SF 2897

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health care; establishing a community-based health care coverage
program demonstration project; proposing coding for new law in Minnesota
Statutes, chapter 62A.

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

Section 1.

new text begin [62A.67] COMMUNITY-BASED HEALTH CARE COVERAGE
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin A community-based health care initiative may develop and
operate a community-based health care coverage program that offers to eligible individuals
and their dependents the option of purchasing through their employer health care coverage
on a fixed prepaid basis without meeting the requirements of chapter 60A, 62A, 62C, 62D,
62Q, or 62T, or any other law or rule that applies to entities licensed under these chapters.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following definitions apply:
new text end

new text begin (a) "Community-based" means located in or primarily relating to the community
of geographically contiguous political subdivisions, as determined by the board of a
community-based health initiative that is served by the community-based health care
coverage program.
new text end

new text begin (b) "Community-based health care coverage program" or "program" means a
program administered by a community-based health initiative that provides health care
services through provider members of a community-based health network or combination
of networks to eligible individuals and their dependents who are enrolled in the program.
new text end

new text begin (c) "Community-based health initiative" means a nonprofit corporation that is
governed by a board that has at least 80 percent of its members residing in the community
and includes representatives of the participating network providers and employers.
new text end

new text begin (d) "Community-based health network" means a contract-based network organized
by the community-based health initiative to provide or support the delivery of health
care services to enrollees of the community-based health care coverage program on a
risk-sharing or nonrisk-sharing basis.
new text end

new text begin (e) "Dependent" means an eligible employee's spouse or unmarried child who is
under the age of 19 years.
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new text begin Subd. 3. new text end

new text begin Approval. new text end

new text begin Prior to the operation of a community-based health care
coverage program, a community-based health initiative shall submit to the commissioner
of health for approval the community-based health care coverage program developed by
the initiative. The commissioner shall only approve a program that has been awarded
a community access program grant from the United States Department of Health and
Human Services. The commissioner shall ensure that the program meets the federal grant
requirements and any requirements described in this section and is actuarially sound based
on a review of appropriate records and methods utilized by the community-based health
initiative in establishing premium rates for the community-based health care coverage
program.
new text end

new text begin Subd. 4. new text end

new text begin Establishment. new text end

new text begin The initiative shall establish and operate upon approval
by the commissioner of health a community-based health care coverage program. The
operational structure established by the initiative shall include, but is not limited to:
new text end

new text begin (1) establishing a process for enrolling eligible individuals and their dependents;
new text end

new text begin (2) collecting and coordinating premiums from enrollees and employers of enrollees;
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new text begin (3) providing payment to participating providers;
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new text begin (4) establishing a basic benefit set according to subdivision 7 and establishing
premium rates and cost-sharing requirements;
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new text begin (5) creating incentives to encourage primary care and wellness services; and
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new text begin (6) initiating disease management services, as appropriate.
new text end

new text begin The payments collected under clause (2) may be used to capture available federal
funds.
new text end

new text begin Subd. 5. new text end

new text begin Qualifying employees. new text end

new text begin To be eligible for the community-based health
care coverage program, an individual must:
new text end

new text begin (1) reside in or work within the designated community-based geographic area
served by the program;
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new text begin (2) be employed by a qualifying employer or be an employee's dependent;
new text end

new text begin (3) have no other health coverage while enrolled; and
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new text begin (4) not be enrolled in medical assistance, MinnesotaCare, or Medicare.
new text end

new text begin Subd. 6. new text end

new text begin Qualifying employers. new text end

new text begin (a) To qualify for participation in the
community-based health care coverage program, an employer must:
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new text begin (1) employ at least one but no more than 50 employees at the time of initial
enrollment in the program;
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new text begin (2) pay its employees a median wage of $12.50 per hour or less; and
new text end

new text begin (3) not have offered employer-subsidized health coverage to its employees for
at least 12 months prior to the initial enrollment in the program. For purposes of this
section, "employer-subsidized health coverage" means health care coverage for which the
employer pays at least 50 percent of the cost of coverage for the employee.
new text end

new text begin (b) To participate in the program, a qualifying employer agrees to:
new text end

new text begin (1) offer health care coverage through the program to all eligible employees and
their dependents regardless of health status;
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new text begin (2) participate in the program for an initial term of at least one year; and
new text end

new text begin (3) provide the initiative with any employee information deemed necessary by the
initiative to determine eligibility and premium payments.
new text end

new text begin Subd. 7. new text end

new text begin Coverage. new text end

new text begin (a) The initiative shall establish the health care benefits offered
through the community-based health care coverage program. The benefits established
shall include, at a minimum:
new text end

new text begin (1) child health supervision services up to age 18, as defined under section 62A.047;
and
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new text begin (2) preventive services, including:
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new text begin (i) health education and wellness services;
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new text begin (ii) health supervision, evaluation, and follow-up;
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new text begin (iii) immunizations; and
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new text begin (iv) early disease detection.
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new text begin (b) Coverage of health care services offered by the program may be limited to
participating health care providers or health networks. All services covered under the
program must be services that are offered within the scope of practice of the participating
health care providers.
new text end

new text begin (c) The initiative may establish an annual aggregate benefit cap and cost-sharing
requirements. Any co-payment or deductible provisions established may not discriminate
on the basis of age, sex, race, disability, economic status, or length of enrollment in the
program.
new text end

new text begin Subd. 8. new text end

new text begin Enrollee information. new text end

new text begin (a) The initiative must provide an individual or
family who enrolls in the program a clear and concise written statement that includes
the following information:
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new text begin (1) health care services that are provided under the program;
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new text begin (2) any exclusions or limitations on the health care services offered, including any
cost-sharing arrangements or prior authorization requirements;
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new text begin (3) a list of where the health care services can be obtained and the fact that all
health care services must be provided by or through a participating health care provider or
community-based health network;
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new text begin (4) a description of the program's method for resolving enrollee complaints,
including how an enrollee can file a complaint with the Department of Health; and
new text end

new text begin (5) the conditions under which the program or coverage through the program may be
canceled or terminated.
new text end

new text begin (b) The commissioner of health must approve a copy of the written statement prior
to the operation of the program.
new text end

new text begin Subd. 9. new text end

new text begin Complaint process. new text end

new text begin The initiative must establish a complaint resolution
process. The process must ensure that complaints are resolved within 60 days of receiving
the complaint. The initiative must report any complaint that is not resolved within 60
days to the commissioner of health.
new text end

new text begin Subd. 10. new text end

new text begin Limitations on enrollment. new text end

new text begin (a) The initiative may limit enrollment in the
program. If enrollment is limited, a waiting list must be established.
new text end

new text begin (b) The initiative shall not restrict or deny enrollment in the program except for
nonpayment of premiums, fraud or misrepresentation, or as otherwise permitted under
this section.
new text end

new text begin (c) The initiative may require a certain percentage of participation from eligible
employees of a participating employer before coverage can be offered through the
program.
new text end

new text begin Subd. 11. new text end

new text begin Report. new text end

new text begin (a) The initiative shall submit a report to the commissioner
of health and the legislature on or before March 15 of each year, beginning March 15,
2008. The report shall include:
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new text begin (1) an analysis of the financial status of the program, including the premium rates,
cost per member per month, claims paid out, premiums received, and administrative
expenses;
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new text begin (2) a description of the health care benefits offered and an analysis of the services
utilized;
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new text begin (3) data on the number of employers participating, employees and dependents
covered under the program, and the number of health care providers participating; and
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new text begin (4) any other information requested by the commissioner of health or the legislature.
new text end

new text begin (b) The report shall include any recommendations on improving and expanding the
community-based health care coverage program to other geographical areas of the state.
new text end

new text begin Subd. 12. new text end

new text begin Sunset. new text end

new text begin This section expires December 31, 2011.
new text end