HF 57

1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/08/2021 04:17pm

A bill for an act
relating to health; requiring medical practices to make available to the public their
current standard charges; authorizing the commissioner of health to establish a
price comparison tool for items and services offered by medical practices; proposing
coding for new law in Minnesota Statutes, chapter 62J.

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

Section 1.

new text begin [62J.826] MEDICAL PRACTICES; CURRENT STANDARD CHARGES;
COMPARISON TOOL.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
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new text begin (b) "Chargemaster" means the list of all individual items and services maintained by a
medical practice for which the medical practice has established a charge.
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new text begin (c) "Diagnostic laboratory testing" means a service charged using a CPT code within
the CPT code range of 80047 to 89398.
new text end

new text begin (d) "Diagnostic radiology service" means a service charged using a CPT code within
the CPT code range of 70010 to 7999 and includes the provision of x-rays, computed
tomography scans, positron emission tomography scans, magnetic resonance imaging scans,
and mammographies.
new text end

new text begin (e) "Hospital" means an acute care institution licensed under sections 144.50 to 144.58,
but does not include a health care institution conducted for those who rely primarily upon
treatment by prayer or spiritual means in accordance with the creed or tenets of any church
or denomination.
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new text begin (f) "Medical practice" means a business that:
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new text begin (1) earns revenue by providing medical care to the public;
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new text begin (2) issues payment claims to health plan companies and other payers; and
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new text begin (3) may be identified by its federal tax identification number.
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new text begin (g) "Outpatient surgical center" means a health care facility other than a hospital offering
elective outpatient surgery under a license issued under sections 144.50 to 144.58.
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new text begin Subd. 2. new text end

new text begin Requirement; current standard charges. new text end

new text begin The following medical practices
must make available to the public a list of their current standard charges, as reflected in the
medical practice's chargemaster, for all items and services provided by the medical practice:
new text end

new text begin (1) hospitals;
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new text begin (2) outpatient surgical centers; and
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new text begin (3) any other medical practice that has revenue of greater than $50,000,000 per year and
that derives the majority of its revenue by providing one or more of the following services:
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new text begin (i) diagnostic radiology services;
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new text begin (ii) diagnostic laboratory testing;
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new text begin (iii) orthopedic surgical procedures, including joint arthroplasty procedures within the
CPT code range of 26990 to 27899;
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new text begin (iv) opthalmologic surgical procedures, including cataract surgery coded using CPT
code 66982 or 66984, or refractive correction surgery to improve visual acuity;
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new text begin (v) anesthesia services commonly provided as an ancillary to services provided at a
hospital, outpatient surgical center, or medical practice that provides orthopedic surgical
procedures or opthalmologic surgical procedures; or
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new text begin (vi) oncology services, including radiation oncology treatments within the CPT code
range of 77261 to 77799 and drug infusions.
new text end

new text begin Subd. 3. new text end

new text begin Required file format and data attributes. new text end

new text begin (a) A medical practice required to
post its current standard charges must post the following data attributes in the listed order:
new text end

new text begin (1) federal tax identification number for the medical practice;
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new text begin (2) name of the medical practice, defined as the provider name that the medical practice
enters on the CMS claim form 1500 or a successor form when it submits health care claims
to a payer organization;
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new text begin (3) internal chargemaster record identification, defined as the internal record identifier
for this chargemaster line item in the medical practice's billing system;
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new text begin (4) service billing code system, defined as a code signifying the HIPAA-compliant
billing code system from which the service billing code was drawn;
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new text begin (5) service billing code, defined as a specific billing code drawn from the service billing
code system denoted by the value in the service billing code type field;
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new text begin (6) service description, defined as the shortest, nonabbreviated official description
associated with the service billing code in the applicable service billing code system;
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new text begin (7) revenue code, defined as the National Uniform Billing Committee revenue code
denoting the patient's location within the medical practice where the patient will receive the
item or service subject to this charge. This value is required only if the charge amount is
dependent on the location within the medical practice where the item or service is provided;
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new text begin (8) revenue code description, defined as the description provided by the National Uniform
Billing Committee for the revenue code. This value is required only if the charge amount
is dependent on the location within the medical practice where the item or service is provided;
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new text begin (9) national drug code, defined as the national drug code for a drug that is administered
as part of the service subject to this charge. This field is required only when the charge
amount is dependent on which, if any, drug is being administered as part of this service;
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new text begin (10) national drug code description, defined as the official description associated with
the national drug code for a drug that is administered as part of the service subject to this
charge. This field is required only when the charge amount is dependent on which, if any,
drug is being administered as part of this service;
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new text begin (11) inpatient gross charge, defined as the charge for an individual item or service that
is reflected on a hospital's chargemaster, absent any discounts as defined in Code of Federal
Regulations, title 45, section 180.20, for an item or service provided on an inpatient basis;
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new text begin (12) outpatient gross charge, defined as the charge for an individual item or service that
is reflected on a chargemaster, absent any discounts as defined in Code of Federal
Regulations, title 45, section 180.20, for an item or service provided on an outpatient basis;
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new text begin (13) inpatient discounted cash price, defined as the charge that applies to an individual
who pays cash or a cash equivalent for an item or service being reported under this section
and provided on an inpatient basis;
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new text begin (14) outpatient discounted cash price, defined as the charge that applies to an individual
who pays cash or a cash equivalent for an item or service being reported under this section
and provided on an outpatient basis;
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new text begin (15) charge unit, defined as the unit cost basis for the charge; and
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new text begin (16) effective date of the charge.
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new text begin (b) The data attributes specified in paragraph (a) must be posted in the form of a comma
separated values file.
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new text begin (c) The data attributes specified in paragraph (a) must be reported to the commissioner
of health in a form, manner, and frequency specified by the commissioner, and must be
made available to the public in a form and manner specified by the commissioner.
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new text begin Subd. 4. new text end

new text begin Price comparison tool. new text end

new text begin The commissioner shall use the information reported
to the commissioner under subdivision 3 to develop and make available to the public, a tool
for the public to use to compare charges for a specific item or service across medical practices
that offer that item or service. The commissioner may contract with a third party for the
development and operation of this tool.
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new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022.
new text end