1.1.................... moves to amend H.F. No. 8, the first engrossment, as follows:
1.2Delete everything after the enacting clause and insert:
1.3 "Section 1. Minnesota Statutes 2010, section 62E.08, subdivision 1, is amended to read:
1.4 Subdivision 1.
Establishment. The association shall establish the following
1.5maximum premiums to be charged for membership in the comprehensive health insurance
1.6plan:
1.7(a) the premium for the number one qualified plan shall range from a minimum of
1.8101 percent to a maximum of 125 percent of the weighted average of rates charged by
1.9those insurers and health maintenance organizations with individuals enrolled in:
1.10(1) $1,000 annual deductible individual plans of insurance in force in Minnesota;
1.11(2) individual health maintenance organization contracts of coverage with a $1,000
1.12annual deductible which are in force in Minnesota; and
1.13(3) other plans of coverage similar to plans offered by the association based on
1.14generally accepted actuarial principles;
1.15(b) the premium for the number two qualified plan shall range from a minimum of
1.16101 percent to a maximum of 125 percent of the weighted average of rates charged by
1.17those insurers and health maintenance organizations with individuals enrolled in:
1.18(1) $500 annual deductible individual plans of insurance in force in Minnesota;
1.19(2) individual health maintenance organization contracts of coverage with a $500
1.20annual deductible which are in force in Minnesota; and
1.21(3) other plans of coverage similar to plans offered by the association based on
1.22generally accepted actuarial principles;
1.23(c) the premiums for the plans with a $2,000, $5,000, or $10,000 annual deductible
1.24shall range from a minimum of 101 percent to a maximum of 125 percent of the weighted
1.25average of rates charged by those insurers and health maintenance organizations with
1.26individuals enrolled in:
2.1(1) $2,000, $5,000, or $10,000 annual deductible individual plans, respectively, in
2.2force in Minnesota; and
2.3(2) individual health maintenance organization contracts of coverage with a $2,000,
2.4$5,000, or $10,000 annual deductible, respectively, which are in force in Minnesota; or
2.5(3) other plans of coverage similar to plans offered by the association based on
2.6generally accepted actuarial principles;
2.7(d) the premium for each type of Medicare supplement plan required to be offered
2.8by the association pursuant to section
62E.12 shall range from a minimum of 101 percent
2.9to a maximum of 125 percent of the weighted average of rates charged by those insurers
2.10and health maintenance organizations with individuals enrolled in:
2.11(1) Medicare supplement plans in force in Minnesota;
2.12(2) health maintenance organization Medicare supplement contracts of coverage
2.13which are in force in Minnesota; and
2.14(3) other plans of coverage similar to plans offered by the association based on
2.15generally accepted actuarial principles; and
2.16(e) the charge for health maintenance organization coverage shall be based on
2.17generally accepted actuarial principles.
2.18(f) the premium for a high-deductible, basic plan offered under section 62E.121 shall
2.19range from a minimum of 101 percent to a maximum of 125 percent of the weighted
2.20average of rates charged by those insurers and health maintenance organizations offering
2.21comparable plans outside of the Minnesota Comprehensive Health Association.
2.22The list of insurers and health maintenance organizations whose rates are used to
2.23establish the premium for coverage offered by the association pursuant to paragraphs (a)
2.24to (d)
and (f) shall be established by the commissioner on the basis of information which
2.25shall be provided to the association by all insurers and health maintenance organizations
2.26annually at the commissioner's request. This information shall include the number of
2.27individuals covered by each type of plan or contract specified in paragraphs (a) to (d)
and
2.28(f) that is sold, issued, and renewed by the insurers and health maintenance organizations,
2.29including those plans or contracts available only on a renewal basis. The information shall
2.30also include the rates charged for each type of plan or contract.
2.31In establishing premiums pursuant to this section, the association shall utilize
2.32generally accepted actuarial principles, provided that the association shall not discriminate
2.33in charging premiums based upon sex. In order to compute a weighted average for each
2.34type of plan or contract specified under paragraphs (a) to (d)
and (f), the association
2.35shall, using the information collected pursuant to this subdivision, list insurers and health
2.36maintenance organizations in rank order of the total number of individuals covered by
3.1each insurer or health maintenance organization. The association shall then compute
3.2a weighted average of the rates charged for coverage by all the insurers and health
3.3maintenance organizations by:
3.4(1) multiplying the numbers of individuals covered by each insurer or health
3.5maintenance organization by the rates charged for coverage;
3.6(2) separately summing both the number of individuals covered by all the insurers
3.7and health maintenance organizations and all the products computed under clause (1); and
3.8(3) dividing the total of the products computed under clause (1) by the total number
3.9of individuals covered.
3.10The association may elect to use a sample of information from the insurers and
3.11health maintenance organizations for purposes of computing a weighted average. In no
3.12case, however, may a sample used by the association to compute a weighted average
3.13include information from fewer than the two insurers or health maintenance organizations
3.14highest in rank order.
3.15 Sec. 2.
[62E.121] HIGH-DEDUCTIBLE, BASIC PLAN.
3.16 Subdivision 1. Required offering. The Minnesota Comprehensive Health
3.17Association shall offer a high-deductible, basic plan that meets the requirements specified
3.18in this section. The high-deductible, basic plan is a one-person plan. Any dependents
3.19must be covered separately.
3.20 Subd. 2. Annual deductible; out-of-pocket maximum. (a) The plan shall provide
3.21the following in-network annual deductible options: $3,000, $6,000, $9,000, and $12,000.
3.22The in-network annual out-of-pocket maximum for each annual deductible option shall be
3.23$1,000 greater than the amount of the annual deductible.
3.24(b) The deductible is subject to an annual increase, based on the change in the
3.25consumer price index (CPI).
3.26 Subd. 3. Office visits for nonpreventive care. The following co-payments shall
3.27apply for each of the first three office visits per calendar year for nonpreventive care:
3.28(1) $30 per visit for the $3,000 annual deductible option;
3.29(2) $40 per visit for the $6,000 annual deductible option;
3.30(3) $50 per visit for the $9,000 annual deductible option; and
3.31(4) $60 per visit for the $12,000 annual deductible option.
3.32For the fourth and subsequent visits during the calendar year, 80 percent coverage is
3.33provided under all deductible options, after the deductible is met.
3.34 Subd. 4. Preventive care. One hundred percent coverage is provided for preventive
3.35care, and no co-payment, coinsurance, or deductible requirements apply.
4.1 Subd.5. Prescription drugs. A $10 co-payment applies to preferred generic drugs.
4.2Preferred brand-name drugs require an enrollee payment of 100 percent of the health
4.3plan's discounted rate.
4.4 Subd. 6. Convenience care center visits. A $20 co-payment applies for the first
4.5three convenience care center visits during a calendar year. For the fourth and subsequent
4.6visits during a calendar year, 80 percent coverage is provided after the deductible is met.
4.7 Subd. 7. Urgent care center visits. A $100 co-payment applies for the first urgent
4.8care center visit during a calendar year. For the second and subsequent visits during a
4.9calendar year, 80 percent coverage is provided after the deductible is met.
4.10 Subd. 8. Emergency room visits. A $200 co-payment applies for the first
4.11emergency room visit during a calendar year. For the second and subsequent visits during
4.12a calendar year, 80 percent coverage is provided after the deductible is met.
4.13 Subd. 9. Lab and x-ray; hospital services; ambulance; surgery. Lab and x-ray
4.14services, hospital services, ambulance services, and surgery are covered at 80 percent
4.15after the deductible is met.
4.16 Subd. 10. Eyewear. The health plan pays up to $50 per calendar year for eyewear.
4.17 Subd. 11. Maternity. Maternity, labor and delivery, and postpartum care are not
4.18covered. One hundred percent coverage is provided for prenatal care and no deductible
4.19applies.
4.20 Subd. 12. Other eligible health care services. Other eligible health care services
4.21are covered at 80 percent after the deductible is met.
4.22 Subd. 13. Option to remove mental health and substance abuse coverage.
4.23Enrollees have the option of removing mental health and substance abuse coverage, in
4.24exchange for a reduced premium.
4.25 Subd. 14. Option to upgrade prescription drug coverage. Enrollees have
4.26the option to upgrade prescription drug coverage to include coverage for preferred
4.27brand-name drugs with a $50 co-payment and coverage for non-preferred drugs with a
4.28$100 co-payment, in exchange for an increased premium.
4.29 Subd. 15. Out-of-network services. (a) The out-of-network annual deductible is
4.30double the in-network annual deductible.
4.31(b) There is no out-of-pocket maximum for out-of-network services.
4.32(c) Benefits for out-of-network services are covered at 60 percent, after the
4.33deductible is met.
4.34(d) The lifetime maximum benefit for out-of-network services is $1,000,000.
4.35 Subd. 16. Services not covered. Services not covered include: custodial care
4.36or rest care; most dental services; cosmetic services; refractive eye surgery; infertility
5.1services; and services that are investigational, not medically necessary, or received while
5.2on military duty.
5.3 Sec. 3. Minnesota Statutes 2010, section 62E.14, is amended by adding a subdivision
5.4to read:
5.5 Subd. 4f. Waiver of preexisting conditions for persons covered by healthy
5.6Minnesota contribution program. A person may enroll in the comprehensive plan with
5.7a waiver of the preexisting condition limitation in subdivision 3 if the person is eligible for
5.8the healthy Minnesota contribution program, and has been denied coverage as described
5.9under section 256L.031, subdivision 6.
5.10 Sec. 4. Minnesota Statutes 2010, section 256B.04, subdivision 18, is amended to read:
5.11 Subd. 18.
Applications for medical assistance. (a) The state agency may
5.12take applications for medical assistance and conduct eligibility determinations for
5.13MinnesotaCare enrollees.
5.14 (b) The commissioner of human services shall modify the Minnesota health care
5.15programs application form to add a question asking applicants: "Are you a U.S. military
5.16veteran?"
5.17 Sec. 5.
[256L.031] HEALTHY MINNESOTA CONTRIBUTION PROGRAM.
5.18 Subdivision 1. Defined contributions to enrollees. (a) Beginning January 1, 2012,
5.19the commissioner shall provide each MinnesotaCare enrollee eligible under section
5.20256L.04, subdivision 7, with gross family income equal to or greater than 133 percent
5.21of the federal poverty guidelines, with a monthly defined contribution to purchase health
5.22coverage under a health plan as defined in section 62A.011, subdivision 3. Beginning
5.23January 1, 2012, or upon federal approval, whichever is later, the commissioner shall
5.24provide each MinnesotaCare enrollee eligible under section 256L.04, subdivision 1, with
5.25gross family income equal to or greater than 133 percent of the federal poverty guidelines,
5.26with a monthly defined contribution to purchase health coverage under a health plan as
5.27defined in section 62A.011, subdivision 3, offered by a health plan company as defined
5.28in section 62Q.01, subdivision 4.
5.29(b) Enrollees eligible under paragraph (a) shall not be charged premiums under
5.30section 256L.15 and are exempt from the managed care enrollment requirement of section
5.31256L.12.
5.32(c) Sections 256L.03; 256L.05, subdivision 3; and 256L.11 do not apply to
5.33enrollees eligible under paragraph (a). Covered services, cost sharing, disenrollment
6.1for nonpayment of premium, enrollee appeal rights and complaint procedures, and the
6.2effective date of coverage for enrollees eligible under paragraph (a) shall be as provided
6.3under the terms of the health plan purchased by the enrollee.
6.4(d) Unless otherwise provided in this section, all MinnesotaCare requirements
6.5related to eligibility, income and asset methodology, income reporting, and program
6.6administration, continue to apply to enrollees obtaining coverage under this section.
6.7 Subd. 2. Use of defined contribution. An enrollee may use up to the monthly
6.8defined contribution to pay premiums for coverage under a health plan as defined in
6.9section 62A.011, subdivision 3.
6.10 Subd. 3. Determination of defined contribution amount. (a) The commissioner
6.11shall determine the defined contribution sliding scale using the base contribution specified
6.12in paragraph (b) for the specified age ranges. The commissioner shall use a sliding scale
6.13for defined contributions that provides:
6.14(1) persons with household incomes equal to 133 percent of the federal poverty
6.15guidelines with a defined contribution of 150 percent of the base contribution;
6.16(2) persons with household incomes equal to 175 percent of the federal poverty
6.17guidelines with a defined contribution of 100 percent of the base contribution;
6.18(3) persons with household incomes equal to or greater than 250 percent of
6.19the federal poverty guidelines with a defined contribution of 80 percent of the base
6.20contribution; and
6.21(4) persons with household incomes in evenly spaced increments between the
6.22percentages of the federal poverty guideline specified in clauses (1) to (3) with a base
6.23contribution that is a percentage interpolated from the defined contribution percentages
6.24specified in clauses (1) to (3).
6.25
|
Age
|
Monthly Per-Person Base Contribution
|
6.26
|
Under 21
|
$122.79
|
6.27
|
21-29
|
122.79
|
6.28
|
30-31
|
129.19
|
6.29
|
32-33
|
132.38
|
6.30
|
34-35
|
134.31
|
6.31
|
36-37
|
136.06
|
6.32
|
38-39
|
141.02
|
6.33
|
40-41
|
151.25
|
6.34
|
42-43
|
159.89
|
6.35
|
44-45
|
175.08
|
6.36
|
46-47
|
191.71
|
6.37
|
48-49
|
213.13
|
6.38
|
50-51
|
239.51
|
7.1
|
52-53
|
266.69
|
7.2
|
54-55
|
293.88
|
7.3
|
56-57
|
323.77
|
7.4
|
58-59
|
341.20
|
7.5
|
60+
|
357.19
|
7.6(b) The commissioner shall multiply the defined contribution amounts developed
7.7under paragraph (a) by 1.20 for enrollees who are denied coverage under an individual
7.8health plan by a health plan company and who purchase coverage through the Minnesota
7.9Comprehensive Health Association.
7.10(c) Notwithstanding paragraphs (a) and (b), the monthly defined contribution shall
7.11not exceed 90 percent of the monthly premium for the health plan purchased by the
7.12enrollee. If the enrollee purchases coverage under a health plan that does not include
7.13mental health services and chemical dependency treatment services, the monthly defined
7.14contribution amount determined under this subdivision shall be reduced by five percent.
7.15 Subd. 4. Administration by commissioner. The commissioner shall administer the
7.16defined contributions. The commissioner shall:
7.17 (1) calculate and process defined contributions for enrollees; and
7.18 (2) pay the defined contribution amount to health plan companies or the Minnesota
7.19Comprehensive Health Association, as applicable, for enrollee health plan coverage.
7.20 Subd. 5. Assistance to enrollees. The commissioner of human services, in
7.21consultation with the commissioner of commerce, shall develop an efficient and
7.22cost-effective method of referring eligible applicants to professional insurance agent
7.23associations.
7.24 Subd. 6. Minnesota Comprehensive Health Association (MCHA). Beginning
7.25January 1, 2012, MinnesotaCare enrollees who are denied coverage under an individual
7.26health plan by a health plan company are eligible for coverage through a health plan
7.27offered by the Minnesota Comprehensive Health Association and may enroll in MCHA
7.28in accordance with section 62E.14. Any difference between the revenue and covered
7.29losses to the MCHA related to implementation of this section shall be paid to the MCHA
7.30from the health care access fund.
7.31 Subd. 7. Federal approval. The commissioner shall seek all federal waivers
7.32and approvals necessary to implement coverage under this section for MinnesotaCare
7.33enrollees eligible under section 256L.04, subdivision 1, with gross family incomes equal
7.34to or greater than 133 percent of the federal poverty guidelines, while continuing to
7.35receive federal matching funds.
8.1 Sec. 6. Minnesota Statutes 2010, section 256L.05, is amended by adding a subdivision
8.2to read:
8.3 Subd. 6. Referral of veterans. The commissioner shall ensure that all applicants
8.4for MinnesotaCare with incomes less than 133 percent of the federal poverty guidelines
8.5who identify themselves as veterans are referred to a county veterans service officer for
8.6assistance in applying to the U.S. Department of Veterans Affairs for any veterans benefits
8.7for which they may be eligible.
8.8 Sec. 7.
COVERAGE FOR LOWER-INCOME MINNESOTACARE
8.9ENROLLEES.
8.10The commissioner of human services shall develop and present to the legislature,
8.11by December 15, 2011, a plan to redesign service delivery for MinnesotaCare enrollees
8.12eligible under Minnesota Statutes, section 256L.04, subdivisions 1 and 7, with incomes
8.13less than 133 percent of the federal poverty guidelines. The plan must be designed to
8.14improve continuity and quality of care, reduce unnecessary emergency room visits, and
8.15reduce average per-enrollee costs. In developing the plan, the commissioner shall consider
8.16innovative methods of service delivery, including but not limited to increasing the use
8.17and choice of private sector health plan coverage and encouraging the use of community
8.18health clinics, as defined in the federal Community Health Care Act of 1964, as health
8.19care homes.
8.20 Sec. 8.
DIRECTION TO COMMISSIONER; FEDERAL WAIVERS.
8.21(a) The commissioner of human services shall apply to the Centers for Medicare and
8.22Medicaid Services for federal waivers to cover:
8.23(1) families with children eligible under Minnesota Statutes, section 256L.04,
8.24subdivision 1; and
8.25(2) adults eligible under Minnesota Statutes, section 256L.04, subdivision 1,
8.26under the MinnesotaCare healthy Minnesota contribution program established under
8.27Minnesota Statutes, section 256L.031, by July 1, 2011. The commissioner shall report to
8.28the legislative committees with jurisdiction over health and human services policy and
8.29finance whether or not the federal waiver application was accepted within ten working
8.30days of receipt of the decision.
8.31(b) The commissioner of human services shall apply to the Centers for Medicare
8.32and Medicaid Services (CMS) for a section 1115(a) demonstration waiver, and any other
8.33necessary federal waivers and amendments, including, but not limited to, a waiver of the
8.34appropriate sections of title XIX, 42 U.S.C. section 1396a and a waiver of the maintenance
9.1of effort provisions in section 2001 of the Patient Protection and Affordable Care Act,
9.2Public Law 111-148, that would provide Minnesota with medical assistance program
9.3flexibility in exchange for federal budget certainty. The commissioner shall seek federal
9.4approval to enter into an agreement with CMS under which Minnesota would:
9.5(1) accept an aggregate annual allotment for the medical assistance program, trended
9.6forward at an agreed upon rate, with protections to cover medical inflation and projected
9.7caseload growth; and
9.8(2) receive federal waivers of Medicaid requirements related to: state-wideness and
9.9comparability of services; the amount, duration, and scope of services; freedom of choice;
9.10cost-sharing; and other areas of program administration specified by the commissioner.
9.11EFFECTIVE DATE.This section is effective the day following final enactment."
9.12Delete the title and insert:
9.14relating to human services; establishing the healthy Minnesota contribution
9.15program; requiring plan to redesign service delivery for lower-income
9.16MinnesotaCare enrollees; requiring the Minnesota Comprehensive Health
9.17Association to offer a high-deductible, basic plan; requiring the commissioner
9.18of human services to seek federal waivers; amending Minnesota Statutes 2010,
9.19sections 62E.08, subdivision 1; 62E.14, by adding a subdivision; 256B.04,
9.20subdivision 18; 256L.05, by adding a subdivision; proposing coding for new law
9.21in Minnesota Statutes, chapters 62E; 256L."