SF 3164

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; reenacting a health care purchasing alliance
stop-loss fund repealed in 2007; extending its existence and adjusting eligibility;
appropriating money; proposing coding for new law in Minnesota Statutes,
chapter 256.

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

Section 1.

new text begin [256.9561] PURCHASING ALLIANCE STOP-LOSS FUND.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms defined in
this subdivision have the meaning given.
new text end

new text begin (b) "Commissioner" means the commissioner of human services.
new text end

new text begin (c) "Health plan" means a policy, contract, or certificate issued by a health plan
company to a qualifying purchasing alliance. Any health plan issued to the members of a
qualifying purchasing alliance must meet the requirements of chapter 62L.
new text end

new text begin (d) "Health plan company" means:
new text end

new text begin (1) a health carrier as defined under section 62A.011, subdivision 2;
new text end

new text begin (2) a community integrated service network operating under chapter 62N; or
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new text begin (3) an accountable provider network operating under chapter 62T.
new text end

new text begin (e) "Qualifying employer" means an employer who:
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new text begin (1) is a member of a qualifying purchasing alliance;
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new text begin (2) has at least one employee but no more than 49 employees at the time of initial
membership to a qualifying purchasing alliance or is a sole proprietor or farmer;
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new text begin (3) did not offer employer-subsidized health care coverage to its employees for at
least 12 months prior to joining the purchasing alliance; and
new text end

new text begin (4) is offering health coverage through the purchasing alliance to all employees who
work at least 20 hours per week unless the employee is eligible for Medicare. For purposes
of this subdivision, "employer-subsidized health coverage" means health coverage for
which the employer pays at least 50 percent of the cost of coverage for the employee.
new text end

new text begin (f) "Qualifying enrollee" means an employee of a qualifying employer or the
employee's dependent covered by a health plan.
new text end

new text begin (g) "Qualifying purchasing alliance" means a purchasing alliance as defined in
section 62T.01, subdivision 2, that:
new text end

new text begin (1) meets the requirements of chapter 62T;
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new text begin (2) services a geographic area located in outstate Minnesota; and
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new text begin (3) is registered with the Department of Health as a health care purchasing alliance
on April 1, 2008.
new text end

new text begin Subd. 2. new text end

new text begin Creation of account. new text end

new text begin (a) A purchasing alliance stop-loss fund account
is established in the general fund. The commissioner shall use the money to establish
a stop-loss fund from which a health plan company may receive reimbursement for
claims paid for qualifying enrollees. The account consists of money appropriated by the
legislature. Money from the account must be used for the stop-loss fund.
new text end

new text begin (b) The commissioner may accept grants from public or private entities for the
purpose of expanding the stop-loss fund. Any money received by the commissioner must
be deposited in the account and distributed in accordance with this section.
new text end

new text begin Subd. 3. new text end

new text begin Reimbursement. new text end

new text begin (a) A health plan company may receive reimbursement
from the fund for 90 percent of the payments made, less any third-party recoveries, for
claims incurred in a calendar year for a qualifying enrollee for services that in aggregate
exceed $30,000 but not of the payments that exceed $100,000.
new text end

new text begin (b) Claims shall be reported and funds shall be distributed on a calendar-year basis.
Claims incurred by a qualifying enrollee are eligible for reimbursement for a two-year
period beginning from the date of enrollment. During this two-year period, claims shall be
eligible for reimbursement only for the calendar year in which the claims were incurred.
new text end

new text begin (c) Once claims incurred on behalf of a qualifying enrollee reach $100,000 in a
given calendar year, no further claims may be submitted for reimbursement on behalf of
that enrollee in that calendar year.
new text end

new text begin (d) If a health plan company collects third-party recoveries for a claim after the
health plan company has received reimbursement for the claim from the stop-loss fund
account, the health plan company must reimburse the account with the amount that would
have been subtracted from the payment under this subdivision. The health plan company
shall not be required to reimburse the account for more than the amount received by the
health plan company for that claim as calculated under subdivision 5.
new text end

new text begin Subd. 4. new text end

new text begin Request process. new text end

new text begin (a) Each health plan company must submit a request
for reimbursement from the fund on a form prescribed by the commissioner. Requests
for payment must be submitted no later than April 1 following the end of the calendar
year for which the reimbursement request is being made.
new text end

new text begin (b) The commissioner may require a health plan company to submit claims data as
needed in connection with the reimbursement request.
new text end

new text begin Subd. 5. new text end

new text begin Distribution. new text end

new text begin (a) The commissioner shall calculate the total claims
reimbursement amount for all qualifying health plan companies for the calendar year for
which claims are being reported and shall distribute the stop-loss funds before June 30
of the following calendar year.
new text end

new text begin (b) In the event that the total amount requested for reimbursement by the health plan
companies for a calendar year exceeds the funds available for distribution for claims
paid by all health plan companies during the same calendar year, the commissioner shall
provide for the pro rata distribution of the available funds. Each health plan company
shall be eligible to receive only a proportionate amount of the available funds as the
health plan company's total eligible claims paid compares to the total eligible claims
paid by all health plan companies.
new text end

new text begin (c) In the event that funds available for distribution for claims paid by all health plan
companies during a calendar year exceed the total amount requested for reimbursement
by all health plan companies during the same calendar year, any excess funds shall be
reallocated for distribution in the next calendar year and may carry over into the next
biennium.
new text end

new text begin Subd. 6. new text end

new text begin Data. new text end

new text begin Upon the request of the commissioner, each health plan company
shall furnish data the commissioner deems necessary to administer the fund. The
commissioner may require that the data be submitted on a per enrollee, aggregate, or
categorical basis. Any data submitted under this section shall be classified as private data
or nonpublic data as defined in section 13.02.
new text end

new text begin Subd. 7. new text end

new text begin Delegation. new text end

new text begin The commissioner may delegate any or all of the
commissioner's administrative duties to another state agency or to a private contractor.
new text end

new text begin Subd. 8. new text end

new text begin Expiration. new text end

new text begin This section expires January 1, 2013.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2008.
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Sec. 2. new text begin APPROPRIATION.
new text end

new text begin $....... is appropriated in fiscal year 2009 from the health care access fund to the
commissioner of human services for the purpose of Minnesota Statutes, section 256.9561.
The funds are available until spent.
new text end