HF 4140

as introduced - 91st Legislature (2019 - 2020) Posted on 03/04/2020 03:39pm

A bill for an act
relating to health care; modifying the coverage for unauthorized provider services
when an enrollee has a reasonable expectation that the provider is authorized;
amending Minnesota Statutes 2018, section 62Q.556, subdivision 1.

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

Section 1.

Minnesota Statutes 2018, section 62Q.556, subdivision 1, is amended to read:

Subdivision 1.

Unauthorized provider services.

(a) Except as provided in paragraph
(c), unauthorized provider services occur when an enrollee receives services:

(1) from a nonparticipating provider at a participating hospital or ambulatory surgical
center, when the services are rendered:

(i) due to the unavailability of a participating provider;

(ii) by a nonparticipating provider without the enrollee's knowledge; or

(iii) due to the need for unforeseen services arising at the time the services are being
rendered; deleted text begin or
deleted text end

(2) from a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or other
medical testing facility deleted text begin . deleted text end new text begin ; or
new text end

new text begin (3) from a nonparticipating provider, hospital, or ambulatory surgical center when the
enrollee has a reasonable expectation that the provider, hospital, or ambulatory surgical
center is an authorized or participating provider.
new text end

(b) Unauthorized provider services do not include emergency services as defined in
section 62Q.55, subdivision 3.

(c) The services described in paragraph (a), clause (2), are not unauthorized provider
services if the enrollee gives advance written consent to the provider acknowledging that
the use of a provider, or the services to be rendered, may result in costs not covered by the
health plan. new text begin The services described in paragraph (a), clause (3), are not unauthorized provider
services if the enrollee was provided written notice by the enrollee's health plan company
prior to receiving any services from the provider, hospital, or ambulatory surgical center
stating that the provider, hospital, or ambulatory surgical center is not a participating provider,
and that any services received may result in costs not being covered by the enrollee's health
plan.
new text end