HF 3956

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; establishing a definition of 
  1.3             medically necessary care for health plans; proposing 
  1.4             coding for new law in Minnesota Statutes, chapter 62Q. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [62Q.235] [MEDICALLY NECESSARY CARE.] 
  1.7      For purposes of coverage under a health plan, "medically 
  1.8   necessary care" means diagnostic services, preventive services, 
  1.9   and health care services that are appropriate, in terms of type, 
  1.10  frequency, level, setting, and duration, to the enrollee's 
  1.11  diagnosis or condition.  Medically necessary care must be 
  1.12  consistent with generally accepted practice parameters, as 
  1.13  determined by practicing health care providers in the same or 
  1.14  similar general specialty as typically manages the condition, 
  1.15  procedure, or treatment at issue, and must: 
  1.16     (1) help restore, establish, maintain, or improve the 
  1.17  enrollee's health or function; 
  1.18     (2) prevent deterioration of the enrollee's health 
  1.19  condition; or 
  1.20     (3) prevent the reasonably likely onset of a health problem 
  1.21  or detect an incipient problem.