Subdivision 1. Authorization.
The commissioner may grant waivers from the requirements
of law for the contracting arrangement between a health care purchasing alliance and an
accountable provider network in the areas listed in subdivisions 2 to 4. The commissioner may
not waive the following state consumer protection and quality assurance laws:
(1) laws requiring that enrollees be informed of any restrictions, requirements, or limitations
on coverage, services, or access to specialists and other providers;
(2) laws allowing consumers to complain to or appeal to a state regulatory agency if denied
benefits or services;
(3) laws prohibiting gag clauses and other restrictions on communication between a patient
and their physician or provider;
(4) laws allowing consumers to obtain information on provider financial incentives, which
may affect treatment;
(5) laws requiring the submission of information needed to monitor quality of care and
enrollee rights, except the submission may be done in a manner approved by the commissioner
under subdivision 4;
(6) laws protecting enrollee privacy and confidentiality of records;
(7) minimum standards for adequate provider network capacity and geographic access
(8) laws assuring continuity of care when a patient must change providers;
(9) laws governing coverage of emergency services;
(10) laws prohibiting excessive or unreasonable administrative fees or expenses; and
(11) other laws or rules that are directly related to quality of care, consumer protection,
and due process rights.
Subd. 2. Solvency protection.
(a) The commissioner may waive the requirements of sections
, and may substitute capital and surplus requirements that are reduced from the
levels required of other risk-bearing entities in order to reflect its reduced risk exposure. If risk is
being underwritten, the underwriter cannot have more than 25 percent of the representation on the
governing board of the accountable provider network. The reduced requirements must include at
least the following levels of capital and surplus: (i) a deposit of $500,000 and (ii) the greater of
an estimated 15 percent of gross premium revenues or twice the net retained annual risk up to
$750,000 on a single enrollee. Net retained annual risk may be, for example, the lowest annual
deductible under a provider stop-loss insurance policy that covers all costs above the deductible.
Assets supporting the deposit must meet the standards for deposits referenced in section
or be guaranteed by an entity that is approved and can be monitored by the commissioner.
Assets supporting the capital must meet the investment guidelines referenced in section
Members of a purchasing alliance may assist in meeting the solvency requirements through a
subordinated solvency contribution under a contract approved by the commissioner. For the
purposes of this subdivision, "subordinated solvency contribution" means a contribution to the
accountable provider network by a purchasing alliance member that is evidenced by a promissory
note or other instrument that allows for repayment of the contribution in the manner provided
in a contract approved by the commissioner.
(b) An accountable provider network may propose a method of reporting income, expenses,
claims payments, and other financial information in a manner which adequately demonstrates
ongoing compliance with the standards for capital, surplus, and claims reserves agreed to under
(c) An accountable provider network may demonstrate ability to continue to deliver the
contracted health care services to the purchasing alliance through arrangements which ensure
that, subject to 60 days' notice of intent to discontinue the contracting arrangement, provider
participants will continue to meet their obligation to provide health care services to enrollees for
a period of 60 days.
Subd. 3. Marketing and disclosure.
The accountable provider network, in conjunction
with the health care purchasing alliance, may propose alternative methods to present marketing
and disclosure information which assure the accountability to consumers who are offered and
who receive their services.
Subd. 4. Quality assurance.
The accountable provider network may propose an alternative
quality assurance program which incorporates effective methods for reviewing and evaluating
data related to quality of care and ways to identify and correct quality problems.
History: 1997 c 225 art 5 s 6; 2000 c 295 s 5,6