1.1                          A bill for an act 
  1.2             relating to health; clarifying the status of the 
  1.3             comprehensive health association under medical 
  1.4             assistance and general assistance medical care; 
  1.5             clarifying eligibility; opening the process for 
  1.6             selecting a writing carrier; permitting contributing 
  1.7             members to offset assessments against premium taxes; 
  1.8             eliminating the four-month waiting period under 
  1.9             MinnesotaCare for association enrollees; modifying 
  1.10            coverage for medical assistance enrollees; 
  1.11            transferring insurance premium tax revenue to the 
  1.12            general fund; appropriating money; amending Minnesota 
  1.13            Statutes 1996, sections 62A.045; 62E.02, subdivisions 
  1.14            13 and 18; 62E.04, subdivision 8; 62E.11, by adding a 
  1.15            subdivision; 62E.13, subdivision 2; 256.9357, 
  1.16            subdivision 3; 256B.056, subdivision 8; 256B.0625, 
  1.17            subdivision 15; 256D.03, subdivision 3b; and 295.58. 
  1.18  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.19     Section 1.  Minnesota Statutes 1996, section 62A.045, is 
  1.20  amended to read: 
  1.21     62A.045 [PAYMENTS ON BEHALF OF WELFARE RECIPIENTS.] 
  1.22     (a) No health plan issued or renewed to provide coverage to 
  1.23  a Minnesota resident shall contain any provision denying or 
  1.24  reducing benefits because services are rendered to a person who 
  1.25  is eligible for or receiving medical benefits pursuant to title 
  1.26  XIX of the Social Security Act (Medicaid) in this or any other 
  1.27  state; chapter 256; 256B; or 256D or services pursuant to 
  1.28  section 252.27; 256.9351 to 256.9361; 260.251, subdivision 1a; 
  1.29  or 393.07, subdivision 1 or 2.  No health carrier providing 
  1.30  benefits under plans covered by this section shall use 
  1.31  eligibility for medical programs named in this section as an 
  2.1   underwriting guideline or reason for nonacceptance of the risk. 
  2.2      (b) If payment for covered expenses has been made under 
  2.3   state medical programs for health care items or services 
  2.4   provided to an individual, and a third party has a legal 
  2.5   liability to make payments, the rights of payment and appeal of 
  2.6   an adverse coverage decision for the individual, or in the case 
  2.7   of a child their responsible relative or caretaker, will be 
  2.8   subrogated to the state and/or its authorized agent.  
  2.9      (c) Notwithstanding any law to the contrary, when a person 
  2.10  covered by a health plan receives medical benefits according to 
  2.11  any statute listed in this section, payment for covered services 
  2.12  or notice of denial for services billed by the provider must be 
  2.13  issued directly to the provider.  If a person was receiving 
  2.14  medical benefits through the department of human services at the 
  2.15  time a service was provided, the provider must indicate this 
  2.16  benefit coverage on any claim forms submitted by the provider to 
  2.17  the health carrier for those services.  If the commissioner of 
  2.18  human services notifies the health carrier that the commissioner 
  2.19  has made payments to the provider, payment for benefits or 
  2.20  notices of denials issued by the health carrier must be issued 
  2.21  directly to the commissioner.  Submission by the department to 
  2.22  the health carrier of the claim on a department of human 
  2.23  services claim form is proper notice and shall be considered 
  2.24  proof of payment of the claim to the provider and supersedes any 
  2.25  contract requirements of the health carrier relating to the form 
  2.26  of submission.  Liability to the insured for coverage is 
  2.27  satisfied to the extent that payments for those benefits are 
  2.28  made by the health carrier to the provider or the commissioner 
  2.29  as required by this section. 
  2.30     (d) When a state agency has acquired the rights of an 
  2.31  individual eligible for medical programs named in this section 
  2.32  and has health benefits coverage through a health carrier, the 
  2.33  health carrier shall not impose requirements that are different 
  2.34  from requirements applicable to an agent or assignee of any 
  2.35  other individual covered. 
  2.36     (e) For the purpose of this section, health plan includes 
  3.1   coverage offered by integrated service networks, community 
  3.2   integrated service networks, any plan governed under the federal 
  3.3   Employee Retirement Income Security Act of 1974 (ERISA), United 
  3.4   States Code, title 29, sections 1001 to 1461, and coverage 
  3.5   offered under the exclusions listed in section 62A.011, 
  3.6   subdivision 3, clauses (2), (6), (9), (10), and (12).  This 
  3.7   section does not apply to coverage issued by the Minnesota 
  3.8   comprehensive health association under chapter 62E. 
  3.9      Sec. 2.  Minnesota Statutes 1996, section 62E.02, 
  3.10  subdivision 13, is amended to read: 
  3.11     Subd. 13.  [ELIGIBLE PERSON.] (a) "Eligible person" means 
  3.12  an individual who: 
  3.13     (1) is currently and has been a resident of Minnesota for 
  3.14  the six months immediately preceding the date of receipt by the 
  3.15  association or its writing carrier of a completed certificate of 
  3.16  eligibility; 
  3.17     (2) is not enrolled in medical assistance under chapter 
  3.18  256B or 256D; and 
  3.19     who (3) meets the enrollment requirements of section 62E.14.
  3.20     (b) Individuals who, prior to July 1, 1997, were both 
  3.21  enrolled in medical assistance under chapter 256B or 256D and 
  3.22  covered under a qualified or Medicare supplement plan issued by 
  3.23  the association, remain eligible for a fiscal year only if the 
  3.24  commissioner of finance, upon consultation with the association, 
  3.25  has determined by June 15 of the preceding fiscal year that the 
  3.26  legislature has appropriated sufficient funds to the association 
  3.27  to cover the individuals' total administrative and claims costs, 
  3.28  net of premiums paid, for the upcoming fiscal year. 
  3.29     Sec. 3.  Minnesota Statutes 1996, section 62E.02, 
  3.30  subdivision 18, is amended to read: 
  3.31     Subd. 18.  [WRITING CARRIER.] "Writing carrier" means the 
  3.32  insurer or insurers, health maintenance organization or 
  3.33  organizations, integrated service network or networks, and 
  3.34  community integrated service network or networks, or other 
  3.35  entity selected by the association and approved by the 
  3.36  commissioner to administer the comprehensive health insurance 
  4.1   plan. 
  4.2      Sec. 4.  Minnesota Statutes 1996, section 62E.04, 
  4.3   subdivision 8, is amended to read: 
  4.4      Subd. 8.  [REDUCTION OF BENEFITS BECAUSE OF OTHER 
  4.5   SERVICES.] No policy of accident and health insurance shall 
  4.6   contain any provision denying or reducing benefits because 
  4.7   services are rendered to an insured or dependent who is eligible 
  4.8   for or receiving benefits pursuant to chapters 256B and 256D, or 
  4.9   sections 252.27; 260.251, subdivision 1a; 393.07, subdivision 1 
  4.10  or 2.  This subdivision does not apply to coverage issued by the 
  4.11  Minnesota comprehensive health association under this chapter. 
  4.12     Sec. 5.  Minnesota Statutes 1996, section 62E.11, is 
  4.13  amended by adding a subdivision to read: 
  4.14     Subd. 8a.  [TAX OFFSET.] Beginning January 1, 1997, an 
  4.15  annual fiscal year-end or interim assessment paid by a 
  4.16  contributing member under this chapter may be offset against the 
  4.17  premium tax payable by that contributing member under section 
  4.18  60A.15 for the year in which the annual fiscal year-end or 
  4.19  interim assessment is paid.  In no event may a contributing 
  4.20  member's total offset in any given year exceed one percent of 
  4.21  its premiums as defined in section 60A.15, subdivision 1, 
  4.22  paragraph (b), for that same year. 
  4.23     Sec. 6.  Minnesota Statutes 1996, section 62E.13, 
  4.24  subdivision 2, is amended to read: 
  4.25     Subd. 2.  The association may select policies and 
  4.26  contracts, or parts thereof, submitted by a member or members of 
  4.27  the association, or by the association or others, to develop 
  4.28  specifications for bids from any members entity which wish 
  4.29  wishes to be selected as a writing carrier to administer the 
  4.30  state plan.  The selection of the writing carrier shall be based 
  4.31  upon criteria including established by the board of directors of 
  4.32  the association and approved by the commissioner.  The criteria 
  4.33  shall outline specific qualifications that an entity must 
  4.34  satisfy in order to be selected and, at a minimum, shall include 
  4.35  the member's entity's proven ability to handle large group 
  4.36  accident and health insurance cases, efficient claim paying 
  5.1   capacity, and the estimate of total charges for administering 
  5.2   the plan.  The association may select separate writing carriers 
  5.3   for the two types of qualified plans, the qualified medicare 
  5.4   supplement plan, and the health maintenance organization 
  5.5   contract. 
  5.6      Sec. 7.  Minnesota Statutes 1996, section 256.9357, 
  5.7   subdivision 3, is amended to read: 
  5.8      Subd. 3.  [PERIOD UNINSURED.] To be eligible for subsidized 
  5.9   premium payments based on a sliding scale, families and 
  5.10  individuals initially enrolled in the MinnesotaCare program 
  5.11  under section 256.9354, subdivisions 4 and 5, must have had no 
  5.12  health coverage for at least four months prior to application.  
  5.13  The commissioner may change this eligibility criterion for 
  5.14  sliding scale premiums without complying with rulemaking 
  5.15  requirements in order to remain within the limits of available 
  5.16  appropriations.  The requirement of at least four months of no 
  5.17  health coverage prior to application for the MinnesotaCare 
  5.18  program does not apply to: 
  5.19     (1) families, children, and individuals who want to apply 
  5.20  for the MinnesotaCare program upon termination from the medical 
  5.21  assistance program, general assistance medical care program, or 
  5.22  coverage under a regional demonstration project for the 
  5.23  uninsured funded under section 256B.73, the Hennepin county 
  5.24  assured care program, or the Group Health, Inc., community 
  5.25  health plan; 
  5.26     (2) families and individuals initially enrolled under 
  5.27  section 256.9354, subdivisions 1, paragraph (a), and 2; 
  5.28     (3) children enrolled pursuant to Laws 1992, chapter 549, 
  5.29  article 4, section 17; or 
  5.30     (4) individuals currently serving or who have served in the 
  5.31  military reserves, and dependents of these individuals, if these 
  5.32  individuals:  (i) reapply for MinnesotaCare coverage after a 
  5.33  period of active military service during which they had been 
  5.34  covered by the Civilian Health and Medical Program of the 
  5.35  Uniformed Services (CHAMPUS); (ii) were covered under 
  5.36  MinnesotaCare immediately prior to obtaining coverage under 
  6.1   CHAMPUS; and (iii) have maintained continuous coverage; or 
  6.2      (5) individuals and families whose only health coverage 
  6.3   during the four months prior to application was a qualified or 
  6.4   Medicare supplement plan issued by the Minnesota comprehensive 
  6.5   health association under chapter 62E. 
  6.6      Sec. 8.  Minnesota Statutes 1996, section 256B.056, 
  6.7   subdivision 8, is amended to read: 
  6.8      Subd. 8.  [COOPERATION.] To be eligible for medical 
  6.9   assistance, applicants and recipients must cooperate with the 
  6.10  state and local agency to identify potentially liable 
  6.11  third-party payers and assist the state in obtaining third party 
  6.12  payments, unless good cause for noncooperation is determined 
  6.13  according to Code of Federal Regulations, title 42, part 
  6.14  433.147.  "Cooperation" includes identifying any third party who 
  6.15  may be liable for care and services provided under this chapter 
  6.16  to the applicant, recipient, or any other family member for whom 
  6.17  application is made and providing relevant information to assist 
  6.18  the state in pursuing a potentially liable third party.  
  6.19  Cooperation also includes providing information about a group 
  6.20  health plan for which the person may be eligible and if the plan 
  6.21  is determined cost-effective by the state agency and premiums 
  6.22  are paid by the local agency or there is no cost to the 
  6.23  recipient, they must enroll or remain enrolled with the group.  
  6.24  For purposes of this subdivision, coverage provided by the 
  6.25  Minnesota comprehensive health association under chapter 62E 
  6.26  shall not be considered group health plan coverage or 
  6.27  cost-effective by the state and local agency.  Cost-effective 
  6.28  insurance premiums approved for payment by the state agency and 
  6.29  paid by the local agency are eligible for reimbursement 
  6.30  according to section 256B.19. 
  6.31     Sec. 9.  Minnesota Statutes 1996, section 256B.0625, 
  6.32  subdivision 15, is amended to read: 
  6.33     Subd. 15.  [HEALTH PLAN PREMIUMS AND COPAYMENTS.] (a) 
  6.34  Medical assistance covers health care prepayment plan premiums, 
  6.35  insurance premiums, and copayments if determined to be 
  6.36  cost-effective by the commissioner.  For purposes of obtaining 
  7.1   Medicare part A and part B, and copayments, expenditures may be 
  7.2   made even if federal funding is not available. 
  7.3      (b) The state and local agency shall not pay premiums, 
  7.4   deductibles, coinsurance, or copayments that a recipient is 
  7.5   required to pay under a qualified or Medicare supplement plan 
  7.6   issued by the Minnesota comprehensive health association. 
  7.7      (c) Paragraph (b) shall not apply in a fiscal year to 
  7.8   recipients covered under a qualified or Medicare supplement plan 
  7.9   issued by the Minnesota comprehensive health association prior 
  7.10  to July 1, 1997, if the commissioner of finance, upon 
  7.11  consultation with the association, has determined by June 15 of 
  7.12  the preceding fiscal year that the legislature has appropriated 
  7.13  sufficient funds to the association to cover all such 
  7.14  recipients' total administrative and claims costs, net of 
  7.15  premiums paid, for the upcoming fiscal year. 
  7.16     Sec. 10.  Minnesota Statutes 1996, section 256D.03, 
  7.17  subdivision 3b, is amended to read: 
  7.18     Subd. 3b.  [COOPERATION.] (a) General assistance or general 
  7.19  assistance medical care applicants and recipients must cooperate 
  7.20  with the state and local agency to identify potentially liable 
  7.21  third-party payors and assist the state in obtaining third-party 
  7.22  payments.  Cooperation includes identifying any third party who 
  7.23  may be liable for care and services provided under this chapter 
  7.24  to the applicant, recipient, or any other family member for whom 
  7.25  application is made and providing relevant information to assist 
  7.26  the state in pursuing a potentially liable third party.  General 
  7.27  assistance medical care applicants and recipients must cooperate 
  7.28  by providing information about any group health plan in which 
  7.29  they may be eligible to enroll.  They must cooperate with the 
  7.30  state and local agency in determining if the plan is 
  7.31  cost-effective.  For purposes of this subdivision, coverage 
  7.32  provided by the Minnesota comprehensive health association under 
  7.33  chapter 62E shall not be considered group health plan coverage 
  7.34  or cost-effective by the state and local agency.  If the plan is 
  7.35  determined cost-effective and the premium will be paid by the 
  7.36  state or local agency or is available at no cost to the person, 
  8.1   they must enroll or remain enrolled in the group health plan.  
  8.2   Cost-effective insurance premiums approved for payment by the 
  8.3   state agency and paid by the local agency are eligible for 
  8.4   reimbursement according to subdivision 6.  
  8.5      (b) The state and local agency shall not pay premiums, 
  8.6   deductibles, coinsurance, or copayments that a recipient is 
  8.7   required to pay under a qualified or Medicare supplement plan 
  8.8   issued by the Minnesota comprehensive health association. 
  8.9      (c) Paragraph (b) shall not apply in a fiscal year to 
  8.10  recipients covered under a qualified or Medicare supplement plan 
  8.11  issued by the Minnesota comprehensive health association prior 
  8.12  to July 1, 1997, if the commissioner of finance, upon 
  8.13  consultation with the association, has determined by June 15 of 
  8.14  the preceding fiscal year that the legislature has appropriated 
  8.15  sufficient funds to the association to cover all such 
  8.16  recipients' total administrative and claims costs, net of 
  8.17  premiums paid, for the upcoming fiscal year. 
  8.18     Sec. 11.  Minnesota Statutes 1996, section 295.58, is 
  8.19  amended to read: 
  8.20     295.58 [DEPOSIT OF REVENUES AND PAYMENT OF REFUNDS.] 
  8.21     The commissioner shall deposit all revenues, including 
  8.22  penalties and interest, derived from the taxes imposed by 
  8.23  sections 295.50 to 295.57 and from the insurance premiums tax on 
  8.24  health maintenance organizations, community integrated service 
  8.25  networks, integrated service networks, and nonprofit health 
  8.26  service plan corporations in the health care access fund in the 
  8.27  state treasury.  Refunds of overpayments must be paid from the 
  8.28  health care access fund in the state treasury.  There is 
  8.29  annually appropriated from the health care access fund to the 
  8.30  commissioner of revenue the amount necessary to make any refunds 
  8.31  required under section 295.54. 
  8.32     Sec. 12.  [DEPOSIT OF REVENUES.] 
  8.33     After December 31, 1996, the commissioner of revenue shall 
  8.34  deposit all revenues due under Minnesota Statutes, section 
  8.35  60A.15, subdivision 1, paragraph (d), into the general fund of 
  8.36  the state treasury. 
  9.1      Sec. 13.  [APPROPRIATION.] 
  9.2      $....... is appropriated in fiscal year 1998 and $....... 
  9.3   is appropriated in fiscal year 1999 from the general fund to the 
  9.4   board of directors of the Minnesota comprehensive health 
  9.5   association to cover the total administrative and claims costs 
  9.6   associated with those individuals who are covered by a qualified 
  9.7   or Medicare supplement plan issued by the association and who 
  9.8   are enrolled in medical assistance under Minnesota Statutes, 
  9.9   chapter 256B or 256D.  
  9.10     Sec. 14.  [EFFECTIVE DATE.] 
  9.11     Sections 1 to 11 are effective the day following final 
  9.12  enactment.  Section 12 is effective for all revenues due after 
  9.13  December 31, 1996.