Minnesota Legislature
HF 3658
as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am
Bill Text Versions
| Engrossments | ||
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| Introduction | Posted on 03/16/2006 |
Current Version - as introduced
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A bill for an act
relating to health; authorizing business organizations to obtain certificates of
authority to operate as health maintenance organizations; providing for hospital
pricing transparency and provider pricing fairness; authorizing small health
plan purchasing pools; providing for a health insurance tax; regulating provider
disclosures of reimbursement; amending Minnesota Statutes 2004, sections
62D.02, subdivision 4, by adding a subdivision; 62D.03, subdivision 1; 62D.05,
subdivision 1; 62J.81, subdivision 1; 297I.01, subdivision 10; Minnesota Statutes
2005 Supplement, sections 62J.052; 297I.05, subdivision 5; proposing coding
for new law in Minnesota Statutes, chapters 62J; 62Q; repealing Minnesota
Statutes 2004, sections 62J.17; 62J.25.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2004, section 62D.02, is amended by adding a
subdivision to read:
new text begin Subd. 1a. new text end
new text begin Authorized entity. new text end
new text begin
"Authorized entity" means a corporation organized
under chapter 302A, 317A, or the similar laws of another state; a limited liability company
organized under chapter 322B or the similar laws of another state; or a local government
unit as defined in subdivision 11.
new text end
Sec. 2.
Minnesota Statutes 2004, section 62D.02, subdivision 4, is amended to read:
Subd. 4.
Health maintenance organization.
(a) "Health maintenance organization"
means deleted text begin a nonprofit corporation organized under chapter 317A, or a local governmental unit
as defined in subdivision 11deleted text end new text begin an authorized entitynew text end , controlled and operated as provided in
sections 62D.01 to 62D.30, which provides, either directly or through arrangements with
providers or other persons, comprehensive health maintenance services, or arranges for
the provision of these services, to enrollees on the basis of a fixed prepaid sum without
regard to the frequency or extent of services furnished to any particular enrollee.
(b) (Expired)
Sec. 3.
Minnesota Statutes 2004, section 62D.03, subdivision 1, is amended to read:
Subdivision 1.
Certificate of authority required.
Notwithstanding any law of this
state to the contrary, deleted text begin any nonprofit corporation organized to do so or a local governmental
unitdeleted text end new text begin an authorized entitynew text end may apply to the commissioner of health for a certificate of
authority to establish and operate a health maintenance organization in compliance with
sections 62D.01 to 62D.30. No person shall establish or operate a health maintenance
organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive
advance or periodic consideration in conjunction with a health maintenance organization
or health maintenance contract unless the organization has a certificate of authority under
sections 62D.01 to 62D.30. new text begin An out-of-state corporation or out-of-state limited liability
company may qualify to apply for a certificate of authority under this chapter, subject to
obtaining a certificate of authority to do business in this state under section 303.08 or
322B.915, as appropriate, and compliance with this chapter and other applicable state laws.
new text end
Sec. 4.
Minnesota Statutes 2004, section 62D.05, subdivision 1, is amended to read:
Subdivision 1.
Authority granted.
Any deleted text begin nonprofit corporation or local governmental
unitdeleted text end new text begin authorized entity new text end may, upon obtaining a certificate of authority as required in sections
62D.01 to 62D.30, operate as a health maintenance organization.
Sec. 5.
Minnesota Statutes 2005 Supplement, section 62J.052, is amended to read:
62J.052 PROVIDER COST DISCLOSURE.
(a) Each health care provider, as defined by section 62J.03, subdivision 8, except
hospitals and outpatient surgical centersnew text begin subject to the requirements of section 62J.823new text end ,
shall provide the following information:
(1) the average allowable payment from private third-party payers for the deleted text begin 20deleted text end new text begin 50new text end
services or procedures most commonly performed;
(2) the average payment rates for those services and procedures for medical
assistance;
(3) the average charge for those services and procedures for individuals who have no
applicable private or public coverage; and
(4) the average charge for those services and procedures, including all patients.
new text begin
(b) Each pharmacy, as defined in section 151.01, subdivision 2, shall provide the
following information:
new text end
new text begin
(1) the average allowable payment from private third-party payers for the 50 most
commonly prescribed prescription drugs;
new text end
new text begin
(2) the average payment rates for those prescription drugs for medical assistance;
new text end
new text begin
(3) the average charge for those prescription drugs for individuals who have no
applicable private or public coverage; and
new text end
new text begin
(4) the average charge for those services and procedures, including all individuals.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end This information shall be updated annually and be readily available at no
cost to the public on site.
Sec. 6.
new text begin
[62J.823] HOSPITAL PRICING TRANSPARENCY.
new text end
new text begin Subdivision 1. new text end
new text begin Short title. new text end
new text begin
This section may be cited as the Hospital Pricing
Transparency Act.
new text end
new text begin Subd. 2. new text end
new text begin Definition. new text end
new text begin
For the purposes of this section, "estimate" means any of
the following:
new text end
new text begin
(1) the actual price expected to be charged to the individual based on the specific
diagnostic related group code or specific procedure code or codes reflecting any discounts
the individual would receive;
new text end
new text begin
(2) the actual price expected to be charged to the individual based on the specific
diagnostic related group code or specific procedure code or codes to be performed without
taking into account any discounts the individual may receive;
new text end
new text begin
(3) the average billed rate of all of the specific diagnostic related group code or
procedure code performed in the last six months;
new text end
new text begin
(4) the average billed rate of the most recently performed services of the same
diagnostic related group code or procedure code; or
new text end
new text begin
(5) any other estimate that will provide a patient with an accurate view of their
potential financial obligations if the services are performed by the hospital.
new text end
new text begin Subd. 3. new text end
new text begin Applicability and scope. new text end
new text begin
Any hospital, as defined in section 144.696,
subdivision 3, and outpatient surgical center, as defined in section 144.696, subdivision 4,
shall provide a written estimate of the cost of a specific service or stay upon the request of
a patient, doctor, or the patient??a??a??s representative. The request must include:
new text end
new text begin
(1) the specific diagnostic related group code;
new text end
new text begin
(2) the name of the procedure or procedures to be performed;
new text end
new text begin
(3) the type of treatment to be received; or
new text end
new text begin
(4) any other information that will allow the hospital or outpatient surgical center to
determine the specific diagnostic related group or procedure code or codes.
new text end
new text begin Subd. 4. new text end
new text begin Estimate. new text end
new text begin
(a) An estimate provided by the hospital or outpatient surgical
center must contain:
new text end
new text begin
(1) the method used to calculate the estimate;
new text end
new text begin
(2) the specific diagnostic related group or procedure code or codes used to calculate
the estimate;
new text end
new text begin
(3) the name of any network or program that resulted in a discounted rate; and
new text end
new text begin
(4) a statement indicating that the estimate, while accurate, may not reflect the
actual billed charges and that the final bill may be higher or lower depending on the
patient??a??a??s specific circumstances.
new text end
new text begin
(b) The estimate may be provided in any method that meets the needs of the patient
and the hospital or outpatient surgical center, including electronically; however, a paper
copy must be provided if specifically requested.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2007.
new text end
Sec. 7.
Minnesota Statutes 2004, section 62J.81, subdivision 1, is amended to read:
Subdivision 1.
Required disclosure of estimated payment.
new text begin (a) new text end A health care
provider, as defined in section 62J.03, subdivision 8, new text begin or the provider's designee, new text end shall,
at the request of a consumer, provide that consumer with a good faith estimate of the
reimbursement the provider expects to receive from the health plan company in which the
consumer is enrolled. Health plan companies must allow contracted providersnew text begin , or their
designee,new text end to release this information. A good faith estimate must also be made available
at the request of a consumer who is not enrolled in a health plan company. Payment
information provided by a providernew text begin , or by the provider's designee,new text end to a patient pursuant to
this subdivision does not constitute a legally binding estimate of the cost of services.
new text begin
(b) A health plan company, as defined in section 62J.03, subdivision 10, shall,
at the request of an enrollee, provide that enrollee with a good faith estimate of the
reimbursement the health plan company would expect to pay to a specified provider for a
health care service specified by the enrollee. An estimate provided to an enrollee under
this paragraph is not a legally binding estimate of the reimbursement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
new text begin
[62J.83] PROVIDER PRICING FAIRNESS.
new text end
new text begin
(a) No health care provider, as defined in section 62J.03, subdivision 8, shall vary
the payment amount that it accepts as full payment for a health care service based upon
the identity of the payer, upon a contractual relationship with a payer, upon the identity
of the patient, or upon whether the patient has coverage through a group purchaser, as
defined in section 62J.03, subdivision 6.
new text end
new text begin
(b) This section does not apply to a variation based upon a payer being a
governmental entity.
new text end
new text begin
(c) This section does not affect the right of a provider to provide charity care or care
for a reduced price due to financial hardship of the patient or due to the patient being a
relative or friend of the provider.
new text end
Sec. 9.
new text begin
[62Q.80] SMALL HEALTH PLAN PURCHASING POOL.
new text end
new text begin
(a) Health plan companies whose premium volume is less than ten percent of
total premiums in the Minnesota health plan market may create a purchasing pool for
group contracting for health care from health care providers for purposes of this section.
Membership by a health plan company is voluntary. For purposes of the ten percent
calculation, a health plan company's premiums include those of its affiliates.
new text end
new text begin
(b) Members of the pool may use the contracted health care for purposes of meeting
their obligations to their enrollees under health plans.
new text end
new text begin
(c) The pool or its members may offer and sell health care discount cards to persons
who have no public sector or private sector health coverage. The discount cards must
entitle the purchasers to discounted charges from health care providers that participate
in the program. The discount cards need not provide their purchasers with the same
discounted prices used under paragraph (b). The discount cards, and advertisements
regarding them, must clearly indicate that the discount card program is not insurance
or health maintenance coverage, and that the purchaser must check with a provider to
determine whether the provider accepts the card.
new text end
new text begin
(d) The commissioner of commerce shall oversee and supervise this purchasing pool
to ensure that it promotes competition in the market for health plan coverage in this state
by enabling its members to participate in the health plan market in this state on a more
equal footing with their larger competitors.
new text end
Sec. 10.
Minnesota Statutes 2004, section 297I.01, subdivision 10, is amended to read:
Subd. 10.
Health deleted text begin maintenance organizationdeleted text end new text begin insurancenew text end .
"Health deleted text begin maintenance
organization" has the meaning given in section 62D.02, subdivision 4.deleted text end new text begin insurance" means
coverage under:new text end
new text begin
(1) a health plan as defined in section 62A.011, subdivision 3, except the exclusions
under clauses (6), (9), (10), and (12) do not apply; and
new text end
new text begin
(2) stop-loss insurance purchased in connection with a self-insurance plan for
employee health benefits.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for premiums received after
December 31, 2006.
new text end
Sec. 11.
Minnesota Statutes 2005 Supplement, section 297I.05, subdivision 5, is
amended to read:
Subd. 5.
Health deleted text begin maintenance organizations, nonprofit health service plan
corporations, and community integrated service networksdeleted text end new text begin insurancenew text end .
(a) A tax is
imposed on health deleted text begin maintenance organizations, community integrated service networks,
and nonprofit health care service plan corporations. The rate of tax isdeleted text end new text begin insurancenew text end equal to
deleted text begin onedeleted text end new text begin ...new text end percent of gross premiums less return premiums on all direct business received by
the deleted text begin organization, network, or corporation deleted text end new text begin health carrier, as defined in section 62A.011,
subdivision 2, new text end or its agents in Minnesota, in cash or otherwise, in the calendar year.new text begin The
tax imposed under this subdivision is in lieu of the tax on health insurance that would
otherwise apply under any other subdivision of this section, except subdivision 11.
new text end
(b) The commissioner shall deposit all revenues, including penalties and interest,
collected under new text begin the tax under new text end this deleted text begin chapter from health maintenance organizations,
community integrated service networks, and nonprofit health service plan corporationsdeleted text end new text begin
subdivisionnew text end in the health care access fund. Refunds of overpayments of tax imposed
by this subdivision must be paid from the health care access fund. There is annually
appropriated from the health care access fund to the commissioner the amount necessary
to make any refunds of the tax imposed under this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for premiums received after
December 31, 2006.
new text end
Sec. 12. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2004, section 62J.17,
new text end
new text begin
is repealed effective the day following
final enactment.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2004, section 62J.25,
new text end
new text begin
is repealed effective for care provided
on or after January 1, 2007.
new text end