1.1                          A bill for an act 
  1.2             relating to insurance; creating a stop-loss fund 
  1.3             account; appropriating money; proposing coding for new 
  1.4             law in Minnesota Statutes, chapter 43A.  
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [43A.50] [STOP-LOSS FUND.] 
  1.7      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.8   section, the following definitions apply:  
  1.9      (a) "Commissioner" means the commissioner of employee 
  1.10  relations.  
  1.11     (b) "Health benefit plan" means a health benefit plan as 
  1.12  defined in section 62L.02, subdivision 15. 
  1.13     (c) "Health plan company" means a health carrier as defined 
  1.14  under section 62L.02, subdivision 16. 
  1.15     (d) "Qualifying employer" means a nursing facility that is: 
  1.16     (1) reimbursed under section 256B.431 or 256B.434; 
  1.17     (2) has no fewer than two and no more than 50 employees; 
  1.18  and 
  1.19     (3) who offers health care coverage to all employees 
  1.20  working at least 20 hours per week. 
  1.21     (e) "Qualifying enrollee" means an employee of a qualifying 
  1.22  employer or the employee's dependent covered by a health benefit 
  1.23  plan. 
  1.24     Subd. 2.  [CREATION OF ACCOUNT.] A stop-loss fund account 
  1.25  is established in the general fund.  The commissioner shall use 
  2.1   the money to establish a stop-loss fund from which a health plan 
  2.2   company may receive reimbursement for claims paid for qualified 
  2.3   enrollees.  The account consists of money appropriated by the 
  2.4   legislature.  Money from the account must be used for the 
  2.5   stop-loss fund.  
  2.6      Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
  2.7   receive reimbursement from the fund for 90 percent of any claims 
  2.8   paid between $30,000 and $100,000 in a calendar year for a 
  2.9   qualifying enrollee.  
  2.10     (b) Claims shall be reported and funds shall be distributed 
  2.11  on a calendar-year basis.  Claims shall be eligible for 
  2.12  reimbursement only for the calendar year in which the claims 
  2.13  were paid.  
  2.14     (c) Once claims paid on behalf of a qualifying enrollee 
  2.15  reach $100,000 in a given calendar year, no further claims may 
  2.16  be submitted for reimbursement on behalf of that enrollee.  
  2.17     Subd. 4.  [REQUEST PROCESS.] (a) Each health plan company 
  2.18  must submit a request for reimbursement from the fund on a form 
  2.19  prescribed by the commissioner.  Requests for payment must be 
  2.20  submitted no later than April 1 following the end of the 
  2.21  calendar year for which the reimbursement request is being made, 
  2.22  beginning April 1, 2002. 
  2.23     (b) The commissioner may require a health plan company to 
  2.24  submit claims data as needed in connection with the 
  2.25  reimbursement request.  
  2.26     Subd. 5.  [DISTRIBUTION.] (a) The commissioner shall 
  2.27  calculate the total claims reimbursement amount for all health 
  2.28  plan companies for the calendar year for which claims are being 
  2.29  reported and shall distribute the stop-loss funds on an annual 
  2.30  basis.  
  2.31     (b) In the event that the total amount requested for 
  2.32  reimbursement by all health plan companies for a calendar year 
  2.33  exceeds the funds available for distribution for claims paid by 
  2.34  all health plan companies during the same calendar year, the 
  2.35  commissioner shall provide for the pro rata distribution of the 
  2.36  available funds.  Each health plan company shall be eligible to 
  3.1   receive only a proportionate amount of the available funds as 
  3.2   the health plan company's total eligible claims paid compares to 
  3.3   the total eligible claims paid by all health plan companies.  
  3.4      (c) In the event that funds available for distribution for 
  3.5   claims paid by all health plan companies during a calendar year 
  3.6   exceed the total amount requested for reimbursement by all 
  3.7   health plan companies during the same calendar year, any excess 
  3.8   funds shall be reallocated for distribution in the next calendar 
  3.9   year.  
  3.10     Subd. 6.  [DATA.] Upon the request of the commissioner, 
  3.11  each health plan company shall furnish such data as the 
  3.12  commissioner deems necessary to administer the fund.  The 
  3.13  commissioner may require that such data be submitted on a per 
  3.14  enrollee, aggregate, or categorical basis.  Any data submitted 
  3.15  under this section shall be classified as private data or 
  3.16  nonpublic data as defined in section 13.02. 
  3.17     Subd. 7.  [DELEGATION.] The commissioner may delegate any 
  3.18  or all of the commissioner's administrative duties to another 
  3.19  state agency or to a private contractor.  
  3.20     Subd. 8.  [REPORT.] The commissioner of health, in 
  3.21  consultation with the commissioner of commerce, shall evaluate 
  3.22  the extent to which the stop-loss fund increases the 
  3.23  availability of employer-subsidized health coverage for 
  3.24  employees of nursing facilities.  A preliminary report must be 
  3.25  submitted to the legislature by February 15, 2003, and a final 
  3.26  report must be submitted February 15, 2004. 
  3.27     Subd. 9.  [SUNSET.] This section shall expire January 1, 
  3.28  2005. 
  3.29     Sec. 2.  [APPROPRIATION.] 
  3.30     $....... is appropriated for the biennium beginning July 1, 
  3.31  2001, from the general fund to the commissioner of employee 
  3.32  relations to be deposited in the stop-loss fund account to be 
  3.33  distributed in accordance with section 1.