Minnesota Legislature
SF 1208
as introduced - 91st Legislature (2019 - 2020) Posted on 02/14/2019 03:10pm
1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14
1.15
1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 2.1 2.2
2.3
2.4 2.5 2.6 2.7
2.8
2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31
3.1
3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12
3.13
3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31
3.32
4.1 4.2 4.3
4.4
A bill for an act
relating to health care; requiring health maintenance organizations to be nonprofit
corporations; amending Minnesota Statutes 2018, sections 62D.02, subdivision 4;
62D.03, subdivision 1; 62D.05, subdivision 1; 62D.06, subdivision 1; 62D.12, by
adding a subdivision; 62D.19; 62E.02, subdivision 3.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 62D.02, subdivision 4, is amended to read:
Subd. 4.
Health maintenance organization.
"Health maintenance organization" means
a deleted text begin foreign or domesticdeleted text end new text begin nonprofitnew text end corporationnew text begin organized under chapter 317Anew 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2018, 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 begin foreign or domesticdeleted text end new text begin nonprofitnew 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. 3.
Minnesota Statutes 2018, section 62D.05, subdivision 1, is amended to read:
Subdivision 1.
Authority granted.
Any new text begin nonprofit new 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. 4.
Minnesota Statutes 2018, 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 new text begin nonprofit new text end corporation may include
enrollees, providers, or other individuals; provided, however, that after a health maintenance
organization which is a new text begin nonprofit new 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. 5.
Minnesota Statutes 2018, section 62D.12, is amended by adding a subdivision to
read:
new text begin Subd. 8a. new text end
new text begin Net earnings. new text end
new text begin
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.
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. 6.
Minnesota Statutes 2018, 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.30new text begin , in order to
safeguard the underlying nonprofit status of health maintenance organizations,new 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. 7.
Minnesota Statutes 2018, section 62E.02, subdivision 3, is amended to read:
Subd. 3.
Health maintenance organization.
"Health maintenance organization" means
a new text begin nonprofit new 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