2001 Minnesota Statutes

     256.956 Purchasing alliance stop-loss fund. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, the following definitions apply:  

    (a) "Commissioner" means the commissioner of human services.

    (b) "Health plan" means a policy, contract, or certificate 
 issued by a health plan company to a qualifying purchasing 
 alliance.  Any health plan issued to the members of a qualifying 
 purchasing alliance must meet the requirements of chapter 62L.  

    (c) "Health plan company" means: 

    (1) a health carrier as defined under section 62A.011, 
 subdivision 2; 

    (2) a community integrated service network operating under 
 chapter 62N; or 

    (3) an accountable provider network operating under chapter 
 62T.  

    (d) "Qualifying employer" means an employer who: 

    (1) is a member of a qualifying purchasing alliance; 

    (2) has at least one employee but no more than ten 
 employees or is a sole proprietor or farmer; 

    (3) did not offer employer-subsidized health care coverage 
 to its employees for at least 12 months prior to joining the 
 purchasing alliance; and 

    (4) is offering health coverage through the purchasing 
 alliance to all employees who work at least 20 hours per week 
 unless the employee is eligible for Medicare. 

 For purposes of this subdivision, "employer-subsidized health 
 coverage" means health coverage for which the employer pays at 
 least 50 percent of the cost of coverage for the employee.  

    (e) "Qualifying enrollee" means an employee of a qualifying 
 employer or the employee's dependent covered by a health plan.  

    (f) "Qualifying purchasing alliance" means a purchasing 
 alliance as defined in section 62T.01, subdivision 2, that: 

    (1) meets the requirements of chapter 62T; 

    (2) services a geographic area located in outstate 
 Minnesota, excluding the city of Duluth; and 

    (3) is organized and operating before May 1, 2001. 

    The criteria used by the qualifying purchasing alliance for 
 membership must be approved by the commissioner of health.  A 
 qualifying purchasing alliance may begin enrolling qualifying 
 employers after July 1, 2001, with enrollment ending by December 
 31, 2003.  

    Subd. 2.    Creation of account.  A purchasing alliance 
 stop-loss fund account is established in the general fund.  The 
 commissioner shall use the money to establish a stop-loss fund 
 from which a health plan company may receive reimbursement for 
 claims paid for qualifying enrollees.  The account consists of 
 money appropriated by the legislature.  Money from the account 
 must be used for the stop-loss fund.  

    Subd. 3.    Reimbursement.  (a) A health plan company 
 may receive reimbursement from the fund for 90 percent of the 
 portion of the claim that exceeds $30,000 but not of the portion 
 that exceeds $100,000 in a calendar year for a qualifying 
 enrollee.  

    (b) Claims shall be reported and funds shall be distributed 
 on a calendar-year basis.  Claims shall be eligible for 
 reimbursement only for the calendar year in which the claims 
 were paid.  

    (c) Once claims paid on behalf of a qualifying enrollee 
 reach $100,000 in a given calendar year, no further claims may 
 be submitted for reimbursement on behalf of that enrollee in 
 that calendar year.  

    Subd. 4.    Request process.  (a) Each health plan 
 company must submit a request for reimbursement from the fund on 
 a form prescribed by the commissioner.  Requests for payment 
 must be submitted no later than April 1 following the end of the 
 calendar year for which the reimbursement request is being made, 
 beginning April 1, 2002. 

    (b) The commissioner may require a health plan company to 
 submit claims data as needed in connection with the 
 reimbursement request.  

    Subd. 5.    Distribution.  (a) The commissioner shall 
 calculate the total claims reimbursement amount for all 
 qualifying health plan companies for the calendar year for which 
 claims are being reported and shall distribute the stop-loss 
 funds on an annual basis.  

    (b) In the event that the total amount requested for 
 reimbursement by the health plan companies for a calendar year 
 exceeds the funds available for distribution for claims paid by 
 all health plan companies during the same calendar year, the 
 commissioner shall provide for the pro rata distribution of the 
 available funds.  Each health plan company shall be eligible to 
 receive only a proportionate amount of the available funds as 
 the health plan company's total eligible claims paid compares to 
 the total eligible claims paid by all health plan companies.  

    (c) In the event that funds available for distribution for 
 claims paid by all health plan companies during a calendar year 
 exceed the total amount requested for reimbursement by all 
 health plan companies during the same calendar year, any excess 
 funds shall be reallocated for distribution in the next calendar 
 year.  

    Subd. 6.    Data.  Upon the request of the commissioner, 
 each health plan company shall furnish such data as the 
 commissioner deems necessary to administer the fund.  The 
 commissioner may require that such data be submitted on a per 
 enrollee, aggregate, or categorical basis.  Any data submitted 
 under this section shall be classified as private data or 
 nonpublic data as defined in section 13.02. 

    Subd. 7.    Delegation.  The commissioner may delegate 
 any or all of the commissioner's administrative duties to 
 another state agency or to a private contractor.  

    Subd. 8.    Report.  The commissioner of commerce, in 
 consultation with the office of rural health and the qualifying 
 purchasing alliances, shall evaluate the extent to which the 
 purchasing alliance stop-loss fund increases the availability of 
 employer-subsidized health care coverage for residents residing 
 in the geographic areas served by the qualifying purchasing 
 alliances.  A preliminary report must be submitted to the 
 legislature by February 15, 2003, and a final report must be 
 submitted by February 15, 2004.  

    Subd. 9.    Sunset.  This section shall expire January 
 1, 2005.  

    HIST: 1Sp2001 c 9 art 2 s 9