SF 684

as introduced - 91st Legislature (2019 - 2020) Posted on 01/31/2019 03:16pm

A bill for an act
relating to health care; creating MinnesotaCare Buy-In Option health plans to be
offered as an option to individuals who reside in eligible counties; requiring
provider rates to be at least paid at the Medicare rate; requiring a report; proposing
coding for new law in Minnesota Statutes, chapter 256L.

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

Section 1.

new text begin [256L.29] MINNESOTACARE BUY-IN OPTION.
new text end

new text begin Subdivision 1. new text end

new text begin Request for federal authority. new text end

new text begin (a) The commissioner of human services
shall seek all necessary federal waivers to establish the MinnesotaCare Buy-In Option under
this section.
new text end

new text begin (b) The commissioner shall also seek all necessary federal waivers to:
new text end

new text begin (1) allow eligible individuals to use advance premium tax credits and cost-sharing
reductions to purchase the MinnesotaCare Buy-In Option;
new text end

new text begin (2) offer the MinnesotaCare Buy-In Option through the MNsure website as a coverage
option and to be compared with qualified health plans offered through the MNsure website;
and
new text end

new text begin (3) maintain MinnesotaCare program requirements and funding mechanisms that provide
coverage to persons eligible under section 256L.04.
new text end

new text begin (c) The commissioner is exempt from the requirements in chapter 16C to contract for
actuarial services that satisfy the waiver submission requirements under this subdivision.
The commissioner may utilize existing contracts to satisfy the waiver submission
requirements of this subdivision.
new text end

new text begin Subd. 2. new text end

new text begin Administration. new text end

new text begin (a) The commissioner shall:
new text end

new text begin (1) coordinate administration of the MinnesotaCare Buy-In Option with the
MinnesotaCare program, as described in section 256L.04, to maximize efficiency and
improve continuity of care for enrollees;
new text end

new text begin (2) implement mechanisms to ensure the long-term financial sustainability of
MinnesotaCare and mitigate any adverse financial impacts to the state and MNsure and
mitigate any adverse financial impacts to the individual and small group insurance markets.
These mechanisms must minimize adverse selection, state financial risk and contribution,
and negative impacts to premiums in the individual and group health insurance markets;
new text end

new text begin (3) establish a cost allocation methodology to reimburse MNsure operations in lieu of
the premium withhold for qualified health plans under section 62V.05; and
new text end

new text begin (4) establish provider reimbursement rates paid at the Medicare reimbursement rate or
at the MinnesotaCare payment rate, whichever is greater.
new text end

new text begin (b) An individual who is determined eligible for enrollment in a qualified health plan
with or without advance payments of the premium tax credit and with or without cost-sharing
reductions according to Code of Federal Regulations, title 45, section 155.305, paragraphs
(a), (f), and (g), is eligible to purchase and enroll in a MinnesotaCare Buy-In Option health
plan instead of purchasing a qualified health plan as defined under section 62V.02.
new text end

new text begin (c) The MinnesotaCare Buy-In Option shall be considered the MinnesotaCare program
for purposes of the requirements for health maintenance organizations under section 62D.04,
subdivision 5, and providers under section 256B.0644.
new text end

new text begin (d) The commissioner has the authority to accept and expend all enrollee premiums and
federal funds made available under this section upon federal approval.
new text end

new text begin Subd. 3. new text end

new text begin Establishment of health plans. new text end

new text begin (a) The commissioner shall establish two
MinnesotaCare Buy-In Option health plans: one health plan shall provide benefits that are
actuarially equivalent to 70 percent of the full actuarial value of the benefits provided under
the health plan, and one health plan shall provide benefits that are actuarially equivalent to
80 percent of the full actuarial value of the benefits provided under the health plan. The
benefits of the health plans shall be based on the benefits provided in section 256L.03.
new text end

new text begin (b) The same annual open and special enrollment periods established for individual
health plans under section 62K.15 shall apply for the MinnesotaCare Buy-In Option health
plans. MinnesotaCare Buy-In Option health plans shall be offered through the MNsure
website as defined in section 62V.02, subdivision 13, and may be offered outside of the
MNsure website.
new text end

new text begin (c) The commissioner may contract with vendors to provide services consistent with
sections 256L.12 and 256L.121 or contract directly with health care providers. If the
commissioner contracts with a participating entity to provide services under this section,
the commissioner shall ensure that the participating entity provider reimbursement rates are
at least at the rates required under subdivision 2, paragraph (a), clause (4).
new text end

new text begin Subd. 4. new text end

new text begin Eligible counties. new text end

new text begin (a) For the open enrollment period beginning November 1,
2020, and each open enrollment period thereafter, the MinnesotaCare Buy-In Option health
plans shall only be made available to consumers in a county that has been deemed eligible
by the commissioner of commerce.
new text end

new text begin (b) The commissioner of commerce, in consultation with the commissioner of health,
shall deem a county eligible if there is not at least one health carrier in the county's service
area actively marketing at least one silver level health plan and one gold level health plan
without limits on enrollment or waivers from the network adequacy requirements under
section 62K.10.
new text end

new text begin (c) By July 15, 2019, and each July 1 thereafter, the commissioner of commerce shall
provide the commissioner of human services with a preliminary report of the counties
deemed eligible under this subdivision. By October 1, 2019, and each October 1 thereafter,
the commissioner of commerce shall report to the chairs and ranking minority members of
the legislative committees with jurisdiction over health care policy and finance the final list
of the counties deemed eligible for the MinnesotaCare Buy-In Option health plan under this
subdivision.
new text end

new text begin (d) Once a county has been deemed eligible by the commissioner of commerce under
this subdivision, the MinnesotaCare Buy-In Option health plans shall become available as
an option for that county for the following open enrollment period and future open enrollment
periods in subsequent years as long as the optional health plans continue to meet all applicable
state and federal requirements.
new text end

new text begin Subd. 5. new text end

new text begin Premium administration and payment. new text end

new text begin The commissioner shall establish an
annual per-enrollee premium rate sufficient to cover state administrative costs and payments
by the state to participating entities under sections 256L.12 and 256L.121, or to health care
providers.
new text end

new text begin Subd. 6. new text end

new text begin Premium tax credits, cost-sharing reductions, and subsidies. new text end

new text begin (a) A person
who is eligible under this section and whose income is less than or equal to 400 percent of
the federal poverty guidelines may qualify for advance premium tax credits and cost-sharing
reductions to purchase a health plan established under this section.
new text end

new text begin (b) There shall be no state subsidy to a person eligible for the MinnesotaCare Buy-In
Option.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Health plans established under this section shall be offered
beginning January 1, 2021, 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