State Health Care programs

Section 1 (16A.724, subdivision 5) states that effective January 1, 2012, revenue in the health care access fund that the Commissioner of Management and Budget determines is not needed to fund the MinnesotaCare program is available to the Commissioner of Human Services to provide health care subsidies to individuals and households with gross family incomes greater than 133-1/3 percent but not exceeding 400 percent of the federal poverty guidelines (FPG).

Section 2 (62U.05) adds accountable care organizations (ACO) to this section (provider pricing for baskets of care) by requiring the Commissioner of Health to establish uniform definitions for the total cost of providing all necessary services to a patient through an ACO and develop a standard method and format for an ACO to use for submitting package prices for the total cost of care. The commissioner is also required to establish quality measures for the totals cost of care for services delivered through an ACO and requires the commissioner by January 1, 2012, to publish comparative price and quality information on the total cost of care for services delivered through an ACO.

Section 3 (256.01, subdivision 30) authorizes the Commissioner of Human Services to enter into agreements with other states to establish by January 1, 2012, a regional payment reform system to reimburse physician groups, integrated delivery systems, and ACOs that provide services to Medicare enrollees.

Section 4 (256.02, subdivision 31) authorizes the Commissioner of Human Services by January 1, 2012, to develop and offer a publicly administered health plan that meets the requirements of Public Law Number 111-XXX and is offered through the Minnesota health exchange.

Section 5 (256B.055, subdivision 15) extends medical assistance coverage to individuals who are over the age of 21 and under the age of 65, not pregnant, and who do not meet another eligibility category.

Section 6 (256B.056, subdivision 1e) effective July 1, 2014, requires the Commissioner of Human Services to calculate income eligibility for medical assistance based on modified gross income as required under Public Law Number 111-XXX.

Section 7 (256B.056, subdivision 3) states that no asset limits shall apply for individuals eligible under section 5 and for families with children.

Section 8 (256B.056, subdivision 3f) requires the commissioner to use a net income standard as required under the Public Law Number 111-XXX with no income disregards except those that are used to determine eligibility for long-term care services and supports beginning July 1, 2014.

Section 9 (256B.056, subdivision 4) increase the medical assistance income eligibility limit for families with children and establishes the income limit for single adults to 133-1/3 percent of FPG beginning July 1, 2011.

Section 10 (256B.0754, subdivision 3) requires the commissioner beginning July 1, 2011, to deliver services to enrollees in the state health care programs through accountable care organizations and to provide incentive payments to ACOs that meet or exceed annual quality and performance targets.

Section 11(256L.04, subdivision 1) states that beginning July 1, 2012, adults are no longer eligible for MinnesotaCare.

Section 12 (295.52, subdivision 8) reduces the MinnesotaCare tax by an unspecified amount beginning October 1, 2013.

Section 13 repeals MinnesotaCare for adults with no children effective January 1, 2012; repeals the rest of MinnesotaCare effective October 1, 2019, or upon the sunset of any maintenance of effort requirements for children's Medicaid eligibility; and repeals the MinnesotaCare provider taxes and the premium tax effective October 1, 2019, or upon the sunset of any maintenance of effort requirements for children's eligibility.

Article 2

Private Sector Health Insurance Reform

Section 1 (62U.11) establishes the Minnesota health insurance exchange.

Subdivision 1 provides a citation.

Subdivision 2 creates the Minnesota health insurance exchange as an unincorporated association that is required to incorporate as a nonprofit corporation.

Subdivision 3 defines terms.

Subdivision 4, paragraph(a), requires only individual market health plans and small employer health benefit plans offered by health plan companies licensed to issue health plans in Minnesota may be made available through the exchange.

Paragraph (b) requires each health plan to meet the essential benefit set and design requirements provided under Minnesota Statutes, section 62U.08, in addition to any requirements for qualifying coverage required under federal law.

Paragraph (c) requires a health plan company that issues health plans for the individual or small employer market to offer at lease one health plan through the exchange.

Paragraph (d) requires health plan offered through Minnesota Comprehensive Health Association (MCHA) to be available through the exchange.

Paragraph (e) requires health plans offered through MinnesotaCare to be made available through the exchange to individual and families who meet the eligibility requirements of MinnesotaCare and who pay premiums through an employer Section 125 plan.

Paragraph (f) states that nothing in this section restricts the sale of individual or small employer market health plans outside the exchange. Requirements applicable to issuance, renewal, and cancellation and pricing of coverage are the same for health plans purchased inside or outside the exchange.

Subdivision 5 requires the exchange to help consumers to compare and understand the standardized health plan options.

Subdivision 6 states that eligible individuals may purchase health plans directly through the exchange or through an employer Section 125 plan. To be eligible an individual (1) must be a Minnesota resident; (2) must be a student attending an institution outside of Minnesota if Minnesota residency is maintained; (3) is not be a Minnesota resident but is employed by an employer physically located in Minnesota and the employer offers a Section 125 Plan; or (4) is a dependent of another individual who is eligible to participate in the exchange.

Subdivision 7 authorizes small employers to purchase small employer health benefit plans through the exchange.

Subdivision 8 authorizes the exchange to serve as a coordinating entity for enrollment and collection and transfer of premium payments for health plans sold to individuals and small employers through the exchange. This subdivision also describes other responsibilities of the exchange.

Subdivision 9 states that the state is not liable for the actions of the exchange.

Subdivision 10 describes the powers of the exchange.

Subdivision 11 requires the exchange to establish procedures for resolving disputes with respect to the eligibility of an individual to participate in the exchange.

Subdivision 12 states that the exchange is to be governed by a board of directors with 11 members. This subdivision describes the membership of the initial board.

Subdivision 13 describes the membership of the ongoing board.

Subdivision 14 describes the operations of the board of directors.

Subdivision 15 requires the board of directors to appoint an exchange director and describes the duties of the director.

Subdivision 16 requires the exchange to certify to the State Board of Investment that a portion of the assets of the exchange are not required for immediate use. Any investment earnings on assets transferred to the State Board of Investment must be maintained in an account in the state treasury. Money in the account may be spent as appropriated by law, for the purposes of assisting individuals in paying premiums and for making health insurance products more affordable.

Subdivision 17 requires the legislative auditor to audit the exchange.

Subdivision 18 states that an individual has the right to choose any insurance producer licensed in this state to assist the individual in purchasing a health plan through the exchange. The exchange may pay the producer a commission.

Subdivision 19 states that health plan coverage through the exchange begins on January 1, 2012. The exchange must be operational to assist employers and individuals by July 1, 2011, and be prepared for enrollment by January 1, 2012.

Section 2 (62U.12) requires the Commissioner of Commerce, in consultation with the Commissioner of Health, to participate in discussions with insurance regulators of other states about the possibility of entering into one or more interstate compacts to permit the sale of health coverage across state lines as authorized by federal law. This section prohibits the commissioner from entering into a compact on behalf of the state unless authorized by state law to enter into the specific compact.

Section 3 (62U.13) establishes an individual mandate.

Subdivision 1 requires each state resident to obtain and maintain continuous qualifying health coverage beginning January 1, 2012.

Subdivision 2 defines qualifying coverage.

Subdivision 3 states that an individual will be in compliance with the individual mandate if the individual has coverage in the private insurance market that is (1) through a self-funded employer or union based group coverage; (2) provided by or through a local, state or federal government program; or (3) other qualifying coverage approved by the Commissioner of Revenue.

Subdivision 4 states that effective July 1, 2012, all individual coverage marketed or sold in the state must be available on a guaranteed issue basis with no preexisting condition limitations or exclusions.

Subdivision 5 states that July 1, 2012, all qualifying coverage offered, sold, or renewed in the state must have a premium rate that does not vary based on health status, age, gender, occupation, or any other factor other than the number of persons covered by the policy.

Subdivision 6 requires the Commissioner of Revenue to enforce this subdivision 1 and to impose a penalty of an unspecified amount for each violation. The Commissioners of Commerce and Health are requires to enforce this section as it applies to health plan companies.

Subdivision 7 requires the Minnesota health insurance exchange to effective January 1, 2012, to automatically enroll all MCHA enrollees enrolled as of December 31, 2011, into individual qualifying coverage through the exchange. The exchange shall enroll the person into a plan that is as similar as possible to the coverage the person had under MCHA and the person is permitted to switch to another plan available through the exchange with no penalty.

Section 4 requires the Revisor to remove for statute and rules references to MCHA effective January 1, 2012.

Section 5 repeals MCHA effective January 1, 2012.

KC:ph

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