1.1.................... moves to amend S.F. No. 1, the second engrossment, as follows:
1.2Delete everything after the enacting clause and insert:


1.5    Section 1. DEFINITIONS.
1.6    Subdivision 1. Scope. For purposes of sections 1 to 5, the following terms have the
1.7meanings given.
1.8    Subd. 2. Eligible individual. "Eligible individual" means a Minnesota resident who is
1.9not receiving a premium tax credit under Code of Federal Regulations and is not receiving
1.10public program coverage under Minnesota Statutes, section 256B.055, or 256L.04.
1.11    Subd. 3. Gross premium. "Gross premium" means the amount billed for a health plan
1.12purchased by an eligible individual prior to a state premium subsidy, as defined in subdivision
1.135, in a calendar year.
1.14    Subd. 4. Net premium. "Net premium" means the gross premium less the premium
1.15subsidy defined in subdivision 5.
1.16    Subd. 5. Premium subsidy. "Premium subsidy":
1.17(1) is a payment made on behalf of eligible individuals for the promotion of general
1.18welfare, and is not compensation for any services;
1.19(2) is equal to 25 percent of the monthly gross premium otherwise paid by or on behalf
1.20of the eligible individual for coverage purchased in the individual market, that covers the
1.21eligible individual and the eligible individual's spouse and dependents; and
1.22(3) is excluded from any calculation used to determine eligibility within any of the
1.23Department of Human Services programs.
2.1    Subd. 6. Health carrier. "Health carrier" has the meaning given in Minnesota Statutes,
2.2section 62A.011, subdivision 2.
2.3    Subd. 7. Commissioner. "Commissioner" means the commissioner of management and
2.4budget.
2.5    Subd. 8. Individual market. "Individual market" means the market for health insurance
2.6coverage offered to individuals other than in connection with a group health plan, as defined
2.7in Minnesota Statutes, section 62A.011, subdivision 5.

2.8    Sec. 2. PAYMENT TO HEALTH CARRIERS ON BEHALF OF ELIGIBLE
2.9INDIVIDUALS.
2.10    Subdivision 1. Program established. The commissioner of Minnesota Management
2.11and Budget, in consultation with the commissioner of commerce and the commissioner of
2.12human services, shall establish and administer the premium subsidy program authorized by
2.13this act, to help eligible individuals pay for coverage in the individual market in 2017.
2.14    Subd. 2. Premium subsidy provided. A health carrier shall provide a premium subsidy
2.15to an eligible individual who purchases a health plan in the individual market. An eligible
2.16individual shall pay the net premium amount to the health carrier.
2.17    Subd. 3. Payments to health carriers. The commissioner shall make payments to health
2.18carriers on behalf of eligible individuals effectuating coverage for calendar year 2017, for
2.19the months in that year for which the individual has paid the net premium amount to the
2.20health carrier. Payments to health carriers shall be based on the premium subsidy available
2.21to eligible individuals in the individual market, regardless of the cost of coverage purchased.
2.22Health carriers seeking reimbursement from the commissioner must submit an invoice and
2.23supporting information to the commissioner, in a form prescribed by the commissioner, in
2.24order to be eligible for payment. Total state payments to health carriers must be made within
2.25the limits of the available appropriation in section 5. The commissioner shall prorate
2.26payments to health carriers if necessary, so as not to exceed the available appropriation.

2.27    Sec. 3. AUDIT.
2.28The commissioner of commerce shall conduct audits of the health carriers' supporting
2.29data, as prescribed by the commissioner, to determine whether payments align with criteria
2.30established in sections 1 and 2. The Department of Human Services shall provide data as
2.31necessary to the Department of Commerce to complete the audit. All data collected for that
2.32purpose shall be held as confidential and nonpublic as defined in Minnesota Statutes, chapter
3.113. The commissioner shall withhold payments from or charge back payments to the health
3.2carriers to the extent they do not align with the criteria established in sections 1 and 2, as
3.3determined by the Department of Commerce.

3.4    Sec. 4. APPLICABILITY OF GROSS PREMIUM.
3.5Notwithstanding premium subsidies provided under section 2, the premium base for
3.6calculating the amount of any applicable premium taxes under Minnesota Statutes, chapter
3.7297I or premium withholds under Minnesota Statutes, section 62V.05, subdivision 2, shall
3.8be the gross premium, for health plans purchased by eligible individuals in the individual
3.9market.

3.10    Sec. 5. TRANSFER.
3.11$311,945,000 in fiscal year 2017 is transferred from the budget reserve account in
3.12Minnesota Statutes, section 16A.152, subdivision 1a, to the general fund.

3.13    Sec. 6. APPROPRIATIONS.
3.14(a) $311,645,000 in fiscal year 2017 is appropriated from the general fund to the
3.15commissioner of Minnesota Management and Budget for the purposes of making payments
3.16as defined in section 2. The appropriation is onetime and is available through June 30, 2018.
3.17(b) $300,000 in fiscal year 2017 is appropriated from the general fund to the commissioner
3.18of commerce for purposes of section 3, and to facilitate payments to health carriers. The
3.19appropriation is onetime and is available until expended.

3.20    Sec. 7. EFFECTIVE DATE.
3.21Sections 1 to 6 are effective the day following final enactment.


3.24    Section 1. TRANSITION OF CARE COVERAGE FOR CALENDAR YEAR 2017;
3.25INVOLUNTARY TERMINATION OF COVERAGE.
3.26    Subdivision 1. Definitions. (a) For purposes of this section, the following terms have
3.27the meanings given.
3.28(b) "Enrollee" has the meaning given in Minnesota Statutes, section 62Q.01, subdivision
3.292b.
4.1(c) "Health plan" has the meaning given in Minnesota Statutes, section 62Q.01,
4.2subdivision 3.
4.3(d) "Health plan company" has the meaning given in Minnesota Statutes, section 62Q.01,
4.4subdivision 4.
4.5(e) "Individual market" has the meaning given in Minnesota Statutes, section 62A.011,
4.6subdivision 5.
4.7(f) "Involuntary termination of coverage" means the termination of a health plan due to
4.8a health plan company's refusal to renew the health plan in the individual market because
4.9the health plan company elects to cease offering individual market health plans in all or
4.10some geographic rating areas of the state.
4.11    Subd. 2. Application. This section applies to an enrollee who is subject to a change in
4.12health plans in the individual market due to an involuntary termination of coverage from a
4.13health plan in the individual market after October 31, 2016, and before January 1, 2017,
4.14and who enrolls in a new health plan in the individual market for all or a portion of calendar
4.15year 2017 that goes into effect after December 31, 2016, and before March 2, 2017.
4.16    Subd. 3. Change in health plans; transition of care coverage. (a) If an enrollee satisfies
4.17the criteria in subdivision 2, the enrollee's new health plan company must provide, upon
4.18request of the enrollee or the enrollee's health care provider, authorization to receive services
4.19that are otherwise covered under the terms of the enrollee's calendar year 2017 health plan
4.20from a provider who provided care on an in-network basis to the enrollee during calendar
4.21year 2016 but who is out of network in the enrollee's calendar year 2017 health plan:
4.22(1) for up to 120 days if the enrollee has received a diagnosis of, or is engaged in a
4.23current course of treatment for, one or more of the following conditions:
4.24(i) an acute condition;
4.25(ii) a life-threatening mental or physical illness;
4.26(iii) pregnancy beyond the first trimester of pregnancy;
4.27(iv) a physical or mental disability defined as an inability to engage in one or more major
4.28life activities, provided the disability has lasted or can be expected to last for at least one
4.29year or can be expected to result in death; or
4.30(v) a disabling or chronic condition that is in an acute phase; or
4.31(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
4.32lifetime of 180 days or less.
5.1(b) For all requests for authorization under this subdivision, the health plan company
5.2must grant the request for authorization unless the enrollee does not meet the criteria in
5.3paragraph (a) or subdivision 2.
5.4(c) The commissioner of Minnesota Management and Budget must reimburse the
5.5enrollee's new health plan company for costs attributed to services authorized under this
5.6subdivision. Costs eligible for reimbursement under this paragraph are the difference between
5.7the health plan company's reimbursement rate for in-network providers for a service
5.8authorized under this subdivision and its rate for out-of-network providers for the service.
5.9The health plan company must seek reimbursement from the commissioner for costs
5.10attributed to services authorized under this subdivision, in a form and manner mutually
5.11agreed upon by the commissioner and the affected health plan companies. Total state
5.12reimbursements to health plan companies under this paragraph are subject to the limits of
5.13the available appropriation. In the event that funding for reimbursements to health plan
5.14companies is not sufficient to fully reimburse health plan companies for the costs attributed
5.15to services authorized under this subdivision, health plan companies must continue to cover
5.16services authorized under this subdivision.
5.17    Subd. 4. Limitations. (a) Subdivision 3 applies only if the enrollee's health care provider
5.18agrees to:
5.19(1) accept as payment in full the lesser of:
5.20(i) the health plan company's reimbursement rate for in-network providers for the same
5.21or similar service; or
5.22(ii) the provider's regular fee for that service;
5.23(2) request authorization for services in the form and manner specified by the enrollee's
5.24new health plan company, if the provider chooses to request authorization; and
5.25(3) provide the enrollee's new health plan company with all necessary medical information
5.26related to the care provided to the enrollee.
5.27(b) Nothing in this section requires a health plan company to provide coverage for a
5.28health care service or treatment that is not covered under the enrollee's health plan.
5.29    Subd. 5. Request for authorization. The enrollee's health plan company may require
5.30medical records and other supporting documentation to be submitted with a request for
5.31authorization under subdivision 3. If authorization is denied, the health plan company must
5.32explain the criteria used to make its decision on the request for authorization and must
5.33explain the enrollee's right to appeal the decision. If an enrollee chooses to appeal a denial,
6.1the enrollee must appeal the denial within five business days of the date on which the enrollee
6.2receives the denial. If authorization is granted, the health plan company must provide the
6.3enrollee, within five business days of granting the authorization, with an explanation of
6.4how transition of care will be provided.
6.5EFFECTIVE DATE.This section is effective for health plans issued after December
6.631, 2016, and before March 2, 2017, and that are in effect for all or a portion of calendar
6.7year 2017. This section expires June 30, 2018.

6.8    Sec. 2. APPROPRIATION; COVERAGE FOR TRANSITION OF CARE.
6.9$15,000,000 in fiscal year 2017 is appropriated from the general fund to the commissioner
6.10of Minnesota Management and Budget to reimburse health plan companies for costs attributed
6.11to coverage of transition of care services under section 1. No more than three percent of
6.12this appropriation is available to the commissioner for administrative costs. This is a onetime
6.13appropriation and is available until June 30, 2018.
6.14EFFECTIVE DATE.This section is effective the day following final enactment."
6.15Amend the title accordingly