SF 1113

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 09/03/2015 02:21pm

A bill for an act
relating to state government; regulating insurance; requiring third-party payer
payments within a certain time limit; requiring third-party payers to include
certain information; establishing a long-term care call center; providing for the
development of a life stage planning insurance product; amending Minnesota
Statutes 2014, sections 62A.045; 256.015, subdivision 7; 256.975, subdivision 8.

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

Section 1.

Minnesota Statutes 2014, section 62A.045, is amended to read:

62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT
HEALTH PROGRAMS.

(a) As a condition of doing business in Minnesota or providing coverage to
residents of Minnesota covered by this section, each health insurer shall comply with the
requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171, including
any federal regulations adopted under that act, to the extent that it imposes a requirement
that applies in this state and that is not also required by the laws of this state. This section
does not require compliance with any provision of the federal act prior to the effective date
provided for that provision in the federal act. The commissioner shall enforce this section.

For the purpose of this section, "health insurer" includes self-insured plans, group
health plans (as defined in section 607(1) of the Employee Retirement Income Security
Act of 1974), service benefit plans, managed care organizations, pharmacy benefit
managers, or other parties that are by contract legally responsible to pay a claim for a
health-care item or service for an individual receiving benefits under paragraph (b).

(b) No plan offered by a health insurer issued or renewed to provide coverage to
a Minnesota resident shall contain any provision denying or reducing benefits because
services are rendered to a person who is eligible for or receiving medical benefits pursuant
to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256;
256B; or 256D or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331,
subdivision 2; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health insurer
providing benefits under plans covered by this section shall use eligibility for medical
programs named in this section as an underwriting guideline or reason for nonacceptance
of the risk.

(c) If payment for covered expenses has been made under state medical programs for
health care items or services provided to an individual, and a third party has a legal liability
to make payments, the rights of payment and appeal of an adverse coverage decision for the
individual, or in the case of a child their responsible relative or caretaker, will be subrogated
to the state agency. The state agency may assert its rights under this section within three
years of the date the service was rendered. For purposes of this section, "state agency"
includes prepaid health plans under contract with the commissioner according to sections
256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; children's mental health
collaboratives under section 245.493; demonstration projects for persons with disabilities
under section 256B.77; nursing homes under the alternative payment demonstration project
under section 256B.434; and county-based purchasing entities under section 256B.692.

(d) Notwithstanding any law to the contrary, when a person covered by a plan
offered by a health insurer receives medical benefits according to any statute listed in this
section, payment for covered services or notice of denial for services billed by the provider
must be issued directly to the provider. If a person was receiving medical benefits through
the Department of Human Services at the time a service was provided, the provider must
indicate this benefit coverage on any claim forms submitted by the provider to the health
insurer for those services. If the commissioner of human services notifies the health
insurer that the commissioner has made payments to the provider, payment for benefits or
notices of denials issued by the health insurer must be issued directly to the commissioner.
Submission by the department to the health insurer of the claim on a Department of
Human Services claim form is proper notice and shall be considered proof of payment of
the claim to the provider and supersedes any contract requirements of the health insurer
relating to the form of submission. Liability to the insured for coverage is satisfied to the
extent that payments for those benefits are made by the health insurer to the provider or
the commissioner as required by this section.

(e) When a state agency has acquired the rights of an individual eligible for medical
programs named in this section and has health benefits coverage through a health insurer,
the health insurer shall not impose requirements that are different from requirements
applicable to an agent or assignee of any other individual covered.

new text begin
(f) A health insurer must process a claim made by a state agency for covered
expenses paid under state medical programs within 90 business days of the claim's
submission. If the health insurer needs additional information to process the claim,
the health insurer may be granted an additional 30 business days to process the claim,
provided the health insurer submits the request for additional information to the state
agency within 30 business days after the health insurer received the claim.
new text end

new text begin (g) A health insurer may request a refund of a claim paid in error to the Department
of Human Services within two years of the date the payment was made to the department.
A request for a refund shall not be honored by the department if the health insurer makes
the request after the time period has lapsed.
new text end

Sec. 2.

Minnesota Statutes 2014, section 256.015, subdivision 7, is amended to read:

Subd. 7.

Cooperation with information requests required.

(a) Upon the request
of the commissioner of human services:

(1) any state agency or third-party payer shall cooperate by furnishing information to
help establish a third-party liability, as required by the federal Deficit Reduction Act of
2005, Public Law 109-171;

(2) any employer or third-party payer shall cooperate by furnishing a data file
containing information about group health insurance plan or medical benefit plan coverage
of its employees or insureds within 60 days of the request. new text begin The information in the data
file must include at least the following: full name, date of birth, Social Security number
if collected by the employer or third-party payer, employer name, policy identification
number, group identification number, and plan or coverage type.
new text end

(b) For purposes of section 176.191, subdivision 4, the commissioner of labor and
industry may allow the commissioner of human services and county agencies direct access
and data matching on information relating to workers' compensation claims in order to
determine whether the claimant has reported the fact of a pending claim and the amount
paid to or on behalf of the claimant to the commissioner of human services.

(c) For the purpose of compliance with section 169.09, subdivision 13, and
federal requirements under Code of Federal Regulations, title 42, section 433.138
(d)(4), the commissioner of public safety shall provide accident data as requested by
the commissioner of human services. The disclosure shall not violate section 169.09,
subdivision 13, paragraph (d).

(d) The commissioner of human services and county agencies shall limit its use of
information gained from agencies, third-party payers, and employers to purposes directly
connected with the administration of its public assistance and child support programs. The
provision of information by agencies, third-party payers, and employers to the department
under this subdivision is not a violation of any right of confidentiality or data privacy.

Sec. 3.

Minnesota Statutes 2014, section 256.975, subdivision 8, is amended to read:

Subd. 8.

deleted text begin Promotion of deleted text end new text begin Establish new text end long-term care deleted text begin insurance deleted text end new text begin call center new text end .

Within
the limits of appropriations specifically for this purpose, the Minnesota Board on Aging,
deleted text begin either directly or deleted text end through deleted text begin contract, deleted text end new text begin its Senior LinkAge Line established under section
256.975, subdivision 7, new text end shall deleted text begin promote the provision of employer-sponsored, deleted text end new text begin establish
a long-term care call center that promotes planning for long-term care and provides
information about new text end long-term care insurance new text begin , other long-term care financing options, and
resources that support Minnesotans as they age or have more long-term chronic care
needs new text end . The board shall deleted text begin encourage private and public sector employers to make long-term
care insurance available to employees, provide interested employers with information
on the long-term care insurance product offered to state employees, and provide deleted text end new text begin work
with a variety of stakeholders, including employers, insurance providers, brokers, or
other sellers of products and consumers to develop the call center. The board shall seek
new text end technical assistance deleted text begin to employers in designing long-term care insurance products and
contacting companies offering long-term care insurance products deleted text end new text begin from the commissioner
for implementation of the call center new text end .

Sec. 4. new text begin DEVELOPMENT OF LONG-TERM CARE, LIFE STAGE PLANNING
INSURANCE PRODUCT.
new text end

new text begin The commissioner of human services, in consultation with members of the Own
Your Future Advisory Council, the commissioner of commerce, and other stakeholders
shall conduct research on the feasibility of creating a life stage planning insurance
product that merges term life insurance with long-term care insurance coverage. The
commissioner shall:
new text end

new text begin (1) conduct product evaluation research with consumers;
new text end

new text begin (2) conduct an actuarial analysis to evaluate likely levels for insurer pricing for the
product;
new text end

new text begin (3) meet with insurance carriers to determine interest in pursuing the product;
new text end

new text begin (4) identify specific state laws and regulations that may need to be amended to
make the product available; and
new text end

new text begin (5) develop one or more pilot programs to market test the product.
new text end