1.1                          A bill for an act 
  1.2             relating to health care; modifying the calculation of 
  1.3             certain premium taxes; abolishing the regional 
  1.4             coordinating boards; providing for assessments of 
  1.5             proposed health coverage mandates; appropriating 
  1.6             money; amending Minnesota Statutes 1996, section 
  1.7             62J.09, subdivision 8; Minnesota Statutes 1997 
  1.8             Supplement, sections 60A.15, subdivision 1; 62Q.105, 
  1.9             subdivision 1; and 62Q.30; proposing coding for new 
  1.10            law in Minnesota Statutes, chapter 62A; repealing 
  1.11            Minnesota Statutes 1997 Supplement, sections 16B.93; 
  1.12            16B.94; 16B.95; 16B.96; and 62J.685. 
  1.13  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.14     Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.15  60A.15, subdivision 1, is amended to read: 
  1.16     Subdivision 1.  [DOMESTIC AND FOREIGN COMPANIES.] (a) On or 
  1.17  before April 1, June 1, and December 1 of each year, every 
  1.18  domestic and foreign company, including town and farmers' mutual 
  1.19  insurance companies, domestic mutual insurance companies, marine 
  1.20  insurance companies, health maintenance organizations, community 
  1.21  integrated service networks, and nonprofit health service plan 
  1.22  corporations, shall pay to the commissioner of revenue 
  1.23  installments equal to one-third of the insurer's total estimated 
  1.24  tax for the current year.  Except as provided in paragraphs (d), 
  1.25  (e), (h), and (i), installments must be based on a sum equal to 
  1.26  two percent of the premiums described in paragraph (b). 
  1.27     (b) Installments under paragraph (a), (d), or (e) are 
  1.28  percentages of gross premiums less return premiums on all direct 
  1.29  business received by the insurer in this state, or by its agents 
  2.1   for it, in cash or otherwise, during such year. 
  2.2      (c) Failure of a company to make payments of at least 
  2.3   one-third of either (1) the total tax paid during the previous 
  2.4   calendar year or (2) 80 percent of the actual tax for the 
  2.5   current calendar year shall subject the company to the penalty 
  2.6   and interest provided in this section, unless the total tax for 
  2.7   the current tax year is $500 or less. 
  2.8      (d) For health maintenance organizations, nonprofit health 
  2.9   service plan corporations, and community integrated service 
  2.10  networks, the installments must be based on an amount determined 
  2.11  under paragraph (h) or (i). 
  2.12     (e) For purposes of computing installments for town and 
  2.13  farmers' mutual insurance companies and for mutual property 
  2.14  casualty companies with total assets on December 31, 1989, of 
  2.15  $1,600,000,000 or less, the following rates apply: 
  2.16     (1) for all life insurance, two percent; 
  2.17     (2) for town and farmers' mutual insurance companies and 
  2.18  for mutual property and casualty companies with total assets of 
  2.19  $5,000,000 or less, on all other coverages, one percent; and 
  2.20     (3) for mutual property and casualty companies with total 
  2.21  assets on December 31, 1989, of $1,600,000,000 or less, on all 
  2.22  other coverages, 1.26 percent. 
  2.23     (f) If the aggregate amount of premium tax payments under 
  2.24  this section and the fire marshal tax payments under section 
  2.25  299F.21 made during a calendar year is equal to or exceeds 
  2.26  $120,000, all tax payments in the subsequent calendar year must 
  2.27  be paid by means of a funds transfer as defined in section 
  2.28  336.4A-104, paragraph (a).  The funds transfer payment date, as 
  2.29  defined in section 336.4A-401, must be on or before the date the 
  2.30  payment is due.  If the date the payment is due is not a funds 
  2.31  transfer business day, as defined in section 336.4A-105, 
  2.32  paragraph (a), clause (4), the payment date must be on or before 
  2.33  the funds transfer business day next following the date the 
  2.34  payment is due.  
  2.35     (g) Premiums under accident and health insurance policies, 
  2.36  medical assistance, general assistance medical care, the 
  3.1   MinnesotaCare program, and the Minnesota comprehensive health 
  3.2   insurance plan and all payments, revenues, and reimbursements 
  3.3   received from the federal government for Medicare-related 
  3.4   coverage as defined in section 62A.31, subdivision 3, paragraph 
  3.5   (e), are not subject to tax under this section. 
  3.6      (h) For calendar years 1998 and 1999, the installments for 
  3.7   health maintenance organizations, community integrated service 
  3.8   networks, and nonprofit health service plan corporations must be 
  3.9   based on an amount equal to one percent of premiums described 
  3.10  under paragraph (b).  Health maintenance organizations, 
  3.11  community integrated service networks, and nonprofit health 
  3.12  service plan corporations that have met the cost containment 
  3.13  goals established under section 62J.04 in the individual and 
  3.14  small employer market for calendar year 1996 are exempt from 
  3.15  payment of the tax imposed under this section for premiums paid 
  3.16  after March 30, 1997, and before April 1, 1998.  Health 
  3.17  maintenance organizations, community integrated service 
  3.18  networks, and nonprofit health service plan corporations that 
  3.19  have met the cost containment goals established under section 
  3.20  62J.04 in the individual and small employer market for calendar 
  3.21  year 1997 are exempt from payment of the tax imposed under this 
  3.22  section for premiums paid after March 30, 1998, and before April 
  3.23  1, 1999.  
  3.24     (i) For calendar years after 1999, ~~the commissioner of~~ 
  3.25  ~~finance shall determine the balance of the health care access~~ 
  3.26  ~~fund on September 1 of each year beginning September 1, 1999.~~  
  3.27  ~~If the commissioner determines that there is no structural~~ 
  3.28  ~~deficit for the next fiscal year, no tax shall be imposed under~~ 
  3.29  ~~paragraph (d) for the following calendar year.  If the~~ 
  3.30  ~~commissioner determines that there will be a structural deficit~~ 
  3.31  ~~in the fund for the following fiscal year, then the~~ 
  3.32  ~~commissioner, in consultation with the commissioner of revenue,~~ 
  3.33  ~~shall determine the amount needed to eliminate the structural~~ 
  3.34  ~~deficit and a tax shall be imposed under paragraph (d) for the~~ 
  3.35  ~~following calendar year.  The commissioner shall determine the~~ 
  3.36  ~~rate of the tax as either one-quarter of one percent, one-half~~ 
  4.1   ~~of one percent, three-quarters of one percent, or one percent of~~ 
  4.2   ~~premiums described in paragraph (b), whichever is the lowest of~~ 
  4.3   ~~those rates that the commissioner determines will produce~~ 
  4.4   ~~sufficient revenue to eliminate the projected structural~~ 
  4.5   ~~deficit.  The commissioner of finance shall publish in the State~~ 
  4.6   ~~Register by October 1 of each year the amount of tax to be~~ 
  4.7   ~~imposed for the following calendar year~~ premiums paid to health 
  4.8   maintenance organizations, nonprofit health service plan 
  4.9   corporations, and community integrated service networks are not 
  4.10  subject to tax under this section. 
  4.11     (j) In approving the premium rates as required in sections 
  4.12  62L.08, subdivision 8, and 62A.65, subdivision 3, the 
  4.13  commissioners of health and commerce shall ensure that any 
  4.14  exemption from the tax as described in paragraphs (h) and (i) is 
  4.15  reflected in the premium rate. 
  4.16     Sec. 2.  [62A.310] [ASSESSMENT OF PROPOSED HEALTH COVERAGE 
  4.17  MANDATES.] 
  4.18     Subdivision 1.  [DEFINITIONS.] For purposes of this 
  4.19  section, the following terms have the meanings given unless the 
  4.20  context otherwise requires: 
  4.21     (1) "mandated health benefit proposal" means a proposal 
  4.22  that would statutorily require a health plan to do the following:
  4.23     (i) provide coverage or increase the amount of coverage for 
  4.24  the treatment of a particular disease, condition, or other 
  4.25  health care need; or 
  4.26     (ii) provide coverage or increase the amount of coverage of 
  4.27  a particular type of health care treatment or service or of 
  4.28  equipment, supplies, or drugs used in connection with a health 
  4.29  care treatment or service. 
  4.30     "Mandated benefit proposal" does not include health benefit 
  4.31  proposals amending the scope of practice of a licensed health 
  4.32  care professional; 
  4.33     (2) "commissioner" means the commissioner of commerce; and 
  4.34     (3) "health plan" means a health plan as defined in section 
  4.35  62A.011, subdivision 3, but includes coverage listed in clauses 
  4.36  (7) and (10), of that definition. 
  5.1      Subd. 2.  [HEALTH COVERAGE MANDATE ASSESSMENT PROCESS.] The 
  5.2   commissioners of health and commerce, in consultation with the 
  5.3   commissioners of human services and employee relations, shall 
  5.4   establish and administer a process for the review, assessment, 
  5.5   and analysis of mandated health benefit proposals.  The purpose 
  5.6   of the assessment is to provide the legislature with a complete 
  5.7   and timely analysis of all ramifications of any mandated health 
  5.8   benefit proposal.  The assessment must include, in addition to 
  5.9   any other relevant information, the following: 
  5.10     (1) scientific and medical information on the proposed 
  5.11  health benefit, on the potential for harm or benefit to the 
  5.12  patient, and on the comparative benefit or harm from alternative 
  5.13  forms of treatment; and 
  5.14     (2) public health, economic, fiscal, and consumer 
  5.15  information on the impact of the proposed mandate on persons 
  5.16  receiving health services in Minnesota, on the relative cost 
  5.17  effectiveness of the benefit, and on the health care system in 
  5.18  general. 
  5.19     The commissioners of health and commerce shall summarize 
  5.20  the nature and quality of available information in these areas, 
  5.21  and, if possible, shall provide any preliminary information to 
  5.22  the public as part of the public hearing process required in 
  5.23  subdivision 5.  The commissioners may conduct research into 
  5.24  these issues, or may certify existing research as sufficient to 
  5.25  meet the informational needs of the legislature. 
  5.26     Subd. 3.  [REQUESTS FOR ASSESSMENT.] Whenever a legislative 
  5.27  measure containing a mandated health benefit proposal is 
  5.28  introduced as a bill or offered as an amendment to a bill or is 
  5.29  likely to be introduced or offered as an amendment, the chairs 
  5.30  of the standing committees having jurisdiction over the proposal 
  5.31  shall request that the commissioner complete an assessment of 
  5.32  the proposal in order to facilitate any committee action by 
  5.33  either house of the legislature.  A person or organization may 
  5.34  also request that the commissioner complete an assessment.  If 
  5.35  multiple requests are received, the commissioner shall consult 
  5.36  with the chairs of the standing legislative committees having 
  6.1   jurisdiction over mandated health benefit proposals to 
  6.2   prioritize the requests. 
  6.3      Subd. 4.  [ASSESSMENT OF PROPOSED MANDATES; REPORT TO THE 
  6.4   LEGISLATURE.] The commissioner in consultation with the 
  6.5   commissioner of health shall conduct an assessment of each 
  6.6   mandated health benefit proposal selected for assessment and 
  6.7   submit a report to the legislature no later than 180 days after 
  6.8   the request.  The commissioner shall, in consultation with the 
  6.9   chairs of the standing committees having jurisdiction over the 
  6.10  proposal, develop a reporting date for each proposal to be 
  6.11  assessed.  If the commissioner determines that the assessment of 
  6.12  a particular mandated health benefit proposal should be 
  6.13  completed entirely or in part by the commissioner of health, the 
  6.14  commissioner of health shall complete the assessment and submit 
  6.15  the report to the legislature.  The commissioner responsible for 
  6.16  completing an assessment may seek the assistance and advice of 
  6.17  consultants, contractors, researchers, community leaders, or 
  6.18  other persons or organizations with relevant expertise.  The 
  6.19  commissioner may certify existing research as sufficient to meet 
  6.20  the informational needs of the legislature.  Prior to completion 
  6.21  of an assessment report, the commissioner must gather the 
  6.22  information required under subdivisions 2 and 5. 
  6.23     Subd. 5.  [CITIZENS ADVISORY TASK FORCE.] The commissioner 
  6.24  shall appoint a citizens advisory task force in accordance with 
  6.25  section 15.014, subdivision 2, to provide comments and 
  6.26  recommendations to the commissioner on health benefit mandate 
  6.27  proposals.  In preparing these comments and recommendations, it 
  6.28  shall be the purpose of the task force to determine which 
  6.29  approach to a proposed mandated benefit best serves the general 
  6.30  public interest.  Members should be impartial consumers of 
  6.31  health care services.  The citizens advisory task force shall 
  6.32  consist of at least one member from each regional coordinating 
  6.33  board.  The citizens advisory task force shall solicit comments 
  6.34  and recommendations on a mandated health benefit proposal from 
  6.35  any interested persons and organizations and may hold public 
  6.36  hearings.  The citizens advisory task force shall submit its 
  7.1   comments and recommendations to the commissioner. 
  7.2      Subd. 6.  [ADVICE AND RECOMMENDATIONS.] The commissioner 
  7.3   may appoint an ad hoc advisory panel of providers, consumer 
  7.4   representatives, health plan companies, medical technology 
  7.5   companies, economists, actuaries, and other expert persons to 
  7.6   assist the commissioner in completing a mandate review. 
  7.7      Subd. 7.  [REPORT.] The commissioner shall provide a 
  7.8   summary report of all findings and recommendations to the 
  7.9   relevant committee chairs, to the author of the proposed benefit 
  7.10  mandate, or the entity that requested the assessment. 
  7.11     Sec. 3.  Minnesota Statutes 1996, section 62J.09, 
  7.12  subdivision 8, is amended to read: 
  7.13     Subd. 8.  [REPEALER.] This section is repealed effective 
  7.14  July 1, ~~2000~~ 1998. 
  7.15     Sec. 4.  Minnesota Statutes 1997 Supplement, section 
  7.16  62Q.105, subdivision 1, is amended to read: 
  7.17     Subdivision 1.  [ESTABLISHMENT.] Each health plan company 
  7.18  shall establish and make available to enrollees, by July 1, ~~1998~~ 
  7.19  1999, an informal complaint resolution process that meets the 
  7.20  requirements of this section.  A health plan company must make 
  7.21  reasonable efforts to resolve enrollee complaints, and must 
  7.22  inform complainants in writing of the company's decision within 
  7.23  30 days of receiving the complaint.  The complaint resolution 
  7.24  process must treat the complaint and information related to it 
  7.25  as required under sections 72A.49 to 72A.505.  
  7.26     Sec. 5.  Minnesota Statutes 1997 Supplement, section 
  7.27  62Q.30, is amended to read: 
  7.28     62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION 
  7.29  PROCESS.] 
  7.30     The commissioner shall establish an expedited fact finding 
  7.31  and dispute resolution process to assist enrollees of health 
  7.32  plan companies with contested treatment, coverage, and service 
  7.33  issues to be in effect July 1, ~~1998~~ 1999.  If the disputed issue 
  7.34  relates to whether a service is appropriate and necessary, the 
  7.35  commissioner shall issue an order only after consulting with 
  7.36  appropriate experts knowledgeable, trained, and practicing in 
  8.1   the area in dispute, reviewing pertinent literature, and 
  8.2   considering the availability of satisfactory alternatives.  The 
  8.3   commissioner shall take steps including but not limited to 
  8.4   fining, suspending, or revoking the license of a health plan 
  8.5   company that is the subject of repeated orders by the 
  8.6   commissioner that suggests a pattern of inappropriate 
  8.7   underutilization.  
  8.8      Sec. 6.  [APPROPRIATION.] 
  8.9      $....... is appropriated from the general fund to the 
  8.10  commissioner of commerce to operate the mandate assessment 
  8.11  process under section 2. 
  8.12     Sec. 7.  [REPEALER.] 
  8.13     Minnesota Statutes 1997 Supplement, sections 16B.93; 
  8.14  16B.94; 16B.95; 16B.96; and 62J.685, are repealed.  
  8.15     Sec. 8.  [EFFECTIVE DATE.] 
  8.16     Section 3 is effective June 30, 1998.