HF 2213

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; requiring disclosures of certain
payments; requiring disclosure of and limiting certain
charges to the uninsured; limiting provider recourse;
providing remedies; 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.82] PROVIDER PAYMENT DISCLOSURE; CHARGES
TO UNINSURED; PROVIDER RECOURSE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this
section, the terms defined in this subdivision have the meanings
given them.
new text end

new text begin (b) "Covered individual" means an individual who has health
plan company or public health care program coverage for health
care services.
new text end

new text begin (c) "CPT code" means a code contained in the most current
edition of the Physician's Current Procedural Terminology (CPT)
manual published by the American Medical Association and
available for purchase through the American Medical Association,
Order Department: OP054193, P.O. Box 10950, Chicago, Illinois
60610.
new text end

new text begin (d) "Dependent" has the meaning given under section 62L.02,
subdivision 11.
new text end

new text begin (e) "Health care service" has the meaning given under
section 62J.17, subdivision 2.
new text end

new text begin (f) "Health plan company" has the meaning given under
section 62Q.01, subdivision 4.
new text end

new text begin (g) "Person" means an individual, corporation, firm,
partnership, incorporated or unincorporated association, or any
other legal or commercial entity.
new text end

new text begin (h) "Provider" has the meaning given under section 62J.03,
subdivision 8.
new text end

new text begin (i) "Third-party payer" means a health plan company or a
public health care plan or program.
new text end

new text begin (j) "Uninsured individual" means a person or dependent who
does not have health plan company coverage or who is not
otherwise covered by a third-party payer.
new text end

new text begin Subd. 2. new text end

new text begin Provider payment disclosures. new text end

new text begin (a) A provider
shall make available and, to the extent possible, immediately
provide to any person who requests it, at no cost, the following
information:
new text end

new text begin (1) by CPT code, or other billing identifier as may be
required to be used in billing for health care services, and
narrative description, the amount the provider receives as
payment for health care services from the federal Medicare
program; and
new text end

new text begin (2) by CPT code, or other billing identifier as may be
required to be used in billing for health care services, and
narrative description, the amount the provider receives as
payment for health care services from the medical assistance
program administered by the commissioner of human services.
new text end

new text begin (b) If a provider is unable to immediately provide the
amount it receives as payment for health care services in
response to a request made under this subdivision, the provider
shall make available and provide the information to the person
who requested it as soon as reasonably practicable, but in no
event shall the time for disclosure be delayed by more than ten
business days.
new text end

new text begin (c) The information required under this subdivision shall
be revised quarterly as necessary to reflect any changes to the
amounts the provider receives under paragraph (a).
new text end

new text begin Subd. 3. new text end

new text begin Notice to uninsured. new text end

new text begin (a) A provider may attempt
to obtain from a person or the person's representative
information about whether any third-party payer may fully or
partially cover the charges for health care services rendered by
the provider to the person.
new text end

new text begin (b) A provider shall inform each person, both orally and in
writing, immediately upon first meeting with that person, or as
soon as practicable thereafter, that uninsured individuals will
be charged or billed for health care services in amounts that do
not exceed the amounts described in subdivision 4.
new text end

new text begin (c) If, at the time health care services are provided, a
person has not provided proof of coverage by a third-party payer
or a provider otherwise determines that the person is an
uninsured individual, the provider, as part of any billing to
the person, shall provide the person with a clear and
conspicuous notice that includes:
new text end

new text begin (1) a statement of charges for health care services
rendered by the provider;
new text end

new text begin (2) for each of the health care services rendered by the
provider, the amounts required to be disclosed under subdivision
2; and
new text end

new text begin (3) a statement that uninsured individuals will be charged
or billed for health care services in amounts that do not exceed
the amounts described in subdivision 4.
new text end

new text begin (d) For purposes of the notice required under paragraph
(c), a provider may incorporate the items into the provider's
existing billing statements and is not required to develop a
separate notice. All communications to a person required by
this subdivision must be language appropriate.
new text end

new text begin Subd. 4. new text end

new text begin Provider charges to uninsured. new text end

new text begin In billing or
charging an uninsured individual or the individual's
representative for health care services, a provider shall not
bill or charge more than the higher of the Medicare or medical
assistance payment required to be disclosed under subdivision 2
at the time the bill or charge is issued, plus five percent.
After a bill or charge is issued under this subdivision, a
provider may not increase the bill or charge, even if the amount
disclosed under subdivision 2 has increased.
new text end

new text begin Subd. 5. new text end

new text begin Limitations. new text end

new text begin Notwithstanding any other
provision of law, the amounts paid by uninsured individuals for
health care services according to subdivision 4 does not
constitute a provider's uniform, published, prevailing, or
customary charges, or its usual fees to the general public, for
purposes of any payment limit under the Medicare or medical
assistance programs or any other federal or state financed
health care program.
new text end

new text begin Subd. 6. new text end

new text begin Recourse limited. new text end

new text begin (a) Providers under agreement
with a health plan company or public health care plan or program
to provide health care services shall not have recourse against
covered individuals, or persons acting on their behalf, for
amounts above those specified in the evidence of coverage or
other plan or program document as co-payments or coinsurance for
health care services. This subdivision applies but is not
limited to the following events:
new text end

new text begin (1) nonpayment by the health plan company;
new text end

new text begin (2) insolvency of the health plan company; and
new text end

new text begin (3) breach of the agreement between the health plan company
and the provider.
new text end

new text begin (b) This subdivision does not limit a provider's ability to
seek payment from any person other than the covered individual,
the covered individual's guardian or conservator, the covered
individual's immediate family members, or the covered
individual's legal representative in the event of nonpayment by
a health plan company.
new text end

new text begin Subd. 7. new text end

new text begin Remedies. new text end

new text begin A person may file an action in
district court seeking injunctive relief and damages for
violations of this section. In any such action, a person may
also recover costs and disbursements and reasonable attorney
fees.
new text end

new text begin Subd. 8. new text end

new text begin Grounds for disciplinary action. new text end

new text begin Violations of
this section may be grounds for disciplinary or regulatory
action against a provider by the appropriate licensing board or
agency.
new text end

new text begin Subd. 9. new text end

new text begin Authority of attorney general. new text end

new text begin The attorney
general may investigate violations of this section under section
8.31. The attorney general may file an action for violations of
this section according to section 8.31 or may pursue other
remedies available to the attorney general.
new text end