1.1                          A bill for an act
  1.2             relating to insurance; revising certain provisions 
  1.3             involving state regulation of private health coverage; 
  1.4             transferring certain regulatory control; establishing 
  1.5             requirements for managed care plans; amending 
  1.6             Minnesota Statutes 2000, sections 62A.021, subdivision 
  1.7             1; 62A.041, subdivisions 1 and 2; 62A.042; 62A.043, 
  1.8             subdivision 1; 62A.105; 62A.14; 62A.149, subdivision 
  1.9             1; 62A.15, subdivision 1; 62A.152, subdivision 1; 
  1.10            62A.153; 62A.20; 62A.21; 62A.615; 62A.616; 62A.65, 
  1.11            subdivision 5; 62D.02, subdivisions 3 and 8; 62D.12, 
  1.12            subdivisions 1 and 1a; 62D.15, subdivision 1; 62D.24; 
  1.13            62E.05, subdivision 2; 62E.11, subdivision 13; 62E.14, 
  1.14            subdivision 6; 62E.16; 62J.041, subdivision 4; 
  1.15            62J.701; 62J.74, subdivisions 1 and 2; 62J.75; 62L.02, 
  1.16            subdivision 8; 62L.05, subdivision 12; 62L.08, 
  1.17            subdivisions 10 and 11; 62L.09, subdivision 3; 62L.10, 
  1.18            subdivision 4; 62L.11, subdivision 2; 62L.12, 
  1.19            subdivision 2; 62M.11; 62M.16; 62N.02, subdivision 4; 
  1.20            62N.26; 62Q.01, subdivision 2; 62Q.03, subdivision 5a; 
  1.21            62Q.07; 62Q.106; 62Q.22, subdivisions 2, 6, and 7; 
  1.22            62Q.32; 62Q.33, subdivision 2; 62Q.49, subdivision 2; 
  1.23            62Q.51, subdivision 3; 62Q.525, subdivision 3; 62Q.68, 
  1.24            subdivision 1; 62Q.69, subdivisions 2 and 3; 62Q.71; 
  1.25            62Q.72; 62Q.73, subdivisions 3, 4, 5, and 6; 62R.04, 
  1.26            subdivision 5; 62R.06, subdivision 1; 62T.01, 
  1.27            subdivision 4; 256B.692, subdivisions 2 and 7; and 
  1.28            257.34, subdivision 1; proposing coding for new law as 
  1.29            Minnesota Statutes, chapter 62U; repealing Minnesota 
  1.30            Statutes 2000, sections 62A.049; 62A.21, subdivision 
  1.31            3; 62C.14, subdivisions 5, 5a, 5b, and 14; 62C.142; 
  1.32            62D.09, subdivision 3; 62D.101; 62D.105; 62D.12, 
  1.33            subdivision 19; 62D.123, subdivisions 2, 3, and 4; 
  1.34            62D.124; 62Q.095, subdivisions 1, 2, 3, 4, and 6; and 
  1.35            62Q.45; Minnesota Rules, parts 4685.0801, subpart 7; 
  1.36            4685.1010; 4685.1105; 4685.1110; 4685.1115; 4685.1120; 
  1.37            4685.1125; 4685.1130; 4685.1300; 4685.1900; 4685.2000; 
  1.38            and 4685.2200, subpart 3. 
  1.39  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.40                             ARTICLE 1
  1.41            CONSISTENT REGULATION OF MANAGED CARE PLANS
  1.42     Section 1.  [62U.01] [DEFINITIONS.] 
  2.1      Subdivision 1.  [APPLICABILITY.] For purposes of this 
  2.2   chapter, the terms defined in this section have the meaning 
  2.3   given. 
  2.4      Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
  2.5   commissioner of commerce. 
  2.6      Subd. 3.  [COPAYMENT.] "Copayment" means an amount an 
  2.7   enrollee must pay to receive a specific service that is not 
  2.8   fully prepaid.  Copayment includes coinsurance. 
  2.9      Subd. 4.  [DEDUCTIBLE.] "Deductible" means the amount an 
  2.10  enrollee is responsible to pay out-of-pocket before the managed 
  2.11  care organization begins to pay the costs associated with 
  2.12  treatment. 
  2.13     Subd. 5.  [ENROLLEE.] "Enrollee" means a natural person 
  2.14  covered by a health plan and includes an insured, policyholder, 
  2.15  subscriber, contract holder, member, certificate holder, or any 
  2.16  other natural person covered by a health plan, whether as a 
  2.17  spouse, dependent, former dependent, or otherwise. 
  2.18     Subd. 6.  [EVIDENCE OF COVERAGE.] "Evidence of coverage" 
  2.19  means a statement issued to an enrollee by the health plan 
  2.20  company or by the group policyholder or group contract holder 
  2.21  that sets out the coverage and other rights to which the 
  2.22  enrollee is entitled under the health benefit plan. 
  2.23     Subd. 7.  [FACILITY.] "Facility" means an institution 
  2.24  providing health care services or a health care setting, 
  2.25  including but not limited to a hospital or other licensed 
  2.26  inpatient center; an ambulatory surgical or treatment center; a 
  2.27  skilled nursing center; a residential treatment center; a 
  2.28  diagnostic, laboratory, or imaging center; or a rehabilitation 
  2.29  or other therapeutic health setting. 
  2.30     Subd. 8.  [HEALTH PLAN.] "Health plan" means a policy, 
  2.31  contract, certificate, or agreement offered or issued by a 
  2.32  health plan company to provide, deliver, arrange for, pay for, 
  2.33  or reimburse any of the costs of health care services.  Health 
  2.34  plan includes a policy or certificate of accident and sickness 
  2.35  insurance as defined in section 62A.01 offered by an insurance 
  2.36  company licensed under chapter 60A; a subscriber contract or 
  3.1   certificate offered by a nonprofit health service plan 
  3.2   corporation operating under chapter 62C; a health maintenance 
  3.3   contract or certificate offered by a health maintenance 
  3.4   organization operating under chapter 62D; health coverage 
  3.5   offered by a joint self-insurance employee health plan operating 
  3.6   under chapter 62H; or a health benefit certificate offered by a 
  3.7   fraternal benefit society operating under chapter 64B.  Health 
  3.8   plan means individual and group coverage, unless otherwise 
  3.9   specified.  Health plan does not include coverage that is: 
  3.10     (1) limited to disability or income protection coverage; 
  3.11     (2) automobile medical payment coverage; 
  3.12     (3) supplemental to liability insurance; 
  3.13     (4) designed solely to provide payments on a per diem, 
  3.14  fixed indemnity, or non-expense-incurred basis; 
  3.15     (5) credit accident and health insurance as defined in 
  3.16  section 62B.02; 
  3.17     (6) designed solely to provide dental or vision care; 
  3.18     (7) blanket accident and sickness insurance as defined in 
  3.19  section 62A.11; 
  3.20     (8) accident-only coverage; 
  3.21     (9) a long-term care policy as defined in section 62A.46 or 
  3.22  long-term care insurance as defined in 62S.01; 
  3.23     (10) issued as a supplement to Medicare, as defined in 
  3.24  sections 62A.31 to 62A.44, or policies, contracts, or 
  3.25  certificates that supplement Medicare issued by health 
  3.26  maintenance organizations or those policies, contracts, or 
  3.27  certificates governed by section 1833 or 1876 of the federal 
  3.28  Social Security Act, United States Code, title 42, sections 
  3.29  1395l and 1395mm, as amended; 
  3.30     (11) workers' compensation insurance; or 
  3.31     (12) issued solely as a companion to a health maintenance 
  3.32  contract as described in section 62D.12, subdivision 1a, so long 
  3.33  as the health maintenance contract meets the definition of a 
  3.34  health plan. 
  3.35     Subd. 9.  [HEALTH PLAN COMPANY.] "Health plan company" 
  3.36  means an entity subject to the insurance laws and regulations of 
  4.1   this state, or subject to the jurisdiction of the commissioner, 
  4.2   that contracts or offers to contract to provide, deliver, 
  4.3   arrange for, pay for, or reimburse any of the costs of health 
  4.4   care services, including an insurance company licensed under 
  4.5   chapter 60A; a nonprofit health service plan corporation 
  4.6   operating under chapter 62C; a health maintenance organization 
  4.7   operating under chapter 62D; a joint self-insurance employee 
  4.8   health plan that is subject to chapter 62H; a community 
  4.9   integrated service network as defined in section 62N.02, 
  4.10  subdivision 4a; a fraternal benefit society operating under 
  4.11  chapter 64B; or any other entity providing a plan of health 
  4.12  insurance, health benefits, or health services.  "Health plan 
  4.13  company" does not include an employer with respect to a 
  4.14  self-insured employee health benefit plan organized and offered 
  4.15  by the employer to its employees under the Federal Employee 
  4.16  Retirement Income Security Act of 1974, and this chapter does 
  4.17  not apply to those plans. 
  4.18     Subd. 10.  [HEALTH CARE PROFESSIONAL.] "Health care 
  4.19  professional" means a physician or other health care 
  4.20  practitioner licensed, accredited, or certified to perform 
  4.21  specified health care services consistent with state law. 
  4.22     Subd. 11.  [HEALTH CARE PROVIDER OR PROVIDER.] "Health care 
  4.23  provider" or "provider" means a health care professional or 
  4.24  facility. 
  4.25     Subd. 12.  [HEALTH CARE SERVICES.] "Health care services" 
  4.26  means services for the diagnosis, prevention, treatment, cure, 
  4.27  or relief of a health condition, illness, injury, or disease. 
  4.28     Subd. 13.  [INDIVIDUAL COVERAGE, INDIVIDUAL HEALTH PLAN, OR 
  4.29  INDIVIDUAL MANAGED CARE PLAN.] "Individual coverage," 
  4.30  "individual health plan," or "individual managed care plan" 
  4.31  means coverage, a health plan, or a managed care plan, as 
  4.32  appropriate, issued to and covering an individual.  The 
  4.33  individual coverage, health plan, or managed care plan, as 
  4.34  appropriate, may also cover dependents of the individual. 
  4.35     Subd. 14.  [MANAGED CARE PLAN.] (a) "Managed care plan" 
  4.36  means a health plan that either requires an enrollee to use or 
  5.1   creates incentives, including financial incentives, for an 
  5.2   enrollee to use health care providers managed, owned, or 
  5.3   employed by or under contract with the health plan company and 
  5.4   that results in an enrollee being subject to at least one of the 
  5.5   following: 
  5.6      (1) use of prescriptions included in a drug formulary, 
  5.7   unless a higher copayment is applied; 
  5.8      (2) use of a provider to coordinate some or all health care 
  5.9   services; 
  5.10     (3) having the enrollee's health care subject to 
  5.11  utilization review, as defined in section 62M.02, subdivision 
  5.12  20; and 
  5.13     (4) other managed care techniques designed to use health 
  5.14  care protocols to control costs or access to health care 
  5.15  services. 
  5.16     (b) A health plan is not a managed care plan if the 
  5.17  financial incentive to use certain health care providers is 
  5.18  solely the difference in the obligation of the enrollee to pay 
  5.19  for the balance of charges after the health plan company has 
  5.20  paid its usual and customary charges. 
  5.21     Subd. 15.  [PARTICIPATING PROVIDER.] "Participating 
  5.22  provider" means a provider that, under an express contract with 
  5.23  a health plan company or with its contractor or subcontractor, 
  5.24  has agreed to provide health care services to enrollees with an 
  5.25  expectation of receiving payment, other than copayments or 
  5.26  deductibles, directly or indirectly from the health plan company.
  5.27     Subd. 16.  [PERSON.] "Person" means an individual, a 
  5.28  corporation, a partnership, an association, a joint venture, a 
  5.29  joint stock company, a trust, an unincorporated organization, 
  5.30  any similar entity, or a combination of the foregoing. 
  5.31     Sec. 2.  [62U.02] [APPLICABILITY AND SCOPE.] 
  5.32     (a) This chapter applies to all health plan companies 
  5.33  offering, selling, issuing, or renewing a managed care plan in 
  5.34  this state or to cover a resident of this state, except that 
  5.35  this chapter does not apply to health plan companies whose 
  5.36  annual Minnesota private health premium revenues are less than 
  6.1   five percent of the total annual Minnesota private health 
  6.2   premium revenues, as measured by the assessment base of the 
  6.3   Minnesota comprehensive health association.  For purposes of 
  6.4   this percentage calculation, a health plan company's premiums 
  6.5   include the Minnesota private health premium revenues of its 
  6.6   affiliates. 
  6.7      (b) Notwithstanding paragraph (a), sections 62U.01 to 
  6.8   62U.16 apply to all health maintenance organizations. 
  6.9      (c) Notwithstanding paragraph (a), sections 62U.13, 62U.14, 
  6.10  and 62U.15 apply to managed care plans offered in connection 
  6.11  with medical assistance under chapter 256B, general assistance 
  6.12  medical care under chapter 256D, or the MinnesotaCare program 
  6.13  under chapter 256L. 
  6.14     (d) When this chapter states that a health plan company or 
  6.15  a managed care plan must comply with a referenced statute or 
  6.16  rule that by its terms applies only to a specific type of health 
  6.17  plan company or health plan, the requirement of this chapter is 
  6.18  that all health plan companies or managed care plans referenced 
  6.19  in the requirement of this chapter must comply with the 
  6.20  referenced statute or rule. 
  6.21     Sec. 3.  [62U.03] [APPROVAL OF MANAGED CARE PLANS.] 
  6.22     (a) No person shall offer, issue, sell, or renew a managed 
  6.23  care plan in this state or to cover a resident of this state, 
  6.24  without first obtaining approval to do so from the commissioner 
  6.25  under this section.  Existing managed care plans are deemed 
  6.26  approved if the health plan company has previously demonstrated 
  6.27  to either the commissioner of health or the commissioner of 
  6.28  commerce that the managed care plan complies with this chapter. 
  6.29     (b) A health plan company may apply to the commissioner 
  6.30  under this section for approval of a managed care plan. 
  6.31     (c) The commissioner shall approve an application from a 
  6.32  health plan company made under this section if the commissioner 
  6.33  determines, based upon the application and any other information 
  6.34  available to the commissioner, that the applicant intends to and 
  6.35  has the capacity to fully comply with this chapter and with all 
  6.36  other laws of this state that apply to the health plan company 
  7.1   in connection with the managed care plan. 
  7.2      (d) The commissioner shall approve, disapprove, or approve 
  7.3   conditional upon proposed modification, an application no later 
  7.4   than 60 days after receipt by the commissioner of a completed 
  7.5   application, including all supporting materials required by law 
  7.6   or requested by the commissioner. 
  7.7      Sec. 4.  [62U.04] [APPLICATION FORM AND REQUIREMENTS; OTHER 
  7.8   LAW.] 
  7.9      (a) The commissioner may prescribe an application form for 
  7.10  approval of a managed care plan and may specify the items 
  7.11  required to be submitted in connection with the application 
  7.12  consistent with the provisions of this chapter. 
  7.13     (b) The required submissions must include materials 
  7.14  sufficient to permit the commissioner to determine that the 
  7.15  proposed managed care plan fully complies with this chapter. 
  7.16     (c) This section does not limit requirements provided 
  7.17  elsewhere in law that apply in connection with approval of a 
  7.18  managed care plan. 
  7.19     Sec. 5.  [62U.05] [COVERED HEALTH CARE SERVICES.] 
  7.20     Subdivision 1.  [REQUIRED COVERAGE.] (a) A group managed 
  7.21  care plan must cover at least the health care services included 
  7.22  in the definition of comprehensive health maintenance services 
  7.23  under section 62D.02, subdivision 7, and Minnesota Rules, part 
  7.24  4685.0700, subparts 1 and 2.  
  7.25     (b) An individual managed care plan must comply with the 
  7.26  benefit requirements that apply to an insurance company licensed 
  7.27  under chapter 60A and need not comply with additional or 
  7.28  different benefit requirements that apply to companies licensed 
  7.29  under chapter 62C, 62D, or 62N. 
  7.30     (c) A managed care plan must not use a definition of 
  7.31  "medically necessary," "medical necessity," or similar term that 
  7.32  is more restrictive than the definition of "medically necessary 
  7.33  care" provided in Minnesota Rules, part 4685.0100, subpart 9b. 
  7.34     Subd. 2.  [EXCEPTIONS.] (a) Exclusions of and limitations 
  7.35  on the services required under subdivision 1 are permitted 
  7.36  subject to prior written approval by the commissioner based on 
  8.1   the standards in paragraphs (b) to (d). 
  8.2      (b) Exclusions and limitations based on services being 
  8.3   experimental, investigative, or unproven must not be more 
  8.4   restrictive than provided in Minnesota Rules, part 4685.0700, 
  8.5   subpart 4, item F. 
  8.6      (c) Exclusions and limitations based on use of a drug 
  8.7   formulary must not be more restrictive than provided in 
  8.8   Minnesota Rules, part 4685.0700, subpart 3, item A. 
  8.9      (d) Exclusions and limitations must not be unjust, unfair, 
  8.10  or inequitable, as provided in section 62A.02, subdivision 3, or 
  8.11  have the effect of substantially eliminating or restricting 
  8.12  services otherwise covered in the plan. 
  8.13     (e) Exclusions of and limitations on the services required 
  8.14  under subdivision 1 are permitted at least to the extent 
  8.15  described in Minnesota Rules, part 4685.0700, subparts 3 and 4.  
  8.16  Variations on those exclusions and limitations may be requested 
  8.17  under paragraph (a). 
  8.18     Subd. 3.  [OTHER STATE LAW.] (a) A managed care plan must 
  8.19  cover all health care services, in addition to those required 
  8.20  under subdivision 1, that are required under other state law. 
  8.21     (b) A managed care plan must comply with sections 62D.102 
  8.22  and 62D.103. 
  8.23     (c) A managed care plan need not comply with this section 
  8.24  to the extent permitted under chapter 62L with respect to 
  8.25  managed care plans offered to small employers in compliance with 
  8.26  section 62L.05 or 62L.055. 
  8.27     Sec. 6.  [62U.06] [DISPUTE RESOLUTION AND UTILIZATION 
  8.28  REVIEW.] 
  8.29     (a) A health plan company must, with respect to its managed 
  8.30  care plans, comply with chapter 62M, sections 62Q.68 to 62Q.73, 
  8.31  and all other related applicable state laws. 
  8.32     (b) A health plan company must not deny or limit coverage 
  8.33  of a service that an enrollee has already received solely on the 
  8.34  basis of the lack of prior authorization or second opinion, to 
  8.35  the extent that the service would otherwise have been covered 
  8.36  under the enrollee's health plan by the health plan company had 
  9.1   prior authorization or a second opinion been obtained. 
  9.2      Sec. 7.  [62U.07] [EVIDENCE OF COVERAGE.] 
  9.3      A health plan company shall, in connection with a managed 
  9.4   care plan, comply with section 62D.07. 
  9.5      Sec. 8.  [62U.08] [INFORMATION TO ENROLLEES.] 
  9.6      A health plan company shall, in connection with a managed 
  9.7   care plan, comply with section 62D.09, subdivisions 1, 2, and 4 
  9.8   to 8. 
  9.9      Sec. 9.  [62U.09] [ENROLLEES HELD HARMLESS.] 
  9.10     A health plan company shall, in connection with a managed 
  9.11  care plan, comply with section 62D.12, subdivision 5. 
  9.12     Sec. 10.  [62U.10] [ENFORCEMENT.] 
  9.13     The commissioner shall enforce this chapter under sections 
  9.14  60A.031; 60A.052; 62D.14, subdivisions 3, 4a, and 5; and 62D.15 
  9.15  to 62D.17.  Administrative penalties for violations of this 
  9.16  chapter are as provided in section 62D.17. 
  9.17     Sec. 11.  [62U.11] [DELEGATION OF RESPONSIBILITY AND 
  9.18  SHARING OF RISKS.] 
  9.19     Subdivision 1.  [APPROVAL OF DELEGATION AGREEMENT.] (a) 
  9.20  Before delegating any of its obligations or responsibilities 
  9.21  under a managed care plan or under this chapter to another 
  9.22  entity, a health plan company shall file with the commissioner a 
  9.23  copy of the form of the delegation agreement for written 
  9.24  approval.  
  9.25     (b) The delegation agreement must: 
  9.26     (1) provide for regular monitoring of the delegatee's 
  9.27  performance by the health plan company; 
  9.28     (2) permit periodic and other audits of the delegatee by 
  9.29  the commissioner with respect to this chapter; and 
  9.30     (3) provide that the delegated functions must be carried 
  9.31  out in a manner consistent with state law. 
  9.32     (c) The health plan company retains ultimate responsibility 
  9.33  for performance of the delegated functions, and the delegatee is 
  9.34  not subject to the enforcement authority of the commissioner.  
  9.35     Subd. 2.  [PROVIDER AGREEMENTS.] (a) An agreement between a 
  9.36  health plan company and a provider in which the provider agrees 
 10.1   to undertake specified responsibilities under this chapter, in 
 10.2   connection with a managed care plan, is subject to subdivision 1.
 10.3      (b) A health plan company, in connection with a managed 
 10.4   care plan, may enter into an agreement under subdivision 1 with 
 10.5   a provider, which agreement structures payments to the provider 
 10.6   based on the efficient provision of services or as incentives to 
 10.7   provide quality care.  
 10.8      (c) Assumption of risk by a provider under this section is 
 10.9   not insurance for purposes of section 60A.02, subdivision 3. 
 10.10     Sec. 12.  [62U.12] [SUBROGATION AND COORDINATION OF 
 10.11  BENEFITS.] 
 10.12     (a) A managed care plan may contain subrogation provisions 
 10.13  as permitted and limited under sections 62A.095 and 62A.096 and 
 10.14  Minnesota Rules, part 4685.0900. 
 10.15     (b) A health plan company, in connection with a group 
 10.16  managed care plan, must comply with Minnesota Rules, chapter 
 10.17  2742, relating to coordination of benefits.  The health plan 
 10.18  company must not refuse to provide covered health services on 
 10.19  the basis that it has the right to coordinate benefits.  The 
 10.20  services must be provided prior to coordination. 
 10.21     Sec. 13.  [62U.13] [QUALITY ASSESSMENT AND PERFORMANCE 
 10.22  IMPROVEMENT.] 
 10.23     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 10.24  section, the terms defined in this subdivision have the meanings 
 10.25  given. 
 10.26     (b) "Outcome or outcome of care" means the end result of 
 10.27  health care or a change in patient health status.  Examples of 
 10.28  outcomes of care include a hospital admission or readmission, an 
 10.29  advanced stage of a disease, recovery, alleviation of symptoms, 
 10.30  or death. 
 10.31     (c) "Performance improvement" means the effort to improve 
 10.32  the timeliness, processes, and outcomes related to the provision 
 10.33  of care within the health plan company.  
 10.34     (d) "Quality assessment" means the measurement and 
 10.35  evaluation of the quality and outcomes of care provided to 
 10.36  individuals, groups, or populations. 
 11.1      Subd. 2.  [HEALTH PLAN COMPANY REQUIREMENTS.] A health plan 
 11.2   company that provides managed care plans shall develop and 
 11.3   maintain a quality assessment and performance improvement 
 11.4   program, which includes the infrastructure and disclosure 
 11.5   systems and activities necessary to measure and improve the 
 11.6   quality of health care services provided to covered persons 
 11.7   under the managed care plan.  A health plan company shall: 
 11.8      (1) establish a program designed to assess the quality of 
 11.9   health care provided to covered persons and capable of 
 11.10  identifying opportunities to improve care.  The program must 
 11.11  include systematic collection, analysis, and reporting of 
 11.12  relevant data.  The program must be structured to identify 
 11.13  practices that result in improved outcomes, identify problematic 
 11.14  utilization patterns, identify those providers that may be 
 11.15  responsible for either exemplary or problematic patterns, and 
 11.16  foster an environment of continuous quality improvement; 
 11.17     (2) file a written description of the quality assessment 
 11.18  and performance improvement program with the commissioner, which 
 11.19  must include a signed certification by a corporate officer of 
 11.20  the health plan company that the filing meets the requirements 
 11.21  of this section; 
 11.22     (3) communicate findings from its quality assessment and 
 11.23  performance improvement program activities at least annually to 
 11.24  applicable regulatory agencies, providers, purchasers, and 
 11.25  consumers, as provided in subdivision 5; 
 11.26     (4) on a continuing basis, use findings from its quality 
 11.27  assessment and performance improvement program activities to 
 11.28  work with participating providers and other staff to improve the 
 11.29  health care delivered to covered persons; 
 11.30     (5) report to the appropriate licensing authority any 
 11.31  persistent pattern of problematic care provided by a provider 
 11.32  consistent with sections 147.111, 147.121, 148.263, 148.264, and 
 11.33  other similar laws applicable to credentialed providers; 
 11.34     (6) design, measure, assess, and improve the processes and 
 11.35  outcomes of care as identified in the health plan company's 
 11.36  quality assessment and performance improvement program that is 
 12.1   filed with the commissioner, meets all requirements of 
 12.2   subdivision 3, and is otherwise consistent with this section; 
 12.3      (7) ensure that participating providers have the 
 12.4   opportunity to participate in developing, implementing, and 
 12.5   evaluating the quality assessment and performance improvement 
 12.6   program; and 
 12.7      (8) include information from covered persons in the 
 12.8   development of the quality assessment and performance 
 12.9   improvement program, including satisfaction survey results and 
 12.10  other general comments. 
 12.11     Subd. 3.  [QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT 
 12.12  PROGRAM REQUIREMENTS.] (a) A quality assessment and performance 
 12.13  improvement program required under subdivision 2 must include a 
 12.14  written statement, including a description of data collection 
 12.15  activities, information systems, and performance improvement 
 12.16  activities, and an annual effectiveness review of the quality 
 12.17  assessment and performance improvement program. 
 12.18     (b) A quality assessment and performance improvement 
 12.19  program required under subdivision 2 must include a written plan 
 12.20  that describes how the health plan company intends to: 
 12.21     (1) analyze both processes and outcomes of care, including 
 12.22  focused review of individual cases as appropriate, to discern 
 12.23  the causes of variation; 
 12.24     (2) identify topics to be reviewed by the quality 
 12.25  assessment and performance improvement program each year.  In 
 12.26  determining topics for review, the health plan company shall 
 12.27  consider problems; potential problems; areas with potential for 
 12.28  improvements in care; practices and diagnoses that affect a 
 12.29  substantial number of the plan's covered persons or that could 
 12.30  place covered persons at serious risk; and illnesses associated 
 12.31  with increased mortality and morbidity.  This clause must not be 
 12.32  construed to require a health carrier to review every disease, 
 12.33  illness, and condition that may affect an enrollee of a managed 
 12.34  care plan offered by the health plan company; 
 12.35     (3) use a range of appropriate methods to analyze quality, 
 12.36  including: 
 13.1      (i) collection and analysis of information on 
 13.2   overutilization and underutilization of services; 
 13.3      (ii) evaluation of courses of treatment and outcomes of 
 13.4   health care, including health status measures, consistent with 
 13.5   reference databases such as current medical research, knowledge, 
 13.6   standards, and practice guidelines; 
 13.7      (iii) collection and analysis of information specific to a 
 13.8   covered person or provider, gathered from multiple sources 
 13.9   including but not limited to utilization management, claims 
 13.10  processing, and documentation of satisfaction surveys; and 
 13.11     (iv) ongoing evaluation of enrollee complaints that are 
 13.12  related to quality of and access to care.  The data on 
 13.13  complaints related to quality of and access to care must be 
 13.14  evaluated by the health plan company at least quarterly; 
 13.15     (4) compare program findings with past performance, as 
 13.16  appropriate, and with internal goals and external standards, 
 13.17  when available, such as those standards developed by recognized 
 13.18  state and national accreditation organizations; 
 13.19     (5) establish and implement policies and procedures for 
 13.20  provider selection, credentialing, and recredentialing that, at 
 13.21  a minimum, are consistent with accepted community standards; 
 13.22     (6) measure the performance of participating providers and 
 13.23  conduct peer review activities, such as: 
 13.24     (i) identifying practices that do not, at a minimum, meet 
 13.25  accepted community standards; and 
 13.26     (ii) taking appropriate action to ensure that participating 
 13.27  providers meet accepted community standards; 
 13.28     (7) distribute information and educate providers regarding 
 13.29  accepted standards, treatment protocols, and practice 
 13.30  guidelines; 
 13.31     (8) support and promote population-based health quality 
 13.32  assessment and improvement through communication with public 
 13.33  health agencies and participation in regional or statewide 
 13.34  health quality assessment and improvement activities, including 
 13.35  the communication and participation required under section 
 13.36  62Q.075; and 
 14.1      (9) identify, document, and implement performance 
 14.2   improvement strategies related to program findings, including: 
 14.3      (i) measurable objectives for each action, including the 
 14.4   degree of expected change in persons or situations; 
 14.5      (ii) time frames for performance improvement activities; 
 14.6      (iii) persons responsible for implementation of performance 
 14.7   improvement strategies; and 
 14.8      (iv) a schedule to monitor the effectiveness of the 
 14.9   performance improvement strategies. 
 14.10     Subd. 4.  [AUDITS.] The commissioner shall conduct routine 
 14.11  audits of quality assessment and performance improvement 
 14.12  programs to ensure compliance with this section.  If an 
 14.13  independent organization has conducted an audit of the quality 
 14.14  assessment and performance improvement program of the health 
 14.15  plan company: 
 14.16     (1) the commissioner may accept the independent audit and 
 14.17  require no further audit if the results of the independent audit 
 14.18  show that the quality assessment and performance improvement 
 14.19  program of the health plan company meets the requirements of 
 14.20  this section; 
 14.21     (2) the commissioner may accept the independent audit and 
 14.22  limit further auditing if the results of the independent audit 
 14.23  show that the quality assessment and performance improvement 
 14.24  program of the health plan company partially meets the 
 14.25  requirements of this section.  Auditing by the commissioner must 
 14.26  be limited to program areas where fulfillment of the 
 14.27  requirements of this section has not been demonstrated; 
 14.28     (3) the health plan company must demonstrate to the 
 14.29  commissioner that the independent organization that conducted 
 14.30  the audit is qualified and that the results of the audit 
 14.31  demonstrate that the quality assessment and performance 
 14.32  improvement program of the health plan company partially or 
 14.33  fully meets the requirements of this section; and 
 14.34     (4) if the commissioner has partially or fully accepted an 
 14.35  independent audit of the quality assessment and performance 
 14.36  improvement program of the health plan company, the commissioner 
 15.1   may use the finding of a deficiency with regard to statutes or 
 15.2   rules by an independent audit as the basis for a targeted audit 
 15.3   or enforcement action. 
 15.4      Subd. 5.  [REPORTING AND DISCLOSURE.] (a) A health plan 
 15.5   company shall document and communicate information about its 
 15.6   quality assessment and performance improvement program according 
 15.7   to this subdivision.  The health plan company shall: 
 15.8      (1) include a summary of its quality assessment and 
 15.9   performance improvement program in marketing materials; 
 15.10     (2) include a description of its quality assessment and 
 15.11  performance improvement program and a statement of patient 
 15.12  rights and responsibilities with respect to the program in the 
 15.13  certificate of coverage or handbook provided to newly enrolled 
 15.14  enrollees; 
 15.15     (3) make available annually to providers and enrollees 
 15.16  findings from its quality assessment and performance improvement 
 15.17  program and information about its progress in meeting internal 
 15.18  goals and external standards, when available.  The reports shall 
 15.19  include a description of the methods used to assess each 
 15.20  specific area and an explanation of how any assumptions affect 
 15.21  the findings; and 
 15.22     (4) submit annually to the commissioner a comprehensive 
 15.23  summary of the activities required by subdivision 3 and the 
 15.24  findings described in clause (3). 
 15.25     (b) By July 1 of each year, a health plan company shall 
 15.26  file a report with the commissioner of health, without a filing 
 15.27  fee.  The commissioner of health may specify the audit 
 15.28  procedures, format, and content of the report including 
 15.29  identification of the specific measures related to the outcomes 
 15.30  of care, effectiveness of care, use of services, access to care, 
 15.31  medical errors, and patient satisfaction to be included.  To 
 15.32  determine the specific measures to be reported, the commissioner 
 15.33  of health shall consider: 
 15.34     (1) current public health goals established under section 
 15.35  62J.212; and 
 15.36     (2) measures established by recognized state or national 
 16.1   health data reporting organizations and accreditation 
 16.2   organizations. 
 16.3      Sec. 14.  [62U.14] [NETWORK ADEQUACY.] 
 16.4      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 16.5   section, the terms defined in this subdivision have the meanings 
 16.6   given. 
 16.7      (b) "General hospital" has the meaning given in Minnesota 
 16.8   Rules, part 4640.0100, subpart 4. 
 16.9      (c) "Service area" means the geographic locations, 
 16.10  identified according to recognized political subdivisions such 
 16.11  as cities, counties, and townships, in which the health plan 
 16.12  company is approved by the commissioner to market its managed 
 16.13  care product. 
 16.14     (d) "Specialized hospital" has the meaning given in 
 16.15  Minnesota Rules, part 4640.0100, subpart 10. 
 16.16     Subd. 2.  [NETWORK ADEQUACY STANDARDS.] (a) Eligible 
 16.17  persons must not be denied enrollment or continued enrollment in 
 16.18  a managed care plan solely on the basis that the eligible person 
 16.19  lives or works outside of the designated service area.  Before 
 16.20  enrolling a person who resides outside of the health plan 
 16.21  company's approved service area, the health plan company shall 
 16.22  provide each prospective enrollee with a written notice of the 
 16.23  consequences of this special enrollment. 
 16.24     (b) A health plan company providing a managed care plan 
 16.25  shall maintain a network that is sufficient in numbers and types 
 16.26  of providers to ensure that all services to enrollees in the 
 16.27  managed care plan's service area will be accessible without 
 16.28  unreasonable delay.  At a minimum, the health plan company must 
 16.29  meet the network adequacy standards in paragraphs (c) to (w). 
 16.30     (c) The health plan company must have available, either 
 16.31  directly or through arrangements, appropriate and sufficient 
 16.32  personnel, physical resources, and equipment to meet the 
 16.33  projected needs of its enrollees for covered health care 
 16.34  services.  The health plan company, in coordination with 
 16.35  participating providers, shall develop and implement written 
 16.36  standards or guidelines that assess the capacity of each 
 17.1   provider network to provide timely access to health care 
 17.2   services according to the following:  the health plan company, 
 17.3   either directly or through its provider contracts, shall arrange 
 17.4   for covered health care services, including referrals to 
 17.5   participating and nonparticipating providers, to be accessible 
 17.6   to enrollees on a timely basis in accordance with medically 
 17.7   appropriate guidelines consistent with accepted standards of 
 17.8   practice.  
 17.9      (d) Covered persons must have access to emergency services 
 17.10  24 hours per day, seven days per week. 
 17.11     (e) Primary care and specialty physician services must be 
 17.12  available and accessible within the managed care plan's service 
 17.13  area.  The health plan company shall fulfill this requirement 
 17.14  through written standards for: 
 17.15     (1) regularly scheduled appointments during normal business 
 17.16  hours; 
 17.17     (2) after hours clinics; 
 17.18     (3) use of a 24-hour answering service with standards for 
 17.19  maximum allowable call-back times based upon what is medically 
 17.20  appropriate to each situation; and 
 17.21     (4) referrals to urgent care centers, where available, and 
 17.22  to hospital emergency care. 
 17.23     (f) The health plan company shall provide or contract with 
 17.24  a sufficient number of primary care physicians to meet the 
 17.25  projected needs of its enrollees for primary care physician 
 17.26  services. 
 17.27     (g) The health plan company shall ensure that there are a 
 17.28  sufficient number of primary care physicians with hospital 
 17.29  admitting privileges at one or more participating general 
 17.30  hospitals within the managed care plan's service area to ensure 
 17.31  that necessary hospital admissions are made on a timely basis 
 17.32  consistent with accepted standards of practice. 
 17.33     (h) The health plan company shall provide directly, 
 17.34  contract for, or otherwise arrange for, specialty physician 
 17.35  services that are covered benefits and to which enrollees have 
 17.36  access in the managed care plan's service area. 
 18.1      (i) Specialty physician services to which enrollees do not 
 18.2   have continued access, for example, referrals for consultation 
 18.3   or second opinions, shall be provided by the health plan company 
 18.4   through contracts or other arrangements with specialty 
 18.5   physicians. 
 18.6      (j) The health plan company shall ensure that there are a 
 18.7   sufficient number of specialty physicians with hospital 
 18.8   admitting privileges to ensure that necessary hospital 
 18.9   admissions are made on a timely basis consistent with accepted 
 18.10  standards of practice. 
 18.11     (k) Services of one or more general hospitals licensed 
 18.12  under sections 144.50 to 144.58 must be provided through 
 18.13  contracts between the health plan company and hospitals.  The 
 18.14  services must be available and accessible, on a timely basis 
 18.15  consistent with accepted standards of practice, 24 hours per 
 18.16  day, seven days per week, within the managed care plan's service 
 18.17  area.  Services of specialized hospitals licensed under sections 
 18.18  144.50 to 144.58, including chemical dependency and mental 
 18.19  health services, must be provided through contracts between the 
 18.20  health plan company or its contracted providers and hospitals, 
 18.21  either within or outside the managed care plan's service area.  
 18.22  The services must be available during normal business hours 
 18.23  consistent with accepted standards of practice. 
 18.24     (l) The health plan company shall contract with or employ 
 18.25  sufficient numbers of providers of ancillary services to meet 
 18.26  the projected needs of its enrollees.  The services must be 
 18.27  available during normal daytime business hours consistent with 
 18.28  accepted standards of practice. 
 18.29     (m) The health plan company shall contract with or employ 
 18.30  sufficient numbers of qualified providers of outpatient mental 
 18.31  health and chemical dependency services to meet the projected 
 18.32  needs of its enrollees consistent with accepted standards of 
 18.33  practice and meeting the following requirements: 
 18.34     (1) services for enrollees with alcohol and other chemical 
 18.35  dependency problems must be provided by outpatient treatment 
 18.36  programs licensed by the commissioner of human services under 
 19.1   Minnesota Rules, parts 9530.5000 to 9530.6400, or by hospitals 
 19.2   licensed under Minnesota Rules, chapter 4640; 
 19.3      (2) outpatient chemical dependency treatment programs 
 19.4   serving adolescents must meet all of the requirements of the 
 19.5   commissioner of human services contained in Minnesota Rules, 
 19.6   part 9530.6400; 
 19.7      (3) outpatient mental health services must be provided by 
 19.8   licensed psychiatrists, psychologists, social workers, marriage 
 19.9   and family therapists, or psychiatric nurses, as appropriate in 
 19.10  each case, and by mental health centers or mental health clinics 
 19.11  licensed by the commissioner of human services under Minnesota 
 19.12  Rules, chapter 9520; and 
 19.13     (4) the health plan company, either directly or through its 
 19.14  contracted mental health or chemical dependency provider, shall 
 19.15  have services available that are culturally specific or 
 19.16  appropriate to a specific age, gender, or sexual preference. 
 19.17     If any of the services in items (1) to (4) cannot be 
 19.18  provided by licensed providers and programs, the health plan 
 19.19  company shall file a request for an exception to the 
 19.20  requirements of items (1) to (4).  A request for an exception is 
 19.21  considered a filing under Minnesota Rules, part 4685.3300.  The 
 19.22  health plan company shall submit specific data in support of its 
 19.23  request. 
 19.24     (n) The health plan company shall provide directly, 
 19.25  contract for, or otherwise arrange for residential treatment 
 19.26  programs licensed by the commissioner of human services under 
 19.27  Minnesota Rules, parts 9530.4100 to 9530.4450, to provide 
 19.28  services to enrollees with alcohol and other chemical dependency 
 19.29  problems. 
 19.30     (o) In any case where the health plan company has an 
 19.31  insufficient number or type of participating providers to 
 19.32  provide a covered benefit, the health plan company shall ensure 
 19.33  that the enrollee obtains the covered benefit at no greater cost 
 19.34  to the enrollee than if the benefit were obtained from a 
 19.35  participating provider or shall make other arrangements 
 19.36  acceptable to the commissioner. 
 20.1      (p) If a specific managed care plan provider refuses to 
 20.2   continue to provide care to a specific managed care plan 
 20.3   enrollee, the health plan company shall furnish the enrollee 
 20.4   with the name, address, and telephone number of other 
 20.5   participating providers in the same area of medical specialty. 
 20.6   Examples of reasons for refusal to continue to provide care to 
 20.7   an enrollee are:  unpaid bills incurred by that individual 
 20.8   before enrollment in the managed care plan; unpaid copayments or 
 20.9   coinsurance incurred by the enrollee after enrollment in the 
 20.10  managed care plan; an enrollee who is uncooperative or abusive 
 20.11  toward the provider; and the inability of the enrollee and the 
 20.12  provider to agree on a course of treatment. 
 20.13     (q) The health plan company is responsible for implementing 
 20.14  a system that, to the greatest possible extent, ensures that 
 20.15  referrals, either by the health plan company or by a 
 20.16  participating provider, are made to participating providers.  An 
 20.17  enrollee cannot be held liable if the managed care plan 
 20.18  provider, in error, gives a referral to a nonparticipating 
 20.19  provider.  This issue may be addressed in contracts between the 
 20.20  health plan company and its providers. 
 20.21     (r) Referral procedures must be described in an enrollee's 
 20.22  evidence of coverage and must be available to an enrollee upon 
 20.23  request for information regarding referral procedures. 
 20.24  Information regarding referral procedures must clearly describe 
 20.25  at least the following: 
 20.26     (1) under what circumstances and for what services a 
 20.27  referral is necessary; 
 20.28     (2) how to request a referral; 
 20.29     (3) how to request a standing referral; and 
 20.30     (4) how to appeal a referral determination. 
 20.31     (s) In plans in which referrals to specialty providers and 
 20.32  ancillary services are required, the health plan company shall 
 20.33  inform its primary care and other authorized providers of the 
 20.34  providers' responsibility to provide written referrals and any 
 20.35  specific procedures that must be followed in providing referrals.
 20.36     (t) This paragraph applies to a health plan company that 
 21.1   arranges for the services of assigned or selected primary care 
 21.2   providers to provide initial and basic care to enrollees.  An 
 21.3   enrollee who is dissatisfied with the assigned or selected 
 21.4   primary care provider must be allowed to change primary care 
 21.5   providers according to the health plan company's procedures and 
 21.6   policies.  If requested by an enrollee or if determined to be 
 21.7   necessary because of a pattern of inappropriate utilization of 
 21.8   services, an enrollee's health care may be supervised and 
 21.9   coordinated by the primary care provider. 
 21.10     (u) Within the managed care plan's service area, the 
 21.11  maximum travel distance or time must be the lesser of 30 miles 
 21.12  or 30 minutes to the nearest provider of each of the following 
 21.13  services:  primary care services, mental health services, and 
 21.14  general hospital services.  The health plan company shall 
 21.15  designate which method is used. 
 21.16     (v) Within a managed care plan's service area, the maximum 
 21.17  travel distance or time must be the lesser of 60 miles or 60 
 21.18  minutes to the nearest provider of specialty physician services, 
 21.19  ancillary services, specialized hospital services, and all other 
 21.20  health services not listed in paragraph (u).  The health carrier 
 21.21  shall designate which method is used. 
 21.22     (w) The commissioner shall grant an exception to a 
 21.23  requirement in paragraph (u) or (v) if the health plan company 
 21.24  can demonstrate with specific data that the requirement of 
 21.25  paragraph (u) or (v) is not feasible in a particular service 
 21.26  area or part of a service area.  The health plan company shall 
 21.27  submit specific data in support of its request.  Paragraphs (u) 
 21.28  and (v) do not apply if an enrollee is referred to a referral 
 21.29  center for health care services.  Paragraph (u) does not apply 
 21.30  if an enrollee has chosen a managed care plan with full 
 21.31  knowledge that the managed care plan has no participating 
 21.32  providers within 30 miles or 30 minutes of the enrollee's place 
 21.33  of residence. 
 21.34     Subd. 3.  [ACCESS PLAN; PRIOR APPROVAL.] Beginning January 
 21.35  1, 2002, a health plan company shall file for prior approval 
 21.36  with the commissioner an access plan meeting the requirements of 
 22.1   this section for each of the managed care plans that the health 
 22.2   plan company offers in the state.  The health plan company shall 
 22.3   make the access plans available on its business premises and 
 22.4   shall provide them to any interested party upon request.  The 
 22.5   health plan company shall prepare and file an access plan prior 
 22.6   to offering a new managed care plan and shall update and file 
 22.7   changes for an existing access plan whenever it makes any 
 22.8   material change to an existing managed care plan.  The access 
 22.9   plan must describe or contain at least the following: 
 22.10     (1) the health plan company's network that is available to 
 22.11  enrollees under the managed care plan, including a description 
 22.12  of the available care systems, if applicable; 
 22.13     (2) the health plan company's procedures for making 
 22.14  referrals, including standing referrals under section 62Q.58 
 22.15  within and outside its network; 
 22.16     (3) the health plan company's process for monitoring and 
 22.17  ensuring on an ongoing basis the sufficiency of the network to 
 22.18  meet the health care needs of populations that enroll in the 
 22.19  managed care plan; 
 22.20     (4) the health plan company's system for ensuring file 
 22.21  coordination and continuity of care for enrollees referred to 
 22.22  specialty physicians; 
 22.23     (5) the health plan company's process for enabling 
 22.24  enrollees to change primary care professionals; and 
 22.25     (6) the health plan company's proposed plan for providing 
 22.26  continuity of care in the event of contract termination as 
 22.27  required under section 62Q.56. 
 22.28     Sec. 15.  [62U.15] [PROVIDER CONTRACTS.] 
 22.29     (a) A health plan company shall, in connection with a 
 22.30  managed care plan, comply with section 62D.123. 
 22.31     (b) An agreement to provide health care services between a 
 22.32  provider and a health plan company must require the provider to 
 22.33  cooperate with and participate in the health plan company's 
 22.34  quality assessment and performance improvement program, dispute 
 22.35  resolution procedure, and utilization review program. 
 22.36     (c) An agreement to provide health care services between a 
 23.1   provider and a health plan company must require that if the 
 23.2   provider terminates the agreement, without cause, the provider 
 23.3   shall give the health plan company 120 days' advance notice of 
 23.4   termination. 
 23.5      (d) The rights and responsibilities under a contract 
 23.6   between a health plan company and a participating provider must 
 23.7   not be assigned or delegated by the provider without the prior 
 23.8   written consent of the health plan company and the contract must 
 23.9   so provide. 
 23.10     (e) A health plan company is responsible for ensuring that 
 23.11  a participating provider furnishes covered benefits to all 
 23.12  enrollees without regard to the enrollee's enrollment in the 
 23.13  plan as a private purchaser of the plan or as a participant in 
 23.14  publicly financed programs of health care services.  This 
 23.15  paragraph does not apply to circumstances when the provider 
 23.16  should not render services due to limitations arising from lack 
 23.17  of training, experience, or skill or from licensing restrictions.
 23.18     (f) A health plan company shall not penalize a provider 
 23.19  because the provider, in good faith, reports to state or federal 
 23.20  authorities any act or practice by the health plan company that 
 23.21  jeopardizes patient health or welfare. 
 23.22     (g) A health plan company shall establish a mechanism by 
 23.23  which the participating providers may determine in a timely 
 23.24  manner whether or not a person is covered by the health plan 
 23.25  company. 
 23.26     (h) A health plan company shall establish procedures for 
 23.27  resolution of administrative, payment, or other disputes between 
 23.28  providers and the health plan company. 
 23.29     (i) A contract between a health plan company and a provider 
 23.30  must not contain definitions or other provisions that conflict 
 23.31  with the definitions or provisions contained in the managed care 
 23.32  plan or this section. 
 23.33     Sec. 16.  [62U.16] [UNIFORM ENROLLEE COST-SHARING.] 
 23.34     Subdivision 1.  [COPAYMENTS.] Copayments in managed care 
 23.35  plans must not be unfair, unjust, or inequitable, as provided in 
 23.36  section 62A.02.  No managed care plan may provide for copayments 
 24.1   in excess of 50 percent, except for noncovered benefits.  
 24.2   Noncovered benefits include covered services that the enrollee 
 24.3   elects without prior approval to receive out-of-network or from 
 24.4   a broader network and nonformulary prescription drugs.  
 24.5   Copayments may be expressed as percentages or flat fees as 
 24.6   provided in Minnesota Rules, part 4685.0801.  The 25 percent 
 24.7   copayment limitation of Minnesota Rules, part 4685.0700, subpart 
 24.8   3, item A, subitem (3), unit (b); and part 4685.0801, subparts 1 
 24.9   and 2, do not apply to a managed care plan that complies with 
 24.10  this subdivision.  
 24.11     Subd. 2.  [DEDUCTIBLES.] (a) Deductibles included in 
 24.12  managed care plans must not exceed: 
 24.13     (1) for group health plans, $5,000 per individual per year 
 24.14  and $10,000 per family per year; or 
 24.15     (2) for individual health plans, $10,000 per person per 
 24.16  year and $20,000 per family per year.  
 24.17     (b) Covered charges must count toward the deductible for 
 24.18  individual health plans whether incurred from participating or 
 24.19  nonparticipating providers. 
 24.20     Subd. 3.  [ANNUAL OUT-OF-POCKET MAXIMUMS.] A managed care 
 24.21  plan must provide for an out-of-pocket maximum on enrollee 
 24.22  cost-sharing not to exceed $8,000 per person per year on group 
 24.23  health plans and $15,000 per person per year on individual 
 24.24  health plans.  Covered charges must count toward the 
 24.25  out-of-pocket maximum whether incurred from participating or 
 24.26  nonparticipating providers. 
 24.27     Subd. 4.  [LIFETIME MAXIMUM BENEFITS.] A managed care plan 
 24.28  must not provide for a lifetime maximum benefit limit less than 
 24.29  the amount required under section 62E.12 for coverage issued by 
 24.30  the Minnesota comprehensive health association.  If a managed 
 24.31  care plan includes a lifetime maximum benefit limit, the 
 24.32  benefits that were provided to the enrollee when the managed 
 24.33  care plan did not have a lifetime maximum benefit limit may not 
 24.34  be counted toward that limit. 
 24.35     Subd. 5.  [EXCEPTIONS.] (a) Subdivisions 1 and 2 do not 
 24.36  apply to the extent that another law requires lower enrollee 
 25.1   cost-sharing for specific services than that specified in 
 25.2   subdivisions 1 and 2 or to preventive services as defined in 
 25.3   Minnesota Rules, part 4685.0801, subpart 8. 
 25.4      (b) This section does not apply to the two small employer 
 25.5   plans described in section 62L.05 or to plans described in 
 25.6   section 62L.055. 
 25.7      Sec. 17.  [REPEALER.] 
 25.8      (a) Minnesota Statutes 2000, sections 62D.09, subdivision 
 25.9   3; and 62D.12, subdivision 19, are repealed. 
 25.10     (b) Minnesota Rules, parts 4685.0801, subpart 7; 4685.1010; 
 25.11  4685.1300; 4685.1900; 4685.2000; and 4685.2200, subpart 3, are 
 25.12  repealed. 
 25.13     (c) Minnesota Statutes, sections 62D.123, subdivisions 2, 
 25.14  3, and 4; and 62D.124, are repealed effective January 1, 2004. 
 25.15     (d) Minnesota Rules, parts 4685.1105; 4685.1110; 4685.1115; 
 25.16  4685.1120; 4685.1125; and 4685.1130, are repealed effective 
 25.17  January 1, 2004. 
 25.18     Sec. 18.  [EFFECTIVE DATE.] 
 25.19     Sections 1 to 12, 16, and 17 are effective January 1, 2002, 
 25.20  and apply to managed care plans issued or renewed on or after 
 25.21  that date.  Sections 13 to 15 are effective January 1, 2004, and 
 25.22  apply to managed care plans issued or renewed on or after that 
 25.23  date. 
 25.24                             ARTICLE 2 
 25.25     RELATED AND CONFORMING CHANGES IN MANAGED CARE REGULATION
 25.26     Section 1.  Minnesota Statutes 2000, section 62A.021, 
 25.27  subdivision 1, is amended to read: 
 25.28     Subdivision 1.  [LOSS RATIO STANDARDS.] (a) Notwithstanding 
 25.29  section 62A.02, subdivision 3, relating to loss ratios, health 
 25.30  care policies or certificates shall not be delivered or issued 
 25.31  for delivery to an individual or to a small employer as defined 
 25.32  in section 62L.02, unless the policies or certificates can be 
 25.33  expected, as estimated for the entire period for which rates are 
 25.34  computed to provide coverage, to return to Minnesota 
 25.35  policyholders and certificate holders in the form of aggregate 
 25.36  benefits not including anticipated refunds or credits, provided 
 26.1   under the policies or certificates, (1) at least 75 percent of 
 26.2   the aggregate amount of premiums earned in the case of policies 
 26.3   issued in the small employer market, as defined in section 
 26.4   62L.02, subdivision 27, calculated on an aggregate basis; and 
 26.5   (2) at least 65 percent of the aggregate amount of premiums 
 26.6   earned in the case of each policy form or certificate form 
 26.7   issued in the individual market; calculated on the basis of 
 26.8   incurred claims experience or incurred health care expenses 
 26.9   where coverage is provided by a health maintenance organization 
 26.10  on a service rather than reimbursement basis and earned premiums 
 26.11  for the period and according to accepted actuarial principles 
 26.12  and practices.  Assessments by the reinsurance association 
 26.13  created in chapter 62L and all types of taxes, surcharges, or 
 26.14  assessments created by Laws 1992, chapter 549, or created on or 
 26.15  after April 23, 1992, are included in the calculation of 
 26.16  incurred claims experience or incurred health care expenses.  
 26.17  The applicable percentage for policies and certificates issued 
 26.18  in the small employer market, as defined in section 62L.02, 
 26.19  increases by one percentage point on July 1 of each year, 
 26.20  beginning on July 1, 1994, until an 82 percent loss ratio is 
 26.21  reached on July 1, 2000.  The applicable percentage for policy 
 26.22  forms and certificate forms issued in the individual market 
 26.23  increases by one percentage point on July 1 of each year, 
 26.24  beginning on July 1, 1994, until a 72 percent loss ratio is 
 26.25  reached on July 1, 2000.  A health carrier that enters a market 
 26.26  after July 1, 1993, does not start at the beginning of the 
 26.27  phase-in schedule and must instead comply with the loss ratio 
 26.28  requirements applicable to other health carriers in that market 
 26.29  for each time period.  Premiums earned and claims incurred in 
 26.30  markets other than the small employer and individual markets are 
 26.31  not relevant for purposes of this section. 
 26.32     (b) All filings of rates and rating schedules shall 
 26.33  demonstrate that actual expected claims in relation to premiums 
 26.34  comply with the requirements of this section when combined with 
 26.35  actual experience to date.  Filings of rate revisions shall also 
 26.36  demonstrate that the anticipated loss ratio over the entire 
 27.1   future period for which the revised rates are computed to 
 27.2   provide coverage can be expected to meet the appropriate loss 
 27.3   ratio standards, and aggregate loss ratio from inception of the 
 27.4   policy form or certificate form shall equal or exceed the 
 27.5   appropriate loss ratio standards. 
 27.6      (c) A health carrier that issues health care policies and 
 27.7   certificates to individuals or to small employers, as defined in 
 27.8   section 62L.02, in this state shall file annually its rates, 
 27.9   rating schedule, and supporting documentation including ratios 
 27.10  of incurred losses to earned premiums by policy form or 
 27.11  certificate form duration for approval by the commissioner 
 27.12  according to the filing requirements and procedures prescribed 
 27.13  by the commissioner.  The supporting documentation shall also 
 27.14  demonstrate in accordance with actuarial standards of practice 
 27.15  using reasonable assumptions that the appropriate loss ratio 
 27.16  standards can be expected to be met over the entire period for 
 27.17  which rates are computed.  The demonstration shall exclude 
 27.18  active life reserves.  If the data submitted does not confirm 
 27.19  that the health carrier has satisfied the loss ratio 
 27.20  requirements of this section, the commissioner shall notify the 
 27.21  health carrier in writing of the deficiency.  The health carrier 
 27.22  shall have 30 days from the date of the commissioner's notice to 
 27.23  file amended rates that comply with this section.  If the health 
 27.24  carrier fails to file amended rates within the prescribed time, 
 27.25  the commissioner shall order that the health carrier's filed 
 27.26  rates for the nonconforming policy form or certificate form be 
 27.27  reduced to an amount that would have resulted in a loss ratio 
 27.28  that complied with this section had it been in effect for the 
 27.29  reporting period of the supplement.  The health carrier's 
 27.30  failure to file amended rates within the specified time or the 
 27.31  issuance of the commissioner's order amending the rates does not 
 27.32  preclude the health carrier from filing an amendment of its 
 27.33  rates at a later time.  The commissioner shall annually make the 
 27.34  submitted data available to the public at a cost not to exceed 
 27.35  the cost of copying.  The data must be compiled in a form useful 
 27.36  for consumers who wish to compare premium charges and loss 
 28.1   ratios. 
 28.2      (d) Each sale of a policy or certificate that does not 
 28.3   comply with the loss ratio requirements of this section is an 
 28.4   unfair or deceptive act or practice in the business of insurance 
 28.5   and is subject to the penalties in sections 72A.17 to 72A.32. 
 28.6      (e)(1) For purposes of this section, health care policies 
 28.7   issued as a result of solicitations of individuals through the 
 28.8   mail or mass media advertising, including both print and 
 28.9   broadcast advertising, shall be treated as individual policies. 
 28.10     (2) For purposes of this section, (i) "health care policy" 
 28.11  or "health care certificate" is a health plan as defined in 
 28.12  section 62A.011; and (ii) "health carrier" has the meaning given 
 28.13  in section 62A.011 and includes all health carriers delivering 
 28.14  or issuing for delivery health care policies or certificates in 
 28.15  this state or offering these policies or certificates to 
 28.16  residents of this state.  
 28.17     (f) The loss ratio phase-in as described in paragraph (a) 
 28.18  does not apply to individual policies and small employer 
 28.19  policies issued by a health plan company that is assessed less 
 28.20  than three percent of the total annual amount assessed by the 
 28.21  Minnesota comprehensive health association.  These policies must 
 28.22  meet a 68 percent loss ratio for individual policies, a 71 
 28.23  percent loss ratio for small employer policies with fewer than 
 28.24  ten employees, and a 75 percent loss ratio for all other small 
 28.25  employer policies. 
 28.26     (g) The ~~commissioners~~ commissioner of commerce ~~and health~~ 
 28.27  shall ~~each~~ annually issue a public report listing, by health 
 28.28  plan company, the actual loss ratios experienced in the 
 28.29  individual and small employer markets in this state ~~by the~~ 
 28.30  ~~health plan companies that the commissioners respectively~~ 
 28.31  ~~regulate.  The commissioners shall coordinate release of these~~ 
 28.32  ~~reports so as to release them as a joint report or as separate~~ 
 28.33  ~~reports issued the same day~~.  The report ~~or reports~~ shall be 
 28.34  released no later than June 1 for loss ratios experienced for 
 28.35  the preceding calendar year.  Health plan companies shall 
 28.36  provide to the ~~commissioners~~ commissioner any information 
 29.1   requested by the ~~commissioners~~ commissioner for purposes of this 
 29.2   paragraph. 
 29.3      Sec. 2.  Minnesota Statutes 2000, section 62A.105, is 
 29.4   amended to read: 
 29.5      62A.105 [COVERAGES; TRANSFERS TO SUBSTANTIALLY SIMILAR 
 29.6   PRODUCTS.] 
 29.7      Subdivision 1.  [SCOPE.] No individual policy of accident 
 29.8   and sickness regulated under this chapter or ~~subscriber contract~~ 
 29.9   ~~regulated under chapter 62C~~ individual health plan shall be 
 29.10  issued, renewed, or continued to provide coverage to a Minnesota 
 29.11  resident unless it satisfies the requirements of subdivision 2. 
 29.12     Subd. 2.  [REQUIREMENT.] If an issuer of policies or plans 
 29.13  referred to in subdivision 1 ceases to offer a particular policy 
 29.14  or ~~subscriber contract~~ plan to the general public or otherwise 
 29.15  stops adding new insureds to the group of covered persons, the 
 29.16  issuer shall allow any covered person to transfer to another 
 29.17  substantially similar policy or ~~contract~~ plan currently being 
 29.18  sold by the issuer.  The issuer shall permit the transfer 
 29.19  without any preexisting condition limitation, waiting period, or 
 29.20  other restriction of any type other than those which applied to 
 29.21  the insured under the prior policy or ~~contract~~ plan.  This 
 29.22  section does not apply to persons who were covered under an 
 29.23  individual policy or ~~contract~~ plan prior to July 1, 1994. 
 29.24     Sec. 3.  Minnesota Statutes 2000, section 62A.615, is 
 29.25  amended to read: 
 29.26     62A.615 [PREEXISTING CONDITIONS DISCLOSED AT TIME OF 
 29.27  APPLICATION.] 
 29.28     No ~~insurer~~ health plan company may cancel or rescind a 
 29.29  ~~health insurance~~ policy of accident and sickness insurance or a 
 29.30  health plan for a preexisting condition of which the application 
 29.31  or other information provided by the insured reasonably gave the 
 29.32  ~~insurer~~ health plan company notice.  No ~~insurer~~ health plan 
 29.33  company may restrict coverage for a preexisting condition of 
 29.34  which the application or other information provided by the 
 29.35  insured reasonably gave the ~~insurer~~ health plan company notice 
 29.36  unless the coverage is restricted at the time the policy or plan 
 30.1   is issued and the restriction is disclosed in writing to the 
 30.2   insured at the time the policy or plan is issued. 
 30.3      Sec. 4.  Minnesota Statutes 2000, section 62D.02, 
 30.4   subdivision 3, is amended to read: 
 30.5      Subd. 3.  [~~COMMISSIONER OF HEALTH OR~~ COMMISSIONER.] 
 30.6   ~~"Commissioner of health" or~~ "Commissioner" means the state 
 30.7   commissioner of ~~health~~ commerce or a designee. 
 30.8      Sec. 5.  Minnesota Statutes 2000, section 62D.02, 
 30.9   subdivision 8, is amended to read: 
 30.10     Subd. 8.  [HEALTH MAINTENANCE CONTRACT.] "Health 
 30.11  maintenance contract" means any contract whereby a health 
 30.12  maintenance organization agrees to provide comprehensive health 
 30.13  maintenance services to enrollees, provided that the contract 
 30.14  may contain reasonable enrollee copayment provisions.  An 
 30.15  individual or group health maintenance contract may contain the 
 30.16  copayment and deductible provisions specified in this 
 30.17  subdivision.  Copayment and deductible provisions in group 
 30.18  contracts shall not discriminate on the basis of age, sex, race, 
 30.19  length of enrollment in the plan, or economic status; and during 
 30.20  every open enrollment period in which all offered health benefit 
 30.21  plans, including those subject to the jurisdiction of the 
 30.22  ~~commissioners of commerce or health~~ commissioner, fully 
 30.23  participate without any underwriting restrictions, copayment and 
 30.24  deductible provisions shall not discriminate on the basis of 
 30.25  preexisting health status.  ~~In no event shall the sum of the~~ 
 30.26  ~~annual copayments and deductible exceed the maximum~~ 
 30.27  ~~out-of-pocket expenses allowable for a number three qualified~~ 
 30.28  ~~plan under section 62E.06, nor shall that sum exceed $5,000 per~~ 
 30.29  ~~family.  The annual deductible must not exceed $1,000 per~~ 
 30.30  ~~person.  The annual deductible must not apply to preventive~~ 
 30.31  ~~health services as described in Minnesota Rules, part 4685.0801,~~ 
 30.32  ~~subpart 8.~~  Where sections 62D.01 to 62D.30 permit a health 
 30.33  maintenance organization to contain reasonable copayment 
 30.34  provisions for preexisting health status, these provisions may 
 30.35  vary with respect to length of enrollment in the plan.  Any 
 30.36  contract may provide for health care services in addition to 
 31.1   those set forth in subdivision 7. 
 31.2      Sec. 6.  Minnesota Statutes 2000, section 62D.12, 
 31.3   subdivision 1, is amended to read: 
 31.4      Subdivision 1.  [FALSE REPRESENTATIONS.] No health 
 31.5   maintenance organization or representative thereof may cause or 
 31.6   knowingly permit the use of advertising or solicitation which is 
 31.7   untrue or misleading, or any form of evidence of coverage which 
 31.8   is deceptive.  Each health maintenance organization shall be 
 31.9   subject to sections 72A.17 to 72A.32, relating to the regulation 
 31.10  of trade practices, except ~~(a)~~ to the extent that the nature of 
 31.11  a health maintenance organization renders such sections clearly 
 31.12  inappropriate ~~and (b) that enforcement shall be by the~~ 
 31.13  ~~commissioner of health and not by the commissioner of commerce~~.  
 31.14  Every health maintenance organization shall be subject to 
 31.15  sections 8.31 and 325F.69. 
 31.16     Sec. 7.  Minnesota Statutes 2000, section 62D.15, 
 31.17  subdivision 1, is amended to read: 
 31.18     Subdivision 1.  [GROUNDS FOR SUSPENSION OR REVOCATION.] The 
 31.19  commissioner ~~of health~~ may suspend or revoke any certificate of 
 31.20  authority issued to a health maintenance organization under 
 31.21  sections 62D.01 to 62D.30 if the commissioner finds that: 
 31.22     ~~(a)~~ (1) the health maintenance organization is operating 
 31.23  significantly in contravention of its basic organizational 
 31.24  document, its health maintenance contract, or in a manner 
 31.25  contrary to that described in and reasonably inferred from any 
 31.26  other information submitted under section 62D.03, unless 
 31.27  amendments to such submissions have been filed with and approved 
 31.28  by the commissioner ~~of health~~; 
 31.29     ~~(b)~~ (2) the health maintenance organization issues 
 31.30  evidences of coverage which do not comply with the requirements 
 31.31  of section 62D.07; 
 31.32     ~~(c)~~ (3) the health maintenance organization is unable to 
 31.33  fulfill its obligations to furnish comprehensive health 
 31.34  maintenance services as required under its health maintenance 
 31.35  contract; 
 31.36     ~~(d)~~ (4) the health maintenance organization is no longer 
 32.1   financially responsible and may reasonably be expected to be 
 32.2   unable to meet its obligations to enrollees or prospective 
 32.3   enrollees; 
 32.4      ~~(e)~~ (5) the health maintenance organization has failed to 
 32.5   implement a mechanism affording the enrollees an opportunity to 
 32.6   participate in matters of policy and operation under section 
 32.7   62D.06; 
 32.8      ~~(f)~~ (6) the health maintenance organization has failed to 
 32.9   implement the complaint system required by section 62D.11 in a 
 32.10  manner designed to reasonably resolve valid complaints; 
 32.11     ~~(g)~~ (7) the health maintenance organization, or any person 
 32.12  acting with its sanction, has advertised or merchandised its 
 32.13  services in an untrue, misrepresentative, misleading, deceptive, 
 32.14  or unfair manner; 
 32.15     ~~(h)~~ (8) the continued operation of the health maintenance 
 32.16  organization would be hazardous to its enrollees; ~~or~~ 
 32.17     ~~(i)~~ (9) the health maintenance organization has otherwise 
 32.18  failed to substantially comply with sections 62D.01 to 62D.30 or 
 32.19  with any other statute or administrative rule applicable to 
 32.20  health maintenance organizations, or has submitted false 
 32.21  information in any report required hereunder; 
 32.22     (10) any situation described in section 60A.052, 
 32.23  subdivision 1, exists; 
 32.24     (11) the provider network in the managed care service area 
 32.25  is inadequate in terms of the number, location, and field of 
 32.26  specialty of its providers; or 
 32.27     (12) the health services provided or arranged are 
 32.28  substantially inappropriate, untimely, or otherwise inconsistent 
 32.29  with current professional knowledge and accepted standards of 
 32.30  practice. 
 32.31     Sec. 8.  Minnesota Statutes 2000, section 62D.24, is 
 32.32  amended to read: 
 32.33     62D.24 [~~STATE~~ COMMISSIONER OF ~~HEALTH'S~~ COMMERCE'S AUTHORITY 
 32.34  TO CONTRACT.] 
 32.35     The commissioner of ~~health~~ commerce, in carrying out the 
 32.36  obligations under sections 62D.01 to 62D.30, may contract with 
 33.1   the commissioner of ~~commerce~~ health or other qualified persons 
 33.2   to make recommendations concerning the determinations required 
 33.3   to be made.  Such recommendations may be accepted in full or in 
 33.4   part by the commissioner of ~~health~~ commerce. 
 33.5      Sec. 9.  Minnesota Statutes 2000, section 62E.05, 
 33.6   subdivision 2, is amended to read: 
 33.7      Subd. 2.  [ANNUAL REPORT.] (a) All health plan companies, 
 33.8   as defined in section 62Q.01, shall annually report to the 
 33.9   commissioner ~~responsible for their regulation~~.  The following 
 33.10  information shall be reported to the ~~appropriate~~ commissioner on 
 33.11  February 1 of each year: 
 33.12     (1) the number of individuals and groups who received 
 33.13  coverage in the prior year through the qualified plans; and 
 33.14     (2) the number of individuals and groups who received 
 33.15  coverage in the prior year through each of the unqualified plans 
 33.16  sold by the company. 
 33.17     (b) The state of Minnesota or any of its departments, 
 33.18  agencies, programs, instrumentalities, or political 
 33.19  subdivisions, shall report in writing to the association and to 
 33.20  the commissioner of commerce no later than September 15 of each 
 33.21  year regarding the number of persons and the amount of premiums, 
 33.22  deductibles, copayments, or coinsurance that it paid for on 
 33.23  behalf of enrollees in the comprehensive health association.  
 33.24  This report must contain only summary information and must not 
 33.25  include any individually identifiable data.  The report must 
 33.26  cover the 12-month period ending the preceding June 30. 
 33.27     Sec. 10.  Minnesota Statutes 2000, section 62E.11, 
 33.28  subdivision 13, is amended to read: 
 33.29     Subd. 13.  [STATE FUNDING; EFFECT ON PREMIUM RATES OF 
 33.30  MEMBERS.] In approving the premium rates as required in sections 
 33.31  62A.65, subdivision 3; and 62L.08, subdivision 8, the 
 33.32  ~~commissioners of health and~~ commissioner of commerce shall 
 33.33  ensure that any appropriation to reduce the annual assessment 
 33.34  made on the contributing members to cover the costs of the 
 33.35  Minnesota comprehensive health insurance plan as required under 
 33.36  this section is reflected in the premium rates charged by each 
 34.1   contributing member. 
 34.2      Sec. 11.  Minnesota Statutes 2000, section 62E.14, 
 34.3   subdivision 6, is amended to read: 
 34.4      Subd. 6.  [TERMINATION OF INDIVIDUAL POLICY OR CONTRACT.] A 
 34.5   Minnesota resident who holds an individual health maintenance 
 34.6   contract, individual nonprofit health service corporation 
 34.7   contract, or an individual insurance policy previously approved 
 34.8   by the ~~commissioners of health or~~ commissioner of commerce, may 
 34.9   enroll in the comprehensive health insurance plan with a waiver 
 34.10  of the preexisting condition as described in subdivision 3, 
 34.11  without interruption in coverage, provided (1) no replacement 
 34.12  coverage that meets the requirements of section 62D.121 was 
 34.13  offered by the contributing member, and (2) the policy or 
 34.14  contract has been terminated for reasons other than (a) 
 34.15  nonpayment of premium; (b) failure to make copayments required 
 34.16  by the health care plan; (c) moving out of the area served; or 
 34.17  (d) a materially false statement or misrepresentation by the 
 34.18  enrollee in the application for membership; and, provided 
 34.19  further, that the option to enroll in the plan is exercised 
 34.20  within 30 days of termination of the existing policy or contract.
 34.21     Coverage allowed under this section is effective when the 
 34.22  contract or policy is terminated and the enrollee has completed 
 34.23  the proper application and paid the required premium or fee. 
 34.24     Expenses incurred from the preexisting conditions of 
 34.25  individuals enrolled in the state plan under this subdivision 
 34.26  must be paid by the contributing member canceling coverage as 
 34.27  set forth in section 62E.11, subdivision 10. 
 34.28     The application must include evidence of termination of the 
 34.29  existing policy or certificate as required in subdivision 1. 
 34.30     Sec. 12.  Minnesota Statutes 2000, section 62J.041, 
 34.31  subdivision 4, is amended to read: 
 34.32     Subd. 4.  [MONITORING OF RESERVES.] (a) The ~~commissioners~~ 
 34.33  ~~of health and~~ commissioner of commerce shall monitor health plan 
 34.34  company reserves and net worth as established under chapters 
 34.35  60A, 62C, 62D, 62H, and 64B~~, with respect to the health plan~~ 
 34.36  ~~companies that each commissioner respectively regulates~~ to 
 35.1   assess the degree to which savings resulting from the 
 35.2   establishment of cost containment goals are passed on to 
 35.3   consumers in the form of lower premium rates.  
 35.4      (b) Health plan companies shall fully reflect in the 
 35.5   premium rates the savings generated by the cost containment 
 35.6   goals.  No premium rate, currently reviewed by the ~~departments~~ 
 35.7   ~~of health or~~ commissioner of commerce, may be approved for those 
 35.8   health plan companies unless the health plan company establishes 
 35.9   to the satisfaction of the commissioner of commerce ~~or the~~ 
 35.10  ~~commissioner of health, as appropriate,~~ that the proposed new 
 35.11  rate would comply with this paragraph. 
 35.12     (c) Health plan companies, except those licensed under 
 35.13  chapter 60A to sell accident and sickness insurance under 
 35.14  chapter 62A, shall annually before the end of the fourth fiscal 
 35.15  quarter provide to the commissioner of ~~health or~~ commerce~~, as~~ 
 35.16  ~~applicable,~~ a projection of the level of reserves the company 
 35.17  expects to attain during each quarter of the following fiscal 
 35.18  year.  These health plan companies shall submit with required 
 35.19  quarterly financial statements a calculation of the actual 
 35.20  reserve level attained by the company at the end of each quarter 
 35.21  including identification of the sources of any significant 
 35.22  changes in the reserve level and an updated projection of the 
 35.23  level of reserves the health plan company expects to attain by 
 35.24  the end of the fiscal year.  In cases where the health plan 
 35.25  company has been given a certificate to operate a new health 
 35.26  maintenance organization under chapter 62D, or been licensed as 
 35.27  a community integrated service network under chapter 62N, or 
 35.28  formed an affiliation with one of these organizations, the 
 35.29  health plan company shall also submit with its quarterly 
 35.30  financial statement, total enrollment at the beginning and end 
 35.31  of the quarter and enrollment changes within each service area 
 35.32  of the new organization.  The reserve calculations shall be 
 35.33  maintained by the ~~commissioners~~ commissioner of commerce as 
 35.34  trade secret information, except to the extent that such 
 35.35  information is also required to be filed by another provision of 
 35.36  state law and is not treated as trade secret information under 
 36.1   such other provisions. 
 36.2      (d) Health plan companies in paragraph (c) whose reserves 
 36.3   are less than the required minimum or more than the required 
 36.4   maximum at the end of the fiscal year shall submit a plan of 
 36.5   corrective action to the commissioner of ~~health or~~ commerce 
 36.6   under subdivision 7. 
 36.7      (e) The commissioner of commerce~~, in consultation with the~~ 
 36.8   ~~commissioner of health,~~ shall report to the legislature no later 
 36.9   than January 15, 1995, as to whether the concept of a reserve 
 36.10  corridor or other mechanism for purposes of monitoring reserves 
 36.11  is adaptable for use with indemnity health insurers that do 
 36.12  business in multiple states and that must comply with their 
 36.13  domiciliary state's reserves requirements. 
 36.14     Sec. 13.  Minnesota Statutes 2000, section 62J.701, is 
 36.15  amended to read: 
 36.16     62J.701 [GOVERNMENTAL PROGRAMS.] 
 36.17     Beginning January 1, 1999, the provisions in paragraphs (a) 
 36.18  to (d) apply. 
 36.19     (a) For purposes of sections 62J.695 to 62J.80, the 
 36.20  requirements and other provisions that apply to health plan 
 36.21  companies also apply to governmental programs. 
 36.22     (b) For purposes of this section, "governmental programs" 
 36.23  means the medical assistance program, the MinnesotaCare program, 
 36.24  the general assistance medical care program, the state employee 
 36.25  group insurance program, the public employees insurance program 
 36.26  under section 43A.316, and coverage provided by political 
 36.27  subdivisions under section 471.617. 
 36.28     (c) Notwithstanding paragraph (a), section 62J.72 does not 
 36.29  apply to the fee-for-service programs under medical assistance, 
 36.30  MinnesotaCare, and general assistance medical care. 
 36.31     (d) If a state commissioner or local unit of government 
 36.32  contracts with a health plan company or a third-party 
 36.33  administrator, the contract may assign any obligations under 
 36.34  paragraph (a) to the health plan company or third-party 
 36.35  administrator.  Nothing in this paragraph shall be construed to 
 36.36  remove or diminish any enforcement responsibilities of the 
 37.1   ~~commissioners of health or~~ commissioner of commerce provided in 
 37.2   sections 62J.695 to 62J.80. 
 37.3      Sec. 14.  Minnesota Statutes 2000, section 62J.74, 
 37.4   subdivision 1, is amended to read: 
 37.5      Subdivision 1.  [AUTHORITY.] The ~~commissioners~~ commissioner 
 37.6   of ~~health and~~ commerce shall ~~each~~ periodically review contracts 
 37.7   and arrangements among health care providing entities and health 
 37.8   plan companies ~~they regulate~~ to determine compliance with 
 37.9   sections 62J.70 to 62J.73.  Any person may submit a contract or 
 37.10  arrangement to the ~~relevant~~ commissioner for review if the 
 37.11  person believes sections 62J.70 to 62J.73 have been violated.  
 37.12  Any provision of a contract or arrangement found by the ~~relevant~~ 
 37.13  commissioner to violate this section is null and void, and the 
 37.14  ~~relevant~~ commissioner may assess civil penalties against the 
 37.15  health plan company in an amount not to exceed $2,500 for each 
 37.16  day the contract or arrangement is in effect, and may use the 
 37.17  enforcement procedures otherwise available to the commissioner.  
 37.18  All due process rights afforded under chapter 14 apply to this 
 37.19  section.  
 37.20     Sec. 15.  Minnesota Statutes 2000, section 62J.74, 
 37.21  subdivision 2, is amended to read: 
 37.22     Subd. 2.  [ASSISTANCE TO LICENSING BOARDS.] A 
 37.23  health-related licensing board as defined under section 214.01, 
 37.24  subdivision 2, shall submit a contract or arrangement to the 
 37.25  ~~relevant~~ commissioner of commerce for review if the board 
 37.26  believes sections 62J.70 to 62J.73 have been violated.  If the 
 37.27  commissioner determines that any provision of a contract or 
 37.28  arrangement violates those sections, the board may take 
 37.29  disciplinary action against any person who is licensed or 
 37.30  regulated by the board who entered into the contract arrangement.
 37.31     Sec. 16.  Minnesota Statutes 2000, section 62J.75, is 
 37.32  amended to read: 
 37.33     62J.75 [CONSUMER ADVISORY BOARD.] 
 37.34     (a) The consumer advisory board consists of 18 members 
 37.35  appointed in accordance with paragraph (b).  All members must be 
 37.36  public, consumer members who: 
 38.1      (1) do not have and never had a material interest in either 
 38.2   the provision of health care services or in an activity directly 
 38.3   related to the provision of health care services, such as health 
 38.4   insurance sales or health plan administration; 
 38.5      (2) are not registered lobbyists; and 
 38.6      (3) are not currently responsible for or directly involved 
 38.7   in the purchasing of health insurance for a business or 
 38.8   organization. 
 38.9      (b) The governor, the speaker of the house of 
 38.10  representatives, and the subcommittee on committees of the 
 38.11  committee on rules and administration of the senate shall each 
 38.12  appoint six members.  Members may be compensated in accordance 
 38.13  with section 15.059, subdivision 3, except that members shall 
 38.14  not receive per diem compensation or reimbursements for child 
 38.15  care expenses. 
 38.16     (c) The board shall advise the ~~commissioners of health and~~ 
 38.17  commissioner of commerce on the following: 
 38.18     (1) the needs of health care consumers and how to better 
 38.19  serve and educate the consumers on health care concerns and 
 38.20  recommend solutions to identified problems; and 
 38.21     (2) consumer protection issues in the self-insured market, 
 38.22  including, but not limited to, public education needs. 
 38.23     The board also may make recommendations to the legislature 
 38.24  on these issues. 
 38.25     (d) The board and this section expire June 30, 2001. 
 38.26     Sec. 17.  Minnesota Statutes 2000, section 62L.02, 
 38.27  subdivision 8, is amended to read: 
 38.28     Subd. 8.  [COMMISSIONER.] "Commissioner" means the 
 38.29  commissioner of commerce ~~for health carriers subject to the~~ 
 38.30  ~~jurisdiction of the department of commerce or the commissioner~~ 
 38.31  ~~of health for health carriers subject to the jurisdiction of the~~ 
 38.32  ~~department of health,~~ or the ~~relevant~~ commissioner's designated 
 38.33  representative.  ~~For purposes of sections 62L.13 to 62L.22,~~ 
 38.34  ~~"commissioner" means the commissioner of commerce or that~~ 
 38.35  ~~commissioner's designated representative.~~ 
 38.36     Sec. 18.  Minnesota Statutes 2000, section 62L.05, 
 39.1   subdivision 12, is amended to read: 
 39.2      Subd. 12.  [DEMONSTRATION PROJECTS.] Nothing in this 
 39.3   chapter prohibits a health maintenance organization from 
 39.4   offering a demonstration project authorized under section 62D.30.
 39.5   The commissioner ~~of health~~ may approve a demonstration project 
 39.6   which offers benefits that do not meet the requirements of a 
 39.7   small employer plan if the commissioner finds that the 
 39.8   requirements of section 62D.30 are otherwise met. 
 39.9      Sec. 19.  Minnesota Statutes 2000, section 62L.08, 
 39.10  subdivision 10, is amended to read: 
 39.11     Subd. 10.  [RATING REPORT.] Beginning January 1, 1995, and 
 39.12  annually thereafter, the ~~commissioners~~ commissioner of ~~health~~ 
 39.13  ~~and~~ commerce shall provide a ~~joint~~ report to the legislature on 
 39.14  the effect of the rating restrictions required by this section 
 39.15  and the appropriateness of proceeding with additional rate 
 39.16  reform.  Each report must include an analysis of the 
 39.17  availability of health care coverage due to the rating reform, 
 39.18  the equitable and appropriate distribution of risk and 
 39.19  associated costs, the effect on the self-insurance market, and 
 39.20  any resulting or anticipated change in health plan design and 
 39.21  market share and availability of health carriers. 
 39.22     Sec. 20.  Minnesota Statutes 2000, section 62L.08, 
 39.23  subdivision 11, is amended to read: 
 39.24     Subd. 11.  [LOSS RATIO STANDARDS.] Notwithstanding section 
 39.25  62A.02, subdivision 3, relating to loss ratios, each policy or 
 39.26  contract form used with respect to a health benefit plan 
 39.27  offered, or issued in the small employer market, is subject, 
 39.28  beginning July 1, 1993, to section 62A.021.  ~~The commissioner of~~ 
 39.29  ~~health has, with respect to carriers under that commissioner's~~ 
 39.30  ~~jurisdiction, all of the powers of the commissioner of commerce~~ 
 39.31  ~~under that section.~~ 
 39.32     Sec. 21.  Minnesota Statutes 2000, section 62L.09, 
 39.33  subdivision 3, is amended to read: 
 39.34     Subd. 3.  [REENTRY PROHIBITION.] (a) Except as otherwise 
 39.35  provided in paragraph (b), a health carrier that ceases to do 
 39.36  business in the small employer market after July 1, 1993, is 
 40.1   prohibited from writing new business in the small employer 
 40.2   market in this state for a period of five years from the date of 
 40.3   notice to the commissioner.  This subdivision applies to any 
 40.4   health maintenance organization that ceases to do business in 
 40.5   the small employer market in one service area with respect to 
 40.6   that service area only.  Nothing in this subdivision prohibits 
 40.7   an affiliated health maintenance organization from continuing to 
 40.8   do business in the small employer market in that same service 
 40.9   area.  
 40.10     (b) The commissioner of commerce ~~or the commissioner of~~ 
 40.11  ~~health~~ may permit a health carrier that ceases to do business in 
 40.12  the small employer market in this state after July 1, 1993, to 
 40.13  begin writing new business in the small employer market if: 
 40.14     (1) since the carrier ceased doing business in the small 
 40.15  employer market, legislative action has occurred that has 
 40.16  significantly changed the effect on the carrier of its decision 
 40.17  to cease doing business in the small employer market; and 
 40.18     (2) the commissioner deems it appropriate. 
 40.19     Sec. 22.  Minnesota Statutes 2000, section 62L.10, 
 40.20  subdivision 4, is amended to read: 
 40.21     Subd. 4.  [REVIEW OF PREMIUM RATES.] The commissioner shall 
 40.22  regulate premium rates charged or proposed to be charged by all 
 40.23  health carriers in the small employer market under section 
 40.24  62A.02.  ~~The commissioner of health has, with respect to~~ 
 40.25  ~~carriers under that commissioner's jurisdiction, all of the~~ 
 40.26  ~~powers of the commissioner of commerce under that section.~~ 
 40.27     Sec. 23.  Minnesota Statutes 2000, section 62L.11, 
 40.28  subdivision 2, is amended to read: 
 40.29     Subd. 2.  [ENFORCEMENT POWERS.] The ~~commissioners~~ 
 40.30  commissioner of ~~health and~~ commerce ~~each~~ has for purposes of 
 40.31  this chapter all of ~~each~~ the commissioner's ~~respective~~ powers 
 40.32  under other chapters that are applicable to ~~their respective~~ the 
 40.33  commissioner's duties under this chapter.  
 40.34     Sec. 24.  Minnesota Statutes 2000, section 62M.11, is 
 40.35  amended to read: 
 40.36     62M.11 [COMPLAINTS TO COMMERCE ~~OR HEALTH~~.] 
 41.1      Notwithstanding the provisions of sections 62M.01 to 
 41.2   62M.16, an enrollee may file a complaint regarding a 
 41.3   determination not to certify directly to the commissioner 
 41.4   ~~responsible for regulating the utilization review~~ 
 41.5   ~~organization~~ of commerce. 
 41.6      Sec. 25.  Minnesota Statutes 2000, section 62M.16, is 
 41.7   amended to read: 
 41.8      62M.16 [RULEMAKING.] 
 41.9      If it is determined that rules are reasonable and necessary 
 41.10  to accomplish the purpose of sections 62M.01 to 62M.16, the 
 41.11  rules must be adopted ~~through a joint rulemaking process~~ by ~~both~~ 
 41.12  the ~~department~~ commissioner of commerce ~~and the department of~~ 
 41.13  ~~health~~. 
 41.14     Sec. 26.  Minnesota Statutes 2000, section 62N.02, 
 41.15  subdivision 4, is amended to read: 
 41.16     Subd. 4.  [COMMISSIONER.] "Commissioner" means the 
 41.17  commissioner of ~~health~~ commerce or the commissioner's designated 
 41.18  representative. 
 41.19     Sec. 27.  Minnesota Statutes 2000, section 62N.26, is 
 41.20  amended to read: 
 41.21     62N.26 [SHARED SERVICES COOPERATIVE.] 
 41.22     The commissioner of ~~health~~ commerce shall establish, or 
 41.23  assist in establishing, a shared services cooperative organized 
 41.24  under chapter 308A to make available administrative and legal 
 41.25  services, technical assistance, provider contracting and billing 
 41.26  services, and other services to those community integrated 
 41.27  service networks that choose to participate in the cooperative.  
 41.28  The commissioner shall provide, to the extent funds are 
 41.29  appropriated, start-up loans sufficient to maintain the shared 
 41.30  services cooperative until its operations can be maintained by 
 41.31  fees and contributions.  The cooperative must not be staffed, 
 41.32  administered, or supervised by the commissioner of ~~health~~ 
 41.33  commerce.  The cooperative shall make use of existing resources 
 41.34  that are already available in the community, to the extent 
 41.35  possible. 
 41.36     Sec. 28.  Minnesota Statutes 2000, section 62Q.01, 
 42.1   subdivision 2, is amended to read: 
 42.2      Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
 42.3   commissioner of ~~health for purposes of regulating health~~ 
 42.4   ~~maintenance organizations, and community integrated service~~ 
 42.5   ~~networks, or the commissioner of~~ commerce ~~for purposes of~~ 
 42.6   ~~regulating all other health plan companies.  For all other~~ 
 42.7   ~~purposes, "commissioner" means the commissioner of health~~. 
 42.8      Sec. 29.  Minnesota Statutes 2000, section 62Q.03, 
 42.9   subdivision 5a, is amended to read: 
 42.10     Subd. 5a.  [PUBLIC PROGRAMS.] (a) A separate risk 
 42.11  adjustment system must be developed for state-run public 
 42.12  programs, including medical assistance, general assistance 
 42.13  medical care, and MinnesotaCare.  The system must be developed 
 42.14  in accordance with the general risk adjustment methodologies 
 42.15  described in this section, must include factors in addition to 
 42.16  age and sex adjustment, and may include additional demographic 
 42.17  factors, different targeted conditions, and/or different payment 
 42.18  amounts for conditions.  The risk adjustment system for public 
 42.19  programs must attempt to reflect the special needs related to 
 42.20  poverty, cultural, or language barriers and other needs of the 
 42.21  public program population. 
 42.22     (b) The commissioners of health and human services shall 
 42.23  jointly convene a public programs risk adjustment work group 
 42.24  responsible for advising the commissioners in the design of the 
 42.25  public programs risk adjustment system.  The public programs 
 42.26  risk adjustment work group is governed by section 15.059 for 
 42.27  purposes of membership terms, expiration, and removal of 
 42.28  members.  The work group shall meet at the discretion of the 
 42.29  commissioners of health and human services.  The commissioner of 
 42.30  health shall work with the risk adjustment association to ensure 
 42.31  coordination between the risk adjustment systems for the public 
 42.32  and private sectors.  The commissioner of human services shall 
 42.33  seek any needed federal approvals necessary for the inclusion of 
 42.34  the medical assistance program in the public programs risk 
 42.35  adjustment system.  
 42.36     (c) The public programs risk adjustment work group must be 
 43.1   representative of the persons served by publicly paid health 
 43.2   programs and providers and health plans that meet their needs.  
 43.3   To the greatest extent possible, the appointing authorities 
 43.4   shall attempt to select representatives that have historically 
 43.5   served a significant number of persons in publicly paid health 
 43.6   programs or the uninsured.  Membership of the work group shall 
 43.7   be as follows: 
 43.8      (1) one provider member appointed by the Minnesota Medical 
 43.9   Association; 
 43.10     (2) two provider members appointed by the Minnesota 
 43.11  Hospital Association, at least one of whom must represent a 
 43.12  major disproportionate share hospital; 
 43.13     (3) five members appointed by the Minnesota Council of 
 43.14  HMOs, one of whom must represent an HMO with fewer than 50,000 
 43.15  enrollees located outside the metropolitan area and one of whom 
 43.16  must represent an HMO with at least 50 percent of total 
 43.17  membership enrolled through a public program; 
 43.18     (4) two representatives of counties appointed by the 
 43.19  Association of Minnesota Counties; 
 43.20     (5) three representatives of organizations representing the 
 43.21  interests of families, children, childless adults, and elderly 
 43.22  persons served by the various publicly paid health programs 
 43.23  appointed by the governor; 
 43.24     (6) two representatives of persons with mental health, 
 43.25  developmental or physical disabilities, chemical dependency, or 
 43.26  chronic illness appointed by the governor; and 
 43.27     (7) three public members appointed by the governor, at 
 43.28  least one of whom must represent a community health board.  The 
 43.29  risk adjustment association may appoint a representative, if a 
 43.30  representative is not otherwise appointed by an appointing 
 43.31  authority. 
 43.32     (d) The commissioners of health and human services, with 
 43.33  the advice of the public programs risk adjustment work group, 
 43.34  shall develop a work plan and time frame and shall coordinate 
 43.35  their efforts with the private sector risk adjustment 
 43.36  association's activities and other state initiatives related to 
 44.1   public program managed care reimbursement. 
 44.2      (e) Before including risk adjustment in a contract for the 
 44.3   prepaid medical assistance program, the prepaid general 
 44.4   assistance medical care program, or the MinnesotaCare program, 
 44.5   the commissioner of human services shall provide to the 
 44.6   contractor an analysis of the expected impact on the contractor 
 44.7   of the implementation of risk adjustment.  This analysis may be 
 44.8   limited by the available data and resources, as determined by 
 44.9   the commissioner of human services, and shall not be binding on 
 44.10  future contract periods.  This paragraph shall not apply if the 
 44.11  contractor has not supplied information to the commissioner of 
 44.12  human services related to the risk adjustment analysis. 
 44.13     (f) The commissioner of human services shall report to the 
 44.14  public program risk adjustment work group on the methodology the 
 44.15  department will use for risk adjustment prior to implementation 
 44.16  of the risk adjustment payment methodology.  Upon completion of 
 44.17  the report to the work group, the commissioner of human services 
 44.18  shall phase in risk adjustment according to the following 
 44.19  schedule: 
 44.20     (1) for the first contract year, no more than ten percent 
 44.21  of reimbursements shall be risk adjusted; and 
 44.22     (2) for the second contract year, no more than 30 percent 
 44.23  of reimbursements shall be risk adjusted. 
 44.24     Sec. 30.  Minnesota Statutes 2000, section 62Q.07, is 
 44.25  amended to read: 
 44.26     62Q.07 [ACTION PLANS.] 
 44.27     Subdivision 1.  [ACTION PLANS REQUIRED.] (a) To increase 
 44.28  public awareness and accountability of health plan companies, 
 44.29  all health plan companies that issue or renew a ~~health plan, as~~ 
 44.30  ~~defined in section 62Q.01~~ managed care plan, as defined in 
 44.31  section 62U.01, must annually file with the ~~applicable~~ 
 44.32  commissioner an action plan that satisfies the requirements of 
 44.33  this section beginning July 1, 1994, as a condition of doing 
 44.34  business in Minnesota.  ~~For purposes of this subdivision,~~ 
 44.35  ~~"health plan" includes the coverages described in section~~ 
 44.36  ~~62A.011, subdivision 3, clause (10).~~  Each health plan company 
 45.1   must also file its action plan with the information 
 45.2   clearinghouse.  Action plans are required solely to provide 
 45.3   information to consumers, purchasers, and the larger community 
 45.4   as a first step toward greater accountability of health plan 
 45.5   companies.  The sole function of the commissioner in relation to 
 45.6   the action plans is to ensure that each health plan company 
 45.7   files a complete action plan, that the action plan is truthful 
 45.8   and not misleading, and that the action plan is reviewed by 
 45.9   appropriate community agencies. 
 45.10     (b) If ~~a~~ the commissioner ~~responsible for regulating a~~ 
 45.11  ~~health plan company required to file an action plan under this~~ 
 45.12  ~~section~~ has reason to believe an action plan is false or 
 45.13  misleading, the commissioner may conduct an investigation to 
 45.14  determine whether the action plan is truthful and not 
 45.15  misleading, and may require the health plan company to submit 
 45.16  any information that the commissioner reasonably deems necessary 
 45.17  to complete the investigation.  If the commissioner determines 
 45.18  that an action plan is false or misleading, the commissioner may 
 45.19  require the health plan company to file an amended plan or may 
 45.20  take any action authorized under chapter 72A. 
 45.21     Subd. 2.  [CONTENTS OF ACTION PLANS.] ~~(a) An action plan~~ 
 45.22  ~~must include a detailed description of all of the health plan~~ 
 45.23  ~~company's methods and procedures, standards, qualifications,~~ 
 45.24  ~~criteria, and credentialing requirements for designating the~~ 
 45.25  ~~providers who are eligible to participate in the health plan~~ 
 45.26  ~~company's provider network, including any limitations on the~~ 
 45.27  ~~numbers of providers to be included in the network.  This~~ 
 45.28  ~~description must be updated by the health plan company and filed~~ 
 45.29  ~~with the applicable agency on a quarterly basis.~~  
 45.30     ~~(b) An action plan must include the number of full-time~~ 
 45.31  ~~equivalent physicians, by specialty, nonphysician providers, and~~ 
 45.32  ~~allied health providers used to provide services.  The action~~ 
 45.33  ~~plan must also describe how the health plan company intends to~~ 
 45.34  ~~encourage the use of nonphysician providers, midlevel~~ 
 45.35  ~~practitioners, and allied health professionals, through at least~~ 
 45.36  ~~consumer education, physician education, and referral and~~ 
 46.1   ~~advisement systems.  The annual action plan must also include~~ 
 46.2   ~~data that is broken down by type of provider, reflecting actual~~ 
 46.3   ~~utilization of midlevel practitioners and allied professionals~~ 
 46.4   ~~by enrollees of the health plan company during the previous~~ 
 46.5   ~~year.  Until July 1, 1995, a health plan company may use~~ 
 46.6   ~~estimates if actual data is not available.  For purposes of this~~ 
 46.7   ~~paragraph, "provider" has the meaning given in section 62J.03,~~ 
 46.8   ~~subdivision 8.~~  
 46.9      ~~(c) An action plan must include a description of the health~~ 
 46.10  ~~plan company's policy on determining the number and the type of~~ 
 46.11  ~~providers that are necessary to deliver cost-effective health~~ 
 46.12  ~~care to its enrollees.  The action plan must also include the~~ 
 46.13  ~~health plan company's strategy, including provider recruitment~~ 
 46.14  ~~and retention activities, for ensuring that sufficient providers~~ 
 46.15  ~~are available to its enrollees.~~ 
 46.16     ~~(d) An action plan must include a description of actions~~ 
 46.17  ~~taken or planned by the health plan company to ensure that~~ 
 46.18  ~~information from report cards, outcome studies, and complaints~~ 
 46.19  ~~is used internally to improve quality of the services provided~~ 
 46.20  ~~by the health plan company.~~ 
 46.21     ~~(e)~~ An action plan must include a detailed description of 
 46.22  the health plan company's policies and procedures for enrolling 
 46.23  and serving high risk and special needs populations.  This 
 46.24  description must also include the barriers that are present for 
 46.25  the high risk and special needs population and how the health 
 46.26  plan company is addressing these barriers in order to provide 
 46.27  greater access to these populations.  "High risk and special 
 46.28  needs populations" includes, but is not limited to, recipients 
 46.29  of medical assistance, general assistance medical care, and 
 46.30  MinnesotaCare; persons with chronic conditions or disabilities; 
 46.31  individuals within certain racial, cultural, and ethnic 
 46.32  communities; individuals and families with low income; 
 46.33  adolescents; the elderly; individuals with limited or no English 
 46.34  language proficiency; persons with high-cost preexisting 
 46.35  conditions; homeless persons; chemically dependent persons; 
 46.36  persons with serious and persistent mental illness; children 
 47.1   with severe emotional disturbance; and persons who are at high 
 47.2   risk of requiring treatment.  For purposes of this paragraph, 
 47.3   "provider" has the meaning given in section 62J.03, subdivision 
 47.4   8. 
 47.5      ~~(f) An action plan must include a general description of~~ 
 47.6   ~~any action the health plan company has taken and those it~~ 
 47.7   ~~intends to take to offer health coverage options to rural~~ 
 47.8   ~~communities and other communities not currently served by the~~ 
 47.9   ~~health plan company.~~ 
 47.10     ~~(g) A health plan company other than a large managed care~~ 
 47.11  ~~plan company may satisfy any of the requirements of the action~~ 
 47.12  ~~plan in paragraphs (a) to (f) by stating that it has no~~ 
 47.13  ~~policies, procedures, practices, or requirements, either written~~ 
 47.14  ~~or unwritten, or formal or informal, and has undertaken no~~ 
 47.15  ~~activities or plans on the issues required to be addressed in~~ 
 47.16  ~~the action plan, provided that the statement is truthful and not~~ 
 47.17  ~~misleading.  For purposes of this paragraph, "large managed care~~ 
 47.18  ~~plan company" means a health maintenance organization or other~~ 
 47.19  ~~health plan company that employs or contracts with health care~~ 
 47.20  ~~providers, that has more than 50,000 enrollees in this state.~~  
 47.21  ~~If a health plan company employs or contracts with providers for~~ 
 47.22  ~~some of its health plans and does not do so for other health~~ 
 47.23  ~~plans that it offers, the health plan company is a large managed~~ 
 47.24  ~~care plan company if it has more than 50,000 enrollees in this~~ 
 47.25  ~~state in health plans for which it does employ or contract with~~ 
 47.26  ~~providers.~~ 
 47.27     Sec. 31.  Minnesota Statutes 2000, section 62Q.106, is 
 47.28  amended to read: 
 47.29     62Q.106 [DISPUTE RESOLUTION BY COMMISSIONER.] 
 47.30     A complainant may at any time submit a complaint to the 
 47.31  ~~appropriate~~ commissioner to investigate.  After investigating a 
 47.32  complaint, or reviewing a company's decision, the ~~appropriate~~ 
 47.33  commissioner may order a remedy as authorized under chapter 45, 
 47.34  60A, or 62D.  
 47.35     Sec. 32.  Minnesota Statutes 2000, section 62Q.22, 
 47.36  subdivision 2, is amended to read: 
 48.1      Subd. 2.  [REGISTRATION.] A community health clinic that 
 48.2   offers a prepaid option under this section must register on an 
 48.3   annual basis with the commissioner ~~of health~~. 
 48.4      Sec. 33.  Minnesota Statutes 2000, section 62Q.22, 
 48.5   subdivision 6, is amended to read: 
 48.6      Subd. 6.  [INFORMATION TO BE PROVIDED.] (a) A community 
 48.7   health clinic must provide an individual or family who purchases 
 48.8   a prepaid option a clear and concise written statement that 
 48.9   includes the following information: 
 48.10     (1) the health care services that the prepaid option 
 48.11  covers; 
 48.12     (2) any exclusions or limitations on the health care 
 48.13  services offered, including any preexisting condition 
 48.14  limitations, cost-sharing arrangements, or prior authorization 
 48.15  requirements; 
 48.16     (3) where the health care services may be obtained; 
 48.17     (4) a description of the clinic's method for resolving 
 48.18  patient complaints, including a description of how a patient can 
 48.19  file a complaint with the ~~department of health~~ commissioner of 
 48.20  commerce; and 
 48.21     (5) a description of the conditions under which the prepaid 
 48.22  option may be canceled or terminated. 
 48.23     (b) The commissioner of ~~health~~ commerce must approve a copy 
 48.24  of the written statement before the community health clinic may 
 48.25  offer the prepaid option described in this section.  
 48.26     Sec. 34.  Minnesota Statutes 2000, section 62Q.22, 
 48.27  subdivision 7, is amended to read: 
 48.28     Subd. 7.  [COMPLAINT PROCESS.] (a) A community health 
 48.29  clinic that offers a prepaid option under this section must 
 48.30  establish a complaint resolution process.  As an alternative to 
 48.31  establishing its own process, a community health clinic may use 
 48.32  the complaint process of another organization.  
 48.33     (b) A community health clinic must make reasonable efforts 
 48.34  to resolve complaints and to inform complainants in writing of 
 48.35  the clinic's decision within 60 days of receiving the complaint. 
 48.36     (c) A community health clinic that offers a prepaid option 
 49.1   under this section must report all complaints that are not 
 49.2   resolved within 60 days to the commissioner ~~of health~~. 
 49.3      Sec. 35.  Minnesota Statutes 2000, section 62Q.32, is 
 49.4   amended to read: 
 49.5      62Q.32 [LOCAL OMBUDSPERSON.] 
 49.6      County board or community health service agencies may 
 49.7   establish an office of ombudsperson to provide a system of 
 49.8   consumer advocacy for persons receiving health care services 
 49.9   through a health plan company.  The ombudsperson's functions may 
 49.10  include, but are not limited to~~:~~ 
 49.11     ~~(a)~~, mediation or advocacy on behalf of a person accessing 
 49.12  the complaint and appeal procedures to ensure that necessary 
 49.13  medical services are provided by the health plan company~~; and~~ 
 49.14     ~~(b) investigation of the quality of services provided to a~~ 
 49.15  ~~person and determine the extent to which quality assurance~~ 
 49.16  ~~mechanisms are needed or any other system change may be needed.~~  
 49.17  ~~The commissioner of health shall make recommendations for~~ 
 49.18  ~~funding these functions including the amount of funding needed~~ 
 49.19  ~~and a plan for distribution.  The commissioner shall submit~~ 
 49.20  ~~these recommendations to the legislative commission on health~~ 
 49.21  ~~care access by January 15, 1996~~. 
 49.22     Sec. 36.  Minnesota Statutes 2000, section 62Q.33, 
 49.23  subdivision 2, is amended to read: 
 49.24     Subd. 2.  [REPORT ON SYSTEM DEVELOPMENT.] The commissioner 
 49.25  of health, in consultation with the state community health 
 49.26  services advisory committee and the commissioner of human 
 49.27  services, and representatives of local health departments, 
 49.28  county government, a municipal government acting as a local 
 49.29  board of health, area Indian health services, health care 
 49.30  providers, and citizens concerned about public health, shall 
 49.31  coordinate the process for defining implementation and financing 
 49.32  responsibilities of the local government core public health 
 49.33  functions.  The commissioner of health shall submit 
 49.34  recommendations and an initial and final report on local 
 49.35  government core public health functions according to the 
 49.36  timeline established in subdivision 5. 
 50.1      Sec. 37.  Minnesota Statutes 2000, section 62Q.49, 
 50.2   subdivision 2, is amended to read: 
 50.3      Subd. 2.  [DISCLOSURE REQUIRED.] (a) All health plans 
 50.4   included in subdivision 1 must clearly specify how the cost of 
 50.5   health care used to calculate any copayments, coinsurance, or 
 50.6   lifetime benefits will be affected by the arrangements described 
 50.7   in subdivision 1. 
 50.8      (b) Any summary or other marketing material used in 
 50.9   connection with marketing of a health plan that is subject to 
 50.10  this section must prominently disclose and clearly explain the 
 50.11  provisions required under paragraph (a), if the summary or other 
 50.12  marketing material refers to copayments, coinsurance, or maximum 
 50.13  lifetime benefits. 
 50.14     (c) A health plan that is subject to paragraph (a) must not 
 50.15  be used in this state if the commissioner of commerce ~~or health,~~ 
 50.16  ~~as appropriate,~~ has determined that it does not comply with this 
 50.17  section. 
 50.18     Sec. 38.  Minnesota Statutes 2000, section 62Q.51, 
 50.19  subdivision 3, is amended to read: 
 50.20     Subd. 3.  [RATE APPROVAL.] The premium rates and cost 
 50.21  sharing requirements for each option must be submitted to the 
 50.22  commissioner ~~of health or the commissioner~~ of commerce as 
 50.23  required by law.  A health plan that includes lower enrollee 
 50.24  cost sharing for services provided by network providers than for 
 50.25  services provided by out-of-network providers, or lower enrollee 
 50.26  cost sharing for services provided with prior authorization or 
 50.27  second opinion than for services provided without prior 
 50.28  authorization or second opinion, qualifies as a point-of-service 
 50.29  option. 
 50.30     Sec. 39.  Minnesota Statutes 2000, section 62Q.525, 
 50.31  subdivision 3, is amended to read: 
 50.32     Subd. 3.  [REQUIRED COVERAGE.] (a) Every type of coverage 
 50.33  included in subdivision 1 that provides coverage for drugs may 
 50.34  not exclude coverage of a drug for the treatment of cancer on 
 50.35  the ground that the drug has not been approved by the federal 
 50.36  Food and Drug Administration for the treatment of cancer if the 
 51.1   drug is recognized for treatment of cancer in one of the 
 51.2   standard reference compendia or in one article in the medical 
 51.3   literature, as defined in subdivision 2.  
 51.4      (b) Coverage of a drug required by this subdivision 
 51.5   includes coverage of medically necessary services directly 
 51.6   related to and required for appropriate administration of the 
 51.7   drug.  
 51.8      (c) Coverage required by this subdivision does not include 
 51.9   coverage of a drug not listed on the formulary of the coverage 
 51.10  included in subdivision 1. 
 51.11     (d) Coverage of a drug required under this subdivision must 
 51.12  not be subject to any copayment, coinsurance, deductible, or 
 51.13  other enrollee cost-sharing greater than the coverage included 
 51.14  in subdivision 1 applies to other drugs. 
 51.15     (e) The commissioner of commerce ~~or health, as appropriate,~~ 
 51.16  may direct a person that issues coverage included in subdivision 
 51.17  1 to make payments required by this section.  
 51.18     Sec. 40.  Minnesota Statutes 2000, section 62Q.68, 
 51.19  subdivision 1, is amended to read: 
 51.20     Subdivision 1.  [APPLICATION.] For purposes of sections 
 51.21  62Q.68 to 62Q.72, the terms defined in this section have the 
 51.22  meanings given them.  For purposes of sections 62Q.69 and 
 51.23  62Q.70, the term "health plan company" does not, except with 
 51.24  respect to managed care plans, as defined in section 62U.01, 
 51.25  include an insurance company licensed under chapter 60A to 
 51.26  offer, sell, or issue a policy of accident and sickness 
 51.27  insurance as defined in section 62A.01 or a nonprofit health 
 51.28  service plan corporation regulated under chapter 62C that only 
 51.29  provides dental coverage or vision coverage. 
 51.30     Sec. 41.  Minnesota Statutes 2000, section 62Q.69, 
 51.31  subdivision 2, is amended to read: 
 51.32     Subd. 2.  [PROCEDURES FOR FILING A COMPLAINT.] (a) A 
 51.33  complainant may submit a complaint to a health plan company 
 51.34  either by telephone or in writing.  If a complaint is submitted 
 51.35  orally and the resolution of the complaint, as determined by the 
 51.36  complainant, is partially or wholly adverse to the complainant, 
 52.1   or the oral complaint is not resolved to the satisfaction of the 
 52.2   complainant, by the health plan company within ten days of 
 52.3   receiving the complaint, the health plan company must inform the 
 52.4   complainant that the complaint may be submitted in writing.  The 
 52.5   health plan company must also offer to provide the complainant 
 52.6   with any assistance needed to submit a written complaint, 
 52.7   including an offer to complete the complaint form for a 
 52.8   complaint that was previously submitted orally and promptly mail 
 52.9   the completed form to the complainant for the complainant's 
 52.10  signature.  At the complainant's request, the health plan 
 52.11  company must provide the assistance requested by the 
 52.12  complainant.  The complaint form must include the following 
 52.13  information: 
 52.14     (1) the telephone number of the office of health care 
 52.15  consumer assistance, advocacy, and information, and the health 
 52.16  plan company member services or other departments or persons 
 52.17  equipped to advise complainants on complaint resolution; 
 52.18     (2) the address to which the form must be sent; 
 52.19     (3) a description of the health plan company's internal 
 52.20  complaint procedure and the applicable time limits; and 
 52.21     (4) the toll-free telephone number of ~~either~~ the 
 52.22  commissioner of ~~health or~~ commerce and notification that the 
 52.23  complainant has the right to submit the complaint at any time to 
 52.24  the ~~appropriate~~ commissioner for investigation. 
 52.25     (b) Upon receipt of a written complaint, the health plan 
 52.26  company must notify the complainant within ten business days 
 52.27  that the complaint was received, unless the complaint is 
 52.28  resolved to the satisfaction of the complainant within the ten 
 52.29  business days. 
 52.30     (c) Each health plan company must provide, in the member 
 52.31  handbook, subscriber contract, or certification of coverage, a 
 52.32  clear and concise description of how to submit a complaint and a 
 52.33  statement that, upon request, assistance in submitting a written 
 52.34  complaint is available from the health plan company. 
 52.35     Sec. 42.  Minnesota Statutes 2000, section 62Q.69, 
 52.36  subdivision 3, is amended to read: 
 53.1      Subd. 3.  [NOTIFICATION OF COMPLAINT DECISIONS.] (a) The 
 53.2   health plan company must notify the complainant in writing of 
 53.3   its decision and the reasons for it as soon as practical but in 
 53.4   no case later than 30 days after receipt of a written complaint. 
 53.5   If the health plan company cannot make a decision within 30 days 
 53.6   due to circumstances outside the control of the health plan 
 53.7   company, the health plan company may take up to 14 additional 
 53.8   days to notify the complainant of its decision.  If the health 
 53.9   plan company takes any additional days beyond the initial 30-day 
 53.10  period to make its decision, it must inform the complainant, in 
 53.11  advance, of the extension and the reasons for the extension.  
 53.12     (b) If the decision is partially or wholly adverse to the 
 53.13  complainant, the notification must inform the complainant of the 
 53.14  right to appeal the decision to the health plan company's 
 53.15  internal appeal process described in section 62Q.70 and the 
 53.16  procedure for initiating an appeal.  
 53.17     (c) The notification must also inform the complainant of 
 53.18  the right to submit the complaint at any time to ~~either~~ the 
 53.19  commissioner of ~~health or~~ commerce for investigation and the 
 53.20  toll-free telephone number of the ~~appropriate~~ commissioner. 
 53.21     Sec. 43.  Minnesota Statutes 2000, section 62Q.71, is 
 53.22  amended to read: 
 53.23     62Q.71 [NOTICE TO ENROLLEES.] 
 53.24     Each health plan company shall provide to enrollees a clear 
 53.25  and concise description of its complaint resolution procedure, 
 53.26  if applicable under section 62Q.68, subdivision 1, and the 
 53.27  procedure used for utilization review as defined under chapter 
 53.28  62M as part of the member handbook, subscriber contract, or 
 53.29  certificate of coverage.  If the health plan company does not 
 53.30  issue a member handbook, the health plan company may provide the 
 53.31  description in another written document.  The description must 
 53.32  specifically inform enrollees:  
 53.33     (1) how to submit a complaint to the health plan company; 
 53.34     (2) if the health plan includes utilization review 
 53.35  requirements, how to notify the utilization review organization 
 53.36  in a timely manner and how to obtain certification for health 
 54.1   care services; 
 54.2      (3) how to request an appeal either through the procedures 
 54.3   described in sections 62Q.69 and 62Q.70 or through the 
 54.4   procedures described in chapter 62M; 
 54.5      (4) of the right to file a complaint with ~~either~~ the 
 54.6   commissioner of ~~health or~~ commerce at any time during the 
 54.7   complaint and appeal process; 
 54.8      (5) of the toll-free telephone number of the ~~appropriate~~ 
 54.9   commissioner; and 
 54.10     (6) ~~of the telephone number of the office of consumer~~ 
 54.11  ~~assistance, advocacy, and information; and~~ 
 54.12     ~~(7)~~ of the right to obtain an external review under section 
 54.13  62Q.73 and a description of when and how that right may be 
 54.14  exercised. 
 54.15     Sec. 44.  Minnesota Statutes 2000, section 62Q.72, is 
 54.16  amended to read: 
 54.17     62Q.72 [RECORDKEEPING; REPORTING.] 
 54.18     Subdivision 1.  [RECORDKEEPING.] Each health plan company 
 54.19  shall maintain records of all enrollee complaints and their 
 54.20  resolutions.  These records shall be retained for five years and 
 54.21  shall be made available to the ~~appropriate~~ commissioner upon 
 54.22  request.  An insurance company licensed under chapter 60A may 
 54.23  instead comply with section 72A.20, subdivision 30, except with 
 54.24  respect to managed care plans, as defined in section 62U.01. 
 54.25     Subd. 2.  [REPORTING.] Each health plan company shall 
 54.26  submit to the ~~appropriate~~ commissioner, as part of the company's 
 54.27  annual filing, data on the number and type of complaints that 
 54.28  are not resolved within 30 days, or, except with respect to 
 54.29  managed care plans, as defined in section 62U.01, 30 business 
 54.30  days as provided under section 72A.201, subdivision 4, clause 
 54.31  (3), for insurance companies licensed under chapter 60A.  The 
 54.32  commissioner shall also make this information available to the 
 54.33  public upon request. 
 54.34     Sec. 45.  Minnesota Statutes 2000, section 62Q.73, 
 54.35  subdivision 3, is amended to read: 
 54.36     Subd. 3.  [RIGHT TO EXTERNAL REVIEW.] (a) Any enrollee or 
 55.1   anyone acting on behalf of an enrollee who has received an 
 55.2   adverse determination may submit a written request for an 
 55.3   external review of the adverse determination, if applicable 
 55.4   under section 62Q.68, subdivision 1, or 62M.06, to the 
 55.5   ~~commissioner of health if the request involves a health plan~~ 
 55.6   ~~company regulated by that commissioner or to the~~ commissioner of 
 55.7   commerce ~~if the request involves a health plan company regulated~~ 
 55.8   ~~by that commissioner~~.  The written request must be accompanied 
 55.9   by a filing fee of $25.  The fee may be waived by the 
 55.10  commissioner of ~~health or~~ commerce in cases of financial 
 55.11  hardship. 
 55.12     (b) Nothing in this section requires the commissioner of 
 55.13  ~~health or~~ commerce to independently investigate an adverse 
 55.14  determination referred for independent external review. 
 55.15     (c) If an enrollee requests an external review, the health 
 55.16  plan company must participate in the external review.  The cost 
 55.17  of the external review in excess of the filing fee described in 
 55.18  paragraph (a) shall be borne by the health plan company.  
 55.19     Sec. 46.  Minnesota Statutes 2000, section 62Q.73, 
 55.20  subdivision 4, is amended to read: 
 55.21     Subd. 4.  [CONTRACT.] Pursuant to a request for proposal, 
 55.22  the commissioner of administration, in consultation with 
 55.23  the ~~commissioners of health and~~ commissioner of commerce, shall 
 55.24  contract with an organization or business entity to provide 
 55.25  independent external reviews of all adverse determinations 
 55.26  submitted for external review.  The contract shall ensure that 
 55.27  the fees for services rendered in connection with the reviews be 
 55.28  reasonable. 
 55.29     Sec. 47.  Minnesota Statutes 2000, section 62Q.73, 
 55.30  subdivision 5, is amended to read: 
 55.31     Subd. 5.  [CRITERIA.] (a) The request for proposal must 
 55.32  require that the entity demonstrate: 
 55.33     (1) no conflicts of interest in that it is not owned, a 
 55.34  subsidiary of, or affiliated with a health plan company or 
 55.35  utilization review organization; 
 55.36     (2) an expertise in dispute resolution; 
 56.1      (3) an expertise in health-related law; 
 56.2      (4) an ability to conduct reviews using a variety of 
 56.3   alternative dispute resolution procedures depending upon the 
 56.4   nature of the dispute; 
 56.5      (5) an ability to provide data to the ~~commissioners of~~ 
 56.6   ~~health and~~ commissioner of commerce on reviews conducted; and 
 56.7      (6) an ability to ensure confidentiality of medical records 
 56.8   and other enrollee information. 
 56.9      (b) The commissioner of administration shall take into 
 56.10  consideration, in awarding the contract according to subdivision 
 56.11  4, any national accreditation standards that pertain to an 
 56.12  external review entity. 
 56.13     Sec. 48.  Minnesota Statutes 2000, section 62Q.73, 
 56.14  subdivision 6, is amended to read: 
 56.15     Subd. 6.  [PROCESS.] (a) Upon receiving a request for an 
 56.16  external review, the external review entity must provide 
 56.17  immediate notice of the review to the enrollee and to the health 
 56.18  plan company.  Within ten business days of receiving notice of 
 56.19  the review, the health plan company and the enrollee must 
 56.20  provide the external review entity with any information that 
 56.21  they wish to be considered.  Each party shall be provided an 
 56.22  opportunity to present its version of the facts and arguments.  
 56.23  An enrollee may be assisted or represented by a person of the 
 56.24  enrollee's choice. 
 56.25     (b) As part of the external review process, any aspect of 
 56.26  an external review involving a medical determination must be 
 56.27  performed by a health care professional with expertise in the 
 56.28  medical issue being reviewed. 
 56.29     (c) An external review shall be made as soon as practical 
 56.30  but in no case later than 40 days after receiving the request 
 56.31  for an external review and must promptly send written notice of 
 56.32  the decision and the reasons for it to the enrollee, the health 
 56.33  plan company, and the commissioner ~~who is responsible for~~ 
 56.34  ~~regulating the health plan company~~. 
 56.35     Sec. 49.  Minnesota Statutes 2000, section 62R.04, 
 56.36  subdivision 5, is amended to read: 
 57.1      Subd. 5.  [COMMISSIONER.] Unless otherwise specified, 
 57.2   "commissioner" means the commissioner ~~of health for a health~~ 
 57.3   ~~care network cooperative licensed under chapter 62D or 62N and~~ 
 57.4   ~~the commissioner~~ of commerce ~~for a health care network~~ 
 57.5   ~~cooperative licensed under chapter 62C~~. 
 57.6      Sec. 50.  Minnesota Statutes 2000, section 62R.06, 
 57.7   subdivision 1, is amended to read: 
 57.8      Subdivision 1.  [PROVIDER CONTRACTS.] A health provider 
 57.9   cooperative and its licensed members may execute marketing and 
 57.10  service contracts requiring the provider members to provide some 
 57.11  or all of their health care services through the provider 
 57.12  cooperative to the enrollees, members, subscribers, or insureds, 
 57.13  of a health care network cooperative, community integrated 
 57.14  service network, nonprofit health service plan, health 
 57.15  maintenance organization, accident and health insurance company, 
 57.16  or any other purchaser, including the state of Minnesota and its 
 57.17  agencies, instruments, or units of local government.  Each 
 57.18  purchasing entity is authorized to execute contracts for the 
 57.19  purchase of health care services from a health provider 
 57.20  cooperative in accordance with this section.  A contract between 
 57.21  a provider cooperative and a purchaser may provide for payment 
 57.22  by the purchaser to the health provider cooperative on a 
 57.23  capitated or similar risk-sharing basis, by fee-for-service 
 57.24  arrangements, or by other financial arrangements authorized 
 57.25  under state law.  Each contract between a provider cooperative 
 57.26  and a purchaser shall be filed by the provider network 
 57.27  cooperative with the commissioner of ~~health~~ commerce and is 
 57.28  subject to the provisions of section 62D.19. 
 57.29     Sec. 51.  Minnesota Statutes 2000, section 62T.01, 
 57.30  subdivision 4, is amended to read: 
 57.31     Subd. 4.  [COMMISSIONER.] "Commissioner" means the 
 57.32  commissioner of ~~health~~ commerce. 
 57.33     Sec. 52.  Minnesota Statutes 2000, section 256B.692, 
 57.34  subdivision 2, is amended to read: 
 57.35     Subd. 2.  [DUTIES OF THE COMMISSIONER OF ~~HEALTH~~ COMMERCE.] 
 57.36  (a) Notwithstanding chapters 62D and 62N, a county that elects 
 58.1   to purchase medical assistance and general assistance medical 
 58.2   care in return for a fixed sum without regard to the frequency 
 58.3   or extent of services furnished to any particular enrollee is 
 58.4   not required to obtain a certificate of authority under chapter 
 58.5   62D or 62N.  The county board of commissioners is the governing 
 58.6   body of a county-based purchasing program.  In a multicounty 
 58.7   arrangement, the governing body is a joint powers board 
 58.8   established under section 471.59.  
 58.9      (b) A county that elects to purchase medical assistance and 
 58.10  general assistance medical care services under this section must 
 58.11  satisfy the commissioner of ~~health~~ commerce that the 
 58.12  requirements for assurance of consumer protection, provider 
 58.13  protection, and fiscal solvency of chapter 62D, applicable to 
 58.14  health maintenance organizations, or chapter 62N, applicable to 
 58.15  community integrated service networks, will be met.  
 58.16     (c) A county must also assure the commissioner of ~~health~~ 
 58.17  commerce that the requirements of sections 62J.041; 62J.48; 
 58.18  62J.71 to 62J.73; 62M.01 to 62M.16; all applicable provisions of 
 58.19  chapter 62Q, including sections 62Q.07; 62Q.075; 62Q.1055; 
 58.20  62Q.106; 62Q.12; 62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23, 
 58.21  paragraph (c); 62Q.43; 62Q.47; 62Q.50; 62Q.52 to 62Q.56; 62Q.58; 
 58.22  62Q.64; 62Q.68 to 62Q.72; and 72A.201 will be met.  
 58.23     (d) All enforcement and rulemaking powers available under 
 58.24  chapters 62D, 62J, 62M, 62N, and 62Q are hereby granted to the 
 58.25  commissioner of ~~health~~ commerce with respect to counties that 
 58.26  purchase medical assistance and general assistance medical care 
 58.27  services under this section.  
 58.28     (e) The commissioner, in consultation with county 
 58.29  government, shall develop administrative and financial reporting 
 58.30  requirements for county-based purchasing programs relating to 
 58.31  sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 
 58.32  62N.31, and other sections as necessary, that are specific to 
 58.33  county administrative, accounting, and reporting systems and 
 58.34  consistent with other statutory requirements of counties.  
 58.35     Sec. 53.  Minnesota Statutes 2000, section 256B.692, 
 58.36  subdivision 7, is amended to read: 
 59.1      Subd. 7.  [DISPUTE RESOLUTION.] In the event the 
 59.2   commissioner rejects a proposal under subdivision 6, the county 
 59.3   board may request the recommendation of a three-person mediation 
 59.4   panel.  The commissioner shall resolve all disputes after taking 
 59.5   into account the recommendations of the mediation panel.  The 
 59.6   panel shall be composed of one designee of the president of the 
 59.7   association of Minnesota counties, one designee of the 
 59.8   commissioner of human services, and one designee of the 
 59.9   commissioner of ~~health~~ commerce. 
 59.10     Sec. 54.  [TRANSFER OF REGULATORY AUTHORITY; CERTAIN 
 59.11  HEALTH-RELATED ORGANIZATIONS.] 
 59.12     (a) Regulatory authority for health maintenance 
 59.13  organizations operating under Minnesota Statutes, chapter 62D; 
 59.14  community integrated service networks, as defined in Minnesota 
 59.15  Statutes, section 62N.02, subdivision 4a; health care 
 59.16  cooperatives operating under Minnesota Statutes, chapter 62R; 
 59.17  and health care purchasing alliances and accountable provider 
 59.18  networks operating under Minnesota Statutes, chapter 62T; is 
 59.19  transferred from the commissioner of health to the commissioner 
 59.20  of commerce, effective January 1, 2002. 
 59.21     (b) Minnesota Statutes, section 15.039, applies to the 
 59.22  transfer provided in paragraph (a). 
 59.23     Sec. 55.  [REVISOR INSTRUCTION.] 
 59.24     (a) The revisor of statutes shall change the term 
 59.25  "commissioner of health" and similar references to "commissioner 
 59.26  of commerce" and change the term "department of health" and 
 59.27  similar references to "department of commerce" in Minnesota 
 59.28  Statutes, chapters 62D, but not section 62D.02, subdivision 12; 
 59.29  62E; and 62N. 
 59.30     (b) The revisor of statutes shall recode Minnesota 
 59.31  Statutes, section 62Q.095, subdivision 5, as a new subdivision 
 59.32  of Minnesota Statutes, section 62Q.10. 
 59.33     Sec. 56.  [STUDY AND REPORT.] 
 59.34     The commissioner of health shall study and report to the 
 59.35  legislature, no later than January 1, 2004, on premium cost, 
 59.36  subscriber liability, and health outcomes under different types 
 60.1   of health plan regulation by the state.  The commissioner shall 
 60.2   use data available to the commissioner under Minnesota Statutes, 
 60.3   section 62J.38, and otherwise.  The reports must be submitted to 
 60.4   the legislature in compliance with Minnesota Statutes, section 
 60.5   3.195. 
 60.6      Sec. 57.  [REPEALER.] 
 60.7      Minnesota Statutes 2000, sections 62Q.095, subdivisions 1, 
 60.8   2, 3, 4, and 6; and 62Q.45, are repealed. 
 60.9      Sec. 58.  [EFFECTIVE DATE.] 
 60.10     Sections 1 to 57 are effective January 1, 2002.  Amendments 
 60.11  involving transfer of regulatory authority to the commissioner 
 60.12  of commerce are effective on that date.  Amendments affecting 
 60.13  coverage are effective that date and apply to coverage issued or 
 60.14  renewed on or after that date.  
 60.15                             ARTICLE 3 
 60.16                    MINIMUM BENEFITS CONFORMITY 
 60.17     Section 1.  Minnesota Statutes 2000, section 62A.041, 
 60.18  subdivision 1, is amended to read: 
 60.19     Subdivision 1.  [DISCRIMINATION PROHIBITED AGAINST 
 60.20  UNMARRIED WOMEN.] Each group policy of accident and health 
 60.21  insurance and each group health ~~maintenance contract~~ plan shall 
 60.22  provide the same coverage for maternity benefits to unmarried 
 60.23  women and minor female dependents that it provides to married 
 60.24  women including the wives of employees choosing dependent family 
 60.25  coverage.  If an unmarried insured or an unmarried enrollee is a 
 60.26  parent of a dependent child, each group policy and each group 
 60.27  ~~contract~~ health plan shall provide the same coverage for that 
 60.28  child as that provided for the child of a married employee 
 60.29  choosing dependent family coverage if the insured or the 
 60.30  enrollee elects dependent family coverage. 
 60.31     Each individual policy of accident and health insurance and 
 60.32  each individual health ~~maintenance contract~~ plan shall provide 
 60.33  the same coverage for maternity benefits to unmarried women and 
 60.34  minor female dependents as that provided for married women.  If 
 60.35  an unmarried insured or an unmarried enrollee is a parent of a 
 60.36  dependent child, each individual policy and each individual 
 61.1   ~~contract~~ health plan shall also provide the same coverage for 
 61.2   that child as that provided for the child of a married insured 
 61.3   or a married enrollee choosing dependent family coverage if the 
 61.4   insured or the enrollee elects dependent family coverage. 
 61.5      Sec. 2.  Minnesota Statutes 2000, section 62A.041, 
 61.6   subdivision 2, is amended to read: 
 61.7      Subd. 2.  [LIMITATION ON COVERAGE PROHIBITED.] Each group 
 61.8   policy of accident and health insurance, except for policies 
 61.9   which only provide coverage for specified diseases, or each 
 61.10  group ~~subscriber contract of accident and health insurance or~~ 
 61.11  ~~health maintenance contract, issued or renewed after August 1,~~ 
 61.12  ~~1987,~~ health plan shall include maternity benefits in the same 
 61.13  manner as any other illness covered under the policy or ~~contract~~ 
 61.14  health plan.  
 61.15     Sec. 3.  Minnesota Statutes 2000, section 62A.042, is 
 61.16  amended to read: 
 61.17     62A.042 [FAMILY COVERAGE; COVERAGE OF NEWBORN INFANTS AND 
 61.18  CLEFT LIP AND CLEFT PALATE.] 
 61.19     Subdivision 1.  [INDIVIDUAL FAMILY POLICIES.] (a) No policy 
 61.20  of individual accident and sickness insurance which provides for 
 61.21  insurance for more than one person under section 62A.03, 
 61.22  subdivision 1, clause (3), and no individual health ~~maintenance~~ 
 61.23  ~~contract~~ plan which provides for coverage for more than one 
 61.24  person ~~under chapter 62D~~, shall be renewed to insure or cover 
 61.25  any person in this state or be delivered or issued for delivery 
 61.26  to any person in this state unless the policy or ~~contract~~ health 
 61.27  plan includes as insured or covered members of the family any 
 61.28  newborn infants immediately from the moment of birth and 
 61.29  thereafter which ~~insurance or contract~~ policy or health plan 
 61.30  shall provide coverage for illness, injury, congenital 
 61.31  malformation, or premature birth.  For purposes of this 
 61.32  paragraph, "newborn infants" includes grandchildren who are 
 61.33  financially dependent upon a covered grandparent and who reside 
 61.34  with that covered grandparent continuously from birth.  No 
 61.35  policy or ~~contract~~ health plan covered by this section may 
 61.36  require notification to a health carrier as a condition for this 
 62.1   dependent coverage.  However, if the policy or ~~contract~~ health 
 62.2   plan mandates an additional premium for each dependent, the 
 62.3   health carrier shall be entitled to all premiums that would have 
 62.4   been collected had the health carrier been aware of the 
 62.5   additional dependent.  The health carrier may withhold payment 
 62.6   of any health benefits for the new dependent until it has been 
 62.7   compensated with the applicable premium which would have been 
 62.8   owed if the health carrier had been informed of the additional 
 62.9   dependent immediately. 
 62.10     (b) The coverage under paragraph (a) includes benefits for 
 62.11  inpatient or outpatient expenses arising from medical and dental 
 62.12  treatment up to age 18, including orthodontic and oral surgery 
 62.13  treatment, involved in the management of birth defects known as 
 62.14  cleft lip and cleft palate.  If orthodontic services are 
 62.15  eligible for coverage under a dental insurance plan and another 
 62.16  policy or ~~contract~~ health plan, the dental plan shall be primary 
 62.17  and the other policy or ~~contract~~ health plan shall be secondary 
 62.18  in regard to the coverage required under paragraph (a).  Payment 
 62.19  for dental or orthodontic treatment not related to the 
 62.20  management of the congenital condition of cleft lip and cleft 
 62.21  palate shall not be covered under this provision.  
 62.22     Subd. 2.  [GROUP POLICIES.] (a) No group accident and 
 62.23  sickness insurance policy and no group health ~~maintenance~~ 
 62.24  ~~contract~~ plan which ~~provide~~ provides for coverage of family 
 62.25  members or other dependents of an employee or other member of 
 62.26  the covered group shall be renewed to cover members of a group 
 62.27  located in this state or delivered or issued for delivery to any 
 62.28  person in this state unless the policy or ~~contract~~ health plan 
 62.29  includes as insured or covered family members or dependents any 
 62.30  newborn infants immediately from the moment of birth and 
 62.31  thereafter which ~~insurance or contract~~ policy or health plan 
 62.32  shall provide coverage for illness, injury, congenital 
 62.33  malformation, or premature birth.  For purposes of this 
 62.34  paragraph, "newborn infants" includes grandchildren who are 
 62.35  financially dependent upon a covered grandparent and who reside 
 62.36  with that covered grandparent continuously from birth.  No 
 63.1   policy or ~~contract~~ health plan covered by this section may 
 63.2   require notification to a health carrier as a condition for this 
 63.3   dependent coverage.  However, if the policy or ~~contract~~ health 
 63.4   plan mandates an additional premium for each dependent, the 
 63.5   health carrier shall be entitled to all premiums that would have 
 63.6   been collected had the health carrier been aware of the 
 63.7   additional dependent.  The health carrier may reduce the health 
 63.8   benefits owed to the insured, certificate holder, member, or 
 63.9   subscriber by the amount of past due premiums applicable to the 
 63.10  additional dependent. 
 63.11     (b) The coverage under paragraph (a) includes benefits for 
 63.12  inpatient or outpatient expenses arising from medical and dental 
 63.13  treatment up to age 18, including orthodontic and oral surgery 
 63.14  treatment, involved in the management of birth defects known as 
 63.15  cleft lip and cleft palate.  If orthodontic services are 
 63.16  eligible for coverage under a dental insurance plan and another 
 63.17  policy or ~~contract~~ health plan, the dental plan shall be primary 
 63.18  and the other policy or ~~contract~~ health plan shall be secondary 
 63.19  in regard to the coverage required under paragraph (a).  Payment 
 63.20  for dental or orthodontic treatment not related to the 
 63.21  management of the congenital condition of cleft lip and cleft 
 63.22  palate shall not be covered under this provision. 
 63.23     Sec. 4.  Minnesota Statutes 2000, section 62A.043, 
 63.24  subdivision 1, is amended to read: 
 63.25     Subdivision 1.  The provisions of this section ~~shall~~ apply 
 63.26  to all individual or group policies or ~~subscriber contracts~~ 
 63.27  health plans providing payment for care in this state~~, which~~ 
 63.28  ~~policies or contracts are issued or renewed after August 1, 1976~~ 
 63.29  ~~by an accident and health insurance company regulated under this~~ 
 63.30  ~~chapter, or a nonprofit health service plan corporation~~ 
 63.31  ~~regulated under chapter 62C~~. 
 63.32     Sec. 5.  Minnesota Statutes 2000, section 62A.14, is 
 63.33  amended to read: 
 63.34     62A.14 [HANDICAPPED CHILDREN.] 
 63.35     Subdivision 1.  [INDIVIDUAL FAMILY POLICIES.] An individual 
 63.36  hospital or medical expense insurance policy delivered or issued 
 64.1   for delivery in this state more than 120 days after May 16, 
 64.2   1969, or an individual ~~health maintenance contract~~ health plan 
 64.3   delivered or issued for delivery in this state after August 1, 
 64.4   1984, which provides that coverage of a dependent child shall 
 64.5   terminate upon attainment of the limiting age for dependent 
 64.6   children specified in the policy or ~~contract~~ health plan shall 
 64.7   also provide in substance that attainment of such limiting age 
 64.8   shall not operate to terminate the coverage of such child while 
 64.9   the child is and continues to be both (a) incapable of 
 64.10  self-sustaining employment by reason of mental retardation, 
 64.11  mental illness or disorder, or physical handicap and (b) chiefly 
 64.12  dependent upon the policyholder for support and maintenance, 
 64.13  provided proof of such incapacity and dependency is furnished to 
 64.14  the ~~insurer or~~ health ~~maintenance organization~~ carrier by the 
 64.15  policyholder or enrollee within 31 days of the child's 
 64.16  attainment of the limiting age and subsequently as may be 
 64.17  required by the ~~insurer or organization~~ health carrier but not 
 64.18  more frequently than annually after the two-year period 
 64.19  following the child's attainment of the limiting age.  
 64.20     Subd. 2.  [GROUP POLICIES.] A group hospital or medical 
 64.21  expense insurance policy delivered or issued for delivery in 
 64.22  this state more than 120 days after May 16, 1969, or a group 
 64.23  health ~~maintenance contract~~ plan delivered or issued for 
 64.24  delivery in this state after August 1, 1984, which provides that 
 64.25  coverage of a dependent child of an employee or other member of 
 64.26  the covered group shall terminate upon attainment of the 
 64.27  limiting age for dependent children specified in the policy 
 64.28  or ~~contract~~ health plan shall also provide in substance that 
 64.29  attainment of such limiting age shall not operate to terminate 
 64.30  the coverage of such child while the child is and continues to 
 64.31  be both (a) incapable of self-sustaining employment by reason of 
 64.32  mental retardation, mental illness or disorder, or physical 
 64.33  handicap and (b) chiefly dependent upon the employee or member 
 64.34  for support and maintenance, provided proof of such incapacity 
 64.35  and dependency is furnished to the ~~insurer or organization~~ 
 64.36  health carrier by the employee or member within 31 days of the 
 65.1   child's attainment of the limiting age and subsequently as may 
 65.2   be required by the ~~insurer or organization~~ health carrier but 
 65.3   not more frequently than annually after the two-year period 
 65.4   following the child's attainment of the limiting age. 
 65.5      Sec. 6.  Minnesota Statutes 2000, section 62A.149, 
 65.6   subdivision 1, is amended to read: 
 65.7      Subdivision 1.  With the exception of managed care plans as 
 65.8   defined in section 62U.01, the provisions of this section apply 
 65.9   to all group policies of accident and health insurance and group 
 65.10  subscriber contracts offered by nonprofit health service plan 
 65.11  corporations regulated under chapter 62C, and to a plan or 
 65.12  policy that is individually underwritten or provided for a 
 65.13  specific individual and family members as a nongroup policy 
 65.14  unless the individual elects in writing to refuse benefits under 
 65.15  this subdivision in exchange for an appropriate reduction in 
 65.16  premiums or subscriber charges under the policy or plan, when 
 65.17  the policies or subscriber contracts are issued or delivered in 
 65.18  Minnesota or provide benefits to Minnesota residents enrolled 
 65.19  thereunder. 
 65.20     This section does not apply to policies designed primarily 
 65.21  to provide coverage payable on a per diem, fixed indemnity or 
 65.22  nonexpense incurred basis or policies that provide accident only 
 65.23  coverage.  
 65.24     Every insurance policy or subscriber contract included 
 65.25  within the provisions of this subdivision, upon issuance or 
 65.26  renewal, shall provide for payment of benefits for the treatment 
 65.27  of alcoholism, chemical dependency or drug addiction to any 
 65.28  Minnesota resident entitled to coverage thereunder on the same 
 65.29  basis as coverage for other benefits when treatment is rendered 
 65.30  in 
 65.31     (1) a licensed hospital, 
 65.32     (2) a residential treatment program as licensed by the 
 65.33  state of Minnesota pursuant to diagnosis or recommendation by a 
 65.34  doctor of medicine, 
 65.35     (3) a nonresidential treatment program approved or licensed 
 65.36  by the state of Minnesota. 
 66.1      Sec. 7.  Minnesota Statutes 2000, section 62A.15, 
 66.2   subdivision 1, is amended to read: 
 66.3      Subdivision 1.  [APPLICABILITY.] The provisions of this 
 66.4   section apply to all group policies or ~~subscriber contracts~~ 
 66.5   individual or group health plans providing payment for care in 
 66.6   this state~~, which are issued by accident and health insurance~~ 
 66.7   ~~companies regulated under this chapter and nonprofit health~~ 
 66.8   ~~service plan corporations regulated under chapter 62C~~. 
 66.9      Sec. 8.  Minnesota Statutes 2000, section 62A.152, 
 66.10  subdivision 1, is amended to read: 
 66.11     Subdivision 1.  [SCOPE.] With the exception of managed care 
 66.12  plans as defined in section 62U.01, the provisions of this 
 66.13  section apply (a) to all group policies or subscriber contracts 
 66.14  which provide benefits for at least 100 certificate holders who 
 66.15  are residents of this state or groups of which more than 90 
 66.16  percent are residents of this state and are issued, delivered, 
 66.17  or renewed by accident and health insurance companies regulated 
 66.18  under this chapter, or by nonprofit health service plan 
 66.19  corporations regulated under chapter 62C and (b), unless waived 
 66.20  by the commissioner to the extent applicable to holders who are 
 66.21  both nonresidents and employed outside this state, to all group 
 66.22  policies or subscriber contracts which are issued, delivered, or 
 66.23  renewed within this state by accident and health insurance 
 66.24  companies regulated under this chapter, or by nonprofit health 
 66.25  service plan corporations regulated under chapter 62C. 
 66.26     Sec. 9.  Minnesota Statutes 2000, section 62A.153, is 
 66.27  amended to read: 
 66.28     62A.153 [OUTPATIENT MEDICAL AND SURGICAL SERVICES.] 
 66.29     No policy or plan of health, medical, hospitalization, or 
 66.30  accident and sickness insurance regulated under this chapter, or 
 66.31  ~~subscriber contract provided by a nonprofit health service plan~~ 
 66.32  ~~corporation regulated under chapter 62C~~ health plan that 
 66.33  provides coverage for services in a hospital shall be issued, 
 66.34  renewed, continued, delivered, issued for delivery or executed 
 66.35  in this state, or approved for issuance or renewal in this state 
 66.36  ~~by the commissioner of commerce~~ unless the policy, plan, or 
 67.1   ~~contract~~ health plan specifically provides coverage for a health 
 67.2   care treatment or surgery on an outpatient basis at a facility 
 67.3   equipped to perform these services, whether or not the facility 
 67.4   is part of a hospital.  Coverage shall be on the same basis as 
 67.5   coverage provided for the same health care treatment or service 
 67.6   in a hospital. 
 67.7      Sec. 10.  Minnesota Statutes 2000, section 62A.20, is 
 67.8   amended to read: 
 67.9      62A.20 [CONTINUATION COVERAGE OF CURRENT SPOUSE AND 
 67.10  CHILDREN.] 
 67.11     Subdivision 1.  [REQUIREMENT.] Every policy of accident and 
 67.12  health insurance providing coverage of hospital or medical 
 67.13  expense on either an expense-incurred basis or other than an 
 67.14  expense-incurred basis, or health plan, which in addition to 
 67.15  covering the insured also provides coverage to the spouse and 
 67.16  dependent children of the insured shall contain: 
 67.17     (1) a provision which permits the spouse and dependent 
 67.18  children to elect to continue coverage when the insured becomes 
 67.19  enrolled for benefits under Title XVIII of the Social Security 
 67.20  Act (Medicare); and 
 67.21     (2) a provision which permits the dependent children to 
 67.22  continue coverage when they cease to be dependent children under 
 67.23  the generally applicable requirement of the plan. 
 67.24     Subd. 2.  [CONTINUATION PRIVILEGE.] The coverage described 
 67.25  in subdivision 1 may be continued until the earlier of the 
 67.26  following dates: 
 67.27     (1) the date coverage would otherwise terminate under the 
 67.28  policy or health plan; 
 67.29     (2) 36 months after continuation by the spouse or dependent 
 67.30  was elected; or 
 67.31     (3) the spouse or dependent children become covered under 
 67.32  another group health plan. 
 67.33     If coverage is provided under a group policy or group 
 67.34  health plan, any required premium contributions for the coverage 
 67.35  shall be paid by the insured on a monthly basis to the group 
 67.36  policyholder for remittance to the ~~insurer~~ health carrier.  In 
 68.1   no event shall the amount of premium charged exceed 102 percent 
 68.2   of the cost to the plan for such period of coverage for other 
 68.3   similarly situated spouse and dependent children to whom 
 68.4   subdivision 1 is not applicable, without regard to whether such 
 68.5   cost is paid by the employer or employee. 
 68.6      Sec. 11.  Minnesota Statutes 2000, section 62A.21, is 
 68.7   amended to read: 
 68.8      62A.21 [CONTINUATION AND CONVERSION PRIVILEGES FOR INSURED 
 68.9   FORMER SPOUSES AND CHILDREN.] 
 68.10     Subdivision 1.  No policy of accident and health insurance 
 68.11  providing coverage of hospital or medical expense on either an 
 68.12  expense incurred basis or other than an expense incurred basis, 
 68.13  or health plan, which in addition to covering the insured also 
 68.14  provides coverage to the spouse of the insured, shall contain a 
 68.15  provision for termination of coverage for a spouse covered under 
 68.16  the policy or health plan solely as a result of a break in the 
 68.17  marital relationship. 
 68.18     Subd. 2a.  [CONTINUATION PRIVILEGE.] Every policy or health 
 68.19  plan described in subdivision 1 shall contain a provision which 
 68.20  permits continuation of coverage under the policy or health plan 
 68.21  for the insured's former spouse and dependent children upon 
 68.22  entry of a valid decree of dissolution of marriage.  The 
 68.23  coverage shall be continued until the earlier of the following 
 68.24  dates: 
 68.25     (a) the date the insured's former spouse becomes covered 
 68.26  under any other group health plan; or 
 68.27     (b) the date coverage would otherwise terminate under the 
 68.28  policy or health plan. 
 68.29     If the coverage is provided under a group policy or group 
 68.30  health plan, any required premium contributions for the coverage 
 68.31  shall be paid by the insured on a monthly basis to the group 
 68.32  policyholder for remittance to the ~~insurer~~ health carrier.  The 
 68.33  policy or health plan must require the group policyholder to, 
 68.34  upon request, provide the insured with written verification from 
 68.35  the ~~insurer~~ health carrier of the cost of this coverage promptly 
 68.36  at the time of eligibility for this coverage and at any time 
 69.1   during the continuation period.  In no event shall the amount of 
 69.2   premium charged exceed 102 percent of the cost to the plan for 
 69.3   such period of coverage for other similarly situated spouses and 
 69.4   dependent children with respect to whom the marital relationship 
 69.5   has not dissolved, without regard to whether such cost is paid 
 69.6   by the employer or employee. 
 69.7      Subd. 2b.  [CONVERSION PRIVILEGE.] Every policy or health 
 69.8   plan described in subdivision 1 shall contain a provision 
 69.9   allowing a former spouse and dependent children of an insured, 
 69.10  without providing evidence of insurability, to obtain from 
 69.11  the ~~insurer~~ health carrier at the expiration of any continuation 
 69.12  of coverage required under subdivision 2a or sections 62A.146 
 69.13  and 62A.20, conversion coverage providing at least the minimum 
 69.14  benefits of a qualified plan as prescribed by section 62E.06 and 
 69.15  the option of a number three qualified plan, a number two 
 69.16  qualified plan, a number one qualified plan as provided by 
 69.17  section 62E.06, subdivisions 1 to 3, provided application is 
 69.18  made to the ~~insurer~~ health carrier within 30 days following 
 69.19  notice of the expiration of the continued coverage and upon 
 69.20  payment of the appropriate premium.  The individual policy or 
 69.21  individual health plan shall be renewable at the option of the 
 69.22  covered person as long as the covered person is not covered 
 69.23  under another qualified plan as defined in section 62E.02, 
 69.24  subdivision 4.  Any revisions in the table of rate for the 
 69.25  individual policy or individual health plan shall apply to the 
 69.26  covered person's original age at entry and shall apply equally 
 69.27  to all similar policies or health plans issued by the 
 69.28  ~~insurer~~ health carrier. 
 69.29     A policy or health plan providing reduced benefits at a 
 69.30  reduced premium rate may be accepted by the covered person in 
 69.31  lieu of the optional coverage otherwise required by this 
 69.32  subdivision. 
 69.33     ~~Subd. 3.  Subdivision 1 applies to every policy of accident~~ 
 69.34  ~~and health insurance which is delivered, issued for delivery,~~ 
 69.35  ~~renewed or amended on or after July 19, 1977.~~ 
 69.36     ~~Subdivisions 2a and 2b apply to every policy of accident~~ 
 70.1   ~~and health insurance which is delivered, issued for delivery,~~ 
 70.2   ~~renewed, or amended on or after August 1, 1981.~~  
 70.3      Sec. 12.  Minnesota Statutes 2000, section 62A.616, is 
 70.4   amended to read: 
 70.5      62A.616 [COVERAGE FOR NURSING HOME CARE FOR TERMINALLY ILL 
 70.6   AND OTHER SERVICES.] 
 70.7      ~~An insurer~~ A health carrier may offer a health plan that 
 70.8   covers nursing home care for the terminally ill, personal care 
 70.9   attendants, and hospice care.  For the purposes of this section, 
 70.10  "terminally ill" means a diagnosis certified by a physician that 
 70.11  a person has less than six months to live. 
 70.12     Sec. 13.  Minnesota Statutes 2000, section 62A.65, 
 70.13  subdivision 5, is amended to read: 
 70.14     Subd. 5.  [PORTABILITY AND CONVERSION OF COVERAGE.] (a) No 
 70.15  individual health plan may be offered, sold, issued, or with 
 70.16  respect to children age 18 or under renewed, to a Minnesota 
 70.17  resident that contains a preexisting condition limitation, 
 70.18  preexisting condition exclusion, or exclusionary rider, unless 
 70.19  the limitation or exclusion is permitted under this subdivision 
 70.20  and under chapter 62L, provided that, except for children age 18 
 70.21  or under, underwriting restrictions may be retained on 
 70.22  individual contracts that are issued without evidence of 
 70.23  insurability as a replacement for prior individual coverage that 
 70.24  was sold before May 17, 1993.  The individual may be subjected 
 70.25  to an 18-month preexisting condition limitation, unless the 
 70.26  individual has maintained continuous coverage as defined in 
 70.27  section 62L.02.  The individual must not be subjected to an 
 70.28  exclusionary rider.  An individual who has maintained continuous 
 70.29  coverage may be subjected to a one-time preexisting condition 
 70.30  limitation of up to 12 months, with credit for time covered 
 70.31  under qualifying coverage as defined in section 62L.02, at the 
 70.32  time that the individual first is covered under an individual 
 70.33  health plan by any health carrier.  Credit must be given for all 
 70.34  qualifying coverage with respect to all preexisting conditions, 
 70.35  regardless of whether the conditions were preexisting with 
 70.36  respect to any previous qualifying coverage.  The individual 
 71.1   must not be subjected to an exclusionary rider.  Thereafter, the 
 71.2   individual must not be subject to any preexisting condition 
 71.3   limitation, preexisting condition exclusion, or exclusionary 
 71.4   rider under an individual health plan by any health carrier, 
 71.5   except an unexpired portion of a limitation under prior 
 71.6   coverage, so long as the individual maintains continuous 
 71.7   coverage as defined in section 62L.02. 
 71.8      (b) A health carrier must offer an individual health plan 
 71.9   to any individual previously covered under a group health plan 
 71.10  issued by that health carrier, regardless of the size of the 
 71.11  group, so long as the individual maintained continuous coverage 
 71.12  as defined in section 62L.02.  If the individual has available 
 71.13  any continuation coverage provided under sections 62A.146; 
 71.14  62A.148; 62A.17, subdivisions 1 and 2; 62A.20; or 62A.21~~;~~ 
 71.15  ~~62C.142; 62D.101; or 62D.105~~, or continuation coverage provided 
 71.16  under federal law, the health carrier need not offer coverage 
 71.17  under this paragraph until the individual has exhausted the 
 71.18  continuation coverage.  The offer must not be subject to 
 71.19  underwriting, except as permitted under this paragraph.  A 
 71.20  health plan issued under this paragraph must be a qualified plan 
 71.21  as defined in section 62E.02 and must not contain any 
 71.22  preexisting condition limitation, preexisting condition 
 71.23  exclusion, or exclusionary rider, except for any unexpired 
 71.24  limitation or exclusion under the previous coverage.  The 
 71.25  individual health plan must cover pregnancy on the same basis as 
 71.26  any other covered illness under the individual health plan.  The 
 71.27  initial premium rate for the individual health plan must comply 
 71.28  with subdivision 3.  The premium rate upon renewal must comply 
 71.29  with subdivision 2.  In no event shall the premium rate exceed 
 71.30  90 percent of the premium charged for comparable individual 
 71.31  coverage by the Minnesota comprehensive health association, and 
 71.32  the premium rate must be less than that amount if necessary to 
 71.33  otherwise comply with this section.  An individual health plan 
 71.34  offered under this paragraph to a person satisfies the health 
 71.35  carrier's obligation to offer conversion coverage under section 
 71.36  62E.16, with respect to that person.  Coverage issued under this 
 72.1   paragraph must provide that it cannot be canceled or nonrenewed 
 72.2   as a result of the health carrier's subsequent decision to leave 
 72.3   the individual, small employer, or other group market.  Section 
 72.4   72A.20, subdivision 28, applies to this paragraph. 
 72.5      Sec. 14.  Minnesota Statutes 2000, section 62D.12, 
 72.6   subdivision 1a, is amended to read: 
 72.7      Subd. 1a.  [SWING-OUT PRODUCTS.] Notwithstanding 
 72.8   subdivision 1, nothing in sections ~~62A.049,~~ 62A.60~~,~~ and 72A.201, 
 72.9   subdivision 4a, applies to a commercial health policy issued 
 72.10  under this chapter as a companion to a health maintenance 
 72.11  contract. 
 72.12     Sec. 15.  Minnesota Statutes 2000, section 62E.16, is 
 72.13  amended to read: 
 72.14     62E.16 [POLICY CONVERSION RIGHTS.] 
 72.15     Every program of self-insurance, policy of group accident 
 72.16  and health insurance or contract of coverage by a health 
 72.17  maintenance organization written or renewed in this state, shall 
 72.18  include, in addition to the provisions required by section 
 72.19  62A.17, the right to convert to an individual coverage qualified 
 72.20  plan without the addition of underwriting restrictions after the 
 72.21  individual insured has exhausted any continuation coverage 
 72.22  provided under section 62A.146; 62A.148; 62A.17, subdivisions 1 
 72.23  and 2; 62A.20; or 62A.21~~; 62C.142; 62D.101; or 62D.105~~, or 
 72.24  continuation coverage provided under federal law, if any 
 72.25  continuation coverage is available to the individual, and then 
 72.26  leaves the group regardless of the reason for leaving the group 
 72.27  or if an employer member of a group ceases to remit payment so 
 72.28  as to terminate coverage for its employees, or upon cancellation 
 72.29  or termination of the coverage for the group except where 
 72.30  uninterrupted and continuous group coverage is otherwise 
 72.31  provided to the group.  If the health maintenance organization 
 72.32  has canceled coverage for the group because of a loss of 
 72.33  providers in a service area, the health maintenance organization 
 72.34  shall arrange for other health maintenance or indemnity 
 72.35  conversion options that shall be offered to enrollees without 
 72.36  the addition of underwriting restrictions.  The required 
 73.1   conversion contract must treat pregnancy the same as any other 
 73.2   covered illness under the conversion contract.  The person may 
 73.3   exercise this right to conversion within 30 days of exhausting 
 73.4   any continuation coverage provided under section 62A.146; 
 73.5   62A.148; 62A.17, subdivisions 1 and 2; 62A.20; or 62A.21, or 
 73.6   continuation coverage provided under federal law, and then 
 73.7   leaving the group or within 30 days following receipt of due 
 73.8   notice of cancellation or termination of coverage of the group 
 73.9   or of the employer member of the group and upon payment of 
 73.10  premiums from the date of termination or cancellation.  Due 
 73.11  notice of cancellation or termination of coverage for a group or 
 73.12  of the employer member of the group shall be provided to each 
 73.13  employee having coverage in the group by the insurer, 
 73.14  self-insurer or health maintenance organization canceling or 
 73.15  terminating the coverage except where reasonable evidence 
 73.16  indicates that uninterrupted and continuous group coverage is 
 73.17  otherwise provided to the group.  Every employer having a policy 
 73.18  of group accident and health insurance, group subscriber or 
 73.19  contract of coverage by a health maintenance organization shall, 
 73.20  upon request, provide the insurer or health maintenance 
 73.21  organization a list of the names and addresses of covered 
 73.22  employees.  Plans of health coverage shall also include a 
 73.23  provision which, upon the death of the individual in whose name 
 73.24  the contract was issued, permits every other individual then 
 73.25  covered under the contract to elect, within the period specified 
 73.26  in the contract, to continue coverage under the same or a 
 73.27  different contract without the addition of underwriting 
 73.28  restrictions until the individual would have ceased to have been 
 73.29  entitled to coverage had the individual in whose name the 
 73.30  contract was issued lived.  An individual conversion contract 
 73.31  issued by a health maintenance organization shall not be deemed 
 73.32  to be an individual enrollment contract for the purposes of 
 73.33  section 62D.10.  An individual health plan offered under section 
 73.34  62A.65, subdivision 5, paragraph (b), to a person satisfies the 
 73.35  health carrier's obligation to offer conversion coverage under 
 73.36  this section with respect to that person. 
 74.1      Sec. 16.  Minnesota Statutes 2000, section 62L.12, 
 74.2   subdivision 2, is amended to read: 
 74.3      Subd. 2.  [EXCEPTIONS.] (a) A health carrier may sell, 
 74.4   issue, or renew individual conversion policies to eligible 
 74.5   employees otherwise eligible for conversion coverage under 
 74.6   section 62D.104 as a result of leaving a health maintenance 
 74.7   organization's service area. 
 74.8      (b) A health carrier may sell, issue, or renew individual 
 74.9   conversion policies to eligible employees otherwise eligible for 
 74.10  conversion coverage as a result of the expiration of any 
 74.11  continuation of group coverage required under sections 62A.146, 
 74.12  62A.17, and 62A.21~~, 62C.142, 62D.101, and 62D.105~~. 
 74.13     (c) A health carrier may sell, issue, or renew conversion 
 74.14  policies under section 62E.16 to eligible employees. 
 74.15     (d) A health carrier may sell, issue, or renew individual 
 74.16  continuation policies to eligible employees as required. 
 74.17     (e) A health carrier may sell, issue, or renew individual 
 74.18  health plans if the coverage is appropriate due to an unexpired 
 74.19  preexisting condition limitation or exclusion applicable to the 
 74.20  person under the employer's group health plan or due to the 
 74.21  person's need for health care services not covered under the 
 74.22  employer's group health plan. 
 74.23     (f) A health carrier may sell, issue, or renew an 
 74.24  individual health plan, if the individual has elected to buy the 
 74.25  individual health plan not as part of a general plan to 
 74.26  substitute individual health plans for a group health plan nor 
 74.27  as a result of any violation of subdivision 3 or 4. 
 74.28     (g) Nothing in this subdivision relieves a health carrier 
 74.29  of any obligation to provide continuation or conversion coverage 
 74.30  otherwise required under federal or state law. 
 74.31     (h) Nothing in this chapter restricts the offer, sale, 
 74.32  issuance, or renewal of coverage issued as a supplement to 
 74.33  Medicare under sections 62A.31 to 62A.44, or policies or 
 74.34  contracts that supplement Medicare issued by health maintenance 
 74.35  organizations, or those contracts governed by section 1833 or 
 74.36  1876 of the federal Social Security Act, United States Code, 
 75.1   title 42, section 1395 et seq., as amended. 
 75.2      (i) Nothing in this chapter restricts the offer, sale, 
 75.3   issuance, or renewal of individual health plans necessary to 
 75.4   comply with a court order. 
 75.5      Sec. 17.  Minnesota Statutes 2000, section 257.34, 
 75.6   subdivision 1, is amended to read: 
 75.7      Subdivision 1.  [ACKNOWLEDGMENT BY PARENTS.] The mother and 
 75.8   father of a child born to a mother who was not married to the 
 75.9   child's father when the child was conceived nor when the child 
 75.10  was born may, in a writing signed by both of them before a 
 75.11  notary public, declare and acknowledge under oath that they are 
 75.12  the biological parents of the child.  The declaration may 
 75.13  provide that any such child born to the mother at any time 
 75.14  before or up to ten months after the date of execution of the 
 75.15  declaration is the biological child of the signatories.  
 75.16  Execution of the declaration shall: 
 75.17     (a) have the same consequences as an acknowledgment by the 
 75.18  signatories of parentage of the child for the purposes of 
 75.19  ~~sections~~ section 62A.041 ~~and 62C.14, subdivision 5a~~; 
 75.20     (b) be conclusive evidence that the signatories are parents 
 75.21  of the child for the purposes of sections 176.111, 197.75, and 
 75.22  197.752; 
 75.23     (c) create a presumption that the signatory is the 
 75.24  biological father of the child for the purposes of sections 
 75.25  257.51 to 257.74; 
 75.26     (d) when timely filed with the department of health as 
 75.27  provided in section 259.52, qualify as an affidavit stating the 
 75.28  intention of the signatories to retain parental rights as 
 75.29  provided in section 259.52 if it contains the information 
 75.30  required by section 259.52 or rules promulgated thereunder; 
 75.31     (e) have the same consequences as a writing declaring 
 75.32  paternity of the child for the purposes of section 524.2-109; 
 75.33  and 
 75.34     (f) be conclusive evidence that the signatories are parents 
 75.35  of the child for the purposes of chapter 573. 
 75.36     Sec. 18.  [REPEALER.] 
 76.1      Minnesota Statutes 2000, sections 62A.049; 62A.21, 
 76.2   subdivision 3; 62C.14, subdivisions 5, 5a, 5b, and 14; 62C.142; 
 76.3   62D.101; and 62D.105, are repealed. 
 76.4      Sec. 19.  [EFFECTIVE DATE.] 
 76.5      Sections 1 to 18 are effective January 1, 2002, and apply 
 76.6   to coverage issued on or after that date.