First, the bill establishes a $300 million premium relief program to provide direct financial assistance to individuals who are purchasing health insurance and who do not receive government subsidies. Under the program, every month health plan companies will provide the Commissioner of the Department of Management and Budget with information on everyone who has purchased effectuated coverage. This information will include name, address, or other identifying information and the premium paid for coverage. The individual must then apply to the Commissioner for premium assistance. The application will include the individual or family's modified adjusted gross income.
In contrast to what was proposed by the governor last month, the Republicans decided to make this program income sensitive. For the first three months of the program,all eligible individuals making less than 800% of federal poverty ($95,040 for an individual, or $194,400 for a family of four) would qualify for premium assistance equal to 25% of their premium. Then for the remaining nine months of 2017, there will be three categories of premium assistance based upon levels of income between 300 and 800 percent of poverty. Between April 1 and December 31 of 2017, the assistance will be 30%, 25% and 20% based upon income level. The assistance program must not exceed the $300 million appropriation. If it does the commissioner would adjust premium assistance most likely at higher income levels.
Fifteen million dollars will be set aside for continuing care for people who have been required to change health plans and have lost their current provider. This money would go to their new health plan which would be required to allow patients currently engaged in a course of treatment to continue with their doctor for acute conditions, life-threatening mental or physical illness, pregnancies beyond the first trimester and for special provisions and treatment for the last six months of life. This would be available immediately after passage and appears to not be tied to income.
Other provisions include allowing small business to reduce their reinsurance attachment point and narrow their claims settlement period making it easier for them to self-insure, requiring the DOC to disclose filed rates to the public earlier so they can react to future rate increases and last but not least allowing for-profit HMOs to enter our market. Only non-profit HMOs are allowed currently in Minnesota.
Another portion of the bill relates to surprise billing. Surprise billing occurs when a person is receiving care from a large clinic or hospital. Often as part of that care, a non-network provider will be called in to provide medical or diagnostic services. Afterwards the health plan does not pay network provider rates and the patient then is billed directly for the full-service rate. Generally, the patients never have knowledge of the provider's status until they get the bill, hence the surprise. This proposal would require the plans to take steps to avoid this practice and require the non-participating provider to accept in-network payment rates. This could be a bit controversial.
The House Republicans are putting this legislation on a fast track and would like to pass this legislation as early as next week. The Senate has indicated that will have a few hearings on their bill prior to its passage. Once the bills are passed, they will be sent to a conference committee where negotiations with the governor will begin. Governor Dayton has yet to express his opinion of the legislation.