Bill Text: MN SF2630 | 2013-2014 | 88th Legislature | Introduced
Bill Title: MNsure health carriers and health plans participation requirements modifications
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2014-03-12 - Referred to Health, Human Services and Housing [SF2630 Detail]
Download: Minnesota-2013-SF2630-Introduced.html
1.2relating to health insurance; modifying the participation requirements for health
1.3carriers and health plans for MNsure;amending Minnesota Statutes 2013
1.4Supplement, section 62V.05, subdivision 5.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2013 Supplement, section 62V.05, subdivision 5, is
1.7amended to read:
1.8 Subd. 5. Health carrier and health plan requirements; participation. (a)
1.9Beginning January 1, 2015, the board may establish certification requirements for health
1.10carriers and health plans to be offered through MNsure that satisfy federal requirements
1.11under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.
1.12(b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory
1.13requirements that:
1.14(1) apply uniformly to all health carriers and health plans in the individual market;
1.15(2) apply uniformly to all health carriers and health plans in the small group market;
1.16and
1.17(3) satisfy minimum federal certification requirements under section 1311(c)(1) of
1.18the Affordable Care Act, Public Law 111-148.
1.19(c) In accordance with section 1311(e) of the Affordable Care Act, Public Law
1.20111-148, the board shall establish policies and procedures for certificationand selection
1.21 of health plans to be offered as qualified health plans through MNsure. The board shall
1.22certifyand select a health plan as a qualified health plan to be offered through MNsure, if:
1.23(1) the health plan meets the minimum certification requirements established in
1.24paragraph (a) or the market regulatory requirements in paragraph (b);
2.1(2) the board determines that making the health plan available through MNsure is in
2.2the interest of qualified individuals and qualified employers;
2.3(3) the health carrier applying to offer the health plan through MNsure also applies
2.4to offer health plans at each actuarial value level and service area that the health carrier
2.5currently offers in the individual and small group markets; and
2.6(4) the health carrier does not apply to offer health plans in the individual and
2.7small group markets through MNsure under a separate license of a parent organization
2.8or holding company under section
60D.15, that is different from what the health carrier
2.9offers in the individual and small group markets outside MNsure.
2.10(d) In determining the interests of qualified individuals and employers under
2.11paragraph (c), clause (2), the board may not exclude a health plan for any reason specified
2.12under section 1311(e)(1)(B) of the Affordable Care Act, Public Law 111-148. The board
2.13may consider:
2.14(1) affordability;
2.15(2) quality and value of health plans;
2.16(3) promotion of prevention and wellness;
2.17(4) promotion of initiatives to reduce health disparities;
2.18(5) market stability and adverse selection;
2.19(6) meaningful choices and access;
2.20(7) alignment and coordination with state agency and private sector purchasing
2.21strategies and payment reform efforts; and
2.22(8) other criteria that the board determines appropriate.
2.23(e) For qualified health plans offered through MNsure on or after January 1, 2015,
2.24the board shall establish policies and procedures under paragraphs (c) and (d) for selection
2.25of health plans to be offered as qualified health plans through MNsure by February 1
2.26of each year, beginning February 1, 2014. The board shall consistently and uniformly
2.27apply all policies and procedures and any requirements, standards, or criteria to all health
2.28carriers and health plans. For any policies, procedures, requirements, standards, or criteria
2.29that are defined as rules under section
14.02, subdivision 4, the board may use the process
2.30described in subdivision 9.
2.31(f) For 2014, the board shall not have the power to select health carriers and health
2.32plans for participation in MNsure. The board shall permit all health plans that meet the
2.33certification requirements under section 1311(c)(1) of the Affordable Care Act, Public
2.34Law 111-148, to be offered through MNsure.
2.35(g) Under this subdivision, the board shall have the power to verify that health
2.36carriers and health plans are properly certified to be eligible for participation in MNsure.
3.1(h) The board has the authority to decertify health carriers and health plans that
3.2fail to maintain compliance with section 1311(c)(1) of the Affordable Care Act, Public
3.3Law 111-148.
3.4(1) the health plan provides the essential health benefits package described in section
3.51302(a) of the Affordable Care Act, except that the plan is not required to provide essential
3.6benefits that duplicate the minimum benefits of dental plans if:
3.7(i) MNsure has determined that at least one qualified dental plan is available to
3.8supplement the health plan's coverage; and
3.9(ii) the health carrier makes a prominent disclosure at the time it offers the health
3.10plan, in a form approved by MNsure, that the health plan does not provide the full range of
3.11essential pediatric benefits and that the dental plans providing those benefits and other
3.12dental benefits not covered by the health plan are offered through MNsure;
3.13(2) the premium rates and policy forms have been approved by the commissioner of
3.14commerce or the commissioner of health;
3.15(3) the health plan provides at least a bronze level of coverage unless the health plan
3.16is certified as a qualified catastrophic plan, meets the requirements of section 1302(e) of
3.17the Affordable Care Act for catastrophic plans, and will only be offered to individuals
3.18eligible for catastrophic coverage;
3.19(4) the health plan's cost-sharing requirements do not exceed the limits established
3.20under section 1032(c)(1) of the Affordable Care Act and, if the health plan is offered to
3.21a qualified employer, the health plan's deductible does not exceed the limits established
3.22under section 1032(c)(2) of the Affordable Care Act;
3.23(5) the health carrier offering the health plan:
3.24(i) is licensed and in good standing;
3.25(ii) offers at least one qualified health plan at the silver level and at least one qualified
3.26health plan at the gold level through MNsure;
3.27(iii) for each metal level in which the health carrier participates, offers coverage in
3.28that level to individuals who, as of the beginning of a plan or policy year, have not attained
3.29the age of 21;
3.30(iv) charges the same premium rate for each qualified health plan without regard to
3.31whether the plan is offered through MNsure and without regard to whether the health plan
3.32is offered directly from the health carrier or through an insurance producer;
3.33(v) does not charge any cancellation fees or penalties; and
3.34(vi) complies with the regulations developed by the Secretary of Health and Human
3.35Services under section 1311(d) of the Affordable Care Act and other requirements that
3.36MNsure may establish;
4.1(6) the health plan meets the requirements of certification as promulgated by rule by
4.2MNsure pursuant to this chapter and under section 1311(c) of the Affordable Care Act; and
4.3(7) MNsure determines that making the health plan available through MNsure is in
4.4the interest of qualified individuals and qualified employers.
4.5(d) The provisions of this chapter that are applicable to qualified health plans must
4.6allow for and apply to the extent relevant to dental plans except as modified in accordance
4.7with clauses (1) to (3):
4.8(1) the dental organization must be licensed to offer stand-alone dental plans but
4.9need not be licensed to offer health plans;
4.10(2) the dental plan must be limited to dental and oral health benefits, without
4.11substantially duplicating the benefits typically offered by health plans without dental
4.12coverage and must include, at a minimum, the essential pediatric dental benefits pursuant
4.13to section 1302(b)(1)(J) of the Affordable Care Act; and
4.14(3) a health carrier and a dental organization may jointly offer a comprehensive
4.15health plan through MNsure in which the essential pediatric dental benefits are provided
4.16by the dental organization and the other benefits are provided by the health carrier.
4.17(e) All health carriers and health plans that have met the certification requirements
4.18of this subdivision are eligible for participation in MNsure.
4.19(i) (f) For qualified health plans offered through MNsure beginning January 1,
4.202015, health carriers must use the most current addendum for Indian health care providers
4.21approved by the Centers for Medicare and Medicaid Services and the tribes as part of their
4.22contracts with Indian health care providers. MNsure shall comply with all future changes
4.23in federal law with regard to health coverage for the tribes.
1.3carriers and health plans for MNsure;amending Minnesota Statutes 2013
1.4Supplement, section 62V.05, subdivision 5.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2013 Supplement, section 62V.05, subdivision 5, is
1.7amended to read:
1.8 Subd. 5. Health carrier and health plan requirements; participation. (a)
1.9Beginning January 1, 2015, the board may establish certification requirements for health
1.10carriers and health plans to be offered through MNsure that satisfy federal requirements
1.11under section 1311(c)(1) of the Affordable Care Act, Public Law 111-148.
1.12(b) Paragraph (a) does not apply if by June 1, 2013, the legislature enacts regulatory
1.13requirements that:
1.14(1) apply uniformly to all health carriers and health plans in the individual market;
1.15(2) apply uniformly to all health carriers and health plans in the small group market;
1.16and
1.17(3) satisfy minimum federal certification requirements under section 1311(c)(1) of
1.18the Affordable Care Act, Public Law 111-148.
1.19(c) In accordance with section 1311(e) of the Affordable Care Act, Public Law
1.20111-148, the board shall establish policies and procedures for certification
1.21 of health plans to be offered as qualified health plans through MNsure. The board shall
1.22certify
1.23
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3.4(1) the health plan provides the essential health benefits package described in section
3.51302(a) of the Affordable Care Act, except that the plan is not required to provide essential
3.6benefits that duplicate the minimum benefits of dental plans if:
3.7(i) MNsure has determined that at least one qualified dental plan is available to
3.8supplement the health plan's coverage; and
3.9(ii) the health carrier makes a prominent disclosure at the time it offers the health
3.10plan, in a form approved by MNsure, that the health plan does not provide the full range of
3.11essential pediatric benefits and that the dental plans providing those benefits and other
3.12dental benefits not covered by the health plan are offered through MNsure;
3.13(2) the premium rates and policy forms have been approved by the commissioner of
3.14commerce or the commissioner of health;
3.15(3) the health plan provides at least a bronze level of coverage unless the health plan
3.16is certified as a qualified catastrophic plan, meets the requirements of section 1302(e) of
3.17the Affordable Care Act for catastrophic plans, and will only be offered to individuals
3.18eligible for catastrophic coverage;
3.19(4) the health plan's cost-sharing requirements do not exceed the limits established
3.20under section 1032(c)(1) of the Affordable Care Act and, if the health plan is offered to
3.21a qualified employer, the health plan's deductible does not exceed the limits established
3.22under section 1032(c)(2) of the Affordable Care Act;
3.23(5) the health carrier offering the health plan:
3.24(i) is licensed and in good standing;
3.25(ii) offers at least one qualified health plan at the silver level and at least one qualified
3.26health plan at the gold level through MNsure;
3.27(iii) for each metal level in which the health carrier participates, offers coverage in
3.28that level to individuals who, as of the beginning of a plan or policy year, have not attained
3.29the age of 21;
3.30(iv) charges the same premium rate for each qualified health plan without regard to
3.31whether the plan is offered through MNsure and without regard to whether the health plan
3.32is offered directly from the health carrier or through an insurance producer;
3.33(v) does not charge any cancellation fees or penalties; and
3.34(vi) complies with the regulations developed by the Secretary of Health and Human
3.35Services under section 1311(d) of the Affordable Care Act and other requirements that
3.36MNsure may establish;
4.1(6) the health plan meets the requirements of certification as promulgated by rule by
4.2MNsure pursuant to this chapter and under section 1311(c) of the Affordable Care Act; and
4.3(7) MNsure determines that making the health plan available through MNsure is in
4.4the interest of qualified individuals and qualified employers.
4.5(d) The provisions of this chapter that are applicable to qualified health plans must
4.6allow for and apply to the extent relevant to dental plans except as modified in accordance
4.7with clauses (1) to (3):
4.8(1) the dental organization must be licensed to offer stand-alone dental plans but
4.9need not be licensed to offer health plans;
4.10(2) the dental plan must be limited to dental and oral health benefits, without
4.11substantially duplicating the benefits typically offered by health plans without dental
4.12coverage and must include, at a minimum, the essential pediatric dental benefits pursuant
4.13to section 1302(b)(1)(J) of the Affordable Care Act; and
4.14(3) a health carrier and a dental organization may jointly offer a comprehensive
4.15health plan through MNsure in which the essential pediatric dental benefits are provided
4.16by the dental organization and the other benefits are provided by the health carrier.
4.17(e) All health carriers and health plans that have met the certification requirements
4.18of this subdivision are eligible for participation in MNsure.
4.19
4.202015, health carriers must use the most current addendum for Indian health care providers
4.21approved by the Centers for Medicare and Medicaid Services and the tribes as part of their
4.22contracts with Indian health care providers. MNsure shall comply with all future changes
4.23in federal law with regard to health coverage for the tribes.
