.................... moves to amend H.F. No. 1865, the first engrossment, as follows:
Delete everything after the enacting clause and insert:
"Section 1. HEALTHY MINNESOTA PLAN; PRIVATE SECTOR COVERAGE.
1.4It is the intent of the State of Minnesota to enact a coverage program that utilizes
1.5market-based solutions within the health care sector that provides access to high quality
1.6health care, reduces costs for coverage, and utilizes commercial reimbursement rates to
1.8EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 2. Minnesota Statutes 2008, section 256L.01, is amended by adding a subdivision
1.11 Subd. 6. Qualified adult. "Qualified adult" means an individual residing in a
1.12household with no children enrolled under section 256L.04, subdivision 7.
1.13EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 3. Minnesota Statutes 2008, section 256L.03, subdivision 1, is amended to read:
Subdivision 1. Covered health services. For families and children,
services" means the health services reimbursed under chapter 256B, with the exception of
inpatient hospital services, special education services, private duty nursing services, adult
dental care services other than services covered under section
, orthodontic services, nonemergency medical transportation services, personal care
assistant and case management services, nursing home or intermediate care facilities
services, inpatient mental health services, and chemical dependency services.
No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.
Covered health services shall be expanded as provided in this section.
2.2EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 4. Minnesota Statutes 2008, section 256L.03, subdivision 3, is amended to read:
Subd. 3. Inpatient hospital services.
(a) Covered health services shall include
inpatient hospital services, including inpatient hospital mental health services and inpatient
hospital and residential chemical dependency treatment, subject to those limitations
necessary to coordinate the provision of these services with eligibility under the medical
assistance spenddown. The inpatient hospital benefit for adult enrollees
who qualify under
256L.04, subdivision 7 , or
who qualify under section
256L.04, subdivisions 1 and
, with family gross income that exceeds 200 percent of the federal poverty guidelines or
215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
pregnant, is subject to an annual limit of $10,000.
(b) Admissions for inpatient hospital services paid for under section
, must be certified as medically necessary in accordance with Minnesota
Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
(1) all admissions must be certified, except those authorized under rules established
254A.03, subdivision 3
, or approved under Medicare; and
(2) payment under section
256L.11, subdivision 3
, shall be reduced by five percent
for admissions for which certification is requested more than 30 days after the day of
admission. The hospital may not seek payment from the enrollee for the amount of the
payment reduction under this clause.
2.22EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 5. [256L.031] COVERED HEALTH SERVICES; QUALIFIED ADULTS.
2.24 Subdivision 1. Covered health care services. For qualified adults, "covered health
2.25services" means all services covered under the health plan benefit design established by
2.26the commissioner under section 256L.033.
2.27 Subd. 2. Contract with third-party administrator; enrollment of qualified
2.28adults. The commissioner shall contract with health plan companies, as defined in section
2.2962Q.01, subdivision 4, to provide to qualified adults the coverage established under
2.30section 256L.033. The commissioner shall contract with a third-party administrator that
2.31will distribute premiums to health plan companies that provide or arrange for high-quality,
2.32cost-effective care. The commissioner shall pay an administrative fee to the contracted
2.33third-party administrator for each qualified adult enrolled in the Healthy Minnesota
3.1Plan. State premium payment rates must be sufficient to allow health plan companies to
3.2reimburse providers at private sector provider payment rates.
3.3 Subd. 3. Enrollment of qualified adults. The commissioner shall develop and
3.4implement procedures to enroll and disenroll qualified adults with health plan companies
3.5that provide the coverage established under section 256L.033. Qualified adults are exempt
3.6from enrollment with managed care plans under section 256L.12, but may enroll with
3.7managed care plans to obtain the coverage established under section 256L.033. An
3.8enrollee may change health plans or switch coverage annually during an open enrollment
3.9period. The commissioner may expand the definition of "qualified adult" to other
3.10eligibility groups as feasible, subject to any necessary federal approval.
3.11 Subd. 4. Enrollment; professional insurance agent associations. (a) The
3.12commissioner of human services shall accept applications, determine eligibility based on
3.13the eligibility criteria in this chapter, translate standardized documents, and refer enrollees
3.14to a certified insurance agent.
3.15(b) The commissioner of human services, in consultation with the commissioner
3.16of commerce, shall develop an efficient and cost-effective method of referring eligible
3.17applicants to professional insurance agent associations. The commissioner of commerce
3.18shall authorize professional insurance agent associations to recruit, train, and certify all
3.19agents and brokers that intend to administer Healthy Minnesota Plan coverage, prior to any
3.20Minnesota Healthy Plan enrollment activity by agents. For purposes of this requirement,
3.21"professional insurance agent associations" means the Minnesota National Association of
3.22Health Underwriters, the National Association of Independent Financial Advisors (MN),
3.23and the Minnesota Independent Insurance Agents and Brokers.
3.24 Subd. 5. MCHA. MinnesotaCare enrollees who are denied coverage under an
3.25individual health plan by a health plan company are eligible for coverage through a health
3.26plan offered by the Minnesota Comprehensive Health Association, as provided under
3.27section 256L.033. The cost to the Minnesota Comprehensive Health Association related
3.28to coverage of MinnesotaCare enrollees denied coverage under an individual health plan
3.29shall be paid through the health care access fund.
3.30EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 6. [256L.032] MINNESOTACARE; HEALTHY MINNESOTA ACCOUNTS.
3.32 Subdivision 1. Establishment. The commissioner shall establish and administer for
3.33each recipient a Healthy Minnesota Plan, which consists of a private sector major medical
3.34health plan combined with a $3,100 deductible that is funded in part by the state through
3.35a health reimbursement arrangement (HRA). The commissioner shall authorize private
4.1sector plan companies to provide individual major medical health plan coverage to a
4.2recipient. The commissioner shall contract with a third-party administrator to manage the
4.3health reimbursement arrangement and to establish and administer a Healthy Minnesota
4.4Plan account for that recipient.
4.5 Subd. 2. Funds available to enrollees for health care expenses. In addition to
4.6providing major medical health coverage, the commissioner shall make available up to
4.7$2,100 per plan year for each enrollee's Healthy Minnesota Plan account for eligible
4.8health care expenses, through the health reimbursement arrangement as defined in section
4.9213(d) of the Internal Revenue Code.
4.10 Subd. 3. Healthy Minnesota Plan reserve. The commissioner shall maintain
4.11a Healthy Minnesota Plan reserve equal to 30 percent of the state's maximum claim
4.12obligations under subdivision 2 for the current and following fiscal year, as estimated
4.13by the commissioner of finance.
4.14EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 7. [256L.033] HEALTHY MINNESOTA PLAN; PRIVATE SECTOR
4.17(a) Qualified adults enrolled in MinnesotaCare shall enroll in their choice of the
4.18individual health plans authorized by the commissioner. The health plans must meet the
4.19benefit design and cost-sharing requirements established by the commissioner. The health
4.20plan benefit design and cost-sharing must be actuarially equivalent to that provided under
4.21section 256L.03 to nonpregnant adults without children eligible under section 256L.04,
4.22subdivision 7, and in addition to coverage of physician, inpatient and outpatient hospital,
4.23and other acute care services, must also include:
4.24(1) vision and eyewear coverage;
4.25(2) dental coverage;
4.26(3) prescription drug coverage;
4.27(4) preventive care; and
4.28(5) a lifetime maximum benefit of $5,000,000.
4.29(b) The commissioner shall administer the Healthy Minnesota Plan and Healthy
4.30Minnesota Plan accounts, which must be designed to the extent possible to function in
4.31the same manner as a voluntary employee beneficiary association qualified under Internal
4.32Revenue Code, section 501(c)(9) or a government plan qualified under Internal Revenue
4.33Code, section 115, to the extent practicable for a plan not providing benefits to employees.
4.34(c) All payments out of the Healthy Minnesota Plan arrangement must be adjudicated
4.35by a third-party administrator contracted for by the commissioner in the same manner used
5.1for Health Reimbursement Accounts under federal law, except as otherwise provided in
5.2section 256L.032, subdivision 1.
5.3(d) Providers of individual health plans available for enrollment under paragraph
5.4(a) may decline to cover a prospective enrollee on the basis of medical underwriting
5.5permitted under section 62A.65 in the private market. A person rejected for coverage on
5.6that basis shall apply for and enroll in a plan which must be provided by the Minnesota
5.7Comprehensive Health Association (MCHA) governed under chapter 62E, without a
5.8preexisting condition limitation, even if use of a preexisting condition is otherwise
5.9permitted under chapter 62E. The plan benefit design must be identical to that established
5.10under paragraph (a). The commissioner shall pay the premium for the person's coverage.
5.11(e) All health plan companies offering individual coverage must offer the benefit
5.12set established under this section in the individual market.
5.13EFFECTIVE DATE.This section is effective January 1, 2010.
Sec. 8. Minnesota Statutes 2008, section 256L.15, is amended by adding a subdivision
5.16 Subd. 1c. Premium payment waived for qualified adults. Qualified adults are
5.17exempt from sliding scale premiums.
5.18EFFECTIVE DATE.This section is effective January 1, 2010.
Amend the title accordingly