Minnesota Session Laws - 1991, Regular Session

  

                         Laws of Minnesota 1991 

                        CHAPTER 165-H.F.No. 815 
           An act relating to insurance; the Minnesota 
          comprehensive health insurance plan; regulating 
          premium determinations, meetings, and experimental 
          delivery and managed care delivery methods; 
          authorizing preferred provider networks; classifying 
          PPO agreement data; regulating access; amending 
          Minnesota Statutes 1990, sections 13.71, by adding a 
          subdivision; 62E.08, by adding a subdivision; 62E.10, 
          subdivisions 4 and 9; 62E.12; 62E.13, by adding a 
          subdivision; and 62E.14, by adding a subdivision; 
          proposing coding for new law in Minnesota Statutes, 
          chapter 62E. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
     Section 1.  Minnesota Statutes 1990, section 13.71, is 
amended by adding a subdivision to read: 
    Subd. 7.  [CLASSIFICATION OF PPO AGREEMENT DATA.] Data 
described in section 62E.13, subdivision 11, are nonpublic data. 
    Sec. 2.  Minnesota Statutes 1990, section 62E.08, is 
amended by adding a subdivision to read: 
    Subd. 3.  [DETERMINATION OF RATES.] Premium rates under 
this section must be determined annually.  These rates are 
effective July 1 of each year and must be based on a survey of 
approved rates of insurers in effect, or to be in effect, on 
April 1 of the same calendar year. 
    Sec. 3.  Minnesota Statutes 1990, section 62E.10, 
subdivision 4, is amended to read: 
    Subd. 4.  [OPEN MEETINGS.] All meetings of the association, 
its board, and any committees of the association shall comply 
with the provisions of section 471.705, except that during any 
portion of a meeting during which an enrollee's appeal of an 
action of the writing carrier is being heard, that portion of 
the meeting must be closed at the enrollee's request. 
    Sec. 4.  Minnesota Statutes 1990, section 62E.10, 
subdivision 9, is amended to read: 
    Subd. 9.  [EXPERIMENTAL DELIVERY METHOD.] The association 
may petition the commissioner of commerce for a waiver to allow 
the experimental use of alternative means of health care 
delivery.  The commissioner may approve the use of the 
alternative means the commissioner considers appropriate.  The 
commissioner may waive any of the requirements of this chapter 
and chapters 60A, 62A, and 62D in granting the waiver.  The 
commissioner may also grant to the association any additional 
powers as are necessary to facilitate the specific waiver, 
including the power to implement a provider payment schedule.  
    This subdivision is effective until August 1, 1991 1992. 
    Sec. 5.  [62E.101] [MANAGED CARE DELIVERY METHOD.] 
    The association may form a preferred provider network or 
contract with an existing provider network to deliver the 
services and benefits provided for in the plans of health 
coverage offered.  If the association does not contract with an 
existing provider network, the association may adopt a provider 
payment schedule and negotiate provider payment rates subject to 
the approval of the commissioner.  
    Sec. 6.  Minnesota Statutes 1990, section 62E.12, is 
amended to read: 
    62E.12 [MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE 
PLAN.] 
    The association through its comprehensive health insurance 
plan shall offer policies which provide the benefits of a number 
one qualified plan, a number two qualified plan and a 
qualified basic and extended basic medicare supplement plan 
plans.  The requirement that a policy issued by the association 
must be a qualified plan is satisfied if the association 
contracts with a preferred provider network and the level of 
benefits for services provided within the network satisfies the 
requirements of a qualified plan.  If the association uses a 
preferred provider network, payments to nonparticipating 
providers must meet the minimum requirements of section 72A.20, 
subdivision 15.  They shall offer health maintenance 
organization contracts in those areas of the state where a 
health maintenance organization has agreed to make the coverage 
available and has been selected as a writing carrier.  
Notwithstanding the provisions of section 62E.06 the state plan 
shall exclude coverage of services of a private duty nurse other 
than on an inpatient basis and any charges for treatment in a 
hospital located outside of the state of Minnesota in which the 
covered person is receiving treatment for a mental or nervous 
disorder, unless similar treatment for the mental or nervous 
disorder is medically necessary, unavailable in Minnesota and 
provided upon referral by a licensed Minnesota medical 
practitioner.  
    Sec. 7.  Minnesota Statutes 1990, section 62E.13, is 
amended by adding a subdivision to read: 
    Subd. 11.  [CLASSIFICATION OF PPO AGREEMENT DATA.] If the 
writing carrier uses its own provider agreements for the 
association's preferred provider network in lieu of agreements 
exclusively between the association and the providers, then the 
terms and conditions of those agreements are nonpublic data as 
defined in section 13.02, subdivision 9. 
    Sec. 8.  Minnesota Statutes 1990, section 62E.14, is 
amended by adding a subdivision to read: 
    Subd. 4c.  [WAIVER OF PREEXISTING CONDITIONS FOR PERSONS 
WHOSE COVERAGE IS TERMINATED OR WHO EXCEED THE MAXIMUM LIFETIME 
BENEFIT.] A Minnesota resident may enroll in the comprehensive 
health plan with a waiver of the preexisting condition 
limitation described in subdivision 3 if that person applies for 
coverage within 90 days of termination of prior coverage and if 
the termination is for reasons other than fraud or nonpayment of 
premiums.  
    For purposes of this subdivision, termination of prior 
coverage includes exceeding the maximum lifetime benefit of 
existing coverage. 
    Coverage in the comprehensive health plan is effective on 
the date of termination of prior coverage.  The availability of 
conversion rights does not affect a person's rights under this 
subdivision. 
    This section does not apply to prior coverage provided 
under policies designed primarily to provide coverage payable on 
a per diem, fixed indemnity, or nonexpense incurred basis, or 
policies providing only accident coverage. 
    Sec. 9.  [EFFECTIVE DATE.] 
    Sections 1 and 3 to 7 are effective the day following final 
enactment.  Section 8 is effective retroactively to May 1, 1991. 
    Presented to the governor May 21, 1991 
    Signed by the governor May 24, 1991, 5:10 p.m.