HF 1176

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/03/2023 03:57pm

A bill for an act
relating to insurance; specifying provisions for third-party payers and dental
providers; amending Minnesota Statutes 2022, sections 62Q.735, subdivisions 1,
5; 62Q.76, by adding a subdivision; 62Q.78, by adding subdivisions.

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

Section 1.

Minnesota Statutes 2022, section 62Q.735, subdivision 1, is amended to read:

Subdivision 1.

Contract disclosure.

(a) Before requiring a health care provider to sign
a contract, a health plan company shall give to the provider a complete copy of the proposed
contract, including:

(1) all attachments and exhibits;

(2) operating manuals;

(3) a general description of the health plan company's health service coding guidelines
and requirement for procedures and diagnoses with modifiers, and multiple procedures; and

(4) all guidelines and treatment parameters incorporated or referenced in the contract.

(b) The health plan company shall make available to the provider the fee schedule or a
method or process that allows the provider to determine the fee schedule for each health
care service to be provided under the contract.

(c) deleted text begin Notwithstanding paragraph (b), a health plan company that is a dental plan
organization, as defined in section 62Q.76, shall disclose information related to the individual
contracted provider's expected reimbursement from the dental plan organization. deleted text end Nothing
in this section requires a dental plan organization to disclose the plan's aggregate maximum
allowable fee table used to determine other providers' fees. The contracted provider must
not release this information in any way that would violate any state or federal antitrust law.

Sec. 2.

Minnesota Statutes 2022, section 62Q.735, subdivision 5, is amended to read:

Subd. 5.

Fee schedules.

deleted text begin (a) deleted text end A health plan company shall provide, upon request, any
additional fees or fee schedules relevant to the particular provider's practice beyond those
provided with the renewal documents for the next contract year to all participating providers,
excluding claims paid under the pharmacy benefit. Health plan companies may fulfill the
requirements of this section by making the full fee schedules available through a secure
web portal for contracted providers.

deleted text begin (b) A dental organization may satisfy paragraph (a) by complying with section 62Q.735,
subdivision 1, paragraph (c).
deleted text end

Sec. 3.

Minnesota Statutes 2022, section 62Q.76, is amended by adding a subdivision to
read:

new text begin Subd. 9. new text end

new text begin Third party. new text end

new text begin "Third party" means a person or entity that enters into a contract
with a dental organization or with another third party to gain access to the dental care services
or contractual discounts under a dental provider contract. Third party does not include an
enrollee of a dental organization or an employer or other group for whom the dental
organization provides administrative services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2024, and applies to dental
plans and dental provider agreements offered, issued, or renewed on or after that date.
new text end

Sec. 4.

Minnesota Statutes 2022, section 62Q.78, is amended by adding a subdivision to
read:

new text begin Subd. 7. new text end

new text begin Method of payments. new text end

new text begin A dental provider contract must include a method of
payment for dental care services in which no fees associated with the method of payment,
including credit card fees and fees related to payment in the form of digital or virtual
currency, are incurred by the dentist or dental clinic. Any fees that may be incurred from a
payment must be disclosed to a dentist prior to entering into or renewing a dental provider
contract. For purposes of this section, fees related to a provider's electronic claims processing
vendor, financial institution, or other vendor used by a provider to facilitate the submission
of claims are excluded.
new text end

Sec. 5.

Minnesota Statutes 2022, section 62Q.78, is amended by adding a subdivision to
read:

new text begin Subd. 8. new text end

new text begin Network leasing. new text end

new text begin (a) A dental organization may grant a third party access to
a dental provider contract or a provider's dental care services or contractual discounts
provided pursuant to a dental provider contract if, at the time the dental provider contract
is entered into or renewed, the dental organization allows a dentist to choose not to participate
in third-party access to the dental provider contract, without any penalty to the dentist. The
third-party access provision of the dental provider contract must be clearly identified. A
dental organization must not grant a third party access to the dental provider contract of any
dentist who does not participate in third-party access to the dental provider contract.
new text end

new text begin (b) Notwithstanding paragraph (a), if a dental organization exists solely for the purpose
of recruiting dentists for dental provider contracts that establish a network to be leased to
third parties, the dentist waives the right to choose whether to participate in third-party
access.
new text end

new text begin (c) A dental organization may grant a third party access to a dental provider contract,
or a dentist's dental care services or contractual discounts under a dental provider contract,
if the following requirements are met:
new text end

new text begin (1) the dental organization lists all third parties that may have access to the dental provider
contract on the dental organization's website, which must be updated at least once every 90
days;
new text end

new text begin (2) the dental provider contract states that the dental organization may enter into an
agreement with a third party that would allow the third party to obtain the dental
organization's rights and responsibilities as if the third party were the dental organization,
and the dentist chose to participate in third-party access at the time the dental provider
contract was entered into; and
new text end

new text begin (3) the third party accessing the dental provider contract agrees to comply with all
applicable terms of the dental provider contract.
new text end

new text begin (d) A dentist is not bound by and is not required to perform dental care services under
a dental provider contract granted to a third party in violation of this section.
new text end

new text begin (e) This subdivision does not apply when:
new text end

new text begin (1) the dental provider contract is for dental services provided under a public health plan
program, including but not limited to medical assistance, MinnesotaCare, Medicare, or
Medicare Advantage; or
new text end

new text begin (2) access to a dental provider contract is granted to a dental organization, an entity
operating in accordance with the same brand licensee program as the dental organization
or other entity, or to an entity that is an affiliate of the dental organization, provided the
entity agrees to substantially similar terms and conditions as the originating dental provider
contract between the dental organization and the dentist or dental clinic. A list of the dental
organization's affiliates must be posted on the dental organization's website.
new text end