SF 224

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to human services; modifying the purchasing 
  1.3             alliance stop-loss fund; amending Minnesota Statutes 
  1.4             2002, sections 256.956, subdivisions 1, 2, 3, 9.  
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  Minnesota Statutes 2002, section 256.956, 
  1.7   subdivision 1, is amended to read: 
  1.8      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.9   section, the following definitions apply:  
  1.10     (a) "Commissioner" means the commissioner of human services.
  1.11     (b) "Health plan" means a policy, contract, or certificate 
  1.12  issued by a health plan company to a qualifying purchasing 
  1.13  alliance.  Any health plan issued to the members of a qualifying 
  1.14  purchasing alliance must meet the requirements of chapter 62L.  
  1.15     (c) "Health plan company" means: 
  1.16     (1) a health carrier as defined under section 62A.011, 
  1.17  subdivision 2; 
  1.18     (2) a community integrated service network operating under 
  1.19  chapter 62N; or 
  1.20     (3) an accountable provider network operating under chapter 
  1.21  62T.  
  1.22     (d) "Qualifying employer" means an employer who: 
  1.23     (1) is a member of a qualifying purchasing alliance; 
  1.24     (2) has at least one employee but no more than ten 
  1.25  employees or is a sole proprietor or farmer; 
  2.1      (3) did not offer employer-subsidized health care coverage 
  2.2   to its employees for at least 12 months prior to joining the 
  2.3   purchasing alliance; and 
  2.4      (4) is offering health coverage through the purchasing 
  2.5   alliance to all employees who work at least 20 hours per week 
  2.6   unless the employee is eligible for Medicare. 
  2.7   For purposes of this subdivision, "employer-subsidized health 
  2.8   coverage" means health coverage for which the employer pays at 
  2.9   least 50 percent of the cost of coverage for the employee.  
  2.10     (e) "Qualifying enrollee" means an employee of a qualifying 
  2.11  employer or the employee's dependent covered by a health plan.  
  2.12     (f) "Qualifying purchasing alliance" means a purchasing 
  2.13  alliance as defined in section 62T.01, subdivision 2, that: 
  2.14     (1) meets the requirements of chapter 62T; 
  2.15     (2) services a geographic area located in outstate 
  2.16  Minnesota, excluding the city of Duluth; and 
  2.17     (3) is organized and operating before May 1, 2001. 
  2.18     The criteria used by the qualifying purchasing alliance for 
  2.19  membership must be approved by the commissioner of health.  The 
  2.20  commissioner shall approve any criteria needed in order to 
  2.21  receive grants from other public or private entities.  A 
  2.22  qualifying purchasing alliance may begin enrolling qualifying 
  2.23  employers after July 1, 2001, with enrollment ending by December 
  2.24  31, 2003.  The commissioner may waive the criteria described in 
  2.25  clause (3) if this criteria inhibits the commissioner's ability 
  2.26  to obtain grants from other public or private entities. 
  2.27     Sec. 2.  Minnesota Statutes 2002, section 256.956, 
  2.28  subdivision 2, is amended to read: 
  2.29     Subd. 2.  [CREATION OF ACCOUNT.] (a) A purchasing alliance 
  2.30  stop-loss fund account is established in the general fund.  The 
  2.31  commissioner shall use the money to establish a stop-loss fund 
  2.32  from which a health plan company may receive reimbursement for 
  2.33  claims paid for qualifying enrollees.  The account consists of 
  2.34  money appropriated by the legislature.  Money from the account 
  2.35  must be used for the stop-loss fund.  
  2.36     (b) The commissioner may accept grants from public or 
  3.1   private entities for the purpose of expanding the stop-loss fund.
  3.2   Any money received by the commissioner must be deposited in the 
  3.3   account and distributed in accordance with this section.  
  3.4      Sec. 3.  Minnesota Statutes 2002, section 256.956, 
  3.5   subdivision 3, is amended to read: 
  3.6      Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
  3.7   receive reimbursement from the fund for 90 percent of the 
  3.8   portion of the claim that exceeds $30,000 but not of the portion 
  3.9   that exceeds $100,000 in a calendar year for a qualifying 
  3.10  enrollee.  
  3.11     (b) Claims shall be reported and funds shall be distributed 
  3.12  on a calendar-year basis.  Claims incurred by a qualifying 
  3.13  enrollee are eligible for reimbursement for a two-year period 
  3.14  beginning from the date of enrollment.  During this two-year 
  3.15  period, claims shall be eligible for reimbursement only for the 
  3.16  calendar year in which the claims were paid incurred.  
  3.17     (c) Once claims paid on behalf of a qualifying enrollee 
  3.18  reach $100,000 in a given calendar year, no further claims may 
  3.19  be submitted for reimbursement on behalf of that enrollee in 
  3.20  that calendar year.  
  3.21     Sec. 4.  Minnesota Statutes 2002, section 256.956, 
  3.22  subdivision 9, is amended to read: 
  3.23     Subd. 9.  [SUNSET.] This section shall expire January 1, 
  3.24  2005, or until all funds deposited in the account have been 
  3.25  distributed, whichever is later. 
  3.26     Sec. 5.  [PURCHASING ALLIANCE STOP-LOSS FUND ACCOUNT.] 
  3.27     Any funds appropriated to the purchasing alliance stop-loss 
  3.28  fund account as part of the base appropriation for fiscal years 
  3.29  2004 and 2005 shall only be available for claim reimbursements 
  3.30  for qualifying enrollees who are members of purchasing alliances 
  3.31  that meet the criteria described under Minnesota Statutes, 
  3.32  section 256.956, subdivision 1, paragraph (f), clauses (1), (2), 
  3.33  and (3).