HF 730

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:41am

A bill for an act
relating to insurance; requiring health plans to cover formulary-based wound
care; proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

new text begin [62Q.59] FORMULARY-BASED WOUND CARE.
new text end

new text begin Subdivision 1. new text end

new text begin Wound care. new text end

new text begin Effective January 1, 2010, a health plan must cover,
and reimburse at 100 percent of billed charges, formulary-based wound care provided to
a resident of a nursing facility licensed under sections 144A.02 to 144A.10, or to an
individual residing in the individual's home or a community-based setting, if:
new text end

new text begin (1) the wound care is prescribed by a physician under bundled medical codes for the
episode of care, in compliance with a wound care formulary that incorporates:
new text end

new text begin (i) health care provider training;
new text end

new text begin (ii) new wound diagnostic, treatment, and prevention technologies;
new text end

new text begin (iii) Web-based software for resident and patient measurement, monitoring, and
reporting; and
new text end

new text begin (iv) wound prevention and treatment guidelines for adaptation of formulary elements
to all types of wounds;
new text end

new text begin (2) documentation of patient compliance is provided; and
new text end

new text begin (3) documentation is provided that use of the wound formulary resulted in an
improvement of 50 percent or more above a clinical baseline for the patient, and cost
savings for care provided to the patient of at least 25 percent, relative to the projected cost
of wound care in hospital, wound clinic, and specialty clinic settings.
new text end

new text begin Subd. 2. new text end

new text begin Application. new text end

new text begin This section applies to health plans offered, sold, issued,
or renewed on or after January 1, 2010.
new text end