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SF 1

3rd Engrossment - 90th Legislature (2017 - 2018) Posted on 01/31/2017 08:41am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
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.

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

ARTICLE 1

PREMIUM SUBSIDY PROGRAM

Section 1. new text beginDEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin For purposes of sections 1 to 6, the following terms have the
meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of Minnesota
Management and Budget.
new text end

new text begin Subd. 3. new text end

new text begin Eligible individual. new text end

new text begin "Eligible individual" means a Minnesota resident who:
new text end

new text begin (1) is not receiving a premium tax credit under Code of Federal Regulations, title 26,
section 1.36B-2, as of the date their coverage is effectuated;
new text end

new text begin (2) is not enrolled in public program coverage under Minnesota Statutes, section
256B.055, or 256L.04; and
new text end

new text begin (3) purchased an individual health plan from a health carrier in the individual market.
new text end

new text begin Subd. 4. new text end

new text begin Gross premium. new text end

new text begin "Gross premium" means the amount billed for a health plan
purchased by an eligible individual prior to a premium subsidy in a calendar year.
new text end

new text begin Subd. 5. new text end

new text begin Health carrier. new text end

new text begin "Health carrier" has the meaning given in Minnesota Statutes,
section 62A.011, subdivision 2.
new text end

new text begin Subd. 6. new text end

new text begin Individual health plan. new text end

new text begin "Individual health plan" has the meaning given in
Minnesota Statutes, section 62A.011, subdivision 4.
new text end

new text begin Subd. 7. new text end

new text begin Individual market. new text end

new text begin "Individual market" has the meaning given in Minnesota
Statutes, section 62A.011, subdivision 5.
new text end

new text begin Subd. 8. new text end

new text begin Net premium. new text end

new text begin "Net premium" means the gross premium less the premium
subsidy.
new text end

new text begin Subd. 9. new text end

new text begin Premium subsidy. new text end

new text begin "Premium subsidy":
new text end

new text begin (1) is a payment made on behalf of eligible individuals for the promotion of general
welfare, and is not compensation for any services;
new text end

new text begin (2) is equal to 25 percent of the monthly gross premium otherwise paid by or on behalf
of the eligible individual for coverage purchased in the individual market, that covers the
eligible individual and the eligible individual's spouse and dependents, or the percentage
established by the commissioner under section 2, subdivision 3, paragraph (c); and
new text end

new text begin (3) is excluded from any calculation used to determine eligibility within any of the
Department of Human Services programs.
new text end

Sec. 2. new text beginPAYMENT TO HEALTH CARRIERS ON BEHALF OF ELIGIBLE
INDIVIDUALS.
new text end

new text begin Subdivision 1. new text end

new text begin Program established. new text end

new text begin The commissioner of Minnesota Management
and Budget, in consultation with the commissioner of commerce and the commissioner of
human services, shall establish and administer the premium subsidy program authorized by
this act, to help eligible individuals pay for coverage in the individual market in 2017.
new text end

new text begin Subd. 2. new text end

new text begin Premium subsidy provided. new text end

new text begin As soon as practicable, but no later than April
30, 2017, health carriers shall begin paying a premium subsidy to each eligible individual
who purchases a health plan in the individual market, for all the months for which the net
premium is paid. An eligible individual shall pay the net premium amount to the health
carrier.
new text end

new text begin Subd. 3. new text end

new text begin Payments to health carriers. new text end

new text begin (a) The commissioner shall make payments to
health carriers on behalf of eligible individuals effectuating coverage for calendar year 2017,
for the months in that year for which the individual has paid the net premium amount to the
health carrier. Payments to health carriers shall be based on the premium subsidy available
to eligible individuals in the individual market, regardless of the cost of coverage purchased.
The commissioner shall not withhold payments because a health carrier cannot prove an
enrollee is an eligible individual.
new text end

new text begin (b) Health carriers seeking reimbursement from the commissioner must submit an invoice
and supporting information to the commissioner, using a form developed by the
commissioner, in order to be eligible for payment. The commissioner shall finalize the form
by March 1, 2017.
new text end

new text begin (c) Total state payments to health carriers must be made within the limits of the available
appropriation. The commissioner shall reimburse health carriers at the full requested amount
up to the level of the appropriation. The commissioner, by July 15, 2017, shall determine
whether the available appropriation will be sufficient to provide premium subsidies equal
to 25 percent of the gross premium for the period September 1, 2017, through December
31, 2017. If the commissioner determines that the available appropriation is not sufficient,
the commissioner shall reduce the premium subsidy percentage, beginning September 1,
2017, through the remainder of the calendar year, by an amount sufficient to ensure that the
total amount of premium subsidies provided for the calendar year does not exceed the
available appropriation. The commissioner shall notify health carriers of any reduced
premium subsidy percentage within five days of making a determination. Health carriers
shall provide enrollees with at least 30 days' notice of any reduction in the premium subsidy
percentage.
new text end

new text begin (d) The commissioner shall consider health carriers as vendors under Minnesota Statutes,
section 16A.124, subdivision 3, and each monthly invoice shall represent the completed
delivery of the service.
new text end

new text begin Subd. 4. new text end

new text begin Data practices. new text end

new text begin (a) The definitions in Minnesota Statutes, section 13.02, apply
to this subdivision.
new text end

new text begin (b) Government data on an enrollee or health carrier under this section are private data
on individuals or nonpublic data, except that the total reimbursement requested by a health
carrier and the total state payment to the health carrier are public data.
new text end

new text begin (c) Notwithstanding Minnesota Statutes, section 138.17, government data on an enrollee
or health carrier under this section must be destroyed by June 30, 2018, or upon completion
by the legislative auditor of the audits required by section 3, whichever is later.
new text end

Sec. 3. new text beginAUDITS.
new text end

new text begin (a) The legislative auditor shall conduct audits of the health carriers' supporting data, as
prescribed by the commissioner, to determine whether payments align with criteria
established in sections 1 and 2. The commissioner of human services shall provide data as
necessary to the legislative auditor to complete the audit. The commissioner shall withhold
or charge back payments to the health carriers to the extent they do not align with the criteria
established in sections 1 and 2, as determined by the audit.
new text end

new text begin (b) The legislative auditor shall audit the extent to which health carriers provided premium
subsidies to persons meeting the residency and other eligibility requirements specified in
section 1, subdivision 3. The legislative auditor shall report to the commissioner the amount
of premium subsidies provided by each health carrier to persons not eligible for a premium
subsidy. The commissioner, in consultation with the commissioners of commerce and health,
shall develop and implement a process to recover from health carriers the amount of premium
subsidies received for enrollees determined to be ineligible for premium subsidies by the
legislative auditor. The legislative auditor, when conducting the required audit, and the
commissioner, when determining the amount of premium subsidy to be recovered, may
take into account the extent to which a health carrier makes use of the Minnesota eligibility
system, as defined in Minnesota Statutes, section 62V.055, subdivision 1.
new text end

Sec. 4. new text beginAPPLICABILITY OF GROSS PREMIUM.
new text end

new text begin Notwithstanding premium subsidies provided under section 2, the premium base for
calculating the amount of any applicable premium taxes under Minnesota Statutes, chapter
297I, shall be the gross premium for health plans purchased by eligible individuals in the
individual market.
new text end

Sec. 5. new text beginSUNSET.
new text end

new text begin This article sunsets June 30, 2018.
new text end

Sec. 6. new text beginTRANSFER.
new text end

new text begin $326,945,000 in fiscal year 2017 is transferred from the budget reserve account in
Minnesota Statutes, section 16A.152, subdivision 1a, to the general fund.
new text end

Sec. 7. new text beginAPPROPRIATIONS.
new text end

new text begin (a) $311,788,000 in fiscal year 2017 is appropriated from the general fund to the
commissioner of management and budget for premium assistance under section 2. This
appropriation is onetime and is available through June 30, 2018.
new text end

new text begin (b) $157,000 in fiscal year 2017 is appropriated from the general fund to the legislative
auditor for purposes of section 3. This appropriation is onetime.
new text end

new text begin (c) Any unexpended amount from the appropriation in paragraph (a) after June 30, 2018,
shall be transferred on July 1, 2018, from the general fund to the budget reserve account
under Minnesota Statutes, section 16A.152, subdivision 1a.
new text end

Sec. 8. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 to 7 are effective the day following final enactment.
new text end

ARTICLE 2

INSURANCE 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 61A.02 shall be nonpublic data until
the filing becomes effective.

(b) All forms, rates, and related information filed with the commissioner under section
62A.02 shall be nonpublic data until the filing becomes effective.

(c) All forms, rates, and related information filed with the commissioner under section
62C.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
70A.06 shall be nonpublic data until the filing becomes effective.

(e) All forms, rates, and related information filed with the commissioner under section
79.56 shall be nonpublic data until the filing becomes effective.

(f) Notwithstanding paragraphs (b) and (c), for all rate increases subject to review under
section 2794 of the Public Health Services Act and any amendments to, or regulations, or
guidance issued under the act that are filed with the commissioner on or after September 1,
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 I
and II of the Preliminary Justifications of the rate increases subject to review; and

(4) must provide notice to the public on the Department of Commerce's Web site of the
review of the proposed rate, which must include a statement that the public has 30 calendar
days to submit written comments to the commissioner on the rate filing subject to review.

new text begin (g) Notwithstanding paragraphs (b) and (c), for all proposed premium rates filed with
the commissioner for individual health plans, as defined in section 62A.011, subdivision 4,
and small group health plans, as defined in section 62K.03, subdivision 12, the commissioner
must provide public access on the Department of Commerce's Web site to compiled data
of the proposed changes to rates, separated by health plan and geographic rating area, within
ten business days after the deadline by which health carriers, as defined in section 62A.011,
subdivision 2, must submit proposed rates to the commissioner for approval.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 30 days following final enactment.
new text end

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, that
provides coverage to an employer for health care expenses incurred under an
employer-sponsored plan provided to the employer's employees, retired employees, or their
dependents, shall issue the policy or evidence of coverage as a health plan if the policy or
evidence of coverage:

(1) has a specific attachment point for claims incurred per individual that is lower than
$20,000; or

deleted text begin (2) has an aggregate attachment point, for groups of 50 or fewer, that is lower than the
greater of:
deleted text end

deleted text begin (i) $4,000 times the number of group members;
deleted text end

deleted text begin (ii) 120 percent of expected claims; or
deleted text end

deleted text begin (iii) $20,000; or
deleted text end

deleted text begin (3)deleted text endnew text begin (2)new text end has an aggregate attachment point deleted text beginfor groups of 51 or moredeleted text end that is lower than
110 percent of expected claims.

(b) An insurer shall determine the number of persons in a group, for the purposes of this
section, on a consistent basis, at least annually. Where the insurance policy or evidence of
coverage applies to a contract period of more than one year, the dollar amounts set forth in
paragraph (a), deleted text beginclausesdeleted text endnew text begin clausenew text end (1) deleted text beginand (2)deleted text end, must be multiplied by the length of the contract
period expressed in years.

deleted text begin (c) The commissioner may adjust the constant dollar amounts provided in paragraph
(a), clauses (1), (2), and (3), on January 1 of any year, based upon changes in the medical
component of the Consumer Price Index (CPI). Adjustments must be in increments of $100
and must not be made unless at least that amount of adjustment is required. The commissioner
shall publish any change in these dollar amounts at least six months before their effective
date.
deleted text end

deleted text begin (d)deleted text endnew text begin (c)new text end 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 policy or
evidence of coverage administered on a group basis is a health plan regardless of whether
the policy or evidence of coverage is denominated as stop loss coverage.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2017, and applies to policies or
evidence of coverage offered, issued, or renewed to an employer on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2016, section 60A.236, is amended to read:


60A.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 than
deleted text begin coverage of alldeleted text endnew text begin the following:
new text end

new text begin (1)new text end claims incurred during the contract period deleted text beginregardless of when the claims aredeleted text endnew text begin; and
new text end

new text begin (2)new text end paidnew text begin by the plan during the contract period or within three months after expiration
of the contract period
new text end.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective June 1, 2017, and applies to policies or
evidence of coverage offered, issued, or renewed to an employer on or after that date.
new text end

Sec. 4.

Minnesota Statutes 2016, section 62D.02, subdivision 4, is amended to read:


Subd. 4.

Health maintenance organization.

deleted text begin(a)deleted text end "Health maintenance organization"
means a deleted text beginnonprofitdeleted text end new text beginforeign or domestic new text endcorporation deleted text beginorganized under chapter 317Adeleted text end, or a local
governmental unit as defined in subdivision 11, controlled and operated as provided in
sections 62D.01 to 62D.30, which provides, either directly or through arrangements with
providers or other persons, comprehensive health maintenance services, or arranges for the
provision of these services, to enrollees on the basis of a fixed prepaid sum without regard
to the frequency or extent of services furnished to any particular enrollee.

deleted text begin (b) [Expired]
deleted 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. 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 deleted text beginnonprofitdeleted text endnew text begin foreign or domesticnew text end corporation organized to do so or a local
governmental unit may apply to the commissioner of health for a certificate of authority to
establish and operate a health maintenance organization in compliance with sections 62D.01
to 62D.30. 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 or periodic
consideration in conjunction with a health maintenance organization or health maintenance
contract unless the organization has a certificate of authority under sections 62D.01 to
62D.30.

new text begin EFFECTIVE DATE. new text end

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

Sec. 6.

Minnesota Statutes 2016, section 62D.05, subdivision 1, is amended to read:


Subdivision 1.

Authority granted.

Any deleted text beginnonprofitdeleted text end corporation or local governmental
unit may, upon obtaining a certificate of authority as required in sections 62D.01 to 62D.30,
operate as a health maintenance organization.

new text begin EFFECTIVE DATE. new text end

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

Sec. 7.

Minnesota Statutes 2016, section 62D.06, subdivision 1, is amended to read:


Subdivision 1.

Governing body composition; enrollee advisory body.

The governing
body of any health maintenance organization which is a deleted text beginnonprofitdeleted text end corporation may include
enrollees, providers, or other individuals; provided, however, that after a health maintenance
organization which is a deleted text beginnonprofitdeleted text end corporation has been authorized under sections 62D.01
to 62D.30 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 and
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 to the
governing body shall not exceed the number of enrollees elected to the governing body. An
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;
or

(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 or
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 62D.01 to 62D.30 for one year, an enrollee advisory body shall
be established. The enrollees who make up this advisory body shall be elected by the enrollees
from among the enrollees.

new text begin EFFECTIVE DATE. new text end

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

Sec. 8.

Minnesota Statutes 2016, section 62D.19, is amended to read:


62D.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. The
commissioner of health shall implement and enforce this section by rules adopted under
this section.

In an effort to achieve the stated purposes of sections 62D.01 to 62D.30deleted text begin; in order to
safeguard the underlying nonprofit status of health maintenance organizations;
deleted text end 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 enrollees,
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 of
a health maintenance organization, officers or trustees of the health maintenance organization
who have breached their fiduciary duty in entering into and performing such contracts.

new text begin EFFECTIVE DATE. new text end

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

Sec. 9.

Minnesota Statutes 2016, section 62E.02, subdivision 3, is amended to read:


Subd. 3.

Health maintenance organization.

"Health maintenance organization" means
a deleted text beginnonprofitdeleted text end corporation licensed and operated as provided in chapter 62D.

new text begin EFFECTIVE DATE. new text end

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

Sec. 10.

new text begin [62H.18] AGRICULTURAL COOPERATIVE HEALTH PLAN.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Agricultural cooperative" means a cooperative organized under chapter 308A or
308B that meets the requirements of subdivision 2.
new text end

new text begin (c) "Broker" means an insurance agent engaged in brokerage business according to
section 60K.49.
new text end

new text begin (d) "Employee Retirement Income Security Act" means the Employee Retirement Income
Security Act of 1974, United States Code, title 29, sections 1001, et seq.
new text end

new text begin (e) "Enrollee" means a natural person covered by a joint self-insurance plan operating
under this section.
new text end

new text begin (f) "Insurance agent" has the meaning given to insurance agent in section 60A.02,
subdivision 7.
new text end

new text begin (g) "Joint self-insurance plan" or "plan" means a plan or any other arrangement established
for the benefit of two or more entities authorized to transact business in the state, in order
to jointly self-insure through a single employee welfare benefit plan funded through a trust,
to provide health, dental, or other benefits as permitted under the Employee Retirement
Income Security Act.
new text end

new text begin (h) "Service plan administrator" means a vendor of risk management services licensed
under section 60A.23.
new text end

new text begin (i) "Trust" means a trust established to accept and hold assets of the joint self-insurance
plan in trust and use and disperse funds in accordance with the terms of the written trust
document and joint self-insurance plan for the sole purposes of providing benefits and
defraying reasonable administrative costs of providing the benefits.
new text end

new text begin Subd. 2. new text end

new text begin Exemption. new text end

new text begin A joint self-insurance plan, its service plan administrator, stop loss
carrier, and any broker assisting the agricultural cooperative are exempt from sections
62H.01 to 62H.17, and are governed by the requirements of this section, if the joint
self-insurance plan is administrated through a trust established by an agricultural cooperative
that:
new text end

new text begin (1) has members who (i) actively work in production agriculture in Minnesota and file
either Form 1065 or Schedule F with the member's income tax return; or (ii) provide direct
services to production agriculture in Minnesota;
new text end

new text begin (2) specifies criteria for membership in the agricultural cooperative in their articles of
organization or bylaws, however criteria cannot be based on health status factors of the
individuals to be covered through the joint self-insurance plan; and
new text end

new text begin (3) grants at least 51 percent of the aggregate voting power on matters for which all
members may vote to members who satisfy clause (1) and any additional criteria in the
agricultural cooperative's articles of organization and bylaws.
new text end

new text begin Subd. 3. new text end

new text begin Plan requirements. new text end

new text begin A joint self-insurance plan operating under this section
must:
new text end

new text begin (1) offer health coverage to members of the agricultural cooperative that establishes the
plan and their dependents, to employees of members of the agricultural cooperative that
establishes the plan and their dependents, or to employees of the agricultural cooperative
that establishes the plan and their dependents. Health coverage may be offered only to those
individuals who meet certain criteria described in the joint self-insurance plan governing
documents, however the criteria cannot be based on health status factors of the individuals
to be covered through the joint self-insurance plan;
new text end

new text begin (2) include stop-loss coverage with an individual attachment point not lower than $20,000
and an aggregate attachment point not lower than 110 percent of expected claims, issued
by an insurance company licensed in Minnesota;
new text end

new text begin (3) establish a reserve fund, certified by an actuary to be sufficient to cover unpaid claim
liability for incurred but not reported liabilities in the event of plan termination. Certification
from the actuary must include all maximum funding requirements for plan fixed cost
requirements and current claims liability requirements, and must include a calculation of
the reserve levels needed to fund all incurred but not reported liabilities in the event of
member or plan termination. These reserve funds must be held in a trust;
new text end

new text begin (4) be governed by a board elected by agricultural cooperative members that participate
in the plan;
new text end

new text begin (5) contract for services with a service plan administrator; and
new text end

new text begin (6) satisfy the requirements of the Employee Retirement Income Security Act that apply
to employee welfare benefit plans.
new text end

new text begin Subd. 4. new text end

new text begin Submission of documents to commissioner of commerce. new text end

new text begin A joint
self-insurance plan operating under this section must submit to the commissioner of
commerce copies of all filings and reports that are submitted to the United States Department
of Labor according to the Employee Retirement Income Security Act. Members participating
in the joint self-insurance plan may designate an agricultural cooperative that establishes
the plan as the entity responsible for satisfying the reporting requirements of the Employee
Retirement Income Security Act and for providing copies of these filings and reports to the
commissioner of commerce.
new text end

new text begin Subd. 5. new text end

new text begin Participation; termination of participation. new text end

new text begin If a member chooses to participate
in a joint self-insurance plan under this section, the member must participate in the plan for
at least three consecutive years. If a member terminates participation in the plan before the
end of the three-year period, a financial penalty may be assessed under the plan, not to
exceed the amount contributed by the member to the plan reserves.
new text end

new text begin Subd. 6. new text end

new text begin Single risk pool. new text end

new text begin The enrollees of a joint self-insurance plan operating under
this section shall be members of a single risk pool. The plan shall provide benefits as a
single, self-insured plan with the size of the plan based on the total enrollees in the risk
pool.
new text end

new text begin Subd. 7. new text end

new text begin Promotion, marketing, sale of coverage. new text end

new text begin (a) Coverage in a joint self-insurance
plan operating under this section may be promoted, marketed, and sold by insurance agents
and brokers to members of the agricultural cooperative sponsoring the plan and their
dependents, employees of members of the agricultural cooperative sponsoring the plan and
their dependents, and employees of the agricultural cooperative sponsoring the plan and
their dependents.
new text end

new text begin (b) Coverage in a joint self-insurance plan operating under this section may be promoted
and marketed by a cooperative organized under chapter 308A or 308B to persons who may
be eligible to participate in the joint self-insurance plan.
new text end

new text begin Subd. 8. new text end

new text begin Taxation. new text end

new text begin Joint self-insurance plans are exempt from the taxation imposed
under section 297I.05, subdivision 12.
new text end

new text begin Subd. 9. new text end

new text begin Compliance with other laws. new text end

new text begin A joint self-insurance plan operating under this
section:
new text end

new text begin (1) is exempt from providing the mandated health benefits in chapters 62A and 62Q, if
the plan otherwise provides the benefits required under the Employee Retirement Income
Security Act;
new text end

new text begin (2) is exempt from the continuation requirements in sections 62A.146, 62A.16, 62A.17,
62A.20, and 62A.21, if the plan complies with the continuation requirements under the
Employee Retirement Income Security Act; and
new text end

new text begin (3) must comply with all requirements of the Affordable Care Act, as defined in section
62A.011, subdivision 1a, to the extent that they apply to such plans.
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. 11.

Minnesota Statutes 2016, section 62K.10, is amended by adding a subdivision to
read:


new text begin Subd. 5a. new text end

new text begin Appeal of waiver of network adequacy requirements. new text end

new text begin (a) If a health carrier
receives a waiver under subdivision 5 applicable to a health plan's provider network, a
provider who is in the service area served by the health plan and who is aggrieved by the
issuance of the waiver may appeal the commissioner's decision using the contested case
procedures in sections 14.57 to 14.62. A contested case proceeding must be initiated within
60 days after the date on which the commissioner grants a waiver, except that a proceeding
regarding a waiver in effect as of January 1, 2017, must be initiated within 60 days after
the effective date of this subdivision. The commissioner must provide timely notice of an
appeal under this subdivision to the health carrier that received the waiver that is subject to
the appeal. After considering the appeal, the administrative law judge must either uphold
or nullify the waiver of network adequacy requirements. The prevailing party in the contested
case proceeding may seek an award of expenses and fees from the nonprevailing party by
applying to the administrative law judge using the procedure in section 15.472, paragraph
(b). The administrative law judge shall award fees and expenses to the prevailing party if
the administrative law judge finds that the position of the nonprevailing party was not
substantially justified. For purposes of this paragraph, "substantially justified" has the
meaning given in section 15.471, subdivision 8.
new text end

new text begin (b) The decision of the administrative law judge constitutes the final decision regarding
the waiver. A party aggrieved by the administrative law judge's decision may seek judicial
review of the decision as provided in chapter 14. If the waiver is nullified and no judicial
review is sought, the health carrier must comply with the network adequacy requirements
in subdivisions 2, 3, and 4, within 30 days after the deadline for seeking judicial review in
section 14.63.
new text end

new text begin (c) This subdivision expires December 31, 2018.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment, and
applies to network adequacy waivers in effect on or after January 1, 2017.
new text end

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 62D.104 as a
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 62A.146, 62A.17, 62A.21, 62C.142, 62D.101,
and 62D.105.

(c) A health carrier may renew conversion policies to eligible employees.

(d) A health carrier may sell, issue, or renew individual continuation policies to eligible
employees as required.

(e) A health carrier may sell, issue, or renew individual health plans if the coverage is
appropriate due to an unexpired preexisting condition limitation or exclusion applicable to
the person under the employer's group health plan or due to the person's need for health
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 subdivision
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 the
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 issued
as a supplement to Medicare under sections 62A.3099 to 62A.44, 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 persons
eligible for an employer group health plan, if the individual health plan is a high deductible
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 health
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 one or
more employees of a small employer if the individual health plan is marketed directly to
all employees of the small employer and the small employer does not contribute directly or
indirectly to the premiums or facilitate the administration of the individual health plan. The
requirement to market an individual health plan to all employees does not require the health
carrier to offer or issue an individual health plan to any employee. For purposes of this
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 merely
collects the premiums from an employee's wages or salary through payroll deductions and
submits payment for the premiums of one or more employees in a lump sum to the health
carrier. Except for coverage under section 62A.65, subdivision 5, paragraph (b), at the
request of an employee, the health carrier may bill the employer for the premiums payable
by the employee, provided that the employer is not liable for payment except from payroll
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 at least
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
under section 62L.03 to the employees within the past 12 months.

new text begin (m) A health carrier may offer, sell, issue, or renew an individual health plan to one or
more employees of a small employer if the small employer, eligible employee, and individual
health plan are in compliance with the 21st Century Cures Act, Public Law 114-255, section
18001.
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. 13.

new text begin [62Q.556] UNAUTHORIZED PROVIDER SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Unauthorized provider services. new text end

new text begin (a) Except as provided in paragraph
(c), unauthorized provider services occur when an enrollee receives services:
new text end

new text begin (1) from a nonparticipating provider at a participating hospital or ambulatory surgical
center, when the services are rendered:
new text end

new text begin (i) due to the unavailability of a participating provider;
new text end

new text begin (ii) by a nonparticipating provider without the enrollee's knowledge; or
new text end

new text begin (iii) due to the need for unforeseen services arising at the time the services are being
rendered; or
new text end

new text begin (2) from a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or other
medical testing facility.
new text end

new text begin (b) Unauthorized provider services do not include emergency services as defined in
section 62Q.55, subdivision 3.
new text end

new text begin (c) The services described in paragraph (a), clause (2), are not unauthorized provider
services if the enrollee gives advance written consent to the provider acknowledging that
the use of a provider, or the services to be rendered, may result in costs not covered by the
health plan.
new text end

new text begin Subd. 2. new text end

new text begin Prohibition. new text end

new text begin (a) An enrollee's financial responsibility for the unauthorized
provider services shall be the same cost-sharing requirements, including co-payments,
deductibles, coinsurance, coverage restrictions, and coverage limitations, as those applicable
to services received by the enrollee from a participating provider. A health plan company
must apply any enrollee cost sharing requirements, including co-payments, deductibles, and
coinsurance, for unauthorized provider services to the enrollee's annual out-of-pocket limit
to the same extent payments to a participating provider would be applied.
new text end

new text begin (b) A health plan company must attempt to negotiate the reimbursement, less any
applicable enrollee cost sharing under paragraph (a), for the unauthorized provider services
with the nonparticipating provider. If a health plan company's and nonparticipating provider's
attempts to negotiate reimbursement for the health care services do not result in a resolution,
the health plan company or provider may elect to refer the matter for binding arbitration,
chosen in accordance with paragraph (c). A nondisclosure agreement must be executed by
both parties prior to engaging an arbitrator in accordance with this section. The cost of
arbitration must be shared equally between the parties.
new text end

new text begin (c) The commissioner of health, in consultation with the commissioner of the Bureau
of Mediation Services, must develop a list of professionals qualified in arbitration, for the
purpose of resolving disputes between a health plan company and nonparticipating provider
arising from the payment for unauthorized provider services. The commissioner of health
shall publish the list on the department of health's Web Site, and update the list as appropriate.
new text end

new text begin (d) The arbitrator must consider relevant information, including the health plan company's
payments to other nonparticipating providers for the same services, the circumstances and
complexity of the particular case, and the usual and customary rate for the service based on
information available in a database in a national, independent, not-for-profit corporation,
and similar fees received by the provider for the same services from other health plans in
which the provider is nonparticipating, in reaching a decision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective 90 days following final enactment and
applies to provider services provided on or after that date.
new text end

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 and
contracts of coverage under chapter 79; and

(4) the direct funded premium received by the reinsurance association under section
79.34 from self-insurers approved under section 176.181 and political subdivisions that
self-insure.

(b) A tax is imposed on a joint self-insurance plan operating under chapter 60F. The rate
of tax is equal to two percent of the total amount of claims paid during the fund year, with
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 62Hnew text begin, except
as provided in section 62H.18, subdivision 8
new text end. 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 wholly
or partially reimbursed through stop-loss insurance.

(d) A tax is imposed equal to the tax imposed under section 297I.05, subdivision 5, on
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 or
otherwise, during the year.

new text begin EFFECTIVE DATE. new text end

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

Sec. 15. new text beginTRANSITION OF CARE COVERAGE FOR CALENDAR YEAR 2017;
INVOLUNTARY TERMINATION OF COVERAGE.
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 following terms have
the meanings given.
new text end

new text begin (b) "Enrollee" has the meaning given in Minnesota Statutes, section 62Q.01, subdivision
2b.
new text end

new text begin (c) "Health plan" has the meaning given in Minnesota Statutes, section 62Q.01,
subdivision 3.
new text end

new text begin (d) "Health plan company" has the meaning given in Minnesota Statutes, section 62Q.01,
subdivision 4.
new text end

new text begin (e) "Individual market" has the meaning given in Minnesota Statutes, section 62A.011,
subdivision 5.
new text end

new text begin (f) "Involuntary termination of coverage" means the termination of a health plan due to
a health plan company's refusal to renew the health plan in the individual market because
the health plan company elects to cease offering individual market health plans in all or
some geographic rating areas of the state.
new text end

new text begin Subd. 2. new text end

new text begin Application. new text end

new text begin This section applies to an enrollee who is subject to a change in
health plans in the individual market due to an involuntary termination of coverage from a
health plan in the individual market after October 31, 2016, and before January 1, 2017,
and who enrolls in a new health plan in the individual market for all or a portion of calendar
year 2017 that goes into effect after December 31, 2016, and before March 2, 2017.
new text end

new text begin Subd. 3. new text end

new text begin Change in health plans; transition of care coverage. new text end

new text begin (a) If an enrollee satisfies
the criteria in subdivision 2, the enrollee's new health plan company must provide, upon
request of the enrollee or the enrollee's health care provider, authorization to receive services
that are otherwise covered under the terms of the enrollee's calendar year 2017 health plan
from a provider who provided care on an in-network basis to the enrollee during calendar
year 2016 but who is out of network in the enrollee's calendar year 2017 health plan:
new text end

new text begin (1) for up to 120 days if the enrollee has, within 45 days before an involuntary termination
of coverage, received a diagnosis of, or is engaged in a current course of treatment for, one
or more of the following conditions:
new text end

new text begin (i) an acute condition;
new text end

new text begin (ii) a life-threatening mental or physical illness;
new text end

new text begin (iii) pregnancy beyond the first trimester of pregnancy;
new text end

new text begin (iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided the disability has lasted or can be expected to last for at least one
year or can be expected to result in death; or
new text end

new text begin (v) a disabling or chronic condition that is in an acute phase; or
new text end

new text begin (2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
new text end

new text begin (b) For all requests for authorization under this subdivision, the health plan company
must grant the request for authorization unless the enrollee does not meet the criteria in
paragraph (a) or subdivision 2.
new text end

new text begin Subd. 4. new text end

new text begin Limitations. new text end

new text begin (a) Subdivision 3 applies only if the enrollee's health care provider
agrees to:
new text end

new text begin (1) accept as payment in full the lesser of:
new text end

new text begin (i) the health plan company's reimbursement rate for in-network providers for the same
or similar service; or
new text end

new text begin (ii) the provider's regular fee for that service;
new text end

new text begin (2) request authorization for services in the form and manner specified by the enrollee's
new health plan company; and
new text end

new text begin (3) provide the enrollee's new health plan company with all necessary medical information
related to the care provided to the enrollee.
new text end

new text begin (b) Nothing in this section requires a health plan company to provide coverage for a
health care service or treatment that is not covered under the enrollee's health plan.
new text end

new text begin Subd. 5. new text end

new text begin Request for authorization. new text end

new text begin The enrollee's health plan company may require
medical records and other supporting documentation to be submitted with a request for
authorization under subdivision 3 to the extent that the records and other documentation
are relevant to a determination regarding the existence of a condition under subdivision 3,
paragraph (a). If authorization is denied, the health plan company must explain the criteria
used to make its decision on the request for authorization and must explain the enrollee's
right to appeal the decision. If an enrollee chooses to appeal a denial, the enrollee must
appeal the denial within five business days of the date on which the enrollee receives the
denial. If authorization is granted, the health plan company must provide the enrollee, within
five business days of granting the authorization, with an explanation of how transition of
care will be provided.
new text end

new text begin Subd. 6. new text end

new text begin Reimbursement. new text end

new text begin (a) The commissioner of management and budget must
reimburse the enrollee's new health plan company for the cost of claims that the health plan
company certifies as eligible for reimbursement under this subdivision. The cost eligible
for reimbursement under this subdivision is the difference between the in-network level of
benefits under the enrollee's health plan and the out-of-network level of benefits under the
enrollee's health plan. The health plan company must seek reimbursement for the cost of
claims from the commissioner in a form and manner mutually agreed upon by the
commissioner and the affected health plan companies. Total state reimbursements to health
plan companies under this subdivision are subject to the limits of the available appropriation
and the commissioner may prorate equally across all claims paid as necessary. In the event
that funding for reimbursements to health plan companies is not sufficient to fully reimburse
health plan companies for the costs of claims for reimbursement for services authorized
under this section, health plan companies must continue to cover services authorized under
this section.
new text end

new text begin (b) For any service provided under this section, the enrollee shall not owe the provider
more than the cost-sharing amount the enrollee would be required to pay if the services
were performed by an in-network provider under the enrollee's new health plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans issued after December
31, 2016, and before March 2, 2017, and that are in effect for all or a portion of calendar
year 2017. This section expires June 30, 2018.
new text end

Sec. 16. new text beginCOSTS RELATED TO IMPLEMENTATION OF THIS ACT.
new text end

new text begin A state agency that incurs administrative costs to implement any provision in this act
and does not receive an appropriation for administrative costs in this act, must implement
the act within the limits of existing appropriations.
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. 17. new text beginINSURANCE MARKET OPTIONS.
new text end

new text begin The commissioner of commerce shall report by March 1, 2017, to the standing committees
of the legislature having jurisdiction over insurance and health on the past and future use
of Minnesota Statutes 2005, section 62L.056, and Minnesota Statutes, section 62Q.188,
including:
new text end

new text begin (1) rate and form filings received, approved, or withdrawn;
new text end

new text begin (2) barriers to current utilization, including federal and state laws; and
new text end

new text begin (3) recommendations for allowing or increasing the offering of health plans compliant
with Minnesota Statutes, section 62Q.188.
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. 18. new text beginAPPROPRIATION.
new text end

new text begin $15,000,000 in fiscal year 2017 is appropriated from the general fund to the commissioner
of management and budget to reimburse health plan companies for costs of claims eligible
for reimbursement for coverage of transition of care services. Of this amount, $272,400 is
available to the commissioner for purposes of administering reimbursement for coverage
of transition of care services and administering the premium subsidy program in article 1.
This is a onetime appropriation and is available until June 30, 2018. Any funds remaining
from this appropriation after June 30, 2018, shall be transferred on July 1, 2018, from the
general fund to the budget reserve account in Minnesota Statutes, section 16A.152,
subdivision 1a.
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. 19. new text begin REPEALER.
new text end

new text begin (a) new text end new text begin Minnesota Statutes 2016, section 62D.12, subdivision 9, new text end new text begin is repealed effective the
day following final enactment.
new text end

new text begin (b) new text end new text begin Laws 2007, chapter 147, article 12, section 14, as amended by Laws 2010, chapter
344, section 4, Laws 2010, chapter 384, section 99, Laws 2013, chapter 135, article 1,
section 9; Laws 2010, chapter 384, section 99; and Laws 2013, chapter 135, article 1, section
9,
new text end new text begin are repealed effective the day following final enactment.
new text end

APPENDIX

Repealed Minnesota Statutes: S0001-3

62D.12 PROHIBITED PRACTICES.

Subd. 9.

Net earnings.

All net earnings of the health maintenance organization shall be devoted to the nonprofit purposes of the health maintenance organization in providing comprehensive health care. No health maintenance organization shall provide for the payment, whether directly or indirectly, of any part of its net earnings, to any person as a dividend or rebate; provided, however, that health maintenance organizations may make payments to providers or other persons based upon the efficient provision of services or as incentives to provide quality care. The commissioner of health shall, pursuant to sections 62D.01 to 62D.30, revoke the certificate of authority of any health maintenance organization in violation of this subdivision.

Repealed Minnesota Session Laws: S0001-3

Laws 2007, chapter 147, article 12, section 14, as amended by Laws 2010, chapter 344, section 4; as amended by Laws 2010, chapter 384, section 99; as amended by Laws 2013, chapter 135, article 1, section 9; as amended by Laws 2017, chapter 2, article 2, section 19

Sec. 4.

Laws 2007, chapter 147, article 12, section 14, is amended to read:


Sec. 14. AGRICULTURAL COOPERATIVE HEALTH PLAN FOR FARMERS.

Subdivision 1.

Pilot project requirements.

Notwithstanding contrary provisions of Minnesota Statutes, chapter 62H, the following apply to a joint self-insurance pilot project administered by a trust sponsored by one or more agricultural cooperatives organized under Minnesota Statutes, chapter 308A or 308B, or under a federal charter for the purpose of offering health coverage to members of the cooperatives and their families, provided the project satisfies the other requirements of Minnesota Statutes, chapter 62H:

(1) Minnesota Statutes, section 62H.02, paragraph (b), does not apply;

(2) the notice period required under Minnesota Statutes, section 62H.02, paragraph (e), is 90 days;

(3) a joint self-insurance plan may elect to treat the sale of a health plan to or for an employer that has only one eligible employee who has not waived coverage as the sale of an individual health plan as allowed under Minnesota Statutes, section 62L.02, subdivision 26;

(4) Minnesota Statutes, section 297I.05, subdivision 12, paragraph (c), applies; and

(5) the trust must pay the assessment for the Minnesota Comprehensive Health Association as provided under Minnesota Statutes, section 62E.11.

Subd. 2.

Evaluation and renewal.

The pilot project authorized under this section is for a period of four years from the date of initial enrollment. The commissioner of commerce shall grant an extension of four additional years if the trust provides evidence that it remains in compliance with the requirements of this section and other applicable laws and rules. If the commissioner determines that the operation of the trust has not improved access, expanded health plan choices, or improved the affordability of health coverage for farm families, or that it has significantly damaged access, choice, or affordability for other consumers not enrolled in the trust, the commissioner shall provide at least 180 days' advance written notice to the trust and to the chairs of the senate and house finance and policy committees with jurisdiction over health and insurance of the commissioner's intention not to renew the pilot project at the expiration of a four-year period.

Subd. 3.

Use of surplus lines.

Plans created under this section may use surplus lines carriers to fulfill its obligations under chapter 62H.

Laws 2010, chapter 384, section 99 by Laws 2017, chapter 2, article 2, section 19

Sec. 99.

Laws 2007, chapter 147, article 12, section 14, is amended to read:


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EFFECTIVE DATE.

This section is effective the day following final enactment.

Laws 2013, chapter 135, article 1, section 9 by Laws 2017, chapter 2, article 2, section 19

Sec. 9.

Laws 2007, chapter 147, article 12, section 14, as amended by Laws 2010, chapter 344, section 4, subdivision 1, and Laws 2010, chapter 384, section 99, is amended to read:


EFFECTIVE DATE.

This section is effective the day following final enactment.