SF 1074

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/02/2023 10:18am

A bill for an act
relating to health insurance; establishing a standardized health plan to be offered
in the individual and small group insurance markets; requiring a report;
appropriating money; proposing coding for new law in Minnesota Statutes, chapter
62E.

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

Section 1.

new text begin [62E.60] CITATION.
new text end

new text begin Sections 62E.60 to 62E.70 may be cited as the "Minnesota Standardized Health Plan
Act."
new text end

Sec. 2.

new text begin [62E.61] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin For purposes of sections 62E.60 to 62E.70, the terms defined
in this section have the meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Advisory board. new text end

new text begin "Advisory board" means the board established under section
62E.65.
new text end

new text begin Subd. 3. new text end

new text begin Affordable Care Act. new text end

new text begin "Affordable Care Act" has the meaning given in section
62K.03, subdivision 2.
new text end

new text begin Subd. 4. new text end

new text begin Critical access hospital. new text end

new text begin "Critical access hospital" means a hospital that is
federally certified or is undergoing federal certification as a critical access hospital pursuant
to Code of Federal Regulations, title 42, section 485, subpart F.
new text end

new text begin Subd. 5. new text end

new text begin Equivalent rate. new text end

new text begin "Equivalent rate" means:
new text end

new text begin (1) for a hospital that is a pediatric specialty hospital with a level one trauma center, the
payment rate determined by the medical assistance fee schedule for the hospital from the
most recent year for which a complete set of hospital financial data is publicly available on
July 1, 2023, multiplied by a conversion factor equal to the ratio of the statewide
payment-to-cost ratio for Medicare to the hospital's specific payment-to-cost ratio for the
most recent set of hospital financial data publicly available on July 1, 2023. In any given
year, the rate must be adjusted annually for cumulative inflation by a factor equal to the
average percent increase in the Medicare inpatient and outpatient prospective payment
systems over the previous three years; and
new text end

new text begin (2) for any health care service that does not have an existing Medicare reimbursement
rate and for services that have low volume statewide relative to other Medicare services,
including pediatric and obstetric services, a rate set by the commissioner after consultation
with hospitals, physicians, other health care providers, and the commissioners of health and
human services. The equivalent rate must utilize the ratio of medical assistance payment
rates to existing Medicare payment rates whenever possible.
new text end

new text begin Subd. 6. new text end

new text begin Essential access hospital. new text end

new text begin "Essential access hospital" means a critical access
hospital or an acute care hospital located in a rural area, as defined in the federal Medicare
regulations, Code of Federal Regulations, title 42, section 405.1041, with no more than 25
licensed hospital beds.
new text end

new text begin Subd. 7. new text end

new text begin Essential community provider. new text end

new text begin "Essential community provider" means a
provider that is designated as an essential community provider by the commissioner of
health in accordance with section 62Q.19.
new text end

new text begin Subd. 8. new text end

new text begin Health care cooperative. new text end

new text begin "Health care cooperative" has the meaning given in
section 62R.04.
new text end

new text begin Subd. 9. new text end

new text begin Health care provider. new text end

new text begin "Health care provider" means a health professional
licensed, certified, or registered under chapters 147, 147A, 147C, 148, 148E, 148F, 150A,
151, or 153.
new text end

new text begin Subd. 10. new text end

new text begin Health carrier. new text end

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

new text begin Subd. 11. new text end

new text begin Health plan. new text end

new text begin "Health plan" means a policy, contract, certificate, or agreement,
as defined in section 62A.011, subdivision 3.
new text end

new text begin Subd. 12. new text end

new text begin Health system. new text end

new text begin "Health system" means a corporation or other organization
that owns, contains, or operates three or more hospitals.
new text end

new text begin Subd. 13. new text end

new text begin Individual health plan. new text end

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

new text begin Subd. 14. new text end

new text begin Individual market. new text end

new text begin "Individual market" means the market for health insurance
coverage offered to individuals either through MNsure or outside of MNsure.
new text end

new text begin Subd. 15. new text end

new text begin Insurance producer. new text end

new text begin "Insurance producer" has the meaning given in section
60K.31, subdivision 6.
new text end

new text begin Subd. 16. new text end

new text begin Medical inflation. new text end

new text begin "Medical inflation" means the annual percentage change
in the medical care index component of the United States Department of Labor's Bureau of
Labor Statistics' consumer price index for medical care services and medical care
commodities, or the applicable predecessor or successor index, based on the average change
in the medical care index over the previous ten years.
new text end

new text begin Subd. 17. new text end

new text begin Medicare reimbursement rate. new text end

new text begin (a) "Medicare reimbursement rate" means
the facility-specific reimbursement rate for a particular health care service provided under
title XVIII of the federal Social Security Act, United States Code, title 42, section 1395, et
seq., as amended.
new text end

new text begin (b) For a critical access hospital that is reimbursed through the Medicare prospective
payments systems rate, Medicare reimbursement rate means the rate based on allowable
costs as reported in Medicare cost reports and the hospital cost-to-charge ratios for the
specific hospital.
new text end

new text begin Subd. 18. new text end

new text begin MNsure. new text end

new text begin "MNsure" has the meaning given in section 62V.02, subdivision 8.
new text end

new text begin Subd. 19. new text end

new text begin Small group health plan. new text end

new text begin "Small group health plan" has the meaning given
in section 62K.03, subdivision 12.
new text end

new text begin Subd. 20. new text end

new text begin Small group market. new text end

new text begin "Small group market" has the meaning given in section
62V.02, subdivision 12.
new text end

new text begin Subd. 21. new text end

new text begin Standardized health plan. new text end

new text begin "Standardized health plan" means the health plan
designed pursuant to section 62E.62.
new text end

Sec. 3.

new text begin [62E.62] STANDARDIZED HEALTH PLAN.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin (a) By January 1, 2025, the commissioner must by rule
establish a standardized health plan to be offered by health carriers licensed in Minnesota
that offer health plans in the individual and small group markets. The standardized health
plan must:
new text end

new text begin (1) offer health coverage at the bronze, silver, and gold levels of coverage as described
under section 62K.06;
new text end

new text begin (2) include, at a minimum, essential health benefits in accordance with the requirements
of the Affordable Care Act;
new text end

new text begin (3) be actuarially sound and allow the health carrier to continue to meet any statutory
financial requirements;
new text end

new text begin (4) comply with the Affordable Care Act, including the risk-adjustment requirements
under Code of Federal Regulations, title 45, section 153, and any state law that applies to
individual or small group health plans; and
new text end

new text begin (5) have defined cost-sharing that is designed to improve access and affordability and
decrease racial health disparities through a variety of means, including improving perinatal
health care coverage and providing first dollar coverage for certain high value services,
including primary and behavioral health care.
new text end

new text begin (c) When creating the standardized health plan, the commissioner, in coordination with
the commissioners of health, human services, and management and budget, must establish
a stakeholder engagement process that includes physicians; health care industry and consumer
representatives; representatives of health care providers and individuals who work in health
care; and individuals who work with or represent communities that are affected by higher
rates of health disparities and inequities.
new text end

new text begin (d) The commissioner may update the standardized health plan annually through the
stakeholder engagement process described under paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Network adequacy requirements. new text end

new text begin (a) Each standardized health plan must
have a network that meets the network adequacy requirements in section 62K.10.
new text end

new text begin (b) Each network must also:
new text end

new text begin (1) be culturally responsive and, to the extent possible, reflect the diversity of the
standardized health plan's enrollees in terms of race, ethnicity, gender identity, and sexual
orientation in the service area that the network covers;
new text end

new text begin (2) be no more narrow than the most restrictive network the health carrier is offering
for nonstandardized health plans in the individual market for the medal tier for that rating
area; and
new text end

new text begin (3) include the essential community providers located in the service area of the
standardized health plan.
new text end

new text begin (c) If a health carrier is unable to achieve the network adequacy requirements specified
in this subdivision, the health carrier must file an action plan with the commissioner that
describes the health carrier's efforts to achieve the requirements of this subdivision.
new text end

new text begin (d) The commissioner must promulgate rules regarding network adequacy requirements
and the required action plan described in paragraph (c).
new text end

new text begin Subd. 3. new text end

new text begin Offerings. new text end

new text begin (a) Beginning January 1, 2026, a health carrier that offers an
individual health plan to Minnesota residents must offer the standardized health plan in the
individual market in each county where the health carrier offers an individual health plan
and must offer the standardized health plan throughout the entire county, unless the health
carrier complies with section 62K.13.
new text end

new text begin (b) Beginning January 1, 2026, any health carrier that offers a small group health plan
in Minnesota must offer the standardized health plan in the small group market in each
county where the health carrier offers a small group health plan and must offer the
standardized health plan throughout the entire county, unless the health carrier complies
with section 62K.13.
new text end

new text begin (c) A health carrier offering individual health plans must offer the standardized health
plan through MNsure during (1) the open enrollment period described in section 62K.15,
and (2) any special or limited open enrollment periods as defined under the Affordable Care
Act. The standardized health plans must be offered in a manner that allows consumers to
easily compare the standardized health plans offered by each health carrier.
new text end

Sec. 4.

new text begin [62E.63] PREMIUM RATES.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin (a) In the individual market for the plan year beginning
January 1, 2026, and in the small group market beginning January 1, 2026, a health carrier
must offer the standardized health plan at a premium rate that is at least five percent less
than the premium rate for the health plans that the health carrier offered in the individual
and small group markets in the 2024 calendar year, as adjusted for medical inflation. The
commissioner must calculate the premium rate reduction based on the rates charged in the
same county in which the health carrier offered health plans in the individual and small
group markets in calendar year 2024.
new text end

new text begin (b) For a health carrier offering the standardized health plan in the 2026 plan year in a
county in which the health carrier did not offer a health plan in the individual or small group
market in the 2024 calendar year, the health carrier that offers the standardized health plan
must offer the standardized health plan:
new text end

new text begin (1) in the individual market at a premium that is at least five percent less than the average
premium rate for individual health plans offered in that county in 2024, calculated based
on the average premium rate for individual health plans offered in that county, as adjusted
for medical inflation; and
new text end

new text begin (2) in the small group market at a premium rate that is at least five percent less than the
average premium rate for small group plans offered in that county in 2024, as adjusted for
medical inflation.
new text end

new text begin (c) In the individual market, for the plan year beginning January 1, 2027, and in the
small group market, beginning January 1, 2027, a health carrier must offer the standardized
health plan at a premium rate that is at least ten percent less than the premium rate for health
plans that the health carrier offered in the individual and small group markets in the 2024
calendar year, as adjusted for medical inflation. The commissioner must calculate the
premium rate reduction based on the rates charged in the same county in which the health
carrier offered health plans in the individual and small group markets in 2024.
new text end

new text begin (d) For a health carrier offering the standardized health plan in the 2027 plan year in a
county in which the carrier did not offer a health plan in the individual or small group market
in the 2024 calendar year, a health carrier that offers the standardized health plan must offer
the standardized health plan:
new text end

new text begin (1) in the individual market at a premium that is at least ten percent less than the average
premium rate for individual health plans offered in that county in 2024, calculated based
on the average premium rate for individual health plans offered in that county, as adjusted
for medical inflation; and
new text end

new text begin (2) in the small group market at a premium rate that is at least ten percent less than the
average premium rate for small group plans offered in that county in 2024, as adjusted for
medical inflation.
new text end

new text begin (e) In the individual market, for the plan year beginning January 1, 2028, and in the
small group market, beginning January 1, 2028, a health carrier must offer the standardized
health plan at a premium rate that is at least 15 percent less than the premium rate for health
plans that the health carrier offered in the individual and small group markets in the 2024
calendar year, as adjusted for medical inflation. The commissioner must calculate the
premium rate reduction based on the rates charged in the same county in which the carrier
offered health plans in the individual and small group markets in 2024.
new text end

new text begin (f) For a health carrier offering the standardized health plan in the 2028 plan year in a
county in which the carrier did not offer a health plan in the individual or small group market
in the 2024 calendar year, the health carrier that offers the standardized health plan must
offer the standardized health plan:
new text end

new text begin (1) in the individual market at a premium that is at least 15 percent less than the average
premium rate for individual health plans offered in that county in 2024, calculated based
on the average premium rate for individual health plans offered in that county, as adjusted
for medical inflation; and
new text end

new text begin (2) in the small group market at a premium rate that is at least 15 percent less than the
average premium rate for small group plans offered in that county in 2024, as adjusted for
medical inflation.
new text end

new text begin (g) For the plan year beginning on or after January 1, 2029, and each year thereafter, a
health carrier must limit any annual percentage increase in the premium rate for the
standardized health plan in both the individual and small group markets to a rate that is no
more than medical inflation, relative to the previous year.
new text end

new text begin Subd. 2. new text end

new text begin Commissions. new text end

new text begin Any commission paid to insurance producers to sell the
standardized health plan must be comparable to the average commission paid to sell other
health plans offered in the individual and small group markets.
new text end

Sec. 5.

new text begin [62E.64] RATE FILINGS; FAILURE TO MEET PREMIUM
REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Filings. new text end

new text begin Each health carrier must file the health carrier's rates for the
standardized health plan at the premium rates required under section 62E.63, in accordance
with the rate filing requirements in section 62A.02.
new text end

new text begin Subd. 2. new text end

new text begin Failure to meet premium rates. new text end

new text begin (a) If a health carrier is unable to offer the
standardized health plan at the premium rate in any year as required under section 62E.63,
the health carrier must notify the commissioner of the reasons why the health carrier is
unable to meet the premium requirements within the following timeline:
new text end

new text begin (1) for premium rates applicable in 2026, by May 1, 2025; and
new text end

new text begin (2) for premium rates applicable in 2027 or any subsequent year, by March 1 of the year
preceding the year in which the premium rates go into effect.
new text end

new text begin (b) If a health carrier notifies the commissioner that the health carrier is unable to offer
the standardized health plan at the premium rate in accordance with paragraph (a), or the
commissioner determines, with support from an independent actuary and based on a review
of the rate and form filings, that a health carrier has not met the premium requirements
under section 62E.63 or the health carrier has not met the network adequacy requirements
specified in section 62E.62, the commissioner must hold a public hearing prior to the approval
of the health carrier's final rates. For purposes of holding a public hearing, the commissioner
must consider that a health carrier has met the network adequacy requirements if the health
carrier files the action plan as required in section 62E.62, subdivision 2, paragraph (c).
new text end

new text begin (c) If a public health hearing is held, the commissioner must provide public notice of
the hearing and must provide the opportunity for all affected parties to offer public testimony
at the public hearing, including health carriers, hospitals, health care providers, consumer
advocacy organizations, and consumers. All affected parties must be given the opportunity
to present evidence regarding the health carrier's ability to meet the premium rate
requirements or meet the network adequacy requirements. The commissioner must limit
the evidence presented at the hearing to information that is related to the reasons the health
carrier failed to meet the premium rate requirements or meet the network adequacy
requirements for the standardized health plan in any single county or service area.
new text end

new text begin (d) The Office of the Insurance Ombudsman established in section 62E.66 must represent
the interests of the consumers at any public hearing held in accordance with this subdivision.
new text end

new text begin (e) For the purpose of making a decision under this subdivision regarding rates, the
commissioner must consider:
new text end

new text begin (1) any actuarial differences between the standardized health plan and the health plans
the health carrier offered in the 2024 calendar year;
new text end

new text begin (2) any changes to the standardized health plan; and
new text end

new text begin (3) any state or federal health benefit coverage mandates implemented after the 2024
plan year.
new text end

new text begin (f) If a health carrier maintains that a hospital or health care provider is responsible for
a health carrier's inability to meet premium rates or network adequacy requirements, the
health carrier must provide the commissioner with reasonable information necessary to
identify which hospitals or health care providers were the cause of the health carrier's failure
to meet the premium rate requirements or meet network adequacy requirements.
new text end

new text begin (g) The commissioner must not use the failure of a health carrier to meet the premium
rate requirements for the standardized health plan in a county as a reason to deny premium
rate for a nonstandardized health plan offered by that health carrier in that county.
new text end

new text begin Subd. 3. new text end

new text begin Setting reimbursement rates. new text end

new text begin (a) The commissioner may, based on the evidence
presented at a hearing held pursuant to subdivision 2 and other available data and actuarial
analysis:
new text end

new text begin (1) establish health carrier reimbursement rates under the standardized health plan for
hospital services, if necessary, to meet network adequacy requirements or premium rate
requirements and require licensed hospitals to accept the reimbursement rates if established
in accordance with this subdivision;
new text end

new text begin (2) establish health carrier reimbursement rates under the standardized health plan, if
necessary, for health care providers for categories of services within the geographic service
area for the standardized health plan and require health care providers to accept the
reimbursement rates established pursuant to this section, if necessary, to ensure the
standardized health plan meets the premium rate requirements or network adequacy
requirements. The commissioner must not require a health care provider, other than a hospital
that provides a majority of covered professional services through a single, contracted medical
group for a health maintenance organization, to contract with any other health carrier; and
new text end

new text begin (3) require the health carrier to offer the standardized health plan in specific counties
where no health carrier is offering the standardized health plan in that plan year in either
the individual or small group market. In determining whether to require the health carrier
to offer the standardized must plan in a specific county, the commissioner shall consider:
new text end

new text begin (i) the health carrier's structure, the number of covered lives the health carrier has in all
lines of business in each county, and the health carrier's existing service area; and
new text end

new text begin (ii) alternative health care coverage available in each county, including health care
cooperatives.
new text end

new text begin (b) The commissioner must only set reimbursement rates pursuant to this section for
hospitals and health care providers that prevent the health carrier from meeting the premium
rate requirements or network adequacy requirements for the standardized health plan being
offered in a specific county or service area.
new text end

new text begin Subd. 4. new text end

new text begin Setting reimbursement rates for hospitals. new text end

new text begin (a) When establishing the
reimbursement rates for hospitals under subdivision 3:
new text end

new text begin (1) the base reimbursement rate for hospital services must be not less than 155 percent
of the hospital's Medicare reimbursement rate or equivalent rate;
new text end

new text begin (2) a hospital that is an essential access hospital or that is independent and not part of a
health system must receive a 20 percentage point increase in the base reimbursement rate;
new text end

new text begin (3) a hospital that is an essential access hospital that is not part of a health system must
receive a 40 percentage point increase in the base reimbursement rate;
new text end

new text begin (4) a hospital that is a pediatric specialty hospital with a level one pediatric trauma center
must receive a 55 percentage point increase in the base reimbursement rate and is not eligible
for additional factors under the subdivision;
new text end

new text begin (5) a hospital with a combined percentage of patients who are enrolled in the medical
assistance program, MinnesotaCare, or Medicare that exceeds the statewide average must
receive up to a 30 percentage point increase in the hospital's base reimbursement rate, with
the actual increase to be determined based on the hospital's percentage share of such patients;
and
new text end

new text begin (6) a hospital that is efficient in managing the underlying cost of care, as determined by
the hospital's total margins, operating costs, and net patient revenue, must receive up to a
40 percentage point increase in its base reimbursement rate.
new text end

new text begin (b) Notwithstanding paragraph (a), clauses (1) to (6), when determining the
reimbursement rates for hospitals, the commissioner may consult with employee membership
organizations representing health care providers' employees and with hospital-based health
care providers and consider the cost of adequate wages, benefits, staffing, and training for
health care employees to provide continuous quality care.
new text end

new text begin Subd. 5. new text end

new text begin Setting reimbursement rates for health care providers. new text end

new text begin When establishing
the reimbursement rates for health care providers under subdivision 3, the rates must not
be less than 135 percent of the Medicare rates within the applicable geographic region for
the same service.
new text end

new text begin Subd. 6. new text end

new text begin Exceptions. new text end

new text begin (a) Notwithstanding subdivision 4, the commissioner must not set
reimbursement rates for:
new text end

new text begin (1) a hospital at less than 165 percent of the Medicare reimbursement rate or the
equivalent rate; and
new text end

new text begin (2) any hospital for any plan year at an amount that is more than 20 percent lower than
the rate negotiated between the health carrier and the hospital for the previous plan year.
new text end

new text begin (b) Notwithstanding subdivision 4, for a hospital with a negotiated reimbursement rate
that is lower than ten percent of the statewide hospital median reimbursement rate measured
as a percentage of Medicare for the 2024 plan year using data from the all-payer claims
database described in section 62U.04, the commissioner must set the reimbursement rate
for that hospital at no less than the greater of:
new text end

new text begin (1) the hospital's commercial reimbursement rate as a percentage of Medicare, minus
one-third of the difference between the hospital's 2024 commercial reimbursement rate as
a percentage of Medicare and the rate established by subdivision 4;
new text end

new text begin (2) 165 percent of the hospital's Medicare reimbursement rate or equivalent rate; or
new text end

new text begin (3) the rate established under subdivision 4.
new text end

new text begin Subd. 7. new text end

new text begin Participation in the standard health plan. new text end

new text begin (a) The commissioner may require
a health care provider, after a hearing pursuant to subdivision 2, to participate in a
standardized health plan network and to accept the reimbursement rate described in
subdivision 5. A health care provider is prohibited from refusing to provide a covered health
care service to a patient solely on the basis that the patient is enrolled in a standardized
health plan.
new text end

new text begin (b) The commissioner may require a licensed hospital, after a hearing pursuant to
subdivision 2, to participate in a standardized health plan. If a hospital is required to
participate in the standardized health plan and refuses to participate, the commissioner must
notify the commissioner of health. If the commissioner of health receives notification from
the commissioner, the commissioner of health must issue a warning to the hospital. If the
hospital refuses to participate in the standardized health plan after receiving the warning,
the commissioner of health:
new text end

new text begin (1) must fine the hospital up to $10,000 per day for the first 30 days that the hospital
refuses to participate and up to $40,000 per day for each day over 30 days that the hospital
refuses to participate; and
new text end

new text begin (2) may suspend or impose conditions on the hospital's license.
new text end

new text begin (c) When determining the appropriate fine or action concerning a hospital's license
pursuant to paragraph (b), the commissioner of health must consider (1) any recommendations
from the commissioner; (2) the hospital's financial circumstances; and (3) other circumstances
deemed relevant by the commissioner of health.
new text end

new text begin Subd. 8. new text end

new text begin Appeal. new text end

new text begin A health carrier, hospital, or health care provider may appeal a decision
by the commissioner made pursuant to this section to the district court in the applicable
jurisdiction. The commissioner's decision is the final agency subject to judicial review
pursuant to chapter 14.
new text end

new text begin Subd. 9. new text end

new text begin Balance billing. new text end

new text begin A hospital or health care provider must not balance bill any
standardized health plan enrollee for services covered by the standardized health plan and
must accept the reimbursement rates established by the commissioner pursuant to subdivision
3 or 4, if applicable for the service provided to the enrollee.
new text end

new text begin Subd. 10. new text end

new text begin Rules. new text end

new text begin The commissioner must adopt rules to ensure there is not an unfair
competitive advantage for a health carrier that intends to offer the standardized health plan
in the individual or small group market in a county where the health carrier has not previously
offered health plans in that market or with a hospital with which the health carrier has not
previously had a contract. The rules must align with the hospital reimbursement
methodologies described in this section.
new text end

Sec. 6.

new text begin [62E.65] MINNESOTA STANDARDIZED HEALTH PLAN ADVISORY
BOARD.
new text end

new text begin Subdivision 1. new text end

new text begin Membership. new text end

new text begin (a) The governor must appoint up to 11 members to the
Minnesota Standardized Health Plan Advisory Board. To the extent possible, the governor
must appoint members who are diverse regarding race, ethnicity, immigration status, age,
sexual orientation, gender identity, and geography. When considering the geographic
diversity of the advisory board the governor must appoint members from both rural and
urban areas of Minnesota.
new text end

new text begin (b) The advisory board membership must consist of at least one member who:
new text end

new text begin (1) has faced barriers to health access due to race, immigration status, or socioeconomic
status;
new text end

new text begin (2) represents consumer advocacy organizations;
new text end

new text begin (3) has expertise in health equity;
new text end

new text begin (4) has expertise in purchasing health benefits for small businesses;
new text end

new text begin (5) represents health carriers or has actuarial experience in designing a health insurance
plan and setting rates;
new text end

new text begin (6) represents hospitals or has experience with negotiating contracts between hospitals
and health carriers;
new text end

new text begin (7) represents health care providers or has experience with negotiating contracts between
health care providers and health carriers;
new text end

new text begin (8) represents an employee organization that represents employees in the health care
industry; and
new text end

new text begin (9) is a licensed physician who is actively practicing in this state or is retired but practiced
in this state.
new text end

new text begin (c) Initial appointments must be made by September 30, 2023.
new text end

new text begin Subd. 2. new text end

new text begin Organization. new text end

new text begin The advisory board must be organized and administered under
section 15.0575.
new text end

new text begin Subd. 3. new text end

new text begin Duties. new text end

new text begin (a) The commissioner must consult with the advisory board in
implementing sections 62E.60 to 62E.70.
new text end

new text begin (b) In addition to consulting with the commissioner, the advisory board may:
new text end

new text begin (1) consider recommendations to streamline prior authorization and utilization
management processes for the standardized health plan;
new text end

new text begin (2) recommend ways to keep health care services in the communities where patients
live; and
new text end

new text begin (3) consider whether alternative payment models may be appropriate for particular
services, considering the impacts alternative payment models have on access to services
and to health outcomes.
new text end

new text begin Subd. 4. new text end

new text begin Technical support. new text end

new text begin The Department of Commerce must provide technical and
administrative support to the advisory board.
new text end

Sec. 7.

new text begin [62E.66] OFFICE OF INSURANCE OMBUDSMAN.
new text end

new text begin (a) The Office of Insurance Ombudsman is created within the Department of Commerce
to act as an advocate for consumer interests in matters related to access to and the
affordability of the standardized health plan. The ombudsman must:
new text end

new text begin (1) interact with consumers regarding access, affordability, and coverage issues relating
to the standardized health plan;
new text end

new text begin (2) evaluate data to assess the standardized health plan's network adequacy and
affordability; and
new text end

new text begin (3) represent the interests of consumers in any public hearing held pursuant to section
62E.64.
new text end

new text begin (b) The ombudsman must act independently of the Department of Commerce. Any
recommendations made or positions taken by the ombudsman do not reflect the
recommendations of positions of the Department of Commerce or the commissioner.
new text end

Sec. 8.

new text begin [62E.67] RULES.
new text end

new text begin The commissioner may adopt rules as necessary to develop, implement, and operate
sections 62E.60 to 62E.70, using the expedited rulemaking process in section 14.389.
new text end

Sec. 9.

new text begin [62E.68] COST SHIFTING.
new text end

new text begin (a) If the administrator of a self-funded health insurance plan voluntarily provides the
commissioner with the plan's contracted rates and any other information deemed necessary
and agreed upon by the plan's administrator and the commissioner, the commissioner may
evaluate whether the rates of the self-funded health insurance plan reflect a cost shift between
the self-funded plan and the standardized health plan offered by a health carrier pursuant
to section 62E.62.
new text end

new text begin (b) If the commissioner, in consultation with the commissioner of health, determines
that there is a cost shift, the commissioner must, to the extent practicable, provide to the
administrator of the self-funded plan a description of which categories of services have
experienced the greatest cost shift.
new text end

Sec. 10.

new text begin [62E.69] REPORTS.
new text end

new text begin (a) The commissioner must contract with an independent third-party organization to
submit three reports regarding the implementation of sections 62E.60 to 62E.70 as it relates
to staffing, wages, benefits, training, and working conditions of hospital workers, to the
extent information is available.
new text end

new text begin (b) When choosing an independent third-party organization, the commissioner must
consider organizations with experience conducting in-person interviews with health care
employers and employees in Minnesota.
new text end

new text begin (c) The independent third-party organization may make policy recommendations related
to information in the report and may include data collected from employers, employees,
and other third-party sources.
new text end

new text begin (d) The independent third party organization must submit the reports required under this
section to the commissioner as follows:
new text end

new text begin (1) the first report by July 1, 2026;
new text end

new text begin (2) the second report by July 1, 2027; and
new text end

new text begin (3) the third report by July 1, 2028.
new text end

Sec. 11.

new text begin [62E.70] STANDARDIZED HEALTH PLAN SURVEY.
new text end

new text begin (a) MNsure, in consultation with the advisory board, must develop and conduct a survey
in collaboration with the commissioner that addresses the experience of consumers who
purchase the standardized health plan. The survey must be completed by January 1, 2029.
new text end

new text begin (b) A summary of the results of the survey must be submitted by the commissioner to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health insurance by April 1, 2029.
new text end

Sec. 12. new text begin MINNESOTA STANDARDIZED HEALTH PLAN FEDERAL WAIVER
REQUEST.
new text end

new text begin (a) The commissioner of commerce, in consultation with the commissioners of health
and human services and the MNsure board, must apply to the secretary of the United States
Department of Health and Human Services for a state innovation waiver, as authorized
under section 1332 of the Affordable Care Act, to waive one or more requirements of the
Affordable Care Act in order to capture all applicable savings to the federal government as
a result of the implementation of the standardized health plan under Minnesota Statutes,
sections 62E.60 to 62E.70.
new text end

new text begin (b) Upon approval of the section 1332 waiver application, the commissioner may use
federal money received through the waiver to implement Minnesota Statutes, sections 62E.60
to 62E.70.
new text end

new text begin (c) The implementation and operation of Minnesota Statutes, section 62E.62, is contingent
on the approval of the section 1332 waiver application and the receipt of federal funds.
new text end