new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin For purposes of sections 1 to 6, the following terms have the
meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of Minnesota
Management and Budget.
new text end

new text begin Subd. 3. new text end

new text begin Eligible individual. new text end

new text begin "Eligible individual" means a Minnesota resident who:
new text end

new text begin (1) is not receiving a premium tax credit under Code of Federal Regulations, title 26,
section 1.36B-2, as of the date their coverage is effectuated;
new text end

new text begin (2) is not enrolled in public program coverage under Minnesota Statutes, section
256B.055, or 256L.04; and
new text end

new text begin (3) purchased an individual health plan from a health carrier in the individual market.
new text end

new text begin Subd. 4. new text end

new text begin Gross premium. new text end

new text begin "Gross premium" means the amount billed for a health plan
purchased by an eligible individual prior to a premium subsidy in a calendar year.
new text end

new text begin Subd. 5. new text end

new text begin Health carrier. new text end

new text begin "Health carrier" has the meaning given in Minnesota Statutes,
section 62A.011, subdivision 2.
new text end

new text begin Subd. 6. new text end

new text begin Individual health plan. new text end

new text begin "Individual health plan" has the meaning given in
Minnesota Statutes, section 62A.011, subdivision 4.
new text end

new text begin Subd. 7. new text end

new text begin Individual market. new text end

new text begin "Individual market" has the meaning given in Minnesota
Statutes, section 62A.011, subdivision 5.
new text end

new text begin Subd. 8. new text end

new text begin Net premium. new text end

new text begin "Net premium" means the gross premium less the premium
subsidy.
new text end

new text begin Subd. 9. new text end

new text begin Premium subsidy. new text end

new text begin "Premium subsidy":
new text end

new text begin (1) is a payment made on behalf of eligible individuals for the promotion of general
welfare, and is not compensation for any services;
new text end

new text begin (2) is equal to 25 percent of the monthly gross premium otherwise paid by or on behalf
of the eligible individual for coverage purchased in the individual market, that covers the
eligible individual and the eligible individual's spouse and dependents, or the percentage
established by the commissioner under section 2, subdivision 3, paragraph (c); and
new text end

new text begin (3) is excluded from any calculation used to determine eligibility within any of the
Department of Human Services programs.
new text end

new text begin Subdivision 1. new text end

new text begin Program established. new text end

new text begin The commissioner of Minnesota Management
and Budget, in consultation with the commissioner of commerce and the commissioner of
human services, shall establish and administer the premium subsidy program authorized by
this act, to help eligible individuals pay for coverage in the individual market in 2017.
new text end

new text begin Subd. 2. new text end

new text begin Premium subsidy provided. new text end

new text begin As soon as practicable, but no later than April
30, 2017, health carriers shall begin paying a premium subsidy to each eligible individual
who purchases a health plan in the individual market, for all the months for which the net
premium is paid. An eligible individual shall pay the net premium amount to the health
carrier.
new text end

new text begin Subd. 3. new text end

new text begin Payments to health carriers. new text end

new text begin (a) The commissioner shall make payments to
health carriers on behalf of eligible individuals effectuating coverage for calendar year 2017,
for the months in that year for which the individual has paid the net premium amount to the
health carrier. Payments to health carriers shall be based on the premium subsidy available
to eligible individuals in the individual market, regardless of the cost of coverage purchased.
The commissioner shall not withhold payments because a health carrier cannot prove an
enrollee is an eligible individual.
new text end

new text begin (b) Health carriers seeking reimbursement from the commissioner must submit an invoice
and supporting information to the commissioner, using a form developed by the
commissioner, in order to be eligible for payment. The commissioner shall finalize the form
by March 1, 2017.
new text end

new text begin (c) Total state payments to health carriers must be made within the limits of the available
appropriation. The commissioner shall reimburse health carriers at the full requested amount
up to the level of the appropriation. The commissioner, by July 15, 2017, shall determine
whether the available appropriation will be sufficient to provide premium subsidies equal
to 25 percent of the gross premium for the period September 1, 2017, through December
31, 2017. If the commissioner determines that the available appropriation is not sufficient,
the commissioner shall reduce the premium subsidy percentage, beginning September 1,
2017, through the remainder of the calendar year, by an amount sufficient to ensure that the
total amount of premium subsidies provided for the calendar year does not exceed the
available appropriation. The commissioner shall notify health carriers of any reduced
premium subsidy percentage within five days of making a determination. Health carriers
shall provide enrollees with at least 30 days' notice of any reduction in the premium subsidy
percentage.
new text end

new text begin (d) The commissioner shall consider health carriers as vendors under Minnesota Statutes,
section 16A.124, subdivision 3, and each monthly invoice shall represent the completed
delivery of the service.
new text end

new text begin Subd. 4. new text end

new text begin Data practices. new text end

new text begin (a) The definitions in Minnesota Statutes, section 13.02, apply
to this subdivision.
new text end

new text begin (b) Government data on an enrollee or health carrier under this section are private data
on individuals or nonpublic data, except that the total reimbursement requested by a health
carrier and the total state payment to the health carrier are public data.
new text end

new text begin (c) Notwithstanding Minnesota Statutes, section 138.17, government data on an enrollee
or health carrier under this section must be destroyed by June 30, 2018, or upon completion
by the legislative auditor of the audits required by section 3, whichever is later.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
new text end

new text begin (b) "Enrollee" has the meaning given in Minnesota Statutes, section 62Q.01, subdivision
2b.
new text end

new text begin (c) "Health plan" has the meaning given in Minnesota Statutes, section 62Q.01,
subdivision 3.
new text end

new text begin (d) "Health plan company" has the meaning given in Minnesota Statutes, section 62Q.01,
subdivision 4.
new text end

new text begin (e) "Individual market" has the meaning given in Minnesota Statutes, section 62A.011,
subdivision 5.
new text end

new text begin (f) "Involuntary termination of coverage" means the termination of a health plan due to
a health plan company's refusal to renew the health plan in the individual market because
the health plan company elects to cease offering individual market health plans in all or
some geographic rating areas of the state.
new text end

new text begin Subd. 2. new text end

new text begin Application. new text end

new text begin This section applies to an enrollee who is subject to a change in
health plans in the individual market due to an involuntary termination of coverage from a
health plan in the individual market after October 31, 2016, and before January 1, 2017,
and who enrolls in a new health plan in the individual market for all or a portion of calendar
year 2017 that goes into effect after December 31, 2016, and before March 2, 2017.
new text end

new text begin Subd. 3. new text end

new text begin Change in health plans; transition of care coverage. new text end

new text begin (a) If an enrollee satisfies
the criteria in subdivision 2, the enrollee's new health plan company must provide, upon
request of the enrollee or the enrollee's health care provider, authorization to receive services
that are otherwise covered under the terms of the enrollee's calendar year 2017 health plan
from a provider who provided care on an in-network basis to the enrollee during calendar
year 2016 but who is out of network in the enrollee's calendar year 2017 health plan:
new text end

new text begin (1) for up to 120 days if the enrollee has, within 45 days before an involuntary termination
of coverage, received a diagnosis of, or is engaged in a current course of treatment for, one
or more of the following conditions:
new text end

new text begin (i) an acute condition;
new text end

new text begin (ii) a life-threatening mental or physical illness;
new text end

new text begin (iii) pregnancy beyond the first trimester of pregnancy;
new text end

new text begin (iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided the disability has lasted or can be expected to last for at least one
year or can be expected to result in death; or
new text end

new text begin (v) a disabling or chronic condition that is in an acute phase; or
new text end

new text begin (2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
new text end

new text begin (b) For all requests for authorization under this subdivision, the health plan company
must grant the request for authorization unless the enrollee does not meet the criteria in
paragraph (a) or subdivision 2.
new text end

new text begin Subd. 4. new text end

new text begin Limitations. new text end

new text begin (a) Subdivision 3 applies only if the enrollee's health care provider
agrees to:
new text end

new text begin (1) accept as payment in full the lesser of:
new text end

new text begin (i) the health plan company's reimbursement rate for in-network providers for the same
or similar service; or
new text end

new text begin (ii) the provider's regular fee for that service;
new text end

new text begin (2) request authorization for services in the form and manner specified by the enrollee's
new health plan company; and
new text end

new text begin (3) provide the enrollee's new health plan company with all necessary medical information
related to the care provided to the enrollee.
new text end

new text begin (b) Nothing in this section requires a health plan company to provide coverage for a
health care service or treatment that is not covered under the enrollee's health plan.
new text end

new text begin Subd. 5. new text end

new text begin Request for authorization. new text end

new text begin The enrollee's health plan company may require
medical records and other supporting documentation to be submitted with a request for
authorization under subdivision 3 to the extent that the records and other documentation
are relevant to a determination regarding the existence of a condition under subdivision 3,
paragraph (a). If authorization is denied, the health plan company must explain the criteria
used to make its decision on the request for authorization and must explain the enrollee's
right to appeal the decision. If an enrollee chooses to appeal a denial, the enrollee must
appeal the denial within five business days of the date on which the enrollee receives the
denial. If authorization is granted, the health plan company must provide the enrollee, within
five business days of granting the authorization, with an explanation of how transition of
care will be provided.
new text end

new text begin Subd. 6. new text end

new text begin Reimbursement. new text end

new text begin (a) The commissioner of management and budget must
reimburse the enrollee's new health plan company for the cost of claims that the health plan
company certifies as eligible for reimbursement under this subdivision. The cost eligible
for reimbursement under this subdivision is the difference between the in-network level of
benefits under the enrollee's health plan and the out-of-network level of benefits under the
enrollee's health plan. The health plan company must seek reimbursement for the cost of
claims from the commissioner in a form and manner mutually agreed upon by the
commissioner and the affected health plan companies. Total state reimbursements to health
plan companies under this subdivision are subject to the limits of the available appropriation
and the commissioner may prorate equally across all claims paid as necessary. In the event
that funding for reimbursements to health plan companies is not sufficient to fully reimburse
health plan companies for the costs of claims for reimbursement for services authorized
under this section, health plan companies must continue to cover services authorized under
this section.
new text end

new text begin (b) For any service provided under this section, the enrollee shall not owe the provider
more than the cost-sharing amount the enrollee would be required to pay if the services
were performed by an in-network provider under the enrollee's new health plan.
new text end