Article 1 - Premium Assistance
Section 1 establishes definitions for purposes of the premium subsidy program.
Section 2 establishes the program which provides a subsidy of 25% of monthly gross premium in the individual market and is administered by the commissioner of management and budget through health carriers. Individuals receiving advance premium tax credits or enrolled in public program coverage are not eligible. Payments to health carriers for subsidies provided to individuals by the health carriers must be made within the limits of the available appropriation. Procedures are specified for lowering the premium subsidy percentage if the appropriation is not sufficient.
Section 3 requires the legislative auditor to conduct audits related to the program.
Section 4 specifies that notwithstanding the premium subsidies provided by the bill, the premium base for calculating premium taxes is the gross premium for the individual health plans.
Section 5 sunsets the program June 30, 2018.
Section 6 transfers $326,945,000 from the budget reserve account to the general fund.
Section 7 appropriates $311,788,000 from the general fund to the commissioner of Minnesota Management and Budget on a onetime basis for the program. Also appropriates $157,000 on a onetime basis for the audit by the legislative auditor. Unexpended amounts are transferred back to the budget reserve account.
Section 8 makes the article effective the day following final enactment.
Article 2 - Insurance Market Reforms
Section 1 requires the Commissioner of Commerce to provide public access to certain compiled data of proposed changes to health insurance rates within ten business days after the filing deadline.
Section 2 sets the stop-loss aggregate attachment point for all groups at no less than 110% of expected claims.
Section 3 requires claim settlement periods under a stop loss policy to be no less favorable than claims incurred during the contract period and paid by the plan during the contract period or within three months after expiration of the contract period.
Sections 4 -9 allows for profit HMOs to operate in the state.
Section 10, subdivision 1, establishes definitions for purposes of authorizing agricultural cooperative health plans.
Subdivision 2 grants an exemption from joint-self insurance plan statutes if the plan meets specified conditions including that the plan is sponsored by an agricultural cooperative whose members are engaged in production agriculture.
Subdivision 3 establishes requirements for the joint self-insurance plan, including stop-loss and reserve requirements.
Subdivision 4 requires submission of plan documents to the Commissioner of Commerce.
Subdivision 5 requires a member to participate in the plan for three years or pay a financial penalty.
Subdivision 6 establishes the plan as a single risk pool.
Subdivision 7 allows for marketing of the plan.
Subdivision 8 exempts the agricultural cooperative health plan from premium taxes.
Subdivision 9 grants exemptions from benefit mandate and continuation requirements under state law, if the plan provides benefits required under ERISA and the Affordable Care Act.
Section 11 establishes procedures for a health provider to appeal a waiver received by a health plan related to network adequacy requirements.
Section 12 allows a health carrier to issue an individual plan to an employee of a small employer if the small employer is in compliance with the federal 21st Century Cures Act.
Section 13 requires an enrollee to have the same cost sharing requirements for defined unauthorized provider services as those applicable to services received from a participating provider in a health plan network.
Section 14 is a conforming change related to the premium tax exemption for agricultural cooperative health plans.
Section 15 entitles an enrollee suffering from specified conditions who was involuntarily terminated in the individual market to receive services otherwise covered under the terms of a 2017 health plan from a provider who provided in-network care to the enrollee during 2016 but who is out of network for 2017. The Commissioner of Minnesota Management and Budget is required to reimburse the new health plan company for the costs of services authorized under this section. This only applies if the enrollee’s health care provider agrees to specified terms. The health plan company may require medical records and other supporting information be provided with a request for authorization.
Section 16 requires an agency incurring administrative costs under the act to perform its duties within existing appropriations unless otherwise provided.
Section 17 requires the Commissioner of Commerce to report by March 1, 2017, on specified issues related to the use of certain sections of Minnesota Statutes related to health care access.
Section 18 appropriates $15,000,000 from the general fund to the Commissioner of Minnesota Management and Budget for the purposes of section 15 (transition of care coverage). This is a onetime appropriation and is available until June 30, 2018.
Section 19 repeals an HMO provision and a pilot program for agricultural cooperatives as conforming changes.