Minnesota Legislature
SF 726
1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am
Current Version - 1st Engrossment
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A bill for an act
relating to health care; creating a demonstration project for northeastern
Minnesota to operate a community-based health care coverage program;
removing references to federal grant program; changing the evaluation report due
dates; appropriating money; amending Minnesota Statutes 2006, section 62Q.80,
subdivisions 3, 4, 13, 14, by adding a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2006, section 62Q.80, is amended by adding a
subdivision to read:
new text begin Subd. 1a. new text end
new text begin Demonstration project. new text end
new text begin
The commissioner of health shall award a
demonstration project grant to a community-based health care initiative to develop and
operate a community-based health care coverage program to operate within Carlton,
Cook, Lake, and St. Louis Counties. The demonstration project shall extend for five years
and must comply with all the requirements of this section.
new text end
Sec. 2.
Minnesota Statutes 2006, section 62Q.80, subdivision 3, is amended to read:
Subd. 3.
Approval.
(a) Prior to the operation of a community-based health care
coverage program, a community-based health initiative shall submit to the commissioner
of health for approval the community-based health care coverage program developed by
the initiative. deleted text begin The commissioner shall only approve a program that has been awarded
a community access program grant from the United States Department of Health and
Human Services.deleted text end The commissioner shall ensure that the program meets deleted text begin the federal grantdeleted text end
deleted text begin requirements anddeleted text end any requirements described in this section and is actuarially sound based
on a review of appropriate records and methods utilized by the community-based health
initiative in establishing premium rates for the community-based health care coverage
program.
(b) Prior to approval, the commissioner shall also ensure that:
(1) the benefits offered comply with subdivision 8 and that there are adequate
numbers of health care providers participating in the community-based health network to
deliver the benefits offered under the program;
(2) the activities of the program are limited to activities that are exempt under this
section or otherwise from regulation by the commissioner of commerce;
(3) the complaint resolution process meets the requirements of subdivision 10; and
(4) the data privacy policies and procedures comply with state and federal law.
Sec. 3.
Minnesota Statutes 2006, section 62Q.80, subdivision 4, is amended to read:
Subd. 4.
Establishment.
deleted text begin (a)deleted text end The initiative shall establish and operate upon approval
by the commissioner of health a community-based health care coverage program. The
operational structure established by the initiative shall include, but is not limited to:
(1) establishing a process for enrolling eligible individuals and their dependents;
(2) collecting and coordinating premiums from enrollees and employers of enrollees;
(3) providing payment to participating providers;
(4) establishing a benefit set according to subdivision 8 and establishing premium
rates and cost-sharing requirements;
(5) creating incentives to encourage primary care and wellness services; and
(6) initiating disease management services, as appropriate.
deleted text begin
(b) The payments collected under paragraph (a), clause (2), may be used to capture
available federal funds.
deleted text end
Sec. 4.
Minnesota Statutes 2006, section 62Q.80, subdivision 13, is amended to read:
Subd. 13.
Report.
(a) The initiative shall submit quarterly status reports to the
commissioner of health on January 15, April 15, July 15, and October 15 of each year,
with the first report due January 15, deleted text begin 2007deleted text end new text begin 2008new text end . The status report shall include:
(1) the financial status of the program, including the premium rates, cost per member
per month, claims paid out, premiums received, and administrative expenses;
(2) a description of the health care benefits offered and the services utilized;
(3) the number of employers participating, the number of employees and dependents
covered under the program, and the number of health care providers participating;
(4) a description of the health outcomes to be achieved by the program and a status
report on the performance measurements to be used and collected; and
(5) any other information requested by the commissioner of health or commerce or
the legislature.
(b) The initiative shall contract with an independent entity to conduct an evaluation
of the program to be submitted to the commissioners of health and commerce and the
legislature by January 15, deleted text begin 2009deleted text end new text begin 2010new text end . The evaluation shall include:
(1) an analysis of the health outcomes established by the initiative and the
performance measurements to determine whether the outcomes are being achieved;
(2) an analysis of the financial status of the program, including the claims to
premiums loss ratio and utilization and cost experience;
(3) the demographics of the enrollees, including their age, gender, family income,
and the number of dependents;
(4) the number of employers and employees who have been denied access to the
program and the basis for the denial;
(5) specific analysis on enrollees who have aggregate medical claims totaling over
$5,000 per year, including data on the enrollee's main diagnosis and whether all the
medical claims were covered by the program;
(6) number of enrollees referred to state public assistance programs;
(7) a comparison of employer-subsidized health coverage provided in a comparable
geographic area to the designated community-based geographic area served by the
program, including, to the extent available:
(i) the difference in the number of employers with 50 or fewer employees offering
employer-subsidized health coverage;
(ii) the difference in uncompensated care being provided in each area; and
(iii) a comparison of health care outcomes and measurements established by the
initiative; and
(8) any other information requested by the commissioner of health or commerce.
Sec. 5.
Minnesota Statutes 2006, section 62Q.80, subdivision 14, is amended to read:
Subd. 14.
Sunset.
This section expires December 31, deleted text begin 2011deleted text end new text begin 2012new text end .
Sec. 6. new text begin APPROPRIATION.
new text end
new text begin
$1,050,000 is appropriated for the biennium beginning July 1, 2007, from the
general fund to the commissioner of health for the demonstration project grant described
in Minnesota Statutes, section 62Q.80, subdivision 1a. This is a onetime appropriation
and is available until June 30, 2012.
new text end