SF 527

as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to commerce; transferring the regulation of 
  1.3             certain health carriers and health care functions from 
  1.4             the department of health to the department of 
  1.5             commerce; amending Minnesota Statutes 1994, sections 
  1.6             62A.011, by adding a subdivision; 62D.02, subdivisions 
  1.7             3 and 8; 62D.12, subdivision 1; 62D.24; 62E.11, 
  1.8             subdivision 12; 62E.14, subdivision 6; 62L.02, 
  1.9             subdivision 8; 62L.08, subdivisions 10 and 11; 62L.10, 
  1.10            subdivision 4; 62L.11, subdivision 2; 62M.11; 62M.16; 
  1.11            62N.02, subdivision 4; 62P.02; 62P.04, subdivisions 4 
  1.12            and 7; 62Q.01, subdivision 2; 62Q.03, subdivisions 4, 
  1.13            8, and 10; 62Q.07, subdivision 1; 62Q.075, subdivision 
  1.14            4; 62Q.09, subdivision 3; 62Q.11, subdivisions 1 and 
  1.15            2; and 62R.04, subdivision 5; repealing Minnesota 
  1.16            Statutes 1994, sections 62P.04, subdivision 6; 62P.09, 
  1.17            subdivision 2; 62Q.03, subdivision 5; and 62Q.21, 
  1.18            subdivision 4.  
  1.19  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.20     Section 1.  Minnesota Statutes 1994, section 62A.011, is 
  1.21  amended by adding a subdivision to read: 
  1.22     Subd. 4.  [COMMISSIONER.] "Commissioner" means the 
  1.23  commissioner of commerce. 
  1.24     Sec. 2.  Minnesota Statutes 1994, section 62D.02, 
  1.25  subdivision 3, is amended to read: 
  1.26     Subd. 3.  "Commissioner of health commerce" or 
  1.27  "commissioner" means the state commissioner of health commerce 
  1.28  or a designee. 
  1.29     Sec. 3.  Minnesota Statutes 1994, section 62D.02, 
  1.30  subdivision 8, is amended to read: 
  1.31     Subd. 8.  "Health maintenance contract" means any contract 
  1.32  whereby a health maintenance organization agrees to provide 
  2.1   comprehensive health maintenance services to enrollees, provided 
  2.2   that the contract may contain reasonable enrollee copayment 
  2.3   provisions.  Copayment provisions in group contracts shall not 
  2.4   discriminate on the basis of age, sex, race, length of 
  2.5   enrollment in the plan, or economic status; and during every 
  2.6   open enrollment period in which all offered health benefit 
  2.7   plans, including those subject to the jurisdiction of the 
  2.8   commissioners commissioner of commerce or health, fully 
  2.9   participate without any underwriting restrictions, copayment 
  2.10  provisions shall not discriminate on the basis of preexisting 
  2.11  health status.  In no event shall the annual copayment exceed 
  2.12  the maximum out-of-pocket expenses allowable for a number three 
  2.13  qualified insurance policy under section 62E.06.  Where sections 
  2.14  62D.01 to 62D.30 permit a health maintenance organization to 
  2.15  contain reasonable copayment provisions for preexisting health 
  2.16  status, these provisions may vary with respect to length of 
  2.17  enrollment in the plan.  Any contract may provide for health 
  2.18  care services in addition to those set forth in subdivision 7.  
  2.19     Sec. 4.  Minnesota Statutes 1994, section 62D.12, 
  2.20  subdivision 1, is amended to read: 
  2.21     Subdivision 1.  No health maintenance organization or 
  2.22  representative thereof may cause or knowingly permit the use of 
  2.23  advertising or solicitation which is untrue or misleading, or 
  2.24  any form of evidence of coverage which is deceptive.  Each 
  2.25  health maintenance organization shall be subject to sections 
  2.26  72A.17 to 72A.32, relating to the regulation of trade practices, 
  2.27  except (a) to the extent that the nature of a health maintenance 
  2.28  organization renders such sections clearly inappropriate and (b) 
  2.29  that enforcement shall be by the commissioner of health and not 
  2.30  by the commissioner of commerce.  Every health maintenance 
  2.31  organization shall be subject to sections 8.31 and 325F.69. 
  2.32     Sec. 5.  Minnesota Statutes 1994, section 62D.24, is 
  2.33  amended to read: 
  2.34     62D.24 [STATE COMMISSIONER OF HEALTH'S COMMISSIONER'S 
  2.35  AUTHORITY TO CONTRACT.] 
  2.36     The commissioner of health, in carrying out the obligations 
  3.1   under sections 62D.01 to 62D.30, may contract with 
  3.2   the commissioner of commerce or other qualified persons to make 
  3.3   recommendations concerning the determinations required to be 
  3.4   made.  Such recommendations may be accepted in full or in part 
  3.5   by the commissioner of health. 
  3.6      Sec. 6.  Minnesota Statutes 1994, section 62E.11, 
  3.7   subdivision 12, is amended to read: 
  3.8      Subd. 12.  [FUNDING.] Notwithstanding subdivision 5, the 
  3.9   claims expenses and operating and administrative expenses of the 
  3.10  association incurred on or after January 1, 1994, to the extent 
  3.11  that they exceed the premiums received, shall be paid from the 
  3.12  health care access account established in section 16A.724, to 
  3.13  the extent appropriated for that purpose by the legislature.  
  3.14  Any such expenses not paid from that account shall be paid as 
  3.15  otherwise provided in this section.  All contributing members 
  3.16  shall adjust their premium rates to fully reflect funding 
  3.17  provided under this subdivision.  The commissioner of 
  3.18  commerce or the commissioner of health, as appropriate, shall 
  3.19  require contributing members to prove compliance with this rate 
  3.20  adjustment requirement. 
  3.21     Sec. 7.  Minnesota Statutes 1994, section 62E.14, 
  3.22  subdivision 6, is amended to read: 
  3.23     Subd. 6.  [TERMINATION OF INDIVIDUAL POLICY OR CONTRACT.] A 
  3.24  Minnesota resident who holds an individual health maintenance 
  3.25  contract, individual nonprofit health service corporation 
  3.26  contract, or an individual insurance policy previously approved 
  3.27  by the commissioners of health or commissioner of commerce, may 
  3.28  enroll in the comprehensive health insurance plan with a waiver 
  3.29  of the preexisting condition as described in subdivision 3, 
  3.30  without interruption in coverage, provided (1) no replacement 
  3.31  coverage that meets the requirements of section 62D.121 was 
  3.32  offered by the contributing member, and (2) the policy or 
  3.33  contract has been terminated for reasons other than (a) 
  3.34  nonpayment of premium; (b) failure to make copayments required 
  3.35  by the health care plan; (c) moving out of the area served; or 
  3.36  (d) a materially false statement or misrepresentation by the 
  4.1   enrollee in the application for membership; and, provided 
  4.2   further, that the option to enroll in the plan is exercised 
  4.3   within 30 days of termination of the existing policy or contract.
  4.4      Coverage allowed under this section is effective when the 
  4.5   contract or policy is terminated and the enrollee has completed 
  4.6   the proper application and paid the required premium or fee. 
  4.7      Expenses incurred from the preexisting conditions of 
  4.8   individuals enrolled in the state plan under this subdivision 
  4.9   must be paid by the contributing member canceling coverage as 
  4.10  set forth in section 62E.11, subdivision 10. 
  4.11     The application must include evidence of termination of the 
  4.12  existing policy or certificate as required in subdivision 1. 
  4.13     Sec. 8.  Minnesota Statutes 1994, section 62L.02, 
  4.14  subdivision 8, is amended to read: 
  4.15     Subd. 8.  [COMMISSIONER.] "Commissioner" means the 
  4.16  commissioner of commerce for health carriers subject to the 
  4.17  jurisdiction of the department of commerce or the commissioner 
  4.18  of health for health carriers subject to the jurisdiction of the 
  4.19  department of health, or the relevant commissioner's designated 
  4.20  representative.  For purposes of sections 62L.13 to 62L.22, 
  4.21  "commissioner" means the commissioner of commerce or that 
  4.22  commissioner's designated representative. 
  4.23     Sec. 9.  Minnesota Statutes 1994, section 62L.08, 
  4.24  subdivision 10, is amended to read: 
  4.25     Subd. 10.  [RATING REPORT.] Beginning January 1, 1995, and 
  4.26  annually thereafter, the commissioners of health and 
  4.27  commerce commissioner shall provide a joint report to the 
  4.28  legislature on the effect of the rating restrictions required by 
  4.29  this section and the appropriateness of proceeding with 
  4.30  additional rate reform.  Each report must include an analysis of 
  4.31  the availability of health care coverage due to the rating 
  4.32  reform, the equitable and appropriate distribution of risk and 
  4.33  associated costs, the effect on the self-insurance market, and 
  4.34  any resulting or anticipated change in health plan design and 
  4.35  market share and availability of health carriers. 
  4.36     Sec. 10.  Minnesota Statutes 1994, section 62L.08, 
  5.1   subdivision 11, is amended to read: 
  5.2      Subd. 11.  [LOSS RATIO STANDARDS.] Notwithstanding section 
  5.3   62A.02, subdivision 3, relating to loss ratios, each policy or 
  5.4   contract form used with respect to a health benefit plan 
  5.5   offered, or issued in the small employer market, is subject, 
  5.6   beginning July 1, 1993, to section 62A.021.  The commissioner of 
  5.7   health has, with respect to carriers under that commissioner's 
  5.8   jurisdiction, all of the powers of the commissioner of commerce 
  5.9   under that section. 
  5.10     Sec. 11.  Minnesota Statutes 1994, section 62L.10, 
  5.11  subdivision 4, is amended to read: 
  5.12     Subd. 4.  [REVIEW OF PREMIUM RATES.] The commissioner shall 
  5.13  regulate premium rates charged or proposed to be charged by all 
  5.14  health carriers in the small employer market under section 
  5.15  62A.02.  The commissioner of health has, with respect to 
  5.16  carriers under that commissioner's jurisdiction, all of the 
  5.17  powers of the commissioner of commerce under that section. 
  5.18     Sec. 12.  Minnesota Statutes 1994, section 62L.11, 
  5.19  subdivision 2, is amended to read: 
  5.20     Subd. 2.  [ENFORCEMENT POWERS.] The commissioners of health 
  5.21  and commerce each commissioner has for purposes of this chapter 
  5.22  all of each the commissioner's respective powers under other 
  5.23  chapters that are applicable to their respective the 
  5.24  commissioner's duties under this chapter.  
  5.25     Sec. 13.  Minnesota Statutes 1994, section 62M.11, is 
  5.26  amended to read: 
  5.27     62M.11 [COMPLAINTS TO COMMERCE OR HEALTH.] 
  5.28     Notwithstanding the provisions of sections 62M.01 to 
  5.29  62M.16, an enrollee may file a complaint regarding a 
  5.30  determination not to certify directly to the commissioner 
  5.31  responsible for regulating the utilization review 
  5.32  organization of commerce. 
  5.33     Sec. 14.  Minnesota Statutes 1994, section 62M.16, is 
  5.34  amended to read: 
  5.35     62M.16 [RULEMAKING.] 
  5.36     If it is determined that The commissioner of commerce may 
  6.1   adopt rules are reasonable and necessary to accomplish the 
  6.2   purpose of sections 62M.01 to 62M.16, the rules must be adopted 
  6.3   through a joint rulemaking process by both the department of 
  6.4   commerce and the department of health. 
  6.5      Sec. 15.  Minnesota Statutes 1994, section 62N.02, 
  6.6   subdivision 4, is amended to read: 
  6.7      Subd. 4.  [COMMISSIONER.] "Commissioner" means the 
  6.8   commissioner of health commerce or the commissioner's designated 
  6.9   representative. 
  6.10     Sec. 16.  Minnesota Statutes 1994, section 62P.02, is 
  6.11  amended to read: 
  6.12     62P.02 [DEFINITIONS.] 
  6.13     (a) For purposes of this chapter, the following definitions 
  6.14  apply: 
  6.15     (b) "All-payer insurer" means a health carrier as defined 
  6.16  in section 62A.011, subdivision 2.  The term does not include 
  6.17  community integrated service networks or integrated service 
  6.18  networks licensed under chapter 62N. 
  6.19     (c) "All-payer reimbursement level" means the reimbursement 
  6.20  amount specified by the all-payer reimbursement system. 
  6.21     (d) "All-payer reimbursement system" means the 
  6.22  Minnesota-specific physician and independent provider fee 
  6.23  schedule, the Minnesota-specific hospital reimbursement system, 
  6.24  and other provider payment methods established under this 
  6.25  chapter or rules adopted under this chapter. 
  6.26     (e) "Commissioner" means the commissioner of health 
  6.27  commerce. 
  6.28     (f) "Health care provider" has the meaning given in section 
  6.29  62J.03, subdivision 8. 
  6.30     Sec. 17.  Minnesota Statutes 1994, section 62P.04, 
  6.31  subdivision 4, is amended to read: 
  6.32     Subd. 4.  [MONITORING OF RESERVES.] (a) The 
  6.33  commissioners commissioner of health and commerce shall monitor 
  6.34  health plan company reserves and net worth as established under 
  6.35  chapters 60A, 62C, 62D, 62H, and 64B, with respect to the health 
  6.36  plan companies that each commissioner respectively regulates to 
  7.1   ensure that savings resulting from the establishment of 
  7.2   expenditure limits are passed on to consumers in the form of 
  7.3   lower premium rates.  
  7.4      (b) Health plan companies shall fully reflect in the 
  7.5   premium rates the savings generated by the expenditure limits.  
  7.6   No premium rate, currently reviewed by the departments 
  7.7   department of health or commerce, may be approved for those 
  7.8   health plan companies unless the health plan company establishes 
  7.9   to the satisfaction of the commissioner of commerce or the 
  7.10  commissioner of health, as appropriate, that the proposed new 
  7.11  rate would comply with this paragraph. 
  7.12     (c) Health plan companies, except those licensed under 
  7.13  chapter 60A to sell accident and sickness insurance under 
  7.14  chapter 62A, shall annually before the end of the fourth fiscal 
  7.15  quarter provide to the commissioner of health or commerce, as 
  7.16  applicable, a projection of the level of reserves the company 
  7.17  expects to attain during each quarter of the following fiscal 
  7.18  year.  These health plan companies shall submit with required 
  7.19  quarterly financial statements a calculation of the actual 
  7.20  reserve level attained by the company at the end of each quarter 
  7.21  including identification of the sources of any significant 
  7.22  changes in the reserve level and an updated projection of the 
  7.23  level of reserves the health plan company expects to attain by 
  7.24  the end of the fiscal year.  In cases where the health plan 
  7.25  company has been given a certificate to operate a new health 
  7.26  maintenance organization under chapter 62D, or been licensed as 
  7.27  an integrated service network or community integrated service 
  7.28  network under chapter 62N, or formed an affiliation with one of 
  7.29  these organizations, the health plan company shall also submit 
  7.30  with its quarterly financial statement, total enrollment at the 
  7.31  beginning and end of the quarter and enrollment changes within 
  7.32  each service area of the new organization.  The reserve 
  7.33  calculations shall be maintained by the commissioners 
  7.34  commissioner as trade secret information, except to the extent 
  7.35  that such information is also required to be filed by another 
  7.36  provision of state law and is not treated as trade secret 
  8.1   information under such other provisions. 
  8.2      (d) Health plan companies in paragraph (c) whose reserves 
  8.3   are less than the required minimum or more than the required 
  8.4   maximum at the end of the fiscal year shall submit a plan of 
  8.5   corrective action to the commissioner of health or commerce 
  8.6   under subdivision 7. 
  8.7      (e) The commissioner of commerce, in consultation with the 
  8.8   commissioner of health, shall report to the legislature no later 
  8.9   than January 15, 1995, as to whether the concept of a reserve 
  8.10  corridor or other mechanism for purposes of monitoring reserves 
  8.11  is adaptable for use with indemnity health insurers that do 
  8.12  business in multiple states and that must comply with their 
  8.13  domiciliary state's reserves requirements. 
  8.14     Sec. 18.  Minnesota Statutes 1994, section 62P.04, 
  8.15  subdivision 7, is amended to read: 
  8.16     Subd. 7.  [ENFORCEMENT.] (a) The commissioners of health 
  8.17  and commerce commissioner shall enforce the reserve limits 
  8.18  referenced in subdivision 4, with respect to the health plan 
  8.19  companies that each commissioner respectively regulates.  Each 
  8.20  The commissioner shall require health plan companies under the 
  8.21  commissioner's jurisdiction to submit plans of corrective action 
  8.22  when the reserve requirement is not met.  The plan of correction 
  8.23  must address the following: 
  8.24     (1) actuarial assumptions used in forecasting future 
  8.25  financial results; 
  8.26     (2) trend assumptions used in setting future premiums; 
  8.27     (3) demographic, geographic, and private and public sector 
  8.28  mix of the population covered by the health plan company; 
  8.29     (4) proposed rate increases or decreases; 
  8.30     (5) growth limits applied under section 62J.04, subdivision 
  8.31  1, paragraph (b); and 
  8.32     (6) other factors deemed appropriate by the health plan 
  8.33  company or commissioner. 
  8.34  If the health plan company's reserves exceed the required 
  8.35  maximum, the plan of correction shall address how the health 
  8.36  plan company will come into compliance and set forth a timetable 
  9.1   within which compliance would be achieved.  The plan of 
  9.2   correction may propose premium refunds, credits for prior 
  9.3   premiums paid, policyholder dividends, or any combination of 
  9.4   these or other methods which will benefit enrollees and/or 
  9.5   Minnesota residents and are such that the reserve requirements 
  9.6   can reasonably be expected to be met.  The commissioner's 
  9.7   evaluation of the plan of correction must consider: 
  9.8      (1) whether implementation of the plan would provide the 
  9.9   company with an unfair advantage in the market; 
  9.10     (2) the extent to which the reserve excess was created by 
  9.11  any movement of enrolled persons to another organization formed 
  9.12  by the company; 
  9.13     (3) whether any proposed premium refund, credit, and/or 
  9.14  dividend represents an equitable allocation to policyholders 
  9.15  covered in prior periods as determined using sound actuarial 
  9.16  practice; and 
  9.17     (4) any other factors deemed appropriate by the applicable 
  9.18  commissioner. 
  9.19     (b) The plan of correction is subject to approval by the 
  9.20  commissioner of health or commerce, as applicable.  If such a 
  9.21  plan is not approved by the applicable commissioner, the 
  9.22  applicable commissioner shall enter an order stating the steps 
  9.23  that the health plan company must take to come into compliance.  
  9.24  Within 30 days of the date of such order, the health plan 
  9.25  company must file a notice of appeal with the applicable 
  9.26  commissioner or comply with the commissioner's order.  If an 
  9.27  appeal is filed, such appeal is governed by chapter 14. 
  9.28     (c) Health plan companies that exceed the expenditure 
  9.29  limits based on two-year average expenditure data (1994 and 
  9.30  1995, 1996 and 1997) shall be required by the appropriate 
  9.31  commissioner to pay back the amount exceeding the expenditure 
  9.32  limit through an assessment on the health plan company.  A 
  9.33  health plan company may appeal the commissioner's order to pay 
  9.34  back the amount exceeding the expenditure limit by mailing to 
  9.35  the commissioner a written notice of appeal within 30 days from 
  9.36  the date the commissioner's order was mailed.  The contested 
 10.1   case and judicial review provisions of chapter 14 apply to the 
 10.2   appeal.  The health plan company shall pay the amount specified 
 10.3   by the commissioner either to the commissioner or into an escrow 
 10.4   account until final resolution of the appeal.  Notwithstanding 
 10.5   sections 3.762 to 3.765, each party is responsible for its own 
 10.6   fees and expenses, including attorneys fees, for the appeal.  
 10.7   Any amount required to be paid back under this section shall be 
 10.8   deposited in the health care access fund.  The appropriate 
 10.9   commissioner may approve a different repayment method to take 
 10.10  into account the health plan company's financial condition.  
 10.11  Health plan companies shall comply with the limits but shall 
 10.12  also guarantee that their contractual obligations are met.  
 10.13  Health plan companies are prohibited from meeting spending 
 10.14  obligations by increasing subscriber liability, including 
 10.15  copayments and deductibles and amounts in excess of benefit plan 
 10.16  maximums. 
 10.17     Sec. 19.  Minnesota Statutes 1994, section 62Q.01, 
 10.18  subdivision 2, is amended to read: 
 10.19     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
 10.20  commissioner of health commerce. 
 10.21     Sec. 20.  Minnesota Statutes 1994, section 62Q.03, 
 10.22  subdivision 4, is amended to read: 
 10.23     Subd. 4.  [EXPERT PANEL.] The commissioners of health and 
 10.24  commerce commissioner shall convene an expert advisory panel 
 10.25  comprised of, but not limited to, the board members of the 
 10.26  Minnesota risk adjustment association, as described in 
 10.27  subdivision 8, and experts from the fields of epidemiology, 
 10.28  health services research, and health economics.  
 10.29  The commissioners commissioner may also convene technical work 
 10.30  groups that may include members of the expert advisory panel and 
 10.31  other persons, all selected in the sole discretion of the 
 10.32  commissioners.  The expert advisory panel and the workgroups 
 10.33  shall assist and advise the commissioners of health and commerce 
 10.34  commissioner in preparing the implementation report described in 
 10.35  subdivision 5. 
 10.36     Sec. 21.  Minnesota Statutes 1994, section 62Q.03, 
 11.1   subdivision 8, is amended to read: 
 11.2      Subd. 8.  [GOVERNANCE.] (a) The association shall be 
 11.3   governed by an interim 19-member board as follows:  one provider 
 11.4   member appointed by the Minnesota Hospital Association; one 
 11.5   provider member appointed by the Minnesota Medical Association; 
 11.6   one provider member appointed by the governor; three members 
 11.7   appointed by the Minnesota Council of HMOs to include an HMO 
 11.8   with at least 50 percent of total membership enrolled through a 
 11.9   public program; three members appointed by Blue Cross and Blue 
 11.10  Shield of Minnesota, to include a member from a Blue Cross and 
 11.11  Blue Shield of Minnesota affiliated health plan with fewer than 
 11.12  50,000 enrollees and located outside the Minneapolis-St. Paul 
 11.13  metropolitan area; two members appointed by the Insurance 
 11.14  Federation of Minnesota; one member appointed by the Minnesota 
 11.15  Association of Counties; and three public members appointed by 
 11.16  the governor, to include at least one representative of a public 
 11.17  program.  The commissioners of health, commerce, human services, 
 11.18  and employee relations shall be nonvoting ex officio members. 
 11.19     (b) The board may elect officers and establish committees 
 11.20  as necessary. 
 11.21     (c) A majority of the members of the board constitutes a 
 11.22  quorum for the transaction of business. 
 11.23     (d) Approval by a majority of the board members present is 
 11.24  required for any action of the board. 
 11.25     (e) Interim board members shall be appointed by July 1, 
 11.26  1994, and shall serve until a new board is elected according to 
 11.27  the plan developed by the association. 
 11.28     (f) A member may designate a representative to act as a 
 11.29  member of the interim board in the member's absence. 
 11.30     Sec. 22.  Minnesota Statutes 1994, section 62Q.03, 
 11.31  subdivision 10, is amended to read: 
 11.32     Subd. 10.  [SUPERVISION.] The association's activities 
 11.33  shall be supervised by the commissioners of health and commerce 
 11.34  commissioner. 
 11.35     Sec. 23.  Minnesota Statutes 1994, section 62Q.07, 
 11.36  subdivision 1, is amended to read: 
 12.1      Subdivision 1.  [ACTION PLANS REQUIRED.] (a) To increase 
 12.2   public awareness and accountability of health plan companies, 
 12.3   all health plan companies must annually file with the applicable 
 12.4   commissioner an action plan that satisfies the requirements of 
 12.5   this section beginning July 1, 1994, as a condition of doing 
 12.6   business in Minnesota.  Each health plan company must also file 
 12.7   its action plan with the information clearinghouse.  Action 
 12.8   plans are required solely to provide information to consumers, 
 12.9   purchasers, and the larger community as a first step toward 
 12.10  greater accountability of health plan companies.  The sole 
 12.11  function of the commissioner in relation to the action plans is 
 12.12  to ensure that each health plan company files a complete action 
 12.13  plan, that the action plan is truthful and not misleading, and 
 12.14  that the action plan is reviewed by appropriate community 
 12.15  agencies. 
 12.16     (b) If a commissioner responsible for regulating a health 
 12.17  plan company required to file an action plan under this section 
 12.18  has reason to believe an action plan is false or misleading, the 
 12.19  commissioner may conduct an investigation to determine whether 
 12.20  the action plan is truthful and not misleading, and may require 
 12.21  the health plan company to submit any information that the 
 12.22  commissioner reasonably deems necessary to complete the 
 12.23  investigation.  If the commissioner determines that an action 
 12.24  plan is false or misleading, the commissioner may require the 
 12.25  health plan company to file an amended plan or may take any 
 12.26  action authorized under chapter 72A. 
 12.27     Sec. 24.  Minnesota Statutes 1994, section 62Q.075, 
 12.28  subdivision 4, is amended to read: 
 12.29     Subd. 4.  [REVIEW.] Upon receipt of the plan, the 
 12.30  appropriate commissioner shall provide a copy to the regional 
 12.31  coordinating boards, local community health boards, and other 
 12.32  relevant community organizations within the managed care 
 12.33  organization's service area.  After reviewing the plan, these 
 12.34  community groups may submit written comments on the plan to 
 12.35  either the commissioner of health or commerce, as applicable, 
 12.36  and may advise the commissioner of the managed care 
 13.1   organization's effectiveness in assisting to achieve regional 
 13.2   public health goals.  The plan may be reviewed by the county 
 13.3   boards, or city councils acting as a local board of health in 
 13.4   accordance with chapter 145A, within the managed care 
 13.5   organization's service area to determine whether the plan is 
 13.6   consistent with the goals and objectives of the plans required 
 13.7   under chapters 145A and 256E and whether the plan meets the 
 13.8   needs of the community.  The county board, or applicable city 
 13.9   council, may also review and make recommendations on the 
 13.10  availability and accessibility of services provided by the 
 13.11  managed care organization.  The county board, or applicable city 
 13.12  council, may submit written comments to the appropriate 
 13.13  commissioner, and may advise the commissioner of the managed 
 13.14  care organization's effectiveness in assisting to meet the needs 
 13.15  and goals as defined under the responsibilities of chapters 145A 
 13.16  and 256E.  Copies of these written comments must be provided to 
 13.17  the managed care organization.  The plan and any comments 
 13.18  submitted must be filed with the information clearinghouse to be 
 13.19  distributed to the public. 
 13.20     Sec. 25.  Minnesota Statutes 1994, section 62Q.09, 
 13.21  subdivision 3, is amended to read: 
 13.22     Subd. 3.  [ENFORCEMENT.] Either The commissioner of health 
 13.23  or commerce shall periodically review contracts among health 
 13.24  care providing entities and health plan companies to determine 
 13.25  compliance with this section.  Any provider may submit a 
 13.26  contract to the commissioner for review if the provider believes 
 13.27  this section has been violated.  Any provision of a contract 
 13.28  found to violate this section is null and void, and the 
 13.29  commissioner may seek civil penalties in an amount not to exceed 
 13.30  $25,000 for each such contract. 
 13.31     Sec. 26.  Minnesota Statutes 1994, section 62Q.11, 
 13.32  subdivision 1, is amended to read: 
 13.33     Subdivision 1.  [ESTABLISHED.] The commissioners of health 
 13.34  and commerce commissioner shall make dispute resolution 
 13.35  processes available to encourage early settlement of disputes in 
 13.36  order to avoid the time and cost associated with litigation and 
 14.1   other formal adversarial hearings.  For purposes of this 
 14.2   section, "dispute resolution" means the use of negotiation, 
 14.3   mediation, arbitration, mediation-arbitration, neutral fact 
 14.4   finding, and minitrials.  These processes shall be nonbinding 
 14.5   unless otherwise agreed to by all parties to the dispute. 
 14.6      Sec. 27.  Minnesota Statutes 1994, section 62Q.11, 
 14.7   subdivision 2, is amended to read: 
 14.8      Subd. 2.  [REQUIREMENTS.] (a) If an enrollee, health care 
 14.9   provider, or applicant for network provider status chooses to 
 14.10  use a dispute resolution process prior to the filing of a formal 
 14.11  claim or of a lawsuit, the health plan company must participate. 
 14.12     (b) If an enrollee, health care provider, or applicant for 
 14.13  network provider status chooses to use a dispute resolution 
 14.14  process after the filing of a lawsuit, the health plan company 
 14.15  must participate in dispute resolution, including, but not 
 14.16  limited to, alternative dispute resolution under rule 114 of the 
 14.17  Minnesota general rules of practice. 
 14.18     (c) The commissioners of health and commerce commissioner 
 14.19  shall inform and educate health plan companies' enrollees about 
 14.20  dispute resolution and its benefits. 
 14.21     (d) A health plan company may encourage but not require an 
 14.22  enrollee to submit a complaint to alternative dispute resolution.
 14.23     Sec. 28.  Minnesota Statutes 1994, section 62R.04, 
 14.24  subdivision 5, is amended to read: 
 14.25     Subd. 5.  [COMMISSIONER.] Unless otherwise specified, 
 14.26  "Commissioner" means the commissioner of health for a health 
 14.27  care network cooperative licensed under chapter 62D or 62N and 
 14.28  the commissioner of commerce for a health care network 
 14.29  cooperative licensed under chapter 62C. 
 14.30     Sec. 29.  [TRANSFER OF POWERS.] 
 14.31     The responsibilities of the department of health and its 
 14.32  commissioner under Minnesota Statutes, chapters 62A, 62D, 62L, 
 14.33  62M, 62N, 62P, 62Q, and 62R, are transferred to the department 
 14.34  of commerce and its commissioner.  Minnesota Statutes, section 
 14.35  15.039, applies to this transfer. 
 14.36     Sec. 30.  [REVISOR'S INSTRUCTION.] 
 15.1      The revisor of statutes shall change the terms "department 
 15.2   of health," "commissioner of health," or similar terms to 
 15.3   "department of commerce," "commissioner of commerce," or similar 
 15.4   terms wherever appropriate in Minnesota Rules and Minnesota 
 15.5   Statutes to reflect the transfer in section 29. 
 15.6      Sec. 31.  [REPEALER.] 
 15.7      Minnesota Statutes 1994, sections 62P.04, subdivision 6; 
 15.8   62P.09, subdivision 2; 62Q.03, subdivision 5; and 62Q.21, 
 15.9   subdivision 4, are repealed.