HF 1653

as introduced - 90th Legislature (2017 - 2018) Posted on 02/23/2017 01:30pm

A bill for an act
relating to insurance; health; requiring health plan companies to include certain
providers in-network; amending Minnesota Statutes 2016, section 62K.10,
subdivision 1, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2016, section 62K.10, subdivision 1, is amended to read:

Subdivision 1.

Applicability.

(a) new text begin Except as provided in subdivision 4a, new text end this section
applies to all health carriers that either require an enrollee to use or that create incentives,
including financial incentives, for an enrollee to use, health care providers that are managed,
owned, under contract with, or employed by the health carrier. A health carrier that does
not manage, own, or contract directly with providers in Minnesota is exempt from this
section, unless it is part of a holding company as defined in section 60D.15 that in aggregate
exceeds ten percent in either the individual or small group market in Minnesota.

(b) Health carriers renting provider networks from other entities must submit the rental
agreement or contract to the commissioner of health for approval. In reviewing the
agreements or contracts, the commissioner shall review the agreement or contract to ensure
that the entity contracting with health care providers accepts responsibility to meet the
requirements in this section.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans offered, issued, or
renewed on or after January 1, 2018.
new text end

Sec. 2.

Minnesota Statutes 2016, section 62K.10, is amended by adding a subdivision to
read:

new text begin Subd. 4a. new text end

new text begin Network adequacy; low-population counties. new text end

new text begin (a) For the purposes of this
subdivision, "low-population county" means a county in Minnesota with a population of
25,000 or less according to the most recent population estimate available from the United
States Census Bureau.
new text end

new text begin (b) A health carrier with a provider network that operates in all or a portion of a
low-population county must allow any provider who provides care in the service area covered
by the provider network and who offers the following types of services to join the network
at any time:
new text end

new text begin (1) physicians offering specialty services;
new text end

new text begin (2) obstetric and gynecologic services;
new text end

new text begin (3) pediatric services; and
new text end

new text begin (4) mental health and substance use disorder treatment services.
new text end

new text begin (c) A provider network that operates in a low-population county must include a sufficient
number and type of providers to ensure that covered services are available to all enrollees
within three business days of a request for services from an enrollee.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for health plans offered, issued, or
renewed on or after January 1, 2018.
new text end