HF 2311

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/18/2021 04:18pm

A bill for an act
relating to health; modifying requirements for information on patient medical bills;
establishing health care price transparency requirements; amending Minnesota
Statutes 2020, sections 62J.701; 62J.72, subdivision 3; proposing coding for new
law in Minnesota Statutes, chapter 62J.

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

Section 1.

Minnesota Statutes 2020, section 62J.701, is amended to read:

62J.701 GOVERNMENTAL PROGRAMS.

deleted text begin (a) Beginning January 1, 1999, the provisions in paragraphs (b) to (e) apply.
deleted text end

deleted text begin (b) deleted text end new text begin (a) new text end For purposes of sections 62J.695 to 62J.80, the requirements and other provisions
that apply to health plan companies also apply to governmental programs.

deleted text begin (c) deleted text end new text begin (b) new text end For purposes of this section, "governmental programs" means the medical
assistance program, the MinnesotaCare program, the state employee group insurance
program, the public employees insurance program under section 43A.316, and coverage
provided by political subdivisions under section 471.617.

deleted text begin (d) deleted text end new text begin (c) new text end Notwithstanding paragraph deleted text begin (b) deleted text end new text begin (a) new text end , section 62J.72 does not apply to the
fee-for-service programs under medical assistance and MinnesotaCare new text begin and section 62J.72,
subdivision 3, paragraph (b), does not apply to the prepaid medical assistance program or
MinnesotaCare new text end .

deleted text begin (e) deleted text end new text begin (d) new text end If a state commissioner or local unit of government contracts with a health plan
company or a third-party administrator, the contract may assign any obligations under
paragraph deleted text begin (b) deleted text end new text begin (a) new text end to the health plan company or third-party administrator. Nothing in this
paragraph shall be construed to remove or diminish any enforcement responsibilities of the
commissioners of health or commerce provided in sections 62J.695 to 62J.80.

Sec. 2.

Minnesota Statutes 2020, section 62J.72, subdivision 3, is amended to read:

Subd. 3.

Information on patients' medical bills.

new text begin (a) new text end A health plan company and health
care provider shall provide patients and enrollees with a copy of an explicit and intelligible
bill deleted text begin whenever the patient or enrollee is sent a bill and is responsible for paying any portion
of that bill deleted text end . The deleted text begin bills deleted text end new text begin bill new text end must contain descriptive language sufficient to be understood by
the average patient or enrollee. This subdivision does not apply to a flat co-pay paid by the
patient or enrollee at the time the service is required.

new text begin (b) In addition to the requirements in paragraph (a), when a health care provider transmits
a bill to a patient, the bill must specify the following for the health care services provided:
new text end

new text begin (1) the dollar amount the provider is willing to accept as payment in full;
new text end

new text begin (2) the Medicare-allowable fee-for-service payment rate; and
new text end

new text begin (3) the provider's Medicare percent, as defined in section 62J.85, subdivision 1.
new text end

new text begin For patients covered by a health plan, a provider must also include a copy of the Medicare
percent disclosure form signed by the patient or the patient's representative, as required
under section 62J.85, subdivision 5.
new text end

Sec. 3.

new text begin [62J.85] HEALTH CARE PRICE TRANSPARENCY; NOTICE AND
DISCLOSURE OF MEDICARE PERCENT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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

new text begin (b) "Health plan" has the meaning given in section 62A.011, subdivision 3, and does
not include coverage provided under medical assistance, MinnesotaCare, or Medicare Part
A, Part B, or Part C.
new text end

new text begin (c) "Medicare percent" means the percentage of the Medicare allowable payment rate
that a health care provider accepts as payment in full for health care services provided by
that provider.
new text end

new text begin Subd. 2. new text end

new text begin Additional required disclosures by provider. new text end

new text begin (a) Before a health care provider
provides any health care services to a patient, the provider or the provider's designee, as
agreed to by that designee, must determine whether the proposed health care services are
covered by the patient's health plan. If any of the health care services are not covered by
the patient's health plan, the provider or the provider's designee must provide the patient
with a notice specifying the services not covered by the patient's health plan and must retain
a copy of the notice signed by the patient. If a provider fails to disclose to a patient that a
service is not covered, the provider is prohibited from billing the patient for that noncovered
service. If a provider complies with the disclosure and signature requirements of this
paragraph, and the patient receives the noncovered services from the provider, the patient
must pay for the services received.
new text end

new text begin (b) In addition to the information required to be disclosed under paragraph (a), before
a health care provider provides any health care services to a patient, the provider or the
provider's designee, as agreed to by that designee, must determine whether the provider
participates in the provider network for the patient's health plan and must disclose the
provider's network participation status to the patient. If the provider does not participate in
the provider network for the patient's health plan, the provider must obtain a signed
acknowledgment from the patient indicating that the patient understands the provider is
out-of-network. If the provider fails to obtain the signed acknowledgment from the patient
under this paragraph, the provider shall not bill the patient for services provided to the
patient for any amount that is in addition to the amount authorized for the services in the
in-network average fee schedule of the patient's health plan.
new text end

new text begin Subd. 3. new text end

new text begin Required notice. new text end

new text begin (a) A health care provider must establish a Medicare percent
that the provider will accept as payment in full for health care services provided by that
provider. A provider must provide notice to patients and the public of the provider's Medicare
percent by:
new text end

new text begin (1) posting information describing the Medicare percent and specifying the provider's
Medicare percent in a prominent, clearly visible location at or near the provider's reception
desk, registration desk, or patient check-in area;
new text end

new text begin (2) posting information describing the Medicare percent and specifying the provider's
Medicare percent on the provider's public website; and
new text end

new text begin (3) including information describing the Medicare percent and specifying the provider's
Medicare percent on any document related to provider payments that the provider requires
a patient or patient's representative to sign.
new text end

new text begin (b) The notices required in paragraph (a) must include the following statement: "The
Medicare percent means the percentage of Medicare reimbursement that this provider will
accept as payment in full for services provided to patients. The Medicare percent can be
used by a patient to compare the cost of care between providers.
new text end

new text begin Subd. 4. new text end

new text begin Application of hospital's, health care facility's, or clinic's Medicare percent
to employed, affiliated, or contracted providers. new text end

new text begin A health care provider employed by,
affiliated with, or under contract with a hospital, health care facility, or medical clinic shall
not be reimbursed at an amount greater than the amount of the hospital's or clinic's Medicare
percent.
new text end

new text begin Subd. 5. new text end

new text begin Medicare percent disclosure form. new text end

new text begin (a) Before providing health care services
to a patient, a health care provider must:
new text end

new text begin (1) provide the patient or patient's representative with a Medicare percent disclosure
form describing the Medicare percent; and
new text end

new text begin (2) obtain the signature of the patient or patient's representative on a copy of the form
retained by the provider.
new text end

new text begin The Medicare percent disclosure form of a hospital, health care facility, or medical clinic
must also include the following statement in 12-point, bold type: "ALL PROVIDERS OF
HEALTH CARE SUPPORT SERVICES, INCLUDING SERVICES PROVIDED BY
HEALTH PROFESSIONALS, THAT FORM A PART OF THE HEALTH CARE FOR
PATIENTS AT THIS FACILITY OR CLINIC HAVE AGREED TO ACCEPT THE
FACILITY'S OR CLINIC'S MEDICARE PERCENT AS PAYMENT IN FULL FOR THEIR
SERVICES." Except as provided in paragraph (c), if a provider fails to provide a patient or
patient's representative with the disclosure form required by this paragraph, the provider is
subject to a $1,000 fine to be paid to the patient or credited to the patient's account with the
provider.
new text end

new text begin (b) For patients covered by a health plan, a provider must include a copy of the disclosure
form signed by the patient or patient's representative with all bills submitted to a health plan
company. If a provider fails to include a copy of the signed disclosure form in a bill submitted
to a health plan company, the provider shall not be reimbursed at an amount greater than
the Medicare-allowable payment rate for the services listed on the provider's bill as payment
in full for those services.
new text end

new text begin (c) A provider shall be reimbursed at no more than ..... percent of the Medicare-allowable
payment rate for a specific health care service or at the provider's disclosed Medicare percent,
whichever is less, if a provider fails to provide a patient or patient's representative with the
disclosure form required in paragraph (a) because:
new text end

new text begin (1) the patient is unconscious or incapacitated and unable to sign the disclosure form;
and
new text end

new text begin (2) no representative for the patient is present at the time health care services are provided
to the patient.
new text end