HF 3413

as introduced - 90th Legislature (2017 - 2018) Posted on 03/08/2018 02:19pm

A bill for an act
relating to health care; requiring uniform rates for primary care services provided
by primary care providers located within a geographic rating area or service area;
amending Minnesota Statutes 2016, section 256B.69, by adding a subdivision;
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.679] PRIMARY CARE PAYMENT RATES.
new text end

new text begin Subdivision 1. new text end

new text begin Payment rate equalization. new text end

new text begin (a) A health plan company offering a group
health plan or individual health plan shall reimburse all in-network primary care providers
located within the same geographic rating area at the same payment rate for each primary
care service covered by the health plan. The payment rate may be different for in-network
primary care providers located in a different geographic rating area, but must be the same
for providers located within each geographic rating area.
new text end

new text begin (b) The health plan company may negotiate payment rates with each primary care
provider, but is prohibited from paying any provider a rate that is different than the highest
negotiated rate.
new text end

new text begin (c) The health plan company may require the primary care provider to meet reasonable
data, utilization review, referral criteria, and quality reassurance requirements on the same
basis as other in-network providers.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Primary care provider" means: (1) a physician licensed under chapter 147; (2) an
advanced practice registered nurse licensed under chapter 148, who specializes in the practice
of family medicine, general internal medicine, obstetrics, and gynecology or general
pediatrics; or (3) a health clinic that specializes in the areas specified in clause (2) and
utilizes a primary care team that includes physicians, physician assistants, or advanced
practice registered nurses.
new text end

new text begin (c) "Geographic rating areas" means the nine state-specific geographic rating areas
established for purposes of insurance rate pricing within the state.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2019, and applies to any health
plan issued or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2016, section 256B.69, is amended by adding a subdivision to
read:

new text begin Subd. 5l. new text end

new text begin Primary care payment rates. new text end

new text begin The commissioner shall ensure that managed
care organizations contracting with the commissioner under this section or section 256L.12
comply with section 62Q.679. For purposes of this subdivision and compliance with section
62Q.679, payment rates shall be the same for primary care providers located within each
service area the managed care organization contracts with the commissioner to provide
health coverage to enrollees.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2019.
new text end