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HF 5

9th Engrossment - 88th Legislature (2013 - 2014) Posted on 03/21/2013 08:32am

KEY: stricken = removed, old language. underscored = added, new language.

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1.1A bill for an act
1.2relating to commerce; establishing the Minnesota Insurance Marketplace;
1.3prescribing its powers and duties; prohibiting abortion coverage with certain
1.4exemptions; recognizing the right to a person's physician of choice; establishing
1.5the right not to participate; specifying open meeting requirements and data
1.6practices procedures; appropriating money;amending Minnesota Statutes 2012,
1.7section 13.7191, by adding a subdivision; proposing coding for new law as
1.8Minnesota Statutes, chapter 62V.
1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.10    Section 1. Minnesota Statutes 2012, section 13.7191, is amended by adding a
1.11subdivision to read:
1.12    Subd. 14a. Minnesota Insurance Marketplace. Classification and sharing of data
1.13of the Minnesota Insurance Marketplace is governed by section 62V.06.

1.14    Sec. 2. [62V.01] TITLE.
1.15This chapter may be cited as the "Minnesota Insurance Marketplace Act."

1.16    Sec. 3. [62V.02] DEFINITIONS.
1.17    Subdivision 1. Scope. For the purposes of this chapter, the following terms have
1.18the meanings given.
1.19    Subd. 2. Board. "Board" means the board of directors specified in section 62V.04.
1.20    Subd. 3. Health benefit plan. "Health benefit plan" means a policy, contract,
1.21certificate, or agreement defined in section 62A.011, subdivision 3, and a dental plan
1.22defined in section 62Q.76, subdivision 3.
1.23    Subd. 4. Health carrier. "Health carrier" has the meaning defined in section
1.2462A.011.
2.1    Subd. 5. Individual market. "Individual market" means the market for health
2.2insurance coverage offered to individuals.
2.3    Subd. 6. Insurance producer. "Insurance producer" has the meaning defined
2.4in section 60K.31.
2.5    Subd. 7. Minnesota Insurance Marketplace. "Minnesota Insurance Marketplace"
2.6means the Minnesota Insurance Marketplace created as a state health benefit exchange
2.7as described in section 1311 of the federal Patient Protection and Affordable Care Act
2.8(Public Law 111-148), and further defined through amendments to the act and regulations
2.9issued under the act.
2.10    Subd. 8. Navigator. "Navigator" has the meaning described in section 1311(i) of
2.11the federal Patient Protection and Affordable Care Act (Public Law 111-148), and further
2.12defined through amendments to the act and regulations issued under the act.
2.13    Subd. 9. MAGI public health care program. "MAGI public health care
2.14program" means any exchange enrollment public health care program administered by
2.15the commissioner of human services whereby eligibility for the program is determined
2.16according to a modified adjusted gross income standard.
2.17    Subd. 10. Small group market. "Small group market" means the market for health
2.18insurance coverage offered to small employers as defined in section 62L.02, subdivision 26.

2.19    Sec. 4. [62V.03] MINNESOTA INSURANCE MARKETPLACE;
2.20ESTABLISHMENT.
2.21    Subdivision 1. Creation. The Minnesota Insurance Marketplace is created as a
2.22board under section 15.012, paragraph (a), to:
2.23(1) promote informed consumer choice through innovation, competition, quality,
2.24value, market participation, affordability, suitable and meaningful choices, health
2.25improvement, care management, and portability of health benefit plans;
2.26(2) facilitate and simplify the comparison, choice, enrollment, and purchase of health
2.27benefit plans for individuals purchasing in the individual market through the Minnesota
2.28Insurance Marketplace and for employees and employers purchasing in the small group
2.29market through the Minnesota Insurance Marketplace;
2.30(3) assist small employers with access to small business health insurance tax credits
2.31and to assist individuals with access to MAGI public health care programs, premium
2.32assistance tax credits and cost-sharing reductions, and certificates of exemption from
2.33individual responsibility requirements;
3.1(4) facilitate the integration and transition of individuals between MAGI public
3.2health care programs and health benefit plans in the individual or group market and
3.3develop processes that, to the maximum extent possible, provide for continuous coverage;
3.4    (5) establish a name for the Web-based exchange based on market studies that show
3.5maximum effectiveness in attracting the uninsured and motivating them to take action; and
3.6    (6) evaluate the effectiveness of the outreach and implementation activities of the
3.7Minnesota Insurance Marketplace in reducing the rate of uninsurance in Minnesota and
3.8in addressing the above responsibilities.
3.9    Subd. 2. Application of other law. (a) The Minnesota Insurance Marketplace
3.10must be reviewed by the legislative auditor under section 3.971. The legislative auditor
3.11shall audit the books, accounts, and affairs of the Minnesota Insurance Marketplace
3.12once each year or less frequently as the legislative auditor's funds and personnel permit.
3.13Pursuant to section 3.97, subdivision 3a, the Legislative Audit Commission is requested
3.14to direct the legislative auditor to report by March 1, 2014, to the legislature on any
3.15duplication of services that occurs within state government as a result of the creation of the
3.16Minnesota Insurance Marketplace. The legislative auditor may make recommendations on
3.17consolidating or eliminating any services deemed duplicative. The board shall reimburse
3.18the legislative auditor for any costs incurred in the creation of this report.
3.19(b) Board members of the Minnesota Insurance Marketplace are subject to section
3.2010A.07. Board members and the personnel of the Minnesota Insurance Marketplace
3.21are subject to section 10A.071.
3.22(c) All meetings of the board shall comply with the open meeting law in chapter
3.2313D, except that:
3.24(1) meetings, or portions of meetings, regarding compensation negotiations with the
3.25director or managerial staff may be closed in the same manner and according to the same
3.26procedures identified in section 13D.03;
3.27(2) meetings regarding contract negotiation strategy may be closed in the same
3.28manner and according to the same procedures identified in section 13D.05, subdivision 3,
3.29paragraph (c); and
3.30(3) meetings, or portions of meetings, regarding not public data described in section
3.3162V.06, subdivision 2, and regarding trade secret information as defined in section 13.37,
3.32subdivision 1, paragraph (b), are closed to the public, but must otherwise comply with
3.33the procedures identified in chapter 13D.
3.34(d) The Minnesota Insurance Marketplace and provisions specified under this
3.35chapter are exempt from:
3.36(1) chapter 14, including section 14.386 but not sections 14.48 to 14.69; and
4.1(2) chapters 16B and 16C, with the exception of sections 16C.08, subdivision
4.22, paragraph (b), clauses (1) to (8); 16C.086; 16C.09, paragraph (a), clauses (1) and
4.3(3), paragraph (b), and paragraph (c); and section 16C.16. However, the Minnesota
4.4Insurance Marketplace, in consultation with the commissioner of administration, shall
4.5implement policies and procedures to establish an open and competitive procurement
4.6process for the Minnesota Insurance Marketplace that, to the extent practicable, conforms
4.7to the principles and procedures contained in chapters 16B and 16C. In addition, the
4.8Minnesota Insurance Marketplace may enter into an agreement with the commissioner of
4.9administration for other services.
4.10    Subd. 3. Continued operation of a private marketplace. (a) Nothing in this
4.11chapter shall be construed to prohibit: (1) a health carrier from offering outside of
4.12the Minnesota Insurance Marketplace a health benefit plan to a qualified individual
4.13or qualified employer; and (2) a qualified individual from enrolling in, or a qualified
4.14employer from selecting for its employees, a health benefit plan offered outside of the
4.15Minnesota Insurance Marketplace.
4.16    (b) Nothing in this chapter shall be construed to restrict the choice of a qualified
4.17individual to enroll or not enroll in a qualified health plan or to participate in the Minnesota
4.18Insurance Marketplace. Nothing in this chapter shall be construed to compel an individual
4.19to enroll in a qualified health plan or to participate in the Minnesota Insurance Marketplace.
4.20    (c) For purposes of this subdivision, "qualified individual" and "qualified employer"
4.21have the meanings given in section 1312 of the Affordable Care Act, Public Law 111-148,
4.22and further defined through amendments to the act and regulations issued under the act.

4.23    Sec. 5. [62V.04] GOVERNANCE.
4.24    Subdivision 1. Board. The Minnesota Insurance Marketplace is governed by a
4.25board of directors with seven members.
4.26    Subd. 2. Appointment. (a) Board membership of the Minnesota Insurance
4.27Marketplace consists of the following:
4.28(1) three members appointed by the governor with the advice and consent of both
4.29the senate and the house of representatives acting separately in accordance with paragraph
4.30(d), with one member representing the interests of individual consumers eligible for
4.31individual market coverage, one member representing individual consumers eligible
4.32for MAGI public health care program coverage, and one member representing small
4.33employers. Members are appointed to serve four-year staggered terms following the
4.34initial staggered-term lot determination;
5.1(2) three members appointed by the governor with the advice and consent of both the
5.2senate and the house of representatives acting separately in accordance with paragraph (d)
5.3who have demonstrated expertise, leadership, and innovation in the following areas: one
5.4member representing the areas of health administration, health care finance, health plan
5.5purchasing, and health care delivery systems; one member representing the areas of public
5.6health, health disparities, MAGI public health care programs, and the uninsured; and
5.7one member representing health policy issues related to the small group and individual
5.8markets. Members are appointed to serve four-year staggered terms following the initial
5.9staggered-term lot determination; and
5.10(3) the commissioner of human services or a designee.
5.11(b) Section 15.0597 shall apply to all appointments, except for the commissioner
5.12and initial appointments.
5.13(c) The governor shall make appointments to the board that are consistent with
5.14federal law and regulations regarding its composition and structure.
5.15(d) Upon appointment by the governor, a board member shall exercise duties of
5.16office immediately. If both the house of representatives and the senate vote not to confirm
5.17an appointment, the appointment terminates on the day following the vote not to confirm
5.18in the second body to vote.
5.19(e) Initial appointments shall be made by April 30, 2013.
5.20    (f) One of the members appointed under paragraph (a), clauses (1) and (2), must have
5.21experience in representing the needs of vulnerable populations and persons with disabilities.
5.22    (g) Membership on the board must include representation from outside the
5.23seven-county metropolitan area, as defined in section 473.121, subdivision 2.
5.24    Subd. 3. Terms. (a) Board members may serve no more than two consecutive
5.25terms, except for the commissioner or the commissioner's designee, who shall serve
5.26until replaced by the governor.
5.27(b) A board member may resign at any time by giving written notice to the board.
5.28(c) The appointed members under subdivision 2, paragraph (a), clauses (1) and (2),
5.29shall have an initial term of two, three, or four years, determined by lot by the secretary of
5.30state.
5.31    Subd. 4. Conflicts of interest. (a) Within one year prior to or at any time during
5.32their appointed term, board members appointed under subdivision 2, paragraph (a),
5.33clauses (1) and (2), shall not be employed by, be a member of the board of directors of,
5.34or otherwise be a representative of a health carrier, institutional health care provider or
5.35other entity providing health care, navigator, insurance producer, or other entity in the
5.36business of selling items or services of significant value to or through the Minnesota
6.1Insurance Marketplace. No member of the board may currently serve as a lobbyist, as
6.2defined under section 10A.01, subdivision 21.
6.3    (b) Directors must recuse themselves from discussion of and voting on an official
6.4matter if the director has a conflict of interest. A conflict of interest means an association
6.5including a financial or personal association that has the potential to bias or have the
6.6appearance of biasing a director's decisions in matters related to the exchange or the
6.7conduct of activities under this act.
6.8    Subd. 5. Acting chair; first meeting; supervision. (a) The governor shall designate
6.9as acting chair one of the appointees described in subdivision 2.
6.10(b) The board shall hold its first meeting within 60 days of enactment.
6.11(c) The board shall elect a chair to replace the acting chair at the first meeting.
6.12    Subd. 6. Chair. The board shall have a chair, elected by a majority of members.
6.13The chair shall serve for one year.
6.14    Subd. 7. Officers. The members of the board shall elect officers by a majority of
6.15members. The officers shall serve for one year.
6.16    Subd. 8. Vacancies. If a vacancy occurs for a board seat that was appointed
6.17by the governor, the governor shall appoint a new member within 90 days, and the
6.18newly appointed member shall be subject to the same confirmation process described in
6.19subdivision 2.
6.20    Subd. 9. Removal. A board member may be removed by the board only for cause,
6.21following notice, hearing, and a two-thirds vote of the board. A conflict of interest as
6.22defined in subdivision 4 shall be cause for removal from the board.
6.23    Subd. 10. Meetings. The board shall meet at least quarterly.
6.24    Subd. 11. Quorum. A majority of the members of the board constitutes a quorum,
6.25and the affirmative vote of a majority of members of the board is necessary and sufficient
6.26for action taken by the board.
6.27    Subd. 12. Compensation. Board members may be compensated according to
6.28section 15.0575.
6.29    Subd. 13. Advisory committees. (a) The board may establish, as necessary,
6.30advisory committees to gather information related to the operation of the Minnesota
6.31Insurance Marketplace.
6.32(b) Section 15.0597 shall not apply to any advisory committee established by the
6.33board.

6.34    Sec. 6. [62V.05] RESPONSIBILITIES AND POWERS OF THE MINNESOTA
6.35INSURANCE MARKETPLACE.
7.1    Subdivision 1. General. (a) The board shall operate the Minnesota Insurance
7.2Marketplace according to this chapter and applicable state and federal law.
7.3(b) The board has the power to:
7.4(1) employ personnel and delegate administrative, operational, and other
7.5responsibilities to the director and other personnel as deemed appropriate by the board.
7.6This authority is subject to chapters 43A and 179A. The director and managerial staff of
7.7the Minnesota Insurance Marketplace shall serve in the unclassified service and shall be
7.8governed by a compensation plan prepared by the board, submitted to the commissioner
7.9of management and budget for review and comment within 14 days of its receipt, and
7.10approved by the Legislative Coordinating Commission and the legislature under section
7.113.855, except that section 15A.0815, subdivision 5, paragraph (e), shall not apply;
7.12(2) establish the budget of the Minnesota Insurance Marketplace;
7.13(3) seek and accept money, grants, loans, donations, materials, services, or
7.14advertising revenue from government agencies, philanthropic organizations, and public
7.15and private sources to fund the operation of the Minnesota Insurance Marketplace. No
7.16revenue raising effort shall advantage any specific health benefit plan, health carrier, or
7.17insurer producer active in the business of the Minnesota Insurance Marketplace;
7.18(4) contract for the receipt and provision of goods and services;
7.19(5) enter into information-sharing agreements with federal and state agencies and
7.20other entities, provided the agreements include adequate protections with respect to
7.21the confidentiality and integrity of the information to be shared, and comply with all
7.22applicable state and federal laws, regulations, and rules, including the requirements of
7.23section 62V.06; and
7.24    (6) exercise all powers reasonably necessary to implement and administer the
7.25requirements of this chapter and the Affordable Care Act, Public Law 111-148.
7.26(c) The board shall establish policies and procedures to gather public comment and
7.27provide public notice in the State Register.
7.28(d) Within 180 days of enactment, the board shall establish bylaws, policies,
7.29and procedures governing the operations of the Minnesota Insurance Marketplace in
7.30accordance with this chapter.
7.31(e) If the board's policies, procedures, or other statements are rules, as defined in
7.32section 14.02, subdivision 4, the following requirements apply:
7.33(1) the board shall publish proposed rules in the State Register;
7.34(2) interested parties have 30 days to comment on the proposed rules. The board
7.35must consider comments it receives. After the board has considered all comments, the
7.36board shall publish the final rule in the State Register;
8.1(3) if the adopted rules are the same as the proposed rules, the notice shall state that
8.2the rules have been adopted as proposed and shall cite the prior publication. If the adopted
8.3rules differ from the proposed rules, the portions of the adopted rules that differ from the
8.4proposed rules shall be included in the notice of adoption, together with a citation to the
8.5prior State Register that contained the notice of the proposed rules; and
8.6(4) rules published in the State Register before January 1, 2014, take effect upon
8.7publication. Rules published in the State Register on and after January 1, 2014, take
8.8effect 30 days after publication.
8.9    Subd. 2. Operations funding. (a) Prior to January 1, 2015, the Minnesota
8.10Insurance Marketplace shall retain or collect up to 3.5 percent of total premiums for
8.11individual market and small group market health benefit plans sold through the Minnesota
8.12Insurance Marketplace to fund cash reserves of the Minnesota Insurance Marketplace, but
8.13the amount collected shall not exceed a dollar amount equal to 25 percent of the funds
8.14collected under section 62E.11, subdivision 6, for calendar year 2012.
8.15    (b) Beginning January 1, 2015, the Minnesota Insurance Marketplace shall retain or
8.16collect up to 3.5 percent of premiums for individual market and small group market health
8.17benefit plans sold through the Minnesota Insurance Marketplace to fund operations of the
8.18Minnesota Insurance Marketplace, but the amount collected shall not exceed a dollar
8.19amount equal to 50 percent of the funds collected under section 62E.11, subdivision 6,
8.20for calendar year 2012.
8.21    (c) Beginning January 1, 2016, the Minnesota Insurance Marketplace shall retain
8.22or collect up to 3.5 percent of premiums for individual market and small group market
8.23health benefit plans sold through the Minnesota Insurance Marketplace to fund operations
8.24of the Minnesota Insurance Marketplace, but the annual growth in the amount collected
8.25or retained shall not exceed the annual rate of inflation after accounting for year-to-year
8.26enrollment changes and may never exceed 100 percent of the funds collected under section
8.2762E.11, subdivision 6, for calendar year 2012.
8.28    Subd. 3. Abortion coverage prohibited. (a) No abortion coverage may be provided
8.29by a qualified health benefit plan offered through the Minnesota Insurance Marketplace
8.30created pursuant to the Affordable Care Act, Public Law 111-148.
8.31(b) This limitation shall not apply to an abortion:
8.32(1) performed to prevent the death of the mother;
8.33(2) when the pregnancy is the result of criminal sexual conduct as defined in
8.34section 609.342, subdivision 1, clauses (c), (d), (e), item (i), and (f), and the incident is
8.35reported within 48 hours after the incident occurs to a valid law enforcement agency for
8.36investigation, unless the victim is physically unable to report the criminal sexual conduct,
9.1in which case the report shall be made within 48 hours after the victim becomes physically
9.2able to report the criminal sexual conduct; or
9.3(3) when the pregnancy is the result of incest, but only if the incident and relative are
9.4reported to a valid law enforcement agency for investigation prior to the abortion.
9.5    Subd. 4. Insurance producers. (a) The board, in consultation with the
9.6commissioner of commerce, shall establish minimum standards for certifying insurance
9.7producers who may sell health benefit plans through the Minnesota Insurance Marketplace.
9.8Producers must complete four hours of training in order to receive certification. The
9.9training must include online enrollment tools, compliance with privacy and security
9.10standards, an assessment of the affordability of various cost-sharing responsibilities, how
9.11to evaluate known health needs for that individual and the likely health needs for the
9.12relevant age group, the eligibility requirements for premium assistance and MAGI public
9.13health care programs, the availability of navigator assistance and enrollment support,
9.14tax provisions that may apply to group health benefit plan purchases, and Minnesota
9.15specific programs and marketplace laws. Certification and training shall be administered
9.16by the commissioner of commerce, and the training required under this section shall
9.17qualify as continuing education required under chapter 60K. In order to remain certified
9.18under this subdivision, insurance producers must comply with all applicable certification
9.19requirements, including the requirements established under paragraphs (d) and (e). A
9.20person shall not sell, solicit, or negotiate insurance for any class or classes of insurance
9.21unless the person is licensed for that line of authority under sections 60K.30 to 60K.56.
9.22(b) Producer compensation shall be established by health carriers that provide health
9.23benefit plans through the Minnesota Insurance Marketplace. Compensation to producers
9.24must be equivalent for health benefit plans sold through the marketplace or outside the
9.25marketplace.
9.26(c) Each health carrier that offers or sells health benefit plans through the Minnesota
9.27Insurance Marketplace shall report in writing to the marketplace on a quarterly basis the
9.28compensation and other incentives it offers or provides to its insurance producers with
9.29regard to each type of health benefit plan the health carrier offers or sells both inside and
9.30outside the marketplace.
9.31(d) Nothing in this act shall prohibit an insurance producer from offering professional
9.32advice and recommendations to a small group purchaser based upon information provided
9.33to the producer.
9.34(e) An insurance producer that offers health benefit plans in the individual market
9.35must not sell or renew an individual health benefit plan to a person whose income
9.36indicates the person may be eligible for either premium assistance or a MAGI public
10.1health program, without first informing the person of the person's potential eligibility for
10.2premium assistance or a MAGI public health program and either offering assistance in
10.3determining the person's eligibility, or referring the person for assistance in determining
10.4eligibility. Nothing in this paragraph prohibits an individual from refusing to apply for
10.5any public program or tax credit.
10.6(f) An insurance producer that offers health benefit plans in the small group market
10.7shall notify each small group purchaser of which group health benefit plans qualify for
10.8Internal Revenue Service approved section 125 tax benefits. The insurance producer shall
10.9also notify small group purchasers of state law provisions that benefit small group plans
10.10when the employer agrees to pay 50 percent or more of its employees' premium. Persons
10.11who are eligible for cost-effective medical assistance will count toward the 75 percent
10.12participation requirement in section 62L.03, subdivision 3.
10.13    (g) Any insurance producer assisting an individual or small employer with
10.14purchasing coverage through the Minnesota Insurance Marketplace must disclose, orally
10.15and in writing, to the individual or small employer at the time of the first solicitation with
10.16the prospective purchaser the following:
10.17    (1) the health carriers and qualified health plans offered through the Minnesota
10.18Insurance Marketplace that the producer is authorized to sell, and that the producer may
10.19not be authorized to sell all the qualified health plans offered through the Minnesota
10.20Insurance Marketplace;
10.21    (2) the producer may be receiving compensation from a health carrier for enrolling
10.22the individual or small employer into a particular health plan; and
10.23    (3) information on all qualified health plans offered through the Minnesota Insurance
10.24Marketplace is available through the Minnesota Insurance Marketplace Web site.
10.25For purposes of this paragraph, "solicitation" means any contact by a producer, or any
10.26person acting on behalf of a producer made for the purpose of selling or attempting to sell
10.27coverage through the Minnesota Insurance Marketplace. If the first solicitation is made by
10.28telephone, the disclosures required under this paragraph need not be made in writing, but
10.29the fact that disclosure has been made must be memorialized when the policy is delivered.
10.30    Subd. 5. Navigator; in-person assisters; call center. (a) The board shall establish
10.31policies and procedures for the ongoing operation of a navigator program, in-person
10.32assister program, call center, and customer service provisions for the Minnesota Insurance
10.33Marketplace to be implemented beginning January 1, 2015. The policies and procedures
10.34must require that a person complete at least eight hours of training specific to helping
10.35people obtain insurance through the exchange before working as an in-person assister or
11.1before working as or on behalf of a navigator directly with people seeking insurance
11.2through the exchange.
11.3(b) Until the implementation of the policies and procedures described in paragraph
11.4(a), the following shall be in effect:
11.5(1) the navigator program shall be fulfilled through section 256.962;
11.6(2) entities eligible to be navigators, including insurance producers, Indian tribes and
11.7organizations, and counties may serve as in-person assisters;
11.8(3) the board shall establish requirements and compensation for the in-person
11.9assister program by April 30, 2013. Compensation for in-person assisters must take
11.10into account any other compensation received by the in-person assister for conducting
11.11the same or similar services; and
11.12(4) call center operations shall utilize existing state resources and personnel,
11.13including referrals to counties for medical assistance.
11.14(c) The board shall establish a toll-free number for the Minnesota Insurance
11.15Marketplace and may hire and contract for additional resources as deemed necessary.
11.16    (d) In establishing training standards for the navigator program, the board must
11.17ensure that all entities and individuals carrying out navigator functions have training in
11.18the needs of underserved and vulnerable populations; eligibility and enrollment rules
11.19and procedures; the range of available public health care programs and qualified health
11.20plan options available through the Minnesota Insurance Marketplace; and privacy and
11.21security standards. For calendar year 2014, the commissioner of human services shall
11.22ensure that the program under section 256.962 provides application assistance for both
11.23qualified health plans offered through the Minnesota Insurance Marketplace and public
11.24health care programs.
11.25(e) Any individual or entity acting as a navigator or in-person assister shall be
11.26personally liable for all damages resulting from the individual's or entity's acts or
11.27omissions in providing assistance to marketplace participants.
11.28    Subd. 6. Health carrier requirements; participation. (a) Beginning January 1,
11.292015, the board shall have the power to establish certification requirements for health
11.30carriers and health benefit plans offered through the Minnesota Insurance Marketplace
11.31unless by June 1, 2013, the legislature enacts regulatory requirements that:
11.32(1) apply uniformly to all health carriers and health benefit plans in the individual
11.33market;
11.34(2) apply uniformly to all health carriers and health benefit plans in the small
11.35group market; and
12.1(3) satisfy federal certification requirements for the Minnesota Insurance
12.2Marketplace.
12.3(b) For certification requirements established by the board under paragraph (a), the
12.4board shall establish network adequacy requirements that are not inconsistent with the
12.5most popular health benefit plans offered through the Minnesota Insurance Marketplace
12.6under paragraph (c) in 2014 or 2015.
12.7(c) No health carrier shall be required to participate in the Minnesota Insurance
12.8Marketplace. Beginning January 1, 2015, for those health carriers that opt to participate in
12.9the Minnesota Insurance Marketplace, the board shall approve two health benefit plans,
12.10of which one must be the most popular health benefit plan that a health carrier offers at
12.11each of the catastrophic, bronze, silver, and gold actuarial value levels for each service
12.12area in which the health carrier offers coverage in the individual and small group markets.
12.13The most popular health benefit plan is determined by the highest enrollment inside and
12.14outside the Minnesota Insurance Marketplace by number of lives at the end of the open
12.15enrollment period in the preceding year, excluding health benefit plans closed to new
12.16enrollment as of the preceding year. In determining the most popular health benefit
12.17plans, health benefit plans offered in the individual market prior to January 1, 2014, are
12.18not included. If a health carrier participating in the Minnesota Insurance Marketplace
12.19offers less than two health benefit plans in an actuarial value level or service area in the
12.20individual or small group market, the health carrier shall offer all health benefit plans it
12.21offers in that actuarial value level or service area in the individual or small group market
12.22in the Minnesota Insurance Marketplace.
12.23(d) If a health carrier or parent organization participating in the Minnesota Insurance
12.24Marketplace offers health benefit plans outside the Minnesota Insurance Marketplace in
12.25the individual or small group market, the health carrier must offer health benefit plans
12.26at the silver and gold actuarial levels outside the Minnesota Insurance Marketplace for
12.27each service area in which the health carrier offers coverage in the individual and small
12.28group markets.
12.29(e) Beginning January 1, 2015, the board has the power to select health benefit plans
12.30in addition to those specified in paragraph (c) to participate in the Minnesota Insurance
12.31Marketplace. In the selection process, the board shall seek to provide health coverage
12.32choices that offer the optimal combination of choice, value, quality, and service. Selection
12.33of additional health benefit plans must be determined in the best interests of individual
12.34consumers and employers and within federal requirements. The board shall consistently
12.35and uniformly apply requirements, standards, and criteria to all health carriers and health
12.36benefit plans. In determining the best interests, the board shall consider:
13.1(1) affordability and value;
13.2(2) promotions of high-quality care;
13.3(3) promotion of prevention and wellness;
13.4(4) ensuring access to care;
13.5(5) alignment and coordination with state agency and private sector purchasing
13.6strategies and payment reform efforts; and
13.7(6) other criteria that the board determines appropriate.
13.8(f) For health benefit plans offered through the Minnesota Insurance Marketplace
13.9beginning January 1, 2015, health carriers must use the most current addendum for Indian
13.10health care providers approved by the Centers for Medicare and Medicaid Services and
13.11the tribes as part of their contracts with Indian health care providers.
13.12(g) For 2014, the board shall not have the power to select health carriers and health
13.13benefit plans for participation in the Minnesota Insurance Marketplace. The board shall
13.14have the power to verify that health carriers and health benefit plans were properly
13.15certified under certification guidance in place on January 1, 2013, to be eligible for
13.16participation in the Minnesota Insurance Marketplace. Notwithstanding the foregoing, any
13.17catastrophic health plan, as defined in section 1302(e) of the federal Patient Protection
13.18and Affordable Care Act (Public Law 111-148), shall be eligible for participation in the
13.19Minnesota Insurance Marketplace in 2014.
13.20(h) The board has the authority to decertify health carriers and health benefit plans
13.21that fail to maintain compliance with section 1311(c) of the federal Patient Protection and
13.22Affordable Care Act (Public Law 111-148).
13.23    Subd. 7. Appeals. (a) The board may conduct hearings, appoint hearing officers,
13.24and recommend final orders related to appeals of any Minnesota Insurance Marketplace
13.25determinations, except for those determinations identified in paragraph (d). An appeal
13.26by a health carrier regarding a specific certification or selection determination made by
13.27the Minnesota Insurance Marketplace under subdivision 6, paragraph (a) or (b), must be
13.28conducted as a contested case proceeding under chapter 14, with the report or order of
13.29the administrative law judge constituting the final decision in the case, subject to judicial
13.30review under sections 14.63 to 14.69. For other appeals, the board shall establish hearing
13.31processes which provide for a reasonable opportunity to be heard and timely resolution of
13.32the appeal and which are consistent with the requirements of federal law and guidance.
13.33An appealing party may be represented by legal counsel at these hearings, but this is
13.34not a requirement.
13.35(b) The Minnesota Insurance Marketplace may establish service-level agreements
13.36with state agencies to conduct hearings for appeals. Notwithstanding section 471.59,
14.1subdivision 1, a state agency is authorized to enter into service-level agreements for this
14.2purpose with the Minnesota Insurance Marketplace.
14.3(c) For proceedings under this subdivision, the Minnesota Insurance Marketplace may
14.4be represented by an attorney who is an employee of the Minnesota Insurance Marketplace.
14.5(d) This subdivision does not apply to appeals of determinations where a state
14.6agency hearing is available under section 256.045.
14.7    Subd. 8. Agreements; consultation. (a) The board shall:
14.8(1) establish and maintain an agreement with the chief information officer of
14.9the Office of Enterprise Technology for information technology services that ensures
14.10coordination with MAGI public health care programs. The board may establish and
14.11maintain agreements with the chief information officer of the Office of Enterprise
14.12Technology for other information technology services, including an agreement that would
14.13permit the Minnesota Insurance Marketplace to administer eligibility for additional health
14.14care and public assistance programs under the authority of the commissioner of human
14.15services;
14.16(2) establish and maintain an agreement with the commissioner of human services
14.17for cost allocation and services regarding eligibility determinations and enrollment for
14.18MAGI public health care programs. The board may establish and maintain an agreement
14.19with the commissioner of human services for other services;
14.20(3) establish and maintain an agreement with the commissioners of commerce
14.21and health for services regarding enforcement of Minnesota Insurance Marketplace
14.22certification requirements for health benefit plans offered through the Minnesota Insurance
14.23Marketplace. The board may establish and maintain agreements with the commissioners
14.24of commerce and health for other services; and
14.25(4) establish interagency agreements to transfer funds to other state agencies for
14.26their costs related to implementing and operating the Minnesota Insurance Marketplace,
14.27excluding medical assistance allocatable costs.
14.28(b) The board shall consult with the commissioners of commerce and health
14.29regarding the operations of the Minnesota Insurance Marketplace.
14.30(c) The board shall consult with Indian tribes and organizations regarding the
14.31operation of the Minnesota Insurance Marketplace.
14.32(d) The board shall establish an advisory committee consisting of representatives
14.33from the health care industry, consumers, and other stakeholders to provide information
14.34and advise the board on the operations of the Minnesota Insurance Marketplace.
14.35    Subd. 9. Limitations; risk-bearing. (a) The board shall not bear insurance risk or
14.36enter into any agreement with health care providers to pay claims.
15.1(b) Nothing in this subdivision shall prevent the Minnesota Insurance Marketplace
15.2from providing insurance for its employees.

15.3    Sec. 7. [62V.06] DATA PRACTICES.
15.4    Subdivision 1. Applicability. The Minnesota Insurance Marketplace is a state
15.5agency for purposes of the Minnesota Government Data Practices Act and is subject to all
15.6provisions of chapter 13, in addition to the requirements contained in this section.
15.7    Subd. 2. Definitions. As used in this section:
15.8    (1) "individual" means an individual according to section 13.02, subdivision 8, but
15.9does not include a vendor of services; and
15.10    (2) "participating" means that an individual, employee, or employer is seeking, or
15.11has sought an eligibility determination, enrollment processing, or premium processing
15.12through the Minnesota Insurance Marketplace.
15.13    Subd. 3. General data classifications. The following data collected, created, or
15.14maintained by the Minnesota Insurance Marketplace (Marketplace) are classified as
15.15private data on individuals, as defined in section 13.02, subdivision 12, or nonpublic data,
15.16as defined in section 13.02, subdivision 9:
15.17(1) data on any individual participating in the Marketplace;
15.18(2) data on any individuals participating in the Marketplace as employees of an
15.19employer participating in the Marketplace; and
15.20(3) data on employers participating in the Marketplace.
15.21    Subd. 4. Application and certification data. (a) Data submitted by an insurance
15.22producer in an application for certification to sell a health benefit plan through the
15.23Marketplace, or submitted by an applicant seeking permission or a commission to act as a
15.24navigator or in-person assister, are classified as follows:
15.25(1) at the time the application is submitted, all data contained in the application are
15.26private data, as defined in section 13.02, subdivision 12, or nonpublic data as defined in
15.27section 13.02, subdivision 9, except that the name of the applicant is public; and
15.28(2) upon a final determination related to the application for certification by the
15.29Marketplace, all data contained in the application are public, with the exception of trade
15.30secret data as defined in section 13.37.
15.31(b) Data created or maintained by a government entity as part of the evaluation of
15.32an application are protected nonpublic data, as defined in section 13.02, subdivision 13,
15.33until a final determination as to certification is made and all rights of appeal have been
15.34exhausted. Upon a final determination and exhaustion of all rights of appeal, these data are
16.1public, with the exception of trade secret data as defined in section 13.37 and data subject
16.2to attorney-client privilege or other protection as provided in section 13.393.
16.3(c) If an application is denied, the public data must include the criteria used by the
16.4board to evaluate the application and the specific reasons for the denial, and these data
16.5must be published on the Marketplace Web site.
16.6    Subd. 5. Data sharing. (a) The Minnesota Insurance Marketplace may share or
16.7disseminate data classified as private or nonpublic in subdivision 4 as follows:
16.8(1) to the subject of the data, as provided in section 13.04;
16.9    (2) according to a court order;
16.10    (3) according to a state or federal law specifically authorizing access to the data;
16.11(4) with other state or federal agencies, only to the extent necessary to verify the
16.12identity of, determine the eligibility of, process premiums for, process enrollment of, or
16.13investigate fraud related to an individual, employer, or employee participating in the
16.14Marketplace, provided that the Marketplace must enter into a data-sharing agreement with
16.15the agency prior to sharing data under this clause; and
16.16(5) with a nongovernmental person or entity, only to the extent necessary to verify
16.17the identity of, determine the eligibility of, process premiums for, process enrollment
16.18of, or investigate fraud related to an individual, employer, or employee participating in
16.19the Marketplace, provided that the Marketplace must enter a contract with the person
16.20or entity, as provided in section 13.05, subdivision 6 or 11, prior to disseminating data
16.21under this clause.
16.22    (b) The Minnesota Insurance Marketplace may share or disseminate data classified
16.23as private or nonpublic in subdivision 4 as follows:
16.24    (1) to the subject of the data, as provided in section 13.04;
16.25    (2) according to a court order;
16.26    (3) according to a state or federal law specifically authorizing access to the data;
16.27    (4) with other state or federal agencies, only to the extent necessary to carry out the
16.28functions of the Marketplace, provided that the Marketplace must enter into a data-sharing
16.29agreement with the agency prior to sharing data under this clause; and
16.30    (5) with a nongovernmental person or entity, only to the extent necessary to carry
16.31out the functions of the Marketplace, provided that the Marketplace must enter a contract
16.32with the person or entity, as provided in section 13.05, subdivision 6 or 11, prior to
16.33disseminating data under this clause.
16.34(c) Sharing or disseminating data outside of the exchange in a manner not authorized
16.35by this subdivision is prohibited. The list of authorized dissemination and sharing
17.1contained in this subdivision must be included in the Tennessen warning required by
17.2section 13.04, subdivision 2.
17.3    (d) Until July 1, 2014, state agencies must share data classified as private or
17.4nonpublic on individuals, employees, or employers participating in the Marketplace with
17.5the Marketplace, only to the extent such data are necessary to verify the identity of,
17.6determine the eligibility of, process premiums for, process enrollment of, or investigate
17.7fraud related to a Marketplace participant. The agency must enter into a data-sharing
17.8agreement with the Marketplace prior to sharing any data under this paragraph.
17.9(e) The Minnesota Insurance Marketplace may not share or disseminate outside of
17.10the marketplace data that indicates whether or not an individual or employee participating
17.11in the marketplace has a history of tobacco use or owns a gun or has a firearm in their home.
17.12    Subd. 6. Notice and disclosures. (a) In addition to the Tennessen warning required
17.13by section 13.04, subdivision 2, the Marketplace must provide any data subject asked to
17.14supply private data with:
17.15(1) a notice of rights related to the handling of genetic information, pursuant to
17.16section 13.386; and
17.17(2) a notice of the records retention policy of the Marketplace, detailing the length of
17.18time the Marketplace will retain data on the individual and the manner in which it will
17.19be destroyed upon expiration of that time.
17.20(b) All notices required by this subdivision, including the Tennessen warning, must
17.21be provided in an electronic format suitable for downloading or printing.
17.22    Subd. 7. Summary data. In addition to creation and disclosure of summary data
17.23derived from private data on individuals, as permitted by section 13.05, subdivision 7,
17.24the Marketplace may create and disclose summary data derived from data classified as
17.25nonpublic under this section.
17.26    Subd. 8. Access to data; audit trail. (a) Only individuals with explicit authorization
17.27from the board may enter, update, or access not public data collected, created, or
17.28maintained by the Marketplace. The ability of authorized individuals to enter, update, or
17.29access data must be limited through the use of role-based access that corresponds to
17.30the official duties or training level of the individual, and the statutory authorization that
17.31grants access for that purpose. All queries and responses, and all actions in which data are
17.32entered, updated, accessed, or shared or disseminated outside of the marketplace, must
17.33be recorded in a data audit trail. Data contained in the audit trail are public, to the extent
17.34that the data are not otherwise classified by this section.
17.35The board shall immediately and permanently revoke the authorization of any
17.36individual determined to have willfully entered, updated, accessed, shared, or disseminated
18.1data in violation of this section, or any provision of chapter 13. If an individual is
18.2determined to have willfully gained access to data without explicit authorization from the
18.3board, the board shall forward the matter to the county attorney for prosecution.
18.4(b) This subdivision shall not limit or affect the authority of the legislative auditor to
18.5access data needed to conduct audits, evaluations, or investigations of the Marketplace
18.6or the obligation of the board and Marketplace employees to comply with section 3.978,
18.7subdivision 2.
18.8(c) This subdivision does not apply to actions taken by a Minnesota Insurance
18.9Marketplace participant to enter, update, or access data held by the Minnesota Insurance
18.10Marketplace, if the participant is the subject of the data that is entered, updated, or accessed.
18.11    Subd. 9. Sale of data prohibited. The Marketplace may not sell any data collected,
18.12created, or maintained by the Marketplace, regardless of its classification, for commercial
18.13or any other purposes.

18.14    Sec. 8. [62V.07] FUNDS.
18.15All funds received by the Minnesota Insurance Marketplace must be deposited in a
18.16dedicated account in the special revenue fund which may earn interest and are appropriated
18.17to the Minnesota Insurance Marketplace for the purpose for which the funds were received.

18.18    Sec. 9. [62V.08] REPORT.
18.19(a) The Minnesota Insurance Marketplace shall submit a report to the legislature by
18.20January 15, 2015, and each January 15 thereafter, on: (1) the performance of Minnesota
18.21Insurance Marketplace operations; (2) meeting the Minnesota Insurance Marketplace
18.22responsibilities; and (3) an accounting of the Minnesota Insurance Marketplace budget
18.23activities.
18.24(b) The exchange must publish the administrative and operational costs of the
18.25exchange on a Web site to educate consumers on those costs. The information published
18.26must include the amount of premiums and federal premium subsidies collected by the
18.27exchange; the amount and source of revenue received under section 62V.05, subdivision
18.281, paragraph (b), clause (3); the amount and source of any other fees collected by the
18.29exchange for purposes of supporting its operations; and any misuse of funds as identified
18.30in accordance with section 3.975. The Web site must be updated at least annually.

18.31    Sec. 10. [62V.09] EXPIRATION AND SUNSET EXCLUSION.
19.1Notwithstanding Minnesota Statutes, section 15.059, the Minnesota Insurance
19.2Marketplace Act shall not expire. The board is not subject to review or sunsetting under
19.3Minnesota Statutes, chapter 3D.

19.4    Sec. 11. [62V.10] RIGHT NOT TO PARTICIPATE.
19.5Nothing in this chapter infringes on the right of a Minnesota citizen not to participate
19.6in the Minnesota Insurance Marketplace.

19.7    Sec. 12. [62V.11] RIGHT TO PHYSICIAN OF CHOICE.
19.8Nothing in this chapter shall prohibit a person using a federal premium tax credit or
19.9cost-sharing subsidy to purchase a health benefit plan through the Minnesota Insurance
19.10Exchange from receiving care from the physician of their choice.

19.11    Sec. 13. TRANSITION OF AUTHORITY.
19.12(a) Upon the effective date of this act, the commissioner of management and budget
19.13shall exercise all authorities and responsibilities under Minnesota Statutes, sections
19.1462V.03 and 62V.05 until the board has satisfied the requirements of Minnesota Statutes,
19.15section 62V.05, subdivision 1, paragraph (d).
19.16(b) Upon the establishment of bylaws, policies, and procedures governing the
19.17operations of the Minnesota Insurance Marketplace by the board as required under
19.18Minnesota Statutes, section 62V.05, subdivision 1, paragraph (d), all personnel, assets,
19.19contracts, obligations, and funds managed by the commissioner of management and
19.20budget for the design and development of the Minnesota Insurance Marketplace shall be
19.21transferred to the board. Existing personnel managed by the commissioner of management
19.22and budget for the design and development of the Minnesota Insurance Marketplace shall
19.23staff the board upon enactment.

19.24    Sec. 14. MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION.
19.25    The commissioner of commerce, in consultation with the board of directors of the
19.26Minnesota Comprehensive Health Association, has the authority to determine the need
19.27for and to implement the eventual appropriate termination of coverage provided by the
19.28Minnesota Comprehensive Health Association under Minnesota Statutes, chapter 62E.
19.29The phase-out of coverage shall begin no sooner than January 1, 2014.

19.30    Sec. 15. EFFECTIVE DATE.
20.1Sections 1 to 14 are effective the day following final enactment. Any actions taken
20.2by any state agencies in furtherance of the design, development, and implementation of the
20.3Minnesota Insurance Marketplace prior to the effective date shall be considered actions
20.4taken by the Minnesota Insurance Marketplace and shall be governed by the provisions of
20.5this chapter and state law. Health benefit plan coverage through the Minnesota Insurance
20.6Marketplace is effective January 1, 2014.

700 State Office Building, 100 Rev. Dr. Martin Luther King Jr. Blvd., St. Paul, MN 55155 ♦ Phone: (651) 296-2868 ♦ TTY: 1-800-627-3529 ♦ Fax: (651) 296-0569