SF 1081

2nd Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to insurance; requiring an affirmative 
  1.3             provider consent to participate in a network under a 
  1.4             category of coverage; requiring disclosure of changes 
  1.5             in a provider's contract; establishing a moratorium on 
  1.6             managed care automobile insurance plans; amending 
  1.7             Minnesota Statutes 2000, section 62Q.74, subdivisions 
  1.8             2, 3, 4; proposing coding for new law in Minnesota 
  1.9             Statutes, chapter 62Q. 
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2000, section 62Q.74, 
  1.12  subdivision 2, is amended to read: 
  1.13     Subd. 2.  [PROVIDER CONSENT REQUIRED.] (a) No network 
  1.14  organization shall require a health care provider to participate 
  1.15  in a network under a category of coverage that differs from the 
  1.16  category or categories of coverage to which the existing 
  1.17  contract between the network organization and the provider 
  1.18  applies, without the affirmative consent of the provider 
  1.19  obtained under subdivision 3.  
  1.20     (b) This section does not apply to situations in which the 
  1.21  network organization wishes the provider to participate in a new 
  1.22  or different plan or other arrangement within a category of 
  1.23  coverage that is already provided for in an existing contract 
  1.24  between the network organization and the provider. 
  1.25     (c) Compliance with this section may not be waived in a 
  1.26  contract or otherwise. 
  1.27     Sec. 2.  Minnesota Statutes 2000, section 62Q.74, 
  2.1   subdivision 3, is amended to read: 
  2.2      Subd. 3.  [CONSENT PROCEDURE.] (a) The network 
  2.3   organization, if it wishes to apply an existing contract with a 
  2.4   provider to a different category of coverage, shall first notify 
  2.5   the provider in writing.  The written notice must include at 
  2.6   least the following: 
  2.7      (1) the network organization's name, address, and telephone 
  2.8   number, and the name of the specific network, if it differs from 
  2.9   that of the network organization; 
  2.10     (2) a description of the proposed new category of coverage; 
  2.11     (3) the names of all payers expected by the network 
  2.12  organization to use the network for the new category of 
  2.13  coverage; 
  2.14     (4) the approximate number of current enrollees of the 
  2.15  network organization in that category of coverage within the 
  2.16  provider's geographical area; 
  2.17     (5) a disclosure of all contract terms of the proposed new 
  2.18  category of coverage, including the discount or reduced fees, 
  2.19  care guidelines, utilization review criteria, prior 
  2.20  authorization process, and dispute resolution process; 
  2.21     (6) a form for the provider's convenience in accepting or 
  2.22  declining participation in the proposed new category of 
  2.23  coverage, provided that the provider need not use that form in 
  2.24  responding; and 
  2.25     (7) a statement informing the provider of the provisions of 
  2.26  paragraph (b). 
  2.27     (b) If the provider does not decline participation within 
  2.28  30 days after the postmark date of the notice, the provider is 
  2.29  deemed to have accepted the proposed new category of 
  2.30  coverage Unless the provider has affirmatively agreed to 
  2.31  participate within 60 days after the postmark date of the 
  2.32  notice, the provider is deemed to have not accepted the proposed 
  2.33  new category of coverage. 
  2.34     Sec. 3.  Minnesota Statutes 2000, section 62Q.74, 
  2.35  subdivision 4, is amended to read: 
  2.36     Subd. 4.  [CONTRACT TERMINATION RESTRICTED.] (a) A network 
  3.1   organization must not terminate an existing contract with a 
  3.2   provider, or fail to honor the contract in good faith, based 
  3.3   solely on the provider's decision not to accept a proposed new 
  3.4   category of coverage.  The most recent agreed-upon contractual 
  3.5   obligations remain in force until the existing contract's 
  3.6   renewal or termination date. 
  3.7      (b) If a provider declines to participate in a category of 
  3.8   coverage, the network organization must permit the provider the 
  3.9   opportunity to participate in that category of coverage when the 
  3.10  organization determines a demographic or geographic need. 
  3.11     Sec. 4.  [62Q.745] [PROVIDER CONTRACT AMENDMENT 
  3.12  DISCLOSURE.] 
  3.13     (a) Any amendment or change in the terms of an existing 
  3.14  contract between a network organization and a health care 
  3.15  provider must be disclosed to the provider. 
  3.16     (b) Any amendment or change in the contract that alters the 
  3.17  financial reimbursement or alters the written contractual 
  3.18  policies and procedures governing the relationship between the 
  3.19  provider and the network organization must be disclosed to the 
  3.20  provider before the amendment or change is deemed to be in 
  3.21  effect. 
  3.22     (c) For purposes of this section, "network organization" 
  3.23  and "health care provider" or "provider" have the meanings given 
  3.24  in section 62Q.74. 
  3.25     Sec. 5.  [MORATORIUM] 
  3.26     Subdivision 1.  [MORATORIUM ON NEW MANAGED CARE AUTOMOBILE 
  3.27  INSURANCE PLANS.] No health plan company as defined under 
  3.28  Minnesota Statutes, section 62Q.01, subdivision 4, or automobile 
  3.29  insurance company licensed under Minnesota Statutes, chapter 
  3.30  65B, may sign any new no-fault automobile insurance managed care 
  3.31  contract with a health care provider between January 1, 2001, 
  3.32  and June 30, 2002.  A "managed care contract" is defined for 
  3.33  purposes of this section as a contract with a health care 
  3.34  provider that provides for prior authorization requirements, 
  3.35  formulary limitations, rate capitation, restricted protocols, or 
  3.36  preestablished limitations on the type, duration, or frequency 
  4.1   of care. 
  4.2      Subd. 2.  [LIMITED PANEL DISCLOSURE.] Effective July 1, 
  4.3   2001, an insurer regulated under Minnesota Statutes, chapter 
  4.4   65B, with a managed care contract as defined under subdivision 
  4.5   1, must provide to the insured upon notice of an automobile 
  4.6   injury claim report a disclosure statement informing the insured 
  4.7   of the following: 
  4.8      (1) under state law, the injured has the option of 
  4.9   receiving medical care for injuries received in an automobile 
  4.10  accident from any licensed provider or health care facility and 
  4.11  is not required to seek medical care through a case management 
  4.12  program or from a designated network of providers, hospitals, or 
  4.13  clinics; and 
  4.14     (2) if the insured receives medical care through a case 
  4.15  management program or a designated provider network, medical 
  4.16  care may be restricted in terms of the type, duration, or 
  4.17  frequency of the care provided and the insured may be required 
  4.18  to seek prior authorization before medical care is reimbursed by 
  4.19  the insurer. 
  4.20     Subd. 3.  [EXISTING MANAGED CARE CONTRACTS.] Any health 
  4.21  plan company or automobile insurer that is party to a managed 
  4.22  care contract in existence prior to the moratorium created on 
  4.23  January 1, 2001, must comply with the following provisions 
  4.24  during the moratorium created under this act: 
  4.25     (1) no such managed care contract shall be extended to any 
  4.26  additional insurers; and 
  4.27     (2) if a provider has declined to participate in a category 
  4.28  of coverage, the network organization must permit the provider 
  4.29  the opportunity to participate in that category of coverage on 
  4.30  an annual basis. 
  4.31     Subd. 4.  [SUNSET.] This section is repealed effective June 
  4.32  30, 2002. 
  4.33     Sec. 6.  [EFFECTIVE DATE.] 
  4.34     Section 5 is effective the day following final enactment.