Minnesota Session Laws - 1983, Regular Session

  

                         Laws of Minnesota 1983 

                        CHAPTER 205--H.F.No. 290
           An act relating to health maintenance organizations; 
          authorizing a local governmental unit to operate as a 
          health maintenance organization; requiring the 
          establishment of an advisory body to the organization; 
          requiring a report to the legislature; amending 
          Minnesota Statutes 1982, sections 62D.02, subdivision 
          4, and by adding a subdivision; 62D.03, subdivisions 1 
          and 4; 62D.05, subdivision 1; and 62D.06, subdivision 
          1. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1982, section 62D.02, 
subdivision 4, is amended to read: 
    Subd. 4.  "Health maintenance organization" means a 
nonprofit corporation organized under chapter 317, or a local 
governmental unit as defined in subdivision 11, controlled and 
operated as provided in sections 62D.01 to 62D.29, which 
provides, either directly or through arrangements with providers 
or other persons, comprehensive health maintenance services, or 
arranges for the provision of such these services, to enrollees 
on the basis of a fixed prepaid sum without regard to the 
frequency or extent of services furnished to any particular 
enrollee. 
    Sec. 2.  Minnesota Statutes 1982, section 62D.02, is 
amended by adding a subdivision to read: 
    Subd. 11.  "Local governmental unit" means any statutory or 
home rule charter city or county.  
    Sec. 3.  Minnesota Statutes 1982, section 62D.03, 
subdivision 1, is amended to read: 
    Subdivision 1.  Notwithstanding any law of this state to 
the contrary, any nonprofit corporation organized to do so or a 
local governmental unit may apply to the commissioner of health 
for a certificate of authority to establish and operate a health 
maintenance organization in compliance with sections 62D.01 to 
62D.29.  No person shall establish or operate a health 
maintenance organization in this state, nor sell or offer to 
sell, or solicit offers to purchase or receive advance or 
periodic consideration in conjunction with a health maintenance 
organization or health maintenance contract unless such the 
organization has a certificate of authority under sections 
62D.01 to 62D.29. 
    Sec. 4.  Minnesota Statutes 1982, section 62D.03, 
subdivision 4, is amended to read: 
    Subd. 4.  Each application for a certificate of authority 
shall be verified by an officer or authorized representative of 
the applicant, and shall be in a form prescribed by the 
commissioner of health.  Each application shall include the 
following: 
    (a) a copy of the basic organizational document, if any, of 
the applicant; such as the articles of incorporation, or other 
applicable documents, and all amendments thereto; 
    (b) a copy of the bylaws, rules and regulations, or similar 
document, if any, and all amendments thereto which regulate the 
conduct of the affairs of the applicant; 
    (c) a list of the names, addresses, and official positions 
of the following persons: 
    All members of the board of directors or governing body of 
the local governmental unit, and the principal officers of the 
organization; which shall contain a full disclosure in the 
application of the extent and nature of any contract or 
financial arrangements between them and the health maintenance 
organization, including a full disclosure of any financial 
arrangements between them and any provider or other person 
concerning any financial relationship with the health 
maintenance organization; 
    (d) a statement generally describing the health maintenance 
organization, its health care plan or plans, facilities, and 
personnel, including a statement describing the manner in which 
the applicant proposes to provide enrollees with comprehensive 
health maintenance services; 
    (e) a copy of the form of each evidence of coverage to be 
issued to the enrollees; 
    (f) a copy of the form of each individual or group health 
maintenance contract which is to be issued to enrollees or their 
representatives; 
    (g) financial statements showing the applicant's assets, 
liabilities, and sources of financial support.  If the 
applicant's financial affairs are audited by independent 
certified public accountants, a copy of the applicant's most 
recent certified financial statement may be deemed to satisfy 
this requirement; 
    (h) (1) a description of the proposed method of marketing 
the plan, (2) a schedule of proposed charges, and (3) a 
financial plan which includes a three year projection of the 
expenses and income and other sources of future capital; 
    (i) a statement reasonably describing the geographic area 
or areas to be served and the type or types of enrollees to be 
served; 
    (j) a description of the complaint procedures to be 
utilized as required under section 62D.11; 
    (k) a description of the procedures and programs to be 
implemented to meet the requirements of section 62D.04, 
subdivision 1, clauses (b) and (c) and to monitor the quality of 
health care provided to enrollees; 
    (l) a description of the mechanism by which enrollees will 
be afforded an opportunity to participate in matters of policy 
and operation under section 62D.06; 
    (m) such other information as the commissioner of health 
may reasonably require to be provided. 
    Sec. 5.  Minnesota Statutes 1982, section 62D.05, 
subdivision 1, is amended to read: 
    Subdivision 1.  Any nonprofit corporation or local 
governmental unit may, upon obtaining a certificate of authority 
as required in sections 62D.01 to 62D.29, operate as a health 
maintenance organization.  
    Sec. 6.  Minnesota Statutes 1982, section 62D.06, 
subdivision 1, is amended to read: 
    Subdivision 1.  The governing body of any health 
maintenance organization which is a nonprofit corporation may 
include enrollees, providers, or other individuals; provided, 
however, that after a health maintenance organization which is a 
nonprofit corporation has been authorized under sections 62D.01 
to 62D.29 for one year, at least 40 percent of the governing 
body shall be composed of consumers elected by the enrollees 
from among the enrollees. 
    After a health maintenance organization which is a local 
governmental unit has been authorized under sections 62D.01 to 
62D.29 for one year, an enrollee advisory body shall be 
established.  The enrollees who make up this advisory body shall 
be elected by the enrollees from among the enrollees.  
    Sec. 7.  [REPORT TO LEGISLATURE.] 
    Any county or home rule charter city establishing a health 
maintenance organization under sections 1 to 6 shall report to 
the legislature no later than January 1, 1985, on the operation 
of its health maintenance organization, including utilization by 
public assistance recipients and by individuals who are not 
public assistance recipients, the amount of money provided to 
the health maintenance organization by the county, and any cost 
savings. 
    Approved May 20, 1983