SF 349

as introduced - 89th Legislature (2015 - 2016) Posted on 01/27/2015 09:46am

A bill for an act
relating to health; permitting Minnesota residents to buy health coverage
approved in other states; requiring an independent cost-benefit analysis of
MNsure; requiring line controls testing of the information technology systems
used in MNsure three months prior to use by the public; modifying participation
requirements for health plans to be offered for sale through MNsure; limiting
the MNsure Board from increasing the premium withhold without legislative
approval; requiring an independent financial audit of MNsure; amending
Minnesota Statutes 2014, sections 62A.02, subdivision 7; 62V.03, by adding
a subdivision; 62V.05, subdivisions 2, 5; proposing coding for new law in
Minnesota Statutes, chapter 62A.

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

Section 1.

Minnesota Statutes 2014, section 62A.02, subdivision 7, is amended to read:

Subd. 7.

Filing by domestic insurers for purposes of complying with another
state's filing requirements.

A domestic insurer may file with the commissioner for
informational purposes only a policy or certificate of insurance that is not intended to be
offered or sold within this state. This subdivision only applies to the filing in Minnesota
of a policy or certificate of insurance issued to an insured or certificate holder located
outside of this state when the filing is for the express purpose of complying with the law
of the state in which the insured or certificate holder resides. deleted text begin In no event may a policy
or certificate of insurance filed under this subdivision for out-of-state use be issued or
delivered in Minnesota unless and until the policy or certificate of insurance is approved
under subdivision 2.
deleted text end

Sec. 2.

new text begin [62A.026] RIGHT TO BUY AND SELL HEALTH COVERAGE
APPROVED IN OTHER STATES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Commissioner" means the commissioner of commerce or the commissioner of
health, as appropriate, depending upon which commissioner would have authority over
the insurance company or health plan if it were subject to the laws of this state.
new text end

new text begin (c) "Health plan" has the meaning given in section 62A.011, subdivision 3, but
includes coverage described in clauses (6) and (10) of that subdivision, and without regard
to the references in that subdivision requiring the entities providing the health plan to be
licensed in or operating under the laws of this state.
new text end

new text begin (d) "Insurance company," "domestic," "alien," "foreign," and "state" have the
meanings given in section 60A.02. Insurance company includes a health maintenance
organization or health service plan corporation, whether nonprofit or for profit.
new text end

new text begin Subd. 2. new text end

new text begin Purchase of a health plan permitted to be sold in another state. new text end

new text begin (a)
Notwithstanding section 62A.02 or any other law to the contrary, any resident of this
state and any employer that employs residents of this state may purchase a health plan
that has not been approved by the commissioner, if the health plan is permitted to be sold
in any other state.
new text end

new text begin (b) Notwithstanding section 62A.02 or any other law to the contrary, any insurance
company, whether domestic, foreign, or alien, that is permitted to offer, sell, issue, or
renew a health plan in any other state under the laws of that state, may also do so with
respect to that health plan in this state. The insurance company need not have a certificate
of authority, license, or other authorization from the commissioner to do business in this
state. This paragraph does not exempt the insurance company from compliance with
chapter 303, relating to foreign business entities.
new text end

new text begin (c) Notwithstanding section 62A.02 or any other law to the contrary, any insurance
agent licensed or otherwise permitted to offer and sell health plans in this state or in a
state in which the health plan is permitted to be offered and sold, may offer and sell to a
resident of this state or to an employer that employs residents of this state any health plan
permitted to be offered and sold under paragraph (b) and is not, in connection with that
transaction, subject to the laws of this state regulating insurance agents.
new text end

new text begin (d) Notwithstanding section 62A.02 or any other law to the contrary, an insurance
company and a health plan offered, issued, sold, or renewed by the insurance company
under authority of this section are:
new text end

new text begin (1) not, in connection with that health plan, subject to the authority of the
commissioner in any respect, and the insurance company need not provide any filing or
notification to the commissioner;
new text end

new text begin (2) not, in connection with that health plan, required to comply with any law of
this state relating to insurance companies or health plans, including, but not limited to,
chapters 45 and 60A to 72C; and
new text end

new text begin (3) subject to the tax laws of this state, including chapter 297I, on the same basis
as other insurance companies doing business in this state and other health plans sold in
this state.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 3.

Minnesota Statutes 2014, section 62V.03, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin IT systems testing. new text end

new text begin Prior to the beginning of each annual open enrollment
period for MNsure, beginning in calendar year 2015, MNsure shall conduct line control
testing of any information technology systems used in the application or enrollment
processes that are to be used by consumers to ensure reliability, compatibility, and
consumer confidence. The testing shall be conducted for at least three months before
being made available for use by the public through the MNsure Web site.
new text end

Sec. 4.

Minnesota Statutes 2014, section 62V.05, subdivision 2, is amended to read:

Subd. 2.

Operations funding.

(a) Prior to January 1, 2015, MNsure shall retain or
collect up to 1.5 percent of total premiums for individual and small group market health
plans and dental plans sold through MNsure to fund the cash reserves of MNsure, but
the amount collected shall not exceed a dollar amount equal to 25 percent of the funds
collected under section 62E.11, subdivision 6, for calendar year 2012.

(b) Beginning January 1, 2015, MNsure shall retain or collect up to 3.5 percent of
total premiums for individual and small group market health plans and dental plans sold
through MNsure to fund the operations of MNsure, but the amount collected shall not
exceed a dollar amount equal to 50 percent of the funds collected under section 62E.11,
subdivision 6, for calendar year 2012.

(c) Beginning January 1, 2016, MNsure shall retain or collect up to 3.5 percent of
total premiums for individual and small group market health plans and dental plans sold
through MNsure to fund the operations of MNsure, but the amount collected may never
exceed a dollar amount greater than 100 percent of the funds collected under section
62E.11, subdivision 6, for calendar year 2012.

new text begin (d) Any increase in the percent of total premiums retained or collected under
paragraph (c) to fund the operations of MNsure must be approved in law.
new text end

deleted text begin (d) deleted text end new text begin (e) new text end For fiscal years 2014 and 2015, the commissioner of management and
budget is authorized to provide cash flow assistance of up to $20,000,000 from the
special revenue fund or the statutory general fund under section 16A.671, subdivision 3,
paragraph (a), to MNsure. Any funds provided under this paragraph shall be repaid,
with interest, by June 30, 2015.

deleted text begin (e) deleted text end new text begin (f) new text end Funding for the operations of MNsure shall cover any compensation provided
to navigators participating in the navigator program.

Sec. 5.

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:

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

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

deleted text begin (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
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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. 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, 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 end

deleted text begin (g) 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 end

deleted text begin (h) 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 end

new text begin (1) the health plan provides the essential health benefits package described in section
1302(a) of the Affordable Care Act, except that the plan is not required to provide essential
benefits that duplicate the minimum benefits of dental plans if:
new text end

new text begin (i) MNsure has determined that at least one qualified dental plan is available to
supplement the health plan's coverage; and
new text end

new text begin (ii) the health carrier makes a prominent disclosure at the time it offers the health
plan, in a form approved by MNsure, that the health plan does not provide the full range of
essential pediatric benefits and that the dental plans providing those benefits and other
dental benefits not covered by the health plan are offered through MNsure;
new text end

new text begin (2) the premium rates and policy forms have been approved by the commissioner of
commerce or the commissioner of health;
new text end

new text begin (3) the health plan provides at least a bronze level of coverage unless the health plan
is certified as a qualified catastrophic plan, meets the requirements of section 1302(e) of
the Affordable Care Act for catastrophic plans, and is only offered to individuals eligible
for catastrophic coverage;
new text end

new text begin (4) the health plan's cost-sharing requirements do not exceed the limits established
under section 1032(c)(1) of the Affordable Care Act and, if the health plan is offered to
a qualified employer, the health plan's deductible does not exceed the limits established
under section 1032(c)(2) of the Affordable Care Act;
new text end

new text begin (5) the health carrier offering the health plan:
new text end

new text begin (i) is licensed and in good standing;
new text end

new text begin (ii) offers at least one qualified health plan at the silver level and at least one qualified
health plan at the gold level through MNsure;
new text end

new text begin (iii) for each metal level in which the health carrier participates, offers coverage in
that level to individuals who, as of the beginning of a plan or policy year, have not attained
the age of 21;
new text end

new text begin (iv) charges the same premium rate for each qualified health plan without regard to
whether the plan is offered through MNsure and without regard to whether the health plan
is offered directly from the health carrier or through an insurance producer;
new text end

new text begin (v) does not charge any cancellation fees or penalties; and
new text end

new text begin (vi) complies with the regulations developed by the secretary of health and human
services under section 1311(d) of the Affordable Care Act; and
new text end

new text begin (6) the health plan meets the requirements of certification under section 1311(c) of
the Affordable Care Act.
new text end

new text begin (d) The provisions of this chapter that are applicable to qualified health plans must
allow for and apply to the extent relevant to dental plans except as modified in accordance
with clauses (1) to (3):
new text end

new text begin (1) the dental organization must be licensed to offer stand-alone dental plans but
need not be licensed to offer health plans;
new text end

new text begin (2) the dental plan must be limited to dental and oral health benefits, without
substantially duplicating the benefits typically offered by health plans without dental
coverage and must include, at a minimum, the essential pediatric dental benefits pursuant
to section 1302(b)(1)(J) of the Affordable Care Act; and
new text end

new text begin (3) a health carrier and a dental organization may jointly offer a comprehensive
health plan through MNsure in which the essential pediatric dental benefits are provided
by the dental organization and the other benefits are provided by the health carrier.
new text end

new text begin (e) All health carriers and health plans that have met the certification requirements
of this subdivision are eligible for participation in MNsure.
new text end

deleted text begin (i) deleted text end new text begin (f) 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.

Sec. 6. new text begin FINANCIAL AUDIT.
new text end

new text begin (a) Notwithstanding Minnesota Statutes, section 62V.03, subdivision 2, paragraph
(a), MNsure shall contract with an independent audit firm to conduct an analysis on
the operations of MNsure from July 1, 2013, to June 30, 2015. The analysis shall
encompass an accounting of the operational costs of MNsure related to qualified health
plan enrollment that includes the administrative, IT systems, and customer services
expenditures, including all outreach grants awarded. The analysis shall also include an
accounting of all federal funds related to qualified health plans expended or obligated and
the total amount of premiums withheld. A cost-benefit analysis shall be conducted on the
expenditures made based on the number of individuals and families who have enrolled in
a qualified health plan through MNsure.
new text end

new text begin (b) The results of the audit and analysis shall be submitted to the legislative oversight
committee established under Minnesota Statutes, section 62V.11, and the chairs and
ranking minority members of the legislative committees with jurisdiction over MNsure by
January 15, 2016.
new text end

new text begin (c) The costs and expenses of the audit and analysis shall be paid by MNsure.
new text end