of paragraph (b), clauses (5) and (6), no 6.35 enrollment of an individual with an organization or provider 6.36 described in paragraph (b), clause (5)(i), or with a plan or in 7.1 a program described in paragraph (b), clause (6), may be deemed 7.2 to be an initial enrollment under this paragraph after the 7.3 two-year period beginning on the date on which the individual 7.4 first enrolled with the organization, provider, plan, or program. 7.5 (e) The Medicare supplement policy to which eligible 7.6 persons are entitled under: 7.7 (1) paragraph (b), clauses (1) to (4), is any Medicare 7.8 supplement policy that has a benefit package consisting of the 7.9 basic Medicare supplement plan described in section 62A.316, 7.10 paragraph (a), plus any combination of the three optional riders 7.11 described in section 62A.316, paragraph (b), clauses (1) to (3), 7.12 offered by any issuer; 7.13 (2) paragraph (b), clause (5), is the same Medicare 7.14 supplement policy in which the individual was most recently 7.15 previously enrolled, if available from the same issuer, or, if 7.16 not so available, any policy described in clause (1) offered by 7.17 any issuer; 7.18 (3) paragraph (b), clause (6), shall include any Medicare 7.19 supplement policy offered by any issuer. 7.20 (d)(f)(1) At the time of an event described in paragraph 7.21 (b), because of which an individual loses coverage or benefits 7.22 due to the termination of a contract or agreement, policy, or 7.23 plan, the organization that terminates the contract or 7.24 agreement, the issuer terminating the policy, or the 7.25 administrator of the plan being terminated, respectively, shall 7.26 notify the individual of the individual's rights under this 7.27 subdivision, and of the obligations of issuers of Medicare 7.28 supplement policies under paragraph (a). The notice must be 7.29 communicated contemporaneously with the notification of 7.30 termination. 7.31 (2) At the time of an event described in paragraph (b), 7.32 because of which an individual ceases enrollment under a 7.33 contract or agreement, policy, or plan, the organization that 7.34 offers the contract or agreement, regardless of the basis for 7.35 the cessation of enrollment, the issuer offering the policy, or 7.36 the administrator of the plan, respectively, shall notify the 8.1 individual of the individual's rights under this subdivision, 8.2 and of the obligations of issuers of Medicare supplement 8.3 policies under paragraph (a). The notice must be communicated 8.4 within ten working days of the issuer receiving notification of 8.5 disenrollment. 8.6 (e)(g) Reference in this subdivision to a situation in 8.7 which, or to a basis upon which, an individual's coverage has 8.8 been terminated does not provide authority under the laws of 8.9 this state for the termination in that situation or upon that 8.10 basis. 8.11 (f)(h) An individual's rights under this subdivision are 8.12 in addition to, and do not modify or limit, the individual's 8.13 rights under subdivision 1h. 8.14 Sec. 3. Minnesota Statutes 2002, section 62A.31, is 8.15 amended by adding a subdivision to read: 8.16 Subd. 7. [MEDICARE PRESCRIPTION DRUG BENEFIT.] If congress 8.17 enacts legislation creating a prescription drug benefit in the 8.18 Medicare program, nothing in this section or any other section 8.19 shall prohibit an issuer of a Medicare supplement policy from 8.20 offering this prescription drug benefit consistent with the 8.21 applicable federal law or regulations. If an issuer offers the 8.22 federal benefit, such an offer shall be deemed to meet the 8.23 issuer's mandatory offer obligations under this section and may, 8.24 at the discretion of the issuer, constitute replacement coverage 8.25 as defined in subdivision 1i for any existing policy containing 8.26 a prescription drug benefit. 8.27 Sec. 4. Minnesota Statutes 2002, section 62A.315, is 8.28 amended to read: 8.29 62A.315 [EXTENDED BASIC MEDICARE SUPPLEMENT PLAN; 8.30 COVERAGE.] 8.31 The extended basic Medicare supplement plan must have a 8.32 level of coverage so that it will be certified as a qualified 8.33 plan pursuant to section 62E.07, and will provide: 8.34 (1) coverage for all of the Medicare part A inpatient 8.35 hospital deductible and coinsurance amounts, and 100 percent of 8.36 all Medicare part A eligible expenses for hospitalization not 9.1 covered by Medicare; 9.2 (2) coverage for the daily copayment amount of Medicare 9.3 part A eligible expenses for the calendar year incurred for 9.4 skilled nursing facility care; 9.5 (3) coverage for the copaymentcoinsurance amount or in the 9.6 case of hospital outpatient department services paid under a 9.7 prospective payment system, the co-payment amount, of Medicare 9.8 eligible expenses under Medicare part B regardless of hospital 9.9 confinement, and the Medicare part B deductible amount; 9.10 (4) 80 percent of the usual and customary hospital and 9.11 medical expenses and supplies described in section 62E.06, 9.12 subdivision 1, not to exceed any charge limitation established 9.13 by the Medicare program or state law, the usual and customary 9.14 hospital and medical expenses and supplies, described in section 9.15 62E.06, subdivision 1, while in a foreign country, and 9.16 prescription drug expenses, not covered by Medicare; 9.17 (5) coverage for the reasonable cost of the first three 9.18 pints of blood, or equivalent quantities of packed red blood 9.19 cells as defined under federal regulations under Medicare parts 9.20 A and B, unless replaced in accordance with federal regulations; 9.21 (6) 100 percent of the cost of immunizations and routine 9.22 screening procedures for cancer, including mammograms and pap 9.23 smears; 9.24 (7) preventive medical care benefit: coverage for the 9.25 following preventive health services: 9.26 (i) an annual clinical preventive medical history and 9.27 physical examination that may include tests and services from 9.28 clause (ii) and patient education to address preventive health 9.29 care measures; 9.30 (ii) any one or a combination of the following preventive 9.31 screening tests or preventive services, the frequency of which 9.32 is considered medically appropriate: 9.33 (A) fecal occult blood test and/or digital rectal 9.34 examination; 9.35 (B) dipstick urinalysis for hematuria, bacteriuria, and 9.36 proteinuria; 10.1 (C) pure tone (air only) hearing screening test 10.2 administered or ordered by a physician; 10.3 (D) serum cholesterol screening every five years; 10.4 (E) thyroid function test; 10.5 (F) diabetes screening; 10.6 (iii) any other tests or preventive measures determined 10.7 appropriate by the attending physician. 10.8 Reimbursement shall be for the actual charges up to 100 10.9 percent of the Medicare-approved amount for each service as if 10.10 Medicare were to cover the service as identified in American 10.11 Medical Association current procedural terminology (AMA CPT) 10.12 codes to a maximum of $120 annually under this benefit. This 10.13 benefit shall not include payment for any procedure covered by 10.14 Medicare; 10.15 (8) at-home recovery benefit: coverage for services to 10.16 provide short-term at-home assistance with activities of daily 10.17 living for those recovering from an illness, injury, or surgery: 10.18 (i) for purposes of this benefit, the following definitions 10.19 shall apply: 10.20 (A) "activities of daily living" include, but are not 10.21 limited to, bathing, dressing, personal hygiene, transferring, 10.22 eating, ambulating, assistance with drugs that are normally 10.23 self-administered, and changing bandages or other dressings; 10.24 (B) "care provider" means a duly qualified or licensed home 10.25 health aide/homemaker, personal care aide, or nurse provided 10.26 through a licensed home health care agency or referred by a 10.27 licensed referral agency or licensed nurses registry; 10.28 (C) "home" means a place used by the insured as a place of 10.29 residence, provided that the place would qualify as a residence 10.30 for home health care services covered by Medicare. A hospital 10.31 or skilled nursing facility shall not be considered the 10.32 insured's place of residence; 10.33 (D) "at-home recovery visit" means the period of a visit 10.34 required to provide at-home recovery care, without limit on the 10.35 duration of the visit, except each consecutive four hours in a 10.36 24-hour period of services provided by a care provider is one 11.1 visit; 11.2 (ii) coverage requirements and limitations: 11.3 (A) at-home recovery services provided must be primarily 11.4 services that assist in activities of daily living; 11.5 (B) the insured's attending physician must certify that the 11.6 specific type and frequency of at-home recovery services are 11.7 necessary because of a condition for which a home care plan of 11.8 treatment was approved by Medicare; 11.9 (C) coverage is limited to: 11.10 (I) no more than the number and type of at-home recovery 11.11 visits certified as medically necessary by the insured's 11.12 attending physician. The total number of at-home recovery 11.13 visits shall not exceed the number of Medicare-approved home 11.14 health care visits under a Medicare-approved home care plan of 11.15 treatment; 11.16 (II) the actual charges for each visit up to a maximum 11.17 reimbursement of $40 per visit; 11.18 (III) $1,600 per calendar year; 11.19 (IV) seven visits in any one week; 11.20 (V) care furnished on a visiting basis in the insured's 11.21 home; 11.22 (VI) services provided by a care provider as defined in 11.23 this section; 11.24 (VII) at-home recovery visits while the insured is covered 11.25 under the policy or certificate and not otherwise excluded; 11.26 (VIII) at-home recovery visits received during the period 11.27 the insured is receiving Medicare-approved home care services or 11.28 no more than eight weeks after the service date of the last 11.29 Medicare-approved home health care visit; 11.30 (iii) coverage is excluded for: 11.31 (A) home care visits paid for by Medicare or other 11.32 government programs; and 11.33 (B) care provided by family members, unpaid volunteers, or 11.34 providers who are not care providers. 11.35 Sec. 5. Minnesota Statutes 2002, section 62A.316, is 11.36 amended to read: 12.1 62A.316 [BASIC MEDICARE SUPPLEMENT PLAN; COVERAGE.] 12.2 (a) The basic Medicare supplement plan must have a level of 12.3 coverage that will provide: 12.4 (1) coverage for all of the Medicare part A inpatient 12.5 hospital coinsurance amounts, and 100 percent of all Medicare 12.6 part A eligible expenses for hospitalization not covered by 12.7 Medicare, after satisfying the Medicare part A deductible; 12.8 (2) coverage for the daily copayment amount of Medicare 12.9 part A eligible expenses for the calendar year incurred for 12.10 skilled nursing facility care; 12.11 (3) coverage for the copaymentcoinsurance amount, or in 12.12 the case of outpatient department services paid under a 12.13 prospective payment system, the co-payment amount, of Medicare 12.14 eligible expenses under Medicare part B regardless of hospital 12.15 confinement, subject to the Medicare part B deductible amount; 12.16 (4) 80 percent of the hospital and medical expenses and 12.17 supplies incurred during travel outside the United States as a 12.18 result of a medical emergency; 12.19 (5) coverage for the reasonable cost of the first three 12.20 pints of blood, or equivalent quantities of packed red blood 12.21 cells as defined under federal regulations under Medicare parts 12.22 A and B, unless replaced in accordance with federal regulations; 12.23 (6) 100 percent of the cost of immunizations and routine 12.24 screening procedures for cancer screening including mammograms 12.25 and pap smears; and 12.26 (7) 80 percent of coverage for all physician prescribed 12.27 medically appropriate and necessary equipment and supplies used 12.28 in the management and treatment of diabetes. Coverage must 12.29 include persons with gestational, type I, or type II diabetes. 12.30 (b) Only the following optional benefit riders may be added 12.31 to this plan: 12.32 (1) coverage for all of the Medicare part A inpatient 12.33 hospital deductible amount; 12.34 (2) a minimum of 80 percent of eligible medical expenses 12.35 and supplies not covered by Medicare part B, not to exceed any 12.36 charge limitation established by the Medicare program or state 13.1 law; 13.2 (3) coverage for all of the Medicare part B annual 13.3 deductible; 13.4 (4) coverage for at least 50 percent, or the equivalent of 13.5 50 percent, of usual and customary prescription drug expenses; 13.6 (5) coverage for the following preventive health services: 13.7 (i) an annual clinical preventive medical history and 13.8 physical examination that may include tests and services from 13.9 clause (ii) and patient education to address preventive health 13.10 care measures; 13.11 (ii) any one or a combination of the following preventive 13.12 screening tests or preventive services, the frequency of which 13.13 is considered medically appropriate: 13.14 (A) fecal occult blood test and/or digital rectal 13.15 examination; 13.16 (B) dipstick urinalysis for hematuria, bacteriuria, and 13.17 proteinuria; 13.18 (C) pure tone (air only) hearing screening test, 13.19 administered or ordered by a physician; 13.20 (D) serum cholesterol screening every five years; 13.21 (E) thyroid function test; 13.22 (F) diabetes screening; 13.23 (iii) any other tests or preventive measures determined 13.24 appropriate by the attending physician. 13.25 Reimbursement shall be for the actual charges up to 100 13.26 percent of the Medicare-approved amount for each service, as if 13.27 Medicare were to cover the service as identified in American 13.28 Medical Association current procedural terminology (AMA CPT) 13.29 codes, to a maximum of $120 annually under this benefit. This 13.30 benefit shall not include payment for a procedure covered by 13.31 Medicare; 13.32 (6) coverage for services to provide short-term at-home 13.33 assistance with activities of daily living for those recovering 13.34 from an illness, injury, or surgery: 13.35 (i) For purposes of this benefit, the following definitions 13.36 apply: 14.1 (A) "activities of daily living" include, but are not 14.2 limited to, bathing, dressing, personal hygiene, transferring, 14.3 eating, ambulating, assistance with drugs that are normally 14.4 self-administered, and changing bandages or other dressings; 14.5 (B) "care provider" means a duly qualified or licensed home 14.6 health aide/homemaker, personal care aid, or nurse provided 14.7 through a licensed home health care agency or referred by a 14.8 licensed referral agency or licensed nurses registry; 14.9 (C) "home" means a place used by the insured as a place of 14.10 residence, provided that the place would qualify as a residence 14.11 for home health care services covered by Medicare. A hospital 14.12 or skilled nursing facility shall not be considered the 14.13 insured's place of residence; 14.14 (D) "at-home recovery visit" means the period of a visit 14.15 required to provide at-home recovery care, without limit on the 14.16 duration of the visit, except each consecutive four hours in a 14.17 24-hour period of services provided by a care provider is one 14.18 visit; 14.19 (ii) Coverage requirements and limitations: 14.20 (A) at-home recovery services provided must be primarily 14.21 services that assist in activities of daily living; 14.22 (B) the insured's attending physician must certify that the 14.23 specific type and frequency of at-home recovery services are 14.24 necessary because of a condition for which a home care plan of 14.25 treatment was approved by Medicare; 14.26 (C) coverage is limited to: 14.27 (I) no more than the number and type of at-home recovery 14.28 visits certified as necessary by the insured's attending 14.29 physician. The total number of at-home recovery visits shall 14.30 not exceed the number of Medicare-approved home care visits 14.31 under a Medicare-approved home care plan of treatment; 14.32 (II) the actual charges for each visit up to a maximum 14.33 reimbursement of $40 per visit; 14.34 (III) $1,600 per calendar year; 14.35 (IV) seven visits in any one week; 14.36 (V) care furnished on a visiting basis in the insured's 15.1 home; 15.2 (VI) services provided by a care provider as defined in 15.3 this section; 15.4 (VII) at-home recovery visits while the insured is covered 15.5 under the policy or certificate and not otherwise excluded; 15.6 (VIII) at-home recovery visits received during the period 15.7 the insured is receiving Medicare-approved home care services or 15.8 no more than eight weeks after the service date of the last 15.9 Medicare-approved home health care visit; 15.10 (iii) Coverage is excluded for: 15.11 (A) home care visits paid for by Medicare or other 15.12 government programs; and 15.13 (B) care provided by family members, unpaid volunteers, or 15.14 providers who are not care providers; 15.15 (7) coverage for at least 50 percent, or the equivalent of 15.16 50 percent, of usual and customary prescription drug expenses to 15.17 a maximum of $1,200 paid by the issuer annually under this 15.18 benefit. An issuer of Medicare supplement insurance policies 15.19 that elects to offer this benefit rider shall also make 15.20 available coverage that contains the rider specified in clause 15.21 (4). 15.22 ARTICLE 2 15.23 OTHER HEALTH COVERAGE 15.24 Section 1. Minnesota Statutes 2002, section 62A.021, 15.25 subdivision 1, is amended to read: 15.26 Subdivision 1. [LOSS RATIO STANDARDS.] (a) Notwithstanding 15.27 section 62A.02, subdivision 3, relating to loss ratios, health 15.28 care policies or certificates shall not be delivered or issued 15.29 for delivery to an individual or to a small employer as defined 15.30 in section 62L.02, unless the policies or certificates can be 15.31 expected, as estimated for the entire period for which rates are 15.32 computed to provide coverage, to return to Minnesota 15.33 policyholders and certificate holders in the form of aggregate 15.34 benefits not including anticipated refunds or credits, provided 15.35 under the policies or certificates, (1) at least 75 percent of 15.36 the aggregate amount of premiums earned in the case of policies 16.1 issued in the small employer market, as defined in section 16.2 62L.02, subdivision 27, calculated on an aggregate basis; and 16.3 (2) at least 65 percent of the aggregate amount of premiums 16.4 earned in the case of each policy form or certificate form 16.5 issued in the individual market; calculated on the basis of 16.6 incurred claims experience or incurred health care expenses 16.7 where coverage is provided by a health maintenance organization 16.8 on a service rather than reimbursement basis and earned premiums 16.9 for the period and according to accepted actuarial principles 16.10 and practices. Assessments by the reinsurance association 16.11 created in chapter 62L and all types of taxes, surcharges, or 16.12 assessments created by Laws 1992, chapter 549, or created on or 16.13 after April 23, 1992, are included in the calculation of 16.14 incurred claims experience or incurred health care expenses. 16.15 The applicable percentage for policies and certificates issued 16.16 in the small employer market, as defined in section 62L.02, 16.17 increases by one percentage point on July 1 of each year, 16.18 beginning on July 1, 1994, until an 82 percent loss ratio is 16.19 reached on July 1, 2000. The applicable percentage for policy 16.20 forms and certificate forms issued in the individual market 16.21 increases by one percentage point on July 1 of each year, 16.22 beginning on July 1, 1994, until a 72 percent loss ratio is 16.23 reached on July 1, 2000. A health carrier that enters a market 16.24 after July 1, 1993, does not start at the beginning of the 16.25 phase-in schedule and must instead comply with the loss ratio 16.26 requirements applicable to other health carriers in that market 16.27 for each time period. Premiums earned and claims incurred in 16.28 markets other than the small employer and individual markets are 16.29 not relevant for purposes of this section. 16.30 (b) All filings of rates and rating schedules shall 16.31 demonstrate that actual expected claims in relation to premiums 16.32 comply with the requirements of this section when combined with 16.33 actual experience to date. Filings of rate revisions shall also 16.34 demonstrate that the anticipated loss ratio over the entire 16.35 future period for which the revised rates are computed to 16.36 provide coverage can be expected to meet the appropriate loss 17.1 ratio standards, and aggregate loss ratio from inception of the 17.2 policy form or certificate form shall equal or exceed the 17.3 appropriate loss ratio standards. 17.4 (c) A health carrier that issues health care policies and 17.5 certificates to individuals or to small employers, as defined in 17.6 section 62L.02, in this state shall file annually its rates, 17.7 rating schedule, and supporting documentation including ratios 17.8 of incurred losses to earned premiums by policy form or 17.9 certificate form duration for approval by the commissioner 17.10 according to the filing requirements and procedures prescribed 17.11 by the commissioner. The supporting documentation shall also 17.12 demonstrate in accordance with actuarial standards of practice 17.13 using reasonable assumptions that the appropriate loss ratio 17.14 standards can be expected to be met over the entire period for 17.15 which rates are computed. The demonstration shall exclude 17.16 active life reserves. If the data submitted does not confirm 17.17 that the health carrier has satisfied the loss ratio 17.18 requirements of this section, the commissioner shall notify the 17.19 health carrier in writing of the deficiency. The health carrier 17.20 shall have 30 days from the date of the commissioner's notice to 17.21 file amended rates that comply with this section. If the health 17.22 carrier fails to file amended rates within the prescribed time, 17.23 the commissioner shall order that the health carrier's filed 17.24 rates for the nonconforming policy form or certificate form be 17.25 reduced to an amount that would have resulted in a loss ratio 17.26 that complied with this section had it been in effect for the 17.27 reporting period of the supplement. The health carrier's 17.28 failure to file amended rates within the specified time or the 17.29 issuance of the commissioner's order amending the rates does not 17.30 preclude the health carrier from filing an amendment of its 17.31 rates at a later time. The commissioner shall annually make the 17.32 submitted data available to the public at a cost not to exceed 17.33 the cost of copying. The data must be compiled in a form useful 17.34 for consumers who wish to compare premium charges and loss 17.35 ratios. 17.36 (d) Each sale of a policy or certificate that does not 18.1 comply with the loss ratio requirements of this section is an 18.2 unfair or deceptive act or practice in the business of insurance 18.3 and is subject to the penalties in sections 72A.17 to 72A.32. 18.4 (e)(1) For purposes of this section, health care policies 18.5 issued as a result of solicitations of individuals through the 18.6 mail or mass media advertising, including both print and 18.7 broadcast advertising, shall be treated as individual policies. 18.8 (2) For purposes of this section, (i) "health care policy" 18.9 or "health care certificate" is a health plan as defined in 18.10 section 62A.011; and (ii) "health carrier" has the meaning given 18.11 in section 62A.011 and includes all health carriers delivering 18.12 or issuing for delivery health care policies or certificates in 18.13 this state or offering these policies or certificates to 18.14 residents of this state. 18.15 (f) The loss ratio phase-in as described in paragraph (a) 18.16 does not apply to individual policies and small employer 18.17 policies issued by a health plan company that is assessed less 18.18 than three percent of the total annual amount assessed by the 18.19 Minnesota comprehensive health association. These policies must 18.20 meet a 68 percent loss ratio for individual policies, a 71 18.21 percent loss ratio for small employer policies with fewer than 18.22 ten employees, and a 75 percent loss ratio for all other small 18.23 employer policies. 18.24 (g) Notwithstanding paragraphs (a) and (f), the loss ratio 18.25 shall be 60 percent for a policy or certificate of accident and18.26 sickness insurance as defined in section 62A.01health plan as 18.27 defined in section 62A.011, offered by an insurance company 18.28 licensed under chapter 60A that is assessed less than ten 18.29 percent of the total annual amount assessed by the Minnesota 18.30 Comprehensive Health Association. For purposes of the 18.31 percentage calculation of the association's assessments, an 18.32 insurance company's assessments include those of its affiliates. 18.33 (h) The commissioners of commerce and health shall each 18.34 annually issue a public report listing, by health plan company, 18.35 the actual loss ratios experienced in the individual and small 18.36 employer markets in this state by the health plan companies that 19.1 the commissioners respectively regulate. The commissioners 19.2 shall coordinate release of these reports so as to release them 19.3 as a joint report or as separate reports issued the same day. 19.4 The report or reports shall be released no later than June 1 for 19.5 loss ratios experienced for the preceding calendar year. Health 19.6 plan companies shall provide to the commissioners any 19.7 information requested by the commissioners for purposes of this 19.8 paragraph. 19.9 Sec. 2. [62J.26] [EVALUATION OF PROPOSED HEALTH COVERAGE 19.10 MANDATES.] 19.11 Subdivision 1. [DEFINITIONS.] For purposes of this 19.12 section, the following terms have the meanings given unless the 19.13 context otherwise requires: 19.14 (1) "commissioner" means the commissioner of commerce; 19.15 (2) "health plan" means a health plan as defined in section 19.16 62A.011, subdivision 3, but includes coverage listed in clauses 19.17 (7) and (10), of that definition; 19.18 (3) "mandated health benefit proposal" means a proposal 19.19 that would statutorily require a health plan to do the following: 19.20 (i) provide coverage or increase the amount of coverage for 19.21 the treatment of a particular disease, condition, or other 19.22 health care need; 19.23 (ii) provide coverage or increase the amount of coverage of 19.24 a particular type of health care treatment or service or of 19.25 equipment, supplies, or drugs used in connection with a health 19.26 care treatment or service; or 19.27 (iii) provide coverage for care delivered by a specific 19.28 type of provider. 19.29 "Mandated health benefit proposal" does not include health 19.30 benefit proposals amending the scope of practice of a licensed 19.31 health care professional. 19.32 Subd. 2. [EVALUATION PROCESS AND CONTENT.] (a) The 19.33 commissioner, in consultation with the commissioners of health 19.34 and employee relations, must evaluate mandated health benefit 19.35 proposals as provided under subdivision 3. 19.36 (b) The purpose of the evaluation is to provide the 20.1 legislature with a complete and timely analysis of all 20.2 ramifications of any mandated health benefit proposal. The 20.3 evaluation must include, in addition to other relevant 20.4 information, the following: 20.5 (1) scientific and medical information on the proposed 20.6 health benefit, on the potential for harm or benefit to the 20.7 patient, and on the comparative benefit or harm from alternative 20.8 forms of treatment; 20.9 (2) public health, economic, and fiscal impacts of the 20.10 proposed mandate on persons receiving health services in 20.11 Minnesota, on the relative cost-effectiveness of the benefit, 20.12 and on the health care system in general; 20.13 (3) the extent to which the service is generally utilized 20.14 by a significant portion of the population; 20.15 (4) the extent to which insurance coverage for the proposed 20.16 mandated benefit is already generally available; 20.17 (5) the extent to which the mandated coverage will increase 20.18 or decrease the cost of the service; and 20.19 (6) the commissioner may consider actuarial analysis done 20.20 by health insurers in determining the cost of the proposed 20.21 mandated benefit. 20.22 (c) The commissioner must summarize the nature and quality 20.23 of available information on these issues, and, if possible, must 20.24 provide preliminary information to the public. The commissioner 20.25 may conduct research on these issues or may determine that 20.26 existing research is sufficient to meet the informational needs 20.27 of the legislature. The commissioner may seek the assistance 20.28 and advice of researchers, community leaders, or other persons 20.29 or organizations with relevant expertise. 20.30 Subd. 3. [REQUESTS FOR EVALUATION.] (a) Whenever a 20.31 legislative measure containing a mandated health benefit 20.32 proposal is introduced as a bill or offered as an amendment to a 20.33 bill, or is likely to be introduced as a bill or offered as an 20.34 amendment, a chair of any standing legislative committee that 20.35 has jurisdiction over the subject matter of the proposal may 20.36 request that the commissioner complete an evaluation of the 21.1 proposal under this section, and inform any committee of floor 21.2 action by either house of the legislature. 21.3 (b) The commissioner must conduct an evaluation described 21.4 in subdivision 2 of each mandated health benefit proposal for 21.5 which an evaluation is requested under paragraph (a), unless the 21.6 commissioner determines under paragraph (c) that priorities and 21.7 resources do not permit its evaluation. 21.8 (c) If requests for evaluation of multiple proposals are 21.9 received, the commissioner must consult with the chairs of the 21.10 standing legislative committees having jurisdiction over the 21.11 subject matter of the mandated health benefit proposals to 21.12 prioritize the requests and establish a reporting date for each 21.13 proposal to be evaluated. The commissioner is not required to 21.14 direct an unreasonable quantity of the commissioner's resources 21.15 to these evaluations. No more than three evaluations may be 21.16 performed under this section in any fiscal year. 21.17 Subd. 4. [SOURCES OF FUNDING.] (a) The commissioner need 21.18 not use any funds for purposes of this section other than as 21.19 provided in this subdivision or as specified in an appropriation. 21.20 (b) The commissioner may seek and accept funding from 21.21 sources other than the state to pay for evaluations under this 21.22 section, to supplement or replace state appropriations. Any 21.23 money received under this paragraph must be deposited in the 21.24 state treasury, credited to a separate account for this purpose 21.25 in the special revenue fund, and is appropriated to the 21.26 commissioner for purposes of this section. 21.27 (c) If a request for an evaluation under this section has 21.28 been made, the commissioner may use for purposes of the 21.29 evaluation: 21.30 (1) any funds appropriated to the commissioner specifically 21.31 for purposes of this section; or 21.32 (2) funds available under paragraph (b), if use of the 21.33 funds for evaluation of that mandated health benefit proposal is 21.34 consistent with any restrictions imposed by the source of the 21.35 funds. 21.36 (d) If a request for an evaluation under this section has 22.1 been made, and sufficient funds for the evaluation are not 22.2 available under paragraph (c), then the mandated health benefit 22.3 proposal must not be enacted until an appropriation to the 22.4 commissioner for the purpose of paying the cost of an evaluation 22.5 under this section has been enacted and the effective date of 22.6 that appropriation has arrived. 22.7 Subd. 5. [REPORT TO LEGISLATURE.] The commissioner must 22.8 submit a written report on the evaluation to the legislature no 22.9 later than 180 days after the request. The report must be 22.10 submitted in compliance with sections 3.195 and 3.197. 22.11 Sec. 3. Minnesota Statutes 2002, section 62J.52, 22.12 subdivision 1, is amended to read: 22.13 Subdivision 1. [UNIFORM BILLING FORM HCFA 1450.] (a) On 22.14 and after January 1, 1996, all institutional inpatient hospital 22.15 services, ancillary services, institutionally owned or operated 22.16 outpatient services rendered by providers in Minnesota, and 22.17 institutional or noninstitutional home health services that are 22.18 not being billed using an equivalent electronic billing format, 22.19 must be billed using the uniform billing form HCFA 1450, except 22.20 as provided in subdivision 5. 22.21 (b) The instructions and definitions for the use of the 22.22 uniform billing form HCFA 1450 shall be in accordance with the 22.23 uniform billing form manual specified by the commissioner. In 22.24 promulgating these instructions, the commissioner may utilize 22.25 the manual developed by the National Uniform Billing Committee, 22.26 as adopted and finalized by the Minnesota uniform billing 22.27 committee. 22.28 (c) Services to be billed using the uniform billing form 22.29 HCFA 1450 include: institutional inpatient hospital services 22.30 and distinct units in the hospital such as psychiatric unit 22.31 services, physical therapy unit services, swing bed (SNF) 22.32 services, inpatient state psychiatric hospital services, 22.33 inpatient skilled nursing facility services, home health 22.34 services (Medicare part A), and hospice services; ancillary 22.35 services, where benefits are exhausted or patient has no 22.36 Medicare part A, from hospitals, state psychiatric hospitals, 23.1 skilled nursing facilities, and home health (Medicare part B); 23.2 institutional owned or operated outpatient services such as 23.3 waivered services, hospital outpatient services, including 23.4 ambulatory surgical center services, hospital referred 23.5 laboratory services, hospital-based ambulance services, and 23.6 other hospital outpatient services, skilled nursing facilities, 23.7 home health, including infusion therapy,freestanding renal 23.8 dialysis centers, comprehensive outpatient rehabilitation 23.9 facilities (CORF), outpatient rehabilitation facilities (ORF), 23.10 rural health clinics, and community mental health centers; home 23.11 health services such as home health intravenous therapy 23.12 providers, waivered services, personal care attendants, and 23.13 hospice; and any other health care provider certified by the 23.14 Medicare program to use this form. 23.15 (d) On and after January 1, 1996, a mother and newborn 23.16 child must be billed separately, and must not be combined on one 23.17 claim form. 23.18 Sec. 4. Minnesota Statutes 2002, section 62J.52, 23.19 subdivision 2, is amended to read: 23.20 Subd. 2. [UNIFORM BILLING FORM HCFA 1500.] (a) On and 23.21 after January 1, 1996, all noninstitutional health care services 23.22 rendered by providers in Minnesota except dental or pharmacy 23.23 providers, that are not currently being billed using an 23.24 equivalent electronic billing format, must be billed using the 23.25 health insurance claim form HCFA 1500, except as provided in 23.26 subdivision 5. 23.27 (b) The instructions and definitions for the use of the 23.28 uniform billing form HCFA 1500 shall be in accordance with the 23.29 manual developed by the administrative uniformity committee 23.30 entitled standards for the use of the HCFA 1500 form, dated 23.31 February 1994, as further defined by the commissioner. 23.32 (c) Services to be billed using the uniform billing form 23.33 HCFA 1500 include physician services and supplies, durable 23.34 medical equipment, noninstitutional ambulance services, 23.35 independent ancillary services including occupational therapy, 23.36 physical therapy, speech therapy and audiology, home infusion 24.1 therapy, podiatry services, optometry services, mental health 24.2 licensed professional services, substance abuse licensed 24.3 professional services, nursing practitioner professional 24.4 services, certified registered nurse anesthetists, 24.5 chiropractors, physician assistants, laboratories, medical 24.6 suppliers, and other health care providers such as day activity 24.7 centers and freestanding ambulatory surgical centers. 24.8 Sec. 5. [EFFECTIVE DATE.] 24.9 Section 1 is effective the day following final enactment 24.10 and applies to policies or certificates issued on or after that 24.11 date. Section 2 is effective January 1, 2004.