1.1                          A bill for an act 
  1.2             relating to insurance; providing for deemed compliance 
  1.3             on the basis of accreditation; permitting required 
  1.4             information to be available electronically; 
  1.5             establishing a process for consolidation of health 
  1.6             maintenance regulation; amending Minnesota Statutes 
  1.7             2002, section 72A.20, by adding a subdivision; 
  1.8             proposing coding for new law in Minnesota Statutes, 
  1.9             chapter 62Q. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  [62Q.37] [AUDITS CONDUCTED BY A NATIONALLY 
  1.12  RECOGNIZED INDEPENDENT ORGANIZATION.] 
  1.13     Subdivision 1.  [APPLICABILITY.] This section applies only 
  1.14  to (i) a nonprofit health service plan corporation operating 
  1.15  under chapter 62C, (ii) a health maintenance organization 
  1.16  operating under chapter 62D, (iii) a community integrated 
  1.17  service network operating under chapter 62N, and (iv) managed 
  1.18  care organizations operating under chapter 256B, 256D, or 256L. 
  1.19     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  1.20  terms defined have the meanings given. 
  1.21     (a) "Commissioner" means the commissioner of health for 
  1.22  purposes of regulating health maintenance organizations and 
  1.23  community integrated service networks, the commissioner of 
  1.24  commerce for purposes of regulating nonprofit health service 
  1.25  plan corporations, or the commissioner of human services for the 
  1.26  purpose of contracting with managed care organizations serving 
  1.27  persons enrolled in programs under chapter 256B, 256D, or 256L. 
  2.1      (b) "Health plan company" means (i) a nonprofit health 
  2.2   service plan corporation operating under chapter 62C, (ii) a 
  2.3   health maintenance organization operating under chapter 62D, 
  2.4   (iii) a community integrated service network operating under 
  2.5   chapter 62N, or (iv) a managed care organization operating under 
  2.6   chapter 256B, 256D, or 256L. 
  2.7      (c) "Nationally recognized independent organization" means 
  2.8   (i) an organization that sets specific national standards 
  2.9   governing health care quality assurance processes, utilization 
  2.10  review, provider credentialing, marketing and other topics 
  2.11  covered by this chapter and other chapters, and audits and 
  2.12  provides accreditation to those health plan companies that meet 
  2.13  those standards.  The American Accreditation Health Care 
  2.14  Commission (URAC), the National Committee for Quality Assurance 
  2.15  (NCQA), and the Joint Commission on Accreditation of Healthcare 
  2.16  Organizations (JCAHO) are, at a minimum, defined as nationally 
  2.17  recognized independent organizations; and (ii) the Centers for 
  2.18  Medicare and Medicaid Services for purposes of reviews or audits 
  2.19  conducted of health plan companies under Part C of Title XVIII 
  2.20  of the Social Security Act or under section 1876 of the Social 
  2.21  Security Act. 
  2.22     (d) "Performance standard" means those standards relating 
  2.23  to quality management and improvement, access and availability 
  2.24  of service, utilization review, provider selection, provider 
  2.25  credentialing, marketing, member rights and responsibilities, 
  2.26  complaints, appeals, grievance systems, enrollee information and 
  2.27  materials, enrollment and disenrollment, subcontractual 
  2.28  relationships and delegation, confidentiality, continuity and 
  2.29  coordination of care, assurance of adequate capacity and 
  2.30  services, coverage and authorization of services, practice 
  2.31  guidelines, health information systems, and financial solvency. 
  2.32     Subd. 3.  [AUDITS.] The commissioners may conduct routine 
  2.33  audits and investigations as prescribed under their respective 
  2.34  state authorizing statutes.  If a nationally recognized 
  2.35  independent organization has conducted an audit of the health 
  2.36  plan company using audit procedures that are comparable to or 
  3.1   more stringent than the commissioner's audit procedures: 
  3.2      (1) the commissioner may accept the independent audit and 
  3.3   require no further audit if the results of the independent audit 
  3.4   show that the performance standard being audited meets or 
  3.5   exceeds state standards; 
  3.6      (2) the commissioner may accept the independent audit and 
  3.7   limit further auditing if the results of the independent audit 
  3.8   show that the performance standard being audited partially meets 
  3.9   state standards; 
  3.10     (3) the health plan company must demonstrate to the 
  3.11  commissioner that the nationally recognized independent 
  3.12  organization that conducted the audit is qualified and that the 
  3.13  results of the audit demonstrate that the particular performance 
  3.14  standard partially or fully meets state standards; and 
  3.15     (4) if the commissioner has partially or fully accepted an 
  3.16  independent audit of the performance standard, the commissioner 
  3.17  may use the finding of a deficiency with regard to statutes or 
  3.18  rules by an independent audit as the basis for a targeted audit 
  3.19  or enforcement action. 
  3.20     Subd. 4.  [DISCLOSURE OF NATIONAL STANDARDS AND 
  3.21  REPORTS.] The health plan company shall provide the commissioner 
  3.22  (1) a copy of the current nationally recognized independent 
  3.23  organization's standards upon which the acceptable accreditation 
  3.24  status has been granted, and (2) a copy of the most current 
  3.25  final audit report issued by the nationally recognized 
  3.26  independent organization. 
  3.27     Subd. 5.  [ACCREDITATION NOT REQUIRED.] Nothing in this 
  3.28  section shall require a health plan company to seek an 
  3.29  acceptable accreditation status from a nationally recognized 
  3.30  independent organization. 
  3.31     Subd. 6.  [CONTINUED AUTHORITY.] Nothing in this section 
  3.32  shall preclude the commissioners from conducting audits and 
  3.33  investigations, or requesting data as granted under their 
  3.34  respective state authorizing statutes. 
  3.35     Subd. 7.  [HUMAN SERVICES.] The commissioner of human 
  3.36  services shall implement this section in a manner that is 
  4.1   consistent with applicable federal laws and regulations. 
  4.2      Subd. 8.  [CONFIDENTIALITY.] Any documents provided to the 
  4.3   commissioner related to the audit report that may be accepted 
  4.4   under this section are private data on individuals pursuant to 
  4.5   chapter 13 and may only be released as permitted under section 
  4.6   60A.03, subdivision 9. 
  4.7      Sec. 2.  Minnesota Statutes 2002, section 72A.20, is 
  4.8   amended by adding a subdivision to read: 
  4.9      Subd. 37.  [ELECTRONIC TRANSMISSION OF REQUIRED 
  4.10  INFORMATION.] A health carrier as defined in section 62A.011, 
  4.11  subdivision 2, is not in violation of this chapter for 
  4.12  electronically transmitting or electronically making available 
  4.13  information otherwise required to be delivered in writing under 
  4.14  chapters 62A to 62Q and 72A to an enrollee as defined in section 
  4.15  62Q.01, subdivision 2, paragraph (a), and is in compliance with 
  4.16  the requirements of those chapters if the following conditions 
  4.17  are met: 
  4.18     (1) the health plan informs the enrollee or dependent that 
  4.19  electronic transmission or access is available, and at the 
  4.20  discretion of the health plan, the enrollee or dependent is 
  4.21  given one of the following options: 
  4.22     (i) electronic transmission or access will occur only if 
  4.23  the enrollee or dependent affirmatively requests to the health 
  4.24  carrier that the required information be electronically 
  4.25  transmitted or available and a record of that request is 
  4.26  retained by the health carrier; or 
  4.27     (ii) electronic transmission or access will automatically 
  4.28  occur if the enrollee or dependent has not opted out of that 
  4.29  manner of transmission by request to the health carrier and 
  4.30  requested that the information be provided in writing.  If the 
  4.31  enrollee or dependent opts out of electronic transmission, a 
  4.32  record of that request must be retained by the health carrier; 
  4.33     (2) the enrollee or dependent is allowed to withdraw the 
  4.34  request at any time; 
  4.35     (3) if the information transmitted electronically contains 
  4.36  individually identifiable data, it must be transmitted to a 
  5.1   secured mailbox.  If the information made available 
  5.2   electronically contains individually identifiable data, it must 
  5.3   be made available at a password-protected secured Web site; 
  5.4      (4) the enrollee or dependent is provided a customer 
  5.5   service number on their member card that can be called to 
  5.6   request a written copy of the document; and 
  5.7      (5) the electronic transmission or electronic availability 
  5.8   meets all other requirements of the chapter including, but not 
  5.9   limited to, size of the typeface and any required time frames 
  5.10  for distribution. 
  5.11     Sec. 3.  [TRANSFER OF JURISDICTION.] 
  5.12     The commissioners of health and commerce shall develop a 
  5.13  plan for the total transfer of jurisdiction from the department 
  5.14  of health to commerce for any health plan company as defined in 
  5.15  Minnesota Statutes, section 62Q.01, subdivision 4; community 
  5.16  integrated service networks as defined in Minnesota Statutes, 
  5.17  section 62N.02; health care cooperatives operating under 
  5.18  Minnesota Statutes, chapter 62R; and health care cooperatives 
  5.19  operating under Minnesota Statutes, chapter 62T.  Upon 
  5.20  completion of the plan, the governor shall issue an executive 
  5.21  order implementing the transfer.  The transfer must be completed 
  5.22  no later than July 1, 2005.  The revisor shall include the 
  5.23  statutory revisions necessitated by this transfer in a revisor's 
  5.24  bill prepared for the 2006 legislative session.