SF 1473

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:21am

A bill for an act
relating to health care reform; increasing affordability and eligibility for state
health care programs; establishing the Minnesota Health Insurance Exchange;
continuing payment reform; creating an affordability standard; establishing
goals for universal coverage and a contingent individual responsibility mandate;
amending Minnesota Statutes 2008, sections 13.46, subdivision 2; 62E.141;
62L.12, subdivisions 2, 4; 62U.04, subdivisions 3, 8; 62U.05; 62U.07, by
adding a subdivision; 62U.08, subdivision 2; 256.01, by adding a subdivision;
256B.056, subdivision 10; 256B.057, subdivision 8; 256L.03, subdivisions 3,
5; 256L.04, subdivisions 1, 7; 256L.05, by adding a subdivision; 256L.07,
subdivisions 1, 3; 256L.15, by adding a subdivision; proposing coding for new
law in Minnesota Statutes, chapter 62U.

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

Section 1.

Minnesota Statutes 2008, section 13.46, subdivision 2, is amended to read:

Subd. 2.

General.

(a) Unless the data is summary data or a statute specifically
provides a different classification, data on individuals collected, maintained, used, or
disseminated by the welfare system is private data on individuals, and shall not be
disclosed except:

(1) according to section 13.05;

(2) according to court order;

(3) according to a statute specifically authorizing access to the private data;

(4) to an agent of the welfare system, including a law enforcement person, attorney,
or investigator acting for it in the investigation or prosecution of a criminal or civil
proceeding relating to the administration of a program;

(5) to personnel of the welfare system who require the data to verify an individual's
identity; determine eligibility, amount of assistance, and the need to provide services to
an individual or family across programs; evaluate the effectiveness of programs; assess
parental contribution amounts; and investigate suspected fraud;

(6) to administer federal funds or programs;

(7) between personnel of the welfare system working in the same program;

(8) to the Department of Revenue to assess parental contribution amounts for
purposes of section 252.27, subdivision 2a, administer and evaluate tax refund or tax credit
programs and to identify individuals who may benefit from these programs. The following
information may be disclosed under this paragraph: an individual's and their dependent's
names, dates of birth, Social Security numbers, income, addresses, and other data as
required, upon request by the Department of Revenue. Disclosures by the commissioner
of revenue to the commissioner of human services for the purposes described in this clause
are governed by section 270B.14, subdivision 1. Tax refund or tax credit programs include,
but are not limited to, the dependent care credit under section 290.067, the Minnesota
working family credit under section 290.0671, the property tax refund and rental credit
under section 290A.04, and the Minnesota education credit under section 290.0674;

(9) between the Department of Human Services, the Department of Employment
and Economic Development, and when applicable, the Department of Education, for
the following purposes:

(i) to monitor the eligibility of the data subject for unemployment benefits, for any
employment or training program administered, supervised, or certified by that agency;

(ii) to administer any rehabilitation program or child care assistance program,
whether alone or in conjunction with the welfare system;

(iii) to monitor and evaluate the Minnesota family investment program or the child
care assistance program by exchanging data on recipients and former recipients of food
support, cash assistance under chapter 256, 256D, 256J, or 256K, child care assistance
under chapter 119B, or medical programs under chapter 256B, 256D, or 256L; and

(iv) to analyze public assistance employment services and program utilization,
cost, effectiveness, and outcomes as implemented under the authority established in Title
II, Sections 201-204 of the Ticket to Work and Work Incentives Improvement Act of
1999. Health records governed by sections 144.291 to 144.298 and "protected health
information" as defined in Code of Federal Regulations, title 45, section 160.103, and
governed by Code of Federal Regulations, title 45, parts 160-164, including health care
claims utilization information, must not be exchanged under this clause;

(10) to appropriate parties in connection with an emergency if knowledge of
the information is necessary to protect the health or safety of the individual or other
individuals or persons;

(11) data maintained by residential programs as defined in section 245A.02 may
be disclosed to the protection and advocacy system established in this state according
to Part C of Public Law 98-527 to protect the legal and human rights of persons with
developmental disabilities or other related conditions who live in residential facilities for
these persons if the protection and advocacy system receives a complaint by or on behalf
of that person and the person does not have a legal guardian or the state or a designee of
the state is the legal guardian of the person;

(12) to the county medical examiner or the county coroner for identifying or locating
relatives or friends of a deceased person;

(13) data on a child support obligor who makes payments to the public agency
may be disclosed to the Minnesota Office of Higher Education to the extent necessary to
determine eligibility under section 136A.121, subdivision 2, clause (5);

(14) participant Social Security numbers and names collected by the telephone
assistance program may be disclosed to the Department of Revenue to conduct an
electronic data match with the property tax refund database to determine eligibility under
section 237.70, subdivision 4a;

(15) the current address of a Minnesota family investment program participant
may be disclosed to law enforcement officers who provide the name of the participant
and notify the agency that:

(i) the participant:

(A) is a fugitive felon fleeing to avoid prosecution, or custody or confinement after
conviction, for a crime or attempt to commit a crime that is a felony under the laws of the
jurisdiction from which the individual is fleeing; or

(B) is violating a condition of probation or parole imposed under state or federal law;

(ii) the location or apprehension of the felon is within the law enforcement officer's
official duties; and

(iii) the request is made in writing and in the proper exercise of those duties;

(16) the current address of a recipient of general assistance or general assistance
medical care may be disclosed to probation officers and corrections agents who are
supervising the recipient and to law enforcement officers who are investigating the
recipient in connection with a felony level offense;

(17) information obtained from food support applicant or recipient households may
be disclosed to local, state, or federal law enforcement officials, upon their written request,
for the purpose of investigating an alleged violation of the Food Stamp Act, according
to Code of Federal Regulations, title 7, section 272.1(c);

(18) the address, Social Security number, and, if available, photograph of any
member of a household receiving food support shall be made available, on request, to a
local, state, or federal law enforcement officer if the officer furnishes the agency with the
name of the member and notifies the agency that:

(i) the member:

(A) is fleeing to avoid prosecution, or custody or confinement after conviction, for a
crime or attempt to commit a crime that is a felony in the jurisdiction the member is fleeing;

(B) is violating a condition of probation or parole imposed under state or federal
law; or

(C) has information that is necessary for the officer to conduct an official duty related
to conduct described in subitem (A) or (B);

(ii) locating or apprehending the member is within the officer's official duties; and

(iii) the request is made in writing and in the proper exercise of the officer's official
duty;

(19) the current address of a recipient of Minnesota family investment program,
general assistance, general assistance medical care, or food support may be disclosed to
law enforcement officers who, in writing, provide the name of the recipient and notify the
agency that the recipient is a person required to register under section 243.166, but is not
residing at the address at which the recipient is registered under section 243.166;

(20) certain information regarding child support obligors who are in arrears may be
made public according to section 518A.74;

(21) data on child support payments made by a child support obligor and data on
the distribution of those payments excluding identifying information on obligees may be
disclosed to all obligees to whom the obligor owes support, and data on the enforcement
actions undertaken by the public authority, the status of those actions, and data on the
income of the obligor or obligee may be disclosed to the other party;

(22) data in the work reporting system may be disclosed under section 256.998,
subdivision 7;

(23) to the Department of Education for the purpose of matching Department of
Education student data with public assistance data to determine students eligible for free
and reduced-price meals, meal supplements, and free milk according to United States
Code, title 42, sections 1758, 1761, 1766, 1766a, 1772, and 1773; to allocate federal and
state funds that are distributed based on income of the student's family; and to verify
receipt of energy assistance for the telephone assistance plan;

(24) the current address and telephone number of program recipients and emergency
contacts may be released to the commissioner of health or a local board of health as
defined in section 145A.02, subdivision 2, when the commissioner or local board of health
has reason to believe that a program recipient is a disease case, carrier, suspect case, or at
risk of illness, and the data are necessary to locate the person;

(25) to other state agencies, statewide systems, and political subdivisions of this
state, including the attorney general, and agencies of other states, interstate information
networks, federal agencies, and other entities as required by federal regulation or law for
the administration of the child support enforcement program;

(26) to personnel of public assistance programs as defined in section 256.741, for
access to the child support system database for the purpose of administration, including
monitoring and evaluation of those public assistance programs;

(27) to monitor and evaluate the Minnesota family investment program by
exchanging data between the Departments of Human Services and Education, on
recipients and former recipients of food support, cash assistance under chapter 256, 256D,
256J, or 256K, child care assistance under chapter 119B, or medical programs under
chapter 256B, 256D, or 256L;

(28) to evaluate child support program performance and to identify and prevent
fraud in the child support program by exchanging data between the Department of Human
Services, Department of Revenue under section 270B.14, subdivision 1, paragraphs (a)
and (b), without regard to the limitation of use in paragraph (c), Department of Health,
Department of Employment and Economic Development, and other state agencies as is
reasonably necessary to perform these functions; deleted text begin or
deleted text end

(29) counties operating child care assistance programs under chapter 119B may
disseminate data on program participants, applicants, and providers to the commissioner
of education new text begin ; or
new text end

new text begin (30) according to section 256.01, subdivision 27, between the welfare system and the
Minnesota Health Insurance Exchange under section 62U.11, in order to collect premiums
from individuals in the medical assistance employed persons with disabilities program
and the MinnesotaCare program under chapters 256B and 256L, and to administer the
individual's and the individual's family's participation in the exchange new text end .

(b) Information on persons who have been treated for drug or alcohol abuse may
only be disclosed according to the requirements of Code of Federal Regulations, title
42, sections 2.1 to 2.67.

(c) Data provided to law enforcement agencies under paragraph (a), clause (15),
(16), (17), or (18), or paragraph (b), are investigative data and are confidential or protected
nonpublic while the investigation is active. The data are private after the investigation
becomes inactive under section 13.82, subdivision 5, paragraph (a) or (b).

(d) Mental health data shall be treated as provided in subdivisions 7, 8, and 9, but is
not subject to the access provisions of subdivision 10, paragraph (b).

For the purposes of this subdivision, a request will be deemed to be made in writing
if made through a computer interface system.

Sec. 2.

Minnesota Statutes 2008, section 62E.141, is amended to read:

62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.

No employee of an employer that offers a new text begin group new text end health plan, under which the
employee is eligible for coverage, is eligible to enroll, or continue to be enrolled, in
the Comprehensive Health Association, except for enrollment or continued enrollment
necessary to cover conditions that are subject to an unexpired preexisting condition
limitation, preexisting condition exclusion, or exclusionary rider under the employer's
new text begin group new text end health plan. This section does not apply to persons enrolled in the Comprehensive
Health Association as of June 30, 1993. With respect to persons eligible to enroll in the
new text begin group new text end health plan of an employer that has more than 29 current employees, as defined
in section 62L.02, this section does not apply to persons enrolled in the Comprehensive
Health Association as of December 31, 1994.

Sec. 3.

Minnesota Statutes 2008, section 62L.12, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

(a) A health carrier may sell, issue, or 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 sell, issue, or 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 sell, issue, or renew conversion policies under section
62E.16 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) Nothing in this subdivision relieves a health carrier of any obligation to provide
continuation or conversion coverage otherwise required under federal or state law.

(h) 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.

(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual
health plans necessary to comply with a court order.

(j) 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.

(k) 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 new text begin to
all employees or through the Minnesota Health Insurance Exchange under section 62U.11 new text end
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. new text begin
Except as provided in section 62U.07, subdivision 5, paragraph (b), new text end 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 new text begin or to the Minnesota Health Insurance Exchange under section 62U.11 new text end .
Except for coverage under section 62A.65, subdivision 5, paragraph (b), or 62E.16, at the
request of an employee, the health carrier new text begin or the Minnesota Health Insurance Exchange
under section 62U.11 new text end 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 new text begin or the Minnesota Health Insurance Exchange, as applicable, new text end 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.

The employer must provide a written and signed statement to the health carrier new text begin or
the Minnesota Health Insurance Exchange, as applicable, stating new text end that the employer is not
contributing directly or indirectly to the employee's premiums. new text begin The Minnesota Health
Insurance Exchange under section 62U.11 shall provide health carriers with enrolled
employees of the employer a copy of the employer's statement. new text end The health carrier may
rely on the employer's statement and is not required to guarantee-issue individual health
plans to the employer's deleted text begin other current or future deleted text end employees new text begin , except as required under section
62U.07, subdivision 5, paragraph (b) new text end .

Sec. 4.

Minnesota Statutes 2008, section 62L.12, subdivision 4, is amended to read:

Subd. 4.

Employer prohibition.

A small employer new text begin offering a health benefit plan new text end
shall not encourage or direct an employee or applicant to:

(1) refrain from filing an application for health coverage when other similarly
situated employees may file an application for health coverage;

(2) file an application for health coverage during initial eligibility for coverage,
the acceptance of which is contingent on health status, when other similarly situated
employees may apply for health coverage, the acceptance of which is not contingent on
health status;

(3) seek coverage from another health carrier, including, but not limited to, MCHA;
or

(4) cause coverage to be issued on different terms because of the health status or
claims experience of that person or the person's dependents.

Sec. 5.

Minnesota Statutes 2008, section 62U.04, subdivision 3, is amended to read:

Subd. 3.

Provider peer grouping.

(a) The commissioner shall develop a peer
grouping system for providers based on a combined measure that incorporates both
provider risk-adjusted new text begin total new text end cost of care and quality of care, and for specific conditions
as determined by the commissioner. In developing this system, the commissioner shall
consult and coordinate with health care providers, health plan companies, state agencies,
and organizations that work to improve health care quality in Minnesota. For purposes of
the final establishment of the peer grouping system, the commissioner shall not contract
with any private entity, organization, or consortium of entities that has or will have a direct
financial interest in the outcome of the system.

(b) Beginning June 1, 2010, the commissioner shall disseminate information to
providers on their cost of care, resource use, quality of care, and the results of the grouping
developed under this subdivision in comparison to an appropriate peer group. Any
analyses or reports that identify providers may only be published after the provider has
been provided the opportunity by the commissioner to review the underlying data and
submit comments. The provider shall have 21 days to review the data for accuracy.

(c) The commissioner shall establish an appeals process to resolve disputes from
providers regarding the accuracy of the data used to develop analyses or reports.

(d) Beginning September 1, 2010, the commissioner shall, no less than annually,
publish information on providers' cost, quality, and the results of the peer grouping
process. The results that are published must be on a risk-adjusted basis.

Sec. 6.

Minnesota Statutes 2008, section 62U.04, subdivision 8, is amended to read:

Subd. 8.

Provider innovation to reduce health care costs and improve quality.

(a) Nothing in this section shall prohibit group purchasers and health care providers,
upon mutual agreement, from entering into arrangements that establish package prices
for a comprehensive set of services or separately for the cost of care for specific health
conditions in addition to the deleted text begin baskets of care established in deleted text end new text begin package prices established
under new text end section 62U.05, in order to give providers the flexibility to innovate on ways to
reduce health care costs while improving overall quality of care and health outcomes.

(b) The commissioner of health may convene working groups of private sector
payers and health care providers to discuss and develop new strategies for reforming
health care payment systems to promote innovative care delivery that reduces health
care costs and improves quality.

Sec. 7.

Minnesota Statutes 2008, section 62U.05, is amended to read:

62U.05 PROVIDER PRICING FOR BASKETS OF CARE new text begin AND TOTAL
COST OF CARE new text end .

Subdivision 1.

Establishment of definitions.

(a) By July 1, 2009, the commissioner
of health shall establish uniform definitions for baskets of care beginning with a minimum
of seven baskets of care. In selecting health conditions for which baskets of care should
be defined, the commissioner shall consider coronary artery and heart disease, diabetes,
asthma, and depression. In selecting health conditions, the commissioner shall also
consider the prevalence of the health conditions, the cost of treating the health conditions,
and the potential for innovations to reduce cost and improve quality.

(b) The commissioner shall convene one or more work groups to assist in
establishing these definitions. Each work group shall include members appointed by
statewide associations representing relevant health care providers and health plan
companies, and organizations that work to improve health care quality in Minnesota.

(c) To the extent possible, the baskets of care new text begin and the total cost of care as specified
under paragraph (d) new text end must incorporate a patient-directed, decision-making support model.

new text begin (d) By July 1, 2010, the commissioner shall establish uniform definitions for the
total cost of providing all necessary services to a patient, and shall develop a standard
method and format for providers to use for submitting package prices for the total cost of
care. This method shall be published in the State Register and must be made available to
all providers.
new text end

Subd. 2.

Package prices.

(a) Beginning January 1, 2010, health care providers
may establish package prices for the baskets of care defined under subdivision 1. new text begin By
January 1, 2011, health care providers may establish package prices for the total cost of
care defined under subdivision 1.
new text end

(b) Beginning January 1, 2010, no health care provider or group of providers that
has established a package price for a basket of care under this section new text begin , and beginning
January 1, 2011, no health care provider or group of providers that has established a
package price for the total cost of care under this section new text end shall vary the payment amount
that the provider accepts as full payment for a health care service based upon the identity
of the payer, upon a contractual relationship with a payer, upon the identity of the patient,
or upon whether the patient has coverage through a group purchaser. This paragraph
applies only to health care services provided to Minnesota residents or to non-Minnesota
residents who obtain health insurance through a Minnesota employer. This paragraph does
not apply to services paid for by Medicare, state public health care programs through
fee-for-service or prepaid arrangements, workers' compensation, or no-fault automobile
insurance. This paragraph does not affect the right of a provider to provide charity care
or care for a reduced price due to financial hardship of the patient or due to the patient
being a relative or friend of the provider.

Subd. 3.

Quality measurements for baskets of care.

(a) The commissioner shall
establish quality measurements for the defined baskets of care by December 31, 2009. new text begin The
commissioner shall establish quality measures for the total cost of care by December 31,
2010. new text end The commissioner may contract with an organization that works to improve health
care quality to make recommendations about the use of existing measures or establishing
new measures where no measures currently exist.

(b) Beginning July 1, 2010, the commissioner or the commissioner's designee shall
publish comparative price and quality information on the baskets of care in a manner
that is easily accessible and understandable to the public, as this information becomes
available. new text begin Beginning July 1, 2011, the commissioner or the commissioner's designee shall
publish comparative price and quality information on total cost of care in a manner that is
easily accessible and understandable to the public, as this information becomes available.
new text end

Sec. 8.

Minnesota Statutes 2008, section 62U.07, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Health plan company requirements. new text end

new text begin (a) Individuals who are eligible
to use an employer Section 125 Plan may use it to pay for an individual market health
plan for which the individual is eligible and purchase it through the exchange, including
an individual market health plan, MinnesotaCare, and the Minnesota Comprehensive
Health Association.
new text end

new text begin (b) Individuals who purchase an individual market health plan through a Section 125
Plan may purchase coverage on a guaranteed issue basis during an annual open enrollment
period that coincides with the open enrollment period for the employer's Section 125 Plan
or upon experiencing a qualifying event as defined in United States Code, title 43, section
4980B. Nothing in this section precludes a health plan company from issuing coverage
with preexisting condition limitations allowed elsewhere in law. Health plans may not
charge higher or lower premiums based on health status for individuals who purchase
coverage on a guaranteed issue basis under this section, except for variations in premium
that are allowable based on tobacco use.
new text end

Sec. 9.

Minnesota Statutes 2008, section 62U.08, subdivision 2, is amended to read:

Subd. 2.

Duties.

new text begin (a) new text end By October 15, 2009, the work group shall develop and submit
to the commissioner an initial essential benefit set and design that includes coverage
for a broad range of services, is based on scientific evidence that services are clinically
effective and cost-effective, and provides lower enrollee cost sharing for services that
have been determined to be cost-effective. The benefit set must include necessary
evidence-based health care services, procedures, diagnostic tests, and technologies that
are scientifically proven to be both clinically effective and cost-effective. In developing
its recommendations, the work group may consult with the Institute for Clinical Systems
Improvement (ICSI) to assemble existing scientifically based practice standards.

new text begin (b) The benefit set and design must be used as a minimum requirement for health
plans offered through the Minnesota Health Insurance Exchange established under
section 62U.11. The benefit set and design must include a limited number of maximum
cost-sharing variations based upon deductibles and maximum out-of-pocket costs. There
must be no maximum lifetime benefit.
new text end

new text begin (c) The commissioner shall review the benefit set and design on an ongoing periodic
basis and shall adjust the benefit set and design as necessary, to ensure that the benefit set
and design continues to be safe, effective, and scientifically based.
new text end

Sec. 10.

new text begin [62U.11] MINNESOTA HEALTH INSURANCE EXCHANGE.
new text end

new text begin Subdivision 1. new text end

new text begin Title; citation. new text end

new text begin This section may be cited as the "Minnesota Health
Insurance Exchange."
new text end

new text begin Subd. 2. new text end

new text begin Creation; tax exemption. new text end

new text begin The Minnesota Health Insurance Exchange
is created for the limited purpose of providing individuals with greater access, choice,
portability, and affordability of health insurance products. The Minnesota Health
Insurance Exchange is created as an unincorporated association and shall promptly
incorporate as a nonprofit corporation under chapter 317A and apply for qualification
under section 501(c) of the Internal Revenue Code.
new text end

new text begin Subd. 3. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have the
meanings given them.
new text end

new text begin (a) "Board" means the Board of Directors of the Minnesota Health Insurance
Exchange under subdivision 13.
new text end

new text begin (b) "Commissioner" means:
new text end

new text begin (1) the commissioner of commerce for health plan companies subject to the
jurisdiction of the Department of Commerce;
new text end

new text begin (2) the commissioner of health for health plan companies subject to the jurisdiction
of the Department of Health; or
new text end

new text begin (3) either commissioner's designated representative.
new text end

new text begin (c) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996.
new text end

new text begin (d) "Individual market health plan" means a health plan as defined in section
62A.011, that is designed for sale in the individual market and that may cover either an
individual or an individual and the individual's dependents.
new text end

new text begin (e) "Small employer" means a small employer as defined in section 62L.02,
subdivision 26.
new text end

new text begin (f) "Small employer health benefit plan" means a health benefit plan as defined in
section 62L.02, subdivision 15.
new text end

new text begin Subd. 4. new text end

new text begin Health plan company and health plan participation and availability.
new text end

new text begin (a) Only individual market health plans and small employer health benefit plans offered by
a health plan company licensed to issue health plans in Minnesota may be made available
for purchase through the exchange.
new text end

new text begin (b) Each health plan made available by a health plan company through the exchange
must meet the essential benefit set and design requirements provided under section 62U.08.
new text end

new text begin (c) Any health plan company that issues health plans in the individual or small
employer market in this state must offer through the exchange at least one health plan that
meets the benefit set and design established under section 62U.08.
new text end

new text begin (d) Health plans offered through the Minnesota Comprehensive Health Association
as defined in section 62E.10 must be available for sale through the exchange as determined
by the Minnesota Comprehensive Health Association.
new text end

new text begin (e) Health plans offered through the MinnesotaCare program must be available
through the exchange to individuals and families who meet the eligibility requirements
for MinnesotaCare, as determined by the commissioner of human services, and who pay
premiums through an employer Section 125 Plan.
new text end

new text begin (f) Nothing in this section restricts the sale of individual market health plans and
small employer health benefit plans outside of the exchange. The requirements applicable
to issuance, renewal, cancellation, and pricing of coverage are the same for health plans
purchased inside and outside the exchange, except as described under section 62U.07,
subdivision 5, paragraph (b).
new text end

new text begin Subd. 5. new text end

new text begin Comparison of health plans. new text end

new text begin The exchange shall help consumers
understand and compare the standardized health plan options established under section
62U.08. Within each standardized plan grouping, the exchange shall provide easy ways
for consumers to select among the offerings by comparing quality ratings, searching for
a particular provider in its network, or by cost factors. This information must be made
available via the Internet as well as by toll-free telephone assistance and written materials.
new text end

new text begin Subd. 6. new text end

new text begin Individual participation and eligibility. new text end

new text begin (a) Individuals are eligible to
purchase health plans directly through the exchange or through an employer Section
125 Plan under section 62U.07.
new text end

new text begin (b) Nothing in this section requires guaranteed issue of individual market health
plans offered through the exchange except as provided under section 62U.07, subdivision
5, paragraph (b).
new text end

new text begin (c) Individuals are eligible to purchase individual market health plans through the
exchange by meeting one or more of the following qualifications:
new text end

new text begin (1) the individual is a Minnesota resident, meaning the individual is physically
residing on a permanent basis in a place in this state that is the person's principal residence
and from which the person is absent only for temporary purposes;
new text end

new text begin (2) the individual is a student attending an institution outside of Minnesota and
maintains Minnesota residency;
new text end

new text begin (3) the individual is not a Minnesota resident but is employed by an employer
physically located within the state and the individual's employer is required to offer a
Section 125 Plan under section 62U.07; or
new text end

new text begin (4) the individual is a dependent, as defined in section 62L.02, of another individual
who is eligible to participate in the exchange.
new text end

new text begin (d) A self-employed individual, including a partner of a partnership, a member of
a limited liability company, or other owner of a business, who may not be eligible to
participate in a Section 125 plan, may obtain coverage through the exchange either as an
individual under paragraph (c) or as an employee covered under a small employer health
benefit plan if permitted under chapter 62L.
new text end

new text begin Subd. 7. new text end

new text begin Small employer participation and eligibility. new text end

new text begin Small employers, as
defined in section 62L.02, may purchase small employer health benefit plans through
the exchange.
new text end

new text begin Subd. 8. new text end

new text begin Responsibilities of exchange. new text end

new text begin The exchange may serve as a coordinating
entity for enrollment and collection and transfer of premium payments for health plans
sold to individuals and small employers through the exchange. The exchange must be
responsible for the following functions:
new text end

new text begin (1) publicizing the exchange including, but not limited to, its functions, eligibility
rules, and enrollment procedures;
new text end

new text begin (2) providing assistance to employers to establish Section 125 Plans under section
62U.07;
new text end

new text begin (3) providing education and assistance to employers to help them understand the
requirements of Section 125 Plans and compliance with applicable regulations;
new text end

new text begin (4) creating a system to allow individuals to compare and enroll in health plans
offered through the exchange, including a system of comparative rating of health plans
and benefit sets;
new text end

new text begin (5) creating a system to collect and transmit to the applicable health plan companies
all premium payments made by individuals and small employers, including developing
mechanisms to receive and process automatic payroll deductions for individuals who
purchase coverage through employer Section 125 Plans;
new text end

new text begin (6) for participating employers, billing the employer for the premiums payable by
the employer for a small employer health benefit plan;
new text end

new text begin (7) for individuals purchasing individual market health plans through a Section 125
Plan, billing the individual's employer for premiums payable by the employee, provided
that the employer is not liable for payment except from payroll deductions for that purpose;
new text end

new text begin (8) providing information on public insurance programs to individuals who may
qualify for these programs, and provide application assistance if needed on applying
for these programs;
new text end

new text begin (9) establishing a mechanism with the Department of Human Services to transfer
premiums paid by Minnesota health care program enrollees from Section 125 Plans;
new text end

new text begin (10) establishing procedures to account for all funds received and disbursed by
the exchange; and
new text end

new text begin (11) making available to the public, within 90 days after the end of each fiscal year, a
report of an independent audit of the exchange's accounts.
new text end

new text begin Subd. 9. new text end

new text begin State not liable. new text end

new text begin The state is not liable for the actions of the exchange.
new text end

new text begin Subd. 10. new text end

new text begin Powers of exchange. new text end

new text begin The exchange shall have the power to:
new text end

new text begin (1) contract with insurance producers licensed in accident and health insurance
under chapter 60K and vendors to perform one or more of the functions in subdivision 8;
new text end

new text begin (2) contract with employers to collect premiums for small employer health benefit
plans and for individual market health plans purchased through a Section 125 Plan;
new text end

new text begin (3) establish and assess fees on health plan premiums of small employer health
benefit plans and individual market health plans to fund the cost of administering the
exchange;
new text end

new text begin (4) seek and directly receive grant funding from government agencies or private
philanthropic organizations, other than those connected with Minnesota-based nonprofit
health providers or health plan companies, to defray the costs of operating the exchange;
new text end

new text begin (5) establish and administer rules and procedures governing the operations of the
exchange;
new text end

new text begin (6) establish one or more service centers within Minnesota;
new text end

new text begin (7) sue or be sued or otherwise take any necessary or proper legal action;
new text end

new text begin (8) establish bank accounts and borrow money; and
new text end

new text begin (9) enter into agreements with the commissioners of commerce, health, human
services, revenue, employment and economic development, and other state agencies as
necessary for the exchange to implement the provisions of this section.
new text end

new text begin Subd. 11. new text end

new text begin Dispute resolution. new text end

new text begin The exchange shall establish procedures for
resolving disputes with respect to the eligibility of an individual to participate in the
exchange. The exchange shall not have the authority or responsibility to intervene in or
resolve disputes between an individual and a health plan or health plan company. If the
exchange receives complaints involving such disputes from individuals participating in
the exchange, the exchange shall inform the individual about the right to make such
complaints to the commissioner to be resolved according to sections 62Q.68 to 62Q.73.
new text end

new text begin Subd. 12. new text end

new text begin Governance. new text end

new text begin The exchange shall be governed by a board of directors
with 11 members. The board shall convene on or before July 1, 2009, after the initial board
members have been selected. The initial board membership consists of the following:
new text end

new text begin (1) the commissioner of commerce;
new text end

new text begin (2) the commissioner of human services;
new text end

new text begin (3) the commissioner of health; and
new text end

new text begin (4) eight members with knowledge and experience related to health insurance
and health insurance markets, appointed to serve three-year terms as follows: two
nonlegislators appointed by the Subcommittee on Committees of the Committee on Rules
and Administration of the senate; two nonlegislators appointed by the speaker of the
house; and four members appointed by the governor.
new text end

new text begin Subd. 13. new text end

new text begin Subsequent board membership. new text end

new text begin (a) Effective July 1, 2012, ongoing
membership of the exchange consists of the following:
new text end

new text begin (1) the commissioner of commerce;
new text end

new text begin (2) the commissioner of human services;
new text end

new text begin (3) the commissioner of health;
new text end

new text begin (4) two members appointed as follows: one nonlegislator appointed by the
Subcommittee on Committees of the Committee on Rules and Administration of the senate
and one nonlegislator appointed by the speaker of the house to serve two-year terms.
These appointed members are eligible to be reappointed for one additional term; and
new text end

new text begin (5) four members elected by the membership of the exchange, of which two are
elected to serve a two-year term and two are elected to serve a three-year term.
new text end

new text begin (b) Elected members may serve more than one term. At least one of the elected
members must represent a small employer and at least one member must be a person who
purchases an individual market health plan through the exchange.
new text end

new text begin Subd. 14. new text end

new text begin Operations of board. new text end

new text begin Officers of the board of directors are elected by
members of the board and serve one-year terms. Six members of the board constitute a
quorum, and the affirmative vote of six members of the board is necessary and sufficient
for any action taken by the board. Board members serve without pay, but are reimbursed
for actual expenses incurred in the performance of their duties. Board meetings must be
open to the public, except as specified in the bylaws of the exchange.
new text end

new text begin Subd. 15. new text end

new text begin Operations of exchange. new text end

new text begin The board of directors shall appoint an
exchange director who shall:
new text end

new text begin (1) be a full-time employee of the exchange;
new text end

new text begin (2) administer all of the activities and contracts of the exchange; and
new text end

new text begin (3) hire and supervise the staff of the exchange.
new text end

new text begin Subd. 16. new text end

new text begin Investment of assets. new text end

new text begin The exchange must certify to the State Board of
Investment that a portion of the assets of the exchange, in the judgment of the exchange
director, are not required for immediate use. Investment earnings on assets transferred to
the State Board of Investment under this subdivision must be maintained in an account
in the state treasury. Money in the account may be spent, as appropriated by law, for
purposes related to assisting individuals in paying health insurance premiums and for
making health insurance products more affordable.
new text end

new text begin Subd. 17. new text end

new text begin Audit. new text end

new text begin The legislative auditor must audit the exchange, as provided in
sections 3.971 and 3.972.
new text end

new text begin Subd. 18. new text end

new text begin Insurance producers. new text end

new text begin An individual has the right to choose any
insurance producer licensed in accident and health insurance under chapter 60K to assist
the individual in purchasing an individual market health plan through the exchange. When
a producer licensed in accident and health insurance under chapter 60K enrolls an eligible
individual in the exchange, the health plan company chosen by the individual may pay the
producer a commission.
new text end

new text begin Subd. 19. new text end

new text begin Implementation. new text end

new text begin Health plan coverage through the exchange begins on
July 1, 2010. The exchange must be operational to assist employers and individuals by
January 1, 2010, and be prepared for enrollment by June 1, 2010.
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.

new text begin [62U.12] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT
INDIVIDUAL RESPONSIBILITY REQUIREMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Phase-in goals. new text end

new text begin The state's phase-in goals for progress toward
universal health coverage for Minnesota residents are:
new text end

new text begin (1) 94 percent insured by end of fiscal year 2010;
new text end

new text begin (2) 96 percent insured by end of fiscal year 2012;
new text end

new text begin (3) 97 percent insured by end of fiscal year 2013; and
new text end

new text begin (4) 98 percent insured by end of fiscal year 2014 and thereafter.
new text end

new text begin Subd. 2. new text end

new text begin Measurement of percentage insured. new text end

new text begin The commissioner of health must
determine what percentage of Minnesota residents are insured. The determination must be
based on an annual survey of the Minnesota population younger than 65, to be conducted
or contracted for by the commissioner of health. The survey must include questions
related to the type of insurance, amount of cost sharing, and potential barriers to public
program enrollment.
new text end

new text begin Subd. 3. new text end

new text begin Contingent individual responsibility requirement. new text end

new text begin (a) If the increased
affordability, cost containment, insurance reform, and voluntary efforts provided for under
this act and Laws 2008, chapter 358, fail to achieve universal coverage, an individual
responsibility requirement is deemed to be necessary.
new text end

new text begin (b) If any one of the phase-in goals in subdivision 1 for fiscal year 2012 or later is not
met, as determined by the commissioner of health, an individual responsibility requirement
requiring every Minnesota resident to obtain and maintain health coverage from a public
or private sector source of the person's choice must become effective 12 months after the
end of that fiscal year, provided that the commissioner certifies that health plans that meet
the affordability standard under section 62U.13 are available to Minnesotans.
new text end

new text begin (c) Failure to comply with the individual responsibility requirement is not a crime
but must subject the person to a financial penalty to be specified in law.
new text end

new text begin (d) An individual need not comply with the individual responsibility requirement if
the individual objects to the requirement on the basis of a conscientiously held religious
belief or bona fide religious practice. In the case of a minor child, this paragraph applies
to the belief or practice of the child's parents. An individual may, but is not required to,
apply to the commissioner of health for a written waiver of the requirement based upon
this paragraph. The commissioner shall approve the waiver if the applicant provides
satisfactory proof of eligibility for the waiver under this paragraph.
new text end

new text begin (e) An individual with gross household income that exceeds 400 percent of the
federal poverty guidelines need not comply with the individual responsibility mandate if
the commissioner certifies that a health plan is not available in the individual's geographic
area for which the sum of premiums, deductibles, and other out-of-pocket costs paid for
health coverage by the individual does not exceed ten percent of gross income.
new text end

Sec. 12.

new text begin [62U.13] AFFORDABILITY STANDARD.
new text end

new text begin Subdivision 1. new text end

new text begin Definition of affordability. new text end

new text begin For purposes of this section, coverage is
"affordable" if the sum of premiums, deductibles, and other out-of-pocket costs paid by an
individual or family for health coverage does not exceed the applicable percentage of the
individual or family's gross monthly income specified in subdivision 2.
new text end

new text begin Subd. 2. new text end

new text begin Affordability standard. new text end

new text begin The following affordability standard is
established for individuals and households with gross family incomes of 400 percent
of the federal poverty guidelines or less.
new text end

new text begin new text begin AFFORDABILITY STANDARD new text end new text end
	new text begin Federal Poverty Guideline Range new text end			new text begin Percentage of Average Gross Monthly Income new text end
	new text begin 0-33% new text end			new text begin minimum new text end
	new text begin 33-54% new text end			new text begin 1.1% new text end
	new text begin 55-81% new text end			new text begin 1.2% new text end
	new text begin 82-109% new text end			new text begin 1.6% new text end
	new text begin 110-136% new text end			new text begin 2.4% new text end
	new text begin 137-164% new text end			new text begin 2.9% new text end
	new text begin 165-191% new text end			new text begin 3.9% new text end
	new text begin 192-219% new text end			new text begin 4.6% new text end
	new text begin 220-248% new text end			new text begin 5.4% new text end
	new text begin 248-274% new text end			new text begin 6.0% new text end
	new text begin 275-300% new text end			new text begin 6.0% new text end
	new text begin 301-324% new text end			new text begin 6.5% new text end
	new text begin 325-349% new text end			new text begin 7.2% new text end
	new text begin 350-374% new text end			new text begin 7.8% new text end
	new text begin 375-400% new text end			new text begin 8.0% new text end

new text begin For purposes of this subdivision, "minimum" means a monthly premium of $4.
new text end

Sec. 13.

Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
to read:

new text begin Subd. 29. new text end

new text begin Exchange of data. new text end

new text begin An entity that is part of the welfare system as defined
in section 13.46, subdivision 1, paragraph (c), and the Minnesota Health Insurance
Exchange under section 62U.11 may exchange private data about individuals without
the individual's consent in order to collect premiums from individuals in the medical
assistance employed persons with disabilities program and the MinnesotaCare program
under chapters 256B and 256L. This subdivision only applies if the entity that is part of
the welfare system and the Minnesota Health Insurance Exchange have entered into an
agreement that complies with the requirements in Code of Federal Regulations, title
45, section 164.314.
new text end

Sec. 14.

Minnesota Statutes 2008, section 256B.056, subdivision 10, is amended to
read:

Subd. 10.

Eligibility verification.

(a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.

(b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.

(c) The commissioner shall verify deleted text begin assets and deleted text end income for all applicants, and for all
recipients upon renewal. new text begin The commissioner shall verify liquid assets for applicants, and
for recipients upon renewal, only if the applicant or recipient reports total countable
assets within ten percent of the applicable asset limit. The commissioner may verify
nonliquid assets, but is not required to do so. This paragraph does not apply to applicants
or recipients applying for or receiving medical assistance payment of long-term care
services, including services under section 256B.0915, 256B.092, or 256B.49.
new text end

new text begin (d) The commissioner shall designate locations where enrollees may submit renewal
forms including, but not limited to, community clinics and health care providers' offices.
The designated sites shall forward the renewal forms to the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (c) is effective January 1, 2010.
new text end

Sec. 15.

Minnesota Statutes 2008, section 256B.057, subdivision 8, is amended to read:

Subd. 8.

Children under age two.

Medical assistance may be paid for a child under
two years of age whose countable family income is above 275 percent of the federal
poverty guidelines for the same size family but less than or equal to deleted text begin 280 deleted text end new text begin 305 new text end percent of the
federal poverty guidelines for the same size family.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later.
new text end

Sec. 16.

Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:

Subd. 3.

Inpatient hospital services.

(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
2, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of deleted text begin $10,000 deleted text end new text begin $20,000 new text end .

(b) Admissions for inpatient hospital services paid for under section 256L.11,
subdivision 3, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):

(1) all admissions must be certified, except those authorized under rules established
under section 254A.03, subdivision 3, or approved under Medicare; and

(2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, for single adults
and households with no children enrolled under section 256L.07, subdivision 4, and is
effective July 1, 2010, or upon federal approval, whichever is later, for adults in families
with children enrolled under section 256L.04, subdivision 1. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 17.

Minnesota Statutes 2008, section 256L.03, subdivision 5, is amended to read:

Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
and (c), the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for all enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.

(c) Paragraph (a) does not apply to pregnant women and children under the age of 21.

(d) Paragraph (a), clause (4), does not apply to mental health services.

(e) Adult enrollees with family gross income that exceeds 200 percent of the federal
poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
and who are not pregnant shall be financially responsible for the coinsurance amount, if
applicable, and amounts which exceed the deleted text begin $10,000 deleted text end new text begin $20,000 new text end inpatient hospital benefit limit.

(f) When a MinnesotaCare enrollee becomes a member of a prepaid health
plan, or changes from one prepaid health plan to another during a calendar year, any
charges submitted towards the deleted text begin $10,000 deleted text end new text begin $20,000 new text end annual inpatient benefit limit, and any
out-of-pocket expenses incurred by the enrollee for inpatient services, that were submitted
or incurred prior to enrollment, or prior to the change in health plans, shall be disregarded.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2010, for single adults
and households with no children enrolled under section 256L.04, subdivision 7, and is
effective July 1, 2010, or upon federal approval, whichever is later, for adults in families
with children enrolled under section 256L.04, subdivision 1. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 18.

Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:

Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) deleted text begin Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $57,500.
deleted text end

deleted text begin (e) deleted text end Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 19.

Minnesota Statutes 2008, section 256L.04, subdivision 7, is amended to read:

Subd. 7.

Single adults and households with no children.

(a) The definition of
eligible persons includes all individuals and households with no children who have gross
family incomes that are equal to or less than 200 percent of the federal poverty guidelines.

(b) Effective July 1, 2009, the definition of eligible persons includes all individuals
and households with no children who have gross family incomes that are equal to or less
than deleted text begin 250 deleted text end new text begin 300 new text end percent of the federal poverty guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010.
new text end

Sec. 20.

Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision
to read:

new text begin Subd. 6. new text end

new text begin Delayed verification. new text end

new text begin On the basis of information provided on the
completed application, an applicant whose gross income is less than 90 percent of
the applicable income standard and meets all other eligibility requirements, including
compliance at the time of application with citizenship or nationality documentation
requirements under section 256L.04, subdivision 10, must be determined eligible and
enrolled upon payment of premiums according to subdivision 3. The applicant shall
provide all required verifications within 60 days' notice of the eligibility determination,
or eligibility shall be denied or canceled. Applicants who are denied or canceled for
failure to provide all required verifications are not eligible for coverage using the delayed
verification procedures in this subdivision for 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 21.

Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:

Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than 150 percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 deleted text begin and the four-month requirement in subdivision 3 deleted text end , as
long as they maintain continuous coverage in the MinnesotaCare program or medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare.

Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above deleted text begin 275 deleted text end new text begin 300 new text end percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7,
whose income increases above 200 percent of the federal poverty guidelines or deleted text begin 250 deleted text end new text begin 300 new text end
percent of the federal poverty guidelines on or after July 1, deleted text begin 2009 deleted text end new text begin 2010 new text end , are no longer
eligible for the program and shall be disenrolled by the commissioner. For persons
disenrolled under this subdivision, MinnesotaCare coverage terminates the last day of
the calendar month following the month in which the commissioner determines that the
income of a family or individual exceeds program income limits.

(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment. The
premium for children remaining eligible under this clause shall be the maximum premium
determined under section 256L.15, subdivision 2, paragraph (b).

deleted text begin (c) Notwithstanding paragraphs (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
of eligibility.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2010, or upon federal
approval, whichever is later, except that the amendment to paragraph (a) related to the
four-month requirement is effective January 1, 2011, or upon federal approval, whichever
is later. The commissioner of human services shall notify the revisor of statutes when
federal approval is obtained.
new text end

Sec. 22.

Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:

Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text begin or for at least four
months prior to application and renewal deleted text end . Children enrolled in the original children's health
plan and children in families with income equal to or less than 150 percent of the federal
poverty guidelines, who have other health insurance, are eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of deleted text begin the four-month requirement described in deleted text end this subdivision.

deleted text begin (c) deleted text end For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

deleted text begin (d) deleted text end new text begin (c) new text end Applicants who were recipients of medical assistance or general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

deleted text begin (e) Cost-effective health insurance that was paid for by medical assistance is not
considered health coverage for purposes of the four-month requirement under this
section, except if the insurance continued after medical assistance no longer considered it
cost-effective or after medical assistance closed.
deleted text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end

Sec. 23.

Minnesota Statutes 2008, section 256L.15, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin First month premium exemption. new text end

new text begin New enrollee households are exempt
from premiums for the first month of MinnesotaCare enrollment. For purposes of this
exemption, a "new enrollee household" is a household which has not been enrolled in
MinnesotaCare for at least one year prior to application.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2011, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.
new text end