HF 1677

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 03/02/2023 05:25pm

A bill for an act
relating to insurance; providing for network adequacy; requiring a report; amending
Minnesota Statutes 2022, sections 62K.10, subdivision 4; 62Q.096; 62Q.47.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2022, section 62K.10, subdivision 4, is amended to read:

Subd. 4.

Network adequacy.

new text begin (a) new text end Each designated provider network must include a
sufficient number and type of providers, including providers that specialize in mental health
and substance use disorder services, to ensure that covered services are available to all
enrollees without unreasonable delay. In determining network adequacy, the commissioner
of health shall consider availability of services, including the following:

(1) primary care physician services are available and accessible 24 hours per day, seven
days per week, within the network area;

(2) a sufficient number of primary care physicians have hospital admitting privileges at
one or more participating hospitals within the network area so that necessary admissions
are made on a timely basis consistent with generally accepted practice parameters;

(3) specialty physician service is available through the network or contract arrangement;

(4) mental health and substance use disorder treatment providers are available and
accessible through the network or contract arrangement;

(5) to the extent that primary care services are provided through primary care providers
other than physicians, and to the extent permitted under applicable scope of practice in state
law for a given provider, these services shall be available and accessible; and

(6) the network has available, either directly or through arrangements, appropriate and
sufficient personnel, physical resources, and equipment to meet the projected needs of
enrollees for covered health care services.

new text begin (b) The commissioner must determine network sufficiency in a manner that is consistent
with the requirements of this section and may establish sufficiency by referencing any
reasonable criteria, which may include but is not limited to:
new text end

new text begin (1) provider-covered person ratios by specialty;
new text end

new text begin (2) primary care professional-covered person ratios;
new text end

new text begin (3) geographic accessibility of providers;
new text end

new text begin (4) geographic variation and population dispersion;
new text end

new text begin (5) waiting times for an appointment with participating providers;
new text end

new text begin (6) hours of operation;
new text end

new text begin (7) the ability of the network to meet the needs of covered persons, which may include:
(i) low-income persons; (ii) children and adults with serious, chronic, or complex health
conditions, physical disabilities, or mental illness; or (iii) persons with limited English
proficiency and persons from underserved communities;
new text end

new text begin (8) other health care service delivery system options, including telemedicine or telehealth,
mobile clinics, centers of excellence, and other ways of delivering care; and
new text end

new text begin (9) the volume of technological and specialty care services available to serve the needs
of covered persons that need technologically advanced or specialty care services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2022, section 62Q.096, is amended to read:

62Q.096 CREDENTIALING OF PROVIDERS.

new text begin (a) new text end If a health plan company has initially credentialed, as providers in its provider network,
individual providers employed by or under contract with an entity that:

(1) is authorized to bill under section 256B.0625, subdivision 5;

(2) is a mental health clinic certified under section 245I.20;

(3) is designated an essential community provider under section 62Q.19; and

(4) is under contract with the health plan company to provide mental health services,
the health plan company must continue to credential at least the same number of providers
from that entity, as long as those providers meet the health plan company's credentialing
standards.

new text begin (b) In order to ensure timely access by patients to mental health services, between July
1, 2023, and June 30, 2025, a health plan company must credential and enter into a contract
for mental health services with any provider of mental health services that:
new text end

new text begin (1) meets the health plan company's credential requirements. For purposes of credentialing
under this paragraph, a health plan company may waive credentialing requirements that are
not directly related to quality of care in order to ensure patient access to providers from
underserved communities or to providers in rural areas;
new text end

new text begin (2) seeks to receive a credential from the health plan company;
new text end

new text begin (3) agrees to the health plan company's contract terms. The contract shall include payment
rates that are usual and customary for the services provided;
new text end

new text begin (4) is accepting new patients; and
new text end

new text begin (5) is not already under a contract with the health plan company under a separate tax
identification number or, if already under a contract with the health plan company, has
provided notice to the health plan company of termination of the existing contract.
new text end

new text begin (c) new text end A health plan company shall not refuse to credential these providers on the grounds
that their provider network has new text begin :
new text end

new text begin (1) new text end a sufficient number of providers of that type new text begin , including but not limited to the provider
types identified in paragraph (a); or
new text end

new text begin (2) a sufficient number of providers of mental health services in the aggregate new text end .

new text begin (d) A health plan company must credential a mental health provider that meets the health
plan company's standards in order to ensure fast access to mental health treatment.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2023.
new text end

Sec. 3.

Minnesota Statutes 2022, section 62Q.47, is amended to read:

62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY
SERVICES.

(a) All health plans, as defined in section 62Q.01, that provide coverage for alcoholism,
mental health, or chemical dependency services, must comply with the requirements of this
section.

(b) Cost-sharing requirements and benefit or service limitations for outpatient mental
health and outpatient chemical dependency and alcoholism services, except for persons
placed in chemical dependency services under Minnesota Rules, parts 9530.6600 to
9530.6655, must not place a greater financial burden on the insured or enrollee, or be more
restrictive than those requirements and limitations for outpatient medical services.

(c) Cost-sharing requirements and benefit or service limitations for inpatient hospital
mental health and inpatient hospital and residential chemical dependency and alcoholism
services, except for persons placed in chemical dependency services under Minnesota Rules,
parts 9530.6600 to 9530.6655, must not place a greater financial burden on the insured or
enrollee, or be more restrictive than those requirements and limitations for inpatient hospital
medical services.

(d) A health plan company must not impose an NQTL with respect to mental health and
substance use disorders in any classification of benefits unless, under the terms of the health
plan as written and in operation, any processes, strategies, evidentiary standards, or other
factors used in applying the NQTL to mental health and substance use disorders in the
classification are comparable to, and are applied no more stringently than, the processes,
strategies, evidentiary standards, or other factors used in applying the NQTL with respect
to medical and surgical benefits in the same classification.

(e) All health plans must meet the requirements of the federal Mental Health Parity Act
of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008; the Affordable Care Act; and any amendments to, and federal
guidance or regulations issued under, those acts.

(f) The commissioner may require information from health plan companies to confirm
that mental health parity is being implemented by the health plan company. Information
required may include comparisons between mental health and substance use disorder
treatment and other medical conditions, including a comparison of prior authorization
requirements, drug formulary design, claim denials, rehabilitation services, and other
information the commissioner deems appropriate.

(g) Regardless of the health care provider's professional license, if the service provided
is consistent with the provider's scope of practice and the health plan company's credentialing
and contracting provisions, mental health therapy visits and medication maintenance visits
shall be considered primary care visits for the purpose of applying any enrollee cost-sharing
requirements imposed under the enrollee's health plan.

(h) By June 1 of each year, beginning June 1, 2021, the commissioner of commerce, in
consultation with the commissioner of health, shall submit a report on compliance and
oversight to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and commerce. The report must:

(1) describe the commissioner's process for reviewing health plan company compliance
with United States Code, title 42, section 18031(j), any federal regulations or guidance
relating to compliance and oversight, and compliance with this section and section 62Q.53;

(2) identify any enforcement actions taken by either commissioner during the preceding
12-month period regarding compliance with parity for mental health and substance use
disorders benefits under state and federal law, summarizing the results of any market conduct
examinations. The summary must include: (i) the number of formal enforcement actions
taken; (ii) the benefit classifications examined in each enforcement action; and (iii) the
subject matter of each enforcement action, including quantitative and nonquantitative
treatment limitations;

(3) detail any corrective action taken by either commissioner to ensure health plan
company compliance with this section, section 62Q.53, and United States Code, title 42,
section 18031(j); and

(4) describe the information provided by either commissioner to the public about
alcoholism, mental health, or chemical dependency parity protections under state and federal
law.

The report must be written in nontechnical, readily understandable language and must be
made available to the public by, among other means as the commissioners find appropriate,
posting the report on department websites. Individually identifiable information must be
excluded from the report, consistent with state and federal privacy protections.

new text begin (i) The commissioner must require health plans with contracts under section 256B.69
to use the timely filing timelines and prior authorization processes consistent with medical
assistance fee-for-service for mental health and substance use disorder services covered
under medical assistance.
new text end

Sec. 4. new text begin GEOGRAPHIC ACCESSIBILITY AND NETWORK ADEQUACY STUDY.
new text end

new text begin (a) The commissioner of health, in consultation with the commissioner of commerce
and stakeholders, must study and develop recommendations on additional methods, other
than maximum distance and travel times for enrollees, to determine adequate geographic
accessibility of health care providers and the adequacy of health care provider networks
maintained by health plan companies. The commissioner may examine the effectiveness
and feasibility of using the following methods to determine geographic accessibility and
network adequacy:
new text end

new text begin (1) establishing ratios of providers to enrollees by provider specialty;
new text end

new text begin (2) establishing ratios of primary care providers to enrollees; and
new text end

new text begin (3) establishing maximum waiting times for appointments with participating providers.
new text end

new text begin (b) The commissioner must examine:
new text end

new text begin (1) geographic accessibility of providers under current law;
new text end

new text begin (2) geographic variation and population dispersion;
new text end

new text begin (3) how provider hours of operations limit access to care;
new text end

new text begin (4) the ability of existing networks to meet the needs of enrollees, which may include
low-income persons; children and adults with serious, chronic, or complex health conditions,
physical disabilities, or mental illness; or persons with limited English proficiency and
persons from underserved communities;
new text end

new text begin (5) other health care service delivery options, including telehealth, mobile clinics, centers
of excellence, and other ways of delivering care; and
new text end

new text begin (6) the availability of services needed to meet the needs of enrollees requiring
technologically advanced or specialty care services.
new text end

new text begin (c) The commissioner must submit to the legislature a report on the study and
recommendations required by this section no later than January 15, 2024.
new text end