SF 49

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/06/2024 04:03pm

A bill for an act
relating to health; establishing an easy enrollment health insurance outreach
program; providing for a state-funded cost-sharing reduction program for enrollees
of certain health plans through MNsure; establishing the Health Care Affordability
Board and Health Care Affordability Advisory Council; requiring monitoring of
and recommendations related to health care market trends; requiring reports;
providing for civil penalties; modifying premium scale; establishing requirements
for a transition to a public option; requiring recommendations for and studies of
alternative payment models; appropriating money; amending Minnesota Statutes
2022, sections 62K.15; 62U.04, subdivision 11; 256.962, subdivision 5; 256B.04,
by adding a subdivision; 256B.056, subdivision 7; 256B.0631, by adding a
subdivision; 256L.04, subdivisions 7a, 10, by adding a subdivision; 256L.07,
subdivision 1; 256L.15, subdivision 2; 270B.14, by adding a subdivision; proposing
coding for new law in Minnesota Statutes, chapters 62J; 62V; 290; repealing
Minnesota Statutes 2022, section 256B.0631, subdivisions 1, 2, 3.

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

ARTICLE 1

FACILITATING ENROLLMENT

Section 1.

Minnesota Statutes 2022, section 62K.15, is amended to read:

62K.15 ANNUAL OPEN ENROLLMENT PERIODS; SPECIAL ENROLLMENT
PERIODS.

(a) Health carriers offering individual health plans must limit annual enrollment in the
individual market to the annual open enrollment periods for MNsure. Nothing in this section
limits the application of special or limited open enrollment periods as defined under the
Affordable Care Act.

(b) Health carriers offering individual health plans must inform all applicants at the time
of application and enrollees at least annually of the open and special enrollment periods as
defined under the Affordable Care Act.

(c) Health carriers offering individual health plans must provide a special enrollment
period for enrollment in the individual market by employees of a small employer that offers
a qualified small employer health reimbursement arrangement in accordance with United
States Code, title 26, section 9831(d). The special enrollment period shall be available only
to employees newly hired by a small employer offering a qualified small employer health
reimbursement arrangement, and to employees employed by the small employer at the time
the small employer initially offers a qualified small employer health reimbursement
arrangement. For employees newly hired by the small employer, the special enrollment
period shall last for 30 days after the employee's first day of employment. For employees
employed by the small employer at the time the small employer initially offers a qualified
small employer health reimbursement arrangement, the special enrollment period shall last
for 30 days after the date the arrangement is initially offered to employees.

(d) The commissioner of commerce shall enforce this section.

new text begin (e) Health carriers offering individual health plans through MNsure must provide a
special enrollment period as required under the easy enrollment health insurance outreach
program under section 62V.13.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after December
31, 2023, and applies to health plans offered, issued, or sold on or after January 1, 2024.
new text end

Sec. 2.

new text begin [62V.13] EASY ENROLLMENT HEALTH INSURANCE OUTREACH
PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The board, in cooperation with the commissioner of
revenue, must establish the easy enrollment health insurance outreach program to:
new text end

new text begin (1) reduce the number of uninsured Minnesotans and increase access to affordable health
insurance coverage;
new text end

new text begin (2) allow the commissioner of revenue to provide return information, at the request of
the taxpayer, to MNsure to provide the taxpayer with information about the potential
eligibility for financial assistance and health insurance enrollment options through MNsure;
new text end

new text begin (3) allow MNsure to estimate taxpayer potential eligibility for financial assistance for
health insurance coverage; and
new text end

new text begin (4) allow MNsure to conduct targeted outreach to assist interested taxpayer households
in applying for and enrolling in affordable health insurance options through MNsure,
including connecting interested taxpayer households with a navigator or broker for free
enrollment assistance.
new text end

new text begin Subd. 2. new text end

new text begin Screening for eligibility for insurance assistance. new text end

new text begin Upon receipt of and based
on return information received from the commissioner of revenue under section 270B.14,
subdivision 22, MNsure may make a projected assessment on whether the interested
taxpayer's household may qualify for a financial assistance program for health insurance
coverage.
new text end

new text begin Subd. 3. new text end

new text begin Outreach letter and special enrollment period. new text end

new text begin (a) MNsure must provide a
written letter of the projected assessment under subdivision 2 to a taxpayer who indicates
to the commissioner of revenue that the taxpayer is interested in obtaining information on
access to health insurance.
new text end

new text begin (b) MNsure must allow a special enrollment period for taxpayers who receive the outreach
letter in paragraph (a) and are determined eligible to enroll in a qualified health plan through
MNsure. The triggering event for the special enrollment period is the day the outreach letter
under this subdivision is mailed to the taxpayer. An eligible individual, and their dependents,
have 65 days from the triggering event to select a qualifying health plan and coverage for
the qualifying health plan is effective the first day of the month after plan selection.
new text end

new text begin (c) Taxpayers who have a member of the taxpayer's household currently enrolled in a
qualified health plan through MNsure are not eligible for the special enrollment under
paragraph (b).
new text end

new text begin (d) MNsure must provide information about the easy enrollment health insurance outreach
program and the special enrollment period described in this subdivision to the general public.
new text end

new text begin Subd. 4. new text end

new text begin Appeals. new text end

new text begin (a) Projected eligibility assessments for financial assistance under
this section are not appealable.
new text end

new text begin (b) Qualification for the special enrollment period under this section is appealable to
MNsure under this chapter and Minnesota Rules, chapter 7700.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after December
31, 2023, and applies to health plans offered, issued, or sold on or after January 1, 2024.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256.962, subdivision 5, is amended to read:

Subd. 5.

Incentive program.

Beginning January 1, 2008, the commissioner shall establish
an incentive program for organizations and licensed insurance producers under chapter 60K
that directly identify and assist potential enrollees in filling out and submitting an application.
For each applicant who is successfully enrolled in MinnesotaCare or medical assistance,
the commissioner, within the available appropriation, shall pay the organization or licensed
insurance producer a deleted text begin $70 deleted text end new text begin $100 new text end application assistance bonus. The organization or licensed
insurance producer may provide an applicant a gift certificate or other incentive upon
enrollment.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
new text end

Sec. 4.

Minnesota Statutes 2022, section 256B.04, is amended by adding a subdivision to
read:

new text begin Subd. 26. new text end

new text begin Disenrollment under medical assistance and MinnesotaCare. new text end

new text begin (a) The
commissioner shall regularly update mailing addresses and other contact information for
medical assistance and MinnesotaCare enrollees in cases of returned mail and nonresponse
using information available through managed care and county-based purchasing plans, state
health and human services programs, and other sources.
new text end

new text begin (b) The commissioner shall not disenroll an individual from medical assistance or
MinnesotaCare in cases of returned mail until the commissioner makes at least two attempts
by phone, email, or other methods to contact the individual. The commissioner may disenroll
the individual after providing no less than 30 days for the individual to respond to the most
recent contact attempt.
new text end

Sec. 5.

Minnesota Statutes 2022, section 256B.056, subdivision 7, is amended to read:

Subd. 7.

Period of eligibility.

(a) Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.

new text begin (b) Notwithstanding any other law to the contrary:
new text end

new text begin (1) a child under 21 years of age who is determined eligible for medical assistance must
remain eligible for a period of 12 months; and
new text end

new text begin (2) a child under six years of age who is determined eligible for medical assistance must
remain eligible through the month in which the child reaches six years of age.
new text end

new text begin (c) A child's eligibility under paragraph (b) may be terminated earlier if:
new text end

new text begin (i) the child or the child's representative requests voluntary termination of eligibility;
new text end

new text begin (ii) the child ceases to be a resident of this state;
new text end

new text begin (iii) the child dies;
new text end

new text begin (iv) the child attains the maximum age; or
new text end

new text begin (v) the agency determines eligibility was erroneously granted at the most recent eligibility
determination due to agency error or fraud, abuse, or perjury attributed to the child or the
child's representative.
new text end

deleted text begin (b) deleted text end new text begin (d) new text end For a person eligible for an insurance affordability program as defined in section
256B.02, subdivision 19, who reports a change that makes the person eligible for medical
assistance, eligibility is available for the month the change was reported and for three months
prior to the month the change was reported, if the person was eligible in those prior months.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2024, 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. 6.

Minnesota Statutes 2022, section 256L.04, subdivision 10, is amended to read:

Subd. 10.

Citizenship requirements.

(a) Eligibility for MinnesotaCare is limited to
citizens or nationals of the United States and lawfully present noncitizens as defined in
Code of Federal Regulations, title 8, section 103.12. Undocumented noncitizens new text begin , with the
exception of children under 19 years of age, new text end are ineligible for MinnesotaCare. For purposes
of this subdivision, an undocumented noncitizen is an individual who resides in the United
States without the approval or acquiescence of the United States Citizenship and Immigration
Services. Families with children who are citizens or nationals of the United States must
cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.

(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are lawfully present and ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal poverty
guidelines.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 7.

Minnesota Statutes 2022, section 270B.14, is amended by adding a subdivision to
read:

new text begin Subd. 22. new text end

new text begin Disclosure to MNsure board. new text end

new text begin The commissioner may disclose a return or
return information to the MNsure board if a taxpayer makes the designation under section
290.433 on an income tax return filed with the commissioner. The commissioner must only
disclose data necessary to provide the taxpayer with information about the potential eligibility
for financial assistance and health insurance enrollment options under section 62V.13.
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. 8.

new text begin [290.433] EASY ENROLLMENT HEALTH INSURANCE OUTREACH
PROGRAM CHECKOFF.
new text end

new text begin Subdivision 1. new text end

new text begin Taxpayer designation. new text end

new text begin Any individual who files an income tax return
may designate on their original return a request that the commissioner provide their return
information to the MNsure board for purposes of providing the individual with information
about potential eligibility for financial assistance and health insurance enrollment options
under section 62V.13, to the extent necessary to administer the easy enrollment health
insurance outreach program.
new text end

new text begin Subd. 2. new text end

new text begin Form. new text end

new text begin The commissioner shall notify filers of their ability to make the
designation in subdivision 1 on their income tax return.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for taxable years beginning after December
31, 2023.
new text end

Sec. 9. new text begin DIRECTION TO MNSURE BOARD AND COMMISSIONER.
new text end

new text begin The MNsure board and the commissioner of the Department of Revenue must develop
and implement systems, policies, and procedures that encourage, facilitate, and streamline
data sharing, projected eligibility assessments, and notice to taxpayers to achieve the purpose
of the easy enrollment health insurance outreach program under Minnesota Statutes, section
62V.13, for operation beginning with tax year 2023.
new text end

ARTICLE 2

AFFORDABILITY

Section 1.

new text begin [62J.86] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For the purposes of sections 62J.86 to 62J.92, the following
terms have the meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Advisory council. new text end

new text begin "Advisory council" means the Health Care Affordability
Advisory Council established under section 62J.88.
new text end

new text begin Subd. 3. new text end

new text begin Board. new text end

new text begin "Board" means the Health Care Affordability Board established under
section 62J.87.
new text end

Sec. 2.

new text begin [62J.87] HEALTH CARE AFFORDABILITY BOARD.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The Legislative Coordinating Commission shall establish
the Health Care Affordability Board, which shall be governed as a board under section
15.012, paragraph (a), to protect consumers, state and local governments, health plan
companies, providers, and other health care system stakeholders from unaffordable health
care costs. The board must be operational by January 1, 2024.
new text end

new text begin Subd. 2. new text end

new text begin Membership. new text end

new text begin (a) The Health Care Affordability Board consists of 13 members,
appointed as follows:
new text end

new text begin (1) five members appointed by the governor;
new text end

new text begin (2) two members appointed by the majority leader of the senate;
new text end

new text begin (3) two members appointed by the minority leader of the senate;
new text end

new text begin (4) two members appointed by the speaker of the house; and
new text end

new text begin (5) two members appointed by the minority leader of the house of representatives.
new text end

new text begin (b) All appointed members must have knowledge and demonstrated expertise in one or
more of the following areas: health care finance, health economics, health care management
or administration at a senior level, health care consumer advocacy, representing the health
care workforce as a leader in a labor organization, purchasing health care insurance as a
health benefits administrator, delivery of primary care, health plan company administration,
public or population health, and addressing health disparities and structural inequities.
new text end

new text begin (c) A member may not participate in board proceedings involving an organization,
activity, or transaction in which the member has either a direct or indirect financial interest,
other than as an individual consumer of health services.
new text end

new text begin (d) The Legislative Coordinating Commission shall coordinate appointments under this
subdivision to ensure that board members are appointed by August 1, 2023, and that board
members as a whole meet all of the criteria related to the knowledge and expertise specified
in paragraph (b).
new text end

new text begin Subd. 3. new text end

new text begin Terms. new text end

new text begin (a) Board appointees shall serve four-year terms. A board member shall
not serve more than three consecutive terms.
new text end

new text begin (b) A board member may resign at any time by giving written notice to the board.
new text end

new text begin Subd. 4. new text end

new text begin Chair; other officers. new text end

new text begin (a) The governor shall designate an acting chair from
the members appointed by the governor.
new text end

new text begin (b) The board shall elect a chair to replace the acting chair at the first meeting of the
board by a majority of the members. The chair shall serve for two years.
new text end

new text begin (c) The board shall elect a vice-chair and other officers from its membership as it deems
necessary.
new text end

new text begin Subd. 5. new text end

new text begin Staff; technical assistance; contracting. new text end

new text begin (a) The board shall hire a full-time
executive director and other staff, who shall serve in the unclassified service. The executive
director must have significant knowledge and expertise in health economics and demonstrated
experience in health policy.
new text end

new text begin (b) The attorney general shall provide legal services to the board.
new text end

new text begin (c) The Health Economics Division within the Department of Health shall provide
technical assistance to the board in analyzing health care trends and costs and in setting
health care spending growth targets.
new text end

new text begin (d) The board may employ or contract for professional and technical assistance, including
actuarial assistance, as the board deems necessary to perform the board's duties.
new text end

new text begin Subd. 6. new text end

new text begin Access to information. new text end

new text begin (a) The board may request that a state agency provide
the board with any publicly available information in a usable format as requested by the
board, at no cost to the board.
new text end

new text begin (b) The board may request from a state agency unique or custom data sets, and the agency
may charge the board for providing the data at the same rate the agency would charge any
other public or private entity.
new text end

new text begin (c) Any information provided to the board by a state agency must be de-identified. For
purposes of this subdivision, "de-identification" means the process used to prevent the
identity of a person or business from being connected with the information and ensuring
all identifiable information has been removed.
new text end

new text begin (d) Any data submitted to the board shall retain its original classification under the
Minnesota Data Practices Act in chapter 13.
new text end

new text begin Subd. 7. new text end

new text begin Compensation. new text end

new text begin Board members shall not receive compensation but may receive
reimbursement for expenses as authorized under section 15.059, subdivision 3.
new text end

new text begin Subd. 8. new text end

new text begin Meetings. new text end

new text begin (a) Meetings of the board are subject to chapter 13D. The board shall
meet publicly at least quarterly. The board may meet in closed session when reviewing
proprietary information as specified in section 62J.71, subdivision 4.
new text end

new text begin (b) The board shall announce each public meeting at least two weeks prior to the
scheduled date of the meeting. Any materials for the meeting shall be made public at least
one week prior to the scheduled date of the meeting.
new text end

new text begin (c) At each public meeting, the board shall provide the opportunity for comments from
the public, including the opportunity for written comments to be submitted to the board
prior to a decision by the board.
new text end

Sec. 3.

new text begin [62J.88] HEALTH CARE AFFORDABILITY ADVISORY COUNCIL.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The governor shall appoint a Health Care Affordability
Advisory Council to provide advice to the board on health care costs and access issues and
to represent the views of patients and other stakeholders. Members of the advisory council
shall be appointed based on their knowledge and demonstrated expertise in one or more of
the following areas: health care delivery, ensuring health care access for diverse populations,
public and population health, patient perspectives, health care cost trends and drivers, clinical
and health services research, innovation in health care delivery, and health care benefits
management.
new text end

new text begin Subd. 2. new text end

new text begin Duties; reports. new text end

new text begin (a) The council shall provide technical recommendations to
the board on:
new text end

new text begin (1) the identification of economic indicators and other metrics related to the development
and setting of health care spending growth targets;
new text end

new text begin (2) data sources for measuring health care spending; and
new text end

new text begin (3) measurement of the impact of health care spending growth targets on diverse
communities and populations, including but not limited to those communities and populations
adversely affected by health disparities.
new text end

new text begin (b) The council shall report technical recommendations and a summary of its activities
to the board at least annually, and shall submit additional reports on its activities and
recommendations to the board, as requested by the board or at the discretion of the council.
new text end

new text begin Subd. 3. new text end

new text begin Terms. new text end

new text begin (a) The initial appointed advisory council members shall serve staggered
terms of two, three, or four years determined by lot by the secretary of state. Following the
initial appointments, advisory council members shall serve four-year terms.
new text end

new text begin (b) Removal and vacancies of advisory council members shall be governed by section
15.059.
new text end

new text begin Subd. 4. new text end

new text begin Compensation. new text end

new text begin Advisory council members may be compensated according to
section 15.059.
new text end

new text begin Subd. 5. new text end

new text begin Meetings. new text end

new text begin The advisory council shall meet at least quarterly. Meetings of the
advisory council are subject to chapter 13D.
new text end

new text begin Subd. 6. new text end

new text begin Exemption. new text end

new text begin Notwithstanding section 15.059, the advisory council shall not
expire.
new text end

Sec. 4.

new text begin [62J.89] DUTIES OF THE BOARD.
new text end

new text begin Subdivision 1. new text end

new text begin General. new text end

new text begin (a) The board shall monitor the administration and reform of
the health care delivery and payment systems in the state. The board shall:
new text end

new text begin (1) set health care spending growth targets for the state, as specified under section 62J.90;
new text end

new text begin (2) enhance the transparency of provider organizations;
new text end

new text begin (3) monitor the adoption and effectiveness of alternative payment methodologies;
new text end

new text begin (4) foster innovative health care delivery and payment models that lower health care
cost growth while improving the quality of patient care;
new text end

new text begin (5) monitor and review the impact of changes within the health care marketplace; and
new text end

new text begin (6) monitor patient access to necessary health care services.
new text end

new text begin (b) The board shall establish goals to reduce health care disparities in racial and ethnic
communities and to ensure access to quality care for persons with disabilities or with chronic
or complex health conditions.
new text end

new text begin Subd. 2. new text end

new text begin Market trends. new text end

new text begin The board shall monitor efforts to reform the health care
delivery and payment system in Minnesota to understand emerging trends in the commercial
health insurance market, including large self-insured employers and the state's public health
care programs, in order to identify opportunities for state action to achieve:
new text end

new text begin (1) improved patient experience of care, including quality and satisfaction;
new text end

new text begin (2) improved health of all populations, including a reduction in health disparities; and
new text end

new text begin (3) a reduction in the growth of health care costs.
new text end

new text begin Subd. 3. new text end

new text begin Recommendations for reform. new text end

new text begin The board shall make recommendations for
legislative policy, market, or any other reforms to:
new text end

new text begin (1) lower the rate of growth in commercial health care costs and public health care
program spending in the state;
new text end

new text begin (2) positively impact the state's rankings in the areas listed in this subdivision and
subdivision 2; and
new text end

new text begin (3) improve the quality and value of care for all Minnesotans, and for specific populations
adversely affected by health inequities.
new text end

new text begin Subd. 4. new text end

new text begin Office of Patient Protection. new text end

new text begin The board shall establish an Office of Patient
Protection, to be operational by January 1, 2025. The office shall assist consumers with
issues related to access and quality of health care, and advise the legislature on ways to
reduce consumer health care spending and improve consumer experiences by reducing
complexity for consumers.
new text end

Sec. 5.

new text begin [62J.90] HEALTH CARE SPENDING GROWTH TARGETS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment and administration. new text end

new text begin The board shall establish and
administer the health care spending growth target program to limit health care spending
growth in the state, and shall report regularly to the legislature and the public on progress
toward these targets.
new text end

new text begin Subd. 2. new text end

new text begin Methodology. new text end

new text begin (a) The board shall develop a methodology to establish annual
health care spending growth targets and the economic indicators to be used in establishing
the initial and subsequent target levels.
new text end

new text begin (b) The health care spending growth target must:
new text end

new text begin (1) use a clear and operational definition of total state health care spending;
new text end

new text begin (2) promote a predictable and sustainable rate of growth for total health care spending
as measured by an established economic indicator, such as the rate of increase of the state's
economy or of the personal income of residents of this state, or a combination;
new text end

new text begin (3) define the health care markets and the entities to which the targets apply;
new text end

new text begin (4) take into consideration the potential for variability in targets across public and private
payers;
new text end

new text begin (5) account for the health status of patients; and
new text end

new text begin (6) incorporate specific benchmarks related to health equity.
new text end

new text begin (c) In developing, implementing, and evaluating the growth target program, the board
shall:
new text end

new text begin (1) consider the incorporation of quality of care and primary care spending goals;
new text end

new text begin (2) ensure that the program does not place a disproportionate burden on communities
most impacted by health disparities, the providers who primarily serve communities most
impacted by health disparities, or individuals who reside in rural areas or have high health
care needs;
new text end

new text begin (3) explicitly consider payment models that help ensure financial sustainability of rural
health care delivery systems and the ability to provide population health;
new text end

new text begin (4) allow setting growth targets that encourage an individual health care entity to serve
populations with greater health care risks by incorporating:
new text end

new text begin (i) a risk factor adjustment reflecting the health status of the entity's patient mix; and
new text end

new text begin (ii) an equity adjustment accounting for the social determinants of health and other
factors related to health equity for the entity's patient mix;
new text end

new text begin (5) ensure that growth targets:
new text end

new text begin (i) do not constrain the Minnesota health care workforce, including the need to provide
competitive wages and benefits;
new text end

new text begin (ii) do not limit the use of collective bargaining or place a floor or ceiling on health care
workforce compensation; and
new text end

new text begin (iii) promote workforce stability and maintain high-quality health care jobs; and
new text end

new text begin (6) consult with the advisory council and other stakeholders.
new text end

new text begin Subd. 3. new text end

new text begin Data. new text end

new text begin The board shall identify data to be used for tracking performance in
meeting the growth target and identify methods of data collection necessary for efficient
implementation by the board. In identifying data and methods, the board shall:
new text end

new text begin (1) consider the availability, timeliness, quality, and usefulness of existing data, including
the data collected under section 62U.04;
new text end

new text begin (2) assess the need for additional investments in data collection, data validation, or data
analysis capacity to support the board in performing its duties; and
new text end

new text begin (3) minimize the reporting burden to the extent possible.
new text end

new text begin Subd. 4. new text end

new text begin Setting growth targets; related duties. new text end

new text begin (a) The board, by June 15, 2024, and
by June 15 of each succeeding calendar year through June 15, 2028, shall establish annual
health care spending growth targets for the next calendar year consistent with the
requirements of this section. The board shall set annual health care spending growth targets
for the five-year period from January 1, 2025, through December 31, 2029.
new text end

new text begin (b) The board shall periodically review all components of the health care spending
growth target program methodology, economic indicators, and other factors. The board may
revise the annual spending growth targets after a public hearing, as appropriate. If the board
revises a spending growth target, the board must provide public notice at least 60 days
before the start of the calendar year to which the revised growth target will apply.
new text end

new text begin (c) The board, based on an analysis of drivers of health care spending and evidence from
public testimony, shall evaluate strategies and new policies, including the establishment of
accountability mechanisms, that are able to contribute to meeting growth targets and limiting
health care spending growth without increasing disparities in access to health care.
new text end

new text begin Subd. 5. new text end

new text begin Hearings. new text end

new text begin At least annually, the board shall hold public hearings to present
findings from spending growth target monitoring. The board shall also regularly hold public
hearings to take testimony from stakeholders on health care spending growth, setting and
revising health care spending growth targets, the impact of spending growth and growth
targets on health care access and quality, and as needed to perform the duties assigned under
section 62J.89, subdivisions 1, 2, and 3.
new text end

Sec. 6.

new text begin [62J.91] NOTICE TO HEALTH CARE ENTITIES.
new text end

new text begin Subdivision 1. new text end

new text begin Notice. new text end

new text begin (a) The board shall provide notice to all health care entities that
have been identified by the board as exceeding the spending growth target for any given
year.
new text end

new text begin (b) For purposes of this section, "health care entity" shall be defined by the board during
the development of the health care spending growth methodology. When developing this
methodology, the board shall consider a definition of health care entity that includes clinics,
hospitals, ambulatory surgical centers, physician organizations, accountable care
organizations, integrated provider and plan systems, and other entities defined by the board,
provided that physician organizations with a patient panel of 15,000 or fewer, or which
represent providers who collectively receive less than $25,000,000 in annual net patient
service revenue from health plan companies and other payers, shall be exempt.
new text end

new text begin Subd. 2. new text end

new text begin Performance improvement plans. new text end

new text begin (a) The board shall establish and implement
procedures to assist health care entities to improve efficiency and reduce cost growth by
requiring some or all health care entities provided notice under subdivision 1 to file and
implement a performance improvement plan. The board shall provide written notice of this
requirement to health care entities.
new text end

new text begin (b) Within 45 days of receiving a notice of the requirement to file a performance
improvement plan, a health care entity shall:
new text end

new text begin (1) file a performance improvement plan with the board; or
new text end

new text begin (2) file an application with the board to waive the requirement to file a performance
improvement plan or extend the timeline for filing a performance improvement plan.
new text end

new text begin (c) The health care entity may file any documentation or supporting evidence with the
board to support the health care entity's application to waive or extend the timeline to file
a performance improvement plan. The board shall require the health care entity to submit
any other relevant information it deems necessary in considering the waiver or extension
application, provided that this information shall be made public at the discretion of the
board. The board may waive or delay the requirement for a health care entity to file a
performance improvement plan in response to a waiver or extension request in light of all
information received from the health care entity, based on a consideration of the following
factors:
new text end

new text begin (1) the costs, price, and utilization trends of the health care entity over time, and any
demonstrated improvement in reducing per capita medical expenses adjusted by health
status;
new text end

new text begin (2) any ongoing strategies or investments that the health care entity is implementing to
improve future long-term efficiency and reduce cost growth;
new text end

new text begin (3) whether the factors that led to increased costs for the health care entity can reasonably
be considered to be unanticipated and outside of the control of the entity. new text end new text begin These factors may
include but shall not be limited to age and other health status adjusted factors and other cost
inputs such as pharmaceutical expenses and medical device expenses;
new text end

new text begin (4) the overall financial condition of the health care entity; and
new text end

new text begin (5) any other factors the board considers relevant. If the board declines to waive or
extend the requirement for the health care entity to file a performance improvement plan,
the board shall provide written notice to the health care entity that its application for a waiver
or extension was denied and the health care entity shall file a performance improvement
plan.
new text end

new text begin (d) A health care entity shall file a performance improvement plan with the board:
new text end

new text begin (1) within 45 days of receipt of an initial notice;
new text end

new text begin (2) if the health care entity has requested a waiver or extension, within 45 days of receipt
of a notice that such waiver or extension has been denied; or
new text end

new text begin (3) if the health care entity is granted an extension, on the date given on the extension.
new text end

new text begin The performance improvement plan shall identify the causes of the entity's cost growth and
shall include but not be limited to specific strategies, adjustments, and action steps the entity
proposes to implement to improve cost performance. The proposed performance improvement
plan shall include specific identifiable and measurable expected outcomes and a timetable
for implementation. The timetable for a performance improvement plan must not exceed
18 months.
new text end

new text begin (e) The board shall approve any performance improvement plan that it determines is
reasonably likely to address the underlying cause of the entity's cost growth and has a
reasonable expectation for successful implementation. If the board determines that the
performance improvement plan is unacceptable or incomplete, the board may provide
consultation on the criteria that have not been met and may allow an additional time period
of up to 30 calendar days for resubmission. Upon approval of the proposed performance
improvement plan, the board shall notify the health care entity to begin immediate
implementation of the performance improvement plan. Public notice shall be provided by
the board on its website, identifying that the health care entity is implementing a performance
improvement plan. All health care entities implementing an approved performance
improvement plan shall be subject to additional reporting requirements and compliance
monitoring, as determined by the board. The board shall provide assistance to the health
care entity in the successful implementation of the performance improvement plan.
new text end

new text begin (f) All health care entities shall in good faith work to implement the performance
improvement plan. At any point during the implementation of the performance improvement
plan, the health care entity may file amendments to the performance improvement plan,
subject to approval of the board. At the conclusion of the timetable established in the
performance improvement plan, the health care entity shall report to the board regarding
the outcome of the performance improvement plan. If the board determines the performance
improvement plan was not implemented successfully, the board shall:
new text end

new text begin (1) extend the implementation timetable of the existing performance improvement plan;
new text end

new text begin (2) approve amendments to the performance improvement plan as proposed by the health
care entity;
new text end

new text begin (3) require the health care entity to submit a new performance improvement plan; or
new text end

new text begin (4) waive or delay the requirement to file any additional performance improvement
plans.
new text end

new text begin Upon the successful completion of the performance improvement plan, the board shall
remove the identity of the health care entity from the board's website. The board may assist
health care entities with implementing the performance improvement plans or otherwise
ensure compliance with this subdivision.
new text end

new text begin (g) If the board determines that a health care entity has:
new text end

new text begin (1) willfully neglected to file a performance improvement plan with the board within
45 days as required;
new text end

new text begin (2) failed to file an acceptable performance improvement plan in good faith with the
board;
new text end

new text begin (3) failed to implement the performance improvement plan in good faith; or
new text end

new text begin (4) knowingly failed to provide information required by this subdivision to the board or
knowingly provided false information, the board may assess a civil penalty to the health
care entity of not more than $500,000. The board shall only impose a civil penalty as a last
resort.
new text end

Sec. 7.

new text begin [62J.92] REPORTING REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin General requirement. new text end

new text begin (a) The board shall present the reports required
by this section to the chairs and ranking members of the legislative committees with primary
jurisdiction over health care finance and policy. The board shall also make these reports
available to the public on the board's website.
new text end

new text begin (b) The board may contract with a third-party vendor for technical assistance in preparing
the reports.
new text end

new text begin Subd. 2. new text end

new text begin Progress reports. new text end

new text begin The board shall submit written progress updates about the
development and implementation of the health care spending growth target program by
February 15, 2025, and February 15, 2026. The updates must include reporting on board
membership and activities, program design decisions, planned timelines for implementation
of the program, and the progress of implementation. The reports must include the
methodological details underlying program design decisions.
new text end

new text begin Subd. 3. new text end

new text begin Health care spending trends. new text end

new text begin By December 15, 2025, and every December
15 thereafter, the board shall submit a report on health care spending trends and the health
care spending growth target program that includes:
new text end

new text begin (1) spending growth in aggregate and for entities subject to health care spending growth
targets relative to established target levels;
new text end

new text begin (2) findings from analyses of drivers of health care spending growth;
new text end

new text begin (3) estimates of the impact of health care spending growth on Minnesota residents,
including for communities most impacted by health disparities, related to their access to
insurance and care, value of health care, and the ability to pursue other spending priorities;
new text end

new text begin (4) the potential and observed impact of the health care growth targets on the financial
viability of the rural delivery system;
new text end

new text begin (5) changes under consideration for revising the methodology to monitor or set growth
targets;
new text end

new text begin (6) recommendations for initiatives to assist health care entities in meeting health care
spending growth targets, including broader and more transparent adoption of value-based
payment arrangements; and
new text end

new text begin (7) the number of health care entities whose spending growth exceeded growth targets,
information on performance improvement plans and the extent to which the plans were
completed, and any civil penalties imposed on health care entities related to noncompliance
with performance improvement plans and related requirements.
new text end

Sec. 8.

Minnesota Statutes 2022, section 62U.04, subdivision 11, is amended to read:

Subd. 11.

Restricted uses of the all-payer claims data.

(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:

(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;

(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; deleted text begin and
deleted text end

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;

(ii) not identify individual patients, payers, or providers;

(iii) be updated by the commissioner, at least annually, with the most current data
available;

(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and

(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) to provide technical assistance to the Health Care Affordability Board to implement
sections 62J.86 to 62J.92.
new text end

(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.

(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.

(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.

(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).

Sec. 9.

new text begin [62V.12] STATE-FUNDED COST-SHARING REDUCTIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin (a) The board must develop and administer a state-funded
cost-sharing reduction program for eligible persons who enroll in a silver level qualified
health plan through MNsure. The board must implement the cost-sharing reduction program
for plan years beginning on or after January 1, 2024.
new text end

new text begin (b) For purposes of this section, an "eligible person" is an individual who meets the
eligibility criteria to receive a cost-sharing reduction under Code of Federal Regulations,
title 45, section 155.305(g).
new text end

new text begin Subd. 2. new text end

new text begin Reduction in cost-sharing. new text end

new text begin (a) The cost-sharing reduction program must use
state funds to reduce enrollee cost-sharing by increasing the actuarial value of silver level
health plans for eligible persons beyond the 73 percent value established in Code of Federal
Regulations, title 45, section 156.420(a)(3)(ii), to an actuarial value of 87 percent.
new text end

new text begin (b) Paragraph (a) applies beginning for plan year 2024 for eligible individuals expected
to have a household income above 200 percent of the federal poverty level but that does
not exceed 250 percent of the federal poverty level, for the benefit year for which coverage
is requested.
new text end

new text begin (c) Beginning for plan year 2026, the cost-sharing reduction program applies for eligible
individuals expected to have a household income above 250 percent of the federal poverty
level but that does not exceed 300 percent of the federal poverty level, for the benefit year
for which coverage is requested. Under this paragraph, the cost-sharing reduction program
applies by increasing the actuarial value of silver level health plans for eligible persons to
the 73 percent actuarial value established in Code of Federal Regulations, title 45, section
156.420(a)(3)(ii).
new text end

new text begin Subd. 3. new text end

new text begin Administration. new text end

new text begin The board, when administering the program, must:
new text end

new text begin (1) allow eligible persons to enroll in a silver level health plan with a state-funded
cost-sharing reduction;
new text end

new text begin (2) modify the MNsure shopping tool to display the total cost-sharing reduction benefit
available to individuals eligible under this section; and
new text end

new text begin (3) reimburse health carriers on a quarterly basis for the cost to the health plan providing
the state-funded cost-sharing reductions.
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. 10.

Minnesota Statutes 2022, section 256B.0631, is amended by adding a subdivision
to read:

new text begin Subd. 1a. new text end

new text begin Prohibition on cost-sharing and deductibles. new text end

new text begin The medical assistance benefit
plan must not include cost-sharing or deductibles for any medical assistance recipient or
benefit.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2025, and applies to all medical
assistance benefit plans offered, issued, or renewed on or after that date.
new text end

Sec. 11. new text begin RECOMMENDATIONS; OFFICE OF PATIENT PROTECTION.
new text end

new text begin (a) The commissioners of human services, health, and commerce and the MNsure board
shall submit to the health care affordability board and the chairs and ranking minority
members of the legislative committees with primary jurisdiction over health and human
services finance and policy and commerce by January 15, 2024, a report on the organization
and duties of the Office of Patient Protection, to be established under Minnesota Statutes,
section 62J.89, subdivision 4. The report must include recommendations on how the office
shall:
new text end

new text begin (1) coordinate or consolidate within the office existing state agency patient protection
activities, including but not limited to the activities of ombudsman offices and the MNsure
board;
new text end

new text begin (2) enforce standards and procedures under Minnesota Statutes, chapter 62M, for
utilization review organizations;
new text end

new text begin (3) work with private sector and state agency consumer assistance programs to assist
consumers with questions or concerns relating to public programs and private insurance
coverage;
new text end

new text begin (4) establish and implement procedures to assist consumers aggrieved by restrictions on
patient choice, denials of services, and reductions in quality of care resulting from any final
action by a payer or provider; and
new text end

new text begin (5) make health plan company quality of care and patient satisfaction information and
other information collected by the office readily accessible to consumers on the board's
website.
new text end

new text begin (b) The commissioners and the MNsure board shall consult with stakeholders as they
develop the recommendations. The stakeholders consulted must include but are not limited
to organizations and individuals representing: underserved communities; persons with
disabilities; low-income Minnesotans; senior citizens; and public and private sector health
plan enrollees, including persons who purchase coverage through MNsure, health plan
companies, and public and private sector purchasers of health coverage.
new text end

new text begin (c) The commissioners and the MNsure board may contract with a third party to develop
the report and recommendations.
new text end

Sec. 12. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2022, section 256B.0631, subdivisions 1, 2, and 3, new text end new text begin are repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2025.
new text end

ARTICLE 3

PUBLIC OPTION

Section 1.

Minnesota Statutes 2022, section 256L.04, subdivision 7a, is amended to read:

Subd. 7a.

Ineligibility.

Adults whose income is greater than the limits established under
this section may not enroll in the MinnesotaCare program new text begin , except as provided in subdivision
15 new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, or upon federal approval,
whichever is later, subject to certification under section 7. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256L.04, is amended by adding a subdivision to
read:

new text begin Subd. 15. new text end

new text begin Persons eligible for public option. new text end

new text begin (a) Families and individuals with income
above the maximum income eligibility limit specified in subdivision 1 or 7 but who meet
all other MinnesotaCare eligibility requirements are eligible for MinnesotaCare. All other
provisions of this chapter apply unless otherwise specified.
new text end

new text begin (b) Families and individuals may enroll in MinnesotaCare under this subdivision only
during an annual open enrollment period or special enrollment period, as designated by
MNsure in compliance with Code of Federal Regulations, title 45, parts 155.410 and 155.420.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, or upon federal approval,
whichever is later, subject to certification under section 7. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2022, section 256L.07, subdivision 1, is amended to read:

Subdivision 1.

General requirements.

Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty
guidelines deleted text begin , deleted text end are no longer eligible for the program and deleted text begin shall deleted text end new text begin must new text end be disenrolled by the
commissioner new text begin , unless the individuals continue MinnesotaCare enrollment through the public
option under section 256L.04, subdivision 15 new text end . For persons disenrolled under this subdivision,
MinnesotaCare coverage terminates the last day of the calendar month in which the
commissioner sends advance notice according to Code of Federal Regulations, title 42,
section 431.211, that indicates the income of a family or individual exceeds program income
limits.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, or upon federal approval,
whichever is later, subject to certification under section 7. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end

Sec. 4.

Minnesota Statutes 2022, section 256L.15, subdivision 2, is amended to read:

Subd. 2.

Sliding fee scale; monthly individual or family income.

(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.

deleted text begin (b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end Paragraph deleted text begin (b) deleted text end new text begin (a) new text end does not apply to deleted text begin :
deleted text end

deleted text begin (1) deleted text end children 20 years of age or younger deleted text begin ; and
deleted text end

deleted text begin (2) individuals with household incomes below 35 percent of the federal poverty deleted text end
deleted text begin guidelines deleted text end .

deleted text begin (d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
deleted text end

deleted text begin Federal Poverty Guideline deleted text end deleted text begin Greater than or Equal to deleted text end	deleted text begin Less than deleted text end	deleted text begin Individual Premium deleted text end deleted text begin Amount deleted text end
deleted text begin 35% deleted text end	deleted text begin 55% deleted text end	deleted text begin $4 deleted text end
deleted text begin 55% deleted text end	deleted text begin 80% deleted text end	deleted text begin $6 deleted text end
deleted text begin 80% deleted text end	deleted text begin 90% deleted text end	deleted text begin $8 deleted text end
deleted text begin 90% deleted text end	deleted text begin 100% deleted text end	deleted text begin $10 deleted text end
deleted text begin 100% deleted text end	deleted text begin 110% deleted text end	deleted text begin $12 deleted text end
deleted text begin 110% deleted text end	deleted text begin 120% deleted text end	deleted text begin $14 deleted text end
deleted text begin 120% deleted text end	deleted text begin 130% deleted text end	deleted text begin $15 deleted text end
deleted text begin 130% deleted text end	deleted text begin 140% deleted text end	deleted text begin $16 deleted text end
deleted text begin 140% deleted text end	deleted text begin 150% deleted text end	deleted text begin $25 deleted text end
deleted text begin 150% deleted text end	deleted text begin 160% deleted text end	deleted text begin $37 deleted text end
deleted text begin 160% deleted text end	deleted text begin 170% deleted text end	deleted text begin $44 deleted text end
deleted text begin 170% deleted text end	deleted text begin 180% deleted text end	deleted text begin $52 deleted text end
deleted text begin 180% deleted text end	deleted text begin 190% deleted text end	deleted text begin $61 deleted text end
deleted text begin 190% deleted text end	deleted text begin 200% deleted text end	deleted text begin $71 deleted text end
deleted text begin 200% deleted text end		deleted text begin $80 deleted text end

deleted text begin (e) deleted text end new text begin (c) new text end Beginning January 1, deleted text begin 2021 deleted text end new text begin 2024 new text end , new text begin the commissioner shall continue to charge
premiums in accordance with the simplified premium scale established to comply with the
American Rescue Plan Act of 2021, in effect from January 1, 2021, through December 31,
2025, for families and individuals eligible under section 256L.04, subdivisions 1 and 7. new text end The
commissioner shall adjust the premium scale deleted text begin established under paragraph (d) deleted text end new text begin as needed new text end to
ensure that premiums do not exceed the amount that an individual would have been required
to pay if the individual was enrolled in an applicable benchmark plan in accordance with
the Code of Federal Regulations, title 42, section 600.505 (a)(1).

new text begin (d) The commissioner shall establish a sliding premium scale for persons eligible through
the public option under section 256L.04, subdivision 15. Beginning January 1, 2027, persons
eligible through the public option shall pay premiums according to this premium scale.
Persons eligible through the public option who are 20 years of age or younger are exempt
from paying premiums.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and certification under
section 7 is not required, except that paragraph (d) is effective January 1, 2027, or upon
federal approval, whichever is later, subject to certification under section 7. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

Sec. 5. new text begin TRANSITION TO MINNESOTACARE PUBLIC OPTION.
new text end

new text begin (a) The commissioner of human services must continue to administer MinnesotaCare
as a basic health program in accordance with Minnesota Statutes, section 256L.02,
subdivision 5, and must seek federal waivers, approvals, and law changes as required under
section 6.
new text end

new text begin (b) The commissioner must present an implementation plan for the MinnesotaCare public
option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care policy
and finance by December 15, 2024. The plan must include:
new text end

new text begin (1) recommendations for any changes to the MinnesotaCare public option necessary to
continue federal basic health program funding or to receive other federal funding;
new text end

new text begin (2) recommendations for ensuring sufficient provider participation in MinnesotaCare;
new text end

new text begin (3) estimates of state costs related to the MinnesotaCare public option;
new text end

new text begin (4) a description of the proposed premium scale for persons eligible through the public
option, including an analysis of the extent to which the proposed premium scale:
new text end

new text begin (i) ensures affordable premiums for persons across the income spectrum enrolled under
the public option; and
new text end

new text begin (ii) avoids premium cliffs for persons transitioning to and enrolled under the public
option; and
new text end

new text begin (5) draft legislation that includes any additional policy and conforming changes necessary
to implement the MinnesotaCare public option and the implementation plan
recommendations.
new text end

new text begin (c) The commissioner shall present to the chairs and ranking minority members of the
legislative committees with jurisdiction over health care policy and finance, by January 15,
2025, a report comparing service delivery and payment system models for delivering services
to MinnesotaCare enrollees eligible under Minnesota Statutes, section 256L.04, subdivisions
1, 7, and 15. The report must compare the current delivery model with at least two alternative
models. The alternative models must include a state-based model in which the state holds
the plan risk as the insurer and may contract with a third-party administrator for claims
processing and plan administration. The alternative models may include but are not limited
to:
new text end

new text begin (1) expanding the use of integrated health partnerships under Minnesota Statutes, section
256B.0755;
new text end

new text begin (2) delivering care under fee-for-service through a primary care case management system;
and
new text end

new text begin (3) continuing to contract with managed care and county-based purchasing plans for
some or all enrollees under modified contracts.
new text end

new text begin (d) The report must also include:
new text end

new text begin (1) a description of how each model would address:
new text end

new text begin (i) racial inequities in the delivery of health care and health care outcomes;
new text end

new text begin (ii) geographic inequities in the delivery of health care;
new text end

new text begin (iii) incentives for preventive care and other best practices; and
new text end

new text begin (iv) reimbursement of providers for high-quality, value-based care at levels sufficient
to sustain or increase enrollee access to care;
new text end

new text begin (2) a comparison of the projected cost of each model; and
new text end

new text begin (3) an implementation timeline for each model that includes the earliest date by which
each model could be implemented if authorized during the 2025 legislative session.
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. 6. new text begin REQUEST FOR FEDERAL APPROVAL.
new text end

new text begin (a) The commissioner of human services must seek all federal waivers, approvals, and
law changes necessary to implement article 3, including but not limited to those waivers,
approvals, and law changes necessary to allow the state to:
new text end

new text begin (1) continue receiving federal basic health program payments for basic health
program-eligible MinnesotaCare enrollees and to receive other federal funding for the
MinnesotaCare public option;
new text end

new text begin (2) receive federal payments equal to the value of premium tax credits and cost-sharing
reductions that MinnesotaCare enrollees with household incomes greater than 200 percent
of the federal poverty guidelines would otherwise have received; and
new text end

new text begin (3) receive federal payments equal to the value of emergency medical assistance that
would otherwise have been paid to the state for covered services provided to eligible
enrollees.
new text end

new text begin (b) In implementing this section, the commissioner of human services must contract
with one or more independent entities to conduct an actuarial analysis of the implementation,
administration, and effects of the provisions of article 3, including but not limited to benefits,
costs, impacts on coverage, and affordability to the state and eligible enrollees, impacts on
the state's individual market, and compliance with federal law, at a minimum as necessary
to obtain any waivers, approvals, and law changes sought under this section.
new text end

new text begin (c) In implementing this section, the commissioner of human services must consult with
the commissioner of commerce and the Board of Directors of MNsure and may contract
for technical assistance.
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. 7. new text begin CONTINGENT EFFECTIVE DATE.
new text end

new text begin Sections 1, 2, and 3, and the specified portion of section 4, are effective January 1, 2027,
or upon federal approval, whichever is later, but only if the commissioner of human services
certifies to the legislature the following:
new text end

new text begin (1) that implementation of those sections will not result in substantial reduction in federal
basic health program funding for MinnesotaCare enrollees with incomes not exceeding 200
percent of the federal poverty guidelines;
new text end

new text begin (2) premiums necessary to operationalize the program are deemed affordable in
accordance with applicable federal law;
new text end

new text begin (3) the actuarial value of benefit does not fall below 94 percent and the benefit set is
equal to or greater than that historically available in MinnesotaCare;
new text end

new text begin (4) the 1332 waiver was approved consistent, or without substantial deviation, from the
implementation plan;
new text end

new text begin (5) the commissioner of commerce certifies that the public option would expand plan
options available for individuals purchasing coverage;
new text end

new text begin (6) the state receives a substantially similar pass-through funding amount from the federal
government that would have otherwise gone to enrollees' advanced premium tax credits;
new text end

new text begin (7) individuals currently served by the MinnesotaCare program are not disproportionally
or substantively negatively impacted in order to make the public option affordable or
implementable; and
new text end

new text begin (8) individuals currently served by the Medical Assistance program are not
disproportionally or substantively negatively impacted in order to make the public option
affordable or implementable.
new text end

new text begin The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end

ARTICLE 4

HEALTH CARE MODEL STUDIES

Section 1. new text begin ANALYSIS OF BENEFITS AND COSTS OF A UNIVERSAL HEALTH
CARE SYSTEM.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) "Total public and private health care spending" means:
new text end

new text begin (1) spending on all medical care including but not limited to dental, vision and hearing,
mental health, chemical dependency treatment, prescription drugs, medical equipment and
supplies, long-term care, and home care, whether paid through premiums, co-pays and
deductibles, other out-of-pocket payments, or other funding from government, employers,
or other sources; and
new text end

new text begin (2) the costs associated with administering, delivering, and paying for the care. The costs
of administering, delivering, and paying for the care includes all expenses by insurers,
providers, employers, individuals, and government to select, negotiate, purchase, and
administer insurance and care including but not limited to coverage for health care, dental,
long-term care, prescription drugs, medical expense portions of workers compensation and
automobile insurance, and the cost of administering and paying for all health care products
and services that are not covered by insurance.
new text end

new text begin (b) "All necessary care" means the full range of services listed in the proposed Minnesota
Health Plan legislation, including medical, dental, vision and hearing, mental health, chemical
dependency treatment, reproductive and sexual health, prescription drugs, medical equipment
and supplies, long-term care, home care, and coordination of care.
new text end

new text begin Subd. 2. new text end

new text begin Initial assumptions. new text end

new text begin (a) When calculating administrative savings under the
universal health proposal, the analysts shall recognize that simple, direct payment of medical
services avoids the need for provider networks, eliminates prior authorization requirements,
and eliminates administrative complexity of other payment schemes along with the need
for creating risk adjustment mechanisms, and measuring, tracking, and paying under those
risk adjusted or nonrisk adjusted payment schemes by both providers and payors.
new text end

new text begin (b) The analysts shall assume that, while gross provider payments may be reduced to
reflect reduced administrative costs, net provider income would remain similar to the current
system. However, they shall not assume that payment rate negotiations will track current
Medicaid, Medicare, or market payment rates or a combination of those rates, because
provider compensation, after adjusting for reduced administrative costs, would not be
universally raised or lowered but would be negotiated based on market needs, so provider
compensation might be raised in an underserved area such as mental health but lowered in
other areas.
new text end

Sec. 2. new text begin BENEFIT AND COST ANALYSIS OF A UNIVERSAL HEALTH REFORM
PROPOSAL.
new text end

new text begin Subdivision 1. new text end

new text begin Contract for analysis of proposal. new text end

new text begin The commissioner of health shall
contract with one or more independent entities to conduct an analysis of the benefits and
costs of a legislative proposal for a universal health care financing system and a similar
analysis of the current health care financing system to assist the state in comparing the
proposal to the current system. The contract must strive to produce estimates for all elements
in subdivision 3.
new text end

new text begin Subd. 2. new text end

new text begin Proposal. new text end

new text begin The commissioner of health, with input from the commissioners of
human services and commerce, shall submit to the contractor for analysis the legislative
proposal known as the Minnesota Health Plan, proposed in 2023 Senate File No. 2740;
House File No. 2798, if enacted, that would offer a universal health care plan designed to
meet a set of principles, including:
new text end

new text begin (1) ensure all Minnesotans are covered;
new text end

new text begin (2) cover all necessary care; and
new text end

new text begin (3) allow patients to choose their doctors, hospitals, and other providers.
new text end

new text begin Subd. 3. new text end

new text begin Proposal analysis. new text end

new text begin (a) The analysis must measure the performance of both the
proposed Minnesota Health Plan and the current public and private health care financing
system over a ten-year period to contrast the impact on:
new text end

new text begin (1) coverage: the number of people who are uninsured versus the number of people who
are insured;
new text end

new text begin (2) benefit completeness: adequacy of coverage measured by the completeness of the
coverage and the number of people lacking coverage for key necessary care elements such
as dental, long-term care, medical equipment or supplies, vision and hearing, or other health
services that are not covered, if any. The analysis must take into account the vast variety of
benefit designs in the commercial market and report the extent of coverage in each area;
new text end

new text begin (3) underinsurance: whether people with coverage can afford the care they need or
whether cost prevents them from accessing care. This includes affordability in terms of
premiums, deductibles, and out-of-pocket expenses;
new text end

new text begin (4) system capacity: the timeliness and appropriateness of the care received and whether
people turn to inappropriate care such as emergency rooms because of a lack of proper care
in accordance with clinical guidelines; and
new text end

new text begin (5) health care spending: total public and private health care spending in Minnesota
under the current system versus under the Minnesota Health Plan legislative proposal,
including all spending by individuals, businesses, and government. Where relevant, the
analysis shall be broken out by key necessary care areas, such as medical, dental, and mental
health. The analysis of total health care spending shall examine whether there are savings
or additional costs under the legislative proposal compared to the existing system due to:
new text end

new text begin (i) changes in cost of insurance, billing, underwriting, marketing, evaluation, and other
administrative functions for all entities involved in the health care system, including savings
from global budgeting for hospitals and institutional care instead of billing for individual
services provided;
new text end

new text begin (ii) changed prices on medical services and products, including pharmaceuticals, due to
price negotiations under the proposal;
new text end

new text begin (iii) impact on utilization, health outcomes, and workplace absenteeism due to prevention,
early intervention, and health-promoting activities;
new text end

new text begin (iv) shortages or excess capacity of medical facilities, equipment, and personnel, including
caregivers and staff, under either the current system or the proposal, including capacity of
clinics, hospitals, and other appropriate care sites versus inappropriate emergency room
usage. The analysis shall break down capacity by geographic differences such as rural versus
metro, and disparate access by population group;
new text end

new text begin (v) the impact on state, local, and federal government non-health-care expenditures.
This may include areas such as reduced crime and out-of-home placement costs due to
mental health or chemical dependency coverage. Additional definition may further develop
hypotheses for other impacts that warrant analysis;
new text end

new text begin (vi) job losses or gains within the health care system; specifically, in health care delivery,
health billing, and insurance administration;
new text end

new text begin (vii) job losses or gains elsewhere in the economy under the proposal due to
implementation of the resulting reduction of insurance and administrative burdens on
businesses; and
new text end

new text begin (viii) impact on disparities in health care access and outcomes.
new text end

new text begin (b) The contractor or contractors shall propose an iterative process for designing and
conducting the analysis. Steps shall be reviewed with and approved by the commissioner
of health and lead house and senate authors of the legislative proposal, and shall include
but not be limited to:
new text end

new text begin (1) clarification of the specifics of the proposal. The analysis shall assume that the
provisions in the proposal are not preempted by federal law or that the federal government
gives a waiver to the preemptions;
new text end

new text begin (2) additional data elements needed to accomplish goals of the analysis;
new text end

new text begin (3) assumptions analysts are using in their analysis and the quality of the evidence behind
those assumptions;
new text end

new text begin (4) timing of each stage of the project with agreed upon decision points;
new text end

new text begin (5) approaches to address any services currently provided in the existing health care
system that may not be provided for within the Minnesota Health Plan as proposed; and
new text end

new text begin (6) optional scenarios provided by contractor or contractors with minor alterations in
the proposed plan related to services covered or cost-sharing if those scenarios might be
helpful to the legislature.
new text end

new text begin (c) The commissioner shall issue a final report by January 15, 2026, and may provide
interim reports and status updates to the governor and the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance aligned with the iterative process defined above.
new text end

new text begin (d) The contractor may offer a modeling tool as deliverable with a line-item cost provided.
new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective the day following final enactment.
new text end

ARTICLE 5

APPROPRIATIONS

Section 1. new text begin COMMISSIONER OF HUMAN SERVICES.
new text end

new text begin (a) $505,000 in fiscal year 2024 and $579,000 in fiscal year 2025 are appropriated from
the general fund to the commissioner of human services for easy enrollment.
new text end

new text begin (b) $5,293,000 in fiscal year 2024 and $25,574,000 in fiscal year 2025 are appropriated
from the general fund to the commissioner of human services for medical assistance.
new text end

new text begin (c) $72,000 in fiscal year 2024 and $84,000 in fiscal year 2025 are appropriated from
the general fund to the commissioner of human services for responsibilities under the health
care affordability board.
new text end

new text begin (d) $9,255,000 in fiscal year 2024 and $8,167,000 in fiscal year 2025 are appropriated
from the general fund to the commissioner of human services for the MinnesotaCare public
option. The base for this appropriation is $3,417,000 in fiscal year 2026 and $7,960,000 in
fiscal year 2027.
new text end

new text begin (e) $15,000 in fiscal year 2024 and $3,000 in fiscal year 2025 are appropriated from the
general fund to the commissioner of human services for system costs.
new text end

new text begin (f) $1,470,000 in fiscal year 2024 and $1,470,000 in fiscal year 2025 are appropriated
from the health care access fund to the commissioner of human services for incentive
payments to navigators.
new text end

new text begin (g) $1,077,000 in fiscal year 2025 is appropriated from the general fund to the
commissioner of human services for MinnesotaCare.
new text end

Sec. 2. new text begin BOARD OF DIRECTORS OF MNSURE.
new text end

new text begin (a) $15,000,000 in fiscal year 2024 and $30,000,000 in fiscal year 2025 are appropriated
from the general fund to the Board of Directors of MNsure to implement the cost-sharing
reduction program under Minnesota Statutes, section 62V.12. The base for this appropriation
is $32,500,000 in fiscal year 2026 and $35,000,000 in fiscal year 2027.
new text end

new text begin (b) $3,000,000 in fiscal year 2024 is appropriated from the general fund to the Board of
Directors of MNsure to modernize MNsure's information technology infrastructure and
expand service capacities to implement the cost-sharing reduction program under Minnesota
Statutes, section 62V.12. This is a onetime appropriation.
new text end

new text begin (c) $313,000 in fiscal year 2024 and $514,000 in fiscal year 2025 are appropriated from
the general fund to the Board of Directors of MNsure for administrative costs for the
cost-sharing reduction program under Minnesota Statutes, section 62V.12.
new text end

new text begin (d) $70,000 in fiscal year 2024 and $70,000 in fiscal year 2025 are appropriated from
the general fund to the Board of Directors of MNsure for easy enrollment.
new text end

new text begin (e) $39,000 in fiscal year 2024 and $16,000 in fiscal year 2025 are appropriated from
the general fund to the Board of Directors of MNsure for responsibilities under the health
care affordability board.
new text end

new text begin (f) $4,200,000 in fiscal year 2025 is appropriated from the general fund to the Board of
Directors of MNsure to implement the MinnesotaCare public option. This is a onetime
appropriation.
new text end

Sec. 3. new text begin COMMISSIONER OF HEALTH.
new text end

new text begin (a) $2,795,000 in fiscal year 2024 and $3,046,000 in fiscal year 2025 are appropriated
from the general fund to the commissioner of health to fund activities of the health economics
division necessary to implement article 2, sections 1 to 8. The general fund base for this
appropriation is $2,994,000 in fiscal year 2026 and $2,994,000 in fiscal year 2027.
new text end

new text begin (b) $1,200,000 is appropriated in fiscal year 2024 from the general fund to the
commissioner of health to conduct an economic analysis of benefits and costs of the health
care system proposal in section 1 and to contract as necessary to complete the analysis. This
is a onetime appropriation and is available until June 30, 2026.
new text end

Sec. 4. new text begin COMMISSIONER OF REVENUE.
new text end

new text begin $40,000 in fiscal year 2024 and $4,000 in fiscal year 2025 are appropriated from the
general fund to the commissioner of revenue for easy enrollment.
new text end

Sec. 5. new text begin COMMISSIONER OF COMMERCE.
new text end

new text begin $42,000 in fiscal year 2024 and $17,000 in fiscal year 2025 are appropriated from the
general fund to the commissioner of commerce for responsibilities under the health care
affordability board.
new text end

Sec. 6. new text begin HEALTH CARE AFFORDABILITY BOARD.
new text end

new text begin $1,336,000 in fiscal year 2024 and $1,727,000 in fiscal year 2025 are appropriated from
the general fund to the Health Care Affordability Board to implement article 2, sections 1
to 8. The general fund base for this appropriation is $1,793,000 in fiscal year 2026 and
$1,790,000 in fiscal year 2027.
new text end

APPENDIX

Repealed Minnesota Statutes: S0049-1

256B.0631 MEDICAL ASSISTANCE CO-PAYMENTS.

Subdivision 1.

Cost-sharing.

(a) Except as provided in subdivision 2, the medical assistance benefit plan shall include the following cost-sharing for all recipients, effective for services provided from September 1, 2011, to December 31, 2023:

(1) $3 per nonpreventive visit, except as provided in paragraph (b). 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 assistant, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist;

(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this co-payment shall be increased to $20 upon federal approval;

(3) $3 per brand-name drug prescription, $1 per generic drug prescription, and $1 per prescription for a brand-name multisource drug listed in preferred status on the preferred drug list, subject to a $12 per month maximum for prescription drug co-payments. No co-payments shall apply to antipsychotic drugs when used for the treatment of mental illness;

(4) a family deductible equal to $2.75 per month per family and adjusted annually by the percentage increase in the medical care component of the CPI-U for the period of September to September of the preceding calendar year, rounded to the next higher five-cent increment;

(5) total monthly cost-sharing must not exceed five percent of family income. For purposes of this paragraph, family income is the total earned and unearned income of the individual and the individual's spouse, if the spouse is enrolled in medical assistance and also subject to the five percent limit on cost-sharing. This paragraph does not apply to premiums charged to individuals described under section 256B.057, subdivision 9; and

(6) cost-sharing for prescription drugs and related medical supplies to treat chronic disease must comply with the requirements of section 62Q.481.

(b) Recipients of medical assistance are responsible for all co-payments and deductibles in this subdivision.

(c) Notwithstanding paragraph (b), the commissioner, through the contracting process under sections 256B.69 and 256B.692, may allow managed care plans and county-based purchasing plans to waive the family deductible under paragraph (a), clause (4). The value of the family deductible shall not be included in the capitation payment to managed care plans and county-based purchasing plans. Managed care plans and county-based purchasing plans shall certify annually to the commissioner the dollar value of the family deductible.

(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the family deductible described under paragraph (a), clause (4), from individuals and allow long-term care and waivered service providers to assume responsibility for payment.

(e) Notwithstanding paragraph (b), the commissioner, through the contracting process under section 256B.0756 shall allow the pilot program in Hennepin County to waive co-payments. The value of the co-payments shall not be included in the capitation payment amount to the integrated health care delivery networks under the pilot program.

Subd. 2.

Exceptions.

Co-payments and deductibles shall be subject to the following exceptions:

(1) children under the age of 21;

(2) pregnant women for services that relate to the pregnancy or any other medical condition that may complicate the pregnancy;

(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or intermediate care facility for the developmentally disabled;

(4) recipients receiving hospice care;

(5) 100 percent federally funded services provided by an Indian health service;

(6) emergency services;

(7) family planning services;

(8) services that are paid by Medicare, resulting in the medical assistance program paying for the coinsurance and deductible;

(9) co-payments that exceed one per day per provider for nonpreventive visits, eyeglasses, and nonemergency visits to a hospital-based emergency room;

(10) services, fee-for-service payments subject to volume purchase through competitive bidding;

(11) American Indians who meet the requirements in Code of Federal Regulations, title 42, sections 447.51 and 447.56;

(12) persons needing treatment for breast or cervical cancer as described under section 256B.057, subdivision 10; and

(13) services that currently have a rating of A or B from the United States Preventive Services Task Force (USPSTF), immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and preventive services and screenings provided to women as described in Code of Federal Regulations, title 45, section 147.130.

Subd. 3.

Collection.

(a) The medical assistance reimbursement to the provider shall be reduced by the amount of the co-payment or deductible, except that reimbursements shall not be reduced:

(1) once a recipient has reached the $12 per month maximum for prescription drug co-payments; or

(2) for a recipient who has met their monthly five percent cost-sharing limit.

(b) The provider collects the co-payment or deductible from the recipient. Providers may not deny services to recipients who are unable to pay the co-payment or deductible.