HF 5

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 03/11/2015 12:23pm

A bill for an act
relating to MNsure; requiring the commissioner of commerce to seek federal
approval to allow the purchase of qualified health plans and the receipt of
premium tax credits and cost-sharing reductions outside of MNsure; making
changes to the organization of MNsure; requiring background checks on
navigators operating in MNsure; removing certain exemptions; amending
Minnesota Statutes 2014, sections 62V.03, subdivision 2; 62V.04, subdivisions 1,
2, 4; 62V.05, subdivisions 1, 4, 5; 62V.11, subdivision 2, by adding a subdivision;
proposing coding for new law in Minnesota Statutes, chapter 62V.

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

Section 1. new text begin EXPANDED ACCESS TO QUALIFIED HEALTH PLANS AND
SUBSIDIES.
new text end

new text begin The commissioner of commerce, in consultation with the board of directors of
MNsure and the MNsure legislative oversight committee, shall develop a proposal to
allow individuals to purchase qualified health plans outside of MNsure directly from
health plan companies and to allow eligible individuals to receive advanced premium tax
credits and cost-sharing reductions when purchasing these health plans. The commissioner
shall seek all federal waivers and approvals necessary to implement this proposal.
The commissioner shall submit a draft proposal to the MNsure board and the MNsure
legislative oversight committee at least 30 days before submitting a final proposal to the
federal government and shall notify the board and legislative oversight committee of any
federal decision or action related to the proposal.
new text end

Sec. 2.

Minnesota Statutes 2014, section 62V.03, subdivision 2, is amended to read:

Subd. 2.

Application of other law.

(a) MNsure must be reviewed by the legislative
auditor under section 3.971. The legislative auditor shall audit the books, accounts, and
affairs of MNsure once each year or less frequently as the legislative auditor's funds and
personnel permit. Upon the audit of the financial accounts and affairs of MNsure, MNsure
is liable to the state for the total cost and expenses of the audit, including the salaries paid
to the examiners while actually engaged in making the examination. The legislative
auditor may bill MNsure either monthly or at the completion of the audit. All collections
received for the audits must be deposited in the general fund and are appropriated to
the legislative auditor. Pursuant to section 3.97, subdivision 3a, the Legislative Audit
Commission is requested to direct the legislative auditor to report by March 1, 2014, to
the legislature on any duplication of services that occurs within state government as a
result of the creation of MNsure. The legislative auditor may make recommendations on
consolidating or eliminating any services deemed duplicative. The board shall reimburse
the legislative auditor for any costs incurred in the creation of this report.

(b) Board members of MNsure are subject to sections 10A.07 and 10A.09. Board
members and the personnel of MNsure are subject to section 10A.071.

(c) All meetings of the board shall comply with the open meeting law in chapter
13D deleted text begin , except that: deleted text end new text begin .
new text end

deleted text begin (1) meetings, or portions of meetings, regarding compensation negotiations with the
director or managerial staff may be closed in the same manner and according to the same
procedures identified in section 13D.03;
deleted text end

deleted text begin (2) meetings regarding contract negotiation strategy may be closed in the same
manner and according to the same procedures identified in section 13D.05, subdivision 3,
paragraph (c); and
deleted text end

deleted text begin (3) meetings, or portions of meetings, regarding not public data described in section
62V.06, subdivision 3, and regarding trade secret information as defined in section 13.37,
subdivision 1, paragraph (b), are closed to the public, but must otherwise comply with
the procedures identified in chapter 13D.
deleted text end

(d) MNsure and provisions specified under this chapter are exempt from deleted text begin :
deleted text end

deleted text begin (1) deleted text end chapter 14, including section 14.386, except as specified in section 62V.05 deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (2) chapters 16B and 16C, with the exception of sections 16C.08, subdivision 2,
paragraph (b), clauses (1) to (8); 16C.086; 16C.09, paragraph (a), clauses (1) and (3),
paragraph (b), and paragraph (c); and section 16C.16. However, MNsure, in consultation
with the commissioner of administration, shall implement policies and procedures to
establish an open and competitive procurement process for MNsure that, to the extent
practicable, conforms to the principles and procedures contained in chapters 16B and 16C.
In addition, MNsure may enter into an agreement with the commissioner of administration
for other services.
deleted text end

(e) The board and the Web site are exempt from chapter 60K. Any employee of
MNsure who sells, solicits, or negotiates insurance to individuals or small employers must
be licensed as an insurance producer under chapter 60K.

(f) Section 3.3005 applies to any federal funds received by MNsure.

deleted text begin (g) MNsure is exempt from the following sections in chapter 16E: 16E.01,
subdivision 3, paragraph (b); 16E.03, subdivisions 3 and 4; 16E.04, subdivision 1,
subdivision 2, paragraph (c), and subdivision 3, paragraph (b); 16E.0465; 16E.055;
16E.145; 16E.15; 16E.16; 16E.17; 16E.18; and 16E.22.
deleted text end

deleted text begin (h) deleted text end new text begin (g) new text end A MNsure decision that requires a vote of the board, other than a decision
that applies only to hiring of employees or other internal management of MNsure, is an
"administrative action" under section 10A.01, subdivision 2.

Sec. 3.

Minnesota Statutes 2014, section 62V.04, subdivision 1, is amended to read:

Subdivision 1.

Board.

MNsure is governed by a board of directors with deleted text begin seven deleted text end new text begin 11 new text end
members.

Sec. 4.

Minnesota Statutes 2014, section 62V.04, subdivision 2, is amended to read:

Subd. 2.

Appointment.

(a) Board membership of MNsure consists of the following:

(1) deleted text begin three deleted text end new text begin six new text end members appointed by the governor with the advice and consent of
both the senate and the house of representatives acting separately in accordance with
paragraph (d), with one member representing the interests of individual consumers eligible
for individual market coverage, one member representing individual consumers eligible
for public health care program coverage, deleted text begin and deleted text end one member representing small employers new text begin ,
one member who is an insurance producer, and two members who are county employees
involved in the administration of public health care programs new text end . Members are appointed to
serve four-year terms following the initial staggered-term lot determination;

(2) three members appointed by the governor with the advice and consent of both the
senate and the house of representatives acting separately in accordance with paragraph (d)
who have demonstrated expertise, leadership, and innovation in the following areas: one
member representing the areas of health administration, health care finance, health plan
purchasing, and health care delivery systems; one member representing the areas of public
health, health disparities, public health care programs, and the uninsured; and one member
representing health policy issues related to the small group and individual markets.
Members are appointed to serve four-year terms following the initial staggered-term lot
determination; deleted text begin and
deleted text end

(3) the commissioner of human services or a designee new text begin ; and
new text end

new text begin (4) the chief information officer of MN.IT Services or a designee new text end .

(b) Section 15.0597 shall apply to all appointments, except for the commissioner.

(c) The governor shall make appointments to the board that are consistent with
federal law and regulations regarding its composition and structure. All board members
appointed by the governor must be legal residents of Minnesota.

(d) Upon appointment by the governor, a board member shall exercise duties of
office immediately. If both the house of representatives and the senate vote not to confirm
an appointment, the appointment terminates on the day following the vote not to confirm
in the second body to vote.

(e) deleted text begin Initial appointments shall be made by April 30, 2013.
deleted text end

deleted text begin (f) deleted text end One of the deleted text begin six deleted text end new text begin nine new text end members appointed under paragraph (a), clause (1) or (2),
must have experience in representing the needs of vulnerable populations and persons
with disabilities.

deleted text begin (g) deleted text end new text begin (f) new text end Membership on the board must include representation from outside the
seven-county metropolitan area, as defined in section 473.121, subdivision 2.

Sec. 5.

Minnesota Statutes 2014, section 62V.04, subdivision 4, is amended to read:

Subd. 4.

Conflicts of interest.

(a) Within one year prior to or at any time during
their appointed term, board members appointed under subdivision 2, paragraph (a),
clauses (1) and (2), shall not be employed by, be a member of the board of directors of, or
otherwise be a representative of a health carrier, institutional health care provider or other
entity providing health care, navigator, deleted text begin insurance producer, deleted text end or other entity in the business
of selling items or services of significant value to or through MNsure. For purposes of this
paragraph, "health care provider or entity" does not include an academic institution.

(b) Board members must recuse themselves from discussion of and voting on
an official matter if the board member has a conflict of interest. new text begin For board members
other than an insurance producer or a county employee, new text end a conflict of interest means an
association including a financial or personal association that has the potential to bias or
have the appearance of biasing a board member's decisions in matters related to MNsure
or the conduct of activities under this chapter. new text begin The board member who is an insurance
producer and the board members who are county employees are subject to section 10A.07.
new text end

(c) No board member shall have a spouse who is an executive of a health carrier.

(d) No member of the board may currently serve as a lobbyist, as defined under
section 10A.01, subdivision 21.

Sec. 6.

new text begin [62V.045] EXECUTIVE DIRECTOR.
new text end

new text begin The governor shall appoint the executive director of MNsure. The executive director
serves in the unclassified service at the pleasure of the governor.
new text end

Sec. 7.

Minnesota Statutes 2014, section 62V.05, subdivision 1, is amended to read:

Subdivision 1.

General.

(a) The board shall operate MNsure according to this
chapter and applicable state and federal law.

(b) The board has the power to:

(1) employ personnel new text begin , subject to the power of the governor to appoint the executive
director, new text end and delegate administrative, operational, and other responsibilities to the director
and other personnel as deemed appropriate by the board. This authority is subject to
chapters 43A and 179A. The director and managerial staff of MNsure shall serve in the
unclassified service deleted text begin and shall be governed by a compensation plan prepared by the board,
submitted to the commissioner of management and budget for review and comment within
14 days of its receipt, and approved by the Legislative Coordinating Commission and the
legislature under section 3.855, except that section 15A.0815, subdivision 5, paragraph
(e), shall not apply deleted text end new text begin . The director of MNsure shall not receive a salary increase on or
after July 1, 2015, unless the increase is approved under the process specified in section
15A.0815, subdivision 5 new text end ;

(2) establish the budget of MNsure;

(3) seek and accept money, grants, loans, donations, materials, services, or
advertising revenue from government agencies, philanthropic organizations, and public
and private sources to fund the operation of MNsure. No health carrier or insurance
producer shall advertise on MNsure;

(4) contract for the receipt and provision of goods and services;

(5) enter into information-sharing agreements with federal and state agencies and
other entities, provided the agreements include adequate protections with respect to
the confidentiality and integrity of the information to be shared, and comply with all
applicable state and federal laws, regulations, and rules, including the requirements of
section 62V.06; and

(6) exercise all powers reasonably necessary to implement and administer the
requirements of this chapter and the Affordable Care Act, Public Law 111-148.

(c) The board shall establish policies and procedures to gather public comment and
provide public notice in the State Register.

(d) Within 180 days of enactment, the board shall establish bylaws, policies, and
procedures governing the operations of MNsure in accordance with this chapter.

Sec. 8.

Minnesota Statutes 2014, section 62V.05, subdivision 4, is amended to read:

Subd. 4.

Navigator; in-person assisters; call center.

(a) The board shall
establish policies and procedures for the ongoing operation of a navigator program,
in-person assister program, call center, and customer service provisions for MNsure to be
implemented beginning January 1, 2015.

(b) Until the implementation of the policies and procedures described in paragraph
(a), the following shall be in effect:

(1) the navigator program shall be met by section 256.962;

(2) entities eligible to be navigators, including entities defined in Code of Federal
Regulations, title 45, part 155.210 (c)(2), may serve as in-person assisters;

(3) the board shall establish requirements and compensation for the navigator
program and the in-person assister program by April 30, 2013. Compensation for
navigators and in-person assisters must take into account any other compensation received
by the navigator or in-person assister for conducting the same or similar services; and

(4) call center operations shall utilize existing state resources and personnel,
including referrals to counties for medical assistance.

(c) The board shall establish a toll-free number for MNsure and may hire and
contract for additional resources as deemed necessary.

(d) The navigator program and in-person assister program must meet the
requirements of section 1311(i) of the Affordable Care Act, Public Law 111-148. In
establishing training standards for the navigators and in-person assisters, the board must
ensure that all entities and individuals carrying out navigator and in-person assister
functions have training in the needs of underserved and vulnerable populations; eligibility
and enrollment rules and procedures; the range of available public health care programs
and qualified health plan options offered through MNsure; and privacy and security
standards. For calendar year 2014, the commissioner of human services shall ensure that
the navigator program under section 256.962 provides application assistance for both
qualified health plans offered through MNsure and public health care programs.

(e) The board must ensure that any information provided by navigators, in-person
assisters, the call center, or other customer assistance portals be accessible to persons
with disabilities and that information provided on public health care programs include
information on other coverage options available to persons with disabilities.

new text begin (f) Any person who serves as a navigator shall be subject to background checks.
Prior to employment as a navigator, the person must submit a completed criminal history
records check consent form, a full set of classifiable fingerprints, and the required fees
for submission to the Bureau of Criminal Apprehension. The bureau must conduct a
Minnesota criminal history records check and the superintendent is authorized to exchange
the fingerprints with the Federal Bureau of Investigation to obtain the applicant's national
criminal history record information. The bureau shall return the results of the Minnesota
and federal criminal history records check to the board.
new text end

Sec. 9.

Minnesota Statutes 2014, section 62V.05, subdivision 5, is amended to read:

Subd. 5.

Health carrier and health plan requirements; participation.

(a)
Beginning January 1, 2015, the board may establish certification requirements for health
carriers and health plans to be offered through MNsure that satisfy federal requirements
under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.

(b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory
requirements that:

(1) apply uniformly to all health carriers and health plans in the individual market;

(2) apply uniformly to all health carriers and health plans in the small group market;
and

(3) satisfy minimum federal certification requirements under section 1311(c)(1) of
the Affordable Care Act, Public Law 111-148.

(c) In accordance with section 1311(e) of the Affordable Care Act, Public Law
111-148, the board shall establish policies and procedures for certification deleted text begin and selection deleted text end
of health plans to be offered as qualified health plans through MNsure. The board shall
certify deleted text begin and select deleted text end a health plan as a qualified health plan to be offered through MNsure, if:

(1) the health plan meets the minimum certification requirements established in
paragraph (a) or the market regulatory requirements in paragraph (b);

(2) the board determines that making the health plan available through MNsure is in
the interest of qualified individuals and qualified employers;

(3) the health carrier applying to offer the health plan through MNsure also applies
to offer health plans at each actuarial value level and service area that the health carrier
currently offers in the individual and small group markets; and

(4) the health carrier does not apply to offer health plans in the individual and
small group markets through MNsure under a separate license of a parent organization
or holding company under section 60D.15, that is different from what the health carrier
offers in the individual and small group markets outside MNsure.

(d) In determining the interests of qualified individuals and employers under
paragraph (c), clause (2), the board may not exclude a health plan for any reason specified
under section 1311(e)(1)(B) of the Affordable Care Act, Public Law 111-148. deleted text begin The board
may consider:
deleted text end

deleted text begin (1) affordability;
deleted text end

deleted text begin (2) quality and value of health plans;
deleted text end

deleted text begin (3) promotion of prevention and wellness;
deleted text end

deleted text begin (4) promotion of initiatives to reduce health disparities;
deleted text end

deleted text begin (5) market stability and adverse selection;
deleted text end

deleted text begin (6) meaningful choices and access;
deleted text end

deleted text begin (7) alignment and coordination with state agency and private sector purchasing
strategies and payment reform efforts; and
deleted text end

deleted text begin (8) other criteria that the board determines appropriate.
deleted text end

deleted text begin (e) For qualified health plans offered through MNsure on or after January 1, 2015,
the board shall establish policies and procedures under paragraphs (c) and (d) for selection
of health plans to be offered as qualified health plans through MNsure by February 1
of each year, beginning February 1, 2014. The board shall consistently and uniformly
apply all policies and procedures and any requirements, standards, or criteria to all health
carriers and health plans. For any policies, procedures, requirements, standards, or criteria
that are defined as rules under section 14.02, subdivision 4, the board may use the process
described in subdivision 9.
deleted text end

deleted text begin (f) For 2014, deleted text end new text begin (e) new text end The board shall not have the power to select health carriers and
health plans for participation in MNsure. The board shall permit all health plans that meet
the certification requirements under section 1311(c)(1) of the Affordable Care Act, Public
Law 111-148, to be offered through MNsure.

deleted text begin (g) deleted text end new text begin (f) new text end Under this subdivision, the board shall have the power to verify that health
carriers and health plans are properly certified to be eligible for participation in MNsure.

deleted text begin (h) deleted text end new text begin (g) new text end The board has the authority to decertify health carriers and health plans that
fail to maintain compliance with section 1311(c)(1) of the Affordable Care Act, Public
Law 111-148.

deleted text begin (i) deleted text end new text begin (h) new text end For qualified health plans offered through MNsure beginning January 1,
2015, health carriers must use the most current addendum for Indian health care providers
approved by the Centers for Medicare and Medicaid Services and the tribes as part of their
contracts with Indian health care providers. MNsure shall comply with all future changes
in federal law with regard to health coverage for the tribes.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2015.
new text end

Sec. 10.

Minnesota Statutes 2014, section 62V.11, subdivision 2, is amended to read:

Subd. 2.

Membership; meetings; compensation.

(a) The Legislative Oversight
Committee shall consist of five members of the senate, three members appointed by
the majority leader of the senate, and two members appointed by the minority leader of
the senate; and five members of the house of representatives, three members appointed
by the speaker of the house, and two members appointed by the minority leader of the
house of representatives.

(b) Appointed legislative members serve at the pleasure of the appointing authority
and shall continue to serve until their successors are appointed.

(c) The first meeting of the committee shall be convened by the chair of the
Legislative Coordinating Commission. Members shall elect a chair at the first meeting.
The chair must convene at least one meeting deleted text begin annually deleted text end new text begin each quarter of the year new text end , and may
convene other meetings as deemed necessary.

Sec. 11.

Minnesota Statutes 2014, section 62V.11, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Reports to the commission. new text end

new text begin (a) The board shall submit an enrollment
report to the commission on a monthly basis. The report must include:
new text end

new text begin (1) total enrollment numbers;
new text end

new text begin (2) the number of commercial plans selected;
new text end

new text begin (3) the percentage of the commercial plans for which the first month's premium
has been paid; and
new text end

new text begin (4) the average number of days between a consumer's submission of an application
and transmittal to the health carrier chosen.
new text end

new text begin (b) At each of the commission's quarterly meetings, the board shall present the
following information:
new text end

new text begin (1) at the first quarterly meeting, a progress report on the most recent MNsure
open enrollment period and a progress report on technology upgrades and any proposed
schedule for future technology upgrades;
new text end

new text begin (2) at the second quarterly meeting, the annual budget for MNsure, as required by
subdivision 4;
new text end

new text begin (3) at the third quarterly meeting, a hearing in conjunction with the Department of
Human Services regarding any backlog created by qualifying life events for enrollees in
public or private health plans through MNsure; and
new text end

new text begin (4) at the fourth quarterly meeting, a hearing in conjunction with the Department of
Commerce on the release of premium rates and in conjunction with the Department of
Human Services on reimbursement of MNsure for public program enrollment.
new text end

Sec. 12. new text begin TRANSITION.
new text end

new text begin (a) The commissioner of management and budget must assign the positions of
managerial employees of MNsure, other than the director, to salary ranges and salaries in
the managerial plan, effective the first payroll period beginning on or after July 1, 2015.
new text end

new text begin (b) Of the four additional members of the board appointed under section 3, one shall
have an initial term of two years, two shall have an initial term of three years, and one
shall have an initial term of four years, determined by lot by the secretary of state.
new text end

new text begin (c) Board members must be appointed by the governor within 30 days of final
enactment of these sections.
new text end

Sec. 13. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 12 are effective July 1, 2015.
new text end