reglab/statecodes huggingface dataset:
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.292 — Right To Reduce Coverage And Lower Premiums.

62S.292 RIGHT TO REDUCE COVERAGE AND LOWER PREMIUMS.
Subdivision 1.
Required policy or certificate provision.
Every long-term care insurance policy and certificate shall include a provision that allows the policyholder or certificate holder to reduce coverage and lower the policy or certificate premium in at least one of the following ways:
(1) reducing the maximum benefit; or
(2) reducing the daily, weekly, or monthly benefit amount.
The insurer may also offer other reduction options that are consistent with the policy or certificate design or the carrier's administrative processes.
The provision shall include a description of the ways in which coverage may be reduced and the process for requesting and implementing a reduction in coverage.
Subd. 2.
Age determination.
The age to determine the premium for the reduced coverage shall be based on the age used to determine the premiums for the coverage currently in force.
Subd. 3.
Limitation.
The insurer may limit any reduction in coverage to plans or options available for that policy form and to those for which benefits will be available after consideration of claims paid or payable.
Subd. 4.
Written reminder.
If a policy or certificate is about to lapse, the insurer shall provide a written reminder to the policyholder or certificate holder of the right to reduce coverage and premiums in the notice required by section 62S.19, subdivision 3.
Subd. 5.
Nonapplication.
This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.
History:
2008 c 344 s 40; 2009 c 86 art 1 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.31 — Requirement To Deliver Shopper's Guide.

62S.31 REQUIREMENT TO DELIVER SHOPPER'S GUIDE.
Subdivision 1.
Shopper's guide.
A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate:
(1) in the case of agent solicitations, an agent must deliver the shopper's guide before the presentation of an application or enrollment form; and
(2) in the case of direct response solicitations, the shopper's guide must be presented in conjunction with an application or enrollment form.
Subd. 2.
Exception.
Subdivision 1 does not apply to life insurance policies or riders containing accelerated long-term care benefits. The policy summary required under section 62S.10 must be furnished with a life insurance policy or rider containing accelerated long-term care benefits.
History:
1997 c 71 art 1 s 31
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.312 — Consumer Protection Standards For Long-term Care Partnership Policies.

62S.312 CONSUMER PROTECTION STANDARDS FOR LONG-TERM CARE PARTNERSHIP POLICIES.
To qualify as a long-term care partnership policy under this chapter, long-term care insurance policies must meet the requirements for being tax qualified as defined in section 7702B(b) of the Internal Revenue Code and meet certain consumer protection requirements in section 6021(a)(1)(B)(5)(A) of the Deficit Reduction Act of 2005, Public Law 109-171, which are taken from the National Association of Insurance Commissioners (NAIC) Model Act and Regulation of 2000. Insurance carriers must certify for each policy form to be included in the long-term care partnership that the form complies with the requirements of the NAIC Model Act and Regulation of 2000 as implemented in sections 62S.05 to 62S.11; 62S.13 to 62S.18; 62S.19; 62S.20, subdivisions 1 to 5; 62S.21; 62S.22; 62S.24; 62S.25; 62S.266; 62S.28; 62S.29; 62S.30; and 62S.31.
History:
2010 c 310 art 4 s 2
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.315 — Producer Training.

62S.315 PRODUCER TRAINING.
The commissioner shall approve producer training requirements in accordance with the NAIC Long-Term Care Insurance Model Act provisions. The commissioner of the Department of Human Services shall provide technical assistance and information to the commissioner in accordance with Public Law 109-171, section 6021.
History:
2006 c 255 s 56; 2006 c 282 art 17 s 22; 2009 c 86 art 1 s 88
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.32 — Application.

62S.32 APPLICATION.
Subdivision 1.
Medicare supplement insurance policy.
Medicare supplement insurance policy laws do not apply to long-term care insurance.
Subd. 2.
Qualified long-term care insurance policy.
This chapter applies to long-term care insurance marketed as a qualified long-term care policy. This chapter does not apply to long-term care insurance governed by sections 62A.46 to 62A.56.
History:
1997 c 71 art 1 s 32
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.33 — Penalties.

62S.33 PENALTIES.
In addition to any other penalties provided by the laws of this state, an insurer or agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of the insurance is subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater.
History:
1997 c 71 art 1 s 33
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.34 — Regulatory Flexibility.

62S.34 REGULATORY FLEXIBILITY.
The commissioner may, upon written request, issue an order to modify or suspend a specific provision or provisions of this chapter with respect to a specific long-term care insurance policy or certificate upon a written finding that:
(1) the modification or suspension is in the best interest of the insureds;
(2) the purpose to be achieved could not be effectively or efficiently achieved without the modification or suspension; and
(3)(i) the modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long-term care;
(ii) the policy or certificate is to be issued to residents of a life care or continuing care retirement community or some other residential community for the elderly and the modification or suspension is reasonably related to the special needs or nature of such a community; or
(iii) the modification or suspension is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product.
History:
1Sp2003 c 14 art 2 s 6
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.01 — Definitions.

62T.01 DEFINITIONS.
Subdivision 1.
Scope.
For purposes of this chapter, the terms in this section have the meanings given.
Subd. 2.
Health care purchasing alliance.
"Health care purchasing alliance" means a business organization created under this chapter to negotiate the purchase of health care services for employers. Nothing in this chapter shall be deemed to regulate or impose any requirements on a self-insured employer or labor union. A health care purchasing alliance may include a grouping of:
(1) businesses, including small businesses with one employee. The businesses may or may not be organized under section 62Q.17 as a purchasing pool;
(2) trade association members or church organizations under section 60A.02 or union members who are not in a self-insured benefit plan;
(3) multiple employer welfare associations under chapter 62H;
(4) municipalities, townships, or counties;
(5) other government entities; or
(6) any combination of clauses (1) to (5).
The alliance may determine the definition of a business of one employee, but must adhere to its definition and show no bias in selection of members based on that definition.
Subd. 3.
Accountable provider network.
"Accountable provider network" means a group of health care providers organized to market health care services on a risk-sharing or non-risk-sharing basis with a health care purchasing alliance. Accountable provider networks shall operate as not-for-profit entities or as health care cooperatives, as allowed under chapter 62R. This chapter applies only when an accountable provider network is marketing and selling services and benefits to the employees of businesses as authorized in section 62T.05.
Subd. 4.
Commissioner.
"Commissioner" means the commissioner of health.
History:
1997 c 225 art 5 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.02 — Purchasing Alliances.

62T.02 PURCHASING ALLIANCES.
Subdivision 1.
Registration.
Purchasing alliances must register prior to offering coverage, and annually on July 1 thereafter, with the commissioner on a form prescribed by the commissioner.
Subd. 2.
Common factors.
All participants in a purchasing alliance must live within a common geographic region, be employed in a similar occupation, or share some other common factor as approved by the commissioner. The membership criteria must not be designed to include disproportionately employers, groups, or individuals likely to have low costs of health coverage, or to exclude disproportionately employers, groups, or individuals likely to have high costs of health coverage.
Subd. 3.
Seasonal employees.
A purchasing alliance may define eligible employees to include seasonal employees. For purposes of this chapter, "seasonal employee" means an employee who is employed on a full-time basis for at least six months during the calendar year and is unemployed for no longer than four months during the calendar year. If seasonal employees are included:
(1) the alliance must not show bias in the selection of members based on the percentage of seasonal employees employed by an employer member;
(2) prior to issuance or renewal, the employer must inform the alliance that it will include seasonal employees;
(3) the employer must cover seasonal employees for the entire term of its plan year; and
(4) the purchasing alliance may require an employer-member contribution of at least 50 percent of the cost of employee coverage during the months the seasonal employee is unemployed.
History:
1997 c 225 art 5 s 2; 2004 c 268 s 10; 2004 c 288 art 6 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.025 — Employer-member Contribution.

62T.025 EMPLOYER-MEMBER CONTRIBUTION.
If an employer-member of a purchasing alliance can demonstrate that the member has not offered employee health coverage for a year or more, the member may contribute 25 percent or more of the cost of employee coverage for up to 36 months. This provision only applies to rural purchasing alliances organized under this chapter and operating prior to May 1, 2000. The affected purchasing alliances may develop membership criteria which disallow an employer contribution below 50 percent.
History:
2000 c 295 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.03 — Application Of Other Laws.

62T.03 APPLICATION OF OTHER LAWS.
Subdivision 1.
State law.
An accountable provider network is subject to all requirements applicable to a health plan company licensed in the state, except as otherwise noted in this chapter. An accountable provider network and a health care purchasing alliance must comply with all requirements of chapter 62L, except for modifications and waivers permitted under this chapter. A contracting arrangement between a health care purchasing alliance and an accountable provider network for provision of health care benefits must provide consumer protection functions comparable to those currently required of a health plan company licensed under section 62N.25, and other statutes referenced in that section, except for modifications and waivers permitted under this chapter.
Subd. 2.
Federal law.
A self-insured employer may participate as an affiliate member of a purchasing alliance without participation affecting the employer's standing under the federal Employee Retirement Income Security Act (ERISA) of 1974. An affiliate member is one that may purchase administrative services with the purchasing alliance and may participate in activities undertaken to educate and promote health improvement of the purchasing alliance enrollees or community residents.
History:
1997 c 225 art 5 s 3; 2000 c 295 s 2
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.04 — Complaint System.

62T.04 COMPLAINT SYSTEM.
Accountable provider networks must establish and maintain an enrollee complaint system as required under sections 62Q.68 to 62Q.72 or as required by a contract with a purchasing alliance. The contract must be approved by the commissioner. The accountable provider network may contract with the health care purchasing alliance or a vendor for operation of this system. The commissioner may not waive any enrollee rights relating to external review.
History:
1997 c 225 art 5 s 4; 1999 c 239 s 40; 2000 c 295 s 3
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.05 — Benefits.

62T.05 BENEFITS.
An accountable provider network may offer and sell any benefits permitted to be offered and sold by health plan companies under Minnesota law. An accountable provider network may, after consultation with the purchasing alliance, offer only one benefit plan to employer-members of the alliance.
History:
1997 c 225 art 5 s 5; 2000 c 295 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.07 — Criteria For Granting Waivers.

62T.07 CRITERIA FOR GRANTING WAIVERS.
The commissioner may approve a request for waiver under section 62T.06 if the applicant demonstrates that the contracting arrangement between a health care purchasing alliance and an accountable provider network will meet the following criteria:
(a) The arrangement would be likely to result in:
(1) more choice in benefits and prices;
(2) lower costs;
(3) increased access to health care coverage by small businesses;
(4) increased access to providers who have demonstrated a long-term commitment to the community being serviced; or
(5) increased quality of health care than would otherwise occur under the existing market conditions. In the event that a proposed arrangement appears likely to improve one or two of the criteria at the expense of another one or two of the criteria, the commissioner shall not approve the waiver.
(b) The proposed alternative methods would provide equal or improved results in consumer protection than would result under the existing consumer protections requirements.
History:
1997 c 225 art 5 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.08 — Supervision And Revocation Of Waivers.

62T.08 SUPERVISION AND REVOCATION OF WAIVERS.
(a) The commissioner shall appropriately supervise and monitor approved waivers.
(b) The commissioner may revoke approval of a waiver if the contracting arrangement no longer satisfies the criteria in section 62T.07, paragraphs (a) and (b).
History:
1997 c 225 art 5 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.09 — Minnesota Comprehensive Health Association.

62T.09 MINNESOTA COMPREHENSIVE HEALTH ASSOCIATION.
A health care purchasing alliance must pay the assessment required of contributing members pursuant to section 62E.11.
History:
1997 c 225 art 5 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.10 — Minnesotacare Tax.

62T.10 MINNESOTACARE TAX.
An accountable provider network shall file with the commissioner of revenue all returns and pay to the commissioner of revenue all amounts required under chapter 297I.
History:
1997 c 225 art 5 s 10; 2000 c 394 art 2 s 17
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.11 — Duties Of Commissioner.

62T.11 DUTIES OF COMMISSIONER.
(a) By July 1, 1997, the commissioner shall make available application forms for licensure as an accountable provider network. The accountable provider network may begin doing business after application has been approved.
(b) Upon receipt of an application for a certificate of authority, the commissioner shall grant or deny licensure and waivers requested within 90 days of receipt of a complete application if all requirements are substantially met. For a period of six years after July 1, 1997, the commissioner may approve up to five applications, none of which may be from health plan companies. If no written response has been received within 90 days, the application is approved. When the commissioner denies an application or waiver request, the commissioner shall notify the applicant in writing specifically stating the grounds for the denial and specific suggestions for how to remedy the denial. The commissioner will entertain reconsiderations. Within 90 days after the denial, the applicant may file a written request for an administrative hearing and review of the commissioner's determination. The hearing is subject to judicial review as provided by chapter 14.
(c) All monitoring, enforcement, and rulemaking powers available under chapter 62N are granted to the commissioner to assure continued compliance with provisions of this chapter. The commissioner shall honor the intent of this section to foster community-focused, affordable health coverage for small employers and their employees.
(d) The commissioner may contract with other entities as necessary to carry out the responsibilities in this chapter.
History:
1997 c 225 art 5 s 11; 2000 c 295 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62T — Community Purchasing Arrangements › Section 62T.12 — Fees.

62T.12 FEES.
Every accountable provider network subject to this chapter shall pay to the commissioner fees as prescribed by the commissioner pursuant to section 144.122. The initial fees are:
(1) filing an application for licensure, $500;
(2) filing an amendment to a license, $90;
(3) filing an annual report, $200;
(4) filing of renewal of licensure based on a fee of $1,000 per 1,000 enrollees, with renewal every three years; and
(5) other filing fees as specified by rule.
History:
1997 c 225 art 5 s 12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62U — Health Care Payment And Pricing Reform › Section 62U.05 — Provider Pricing For Baskets Of Care.

62U.05 PROVIDER PRICING FOR BASKETS OF CARE.
Subdivision 1.
Establishment of definitions.
(a) By July 1, 2009, the commissioner of health shall establish uniform definitions for baskets of care beginning with a minimum of seven baskets of care. In selecting health conditions for which baskets of care should be defined, the commissioner shall consider coronary artery and heart disease, diabetes, asthma, and depression. In selecting health conditions, the commissioner shall also consider the prevalence of the health conditions, the cost of treating the health conditions, and the potential for innovations to reduce cost and improve quality.
(b) The commissioner shall convene one or more work groups to assist in establishing these definitions. Each work group shall include members appointed by statewide associations representing relevant health care providers and health plan companies, and organizations that work to improve health care quality in Minnesota.
(c) To the extent possible, the baskets of care must incorporate a patient-directed, decision-making support model.
Subd. 2.
Package prices.
(a) Beginning January 1, 2010, health care providers may establish package prices for the baskets of care defined under subdivision 1.
(b) Beginning January 1, 2010, no health care provider or group of providers that has established a package price for a basket of care under this section shall vary the payment amount that the provider accepts as full payment for a health care service based upon the identity of the payer, upon a contractual relationship with a payer, upon the identity of the patient, or upon whether the patient has coverage through a group purchaser. This paragraph applies only to health care services provided to Minnesota residents or to non-Minnesota residents who obtain health insurance through a Minnesota employer. This paragraph does not apply to services paid for by Medicare, state public health care programs through fee-for-service or prepaid arrangements, workers' compensation, or no-fault automobile insurance. This paragraph does not affect the right of a provider to provide charity care or care for a reduced price due to financial hardship of the patient or due to the patient being a relative or friend of the provider.
Subd. 3.
Quality measurements for baskets of care.
(a) The commissioner shall establish quality measurements for the defined baskets of care by December 31, 2009. The commissioner may contract with an organization that works to improve health care quality to make recommendations about the use of existing measures or establishing new measures where no measures currently exist.
(b) Beginning July 1, 2010, the commissioner or the commissioner's designee shall publish comparative price and quality information on the baskets of care in a manner that is easily accessible and understandable to the public, as this information becomes available.
History:
2008 c 358 art 4 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62U — Health Care Payment And Pricing Reform › Section 62U.06 — Coordination; Legislative Oversight.

62U.06 COORDINATION; LEGISLATIVE OVERSIGHT.
Subdivision 1.
Coordination.
In carrying out the responsibilities of this chapter, the commissioner of health shall ensure that the activities and data collection are implemented in an integrated and coordinated manner that avoids unnecessary duplication of effort. To the extent possible, the commissioner shall use existing data sources and implement methods to streamline data collection in order to reduce public and private sector administrative costs.
Subd. 2.
Legislative oversight.
Beginning January 15, 2009, the commissioner of health shall submit to the chairs and ranking minority members of the legislative committees with jurisdiction over health care policy and finance periodic progress reports on the implementation of this chapter and sections 62U.03 and 256B.0753 to 256B.0754.
Subd. 3.
Rulemaking.
For purposes of this chapter, the commissioner may use the expedited rulemaking process under section 14.389.
History:
2008 c 358 art 4 s 9; 1Sp2011 c 9 art 6 s 17; 2020 c 115 art 3 s 39; 2022 c 55 art 1 s 15
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62U — Health Care Payment And Pricing Reform › Section 62U.08 — Essential Benefit Set.

62U.08 ESSENTIAL BENEFIT SET.
Subdivision 1.
Work group created.
The commissioner of health shall convene a work group to make recommendations on the design of a health benefit set that provides coverage for a broad range of services and technologies, is based on scientific evidence that the services and technologies are clinically effective and cost-effective, and provides lower enrollee cost sharing for services and technologies that have been determined to be cost-effective. The work group shall include representatives of health care providers, health plans, state agencies, and employers. Members of the work group must have expertise in standards for evidence-based care, benefit design and development, actuarial analysis, or knowledge relating to the analysis of the cost impact of coverage of specified benefits. The work group must meet at least once per year and at other times as necessary to make recommendations to the commissioner on updating the benefit set as necessary to ensure that the benefit set continues to be safe, effective, and scientifically based.
Subd. 2.
Duties.
By October 15, 2009, the work group shall develop and submit to the commissioner an initial essential benefit set and design that includes coverage for a broad range of services, is based on scientific evidence that services are clinically effective and cost-effective, and provides lower enrollee cost sharing for services that have been determined to be cost-effective. The benefit set must include necessary evidence-based health care services, procedures, diagnostic tests, and technologies that are scientifically proven to be both clinically effective and cost-effective. In developing its recommendations, the work group may consult with the Institute for Clinical Systems Improvement (ICSI) to assemble existing scientifically based practice standards.
Subd. 3.
Report.
By January 15, 2010, the commissioner shall report the recommendations of the work group to the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health care policy and finance.
History:
2008 c 358 art 4 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62U — Health Care Payment And Pricing Reform › Section 62U.10 — Health Care Transfer, Savings, And Repayment.

62U.10 HEALTH CARE TRANSFER, SAVINGS, AND REPAYMENT.
Subdivision 1.
Health care access fund transfer.
On June 30, 2009, the commissioner of management and budget shall transfer $50,000,000 from the health care access fund to the general fund.
Subd. 2.
Projected spending baseline.
(a) By June 1, 2009, the commissioner of health shall calculate the annual projected total private and public health care spending for residents of this state and establish a health care spending baseline, beginning for calendar year 2008 and for the next ten years based on the annual projected growth in spending.
(b) In establishing the health care spending baseline, the commissioner shall use the Centers for Medicare and Medicaid Services forecast for total growth in national health care expenditures and adjust this forecast to reflect the demographics, health status, and other factors deemed necessary by the commissioner. The commissioner shall contract with an actuarial consultant to make recommendations for the adjustments needed to specifically reflect projected spending for residents of this state.
(c) The commissioner may adjust the projected baseline as necessary to reflect any updated federal projections or account for unanticipated changes in federal policy.
(d) Medicare and long-term care spending must not be included in the calculations required under this section.
Subd. 3.
MS 2020 [Repealed, 2022 c 98 art 14 s 33]
Subd. 4.
Repayment of transfer.
When accumulated savings accruing to state-administered health care programs, as calculated under subdivision 3, meet or exceed $50,000,000, the commissioner of health shall certify that event to the commissioner of management and budget. In the next fiscal year following the certification, the commissioner of management and budget shall transfer $50,000,000 from the general fund to the health care access fund. The amount necessary to make the transfer is appropriated from the general fund to the commissioner of management and budget.
Subd. 5.
Definitions.
(a) For purposes of this section, the following definitions apply.
(b) "Public health care spending" means spending for a state-administered health care program.
(c) "State-administered health care program" means medical assistance, MinnesotaCare, and the state employee group insurance program.
Subd. 6.
MS 2022 [Repealed, 2023 c 70 art 4 s 113]
Subd. 7.
MS 2022 [Repealed, 2023 c 70 art 4 s 113]
Subd. 8.
MS 2022 [Repealed, 2023 c 70 art 4 s 113]
History:
2008 c 363 art 17 s 1; 2009 c 101 art 2 s 109; 2015 c 71 art 8 s 9-11; 2016 c 158 art 2 s 31
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62U — Health Care Payment And Pricing Reform › Section 62U.15 — Alzheimer's Disease; Prevalence And Screening Measures.

62U.15 ALZHEIMER'S DISEASE; PREVALENCE AND SCREENING MEASURES.
Subdivision 1.
Data from providers.
(a) By July 1, 2012, the commissioner shall review currently available quality measures and make recommendations for future measurement aimed at improving assessment and care related to Alzheimer's disease and other dementia diagnoses, including improved rates and results of cognitive screening, rates of Alzheimer's and other dementia diagnoses, and prescribed care and treatment plans.
(b) The commissioner may contract with a private entity to complete the requirements in this subdivision. If the commissioner contracts with a private entity already under contract through section 62U.02, then the commissioner may use a sole source contract and is exempt from competitive procurement processes.
Subd. 2.
MS 2018 [Repealed, 2020 c 115 art 3 s 40]
Subd. 3.
Comparison data.
The commissioner, with the commissioner of human services, the Minnesota Board on Aging, and other appropriate state offices, shall jointly review existing and forthcoming literature in order to estimate differences in the outcomes and costs of current practices for caring for those with Alzheimer's disease and other dementias, compared to the outcomes and costs resulting from:
(1) earlier identification of Alzheimer's and other dementias;
(2) improved support of family caregivers; and
(3) improved collaboration between medical care management and community-based supports.
Subd. 4.
Reporting.
By January 15, 2013, the commissioner must report to the legislature on progress toward establishment and collection of quality measures required under this section.
History:
1Sp2011 c 9 art 2 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.02 — Definitions.

62V.02 DEFINITIONS.
Subdivision 1.
Scope.
For the purposes of this chapter, the following terms have the meanings given.
Subd. 2.
Board.
"Board" means the Board of Directors of MNsure specified in section 62V.04.
Subd. 3.
Dental plan.
"Dental plan" has the meaning defined in section 62Q.76, subdivision 3.
Subd. 4.
Health plan.
"Health plan" means a policy, contract, certificate, or agreement defined in section 62A.011, subdivision 3.
Subd. 5.
Health carrier.
"Health carrier" has the meaning defined in section 62A.011.
Subd. 6.
Individual market.
"Individual market" means the market for health insurance coverage offered to individuals.
Subd. 7.
Insurance producer.
"Insurance producer" has the meaning defined in section 60K.31.
Subd. 8.
MNsure.
"MNsure" means the state health benefit exchange as described in section 1311 of the federal Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act.
Subd. 9.
Navigator.
"Navigator" has the meaning described in section 1311(i) of the federal Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act.
Subd. 10.
Public health care program.
"Public health care program" means any public health care program administered by the commissioner of human services.
Subd. 11.
Qualified health plan.
"Qualified health plan" means a health plan that meets the definition in section 1301(a) of the Affordable Care Act, Public Law 111-148, and has been certified by the board in accordance with section 62V.05, subdivision 5, to be offered through MNsure.
Subd. 12.
Small group market.
"Small group market" means the market for health insurance coverage offered to small employers as defined in section 62L.02, subdivision 26.
Subd. 13.
Website.
"Website" means a site maintained on the World Wide Web by MNsure that allows for access to information and services provided by MNsure.
History:
2013 c 9 s 4; 2013 c 108 art 1 s 67
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.051 — Mnsure; Consumer Retroactive Appointment Of A Navigator Or Producer Permitted.

62V.051 MNSURE; CONSUMER RETROACTIVE APPOINTMENT OF A NAVIGATOR OR PRODUCER PERMITTED.
Notwithstanding any other law or rule to the contrary, for up to six months after the effective date of the qualified health plan, MNsure must permit a qualified health plan policyholder, who has not designated a navigator or an insurance producer, to retroactively appoint a navigator or insurance producer. MNsure must provide notice of the retroactive appointment to the health carrier. The health carrier must retroactively pay commissions to the insurance producer if the producer can demonstrate that they were certified by MNsure at the time of the original enrollment, were appointed by the selected health carrier at the time of the enrollment, and that an agent of record agreement was executed prior to or at the time of the effective date of the policy. MNsure must adopt a standard form of agent of record agreement for purposes of this section.
History:
2015 c 58 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.07 — Funds.

62V.07 FUNDS.
(a) The MNsure account is created in the special revenue fund of the state treasury. All funds received by MNsure shall be deposited in the account. Funds in the account are appropriated to MNsure for the operation of MNsure. Notwithstanding section 11A.20, all investment income and all investment losses attributable to the investment of the MNsure account not currently needed, shall be credited to the MNsure account.
(b) The budget submitted to the legislature under section 16A.11 must include budget information for MNsure.
History:
2013 c 9 s 9; 2013 c 108 art 1 s 67
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.08 — Reports.

62V.08 REPORTS.
(a) MNsure shall submit a report to the legislature by January 15, 2015, and each January 15 thereafter, on: (1) the performance of MNsure operations; (2) meeting MNsure responsibilities; (3) an accounting of MNsure budget activities; (4) practices and procedures that have been implemented to ensure compliance with data practices laws, and a description of any violations of data practices laws or procedures; and (5) the effectiveness of the outreach and implementation activities of MNsure in reducing the rate of uninsurance.
(b) MNsure must publish its administrative and operational costs on a website to educate consumers on those costs. The information published must include: (1) the amount of premiums and federal premium subsidies collected; (2) the amount and source of revenue received under section 62V.05, subdivision 1, paragraph (b), clause (3); (3) the amount and source of any other fees collected for purposes of supporting operations; and (4) any misuse of funds as identified in accordance with section 3.975. The website must be updated at least annually.
History:
2013 c 9 s 10; 2013 c 108 art 1 s 67
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.09 — Expiration And Sunset Exclusion.

62V.09 EXPIRATION AND SUNSET EXCLUSION.
Notwithstanding section 15.059, the board and its advisory committees shall not expire, except as specified in section 62V.04, subdivision 13. The board and its advisory committees are not subject to review or sunsetting under chapter 3D.
History:
2013 c 9 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.10 — Right Not To Participate.

62V.10 RIGHT NOT TO PARTICIPATE.
Nothing in this chapter infringes on the right of a Minnesota citizen not to participate in MNsure.
History:
2013 c 9 s 12; 2013 c 108 art 1 s 67
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.11 — Legislative Oversight Committee.

62V.11 LEGISLATIVE OVERSIGHT COMMITTEE.
Subdivision 1.
Legislative oversight.
(a) The Legislative Oversight Committee is established to provide oversight to the implementation of this chapter and the operation of MNsure.
(b) The committee shall review the operations of MNsure at least annually and shall recommend necessary changes in policy, implementation, and statutes to the board and to the legislature.
(c) MNsure shall present to the committee the annual report required in section 62V.08, the appeals process under section 62V.05, subdivision 6, and the actions taken regarding the treatment of multiemployer plans.
Subd. 2.
Membership; meetings; compensation.
(a) The Legislative Oversight Committee shall consist of five members of the senate, three members appointed by the majority leader of the senate, and two members appointed by the minority leader of the senate; and five members of the house of representatives, three members appointed by the speaker of the house, and two members appointed by the minority leader of the house of representatives.
(b) Appointed legislative members serve at the pleasure of the appointing authority and shall continue to serve until their successors are appointed.
(c) The first meeting of the committee shall be convened by the chair of the Legislative Coordinating Commission. Members shall elect a chair at the first meeting. The chair must convene at least one meeting annually, and may convene other meetings as deemed necessary.
Subd. 3.
[Repealed, 2015 c 71 art 12 s 9]
Subd. 4.
Review of costs.
The board shall submit for review the annual budget of MNsure for the next fiscal year by March 15 of each year, beginning March 15, 2014.
Subd. 5.
Review of Minnesota eligibility system funding and expenditures.
The committee shall review quarterly reports submitted by the Minnesota Eligibility System Executive Steering Committee under section 62V.055, subdivision 3, regarding Minnesota eligibility system funding and expenditures.
History:
2013 c 9 s 13; 2013 c 108 art 1 s 67; 2016 c 163 art 4 s 3
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62V — Mnsure › Section 62V.13 — Easy Enrollment Health Insurance Outreach Program.

62V.13 EASY ENROLLMENT HEALTH INSURANCE OUTREACH PROGRAM.
Subdivision 1.
Establishment.
The board, in cooperation with the commissioner of revenue, must establish the easy enrollment health insurance outreach program to:
(1) reduce the number of uninsured Minnesotans and increase access to affordable health insurance coverage;
(2) allow the commissioner of revenue to provide return information, at the request of the taxpayer, to MNsure to provide the taxpayer with information about the taxpayer's potential eligibility for financial assistance and health insurance enrollment options through MNsure;
(3) allow MNsure to estimate taxpayer potential eligibility for financial assistance for health insurance coverage; and
(4) allow MNsure to conduct targeted outreach to assist interested taxpayer households in applying for and enrolling in affordable health insurance options through MNsure, including connecting interested taxpayer households with a navigator or broker for free enrollment assistance.
Subd. 2.
Screening for eligibility for insurance assistance.
Upon receipt of and based on return information received from the commissioner of revenue under section 270B.14, subdivision 22, MNsure may make a projected assessment on whether the interested taxpayer's household may qualify for a financial assistance program for health insurance coverage.
Subd. 3.
Outreach letter and special enrollment period.
(a) MNsure must provide a written letter of the projected assessment under subdivision 2 to a taxpayer who indicates to the commissioner of revenue that the taxpayer is interested in obtaining information on access to health insurance.
(b) MNsure must allow a special enrollment period for taxpayers who receive the outreach letter in paragraph (a) and are determined eligible to enroll in a qualified health plan through MNsure. The triggering event for the special enrollment period is the day the outreach letter under this subdivision is mailed to the taxpayer. An eligible individual, and their dependents, have 65 days from the triggering event to select a qualifying health plan and coverage for the qualifying health plan is effective the first day of the month after plan selection.
(c) Taxpayers who have a member of the taxpayer's household currently enrolled in a qualified health plan through MNsure are not eligible for the special enrollment under paragraph (b).
(d) MNsure must provide information to the general public about the easy enrollment health insurance outreach program and the special enrollment period described in this subdivision.
Subd. 4.
Appeals.
(a) Projected eligibility assessments for financial assistance under this section are not appealable.
(b) Qualification for the special enrollment period under this section is appealable to MNsure under this chapter and Minnesota Rules, chapter 7700.
History:
2023 c 70 art 16 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62W — Minnesota Pharmacy Benefit Manager › Section 62W.04 — Pharmacy Benefit Manager General Business Practices.

62W.04 PHARMACY BENEFIT MANAGER GENERAL BUSINESS PRACTICES.
(a) A pharmacy benefit manager must exercise good faith and fair dealing in the performance of its contractual duties. A provision in a contract between a pharmacy benefit manager and a health carrier or a network pharmacy that attempts to waive or limit this obligation is void.
(b) A pharmacy benefit manager must notify a health carrier in writing of any activity, policy, or practice of the pharmacy benefit manager that directly or indirectly presents a conflict of interest with the duties imposed in this section.
History:
2019 c 39 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62W — Minnesota Pharmacy Benefit Manager › Section 62W.05 — Pharmacy Benefit Manager Network Adequacy.

62W.05 PHARMACY BENEFIT MANAGER NETWORK ADEQUACY.
Subdivision 1.
Requirements.
(a) A pharmacy benefit manager must provide an adequate and accessible pharmacy network for the provision of prescription drugs that meet the relevant requirements in section 62K.10. Mail order pharmacies must not be included in the calculations of determining the adequacy of the pharmacy benefit manager's pharmacy network under section 62K.10.
(b) A pharmacy benefit manager must submit to the commissioner a pharmacy network adequacy report describing the pharmacy network and pharmacy accessibility in this state, with the pharmacy benefit manager's license application and renewal, in a manner prescribed by the commissioner.
Subd. 2.
Network adequacy waiver.
A pharmacy benefit manager may apply for a waiver from the commissioner of health if the pharmacy benefit manager is unable to meet the network adequacy requirements under subdivision 1. A waiver application must be submitted to the commissioner of health on a form prescribed by the commissioner of health and must:
(1) demonstrate with specific data why the pharmacy benefit manager is not able to meet the requirements; and
(2) include information as to the steps that were and will be taken to address network adequacy.
If a waiver is granted by the commissioner of health, the waiver shall automatically expire after three years. If a renewal of the waiver is sought, the commissioner of health shall consider steps that the pharmacy benefit manager has taken over the past three-year period to address network adequacy.
Subd. 3.
Accreditation standards.
A pharmacy benefit manager must not require pharmacy accreditation standards or recertification requirements to participate in a network that are inconsistent with, more stringent than, or in addition to federal and state requirements for licensure as a pharmacy in this state unless authorized under this chapter.
History:
2019 c 39 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62W — Minnesota Pharmacy Benefit Manager › Section 62W.075 — Therapeutic Alternative Prescription Drug.

62W.075 THERAPEUTIC ALTERNATIVE PRESCRIPTION DRUG.
A pharmacy benefit manager or health carrier must not require, or demonstrate a preference for, a pharmacy to dispense a therapeutically equivalent or therapeutically alternative drug that costs the enrollee more out-of-pocket than the prescribed drug, unless the substitution is made for medical reasons that benefit the patient. Before a substitution is made under this section, the pharmacy must obtain approval from the prescribing practitioner and must inform the enrollee of the reason for the substitution.
History:
2019 c 39 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62W — Minnesota Pharmacy Benefit Manager › Section 62W.076 — Specialty Pharmacy.

62W.076 SPECIALTY PHARMACY.
A pharmacy benefit manager that contracts with a specialty pharmacy must disclose to an enrollee, upon request, the enrollee's out-of-pocket costs at the specialty pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-pocket cost at a network retail pharmacy that is identified by the enrollee that is within the enrollee's health plan network.
History:
2019 c 39 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62W — Minnesota Pharmacy Benefit Manager › Section 62W.077 — Preferred Network.

62W.077 PREFERRED NETWORK.
A pharmacy benefit manager that uses a preferred network of pharmacies must disclose to an enrollee upon request the enrollee's out-of-pocket cost at the preferred pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-pocket cost at a nonpreferred pharmacy identified by the enrollee that is within the enrollee's health plan network.
History:
2019 c 39 s 10