1.1                          A bill for an act 
  1.2             relating to health; establishing the long-term care 
  1.3             employee health insurance assistance program; 
  1.4             appropriating money; amending Minnesota Statutes 2000, 
  1.5             sections 62D.04, subdivision 5; and 256L.07, 
  1.6             subdivision 2; proposing coding for new law in 
  1.7             Minnesota Statutes, chapter 256. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2000, section 62D.04, 
  1.10  subdivision 5, is amended to read: 
  1.11     Subd. 5.  [PARTICIPATION; GOVERNMENT PROGRAMS.] Health 
  1.12  maintenance organizations shall, as a condition of receiving and 
  1.13  retaining a certificate of authority, participate in the medical 
  1.14  assistance, general assistance medical care, and MinnesotaCare 
  1.15  programs and the long-term care employee health insurance 
  1.16  assistance program established under section 256.956.  A health 
  1.17  maintenance organization is required to submit proposals in good 
  1.18  faith that meet the requirements of the request for proposal 
  1.19  provided that the requirements can be reasonably met by a health 
  1.20  maintenance organization to serve individuals eligible for the 
  1.21  above programs in a geographic region of the state if, at the 
  1.22  time of publication of a request for proposal, the percentage of 
  1.23  recipients in the public programs in the region who are enrolled 
  1.24  in the health maintenance organization is less than the health 
  1.25  maintenance organization's percentage of the total number of 
  1.26  individuals enrolled in health maintenance organizations in the 
  2.1   same region.  Geographic regions shall be defined by the 
  2.2   commissioner of human services in the request for proposals. 
  2.3      Sec. 2.  [256.956] [LONG-TERM CARE EMPLOYEE HEALTH 
  2.4   INSURANCE ASSISTANCE PROGRAM.] 
  2.5      Subdivision 1.  [DEFINITIONS.] (a) For the purpose of this 
  2.6   section, the definitions have the meanings given them.  
  2.7      (b) "Commissioner" means the commissioner of human services.
  2.8      (c) "Dependent" means an eligible employee's unmarried 
  2.9   child who is under the age of 19 years.  For the purpose of this 
  2.10  definition, a dependent includes a child for whom an eligible 
  2.11  employee or an eligible employee's spouse has been appointed 
  2.12  legal guardian or an adopted child as defined under section 
  2.13  62A.27.  A dependent does not include: 
  2.14     (1) a child of an eligible employee who is eligible for 
  2.15  health coverage through medical assistance or through an 
  2.16  employer-subsidized health plan where an employer other than the 
  2.17  employer of the eligible employee pays at least 50 percent of 
  2.18  the cost of coverage for the child; 
  2.19     (2) a child of an eligible employee who is excluded from 
  2.20  coverage under title XXI of the Balanced Budget Act of 1997; or 
  2.21     (3) a spouse of an eligible employee unless the cost of 
  2.22  providing health coverage to the spouse does not increase the 
  2.23  cost of the coverage. 
  2.24     (d) "Eligible employee" means an individual employed by an 
  2.25  employer in a position other than as an administrator or in the 
  2.26  central office, and includes both full-time and part-time 
  2.27  employees.  An "employee" does not include an individual who:  
  2.28     (1) works on a temporary or substitute basis; 
  2.29     (2) is hired as an independent contractor; or 
  2.30     (3) is a state employee.  
  2.31     (e) "Employer" means any of the following: 
  2.32     (1) a nursing facility reimbursed under section 256B.431 or 
  2.33  256B.434; 
  2.34     (2) a facility reimbursed under sections 256B.501 and 
  2.35  256B.5011 and Laws 1993, First Special Session chapter 1, 
  2.36  article 4, section 11; or 
  3.1      (3) a provider who provides home and community-based 
  3.2   waivered services for persons with mental retardation or related 
  3.3   conditions under section 256B.501; home and community-based 
  3.4   waivered services for the elderly under section 256B.0915; 
  3.5   waivered services under community alternatives for disabled 
  3.6   individuals under section 256B.49; community alternative care 
  3.7   waivered services under section 256B.49; traumatic brain injury 
  3.8   waivered services under section 256B.49; nursing services and 
  3.9   home health services under section 256B.0625, subdivision 6a; 
  3.10  personal care services and nursing supervision of personal care 
  3.11  services under section 256B.0625, subdivision 19a; private-duty 
  3.12  nursing services under section 256B.0625, subdivision 7; day 
  3.13  training and habilitation services for adults with mental 
  3.14  retardation or related conditions under sections 252.40 to 
  3.15  252.46; alternative care services under section 256B.0913; adult 
  3.16  residential program grants under Minnesota Rules, parts 
  3.17  9535.2000 to 9535.3000; adult and family community support 
  3.18  grants under Minnesota Rules, parts 9535.1700 to 9535.1760; 
  3.19  semi-independent living services under section 252.275, 
  3.20  including SILS funding under county social services grants 
  3.21  formerly funded under chapter 256I; community support services 
  3.22  for deaf and hard-of-hearing adults with mental illness who use 
  3.23  or wish to use sign language as their primary means of 
  3.24  communication; or living skills training programs for persons 
  3.25  with intractable epilepsy who need assistance in the transition 
  3.26  to independent living. 
  3.27  Employer includes both for-profit and nonprofit entities. 
  3.28     (f) "Program" means the long-term care employee health 
  3.29  insurance assistance program.  
  3.30     Subd. 2.  [PROGRAM.] (a) The commissioner shall establish 
  3.31  and administer the long-term care employee health insurance 
  3.32  assistance program to provide the advantages of pooling for the 
  3.33  purchase of health coverage for long-term care employers.  
  3.34     (b) The commissioner shall solicit bids from health 
  3.35  maintenance organizations licensed under chapter 62D to provide 
  3.36  health coverage to the dependents of eligible employees.  
  4.1   Coverage shall be offered on a guaranteed-issue and renewal 
  4.2   basis.  No health maintenance organization is required to 
  4.3   provide coverage to an eligible employee's dependent who does 
  4.4   not reside within the health maintenance organization's approved 
  4.5   service area.  
  4.6      (c) The commissioner shall, consistent with the provisions 
  4.7   of this section, determine coverage options, premium 
  4.8   arrangements, contractual arrangements, and all other matters 
  4.9   necessary to administer the program.  
  4.10     (d) The commissioner may extend the program to include 
  4.11  coverage for the eligible employee and noneligible employee.  
  4.12  The cost of coverage for the eligible employee shall be the 
  4.13  responsibility of the employer or employee.  
  4.14     (e) The commissioner shall consult with representatives of 
  4.15  the long-term care industry on issues related to the 
  4.16  administration of the program. 
  4.17     Subd. 3.  [EMPLOYER REQUIREMENTS.] (a) All employers may 
  4.18  participate in the program subject to the requirements of this 
  4.19  section.  The commissioner shall establish procedures for an 
  4.20  employer to apply for coverage through this program.  These 
  4.21  procedures may include requiring eligible employees to provide 
  4.22  relevant financial information to determine the eligibility of 
  4.23  their dependents.  
  4.24     (b) A participating employer must offer coverage to all 
  4.25  dependents of eligible employees. 
  4.26     (c) The participating employer must provide to the 
  4.27  commissioner any employee information deemed necessary by the 
  4.28  commissioner to determine eligibility and premium payments and 
  4.29  must notify the commissioner upon a change in an employee's or 
  4.30  an employee's dependent's eligibility.  
  4.31     (d) The initial term of the employer's coverage must be for 
  4.32  at least one year but may be made automatically renewable from 
  4.33  term to term in the absence of notice of termination by either 
  4.34  the employer or the commissioner.  
  4.35     Subd. 4.  [INDIVIDUAL ELIGIBILITY.] (a) The commissioner 
  4.36  may require a probationary period for new employees of no more 
  5.1   than 90 days before the dependents of a new employee become 
  5.2   eligible for coverage through the program. 
  5.3      (b) A participating employer may elect to provide coverage 
  5.4   through the program to: 
  5.5      (1) the eligible and noneligible employees, if the program 
  5.6   is extended to by the commissioner to include these individuals; 
  5.7      (2) the dependents of noneligible employees who are 
  5.8   employed as an administrator or in a central office position; 
  5.9      (3) dependents of eligible and noneligible employees who 
  5.10  are under the age of 25 years and who are full-time students; 
  5.11  and 
  5.12     (4) the spouses of eligible and noneligible employees. 
  5.13  The cost of coverage for these individuals shall be the 
  5.14  responsibility of the employer or employee. 
  5.15     (c) The commissioner may require a certain percentage of 
  5.16  participation of these individuals described in paragraph (b) 
  5.17  before coverage can be offered through the program. 
  5.18     Subd. 5.  [COVERAGE.] (a) The health plan offered must meet 
  5.19  all applicable requirements of chapters 62A and 62D and sections 
  5.20  62J.71 to 62J.73; 62M.01 to 62M.16; 62Q.1055; 62Q.106; 62Q.12; 
  5.21  62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23; 62Q.43; 62Q.47; 62Q.52 
  5.22  to 62Q.58; and 62Q.68 to 62Q.73.  
  5.23     (b) The health plan offered must meet all underwriting 
  5.24  requirements of chapter 62L and must provide periodic open 
  5.25  enrollments for eligible employees where a choice in coverage 
  5.26  exists. 
  5.27     (c) The commissioner shall establish the benefits to be 
  5.28  provided under this program in accordance with the following: 
  5.29     (1) the benefits provided must comply with title XXI of the 
  5.30  Balanced Budget Act of 1997 and be at least equivalent to the 
  5.31  lowest benchmark allowable under title XXI; 
  5.32     (2) preventive and restorative dental services must be 
  5.33  included as part of the benefits offered to dependents; and 
  5.34     (3) there shall be no deductibles, co-payments, or 
  5.35  coinsurance requirements on the services provided to dependents. 
  5.36     Subd. 6.  [PREMIUMS.] (a) The commissioner shall determine 
  6.1   premium rates and rating methods for the coverage offered 
  6.2   through the program.  
  6.3      (b) The commissioner shall pay the premiums for the 
  6.4   dependents of eligible employees directly to the health 
  6.5   maintenance organization.  
  6.6      (c) Payment of any remaining premiums must be collected by 
  6.7   the participating employer and paid directly to the health 
  6.8   maintenance organization. 
  6.9      (d) Any premiums paid by the state under this section are 
  6.10  not subject to taxes or surcharges imposed under chapter 297I, 
  6.11  chapter 295, or section 256.9657 and shall be excluded when 
  6.12  determining a health maintenance organization's total premium 
  6.13  under section 62E.11. 
  6.14     Sec. 3.  Minnesota Statutes 2000, section 256L.07, 
  6.15  subdivision 2, is amended to read: 
  6.16     Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
  6.17  COVERAGE.] (a) To be eligible, a family or individual must not 
  6.18  have access to subsidized health coverage through an employer 
  6.19  and must not have had access to employer-subsidized coverage 
  6.20  through a current employer for 18 months prior to application or 
  6.21  reapplication.  A family or individual whose employer-subsidized 
  6.22  coverage is lost due to an employer terminating health care 
  6.23  coverage as an employee benefit during the previous 18 months is 
  6.24  not eligible.  
  6.25     (b) For purposes of this requirement, subsidized health 
  6.26  coverage means health coverage for which the employer pays at 
  6.27  least 50 percent of the cost of coverage for the employee or 
  6.28  dependent, or a higher percentage as specified by the 
  6.29  commissioner.  Children are eligible for employer-subsidized 
  6.30  coverage through either parent, including the noncustodial 
  6.31  parent.  Children who are eligible for coverage under the 
  6.32  long-term care employee health insurance assistance program 
  6.33  established under section 256.956 are considered to have access 
  6.34  to subsidized health coverage under this subdivision.  The 
  6.35  commissioner must treat employer contributions to Internal 
  6.36  Revenue Code Section 125 plans and any other employer benefits 
  7.1   intended to pay health care costs as qualified employer 
  7.2   subsidies toward the cost of health coverage for employees for 
  7.3   purposes of this subdivision. 
  7.4      Sec. 4.  [CHIP WAIVER.] 
  7.5      The commissioner of human services shall seek all waivers 
  7.6   necessary to obtain enhanced matching funds under the state 
  7.7   children's health insurance program established as title XXI of 
  7.8   the Balanced Budget Act of 1997.  
  7.9      Sec. 5.  [APPROPRIATION.] 
  7.10     $....... is appropriated in the biennium ending June 30, 
  7.11  2003, from the general fund to the commissioner of human 
  7.12  services for the long-term care employee health insurance 
  7.13  assistance program. 
  7.14     Sec. 6.  [EFFECTIVE DATE.] 
  7.15     Sections 1 to 3 are effective upon federal approval to 
  7.16  receive enhanced matching funds under the state children's 
  7.17  health insurance program.  Section 4 is effective the day 
  7.18  following final enactment.