1997 Minnesota Statutes

     62D.30 Demonstration projects. 

    Subdivision 1.  The commissioner of health may establish 
 demonstration projects to allow health maintenance organizations 
 to extend coverage to:  

    (a) Individuals enrolled in Part A or Part B, or both, of 
 the Medicare program, Title XVIII of the Social Security Act, 
 United States Code, title 42, section 1395 et seq.; 

    (b) Groups of fewer than 50 employees where each group is 
 covered by a single group health policy; 

    (c) Individuals who are not eligible for enrollment in any 
 group health maintenance contracts; and 

    (d) Low income population groups.  

    For purposes of this section, the commissioner of health 
 may waive compliance with minimum benefits pursuant to sections 
 62A.151 and 62D.02, subdivision 7, full financial risk pursuant 
 to section 62D.04, subdivision 1, clause (f), open enrollment 
 pursuant to section 62D.10, and to applicable rules if there is 
 reasonable evidence that the rules prohibit the operation of the 
 demonstration project.  The commissioner shall provide for 
 public comment before any statute or rule is waived.  

    Subd. 2.  A demonstration project must provide health 
 benefits equal to or exceeding the level of benefits provided in 
 Title XVIII of the Social Security Act and an out of hospital 
 prescription drug benefit.  The out of hospital prescription 
 drug benefit may be waived by the commissioner if the health 
 maintenance organization presents evidence satisfactory to the 
 commissioner that the inclusion of the benefit would restrict 
 the operation of the demonstration project.  

    Subd. 3.  A health maintenance organization electing to 
 participate in a demonstration project shall apply to the 
 commissioner for approval on a form developed by the 
 commissioner.  The application shall include at least the 
 following:  

    (a) A statement identifying the population that the 
 project is designed to serve; 

    (b) A description of the proposed project including a 
 statement projecting a schedule of costs and benefits for the 
 enrollee; 

    (c) Reference to the sections of Minnesota Statutes and 
 department of health rules for which waiver is requested; 

    (d) Evidence that application of the requirements of 
 applicable Minnesota Statutes and department of health rules 
 would, unless waived, prohibit the operation of the 
 demonstration project; 

    (e) Evidence that another arrangement is available for 
 assumption of full financial risk if full financial risk is 
 waived under subdivision 1; 

    (f) An estimate of the number of years needed to 
 adequately demonstrate the project's effects; and 

    (g) Other information the commissioner may reasonably 
 require.  

    Subd. 4.  The commissioner shall approve, deny, or refer 
 back to the health maintenance organization for modification, 
 the application for a demonstration project within 60 days of 
 receipt from the health maintenance organization.  

    Subd. 5.  The commissioner may approve an application for 
 a demonstration project for a maximum of six years, with an 
 option to renew.  

    Subd. 6.  Each health maintenance organization for which a 
 demonstration project is approved shall annually file a report 
 with the commissioner summarizing the project's experience at 
 the same time it files its annual report required by section 
 62D.08.  The report shall be on a form developed by the 
 commissioner and shall be separate from the annual report 
 required by section 62D.08.  

    Subd. 7.  The commissioner may rescind approval of a 
 demonstration project if the commissioner makes any of the 
 findings listed in section 62D.15, subdivision 1, with respect 
 to the project for which it has not been granted a specific 
 exemption, or if the commissioner finds that the project's 
 operation is contrary to the information contained in the 
 approved application.  

    HIST: 1979 c 268 s 1