Article 1 - Premium Assistance

Section 1 requires the Commissioner of Minnesota Management and Budget, in consultation with the Commissioners of Commerce and Revenue, to establish and administer a premium assistance program for eligible persons in the individual market for 2017.

Section 2 provides definitions for purposes of the premium assistance program.

Section 3, subdivision 1, allows an eligible individual to apply for premium assistance no later than January 31, 2018, in a manner and form prescribed by the Commissioner of Minnesota Management and Budget. The commissioner must notify applicants of their eligibility status and their premium assistance amount.

Subdivision 2 requires health plan companies to provide specified information to the commissioner with respect to each individual for whom it provides qualified health coverage.

Subdivision 3 establishes income eligibility rules for the program. Individuals earning more than 300 percent but less than 800 percent of the federal poverty line are eligible.

Subdivision 4 requires the commissioner to determine premium assistance amounts such that the appropriation for the program is not exceeded. Until March 31, eligible individuals qualify for assistance of 25 percent of premium, and after that until December 31, eligible individuals qualify for assistance on a sliding scale depending on income (20 to 30 percent of premium) with the assistance for the top income group dependent on availability of funding.

Subdivision 5 requires the commissioner to provide the assistance amount to the individual on a monthly basis. The individual may be required to provide documentation of payment of the premium.

Subdivision 6 allows the commissioner to contract with a third-party administrator to determine eligibility for assistance.

Subdivision 7 requires the commissioner to verify that applicants are residents of Minnesota.

Section 4 requires the legislative auditor to audit implementation of the program. A report is due to the Legislature by June 1, 2018. The Commissioner of Revenue has access to specified data to identify ineligible individuals. The Commissioner of Revenue is directed to recover amounts improperly paid in the manner provided for unpaid taxes.

Section 5 specifies that individual data related to premium assistance is private data.

Section 6 transfers $300,157,000 from the budget reserve to the general fund.

Section 7 appropriates $285,000,000 from the general fund to Commissioner of Minnesota Management and Budget for the premium assistance program on a one-time basis. Also appropriates $157,000 on a onetime basis to the legislative auditor for the audit.

This article is 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 within ten business days after the filing deadline.

Section 2 reduces the allowed attachment point for claims per individual for a stop loss policy from $20,000 to $10,000. Aggregate attachment point for all groups is set 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 one month after expiration of the contract period.

Sections 4 -9 allows for profit HMOs to operate in the state.

Section 10 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 11 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 12 requires an agency incurring administrative costs under the act to perform its duties within existing appropriations unless otherwise provided.

Section 13 requires the Commissioner of Commerce to report by February 15, 2017, on specified issues related to residency verification and use of certain sections of Minnesota Statutes related to health care access.

Section 14 appropriates $15,000,000 from the general fund to the Commissioner of Minnesota Management and Budget for the purposes of section 11 (transition of care coverage). This is a onetime appropriation and is available until June 30, 2021.

Section 15 repeals an HMO provision as a conforming change.

Sections 1-3 of this article are effective 30 days following final enactment.  Sections 4-10 and 13-15 are effective the day following final enactment. Section 11 is effective for health plans issued after December 31, 2016 and before March 2, 2017 and in effect for all or a portion of calendar year 2017.

Article 3 – Reinsurance

Section 1 establishes definitions for purposes of the reinsurance program.

Section 2 requires the Commissioner of Commerce to require health carriers to calculate the health premium amount that would be charged had the reinsurance program not been established, and submit this information as part of the rate filing.

Section 3, subdivision 1, establishes MCHA as the entity to administer the state reinsurance program.

Subdivision 2 establishes a timetable for the MCHA board to propose to the Commissioner of Commerce the payment parameters. For plan year 2018 the attachment point is $70,000, the reinsurance cap is set at $250,000, and the coinsurance rate is 50%.

Subdivision 3 sets forth how the payment parameters are applied to calculate security plan payments.

Subdivision 4 establishes the process for a health carrier to request security plan payments. MCHA must be provided access to the data within a specified dedicated data environment. Record keeping and audit requirements are set forth.

Subdivision 5 requires the association to notify eligible health carriers of premium security plan payments to be made by June 30 of the year following the applicable plan year.

Subdivision 6 requires the association to make the plan payments by August 15 of the year following the applicable plan year.

Subdivision 7 requires MCHA to use existing monetary reserves to offset costs of the reinsurance program.

Subdivision 8 classifies data of the association under this section as private data on individuals or nonpublic data.

Subdivision 9 appropriates $150,000,000 from the general fund for the reinsurance program.

Section 4 sets forth accounting and auditing requirements for the reinsurance program. The Commissioner of Commerce or legislative auditor has authority to audit the program. An independent external audit is required for each plan year.

Section 5 requires the Commissioner of Commerce to apply for a waiver to the Secretary of HHS for the sole purpose of implementing the premium security plan in a manner that maximizes federal funding. The waiver would be intended to ensure that eligible residents receive premium tax credits as if the premium security plan did not exist and federal funding for Minnesota care continues as to be based on market premiums and cost-sharing before the impact of reinsurance.

Section 6 makes the article effective the day following final enactment.

Article 4 – Agricultural Cooperative Health Plans

Section 1, subdivision 1, establishes definitions for purposes of the section.

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.

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 grants exemptions from benefit mandate and continuation requirements under state law.

Section 2 repeals an existing pilot program for agricultural cooperative health plans.

CBS:rer