Minnesota 2023-2024 Regular Session

Minnesota House Bill HF2699 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to taxation; gross revenues; creating a health insurance claims assessment;
3	3	1.3 proposing coding for new law in Minnesota Statutes, chapter 295.
4	4	1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
5	5	1.5 Section 1. [295.65] CLAIMS EXPENDITURE ASSESSMENT.
6	6	1.6 Subdivision 1.Definitions.(a) For the purposes of this section, the following terms have
7	7	1.7the meanings given.
8	8	1.8 (b) "Commissioner" means the commissioner of revenue.
9	9	1.9 (c) "Claims-related expenses" means any of the following:
10	10	1.10 (1) cost containment expenses, including but not limited to payments for utilization
11	11	1.11review, coordinated care or case management, disease management, medication review
12	12	1.12management, risk assessment, or similar administrative services intended to reduce the
13	13	1.13claims paid for health care services provided to covered individuals by attempting to ensure
14	14	1.14that needed services are delivered in the most efficacious manner possible or by helping
15	15	1.15covered individuals maintain or improve their health;
16	16	1.16 (2) payments that are made to or by an organized group of health care providers in
17	17	1.17accordance with managed care risk arrangements or network access agreements that are
18	18	1.18unrelated to the provisions of health care services to specific covered individuals; and
19	19	1.19 (3) general administrative expenses.
20	20	1Section 1.
21	21	REVISOR EAP/HL 23-0069412/20/22
22	22	State of Minnesota
23	23	This Document can be made available
24	24	in alternative formats upon request
25	25	HOUSE OF REPRESENTATIVES
26	26	H. F. No. 2699
27	27	NINETY-THIRD SESSION
28	28	Authored by Acomb03/08/2023
29	29	The bill was read for the first time and referred to the Committee on Taxes 2.1 (d) "Domicile" has the meaning provided in Minnesota Rules, part 8001.0300, subpart
30	30	2.22. A rebuttable presumption exists that an individual's home address as maintained by the
31	31	2.3health plan company or third-party administrator indicates where that individual is domiciled.
32	32	2.4 (e) "Excess loss" or "stop loss" means coverage that provides insurance protection against
33	33	2.5the accumulation of total claims exceeding a stated level for a group as a whole or protection
34	34	2.6against a high-dollar claim on any one individual.
35	35	2.7 (f) "Group health plan" means an employee welfare benefit plan as defined in section
36	36	2.8(1) of subtitle A of title 1 of the Employee Retirement Income Security Act of 1974, Public
37	37	2.9Law 93-406, United States Code, title 29, section 1002, to the extent the health plan provides
38	38	2.10medical care, including items and services paid for as medical care to employees or their
39	39	2.11dependents as defined under the terms of the plan directly or through insurance,
40	40	2.12reimbursement, or otherwise. Group health plan includes an employer directly operating a
41	41	2.13self-insurance plan for its employees' benefits and an entity that administers a program of
42	42	2.14health benefits established pursuant to a collective bargaining agreement between an
43	43	2.15employer, or group or association of employers, and a union or unions.
44	44	2.16 (g) "Health plan company" has the meaning provided in section 62Q.01, subdivision 4.
45	45	2.17For purposes of this section, health plan company includes a county-based purchasing plan
46	46	2.18authorized under section 256B.692; an integrated health partnership authorized under section
47	47	2.19256B.0755; and a group health plan sponsor.
48	48	2.20 (h) "Health care provider" or "provider" means a health care provider as defined in
49	49	2.21section 62J.03, subdivision 8.
50	50	2.22 (i) "Health care services" means the following:
51	51	2.23 (1) services included in providing medical care, dental care, pharmaceutical benefits, or
52	52	2.24hospitalization, including but not limited to services provided in a hospital, surgical center,
53	53	2.25or health care facilities;
54	54	2.26 (2) ancillary services, including but not limited to ambulatory services and emergency
55	55	2.27and nonemergency transportation;
56	56	2.28 (3) services provided by a health care provider, including but not limited to health care
57	57	2.29professionals licensed by the state; and
58	58	2.30 (4) behavioral health services, including but not limited to mental health and substance
59	59	2.31abuse services.
60	60	2.32 (j) "Managed care risk arrangement" means an arrangement where participating hospitals
61	61	2.33and health care providers agree to a managed care risk incentive that shares favorable or
62	62	2Section 1.
63	63	REVISOR EAP/HL 23-0069412/20/22 3.1unfavorable claims experience. A managed care risk arrangement payment to a participating
64	64	3.2health care provider is generally subject to a retention requirement and the distribution of
65	65	3.3that retained payment is contingent on the result of the risk incentive arrangement.
66	66	3.4 (k) "Network access arrangement" means an agreement that allows a network access to
67	67	3.5another provider network for certain services that are not readily available in the accessing
68	68	3.6network.
69	69	3.7 (l) "Paid claims" mean actual payments, including net adjustments, made to a health
70	70	3.8care provider or reimbursed to an individual by a health plan company or third-party
71	71	3.9administrator or excess loss or stop loss insurer. Paid claims include payments, including
72	72	3.10net adjustments, made under a service contract for administrative services only, for health
73	73	3.11care services provided under group health plans; any claims for service in this state by a
74	74	3.12pharmacy benefits manager; and individual, nongroup, and group insurance coverage to
75	75	3.13residents of this state paid in this state that affect the rights of an insured in this state and
76	76	3.14bear a reasonable relation to this state, regardless of whether the coverage is delivered,
77	77	3.15renewed, or issued for delivery in this state. If a health plan company or a third-party
78	78	3.16administrator is contractually entitled to withhold a certain amount from payments due to
79	79	3.17providers of health care services in order to help ensure that the providers can fulfill any
80	80	3.18quality or financial obligations they may have under a managed care risk arrangement, the
81	81	3.19full amounts due to the providers before that amount is withheld shall be included in paid
82	82	3.20claims. A paid claim does not include any of the following:
83	83	3.21 (1) claims-related expenses;
84	84	3.22 (2) payments made to a qualifying provider under an incentive compensation arrangement
85	85	3.23if the payments are not reflected in the processing of claims submitted for services provided
86	86	3.24to specific covered individuals;
87	87	3.25 (3) claims paid by a health plan company or third-party administrator for specified
88	88	3.26accident, accident-only coverage, credit, disability income, long-term care, health-related
89	89	3.27claims under automobile insurance, homeowners insurance, farm owners, commercial
90	90	3.28multi-peril, and workers' compensation or coverage issued as a supplement to liability
91	91	3.29insurance;
92	92	3.30 (4) claims paid for services provided to a nonresident of Minnesota;
93	93	3.31 (5) claims paid under a federal employee health benefit program, Medicare, Medicare
94	94	3.32Advantage, Medicare part D, Tricare, or by the United States Veterans Administration;
95	95	3Section 1.
96	96	REVISOR EAP/HL 23-0069412/20/22 4.1 (6) reimbursements to individuals under a flexible spending arrangement as that term
97	97	4.2is defined in section 106(c)(2) of the Internal Revenue Code; a health savings account as
98	98	4.3defined in section 223 of the Internal Revenue Code; an Archer medical savings account
99	99	4.4as defined in section 220 of the Internal Revenue Code; a Medicare Advantage MSA as
100	100	4.5defined in section 138 of the Internal Revenue Code; or other health reimbursement
101	101	4.6arrangement authorized under federal law; and
102	102	4.7 (7) health care services costs paid by an individual under the individual's health plan
103	103	4.8cost-sharing requirements, including deductibles, coinsurance, or co-payments.
104	104	4.9 (m) "Resident" means an individual whose domicile is in Minnesota.
105	105	4.10 (n) "Self-insurance plan" has the meaning given in section 60A.23, subdivision 8.
106	106	4.11 (o) "Third-party administrator" means a vendor of risk management services or an entity
107	107	4.12that administers, for compensation, a self-insurance or insurance plan. Third-party
108	108	4.13administrator includes a pharmacy benefit manager as defined under section 151.71 that
109	109	4.14pays claims for pharmaceutical services under a contract with a health plan company or
110	110	4.15self-insurer.
111	111	4.16 Subd. 2.Claims expenditure assessment.(a) For dates of service beginning on or after
112	112	4.17January 1, 2023, an assessment of two percent shall be collected from each health plan
113	113	4.18company and third-party administrator on the claims paid by that health plan company or
114	114	4.19third-party administrator.
115	115	4.20 (b) If a group health plan uses the services of a third-party administrator or excess loss
116	116	4.21or stop loss insurer, the following shall apply:
117	117	4.22 (1) a group health plan sponsor is not responsible for an assessment under this section
118	118	4.23for a paid claim if the assessment on that claim has been paid by a third-party administrator
119	119	4.24or excess loss or stop loss insurer, except as provided in subdivision 3;
120	120	4.25 (2) except as provided in clause (4), the third-party administrator is responsible for all
121	121	4.26assessments on paid claims paid by the third-party administrator;
122	122	4.27 (3) except as provided in clause (4), the excess loss or stop loss insurer is responsible
123	123	4.28for all assessments on paid claims paid by the excess loss or stop loss insurer; and
124	124	4.29 (4) if there is both a third-party administrator and an excess loss or stop loss insurer
125	125	4.30servicing a group health plan, the third-party administrator is responsible for all assessments
126	126	4.31for paid claims that are not reimbursed by the excess loss or stop loss insurer and the excess
127	127	4.32loss or stop loss insurer is responsible for all assessments for paid claims that are reimbursable
128	128	4.33to the excess loss or stop loss insurer.
129	129	4Section 1.
130	130	REVISOR EAP/HL 23-0069412/20/22 5.1 (c) To the extent an assessment paid under this section for paid claims is inaccurate due
131	131	5.2to subsequent claims adjustments or recoveries, subsequent filings shall be adjusted to
132	132	5.3accurately reflect the correct assessment based on actual claims paid.
133	133	5.4 Subd. 3.Collection methodology.(a) A health plan company or third-party administrator
134	134	5.5may collect the assessment levied under this section from an individual, employer, or group
135	135	5.6health plan sponsor, subject to the following:
136	136	5.7 (1) any methodology used must be applied uniformly within a line of business; and
137	137	5.8 (2) the amount collected must only reflect the assessment levied under this section and
138	138	5.9must not include any additional amounts such as administrative expenses.
139	139	5.10 (b) The amount collected by a health plan company under this subdivision shall not be
140	140	5.11considered as an element or factor of a rate for purposes of rate filing or approval
141	141	5.12requirements with the commissioner of commerce.
142	142	5.13 Subd. 4.Filing; payment method.(a) Every health plan company and third-party
143	143	5.14administrator with paid claims subject to the assessment under this section shall file with
144	144	5.15the commissioner on April 30, July 30, October 30, and January 30 of each year a return
145	145	5.16for the preceding calendar quarter in a form prescribed by the commissioner. Each health
146	146	5.17plan company and third-party administrator shall pay to the commissioner the amount of
147	147	5.18the assessment imposed under this section for the paid claims included in the return. The
148	148	5.19commissioner may require each health plan company and third-party administrator to file
149	149	5.20with the commissioner an annual reconciliation return.
150	150	5.21 (b) If a due date falls on a Saturday, Sunday, or state or federal holiday, the return and
151	151	5.22assessments are due the next succeeding business day.
152	152	5.23 (c) The commissioner may require that payment of the assessment be made by an
153	153	5.24electronic funds transfer method approved by the commissioner.
154	154	5.25 Subd. 5.Records; failure to file return.(a) A health plan company or third-party
155	155	5.26administrator liable for an assessment under this section shall keep accurate and complete
156	156	5.27records and pertinent documents as required by the commissioner.
157	157	5.28 (b) If a health plan company or third-party administrator fails to file a return or keep
158	158	5.29proper records as required under this subdivision, or if the commissioner has reason to
159	159	5.30believe that any records kept or returns filed are inaccurate or incomplete and that additional
160	160	5.31assessments are due, the commissioner may assess the amount of the assessment due from
161	161	5.32the health plan company or third-party administrator based on information that is available
162	162	5.33or that may become available to the commissioner.
163	163	5Section 1.
164	164	REVISOR EAP/HL 23-0069412/20/22 6.1 Subd. 6.Failure to pay assessment.The commissioner shall notify the commissioners
165	165	6.2of commerce and health of any final determination that a health plan company or third-party
166	166	6.3administrator has failed to pay an assessment, interest, or penalty when due. The
167	167	6.4commissioner of commerce or commissioner of health may suspend or revoke, after notice
168	168	6.5and hearing, the certificate of authority or license to operate in this state. A certificate of
169	169	6.6authority or license that is suspended or revoked under this subdivision shall not be reinstated
170	170	6.7until any delinquent assessment, interest, or penalty has been paid.
171	171	6.8 Subd. 7.Deposit of revenues.The commissioner shall deposit all revenues and interest
172	172	6.9derived from the assessment imposed under this section in the health care access fund. All
173	173	6.10revenues and interest derived from the assessment imposed by this section shall be
174	174	6.11appropriated only for the administration of the MinnesotaCare and medical assistance
175	175	6.12programs, the implementation of the assessment imposed under subdivision 2, and existing
176	176	6.13ongoing appropriations.
177	177	6Section 1.
178	178	REVISOR EAP/HL 23-0069412/20/22