1.1                          A bill for an act 
  1.2             relating to health; permitting a health maintenance 
  1.3             organization rural demonstration project; modifying 
  1.4             enrollee cost-sharing provisions for health 
  1.5             maintenance organizations; amending Minnesota Statutes 
  1.6             2000, sections 62D.02, subdivision 8; 62D.30, by 
  1.7             adding a subdivision. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2000, section 62D.02, 
  1.10  subdivision 8, is amended to read: 
  1.11     Subd. 8.  [HEALTH MAINTENANCE CONTRACT.] "Health 
  1.12  maintenance contract" means any contract whereby a health 
  1.13  maintenance organization agrees to provide comprehensive health 
  1.14  maintenance services to enrollees, provided that the contract 
  1.15  may contain reasonable enrollee copayment co-payment 
  1.16  provisions.  An individual or group health maintenance contract 
  1.17  may contain the copayment co-payment and deductible provisions 
  1.18  specified in this subdivision.  Copayment Co-payment and 
  1.19  deductible provisions in group contracts shall not discriminate 
  1.20  on the basis of age, sex, race, length of enrollment in the 
  1.21  plan, or economic status; and during every open enrollment 
  1.22  period in which all offered health benefit plans, including 
  1.23  those subject to the jurisdiction of the commissioners of 
  1.24  commerce or health, fully participate without any underwriting 
  1.25  restrictions, copayment co-payment and deductible provisions 
  1.26  shall not discriminate on the basis of preexisting health 
  2.1   status.  A health maintenance organization may impose a flat fee 
  2.2   co-payment not to exceed 50 percent of the median cost of 
  2.3   prescription drugs.  In no event shall the total sum of the all 
  2.4   annual copayments and deductible exceed the maximum 
  2.5   out-of-pocket expenses allowable for a number three qualified 
  2.6   plan under section 62E.06, nor shall that sum exceed $5,000 per 
  2.7   family.  The annual deductible must not exceed $1,000 per person 
  2.8   co-payments exceed $500 or the annual maximum out-of-pocket sum 
  2.9   exceed $3,000 per family.  The annual deductible must not apply 
  2.10  to preventive health services as described in Minnesota Rules, 
  2.11  part 4685.0801, subpart 8.  Where sections 62D.01 to 62D.30 
  2.12  permit a health maintenance organization to contain 
  2.13  reasonable copayment co-payment provisions for preexisting 
  2.14  health status, these provisions may vary with respect to length 
  2.15  of enrollment in the plan.  Any contract may provide for health 
  2.16  care services in addition to those set forth in subdivision 7. 
  2.17     Sec. 2.  Minnesota Statutes 2000, section 62D.30, is 
  2.18  amended by adding a subdivision to read: 
  2.19     Subd. 8.  [RURAL DEMONSTRATION PROJECT.] (a) The 
  2.20  commissioner may permit demonstration projects to allow health 
  2.21  maintenance organizations to extend coverage to a health 
  2.22  improvement and purchasing coalition located in rural Minnesota, 
  2.23  comprised of the health maintenance organization and members 
  2.24  from a geographic area.  For purposes of this subdivision, rural 
  2.25  is defined as greater Minnesota excluding the seven-county 
  2.26  metropolitan area of Anoka, Carver, Dakota, Hennepin, Ramsey, 
  2.27  Scott, and Washington.  The coalition must be designed in such a 
  2.28  way that members will: 
  2.29     (1) become better informed about health care trends and 
  2.30  cost increases; 
  2.31     (2) be actively engaged in the design of health benefit 
  2.32  options that will meet the needs of their community; 
  2.33     (3) pool their insurance risk; 
  2.34     (4) purchase these products from the health maintenance 
  2.35  organization involved in the demonstration project; and 
  2.36     (5) actively participate in health improvement decisions 
  3.1   for their community. 
  3.2      (b) The commissioner must consider the following when 
  3.3   approving applications for rural demonstration projects: 
  3.4      (1) the extent of consumer involvement in development of 
  3.5   the project; 
  3.6      (2) the degree to which the project is likely to reduce the 
  3.7   number of uninsured or to maintain existing coverage; and 
  3.8      (3) a plan to evaluate and report to the commissioner and 
  3.9   legislature as prescribed by paragraph (e). 
  3.10     (c) For purposes of this subdivision, the commissioner must 
  3.11  waive compliance with the following statutes and rules:  the 
  3.12  cost-sharing restrictions under section 62D.02, subdivision 8, 
  3.13  which for purposes of this subdivision is the sum of the annual 
  3.14  co-payments and deductible which is prohibited from exceeding 
  3.15  the maximum out-of-pocket expenses allowable for a number three 
  3.16  qualified plan under section 62E.06 or $5,000 per family and an 
  3.17  annual deductible of $1,000 per person and Minnesota Rules, part 
  3.18  4685.0801, subparts 1 to 7; for a period of at least two years, 
  3.19  participation in government programs under section 62D.04, 
  3.20  subdivision 5, in the counties of the demonstration project if 
  3.21  that compliance would have been required solely due to 
  3.22  participation in the demonstration project and shall continue to 
  3.23  waive this requirement beyond two years if the enrollment in the 
  3.24  demonstration project is less than 10,000 enrollees; small 
  3.25  employer marketing under section 62L.05, subdivisions 1 to 3; 
  3.26  and small employer geographic premium variations under section 
  3.27  62L.08, subdivision 4.  The commissioner shall approve enrollee 
  3.28  cost-sharing features desired by the coalition that 
  3.29  appropriately share costs between employers, individuals, and 
  3.30  the health maintenance organization.  
  3.31     (d) The health maintenance organization may make the 
  3.32  starting date of the project contingent upon a minimum number of 
  3.33  enrollees as cited in the application, provide for an initial 
  3.34  term of contract with the purchasers of a minimum of three 
  3.35  years, and impose a reasonable penalty for employers who 
  3.36  withdraw early from the project.  For purposes of this 
  4.1   subdivision, loss ratios are to be determined as if the policies 
  4.2   issued under this section are considered individual or small 
  4.3   employer policies pursuant to section 62A.021, subdivision 1, 
  4.4   paragraph (f).  The health maintenance organization may consider 
  4.5   businesses of one to be a small employer under section 62L.02, 
  4.6   subdivision 26.  The health maintenance organization may limit 
  4.7   enrollment and establish enrollment criteria for businesses of 
  4.8   one.  Health improvement and purchasing coalitions under this 
  4.9   subdivision are not associations under section 62L.045, 
  4.10  subdivision 1, paragraph (a). 
  4.11     (e) The health improvement and purchasing coalition must 
  4.12  report to the commissioner and legislature annually on the 
  4.13  progress of the demonstration project and, to the extent 
  4.14  possible, any significant findings in the criteria listed in 
  4.15  clauses (1), (2), and (3) for the final report.  The coalition 
  4.16  must submit a final report five years from the starting date of 
  4.17  the project.  The final report must detail significant findings 
  4.18  from the project and must include, to the extent available, but 
  4.19  should not be limited to, information on the following: 
  4.20     (1) the extent to which the project had an impact on the 
  4.21  number of uninsured in the project area; 
  4.22     (2) the effect on health coverage premiums for groups in 
  4.23  the project's geographic area, including those purchasing health 
  4.24  coverage outside the health improvement and purchasing 
  4.25  coalition; and 
  4.26     (3) the degree to which health care consumers were involved 
  4.27  in the development and implementation of the demonstration 
  4.28  project. 
  4.29     (f) The commissioner must limit the number of demonstration 
  4.30  projects under this subdivision to five projects. 
  4.31     (g) Approval of the application for the demonstration 
  4.32  project is deemed to be in compliance with sections 62E.03 and 
  4.33  62E.06, subdivisions 1, paragraph (a), 2, and 3. 
  4.34     (h) Subdivisions 2 to 7 apply to demonstration projects 
  4.35  under this subdivision.  Waivers permitted under subdivision 1 
  4.36  do not apply to demonstration projects under this subdivision. 
  5.1      (i) If a demonstration project under this subdivision works 
  5.2   in conjunction with a purchasing alliance formed under chapter 
  5.3   62T, that chapter will apply to the purchasing alliance except 
  5.4   to the extent that chapter 62T is inconsistent with this 
  5.5   subdivision. 
  5.6      Sec. 3.  [EFFECTIVE DATE.] 
  5.7      Section 2 is effective the day following final enactment.