HF 2190

1st Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health insurance; making technical 
  1.3             changes; allowing re-entry into the small employer 
  1.4             market under certain circumstances; establishing 
  1.5             compensation for the reinsurance association; 
  1.6             clarifying permitted investments and guarantees for 
  1.7             integrated service networks; expanding eligibility for 
  1.8             the MinnesotaCare Program; providing for the 
  1.9             cancellation of recodification efforts; reducing 
  1.10            appropriation; appropriating money; amending Minnesota 
  1.11            Statutes 1994, sections 62A.65, subdivision 3; 62J.25; 
  1.12            62L.09, subdivision 3; 62L.14, subdivision 7; and 
  1.13            62N.25, subdivision 5; Minnesota Statutes 1995 
  1.14            Supplement, sections 62A.65, subdivision 5; 62J.042, 
  1.15            subdivision 4; 62L.045, subdivision 1; 62L.12, 
  1.16            subdivision 2; 62M.09, subdivision 5; 62N.076, 
  1.17            subdivision 3; 62N.077, subdivision 2; 62Q.01, 
  1.18            subdivision 3; 256.9354, subdivision 5; and 256.9358, 
  1.19            subdivision 4; repealing Minnesota Statutes 1994, 
  1.20            section 62N.33; Laws 1993, chapter 247, article 4, 
  1.21            section 8; Laws 1994, chapter 625, article 5, section 
  1.22            5, as amended; Laws 1995, chapters 96, section 2; 234, 
  1.23            article 3, section 3; 248, article 10, section 15; and 
  1.24            First Special Session chapter 3, article 13, section 2.
  1.25  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.26     Section 1.  Minnesota Statutes 1994, section 62A.65, 
  1.27  subdivision 3, is amended to read: 
  1.28     Subd. 3.  [PREMIUM RATE RESTRICTIONS.] No individual health 
  1.29  plan may be offered, sold, issued, or renewed to a Minnesota 
  1.30  resident unless the premium rate charged is determined in 
  1.31  accordance with the following requirements:  
  1.32     (a) Premium rates must be no more than 25 percent above and 
  1.33  no more than 25 percent below the index rate charged to 
  1.34  individuals for the same or similar coverage, adjusted pro rata 
  1.35  for rating periods of less than one year.  The premium 
  2.1   variations permitted by this paragraph must be based only upon 
  2.2   health status, claims experience, and occupation.  For purposes 
  2.3   of this paragraph, health status includes refraining from 
  2.4   tobacco use or other actuarially valid lifestyle factors 
  2.5   associated with good health, provided that the lifestyle factor 
  2.6   and its effect upon premium rates have been determined by the 
  2.7   commissioner to be actuarially valid and have been approved by 
  2.8   the commissioner.  Variations permitted under this paragraph 
  2.9   must not be based upon age or applied differently at different 
  2.10  ages.  This paragraph does not prohibit use of a constant 
  2.11  percentage adjustment for factors permitted to be used under 
  2.12  this paragraph. 
  2.13     (b) Premium rates may vary based upon the ages of covered 
  2.14  persons only as provided in this paragraph and paragraph (i).  
  2.15  In addition to the variation permitted under paragraph (a), each 
  2.16  health carrier may use an additional premium variation based 
  2.17  upon age of up to plus or minus 50 percent of the index rate. 
  2.18     (c) A health carrier may request approval by the 
  2.19  commissioner to establish no more than three geographic regions 
  2.20  and to establish separate index rates for each region, provided 
  2.21  that the index rates do not vary between any two regions by more 
  2.22  than 20 percent.  Health carriers that do not do business in the 
  2.23  Minneapolis/St. Paul metropolitan area may request approval for 
  2.24  no more than two geographic regions, and clauses (2) and (3) do 
  2.25  not apply to approval of requests made by those health 
  2.26  carriers.  The commissioner may grant approval if the following 
  2.27  conditions are met: 
  2.28     (1) the geographic regions must be applied uniformly by the 
  2.29  health carrier; 
  2.30     (2) one geographic region must be based on the 
  2.31  Minneapolis/St. Paul metropolitan area; 
  2.32     (3) for each geographic region that is rural, the index 
  2.33  rate for that region must not exceed the index rate for the 
  2.34  Minneapolis/St. Paul metropolitan area; and 
  2.35     (4) the health carrier provides actuarial justification 
  2.36  acceptable to the commissioner for the proposed geographic 
  3.1   variations in index rates, establishing that the variations are 
  3.2   based upon differences in the cost to the health carrier of 
  3.3   providing coverage. 
  3.4      (d) Health carriers may use rate cells and must file with 
  3.5   the commissioner the rate cells they use.  Rate cells must be 
  3.6   based upon the number of adults or children covered under the 
  3.7   policy and may reflect the availability of Medicare coverage.  
  3.8   The rates for different rate cells must not in any way reflect 
  3.9   generalized differences in expected costs between principal 
  3.10  insureds and their spouses. 
  3.11     (e) In developing its index rates and premiums for a health 
  3.12  plan, a health carrier shall take into account only the 
  3.13  following factors: 
  3.14     (1) actuarially valid differences in rating factors 
  3.15  permitted under paragraphs (a) and (b); and 
  3.16     (2) actuarially valid geographic variations if approved by 
  3.17  the commissioner as provided in paragraph (c). 
  3.18     (f) All premium variations must be justified in initial 
  3.19  rate filings and upon request of the commissioner in rate 
  3.20  revision filings.  All rate variations are subject to approval 
  3.21  by the commissioner. 
  3.22     (g) The loss ratio must comply with the section 62A.021 
  3.23  requirements for individual health plans. 
  3.24     (h) The rates must not be approved, unless the commissioner 
  3.25  has determined that the rates are reasonable.  In determining 
  3.26  reasonableness, the commissioner shall consider the growth rates 
  3.27  applied under section 62J.04, subdivision 1, paragraph (b), to 
  3.28  the calendar year or years that the proposed premium rate would 
  3.29  be in effect, actuarially valid changes in risks associated with 
  3.30  the enrollee populations, and actuarially valid changes as a 
  3.31  result of statutory changes in Laws 1992, chapter 549. 
  3.32     (i) Separate premium rates for coverage of a child may, at 
  3.33  the option of the health carrier and with the approval of the 
  3.34  commissioner, be below the rates that would otherwise be 
  3.35  permitted under paragraph (b).  Those separate rates are not 
  3.36  considered for purposes of determining the index rate.  The 
  4.1   maximum age of a child eligible for these separate rates may be 
  4.2   any age selected by the health carrier and approved by the 
  4.3   commissioner. 
  4.4      Sec. 2.  Minnesota Statutes 1995 Supplement, section 
  4.5   62A.65, subdivision 5, is amended to read: 
  4.6      Subd. 5.  [PORTABILITY OF COVERAGE.] (a) No individual 
  4.7   health plan may be offered, sold, issued, or with respect to 
  4.8   children age 18 or under renewed, to a Minnesota resident that 
  4.9   contains a preexisting condition limitation, preexisting 
  4.10  condition exclusion, or exclusionary rider, unless the 
  4.11  limitation or exclusion is permitted under this subdivision, 
  4.12  provided that, except for children age 18 or under, underwriting 
  4.13  restrictions may be retained on individual contracts that are 
  4.14  issued without evidence of insurability as a replacement for 
  4.15  prior individual coverage that was sold before May 17, 1993.  
  4.16  The individual may be subjected to an 18-month preexisting 
  4.17  condition limitation, unless the individual has maintained 
  4.18  continuous coverage as defined in section 62L.02.  The 
  4.19  individual must not be subjected to an exclusionary rider.  An 
  4.20  individual who has maintained continuous coverage may be 
  4.21  subjected to a one-time preexisting condition limitation of up 
  4.22  to 12 months, with credit for time covered under qualifying 
  4.23  coverage as defined in section 62L.02, at the time that the 
  4.24  individual first is covered under an individual health plan by 
  4.25  any health carrier.  Credit must be given for all qualifying 
  4.26  coverage with respect to all preexisting conditions, regardless 
  4.27  of whether the conditions were preexisting with respect to any 
  4.28  previous qualifying coverage.  The individual must not be 
  4.29  subjected to an exclusionary rider.  Thereafter, the individual 
  4.30  must not be subject to any preexisting condition limitation, 
  4.31  preexisting condition exclusion, or exclusionary rider under an 
  4.32  individual health plan by any health carrier, except an 
  4.33  unexpired portion of a limitation under prior coverage, so long 
  4.34  as the individual maintains continuous coverage as defined in 
  4.35  section 62L.02.  For purposes of the 12-month and 18-month 
  4.36  preexisting condition limitations referred to in this paragraph, 
  5.1   "preexisting condition" has the meaning given in section 62L.02, 
  5.2   subdivision 23. 
  5.3      (b) A health carrier must offer an individual health plan 
  5.4   to any individual previously covered under a group health plan 
  5.5   issued by that health carrier, regardless of the size of the 
  5.6   group, so long as the individual maintained continuous coverage 
  5.7   as defined in section 62L.02.  The offer must not be subject to 
  5.8   underwriting, except as permitted under this paragraph.  A 
  5.9   health plan issued under this paragraph must be a qualified plan 
  5.10  as defined in section 62E.02 and must not contain any 
  5.11  preexisting condition limitation, preexisting condition 
  5.12  exclusion, or exclusionary rider, except for any unexpired 
  5.13  limitation or exclusion under the previous coverage.  The 
  5.14  individual health plan must cover pregnancy on the same basis as 
  5.15  any other covered illness under the individual health plan.  The 
  5.16  initial premium rate for the individual health plan must comply 
  5.17  with subdivision 3.  The premium rate upon renewal must comply 
  5.18  with subdivision 2.  In no event shall the premium rate exceed 
  5.19  90 percent of the premium charged for comparable individual 
  5.20  coverage by the Minnesota comprehensive health association, and 
  5.21  the premium rate must be less than that amount if necessary to 
  5.22  otherwise comply with this section.  An individual health plan 
  5.23  offered under this paragraph to a person satisfies the health 
  5.24  carrier's obligation to offer conversion coverage under section 
  5.25  62E.16, with respect to that person.  Coverage issued under this 
  5.26  paragraph must provide that it cannot be canceled or nonrenewed 
  5.27  as a result of the health carrier's subsequent decision to leave 
  5.28  the individual, small employer, or other group market.  Section 
  5.29  72A.20, subdivision 28, applies to this paragraph. 
  5.30     Sec. 3.  Minnesota Statutes 1995 Supplement, section 
  5.31  62J.042, subdivision 4, is amended to read: 
  5.32     Subd. 4.  [MONITORING AND ENFORCEMENT.] Health care 
  5.33  providers shall submit to the commissioner of health, in the 
  5.34  form and at the times required by the commissioner, all 
  5.35  information the commissioner determines to be necessary to 
  5.36  implement and enforce this section.  The commissioner shall 
  6.1   regularly audit all health clinics employing or contracting with 
  6.2   over 100 physicians.  The commissioner shall also audit, at 
  6.3   times and in a manner that does not interfere with delivery of 
  6.4   patient care, a sample of smaller clinics and other health care 
  6.5   providers.  Providers that exceed revenue limits based on 
  6.6   two-year average revenue data shall be required by the 
  6.7   commissioner to pay back the amount exceeding the revenue limits 
  6.8   during the following calendar year.  
  6.9      Pharmacists may adjust their revenue figures for increases 
  6.10  in drug product costs that are set by the manufacturer.  The 
  6.11  commissioner shall consult with pharmacy groups, including 
  6.12  pharmacies, wholesalers, drug manufacturers, health plans, and 
  6.13  other interested parties, to determine the methodology for 
  6.14  measuring and implementing the interim growth limits while 
  6.15  taking into account the adjustments for drug product costs. 
  6.16     The commissioner shall monitor providers meeting the growth 
  6.17  limits based on their current fees on an annual basis.  The fee 
  6.18  charged for each service must be based on a weighted average 
  6.19  across 12 months and compared to the weighted average for the 
  6.20  previous 12-month period.  The percentage increase in the 
  6.21  average fee from 1993 to 1994, and from 1994 to 1995, from 1995 
  6.22  to 1996, and from 1996 to 1997 is subject to the growth limits 
  6.23  established under section 62J.04, subdivision 1, paragraph (b).  
  6.24  The percentage increase in the average fee from 1995 to 1996, 
  6.25  and from 1996 to 1997 is subject to the change in the regional 
  6.26  consumer price index for urban consumers for the previous year 
  6.27  published in the State Register in January of the year that the 
  6.28  growth limit is in effect.  The audit process may include a 
  6.29  review of the provider's monthly fee schedule, and a random 
  6.30  claims analysis for the provider during different parts of the 
  6.31  year to monitor variations in fees.  The commissioner shall 
  6.32  require providers that exceed growth limits, based on annual 
  6.33  fees, to pay back during the following calendar year the amount 
  6.34  of fees received exceeding the limit. 
  6.35     The commissioner shall notify each provider that has 
  6.36  exceeded its revenue or fee limit, at least 30 days before 
  7.1   taking action, and shall provide each provider with ten days to 
  7.2   provide an explanation for exceeding the revenue or fee limit.  
  7.3   The commissioner shall review the explanation and may change a 
  7.4   determination if the commissioner determines the explanation to 
  7.5   be valid. 
  7.6      The commissioner may approve a different repayment schedule 
  7.7   for a health care provider that takes into account the 
  7.8   provider's financial condition.  
  7.9      A provider may appeal the commissioner's order to pay back 
  7.10  the amount exceeding the revenue or fee limit by mailing a 
  7.11  written notice of appeal to the commissioner within 30 days 
  7.12  after the commissioner's order was mailed.  The contested case 
  7.13  and judicial review provisions of chapter 14 apply to the 
  7.14  appeal.  The provider shall pay the amount specified by the 
  7.15  commissioner either to the commissioner or into an escrow 
  7.16  account until final resolution of the appeal.  Notwithstanding 
  7.17  sections 3.762 to 3.765, each party is responsible for its own 
  7.18  fees and expenses, including attorneys fees, for the appeal.  
  7.19  Any amount required to be paid back under this section shall be 
  7.20  deposited in the health care access fund. 
  7.21     Sec. 4.  Minnesota Statutes 1994, section 62J.25, is 
  7.22  amended to read: 
  7.23     62J.25 [MANDATORY MEDICARE ASSIGNMENT.] 
  7.24     (a) Effective January 1, 1993, a health care provider 
  7.25  authorized to participate in the Medicare program shall not 
  7.26  charge to or collect from a Medicare beneficiary who is a 
  7.27  Minnesota resident any amount in excess of 115 percent of the 
  7.28  Medicare-approved amount for any Medicare-covered service 
  7.29  provided. 
  7.30     (b) Effective January 1, 1994, a health care provider 
  7.31  authorized to participate in the Medicare program shall not 
  7.32  charge to or collect from a Medicare beneficiary who is a 
  7.33  Minnesota resident any amount in excess of 110 percent of the 
  7.34  Medicare-approved amount for any Medicare-covered service 
  7.35  provided. 
  7.36     (c) Effective January 1, 1995, a health care provider 
  8.1   authorized to participate in the Medicare program shall not 
  8.2   charge to or collect from a Medicare beneficiary who is a 
  8.3   Minnesota resident any amount in excess of 105 percent of the 
  8.4   Medicare-approved amount for any Medicare-covered service 
  8.5   provided. 
  8.6      (d) Effective January 1, 1996, a health care provider 
  8.7   authorized to participate in the Medicare program shall not 
  8.8   charge to or collect from a Medicare beneficiary who is a 
  8.9   Minnesota resident any amount in excess of the Medicare-approved 
  8.10  amount for any Medicare-covered service provided. 
  8.11     (e) This section does not apply to ambulance services as 
  8.12  defined in section 144.801, subdivision 4. 
  8.13     Sec. 5.  Minnesota Statutes 1995 Supplement, section 
  8.14  62L.045, subdivision 1, is amended to read: 
  8.15     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  8.16  section, the following terms have the meanings given: 
  8.17     (a) "Association" means: 
  8.18     (1) an association as defined in section 60A.02; 
  8.19     (2) a group or organization of political subdivisions; 
  8.20     (3) an educational cooperative service unit a service 
  8.21  cooperative created under section 123.58 123.582; or 
  8.22     (4) a joint self-insurance pool authorized under section 
  8.23  471.617, subdivision 2. 
  8.24     (b) "Qualified association" means an association, as 
  8.25  defined in this subdivision, that: 
  8.26     (1) is registered with the commissioner of commerce; 
  8.27     (2) provides health plan coverage through a health carrier 
  8.28  that participates in the small employer market in this state, 
  8.29  other than through associations, to the extent that the 
  8.30  association purchases health plan coverage rather than 
  8.31  self-insures; 
  8.32     (3) has and adheres to membership and participation 
  8.33  criteria and health plan coverage eligibility criteria that are 
  8.34  not designed to disproportionately include or attract small 
  8.35  employers that are likely to have low costs of health coverage 
  8.36  or to disproportionately exclude or repel small employers that 
  9.1   are likely to have high costs of health coverage; and 
  9.2      (4) permits any small employer that meets its membership, 
  9.3   participation, and eligibility criteria to become a member and 
  9.4   to obtain health plan coverage through the association.  
  9.5      Sec. 6.  Minnesota Statutes 1994, section 62L.09, 
  9.6   subdivision 3, is amended to read: 
  9.7      Subd. 3.  [REENTRY PROHIBITION.] (a) Except as provided in 
  9.8   paragraph (b), a health carrier that ceases to do business in 
  9.9   the small employer market after July 1, 1993, is prohibited from 
  9.10  writing new business in the small employer market in this state 
  9.11  for a period of five years from the date of notice to the 
  9.12  commissioner.  This subdivision applies to any health 
  9.13  maintenance organization that ceases to do business in the small 
  9.14  employer market in one service area with respect to that service 
  9.15  area only.  Nothing in this subdivision prohibits an affiliated 
  9.16  health maintenance organization from continuing to do business 
  9.17  in the small employer market in that same service area. 
  9.18     (b) The commissioner of commerce or the commissioner of 
  9.19  health may permit a health carrier that ceases to do business in 
  9.20  the small employer market in this state after July 1, 1993, to 
  9.21  begin writing new business in the small employer market if: 
  9.22     (1) since the carrier ceased doing business in the small 
  9.23  employer market, legislative action has occurred that has 
  9.24  significantly changed the effect on the carrier of its decision 
  9.25  to cease doing business in the small employer market; and 
  9.26     (2) the commissioner deems it appropriate. 
  9.27     Sec. 7.  Minnesota Statutes 1995 Supplement, section 
  9.28  62L.12, subdivision 2, is amended to read: 
  9.29     Subd. 2.  [EXCEPTIONS.] (a) A health carrier may sell, 
  9.30  issue, or renew individual conversion policies to eligible 
  9.31  employees otherwise eligible for conversion coverage under 
  9.32  section 62D.104 as a result of leaving a health maintenance 
  9.33  organization's service area. 
  9.34     (b) A health carrier may sell, issue, or renew individual 
  9.35  conversion policies to eligible employees otherwise eligible for 
  9.36  conversion coverage as a result of the expiration of any 
 10.1   continuation of group coverage required under sections 62A.146, 
 10.2   62A.17, 62A.21, 62C.142, 62D.101, and 62D.105. 
 10.3      (c) A health carrier may sell, issue, or renew conversion 
 10.4   policies under section 62A.65, subdivision 5, paragraph (b), or 
 10.5   62E.16 to eligible employees. 
 10.6      (d) A health carrier may sell, issue, or renew individual 
 10.7   continuation policies to eligible employees as required. 
 10.8      (e) A health carrier may sell, issue, or renew individual 
 10.9   health plans if the coverage is appropriate due to an unexpired 
 10.10  preexisting condition limitation or exclusion applicable to the 
 10.11  person under the employer's group health plan or due to the 
 10.12  person's need for health care services not covered under the 
 10.13  employer's group health plan. 
 10.14     (f) A health carrier may sell, issue, or renew an 
 10.15  individual health plan, if the individual has elected to buy the 
 10.16  individual health plan not as part of a general plan to 
 10.17  substitute individual health plans for a group health plan nor 
 10.18  as a result of any violation of subdivision 3 or 4. 
 10.19     (g) Nothing in this subdivision relieves a health carrier 
 10.20  of any obligation to provide continuation or conversion coverage 
 10.21  otherwise required under federal or state law. 
 10.22     (h) Nothing in this chapter restricts the offer, sale, 
 10.23  issuance, or renewal of coverage issued as a supplement to 
 10.24  Medicare under sections 62A.31 to 62A.44, or policies or 
 10.25  contracts that supplement Medicare issued by health maintenance 
 10.26  organizations, or those contracts governed by section 1833 or 
 10.27  1876 of the federal Social Security Act, United States Code, 
 10.28  title 42, section 1395 et. seq., as amended. 
 10.29     (i) Nothing in this chapter restricts the offer, sale, 
 10.30  issuance, or renewal of individual health plans necessary to 
 10.31  comply with a court order. 
 10.32     (j) For purposes of this subdivision, "conversion policy" 
 10.33  or "conversion coverage" includes coverage described in section 
 10.34  62A.65, subdivision 5, paragraph (b). 
 10.35     Sec. 8.  Minnesota Statutes 1994, section 62L.14, 
 10.36  subdivision 7, is amended to read: 
 11.1      Subd. 7.  [COMPENSATION.] Public directors may be 
 11.2   reimbursed by the association for reasonable and necessary 
 11.3   expenses incurred by them in performing their duties as 
 11.4   directors, but shall not otherwise be compensated by the 
 11.5   association for their services and may be compensated by the 
 11.6   association at a rate of up to $55 per day spent on authorized 
 11.7   association activities. 
 11.8      Sec. 9.  Minnesota Statutes 1995 Supplement, section 
 11.9   62M.09, subdivision 5, is amended to read: 
 11.10     Subd. 5.  [WRITTEN CLINICAL CRITERIA.] A utilization review 
 11.11  organization's decisions must be supported by written clinical 
 11.12  criteria and review procedures in compliance with section 
 11.13  62M.07, paragraph (c).  Clinical criteria and review procedures 
 11.14  must be established with appropriate involvement from actively 
 11.15  practicing physicians.  A utilization review organization must 
 11.16  use written clinical criteria, as required, for determining the 
 11.17  appropriateness of the certification request.  The utilization 
 11.18  review organization must have a procedure for ensuring, at a 
 11.19  minimum, the annual evaluation and updating of the written 
 11.20  criteria based on sound clinical principles. 
 11.21     Sec. 10.  Minnesota Statutes 1995 Supplement, section 
 11.22  62N.076, subdivision 3, is amended to read: 
 11.23     Subd. 3.  [PERMITTED INVESTMENT.] (a) An integrated service 
 11.24  network shall make investments may invest only in securities or 
 11.25  property designated by law as permitted for domestic life 
 11.26  insurance companies; this restriction includes compliance.  
 11.27  Except as provided in paragraph (b), an integrated service 
 11.28  network must comply with percentage limitations that apply to 
 11.29  domestic life insurance companies.  A 
 11.30     (b) An integrated service network may, however, invest in 
 11.31  real estate, including leasehold improvements, for the 
 11.32  convenience and accommodation of its operations, including the 
 11.33  home office, branch offices, medical facilities, and field 
 11.34  operations, in excess of the percentage permitted for a domestic 
 11.35  life insurance company, but not to.  The investment in real 
 11.36  estate described in this paragraph may exceed 25 percent of its 
 12.1   the integrated service network's total admitted assets only if:  
 12.2      (1) the total of real estate assets and assets described in 
 12.3   section 62D.044, clause (17), does not exceed the total combined 
 12.4   percentage limitations allowed under this paragraph and section 
 12.5   62D.044, clause (17); or 
 12.6      (2) the commissioner determines that the percentage is 
 12.7   insufficient to provide convenient accommodation of the 
 12.8   network's business.  
 12.9      Sec. 11.  Minnesota Statutes 1995 Supplement, section 
 12.10  62N.077, subdivision 2, is amended to read: 
 12.11     Subd. 2.  [SECURITY FOR GUARANTEE.] (a) If the guaranteeing 
 12.12  organization is regulated for solvency by the commissioner of 
 12.13  commerce or health, the guarantee must be treated as a liability 
 12.14  for purposes of solvency regulation of the guaranteeing 
 12.15  organization.  If the guaranteeing organization becomes 
 12.16  insolvent, a claim by the network on the guarantee must be at 
 12.17  least of equal priority with claims of enrollees or other policy 
 12.18  holders of the insolvent guaranteeing organization. 
 12.19     (b) If the guaranteeing organization is not regulated for 
 12.20  solvency by the commissioner of commerce or health, the 
 12.21  organization must maintain assets, except if, when calculated in 
 12.22  combination with the assets described in section 62D.044, clause 
 12.23  (17), the total of those assets and the real estate assets 
 12.24  described in this subdivision do not exceed the total combined 
 12.25  percent limitations allowable under this section and section 
 12.26  62D.044, clause (17), or except if permitted by the commissioner 
 12.27  upon a finding that the percentage of the integrated service 
 12.28  network's admitted assets is insufficient to provide convenient 
 12.29  accommodation of the network's business acceptable to the 
 12.30  commissioner, with a market value at least equal to the amount 
 12.31  of the guarantee, in a custodial or other controlled account on 
 12.32  terms acceptable to the commissioner of health.  
 12.33     Sec. 12.  Minnesota Statutes 1994, section 62N.25, 
 12.34  subdivision 5, is amended to read: 
 12.35     Subd. 5.  [BENEFITS.] Community integrated service networks 
 12.36  must offer the health maintenance organization benefit set, as 
 13.1   defined in chapter 62D, and other laws applicable to entities 
 13.2   regulated under chapter 62D, except that the community 
 13.3   integrated service network may impose a deductible, not to 
 13.4   exceed $1,000 per person per year, provided that out-of-pocket 
 13.5   expenses on covered services do not exceed $3,000 per person or 
 13.6   $5,000 per family per year.  The deductible must not apply to 
 13.7   preventive health services as described in Minnesota Rules, part 
 13.8   4685.0801, subpart 8.  Community networks and chemical 
 13.9   dependency facilities under contract with a community network 
 13.10  shall use the assessment criteria in Minnesota Rules, parts 
 13.11  9530.6600 to 9530.6660, when assessing enrollees for chemical 
 13.12  dependency treatment.  
 13.13     Sec. 13.  Minnesota Statutes 1995 Supplement, section 
 13.14  62Q.01, subdivision 3, is amended to read: 
 13.15     Subd. 3.  [HEALTH PLAN.] "Health plan" means a health plan 
 13.16  as defined in section 62A.011; or a policy, contract, or 
 13.17  certificate issued by a community integrated service network; or 
 13.18  by an integrated service network. 
 13.19     Sec. 14.  Minnesota Statutes 1995 Supplement, section 
 13.20  256.9354, subdivision 5, is amended to read: 
 13.21     Subd. 5.  [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO 
 13.22  CHILDREN.] (a) Beginning October 1, 1994, the definition of 
 13.23  "eligible persons" is expanded to include all individuals and 
 13.24  households with no children who have gross family incomes that 
 13.25  are equal to or less than 125 percent of the federal poverty 
 13.26  guidelines and who are not eligible for medical assistance 
 13.27  without a spenddown under chapter 256B.  
 13.28     (b) After October 1, 1995 Beginning July 1, 1996, the 
 13.29  commissioner of human services may shall expand the definition 
 13.30  of "eligible persons" to include all individuals and households 
 13.31  with no children who have gross family incomes that are equal to 
 13.32  or less than 135 150 percent of federal poverty guidelines and 
 13.33  are not eligible for medical assistance without a spenddown 
 13.34  under chapter 256B.  This expansion may must occur only 
 13.35  if unless the commissioner certifies that the financial 
 13.36  management requirements of section 256.9352, subdivision 3, can 
 14.1   cannot be met. 
 14.2      (c) The commissioners of health and human services, in 
 14.3   consultation with the legislative commission on health care 
 14.4   access, shall make preliminary recommendations to the 
 14.5   legislature by October 1, 1995, and final recommendations to the 
 14.6   legislature by February 1, 1996, on whether a further expansion 
 14.7   of the definition of "eligible persons" to include all 
 14.8   individuals and households with no children who have gross 
 14.9   family incomes that are equal to or less than 150 percent of 
 14.10  federal poverty guidelines and are not eligible for medical 
 14.11  assistance without a spenddown under chapter 256B would be 
 14.12  allowed under the financial management constraints outlined in 
 14.13  section 256.9352, subdivision 3.  
 14.14     (d) All eligible persons under paragraphs (a) and (b) are 
 14.15  eligible for coverage through the MinnesotaCare program but must 
 14.16  pay a premium as determined under sections 256.9357 and 
 14.17  256.9358.  Individuals and families whose income is greater than 
 14.18  the limits established under section 256.9358 may not enroll in 
 14.19  the MinnesotaCare program. 
 14.20     Sec. 15.  Minnesota Statutes 1995 Supplement, section 
 14.21  256.9358, subdivision 4, is amended to read: 
 14.22     Subd. 4.  [INELIGIBILITY.] Families with children whose 
 14.23  gross monthly income is above the amount specified in 
 14.24  subdivision 3 are not eligible for the plan.  Beginning October 
 14.25  1, 1994, an individual or households with no children whose 
 14.26  gross income is greater than 125 percent of the federal poverty 
 14.27  guidelines are ineligible for the plan, unless the definition of 
 14.28  "eligible persons" has been expanded by the commissioner of 
 14.29  human services in accordance with section 256.9354, subdivision 
 14.30  5. 
 14.31     Sec. 16.  [INSTRUCTION TO REVISOR.] 
 14.32     The revisor of statutes is instructed to change the heading 
 14.33  before Minnesota Statutes 1995 Supplement, section 62J.2930, to 
 14.34  "Data Collection and Research Initiatives." 
 14.35     Sec. 17.  [APPROPRIATION.] 
 14.36     The appropriation in Laws 1995, chapter 234, article 11, 
 15.1   section 2, for the department of human services for fiscal year 
 15.2   1996 is reduced by $265,000, and the appropriation for fiscal 
 15.3   year 1997 is increased by $174,000. 
 15.4      Sec. 18.  [REPEALER.] 
 15.5      (a) Minnesota Statutes 1994, section 62N.33, is repealed 
 15.6   effective retroactively to July 1, 1995. 
 15.7      (b) Laws 1993, chapter 247, article 4, section 8; Laws 
 15.8   1995, chapter 96, section 2; chapter 234, article 3, section 3; 
 15.9   chapter 248, article 10, section 15; and First Special Session 
 15.10  chapter 3, article 13, section 2, are repealed. 
 15.11     (c) Laws 1994, chapter 625, article 5, section 5, as 
 15.12  amended by Laws 1995, chapter 234, article 3, section 8, is 
 15.13  repealed. 
 15.14     Sec. 19.  [EFFECTIVE DATE.] 
 15.15     Section 18 is effective the day following final enactment.