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HF 2762

2nd Engrossment - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Introduction Posted on 03/04/2004
1st Engrossment Posted on 03/15/2004
2nd Engrossment Posted on 05/15/2004

Current Version - 2nd Engrossment

  1.1                          A bill for an act 
  1.2             relating to health; regulating coverages; regulating 
  1.3             the Minnesota Comprehensive Health Association; 
  1.4             providing for the composition of the board; 
  1.5             authorizing an enrollee incentive for participation in 
  1.6             a disease management program; phasing out 
  1.7             Medicare-extended basic supplement plans; providing 
  1.8             for high deductible plans; authorizing purchasing 
  1.9             alliances to include seasonal employees; regulating 
  1.10            trade practices; regulating certain health occupations 
  1.11            and professions; requiring certain pharmacy benefit 
  1.12            disclosures; providing an effective date for a certain 
  1.13            hospital construction moratorium exemption; requiring 
  1.14            a study; amending Minnesota Statutes 2002, sections 
  1.15            62A.65, subdivision 5; 62E.10, subdivisions 2, 10; 
  1.16            62L.12, subdivisions 2, 3; 62Q.01, by adding a 
  1.17            subdivision; 62T.02, by adding a subdivision; 72A.20, 
  1.18            by adding a subdivision; 147.03, subdivision 1; 
  1.19            Minnesota Statutes 2003 Supplement, sections 62E.12; 
  1.20            256B.69, subdivision 4; proposing coding for new law 
  1.21            in Minnesota Statutes, chapters 62Q; 151. 
  1.23     Section 1.  Minnesota Statutes 2002, section 62A.65, 
  1.24  subdivision 5, is amended to read: 
  1.26  individual health plan may be offered, sold, issued, or with 
  1.27  respect to children age 18 or under renewed, to a Minnesota 
  1.28  resident that contains a preexisting condition limitation, 
  1.29  preexisting condition exclusion, or exclusionary rider, unless 
  1.30  the limitation or exclusion is permitted under this subdivision 
  1.31  and under chapter 62L, provided that, except for children age 18 
  1.32  or under, underwriting restrictions may be retained on 
  1.33  individual contracts that are issued without evidence of 
  2.1   insurability as a replacement for prior individual coverage that 
  2.2   was sold before May 17, 1993.  The individual may be subjected 
  2.3   to an 18-month preexisting condition limitation, unless the 
  2.4   individual has maintained continuous coverage as defined in 
  2.5   section 62L.02.  The individual must not be subjected to an 
  2.6   exclusionary rider.  An individual who has maintained continuous 
  2.7   coverage may be subjected to a onetime preexisting condition 
  2.8   limitation of up to 12 months, with credit for time covered 
  2.9   under qualifying coverage as defined in section 62L.02, at the 
  2.10  time that the individual first is covered under an individual 
  2.11  health plan by any health carrier.  Credit must be given for all 
  2.12  qualifying coverage with respect to all preexisting conditions, 
  2.13  regardless of whether the conditions were preexisting with 
  2.14  respect to any previous qualifying coverage.  The individual 
  2.15  must not be subjected to an exclusionary rider.  Thereafter, the 
  2.16  individual must not be subject to any preexisting condition 
  2.17  limitation, preexisting condition exclusion, or exclusionary 
  2.18  rider under an individual health plan by any health carrier, 
  2.19  except an unexpired portion of a limitation under prior 
  2.20  coverage, so long as the individual maintains continuous 
  2.21  coverage as defined in section 62L.02. 
  2.22     (b) A health carrier must offer an individual health plan 
  2.23  to any individual previously covered under a group health plan 
  2.24  issued by that health carrier, regardless of the size of the 
  2.25  group, so long as the individual maintained continuous coverage 
  2.26  as defined in section 62L.02.  If the individual has available 
  2.27  any continuation coverage provided under sections 62A.146; 
  2.28  62A.148; 62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142; 
  2.29  62D.101; or 62D.105, or continuation coverage provided under 
  2.30  federal law, the health carrier need not offer coverage under 
  2.31  this paragraph until the individual has exhausted the 
  2.32  continuation coverage.  The offer must not be subject to 
  2.33  underwriting, except as permitted under this paragraph.  A 
  2.34  health plan issued under this paragraph must be a qualified plan 
  2.35  as defined in section 62E.02 and must not contain any 
  2.36  preexisting condition limitation, preexisting condition 
  3.1   exclusion, or exclusionary rider, except for any unexpired 
  3.2   limitation or exclusion under the previous coverage.  The 
  3.3   individual health plan must cover pregnancy on the same basis as 
  3.4   any other covered illness under the individual health plan.  The 
  3.5   offer of coverage by the health carrier must inform the 
  3.6   individual that the coverage, including what is covered and the 
  3.7   health care providers from whom covered care may be obtained, 
  3.8   may not be the same as the individual's coverage under the group 
  3.9   health plan.  The offer of coverage by the health carrier must 
  3.10  also inform the individual that the individual, if a Minnesota 
  3.11  resident, may be eligible to obtain coverage from (i) other 
  3.12  private sources of health coverage, or (ii) the Minnesota 
  3.13  Comprehensive Health Association, without a preexisting 
  3.14  condition limitation, and must provide the telephone number used 
  3.15  by that association for enrollment purposes.  The initial 
  3.16  premium rate for the individual health plan must comply with 
  3.17  subdivision 3.  The premium rate upon renewal must comply with 
  3.18  subdivision 2.  In no event shall the premium rate exceed 100 
  3.19  percent of the premium charged for comparable individual 
  3.20  coverage by the Minnesota Comprehensive Health Association, and 
  3.21  the premium rate must be less than that amount if necessary to 
  3.22  otherwise comply with this section.  An individual health plan 
  3.23  offered under this paragraph to a person satisfies the health 
  3.24  carrier's obligation to offer conversion coverage under section 
  3.25  62E.16, with respect to that person.  Coverage issued under this 
  3.26  paragraph must provide that it cannot be canceled or nonrenewed 
  3.27  as a result of the health carrier's subsequent decision to leave 
  3.28  the individual, small employer, or other group market.  Section 
  3.29  72A.20, subdivision 28, applies to this paragraph. 
  3.30     [EFFECTIVE DATE.] This section is effective January 1, 
  3.31  2005, and applies to conversion coverage offered on or after 
  3.32  that date. 
  3.33     Sec. 2.  Minnesota Statutes 2002, section 62E.10, 
  3.34  subdivision 2, is amended to read: 
  3.35     Subd. 2.  [BOARD OF DIRECTORS; ORGANIZATION.] The board of 
  3.36  directors of the association shall be made up of nine eleven 
  4.1   members as follows:  five six directors selected by contributing 
  4.2   members, subject to approval by the commissioner, one of which 
  4.3   must be a health actuary; four five public directors selected by 
  4.4   the commissioner, at least two of whom must be plan enrollees, 
  4.5   two of whom must be representatives of employers whose accident 
  4.6   and health insurance premiums are part of the association's 
  4.7   assessment base, and one of whom must be a licensed insurance 
  4.8   agent.  At least two of the public directors must reside outside 
  4.9   of the seven-county metropolitan area.  Public members may 
  4.10  include licensed insurance agents.  In determining voting rights 
  4.11  at members' meetings, each member shall be entitled to vote in 
  4.12  person or proxy.  The vote shall be a weighted vote based upon 
  4.13  the member's cost of self-insurance, accident and health 
  4.14  insurance premium, subscriber contract charges, health 
  4.15  maintenance contract payment, or community integrated service 
  4.16  network payment derived from or on behalf of Minnesota residents 
  4.17  in the previous calendar year, as determined by the 
  4.18  commissioner.  In approving directors of the board, the 
  4.19  commissioner shall consider, among other things, whether all 
  4.20  types of members are fairly represented.  Directors selected by 
  4.21  contributing members may be reimbursed from the money of the 
  4.22  association for expenses incurred by them as directors, but 
  4.23  shall not otherwise be compensated by the association for their 
  4.24  services.  The costs of conducting meetings of the association 
  4.25  and its board of directors shall be borne by members of the 
  4.26  association. 
  4.27     Sec. 3.  Minnesota Statutes 2002, section 62E.10, 
  4.28  subdivision 10, is amended to read: 
  4.29     Subd. 10.  [COST CONTAINMENT GOALS.] (a) By July 1, 2001, 
  4.30  the association shall investigate managed care delivery systems, 
  4.31  and if cost effective, enter into contracts with third-party 
  4.32  entities as provided in section 62E.101. 
  4.33     (b) By July 1, 2001, the association shall establish a 
  4.34  system to annually identify individuals insured by the Minnesota 
  4.35  Comprehensive Health Association who may be eligible for private 
  4.36  health care coverage, medical assistance, state drug programs, 
  5.1   or other state or federal programs and notify them about their 
  5.2   eligibility for these programs. 
  5.3      (c) The association shall endeavor to reduce health care 
  5.4   costs using additional methods consistent with effective patient 
  5.5   care.  At a minimum, by July 1, 2001, the association shall: 
  5.6      (1) develop a focused chronic disease management and case 
  5.7   management program; 
  5.8      (2) develop a comprehensive program of preventive care; and 
  5.9      (3) implement a total drug formulary program. 
  5.10     The association may establish an enrollee incentive based 
  5.11  on enrollee participation in the chronic disease management and 
  5.12  case management program developed under this section.  
  5.13     Sec. 4.  Minnesota Statutes 2003 Supplement, section 
  5.14  62E.12, is amended to read: 
  5.16  PLAN.] 
  5.17     (a) The association through its comprehensive health 
  5.18  insurance plan shall offer policies which provide the benefits 
  5.19  of a number one qualified plan and a number two qualified plan, 
  5.20  except that the maximum lifetime benefit on these plans shall be 
  5.21  $2,800,000; and an extended basic Medicare supplement plan and a 
  5.22  basic Medicare supplement plan as described in sections 62A.31 
  5.23  to 62A.44.  The association may also offer a plan that is 
  5.24  identical to a number one and number two qualified plan except 
  5.25  that it has a $2,000 annual deductible and a $2,800,000 maximum 
  5.26  lifetime benefit.  The association, subject to the approval of 
  5.27  the commissioner, may also offer plans that are identical to the 
  5.28  number one or number two qualified plan, except that they have 
  5.29  annual deductibles of $5,000 and $10,000, respectively; have 
  5.30  limitations on total annual out-of-pocket expenses equal to 
  5.31  those annual deductibles and therefore cover 100 percent of the 
  5.32  allowable cost of covered services in excess of those annual 
  5.33  deductibles; and have a $2,800,000 maximum lifetime benefit.  As 
  5.34  of January 1, 2006, the association shall no longer be required 
  5.35  to offer an extended basic Medicare supplement plan.  
  5.36     (b) The requirement that a policy issued by the association 
  6.1   must be a qualified plan is satisfied if the association 
  6.2   contracts with a preferred provider network and the level of 
  6.3   benefits for services provided within the network satisfies the 
  6.4   requirements of a qualified plan.  If the association uses a 
  6.5   preferred provider network, payments to nonparticipating 
  6.6   providers must meet the minimum requirements of section 72A.20, 
  6.7   subdivision 15.  
  6.8      (c) The association shall offer health maintenance 
  6.9   organization contracts in those areas of the state where a 
  6.10  health maintenance organization has agreed to make the coverage 
  6.11  available and has been selected as a writing carrier.  
  6.12     (d) Notwithstanding the provisions of section 62E.06 and 
  6.13  unless those charges are billed by a provider that is part of 
  6.14  the association's preferred provider network, the state plan 
  6.15  shall exclude coverage of services of a private duty nurse other 
  6.16  than on an inpatient basis and any charges for treatment in a 
  6.17  hospital located outside of the state of Minnesota in which the 
  6.18  covered person is receiving treatment for a mental or nervous 
  6.19  disorder, unless similar treatment for the mental or nervous 
  6.20  disorder is medically necessary, unavailable in Minnesota and 
  6.21  provided upon referral by a licensed Minnesota medical 
  6.22  practitioner. 
  6.23     Sec. 5.  Minnesota Statutes 2002, section 62L.12, 
  6.24  subdivision 2, is amended to read: 
  6.25     Subd. 2.  [EXCEPTIONS.] (a) A health carrier may sell, 
  6.26  issue, or renew individual conversion policies to eligible 
  6.27  employees otherwise eligible for conversion coverage under 
  6.28  section 62D.104 as a result of leaving a health maintenance 
  6.29  organization's service area. 
  6.30     (b) A health carrier may sell, issue, or renew individual 
  6.31  conversion policies to eligible employees otherwise eligible for 
  6.32  conversion coverage as a result of the expiration of any 
  6.33  continuation of group coverage required under sections 62A.146, 
  6.34  62A.17, 62A.21, 62C.142, 62D.101, and 62D.105. 
  6.35     (c) A health carrier may sell, issue, or renew conversion 
  6.36  policies under section 62E.16 to eligible employees. 
  7.1      (d) A health carrier may sell, issue, or renew individual 
  7.2   continuation policies to eligible employees as required. 
  7.3      (e) A health carrier may sell, issue, or renew individual 
  7.4   health plans if the coverage is appropriate due to an unexpired 
  7.5   preexisting condition limitation or exclusion applicable to the 
  7.6   person under the employer's group health plan or due to the 
  7.7   person's need for health care services not covered under the 
  7.8   employer's group health plan. 
  7.9      (f) A health carrier may sell, issue, or renew an 
  7.10  individual health plan, if the individual has elected to buy the 
  7.11  individual health plan not as part of a general plan to 
  7.12  substitute individual health plans for a group health plan nor 
  7.13  as a result of any violation of subdivision 3 or 4. 
  7.14     (g) Nothing in this subdivision relieves a health carrier 
  7.15  of any obligation to provide continuation or conversion coverage 
  7.16  otherwise required under federal or state law. 
  7.17     (h) Nothing in this chapter restricts the offer, sale, 
  7.18  issuance, or renewal of coverage issued as a supplement to 
  7.19  Medicare under sections 62A.31 to 62A.44, or policies or 
  7.20  contracts that supplement Medicare issued by health maintenance 
  7.21  organizations, or those contracts governed by section 1833 or 
  7.22  1876 of the federal Social Security Act, United States Code, 
  7.23  title 42, section 1395 et seq., as amended. 
  7.24     (i) Nothing in this chapter restricts the offer, sale, 
  7.25  issuance, or renewal of individual health plans necessary to 
  7.26  comply with a court order. 
  7.27     (j) A health carrier may offer, issue, sell, or renew an 
  7.28  individual health plan to persons eligible for an employer group 
  7.29  health plan, if the individual health plan is a high deductible 
  7.30  health plan for use in connection with an existing health 
  7.31  savings account, in compliance with the Internal Revenue Code, 
  7.32  section 223.  In that situation, the same or a different health 
  7.33  carrier may offer, issue, sell, or renew a group health plan to 
  7.34  cover the other eligible employees in the group. 
  7.35     [EFFECTIVE DATE.] This section is effective January 1, 2004.
  7.36     Sec. 6.  Minnesota Statutes 2002, section 62L.12, 
  8.1   subdivision 3, is amended to read: 
  8.2      Subd. 3.  [AGENT'S LICENSURE.] An agent licensed under 
  8.3   chapter 60K or section 62C.17 who knowingly and willfully breaks 
  8.4   apart a small group for the purpose of selling individual health 
  8.5   plans to eligible employees and dependents of a small employer 
  8.6   that meets the participation and contribution requirements of 
  8.7   section 62L.03, subdivision 3, is guilty of an unfair trade 
  8.8   practice and subject to disciplinary action, including the 
  8.9   revocation or suspension of license, under section 60K.43 or 
  8.10  62C.17.  The action must be by order and subject to the notice, 
  8.11  hearing, and appeal procedures specified in section 60K.43.  The 
  8.12  action of the commissioner is subject to judicial review as 
  8.13  provided under chapter 14.  This section does not apply to any 
  8.14  action performed by an agent that would be permitted for a 
  8.15  health carrier under subdivision 2. 
  8.16     [EFFECTIVE DATE.] This section is effective January 1, 2004.
  8.17     Sec. 7.  Minnesota Statutes 2002, section 62Q.01, is 
  8.18  amended by adding a subdivision to read: 
  8.19     Subd. 4a.  [HIGH DEDUCTIBLE HEALTH PLANS.] "High deductible 
  8.20  health plans" means those health coverage plans issued by a 
  8.21  health plan company as defined under the provisions of sections 
  8.22  220 and 223 of the Internal Revenue Code of 1986, and 
  8.23  implementing regulations. 
  8.24     [EFFECTIVE DATE.] This section is effective January 1, 2004.
  8.25     Sec. 8.  [62Q.025] [PRODUCT APPROVALS.] 
  8.26     Subdivision 1.  [QUALIFIED PLAN.] A high deductible health 
  8.27  plan shall be deemed a qualified plan under sections 62E.06 and 
  8.28  62E.12.  The plan must meet all other requirements of state law 
  8.29  except those that are inconsistent with a high deductible health 
  8.30  plan as defined in sections 220 and 223 of the Internal Revenue 
  8.31  Code and supporting regulations. 
  8.32     Subd. 2.  [AUTHORIZATION.] Notwithstanding any other law of 
  8.33  this state, any health plan company defined in section 62Q.01, 
  8.34  subdivision 4, is permitted to offer high deductible health 
  8.35  plans. 
  8.36     [EFFECTIVE DATE.] This section is effective January 1, 2004.
  9.1      Sec. 9.  [62Q.182] [SHORT-TERM COVERAGE; APPLICABILITY.] 
  9.2      Notwithstanding section 62A.65, subdivision 3, paragraph 
  9.3   (g), and subdivision 7, paragraph (c), short-term coverage is 
  9.4   not subject to section 62A.021. 
  9.5      Sec. 10.  Minnesota Statutes 2002, section 62T.02, is 
  9.6   amended by adding a subdivision to read: 
  9.7      Subd. 3.  [SEASONAL EMPLOYEES.] A purchasing alliance may 
  9.8   define eligible employees to include seasonal employees.  For 
  9.9   purposes of this chapter, "seasonal employee" means an employee 
  9.10  who is employed on a full-time basis for at least six months 
  9.11  during the calendar year and is unemployed for no longer than 
  9.12  four months during the calendar year.  If seasonal employees are 
  9.13  included: 
  9.14     (1) the alliance must not show bias in the selection of 
  9.15  members based on the percentage of seasonal employees employed 
  9.16  by an employer member; 
  9.17     (2) prior to issuance or renewal, the employer must inform 
  9.18  the alliance that it will include seasonal employees; 
  9.19     (3) the employer must cover seasonal employees for the 
  9.20  entire term of its plan year; and 
  9.21     (4) the purchasing alliance may require an employer-member 
  9.22  contribution of at least 50 percent of the cost of employee 
  9.23  coverage during the months the seasonal employee is unemployed. 
  9.24     Sec. 11.  Minnesota Statutes 2002, section 72A.20, is 
  9.25  amended by adding a subdivision to read: 
  9.27  INFORMATION.] A health carrier, as defined in section 62A.011, 
  9.28  subdivision 2, is not in violation of this chapter for 
  9.29  electronically transmitting or electronically making available 
  9.30  information otherwise required to be delivered in writing under 
  9.31  chapters 62A to 62Q and 72A to an enrollee as defined in section 
  9.32  62Q.01, subdivision 2a, and with the requirements of those 
  9.33  chapters if the following conditions are met: 
  9.34     (1) the health carrier informs the enrollee that electronic 
  9.35  transmission or access is available and, at the discretion of 
  9.36  the health carrier, the enrollee is given one of the following 
 10.1   options: 
 10.2      (i) electronic transmission or access will occur only if 
 10.3   the enrollee affirmatively requests to the health carrier that 
 10.4   the required information be electronically transmitted or 
 10.5   available and a record of that request is retained by the health 
 10.6   carrier; or 
 10.7      (ii) electronic transmission or access will automatically 
 10.8   occur if the enrollee has not opted out of that manner of 
 10.9   transmission by request to the health carrier and requested that 
 10.10  the information be provided in writing.  If the enrollee opts 
 10.11  out of electronic transmission, a record of that request must be 
 10.12  retained by the health carrier; 
 10.13     (2) the enrollee is allowed to withdraw the request at any 
 10.14  time; 
 10.15     (3) if the information transmitted electronically contains 
 10.16  individually identifiable data, it must be transmitted to a 
 10.17  secured mailbox.  If the information made available 
 10.18  electronically contains individually identifiable data, it must 
 10.19  be made available at a password-protected secured Web site; 
 10.20     (4) the enrollee is provided a customer service number on 
 10.21  the enrollee's member card that may be called to request a 
 10.22  written copy of the document; and 
 10.23     (5) the electronic transmission or electronic availability 
 10.24  meets all other requirements of this chapter including, but not 
 10.25  limited to, size of the typeface and any required time frames 
 10.26  for distribution. 
 10.27     Sec. 12.  Minnesota Statutes 2002, section 147.03, 
 10.28  subdivision 1, is amended to read: 
 10.29     Subdivision 1.  [ENDORSEMENT; RECIPROCITY.] (a) The board 
 10.30  may issue a license to practice medicine to any person who 
 10.31  satisfies the requirements in paragraphs (b) to (f).  
 10.32     (b) The applicant shall satisfy all the requirements 
 10.33  established in section 147.02, subdivision 1, paragraphs (a), 
 10.34  (b), (d), (e), and (f).  
 10.35     (c) The applicant shall: 
 10.36     (1) have passed an examination prepared and graded by the 
 11.1   Federation of State Medical Boards, the National Board of 
 11.2   Medical Examiners, or the United States Medical Licensing 
 11.3   Examination program in accordance with section 147.02, 
 11.4   subdivision 1, paragraph (c), clause (2); the National Board of 
 11.5   Osteopathic Examiners; or the Medical Council of Canada; and 
 11.6      (2) have a current license from the equivalent licensing 
 11.7   agency in another state or Canada and, if the examination in 
 11.8   clause (1) was passed more than ten years ago, either: 
 11.9      (i) pass the Special Purpose Examination of the Federation 
 11.10  of State Medical Boards with a score of 75 or better within 
 11.11  three attempts; or 
 11.12     (ii) have a current certification by a specialty board of 
 11.13  the American Board of Medical Specialties, of the American 
 11.14  Osteopathic Association Bureau of Professional Education, or of 
 11.15  the Royal College of Physicians and Surgeons of Canada. 
 11.16     (d) The applicant shall pay a fee established by the board 
 11.17  by rule.  The fee may not be refunded.  
 11.18     (e) The applicant must not be under license suspension or 
 11.19  revocation by the licensing board of the state or jurisdiction 
 11.20  in which the conduct that caused the suspension or revocation 
 11.21  occurred. 
 11.22     (f) The applicant must not have engaged in conduct 
 11.23  warranting disciplinary action against a licensee, or have been 
 11.24  subject to disciplinary action other than as specified in 
 11.25  paragraph (e).  If an applicant does not satisfy the 
 11.26  requirements stated in this paragraph, the board may issue a 
 11.27  license only on the applicant's showing that the public will be 
 11.28  protected through issuance of a license with conditions or 
 11.29  limitations the board considers appropriate. 
 11.30     (g) Upon the request of an applicant, the board may conduct 
 11.31  the final interview of the applicant by teleconference. 
 11.32     Sec. 13.  [151.214] [PAYMENT DISCLOSURE.] 
 11.33     Subdivision 1.  [EXPLANATION OF PHARMACY BENEFITS.] A 
 11.34  pharmacist licensed under this chapter must provide to a 
 11.35  patient, for each prescription dispensed where part or all of 
 11.36  the cost of the prescription is being paid or reimbursed by an 
 12.1   employer-sponsored plan or health plan company, or its 
 12.2   contracted pharmacy benefit manager, the patient's co-payment 
 12.3   amount and the usual and customary price of the prescription or 
 12.4   the amount the pharmacy will be paid for the prescription drug 
 12.5   by the patient's employer-sponsored plan or health plan company, 
 12.6   or its contracted pharmacy benefit manager. 
 12.7      Subd. 2.  [NO PROHIBITION ON DISCLOSURE.] No contracting 
 12.8   agreement between an employer-sponsored health plan or health 
 12.9   plan company, or its contracted pharmacy benefit manager, and a 
 12.10  resident or nonresident pharmacy registered under this chapter, 
 12.11  may prohibit the pharmacy from disclosing to patients 
 12.12  information a pharmacy is required or given the option to 
 12.13  provide under subdivision 1. 
 12.14     Sec. 14.  Minnesota Statutes 2003 Supplement, section 
 12.15  256B.69, subdivision 4, is amended to read: 
 12.16     Subd. 4.  [LIMITATION OF CHOICE.] (a) The commissioner 
 12.17  shall develop criteria to determine when limitation of choice 
 12.18  may be implemented in the experimental counties.  The criteria 
 12.19  shall ensure that all eligible individuals in the county have 
 12.20  continuing access to the full range of medical assistance 
 12.21  services as specified in subdivision 6.  
 12.22     (b) The commissioner shall exempt the following persons 
 12.23  from participation in the project, in addition to those who do 
 12.24  not meet the criteria for limitation of choice:  
 12.25     (1) persons eligible for medical assistance according to 
 12.26  section 256B.055, subdivision 1; 
 12.27     (2) persons eligible for medical assistance due to 
 12.28  blindness or disability as determined by the Social Security 
 12.29  Administration or the state medical review team, unless:  
 12.30     (i) they are 65 years of age or older; or 
 12.31     (ii) they reside in Itasca County or they reside in a 
 12.32  county in which the commissioner conducts a pilot project under 
 12.33  a waiver granted pursuant to section 1115 of the Social Security 
 12.34  Act; 
 12.35     (3) recipients who currently have private coverage through 
 12.36  a health maintenance organization; 
 13.1      (4) recipients who are eligible for medical assistance by 
 13.2   spending down excess income for medical expenses other than the 
 13.3   nursing facility per diem expense; 
 13.4      (5) recipients who receive benefits under the Refugee 
 13.5   Assistance Program, established under United States Code, title 
 13.6   8, section 1522(e); 
 13.7      (6) children who are both determined to be severely 
 13.8   emotionally disturbed and receiving case management services 
 13.9   according to section 256B.0625, subdivision 20; 
 13.10     (7) adults who are both determined to be seriously and 
 13.11  persistently mentally ill and received case management services 
 13.12  according to section 256B.0625, subdivision 20; 
 13.13     (8) persons eligible for medical assistance according to 
 13.14  section 256B.057, subdivision 10; and 
 13.15     (9) persons with access to cost-effective 
 13.16  employer-sponsored private health insurance or persons enrolled 
 13.17  in an individual health plan determined to be cost-effective 
 13.18  according to section 256B.0625, subdivision 15.  
 13.19  Children under age 21 who are in foster placement may enroll in 
 13.20  the project on an elective basis.  Individuals excluded under 
 13.21  clauses (1), (6), and (7) may choose to enroll on an elective 
 13.22  basis.  The commissioner may enroll recipients in the prepaid 
 13.23  medical assistance program for seniors who are (1) age 65 and 
 13.24  over, and (2) eligible for medical assistance by spending down 
 13.25  excess income. 
 13.26     (c) The commissioner may allow persons with a one-month 
 13.27  spenddown who are otherwise eligible to enroll to voluntarily 
 13.28  enroll or remain enrolled, if they elect to prepay their monthly 
 13.29  spenddown to the state.  
 13.30     (d) The commissioner may require those individuals to 
 13.31  enroll in the prepaid medical assistance program who otherwise 
 13.32  would have been excluded under paragraph (b), clauses (1), (3), 
 13.33  and (8), and under Minnesota Rules, part 9500.1452, subpart 2, 
 13.34  items H, K, and L.  
 13.35     (e) Before limitation of choice is implemented, eligible 
 13.36  individuals shall be notified and after notification, shall be 
 14.1   allowed to choose only among demonstration providers.  The 
 14.2   commissioner may assign an individual with private coverage 
 14.3   through a health maintenance organization, to the same health 
 14.4   maintenance organization for medical assistance coverage, if the 
 14.5   health maintenance organization is under contract for medical 
 14.6   assistance in the individual's county of residence.  After 
 14.7   initially choosing a provider, the recipient is allowed to 
 14.8   change that choice only at specified times as allowed by the 
 14.9   commissioner.  If a demonstration provider ends participation in 
 14.10  the project for any reason, a recipient enrolled with that 
 14.11  provider must select a new provider but may change providers 
 14.12  without cause once more within the first 60 days after 
 14.13  enrollment with the second provider. 
 14.14     (f) An infant born to a woman who is eligible for and 
 14.15  receiving medical assistance and who is enrolled in the prepaid 
 14.16  medical assistance program shall be retroactively enrolled to 
 14.17  the month of birth in the same managed care plan as the mother 
 14.18  once the child is enrolled in medical assistance unless the 
 14.19  child is determined to be excluded from enrollment in a prepaid 
 14.20  plan under this section.  
 14.21     [EFFECTIVE DATE.] This section is effective July 1, 2004, 
 14.22  or upon federal approval, whichever is later. 
 14.25     Laws 2004, chapter 187, is effective July 1, 2004.  
 14.26     [EFFECTIVE DATE.] This section is effective July 1, 2004. 
 14.28     The commissioner of commerce, in consultation with the 
 14.29  Minnesota Comprehensive Health Association, shall contract with 
 14.30  an independent entity to conduct an analysis of the eligibility 
 14.31  standards used for enrollment for coverage under the Minnesota 
 14.32  Comprehensive Health Association in terms of the use of 
 14.33  presumptive conditions for automatic eligibility and the 
 14.34  underwriting practices for the individual market regarding the 
 14.35  denial or limitations of coverage due to preexisting 
 14.36  conditions.  The analysis must compare the Minnesota 
 15.1   Comprehensive Health Association's practices with that of other 
 15.2   states' high-risk pools and examine the basis for denials within 
 15.3   the individual market.  The analysis must also determine whether 
 15.4   there should be additional guidelines or standards in place 
 15.5   before the existence of a specific condition or diagnosis is 
 15.6   denied coverage in the individual market or deemed automatically 
 15.7   eligible for coverage under the Minnesota Comprehensive Health 
 15.8   Association.  
 15.9      The commissioner of commerce shall submit the results of 
 15.10  the study and any recommendations to the legislature by January 
 15.11  15, 2005.