HF 560

4th Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; providing patient protections; 
  1.3             requiring certain coverage; providing for 
  1.4             cost-sharing; amending Minnesota Statutes 2000, 
  1.5             sections 45.027, subdivision 6; 62D.02, subdivision 8; 
  1.6             62D.17, subdivision 1; 62J.38; 62M.02, subdivision 21; 
  1.7             62Q.56; 62Q.58; 253B.02, subdivision 10; 253B.045, 
  1.8             subdivision 6; 253B.10, subdivision 4; 260C.201, 
  1.9             subdivision 1; proposing coding for new law in 
  1.10            Minnesota Statutes, chapters 62D; 62Q. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 2000, section 45.027, 
  1.13  subdivision 6, is amended to read: 
  1.14     Subd. 6.  [VIOLATIONS AND PENALTIES.] The commissioner may 
  1.15  impose a civil penalty not to exceed $10,000 per violation upon 
  1.16  a person who violates any law, rule, or order related to the 
  1.17  duties and responsibilities entrusted to the commissioner unless 
  1.18  a different penalty is specified.  If a civil penalty is imposed 
  1.19  on a health carrier as defined in section 62A.011, the 
  1.20  commissioner must divide 50 percent of the amount among any 
  1.21  policy holders or certificate holders affected by the violation, 
  1.22  unless the commissioner certifies in writing that the division 
  1.23  and distribution to enrollees would be too administratively 
  1.24  complex or that the number of enrollees affected by the penalty 
  1.25  would result in a distribution of less than $50 per enrollee.  
  1.26     Sec. 2.  Minnesota Statutes 2000, section 62D.02, 
  1.27  subdivision 8, is amended to read: 
  1.28     Subd. 8.  [HEALTH MAINTENANCE CONTRACT.] "Health 
  2.1   maintenance contract" means any contract whereby a health 
  2.2   maintenance organization agrees to provide comprehensive health 
  2.3   maintenance services to enrollees, provided that the contract 
  2.4   may contain reasonable enrollee copayment cost-sharing 
  2.5   provisions that comply with section 62D.099.  An individual or 
  2.6   group health maintenance contract may contain the copayment and 
  2.7   deductible provisions specified in this subdivision.  Copayment 
  2.8   and deductible provisions in group contracts shall not 
  2.9   discriminate on the basis of age, sex, race, length of 
  2.10  enrollment in the plan, or economic status; and during every 
  2.11  open enrollment period in which all offered health benefit 
  2.12  plans, including those subject to the jurisdiction of the 
  2.13  commissioners of commerce or health, fully participate without 
  2.14  any underwriting restrictions, copayment and deductible 
  2.15  provisions shall not discriminate on the basis of preexisting 
  2.16  health status.  In no event shall the sum of the annual 
  2.17  copayments and deductible exceed the maximum out-of-pocket 
  2.18  expenses allowable for a number three qualified plan under 
  2.19  section 62E.06, nor shall that sum exceed $5,000 per family.  
  2.20  The annual deductible must not exceed $1,000 per person.  The 
  2.21  annual deductible must not apply to preventive health services 
  2.22  as described in Minnesota Rules, part 4685.0801, subpart 8.  
  2.23  Where sections 62D.01 to 62D.30 permit a health maintenance 
  2.24  organization to contain reasonable copayment provisions for 
  2.25  preexisting health status, these provisions may vary with 
  2.26  respect to length of enrollment in the plan.  Any contract may 
  2.27  provide for health care services in addition to those set forth 
  2.28  in subdivision 7. 
  2.29     Sec. 3.  [62D.099] [ENROLLEE COST-SHARING.] 
  2.30     Subdivision 1.  [COPAYMENTS.] (a) A health maintenance 
  2.31  organization may impose coinsurance expressed as percentages, or 
  2.32  flat fee copayments as provided in paragraph (b).  Under the 
  2.33  terms of the health plan, coinsurance may be imposed up to a 
  2.34  maximum of 50 percent on the provider amount paid at the time 
  2.35  the claim is processed irrespective of any subsequent 
  2.36  adjustments that might be made based upon a withhold or year-end 
  3.1   settlement.  The 50 percent limitation does not apply to 
  3.2   services that may be excluded, covered services that the 
  3.3   enrollee elects to receive out-of-network or from a broader 
  3.4   network, or to nonformulary prescription drugs. 
  3.5      (b) The health maintenance organization may establish 
  3.6   predetermined flat fee copayments for categories of similar 
  3.7   services or goods.  Flat fee copayments based on categories of 
  3.8   similar services or goods must be calculated independently for 
  3.9   Medicare-related products, individual plans, and group plans.  A 
  3.10  health maintenance organization may impose a flat fee copayment 
  3.11  of up to 50 percent of the median provider's charges for similar 
  3.12  services or goods received by enrollees.  A health maintenance 
  3.13  organization may request the commissioner to approve a copayment 
  3.14  which exceeds the 50 percent limitation for prescription drug 
  3.15  benefits for Medicare-related products.  The request must be 
  3.16  made in writing to the commissioner and must include sufficient 
  3.17  documentation to demonstrate that the requested copayment is 
  3.18  reasonable under this section. 
  3.19     (c) For purposes of this section, a "category of similar 
  3.20  services or goods" is any group of related services for which a 
  3.21  single copayment is sought.  Examples of categories include the 
  3.22  following or any subset of the following: 
  3.23     (1) inpatient hospital care; 
  3.24     (2) inpatient physician care; 
  3.25     (3) outpatient health services, which may include, but are 
  3.26  not limited to, office visits or outpatient laboratory and 
  3.27  radiology; 
  3.28     (4) outpatient surgery, which may include provider and 
  3.29  facility charges; 
  3.30     (5) emergency services, which may include provider and 
  3.31  facility charges; 
  3.32     (6) outpatient prescription drugs; 
  3.33     (7) skilled nursing care; and 
  3.34     (8) any other nonphysician service categorized singly 
  3.35  according to provider type. 
  3.36     (d) To determine the median aggregate charge for a category 
  4.1   of similar services, the health maintenance organization must 
  4.2   follow the following steps and submit the results to the 
  4.3   commissioner for approval of the copayment: 
  4.4      (1) identify all charges for the services or goods for the 
  4.5   relevant type of product:  Medicare-related, individual, or 
  4.6   group.  The health maintenance organization may use all charges 
  4.7   or may choose a sample of charges from the total population.  
  4.8   Any sample used must be randomly selected and large enough to be 
  4.9   statistically reliable.  "Statistically reliable" means that any 
  4.10  other sample drawn in the same manner would produce essentially 
  4.11  the same results; 
  4.12     (2) if the health maintenance organization does not use 
  4.13  charges that span 12 months, the health maintenance organization 
  4.14  must explain how the time period used is sufficient to include 
  4.15  seasonal fluctuations in the utilization of services; 
  4.16     (3) a statement that the sample is statistically reliable, 
  4.17  with an explanation of how the sample is drawn so that it is 
  4.18  representative of the larger health maintenance organization 
  4.19  population; and 
  4.20     (4) a narrative description of the services included in the 
  4.21  category. 
  4.22     Subd. 2.  [DEDUCTIBLES.] Under the terms of the health 
  4.23  plan, deductible amounts may be imposed as follows: 
  4.24     (1) for group health plans, $5,000 per person per year and 
  4.25  $10,000 per family per year increased annually in accordance 
  4.26  with the medical component of the Consumer Price Index; or 
  4.27     (2) for individual health plans, $10,000 per person per 
  4.28  year and $20,000 per family per year increased annually in 
  4.29  accordance with the medical component of the Consumer Price 
  4.30  Index. 
  4.31     Subd. 3.  [ANNUAL OUT-OF-POCKET MAXIMUM AMOUNTS.] A health 
  4.32  maintenance organization shall provide for an out-of-pocket 
  4.33  maximum on enrollee cost-sharing up to $8,000 per person per 
  4.34  year on group health plans and up to $15,000 per person per year 
  4.35  on individual health plans.  The out-of-pocket maximum amounts 
  4.36  shall be adjusted for inflation on an annual basis in accordance 
  5.1   with the medical component of the Consumer Price Index. 
  5.2      Sec. 4.  Minnesota Statutes 2000, section 62D.17, 
  5.3   subdivision 1, is amended to read: 
  5.4      Subdivision 1.  [ADMINISTRATIVE PENALTY.] The commissioner 
  5.5   of health may, for any violation of statute or rule applicable 
  5.6   to a health maintenance organization, or in lieu of suspension 
  5.7   or revocation of a certificate of authority under section 
  5.8   62D.15, levy an administrative penalty in an amount up to 
  5.9   $25,000 for each violation.  In the case of contracts or 
  5.10  agreements made pursuant to section 62D.05, subdivisions 2 to 4, 
  5.11  each contract or agreement entered into or implemented in a 
  5.12  manner which violates sections 62D.01 to 62D.30 shall be 
  5.13  considered a separate violation.  In determining the level of an 
  5.14  administrative penalty, the commissioner shall consider the 
  5.15  following factors: 
  5.16     (1) the number of enrollees affected by the violation; 
  5.17     (2) the effect of the violation on enrollees' health and 
  5.18  access to health services; 
  5.19     (3) if only one enrollee is affected, the effect of the 
  5.20  violation on that enrollee's health; 
  5.21     (4) whether the violation is an isolated incident or part 
  5.22  of a pattern of violations; and 
  5.23     (5) the economic benefits derived by the health maintenance 
  5.24  organization or a participating provider by virtue of the 
  5.25  violation. 
  5.26     Reasonable notice in writing to the health maintenance 
  5.27  organization shall be given of the intent to levy the penalty 
  5.28  and the reasons therefor, and the health maintenance 
  5.29  organization may have 15 days within which to file a written 
  5.30  request for an administrative hearing and review of the 
  5.31  commissioner of health's determination.  Such administrative 
  5.32  hearing shall be subject to judicial review pursuant to chapter 
  5.33  14.  If an administrative penalty is levied, the commissioner 
  5.34  must divide 50 percent of the amount among any enrollees 
  5.35  affected by the violation, unless the commissioner certifies in 
  5.36  writing that the division and distribution to enrollees would be 
  6.1   too administratively complex or that the number of enrollees 
  6.2   affected by the penalty would result in a distribution of less 
  6.3   than $50 per enrollee. 
  6.4      Sec. 5.  Minnesota Statutes 2000, section 62J.38, is 
  6.5   amended to read: 
  6.6      62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 
  6.7      (a) The commissioner shall require group purchasers to 
  6.8   submit detailed data on total health care spending for each 
  6.9   calendar year.  Group purchasers shall submit data for the 1993 
  6.10  calendar year by April 1, 1994, and each April 1 thereafter 
  6.11  shall submit data for the preceding calendar year. 
  6.12     (b) The commissioner shall require each group purchaser to 
  6.13  submit data on revenue, expenses, and member months, as 
  6.14  applicable.  Revenue data must distinguish between premium 
  6.15  revenue and revenue from other sources and must also include 
  6.16  information on the amount of revenue in reserves and changes in 
  6.17  reserves.  Expenditure data, including raw data from claims, may 
  6.18  must distinguish between costs incurred for patient care and 
  6.19  administrative costs.  Expenditure data must be provided 
  6.20  separately for the following categories or and for other 
  6.21  categories required by the commissioner:  physician services, 
  6.22  dental services, other professional services, inpatient hospital 
  6.23  services, outpatient hospital services, emergency, pharmacy 
  6.24  services and other nondurable medical goods, mental health, and 
  6.25  chemical dependency services, other expenditures, subscriber 
  6.26  liability, and administrative costs.  Administrative costs must 
  6.27  include costs for marketing; advertising; overhead; salaries and 
  6.28  benefits of central office staff who do not provide direct 
  6.29  patient care; underwriting; lobbying; claims processing; 
  6.30  provider contracting and credentialing; detection and prevention 
  6.31  of payment for fraudulent or unjustified requests for 
  6.32  reimbursement or services; clinical quality assurance and other 
  6.33  types of medical care quality improvement efforts; concurrent or 
  6.34  prospective utilization review as defined in section 62M.02; 
  6.35  costs incurred to acquire a hospital, clinic, or health care 
  6.36  facility, or the assets thereof; capital costs incurred on 
  7.1   behalf of a hospital or clinic; lease payments; or any other 
  7.2   costs incurred pursuant to a partnership, joint venture, 
  7.3   integration, or affiliation agreement with a hospital, clinic, 
  7.4   or other health care provider.  Capital costs and costs incurred 
  7.5   must be reported according to standard accounting principles.  
  7.6   The reports of this data must also separately identify expenses 
  7.7   for local, state, and federal taxes, fees, and assessments.  The 
  7.8   commissioner may require each group purchaser to submit any 
  7.9   other data, including data in unaggregated form, for the 
  7.10  purposes of developing spending estimates, setting spending 
  7.11  limits, and monitoring actual spending and costs.  In addition 
  7.12  to reporting administrative costs incurred to acquire a 
  7.13  hospital, clinic, or health care facility, or the assets 
  7.14  thereof; or any other costs incurred pursuant to a partnership, 
  7.15  joint venture, integration, or affiliation agreement with a 
  7.16  hospital, clinic, or other health care provider, reports 
  7.17  submitted under this section also must include the payments made 
  7.18  during the calendar year for these purposes.  
  7.19     (c) The commissioner may collect information on: 
  7.20     (1) premiums, benefit levels, managed care procedures, and 
  7.21  other features of health plan companies; 
  7.22     (2) prices, provider experience, and other information for 
  7.23  services less commonly covered by insurance or for which 
  7.24  patients commonly face significant out-of-pocket expenses; and 
  7.25     (3) information on health care services not provided 
  7.26  through health plan companies, including information on prices, 
  7.27  costs, expenditures, and utilization. 
  7.28     (d) All group purchasers shall provide the required data 
  7.29  using a uniform format and uniform definitions, as prescribed by 
  7.30  the commissioner. 
  7.31     Sec. 6.  Minnesota Statutes 2000, section 62M.02, 
  7.32  subdivision 21, is amended to read: 
  7.33     Subd. 21.  [UTILIZATION REVIEW ORGANIZATION.] "Utilization 
  7.34  review organization" means an entity including but not limited 
  7.35  to an insurance company licensed under chapter 60A to offer, 
  7.36  sell, or issue a policy of accident and sickness insurance as 
  8.1   defined in section 62A.01; a health service plan licensed under 
  8.2   chapter 62C; a health maintenance organization licensed under 
  8.3   chapter 62D; a community integrated service network licensed 
  8.4   under chapter 62N; an accountable provider network operating 
  8.5   under chapter 62T; a fraternal benefit society operating under 
  8.6   chapter 64B; a joint self-insurance employee health plan 
  8.7   operating under chapter 62H; a multiple employer welfare 
  8.8   arrangement, as defined in section 3 of the Employee Retirement 
  8.9   Income Security Act of 1974 (ERISA), United States Code, title 
  8.10  29, section 1103, as amended; a third party administrator 
  8.11  licensed under section 60A.23, subdivision 8, which conducts 
  8.12  utilization review and determines certification of an admission, 
  8.13  extension of stay, or other health care services for a Minnesota 
  8.14  resident; or any entity performing utilization review that is 
  8.15  affiliated with, under contract with, or conducting utilization 
  8.16  review on behalf of, a business entity in this state.  
  8.17  Utilization review organization does not include a clinic or 
  8.18  health care system acting pursuant to a written delegation 
  8.19  agreement with an otherwise regulated utilization review 
  8.20  organization that contracts with the clinic or health care 
  8.21  system.  The regulated utilization review organization is 
  8.22  accountable for the delegated utilization review activities of 
  8.23  the clinic or health care system. 
  8.24     Sec. 7.  [62Q.471] [EXCLUSION FOR SUICIDE ATTEMPTS 
  8.25  PROHIBITED.] 
  8.26     (a) No health plan may exclude or reduce coverage for 
  8.27  health care for an enrollee who is otherwise covered under the 
  8.28  health plan on the basis that the need for the health care arose 
  8.29  out of a suicide or suicide attempt by the enrollee. 
  8.30     (b) For purposes of this section, "health plan" has the 
  8.31  meaning given in section 62Q.01, subdivision 3, but includes the 
  8.32  coverages described in section 62A.011, subdivision 3, clauses 
  8.33  (7) and (10). 
  8.34     [EFFECTIVE DATE.] This section is effective January 1, 
  8.35  2002, and applies to contracts issued or renewed on or after 
  8.36  that date. 
  9.1      Sec. 8.  [62Q.527] [COVERAGE OF NONFORMULARY DRUGS FOR 
  9.2   MENTAL ILLNESS AND EMOTIONAL DISTURBANCE.] 
  9.3      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
  9.4   section, the following terms have the meanings given to them. 
  9.5      (b) "Emotional disturbance" has the meaning given in 
  9.6   section 245.4871, subdivision 15. 
  9.7      (c) "Mental illness" has the meaning given in section 
  9.8   245.462, subdivision 20, paragraph (a). 
  9.9      (d) "Health plan" has the meaning given in section 62Q.01, 
  9.10  subdivision 3, but includes the coverages described in section 
  9.11  62A.011, subdivision 3, clauses (7) and (10). 
  9.12     Subd. 2.  [REQUIRED COVERAGE FOR ANTIPSYCHOTIC DRUGS.] A 
  9.13  health plan that provides drug coverage must provide coverage 
  9.14  for an antipsychotic drug prescribed to treat emotional 
  9.15  disturbance or mental illness regardless of whether the drug is 
  9.16  in the health plan's drug formulary, if the health care provider 
  9.17  prescribing the drug indicates to the dispensing pharmacist, 
  9.18  orally or in writing according to section 151.21, that the 
  9.19  prescription must be dispensed as communicated and certifies in 
  9.20  writing to the health plan company that the health care provider 
  9.21  has considered any equivalent drug in the health plan's 
  9.22  formulary and has determined that the drug prescribed will best 
  9.23  treat the patient's condition.  A health plan is not required to 
  9.24  provide coverage for a drug if the drug was removed from the 
  9.25  health plan's drug formulary for safety reasons.  For drugs 
  9.26  covered under this section, no health plan company that has 
  9.27  received the certification from the health care provider may: 
  9.28     (1) impose a special deductible, copayment, coinsurance, or 
  9.29  other special payment requirement that the health plan does not 
  9.30  apply to drugs that are in the health plan's drug formulary; or 
  9.31     (2) require written certification from the prescribing 
  9.32  provider each time a prescription is refilled or renewed that 
  9.33  the drug prescribed will best treat the patient's condition. 
  9.34     Subd. 3.  [CONTINUING CARE.] (a) Individuals receiving a 
  9.35  prescribed drug to treat a diagnosed mental illness or emotional 
  9.36  disturbance may continue to receive the prescribed drug for up 
 10.1   to one year without the imposition of a special deductible, 
 10.2   copayment, coinsurance, or other special payment requirements, 
 10.3   when a health plan's drug formulary changes or an enrollee 
 10.4   changes health plans and the medication has been shown to 
 10.5   effectively treat the patient's condition.  In order to be 
 10.6   eligible for this continuing care benefit: 
 10.7      (1) the patient must have been treated with the drug for 90 
 10.8   days prior to a change in a health plan's drug formulary or a 
 10.9   change in the enrollee's health plan; 
 10.10     (2) the health care provider prescribing the drug indicates 
 10.11  to the dispensing pharmacist, orally or in writing according to 
 10.12  section 151.21, that the prescription must be dispensed as 
 10.13  communicated; and 
 10.14     (3) the health care provider prescribing the drug annually 
 10.15  certifies in writing to the health plan company that the drug 
 10.16  prescribed will best treat the patient's condition. 
 10.17     (b) A health plan is not required to provide coverage for a 
 10.18  drug if the drug was removed from the health plan's drug 
 10.19  formulary for safety reasons. 
 10.20     (c) The continuing care benefit shall be extended annually 
 10.21  when the health care provider prescribing the drug: 
 10.22     (1) indicates to the dispensing pharmacist, orally or in 
 10.23  writing according to section 151.21, that the prescription must 
 10.24  be dispensed as communicated; and 
 10.25     (2) certifies in writing to the health plan company that 
 10.26  the drug prescribed will best treat the patient's condition. 
 10.27     Subd. 4.  [EXCEPTION TO FORMULARY.] A health plan must 
 10.28  promptly grant an exception to the health plan's drug formulary 
 10.29  for a patient when the health care provider prescribing the drug 
 10.30  indicates to the health plan that: 
 10.31     (1) the formulary drug causes an adverse reaction in the 
 10.32  patient; 
 10.33     (2) the formulary drug is contraindicated for the patient; 
 10.34  or 
 10.35     (3) the health care provider demonstrates to the health 
 10.36  plan that the prescription must be dispensed as written to 
 11.1   provide maximum medical benefit to the patient. 
 11.2      [EFFECTIVE DATE.] This section is effective January 1, 
 11.3   2002, and applies to contracts issued or renewed on or after 
 11.4   that date. 
 11.5      Sec. 9.  [62Q.535] [COVERAGE FOR COURT-ORDERED MENTAL 
 11.6   HEALTH SERVICES.] 
 11.7      Subdivision 1.  [MENTAL HEALTH SERVICES.] For purposes of 
 11.8   this section, mental health services means all covered services 
 11.9   that are intended to treat or ameliorate an emotional, 
 11.10  behavioral, or psychiatric condition and that are covered by the 
 11.11  policy, contract, or certificate of coverage of the enrollee's 
 11.12  health plan company or by law. 
 11.13     Subd. 2.  [COVERAGE REQUIRED.] All health plan companies 
 11.14  that provide coverage for mental health services must cover or 
 11.15  provide mental health services ordered by a court of competent 
 11.16  jurisdiction under a court order that is issued on the basis of 
 11.17  a behavioral care evaluation, performed by a licensed 
 11.18  psychiatrist or a doctoral-level licensed psychologist, which 
 11.19  includes a diagnosis and an individual treatment plan for care 
 11.20  in the most appropriate, least restrictive environment.  The 
 11.21  health plan company must be given a copy of the court order and 
 11.22  behavioral evaluation.  The health plan company shall be 
 11.23  financially liable for the evaluation if performed by a 
 11.24  participating provider of the health plan company and shall be 
 11.25  financially liable for the care included in the court-ordered 
 11.26  treatment plan if the care is covered by the health plan company 
 11.27  and ordered to be provided by a participating provider or 
 11.28  another provider as required by rule or statute.  This 
 11.29  court-ordered coverage must not be subject to a separate medical 
 11.30  necessity determination by a health plan company under its 
 11.31  utilization procedures.  
 11.32     [EFFECTIVE DATE.] This section is effective July 1, 2001, 
 11.33  and applies to contracts issued or renewed on or after that date.
 11.34     Sec. 10.  Minnesota Statutes 2000, section 62Q.56, is 
 11.35  amended to read: 
 11.36     62Q.56 [CONTINUITY OF CARE.] 
 12.1      Subdivision 1.  [CHANGE IN HEALTH CARE PROVIDER.] (a) If 
 12.2   enrollees are required to access services through selected 
 12.3   primary care providers for coverage, the health plan company 
 12.4   shall prepare a written plan that provides for continuity of 
 12.5   care in the event of contract termination between the health 
 12.6   plan company and any of the contracted primary care providers, 
 12.7   specialists, or general hospital providers.  For purposes of 
 12.8   this section, termination includes nonrenewal.  The written plan 
 12.9   must explain: 
 12.10     (1) how the health plan company will inform affected 
 12.11  enrollees, insureds, or beneficiaries about termination at least 
 12.12  30 days before the termination is effective, if the health plan 
 12.13  company or health care network cooperative has received at least 
 12.14  120 days' prior notice; 
 12.15     (2) how the health plan company will inform the affected 
 12.16  enrollees about what other participating providers are available 
 12.17  to assume care and how it will facilitate an orderly transfer of 
 12.18  its enrollees from the terminating provider to the new provider 
 12.19  to maintain continuity of care; 
 12.20     (3) the procedures by which enrollees will be transferred 
 12.21  to other participating providers, when special medical needs, 
 12.22  special risks, or other special circumstances, such as cultural 
 12.23  or language barriers, require them to have a longer transition 
 12.24  period or be transferred to nonparticipating providers; 
 12.25     (4) who will identify enrollees with special medical needs 
 12.26  or at special risk and what criteria will be used for this 
 12.27  determination; and 
 12.28     (5) how continuity of care will be provided for enrollees 
 12.29  identified as having special needs or at special risk, and 
 12.30  whether the health plan company has assigned this responsibility 
 12.31  to its contracted primary care providers. 
 12.32     (b) If the contract termination was not for cause, 
 12.33  enrollees can request a referral to the terminating provider for 
 12.34  up to 120 days if they have special medical needs or have other 
 12.35  special circumstances, such as cultural or language barriers.  
 12.36  The health plan company can require medical records and other 
 13.1   supporting documentation in support of the requested referral.  
 13.2   Each request for referral to a terminating provider shall be 
 13.3   considered by the health plan company on a case-by-case basis.: 
 13.4      (1) if the contract was terminated by the health plan 
 13.5   company, the terminated provider and all enrollees being treated 
 13.6   by that provider must be notified of the enrollees' rights to 
 13.7   continuity of care with the terminated provider; 
 13.8      (2) the health plan company must provide, upon request, 
 13.9   authorization to receive services that are otherwise covered 
 13.10  under the terms of the health plan through the enrollee's 
 13.11  current provider for up to 120 days if the enrollee is engaged 
 13.12  in a current course of treatment for one or more of the 
 13.13  following conditions: 
 13.14     (i) an acute condition; 
 13.15     (ii) a life-threatening mental or physical illness; 
 13.16     (iii) pregnancy beyond the first trimester of pregnancy; 
 13.17     (iv) a physical or mental disability defined as an 
 13.18  inability to engage in one or more major life activities, 
 13.19  provided that the disability has lasted or can be expected to 
 13.20  last for at least a year or can be expected to result in death; 
 13.21  or 
 13.22     (v) a disabling or chronic condition that is in an acute 
 13.23  phase; and 
 13.24     (3) the health plan company must provide, upon request, 
 13.25  authorization to receive services that are otherwise covered 
 13.26  under the terms of the health plan through the enrollee's 
 13.27  current provider for the rest of the enrollee's life if a 
 13.28  physician certifies that the enrollee has an expected lifetime 
 13.29  of 180 days or less.  
 13.30  For all requests for authorization to receive services under 
 13.31  this paragraph, the health plan company must grant the request 
 13.32  unless the enrollee does not meet the criteria provided in this 
 13.33  paragraph. 
 13.34     (c) The health plan company shall prepare a written plan 
 13.35  that provides a process for coverage determinations regarding 
 13.36  continuity of care of up to 120 days for enrollees who request 
 14.1   continuity of care with their former provider, if the enrollee: 
 14.2      (1) is receiving culturally appropriate services and the 
 14.3   health plan company does not have a provider in its preferred 
 14.4   provider network with special expertise in the delivery of those 
 14.5   culturally appropriate services within the time and distance 
 14.6   requirements of section 62D.124, subdivision 1; or 
 14.7      (2) does not speak English and the health plan company does 
 14.8   not have a provider in its preferred provider network who can 
 14.9   communicate with the enrollee, either directly or through an 
 14.10  interpreter, within the time and distance requirements of 
 14.11  section 62D.124, subdivision 1. 
 14.12  The written plan must explain the criteria that will be used to 
 14.13  determine whether a need for continuity of care exists and how 
 14.14  it will be provided. 
 14.15     (d) This paragraph applies to requests under paragraph (b) 
 14.16  or (c).  The health plan company may require medical records and 
 14.17  other supporting documentation to be submitted with the request 
 14.18  for authorization.  If an authorization is denied, the health 
 14.19  plan company must explain the criteria it used to make its 
 14.20  decision on the request for authorization.  If an authorization 
 14.21  is granted, the health plan company must explain how continuity 
 14.22  of care will be provided.  
 14.23     (c) (e) If the contract termination was for cause, 
 14.24  enrollees must be notified of the change and transferred to 
 14.25  participating providers in a timely manner so that health care 
 14.26  services remain available and accessible to the affected 
 14.27  enrollees.  The health plan company is not required to refer an 
 14.28  enrollee back to the terminating provider if the termination was 
 14.29  for cause. 
 14.30     Subd. 2.  [CHANGE IN HEALTH PLANS.] (a) The health plan 
 14.31  company shall prepare a written plan that provides a process for 
 14.32  coverage determinations for continuity of care for new enrollees 
 14.33  with special needs, special risks, or other special 
 14.34  circumstances, such as cultural or language barriers, who 
 14.35  request continuity of care with their former provider for up to 
 14.36  120 days.  The written plan must explain the criteria that will 
 15.1   be used for determining special needs cases, and how continuity 
 15.2   of care will be provided.  If an enrollee is subject to a change 
 15.3   in health plans, the enrollee's new health plan company must 
 15.4   provide, upon request: 
 15.5      (1) authorization to receive services that are otherwise 
 15.6   covered under the terms of the new health plan through the 
 15.7   enrollee's current provider for up to 120 days if the enrollee 
 15.8   is engaged in a current course of treatment for one or more of 
 15.9   the following conditions: 
 15.10     (i) an acute condition; 
 15.11     (ii) a life-threatening mental or physical illness; 
 15.12     (iii) pregnancy beyond the first trimester of pregnancy; 
 15.13     (iv) a physical or mental disability defined as an 
 15.14  inability to engage in one or more major life activities, 
 15.15  provided that the disability has lasted or can be expected to 
 15.16  last for at least a year or can be expected to result in death; 
 15.17  or 
 15.18     (v) a disabling or chronic condition that is in an acute 
 15.19  phase; and 
 15.20     (2) authorization to receive services that are otherwise 
 15.21  covered under the terms of the health plan through the 
 15.22  enrollee's current provider for the rest of the enrollee's life 
 15.23  if a physician certifies that the enrollee has an expected 
 15.24  lifetime of 180 days or less. 
 15.25  For all requests for authorization under this paragraph, the 
 15.26  health plan company must grant the request for authorization 
 15.27  unless the enrollee does not meet the criteria provided in this 
 15.28  paragraph. 
 15.29     (b) The health plan company shall prepare a written plan 
 15.30  that provides a process for coverage determinations regarding 
 15.31  continuity of care of up to 120 days for new enrollees who 
 15.32  request continuity of care with their former provider, if the 
 15.33  new enrollee: 
 15.34     (1) is receiving culturally appropriate services and the 
 15.35  health plan company does not have a provider in its preferred 
 15.36  provider network with special expertise in the delivery of those 
 16.1   culturally appropriate services within the time and distance 
 16.2   requirements of section 62D.124, subdivision 1; or 
 16.3      (2) does not speak English and the health plan company does 
 16.4   not have a provider in its preferred provider network who can 
 16.5   communicate with the enrollee, either directly or through an 
 16.6   interpreter, within the time and distance requirements of 
 16.7   section 62D.124, subdivision 1. 
 16.8   The written plan must explain the criteria that will be used to 
 16.9   determine whether a need for continuity of care exists and how 
 16.10  it will be provided. 
 16.11     (c) This paragraph applies to requests under paragraph (a) 
 16.12  or (b).  The health plan company may require medical records and 
 16.13  other supporting documentation to be submitted with the request 
 16.14  for authorization.  If an authorization is denied, the health 
 16.15  plan company must explain the criteria it used to make its 
 16.16  decision on the request for authorization.  If an authorization 
 16.17  is granted, the health plan company must explain how continuity 
 16.18  of care will be provided.  
 16.19     (b) (d) This subdivision applies only to group coverage and 
 16.20  continuation and conversion coverage, and applies only to 
 16.21  changes in health plans made by the employer. 
 16.22     Subd. 2a.  [LIMITATIONS.] (a) Subdivisions 1 and 2 apply 
 16.23  only if the enrollee's health care provider agrees to: 
 16.24     (1) accept as payment in full the lesser of the health plan 
 16.25  company's reimbursement rate for in-network providers for the 
 16.26  same or similar service or the enrollee's health care provider's 
 16.27  regular fee for that service; 
 16.28     (2) adhere to the health plan company's preauthorization 
 16.29  requirements; and 
 16.30     (3) provide the health plan company with all necessary 
 16.31  medical information related to the care provided to the enrollee.
 16.32     (b) Nothing in this section requires a health plan company 
 16.33  to provide coverage for a health care service or treatment that 
 16.34  is not covered under the enrollee's health plan.  
 16.35     Subd. 3.  [DISCLOSURES DISCLOSURE.] The written plans 
 16.36  required under this section must be made available upon request 
 17.1   to enrollees or prospective enrollees Information regarding an 
 17.2   enrollee's rights under this section must be included in member 
 17.3   contracts or certificates of coverage and must be provided by a 
 17.4   health plan company upon request of an enrollee or prospective 
 17.5   enrollee. 
 17.6      Sec. 11.  Minnesota Statutes 2000, section 62Q.58, is 
 17.7   amended to read: 
 17.8      62Q.58 [ACCESS TO SPECIALTY CARE.] 
 17.9      Subdivision 1.  [STANDING REFERRAL.] A health plan company 
 17.10  shall establish a procedure by which an enrollee may apply 
 17.11  for and, if appropriate, receive a standing referral to a health 
 17.12  care provider who is a specialist if a referral to a specialist 
 17.13  is required for coverage.  This procedure for a standing 
 17.14  referral must specify the necessary criteria and conditions, 
 17.15  which must be met in order for an enrollee to obtain a standing 
 17.16  referral managed care review and approval an enrollee must 
 17.17  obtain before such a standing referral is permitted. 
 17.18     Subd. 1a.  [MANDATORY STANDING REFERRAL.] An enrollee who 
 17.19  requests a standing referral to a specialist qualified to treat 
 17.20  the specific condition described in clauses (1) to (5) must be 
 17.21  given a standing referral for visits to such a specialist if 
 17.22  benefits for such treatment are provided under the health plan 
 17.23  and the enrollee has any of the following conditions:  
 17.24     (1) a chronic health condition; 
 17.25     (2) a life-threatening mental or physical illness; 
 17.26     (3) pregnancy beyond the first trimester of pregnancy; 
 17.27     (4) a degenerative disease or disability; or 
 17.28     (5) any other condition or disease of sufficient 
 17.29  seriousness and complexity to require treatment by a specialist. 
 17.30     Nothing in this section limits the application of section 
 17.31  62Q.52 specifying direct access to obstetricians and 
 17.32  gynecologists. 
 17.33     Subd. 2.  [COORDINATION OF SERVICES.] A primary care 
 17.34  provider or primary care group shall remain responsible for 
 17.35  coordinating the care of an enrollee who has received a standing 
 17.36  referral to a specialist.  The specialist shall not make any 
 18.1   secondary referrals related to primary care services without 
 18.2   prior approval by the primary care provider or primary care 
 18.3   group.  However, An enrollee with a standing referral to a 
 18.4   specialist may request primary care services from that 
 18.5   specialist.  The specialist, in agreement with the enrollee and 
 18.6   primary care provider or primary care group, may elect to 
 18.7   provide primary care services to that the enrollee, authorize 
 18.8   tests and services, and make secondary referrals according to 
 18.9   procedures established by the health plan company.  The health 
 18.10  plan company may limit the primary care services, tests and 
 18.11  services, and secondary referrals authorized under this 
 18.12  subdivision to those that are related to the specific condition 
 18.13  or conditions for which the standing referral was made. 
 18.14     Subd. 3.  [DISCLOSURE.] Information regarding referral 
 18.15  procedures must be included in member contracts or certificates 
 18.16  of coverage and must be provided to an enrollee or prospective 
 18.17  enrollee by a health plan company upon request. 
 18.18     Subd. 4.  [REFERRAL.] (a) If a standing referral is 
 18.19  authorized under subdivision 1 or is mandatory under subdivision 
 18.20  1a, the health plan company must provide a referral to an 
 18.21  appropriate participating specialist who is reasonably available 
 18.22  and accessible to provide the treatment or to a nonparticipating 
 18.23  specialist if the health plan company does not have an 
 18.24  appropriate participating specialist who is reasonably available 
 18.25  and accessible to treat the enrollee's condition or disease. 
 18.26     (b) If an enrollee receives services from a 
 18.27  nonparticipating specialist because a participating specialist 
 18.28  is not available, services must be provided at no additional 
 18.29  cost to the enrollee beyond what the enrollee would otherwise 
 18.30  pay for services received from a participating specialist. 
 18.31     Sec. 12.  Minnesota Statutes 2000, section 253B.02, 
 18.32  subdivision 10, is amended to read: 
 18.33     Subd. 10.  [INTERESTED PERSON.] "Interested person" means: 
 18.34     (1) an adult, including but not limited to, a public 
 18.35  official, including a local welfare agency acting under section 
 18.36  626.5561, and the legal guardian, spouse, parent, legal counsel, 
 19.1   adult child, next of kin, or other person designated by a 
 19.2   proposed patient; or 
 19.3      (2) a health plan company that is providing coverage for a 
 19.4   proposed patient.  
 19.5      Sec. 13.  Minnesota Statutes 2000, section 253B.045, 
 19.6   subdivision 6, is amended to read: 
 19.7      Subd. 6.  [COVERAGE.] A health plan company that provides 
 19.8   coverage for mental health services must provide coverage, 
 19.9   according to the terms of the policy, contract, or certificate 
 19.10  of coverage, for all medically necessary covered comply with 
 19.11  section 62Q.535 for all mental health services as determined by 
 19.12  section 62Q.53 provided to an enrollee that are ordered by the 
 19.13  court under this chapter.  For purposes of this subdivision, 
 19.14  "mental health services" has the meaning given in section 
 19.15  62Q.535, subdivision 1. 
 19.16     [EFFECTIVE DATE.] This section is effective July 1, 2001, 
 19.17  and applies to contracts issued or renewed on or after that date.
 19.18     Sec. 14.  Minnesota Statutes 2000, section 253B.10, 
 19.19  subdivision 4, is amended to read: 
 19.20     Subd. 4.  [PRIVATE TREATMENT.] Patients or other 
 19.21  responsible persons are required to pay the necessary charges 
 19.22  for patients committed or transferred to private treatment 
 19.23  facilities.  Private treatment facilities may refuse to accept a 
 19.24  committed person.  Insurers must provide court-ordered treatment 
 19.25  and services as ordered by the court under section 253B.045, 
 19.26  subdivision 6, or as required under chapter 62M. 
 19.27     [EFFECTIVE DATE.] This section is effective July 1, 2001, 
 19.28  and applies to contracts issued or renewed on or after that date.
 19.29     Sec. 15.  Minnesota Statutes 2000, section 260C.201, 
 19.30  subdivision 1, is amended to read: 
 19.31     Subdivision 1.  [DISPOSITIONS.] (a) If the court finds that 
 19.32  the child is in need of protection or services or neglected and 
 19.33  in foster care, it shall enter an order making any of the 
 19.34  following dispositions of the case: 
 19.35     (1) place the child under the protective supervision of the 
 19.36  local social services agency or child-placing agency in the home 
 20.1   of a parent of the child under conditions prescribed by the 
 20.2   court directed to the correction of the child's need for 
 20.3   protection or services, or: 
 20.4      (i) the court may order the child into the home of a parent 
 20.5   who does not otherwise have legal custody of the child, however, 
 20.6   an order under this section does not confer legal custody on 
 20.7   that parent; 
 20.8      (ii) if the court orders the child into the home of a 
 20.9   father who is not adjudicated, he must cooperate with paternity 
 20.10  establishment proceedings regarding the child in the appropriate 
 20.11  jurisdiction as one of the conditions prescribed by the court 
 20.12  for the child to continue in his home; 
 20.13     (iii) the court may order the child into the home of a 
 20.14  noncustodial parent with conditions and may also order both the 
 20.15  noncustodial and the custodial parent to comply with the 
 20.16  requirements of a case plan under subdivision 2; 
 20.17     (2) transfer legal custody to one of the following: 
 20.18     (i) a child-placing agency; or 
 20.19     (ii) the local social services agency. 
 20.20     In placing a child whose custody has been transferred under 
 20.21  this paragraph, the agencies shall follow the requirements of 
 20.22  section 260C.193, subdivision 3; 
 20.23     (3) if the child has been adjudicated as a child in need of 
 20.24  protection or services because the child is in need of special 
 20.25  treatment and services or care for reasons of physical or mental 
 20.26  health to treat or ameliorate a physical or mental disability, 
 20.27  the court may order the child's parent, guardian, or custodian 
 20.28  to provide it.  If the parent, guardian, or custodian fails or 
 20.29  is unable to provide this treatment or care, the court may order 
 20.30  it provided.  The court may also order the child's health plan 
 20.31  company to provide mental health services to the child under 
 20.32  section 62Q.535.  Absent specific written findings by the court 
 20.33  that the child's disability is the result of abuse or neglect by 
 20.34  the child's parent or guardian, the court shall not transfer 
 20.35  legal custody of the child for the purpose of obtaining special 
 20.36  treatment or care solely because the parent is unable to provide 
 21.1   the treatment or care.  If the court's order for mental health 
 21.2   treatment is based on a diagnosis made by a treatment 
 21.3   professional, the court may order that the diagnosing 
 21.4   professional not provide the treatment to the child if it finds 
 21.5   that such an order is in the child's best interests; or 
 21.6      (4) if the court believes that the child has sufficient 
 21.7   maturity and judgment and that it is in the best interests of 
 21.8   the child, the court may order a child 16 years old or older to 
 21.9   be allowed to live independently, either alone or with others as 
 21.10  approved by the court under supervision the court considers 
 21.11  appropriate, if the county board, after consultation with the 
 21.12  court, has specifically authorized this dispositional 
 21.13  alternative for a child. 
 21.14     (b) If the child was adjudicated in need of protection or 
 21.15  services because the child is a runaway or habitual truant, the 
 21.16  court may order any of the following dispositions in addition to 
 21.17  or as alternatives to the dispositions authorized under 
 21.18  paragraph (a): 
 21.19     (1) counsel the child or the child's parents, guardian, or 
 21.20  custodian; 
 21.21     (2) place the child under the supervision of a probation 
 21.22  officer or other suitable person in the child's own home under 
 21.23  conditions prescribed by the court, including reasonable rules 
 21.24  for the child's conduct and the conduct of the parents, 
 21.25  guardian, or custodian, designed for the physical, mental, and 
 21.26  moral well-being and behavior of the child; or with the consent 
 21.27  of the commissioner of corrections, place the child in a group 
 21.28  foster care facility which is under the commissioner's 
 21.29  management and supervision; 
 21.30     (3) subject to the court's supervision, transfer legal 
 21.31  custody of the child to one of the following: 
 21.32     (i) a reputable person of good moral character.  No person 
 21.33  may receive custody of two or more unrelated children unless 
 21.34  licensed to operate a residential program under sections 245A.01 
 21.35  to 245A.16; or 
 21.36     (ii) a county probation officer for placement in a group 
 22.1   foster home established under the direction of the juvenile 
 22.2   court and licensed pursuant to section 241.021; 
 22.3      (4) require the child to pay a fine of up to $100.  The 
 22.4   court shall order payment of the fine in a manner that will not 
 22.5   impose undue financial hardship upon the child; 
 22.6      (5) require the child to participate in a community service 
 22.7   project; 
 22.8      (6) order the child to undergo a chemical dependency 
 22.9   evaluation and, if warranted by the evaluation, order 
 22.10  participation by the child in a drug awareness program or an 
 22.11  inpatient or outpatient chemical dependency treatment program; 
 22.12     (7) if the court believes that it is in the best interests 
 22.13  of the child and of public safety that the child's driver's 
 22.14  license or instruction permit be canceled, the court may order 
 22.15  the commissioner of public safety to cancel the child's license 
 22.16  or permit for any period up to the child's 18th birthday.  If 
 22.17  the child does not have a driver's license or permit, the court 
 22.18  may order a denial of driving privileges for any period up to 
 22.19  the child's 18th birthday.  The court shall forward an order 
 22.20  issued under this clause to the commissioner, who shall cancel 
 22.21  the license or permit or deny driving privileges without a 
 22.22  hearing for the period specified by the court.  At any time 
 22.23  before the expiration of the period of cancellation or denial, 
 22.24  the court may, for good cause, order the commissioner of public 
 22.25  safety to allow the child to apply for a license or permit, and 
 22.26  the commissioner shall so authorize; 
 22.27     (8) order that the child's parent or legal guardian deliver 
 22.28  the child to school at the beginning of each school day for a 
 22.29  period of time specified by the court; or 
 22.30     (9) require the child to perform any other activities or 
 22.31  participate in any other treatment programs deemed appropriate 
 22.32  by the court.  
 22.33     To the extent practicable, the court shall enter a 
 22.34  disposition order the same day it makes a finding that a child 
 22.35  is in need of protection or services or neglected and in foster 
 22.36  care, but in no event more than 15 days after the finding unless 
 23.1   the court finds that the best interests of the child will be 
 23.2   served by granting a delay.  If the child was under eight years 
 23.3   of age at the time the petition was filed, the disposition order 
 23.4   must be entered within ten days of the finding and the court may 
 23.5   not grant a delay unless good cause is shown and the court finds 
 23.6   the best interests of the child will be served by the delay. 
 23.7      (c) If a child who is 14 years of age or older is 
 23.8   adjudicated in need of protection or services because the child 
 23.9   is a habitual truant and truancy procedures involving the child 
 23.10  were previously dealt with by a school attendance review board 
 23.11  or county attorney mediation program under section 260A.06 or 
 23.12  260A.07, the court shall order a cancellation or denial of 
 23.13  driving privileges under paragraph (b), clause (7), for any 
 23.14  period up to the child's 18th birthday. 
 23.15     (d) In the case of a child adjudicated in need of 
 23.16  protection or services because the child has committed domestic 
 23.17  abuse and been ordered excluded from the child's parent's home, 
 23.18  the court shall dismiss jurisdiction if the court, at any time, 
 23.19  finds the parent is able or willing to provide an alternative 
 23.20  safe living arrangement for the child, as defined in Laws 1997, 
 23.21  chapter 239, article 10, section 2. 
 23.22     Sec. 16.  [QUALITY OF PATIENT CARE.] 
 23.23     The commissioner of health shall evaluate the feasibility 
 23.24  of collecting data on the quality of patient care provided in 
 23.25  hospitals, outpatient surgical centers, and other health care 
 23.26  facilities.  In the evaluation, the commissioner shall examine 
 23.27  the appropriate roles of the public and private sectors and the 
 23.28  need for risk-adjusting data.  The evaluation must consider 
 23.29  mechanisms to identify the quality of nursing care provided to 
 23.30  consumers by examining variables such as skin breakdown and 
 23.31  patient injuries.  Any plan developed to collect data must also 
 23.32  address issues related to the release of the data in a useful 
 23.33  form to the public.  The commissioner shall prepare and 
 23.34  distribute a written report of the evaluation by January 15, 
 23.35  2002. 
 23.36     Sec. 17.  [EFFECTIVE DATE.] 
 24.1      Sections 1 and 4 are effective for violations committed on 
 24.2   or after August 1, 2001.  Section 5 is effective beginning with 
 24.3   the report for the 2001 calendar year.  Sections 6 and 16 are 
 24.4   effective the day following final enactment.  Sections 2, 3, 10, 
 24.5   and 11 are effective January 1, 2002, and apply to health plans 
 24.6   issued or renewed on or after that date.