SF 720

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 03/08/2017 10:32am

A bill for an act
relating to commerce; authorizing the Minnesota premium security plan as a
state-based reinsurance program administered by the Minnesota Comprehensive
Health Association; modifying certain provider taxes; imposing a reinsurance tax;
appropriating money; amending Minnesota Statutes 2016, sections 295.52,
subdivisions 1, 1a, 3, 4, 4a, by adding a subdivision; 295.58; proposing coding for
new law in Minnesota Statutes, chapter 62E.

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

Section 1.

[62E.21] DEFINITIONS.

Subdivision 1.

Application.

For the purposes of sections 62E.21 to 62E.25, the terms
and phrases defined in this section have the meanings given them.

Subd. 2.

Affordable Care Act.

"Affordable Care Act" means the Affordable Care Act
as defined in section 62A.011, subdivision 1a.

Subd. 3.

Attachment point.

"Attachment point" means the threshold dollar amount for
claims costs incurred by an eligible health carrier for an enrolled individual's covered benefits
in a plan year, after which threshold the claims costs for such benefits are eligible for
Minnesota premium security plan payments.

Subd. 4.

Board.

"Board" means the board of directors of the Minnesota Comprehensive
Health Association established under section 62E.10.

Subd. 5.

Coinsurance rate.

"Coinsurance rate" means the rate, established by the board
of the Minnesota Comprehensive Health Association, at which the association will reimburse
the eligible health carrier for claims costs incurred for an enrolled individual's covered
benefits in a plan year after the attachment point and before the reinsurance cap.

Subd. 6.

Commissioner.

"Commissioner" means the commissioner of commerce.

Subd. 7.

Eligible health carrier.

"Eligible health carrier" means:

(1) an insurance company licensed under chapter 60A to offer, sell, or issue a policy of
accident and sickness insurance as defined in section 62A.01;

(2) a nonprofit health service plan corporation operating under chapter 62C; or

(3) a health maintenance organization operating under chapter 62D

offering health plans in the individual market and incurring claims costs for an individual
enrollee's covered benefits in the applicable plan year that exceed the attachment point under
the Minnesota premium security plan.

Subd. 8.

Individual market.

"Individual market" has the meaning given in section
62A.011, subdivision 5.

Subd. 9.

Minnesota Comprehensive Health Association or association.

"Minnesota
Comprehensive Health Association" or "association" has the meaning given in section
62E.02, subdivision 14.

Subd. 10.

Minnesota premium security plan.

The "Minnesota premium security plan"
means the state-based reinsurance program authorized under section 62E.23.

Subd. 11.

Plan year.

"Plan year" means a calendar year for which an eligible health
carrier provides coverage under a health plan in the individual market.

Subd. 12.

Reinsurance cap.

"Reinsurance cap" means the threshold dollar amount for
claims costs incurred by an eligible health carrier for an enrolled individual's covered
benefits, after which threshold the claims costs for such benefits are no longer eligible for
Minnesota premium security plan payments, established by the board of the Minnesota
Comprehensive Health Association.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 2.

[62E.22] DUTIES OF COMMISSIONER.

In the implementation and operation of the Minnesota premium security plan, established
under section 62E.23, the commissioner shall require eligible health carriers to calculate
the premium amount the eligible health carrier would have charged for the applicable plan
year had the Minnesota premium security plan not been established and to submit this
information as part of the rate filing.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 3.

[62E.23] MINNESOTA PREMIUM SECURITY PLAN.

Subdivision 1.

The Minnesota premium security plan as state-based reinsurance.

The association is Minnesota's reinsurance entity to administer the state-based reinsurance
program referred to as the Minnesota premium security plan. The Minnesota premium
security plan shall be designed to protect consumers by mitigating the impact of high-risk
individuals on rates in the individual market.

Subd. 2.

Minnesota premium security plan parameters.

(a) The board shall propose
to the commissioner the Minnesota premium security plan payment parameters for the next
plan year by January 15 of the calendar year prior to the applicable plan year. In developing
the proposed payment parameters, the board shall consider the anticipated impact on
premiums. The commissioner shall approve the payment parameters no later than 14 calendar
days following the board proposal. In developing the proposed payment parameters for plan
year 2019 and after, the board may develop methods to account for variations in costs within
the Minnesota premium security plan.

(b) For plan year 2018, the Minnesota premium security plan parameters, including the
attachment point, reinsurance cap, and coinsurance rate, shall be established within the
parameters of the appropriated funds as follows:

(1) the attachment point is set at $45,000;

(2) the reinsurance cap is set at $250,000; and

(3) the coinsurance rate is set at 80 percent.

(c) All eligible health carriers receiving Minnesota premium security plan payments
must apply the Minnesota premium security plan's parameters established under paragraph
(a) or (b), as applicable, when calculating reinsurance payments.

Subd. 3.

Payments under Minnesota premium security plan.

(a) Each Minnesota
premium security plan payment must be calculated with respect to an eligible health carrier's
incurred claims costs for an individual enrollee's covered benefits in the applicable plan
year. If such claims costs do not exceed the attachment point, payment will be zero dollars.
If such claims costs exceed the attachment point, payment will be calculated as the product
of the coinsurance rate multiplied by the lesser of:

(1) such claims costs minus the attachment point; or

(2) the reinsurance cap minus the attachment point.

(b) The board must ensure that the payments made to eligible health carriers must not
exceed the eligible health carrier's total paid amount for any eligible claim. For purposes
of this paragraph, "total paid amount of an eligible claim" means the amount paid by the
eligible health carrier based upon the allowed amount less any deductible, coinsurance, or
co-payment, as of the time the data is submitted or made accessible under subdivision 4,
paragraph (b), clause (1).

Subd. 4.

Requests for Minnesota premium security plan payments.

(a) An eligible
health carrier may make a request for payment when the eligible health carrier's claims costs
for an enrollee meet the criteria for payment under subdivision 3 and the requirements of
this subdivision.

(b)(1) To be eligible for Minnesota premium security plan payments, an eligible health
carrier must provide to the association access to the data within the dedicated data
environment established by the eligible health carrier under the federal Risk Adjustment
Program. Eligible health carriers must submit an attestation to the board asserting entity
compliance with the dedicated data environments, data requirements, establishment and
usage of masked enrollee identification numbers, and data submission deadlines; and

(2) an eligible health carrier must provide the required access under clause (1) for the
applicable plan year by April 30 of the year following the end of the applicable plan year.

(c) An eligible health carrier must make requests for payment according to the
requirements established by the board.

(d) An eligible health carrier must maintain documents and records, whether paper,
electronic, or in other media, sufficient to substantiate the requests for Minnesota premium
security plan payments made pursuant to this section for a period of at least ten years and
must make those documents and records available upon request from the state or its designee
for purposes of verification, investigation, audit, or other review of Minnesota premium
security plan payment requests.

(e) The association or its designee may audit an eligible health carrier to assess the health
carrier's compliance with the requirements of this section. The eligible health carrier must
ensure that its relevant contracts, subcontractors, or agents cooperate with any audit under
this section. If an audit results in a proposed finding of material weakness or significant
deficiency with respect to compliance with any requirement under this section, the eligible
health carrier may provide a response to the draft audit report within 30 calendar days.
Within 30 calendar days of the issuance of the final audit report, the eligible health carrier
must complete the following:

(1) provide a written corrective action plan to the association for approval if the final
audit results in a finding of material weakness or significant deficiency with respect to
compliance with any requirement under this section;

(2) implement that plan; and

(3) provide to the association written documentation of the corrective actions once taken.

Subd. 5.

Notification of Minnesota premium security plan payments.

(a) For each
applicable plan year, the association must notify eligible health carriers annually of Minnesota
premium security plan payments, if applicable, to be made for the applicable plan year no
later than June 30 of the year following the applicable plan year.

(b) An eligible health carrier may follow the appeals procedure under section 62E.10,
subdivision 2a.

(c) For each applicable plan year, the board must provide to each eligible health carrier
the calculation of total Minnesota premium security plan payment requests on a quarterly
basis during the applicable plan year.

Subd. 6.

Disbursement of Minnesota premium security plan payments.

The
association must:

(1) collect or access data required to determine Minnesota premium security plan
payments from an eligible health carrier according to the data requirements under subdivision
5; and

(2) make Minnesota premium security plan payments to the eligible health carrier after
receiving a valid claim for payment from that eligible health carrier by August 15 of the
year following the applicable plan year.

Subd. 7.

Data.

Government data of the association under this section are private data
on individuals or nonpublic data as defined in section 13.02, subdivision 9 or 12.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 4.

[62E.24] ACCOUNTING, REPORTING, AND AUDITING.

Subdivision 1.

Accounting requirements.

For each plan year, the board must ensure
that it keeps an accounting of:

(1) all claims for Minnesota premium security plan payments received from eligible
health carriers;

(2) all Minnesota premium security plan payments made to eligible health carriers;

(3) all administrative expenses incurred for the Minnesota premium security plan; and

(4) all assessments made for security plan costs.

Subd. 2.

Summary report.

The board must submit to the commissioner and make public
a report on the Minnesota premium security plan operations for each plan year by November
1 following the applicable year or 60 calendar days following the last disbursement of
Minnesota premium security plan payments for the applicable plan year.

Subd. 3.

Audits.

The commissioner or designee may conduct a financial or programmatic
audit of the Minnesota premium security plan to assess its compliance with the requirements.
The board must ensure that it and any relevant contractors, subcontractors, or agents
cooperate with any audit. The Minnesota premium security plan is subject to audit by the
legislative auditor.

Subd. 4.

Independent external audit.

The board must engage an independent qualified
auditing entity to perform a financial and programmatic audit for each plan year of the
Minnesota premium security plan in accordance with generally accepted auditing standards.
The board must:

(1) provide to the commissioner the results of the audit, in the manner and time frame
to be specified by the commissioner;

(2) identify to the commissioner any material weakness or significant deficiency identified
in the audit, and address in writing to the commissioner how the board intends to correct
any such material weakness or significant deficiency; and

(3) make public the results of the audit, including any material weakness or significant
deficiency and how the board intends to correct the material weakness or significant
deficiency.

Subd. 5.

Action on audit findings.

If an audit results in a finding of material weakness
or significant deficiency with respect to compliance with any requirement under this section,
the commissioner of commerce must ensure the board:

(1) within 60 calendar days of the issuance of the final audit report, provides a written
corrective action plan to the commissioner for approval;

(2) implements that plan; and

(3) provides to the commissioner written documentation of the corrective actions once
taken.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 5.

[62E.25] FUNDING OF MINNESOTA PREMIUM SECURITY PLAN.

(a) The reinsurance fund account is created in the special revenue fund of the state
treasury. Funds in the account are appropriated to the commissioner of commerce as fiscal
agent for the association for the Minnesota premium security plan. Notwithstanding section
11A.20, all investment income and all investment losses attributable to the investment of
the reinsurance account not currently needed shall be credited to the reinsurance fund
account.

(b) The association shall fund the Minnesota premium security plan using the following
sources, in the following order:

(1) any federal funds available, whether through grants or otherwise;

(2) monetary reserves of the association; and

(3) the reinsurance tax imposed by section 295.52, subdivision 9.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 6.

Minnesota Statutes 2016, section 295.52, subdivision 1, is amended to read:

Subdivision 1.

Hospital tax.

A tax is imposed on each hospital equal to two one percent
of its gross revenues.

EFFECTIVE DATE.

This section is effective for the tax year beginning January 1,
2018.

Sec. 7.

Minnesota Statutes 2016, section 295.52, subdivision 1a, is amended to read:

Subd. 1a.

Surgical center tax.

A tax is imposed on each surgical center equal to two
one percent of its gross revenues.

EFFECTIVE DATE.

This section is effective for the tax year beginning January 1,
2018.

Sec. 8.

Minnesota Statutes 2016, section 295.52, subdivision 3, is amended to read:

Subd. 3.

Wholesale drug distributor tax.

A tax is imposed on each wholesale drug
distributor equal to two one percent of its gross revenues.

EFFECTIVE DATE.

This section is effective for the tax year beginning January 1,
2018.

Sec. 9.

Minnesota Statutes 2016, section 295.52, subdivision 4, is amended to read:

Subd. 4.

Use tax; legend drugs.

(a) A person that receives legend drugs for resale or
use in Minnesota, other than from a wholesale drug distributor that is subject to tax under
subdivision 3 or 9, is subject to a tax equal to the price paid for the legend drugs multiplied
by the tax percentage specified in this section. Liability for the tax is incurred when legend
drugs are received or delivered in Minnesota by the person.

(b) A tax imposed under this subdivision does not apply to purchases by an individual
for personal consumption.

Sec. 10.

Minnesota Statutes 2016, section 295.52, subdivision 4a, is amended to read:

Subd. 4a.

Tax collection.

A wholesale drug distributor with nexus in Minnesota, who
is not subject to tax under subdivision 3 or 9, on all or a particular transaction is required
to collect the tax imposed under subdivision 4, from the purchaser of the drugs and give the
purchaser a receipt for the tax paid. The tax collected shall be remitted to the commissioner
in the manner prescribed by section 295.55, subdivision 3.

Sec. 11.

Minnesota Statutes 2016, section 295.52, is amended by adding a subdivision to
read:

Subd. 9.

Reinsurance tax.

(a) A tax is imposed on each hospital equal to one percent
of its gross revenues.

(b) A tax is imposed on each surgical center equal to one percent of its gross revenues.

(c) A tax is imposed on each wholesale drug distributor equal to one percent of its gross
revenues.

(d) This subdivision expires January 1, 2020.

EFFECTIVE DATE.

This section is effective for the tax year beginning January 1,
2018.

Sec. 12.

Minnesota Statutes 2016, section 295.58, is amended to read:

295.58 DEPOSIT OF REVENUES AND PAYMENT OF REFUNDS.

(a) The commissioner shall deposit all revenues, including penalties and interest, derived
from the taxes imposed by sections 295.50 to 295.57, except the tax imposed by section
295.52, subdivision 9, and from the insurance premiums tax imposed by section 297I.05,
subdivision 5, on health maintenance organizations, community integrated service networks,
and nonprofit health service plan corporations in the health care access fund. There is
annually appropriated from the health care access fund to the commissioner of revenue the
amount necessary to make refunds under this chapter.

(b) The commissioner shall deposit all revenues, including penalties and interest, from
the tax imposed by section 295.52, subdivision 9, in the reinsurance fund account created
under section 62E.25.

EFFECTIVE DATE.

This section is effective for the tax year beginning January 1,
2018.

Sec. 13. STATE INNOVATION WAIVER.

Subdivision 1.

Authority to submit a waiver application.

The commissioner of
commerce shall apply to the United States Secretary of Health and Human Services under
United States Code, title 42, section 18052, for a waiver of applicable provisions of the
Affordable Care Act with respect to health insurance coverage in the state for a plan year
beginning on or after January 1, 2018, for the sole purpose of implementing the Minnesota
premium security plan in a manner that maximizes federal funding for Minnesota. The
commissioner shall implement a state plan for meeting the waiver requirements in a manner
consistent with state and federal law, and as approved by the United States Secretary of
Health and Human Services.

Subd. 2.

Consultation.

In developing the waiver application, the commissioner shall
consult with the Department of Human Services and MNsure.

Subd. 3.

Application deadline.

The commissioner shall submit the application waiver
to the appropriate federal agency on or before July 5, 2017. The commissioner shall follow
all application instructions. The commissioner shall complete the draft application for public
review and comment by June 1, 2017.

Subd. 4.

Appropriation.

$155,000 in fiscal year 2018 is appropriated to the commissioner
of commerce to prepare and submit a state innovation waiver.

EFFECTIVE DATE.

This section is effective the day following final enactment.