HF 1782

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/26/2024 03:46pm

A bill for an act
relating to health care; requiring health plan companies to establish an appeal
process for providers to access if the provider's contract is terminated for cause;
prohibiting a health plan company from terminating a provider's contract without
cause; amending Minnesota Statutes 2022, sections 62Q.56, subdivision 1a;
62Q.733, subdivision 1; proposing coding for new law in Minnesota Statutes,
chapter 62Q.

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

Section 1.

Minnesota Statutes 2022, section 62Q.56, subdivision 1a, is amended to read:

Subd. 1a.

Change in health care provider; new text begin nonrenewal new text end termination deleted text begin not for cause deleted text end .

(a)
If the contract termination was deleted text begin not for cause and deleted text end new text begin a nonrenewal or new text end the contract was terminated
by the health plan company, the health plan company must provide the terminated provider
and all enrollees being treated by that provider with notification of the enrollees' rights to
continuity of care with the terminated provider.

(b) The health plan company must provide, upon request, authorization to receive services
that are otherwise covered under the terms of the health plan through the enrollee's current
provider:

(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one
or more of the following conditions:

(i) an acute condition;

(ii) a life-threatening mental or physical illness;

(iii) pregnancy beyond the first trimester of pregnancy;

(iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided that the disability has lasted or can be expected to last for at least
one year, or can be expected to result in death; or

(v) a disabling or chronic condition that is in an acute phase; or

(2) for the rest of the enrollee's life if a physician, advanced practice registered nurse,
or physician assistant certifies that the enrollee has an expected lifetime of 180 days or less.

For all requests for authorization to receive services under this paragraph, the health plan
company must grant the request unless the enrollee does not meet the criteria provided in
this paragraph.

(c) The health plan company shall prepare a written plan that provides a process for
coverage determinations regarding continuity of care of up to 120 days for enrollees who
request continuity of care with their former provider, if the enrollee:

(1) is receiving culturally appropriate services and the health plan company does not
have a provider in its preferred provider network with special expertise in the delivery of
those culturally appropriate services within the time and distance requirements of section
62D.124, subdivision 1; or

(2) does not speak English and the health plan company does not have a provider in its
preferred provider network who can communicate with the enrollee, either directly or through
an interpreter, within the time and distance requirements of section 62D.124, subdivision
1.

The written plan must explain the criteria that will be used to determine whether a need for
continuity of care exists and how it will be provided.

Sec. 2.

Minnesota Statutes 2022, section 62Q.733, subdivision 1, is amended to read:

Subdivision 1.

Applicability.

For purposes of sections 62Q.732 to deleted text begin 62Q.739 deleted text end new text begin 62Q.7391 new text end ,
the following definitions apply.

Sec. 3.

new text begin [62Q.7391] HEALTH CARE PROVIDER CONTRACT TERMINATION.
new text end

new text begin Subdivision 1. new text end

new text begin Termination for cause. new text end

new text begin (a) A contract between a health care provider
and a health plan company may be terminated by the health plan company for cause only
if the contract includes an appeal process for the provider to appeal the termination. The
health plan company must provide the provider with written notice of termination that
includes:
new text end

new text begin (1) the reasons for termination;
new text end

new text begin (2) the date upon which the termination is effective; and
new text end

new text begin (3) a statement that the provider has the right to appeal the termination decision and a
description of the appeal process available to the provider to request an appeal.
new text end

new text begin (b) The process must allow the provider the opportunity to request an appeal and present
any relevant documents and arguments against termination.
new text end

new text begin (c) A health plan company may unilaterally terminate a contract with a health care
provider, without appeal rights, for certain causes including but not limited to:
new text end

new text begin (1) a credible allegation of or proven fraud, waste, or abuse;
new text end

new text begin (2) loss of licensure to practice or loss of liability insurance;
new text end

new text begin (3) concerns for the health or safety of a patient, including:
new text end

new text begin (i) a credible allegation or proven act of abuse, neglect, or endangerment of a patient;
new text end

new text begin (ii) a credible allegation or proven act of sexual abuse;
new text end

new text begin (iii) a credible allegation or proven act of discrimination under the nondiscrimination
provision in section 1557 of the Affordable Care Act and the Minnesota Human Rights Act
under chapter 363A;
new text end

new text begin (iv) improper or overprescribing prescription medication; or
new text end

new text begin (v) other health or safety concerns;
new text end

new text begin (4) the provider ceases to provide care;
new text end

new text begin (5) the provider's suspension or exclusion from participation in federal or state health
care programs, including appearance on the CMS Preclusion List;
new text end

new text begin (6) the provider fails to comply with any term of licensure status, credentialing, and
compliance standards;
new text end

new text begin (7) the provider fails to comply with any federal or state law;
new text end

new text begin (8) the provider becomes insolvent, is adjudicated as bankrupt, has a receiver appointed,
or makes a general assignment for the benefit of creditors; or
new text end

new text begin (9) the provider does not disclose any change in the participant's name, tax ID, merger,
acquisition, affiliation, or change in 50 percent or more of ownership interests in a timely
manner.
new text end

new text begin Subd. 2. new text end

new text begin Termination not for cause. new text end

new text begin A health plan company is prohibited from
terminating a contract with a health care provider without cause.
new text end