SF 2630

as introduced - 88th Legislature (2013 - 2014) Posted on 03/13/2014 09:36am

A bill for an act
relating to health insurance; modifying the participation requirements for health
carriers and health plans for MNsure; amending Minnesota Statutes 2013
Supplement, section 62V.05, subdivision 5.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 62V.05, subdivision 5, is
amended to read:

Subd. 5.

Health carrier and health plan requirements; participation.

(a)
Beginning January 1, 2015, the board may establish certification requirements for health
carriers and health plans to be offered through MNsure that satisfy federal requirements
under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.

(b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory
requirements that:

(1) apply uniformly to all health carriers and health plans in the individual market;

(2) apply uniformly to all health carriers and health plans in the small group market;
and

(3) satisfy minimum federal certification requirements under section 1311(c)(1) of
the Affordable Care Act, Public Law 111-148.

(c) In accordance with section 1311(e) of the Affordable Care Act, Public Law
111-148, the board shall establish policies and procedures for certification deleted text begin and selection
deleted text end of health plans to be offered as qualified health plans through MNsure. The board shall
certify deleted text begin and select deleted text end a health plan as a qualified health plan to be offered through MNsure, if:

deleted text begin (1) the health plan meets the minimum certification requirements established in
paragraph (a) or the market regulatory requirements in paragraph (b);
deleted text end

deleted text begin (2) the board determines that making the health plan available through MNsure is in
the interest of qualified individuals and qualified employers;
deleted text end

deleted text begin (3) the health carrier applying to offer the health plan through MNsure also applies
to offer health plans at each actuarial value level and service area that the health carrier
currently offers in the individual and small group markets; and
deleted text end

deleted text begin (4) the health carrier does not apply to offer health plans in the individual and
small group markets through MNsure under a separate license of a parent organization
or holding company under section 60D.15, that is different from what the health carrier
offers in the individual and small group markets outside MNsure.
deleted text end

deleted text begin (d) In determining the interests of qualified individuals and employers under
paragraph (c), clause (2), the board may not exclude a health plan for any reason specified
under section 1311(e)(1)(B) of the Affordable Care Act, Public Law 111-148. The board
may consider:
deleted text end

deleted text begin (1) affordability;
deleted text end

deleted text begin (2) quality and value of health plans;
deleted text end

deleted text begin (3) promotion of prevention and wellness;
deleted text end

deleted text begin (4) promotion of initiatives to reduce health disparities;
deleted text end

deleted text begin (5) market stability and adverse selection;
deleted text end

deleted text begin (6) meaningful choices and access;
deleted text end

deleted text begin (7) alignment and coordination with state agency and private sector purchasing
strategies and payment reform efforts; and
deleted text end

deleted text begin (8) other criteria that the board determines appropriate.
deleted text end

deleted text begin (e) For qualified health plans offered through MNsure on or after January 1, 2015,
the board shall establish policies and procedures under paragraphs (c) and (d) for selection
of health plans to be offered as qualified health plans through MNsure by February 1
of each year, beginning February 1, 2014. The board shall consistently and uniformly
apply all policies and procedures and any requirements, standards, or criteria to all health
carriers and health plans. For any policies, procedures, requirements, standards, or criteria
that are defined as rules under section 14.02, subdivision 4, the board may use the process
described in subdivision 9.
deleted text end

deleted text begin (f) For 2014, the board shall not have the power to select health carriers and health
plans for participation in MNsure. The board shall permit all health plans that meet the
certification requirements under section 1311(c)(1) of the Affordable Care Act, Public
Law 111-148, to be offered through MNsure.
deleted text end

deleted text begin (g) Under this subdivision, the board shall have the power to verify that health
carriers and health plans are properly certified to be eligible for participation in MNsure.
deleted text end

deleted text begin (h) The board has the authority to decertify health carriers and health plans that
fail to maintain compliance with section 1311(c)(1) of the Affordable Care Act, Public
Law 111-148.
deleted text end

new text begin (1) the health plan provides the essential health benefits package described in section
1302(a) of the Affordable Care Act, except that the plan is not required to provide essential
benefits that duplicate the minimum benefits of dental plans if:
new text end

new text begin (i) MNsure has determined that at least one qualified dental plan is available to
supplement the health plan's coverage; and
new text end

new text begin (ii) the health carrier makes a prominent disclosure at the time it offers the health
plan, in a form approved by MNsure, that the health plan does not provide the full range of
essential pediatric benefits and that the dental plans providing those benefits and other
dental benefits not covered by the health plan are offered through MNsure;
new text end

new text begin (2) the premium rates and policy forms have been approved by the commissioner of
commerce or the commissioner of health;
new text end

new text begin (3) the health plan provides at least a bronze level of coverage unless the health plan
is certified as a qualified catastrophic plan, meets the requirements of section 1302(e) of
the Affordable Care Act for catastrophic plans, and will only be offered to individuals
eligible for catastrophic coverage;
new text end

new text begin (4) the health plan's cost-sharing requirements do not exceed the limits established
under section 1032(c)(1) of the Affordable Care Act and, if the health plan is offered to
a qualified employer, the health plan's deductible does not exceed the limits established
under section 1032(c)(2) of the Affordable Care Act;
new text end

new text begin (5) the health carrier offering the health plan:
new text end

new text begin (i) is licensed and in good standing;
new text end

new text begin (ii) offers at least one qualified health plan at the silver level and at least one qualified
health plan at the gold level through MNsure;
new text end

new text begin (iii) for each metal level in which the health carrier participates, offers coverage in
that level to individuals who, as of the beginning of a plan or policy year, have not attained
the age of 21;
new text end

new text begin (iv) charges the same premium rate for each qualified health plan without regard to
whether the plan is offered through MNsure and without regard to whether the health plan
is offered directly from the health carrier or through an insurance producer;
new text end

new text begin (v) does not charge any cancellation fees or penalties; and
new text end

new text begin (vi) complies with the regulations developed by the Secretary of Health and Human
Services under section 1311(d) of the Affordable Care Act and other requirements that
MNsure may establish;
new text end

new text begin (6) the health plan meets the requirements of certification as promulgated by rule by
MNsure pursuant to this chapter and under section 1311(c) of the Affordable Care Act; and
new text end

new text begin (7) MNsure determines that making the health plan available through MNsure is in
the interest of qualified individuals and qualified employers.
new text end

new text begin (d) The provisions of this chapter that are applicable to qualified health plans must
allow for and apply to the extent relevant to dental plans except as modified in accordance
with clauses (1) to (3):
new text end

new text begin (1) the dental organization must be licensed to offer stand-alone dental plans but
need not be licensed to offer health plans;
new text end

new text begin (2) the dental plan must be limited to dental and oral health benefits, without
substantially duplicating the benefits typically offered by health plans without dental
coverage and must include, at a minimum, the essential pediatric dental benefits pursuant
to section 1302(b)(1)(J) of the Affordable Care Act; and
new text end

new text begin (3) a health carrier and a dental organization may jointly offer a comprehensive
health plan through MNsure in which the essential pediatric dental benefits are provided
by the dental organization and the other benefits are provided by the health carrier.
new text end

new text begin (e) All health carriers and health plans that have met the certification requirements
of this subdivision are eligible for participation in MNsure.
new text end

deleted text begin (i) deleted text end new text begin (f) new text end For qualified health plans offered through MNsure beginning January 1,
2015, health carriers must use the most current addendum for Indian health care providers
approved by the Centers for Medicare and Medicaid Services and the tribes as part of their
contracts with Indian health care providers. MNsure shall comply with all future changes
in federal law with regard to health coverage for the tribes.