Legislative Session number- 88

Bill Name: SF0662

3E Relating to health plan regulation; regulating policy and contract coverages;
conforming state law to federal requirements; establishing a working group on
health plan market rules

ARTICLE 1 - AFFORDABLE CARE ACT
CONFORMITY

Expanding and modifying certain statutes to conform to the
provisions of the federal affordable care act (ACA), including the federal
Health Care and Education Reconciliation Act of 2010, and applicable
regulations; modifying certain provisions relating to commissioner of management
and budget contracting authority, Minnesota employees insurance program
eligibility, classification of insurance contracts filing data, filing and
content of policy forms by insurers for purposes of complying all qualified
health plans offered through the Minnesota insurance marketplace with the ACA by
including a grace period provision; modifying children's health supervision
services and prenatal care services; modifying limitations of preauthorizations
for emergencies, alcoholics and drug dependents benefits; modifying individual
policy conversion provisions, including conversion privileges for insured former
spouses and children, coverage for scalp hair prosthesis and coverage of
dependents; modifying and conforming the scope of coverage for dependents by
plans other than health plans, prohibiting restrictions, specifying compliance
requirements, defining dependent, modifying preexisting conditions disclosure
methods and certain individual market regulations, modifying individual health
plan premium rate restrictions, modifying portability and conversion of coverage
requirements; modifying provisions relating to nonprofit health service plan
corporations subscriber contracts for disabled dependents and conversion
privileges, health maintenance organizations (HMO) evidence of coverage, and
enrollee cost sharing; defining essential health benefits under comprehensive
health insurance, major medical coverages, minimum benefits of qualified number
three plan; modifying the definition of dependent under the small employer
insurance reform; excepting small group health plans offered through the
Minnesota insurance marketplace (MNSure) from the small employer individual
health plan definition; modifying certain underwriting restrictions; modifying
restrictions relating to premium rates; modifying utilization review and appeals
of health care procedures, health plan companies regulations and coverage
requirements, insurance industry trade practices regulations, and municipal
joint powers group benefits for officers, employees, and retirees; defining and
redefining certain terms relating to health plan companies; prohibiting health
plan recessions; providing for coverage for preventative items and services;
modifying direct access to obstetric and gynecologic services; providing for
coverage for participation in approved clinical trials; modifying certain
emergency services provisions; providing for designation of primary care
provider; specifying additional required information; prohibiting lifetime and
annual limits; modifying certain complaint procedures; modifying enrollee notice
provisions; modifying external review of adverse determinations; specifying
essential health benefit package requirements; requiring a benefits and coverage
explanation; modifying municipal joint powers for group benefits for dependents;
repealing certain provisions relating to preexisting conditions disclosed at
time of application, comprehensive health insurance individual market regulation
guaranteed market regulation, the definition of dependent, policy conversion
rights, and relationship to temporary federal high-risk pool, certain provisions
relating to small employer plan benefits and phase-in, and audits conducted by
independent organization accreditation requirements

ARTICLE 2 - HEALTH PLAN
MARKET RULES

"Minnesota Health Plan Market Rules"; specifying applicability
to individual market or small group market health plans; defining terms;
specifying administrative procedures for enforcement; specifying metal levels
(bronze, silver, gold) for mandatory offerings; specifying marketing standards,
geographic accessibility, provider network adequacy, service area requirements,
and limited scope dental plans; requiring the commissioner of commerce to
convene a market rules working group to study and make recommendations on market
requirement establishment with uniform application in individual and small group
market health plans, specifying certain duties and membership requirements,
providing an expiration date; repealing geographic accessibility
(je)