CONFERENCE COMMITTEE REPORT ON S.F. No. 1
relating to health care coverage; providing a temporary program to help pay for
health insurance premiums; modifying requirements for health maintenance
organizations; modifying provisions governing health insurance; requiring reports;
establishing a state reinsurance program through the Minnesota Comprehensive
Health Association; authorizing agricultural cooperative health plans; appropriating
money;amending Minnesota Statutes 2016, sections 60A.08, subdivision 15;
60A.235, subdivision 3; 60A.236; 62D.02, subdivision 4; 62D.03, subdivision 1;
62D.05, subdivision 1; 62D.06, subdivision 1; 62D.19; 62E.02, subdivision 3;
62L.12, subdivision 2; proposing coding for new law in Minnesota Statutes,
chapters 62E; 62H; repealing Minnesota Statutes 2016, section 62D.12, subdivision
9; Laws 2007, chapter 147, article 12, section 14, as amended.
January 25, 2017
The Honorable Michelle L. Fischbach
President of the Senate
The Honorable Kurt L. Daudt
Speaker of the House of Representatives
We, the undersigned conferees for S.F. No. 1 report that we have agreed upon the items
in dispute and recommend as follows:
That the House recede from its amendments and that S.F. No. 1 be further amended as
Delete everything after the enacting clause and insert:
1.25PREMIUM SUBSIDY PROGRAM
Section 1. DEFINITIONS.
1.27 Subdivision 1. Scope. For purposes of sections 1 to 6, the following terms have the
2.1 Subd. 2. Commissioner. "Commissioner" means the commissioner of Minnesota
2.2Management and Budget.
2.3 Subd. 3. Eligible individual. "Eligible individual" means a Minnesota resident who:
2.4(1) is not receiving a premium tax credit under Code of Federal Regulations, title
2.5section 1.36B-2, as of the date their coverage is effectuated;
2.6(2) is not enrolled in public program coverage under Minnesota Statutes, section
2.7256B.055, or 256L.04; and
2.8(3) purchased an individual health plan from a health carrier in the individual market.
2.9 Subd. 4. Gross premium. "Gross premium" means the amount billed for a health plan
2.10purchased by an eligible individual prior to a premium subsidy in a calendar year.
2.11 Subd. 5. Health carrier. "Health carrier" has the meaning given in Minnesota Statutes,
2.12section 62A.011, subdivision 2.
2.13 Subd. 6. Individual health plan. "Individual health plan" has the meaning given in
2.14Minnesota Statutes, section 62A.011, subdivision 4.
2.15 Subd. 7. Individual market. "Individual market" has the meaning given in Minnesota
2.16Statutes, section 62A.011, subdivision 5.
2.17 Subd. 8. Net premium. "Net premium" means the gross premium less the premium
2.19 Subd. 9. Premium subsidy. "Premium subsidy":
2.20(1) is a payment made on behalf of eligible individuals for the promotion of general
2.21welfare, and is not compensation for any services;
2.22(2) is equal to 25 percent of the monthly gross premium otherwise paid by or on behalf
2.23of the eligible individual for coverage purchased in the individual market, that covers
2.24eligible individual and the eligible individual's spouse and dependents, or the percentage
2.25established by the commissioner under section 2, subdivision 3, paragraph (c); and
2.26(3) is excluded from any calculation used to determine eligibility within any of the
2.27Department of Human Services programs.
Sec. 2. PAYMENT TO HEALTH CARRIERS ON BEHALF OF ELIGIBLE
3.3 Subdivision 1. Program established. The commissioner of Minnesota Management
3.4and Budget, in consultation with the commissioner of commerce and the commissioner
3.5human services, shall establish and administer the premium subsidy program authorized
3.6this act, to help eligible individuals pay for coverage in the individual market in
3.7 Subd. 2. Premium subsidy provided. As soon as practicable, but no later than April
3.830, 2017, health carriers shall begin paying a premium subsidy to each eligible individual
3.9who purchases a health plan in the individual market, for all the months for which
3.10premium is paid. An eligible individual shall pay the net premium amount to the health
3.12 Subd. 3. Payments to health carriers. (a) The commissioner shall make payments to
3.13health carriers on behalf of eligible individuals effectuating coverage for calendar
3.14for the months in that year for which the individual has paid the net premium amount
3.15health carrier. Payments to health carriers shall be based on the premium subsidy
3.16to eligible individuals in the individual market, regardless of the cost of coverage
3.17The commissioner shall not withhold payments because a health carrier cannot prove
3.18enrollee is an eligible individual.
3.19(b) Health carriers seeking reimbursement from the commissioner must submit an invoice
3.20and supporting information to the commissioner, using a form developed by the
3.21commissioner, in order to be eligible for payment. The commissioner shall finalize
3.22by March 1, 2017.
3.23(c) Total state payments to health carriers must be made within the limits of the
3.24appropriation. The commissioner shall reimburse health carriers at the full requested
3.25up to the level of the appropriation. The commissioner, by July 15, 2017, shall determine
3.26whether the available appropriation will be sufficient to provide premium subsidies
3.27to 25 percent of the gross premium for the period September 1, 2017, through December
3.2831, 2017. If the commissioner determines that the available appropriation is not sufficient,
3.29the commissioner shall reduce the premium subsidy percentage, beginning September
3.302017, through the remainder of the calendar year, by an amount sufficient to ensure
3.31total amount of premium subsidies provided for the calendar year does not exceed the
3.32available appropriation. The commissioner shall notify health carriers of any reduced
3.33premium subsidy percentage within five days of making a determination. Health carriers
4.1shall provide enrollees with at least 30 days' notice of any reduction in the premium
4.3(d) The commissioner shall consider health carriers as vendors under Minnesota Statutes,
4.4section 16A.124, subdivision 3, and each monthly invoice shall represent the completed
4.5delivery of the service.
4.6 Subd. 4. Data practices. (a) The definitions in Minnesota Statutes, section 13.02, apply
4.7to this subdivision.
4.8(b) Government data on an enrollee or health carrier under this section are private
4.9on individuals or nonpublic data, except that the total reimbursement requested by
4.10carrier and the total state payment to the health carrier are public data.
4.11(c) Notwithstanding Minnesota Statutes, section 138.17, government data on an enrollee
4.12or health carrier under this section must be destroyed by June 30, 2018, or upon completion
4.13by the legislative auditor of the audits required by section 3, whichever is later.
Sec. 3. AUDITS.
4.15(a) The legislative auditor shall conduct audits of the health carriers' supporting
4.16prescribed by the commissioner, to determine whether payments align with criteria
4.17established in sections 1 and 2. The commissioner of human services shall provide
4.18necessary to the legislative auditor to complete the audit. The commissioner shall
4.19or charge back payments to the health carriers to the extent they do not align with
4.20established in sections 1 and 2, as determined by the audit.
4.21(b) The legislative auditor shall audit the extent to which health carriers provided
4.22subsidies to persons meeting the residency and other eligibility requirements specified
4.23section 1, subdivision 3. The legislative auditor shall report to the commissioner
4.24of premium subsidies provided by each health carrier to persons not eligible for a
4.25subsidy. The commissioner, in consultation with the commissioners of commerce and
4.26shall develop and implement a process to recover from health carriers the amount of
4.27subsidies received for enrollees determined to be ineligible for premium subsidies
4.28legislative auditor. The legislative auditor, when conducting the required audit,
4.29commissioner, when determining the amount of premium subsidy to be recovered, may
4.30take into account the extent to which a health carrier makes use of the Minnesota
4.31system, as defined in Minnesota Statutes, section 62V.055, subdivision 1.
Sec. 4. APPLICABILITY OF GROSS PREMIUM.
5.2Notwithstanding premium subsidies provided under section 2, the premium base for
5.3calculating the amount of any applicable premium taxes under Minnesota Statutes, chapter
5.4297I, shall be the gross premium for health plans purchased by eligible individuals
Sec. 5. SUNSET.
5.7This article sunsets June 30, 2018.
Sec. 6. TRANSFER.
5.9$326,945,000 in fiscal year 2017 is transferred from the budget reserve account in
5.10Minnesota Statutes, section 16A.152, subdivision 1a, to the general fund.
Sec. 7. APPROPRIATIONS.
5.12(a) $311,788,000 in fiscal year 2017 is appropriated from the general fund to the
5.13commissioner of management and budget for premium assistance under section 2. This
5.14appropriation is onetime and is available through June 30, 2018.
5.15(b) $157,000 in fiscal year 2017 is appropriated from the general fund to the legislative
5.16auditor for purposes of section 3. This appropriation is onetime.
5.17(c) Any unexpended amount from the appropriation in paragraph (a) after June 30, 2018,
5.18shall be transferred on July 1, 2018, from the general fund to the budget reserve
5.19under Minnesota Statutes, section 16A.152, subdivision 1a.
Sec. 8. EFFECTIVE DATE.
5.21Sections 1 to 7 are effective the day following final enactment.
5.23INSURANCE MARKET REFORMS
Section 1. Minnesota Statutes 2016, section 60A.08, subdivision 15, is amended to read:
Subd. 15. Classification of insurance filings data.
(a) All forms, rates, and related
information filed with the commissioner under section
shall be nonpublic data until
the filing becomes effective.
(b) All forms, rates, and related information filed with the commissioner under section
shall be nonpublic data until the filing becomes effective.
(c) All forms, rates, and related information filed with the commissioner under section
6.462C.14, subdivision 10
, shall be nonpublic data until the filing becomes effective.
(d) All forms, rates, and related information filed with the commissioner under section
shall be nonpublic data until the filing becomes effective.
(e) All forms, rates, and related information filed with the commissioner under section
shall be nonpublic data until the filing becomes effective.
(f) Notwithstanding paragraphs (b) and (c), for all rate increases subject to review
section 2794 of the Public Health Services Act and any amendments to, or regulations,
guidance issued under the act that are filed with the commissioner on or after September
2011, the commissioner:
(1) may acknowledge receipt of the information;
(2) may acknowledge that the corresponding rate filing is pending review;
(3) must provide public access from the Department of Commerce's Web site to parts
and II of the Preliminary Justifications of the rate increases subject to review;
(4) must provide notice to the public on the Department of Commerce's Web site of
review of the proposed rate, which must include a statement that the public has 30
days to submit written comments to the commissioner on the rate filing subject to
6.20 (g) Notwithstanding paragraphs (b) and (c), for all proposed premium rates filed with
6.21the commissioner for individual health plans, as defined in section 62A.011, subdivision
6.22and small group health plans, as defined in section 62K.03, subdivision 12, the commissioner
6.23must provide public access on the Department of Commerce's Web site to compiled data
6.24of the proposed changes to rates, separated by health plan and geographic rating area,
6.25ten business days after the deadline by which health carriers, as defined in section
6.26subdivision 2, must submit proposed rates to the commissioner for approval.
6.27EFFECTIVE DATE.This section is effective 30 days following final enactment.
Sec. 2. Minnesota Statutes 2016, section 60A.235, subdivision 3, is amended to read:
Subd. 3. Health plan policies issued as stop loss coverage.
(a) An insurance company
or health carrier issuing or renewing an insurance policy or other evidence of coverage,
provides coverage to an employer for health care expenses incurred under an
employer-sponsored plan provided to the employer's employees, retired employees, or
dependents, shall issue the policy or evidence of coverage as a health plan if the
evidence of coverage:
(1) has a specific attachment point for claims incurred per individual that is lower
(2) has an aggregate attachment point, for groups of 50 or fewer, that is lower than
7.6 greater of:
7.7 (i) $4,000 times the number of group members;
7.8 (ii) 120 percent of expected claims; or
7.9 (iii) $20,000; or
7.10 (3) (2)
has an aggregate attachment point
for groups of 51 or more
that is lower than
110 percent of expected claims.
(b) An insurer shall determine the number of persons in a group, for the purposes
section, on a consistent basis, at least annually. Where the insurance policy or evidence
coverage applies to a contract period of more than one year, the dollar amounts set
, must be multiplied by the length of the contract
period expressed in years.
(c) The commissioner may adjust the constant dollar amounts provided in paragraph
7.18 (a), clauses (1), (2), and (3), on January 1 of any year, based upon changes in the
7.19 component of the Consumer Price Index (CPI). Adjustments must be in increments of
7.20 and must not be made unless at least that amount of adjustment is required. The commissioner
7.21 shall publish any change in these dollar amounts at least six months before their
7.23 (d) (c)
A policy or evidence of coverage issued by an insurance company or health carrier
that provides direct coverage of health care expenses of an individual including a
evidence of coverage administered on a group basis is a health plan regardless of
the policy or evidence of coverage is denominated as stop loss coverage.
7.27EFFECTIVE DATE.This section is effective June 1, 2017, and applies to policies or
7.28evidence of coverage offered, issued, or renewed to an employer on or after that date.
Sec. 3. Minnesota Statutes 2016, section 60A.236, is amended to read:
7.3060A.236 STOP LOSS REGULATION; SMALL EMPLOYER COVERAGE.
A contract providing stop loss coverage, issued or renewed to a small employer, as
defined in section
62L.02, subdivision 26
, or to a plan sponsored by a small employer, must
include a claim settlement period no less favorable to the small employer or plan
coverage of all the following:
claims incurred during the contract period
regardless of when the claims are; and
paid by the plan during the contract period or within three months after expiration
8.7of the contract period
8.8EFFECTIVE DATE.This section is effective June 1, 2017, and applies to policies or
8.9evidence of coverage offered, issued, or renewed to an employer on or after that date.
Sec. 4. Minnesota Statutes 2016, section 62D.02, subdivision 4, is amended to read:
Subd. 4. Health maintenance organization.
"Health maintenance organization"
nonprofit foreign or domestic
organized under chapter 317A
, or a local
governmental unit as defined in subdivision 11, controlled and operated as provided
, which provides, either directly or through arrangements with
providers or other persons, comprehensive health maintenance services, or arranges
provision of these services, to enrollees on the basis of a fixed prepaid sum without
to the frequency or extent of services furnished to any particular enrollee.
8.19EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 5. Minnesota Statutes 2016, section 62D.03, subdivision 1, is amended to read:
Subdivision 1. Certificate of authority required.
Notwithstanding any law of this state
to the contrary, any
nonprofit foreign or domestic
corporation organized to do so or a local
governmental unit may apply to the commissioner of health for a certificate of authority
establish and operate a health maintenance organization in compliance with sections
. No person shall establish or operate a health maintenance organization in this
state, nor sell or offer to sell, or solicit offers to purchase or receive advance
consideration in conjunction with a health maintenance organization or health maintenance
contract unless the organization has a certificate of authority under sections
8.30EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 6. Minnesota Statutes 2016, section 62D.05, subdivision 1, is amended to read:
Subdivision 1. Authority granted.
corporation or local governmental
unit may, upon obtaining a certificate of authority as required in sections
operate as a health maintenance organization.
9.5EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 7. Minnesota Statutes 2016, section 62D.06, subdivision 1, is amended to read:
Subdivision 1. Governing body composition; enrollee advisory body.
body of any health maintenance organization which is a
corporation may include
enrollees, providers, or other individuals; provided, however, that after a health
organization which is a
corporation has been authorized under sections
for one year, at least 40 percent of the governing body shall be composed of
enrollees and members elected by the enrollees and members from among the enrollees
members. For purposes of this section, "member" means a consumer who receives health
care services through a self-insured contract that is administered by the health maintenance
organization or its related third-party administrator. The number of members elected
governing body shall not exceed the number of enrollees elected to the governing body.
enrollee or member elected to the governing board may not be a person:
(1) whose occupation involves, or before retirement involved, the administration of
health activities or the provision of health services;
(2) who is or was employed by a health care facility as a licensed health professional;
(3) who has or had a direct substantial financial or managerial interest in the rendering
of a health service, other than the payment of a reasonable expense reimbursement
compensation as a member of the board of a health maintenance organization.
After a health maintenance organization which is a local governmental unit has been
authorized under sections
for one year, an enrollee advisory body shall
be established. The enrollees who make up this advisory body shall be elected by the
from among the enrollees.
9.29EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 8. Minnesota Statutes 2016, section 62D.19, is amended to read:
9.3162D.19 UNREASONABLE EXPENSES.
No health maintenance organization shall incur or pay for any expense of any nature
which is unreasonably high in relation to the value of the service or goods provided.
commissioner of health shall implement and enforce this section by rules adopted under
In an effort to achieve the stated purposes of sections
; in order to
10.6 safeguard the underlying nonprofit status of health maintenance organizations;
and to ensure
that the payment of health maintenance organization money to major participating entities
results in a corresponding benefit to the health maintenance organization and its
when determining whether an organization has incurred an unreasonable expense in relation
to a major participating entity, due consideration shall be given to, in addition
to any other
appropriate factors, whether the officers and trustees of the health maintenance organization
have acted with good faith and in the best interests of the health maintenance organization
in entering into, and performing under, a contract under which the health maintenance
organization has incurred an expense. The commissioner has standing to sue, on behalf
a health maintenance organization, officers or trustees of the health maintenance
who have breached their fiduciary duty in entering into and performing such contracts.
10.17EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 9. Minnesota Statutes 2016, section 62E.02, subdivision 3, is amended to read:
Subd. 3. Health maintenance organization.
"Health maintenance organization" means
corporation licensed and operated as provided in chapter 62D.
10.21EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 10. [62H.18] AGRICULTURAL COOPERATIVE HEALTH PLAN.
10.23 Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this section.
10.24(b) "Agricultural cooperative" means a cooperative organized under chapter 308A or
10.25308B that meets the requirements of subdivision 2.
10.26(c) "Broker" means an insurance agent engaged in brokerage business according to
10.28(d) "Employee Retirement Income Security Act" means the Employee Retirement Income
10.29Security Act of 1974, United States Code, title 29, sections 1001, et seq.
10.30(e) "Enrollee" means a natural person covered by a joint self-insurance plan operating
10.31under this section.
11.1(f) "Insurance agent" has the meaning given to insurance agent in section 60A.02,
11.3(g) "Joint self-insurance plan" or "plan" means a plan or any other arrangement established
11.4for the benefit of two or more entities authorized to transact business in the state,
11.5to jointly self-insure through a single employee welfare benefit plan funded through
11.6to provide health, dental, or other benefits as permitted under the Employee Retirement
11.7Income Security Act.
11.8(h) "Service plan administrator" means a vendor of risk management services licensed
11.9under section 60A.23.
11.10(i) "Trust" means a trust established to accept and hold assets of the joint self-insurance
11.11plan in trust and use and disperse funds in accordance with the terms of the written
11.12document and joint self-insurance plan for the sole purposes of providing benefits
11.13defraying reasonable administrative costs of providing the benefits.
11.14 Subd. 2. Exemption. A joint self-insurance plan, its service plan administrator, stop loss
11.15carrier, and any broker assisting the agricultural cooperative are exempt from sections
11.1662H.01 to 62H.17, and are governed by the requirements of this section, if the joint
11.17self-insurance plan is administrated through a trust established by an agricultural
11.19(1) has members who (i) actively work in production agriculture in Minnesota and file
11.20either Form 1065 or Schedule F with the member's income tax return; or (ii) provide
11.21services to production agriculture in Minnesota;
11.22(2) specifies criteria for membership in the agricultural cooperative in their articles
11.23organization or bylaws, however criteria cannot be based on health status factors
11.24individuals to be covered through the joint self-insurance plan; and
11.25(3) grants at least 51 percent of the aggregate voting power on matters for which
11.26members may vote to members who satisfy clause (1) and any additional criteria in
11.27agricultural cooperative's articles of organization and bylaws.
11.28 Subd. 3. Plan requirements. A joint self-insurance plan operating under this section
11.30(1) offer health coverage to members of the agricultural cooperative that establishes
11.31plan and their dependents, to employees of members of the agricultural cooperative
11.32establishes the plan and their dependents, or to employees of the agricultural cooperative
11.33that establishes the plan and their dependents. Health coverage may be offered only
12.1individuals who meet certain criteria described in the joint self-insurance plan governing
12.2documents, however the criteria cannot be based on health status factors of the individuals
12.3to be covered through the joint self-insurance plan;
12.4(2) include stop-loss coverage with an individual attachment point not lower than
12.5and an aggregate attachment point not lower than 110 percent of expected claims, issued
12.6by an insurance company licensed in Minnesota;
12.7(3) establish a reserve fund, certified by an actuary to be sufficient to cover unpaid
12.8liability for incurred but not reported liabilities in the event of plan termination.
12.9from the actuary must include all maximum funding requirements for plan fixed cost
12.10requirements and current claims liability requirements, and must include a calculation
12.11the reserve levels needed to fund all incurred but not reported liabilities in the
12.12member or plan termination. These reserve funds must be held in a trust;
12.13(4) be governed by a board elected by agricultural cooperative members that participate
12.14in the plan;
12.15(5) contract for services with a service plan administrator; and
12.16(6) satisfy the requirements of the Employee Retirement Income Security Act that apply
12.17to employee welfare benefit plans.
12.18 Subd. 4. Submission of documents to commissioner of commerce. A joint
12.19self-insurance plan operating under this section must submit to the commissioner of
12.20commerce copies of all filings and reports that are submitted to the United States
12.21of Labor according to the Employee Retirement Income Security Act. Members participating
12.22in the joint self-insurance plan may designate an agricultural cooperative that establishes
12.23the plan as the entity responsible for satisfying the reporting requirements of the
12.24Retirement Income Security Act and for providing copies of these filings and reports
12.25commissioner of commerce.
12.26 Subd. 5. Participation; termination of participation. If a member chooses to participate
12.27in a joint self-insurance plan under this section, the member must participate in
the plan for
12.28at least three consecutive years. If a member terminates participation in the plan
12.29end of the three-year period, a financial penalty may be assessed under the plan,
12.30exceed the amount contributed by the member to the plan reserves.
12.31 Subd. 6. Single risk pool. The enrollees of a joint self-insurance plan operating under
12.32this section shall be members of a single risk pool. The plan shall provide benefits
13.1single, self-insured plan with the size of the plan based on the total enrollees in
13.3 Subd. 7. Promotion, marketing, sale of coverage. (a) Coverage in a joint self-insurance
13.4plan operating under this section may be promoted, marketed, and sold by insurance
13.5and brokers to members of the agricultural cooperative sponsoring the plan and their
13.6dependents, employees of members of the agricultural cooperative sponsoring the plan
13.7their dependents, and employees of the agricultural cooperative sponsoring the plan
13.9(b) Coverage in a joint self-insurance plan operating under this section may be promoted
13.10and marketed by a cooperative organized under chapter 308A or 308B to persons who
13.11be eligible to participate in the joint self-insurance plan.
13.12 Subd. 8. Taxation. Joint self-insurance plans are exempt from the taxation imposed
13.13under section 297I.05, subdivision 12.
13.14 Subd. 9. Compliance with other laws. A joint self-insurance plan operating under this
13.16(1) is exempt from providing the mandated health benefits in chapters 62A and 62Q,
13.17the plan otherwise provides the benefits required under the Employee Retirement Income
13.19(2) is exempt from the continuation requirements in sections 62A.146, 62A.16, 62A.17,
13.2062A.20, and 62A.21, if the plan complies with the continuation requirements under
13.21Employee Retirement Income Security Act; and
13.22(3) must comply with all requirements of the Affordable Care Act, as defined in section
13.2362A.011, subdivision 1a, to the extent that they apply to such plans.
13.24EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 11. Minnesota Statutes 2016, section 62K.10, is amended by adding a subdivision to
13.27 Subd. 5a. Appeal of waiver of network adequacy requirements. (a) If a health carrier
13.28receives a waiver under subdivision 5 applicable to a health plan's provider network,
13.29provider who is in the service area served by the health plan and who is aggrieved
13.30issuance of the waiver may appeal the commissioner's decision using the contested
13.31procedures in sections 14.57 to 14.62. A contested case proceeding must be initiated
13.3260 days after the date on which the commissioner grants a waiver, except that a proceeding
14.1regarding a waiver in effect as of January 1, 2017, must be initiated within 60 days
14.2the effective date of this subdivision. The commissioner must provide timely notice
14.3appeal under this subdivision to the health carrier that received the waiver that
is subject to
14.4the appeal. After considering the appeal, the administrative law judge must either
14.5or nullify the waiver of network adequacy requirements. The prevailing party in the
14.6case proceeding may seek an award of expenses and fees from the nonprevailing party
14.7applying to the administrative law judge using the procedure in section 15.472, paragraph
14.8(b). The administrative law judge shall award fees and expenses to the prevailing
14.9the administrative law judge finds that the position of the nonprevailing party was
14.10substantially justified. For purposes of this paragraph, "substantially justified"
14.11meaning given in section 15.471, subdivision 8.
14.12(b) The decision of the administrative law judge constitutes the final decision regarding
14.13the waiver. A party aggrieved by the administrative law judge's decision may seek
14.14review of the decision as provided in chapter 14. If the waiver is nullified and no
14.15review is sought, the health carrier must comply with the network adequacy requirements
14.16in subdivisions 2, 3, and 4, within 30 days after the deadline for seeking judicial
14.18(c) This subdivision expires December 31, 2018.
14.19EFFECTIVE DATE.This section is effective the day following final enactment, and
14.20applies to network adequacy waivers in effect on or after January 1, 2017.
Sec. 12. Minnesota Statutes 2016, section 62L.12, subdivision 2, is amended to read:
Subd. 2. Exceptions.
(a) A health carrier may renew individual conversion policies to
eligible employees otherwise eligible for conversion coverage under section
result of leaving a health maintenance organization's service area.
(b) A health carrier may renew individual conversion policies to eligible employees
otherwise eligible for conversion coverage as a result of the expiration of any continuation
of group coverage required under sections
(c) A health carrier may renew conversion policies to eligible employees.
(d) A health carrier may sell, issue, or renew individual continuation policies to
employees as required.
(e) A health carrier may sell, issue, or renew individual health plans if the coverage
appropriate due to an unexpired preexisting condition limitation or exclusion applicable
the person under the employer's group health plan or due to the person's need for
care services not covered under the employer's group health plan.
(f) A health carrier may sell, issue, or renew an individual health plan, if the individual
has elected to buy the individual health plan not as part of a general plan to substitute
individual health plans for a group health plan nor as a result of any violation of
3 or 4.
(g) A health carrier may sell, issue, or renew an individual health plan if coverage
provided by the employer is determined to be unaffordable under the provisions of
Affordable Care Act as defined in section
62A.011, subdivision 1a
(h) Nothing in this subdivision relieves a health carrier of any obligation to provide
continuation or conversion coverage otherwise required under federal or state law.
(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage
as a supplement to Medicare under sections
, or policies or contracts
that supplement Medicare issued by health maintenance organizations, or those contracts
governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social Security
Act, United States Code, title 42, section 1395 et seq., as amended.
(j) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
health plans necessary to comply with a court order.
(k) A health carrier may offer, issue, sell, or renew an individual health plan to
eligible for an employer group health plan, if the individual health plan is a high
health plan for use in connection with an existing health savings account, in compliance
with the Internal Revenue Code, section 223. In that situation, the same or a different
carrier may offer, issue, sell, or renew a group health plan to cover the other eligible
employees in the group.
(l) A health carrier may offer, sell, issue, or renew an individual health plan to
more employees of a small employer if the individual health plan is marketed directly
all employees of the small employer and the small employer does not contribute directly
indirectly to the premiums or facilitate the administration of the individual health
requirement to market an individual health plan to all employees does not require
carrier to offer or issue an individual health plan to any employee. For purposes
paragraph, an employer is not contributing to the premiums or facilitating the administration
of the individual health plan if the employer does not contribute to the premium and
collects the premiums from an employee's wages or salary through payroll deductions
submits payment for the premiums of one or more employees in a lump sum to the health
carrier. Except for coverage under section
, subdivision 5, paragraph (b), at the
request of an employee, the health carrier may bill the employer for the premiums
by the employee, provided that the employer is not liable for payment except from
deductions for that purpose. If an employer is submitting payments under this paragraph,
the health carrier shall provide a cancellation notice directly to the primary insured
ten days prior to termination of coverage for nonpayment of premium. Individual coverage
under this paragraph may be offered only if the small employer has not provided coverage
to the employees within the past 12 months.
16.9(m) A health carrier may offer, sell, issue, or renew an individual health plan to
16.10more employees of a small employer if the small employer, eligible employee, and individual
16.11health plan are in compliance with the 21st Century Cures Act, Public Law 114-255,
16.13EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 13. [62Q.556] UNAUTHORIZED PROVIDER SERVICES.
16.15 Subdivision 1. Unauthorized provider services. (a) Except as provided in paragraph
16.16(c), unauthorized provider services occur when an enrollee receives services:
16.17(1) from a nonparticipating provider at a participating hospital or ambulatory surgical
16.18center, when the services are rendered:
16.19(i) due to the unavailability of a participating provider;
16.20(ii) by a nonparticipating provider without the enrollee's knowledge; or
16.21(iii) due to the need for unforeseen services arising at the time the services are
16.23(2) from a participating provider that sends a specimen taken from the enrollee in
16.24participating provider's practice setting to a nonparticipating laboratory, pathologist,
16.25medical testing facility.
16.26(b) Unauthorized provider services do not include emergency services as defined in
16.27section 62Q.55, subdivision 3.
16.28(c) The services described in paragraph (a), clause (2), are not unauthorized provider
16.29services if the enrollee gives advance written consent to the provider acknowledging
16.30the use of a provider, or the services to be rendered, may result in costs not covered
17.1 Subd. 2. Prohibition. (a) An enrollee's financial responsibility for the unauthorized
17.2provider services shall be the same cost-sharing requirements, including co-payments,
17.3deductibles, coinsurance, coverage restrictions, and coverage limitations, as those
17.4to services received by the enrollee from a participating provider. A health plan
17.5must apply any enrollee cost sharing requirements, including co-payments, deductibles,
17.6coinsurance, for unauthorized provider services to the enrollee's annual out-of-pocket
17.7to the same extent payments to a participating provider would be applied.
17.8(b) A health plan company must attempt to negotiate the reimbursement, less any
17.9applicable enrollee cost sharing under paragraph (a), for the unauthorized provider
17.10with the nonparticipating provider. If a health plan company's and nonparticipating
17.11attempts to negotiate reimbursement for the health care services do not result in
17.12the health plan company or provider may elect to refer the matter for binding arbitration,
17.13chosen in accordance with paragraph (c). A nondisclosure agreement must be executed
17.14both parties prior to engaging an arbitrator in accordance with this section. The
17.15arbitration must be shared equally between the parties.
17.16(c) The commissioner of health, in consultation with the commissioner of the Bureau
17.17of Mediation Services, must develop a list of professionals qualified in arbitration,
17.18purpose of resolving disputes between a health plan company and nonparticipating provider
17.19arising from the payment for unauthorized provider services. The commissioner of health
17.20shall publish the list on the department of health's Web Site, and update the list
17.21(d) The arbitrator must consider relevant information, including the health plan company's
17.22payments to other nonparticipating providers for the same services, the circumstances
17.23complexity of the particular case, and the usual and customary rate for the service
17.24information available in a database in a national, independent, not-for-profit corporation,
17.25and similar fees received by the provider for the same services from other health
17.26which the provider is nonparticipating, in reaching a decision.
17.27EFFECTIVE DATE.This section is effective 90 days following final enactment and
17.28applies to provider services provided on or after that date.
Sec. 14. Minnesota Statutes 2016, section 297I.05, subdivision 12, is amended to read:
Subd. 12. Other entities.
(a) A tax is imposed equal to two percent of:
(1) gross premiums less return premiums written for risks resident or located in Minnesota
by a risk retention group;
(2) gross premiums less return premiums received by an attorney in fact acting in
accordance with chapter 71A;
(3) gross premiums less return premiums received pursuant to assigned risk policies
contracts of coverage under chapter 79; and
(4) the direct funded premium received by the reinsurance association under section
from self-insurers approved under section
and political subdivisions that
(b) A tax is imposed on a joint self-insurance plan operating under chapter 60F. The
of tax is equal to two percent of the total amount of claims paid during the fund
no deduction for claims wholly or partially reimbursed through stop-loss insurance.
(c) A tax is imposed on a joint self-insurance plan operating under chapter 62H, except
18.12as provided in section 62H.18, subdivision 8
. The rate of tax is equal to two percent of the
total amount of claims paid during the fund's fiscal year, with no deduction for claims
or partially reimbursed through stop-loss insurance.
(d) A tax is imposed equal to the tax imposed under section
297I.05, subdivision 5
the gross premiums less return premiums on all coverages received by an accountable
provider network or agents of an accountable provider network in Minnesota, in cash
otherwise, during the year.
18.19EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 15. TRANSITION OF CARE COVERAGE FOR CALENDAR YEAR 2017;
18.21INVOLUNTARY TERMINATION OF COVERAGE.
18.22 Subdivision 1. Definitions. (a) For purposes of this section, the following terms have
18.23the meanings given.
18.24(b) "Enrollee" has the meaning given in Minnesota Statutes, section 62Q.01, subdivision
18.26(c) "Health plan" has the meaning given in Minnesota Statutes, section 62Q.01,
18.28(d) "Health plan company" has the meaning given in Minnesota Statutes, section 62Q.01,
18.30(e) "Individual market" has the meaning given in Minnesota Statutes, section 62A.011,
19.1(f) "Involuntary termination of coverage" means the termination of a health plan due
19.2a health plan company's refusal to renew the health plan in the individual market
19.3the health plan company elects to cease offering individual market health plans in
19.4some geographic rating areas of the state.
19.5 Subd. 2. Application. This section applies to an enrollee who is subject to a change in
19.6health plans in the individual market due to an involuntary termination of coverage
19.7health plan in the individual market after October 31, 2016, and before January 1,
19.8and who enrolls in a new health plan in the individual market for all or a portion
19.9year 2017 that goes into effect after December 31, 2016, and before March 2, 2017.
19.10 Subd. 3. Change in health plans; transition of care coverage. (a) If an enrollee satisfies
19.11the criteria in subdivision 2, the enrollee's new health plan company must provide,
19.12request of the enrollee or the enrollee's health care provider, authorization to receive
19.13that are otherwise covered under the terms of the enrollee's calendar year 2017 health
19.14from a provider who provided care on an in-network basis to the enrollee during calendar
19.15year 2016 but who is out of network in the enrollee's calendar year 2017 health plan:
19.16(1) for up to 120 days if the enrollee has, within 45 days before an involuntary termination
19.17of coverage, received a diagnosis of, or is engaged in a current course of treatment
19.18or more of the following conditions:
19.19(i) an acute condition;
19.20(ii) a life-threatening mental or physical illness;
19.21(iii) pregnancy beyond the first trimester of pregnancy;
19.22(iv) a physical or mental disability defined as an inability to engage in one or more
19.23life activities, provided the disability has lasted or can be expected to last for
at least one
19.24year or can be expected to result in death; or
19.25(v) a disabling or chronic condition that is in an acute phase; or
19.26(2) for the rest of the enrollee's life if a physician certifies that the enrollee
has an expected
19.27lifetime of 180 days or less.
19.28(b) For all requests for authorization under this subdivision, the health plan company
19.29must grant the request for authorization unless the enrollee does not meet the criteria
19.30paragraph (a) or subdivision 2.
19.31 Subd. 4. Limitations. (a) Subdivision 3 applies only if the enrollee's health care provider
20.1(1) accept as payment in full the lesser of:
20.2(i) the health plan company's reimbursement rate for in-network providers for the
20.3or similar service; or
20.4(ii) the provider's regular fee for that service;
20.5(2) request authorization for services in the form and manner specified by the enrollee's
20.6new health plan company; and
20.7(3) provide the enrollee's new health plan company with all necessary medical information
20.8related to the care provided to the enrollee.
20.9(b) Nothing in this section requires a health plan company to provide coverage for
20.10health care service or treatment that is not covered under the enrollee's health plan.
20.11 Subd. 5. Request for authorization. The enrollee's health plan company may require
20.12medical records and other supporting documentation to be submitted with a request
20.13authorization under subdivision 3 to the extent that the records and other documentation
20.14are relevant to a determination regarding the existence of a condition under subdivision
20.15paragraph (a). If authorization is denied, the health plan company must explain the
20.16used to make its decision on the request for authorization and must explain the enrollee's
20.17right to appeal the decision. If an enrollee chooses to appeal a denial, the enrollee
20.18appeal the denial within five business days of the date on which the enrollee receives
20.19denial. If authorization is granted, the health plan company must provide the enrollee,
20.20five business days of granting the authorization, with an explanation of how transition
20.21care will be provided.
20.22 Subd. 6. Reimbursement. (a) The commissioner of management and budget must
20.23reimburse the enrollee's new health plan company for the cost of claims that the health
20.24company certifies as eligible for reimbursement under this subdivision. The cost
20.25for reimbursement under this subdivision is the difference between the in-network
20.26benefits under the enrollee's health plan and the out-of-network level of benefits
20.27enrollee's health plan. The health plan company must seek reimbursement for the cost
20.28claims from the commissioner in a form and manner mutually agreed upon by the
20.29commissioner and the affected health plan companies. Total state reimbursements to
20.30plan companies under this subdivision are subject to the limits of the available appropriation
20.31and the commissioner may prorate equally across all claims paid as necessary. In the
20.32that funding for reimbursements to health plan companies is not sufficient to fully
20.33health plan companies for the costs of claims for reimbursement for services authorized
21.1under this section, health plan companies must continue to cover services authorized
21.3(b) For any service provided under this section, the enrollee shall not owe the provider
21.4more than the cost-sharing amount the enrollee would be required to pay if the services
21.5were performed by an in-network provider under the enrollee's new health plan.
21.6EFFECTIVE DATE.This section is effective for health plans issued after December
21.731, 2016, and before March 2, 2017, and that are in effect for all or a portion of
21.8year 2017. This section expires June 30, 2018.
Sec. 16. COSTS RELATED TO IMPLEMENTATION OF THIS ACT.
21.10A state agency that incurs administrative costs to implement any provision in this
21.11and does not receive an appropriation for administrative costs in this act, must implement
21.12the act within the limits of existing appropriations.
21.13EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 17. INSURANCE MARKET OPTIONS.
21.15The commissioner of commerce shall report by March 1, 2017, to the standing committees
21.16of the legislature having jurisdiction over insurance and health on the past and future
21.17of Minnesota Statutes 2005, section 62L.056, and Minnesota Statutes, section 62Q.188,
21.19(1) rate and form filings received, approved, or withdrawn;
21.20(2) barriers to current utilization, including federal and state laws; and
21.21(3) recommendations for allowing or increasing the offering of health plans compliant
21.22with Minnesota Statutes, section 62Q.188.
21.23EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 18. APPROPRIATION.
21.25$15,000,000 in fiscal year 2017 is appropriated from the general fund to the commissioner
21.26of management and budget to reimburse health plan companies for costs of claims eligible
21.27for reimbursement for coverage of transition of care services. Of this amount, $272,400
21.28available to the commissioner for purposes of administering reimbursement for coverage
21.29of transition of care services and administering the premium subsidy program in article
21.30This is a onetime appropriation and is available until June 30, 2018. Any funds remaining
22.1from this appropriation after June 30, 2018, shall be transferred on July 1, 2018,
22.2general fund to the budget reserve account in Minnesota Statutes, section 16A.152,
22.4EFFECTIVE DATE.This section is effective the day following final enactment.
Sec. 19. REPEALER.
22.6(a) Minnesota Statutes 2016, section 62D.12, subdivision 9, is repealed effective the
22.7day following final enactment.
22.8(b) Laws 2007, chapter 147, article 12, section 14, as amended by Laws 2010, chapter
22.9344, section 4, Laws 2010, chapter 384, section 99, Laws 2013, chapter 135, article
22.10section 9; Laws 2010, chapter 384, section 99; and Laws 2013, chapter 135, article
22.119, are repealed effective the day following final enactment.
Delete the title and insert:
relating to health care coverage; providing a temporary program to help pay for
health insurance premiums; requiring audits by the legislative auditor; modifying
requirements for health maintenance organizations; modifying provisions governing
health insurance; authorizing agricultural cooperative health plans; modifying a
tax provision; authorizing transition of care coverage for 2017; requiring reports;
transferring funds; appropriating money;amending Minnesota Statutes 2016,
sections 60A.08, subdivision 15; 60A.235, subdivision 3; 60A.236; 62D.02,
subdivision 4; 62D.03, subdivision 1; 62D.05, subdivision 1; 62D.06, subdivision
1; 62D.19; 62E.02, subdivision 3; 62K.10, by adding a subdivision; 62L.12,
subdivision 2; 297I.05, subdivision 12; proposing coding for new law in Minnesota
Statutes, chapters 62H; 62Q; repealing Minnesota Statutes 2016, section 62D.12,
subdivision 9; Laws 2007, chapter 147, article 12, section 14, as amended; Laws
2010, chapter 384, section 99; Laws 2013, chapter 135, article 1, section 9."
|We request the adoption of this report and repassage of the bill.
|Michelle R. Benson
|Gary H. Dahms
||Scott M. Jensen