Minnesota Session Laws - 2003, Regular Session

                             CHAPTER 20-H.F.No. 266 
                  An act relating to human services; modifying the 
                  purchasing alliance stop-loss fund; amending Minnesota 
                  Statutes 2002, section 256.956, subdivisions 1, 2, 3, 
                  4, 5, 9. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 2002, section 256.956, 
        subdivision 1, is amended to read: 
           Subdivision 1.  [DEFINITIONS.] For purposes of this 
        section, the following definitions apply:  
           (a) "Commissioner" means the commissioner of human services.
           (b) "Health plan" means a policy, contract, or certificate 
        issued by a health plan company to a qualifying purchasing 
        alliance.  Any health plan issued to the members of a qualifying 
        purchasing alliance must meet the requirements of chapter 62L.  
           (c) "Health plan company" means: 
           (1) a health carrier as defined under section 62A.011, 
        subdivision 2; 
           (2) a community integrated service network operating under 
        chapter 62N; or 
           (3) an accountable provider network operating under chapter 
        62T.  
           (d) "Qualifying employer" means an employer who: 
           (1) is a member of a qualifying purchasing alliance; 
           (2) has at least one employee but no more than ten 
        employees at the time of initial membership to a qualifying 
        purchasing alliance or is a sole proprietor or farmer; 
           (3) did not offer employer-subsidized health care coverage 
        to its employees for at least 12 months prior to joining the 
        purchasing alliance; and 
           (4) is offering health coverage through the purchasing 
        alliance to all employees who work at least 20 hours per week 
        unless the employee is eligible for Medicare. 
        For purposes of this subdivision, "employer-subsidized health 
        coverage" means health coverage for which the employer pays at 
        least 50 percent of the cost of coverage for the employee.  
           (e) "Qualifying enrollee" means an employee of a qualifying 
        employer or the employee's dependent covered by a health plan.  
           (f) "Qualifying purchasing alliance" means a purchasing 
        alliance as defined in section 62T.01, subdivision 2, that: 
           (1) meets the requirements of chapter 62T; 
           (2) services a geographic area located in outstate 
        Minnesota, excluding the city of Duluth; and 
           (3) is organized and operating before May 1, 2001. 
           The criteria used by the qualifying purchasing alliance for 
        membership must be approved by the commissioner of health.  The 
        commissioner of health shall approve any criteria needed in 
        order to receive grants from other public or private entities.  
        A qualifying purchasing alliance may begin enrolling qualifying 
        employers after July 1, 2001, with enrollment ending by December 
        31, 2003.  The commissioner of health may waive the requirement 
        described in clause (3) if this requirement inhibits the 
        commissioner's ability to obtain grants from other public or 
        private entities. 
           Sec. 2.  Minnesota Statutes 2002, section 256.956, 
        subdivision 2, is amended to read: 
           Subd. 2.  [CREATION OF ACCOUNT.] (a) A purchasing alliance 
        stop-loss fund account is established in the general fund.  The 
        commissioner shall use the money to establish a stop-loss fund 
        from which a health plan company may receive reimbursement for 
        claims paid for qualifying enrollees.  The account consists of 
        money appropriated by the legislature.  Money from the account 
        must be used for the stop-loss fund.  
           (b) The commissioner may accept grants from public or 
        private entities for the purpose of expanding the stop-loss fund.
        Any money received by the commissioner must be deposited in the 
        account and distributed in accordance with this section.  
           Sec. 3.  Minnesota Statutes 2002, section 256.956, 
        subdivision 3, is amended to read: 
           Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
        receive reimbursement from the fund for 90 percent of the 
        portion of the claim that exceeds payments made, less any 
        third-party recoveries, for claims incurred in a calendar year 
        for a qualifying enrollee for services that in aggregate 
        exceed $30,000 but not of the portion that exceeds payments that 
        exceed $100,000 in a calendar year for a qualifying enrollee.  
           (b) Claims shall be reported and funds shall be distributed 
        on a calendar-year basis.  Claims incurred by a qualifying 
        enrollee are eligible for reimbursement for a two-year period 
        beginning from the date of enrollment.  During this two-year 
        period, claims shall be eligible for reimbursement only for the 
        calendar year in which the claims were paid incurred.  
           (c) Once claims paid incurred on behalf of a qualifying 
        enrollee reach $100,000 in a given calendar year, no further 
        claims may be submitted for reimbursement on behalf of that 
        enrollee in that calendar year.  
           (d) If a health plan company collects third-party 
        recoveries for a claim after the health plan company has 
        received reimbursement for the claim from the stop-loss fund 
        account, the health plan company must reimburse the account with 
        the amount that would have been subtracted from the payment 
        under this subdivision.  The health plan company shall not be 
        required to reimburse the account for more than the amount 
        received by the health plan company for that claim as calculated 
        under subdivision 5. 
           Sec. 4.  Minnesota Statutes 2002, section 256.956, 
        subdivision 4, is amended to read: 
           Subd. 4.  [REQUEST PROCESS.] (a) Each health plan company 
        must submit a request for reimbursement from the fund on a form 
        prescribed by the commissioner.  Requests for payment must be 
        submitted no later than April 1 following the end of the 
        calendar year for which the reimbursement request is being made, 
        beginning April 1, 2002. 
           (b) The commissioner may require a health plan company to 
        submit claims data as needed in connection with the 
        reimbursement request.  
           Sec. 5.  Minnesota Statutes 2002, section 256.956, 
        subdivision 5, is amended to read: 
           Subd. 5.  [DISTRIBUTION.] (a) The commissioner shall 
        calculate the total claims reimbursement amount for all 
        qualifying health plan companies for the calendar year for which 
        claims are being reported and shall distribute the stop-loss 
        funds on an annual basis before June 30 of the following 
        calendar year.  
           (b) In the event that the total amount requested for 
        reimbursement by the health plan companies for a calendar year 
        exceeds the funds available for distribution for claims paid by 
        all health plan companies during the same calendar year, the 
        commissioner shall provide for the pro rata distribution of the 
        available funds.  Each health plan company shall be eligible to 
        receive only a proportionate amount of the available funds as 
        the health plan company's total eligible claims paid compares to 
        the total eligible claims paid by all health plan companies.  
           (c) In the event that funds available for distribution for 
        claims paid by all health plan companies during a calendar year 
        exceed the total amount requested for reimbursement by all 
        health plan companies during the same calendar year, any excess 
        funds shall be reallocated for distribution in the next calendar 
        year and may carry over into the next biennium.  
           Sec. 6.  Minnesota Statutes 2002, section 256.956, 
        subdivision 9, is amended to read: 
           Subd. 9.  [SUNSET.] This section shall expire January 1, 
        2005, or until all funds deposited in the account have been 
        distributed, whichever is later. 
           Presented to the governor April 22, 2003 
           Signed by the governor April 23, 2003, 3:30 p.m.