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S.F. No. 1 - Minnesota Insurance Marketplace Act, 8th Engrossment
 
Author: Senator Tony Lourey
 
Prepared By: Stephanie James, Senate Counsel (651/296-0103)
 
Date: March 4, 2013



 

SF 1 establishes the Minnesota Insurance Marketplace.

Section 1 (13.7191, subdivision 14a) specifies in chapter 13 that the classification and sharing of data of the Minnesota Insurance Marketplace is governed by section 62V.06.

Section 2 (13D.08, subdivision 5a) specifies in the open meeting chapter (13D) that the meetings of the Minnesota Insurance Marketplace are governed under section 62V.03.

Section 3 (16A.725, subdivision 2a, paragraph (a)) requires the Board of the Minnesota Insurance Marketplace to certify to the Commissioner of Management and Budget the estimated costs necessary to fund the operations of the Marketplace by March 1 of each year, beginning March 1, 2015, for the next fiscal year.

Paragraph (b) requires the board to certify the estimated costs not covered by federal funds for fiscal years 2014 and 2015 by June 1, 2013.

Section 4 (16A.725, subdivision 3) requires the Commissioner of Management and Budget to first transfer from the health impact fund to the Minnesota Insurance Marketplace special account, the amount of certified expenditures under section 16A.725, subdivision 2a, or the balance of the fund, whichever is less.  This transfer is to occur each fiscal year and before any other transfer from the fund.

Section 5 (62V.01) states that this chapter (62V) may be cited as the "Minnesota Insurance Marketplace Act."

Section 6 (62V.02) defines the following terms:  board; dental plan; health plan; health carrier; individual market; insurance provider; Minnesota Insurance Marketplace; navigator; public health care program; qualified health plan; and small group market.

Section 7 (62V.03) creates the Minnesota Insurance Marketplace.

Subdivision 1 creates the Minnesota Insurance Marketplace as a board with the following duties to:

 (1) promote innovation, competition, quality, value, market participation, affordability, meaningful choices, health improvement, care management, reduction of health disparities, and portability of health plans;

 (2) facilitate and simplify the comparison, choice, enrollment, and purchase of health plans for individuals purchasing in the individual market and employees and employers purchasing in the small group market through the Minnesota Insurance Marketplace;

 (3) assist small employers with access to small business health insurance tax credits and to assist individuals with access to public health care programs, premium assistance tax credits, cost-sharing reductions, and certificates of exemption from individual responsibility requirements; and

 (4) facilitate the integration and transition of individuals between public health care programs and health plans in the individual market. 

Subdivision 2 outlines the applicability of other laws in terms of the Minnesota Insurance Marketplace.

Paragraph (a) states that the Marketplace is subject to review by the legislative auditor under section 3.971.

Paragraph (b) states that board members are subject to section 10A.07 (conflict of interest disclosure).  The board members and personnel are subject to section 10A.071 (gift ban). 

Paragraph (c) requires all meetings of the board to comply with the open meeting law with the exception of meetings regarding personnel negotiations; contract negotiations; and not public, or trade secret information. 

Paragraph (d) states that, except as specified elsewhere in this act, the Minnesota Insurance Marketplace is exempt from chapter 14 (administrative procedures), including section 14.386 (procedures for adopting exempt rules).

Paragraph (e) exempts the board and the Web site from chapter 60K. (insurance producer licensure)

Paragraph (f) states that section 3.3005 applies to any federal funds received by the Minnesota Insurance Marketplace. (Legislative Advisory Commission review)

Paragraph (g) exempts the Marketplace from several sections in chapter 16E. (Office of Enterprise Technology) 

Section 8 (62V.04) describes the governance structure of the Minnesota Insurance Marketplace.

Subdivision 1 states that the Marketplace will be governed by a board of directors consisting of seven members.

Subdivision 2 describes the board membership appointments.

Subdivision 3 describes the terms of the board membership.

Subdivision 4 describes the conflict of interest specifications for the board members.  Specifies that no board member shall have a close family member who is an executive of a health carrier.

Subdivision 5 requires the Governor to designate one of the appointees as the acting chair until the board elects a chair.  The board is required to hold its first meeting within 60 days of enactment, and elect a chair at the first meeting. 

Subdivision 6 requires the chair to be elected by a majority of members and specifies that the chair serves for one year.

Subdivision 7 requires the members of the board to elect officers by a majority of the members and specifies that the officers shall serve for one year.

Subdivision 8 sets out how a board vacancy is to be filled. 

Subdivision 9 states that a board member may be removed only for cause, and that a conflict of interest shall be cause for removal.

Subdivision 10 requires the board to meet at least quarterly.

Subdivision 11 describes what constitutes a quorum.

Subdivision 12, paragraph (a), authorizes compensation for the board members, capped by section 15A.0815, subdivision 4 (25 percent of the Governor's salary) until December 31, 2015.  The process for setting salaries is in accordance with section 15A.0815, subdivision 5 (appointing authority submits recommendations to the Legislative Coordinating Commission).

Paragraph (b) states that beginning January 1, 2016, compensation is in accordance with section 15.075 ($55 per day, plus expenses).

Subdivision 13 requires the board to establish the advisory committees required under federal law and authorizes the board to establish other advisory committees as necessary. 

Section 9 (62V.05) describes the basic responsibilities of the Minnesota Insurance Marketplace.

Subdivision 1, paragraph (a), requires the Marketplace to implement and operate the Marketplace in accordance with this chapter and applicable state and federal laws.

Paragraph (b) authorizes the Marketplace to:

(1) employ personnel and delegate administrative, operational, and other responsibilities to the director and other personnel as deemed appropriate by the board; specifies that the director and managerial staff are unclassified and governed by a compensation plan prepared by the board, submitted to the Commissioner of Management and Budget for review and comment within 14 days of its receipt, and approved by the Legislative Coordinating Commission and the legislature;

(2) establish the budget for the Marketplace;

(3) seek and accept money, grants, loans, donations, materials, services, or advertising revenue from government agencies, philanthropic organizations, and public and private sources to fund the operation of the Marketplace;

(4) contract for the receipt and provision of goods and services;

(5) enter into information-sharing agreements with state and federal agencies and other entities, provided as authorized under section 62V.06; and

(6) take any other actions reasonably required to implement and administer its responsibilities. 

Paragraph (c) requires the board within 180 days of enactment to establish bylaws, policies, and procedures governing the operations of the Minnesota Insurance Marketplace. 

Subdivision 2 requires that funds collected for the operations of the Marketplace cover any compensation provided to navigators in the navigator program.  Requires the Marketplace to post on its Web site the annual estimated costs necessary to fund the operations of the Marketplace as certified to the Commissioner of Management and Budget.

Subdivision 3 establishes requirements for insurance producers assisting individuals and small employers purchasing coverage through the Marketplace.

Paragraph (a) requires,within 30 days of enactment, the Commissioner of Management and Budget, in consultation with the Commissioner of Commerce, to establish requirements for insurance producers assisting individuals and small employers with coverage through the Marketplace.  These requirements shall remain in effect until the implementation of the requirements established by the board under paragraph (b), or January 1, 2015, whichever is later.

Paragraph (b) authorizes the board, in consultation with the Commissioner of Commerce, to establish certification requirements for insurance producers assisting individuals and small employers with coverage through the Marketplace.  Specifies that certification shall be issued by the Minnesota Insurance Marketplace.

Paragraph (c) states that certification requirements must not exceed the requirements under federal law and specifies that certification must include training in certain areas.  Training required for certification shall qualify for continuing education requirements and must comply with course approval. 

Paragraph (d) states that the compensation paid to insurance producers must be the same for health plans offered or sold inside and outside of the Minnesota Insurance Marketplace.  Specifies that compensation must be set by the health carrier and not the board.

Paragraph (e) states that any compensation structure established by a health carrier for the group market must include compensation for defined contribution plans that involve multiple health carriers and that the compensation must be commensurate with other small group market defined health plans.

Paragraph (f) specifies that any insurance producer assisting an individual or small employer with purchasing coverage through the Minnesota Insurance Marketplace must disclose, orally and in writing, at the time of first solicitation the following:

  1. the health carriers and qualified health plans offered through the Minnesota Insurance Marketplace that the producer is authorized to sell and that the producer may not be authorized to sell all the health plans offered through the Marketplace;
  2. that the producer may be receiving compensation from a health carrier for enrolling the prospective buyer in a specific health plan; and
  3. information on all qualified health plans offered through the Marketplace is available through the Marketplace Web site.

Paragraph (g) requires the health carriers that offer or sell qualified health plans through the Marketplace to report to the board and the Commissioner of Commerce the compensation offered or provided to the producers for each type of health plan the health carrier offers inside and outside of the Marketplace.

Paragraph (h) states that nothing in this subdivision shall be construed to limit the licensure requirements or regulatory functions of the Commissioner of Commerce under chapter 60K.

Subdivision 4 establishes the policies and procedures for navigators, in-person assisters, call center, and customer services provisions.

Paragraph (a) authorizes the board to establish policies and procedures for the ongoing operation of a navigator program, in-person assister program, call center, and customer service provisions for the Marketplace to be implemented beginning January 1, 2015.

Paragraph (b) prior to the implementation of the policies and procedures described in paragraph (a), the following will be in effect:

(1) the navigator program will be met by section 256.962;

(2) entities eligible to be navigators may serve as in-person assisters;

(3) the Commissioner of Management and Budget shall establish requirements and compensation for the navigator program and in-person assister program within 30 days of enactment; and

 (4) call center operations shall utilize existing state resources and personnel, including referrals to counties for medical assistance.

Paragraph (c) requires the Commissioner of Management and Budget to establish a toll free number for the Marketplace and authorizes the commissioner to hire and contract for additional resources as needed.

Paragraph (d) states that the navigator and in-person assister programs must meet federal requirements and that the training standards for the navigator and in-person assister programs include training in the needs of under-served and vulnerable populations, eligibility rules and regulations, available public health care programs, qualified health plan options available through the Marketplace, and privacy and security standards.  States that for calendar year 2014, the Commissioner of Human Services shall ensure that the navigator program provides application assistance for both qualified health plans offered through the Marketplace and the public health care programs.

Paragraph (e) ensures that any information provided by navigators, in-person assisters, the call center, or other customer assistance portals be accessible to persons with disabilities and include information on other available coverage options. 

Subdivision 5 establishes health carrier and health plan requirements.

Paragraph (a) authorizes the board to establish certification requirements for health carriers and health plans offered through the Marketplace beginning January 1, 2015.

Paragraph (b) states that paragraph (a) does not apply if the legislature enacts by June 1, 2013, regulatory requirements that:  (1) apply uniformly to all health carriers and health plans in the individual market; (2) apply uniformly to all health carriers and health plans in the small group market; and (3) satisfy federal certification requirements.

Paragraph (c) requires the board to establish certification procedures for selection of health plans to be offered through the Minnesota Insurance Marketplace.  The board shall certify a health plan as a qualified health plan if:  (1) the health plan meets the minimum federal certification requirements or meets the market regulatory requirements; and (2) the board determines that making the health plan available through the Marketplace is in the interest of the qualified individuals and employers using the Marketplace.

Paragraph (d) provides a list of areas that the board may consider in determining the interests of qualified individuals and small employers.

Paragraph (e) states that for qualified health plans offered through the Marketplace effective January 1, 2014, the board shall determine whether offering a health plan is in the interests of individuals and employers by considering the following:  reasonableness of expected costs supporting the plan’s premiums and cost-sharing structure; quality and sufficiency of the plan’s provider networks; quality improvement activities; quality initiatives related to cultural and linguistic competency; initiatives for improving health, disease prevention and wellness; and providing a manageable number of choices to consumers that present clear product differentiation.

Paragraph (f) states that for qualified health plans offered through the Marketplace, effective January 1, 2015, and after, the board is required to establish the criteria for determining whether offering a health plan is in the interests of individuals and employers by February 1 of each year beginning February 1, 2014.  The criteria must include the measure to be used by the board to determine whether the criteria have been met.  Permits the board to use the rulemaking process described under subdivision 9 when establishing the selection criteria.

Paragraph (g) states that for qualified health plans offered through the Marketplace beginning January 1, 2015, health carriers are required to use the most current addendum for Indian health care providers approved by CMS and the tribes as part of their contracts with Indian health care providers.

Subdivision 6 sets procedures for appeals of board decisions.

Paragraph (a) requires the board to establish a process for appeal of individual or employer eligibility determinations and redeterminations of the Minnesota Insurance Marketplace.  Requires the process to be substantially similar to the hearing process under the section 256.045, and must include judicial review in the manner specified under section 256.045.

Paragraph (b) authorizes the Marketplace to establish service level agreements with state agencies to conduct hearings for appeals.

Paragraph (c) states that the Marketplace may be represented by an attorney who is an employee of the Marketplace.

Paragraph (d) makes this appeals process inapplicable to appeals of determinations where a state agency hearing is available for certain human services matters (section 256.045).

Subdivision 7 states that a health carrier that is aggrieved by a decision of the board regarding its compliance with certification requirements or participation in the Minnesota Insurance Marketplace is entitled to a contested case proceeding under chapter 14.  The report or order of the administrative law judge constitutes a final decision, subject to judicial review under sections 14.63 to 14.69.

Subdivision 8, paragraph (a), requires the board to establish and maintain the following agreements with:

 (1) the Office of Enterprise Technology for information technology services that ensures coordination with public health care programs and other information technology services;

 (2) the Commissioner of Human Services for cost allocation and service regarding eligibility determination and enrollment for public health care programs and for other services; and

 (3) the Commissioners of Commerce and Health for services regarding enforcement of Marketplace certification requirements for health plans offered through the Marketplace and other services. 

Paragraph (b) requires the board to consult with the Commissioners of Commerce and Health regarding the operations of the Marketplace.

Paragraph (c) requires the board to consult with Indian tribes regarding the operations of the Marketplace.

Paragraph (d) requires the board, beginning March 15, 2014, and each March 15 thereafter, to submit a report to the legislature on all agreements entered into in accordance with this subdivision.

Subdivision 9 establishes a rulemaking process for the Marketplace to follow upon enactment until January 1, 2014.

Paragraph (a) authorizes the specified rulemaking process to be followed.

Paragraph (b) requires publication of proposed rules in the State Register.

Paragraph (c) allows interested parties 21 days after publication to comment on the proposed rules.  After considering all comments, the Marketplace shall publish notice in the State Register that the rules have been adopted and the rules shall take effect on publication.

Paragraph (d) requires that, if the adopted rules are the same as the proposed rules, the notice state that the rules have been adopted as proposed and shall cite the prior publication.  If the adopted rules differ from the proposed rules, the portions of the rules that differ from the proposed rules shall be included in the notice of adoption, together with a citation to the prior State Register that contained the notice of proposed rules.

Paragraph (e) requires the Marketplace to seek comments from the Department of Administration, Information Policy Analysis Division, before adopting any final rules involving the use or disclosure of not public data.

Paragraph (f) requires the Marketplace to report by January 15, 2014, to the chairs and ranking minority members of the committees in the senate and the house with primary jurisdiction over commerce and health.  The report must list and describe all rules promulgated under this subdivision.

Paragraph (g) states that if the process outlined in this subdivision is not used, the board is required to use standard rulemaking.

Subdivision 10 authorizes the Marketplace to use an expedited rulemaking process (section 14.389) after January 1, 2014.  If the expedited rulemaking process is not used, the board is required to use standard rulemaking.

Subdivision 11 clarifies that dental plans are subject to the same provisions and certification requirements as health plans to the extent practicable.

Subdivision 12 states that the board shall not bear insurance risk or enter into any agreement with providers to pay claims.

Section 10 (62V.06, paragraph (a)) states that the definitions in section 13.02 apply.

Paragraph (b) states that the data of the Marketplace on individuals, employees of employers, and employers using the Marketplace are private data on individuals or nonpublic data.  This section authorizes the Marketplace to share not public data with state and federal agencies and other entities and state agencies to share not public data if the board determines that the exchange of data is reasonably necessary to carry out the functions of the Marketplace.  Data-sharing agreements must include adequate protections with respect to confidentiality and integrity of the data shared.  The Marketplace is authorized to derive summary data from nonpublic data under this section. No personal medical data can be shared under this section.

Paragraph (c) states that if a conflict exists between federal data practices law and state law, the state law controls to the extent that it is more protectiove of the rights and privacy of data.

Paragraph (d) requires the Marketplace to prepare a list of persons with whom it has entered into a data-sharing agreement and a description of the data bases maintained and requires that a printable version of the list and descriptions be on the Web site.

Paragraph (e) states that if the board determines that an individual has willfully collected, altered, accessed, acquired, received, shared, or disseminated data  in violation of this chapter, the board shall revoke the authority of the individual to access the data and shall forward the matter to the appropriate prosecutorial authority if acquired without explicit authorization.

Section 11 (62V.07) states that the Minnesota Insurance Marketplace account is created in the special revenue fund and that all funds received by the Marketplace be deposited in the account.  The funds in the account are appropriated to the Marketplace.  

Section 12 (62V.08) requires the Marketplace to submit a report to the legislature by January 15, 2015, and each January 15 thereafter, on the performance of the Marketplace operations; meeting the Marketplace’s responsibilities; an accounting of the budget activities; and practices and procedures that have been implemented to ensure compliance with data practice laws..

Section 13 (62V.09) states that the board and its advisory committees do not expire, except as specified in section 62V.04, subdivision 13, and that the board and its advisory committees are not subject to review or sunsetting under chapter 3D.

Section 14 establishes a legislative oversight committee of five senators and five representatives to review the operations of the Minnesota Insurance Marketplace and recommend necessary changes in policy, implementation, and statutes to the board and legislature.  The committee is required to meet at least once a year and the Minnesota Insurance Marketplace is required to present to the committee its annual report, as well as all other required reports.  The estimated costs to fund the operations of the Marketplace must be submitted to the committee for review.

Section 15, paragraph (a) authorizes the Commissioner of Minnesota Management and Budget (MMB) to exercise all responsibilities of the Marketplace under sections 62V.03 and 62V.05, until the board has established bylaws, policies, and procedures as required under section 62V.05, subdivision 1, paragraph (d).  MMB is exempt from the same statutory provisions as the board (chapter 14, including section 14.386; and section 16A.386), while exercising the authorities and responsibilities of the board.

Paragraph (b) states that upon the establishment of required bylaws, policies, and procedures, all personnel, assets, contracts, obligations, and funds managed by the Marketplace shall be transferred to the board and existing personnel managed by the Commissioner of Management and Budget shall staff the board upon enactment.

Section 16 states that the Commissioner of Commerce, in consultation with the Board of Directors of the Minnesota Comprehensive Health Association (MCHA), has the authority to develop and implement the phase out and eventual termination of coverage provided by MCHA, beginning no sooner than January 1, 2014, or upon the effective date of the operation of the Minnesota Insurance Marketplace, whichever is later, and that the plan must ensure the least amount of disruption to the enrollees' health coverage.  Member assessments established under section 62E.11 shall take into consideration any phase out of coverage implemented under this section.

Section 17 requires the board to submit a report to the legislature on the appeals process for eligibility determinations that the board is required to establish under section 62V.05, subdivision 6.

Section 18 requires the Minnesota Insurance Marketplace to take necessary action regarding multiemployer health plans on or after the date that final federal regulations are adopted regarding the treatment of multiemployer plans to:  (1) ensure that multiemployer plans are notified of the final federal rules; (2) conform policies and procedures to the federal rules; and (3) permit multiemployer plans to participate in the Marketplace to the extent permitted by federal rules.

Section 19 repeals section 256.9658, subdivision 1 (purpose statement for the tobacco health impact fee).

Section 20 states that this act is effective the day following final enactment, and that any actions taken by state agencies in the furtherance of the design, development, and implementation of the Marketplace prior to the effective date shall be considered actions taken by the Marketplace.  This section also states that health plan and dental plan coverage through the Marketplace is effective January 1, 2014.  

KC/SJJ:dv

 

 

 

 

 

 

 

 
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